National University NUR 510 Final Exam (pdf) | 2026/2027 |
Advanced Pathophysiology Q&A | Nursing
1. A 55-year-old patient with a 30-pack-year smoking history presents with a
persistent cough and weight loss. Imaging reveals a central lung mass, and
biopsy shows malignant cells with keratin pearls. Which of the following is
the most likely diagnosis?
A) Squamous cell carcinoma of the lung
B) Adenocarcinoma of the lung
C) Small cell lung carcinoma
D) Large cell carcinoma of the lung
Correct Answer: Squamous cell carcinoma of the lung
Rationale: Squamous cell carcinoma is strongly associated with smoking and
typically arises in central airways. The presence of keratin pearls on histology
is a hallmark of this tumor. Adenocarcinomas are more peripheral, small cell
carcinoma has neuroendocrine features, and large cell carcinoma lacks
specific differentiation.
2. A 45-year-old patient with type 1 diabetes mellitus presents with nausea,
vomiting, abdominal pain, and a fruity odor on the breath. Arterial blood gas
reveals a pH of 7.20 and bicarbonate of 10 mEq/L. Which of the following is
the most appropriate initial fluid resuscitation?
A) 0.9% normal saline
B) 0.45% normal saline
C) 5% dextrose in water
D) 3% normal saline
Correct Answer: 0.9% normal saline
,Rationale: Diabetic ketoacidosis (DKA) presents with hyperglycemia, ketosis,
and metabolic acidosis. Initial fluid resuscitation with 0.9% normal saline
restores intravascular volume and improves tissue perfusion. Hypotonic
fluids are used later, and dextrose is added once glucose falls below 250
mg/dL.
3. A 68-year-old patient with chronic kidney disease presents with fatigue,
bone pain, and muscle weakness. Laboratory studies reveal a serum calcium
of 8.0 mg/dL, phosphorus of 5.8 mg/dL, and PTH of 180 pg/mL. This
presentation is most consistent with which of the following?
A) Primary hyperparathyroidism
B) Secondary hyperparathyroidism
C) Tertiary hyperparathyroidism
D) Hypoparathyroidism
Correct Answer: Secondary hyperparathyroidism
Rationale: Secondary hyperparathyroidism occurs in chronic kidney disease
due to decreased renal production of calcitriol, leading to hypocalcemia and
hyperphosphatemia. The resulting stimulus causes compensatory PTH
elevation. Primary hyperparathyroidism presents with hypercalcemia.
4. A 30-year-old patient with a history of Graves' disease presents with
palpitations, heat intolerance, and weight loss despite increased appetite.
Which of the following best describes the underlying pathophysiology of this
condition?
A) Autoimmune destruction of the thyroid gland leading to hormone
deficiency
B) Autoantibodies that stimulate the thyroid-stimulating hormone receptor
C) A benign tumor of the pituitary gland secreting excess TSH
D) Dietary iodine deficiency leading to increased TSH secretion
,Correct Answer: Autoantibodies that stimulate the thyroid-stimulating
hormone receptor
Rationale: Graves' disease is an autoimmune disorder caused by thyroid-
stimulating immunoglobulins (TSI) that bind to and activate the TSH receptor
on thyroid follicular cells. This results in unregulated production and release
of thyroid hormones, leading to hyperthyroidism.
5. A 60-year-old patient with a history of hypertension presents with a
sudden onset of severe headache, nausea, and vomiting. Blood pressure is
220/120 mmHg. Neurologic examination reveals no focal deficits. Which of
the following is the most appropriate initial diagnostic study?
A) CT scan of the head without contrast
B) Lumbar puncture
C) Magnetic resonance angiography
D) Carotid ultrasound
Correct Answer: CT scan of the head without contrast
Rationale: A hypertensive emergency with severe headache requires
immediate evaluation for intracranial pathology, including hemorrhage. A
non-contrast CT scan of the head is the initial imaging study of choice to rule
out hemorrhagic stroke. Lumbar puncture is contraindicated if increased
intracranial pressure is suspected.
6. A 65-year-old patient with a history of smoking presents with progressive
dyspnea, chronic cough, and barrel-shaped chest. Pulmonary function tests
reveal a decreased FEV1/FVC ratio and increased residual volume. Which of
the following is the most likely diagnosis?
A) Restrictive lung disease
, B) Obstructive lung disease
C) Pulmonary fibrosis
D) Asthma
Correct Answer: Obstructive lung disease
Rationale: Obstructive lung diseases, such as COPD, are characterized by
airway obstruction leading to decreased FEV1/FVC ratio (< 0.70). Air trapping
results in increased residual volume and total lung capacity. Emphysema is a
subtype of COPD with destruction of alveolar walls.
7. A 55-year-old patient with a history of alcohol use disorder presents with
confusion, ataxia, and ophthalmoplegia. This clinical triad is most consistent
with which of the following?
A) Wernicke's encephalopathy
B) Korsakoff syndrome
C) Delirium tremens
D) Cerebellar degeneration
Correct Answer: Wernicke's encephalopathy
Rationale: Wernicke's encephalopathy is a neurologic emergency caused by
thiamine deficiency, commonly seen in patients with alcohol use disorder.
The classic triad consists of confusion, ataxia, and ophthalmoplegia. Prompt
treatment with thiamine is essential to prevent progression to Korsakoff
syndrome.
8. A 50-year-old patient presents with a 2-day history of progressive swelling,
pain, and erythema of the left lower extremity. Ultrasound reveals a non-
compressible deep vein in the popliteal fossa. Which of the following is the
most appropriate initial anticoagulation strategy?
Advanced Pathophysiology Q&A | Nursing
1. A 55-year-old patient with a 30-pack-year smoking history presents with a
persistent cough and weight loss. Imaging reveals a central lung mass, and
biopsy shows malignant cells with keratin pearls. Which of the following is
the most likely diagnosis?
A) Squamous cell carcinoma of the lung
B) Adenocarcinoma of the lung
C) Small cell lung carcinoma
D) Large cell carcinoma of the lung
Correct Answer: Squamous cell carcinoma of the lung
Rationale: Squamous cell carcinoma is strongly associated with smoking and
typically arises in central airways. The presence of keratin pearls on histology
is a hallmark of this tumor. Adenocarcinomas are more peripheral, small cell
carcinoma has neuroendocrine features, and large cell carcinoma lacks
specific differentiation.
2. A 45-year-old patient with type 1 diabetes mellitus presents with nausea,
vomiting, abdominal pain, and a fruity odor on the breath. Arterial blood gas
reveals a pH of 7.20 and bicarbonate of 10 mEq/L. Which of the following is
the most appropriate initial fluid resuscitation?
A) 0.9% normal saline
B) 0.45% normal saline
C) 5% dextrose in water
D) 3% normal saline
Correct Answer: 0.9% normal saline
,Rationale: Diabetic ketoacidosis (DKA) presents with hyperglycemia, ketosis,
and metabolic acidosis. Initial fluid resuscitation with 0.9% normal saline
restores intravascular volume and improves tissue perfusion. Hypotonic
fluids are used later, and dextrose is added once glucose falls below 250
mg/dL.
3. A 68-year-old patient with chronic kidney disease presents with fatigue,
bone pain, and muscle weakness. Laboratory studies reveal a serum calcium
of 8.0 mg/dL, phosphorus of 5.8 mg/dL, and PTH of 180 pg/mL. This
presentation is most consistent with which of the following?
A) Primary hyperparathyroidism
B) Secondary hyperparathyroidism
C) Tertiary hyperparathyroidism
D) Hypoparathyroidism
Correct Answer: Secondary hyperparathyroidism
Rationale: Secondary hyperparathyroidism occurs in chronic kidney disease
due to decreased renal production of calcitriol, leading to hypocalcemia and
hyperphosphatemia. The resulting stimulus causes compensatory PTH
elevation. Primary hyperparathyroidism presents with hypercalcemia.
4. A 30-year-old patient with a history of Graves' disease presents with
palpitations, heat intolerance, and weight loss despite increased appetite.
Which of the following best describes the underlying pathophysiology of this
condition?
A) Autoimmune destruction of the thyroid gland leading to hormone
deficiency
B) Autoantibodies that stimulate the thyroid-stimulating hormone receptor
C) A benign tumor of the pituitary gland secreting excess TSH
D) Dietary iodine deficiency leading to increased TSH secretion
,Correct Answer: Autoantibodies that stimulate the thyroid-stimulating
hormone receptor
Rationale: Graves' disease is an autoimmune disorder caused by thyroid-
stimulating immunoglobulins (TSI) that bind to and activate the TSH receptor
on thyroid follicular cells. This results in unregulated production and release
of thyroid hormones, leading to hyperthyroidism.
5. A 60-year-old patient with a history of hypertension presents with a
sudden onset of severe headache, nausea, and vomiting. Blood pressure is
220/120 mmHg. Neurologic examination reveals no focal deficits. Which of
the following is the most appropriate initial diagnostic study?
A) CT scan of the head without contrast
B) Lumbar puncture
C) Magnetic resonance angiography
D) Carotid ultrasound
Correct Answer: CT scan of the head without contrast
Rationale: A hypertensive emergency with severe headache requires
immediate evaluation for intracranial pathology, including hemorrhage. A
non-contrast CT scan of the head is the initial imaging study of choice to rule
out hemorrhagic stroke. Lumbar puncture is contraindicated if increased
intracranial pressure is suspected.
6. A 65-year-old patient with a history of smoking presents with progressive
dyspnea, chronic cough, and barrel-shaped chest. Pulmonary function tests
reveal a decreased FEV1/FVC ratio and increased residual volume. Which of
the following is the most likely diagnosis?
A) Restrictive lung disease
, B) Obstructive lung disease
C) Pulmonary fibrosis
D) Asthma
Correct Answer: Obstructive lung disease
Rationale: Obstructive lung diseases, such as COPD, are characterized by
airway obstruction leading to decreased FEV1/FVC ratio (< 0.70). Air trapping
results in increased residual volume and total lung capacity. Emphysema is a
subtype of COPD with destruction of alveolar walls.
7. A 55-year-old patient with a history of alcohol use disorder presents with
confusion, ataxia, and ophthalmoplegia. This clinical triad is most consistent
with which of the following?
A) Wernicke's encephalopathy
B) Korsakoff syndrome
C) Delirium tremens
D) Cerebellar degeneration
Correct Answer: Wernicke's encephalopathy
Rationale: Wernicke's encephalopathy is a neurologic emergency caused by
thiamine deficiency, commonly seen in patients with alcohol use disorder.
The classic triad consists of confusion, ataxia, and ophthalmoplegia. Prompt
treatment with thiamine is essential to prevent progression to Korsakoff
syndrome.
8. A 50-year-old patient presents with a 2-day history of progressive swelling,
pain, and erythema of the left lower extremity. Ultrasound reveals a non-
compressible deep vein in the popliteal fossa. Which of the following is the
most appropriate initial anticoagulation strategy?
