NSG 3850 PATHOPHYSIOLOGY FOR
NURSES II - EXAM 2 COMPREHENSIVE
REVIEW
1. Which physiological mechanism is primarily responsible for the development of secondary
hyperparathyroidism in patients with Chronic Kidney Disease (CKD)?
A. Excessive intake of dietary calcium
B. Primary tumor growth in the parathyroid glands
C. Decreased activation of Vitamin D and phosphate retention leading to hypocalcemia
D. Direct stimulation of the parathyroid by uremic toxins
Answer: C
Conceptual Explanation: In CKD, the kidneys fail to activate Vitamin D and cannot excrete
phosphate. High phosphate binds to calcium, and low active Vitamin D reduces calcium
absorption, leading to hypocalcemia, which chronically stimulates the parathyroid glands
to release PTH.
,2. In the pathogenesis of Acute Respiratory Distress Syndrome (ARDS), what is the primary
consequence of increased alveolar-capillary membrane permeability?
A. Protein-rich fluid leakage into the alveoli causing pulmonary edema
B. Hyperinflation of alveoli
C. Increased surfactant production
D. Decreased pulmonary artery pressure
Answer: A
Conceptual Explanation: ARDS is characterized by damage to the alveolar-capillary
membrane, allowing protein-rich fluid to leak into the alveolar space, which inactivates
surfactant and leads to non-cardiogenic pulmonary edema and atelectasis.
3. Which statement best describes the pathophysiology of Prerenal Acute Kidney Injury (AKI)?
A. Reduced renal perfusion without structural damage to the kidney parenchyma
B. Direct damage to the nephron structures by nephrotoxins
C. Obstruction of the urinary tract causing back-pressure
D. Inflammation of the glomerular capillaries
Answer: A
Conceptual Explanation: Prerenal AKI is caused by factors that decrease systemic blood
flow to the kidneys (like hypovolemia or heart failure), reducing GFR without initially
causing structural damage to the kidney itself.
, 4. A patient with Liver Cirrhosis develops Hepatic Encephalopathy. What is the central
neurotoxin implicated in this condition?
A. Bilirubin
B. Ammonia
C. Albumin
D. Alanine aminotransferase (ALT)
Answer: B
Conceptual Explanation: When the liver is unable to convert ammonia (a byproduct of
protein metabolism) into urea, ammonia levels rise in the blood, cross the blood-brain
barrier, and cause neurotoxic effects.
5. What is the hallmark physiological finding in Nephrotic Syndrome?
A. Massive proteinuria (>3.5 g/day) due to increased glomerular permeability
B. Hematuria and RBC casts
C. Severe hypertension due to renin-angiotensin activation
D. Oliguria and azotemia
Answer: A
Conceptual Explanation: Nephrotic syndrome is characterized by massive proteinuria,
hypoalbuminemia, and edema, whereas Nephritic syndrome is characterized by hematuria
and inflammatory markers.
NURSES II - EXAM 2 COMPREHENSIVE
REVIEW
1. Which physiological mechanism is primarily responsible for the development of secondary
hyperparathyroidism in patients with Chronic Kidney Disease (CKD)?
A. Excessive intake of dietary calcium
B. Primary tumor growth in the parathyroid glands
C. Decreased activation of Vitamin D and phosphate retention leading to hypocalcemia
D. Direct stimulation of the parathyroid by uremic toxins
Answer: C
Conceptual Explanation: In CKD, the kidneys fail to activate Vitamin D and cannot excrete
phosphate. High phosphate binds to calcium, and low active Vitamin D reduces calcium
absorption, leading to hypocalcemia, which chronically stimulates the parathyroid glands
to release PTH.
,2. In the pathogenesis of Acute Respiratory Distress Syndrome (ARDS), what is the primary
consequence of increased alveolar-capillary membrane permeability?
A. Protein-rich fluid leakage into the alveoli causing pulmonary edema
B. Hyperinflation of alveoli
C. Increased surfactant production
D. Decreased pulmonary artery pressure
Answer: A
Conceptual Explanation: ARDS is characterized by damage to the alveolar-capillary
membrane, allowing protein-rich fluid to leak into the alveolar space, which inactivates
surfactant and leads to non-cardiogenic pulmonary edema and atelectasis.
3. Which statement best describes the pathophysiology of Prerenal Acute Kidney Injury (AKI)?
A. Reduced renal perfusion without structural damage to the kidney parenchyma
B. Direct damage to the nephron structures by nephrotoxins
C. Obstruction of the urinary tract causing back-pressure
D. Inflammation of the glomerular capillaries
Answer: A
Conceptual Explanation: Prerenal AKI is caused by factors that decrease systemic blood
flow to the kidneys (like hypovolemia or heart failure), reducing GFR without initially
causing structural damage to the kidney itself.
, 4. A patient with Liver Cirrhosis develops Hepatic Encephalopathy. What is the central
neurotoxin implicated in this condition?
A. Bilirubin
B. Ammonia
C. Albumin
D. Alanine aminotransferase (ALT)
Answer: B
Conceptual Explanation: When the liver is unable to convert ammonia (a byproduct of
protein metabolism) into urea, ammonia levels rise in the blood, cross the blood-brain
barrier, and cause neurotoxic effects.
5. What is the hallmark physiological finding in Nephrotic Syndrome?
A. Massive proteinuria (>3.5 g/day) due to increased glomerular permeability
B. Hematuria and RBC casts
C. Severe hypertension due to renin-angiotensin activation
D. Oliguria and azotemia
Answer: A
Conceptual Explanation: Nephrotic syndrome is characterized by massive proteinuria,
hypoalbuminemia, and edema, whereas Nephritic syndrome is characterized by hematuria
and inflammatory markers.
