Galen NSG 3850 Exam 2 | Pathophysiology for
Nurses II (2026) Actual Q&A PDF
1. A patient with a history of stable angina reports that chest pain now occurs with
minimal exertion and lasts longer than 15 minutes. Which pathophysiological change
best explains this progression?
A) Complete occlusion of a coronary artery by a thrombus
B) Rupture of an atherosclerotic plaque with partial thrombosis
C) Fixed atherosclerotic narrowing without plaque disruption
D) Transient vasospasm of a non-diseased coronary artery
Correct Answer: Rupture of an atherosclerotic plaque with partial thrombosis
Rationale: Unstable angina results from plaque rupture with superimposed partial
thrombosis, leading to reduced coronary blood flow without complete occlusion.
Complete occlusion causes acute myocardial infarction. Fixed narrowing without
disruption characterizes stable angina.
2. A patient with acute myocardial infarction develops a new holosystolic murmur at
the cardiac apex that radiates to the axilla. Which complication is most likely?
A) Ventricular septal rupture
B) Papillary muscle rupture
C) Free wall rupture
D) Pericarditis
Correct Answer: Papillary muscle rupture
,Rationale: Papillary muscle rupture causes acute mitral regurgitation, producing a
holosystolic murmur at the apex radiating to the axilla. Ventricular septal rupture
produces a harsh holosystolic murmur at the left sternal border.
3. A patient with heart failure has an ejection fraction of 30% and complains of
orthopnea and paroxysmal nocturnal dyspnea. Which hemodynamic abnormality is
the primary cause of these symptoms?
A) Decreased systemic vascular resistance
B) Increased left ventricular end-diastolic pressure
C) Decreased right ventricular stroke volume
D) Increased pulmonary vascular resistance
Correct Answer: Increased left ventricular end-diastolic pressure
Rationale: Reduced ejection fraction leads to increased left ventricular end-diastolic
pressure, which is transmitted backward to the pulmonary circulation, causing
pulmonary congestion and symptoms of orthopnea and paroxysmal nocturnal
dyspnea.
4. A patient with chronic hypertension develops a sustained elevation in systemic
vascular resistance. Which compensatory mechanism initially maintains cardiac
output in this setting?
A) Decreased heart rate
B) Increased stroke volume
C) Increased myocardial contractility
D) Decreased venous return
Correct Answer: Increased myocardial contractility
,Rationale: In early hypertension, increased afterload is initially compensated by
increased myocardial contractility (Frank-Starling mechanism) to maintain stroke
volume and cardiac output. Heart rate typically increases, not decreases.
5. A patient with pericarditis presents with chest pain that is relieved by sitting
forward and worsens with inspiration. Which pathophysiological process is
responsible for this pain pattern?
A) Myocardial ischemia from reduced coronary flow
B) Inflammation of the parietal pericardium with friction
C) Aortic dissection involving the pericardial sac
D) Pulmonary embolism with pleural irritation
Correct Answer: Inflammation of the parietal pericardium with friction
Rationale: Pericarditis involves inflammation of the pericardial sac, causing friction
rub and pain that is positional and pleuritic. Myocardial ischemia causes pressure-like
pain unrelated to position.
6. Which compartment contains approximately two-thirds of total body water?
A) Extracellular fluid
B) Intravascular fluid
C) Interstitial fluid
D) Intracellular fluid
Correct Answer: Intracellular fluid
Rationale: Intracellular fluid (ICF) holds about two-thirds of total body water.
Extracellular fluid makes up the remaining one-third, which includes interstitial and
intravascular compartments.
, 7. A patient's serum sodium level is 116 mEq/L. The nurse anticipates which priority
assessment finding?
A) Seizures and coma
B) Thirst and dry mucous membranes
C) Muscle cramps and hyperreflexia
D) Bounding pulse and hypertension
Correct Answer: Seizures and coma
Rationale: Severe hyponatremia causes water to shift into brain cells, leading to
cerebral edema and neurological symptoms such as seizures and coma. Thirst and
dry mucous membranes indicate hypernatremia.
8. Which ECG change is characteristic of hyperkalemia?
A) Flattened T waves
B) Peaked T waves
C) Prominent U waves
D) Prolonged QT interval
Correct Answer: Peaked T waves
Rationale: Elevated potassium levels cause tall, peaked T waves, widened QRS, and
prolonged PR interval. Flattened T waves and U waves are associated with
hypokalemia.
9. A patient receiving furosemide is at highest risk for developing which electrolyte
imbalance?
Nurses II (2026) Actual Q&A PDF
1. A patient with a history of stable angina reports that chest pain now occurs with
minimal exertion and lasts longer than 15 minutes. Which pathophysiological change
best explains this progression?
A) Complete occlusion of a coronary artery by a thrombus
B) Rupture of an atherosclerotic plaque with partial thrombosis
C) Fixed atherosclerotic narrowing without plaque disruption
D) Transient vasospasm of a non-diseased coronary artery
Correct Answer: Rupture of an atherosclerotic plaque with partial thrombosis
Rationale: Unstable angina results from plaque rupture with superimposed partial
thrombosis, leading to reduced coronary blood flow without complete occlusion.
Complete occlusion causes acute myocardial infarction. Fixed narrowing without
disruption characterizes stable angina.
2. A patient with acute myocardial infarction develops a new holosystolic murmur at
the cardiac apex that radiates to the axilla. Which complication is most likely?
A) Ventricular septal rupture
B) Papillary muscle rupture
C) Free wall rupture
D) Pericarditis
Correct Answer: Papillary muscle rupture
,Rationale: Papillary muscle rupture causes acute mitral regurgitation, producing a
holosystolic murmur at the apex radiating to the axilla. Ventricular septal rupture
produces a harsh holosystolic murmur at the left sternal border.
3. A patient with heart failure has an ejection fraction of 30% and complains of
orthopnea and paroxysmal nocturnal dyspnea. Which hemodynamic abnormality is
the primary cause of these symptoms?
A) Decreased systemic vascular resistance
B) Increased left ventricular end-diastolic pressure
C) Decreased right ventricular stroke volume
D) Increased pulmonary vascular resistance
Correct Answer: Increased left ventricular end-diastolic pressure
Rationale: Reduced ejection fraction leads to increased left ventricular end-diastolic
pressure, which is transmitted backward to the pulmonary circulation, causing
pulmonary congestion and symptoms of orthopnea and paroxysmal nocturnal
dyspnea.
4. A patient with chronic hypertension develops a sustained elevation in systemic
vascular resistance. Which compensatory mechanism initially maintains cardiac
output in this setting?
A) Decreased heart rate
B) Increased stroke volume
C) Increased myocardial contractility
D) Decreased venous return
Correct Answer: Increased myocardial contractility
,Rationale: In early hypertension, increased afterload is initially compensated by
increased myocardial contractility (Frank-Starling mechanism) to maintain stroke
volume and cardiac output. Heart rate typically increases, not decreases.
5. A patient with pericarditis presents with chest pain that is relieved by sitting
forward and worsens with inspiration. Which pathophysiological process is
responsible for this pain pattern?
A) Myocardial ischemia from reduced coronary flow
B) Inflammation of the parietal pericardium with friction
C) Aortic dissection involving the pericardial sac
D) Pulmonary embolism with pleural irritation
Correct Answer: Inflammation of the parietal pericardium with friction
Rationale: Pericarditis involves inflammation of the pericardial sac, causing friction
rub and pain that is positional and pleuritic. Myocardial ischemia causes pressure-like
pain unrelated to position.
6. Which compartment contains approximately two-thirds of total body water?
A) Extracellular fluid
B) Intravascular fluid
C) Interstitial fluid
D) Intracellular fluid
Correct Answer: Intracellular fluid
Rationale: Intracellular fluid (ICF) holds about two-thirds of total body water.
Extracellular fluid makes up the remaining one-third, which includes interstitial and
intravascular compartments.
, 7. A patient's serum sodium level is 116 mEq/L. The nurse anticipates which priority
assessment finding?
A) Seizures and coma
B) Thirst and dry mucous membranes
C) Muscle cramps and hyperreflexia
D) Bounding pulse and hypertension
Correct Answer: Seizures and coma
Rationale: Severe hyponatremia causes water to shift into brain cells, leading to
cerebral edema and neurological symptoms such as seizures and coma. Thirst and
dry mucous membranes indicate hypernatremia.
8. Which ECG change is characteristic of hyperkalemia?
A) Flattened T waves
B) Peaked T waves
C) Prominent U waves
D) Prolonged QT interval
Correct Answer: Peaked T waves
Rationale: Elevated potassium levels cause tall, peaked T waves, widened QRS, and
prolonged PR interval. Flattened T waves and U waves are associated with
hypokalemia.
9. A patient receiving furosemide is at highest risk for developing which electrolyte
imbalance?
