NRMS 5190 Pathophysiology Exam 2 Questions with Answers| SUNY
Downstate Medical Center| Pass Guaranteed| Updated
1. Approximately what percentage of total body water is located in the intracellular
fluid (ICF) compartment in an adult?
A. 25%
B. 40%
C. 66%
D. 80%
Answer: C
Rationale: Roughly two-thirds (about 66%, or 40% of total body weight) of total body
water is intracellular, while the remaining third is extracellular, divided between the
interstitial fluid (~75% of ECF) and plasma (~25% of ECF).
2. Which of the following best describes the movement of fluid by osmosis?
A. Movement of solute from an area of high concentration to low concentration
B. Movement of water across a semipermeable membrane from an area of low
solute concentration to high solute concentration
C. Bulk movement of fluid due to hydrostatic pressure differences
D. Active transport of water requiring ATP
Answer: B
Rationale: Osmosis is the passive movement of water across a semipermeable
membrane from a region of lower solute concentration to one of higher solute
concentration, in an attempt to equalize concentration on both sides; it does not require
ATP.
3. A client has a serum sodium level of 122 mEq/L. Which manifestation would the
nurse expect related to this electrolyte imbalance?
A. Muscle twitching and hyperreflexia only
B. Confusion, headache, and, if severe, seizures due to cerebral edema
C. Peaked T waves on ECG
D. Polyuria and intense thirst
Answer: B
,Rationale: Hyponatremia causes water to shift into brain cells by osmosis, producing
cerebral edema; manifestations range from headache and confusion to lethargy,
seizures, and coma as the sodium level drops, especially with rapid onset.
4. Which condition is most likely to cause hypernatremia?
A. Excessive antidiuretic hormone (ADH) secretion
B. Diabetes insipidus with loss of free water
C. Overhydration with hypotonic fluids
D. Adrenal insufficiency
Answer: B
Rationale: Diabetes insipidus results in insufficient ADH activity, causing the kidneys to
excrete large volumes of dilute urine (free water loss) without adequate fluid
replacement, concentrating the remaining serum sodium and producing hypernatremia.
5. A client with a serum potassium level of 6.8 mEq/L would be expected to show
which ECG change?
A. Flattened T waves and prominent U waves
B. Peaked, tall T waves and widened QRS complex
C. Shortened QT interval
D. Normal ECG pattern
Answer: B
Rationale: Hyperkalemia increases myocardial cell excitability initially, producing tall,
peaked T waves, and as it worsens, widens the QRS complex and can progress to a sine-
wave pattern and cardiac arrest; this is a medical emergency.
6. Which of the following is a common cause of hypokalemia?
A. Renal failure
B. Use of loop or thiazide diuretics
C. Tissue trauma/cell lysis
D. ACE inhibitor therapy
Answer: B
Rationale: Loop diuretics (furosemide) and thiazide diuretics increase renal potassium
excretion, commonly leading to hypokalemia. Renal failure, tissue trauma, and ACE
inhibitors are more commonly associated with hyperkalemia.
7. A client with chronic vomiting is at risk for which acid-base imbalance?
, A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Answer: B
Rationale: Loss of hydrochloric acid (gastric contents) through prolonged vomiting
results in a relative excess of bicarbonate, producing metabolic alkalosis; this is often
accompanied by hypokalemia and hypochloremia.
8. Which arterial blood gas result reflects uncompensated metabolic acidosis?
A. pH 7.28, PaCO2 40 mmHg, HCO3 15 mEq/L
B. pH 7.50, PaCO2 30 mmHg, HCO3 24 mEq/L
C. pH 7.30, PaCO2 55 mmHg, HCO3 26 mEq/L
D. pH 7.48, PaCO2 45 mmHg, HCO3 32 mEq/L
Answer: A
Rationale: A low pH (<7.35) with a low bicarbonate (<22) and a normal PaCO2 (35-45,
no respiratory compensation yet) indicates uncompensated metabolic acidosis, as seen
in conditions such as diabetic ketoacidosis or renal failure.
9. A client with a calcium level of 6.5 mg/dL would be expected to exhibit which
finding?
A. Positive Chvostek's and Trousseau's signs with tetany
B. Constipation and lethargy
C. Decreased deep tendon reflexes
D. Polyuria and kidney stones
Answer: A
Rationale: Hypocalcemia increases neuromuscular excitability, producing positive
Chvostek's sign (facial twitching) and Trousseau's sign (carpal spasm), along with
paresthesias and tetany. Hypercalcemia, in contrast, causes constipation, lethargy,
decreased reflexes, and kidney stones.
10. Which mechanism explains the development of edema in a client with severe
hypoalbuminemia (e.g., nephrotic syndrome, cirrhosis)?
A. Increased capillary hydrostatic pressure
B. Decreased plasma oncotic (colloid osmotic) pressure allowing fluid to shift into the
interstitium
, C. Increased plasma oncotic pressure
D. Lymphatic obstruction
Answer: B
Rationale: Albumin is the primary determinant of plasma oncotic pressure, which
normally holds fluid within the vasculature. When albumin is low, oncotic pressure falls,
and fluid shifts out of capillaries into the interstitial space, causing edema.
11. A client with syndrome of inappropriate antidiuretic hormone (SIADH) would be
expected to show which laboratory findings?
A. Hypernatremia and dilute urine
B. Hyponatremia, concentrated urine, and low serum osmolality
C. Hyperkalemia and metabolic alkalosis
D. Normal sodium with polyuria
Answer: B
Rationale: SIADH causes excessive water reabsorption by the kidneys due to
inappropriate ADH secretion, resulting in dilutional hyponatremia, low serum osmolality,
and inappropriately concentrated urine despite low serum sodium.
12. Which type of IV fluid would cause cells to shrink (crenate) if infused rapidly?
A. Isotonic solution (0.9% NaCl)
B. Hypotonic solution (0.45% NaCl)
C. Hypertonic solution (3% NaCl)
D. Dextrose 5% in water alone
Answer: C
Rationale: Hypertonic solutions have a higher solute concentration than the intracellular
fluid, drawing water out of cells by osmosis and causing them to shrink (crenate); this
can be dangerous if infused too rapidly, causing intravascular volume overload and
cellular dehydration.
13. A client with a magnesium level of 1.0 mEq/L (low) would be expected to exhibit
which finding?
A. Hyporeflexia and lethargy
B. Hyperreflexia, tremors, and increased risk of dysrhythmias
C. Bradycardia and hypotension
D. Decreased neuromuscular excitability
Answer: B
Downstate Medical Center| Pass Guaranteed| Updated
1. Approximately what percentage of total body water is located in the intracellular
fluid (ICF) compartment in an adult?
A. 25%
B. 40%
C. 66%
D. 80%
Answer: C
Rationale: Roughly two-thirds (about 66%, or 40% of total body weight) of total body
water is intracellular, while the remaining third is extracellular, divided between the
interstitial fluid (~75% of ECF) and plasma (~25% of ECF).
2. Which of the following best describes the movement of fluid by osmosis?
A. Movement of solute from an area of high concentration to low concentration
B. Movement of water across a semipermeable membrane from an area of low
solute concentration to high solute concentration
C. Bulk movement of fluid due to hydrostatic pressure differences
D. Active transport of water requiring ATP
Answer: B
Rationale: Osmosis is the passive movement of water across a semipermeable
membrane from a region of lower solute concentration to one of higher solute
concentration, in an attempt to equalize concentration on both sides; it does not require
ATP.
3. A client has a serum sodium level of 122 mEq/L. Which manifestation would the
nurse expect related to this electrolyte imbalance?
A. Muscle twitching and hyperreflexia only
B. Confusion, headache, and, if severe, seizures due to cerebral edema
C. Peaked T waves on ECG
D. Polyuria and intense thirst
Answer: B
,Rationale: Hyponatremia causes water to shift into brain cells by osmosis, producing
cerebral edema; manifestations range from headache and confusion to lethargy,
seizures, and coma as the sodium level drops, especially with rapid onset.
4. Which condition is most likely to cause hypernatremia?
A. Excessive antidiuretic hormone (ADH) secretion
B. Diabetes insipidus with loss of free water
C. Overhydration with hypotonic fluids
D. Adrenal insufficiency
Answer: B
Rationale: Diabetes insipidus results in insufficient ADH activity, causing the kidneys to
excrete large volumes of dilute urine (free water loss) without adequate fluid
replacement, concentrating the remaining serum sodium and producing hypernatremia.
5. A client with a serum potassium level of 6.8 mEq/L would be expected to show
which ECG change?
A. Flattened T waves and prominent U waves
B. Peaked, tall T waves and widened QRS complex
C. Shortened QT interval
D. Normal ECG pattern
Answer: B
Rationale: Hyperkalemia increases myocardial cell excitability initially, producing tall,
peaked T waves, and as it worsens, widens the QRS complex and can progress to a sine-
wave pattern and cardiac arrest; this is a medical emergency.
6. Which of the following is a common cause of hypokalemia?
A. Renal failure
B. Use of loop or thiazide diuretics
C. Tissue trauma/cell lysis
D. ACE inhibitor therapy
Answer: B
Rationale: Loop diuretics (furosemide) and thiazide diuretics increase renal potassium
excretion, commonly leading to hypokalemia. Renal failure, tissue trauma, and ACE
inhibitors are more commonly associated with hyperkalemia.
7. A client with chronic vomiting is at risk for which acid-base imbalance?
, A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Answer: B
Rationale: Loss of hydrochloric acid (gastric contents) through prolonged vomiting
results in a relative excess of bicarbonate, producing metabolic alkalosis; this is often
accompanied by hypokalemia and hypochloremia.
8. Which arterial blood gas result reflects uncompensated metabolic acidosis?
A. pH 7.28, PaCO2 40 mmHg, HCO3 15 mEq/L
B. pH 7.50, PaCO2 30 mmHg, HCO3 24 mEq/L
C. pH 7.30, PaCO2 55 mmHg, HCO3 26 mEq/L
D. pH 7.48, PaCO2 45 mmHg, HCO3 32 mEq/L
Answer: A
Rationale: A low pH (<7.35) with a low bicarbonate (<22) and a normal PaCO2 (35-45,
no respiratory compensation yet) indicates uncompensated metabolic acidosis, as seen
in conditions such as diabetic ketoacidosis or renal failure.
9. A client with a calcium level of 6.5 mg/dL would be expected to exhibit which
finding?
A. Positive Chvostek's and Trousseau's signs with tetany
B. Constipation and lethargy
C. Decreased deep tendon reflexes
D. Polyuria and kidney stones
Answer: A
Rationale: Hypocalcemia increases neuromuscular excitability, producing positive
Chvostek's sign (facial twitching) and Trousseau's sign (carpal spasm), along with
paresthesias and tetany. Hypercalcemia, in contrast, causes constipation, lethargy,
decreased reflexes, and kidney stones.
10. Which mechanism explains the development of edema in a client with severe
hypoalbuminemia (e.g., nephrotic syndrome, cirrhosis)?
A. Increased capillary hydrostatic pressure
B. Decreased plasma oncotic (colloid osmotic) pressure allowing fluid to shift into the
interstitium
, C. Increased plasma oncotic pressure
D. Lymphatic obstruction
Answer: B
Rationale: Albumin is the primary determinant of plasma oncotic pressure, which
normally holds fluid within the vasculature. When albumin is low, oncotic pressure falls,
and fluid shifts out of capillaries into the interstitial space, causing edema.
11. A client with syndrome of inappropriate antidiuretic hormone (SIADH) would be
expected to show which laboratory findings?
A. Hypernatremia and dilute urine
B. Hyponatremia, concentrated urine, and low serum osmolality
C. Hyperkalemia and metabolic alkalosis
D. Normal sodium with polyuria
Answer: B
Rationale: SIADH causes excessive water reabsorption by the kidneys due to
inappropriate ADH secretion, resulting in dilutional hyponatremia, low serum osmolality,
and inappropriately concentrated urine despite low serum sodium.
12. Which type of IV fluid would cause cells to shrink (crenate) if infused rapidly?
A. Isotonic solution (0.9% NaCl)
B. Hypotonic solution (0.45% NaCl)
C. Hypertonic solution (3% NaCl)
D. Dextrose 5% in water alone
Answer: C
Rationale: Hypertonic solutions have a higher solute concentration than the intracellular
fluid, drawing water out of cells by osmosis and causing them to shrink (crenate); this
can be dangerous if infused too rapidly, causing intravascular volume overload and
cellular dehydration.
13. A client with a magnesium level of 1.0 mEq/L (low) would be expected to exhibit
which finding?
A. Hyporeflexia and lethargy
B. Hyperreflexia, tremors, and increased risk of dysrhythmias
C. Bradycardia and hypotension
D. Decreased neuromuscular excitability
Answer: B
