Pathophysiology Nursing 2026 Diagnostic
Findings Study Guide Practice Test
Questions Lab Values Imaging Disease
Manifestations Clinical Reasoning
Explanations
Section 1: Cardiovascular Pathophysiology (Questions 1-25)
1. A patient presents to the emergency department with crushing chest pain.
An ECG shows ST-segment elevation in leads II, III, and aVF. Which
coronary artery is most likely occluded?
A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery
D. Left main coronary artery
Rationale: ST-segment elevation in leads II, III, and aVF indicates an inferior wall
myocardial infarction. The right coronary artery (RCA) supplies the inferior wall
of the left ventricle in most individuals. The left anterior descending artery supplies
the anterior wall (leads V1-V4), and the left circumflex artery supplies the lateral
wall (leads I, aVL, V5-V6).
2. A patient with heart failure has a B-type natriuretic peptide (BNP) level of
1,200 pg/mL. This elevated value is primarily a result of:
A. Renal failure
B. Ventricular stretch due to volume overload
C. Hepatic dysfunction
D. Skeletal muscle damage
Rationale: BNP is a hormone released by the ventricles of the heart in response to
stretching and stress caused by increased blood volume and pressure. An elevated
,BNP level is a key diagnostic marker for heart failure and correlates with the
severity of ventricular dysfunction.
3. A patient's arterial blood gas shows a pH of 7.30, PaCO2 of 50 mmHg, and
HCO3 of 24 mEq/L. This ABG is most consistent with:
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Rationale: A pH below 7.35 indicates acidosis. A PaCO2 above 45 mmHg
indicates respiratory retention of carbon dioxide, which is an acid. Since the
primary abnormality is an elevated PaCO2 and the bicarbonate is normal
(uncompensated), this is an acute respiratory acidosis.
4. A patient with a history of atrial fibrillation is at highest risk for which type
of stroke?
A. Hemorrhagic stroke
B. Embolic stroke
C. Lacunar stroke
D. Transient ischemic attack
Rationale: Atrial fibrillation causes blood to pool in the atria, leading to the
formation of clots. These clots can embolize (travel through the bloodstream) to
the brain, causing an embolic stroke. This is why patients with atrial fibrillation are
often prescribed anticoagulants.
5. A patient's lipid panel shows LDL of 190 mg/dL, HDL of 30 mg/dL, and
triglycerides of 400 mg/dL. Which of these findings is the most significant risk
factor for atherosclerosis?
A. High HDL
B. High LDL
C. High triglycerides
D. Low total cholesterol
Rationale: Elevated low-density lipoprotein (LDL) is the primary driver of
atherosclerosis. LDL particles deposit cholesterol into the arterial walls, forming
plaques. While high triglycerides and low HDL are also risk factors, high LDL is
the most direct and significant contributor to plaque formation.
6. A patient with suspected infective endocarditis has blood cultures drawn.
The most common causative organism is:
,A. Escherichia coli
B. Staphylococcus aureus
C. Pseudomonas aeruginosa
D. Candida albicans
Rationale: Staphylococcus aureus, including methicillin-resistant S. aureus
(MRSA), is the most common cause of infective endocarditis, particularly in acute
cases and in patients with a history of IV drug use or healthcare exposure.
Streptococci are also common, especially in subacute cases.
7. A patient's echocardiogram reveals a left ventricular ejection fraction
(LVEF) of 25%. This finding indicates:
A. Normal systolic function
B. Severe systolic heart failure
C. Diastolic dysfunction
D. Aortic stenosis
Rationale: The ejection fraction is the percentage of blood in the left ventricle that
is pumped out with each beat. A normal LVEF is typically 55-70%. An LVEF of
25% indicates severely reduced systolic function, meaning the heart is unable to
pump blood forward effectively. This is a hallmark of heart failure with reduced
ejection fraction (HFrEF).
8. A patient with a deep vein thrombosis (DVT) is at risk for which life-
threatening complication?
A. Myocardial infarction
B. Pulmonary embolism
C. Stroke
D. Aortic dissection
Rationale: A deep vein thrombosis (DVT) is a blood clot that forms in a deep
vein, usually in the leg. If the clot breaks loose (embolizes), it can travel through
the venous system to the right side of the heart and then into the pulmonary
arteries, causing a pulmonary embolism (PE), which can be fatal.
9. A patient with hypertension has a serum creatinine of 2.0 mg/dL and
proteinuria. These findings suggest:
A. Essential hypertension
B. Hypertensive nephrosclerosis
C. Primary hyperaldosteronism
D. Pheochromocytoma
, Rationale: Chronic, poorly controlled hypertension damages the small blood
vessels in the kidneys, leading to nephrosclerosis. This results in impaired kidney
function, manifested by an elevated serum creatinine and proteinuria (protein in the
urine).
10. The classic ECG finding in a patient with hyperkalemia is:
A. Prominent U waves
B. Tall, peaked T waves
C. Prolonged QT interval
D. ST-segment depression
Rationale: Hyperkalemia (elevated serum potassium) affects the electrical
conduction of the heart. The earliest and most classic ECG change is tall, peaked,
or "tented" T waves. As potassium levels rise further, the QRS complex may
widen, and the rhythm can deteriorate into ventricular fibrillation or asystole.
11. A patient with aortic stenosis presents with the classic triad of symptoms.
Which of the following is NOT part of this triad?
A. Angina
B. Syncope
C. Palpitations
D. Dyspnea on exertion
Rationale: The classic triad of symptoms for aortic stenosis is angina (chest pain),
syncope (fainting), and dyspnea on exertion (shortness of breath with activity).
These symptoms occur because the narrowed valve obstructs blood flow from the
left ventricle to the body, leading to decreased cardiac output and increased
workload on the heart. Palpitations are not part of the classic triad.
12. A patient's D-dimer test is elevated. This finding is most useful for:
A. Confirming a diagnosis of DVT.
B. Ruling out a diagnosis of DVT or PE when combined with clinical
probability.
C. Determining the size of a thrombus.
D. Monitoring the effectiveness of anticoagulation.
Rationale: The D-dimer is a fibrin degradation product, and its levels rise when a
clot is being broken down. It is a highly sensitive but non-specific test. A negative
D-dimer in a patient with low clinical probability can effectively rule out DVT or
PE. However, an elevated D-dimer can be caused by many conditions (infection,
surgery, pregnancy, cancer), so it cannot confirm the diagnosis on its own.
Findings Study Guide Practice Test
Questions Lab Values Imaging Disease
Manifestations Clinical Reasoning
Explanations
Section 1: Cardiovascular Pathophysiology (Questions 1-25)
1. A patient presents to the emergency department with crushing chest pain.
An ECG shows ST-segment elevation in leads II, III, and aVF. Which
coronary artery is most likely occluded?
A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery
D. Left main coronary artery
Rationale: ST-segment elevation in leads II, III, and aVF indicates an inferior wall
myocardial infarction. The right coronary artery (RCA) supplies the inferior wall
of the left ventricle in most individuals. The left anterior descending artery supplies
the anterior wall (leads V1-V4), and the left circumflex artery supplies the lateral
wall (leads I, aVL, V5-V6).
2. A patient with heart failure has a B-type natriuretic peptide (BNP) level of
1,200 pg/mL. This elevated value is primarily a result of:
A. Renal failure
B. Ventricular stretch due to volume overload
C. Hepatic dysfunction
D. Skeletal muscle damage
Rationale: BNP is a hormone released by the ventricles of the heart in response to
stretching and stress caused by increased blood volume and pressure. An elevated
,BNP level is a key diagnostic marker for heart failure and correlates with the
severity of ventricular dysfunction.
3. A patient's arterial blood gas shows a pH of 7.30, PaCO2 of 50 mmHg, and
HCO3 of 24 mEq/L. This ABG is most consistent with:
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Rationale: A pH below 7.35 indicates acidosis. A PaCO2 above 45 mmHg
indicates respiratory retention of carbon dioxide, which is an acid. Since the
primary abnormality is an elevated PaCO2 and the bicarbonate is normal
(uncompensated), this is an acute respiratory acidosis.
4. A patient with a history of atrial fibrillation is at highest risk for which type
of stroke?
A. Hemorrhagic stroke
B. Embolic stroke
C. Lacunar stroke
D. Transient ischemic attack
Rationale: Atrial fibrillation causes blood to pool in the atria, leading to the
formation of clots. These clots can embolize (travel through the bloodstream) to
the brain, causing an embolic stroke. This is why patients with atrial fibrillation are
often prescribed anticoagulants.
5. A patient's lipid panel shows LDL of 190 mg/dL, HDL of 30 mg/dL, and
triglycerides of 400 mg/dL. Which of these findings is the most significant risk
factor for atherosclerosis?
A. High HDL
B. High LDL
C. High triglycerides
D. Low total cholesterol
Rationale: Elevated low-density lipoprotein (LDL) is the primary driver of
atherosclerosis. LDL particles deposit cholesterol into the arterial walls, forming
plaques. While high triglycerides and low HDL are also risk factors, high LDL is
the most direct and significant contributor to plaque formation.
6. A patient with suspected infective endocarditis has blood cultures drawn.
The most common causative organism is:
,A. Escherichia coli
B. Staphylococcus aureus
C. Pseudomonas aeruginosa
D. Candida albicans
Rationale: Staphylococcus aureus, including methicillin-resistant S. aureus
(MRSA), is the most common cause of infective endocarditis, particularly in acute
cases and in patients with a history of IV drug use or healthcare exposure.
Streptococci are also common, especially in subacute cases.
7. A patient's echocardiogram reveals a left ventricular ejection fraction
(LVEF) of 25%. This finding indicates:
A. Normal systolic function
B. Severe systolic heart failure
C. Diastolic dysfunction
D. Aortic stenosis
Rationale: The ejection fraction is the percentage of blood in the left ventricle that
is pumped out with each beat. A normal LVEF is typically 55-70%. An LVEF of
25% indicates severely reduced systolic function, meaning the heart is unable to
pump blood forward effectively. This is a hallmark of heart failure with reduced
ejection fraction (HFrEF).
8. A patient with a deep vein thrombosis (DVT) is at risk for which life-
threatening complication?
A. Myocardial infarction
B. Pulmonary embolism
C. Stroke
D. Aortic dissection
Rationale: A deep vein thrombosis (DVT) is a blood clot that forms in a deep
vein, usually in the leg. If the clot breaks loose (embolizes), it can travel through
the venous system to the right side of the heart and then into the pulmonary
arteries, causing a pulmonary embolism (PE), which can be fatal.
9. A patient with hypertension has a serum creatinine of 2.0 mg/dL and
proteinuria. These findings suggest:
A. Essential hypertension
B. Hypertensive nephrosclerosis
C. Primary hyperaldosteronism
D. Pheochromocytoma
, Rationale: Chronic, poorly controlled hypertension damages the small blood
vessels in the kidneys, leading to nephrosclerosis. This results in impaired kidney
function, manifested by an elevated serum creatinine and proteinuria (protein in the
urine).
10. The classic ECG finding in a patient with hyperkalemia is:
A. Prominent U waves
B. Tall, peaked T waves
C. Prolonged QT interval
D. ST-segment depression
Rationale: Hyperkalemia (elevated serum potassium) affects the electrical
conduction of the heart. The earliest and most classic ECG change is tall, peaked,
or "tented" T waves. As potassium levels rise further, the QRS complex may
widen, and the rhythm can deteriorate into ventricular fibrillation or asystole.
11. A patient with aortic stenosis presents with the classic triad of symptoms.
Which of the following is NOT part of this triad?
A. Angina
B. Syncope
C. Palpitations
D. Dyspnea on exertion
Rationale: The classic triad of symptoms for aortic stenosis is angina (chest pain),
syncope (fainting), and dyspnea on exertion (shortness of breath with activity).
These symptoms occur because the narrowed valve obstructs blood flow from the
left ventricle to the body, leading to decreased cardiac output and increased
workload on the heart. Palpitations are not part of the classic triad.
12. A patient's D-dimer test is elevated. This finding is most useful for:
A. Confirming a diagnosis of DVT.
B. Ruling out a diagnosis of DVT or PE when combined with clinical
probability.
C. Determining the size of a thrombus.
D. Monitoring the effectiveness of anticoagulation.
Rationale: The D-dimer is a fibrin degradation product, and its levels rise when a
clot is being broken down. It is a highly sensitive but non-specific test. A negative
D-dimer in a patient with low clinical probability can effectively rule out DVT or
PE. However, an elevated D-dimer can be caused by many conditions (infection,
surgery, pregnancy, cancer), so it cannot confirm the diagnosis on its own.
