NR 507 Exam 2 Actual Exam V2 | NR 507 Advanced Pathophysiology
(NR507 Exam 2) [PDF] | Chamberlain University
1. A 65-year-old male with a history of hypertension presents with progressive shortness of
breath. Echocardiography reveals left ventricular hypertrophy and fibrosis. Which mediator is
primarily responsible for stimulating collagen synthesis and cardiac remodeling in this
patient?
A. Atrial natriuretic peptide
B. Nitric oxide
C. Angiotensin II
D. Bradykinin
Answer: C
Rationale: Angiotensin II is a potent vasoconstrictor that also acts as a growth factor for
myocytes and fibroblasts. It promotes the production of collagen, leading to the structural
changes known as cardiac remodeling. This process increases ventricular stiffness and
contributes to the progression of heart failure.
2. A patient is diagnosed with stable angina. During an exercise stress test, the patient
experiences chest pain. What is the underlying pathophysiological mechanism of this pain?
A. Complete occlusion of the coronary artery by a thrombus
B. Vasospasm of the coronary arteries at rest
C. Myocardial oxygen demand exceeding the limited supply
D. Inflammation of the pericardial sac
Answer: C
Rationale: Stable angina occurs when there is a fixed atherosclerotic plaque that limits
coronary blood flow. During physical exertion, the heart’s demand for oxygen increases
significantly. Because the blood flow is restricted, the supply cannot meet this demand,
leading to transient myocardial ischemia and pain.
3. A 58-year-old female smoker presents with chronic leg pain and a non-healing ulcer on her
toe. Laboratory results show elevated C-reactive protein. Which process describes the initial
step in her endothelial dysfunction?
A. Increased expression of adhesion molecules and reduced vasodilator bioavailability
B. Excessive production of Nitric Oxide
C. Inhibition of the Renin-Angiotensin system
,D. Decreased oxidative stress within the vessel wall
Answer: A
Rationale: Endothelial dysfunction begins with injury to the vessel wall, often caused by
smoking or hypertension. This injury leads to decreased production of nitric oxide and
increased expression of adhesion molecules like ICAM-1. These changes promote leukocyte
recruitment and the formation of atherosclerotic plaques.
4. A patient post-surgery develops sudden onset pleuritic chest pain and hemoptysis. A CT
scan confirms a pulmonary embolism. Which of Virchow’s triad components was most likely
the primary trigger?
A. Vessel wall injury
B. Endothelial denudation
C. Hypercoagulability
D. Stasis of blood flow
Answer: D
Rationale: Post-surgical immobility leads to the stasis of blood flow, particularly in the
deep veins of the lower extremities. Stasis allows for the accumulation of clotting factors
and promotes thrombus formation. This thrombus can later embolize to the pulmonary
vasculature, causing the observed symptoms.
5. A 70-year-old male with long-standing COPD presents with edema in his lower extremities
and jugular venous distention. His mean pulmonary artery pressure is 35 mmHg. What is the
most likely diagnosis?
A. Primary Pulmonary Hypertension
B. Left-sided heart failure
C. Cor Pulmonale
D. Mitral Valve Prolapse
Answer: C
Rationale: Cor pulmonale is defined as right ventricular hypertrophy and failure resulting
from pulmonary hypertension caused by lung disease. In chronic COPD, alveolar hypoxia
causes pulmonary vasoconstriction, which increases the workload on the right ventricle.
Over time, this leads to the clinical manifestations of right-sided heart failure.
6. A patient in the ICU has a PaO2 of 50 mmHg while receiving 100% oxygen. The chest X-ray
shows diffuse bilateral infiltrates. Which phase of Acute Respiratory Distress Syndrome
(ARDS) is characterized by the formation of hyaline membranes?
A. Proliferative phase
, B. Exudative phase
C. Fibrotic phase
D. Resolution phase
Answer: B
Rationale: The exudative phase of ARDS occurs within the first 72 hours of injury. It
involves endothelial damage, increased capillary permeability, and the accumulation of
protein-rich fluid in the alveoli. This fluid, along with cellular debris, forms the
characteristic hyaline membranes that impair gas exchange.
7. A patient with severe pneumonia has an area of the lung that is perfused but not
ventilated. How would this Ventilation-Perfusion (V/Q) relationship be categorized?
A. Dead space
B. High V/Q ratio
C. Normal mismatch
D. Shunt
Answer: D
Rationale: A shunt occurs when blood flows through the pulmonary capillaries without
participating in gas exchange because the alveoli are collapsed or filled with fluid. This
results in a low V/Q ratio. Shunting is a major cause of hypoxemia in conditions like
pneumonia or ARDS.
8. Chronic respiratory failure is often characterized by hypercapnia. Which of the following is
a primary compensatory mechanism for chronic CO2 retention?
A. Increased renal reabsorption of bicarbonate
B. Increased renal excretion of bicarbonate
C. Decreased respiratory rate
D. Increased sensitivity of central chemoreceptors
Answer: A
Rationale: In chronic respiratory failure, the kidneys compensate for elevated PaCO2
levels by retaining bicarbonate (HCO3-). This process helps to normalize the blood pH
despite the presence of respiratory acidosis. This compensation typically takes several days
to become fully effective.
9. In the context of myocardial ischemia, what does ‘stunned myocardium’ refer to?
A. Permanent necrosis of myocardial tissue
B. Temporary loss of contractile function that persists after reperfusion
(NR507 Exam 2) [PDF] | Chamberlain University
1. A 65-year-old male with a history of hypertension presents with progressive shortness of
breath. Echocardiography reveals left ventricular hypertrophy and fibrosis. Which mediator is
primarily responsible for stimulating collagen synthesis and cardiac remodeling in this
patient?
A. Atrial natriuretic peptide
B. Nitric oxide
C. Angiotensin II
D. Bradykinin
Answer: C
Rationale: Angiotensin II is a potent vasoconstrictor that also acts as a growth factor for
myocytes and fibroblasts. It promotes the production of collagen, leading to the structural
changes known as cardiac remodeling. This process increases ventricular stiffness and
contributes to the progression of heart failure.
2. A patient is diagnosed with stable angina. During an exercise stress test, the patient
experiences chest pain. What is the underlying pathophysiological mechanism of this pain?
A. Complete occlusion of the coronary artery by a thrombus
B. Vasospasm of the coronary arteries at rest
C. Myocardial oxygen demand exceeding the limited supply
D. Inflammation of the pericardial sac
Answer: C
Rationale: Stable angina occurs when there is a fixed atherosclerotic plaque that limits
coronary blood flow. During physical exertion, the heart’s demand for oxygen increases
significantly. Because the blood flow is restricted, the supply cannot meet this demand,
leading to transient myocardial ischemia and pain.
3. A 58-year-old female smoker presents with chronic leg pain and a non-healing ulcer on her
toe. Laboratory results show elevated C-reactive protein. Which process describes the initial
step in her endothelial dysfunction?
A. Increased expression of adhesion molecules and reduced vasodilator bioavailability
B. Excessive production of Nitric Oxide
C. Inhibition of the Renin-Angiotensin system
,D. Decreased oxidative stress within the vessel wall
Answer: A
Rationale: Endothelial dysfunction begins with injury to the vessel wall, often caused by
smoking or hypertension. This injury leads to decreased production of nitric oxide and
increased expression of adhesion molecules like ICAM-1. These changes promote leukocyte
recruitment and the formation of atherosclerotic plaques.
4. A patient post-surgery develops sudden onset pleuritic chest pain and hemoptysis. A CT
scan confirms a pulmonary embolism. Which of Virchow’s triad components was most likely
the primary trigger?
A. Vessel wall injury
B. Endothelial denudation
C. Hypercoagulability
D. Stasis of blood flow
Answer: D
Rationale: Post-surgical immobility leads to the stasis of blood flow, particularly in the
deep veins of the lower extremities. Stasis allows for the accumulation of clotting factors
and promotes thrombus formation. This thrombus can later embolize to the pulmonary
vasculature, causing the observed symptoms.
5. A 70-year-old male with long-standing COPD presents with edema in his lower extremities
and jugular venous distention. His mean pulmonary artery pressure is 35 mmHg. What is the
most likely diagnosis?
A. Primary Pulmonary Hypertension
B. Left-sided heart failure
C. Cor Pulmonale
D. Mitral Valve Prolapse
Answer: C
Rationale: Cor pulmonale is defined as right ventricular hypertrophy and failure resulting
from pulmonary hypertension caused by lung disease. In chronic COPD, alveolar hypoxia
causes pulmonary vasoconstriction, which increases the workload on the right ventricle.
Over time, this leads to the clinical manifestations of right-sided heart failure.
6. A patient in the ICU has a PaO2 of 50 mmHg while receiving 100% oxygen. The chest X-ray
shows diffuse bilateral infiltrates. Which phase of Acute Respiratory Distress Syndrome
(ARDS) is characterized by the formation of hyaline membranes?
A. Proliferative phase
, B. Exudative phase
C. Fibrotic phase
D. Resolution phase
Answer: B
Rationale: The exudative phase of ARDS occurs within the first 72 hours of injury. It
involves endothelial damage, increased capillary permeability, and the accumulation of
protein-rich fluid in the alveoli. This fluid, along with cellular debris, forms the
characteristic hyaline membranes that impair gas exchange.
7. A patient with severe pneumonia has an area of the lung that is perfused but not
ventilated. How would this Ventilation-Perfusion (V/Q) relationship be categorized?
A. Dead space
B. High V/Q ratio
C. Normal mismatch
D. Shunt
Answer: D
Rationale: A shunt occurs when blood flows through the pulmonary capillaries without
participating in gas exchange because the alveoli are collapsed or filled with fluid. This
results in a low V/Q ratio. Shunting is a major cause of hypoxemia in conditions like
pneumonia or ARDS.
8. Chronic respiratory failure is often characterized by hypercapnia. Which of the following is
a primary compensatory mechanism for chronic CO2 retention?
A. Increased renal reabsorption of bicarbonate
B. Increased renal excretion of bicarbonate
C. Decreased respiratory rate
D. Increased sensitivity of central chemoreceptors
Answer: A
Rationale: In chronic respiratory failure, the kidneys compensate for elevated PaCO2
levels by retaining bicarbonate (HCO3-). This process helps to normalize the blood pH
despite the presence of respiratory acidosis. This compensation typically takes several days
to become fully effective.
9. In the context of myocardial ischemia, what does ‘stunned myocardium’ refer to?
A. Permanent necrosis of myocardial tissue
B. Temporary loss of contractile function that persists after reperfusion
