NURS 5350 Advanced Pathophysiology — Exam 2
(2026/2027)
Original 200-Question Practice Exam with Answers
& Rationales — UT Tyler–Aligned Study Tool
Chapter 1 — Cardiovascular Pathophysiology
Questions 1–45
Question 1: A 58-year-old man has endothelial injury from chronic hypertension
and smoking. Which process best describes the earliest step in atherosclerosis?
A. Medial calcification with normal intima
B. Endothelial dysfunction with increased permeability and leukocyte adhesion
C. Acute plaque rupture with complete coronary occlusion
D. Compensatory venous dilation with reduced shear stress
Correct Answer: B
Rationale: Atherosclerosis begins with endothelial injury/dysfunction,
which increases permeability, allows LDL entry, and promotes adhesion of
monocytes and lymphocytes. Medial calcification and plaque rupture occur later.
Question 2: Oxidized LDL in the arterial intima is most directly responsible for
which step in atherogenesis?
A. Conversion of monocytes into foam cells
B. Immediate rupture of the fibrous cap
C. Decreased smooth muscle migration
D. Reduced inflammatory cytokine release
Correct Answer: A
Rationale: Oxidized LDL is chemotactic and cytotoxic; macrophages engulf
it via scavenger receptors and become foam cells, the hallmark of the fatty streak.
,Question 3: A patient reports chest pressure with exertion that resolves within 5
minutes of rest. Which mechanism best explains stable angina?
A. Transient coronary vasospasm at rest
B. Fixed atherosclerotic obstruction causing demand-induced ischemia
C. Complete coronary occlusion with transmural necrosis
D. Acute pericardial inflammation
Correct Answer: B
Rationale: Stable angina occurs when a fixed coronary stenosis limits flow
during increased myocardial oxygen demand; rest reduces demand and relieves
symptoms.
Question 4: A 62-year-old woman has chest pain at rest with ST-segment
depression and elevated troponin but no ST elevation. Which process is most
likely?
A. Stable angina
B. Unstable angina/NSTEMI with subendocardial ischemia
C. Pericarditis
D. Aortic dissection
Correct Answer: B
Rationale: Plaque rupture with partial thrombosis causes unstable
angina/NSTEMI. ST depression and troponin elevation indicate subendocardial
injury without full-thickness infarction.
Question 5: Which ECG finding is most consistent with an acute ST-elevation
myocardial infarction?
A. ST elevation in contiguous leads
B. Diffuse PR depression
C. Peaked T waves only in V1
D. Irregularly irregular rhythm without P waves
, Correct Answer: A
Rationale: STEMI is diagnosed by ST elevation in anatomically contiguous
leads, reflecting transmural myocardial injury. Diffuse PR depression suggests
pericarditis.
Question 6: A patient with acute MI develops ventricular fibrillation. Which
mechanism best explains this complication?
A. Reentry from ischemic myocardial irritability
B. Complete heart block
C. Increased vagal tone
D. Pericardial effusion
Correct Answer: A
Rationale: Ischemic myocardium has altered conduction and
refractoriness, predisposing to reentrant ventricular arrhythmias such as VF.
Question 7: In most patients with primary hypertension, which combination best
characterizes the underlying pathophysiology?
A. Increased systemic vascular resistance and neurohormonal activation
B. Pure volume overload with suppressed RAAS
C. Isolated reduction in cardiac output
D. Autoimmune destruction of arterioles
Correct Answer: A
Rationale: Primary hypertension involves increased SVR, sympathetic
overactivity, RAAS activation, and endothelial dysfunction. Volume overload alone
is more typical of renal parenchymal disease.
Question 8: Angiotensin II contributes to hypertension by which combined effect?
A. Vasodilation and natriuresis
B. Vasoconstriction and aldosterone-mediated sodium retention
, C. Bradycardia and reduced thirst
D. Inhibition of ADH release
Correct Answer: B
Rationale: Angiotensin II is a potent vasoconstrictor and stimulates
aldosterone, causing sodium and water retention, both of which raise blood
pressure.
Question 9: Which finding most suggests secondary hypertension?
A. Onset at age 55 with mild elevation
B. Resistant hypertension with hypokalemia and elevated aldosterone-to-renin
ratio
C. Hypertension with obesity and family history
D. Blood pressure that responds to lifestyle change
Correct Answer: B
Rationale: Primary aldosteronism is a common secondary cause and
classically causes resistant hypertension with hypokalemia and high aldosterone
relative to renin.
Question 10: SATA: Which are recognized risk factors for atherosclerosis?
A. Cigarette smoking
B. LDL elevation
C. Regular aerobic exercise
D. Diabetes mellitus
E. Hypertension
Correct Answer: A, B, D, E
Rationale: Smoking, elevated LDL, diabetes, and hypertension all promote
endothelial injury and atherogenesis. Regular aerobic exercise reduces risk.
(2026/2027)
Original 200-Question Practice Exam with Answers
& Rationales — UT Tyler–Aligned Study Tool
Chapter 1 — Cardiovascular Pathophysiology
Questions 1–45
Question 1: A 58-year-old man has endothelial injury from chronic hypertension
and smoking. Which process best describes the earliest step in atherosclerosis?
A. Medial calcification with normal intima
B. Endothelial dysfunction with increased permeability and leukocyte adhesion
C. Acute plaque rupture with complete coronary occlusion
D. Compensatory venous dilation with reduced shear stress
Correct Answer: B
Rationale: Atherosclerosis begins with endothelial injury/dysfunction,
which increases permeability, allows LDL entry, and promotes adhesion of
monocytes and lymphocytes. Medial calcification and plaque rupture occur later.
Question 2: Oxidized LDL in the arterial intima is most directly responsible for
which step in atherogenesis?
A. Conversion of monocytes into foam cells
B. Immediate rupture of the fibrous cap
C. Decreased smooth muscle migration
D. Reduced inflammatory cytokine release
Correct Answer: A
Rationale: Oxidized LDL is chemotactic and cytotoxic; macrophages engulf
it via scavenger receptors and become foam cells, the hallmark of the fatty streak.
,Question 3: A patient reports chest pressure with exertion that resolves within 5
minutes of rest. Which mechanism best explains stable angina?
A. Transient coronary vasospasm at rest
B. Fixed atherosclerotic obstruction causing demand-induced ischemia
C. Complete coronary occlusion with transmural necrosis
D. Acute pericardial inflammation
Correct Answer: B
Rationale: Stable angina occurs when a fixed coronary stenosis limits flow
during increased myocardial oxygen demand; rest reduces demand and relieves
symptoms.
Question 4: A 62-year-old woman has chest pain at rest with ST-segment
depression and elevated troponin but no ST elevation. Which process is most
likely?
A. Stable angina
B. Unstable angina/NSTEMI with subendocardial ischemia
C. Pericarditis
D. Aortic dissection
Correct Answer: B
Rationale: Plaque rupture with partial thrombosis causes unstable
angina/NSTEMI. ST depression and troponin elevation indicate subendocardial
injury without full-thickness infarction.
Question 5: Which ECG finding is most consistent with an acute ST-elevation
myocardial infarction?
A. ST elevation in contiguous leads
B. Diffuse PR depression
C. Peaked T waves only in V1
D. Irregularly irregular rhythm without P waves
, Correct Answer: A
Rationale: STEMI is diagnosed by ST elevation in anatomically contiguous
leads, reflecting transmural myocardial injury. Diffuse PR depression suggests
pericarditis.
Question 6: A patient with acute MI develops ventricular fibrillation. Which
mechanism best explains this complication?
A. Reentry from ischemic myocardial irritability
B. Complete heart block
C. Increased vagal tone
D. Pericardial effusion
Correct Answer: A
Rationale: Ischemic myocardium has altered conduction and
refractoriness, predisposing to reentrant ventricular arrhythmias such as VF.
Question 7: In most patients with primary hypertension, which combination best
characterizes the underlying pathophysiology?
A. Increased systemic vascular resistance and neurohormonal activation
B. Pure volume overload with suppressed RAAS
C. Isolated reduction in cardiac output
D. Autoimmune destruction of arterioles
Correct Answer: A
Rationale: Primary hypertension involves increased SVR, sympathetic
overactivity, RAAS activation, and endothelial dysfunction. Volume overload alone
is more typical of renal parenchymal disease.
Question 8: Angiotensin II contributes to hypertension by which combined effect?
A. Vasodilation and natriuresis
B. Vasoconstriction and aldosterone-mediated sodium retention
, C. Bradycardia and reduced thirst
D. Inhibition of ADH release
Correct Answer: B
Rationale: Angiotensin II is a potent vasoconstrictor and stimulates
aldosterone, causing sodium and water retention, both of which raise blood
pressure.
Question 9: Which finding most suggests secondary hypertension?
A. Onset at age 55 with mild elevation
B. Resistant hypertension with hypokalemia and elevated aldosterone-to-renin
ratio
C. Hypertension with obesity and family history
D. Blood pressure that responds to lifestyle change
Correct Answer: B
Rationale: Primary aldosteronism is a common secondary cause and
classically causes resistant hypertension with hypokalemia and high aldosterone
relative to renin.
Question 10: SATA: Which are recognized risk factors for atherosclerosis?
A. Cigarette smoking
B. LDL elevation
C. Regular aerobic exercise
D. Diabetes mellitus
E. Hypertension
Correct Answer: A, B, D, E
Rationale: Smoking, elevated LDL, diabetes, and hypertension all promote
endothelial injury and atherogenesis. Regular aerobic exercise reduces risk.
