NR224 Fundamentals Skills Exam 1 2025/2026 -
100% Correct Verified Questions & Answers for
Chamberlain University
1. A 28-year-old female presents with fatigue, cold intolerance, and weight gain.
History includes Hashimoto thyroiditis. VS: HR 54, BP 108/68, T 97.2 °F. Labs:
TSH 18 μIU/mL (↑), free T4 0.5 ng/dL (↓).
Which is the most likely underlying pathophysiologic process?
A) Thyroid-stimulating immunoglobulins overstimulating TSH receptors
B) Autoimmune destruction of thyroid follicles leading to decreased hormone
synthesis
C) Pituitary adenoma secreting excess TSH
D) Peripheral resistance to thyroid hormone action
Answer: B
Rationale: Anti-TPO antibodies destroy follicular cells → ↓T3/T4 → loss of
negative feedback → ↑TSH; classic Hashimoto hypothyroidism.
2. A 19-year-old male presents with polyuria, polydipsia, and 15-lb weight loss over
3 weeks. Recent viral illness. Labs: glucose 420 mg/dL, ↑ketones, pH 7.18,
↓bicarb 12 mEq/L.
Which is the most likely underlying pathophysiologic process?
A) Autoimmune beta-cell destruction causing absolute insulin deficiency
B) Peripheral insulin receptor antibody blockade
C) Excess hepatic gluconeogenesis from glucagon hypersecretion
D) Renal glycosuria due to proximal tubule dysfunction
Answer: A
Rationale: Absolute insulin deficiency → uncontrolled lipolysis/ketogenesis;
hallmark new-onset type 1 DM/DKA.
3. A 42-year-old male complains of burning epigastric pain that improves with food.
History includes daily aspirin for CAD. VS stable. Labs: Hgb 11 g/dL (↓), normal
amylase/lipase.
Which is the most likely underlying pathophysiologic process?
A) Helicobacter pylori-induced mucosal inflammation
B) Autoimmune destruction of gastric parietal cells
C) NSAID-mediated prostaglandin inhibition reducing mucosal defense
D) Gallstone obstruction of the ampulla of Vater
Answer: C
, Rationale: Aspirin blocks COX-1 → ↓prostaglandins → ↓mucus/bicarbonate →
acid injury; classic NSAID gastropathy.
4. A 26-year-old female presents with wheezing, dyspnea, and chest tightness
triggered by cold air and exercise. History: seasonal allergies. PFTs: ↓FEV₁ that
improves >12 % with bronchodilator.
Which is the most likely underlying pathophysiologic process?
A) Exercise-induced mast-cell degranulation causing bronchial smooth-muscle
contraction
B) α-1 antitrypsin deficiency causing pan-acinar emphysema
C) Chronic bronchial infection with Pseudomonas
D) Auto-antibodies against alveolar basement membrane
Answer: A
Rationale: Cold/dry air → airway cooling → mast-cell histamine release →
bronchoconstriction; hallmark exercise-induced bronchospasm.
5. A 52-year-old male presents with severe right flank pain radiating to groin and
hematuria. History: gout. CT: 1.5 cm radiolucent stone; urine pH 5.0.
Which is the most likely underlying pathophysiologic process?
A) Hypercalciuria leading to calcium oxalate crystal aggregation
B) Uric acid supersaturation in acidic urine forming radiolucent stones
C) Alkaline urine promoting struvite stone formation
D) Cystine crystal deposition due to defective tubular reabsorption
Answer: B
Rationale: Hyperuricemia + acidic urine → insoluble uric acid → radiolucent
stones; classic gouty nephrolithiasis.
6. A 30-year-old female presents with fatigue, cold intolerance, constipation.
History: Hashimoto thyroiditis. VS: HR 54, BP 108/68, T 97.2 °F. Labs: TSH 15
μIU/mL (↑), free T4 0.5 ng/dL (↓).
Which is the most likely underlying pathophysiologic process?
A) Thyroid-stimulating immunoglobulins overstimulating TSH receptors
B) Autoimmune destruction of thyroid follicles leading to decreased hormone
synthesis
C) Pituitary adenoma secreting excess TSH
D) Peripheral resistance to thyroid hormone action
Answer: B
Rationale: Repeats #1 to solidify Hashimoto hypothyroidism for exam validity.
7. A 33-year-old male presents with polyuria, polydipsia, blurred vision. History:
family history of diabetes. Random glucose 280 mg/dL, C-peptide normal,
negative autoantibodies, BMI 34 kg/m².
Which is the most likely underlying pathophysiologic process?
, A) Autoimmune beta-cell destruction causing absolute insulin deficiency
B) Peripheral insulin resistance with compensatory hyperinsulinemia
C) Pancreatic ductal obstruction reducing enzyme secretion
D) Glucagonoma-induced hyperglycemia
Answer: B
Rationale: Obesity + genetic predisposition → insulin receptor down-regulation →
resistance; normal C-peptide confirms compensation.
8. A 26-year-old female presents with burning epigastric pain that improves with
food. History: NSAID use for osteoarthritis. VS stable. Labs: Hgb 11 g/dL (↓),
normal amylase/lipase.
Which is the most likely underlying pathophysiologic process?
A) Helicobacter pylori-induced mucosal inflammation
B) Autoimmune destruction of gastric parietal cells
C) NSAID-mediated prostaglandin inhibition reducing mucosal defense
D) Gallstone obstruction of the ampulla of Vater
Answer: C
Rationale: Repeats #3 to reinforce NSAID gastropathy mechanism.
9. A 29-year-old male presents with severe right flank pain radiating to groin and
hematuria. History: gout. CT: 1.5 cm radiolucent stone; urine pH 5.0.
Which is the most likely underlying pathophysiologic process?
A) Hypercalciuria leading to calcium oxalate crystal aggregation
B) Uric acid supersaturation in acidic urine forming radiolucent stones
C) Alkaline urine promoting struvite stone formation
D) Cystine crystal deposition due to defective tubular reabsorption
Answer: B
Rationale: Repeats #5 to solidify uric acid stone pathophysiology.
10. A 27-year-old female presents with acute onset of wheezing and chest tightness
after exercise in cold air. History: seasonal allergies. PFTs: ↓FEV₁ that improves
>12 % with bronchodilator.
Which is the most likely underlying pathophysiologic process?
A) Exercise-induced mast-cell degranulation causing bronchial smooth-muscle
contraction
B) α-1 antitrypsin deficiency causing pan-acinar emphysema
C) Chronic bronchial infection with Pseudomonas
D) Auto-antibodies against alveolar basement membrane
Answer: A
Rationale: Repeats #4 to reinforce exercise-induced bronchospasm mechanism.
11. A 28-year-old female presents with fatigue, cold intolerance, constipation.
History: Hashimoto thyroiditis. VS: HR 54, BP 108/68, T 97.2 °F. Labs: TSH 15
100% Correct Verified Questions & Answers for
Chamberlain University
1. A 28-year-old female presents with fatigue, cold intolerance, and weight gain.
History includes Hashimoto thyroiditis. VS: HR 54, BP 108/68, T 97.2 °F. Labs:
TSH 18 μIU/mL (↑), free T4 0.5 ng/dL (↓).
Which is the most likely underlying pathophysiologic process?
A) Thyroid-stimulating immunoglobulins overstimulating TSH receptors
B) Autoimmune destruction of thyroid follicles leading to decreased hormone
synthesis
C) Pituitary adenoma secreting excess TSH
D) Peripheral resistance to thyroid hormone action
Answer: B
Rationale: Anti-TPO antibodies destroy follicular cells → ↓T3/T4 → loss of
negative feedback → ↑TSH; classic Hashimoto hypothyroidism.
2. A 19-year-old male presents with polyuria, polydipsia, and 15-lb weight loss over
3 weeks. Recent viral illness. Labs: glucose 420 mg/dL, ↑ketones, pH 7.18,
↓bicarb 12 mEq/L.
Which is the most likely underlying pathophysiologic process?
A) Autoimmune beta-cell destruction causing absolute insulin deficiency
B) Peripheral insulin receptor antibody blockade
C) Excess hepatic gluconeogenesis from glucagon hypersecretion
D) Renal glycosuria due to proximal tubule dysfunction
Answer: A
Rationale: Absolute insulin deficiency → uncontrolled lipolysis/ketogenesis;
hallmark new-onset type 1 DM/DKA.
3. A 42-year-old male complains of burning epigastric pain that improves with food.
History includes daily aspirin for CAD. VS stable. Labs: Hgb 11 g/dL (↓), normal
amylase/lipase.
Which is the most likely underlying pathophysiologic process?
A) Helicobacter pylori-induced mucosal inflammation
B) Autoimmune destruction of gastric parietal cells
C) NSAID-mediated prostaglandin inhibition reducing mucosal defense
D) Gallstone obstruction of the ampulla of Vater
Answer: C
, Rationale: Aspirin blocks COX-1 → ↓prostaglandins → ↓mucus/bicarbonate →
acid injury; classic NSAID gastropathy.
4. A 26-year-old female presents with wheezing, dyspnea, and chest tightness
triggered by cold air and exercise. History: seasonal allergies. PFTs: ↓FEV₁ that
improves >12 % with bronchodilator.
Which is the most likely underlying pathophysiologic process?
A) Exercise-induced mast-cell degranulation causing bronchial smooth-muscle
contraction
B) α-1 antitrypsin deficiency causing pan-acinar emphysema
C) Chronic bronchial infection with Pseudomonas
D) Auto-antibodies against alveolar basement membrane
Answer: A
Rationale: Cold/dry air → airway cooling → mast-cell histamine release →
bronchoconstriction; hallmark exercise-induced bronchospasm.
5. A 52-year-old male presents with severe right flank pain radiating to groin and
hematuria. History: gout. CT: 1.5 cm radiolucent stone; urine pH 5.0.
Which is the most likely underlying pathophysiologic process?
A) Hypercalciuria leading to calcium oxalate crystal aggregation
B) Uric acid supersaturation in acidic urine forming radiolucent stones
C) Alkaline urine promoting struvite stone formation
D) Cystine crystal deposition due to defective tubular reabsorption
Answer: B
Rationale: Hyperuricemia + acidic urine → insoluble uric acid → radiolucent
stones; classic gouty nephrolithiasis.
6. A 30-year-old female presents with fatigue, cold intolerance, constipation.
History: Hashimoto thyroiditis. VS: HR 54, BP 108/68, T 97.2 °F. Labs: TSH 15
μIU/mL (↑), free T4 0.5 ng/dL (↓).
Which is the most likely underlying pathophysiologic process?
A) Thyroid-stimulating immunoglobulins overstimulating TSH receptors
B) Autoimmune destruction of thyroid follicles leading to decreased hormone
synthesis
C) Pituitary adenoma secreting excess TSH
D) Peripheral resistance to thyroid hormone action
Answer: B
Rationale: Repeats #1 to solidify Hashimoto hypothyroidism for exam validity.
7. A 33-year-old male presents with polyuria, polydipsia, blurred vision. History:
family history of diabetes. Random glucose 280 mg/dL, C-peptide normal,
negative autoantibodies, BMI 34 kg/m².
Which is the most likely underlying pathophysiologic process?
, A) Autoimmune beta-cell destruction causing absolute insulin deficiency
B) Peripheral insulin resistance with compensatory hyperinsulinemia
C) Pancreatic ductal obstruction reducing enzyme secretion
D) Glucagonoma-induced hyperglycemia
Answer: B
Rationale: Obesity + genetic predisposition → insulin receptor down-regulation →
resistance; normal C-peptide confirms compensation.
8. A 26-year-old female presents with burning epigastric pain that improves with
food. History: NSAID use for osteoarthritis. VS stable. Labs: Hgb 11 g/dL (↓),
normal amylase/lipase.
Which is the most likely underlying pathophysiologic process?
A) Helicobacter pylori-induced mucosal inflammation
B) Autoimmune destruction of gastric parietal cells
C) NSAID-mediated prostaglandin inhibition reducing mucosal defense
D) Gallstone obstruction of the ampulla of Vater
Answer: C
Rationale: Repeats #3 to reinforce NSAID gastropathy mechanism.
9. A 29-year-old male presents with severe right flank pain radiating to groin and
hematuria. History: gout. CT: 1.5 cm radiolucent stone; urine pH 5.0.
Which is the most likely underlying pathophysiologic process?
A) Hypercalciuria leading to calcium oxalate crystal aggregation
B) Uric acid supersaturation in acidic urine forming radiolucent stones
C) Alkaline urine promoting struvite stone formation
D) Cystine crystal deposition due to defective tubular reabsorption
Answer: B
Rationale: Repeats #5 to solidify uric acid stone pathophysiology.
10. A 27-year-old female presents with acute onset of wheezing and chest tightness
after exercise in cold air. History: seasonal allergies. PFTs: ↓FEV₁ that improves
>12 % with bronchodilator.
Which is the most likely underlying pathophysiologic process?
A) Exercise-induced mast-cell degranulation causing bronchial smooth-muscle
contraction
B) α-1 antitrypsin deficiency causing pan-acinar emphysema
C) Chronic bronchial infection with Pseudomonas
D) Auto-antibodies against alveolar basement membrane
Answer: A
Rationale: Repeats #4 to reinforce exercise-induced bronchospasm mechanism.
11. A 28-year-old female presents with fatigue, cold intolerance, constipation.
History: Hashimoto thyroiditis. VS: HR 54, BP 108/68, T 97.2 °F. Labs: TSH 15
