NURS 6501 Advanced Pathophysiology Week 11
Final Exam - Walden University MSN Program -
2026-2027
Walden University MSN | 100 items | 100 % synthesis/analysis | 3 h
SECTION 1 Systemic Failure & Homeostatic Collapse (Q 1 – 30)
Q1
68-y/o M, HFrEF, acute hypoxic respiratory failure, IV furosemide 3 d → dyspnea ↓, Cr 1.2
→ 2.1 mg/dL, BUN/Cr > 20, oliguria. AKI best characterised as:
A. ATN from hypotension
B. Prerenal azotaemia from diuresis
C. Post-renal obstruction
D. Cardiorenal syndrome type 1
Answer: D – acute HF → ↓ CO & renal venous congestion → integrated cardiorenal
pathophysiology; high BUN/Cr supports renal under-perfusion but syndrome is primary
driver.
Q2
Gram-negative septic shock → DIC. Primary initiator?
A. Endothelial TF exposure
,B. Direct toxin clotting activation
C. Platelet aggregation
D. Liver failure
Answer: A – LPS/cytokines damage endothelium → TF → systemic thrombin
generation.
Q3
Which mixed acid-base in septic shock on mechanical ventilation?
A. Respiratory acidosis + metabolic alkalosis
B. Respiratory alkalosis + metabolic acidosis
C. Metabolic acidosis + respiratory acidosis
D. Metabolic alkalosis + respiratory alkalosis
Answer: B – hyperventilation (resp alkalosis) + lactic acidosis (metabolic).
Q4
Which mediator drives capillary leak in early septic shock?
A. IL-10
B. TNF-α
C. TGF-β
D. IL-4
Answer: B – TNF-α ↑ endothelial permeability.
,Q5
Patient with cardiogenic shock on dobutamine. Which finding suggests transition to
MODS?
A. Urine output 40 mL/h
B. Platelet count 80 k/µL
C. CVP 8 mmHg
D. Lactate 1.5 mmol/L
Answer: B – thrombocytopenia indicates hematologic organ dysfunction.
Q6
Which mechanism explains hepatorenal syndrome type 1?
A. Glomerulonephritis
B. Renal vasoconstriction + portal hypertension
C. ATN from hypotension
D. Drug nephrotoxicity
Answer: B – splanchnic vasodilation → effective hypovolemia → renal vasoconstriction.
Q7
Which biochemical pattern expected in obstructive post-renal AKI?
A. FENa < 1 %
B. Urine Na 10 mmol/L
, C. BUN/Cr < 10
D. FeUrea < 35 %
Answer: C – back-pressure → BUN rises disproportionately.
Q8
Which cytokine principally drives SIRS fever?
A. IL-1β
B. IL-6
C. TNF-α
D. IFN-γ
Answer: A – acts on hypothalamic set-point.
Q9
Which compensatory response is MOST immediate in hemorrhagic shock?
A. Renin release
B. Baroreflex tachycardia
C. Cortisol surge
D. ADH secretion
Answer: B – neural reflex < 1 s.
Q10
Final Exam - Walden University MSN Program -
2026-2027
Walden University MSN | 100 items | 100 % synthesis/analysis | 3 h
SECTION 1 Systemic Failure & Homeostatic Collapse (Q 1 – 30)
Q1
68-y/o M, HFrEF, acute hypoxic respiratory failure, IV furosemide 3 d → dyspnea ↓, Cr 1.2
→ 2.1 mg/dL, BUN/Cr > 20, oliguria. AKI best characterised as:
A. ATN from hypotension
B. Prerenal azotaemia from diuresis
C. Post-renal obstruction
D. Cardiorenal syndrome type 1
Answer: D – acute HF → ↓ CO & renal venous congestion → integrated cardiorenal
pathophysiology; high BUN/Cr supports renal under-perfusion but syndrome is primary
driver.
Q2
Gram-negative septic shock → DIC. Primary initiator?
A. Endothelial TF exposure
,B. Direct toxin clotting activation
C. Platelet aggregation
D. Liver failure
Answer: A – LPS/cytokines damage endothelium → TF → systemic thrombin
generation.
Q3
Which mixed acid-base in septic shock on mechanical ventilation?
A. Respiratory acidosis + metabolic alkalosis
B. Respiratory alkalosis + metabolic acidosis
C. Metabolic acidosis + respiratory acidosis
D. Metabolic alkalosis + respiratory alkalosis
Answer: B – hyperventilation (resp alkalosis) + lactic acidosis (metabolic).
Q4
Which mediator drives capillary leak in early septic shock?
A. IL-10
B. TNF-α
C. TGF-β
D. IL-4
Answer: B – TNF-α ↑ endothelial permeability.
,Q5
Patient with cardiogenic shock on dobutamine. Which finding suggests transition to
MODS?
A. Urine output 40 mL/h
B. Platelet count 80 k/µL
C. CVP 8 mmHg
D. Lactate 1.5 mmol/L
Answer: B – thrombocytopenia indicates hematologic organ dysfunction.
Q6
Which mechanism explains hepatorenal syndrome type 1?
A. Glomerulonephritis
B. Renal vasoconstriction + portal hypertension
C. ATN from hypotension
D. Drug nephrotoxicity
Answer: B – splanchnic vasodilation → effective hypovolemia → renal vasoconstriction.
Q7
Which biochemical pattern expected in obstructive post-renal AKI?
A. FENa < 1 %
B. Urine Na 10 mmol/L
, C. BUN/Cr < 10
D. FeUrea < 35 %
Answer: C – back-pressure → BUN rises disproportionately.
Q8
Which cytokine principally drives SIRS fever?
A. IL-1β
B. IL-6
C. TNF-α
D. IFN-γ
Answer: A – acts on hypothalamic set-point.
Q9
Which compensatory response is MOST immediate in hemorrhagic shock?
A. Renin release
B. Baroreflex tachycardia
C. Cortisol surge
D. ADH secretion
Answer: B – neural reflex < 1 s.
Q10
