______________________________________
NSG 3850 EXAM 4
VERSION A
PATHOPHYSIOLOGY FOR NURSES II
LATEST UPDATE
GALEN COLLEGE OF NURSING
EXAM-STYLE QUESTIONS & CORRECT
ANSWERS
EXAM NAME: NSG 3850 Exam 4 – Version A
PROGRAM: NR (Nursing Program)
COURSE NAME: Pathophysiology for Nurses II (NSG 3850)
NSG 3850 PATHOPHYSIOLOGY
FOR NURSES II
,NSG 3850 Exam 4 – Version A
Pathophysiology for Nurses II
High-Yield Case Scenario Questions & Rationales
Question 1: Ascites in Advanced Liver Disease
A nurse is caring for a 58-year-old client with a long history of cirrhosis related to
chronic alcohol use. During assessment, the nurse notes abdominal distention, shifting
dullness, and a fluid wave. Laboratory results reveal significantly decreased serum
albumin levels. The provider explains that the client’s ascites developed because fluid is
leaking into the peritoneal cavity. Which pathophysiological process is the primary
etiological factor contributing to this complication?
a. Portal hypertension
b. Plasma hypoalbuminemia
c. Impaired absorption of fat-soluble vitamins
d. Accumulation of ammonia in the peritoneal cavity
Rationale:
Albumin is the major protein responsible for maintaining oncotic pressure within the
vascular system. In advanced liver disease, impaired hepatic protein synthesis causes
hypoalbuminemia, allowing fluid to move from the bloodstream into the interstitial and
peritoneal spaces. This leads to ascites formation and generalized edema. Although
portal hypertension contributes to fluid accumulation, low albumin is the primary direct
mechanism reducing plasma oncotic pressure. Ammonia accumulation contributes to
hepatic encephalopathy rather than ascites formation.
Question 2: Acute Cholecystitis Pathophysiology
,A nurse is caring for a client admitted to the emergency department with severe right
upper quadrant pain, nausea, vomiting, and fever after eating a high-fat meal.
Ultrasound imaging reveals gallbladder inflammation and gallstones obstructing bile
flow. The healthcare provider diagnoses acute cholecystitis and explains the underlying
disease process to the client. Which factor contributes most to the pathological process
of this condition?
a. Enzymatic activation causing autoimmune gallbladder stones
b. Lecithin production causing cholesterol solidification
c. Vascular insufficiency causing ischemic injury
d. Cystic duct obstruction
Rationale:
Acute cholecystitis most commonly occurs when a gallstone obstructs the cystic duct,
preventing bile from leaving the gallbladder. This causes bile stasis, inflammation,
increased intraluminal pressure, and eventual infection. The obstruction initiates the
inflammatory cascade responsible for the client’s pain and fever. While ischemia and
bacterial infection can develop later, they are secondary complications rather than the
primary cause. Prompt treatment is important to prevent gallbladder rupture or sepsis.
Question 3: Clinical Manifestations of Chronic Cholelithiasis
A nurse is interviewing a client with a history of recurrent gallstones who reports several
months of abdominal discomfort. The client describes episodes of pain occurring after
meals, especially after consuming greasy foods. The provider suspects chronic
cholelithiasis and orders diagnostic imaging. Which symptom should the nurse expect
the client to report most commonly?
a. Persistent epigastric pain
b. Functional dyspepsia
c. Gray-blue discoloration at the flank
d. Left upper quadrant pain radiating to the back
, Rationale:
Clients with chronic cholelithiasis frequently experience recurrent epigastric or right
upper quadrant pain, especially after fatty meals stimulate gallbladder contraction. The
pain is caused by intermittent obstruction of bile flow by gallstones. Symptoms are
often described as dull, persistent, or cramping and may radiate mildly to the back or
shoulder. Gray-blue flank discoloration is associated with hemorrhagic pancreatitis
rather than gallstones. Severe left upper quadrant pain suggests pancreatic involvement
instead.
Question 4: Hepatitis A Virus Transmission
A community health nurse is teaching a group of travelers about hepatitis A virus
prevention before an overseas mission trip. One participant asks how the infection is
most commonly transmitted and what environmental factors increase risk. The nurse
emphasizes the importance of sanitation and clean water sources in preventing
infection. Which statement by the nurse is most accurate?
a. “It is very important to get regular hepatitis titers if you are on dialysis.”
b. “Lack of safe water and poor sanitation are big risk factors.”
c. “This is a chronic illness with no lifelong immunity.”
d. “Do not travel for extended periods overseas.”
Rationale:
Hepatitis A virus is transmitted through the fecal-oral route, often through
contaminated food or water supplies. Poor sanitation and lack of clean drinking water
are major global risk factors. Unlike hepatitis B or C, hepatitis A does not typically
become chronic and usually resolves completely with lifelong immunity after infection.
Vaccination is highly effective for prevention. Travelers to areas with poor sanitation are
strongly encouraged to receive immunization before departure.
Question 5: Interpretation of Positive Anti-HCV Results
NSG 3850 EXAM 4
VERSION A
PATHOPHYSIOLOGY FOR NURSES II
LATEST UPDATE
GALEN COLLEGE OF NURSING
EXAM-STYLE QUESTIONS & CORRECT
ANSWERS
EXAM NAME: NSG 3850 Exam 4 – Version A
PROGRAM: NR (Nursing Program)
COURSE NAME: Pathophysiology for Nurses II (NSG 3850)
NSG 3850 PATHOPHYSIOLOGY
FOR NURSES II
,NSG 3850 Exam 4 – Version A
Pathophysiology for Nurses II
High-Yield Case Scenario Questions & Rationales
Question 1: Ascites in Advanced Liver Disease
A nurse is caring for a 58-year-old client with a long history of cirrhosis related to
chronic alcohol use. During assessment, the nurse notes abdominal distention, shifting
dullness, and a fluid wave. Laboratory results reveal significantly decreased serum
albumin levels. The provider explains that the client’s ascites developed because fluid is
leaking into the peritoneal cavity. Which pathophysiological process is the primary
etiological factor contributing to this complication?
a. Portal hypertension
b. Plasma hypoalbuminemia
c. Impaired absorption of fat-soluble vitamins
d. Accumulation of ammonia in the peritoneal cavity
Rationale:
Albumin is the major protein responsible for maintaining oncotic pressure within the
vascular system. In advanced liver disease, impaired hepatic protein synthesis causes
hypoalbuminemia, allowing fluid to move from the bloodstream into the interstitial and
peritoneal spaces. This leads to ascites formation and generalized edema. Although
portal hypertension contributes to fluid accumulation, low albumin is the primary direct
mechanism reducing plasma oncotic pressure. Ammonia accumulation contributes to
hepatic encephalopathy rather than ascites formation.
Question 2: Acute Cholecystitis Pathophysiology
,A nurse is caring for a client admitted to the emergency department with severe right
upper quadrant pain, nausea, vomiting, and fever after eating a high-fat meal.
Ultrasound imaging reveals gallbladder inflammation and gallstones obstructing bile
flow. The healthcare provider diagnoses acute cholecystitis and explains the underlying
disease process to the client. Which factor contributes most to the pathological process
of this condition?
a. Enzymatic activation causing autoimmune gallbladder stones
b. Lecithin production causing cholesterol solidification
c. Vascular insufficiency causing ischemic injury
d. Cystic duct obstruction
Rationale:
Acute cholecystitis most commonly occurs when a gallstone obstructs the cystic duct,
preventing bile from leaving the gallbladder. This causes bile stasis, inflammation,
increased intraluminal pressure, and eventual infection. The obstruction initiates the
inflammatory cascade responsible for the client’s pain and fever. While ischemia and
bacterial infection can develop later, they are secondary complications rather than the
primary cause. Prompt treatment is important to prevent gallbladder rupture or sepsis.
Question 3: Clinical Manifestations of Chronic Cholelithiasis
A nurse is interviewing a client with a history of recurrent gallstones who reports several
months of abdominal discomfort. The client describes episodes of pain occurring after
meals, especially after consuming greasy foods. The provider suspects chronic
cholelithiasis and orders diagnostic imaging. Which symptom should the nurse expect
the client to report most commonly?
a. Persistent epigastric pain
b. Functional dyspepsia
c. Gray-blue discoloration at the flank
d. Left upper quadrant pain radiating to the back
, Rationale:
Clients with chronic cholelithiasis frequently experience recurrent epigastric or right
upper quadrant pain, especially after fatty meals stimulate gallbladder contraction. The
pain is caused by intermittent obstruction of bile flow by gallstones. Symptoms are
often described as dull, persistent, or cramping and may radiate mildly to the back or
shoulder. Gray-blue flank discoloration is associated with hemorrhagic pancreatitis
rather than gallstones. Severe left upper quadrant pain suggests pancreatic involvement
instead.
Question 4: Hepatitis A Virus Transmission
A community health nurse is teaching a group of travelers about hepatitis A virus
prevention before an overseas mission trip. One participant asks how the infection is
most commonly transmitted and what environmental factors increase risk. The nurse
emphasizes the importance of sanitation and clean water sources in preventing
infection. Which statement by the nurse is most accurate?
a. “It is very important to get regular hepatitis titers if you are on dialysis.”
b. “Lack of safe water and poor sanitation are big risk factors.”
c. “This is a chronic illness with no lifelong immunity.”
d. “Do not travel for extended periods overseas.”
Rationale:
Hepatitis A virus is transmitted through the fecal-oral route, often through
contaminated food or water supplies. Poor sanitation and lack of clean drinking water
are major global risk factors. Unlike hepatitis B or C, hepatitis A does not typically
become chronic and usually resolves completely with lifelong immunity after infection.
Vaccination is highly effective for prevention. Travelers to areas with poor sanitation are
strongly encouraged to receive immunization before departure.
Question 5: Interpretation of Positive Anti-HCV Results
