Chamberlain NR283 Pathophysiology Exam
2(Week 3-5) Questions And Well Graded
Solutions With Rationales Updated 2026-
2027
Ace your NR283 Pathophysiology Exam 2 with this ultimate study guide covering Weeks 3, 4, and 5.
This high-yield resource delivers clear breakdowns of fluid shifts, SIADH vs. DI, COPD, MI, shock,
and increased ICP (Cushing's triad). Master complex GI and renal topics including cirrhosis,
pancreatitis, and acute kidney injury mechanisms. Includes targeted practice questions with
complete rationales to boost your critical thinking and ensure you score high on exam day. Perfect
for nursing students
1. A nurse evaluates a patient with severe dehydration. Which cellular fluid shift
happens during this hypertonic state?
A) Fluid moves from the intravascular space into the intracellular space.
B) Fluid moves from the intracellular space into the extracellular space.
C) Fluid moves from the interstitial space into the intracellular space.
D) Fluid stops moving across the semipermeable cell membrane.
Answer: B) Fluid moves from the intracellular space into the extracellular
space.
Rationale: In dehydration, the extracellular fluid becomes hypertonic. Water moves
by osmosis out of the cells and into the extracellular space to equalize concentration,
causing cellular shrinkage.
2. A patient with Syndrome of Inappropriate Antidiuretic Hormone (SIADH) is admitted.
Which laboratory value should the nurse expect?
A) Serum sodium 118 mEq/L
B) Serum sodium 152 mEq/L
C) Serum osmolality 320 mOsm/kg
D) Urine specific gravity 1.002
Answer: A) Serum sodium 118 mEq/L
Rationale: SIADH causes excessive water retention by the kidneys. This dilutes the
extracellular fluid, resulting in dilutional hyponatremia (sodium below 135 mEq/L) and
low serum osmolality.
3. Which clinical presentation is a hallmark manifestation of Diabetes Insipidus (DI)?
A) Oliguria and weight gain
B) Peripheral edema and hypertension
C) Polyuria and excessive thirst
D) Bradycardia and bradypnea
Answer: C) Polyuria and excessive thirst
Rationale: DI is caused by a deficiency of or lack of response to ADH. This results in
the inability of the kidneys to concentrate urine, leading to massive polyuria and
secondary polydipsia (excessive thirst).
4. During an acute asthma attack, what is the primary pathophysiology responsible for
airway obstruction?
, A) Destruction of alveolar walls and loss of elastic recoil
B) Permanent dilation of the bronchioles with fibrotic scarring
C) Bronchoconstriction, mucosal edema, and thick mucus hypersecretion
D) Fluid accumulation in the alveolar spaces due to high hydrostatic pressure
Answer: C) Bronchoconstriction, mucosal edema, and thick mucus
hypersecretion
Rationale: Asthma is an inflammatory airway disease. Exposure to triggers causes
IgE-mediated mast cell degranulation, leading to smooth muscle contraction,
mucosal inflammation, and thick mucus plugs.
5. A patient with advanced emphysema exhibits a barrel chest. What underlying
mechanism drives this structural change?
A) Chronic hypertrophy of the pectoralis muscles from coughing
B) Pulmonary edema causing fluid buildup in the thoracic cavity
C) Air trapping and alveolar hyperinflation from loss of lung elasticity
D) Fluid collection in the pleural space compressing the lungs
Answer: C) Air trapping and alveolar hyperinflation from loss of lung elasticity
Rationale: Emphysema destroys alveolar walls and elastin fibers. This causes small
airways to collapse during expiration, trapping air inside the lungs and progressively
expanding the anterior-posterior chest diameter.
6. Which assessment finding validates a diagnosis of chronic bronchitis over
emphysema?
A) Minimal sputum production and a pink complexion
B) Hyperventilation and a thin, cachectic body frame
C) Chronic productive cough lasting at least 3 months for 2 consecutive years
D) Chest X-ray showing hyperinflated lungs and a flattened diaphragm
Answer: C) Chronic productive cough lasting at least 3 months for 2
consecutive years
Rationale: Chronic bronchitis is clinically defined by a chronic, mucus-producing
cough that lasts for a minimum of 3 months per year for at least 2 consecutive years,
driven by goblet cell hyperplasia.
7. A patient presents with sudden-onset sharp chest pain and dyspnea. Assessment
reveals absent breath sounds on the right side and tracheal deviation to the left.
Which condition is occurring?
A) Large pulmonary embolism
B) Right-sided pleural effusion
C) Tension pneumothorax
D) Acute respiratory distress syndrome
Answer: C) Tension pneumothorax
Rationale: A tension pneumothorax allows air to enter the pleural space but not
escape. Pressure builds up, collapsing the affected lung, shifting the mediastinum,
and deviating the trachea toward the unaffected side.
8. Which risk factor is most heavily associated with the development of a pulmonary
embolism (PE)?
A) Chronic sinusitis
B) Deep vein thrombosis (DVT) in a lower extremity
, C) Mitral valve regurgitation
D) Chronic occupational asbestos exposure
Answer: B) Deep vein thrombosis (DVT) in a lower extremity
Rationale: Most pulmonary emboli originate as thrombi in the deep veins of the lower
extremities or pelvis, breaking free and traveling through the right side of the heart
into the pulmonary arterial bed.
9. A patient is diagnosed with a myocardial infarction (MI). Which serum biomarker is
most specific for confirming myocardial necrosis?
A) Creatinine kinase (CK-BB)
B) B-type natriuretic peptide (BNP)
C) Cardiac Troponin I
D) C-reactive protein (CRP)
Answer: C) Cardiac Troponin I
Rationale: Troponin I is highly specific to cardiac muscle tissue. It releases into the
bloodstream following myocardial cell injury and necrosis, making it the gold
standard marker for diagnosing an acute MI.
10. What is the fundamental pathophysiology underlying all types of shock?
A) Systemic infection with positive blood cultures
B) Decreased cardiac output from structural heart failure
C) Inadequate tissue perfusion leading to cellular hypoxia
D) Loss of sympathetic nervous system vascular tone
Answer: C) Inadequate tissue perfusion leading to cellular hypoxia
Rationale: While the causes differ (hypovolemic, cardiogenic, septic, neurogenic),
the universal defining feature of shock is widespread systemic hypoperfusion, which
deprives cells of oxygen and nutrients.
11. A nurse assesses an adult patient for early signs of increased intracranial pressure
(ICP). Which finding is most sensitive?
A) Cushing’s triad
B) Ipsilateral fixed, dilated pupil
C) Decreased level of consciousness (LOC)
D) Decerebrate posturing
Answer: C) Decreased level of consciousness (LOC)
Rationale: The cerebral cortex is highly sensitive to changes in oxygenation and
perfusion. Alterations in LOC, such as restlessness, confusion, or lethargy, represent
the earliest clinical signs of rising ICP.
12. Which triad of symptoms indicates a late, life-threatening progression of increased
intracranial pressure (Cushing’s triad)?
A) Tachycardia, hypotension, and tachypnea
B) Bradycardia, systolic hypertension with widened pulse pressure, and irregular
respirations
C) Hypothermia, miosis, and neck rigidity
D) Hypotension, muffled heart sounds, and jugular venous distention
Answer: B) Bradycardia, systolic hypertension with widened pulse pressure,
and irregular respirations
Rationale: Cushing's triad occurs when the brainstem is compressed. The body
, compensates for cerebral ischemia by raising systolic blood pressure, triggering
reflex bradycardia and disrupting the respiratory center.
13. An infant is evaluated for increased intracranial pressure (ICP). Which clinical
manifestation unique to this age group should the nurse monitor for?
A) Projectile vomiting and a flat fontanel
B) Bulging fontanels and separated cranial sutures
C) Ability to follow targets with eyes easily
D) Decreased head circumference measurements
Answer: B) Bulging fontanels and separated cranial sutures
Rationale: Because an infant's cranial sutures are not yet fused, rising intracranial
pressure forces the bones apart and causes the soft fontanels to bulge outward.
14. A patient has a stroke resulting from a thrombus blocking a cerebral artery. How is
this classified?
A) Hemorrhagic stroke
B) Ischemic stroke
C) Transient ischemic attack
D) Subarachnoid hemorrhage
Answer: B) Ischemic stroke
Rationale: Ischemic strokes are caused by an occlusion of a cerebral artery due to a
thrombus or embolus, cutting off blood supply to downstream brain tissue.
15. A patient with pernicious anemia reports numbness and tingling in their fingers. What
causes these neurological symptoms?
A) Severe iron deficiency causing peripheral nerve atrophy
B) Vitamin B12 deficiency leading to demyelination of peripheral nerves
C) Folic acid deficiency causing decreased synaptic transmission
D) Microvascular occlusions from sickled red blood cells
Answer: B) Vitamin B12 deficiency leading to demyelination of peripheral
nerves
Rationale: Pernicious anemia stems from a lack of intrinsic factor, preventing Vitamin
B12 absorption. B12 is essential for myelin sheath maintenance; its absence triggers
peripheral nerve demyelination and paresthesias.
16. A 5-year-old child is diagnosed with Acute Lymphoblastic Leukemia (ALL). What is
the primary cellular feature of this disease?
A) Uncontrolled proliferation of mature, functioning granulocytes
B) Malignant transformation and accumulation of immature lymphoblasts
C) Excess production of mature erythrocytes in the bone marrow
D) Severe deficiency of thrombocytes due to splenic sequestration
Answer: B) Malignant transformation and accumulation of immature
lymphoblasts
Rationale: ALL is characterized by the overproduction and accumulation of
malignant, immature white blood cells (lymphoblasts) that crowd out healthy cells in
the bone marrow.
17. A patient with advanced liver cirrhosis develops esophageal varices. Which
underlying problem causes this complication?
2(Week 3-5) Questions And Well Graded
Solutions With Rationales Updated 2026-
2027
Ace your NR283 Pathophysiology Exam 2 with this ultimate study guide covering Weeks 3, 4, and 5.
This high-yield resource delivers clear breakdowns of fluid shifts, SIADH vs. DI, COPD, MI, shock,
and increased ICP (Cushing's triad). Master complex GI and renal topics including cirrhosis,
pancreatitis, and acute kidney injury mechanisms. Includes targeted practice questions with
complete rationales to boost your critical thinking and ensure you score high on exam day. Perfect
for nursing students
1. A nurse evaluates a patient with severe dehydration. Which cellular fluid shift
happens during this hypertonic state?
A) Fluid moves from the intravascular space into the intracellular space.
B) Fluid moves from the intracellular space into the extracellular space.
C) Fluid moves from the interstitial space into the intracellular space.
D) Fluid stops moving across the semipermeable cell membrane.
Answer: B) Fluid moves from the intracellular space into the extracellular
space.
Rationale: In dehydration, the extracellular fluid becomes hypertonic. Water moves
by osmosis out of the cells and into the extracellular space to equalize concentration,
causing cellular shrinkage.
2. A patient with Syndrome of Inappropriate Antidiuretic Hormone (SIADH) is admitted.
Which laboratory value should the nurse expect?
A) Serum sodium 118 mEq/L
B) Serum sodium 152 mEq/L
C) Serum osmolality 320 mOsm/kg
D) Urine specific gravity 1.002
Answer: A) Serum sodium 118 mEq/L
Rationale: SIADH causes excessive water retention by the kidneys. This dilutes the
extracellular fluid, resulting in dilutional hyponatremia (sodium below 135 mEq/L) and
low serum osmolality.
3. Which clinical presentation is a hallmark manifestation of Diabetes Insipidus (DI)?
A) Oliguria and weight gain
B) Peripheral edema and hypertension
C) Polyuria and excessive thirst
D) Bradycardia and bradypnea
Answer: C) Polyuria and excessive thirst
Rationale: DI is caused by a deficiency of or lack of response to ADH. This results in
the inability of the kidneys to concentrate urine, leading to massive polyuria and
secondary polydipsia (excessive thirst).
4. During an acute asthma attack, what is the primary pathophysiology responsible for
airway obstruction?
, A) Destruction of alveolar walls and loss of elastic recoil
B) Permanent dilation of the bronchioles with fibrotic scarring
C) Bronchoconstriction, mucosal edema, and thick mucus hypersecretion
D) Fluid accumulation in the alveolar spaces due to high hydrostatic pressure
Answer: C) Bronchoconstriction, mucosal edema, and thick mucus
hypersecretion
Rationale: Asthma is an inflammatory airway disease. Exposure to triggers causes
IgE-mediated mast cell degranulation, leading to smooth muscle contraction,
mucosal inflammation, and thick mucus plugs.
5. A patient with advanced emphysema exhibits a barrel chest. What underlying
mechanism drives this structural change?
A) Chronic hypertrophy of the pectoralis muscles from coughing
B) Pulmonary edema causing fluid buildup in the thoracic cavity
C) Air trapping and alveolar hyperinflation from loss of lung elasticity
D) Fluid collection in the pleural space compressing the lungs
Answer: C) Air trapping and alveolar hyperinflation from loss of lung elasticity
Rationale: Emphysema destroys alveolar walls and elastin fibers. This causes small
airways to collapse during expiration, trapping air inside the lungs and progressively
expanding the anterior-posterior chest diameter.
6. Which assessment finding validates a diagnosis of chronic bronchitis over
emphysema?
A) Minimal sputum production and a pink complexion
B) Hyperventilation and a thin, cachectic body frame
C) Chronic productive cough lasting at least 3 months for 2 consecutive years
D) Chest X-ray showing hyperinflated lungs and a flattened diaphragm
Answer: C) Chronic productive cough lasting at least 3 months for 2
consecutive years
Rationale: Chronic bronchitis is clinically defined by a chronic, mucus-producing
cough that lasts for a minimum of 3 months per year for at least 2 consecutive years,
driven by goblet cell hyperplasia.
7. A patient presents with sudden-onset sharp chest pain and dyspnea. Assessment
reveals absent breath sounds on the right side and tracheal deviation to the left.
Which condition is occurring?
A) Large pulmonary embolism
B) Right-sided pleural effusion
C) Tension pneumothorax
D) Acute respiratory distress syndrome
Answer: C) Tension pneumothorax
Rationale: A tension pneumothorax allows air to enter the pleural space but not
escape. Pressure builds up, collapsing the affected lung, shifting the mediastinum,
and deviating the trachea toward the unaffected side.
8. Which risk factor is most heavily associated with the development of a pulmonary
embolism (PE)?
A) Chronic sinusitis
B) Deep vein thrombosis (DVT) in a lower extremity
, C) Mitral valve regurgitation
D) Chronic occupational asbestos exposure
Answer: B) Deep vein thrombosis (DVT) in a lower extremity
Rationale: Most pulmonary emboli originate as thrombi in the deep veins of the lower
extremities or pelvis, breaking free and traveling through the right side of the heart
into the pulmonary arterial bed.
9. A patient is diagnosed with a myocardial infarction (MI). Which serum biomarker is
most specific for confirming myocardial necrosis?
A) Creatinine kinase (CK-BB)
B) B-type natriuretic peptide (BNP)
C) Cardiac Troponin I
D) C-reactive protein (CRP)
Answer: C) Cardiac Troponin I
Rationale: Troponin I is highly specific to cardiac muscle tissue. It releases into the
bloodstream following myocardial cell injury and necrosis, making it the gold
standard marker for diagnosing an acute MI.
10. What is the fundamental pathophysiology underlying all types of shock?
A) Systemic infection with positive blood cultures
B) Decreased cardiac output from structural heart failure
C) Inadequate tissue perfusion leading to cellular hypoxia
D) Loss of sympathetic nervous system vascular tone
Answer: C) Inadequate tissue perfusion leading to cellular hypoxia
Rationale: While the causes differ (hypovolemic, cardiogenic, septic, neurogenic),
the universal defining feature of shock is widespread systemic hypoperfusion, which
deprives cells of oxygen and nutrients.
11. A nurse assesses an adult patient for early signs of increased intracranial pressure
(ICP). Which finding is most sensitive?
A) Cushing’s triad
B) Ipsilateral fixed, dilated pupil
C) Decreased level of consciousness (LOC)
D) Decerebrate posturing
Answer: C) Decreased level of consciousness (LOC)
Rationale: The cerebral cortex is highly sensitive to changes in oxygenation and
perfusion. Alterations in LOC, such as restlessness, confusion, or lethargy, represent
the earliest clinical signs of rising ICP.
12. Which triad of symptoms indicates a late, life-threatening progression of increased
intracranial pressure (Cushing’s triad)?
A) Tachycardia, hypotension, and tachypnea
B) Bradycardia, systolic hypertension with widened pulse pressure, and irregular
respirations
C) Hypothermia, miosis, and neck rigidity
D) Hypotension, muffled heart sounds, and jugular venous distention
Answer: B) Bradycardia, systolic hypertension with widened pulse pressure,
and irregular respirations
Rationale: Cushing's triad occurs when the brainstem is compressed. The body
, compensates for cerebral ischemia by raising systolic blood pressure, triggering
reflex bradycardia and disrupting the respiratory center.
13. An infant is evaluated for increased intracranial pressure (ICP). Which clinical
manifestation unique to this age group should the nurse monitor for?
A) Projectile vomiting and a flat fontanel
B) Bulging fontanels and separated cranial sutures
C) Ability to follow targets with eyes easily
D) Decreased head circumference measurements
Answer: B) Bulging fontanels and separated cranial sutures
Rationale: Because an infant's cranial sutures are not yet fused, rising intracranial
pressure forces the bones apart and causes the soft fontanels to bulge outward.
14. A patient has a stroke resulting from a thrombus blocking a cerebral artery. How is
this classified?
A) Hemorrhagic stroke
B) Ischemic stroke
C) Transient ischemic attack
D) Subarachnoid hemorrhage
Answer: B) Ischemic stroke
Rationale: Ischemic strokes are caused by an occlusion of a cerebral artery due to a
thrombus or embolus, cutting off blood supply to downstream brain tissue.
15. A patient with pernicious anemia reports numbness and tingling in their fingers. What
causes these neurological symptoms?
A) Severe iron deficiency causing peripheral nerve atrophy
B) Vitamin B12 deficiency leading to demyelination of peripheral nerves
C) Folic acid deficiency causing decreased synaptic transmission
D) Microvascular occlusions from sickled red blood cells
Answer: B) Vitamin B12 deficiency leading to demyelination of peripheral
nerves
Rationale: Pernicious anemia stems from a lack of intrinsic factor, preventing Vitamin
B12 absorption. B12 is essential for myelin sheath maintenance; its absence triggers
peripheral nerve demyelination and paresthesias.
16. A 5-year-old child is diagnosed with Acute Lymphoblastic Leukemia (ALL). What is
the primary cellular feature of this disease?
A) Uncontrolled proliferation of mature, functioning granulocytes
B) Malignant transformation and accumulation of immature lymphoblasts
C) Excess production of mature erythrocytes in the bone marrow
D) Severe deficiency of thrombocytes due to splenic sequestration
Answer: B) Malignant transformation and accumulation of immature
lymphoblasts
Rationale: ALL is characterized by the overproduction and accumulation of
malignant, immature white blood cells (lymphoblasts) that crowd out healthy cells in
the bone marrow.
17. A patient with advanced liver cirrhosis develops esophageal varices. Which
underlying problem causes this complication?
