NUR 376 Exam 2 – Applied Pathophysiology –
Official Blueprint Replica
Q1: A patient with left-sided heart failure presents with dyspnea, orthopnea, and crackles on
lung auscultation. The primary pathophysiologic mechanism producing these symptoms is:
A. Increased systemic vascular resistance
B. Decreased cardiac output with renal hypoperfusion
C. Elevated pulmonary venous pressure [CORRECT]
D. Right ventricular hypertrophy
Correct Answer: C
Rationale: Correct because left-sided heart failure causes increased left ventricular end-
diastolic pressure, which backs up into the pulmonary venous system, leading to pulmonary
congestion and respiratory symptoms.
Q2: A patient with chronic hypertension develops concentric left ventricular hypertrophy. This
cardiac adaptation is primarily a response to:
A. Increased preload
B. Decreased afterload
C. Increased afterload [CORRECT]
D. Decreased contractility
Correct Answer: C
Rationale: Correct because chronic hypertension increases systemic vascular resistance
(afterload), causing the left ventricle to hypertrophy concentrically to maintain wall tension
and cardiac output.
Q3: A patient with unstable angina has chest pain at rest with ST-segment depression on ECG.
The underlying pathophysiology is:
A. Complete occlusion of a coronary artery
B. Fixed coronary artery stenosis with stable plaque
C. Ruptured atherosclerotic plaque with transient thrombosis [CORRECT]
,D. Coronary artery spasm without atherosclerosis
Correct Answer: C
Rationale: Correct because unstable angina results from non-occlusive thrombus formation
over a ruptured or eroded atherosclerotic plaque, causing transient, subendocardial ischemia
at rest.
Q4: A patient is diagnosed with essential hypertension. Which pathophysiologic mechanism is
most consistently associated with this condition?
A. Increased renal blood flow
B. Decreased sympathetic nervous system activity
C. Increased systemic vascular resistance [CORRECT]
D. Decreased cardiac output
Correct Answer: C
Rationale: Correct because essential hypertension is characterized by elevated systemic
vascular resistance due to arteriolar vasoconstriction, often with sodium retention and
increased sympathetic tone.
Q5: A patient with aortic stenosis develops syncope during exertion. This symptom is most
directly related to:
A. Decreased cerebral perfusion from reduced cardiac output [CORRECT]
B. Arrhythmia triggered by left ventricular strain
C. Baroreceptor failure with hypotension
D. Coronary ischemia from reduced diastolic filling
Correct Answer: A
Rationale: Correct because fixed outflow obstruction in aortic stenosis prevents adequate
cardiac output increase during exertion, leading to cerebral hypoperfusion and syncope.
Q6: Which laboratory finding is most suggestive of acute myocardial infarction?
A. Elevated creatine kinase-MB with rising troponin [CORRECT]
B. Elevated B-type natriuretic peptide only
C. Low serum potassium and magnesium
, D. Elevated C-reactive protein and ESR
Correct Answer: A
Rationale: Correct because elevated CK-MB and cardiac troponins (troponin I or T) indicate
myocardial necrosis; troponin rise is more specific and remains elevated longer.
Q7: A patient with heart failure has jugular venous distention, hepatomegaly, and peripheral
edema. These findings are characteristic of:
A. Left-sided heart failure
B. Right-sided heart failure [CORRECT]
C. High-output heart failure
D. Diastolic heart failure
Correct Answer: B
Rationale: Correct because right-sided heart failure causes systemic venous congestion,
manifesting as jugular venous distention, hepatic engorgement, and dependent edema.
Q8: The most common cause of infective endocarditis in intravenous drug users is:
A. Staphylococcus aureus [CORRECT]
B. Streptococcus viridans
C. Enterococcus faecalis
D. Pseudomonas aeruginosa
Correct Answer: A
Rationale: Correct because S. aureus is the predominant organism causing right-sided
infective endocarditis in IV drug users, typically involving the tricuspid valve.
Q9: A patient with pericarditis has chest pain that improves when leaning forward. This pain
is caused by:
A. Myocardial ischemia
B. Pleural irritation
C. Pericardial friction and inflammation [CORRECT]
D. Esophageal spasm
Official Blueprint Replica
Q1: A patient with left-sided heart failure presents with dyspnea, orthopnea, and crackles on
lung auscultation. The primary pathophysiologic mechanism producing these symptoms is:
A. Increased systemic vascular resistance
B. Decreased cardiac output with renal hypoperfusion
C. Elevated pulmonary venous pressure [CORRECT]
D. Right ventricular hypertrophy
Correct Answer: C
Rationale: Correct because left-sided heart failure causes increased left ventricular end-
diastolic pressure, which backs up into the pulmonary venous system, leading to pulmonary
congestion and respiratory symptoms.
Q2: A patient with chronic hypertension develops concentric left ventricular hypertrophy. This
cardiac adaptation is primarily a response to:
A. Increased preload
B. Decreased afterload
C. Increased afterload [CORRECT]
D. Decreased contractility
Correct Answer: C
Rationale: Correct because chronic hypertension increases systemic vascular resistance
(afterload), causing the left ventricle to hypertrophy concentrically to maintain wall tension
and cardiac output.
Q3: A patient with unstable angina has chest pain at rest with ST-segment depression on ECG.
The underlying pathophysiology is:
A. Complete occlusion of a coronary artery
B. Fixed coronary artery stenosis with stable plaque
C. Ruptured atherosclerotic plaque with transient thrombosis [CORRECT]
,D. Coronary artery spasm without atherosclerosis
Correct Answer: C
Rationale: Correct because unstable angina results from non-occlusive thrombus formation
over a ruptured or eroded atherosclerotic plaque, causing transient, subendocardial ischemia
at rest.
Q4: A patient is diagnosed with essential hypertension. Which pathophysiologic mechanism is
most consistently associated with this condition?
A. Increased renal blood flow
B. Decreased sympathetic nervous system activity
C. Increased systemic vascular resistance [CORRECT]
D. Decreased cardiac output
Correct Answer: C
Rationale: Correct because essential hypertension is characterized by elevated systemic
vascular resistance due to arteriolar vasoconstriction, often with sodium retention and
increased sympathetic tone.
Q5: A patient with aortic stenosis develops syncope during exertion. This symptom is most
directly related to:
A. Decreased cerebral perfusion from reduced cardiac output [CORRECT]
B. Arrhythmia triggered by left ventricular strain
C. Baroreceptor failure with hypotension
D. Coronary ischemia from reduced diastolic filling
Correct Answer: A
Rationale: Correct because fixed outflow obstruction in aortic stenosis prevents adequate
cardiac output increase during exertion, leading to cerebral hypoperfusion and syncope.
Q6: Which laboratory finding is most suggestive of acute myocardial infarction?
A. Elevated creatine kinase-MB with rising troponin [CORRECT]
B. Elevated B-type natriuretic peptide only
C. Low serum potassium and magnesium
, D. Elevated C-reactive protein and ESR
Correct Answer: A
Rationale: Correct because elevated CK-MB and cardiac troponins (troponin I or T) indicate
myocardial necrosis; troponin rise is more specific and remains elevated longer.
Q7: A patient with heart failure has jugular venous distention, hepatomegaly, and peripheral
edema. These findings are characteristic of:
A. Left-sided heart failure
B. Right-sided heart failure [CORRECT]
C. High-output heart failure
D. Diastolic heart failure
Correct Answer: B
Rationale: Correct because right-sided heart failure causes systemic venous congestion,
manifesting as jugular venous distention, hepatic engorgement, and dependent edema.
Q8: The most common cause of infective endocarditis in intravenous drug users is:
A. Staphylococcus aureus [CORRECT]
B. Streptococcus viridans
C. Enterococcus faecalis
D. Pseudomonas aeruginosa
Correct Answer: A
Rationale: Correct because S. aureus is the predominant organism causing right-sided
infective endocarditis in IV drug users, typically involving the tricuspid valve.
Q9: A patient with pericarditis has chest pain that improves when leaning forward. This pain
is caused by:
A. Myocardial ischemia
B. Pleural irritation
C. Pericardial friction and inflammation [CORRECT]
D. Esophageal spasm
