Exam 2 - NUR2063 / NUR 2063 (Latest 2026/2027) : Essent...
OBJECTIVE ASSESSMENT - EXAM
Exam 2 - NUR2063 / NUR 2063 (Latest 2026/2027) :
Essentials of Pathophysiology - Rasmussen 2026/2027
75 VERIFIED 2026/2027 80%
QUESTIONS ANSWERS EDITION PASSING
TOPICS COVERED
• Cellular Biology & Fluid Balance • Endocrine & Metabolic
• Cardiovascular & Respiratory • Immune System Pathophysiology
• GI, Hepatobiliary & Renal • Neurological & Musculoskeletal
COVER PAGE - 1
,Section 1: Cellular Biology, Tissue Integrity & Fluid-Electrolyte Balance
QUESTION 1
A 68-year-old man with chronic heart failure is admitted with severe dyspnea. Laboratory studies reveal a
serum sodium of 128 mEq/L, serum osmolality of 265 mOsm/kg, and urine osmolality of 520 mOsm/kg. His
urine sodium is 45 mEq/L and he has no peripheral edema.
A. Syndrome of inappropriate antidiuretic hormone (SIADH)
B. Hypervolemic hyponatremia from heart failure
C. Hypovolemic hyponatremia from diuretic overuse
D. Pseudohyponatremia from hyperlipidemia
Correct Answer: A
Rationale: SIADH presents with euvolemic hyponatremia, low serum osmolality, inappropriately elevated urine osmolality (> 100
mOsm/kg), and elevated urine sodium (> 20 mEq/L) without edema. Hypervolemic hyponatremia from heart failure would show
peripheral edema and low urine sodium; hypovolemic hyponatremia shows volume depletion signs; pseudohyponatremia has
normal osmolality.
QUESTION 2
A 45-year-old woman presents with muscle weakness, fatigue, and constipation. ECG shows flattened T
waves and prominent U waves. Laboratory studies reveal a serum potassium of 2.8 mEq/L and magnesium of
1.2 mg/dL.
A. Hyperkalemia with secondary hypomagnesemia
B. Hypokalemia with concurrent hypomagnesemia
C. Hypercalcemia with metabolic alkalosis
D. Hyponatremia with volume overload
Correct Answer: B
Rationale: Hypokalemia (K+ < 3.5 mEq/L) causes characteristic ECG changes including flattened T waves, ST depression, and U
waves. Concurrent hypomagnesemia is common and must be corrected first, as magnesium deficiency impairs potassium repletion.
Hyperkalemia causes peaked T waves; hypercalcemia shortens QT interval; hyponatremia does not produce these ECG findings.
QUESTION 3
A 28-year-old man sustains a crush injury to his right leg in a motor vehicle accident. Twelve hours later, he
develops dark tea-colored urine, muscle tenderness, and swelling. Serum creatinine rises from 0.9 to 3.2
mg/dL. Urinalysis shows heme-positive urine with absent RBCs on microscopy.
A. Acute glomerulonephritis from traumatic injury
B. Urinary tract obstruction from bladder rupture
C. Rhabdomyolysis with myoglobinuric acute kidney injury
D. Hemolytic uremic syndrome from trauma
Correct Answer: C
Rationale: Rhabdomyolysis from crush injury releases myoglobin, causing heme-positive urine without intact RBCs (myoglobinuria),
hyperkalemia, hyperphosphatemia, and acute kidney injury. The dark urine and rising creatinine are classic. Glomerulonephritis
shows dysmorphic RBCs and casts; bladder rupture causes abdominal pain and free fluid; HUS presents with thrombocytopenia
and diarrhea.
, QUESTION 4
A 62-year-old woman with small cell lung cancer presents with confusion, lethargy, and seizures. Serum
sodium is 118 mEq/L. She is started on 3% hypertonic saline. Which complication is most likely if correction
occurs too rapidly?
A. Cerebral edema from persistent hyponatremia
B. Pulmonary edema from fluid overload
C. Central pontine myelinolysis (osmotic demyelination)
D. Acute tubular necrosis from hypertonic saline
Correct Answer: D
Rationale: Rapid correction of chronic hyponatremia (> 10-12 mEq/L in 24 hours) risks central pontine myelinolysis, a devastating
demyelinating condition causing locked-in syndrome, dysarthria, and dysphagia. Correction should not exceed 6-8 mEq/L in the first
24 hours. Cerebral edema occurs with uncorrected hyponatremia; pulmonary edema is a volume issue; ATN is not caused by
hypertonic saline.
QUESTION 5
A 55-year-old man with end-stage liver disease presents with abdominal distension and shifting dullness on
percussion. Paracentesis reveals straw-colored fluid with a serum-ascites albumin gradient (SAAG) of 2.1
g/dL and total protein of 1.8 g/dL.
A. Portal hypertension from cirrhosis
B. Peritoneal carcinomatosis
C. Tuberculous peritonitis
D. Nephrotic syndrome
Correct Answer: A
Rationale: A SAAG >= 1.1 g/dL indicates portal hypertension as the cause of ascites, which in this patient with ESLD is due to
cirrhosis. Low ascitic protein (< 2.5 g/dL) further supports cirrhotic ascites. Peritoneal carcinomatosis and TB peritonitis have SAAG
< 1.1; nephrotic syndrome causes peripheral edema, not typically ascites with high SAAG.
QUESTION 6
A 40-year-old woman presents with pallor, glossitis, and paresthesias in her hands and feet. Peripheral smear
shows macrocytic RBCs (MCV 110 fL) and hypersegmented neutrophils. Serum homocysteine is elevated but
methylmalonic acid is normal.
A. Vitamin B12 deficiency
B. Folate deficiency
C. Iron deficiency anemia
D. Chronic liver disease
Correct Answer: B
Rationale: Folate deficiency causes megaloblastic anemia with elevated homocysteine but normal methylmalonic acid (unlike B12
deficiency, which elevates both). Hypersegmented neutrophils and macrocytosis are seen in both. Iron deficiency causes microcytic
anemia; liver disease causes macrocytosis without hypersegmented neutrophils or elevated homocysteine.
OBJECTIVE ASSESSMENT - EXAM
Exam 2 - NUR2063 / NUR 2063 (Latest 2026/2027) :
Essentials of Pathophysiology - Rasmussen 2026/2027
75 VERIFIED 2026/2027 80%
QUESTIONS ANSWERS EDITION PASSING
TOPICS COVERED
• Cellular Biology & Fluid Balance • Endocrine & Metabolic
• Cardiovascular & Respiratory • Immune System Pathophysiology
• GI, Hepatobiliary & Renal • Neurological & Musculoskeletal
COVER PAGE - 1
,Section 1: Cellular Biology, Tissue Integrity & Fluid-Electrolyte Balance
QUESTION 1
A 68-year-old man with chronic heart failure is admitted with severe dyspnea. Laboratory studies reveal a
serum sodium of 128 mEq/L, serum osmolality of 265 mOsm/kg, and urine osmolality of 520 mOsm/kg. His
urine sodium is 45 mEq/L and he has no peripheral edema.
A. Syndrome of inappropriate antidiuretic hormone (SIADH)
B. Hypervolemic hyponatremia from heart failure
C. Hypovolemic hyponatremia from diuretic overuse
D. Pseudohyponatremia from hyperlipidemia
Correct Answer: A
Rationale: SIADH presents with euvolemic hyponatremia, low serum osmolality, inappropriately elevated urine osmolality (> 100
mOsm/kg), and elevated urine sodium (> 20 mEq/L) without edema. Hypervolemic hyponatremia from heart failure would show
peripheral edema and low urine sodium; hypovolemic hyponatremia shows volume depletion signs; pseudohyponatremia has
normal osmolality.
QUESTION 2
A 45-year-old woman presents with muscle weakness, fatigue, and constipation. ECG shows flattened T
waves and prominent U waves. Laboratory studies reveal a serum potassium of 2.8 mEq/L and magnesium of
1.2 mg/dL.
A. Hyperkalemia with secondary hypomagnesemia
B. Hypokalemia with concurrent hypomagnesemia
C. Hypercalcemia with metabolic alkalosis
D. Hyponatremia with volume overload
Correct Answer: B
Rationale: Hypokalemia (K+ < 3.5 mEq/L) causes characteristic ECG changes including flattened T waves, ST depression, and U
waves. Concurrent hypomagnesemia is common and must be corrected first, as magnesium deficiency impairs potassium repletion.
Hyperkalemia causes peaked T waves; hypercalcemia shortens QT interval; hyponatremia does not produce these ECG findings.
QUESTION 3
A 28-year-old man sustains a crush injury to his right leg in a motor vehicle accident. Twelve hours later, he
develops dark tea-colored urine, muscle tenderness, and swelling. Serum creatinine rises from 0.9 to 3.2
mg/dL. Urinalysis shows heme-positive urine with absent RBCs on microscopy.
A. Acute glomerulonephritis from traumatic injury
B. Urinary tract obstruction from bladder rupture
C. Rhabdomyolysis with myoglobinuric acute kidney injury
D. Hemolytic uremic syndrome from trauma
Correct Answer: C
Rationale: Rhabdomyolysis from crush injury releases myoglobin, causing heme-positive urine without intact RBCs (myoglobinuria),
hyperkalemia, hyperphosphatemia, and acute kidney injury. The dark urine and rising creatinine are classic. Glomerulonephritis
shows dysmorphic RBCs and casts; bladder rupture causes abdominal pain and free fluid; HUS presents with thrombocytopenia
and diarrhea.
, QUESTION 4
A 62-year-old woman with small cell lung cancer presents with confusion, lethargy, and seizures. Serum
sodium is 118 mEq/L. She is started on 3% hypertonic saline. Which complication is most likely if correction
occurs too rapidly?
A. Cerebral edema from persistent hyponatremia
B. Pulmonary edema from fluid overload
C. Central pontine myelinolysis (osmotic demyelination)
D. Acute tubular necrosis from hypertonic saline
Correct Answer: D
Rationale: Rapid correction of chronic hyponatremia (> 10-12 mEq/L in 24 hours) risks central pontine myelinolysis, a devastating
demyelinating condition causing locked-in syndrome, dysarthria, and dysphagia. Correction should not exceed 6-8 mEq/L in the first
24 hours. Cerebral edema occurs with uncorrected hyponatremia; pulmonary edema is a volume issue; ATN is not caused by
hypertonic saline.
QUESTION 5
A 55-year-old man with end-stage liver disease presents with abdominal distension and shifting dullness on
percussion. Paracentesis reveals straw-colored fluid with a serum-ascites albumin gradient (SAAG) of 2.1
g/dL and total protein of 1.8 g/dL.
A. Portal hypertension from cirrhosis
B. Peritoneal carcinomatosis
C. Tuberculous peritonitis
D. Nephrotic syndrome
Correct Answer: A
Rationale: A SAAG >= 1.1 g/dL indicates portal hypertension as the cause of ascites, which in this patient with ESLD is due to
cirrhosis. Low ascitic protein (< 2.5 g/dL) further supports cirrhotic ascites. Peritoneal carcinomatosis and TB peritonitis have SAAG
< 1.1; nephrotic syndrome causes peripheral edema, not typically ascites with high SAAG.
QUESTION 6
A 40-year-old woman presents with pallor, glossitis, and paresthesias in her hands and feet. Peripheral smear
shows macrocytic RBCs (MCV 110 fL) and hypersegmented neutrophils. Serum homocysteine is elevated but
methylmalonic acid is normal.
A. Vitamin B12 deficiency
B. Folate deficiency
C. Iron deficiency anemia
D. Chronic liver disease
Correct Answer: B
Rationale: Folate deficiency causes megaloblastic anemia with elevated homocysteine but normal methylmalonic acid (unlike B12
deficiency, which elevates both). Hypersegmented neutrophils and macrocytosis are seen in both. Iron deficiency causes microcytic
anemia; liver disease causes macrocytosis without hypersegmented neutrophils or elevated homocysteine.
