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NSG 3850 Exam 4 Pathophysiology for Nurses II
High-Acuity Nursing Official Practice Exam
Actual Exam 2026/2027 with Detailed Rationales
| Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Cardiovascular & Renal Disorders | Q1 – Q10
Section 2 | Hepatic, Biliary & Gastrointestinal Disorders | Q11 – Q20
Section 3 | Endocrine, Hematologic & Immunologic Disorders | Q21 – Q30
Section 4 | Neurologic & Critical Care Disorders | Q31 – Q40
Section 5 | NGN-Style Clinical Judgment & Integrated Case Analysis | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR & RENAL DISORDERS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old male with a history of heart failure with preserved ejection fraction
(HFpEF) is prescribed furosemide for peripheral edema. During morning rounds,
the nurse observes dry mucous membranes and notes the patient reports dizziness
when standing. Based on these findings, the nurse should assess for fluid volume
deficit.
,2
What is the primary reason this patient is experiencing orthostatic hypotension?
A. Intravascular volume depletion from the loop diuretic reduces venous return to
the heart. ✓ CORRECT
B. Decreased cardiac contractility impairs the ability to maintain blood pressure
upon standing.
C. Structural ventricular stiffening limits the heart's ability to pump effectively
against resistance.
D. Excessive sodium retention in the renal tubules overrides the effects of
prescribed diuretics.
Correct Answer: A
Rationale: Orthostatic hypotension is a classic sign of fluid volume deficit related
to intravascular volume depletion from furosemide. Decreased cardiac contractility
is characteristic of heart failure with reduced ejection fraction (HFrEF), not
HFpEF. Nurses must distinguish between side effects of diuretic therapy and
underlying cardiac dysfunction to accurately identify volume status.
Question 2 of 50
A 72-year-old female with chronic heart failure presents to the emergency
department with anorexia, nausea, and blurred vision with yellow-green halos. Her
heart rate is 48 bpm and irregular. The home medication list includes digoxin and
furosemide.
Which laboratory value most likely explains this patient's current clinical
presentation?
A. Serum sodium of 132 mEq/L indicating hyponatremia.
,3
B. Serum potassium of 2.8 mEq/L indicating hypokalemia. ✓ CORRECT
C. Serum troponin of 0.06 ng/mL indicating mild myocardial injury.
D. Serum creatinine of 1.1 mg/dL indicating normal renal function.
Correct Answer: B
Rationale: Hypokalemia from furosemide greatly increases the risk of digoxin
toxicity, which presents with gastrointestinal symptoms, visual disturbances, and
bradycardia. Hyponatremia does not directly cause these classic digoxin toxicity
manifestations. Checking potassium levels is a critical priority for patients on
concurrent loop diuretics and digoxin therapy.
Question 3 of 50
A 55-year-old male with acute kidney injury has a serum potassium level of 6.8
mEq/L. The telemetry monitor reveals tall, peaked T waves and a widened QRS
complex. The patient complains of severe muscle weakness.
Which pathophysiologic mechanism directly causes the muscle weakness
associated with this condition?
A. Excessive renal excretion of potassium leads to cellular hyperpolarization.
B. Intracellular shift of potassium occurs in response to metabolic acidosis.
C. Reduced resting membrane potential alters neuromuscular excitability. ✓
CORRECT
D. Decreased serum calcium levels potentiate the effects of hyperkalemia.
Correct Answer: C
, 4
Rationale: Hyperkalemia reduces the resting membrane potential, making muscle
cells less excitable and leading to profound muscle weakness. Excessive renal
excretion of potassium would cause hypokalemia, not the elevated potassium seen
here. Peaked T waves and widened QRS complexes are immediate red flags for
impending fatal cardiac dysrhythmias.
Question 4 of 50
A 60-year-old female is receiving a continuous heparin infusion for a deep vein
thrombosis. On day 7 of therapy, her platelet count drops from 220,000/mm³ to
85,000/mm³, and she develops new onset right lower extremity swelling and pain.
Which complication should the nurse suspect based on these assessment findings?
A. Disseminated intravascular coagulation causing widespread microvascular
thrombosis.
B. Hemorrhagic stroke secondary to excessive anticoagulation therapy.
C. Idiopathic thrombocytopenic purpura causing isolated peripheral platelet
destruction.
D. Heparin-induced thrombocytopenia causing paradoxical venous thrombosis. ✓
CORRECT
Correct Answer: D
Rationale: Heparin-induced thrombocytopenia is an immune-mediated adverse
effect characterized by a significant drop in platelets and paradoxical thrombosis.
Disseminated intravascular coagulation typically presents with both bleeding and
clotting, but it is not directly triggered by heparin therapy. The nurse must
immediately stop heparin and notify the provider if this life-threatening
complication is suspected.
NSG 3850 Exam 4 Pathophysiology for Nurses II
High-Acuity Nursing Official Practice Exam
Actual Exam 2026/2027 with Detailed Rationales
| Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Cardiovascular & Renal Disorders | Q1 – Q10
Section 2 | Hepatic, Biliary & Gastrointestinal Disorders | Q11 – Q20
Section 3 | Endocrine, Hematologic & Immunologic Disorders | Q21 – Q30
Section 4 | Neurologic & Critical Care Disorders | Q31 – Q40
Section 5 | NGN-Style Clinical Judgment & Integrated Case Analysis | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR & RENAL DISORDERS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old male with a history of heart failure with preserved ejection fraction
(HFpEF) is prescribed furosemide for peripheral edema. During morning rounds,
the nurse observes dry mucous membranes and notes the patient reports dizziness
when standing. Based on these findings, the nurse should assess for fluid volume
deficit.
,2
What is the primary reason this patient is experiencing orthostatic hypotension?
A. Intravascular volume depletion from the loop diuretic reduces venous return to
the heart. ✓ CORRECT
B. Decreased cardiac contractility impairs the ability to maintain blood pressure
upon standing.
C. Structural ventricular stiffening limits the heart's ability to pump effectively
against resistance.
D. Excessive sodium retention in the renal tubules overrides the effects of
prescribed diuretics.
Correct Answer: A
Rationale: Orthostatic hypotension is a classic sign of fluid volume deficit related
to intravascular volume depletion from furosemide. Decreased cardiac contractility
is characteristic of heart failure with reduced ejection fraction (HFrEF), not
HFpEF. Nurses must distinguish between side effects of diuretic therapy and
underlying cardiac dysfunction to accurately identify volume status.
Question 2 of 50
A 72-year-old female with chronic heart failure presents to the emergency
department with anorexia, nausea, and blurred vision with yellow-green halos. Her
heart rate is 48 bpm and irregular. The home medication list includes digoxin and
furosemide.
Which laboratory value most likely explains this patient's current clinical
presentation?
A. Serum sodium of 132 mEq/L indicating hyponatremia.
,3
B. Serum potassium of 2.8 mEq/L indicating hypokalemia. ✓ CORRECT
C. Serum troponin of 0.06 ng/mL indicating mild myocardial injury.
D. Serum creatinine of 1.1 mg/dL indicating normal renal function.
Correct Answer: B
Rationale: Hypokalemia from furosemide greatly increases the risk of digoxin
toxicity, which presents with gastrointestinal symptoms, visual disturbances, and
bradycardia. Hyponatremia does not directly cause these classic digoxin toxicity
manifestations. Checking potassium levels is a critical priority for patients on
concurrent loop diuretics and digoxin therapy.
Question 3 of 50
A 55-year-old male with acute kidney injury has a serum potassium level of 6.8
mEq/L. The telemetry monitor reveals tall, peaked T waves and a widened QRS
complex. The patient complains of severe muscle weakness.
Which pathophysiologic mechanism directly causes the muscle weakness
associated with this condition?
A. Excessive renal excretion of potassium leads to cellular hyperpolarization.
B. Intracellular shift of potassium occurs in response to metabolic acidosis.
C. Reduced resting membrane potential alters neuromuscular excitability. ✓
CORRECT
D. Decreased serum calcium levels potentiate the effects of hyperkalemia.
Correct Answer: C
, 4
Rationale: Hyperkalemia reduces the resting membrane potential, making muscle
cells less excitable and leading to profound muscle weakness. Excessive renal
excretion of potassium would cause hypokalemia, not the elevated potassium seen
here. Peaked T waves and widened QRS complexes are immediate red flags for
impending fatal cardiac dysrhythmias.
Question 4 of 50
A 60-year-old female is receiving a continuous heparin infusion for a deep vein
thrombosis. On day 7 of therapy, her platelet count drops from 220,000/mm³ to
85,000/mm³, and she develops new onset right lower extremity swelling and pain.
Which complication should the nurse suspect based on these assessment findings?
A. Disseminated intravascular coagulation causing widespread microvascular
thrombosis.
B. Hemorrhagic stroke secondary to excessive anticoagulation therapy.
C. Idiopathic thrombocytopenic purpura causing isolated peripheral platelet
destruction.
D. Heparin-induced thrombocytopenia causing paradoxical venous thrombosis. ✓
CORRECT
Correct Answer: D
Rationale: Heparin-induced thrombocytopenia is an immune-mediated adverse
effect characterized by a significant drop in platelets and paradoxical thrombosis.
Disseminated intravascular coagulation typically presents with both bleeding and
clotting, but it is not directly triggered by heparin therapy. The nurse must
immediately stop heparin and notify the provider if this life-threatening
complication is suspected.
