WILLIAM PATERSON UNIVERSITY
Department of Nursing
NUR 6111 EXAM 2 STUDY GUIDE
QUESTIONS AND ANSWERS
2026 UPDATE | 100% CORRECT
Course: NUR 6111 – Advanced Pathophysiology
Exam: Exam 2 Study Guide & Test Bank
Institution: William Paterson University
Focus Areas: Cardiovascular | Respiratory | Hematologic | Immunologic
Questions: 40 (4 sections × 10 questions)
Cognitive Distribution: 30% Recall | 50% Application | 20% Analysis
Format: 75% Scenario-based | 25% Direct
Total Points: 100 (2.5 points per question)
Date: August 05, 2026
Aligned with 2026–2027 AHA/ACC, GOLD, NIH, and AACN Essentials standards
,NUR 6111 Exam 2 Study Guide | William Paterson University | 2026 Update 100% CORRECT
AACN Essentials Competency Alignment
Domain Competency Exam Sections
1: Knowledge for
Advanced pathophysiologic reasoning across organ systems Sections 1-3
Nursing Practice
Linking cellular mechanisms to clinical presentations and
2: Person-Centered Care Sections 1-3
individualized care
Epidemiology of cardiovascular, respiratory, and hematologic
3: Population Health Sections 1-2
disorders
4: Scholarship for Integration of 2026 evidence-based guidelines and diagnostic
Section 4
Practice standards
Precision diagnostic interpretation, medication safety, and
5: Quality & Safety Section 4
adverse event recognition
6: Interprofessional Collaborative interpretation of advanced biomarkers and
Section 4
Partnerships imaging
8: Informatics &
Application of precision medicine and AI-enhanced diagnostics Section 4
Technology
PART 1: EXAM QUESTIONS
Section 1: Cardiovascular Pathophysiology & Hemodynamics
Q1: A 68-year-old male presents with progressive dyspnea on exertion, bilateral lower extremity edema, and an
ejection fraction of 35%. His BNP is 620 pg/mL. Which pathophysiological mechanism best explains the primary
hemodynamic alteration in this presentation?
A. Impaired ventricular relaxation leading to elevated left ventricular end-diastolic pressure despite preserved
contractility
B. Decreased stroke volume resulting from reduced ventricular chamber compliance and restrictive filling dynamics
C. Reduced forward cardiac output secondary to systolic contractile dysfunction with subsequent neurohormonal
activation and volume retention [CORRECT]
D. Increased afterload from systemic vasoconstriction without impairment of intrinsic myocardial contractility
Q2: A 55-year-old female presents with 45 minutes of crushing substernal chest pain, diaphoresis, and nausea. The
initial ECG reveals ST-segment elevation in leads V2-V4. Which pathophysiological process is most directly
responsible for the ECG findings?
A. Partial thrombotic occlusion of the left anterior descending artery with collateral flow preservation
B. Transmural ischemia due to complete thrombotic occlusion of the left anterior descending artery with absence of
collateral blood supply [CORRECT]
C. Subendocardial ischemia from transient vasospasm without persistent thrombotic occlusion
D. Microvascular dysfunction with intact epicardial coronary arteries and diffuse subendocardial injury
Q3: A 52-year-old African American male with a 10-year history of hypertension has a BP of 172/104 mmHg
despite three antihypertensives. Laboratory studies reveal a low renin level. Which pathophysiological mechanism
best explains his resistant hypertension?
A. Excessive renin-angiotensin-aldosterone system activation with secondary sodium retention and vasoconstriction
B. Enhanced renal sodium reabsorption with volume-dependent hypertension and suppressed renin secretion
[CORRECT]
Page 2
, NUR 6111 Exam 2 Study Guide | William Paterson University | 2026 Update 100% CORRECT
C. Catecholamine excess from an undiagnosed pheochromocytoma with episodic vasoconstriction
D. Primary hyperaldosteronism with elevated aldosterone-to-renin ratio and independent renin suppression
Q4: A 76-year-old female presents with exertional syncope, angina, and dyspnea. Physical examination reveals a
loud, late-peaking systolic ejection murmur at the right upper sternal border with a delayed carotid upstroke. Which
hemodynamic consequence is the primary driver of her symptom triad?
A. Volume overload with secondary left ventricular dilation and reduced ejection fraction
B. Fixed left ventricular outflow tract obstruction creating a pressure gradient that limits stroke volume and coronary
perfusion during exertion [CORRECT]
C. Dynamic outflow tract obstruction that worsens with decreased afterload and improved contractility
D. Diastolic dysfunction from impaired ventricular relaxation without significant systolic pressure gradient
Q5: A 62-year-old male with a history of myocardial infarction presents with progressive orthopnea and a
holosystolic murmur at the apex radiating to the axilla. Echocardiography reveals a flail mitral leaflet with severe
regurgitation. Which pathophysiological consequence most directly explains his orthopnea?
A. Reduced afterload from regurgitant flow into the left atrium improving forward cardiac output
B. Volume overload of the left ventricle from regurgitant flow leading to elevated left atrial pressure and pulmonary
venous congestion [CORRECT]
C. Isolated right ventricular failure from volume overload with secondary systemic venous congestion
D. Pressure overload of the left ventricle from increased afterload and concentric hypertrophy
Q6: A 70-year-old female with an acute anterior STEMI develops hypotension (BP 78/50), cool extremities, oliguria,
and a pulmonary capillary wedge pressure of 24 mmHg. Which pathophysiologic cascade best describes her
condition?
A. Systemic vasodilation with reduced SVR, normal or elevated cardiac output, and warm extremities due to
redistributive shock
B. Acute right ventricular failure with elevated JVP, clear lung fields, and a PCWP less than 15 mmHg
C. Pump failure from extensive myocardial necrosis causing reduced cardiac output, elevated PCWP, systemic
hypoperfusion, and compensatory vasoconstriction [CORRECT]
D. Relative hypovolemia from vasodilation and third-spacing with low PCWP and responsive to volume resuscitation
Q7: Which neurohormonal cascade is primarily activated in HFrEF and contributes to disease progression through
ventricular remodeling?
A. Enhanced parasympathetic tone with decreased heart rate, reduced renin secretion, and natriuresis
B. Upregulation of natriuretic peptide receptors leading to vasodilation and volume depletion without maladaptive
remodeling
C. Sympathetic nervous system activation and RAAS upregulation promoting vasoconstriction, sodium retention,
myocyte apoptosis, and fibrosis [CORRECT]
D. Selective angiotensin-converting enzyme inhibition with decreased aldosterone and resolution of remodeling
Q8: A 78-year-old obese female with hypertension and diabetes presents with dyspnea and an EF of 60%.
Echocardiography shows concentric LVH, elevated E/e' ratio, and left atrial enlargement. Which mechanism best
explains her heart failure phenotype?
A. Systolic contractile dysfunction with reduced stroke volume and eccentric remodeling
B. Impaired ventricular relaxation and increased chamber stiffness causing elevated LVEDP during diastole with
preserved systolic function [CORRECT]
C. Acute mitral regurgitation from papillary muscle rupture producing volume overload
D. Pericardial constriction with equalization of diastolic pressures and Kussmaul sign
Q9: A 58-year-old male with untreated hypertension presents with BP 220/130, headache, visual changes, and new
retinal hemorrhages on funduscopic examination. Which pathophysiologic mechanism underlies the end-organ
Page 3
Department of Nursing
NUR 6111 EXAM 2 STUDY GUIDE
QUESTIONS AND ANSWERS
2026 UPDATE | 100% CORRECT
Course: NUR 6111 – Advanced Pathophysiology
Exam: Exam 2 Study Guide & Test Bank
Institution: William Paterson University
Focus Areas: Cardiovascular | Respiratory | Hematologic | Immunologic
Questions: 40 (4 sections × 10 questions)
Cognitive Distribution: 30% Recall | 50% Application | 20% Analysis
Format: 75% Scenario-based | 25% Direct
Total Points: 100 (2.5 points per question)
Date: August 05, 2026
Aligned with 2026–2027 AHA/ACC, GOLD, NIH, and AACN Essentials standards
,NUR 6111 Exam 2 Study Guide | William Paterson University | 2026 Update 100% CORRECT
AACN Essentials Competency Alignment
Domain Competency Exam Sections
1: Knowledge for
Advanced pathophysiologic reasoning across organ systems Sections 1-3
Nursing Practice
Linking cellular mechanisms to clinical presentations and
2: Person-Centered Care Sections 1-3
individualized care
Epidemiology of cardiovascular, respiratory, and hematologic
3: Population Health Sections 1-2
disorders
4: Scholarship for Integration of 2026 evidence-based guidelines and diagnostic
Section 4
Practice standards
Precision diagnostic interpretation, medication safety, and
5: Quality & Safety Section 4
adverse event recognition
6: Interprofessional Collaborative interpretation of advanced biomarkers and
Section 4
Partnerships imaging
8: Informatics &
Application of precision medicine and AI-enhanced diagnostics Section 4
Technology
PART 1: EXAM QUESTIONS
Section 1: Cardiovascular Pathophysiology & Hemodynamics
Q1: A 68-year-old male presents with progressive dyspnea on exertion, bilateral lower extremity edema, and an
ejection fraction of 35%. His BNP is 620 pg/mL. Which pathophysiological mechanism best explains the primary
hemodynamic alteration in this presentation?
A. Impaired ventricular relaxation leading to elevated left ventricular end-diastolic pressure despite preserved
contractility
B. Decreased stroke volume resulting from reduced ventricular chamber compliance and restrictive filling dynamics
C. Reduced forward cardiac output secondary to systolic contractile dysfunction with subsequent neurohormonal
activation and volume retention [CORRECT]
D. Increased afterload from systemic vasoconstriction without impairment of intrinsic myocardial contractility
Q2: A 55-year-old female presents with 45 minutes of crushing substernal chest pain, diaphoresis, and nausea. The
initial ECG reveals ST-segment elevation in leads V2-V4. Which pathophysiological process is most directly
responsible for the ECG findings?
A. Partial thrombotic occlusion of the left anterior descending artery with collateral flow preservation
B. Transmural ischemia due to complete thrombotic occlusion of the left anterior descending artery with absence of
collateral blood supply [CORRECT]
C. Subendocardial ischemia from transient vasospasm without persistent thrombotic occlusion
D. Microvascular dysfunction with intact epicardial coronary arteries and diffuse subendocardial injury
Q3: A 52-year-old African American male with a 10-year history of hypertension has a BP of 172/104 mmHg
despite three antihypertensives. Laboratory studies reveal a low renin level. Which pathophysiological mechanism
best explains his resistant hypertension?
A. Excessive renin-angiotensin-aldosterone system activation with secondary sodium retention and vasoconstriction
B. Enhanced renal sodium reabsorption with volume-dependent hypertension and suppressed renin secretion
[CORRECT]
Page 2
, NUR 6111 Exam 2 Study Guide | William Paterson University | 2026 Update 100% CORRECT
C. Catecholamine excess from an undiagnosed pheochromocytoma with episodic vasoconstriction
D. Primary hyperaldosteronism with elevated aldosterone-to-renin ratio and independent renin suppression
Q4: A 76-year-old female presents with exertional syncope, angina, and dyspnea. Physical examination reveals a
loud, late-peaking systolic ejection murmur at the right upper sternal border with a delayed carotid upstroke. Which
hemodynamic consequence is the primary driver of her symptom triad?
A. Volume overload with secondary left ventricular dilation and reduced ejection fraction
B. Fixed left ventricular outflow tract obstruction creating a pressure gradient that limits stroke volume and coronary
perfusion during exertion [CORRECT]
C. Dynamic outflow tract obstruction that worsens with decreased afterload and improved contractility
D. Diastolic dysfunction from impaired ventricular relaxation without significant systolic pressure gradient
Q5: A 62-year-old male with a history of myocardial infarction presents with progressive orthopnea and a
holosystolic murmur at the apex radiating to the axilla. Echocardiography reveals a flail mitral leaflet with severe
regurgitation. Which pathophysiological consequence most directly explains his orthopnea?
A. Reduced afterload from regurgitant flow into the left atrium improving forward cardiac output
B. Volume overload of the left ventricle from regurgitant flow leading to elevated left atrial pressure and pulmonary
venous congestion [CORRECT]
C. Isolated right ventricular failure from volume overload with secondary systemic venous congestion
D. Pressure overload of the left ventricle from increased afterload and concentric hypertrophy
Q6: A 70-year-old female with an acute anterior STEMI develops hypotension (BP 78/50), cool extremities, oliguria,
and a pulmonary capillary wedge pressure of 24 mmHg. Which pathophysiologic cascade best describes her
condition?
A. Systemic vasodilation with reduced SVR, normal or elevated cardiac output, and warm extremities due to
redistributive shock
B. Acute right ventricular failure with elevated JVP, clear lung fields, and a PCWP less than 15 mmHg
C. Pump failure from extensive myocardial necrosis causing reduced cardiac output, elevated PCWP, systemic
hypoperfusion, and compensatory vasoconstriction [CORRECT]
D. Relative hypovolemia from vasodilation and third-spacing with low PCWP and responsive to volume resuscitation
Q7: Which neurohormonal cascade is primarily activated in HFrEF and contributes to disease progression through
ventricular remodeling?
A. Enhanced parasympathetic tone with decreased heart rate, reduced renin secretion, and natriuresis
B. Upregulation of natriuretic peptide receptors leading to vasodilation and volume depletion without maladaptive
remodeling
C. Sympathetic nervous system activation and RAAS upregulation promoting vasoconstriction, sodium retention,
myocyte apoptosis, and fibrosis [CORRECT]
D. Selective angiotensin-converting enzyme inhibition with decreased aldosterone and resolution of remodeling
Q8: A 78-year-old obese female with hypertension and diabetes presents with dyspnea and an EF of 60%.
Echocardiography shows concentric LVH, elevated E/e' ratio, and left atrial enlargement. Which mechanism best
explains her heart failure phenotype?
A. Systolic contractile dysfunction with reduced stroke volume and eccentric remodeling
B. Impaired ventricular relaxation and increased chamber stiffness causing elevated LVEDP during diastole with
preserved systolic function [CORRECT]
C. Acute mitral regurgitation from papillary muscle rupture producing volume overload
D. Pericardial constriction with equalization of diastolic pressures and Kussmaul sign
Q9: A 58-year-old male with untreated hypertension presents with BP 220/130, headache, visual changes, and new
retinal hemorrhages on funduscopic examination. Which pathophysiologic mechanism underlies the end-organ
Page 3
