NSG 3850 Exam 3 - Pathophysiology II: 200
Practice Questions with Answers and Rationales
**1. A 65-year-old male with a history of hypertension and smoking presents with substernal chest
pressure radiating to the jaw, diaphoresis, and nausea. ECG shows ST elevation in leads V1–V4. What
is the most likely diagnosis?**
A) Unstable angina
B) Non-STEMI
C) STEMI (anterior wall)
D) Pericarditis
**Answer: C**
*Rationale:* ST elevation in anterior leads (V1–V4) with typical ischemic symptoms indicates an
anterior wall STEMI, which is a complete occlusion of the left anterior descending coronary artery .
**2. A patient with chronic heart failure (HFrEF) is admitted with worsening dyspnea, orthopnea, and
peripheral edema. Which compensatory mechanism contributes most to fluid retention?**
A) Activation of the RAAS system (increased aldosterone and ADH)
B) Decreased sympathetic tone
C) Increased atrial natriuretic peptide (ANP)
D) Decreased renin release
**Answer: A**
*Rationale:* Heart failure activates the RAAS system, leading to sodium and water retention, which
worsens edema and fluid overload .
**3. A 55-year-old female with type 2 diabetes, hypertension, and hyperlipidemia presents with
stable chest pain on exertion that resolves with rest. This is most likely which type of angina?**
A) Unstable angina
B) Variant (Prinzmetal) angina
C) Stable angina (exertional)
D) Non-STEMI
**Answer: C**
*Rationale:* Stable angina is triggered by exertion and relieved by rest, caused by fixed
atherosclerotic narrowing of coronary arteries .
,**4. A patient with severe aortic stenosis presents with syncope on exertion. The nurse understands
this symptom is most likely due to which mechanism?**
A) Increased cardiac output
B) Fixed cardiac output with decreased cerebral perfusion
C) Vasovagal response to chest pain
D) Arrhythmia
**Answer: B**
*Rationale:* In aortic stenosis, the fixed cardiac output cannot increase with exertion, leading to
decreased cerebral perfusion and syncope .
**5. A patient develops cardiogenic shock after an acute myocardial infarction. What is the most
important initial intervention for this patient?**
A) Administer IV fluids
B) Administer inotropic agents
C) Place patient in Trendelenburg position
D) Administer nitroglycerin
**Answer: B**
*Rationale:* Inotropic agents help increase cardiac contractility and improve perfusion in cardiogenic
shock, while IV fluids may worsen pulmonary congestion.
**6. Which finding is most suggestive of left-sided heart failure?**
A) Peripheral edema and jugular venous distention
B) Orthopnea, paroxysmal nocturnal dyspnea, and crackles
C) Hepatomegaly and ascites
D) Weight gain and decreased urine output
**Answer: B**
*Rationale:* Left-sided heart failure causes pulmonary congestion, leading to orthopnea, PND, and
crackles .
**7. What is the classic triad of symptoms seen in severe aortic stenosis?**
A) Chest pain, syncope, and dyspnea on exertion
B) Palpitations, fatigue, and dizziness
C) Orthopnea, edema, and cough
, D) Headache, nausea, and diaphoresis
**Answer: A**
*Rationale:* The classic triad of severe aortic stenosis is syncope (exertional), angina, and dyspnea .
**8. A patient is diagnosed with pericarditis. Which ECG finding is most consistent with this
diagnosis?**
A) ST elevation in a single lead
B) Diffuse ST elevation with concave-up morphology
C) Q waves in multiple leads
D) ST depression in all leads
**Answer: B**
*Rationale:* Pericarditis typically shows diffuse ST elevation with a concave-up morphology,
reflecting inflammation of the pericardial sac.
**9. Which complication is most closely associated with a right-to-left intrapulmonary shunt as seen
in ARDS?**
A) Hypoxemia that responds well to supplemental oxygen
B) Hypoxemia that does NOT respond well to supplemental oxygen
C) Hypercapnia that resolves with oxygen therapy
D) Decreased pulmonary vascular resistance
**Answer: B**
*Rationale:* In a shunt, blood bypasses ventilated alveoli, so increasing FiO₂ does not improve
oxygenation because the shunted blood never contacts oxygen .
---
## Section 2: Respiratory Disorders (Questions 31–60)
**31. A patient with COPD has a barrel-shaped chest and prolonged expiratory phase. This is due to
which pathophysiological mechanism?**
A) Air trapping and loss of elastic recoil
B) Increased compliance from emphysema only
C) Both air trapping and loss of elastic recoil
D) Increased airway resistance only
**Answer: C**
Practice Questions with Answers and Rationales
**1. A 65-year-old male with a history of hypertension and smoking presents with substernal chest
pressure radiating to the jaw, diaphoresis, and nausea. ECG shows ST elevation in leads V1–V4. What
is the most likely diagnosis?**
A) Unstable angina
B) Non-STEMI
C) STEMI (anterior wall)
D) Pericarditis
**Answer: C**
*Rationale:* ST elevation in anterior leads (V1–V4) with typical ischemic symptoms indicates an
anterior wall STEMI, which is a complete occlusion of the left anterior descending coronary artery .
**2. A patient with chronic heart failure (HFrEF) is admitted with worsening dyspnea, orthopnea, and
peripheral edema. Which compensatory mechanism contributes most to fluid retention?**
A) Activation of the RAAS system (increased aldosterone and ADH)
B) Decreased sympathetic tone
C) Increased atrial natriuretic peptide (ANP)
D) Decreased renin release
**Answer: A**
*Rationale:* Heart failure activates the RAAS system, leading to sodium and water retention, which
worsens edema and fluid overload .
**3. A 55-year-old female with type 2 diabetes, hypertension, and hyperlipidemia presents with
stable chest pain on exertion that resolves with rest. This is most likely which type of angina?**
A) Unstable angina
B) Variant (Prinzmetal) angina
C) Stable angina (exertional)
D) Non-STEMI
**Answer: C**
*Rationale:* Stable angina is triggered by exertion and relieved by rest, caused by fixed
atherosclerotic narrowing of coronary arteries .
,**4. A patient with severe aortic stenosis presents with syncope on exertion. The nurse understands
this symptom is most likely due to which mechanism?**
A) Increased cardiac output
B) Fixed cardiac output with decreased cerebral perfusion
C) Vasovagal response to chest pain
D) Arrhythmia
**Answer: B**
*Rationale:* In aortic stenosis, the fixed cardiac output cannot increase with exertion, leading to
decreased cerebral perfusion and syncope .
**5. A patient develops cardiogenic shock after an acute myocardial infarction. What is the most
important initial intervention for this patient?**
A) Administer IV fluids
B) Administer inotropic agents
C) Place patient in Trendelenburg position
D) Administer nitroglycerin
**Answer: B**
*Rationale:* Inotropic agents help increase cardiac contractility and improve perfusion in cardiogenic
shock, while IV fluids may worsen pulmonary congestion.
**6. Which finding is most suggestive of left-sided heart failure?**
A) Peripheral edema and jugular venous distention
B) Orthopnea, paroxysmal nocturnal dyspnea, and crackles
C) Hepatomegaly and ascites
D) Weight gain and decreased urine output
**Answer: B**
*Rationale:* Left-sided heart failure causes pulmonary congestion, leading to orthopnea, PND, and
crackles .
**7. What is the classic triad of symptoms seen in severe aortic stenosis?**
A) Chest pain, syncope, and dyspnea on exertion
B) Palpitations, fatigue, and dizziness
C) Orthopnea, edema, and cough
, D) Headache, nausea, and diaphoresis
**Answer: A**
*Rationale:* The classic triad of severe aortic stenosis is syncope (exertional), angina, and dyspnea .
**8. A patient is diagnosed with pericarditis. Which ECG finding is most consistent with this
diagnosis?**
A) ST elevation in a single lead
B) Diffuse ST elevation with concave-up morphology
C) Q waves in multiple leads
D) ST depression in all leads
**Answer: B**
*Rationale:* Pericarditis typically shows diffuse ST elevation with a concave-up morphology,
reflecting inflammation of the pericardial sac.
**9. Which complication is most closely associated with a right-to-left intrapulmonary shunt as seen
in ARDS?**
A) Hypoxemia that responds well to supplemental oxygen
B) Hypoxemia that does NOT respond well to supplemental oxygen
C) Hypercapnia that resolves with oxygen therapy
D) Decreased pulmonary vascular resistance
**Answer: B**
*Rationale:* In a shunt, blood bypasses ventilated alveoli, so increasing FiO₂ does not improve
oxygenation because the shunted blood never contacts oxygen .
---
## Section 2: Respiratory Disorders (Questions 31–60)
**31. A patient with COPD has a barrel-shaped chest and prolonged expiratory phase. This is due to
which pathophysiological mechanism?**
A) Air trapping and loss of elastic recoil
B) Increased compliance from emphysema only
C) Both air trapping and loss of elastic recoil
D) Increased airway resistance only
**Answer: C**
