,NSG3280/NSG 3280 Exam 2 | Pathophysiology |
Galen College | 26/27 Updated (PDF)
1. A patient with chronic kidney disease develops anemia. What is the primary pathophysiologic cause
of this anemia?
A) Iron deficiency from poor dietary intake
B) Vitamin B12 malabsorption due to uremic toxins
C) Decreased production of erythropoietin by damaged kidneys
D) Hemolysis of red blood cells from uremic environment
Correct Answer: Decreased production of erythropoietin by damaged kidneys
Rationale: The kidneys produce erythropoietin, which stimulates red blood cell production in the bone
marrow. In chronic kidney disease, the damaged renal tissue produces less erythropoietin, leading to
a normocytic, normochromic anemia. Iron deficiency and B12 malabsorption are not the primary
causes in CKD, and hemolysis is less common.
2. The renin-angiotensin-aldosterone system (RAAS) plays a central role in blood pressure regulation.
Which enzyme is responsible for converting angiotensin I to angiotensin II?
A) Renin
B) Aldosterone synthase
C) Angiotensin-converting enzyme (ACE)
D) Angiotensinogenase
Correct Answer: Angiotensin-converting enzyme (ACE)
Rationale: ACE, found primarily in the vascular endothelium of the lungs, cleaves the inactive
decapeptide angiotensin I into the potent vasoconstrictor angiotensin II. Renin converts
angiotensinogen to angiotensin I, and aldosterone is a hormone that acts on the kidneys, not an
enzyme.
3. Which type of necrosis is most commonly associated with a myocardial infarction (heart attack)?
,A) Liquefactive necrosis
B) Caseous necrosis
C) Coagulative necrosis
D) Fat necrosis
Correct Answer: Coagulative necrosis
Rationale: Coagulative necrosis results from ischemia in solid organs like the heart. The cell
architecture is preserved initially while proteins denature, which is characteristic of myocardial
infarction. Liquefactive necrosis is common in the brain, caseous necrosis in tuberculosis, and fat
necrosis in adipose tissue.
4. A patient presents with the classic triad of polyuria, polydipsia, and polyphagia. Blood glucose is
320 mg/dL. Which condition is most likely?
A) Hypoglycemia
B) Diabetes insipidus
C) Diabetes mellitus
D) Addison's disease
Correct Answer: Diabetes mellitus
Rationale: The classic triad of polyuria, polydipsia, and polyphagia, along with a markedly elevated
blood glucose level (>200 mg/dL), confirms the diagnosis of diabetes mellitus. Diabetes insipidus
causes polyuria and polydipsia but without hyperglycemia.
5. Which of the following best describes the primary pathophysiologic mechanism in heart failure with
reduced ejection fraction (HFrEF)?
A) Increased ventricular compliance
B) Impaired ventricular filling
C) Reduced myocardial contractility
D) Excessive preload reduction
, Correct Answer: Reduced myocardial contractility
Rationale: HFrEF is characterized by systolic dysfunction where the left ventricle cannot contract
forcefully enough to eject adequate blood volumes, resulting in a reduced ejection fraction below
40%. Impaired ventricular filling is characteristic of heart failure with preserved ejection fraction
(HFpEF).
6. What is the primary pathophysiologic mechanism in Type 1 Diabetes Mellitus?
A) Insulin resistance in peripheral tissues
B) Decreased insulin secretion due to obesity
C) Autoimmune destruction of pancreatic beta cells
D) Excess glucagon secretion from alpha cells
Correct Answer: Autoimmune destruction of pancreatic beta cells
Rationale: In Type 1 DM, the immune system mistakenly attacks and destroys the insulin-producing
beta cells of the islets of Langerhans, resulting in an absolute insulin deficiency. Insulin resistance is
the hallmark of Type 2 DM.
7. A nurse is reviewing the pathophysiology of a pulmonary embolism. The embolus most commonly
originates from which location?
A) The right atrium
B) The pulmonary arteries
C) The deep veins of the lower extremities
D) The carotid arteries
Correct Answer: The deep veins of the lower extremities
Rationale: A pulmonary embolism is most commonly caused by a thromboembolus that originates
from the deep veins of the lower extremities (deep vein thrombosis). The embolus travels through the
venous system to the right side of the heart and lodges in the pulmonary arteries.
Galen College | 26/27 Updated (PDF)
1. A patient with chronic kidney disease develops anemia. What is the primary pathophysiologic cause
of this anemia?
A) Iron deficiency from poor dietary intake
B) Vitamin B12 malabsorption due to uremic toxins
C) Decreased production of erythropoietin by damaged kidneys
D) Hemolysis of red blood cells from uremic environment
Correct Answer: Decreased production of erythropoietin by damaged kidneys
Rationale: The kidneys produce erythropoietin, which stimulates red blood cell production in the bone
marrow. In chronic kidney disease, the damaged renal tissue produces less erythropoietin, leading to
a normocytic, normochromic anemia. Iron deficiency and B12 malabsorption are not the primary
causes in CKD, and hemolysis is less common.
2. The renin-angiotensin-aldosterone system (RAAS) plays a central role in blood pressure regulation.
Which enzyme is responsible for converting angiotensin I to angiotensin II?
A) Renin
B) Aldosterone synthase
C) Angiotensin-converting enzyme (ACE)
D) Angiotensinogenase
Correct Answer: Angiotensin-converting enzyme (ACE)
Rationale: ACE, found primarily in the vascular endothelium of the lungs, cleaves the inactive
decapeptide angiotensin I into the potent vasoconstrictor angiotensin II. Renin converts
angiotensinogen to angiotensin I, and aldosterone is a hormone that acts on the kidneys, not an
enzyme.
3. Which type of necrosis is most commonly associated with a myocardial infarction (heart attack)?
,A) Liquefactive necrosis
B) Caseous necrosis
C) Coagulative necrosis
D) Fat necrosis
Correct Answer: Coagulative necrosis
Rationale: Coagulative necrosis results from ischemia in solid organs like the heart. The cell
architecture is preserved initially while proteins denature, which is characteristic of myocardial
infarction. Liquefactive necrosis is common in the brain, caseous necrosis in tuberculosis, and fat
necrosis in adipose tissue.
4. A patient presents with the classic triad of polyuria, polydipsia, and polyphagia. Blood glucose is
320 mg/dL. Which condition is most likely?
A) Hypoglycemia
B) Diabetes insipidus
C) Diabetes mellitus
D) Addison's disease
Correct Answer: Diabetes mellitus
Rationale: The classic triad of polyuria, polydipsia, and polyphagia, along with a markedly elevated
blood glucose level (>200 mg/dL), confirms the diagnosis of diabetes mellitus. Diabetes insipidus
causes polyuria and polydipsia but without hyperglycemia.
5. Which of the following best describes the primary pathophysiologic mechanism in heart failure with
reduced ejection fraction (HFrEF)?
A) Increased ventricular compliance
B) Impaired ventricular filling
C) Reduced myocardial contractility
D) Excessive preload reduction
, Correct Answer: Reduced myocardial contractility
Rationale: HFrEF is characterized by systolic dysfunction where the left ventricle cannot contract
forcefully enough to eject adequate blood volumes, resulting in a reduced ejection fraction below
40%. Impaired ventricular filling is characteristic of heart failure with preserved ejection fraction
(HFpEF).
6. What is the primary pathophysiologic mechanism in Type 1 Diabetes Mellitus?
A) Insulin resistance in peripheral tissues
B) Decreased insulin secretion due to obesity
C) Autoimmune destruction of pancreatic beta cells
D) Excess glucagon secretion from alpha cells
Correct Answer: Autoimmune destruction of pancreatic beta cells
Rationale: In Type 1 DM, the immune system mistakenly attacks and destroys the insulin-producing
beta cells of the islets of Langerhans, resulting in an absolute insulin deficiency. Insulin resistance is
the hallmark of Type 2 DM.
7. A nurse is reviewing the pathophysiology of a pulmonary embolism. The embolus most commonly
originates from which location?
A) The right atrium
B) The pulmonary arteries
C) The deep veins of the lower extremities
D) The carotid arteries
Correct Answer: The deep veins of the lower extremities
Rationale: A pulmonary embolism is most commonly caused by a thromboembolus that originates
from the deep veins of the lower extremities (deep vein thrombosis). The embolus travels through the
venous system to the right side of the heart and lodges in the pulmonary arteries.
