NURS618 EXAM 1
NURS618 PATHOPHYSIOLOGY EXAM 1: THE ULTIMATE 200-
QUESTION Q&A STUDY RESOURCE WITH CLINICAL
RATIONALES
Question 1
A 68-year-old male with chronic obstructive pulmonary disease (COPD)
presents with worsening dyspnea and peripheral edema. His arterial
blood gas shows pH 7.32, PaCO2 58 mmHg, HCO3- 30 mEq/L. Which
acid-base disorder is most consistent with these findings?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis with metabolic compensation
C. Metabolic alkalosis with respiratory compensation
D. Mixed respiratory and metabolic acidosis
Answer: B
RATIONALE: The elevated PaCO2 indicates respiratory acidosis. The
elevated HCO3- (above 28 mEq/L) indicates renal compensation, which
takes 3-5 days to develop. This pattern is consistent with chronic
respiratory acidosis with metabolic compensation, commonly seen in
advanced COPD.
Question 2
,A patient with sickle cell disease experiences a vaso-occlusive crisis
following a respiratory infection. Which cellular adaptation is primarily
responsible for the sickling of erythrocytes?
A. Hypoxia-induced polymerization of hemoglobin S
B. Decreased production of erythropoietin
C. Increased red blood cell membrane fluidity
D. Enhanced activity of carbonic anhydrase
Answer: A
RATIONALE: In sickle cell disease, deoxygenated hemoglobin S
polymerizes into rigid rods that distort red blood cells into sickle shapes.
Hypoxia from respiratory infection triggers this polymerization, leading
to vaso-occlusion and tissue ischemia.
Question 3
A 45-year-old woman is diagnosed with Graves' disease. Which
autoantibody is most directly responsible for the hyperthyroidism seen
in this condition?
A. Anti-thyroid peroxidase antibodies
B. Thyroid-stimulating hormone receptor antibodies
C. Anti-thyroglobulin antibodies
D. Anti-microsomal antibodies
Answer: B
RATIONALE: Graves' disease is caused by thyroid-stimulating
immunoglobulins (TSI) that bind to and stimulate TSH receptors on
,thyroid follicular cells, leading to unregulated thyroid hormone
production and release.
Question 4
A patient with chronic kidney disease has a serum potassium level of
6.8 mEq/L. Which electrocardiographic change would you expect to see
first?
A. Tall peaked T waves
B. Widened QRS complex
C. Flattened P waves
D. Prolonged PR interval
Answer: A
RATIONALE: Tall peaked T waves are the earliest electrocardiographic
manifestation of hyperkalemia. As potassium levels rise further, QRS
widening, flattened P waves, and eventually sine wave pattern or
ventricular fibrillation may occur.
Question 5
A neonate is born with a cleft lip and palate. During which gestational
week did the developmental error most likely occur?
A. Week 4-5
B. Week 6-8
C. Week 10-12
D. Week 14-16
, Answer: B
RATIONALE: Cleft lip and palate result from failure of fusion of the
maxillary and medial nasal processes, which occurs during weeks 6-8 of
embryonic development. Environmental and genetic factors can disrupt
this process.
Question 6
A 55-year-old man with hypertension develops sudden severe chest
pain radiating to his back. Aortic dissection is suspected. Which genetic
disorder is most strongly associated with this condition?
A. Down syndrome
B. Turner syndrome
C. Marfan syndrome
D. Klinefelter syndrome
Answer: C
RATIONALE: Marfan syndrome is an autosomal dominant disorder
caused by mutations in the FBN1 gene encoding fibrillin-1, leading to
defective connective tissue. Patients are at increased risk for aortic
dilation and dissection.
Question 7
A patient with systemic lupus erythematosus develops pleuritis and
pericarditis. Which immune mechanism primarily causes these
manifestations?
NURS618 PATHOPHYSIOLOGY EXAM 1: THE ULTIMATE 200-
QUESTION Q&A STUDY RESOURCE WITH CLINICAL
RATIONALES
Question 1
A 68-year-old male with chronic obstructive pulmonary disease (COPD)
presents with worsening dyspnea and peripheral edema. His arterial
blood gas shows pH 7.32, PaCO2 58 mmHg, HCO3- 30 mEq/L. Which
acid-base disorder is most consistent with these findings?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis with metabolic compensation
C. Metabolic alkalosis with respiratory compensation
D. Mixed respiratory and metabolic acidosis
Answer: B
RATIONALE: The elevated PaCO2 indicates respiratory acidosis. The
elevated HCO3- (above 28 mEq/L) indicates renal compensation, which
takes 3-5 days to develop. This pattern is consistent with chronic
respiratory acidosis with metabolic compensation, commonly seen in
advanced COPD.
Question 2
,A patient with sickle cell disease experiences a vaso-occlusive crisis
following a respiratory infection. Which cellular adaptation is primarily
responsible for the sickling of erythrocytes?
A. Hypoxia-induced polymerization of hemoglobin S
B. Decreased production of erythropoietin
C. Increased red blood cell membrane fluidity
D. Enhanced activity of carbonic anhydrase
Answer: A
RATIONALE: In sickle cell disease, deoxygenated hemoglobin S
polymerizes into rigid rods that distort red blood cells into sickle shapes.
Hypoxia from respiratory infection triggers this polymerization, leading
to vaso-occlusion and tissue ischemia.
Question 3
A 45-year-old woman is diagnosed with Graves' disease. Which
autoantibody is most directly responsible for the hyperthyroidism seen
in this condition?
A. Anti-thyroid peroxidase antibodies
B. Thyroid-stimulating hormone receptor antibodies
C. Anti-thyroglobulin antibodies
D. Anti-microsomal antibodies
Answer: B
RATIONALE: Graves' disease is caused by thyroid-stimulating
immunoglobulins (TSI) that bind to and stimulate TSH receptors on
,thyroid follicular cells, leading to unregulated thyroid hormone
production and release.
Question 4
A patient with chronic kidney disease has a serum potassium level of
6.8 mEq/L. Which electrocardiographic change would you expect to see
first?
A. Tall peaked T waves
B. Widened QRS complex
C. Flattened P waves
D. Prolonged PR interval
Answer: A
RATIONALE: Tall peaked T waves are the earliest electrocardiographic
manifestation of hyperkalemia. As potassium levels rise further, QRS
widening, flattened P waves, and eventually sine wave pattern or
ventricular fibrillation may occur.
Question 5
A neonate is born with a cleft lip and palate. During which gestational
week did the developmental error most likely occur?
A. Week 4-5
B. Week 6-8
C. Week 10-12
D. Week 14-16
, Answer: B
RATIONALE: Cleft lip and palate result from failure of fusion of the
maxillary and medial nasal processes, which occurs during weeks 6-8 of
embryonic development. Environmental and genetic factors can disrupt
this process.
Question 6
A 55-year-old man with hypertension develops sudden severe chest
pain radiating to his back. Aortic dissection is suspected. Which genetic
disorder is most strongly associated with this condition?
A. Down syndrome
B. Turner syndrome
C. Marfan syndrome
D. Klinefelter syndrome
Answer: C
RATIONALE: Marfan syndrome is an autosomal dominant disorder
caused by mutations in the FBN1 gene encoding fibrillin-1, leading to
defective connective tissue. Patients are at increased risk for aortic
dilation and dissection.
Question 7
A patient with systemic lupus erythematosus develops pleuritis and
pericarditis. Which immune mechanism primarily causes these
manifestations?
