Advanced Pathophysiology — Shock & Organ Dysfunction Final Examination
NURS 5315 ADVANCED PATHOPHYSIOLOGY – SHOCK & ORGAN
DYSFUNCTION FINAL EXAM QUESTIONS AND CORRECT ANSWERS |
COMPREHENSIVE CLINICAL 2026/2027
ADVANCED PATHOPHYSIOLOGY
SHOCK, SEPSIS AND MULTIPLE ORGAN DYSFUNCTION
FINAL EXAMINATION
1. Which statement best describes the fundamental pathophysiologic
defect common to all forms of shock?
A. Primary failure of the left ventricle
B. Loss of more than 30% of circulating blood volume
C. Systolic blood pressure below 90 mmHg in every patient
D. Inadequate tissue perfusion leading to impaired cellular oxygen use
and metabolism
ANSWER : D. Inadequate tissue perfusion leading to impaired
cellular oxygen use and metabolism
Shock is defined at the cellular level as oxygen delivery or use that fails to
meet metabolic demand; hypotension is often a late finding.
Page 1 of 58
, Advanced Pathophysiology — Shock & Organ Dysfunction Final Examination
2. When cells shift to anaerobic metabolism during shock, the main by-
product that accumulates is:
A. Ketone bodies
B. Lactic acid
C. Ammonia
D. Carbon dioxide only
ANSWER : B. Lactic acid
Without oxygen, pyruvate is converted to lactate, producing a metabolic
(lactic) acidosis.
3. Anaerobic glycolysis yields how many net ATP molecules per glucose
molecule compared with aerobic metabolism?
A. 4 ATP versus 12 ATP
B. 2 ATP versus approximately 36–38 ATP
C. 18 ATP versus 36 ATP
D. No ATP versus 2 ATP
ANSWER : B. 2 ATP versus approximately 36–38 ATP
Anaerobic glycolysis produces only 2 net ATP, which cannot sustain
cellular energy needs.
4. Failure of the sodium–potassium ATPase pump during shock causes
which cellular change?
A. Cell membrane becomes impermeable to sodium
B. Calcium is pumped out of the cell
C. Sodium and water enter the cell, causing cellular swelling
D. Potassium accumulates inside the cell causing shrinkage
ANSWER : C. Sodium and water enter the cell, causing cellular
swelling
Loss of ATP stops the Na+/K+ pump; intracellular sodium rises and water
follows, leading to swelling and potassium leaking out.
Page 2 of 58
, Advanced Pathophysiology — Shock & Organ Dysfunction Final Examination
5. Rupture of lysosomal membranes during progressive shock
contributes to cell death by:
A. Releasing hydrolytic enzymes that digest cellular structures
B. Increasing ATP production in mitochondria
C. Stimulating glycogen synthesis
D. Stabilizing the cell membrane
ANSWER : A. Releasing hydrolytic enzymes that digest cellular
structures
Lysosomal enzymes released into the cytoplasm cause autodigestion and
further tissue injury.
6. Which laboratory value most directly reflects global tissue
hypoperfusion in a patient with shock?
A. Serum amylase
B. Serum albumin
C. Hemoglobin A1C
D. Serum lactate
ANSWER : D. Serum lactate
Rising lactate reflects anaerobic metabolism and correlates with severity
and mortality in shock.
7. The initial (compensatory) response to a fall in cardiac output is
mediated primarily by:
A. Baroreceptor activation of the sympathetic nervous system
B. Release of atrial natriuretic peptide
C. Parasympathetic stimulation of the heart
D. Inhibition of the renin–angiotensin system
ANSWER : A. Baroreceptor activation of the sympathetic nervous
system
Decreased stretch on carotid and aortic baroreceptors triggers
sympathetic discharge, raising heart rate, contractility and vascular tone.
Page 3 of 58
, Advanced Pathophysiology — Shock & Organ Dysfunction Final Examination
8. Activation of the renin–angiotensin–aldosterone system in shock
results in:
A. Vasoconstriction and sodium and water retention
B. Decreased antidiuretic hormone release
C. Vasodilation and diuresis
D. Potassium retention and hypernatremia only
ANSWER : A. Vasoconstriction and sodium and water retention
Angiotensin II constricts vessels, and aldosterone increases renal sodium
and water reabsorption to restore volume.
9. Antidiuretic hormone (vasopressin) released during shock acts to:
A. Decrease thirst
B. Increase water reabsorption in the collecting ducts and constrict
arterioles
C. Dilate splanchnic vessels
D. Increase sodium excretion by the kidney
ANSWER : B. Increase water reabsorption in the collecting ducts and
constrict arterioles
ADH promotes free water retention and, at high levels, causes peripheral
vasoconstriction.
10. Which clinical finding is typically the EARLIEST sign of compensated
shock?
A. Fixed and dilated pupils
B. Tachycardia with narrowed pulse pressure
C. Profound hypotension
D. Anuria
ANSWER : B. Tachycardia with narrowed pulse pressure
Sympathetic compensation raises heart rate and diastolic pressure early,
narrowing pulse pressure before hypotension develops.
Page 4 of 58
NURS 5315 ADVANCED PATHOPHYSIOLOGY – SHOCK & ORGAN
DYSFUNCTION FINAL EXAM QUESTIONS AND CORRECT ANSWERS |
COMPREHENSIVE CLINICAL 2026/2027
ADVANCED PATHOPHYSIOLOGY
SHOCK, SEPSIS AND MULTIPLE ORGAN DYSFUNCTION
FINAL EXAMINATION
1. Which statement best describes the fundamental pathophysiologic
defect common to all forms of shock?
A. Primary failure of the left ventricle
B. Loss of more than 30% of circulating blood volume
C. Systolic blood pressure below 90 mmHg in every patient
D. Inadequate tissue perfusion leading to impaired cellular oxygen use
and metabolism
ANSWER : D. Inadequate tissue perfusion leading to impaired
cellular oxygen use and metabolism
Shock is defined at the cellular level as oxygen delivery or use that fails to
meet metabolic demand; hypotension is often a late finding.
Page 1 of 58
, Advanced Pathophysiology — Shock & Organ Dysfunction Final Examination
2. When cells shift to anaerobic metabolism during shock, the main by-
product that accumulates is:
A. Ketone bodies
B. Lactic acid
C. Ammonia
D. Carbon dioxide only
ANSWER : B. Lactic acid
Without oxygen, pyruvate is converted to lactate, producing a metabolic
(lactic) acidosis.
3. Anaerobic glycolysis yields how many net ATP molecules per glucose
molecule compared with aerobic metabolism?
A. 4 ATP versus 12 ATP
B. 2 ATP versus approximately 36–38 ATP
C. 18 ATP versus 36 ATP
D. No ATP versus 2 ATP
ANSWER : B. 2 ATP versus approximately 36–38 ATP
Anaerobic glycolysis produces only 2 net ATP, which cannot sustain
cellular energy needs.
4. Failure of the sodium–potassium ATPase pump during shock causes
which cellular change?
A. Cell membrane becomes impermeable to sodium
B. Calcium is pumped out of the cell
C. Sodium and water enter the cell, causing cellular swelling
D. Potassium accumulates inside the cell causing shrinkage
ANSWER : C. Sodium and water enter the cell, causing cellular
swelling
Loss of ATP stops the Na+/K+ pump; intracellular sodium rises and water
follows, leading to swelling and potassium leaking out.
Page 2 of 58
, Advanced Pathophysiology — Shock & Organ Dysfunction Final Examination
5. Rupture of lysosomal membranes during progressive shock
contributes to cell death by:
A. Releasing hydrolytic enzymes that digest cellular structures
B. Increasing ATP production in mitochondria
C. Stimulating glycogen synthesis
D. Stabilizing the cell membrane
ANSWER : A. Releasing hydrolytic enzymes that digest cellular
structures
Lysosomal enzymes released into the cytoplasm cause autodigestion and
further tissue injury.
6. Which laboratory value most directly reflects global tissue
hypoperfusion in a patient with shock?
A. Serum amylase
B. Serum albumin
C. Hemoglobin A1C
D. Serum lactate
ANSWER : D. Serum lactate
Rising lactate reflects anaerobic metabolism and correlates with severity
and mortality in shock.
7. The initial (compensatory) response to a fall in cardiac output is
mediated primarily by:
A. Baroreceptor activation of the sympathetic nervous system
B. Release of atrial natriuretic peptide
C. Parasympathetic stimulation of the heart
D. Inhibition of the renin–angiotensin system
ANSWER : A. Baroreceptor activation of the sympathetic nervous
system
Decreased stretch on carotid and aortic baroreceptors triggers
sympathetic discharge, raising heart rate, contractility and vascular tone.
Page 3 of 58
, Advanced Pathophysiology — Shock & Organ Dysfunction Final Examination
8. Activation of the renin–angiotensin–aldosterone system in shock
results in:
A. Vasoconstriction and sodium and water retention
B. Decreased antidiuretic hormone release
C. Vasodilation and diuresis
D. Potassium retention and hypernatremia only
ANSWER : A. Vasoconstriction and sodium and water retention
Angiotensin II constricts vessels, and aldosterone increases renal sodium
and water reabsorption to restore volume.
9. Antidiuretic hormone (vasopressin) released during shock acts to:
A. Decrease thirst
B. Increase water reabsorption in the collecting ducts and constrict
arterioles
C. Dilate splanchnic vessels
D. Increase sodium excretion by the kidney
ANSWER : B. Increase water reabsorption in the collecting ducts and
constrict arterioles
ADH promotes free water retention and, at high levels, causes peripheral
vasoconstriction.
10. Which clinical finding is typically the EARLIEST sign of compensated
shock?
A. Fixed and dilated pupils
B. Tachycardia with narrowed pulse pressure
C. Profound hypotension
D. Anuria
ANSWER : B. Tachycardia with narrowed pulse pressure
Sympathetic compensation raises heart rate and diastolic pressure early,
narrowing pulse pressure before hypotension develops.
Page 4 of 58
