,NU 545 Unit 4 Exam | Physio-Pathological Basis of Advanced
Nursing (2026) Q&A | University of South Alabama
1. Which mechanism best explains the anemia associated with chronic kidney
disease?
A) Deficiency of intrinsic factor due to gastric atrophy
B) Reduced erythropoietin production by peritubular fibroblasts
C) Autoimmune destruction of erythrocyte precursors
D) Chronic blood loss from uremic platelet dysfunction
Correct Answer: Reduced erythropoietin production by peritubular fibroblasts
Rationale: The kidneys produce erythropoietin in response to hypoxia. In
chronic kidney disease, loss of peritubular fibroblasts impairs erythropoietin
synthesis, leading to normocytic normochromic anemia. Intrinsic factor deficiency
causes megaloblastic anemia, autoimmune destruction causes aplastic anemia, and
uremic platelet dysfunction causes bleeding but not primary erythropoietin
deficiency.
2. What is the primary acid-base disturbance in a patient with prolonged
vomiting?
A) Metabolic acidosis
B) Respiratory alkalosis
C) Metabolic alkalosis
D) Respiratory acidosis
Correct Answer: Metabolic alkalosis
,Rationale: Vomiting causes loss of gastric hydrochloric acid, leading to hydrogen
ion depletion and bicarbonate retention. This produces a metabolic alkalosis.
Respiratory alkalosis results from hyperventilation, metabolic acidosis from
bicarbonate loss or acid gain, and respiratory acidosis from hypoventilation.
3. A patient presents with polyuria, polydipsia, and hypernatremia. Which
endocrine disorder is most likely?
A) Syndrome of inappropriate antidiuretic hormone
B) Central diabetes insipidus
C) Primary hyperaldosteronism
D) Cushing syndrome
Correct Answer: Central diabetes insipidus
Rationale: Central diabetes insipidus involves deficient antidiuretic hormone
secretion, preventing water reabsorption in collecting ducts. This causes dilute
polyuria and compensatory polydipsia, with hypernatremia from free water loss.
SIADH causes hyponatremia, hyperaldosteronism causes hypertension and
hypokalemia, and Cushing syndrome causes hyperglycemia and hypertension.
4. Which laboratory finding is most characteristic of disseminated intravascular
coagulation?
A) Elevated platelet count
B) Prolonged prothrombin time and elevated D-dimer
C) Isolated prolongation of activated partial thromboplastin time
D) Increased fibrinogen level
, Correct Answer: Prolonged prothrombin time and elevated D-dimer
Rationale: DIC involves widespread activation of coagulation, consuming
platelets and clotting factors while simultaneously triggering fibrinolysis. This
produces prolonged PT and aPTT, thrombocytopenia, low fibrinogen, and elevated
D-dimer. Elevated platelets suggest reactive thrombocytosis, isolated aPTT
prolongation suggests heparin effect, and increased fibrinogen suggests
inflammation.
5. The nurse is reviewing laboratory results for a patient with SIADH. Which
electrolyte abnormality is expected?
A) Hyperkalemia
B) Hypernatremia
C) Hyponatremia
D) Hypercalcemia
Correct Answer: Hyponatremia
Rationale: SIADH involves excessive antidiuretic hormone, causing water
retention and dilutional hyponatremia. Hyperkalemia is associated with adrenal
insufficiency or renal failure, hypernatremia with diabetes insipidus or
dehydration, and hypercalcemia with hyperparathyroidism or malignancy.
6. Which gastrointestinal disorder is characterized by autoantibodies against
intrinsic factor?
A) Crohn disease
B) Pernicious anemia
C) Celiac disease
Nursing (2026) Q&A | University of South Alabama
1. Which mechanism best explains the anemia associated with chronic kidney
disease?
A) Deficiency of intrinsic factor due to gastric atrophy
B) Reduced erythropoietin production by peritubular fibroblasts
C) Autoimmune destruction of erythrocyte precursors
D) Chronic blood loss from uremic platelet dysfunction
Correct Answer: Reduced erythropoietin production by peritubular fibroblasts
Rationale: The kidneys produce erythropoietin in response to hypoxia. In
chronic kidney disease, loss of peritubular fibroblasts impairs erythropoietin
synthesis, leading to normocytic normochromic anemia. Intrinsic factor deficiency
causes megaloblastic anemia, autoimmune destruction causes aplastic anemia, and
uremic platelet dysfunction causes bleeding but not primary erythropoietin
deficiency.
2. What is the primary acid-base disturbance in a patient with prolonged
vomiting?
A) Metabolic acidosis
B) Respiratory alkalosis
C) Metabolic alkalosis
D) Respiratory acidosis
Correct Answer: Metabolic alkalosis
,Rationale: Vomiting causes loss of gastric hydrochloric acid, leading to hydrogen
ion depletion and bicarbonate retention. This produces a metabolic alkalosis.
Respiratory alkalosis results from hyperventilation, metabolic acidosis from
bicarbonate loss or acid gain, and respiratory acidosis from hypoventilation.
3. A patient presents with polyuria, polydipsia, and hypernatremia. Which
endocrine disorder is most likely?
A) Syndrome of inappropriate antidiuretic hormone
B) Central diabetes insipidus
C) Primary hyperaldosteronism
D) Cushing syndrome
Correct Answer: Central diabetes insipidus
Rationale: Central diabetes insipidus involves deficient antidiuretic hormone
secretion, preventing water reabsorption in collecting ducts. This causes dilute
polyuria and compensatory polydipsia, with hypernatremia from free water loss.
SIADH causes hyponatremia, hyperaldosteronism causes hypertension and
hypokalemia, and Cushing syndrome causes hyperglycemia and hypertension.
4. Which laboratory finding is most characteristic of disseminated intravascular
coagulation?
A) Elevated platelet count
B) Prolonged prothrombin time and elevated D-dimer
C) Isolated prolongation of activated partial thromboplastin time
D) Increased fibrinogen level
, Correct Answer: Prolonged prothrombin time and elevated D-dimer
Rationale: DIC involves widespread activation of coagulation, consuming
platelets and clotting factors while simultaneously triggering fibrinolysis. This
produces prolonged PT and aPTT, thrombocytopenia, low fibrinogen, and elevated
D-dimer. Elevated platelets suggest reactive thrombocytosis, isolated aPTT
prolongation suggests heparin effect, and increased fibrinogen suggests
inflammation.
5. The nurse is reviewing laboratory results for a patient with SIADH. Which
electrolyte abnormality is expected?
A) Hyperkalemia
B) Hypernatremia
C) Hyponatremia
D) Hypercalcemia
Correct Answer: Hyponatremia
Rationale: SIADH involves excessive antidiuretic hormone, causing water
retention and dilutional hyponatremia. Hyperkalemia is associated with adrenal
insufficiency or renal failure, hypernatremia with diabetes insipidus or
dehydration, and hypercalcemia with hyperparathyroidism or malignancy.
6. Which gastrointestinal disorder is characterized by autoantibodies against
intrinsic factor?
A) Crohn disease
B) Pernicious anemia
C) Celiac disease
