NUR 376 Exam 2 Study Guide (2026/2027)
Applied Pathophysiology | Concordia St. Paul –
Practice Questions & Rationales
1. A patient is admitted with a massive myocardial infarction
(MI) of the left ventricle. Which pathophysiological process is
the primary cause of decreased cardiac output immediately
following the infarction?
A) Increased vagal tone
B) Loss of functional myocardial muscle
C) Aortic valve stenosis
D) Systemic vasodilation
Answer: B) Loss of functional myocardial muscle
Rationale: An MI occurs when blood flow to the myocardium is
interrupted, causing ischemia and necrosis. The necrotic muscle
cannot contract, leading to a direct decrease in the heart's
stroke volume and overall cardiac output.
2. A client presents to the emergency department with an ST-
elevation myocardial infarction (STEMI). The nurse understands
that the "window of opportunity" for administering
,thrombolytics (fibrinolytics) to restore blood flow and minimize
myocardial damage is:
A) Within 30 minutes of symptom onset
B) Within 1 to 2 hours
C) Within 12 hours
D) Within 24 hours
Answer: C) Within 12 hours
Rationale: Thrombolytic therapy is most effective when
administered within the first 12 hours of symptom onset, with
the greatest benefit seen within the first 1-2 hours ("time is
muscle").
3. Which pathophysiological mechanism is responsible for the
development of atherosclerosis?
A) Chronic inflammation and endothelial injury leading to lipid
accumulation
B) Autoimmune destruction of the tunica externa
C) Uncontrolled proliferation of smooth muscle cells in the
adventitia
D) Viral infection of the endothelial lining
,Answer: A) Chronic inflammation and endothelial injury leading
to lipid accumulation
Rationale: The response-to-injury hypothesis states that chronic
endothelial injury (from hypertension, smoking, hyperlipidemia)
allows low-density lipoproteins (LDLs) to enter the intima,
triggering an inflammatory response. Macrophages engulf the
lipids, forming foam cells and fatty streaks, which progress to
plaques.
4. A patient with a history of hypertension develops left
ventricular hypertrophy (LVH). This adaptation is primarily an
example of:
A) Dysplasia
B) Hyperplasia
C) Hypertrophy
D) Metaplasia
Answer: C) Hypertrophy
Rationale: Hypertrophy is an increase in cell size. In response to
chronically elevated blood pressure (increased afterload), the
myocardial cells of the left ventricle must work harder, causing
them to enlarge to generate more force.
, 5. A patient is diagnosed with left-sided heart failure. Which
symptom is the nurse most likely to observe?
A) Peripheral edema
B) Jugular venous distension (JVD)
C) Pulmonary crackles and dyspnea
D) Hepatomegaly
Answer: C) Pulmonary crackles and dyspnea
Rationale: Left-sided heart failure causes blood to back up into
the pulmonary circulation. This increases hydrostatic pressure in
the pulmonary capillaries, pushing fluid into the alveoli
(pulmonary edema), causing crackles and dyspnea.
6. A patient with right-sided heart failure develops peripheral
edema. The underlying pathophysiological mechanism for this
edema is:
A) Increased plasma oncotic pressure
B) Decreased capillary hydrostatic pressure
C) Increased capillary hydrostatic pressure
D) Lymphatic obstruction
Answer: C) Increased capillary hydrostatic pressure
Applied Pathophysiology | Concordia St. Paul –
Practice Questions & Rationales
1. A patient is admitted with a massive myocardial infarction
(MI) of the left ventricle. Which pathophysiological process is
the primary cause of decreased cardiac output immediately
following the infarction?
A) Increased vagal tone
B) Loss of functional myocardial muscle
C) Aortic valve stenosis
D) Systemic vasodilation
Answer: B) Loss of functional myocardial muscle
Rationale: An MI occurs when blood flow to the myocardium is
interrupted, causing ischemia and necrosis. The necrotic muscle
cannot contract, leading to a direct decrease in the heart's
stroke volume and overall cardiac output.
2. A client presents to the emergency department with an ST-
elevation myocardial infarction (STEMI). The nurse understands
that the "window of opportunity" for administering
,thrombolytics (fibrinolytics) to restore blood flow and minimize
myocardial damage is:
A) Within 30 minutes of symptom onset
B) Within 1 to 2 hours
C) Within 12 hours
D) Within 24 hours
Answer: C) Within 12 hours
Rationale: Thrombolytic therapy is most effective when
administered within the first 12 hours of symptom onset, with
the greatest benefit seen within the first 1-2 hours ("time is
muscle").
3. Which pathophysiological mechanism is responsible for the
development of atherosclerosis?
A) Chronic inflammation and endothelial injury leading to lipid
accumulation
B) Autoimmune destruction of the tunica externa
C) Uncontrolled proliferation of smooth muscle cells in the
adventitia
D) Viral infection of the endothelial lining
,Answer: A) Chronic inflammation and endothelial injury leading
to lipid accumulation
Rationale: The response-to-injury hypothesis states that chronic
endothelial injury (from hypertension, smoking, hyperlipidemia)
allows low-density lipoproteins (LDLs) to enter the intima,
triggering an inflammatory response. Macrophages engulf the
lipids, forming foam cells and fatty streaks, which progress to
plaques.
4. A patient with a history of hypertension develops left
ventricular hypertrophy (LVH). This adaptation is primarily an
example of:
A) Dysplasia
B) Hyperplasia
C) Hypertrophy
D) Metaplasia
Answer: C) Hypertrophy
Rationale: Hypertrophy is an increase in cell size. In response to
chronically elevated blood pressure (increased afterload), the
myocardial cells of the left ventricle must work harder, causing
them to enlarge to generate more force.
, 5. A patient is diagnosed with left-sided heart failure. Which
symptom is the nurse most likely to observe?
A) Peripheral edema
B) Jugular venous distension (JVD)
C) Pulmonary crackles and dyspnea
D) Hepatomegaly
Answer: C) Pulmonary crackles and dyspnea
Rationale: Left-sided heart failure causes blood to back up into
the pulmonary circulation. This increases hydrostatic pressure in
the pulmonary capillaries, pushing fluid into the alveoli
(pulmonary edema), causing crackles and dyspnea.
6. A patient with right-sided heart failure develops peripheral
edema. The underlying pathophysiological mechanism for this
edema is:
A) Increased plasma oncotic pressure
B) Decreased capillary hydrostatic pressure
C) Increased capillary hydrostatic pressure
D) Lymphatic obstruction
Answer: C) Increased capillary hydrostatic pressure
