NU 621 Advanced Pathophysiology
Midterm Exam
2025
A 77 year old female hospital patient has contracted Clostridium
difficile during her stay and is experiencing severe diarrhea. Which of
the following statements best conveys a risk that this woman faces? She is
susceptible to isotonic fluid volume deficit. ---This woman is at risk of isotonic fluid volume
deficit and sodium imbalances as a result of her diarrhea. She is not likely to develop fluid
volume excess or third spacing as consequences of diarrhea.
Which diuretic acts by inhibiting sodium chloride reabsorption in
the thick ascending limb of the loop of Henle? (Points : 0.4)
Bumetanide (Bumex)
Mannitol (Osmitrol)
Hydrochlorothiazide (Hydrodiuril) hydrochlorothiazide act on the distal
convoluted tubule and inhibit the sodium-chloride symporter leading to a retention of water in
the urine, as water normally follows penetrating solutes.
Acetazolamide (Diamox)
A 77 year old female with a diagnosis of copd is experiencing
impaired gas exchange and CO2 retention, despite a rapid respiratory
rate. Which of the following phenomena would her care team most
realistically anticipate? Her kidneys will adapt with an increase in plasma
HCO3- and her pH will decrease.
Respiratory acidosis is accompanied by renal adaptation with a more marked increase in
plasma HCO3- and a lesser decrease in pH. Her pH is likely below 7.35, and the likely renal
response involves the reabsorption of HCO3- and secretion of H+. Excess CO2 production is not
a common manifestation of obstructive lung disease.
A 68 year old woman with a new onset a vascular dementia has
recently begun retaining urine. Which of the following physiological
,phenomena would her care providers most realistically expect to be
currently occurring as a result of her urinary retention? Hypertrophy of
the bladder muscle and increased bladder wall thickness.
Early accompaniments to urinary retention include hypertrophy of the
bladder muscle and increased thickness of the bladder wall. Renal effects are
unlikely, and decompensation and loss of contraction power are most often later
rather than early effects.
An 87 year old male resident has been consistenly continent of
urine until the last several weeks. Which of the following action by the
care providers at the facility is the most likely priority? Physical exam
The priority in the treatment of incontinence in the elderly is an acknowledgement that it
is not an inevitability and that the exact causes should and most often can be identified. This
identification by way of history-taking and examination would supersede teaching about
protective devices or exercis
Question 2.2. At which of the following locations in the nephron
would a nurse practitioner first expect blood to be largely free of plasma
proteins? (Points : 0.4)
Proximal convoluted tubule
Bowman space Active filtration occurs when the whole blood
enters via the afferent arteriole in to the glomerular capillaries, and the
blood is then filtered into the Bowman space, removing plasma proteins.
The filtrate that enters the proximal convoluted tubule and the loop of
Henle is already free of plasma proteins
Loop of Henle
Afferent arteriole
Question 3.3. A 14-year-old boy who appears to be intoxicated is
brought to the emergency department by ambulance. The EMTs report
that the boy has denied consuming anything out of the ordinary, but an
open antifreeze container was found in the boy's room. Which of the
following is likely to be used to treat the patient's symptoms? (Points :
0.4)
, Gastric lavage
Syrup of ipecac
Fomepizole - Ethylene glycol is found in products ranging from antifreeze and
deicing solutions to carpet and fabric cleaners. It tastes sweet and is intoxicating—the factors
that contribute to its abuse potential. A lethal dose is approximately 100 mL. It is rapidly
absorbed from the intestine, making treatment with either gastric lavage or syrup of ipecac
ineffective. Fomepizole, with specific indications for ethylene glycol poisoning, was recently
approved by the U.S. Food and Drug Administration.
Sodium bicarbonate
Question 4.4. A 4-year-old boy who has been deaf since birth and
has bilateral cataracts has been brought to the emergency department by
his mother because she noticed blood in the toilet after he last voided.
Urinalysis confirms heavy microscopic hematuria as well as proteinuria.
What will the care team's initial differential diagnosis most likely be?
(Points : 0.4)
Alport syndrome-Heavy microscopic hematuria, proteinuria, and
sensorineural deafness and eye disorders are characteristic of Alport
syndrome. This symptomatology is less characteristic of systemic lupus
erythematosus glomerulonephritis, Henoch-Schönlein purpura
nephritis, or immunoglobulin A nephropathy.
Systemic lupus erythematosus glomerulonephritis
Henoch-Schonlein purpura nephritis
Immunoglobulin A nephropathy
Question 5.5. A patient is brought to the emergency department
with complaints of shortness of breath. Assessment reveals a full,
bounding pulse, severe edema, and audible crackles in the lower lung
fields bilaterally. What is the patient's most likely diagnosis? (Points :
0.4)
Hyponatremia
Fluid volume excess - Peripheral and pulmonary edema as well as
a bounding pulse and dyspnea are indicators of fluid volume overload.
Hypocalcemia
Hyperkalemia
, Question 6.6. Which of the following data would a clinician
consider to be most indicative of acute renal failure?(Points : 0.4)
Alterations in blood pH, peripheral edema
Increased nitrogenous waste levels, decreased glomerular
filtration rate (GFR) the hallmark of acute renal injury is azotemia, an
accumulation of nitrogenous wastes such as creatinine, urea nitrogen, and uric acid,
plus a decrease in the GFR of the kidneys. While pH alterations, edema, electrolyte
imbalances, and decreased urine output may accompany acute renal failure, they are
all potentially attributable to other pathologies. Creatinine, GFR, and BUN would
unlikely rise during renal failure.
Decreased serum creatinine and blood urea nitrogen (BUN),
decreased potassium and calcium levels
Decreased urine output, hematuria, increased GFR
Question 7.7. Which of the following substances is most likely to
be reabsorbed in the tubular segments of the nephron using passive
transport mechanisms?
(Points : 0.4)
Water Water is passively reabsorbed across tubular epithelial
membranes, while ions like sodium, phosphate, and calcium necessitate
active transport.
Sodium
Phosphate
Calcium
Question 8.8. A 60-year-old man has been diagnosed with renal
calculi after repeated episodes of excruciating flank pain in recent
weeks. The man states, “I don't know how this could happen to me,
since I'm so careful about eating a healthy diet.” What is the most
appropriate response to the man's statement? (Points : 0.4)
“Your diet may have played a part in this, but in fact genetics is
likely primarily to blame.”
“What you eat can influence your risk of stone formation, but
many other factors like hormones and your metabolism are
Midterm Exam
2025
A 77 year old female hospital patient has contracted Clostridium
difficile during her stay and is experiencing severe diarrhea. Which of
the following statements best conveys a risk that this woman faces? She is
susceptible to isotonic fluid volume deficit. ---This woman is at risk of isotonic fluid volume
deficit and sodium imbalances as a result of her diarrhea. She is not likely to develop fluid
volume excess or third spacing as consequences of diarrhea.
Which diuretic acts by inhibiting sodium chloride reabsorption in
the thick ascending limb of the loop of Henle? (Points : 0.4)
Bumetanide (Bumex)
Mannitol (Osmitrol)
Hydrochlorothiazide (Hydrodiuril) hydrochlorothiazide act on the distal
convoluted tubule and inhibit the sodium-chloride symporter leading to a retention of water in
the urine, as water normally follows penetrating solutes.
Acetazolamide (Diamox)
A 77 year old female with a diagnosis of copd is experiencing
impaired gas exchange and CO2 retention, despite a rapid respiratory
rate. Which of the following phenomena would her care team most
realistically anticipate? Her kidneys will adapt with an increase in plasma
HCO3- and her pH will decrease.
Respiratory acidosis is accompanied by renal adaptation with a more marked increase in
plasma HCO3- and a lesser decrease in pH. Her pH is likely below 7.35, and the likely renal
response involves the reabsorption of HCO3- and secretion of H+. Excess CO2 production is not
a common manifestation of obstructive lung disease.
A 68 year old woman with a new onset a vascular dementia has
recently begun retaining urine. Which of the following physiological
,phenomena would her care providers most realistically expect to be
currently occurring as a result of her urinary retention? Hypertrophy of
the bladder muscle and increased bladder wall thickness.
Early accompaniments to urinary retention include hypertrophy of the
bladder muscle and increased thickness of the bladder wall. Renal effects are
unlikely, and decompensation and loss of contraction power are most often later
rather than early effects.
An 87 year old male resident has been consistenly continent of
urine until the last several weeks. Which of the following action by the
care providers at the facility is the most likely priority? Physical exam
The priority in the treatment of incontinence in the elderly is an acknowledgement that it
is not an inevitability and that the exact causes should and most often can be identified. This
identification by way of history-taking and examination would supersede teaching about
protective devices or exercis
Question 2.2. At which of the following locations in the nephron
would a nurse practitioner first expect blood to be largely free of plasma
proteins? (Points : 0.4)
Proximal convoluted tubule
Bowman space Active filtration occurs when the whole blood
enters via the afferent arteriole in to the glomerular capillaries, and the
blood is then filtered into the Bowman space, removing plasma proteins.
The filtrate that enters the proximal convoluted tubule and the loop of
Henle is already free of plasma proteins
Loop of Henle
Afferent arteriole
Question 3.3. A 14-year-old boy who appears to be intoxicated is
brought to the emergency department by ambulance. The EMTs report
that the boy has denied consuming anything out of the ordinary, but an
open antifreeze container was found in the boy's room. Which of the
following is likely to be used to treat the patient's symptoms? (Points :
0.4)
, Gastric lavage
Syrup of ipecac
Fomepizole - Ethylene glycol is found in products ranging from antifreeze and
deicing solutions to carpet and fabric cleaners. It tastes sweet and is intoxicating—the factors
that contribute to its abuse potential. A lethal dose is approximately 100 mL. It is rapidly
absorbed from the intestine, making treatment with either gastric lavage or syrup of ipecac
ineffective. Fomepizole, with specific indications for ethylene glycol poisoning, was recently
approved by the U.S. Food and Drug Administration.
Sodium bicarbonate
Question 4.4. A 4-year-old boy who has been deaf since birth and
has bilateral cataracts has been brought to the emergency department by
his mother because she noticed blood in the toilet after he last voided.
Urinalysis confirms heavy microscopic hematuria as well as proteinuria.
What will the care team's initial differential diagnosis most likely be?
(Points : 0.4)
Alport syndrome-Heavy microscopic hematuria, proteinuria, and
sensorineural deafness and eye disorders are characteristic of Alport
syndrome. This symptomatology is less characteristic of systemic lupus
erythematosus glomerulonephritis, Henoch-Schönlein purpura
nephritis, or immunoglobulin A nephropathy.
Systemic lupus erythematosus glomerulonephritis
Henoch-Schonlein purpura nephritis
Immunoglobulin A nephropathy
Question 5.5. A patient is brought to the emergency department
with complaints of shortness of breath. Assessment reveals a full,
bounding pulse, severe edema, and audible crackles in the lower lung
fields bilaterally. What is the patient's most likely diagnosis? (Points :
0.4)
Hyponatremia
Fluid volume excess - Peripheral and pulmonary edema as well as
a bounding pulse and dyspnea are indicators of fluid volume overload.
Hypocalcemia
Hyperkalemia
, Question 6.6. Which of the following data would a clinician
consider to be most indicative of acute renal failure?(Points : 0.4)
Alterations in blood pH, peripheral edema
Increased nitrogenous waste levels, decreased glomerular
filtration rate (GFR) the hallmark of acute renal injury is azotemia, an
accumulation of nitrogenous wastes such as creatinine, urea nitrogen, and uric acid,
plus a decrease in the GFR of the kidneys. While pH alterations, edema, electrolyte
imbalances, and decreased urine output may accompany acute renal failure, they are
all potentially attributable to other pathologies. Creatinine, GFR, and BUN would
unlikely rise during renal failure.
Decreased serum creatinine and blood urea nitrogen (BUN),
decreased potassium and calcium levels
Decreased urine output, hematuria, increased GFR
Question 7.7. Which of the following substances is most likely to
be reabsorbed in the tubular segments of the nephron using passive
transport mechanisms?
(Points : 0.4)
Water Water is passively reabsorbed across tubular epithelial
membranes, while ions like sodium, phosphate, and calcium necessitate
active transport.
Sodium
Phosphate
Calcium
Question 8.8. A 60-year-old man has been diagnosed with renal
calculi after repeated episodes of excruciating flank pain in recent
weeks. The man states, “I don't know how this could happen to me,
since I'm so careful about eating a healthy diet.” What is the most
appropriate response to the man's statement? (Points : 0.4)
“Your diet may have played a part in this, but in fact genetics is
likely primarily to blame.”
“What you eat can influence your risk of stone formation, but
many other factors like hormones and your metabolism are
