NURSING PATHOPHYSIOLOGY EXAM #3: ALTERATIONS IN CV FUNCTION &
PERFUSION (2026/2027) | CASE STUDY & STANDARD QUESTIONS WITH CORRECT
ANSWERS
Advanced Pathophysiology Examination: Focus on Cardiac & Vascular Systems | Core Domains: CAD &
ACS, Heart Failure, Valvular Disorders, Cardiomyopathies, Vascular Disorders, Shock States, and
Clinical Interpretation of Cardiac Diagnostics | Graduate-Level Nursing Focus | Case Study & Clinical
Application Exam Format
Exam Structure
This exam for the 2026/2027 cycle is a 55-question assessment that includes complex case study
scenarios (e.g., acute MI, decompensated HF), requiring students to trace the pathophysiology from
cellular injury to systemic manifestations, alongside standard questions on core concepts.
Answer Format
All correct answers must be presented in bold and green, followed by rationales that map the
anatomical lesion or hemodynamic alteration to the expected clinical and diagnostic findings presented in
the case studies and questions.
Questions (55 Total)
1.
A client with heart failure has jugular venous distension (JVD), peripheral edema, and crackles bilaterally.
What is the primary pathophysiological mechanism?
A. Decreased preload
B. Increased hydrostatic pressure from fluid overload
C. Hypoalbuminemia
D. Lymphatic obstruction
In heart failure, poor cardiac output leads to fluid retention and increased venous pressure. This raises
hydrostatic pressure in capillaries, forcing fluid into interstitial spaces—causing JVD, edema, and
pulmonary congestion.
2. A systolic murmur heard best at the right upper sternal border that radiates to the carotids is
characteristic of:
A. Mitral regurgitation
,B. Aortic stenosis
C. Tricuspid regurgitation
D. Pulmonic stenosis
Aortic stenosis produces a harsh, crescendo-decrescendo systolic murmur loudest at the right second
intercostal space (aortic area) with radiation to the carotid arteries due to turbulent flow across the
narrowed valve.
3.
A young athlete collapses during practice and is found to have asymmetric left ventricular hypertrophy on
echo.
What condition is most likely?
A. Dilated cardiomyopathy
B. Hypertrophic cardiomyopathy (HCM)
C. Restrictive cardiomyopathy
D. Myocarditis
HCM involves abnormal thickening of the left ventricular myocardium (often septum), leading to
diastolic dysfunction, outflow obstruction, and risk of sudden cardiac death—especially in young
athletes.
4. Essential hypertension is primarily associated with:
A. Renal artery stenosis
B. Increased peripheral vascular resistance
C. Hyperthyroidism
D. Pheochromocytoma
Primary (essential) hypertension, accounting for 90–95% of cases, results from complex interactions of
genetic, environmental, and neurohormonal factors leading to sustained increase in systemic vascular
resistance.
5.
A client in septic shock has a MAP of 58 mm Hg despite 30 mL/kg fluid resuscitation.
, Which vasopressor is first-line per Surviving Sepsis Guidelines?
A. Epinephrine
B. Norepinephrine
C. Dopamine
D. Phenylephrine
Norepinephrine is the first-line vasopressor in septic shock to achieve MAP ≥65 mm Hg. It primarily
causes vasoconstriction with minimal cardiac stimulation, restoring perfusion pressure.
6. An elevated B-type natriuretic peptide (BNP) level is most indicative of:
A. Myocardial infarction
B. Heart failure
C. Pulmonary embolism
D. Pericarditis
BNP is released by ventricular myocytes in response to stretch and volume overload. Levels >100
pg/mL support a diagnosis of heart failure and correlate with severity.
7.
A 58-year-old male presents with crushing substernal chest pain radiating to the left arm, diaphoresis,
and nausea. ECG shows ST elevation in leads II, III, and aVF.
What coronary artery is most likely occluded?
A. Left anterior descending (LAD)
B. Right coronary artery (RCA)
C. Left circumflex (LCx)
D. Left main coronary artery
Inferior wall MI (ST elevation in II, III, aVF) is typically caused by RCA occlusion. The RCA supplies the
inferior and posterior walls of the left ventricle and the right ventricle.
8.
PERFUSION (2026/2027) | CASE STUDY & STANDARD QUESTIONS WITH CORRECT
ANSWERS
Advanced Pathophysiology Examination: Focus on Cardiac & Vascular Systems | Core Domains: CAD &
ACS, Heart Failure, Valvular Disorders, Cardiomyopathies, Vascular Disorders, Shock States, and
Clinical Interpretation of Cardiac Diagnostics | Graduate-Level Nursing Focus | Case Study & Clinical
Application Exam Format
Exam Structure
This exam for the 2026/2027 cycle is a 55-question assessment that includes complex case study
scenarios (e.g., acute MI, decompensated HF), requiring students to trace the pathophysiology from
cellular injury to systemic manifestations, alongside standard questions on core concepts.
Answer Format
All correct answers must be presented in bold and green, followed by rationales that map the
anatomical lesion or hemodynamic alteration to the expected clinical and diagnostic findings presented in
the case studies and questions.
Questions (55 Total)
1.
A client with heart failure has jugular venous distension (JVD), peripheral edema, and crackles bilaterally.
What is the primary pathophysiological mechanism?
A. Decreased preload
B. Increased hydrostatic pressure from fluid overload
C. Hypoalbuminemia
D. Lymphatic obstruction
In heart failure, poor cardiac output leads to fluid retention and increased venous pressure. This raises
hydrostatic pressure in capillaries, forcing fluid into interstitial spaces—causing JVD, edema, and
pulmonary congestion.
2. A systolic murmur heard best at the right upper sternal border that radiates to the carotids is
characteristic of:
A. Mitral regurgitation
,B. Aortic stenosis
C. Tricuspid regurgitation
D. Pulmonic stenosis
Aortic stenosis produces a harsh, crescendo-decrescendo systolic murmur loudest at the right second
intercostal space (aortic area) with radiation to the carotid arteries due to turbulent flow across the
narrowed valve.
3.
A young athlete collapses during practice and is found to have asymmetric left ventricular hypertrophy on
echo.
What condition is most likely?
A. Dilated cardiomyopathy
B. Hypertrophic cardiomyopathy (HCM)
C. Restrictive cardiomyopathy
D. Myocarditis
HCM involves abnormal thickening of the left ventricular myocardium (often septum), leading to
diastolic dysfunction, outflow obstruction, and risk of sudden cardiac death—especially in young
athletes.
4. Essential hypertension is primarily associated with:
A. Renal artery stenosis
B. Increased peripheral vascular resistance
C. Hyperthyroidism
D. Pheochromocytoma
Primary (essential) hypertension, accounting for 90–95% of cases, results from complex interactions of
genetic, environmental, and neurohormonal factors leading to sustained increase in systemic vascular
resistance.
5.
A client in septic shock has a MAP of 58 mm Hg despite 30 mL/kg fluid resuscitation.
, Which vasopressor is first-line per Surviving Sepsis Guidelines?
A. Epinephrine
B. Norepinephrine
C. Dopamine
D. Phenylephrine
Norepinephrine is the first-line vasopressor in septic shock to achieve MAP ≥65 mm Hg. It primarily
causes vasoconstriction with minimal cardiac stimulation, restoring perfusion pressure.
6. An elevated B-type natriuretic peptide (BNP) level is most indicative of:
A. Myocardial infarction
B. Heart failure
C. Pulmonary embolism
D. Pericarditis
BNP is released by ventricular myocytes in response to stretch and volume overload. Levels >100
pg/mL support a diagnosis of heart failure and correlate with severity.
7.
A 58-year-old male presents with crushing substernal chest pain radiating to the left arm, diaphoresis,
and nausea. ECG shows ST elevation in leads II, III, and aVF.
What coronary artery is most likely occluded?
A. Left anterior descending (LAD)
B. Right coronary artery (RCA)
C. Left circumflex (LCx)
D. Left main coronary artery
Inferior wall MI (ST elevation in II, III, aVF) is typically caused by RCA occlusion. The RCA supplies the
inferior and posterior walls of the left ventricle and the right ventricle.
8.
