NR-283 Exam 2: Pathophysiology V4 Updated and Latest
Questions and Correct Answers with Rationale -
Chamberlain University
1. Which clinical manifestation is most characteristic of left-sided heart failure?
A. Peripheral edema in the lower extremities
B. Pulmonary crackles and dyspnea
C. Jugular venous distention
D. Hepatomegaly and splenomegaly
Ans: B
Rationale: Left-sided heart failure primarily involves the inability of the left ventricle to pump blood into
the systemic circulation. This failure causes a backup of pressure into the left atrium and pulmonary
veins. As hydrostatic pressure increases, fluid is forced into the alveolar spaces of the lungs. The clinical
result is pulmonary congestion, manifesting as crackles and shortness of breath. In contrast, peripheral
edema and jugular distention are hallmarks of right-sided failure. Understanding this distinction is
critical for prioritizing respiratory interventions in nursing care.
2. What is the primary pathophysiological mechanism involved in an acute asthma attack?
A. Permanent destruction of alveolar walls
B. Bronchoconstriction and airway inflammation
C. Productive cough for at least three months
D. Infection of the lower respiratory tract
Ans: B
,Rationale: Asthma is characterized by a hyper-responsive airway that reacts to various environmental
triggers. During an attack, the smooth muscle of the bronchioles constricts, narrowing the airway lumen
significantly. Concurrently, an inflammatory response leads to mucosal edema and increased mucus
production. These factors combine to increase airway resistance and decrease airflow during expiration.
Unlike emphysema, these changes are typically reversible with appropriate treatment such as
bronchodilators. Nurses must recognize wheezing as a primary indicator of this narrowed airway path.
3. In a patient with Chronic Obstructive Pulmonary Disease (COPD), what is the typical drive
for respiration?
A. High levels of carbon dioxide
B. Low levels of oxygen
C. High levels of serum pH
D. Low levels of bicarbonate
Ans: B
Rationale: Patients with chronic COPD often experience long-term retention of carbon dioxide, which
desensitizes central chemoreceptors. Normally, high CO2 levels serve as the primary stimulus for the
respiratory center in the brain. When these receptors fail, the body relies on peripheral chemoreceptors
that respond to low oxygen levels. This phenomenon is known as the hypoxic drive for breathing.
Supplemental oxygen must be administered cautiously to these patients to avoid suppressing their drive
to breathe. Maintaining a balance between oxygenation and respiratory effort is a key nursing
responsibility.
,4. Which acid-base imbalance is expected in a patient who is hyperventilating due to
anxiety?
A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
Ans: B
Rationale: Hyperventilation leads to an excessive loss of carbon dioxide through the lungs. Carbon
dioxide acts as a volatile acid in the bloodstream when converted to carbonic acid. As CO2 levels drop, the
serum pH rises, leading to an alkalotic state. Because the primary cause is a change in ventilation, it is
classified as respiratory alkalosis. Common symptoms include tingling in the extremities and
lightheadedness due to cerebral vasoconstriction. Interventions often focus on calming the patient or
using a rebreathing technique.
5. Which electrolyte imbalance is most closely associated with the development of lethal
cardiac dysrhythmias?
A. Hyponatremia
B. Hypocalcemia
C. Hypermagnesemia
D. Hyperkalemia
Ans: D
, Rationale: Potassium plays a vital role in maintaining the resting membrane potential of cardiac
myocytes. When serum potassium levels rise excessively, the heart becomes more excitable and prone to
irregular rhythms. Hyperkalemia can lead to peaked T-waves and eventually progress to ventricular
fibrillation or asystole. This condition is often seen in patients with renal failure who cannot excrete
potassium effectively. Monitoring serial electrolyte levels and EKG changes is a priority for nursing staff.
Immediate treatment may include insulin and glucose or calcium gluconate to stabilize the heart.
6. What is the primary cause of the ‘barrel chest’ appearance in patients with emphysema?
A. Fluid accumulation in the pleural space
B. Chronic infection of the ribs and sternum
C. Increased thickness of the chest wall muscle
D. Air trapping and hyperinflation of the lungs
Ans: D
Rationale: Emphysema involves the destruction of alveolar walls and the loss of elastic recoil in the
lungs. This loss of elasticity causes the small airways to collapse during expiration, trapping air inside the
alveoli. Over time, this chronic air trapping leads to hyperinflation of the lungs and a change in thoracic
shape. The anterior-posterior diameter of the chest increases, creating the classic barrel chest look. This
anatomical change reflects the significant mechanical disadvantage the patient faces during breathing.
Nurses often observe this sign in long-term smokers with advanced respiratory disease.
Questions and Correct Answers with Rationale -
Chamberlain University
1. Which clinical manifestation is most characteristic of left-sided heart failure?
A. Peripheral edema in the lower extremities
B. Pulmonary crackles and dyspnea
C. Jugular venous distention
D. Hepatomegaly and splenomegaly
Ans: B
Rationale: Left-sided heart failure primarily involves the inability of the left ventricle to pump blood into
the systemic circulation. This failure causes a backup of pressure into the left atrium and pulmonary
veins. As hydrostatic pressure increases, fluid is forced into the alveolar spaces of the lungs. The clinical
result is pulmonary congestion, manifesting as crackles and shortness of breath. In contrast, peripheral
edema and jugular distention are hallmarks of right-sided failure. Understanding this distinction is
critical for prioritizing respiratory interventions in nursing care.
2. What is the primary pathophysiological mechanism involved in an acute asthma attack?
A. Permanent destruction of alveolar walls
B. Bronchoconstriction and airway inflammation
C. Productive cough for at least three months
D. Infection of the lower respiratory tract
Ans: B
,Rationale: Asthma is characterized by a hyper-responsive airway that reacts to various environmental
triggers. During an attack, the smooth muscle of the bronchioles constricts, narrowing the airway lumen
significantly. Concurrently, an inflammatory response leads to mucosal edema and increased mucus
production. These factors combine to increase airway resistance and decrease airflow during expiration.
Unlike emphysema, these changes are typically reversible with appropriate treatment such as
bronchodilators. Nurses must recognize wheezing as a primary indicator of this narrowed airway path.
3. In a patient with Chronic Obstructive Pulmonary Disease (COPD), what is the typical drive
for respiration?
A. High levels of carbon dioxide
B. Low levels of oxygen
C. High levels of serum pH
D. Low levels of bicarbonate
Ans: B
Rationale: Patients with chronic COPD often experience long-term retention of carbon dioxide, which
desensitizes central chemoreceptors. Normally, high CO2 levels serve as the primary stimulus for the
respiratory center in the brain. When these receptors fail, the body relies on peripheral chemoreceptors
that respond to low oxygen levels. This phenomenon is known as the hypoxic drive for breathing.
Supplemental oxygen must be administered cautiously to these patients to avoid suppressing their drive
to breathe. Maintaining a balance between oxygenation and respiratory effort is a key nursing
responsibility.
,4. Which acid-base imbalance is expected in a patient who is hyperventilating due to
anxiety?
A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
Ans: B
Rationale: Hyperventilation leads to an excessive loss of carbon dioxide through the lungs. Carbon
dioxide acts as a volatile acid in the bloodstream when converted to carbonic acid. As CO2 levels drop, the
serum pH rises, leading to an alkalotic state. Because the primary cause is a change in ventilation, it is
classified as respiratory alkalosis. Common symptoms include tingling in the extremities and
lightheadedness due to cerebral vasoconstriction. Interventions often focus on calming the patient or
using a rebreathing technique.
5. Which electrolyte imbalance is most closely associated with the development of lethal
cardiac dysrhythmias?
A. Hyponatremia
B. Hypocalcemia
C. Hypermagnesemia
D. Hyperkalemia
Ans: D
, Rationale: Potassium plays a vital role in maintaining the resting membrane potential of cardiac
myocytes. When serum potassium levels rise excessively, the heart becomes more excitable and prone to
irregular rhythms. Hyperkalemia can lead to peaked T-waves and eventually progress to ventricular
fibrillation or asystole. This condition is often seen in patients with renal failure who cannot excrete
potassium effectively. Monitoring serial electrolyte levels and EKG changes is a priority for nursing staff.
Immediate treatment may include insulin and glucose or calcium gluconate to stabilize the heart.
6. What is the primary cause of the ‘barrel chest’ appearance in patients with emphysema?
A. Fluid accumulation in the pleural space
B. Chronic infection of the ribs and sternum
C. Increased thickness of the chest wall muscle
D. Air trapping and hyperinflation of the lungs
Ans: D
Rationale: Emphysema involves the destruction of alveolar walls and the loss of elastic recoil in the
lungs. This loss of elasticity causes the small airways to collapse during expiration, trapping air inside the
alveoli. Over time, this chronic air trapping leads to hyperinflation of the lungs and a change in thoracic
shape. The anterior-posterior diameter of the chest increases, creating the classic barrel chest look. This
anatomical change reflects the significant mechanical disadvantage the patient faces during breathing.
Nurses often observe this sign in long-term smokers with advanced respiratory disease.
