1
NSG 3850/ NSG3850 Exam 1 – (New 2026/ 2027 Update)
Pathophysiology for Nurses II Review | Questions & Answers |
Grade A| 100% Correct (Verified Solutions)- Galen
1. A patient with left ventricular heart failure would most likely present with
which of the following clinical manifestations?
A. Jugular venous distention and hepatomegaly
B. Dependent edema and ascites
C. Dyspnea, orthopnea, and crackles in the lung bases
D. Peripheral vasodilation and warm extremities
Correct Answer: C
Rationale: Left ventricular failure causes back-up of blood into the pulmonary
circulation, leading to pulmonary congestion. This manifests as dyspnea
(especially on exertion), orthopnea (difficulty breathing when lying flat), and
crackles due to fluid in the alveoli. Right-sided failure causes systemic venous
congestion (JVD, edema, hepatomegaly).
2. Which of the following neurohormonal responses is characteristic of chronic
heart failure?
A. Decreased renin release and increased natriuretic peptides
B. Activation of the renin-angiotensin-aldosterone system (RAAS) and increased
sympathetic nervous system activity
C. Suppression of antidiuretic hormone (ADH) and decreased aldosterone
D. Decreased circulating catecholamines and vasodilation
Correct Answer: B
Rationale: In heart failure, decreased cardiac output triggers compensatory
mechanisms: RAAS activation (leading to sodium and water retention),
sympathetic nervous system activation (increasing heart rate and
pg. 1
,2
vasoconstriction), and release of ADH. These initially help but ultimately worsen
heart failure through increased preload and afterload.
3. The primary difference between systolic and diastolic heart failure is that
systolic failure involves:
A. Impaired ventricular filling with preserved ejection fraction
B. Reduced ejection fraction due to impaired contractility
C. Normal stroke volume with elevated afterload
D. Increased cardiac output at rest
Correct Answer: B
Rationale: Systolic heart failure (HFrEF) is characterized by a reduced ejection
fraction (<40%) because the ventricle cannot contract effectively. Diastolic heart
failure (HFpEF) involves impaired ventricular relaxation and filling, resulting in a
normal or near-normal ejection fraction but reduced stroke volume.
4. Which of the following best describes the pathophysiology of stable angina?
A. Coronary artery vasospasm at rest
B. Fixed atherosclerotic plaque causing ischemia when myocardial oxygen
demand increases
C. Platelet aggregation and complete thrombotic occlusion
D. Microvascular dysfunction without epicardial coronary disease
Correct Answer: B
Rationale: Stable angina occurs when a stable atherosclerotic plaque narrows a
coronary artery, limiting blood flow. At rest, oxygen supply may be adequate, but
during exertion or stress, increased oxygen demand cannot be met, producing
ischemia and chest pain.
5. A patient with ST-segment elevation myocardial infarction (STEMI) has
complete occlusion of a coronary artery. What is the primary cause of the
occlusion?
pg. 2
,3
A. Vasospasm
B. Atherosclerotic plaque rupture with thrombus formation
C. Embolism from the left atrium
D. Coronary artery dissection
Correct Answer: B
Rationale: In STEMI, an unstable atherosclerotic plaque ruptures, exposing
subendothelial collagen, which triggers platelet adhesion and the coagulation
cascade. The resulting thrombus completely occludes the artery, causing
transmural myocardial necrosis.
6. Which cardiac biomarker is the most specific for myocardial injury?
A. CK-MB
B. Myoglobin
C. Troponin I (cTnI)
D. Lactate dehydrogenase (LDH)
Correct Answer: C
Rationale: Cardiac troponins (I and T) are highly specific to cardiac muscle and are
the gold-standard biomarkers for diagnosing myocardial infarction. CK-MB is less
specific; myoglobin rises early but is not cardiac-specific.
7. A patient with a history of rheumatic heart disease develops new-onset atrial
fibrillation and dyspnea. Which valvular abnormality is most likely?
A. Aortic stenosis
B. Mitral regurgitation
C. Mitral stenosis
D. Tricuspid regurgitation
Correct Answer: C
Rationale: Rheumatic heart disease most commonly affects the mitral valve,
leading to mitral stenosis. The narrowed valve impairs left atrial emptying,
increasing left atrial pressure and size, predisposing to atrial fibrillation. Patients
present with dyspnea, hemoptysis, and later right-sided heart failure.
pg. 3
, 4
8. The hallmark pathophysiologic feature of essential hypertension is:
A. Decreased cardiac output and increased systemic vascular resistance
B. Increased cardiac output and normal systemic vascular resistance
C. Normal cardiac output with decreased systemic vascular resistance
D. Initially increased cardiac output, later increased systemic vascular resistance
Correct Answer: D
Rationale: In early essential hypertension, increased sympathetic activity raises
cardiac output. Over time, the vasculature remodels and systemic vascular
resistance increases, which sustains hypertension even as cardiac output returns
to normal.
9. Which of the following statements regarding the pathophysiology of
atherosclerosis is TRUE?
A. Atherosclerosis begins with endothelial injury and dysfunction.
B. HDL cholesterol is the primary lipoprotein that infiltrates the arterial wall.
C. Smooth muscle cells play no role in atheroma development.
D. Calcification of plaques makes them more prone to rupture.
Correct Answer: A
Rationale: Endothelial injury (from hypertension, smoking, hyperlipidemia, etc.)
initiates the atherosclerotic process. LDL cholesterol infiltrates the intima,
becomes oxidized, and is taken up by macrophages, leading to foam cell
formation. Smooth muscle cells migrate and proliferate, contributing to plaque
stability rather than rupture; calcification actually stabilizes plaques.
10. A 60-year-old patient with long-standing hypertension presents with severe
headache, confusion, and papilledema. Blood pressure is 220/130 mmHg. This
presentation is most consistent with:
A. Hypertensive urgency
B. Hypertensive emergency (malignant hypertension)
pg. 4
NSG 3850/ NSG3850 Exam 1 – (New 2026/ 2027 Update)
Pathophysiology for Nurses II Review | Questions & Answers |
Grade A| 100% Correct (Verified Solutions)- Galen
1. A patient with left ventricular heart failure would most likely present with
which of the following clinical manifestations?
A. Jugular venous distention and hepatomegaly
B. Dependent edema and ascites
C. Dyspnea, orthopnea, and crackles in the lung bases
D. Peripheral vasodilation and warm extremities
Correct Answer: C
Rationale: Left ventricular failure causes back-up of blood into the pulmonary
circulation, leading to pulmonary congestion. This manifests as dyspnea
(especially on exertion), orthopnea (difficulty breathing when lying flat), and
crackles due to fluid in the alveoli. Right-sided failure causes systemic venous
congestion (JVD, edema, hepatomegaly).
2. Which of the following neurohormonal responses is characteristic of chronic
heart failure?
A. Decreased renin release and increased natriuretic peptides
B. Activation of the renin-angiotensin-aldosterone system (RAAS) and increased
sympathetic nervous system activity
C. Suppression of antidiuretic hormone (ADH) and decreased aldosterone
D. Decreased circulating catecholamines and vasodilation
Correct Answer: B
Rationale: In heart failure, decreased cardiac output triggers compensatory
mechanisms: RAAS activation (leading to sodium and water retention),
sympathetic nervous system activation (increasing heart rate and
pg. 1
,2
vasoconstriction), and release of ADH. These initially help but ultimately worsen
heart failure through increased preload and afterload.
3. The primary difference between systolic and diastolic heart failure is that
systolic failure involves:
A. Impaired ventricular filling with preserved ejection fraction
B. Reduced ejection fraction due to impaired contractility
C. Normal stroke volume with elevated afterload
D. Increased cardiac output at rest
Correct Answer: B
Rationale: Systolic heart failure (HFrEF) is characterized by a reduced ejection
fraction (<40%) because the ventricle cannot contract effectively. Diastolic heart
failure (HFpEF) involves impaired ventricular relaxation and filling, resulting in a
normal or near-normal ejection fraction but reduced stroke volume.
4. Which of the following best describes the pathophysiology of stable angina?
A. Coronary artery vasospasm at rest
B. Fixed atherosclerotic plaque causing ischemia when myocardial oxygen
demand increases
C. Platelet aggregation and complete thrombotic occlusion
D. Microvascular dysfunction without epicardial coronary disease
Correct Answer: B
Rationale: Stable angina occurs when a stable atherosclerotic plaque narrows a
coronary artery, limiting blood flow. At rest, oxygen supply may be adequate, but
during exertion or stress, increased oxygen demand cannot be met, producing
ischemia and chest pain.
5. A patient with ST-segment elevation myocardial infarction (STEMI) has
complete occlusion of a coronary artery. What is the primary cause of the
occlusion?
pg. 2
,3
A. Vasospasm
B. Atherosclerotic plaque rupture with thrombus formation
C. Embolism from the left atrium
D. Coronary artery dissection
Correct Answer: B
Rationale: In STEMI, an unstable atherosclerotic plaque ruptures, exposing
subendothelial collagen, which triggers platelet adhesion and the coagulation
cascade. The resulting thrombus completely occludes the artery, causing
transmural myocardial necrosis.
6. Which cardiac biomarker is the most specific for myocardial injury?
A. CK-MB
B. Myoglobin
C. Troponin I (cTnI)
D. Lactate dehydrogenase (LDH)
Correct Answer: C
Rationale: Cardiac troponins (I and T) are highly specific to cardiac muscle and are
the gold-standard biomarkers for diagnosing myocardial infarction. CK-MB is less
specific; myoglobin rises early but is not cardiac-specific.
7. A patient with a history of rheumatic heart disease develops new-onset atrial
fibrillation and dyspnea. Which valvular abnormality is most likely?
A. Aortic stenosis
B. Mitral regurgitation
C. Mitral stenosis
D. Tricuspid regurgitation
Correct Answer: C
Rationale: Rheumatic heart disease most commonly affects the mitral valve,
leading to mitral stenosis. The narrowed valve impairs left atrial emptying,
increasing left atrial pressure and size, predisposing to atrial fibrillation. Patients
present with dyspnea, hemoptysis, and later right-sided heart failure.
pg. 3
, 4
8. The hallmark pathophysiologic feature of essential hypertension is:
A. Decreased cardiac output and increased systemic vascular resistance
B. Increased cardiac output and normal systemic vascular resistance
C. Normal cardiac output with decreased systemic vascular resistance
D. Initially increased cardiac output, later increased systemic vascular resistance
Correct Answer: D
Rationale: In early essential hypertension, increased sympathetic activity raises
cardiac output. Over time, the vasculature remodels and systemic vascular
resistance increases, which sustains hypertension even as cardiac output returns
to normal.
9. Which of the following statements regarding the pathophysiology of
atherosclerosis is TRUE?
A. Atherosclerosis begins with endothelial injury and dysfunction.
B. HDL cholesterol is the primary lipoprotein that infiltrates the arterial wall.
C. Smooth muscle cells play no role in atheroma development.
D. Calcification of plaques makes them more prone to rupture.
Correct Answer: A
Rationale: Endothelial injury (from hypertension, smoking, hyperlipidemia, etc.)
initiates the atherosclerotic process. LDL cholesterol infiltrates the intima,
becomes oxidized, and is taken up by macrophages, leading to foam cell
formation. Smooth muscle cells migrate and proliferate, contributing to plaque
stability rather than rupture; calcification actually stabilizes plaques.
10. A 60-year-old patient with long-standing hypertension presents with severe
headache, confusion, and papilledema. Blood pressure is 220/130 mmHg. This
presentation is most consistent with:
A. Hypertensive urgency
B. Hypertensive emergency (malignant hypertension)
pg. 4
