NR283 Exam 3 Actual Exam Style V3 | NR
283 Pathophysiology | Chamberlain
1. A patient presents with a blood glucose level of 850 mg/dL, severe dehydration, and no
detectable ketones in the urine. Which condition is most consistent with these findings?
A. Diabetic Ketoacidosis (DKA)
B. Hyperosmolar Hyperglycemic State (HHS)
C. Somogyi Effect
D. Metabolic Acidosis
Correct Answer: B
Expert Explanation: HHS is characterized by extreme hyperglycemia and profound
dehydration without significant ketosis. This occurs because there is just enough insulin to
prevent fat breakdown but not enough to regulate glucose. It is more common in Type 2
Diabetes patients who experience severe physiological stress.
2. Which clinical manifestation is a hallmark sign of Nephrotic Syndrome due to increased
glomerular permeability?
A. Generalized edema (anasarca)
B. Gross hematuria
C. Elevated serum albumin
D. Decreased serum lipids
,Correct Answer: A
Expert Explanation: Nephrotic Syndrome involves the loss of massive amounts of protein
in the urine, leading to hypoalbuminemia. This decrease in serum oncotic pressure causes
fluid to shift from the vascular space to the interstitium, resulting in severe generalized
edema. Patients often exhibit frothy urine due to the high protein content.
3. A patient with Chronic Kidney Disease (CKD) has a GFR of 12 mL/min/1.73m². How should
the nurse classify this stage of kidney failure?
A. Stage 3
B. Stage 4
C. Stage 2
D. Stage 5
Correct Answer: D
Expert Explanation: Stage 5 CKD is defined by a Glomerular Filtration Rate (GFR) of less
than 15 mL/min/1.73m². This stage is also known as End-Stage Renal Disease (ESRD) and
requires dialysis or transplant for survival. At this point, the kidneys have nearly
completely lost their ability to filter waste and maintain fluid balance.
4. Which pathophysiology explains the development of esophageal varices in patients with
liver cirrhosis?
A. Portal hypertension
B. Decreased production of clotting factors
, C. Biliary obstruction
D. Hypoalbuminemia
Correct Answer: A
Expert Explanation: Portal hypertension results from the obstruction of blood flow
through the scarred, cirrhotic liver. This increased pressure forces blood into collateral
vessels, such as those in the esophagus, which are thin-walled and not designed for high
pressure. Over time, these vessels become distended and fragile, creating a high risk for
life-threatening hemorrhage.
5. Which assessment finding would the nurse expect in a patient experiencing an Addisonian
Crisis?
A. Hypertension and hypernatremia
B. Hyperglycemia and hypokalemia
C. Weight gain and moon face
D. Hypotension and hyperkalemia
Correct Answer: D
Expert Explanation: An Addisonian crisis is an acute adrenal insufficiency characterized
by low levels of cortisol and aldosterone. This leads to severe hypotension due to sodium
loss and water depletion, as well as hyperkalemia. It is a medical emergency that requires
immediate corticosteroid and fluid replacement.
283 Pathophysiology | Chamberlain
1. A patient presents with a blood glucose level of 850 mg/dL, severe dehydration, and no
detectable ketones in the urine. Which condition is most consistent with these findings?
A. Diabetic Ketoacidosis (DKA)
B. Hyperosmolar Hyperglycemic State (HHS)
C. Somogyi Effect
D. Metabolic Acidosis
Correct Answer: B
Expert Explanation: HHS is characterized by extreme hyperglycemia and profound
dehydration without significant ketosis. This occurs because there is just enough insulin to
prevent fat breakdown but not enough to regulate glucose. It is more common in Type 2
Diabetes patients who experience severe physiological stress.
2. Which clinical manifestation is a hallmark sign of Nephrotic Syndrome due to increased
glomerular permeability?
A. Generalized edema (anasarca)
B. Gross hematuria
C. Elevated serum albumin
D. Decreased serum lipids
,Correct Answer: A
Expert Explanation: Nephrotic Syndrome involves the loss of massive amounts of protein
in the urine, leading to hypoalbuminemia. This decrease in serum oncotic pressure causes
fluid to shift from the vascular space to the interstitium, resulting in severe generalized
edema. Patients often exhibit frothy urine due to the high protein content.
3. A patient with Chronic Kidney Disease (CKD) has a GFR of 12 mL/min/1.73m². How should
the nurse classify this stage of kidney failure?
A. Stage 3
B. Stage 4
C. Stage 2
D. Stage 5
Correct Answer: D
Expert Explanation: Stage 5 CKD is defined by a Glomerular Filtration Rate (GFR) of less
than 15 mL/min/1.73m². This stage is also known as End-Stage Renal Disease (ESRD) and
requires dialysis or transplant for survival. At this point, the kidneys have nearly
completely lost their ability to filter waste and maintain fluid balance.
4. Which pathophysiology explains the development of esophageal varices in patients with
liver cirrhosis?
A. Portal hypertension
B. Decreased production of clotting factors
, C. Biliary obstruction
D. Hypoalbuminemia
Correct Answer: A
Expert Explanation: Portal hypertension results from the obstruction of blood flow
through the scarred, cirrhotic liver. This increased pressure forces blood into collateral
vessels, such as those in the esophagus, which are thin-walled and not designed for high
pressure. Over time, these vessels become distended and fragile, creating a high risk for
life-threatening hemorrhage.
5. Which assessment finding would the nurse expect in a patient experiencing an Addisonian
Crisis?
A. Hypertension and hypernatremia
B. Hyperglycemia and hypokalemia
C. Weight gain and moon face
D. Hypotension and hyperkalemia
Correct Answer: D
Expert Explanation: An Addisonian crisis is an acute adrenal insufficiency characterized
by low levels of cortisol and aldosterone. This leads to severe hypotension due to sodium
loss and water depletion, as well as hyperkalemia. It is a medical emergency that requires
immediate corticosteroid and fluid replacement.
