NUR 376 Exam 3 – Applied Pathophysiology –
(2026) Actual Questions & Answers (Concordia)
100% Guarantee Pass
SECTION 1: NEUROLOGICAL PATHOPHYSIOLOGY
1. A patient presents with muscle weakness, atrophy, spasticity, and difficulty
swallowing. The nurse suspects ALS. Which pathophysiological process is most
consistent with this presentation?
• A) Autoimmune demyelination of the central nervous system
• B) Degeneration of both upper and lower motor neurons
• C) Loss of dopamine-producing neurons in the substantia nigra
• D) Autoimmune destruction of acetylcholine receptors at the
neuromuscular junction
Answer: B) Degeneration of both upper and lower motor neurons
Rationale: Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative
disease affecting both upper motor neurons (causing spasticity and hyperreflexia)
and lower motor neurons (causing muscle weakness, atrophy, and fasciculations).
The degeneration leads to progressive paralysis and respiratory failure. Glutamate
excitotoxicity and genetic factors (SOD1 mutations) contribute to neuronal injury
and death .
2. A nurse is comparing Multiple Sclerosis (MS) and Amyotrophic Lateral
Sclerosis (ALS). Which statement accurately describes a key difference?
• A) ALS primarily affects sensory pathways; MS primarily affects motor
pathways
, • B) ALS affects both upper and lower motor neurons; MS affects the myelin
sheath in the CNS
• C) MS causes muscle atrophy; ALS causes demyelination
• D) ALS has a relapsing-remitting course; MS is rapidly progressive and fatal
Answer: B) ALS affects both upper and lower motor neurons; MS affects the
myelin sheath in the CNS
Rationale: ALS is a motor neuron disease causing degeneration of both upper and
lower motor neurons leading to muscle weakness, atrophy, spasticity, and
respiratory failure. MS is an autoimmune disorder characterized by inflammatory
demyelination, gliosis, and axonal damage in the CNS (brain and spinal cord). MS
has a variable relapsing-remitting or progressive course .
3. A patient is diagnosed with Multiple Sclerosis (MS). The nurse understands
that the pathophysiology of MS involves:
• A) Loss of dopamine in the substantia nigra
• B) Autoimmune destruction of acetylcholine receptors
• C) Inflammatory demyelination and axonal degeneration in the CNS
• D) Degeneration of motor neurons in the spinal cord
Answer: C) Inflammatory demyelination and axonal degeneration in the CNS
Rationale: MS is a chronic autoimmune disorder characterized by inflammatory
demyelination, gliosis, and axonal damage throughout the white and gray matter
of the central nervous system. This leads to motor weakness, sensory disturbances,
visual problems (optic neuritis), fatigue, and cognitive changes .
4. Which clinical manifestation is most characteristic of Parkinson's Disease?
• A) Muscle weakness and atrophy
, • B) Resting tremor, rigidity, and bradykinesia
• C) Sensory disturbances and visual problems
• D) Difficulty swallowing and respiratory failure
Answer: B) Resting tremor, rigidity, and bradykinesia
Rationale: Parkinson's Disease features progressive loss of dopamine-producing
neurons in the substantia nigra pars compacta. This disrupts basal ganglia
signaling, causing classic motor signs: resting tremor, rigidity, bradykinesia, and
postural instability. Non-motor symptoms include depression, cognitive
impairment, and autonomic dysfunction .
5. In Parkinson's Disease, the primary neurotransmitter deficiency is:
• A) Acetylcholine
• B) Serotonin
• C) Dopamine
• D) Norepinephrine
Answer: C) Dopamine
Rationale: Parkinson's Disease is characterized by a deficiency of dopamine in the
substantia nigra and striatum due to progressive loss of dopaminergic neurons.
This leads to an imbalance between dopamine and acetylcholine in the basal
ganglia, resulting in the classic motor symptoms of tremor, rigidity, bradykinesia,
and postural instability .
6. A patient with a severe head injury is showing signs of increased intracranial
pressure (ICP). The earliest sign of increased ICP is:
• A) Cushing's triad
• B) Papilledema
, • C) Decreased level of consciousness
• D) Fixed and dilated pupils
Answer: C) Decreased level of consciousness
Rationale: A decreasing level of consciousness is the most reliable and earliest sign
of increased ICP. Early signs include irritability, restlessness, decreased mental
status, drowsiness, and flat affect. As ICP increases, the patient may develop
headache (constant, from meningeal stretching), vomiting without nausea
(pressure on the medulla), and eventually Cushing's triad (hypertension with wide
pulse pressure, bradycardia, and bradypnea) .
7. A patient with increased ICP is exhibiting Cushing's triad. Which assessment
findings support this?
• A) Hypertension, bradycardia, and bradypnea
• B) Hypotension, tachycardia, and tachypnea
• C) Hypertension, tachycardia, and tachypnea
• D) Hypotension, bradycardia, and bradypnea
Answer: A) Hypertension, bradycardia, and bradypnea
Rationale: Cushing's triad is a set of vital sign changes that occur as a late sign of
increased ICP: hypertension with a wide pulse pressure, bradycardia (slowed heart
rate), and bradypnea (irregular respirations). This occurs as pressure on the brain
stem increases, indicating impending herniation and is a medical emergency .
8. A patient with increased ICP has fixed and dilated pupils that are unequal.
This indicates pressure on which cranial nerve?
• A) Cranial nerve II (Optic)
• B) Cranial nerve III (Oculomotor)
(2026) Actual Questions & Answers (Concordia)
100% Guarantee Pass
SECTION 1: NEUROLOGICAL PATHOPHYSIOLOGY
1. A patient presents with muscle weakness, atrophy, spasticity, and difficulty
swallowing. The nurse suspects ALS. Which pathophysiological process is most
consistent with this presentation?
• A) Autoimmune demyelination of the central nervous system
• B) Degeneration of both upper and lower motor neurons
• C) Loss of dopamine-producing neurons in the substantia nigra
• D) Autoimmune destruction of acetylcholine receptors at the
neuromuscular junction
Answer: B) Degeneration of both upper and lower motor neurons
Rationale: Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative
disease affecting both upper motor neurons (causing spasticity and hyperreflexia)
and lower motor neurons (causing muscle weakness, atrophy, and fasciculations).
The degeneration leads to progressive paralysis and respiratory failure. Glutamate
excitotoxicity and genetic factors (SOD1 mutations) contribute to neuronal injury
and death .
2. A nurse is comparing Multiple Sclerosis (MS) and Amyotrophic Lateral
Sclerosis (ALS). Which statement accurately describes a key difference?
• A) ALS primarily affects sensory pathways; MS primarily affects motor
pathways
, • B) ALS affects both upper and lower motor neurons; MS affects the myelin
sheath in the CNS
• C) MS causes muscle atrophy; ALS causes demyelination
• D) ALS has a relapsing-remitting course; MS is rapidly progressive and fatal
Answer: B) ALS affects both upper and lower motor neurons; MS affects the
myelin sheath in the CNS
Rationale: ALS is a motor neuron disease causing degeneration of both upper and
lower motor neurons leading to muscle weakness, atrophy, spasticity, and
respiratory failure. MS is an autoimmune disorder characterized by inflammatory
demyelination, gliosis, and axonal damage in the CNS (brain and spinal cord). MS
has a variable relapsing-remitting or progressive course .
3. A patient is diagnosed with Multiple Sclerosis (MS). The nurse understands
that the pathophysiology of MS involves:
• A) Loss of dopamine in the substantia nigra
• B) Autoimmune destruction of acetylcholine receptors
• C) Inflammatory demyelination and axonal degeneration in the CNS
• D) Degeneration of motor neurons in the spinal cord
Answer: C) Inflammatory demyelination and axonal degeneration in the CNS
Rationale: MS is a chronic autoimmune disorder characterized by inflammatory
demyelination, gliosis, and axonal damage throughout the white and gray matter
of the central nervous system. This leads to motor weakness, sensory disturbances,
visual problems (optic neuritis), fatigue, and cognitive changes .
4. Which clinical manifestation is most characteristic of Parkinson's Disease?
• A) Muscle weakness and atrophy
, • B) Resting tremor, rigidity, and bradykinesia
• C) Sensory disturbances and visual problems
• D) Difficulty swallowing and respiratory failure
Answer: B) Resting tremor, rigidity, and bradykinesia
Rationale: Parkinson's Disease features progressive loss of dopamine-producing
neurons in the substantia nigra pars compacta. This disrupts basal ganglia
signaling, causing classic motor signs: resting tremor, rigidity, bradykinesia, and
postural instability. Non-motor symptoms include depression, cognitive
impairment, and autonomic dysfunction .
5. In Parkinson's Disease, the primary neurotransmitter deficiency is:
• A) Acetylcholine
• B) Serotonin
• C) Dopamine
• D) Norepinephrine
Answer: C) Dopamine
Rationale: Parkinson's Disease is characterized by a deficiency of dopamine in the
substantia nigra and striatum due to progressive loss of dopaminergic neurons.
This leads to an imbalance between dopamine and acetylcholine in the basal
ganglia, resulting in the classic motor symptoms of tremor, rigidity, bradykinesia,
and postural instability .
6. A patient with a severe head injury is showing signs of increased intracranial
pressure (ICP). The earliest sign of increased ICP is:
• A) Cushing's triad
• B) Papilledema
, • C) Decreased level of consciousness
• D) Fixed and dilated pupils
Answer: C) Decreased level of consciousness
Rationale: A decreasing level of consciousness is the most reliable and earliest sign
of increased ICP. Early signs include irritability, restlessness, decreased mental
status, drowsiness, and flat affect. As ICP increases, the patient may develop
headache (constant, from meningeal stretching), vomiting without nausea
(pressure on the medulla), and eventually Cushing's triad (hypertension with wide
pulse pressure, bradycardia, and bradypnea) .
7. A patient with increased ICP is exhibiting Cushing's triad. Which assessment
findings support this?
• A) Hypertension, bradycardia, and bradypnea
• B) Hypotension, tachycardia, and tachypnea
• C) Hypertension, tachycardia, and tachypnea
• D) Hypotension, bradycardia, and bradypnea
Answer: A) Hypertension, bradycardia, and bradypnea
Rationale: Cushing's triad is a set of vital sign changes that occur as a late sign of
increased ICP: hypertension with a wide pulse pressure, bradycardia (slowed heart
rate), and bradypnea (irregular respirations). This occurs as pressure on the brain
stem increases, indicating impending herniation and is a medical emergency .
8. A patient with increased ICP has fixed and dilated pupils that are unequal.
This indicates pressure on which cranial nerve?
• A) Cranial nerve II (Optic)
• B) Cranial nerve III (Oculomotor)
