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NUR 631 Advanced Physiology Pathophysiology
Midterm Newest Exam Preparation With Complete
Questions And Correct Answers With Rationales
Already Graded A+Brand New Version!!
Question 1
A 65-year-old male with a history of hypertension presents with
complaints of progressive shortness of breath and peripheral edema.
His echocardiogram reveals left ventricular hypertrophy with a
preserved ejection fraction. Which of the following pathophysiological
mechanisms best explains his clinical presentation?
A) Increased afterload leading to concentric hypertrophy and diastolic
dysfunction
B) Volume overload leading to eccentric hypertrophy and systolic
dysfunction
C) Decreased cardiac output leading to activation of the renin-
angiotensin-aldosterone system
D) Myocardial ischemia leading to apoptosis and fibrosis of the
ventricular wall
Answer: A
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Explanation: Chronic hypertension increases afterload, which causes the
left ventricle to adapt through concentric hypertrophy (increase in wall
thickness without chamber dilation). This leads to diastolic dysfunction
characterized by impaired relaxation and filling, resulting in symptoms
of heart failure with preserved ejection fraction (HFpEF). The
hypertrophy is a compensatory mechanism to normalize wall stress, but
over time it becomes maladaptive, causing stiffness and reduced
compliance.
Question 2
A patient with chronic obstructive pulmonary disease (COPD) has
arterial blood gas values of pH 7.32, PaCO2 58 mmHg, and HCO3- 28
mEq/L. Which of the following best describes the acid-base
disturbance?
A) Acute respiratory acidosis with no renal compensation
B) Chronic respiratory acidosis with partial renal compensation
C) Metabolic acidosis with respiratory compensation
D) Mixed respiratory and metabolic acidosis
Answer: B
Explanation: The patient has respiratory acidosis as indicated by
elevated PaCO2 (greater than 45 mmHg) and decreased pH. The HCO3-
is elevated above normal (22-26 mEq/L), indicating renal compensation
that has been occurring over time (chronic process). In acute respiratory
acidosis, HCO3- would increase by only 1 mEq/L for every 10 mmHg rise
in PaCO2; here the elevation is more substantial, suggesting chronic
compensation.
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Question 3
In a patient with septic shock, which of the following hemodynamic
parameters would most likely be observed?
A) Decreased cardiac output and increased systemic vascular resistance
B) Increased cardiac output and decreased systemic vascular resistance
C) Decreased cardiac output and decreased systemic vascular
resistance
D) Increased cardiac output and increased systemic vascular resistance
Answer: B
Explanation: Septic shock is characterized by a hyperdynamic state with
increased cardiac output due to systemic vasodilation and reduced
afterload. The release of inflammatory mediators such as nitric oxide
and prostaglandins causes profound vasodilation, leading to decreased
systemic vascular resistance (SVR). Despite the increased cardiac
output, tissue perfusion is compromised due to maldistribution of blood
flow and microvascular dysfunction.
Question 4
Which of the following best describes the mechanism of action of loop
diuretics such as furosemide?
A) Inhibition of sodium-potassium-chloride cotransporter in the thick
ascending loop of Henle
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B) Inhibition of sodium-chloride cotransporter in the distal convoluted
tubule
C) Antagonism of aldosterone receptors in the collecting duct
D) Inhibition of carbonic anhydrase in the proximal convoluted tubule
Answer: A
Explanation: Loop diuretics inhibit the Na+-K+-2Cl- cotransporter
(NKCC2) located on the luminal membrane of the thick ascending limb
of the loop of Henle. This reduces the reabsorption of sodium,
potassium, and chloride, leading to increased excretion of these ions
and water. The thick ascending limb is responsible for reabsorbing
approximately 25% of filtered sodium, making loop diuretics highly
efficacious.
Question 5
A 45-year-old female presents with fatigue, weight gain, cold
intolerance, and constipation. Laboratory evaluation reveals elevated
TSH and low free T4 levels. Which of the following is the most likely
diagnosis?
A) Graves disease
B) Hashimoto thyroiditis
C) Toxic multinodular goiter
D) Pituitary adenoma
Answer: B
NUR 631 Advanced Physiology Pathophysiology
Midterm Newest Exam Preparation With Complete
Questions And Correct Answers With Rationales
Already Graded A+Brand New Version!!
Question 1
A 65-year-old male with a history of hypertension presents with
complaints of progressive shortness of breath and peripheral edema.
His echocardiogram reveals left ventricular hypertrophy with a
preserved ejection fraction. Which of the following pathophysiological
mechanisms best explains his clinical presentation?
A) Increased afterload leading to concentric hypertrophy and diastolic
dysfunction
B) Volume overload leading to eccentric hypertrophy and systolic
dysfunction
C) Decreased cardiac output leading to activation of the renin-
angiotensin-aldosterone system
D) Myocardial ischemia leading to apoptosis and fibrosis of the
ventricular wall
Answer: A
,2|Page
Explanation: Chronic hypertension increases afterload, which causes the
left ventricle to adapt through concentric hypertrophy (increase in wall
thickness without chamber dilation). This leads to diastolic dysfunction
characterized by impaired relaxation and filling, resulting in symptoms
of heart failure with preserved ejection fraction (HFpEF). The
hypertrophy is a compensatory mechanism to normalize wall stress, but
over time it becomes maladaptive, causing stiffness and reduced
compliance.
Question 2
A patient with chronic obstructive pulmonary disease (COPD) has
arterial blood gas values of pH 7.32, PaCO2 58 mmHg, and HCO3- 28
mEq/L. Which of the following best describes the acid-base
disturbance?
A) Acute respiratory acidosis with no renal compensation
B) Chronic respiratory acidosis with partial renal compensation
C) Metabolic acidosis with respiratory compensation
D) Mixed respiratory and metabolic acidosis
Answer: B
Explanation: The patient has respiratory acidosis as indicated by
elevated PaCO2 (greater than 45 mmHg) and decreased pH. The HCO3-
is elevated above normal (22-26 mEq/L), indicating renal compensation
that has been occurring over time (chronic process). In acute respiratory
acidosis, HCO3- would increase by only 1 mEq/L for every 10 mmHg rise
in PaCO2; here the elevation is more substantial, suggesting chronic
compensation.
,3|Page
Question 3
In a patient with septic shock, which of the following hemodynamic
parameters would most likely be observed?
A) Decreased cardiac output and increased systemic vascular resistance
B) Increased cardiac output and decreased systemic vascular resistance
C) Decreased cardiac output and decreased systemic vascular
resistance
D) Increased cardiac output and increased systemic vascular resistance
Answer: B
Explanation: Septic shock is characterized by a hyperdynamic state with
increased cardiac output due to systemic vasodilation and reduced
afterload. The release of inflammatory mediators such as nitric oxide
and prostaglandins causes profound vasodilation, leading to decreased
systemic vascular resistance (SVR). Despite the increased cardiac
output, tissue perfusion is compromised due to maldistribution of blood
flow and microvascular dysfunction.
Question 4
Which of the following best describes the mechanism of action of loop
diuretics such as furosemide?
A) Inhibition of sodium-potassium-chloride cotransporter in the thick
ascending loop of Henle
, 4|Page
B) Inhibition of sodium-chloride cotransporter in the distal convoluted
tubule
C) Antagonism of aldosterone receptors in the collecting duct
D) Inhibition of carbonic anhydrase in the proximal convoluted tubule
Answer: A
Explanation: Loop diuretics inhibit the Na+-K+-2Cl- cotransporter
(NKCC2) located on the luminal membrane of the thick ascending limb
of the loop of Henle. This reduces the reabsorption of sodium,
potassium, and chloride, leading to increased excretion of these ions
and water. The thick ascending limb is responsible for reabsorbing
approximately 25% of filtered sodium, making loop diuretics highly
efficacious.
Question 5
A 45-year-old female presents with fatigue, weight gain, cold
intolerance, and constipation. Laboratory evaluation reveals elevated
TSH and low free T4 levels. Which of the following is the most likely
diagnosis?
A) Graves disease
B) Hashimoto thyroiditis
C) Toxic multinodular goiter
D) Pituitary adenoma
Answer: B
