Galen NSG 3850 Exam 2 | Pathophysiology II (2026) Actual Q&A
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1. A patient with chronic hypertension presents with shortness of breath and peripheral edema.
Which pathophysiological process best explains these symptoms?
A) Decreased systemic vascular resistance
B) Left ventricular hypertrophy with subsequent heart failure
C) Right ventricular failure due to pulmonary embolism
D) Increased cardiac output from sympathetic stimulation
Correct Answer: Left ventricular hypertrophy with subsequent heart failure
Rationale: Chronic hypertension increases afterload, forcing the left ventricle to work harder,
leading to left ventricular hypertrophy (LVH). Over time, LVH progresses to diastolic and systolic
dysfunction, resulting in left-sided heart failure. This causes backup into the pulmonary
circulation (dyspnea) and, if prolonged, can lead to right-sided failure and peripheral edema.
2. A myocardial infarction (MI) most commonly results from which pathophysiological event?
A) Vasospasm of a coronary artery
B) Rupture of an atherosclerotic plaque with subsequent thrombus formation
C) Embolism from a left ventricular thrombus
D) Severe anemia leading to hypoxic injury
Correct Answer: Rupture of an atherosclerotic plaque with subsequent thrombus formation
Rationale: The most common cause of an MI is the rupture or erosion of a vulnerable
atherosclerotic plaque. This exposes underlying collagen and tissue factor, leading to platelet
aggregation and thrombus formation that completely occludes the coronary artery, causing
ischemic necrosis of the myocardium.
,3. The Frank-Starling law of the heart states that:
A) Cardiac output is directly proportional to afterload
B) Stroke volume increases in response to an increase in preload
C) Heart rate is inversely proportional to blood pressure
D) Contractility decreases with increased venous return
Correct Answer: Stroke volume increases in response to an increase in preload
Rationale: The Frank-Starling mechanism describes the intrinsic ability of the heart to adapt to
increased venous return. Increased preload (end-diastolic volume) stretches the myocardial
fibers, leading to a more forceful contraction and increased stroke volume.
4. A patient is diagnosed with left-sided heart failure. Which sign is most characteristic of this
condition?
A) Jugular venous distension
B) Hepatomegaly
C) Peripheral pitting edema
D) Pulmonary crackles (rales)
Correct Answer: Pulmonary crackles (rales)
Rationale: Left-sided heart failure results in an inability to pump blood forward, leading to
backup into the pulmonary circulation. This increases pulmonary capillary hydrostatic pressure,
causing fluid to leak into the interstitial spaces and alveoli, resulting in pulmonary congestion,
crackles, and dyspnea.
,5. A patient presents with confusion, lethargy, and a serum sodium level of 118 mEq/L. Which
assessment finding does the nurse anticipate?
A) Weak pulse and hypotension
B) Thirst and dry mucous membranes
C) Seizures and coma
D) Cardiac dysrhythmias and muscle weakness
Correct Answer: Seizures and coma
Rationale: Severe hyponatremia (sodium <120 mEq/L) leads to cerebral edema due to water
shifting into brain cells, resulting in neurological symptoms such as seizures and coma. Thirst
and dry mucous membranes are signs of hypernatremia, while cardiac dysrhythmias are more
characteristic of hyperkalemia or hypokalemia.
6. The fraction of total body water (TBW) contained in the intracellular space in adults is
approximately:
A) Three-fourths
B) Two-thirds
C) One-half
D) One-third
Correct Answer: Two-thirds
Rationale: Approximately two-thirds (65-75%) of total body water is located within the
intracellular fluid (ICF) compartment, which is the primary fluid compartment of the body. The
remaining one-third is in the extracellular space.
7. The amount of gas remaining in the lungs after a maximal expiration is called the:
, A) Residual volume
B) Functional residual capacity
C) Expiratory reserve volume
D) Vital capacity
Correct Answer: Residual volume
Rationale: Residual volume is the amount of gas remaining in the lungs after a maximal
expiration. Functional residual capacity is the amount of gas left at the end of a normal
expiration. Expiratory reserve volume is the amount expired beyond tidal volume. Vital capacity
is the total volume that can be exhaled during maximal expiration.
8. Shifts in the oxyhemoglobin dissociation curve represent:
A) The effect of carbonic anhydrase on the uptake of CO₂
B) The ability of blood to pick up more CO₂ when PaO₂ is low
C) The amount of hydrogen in solution in the blood
D) Changes in hemoglobin affinity for oxygen
Correct Answer: Changes in hemoglobin affinity for oxygen
Rationale: Shifts in the oxyhemoglobin dissociation curve represent changes in hemoglobin
affinity for oxygen. A right shift indicates decreased affinity (more O₂ released to tissues), while
a left shift indicates increased affinity (less O₂ released).
9. Surfactant is a phospholipid that reduces:
A) Pulmonary vascular capacitance
B) Elastic recoil force
C) Alveolar surface tension
1. A patient with chronic hypertension presents with shortness of breath and peripheral edema.
Which pathophysiological process best explains these symptoms?
A) Decreased systemic vascular resistance
B) Left ventricular hypertrophy with subsequent heart failure
C) Right ventricular failure due to pulmonary embolism
D) Increased cardiac output from sympathetic stimulation
Correct Answer: Left ventricular hypertrophy with subsequent heart failure
Rationale: Chronic hypertension increases afterload, forcing the left ventricle to work harder,
leading to left ventricular hypertrophy (LVH). Over time, LVH progresses to diastolic and systolic
dysfunction, resulting in left-sided heart failure. This causes backup into the pulmonary
circulation (dyspnea) and, if prolonged, can lead to right-sided failure and peripheral edema.
2. A myocardial infarction (MI) most commonly results from which pathophysiological event?
A) Vasospasm of a coronary artery
B) Rupture of an atherosclerotic plaque with subsequent thrombus formation
C) Embolism from a left ventricular thrombus
D) Severe anemia leading to hypoxic injury
Correct Answer: Rupture of an atherosclerotic plaque with subsequent thrombus formation
Rationale: The most common cause of an MI is the rupture or erosion of a vulnerable
atherosclerotic plaque. This exposes underlying collagen and tissue factor, leading to platelet
aggregation and thrombus formation that completely occludes the coronary artery, causing
ischemic necrosis of the myocardium.
,3. The Frank-Starling law of the heart states that:
A) Cardiac output is directly proportional to afterload
B) Stroke volume increases in response to an increase in preload
C) Heart rate is inversely proportional to blood pressure
D) Contractility decreases with increased venous return
Correct Answer: Stroke volume increases in response to an increase in preload
Rationale: The Frank-Starling mechanism describes the intrinsic ability of the heart to adapt to
increased venous return. Increased preload (end-diastolic volume) stretches the myocardial
fibers, leading to a more forceful contraction and increased stroke volume.
4. A patient is diagnosed with left-sided heart failure. Which sign is most characteristic of this
condition?
A) Jugular venous distension
B) Hepatomegaly
C) Peripheral pitting edema
D) Pulmonary crackles (rales)
Correct Answer: Pulmonary crackles (rales)
Rationale: Left-sided heart failure results in an inability to pump blood forward, leading to
backup into the pulmonary circulation. This increases pulmonary capillary hydrostatic pressure,
causing fluid to leak into the interstitial spaces and alveoli, resulting in pulmonary congestion,
crackles, and dyspnea.
,5. A patient presents with confusion, lethargy, and a serum sodium level of 118 mEq/L. Which
assessment finding does the nurse anticipate?
A) Weak pulse and hypotension
B) Thirst and dry mucous membranes
C) Seizures and coma
D) Cardiac dysrhythmias and muscle weakness
Correct Answer: Seizures and coma
Rationale: Severe hyponatremia (sodium <120 mEq/L) leads to cerebral edema due to water
shifting into brain cells, resulting in neurological symptoms such as seizures and coma. Thirst
and dry mucous membranes are signs of hypernatremia, while cardiac dysrhythmias are more
characteristic of hyperkalemia or hypokalemia.
6. The fraction of total body water (TBW) contained in the intracellular space in adults is
approximately:
A) Three-fourths
B) Two-thirds
C) One-half
D) One-third
Correct Answer: Two-thirds
Rationale: Approximately two-thirds (65-75%) of total body water is located within the
intracellular fluid (ICF) compartment, which is the primary fluid compartment of the body. The
remaining one-third is in the extracellular space.
7. The amount of gas remaining in the lungs after a maximal expiration is called the:
, A) Residual volume
B) Functional residual capacity
C) Expiratory reserve volume
D) Vital capacity
Correct Answer: Residual volume
Rationale: Residual volume is the amount of gas remaining in the lungs after a maximal
expiration. Functional residual capacity is the amount of gas left at the end of a normal
expiration. Expiratory reserve volume is the amount expired beyond tidal volume. Vital capacity
is the total volume that can be exhaled during maximal expiration.
8. Shifts in the oxyhemoglobin dissociation curve represent:
A) The effect of carbonic anhydrase on the uptake of CO₂
B) The ability of blood to pick up more CO₂ when PaO₂ is low
C) The amount of hydrogen in solution in the blood
D) Changes in hemoglobin affinity for oxygen
Correct Answer: Changes in hemoglobin affinity for oxygen
Rationale: Shifts in the oxyhemoglobin dissociation curve represent changes in hemoglobin
affinity for oxygen. A right shift indicates decreased affinity (more O₂ released to tissues), while
a left shift indicates increased affinity (less O₂ released).
9. Surfactant is a phospholipid that reduces:
A) Pulmonary vascular capacitance
B) Elastic recoil force
C) Alveolar surface tension
