NURS 115 Prelicensure Pathophysiology
Final Assessment Review
Questions & Solutions
2025
©2025
, 1. A 58‑year‑old male presents with crushing retrosternal chest pain
radiating to his left arm, diaphoresis, and dyspnea. His ECG shows
ST‑segment elevations in the anterior leads. Which pathophysiologic
event most likely precipitated his myocardial infarction?
A. Coronary artery vasospasm
B. Plaque rupture with subsequent thrombosis
C. Transient electrical instability without structural damage
D. Microembolization from aortic plaques
> Correct ANS: B. Plaque rupture with subsequent thrombosis
> Rationale: In myocardial infarction, especially in a case with
ST‑segment changes, atherosclerotic plaque rupture with superimposed
thrombosis is the classic mechanism leading to occlusion of a coronary
artery and myocardial ischemia.
---
2. A 24‑year‑old woman with type 1 diabetes presents to the
emergency department with abdominal pain, rapid breathing, and a
fruity odor on her breath. Laboratory values reveal a high anion gap
metabolic acidosis. What is the primary pathophysiologic mechanism
responsible for her condition?
A. Accumulation of lactic acid due to hypoperfusion
B. Overproduction of ketone bodies resulting from insulin deficiency
C. Renal failure leading to acid retention
D. Excessive ingestion of acidic substances
> Correct ANS: B. Overproduction of ketone bodies resulting from
insulin deficiency
> Rationale: In diabetic ketoacidosis, insulin deficiency forces
increased lipolysis and ketogenesis, leading to the accumulation of
ketone bodies and a high anion gap metabolic acidosis.
©2025
,---
3. A septic patient in the intensive care unit exhibits hypotension,
tachycardia, and warm extremities. Which of the following inflammatory
cytokines is most prominently associated with the vasodilation seen in
septic shock?
A. Interleukin‑1 (IL‑1)
B. Tumor necrosis factor‑alpha (TNF‑α)
C. Interleukin‑10 (IL‑10)
D. Interferon‑gamma (IFN‑γ)
> Correct ANS: B. Tumor necrosis factor‑alpha (TNF‑α)
> Rationale: TNF‑α is a key mediator in sepsis; it induces widespread
vasodilation and increased vascular permeability, leading to hypotension
in septic shock.
---
4. A 65‑year‑old patient with a history of hypertension is admitted
with signs of acute kidney injury. The nurse notes generalized edema and
laboratory findings of hyperkalemia and metabolic acidosis. Which
pathophysiologic process is most likely responsible?
A. Reduced glomerular filtration with retention of metabolic wastes and
electrolytes
B. Overactivation of the renin‑angiotensin‑aldosterone system (RAAS)
leading to sodium retention
C. Direct immune‑mediated tubular injury
D. Increased renal clearance secondary to diuretic therapy
> Correct ANS: A. Reduced glomerular filtration with retention of
metabolic wastes and electrolytes
> Rationale: In acute kidney injury, a decline in glomerular filtration
rate results in the retention of metabolic byproducts (including
potassium), fluid overload, and acid–base imbalances.
©2025
, ---
5. A patient with chronic obstructive pulmonary disease (COPD) is
experiencing an exacerbation. Which gas exchange abnormality is most
frequently observed in these patients?
A. Hypoxemia with hypercapnia
B. Hyperoxemia with hypocapnia
C. Normoxemia with normocapnia
D. Hypoxemia with hypocapnia
> Correct ANS: A. Hypoxemia with hypercapnia
> Rationale: In COPD exacerbations, obstructive airway changes lead
to impaired ventilation. As a result, patients often develop hypoxemia
(low oxygen) and hypercapnia (elevated carbon dioxide), particularly in
advanced stages.
---
6. A 45‑year‑old patient is diagnosed with acute respiratory distress
syndrome (ARDS) following severe pneumonia. Which pathophysiologic
mechanism best explains the development of ARDS in this context?
A. Direct alveolar epithelial injury causing diffuse alveolar damage
B. Increased pulmonary surfactant production leading to alveolar
collapse
C. Chronic narrowing of the bronchial airways
D. Overactivation of the sympathetic nervous system
> Correct ANS: A. Direct alveolar epithelial injury causing diffuse
alveolar damage
> Rationale: ARDS is initiated by injury to the alveolar–capillary
membrane, leading to increased permeability, diffuse alveolar damage,
and subsequent pulmonary edema.
---
©2025
Final Assessment Review
Questions & Solutions
2025
©2025
, 1. A 58‑year‑old male presents with crushing retrosternal chest pain
radiating to his left arm, diaphoresis, and dyspnea. His ECG shows
ST‑segment elevations in the anterior leads. Which pathophysiologic
event most likely precipitated his myocardial infarction?
A. Coronary artery vasospasm
B. Plaque rupture with subsequent thrombosis
C. Transient electrical instability without structural damage
D. Microembolization from aortic plaques
> Correct ANS: B. Plaque rupture with subsequent thrombosis
> Rationale: In myocardial infarction, especially in a case with
ST‑segment changes, atherosclerotic plaque rupture with superimposed
thrombosis is the classic mechanism leading to occlusion of a coronary
artery and myocardial ischemia.
---
2. A 24‑year‑old woman with type 1 diabetes presents to the
emergency department with abdominal pain, rapid breathing, and a
fruity odor on her breath. Laboratory values reveal a high anion gap
metabolic acidosis. What is the primary pathophysiologic mechanism
responsible for her condition?
A. Accumulation of lactic acid due to hypoperfusion
B. Overproduction of ketone bodies resulting from insulin deficiency
C. Renal failure leading to acid retention
D. Excessive ingestion of acidic substances
> Correct ANS: B. Overproduction of ketone bodies resulting from
insulin deficiency
> Rationale: In diabetic ketoacidosis, insulin deficiency forces
increased lipolysis and ketogenesis, leading to the accumulation of
ketone bodies and a high anion gap metabolic acidosis.
©2025
,---
3. A septic patient in the intensive care unit exhibits hypotension,
tachycardia, and warm extremities. Which of the following inflammatory
cytokines is most prominently associated with the vasodilation seen in
septic shock?
A. Interleukin‑1 (IL‑1)
B. Tumor necrosis factor‑alpha (TNF‑α)
C. Interleukin‑10 (IL‑10)
D. Interferon‑gamma (IFN‑γ)
> Correct ANS: B. Tumor necrosis factor‑alpha (TNF‑α)
> Rationale: TNF‑α is a key mediator in sepsis; it induces widespread
vasodilation and increased vascular permeability, leading to hypotension
in septic shock.
---
4. A 65‑year‑old patient with a history of hypertension is admitted
with signs of acute kidney injury. The nurse notes generalized edema and
laboratory findings of hyperkalemia and metabolic acidosis. Which
pathophysiologic process is most likely responsible?
A. Reduced glomerular filtration with retention of metabolic wastes and
electrolytes
B. Overactivation of the renin‑angiotensin‑aldosterone system (RAAS)
leading to sodium retention
C. Direct immune‑mediated tubular injury
D. Increased renal clearance secondary to diuretic therapy
> Correct ANS: A. Reduced glomerular filtration with retention of
metabolic wastes and electrolytes
> Rationale: In acute kidney injury, a decline in glomerular filtration
rate results in the retention of metabolic byproducts (including
potassium), fluid overload, and acid–base imbalances.
©2025
, ---
5. A patient with chronic obstructive pulmonary disease (COPD) is
experiencing an exacerbation. Which gas exchange abnormality is most
frequently observed in these patients?
A. Hypoxemia with hypercapnia
B. Hyperoxemia with hypocapnia
C. Normoxemia with normocapnia
D. Hypoxemia with hypocapnia
> Correct ANS: A. Hypoxemia with hypercapnia
> Rationale: In COPD exacerbations, obstructive airway changes lead
to impaired ventilation. As a result, patients often develop hypoxemia
(low oxygen) and hypercapnia (elevated carbon dioxide), particularly in
advanced stages.
---
6. A 45‑year‑old patient is diagnosed with acute respiratory distress
syndrome (ARDS) following severe pneumonia. Which pathophysiologic
mechanism best explains the development of ARDS in this context?
A. Direct alveolar epithelial injury causing diffuse alveolar damage
B. Increased pulmonary surfactant production leading to alveolar
collapse
C. Chronic narrowing of the bronchial airways
D. Overactivation of the sympathetic nervous system
> Correct ANS: A. Direct alveolar epithelial injury causing diffuse
alveolar damage
> Rationale: ARDS is initiated by injury to the alveolar–capillary
membrane, leading to increased permeability, diffuse alveolar damage,
and subsequent pulmonary edema.
---
©2025
