NU 621 ADVANCED PATHOPHYSIOLOGY EXAM HERZING UNI 2024, Exams of Nursing

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NU 621

Advanced

Pathophysiology

COMPLETED EXAM

1. A 65-year-old man with a history of hypertension, diabetes, and chronic kidney disease presents to the emergency department with shortness of breath, chest pain, and palpitations. He is diagnosed with atrial fibrillation and is started on anticoagulation therapy. Which of the following is the most likely underlying pathophysiological mechanism of his atrial fibrillation? A) Increased sympathetic tone B) Electrical reentry C) Myocardial ischemia D) Ventricular hypertrophy Answer: B) Electrical reentry Rationale: Atrial fibrillation is a common arrhythmia that results from multiple reentrant wavelets of electrical activity in the atria, causing irregular and rapid atrial contractions. The reentry can be triggered by factors such as hypertension, diabetes, ischemia, inflammation, or electrolyte imbalance, which alter the atrial tissue properties and create areas of slow conduction or unidirectional block. Electrical reentry is the most common mechanism of atrial fibrillation, while increased sympathetic tone, myocardial ischemia, and ventricular hypertrophy are more likely to cause other types of arrhythmias.
2. A 50-year-old woman with a history of rheumatoid arthritis and osteoporosis is admitted to the hospital with a fever, cough, and dyspnea. She is diagnosed with community-acquired pneumonia and is started on antibiotics. A chest X-ray reveals a right lower lobe consolidation. Which of the following is the most likely pathophysiological process that leads to the formation of consolidation in pneumonia? A) Alveolar collapse B) Bronchial obstruction C) Inflammatory exudate D) Pulmonary edema Answer: C) Inflammatory exudate

with fatigue, weakness, and muscle pain. She is diagnosed with adrenal insufficiency and is started on hydrocortisone replacement therapy. Which of the following is the most likely pathophysiological type of her adrenal insufficiency? A) Primary B) Secondary C) Tertiary D) Acute Answer: B) Secondary Rationale: Adrenal insufficiency is a condition in which the adrenal glands produce insufficient amounts of cortisol, which is a steroid hormone that regulates metabolism, inflammation, immune response, and stress response. There are different types of adrenal insufficiency depending on the level of dysfunction in the hypothalamic-pituitary-adrenal (HPA) axis. Primary adrenal insufficiency (also known as Addison's disease) is caused by damage or destruction of the adrenal cortex, which leads to low levels of cortisol and aldosterone, and high levels of adrenocorticotropic hormone (ACTH). Secondary adrenal insufficiency is caused by inadequate stimulation of the adrenal cortex by ACTH, which leads to low levels of cortisol, normal or low levels of aldosterone, and low or normal levels of ACTH. Tertiary adrenal insufficiency is caused by inadequate stimulation of the pituitary gland by corticotropin-releasing hormone (CRH), which leads to low levels of cortisol, normal or low levels of aldosterone, and low levels of ACTH and CRH. Acute adrenal insufficiency (also known as adrenal crisis) is a life-threatening condition that occurs when there is a sudden drop in cortisol levels due to stress, trauma, infection, or withdrawal of steroid therapy. In this case, the most likely type of adrenal insufficiency is secondary, as chronic steroid use can suppress the HPA axis and reduce the production of ACTH.

5. A 60-year-old woman with a history of hypertension, hyperlipidemia, and smoking presents to the emergency

department with sudden onset of left-sided weakness, slurred speech, and facial droop. She is diagnosed with ischemic stroke and is given tissue plasminogen activator (tPA) within the therapeutic window. Which of the following is the most likely pathophysiological effect of tPA in ischemic stroke? A) Dissolves the thrombus B) Reduces the inflammation C) Improves the collateral circulation D) Protects the neurons from apoptosis Answer: A) Dissolves the thrombus Rationale: Ischemic stroke is a type of stroke that occurs when a blood vessel supplying the brain is occluded by a thrombus (a blood clot) or an embolus (a traveling clot). This leads to reduced blood flow and oxygen delivery to the affected brain tissue, resulting in ischemia and infarction. tPA is a fibrinolytic agent that can be given intravenously within 4.5 hours of symptom onset to dissolve the thrombus and restore blood flow. The main effect of tPA is to activate plasminogen, which is a precursor of plasmin, an enzyme that degrades fibrin, the main component of clots. tPA does not have significant effects on inflammation, collateral circulation, or neuronal apoptosis.

1. Which of the following mechanisms is NOT involved in the pathophysiology of chronic obstructive pulmonary disease (COPD)? a) Inflammation of the bronchi b) Increased mucus production c) Destruction of alveoli d) Decreased airway resistance Answer: d) Decreased airway resistance Rationale: COPD is characterized by chronic inflammation of the

c) Increased production of adipokines d) Genetic mutation in insulin receptor Answer: c) Increased production of adipokines Rationale: Insulin resistance in type 2 diabetes is primarily caused by increased production of adipokines (e.g., leptin, resistin) from adipose tissue. These adipokines interfere with insulin signaling, leading to reduced glucose uptake by peripheral tissues.

4. What is the primary underlying pathophysiological process in rheumatoid arthritis (RA)? a) Excessive production of synovial fluid b) Autoimmune-mediated joint destruction c) Formation of immune complexes d) Deficiency of anti-inflammatory cytokines Answer: b) Autoimmune-mediated joint destruction Rationale: RA is an autoimmune disease characterized by chronic inflammation and destruction of joint tissues. The immune system perceives the synovial joints as foreign and initiates an immune response, leading to joint inflammation, synovitis, and ultimately joint destruction.
5. Which of the following pathophysiological processes is responsible for the hallmark symptoms of Parkinson's disease? a) Loss of dopaminergic neurons in the substantia nigra b) Accumulation of amyloid plaques in the brain c) Disruption of the blood-brain barrier d) Oxidative stress and mitochondrial dysfunction Answer: a) Loss of dopaminergic neurons in the substantia nigra

Rationale: Parkinson's disease is characterized by the progressive loss of dopaminergic neurons in the substantia nigra region of the brain. This leads to a decrease in dopamine levels, which is responsible for the characteristic motor symptoms such as tremor, rigidity, bradykinesia, and postural instability.

6. Which of the following factors contributes to the development of atherosclerosis? a) Hyperlipidemia b) Hypertension c) Smoking d) All of the above Answer: d) All of the above Rationale: Atherosclerosis is a multifactorial disease, and all the mentioned factors (hyperlipidemia, hypertension, and smoking) contribute to its development. Hyperlipidemia leads to the deposition of cholesterol-rich plaques in the arterial walls, hypertension causes endothelial damage, and smoking promotes oxidative stress and inflammation.
7. Which of the following describes the pathophysiology of acute kidney injury (AKI)? a) Gradual decline in kidney function over several months b) Acute inflammation of the glomeruli c) Sudden reduction in renal blood flow or damage to the kidney tissue d) Autoimmune destruction of renal tubules Answer: c) Sudden reduction in renal blood flow or damage to the kidney tissue Rationale: AKI is characterized by a sudden reduction in renal blood

perfusion, and ultimately, multiple organ dysfunction.

10. Which of the following mechanisms contributes to the pathophysiology of ulcerative colitis? a) Impaired secretion of gastric acid b) Hypomotility of the gastrointestinal tract c) Chronic inflammation of the colonic mucosa d) Deficiency in intrinsic factor production Answer: c) Chronic inflammation of the colonic mucosa Rationale: Ulcerative colitis is a chronic inflammatory bowel disease characterized by recurring inflammation, ulceration, and damage to the colonic mucosa. The inflammatory process leads to the formation of ulcers and the typical symptoms of diarrhea, abdominal pain, and rectal bleeding.
11. Which of the following best describes the pathophysiology of systemic lupus erythematosus (SLE)? a) Chronic damage to the kidneys and renal failure b) Autoimmune destruction of the synovial joints c) Deposition of immune complexes in various tissues d) Impairment of T-cell mediated immune response Answer: c) Deposition of immune complexes in various tissues Rationale: SLE is an autoimmune disease characterized by the formation and deposition of immune complexes in multiple organs and tissues. This immune complex deposition triggers inflammation and tissue damage, leading to symptoms such as joint pain, skin rashes, renal dysfunction, and other systemic manifestations.
12. What is the primary underlying pathophysiological process in multiple sclerosis (MS)?

a) Demyelination of neurons in the central nervous system b) Autoimmune destruction of peripheral nerves c) Impaired neurotransmitter production in the brain d) Deficiency of neuronal growth factors Answer: a) Demyelination of neurons in the central nervous system Rationale: MS is a chronic autoimmune disease characterized by demyelination of neurons in the central nervous system. The immune system mistakenly targets and attacks the myelin sheath, leading to disrupted nerve conduction, neurologic deficits, and various symptoms depending on the affected area.

13. Which of the following pathophysiological processes is responsible for the symptoms of gout? a) Crystal deposition of uric acid in joints b) Autoimmune destruction of joint cartilage c) Impaired excretion of uric acid by the kidneys d) Deficiency of anti-inflammatory cytokines Answer: a) Crystal deposition of uric acid in joints Rationale: Gout is a form of arthritis caused by the deposition of uric acid crystals in joints, leading to inflammation, pain, and swelling. This can occur due to overproduction or underexcretion of uric acid by the kidneys.
14. What is the primary underlying pathophysiological process in cystic fibrosis (CF)? a) Dysfunction of the immune system b) Excessive production of mucus in the airways c) Autoimmune destruction of pancreatic beta cells d) Deficiency in surfactant production in the lungs

Answer: B) Sputum culture and sensitivity Rationale: Sputum culture and sensitivity can identify the causative organism and the appropriate antibiotic therapy for a respiratory infection. ABG analysis can assess the gas exchange and acid-base balance, but it does not indicate the presence of infection. Chest x- ray can show the extent of lung damage, but it cannot differentiate between infection and other causes of inflammation. PFTs can measure the airflow and lung volumes, but they are not specific for infection.

1. A patient with type 1 diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). The nurse monitors the patient's fluid and electrolyte status closely. Which of the following findings would indicate a complication of DKA? A) Serum sodium level of 140 mEq/L B) Serum potassium level of 3.2 mEq/L C) Serum bicarbonate level of 18 mEq/L D) Serum glucose level of 250 mg/dL Answer: B) Serum potassium level of 3.2 mEq/L Rationale: Serum potassium level of 3.2 mEq/L indicates hypokalemia, which is a common complication of DKA due to osmotic diuresis, insulin therapy, and metabolic acidosis. Serum sodium level of 140 mEq/L is within the normal range (135- 145 mEq/L). Serum bicarbonate level of 18 mEq/L is low, but it is expected in DKA due to metabolic acidosis. Serum glucose level of

250 mg/dL is high, but it is lower than the typical range for DKA (300- 800 mg/dL).

2. A patient with systemic lupus erythematosus (SLE) is prescribed prednisone, a corticosteroid, to reduce inflammation and suppress the immune system. The nurse educates the patient about the adverse effects of long-term corticosteroid use. Which of the following statements by the patient indicates a need for further teaching? A) "I should avoid contact with people who are sick or have infections." B) "I should take calcium and vitamin D supplements to prevent osteoporosis." C) "I should check my blood pressure and blood sugar regularly." D) "I should stop taking prednisone when my symptoms improve." Answer: D) "I should stop taking prednisone when my symptoms improve." Rationale: Corticosteroids should not be stopped abruptly, as this can cause adrenal insufficiency, hypotension, and shock. Corticosteroids should be tapered gradually under the supervision of a health care provider. The other statements are correct, as corticosteroids can increase the risk of infection, osteoporosis, hypertension, and hyperglycemia. PART B: What are the main differences between fetal and adult hemoglobin? How do they affect oxygentransport and affinity?
   • Fetal hemoglobin (HbF) has a higher affinity for oxygen than adult

3. What are the main changes in respiratory function that occur during aging? How do they affect lung volumes, gas exchange, and ventilation-perfusion ratio?

• Aging causes several changes in respiratory function, such as decreased lung elasticity, increased chest wall rigidity, decreased alveolar surface area, decreased ciliary function, decreased cough reflex, and decreased immune response. These changes can lead to decreased vital capacity, increased residual volume, increased functional residual capacity, decreased forced expiratory volume in one second (FEV1), decreased forced vital capacity (FVC), decreased FEV1/FVC ratio, decreased diffusing capacity for carbon monoxide (DLCO), decreased arterial oxygen tension (PaO2), increased arterial carbon dioxide tension (PaCO2), increased alveolar-arterial gradient (A-a gradient), and increased ventilation-perfusion mismatch. These changes can also increase the risk of respiratory infections, chronic obstructive pulmonary disease (COPD), pulmonary embolism (PE), and hypoxemia.

4. What are the main changes in renal function that occur during aging? How do they affect glomerular filtration rate (GFR), tubular function, and electrolyte balance?

• Aging causes several changes in renal function, such as decreased renal mass, decreased renal bloodflow,

decreased number of functioning nephrons, decreased glomerular filtration rate (GFR), decreased tubular reabsorption and secretion, decreased renin-angiotensin-aldosterone system (RAAS) activity, decreased antidiuretic hormone (ADH) response, and decreased acid-base regulation. These changes can lead to reduced ability to excrete waste products, reduced ability to concentrate or dilute urine, reduced ability to conserve sodium or potassium, reduced ability to respond to volume or osmotic changes,reduced ability to maintain acid-base balance, and increased susceptibility to dehydration, hyponatremia, hyperkalemia, and metabolic acidosis.

parathyroid hormone;

impaired regulation of glucose metabolismand calcium homeostasis; and reduced responses to stress, growth, reproduction, and circadian rhythm.

6. What are the main changes in immune function that occur during aging? How do they affect innate andadaptive immunity, inflamma tion,and infection ?

• Aging causes several changes in immune function, such as decreased production and function of immune cells,decreased diversity and specificity of antibodies, decreased lymphoid tissue and organ size, decreased thymic output and T cell repertoire, decreased response to antigens