Pathophysiology of Altered Health States Q & A w/ Rationales, Exams of Nursing

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NURSING 7450

Pathophysiology of

Altered Health States

Q & A w/ Rationales

1. Which of the following best describes the pathophysiological mechanism of type 1 diabetes mellitus? a. Insulin resistance b. Antibodies destroying pancreatic beta cells c. Increased production of glucagon d. Kidney dysfunction impairing glucose reabsorption Answer: b. Antibodies destroying pancreatic beta cells Rationale: Type 1 diabetes mellitus is an autoimmune disorder in which the body's immune system mistakenly attacks and destroys pancreatic beta cells, resulting in little to no insulin production.
2. Which of the following occurs as a result of an impaired function of the sinoatrial (SA) node? a. Increased heart rate b. Decreased cardiac contractility c. Irregular heart rhythm d. Vasoconstriction Answer: c. Irregular heart rhythm Rationale: The SA node is responsible for initiating the electrical impulses that regulate the heart's rhythm. If there is an impairment in its function, it can lead to irregular heart rhythms, such as atrial fibrillation or bradycardia.
3. Which statement accurately describes the pathophysiology of asthma?

overload, inflammation, or impaired lymphatic drainage.

5. Which of the following accurately describes the pathophysiology of peptic ulcers? a. Excessive gastric acid secretion leading to erosion of the stomach lining b. Bacterial infection by Helicobacter pylori causing inflammation and tissue damage c. Overproduction of pepsinogen leading to enzymatic digestion of the gastric mucosa d. Impaired blood flow to the gastric mucosa causing tissue ischemia Answer: b. Bacterial infection by Helicobacter pylori causing inflammation and tissue damage Rationale: Peptic ulcers commonly result from infection by the bacteria Helicobacter pylori. The bacteria cause inflammation and damage to the gastric mucosa, leading to the formation of ulcers.
6. Which of the following is a primary cause of chronic kidney disease? a. Hypertension b. Hyperthyroidism c. Diabetes mellitus d. Hepatitis B infection Answer: c. Diabetes mellitus

Rationale: Diabetes mellitus is a leading cause of chronic kidney disease. Persistent high blood glucose levels damage the small blood vessels in the kidneys, impairing their function over time.

7. Which of the following occurs as a compensatory mechanism during respiratory acidosis? a. Increased depth and rate of breathing b. Increased retention of bicarbonate ions by the kidneys c. Decreased excretion of carbon dioxide by the kidneys d. Increased production of respiratory enzymes Answer: a. Increased depth and rate of breathing Rationale: To compensate for respiratory acidosis (excess carbon dioxide in the blood), the body increases the depth and rate of breathing to eliminate more carbon dioxide and restore a more balanced pH.
8. Which of the following is a characteristic feature of rheumatoid arthritis? a. Inflammation and destruction of joint cartilage b. Impaired neuromuscular transmission c. Degeneration of bone tissue due to calcium loss d. Inadequate production of growth hormone Answer: a. Inflammation and destruction of joint cartilage Rationale: Rheumatoid arthritis is an autoimmune disease that primarily affects the joints. It is characterized by

increasing the risk of artery rupture or blockage, leading to a stroke.

11. Why does hyperthyroidism often result in unintended weight loss? a. Increased metabolic rate b. Impaired absorption of nutrients c. Decreased insulin production d. Decreased appetite Answer: a. Increased metabolic rate Rationale: Hyperthyroidism is characterized by excessive production of thyroid hormones, which can significantly increase the body's metabolic rate. This increased metabolism leads to unintended weight loss, despite maintaining adequate nutrition intake.
12. Which of the following best describes the underlying pathophysiology of multiple sclerosis? a. Autoimmune destruction of myelin sheaths in the central nervous system b. Vascular occlusion impairing cerebral blood flow c. Abnormal aggregation of amyloid plaques in the brain d. Degeneration of dopaminergic neurons in the substantia nigra Answer: a. Autoimmune destruction of myelin sheaths in the central nervous system

Rationale: Multiple sclerosis is an autoimmune disease in which the immune system attacks and destroys the myelin sheaths covering nerve fibers in the central nervous system. This demyelination disrupts nerve signaling and leads to various neurological symptoms.

13. Which of the following accurately describes the pathophysiology of heart failure? a. Decreased myocardial oxygen demand due to excessive vasodilation b. Impaired relaxation and filling of the ventricles leading to decreased cardiac output c. Excessive cardiac contractility leading to arrhythmias d. Vasoconstriction and increased total peripheral resistance Answer: b. Impaired relaxation and filling of the ventricles leading to decreased cardiac output Rationale: Heart failure occurs when the heart is unable to effectively pump blood to meet the body's demands. In systolic heart failure, impaired ventricular relaxation and filling result in decreased cardiac output, leading to fluid retention and symptoms of congestion.
14. Which of the following occurs as a result of an insulin deficiency or dysfunction in type 2 diabetes mellitus? a. Increased glucose uptake by muscle cells b. Excessive glycogen breakdown in the liver c. Reduced cellular glucose utilization

B:

Question: A 45-year-old male patient presents with shortness of breath, chest pain, and elevated troponin levels. Which of the following pathophysiological processes is most likely occurring in this patient? A) Chronic obstructive pulmonary disease (COPD) B) Myocardial infarction (MI) C) Pneumonia D) Pulmonary embolism (PE) Answer: B) Myocardial infarction (MI) Rationale: The symptoms and elevated troponin levels indicate myocardial damage, which is characteristic of an MI. Question: A 60-year-old female patient is diagnosed with Type 2 diabetes mellitus. Which of the following pathophysiological mechanisms is primarily responsible for the development of hyperglycemia in this patient? A) Insulin resistance and impaired insulin secretion B) Autoimmune destruction of pancreatic beta cells C) Deficiency of glucagon D) Increased sensitivity of peripheral tissues to insulin Answer: A) Insulin resistance and impaired insulin secretion Rationale: Type 2 diabetes mellitus is characterized by insulin resistance and impaired insulin secretion, leading to elevated blood glucose levels.

Question: A 30-year-old male patient presents with joint pain, swelling, and morning stiffness that improves throughout the day. Which of the following pathophysiological processes is most likely contributing to these symptoms? A) Osteoporosis B) Osteoarthritis C) Rheumatoid arthritis D) Gout Answer: C) Rheumatoid arthritis Rationale: The described symptoms are characteristic of rheumatoid arthritis, an autoimmune disease that causes joint inflammation and damage. Question: A 55-year-old male patient is admitted with confusion, headache, and visual disturbances. Imaging reveals a mass in the pituitary gland. Which of the following pathophysiological mechanisms is most likely associated with these findings? A) Excess production of growth hormone B) Deficiency of antidiuretic hormone (ADH) C) Overproduction of thyroid-stimulating hormone (TSH) D) Prolactin deficiency Answer: A) Excess production of growth hormone Rationale: A pituitary tumor leading to excessive growth hormone can cause visual disturbances, headaches, and cognitive changes. Question: A 70-year-old female patient presents with

C) Reduced renal blood flow D) Lymphatic obstruction Answer: A) Portal hypertension Rationale: Ascites and edema are common sequelae of portal hypertension in chronic liver disease. Question: A 65-year-old female patient presents with fatigue, dyspnea, and pallor. Laboratory tests reveal low hemoglobin and hematocrit levels. Which of the following pathophysiological processes is most likely responsible for these findings? A) Decreased erythropoietin production B) Hemolysis of red blood cells C) Impaired iron absorption D) Bone marrow failure Answer: B) Hemolysis of red blood cells Rationale: The symptoms and laboratory findings are indicative of hemolytic anemia. Question: A 40-year-old female patient is diagnosed with systemic sclerosis (scleroderma). Which of the following pathophysiological processes primarily contributes to the characteristic skin thickening and fibrosis seen in this condition? A) Excessive collagen deposition B) Deficiency of elastin fibers C) Impaired sebaceous gland function D) Overproduction of keratinocytes Answer: A) Excessive collagen deposition Rationale: Systemic sclerosis is characterized by

excessive collagen deposition leading to skin thickening and fibrosis. Question: A 55-year-old male patient presents with sudden- onset severe abdominal pain and hypotension. Imaging reveals an abdominal aortic aneurysm. Which of the following pathophysiological processes is primarily associated with this condition? A) Inflammatory destruction of the aortic wall B) Weakening of the tunica media C) Thrombotic occlusion of the aorta D) Dysfunction of the vasa vasorum Answer: B) Weakening of the tunica media Rationale: Abdominal aortic aneurysm is characterized by weakening of the tunica media, leading to the outpouching of the vessel wall. Question: A 25-year-old female patient presents with excessive thirst, polyuria, and fatigue. Laboratory tests reveal hyperglycemia and ketonuria. Which of the following pathophysiological mechanisms is primarily responsible for these findings? A) Deficiency of insulin B) Excessive production of glucagon C) Impaired glucose uptake by cells D) Defective glycogen breakdown Answer: A) Deficiency of insulin Rationale: The symptoms and laboratory findings are indicative of diabetic ketoacidosis due to insulin deficiency.

onset severe headache, nausea, and photophobia. Examination reveals nuchal rigidity. Which of the following pathophysiological processes is most likely occurring in this patient? A) Cerebral hemorrhage B) Meningitis C) Migraine headache D) Subarachnoid hemorrhage Answer: D) Subarachnoid hemorrhage Rationale: The symptoms, signs, and clinical presentation are indicative of a subarachnoid hemorrhage. Question: A 50-year-old male patient presents with fatigue, weight gain, and cold intolerance. Laboratory tests reveal elevated thyroid-stimulating hormone (TSH) and low free thyroxine (T4) levels. Which of the following pathophysiological mechanisms is primarily responsible for these findings? A) Autoimmune destruction of the thyroid gland B) Excessive iodine intake C) Pituitary adenoma secreting excess TSH D) Deficiency of thyrotropin-releasing hormone (TRH) Answer: A) Autoimmune destruction of the thyroid gland Rationale: The clinical presentation and laboratory findings are consistent with autoimmune hypothyroidism.

C:

1. A 65-year-old man with a history of hypertension, diabetes and chronic kidney disease presents to the emergency department with chest pain, dyspnea and diaphoresis. His electrocardiogram shows ST segment elevation in leads V1-V4. He is diagnosed with an acute anterior myocardial infarction (MI) and is given aspirin, nitroglycerin, morphine and oxygen. He is also started on a heparin infusion and is scheduled for percutaneous coronary intervention (PCI). Which of the following pathophysiological processes is most likely responsible for his MI? a) Coronary artery spasm b) Coronary artery thrombosis* c) Coronary artery embolism d) Coronary artery dissection Rationale: Coronary artery thrombosis is the most common cause of acute MI, especially in patients with atherosclerosis and risk factors such as hypertension, diabetes and chronic kidney disease. A thrombus forms on a ruptured or eroded plaque, occluding the blood flow to the myocardium and causing ischemia and necrosis. Coronary artery spasm, embolism and dissection are less common causes of MI.
2. A 45-year-old woman with a history of systemic lupus

3. A 35-year-old man with a history of alcohol abuse and hepatitis C infection presents to the clinic with abdominal pain, ascites, jaundice and spider angiomas. His liver function tests show elevated serum bilirubin, alkaline phosphatase, gamma-glutamyl transferase (GGT) and aspartate aminotransferase (AST). His serum albumin and prothrombin time are decreased. He is diagnosed with cirrhosis of the liver and is referred to a hepatologist for further management. Which of the following pathophysiological changes is most likely responsible for his ascites? a) Increased portal venous pressure* b) Decreased plasma oncotic pressure c) Increased lymphatic drainage d) Decreased sodium excretion Rationale: Ascites is the accumulation of fluid in the peritoneal cavity due to portal hypertension, which is a common complication of cirrhosis. Portal hypertension results from increased resistance to blood flow through the liver due to fibrosis and nodular regeneration. This causes increased hydrostatic pressure in the portal vein and its tributaries, forcing fluid out of the capillaries into the interstitial space and eventually into the peritoneal cavity. Decreased plasma oncotic pressure due to hypoalbuminemia may also contribute to ascites by reducing the reabsorption of fluid from the interstitial space into the capillaries. Increased lymphatic drainage may help to remove some of the excess fluid from the peritoneal cavity, but it is not sufficient to prevent ascites formation.

Decreased sodium excretion by the kidneys may also contribute to ascites by increasing water retention, but it is not the primary cause of ascites.

4. A 55-year-old woman with a history of hypertension, hyperlipidemia and smoking presents to the clinic with intermittent claudication, which is pain in her lower extremities that occurs with walking and is relieved by rest. She also has cold, pale and cyanotic feet with diminished pulses. She is diagnosed with peripheral arterial disease (PAD) and is prescribed antiplatelet therapy, statins and cilostazol. She is also advised to quit smoking, control her blood pressure and cholesterol levels, and exercise regularly. Which of the following pathophysiological factors is most likely responsible for her intermittent claudication? a) Ischemia* b) Inflammation c) Infection d) Neuropathy Rationale: Intermittent claudication is a classic symptom of PAD, which is a chronic condition characterized by atherosclerosis of the arteries supplying the lower extremities. Atherosclerosis causes narrowing and occlusion of the arteries, reducing blood flow and oxygen delivery to the muscles. This causes ischemia, which manifests as pain, especially during exercise when the oxygen demand exceeds the supply. Inflammation, infection and neuropathy may also cause pain in the lower extremities, but they are not related to PAD or intermittent