Page 1 of 372
GEORGETTE’S LMR PMHNP ACTUAL study
pack
1. A pulmonary embolism (PE) most commonly originates
from:
a) The right atrium
b) Deep veins of the lower extremities
c) The pulmonary artery
d) The cerebral circulation
Answer: b) Deep veins of the lower extremities
Rationale: The vast majority of PEs arise from deep vein thrombosis
(DVT) in the lower extremities (iliofemoral veins). Thrombus
dislodges and travels through the venous system to the right side of
the heart and into the pulmonary arteries.
2. Scenario: Rachel Heidebrink is a 22-year-old female
admitted with shortness of breath and pleuritic chest pain. A
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CT pulmonary angiogram confirms a pulmonary embolism.
Which pathophysiological consequence is most immediately
life-threatening?
a) Pulmonary infarction
b) Increased dead space ventilation
c) Right ventricular failure
d) Systemic hypotension
Answer: c) Right ventricular failure
Rationale: A large PE increases pulmonary vascular resistance,
leading to acute right ventricular pressure overload and dysfunction
(cor pulmonale). This can rapidly progress to right heart failure,
reduced left ventricular preload, and cardiovascular collapse.
While all options are consequences, RV failure is the most
immediately life-threatening.
3. Which of the following is a risk factor for venous
thromboembolism (VTE) that is particularly relevant for a
,Page 3 of 372
22-year-old female?
a) Hypertension
b) Oral contraceptive use
c) Hyperlipidemia
d) Type 2 diabetes
Answer: b) Oral contraceptive use
Rationale: Estrogen-containing oral contraceptives increase the risk
of VTE by 3-6 fold, especially in young women. Other risk factors
include pregnancy, recent surgery, immobilization, inherited
thrombophilias (Factor V Leiden), obesity, and smoking.
Hypertension and diabetes are less common in this age group.
4. The ventilation-perfusion (V/Q) mismatch in a pulmonary
embolism results in:
a) Decreased dead space and hypoxemia
b) Increased dead space and hypoxemia
, Page 4 of 372
c) Decreased dead space and hypercapnia
d) Increased dead space and hypercapnia
Answer: b) Increased dead space and hypoxemia
Rationale: In PE, areas of lung are ventilated but not perfused
(increased dead space). This leads to V/Q mismatch, hypoxemia,
and often hypocapnia (due to compensatory hyperventilation).
Hypercapnia is rare unless the PE is massive and causes severe
shock.
5. Scenario: Rachel’s arterial blood gas (ABG) on room air
shows: pH 7.48, PaCO2 30 mm Hg, PaO2 65 mm Hg, HCO3
22 mEq/L. This pattern is consistent with:
a) Metabolic acidosis
b) Metabolic alkalosis
c) Respiratory acidosis
d) Respiratory alkalosis with hypoxemia
GEORGETTE’S LMR PMHNP ACTUAL study
pack
1. A pulmonary embolism (PE) most commonly originates
from:
a) The right atrium
b) Deep veins of the lower extremities
c) The pulmonary artery
d) The cerebral circulation
Answer: b) Deep veins of the lower extremities
Rationale: The vast majority of PEs arise from deep vein thrombosis
(DVT) in the lower extremities (iliofemoral veins). Thrombus
dislodges and travels through the venous system to the right side of
the heart and into the pulmonary arteries.
2. Scenario: Rachel Heidebrink is a 22-year-old female
admitted with shortness of breath and pleuritic chest pain. A
,Page 2 of 372
CT pulmonary angiogram confirms a pulmonary embolism.
Which pathophysiological consequence is most immediately
life-threatening?
a) Pulmonary infarction
b) Increased dead space ventilation
c) Right ventricular failure
d) Systemic hypotension
Answer: c) Right ventricular failure
Rationale: A large PE increases pulmonary vascular resistance,
leading to acute right ventricular pressure overload and dysfunction
(cor pulmonale). This can rapidly progress to right heart failure,
reduced left ventricular preload, and cardiovascular collapse.
While all options are consequences, RV failure is the most
immediately life-threatening.
3. Which of the following is a risk factor for venous
thromboembolism (VTE) that is particularly relevant for a
,Page 3 of 372
22-year-old female?
a) Hypertension
b) Oral contraceptive use
c) Hyperlipidemia
d) Type 2 diabetes
Answer: b) Oral contraceptive use
Rationale: Estrogen-containing oral contraceptives increase the risk
of VTE by 3-6 fold, especially in young women. Other risk factors
include pregnancy, recent surgery, immobilization, inherited
thrombophilias (Factor V Leiden), obesity, and smoking.
Hypertension and diabetes are less common in this age group.
4. The ventilation-perfusion (V/Q) mismatch in a pulmonary
embolism results in:
a) Decreased dead space and hypoxemia
b) Increased dead space and hypoxemia
, Page 4 of 372
c) Decreased dead space and hypercapnia
d) Increased dead space and hypercapnia
Answer: b) Increased dead space and hypoxemia
Rationale: In PE, areas of lung are ventilated but not perfused
(increased dead space). This leads to V/Q mismatch, hypoxemia,
and often hypocapnia (due to compensatory hyperventilation).
Hypercapnia is rare unless the PE is massive and causes severe
shock.
5. Scenario: Rachel’s arterial blood gas (ABG) on room air
shows: pH 7.48, PaCO2 30 mm Hg, PaO2 65 mm Hg, HCO3
22 mEq/L. This pattern is consistent with:
a) Metabolic acidosis
b) Metabolic alkalosis
c) Respiratory acidosis
d) Respiratory alkalosis with hypoxemia
