NUR 631 Advanced Pathophysiology, Organ System Pathophysiology Exam with Questions and Answers

It covers key domains which include; Neurological System, Endocrine System, Cardiovascular and Hematological Systems, Pulmonary System, Renal and Urological Systems, Gastrointestinal and Hepatic Systems and Gastrointestinal and Hepatic Systems. A 58-year-old patient presents with sudden right-sided weakness and expressive aphasia. CT scan is negative for hemorrhage within the first hour. The clinician suspects an ischemic stroke affecting the left middle cerebral artery territory. Which intervention is most critical in the hyperacute phase to salvage the ischemic penumbra? a. Administration of high-dose corticosteroids to reduce cerebral edema b. Administration of intravenous thrombolytic therapy within the therapeutic window c. Immediate prophylactic anticonvulsant therapy to prevent seizure activity d. Initiation of long-term anticoagulation with warfarin Correct Answer: b. Administration of intravenous thrombolytic therapy within the therapeutic window Rationale: In acute ischemic stroke, the primary goal is rapid reperfusion of the ischemic penumbra before irreversible infarction occurs. Intravenous thrombolytics (e.g., alteplase) are most effective when administered within a narrow time window (generally within 4.5 hours of symptom onset). Corticosteroids and anticonvulsants do not improve perfusion, and anticoagulation is not used in the acute thrombolytic phase due to bleeding risk. A patient with traumatic brain injury develops bradycardia, hypertension with widened pulse pressure, and irregular respirations. These findings suggest increasing intracranial pressure (ICP). What is the underlying physiological mechanism of this clinical triad? a. Sympathetic failure due to medullary infarction b. Increased cerebrospinal fluid production in the choroid plexus c. Direct stimulation of the vagus nerve by cortical injury d. Brainstem compression leading to Cushing reflex activation Correct Answer: d. Brainstem compression leading to Cushing reflex activation Rationale: The Cushing reflex is a late and life-threatening response to increased ICP causing brainstem ischemia. It results in sympathetic-mediated hypertension to maintain cerebral perfusion, baroreceptor-induced bradycardia, and irregular respirations due to respiratory center dysfunction. It reflects impending herniation.