NURS4015 – Pathophysiology, Pharmacology
& Physical Assessment Midterm
Examination Questions & Answers
Question 1
A patient presents with acute onset of shortness of breath, low-grade fever, and a
dry cough. On auscultation, you hear fine late-inspiratory crackles at the lung
bases. Chest X-ray shows bilateral interstitial infiltrates. Which pathophysiologic
process is most likely?
A) Lobar consolidation from Streptococcus pneumoniae
B) Alveolar filling with proteinaceous fluid and hyaline membrane formation
(noncardiogenic pulmonary edema)
C) Bronchial wall thickening from chronic bronchitis
D) Pleural effusion with compression atelectasis
Answer: B) Alveolar filling with proteinaceous fluid and hyaline membrane
formation (noncardiogenic pulmonary edema)
This describes acute respiratory distress syndrome (ARDS) or acute interstitial
pneumonia. Fine late-inspiratory crackles (Velcro crackles) and interstitial
infiltrates indicate interstitial lung disease or pulmonary edema without
cardiogenic findings.
Question 2
A 68-year-old male with hypertension and diabetes presents with sudden, painless
loss of vision in his right eye. Funduscopic exam shows a pale retina with a cherry-
red spot at the fovea. What is the most likely pathophysiologic mechanism?
A) Retinal vein thrombosis leading to hemorrhagic infarction
B) Embolic occlusion of the central retinal artery (CRAO) causing inner retinal
ischemia
,C) Vitreous hemorrhage from diabetic retinopathy
D) Acute angle-closure glaucoma from pupillary block
Answer: B) Embolic occlusion of the central retinal artery (CRAO) causing
inner retinal ischemia
Central retinal artery occlusion causes sudden monocular vision loss. The cherry-
red spot appears because the fovea (thin retina) allows the underlying choroidal
circulation to show through, while the surrounding pale, swollen retina reflects
ischemia.
Question 3
A patient with heart failure is started on furosemide. Which electrolyte abnormality
is most concerning as an adverse effect?
A) Hypernatremia
B) Hypokalemia
C) Hypercalcemia
D) Hypermagnesemia
Answer: B) Hypokalemia
Loop diuretics (furosemide) inhibit the Na-K-2Cl cotransporter in the thick
ascending limb, increasing potassium excretion. Hypokalemia increases risk of
arrhythmias, especially in patients on digoxin. Monitoring potassium is essential.
Question 4
A 35-year-old female presents with episodic palpitations, anxiety, sweating, and
weight loss despite increased appetite. On exam, she has a fine tremor, lid lag, and
a diffusely enlarged thyroid with a bruit. Which laboratory finding would confirm
the diagnosis?
A) Elevated TSH, low free T4
B) Low TSH, elevated free T4 and T3
C) Normal TSH, normal free T4
,D) Elevated TSH, elevated free T4
Answer: B) Low TSH, elevated free T4 and T3
This is Graves' disease, the most common cause of hyperthyroidism. TSH is
suppressed (negative feedback) while thyroid hormones are elevated. Thyroid
stimulating immunoglobulin (TSI) is the specific antibody.
Question 5
A patient is prescribed losartan for hypertension. Which statement best explains
the mechanism of action of losartan?
A) Blocks the angiotensin-converting enzyme (ACE) to prevent angiotensin II
formation
B) Blocks the angiotensin II type 1 (AT1) receptor to prevent vasoconstriction and
aldosterone release
C) Blocks beta-1 adrenergic receptors to decrease heart rate and contractility
D) Inhibits calcium influx into vascular smooth muscle cells
Answer: B) Blocks the angiotensin II type 1 (AT1) receptor to prevent
vasoconstriction and aldosterone release
Losartan is an angiotensin II receptor blocker (ARB). It selectively blocks AT1
receptors, causing vasodilation, decreased aldosterone secretion, and reduced blood
pressure. Unlike ACE inhibitors, it does not affect bradykinin metabolism (no
cough).
Question 6
A 72-year-old male with a history of atrial fibrillation presents with acute onset of
severe left lower quadrant abdominal pain and bloody diarrhea. On exam, he has a
tender, distended abdomen with diminished bowel sounds. Which
pathophysiologic process is most likely?
A) Infectious colitis from Clostridioides difficile
B) Acute mesenteric ischemia from embolus (superior mesenteric artery occlusion)
, C) Diverticulitis with microperforation
D) Inflammatory bowel disease flare
Answer: B) Acute mesenteric ischemia from embolus (superior mesenteric
artery occlusion)
Atrial fibrillation is a risk factor for emboli. Acute mesenteric ischemia presents
with severe abdominal pain out of proportion to exam, followed by bloody
diarrhea. SMA embolism is the most common cause. Immediate surgical
consultation is required.
Question 7
A patient is started on warfarin for a pulmonary embolism. Which laboratory test is
used to monitor warfarin therapy?
A) Activated partial thromboplastin time (aPTT)
B) International normalized ratio (INR)
C) Platelet count
D) Thrombin time
Answer: B) International normalized ratio (INR)
Warfarin inhibits vitamin K-dependent factors (II, VII, IX, X). Prothrombin time
(PT) is prolonged; INR standardizes PT across different reagents. Target INR for
most indications is 2-3. aPTT monitors heparin.
Question 8
A 45-year-old male presents with painless jaundice, dark urine, and pale stools. He
reports unintentional weight loss and vague epigastric discomfort. Which anatomic
location is the most likely source of obstruction?
A) Intrahepatic bile ducts (hepatocellular disease)
B) Common bile duct at the ampulla of Vater (pancreatic head or ampullary tumor)
C) Cystic duct (gallstone)
& Physical Assessment Midterm
Examination Questions & Answers
Question 1
A patient presents with acute onset of shortness of breath, low-grade fever, and a
dry cough. On auscultation, you hear fine late-inspiratory crackles at the lung
bases. Chest X-ray shows bilateral interstitial infiltrates. Which pathophysiologic
process is most likely?
A) Lobar consolidation from Streptococcus pneumoniae
B) Alveolar filling with proteinaceous fluid and hyaline membrane formation
(noncardiogenic pulmonary edema)
C) Bronchial wall thickening from chronic bronchitis
D) Pleural effusion with compression atelectasis
Answer: B) Alveolar filling with proteinaceous fluid and hyaline membrane
formation (noncardiogenic pulmonary edema)
This describes acute respiratory distress syndrome (ARDS) or acute interstitial
pneumonia. Fine late-inspiratory crackles (Velcro crackles) and interstitial
infiltrates indicate interstitial lung disease or pulmonary edema without
cardiogenic findings.
Question 2
A 68-year-old male with hypertension and diabetes presents with sudden, painless
loss of vision in his right eye. Funduscopic exam shows a pale retina with a cherry-
red spot at the fovea. What is the most likely pathophysiologic mechanism?
A) Retinal vein thrombosis leading to hemorrhagic infarction
B) Embolic occlusion of the central retinal artery (CRAO) causing inner retinal
ischemia
,C) Vitreous hemorrhage from diabetic retinopathy
D) Acute angle-closure glaucoma from pupillary block
Answer: B) Embolic occlusion of the central retinal artery (CRAO) causing
inner retinal ischemia
Central retinal artery occlusion causes sudden monocular vision loss. The cherry-
red spot appears because the fovea (thin retina) allows the underlying choroidal
circulation to show through, while the surrounding pale, swollen retina reflects
ischemia.
Question 3
A patient with heart failure is started on furosemide. Which electrolyte abnormality
is most concerning as an adverse effect?
A) Hypernatremia
B) Hypokalemia
C) Hypercalcemia
D) Hypermagnesemia
Answer: B) Hypokalemia
Loop diuretics (furosemide) inhibit the Na-K-2Cl cotransporter in the thick
ascending limb, increasing potassium excretion. Hypokalemia increases risk of
arrhythmias, especially in patients on digoxin. Monitoring potassium is essential.
Question 4
A 35-year-old female presents with episodic palpitations, anxiety, sweating, and
weight loss despite increased appetite. On exam, she has a fine tremor, lid lag, and
a diffusely enlarged thyroid with a bruit. Which laboratory finding would confirm
the diagnosis?
A) Elevated TSH, low free T4
B) Low TSH, elevated free T4 and T3
C) Normal TSH, normal free T4
,D) Elevated TSH, elevated free T4
Answer: B) Low TSH, elevated free T4 and T3
This is Graves' disease, the most common cause of hyperthyroidism. TSH is
suppressed (negative feedback) while thyroid hormones are elevated. Thyroid
stimulating immunoglobulin (TSI) is the specific antibody.
Question 5
A patient is prescribed losartan for hypertension. Which statement best explains
the mechanism of action of losartan?
A) Blocks the angiotensin-converting enzyme (ACE) to prevent angiotensin II
formation
B) Blocks the angiotensin II type 1 (AT1) receptor to prevent vasoconstriction and
aldosterone release
C) Blocks beta-1 adrenergic receptors to decrease heart rate and contractility
D) Inhibits calcium influx into vascular smooth muscle cells
Answer: B) Blocks the angiotensin II type 1 (AT1) receptor to prevent
vasoconstriction and aldosterone release
Losartan is an angiotensin II receptor blocker (ARB). It selectively blocks AT1
receptors, causing vasodilation, decreased aldosterone secretion, and reduced blood
pressure. Unlike ACE inhibitors, it does not affect bradykinin metabolism (no
cough).
Question 6
A 72-year-old male with a history of atrial fibrillation presents with acute onset of
severe left lower quadrant abdominal pain and bloody diarrhea. On exam, he has a
tender, distended abdomen with diminished bowel sounds. Which
pathophysiologic process is most likely?
A) Infectious colitis from Clostridioides difficile
B) Acute mesenteric ischemia from embolus (superior mesenteric artery occlusion)
, C) Diverticulitis with microperforation
D) Inflammatory bowel disease flare
Answer: B) Acute mesenteric ischemia from embolus (superior mesenteric
artery occlusion)
Atrial fibrillation is a risk factor for emboli. Acute mesenteric ischemia presents
with severe abdominal pain out of proportion to exam, followed by bloody
diarrhea. SMA embolism is the most common cause. Immediate surgical
consultation is required.
Question 7
A patient is started on warfarin for a pulmonary embolism. Which laboratory test is
used to monitor warfarin therapy?
A) Activated partial thromboplastin time (aPTT)
B) International normalized ratio (INR)
C) Platelet count
D) Thrombin time
Answer: B) International normalized ratio (INR)
Warfarin inhibits vitamin K-dependent factors (II, VII, IX, X). Prothrombin time
(PT) is prolonged; INR standardizes PT across different reagents. Target INR for
most indications is 2-3. aPTT monitors heparin.
Question 8
A 45-year-old male presents with painless jaundice, dark urine, and pale stools. He
reports unintentional weight loss and vague epigastric discomfort. Which anatomic
location is the most likely source of obstruction?
A) Intrahepatic bile ducts (hepatocellular disease)
B) Common bile duct at the ampulla of Vater (pancreatic head or ampullary tumor)
C) Cystic duct (gallstone)
