NSG 530 Advanced
Pathophysiology Exam 3 | with
Correct Answers
EXAM
Comprehensive study resource for NSG 530 Advanced Pathophysiology Exam 3,
featuring carefully compiled practice questions and verified answers covering
key pathophysiology concepts, disease mechanisms, clinical manifestations,
diagnostic findings, and evidence-based management principles. Ideal for exam
preparation, self-assessment, and concept review. Designed to help nursing
students strengthen critical thinking skills and improve confidence when
preparing for advanced pathophysiology examinations.
1. A 45-year-old female presents with fatigue, weight gain, and constipation.
Labs show TSH 8.5 mIU/L (high), free T4 0.6 ng/dL (low). What is the most
likely diagnosis?
A) Euthyroid sick syndrome
B) Central hypothyroidism
C) Primary hypothyroidism
D) Subclinical hyperthyroidism
Correct Answer: C) Primary hypothyroidism
Rationale: Elevated TSH with low free T4 indicates primary thyroid gland failure.
The pituitary is responding appropriately by increasing TSH secretion.
2. A patient with type 2 diabetes is started on metformin. Which of the
following is a serious but rare adverse effect?
,A) Hypoglycemia
B) Lactic acidosis
C) Weight gain
D) Pancreatitis
Correct Answer: B) Lactic acidosis
Rationale: Metformin can rarely cause lactic acidosis, especially in patients with
renal impairment, liver disease, or hypoxia. It does not typically cause
hypoglycemia or weight gain.
3. A 28-year-old male presents with polyuria, polydipsia, and nocturia. Serum
glucose is 90 mg/dL, sodium 148 mEq/L, and urine specific gravity 1.002.
Which test confirms the diagnosis?
A) Oral glucose tolerance test
B) Water deprivation test
C) HbA1c
D) ACTH stimulation test
Correct Answer: B) Water deprivation test
Rationale: The presentation suggests diabetes insipidus. Water deprivation test
with subsequent vasopressin administration distinguishes central from nephrogenic
DI.
4. A patient with cirrhosis develops asterixis and confusion. Which of the
following is the primary pathophysiological mechanism?
A) Accumulation of ammonia
B) Hypoglycemia
,C) Hypercalcemia
D) Metabolic alkalosis
Correct Answer: A) Accumulation of ammonia
Rationale: Hepatic encephalopathy is primarily due to the liver's inability to
detoxify ammonia, which crosses the blood-brain barrier and affects
neurotransmitter function.
5. A 65-year-old male with hypertension presents with acute onset of flank
pain and hematuria. Creatinine is 2.5 mg/dL (baseline 1.0). Urinalysis shows
dysmorphic RBCs and RBC casts. What is the most likely diagnosis?
A) Acute pyelonephritis
B) Nephrolithiasis
C) Rapidly progressive glomerulonephritis
D) Ischemic ATN
Correct Answer: C) Rapidly progressive glomerulonephritis
Rationale: RBC casts and dysmorphic RBCs indicate glomerular bleeding. Rapid
rise in creatinine with minimal symptoms points to RPGN.
6. A 55-year-old woman with breast cancer develops confusion, polyuria, and
constipation. Serum calcium is 13.5 mg/dL (normal 8.5–10.2). PTH-related
peptide is elevated. Which mechanism explains this?
A) Primary hyperparathyroidism
B) Vitamin D toxicity
C) Malignancy-induced hypercalcemia
D) Hyperthyroidism
, Correct Answer: C) Malignancy-induced hypercalcemia
Rationale: Many solid tumors (especially breast and lung) secrete PTHrP, which
mimics PTH and causes bone resorption and hypercalcemia.
7. A patient with chronic kidney disease stage 4 has a serum phosphorus of 6.5
mg/dL and calcium of 7.8 mg/dL. Which secondary disorder will develop if
untreated?
A) Primary hyperparathyroidism
B) Secondary hyperparathyroidism
C) Hypoparathyroidism
D) Adrenal insufficiency
Correct Answer: B) Secondary hyperparathyroidism
Rationale: Hyperphosphatemia and hypocalcemia in CKD stimulate PTH release.
This is secondary hyperparathyroidism, not primary.
8. A 30-year-old male presents with episodic hypertension, severe headache,
and palpitations. A 24-hour urine shows elevated metanephrines. Which of
the following is the most likely cause?
A) Renin-secreting tumor
B) Pheochromocytoma
C) Cushing’s syndrome
D) Hyperaldosteronism
Correct Answer: B) Pheochromocytoma
Rationale: Episodic hypertension with elevated metanephrines is classic for
pheochromocytoma, a catecholamine-secreting tumor of the adrenal medulla.
Pathophysiology Exam 3 | with
Correct Answers
EXAM
Comprehensive study resource for NSG 530 Advanced Pathophysiology Exam 3,
featuring carefully compiled practice questions and verified answers covering
key pathophysiology concepts, disease mechanisms, clinical manifestations,
diagnostic findings, and evidence-based management principles. Ideal for exam
preparation, self-assessment, and concept review. Designed to help nursing
students strengthen critical thinking skills and improve confidence when
preparing for advanced pathophysiology examinations.
1. A 45-year-old female presents with fatigue, weight gain, and constipation.
Labs show TSH 8.5 mIU/L (high), free T4 0.6 ng/dL (low). What is the most
likely diagnosis?
A) Euthyroid sick syndrome
B) Central hypothyroidism
C) Primary hypothyroidism
D) Subclinical hyperthyroidism
Correct Answer: C) Primary hypothyroidism
Rationale: Elevated TSH with low free T4 indicates primary thyroid gland failure.
The pituitary is responding appropriately by increasing TSH secretion.
2. A patient with type 2 diabetes is started on metformin. Which of the
following is a serious but rare adverse effect?
,A) Hypoglycemia
B) Lactic acidosis
C) Weight gain
D) Pancreatitis
Correct Answer: B) Lactic acidosis
Rationale: Metformin can rarely cause lactic acidosis, especially in patients with
renal impairment, liver disease, or hypoxia. It does not typically cause
hypoglycemia or weight gain.
3. A 28-year-old male presents with polyuria, polydipsia, and nocturia. Serum
glucose is 90 mg/dL, sodium 148 mEq/L, and urine specific gravity 1.002.
Which test confirms the diagnosis?
A) Oral glucose tolerance test
B) Water deprivation test
C) HbA1c
D) ACTH stimulation test
Correct Answer: B) Water deprivation test
Rationale: The presentation suggests diabetes insipidus. Water deprivation test
with subsequent vasopressin administration distinguishes central from nephrogenic
DI.
4. A patient with cirrhosis develops asterixis and confusion. Which of the
following is the primary pathophysiological mechanism?
A) Accumulation of ammonia
B) Hypoglycemia
,C) Hypercalcemia
D) Metabolic alkalosis
Correct Answer: A) Accumulation of ammonia
Rationale: Hepatic encephalopathy is primarily due to the liver's inability to
detoxify ammonia, which crosses the blood-brain barrier and affects
neurotransmitter function.
5. A 65-year-old male with hypertension presents with acute onset of flank
pain and hematuria. Creatinine is 2.5 mg/dL (baseline 1.0). Urinalysis shows
dysmorphic RBCs and RBC casts. What is the most likely diagnosis?
A) Acute pyelonephritis
B) Nephrolithiasis
C) Rapidly progressive glomerulonephritis
D) Ischemic ATN
Correct Answer: C) Rapidly progressive glomerulonephritis
Rationale: RBC casts and dysmorphic RBCs indicate glomerular bleeding. Rapid
rise in creatinine with minimal symptoms points to RPGN.
6. A 55-year-old woman with breast cancer develops confusion, polyuria, and
constipation. Serum calcium is 13.5 mg/dL (normal 8.5–10.2). PTH-related
peptide is elevated. Which mechanism explains this?
A) Primary hyperparathyroidism
B) Vitamin D toxicity
C) Malignancy-induced hypercalcemia
D) Hyperthyroidism
, Correct Answer: C) Malignancy-induced hypercalcemia
Rationale: Many solid tumors (especially breast and lung) secrete PTHrP, which
mimics PTH and causes bone resorption and hypercalcemia.
7. A patient with chronic kidney disease stage 4 has a serum phosphorus of 6.5
mg/dL and calcium of 7.8 mg/dL. Which secondary disorder will develop if
untreated?
A) Primary hyperparathyroidism
B) Secondary hyperparathyroidism
C) Hypoparathyroidism
D) Adrenal insufficiency
Correct Answer: B) Secondary hyperparathyroidism
Rationale: Hyperphosphatemia and hypocalcemia in CKD stimulate PTH release.
This is secondary hyperparathyroidism, not primary.
8. A 30-year-old male presents with episodic hypertension, severe headache,
and palpitations. A 24-hour urine shows elevated metanephrines. Which of
the following is the most likely cause?
A) Renin-secreting tumor
B) Pheochromocytoma
C) Cushing’s syndrome
D) Hyperaldosteronism
Correct Answer: B) Pheochromocytoma
Rationale: Episodic hypertension with elevated metanephrines is classic for
pheochromocytoma, a catecholamine-secreting tumor of the adrenal medulla.
