Test Bank for Applied
Pathophysiology for the Advanced
Practice Nurse, 2nd Edition by Lucie
Dlugasch. Verified 100 Questions,
Correct Answers, and Detailed
Rationales
Question 1
A patient with chronic heart failure develops significant peripheral
edema. Which pathophysiological mechanism is the primary
driver of this fluid accumulation?
A) Increased capillary hydrostatic pressure
B) Decreased capillary oncotic pressure
C) Increased interstitial oncotic pressure
D) Lymphatic obstruction
Answer: A
Rationale: In heart failure, reduced cardiac output leads to
venous congestion and increased venous pressure, which backs
up into the capillaries. This elevates capillary hydrostatic pressure,
forcing fluid out of the capillaries and into the interstitial space.
While decreased oncotic pressure (B) can occur in
malnutrition/liver disease, it is not the primary driver in CHF.
,Lymphatic obstruction (D) is more localized (e.g., filariasis or post-
mastectomy).
Question 2
A patient is diagnosed with metabolic acidosis secondary to
diabetic ketoacidosis. Which compensatory mechanism will the
body employ to restore pH?
A) Increased respiratory rate with decreased tidal volume
B) Increased respiratory rate with increased tidal volume
C) Decreased respiratory rate with increased tidal volume
D) Increased renal reabsorption of bicarbonate
Answer: B
Rationale: The respiratory system compensates for metabolic
acidosis by hyperventilation (increased rate and depth/tidal
volume) to "blow off" CO2, which drives the equation toward
decreased H+ (carbonic acid). Option D (renal reabsorption) is
a corrective mechanism, not a rapid compensatory one; it takes
days to fully activate.
Question 3
A biopsy of a patient's skin lesion reveals atypical melanocytes
confined to the epidermis without invasion into the dermis. This
lesion is classified as which type of neoplasm?
A) Melanoma in situ
B) Invasive malignant melanoma
,C) Dysplastic nevus
D) Seborrheic keratosis
Answer: A
Rationale: The term "in situ" means the abnormal cells are
confined to the epithelial layer (epidermis) and have not breached
the basement membrane to invade the dermis. Once they invade
the dermis, it becomes invasive malignant melanoma (B).
Dysplastic nevi (C) are atypical but not necessarily malignant.
Question 4
A patient with chronic alcoholism presents with confusion, ataxia,
and nystagmus. Thiamine deficiency is suspected. Which cellular
process is directly impaired by the lack of thiamine?
A) Oxidative phosphorylation in the mitochondria
B) Glycolysis in the cytoplasm
C) Beta-oxidation of fatty acids
D) Pentose phosphate pathway
Answer: A
Rationale: Thiamine (vitamin B1) is a coenzyme for pyruvate
dehydrogenase and alpha-ketoglutarate dehydrogenase, both
critical for the Krebs cycle and oxidative phosphorylation within
the mitochondria. Impaired ATP production in highly metabolic
brain cells leads to Wernicke encephalopathy. Glycolysis (B) does
not directly require thiamine.
, Question 5
In a patient with severe sepsis, which inflammatory mediator is
most responsible for increased vascular permeability and
vasodilation leading to distributive shock?
A) Tumor necrosis factor-alpha (TNF-α)
B) Interleukin-2 (IL-2)
C) Platelet-derived growth factor (PDGF)
D) Transforming growth factor-beta (TGF-β)
Answer: A
Rationale: TNF-α is a primary early mediator released from
macrophages in sepsis. It causes endothelial cell activation,
increased vascular permeability (leaky capillaries), and profound
vasodilation (nitric oxide release). IL-2 (B) is more involved in T-
cell proliferation. PDGF (C) and TGF-β (D) are growth factors
involved in tissue repair and fibrosis.
Question 6
A patient with a history of atopy develops hives after eating
shellfish. This reaction is primarily mediated by which
immunoglobulin binding to mast cells?
A) IgG
B) IgM
C) IgA
D) IgE
Answer: D
Rationale: Type I hypersensitivity (anaphylactic) reactions, such as
hives (urticaria) and anaphylaxis, are mediated by IgE. Allergen
Pathophysiology for the Advanced
Practice Nurse, 2nd Edition by Lucie
Dlugasch. Verified 100 Questions,
Correct Answers, and Detailed
Rationales
Question 1
A patient with chronic heart failure develops significant peripheral
edema. Which pathophysiological mechanism is the primary
driver of this fluid accumulation?
A) Increased capillary hydrostatic pressure
B) Decreased capillary oncotic pressure
C) Increased interstitial oncotic pressure
D) Lymphatic obstruction
Answer: A
Rationale: In heart failure, reduced cardiac output leads to
venous congestion and increased venous pressure, which backs
up into the capillaries. This elevates capillary hydrostatic pressure,
forcing fluid out of the capillaries and into the interstitial space.
While decreased oncotic pressure (B) can occur in
malnutrition/liver disease, it is not the primary driver in CHF.
,Lymphatic obstruction (D) is more localized (e.g., filariasis or post-
mastectomy).
Question 2
A patient is diagnosed with metabolic acidosis secondary to
diabetic ketoacidosis. Which compensatory mechanism will the
body employ to restore pH?
A) Increased respiratory rate with decreased tidal volume
B) Increased respiratory rate with increased tidal volume
C) Decreased respiratory rate with increased tidal volume
D) Increased renal reabsorption of bicarbonate
Answer: B
Rationale: The respiratory system compensates for metabolic
acidosis by hyperventilation (increased rate and depth/tidal
volume) to "blow off" CO2, which drives the equation toward
decreased H+ (carbonic acid). Option D (renal reabsorption) is
a corrective mechanism, not a rapid compensatory one; it takes
days to fully activate.
Question 3
A biopsy of a patient's skin lesion reveals atypical melanocytes
confined to the epidermis without invasion into the dermis. This
lesion is classified as which type of neoplasm?
A) Melanoma in situ
B) Invasive malignant melanoma
,C) Dysplastic nevus
D) Seborrheic keratosis
Answer: A
Rationale: The term "in situ" means the abnormal cells are
confined to the epithelial layer (epidermis) and have not breached
the basement membrane to invade the dermis. Once they invade
the dermis, it becomes invasive malignant melanoma (B).
Dysplastic nevi (C) are atypical but not necessarily malignant.
Question 4
A patient with chronic alcoholism presents with confusion, ataxia,
and nystagmus. Thiamine deficiency is suspected. Which cellular
process is directly impaired by the lack of thiamine?
A) Oxidative phosphorylation in the mitochondria
B) Glycolysis in the cytoplasm
C) Beta-oxidation of fatty acids
D) Pentose phosphate pathway
Answer: A
Rationale: Thiamine (vitamin B1) is a coenzyme for pyruvate
dehydrogenase and alpha-ketoglutarate dehydrogenase, both
critical for the Krebs cycle and oxidative phosphorylation within
the mitochondria. Impaired ATP production in highly metabolic
brain cells leads to Wernicke encephalopathy. Glycolysis (B) does
not directly require thiamine.
, Question 5
In a patient with severe sepsis, which inflammatory mediator is
most responsible for increased vascular permeability and
vasodilation leading to distributive shock?
A) Tumor necrosis factor-alpha (TNF-α)
B) Interleukin-2 (IL-2)
C) Platelet-derived growth factor (PDGF)
D) Transforming growth factor-beta (TGF-β)
Answer: A
Rationale: TNF-α is a primary early mediator released from
macrophages in sepsis. It causes endothelial cell activation,
increased vascular permeability (leaky capillaries), and profound
vasodilation (nitric oxide release). IL-2 (B) is more involved in T-
cell proliferation. PDGF (C) and TGF-β (D) are growth factors
involved in tissue repair and fibrosis.
Question 6
A patient with a history of atopy develops hives after eating
shellfish. This reaction is primarily mediated by which
immunoglobulin binding to mast cells?
A) IgG
B) IgM
C) IgA
D) IgE
Answer: D
Rationale: Type I hypersensitivity (anaphylactic) reactions, such as
hives (urticaria) and anaphylaxis, are mediated by IgE. Allergen
