NURS 5315 – Advanced Pathophysiology – Final Exam Review with
Questions and Correct Answers
A patient in respiratory distress and is breathing 33 breaths per minute. Which ABG value is
consistent with the clinical scenario?
PCO2 15
pH 7.30
pH 7.45
O2 sat 100% - correct answer A patient who is breathing 33 breaths per minute is
hyperventilating and blowing off CO2; therefore the PCO2 level will be low. The patient will
most likely experience a respiratory alkalosis and the two pH values provided are not consistent
with this diagnosis.
A patient has a sodium level of 115 mEq/L and is disoriented and lethargic. Which pathological
process best explains this patient's symptoms?
a. The action potential has become hyperpolarized.
b. Water has shifted into the neurons and caused them to swell.
c. Water has shifted into the vascular space and dehydrated the neurons.
d. The action potential has become hypopolarized. - correct answer b. The cause of neurologic
symptoms associated with a sodium imbalance is directly related to fluid shifting into or out of
the neurons of the brain. With a serum sodium of 115 mEq/L, water shifts into the neurons and
causes them to swell. Hypernatremia causes water to shift out of the cell into the intravascular
space and causes the neurons to become dehydrated. An alteration in the action potential is
not seen with sodium imbalances.
A patient experiencing dehydration should be monitored for which electrolyte imbalance?
a. Hyperkalemia
b. Hypocalcemia
c. Hypercalcemia
d. Hyponatermia - correct answer a. Serum osmolality is increased during times of dehydration.
An elevated serum osmolality will pull potassium into the intravascular space from the
intracellular space and cause a rise in serum potassium.
,A married couple presents to your office for genetic counseling. The husband has an autosomal
recessive disease and his wife has a heterozygous genotype for the disease. They ask you, What
is the chance that our baby will have the disease? Which of the following answers is correct?
25%
50%
75%
100% - correct answer A chromosome is a package of material located inside the cell nucleus
which is made of proteins and a single molecule of DNA. There are 23 pairs of chromosomes in
each human cell for a total of 46 chromosomes. Chromosomes are separated into two identical
sets during mitosis or meiosis. This provides a set of chromosomes to each daughter cell which
results from cell division. This process is responsible for the transfer of genetic information to
the daughter cells. The first 22 pairs of chromosomes are known as autosomes. The 23rd pair of
chromosomes is the pair which contains the genetic information for gender. This pair contains
the genetic information which delineates between the male and female genders. Females have
two X chromosomes (XX) and males have an XY chromosome pair. Autosomal chromosomes are
said to be autologous. This means they do not carry genetic information pertaining to gender.
Autosomal genetic diseases are carried on the first 22 pairs of chromosomes. Sex-linked
diseases are only carried on the 23rd pair of chromosomes. The autosomal chromosomes are
nearly identical to one another and are considered homologous to one another. Each
autosomal chromosome in a pair carries identical genes. These two genes are known as alleles.
The alleles occupy the same site on each partner of the chromosome pair and code for the
same genetic trait or physiologic function. Alleles can be dominant or recessive. One allele may
be dominant and the other recessive, or they both may be dominant or both recessive. The
dominant alleles' genetic code will always manifest in the individual's phenotype. The
information in the recessive allele is typically not expressed in the phenotype unless both
alleles are recessive. For the purpose of clarity in use, the dominant gene is assigned a capital
letter and the recessive gene is a
A child is diagnosed with hemophilia. This is an example of which genetic concept?
Phenotype
Genotype
Autosomal transmission of the disease
Transcription - correct answer The expression of a genetic disease is an example of a
phenotype. A genotype is a gene's programming. Hemophilia is transmitted on the x-
chromosome and is not transmitted via the autosomes. This is not an example of transcription.
Dehydration triggers which physiologic response?
, Increased secretion of renin.
Increase secretion of natriuretic peptides.
Decreased secretion of antidiuretic hormone.
Decreased serum osmolality. - correct answer Dehydration will trigger the release of renin
when renal perfusion is impaired. The other answers are seen during times of fluid volume
overload.
A patient on hydrochlorothiazide has a pH of 7.49 and a bicarbonate of 30. Which of the
following pathological processes best explains the abnormal lab values?
a. An accumulation of pancreatic bicarbonate secondary to vomiting and loss of hydrochloric
acid
b. An increased absorption of Na+ and HCO3- in the proximal renal tubule secondary to
increased aldosterone secretion
c Excessive exhalation of CO2 secondary to hyperventilation
d. Distal renal tubular dysfunction causing an accumulation of hydrogen ions - correct answer
The pH value and bicarbonate value are consistent with a metabolic alkalosis. The most likely
cause of the metabolic alkalosis is the use of the hydrochlorothiazide (HCTZ). This is a thiazide
diuretic which can cause a metabolic alkalosis. The use of a thiazide diuretic will increase the
secretion of aldosterone which stimulates the reabsorption of Na+ and HCO3- in the proximal
tubule of the kidney. This is a response directly related to hypovolemia secondary to the
diuretic use. Option A occurs as a result of excessive vomiting. Vomiting does cause a metabolic
alkalosis but there is nothing in the question to suggest that the patient has been vomiting.
Option C would result in a respiratory alkalosis, not a metabolic alkalosis. Option D would cause
a metabolic acidosis (not a metabolic alkalosis) secondary to a renal tubular dysfunction known
as Renal Tubular Acidosis (RTA).
Which patient may experience a decrease in oncotic pressure?
A patient with cirrhosis.
A patient with dehydration.
A patient with heart failure.
Questions and Correct Answers
A patient in respiratory distress and is breathing 33 breaths per minute. Which ABG value is
consistent with the clinical scenario?
PCO2 15
pH 7.30
pH 7.45
O2 sat 100% - correct answer A patient who is breathing 33 breaths per minute is
hyperventilating and blowing off CO2; therefore the PCO2 level will be low. The patient will
most likely experience a respiratory alkalosis and the two pH values provided are not consistent
with this diagnosis.
A patient has a sodium level of 115 mEq/L and is disoriented and lethargic. Which pathological
process best explains this patient's symptoms?
a. The action potential has become hyperpolarized.
b. Water has shifted into the neurons and caused them to swell.
c. Water has shifted into the vascular space and dehydrated the neurons.
d. The action potential has become hypopolarized. - correct answer b. The cause of neurologic
symptoms associated with a sodium imbalance is directly related to fluid shifting into or out of
the neurons of the brain. With a serum sodium of 115 mEq/L, water shifts into the neurons and
causes them to swell. Hypernatremia causes water to shift out of the cell into the intravascular
space and causes the neurons to become dehydrated. An alteration in the action potential is
not seen with sodium imbalances.
A patient experiencing dehydration should be monitored for which electrolyte imbalance?
a. Hyperkalemia
b. Hypocalcemia
c. Hypercalcemia
d. Hyponatermia - correct answer a. Serum osmolality is increased during times of dehydration.
An elevated serum osmolality will pull potassium into the intravascular space from the
intracellular space and cause a rise in serum potassium.
,A married couple presents to your office for genetic counseling. The husband has an autosomal
recessive disease and his wife has a heterozygous genotype for the disease. They ask you, What
is the chance that our baby will have the disease? Which of the following answers is correct?
25%
50%
75%
100% - correct answer A chromosome is a package of material located inside the cell nucleus
which is made of proteins and a single molecule of DNA. There are 23 pairs of chromosomes in
each human cell for a total of 46 chromosomes. Chromosomes are separated into two identical
sets during mitosis or meiosis. This provides a set of chromosomes to each daughter cell which
results from cell division. This process is responsible for the transfer of genetic information to
the daughter cells. The first 22 pairs of chromosomes are known as autosomes. The 23rd pair of
chromosomes is the pair which contains the genetic information for gender. This pair contains
the genetic information which delineates between the male and female genders. Females have
two X chromosomes (XX) and males have an XY chromosome pair. Autosomal chromosomes are
said to be autologous. This means they do not carry genetic information pertaining to gender.
Autosomal genetic diseases are carried on the first 22 pairs of chromosomes. Sex-linked
diseases are only carried on the 23rd pair of chromosomes. The autosomal chromosomes are
nearly identical to one another and are considered homologous to one another. Each
autosomal chromosome in a pair carries identical genes. These two genes are known as alleles.
The alleles occupy the same site on each partner of the chromosome pair and code for the
same genetic trait or physiologic function. Alleles can be dominant or recessive. One allele may
be dominant and the other recessive, or they both may be dominant or both recessive. The
dominant alleles' genetic code will always manifest in the individual's phenotype. The
information in the recessive allele is typically not expressed in the phenotype unless both
alleles are recessive. For the purpose of clarity in use, the dominant gene is assigned a capital
letter and the recessive gene is a
A child is diagnosed with hemophilia. This is an example of which genetic concept?
Phenotype
Genotype
Autosomal transmission of the disease
Transcription - correct answer The expression of a genetic disease is an example of a
phenotype. A genotype is a gene's programming. Hemophilia is transmitted on the x-
chromosome and is not transmitted via the autosomes. This is not an example of transcription.
Dehydration triggers which physiologic response?
, Increased secretion of renin.
Increase secretion of natriuretic peptides.
Decreased secretion of antidiuretic hormone.
Decreased serum osmolality. - correct answer Dehydration will trigger the release of renin
when renal perfusion is impaired. The other answers are seen during times of fluid volume
overload.
A patient on hydrochlorothiazide has a pH of 7.49 and a bicarbonate of 30. Which of the
following pathological processes best explains the abnormal lab values?
a. An accumulation of pancreatic bicarbonate secondary to vomiting and loss of hydrochloric
acid
b. An increased absorption of Na+ and HCO3- in the proximal renal tubule secondary to
increased aldosterone secretion
c Excessive exhalation of CO2 secondary to hyperventilation
d. Distal renal tubular dysfunction causing an accumulation of hydrogen ions - correct answer
The pH value and bicarbonate value are consistent with a metabolic alkalosis. The most likely
cause of the metabolic alkalosis is the use of the hydrochlorothiazide (HCTZ). This is a thiazide
diuretic which can cause a metabolic alkalosis. The use of a thiazide diuretic will increase the
secretion of aldosterone which stimulates the reabsorption of Na+ and HCO3- in the proximal
tubule of the kidney. This is a response directly related to hypovolemia secondary to the
diuretic use. Option A occurs as a result of excessive vomiting. Vomiting does cause a metabolic
alkalosis but there is nothing in the question to suggest that the patient has been vomiting.
Option C would result in a respiratory alkalosis, not a metabolic alkalosis. Option D would cause
a metabolic acidosis (not a metabolic alkalosis) secondary to a renal tubular dysfunction known
as Renal Tubular Acidosis (RTA).
Which patient may experience a decrease in oncotic pressure?
A patient with cirrhosis.
A patient with dehydration.
A patient with heart failure.
