Japan National Nursing Examination Pathophysiology: practice questions

Japan National Nursing Examination · Japan · Ministry of Health, Labour and Welfare (MHLW), Japan

Original practice questions written to the published syllabus · not past papers

10worked here, free

96written to this exam in this subject

22syllabus units

What this subject covers

What disease is actually doing, underneath the diagnosis

In the exams: NORCET: Prelims — nursing syllabus (80 of 100 questions); NCLEX-RN: Physiological Integrity (43–67%); Japan National Nursing Examination: Human structure, function and disease (Core across both sections)

What This Subject Is
Cell Injury
Inflammation
Oedema
Shock
When The Heart Fails
When The Lungs Fail
When The Kidneys Fail
When The Liver Fails
Diabetes As A Worked Example
Atherosclerosis and Its Consequences
Clots
Cancer, In Principle
Immunity Gone Wrong
The Brain Under Pressure
Ageing and Multiple Disease
Pain As A Mechanism
Obstruction As A General Mechanism
Salt, Water and the Brain
Burns and Major Injury
Being Examined On This

Where the 96 questions fall

How our questions for Japan National Nursing Examination spread across the units of Pathophysiology. Difficulty: 21 easy, 54 medium, 21 hard.

End-of-manual check	12
What This Subject Is	4
Cell Injury	4
Inflammation	4
Oedema	4
Shock	4
When The Heart Fails	4
When The Lungs Fail	4
When The Kidneys Fail	4
When The Liver Fails	4
Diabetes As A Worked Example	4
Atherosclerosis and Its Consequences	4
Clots	4
Cancer, In Principle	4
Immunity Gone Wrong	4
The Brain Under Pressure	4
Ageing and Multiple Disease	4
Pain As A Mechanism	4
Obstruction As A General Mechanism	4
Salt, Water and the Brain	4
Burns and Major Injury	4
Being Examined On This	4

10 practice questions, worked

Choose an answer, then open the working. Each explanation says why the right answer is right and why the others are not.

1 · Inflammation · medium

When does inflammation become harmful?

When it is widespread or persists, damaging distant tissue
When it begins the repair of a wound after injury
When it produces mild swelling around a small cut
When it stays local and clears the cause within a few days of starting

Answer and working

A. When it is widespread or persists, damaging distant tissue

Local, short-lived inflammation is protective. Systemic or chronic inflammation damages circulation and organs, as in sepsis or rheumatoid arthritis.

Further reading: Laisha original question, written to the SUNYRA nursing manual: Pathophysiology

2 · Oedema · medium

A patient with right-sided heart failure develops oedema where first?

In the legs and lower back
In one arm, on the side of the heart
In the eyelids and the face
In the lungs

Answer and working

A. In the legs and lower back

The failing right heart backs pressure into the systemic veins, so fluid collects in dependent areas: ankles, legs and sacrum in bed-bound patients. Left-sided failure congests the lungs.

Further reading: Laisha original question, written to the SUNYRA nursing manual: Pathophysiology

3 · When The Heart Fails · medium

A patient with heart failure gains 2 kg in two days. What does this most likely mean?

Fat stores are increasing
Muscle is being rebuilt
The scale is faulty
Fluid is being retained

Answer and working

D. Fluid is being retained

Rapid weight gain reflects fluid retention (1 litre of water weighs about 1 kg). Daily weights are a key nursing observation in heart failure.

Further reading: Laisha original question, written to the SUNYRA nursing manual: Pathophysiology

4 · When The Kidneys Fail · medium

Why does any sustained fall in blood pressure threaten the kidneys?

Filtration depends on the pressure of blood arriving
Low pressure raises the kidney's need for glucose and oxygen
The kidneys store blood for the rest of the body
Low pressure makes urine too dilute to excrete

Answer and working

A. Filtration depends on the pressure of blood arriving

Glomerular filtration needs adequate perfusion pressure; hypotension from any cause reduces filtration and can injure the tubules.

Further reading: Laisha original question, written to the SUNYRA nursing manual: Pathophysiology

5 · Cancer, In Principle · medium

A tumour presses on the bile duct. Which sign is most likely?

Jaundice
Low potassium
A raised haemoglobin
Wheezing on exertion

Answer and working

A. Jaundice

Obstruction of the bile duct stops bile flow, causing jaundice, dark urine and pale stools.

Further reading: Laisha original question, written to the SUNYRA nursing manual: Pathophysiology

6 · Immunity Gone Wrong · hard

Why must transplant recipients take immunosuppressant drugs indefinitely?

The drugs are needed only for the first week
Without them, the graft is recognised as foreign and rejected
The drugs replace the hormones the new organ cannot yet make
The drugs help the new organ grow larger

Answer and working

B. Without them, the graft is recognised as foreign and rejected

Lifelong immunosuppression balances rejection against infection and cancer risk.

Further reading: Laisha original question, written to the SUNYRA nursing manual: Pathophysiology

7 · Pain As A Mechanism · medium

Which description fits nociceptive pain from a fractured bone?

Felt in a distant area of skin
Burning and shooting along a nerve
Present when the patient is anxious, and gone when calm
Sharp, well localised and worse on movement

Answer and working

D. Sharp, well localised and worse on movement

Somatic nociceptive pain is localised and aggravated by movement; burning, shooting pain suggests nerve damage.

Further reading: Laisha original question, written to the SUNYRA nursing manual: Pathophysiology

8 · Pain As A Mechanism · medium

What is central sensitisation?

Pain that stops when the injury heals
An allergic reaction to painkillers
An amplified nervous system, so less stimulus hurts more
Loss of all feeling in an area

Answer and working

C. An amplified nervous system, so less stimulus hurts more

In persistent pain the spinal cord and brain amplify signals; light touch may hurt and pain spreads beyond the original area.

Further reading: Laisha original question, written to the SUNYRA nursing manual: Pathophysiology

9 · Obstruction As A General Mechanism · medium

Which signs suggest a bowel obstruction?

Headache, neck stiffness and photophobia
Constant chest pain and breathlessness
Colicky pain, vomiting, distension and no flatus or stool
Diarrhoea, fever and blood in the urine with loin pain

Answer and working

C. Colicky pain, vomiting, distension and no flatus or stool

The gut contracts against the blockage (colic); high obstructions vomit early, low ones distend first.

Further reading: Laisha original question, written to the SUNYRA nursing manual: Pathophysiology

10 · Obstruction As A General Mechanism · hard

Why is a twisted bowel or a strangulated hernia a surgical emergency?

Its own blood supply is trapped and the tissue dies
It settles with rest and ice packs within a day or two
It causes mild discomfort only
It affects only the skin over the hernia

Answer and working

A. Its own blood supply is trapped and the tissue dies

When the blood supply is compressed, ischaemia and perforation follow within hours, so urgent surgery is needed.

Further reading: Laisha original question, written to the SUNYRA nursing manual: Pathophysiology

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