NCLEX Pathophysiology Exam Guide: Master Disease Processes

Why NCLEX pathophysiology matters

NCLEX pathophysiology links why a disease happens to what you do first. When you connect mechanism → manifestations → safest action, you answer faster and more accurately.

See also internal Study Plans, Analysis & Prioritization , Item Types (NGN), Signup
Authoritative external: NCSBN NCLEX Test Plan (official overview)

Cardiovascular (high yield): MI • HF • Hypertension

Myocardial infarction (MI) — Plaque rupture → thrombus → coronary occlusion → ischemia → necrosis.
Signs: crushing chest pain radiating to jaw/arm, diaphoresis, SOB; troponin ↑.
First steps: ECG, oxygen per order, IV access, rhythm monitoring, provider notification.

Heart failure (HF)

• Left HF: dyspnea, orthopnea, crackles, S3, pink frothy sputum.

• Right HF: edema, JVD, hepatomegaly, ascites.
  Nursing: daily weights, I&O, sodium restriction, ACEi/ARB, diuretic, β-blocker.

Hypertension — Often silent; risks target-organ damage. Treat crisis fast if end-organ issues present.

Respiratory: COPD • Asthma • Pulmonary Embolism

COPD — Chronic bronchitis (mucus) + emphysema (loss of recoil) → air trapping.
Findings: DOE, cough/sputum; later barrel chest, pursed-lip breathing.
Care: low-flow oxygen as ordered, bronchodilators, ICS, smoking cessation, rehab.

Asthma — IgE mast cell release → bronchospasm + inflammation.
Triad: wheeze, night cough, dyspnea. Watch for status asthmaticus.

Pulmonary embolism (PE) — DVT embolus → V/Q mismatch → RV strain.
Signs: sudden dyspnea, pleuritic chest pain, tachycardia; hemoptysis possible.

Neurologic: Stroke • Seizures • Parkinson Disease

Stroke — Ischemic vs hemorrhagic. Use FAST: face droop, arm drift, speech, time.
Priorities: ABCs, rapid activation, BP per protocol, swallow screen before PO.

Seizures / Status — Side-lying, protect head, no objects in mouth, time event, observe; post-ictal safety.

Parkinson disease — ↓ dopamine. Core: resting tremor, bradykinesia, rigidity, postural instability.

Endocrine: Diabetes • Thyroid

Diabetes

• DKA: glucose >250, ketones, pH <7.3, Kussmaul, fruity breath.

• HHS: glucose >600, high osmolality, severe dehydration, minimal ketones.

• Hypoglycemia: shakiness, sweating, confusion → 15 g fast carb.

Thyroid

• Hypo: fatigue, cold intolerance, weight gain, bradycardia; myxedema coma is emergency.

• Hyper (Graves): heat intolerance, weight loss, tremor, tachycardia, exophthalmos; thyroid storm is emergency.

Renal and GI: AKI/CKD • PUD/IBD • Hepatitis

AKI — Pre-renal, intra-renal, post-renal.
Clues: oliguria, fluid overload, electrolyte changes.
Improving sign: urine output rising toward ≥30–50 mL/hr.

CKD — Progressive GFR loss; complications: mineral bone disease, anemia, CVD, acidosis.

PUD —

• Duodenal: pain 2–3 h post-meal, night pain, relieved by food.

• Gastric: pain 30–60 min post-meal, worse with food, weight loss.
  IBD: Crohn (transmural, skip lesions); UC (continuous mucosal, bloody diarrhea).
  Hepatitis: HAV (fecal-oral), HBV (blood/sex/perinatal), HCV (blood); jaundice and RUQ pain in acute phase.

Immune & Inflammatory: HIV • SLE • RA

HIV/AIDS — CD4 loss → OIs (PCP, CMV, MAC), Kaposi sarcoma, wasting.
SLE — malar rash, photosensitivity, arthralgia, nephritis.
RA — symmetric joints, morning stiffness >1 h, systemic symptoms.

Quick labs and red flags

• Glucose 70–100 mg/dL (critical <50 or >400)

• Creatinine 0.6–1.2 mg/dL (critical >4.0)

• BUN 10–20 mg/dL (critical >100)

• Troponin <0.04 ng/mL (positive >0.04)

• INR 0.8–1.1 (very high risk >5.0)

Emergency first moves:
Cardiac—ECG, O₂, IV; Resp—airway + O₂; Neuro—FAST, CT; Endo—glucose, ABG.

Mini practice (fast)

• HF on furosemide—best effect? → Weight ↓ 2 lb/24 h

• Suspected stroke—most urgent? → RR 8/min

• COPD—most concerning? → Confusion/restlessness

• Type 1 DM with fruity breath + Kussmaul? → DKA

• AKI improving? → Urine output ↑ from 20 to 50 mL/hr

More practice : Pathophysiology QBank

What changed (per your checklist)

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