SCI 225 PATHOPHYSIOLOGY
FINAL EXAM — NIGHTINGALE COLLEGE
Official Practice Exam 2026/2027
Total Questions: 50 | Time: 120 min | Pass: 80% (40 of 50)
TABLE OF CONTENTS
Section 1 | Cellular Injury & Adaptation | Q1 – Q10
Section 2 | Genetics, Immunity & Immune Disorders | Q11 – Q23
Section 3 | Fluid, Electrolyte & Acid-Base Balance | Q24 – Q33
Section 4 | Cardiovascular, Respiratory & Renal Pathophysiology | Q34 – Q43
Section 5 | Endocrine Disorders, Neoplasia & Case Analysis | Q44 – Q50
Instructions: Choose the single best answer. Passing Score: 40 of 50 in 120 minutes.
SECTION 1: FOUNDATIONAL CONCEPTS, CELLULAR INJURY & ADAPTATION Q1 –
Q10
Question 1 of 50
A 58-year-old man with a 30-year history of smoking presents to his primary care provider with a chronic cough,
hemoptysis, and unintended weight loss of 15 pounds over two months. A chest CT reveals a 3.5-cm right upper
lobe mass with mediastinal lymphadenopathy. Biopsy confirms non-small cell lung carcinoma. The patient asks
the nurse what 'pathophysiology' means in the context of his disease. Which response by the nurse is most
accurate?
A. Pathophysiology is the study of the functional B. Pathophysiology is the study of the structural
changes that occur in the body as a result of disease or changes that occur in tissues as a result of disease
injury ✓ processes
C. Pathophysiology is the branch of medicine D. Pathophysiology is the investigation of the genetic
concerned with the classification and naming of mutations that predispose individuals to cancer
diseases development
Correct Answer: A
Rationale: Pathophysiology examines the functional and physiological changes that accompany disease, distinguishing
it from pathology, which focuses on structural alterations. The nurse should explain that pathophysiology helps
clinicians understand how the lung tumor is altering his respiratory function, causing symptoms like cough and
hemoptysis. Option B describes pathology rather than pathophysiology, a common point of confusion on nursing
exams.
Question 2 of 50
A 72-year-old woman is admitted to the hospital with an acute exacerbation of heart failure. She has a
documented history of chronic heart failure managed with outpatient medications for the past six years. Her
current hospitalization was triggered by nonadherence to her diuretic regimen and a high-sodium diet over the
holidays. The attending physician documents that her current presentation represents an acute exacerbation of a
chronic disease. Which statement best distinguishes this acute exacerbation from the underlying chronic
condition?
A. The chronic condition involves rapid onset with B. The chronic condition is characterized by a sudden,
severe symptoms, while the exacerbation represents a permanent decline, while the exacerbation is a
gradual worsening over months temporary worsening that may improve with
treatment
C. The chronic condition persists over time with D. The chronic condition always progresses toward
periods of worsening and improvement, while the death without remission, while the exacerbation
1
, exacerbation is an episode of acute decompensation indicates the disease has become terminal
superimposed on the underlying disease ✓
Correct Answer: C
Rationale: A chronic disease persists over an extended period and often shows a pattern of exacerbations and
remissions, whereas an acute exacerbation is a sudden worsening of the chronic condition that may respond to
treatment. The patient's heart failure has been present for years (chronic), but her current episode was triggered by a
specific event (medication nonadherence and dietary indiscretion) and is potentially reversible. Option B incorrectly
suggests chronic conditions involve sudden permanent decline, when in fact they are defined by their long duration and
often fluctuating course.
Question 3 of 50
A 45-year-old man who has been bedridden for six weeks following a traumatic brain injury develops significant
muscle wasting in his lower extremities. Physical therapy notes decreased muscle mass and strength bilaterally.
The patient's serum creatine kinase level is within normal limits, and there is no evidence of nerve compression or
denervation on electromyography. Which type of cellular adaptation best describes this patient's muscle changes?
A. Hypertrophy, because the muscle cells are B. Hyperplasia, because new muscle fibers are being
increasing in size to compensate for reduced neural generated in response to prolonged immobilization
input
C. Pathologic atrophy, because disuse is causing a D. Metaplasia, because the muscle tissue is being
decrease in muscle cell size and functional mass ✓ replaced by connective tissue due to chronic injury
Correct Answer: C
Rationale: Disuse atrophy is a form of pathologic atrophy in which reduced mechanical stimulation leads to a decrease
in cell size and functional tissue mass, as seen in prolonged bed rest or immobilization. The normal serum creatine
kinase and absence of denervation findings rule out acute muscle injury and neurogenic atrophy, supporting a disuse
mechanism. Hypertrophy refers to an increase in cell size, the opposite of what is occurring here, while hyperplasia
involves an increase in cell number, which mature skeletal muscle cells cannot undergo.
Question 4 of 50
A 62-year-old woman with a history of chronic GERD undergoes an upper endoscopy after reporting worsening
dysphagia. Biopsy of the distal esophagus reveals columnar epithelium with intestinal metaplasia, consistent with
Barrett esophagus. The gastroenterologist explains that this change developed as a protective response to chronic
acid exposure. Which statement best characterizes the cellular change that has occurred in this patient's
esophagus?
A. A neoplastic transformation in which normal B. An irreversible change involving disordered
squamous cells have been replaced by malignant cellular growth and nuclear atypia that carries a high
columnar cells with invasive potential risk of progression to cancer
C. A reversible replacement of one adult cell type by D. A compensatory increase in the number of normal
another adult cell type in response to chronic injury squamous cells to reinforce the esophageal lining
and irritation ✓ against acid damage
Correct Answer: C
Rationale: Metaplasia is a reversible adaptive response in which one differentiated adult cell type is replaced by
another, as when chronic acid reflux causes esophageal squamous epithelium to transform into intestinal-type
columnar epithelium (Barrett esophagus). Although Barrett esophagus increases the risk of adenocarcinoma,
metaplasia itself is not neoplastic; it represents the tissue's attempt to better withstand chronic injury. Option B
describes dysplasia rather than metaplasia, a critical distinction because dysplasia involves atypical cellular changes
with greater malignant potential.
2
, Question 5 of 50
A 28-year-old man is brought to the emergency department after being found unconscious in a closed garage with
the car engine running. His carboxyhemoglobin level is 38%, and arterial blood gas reveals a PaO2 of 95 mmHg
on room air. Despite the apparently normal PaO2, he is hypoxic at the tissue level. Which pathophysiologic
mechanism best explains why this patient has cellular hypoxia despite a normal arterial oxygen tension?
A. Carbon monoxide causes alveolar hypoventilation B. Carbon monoxide causes pulmonary edema by
by depressing the respiratory center in the medulla increasing alveolar-capillary membrane permeability
and impairing gas exchange
C. Carbon monoxide directly damages the D. Carbon monoxide binds to hemoglobin with an
mitochondrial electron transport chain, preventing affinity 200 times greater than oxygen, reducing
cellular use of available oxygen oxygen-carrying capacity without affecting dissolved
oxygen levels ✓
Correct Answer: D
Rationale: Carbon monoxide binds to hemoglobin with approximately 200 times the affinity of oxygen, forming
carboxyhemoglobin and reducing the blood's oxygen-carrying capacity. Because PaO2 measures only dissolved oxygen
(not hemoglobin-bound oxygen), it remains normal even though tissue oxygen delivery is severely compromised,
making this a classic example of hypoxic hypoxia with normal PaO2. Option A describes opioid or sedative toxicity
rather than CO poisoning, and while CO can cause mitochondrial toxicity at very high levels, the primary mechanism
at this carboxyhemoglobin level is reduced oxygen transport.
Question 6 of 50
A 55-year-old man with poorly controlled type 2 diabetes mellitus presents with a painful, erythematous, swollen
right great toe. Aspiration of the joint reveals needle-shaped, negatively birefringent crystals under polarized light
microscopy. The patient is diagnosed with acute gouty arthritis. The tissue response surrounding the deposited
crystals is characterized by intense neutrophilic infiltration and liquefactive necrosis. Which type of necrosis is
most consistent with this clinical presentation?
A. Coagulative necrosis, because the ischemic injury B. Liquefactive necrosis, because enzymatic
causes protein denaturation while preserving the basic degradation by neutrophils transforms the affected
tissue architecture tissue into a liquid, viscous debris ✓
C. Caseous necrosis, because the granulomatous D. Fat necrosis, because the enzymatic breakdown of
inflammation produces a cheese-like, amorphous adipose tissue releases fatty acids that form calcium
necrotic center soaps
Correct Answer: B
Rationale: Liquefactive necrosis occurs when hydrolytic enzymes from neutrophils (or occasionally bacteria) digest
dead cells, transforming the tissue into a liquid, viscous material, as seen in gouty tophi, brain infarcts, and bacterial
abscesses. The intense neutrophilic infiltrate in acute gout releases lysosomal enzymes that liquefy the tissue around
deposited urate crystals. Option A describes coagulative necrosis, which is typical of myocardial infarction and
preserves tissue outlines, while caseous necrosis is characteristic of tuberculosis.
Question 7 of 50
A 34-year-old woman from Southeast Asia presents with fever, night sweats, a persistent cough productive of
blood-tinged sputum, and a 10-pound weight loss over two months. A chest radiograph reveals a cavitary lesion in
the right upper lobe. Sputum acid-fast bacilli stain is positive. A biopsy of the cavitary wall would most likely
demonstrate which histopathologic pattern of necrosis?
A. Liquefactive necrosis with extensive neutrophilic B. Coagulative necrosis with preservation of tissue
infiltration and abscess formation within the lung architecture and a well-defined border between viable
parenchyma and dead tissue
C. Caseous necrosis with an amorphous, cheese-like D. Gangrenous necrosis with superimposed bacterial
debris surrounded by granulomatous inflammation infection leading to extensive tissue destruction and
3
FINAL EXAM — NIGHTINGALE COLLEGE
Official Practice Exam 2026/2027
Total Questions: 50 | Time: 120 min | Pass: 80% (40 of 50)
TABLE OF CONTENTS
Section 1 | Cellular Injury & Adaptation | Q1 – Q10
Section 2 | Genetics, Immunity & Immune Disorders | Q11 – Q23
Section 3 | Fluid, Electrolyte & Acid-Base Balance | Q24 – Q33
Section 4 | Cardiovascular, Respiratory & Renal Pathophysiology | Q34 – Q43
Section 5 | Endocrine Disorders, Neoplasia & Case Analysis | Q44 – Q50
Instructions: Choose the single best answer. Passing Score: 40 of 50 in 120 minutes.
SECTION 1: FOUNDATIONAL CONCEPTS, CELLULAR INJURY & ADAPTATION Q1 –
Q10
Question 1 of 50
A 58-year-old man with a 30-year history of smoking presents to his primary care provider with a chronic cough,
hemoptysis, and unintended weight loss of 15 pounds over two months. A chest CT reveals a 3.5-cm right upper
lobe mass with mediastinal lymphadenopathy. Biopsy confirms non-small cell lung carcinoma. The patient asks
the nurse what 'pathophysiology' means in the context of his disease. Which response by the nurse is most
accurate?
A. Pathophysiology is the study of the functional B. Pathophysiology is the study of the structural
changes that occur in the body as a result of disease or changes that occur in tissues as a result of disease
injury ✓ processes
C. Pathophysiology is the branch of medicine D. Pathophysiology is the investigation of the genetic
concerned with the classification and naming of mutations that predispose individuals to cancer
diseases development
Correct Answer: A
Rationale: Pathophysiology examines the functional and physiological changes that accompany disease, distinguishing
it from pathology, which focuses on structural alterations. The nurse should explain that pathophysiology helps
clinicians understand how the lung tumor is altering his respiratory function, causing symptoms like cough and
hemoptysis. Option B describes pathology rather than pathophysiology, a common point of confusion on nursing
exams.
Question 2 of 50
A 72-year-old woman is admitted to the hospital with an acute exacerbation of heart failure. She has a
documented history of chronic heart failure managed with outpatient medications for the past six years. Her
current hospitalization was triggered by nonadherence to her diuretic regimen and a high-sodium diet over the
holidays. The attending physician documents that her current presentation represents an acute exacerbation of a
chronic disease. Which statement best distinguishes this acute exacerbation from the underlying chronic
condition?
A. The chronic condition involves rapid onset with B. The chronic condition is characterized by a sudden,
severe symptoms, while the exacerbation represents a permanent decline, while the exacerbation is a
gradual worsening over months temporary worsening that may improve with
treatment
C. The chronic condition persists over time with D. The chronic condition always progresses toward
periods of worsening and improvement, while the death without remission, while the exacerbation
1
, exacerbation is an episode of acute decompensation indicates the disease has become terminal
superimposed on the underlying disease ✓
Correct Answer: C
Rationale: A chronic disease persists over an extended period and often shows a pattern of exacerbations and
remissions, whereas an acute exacerbation is a sudden worsening of the chronic condition that may respond to
treatment. The patient's heart failure has been present for years (chronic), but her current episode was triggered by a
specific event (medication nonadherence and dietary indiscretion) and is potentially reversible. Option B incorrectly
suggests chronic conditions involve sudden permanent decline, when in fact they are defined by their long duration and
often fluctuating course.
Question 3 of 50
A 45-year-old man who has been bedridden for six weeks following a traumatic brain injury develops significant
muscle wasting in his lower extremities. Physical therapy notes decreased muscle mass and strength bilaterally.
The patient's serum creatine kinase level is within normal limits, and there is no evidence of nerve compression or
denervation on electromyography. Which type of cellular adaptation best describes this patient's muscle changes?
A. Hypertrophy, because the muscle cells are B. Hyperplasia, because new muscle fibers are being
increasing in size to compensate for reduced neural generated in response to prolonged immobilization
input
C. Pathologic atrophy, because disuse is causing a D. Metaplasia, because the muscle tissue is being
decrease in muscle cell size and functional mass ✓ replaced by connective tissue due to chronic injury
Correct Answer: C
Rationale: Disuse atrophy is a form of pathologic atrophy in which reduced mechanical stimulation leads to a decrease
in cell size and functional tissue mass, as seen in prolonged bed rest or immobilization. The normal serum creatine
kinase and absence of denervation findings rule out acute muscle injury and neurogenic atrophy, supporting a disuse
mechanism. Hypertrophy refers to an increase in cell size, the opposite of what is occurring here, while hyperplasia
involves an increase in cell number, which mature skeletal muscle cells cannot undergo.
Question 4 of 50
A 62-year-old woman with a history of chronic GERD undergoes an upper endoscopy after reporting worsening
dysphagia. Biopsy of the distal esophagus reveals columnar epithelium with intestinal metaplasia, consistent with
Barrett esophagus. The gastroenterologist explains that this change developed as a protective response to chronic
acid exposure. Which statement best characterizes the cellular change that has occurred in this patient's
esophagus?
A. A neoplastic transformation in which normal B. An irreversible change involving disordered
squamous cells have been replaced by malignant cellular growth and nuclear atypia that carries a high
columnar cells with invasive potential risk of progression to cancer
C. A reversible replacement of one adult cell type by D. A compensatory increase in the number of normal
another adult cell type in response to chronic injury squamous cells to reinforce the esophageal lining
and irritation ✓ against acid damage
Correct Answer: C
Rationale: Metaplasia is a reversible adaptive response in which one differentiated adult cell type is replaced by
another, as when chronic acid reflux causes esophageal squamous epithelium to transform into intestinal-type
columnar epithelium (Barrett esophagus). Although Barrett esophagus increases the risk of adenocarcinoma,
metaplasia itself is not neoplastic; it represents the tissue's attempt to better withstand chronic injury. Option B
describes dysplasia rather than metaplasia, a critical distinction because dysplasia involves atypical cellular changes
with greater malignant potential.
2
, Question 5 of 50
A 28-year-old man is brought to the emergency department after being found unconscious in a closed garage with
the car engine running. His carboxyhemoglobin level is 38%, and arterial blood gas reveals a PaO2 of 95 mmHg
on room air. Despite the apparently normal PaO2, he is hypoxic at the tissue level. Which pathophysiologic
mechanism best explains why this patient has cellular hypoxia despite a normal arterial oxygen tension?
A. Carbon monoxide causes alveolar hypoventilation B. Carbon monoxide causes pulmonary edema by
by depressing the respiratory center in the medulla increasing alveolar-capillary membrane permeability
and impairing gas exchange
C. Carbon monoxide directly damages the D. Carbon monoxide binds to hemoglobin with an
mitochondrial electron transport chain, preventing affinity 200 times greater than oxygen, reducing
cellular use of available oxygen oxygen-carrying capacity without affecting dissolved
oxygen levels ✓
Correct Answer: D
Rationale: Carbon monoxide binds to hemoglobin with approximately 200 times the affinity of oxygen, forming
carboxyhemoglobin and reducing the blood's oxygen-carrying capacity. Because PaO2 measures only dissolved oxygen
(not hemoglobin-bound oxygen), it remains normal even though tissue oxygen delivery is severely compromised,
making this a classic example of hypoxic hypoxia with normal PaO2. Option A describes opioid or sedative toxicity
rather than CO poisoning, and while CO can cause mitochondrial toxicity at very high levels, the primary mechanism
at this carboxyhemoglobin level is reduced oxygen transport.
Question 6 of 50
A 55-year-old man with poorly controlled type 2 diabetes mellitus presents with a painful, erythematous, swollen
right great toe. Aspiration of the joint reveals needle-shaped, negatively birefringent crystals under polarized light
microscopy. The patient is diagnosed with acute gouty arthritis. The tissue response surrounding the deposited
crystals is characterized by intense neutrophilic infiltration and liquefactive necrosis. Which type of necrosis is
most consistent with this clinical presentation?
A. Coagulative necrosis, because the ischemic injury B. Liquefactive necrosis, because enzymatic
causes protein denaturation while preserving the basic degradation by neutrophils transforms the affected
tissue architecture tissue into a liquid, viscous debris ✓
C. Caseous necrosis, because the granulomatous D. Fat necrosis, because the enzymatic breakdown of
inflammation produces a cheese-like, amorphous adipose tissue releases fatty acids that form calcium
necrotic center soaps
Correct Answer: B
Rationale: Liquefactive necrosis occurs when hydrolytic enzymes from neutrophils (or occasionally bacteria) digest
dead cells, transforming the tissue into a liquid, viscous material, as seen in gouty tophi, brain infarcts, and bacterial
abscesses. The intense neutrophilic infiltrate in acute gout releases lysosomal enzymes that liquefy the tissue around
deposited urate crystals. Option A describes coagulative necrosis, which is typical of myocardial infarction and
preserves tissue outlines, while caseous necrosis is characteristic of tuberculosis.
Question 7 of 50
A 34-year-old woman from Southeast Asia presents with fever, night sweats, a persistent cough productive of
blood-tinged sputum, and a 10-pound weight loss over two months. A chest radiograph reveals a cavitary lesion in
the right upper lobe. Sputum acid-fast bacilli stain is positive. A biopsy of the cavitary wall would most likely
demonstrate which histopathologic pattern of necrosis?
A. Liquefactive necrosis with extensive neutrophilic B. Coagulative necrosis with preservation of tissue
infiltration and abscess formation within the lung architecture and a well-defined border between viable
parenchyma and dead tissue
C. Caseous necrosis with an amorphous, cheese-like D. Gangrenous necrosis with superimposed bacterial
debris surrounded by granulomatous inflammation infection leading to extensive tissue destruction and
3
