1
NSG 3280 Pathophysiology for Nurses I Review
Official Practice Exam Actual Exam 2026/2027
with Detailed Rationales | Complete Exam-Style
Questions | Pass Guaranteed – A+ Graded
Q1: A patient with a casted leg after prolonged immobilization demonstrates
decreased muscle mass. Which cellular adaptation is primarily responsible for this
finding?
A. Hypertrophy
B. Hyperplasia
C. Atrophy [CORRECT]
D. Metaplasia
Correct Answer: C
Rationale: Correct because atrophy is a reduction in cell size resulting from
decreased workload, disuse, or inadequate nutrition. This matches the
pathophysiologic response to prolonged immobilization where muscle cells
decrease in size due to reduced mechanical stimulation.
Q2: A 58-year-old male presents with dyspnea on exertion, orthopnea, and bilateral
ankle edema. Echocardiography reveals an ejection fraction of 32%. Which
primary mechanism explains the development of his edema?
A. Increased oncotic pressure from elevated albumin
B. Decreased capillary permeability in the lower extremities
C. Activation of renin-angiotensin-aldosterone system causing sodium and water
retention [CORRECT]
D. Reversible cellular injury from hypoxia
Correct Answer: C
,2
Rationale: Correct because left ventricular failure with reduced ejection fraction
leads to decreased renal perfusion, activating the RAAS system. This matches the
cascade of sodium and water retention that increases hydrostatic pressure and
produces dependent edema.
Q3: A patient with chronic kidney disease has a serum potassium level of 6.8
mEq/L. Which electrocardiographic change is the priority to assess?
A. Shortened QT interval
B. Prominent U waves
C. Peaked T waves [CORRECT]
D. Widened PR interval with absent P waves
Correct Answer: C
Rationale: Correct because hyperkalemia selectively alters repolarization by
decreasing the resting membrane potential. This matches the classic ECG finding
of tall, peaked T waves, which is the earliest and most priority change to recognize
before life-threatening arrhythmias develop.
Q4: Which cell type is primarily responsible for the initial phagocytic response in
acute bacterial pneumonia?
A. Eosinophils
B. Basophils
C. Neutrophils [CORRECT]
D. Lymphocytes
Correct Answer: C
Rationale: Correct because neutrophils are the first responders to acute bacterial
infection and are the predominant cell in bacterial pneumonia alveolar exudate.
This matches the pathophysiologic expectation for acute pyogenic inflammation
where neutrophils migrate to the site within hours.
,3
Q5: A 34-year-old female presents with fatigue, weight loss, hyperpigmentation of
skin creases, and postural hypotension. Laboratory results show hyponatremia,
hyperkalemia, and low cortisol. Which pathophysiologic mechanism is the
foundation of this disorder?
A. Excess ACTH secretion from a pituitary adenoma
B. Autoimmune destruction of the posterior pituitary
C. Autoimmune destruction of the adrenal cortex leading to mineralocorticoid and
glucocorticoid deficiency [CORRECT]
D. Increased renin secretion from renal juxtaglomerular cells
Correct Answer: C
Rationale: Correct because Addison's disease results from adrenal cortical
destruction, causing deficiency of aldosterone and cortisol. This matches the
presentation of hyperkalemia from lack of aldosterone and hyponatremia from lack
of cortisol and aldosterone, with ACTH elevation causing hyperpigmentation.
Q6: A patient with a traumatic brain injury has an intracranial pressure of 22
mmHg. Which mechanism is most critical in maintaining cerebral perfusion?
A. Decreased systemic vascular resistance
B. Increased cerebrospinal fluid production
C. Cerebral perfusion pressure equals mean arterial pressure minus intracranial
pressure [CORRECT]
D. Autoregulation of cerebral blood flow is lost, causing passive dilation
Correct Answer: C
Rationale: Correct because cerebral perfusion pressure is the driving force for
blood flow to the brain. This matches the Monro-Kellie doctrine where elevated
ICP directly reduces CPP, and maintaining adequate MAP-ICP gradient is the
priority to prevent ischemic brain injury.
Q7: During which phase of wound healing does granulation tissue formation
begin?
, 4
A. Hemostasis phase within minutes of injury
B. Maturation phase beginning at day 7
C. Proliferative phase beginning 3 to 5 days after injury [CORRECT]
D. Inflammatory phase during the first 24 hours
Correct Answer: C
Rationale: Correct because the proliferative phase is characterized by angiogenesis,
fibroblast migration, and granulation tissue formation. This matches the expected
timeline where granulation tissue appears approximately 3 to 5 days following
tissue injury as part of the repair process.
Q8: A child presents with periorbital edema, massive proteinuria,
hypoalbuminemia, and hyperlipidemia. Which pathophysiologic mechanism is the
primary cause of the proteinuria?
A. Increased glomerular hydrostatic pressure from renal artery stenosis
B. Obstruction of the tubulointerstitial space by immune complexes
C. Damage to the glomerular basement membrane causing increased permeability
to plasma proteins [CORRECT]
D. Decreased reabsorption of protein in the proximal tubule
Correct Answer: C
Rationale: Correct because nephrotic syndrome is caused by podocyte damage and
basement membrane disruption that allows massive protein loss in urine. This
matches the classic triad of proteinuria, hypoalbuminemia, and edema that defines
nephrotic syndrome pathophysiology.
Q9: A 28-year-old female has a hemoglobin of 8.2 g/dL, MCV of 72 fL, and serum
ferritin of 8 ng/mL. Which pathophysiologic process best explains these findings?
A. Impaired incorporation of iron into heme due to chronic disease
B. Increased red blood cell destruction in the spleen
C. Inadequate iron stores leading to decreased hemoglobin synthesis [CORRECT]
NSG 3280 Pathophysiology for Nurses I Review
Official Practice Exam Actual Exam 2026/2027
with Detailed Rationales | Complete Exam-Style
Questions | Pass Guaranteed – A+ Graded
Q1: A patient with a casted leg after prolonged immobilization demonstrates
decreased muscle mass. Which cellular adaptation is primarily responsible for this
finding?
A. Hypertrophy
B. Hyperplasia
C. Atrophy [CORRECT]
D. Metaplasia
Correct Answer: C
Rationale: Correct because atrophy is a reduction in cell size resulting from
decreased workload, disuse, or inadequate nutrition. This matches the
pathophysiologic response to prolonged immobilization where muscle cells
decrease in size due to reduced mechanical stimulation.
Q2: A 58-year-old male presents with dyspnea on exertion, orthopnea, and bilateral
ankle edema. Echocardiography reveals an ejection fraction of 32%. Which
primary mechanism explains the development of his edema?
A. Increased oncotic pressure from elevated albumin
B. Decreased capillary permeability in the lower extremities
C. Activation of renin-angiotensin-aldosterone system causing sodium and water
retention [CORRECT]
D. Reversible cellular injury from hypoxia
Correct Answer: C
,2
Rationale: Correct because left ventricular failure with reduced ejection fraction
leads to decreased renal perfusion, activating the RAAS system. This matches the
cascade of sodium and water retention that increases hydrostatic pressure and
produces dependent edema.
Q3: A patient with chronic kidney disease has a serum potassium level of 6.8
mEq/L. Which electrocardiographic change is the priority to assess?
A. Shortened QT interval
B. Prominent U waves
C. Peaked T waves [CORRECT]
D. Widened PR interval with absent P waves
Correct Answer: C
Rationale: Correct because hyperkalemia selectively alters repolarization by
decreasing the resting membrane potential. This matches the classic ECG finding
of tall, peaked T waves, which is the earliest and most priority change to recognize
before life-threatening arrhythmias develop.
Q4: Which cell type is primarily responsible for the initial phagocytic response in
acute bacterial pneumonia?
A. Eosinophils
B. Basophils
C. Neutrophils [CORRECT]
D. Lymphocytes
Correct Answer: C
Rationale: Correct because neutrophils are the first responders to acute bacterial
infection and are the predominant cell in bacterial pneumonia alveolar exudate.
This matches the pathophysiologic expectation for acute pyogenic inflammation
where neutrophils migrate to the site within hours.
,3
Q5: A 34-year-old female presents with fatigue, weight loss, hyperpigmentation of
skin creases, and postural hypotension. Laboratory results show hyponatremia,
hyperkalemia, and low cortisol. Which pathophysiologic mechanism is the
foundation of this disorder?
A. Excess ACTH secretion from a pituitary adenoma
B. Autoimmune destruction of the posterior pituitary
C. Autoimmune destruction of the adrenal cortex leading to mineralocorticoid and
glucocorticoid deficiency [CORRECT]
D. Increased renin secretion from renal juxtaglomerular cells
Correct Answer: C
Rationale: Correct because Addison's disease results from adrenal cortical
destruction, causing deficiency of aldosterone and cortisol. This matches the
presentation of hyperkalemia from lack of aldosterone and hyponatremia from lack
of cortisol and aldosterone, with ACTH elevation causing hyperpigmentation.
Q6: A patient with a traumatic brain injury has an intracranial pressure of 22
mmHg. Which mechanism is most critical in maintaining cerebral perfusion?
A. Decreased systemic vascular resistance
B. Increased cerebrospinal fluid production
C. Cerebral perfusion pressure equals mean arterial pressure minus intracranial
pressure [CORRECT]
D. Autoregulation of cerebral blood flow is lost, causing passive dilation
Correct Answer: C
Rationale: Correct because cerebral perfusion pressure is the driving force for
blood flow to the brain. This matches the Monro-Kellie doctrine where elevated
ICP directly reduces CPP, and maintaining adequate MAP-ICP gradient is the
priority to prevent ischemic brain injury.
Q7: During which phase of wound healing does granulation tissue formation
begin?
, 4
A. Hemostasis phase within minutes of injury
B. Maturation phase beginning at day 7
C. Proliferative phase beginning 3 to 5 days after injury [CORRECT]
D. Inflammatory phase during the first 24 hours
Correct Answer: C
Rationale: Correct because the proliferative phase is characterized by angiogenesis,
fibroblast migration, and granulation tissue formation. This matches the expected
timeline where granulation tissue appears approximately 3 to 5 days following
tissue injury as part of the repair process.
Q8: A child presents with periorbital edema, massive proteinuria,
hypoalbuminemia, and hyperlipidemia. Which pathophysiologic mechanism is the
primary cause of the proteinuria?
A. Increased glomerular hydrostatic pressure from renal artery stenosis
B. Obstruction of the tubulointerstitial space by immune complexes
C. Damage to the glomerular basement membrane causing increased permeability
to plasma proteins [CORRECT]
D. Decreased reabsorption of protein in the proximal tubule
Correct Answer: C
Rationale: Correct because nephrotic syndrome is caused by podocyte damage and
basement membrane disruption that allows massive protein loss in urine. This
matches the classic triad of proteinuria, hypoalbuminemia, and edema that defines
nephrotic syndrome pathophysiology.
Q9: A 28-year-old female has a hemoglobin of 8.2 g/dL, MCV of 72 fL, and serum
ferritin of 8 ng/mL. Which pathophysiologic process best explains these findings?
A. Impaired incorporation of iron into heme due to chronic disease
B. Increased red blood cell destruction in the spleen
C. Inadequate iron stores leading to decreased hemoglobin synthesis [CORRECT]
