NUR 631 Advanced Physiology Pathophysiology Comprehensive Review Examination 250 Questions
NUR 631 Advanced Physiology Pathophysiology
Comprehensive Review Examination
Midterm Final Test Bank 1 - Advanced Physiology and Pathophysiology Review
Q1: Which of the following best describes the primary driving force for the movement of water across a
semi-permeable membrane?
A. Active transport requiring ATP hydrolysis
B. Facilitated diffusion through carrier proteins
C. Osmotic pressure gradient created by solute concentration differences [CORRECT]
D. Co-transport with sodium ions down their concentration gradient
Correct Answer: C
Rationale: Correct because osmosis is the passive movement of water across a semi-permeable membrane driven by the
osmotic pressure gradient created by differences in solute concentration on either side of the membrane.
Q2: A patient presents with severe hyperkalemia. Which cellular mechanism is most immediately affected by
elevated extracellular potassium concentration?
A. The sodium-potassium ATPase pump rate increases to compensate
B. The resting membrane potential becomes more positive (depolarized), approaching threshold [CORRECT]
C. Calcium channel conductance increases, causing muscle contraction
D. Chloride channels open to restore electroneutrality
Correct Answer: B
Rationale: Correct because the resting membrane potential is determined primarily by the potassium equilibrium
potential, and increased extracellular potassium reduces the concentration gradient, making the membrane potential less
negative and closer to the threshold for action potential generation.
Q3: During an action potential, what is the primary reason the rising phase (depolarization) occurs so
rapidly?
A. Potassium efflux through voltage-gated channels
B. Sodium influx through voltage-gated sodium channels that exhibit positive feedback [CORRECT]
C. Calcium entry through L-type channels prolonging depolarization
D. Chloride influx through ligand-gated channels
Correct Answer: B
Rationale: Correct because voltage-gated sodium channels open rapidly in response to depolarization, allowing sodium to
rush into the cell, which causes further depolarization and opens more sodium channels in a self-amplifying positive
feedback cycle.
Q4: A nurse is caring for a patient with myasthenia gravis. Which pathophysiological mechanism underlies
this condition?
A. Autoantibodies block acetylcholine receptors at the neuromuscular junction [CORRECT]
B. Destruction of the postganglionic sympathetic neurons
C. Excessive acetylcholinesterase activity at the synaptic cleft
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, NUR 631 Advanced Physiology Pathophysiology Comprehensive Review Examination 250 Questions
D. Demyelination of the motor neurons in the ventral horn
Correct Answer: A
Rationale: Correct because myasthenia gravis is an autoimmune disorder in which antibodies bind to and block nicotinic
acetylcholine receptors at the neuromuscular junction, reducing the number of functional receptors and impairing
neuromuscular transmission.
Q5: Which statement best explains why the refractory period exists following an action potential?
A. The sodium-potassium pump requires time to restore ionic gradients
B. Voltage-gated sodium channels are inactivated and cannot reopen immediately, and potassium channels
remain open [CORRECT]
C. The cell membrane becomes temporarily impermeable to all ions
D. Calcium accumulation inside the cell prevents further depolarization
Correct Answer: B
Rationale: Correct because during the absolute refractory period, voltage-gated sodium channels are in an inactivated
state and cannot be reopened until they return to the resting conformation, while potassium channels remain open,
maintaining the membrane potential below threshold.
Q6: A researcher observes that a particular solute moves against its concentration gradient without direct
ATP consumption. Which transport mechanism is most likely responsible?
A. Simple diffusion through the lipid bilayer
B. Facilitated diffusion through a channel protein
C. Secondary active transport coupled to the sodium gradient maintained by the Na+/K+ ATPase
[CORRECT]
D. Primary active transport using a calcium ATPase pump
Correct Answer: C
Rationale: Correct because secondary active transport uses the energy stored in the electrochemical gradient of one ion
(typically sodium) established by the Na+/K+ ATPase to drive the uphill transport of another solute against its own
concentration gradient.
Q7: In the context of synaptic transmission, what is the primary function of reuptake transporters in the
presynaptic terminal?
A. Synthesize new neurotransmitter molecules from precursor molecules
B. Package neurotransmitters into synaptic vesicles for future release
C. Rapidly remove neurotransmitter from the synaptic cleft to terminate the signal [CORRECT]
D. Degrade neurotransmitter molecules enzymatically in the synaptic cleft
Correct Answer: C
Rationale: Correct because reuptake transporters actively transport released neurotransmitter back into the presynaptic
terminal, which rapidly terminates the synaptic signal and allows recycling of neurotransmitter molecules for subsequent
release.
Q8: A patient with a tumor compressing the hypothalamus develops hyperthermia. Which hypothalamic
function is most likely impaired?
A. Regulation of circadian rhythms through the suprachiasmatic nucleus
B. Thermoregulation through the anterior hypothalamic preoptic area [CORRECT]
C. Control of anterior pituitary hormone secretion through releasing hormones
D. Regulation of hunger and satiety through the lateral and ventromedial nuclei
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, NUR 631 Advanced Physiology Pathophysiology Comprehensive Review Examination 250 Questions
Correct Answer: B
Rationale: Correct because the anterior hypothalamic preoptic area is the primary thermoregulatory center responsible
for heat dissipation, and its impairment leads to an inability to activate cooling mechanisms such as vasodilation and
sweating, resulting in hyperthermia.
Q9: Which type of glial cell is primarily responsible for myelinating axons in the peripheral nervous system?
A. Oligodendrocytes
B. Astrocytes
C. Schwann cells [CORRECT]
D. Microglia
Correct Answer: C
Rationale: Correct because Schwann cells are the glial cells of the peripheral nervous system responsible for producing
the myelin sheath that wraps around peripheral axons, enabling saltatory conduction of action potentials.
Q10: During the relative refractory period, a stronger-than-normal stimulus can elicit an action potential
because:
A. All sodium channels have recovered from inactivation
B. Some sodium channels have recovered from inactivation while potassium channels are still open, requiring
greater depolarizing current to reach threshold [CORRECT]
C. Calcium channels have replaced sodium channels as the primary depolarizing mechanism
D. The membrane potential is hyperpolarized, making it easier to reach threshold
Correct Answer: B
Rationale: Correct because during the relative refractory period, a subset of voltage-gated sodium channels have
returned from inactivation to the resting state while voltage-gated potassium channels are still open, so a stronger
stimulus is needed to overcome the outward potassium current and depolarize the membrane to threshold.
Q11: A nurse is assessing a patient with a lesion in the dorsal column-medial lemniscal pathway. Which
deficit would the nurse expect to find?
A. Loss of pain and temperature sensation on the contralateral side
B. Loss of fine touch, vibration, and proprioception on the ipsilateral side [CORRECT]
C. Motor weakness on the ipsilateral side
D. Loss of voluntary motor control on the contralateral side
Correct Answer: B
Rationale: Correct because the dorsal column-medial lemniscal pathway carries fine touch, vibration sense, and
proprioceptive information from the ipsilateral side of the body to the contralateral thalamus and cortex, and a lesion
causes ipsilateral sensory deficits.
Q12: Which neurotransmitter is the primary inhibitory neurotransmitter in the central nervous system?
A. Glutamate
B. Acetylcholine
C. Gamma-aminobutyric acid (GABA) [CORRECT]
D. Norepinephrine
Correct Answer: C
Rationale: Correct because GABA is the major inhibitory neurotransmitter in the CNS, and when it binds to GABA-A
receptors it opens chloride channels, hyperpolarizing the postsynaptic neuron and reducing its likelihood of firing an
action potential.
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, NUR 631 Advanced Physiology Pathophysiology Comprehensive Review Examination 250 Questions
Q13: A patient develops orthostatic hypotension after beginning a new medication. Which autonomic nervous
system component is most likely affected by this drug?
A. Parasympathetic cholinergic transmission at the heart
B. Sympathetic adrenergic vasoconstriction of resistance vessels [CORRECT]
C. Parasympathetic control of gastrointestinal motility
D. Sympathetic cholinergic innervation of sweat glands
Correct Answer: B
Rationale: Correct because orthostatic hypotension results from impaired sympathetic vasoconstriction of arterial
resistance vessels in the lower extremities upon standing, causing blood to pool in the legs and reducing venous return
and cardiac output.
Q14: The blood-brain barrier is primarily formed by which of the following structures?
A. Astrocytic foot processes surrounding capillary endothelial cells with tight junctions [CORRECT]
B. The arachnoid membrane and cerebrospinal fluid circulation
C. Microglial cells phagocytosing foreign substances in the brain parenchyma
D. Ependymal cells lining the ventricular system
Correct Answer: A
Rationale: Correct because the blood-brain barrier is formed by specialized capillary endothelial cells connected by tight
junctions, surrounded by astrocytic foot processes that induce and maintain the barrier properties, limiting the passage
of substances from the blood into the brain extracellular fluid.
Q15: Which cranial nerve is responsible for the afferent limb of the gag reflex?
A. Cranial nerve X (vagus nerve)
B. Cranial nerve IX (glossopharyngeal nerve) [CORRECT]
C. Cranial nerve XII (hypoglossal nerve)
D. Cranial nerve VII (facial nerve)
Correct Answer: B
Rationale: Correct because the glossopharyngeal nerve (CN IX) provides the sensory afferent limb of the gag reflex,
carrying sensation from the posterior pharynx to the brainstem, while the vagus nerve (CN X) provides the efferent
motor limb causing pharyngeal constriction.
Q16: A patient with Parkinson disease demonstrates a shuffling gait and resting tremor. Which
neurotransmitter deficiency is primarily responsible for these motor symptoms?
A. Serotonin in the raphe nuclei
B. Dopamine in the nigrostriatal pathway [CORRECT]
C. Norepinephrine in the locus coeruleus
D. Acetylcholine in the basal forebrain
Correct Answer: B
Rationale: Correct because Parkinson disease results from the progressive degeneration of dopaminergic neurons in the
substantia nigra pars compacta, reducing dopamine levels in the nigrostriatal pathway and causing the characteristic
motor symptoms of bradykinesia, resting tremor, rigidity, and postural instability.
Q17: The parasympathetic nervous system uses which neurotransmitter at both preganglionic and
postganglionic synapses?
A. Norepinephrine at postganglionic synapses only
B. Acetylcholine at both preganglionic and postganglionic synapses [CORRECT]
Page 4
NUR 631 Advanced Physiology Pathophysiology
Comprehensive Review Examination
Midterm Final Test Bank 1 - Advanced Physiology and Pathophysiology Review
Q1: Which of the following best describes the primary driving force for the movement of water across a
semi-permeable membrane?
A. Active transport requiring ATP hydrolysis
B. Facilitated diffusion through carrier proteins
C. Osmotic pressure gradient created by solute concentration differences [CORRECT]
D. Co-transport with sodium ions down their concentration gradient
Correct Answer: C
Rationale: Correct because osmosis is the passive movement of water across a semi-permeable membrane driven by the
osmotic pressure gradient created by differences in solute concentration on either side of the membrane.
Q2: A patient presents with severe hyperkalemia. Which cellular mechanism is most immediately affected by
elevated extracellular potassium concentration?
A. The sodium-potassium ATPase pump rate increases to compensate
B. The resting membrane potential becomes more positive (depolarized), approaching threshold [CORRECT]
C. Calcium channel conductance increases, causing muscle contraction
D. Chloride channels open to restore electroneutrality
Correct Answer: B
Rationale: Correct because the resting membrane potential is determined primarily by the potassium equilibrium
potential, and increased extracellular potassium reduces the concentration gradient, making the membrane potential less
negative and closer to the threshold for action potential generation.
Q3: During an action potential, what is the primary reason the rising phase (depolarization) occurs so
rapidly?
A. Potassium efflux through voltage-gated channels
B. Sodium influx through voltage-gated sodium channels that exhibit positive feedback [CORRECT]
C. Calcium entry through L-type channels prolonging depolarization
D. Chloride influx through ligand-gated channels
Correct Answer: B
Rationale: Correct because voltage-gated sodium channels open rapidly in response to depolarization, allowing sodium to
rush into the cell, which causes further depolarization and opens more sodium channels in a self-amplifying positive
feedback cycle.
Q4: A nurse is caring for a patient with myasthenia gravis. Which pathophysiological mechanism underlies
this condition?
A. Autoantibodies block acetylcholine receptors at the neuromuscular junction [CORRECT]
B. Destruction of the postganglionic sympathetic neurons
C. Excessive acetylcholinesterase activity at the synaptic cleft
Page 1
, NUR 631 Advanced Physiology Pathophysiology Comprehensive Review Examination 250 Questions
D. Demyelination of the motor neurons in the ventral horn
Correct Answer: A
Rationale: Correct because myasthenia gravis is an autoimmune disorder in which antibodies bind to and block nicotinic
acetylcholine receptors at the neuromuscular junction, reducing the number of functional receptors and impairing
neuromuscular transmission.
Q5: Which statement best explains why the refractory period exists following an action potential?
A. The sodium-potassium pump requires time to restore ionic gradients
B. Voltage-gated sodium channels are inactivated and cannot reopen immediately, and potassium channels
remain open [CORRECT]
C. The cell membrane becomes temporarily impermeable to all ions
D. Calcium accumulation inside the cell prevents further depolarization
Correct Answer: B
Rationale: Correct because during the absolute refractory period, voltage-gated sodium channels are in an inactivated
state and cannot be reopened until they return to the resting conformation, while potassium channels remain open,
maintaining the membrane potential below threshold.
Q6: A researcher observes that a particular solute moves against its concentration gradient without direct
ATP consumption. Which transport mechanism is most likely responsible?
A. Simple diffusion through the lipid bilayer
B. Facilitated diffusion through a channel protein
C. Secondary active transport coupled to the sodium gradient maintained by the Na+/K+ ATPase
[CORRECT]
D. Primary active transport using a calcium ATPase pump
Correct Answer: C
Rationale: Correct because secondary active transport uses the energy stored in the electrochemical gradient of one ion
(typically sodium) established by the Na+/K+ ATPase to drive the uphill transport of another solute against its own
concentration gradient.
Q7: In the context of synaptic transmission, what is the primary function of reuptake transporters in the
presynaptic terminal?
A. Synthesize new neurotransmitter molecules from precursor molecules
B. Package neurotransmitters into synaptic vesicles for future release
C. Rapidly remove neurotransmitter from the synaptic cleft to terminate the signal [CORRECT]
D. Degrade neurotransmitter molecules enzymatically in the synaptic cleft
Correct Answer: C
Rationale: Correct because reuptake transporters actively transport released neurotransmitter back into the presynaptic
terminal, which rapidly terminates the synaptic signal and allows recycling of neurotransmitter molecules for subsequent
release.
Q8: A patient with a tumor compressing the hypothalamus develops hyperthermia. Which hypothalamic
function is most likely impaired?
A. Regulation of circadian rhythms through the suprachiasmatic nucleus
B. Thermoregulation through the anterior hypothalamic preoptic area [CORRECT]
C. Control of anterior pituitary hormone secretion through releasing hormones
D. Regulation of hunger and satiety through the lateral and ventromedial nuclei
Page 2
, NUR 631 Advanced Physiology Pathophysiology Comprehensive Review Examination 250 Questions
Correct Answer: B
Rationale: Correct because the anterior hypothalamic preoptic area is the primary thermoregulatory center responsible
for heat dissipation, and its impairment leads to an inability to activate cooling mechanisms such as vasodilation and
sweating, resulting in hyperthermia.
Q9: Which type of glial cell is primarily responsible for myelinating axons in the peripheral nervous system?
A. Oligodendrocytes
B. Astrocytes
C. Schwann cells [CORRECT]
D. Microglia
Correct Answer: C
Rationale: Correct because Schwann cells are the glial cells of the peripheral nervous system responsible for producing
the myelin sheath that wraps around peripheral axons, enabling saltatory conduction of action potentials.
Q10: During the relative refractory period, a stronger-than-normal stimulus can elicit an action potential
because:
A. All sodium channels have recovered from inactivation
B. Some sodium channels have recovered from inactivation while potassium channels are still open, requiring
greater depolarizing current to reach threshold [CORRECT]
C. Calcium channels have replaced sodium channels as the primary depolarizing mechanism
D. The membrane potential is hyperpolarized, making it easier to reach threshold
Correct Answer: B
Rationale: Correct because during the relative refractory period, a subset of voltage-gated sodium channels have
returned from inactivation to the resting state while voltage-gated potassium channels are still open, so a stronger
stimulus is needed to overcome the outward potassium current and depolarize the membrane to threshold.
Q11: A nurse is assessing a patient with a lesion in the dorsal column-medial lemniscal pathway. Which
deficit would the nurse expect to find?
A. Loss of pain and temperature sensation on the contralateral side
B. Loss of fine touch, vibration, and proprioception on the ipsilateral side [CORRECT]
C. Motor weakness on the ipsilateral side
D. Loss of voluntary motor control on the contralateral side
Correct Answer: B
Rationale: Correct because the dorsal column-medial lemniscal pathway carries fine touch, vibration sense, and
proprioceptive information from the ipsilateral side of the body to the contralateral thalamus and cortex, and a lesion
causes ipsilateral sensory deficits.
Q12: Which neurotransmitter is the primary inhibitory neurotransmitter in the central nervous system?
A. Glutamate
B. Acetylcholine
C. Gamma-aminobutyric acid (GABA) [CORRECT]
D. Norepinephrine
Correct Answer: C
Rationale: Correct because GABA is the major inhibitory neurotransmitter in the CNS, and when it binds to GABA-A
receptors it opens chloride channels, hyperpolarizing the postsynaptic neuron and reducing its likelihood of firing an
action potential.
Page 3
, NUR 631 Advanced Physiology Pathophysiology Comprehensive Review Examination 250 Questions
Q13: A patient develops orthostatic hypotension after beginning a new medication. Which autonomic nervous
system component is most likely affected by this drug?
A. Parasympathetic cholinergic transmission at the heart
B. Sympathetic adrenergic vasoconstriction of resistance vessels [CORRECT]
C. Parasympathetic control of gastrointestinal motility
D. Sympathetic cholinergic innervation of sweat glands
Correct Answer: B
Rationale: Correct because orthostatic hypotension results from impaired sympathetic vasoconstriction of arterial
resistance vessels in the lower extremities upon standing, causing blood to pool in the legs and reducing venous return
and cardiac output.
Q14: The blood-brain barrier is primarily formed by which of the following structures?
A. Astrocytic foot processes surrounding capillary endothelial cells with tight junctions [CORRECT]
B. The arachnoid membrane and cerebrospinal fluid circulation
C. Microglial cells phagocytosing foreign substances in the brain parenchyma
D. Ependymal cells lining the ventricular system
Correct Answer: A
Rationale: Correct because the blood-brain barrier is formed by specialized capillary endothelial cells connected by tight
junctions, surrounded by astrocytic foot processes that induce and maintain the barrier properties, limiting the passage
of substances from the blood into the brain extracellular fluid.
Q15: Which cranial nerve is responsible for the afferent limb of the gag reflex?
A. Cranial nerve X (vagus nerve)
B. Cranial nerve IX (glossopharyngeal nerve) [CORRECT]
C. Cranial nerve XII (hypoglossal nerve)
D. Cranial nerve VII (facial nerve)
Correct Answer: B
Rationale: Correct because the glossopharyngeal nerve (CN IX) provides the sensory afferent limb of the gag reflex,
carrying sensation from the posterior pharynx to the brainstem, while the vagus nerve (CN X) provides the efferent
motor limb causing pharyngeal constriction.
Q16: A patient with Parkinson disease demonstrates a shuffling gait and resting tremor. Which
neurotransmitter deficiency is primarily responsible for these motor symptoms?
A. Serotonin in the raphe nuclei
B. Dopamine in the nigrostriatal pathway [CORRECT]
C. Norepinephrine in the locus coeruleus
D. Acetylcholine in the basal forebrain
Correct Answer: B
Rationale: Correct because Parkinson disease results from the progressive degeneration of dopaminergic neurons in the
substantia nigra pars compacta, reducing dopamine levels in the nigrostriatal pathway and causing the characteristic
motor symptoms of bradykinesia, resting tremor, rigidity, and postural instability.
Q17: The parasympathetic nervous system uses which neurotransmitter at both preganglionic and
postganglionic synapses?
A. Norepinephrine at postganglionic synapses only
B. Acetylcholine at both preganglionic and postganglionic synapses [CORRECT]
Page 4
