NURS 5433 EXAM (NEW 2026/ 2027 UPDATE)
QUESTIONS AND VERIFIED ANSWERS
WITH RATIONALES| GRADE A+| 100%
CORRECT
1. A patient with a history of chronic alcohol abuse presents with an enlarged liver.
A biopsy reveals increased amounts of smooth endoplasmic reticulum and fatty
changes. Which cellular adaptation has most likely occurred?
A. Atrophy
B. Hypertrophy
C. Hyperplasia
D. Dysplasia
Correct Answer: B. Hypertrophy
Rationale: Hypertrophy is an increase in cell size. In chronic alcohol use, liver
cells adapt by increasing the smooth endoplasmic reticulum to metabolize the
alcohol, leading to cellular enlargement and fatty accumulation. Hyperplasia is an
increase in cell number, atrophy is a decrease in cell size, and dysplasia is
abnormal cell growth.
2. A patient suffers a myocardial infarction. Lab results show elevated levels of
cardiac troponin. Which type of cellular injury is primarily responsible for this
finding?
A. Reversible injury
B. Irreversible injury with necrosis
C. Apoptosis
1
, D. Ischemic hypoxia
Correct Answer: B. Irreversible injury with necrosis
Rationale: The release of intracellular enzymes like troponin indicates severe
damage to the cell membrane, which is the hallmark of irreversible injury leading
to necrosis. Apoptosis is programmed cell death that does not cause inflammation
or release of intracellular contents.
3. Which statement best describes apoptosis?
A. It always triggers a severe inflammatory response.
B. It is a pathological process usually caused by external toxins.
C. It is programmed cell death that eliminates damaged cells without causing
inflammation.
D. It results in cellular swelling and rupture of the plasma membrane.
Correct Answer: C. It is programmed cell death that eliminates damaged or
unnecessary cells without causing inflammation.
Rationale: Apoptosis is an energy-dependent, tightly regulated process that does
not rupture the cell membrane or cause inflammation, unlike necrosis. It is both a
physiological and pathological process.
4. A 65-year-old female with congestive heart failure presents with generalized
edema, weight gain, and a serum sodium level of 128 mEq/L. Which mechanism
best explains her hyponatremia?
A. Hypervolemic hyponatremia due to decreased effective circulating volume
and excess ADH secretion.
B. Hypovolemic hyponatremia due to severe diarrhea.
C. Euvolemic hyponatremia due to SIADH.
D. Hypervolemic hyponatremia due to primary polydipsia.
Correct Answer: A. Hypervolemic hyponatremia due to decreased effective
circulating volume and excess ADH secretion.
2
, Rationale: In CHF, decreased cardiac output triggers baroreceptors, leading to
increased ADH (vasopressin) secretion. This causes water retention that is
disproportionate to sodium retention, resulting in dilutional hyponatremia.
5. A patient with chronic heart failure develops worsening edema and
hyponatremia. What is the most likely pathophysiological mechanism?
A. Reduced aldosterone secretion
B. Increased antidiuretic hormone (ADH) secretion
C. Decreased renin production
D. Impaired atrial natriuretic peptide (ANP) release
Correct Answer: B. Increased antidiuretic hormone (ADH) secretion
Rationale: In CHF, decreased cardiac output triggers baroreceptors, leading to
increased ADH (vasopressin), which causes water retention greater than sodium
retention, resulting in dilutional hyponatremia. Aldosterone initially increases, not
decreases.
6. A 65-year-old with type 2 diabetes presents with painless hematuria. Which
finding on urinalysis is most concerning for renal papillary necrosis?
A. White blood cell casts
B. Dysmorphic red blood cells
C. Gross hematuria with tissue fragments
D. Crystalline casts
Correct Answer: C. Gross hematuria with tissue fragments
Rationale: Renal papillary necrosis, which is common in diabetes, involves the
sloughing of renal papillae, leading to visible tissue fragments in the urine.
Dysmorphic RBCs suggest glomerulonephritis.
7. Which of the following is not one of the three most common causative
organisms for bacterial conjunctivitis?
3
, A. Staphylococcus aureus
B. Pseudomonas
C. Haemophilus influenzae
D. Streptococcus pneumoniae
Correct Answer: B. Pseudomonas
Rationale: The three most common causative organisms for bacterial
conjunctivitis are Streptococcus pneumoniae, Haemophilus influenzae, and
Staphylococcus aureus. Pseudomonas is not typically among the top three for this
condition.
8. A 19-year-old presents with a complaint of bilaterally itchy, red eyes with
tearing that occurs intermittently throughout the year, often accompanied by a
rope-like eye discharge and clear nasal discharge. This is most consistent with
which diagnosis?
A. Bacterial conjunctivitis
B. Viral conjunctivitis
C. Allergic conjunctivitis
D. Blepharitis
Correct Answer: C. Allergic conjunctivitis
Rationale: The classic presentation of allergic conjunctivitis includes bilateral
itching, redness, tearing, and a rope-like or stringy discharge. It is often associated
with other allergic symptoms like a clear nasal discharge.
9. What is the first-line intervention for epistaxis?
A. Nasal packing
B. Cauterization
C. Firm pressure to the area superior to the nasal alar cartilage
D. Topical vasoconstrictors
4
QUESTIONS AND VERIFIED ANSWERS
WITH RATIONALES| GRADE A+| 100%
CORRECT
1. A patient with a history of chronic alcohol abuse presents with an enlarged liver.
A biopsy reveals increased amounts of smooth endoplasmic reticulum and fatty
changes. Which cellular adaptation has most likely occurred?
A. Atrophy
B. Hypertrophy
C. Hyperplasia
D. Dysplasia
Correct Answer: B. Hypertrophy
Rationale: Hypertrophy is an increase in cell size. In chronic alcohol use, liver
cells adapt by increasing the smooth endoplasmic reticulum to metabolize the
alcohol, leading to cellular enlargement and fatty accumulation. Hyperplasia is an
increase in cell number, atrophy is a decrease in cell size, and dysplasia is
abnormal cell growth.
2. A patient suffers a myocardial infarction. Lab results show elevated levels of
cardiac troponin. Which type of cellular injury is primarily responsible for this
finding?
A. Reversible injury
B. Irreversible injury with necrosis
C. Apoptosis
1
, D. Ischemic hypoxia
Correct Answer: B. Irreversible injury with necrosis
Rationale: The release of intracellular enzymes like troponin indicates severe
damage to the cell membrane, which is the hallmark of irreversible injury leading
to necrosis. Apoptosis is programmed cell death that does not cause inflammation
or release of intracellular contents.
3. Which statement best describes apoptosis?
A. It always triggers a severe inflammatory response.
B. It is a pathological process usually caused by external toxins.
C. It is programmed cell death that eliminates damaged cells without causing
inflammation.
D. It results in cellular swelling and rupture of the plasma membrane.
Correct Answer: C. It is programmed cell death that eliminates damaged or
unnecessary cells without causing inflammation.
Rationale: Apoptosis is an energy-dependent, tightly regulated process that does
not rupture the cell membrane or cause inflammation, unlike necrosis. It is both a
physiological and pathological process.
4. A 65-year-old female with congestive heart failure presents with generalized
edema, weight gain, and a serum sodium level of 128 mEq/L. Which mechanism
best explains her hyponatremia?
A. Hypervolemic hyponatremia due to decreased effective circulating volume
and excess ADH secretion.
B. Hypovolemic hyponatremia due to severe diarrhea.
C. Euvolemic hyponatremia due to SIADH.
D. Hypervolemic hyponatremia due to primary polydipsia.
Correct Answer: A. Hypervolemic hyponatremia due to decreased effective
circulating volume and excess ADH secretion.
2
, Rationale: In CHF, decreased cardiac output triggers baroreceptors, leading to
increased ADH (vasopressin) secretion. This causes water retention that is
disproportionate to sodium retention, resulting in dilutional hyponatremia.
5. A patient with chronic heart failure develops worsening edema and
hyponatremia. What is the most likely pathophysiological mechanism?
A. Reduced aldosterone secretion
B. Increased antidiuretic hormone (ADH) secretion
C. Decreased renin production
D. Impaired atrial natriuretic peptide (ANP) release
Correct Answer: B. Increased antidiuretic hormone (ADH) secretion
Rationale: In CHF, decreased cardiac output triggers baroreceptors, leading to
increased ADH (vasopressin), which causes water retention greater than sodium
retention, resulting in dilutional hyponatremia. Aldosterone initially increases, not
decreases.
6. A 65-year-old with type 2 diabetes presents with painless hematuria. Which
finding on urinalysis is most concerning for renal papillary necrosis?
A. White blood cell casts
B. Dysmorphic red blood cells
C. Gross hematuria with tissue fragments
D. Crystalline casts
Correct Answer: C. Gross hematuria with tissue fragments
Rationale: Renal papillary necrosis, which is common in diabetes, involves the
sloughing of renal papillae, leading to visible tissue fragments in the urine.
Dysmorphic RBCs suggest glomerulonephritis.
7. Which of the following is not one of the three most common causative
organisms for bacterial conjunctivitis?
3
, A. Staphylococcus aureus
B. Pseudomonas
C. Haemophilus influenzae
D. Streptococcus pneumoniae
Correct Answer: B. Pseudomonas
Rationale: The three most common causative organisms for bacterial
conjunctivitis are Streptococcus pneumoniae, Haemophilus influenzae, and
Staphylococcus aureus. Pseudomonas is not typically among the top three for this
condition.
8. A 19-year-old presents with a complaint of bilaterally itchy, red eyes with
tearing that occurs intermittently throughout the year, often accompanied by a
rope-like eye discharge and clear nasal discharge. This is most consistent with
which diagnosis?
A. Bacterial conjunctivitis
B. Viral conjunctivitis
C. Allergic conjunctivitis
D. Blepharitis
Correct Answer: C. Allergic conjunctivitis
Rationale: The classic presentation of allergic conjunctivitis includes bilateral
itching, redness, tearing, and a rope-like or stringy discharge. It is often associated
with other allergic symptoms like a clear nasal discharge.
9. What is the first-line intervention for epistaxis?
A. Nasal packing
B. Cauterization
C. Firm pressure to the area superior to the nasal alar cartilage
D. Topical vasoconstrictors
4
