NURS 5315 UTA Advanced Pathophysiology Exam 2 – Latest
2025–2026 Fully Solved.
1. During assessment of a patient with prolonged tissue hypoxia and early reversible cellular injury,
which mechanism should the nurse practitioner identify?
A. nuclear fragmentation
B. lysosomal membrane rupture
C. ATP depletion
D. irreversible plasma membrane disruption
Answer: C. ATP depletion
Rationale: Hypoxia first reduces oxidative phosphorylation and ATP production. ATP-dependent ion
pumps then fail, causing cellular swelling before irreversible membrane and nuclear injury occurs.
2. A clinical case demonstrates chronic systemic hypertension causing increased left ventricular
wall thickness. Which pathophysiologic process best accounts for this finding?
A. myocyte hypertrophy
B. myocyte hyperplasia
C. squamous metaplasia
D. dysplasia
Answer: A. myocyte hypertrophy
Rationale: Adult cardiac myocytes have little capacity for division, so chronic pressure overload enlarges
existing cells, producing hypertrophy.
3. Which underlying alteration most accurately explains controlled removal of damaged cells
without a major inflammatory response?
A. liquefactive necrosis
B. apoptosis
C. coagulative necrosis
D. gangrenous necrosis
Answer: B. apoptosis
Rationale: Apoptosis is programmed cell death with membrane integrity largely preserved and cellular
fragments removed without the marked inflammation typical of necrosis.
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,4. During assessment of a patient with replacement of bronchial ciliated columnar epithelium by
stratified squamous epithelium in a smoker, which mechanism should the nurse practitioner
identify?
A. metaplasia
B. anaplasia
C. hypertrophy
D. hyperplasia
Answer: A. metaplasia
Rationale: Metaplasia is a reversible substitution of one mature cell type for another that is more resistant
to chronic stress.
5. A clinical case demonstrates generalized edema in severe hypoalbuminemia. Which
pathophysiologic process best accounts for this finding?
A. decreased capillary hydrostatic pressure
B. increased plasma oncotic pressure
C. increased lymphatic drainage
D. decreased plasma oncotic pressure
Answer: D. decreased plasma oncotic pressure
Rationale: Low serum albumin reduces the osmotic force that retains water in the vascular space,
promoting interstitial fluid accumulation.
6. Which underlying alteration most accurately explains neurologic deterioration in severe acute
hyponatremia?
A. osmotic water movement out of neurons
B. increased serum osmolality
C. intracellular dehydration
D. water movement into brain cells causing cerebral edema
Answer: D. water movement into brain cells causing cerebral edema
Rationale: Low extracellular sodium lowers serum osmolality, so water enters brain cells and can cause
cerebral edema, seizures, or herniation.
7. During assessment of a patient with ECG changes associated with clinically important
hyperkalemia, which mechanism should the nurse practitioner identify?
A. isolated prolonged QT interval
B. tall peaked T waves
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, C. diffuse ST elevation
D. prominent U waves
Answer: B. tall peaked T waves
Rationale: Hyperkalemia alters myocardial membrane depolarization and commonly produces peaked T
waves before more severe conduction abnormalities develop.
8. A clinical case demonstrates persistent vomiting with elevated serum bicarbonate. Which
pathophysiologic process best accounts for this finding?
A. respiratory alkalosis with renal acid retention
B. metabolic acidosis with hyperventilation
C. respiratory acidosis with bicarbonate loss
D. metabolic alkalosis with compensatory hypoventilation
Answer: D. metabolic alkalosis with compensatory hypoventilation
Rationale: Loss of gastric hydrogen ions produces metabolic alkalosis; respiratory compensation retains
carbon dioxide through hypoventilation.
9. Which underlying alteration most accurately explains diabetic ketoacidosis?
A. normal-anion-gap metabolic alkalosis
B. primary respiratory acidosis
C. high-anion-gap metabolic acidosis
D. primary respiratory alkalosis
Answer: C. high-anion-gap metabolic acidosis
Rationale: Accumulation of ketoacids consumes bicarbonate, producing a high-anion-gap metabolic
acidosis with compensatory hyperventilation.
10. During assessment of a patient with activation of the renin-angiotensin-aldosterone system after
reduced renal perfusion, which mechanism should the nurse practitioner identify?
A. suppression of thirst and aldosterone
B. natriuresis and vasodilation
C. reduced sympathetic activity
D. sodium retention and vasoconstriction
Answer: D. sodium retention and vasoconstriction
Rationale: Angiotensin II causes vasoconstriction and stimulates aldosterone, which increases renal
sodium and water retention.
Page 3
2025–2026 Fully Solved.
1. During assessment of a patient with prolonged tissue hypoxia and early reversible cellular injury,
which mechanism should the nurse practitioner identify?
A. nuclear fragmentation
B. lysosomal membrane rupture
C. ATP depletion
D. irreversible plasma membrane disruption
Answer: C. ATP depletion
Rationale: Hypoxia first reduces oxidative phosphorylation and ATP production. ATP-dependent ion
pumps then fail, causing cellular swelling before irreversible membrane and nuclear injury occurs.
2. A clinical case demonstrates chronic systemic hypertension causing increased left ventricular
wall thickness. Which pathophysiologic process best accounts for this finding?
A. myocyte hypertrophy
B. myocyte hyperplasia
C. squamous metaplasia
D. dysplasia
Answer: A. myocyte hypertrophy
Rationale: Adult cardiac myocytes have little capacity for division, so chronic pressure overload enlarges
existing cells, producing hypertrophy.
3. Which underlying alteration most accurately explains controlled removal of damaged cells
without a major inflammatory response?
A. liquefactive necrosis
B. apoptosis
C. coagulative necrosis
D. gangrenous necrosis
Answer: B. apoptosis
Rationale: Apoptosis is programmed cell death with membrane integrity largely preserved and cellular
fragments removed without the marked inflammation typical of necrosis.
Page 1
,4. During assessment of a patient with replacement of bronchial ciliated columnar epithelium by
stratified squamous epithelium in a smoker, which mechanism should the nurse practitioner
identify?
A. metaplasia
B. anaplasia
C. hypertrophy
D. hyperplasia
Answer: A. metaplasia
Rationale: Metaplasia is a reversible substitution of one mature cell type for another that is more resistant
to chronic stress.
5. A clinical case demonstrates generalized edema in severe hypoalbuminemia. Which
pathophysiologic process best accounts for this finding?
A. decreased capillary hydrostatic pressure
B. increased plasma oncotic pressure
C. increased lymphatic drainage
D. decreased plasma oncotic pressure
Answer: D. decreased plasma oncotic pressure
Rationale: Low serum albumin reduces the osmotic force that retains water in the vascular space,
promoting interstitial fluid accumulation.
6. Which underlying alteration most accurately explains neurologic deterioration in severe acute
hyponatremia?
A. osmotic water movement out of neurons
B. increased serum osmolality
C. intracellular dehydration
D. water movement into brain cells causing cerebral edema
Answer: D. water movement into brain cells causing cerebral edema
Rationale: Low extracellular sodium lowers serum osmolality, so water enters brain cells and can cause
cerebral edema, seizures, or herniation.
7. During assessment of a patient with ECG changes associated with clinically important
hyperkalemia, which mechanism should the nurse practitioner identify?
A. isolated prolonged QT interval
B. tall peaked T waves
Page 2
, C. diffuse ST elevation
D. prominent U waves
Answer: B. tall peaked T waves
Rationale: Hyperkalemia alters myocardial membrane depolarization and commonly produces peaked T
waves before more severe conduction abnormalities develop.
8. A clinical case demonstrates persistent vomiting with elevated serum bicarbonate. Which
pathophysiologic process best accounts for this finding?
A. respiratory alkalosis with renal acid retention
B. metabolic acidosis with hyperventilation
C. respiratory acidosis with bicarbonate loss
D. metabolic alkalosis with compensatory hypoventilation
Answer: D. metabolic alkalosis with compensatory hypoventilation
Rationale: Loss of gastric hydrogen ions produces metabolic alkalosis; respiratory compensation retains
carbon dioxide through hypoventilation.
9. Which underlying alteration most accurately explains diabetic ketoacidosis?
A. normal-anion-gap metabolic alkalosis
B. primary respiratory acidosis
C. high-anion-gap metabolic acidosis
D. primary respiratory alkalosis
Answer: C. high-anion-gap metabolic acidosis
Rationale: Accumulation of ketoacids consumes bicarbonate, producing a high-anion-gap metabolic
acidosis with compensatory hyperventilation.
10. During assessment of a patient with activation of the renin-angiotensin-aldosterone system after
reduced renal perfusion, which mechanism should the nurse practitioner identify?
A. suppression of thirst and aldosterone
B. natriuresis and vasodilation
C. reduced sympathetic activity
D. sodium retention and vasoconstriction
Answer: D. sodium retention and vasoconstriction
Rationale: Angiotensin II causes vasoconstriction and stimulates aldosterone, which increases renal
sodium and water retention.
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