NSG 5140 Advanced Pathophysiology
Final Exam { } Review 2026–2027 |
Original Practice Questions & Answers
with Rationales | South College Study
Guide |
• CORE DOMAINS*
•
1. Cellular Adaptation, Injury, and Death*
•
2. Inflammation and Immune Responses*
•
3. Fluid, Electrolyte, and Acid-Base Balance*
•
4. Cardiovascular Pathophysiology*
•
5. Respiratory Pathophysiology*
•
6. Renal and Urinary Pathophysiology*
•
7. Gastrointestinal Pathophysiology*
•
8. Neurological Pathophysiology*
•
9. Endocrine Pathophysiology*
•
10. Hematologic and Oncologic Pathophysiology*
, • INTRODUCTION*
• This comprehensive examination is designed to assess advanced
pathophysiologic concepts essential for clinical practice. It evaluates
foundational theoretical knowledge, applied professional understanding, and
critical decision-making skills through multiple-choice and scenario-based
questions. The exam emphasizes the integration of pathophysiologic
mechanisms with clinical presentations, diagnostic reasoning, and
therapeutic interventions. Each question challenges the learner to synthesize
complex information, apply regulatory and ethical standards, and prioritize
patient-centered care in real-world situations. Successful completion
demonstrates mastery of advanced pathophysiology necessary for safe and
effective advanced nursing practice.*
SECTION ONE: QUESTIONS 1–100
Q1. A patient with chronic heart failure exhibits peripheral edema and ascites.
Which cellular adaptation is most likely occurring in the hepatocytes due to chronic
venous congestion?
A. Hyperplasia
B. Atrophy
C. Metaplasia
D. Hypertrophy
D. Hypertrophy
RATIONALE: Hypertrophy occurs when cells increase in size due to increased
workload or chronic congestion, as seen in heart failure. The hepatocytes enlarge to
compensate for the increased pressure and workload.
Q2. During the acute inflammatory response, which chemical mediator is primarily
responsible for the initial vasodilation and increased vascular permeability?
A. Leukotrienes
B. Prostaglandins
C. Histamine
D. Tumor necrosis factor-alpha
, C. Histamine
RATIONALE: Histamine is released from mast cells and basophils immediately
upon tissue injury, causing rapid vasodilation and increased capillary permeability,
which facilitates the movement of immune cells to the site.
Q3. A patient presents with a serum pH of 7.25, bicarbonate of 18 mEq/L, and a
PaCO2 of 32 mmHg. What is the primary acid-base disturbance?
A. Respiratory acidosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
B. Metabolic acidosis
RATIONALE: The low pH (acidemia) with a low bicarbonate indicates a
metabolic acidosis. The low PaCO2 suggests a compensatory respiratory alkalosis
(hyperventilation) attempting to correct the pH.
Q4. A 65-year-old male with a history of hypertension and diabetes presents with
sudden onset of severe chest pain radiating to the left arm. ECG reveals ST-
segment elevation. Which pathophysiologic mechanism is most responsible for his
condition?
A. Coronary artery spasm
B. Rupture of an atherosclerotic plaque with thrombus formation
C. Embolization from a left atrial thrombus
D. Myocardial hypertrophy with decreased oxygen supply
B. Rupture of an atherosclerotic plaque with thrombus formation
RATIONALE: ST-segment elevation myocardial infarction is typically caused by
acute occlusion of a coronary artery due to plaque rupture and subsequent
thrombus formation, leading to ischemia and necrosis of the myocardium.
Q5. In a patient with chronic obstructive pulmonary disease (COPD), which of the
following compensatory mechanisms occurs in response to chronic hypercapnia?
A. Increased renal excretion of bicarbonate
B. Increased respiratory rate
, C. Increased renal reabsorption of bicarbonate
D. Decreased production of carbonic anhydrase
C. Increased renal reabsorption of bicarbonate
RATIONALE: Chronic hypercapnia in COPD leads to respiratory acidosis. The
kidneys compensate by retaining bicarbonate (reabsorbing it) and excreting
hydrogen ions to raise serum pH.
Q6. A patient develops anaphylactic shock after a bee sting. Which type of
hypersensitivity reaction is this?
A. Type I – IgE-mediated
B. Type II – Antibody-mediated
C. Type III – Immune complex-mediated
D. Type IV – Cell-mediated
A. Type I – IgE-mediated
RATIONALE: Anaphylaxis is a classic Type I hypersensitivity reaction, caused by
the release of histamine and other mediators from mast cells activated by cross-
linking of IgE antibodies bound to the allergen.
Q7. A 50-year-old woman with a history of alcoholism presents with jaundice,
ascites, and coagulopathy. Which pathophysiologic process is most likely
responsible for her coagulopathy?
A. Vitamin K deficiency due to biliary obstruction
B. Decreased synthesis of clotting factors by the liver
C. Disseminated intravascular coagulation
D. Thrombocytopenia due to splenomegaly
B. Decreased synthesis of clotting factors by the liver
RATIONALE: The liver synthesizes most coagulation factors. In cirrhosis from
alcoholism, hepatic synthetic function is impaired, leading to decreased production
of factors and a prolonged prothrombin time, resulting in bleeding tendency.
Q8. A patient with Addison's disease presents with hyperkalemia. Which of the
following mechanisms best explains this finding?
A. Decreased aldosterone leading to decreased renal potassium excretion
Final Exam { } Review 2026–2027 |
Original Practice Questions & Answers
with Rationales | South College Study
Guide |
• CORE DOMAINS*
•
1. Cellular Adaptation, Injury, and Death*
•
2. Inflammation and Immune Responses*
•
3. Fluid, Electrolyte, and Acid-Base Balance*
•
4. Cardiovascular Pathophysiology*
•
5. Respiratory Pathophysiology*
•
6. Renal and Urinary Pathophysiology*
•
7. Gastrointestinal Pathophysiology*
•
8. Neurological Pathophysiology*
•
9. Endocrine Pathophysiology*
•
10. Hematologic and Oncologic Pathophysiology*
, • INTRODUCTION*
• This comprehensive examination is designed to assess advanced
pathophysiologic concepts essential for clinical practice. It evaluates
foundational theoretical knowledge, applied professional understanding, and
critical decision-making skills through multiple-choice and scenario-based
questions. The exam emphasizes the integration of pathophysiologic
mechanisms with clinical presentations, diagnostic reasoning, and
therapeutic interventions. Each question challenges the learner to synthesize
complex information, apply regulatory and ethical standards, and prioritize
patient-centered care in real-world situations. Successful completion
demonstrates mastery of advanced pathophysiology necessary for safe and
effective advanced nursing practice.*
SECTION ONE: QUESTIONS 1–100
Q1. A patient with chronic heart failure exhibits peripheral edema and ascites.
Which cellular adaptation is most likely occurring in the hepatocytes due to chronic
venous congestion?
A. Hyperplasia
B. Atrophy
C. Metaplasia
D. Hypertrophy
D. Hypertrophy
RATIONALE: Hypertrophy occurs when cells increase in size due to increased
workload or chronic congestion, as seen in heart failure. The hepatocytes enlarge to
compensate for the increased pressure and workload.
Q2. During the acute inflammatory response, which chemical mediator is primarily
responsible for the initial vasodilation and increased vascular permeability?
A. Leukotrienes
B. Prostaglandins
C. Histamine
D. Tumor necrosis factor-alpha
, C. Histamine
RATIONALE: Histamine is released from mast cells and basophils immediately
upon tissue injury, causing rapid vasodilation and increased capillary permeability,
which facilitates the movement of immune cells to the site.
Q3. A patient presents with a serum pH of 7.25, bicarbonate of 18 mEq/L, and a
PaCO2 of 32 mmHg. What is the primary acid-base disturbance?
A. Respiratory acidosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
B. Metabolic acidosis
RATIONALE: The low pH (acidemia) with a low bicarbonate indicates a
metabolic acidosis. The low PaCO2 suggests a compensatory respiratory alkalosis
(hyperventilation) attempting to correct the pH.
Q4. A 65-year-old male with a history of hypertension and diabetes presents with
sudden onset of severe chest pain radiating to the left arm. ECG reveals ST-
segment elevation. Which pathophysiologic mechanism is most responsible for his
condition?
A. Coronary artery spasm
B. Rupture of an atherosclerotic plaque with thrombus formation
C. Embolization from a left atrial thrombus
D. Myocardial hypertrophy with decreased oxygen supply
B. Rupture of an atherosclerotic plaque with thrombus formation
RATIONALE: ST-segment elevation myocardial infarction is typically caused by
acute occlusion of a coronary artery due to plaque rupture and subsequent
thrombus formation, leading to ischemia and necrosis of the myocardium.
Q5. In a patient with chronic obstructive pulmonary disease (COPD), which of the
following compensatory mechanisms occurs in response to chronic hypercapnia?
A. Increased renal excretion of bicarbonate
B. Increased respiratory rate
, C. Increased renal reabsorption of bicarbonate
D. Decreased production of carbonic anhydrase
C. Increased renal reabsorption of bicarbonate
RATIONALE: Chronic hypercapnia in COPD leads to respiratory acidosis. The
kidneys compensate by retaining bicarbonate (reabsorbing it) and excreting
hydrogen ions to raise serum pH.
Q6. A patient develops anaphylactic shock after a bee sting. Which type of
hypersensitivity reaction is this?
A. Type I – IgE-mediated
B. Type II – Antibody-mediated
C. Type III – Immune complex-mediated
D. Type IV – Cell-mediated
A. Type I – IgE-mediated
RATIONALE: Anaphylaxis is a classic Type I hypersensitivity reaction, caused by
the release of histamine and other mediators from mast cells activated by cross-
linking of IgE antibodies bound to the allergen.
Q7. A 50-year-old woman with a history of alcoholism presents with jaundice,
ascites, and coagulopathy. Which pathophysiologic process is most likely
responsible for her coagulopathy?
A. Vitamin K deficiency due to biliary obstruction
B. Decreased synthesis of clotting factors by the liver
C. Disseminated intravascular coagulation
D. Thrombocytopenia due to splenomegaly
B. Decreased synthesis of clotting factors by the liver
RATIONALE: The liver synthesizes most coagulation factors. In cirrhosis from
alcoholism, hepatic synthetic function is impaired, leading to decreased production
of factors and a prolonged prothrombin time, resulting in bleeding tendency.
Q8. A patient with Addison's disease presents with hyperkalemia. Which of the
following mechanisms best explains this finding?
A. Decreased aldosterone leading to decreased renal potassium excretion
