NSG 5140 ADVANCED PATHOPHYSIOLOGY
FINAL EXAM QUESTIONS 2026-2027
COMPREHENSIVE REVIEW QUESTIONS 200 COMPLETE
WITH 100% VERIFIED ANSWERS AND RATIONALES
Q1. A patient with chronic liver disease develops ascites and
peripheral edema. Which pathophysiologic mechanism primarily
contributes to fluid accumulation in this patient?
A. Increased plasma oncotic pressure
B. Decreased hepatic synthesis of albumin
C. Increased antidiuretic hormone secretion
D. Renal artery vasodilation
B. Decreased hepatic synthesis of albumin
RATIONALE: The liver synthesizes albumin, which maintains plasma
oncotic pressure. In chronic liver disease, decreased albumin
production reduces oncotic pressure, allowing fluid to leak into
interstitial spaces and peritoneal cavity, resulting in edema and ascites.
Q2. A 45-year-old patient with type 1 diabetes mellitus presents with
deep, rapid respirations and a fruity odor to their breath. Arterial
blood gas reveals pH 7.20, PaCO2 25 mmHg, and HCO3- 12 mEq/L.
What is the primary acid-base disturbance?
,A. Metabolic acidosis with respiratory compensation
B. Respiratory acidosis with metabolic compensation
C. Metabolic alkalosis with respiratory compensation
D. Respiratory alkalosis with metabolic compensation
A. Metabolic acidosis with respiratory compensation
RATIONALE: The low pH (acidemia), low bicarbonate (HCO3-), and low
PaCO2 indicate metabolic acidosis with respiratory compensation
(Kussmaul respirations). The low PaCO2 represents hyperventilation
attempting to compensate for the metabolic acidosis seen in diabetic
ketoacidosis.
Q3. Which cellular adaptation is characterized by an increase in cell
size and functional capacity in response to increased workload?
A. Hyperplasia
B. Atrophy
C. Metaplasia
D. Hypertrophy
D. Hypertrophy
RATIONALE: Hypertrophy is an increase in cell size due to increased
synthesis of structural proteins and organelles. It occurs in response to
increased workload, such as cardiac muscle hypertrophy in
hypertension or skeletal muscle hypertrophy from exercise.
,Q4. A patient with systemic lupus erythematosus develops
glomerulonephritis. Which type of hypersensitivity reaction is most
likely responsible?
A. Type I hypersensitivity
B. Type II hypersensitivity
C. Type III hypersensitivity
D. Type IV hypersensitivity
C. Type III hypersensitivity
RATIONALE: Systemic lupus erythematosus causes immune complex
deposition (Type III hypersensitivity) in glomeruli, leading to
inflammation and glomerulonephritis. Immune complexes form when
antibodies bind to self-antigens and deposit in tissues.
Q5. A 70-year-old patient with chronic heart failure develops
hyponatremia. Which mechanism best explains this electrolyte
disturbance?
A. Increased sodium excretion by the kidneys
B. Decreased dietary sodium intake
C. Syndrome of inappropriate antidiuretic hormone secretion
D. Increased aldosterone secretion
C. Syndrome of inappropriate antidiuretic hormone secretion
RATIONALE: In chronic heart failure, decreased effective arterial blood
volume stimulates non-osmotic release of ADH, causing water retention
and dilutional hyponatremia. The kidneys retain water while excreting
sodium, leading to low serum sodium levels.
, Q6. During an acute asthma exacerbation, which pathophysiologic
process primarily causes airway obstruction?
A. Increased mucus production with smooth muscle constriction
B. Destruction of alveolar walls
C. Collapse of small airways
D. Pulmonary fibrosis
A. Increased mucus production with smooth muscle constriction
RATIONALE: Asthma is characterized by bronchial hyperresponsiveness
causing smooth muscle constriction, inflammation, and increased
mucus production. These factors collectively narrow airways, increasing
resistance and causing wheezing and dyspnea.
Q7. A patient with acute kidney injury develops metabolic acidosis.
Which mechanism is most responsible?
A. Increased bicarbonate reabsorption
B. Decreased excretion of hydrogen ions
C. Increased production of lactic acid
D. Decreased production of carbonic acid
B. Decreased excretion of hydrogen ions
RATIONALE: The kidneys maintain acid-base balance by excreting
hydrogen ions and reabsorbing bicarbonate. In acute kidney injury,
impaired renal function reduces hydrogen ion excretion, leading to
accumulation of acids and metabolic acidosis.
FINAL EXAM QUESTIONS 2026-2027
COMPREHENSIVE REVIEW QUESTIONS 200 COMPLETE
WITH 100% VERIFIED ANSWERS AND RATIONALES
Q1. A patient with chronic liver disease develops ascites and
peripheral edema. Which pathophysiologic mechanism primarily
contributes to fluid accumulation in this patient?
A. Increased plasma oncotic pressure
B. Decreased hepatic synthesis of albumin
C. Increased antidiuretic hormone secretion
D. Renal artery vasodilation
B. Decreased hepatic synthesis of albumin
RATIONALE: The liver synthesizes albumin, which maintains plasma
oncotic pressure. In chronic liver disease, decreased albumin
production reduces oncotic pressure, allowing fluid to leak into
interstitial spaces and peritoneal cavity, resulting in edema and ascites.
Q2. A 45-year-old patient with type 1 diabetes mellitus presents with
deep, rapid respirations and a fruity odor to their breath. Arterial
blood gas reveals pH 7.20, PaCO2 25 mmHg, and HCO3- 12 mEq/L.
What is the primary acid-base disturbance?
,A. Metabolic acidosis with respiratory compensation
B. Respiratory acidosis with metabolic compensation
C. Metabolic alkalosis with respiratory compensation
D. Respiratory alkalosis with metabolic compensation
A. Metabolic acidosis with respiratory compensation
RATIONALE: The low pH (acidemia), low bicarbonate (HCO3-), and low
PaCO2 indicate metabolic acidosis with respiratory compensation
(Kussmaul respirations). The low PaCO2 represents hyperventilation
attempting to compensate for the metabolic acidosis seen in diabetic
ketoacidosis.
Q3. Which cellular adaptation is characterized by an increase in cell
size and functional capacity in response to increased workload?
A. Hyperplasia
B. Atrophy
C. Metaplasia
D. Hypertrophy
D. Hypertrophy
RATIONALE: Hypertrophy is an increase in cell size due to increased
synthesis of structural proteins and organelles. It occurs in response to
increased workload, such as cardiac muscle hypertrophy in
hypertension or skeletal muscle hypertrophy from exercise.
,Q4. A patient with systemic lupus erythematosus develops
glomerulonephritis. Which type of hypersensitivity reaction is most
likely responsible?
A. Type I hypersensitivity
B. Type II hypersensitivity
C. Type III hypersensitivity
D. Type IV hypersensitivity
C. Type III hypersensitivity
RATIONALE: Systemic lupus erythematosus causes immune complex
deposition (Type III hypersensitivity) in glomeruli, leading to
inflammation and glomerulonephritis. Immune complexes form when
antibodies bind to self-antigens and deposit in tissues.
Q5. A 70-year-old patient with chronic heart failure develops
hyponatremia. Which mechanism best explains this electrolyte
disturbance?
A. Increased sodium excretion by the kidneys
B. Decreased dietary sodium intake
C. Syndrome of inappropriate antidiuretic hormone secretion
D. Increased aldosterone secretion
C. Syndrome of inappropriate antidiuretic hormone secretion
RATIONALE: In chronic heart failure, decreased effective arterial blood
volume stimulates non-osmotic release of ADH, causing water retention
and dilutional hyponatremia. The kidneys retain water while excreting
sodium, leading to low serum sodium levels.
, Q6. During an acute asthma exacerbation, which pathophysiologic
process primarily causes airway obstruction?
A. Increased mucus production with smooth muscle constriction
B. Destruction of alveolar walls
C. Collapse of small airways
D. Pulmonary fibrosis
A. Increased mucus production with smooth muscle constriction
RATIONALE: Asthma is characterized by bronchial hyperresponsiveness
causing smooth muscle constriction, inflammation, and increased
mucus production. These factors collectively narrow airways, increasing
resistance and causing wheezing and dyspnea.
Q7. A patient with acute kidney injury develops metabolic acidosis.
Which mechanism is most responsible?
A. Increased bicarbonate reabsorption
B. Decreased excretion of hydrogen ions
C. Increased production of lactic acid
D. Decreased production of carbonic acid
B. Decreased excretion of hydrogen ions
RATIONALE: The kidneys maintain acid-base balance by excreting
hydrogen ions and reabsorbing bicarbonate. In acute kidney injury,
impaired renal function reduces hydrogen ion excretion, leading to
accumulation of acids and metabolic acidosis.
