NR 547 Advanced Pathophysiology
Midterm 2026 Complete Actual
Exam Questions 1- 00 Examplify
Online Proctored Exam
chamberlain college of nursing.
1. A 68-year-old male with a 45-pack-year history presents with progressive dyspnea on exertion
and a chronic cough productive of scant mucoid sputum. Spirometry reveals a post-
bronchodilator FEV1/FVC ratio of 0.62 and an FEV1 of 54% predicted. Which pathophysiologic
mechanism is most directly responsible for the airflow limitation in this patient?
A. Fixed airway stenosis due to tracheal compression
B. Loss of elastic recoil and increased airway collapsibility
C. Eosinophilic infiltration of the bronchial mucosa
D. Central airway obstruction from a carcinoid tumor
Correct Answer: B
Detailed Rationale: The clinical presentation and spirometric findings are classic for chronic
obstructive pulmonary disease (COPD), specifically emphysema-predominant disease. The key
pathophysiologic driver in emphysema is the destruction of alveolar walls and the supporting
elastin network, which leads to a dramatic loss of the lung's elastic recoil pressure. In a healthy
lung, elastic recoil provides the tethering force that keeps small airways patent during
expiration. With loss of recoil, these airways lack radial traction and collapse prematurely during
forced exhalation, a phenomenon termed expiratory flow limitation. This is best quantified by
the reduced FEV1/FVC ratio and the low FEV1. The loss of elastic fibers is an irreversible
consequence of chronic protease-antiprotease imbalance, primarily driven by cigarette smoke-
induced oxidative stress and neutrophil elastase release .
,2. A 72-year-old female with a history of hypertension and osteoarthritis presents with a 3-week
history of progressive fatigue, anorexia, and a 10-pound unintentional weight loss. She also
reports intermittent low-grade fevers and night sweats. On examination, she has mild
splenomegaly but no lymphadenopathy. Complete blood count shows normocytic anemia,
thrombocytosis, and a white blood cell count of 28,000/μL with 80% neutrophils and 10%
bands. Serum lactate dehydrogenase is elevated, and the uric acid level is 9.5 mg/dL. Peripheral
blood smear reveals toxic granulations and Döhle bodies. Which of the following is the most
likely diagnosis?
A. Chronic myelogenous leukemia
B. Leukemoid reaction
C. Myelodysplastic syndrome
D. Acute myeloid leukemia
Correct Answer: B
Detailed Rationale: This patient's presentation of marked neutrophilic leukocytosis with left shift
(bands), toxic granulations, and Döhle bodies in the setting of systemic symptoms (fever, weight
loss, splenomegaly) is highly suggestive of a leukemoid reaction, which is defined as a white
blood cell count exceeding 50,000/μL (though this patient's count of 28,000 is substantial) with
a pronounced left shift, often due to an underlying inflammatory or infectious process.
However, the key distinguishing feature here is the presence of toxic granulations and Döhle
bodies, which are cytoplasmic changes seen in neutrophils during severe infection or
inflammation, not in neoplastic proliferations. The elevated LDH and uric acid are non-specific
but reflect increased cell turnover. In a leukemoid reaction, the leukocytosis is a reactive process
driven by cytokines like G-CSF, and the bone marrow is hypercellular but without a clonal
population. Chronic myelogenous leukemia (CML) typically presents with a much higher WBC
count (often >100,000/μL) with a spectrum of myeloid maturity (basophilia, eosinophilia) and is
universally associated with the Philadelphia chromosome (t(9;22)); the presence of toxic
granulations is not characteristic .
3. In relation to disease development, the term "etiology" refers to which of the following?
A. Number of people with the disease
B. Cause of the disease
C. Definition of the disease
,D. Outcome of the disease
Correct Answer: B
Detailed Rationale: Etiology refers to the cause or origin of a disease. It seeks to answer the
question of why a disease develops. In pathophysiology, understanding etiology is fundamental
because it determines the appropriate prevention, diagnosis, and treatment strategies. The
number of people with a disease is prevalence. The definition of the disease is its diagnostic
criteria. The outcome is prognosis. Distinguishing between these terms is essential for accurate
clinical reasoning and communication .
4. Which of the following is(are) true about "symptoms"?
A. Objective and measurable
B. The same as "signs"
C. Both of the above
D. Neither of the above
Correct Answer: D
Detailed Rationale: Symptoms are subjective manifestations of a disease that are experienced
by the patient, such as pain, nausea, or fatigue. They cannot be directly measured or observed
by others. Signs, in contrast, are objective and measurable findings that can be observed by the
clinician, such as fever, rash, or elevated blood pressure. Therefore, symptoms are neither
objective and measurable (A) nor the same as signs (B). This distinction is crucial for accurate
history taking and physical examination .
5. What level of prevention is a blood pressure screening program for high school students who
are pregnant?
A. Primary
B. Secondary
C. Tertiary
Correct Answer: B
Detailed Rationale: Secondary prevention focuses on early detection and treatment of disease
in asymptomatic individuals to prevent progression and complications. A blood pressure
, screening program for pregnant high school students aims to detect hypertension early, which
can then be managed to prevent complications such as preeclampsia. Primary prevention would
involve preventing the development of hypertension in the first place (e.g., through lifestyle
education). Tertiary prevention would focus on managing established disease to prevent further
disability .
6. Blockage of the right coronary artery can lead to myocardial cell injury because it results in
which of the following?
A. Bilirubin accumulation in myocardial cells
B. Alteration in the genetic material of myocardial cells
C. Reduced energy production in myocardial cells
D. Activation of the complement system
Correct Answer: C
Detailed Rationale: The right coronary artery supplies blood to the right ventricle and inferior
wall of the left ventricle. Blockage of this artery results in ischemia (reduced blood flow), which
deprives myocardial cells of oxygen and glucose. Without oxygen, oxidative phosphorylation
ceases, and ATP production drops precipitously. This reduced energy production leads to failure
of the sodium-potassium pump, cellular swelling, and eventually irreversible cell injury and
necrosis. This is the fundamental mechanism of ischemic cell injury .
7. When myocardial cells are injured, the function of the Na-K membrane pump may be
impaired. Which of the following may then result?
A. Intracellular sodium will increase
B. Extracellular potassium will decrease
C. Cell volume will decrease
D. All of the above
Correct Answer: A
Detailed Rationale: The sodium-potassium ATPase pump normally moves three sodium ions out
of the cell and two potassium ions into the cell for each ATP consumed, maintaining low
intracellular sodium and high intracellular potassium. When this pump fails due to ATP
Midterm 2026 Complete Actual
Exam Questions 1- 00 Examplify
Online Proctored Exam
chamberlain college of nursing.
1. A 68-year-old male with a 45-pack-year history presents with progressive dyspnea on exertion
and a chronic cough productive of scant mucoid sputum. Spirometry reveals a post-
bronchodilator FEV1/FVC ratio of 0.62 and an FEV1 of 54% predicted. Which pathophysiologic
mechanism is most directly responsible for the airflow limitation in this patient?
A. Fixed airway stenosis due to tracheal compression
B. Loss of elastic recoil and increased airway collapsibility
C. Eosinophilic infiltration of the bronchial mucosa
D. Central airway obstruction from a carcinoid tumor
Correct Answer: B
Detailed Rationale: The clinical presentation and spirometric findings are classic for chronic
obstructive pulmonary disease (COPD), specifically emphysema-predominant disease. The key
pathophysiologic driver in emphysema is the destruction of alveolar walls and the supporting
elastin network, which leads to a dramatic loss of the lung's elastic recoil pressure. In a healthy
lung, elastic recoil provides the tethering force that keeps small airways patent during
expiration. With loss of recoil, these airways lack radial traction and collapse prematurely during
forced exhalation, a phenomenon termed expiratory flow limitation. This is best quantified by
the reduced FEV1/FVC ratio and the low FEV1. The loss of elastic fibers is an irreversible
consequence of chronic protease-antiprotease imbalance, primarily driven by cigarette smoke-
induced oxidative stress and neutrophil elastase release .
,2. A 72-year-old female with a history of hypertension and osteoarthritis presents with a 3-week
history of progressive fatigue, anorexia, and a 10-pound unintentional weight loss. She also
reports intermittent low-grade fevers and night sweats. On examination, she has mild
splenomegaly but no lymphadenopathy. Complete blood count shows normocytic anemia,
thrombocytosis, and a white blood cell count of 28,000/μL with 80% neutrophils and 10%
bands. Serum lactate dehydrogenase is elevated, and the uric acid level is 9.5 mg/dL. Peripheral
blood smear reveals toxic granulations and Döhle bodies. Which of the following is the most
likely diagnosis?
A. Chronic myelogenous leukemia
B. Leukemoid reaction
C. Myelodysplastic syndrome
D. Acute myeloid leukemia
Correct Answer: B
Detailed Rationale: This patient's presentation of marked neutrophilic leukocytosis with left shift
(bands), toxic granulations, and Döhle bodies in the setting of systemic symptoms (fever, weight
loss, splenomegaly) is highly suggestive of a leukemoid reaction, which is defined as a white
blood cell count exceeding 50,000/μL (though this patient's count of 28,000 is substantial) with
a pronounced left shift, often due to an underlying inflammatory or infectious process.
However, the key distinguishing feature here is the presence of toxic granulations and Döhle
bodies, which are cytoplasmic changes seen in neutrophils during severe infection or
inflammation, not in neoplastic proliferations. The elevated LDH and uric acid are non-specific
but reflect increased cell turnover. In a leukemoid reaction, the leukocytosis is a reactive process
driven by cytokines like G-CSF, and the bone marrow is hypercellular but without a clonal
population. Chronic myelogenous leukemia (CML) typically presents with a much higher WBC
count (often >100,000/μL) with a spectrum of myeloid maturity (basophilia, eosinophilia) and is
universally associated with the Philadelphia chromosome (t(9;22)); the presence of toxic
granulations is not characteristic .
3. In relation to disease development, the term "etiology" refers to which of the following?
A. Number of people with the disease
B. Cause of the disease
C. Definition of the disease
,D. Outcome of the disease
Correct Answer: B
Detailed Rationale: Etiology refers to the cause or origin of a disease. It seeks to answer the
question of why a disease develops. In pathophysiology, understanding etiology is fundamental
because it determines the appropriate prevention, diagnosis, and treatment strategies. The
number of people with a disease is prevalence. The definition of the disease is its diagnostic
criteria. The outcome is prognosis. Distinguishing between these terms is essential for accurate
clinical reasoning and communication .
4. Which of the following is(are) true about "symptoms"?
A. Objective and measurable
B. The same as "signs"
C. Both of the above
D. Neither of the above
Correct Answer: D
Detailed Rationale: Symptoms are subjective manifestations of a disease that are experienced
by the patient, such as pain, nausea, or fatigue. They cannot be directly measured or observed
by others. Signs, in contrast, are objective and measurable findings that can be observed by the
clinician, such as fever, rash, or elevated blood pressure. Therefore, symptoms are neither
objective and measurable (A) nor the same as signs (B). This distinction is crucial for accurate
history taking and physical examination .
5. What level of prevention is a blood pressure screening program for high school students who
are pregnant?
A. Primary
B. Secondary
C. Tertiary
Correct Answer: B
Detailed Rationale: Secondary prevention focuses on early detection and treatment of disease
in asymptomatic individuals to prevent progression and complications. A blood pressure
, screening program for pregnant high school students aims to detect hypertension early, which
can then be managed to prevent complications such as preeclampsia. Primary prevention would
involve preventing the development of hypertension in the first place (e.g., through lifestyle
education). Tertiary prevention would focus on managing established disease to prevent further
disability .
6. Blockage of the right coronary artery can lead to myocardial cell injury because it results in
which of the following?
A. Bilirubin accumulation in myocardial cells
B. Alteration in the genetic material of myocardial cells
C. Reduced energy production in myocardial cells
D. Activation of the complement system
Correct Answer: C
Detailed Rationale: The right coronary artery supplies blood to the right ventricle and inferior
wall of the left ventricle. Blockage of this artery results in ischemia (reduced blood flow), which
deprives myocardial cells of oxygen and glucose. Without oxygen, oxidative phosphorylation
ceases, and ATP production drops precipitously. This reduced energy production leads to failure
of the sodium-potassium pump, cellular swelling, and eventually irreversible cell injury and
necrosis. This is the fundamental mechanism of ischemic cell injury .
7. When myocardial cells are injured, the function of the Na-K membrane pump may be
impaired. Which of the following may then result?
A. Intracellular sodium will increase
B. Extracellular potassium will decrease
C. Cell volume will decrease
D. All of the above
Correct Answer: A
Detailed Rationale: The sodium-potassium ATPase pump normally moves three sodium ions out
of the cell and two potassium ions into the cell for each ATP consumed, maintaining low
intracellular sodium and high intracellular potassium. When this pump fails due to ATP
