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NURS 5315 Final Exam: 200 Advanced Pathophysiology
Multiple-Choice Questions with Verified Answers and
Detailed Rationales for Graduate Nursing Students
Section 1: Cellular Adaptation, Injury, and Death (Questions 1-25)
1. A 68-year-old male with severe peripheral artery disease presents with gangrenous changes
in his left great toe. A biopsy of the surrounding tissue would most likely demonstrate which
primary cellular morphologic change?
A. Shrunken basophilic cells with nuclear fragmentation
B. Cellular swelling, organelle disruption, and nuclear pyknosis
C. Coagulative necrosis with preserved cellular outlines
D. Caseating granulomas with giant cells
Correct Answer: C
Rationale: Ischemia caused by arterial occlusion typically leads to coagulative necrosis, where
tissue architecture is preserved but cells are dead due to protein denaturation. Pyknosis is an
early nuclear change, not the classic tissue pattern, while caseating granulomas are
pathognomonic for tuberculosis .
2. A 45-year-old female presents with a painless, firm breast mass. Genetic testing reveals a
BRCA1 mutation. At the cellular level, the BRCA1 protein normally functions to:
,2
A. Promote angiogenesis for tumor sustenance
B. Repair double-stranded DNA breaks via homologous recombination
C. Inhibit apoptosis by upregulating Bcl-2
D. Activate the G1/S cell cycle checkpoint independently of p53
Correct Answer: B
Rationale: BRCA1 is a tumor suppressor gene critical for repairing double-stranded DNA breaks
through homologous recombination. Mutation leads to genomic instability and malignancy.
Distractors A and C describe oncogene/pro-survival functions, while D misstates its checkpoint
role .
3. A 24-year-old male is admitted with a severe crush injury to his lower extremities. His
serum potassium is 7.2 mEq/L, and he exhibits peaked T waves on ECG. The underlying
pathophysiologic mechanism for this hyperkalemia is:
A. Shift of potassium extracellularly due to ATP-dependent Na+/K+ pump failure and cellular
lysis
B. Decreased renal excretion of potassium due to acute tubular necrosis
C. Increased gastrointestinal absorption of potassium from tissue ischemia
D. Metabolic alkalosis causing a shift of hydrogen ions into the cells
Correct Answer: A
,3
Rationale: Crush injuries cause massive cellular trauma, releasing intracellular potassium
directly into extracellular fluid. Ischemia-induced failure of the Na+/K+-ATPase pump
compounds this, as the pump normally returns K+ into cells. Decreased renal excretion takes
hours to days to manifest .
4. A patient with prolonged vomiting has ABG results: pH 7.52, PaCO2 48 mm Hg, HCO3- 38
mEq/L. These findings indicate which acid-base disorder?
A. Uncompensated metabolic alkalosis
B. Partially compensated respiratory acidosis
C. Fully compensated metabolic alkalosis
D. Mixed respiratory and metabolic alkalosis
Correct Answer: C
Rationale: Vomiting causes loss of gastric HCl, leading to metabolic alkalosis (elevated pH and
HCO3-). The elevated PaCO2 represents respiratory compensation (hypoventilation to retain
CO2). Because pH is at the upper limit of normal, it is fully compensated .
5. A 55-year-old male with chronic alcoholism presents with confusion, ataxia, and
ophthalmoplegia. MRI shows mammillary body degeneration. This clinical presentation is
caused by a deficiency in a cofactor required for which cellular process?
, 4
A. Glycolysis
B. Pyruvate dehydrogenase activity and transketolase reactions
C. Beta-oxidation of fatty acids
D. Urea cycle ammonia detoxification
Correct Answer: B
Rationale: Wernicke encephalopathy is caused by thiamine (B1) deficiency. Thiamine is an
essential cofactor for pyruvate dehydrogenase (linking glycolysis to TCA cycle) and transketolase
(pentose phosphate pathway). Deficiency leads to impaired cerebral energy metabolism .
6. A 58-year-old patient with long-standing uncontrolled hypertension develops increased left
ventricular wall thickness. Which cellular adaptation best explains this response?
A. Metaplasia
B. Hypertrophy
C. Hyperplasia
D. Atrophy
Correct Answer: B
Rationale: Hypertrophy is an increase in cell size without an increase in cell number. In the
heart, this occurs in response to chronic pressure overload (hypertension). Cardiac myocytes are
terminally differentiated and cannot divide, so they enlarge instead .
NURS 5315 Final Exam: 200 Advanced Pathophysiology
Multiple-Choice Questions with Verified Answers and
Detailed Rationales for Graduate Nursing Students
Section 1: Cellular Adaptation, Injury, and Death (Questions 1-25)
1. A 68-year-old male with severe peripheral artery disease presents with gangrenous changes
in his left great toe. A biopsy of the surrounding tissue would most likely demonstrate which
primary cellular morphologic change?
A. Shrunken basophilic cells with nuclear fragmentation
B. Cellular swelling, organelle disruption, and nuclear pyknosis
C. Coagulative necrosis with preserved cellular outlines
D. Caseating granulomas with giant cells
Correct Answer: C
Rationale: Ischemia caused by arterial occlusion typically leads to coagulative necrosis, where
tissue architecture is preserved but cells are dead due to protein denaturation. Pyknosis is an
early nuclear change, not the classic tissue pattern, while caseating granulomas are
pathognomonic for tuberculosis .
2. A 45-year-old female presents with a painless, firm breast mass. Genetic testing reveals a
BRCA1 mutation. At the cellular level, the BRCA1 protein normally functions to:
,2
A. Promote angiogenesis for tumor sustenance
B. Repair double-stranded DNA breaks via homologous recombination
C. Inhibit apoptosis by upregulating Bcl-2
D. Activate the G1/S cell cycle checkpoint independently of p53
Correct Answer: B
Rationale: BRCA1 is a tumor suppressor gene critical for repairing double-stranded DNA breaks
through homologous recombination. Mutation leads to genomic instability and malignancy.
Distractors A and C describe oncogene/pro-survival functions, while D misstates its checkpoint
role .
3. A 24-year-old male is admitted with a severe crush injury to his lower extremities. His
serum potassium is 7.2 mEq/L, and he exhibits peaked T waves on ECG. The underlying
pathophysiologic mechanism for this hyperkalemia is:
A. Shift of potassium extracellularly due to ATP-dependent Na+/K+ pump failure and cellular
lysis
B. Decreased renal excretion of potassium due to acute tubular necrosis
C. Increased gastrointestinal absorption of potassium from tissue ischemia
D. Metabolic alkalosis causing a shift of hydrogen ions into the cells
Correct Answer: A
,3
Rationale: Crush injuries cause massive cellular trauma, releasing intracellular potassium
directly into extracellular fluid. Ischemia-induced failure of the Na+/K+-ATPase pump
compounds this, as the pump normally returns K+ into cells. Decreased renal excretion takes
hours to days to manifest .
4. A patient with prolonged vomiting has ABG results: pH 7.52, PaCO2 48 mm Hg, HCO3- 38
mEq/L. These findings indicate which acid-base disorder?
A. Uncompensated metabolic alkalosis
B. Partially compensated respiratory acidosis
C. Fully compensated metabolic alkalosis
D. Mixed respiratory and metabolic alkalosis
Correct Answer: C
Rationale: Vomiting causes loss of gastric HCl, leading to metabolic alkalosis (elevated pH and
HCO3-). The elevated PaCO2 represents respiratory compensation (hypoventilation to retain
CO2). Because pH is at the upper limit of normal, it is fully compensated .
5. A 55-year-old male with chronic alcoholism presents with confusion, ataxia, and
ophthalmoplegia. MRI shows mammillary body degeneration. This clinical presentation is
caused by a deficiency in a cofactor required for which cellular process?
, 4
A. Glycolysis
B. Pyruvate dehydrogenase activity and transketolase reactions
C. Beta-oxidation of fatty acids
D. Urea cycle ammonia detoxification
Correct Answer: B
Rationale: Wernicke encephalopathy is caused by thiamine (B1) deficiency. Thiamine is an
essential cofactor for pyruvate dehydrogenase (linking glycolysis to TCA cycle) and transketolase
(pentose phosphate pathway). Deficiency leads to impaired cerebral energy metabolism .
6. A 58-year-old patient with long-standing uncontrolled hypertension develops increased left
ventricular wall thickness. Which cellular adaptation best explains this response?
A. Metaplasia
B. Hypertrophy
C. Hyperplasia
D. Atrophy
Correct Answer: B
Rationale: Hypertrophy is an increase in cell size without an increase in cell number. In the
heart, this occurs in response to chronic pressure overload (hypertension). Cardiac myocytes are
terminally differentiated and cannot divide, so they enlarge instead .
