RN Pathophysiology ATI Exam – Latest Versions with
Questions, Answers & Rationale
A 68-year-old with chronic hypertension develops left ventricular hypertrophy. Which process
best explains the hypertrophy?
A. Increased apoptosis
B. Myocyte hyperplasia
C. Myocyte hypertrophy
D. Fibroblast proliferation
Rationale: Hypertrophy in cardiac muscle is enlargement of existing myocytes (not
hyperplasia). It’s an adaptive response to increased workload (e.g., pressure overload from
HTN).
In emphysema, which pathophysiologic change primarily causes decreased gas exchange?
A. Mucus hypersecretion
B. Alveolar wall destruction
C. Bronchospasm
D. Surfactant overproduction
Rationale: Emphysema destroys alveolar walls and capillaries, reducing surface area for
diffusion and causing ventilation–perfusion mismatch and hypoxemia.
A patient with type 1 diabetes has polyuria, polydipsia, and weight loss. Which mechanism
explains these symptoms?
,A. Insulin resistance
B. Autoimmune beta-cell destruction
C. Excess glucagon secretion
D. Increased hepatic glycogen
Rationale: Type 1 DM results from autoimmune destruction of pancreatic beta cells → insulin
deficiency → hyperglycemia, osmotic diuresis, and catabolism.
Which electrolyte abnormality is most likely in metabolic alkalosis from prolonged vomiting?
A. Hypokalemia
B. Hyperkalemia
C. Hyperchloremia
D. Hyponatremia
Rationale: Vomiting causes loss of H⁺ and Cl⁻; kidneys retain bicarbonate and excrete K⁺
leading to hypokalemia accompanying metabolic alkalosis.
In sepsis, which cardiovascular change is typical early in distributive shock?
A. High systemic vascular resistance
B. Low cardiac output
C. Vasodilation with warm extremities
D. Bradycardia
Rationale: Early septic (distributive) shock causes vasodilation and warm, flushed skin due to
decreased SVR and often high cardiac output initially.
A patient with nephrotic syndrome has hypoalbuminemia and edema. Which mechanism
causes the edema?
,A. Increased capillary oncotic pressure
B. Decreased capillary hydrostatic pressure
C. Decreased plasma oncotic pressure
D. Increased lymphatic drainage
Rationale: Loss of albumin lowers plasma oncotic pressure so fluid shifts into interstitium,
causing generalized edema in nephrotic syndrome.
Which lab value most specifically indicates hepatocellular injury?
A. Elevated alkaline phosphatase
B. Increased AST and ALT
C. Low albumin only
D. Hyperbilirubinemia only
Rationale: AST and ALT are intracellular liver enzymes released into blood with hepatocyte
damage; ALP elevates with cholestasis.
A patient develops acute tubular necrosis (ATN) after prolonged hypotension. What best
describes ATN?
A. Immune-mediated glomerular disease
B. Ischemic injury to tubular epithelial cells
C. Interstitial fibrosis only
D. Urinary obstruction in ureters
Rationale: ATN arises from ischemic or nephrotoxic injury to renal tubular epithelial cells
causing impaired reabsorption and acute renal failure.
, Which acid–base disturbance occurs with diabetic ketoacidosis (DKA)?
A. Metabolic alkalosis
B. Respiratory alkalosis
C. Metabolic acidosis with an increased anion gap
D. Normal anion gap metabolic acidosis
Rationale: DKA produces ketone acids, causing high anion gap metabolic acidosis; respiratory
compensation via hyperventilation occurs.
In left-sided heart failure, which symptom results from increased pulmonary venous pressure?
A. Peripheral edema
B. Hepatomegaly
C. Pulmonary edema and dyspnea
D. Jugular vein distention only
Rationale: Left heart failure raises pulmonary venous pressure leading to fluid transudation into
alveoli — pulmonary edema, orthopnea, and dyspnea.
Chronic hypoxia in COPD leads to pulmonary hypertension primarily by which mechanism?
A. Destruction of pulmonary capillaries only
B. Hypoxic pulmonary vasoconstriction
C. Increased left atrial pressure
D. Systemic vasodilation
Rationale: Alveolar hypoxia causes vasoconstriction of pulmonary arterioles; chronic hypoxia
leads to vascular remodeling and pulmonary hypertension.
Questions, Answers & Rationale
A 68-year-old with chronic hypertension develops left ventricular hypertrophy. Which process
best explains the hypertrophy?
A. Increased apoptosis
B. Myocyte hyperplasia
C. Myocyte hypertrophy
D. Fibroblast proliferation
Rationale: Hypertrophy in cardiac muscle is enlargement of existing myocytes (not
hyperplasia). It’s an adaptive response to increased workload (e.g., pressure overload from
HTN).
In emphysema, which pathophysiologic change primarily causes decreased gas exchange?
A. Mucus hypersecretion
B. Alveolar wall destruction
C. Bronchospasm
D. Surfactant overproduction
Rationale: Emphysema destroys alveolar walls and capillaries, reducing surface area for
diffusion and causing ventilation–perfusion mismatch and hypoxemia.
A patient with type 1 diabetes has polyuria, polydipsia, and weight loss. Which mechanism
explains these symptoms?
,A. Insulin resistance
B. Autoimmune beta-cell destruction
C. Excess glucagon secretion
D. Increased hepatic glycogen
Rationale: Type 1 DM results from autoimmune destruction of pancreatic beta cells → insulin
deficiency → hyperglycemia, osmotic diuresis, and catabolism.
Which electrolyte abnormality is most likely in metabolic alkalosis from prolonged vomiting?
A. Hypokalemia
B. Hyperkalemia
C. Hyperchloremia
D. Hyponatremia
Rationale: Vomiting causes loss of H⁺ and Cl⁻; kidneys retain bicarbonate and excrete K⁺
leading to hypokalemia accompanying metabolic alkalosis.
In sepsis, which cardiovascular change is typical early in distributive shock?
A. High systemic vascular resistance
B. Low cardiac output
C. Vasodilation with warm extremities
D. Bradycardia
Rationale: Early septic (distributive) shock causes vasodilation and warm, flushed skin due to
decreased SVR and often high cardiac output initially.
A patient with nephrotic syndrome has hypoalbuminemia and edema. Which mechanism
causes the edema?
,A. Increased capillary oncotic pressure
B. Decreased capillary hydrostatic pressure
C. Decreased plasma oncotic pressure
D. Increased lymphatic drainage
Rationale: Loss of albumin lowers plasma oncotic pressure so fluid shifts into interstitium,
causing generalized edema in nephrotic syndrome.
Which lab value most specifically indicates hepatocellular injury?
A. Elevated alkaline phosphatase
B. Increased AST and ALT
C. Low albumin only
D. Hyperbilirubinemia only
Rationale: AST and ALT are intracellular liver enzymes released into blood with hepatocyte
damage; ALP elevates with cholestasis.
A patient develops acute tubular necrosis (ATN) after prolonged hypotension. What best
describes ATN?
A. Immune-mediated glomerular disease
B. Ischemic injury to tubular epithelial cells
C. Interstitial fibrosis only
D. Urinary obstruction in ureters
Rationale: ATN arises from ischemic or nephrotoxic injury to renal tubular epithelial cells
causing impaired reabsorption and acute renal failure.
, Which acid–base disturbance occurs with diabetic ketoacidosis (DKA)?
A. Metabolic alkalosis
B. Respiratory alkalosis
C. Metabolic acidosis with an increased anion gap
D. Normal anion gap metabolic acidosis
Rationale: DKA produces ketone acids, causing high anion gap metabolic acidosis; respiratory
compensation via hyperventilation occurs.
In left-sided heart failure, which symptom results from increased pulmonary venous pressure?
A. Peripheral edema
B. Hepatomegaly
C. Pulmonary edema and dyspnea
D. Jugular vein distention only
Rationale: Left heart failure raises pulmonary venous pressure leading to fluid transudation into
alveoli — pulmonary edema, orthopnea, and dyspnea.
Chronic hypoxia in COPD leads to pulmonary hypertension primarily by which mechanism?
A. Destruction of pulmonary capillaries only
B. Hypoxic pulmonary vasoconstriction
C. Increased left atrial pressure
D. Systemic vasodilation
Rationale: Alveolar hypoxia causes vasoconstriction of pulmonary arterioles; chronic hypoxia
leads to vascular remodeling and pulmonary hypertension.
