NR283 Pathophysiology Final Exam 2026/2027 -
NCLEX-RN Aligned
EXAM STRUCTURE
● Total Questions: 85
○ 80 MC (including 12 SATA)
○ 8 Mechanism Explanation
○ 6 Recent Research
○ 4 Genetic/Molecular
● Organized by: Body systems → complexity
● All rationales: 2026-2027 evidence & nursing implications
DOMAIN A Cellular & Systemic Foundations (20 Q)
1. A 26-year-old trauma patient develops progressive hypotension and ↑ serum
lactate. Which cellular process is PRIMARY?
A. Anaerobic glycolysis & lactic acidosis
B. Apoptosis via caspase-3 activation
C. Autophagy induction
D. Oxidative phosphorylation hyperactivity
Answer: A Rationale: Shock → hypoperfusion → O₂↓ → anaerobic glycolysis →
lactate↑; monitor lactate q2 h, target <2 mmol/L.
2. (SATA) Which laboratory findings indicate APOPTOSIS rather than NECROSIS?
(Select ALL)
A. ↑ Caspase-3 activity
B. ↑ LDH in plasma
C. Intact cell membrane (no leakage)
D. DNA laddering on gel electrophoresis
E. ↑ IL-6 cytokine levels
Answer: A, C, D Rationale: Apoptosis = energy-dependent, membrane intact,
DNA fragmentation in multiples of 180 bp; LDH & IL-6 = necrosis/inflammation
markers.
, 3. A diabetic patient’s wound shows impaired neutrophil chemotaxis. Which
metabolic factor is MOST responsible?
A. Hyperglycemia-induced PKC activation
B. Increased insulin-like growth factor
C. Ketone body accumulation
D. Osmotic diuresis
Answer: A Rationale: Hyperglycemia → PKC↑ → NADPH oxidase dysfunction →
defective respiratory burst & chemotaxis; nursing: tight glucose control 140-180
mg/dL.
[4-20 continue: anion-gap metabolic acidosis, SIADH vs DI, DIC pathway 2026, genetic
imprinting in Prader-Willi, autophagy in cardiac ischemia…]
DOMAIN B Cardiovascular & Hematologic (15 Q)
21. A 55-year-old man (HTN, smoker) has LDL 190 mg/dL, hs-CRP 4.2 mg/L. Which
2026 AHA mechanism explains plaque progression?
A. LDL oxidation → endothelial dysfunction → macrophage foam cells
B. HDL reverse transport failure
C. Vasospasm without plaque change
D. Calcium deposition only
Answer: A Rationale: Oxidized LDL recruits monocytes → foam cells → fatty streak;
monitor CRP as inflammation marker.
22. (SATA) Which compensatory mechanisms occur in LV systolic dysfunction?
(Select ALL)
A. ↑ sympathetic tone (↑ HR)
B. ↑ renin-angiotensin-aldosterone activity
C. ↑ ventricular compliance
D. ↑ ANP secretion initially
E. ↑ preload via vasodilation
Answer: A, B, D Rationale: Frank-Starling ↑ preload, RAAS retains Na⁺/H₂O, ANP
released from stretched atria; compliance ↓ (stiffness ↑), vasoconstriction (not dilation).
NCLEX-RN Aligned
EXAM STRUCTURE
● Total Questions: 85
○ 80 MC (including 12 SATA)
○ 8 Mechanism Explanation
○ 6 Recent Research
○ 4 Genetic/Molecular
● Organized by: Body systems → complexity
● All rationales: 2026-2027 evidence & nursing implications
DOMAIN A Cellular & Systemic Foundations (20 Q)
1. A 26-year-old trauma patient develops progressive hypotension and ↑ serum
lactate. Which cellular process is PRIMARY?
A. Anaerobic glycolysis & lactic acidosis
B. Apoptosis via caspase-3 activation
C. Autophagy induction
D. Oxidative phosphorylation hyperactivity
Answer: A Rationale: Shock → hypoperfusion → O₂↓ → anaerobic glycolysis →
lactate↑; monitor lactate q2 h, target <2 mmol/L.
2. (SATA) Which laboratory findings indicate APOPTOSIS rather than NECROSIS?
(Select ALL)
A. ↑ Caspase-3 activity
B. ↑ LDH in plasma
C. Intact cell membrane (no leakage)
D. DNA laddering on gel electrophoresis
E. ↑ IL-6 cytokine levels
Answer: A, C, D Rationale: Apoptosis = energy-dependent, membrane intact,
DNA fragmentation in multiples of 180 bp; LDH & IL-6 = necrosis/inflammation
markers.
, 3. A diabetic patient’s wound shows impaired neutrophil chemotaxis. Which
metabolic factor is MOST responsible?
A. Hyperglycemia-induced PKC activation
B. Increased insulin-like growth factor
C. Ketone body accumulation
D. Osmotic diuresis
Answer: A Rationale: Hyperglycemia → PKC↑ → NADPH oxidase dysfunction →
defective respiratory burst & chemotaxis; nursing: tight glucose control 140-180
mg/dL.
[4-20 continue: anion-gap metabolic acidosis, SIADH vs DI, DIC pathway 2026, genetic
imprinting in Prader-Willi, autophagy in cardiac ischemia…]
DOMAIN B Cardiovascular & Hematologic (15 Q)
21. A 55-year-old man (HTN, smoker) has LDL 190 mg/dL, hs-CRP 4.2 mg/L. Which
2026 AHA mechanism explains plaque progression?
A. LDL oxidation → endothelial dysfunction → macrophage foam cells
B. HDL reverse transport failure
C. Vasospasm without plaque change
D. Calcium deposition only
Answer: A Rationale: Oxidized LDL recruits monocytes → foam cells → fatty streak;
monitor CRP as inflammation marker.
22. (SATA) Which compensatory mechanisms occur in LV systolic dysfunction?
(Select ALL)
A. ↑ sympathetic tone (↑ HR)
B. ↑ renin-angiotensin-aldosterone activity
C. ↑ ventricular compliance
D. ↑ ANP secretion initially
E. ↑ preload via vasodilation
Answer: A, B, D Rationale: Frank-Starling ↑ preload, RAAS retains Na⁺/H₂O, ANP
released from stretched atria; compliance ↓ (stiffness ↑), vasoconstriction (not dilation).
