NSG5140 Advanced Pathophysiology 2026 Final Exam
– 100 High-Yield Graduate Nursing Questions with
Answer | INSTANT PDF DOWNLOAD
1. A patient with long-standing hypertension develops left ventricular hypertrophy (LVH).
What is the primary pathophysiologic adaptation occurring in the myocardium?
A. Myocardial hyperplasia
B. Eccentric dilation due to volume overload
C. Concentric hypertrophy from pressure overload
D. Myocardial apoptosis
Answer: C
Rationale: Chronic hypertension increases afterload, leading to concentric hypertrophy characterized by
thickened ventricular walls without chamber dilation.
2. A patient with septic shock initially presents with warm, flushed skin and bounding
pulses. Which mechanism explains this finding?
A. Increased systemic vascular resistance
B. Peripheral vasoconstriction
C. Widespread vasodilation from inflammatory mediators
D. Decreased nitric oxide production
Answer: C
Rationale: Early septic shock is distributive, mediated by cytokines and nitric oxide causing vasodilation
and decreased systemic vascular resistance.
3. A patient with diabetic ketoacidosis has K⁺ 5.6 mEq/L on admission. What explains
this laboratory finding?
A. Excess aldosterone secretion
B. Increased renal excretion of potassium
C. Potassium shift from intracellular to extracellular space
D. High dietary potassium intake
,Answer: C
Rationale: Insulin deficiency and acidosis shift potassium out of cells, causing transient hyperkalemia
despite total body potassium depletion.
4. Which mechanism most directly contributes to microalbuminuria in early diabetic
nephropathy?
A. Tubular obstruction
B. Immune complex deposition
C. Glomerular basement membrane thickening and hyperfiltration
D. Renal artery stenosis
Answer: C
Rationale: Chronic hyperglycemia causes glomerular hyperfiltration and basement membrane thickening,
increasing permeability to albumin.
5. A patient presents with metabolic acidosis and an elevated anion gap. Which
condition is most likely responsible?
A. Severe diarrhea
B. Vomiting
C. Lactic acidosis
D. Hyperaldosteronism
Answer: C
Rationale: Lactic acidosis increases unmeasured acids, raising the anion gap.
6. In heart failure with preserved ejection fraction (HFpEF), the primary abnormality is:
A. Impaired systolic contraction
B. Reduced preload
C. Diastolic dysfunction with impaired ventricular relaxation
D. Myocardial infarction
Answer: C
Rationale: HFpEF results from stiff ventricles that cannot relax properly, impairing filling while preserving
EF.
,7. A patient develops acute respiratory distress syndrome (ARDS) following severe
pneumonia. Which pathophysiologic change defines ARDS?
A. Bronchoconstriction
B. Increased alveolar-capillary membrane permeability
C. Pleural effusion formation
D. Decreased pulmonary compliance from fibrosis only
Answer: B
Rationale: ARDS involves inflammatory injury causing leakage of protein-rich fluid into alveoli.
8. A patient with primary adrenal insufficiency presents with hypotension and
hyperkalemia. What mechanism explains the hyperkalemia?
A. Increased ADH secretion
B. Reduced aldosterone production
C. Excess cortisol
D. Increased renin suppression
Answer: B
Rationale: Aldosterone deficiency reduces potassium excretion in the distal nephron.
9. A patient with cirrhosis develops hepatic encephalopathy. Which pathophysiologic
process is responsible for neurologic dysfunction?
A. Hyperglycemia
B. Elevated ammonia crossing the blood-brain barrier
C. Hypocalcemia
D. Increased bilirubin only
Answer: B
Rationale: Ammonia accumulates due to impaired hepatic detoxification, altering neurotransmission.
10. Which process is primarily responsible for plaque rupture in acute coronary
syndrome?
A. Smooth muscle proliferation
B. Endothelial repair
, C. Inflammatory degradation of fibrous cap
D. Hypercalcemia
Answer: C
Rationale: Macrophage-mediated inflammation weakens the fibrous cap, leading to rupture and thrombus
formation.
11. A 68-year-old patient with long-standing hypertension develops progressive
dyspnea. Echocardiogram shows EF 60%, left atrial enlargement, and concentric LV
hypertrophy. BNP is elevated. What is the primary pathophysiologic process?
A. Systolic pump failure
B. Acute plaque rupture
C. Impaired ventricular relaxation and increased filling pressures
D. Right ventricular infarction
Answer: C
Rationale: Preserved EF with hypertrophy and elevated filling pressures indicates HFpEF due to diastolic
dysfunction.
12. A patient with sepsis develops hypotension unresponsive to fluids. Lactate is
elevated. What is the primary reason for elevated lactate in septic shock?
A. Hyperglycemia
B. Mitochondrial dysfunction and tissue hypoperfusion
C. Excess insulin
D. Increased oxygen delivery
Answer: B
Rationale: Septic shock impairs cellular oxygen utilization and perfusion, leading to anaerobic metabolism
and lactate production.
13. A patient with chronic kidney disease develops secondary hyperparathyroidism.
What mechanism triggers increased PTH release?
A. Hypercalcemia
B. Phosphate retention and decreased vitamin D activation
C. Increased calcitonin
D. Aldosterone excess
– 100 High-Yield Graduate Nursing Questions with
Answer | INSTANT PDF DOWNLOAD
1. A patient with long-standing hypertension develops left ventricular hypertrophy (LVH).
What is the primary pathophysiologic adaptation occurring in the myocardium?
A. Myocardial hyperplasia
B. Eccentric dilation due to volume overload
C. Concentric hypertrophy from pressure overload
D. Myocardial apoptosis
Answer: C
Rationale: Chronic hypertension increases afterload, leading to concentric hypertrophy characterized by
thickened ventricular walls without chamber dilation.
2. A patient with septic shock initially presents with warm, flushed skin and bounding
pulses. Which mechanism explains this finding?
A. Increased systemic vascular resistance
B. Peripheral vasoconstriction
C. Widespread vasodilation from inflammatory mediators
D. Decreased nitric oxide production
Answer: C
Rationale: Early septic shock is distributive, mediated by cytokines and nitric oxide causing vasodilation
and decreased systemic vascular resistance.
3. A patient with diabetic ketoacidosis has K⁺ 5.6 mEq/L on admission. What explains
this laboratory finding?
A. Excess aldosterone secretion
B. Increased renal excretion of potassium
C. Potassium shift from intracellular to extracellular space
D. High dietary potassium intake
,Answer: C
Rationale: Insulin deficiency and acidosis shift potassium out of cells, causing transient hyperkalemia
despite total body potassium depletion.
4. Which mechanism most directly contributes to microalbuminuria in early diabetic
nephropathy?
A. Tubular obstruction
B. Immune complex deposition
C. Glomerular basement membrane thickening and hyperfiltration
D. Renal artery stenosis
Answer: C
Rationale: Chronic hyperglycemia causes glomerular hyperfiltration and basement membrane thickening,
increasing permeability to albumin.
5. A patient presents with metabolic acidosis and an elevated anion gap. Which
condition is most likely responsible?
A. Severe diarrhea
B. Vomiting
C. Lactic acidosis
D. Hyperaldosteronism
Answer: C
Rationale: Lactic acidosis increases unmeasured acids, raising the anion gap.
6. In heart failure with preserved ejection fraction (HFpEF), the primary abnormality is:
A. Impaired systolic contraction
B. Reduced preload
C. Diastolic dysfunction with impaired ventricular relaxation
D. Myocardial infarction
Answer: C
Rationale: HFpEF results from stiff ventricles that cannot relax properly, impairing filling while preserving
EF.
,7. A patient develops acute respiratory distress syndrome (ARDS) following severe
pneumonia. Which pathophysiologic change defines ARDS?
A. Bronchoconstriction
B. Increased alveolar-capillary membrane permeability
C. Pleural effusion formation
D. Decreased pulmonary compliance from fibrosis only
Answer: B
Rationale: ARDS involves inflammatory injury causing leakage of protein-rich fluid into alveoli.
8. A patient with primary adrenal insufficiency presents with hypotension and
hyperkalemia. What mechanism explains the hyperkalemia?
A. Increased ADH secretion
B. Reduced aldosterone production
C. Excess cortisol
D. Increased renin suppression
Answer: B
Rationale: Aldosterone deficiency reduces potassium excretion in the distal nephron.
9. A patient with cirrhosis develops hepatic encephalopathy. Which pathophysiologic
process is responsible for neurologic dysfunction?
A. Hyperglycemia
B. Elevated ammonia crossing the blood-brain barrier
C. Hypocalcemia
D. Increased bilirubin only
Answer: B
Rationale: Ammonia accumulates due to impaired hepatic detoxification, altering neurotransmission.
10. Which process is primarily responsible for plaque rupture in acute coronary
syndrome?
A. Smooth muscle proliferation
B. Endothelial repair
, C. Inflammatory degradation of fibrous cap
D. Hypercalcemia
Answer: C
Rationale: Macrophage-mediated inflammation weakens the fibrous cap, leading to rupture and thrombus
formation.
11. A 68-year-old patient with long-standing hypertension develops progressive
dyspnea. Echocardiogram shows EF 60%, left atrial enlargement, and concentric LV
hypertrophy. BNP is elevated. What is the primary pathophysiologic process?
A. Systolic pump failure
B. Acute plaque rupture
C. Impaired ventricular relaxation and increased filling pressures
D. Right ventricular infarction
Answer: C
Rationale: Preserved EF with hypertrophy and elevated filling pressures indicates HFpEF due to diastolic
dysfunction.
12. A patient with sepsis develops hypotension unresponsive to fluids. Lactate is
elevated. What is the primary reason for elevated lactate in septic shock?
A. Hyperglycemia
B. Mitochondrial dysfunction and tissue hypoperfusion
C. Excess insulin
D. Increased oxygen delivery
Answer: B
Rationale: Septic shock impairs cellular oxygen utilization and perfusion, leading to anaerobic metabolism
and lactate production.
13. A patient with chronic kidney disease develops secondary hyperparathyroidism.
What mechanism triggers increased PTH release?
A. Hypercalcemia
B. Phosphate retention and decreased vitamin D activation
C. Increased calcitonin
D. Aldosterone excess
