NURS 231 Pathophysiology Final Exam 2026/2027 – Portage
Learning Complete Final Examination | Actual Questions &
Verified Answers | Comprehensive Pathophysiology
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1. A 68-year-old man with a 40 pack-year smoking history develops persistent
cough and weight loss. Chest imaging reveals a 3 cm hilar mass. Which cellular
adaptation most likely preceded the malignant transformation of his bronchial
epithelium?
A. Hypertrophy
B. Hyperplasia
C. Dysplasia
D. Metaplasia
Correct Answer: C
Rationale: Dysplasia is disordered, non-uniform epithelial growth with cytologic atypia; it
is the penultimate step in the dysplasia → carcinoma in-situ → invasive cancer
sequence. Hyperplasia (B) is increased number of normal cells; dysplasia implies
atypical hyperplasia. Metaplasia (D) is reversible change in cell type (e.g., squamous
metaplasia in smokers) but lacks cytologic atypia.
2. A laboratory technician inadvertently stores RBCs in pure distilled water. Which
membrane transport mechanism causes the rapid swelling and lysis of the cells?
A. Facilitated diffusion
B. Active transport
C. Osmosis
D. Endocytosis
Correct Answer: C
,Rationale: Distilled water is hypotonic; water moves into cells by osmosis, causing
swelling and lysis. No membrane proteins are required.
3. A 28-year-old woman with anorexia nervosa has a serum potassium of 2.4
mEq/L. Which change in resting membrane potential of her cardiac myocytes
predisposes her to ventricular dysrhythmias?
A. Membrane becomes less negative (depolarized)
B. Membrane becomes more negative (hyperpolarized)
C. Threshold potential increases (becomes less negative)
D. Repolarization is delayed
Correct Answer: A
Rationale: Hypokalemia ↑ the K⁺ gradient, causing hyperpolarization (more negative) of
resting potential. However, this is misleading; the critical effect is increased Na⁺ channel
inactivation and delayed repolarization, but the net electrophysiologic consequence is
early after-depolarizations and increased automaticity due to partial depolarization of
Purkinje fibers. Among choices, A is closest to the clinical shorthand that hypokalemia
predisposes to EADs and triggered activity.
4. A 55-year-old man with severe diarrhea develops hyperchloremic metabolic
acidosis. Which compensatory mechanism will increase his arterial pH toward
normal within 24 hours?
A. Renal excretion of HCO₃⁻
B. Hyperventilation to reduce PaCO₂
C. Increased ammoniagenesis
D. Chloride shift into RBCs
Correct Answer: B
Rationale: Within minutes, hyperventilation (Kussmaul) lowers PaCO₂, compensating for
↓HCO₃⁻. Renal compensation (C) takes days.
5. A 72-year-old woman with COPD and chronic hypercapnia is given 4 L/min nasal
cannula. Thirty minutes later she is lethargic and her ABG shows pH 7.28, PaCO₂
70 mmHg (baseline 55), PaO₂ 85 mmHg. Which pathophysiologic mechanism
, best explains her worsening hypercapnia?
A. Oxygen-induced hypoventilation via loss of hypoxic drive
B. Ventilation-perfusion mismatch from O₂-induced atelectasis
C. Increased dead space from airway closure
D. Haldane effect reducing CO₂ carriage
Correct Answer: A
Rationale: In chronic hypercapnia, hypoxic drive dominates; excessive O₂ suppresses
respiratory center → hypoventilation. V/Q mismatch (B) contributes but A is dominant.
6. A 40-year-old man with septic shock receives 6 L crystalloid. His lungs develop
diffuse crackles and CXR shows bilateral infiltrates. Which alteration in Starling
forces best explains the pulmonary edema?
A. ↑ capillary hydrostatic pressure
B. ↓ interstitial hydrostatic pressure
C. ↑ capillary oncotic pressure
D. ↑ capillary permeability
Correct Answer:A
Rationale: Massive fluid resuscitation ↑ Pcap hydrostatic pressure → hydrostatic
pulmonary edema. Permeability (D) defines ARDS but requires inflammatory injury.
7. A 65-year-old woman with long-standing HTN develops left ventricular
hypertrophy. Which cellular process primarily accounts for the increased
thickness of her left ventricular wall?
A. Hyperplasia
B. Hypertrophy
C. Atrophy
D. Metaplasia
Correct Answer: B
Rationale: Pressure overload → sarcomeres added in parallel → concentric hypertrophy
(increased cell size, not number).
, 8. A 50-year-old man with hemochromatosis develops bronze skin pigmentation.
Which pigment is deposited in his skin and accounts for the hyperpigmentation?
A. Hemosiderin
B. Bilirubin
C. Melanin
D. Lipofuscin
Correct Answer: A
Rationale: Iron overload → hemosiderin deposition in dermis; melanin (C) is increased
secondarily but hemosiderin is pathognomonic.
9. A 35-year-old woman with systemic lupus erythematosus has a positive
anti-dsDNA titer. Which type of hypersensitivity reaction is primarily responsible
for her renal involvement?
A. Type I (IgE-mediated)
B. Type II (cytotoxic)
C. Type III (immune-complex)
D. Type IV (delayed)
Correct Answer: C
Rationale: Anti-dsDNA/nuclear antigen immune complexes deposit in glomeruli → Type
III hypersensitivity → lupus nephritis.
10. A 60-year-old man with chronic bronchitis develops a fever and productive cough
of green sputum. Which inflammatory mediator is most responsible for the green
color?
A. Histamine
B. Bradykinin
C. Myeloperoxidase
D. Prostaglandin E₂
Correct Answer: C
Rationale: Myeloperoxidase (green heme enzyme) in neutrophils → verdant sputum.
Learning Complete Final Examination | Actual Questions &
Verified Answers | Comprehensive Pathophysiology
Assessment | Pass Guarantee
1. A 68-year-old man with a 40 pack-year smoking history develops persistent
cough and weight loss. Chest imaging reveals a 3 cm hilar mass. Which cellular
adaptation most likely preceded the malignant transformation of his bronchial
epithelium?
A. Hypertrophy
B. Hyperplasia
C. Dysplasia
D. Metaplasia
Correct Answer: C
Rationale: Dysplasia is disordered, non-uniform epithelial growth with cytologic atypia; it
is the penultimate step in the dysplasia → carcinoma in-situ → invasive cancer
sequence. Hyperplasia (B) is increased number of normal cells; dysplasia implies
atypical hyperplasia. Metaplasia (D) is reversible change in cell type (e.g., squamous
metaplasia in smokers) but lacks cytologic atypia.
2. A laboratory technician inadvertently stores RBCs in pure distilled water. Which
membrane transport mechanism causes the rapid swelling and lysis of the cells?
A. Facilitated diffusion
B. Active transport
C. Osmosis
D. Endocytosis
Correct Answer: C
,Rationale: Distilled water is hypotonic; water moves into cells by osmosis, causing
swelling and lysis. No membrane proteins are required.
3. A 28-year-old woman with anorexia nervosa has a serum potassium of 2.4
mEq/L. Which change in resting membrane potential of her cardiac myocytes
predisposes her to ventricular dysrhythmias?
A. Membrane becomes less negative (depolarized)
B. Membrane becomes more negative (hyperpolarized)
C. Threshold potential increases (becomes less negative)
D. Repolarization is delayed
Correct Answer: A
Rationale: Hypokalemia ↑ the K⁺ gradient, causing hyperpolarization (more negative) of
resting potential. However, this is misleading; the critical effect is increased Na⁺ channel
inactivation and delayed repolarization, but the net electrophysiologic consequence is
early after-depolarizations and increased automaticity due to partial depolarization of
Purkinje fibers. Among choices, A is closest to the clinical shorthand that hypokalemia
predisposes to EADs and triggered activity.
4. A 55-year-old man with severe diarrhea develops hyperchloremic metabolic
acidosis. Which compensatory mechanism will increase his arterial pH toward
normal within 24 hours?
A. Renal excretion of HCO₃⁻
B. Hyperventilation to reduce PaCO₂
C. Increased ammoniagenesis
D. Chloride shift into RBCs
Correct Answer: B
Rationale: Within minutes, hyperventilation (Kussmaul) lowers PaCO₂, compensating for
↓HCO₃⁻. Renal compensation (C) takes days.
5. A 72-year-old woman with COPD and chronic hypercapnia is given 4 L/min nasal
cannula. Thirty minutes later she is lethargic and her ABG shows pH 7.28, PaCO₂
70 mmHg (baseline 55), PaO₂ 85 mmHg. Which pathophysiologic mechanism
, best explains her worsening hypercapnia?
A. Oxygen-induced hypoventilation via loss of hypoxic drive
B. Ventilation-perfusion mismatch from O₂-induced atelectasis
C. Increased dead space from airway closure
D. Haldane effect reducing CO₂ carriage
Correct Answer: A
Rationale: In chronic hypercapnia, hypoxic drive dominates; excessive O₂ suppresses
respiratory center → hypoventilation. V/Q mismatch (B) contributes but A is dominant.
6. A 40-year-old man with septic shock receives 6 L crystalloid. His lungs develop
diffuse crackles and CXR shows bilateral infiltrates. Which alteration in Starling
forces best explains the pulmonary edema?
A. ↑ capillary hydrostatic pressure
B. ↓ interstitial hydrostatic pressure
C. ↑ capillary oncotic pressure
D. ↑ capillary permeability
Correct Answer:A
Rationale: Massive fluid resuscitation ↑ Pcap hydrostatic pressure → hydrostatic
pulmonary edema. Permeability (D) defines ARDS but requires inflammatory injury.
7. A 65-year-old woman with long-standing HTN develops left ventricular
hypertrophy. Which cellular process primarily accounts for the increased
thickness of her left ventricular wall?
A. Hyperplasia
B. Hypertrophy
C. Atrophy
D. Metaplasia
Correct Answer: B
Rationale: Pressure overload → sarcomeres added in parallel → concentric hypertrophy
(increased cell size, not number).
, 8. A 50-year-old man with hemochromatosis develops bronze skin pigmentation.
Which pigment is deposited in his skin and accounts for the hyperpigmentation?
A. Hemosiderin
B. Bilirubin
C. Melanin
D. Lipofuscin
Correct Answer: A
Rationale: Iron overload → hemosiderin deposition in dermis; melanin (C) is increased
secondarily but hemosiderin is pathognomonic.
9. A 35-year-old woman with systemic lupus erythematosus has a positive
anti-dsDNA titer. Which type of hypersensitivity reaction is primarily responsible
for her renal involvement?
A. Type I (IgE-mediated)
B. Type II (cytotoxic)
C. Type III (immune-complex)
D. Type IV (delayed)
Correct Answer: C
Rationale: Anti-dsDNA/nuclear antigen immune complexes deposit in glomeruli → Type
III hypersensitivity → lupus nephritis.
10. A 60-year-old man with chronic bronchitis develops a fever and productive cough
of green sputum. Which inflammatory mediator is most responsible for the green
color?
A. Histamine
B. Bradykinin
C. Myeloperoxidase
D. Prostaglandin E₂
Correct Answer: C
Rationale: Myeloperoxidase (green heme enzyme) in neutrophils → verdant sputum.
