NURS 231 Pathophysiology | Portage Learning | Final Exam
2026/2027 Complete Final Examination | Actual Questions &
Verified Answers | Comprehensive Pathophysiology
Assessment | Pass Guarantee
1. A 68-year-old man with a 40-pack-year history reports 3 months of progressive,
productive morning cough and new-onset facial swelling that worsens when he
bends forward. Chest imaging shows a right perihilar mass compressing the
superior mediastinum. Which pathophysiologic process best explains the facial
swelling?
A. Tumor secretion of ADH → water retention → generalized edema
B. Compression of the superior vena cava → decreased venous return from
head & arms
C. Right-sided heart failure secondary to pulmonary hypertension → systemic
venous congestion
D. Obstruction of lymphatic ducts by malignant cells → secondary lymphedema
of face
Correct Answer: B
Rationale: The positional swelling and mass location create a classic picture of superior
vena cava (SVC) syndrome. The tumor externally compresses the thin-walled SVC,
reducing venous outflow and raising capillary hydrostatic pressure in the
head/neck/upper extremities. ADH (SIADH) would cause hyponatremic water retention
but generalized, not positional, edema. RV failure would require much more extensive
tumor burden to raise PVR. Lymphedema is usually non-pitting and would not fluctuate
with position.
, 2. A patient with chronic kidney disease (GFR 20 mL/min) develops a respiratory
rate of 28/min and complains of "air hunger." ABG: pH 7.28, PaCO₂ 28 mm Hg,
HCO₃⁻ 14 mEq/L. Which statement correctly links the kidney disease to the
respiratory pattern?
A. Decreased phosphate excretion → central chemoreceptor depression →
hypoventilation
B. Accumulation of organic acids → stimulation of peripheral chemoreceptors →
hyperventilation
C. Loss of ammonia generation → metabolic alkalosis → compensatory
hypoventilation
D. Increased anion-gap acidosis → left-shift of oxyhemoglobin curve → tissue
hypoxia → hyperventilation
Correct Answer: B
Rationale: Failing kidneys cannot excrete H⁺ or generate NH₃ → non-anion-gap (or high
anion-gap if phosphates/sulfates accumulate) metabolic acidosis. Low pH stimulates
carotid/aortic bodies → ↑ RR & ↓ PaCO₂ (respiratory compensation). Choice D is
partially correct but stresses the wrong mechanism; the respiratory drive is triggered by
pH, not the O₂-dissociation curve shift.
3. A 24-year-old woman with type 1 diabetes is alert but confused, HR 112, BP
88/50, and her breath smells fruity. Which cellular event is the primary cause of
the hypotension?
A. Osmotic diuresis → hypovolemia → RAAS activation
B. Lipolysis → ketone bodies → strong acids → arteriolar vasodilation
C. Hyperglycemia → intracellular dehydration of vascular smooth muscle →
decreased contractility
D. Ketoacid-induced vasodilation plus osmotic diuresis → absolute hypovolemia
Correct Answer: D
,Rationale: Both mechanisms operate, but vasodilation from acidemia (pH <7.2) reduces
SVR while glucosuria causes 3–6 L fluid loss. The combination produces the observed
orthostatic vital signs. RAAS (A) is compensatory, not causative.
4. A patient in early septic shock has warm, flushed skin. Which microcirculatory
event underlies this finding?
A. Endotoxin → TNF-α → COX-mediated vasodilatory prostaglandins
B. Sympathetic discharge → β₂-receptor stimulation → arteriovenous shunting
C. ADH release → V₂-receptor mediated vasodilation
D. Complement activation → histamine release → venular constriction
Correct Answer: A
Rationale: Inflammatory cytokines up-regulate COX & iNOS → PGE₂ / NO → vascular
smooth-muscle relaxation → warm shock. Histamine causes venular dilation (not
constriction) and is more prominent in anaphylaxis.
5. A victim of house-fire inhalation has cherry-red skin, but SaO₂ by pulse-oximeter
reads 92 %. What is the most accurate explanation?
A. CO shifts the oxyhemoglobin curve right → more O₂ unloading → false low
saturation
B. Methemoglobinemia increases absorbance at 660 nm → falsely low reading
C. Carboxyhemoglobin absorbs light similarly to oxyhemoglobin → falsely
normal/high reading
D. Tissue hypoxia stimulates peripheral chemoreceptors → true SaO₂ falls to 92
%
Correct Answer: C
, Rationale: Standard pulse-ox uses two wavelengths (660 & 940 nm) that cannot
distinguish oxy-Hb from CO-Hb, yielding a falsely "normal" saturation while PaO₂ may
be high. CO also causes left-shift (not right), impairing unloading.
6. A patient with left-sided heart failure develops hepatomegaly and ascites. Which
pressure change is the primary driver of the ascites?
A. ↑ hepatic vein pressure → ↑ sinusoidal hydrostatic pressure → plasma
transudation
B. ↓ plasma oncotic pressure from hepatic synthetic failure
C. Portal vein vasodilation from bacterial translocation
D. Increased intestinal capillary permeability from systemic inflammation
Correct Answer: A
Rationale: Back-up of blood into the hepatic veins raises sinusoidal pressure (cardiac
cirrhosis). Albumin synthesis is initially preserved, and portal hypertension is
post-sinusoidal, not vasodilatory.
7. A patient with COPD retains CO₂ and has worsening dyspnea when started on 6
L/min nasal cannula. The nurse should attribute this deterioration to:
A. O₂-induced absorption atelectasis → increased shunt fraction
B. Loss of hypoxic pulmonary vasoconstriction → ↑ V/Q mismatch
C. O₂-induced hypercarbia from loss of hypoxic ventilatory drive
D. Oxidative injury to type II pneumocytes → decreased surfactant
Correct Answer: C
2026/2027 Complete Final Examination | Actual Questions &
Verified Answers | Comprehensive Pathophysiology
Assessment | Pass Guarantee
1. A 68-year-old man with a 40-pack-year history reports 3 months of progressive,
productive morning cough and new-onset facial swelling that worsens when he
bends forward. Chest imaging shows a right perihilar mass compressing the
superior mediastinum. Which pathophysiologic process best explains the facial
swelling?
A. Tumor secretion of ADH → water retention → generalized edema
B. Compression of the superior vena cava → decreased venous return from
head & arms
C. Right-sided heart failure secondary to pulmonary hypertension → systemic
venous congestion
D. Obstruction of lymphatic ducts by malignant cells → secondary lymphedema
of face
Correct Answer: B
Rationale: The positional swelling and mass location create a classic picture of superior
vena cava (SVC) syndrome. The tumor externally compresses the thin-walled SVC,
reducing venous outflow and raising capillary hydrostatic pressure in the
head/neck/upper extremities. ADH (SIADH) would cause hyponatremic water retention
but generalized, not positional, edema. RV failure would require much more extensive
tumor burden to raise PVR. Lymphedema is usually non-pitting and would not fluctuate
with position.
, 2. A patient with chronic kidney disease (GFR 20 mL/min) develops a respiratory
rate of 28/min and complains of "air hunger." ABG: pH 7.28, PaCO₂ 28 mm Hg,
HCO₃⁻ 14 mEq/L. Which statement correctly links the kidney disease to the
respiratory pattern?
A. Decreased phosphate excretion → central chemoreceptor depression →
hypoventilation
B. Accumulation of organic acids → stimulation of peripheral chemoreceptors →
hyperventilation
C. Loss of ammonia generation → metabolic alkalosis → compensatory
hypoventilation
D. Increased anion-gap acidosis → left-shift of oxyhemoglobin curve → tissue
hypoxia → hyperventilation
Correct Answer: B
Rationale: Failing kidneys cannot excrete H⁺ or generate NH₃ → non-anion-gap (or high
anion-gap if phosphates/sulfates accumulate) metabolic acidosis. Low pH stimulates
carotid/aortic bodies → ↑ RR & ↓ PaCO₂ (respiratory compensation). Choice D is
partially correct but stresses the wrong mechanism; the respiratory drive is triggered by
pH, not the O₂-dissociation curve shift.
3. A 24-year-old woman with type 1 diabetes is alert but confused, HR 112, BP
88/50, and her breath smells fruity. Which cellular event is the primary cause of
the hypotension?
A. Osmotic diuresis → hypovolemia → RAAS activation
B. Lipolysis → ketone bodies → strong acids → arteriolar vasodilation
C. Hyperglycemia → intracellular dehydration of vascular smooth muscle →
decreased contractility
D. Ketoacid-induced vasodilation plus osmotic diuresis → absolute hypovolemia
Correct Answer: D
,Rationale: Both mechanisms operate, but vasodilation from acidemia (pH <7.2) reduces
SVR while glucosuria causes 3–6 L fluid loss. The combination produces the observed
orthostatic vital signs. RAAS (A) is compensatory, not causative.
4. A patient in early septic shock has warm, flushed skin. Which microcirculatory
event underlies this finding?
A. Endotoxin → TNF-α → COX-mediated vasodilatory prostaglandins
B. Sympathetic discharge → β₂-receptor stimulation → arteriovenous shunting
C. ADH release → V₂-receptor mediated vasodilation
D. Complement activation → histamine release → venular constriction
Correct Answer: A
Rationale: Inflammatory cytokines up-regulate COX & iNOS → PGE₂ / NO → vascular
smooth-muscle relaxation → warm shock. Histamine causes venular dilation (not
constriction) and is more prominent in anaphylaxis.
5. A victim of house-fire inhalation has cherry-red skin, but SaO₂ by pulse-oximeter
reads 92 %. What is the most accurate explanation?
A. CO shifts the oxyhemoglobin curve right → more O₂ unloading → false low
saturation
B. Methemoglobinemia increases absorbance at 660 nm → falsely low reading
C. Carboxyhemoglobin absorbs light similarly to oxyhemoglobin → falsely
normal/high reading
D. Tissue hypoxia stimulates peripheral chemoreceptors → true SaO₂ falls to 92
%
Correct Answer: C
, Rationale: Standard pulse-ox uses two wavelengths (660 & 940 nm) that cannot
distinguish oxy-Hb from CO-Hb, yielding a falsely "normal" saturation while PaO₂ may
be high. CO also causes left-shift (not right), impairing unloading.
6. A patient with left-sided heart failure develops hepatomegaly and ascites. Which
pressure change is the primary driver of the ascites?
A. ↑ hepatic vein pressure → ↑ sinusoidal hydrostatic pressure → plasma
transudation
B. ↓ plasma oncotic pressure from hepatic synthetic failure
C. Portal vein vasodilation from bacterial translocation
D. Increased intestinal capillary permeability from systemic inflammation
Correct Answer: A
Rationale: Back-up of blood into the hepatic veins raises sinusoidal pressure (cardiac
cirrhosis). Albumin synthesis is initially preserved, and portal hypertension is
post-sinusoidal, not vasodilatory.
7. A patient with COPD retains CO₂ and has worsening dyspnea when started on 6
L/min nasal cannula. The nurse should attribute this deterioration to:
A. O₂-induced absorption atelectasis → increased shunt fraction
B. Loss of hypoxic pulmonary vasoconstriction → ↑ V/Q mismatch
C. O₂-induced hypercarbia from loss of hypoxic ventilatory drive
D. Oxidative injury to type II pneumocytes → decreased surfactant
Correct Answer: C
