NURS 231 Pathophysiology | Portage Learning | Final Exam
2026/2027 Complete Final Examination | Actual Questions &
Verified Answers | Comprehensive Pathophysiology
Assessment | Pass Guarantee
1. A 64-year-old man with long-standing hypertension presents with exertional
dyspnea and bibasilar crackles. Which cellular adaptation in myocardial fibers is
the primary contributor to his decreased ventricular compliance?
A. Atrophy
B. Metaplasia
C. Hypertrophy
D. Dysplasia
Correct Answer: C
Rationale: Chronic pressure overload stimulates parallel sarcomere deposition →
concentric hypertrophy. Myocytes enlarge but the ventricular wall becomes stiff,
reducing diastolic filling (compliance). Other choices do not explain increased
wall thickness.
2. In diabetic ketoacidosis, which acid-base derangement is the direct consequence
of overproduction of acetoacetate?
A. Respiratory acidosis
B. Increased anion-gap metabolic acidosis
C. Normal anion-gap metabolic acidosis
D. Metabolic alkalosis
Correct Answer: B
Rationale: Ketones are unmeasured anions; their accumulation consumes
bicarbonate → ↑ anion gap. Respiratory acidosis is not primary, and gap remains
elevated.
3. A patient in hypovolemic shock has continuous MAP 55 mmHg. Which renal
tubular segment is first to undergo ischemic necrosis?
A. Distal convoluted tubule
B. Thick ascending limb of Henle
C. Proximal convoluted tubule
, D. Collecting duct
Correct Answer: C
Rationale: Proximal tubule (S3 segment) has highest O₂ demand for active
transport; earliest to show acute tubular necrosis.
4. A full-thickness burn exceeds 30 % TBSA. Which circulating mediator best
explains the systemic capillary leak that produces burn shock?
A. Histamine
B. Bradykinin
C. Interleukin-6
D. Thromboxane A₂
Correct Answer: B
Rationale: Bradykinin increases endothelial permeability by loosening junctions;
major contributor to plasma volume loss. Histamine acts locally; IL-6 is later
cytokine; TXA₂ causes vasoconstriction.
5. A patient with severe COPD retains CO₂. His serum bicarbonate is 38 mEq/L after
4 days. Which renal mechanism maintains this compensation?
A. Increased carbonic anhydrase activity in distal tubule
B. Decreased NH₄⁺ excretion
C. Increased HCO₃⁻ reabsorption and H⁺ secretion
D. Increased phosphate excretion
Correct Answer: C
Rationale: Chronic respiratory acidosis → kidneys increase H⁺ secretion (via
H⁺-ATPase) and HCO₃⁻ generation/reabsorption, raising serum bicarbonate.
6. A 22-year-old with T1DM forgets evening insulin and develops nausea, vomiting,
and K⁺ 5.8 mEq/L despite total-body potassium depletion. Which process
explains the hyperkalemia?
A. Insulin deficit → K⁺ shift into ICF
B. Insulin deficit → K⁺ shift out of ICF
C. Osmotic diuresis → decreased K⁺ excretion
D. Metabolic acidosis stimulates aldosterone
Correct Answer: B
Rationale: Insulin normally drives K⁺ into cells via Na⁺/K⁺-ATPase. Absence
causes extracellular shift. Later, osmotic diuresis depletes total body K⁺.
7. Which pathophysiologic mechanism underlies the warm, flushed skin seen in
septic shock prior to vasopressor administration?
A. Sympathetic overactivity
B. Increased nitric oxide → arteriovenous shunting
C. Endothelin-1 release
D. Complement-mediated vasoconstriction
, Correct Answer: B
Rationale: Cytokine-induced iNOS produces NO → systemic vasodilation &
shunting; cutaneous perfusion rises → warmth. Sympathetic overactivity causes
cold, clammy skin (later).
8. A patient with Alzheimer disease shows rapidly declining attention and
fluctuating cognition. Which neurotransmitter deficit best correlates with these
findings?
A. Dopamine
B. Norepinephrine
C. Acetylcholine
D. Serotonin
Correct Answer: C
Rationale: Cholinergic neurons in nucleus basalis of Meynert project to cortex;
loss impairs attention & memory. Dopamine loss is Parkinson’s hallmark.
9. Which renal hemodynamic change best explains the early hyperfiltration seen in
poorly controlled T2DM?
A. Afferent arteriole vasoconstriction
B. Efferent arteriole dilation
C. Afferent arteriole dilation & efferent constriction
D. Decreased renal prostaglandins
Correct Answer: C
Rationale: Hyperglycemia ↑ GFR via afferent NO-mediated dilation and
RAAS-mediated efferent constriction → ↑ intraglomerular pressure.
10. A patient with cirrhosis develops increasing abdominal girth and
hypoalbuminemia. Which Starling force alteration produces ascites?
A. Decreased plasma oncotic pressure
B. Increased interstitial oncotic pressure
C. Increased capillary hydrostatic pressure in splanchnic bed
D. All of the above
Correct Answer: D
Rationale: Hypoalbuminemia lowers plasma oncotic; portal hypertension raises
capillary hydrostatic; sinusoidal leakage raises interstitial oncotic—all favor fluid
translocation.
11. In acute pancreatitis, which enzyme activation is the primary trigger of
autodigestion and vascular injury?
A. Amylase
B. Lipase
C. Trypsinogen → trypsin
D. Elastase
2026/2027 Complete Final Examination | Actual Questions &
Verified Answers | Comprehensive Pathophysiology
Assessment | Pass Guarantee
1. A 64-year-old man with long-standing hypertension presents with exertional
dyspnea and bibasilar crackles. Which cellular adaptation in myocardial fibers is
the primary contributor to his decreased ventricular compliance?
A. Atrophy
B. Metaplasia
C. Hypertrophy
D. Dysplasia
Correct Answer: C
Rationale: Chronic pressure overload stimulates parallel sarcomere deposition →
concentric hypertrophy. Myocytes enlarge but the ventricular wall becomes stiff,
reducing diastolic filling (compliance). Other choices do not explain increased
wall thickness.
2. In diabetic ketoacidosis, which acid-base derangement is the direct consequence
of overproduction of acetoacetate?
A. Respiratory acidosis
B. Increased anion-gap metabolic acidosis
C. Normal anion-gap metabolic acidosis
D. Metabolic alkalosis
Correct Answer: B
Rationale: Ketones are unmeasured anions; their accumulation consumes
bicarbonate → ↑ anion gap. Respiratory acidosis is not primary, and gap remains
elevated.
3. A patient in hypovolemic shock has continuous MAP 55 mmHg. Which renal
tubular segment is first to undergo ischemic necrosis?
A. Distal convoluted tubule
B. Thick ascending limb of Henle
C. Proximal convoluted tubule
, D. Collecting duct
Correct Answer: C
Rationale: Proximal tubule (S3 segment) has highest O₂ demand for active
transport; earliest to show acute tubular necrosis.
4. A full-thickness burn exceeds 30 % TBSA. Which circulating mediator best
explains the systemic capillary leak that produces burn shock?
A. Histamine
B. Bradykinin
C. Interleukin-6
D. Thromboxane A₂
Correct Answer: B
Rationale: Bradykinin increases endothelial permeability by loosening junctions;
major contributor to plasma volume loss. Histamine acts locally; IL-6 is later
cytokine; TXA₂ causes vasoconstriction.
5. A patient with severe COPD retains CO₂. His serum bicarbonate is 38 mEq/L after
4 days. Which renal mechanism maintains this compensation?
A. Increased carbonic anhydrase activity in distal tubule
B. Decreased NH₄⁺ excretion
C. Increased HCO₃⁻ reabsorption and H⁺ secretion
D. Increased phosphate excretion
Correct Answer: C
Rationale: Chronic respiratory acidosis → kidneys increase H⁺ secretion (via
H⁺-ATPase) and HCO₃⁻ generation/reabsorption, raising serum bicarbonate.
6. A 22-year-old with T1DM forgets evening insulin and develops nausea, vomiting,
and K⁺ 5.8 mEq/L despite total-body potassium depletion. Which process
explains the hyperkalemia?
A. Insulin deficit → K⁺ shift into ICF
B. Insulin deficit → K⁺ shift out of ICF
C. Osmotic diuresis → decreased K⁺ excretion
D. Metabolic acidosis stimulates aldosterone
Correct Answer: B
Rationale: Insulin normally drives K⁺ into cells via Na⁺/K⁺-ATPase. Absence
causes extracellular shift. Later, osmotic diuresis depletes total body K⁺.
7. Which pathophysiologic mechanism underlies the warm, flushed skin seen in
septic shock prior to vasopressor administration?
A. Sympathetic overactivity
B. Increased nitric oxide → arteriovenous shunting
C. Endothelin-1 release
D. Complement-mediated vasoconstriction
, Correct Answer: B
Rationale: Cytokine-induced iNOS produces NO → systemic vasodilation &
shunting; cutaneous perfusion rises → warmth. Sympathetic overactivity causes
cold, clammy skin (later).
8. A patient with Alzheimer disease shows rapidly declining attention and
fluctuating cognition. Which neurotransmitter deficit best correlates with these
findings?
A. Dopamine
B. Norepinephrine
C. Acetylcholine
D. Serotonin
Correct Answer: C
Rationale: Cholinergic neurons in nucleus basalis of Meynert project to cortex;
loss impairs attention & memory. Dopamine loss is Parkinson’s hallmark.
9. Which renal hemodynamic change best explains the early hyperfiltration seen in
poorly controlled T2DM?
A. Afferent arteriole vasoconstriction
B. Efferent arteriole dilation
C. Afferent arteriole dilation & efferent constriction
D. Decreased renal prostaglandins
Correct Answer: C
Rationale: Hyperglycemia ↑ GFR via afferent NO-mediated dilation and
RAAS-mediated efferent constriction → ↑ intraglomerular pressure.
10. A patient with cirrhosis develops increasing abdominal girth and
hypoalbuminemia. Which Starling force alteration produces ascites?
A. Decreased plasma oncotic pressure
B. Increased interstitial oncotic pressure
C. Increased capillary hydrostatic pressure in splanchnic bed
D. All of the above
Correct Answer: D
Rationale: Hypoalbuminemia lowers plasma oncotic; portal hypertension raises
capillary hydrostatic; sinusoidal leakage raises interstitial oncotic—all favor fluid
translocation.
11. In acute pancreatitis, which enzyme activation is the primary trigger of
autodigestion and vascular injury?
A. Amylase
B. Lipase
C. Trypsinogen → trypsin
D. Elastase
