NURS 231 Pathophysiology Final Exam 2026/2027 – Portage Learning
Complete Final Examination | Actual Questions & Verified Answers |
Comprehensive Pathophysiology Assessment | Pass Guarantee
1. A 68-year-old man with a 40 pack-year history arrives in ED with acute onset
right-sided flaccid hemiparesis and global aphasia. CT shows hyperdense left-M1
segment. Which cellular energy change FIRST occurs in the ischemic penumbra?
A. ATP depletion → Na⁺/K⁺ pump failure → cytotoxic edema
B. Anaerobic glycolysis → intracellular alkalosis
C. Calcium efflux → calpain inhibition
D. Mitochondrial biogenesis → ATP surplus
Correct Answer: A
Rationale: Within minutes of occlusion, O₂ and glucose fall; ATP-dependent ion
pumps fail, producing cytotoxic edema that is potentially reversible if perfusion is
restored.
2. The same patient is considered for t-PA. Which parameter best indicates his
blood-brain barrier is still intact enough to minimize hemorrhagic conversion?
A. CSF protein > 100 mg/dL
B. CT without early infarct changes (<1/3 MCA territory)
C. Serum Na⁺ 128 mEq/L
D. Negative Babinski
Correct Answer: B
Rationale: Early CT ischemic changes reflect massive Na⁺/water influx and
correlate with later hemorrhage risk; their absence predicts intact BBB.
3. Two days post-t-PA the patient develops rapid arm swelling. Doppler shows
brachial-vein thrombosis. Which stroke-related pathophysiologic state most
directly predisposed to this DVT?
A. Hypercoagulability from acute-phase reactants plus immobility
B. Disseminated intravascular coagulation triggered by t-PA
C. Right-heart failure from neurogenic stunned myocardium
D. Heparin-induced thrombocytopenia
Correct Answer: A
Rationale: Acute CNS injury releases IL-6, fibrinogen, and tissue factor →
hypercoagulable state; hemiplegia prevents muscle pumping.
4. A 25-year-old male sustains high-cervical hyperextension. Below C4 he has
absent motor/sensory function but preserved diaphragmatic breathing. The
lesion is best classified:
, A. Complete spinal cord transection
B. Central cord syndrome
C. Anterior cord syndrome
D. Brown-Séquard
Correct Answer: B
Rationale: Central cord damages crossing spinothalamic & corticospinal tracts in
central gray, sparing ventral horn diaphragmatic neurons (C3-5).
5. He develops bradycardia 32 bpm and BP 80/40. Mechanism?
A. Loss of descending sympathetic tracts → unopposed vagal tone
B. Catecholamine surge
C. Carotid sinus hypersensitivity
D. Cardiac tamponade
Correct Answer: A
Rationale: Cervical injury interrupts bulbospinal sympathetic outflow (T1-L2);
vagal parasympathetics dominate → neurogenic shock.
6. A patient with Alzheimer disease shows cerebral cortical atrophy. Which cellular
process is MOST responsible for neuron dropout?
A. Apoptosis triggered by amyloid-β oligomer mitochondrial toxicity
B. Necrosis from hypoxia
C. Autophagy hyperactivation sparing cells
D. Dysmyelination
Correct Answer: A
Rationale: Soluble Aβ oligomers impair mitochondrial electron transport, increase
ROS, and activate intrinsic apoptotic cascades.
7. Which neurotransmitter deficit correlates best with the memory consolidation
disturbance in early Alzheimer disease?
A. Acetylcholine (basal forebrain)
B. Dopamine (substantia nigra)
C. GABA (nucleus accumbens)
D. Glycine (spinal cord)
Correct Answer: A
Rationale: Cholinergic projections to hippocampus enhance encoding; their loss
produces early anterograde amnesia.
8. A 55-year-woman notes resting tremor, cogwheel rigidity, and masked facies.
PET shows reduced cortical fluorodopa uptake. Inside neurons, which inclusion
is pathognomonic?
A. Lewy body (α-synuclein)
B. Neurofibrillary tangle (tau)
C. Pick body (tau)
, D. Bunina body (TDP-43)
Correct Answer: A
Rationale: Parkinson disease features dopaminergic neuron Lewy bodies
composed of aggregated α-synuclein.
9. The same patient develops orthostatic hypotension. Which pathophysiologic
change explains this autonomic symptom?
A. Loss of cardiac sympathetic noradrenergic innervation
B. Adrenal medulla hyperplasia
C. Carotid body hypertrophy
D. Increased RAA system activity
Correct Answer: A
Rationale: Lewy pathology also involves sympathetic ganglia → impaired venous
return compensation.
10. Generalized tonic-clonic seizures are initiated by which electrical event?
A. High-frequency burst firing of cortical pyramidal neurons with recruitment of
surrounding cortex
B. Cerebellar Purkinje cell suppression
C. Thalamic spindle oscillations only during sleep
D. Increased glial K⁺ uptake
Correct Answer: A
Rationale: Seizures begin when a focus overcomes surround inhibition,
propagating via glutamatergic circuits.
11. After status epilepticus, the patient is intubated. Which systemic complication
results from persistent excessive muscle contraction?
A. Rhabdomyolysis → myoglobin → ATN
B. Dilutional hyponatremia
C. Hyperalbuminemia
D. Hypoglycemia
Correct Answer: A
Rationale: Continuous convulsions consume ATP → sarcolemma breakdown →
myoglobin release → renal tubular toxicity.
12. A 60-year-old man has BP 190/120 mmHg. His plasma renin is low and
aldosterone suppressed. Which hypertensive mechanism is MOST likely?
A. Primary mineralocorticoid excess
B. Sympathetic overdrive
C. Low cardiac output
D. Increased atrial natriuretic peptide
Correct Answer: A
Complete Final Examination | Actual Questions & Verified Answers |
Comprehensive Pathophysiology Assessment | Pass Guarantee
1. A 68-year-old man with a 40 pack-year history arrives in ED with acute onset
right-sided flaccid hemiparesis and global aphasia. CT shows hyperdense left-M1
segment. Which cellular energy change FIRST occurs in the ischemic penumbra?
A. ATP depletion → Na⁺/K⁺ pump failure → cytotoxic edema
B. Anaerobic glycolysis → intracellular alkalosis
C. Calcium efflux → calpain inhibition
D. Mitochondrial biogenesis → ATP surplus
Correct Answer: A
Rationale: Within minutes of occlusion, O₂ and glucose fall; ATP-dependent ion
pumps fail, producing cytotoxic edema that is potentially reversible if perfusion is
restored.
2. The same patient is considered for t-PA. Which parameter best indicates his
blood-brain barrier is still intact enough to minimize hemorrhagic conversion?
A. CSF protein > 100 mg/dL
B. CT without early infarct changes (<1/3 MCA territory)
C. Serum Na⁺ 128 mEq/L
D. Negative Babinski
Correct Answer: B
Rationale: Early CT ischemic changes reflect massive Na⁺/water influx and
correlate with later hemorrhage risk; their absence predicts intact BBB.
3. Two days post-t-PA the patient develops rapid arm swelling. Doppler shows
brachial-vein thrombosis. Which stroke-related pathophysiologic state most
directly predisposed to this DVT?
A. Hypercoagulability from acute-phase reactants plus immobility
B. Disseminated intravascular coagulation triggered by t-PA
C. Right-heart failure from neurogenic stunned myocardium
D. Heparin-induced thrombocytopenia
Correct Answer: A
Rationale: Acute CNS injury releases IL-6, fibrinogen, and tissue factor →
hypercoagulable state; hemiplegia prevents muscle pumping.
4. A 25-year-old male sustains high-cervical hyperextension. Below C4 he has
absent motor/sensory function but preserved diaphragmatic breathing. The
lesion is best classified:
, A. Complete spinal cord transection
B. Central cord syndrome
C. Anterior cord syndrome
D. Brown-Séquard
Correct Answer: B
Rationale: Central cord damages crossing spinothalamic & corticospinal tracts in
central gray, sparing ventral horn diaphragmatic neurons (C3-5).
5. He develops bradycardia 32 bpm and BP 80/40. Mechanism?
A. Loss of descending sympathetic tracts → unopposed vagal tone
B. Catecholamine surge
C. Carotid sinus hypersensitivity
D. Cardiac tamponade
Correct Answer: A
Rationale: Cervical injury interrupts bulbospinal sympathetic outflow (T1-L2);
vagal parasympathetics dominate → neurogenic shock.
6. A patient with Alzheimer disease shows cerebral cortical atrophy. Which cellular
process is MOST responsible for neuron dropout?
A. Apoptosis triggered by amyloid-β oligomer mitochondrial toxicity
B. Necrosis from hypoxia
C. Autophagy hyperactivation sparing cells
D. Dysmyelination
Correct Answer: A
Rationale: Soluble Aβ oligomers impair mitochondrial electron transport, increase
ROS, and activate intrinsic apoptotic cascades.
7. Which neurotransmitter deficit correlates best with the memory consolidation
disturbance in early Alzheimer disease?
A. Acetylcholine (basal forebrain)
B. Dopamine (substantia nigra)
C. GABA (nucleus accumbens)
D. Glycine (spinal cord)
Correct Answer: A
Rationale: Cholinergic projections to hippocampus enhance encoding; their loss
produces early anterograde amnesia.
8. A 55-year-woman notes resting tremor, cogwheel rigidity, and masked facies.
PET shows reduced cortical fluorodopa uptake. Inside neurons, which inclusion
is pathognomonic?
A. Lewy body (α-synuclein)
B. Neurofibrillary tangle (tau)
C. Pick body (tau)
, D. Bunina body (TDP-43)
Correct Answer: A
Rationale: Parkinson disease features dopaminergic neuron Lewy bodies
composed of aggregated α-synuclein.
9. The same patient develops orthostatic hypotension. Which pathophysiologic
change explains this autonomic symptom?
A. Loss of cardiac sympathetic noradrenergic innervation
B. Adrenal medulla hyperplasia
C. Carotid body hypertrophy
D. Increased RAA system activity
Correct Answer: A
Rationale: Lewy pathology also involves sympathetic ganglia → impaired venous
return compensation.
10. Generalized tonic-clonic seizures are initiated by which electrical event?
A. High-frequency burst firing of cortical pyramidal neurons with recruitment of
surrounding cortex
B. Cerebellar Purkinje cell suppression
C. Thalamic spindle oscillations only during sleep
D. Increased glial K⁺ uptake
Correct Answer: A
Rationale: Seizures begin when a focus overcomes surround inhibition,
propagating via glutamatergic circuits.
11. After status epilepticus, the patient is intubated. Which systemic complication
results from persistent excessive muscle contraction?
A. Rhabdomyolysis → myoglobin → ATN
B. Dilutional hyponatremia
C. Hyperalbuminemia
D. Hypoglycemia
Correct Answer: A
Rationale: Continuous convulsions consume ATP → sarcolemma breakdown →
myoglobin release → renal tubular toxicity.
12. A 60-year-old man has BP 190/120 mmHg. His plasma renin is low and
aldosterone suppressed. Which hypertensive mechanism is MOST likely?
A. Primary mineralocorticoid excess
B. Sympathetic overdrive
C. Low cardiac output
D. Increased atrial natriuretic peptide
Correct Answer: A
