Chamberlain University NR507 Advanced Pathophysiology
Midterm Exam
2026/2027 Academic Year — Comprehensive Sample Exam
Cellular Function, Injury, and Adaptation
Question 1: A patient with chronic liver disease develops jaundice, ascites, and
hepatic encephalopathy. The cellular mechanism underlying these manifestations
is primarily related to:
A) Metaplasia of hepatocytes
B) Loss of hepatocyte function due to necrosis and fibrosis
C) Hyperplasia of Kupffer cells
D) Anaplasia of bile duct epithelium
Correct Answer: B
Rationale: Chronic liver disease leads to progressive hepatocyte necrosis, fibrosis,
and loss of functional liver mass. This results in impaired bilirubin metabolism
(jaundice), portal hypertension (ascites), and failure to detoxify ammonia (hepatic
encephalopathy).
Question 2: A pathologist examines a tissue sample and notes cells of varying size
and shape, with hyperchromatic nuclei and increased mitotic figures. These
findings are characteristic of:
A) Hypertrophy
B) Hyperplasia
C) Dysplasia
D) Metaplasia
Correct Answer: C
Rationale: Dysplasia is characterized by disordered cellular growth with loss of
uniformity, pleomorphism (varying size/shape), hyperchromatic nuclei, and
increased mitotic activity. It is often a precursor to malignancy.
,Question 3: Which of the following is a characteristic of apoptosis?
A) It triggers an inflammatory response
B) It involves cell lysis and release of cellular contents
C) It is a programmed, energy-dependent process
D) It occurs only in response to severe injury
Correct Answer: C
Rationale: Apoptosis is programmed cell death that is energy-dependent
(requires ATP), occurs in a controlled manner, and does NOT trigger
inflammation. It is essential for normal tissue homeostasis and development.
Question 4: A patient’s tumor biopsy shows cells that have lost differentiation
and resemble primitive, embryonic tissue. This finding is termed:
A) Hyperplasia
B) Dysplasia
C) Anaplasia
D) Metaplasia
Correct Answer: C
Rationale: Anaplasia refers to the loss of cellular differentiation and is a hallmark
of malignant neoplasms. Anaplastic cells are undifferentiated, lack normal
architecture, and often exhibit pleomorphism and increased mitotic activity.
Question 5: Which of the following cellular accumulations is most characteristic
of atherosclerosis?
A) Hemosiderin
B) Lipofuscin
C) Cholesterol and lipids
D) Glycogen
Correct Answer: C
Rationale: Atherosclerosis involves the accumulation of cholesterol, lipids, and
foam cells within the arterial intima, leading to plaque formation.
,Fluid, Electrolyte, and Acid-Base Balance
Question 6: A patient with severe vomiting develops metabolic alkalosis. Which of
the following compensatory mechanisms would be expected?
A) Hyperventilation to increase PaCO₂
B) Hypoventilation to increase PaCO₂
C) Increased renal excretion of bicarbonate
D) Decreased renal excretion of hydrogen ions
Correct Answer: B
Rationale: Metabolic alkalosis triggers compensatory hypoventilation (increased
PaCO₂) to buffer the elevated pH. The respiratory system attempts to retain CO₂
to form carbonic acid and lower pH.
Question 7: A patient presents with muscle weakness, cardiac dysrhythmias, and
a serum potassium level of 2.8 mEq/L. The nurse understands that this electrolyte
imbalance is most commonly caused by:
A) Adrenal insufficiency
B) Thiazide diuretic use
C) Metabolic acidosis
D) Hemolysis
Correct Answer: B
Rationale: Hypokalemia (K⁺ < 3.5 mEq/L) is most commonly caused by diuretic use
(thiazides and loop diuretics), which increase renal potassium excretion. Other
causes include vomiting, diarrhea, and hyperaldosteronism.
Question 8: A patient with renal failure has a serum calcium level of 7.2 mg/dL
(normal 8.5–10.2) and a serum phosphorus level of 6.5 mg/dL (normal 2.5–4.5).
What is the underlying mechanism?
A) Decreased vitamin D activation leading to hypocalcemia and
hyperphosphatemia
B) Increased parathyroid hormone secretion
C) Excessive dietary calcium intake
D) Increased renal excretion of phosphorus
, Correct Answer: A
Rationale: In renal failure, the kidneys fail to convert 25-hydroxyvitamin D to
active 1,25-dihydroxyvitamin D, leading to decreased calcium absorption.
Phosphate excretion is also impaired, causing hyperphosphatemia.
Question 9: A patient with salicylate toxicity presents with tachypnea. Which
acid-base disorder is most likely?
A) Metabolic acidosis with respiratory alkalosis
B) Respiratory acidosis only
C) Metabolic alkalosis only
D) Normal acid-base status
Correct Answer: A
Rationale: Salicylate toxicity causes a mixed acid-base disorder: respiratory
alkalosis (direct stimulation of respiratory center) followed by high anion gap
metabolic acidosis (due to accumulation of organic acids).
Question 10: Which electrolyte imbalance is most concerning in a patient with
rhabdomyolysis?
A) Hypokalemia
B) Hyperkalemia
C) Hyponatremia
D) Hypocalcemia
Correct Answer: B
Rationale: Rhabdomyolysis causes massive release of intracellular potassium
from damaged muscle cells, leading to life-threatening hyperkalemia. This can
cause cardiac dysrhythmias and requires immediate intervention.
Immunity and Inflammation
Question 11: A patient develops a rash, fever, and joint pain 7 days after starting
a new antibiotic. This reaction is most likely:
A) Type I hypersensitivity
Midterm Exam
2026/2027 Academic Year — Comprehensive Sample Exam
Cellular Function, Injury, and Adaptation
Question 1: A patient with chronic liver disease develops jaundice, ascites, and
hepatic encephalopathy. The cellular mechanism underlying these manifestations
is primarily related to:
A) Metaplasia of hepatocytes
B) Loss of hepatocyte function due to necrosis and fibrosis
C) Hyperplasia of Kupffer cells
D) Anaplasia of bile duct epithelium
Correct Answer: B
Rationale: Chronic liver disease leads to progressive hepatocyte necrosis, fibrosis,
and loss of functional liver mass. This results in impaired bilirubin metabolism
(jaundice), portal hypertension (ascites), and failure to detoxify ammonia (hepatic
encephalopathy).
Question 2: A pathologist examines a tissue sample and notes cells of varying size
and shape, with hyperchromatic nuclei and increased mitotic figures. These
findings are characteristic of:
A) Hypertrophy
B) Hyperplasia
C) Dysplasia
D) Metaplasia
Correct Answer: C
Rationale: Dysplasia is characterized by disordered cellular growth with loss of
uniformity, pleomorphism (varying size/shape), hyperchromatic nuclei, and
increased mitotic activity. It is often a precursor to malignancy.
,Question 3: Which of the following is a characteristic of apoptosis?
A) It triggers an inflammatory response
B) It involves cell lysis and release of cellular contents
C) It is a programmed, energy-dependent process
D) It occurs only in response to severe injury
Correct Answer: C
Rationale: Apoptosis is programmed cell death that is energy-dependent
(requires ATP), occurs in a controlled manner, and does NOT trigger
inflammation. It is essential for normal tissue homeostasis and development.
Question 4: A patient’s tumor biopsy shows cells that have lost differentiation
and resemble primitive, embryonic tissue. This finding is termed:
A) Hyperplasia
B) Dysplasia
C) Anaplasia
D) Metaplasia
Correct Answer: C
Rationale: Anaplasia refers to the loss of cellular differentiation and is a hallmark
of malignant neoplasms. Anaplastic cells are undifferentiated, lack normal
architecture, and often exhibit pleomorphism and increased mitotic activity.
Question 5: Which of the following cellular accumulations is most characteristic
of atherosclerosis?
A) Hemosiderin
B) Lipofuscin
C) Cholesterol and lipids
D) Glycogen
Correct Answer: C
Rationale: Atherosclerosis involves the accumulation of cholesterol, lipids, and
foam cells within the arterial intima, leading to plaque formation.
,Fluid, Electrolyte, and Acid-Base Balance
Question 6: A patient with severe vomiting develops metabolic alkalosis. Which of
the following compensatory mechanisms would be expected?
A) Hyperventilation to increase PaCO₂
B) Hypoventilation to increase PaCO₂
C) Increased renal excretion of bicarbonate
D) Decreased renal excretion of hydrogen ions
Correct Answer: B
Rationale: Metabolic alkalosis triggers compensatory hypoventilation (increased
PaCO₂) to buffer the elevated pH. The respiratory system attempts to retain CO₂
to form carbonic acid and lower pH.
Question 7: A patient presents with muscle weakness, cardiac dysrhythmias, and
a serum potassium level of 2.8 mEq/L. The nurse understands that this electrolyte
imbalance is most commonly caused by:
A) Adrenal insufficiency
B) Thiazide diuretic use
C) Metabolic acidosis
D) Hemolysis
Correct Answer: B
Rationale: Hypokalemia (K⁺ < 3.5 mEq/L) is most commonly caused by diuretic use
(thiazides and loop diuretics), which increase renal potassium excretion. Other
causes include vomiting, diarrhea, and hyperaldosteronism.
Question 8: A patient with renal failure has a serum calcium level of 7.2 mg/dL
(normal 8.5–10.2) and a serum phosphorus level of 6.5 mg/dL (normal 2.5–4.5).
What is the underlying mechanism?
A) Decreased vitamin D activation leading to hypocalcemia and
hyperphosphatemia
B) Increased parathyroid hormone secretion
C) Excessive dietary calcium intake
D) Increased renal excretion of phosphorus
, Correct Answer: A
Rationale: In renal failure, the kidneys fail to convert 25-hydroxyvitamin D to
active 1,25-dihydroxyvitamin D, leading to decreased calcium absorption.
Phosphate excretion is also impaired, causing hyperphosphatemia.
Question 9: A patient with salicylate toxicity presents with tachypnea. Which
acid-base disorder is most likely?
A) Metabolic acidosis with respiratory alkalosis
B) Respiratory acidosis only
C) Metabolic alkalosis only
D) Normal acid-base status
Correct Answer: A
Rationale: Salicylate toxicity causes a mixed acid-base disorder: respiratory
alkalosis (direct stimulation of respiratory center) followed by high anion gap
metabolic acidosis (due to accumulation of organic acids).
Question 10: Which electrolyte imbalance is most concerning in a patient with
rhabdomyolysis?
A) Hypokalemia
B) Hyperkalemia
C) Hyponatremia
D) Hypocalcemia
Correct Answer: B
Rationale: Rhabdomyolysis causes massive release of intracellular potassium
from damaged muscle cells, leading to life-threatening hyperkalemia. This can
cause cardiac dysrhythmias and requires immediate intervention.
Immunity and Inflammation
Question 11: A patient develops a rash, fever, and joint pain 7 days after starting
a new antibiotic. This reaction is most likely:
A) Type I hypersensitivity
