TEST BANK
Advanced Physiology and Pathophysiology: Essentials for
Clinical Practice
Nancy C. Tkacs, and Linda Herrmann
2nd Edition
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Test Bank - Advanced Physiology and Pathophysiology: Essentials for Clinical Practice, 2nd Edition (Tkacs, 2025)
Advanced Physiology and Pathophysiology: Essentials
for Clinical Practice
Second Edition
Nancy C. Tkacs, PhD, RN
Linda L. Herrmann, PhD, RN, AGACNP-BC, GNP-BC, ACHPN, FAANP
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1|Page
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Test Bank - Advanced Physiology and Pathophysiology: Essentials for Clinical Practice, 2nd Edition (Tkacs, 2025)
Contents
Chapter 1: The Foundational Concepts of Clinical Practice (Instructor Test Bank
Intentionally Omitted)
Chapter 2: Chemical and Biochemical Foundations 1
Chapter 3: Molecular Biology, Genetics, and Genetic Disorders 25
Chapter 4: Cell Physiology and Pathophysiology 43
Chapter 5: Infectious Disease 62
Chapter 6: The Immune System and Leukocyte Function 80
Chapter 7: Neoplasia 99
Chapter 8: Blood and Clotting 116
Chapter 9: Circulation 143
Chapter 10: Heart 170
Chapter 11: Lungs 194
Chapter 12: Kidneys 215
Chapter 13: Gastrointestinal Tract 236
Chapter 14: Liver 256
Chapter 15: Nervous System 277
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Test Bank - Advanced Physiology and Pathophysiology: Essentials for Clinical Practice, 2nd Edition (Tkacs, 2025)
Chapter 16: Musculoskeletal System 305
Chapter 17: Endocrine System 324
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Test Bank - Advanced Physiology and Pathophysiology: Essentials for Clinical Practice, 2nd Edition (Tkacs, 2025)
Chapter 2
Chemical and Biochemical Foundations
Multiple Choice Questions
1. Which of the following best describes why atoms have an overall neutral charge?
a. Electrons orbit on the outside of the atom.
@ Incorrect answer. Although it is true that electrons orbit outside the nucleus, this is not the reason
why atoms have an overall neutral charge.
*b. The number of protons is equal to the number of electrons.
@ Correct answer. There is an equal number of protons, which have a positive charge, and electrons,
which have a negative charge. The positive and negative charges balance one another out for an
overall neutral charge.
c. There are more neutrons than protons.
@ Incorrect answer. There is an equal number of neutrons and protons. Additionally, neutrons have a
neutral charge.
d. There are four electrons in the outer shell.
@ Incorrect answer. Some elements have four electrons in the outer shell, but this is not the reason
for the overall neutral charge. The number of electrons will match the number of protons.
2. Why do hydrogen and potassium readily interact with other atoms?
a. They only have electrons in the first shell.
@ Incorrect answer. Hydrogen has one electron, but potassium has 19 electrons. Therefore, potassium
has two electrons in the first shell, eight in the second and third shells, and one in the fourth shell.
Hydrogen has one electron in the first shell.
1
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Test Bank - Advanced Physiology and Pathophysiology: Essentials for Clinical Practice, 2nd Edition (Tkacs, 2025)
b. They have electrons in all shells.
@ Incorrect answer. Hydrogen has one electron in the first shell. Potassium has two electrons in the
first shell, eight in the second and third shells, and one in the fourth shell.
c. They both have four electrons in the outer shell.
@ Incorrect answer. Both hydrogen and potassium have one electron in their outer shells.
*d. They both have one electron in the outer shell.
@ Correct answer. Both hydrogen and potassium have one electron in their outer shells, meaning they
can readily interact with other atoms.
3. How many electrons does carbon use to interact with other atoms?
*a. 4
@ Correct answer. Carbon has four electrons in its outer shell. Only the electrons in the outer shell, or
valence electrons, are used to interact with other electrons.
b. 6
@ Incorrect answer. While carbon has a total of six electrons, only the electrons in the outer shell are
used to interact with other electrons. Two of carbon’s six electrons are in the first shell.
c. 1
@ Incorrect answer. Carbon has four valence electrons.
d. 2
@ Incorrect answer. While carbon has two electrons in the first shell, it also has four valence
electrons that are used to interact with other elements.
4. Which of the following is true regarding the role of bicarbonate in maintaining homeostasis?
a. Bicarbonate dissociates from hydroxide to form a free hydroxide that neutralizes acid.
@ Incorrect answer. The dissociation of sodium from a hydroxide ion creates a free hydroxide that
neutralizes acid.
2
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Test Bank - Advanced Physiology and Pathophysiology: Essentials for Clinical Practice, 2nd Edition (Tkacs, 2025)
b. Bicarbonate releases protons when diluted with water, which neutralizes acids.
@ Incorrect answer. Acids release protons when placed in water, but bicarbonate is a base.
c. Bicarbonate is partially ionized in water and is considered to be a weak base.
@ Incorrect answer. Acids are ionized in water, not bases like bicarbonate. Both carbonic acid and
phosphoric acid are partly ionized in water and are considered weak acids.
*d. Bicarbonate functions as a buffer to neutralize acids.
@ Correct answer. Bicarbonate is produced in the pancreas for the purpose of neutralizing the acidity
in chyme as it moves from the stomach to the small intestine. It also plays a major role in the carbonic
acid buffer system.
5. Which of the following occurs when carbonic acid is placed in water?
a. Almost all of the protons are released into the water.
@ Incorrect answer. Carbonic acid is a weak acid. Only in strong acids do most of the protons
dissociate into the water.
*b. Some of the protons are released into the water.
@ Correct answer. Carbonic acid is a weak acid, meaning it is only partly ionized in an aqueous
solution. Some of the protons are released into the water.
c. Some of the electrons are released into the water.
@ Incorrect answer. When acids are placed in water, the protons are released. They are classified
based on their tendency to lose protons. Carbonic acid is a weak acid because only a few of its
protons are released into the water.
d. Almost all of the neutrons are released into the water.
@ Incorrect answer. Protons are released when acids are placed in water.
6. Which of the following most fully describes how proteins are used to buffer pH?
a. Proteins are used to neutralize excess acids because they have a carboxylic acid group.
3
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Test Bank - Advanced Physiology and Pathophysiology: Essentials for Clinical Practice, 2nd Edition (Tkacs, 2025)
@ Incorrect answer. The carboxylic acid group enables proteins to neutralize excess bases.
b. Proteins have an amino group, which is an acid, and therefore they can neutralize excess base.
@ Incorrect answer. The amino group is a base, which enables proteins to neutralize excess acids.
c. Proteins are able to neutralize either excess base or excess acid because they have a neutral amino
group.
@ Incorrect answer. The amino group is a base, which enables proteins to neutralize excess acids.
The carboxylic acid group is an acid, which enables proteins to neutralize excess bases.
*d. Proteins are made up of basic amino groups and acidic carboxylic acid groups, which can be used
to neutralize either excess bases or acids.
@ Correct answer. Proteins can neutralize either excess bases or excess acids because they are made
up of an amino group (base) and a carboxylic acid group (acid).
7. Which of the following correctly describes the bond between two oxygen atoms?
*a. Two oxygen atoms share a double bond, enabling them both to fulfill the octet rule.
@ Correct answer. One oxygen atom will share two of its electrons with the other atom, forming a
double bond and fulfilling the octet rule for both atoms.
b. Two oxygen atoms share bonds with two hydrogen atoms, enabling them to fulfill the octet rule.
@ Incorrect answer. Two oxygen atoms only need to share two electrons with one another in order to
form a double bond that fulfills the octet rule.
c. Two oxygen atoms share protons, forming a double bond and fulfilling the octet rule.
@ Incorrect answer. Two oxygen atoms share electrons, not protons, to form a double bond and fulfill
the octet rule.
d. Two oxygen atoms share two electrons to form a double bond and eight neutrons to fulfill the octet
rule.
4
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Test Bank - Advanced Physiology and Pathophysiology: Essentials for Clinical Practice, 2nd Edition (Tkacs, 2025)
@ Incorrect answer. Two oxygen atoms share only two electrons to form a double bond and fulfill the
octet rule.
8. Which of the following correctly describes a molecule that is most likely to be polar?
*a. A molecule enriched in hydroxyl groups
@ Correct answer. A molecule that contains O-H or N-H bonds is most likely to be polar.
b. A molecule modified with additional methyl groups
@ Incorrect answer. Methyl groups only contain carbon and hydrogen, making them nonpolar.
c. A molecule with 14 carbons, all bonded to hydrogens
@ Incorrect answer. A molecule containing only carbon and hydrogen is a nonpolar molecule.
d. A molecule of carbon dioxide with linear symmetry
@ Incorrect answer. Carbon dioxide cannot have an electrical dipole because it is a straight,
symmetrical molecule.
9. Electronegativity is the tendency of an element to attract a bonding pair of electrons. Which of the
following elements is the most electronegative?
a. Hydrogen
@ Incorrect answer. Electronegativity increases across the periodic table. Hydrogen has one electron
and is more likely to release a valence electron.
b. Carbon
@ Incorrect answer. Carbon has four valence electrons.
c. Potassium
@ Incorrect answer. Potassium has one valence electron and is more likely to release it.
*d. Oxygen
@ Correct answer. Oxygen has six valence electrons and is more likely to attract two more electrons
to fulfill the octet rule.
5
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Test Bank - Advanced Physiology and Pathophysiology: Essentials for Clinical Practice, 2nd Edition (Tkacs, 2025)
10. Which of the following accurately describes a fact about hydrophobic molecules?
a. Water is nonpolar so hydrophobic molecules cannot readily dissolve in water.
@ Incorrect answer. Water is polar. Nonpolar molecules are unable to form hydrogen bonds or ionic
interactions with polar molecules. Therefore, hydrophobic molecules cannot dissolve in water.
*b. Hydrophobic molecules help determine the three-dimensional structure of proteins.
@ Correct answer. Many proteins contain both hydrophilic and hydrophobic areas. Hydrophobic
molecules are attracted to other hydrophobic molecules and this interaction contributes to the three-
dimensional structure of the protein.
c. Hydrophobic molecules are unable to dissolve in water because they form hydrogen bonds.
@ Incorrect answer. Hydrophobic molecules are unable to dissolve in water because they cannot form
hydrogen bonds or ionic interactions with water.
d. Hydrophobic molecules cannot be transported in aqueous solutions because they do not dissolve.
@ Incorrect answer. Hydrophobic molecules cannot dissolve in aqueous solutions, but they can be
transported with special packaging.
11. Why do some individuals have lactose intolerance?
*a. Some adults are unable to produce lactase.
@ Correct answer. Some adults are unable to produce lactase, the enzyme needed to breakdown
lactose.
b. In some adults, the enzyme changes shape.
@ Incorrect answer. Some adults are unable to produce lactase.
c. In some adults, the enzyme lactase is unable to break down the milk sugars.
@ Incorrect answer. Some adults lack the ability to produce lactase, which is the enzyme needed to
break down the milk sugar lactose.
d. In some adults, an inappropriate immune response occurs as a result of exposure to lactose.
6
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Advanced Physiology and Pathophysiology: Essentials for
Clinical Practice
Nancy C. Tkacs, and Linda Herrmann
2nd Edition
,______________________________________________________________________________________________
Test Bank - Advanced Physiology and Pathophysiology: Essentials for Clinical Practice, 2nd Edition (Tkacs, 2025)
Advanced Physiology and Pathophysiology: Essentials
for Clinical Practice
Second Edition
Nancy C. Tkacs, PhD, RN
Linda L. Herrmann, PhD, RN, AGACNP-BC, GNP-BC, ACHPN, FAANP
______________________________________________________________________________________________
1|Page
,______________________________________________________________________________________________
Test Bank - Advanced Physiology and Pathophysiology: Essentials for Clinical Practice, 2nd Edition (Tkacs, 2025)
Contents
Chapter 1: The Foundational Concepts of Clinical Practice (Instructor Test Bank
Intentionally Omitted)
Chapter 2: Chemical and Biochemical Foundations 1
Chapter 3: Molecular Biology, Genetics, and Genetic Disorders 25
Chapter 4: Cell Physiology and Pathophysiology 43
Chapter 5: Infectious Disease 62
Chapter 6: The Immune System and Leukocyte Function 80
Chapter 7: Neoplasia 99
Chapter 8: Blood and Clotting 116
Chapter 9: Circulation 143
Chapter 10: Heart 170
Chapter 11: Lungs 194
Chapter 12: Kidneys 215
Chapter 13: Gastrointestinal Tract 236
Chapter 14: Liver 256
Chapter 15: Nervous System 277
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Test Bank - Advanced Physiology and Pathophysiology: Essentials for Clinical Practice, 2nd Edition (Tkacs, 2025)
Chapter 16: Musculoskeletal System 305
Chapter 17: Endocrine System 324
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Test Bank - Advanced Physiology and Pathophysiology: Essentials for Clinical Practice, 2nd Edition (Tkacs, 2025)
Chapter 2
Chemical and Biochemical Foundations
Multiple Choice Questions
1. Which of the following best describes why atoms have an overall neutral charge?
a. Electrons orbit on the outside of the atom.
@ Incorrect answer. Although it is true that electrons orbit outside the nucleus, this is not the reason
why atoms have an overall neutral charge.
*b. The number of protons is equal to the number of electrons.
@ Correct answer. There is an equal number of protons, which have a positive charge, and electrons,
which have a negative charge. The positive and negative charges balance one another out for an
overall neutral charge.
c. There are more neutrons than protons.
@ Incorrect answer. There is an equal number of neutrons and protons. Additionally, neutrons have a
neutral charge.
d. There are four electrons in the outer shell.
@ Incorrect answer. Some elements have four electrons in the outer shell, but this is not the reason
for the overall neutral charge. The number of electrons will match the number of protons.
2. Why do hydrogen and potassium readily interact with other atoms?
a. They only have electrons in the first shell.
@ Incorrect answer. Hydrogen has one electron, but potassium has 19 electrons. Therefore, potassium
has two electrons in the first shell, eight in the second and third shells, and one in the fourth shell.
Hydrogen has one electron in the first shell.
1
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Test Bank - Advanced Physiology and Pathophysiology: Essentials for Clinical Practice, 2nd Edition (Tkacs, 2025)
b. They have electrons in all shells.
@ Incorrect answer. Hydrogen has one electron in the first shell. Potassium has two electrons in the
first shell, eight in the second and third shells, and one in the fourth shell.
c. They both have four electrons in the outer shell.
@ Incorrect answer. Both hydrogen and potassium have one electron in their outer shells.
*d. They both have one electron in the outer shell.
@ Correct answer. Both hydrogen and potassium have one electron in their outer shells, meaning they
can readily interact with other atoms.
3. How many electrons does carbon use to interact with other atoms?
*a. 4
@ Correct answer. Carbon has four electrons in its outer shell. Only the electrons in the outer shell, or
valence electrons, are used to interact with other electrons.
b. 6
@ Incorrect answer. While carbon has a total of six electrons, only the electrons in the outer shell are
used to interact with other electrons. Two of carbon’s six electrons are in the first shell.
c. 1
@ Incorrect answer. Carbon has four valence electrons.
d. 2
@ Incorrect answer. While carbon has two electrons in the first shell, it also has four valence
electrons that are used to interact with other elements.
4. Which of the following is true regarding the role of bicarbonate in maintaining homeostasis?
a. Bicarbonate dissociates from hydroxide to form a free hydroxide that neutralizes acid.
@ Incorrect answer. The dissociation of sodium from a hydroxide ion creates a free hydroxide that
neutralizes acid.
2
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Test Bank - Advanced Physiology and Pathophysiology: Essentials for Clinical Practice, 2nd Edition (Tkacs, 2025)
b. Bicarbonate releases protons when diluted with water, which neutralizes acids.
@ Incorrect answer. Acids release protons when placed in water, but bicarbonate is a base.
c. Bicarbonate is partially ionized in water and is considered to be a weak base.
@ Incorrect answer. Acids are ionized in water, not bases like bicarbonate. Both carbonic acid and
phosphoric acid are partly ionized in water and are considered weak acids.
*d. Bicarbonate functions as a buffer to neutralize acids.
@ Correct answer. Bicarbonate is produced in the pancreas for the purpose of neutralizing the acidity
in chyme as it moves from the stomach to the small intestine. It also plays a major role in the carbonic
acid buffer system.
5. Which of the following occurs when carbonic acid is placed in water?
a. Almost all of the protons are released into the water.
@ Incorrect answer. Carbonic acid is a weak acid. Only in strong acids do most of the protons
dissociate into the water.
*b. Some of the protons are released into the water.
@ Correct answer. Carbonic acid is a weak acid, meaning it is only partly ionized in an aqueous
solution. Some of the protons are released into the water.
c. Some of the electrons are released into the water.
@ Incorrect answer. When acids are placed in water, the protons are released. They are classified
based on their tendency to lose protons. Carbonic acid is a weak acid because only a few of its
protons are released into the water.
d. Almost all of the neutrons are released into the water.
@ Incorrect answer. Protons are released when acids are placed in water.
6. Which of the following most fully describes how proteins are used to buffer pH?
a. Proteins are used to neutralize excess acids because they have a carboxylic acid group.
3
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Test Bank - Advanced Physiology and Pathophysiology: Essentials for Clinical Practice, 2nd Edition (Tkacs, 2025)
@ Incorrect answer. The carboxylic acid group enables proteins to neutralize excess bases.
b. Proteins have an amino group, which is an acid, and therefore they can neutralize excess base.
@ Incorrect answer. The amino group is a base, which enables proteins to neutralize excess acids.
c. Proteins are able to neutralize either excess base or excess acid because they have a neutral amino
group.
@ Incorrect answer. The amino group is a base, which enables proteins to neutralize excess acids.
The carboxylic acid group is an acid, which enables proteins to neutralize excess bases.
*d. Proteins are made up of basic amino groups and acidic carboxylic acid groups, which can be used
to neutralize either excess bases or acids.
@ Correct answer. Proteins can neutralize either excess bases or excess acids because they are made
up of an amino group (base) and a carboxylic acid group (acid).
7. Which of the following correctly describes the bond between two oxygen atoms?
*a. Two oxygen atoms share a double bond, enabling them both to fulfill the octet rule.
@ Correct answer. One oxygen atom will share two of its electrons with the other atom, forming a
double bond and fulfilling the octet rule for both atoms.
b. Two oxygen atoms share bonds with two hydrogen atoms, enabling them to fulfill the octet rule.
@ Incorrect answer. Two oxygen atoms only need to share two electrons with one another in order to
form a double bond that fulfills the octet rule.
c. Two oxygen atoms share protons, forming a double bond and fulfilling the octet rule.
@ Incorrect answer. Two oxygen atoms share electrons, not protons, to form a double bond and fulfill
the octet rule.
d. Two oxygen atoms share two electrons to form a double bond and eight neutrons to fulfill the octet
rule.
4
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Test Bank - Advanced Physiology and Pathophysiology: Essentials for Clinical Practice, 2nd Edition (Tkacs, 2025)
@ Incorrect answer. Two oxygen atoms share only two electrons to form a double bond and fulfill the
octet rule.
8. Which of the following correctly describes a molecule that is most likely to be polar?
*a. A molecule enriched in hydroxyl groups
@ Correct answer. A molecule that contains O-H or N-H bonds is most likely to be polar.
b. A molecule modified with additional methyl groups
@ Incorrect answer. Methyl groups only contain carbon and hydrogen, making them nonpolar.
c. A molecule with 14 carbons, all bonded to hydrogens
@ Incorrect answer. A molecule containing only carbon and hydrogen is a nonpolar molecule.
d. A molecule of carbon dioxide with linear symmetry
@ Incorrect answer. Carbon dioxide cannot have an electrical dipole because it is a straight,
symmetrical molecule.
9. Electronegativity is the tendency of an element to attract a bonding pair of electrons. Which of the
following elements is the most electronegative?
a. Hydrogen
@ Incorrect answer. Electronegativity increases across the periodic table. Hydrogen has one electron
and is more likely to release a valence electron.
b. Carbon
@ Incorrect answer. Carbon has four valence electrons.
c. Potassium
@ Incorrect answer. Potassium has one valence electron and is more likely to release it.
*d. Oxygen
@ Correct answer. Oxygen has six valence electrons and is more likely to attract two more electrons
to fulfill the octet rule.
5
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Test Bank - Advanced Physiology and Pathophysiology: Essentials for Clinical Practice, 2nd Edition (Tkacs, 2025)
10. Which of the following accurately describes a fact about hydrophobic molecules?
a. Water is nonpolar so hydrophobic molecules cannot readily dissolve in water.
@ Incorrect answer. Water is polar. Nonpolar molecules are unable to form hydrogen bonds or ionic
interactions with polar molecules. Therefore, hydrophobic molecules cannot dissolve in water.
*b. Hydrophobic molecules help determine the three-dimensional structure of proteins.
@ Correct answer. Many proteins contain both hydrophilic and hydrophobic areas. Hydrophobic
molecules are attracted to other hydrophobic molecules and this interaction contributes to the three-
dimensional structure of the protein.
c. Hydrophobic molecules are unable to dissolve in water because they form hydrogen bonds.
@ Incorrect answer. Hydrophobic molecules are unable to dissolve in water because they cannot form
hydrogen bonds or ionic interactions with water.
d. Hydrophobic molecules cannot be transported in aqueous solutions because they do not dissolve.
@ Incorrect answer. Hydrophobic molecules cannot dissolve in aqueous solutions, but they can be
transported with special packaging.
11. Why do some individuals have lactose intolerance?
*a. Some adults are unable to produce lactase.
@ Correct answer. Some adults are unable to produce lactase, the enzyme needed to breakdown
lactose.
b. In some adults, the enzyme changes shape.
@ Incorrect answer. Some adults are unable to produce lactase.
c. In some adults, the enzyme lactase is unable to break down the milk sugars.
@ Incorrect answer. Some adults lack the ability to produce lactase, which is the enzyme needed to
break down the milk sugar lactose.
d. In some adults, an inappropriate immune response occurs as a result of exposure to lactose.
6
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