NUR 631 Advanced Physiology & Pathophysiology Midterm
Exam | 100 High-Yield MCQs with Verified Answers &
Rationales (GCU 2026)
Question 1
A 68-year-old patient with chronic ischemia develops cellular injury characterized by decreased
ATP production and failure of sodium-potassium pumps. Which of the following is the earliest
cellular change expected in this condition?
A. Nuclear fragmentation
B. Cell membrane rupture
C. Cellular swelling
D. DNA mutation
✔️ Answer: C. Cellular swelling
Explanation: ATP depletion causes failure of the Na⁺/K⁺ pump, leading to sodium and water
accumulation inside the cell. This results in cellular swelling, which is one of the earliest
reversible changes in cell injury.
Question 2
A patient presents with diabetic ketoacidosis (DKA). Which electrolyte abnormality must be
corrected first during management?
A. Sodium
B. Calcium
C. Potassium
D. Chloride
✔️ Answer: C. Potassium
Explanation: Even if serum potassium appears elevated, total body potassium is depleted.
Insulin therapy shifts potassium into cells, which can cause dangerous hypokalemia if not
corrected first.
Question 3
,Which type of diabetes insipidus results from renal resistance to antidiuretic hormone (ADH)?
A. Neurogenic
B. Nephrogenic
C. Psychogenic
D. Central
✔️ Answer: B. Nephrogenic
Explanation: In nephrogenic diabetes insipidus, the kidneys do not respond to ADH, leading to
excessive excretion of dilute urine despite normal or elevated hormone levels.
Question 4
During an acute inflammatory response, which leukocyte is typically elevated first?
A. Lymphocytes
B. Eosinophils
C. Neutrophils
D. Basophils
✔️ Answer: C. Neutrophils
Explanation: Neutrophils are the first responders during acute inflammation, rapidly migrating
to the site of injury or infection.
Question 5
Which immunoglobulin is most commonly associated with allergic (type I hypersensitivity)
reactions?
A. IgG
B. IgM
C. IgA
D. IgE
✔️ Answer: D. IgE
Explanation: IgE binds to mast cells and basophils. When triggered by allergens, it causes
histamine release, leading to allergic reactions.
Question 6
,A patient with hyperthyroidism is at risk for thyrotoxic crisis. Which clinical sign is most
indicative of this condition?
A. Bradycardia
B. Hypothermia
C. Hyperthermia
D. Constipation
✔️ Answer: C. Hyperthermia
Explanation: Thyroid storm is a life-threatening condition characterized by extreme
hypermetabolism, including high fever, tachycardia, and altered mental status.
Question 7
Which T lymphocyte subtype plays a major role in preventing autoimmune reactions?
A. Cytotoxic T cells
B. Helper T cells
C. Regulatory T cells
D. Memory T cells
✔️ Answer: C. Regulatory T cells
Explanation: Regulatory T cells suppress immune responses and maintain self-tolerance,
preventing the immune system from attacking the body’s own tissues.
Question 8
A newborn relies on passive immunity before developing its own antibody production.
Approximately how long does it take for the infant’s immune system to become functionally
protective?
A. 1–2 months
B. 3–4 months
C. 6–8 months
D. 12 months
✔️ Answer: C. 6–8 months
Explanation: Passive immunity from maternal antibodies declines over time, while the infant
gradually develops its own immune system, becoming more effective around 6–8 months.
, Question 9
Which mechanism best explains tissue damage during hypoxic injury?
A. Increased ATP production
B. Decreased intracellular calcium
C. Reactive oxygen species formation
D. Enhanced protein synthesis
✔️ Answer: C. Reactive oxygen species formation
Explanation: Hypoxia leads to mitochondrial dysfunction and production of reactive oxygen
species, which damage cellular membranes, proteins, and DNA.
Question 10
Which cellular adaptation involves an increase in cell size without an increase in cell number?
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Dysplasia
✔️ Answer: B. Hypertrophy
Explanation: Hypertrophy occurs when cells enlarge to meet increased functional demand, such
as cardiac muscle enlargement in hypertension.
Question 11
A patient with metabolic acidosis is compensating through respiratory mechanisms. Which
arterial blood gas (ABG) change would the nurse expect to observe as part of this compensatory
response?
A. Increased PaCO₂
B. Decreased PaCO₂
C. Increased bicarbonate
D. Decreased oxygen saturation
✔️ Answer: B. Decreased PaCO₂
Explanation: In metabolic acidosis, the lungs compensate by increasing respiratory rate to blow
off CO₂, which reduces carbonic acid and helps raise blood pH.
Exam | 100 High-Yield MCQs with Verified Answers &
Rationales (GCU 2026)
Question 1
A 68-year-old patient with chronic ischemia develops cellular injury characterized by decreased
ATP production and failure of sodium-potassium pumps. Which of the following is the earliest
cellular change expected in this condition?
A. Nuclear fragmentation
B. Cell membrane rupture
C. Cellular swelling
D. DNA mutation
✔️ Answer: C. Cellular swelling
Explanation: ATP depletion causes failure of the Na⁺/K⁺ pump, leading to sodium and water
accumulation inside the cell. This results in cellular swelling, which is one of the earliest
reversible changes in cell injury.
Question 2
A patient presents with diabetic ketoacidosis (DKA). Which electrolyte abnormality must be
corrected first during management?
A. Sodium
B. Calcium
C. Potassium
D. Chloride
✔️ Answer: C. Potassium
Explanation: Even if serum potassium appears elevated, total body potassium is depleted.
Insulin therapy shifts potassium into cells, which can cause dangerous hypokalemia if not
corrected first.
Question 3
,Which type of diabetes insipidus results from renal resistance to antidiuretic hormone (ADH)?
A. Neurogenic
B. Nephrogenic
C. Psychogenic
D. Central
✔️ Answer: B. Nephrogenic
Explanation: In nephrogenic diabetes insipidus, the kidneys do not respond to ADH, leading to
excessive excretion of dilute urine despite normal or elevated hormone levels.
Question 4
During an acute inflammatory response, which leukocyte is typically elevated first?
A. Lymphocytes
B. Eosinophils
C. Neutrophils
D. Basophils
✔️ Answer: C. Neutrophils
Explanation: Neutrophils are the first responders during acute inflammation, rapidly migrating
to the site of injury or infection.
Question 5
Which immunoglobulin is most commonly associated with allergic (type I hypersensitivity)
reactions?
A. IgG
B. IgM
C. IgA
D. IgE
✔️ Answer: D. IgE
Explanation: IgE binds to mast cells and basophils. When triggered by allergens, it causes
histamine release, leading to allergic reactions.
Question 6
,A patient with hyperthyroidism is at risk for thyrotoxic crisis. Which clinical sign is most
indicative of this condition?
A. Bradycardia
B. Hypothermia
C. Hyperthermia
D. Constipation
✔️ Answer: C. Hyperthermia
Explanation: Thyroid storm is a life-threatening condition characterized by extreme
hypermetabolism, including high fever, tachycardia, and altered mental status.
Question 7
Which T lymphocyte subtype plays a major role in preventing autoimmune reactions?
A. Cytotoxic T cells
B. Helper T cells
C. Regulatory T cells
D. Memory T cells
✔️ Answer: C. Regulatory T cells
Explanation: Regulatory T cells suppress immune responses and maintain self-tolerance,
preventing the immune system from attacking the body’s own tissues.
Question 8
A newborn relies on passive immunity before developing its own antibody production.
Approximately how long does it take for the infant’s immune system to become functionally
protective?
A. 1–2 months
B. 3–4 months
C. 6–8 months
D. 12 months
✔️ Answer: C. 6–8 months
Explanation: Passive immunity from maternal antibodies declines over time, while the infant
gradually develops its own immune system, becoming more effective around 6–8 months.
, Question 9
Which mechanism best explains tissue damage during hypoxic injury?
A. Increased ATP production
B. Decreased intracellular calcium
C. Reactive oxygen species formation
D. Enhanced protein synthesis
✔️ Answer: C. Reactive oxygen species formation
Explanation: Hypoxia leads to mitochondrial dysfunction and production of reactive oxygen
species, which damage cellular membranes, proteins, and DNA.
Question 10
Which cellular adaptation involves an increase in cell size without an increase in cell number?
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Dysplasia
✔️ Answer: B. Hypertrophy
Explanation: Hypertrophy occurs when cells enlarge to meet increased functional demand, such
as cardiac muscle enlargement in hypertension.
Question 11
A patient with metabolic acidosis is compensating through respiratory mechanisms. Which
arterial blood gas (ABG) change would the nurse expect to observe as part of this compensatory
response?
A. Increased PaCO₂
B. Decreased PaCO₂
C. Increased bicarbonate
D. Decreased oxygen saturation
✔️ Answer: B. Decreased PaCO₂
Explanation: In metabolic acidosis, the lungs compensate by increasing respiratory rate to blow
off CO₂, which reduces carbonic acid and helps raise blood pH.
