NSG 5140 Advanced Pathophysiology Final Exam
2026 | Realistic Practice Questions with Verified
Answers & Detailed Rationales | Complete South
College Exam Prep Study Guide
Q1
A 67-year-old patient with a long history of uncontrolled hypertension develops thickened
left ventricular walls without an increase in chamber size. Which pathophysiological process
best explains this cardiac remodeling?
A. Volume overload causing eccentric hypertrophy
B. Chronic pressure overload resulting in concentric hypertrophy
C. Decreased preload causing myocardial atrophy
D. Increased venous return leading to ventricular dilation
✅ Answer: B
Rationale: Chronic hypertension increases afterload, forcing the left ventricle to generate
higher pressure. This leads to concentric hypertrophy, characterized by thickened
myocardial walls without dilation, improving pressure generation but reducing compliance.
Q2
A patient presents with diabetic ketoacidosis and laboratory findings show a low pH and low
bicarbonate level. Which compensatory response is expected to occur first?
A. Increased renal excretion of bicarbonate
B. Decreased respiratory rate to retain CO₂
C. Increased renal hydrogen ion retention
D. Increased respiratory rate to reduce carbon dioxide levels
✅ Answer: D
Rationale: In metabolic acidosis, the fastest compensation is respiratory. Hyperventilation
(Kussmaul respirations) reduces CO₂ (an acid), helping raise pH before renal compensation
begins.
,Q3
A patient with nephrotic syndrome develops severe peripheral edema. Which mechanism is
primarily responsible for this fluid accumulation?
A. Increased capillary hydrostatic pressure
B. Increased lymphatic drainage
C. Loss of albumin causing decreased plasma oncotic pressure
D. Decreased capillary permeability
✅ Answer: C
Rationale: Albumin maintains oncotic pressure. Its loss in urine lowers plasma oncotic
pressure, allowing fluid to shift into interstitial spaces, causing edema.
Q4
A patient with chronic obstructive pulmonary disease retains carbon dioxide chronically.
Which acid-base disorder is most consistent with this condition?
A. Respiratory acidosis
B. Metabolic alkalosis
C. Metabolic acidosis
D. Respiratory alkalosis
✅ Answer: A
Rationale: CO₂ retention increases carbonic acid levels, decreasing pH, resulting in
respiratory acidosis. The kidneys may compensate over time by retaining bicarbonate.
Q5
Which electrolyte imbalance is most likely to cause muscle weakness, flattened T waves,
and increased risk of cardiac arrhythmias?
A. Hyperkalemia
B. Hypercalcemia
,C. Hypokalemia
D. Hyponatremia
✅ Answer: C
Rationale: Potassium is essential for cardiac conduction. Low potassium causes delayed
repolarization, leading to arrhythmias and muscle weakness.
Q6
A patient in early septic shock presents with hypotension, warm flushed skin, and bounding
pulses. Which underlying mechanism best explains these findings?
A. Increased systemic vascular resistance
B. Decreased cardiac output
C. Increased blood viscosity
D. Peripheral vasodilation caused by inflammatory mediators
✅ Answer: D
Rationale: Cytokines such as TNF-α and interleukins cause widespread vasodilation,
lowering systemic vascular resistance and producing warm skin.
Q7
A pulmonary embolism leads to impaired oxygenation. Which pathophysiological
mechanism is primarily responsible for hypoxemia in this condition?
A. Increased alveolar ventilation
B. Decreased airway resistance
C. Increased oxygen diffusion capacity
D. Ventilation without perfusion causing V/Q mismatch
✅ Answer: D
Rationale: The embolus blocks blood flow, so oxygenated air cannot transfer oxygen into
circulation—this is dead space ventilation.
, Q8
Which hormone is released first in response to decreased renal perfusion and initiates the
renin-angiotensin-aldosterone system?
A. Aldosterone
B. Antidiuretic hormone
C. Cortisol
D. Renin
✅ Answer: D
Rationale: Renin is secreted by juxtaglomerular cells and begins the RAAS cascade,
ultimately increasing blood pressure and volume.
Q9
A patient with persistent vomiting loses large amounts of gastric acid. Which primary acid-
base imbalance is expected?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic alkalosis
D. Metabolic acidosis
✅ Answer: C
Rationale: Loss of hydrogen ions (HCl) leads to an increase in bicarbonate, producing
alkalosis.
Q10
Which mechanism most directly contributes to insulin resistance in type 2 diabetes mellitus?
A. Increased insulin secretion by pancreatic beta cells
B. Decreased glucose intake
C. Increased insulin receptor sensitivity
D. Reduced cellular responsiveness to insulin signaling pathways
2026 | Realistic Practice Questions with Verified
Answers & Detailed Rationales | Complete South
College Exam Prep Study Guide
Q1
A 67-year-old patient with a long history of uncontrolled hypertension develops thickened
left ventricular walls without an increase in chamber size. Which pathophysiological process
best explains this cardiac remodeling?
A. Volume overload causing eccentric hypertrophy
B. Chronic pressure overload resulting in concentric hypertrophy
C. Decreased preload causing myocardial atrophy
D. Increased venous return leading to ventricular dilation
✅ Answer: B
Rationale: Chronic hypertension increases afterload, forcing the left ventricle to generate
higher pressure. This leads to concentric hypertrophy, characterized by thickened
myocardial walls without dilation, improving pressure generation but reducing compliance.
Q2
A patient presents with diabetic ketoacidosis and laboratory findings show a low pH and low
bicarbonate level. Which compensatory response is expected to occur first?
A. Increased renal excretion of bicarbonate
B. Decreased respiratory rate to retain CO₂
C. Increased renal hydrogen ion retention
D. Increased respiratory rate to reduce carbon dioxide levels
✅ Answer: D
Rationale: In metabolic acidosis, the fastest compensation is respiratory. Hyperventilation
(Kussmaul respirations) reduces CO₂ (an acid), helping raise pH before renal compensation
begins.
,Q3
A patient with nephrotic syndrome develops severe peripheral edema. Which mechanism is
primarily responsible for this fluid accumulation?
A. Increased capillary hydrostatic pressure
B. Increased lymphatic drainage
C. Loss of albumin causing decreased plasma oncotic pressure
D. Decreased capillary permeability
✅ Answer: C
Rationale: Albumin maintains oncotic pressure. Its loss in urine lowers plasma oncotic
pressure, allowing fluid to shift into interstitial spaces, causing edema.
Q4
A patient with chronic obstructive pulmonary disease retains carbon dioxide chronically.
Which acid-base disorder is most consistent with this condition?
A. Respiratory acidosis
B. Metabolic alkalosis
C. Metabolic acidosis
D. Respiratory alkalosis
✅ Answer: A
Rationale: CO₂ retention increases carbonic acid levels, decreasing pH, resulting in
respiratory acidosis. The kidneys may compensate over time by retaining bicarbonate.
Q5
Which electrolyte imbalance is most likely to cause muscle weakness, flattened T waves,
and increased risk of cardiac arrhythmias?
A. Hyperkalemia
B. Hypercalcemia
,C. Hypokalemia
D. Hyponatremia
✅ Answer: C
Rationale: Potassium is essential for cardiac conduction. Low potassium causes delayed
repolarization, leading to arrhythmias and muscle weakness.
Q6
A patient in early septic shock presents with hypotension, warm flushed skin, and bounding
pulses. Which underlying mechanism best explains these findings?
A. Increased systemic vascular resistance
B. Decreased cardiac output
C. Increased blood viscosity
D. Peripheral vasodilation caused by inflammatory mediators
✅ Answer: D
Rationale: Cytokines such as TNF-α and interleukins cause widespread vasodilation,
lowering systemic vascular resistance and producing warm skin.
Q7
A pulmonary embolism leads to impaired oxygenation. Which pathophysiological
mechanism is primarily responsible for hypoxemia in this condition?
A. Increased alveolar ventilation
B. Decreased airway resistance
C. Increased oxygen diffusion capacity
D. Ventilation without perfusion causing V/Q mismatch
✅ Answer: D
Rationale: The embolus blocks blood flow, so oxygenated air cannot transfer oxygen into
circulation—this is dead space ventilation.
, Q8
Which hormone is released first in response to decreased renal perfusion and initiates the
renin-angiotensin-aldosterone system?
A. Aldosterone
B. Antidiuretic hormone
C. Cortisol
D. Renin
✅ Answer: D
Rationale: Renin is secreted by juxtaglomerular cells and begins the RAAS cascade,
ultimately increasing blood pressure and volume.
Q9
A patient with persistent vomiting loses large amounts of gastric acid. Which primary acid-
base imbalance is expected?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic alkalosis
D. Metabolic acidosis
✅ Answer: C
Rationale: Loss of hydrogen ions (HCl) leads to an increase in bicarbonate, producing
alkalosis.
Q10
Which mechanism most directly contributes to insulin resistance in type 2 diabetes mellitus?
A. Increased insulin secretion by pancreatic beta cells
B. Decreased glucose intake
C. Increased insulin receptor sensitivity
D. Reduced cellular responsiveness to insulin signaling pathways
