Pathophysiology (NR 283) Final Exam – Chamberlain University
Study Guide, Practice Questions & Comprehensive Exam Review
Comprehensive study resource for NR 283 Pathophysiology at Chamberlain University. This
guide covers major pathophysiology concepts across all course units, including cellular
adaptation and injury, inflammation, immunity, fluid and electrolyte balance, acid-base
disorders, cardiovascular, respiratory, hematologic, endocrine, neurological, gastrointestinal,
renal, urinary, and reproductive system disorders. Includes practice questions, answer
explanations, concept summaries, and exam-focused review material designed to help nursing
students reinforce key concepts, strengthen clinical reasoning, and prepare effectively for the
final exam.
Question 1
A patient with long-standing chronic obstructive pulmonary disease (COPD) has an
arterial blood gas (ABG) showing respiratory acidosis. Which compensatory mechanism
will the kidneys use to stabilize the blood pH?
A) Excreting large amounts of bicarbonate ions into the urine
B) Retaining hydrogen ions and excreting carbon dioxide
C) Retaining bicarbonate ions and excreting hydrogen ions into the urine
D) Increasing the production of lactic acid to offset alkalinity
Answer: C) Retaining bicarbonate ions and excreting hydrogen ions into the urine
Rationale: In respiratory acidosis, the lungs fail to eliminate adequate carbon dioxide
(CO2). To compensate, the kidneys slowly clear excess metabolic acids by excreting
hydrogen ions (H+) and reabsorbing base bicarbonate ions (HCO3-) back into the
circulation to raise blood pH.
Question 2
A patient is admitted to the medical-surgical unit with an acute flare-up of Crohn's
disease, experiencing severe, watery diarrhea for four days. Which acid-base
imbalance is this patient at highest risk for developing?
A) Respiratory acidosis
B) Respiratory alkalosis
C) Metabolic acidosis
D) Metabolic alkalosis
Answer: C) Metabolic acidosis
Rationale: Fluids below the waist, particularly pancreatic juices and intestinal secretions,
are highly rich in bicarbonate ions. Severe, chronic diarrhea results in a massive loss of
base bicarbonate, tilting the body's balance into metabolic acidosis.
,Question 3
A patient presents to the emergency department after accidentally overdosing on aspirin
(acetylsalicylic acid). The nurse notes the patient is hyperventilating. Which acid-base
imbalance should the nurse expect to find initially?
A) Respiratory acidosis
B) Respiratory alkalosis
C) Metabolic acidosis
D) Metabolic alkalosis
Answer: B) Respiratory alkalosis
Rationale: Salicylate toxicity directly stimulates the respiratory center in the brainstem,
causing hyperventilation. Blowing off excess carbon dioxide (CO2) drops the partial
pressure of arterial carbon dioxide (PaCO2) levels, resulting in an initial respiratory
alkalosis before a mixed metabolic acidosis develops later.
Question 4
A patient with advanced liver cirrhosis has developed severe ascites and general
peripheral edema. The nurse understands that this fluid shift into the interstitial spaces
is caused by:
A) Increased plasma oncotic pressure from sodium retention
B) Decreased capillary hydrostatic pressure due to vasodilation
C) Decreased plasma oncotic pressure due to impaired albumin synthesis
D) Increased lymphatic drainage blocking venous return
Answer: C) Decreased plasma oncotic pressure due to impaired albumin
synthesis
Rationale: The liver is responsible for synthesizing albumin, the main plasma protein
that exerts oncotic pressure to pull fluid into capillaries. In cirrhosis, compromised
albumin production lowers plasma oncotic pressure, allowing fluid to escape into
interstitial spaces.
Question 5
A patient with a history of profound hypokalemia is being monitored via an
electrocardiogram (EKG). Which unique electrical conduction change is a hallmark sign
of a low potassium level?
A) Tall, peaked T waves
,B) Widened QRS complex
C) Presence of prominent U waves
D) Shortened PR interval
Answer: C) Presence of prominent U waves
Rationale: Hypokalemia alters the electrical resting membrane potential of cardiac
muscle cells, delaying ventricular repolarization. On an EKG, this typically manifests as
flattened or inverted T waves, ST-segment depression, and the appearance of a
prominent U wave.
Question 6
A patient arrives at the emergency department with a history of prolonged vomiting due
to food poisoning. The nurse understands that this patient is at risk for metabolic
alkalosis primarily due to the loss of:
A) Sodium bicarbonate from the lower intestines
B) Hydrochloric acid from the gastric mucosa
C) Carbonic acid via hyperventilation
D) Phosphate buffers within the intracellular fluid
Answer: B) Hydrochloric acid from the gastric mucosa
Rationale: Fluids above the waist, particularly gastric secretions, contain high levels of
hydrochloric acid (HCl) and potassium. Prolonged vomiting removes massive amounts
of hydrogen and chloride ions, leaving behind an excess of bicarbonate in the blood.
Question 7
A patient with type 2 diabetes mellitus is admitted to the intensive care unit in a
Hyperosmolar Hyperglycemic State (HHS). Which clinical finding distinguishes HHS
from Diabetic Ketoacidosis (DKA)?
A) Blood glucose levels exceeding 300 mg/dL
B) Severe intravascular dehydration
C) Absence of significant metabolic acidosis and serum ketones
D) Elevated blood urea nitrogen (BUN) and creatinine
Answer: C) Absence of significant metabolic acidosis and serum ketones
Rationale: In HHS (typically seen in Type 2 Diabetes), there is enough endogenous
insulin present to prevent lipolysis and subsequent ketone formation. Thus, patients
present with extreme hyperglycemia and dehydration, but without the ketoacidosis
characteristic of DKA.
, Question 8
A patient is diagnosed with an intrarenal Acute Kidney Injury (AKI). Which etiology
should the nurse identify as a direct cause of intrarenal damage?
A) Severe hypovolemia from a major hemorrhage
B) Bilateral kidney stones blocking the ureters
C) Nephrotoxic injury to tubular cells from aminoglycoside antibiotics
D) Benign prostatic hyperplasia (BPH) restricting urine output
Answer: C) Nephrotoxic injury to tubular cells from aminoglycoside antibiotics
Rationale: Intrarenal AKI occurs when there is direct damage to the kidney tissue itself,
such as Acute Tubular Necrosis (ATN) caused by nephrotoxins, drugs, or severe
ischemia. Hypovolemia is prerenal, while stones and BPH are postrenal causes.
Question 9
A patient with advanced Chronic Kidney Disease (CKD) reports severe, widespread
itching (pruritus). The nurse notes fine, whitish crystals on the patient's skin. This
presentation is known as:
A) Melanin hyperpigmentation
B) Uremic frost
C) Aquagenic pruritus
D) Petechial rash
Answer: B) Uremic frost
Rationale: In advanced end-stage renal disease, high concentrations of urea and other
nitrogenous wastes accumulate in the bloodstream (uremia). When these toxins are
excreted through eccrine sweat glands onto the skin, they evaporate, leaving behind a
white crystalline residue known as uremic frost.
Question 10
A patient with a pituitary tumor develops Diabetes Insipidus (DI). What is the underlying
pathophysiological mechanism of DI, and what urinary manifestation will the nurse
observe?
A) Overproduction of insulin; profound oliguria with high specific gravity
B) Deficiency of antidiuretic hormone (ADH); polyuria with very low specific gravity
C) Excess secretion of aldosterone; anuria with dark hematuria
D) Resistance to parathyroid hormone; glycosuria with high ketones
Study Guide, Practice Questions & Comprehensive Exam Review
Comprehensive study resource for NR 283 Pathophysiology at Chamberlain University. This
guide covers major pathophysiology concepts across all course units, including cellular
adaptation and injury, inflammation, immunity, fluid and electrolyte balance, acid-base
disorders, cardiovascular, respiratory, hematologic, endocrine, neurological, gastrointestinal,
renal, urinary, and reproductive system disorders. Includes practice questions, answer
explanations, concept summaries, and exam-focused review material designed to help nursing
students reinforce key concepts, strengthen clinical reasoning, and prepare effectively for the
final exam.
Question 1
A patient with long-standing chronic obstructive pulmonary disease (COPD) has an
arterial blood gas (ABG) showing respiratory acidosis. Which compensatory mechanism
will the kidneys use to stabilize the blood pH?
A) Excreting large amounts of bicarbonate ions into the urine
B) Retaining hydrogen ions and excreting carbon dioxide
C) Retaining bicarbonate ions and excreting hydrogen ions into the urine
D) Increasing the production of lactic acid to offset alkalinity
Answer: C) Retaining bicarbonate ions and excreting hydrogen ions into the urine
Rationale: In respiratory acidosis, the lungs fail to eliminate adequate carbon dioxide
(CO2). To compensate, the kidneys slowly clear excess metabolic acids by excreting
hydrogen ions (H+) and reabsorbing base bicarbonate ions (HCO3-) back into the
circulation to raise blood pH.
Question 2
A patient is admitted to the medical-surgical unit with an acute flare-up of Crohn's
disease, experiencing severe, watery diarrhea for four days. Which acid-base
imbalance is this patient at highest risk for developing?
A) Respiratory acidosis
B) Respiratory alkalosis
C) Metabolic acidosis
D) Metabolic alkalosis
Answer: C) Metabolic acidosis
Rationale: Fluids below the waist, particularly pancreatic juices and intestinal secretions,
are highly rich in bicarbonate ions. Severe, chronic diarrhea results in a massive loss of
base bicarbonate, tilting the body's balance into metabolic acidosis.
,Question 3
A patient presents to the emergency department after accidentally overdosing on aspirin
(acetylsalicylic acid). The nurse notes the patient is hyperventilating. Which acid-base
imbalance should the nurse expect to find initially?
A) Respiratory acidosis
B) Respiratory alkalosis
C) Metabolic acidosis
D) Metabolic alkalosis
Answer: B) Respiratory alkalosis
Rationale: Salicylate toxicity directly stimulates the respiratory center in the brainstem,
causing hyperventilation. Blowing off excess carbon dioxide (CO2) drops the partial
pressure of arterial carbon dioxide (PaCO2) levels, resulting in an initial respiratory
alkalosis before a mixed metabolic acidosis develops later.
Question 4
A patient with advanced liver cirrhosis has developed severe ascites and general
peripheral edema. The nurse understands that this fluid shift into the interstitial spaces
is caused by:
A) Increased plasma oncotic pressure from sodium retention
B) Decreased capillary hydrostatic pressure due to vasodilation
C) Decreased plasma oncotic pressure due to impaired albumin synthesis
D) Increased lymphatic drainage blocking venous return
Answer: C) Decreased plasma oncotic pressure due to impaired albumin
synthesis
Rationale: The liver is responsible for synthesizing albumin, the main plasma protein
that exerts oncotic pressure to pull fluid into capillaries. In cirrhosis, compromised
albumin production lowers plasma oncotic pressure, allowing fluid to escape into
interstitial spaces.
Question 5
A patient with a history of profound hypokalemia is being monitored via an
electrocardiogram (EKG). Which unique electrical conduction change is a hallmark sign
of a low potassium level?
A) Tall, peaked T waves
,B) Widened QRS complex
C) Presence of prominent U waves
D) Shortened PR interval
Answer: C) Presence of prominent U waves
Rationale: Hypokalemia alters the electrical resting membrane potential of cardiac
muscle cells, delaying ventricular repolarization. On an EKG, this typically manifests as
flattened or inverted T waves, ST-segment depression, and the appearance of a
prominent U wave.
Question 6
A patient arrives at the emergency department with a history of prolonged vomiting due
to food poisoning. The nurse understands that this patient is at risk for metabolic
alkalosis primarily due to the loss of:
A) Sodium bicarbonate from the lower intestines
B) Hydrochloric acid from the gastric mucosa
C) Carbonic acid via hyperventilation
D) Phosphate buffers within the intracellular fluid
Answer: B) Hydrochloric acid from the gastric mucosa
Rationale: Fluids above the waist, particularly gastric secretions, contain high levels of
hydrochloric acid (HCl) and potassium. Prolonged vomiting removes massive amounts
of hydrogen and chloride ions, leaving behind an excess of bicarbonate in the blood.
Question 7
A patient with type 2 diabetes mellitus is admitted to the intensive care unit in a
Hyperosmolar Hyperglycemic State (HHS). Which clinical finding distinguishes HHS
from Diabetic Ketoacidosis (DKA)?
A) Blood glucose levels exceeding 300 mg/dL
B) Severe intravascular dehydration
C) Absence of significant metabolic acidosis and serum ketones
D) Elevated blood urea nitrogen (BUN) and creatinine
Answer: C) Absence of significant metabolic acidosis and serum ketones
Rationale: In HHS (typically seen in Type 2 Diabetes), there is enough endogenous
insulin present to prevent lipolysis and subsequent ketone formation. Thus, patients
present with extreme hyperglycemia and dehydration, but without the ketoacidosis
characteristic of DKA.
, Question 8
A patient is diagnosed with an intrarenal Acute Kidney Injury (AKI). Which etiology
should the nurse identify as a direct cause of intrarenal damage?
A) Severe hypovolemia from a major hemorrhage
B) Bilateral kidney stones blocking the ureters
C) Nephrotoxic injury to tubular cells from aminoglycoside antibiotics
D) Benign prostatic hyperplasia (BPH) restricting urine output
Answer: C) Nephrotoxic injury to tubular cells from aminoglycoside antibiotics
Rationale: Intrarenal AKI occurs when there is direct damage to the kidney tissue itself,
such as Acute Tubular Necrosis (ATN) caused by nephrotoxins, drugs, or severe
ischemia. Hypovolemia is prerenal, while stones and BPH are postrenal causes.
Question 9
A patient with advanced Chronic Kidney Disease (CKD) reports severe, widespread
itching (pruritus). The nurse notes fine, whitish crystals on the patient's skin. This
presentation is known as:
A) Melanin hyperpigmentation
B) Uremic frost
C) Aquagenic pruritus
D) Petechial rash
Answer: B) Uremic frost
Rationale: In advanced end-stage renal disease, high concentrations of urea and other
nitrogenous wastes accumulate in the bloodstream (uremia). When these toxins are
excreted through eccrine sweat glands onto the skin, they evaporate, leaving behind a
white crystalline residue known as uremic frost.
Question 10
A patient with a pituitary tumor develops Diabetes Insipidus (DI). What is the underlying
pathophysiological mechanism of DI, and what urinary manifestation will the nurse
observe?
A) Overproduction of insulin; profound oliguria with high specific gravity
B) Deficiency of antidiuretic hormone (ADH); polyuria with very low specific gravity
C) Excess secretion of aldosterone; anuria with dark hematuria
D) Resistance to parathyroid hormone; glycosuria with high ketones
