NR283 Final Exam / NR 283
Pathophysiology Final Exam Review Guide
with Questions and Well Graded Solutions
with Rationales Updated 2026-2027
Master your NR283 Pathophysiology Final Exam with this comprehensive review guide
tailored for Chamberlain University and top BSN programs. Features high-yield
multiple-choice practice questions covering cellular injury, fluid/electrolytes,
cardiovascular, renal, and endocrine alterations. Each question includes the correct
answer and a detailed rationale to build critical NCLEX-style thinking. Perfect for
boosting your EdApt modules, unit exams, and securing an A on your final HESI
proctored test
Unit 1: Cellular Alterations, Fluid & Electrolytes, and
Inflammation (Questions 1-25)
1|Page
,Question 1: A patient with chronic hypertension exhibits an enlarged left ventricle on
an echocardiogram. This adaptive cellular change is best described as:
A) Hyperplasia
B) Atrophy
C) Hypertrophy
D) Metaplasia
Answer: C) Hypertrophy
Rationale: Hypertrophy is an increase in the size of individual cells, common in
cardiac and skeletal muscle tissue when subjected to an increased workload, such
as high blood pressure.
Question 2: Which adaptive cellular change is characterized by the replacement of
one mature cell type by another mature cell type, often seen in the airways of chronic
smokers?
A) Dysplasia
B) Metaplasia
C) Anaplasia
D) Hyperplasia
Answer: B) Metaplasia
Rationale: Metaplasia is a reversible change where one mature cell type is replaced
by a different mature cell type that is better able to withstand chronic irritation, such
as ciliated columnar epithelium changing to stratified squamous epithelium in
smokers.
Question 3: A biopsy of a cervical lesion reveals cells that vary abnormally in size,
shape, and organization. The nurse recognizes this precancerous cellular alteration
as:
A) Atrophy
B) Metaplasia
C) Hypertrophy
D) Dysplasia
Answer: D) Dysplasia
Rationale: Dysplasia refers to disordered and abnormal cellular growth with
variations in cell size, shape, and organization. It is strongly associated with
precancerous progression and requires clinical monitoring.
Question 4: Which form of cell death involves programmed, orderly self-destruction
without causing an inflammatory response in surrounding tissues?
A) Coagulative necrosis
B) Liquefactive necrosis
C) Apoptosis
D) Caseous necrosis
Answer: C) Apoptosis
Rationale: Apoptosis is genetically programmed cell death that safely removes old or
damaged cells. Because the cellular contents do not leak out into the extracellular
matrix, it does not trigger an inflammatory response.
Question 5: A patient suffers a severe myocardial infarction due to a prolonged lack
of oxygen supply. This irreversible cell death triggered by hypoxic injury is known as:
A) Apoptosis
B) Necrosis
C) Autophagy
2|Page
,D) Atrophy
Answer: B) Necrosis
Rationale: Necrosis is pathological, unprogrammed cell death resulting from severe
acute injury, ischemia, or toxins. It causes cell swelling, membrane rupture, and
triggers inflammation in the surrounding tissue.
Question 6: Which type of necrosis is uniquely characteristic of tuberculosis
infections in the lungs, presenting with a grayish-white, "cheesy" appearance?
A) Liquefactive necrosis
B) Caseous necrosis
C) Coagulative necrosis
D) Fat necrosis
Answer: B) Caseous necrosis
Rationale: Caseous necrosis occurs most commonly in tuberculosis infections. Dead
cells disintegrate but are not completely digested, leaving a soft, crumbly, cheese-
like debris enclosed by a granuloma.
Question 7: During acute cellular swelling (hydropic degeneration) caused by
hypoxia, what is the primary mechanism responsible for the accumulation of water
inside the cell?
A) Increased production of cellular ATP
B) Failure of the ATP-driven sodium-potassium pump
C) Excessive influx of extracellular potassium
D) Rapid efflux of sodium ions
Answer: B) Failure of the ATP-driven sodium-potassium pump
Rationale: Hypoxia impairs aerobic respiration, leading to a drop in ATP production.
Without ATP, the sodium-potassium (Na⁺/K⁺) pump fails, causing sodium to build up
inside the cell. Water follows sodium osmotically, resulting in cellular swelling.
Question 8: A patient is admitted with a serum sodium level of 118 mEq/L. Which
pathophysiological shift occurs regarding fluid movement between body
compartments?
A) Water shifts from the intracellular space to the extracellular space
B) Water shifts from the extracellular space into the intracellular cells
C) Fluid shifts completely out of the vascular compartment into the lymphatic system
D) Hydrostatic pressure increases, forcing protein into the interstitial spaces
Answer: B) Water shifts from the extracellular space into the intracellular cells
Rationale: Severe hyponatremia renders the extracellular fluid hypotonic compared
to the intracellular environment. Water moves osmotically from the lower
concentration area (blood vessels) to the higher concentration area inside the cells,
causing brain swelling and neurological symptoms.
Question 9: A patient presents with generalized edema. The nurse understands that
a decrease in which of the following forces most commonly causes fluid to escape
into the interstitial spaces?
A) Capillary hydrostatic pressure
B) Interstitial hydrostatic pressure
C) Plasma oncotic pressure
D) Tissue osmotic pressure
Answer: C) Plasma oncotic pressure
Rationale: Plasma oncotic (colloid osmotic) pressure is generated primarily by
albumin, which keeps fluid inside blood vessels. A decrease in plasma proteins (due
3|Page
, to malnutrition, liver failure, or nephrotic syndrome) reduces this pulling force,
causing systemic edema.
Question 10: Which hormone is released by the posterior pituitary gland in response
to increased plasma osmolality, acting directly on the kidneys to reabsorb pure
water?
A) Aldosterone
B) Atrial Natriuretic Peptide (ANP)
C) Antidiuretic Hormone (ADH)
D) Renin
Answer: C) Antidiuretic Hormone (ADH)
Rationale: Antidiuretic Hormone (ADH), or vasopressin, acts on the collecting ducts
of the kidneys to increase water reabsorption, concentrating the urine and diluting
the plasma back to normal osmolality.
Question 11: A patient's laboratory values reveal a serum potassium level of 6.5
mEq/L. The nurse should immediately prioritize monitoring for which clinical
manifestation?
A) Decreased deep tendon reflexes
B) Prolonged QT interval and hyporeflexia
C) Severe skeletal muscle hypertrophy
D) Lethal cardiac dysrhythmias
Answer: D) Lethal cardiac dysrhythmias
Rationale: Hyperkalemia alters the resting membrane potential of cardiac muscle
cells, making them hyperexcitable. This can lead to fatal arrhythmias, including tall
peaked T-waves, ventricular fibrillation, or cardiac arrest.
Question 12: A patient has been diagnosed with hypoparathyroidism, resulting in a
dangerously low serum calcium level. Which clinical signs would confirm
hypocalcemia?
A) Positive Chvostek and Trousseau signs
B) Negative Babinski and Romberg signs
C) Hypertrophic cardiomyopathy and polyuria
D) Decreased deep tendon reflexes and bradycardia
Answer: A) Positive Chvostek and Trousseau signs
Rationale: Hypocalcemia increases neuromuscular excitability. A positive Chvostek
sign (facial muscle twitching when the facial nerve is tapped) and a positive
Trousseau sign (carpopedal spasm induced by inflating a blood pressure cuff) are
classic indicators.
Question 13: An arterial blood gas (ABG) report shows: pH 7.28, PaCO₂ 55 mmHg,
and HCO₃⁻ 24 mEq/L. Which acid-base imbalance is present?
A) Metabolic Acidosis
B) Respiratory Acidosis
C) Respiratory Alkalosis
D) Metabolic Alkalosis
Answer: B) Respiratory Acidosis
Rationale: The pH is acidic (< 7.35). The PaCO₂ is elevated (> 45 mmHg), which
accounts for the acidity, while the HCO₃⁻ is within normal limits (22–26 mEq/L). This
points directly to an uncompensated respiratory acidosis, typical of hypoventilation.
4|Page
Pathophysiology Final Exam Review Guide
with Questions and Well Graded Solutions
with Rationales Updated 2026-2027
Master your NR283 Pathophysiology Final Exam with this comprehensive review guide
tailored for Chamberlain University and top BSN programs. Features high-yield
multiple-choice practice questions covering cellular injury, fluid/electrolytes,
cardiovascular, renal, and endocrine alterations. Each question includes the correct
answer and a detailed rationale to build critical NCLEX-style thinking. Perfect for
boosting your EdApt modules, unit exams, and securing an A on your final HESI
proctored test
Unit 1: Cellular Alterations, Fluid & Electrolytes, and
Inflammation (Questions 1-25)
1|Page
,Question 1: A patient with chronic hypertension exhibits an enlarged left ventricle on
an echocardiogram. This adaptive cellular change is best described as:
A) Hyperplasia
B) Atrophy
C) Hypertrophy
D) Metaplasia
Answer: C) Hypertrophy
Rationale: Hypertrophy is an increase in the size of individual cells, common in
cardiac and skeletal muscle tissue when subjected to an increased workload, such
as high blood pressure.
Question 2: Which adaptive cellular change is characterized by the replacement of
one mature cell type by another mature cell type, often seen in the airways of chronic
smokers?
A) Dysplasia
B) Metaplasia
C) Anaplasia
D) Hyperplasia
Answer: B) Metaplasia
Rationale: Metaplasia is a reversible change where one mature cell type is replaced
by a different mature cell type that is better able to withstand chronic irritation, such
as ciliated columnar epithelium changing to stratified squamous epithelium in
smokers.
Question 3: A biopsy of a cervical lesion reveals cells that vary abnormally in size,
shape, and organization. The nurse recognizes this precancerous cellular alteration
as:
A) Atrophy
B) Metaplasia
C) Hypertrophy
D) Dysplasia
Answer: D) Dysplasia
Rationale: Dysplasia refers to disordered and abnormal cellular growth with
variations in cell size, shape, and organization. It is strongly associated with
precancerous progression and requires clinical monitoring.
Question 4: Which form of cell death involves programmed, orderly self-destruction
without causing an inflammatory response in surrounding tissues?
A) Coagulative necrosis
B) Liquefactive necrosis
C) Apoptosis
D) Caseous necrosis
Answer: C) Apoptosis
Rationale: Apoptosis is genetically programmed cell death that safely removes old or
damaged cells. Because the cellular contents do not leak out into the extracellular
matrix, it does not trigger an inflammatory response.
Question 5: A patient suffers a severe myocardial infarction due to a prolonged lack
of oxygen supply. This irreversible cell death triggered by hypoxic injury is known as:
A) Apoptosis
B) Necrosis
C) Autophagy
2|Page
,D) Atrophy
Answer: B) Necrosis
Rationale: Necrosis is pathological, unprogrammed cell death resulting from severe
acute injury, ischemia, or toxins. It causes cell swelling, membrane rupture, and
triggers inflammation in the surrounding tissue.
Question 6: Which type of necrosis is uniquely characteristic of tuberculosis
infections in the lungs, presenting with a grayish-white, "cheesy" appearance?
A) Liquefactive necrosis
B) Caseous necrosis
C) Coagulative necrosis
D) Fat necrosis
Answer: B) Caseous necrosis
Rationale: Caseous necrosis occurs most commonly in tuberculosis infections. Dead
cells disintegrate but are not completely digested, leaving a soft, crumbly, cheese-
like debris enclosed by a granuloma.
Question 7: During acute cellular swelling (hydropic degeneration) caused by
hypoxia, what is the primary mechanism responsible for the accumulation of water
inside the cell?
A) Increased production of cellular ATP
B) Failure of the ATP-driven sodium-potassium pump
C) Excessive influx of extracellular potassium
D) Rapid efflux of sodium ions
Answer: B) Failure of the ATP-driven sodium-potassium pump
Rationale: Hypoxia impairs aerobic respiration, leading to a drop in ATP production.
Without ATP, the sodium-potassium (Na⁺/K⁺) pump fails, causing sodium to build up
inside the cell. Water follows sodium osmotically, resulting in cellular swelling.
Question 8: A patient is admitted with a serum sodium level of 118 mEq/L. Which
pathophysiological shift occurs regarding fluid movement between body
compartments?
A) Water shifts from the intracellular space to the extracellular space
B) Water shifts from the extracellular space into the intracellular cells
C) Fluid shifts completely out of the vascular compartment into the lymphatic system
D) Hydrostatic pressure increases, forcing protein into the interstitial spaces
Answer: B) Water shifts from the extracellular space into the intracellular cells
Rationale: Severe hyponatremia renders the extracellular fluid hypotonic compared
to the intracellular environment. Water moves osmotically from the lower
concentration area (blood vessels) to the higher concentration area inside the cells,
causing brain swelling and neurological symptoms.
Question 9: A patient presents with generalized edema. The nurse understands that
a decrease in which of the following forces most commonly causes fluid to escape
into the interstitial spaces?
A) Capillary hydrostatic pressure
B) Interstitial hydrostatic pressure
C) Plasma oncotic pressure
D) Tissue osmotic pressure
Answer: C) Plasma oncotic pressure
Rationale: Plasma oncotic (colloid osmotic) pressure is generated primarily by
albumin, which keeps fluid inside blood vessels. A decrease in plasma proteins (due
3|Page
, to malnutrition, liver failure, or nephrotic syndrome) reduces this pulling force,
causing systemic edema.
Question 10: Which hormone is released by the posterior pituitary gland in response
to increased plasma osmolality, acting directly on the kidneys to reabsorb pure
water?
A) Aldosterone
B) Atrial Natriuretic Peptide (ANP)
C) Antidiuretic Hormone (ADH)
D) Renin
Answer: C) Antidiuretic Hormone (ADH)
Rationale: Antidiuretic Hormone (ADH), or vasopressin, acts on the collecting ducts
of the kidneys to increase water reabsorption, concentrating the urine and diluting
the plasma back to normal osmolality.
Question 11: A patient's laboratory values reveal a serum potassium level of 6.5
mEq/L. The nurse should immediately prioritize monitoring for which clinical
manifestation?
A) Decreased deep tendon reflexes
B) Prolonged QT interval and hyporeflexia
C) Severe skeletal muscle hypertrophy
D) Lethal cardiac dysrhythmias
Answer: D) Lethal cardiac dysrhythmias
Rationale: Hyperkalemia alters the resting membrane potential of cardiac muscle
cells, making them hyperexcitable. This can lead to fatal arrhythmias, including tall
peaked T-waves, ventricular fibrillation, or cardiac arrest.
Question 12: A patient has been diagnosed with hypoparathyroidism, resulting in a
dangerously low serum calcium level. Which clinical signs would confirm
hypocalcemia?
A) Positive Chvostek and Trousseau signs
B) Negative Babinski and Romberg signs
C) Hypertrophic cardiomyopathy and polyuria
D) Decreased deep tendon reflexes and bradycardia
Answer: A) Positive Chvostek and Trousseau signs
Rationale: Hypocalcemia increases neuromuscular excitability. A positive Chvostek
sign (facial muscle twitching when the facial nerve is tapped) and a positive
Trousseau sign (carpopedal spasm induced by inflating a blood pressure cuff) are
classic indicators.
Question 13: An arterial blood gas (ABG) report shows: pH 7.28, PaCO₂ 55 mmHg,
and HCO₃⁻ 24 mEq/L. Which acid-base imbalance is present?
A) Metabolic Acidosis
B) Respiratory Acidosis
C) Respiratory Alkalosis
D) Metabolic Alkalosis
Answer: B) Respiratory Acidosis
Rationale: The pH is acidic (< 7.35). The PaCO₂ is elevated (> 45 mmHg), which
accounts for the acidity, while the HCO₃⁻ is within normal limits (22–26 mEq/L). This
points directly to an uncompensated respiratory acidosis, typical of hypoventilation.
4|Page
