Chamberlain NR283 Pathophysiology Exam
1 2 3 & Final Exam Test Bank Questions and
Well Graded Solutions with Rationales
Updated 2026-2027
Ace your Pathophysiology exams with this ultimate NR283 comprehensive study bank! This
document features highly targeted, nursing-style multiple-choice questions covering Exam 1,
Exam 2, Exam 3, and the cumulative Final Exam. Each question includes accurate answer
highlights and detailed clinical rationales. Master complex topics like cellular adaptations,
fluid/electrolyte shifts, acid-base balance, cardiovascular defects, renal failure, and endocrine
disorders. Perfect for active recall!
1|Page
, Exam 1: Cellular, Fluid, Electrolyte, & Immune Pathologies
1. A patient presents with a history of chronic smoking, which has caused the ciliated
columnar epithelial cells of the airways to be replaced by stratified squamous
epithelial cells. What is this cellular adaptation called?
a) Atrophy
b) Hypertrophy
c) Dysplasia
d) Metaplasia
Answer: d) Metaplasia
Rationale: Metaplasia is the reversible replacement of one mature cell type by
another mature cell type, usually in response to chronic irritation or stress.
2. A tissue biopsy from a patient’s cervix reveals cells that vary abnormally in size,
shape, and organization. The pathologist notes these changes are precancerous.
How should the nurse document this finding?
a) Hyperplasia
b) Dysplasia
c) Metaplasia
d) Anaplasia
Answer: b) Dysplasia
Rationale: Dysplasia refers to abnormal changes in cell size, shape, and
organization. It is often a precursor to malignancy but is not yet true cancer.
3. A patient with severe coronary artery disease experiences a myocardial infarction.
Hypoxia leads to a decrease in cellular ATP production. Which consequence occurs
first?
a) Influx of calcium into the mitochondria
b) Failure of the sodium-potassium pump causing intracellular swelling
c) Release of lysosomal enzymes into the cytoplasm
d) Cellular shrinkage and dehydration
Answer: b) Failure of the sodium-potassium pump causing intracellular
swelling
Rationale: Decreased ATP causes the sodium-potassium pump to fail. Sodium
accumulates inside the cell, pulling water with it, which leads to acute cellular
swelling.
4. During a surgical procedure, a patient's arterial blood gas (ABG) results are: pH
7.28, PaCO2 55 mmHg, and HCO3 24 mEq/L. How does the nurse interpret these
findings?
a) Metabolic acidosis
b) Respiratory alkalosis
c) Respiratory acidosis
d) Metabolic alkalosis
Answer: c) Respiratory acidosis
Rationale: A pH below 7.35 indicates acidosis. An elevated PaCO2 (above 45
mmHg) with a normal bicarbonate level points directly to a respiratory origin.
5. A patient with a history of severe persistent asthma has the following ABG results:
pH 7.50, PaCO2 28 mmHg, and HCO3 22 mEq/L. What is the primary cause of this
imbalance?
a) Hypoventilation
b) Hyperventilation
c) Retaining bicarbonate
2|Page
, d) Excessive acid ingestion
Answer: b) Hyperventilation
Rationale: The pH is high (alkalosis) and the PaCO2 is low (hypocapnia).
Hyperventilation causes excessive blowing off of CO2, leading to respiratory
alkalosis.
6. A patient presents with severe muscle weakness, fatigue, and an abnormal
electrocardiogram (ECG) showing prominent U waves. Which electrolyte imbalance
does the nurse suspect?
a) Hyperkalemia
b) Hyponatremia
c) Hypokalemia
d) Hypercalcemia
Answer: c) Hypokalemia
Rationale: Hypokalemia (low potassium) lowers the resting membrane potential,
leading to muscle weakness, a prolonged PR interval, and characteristic prominent
U waves on an ECG.
7. A nurse is evaluating an ECG strip for a patient with an elevated serum potassium
level of 6.5 mEq/L. Which cardiac manifestation is most typical for this condition?
a) Tall, peaked T waves
b) Prolonged QT interval
c) ST-segment depression
d) Inverted P waves
Answer: a) Tall, peaked T waves
Rationale: Hyperkalemia alters cardiac conductivity and repolarization, which
manifests classically as narrow, tall, peaked T waves on an ECG.
8. A patient with advanced liver failure presents with ascites and significant lower
extremity pitting edema. What is the primary mechanism behind this fluid
accumulation?
a) Increased capillary hydrostatic pressure
b) Decreased capillary oncotic pressure
c) Increased interstitial oncotic pressure
d) Decreased lymphatic drainage
Answer: b) Decreased capillary oncotic pressure
Rationale: The liver produces albumin. In liver failure, albumin synthesis drops,
lowering capillary oncotic pressure and reducing the vascular pull needed to keep
fluid inside the bloodstream.
9. A patient is admitted with severe dehydration due to prolonged vomiting. The lab
report shows a serum sodium level of 152 mEq/L. Which cellular event will occur as
a result of this imbalance?
a) Cells will swell as water rushes inside
b) Water will shift out of the cells, causing intracellular dehydration
c) Potassium will rush out of the cell to balance the charge
d) Sodium will move freely into the cells down its gradient
Answer: b) Water will shift out of the cells, causing intracellular dehydration
Rationale: Hypernatremia creates a hypertonic extracellular environment, pulling
water out of the intracellular compartment via osmosis and causing cells to shrink.
10. A patient accidentally steps on a rusty nail. Within hours, the foot becomes red,
warm, swollen, and painful. What type of immunity is driving this rapid, non-specific
response?
a) Adaptive immunity
3|Page
, b) Innate immunity
c) Active artificial immunity
d) Passive natural immunity
Answer: b) Innate immunity
Rationale: Innate immunity provides an immediate, non-specific response to injury or
pathogens through mechanisms like inflammation, requiring no prior exposure.
11. During an acute inflammatory response, which cell type arrives first at the site of
injury to phagocytize invading microorganisms?
a) Macrophages
b) Monocytes
c) Lymphocytes
d) Neutrophils
Answer: d) Neutrophils
Rationale: Neutrophils are the primary, first-responding white blood cells during
acute inflammation, arriving within hours to destroy pathogens.
12. A patient experiences a severe allergic reaction to penicillin, manifesting as
bronchospasm and urticaria. Which immunoglobulin mediates this type I
hypersensitivity reaction?
a) IgG
b) IgM
c) IgA
d) IgE
Answer: d) IgE
Rationale: Type I hypersensitivity reactions are mediated by IgE antibodies, which
bind to mast cells and basophils, triggering histamine release.
13. A patient with Type 1 Diabetes Mellitus presents with deep, rapid respirations known
as Kussmaul breathing. What is the underlying pathophysiological purpose of this
respiratory pattern?
a) To retain carbon dioxide to treat alkalosis
b) To blow off carbon dioxide to compensate for metabolic acidosis
c) To increase oxygen intake to treat hypoxemia
d) To clear secretions from the alveolar spaces
Answer: b) To blow off carbon dioxide to compensate for metabolic acidosis
Rationale: Diabetic ketoacidosis creates a metabolic acidosis. The respiratory
system attempts to compensate by hyperventilating (Kussmaul breathing) to reduce
CO2 (an acid).
14. A biopsy of a tumor reveals cells that are poorly differentiated, display marked
pleomorphism, and are actively invading surrounding connective tissue. How should
this tumor be classified?
a) Benign
b) Carcinoma in situ
c) Malignant
d) Hyperplastic
Answer: c) Malignant
Rationale: Malignant tumors are characterized by poor differentiation (anaplasia),
rapid growth, cellular variation (pleomorphism), and the ability to invade surrounding
tissues.
15. A child is diagnosed with Cystic Fibrosis, an autosomal recessive disorder. Both
parents are asymptomatic carriers. What is the mathematical probability that their
next child will inherit the disease?
4|Page
1 2 3 & Final Exam Test Bank Questions and
Well Graded Solutions with Rationales
Updated 2026-2027
Ace your Pathophysiology exams with this ultimate NR283 comprehensive study bank! This
document features highly targeted, nursing-style multiple-choice questions covering Exam 1,
Exam 2, Exam 3, and the cumulative Final Exam. Each question includes accurate answer
highlights and detailed clinical rationales. Master complex topics like cellular adaptations,
fluid/electrolyte shifts, acid-base balance, cardiovascular defects, renal failure, and endocrine
disorders. Perfect for active recall!
1|Page
, Exam 1: Cellular, Fluid, Electrolyte, & Immune Pathologies
1. A patient presents with a history of chronic smoking, which has caused the ciliated
columnar epithelial cells of the airways to be replaced by stratified squamous
epithelial cells. What is this cellular adaptation called?
a) Atrophy
b) Hypertrophy
c) Dysplasia
d) Metaplasia
Answer: d) Metaplasia
Rationale: Metaplasia is the reversible replacement of one mature cell type by
another mature cell type, usually in response to chronic irritation or stress.
2. A tissue biopsy from a patient’s cervix reveals cells that vary abnormally in size,
shape, and organization. The pathologist notes these changes are precancerous.
How should the nurse document this finding?
a) Hyperplasia
b) Dysplasia
c) Metaplasia
d) Anaplasia
Answer: b) Dysplasia
Rationale: Dysplasia refers to abnormal changes in cell size, shape, and
organization. It is often a precursor to malignancy but is not yet true cancer.
3. A patient with severe coronary artery disease experiences a myocardial infarction.
Hypoxia leads to a decrease in cellular ATP production. Which consequence occurs
first?
a) Influx of calcium into the mitochondria
b) Failure of the sodium-potassium pump causing intracellular swelling
c) Release of lysosomal enzymes into the cytoplasm
d) Cellular shrinkage and dehydration
Answer: b) Failure of the sodium-potassium pump causing intracellular
swelling
Rationale: Decreased ATP causes the sodium-potassium pump to fail. Sodium
accumulates inside the cell, pulling water with it, which leads to acute cellular
swelling.
4. During a surgical procedure, a patient's arterial blood gas (ABG) results are: pH
7.28, PaCO2 55 mmHg, and HCO3 24 mEq/L. How does the nurse interpret these
findings?
a) Metabolic acidosis
b) Respiratory alkalosis
c) Respiratory acidosis
d) Metabolic alkalosis
Answer: c) Respiratory acidosis
Rationale: A pH below 7.35 indicates acidosis. An elevated PaCO2 (above 45
mmHg) with a normal bicarbonate level points directly to a respiratory origin.
5. A patient with a history of severe persistent asthma has the following ABG results:
pH 7.50, PaCO2 28 mmHg, and HCO3 22 mEq/L. What is the primary cause of this
imbalance?
a) Hypoventilation
b) Hyperventilation
c) Retaining bicarbonate
2|Page
, d) Excessive acid ingestion
Answer: b) Hyperventilation
Rationale: The pH is high (alkalosis) and the PaCO2 is low (hypocapnia).
Hyperventilation causes excessive blowing off of CO2, leading to respiratory
alkalosis.
6. A patient presents with severe muscle weakness, fatigue, and an abnormal
electrocardiogram (ECG) showing prominent U waves. Which electrolyte imbalance
does the nurse suspect?
a) Hyperkalemia
b) Hyponatremia
c) Hypokalemia
d) Hypercalcemia
Answer: c) Hypokalemia
Rationale: Hypokalemia (low potassium) lowers the resting membrane potential,
leading to muscle weakness, a prolonged PR interval, and characteristic prominent
U waves on an ECG.
7. A nurse is evaluating an ECG strip for a patient with an elevated serum potassium
level of 6.5 mEq/L. Which cardiac manifestation is most typical for this condition?
a) Tall, peaked T waves
b) Prolonged QT interval
c) ST-segment depression
d) Inverted P waves
Answer: a) Tall, peaked T waves
Rationale: Hyperkalemia alters cardiac conductivity and repolarization, which
manifests classically as narrow, tall, peaked T waves on an ECG.
8. A patient with advanced liver failure presents with ascites and significant lower
extremity pitting edema. What is the primary mechanism behind this fluid
accumulation?
a) Increased capillary hydrostatic pressure
b) Decreased capillary oncotic pressure
c) Increased interstitial oncotic pressure
d) Decreased lymphatic drainage
Answer: b) Decreased capillary oncotic pressure
Rationale: The liver produces albumin. In liver failure, albumin synthesis drops,
lowering capillary oncotic pressure and reducing the vascular pull needed to keep
fluid inside the bloodstream.
9. A patient is admitted with severe dehydration due to prolonged vomiting. The lab
report shows a serum sodium level of 152 mEq/L. Which cellular event will occur as
a result of this imbalance?
a) Cells will swell as water rushes inside
b) Water will shift out of the cells, causing intracellular dehydration
c) Potassium will rush out of the cell to balance the charge
d) Sodium will move freely into the cells down its gradient
Answer: b) Water will shift out of the cells, causing intracellular dehydration
Rationale: Hypernatremia creates a hypertonic extracellular environment, pulling
water out of the intracellular compartment via osmosis and causing cells to shrink.
10. A patient accidentally steps on a rusty nail. Within hours, the foot becomes red,
warm, swollen, and painful. What type of immunity is driving this rapid, non-specific
response?
a) Adaptive immunity
3|Page
, b) Innate immunity
c) Active artificial immunity
d) Passive natural immunity
Answer: b) Innate immunity
Rationale: Innate immunity provides an immediate, non-specific response to injury or
pathogens through mechanisms like inflammation, requiring no prior exposure.
11. During an acute inflammatory response, which cell type arrives first at the site of
injury to phagocytize invading microorganisms?
a) Macrophages
b) Monocytes
c) Lymphocytes
d) Neutrophils
Answer: d) Neutrophils
Rationale: Neutrophils are the primary, first-responding white blood cells during
acute inflammation, arriving within hours to destroy pathogens.
12. A patient experiences a severe allergic reaction to penicillin, manifesting as
bronchospasm and urticaria. Which immunoglobulin mediates this type I
hypersensitivity reaction?
a) IgG
b) IgM
c) IgA
d) IgE
Answer: d) IgE
Rationale: Type I hypersensitivity reactions are mediated by IgE antibodies, which
bind to mast cells and basophils, triggering histamine release.
13. A patient with Type 1 Diabetes Mellitus presents with deep, rapid respirations known
as Kussmaul breathing. What is the underlying pathophysiological purpose of this
respiratory pattern?
a) To retain carbon dioxide to treat alkalosis
b) To blow off carbon dioxide to compensate for metabolic acidosis
c) To increase oxygen intake to treat hypoxemia
d) To clear secretions from the alveolar spaces
Answer: b) To blow off carbon dioxide to compensate for metabolic acidosis
Rationale: Diabetic ketoacidosis creates a metabolic acidosis. The respiratory
system attempts to compensate by hyperventilating (Kussmaul breathing) to reduce
CO2 (an acid).
14. A biopsy of a tumor reveals cells that are poorly differentiated, display marked
pleomorphism, and are actively invading surrounding connective tissue. How should
this tumor be classified?
a) Benign
b) Carcinoma in situ
c) Malignant
d) Hyperplastic
Answer: c) Malignant
Rationale: Malignant tumors are characterized by poor differentiation (anaplasia),
rapid growth, cellular variation (pleomorphism), and the ability to invade surrounding
tissues.
15. A child is diagnosed with Cystic Fibrosis, an autosomal recessive disorder. Both
parents are asymptomatic carriers. What is the mathematical probability that their
next child will inherit the disease?
4|Page
