NURS 6501 Advanced Pathophysiology
Final Exam 2026/2027
Question 1. A 58-year-old man with a 20-pack-year smoking history presents with a
chronic cough. Bronchial biopsy reveals replacement of the normal ciliated columnar
epithelium with stratified squamous epithelium. Which cellular adaptation does this
represent?
A. Metaplasia
B. Hyperplasia
C. Atrophy
D. Dysplasia
Correct Answer: B
Rationale: Metaplasia is the reversible replacement of one differentiated cell type with
another, often in response to chronic irritation such as smoking, and is a protective but
potentially precancerous adaptation. Hyperplasia involves increased cell number, dysplasia
involves disordered cell growth, and atrophy involves decreased cell size or number.
Question 2. Which mechanism best explains why cells swell during acute hypoxic injury?
A. Increased protein synthesis
B. Enhanced mitochondrial ATP production
C. Failure of the sodium-potassium ATPase pump leading to intracellular sodium
and water accumulation
D. Decreased membrane permeability
Correct Answer: C
Rationale: Hypoxia reduces ATP production, impairing the sodium-potassium ATPase
pump; sodium then accumulates intracellularly, drawing water in osmotically and causing
cellular swelling, an early and reversible sign of cell injury.
Question 3. A 45-year-old woman presents with fatigue, joint pain, and a malar rash.
Laboratory testing reveals positive antinuclear antibodies and anti-double-stranded DNA
antibodies. Which pathophysiologic process best explains her renal involvement if lupus
nephritis develops?
A. Type III hypersensitivity immune complex deposition in the glomerular basement
membrane
B. Type I hypersensitivity mast cell degranulation
C. Type IV delayed hypersensitivity T-cell mediated destruction
, D. Type II hypersensitivity direct antibody-mediated cytotoxicity
Correct Answer: A
Rationale: Lupus nephritis results from deposition of circulating antigen-antibody immune
complexes in the glomerular basement membrane, triggering complement activation and
inflammation, characteristic of a Type III hypersensitivity reaction.
Question 4. A 3-year-old presents with recurrent sinopulmonary infections and failure to
thrive. Sweat chloride testing is markedly elevated. Which underlying pathophysiologic
defect is responsible for this presentation?
A. Autoimmune destruction of pancreatic beta cells
B. Ciliary dyskinesia due to dynein arm defects
C. Defective CFTR chloride channel causing thick, viscous secretions
D. Deficient alpha-1 antitrypsin production
Correct Answer: C
Rationale: Cystic fibrosis results from mutations in the CFTR gene that impair chloride
transport, leading to thick, dehydrated secretions in the lungs and pancreas, which cause
recurrent infections and malabsorption; the elevated sweat chloride test is diagnostic.
Question 5. A 67-year-old man with a history of atrial fibrillation presents with sudden
left-sided weakness and facial droop. Which pathophysiologic mechanism most likely
caused his stroke?
A. Vasospasm secondary to subarachnoid hemorrhage
B. Cardioembolic occlusion from a thrombus formed in the fibrillating left atrium
C. Hemorrhagic transformation from anticoagulant overdose
D. Thrombotic occlusion from atherosclerotic plaque rupture
Correct Answer: B
Rationale: Atrial fibrillation causes stasis of blood in the left atrial appendage, promoting
thrombus formation; embolization of this thrombus to cerebral vasculature is a common
cause of ischemic stroke in patients with this arrhythmia.
Question 6. Which laboratory finding is most consistent with acute intravascular
hemolysis?
A. Elevated ferritin with low reticulocyte count
B. Isolated elevation of direct bilirubin only
C. Decreased haptoglobin, elevated indirect bilirubin, and hemoglobinuria
D. Elevated haptoglobin and low indirect bilirubin
,Correct Answer: C
Rationale: Intravascular hemolysis releases free hemoglobin into the plasma, which binds
and depletes haptoglobin; the breakdown of hemoglobin also raises indirect bilirubin, and
excess free hemoglobin filtered by the kidneys produces hemoglobinuria.
Question 7. A 72-year-old woman with type 2 diabetes presents with polyuria, confusion,
and a serum glucose of 850 mg/dL without significant ketosis. Which condition best
explains this presentation?
A. Diabetic ketoacidosis
B. Dawn phenomenon
C. Somogyi effect
D. Hyperosmolar hyperglycemic state
Correct Answer: D
Rationale: Hyperosmolar hyperglycemic state typically occurs in type 2 diabetics with
sufficient residual insulin to suppress ketogenesis but not enough to prevent severe
hyperglycemia, leading to profound osmotic diuresis, dehydration, and altered mental
status without significant ketoacidosis.
Question 8. A patient with chronic kidney disease has a serum potassium of 6.8 mEq/L.
Which ECG change would the nurse practitioner expect to see first?
A. Delta wave
B. Prolonged QT interval
C. Pathologic Q waves
D. Peaked T waves
Correct Answer: D
Rationale: Hyperkalemia classically causes peaked, narrow T waves as an early ECG
change due to altered myocardial repolarization; as potassium rises further, PR
prolongation, QRS widening, and eventually a sine-wave pattern can develop.
Question 9. Which acid-base disturbance would be expected in a patient with prolonged
vomiting?
A. Metabolic alkalosis with compensatory respiratory acidosis (hypoventilation)
B. Metabolic acidosis with compensatory respiratory alkalosis
C. Respiratory acidosis with compensatory metabolic alkalosis
D. Respiratory alkalosis with compensatory metabolic acidosis
Correct Answer: A
, Rationale: Loss of hydrochloric acid through vomiting causes metabolic alkalosis; the body
compensates by hypoventilating to retain carbon dioxide, raising PaCO2 and partially
correcting the elevated pH.
Question 10. A 55-year-old man presents with resistant hypertension, hypokalemia, and
metabolic alkalosis. Plasma aldosterone is elevated with suppressed renin. Which diagnosis
is most likely?
A. Secondary hyperaldosteronism from renal artery stenosis
B. Syndrome of inappropriate antidiuretic hormone secretion
C. Primary hyperaldosteronism due to an adrenal adenoma
D. Addison disease
Correct Answer: C
Rationale: Primary hyperaldosteronism, often from an aldosterone-producing adrenal
adenoma, causes autonomous aldosterone secretion that suppresses renin, distinguishing
it from secondary hyperaldosteronism, in which renin is elevated due to a triggering renal
or systemic process.
Question 11. A 40-year-old woman presents with heat intolerance, palpitations, weight loss,
and a fine tremor. TSH is suppressed and free T4 is elevated. Which additional finding would
support a diagnosis of Graves disease specifically?
A. Periorbital edema and bradycardia
B. Exophthalmos and pretibial myxedema
C. Cold intolerance and constipation
D. Elevated TSH with low free T4
Correct Answer: B
Rationale: Graves disease is an autoimmune condition caused by thyroid-stimulating
immunoglobulins, and its extrathyroidal manifestations, including exophthalmos and
pretibial myxedema, distinguish it from other causes of hyperthyroidism, which do not
typically produce these specific findings.
Question 12. Which pathophysiologic process underlies the development of esophageal
varices in a patient with cirrhosis?
A. Decreased portal venous pressure diverting blood to systemic circulation
B. Direct viral invasion of esophageal mucosa
C. Portal hypertension causing collateral vessel formation and dilation in the
esophageal venous plexus
Final Exam 2026/2027
Question 1. A 58-year-old man with a 20-pack-year smoking history presents with a
chronic cough. Bronchial biopsy reveals replacement of the normal ciliated columnar
epithelium with stratified squamous epithelium. Which cellular adaptation does this
represent?
A. Metaplasia
B. Hyperplasia
C. Atrophy
D. Dysplasia
Correct Answer: B
Rationale: Metaplasia is the reversible replacement of one differentiated cell type with
another, often in response to chronic irritation such as smoking, and is a protective but
potentially precancerous adaptation. Hyperplasia involves increased cell number, dysplasia
involves disordered cell growth, and atrophy involves decreased cell size or number.
Question 2. Which mechanism best explains why cells swell during acute hypoxic injury?
A. Increased protein synthesis
B. Enhanced mitochondrial ATP production
C. Failure of the sodium-potassium ATPase pump leading to intracellular sodium
and water accumulation
D. Decreased membrane permeability
Correct Answer: C
Rationale: Hypoxia reduces ATP production, impairing the sodium-potassium ATPase
pump; sodium then accumulates intracellularly, drawing water in osmotically and causing
cellular swelling, an early and reversible sign of cell injury.
Question 3. A 45-year-old woman presents with fatigue, joint pain, and a malar rash.
Laboratory testing reveals positive antinuclear antibodies and anti-double-stranded DNA
antibodies. Which pathophysiologic process best explains her renal involvement if lupus
nephritis develops?
A. Type III hypersensitivity immune complex deposition in the glomerular basement
membrane
B. Type I hypersensitivity mast cell degranulation
C. Type IV delayed hypersensitivity T-cell mediated destruction
, D. Type II hypersensitivity direct antibody-mediated cytotoxicity
Correct Answer: A
Rationale: Lupus nephritis results from deposition of circulating antigen-antibody immune
complexes in the glomerular basement membrane, triggering complement activation and
inflammation, characteristic of a Type III hypersensitivity reaction.
Question 4. A 3-year-old presents with recurrent sinopulmonary infections and failure to
thrive. Sweat chloride testing is markedly elevated. Which underlying pathophysiologic
defect is responsible for this presentation?
A. Autoimmune destruction of pancreatic beta cells
B. Ciliary dyskinesia due to dynein arm defects
C. Defective CFTR chloride channel causing thick, viscous secretions
D. Deficient alpha-1 antitrypsin production
Correct Answer: C
Rationale: Cystic fibrosis results from mutations in the CFTR gene that impair chloride
transport, leading to thick, dehydrated secretions in the lungs and pancreas, which cause
recurrent infections and malabsorption; the elevated sweat chloride test is diagnostic.
Question 5. A 67-year-old man with a history of atrial fibrillation presents with sudden
left-sided weakness and facial droop. Which pathophysiologic mechanism most likely
caused his stroke?
A. Vasospasm secondary to subarachnoid hemorrhage
B. Cardioembolic occlusion from a thrombus formed in the fibrillating left atrium
C. Hemorrhagic transformation from anticoagulant overdose
D. Thrombotic occlusion from atherosclerotic plaque rupture
Correct Answer: B
Rationale: Atrial fibrillation causes stasis of blood in the left atrial appendage, promoting
thrombus formation; embolization of this thrombus to cerebral vasculature is a common
cause of ischemic stroke in patients with this arrhythmia.
Question 6. Which laboratory finding is most consistent with acute intravascular
hemolysis?
A. Elevated ferritin with low reticulocyte count
B. Isolated elevation of direct bilirubin only
C. Decreased haptoglobin, elevated indirect bilirubin, and hemoglobinuria
D. Elevated haptoglobin and low indirect bilirubin
,Correct Answer: C
Rationale: Intravascular hemolysis releases free hemoglobin into the plasma, which binds
and depletes haptoglobin; the breakdown of hemoglobin also raises indirect bilirubin, and
excess free hemoglobin filtered by the kidneys produces hemoglobinuria.
Question 7. A 72-year-old woman with type 2 diabetes presents with polyuria, confusion,
and a serum glucose of 850 mg/dL without significant ketosis. Which condition best
explains this presentation?
A. Diabetic ketoacidosis
B. Dawn phenomenon
C. Somogyi effect
D. Hyperosmolar hyperglycemic state
Correct Answer: D
Rationale: Hyperosmolar hyperglycemic state typically occurs in type 2 diabetics with
sufficient residual insulin to suppress ketogenesis but not enough to prevent severe
hyperglycemia, leading to profound osmotic diuresis, dehydration, and altered mental
status without significant ketoacidosis.
Question 8. A patient with chronic kidney disease has a serum potassium of 6.8 mEq/L.
Which ECG change would the nurse practitioner expect to see first?
A. Delta wave
B. Prolonged QT interval
C. Pathologic Q waves
D. Peaked T waves
Correct Answer: D
Rationale: Hyperkalemia classically causes peaked, narrow T waves as an early ECG
change due to altered myocardial repolarization; as potassium rises further, PR
prolongation, QRS widening, and eventually a sine-wave pattern can develop.
Question 9. Which acid-base disturbance would be expected in a patient with prolonged
vomiting?
A. Metabolic alkalosis with compensatory respiratory acidosis (hypoventilation)
B. Metabolic acidosis with compensatory respiratory alkalosis
C. Respiratory acidosis with compensatory metabolic alkalosis
D. Respiratory alkalosis with compensatory metabolic acidosis
Correct Answer: A
, Rationale: Loss of hydrochloric acid through vomiting causes metabolic alkalosis; the body
compensates by hypoventilating to retain carbon dioxide, raising PaCO2 and partially
correcting the elevated pH.
Question 10. A 55-year-old man presents with resistant hypertension, hypokalemia, and
metabolic alkalosis. Plasma aldosterone is elevated with suppressed renin. Which diagnosis
is most likely?
A. Secondary hyperaldosteronism from renal artery stenosis
B. Syndrome of inappropriate antidiuretic hormone secretion
C. Primary hyperaldosteronism due to an adrenal adenoma
D. Addison disease
Correct Answer: C
Rationale: Primary hyperaldosteronism, often from an aldosterone-producing adrenal
adenoma, causes autonomous aldosterone secretion that suppresses renin, distinguishing
it from secondary hyperaldosteronism, in which renin is elevated due to a triggering renal
or systemic process.
Question 11. A 40-year-old woman presents with heat intolerance, palpitations, weight loss,
and a fine tremor. TSH is suppressed and free T4 is elevated. Which additional finding would
support a diagnosis of Graves disease specifically?
A. Periorbital edema and bradycardia
B. Exophthalmos and pretibial myxedema
C. Cold intolerance and constipation
D. Elevated TSH with low free T4
Correct Answer: B
Rationale: Graves disease is an autoimmune condition caused by thyroid-stimulating
immunoglobulins, and its extrathyroidal manifestations, including exophthalmos and
pretibial myxedema, distinguish it from other causes of hyperthyroidism, which do not
typically produce these specific findings.
Question 12. Which pathophysiologic process underlies the development of esophageal
varices in a patient with cirrhosis?
A. Decreased portal venous pressure diverting blood to systemic circulation
B. Direct viral invasion of esophageal mucosa
C. Portal hypertension causing collateral vessel formation and dilation in the
esophageal venous plexus
