### Advanced Pathophysiology Nursing Exam
Cycle 2025/2026 | University Prep Notes |
NCLEX-Style Comprehensive Study Pack
**100 Questions with Verified Rationales**
---
**1. A patient presents with severe metabolic acidosis. Which of the following laboratory values would
the nurse expect to see?**
A) Serum bicarbonate of 28 mEq/L and pH of 7.50
B) Serum bicarbonate of 12 mEq/L and pH of 7.25
C) Serum bicarbonate of 24 mEq/L and pH of 7.35
D) Serum bicarbonate of 18 mEq/L and pH of 7.45
🎯CORRECT CHOICE: B
💡EXPLANATION: Metabolic acidosis is characterized by a primary decrease in serum bicarbonate
(HCO3-) and a subsequent decrease in pH. A bicarbonate level of 12 mEq/L (normal 22-26) and a pH of
7.25 (normal 7.35-7.45) are classic findings.
**2. Which of the following is the most common cause of chronic liver disease in the United States?**
A) Hepatitis C infection
B) Alcoholic liver disease
C) Non-alcoholic fatty liver disease (NAFLD)
D) Autoimmune hepatitis
🎯CORRECT CHOICE: C
,💡EXPLANATION: NAFLD has become the leading cause of chronic liver disease in the US, driven by the
increasing prevalence of obesity, metabolic syndrome, and type 2 diabetes mellitus. It encompasses a
spectrum from simple steatosis to non-alcoholic steatohepatitis (NASH) and cirrhosis.
**3. A nurse is reviewing the pathophysiology of type 1 diabetes mellitus. Which of the following
statements accurately describes the underlying mechanism?**
A) Insulin resistance at the cellular receptor level
B) Autoimmune destruction of pancreatic beta cells leading to absolute insulin deficiency
C) Decreased production of glucagon by alpha cells
D) Excessive production of insulin by the pancreas
🎯CORRECT CHOICE: B
💡EXPLANATION: Type 1 diabetes is an autoimmune disease where the body's immune system attacks
and destroys the insulin-producing beta cells in the islets of Langerhans of the pancreas. This results in
an absolute deficiency of insulin, requiring exogenous insulin for survival.
**4. A patient with heart failure develops peripheral edema. This is primarily due to which of the
following mechanisms?**
A) Decreased capillary permeability
B) Increased hydrostatic pressure in the venous circulation
C) Decreased plasma oncotic pressure due to protein loss
D) Increased lymphatic drainage
🎯CORRECT CHOICE: B
💡EXPLANATION: In heart failure, the heart's reduced pumping ability causes blood to back up in the
venous circulation. This increases the hydrostatic pressure within the capillaries, forcing fluid out into
the interstitial space, leading to peripheral edema.
**5. The nurse is caring for a patient with a diagnosis of syndrome of inappropriate antidiuretic
hormone (SIADH). Which of the following electrolyte imbalances is a hallmark of this condition?**
A) Hypernatremia
B) Hyponatremia
C) Hyperkalemia
D) Hypokalemia
,🎯CORRECT CHOICE: B
💡EXPLANATION: SIADH is characterized by excessive release of antidiuretic hormone (ADH), leading to
water retention by the kidneys. This excess water dilutes the sodium in the blood, resulting in dilutional
hyponatremia.
**6. A patient is diagnosed with Graves' disease. Which pathophysiological mechanism is responsible for
this condition?**
A) Autoantibodies stimulate the thyroid-stimulating hormone (TSH) receptor, causing hyperthyroidism
B) Destruction of thyroid follicles by cytotoxic T cells
C) A pituitary adenoma secreting excess TSH
D) Iodine deficiency leading to decreased thyroid hormone production
🎯CORRECT CHOICE: A
💡EXPLANATION: Graves' disease is an autoimmune disorder where thyroid-stimulating
immunoglobulins (TSIs) bind to and activate the TSH receptors on the thyroid gland. This stimulates
excessive thyroid hormone production, independent of normal negative feedback regulation.
**7. A nurse is assessing a patient with chronic obstructive pulmonary disease (COPD). Which of the
following is the primary pathophysiological change?**
A) Reversible airflow limitation due to bronchospasm
B) Airflow limitation that is not fully reversible due to airway inflammation and destruction of lung
parenchyma
C) Restrictive lung disease due to fibrosis
D) Complete obstruction of the upper airway
🎯CORRECT CHOICE: B
💡EXPLANATION: COPD is characterized by chronic, progressive, and irreversible airflow limitation. It
involves a combination of small airway disease (bronchiolitis) and parenchymal destruction
(emphysema), leading to obstruction and gas trapping.
**8. The nurse is reviewing the pathophysiology of acute kidney injury (AKI). Which of the following is a
pre-renal cause of AKI?**
A) Acute tubular necrosis
B) Glomerulonephritis
, C) Severe dehydration
D) Urinary obstruction
🎯CORRECT CHOICE: C
💡EXPLANATION: Pre-renal AKI is caused by decreased renal blood flow, leading to reduced glomerular
filtration. Severe dehydration, hemorrhage, and heart failure are common pre-renal causes that
compromise renal perfusion.
**9. A patient with a history of sickle cell disease experiences a vaso-occlusive crisis. What is the
underlying mechanism for this event?**
A) Deoxygenated hemoglobin S polymerizes, causing red blood cells to become sickle-shaped and
obstruct microcirculation
B) Increased production of normal hemoglobin
C) Destruction of red blood cells by the spleen
D) Deficiency of iron leading to microcytic anemia
🎯CORRECT CHOICE: A
💡EXPLANATION: In sickle cell disease, the abnormal hemoglobin S (HbS) polymerizes when
deoxygenated, distorting the red blood cells into a sickle shape. These rigid, sickled cells aggregate and
occlude small blood vessels, causing ischemia, pain, and tissue damage.
**10. A client is diagnosed with pernicious anemia. Which of the following pathophysiological
mechanisms is responsible?**
A) Lack of intrinsic factor prevents the absorption of vitamin B12
B) Iron deficiency due to poor dietary intake
C) Chronic blood loss from the gastrointestinal tract
D) Destruction of red blood cells by autoantibodies
🎯CORRECT CHOICE: A
💡EXPLANATION: Pernicious anemia is caused by the absence of intrinsic factor, a protein produced by
parietal cells in the stomach that is required for vitamin B12 absorption in the ileum. This leads to a
deficiency of vitamin B12, which is essential for red blood cell maturation.
**11. Which of the following best describes the pathophysiology of a myocardial infarction (MI)?**
A) Plaque rupture with thrombus formation causing complete occlusion of a coronary artery
Cycle 2025/2026 | University Prep Notes |
NCLEX-Style Comprehensive Study Pack
**100 Questions with Verified Rationales**
---
**1. A patient presents with severe metabolic acidosis. Which of the following laboratory values would
the nurse expect to see?**
A) Serum bicarbonate of 28 mEq/L and pH of 7.50
B) Serum bicarbonate of 12 mEq/L and pH of 7.25
C) Serum bicarbonate of 24 mEq/L and pH of 7.35
D) Serum bicarbonate of 18 mEq/L and pH of 7.45
🎯CORRECT CHOICE: B
💡EXPLANATION: Metabolic acidosis is characterized by a primary decrease in serum bicarbonate
(HCO3-) and a subsequent decrease in pH. A bicarbonate level of 12 mEq/L (normal 22-26) and a pH of
7.25 (normal 7.35-7.45) are classic findings.
**2. Which of the following is the most common cause of chronic liver disease in the United States?**
A) Hepatitis C infection
B) Alcoholic liver disease
C) Non-alcoholic fatty liver disease (NAFLD)
D) Autoimmune hepatitis
🎯CORRECT CHOICE: C
,💡EXPLANATION: NAFLD has become the leading cause of chronic liver disease in the US, driven by the
increasing prevalence of obesity, metabolic syndrome, and type 2 diabetes mellitus. It encompasses a
spectrum from simple steatosis to non-alcoholic steatohepatitis (NASH) and cirrhosis.
**3. A nurse is reviewing the pathophysiology of type 1 diabetes mellitus. Which of the following
statements accurately describes the underlying mechanism?**
A) Insulin resistance at the cellular receptor level
B) Autoimmune destruction of pancreatic beta cells leading to absolute insulin deficiency
C) Decreased production of glucagon by alpha cells
D) Excessive production of insulin by the pancreas
🎯CORRECT CHOICE: B
💡EXPLANATION: Type 1 diabetes is an autoimmune disease where the body's immune system attacks
and destroys the insulin-producing beta cells in the islets of Langerhans of the pancreas. This results in
an absolute deficiency of insulin, requiring exogenous insulin for survival.
**4. A patient with heart failure develops peripheral edema. This is primarily due to which of the
following mechanisms?**
A) Decreased capillary permeability
B) Increased hydrostatic pressure in the venous circulation
C) Decreased plasma oncotic pressure due to protein loss
D) Increased lymphatic drainage
🎯CORRECT CHOICE: B
💡EXPLANATION: In heart failure, the heart's reduced pumping ability causes blood to back up in the
venous circulation. This increases the hydrostatic pressure within the capillaries, forcing fluid out into
the interstitial space, leading to peripheral edema.
**5. The nurse is caring for a patient with a diagnosis of syndrome of inappropriate antidiuretic
hormone (SIADH). Which of the following electrolyte imbalances is a hallmark of this condition?**
A) Hypernatremia
B) Hyponatremia
C) Hyperkalemia
D) Hypokalemia
,🎯CORRECT CHOICE: B
💡EXPLANATION: SIADH is characterized by excessive release of antidiuretic hormone (ADH), leading to
water retention by the kidneys. This excess water dilutes the sodium in the blood, resulting in dilutional
hyponatremia.
**6. A patient is diagnosed with Graves' disease. Which pathophysiological mechanism is responsible for
this condition?**
A) Autoantibodies stimulate the thyroid-stimulating hormone (TSH) receptor, causing hyperthyroidism
B) Destruction of thyroid follicles by cytotoxic T cells
C) A pituitary adenoma secreting excess TSH
D) Iodine deficiency leading to decreased thyroid hormone production
🎯CORRECT CHOICE: A
💡EXPLANATION: Graves' disease is an autoimmune disorder where thyroid-stimulating
immunoglobulins (TSIs) bind to and activate the TSH receptors on the thyroid gland. This stimulates
excessive thyroid hormone production, independent of normal negative feedback regulation.
**7. A nurse is assessing a patient with chronic obstructive pulmonary disease (COPD). Which of the
following is the primary pathophysiological change?**
A) Reversible airflow limitation due to bronchospasm
B) Airflow limitation that is not fully reversible due to airway inflammation and destruction of lung
parenchyma
C) Restrictive lung disease due to fibrosis
D) Complete obstruction of the upper airway
🎯CORRECT CHOICE: B
💡EXPLANATION: COPD is characterized by chronic, progressive, and irreversible airflow limitation. It
involves a combination of small airway disease (bronchiolitis) and parenchymal destruction
(emphysema), leading to obstruction and gas trapping.
**8. The nurse is reviewing the pathophysiology of acute kidney injury (AKI). Which of the following is a
pre-renal cause of AKI?**
A) Acute tubular necrosis
B) Glomerulonephritis
, C) Severe dehydration
D) Urinary obstruction
🎯CORRECT CHOICE: C
💡EXPLANATION: Pre-renal AKI is caused by decreased renal blood flow, leading to reduced glomerular
filtration. Severe dehydration, hemorrhage, and heart failure are common pre-renal causes that
compromise renal perfusion.
**9. A patient with a history of sickle cell disease experiences a vaso-occlusive crisis. What is the
underlying mechanism for this event?**
A) Deoxygenated hemoglobin S polymerizes, causing red blood cells to become sickle-shaped and
obstruct microcirculation
B) Increased production of normal hemoglobin
C) Destruction of red blood cells by the spleen
D) Deficiency of iron leading to microcytic anemia
🎯CORRECT CHOICE: A
💡EXPLANATION: In sickle cell disease, the abnormal hemoglobin S (HbS) polymerizes when
deoxygenated, distorting the red blood cells into a sickle shape. These rigid, sickled cells aggregate and
occlude small blood vessels, causing ischemia, pain, and tissue damage.
**10. A client is diagnosed with pernicious anemia. Which of the following pathophysiological
mechanisms is responsible?**
A) Lack of intrinsic factor prevents the absorption of vitamin B12
B) Iron deficiency due to poor dietary intake
C) Chronic blood loss from the gastrointestinal tract
D) Destruction of red blood cells by autoantibodies
🎯CORRECT CHOICE: A
💡EXPLANATION: Pernicious anemia is caused by the absence of intrinsic factor, a protein produced by
parietal cells in the stomach that is required for vitamin B12 absorption in the ileum. This leads to a
deficiency of vitamin B12, which is essential for red blood cell maturation.
**11. Which of the following best describes the pathophysiology of a myocardial infarction (MI)?**
A) Plaque rupture with thrombus formation causing complete occlusion of a coronary artery
