NSG 5140 | Midterm Exam: Advanced
Pathophysiology —Exam Newest Version 2026
Question -And Correct Answers.
This practice exam is designed based on the typical curriculum for NSG 5140 Advanced
Pathophysiology, a graduate-level course for advanced practice nursing students. The
focus is on exploring pathophysiologic conditions across the lifespan, cellular changes,
systems-level manifestations, and clinical implications .
Question 1: Cellular Adaptation & Injury
A 65-year-old patient with chronic heart failure presents with peripheral edema
and shortness of breath. Which cellular adaptation is most likely occurring in the
cardiac muscle cells in response to the chronic pressure overload?
A) Hyperplasia
B) Metaplasia
C) Hypertrophy
D) Dysplasia
Correct Answer: C
Hypertrophy is an increase in cell size, which occurs in response to increased workload or
mechanical stress. In chronic heart failure, the cardiac muscle cells enlarge to generate
greater contractile force, though this adaptation is ultimately maladaptive and can lead to
cellular dysfunction. Hyperplasia is an increase in cell number and is more common in
,epithelial cells. Metaplasia is a reversible replacement of one cell type by another.
Dysplasia involves abnormal changes in cell size, shape, and organization.
Question 2: Genetics & Molecular Biology
A 45-year-old woman is found to have a mutation in the BRCA1 gene. Which
pathophysiological mechanism is most directly associated with this mutation?
A) Impaired DNA repair mechanisms leading to increased risk of breast and ovarian
cancers
B) Overproduction of growth hormone causing acromegaly
C) Defective chloride channel transport causing cystic fibrosis
D) Abnormal hemoglobin structure causing sickle cell disease
Correct Answer: A
BRCA1 is a tumor suppressor gene that plays a critical role in DNA damage repair through
homologous recombination. Mutations in this gene lead to genomic instability and
significantly increase the risk of breast, ovarian, and other cancers. This represents a loss-
of-function mutation in a tumor suppressor pathway.
Question 3: Immunology & Hypersensitivity
A patient with a history of penicillin allergy develops hives, angioedema, and
hypotension within minutes of receiving a dose of amoxicillin. This reaction is
classified as which type of hypersensitivity?
,A) Type I (IgE-mediated)
B) Type II (Cytotoxic)
C) Type III (Immune complex-mediated)
D) Type IV (Cell-mediated)
Correct Answer: A
Type I hypersensitivity reactions are immediate, IgE-mediated responses to allergens. Mast
cell degranulation releases histamine and other inflammatory mediators, causing
vasodilation, bronchoconstriction, and anaphylaxis. This reaction occurs within minutes of
exposure. Type II involves antibody-mediated cell destruction; Type III involves immune
complex deposition; Type IV is a delayed T-cell mediated response.
Question 4: Inflammation & Tissue Repair
In the early stages of acute inflammation, which cellular event is primarily
responsible for the "heat" and "redness" observed at the site of injury?
A) Neutrophil chemotaxis
B) Vasodilation mediated by histamine and prostaglandins
C) Macrophage phagocytosis
D) Fibroblast proliferation
Correct Answer: B
Vasodilation (widening of blood vessels) increases blood flow to the injured area, causing
redness (rubor) and heat (calor). This is mediated by chemical mediators such as
histamine, prostaglandins, and bradykinin. This increased blood flow also facilitates the
delivery of leukocytes and plasma proteins to the site of injury.
, Question 5: Fluid & Electrolyte Imbalance
A 72-year-old patient with congestive heart failure is admitted with severe
hyponatremia (serum sodium 118 mEq/L). The patient is lethargic and confused.
What is the most likely underlying pathophysiological mechanism?
A) Increased aldosterone secretion causing sodium retention
B) Syndrome of Inappropriate Antidiuretic Hormone (SIADH) leading to water retention
C) Excessive sodium loss via diuretic therapy
D) Hyperglycemia causing pseudohyponatremia
Correct Answer: B
SIADH results in excessive antidiuretic hormone (ADH) release, causing water retention
and dilutional hyponatremia. The expansion of extracellular fluid volume leads to cerebral
edema, which manifests as confusion, lethargy, and in severe cases, seizures or coma. In
heart failure, impaired cardiac output can stimulate ADH release as a compensatory
mechanism.
Question 6: Alterations in Acid-Base Balance
A patient with a 20-year history of type 1 diabetes mellitus is admitted with
nausea, vomiting, and deep, rapid respirations (Kussmaul respirations). Arterial
blood gas reveals pH 7.20, HCO₃⁻ 12 mEq/L, and PaCO₂ 28 mmHg. This pattern is
consistent with which acid-base disorder?
A) Metabolic acidosis with respiratory compensation
B) Respiratory acidosis with metabolic compensation
Pathophysiology —Exam Newest Version 2026
Question -And Correct Answers.
This practice exam is designed based on the typical curriculum for NSG 5140 Advanced
Pathophysiology, a graduate-level course for advanced practice nursing students. The
focus is on exploring pathophysiologic conditions across the lifespan, cellular changes,
systems-level manifestations, and clinical implications .
Question 1: Cellular Adaptation & Injury
A 65-year-old patient with chronic heart failure presents with peripheral edema
and shortness of breath. Which cellular adaptation is most likely occurring in the
cardiac muscle cells in response to the chronic pressure overload?
A) Hyperplasia
B) Metaplasia
C) Hypertrophy
D) Dysplasia
Correct Answer: C
Hypertrophy is an increase in cell size, which occurs in response to increased workload or
mechanical stress. In chronic heart failure, the cardiac muscle cells enlarge to generate
greater contractile force, though this adaptation is ultimately maladaptive and can lead to
cellular dysfunction. Hyperplasia is an increase in cell number and is more common in
,epithelial cells. Metaplasia is a reversible replacement of one cell type by another.
Dysplasia involves abnormal changes in cell size, shape, and organization.
Question 2: Genetics & Molecular Biology
A 45-year-old woman is found to have a mutation in the BRCA1 gene. Which
pathophysiological mechanism is most directly associated with this mutation?
A) Impaired DNA repair mechanisms leading to increased risk of breast and ovarian
cancers
B) Overproduction of growth hormone causing acromegaly
C) Defective chloride channel transport causing cystic fibrosis
D) Abnormal hemoglobin structure causing sickle cell disease
Correct Answer: A
BRCA1 is a tumor suppressor gene that plays a critical role in DNA damage repair through
homologous recombination. Mutations in this gene lead to genomic instability and
significantly increase the risk of breast, ovarian, and other cancers. This represents a loss-
of-function mutation in a tumor suppressor pathway.
Question 3: Immunology & Hypersensitivity
A patient with a history of penicillin allergy develops hives, angioedema, and
hypotension within minutes of receiving a dose of amoxicillin. This reaction is
classified as which type of hypersensitivity?
,A) Type I (IgE-mediated)
B) Type II (Cytotoxic)
C) Type III (Immune complex-mediated)
D) Type IV (Cell-mediated)
Correct Answer: A
Type I hypersensitivity reactions are immediate, IgE-mediated responses to allergens. Mast
cell degranulation releases histamine and other inflammatory mediators, causing
vasodilation, bronchoconstriction, and anaphylaxis. This reaction occurs within minutes of
exposure. Type II involves antibody-mediated cell destruction; Type III involves immune
complex deposition; Type IV is a delayed T-cell mediated response.
Question 4: Inflammation & Tissue Repair
In the early stages of acute inflammation, which cellular event is primarily
responsible for the "heat" and "redness" observed at the site of injury?
A) Neutrophil chemotaxis
B) Vasodilation mediated by histamine and prostaglandins
C) Macrophage phagocytosis
D) Fibroblast proliferation
Correct Answer: B
Vasodilation (widening of blood vessels) increases blood flow to the injured area, causing
redness (rubor) and heat (calor). This is mediated by chemical mediators such as
histamine, prostaglandins, and bradykinin. This increased blood flow also facilitates the
delivery of leukocytes and plasma proteins to the site of injury.
, Question 5: Fluid & Electrolyte Imbalance
A 72-year-old patient with congestive heart failure is admitted with severe
hyponatremia (serum sodium 118 mEq/L). The patient is lethargic and confused.
What is the most likely underlying pathophysiological mechanism?
A) Increased aldosterone secretion causing sodium retention
B) Syndrome of Inappropriate Antidiuretic Hormone (SIADH) leading to water retention
C) Excessive sodium loss via diuretic therapy
D) Hyperglycemia causing pseudohyponatremia
Correct Answer: B
SIADH results in excessive antidiuretic hormone (ADH) release, causing water retention
and dilutional hyponatremia. The expansion of extracellular fluid volume leads to cerebral
edema, which manifests as confusion, lethargy, and in severe cases, seizures or coma. In
heart failure, impaired cardiac output can stimulate ADH release as a compensatory
mechanism.
Question 6: Alterations in Acid-Base Balance
A patient with a 20-year history of type 1 diabetes mellitus is admitted with
nausea, vomiting, and deep, rapid respirations (Kussmaul respirations). Arterial
blood gas reveals pH 7.20, HCO₃⁻ 12 mEq/L, and PaCO₂ 28 mmHg. This pattern is
consistent with which acid-base disorder?
A) Metabolic acidosis with respiratory compensation
B) Respiratory acidosis with metabolic compensation
