NUR 2063 Exam 1 - Essentials of Pathophysiology Page 1
NUR 2063 Exam 1 - Essentials of Pathophysiology
Comprehensive Review Examination
150 Questions - Detailed Rationales
1. A nurse is reviewing the medical record of a client diagnosed with endometrial hyperplasia. Which of the following
best describes the cellular adaptation occurring?
A. A. A decrease in cell size due to decreased workload
B. B. An increase in the number of cells in response to hormonal stimulation [CORRECT]
C. C. A replacement of one mature cell type by another mature cell type
D. D. Abnormal, disorganized cell growth that is considered precancerous
Correct Answer: B
Rationale: **Correct because** hyperplasia is defined as an increase in the number of cells in an organ or tissue,
commonly occurring in response to hormonal stimulation such as estrogen's effect on the endometrium. This matches the
pathophysiological definition of compensatory or hormonal hyperplasia.
2. A client presents to the emergency department with severe chest pain and is diagnosed with an acute myocardial
infarction. The nurse understands that which type of necrosis is most likely occurring in the affected myocardial
tissue?
A. A. Liquefactive necrosis
B. B. Coagulative necrosis [CORRECT]
C. C. Caseous necrosis
D. D. Fat necrosis
Correct Answer: B
Rationale: **Correct because** coagulative necrosis is the most common form of necrosis and typically results from
ischemic injury, such as that seen in myocardial infarction. The cellular architecture is preserved, creating a firm, pale
tissue appearance. This matches the pathophysiology of hypoxic cell death in the heart.
3. A nurse is caring for a client with a serum sodium level of 125 mEq/L. The client reports headache, confusion, and
muscle cramps. Which of the following nursing interventions is the priority?
A. A. Administer hypertonic saline IV as prescribed
B. B. Restrict free water intake
C. C. Encourage increased oral sodium intake
D. D. Place the client on seizure precautions [CORRECT]
Correct Answer: D
Rationale: **Priority is** ensuring client safety by placing the client on seizure precautions. Severe hyponatremia (serum
sodium less than 130 mEq/L) increases the risk of seizures due to cerebral edema from water shifts into brain cells. This
matches the safety-first approach to electrolyte imbalances.
4. Which of the following immunoglobulins is primarily responsible for mediating Type I hypersensitivity reactions?
A. A. IgG
B. B. IgM
C. C. IgE [CORRECT]
D. D. IgA
Correct Answer: C
,NUR 2063 Exam 1 - Essentials of Pathophysiology Page 2
Rationale: **Correct because** immunoglobulin E (IgE) is the antibody class that binds to mast cells and basophils,
triggering degranulation and the release of histamine and other inflammatory mediators upon re-exposure to an allergen.
This matches the mechanism of immediate hypersensitivity reactions.
5. A nurse is reviewing the pathology report of a client with a malignant tumor. The report indicates that tumor cells
have invaded the lymphatic vessels. The nurse understands that this finding indicates which of the following?
A. A. The tumor is likely benign
B. B. The tumor has undergone anaplasia
C. C. The tumor has the potential for lymphatic spread to distant sites [CORRECT]
D. D. The tumor will remain localized to the primary site
Correct Answer: C
Rationale: **Correct because** invasion of lymphatic vessels by malignant tumor cells indicates the potential for
lymphatic metastasis, which is a key characteristic distinguishing malignant from benign tumors. This matches the
pathophysiological mechanism of tumor spread through the lymphatic system.
6. SCENARIO: A 68-year-old client with chronic obstructive pulmonary disease (COPD) presents to the clinic with
increased dyspnea, confusion, and a morning headache. Arterial blood gas (ABG) results reveal: pH 7.28, PaCO2 58
mmHg, HCO3 32 mEq/L. Which of the following is the correct interpretation of these ABG findings?
A. A. Partially compensated respiratory acidosis [CORRECT]
B. B. Uncompensated respiratory acidosis
C. C. Partially compensated metabolic alkalosis
D. D. Fully compensated respiratory acidosis
Correct Answer: A
Rationale: **Correct because** the pH is below normal (7.28), indicating acidosis. The PaCO2 is elevated (58 mmHg),
indicating a respiratory cause. The HCO3 is elevated (32 mEq/L), indicating renal compensation has begun but the pH
has not yet returned to normal range. This matches the interpretation of partially compensated respiratory acidosis.
7. A nurse is providing care for an older adult client who has been on bed rest for 3 weeks following hip surgery. The
nurse understands that which type of cellular adaptation is occurring in the client's immobilized muscles?
A. A. Hypertrophy
B. B. Hyperplasia
C. C. Atrophy [CORRECT]
D. D. Metaplasia
Correct Answer: C
Rationale: **Correct because** atrophy is a decrease in cell size resulting from reduced workload, disuse, or inadequate
nutrition. Immobilization leads to disuse atrophy of skeletal muscle due to reduced mechanical stimulation and protein
synthesis. This matches the pathophysiology of muscle wasting during prolonged bed rest.
8. A client is receiving furosemide IV for the management of heart failure. Which of the following findings should the
nurse identify as an early indication of hypokalemia?
A. A. Muscle weakness and fatigue [CORRECT]
B. B. Hypertension and bradycardia
C. C. Increased deep tendon reflexes
D. D. Positive Chvostek sign
Correct Answer: A
,NUR 2063 Exam 1 - Essentials of Pathophysiology Page 3
Rationale: **Correct because** loop diuretics such as furosemide increase potassium excretion in the urine, leading to
hypokalemia. Early manifestations include muscle weakness, fatigue, and lethargy due to the role of potassium in
neuromuscular function. This matches the expected clinical presentation of mild to moderate hypokalemia.
9. Which of the following best differentiates apoptosis from necrosis?
A. A. Apoptosis causes inflammation, while necrosis does not
B. B. Apoptosis is a programmed, energy-dependent process that does not trigger inflammation [CORRECT]
C. C. Necrosis is a controlled process that requires ATP
D. D. Apoptosis results from external injury such as hypoxia
Correct Answer: B
Rationale: **Correct because** apoptosis is a genetically programmed, energy-dependent (ATP-requiring) form of
controlled cell death that does not elicit an inflammatory response, unlike necrosis which is uncontrolled cell death that
triggers inflammation. This matches the fundamental pathophysiological distinction between the two processes.
10. A client with hyperparathyroidism has a serum calcium level of 12.8 mg/dL. Which of the following findings
should the nurse anticipate?
A. A. Hypoactive bowel sounds and constipation
B. B. Positive Trousseau sign and laryngospasm
C. C. Polyuria, dehydration, and lethargy [CORRECT]
D. D. Muscle twitching and paresthesias
Correct Answer: C
Rationale: **Correct because** hypercalcemia decreases renal concentrating ability, leading to polyuria and subsequent
dehydration. Elevated calcium also affects the central nervous system, causing lethargy and confusion. This matches the
pathophysiological effects of excess calcium on renal and neurological function.
11. Which of the following cell types is most characteristic of chronic inflammation?
A. A. Neutrophils
B. B. Eosinophils
C. C. Lymphocytes and macrophages [CORRECT]
D. D. Basophils
Correct Answer: C
Rationale: **Correct because** chronic inflammation is characterized by the presence of lymphocytes, plasma cells, and
macrophages rather than the neutrophils that predominate in acute inflammation. This matches the pathophysiology of
prolonged inflammatory responses involving the adaptive immune system.
12. A nurse is caring for a client who underwent a surgical procedure with a clean, approximated incision. Which type
of wound healing should the nurse expect?
A. A. Healing by secondary intention
B. B. Healing by tertiary intention
C. C. Healing by primary intention [CORRECT]
D. D. Delayed closure healing
Correct Answer: C
Rationale: **Correct because** primary intention healing occurs in clean surgical incisions with closely approximated
wound edges, minimal tissue loss, and low risk of infection. The wound heals with minimal scarring in approximately 7 to
10 days. This matches the expected healing process for surgical incisions.
, NUR 2063 Exam 1 - Essentials of Pathophysiology Page 4
13. A nurse is providing genetic counseling to a client who has been diagnosed with Huntington disease. The client
asks about the likelihood of passing the condition to their children. Which of the following responses by the nurse is
accurate?
A. A. Each child has a 25% chance of inheriting the condition
B. B. Each child has a 50% chance of inheriting the condition [CORRECT]
C. C. Only male children are at risk for inheriting the condition
D. D. The condition skips a generation, so the children are not at risk
Correct Answer: B
Rationale: **Correct because** Huntington disease follows an autosomal dominant inheritance pattern, meaning each
child of an affected parent has a 50% chance of inheriting the mutated gene. This matches the Mendelian inheritance
pattern for autosomal dominant disorders.
14. Which of the following chemical mediators is responsible for causing fever, vasodilation, and pain sensitization
during the inflammatory response?
A. A. Histamine
B. B. Bradykinin
C. C. Prostaglandins [CORRECT]
D. D. Serotonin
Correct Answer: C
Rationale: **Correct because** prostaglandins are lipid-derived chemical mediators synthesized from arachidonic acid
that play a key role in promoting fever (by acting on the hypothalamus), vasodilation, and sensitizing pain receptors to
other inflammatory mediators. This matches the pathophysiological actions of prostaglandins in inflammation.
15. A client with diabetic ketoacidosis (DKA) has the following ABG results: pH 7.25, PaCO2 30 mmHg, HCO3 16
mEq/L. Which of the following is the correct interpretation?
A. A. Partially compensated respiratory alkalosis
B. B. Partially compensated metabolic acidosis [CORRECT]
C. C. Uncompensated metabolic acidosis
D. D. Fully compensated metabolic acidosis
Correct Answer: B
Rationale: **Correct because** the pH is below normal (7.25), indicating acidosis. The HCO3 is decreased (16 mEq/L),
pointing to a metabolic cause. The PaCO2 is decreased (30 mmHg), indicating that the lungs are compensating by
hyperventilating to blow off CO2, but the pH has not yet normalized. This matches the interpretation of partially
compensated metabolic acidosis.
16. A nurse is assessing a client with rheumatoid arthritis. Which of the following pathophysiological mechanisms
best explains the joint destruction seen in this condition?
A. A. Deposition of uric acid crystals in the joint space
B. B. Autoimmune-mediated destruction of the synovial membrane and cartilage by pannus formation
[CORRECT]
C. C. Degeneration of articular cartilage due to mechanical wear
D. D. Bacterial infection of the joint causing septic arthritis
Correct Answer: B
Rationale: **Correct because** rheumatoid arthritis is an autoimmune disorder in which inflammatory cells invade the
synovial membrane, forming a thickened, destructive tissue called pannus that erodes articular cartilage and subchondral
bone. This matches the pathophysiology of autoimmune joint destruction in rheumatoid arthritis.
NUR 2063 Exam 1 - Essentials of Pathophysiology
Comprehensive Review Examination
150 Questions - Detailed Rationales
1. A nurse is reviewing the medical record of a client diagnosed with endometrial hyperplasia. Which of the following
best describes the cellular adaptation occurring?
A. A. A decrease in cell size due to decreased workload
B. B. An increase in the number of cells in response to hormonal stimulation [CORRECT]
C. C. A replacement of one mature cell type by another mature cell type
D. D. Abnormal, disorganized cell growth that is considered precancerous
Correct Answer: B
Rationale: **Correct because** hyperplasia is defined as an increase in the number of cells in an organ or tissue,
commonly occurring in response to hormonal stimulation such as estrogen's effect on the endometrium. This matches the
pathophysiological definition of compensatory or hormonal hyperplasia.
2. A client presents to the emergency department with severe chest pain and is diagnosed with an acute myocardial
infarction. The nurse understands that which type of necrosis is most likely occurring in the affected myocardial
tissue?
A. A. Liquefactive necrosis
B. B. Coagulative necrosis [CORRECT]
C. C. Caseous necrosis
D. D. Fat necrosis
Correct Answer: B
Rationale: **Correct because** coagulative necrosis is the most common form of necrosis and typically results from
ischemic injury, such as that seen in myocardial infarction. The cellular architecture is preserved, creating a firm, pale
tissue appearance. This matches the pathophysiology of hypoxic cell death in the heart.
3. A nurse is caring for a client with a serum sodium level of 125 mEq/L. The client reports headache, confusion, and
muscle cramps. Which of the following nursing interventions is the priority?
A. A. Administer hypertonic saline IV as prescribed
B. B. Restrict free water intake
C. C. Encourage increased oral sodium intake
D. D. Place the client on seizure precautions [CORRECT]
Correct Answer: D
Rationale: **Priority is** ensuring client safety by placing the client on seizure precautions. Severe hyponatremia (serum
sodium less than 130 mEq/L) increases the risk of seizures due to cerebral edema from water shifts into brain cells. This
matches the safety-first approach to electrolyte imbalances.
4. Which of the following immunoglobulins is primarily responsible for mediating Type I hypersensitivity reactions?
A. A. IgG
B. B. IgM
C. C. IgE [CORRECT]
D. D. IgA
Correct Answer: C
,NUR 2063 Exam 1 - Essentials of Pathophysiology Page 2
Rationale: **Correct because** immunoglobulin E (IgE) is the antibody class that binds to mast cells and basophils,
triggering degranulation and the release of histamine and other inflammatory mediators upon re-exposure to an allergen.
This matches the mechanism of immediate hypersensitivity reactions.
5. A nurse is reviewing the pathology report of a client with a malignant tumor. The report indicates that tumor cells
have invaded the lymphatic vessels. The nurse understands that this finding indicates which of the following?
A. A. The tumor is likely benign
B. B. The tumor has undergone anaplasia
C. C. The tumor has the potential for lymphatic spread to distant sites [CORRECT]
D. D. The tumor will remain localized to the primary site
Correct Answer: C
Rationale: **Correct because** invasion of lymphatic vessels by malignant tumor cells indicates the potential for
lymphatic metastasis, which is a key characteristic distinguishing malignant from benign tumors. This matches the
pathophysiological mechanism of tumor spread through the lymphatic system.
6. SCENARIO: A 68-year-old client with chronic obstructive pulmonary disease (COPD) presents to the clinic with
increased dyspnea, confusion, and a morning headache. Arterial blood gas (ABG) results reveal: pH 7.28, PaCO2 58
mmHg, HCO3 32 mEq/L. Which of the following is the correct interpretation of these ABG findings?
A. A. Partially compensated respiratory acidosis [CORRECT]
B. B. Uncompensated respiratory acidosis
C. C. Partially compensated metabolic alkalosis
D. D. Fully compensated respiratory acidosis
Correct Answer: A
Rationale: **Correct because** the pH is below normal (7.28), indicating acidosis. The PaCO2 is elevated (58 mmHg),
indicating a respiratory cause. The HCO3 is elevated (32 mEq/L), indicating renal compensation has begun but the pH
has not yet returned to normal range. This matches the interpretation of partially compensated respiratory acidosis.
7. A nurse is providing care for an older adult client who has been on bed rest for 3 weeks following hip surgery. The
nurse understands that which type of cellular adaptation is occurring in the client's immobilized muscles?
A. A. Hypertrophy
B. B. Hyperplasia
C. C. Atrophy [CORRECT]
D. D. Metaplasia
Correct Answer: C
Rationale: **Correct because** atrophy is a decrease in cell size resulting from reduced workload, disuse, or inadequate
nutrition. Immobilization leads to disuse atrophy of skeletal muscle due to reduced mechanical stimulation and protein
synthesis. This matches the pathophysiology of muscle wasting during prolonged bed rest.
8. A client is receiving furosemide IV for the management of heart failure. Which of the following findings should the
nurse identify as an early indication of hypokalemia?
A. A. Muscle weakness and fatigue [CORRECT]
B. B. Hypertension and bradycardia
C. C. Increased deep tendon reflexes
D. D. Positive Chvostek sign
Correct Answer: A
,NUR 2063 Exam 1 - Essentials of Pathophysiology Page 3
Rationale: **Correct because** loop diuretics such as furosemide increase potassium excretion in the urine, leading to
hypokalemia. Early manifestations include muscle weakness, fatigue, and lethargy due to the role of potassium in
neuromuscular function. This matches the expected clinical presentation of mild to moderate hypokalemia.
9. Which of the following best differentiates apoptosis from necrosis?
A. A. Apoptosis causes inflammation, while necrosis does not
B. B. Apoptosis is a programmed, energy-dependent process that does not trigger inflammation [CORRECT]
C. C. Necrosis is a controlled process that requires ATP
D. D. Apoptosis results from external injury such as hypoxia
Correct Answer: B
Rationale: **Correct because** apoptosis is a genetically programmed, energy-dependent (ATP-requiring) form of
controlled cell death that does not elicit an inflammatory response, unlike necrosis which is uncontrolled cell death that
triggers inflammation. This matches the fundamental pathophysiological distinction between the two processes.
10. A client with hyperparathyroidism has a serum calcium level of 12.8 mg/dL. Which of the following findings
should the nurse anticipate?
A. A. Hypoactive bowel sounds and constipation
B. B. Positive Trousseau sign and laryngospasm
C. C. Polyuria, dehydration, and lethargy [CORRECT]
D. D. Muscle twitching and paresthesias
Correct Answer: C
Rationale: **Correct because** hypercalcemia decreases renal concentrating ability, leading to polyuria and subsequent
dehydration. Elevated calcium also affects the central nervous system, causing lethargy and confusion. This matches the
pathophysiological effects of excess calcium on renal and neurological function.
11. Which of the following cell types is most characteristic of chronic inflammation?
A. A. Neutrophils
B. B. Eosinophils
C. C. Lymphocytes and macrophages [CORRECT]
D. D. Basophils
Correct Answer: C
Rationale: **Correct because** chronic inflammation is characterized by the presence of lymphocytes, plasma cells, and
macrophages rather than the neutrophils that predominate in acute inflammation. This matches the pathophysiology of
prolonged inflammatory responses involving the adaptive immune system.
12. A nurse is caring for a client who underwent a surgical procedure with a clean, approximated incision. Which type
of wound healing should the nurse expect?
A. A. Healing by secondary intention
B. B. Healing by tertiary intention
C. C. Healing by primary intention [CORRECT]
D. D. Delayed closure healing
Correct Answer: C
Rationale: **Correct because** primary intention healing occurs in clean surgical incisions with closely approximated
wound edges, minimal tissue loss, and low risk of infection. The wound heals with minimal scarring in approximately 7 to
10 days. This matches the expected healing process for surgical incisions.
, NUR 2063 Exam 1 - Essentials of Pathophysiology Page 4
13. A nurse is providing genetic counseling to a client who has been diagnosed with Huntington disease. The client
asks about the likelihood of passing the condition to their children. Which of the following responses by the nurse is
accurate?
A. A. Each child has a 25% chance of inheriting the condition
B. B. Each child has a 50% chance of inheriting the condition [CORRECT]
C. C. Only male children are at risk for inheriting the condition
D. D. The condition skips a generation, so the children are not at risk
Correct Answer: B
Rationale: **Correct because** Huntington disease follows an autosomal dominant inheritance pattern, meaning each
child of an affected parent has a 50% chance of inheriting the mutated gene. This matches the Mendelian inheritance
pattern for autosomal dominant disorders.
14. Which of the following chemical mediators is responsible for causing fever, vasodilation, and pain sensitization
during the inflammatory response?
A. A. Histamine
B. B. Bradykinin
C. C. Prostaglandins [CORRECT]
D. D. Serotonin
Correct Answer: C
Rationale: **Correct because** prostaglandins are lipid-derived chemical mediators synthesized from arachidonic acid
that play a key role in promoting fever (by acting on the hypothalamus), vasodilation, and sensitizing pain receptors to
other inflammatory mediators. This matches the pathophysiological actions of prostaglandins in inflammation.
15. A client with diabetic ketoacidosis (DKA) has the following ABG results: pH 7.25, PaCO2 30 mmHg, HCO3 16
mEq/L. Which of the following is the correct interpretation?
A. A. Partially compensated respiratory alkalosis
B. B. Partially compensated metabolic acidosis [CORRECT]
C. C. Uncompensated metabolic acidosis
D. D. Fully compensated metabolic acidosis
Correct Answer: B
Rationale: **Correct because** the pH is below normal (7.25), indicating acidosis. The HCO3 is decreased (16 mEq/L),
pointing to a metabolic cause. The PaCO2 is decreased (30 mmHg), indicating that the lungs are compensating by
hyperventilating to blow off CO2, but the pH has not yet normalized. This matches the interpretation of partially
compensated metabolic acidosis.
16. A nurse is assessing a client with rheumatoid arthritis. Which of the following pathophysiological mechanisms
best explains the joint destruction seen in this condition?
A. A. Deposition of uric acid crystals in the joint space
B. B. Autoimmune-mediated destruction of the synovial membrane and cartilage by pannus formation
[CORRECT]
C. C. Degeneration of articular cartilage due to mechanical wear
D. D. Bacterial infection of the joint causing septic arthritis
Correct Answer: B
Rationale: **Correct because** rheumatoid arthritis is an autoimmune disorder in which inflammatory cells invade the
synovial membrane, forming a thickened, destructive tissue called pannus that erodes articular cartilage and subchondral
bone. This matches the pathophysiology of autoimmune joint destruction in rheumatoid arthritis.
