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NURS231 Pathophysiology Final
Exam Portage Learning Actual Exam
2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Cellular Adaptation, Injury & Fluid/Electrolyte Balance | Q1
– Q10
Section 2 | Inflammation, Immunity & Immune Disorders | Q11 – Q22
Section 3 | Genetics & Neoplasia | Q23 – Q30
Section 4 | System-Based Pathophysiology | Q31 – Q42
Section 5 | NGN-Style Clinical Judgment & Integrated Case Analysis |
Q43 – Q50
Instructions: Choose the single best answer unless otherwise indicated.
Pass: 40/50 correct in 90 minutes.
══════════════════════════════════════
SECTION 1: CELLULAR ADAPTATION, INJURY &
FLUID/ELECTROLYTE BALANCE Q1 – Q10
══════════════════════════════════════
,2
Question 1 of 50
A 68-year-old male with a 40-pack-year smoking history presents with
chronic productive cough and progressive dyspnea. A bronchial biopsy
reveals that the normal ciliated columnar epithelial lining has been
replaced by stratified squamous epithelium. The pathologist identifies
this change as a cellular adaptation to chronic irritation from cigarette
smoke.
What type of cellular adaptation is demonstrated in this patient's airway?
A. Hyperplasia – an increase in the number of cells within a tissue due to
increased mitotic activity
B. Metaplasia – the reversible replacement of one mature cell type by
another mature cell type better suited to the environment
C. Dysplasia – disordered cellular maturation characterized by
pleomorphism and loss of normal tissue architecture
D. Hypertrophy – an increase in individual cell size without an increase
in cell number ✓ CORRECT
Correct Answer: B
Rationale: Metaplasia occurs when chronic irritation (such as cigarette
smoke) induces stem cells to differentiate into a more resilient cell
type—in this case, squamous epithelium replaces fragile ciliated
columnar cells to withstand the noxious stimulus. Hypertrophy refers to
enlarged cell size, not replacement of one differentiated cell type by
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another; this is a common distractor because both are adaptive responses
but represent fundamentally different mechanisms. Remember:
metaplasia is reversible if the irritant is removed early, but prolonged
metaplasia can progress to dysplasia and eventually malignancy.
Question 2 of 50
A 54-year-old woman undergoes elective hysterectomy for uterine
fibroids and experiences significant intraoperative blood loss requiring
transfusion of 4 units of packed red blood cells. Postoperatively, her
urine output drops to 0.3 mL/kg/hr despite adequate fluid resuscitation,
and serum creatinine rises from 0.9 mg/dL to 2.8 mg/dL over 48 hours.
Renal biopsy would most likely show which pattern of cellular injury?
A. Coagulative necrosis – preservation of tissue architecture with protein
denaturation and cellular outlines remaining visible
B. Liquefactive necrosis – complete digestion of dead cells resulting in
viscous liquid debris typical of brain ischemia
C. Fat necrosis – enzymatic fat breakdown releasing fatty acids that
saponify into chalky white deposits
D. Caseous necrosis – cheese-like amorphous debris without preserved
architecture seen in granulomatous disease ✓ CORRECT
Correct Answer: A
Rationale: Ischemic injury to the kidney (as seen in acute tubular
necrosis from hypoperfusion) produces coagulative necrosis, where the
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structural framework of the tissue is preserved while proteins denature
and cells die—this is characteristic of hypoxic injury in most solid
organs except the brain. Liquefactive necrosis is specific to the CNS or
bacterial infections where hydrolytic enzymes completely digest the
tissue; confusing these two patterns is a frequent exam error. On boards,
always associate coagulative necrosis with infarcts in the heart, kidney,
and liver.
Question 3 of 50
A 72-year-old man admitted for community-acquired pneumonia
develops worsening confusion, muscle weakness, and nausea on hospital
day 3. His current medications include furosemide 40 mg IV daily and
lisinopril 10 mg daily. Laboratory results reveal Na⁺ 136 mEq/L, K⁺ 6.8
mEq/L, Cl⁻ 100 mEq/L, HCO₃⁻ 22 mEq/L, BUN 32 mg/dL, creatinine
1.8 mg/dL. An ECG shows peaked T waves and a widened QRS
complex.
Which pathophysiologic mechanism best explains this patient's
hyperkalemia?
A. Increased potassium intake combined with intracellular shift caused
by alkalosis
B. Decreased renal excretion of potassium secondary to ACE inhibition
and acute kidney injury
C. Transcellular shift of potassium out of cells triggered by insulin
deficiency and hyperglycemia
NURS231 Pathophysiology Final
Exam Portage Learning Actual Exam
2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Cellular Adaptation, Injury & Fluid/Electrolyte Balance | Q1
– Q10
Section 2 | Inflammation, Immunity & Immune Disorders | Q11 – Q22
Section 3 | Genetics & Neoplasia | Q23 – Q30
Section 4 | System-Based Pathophysiology | Q31 – Q42
Section 5 | NGN-Style Clinical Judgment & Integrated Case Analysis |
Q43 – Q50
Instructions: Choose the single best answer unless otherwise indicated.
Pass: 40/50 correct in 90 minutes.
══════════════════════════════════════
SECTION 1: CELLULAR ADAPTATION, INJURY &
FLUID/ELECTROLYTE BALANCE Q1 – Q10
══════════════════════════════════════
,2
Question 1 of 50
A 68-year-old male with a 40-pack-year smoking history presents with
chronic productive cough and progressive dyspnea. A bronchial biopsy
reveals that the normal ciliated columnar epithelial lining has been
replaced by stratified squamous epithelium. The pathologist identifies
this change as a cellular adaptation to chronic irritation from cigarette
smoke.
What type of cellular adaptation is demonstrated in this patient's airway?
A. Hyperplasia – an increase in the number of cells within a tissue due to
increased mitotic activity
B. Metaplasia – the reversible replacement of one mature cell type by
another mature cell type better suited to the environment
C. Dysplasia – disordered cellular maturation characterized by
pleomorphism and loss of normal tissue architecture
D. Hypertrophy – an increase in individual cell size without an increase
in cell number ✓ CORRECT
Correct Answer: B
Rationale: Metaplasia occurs when chronic irritation (such as cigarette
smoke) induces stem cells to differentiate into a more resilient cell
type—in this case, squamous epithelium replaces fragile ciliated
columnar cells to withstand the noxious stimulus. Hypertrophy refers to
enlarged cell size, not replacement of one differentiated cell type by
,3
another; this is a common distractor because both are adaptive responses
but represent fundamentally different mechanisms. Remember:
metaplasia is reversible if the irritant is removed early, but prolonged
metaplasia can progress to dysplasia and eventually malignancy.
Question 2 of 50
A 54-year-old woman undergoes elective hysterectomy for uterine
fibroids and experiences significant intraoperative blood loss requiring
transfusion of 4 units of packed red blood cells. Postoperatively, her
urine output drops to 0.3 mL/kg/hr despite adequate fluid resuscitation,
and serum creatinine rises from 0.9 mg/dL to 2.8 mg/dL over 48 hours.
Renal biopsy would most likely show which pattern of cellular injury?
A. Coagulative necrosis – preservation of tissue architecture with protein
denaturation and cellular outlines remaining visible
B. Liquefactive necrosis – complete digestion of dead cells resulting in
viscous liquid debris typical of brain ischemia
C. Fat necrosis – enzymatic fat breakdown releasing fatty acids that
saponify into chalky white deposits
D. Caseous necrosis – cheese-like amorphous debris without preserved
architecture seen in granulomatous disease ✓ CORRECT
Correct Answer: A
Rationale: Ischemic injury to the kidney (as seen in acute tubular
necrosis from hypoperfusion) produces coagulative necrosis, where the
, 4
structural framework of the tissue is preserved while proteins denature
and cells die—this is characteristic of hypoxic injury in most solid
organs except the brain. Liquefactive necrosis is specific to the CNS or
bacterial infections where hydrolytic enzymes completely digest the
tissue; confusing these two patterns is a frequent exam error. On boards,
always associate coagulative necrosis with infarcts in the heart, kidney,
and liver.
Question 3 of 50
A 72-year-old man admitted for community-acquired pneumonia
develops worsening confusion, muscle weakness, and nausea on hospital
day 3. His current medications include furosemide 40 mg IV daily and
lisinopril 10 mg daily. Laboratory results reveal Na⁺ 136 mEq/L, K⁺ 6.8
mEq/L, Cl⁻ 100 mEq/L, HCO₃⁻ 22 mEq/L, BUN 32 mg/dL, creatinine
1.8 mg/dL. An ECG shows peaked T waves and a widened QRS
complex.
Which pathophysiologic mechanism best explains this patient's
hyperkalemia?
A. Increased potassium intake combined with intracellular shift caused
by alkalosis
B. Decreased renal excretion of potassium secondary to ACE inhibition
and acute kidney injury
C. Transcellular shift of potassium out of cells triggered by insulin
deficiency and hyperglycemia
