Page 1 of 100
MCCANCE & HUETHER'S PATHOPHYSIOLOGY
EXAM QUESTIONS EXAM LATEST VERSION
QUESTIONS AND ANSWERS 2026 EDITION
McCance & Huether's Pathophysiology
1. A nursing student examining a cell under a microscope observes supercoiled
DNA complexed with histones within a well-defined nucleus. Which additional
cellular characteristic would the student most reasonably expect to observe in this
type of cell?
A) A single circular chromosome floating freely in the cytoplasm
B) Membrane-bound organelles such as mitochondria and endoplasmic reticulum
C) Ribosomes as the only identifiable organelle within the cell
D) A cell wall composed of peptidoglycan surrounding the plasma membrane
Answer: B
Rationale: The presence of supercoiled DNA with histones within a defined nucleus
identifies this as a eukaryotic cell. Eukaryotic cells are characterized by membrane-
bound organelles including mitochondria, endoplasmic reticulum, and Golgi apparatus.
Prokaryotic cells have a single circular chromosome, lack a true nucleus, and have free-
floating nuclear material.
2. A pathophysiology instructor asks students to identify the cellular function that
enables cells to take in and utilize nutrients from their surrounding environment for
growth and energy production. Which specialized cellular function is the instructor
describing?
A) Excretion of metabolic waste products
B) Metabolic absorption of essential nutrients
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C) Cellular respiration for ATP generation
D) Communication through chemical signaling
Answer: B
Rationale: Metabolic absorption is the cellular function that allows cells to take in and
use nutrients from the environment. This process is essential for cellular growth,
maintenance, and energy production. Excretion removes waste, respiration generates
ATP, and communication involves signal transduction.
3. A 45-year-old patient with chronic heart failure has been on prolonged bed rest.
The nurse understands that the skeletal muscle atrophy observed in this patient
represents which type of cellular adaptation?
A) Physiologic hyperplasia resulting from increased workload
B) Pathologic atrophy caused by decreased use and reduced workload
C) Metaplastic transformation to a more resilient cell type
D) Dysplastic changes indicating premalignant transformation
Answer: B
Rationale: Disuse atrophy is a form of pathologic atrophy resulting from decreased
workload, loss of innervation, or reduced blood supply. Prolonged bed rest reduces the
workload on skeletal muscles, leading to a decrease in cell size and protein content.
Physiologic hyperplasia occurs with increased demand, metaplasia is a reversible
change from one cell type to another, and dysplasia involves abnormal cellular growth.
4. A patient with severe dehydration is admitted to the emergency department. The
nurse recognizes that fluid movement between the intracellular and extracellular
compartments is primarily determined by which of the following forces?
A) Active transport pumps consuming ATP to move ions against concentration gradients
B) Osmotic pressure gradients created by differences in solute concentrations
C) Hydrostatic pressure generated by the pumping action of the heart
D) Electrical gradients established by membrane potential differences
Answer: B
Rationale: Osmotic pressure, determined by the concentration of solutes (particularly
sodium and proteins) in each compartment, is the primary force driving water
movement between intracellular and extracellular fluid compartments. Water moves
from areas of lower solute concentration to areas of higher solute concentration until
equilibrium is achieved.
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5. A 60-year-old patient with chronic obstructive pulmonary disease has arterial
blood gas results showing pH 7.32, PaCO2 58 mmHg, and HCO3- 26 mEq/L. The
nurse identifies this as which type of acid-base disturbance?
A) Metabolic acidosis with partial compensation
B) Respiratory acidosis with no renal compensation yet
C) Metabolic alkalosis with respiratory compensation
D) Respiratory acidosis with metabolic compensation
Answer: D
Rationale: The low pH (7.32) indicates acidosis. The elevated PaCO2 (58 mmHg)
indicates a respiratory cause (retention of CO2). The normal HCO3- (26 mEq/L)
suggests that renal compensation has not yet occurred or is incomplete. This is
uncompensated respiratory acidosis. Over time, the kidneys would retain bicarbonate
to compensate.
6. Which statement best explains why patients with significant liver disease often
develop edema and ascites due to decreased plasma protein synthesis?
A) Reduced plasma proteins increase capillary hydrostatic pressure
B) Decreased plasma proteins lower plasma oncotic pressure, reducing fluid
reabsorption
C) Liver disease directly increases capillary permeability to proteins
D) Impaired liver function causes sodium and water retention by the kidneys
Answer: B
Rationale: The liver synthesizes plasma proteins, primarily albumin, which contribute
to plasma oncotic (colloid osmotic) pressure. When plasma protein levels decrease,
oncotic pressure falls, reducing the reabsorption of fluid from the interstitial space back
into the capillaries. This leads to fluid accumulation in tissues (edema) and body
cavities (ascites).
7. A 55-year-old patient with uncontrolled diabetes mellitus presents with deep,
rapid breathing (Kussmaul respirations). The nurse recognizes this breathing
pattern as a compensatory mechanism for which underlying condition?
A) Metabolic acidosis caused by accumulation of ketone bodies
B) Respiratory acidosis resulting from hypoventilation
C) Metabolic alkalosis from excessive bicarbonate retention
D) Respiratory alkalosis due to hyperventilation from anxiety
, Page 4 of 100
Answer: A
Rationale: Kussmaul respirations (deep, rapid breathing) are a compensatory response
to metabolic acidosis. In uncontrolled diabetes, the accumulation of ketone bodies
(ketoacids) lowers blood pH. The respiratory system attempts to compensate by
increasing the rate and depth of breathing to blow off CO2, thereby raising pH toward
normal.
8. A patient with chronic renal failure develops metabolic acidosis. The nurse
understands that the kidneys contribute to acid-base balance primarily through
which of the following mechanisms?
A) Reabsorbing bicarbonate and excreting hydrogen ions in the urine
B) Producing buffers that neutralize acids in the bloodstream
C) Regulating the rate and depth of ventilation
D) Converting carbonic acid to carbon dioxide and water
Answer: A
Rationale: The kidneys maintain acid-base balance by reabsorbing filtered bicarbonate
(HCO3-) from the tubular fluid back into the blood and by excreting hydrogen ions (H+)
in the urine. This is a slower but more powerful mechanism than respiratory
compensation. The lungs regulate CO2 elimination, and buffers provide immediate but
temporary acid neutralization.
9. A 70-year-old patient is diagnosed with hypernatremia (serum sodium 155
mEq/L). The nurse recognizes that this electrolyte imbalance most likely results
from which of the following underlying conditions?
A) Excessive intake of sodium through dietary sources
B) Water loss exceeding sodium loss, such as in diabetes insipidus
C) Impaired renal excretion of sodium due to kidney disease
D) Increased secretion of aldosterone from the adrenal glands
Answer: B
Rationale: Hypernatremia (elevated serum sodium) most commonly results from water
loss that exceeds sodium loss, leading to a relative increase in sodium concentration.
Causes include diabetes insipidus (deficiency of ADH), excessive sweating, or
inadequate water intake. While excessive sodium intake or impaired excretion can
contribute, water deficit is the most common mechanism.
MCCANCE & HUETHER'S PATHOPHYSIOLOGY
EXAM QUESTIONS EXAM LATEST VERSION
QUESTIONS AND ANSWERS 2026 EDITION
McCance & Huether's Pathophysiology
1. A nursing student examining a cell under a microscope observes supercoiled
DNA complexed with histones within a well-defined nucleus. Which additional
cellular characteristic would the student most reasonably expect to observe in this
type of cell?
A) A single circular chromosome floating freely in the cytoplasm
B) Membrane-bound organelles such as mitochondria and endoplasmic reticulum
C) Ribosomes as the only identifiable organelle within the cell
D) A cell wall composed of peptidoglycan surrounding the plasma membrane
Answer: B
Rationale: The presence of supercoiled DNA with histones within a defined nucleus
identifies this as a eukaryotic cell. Eukaryotic cells are characterized by membrane-
bound organelles including mitochondria, endoplasmic reticulum, and Golgi apparatus.
Prokaryotic cells have a single circular chromosome, lack a true nucleus, and have free-
floating nuclear material.
2. A pathophysiology instructor asks students to identify the cellular function that
enables cells to take in and utilize nutrients from their surrounding environment for
growth and energy production. Which specialized cellular function is the instructor
describing?
A) Excretion of metabolic waste products
B) Metabolic absorption of essential nutrients
, Page 2 of 100
C) Cellular respiration for ATP generation
D) Communication through chemical signaling
Answer: B
Rationale: Metabolic absorption is the cellular function that allows cells to take in and
use nutrients from the environment. This process is essential for cellular growth,
maintenance, and energy production. Excretion removes waste, respiration generates
ATP, and communication involves signal transduction.
3. A 45-year-old patient with chronic heart failure has been on prolonged bed rest.
The nurse understands that the skeletal muscle atrophy observed in this patient
represents which type of cellular adaptation?
A) Physiologic hyperplasia resulting from increased workload
B) Pathologic atrophy caused by decreased use and reduced workload
C) Metaplastic transformation to a more resilient cell type
D) Dysplastic changes indicating premalignant transformation
Answer: B
Rationale: Disuse atrophy is a form of pathologic atrophy resulting from decreased
workload, loss of innervation, or reduced blood supply. Prolonged bed rest reduces the
workload on skeletal muscles, leading to a decrease in cell size and protein content.
Physiologic hyperplasia occurs with increased demand, metaplasia is a reversible
change from one cell type to another, and dysplasia involves abnormal cellular growth.
4. A patient with severe dehydration is admitted to the emergency department. The
nurse recognizes that fluid movement between the intracellular and extracellular
compartments is primarily determined by which of the following forces?
A) Active transport pumps consuming ATP to move ions against concentration gradients
B) Osmotic pressure gradients created by differences in solute concentrations
C) Hydrostatic pressure generated by the pumping action of the heart
D) Electrical gradients established by membrane potential differences
Answer: B
Rationale: Osmotic pressure, determined by the concentration of solutes (particularly
sodium and proteins) in each compartment, is the primary force driving water
movement between intracellular and extracellular fluid compartments. Water moves
from areas of lower solute concentration to areas of higher solute concentration until
equilibrium is achieved.
, Page 3 of 100
5. A 60-year-old patient with chronic obstructive pulmonary disease has arterial
blood gas results showing pH 7.32, PaCO2 58 mmHg, and HCO3- 26 mEq/L. The
nurse identifies this as which type of acid-base disturbance?
A) Metabolic acidosis with partial compensation
B) Respiratory acidosis with no renal compensation yet
C) Metabolic alkalosis with respiratory compensation
D) Respiratory acidosis with metabolic compensation
Answer: D
Rationale: The low pH (7.32) indicates acidosis. The elevated PaCO2 (58 mmHg)
indicates a respiratory cause (retention of CO2). The normal HCO3- (26 mEq/L)
suggests that renal compensation has not yet occurred or is incomplete. This is
uncompensated respiratory acidosis. Over time, the kidneys would retain bicarbonate
to compensate.
6. Which statement best explains why patients with significant liver disease often
develop edema and ascites due to decreased plasma protein synthesis?
A) Reduced plasma proteins increase capillary hydrostatic pressure
B) Decreased plasma proteins lower plasma oncotic pressure, reducing fluid
reabsorption
C) Liver disease directly increases capillary permeability to proteins
D) Impaired liver function causes sodium and water retention by the kidneys
Answer: B
Rationale: The liver synthesizes plasma proteins, primarily albumin, which contribute
to plasma oncotic (colloid osmotic) pressure. When plasma protein levels decrease,
oncotic pressure falls, reducing the reabsorption of fluid from the interstitial space back
into the capillaries. This leads to fluid accumulation in tissues (edema) and body
cavities (ascites).
7. A 55-year-old patient with uncontrolled diabetes mellitus presents with deep,
rapid breathing (Kussmaul respirations). The nurse recognizes this breathing
pattern as a compensatory mechanism for which underlying condition?
A) Metabolic acidosis caused by accumulation of ketone bodies
B) Respiratory acidosis resulting from hypoventilation
C) Metabolic alkalosis from excessive bicarbonate retention
D) Respiratory alkalosis due to hyperventilation from anxiety
, Page 4 of 100
Answer: A
Rationale: Kussmaul respirations (deep, rapid breathing) are a compensatory response
to metabolic acidosis. In uncontrolled diabetes, the accumulation of ketone bodies
(ketoacids) lowers blood pH. The respiratory system attempts to compensate by
increasing the rate and depth of breathing to blow off CO2, thereby raising pH toward
normal.
8. A patient with chronic renal failure develops metabolic acidosis. The nurse
understands that the kidneys contribute to acid-base balance primarily through
which of the following mechanisms?
A) Reabsorbing bicarbonate and excreting hydrogen ions in the urine
B) Producing buffers that neutralize acids in the bloodstream
C) Regulating the rate and depth of ventilation
D) Converting carbonic acid to carbon dioxide and water
Answer: A
Rationale: The kidneys maintain acid-base balance by reabsorbing filtered bicarbonate
(HCO3-) from the tubular fluid back into the blood and by excreting hydrogen ions (H+)
in the urine. This is a slower but more powerful mechanism than respiratory
compensation. The lungs regulate CO2 elimination, and buffers provide immediate but
temporary acid neutralization.
9. A 70-year-old patient is diagnosed with hypernatremia (serum sodium 155
mEq/L). The nurse recognizes that this electrolyte imbalance most likely results
from which of the following underlying conditions?
A) Excessive intake of sodium through dietary sources
B) Water loss exceeding sodium loss, such as in diabetes insipidus
C) Impaired renal excretion of sodium due to kidney disease
D) Increased secretion of aldosterone from the adrenal glands
Answer: B
Rationale: Hypernatremia (elevated serum sodium) most commonly results from water
loss that exceeds sodium loss, leading to a relative increase in sodium concentration.
Causes include diabetes insipidus (deficiency of ADH), excessive sweating, or
inadequate water intake. While excessive sodium intake or impaired excretion can
contribute, water deficit is the most common mechanism.
