NUR 505 Advanced Pathophysiology Exam 3 All the
50 Questions from Actual 2026 Version With 100%
Correct Answers and Rationale
1. A patient with chronic kidney disease develops metabolic acidosis. Which physiological
mechanism explains this imbalance?
A. Increased bicarbonate reabsorption
B. Inability to excrete hydrogen ions
C. Excess aldosterone production
D. Increased secretion of potassium
Correct Answer: B
Rationale: CKD reduces the kidneys’ ability to excrete hydrogen ions, resulting in acid
accumulation and metabolic acidosis.
2. Which clinical manifestation is most concerning for a patient experiencing acute
pancreatitis?
A. Hyperactive bowel sounds
B. Ecchymosis around the umbilicus
C. Increased appetite
D. Polyuria
Correct Answer: B
Rationale: Periumbilical bruising (Cullen's sign) indicates retroperitoneal hemorrhage, a severe
complication.
3. A patient has persistent hypertension despite treatment. Primary aldosteronism is
suspected. Which lab value supports the diagnosis?
A. Low sodium, high potassium
B. High sodium, low potassium
C. Normal sodium, normal potassium
D. Low aldosterone
Correct Answer: B
Rationale: Excess aldosterone increases sodium retention and potassium excretion.
4. Which finding indicates decompensated liver cirrhosis?
A. Slightly elevated AST
B. Thrombocytosis
C. Asterixis
D. Soft, non-tender abdomen
Correct Answer: C
Rationale: Asterixis reflects hepatic encephalopathy due to ammonia accumulation.
5. A patient with COPD develops acute respiratory acidosis. Which ABG result is
expected?
A. pH 7.50, PaCO₂ 30, HCO₃ 22
,B. pH 7.30, PaCO₂ 55, HCO₃ 24
C. pH 7.48, PaCO₂ 48, HCO₃ 30
D. pH 7.20, PaCO₂ 20, HCO₃ 18
Correct Answer: B
Rationale: CO₂ retention decreases pH, causing acute respiratory acidosis.
6. Which mechanism contributes to insulin resistance in type 2 diabetes?
A. Increased GLUT-4 transport
B. Enhanced β-cell sensitivity
C. Adipokine-induced inflammation
D. Decreased hepatic glucose output
Correct Answer: C
Rationale: Inflammation from adipose tissue disrupts insulin signaling pathways.
7. A patient with heart failure and high BNP levels is experiencing what physiological
effect?
A. Increased fluid retention
B. Sodium reabsorption
C. Ventricular stretch
D. Decreased preload
Correct Answer: C
Rationale: BNP rises when ventricles stretch due to volume overload.
8. Which disorder is associated with destruction of acetylcholine receptors at the
neuromuscular junction?
A. Guillain-Barré syndrome
B. Multiple sclerosis
C. Myasthenia gravis
D. Amyotrophic lateral sclerosis
Correct Answer: C
Rationale: MG is an autoimmune attack against ACh receptors causing muscle weakness.
9. What is the most common cause of secondary hyperparathyroidism in renal failure?
A. Hypocalcemia
B. Hypercalcemia
C. Elevated vitamin D
D. Dehydration
Correct Answer: A
Rationale: CKD reduces vitamin D activation → low calcium → increased PTH secretion.
10. A patient with sepsis presents with warm, flushed skin and bounding pulses. What stage
does this indicate?
A. Late septic shock
B. Early septic shock
C. Recovery phase
D. Multiple organ dysfunction
, Correct Answer: B
Rationale: Early sepsis causes vasodilation and warm skin (“warm shock”).
11. A patient with Addison’s disease presents with hypotension, hyperpigmentation, and
fatigue. Which lab finding is expected?
A. Hypernatremia, hypokalemia
B. Hyponatremia, hyperkalemia
C. Hypercalcemia, hypokalemia
D. Hypoglycemia, hypernatremia
Correct Answer: B
Rationale: Aldosterone deficiency → sodium loss (hyponatremia) and potassium retention
(hyperkalemia).
12. Which physiological mechanism contributes to hyperthyroid-induced tachycardia?
A. Increased vagal tone
B. Upregulation of β-adrenergic receptors
C. Decreased catecholamine sensitivity
D. Suppressed thyroid hormone production
Correct Answer: B
Rationale: Thyroid hormones increase cardiac β-adrenergic receptor density, raising heart rate.
13. A patient with chronic liver disease develops ascites. What is the main pathophysiologic
cause?
A. Increased oncotic pressure
B. Portal hypertension and hypoalbuminemia
C. Reduced aldosterone secretion
D. Dehydration
Correct Answer: B
Rationale: Portal hypertension ↑ hydrostatic pressure and hypoalbuminemia ↓ oncotic pressure
→ fluid accumulation.
14. A patient with SIADH presents with confusion and seizures. What is the primary lab
abnormality?
A. Hyperkalemia
B. Hypernatremia
C. Hyponatremia
D. Hypercalcemia
Correct Answer: C
Rationale: Excess ADH → water retention → dilutional hyponatremia → neurological
symptoms.
15. Which is a hallmark feature of nephrotic syndrome?
A. Hematuria
B. Massive proteinuria
C. Hypokalemia
D. Low blood pressure
50 Questions from Actual 2026 Version With 100%
Correct Answers and Rationale
1. A patient with chronic kidney disease develops metabolic acidosis. Which physiological
mechanism explains this imbalance?
A. Increased bicarbonate reabsorption
B. Inability to excrete hydrogen ions
C. Excess aldosterone production
D. Increased secretion of potassium
Correct Answer: B
Rationale: CKD reduces the kidneys’ ability to excrete hydrogen ions, resulting in acid
accumulation and metabolic acidosis.
2. Which clinical manifestation is most concerning for a patient experiencing acute
pancreatitis?
A. Hyperactive bowel sounds
B. Ecchymosis around the umbilicus
C. Increased appetite
D. Polyuria
Correct Answer: B
Rationale: Periumbilical bruising (Cullen's sign) indicates retroperitoneal hemorrhage, a severe
complication.
3. A patient has persistent hypertension despite treatment. Primary aldosteronism is
suspected. Which lab value supports the diagnosis?
A. Low sodium, high potassium
B. High sodium, low potassium
C. Normal sodium, normal potassium
D. Low aldosterone
Correct Answer: B
Rationale: Excess aldosterone increases sodium retention and potassium excretion.
4. Which finding indicates decompensated liver cirrhosis?
A. Slightly elevated AST
B. Thrombocytosis
C. Asterixis
D. Soft, non-tender abdomen
Correct Answer: C
Rationale: Asterixis reflects hepatic encephalopathy due to ammonia accumulation.
5. A patient with COPD develops acute respiratory acidosis. Which ABG result is
expected?
A. pH 7.50, PaCO₂ 30, HCO₃ 22
,B. pH 7.30, PaCO₂ 55, HCO₃ 24
C. pH 7.48, PaCO₂ 48, HCO₃ 30
D. pH 7.20, PaCO₂ 20, HCO₃ 18
Correct Answer: B
Rationale: CO₂ retention decreases pH, causing acute respiratory acidosis.
6. Which mechanism contributes to insulin resistance in type 2 diabetes?
A. Increased GLUT-4 transport
B. Enhanced β-cell sensitivity
C. Adipokine-induced inflammation
D. Decreased hepatic glucose output
Correct Answer: C
Rationale: Inflammation from adipose tissue disrupts insulin signaling pathways.
7. A patient with heart failure and high BNP levels is experiencing what physiological
effect?
A. Increased fluid retention
B. Sodium reabsorption
C. Ventricular stretch
D. Decreased preload
Correct Answer: C
Rationale: BNP rises when ventricles stretch due to volume overload.
8. Which disorder is associated with destruction of acetylcholine receptors at the
neuromuscular junction?
A. Guillain-Barré syndrome
B. Multiple sclerosis
C. Myasthenia gravis
D. Amyotrophic lateral sclerosis
Correct Answer: C
Rationale: MG is an autoimmune attack against ACh receptors causing muscle weakness.
9. What is the most common cause of secondary hyperparathyroidism in renal failure?
A. Hypocalcemia
B. Hypercalcemia
C. Elevated vitamin D
D. Dehydration
Correct Answer: A
Rationale: CKD reduces vitamin D activation → low calcium → increased PTH secretion.
10. A patient with sepsis presents with warm, flushed skin and bounding pulses. What stage
does this indicate?
A. Late septic shock
B. Early septic shock
C. Recovery phase
D. Multiple organ dysfunction
, Correct Answer: B
Rationale: Early sepsis causes vasodilation and warm skin (“warm shock”).
11. A patient with Addison’s disease presents with hypotension, hyperpigmentation, and
fatigue. Which lab finding is expected?
A. Hypernatremia, hypokalemia
B. Hyponatremia, hyperkalemia
C. Hypercalcemia, hypokalemia
D. Hypoglycemia, hypernatremia
Correct Answer: B
Rationale: Aldosterone deficiency → sodium loss (hyponatremia) and potassium retention
(hyperkalemia).
12. Which physiological mechanism contributes to hyperthyroid-induced tachycardia?
A. Increased vagal tone
B. Upregulation of β-adrenergic receptors
C. Decreased catecholamine sensitivity
D. Suppressed thyroid hormone production
Correct Answer: B
Rationale: Thyroid hormones increase cardiac β-adrenergic receptor density, raising heart rate.
13. A patient with chronic liver disease develops ascites. What is the main pathophysiologic
cause?
A. Increased oncotic pressure
B. Portal hypertension and hypoalbuminemia
C. Reduced aldosterone secretion
D. Dehydration
Correct Answer: B
Rationale: Portal hypertension ↑ hydrostatic pressure and hypoalbuminemia ↓ oncotic pressure
→ fluid accumulation.
14. A patient with SIADH presents with confusion and seizures. What is the primary lab
abnormality?
A. Hyperkalemia
B. Hypernatremia
C. Hyponatremia
D. Hypercalcemia
Correct Answer: C
Rationale: Excess ADH → water retention → dilutional hyponatremia → neurological
symptoms.
15. Which is a hallmark feature of nephrotic syndrome?
A. Hematuria
B. Massive proteinuria
C. Hypokalemia
D. Low blood pressure
