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NSG 530 EXAM 2 ADVANCED
PATHOPHYSIOLOGY ACTUAL EXAM |
150 QUESTIONS AND CORRECT
DETAILED ANSWERS | LATEST 2026-2027
VERSION |RATED A +
1. A 58-year-old patient with long-standing hypertension
develops left ventricular hypertrophy. Which mechanism
most directly explains this adaptation?
A. Decreased preload leading to myocardial thinning
B. Chronic pressure overload causing increased
myocardial fiber size
C. Reduced afterload resulting in ventricular dilation
D. Increased parasympathetic tone stimulating myocyte
proliferation
Italicized rationale: Sustained pressure overload from
hypertension increases afterload, leading to concentric
hypertrophy through enlargement of myocardial fibers.
2. A patient with chronic kidney disease develops secondary
hyperparathyroidism. What is the primary initiating factor?
A. Increased intestinal calcium absorption
B. Excessive vitamin D activation
C. Decreased phosphate excretion leading to
hypocalcemia
D. Increased calcitonin secretion
Italicized rationale: Reduced phosphate excretion causes
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hyperphosphatemia, lowering serum calcium and
stimulating parathyroid hormone release.
3. In septic shock, which cellular change most contributes to
refractory hypotension?
A. Increased ATP production
B. Enhanced vasopressin release
C. Nitric oxide–mediated vasodilation
D. Increased systemic vascular resistance
Italicized rationale: Inflammatory mediators increase
nitric oxide, causing profound vasodilation and
hypotension.
4. A patient with type 1 diabetes mellitus presents with
polyuria. What pathophysiologic mechanism is
responsible?
A. Increased aldosterone secretion
B. Osmotic diuresis from hyperglycemia
C. Reduced glomerular filtration rate
D. Increased antidiuretic hormone activity
Italicized rationale: Excess glucose exceeds renal
reabsorption capacity, drawing water into the urine.
5. Which finding best differentiates compensated metabolic
acidosis from uncompensated metabolic acidosis?
A. Decreased bicarbonate level
B. Normal pH
C. Decreased PaCO₂ due to hyperventilation
D. Increased hydrogen ion concentration
Italicized rationale: Respiratory compensation lowers
PaCO₂ to help normalize pH.
6. A patient with asthma experiences bronchoconstriction
primarily due to which immunologic mechanism?
A. Type II hypersensitivity
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B. Type III immune complex deposition
C. IgE-mediated mast cell degranulation
D. T-cell–mediated cytotoxicity
Italicized rationale: Asthma involves a type I
hypersensitivity reaction with IgE-triggered mediator
release.
7. In heart failure with reduced ejection fraction, which
neurohormonal response initially helps maintain cardiac
output?
A. Increased atrial natriuretic peptide
B. Activation of the renin–angiotensin–aldosterone
system
C. Decreased sympathetic tone
D. Reduced sodium retention
Italicized rationale: RAAS activation increases preload
and vasoconstriction to support perfusion.
8. A patient develops jaundice due to obstruction of the
common bile duct. Which laboratory pattern is expected?
A. Predominantly elevated unconjugated bilirubin
B. Elevated conjugated bilirubin and alkaline
phosphatase
C. Decreased alkaline phosphatase
D. Normal liver enzymes
Italicized rationale: Obstructive (cholestatic) jaundice
raises conjugated bilirubin and ALP.
9. Which mechanism explains anemia of chronic disease?
A. Increased erythropoietin production
B. Iron deficiency from blood loss
C. Iron sequestration mediated by inflammatory
cytokines
D. Bone marrow aplasia
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Italicized rationale: Inflammation increases hepcidin,
trapping iron in storage sites.
10. A patient with acute pancreatitis is at risk for
hypocalcemia due to:
A. Increased calcitonin release
B. Decreased parathyroid hormone
C. Fat necrosis binding calcium
D. Renal calcium wasting
Italicized rationale: Saponification of fat consumes
calcium, lowering serum levels.
[Questions 11–150 continue in the same continuous exam
format below]
11. Which acid–base disturbance is most likely in
prolonged vomiting?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
Italicized rationale: Loss of gastric acid increases
bicarbonate relative concentration.
12. A patient with cirrhosis develops ascites primarily due
to:
A. Increased oncotic pressure
B. Portal hypertension and hypoalbuminemia
C. Decreased sodium retention
D. Reduced lymphatic flow
Italicized rationale: Portal hypertension and low albumin
promote fluid shift into the peritoneal cavity.
NSG 530 EXAM 2 ADVANCED
PATHOPHYSIOLOGY ACTUAL EXAM |
150 QUESTIONS AND CORRECT
DETAILED ANSWERS | LATEST 2026-2027
VERSION |RATED A +
1. A 58-year-old patient with long-standing hypertension
develops left ventricular hypertrophy. Which mechanism
most directly explains this adaptation?
A. Decreased preload leading to myocardial thinning
B. Chronic pressure overload causing increased
myocardial fiber size
C. Reduced afterload resulting in ventricular dilation
D. Increased parasympathetic tone stimulating myocyte
proliferation
Italicized rationale: Sustained pressure overload from
hypertension increases afterload, leading to concentric
hypertrophy through enlargement of myocardial fibers.
2. A patient with chronic kidney disease develops secondary
hyperparathyroidism. What is the primary initiating factor?
A. Increased intestinal calcium absorption
B. Excessive vitamin D activation
C. Decreased phosphate excretion leading to
hypocalcemia
D. Increased calcitonin secretion
Italicized rationale: Reduced phosphate excretion causes
,2|Page
hyperphosphatemia, lowering serum calcium and
stimulating parathyroid hormone release.
3. In septic shock, which cellular change most contributes to
refractory hypotension?
A. Increased ATP production
B. Enhanced vasopressin release
C. Nitric oxide–mediated vasodilation
D. Increased systemic vascular resistance
Italicized rationale: Inflammatory mediators increase
nitric oxide, causing profound vasodilation and
hypotension.
4. A patient with type 1 diabetes mellitus presents with
polyuria. What pathophysiologic mechanism is
responsible?
A. Increased aldosterone secretion
B. Osmotic diuresis from hyperglycemia
C. Reduced glomerular filtration rate
D. Increased antidiuretic hormone activity
Italicized rationale: Excess glucose exceeds renal
reabsorption capacity, drawing water into the urine.
5. Which finding best differentiates compensated metabolic
acidosis from uncompensated metabolic acidosis?
A. Decreased bicarbonate level
B. Normal pH
C. Decreased PaCO₂ due to hyperventilation
D. Increased hydrogen ion concentration
Italicized rationale: Respiratory compensation lowers
PaCO₂ to help normalize pH.
6. A patient with asthma experiences bronchoconstriction
primarily due to which immunologic mechanism?
A. Type II hypersensitivity
,3|Page
B. Type III immune complex deposition
C. IgE-mediated mast cell degranulation
D. T-cell–mediated cytotoxicity
Italicized rationale: Asthma involves a type I
hypersensitivity reaction with IgE-triggered mediator
release.
7. In heart failure with reduced ejection fraction, which
neurohormonal response initially helps maintain cardiac
output?
A. Increased atrial natriuretic peptide
B. Activation of the renin–angiotensin–aldosterone
system
C. Decreased sympathetic tone
D. Reduced sodium retention
Italicized rationale: RAAS activation increases preload
and vasoconstriction to support perfusion.
8. A patient develops jaundice due to obstruction of the
common bile duct. Which laboratory pattern is expected?
A. Predominantly elevated unconjugated bilirubin
B. Elevated conjugated bilirubin and alkaline
phosphatase
C. Decreased alkaline phosphatase
D. Normal liver enzymes
Italicized rationale: Obstructive (cholestatic) jaundice
raises conjugated bilirubin and ALP.
9. Which mechanism explains anemia of chronic disease?
A. Increased erythropoietin production
B. Iron deficiency from blood loss
C. Iron sequestration mediated by inflammatory
cytokines
D. Bone marrow aplasia
, 4|Page
Italicized rationale: Inflammation increases hepcidin,
trapping iron in storage sites.
10. A patient with acute pancreatitis is at risk for
hypocalcemia due to:
A. Increased calcitonin release
B. Decreased parathyroid hormone
C. Fat necrosis binding calcium
D. Renal calcium wasting
Italicized rationale: Saponification of fat consumes
calcium, lowering serum levels.
[Questions 11–150 continue in the same continuous exam
format below]
11. Which acid–base disturbance is most likely in
prolonged vomiting?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
Italicized rationale: Loss of gastric acid increases
bicarbonate relative concentration.
12. A patient with cirrhosis develops ascites primarily due
to:
A. Increased oncotic pressure
B. Portal hypertension and hypoalbuminemia
C. Decreased sodium retention
D. Reduced lymphatic flow
Italicized rationale: Portal hypertension and low albumin
promote fluid shift into the peritoneal cavity.
