NURS 231 Pathophysiology | Portage Learning | Final Exam
2026/2027 Complete Final Examination | Actual Questions &
Verified Answers | Comprehensive Pathophysiology
Assessment | Pass Guarantee
1. A 68-year-old man with long-standing hypertension presents with fatigue and
decreased urine output. Labs show BUN 68 mg/dL, creatinine 3.2 mg/dL, and
Hgb 8.9 g/dL. Urinalysis reveals broad, waxy casts. Which pathophysiologic
process best explains the anemia?
A. Decreased production of erythropoietin by diseased renal peritubular cells
B. Dietary folate deficiency secondary to uremic anorexia
C. Hemolysis from microangiopathic changes
D. Bone-marrow suppression by circulating inflammatory cytokines
Correct Answer: A
Rationale: Chronic kidney disease (CKD) reduces renal peritubular fibroblast secretion
of erythropoietin (EPO), blunting marrow red-cell production → normocytic,
normochromic anemia. Not primarily nutritional, hemolytic, or cytokine-driven.
2. The same patient develops K⁺ 6.1 mEq/L and peaked T waves. Which
intracellular–extracellular shift contributes most to hyperkalemia in CKD?
A. Insulin excess driving K⁺ into cells
B. Metabolic acidosis forcing K⁺ out of cells in exchange for H⁺
C. Aldosterone excess increasing K⁺ secretion
D. Beta-2 agonist stimulation of Na⁺/K⁺-ATPase
Correct Answer: B
,Rationale: Accumulated organic & inorganic acids extracellularly are buffered partly by
intracellular K⁺ efflux (H⁺↔K⁺ anti-port), compounding the renal K⁺ retention already
present in CKD.
3. A 22-year-old woman with type 1 diabetes reports waking with headache,
nightmares, and capillary glucose 48 mg/dL. Which counter-regulatory hormone
is most responsible for her symptoms?
A. Insulin
B. Cortisol
C. Epinephrine
D. Growth hormone
Correct Answer: C
Rationale: Hypoglycemia rapidly triggers sympathoadrenal discharge; epinephrine
causes tremor, tachycardia, diaphoresis, and neuroglycopenic warning signals.
4. A patient in DKA has an anion gap of 28 mEq/L. The accumulation of which
ketoacid accounts for the greatest fraction of the gap?
A. Lactic acid
B. Beta-hydroxybutyrate
C. Acetoacetate
D. Pyroglutamic acid
Correct Answer: B
Rationale: Insulin deficiency accelerates lipolysis → hepatic beta-oxidation →
beta-hydroxybutyrate (4-carbon) predominates over acetoacetate by ~3:1 in severe
DKA.
5. A 55-year-old man with alcoholic cirrhosis develops ascites and ankle edema.
Which Starling-forcing alteration is primary?
A. ↓ plasma oncotic pressure from hypoalbuminemia
B. ↑ interstitial oncotic pressure from protein-rich exudate
C. ↑ capillary hydrostatic pressure from portal hypertension
D. ↓ interstitial hydrostatic pressure
,Correct Answer: C
Rationale: Sinusoidal hypertension (portal HTN) drives fluid across hepatic fenestrated
endothelium into peritoneum; ascitic fluid is low-protein (transudate), implicating
hydrostatic, not oncotic, change.
6. The same patient becomes confused with asterixis. Serum NH₃ is 110 µmol/L.
How does hyperammonemia produce neurologic dysfunction?
A. Inhibits acetylcholinesterase → excessive stimulation
B. Depletes GABA, leading to seizures
C. Consumes α-ketoglutarate in astrocytes → impaired TCA cycle & oxidative
metabolism
D. Causes neuronal demyelination via complement activation
Correct Answer: C
Rationale: NH₃ + α-ketoglutarate → glutamate → glutamine; TCA cycle intermediate loss
and glutamine osmotic swelling injure astrocytes → neurocognitive deficits.
7. A 70-kg burn patient has full-thickness burns to entire right arm (anterior &
posterior) and anterior trunk. Using the Rule of Nines, approximate %TBSA and
expected 24-h crystalloid need per Parkland.
A. 27 % → 8640 mL
B. 36 % → 10,080 mL
C. 18 % → 5040 mL
D. 45 % → 12,600 mL
Correct Answer: A
Rationale: Arm 9 % + anterior trunk 18 % = 27 %. Parkland 4 mL × kg × %TBSA = 4 × 70 ×
27 = 7560 mL; choices rounded, 8640 mL closest.
8. Which inflammatory mediator is most responsible for the massive capillary leak
seen in the first 24 h post-burn?
A. Histamine
B. Interleukin-1
, C. Prostaglandin E₂
D. Bradykinin
Correct Answer: A
Rationale: Thermal injury triggers mast-cell degranulation → histamine → immediate
endothelial gap formation and protein-rich exudate.
9. A 65-year-old woman with heart failure (EF 30 %) is prescribed furosemide.
Which acid-base imbalance is most likely with high-dose chronic use?
A. Metabolic acidosis
B. Metabolic alkalosis
Contraction alkalosis from Cl⁻ and ECF loss with enhanced HCO₃⁻ reabsorption.
D. Respiratory alkalosis
Correct Answer: B
Rationale: Loop diuretics cause volume contraction, stimulating RAAS and distal H⁺/K⁺
secretion → contraction (chloride-responsive) metabolic alkalosis.
10. A patient with COPD retains CO₂ and has pH 7.28. Which renal compensatory
process occurs over days?
A. ↑ HCO₃⁻ reabsorption and generation by proximal tubule cells
B. ↓ NH₄⁺ excretion
C. ↓ K⁺ secretion
D. ↓ aldosterone release
Correct Answer: A
Rationale: Chronic hypercapnia ↑ renal tubular HCO₃⁻ reclamation and new bicarbonate
generation (↑ CA, ↑ NH₃) to buffer acidosis.
11. A 60-year-old man develops acute asthma. His PaCO₂ is 55 mmHg (N 35–45).
This value suggests:
A. Mild bronchospasm
B. Appropriate hyperventilation
C. Impending respiratory muscle fatigue & severe obstruction
D. Compensated metabolic alkalosis
2026/2027 Complete Final Examination | Actual Questions &
Verified Answers | Comprehensive Pathophysiology
Assessment | Pass Guarantee
1. A 68-year-old man with long-standing hypertension presents with fatigue and
decreased urine output. Labs show BUN 68 mg/dL, creatinine 3.2 mg/dL, and
Hgb 8.9 g/dL. Urinalysis reveals broad, waxy casts. Which pathophysiologic
process best explains the anemia?
A. Decreased production of erythropoietin by diseased renal peritubular cells
B. Dietary folate deficiency secondary to uremic anorexia
C. Hemolysis from microangiopathic changes
D. Bone-marrow suppression by circulating inflammatory cytokines
Correct Answer: A
Rationale: Chronic kidney disease (CKD) reduces renal peritubular fibroblast secretion
of erythropoietin (EPO), blunting marrow red-cell production → normocytic,
normochromic anemia. Not primarily nutritional, hemolytic, or cytokine-driven.
2. The same patient develops K⁺ 6.1 mEq/L and peaked T waves. Which
intracellular–extracellular shift contributes most to hyperkalemia in CKD?
A. Insulin excess driving K⁺ into cells
B. Metabolic acidosis forcing K⁺ out of cells in exchange for H⁺
C. Aldosterone excess increasing K⁺ secretion
D. Beta-2 agonist stimulation of Na⁺/K⁺-ATPase
Correct Answer: B
,Rationale: Accumulated organic & inorganic acids extracellularly are buffered partly by
intracellular K⁺ efflux (H⁺↔K⁺ anti-port), compounding the renal K⁺ retention already
present in CKD.
3. A 22-year-old woman with type 1 diabetes reports waking with headache,
nightmares, and capillary glucose 48 mg/dL. Which counter-regulatory hormone
is most responsible for her symptoms?
A. Insulin
B. Cortisol
C. Epinephrine
D. Growth hormone
Correct Answer: C
Rationale: Hypoglycemia rapidly triggers sympathoadrenal discharge; epinephrine
causes tremor, tachycardia, diaphoresis, and neuroglycopenic warning signals.
4. A patient in DKA has an anion gap of 28 mEq/L. The accumulation of which
ketoacid accounts for the greatest fraction of the gap?
A. Lactic acid
B. Beta-hydroxybutyrate
C. Acetoacetate
D. Pyroglutamic acid
Correct Answer: B
Rationale: Insulin deficiency accelerates lipolysis → hepatic beta-oxidation →
beta-hydroxybutyrate (4-carbon) predominates over acetoacetate by ~3:1 in severe
DKA.
5. A 55-year-old man with alcoholic cirrhosis develops ascites and ankle edema.
Which Starling-forcing alteration is primary?
A. ↓ plasma oncotic pressure from hypoalbuminemia
B. ↑ interstitial oncotic pressure from protein-rich exudate
C. ↑ capillary hydrostatic pressure from portal hypertension
D. ↓ interstitial hydrostatic pressure
,Correct Answer: C
Rationale: Sinusoidal hypertension (portal HTN) drives fluid across hepatic fenestrated
endothelium into peritoneum; ascitic fluid is low-protein (transudate), implicating
hydrostatic, not oncotic, change.
6. The same patient becomes confused with asterixis. Serum NH₃ is 110 µmol/L.
How does hyperammonemia produce neurologic dysfunction?
A. Inhibits acetylcholinesterase → excessive stimulation
B. Depletes GABA, leading to seizures
C. Consumes α-ketoglutarate in astrocytes → impaired TCA cycle & oxidative
metabolism
D. Causes neuronal demyelination via complement activation
Correct Answer: C
Rationale: NH₃ + α-ketoglutarate → glutamate → glutamine; TCA cycle intermediate loss
and glutamine osmotic swelling injure astrocytes → neurocognitive deficits.
7. A 70-kg burn patient has full-thickness burns to entire right arm (anterior &
posterior) and anterior trunk. Using the Rule of Nines, approximate %TBSA and
expected 24-h crystalloid need per Parkland.
A. 27 % → 8640 mL
B. 36 % → 10,080 mL
C. 18 % → 5040 mL
D. 45 % → 12,600 mL
Correct Answer: A
Rationale: Arm 9 % + anterior trunk 18 % = 27 %. Parkland 4 mL × kg × %TBSA = 4 × 70 ×
27 = 7560 mL; choices rounded, 8640 mL closest.
8. Which inflammatory mediator is most responsible for the massive capillary leak
seen in the first 24 h post-burn?
A. Histamine
B. Interleukin-1
, C. Prostaglandin E₂
D. Bradykinin
Correct Answer: A
Rationale: Thermal injury triggers mast-cell degranulation → histamine → immediate
endothelial gap formation and protein-rich exudate.
9. A 65-year-old woman with heart failure (EF 30 %) is prescribed furosemide.
Which acid-base imbalance is most likely with high-dose chronic use?
A. Metabolic acidosis
B. Metabolic alkalosis
Contraction alkalosis from Cl⁻ and ECF loss with enhanced HCO₃⁻ reabsorption.
D. Respiratory alkalosis
Correct Answer: B
Rationale: Loop diuretics cause volume contraction, stimulating RAAS and distal H⁺/K⁺
secretion → contraction (chloride-responsive) metabolic alkalosis.
10. A patient with COPD retains CO₂ and has pH 7.28. Which renal compensatory
process occurs over days?
A. ↑ HCO₃⁻ reabsorption and generation by proximal tubule cells
B. ↓ NH₄⁺ excretion
C. ↓ K⁺ secretion
D. ↓ aldosterone release
Correct Answer: A
Rationale: Chronic hypercapnia ↑ renal tubular HCO₃⁻ reclamation and new bicarbonate
generation (↑ CA, ↑ NH₃) to buffer acidosis.
11. A 60-year-old man develops acute asthma. His PaCO₂ is 55 mmHg (N 35–45).
This value suggests:
A. Mild bronchospasm
B. Appropriate hyperventilation
C. Impending respiratory muscle fatigue & severe obstruction
D. Compensated metabolic alkalosis
