NURS 231 Pathophysiology Final Exam 2026/2027 – Portage
Learning Complete Final Examination | Actual Questions &
Verified Answers | Comprehensive Pathophysiology
Assessment | Pass Guarantee
1. A 58-year-old man with a 40-pack-year history presents with progressive dyspnea
on exertion and a barrel-shaped chest. Arterial blood gases show pH 7.35, PaCO₂
48 mmHg, HCO₃⁻ 28 mEq/L, PaO₂ 62 mmHg. Which intracellular adaptation in
bronchial epithelial cells most directly contributes to the chronic hypercapnia?
A. Increased Na⁺/K⁺-ATPase pumps
B. Up-regulation of carbonic anhydrase activity
C. Enhanced β₂-adrenergic receptors
D. Mitochondrial biogenesis
Correct Answer: B
Rationale: Chronic hypercapnia leads to renal compensation via increased
carbonic-anhydrase-mediated HCO₃⁻ reabsorption; bronchial epithelial cells also
up-regulate the enzyme to buffer CO₂, perpetuating the elevated PaCO₂. The other
choices do not directly affect CO₂ buffering.
2. A patient with congestive heart failure (EF 30%) is started on high-dose
furosemide and develops muscle cramps. Laboratory results: Na⁺ 128 mEq/L, K⁺
2.8 mEq/L, Cl⁻ 90 mEq/L, Mg²⁺ 1.2 mg/dL. Which pathophysiologic mechanism
best explains the low serum potassium?
A. Increased aldosterone secretion triggered by reduced effective circulating
volume
B. Osmotic shift of K⁺ into the intracellular compartment
C. Metabolic acidosis driving K⁺ out of cells
D. Decreased distal tubular flow rate
,Correct Answer: A
Rationale: Loop-diuretic-induced volume depletion activates RAAS; aldosterone
increases K⁺ secretion in cortical collecting duct. Choices B, C, and D are inconsistent
with the given data (no acidosis or low flow).
3. A patient with septic shock develops worsening lactic acidosis despite fluid
resuscitation. Blood pressure 68/40 mmHg, SvO₂ 55%, lactate 9 mmol/L. Which
cellular event is the primary driver of the elevated lactate?
A. Pyruvate dehydrogenase inhibition by endotoxin
B. Oxygen-free radical damage to mitochondrial DNA
C. Glycolytic flux exceeding pyruvate entry into Krebs cycle
D. Activation of inducible nitric-oxide synthase causing cytopathic hypoxia
Correct Answer: D
Rationale: In sepsis NO and peroxynitrite inhibit mitochondrial respiratory enzymes →
cytopathic hypoxia; cells cannot utilize delivered O₂, so pyruvate is shunted to lactate.
Choices A-C are secondary or do not explain normal SvO₂.
4. A 72-year-old woman with atrial fibrillation on warfarin develops acute-onset left
hemiparesis. CT shows no hemorrhage but a hyperdense M1 segment. Which
coagulation pathway component is most directly affected by warfarin’s
therapeutic action?
A. Factor V
B. Factor VII
C. Factor X
D. Fibrinogen
Correct Answer: B
Rationale: Warfarin inhibits vitamin-K-dependent γ-carboxylation; Factor VII (extrinsic
pathway) has the shortest half-life, so PT/INR rises first. Factors V and fibrinogen are
not vitamin-K dependent.
, 5. A patient with CKD stage 4 develops a normocytic, normochromic anemia. Which
pathophysiologic alteration best explains the decreased oxygen-carrying
capacity?
A. Reduced renal erythropoietin synthesis
B. Marrow suppression by uremic toxins
C. Chronic gastrointestinal blood loss
D. Iron sequestration in reticuloendothelial cells
Correct Answer: A
Rationale: Primary driver is inadequate EPO; marrow suppression (B) contributes but is
secondary. No evidence of iron loss (C) or anemia of inflammation (D) in the stem.
6. A 45-year-old man with alcohol-use disorder presents with acute epigastric pain
radiating to the back, serum lipase 1200 U/L, and a calcium of 7.2 mg/dL. Which
pathophysiologic process best accounts for the hypocalcemia?
A. Pancreatic proteases cleaving parathyroid hormone
B. Fat saponification consuming circulating calcium
C. Calcium chelation by free fatty acids
D. Hypomagnesemia-induced PTH resistance
Correct Answer: B
Rationale: Lipase hydrolyzes TG → free fatty acids that bind Ca²⁺ forming soaps in
necrotic fat. Hypomagnesemia (D) is common but not the primary mechanism here.
7. A patient with COPD develops peripheral edema and jugular venous distension.
Arterial blood gases show chronic respiratory acidosis. Which renal tubular cell
adaptation is most responsible for the systemic volume expansion?
A. Increased ENaC channel insertion
B. Up-regulation of H⁺-ATPase pumps
C. Augmented NaHCO₃ cotransporter activity
D. Down-regulation of aquaporin-2
Correct Answer: A
, Rationale: Chronic hypercapnia → renal Na⁺ retention via aldosterone and ENaC
up-regulation, contributing to cor pulmonale edema. H⁺ pumps (B) handle acid, not
volume.
8. A 30-year-old woman with systemic lupus erythematosus develops painless
hematuria and proteinuria. Renal biopsy shows subepithelial immune complex
deposits. Which complement pathway is predominantly activated in this form of
lupus nephritis?
A. Classical
B. Alternative
C. Lectin
D. Terminal only
Correct Answer: A
Rationale: Anti-dsDNA-immune complexes bind C1q → classical pathway, generating
C3a/C5a and membranous injury.
9. A patient with long-standing hypertension develops left-ventricular hypertrophy.
Which intracellular signaling cascade is most directly responsible for the
increased protein synthesis in cardiac myocytes?
A. PLC-IP₃-Ca²⁺
B. JAK-STAT
C. PI3K-Akt-mTOR
D. cAMP-PKA
Correct Answer: C
Rationale: Mechanical stretch and Ang II activate PI3K-Akt-mTOR, promoting
hypertrophic protein synthesis. Other pathways modulate ionotropy or acute stress.
10. A patient with type 2 diabetes and obesity undergoes bariatric surgery. Three
months post-op fasting glucose normalizes despite no medication. Which
pathophysiologic change best explains the euglycemia?
A. Increased adiponectin improving hepatic insulin sensitivity
B. Decreased incretin effect
Learning Complete Final Examination | Actual Questions &
Verified Answers | Comprehensive Pathophysiology
Assessment | Pass Guarantee
1. A 58-year-old man with a 40-pack-year history presents with progressive dyspnea
on exertion and a barrel-shaped chest. Arterial blood gases show pH 7.35, PaCO₂
48 mmHg, HCO₃⁻ 28 mEq/L, PaO₂ 62 mmHg. Which intracellular adaptation in
bronchial epithelial cells most directly contributes to the chronic hypercapnia?
A. Increased Na⁺/K⁺-ATPase pumps
B. Up-regulation of carbonic anhydrase activity
C. Enhanced β₂-adrenergic receptors
D. Mitochondrial biogenesis
Correct Answer: B
Rationale: Chronic hypercapnia leads to renal compensation via increased
carbonic-anhydrase-mediated HCO₃⁻ reabsorption; bronchial epithelial cells also
up-regulate the enzyme to buffer CO₂, perpetuating the elevated PaCO₂. The other
choices do not directly affect CO₂ buffering.
2. A patient with congestive heart failure (EF 30%) is started on high-dose
furosemide and develops muscle cramps. Laboratory results: Na⁺ 128 mEq/L, K⁺
2.8 mEq/L, Cl⁻ 90 mEq/L, Mg²⁺ 1.2 mg/dL. Which pathophysiologic mechanism
best explains the low serum potassium?
A. Increased aldosterone secretion triggered by reduced effective circulating
volume
B. Osmotic shift of K⁺ into the intracellular compartment
C. Metabolic acidosis driving K⁺ out of cells
D. Decreased distal tubular flow rate
,Correct Answer: A
Rationale: Loop-diuretic-induced volume depletion activates RAAS; aldosterone
increases K⁺ secretion in cortical collecting duct. Choices B, C, and D are inconsistent
with the given data (no acidosis or low flow).
3. A patient with septic shock develops worsening lactic acidosis despite fluid
resuscitation. Blood pressure 68/40 mmHg, SvO₂ 55%, lactate 9 mmol/L. Which
cellular event is the primary driver of the elevated lactate?
A. Pyruvate dehydrogenase inhibition by endotoxin
B. Oxygen-free radical damage to mitochondrial DNA
C. Glycolytic flux exceeding pyruvate entry into Krebs cycle
D. Activation of inducible nitric-oxide synthase causing cytopathic hypoxia
Correct Answer: D
Rationale: In sepsis NO and peroxynitrite inhibit mitochondrial respiratory enzymes →
cytopathic hypoxia; cells cannot utilize delivered O₂, so pyruvate is shunted to lactate.
Choices A-C are secondary or do not explain normal SvO₂.
4. A 72-year-old woman with atrial fibrillation on warfarin develops acute-onset left
hemiparesis. CT shows no hemorrhage but a hyperdense M1 segment. Which
coagulation pathway component is most directly affected by warfarin’s
therapeutic action?
A. Factor V
B. Factor VII
C. Factor X
D. Fibrinogen
Correct Answer: B
Rationale: Warfarin inhibits vitamin-K-dependent γ-carboxylation; Factor VII (extrinsic
pathway) has the shortest half-life, so PT/INR rises first. Factors V and fibrinogen are
not vitamin-K dependent.
, 5. A patient with CKD stage 4 develops a normocytic, normochromic anemia. Which
pathophysiologic alteration best explains the decreased oxygen-carrying
capacity?
A. Reduced renal erythropoietin synthesis
B. Marrow suppression by uremic toxins
C. Chronic gastrointestinal blood loss
D. Iron sequestration in reticuloendothelial cells
Correct Answer: A
Rationale: Primary driver is inadequate EPO; marrow suppression (B) contributes but is
secondary. No evidence of iron loss (C) or anemia of inflammation (D) in the stem.
6. A 45-year-old man with alcohol-use disorder presents with acute epigastric pain
radiating to the back, serum lipase 1200 U/L, and a calcium of 7.2 mg/dL. Which
pathophysiologic process best accounts for the hypocalcemia?
A. Pancreatic proteases cleaving parathyroid hormone
B. Fat saponification consuming circulating calcium
C. Calcium chelation by free fatty acids
D. Hypomagnesemia-induced PTH resistance
Correct Answer: B
Rationale: Lipase hydrolyzes TG → free fatty acids that bind Ca²⁺ forming soaps in
necrotic fat. Hypomagnesemia (D) is common but not the primary mechanism here.
7. A patient with COPD develops peripheral edema and jugular venous distension.
Arterial blood gases show chronic respiratory acidosis. Which renal tubular cell
adaptation is most responsible for the systemic volume expansion?
A. Increased ENaC channel insertion
B. Up-regulation of H⁺-ATPase pumps
C. Augmented NaHCO₃ cotransporter activity
D. Down-regulation of aquaporin-2
Correct Answer: A
, Rationale: Chronic hypercapnia → renal Na⁺ retention via aldosterone and ENaC
up-regulation, contributing to cor pulmonale edema. H⁺ pumps (B) handle acid, not
volume.
8. A 30-year-old woman with systemic lupus erythematosus develops painless
hematuria and proteinuria. Renal biopsy shows subepithelial immune complex
deposits. Which complement pathway is predominantly activated in this form of
lupus nephritis?
A. Classical
B. Alternative
C. Lectin
D. Terminal only
Correct Answer: A
Rationale: Anti-dsDNA-immune complexes bind C1q → classical pathway, generating
C3a/C5a and membranous injury.
9. A patient with long-standing hypertension develops left-ventricular hypertrophy.
Which intracellular signaling cascade is most directly responsible for the
increased protein synthesis in cardiac myocytes?
A. PLC-IP₃-Ca²⁺
B. JAK-STAT
C. PI3K-Akt-mTOR
D. cAMP-PKA
Correct Answer: C
Rationale: Mechanical stretch and Ang II activate PI3K-Akt-mTOR, promoting
hypertrophic protein synthesis. Other pathways modulate ionotropy or acute stress.
10. A patient with type 2 diabetes and obesity undergoes bariatric surgery. Three
months post-op fasting glucose normalizes despite no medication. Which
pathophysiologic change best explains the euglycemia?
A. Increased adiponectin improving hepatic insulin sensitivity
B. Decreased incretin effect
