NUR 203 PATHOPHYSIOLOGY EXAM GUIDE 2026/27WITH
QUESTIONS AND CORRECT ANSWERS
1. A 65-year-old patient with chronic heart failure presents with
increased dyspnea, orthopnea, and bilateral leg edema. Which
pathophysiological mechanism primarily contributes to the
development of these symptoms?
A. Decreased aldosterone secretion leading to sodium loss
B. Increased sympathetic nervous system activity causing
vasoconstriction
C. Reduced renin-angiotensin-aldosterone system activation
D. Decreased antidiuretic hormone release
Correct Answer: B
Explanation: In heart failure, reduced cardiac output triggers
compensatory sympathetic nervous system activation, causing
vasoconstriction and increased afterload. This worsens cardiac
workload and contributes to fluid retention through secondary
aldosterone activation, leading to edema and dyspnea. Options A,
C, and D are incorrect because heart failure actually increases, not
decreases, aldosterone, renin-angiotensin system activity, and
ADH release.
2. Which of the following best describes the pathophysiology of
metabolic acidosis in diabetic ketoacidosis (DKA)?
A. Increased bicarbonate reabsorption in the kidneys
B. Accumulation of ketone bodies exceeding the body's buffering
capacity
C. Decreased production of lactic acid
, D. Respiratory compensation through hypoventilation
Correct Answer: B
Explanation: DKA causes metabolic acidosis through excessive
production of ketone bodies (acetoacetate and beta-
hydroxybutyrate) from fat metabolism due to insulin deficiency.
These acidic ketones overwhelm the bicarbonate buffering system,
lowering blood pH. Option A is incorrect as kidneys attempt to
excrete acid, not retain bicarbonate. Option C is wrong because
lactic acid may increase. Option D is incorrect because respiratory
compensation involves hyperventilation (Kussmaul breathing), not
hypoventilation.
3. A patient with chronic obstructive pulmonary disease (COPD) has
arterial blood gas results showing pH 7.32, PaCO2 58 mmHg, and
HCO3- 30 mEq/L. What is the primary acid-base disturbance?
A. Acute respiratory alkalosis
B. Chronic respiratory acidosis with metabolic compensation
C. Metabolic alkalosis with respiratory compensation
D. Mixed metabolic and respiratory acidosis
Correct Answer: B
Explanation: The elevated PaCO2 (normal 35-45 mmHg) indicates
respiratory acidosis, while the elevated HCO3- (normal 22-26
mEq/L) shows renal compensation through bicarbonate retention.
The pH of 7.32 (normal 7.35-7.45) indicates partial compensation,
consistent with chronic COPD. Option A is incorrect because pH is
acidic, not alkalotic. Option C is wrong because the primary
problem is respiratory, not metabolic. Option D is incorrect as
there's no evidence of concurrent metabolic acidosis.
,4. Which mechanism best explains the development of anemia of
chronic disease in patients with long-standing inflammatory
conditions?
A. Increased erythropoietin production by the kidneys
B. Hepcidin-mediated iron sequestration and reduced
erythropoiesis
C. Enhanced red blood cell survival in circulation
D. Increased intestinal iron absorption
Correct Answer: B
Explanation: Chronic inflammation increases hepcidin production
by the liver, which blocks iron release from macrophages and
reduces intestinal iron absorption. This leads to iron sequestration
and decreased availability for erythropoiesis, causing anemia.
Option A is incorrect because erythropoietin is typically blunted in
chronic disease. Options C and D are wrong because RBC survival
is decreased and iron absorption is reduced, not increased.
5. A 45-year-old woman presents with fatigue, weight gain, cold
intolerance, and elevated TSH with low free T4. What is the
underlying pathophysiology?
A. Primary hyperthyroidism with thyroid hormone resistance
B. Primary hypothyroidism due to thyroid gland failure
C. Secondary hypothyroidism from pituitary dysfunction
D. Tertiary hypothyroidism from hypothalamic disease
Correct Answer: B
Explanation: Elevated TSH with low free T4 indicates primary
, hypothyroidism, where the thyroid gland itself fails to produce
adequate hormone, triggering compensatory TSH elevation from
the pituitary. Option A is incorrect because hyperthyroidism would
show low TSH. Option C is wrong because secondary
hypothyroidism (pituitary cause) would show low or normal TSH
with low T4. Option D is incorrect as tertiary hypothyroidism would
also show low TSH.
6. Which pathophysiological change is most characteristic of type 2
diabetes mellitus?
A. Absolute insulin deficiency due to pancreatic beta-cell
destruction
B. Insulin resistance combined with relative insulin deficiency
C. Autoimmune destruction of pancreatic alpha cells
D. Excessive insulin production leading to hypoglycemia
Correct Answer: B
Explanation: Type 2 diabetes is characterized by insulin resistance
in peripheral tissues (muscle, fat, liver) combined with progressive
beta-cell dysfunction leading to relative insulin insufficiency.
Option A describes type 1 diabetes. Option C is incorrect because
alpha cells produce glucagon, and their destruction isn't the
primary problem. Option D is wrong as type 2 diabetes eventually
leads to insulin deficiency, not excess.
7. A patient with cirrhosis develops ascites. Which mechanism is the
PRIMARY contributor to ascites formation?
A. Decreased portal venous pressure
QUESTIONS AND CORRECT ANSWERS
1. A 65-year-old patient with chronic heart failure presents with
increased dyspnea, orthopnea, and bilateral leg edema. Which
pathophysiological mechanism primarily contributes to the
development of these symptoms?
A. Decreased aldosterone secretion leading to sodium loss
B. Increased sympathetic nervous system activity causing
vasoconstriction
C. Reduced renin-angiotensin-aldosterone system activation
D. Decreased antidiuretic hormone release
Correct Answer: B
Explanation: In heart failure, reduced cardiac output triggers
compensatory sympathetic nervous system activation, causing
vasoconstriction and increased afterload. This worsens cardiac
workload and contributes to fluid retention through secondary
aldosterone activation, leading to edema and dyspnea. Options A,
C, and D are incorrect because heart failure actually increases, not
decreases, aldosterone, renin-angiotensin system activity, and
ADH release.
2. Which of the following best describes the pathophysiology of
metabolic acidosis in diabetic ketoacidosis (DKA)?
A. Increased bicarbonate reabsorption in the kidneys
B. Accumulation of ketone bodies exceeding the body's buffering
capacity
C. Decreased production of lactic acid
, D. Respiratory compensation through hypoventilation
Correct Answer: B
Explanation: DKA causes metabolic acidosis through excessive
production of ketone bodies (acetoacetate and beta-
hydroxybutyrate) from fat metabolism due to insulin deficiency.
These acidic ketones overwhelm the bicarbonate buffering system,
lowering blood pH. Option A is incorrect as kidneys attempt to
excrete acid, not retain bicarbonate. Option C is wrong because
lactic acid may increase. Option D is incorrect because respiratory
compensation involves hyperventilation (Kussmaul breathing), not
hypoventilation.
3. A patient with chronic obstructive pulmonary disease (COPD) has
arterial blood gas results showing pH 7.32, PaCO2 58 mmHg, and
HCO3- 30 mEq/L. What is the primary acid-base disturbance?
A. Acute respiratory alkalosis
B. Chronic respiratory acidosis with metabolic compensation
C. Metabolic alkalosis with respiratory compensation
D. Mixed metabolic and respiratory acidosis
Correct Answer: B
Explanation: The elevated PaCO2 (normal 35-45 mmHg) indicates
respiratory acidosis, while the elevated HCO3- (normal 22-26
mEq/L) shows renal compensation through bicarbonate retention.
The pH of 7.32 (normal 7.35-7.45) indicates partial compensation,
consistent with chronic COPD. Option A is incorrect because pH is
acidic, not alkalotic. Option C is wrong because the primary
problem is respiratory, not metabolic. Option D is incorrect as
there's no evidence of concurrent metabolic acidosis.
,4. Which mechanism best explains the development of anemia of
chronic disease in patients with long-standing inflammatory
conditions?
A. Increased erythropoietin production by the kidneys
B. Hepcidin-mediated iron sequestration and reduced
erythropoiesis
C. Enhanced red blood cell survival in circulation
D. Increased intestinal iron absorption
Correct Answer: B
Explanation: Chronic inflammation increases hepcidin production
by the liver, which blocks iron release from macrophages and
reduces intestinal iron absorption. This leads to iron sequestration
and decreased availability for erythropoiesis, causing anemia.
Option A is incorrect because erythropoietin is typically blunted in
chronic disease. Options C and D are wrong because RBC survival
is decreased and iron absorption is reduced, not increased.
5. A 45-year-old woman presents with fatigue, weight gain, cold
intolerance, and elevated TSH with low free T4. What is the
underlying pathophysiology?
A. Primary hyperthyroidism with thyroid hormone resistance
B. Primary hypothyroidism due to thyroid gland failure
C. Secondary hypothyroidism from pituitary dysfunction
D. Tertiary hypothyroidism from hypothalamic disease
Correct Answer: B
Explanation: Elevated TSH with low free T4 indicates primary
, hypothyroidism, where the thyroid gland itself fails to produce
adequate hormone, triggering compensatory TSH elevation from
the pituitary. Option A is incorrect because hyperthyroidism would
show low TSH. Option C is wrong because secondary
hypothyroidism (pituitary cause) would show low or normal TSH
with low T4. Option D is incorrect as tertiary hypothyroidism would
also show low TSH.
6. Which pathophysiological change is most characteristic of type 2
diabetes mellitus?
A. Absolute insulin deficiency due to pancreatic beta-cell
destruction
B. Insulin resistance combined with relative insulin deficiency
C. Autoimmune destruction of pancreatic alpha cells
D. Excessive insulin production leading to hypoglycemia
Correct Answer: B
Explanation: Type 2 diabetes is characterized by insulin resistance
in peripheral tissues (muscle, fat, liver) combined with progressive
beta-cell dysfunction leading to relative insulin insufficiency.
Option A describes type 1 diabetes. Option C is incorrect because
alpha cells produce glucagon, and their destruction isn't the
primary problem. Option D is wrong as type 2 diabetes eventually
leads to insulin deficiency, not excess.
7. A patient with cirrhosis develops ascites. Which mechanism is the
PRIMARY contributor to ascites formation?
A. Decreased portal venous pressure
