NSG 5140 Advanced Pathophysiology Final Exam
{2 versions} Review 2026–2027 | 250 Original
Practice Questions & Answers with Rationales |
South College Study Guide | pdf
Overview & Coverage
Prepare confidently for the NSG 5140 Advanced Pathophysiology Final Exam with this
comprehensive collection of 250 original multiple-choice practice questions and detailed
answer rationales. Designed for graduate nursing students, this review strengthens clinical
reasoning and reinforces the core pathophysiology concepts commonly assessed in advanced
nursing programs. Each question is written to promote application of disease mechanisms,
clinical manifestations, and physiologic principles rather than simple memorization.
Coverage Includes:
Cellular injury, inflammation, and tissue repair
Fluid, electrolyte, and acid-base disorders
Cardiovascular pathophysiology and heart failure
Coronary artery disease, myocardial infarction, and shock
Respiratory disorders including COPD, asthma, ARDS, and pulmonary embolism
Renal disorders, acute kidney injury, and chronic kidney disease
Endocrine disorders including diabetes mellitus, thyroid disease, adrenal disorders, and
calcium regulation
Gastrointestinal and hepatic pathophysiology
Hematologic disorders and coagulation abnormalities
Neurologic disorders including stroke, Parkinson disease, Alzheimer's disease, and
dementia
Immune system disorders, autoimmune diseases, and hypersensitivity reactions
Musculoskeletal disorders including osteoporosis and rheumatoid arthritis
Infectious diseases, sepsis, systemic inflammatory response syndrome (SIRS), and
multiple organ dysfunction syndrome (MODS)
Oncology and mechanisms of carcinogenesis
Graduate-level clinical application scenarios with comprehensive rationales
This study guide is an excellent resource for South College NSG 5140, graduate nursing
pathophysiology courses, comprehensive final exam preparation, and advanced practice nursing
students seeking to master complex disease mechanisms through high-quality, original practice
questions.
,Question 1
A 62-year-old man with long-standing hypertension presents with progressive dyspnea on
exertion, orthopnea, and bilateral lower-extremity edema. Echocardiography demonstrates
concentric left ventricular hypertrophy with preserved ejection fraction. Which
pathophysiologic mechanism most likely explains his symptoms?
A. Dilated cardiomyopathy causing systolic dysfunction
B. Diastolic dysfunction resulting from impaired ventricular relaxation
C. Acute myocardial infarction causing papillary muscle rupture
D. Chronic mitral regurgitation causing volume overload
Answer: B. Diastolic dysfunction resulting from impaired ventricular relaxation
Explanation: Chronic hypertension causes concentric left ventricular hypertrophy, reducing
ventricular compliance and impairing diastolic filling. This leads to heart failure with
preserved ejection fraction (HFpEF), characterized by pulmonary congestion despite a
normal ejection fraction.
Question 2
A 28-year-old woman presents with fatigue, weight loss, hyperpigmentation of the skin,
hypotension, hyponatremia, and hyperkalemia. Laboratory evaluation demonstrates low
serum cortisol and markedly elevated adrenocorticotropic hormone levels. Which disorder
best explains these findings?
A. Secondary adrenal insufficiency
B. Cushing syndrome
C. Hyperaldosteronism
D. Primary adrenal insufficiency (Addison disease)
Answer: D. Primary adrenal insufficiency (Addison disease)
Explanation: Destruction of the adrenal cortex causes deficiencies of cortisol and
aldosterone. Elevated ACTH contributes to skin hyperpigmentation, while aldosterone
deficiency produces hyponatremia, hyperkalemia, and hypotension.
Question 3
,A patient with poorly controlled type 1 diabetes mellitus develops metabolic acidosis during
an episode of diabetic ketoacidosis. Which mechanism is primarily responsible for the acid-
base disturbance?
A. Increased bicarbonate production
B. Excessive carbon dioxide retention
C. Accumulation of ketone bodies due to increased fat metabolism
D. Excessive renal excretion of hydrogen ions
Answer: C. Accumulation of ketone bodies due to increased fat metabolism
Explanation: Absolute insulin deficiency promotes lipolysis and hepatic ketogenesis. The
accumulation of acetoacetate and β-hydroxybutyrate produces a high anion gap metabolic
acidosis.
Question 4
A 45-year-old patient develops septic shock from gram-negative bacteremia. Which
inflammatory mediator plays a central role in producing widespread vasodilation and
increased vascular permeability?
A. Erythropoietin
B. Insulin
C. Thyroxine
D. Tumor necrosis factor-alpha (TNF-α)
Answer: D. Tumor necrosis factor-alpha (TNF-α)
Explanation: TNF-α is a key proinflammatory cytokine released during sepsis. It promotes
endothelial activation, vasodilation, capillary leak, and contributes to the development of
distributive shock.
Question 5
A 54-year-old woman with autoimmune thyroid disease presents with fatigue, cold
intolerance, constipation, weight gain, and dry skin. Laboratory studies reveal elevated
thyroid-stimulating hormone and decreased free thyroxine concentrations. Which
mechanism best explains the elevated thyroid-stimulating hormone level?
, A. Increased secretion of thyroid hormone by the thyroid gland
B. Enhanced negative feedback from circulating thyroxine
C. Reduced negative feedback on the hypothalamic-pituitary axis caused by low
thyroid hormone levels
D. Increased pituitary destruction leading to hormone overproduction
Answer: C. Reduced negative feedback on the hypothalamic-pituitary axis caused by
low thyroid hormone levels
Explanation: In primary hypothyroidism, inadequate thyroid hormone production reduces
negative feedback on the hypothalamus and pituitary gland, resulting in elevated thyroid-
stimulating hormone secretion.
Question 6
A 67-year-old man with a history of chronic smoking presents with progressive dyspnea and
chronic productive cough. Pulmonary function testing reveals a markedly decreased
FEV₁/FVC ratio with minimal reversibility after bronchodilator administration. Which
pathophysiologic process best explains his disease?
A. Restrictive fibrosis causing reduced lung compliance
B. Pulmonary edema caused by left ventricular failure
C. Chronic airway inflammation with destruction of alveolar walls leading to airflow
limitation
D. Acute bronchospasm caused by allergen exposure
Answer: C. Chronic airway inflammation with destruction of alveolar walls leading to
airflow limitation
Explanation: Chronic obstructive pulmonary disease develops through persistent airway
inflammation, mucus hypersecretion, and emphysematous destruction of alveoli, producing
irreversible airflow obstruction.*
Question 7
A 59-year-old woman with long-standing diabetes mellitus develops persistent proteinuria
and declining kidney function. Which pathophysiologic change is primarily responsible for
diabetic nephropathy?
A. Autoimmune destruction of renal tubules
B. Acute renal vasospasm
{2 versions} Review 2026–2027 | 250 Original
Practice Questions & Answers with Rationales |
South College Study Guide | pdf
Overview & Coverage
Prepare confidently for the NSG 5140 Advanced Pathophysiology Final Exam with this
comprehensive collection of 250 original multiple-choice practice questions and detailed
answer rationales. Designed for graduate nursing students, this review strengthens clinical
reasoning and reinforces the core pathophysiology concepts commonly assessed in advanced
nursing programs. Each question is written to promote application of disease mechanisms,
clinical manifestations, and physiologic principles rather than simple memorization.
Coverage Includes:
Cellular injury, inflammation, and tissue repair
Fluid, electrolyte, and acid-base disorders
Cardiovascular pathophysiology and heart failure
Coronary artery disease, myocardial infarction, and shock
Respiratory disorders including COPD, asthma, ARDS, and pulmonary embolism
Renal disorders, acute kidney injury, and chronic kidney disease
Endocrine disorders including diabetes mellitus, thyroid disease, adrenal disorders, and
calcium regulation
Gastrointestinal and hepatic pathophysiology
Hematologic disorders and coagulation abnormalities
Neurologic disorders including stroke, Parkinson disease, Alzheimer's disease, and
dementia
Immune system disorders, autoimmune diseases, and hypersensitivity reactions
Musculoskeletal disorders including osteoporosis and rheumatoid arthritis
Infectious diseases, sepsis, systemic inflammatory response syndrome (SIRS), and
multiple organ dysfunction syndrome (MODS)
Oncology and mechanisms of carcinogenesis
Graduate-level clinical application scenarios with comprehensive rationales
This study guide is an excellent resource for South College NSG 5140, graduate nursing
pathophysiology courses, comprehensive final exam preparation, and advanced practice nursing
students seeking to master complex disease mechanisms through high-quality, original practice
questions.
,Question 1
A 62-year-old man with long-standing hypertension presents with progressive dyspnea on
exertion, orthopnea, and bilateral lower-extremity edema. Echocardiography demonstrates
concentric left ventricular hypertrophy with preserved ejection fraction. Which
pathophysiologic mechanism most likely explains his symptoms?
A. Dilated cardiomyopathy causing systolic dysfunction
B. Diastolic dysfunction resulting from impaired ventricular relaxation
C. Acute myocardial infarction causing papillary muscle rupture
D. Chronic mitral regurgitation causing volume overload
Answer: B. Diastolic dysfunction resulting from impaired ventricular relaxation
Explanation: Chronic hypertension causes concentric left ventricular hypertrophy, reducing
ventricular compliance and impairing diastolic filling. This leads to heart failure with
preserved ejection fraction (HFpEF), characterized by pulmonary congestion despite a
normal ejection fraction.
Question 2
A 28-year-old woman presents with fatigue, weight loss, hyperpigmentation of the skin,
hypotension, hyponatremia, and hyperkalemia. Laboratory evaluation demonstrates low
serum cortisol and markedly elevated adrenocorticotropic hormone levels. Which disorder
best explains these findings?
A. Secondary adrenal insufficiency
B. Cushing syndrome
C. Hyperaldosteronism
D. Primary adrenal insufficiency (Addison disease)
Answer: D. Primary adrenal insufficiency (Addison disease)
Explanation: Destruction of the adrenal cortex causes deficiencies of cortisol and
aldosterone. Elevated ACTH contributes to skin hyperpigmentation, while aldosterone
deficiency produces hyponatremia, hyperkalemia, and hypotension.
Question 3
,A patient with poorly controlled type 1 diabetes mellitus develops metabolic acidosis during
an episode of diabetic ketoacidosis. Which mechanism is primarily responsible for the acid-
base disturbance?
A. Increased bicarbonate production
B. Excessive carbon dioxide retention
C. Accumulation of ketone bodies due to increased fat metabolism
D. Excessive renal excretion of hydrogen ions
Answer: C. Accumulation of ketone bodies due to increased fat metabolism
Explanation: Absolute insulin deficiency promotes lipolysis and hepatic ketogenesis. The
accumulation of acetoacetate and β-hydroxybutyrate produces a high anion gap metabolic
acidosis.
Question 4
A 45-year-old patient develops septic shock from gram-negative bacteremia. Which
inflammatory mediator plays a central role in producing widespread vasodilation and
increased vascular permeability?
A. Erythropoietin
B. Insulin
C. Thyroxine
D. Tumor necrosis factor-alpha (TNF-α)
Answer: D. Tumor necrosis factor-alpha (TNF-α)
Explanation: TNF-α is a key proinflammatory cytokine released during sepsis. It promotes
endothelial activation, vasodilation, capillary leak, and contributes to the development of
distributive shock.
Question 5
A 54-year-old woman with autoimmune thyroid disease presents with fatigue, cold
intolerance, constipation, weight gain, and dry skin. Laboratory studies reveal elevated
thyroid-stimulating hormone and decreased free thyroxine concentrations. Which
mechanism best explains the elevated thyroid-stimulating hormone level?
, A. Increased secretion of thyroid hormone by the thyroid gland
B. Enhanced negative feedback from circulating thyroxine
C. Reduced negative feedback on the hypothalamic-pituitary axis caused by low
thyroid hormone levels
D. Increased pituitary destruction leading to hormone overproduction
Answer: C. Reduced negative feedback on the hypothalamic-pituitary axis caused by
low thyroid hormone levels
Explanation: In primary hypothyroidism, inadequate thyroid hormone production reduces
negative feedback on the hypothalamus and pituitary gland, resulting in elevated thyroid-
stimulating hormone secretion.
Question 6
A 67-year-old man with a history of chronic smoking presents with progressive dyspnea and
chronic productive cough. Pulmonary function testing reveals a markedly decreased
FEV₁/FVC ratio with minimal reversibility after bronchodilator administration. Which
pathophysiologic process best explains his disease?
A. Restrictive fibrosis causing reduced lung compliance
B. Pulmonary edema caused by left ventricular failure
C. Chronic airway inflammation with destruction of alveolar walls leading to airflow
limitation
D. Acute bronchospasm caused by allergen exposure
Answer: C. Chronic airway inflammation with destruction of alveolar walls leading to
airflow limitation
Explanation: Chronic obstructive pulmonary disease develops through persistent airway
inflammation, mucus hypersecretion, and emphysematous destruction of alveoli, producing
irreversible airflow obstruction.*
Question 7
A 59-year-old woman with long-standing diabetes mellitus develops persistent proteinuria
and declining kidney function. Which pathophysiologic change is primarily responsible for
diabetic nephropathy?
A. Autoimmune destruction of renal tubules
B. Acute renal vasospasm
