,NR 547 Advanced Pathophysiology Midterm 2025 Complete Actual
Exam Questions 1- 00 Examplify Online Proctored Exam Full Review
2026 update chamberlain college of nursing.
1. A nurse practitioner is reviewing a biopsy report that describes cells with anaplasia and loss
of differentiation. Which pathophysiologic process is MOST likely occurring?
A. Hyperplasia
B. Metaplasia
C. Dysplasia
D. Neoplasia
Correct Answer: D. Neoplasia
Expert Rationale: Neoplasia refers to new, uncontrolled cell growth that is purposeless and
continues even after the initiating stimulus is removed. Anaplasia (loss of cellular differentiation
and organization) is a hallmark of malignant neoplasms. These cells lose their normal structure
and function, becoming increasingly undifferentiated and primitive-appearing.
Explanation of Incorrect Options:
• A. Hyperplasia: This is an increase in the NUMBER of cells in an organ or tissue, but the
cells remain NORMAL and differentiated. It's reversible and stops when the stimulus is
removed (e.g., breast enlargement during pregnancy).
• B. Metaplasia: This is the reversible replacement of one differentiated cell type with
another differentiated cell type (e.g., Barrett's esophagus where squamous epithelium is
replaced by columnar epithelium). Cells remain differentiated.
• C. Dysplasia: This is disordered cellular growth with loss of cellular uniformity and
architectural orientation. While it's pre-malignant and can progress to neoplasia, it's still
potentially reversible and doesn't show the complete loss of differentiation seen in
anaplasia.
Test-Taking Tip: Cellular adaptations: Hyperplasia = ↑number (normal cells), Hypertrophy =
↑size (normal cells), Atrophy = ↓size/number, Metaplasia = cell type change (reversible),
Dysplasia = disordered growth (pre-cancer), Neoplasia = new growth (anaplasia, irreversible,
malignant). Anaplasia = hallmark of malignancy.
DIF: Analysis
REF: Advanced Pathophysiology: Cellular Biology and Cancer
,OBJ: Cellular adaptations and neoplasia
TOP: Cellular Pathophysiology/Neoplasia
2. A patient presents with metabolic acidosis. The arterial blood gas shows pH 7.25, HCO3- 15
mEq/L, and PaCO2 30 mmHg. What type of compensation is occurring?
A. No compensation
B. Partial respiratory compensation
C. Full respiratory compensation
D. Metabolic compensation
Correct Answer: B. Partial respiratory compensation
Expert Rationale: This ABG shows: pH 7.25 (acidotic, <7.35), HCO3- 15 mEq/L (low, <22 =
metabolic acidosis), PaCO2 30 mmHg (low, <35 = respiratory compensation). The pH is still
abnormal (acidotic), but the PaCO2 has decreased from normal (40 mmHg) toward normal,
indicating the respiratory system is compensating by blowing off CO2. Since pH is still abnormal,
it's PARTIAL compensation, not full.
Explanation of Incorrect Options:
• A. No compensation: This would show abnormal pH, abnormal HCO3-, and NORMAL
PaCO2 (40 mmHg). The low PaCO2 indicates compensation IS occurring.
• C. Full respiratory compensation: This would show pH in the NORMAL range (7.35-7.45),
abnormal HCO3-, and abnormal PaCO2. Full compensation returns pH to normal.
• D. Metabolic compensation: This would occur in respiratory acid-base disorders, where
the kidneys compensate by retaining or excreting HCO3-. This is a METABOLIC acidosis,
so the respiratory system compensates, not the metabolic system.
Test-Taking Tip: ABG compensation: Look at pH first. If pH abnormal = partial or no
compensation. If pH normal = full compensation. Then look at which system is compensating:
Metabolic disorder → Respiratory compensation (lungs change CO2). Respiratory disorder →
Metabolic compensation (kidneys change HCO3-). Remember: "The system NOT causing the
problem does the compensating."
DIF: Analysis
REF: Advanced Pathophysiology: Acid-Base Balance
OBJ: Acid-base compensation mechanisms
TOP: Fluid and Electrolytes/Acid-Base Imbalances
, 3. A patient with chronic kidney disease develops anemia. Which mechanism BEST explains
this pathophysiologic finding?
A. Increased red blood cell destruction
B. Decreased erythropoietin production
C. Bone marrow suppression from uremic toxins
D. Iron deficiency from blood loss
Correct Answer: B. Decreased erythropoietin production
Expert Rationale: The kidneys produce approximately 90% of the body's erythropoietin (EPO), a
hormone that stimulates red blood cell production in the bone marrow. In chronic kidney
disease, damaged renal tissue produces insufficient EPO, leading to decreased RBC production
and normocytic, normochromic anemia. This is the PRIMARY mechanism of anemia in CKD.
Explanation of Incorrect Options:
• A. Increased red blood cell destruction: While uremia can decrease RBC lifespan slightly,
hemolysis is not the primary mechanism of anemia in CKD.
• C. Bone marrow suppression from uremic toxins: Uremic toxins can mildly suppress
bone marrow, but this is a secondary mechanism. The primary cause is EPO deficiency.
• D. Iron deficiency from blood loss: Iron deficiency can occur in CKD (from phlebotomy,
GI bleeding, decreased absorption), but it's not the primary mechanism. Many CKD
patients have adequate iron stores but still develop anemia from EPO deficiency.
Test-Taking Tip: CKD anemia: Primary cause = decreased EPO production (kidneys make 90% of
EPO). Treatment = erythropoiesis-stimulating agents (epoetin alfa, darbepoetin) + iron
supplementation. Anemia typically develops when GFR <60 mL/min. Other CKD hematologic
issues: platelet dysfunction (bleeding risk), leukocyte dysfunction (infection risk).
DIF: Analysis
REF: Advanced Pathophysiology: Renal Pathophysiology
OBJ: Chronic kidney disease complications
TOP: Renal Pathophysiology/Chronic Kidney Disease
4. A patient is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH).
Which laboratory finding would the nurse practitioner EXPECT to see?
Exam Questions 1- 00 Examplify Online Proctored Exam Full Review
2026 update chamberlain college of nursing.
1. A nurse practitioner is reviewing a biopsy report that describes cells with anaplasia and loss
of differentiation. Which pathophysiologic process is MOST likely occurring?
A. Hyperplasia
B. Metaplasia
C. Dysplasia
D. Neoplasia
Correct Answer: D. Neoplasia
Expert Rationale: Neoplasia refers to new, uncontrolled cell growth that is purposeless and
continues even after the initiating stimulus is removed. Anaplasia (loss of cellular differentiation
and organization) is a hallmark of malignant neoplasms. These cells lose their normal structure
and function, becoming increasingly undifferentiated and primitive-appearing.
Explanation of Incorrect Options:
• A. Hyperplasia: This is an increase in the NUMBER of cells in an organ or tissue, but the
cells remain NORMAL and differentiated. It's reversible and stops when the stimulus is
removed (e.g., breast enlargement during pregnancy).
• B. Metaplasia: This is the reversible replacement of one differentiated cell type with
another differentiated cell type (e.g., Barrett's esophagus where squamous epithelium is
replaced by columnar epithelium). Cells remain differentiated.
• C. Dysplasia: This is disordered cellular growth with loss of cellular uniformity and
architectural orientation. While it's pre-malignant and can progress to neoplasia, it's still
potentially reversible and doesn't show the complete loss of differentiation seen in
anaplasia.
Test-Taking Tip: Cellular adaptations: Hyperplasia = ↑number (normal cells), Hypertrophy =
↑size (normal cells), Atrophy = ↓size/number, Metaplasia = cell type change (reversible),
Dysplasia = disordered growth (pre-cancer), Neoplasia = new growth (anaplasia, irreversible,
malignant). Anaplasia = hallmark of malignancy.
DIF: Analysis
REF: Advanced Pathophysiology: Cellular Biology and Cancer
,OBJ: Cellular adaptations and neoplasia
TOP: Cellular Pathophysiology/Neoplasia
2. A patient presents with metabolic acidosis. The arterial blood gas shows pH 7.25, HCO3- 15
mEq/L, and PaCO2 30 mmHg. What type of compensation is occurring?
A. No compensation
B. Partial respiratory compensation
C. Full respiratory compensation
D. Metabolic compensation
Correct Answer: B. Partial respiratory compensation
Expert Rationale: This ABG shows: pH 7.25 (acidotic, <7.35), HCO3- 15 mEq/L (low, <22 =
metabolic acidosis), PaCO2 30 mmHg (low, <35 = respiratory compensation). The pH is still
abnormal (acidotic), but the PaCO2 has decreased from normal (40 mmHg) toward normal,
indicating the respiratory system is compensating by blowing off CO2. Since pH is still abnormal,
it's PARTIAL compensation, not full.
Explanation of Incorrect Options:
• A. No compensation: This would show abnormal pH, abnormal HCO3-, and NORMAL
PaCO2 (40 mmHg). The low PaCO2 indicates compensation IS occurring.
• C. Full respiratory compensation: This would show pH in the NORMAL range (7.35-7.45),
abnormal HCO3-, and abnormal PaCO2. Full compensation returns pH to normal.
• D. Metabolic compensation: This would occur in respiratory acid-base disorders, where
the kidneys compensate by retaining or excreting HCO3-. This is a METABOLIC acidosis,
so the respiratory system compensates, not the metabolic system.
Test-Taking Tip: ABG compensation: Look at pH first. If pH abnormal = partial or no
compensation. If pH normal = full compensation. Then look at which system is compensating:
Metabolic disorder → Respiratory compensation (lungs change CO2). Respiratory disorder →
Metabolic compensation (kidneys change HCO3-). Remember: "The system NOT causing the
problem does the compensating."
DIF: Analysis
REF: Advanced Pathophysiology: Acid-Base Balance
OBJ: Acid-base compensation mechanisms
TOP: Fluid and Electrolytes/Acid-Base Imbalances
, 3. A patient with chronic kidney disease develops anemia. Which mechanism BEST explains
this pathophysiologic finding?
A. Increased red blood cell destruction
B. Decreased erythropoietin production
C. Bone marrow suppression from uremic toxins
D. Iron deficiency from blood loss
Correct Answer: B. Decreased erythropoietin production
Expert Rationale: The kidneys produce approximately 90% of the body's erythropoietin (EPO), a
hormone that stimulates red blood cell production in the bone marrow. In chronic kidney
disease, damaged renal tissue produces insufficient EPO, leading to decreased RBC production
and normocytic, normochromic anemia. This is the PRIMARY mechanism of anemia in CKD.
Explanation of Incorrect Options:
• A. Increased red blood cell destruction: While uremia can decrease RBC lifespan slightly,
hemolysis is not the primary mechanism of anemia in CKD.
• C. Bone marrow suppression from uremic toxins: Uremic toxins can mildly suppress
bone marrow, but this is a secondary mechanism. The primary cause is EPO deficiency.
• D. Iron deficiency from blood loss: Iron deficiency can occur in CKD (from phlebotomy,
GI bleeding, decreased absorption), but it's not the primary mechanism. Many CKD
patients have adequate iron stores but still develop anemia from EPO deficiency.
Test-Taking Tip: CKD anemia: Primary cause = decreased EPO production (kidneys make 90% of
EPO). Treatment = erythropoiesis-stimulating agents (epoetin alfa, darbepoetin) + iron
supplementation. Anemia typically develops when GFR <60 mL/min. Other CKD hematologic
issues: platelet dysfunction (bleeding risk), leukocyte dysfunction (infection risk).
DIF: Analysis
REF: Advanced Pathophysiology: Renal Pathophysiology
OBJ: Chronic kidney disease complications
TOP: Renal Pathophysiology/Chronic Kidney Disease
4. A patient is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH).
Which laboratory finding would the nurse practitioner EXPECT to see?
