NUR 631 ADVANCED PHYSIOLOGY AND
PATHOPHYSIOLOGY MIDTERM AND FINAL EXAM PREP
TEST BANK 1 WITH 280 EXAM QUESTIONS AND CORRECT
ANSWERS/ GCU NUR 631 LATEST EXAM PREP (NEW!)
This document contains 287 multiple-choice questions and answers with
rationales covering advanced physiology and pathophysiology for NUR 631.
Topics include cellular injury, acid-base disorders, shock, heart failure, renal
disease, endocrine disorders, respiratory pathophysiology, immunology,
hematology, and gastrointestinal/hepatic conditions. Each question tests key
concepts relevant to midterm and final exams, with explanations that clarify
mechanisms, diagnostic findings, and clinical correlations. The questions
progress from fundamental pathophysiologic processes to complex
multisystem disorders, emphasizing application to clinical practice. This
resource is designed to reinforce understanding of disease mechanisms,
compensatory responses, and evidence-based management principles essential
for advanced nursing practice.
1. Which cellular change is most characteristic of reversible injury?
A) Karyolysis
B) Mitochondrial swelling
C) Pyknosis
D) Nuclear fragmentation
Answer: B
Rationale: Reversible injury typically shows cellular swelling and mitochondrial
swelling, while karyolysis, pyknosis, and nuclear fragmentation are features of
irreversible injury and necrosis.
2. In apoptosis, which event occurs?
A) Cell swelling and membrane rupture
B) Inflammation of surrounding tissue
C) Formation of apoptotic bodies
D) Random DNA degradation
Answer: C
,Rationale: Apoptosis involves controlled cell shrinkage, chromatin condensation,
and formation of apoptotic bodies that are phagocytosed without inflammation,
unlike necrosis.
3. A patient with chronic heart failure develops dependent edema. This is primarily
due to:
A) Decreased plasma oncotic pressure
B) Increased capillary hydrostatic pressure
C) Lymphatic obstruction
D) Sodium retention alone
Answer: B
Rationale: Chronic heart failure increases venous pressure, raising capillary
hydrostatic pressure, which favors fluid filtration into interstitium, causing
dependent edema.
4. Which acid-base disorder is expected in a patient with severe diarrhea?
A) Metabolic alkalosis
B) Respiratory acidosis
C) Metabolic acidosis
D) Respiratory alkalosis
Answer: C
Rationale: Severe diarrhea causes loss of bicarbonate-rich intestinal fluid, leading
to a non-anion gap metabolic acidosis.
5. During ischemia, the switch to anaerobic glycolysis results in:
A) Increased ATP production
B) Accumulation of lactic acid
C) Alkalosis
D) Increased fatty acid oxidation
Answer: B
Rationale: Anaerobic glycolysis produces lactate and H+, causing intracellular
acidosis, and yields only 2 ATP per glucose, not increased ATP or alkalosis.
6. A patient presents with fever, hypotension, and elevated serum lactate. This is
most consistent with:
A) Cardiogenic shock
B) Distributive shock
C) Hypovolemic shock
D) Obstructive shock
Answer: B
,Rationale: Fever, hypotension, and elevated lactate suggest distributive shock (e.g.,
septic shock), where vasodilation and maldistribution of blood flow cause tissue
hypoxia.
7. Which ion is most critical for myocardial contractility?
A) Sodium
B) Potassium
C) Calcium
D) Chloride
Answer: C
Rationale: Calcium binds to troponin C, initiating cross-bridge formation and
myocardial contraction; altered calcium handling directly affects contractility.
8. In heart failure, activation of the renin-angiotensin-aldosterone system (RAAS)
leads to:
A) Vasodilation
B) Natriuresis
C) Sodium and water retention
D) Decreased afterload
Answer: C
Rationale: RAAS activation increases angiotensin II and aldosterone, promoting
sodium and water retention, vasoconstriction, and increased preload and afterload.
9. A patient with chronic obstructive pulmonary disease (COPD) has a PaCO2 of
60 mmHg and pH 7.32. This represents:
A) Acute respiratory acidosis
B) Chronic respiratory acidosis with renal compensation
C) Metabolic acidosis
D) Mixed disorder
Answer: B
Rationale: Elevated PaCO2 with near-normal pH indicates chronic respiratory
acidosis; renal compensation increases bicarbonate. pH 7.32 is mild acidosis
expected in chronic state.
10. Which finding is characteristic of type 1 diabetes mellitus?
A) Strong association with obesity
B) Autoimmune destruction of pancreatic beta cells
C) Insulin resistance
D) Acanthosis nigricans
Answer: B
, Rationale: Type 1 diabetes results from autoimmune destruction of beta cells,
leading to absolute insulin deficiency; obesity and acanthosis nigricans are typical
of type 2.
11. In hyperkalemia, the cardiac membrane potential becomes:
A) Hyperpolarized
B) Less negative (depolarized)
C) Unchanged
D) More negative
Answer: B
Rationale: Hyperkalemia reduces the potassium gradient, making resting
membrane potential less negative, which can cause peaked T waves and
conduction abnormalities.
12. A patient has anion gap metabolic acidosis. Which of the following is a
common cause?
A) Diarrhea
B) Renal tubular acidosis
C) Salicylate overdose
D) Acetazolamide use
Answer: C
Rationale: Salicylate overdose causes high anion gap metabolic acidosis due to
accumulation of organic acids; diarrhea and RTA cause non-anion gap acidosis.
13. Which compensatory mechanism occurs in metabolic alkalosis?
A) Increased respiratory rate
B) Hypoventilation
C) Increased renal bicarbonate reabsorption
D) Decreased renal acid excretion
Answer: B
Rationale: In metabolic alkalosis, the lungs compensate by hypoventilation to
retain CO2 and raise PaCO2, though this compensation is limited by hypoxemia.
14. Atherosclerotic plaque rupture is most likely to cause:
A) Stable angina
B) Acute coronary syndrome
C) Chronic hypertension
D) Heart failure with preserved ejection fraction
Answer: B
PATHOPHYSIOLOGY MIDTERM AND FINAL EXAM PREP
TEST BANK 1 WITH 280 EXAM QUESTIONS AND CORRECT
ANSWERS/ GCU NUR 631 LATEST EXAM PREP (NEW!)
This document contains 287 multiple-choice questions and answers with
rationales covering advanced physiology and pathophysiology for NUR 631.
Topics include cellular injury, acid-base disorders, shock, heart failure, renal
disease, endocrine disorders, respiratory pathophysiology, immunology,
hematology, and gastrointestinal/hepatic conditions. Each question tests key
concepts relevant to midterm and final exams, with explanations that clarify
mechanisms, diagnostic findings, and clinical correlations. The questions
progress from fundamental pathophysiologic processes to complex
multisystem disorders, emphasizing application to clinical practice. This
resource is designed to reinforce understanding of disease mechanisms,
compensatory responses, and evidence-based management principles essential
for advanced nursing practice.
1. Which cellular change is most characteristic of reversible injury?
A) Karyolysis
B) Mitochondrial swelling
C) Pyknosis
D) Nuclear fragmentation
Answer: B
Rationale: Reversible injury typically shows cellular swelling and mitochondrial
swelling, while karyolysis, pyknosis, and nuclear fragmentation are features of
irreversible injury and necrosis.
2. In apoptosis, which event occurs?
A) Cell swelling and membrane rupture
B) Inflammation of surrounding tissue
C) Formation of apoptotic bodies
D) Random DNA degradation
Answer: C
,Rationale: Apoptosis involves controlled cell shrinkage, chromatin condensation,
and formation of apoptotic bodies that are phagocytosed without inflammation,
unlike necrosis.
3. A patient with chronic heart failure develops dependent edema. This is primarily
due to:
A) Decreased plasma oncotic pressure
B) Increased capillary hydrostatic pressure
C) Lymphatic obstruction
D) Sodium retention alone
Answer: B
Rationale: Chronic heart failure increases venous pressure, raising capillary
hydrostatic pressure, which favors fluid filtration into interstitium, causing
dependent edema.
4. Which acid-base disorder is expected in a patient with severe diarrhea?
A) Metabolic alkalosis
B) Respiratory acidosis
C) Metabolic acidosis
D) Respiratory alkalosis
Answer: C
Rationale: Severe diarrhea causes loss of bicarbonate-rich intestinal fluid, leading
to a non-anion gap metabolic acidosis.
5. During ischemia, the switch to anaerobic glycolysis results in:
A) Increased ATP production
B) Accumulation of lactic acid
C) Alkalosis
D) Increased fatty acid oxidation
Answer: B
Rationale: Anaerobic glycolysis produces lactate and H+, causing intracellular
acidosis, and yields only 2 ATP per glucose, not increased ATP or alkalosis.
6. A patient presents with fever, hypotension, and elevated serum lactate. This is
most consistent with:
A) Cardiogenic shock
B) Distributive shock
C) Hypovolemic shock
D) Obstructive shock
Answer: B
,Rationale: Fever, hypotension, and elevated lactate suggest distributive shock (e.g.,
septic shock), where vasodilation and maldistribution of blood flow cause tissue
hypoxia.
7. Which ion is most critical for myocardial contractility?
A) Sodium
B) Potassium
C) Calcium
D) Chloride
Answer: C
Rationale: Calcium binds to troponin C, initiating cross-bridge formation and
myocardial contraction; altered calcium handling directly affects contractility.
8. In heart failure, activation of the renin-angiotensin-aldosterone system (RAAS)
leads to:
A) Vasodilation
B) Natriuresis
C) Sodium and water retention
D) Decreased afterload
Answer: C
Rationale: RAAS activation increases angiotensin II and aldosterone, promoting
sodium and water retention, vasoconstriction, and increased preload and afterload.
9. A patient with chronic obstructive pulmonary disease (COPD) has a PaCO2 of
60 mmHg and pH 7.32. This represents:
A) Acute respiratory acidosis
B) Chronic respiratory acidosis with renal compensation
C) Metabolic acidosis
D) Mixed disorder
Answer: B
Rationale: Elevated PaCO2 with near-normal pH indicates chronic respiratory
acidosis; renal compensation increases bicarbonate. pH 7.32 is mild acidosis
expected in chronic state.
10. Which finding is characteristic of type 1 diabetes mellitus?
A) Strong association with obesity
B) Autoimmune destruction of pancreatic beta cells
C) Insulin resistance
D) Acanthosis nigricans
Answer: B
, Rationale: Type 1 diabetes results from autoimmune destruction of beta cells,
leading to absolute insulin deficiency; obesity and acanthosis nigricans are typical
of type 2.
11. In hyperkalemia, the cardiac membrane potential becomes:
A) Hyperpolarized
B) Less negative (depolarized)
C) Unchanged
D) More negative
Answer: B
Rationale: Hyperkalemia reduces the potassium gradient, making resting
membrane potential less negative, which can cause peaked T waves and
conduction abnormalities.
12. A patient has anion gap metabolic acidosis. Which of the following is a
common cause?
A) Diarrhea
B) Renal tubular acidosis
C) Salicylate overdose
D) Acetazolamide use
Answer: C
Rationale: Salicylate overdose causes high anion gap metabolic acidosis due to
accumulation of organic acids; diarrhea and RTA cause non-anion gap acidosis.
13. Which compensatory mechanism occurs in metabolic alkalosis?
A) Increased respiratory rate
B) Hypoventilation
C) Increased renal bicarbonate reabsorption
D) Decreased renal acid excretion
Answer: B
Rationale: In metabolic alkalosis, the lungs compensate by hypoventilation to
retain CO2 and raise PaCO2, though this compensation is limited by hypoxemia.
14. Atherosclerotic plaque rupture is most likely to cause:
A) Stable angina
B) Acute coronary syndrome
C) Chronic hypertension
D) Heart failure with preserved ejection fraction
Answer: B
