PORTAGE LEARNING NURS 231 PATHOPHYSIOLOGY 2026/2027 | Page 1 | Passing Score: 75%
PORTAGE LEARNING
NURS 231 Pathophysiology
All Exams Combined
Official Cumulative Exam 2026/2027
180 75% One-Time Cert
QUESTIONS PASSING SCORE RECERTIFICATION
TABLE OF CONTENTS
Section 1 Cell Injury, Inflammation & Repair Q1-Q30
Section 2 Fluid, Electrolyte & Acid-Base Disorders Q31-Q60
Section 3 Cardiovascular & Respiratory Pathophysiology Q61-Q90
Section 4 Renal, GI & Hepatic Pathophysiology Q91-Q120
Section 5 Endocrine & Reproductive Pathophysiology Q121-Q150
Section 6 Neurologic, Musculoskeletal & Integumentary Disorders Q151-Q180
Instructions: Select the single best answer for each question. This exam covers all modules of Portage Learning NURS 231
PORTAGE LEARNING NURS 231 PATHOPHYSIOLOGY - 2026/2027 | Passing Score: 75% | Page 1 of 93
, SECTION 1 | Cell Injury, Inflammation & Repair | Q1-Q30 | NURS 231 Pathophysiology 2026/2027
Q1 Question 1 of 180
A 58-year-old man with a 25-year history of smoking presents with chronic cough.
Bronchoscopy reveals squamous epithelium replacing the normal ciliated columnar cells of
the bronchi. This adaptive cellular change is best described as which of the following?
A. Metaplasia, a reversible change where one adult cell type replaces another
B. Dysplasia, an abnormal proliferation of atypical cells
C. Hyperplasia, an increase in the number of cells in a tissue
D. Hypertrophy, an increase in cell size due to increased functional demand
Correct Answer: A
Rationale:
Metaplasia is a reversible adaptive change in which one differentiated cell type is replaced by another, often
in response to chronic irritation. In smokers, ciliated columnar epithelium is replaced by squamous
epithelium, which is more resistant to smoke but loses mucociliary clearance function. Dysplasia involves
disordered growth, not replacement of cell type.
Q2 Question 2 of 180
A 45-year-old woman suffers an acute myocardial infarction. Histologic examination of the
infarcted myocardial tissue 24 hours later would most likely demonstrate which pattern of
necrosis?
A. Fat necrosis with saponification of adipose tissue
B. Coagulative necrosis with preservation of tissue architecture
C. Liquefactive necrosis with cystic cavity formation
D. Caseous necrosis with granulomatous inflammation
Correct Answer: B
Rationale:
Coagulative necrosis is the hallmark of ischemic injury in solid organs such as the heart. Protein
denaturation preserves the tissue architecture outline while cells are dead. Liquefactive necrosis occurs in
the brain or with bacterial infections, while caseous necrosis is associated with tuberculosis.
PORTAGE LEARNING NURS 231 PATHOPHYSIOLOGY - 2026/2027 | Passing Score: 75% | Page 2 of 93
, SECTION 1 | Cell Injury, Inflammation & Repair | Q1-Q30 | NURS 231 Pathophysiology 2026/2027
Q3 Question 3 of 180
A 62-year-old man with congestive heart failure presents with bilateral lower extremity edema.
The mechanism of edema formation in this patient primarily involves which pathophysiologic
process?
A. Increased capillary permeability from inflammatory mediators causing fluid leakage
B. Lymphatic obstruction preventing interstitial fluid return to the circulation
C. Increased capillary hydrostatic pressure from venous congestion driving fluid into interstitial
spaces
D. Decreased plasma oncotic pressure from hypoalbuminemia allowing fluid extravasation
Correct Answer: C
Rationale:
In congestive heart failure, impaired cardiac output leads to venous congestion and increased venous
pressure, which is transmitted backward to the capillary bed. This increased hydrostatic pressure exceeds
the opposing oncotic pressure, driving fluid out of capillaries into the interstitial space, causing pitting
edema.
Q4 Question 4 of 180
A 35-year-old woman with systemic lupus erythematosus develops proteinuria and facial
edema. Her serum albumin is 2.0 g/dL. The edema in nephrotic syndrome is primarily caused
by which mechanism?
A. Increased capillary hydrostatic pressure from volume overload
B. Lymphatic obstruction from autoimmune-mediated lymph node destruction
C. Increased capillary permeability from complement activation
D. Decreased plasma oncotic pressure from protein loss allowing fluid shift to interstitial space
Correct Answer: D
Rationale:
Nephrotic syndrome causes heavy proteinuria leading to hypoalbuminemia. The decreased plasma oncotic
(colloid osmotic) pressure allows fluid to shift from the vascular compartment into the interstitial space,
causing generalized edema. This contrasts with the hydrostatic mechanism in heart failure.
PORTAGE LEARNING NURS 231 PATHOPHYSIOLOGY - 2026/2027 | Passing Score: 75% | Page 3 of 93
, SECTION 1 | Cell Injury, Inflammation & Repair | Q1-Q30 | NURS 231 Pathophysiology 2026/2027
Q5 Question 5 of 180
A 50-year-old man with chronic alcohol use disorder presents with jaundice and
hepatomegaly. Liver biopsy shows hepatocytes with granular, swollen cytoplasm and Mallory
bodies. The cellular injury pattern is best described as which of the following?
A. Cellular swelling (hydropic degeneration) representing reversible injury from ATP depletion
B. Coagulative necrosis from complete loss of blood supply
C. Apoptosis from programmed cell death activation
D. Metaplasia from chronic toxic exposure
Correct Answer: A
Rationale:
Cellular swelling (hydropic degeneration) is the first manifestation of cell injury, resulting from ATP depletion
that impairs the Na+/K+-ATPase pump. Sodium accumulates intracellularly, water follows osmotically, and
the cell swells. This is a reversible injury pattern. Mallory bodies represent intermediate filament damage but
do not indicate necrosis.
Q6 Question 6 of 180
A 3-year-old boy with recurrent bacterial infections is found to have a deficiency of
myeloperoxidase in neutrophils. This enzyme deficiency most directly impairs which cellular
function?
A. Phagocytosis and engulfment of microorganisms
B. Intracellular killing of phagocytosed organisms via the halide-dependent mechanism
C. Chemotaxis and migration of neutrophils to sites of infection
D. Opsonization and recognition of encapsulated bacteria
Correct Answer: B
Rationale:
Myeloperoxidase (MPO) is a lysosomal enzyme in neutrophil azurophilic granules that converts hydrogen
peroxide and chloride ions to hypochlorous acid (bleach), a potent antimicrobial agent. MPO deficiency
impairs this halide-dependent killing mechanism inside phagolysosomes, though other killing pathways
partially compensate.
PORTAGE LEARNING NURS 231 PATHOPHYSIOLOGY - 2026/2027 | Passing Score: 75% | Page 4 of 93
PORTAGE LEARNING
NURS 231 Pathophysiology
All Exams Combined
Official Cumulative Exam 2026/2027
180 75% One-Time Cert
QUESTIONS PASSING SCORE RECERTIFICATION
TABLE OF CONTENTS
Section 1 Cell Injury, Inflammation & Repair Q1-Q30
Section 2 Fluid, Electrolyte & Acid-Base Disorders Q31-Q60
Section 3 Cardiovascular & Respiratory Pathophysiology Q61-Q90
Section 4 Renal, GI & Hepatic Pathophysiology Q91-Q120
Section 5 Endocrine & Reproductive Pathophysiology Q121-Q150
Section 6 Neurologic, Musculoskeletal & Integumentary Disorders Q151-Q180
Instructions: Select the single best answer for each question. This exam covers all modules of Portage Learning NURS 231
PORTAGE LEARNING NURS 231 PATHOPHYSIOLOGY - 2026/2027 | Passing Score: 75% | Page 1 of 93
, SECTION 1 | Cell Injury, Inflammation & Repair | Q1-Q30 | NURS 231 Pathophysiology 2026/2027
Q1 Question 1 of 180
A 58-year-old man with a 25-year history of smoking presents with chronic cough.
Bronchoscopy reveals squamous epithelium replacing the normal ciliated columnar cells of
the bronchi. This adaptive cellular change is best described as which of the following?
A. Metaplasia, a reversible change where one adult cell type replaces another
B. Dysplasia, an abnormal proliferation of atypical cells
C. Hyperplasia, an increase in the number of cells in a tissue
D. Hypertrophy, an increase in cell size due to increased functional demand
Correct Answer: A
Rationale:
Metaplasia is a reversible adaptive change in which one differentiated cell type is replaced by another, often
in response to chronic irritation. In smokers, ciliated columnar epithelium is replaced by squamous
epithelium, which is more resistant to smoke but loses mucociliary clearance function. Dysplasia involves
disordered growth, not replacement of cell type.
Q2 Question 2 of 180
A 45-year-old woman suffers an acute myocardial infarction. Histologic examination of the
infarcted myocardial tissue 24 hours later would most likely demonstrate which pattern of
necrosis?
A. Fat necrosis with saponification of adipose tissue
B. Coagulative necrosis with preservation of tissue architecture
C. Liquefactive necrosis with cystic cavity formation
D. Caseous necrosis with granulomatous inflammation
Correct Answer: B
Rationale:
Coagulative necrosis is the hallmark of ischemic injury in solid organs such as the heart. Protein
denaturation preserves the tissue architecture outline while cells are dead. Liquefactive necrosis occurs in
the brain or with bacterial infections, while caseous necrosis is associated with tuberculosis.
PORTAGE LEARNING NURS 231 PATHOPHYSIOLOGY - 2026/2027 | Passing Score: 75% | Page 2 of 93
, SECTION 1 | Cell Injury, Inflammation & Repair | Q1-Q30 | NURS 231 Pathophysiology 2026/2027
Q3 Question 3 of 180
A 62-year-old man with congestive heart failure presents with bilateral lower extremity edema.
The mechanism of edema formation in this patient primarily involves which pathophysiologic
process?
A. Increased capillary permeability from inflammatory mediators causing fluid leakage
B. Lymphatic obstruction preventing interstitial fluid return to the circulation
C. Increased capillary hydrostatic pressure from venous congestion driving fluid into interstitial
spaces
D. Decreased plasma oncotic pressure from hypoalbuminemia allowing fluid extravasation
Correct Answer: C
Rationale:
In congestive heart failure, impaired cardiac output leads to venous congestion and increased venous
pressure, which is transmitted backward to the capillary bed. This increased hydrostatic pressure exceeds
the opposing oncotic pressure, driving fluid out of capillaries into the interstitial space, causing pitting
edema.
Q4 Question 4 of 180
A 35-year-old woman with systemic lupus erythematosus develops proteinuria and facial
edema. Her serum albumin is 2.0 g/dL. The edema in nephrotic syndrome is primarily caused
by which mechanism?
A. Increased capillary hydrostatic pressure from volume overload
B. Lymphatic obstruction from autoimmune-mediated lymph node destruction
C. Increased capillary permeability from complement activation
D. Decreased plasma oncotic pressure from protein loss allowing fluid shift to interstitial space
Correct Answer: D
Rationale:
Nephrotic syndrome causes heavy proteinuria leading to hypoalbuminemia. The decreased plasma oncotic
(colloid osmotic) pressure allows fluid to shift from the vascular compartment into the interstitial space,
causing generalized edema. This contrasts with the hydrostatic mechanism in heart failure.
PORTAGE LEARNING NURS 231 PATHOPHYSIOLOGY - 2026/2027 | Passing Score: 75% | Page 3 of 93
, SECTION 1 | Cell Injury, Inflammation & Repair | Q1-Q30 | NURS 231 Pathophysiology 2026/2027
Q5 Question 5 of 180
A 50-year-old man with chronic alcohol use disorder presents with jaundice and
hepatomegaly. Liver biopsy shows hepatocytes with granular, swollen cytoplasm and Mallory
bodies. The cellular injury pattern is best described as which of the following?
A. Cellular swelling (hydropic degeneration) representing reversible injury from ATP depletion
B. Coagulative necrosis from complete loss of blood supply
C. Apoptosis from programmed cell death activation
D. Metaplasia from chronic toxic exposure
Correct Answer: A
Rationale:
Cellular swelling (hydropic degeneration) is the first manifestation of cell injury, resulting from ATP depletion
that impairs the Na+/K+-ATPase pump. Sodium accumulates intracellularly, water follows osmotically, and
the cell swells. This is a reversible injury pattern. Mallory bodies represent intermediate filament damage but
do not indicate necrosis.
Q6 Question 6 of 180
A 3-year-old boy with recurrent bacterial infections is found to have a deficiency of
myeloperoxidase in neutrophils. This enzyme deficiency most directly impairs which cellular
function?
A. Phagocytosis and engulfment of microorganisms
B. Intracellular killing of phagocytosed organisms via the halide-dependent mechanism
C. Chemotaxis and migration of neutrophils to sites of infection
D. Opsonization and recognition of encapsulated bacteria
Correct Answer: B
Rationale:
Myeloperoxidase (MPO) is a lysosomal enzyme in neutrophil azurophilic granules that converts hydrogen
peroxide and chloride ions to hypochlorous acid (bleach), a potent antimicrobial agent. MPO deficiency
impairs this halide-dependent killing mechanism inside phagolysosomes, though other killing pathways
partially compensate.
PORTAGE LEARNING NURS 231 PATHOPHYSIOLOGY - 2026/2027 | Passing Score: 75% | Page 4 of 93
