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WorksheetsExam Overview and Basic Pathophysiology
Total questions: 65
Worksheet time: 33mins
Which Bloom’s Taxonomy purpose is most relevant for categorizing nursing exam questions by cognitive demand?
To calculate percentage grading curves
To schedule weekly lecture hours
To outline legal scope of practice
To classify cognitive levels of learning
Within the NCLEX Client Needs framework, which area includes Safe & Effective Care environment items such as management of care and safety/infection control?
Safe and Effective Care Environment
Physiological Adaptation Domain
Psychosocial Integrity Section
Health Promotion and Maintenance
Which statement best defines pathophysiology at a foundational level?
Listing of hospital billing procedures
Enumeration of public health policies
Study of functional changes in disease
Catalog of normal anatomy structures
A client with chronic myelocytic leukemia is noted to have a Philadelphia chromosome. This finding represents which genetic alteration category?
Epigenetic change unrelated to cancer
Mitochondrial DNA variant of aging
Single-gene mutation without phenotype
Chromosomal aberration linked to disease
Which example best illustrates a protein synthesis defect leading to disease?
Recombinant DNA used for insulin production
Trisomy 21 causing cognitive delays
Sickle cell anemia due to hemoglobin mutation
Gene amplification without clinical effect
Which statement best distinguishes mitochondrial DNA disorders from nuclear DNA disorders?
Nuclear DNA disorders never cause multisystem involvement
Nuclear DNA disorders cannot be inherited from the mother
Mitochondrial disorders always affect chromosome number only
Mitochondrial disorders involve only a small amount of DNA
Trisomy 21, also called Down syndrome, is best classified as which type of chromosomal abnormality?
Aneuploidy due to an extra chromosome
Duplication of mitochondrial DNA
Deletion involving a single gene
Translocation reducing chromosome size
A child has a recessive genetic disease. Which parental genotype combination is most consistent with this outcome?
One parent is homozygous recessive only
Both parents are heterozygous carriers
One parent is homozygous dominant
Both parents are homozygous dominant
Which feature most accurately characterizes autosomal dominant inheritance?
Mitochondrial DNA is always involved
Two mutant alleles are always required
One mutant allele can cause the phenotype
Only males manifest the phenotype
In sickle cell disease, which mechanism most directly leads to ischemic pain crises?
Sickled erythrocytes obstruct capillaries
Excess white cells destroy endothelium
Platelet deficiency causes vessel rupture
Hyperoxia reduces vascular tone
Which scenario best illustrates a structural chromosomal aberration?
Translocation forming the Philadelphia chromosome
Point mutation altering beta‑globin
Nondisjunction adding an extra chromosome 21
Triploidy involving an entire extra set
A couple asks about risks when both are heterozygous carriers for an autosomal recessive disease. Which Punnett square outcome is correct for each pregnancy?
75% affected, 25% unaffected, 0% carriers
0% affected, 50% carriers, 50% unaffected
50% affected, 50% unaffected, 0% carriers
25% affected, 50% carriers, 25% unaffected
Polycystic kidney disease (PKD) is cited as an autosomal dominant condition. Which genotype can express PKD?
Homozygous recessive only
Heterozygous recessive only
Heterozygous or homozygous dominant
Homozygous dominant only
Which pathway converts stored glycogen to glucose during fasting or increased demand?
Beta-oxidation in mitochondria
Gluconeogenesis in adipose tissue
Glycogenesis in liver and muscle
Glycogenolysis in liver and muscle
During prolonged fasting when glycogen stores are depleted, which process primarily produces new glucose from noncarbohydrate substrates?
Glycogenolysis in skeletal muscle
Glycolysis in red blood cells
Gluconeogenesis in liver and kidney
Lipogenesis in adipose tissue
Which statement best describes anaerobic glycolysis?
Yields two ATP per glucose without oxygen
Yields thirty-two ATP with abundant oxygen
Produces acetyl-CoA for the Krebs cycle
Consumes lactate to generate pyruvate
A direct metabolic consequence of cellular hypoxia is best described as:
Activation of gluconeogenesis in muscle
Decreased ATP and increased lactic acid
Increased ATP and decreased pyruvate
Enhanced oxidative phosphorylation efficiency
Which finding most strongly indicates metabolic acidosis rather than respiratory acidosis?
Low pH with normal HCO3 level
Low pH with low HCO3 level
Normal pH with high HCO3 level
Low pH with elevated CO2 level
Normal arterial pH range for the human body is:
7.15 to 7.25
7.45 to 7.55
7.25 to 7.35
7.35 to 7.45
Which alteration commonly contributes to metabolic acidosis in kidney failure?
Overproduction of bicarbonate in renal tubules
Retention of carbon dioxide from hypoventilation
Accumulation of hydrogen ions due to impaired excretion
Excessive loss of hydrogen ions due to hyperventilation
In thiamine deficiency, ATP production decreases primarily because:
Insulin secretion completely halts glucose uptake
Pyruvate cannot efficiently enter the Krebs cycle
Anaerobic glycolysis yields thirty-two ATP
Glycogen stores rapidly expand in the liver
Which clinical pattern best matches respiratory acidosis?
High pH with high HCO3 due to diuretics
Low pH with low HCO3 due to diarrhea
High pH with low HCO3 due to vomiting
Low pH with normal HCO3 due to CO2 retention
Which sequence reflects normal postprandial carbohydrate handling?
Carb absorption, gluconeogenesis, protein catabolism
Carb absorption, ketone production, acidosis occurs
Carb absorption, glucagon release, lipolysis begins
Carb absorption, insulin release, cellular uptake
A patient with Type 1 diabetes develops ketonemia and acetone breath during insulin deficiency because cells:
Oxidize amino acids producing excess bicarbonate
Prefer anaerobic glycolysis producing no acids
Increase glycogenesis leading to hypoketonemia
Use fatty acids generating ketones for energy
Which electrolyte-related consequence is most likely when solute status changes in the plasma compartment first?
Permanent expansion of extracellular fluid only
Domino shifts leading to intracellular alterations
Immediate hyperventilation preventing fluid shifts
No change because compartments are independent
Which change to resting membrane potential is expected when more cations enter a neuron at rest?
RMP stays unchanged and excitability decreases
RMP oscillates unpredictably and excitability varies
RMP shifts more negative and cell hyperpolarizes
RMP shifts more positive and cell hypopolarizes
Hypocalcemia has a special effect on cell membranes primarily by causing which change?
Increases Na+ permeability and excitability
Blocks Cl− channels and depolarization
Decreases Na+ permeability and excitability
Increases K+ permeability and hyperpolarization
Hypercalcemia typically causes which membrane effect and symptom pattern?
Decreased Cl− influx with tremors
Increased K+ efflux with muscle twitching
Decreased Na+ permeability with sluggish weakness
Increased Na+ permeability with tetany signs
The term describing the concentration of solutes per kilogram of solvent is best defined as
Osmolality of a solution
Oncotic pressure of plasma
Osmotic pressure across tissue
Tonicity of an infusion
Which statement best explains the direction of water movement by osmosis between two compartments?
Water moves toward the higher hydrostatic pressure
Water moves toward the lower solute concentration
Water moves toward the larger fluid volume
Water moves toward the higher solute concentration
Normal serum osmolality is closest to which range?
3.5–5.0 mEq/L potassium
7.35–7.45 arterial pH
120–135 mEq/L sodium
280–295 mOsm/kg water
A patient with vomiting and diarrhea loses water more than solutes. Which plasma change is most likely?
Hyperosmolar plasma with high osmotic pressure
Hypoosmolar plasma with low osmotic pressure
Hyperoncotic plasma with high protein levels
Isotonic plasma with normal oncotic pressure
With hyperosmolar plasma, the expected net fluid shift is most likely
From tissue to blood causing dehydration signs
From blood to tissue causing edema formation
Between cells with no compartment change
Into cells causing cellular swelling only
In response to hyperosmolar plasma, which compensatory system primarily activates to retain water and sodium?
Hypothalamic–pituitary–thyroid axis
Renin–angiotensin–aldosterone system
Natriuretic peptide system
Parasympathetic nervous system
Excessive water intake or SIADH most directly leads to which plasma state?
Isotonic plasma with stable tonicity
Hyperoncotic plasma with increased proteins
Hyperosmolar plasma with concentration
Hypoosmolar plasma with dilutional effects
Loss of plasma proteins in nephrotic syndrome mainly reduces which pressure, promoting edema?
Alveolar osmotic pressure
Interstitial hydrostatic pressure
Hydrostatic pressure in capillaries
Oncotic pressure within plasma
Cirrhosis with impaired protein synthesis most likely produces which lab finding and fluid status?
Normal osmolality with euvolemia
Low serum osmolality with fluid overload
High serum osmolality with dehydration
High oncotic pressure with diuresis
Which summary statement correctly pairs plasma osmolar status with clinical outcome?
Hyperosmolar plasma draws water into blood, causing dehydration
Hypoosmolar plasma draws water into blood, causing dehydration
Hypoosmolar plasma pulls water into cells, causing dehydration
Hyperosmolar plasma pushes water to tissues, causing edema
Edema can result from osmolar changes or increased hydrostatic pressure. Which example best represents the latter?
SIADH increases water and dilutes plasma
Pathologically increased blood pressure mechanically pushes fluid
Proteinuria reduces oncotic pull within vessels
Vomiting decreases water and concentrates plasma
Which nursing intervention best addresses symptomatic hypoosmolar plasma with pulmonary edema?
Encourage rapid oral free water intake
Restrict sodium while increasing fluids
Initiate hypotonic IV solution bolus
Administer hypertonic IV solution as ordered
Which process describes programmed cell death that is normal and controlled?
Apoptosis
Necrosis
Autolysis
Gangrene
A hallmark difference between benign and malignant neoplasms is best described as which feature?
Lack of any mass effect
Encapsulation with slow growth
Well-differentiated anaplasia
Inability to form new vessels
During cellular injury from ischemia, which immediate energy change occurs first?
Mitochondria increase ATP production
Protein synthesis accelerates rapidly
ATP depletion reduces Na⁺/K⁺ pump
Cell membrane gains integrity quickly
Free radicals primarily injure cells because they
steal electrons causing oxidation
supply extra electrons to DNA
stabilize membranes with peroxides
increase ATP by phosphorylation
Which antioxidant enzyme directly detoxifies superoxide in cells?
Caspase 3
DNA polymerase
Superoxide dismutase
Na⁺/K⁺ ATPase
Which change is most consistent with anaplasia in malignant tumors?
Stable specialized functions
Uniform nuclei and polarity
Orderly maturation and size
Loss of differentiation and atypia
Activation of an oncogene most directly promotes which cellular effect?
Enhanced DNA repair fidelity
Apoptotic signaling increase
Uncontrolled clonal proliferation
Permanent cell cycle arrest
Which best defines the T in the TNM cancer staging system?
Histologic cell appearance
Number of involved nodes
Presence of distant spread
Primary tumor size or extent
A patient with CO poisoning improves with 100% oxygen because carboxyhemoglobin
prevents any ATP use in cells
binds O₂ more strongly than CO
cannot be measured by tests
releases CO when O₂ is high
Which pattern best distinguishes necrosis from apoptosis?
Cell swelling with membrane rupture
Cell shrinkage with intact membrane
Caspase-dependent nuclear laddering
Phagocytosis without inflammation
Which laboratory rise best indicates leakage of intracellular enzymes from injured muscle?
Increased CK and troponin
Decreased serum albumin
Elevated bilirubin fraction
Low blood glucose level
Which cellular target is a primary site of free radical damage leading to leaky cells?
Centrioles via depolymerization
Ribosomal RNA via alkylation
Lipid membranes via peroxidation
Lysozymes via neutralization
Which term describes tumor-driven new blood vessel growth that supports rapid proliferation?
Angiogenesis
Lymphangiitis
Hemostasis
Vasculitis
Which cancer marker is most commonly associated with prostate tissue?
Prostate-specific antigen
Alpha-fetoprotein
Carcinoembryonic antigen
CA-125 glycoprotein
Chronic myelogenous leukemia is classically linked to which genetic change?
Philadelphia chromosome translocation
Whole genome duplication event
Point mutation in tumor suppressor
Mitochondrial DNA deletion
In an autosomal recessive disease, which genotype results in having the disease?
AA genotype present
Aa genotype present
A-only allele present
aa genotype present
In an autosomal dominant disease, which genotype indicates a carrier without disease?
Aa genotype only
No carrier exists
aa genotype only
AA genotype only
Two carrier parents (Aa × Aa) for an autosomal recessive trait have a child. What is the probability the child will have the disease?
25 percent chance
50 percent chance
75 percent chance
33 percent chance
One parent is heterozygous affected (Aa) and the other is homozygous normal (aa) for an autosomal dominant disease. What percent of children will be affected?
0 percent affected
100 percent affected
25 percent affected
50 percent affected
Which statement best differentiates genotype from phenotype in clinical genetics?
Phenotype is gamete type
Phenotype is DNA sequence
Genotype is allele combination
Genotype is observable traits
A diagram shows water moving from tissue into plasma when plasma osmolality increases. Which principle explains this shift?
Capillary leak prevents osmotic
Concentration calls osmotic
Oncotic pressure ignores
Hydrostatic pressure calls
Severe watery diarrhea removes water from the plasma compartment. What immediate effect does this have on plasma compared to tissue?
Both compartments stay equal
Tissue becomes more concentrated
Plasma becomes less concentrated
Plasma becomes more concentrated
Following plasma hyperosmolality, water shifts from tissue to blood. What cellular change is expected in tissues?
Cells remain unchanged
Cells shrink and dehydrate
Cells swell and lyse
Cells gain glycogen
Which bedside assessment most directly reflects tissue dehydration after fluid shifts from tissue to blood during diarrhea?
Jugular venous distension
Bounding peripheral pulses
Moist oral mucosa
Poor skin turgor noted
When evaluating acid–base and electrolytes using quick cues, which pairing is most appropriate?
pH questions—think sodium movement
Potassium questions—think acid or base
Sodium chloride questions—think osmolality
Calcium questions—think stool osmolality
