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Exam 2: NSG 3280 / NSG3280 (Latest Update 2025 /
2026) Pathophysiology for Nurses I | Questions and
Verified Answers | Grade A | 100% Correct - Galen
1. A patient with chronic hypertension develops left ventricular hypertrophy.
This cellular adaptation is best described as:
A. Atrophy
B. Hyperplasia
C. Metaplasia
D. Hypertrophy
Answer: D. Hypertrophy
Rationale: Hypertrophy is an increase in cell size (and often organ size) without an
increase in cell number. In response to the sustained pressure overload of
hypertension, cardiac myocytes enlarge, leading to ventricular wall thickening.
Atrophy is a decrease in cell size, hyperplasia is an increase in cell number, and
metaplasia is a change from one mature cell type to another.
2. A patient with long-standing GERD undergoes esophageal biopsy. The
pathology report indicates columnar epithelium in the distal esophagus,
replacing the normal squamous epithelium. This change is termed:
A. Dysplasia
B. Anaplasia
C. Metaplasia
D. Neoplasia
Answer: C. Metaplasia.
Rationale: Metaplasia is a reversible replacement of one mature cell type by
another. In Barrett's esophagus, chronic acid exposure causes the esophageal
squamous epithelium to be replaced by more acid-resistant columnar epithelium
(intestinal metaplasia), which increases the risk of dysplasia and adenocarcinoma.
pg. 1
,2
3. Which of the following is characteristic of irreversible cell injury leading to
necrosis, but not apoptosis?
A. Cell shrinkage and membrane blebbing
B. Caspase activation
C. Inflammatory response due to membrane rupture
D. DNA fragmentation into nucleosomal units
Answer: C. Inflammatory response due to membrane rupture.
Rationale: Necrosis is unregulated cell death from severe injury, characterized by
cell swelling, membrane rupture, and the release of intracellular contents that
triggers inflammation. Apoptosis is a programmed, energy-dependent process
that results in cell shrinkage, blebbing, DNA fragmentation, and phagocytosis
without inducing inflammation.
4. A patient's lab work shows elevated troponin I and CK-MB. The most likely
cellular event is:
A. Apoptosis of myocardial cells
B. Coagulative necrosis of myocardial tissue
C. Caseous necrosis
D. Fat necrosis
Answer: B. Coagulative necrosis of myocardial tissue.
Rationale: Coagulative necrosis, typical of hypoxic injury in all tissues except the
brain, is the mechanism of myocardial infarction. Cell outlines are preserved but
the tissue is dead. Troponin and CK-MB are intracellular proteins released upon
myocyte necrosis. Apoptosis is not the primary mechanism in an acute MI.
5. A patient undergoes surgery and develops a wound that heals by granulation
tissue formation and wound contraction. This is an example of:
A. Primary intention
B. Secondary intention
C. Tertiary intention
D. Keloid formation
pg. 2
,3
Answer: B. Secondary intention.
Rationale: Secondary intention occurs when the wound edges are not
approximated (e.g., ulcer, large open wound). Healing involves granulation tissue
filling the gap and wound contraction to close it. Primary intention is for clean,
approximated surgical incisions. Tertiary (delayed primary) intention is when a
contaminated wound is left open initially and closed later.
Immunity and Inflammation
6. A patient with seasonal allergies develops sneezing, runny nose, and watery
eyes within minutes of exposure to pollen. This reaction is mediated by:
A. IgG antibodies
B. IgM antibodies
C. IgE antibodies and mast cell degranulation
D. T-cell cytotoxicity
Answer: C. IgE antibodies and mast cell degranulation.
Rationale: Type I hypersensitivity (IgE-mediated) involves sensitization to an
allergen, IgE production, and binding to mast cells. On re-exposure, the allergen
cross-links IgE, triggering mast cell degranulation and release of histamine,
leukotrienes, and other mediators, causing immediate symptoms.
7. A patient with systemic lupus erythematosus (SLE) has renal involvement.
The pathogenesis is primarily which type of hypersensitivity?
A. Type I (IgE-mediated)
B. Type II (antibody-mediated cytotoxicity)
C. Type III (immune complex-mediated)
D. Type IV (cell-mediated)
Answer: C. Type III (immune complex-mediated).
Rationale: In SLE, autoantibodies form immune complexes with self-antigens (e.g.,
DNA). These complexes deposit in tissues such as glomeruli, joints, and skin,
activating complement and causing inflammation. Type II involves antibodies
binding directly to cell surfaces (e.g., autoimmune hemolytic anemia). Type IV is
T-cell mediated (e.g., contact dermatitis, tuberculosis).
pg. 3
, 4
8. A patient with HIV has a CD4 count of 180 cells/µL. The nurse understands
that the patient is at high risk for opportunistic infections because HIV primarily
affects:
A. B lymphocytes and antibody production
B. Helper T (CD4+) lymphocytes
C. Neutrophils
D. Macrophages
Answer: B. Helper T (CD4+) lymphocytes.
Rationale: HIV infects and destroys CD4+ T cells, which are central to
orchestrating both cell-mediated and humoral immunity. When the CD4 count
drops below 200 cells/µL, the patient is severely immunocompromised and at risk
for infections such as Pneumocystis jirovecii pneumonia (PJP) and
cytomegalovirus.
9. A patient receives a blood transfusion and develops fever, chills, and back
pain. The nurse suspects an acute hemolytic transfusion reaction. This is an
example of:
A. Type I hypersensitivity
B. Type II hypersensitivity
C. Type III hypersensitivity
D. Type IV hypersensitivity
Answer: B. Type II hypersensitivity.
Rationale: Type II reactions (cytotoxic) occur when IgG or IgM antibodies bind to
cell surface antigens. In ABO-incompatible transfusion, preformed antibodies bind
to donor RBCs, activating complement and causing rapid intravascular hemolysis,
leading to the symptoms described.
Cancer Biology
10. A biopsy of a breast mass reveals cells with marked variation in size and
shape, hyperchromatic nuclei, and loss of tissue architecture. These findings are
pg. 4
Exam 2: NSG 3280 / NSG3280 (Latest Update 2025 /
2026) Pathophysiology for Nurses I | Questions and
Verified Answers | Grade A | 100% Correct - Galen
1. A patient with chronic hypertension develops left ventricular hypertrophy.
This cellular adaptation is best described as:
A. Atrophy
B. Hyperplasia
C. Metaplasia
D. Hypertrophy
Answer: D. Hypertrophy
Rationale: Hypertrophy is an increase in cell size (and often organ size) without an
increase in cell number. In response to the sustained pressure overload of
hypertension, cardiac myocytes enlarge, leading to ventricular wall thickening.
Atrophy is a decrease in cell size, hyperplasia is an increase in cell number, and
metaplasia is a change from one mature cell type to another.
2. A patient with long-standing GERD undergoes esophageal biopsy. The
pathology report indicates columnar epithelium in the distal esophagus,
replacing the normal squamous epithelium. This change is termed:
A. Dysplasia
B. Anaplasia
C. Metaplasia
D. Neoplasia
Answer: C. Metaplasia.
Rationale: Metaplasia is a reversible replacement of one mature cell type by
another. In Barrett's esophagus, chronic acid exposure causes the esophageal
squamous epithelium to be replaced by more acid-resistant columnar epithelium
(intestinal metaplasia), which increases the risk of dysplasia and adenocarcinoma.
pg. 1
,2
3. Which of the following is characteristic of irreversible cell injury leading to
necrosis, but not apoptosis?
A. Cell shrinkage and membrane blebbing
B. Caspase activation
C. Inflammatory response due to membrane rupture
D. DNA fragmentation into nucleosomal units
Answer: C. Inflammatory response due to membrane rupture.
Rationale: Necrosis is unregulated cell death from severe injury, characterized by
cell swelling, membrane rupture, and the release of intracellular contents that
triggers inflammation. Apoptosis is a programmed, energy-dependent process
that results in cell shrinkage, blebbing, DNA fragmentation, and phagocytosis
without inducing inflammation.
4. A patient's lab work shows elevated troponin I and CK-MB. The most likely
cellular event is:
A. Apoptosis of myocardial cells
B. Coagulative necrosis of myocardial tissue
C. Caseous necrosis
D. Fat necrosis
Answer: B. Coagulative necrosis of myocardial tissue.
Rationale: Coagulative necrosis, typical of hypoxic injury in all tissues except the
brain, is the mechanism of myocardial infarction. Cell outlines are preserved but
the tissue is dead. Troponin and CK-MB are intracellular proteins released upon
myocyte necrosis. Apoptosis is not the primary mechanism in an acute MI.
5. A patient undergoes surgery and develops a wound that heals by granulation
tissue formation and wound contraction. This is an example of:
A. Primary intention
B. Secondary intention
C. Tertiary intention
D. Keloid formation
pg. 2
,3
Answer: B. Secondary intention.
Rationale: Secondary intention occurs when the wound edges are not
approximated (e.g., ulcer, large open wound). Healing involves granulation tissue
filling the gap and wound contraction to close it. Primary intention is for clean,
approximated surgical incisions. Tertiary (delayed primary) intention is when a
contaminated wound is left open initially and closed later.
Immunity and Inflammation
6. A patient with seasonal allergies develops sneezing, runny nose, and watery
eyes within minutes of exposure to pollen. This reaction is mediated by:
A. IgG antibodies
B. IgM antibodies
C. IgE antibodies and mast cell degranulation
D. T-cell cytotoxicity
Answer: C. IgE antibodies and mast cell degranulation.
Rationale: Type I hypersensitivity (IgE-mediated) involves sensitization to an
allergen, IgE production, and binding to mast cells. On re-exposure, the allergen
cross-links IgE, triggering mast cell degranulation and release of histamine,
leukotrienes, and other mediators, causing immediate symptoms.
7. A patient with systemic lupus erythematosus (SLE) has renal involvement.
The pathogenesis is primarily which type of hypersensitivity?
A. Type I (IgE-mediated)
B. Type II (antibody-mediated cytotoxicity)
C. Type III (immune complex-mediated)
D. Type IV (cell-mediated)
Answer: C. Type III (immune complex-mediated).
Rationale: In SLE, autoantibodies form immune complexes with self-antigens (e.g.,
DNA). These complexes deposit in tissues such as glomeruli, joints, and skin,
activating complement and causing inflammation. Type II involves antibodies
binding directly to cell surfaces (e.g., autoimmune hemolytic anemia). Type IV is
T-cell mediated (e.g., contact dermatitis, tuberculosis).
pg. 3
, 4
8. A patient with HIV has a CD4 count of 180 cells/µL. The nurse understands
that the patient is at high risk for opportunistic infections because HIV primarily
affects:
A. B lymphocytes and antibody production
B. Helper T (CD4+) lymphocytes
C. Neutrophils
D. Macrophages
Answer: B. Helper T (CD4+) lymphocytes.
Rationale: HIV infects and destroys CD4+ T cells, which are central to
orchestrating both cell-mediated and humoral immunity. When the CD4 count
drops below 200 cells/µL, the patient is severely immunocompromised and at risk
for infections such as Pneumocystis jirovecii pneumonia (PJP) and
cytomegalovirus.
9. A patient receives a blood transfusion and develops fever, chills, and back
pain. The nurse suspects an acute hemolytic transfusion reaction. This is an
example of:
A. Type I hypersensitivity
B. Type II hypersensitivity
C. Type III hypersensitivity
D. Type IV hypersensitivity
Answer: B. Type II hypersensitivity.
Rationale: Type II reactions (cytotoxic) occur when IgG or IgM antibodies bind to
cell surface antigens. In ABO-incompatible transfusion, preformed antibodies bind
to donor RBCs, activating complement and causing rapid intravascular hemolysis,
leading to the symptoms described.
Cancer Biology
10. A biopsy of a breast mass reveals cells with marked variation in size and
shape, hyperchromatic nuclei, and loss of tissue architecture. These findings are
pg. 4
