NURS 618 / NURS618 Pathophysiology Exam 1 Practice
Test Actual 2026/2027 with Detailed Rationales | 100%
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SECTION 1: Cellular Pathophysiology & Adaptation (12 Questions)
Q1: A 65-year-old patient with heart failure has an enlarged heart on chest x-ray. The
cardiomyocytes demonstrate increased cell size with increased functional demand.
This cellular adaptation is best described as:
A. Hyperplasia
B. Hypertrophy [CORRECT]
C. Metaplasia
D. Dysplasia
Correct Answer: B
Rationale: Hypertrophy is an increase in cell size resulting in enlarged organ mass,
commonly seen in cardiac muscle responding to increased workload such as
hypertension or valvular disease.
Q2: A postmenopausal woman has endometrial atrophy. Which mechanism best
explains this cellular change?
A. Increased hormonal stimulation
B. Decreased estrogen stimulation leading to reduced protein synthesis and cell size
[CORRECT]
C. Increased cell division
D. Inflammatory cell infiltration
Correct Answer: B
Rationale: Atrophy results from decreased workload, hormonal stimulation, or
nutrient supply, causing reduced protein synthesis and organelle loss;
postmenopausal endometrial atrophy follows estrogen decline.
Q3: A smoker's bronchial epithelium transforms from pseudostratified ciliated
columnar to stratified squamous epithelium. This change represents:
,A. Dysplasia
B. Hyperplasia
C. Metaplasia [CORRECT]
D. Anaplasia
Correct Answer: C
Rationale: Metaplasia is the reversible replacement of one differentiated cell type
with another better suited to withstand chronic irritation, such as squamous
metaplasia in respiratory epithelium from smoking.
Q4: In ischemic cell injury, which intracellular change is the earliest and still
reversible event?
A. Karyorrhexis
B. Cell membrane rupture
C. Decreased ATP and cellular swelling [CORRECT]
D. Lysosomal enzyme release
Correct Answer: C
Rationale: Decreased ATP causes Na+/K+-ATPase pump failure, leading to cellular
swelling from water influx; this is the earliest reversible change before irreversible
membrane damage occurs.
Q5: A biopsy reveals cells with shrunken, intensely eosinophilic cytoplasm, pyknotic
nuclei, intact cell membranes, and no inflammatory infiltrate. This pattern is
characteristic of:
A. Coagulative necrosis
B. Liquefactive necrosis
C. Apoptosis [CORRECT]
D. Caseous necrosis
Correct Answer: C
Rationale: Apoptosis features cell shrinkage, chromatin condensation, intact
membranes, and absence of inflammation, distinguishing it from necrosis which
involves cell swelling and inflammatory response.
Q6: Which enzyme is responsible for generating reactive oxygen species during
ischemia-reperfusion injury?
A. Cytochrome P450
B. Xanthine oxidase [CORRECT]
, C. Cyclooxygenase
D. Lipoxygenase
Correct Answer: B
Rationale: During ischemia, xanthine dehydrogenase converts to xanthine oxidase;
upon reperfusion, this enzyme generates superoxide and hydrogen peroxide from
accumulated hypoxanthine and oxygen.
Q7: A patient with chronic alcoholism develops hepatic steatosis. Which mechanism
is primarily responsible for fatty change in hepatocytes?
A. Increased fatty acid oxidation
B. Decreased lipoprotein synthesis and export, and increased triglyceride synthesis
[CORRECT]
C. Increased bile acid production
D. Enhanced mitochondrial beta-oxidation
Correct Answer: B
Rationale: Alcohol metabolism depletes NAD+, impairs mitochondrial beta-oxidation,
and reduces lipoprotein synthesis, causing triglyceride accumulation in hepatocytes
characteristic of fatty liver.
Q8: The intrinsic pathway of apoptosis is initiated by:
A. Death receptor-ligand binding on the cell surface
B. Activation of caspase-8
C. Mitochondrial release of cytochrome c and activation of caspase-9 [CORRECT]
D. Fas ligand binding only
Correct Answer: C
Rationale: The intrinsic pathway involves mitochondrial outer membrane
permeabilization, cytochrome c release, apoptosome formation with Apaf-1, and
caspase-9 activation leading to executioner caspase activation.
Q9: A patient with chronic kidney disease develops metastatic calcification in normal
tissues. Which laboratory abnormality is most responsible?
A. Hypophosphatemia
B. Hyperphosphatemia with secondary hyperparathyroidism [CORRECT]
C. Hypocalcemia alone
D. Respiratory alkalosis
Correct Answer: B
Test Actual 2026/2027 with Detailed Rationales | 100%
Verified | Pass Guaranteed – A+ Graded
SECTION 1: Cellular Pathophysiology & Adaptation (12 Questions)
Q1: A 65-year-old patient with heart failure has an enlarged heart on chest x-ray. The
cardiomyocytes demonstrate increased cell size with increased functional demand.
This cellular adaptation is best described as:
A. Hyperplasia
B. Hypertrophy [CORRECT]
C. Metaplasia
D. Dysplasia
Correct Answer: B
Rationale: Hypertrophy is an increase in cell size resulting in enlarged organ mass,
commonly seen in cardiac muscle responding to increased workload such as
hypertension or valvular disease.
Q2: A postmenopausal woman has endometrial atrophy. Which mechanism best
explains this cellular change?
A. Increased hormonal stimulation
B. Decreased estrogen stimulation leading to reduced protein synthesis and cell size
[CORRECT]
C. Increased cell division
D. Inflammatory cell infiltration
Correct Answer: B
Rationale: Atrophy results from decreased workload, hormonal stimulation, or
nutrient supply, causing reduced protein synthesis and organelle loss;
postmenopausal endometrial atrophy follows estrogen decline.
Q3: A smoker's bronchial epithelium transforms from pseudostratified ciliated
columnar to stratified squamous epithelium. This change represents:
,A. Dysplasia
B. Hyperplasia
C. Metaplasia [CORRECT]
D. Anaplasia
Correct Answer: C
Rationale: Metaplasia is the reversible replacement of one differentiated cell type
with another better suited to withstand chronic irritation, such as squamous
metaplasia in respiratory epithelium from smoking.
Q4: In ischemic cell injury, which intracellular change is the earliest and still
reversible event?
A. Karyorrhexis
B. Cell membrane rupture
C. Decreased ATP and cellular swelling [CORRECT]
D. Lysosomal enzyme release
Correct Answer: C
Rationale: Decreased ATP causes Na+/K+-ATPase pump failure, leading to cellular
swelling from water influx; this is the earliest reversible change before irreversible
membrane damage occurs.
Q5: A biopsy reveals cells with shrunken, intensely eosinophilic cytoplasm, pyknotic
nuclei, intact cell membranes, and no inflammatory infiltrate. This pattern is
characteristic of:
A. Coagulative necrosis
B. Liquefactive necrosis
C. Apoptosis [CORRECT]
D. Caseous necrosis
Correct Answer: C
Rationale: Apoptosis features cell shrinkage, chromatin condensation, intact
membranes, and absence of inflammation, distinguishing it from necrosis which
involves cell swelling and inflammatory response.
Q6: Which enzyme is responsible for generating reactive oxygen species during
ischemia-reperfusion injury?
A. Cytochrome P450
B. Xanthine oxidase [CORRECT]
, C. Cyclooxygenase
D. Lipoxygenase
Correct Answer: B
Rationale: During ischemia, xanthine dehydrogenase converts to xanthine oxidase;
upon reperfusion, this enzyme generates superoxide and hydrogen peroxide from
accumulated hypoxanthine and oxygen.
Q7: A patient with chronic alcoholism develops hepatic steatosis. Which mechanism
is primarily responsible for fatty change in hepatocytes?
A. Increased fatty acid oxidation
B. Decreased lipoprotein synthesis and export, and increased triglyceride synthesis
[CORRECT]
C. Increased bile acid production
D. Enhanced mitochondrial beta-oxidation
Correct Answer: B
Rationale: Alcohol metabolism depletes NAD+, impairs mitochondrial beta-oxidation,
and reduces lipoprotein synthesis, causing triglyceride accumulation in hepatocytes
characteristic of fatty liver.
Q8: The intrinsic pathway of apoptosis is initiated by:
A. Death receptor-ligand binding on the cell surface
B. Activation of caspase-8
C. Mitochondrial release of cytochrome c and activation of caspase-9 [CORRECT]
D. Fas ligand binding only
Correct Answer: C
Rationale: The intrinsic pathway involves mitochondrial outer membrane
permeabilization, cytochrome c release, apoptosome formation with Apaf-1, and
caspase-9 activation leading to executioner caspase activation.
Q9: A patient with chronic kidney disease develops metastatic calcification in normal
tissues. Which laboratory abnormality is most responsible?
A. Hypophosphatemia
B. Hyperphosphatemia with secondary hyperparathyroidism [CORRECT]
C. Hypocalcemia alone
D. Respiratory alkalosis
Correct Answer: B
