NR 283 Pathophysiology Exam 1 Official Practice
Exam Actual Exam 2026/2027 with Detailed
Rationales | Complete Exam-Style Questions |
Pass Guaranteed – A+ Graded
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SECTION 1: CELLULAR BIOLOGY, ADAPTATION & INJURY Q1 – Q10
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Question 1 of 50
68-year-old male with a fractured femur has been on bed rest for 6 weeks. Muscle biopsy
A
reveals a decrease in cell size due to decreased protein synthesis and increased proteolysis.
Identify the cellular adaptation occurring in this patient.
. Hypertrophy
A
B. Atrophy
C. Metaplasia
D. Hyperplasia
orrect Answer: B
C
Rationale: Atrophy is a decrease in cell size due to decreased workload, represented here by
disuse. Hypertrophy is an increase in cell size, while hyperplasia is an increase in cell number,
neither of which occurs in immobilized skeletal muscle. Look for decreased use or inadequate
nutrition to point toward atrophy.
Question 2 of 50
55-year-old female with chronic hypertension has an echocardiogram showing an increased
A
left ventricular wall thickness without an increase in chamber size. Determine the primary
cellular mechanism responsible for this myocardial adaptation.
. Increased number of myocardial cells due to chronic pressure
A
B. Accumulation of lipofuscin within the cardiac myocytes
C. Increase in myocardial cell size in response to increased workload
D. Replacement of normal myocardium with fibrous connective tissue
Correct Answer: C
, ationale: Hypertrophy is an increase in cell size resulting from increased workload or hormonal
R
stimulation, as seen in the cardiac myocytes responding to elevated systemic vascular
resistance. The myocardium cannot undergo hyperplasia because cardiac myocytes are
terminally differentiated and cannot increase in number. On exams, remember that pressure
overload leads to concentric hypertrophy, whereas volume overload leads to eccentric
hypertrophy.
Question 3 of 50
42-year-old female presents with heavy, irregular menstrual bleeding. Endometrial biopsy
A
reveals an abnormally increased number of endometrial glandular cells. Identify the specific
cellular adaptation triggered by the prolonged estrogen exposure.
. Pathologic hyperplasia driven by hormonal stimulation
A
B. Metaplasia of the endometrial stroma to glandular tissue
C. Compensatory hyperplasia in response to tissue loss
D. Dysplasia characterized by abnormal maturation of cells
orrect Answer: A
C
Rationale: Pathologic hyperplasia occurs when a tissue, such as the endometrium, proliferates
excessively in response to unopposed estrogen stimulation. Compensatory hyperplasia occurs
when tissue regenerates after injury or resection, such as liver regeneration, not in response to
hormones. Distinguish hormonal hyperplasia from compensatory hyperplasia based on the
initiating stimulus.
Question 4 of 50
50-year-old male with a 20-year history of gastroesophageal reflux disease undergoes
A
endoscopy, revealing a replacement of normal esophageal squamous epithelium with columnar
epithelium. Explain the pathophysiologic purpose of this cellular adaptation.
. To increase the surface area for acid absorption in the esophagus
A
B. To transform the esophageal cells into a more resistant cell type
C. To initiate a pre-malignant transformation through anaplasia
D. To decrease the metabolic rate of the esophageal tissue
orrect Answer: B
C
Rationale: Metaplasia is a reversible, adaptive substitution of one adult cell type for another,
allowing the tissue to better withstand chronic stress, such as replacing squamous cells with
acid-resistant columnar cells. Although metaplasia is an adaptive response, it is not
pre-malignant itself, but prolonged metaplasia can increase the risk of dysplasia and neoplasia.
Remember that metaplasia is a survival mechanism, not a direct step toward cancer, though it
creates a vulnerable environment.
, Question 5 of 50
32-year-old female has an abnormal Pap smear. Colposcopy with biopsy shows disorganized,
A
atypical cervical cells with enlarged, hyperchromatic nuclei that do not extend through the full
epithelial thickness. Determine the correct classification of this cellular change.
. Metaplasia with full-thickness cellular replacement
A
B. Carcinoma in situ with invasion of the basement membrane
C. Dysplasia characterized by abnormal, atypical cellular proliferation
D. Anaplasia with loss of cellular differentiation and function
orrect Answer: C
C
Rationale: Dysplasia refers to abnormal, atypical cellular proliferation and disorganized
arrangement that does not penetrate the basement membrane, often triggered by chronic
irritation or HPV. Carcinoma in situ involves full-thickness dysplasia without basement
membrane invasion, whereas anaplasia refers to undifferentiated cells characteristic of
malignant neoplasms. Look for the terms "atypical" and "disorganized" without full-thickness
involvement to identify dysplasia.
Question 6 of 50
19-year-old male suffers a severe crush injury to the right leg, resulting in widespread cellular
A
swelling, rupture of plasma membranes, and release of intracellular enzymes into the
bloodstream. Identify the mechanism of cell death occurring in this tissue.
. Apoptosis triggered by severe extracellular trauma
A
B. Coagulative necrosis resulting from interrupted blood supply
C. Liquefactive necrosis characterized by enzymatic tissue digestion
D. Necrosis characterized by uncontrolled enzymatic digestion and inflammation
orrect Answer: D
C
Rationale: Necrosis is uncontrolled, pathological cell death resulting from overwhelming injury,
leading to cellular swelling, membrane rupture, and inflammatory responses due to the release
of intracellular contents. Apoptosis is a programmed, energy-dependent, orderly cell death that
does not trigger an inflammatory response, making it the opposite of the process described.
Always associate membrane rupture and inflammation with necrosis, while shrinkage and
phagocytosis without inflammation indicate apoptosis.
Question 7 of 50
65-year-old male experiences sudden coronary artery occlusion. Within minutes, the
A
cardiomyocytes deplete their ATP, leading to failure of the sodium-potassium pump. Explain the
immediate cellular consequence of this ATP depletion.
Exam Actual Exam 2026/2027 with Detailed
Rationales | Complete Exam-Style Questions |
Pass Guaranteed – A+ Graded
═════════════════════════════════════
═
SECTION 1: CELLULAR BIOLOGY, ADAPTATION & INJURY Q1 – Q10
══════════════════════════════════════
Question 1 of 50
68-year-old male with a fractured femur has been on bed rest for 6 weeks. Muscle biopsy
A
reveals a decrease in cell size due to decreased protein synthesis and increased proteolysis.
Identify the cellular adaptation occurring in this patient.
. Hypertrophy
A
B. Atrophy
C. Metaplasia
D. Hyperplasia
orrect Answer: B
C
Rationale: Atrophy is a decrease in cell size due to decreased workload, represented here by
disuse. Hypertrophy is an increase in cell size, while hyperplasia is an increase in cell number,
neither of which occurs in immobilized skeletal muscle. Look for decreased use or inadequate
nutrition to point toward atrophy.
Question 2 of 50
55-year-old female with chronic hypertension has an echocardiogram showing an increased
A
left ventricular wall thickness without an increase in chamber size. Determine the primary
cellular mechanism responsible for this myocardial adaptation.
. Increased number of myocardial cells due to chronic pressure
A
B. Accumulation of lipofuscin within the cardiac myocytes
C. Increase in myocardial cell size in response to increased workload
D. Replacement of normal myocardium with fibrous connective tissue
Correct Answer: C
, ationale: Hypertrophy is an increase in cell size resulting from increased workload or hormonal
R
stimulation, as seen in the cardiac myocytes responding to elevated systemic vascular
resistance. The myocardium cannot undergo hyperplasia because cardiac myocytes are
terminally differentiated and cannot increase in number. On exams, remember that pressure
overload leads to concentric hypertrophy, whereas volume overload leads to eccentric
hypertrophy.
Question 3 of 50
42-year-old female presents with heavy, irregular menstrual bleeding. Endometrial biopsy
A
reveals an abnormally increased number of endometrial glandular cells. Identify the specific
cellular adaptation triggered by the prolonged estrogen exposure.
. Pathologic hyperplasia driven by hormonal stimulation
A
B. Metaplasia of the endometrial stroma to glandular tissue
C. Compensatory hyperplasia in response to tissue loss
D. Dysplasia characterized by abnormal maturation of cells
orrect Answer: A
C
Rationale: Pathologic hyperplasia occurs when a tissue, such as the endometrium, proliferates
excessively in response to unopposed estrogen stimulation. Compensatory hyperplasia occurs
when tissue regenerates after injury or resection, such as liver regeneration, not in response to
hormones. Distinguish hormonal hyperplasia from compensatory hyperplasia based on the
initiating stimulus.
Question 4 of 50
50-year-old male with a 20-year history of gastroesophageal reflux disease undergoes
A
endoscopy, revealing a replacement of normal esophageal squamous epithelium with columnar
epithelium. Explain the pathophysiologic purpose of this cellular adaptation.
. To increase the surface area for acid absorption in the esophagus
A
B. To transform the esophageal cells into a more resistant cell type
C. To initiate a pre-malignant transformation through anaplasia
D. To decrease the metabolic rate of the esophageal tissue
orrect Answer: B
C
Rationale: Metaplasia is a reversible, adaptive substitution of one adult cell type for another,
allowing the tissue to better withstand chronic stress, such as replacing squamous cells with
acid-resistant columnar cells. Although metaplasia is an adaptive response, it is not
pre-malignant itself, but prolonged metaplasia can increase the risk of dysplasia and neoplasia.
Remember that metaplasia is a survival mechanism, not a direct step toward cancer, though it
creates a vulnerable environment.
, Question 5 of 50
32-year-old female has an abnormal Pap smear. Colposcopy with biopsy shows disorganized,
A
atypical cervical cells with enlarged, hyperchromatic nuclei that do not extend through the full
epithelial thickness. Determine the correct classification of this cellular change.
. Metaplasia with full-thickness cellular replacement
A
B. Carcinoma in situ with invasion of the basement membrane
C. Dysplasia characterized by abnormal, atypical cellular proliferation
D. Anaplasia with loss of cellular differentiation and function
orrect Answer: C
C
Rationale: Dysplasia refers to abnormal, atypical cellular proliferation and disorganized
arrangement that does not penetrate the basement membrane, often triggered by chronic
irritation or HPV. Carcinoma in situ involves full-thickness dysplasia without basement
membrane invasion, whereas anaplasia refers to undifferentiated cells characteristic of
malignant neoplasms. Look for the terms "atypical" and "disorganized" without full-thickness
involvement to identify dysplasia.
Question 6 of 50
19-year-old male suffers a severe crush injury to the right leg, resulting in widespread cellular
A
swelling, rupture of plasma membranes, and release of intracellular enzymes into the
bloodstream. Identify the mechanism of cell death occurring in this tissue.
. Apoptosis triggered by severe extracellular trauma
A
B. Coagulative necrosis resulting from interrupted blood supply
C. Liquefactive necrosis characterized by enzymatic tissue digestion
D. Necrosis characterized by uncontrolled enzymatic digestion and inflammation
orrect Answer: D
C
Rationale: Necrosis is uncontrolled, pathological cell death resulting from overwhelming injury,
leading to cellular swelling, membrane rupture, and inflammatory responses due to the release
of intracellular contents. Apoptosis is a programmed, energy-dependent, orderly cell death that
does not trigger an inflammatory response, making it the opposite of the process described.
Always associate membrane rupture and inflammation with necrosis, while shrinkage and
phagocytosis without inflammation indicate apoptosis.
Question 7 of 50
65-year-old male experiences sudden coronary artery occlusion. Within minutes, the
A
cardiomyocytes deplete their ATP, leading to failure of the sodium-potassium pump. Explain the
immediate cellular consequence of this ATP depletion.
