Herzing University
N U R S I N G PAT H O P H Y S I O L O G Y
NSG120 Final Examination
Comprehensive Exam Review
100 Questions with Verified Answers and Comprehensive Rationales
All Units Covered | 2026/2027 Curriculum Update
COURSE NSG 120
TOTAL QUESTIONS 100 Multiple Choice
SECTIONS 10 Content Areas
ACADEMIC YEAR 2026 - 2027
Latest 2026/2027 Update | Herzing University Curriculum Standards
,NSG120 Nursing Pathophysiology Final Exam | Herzing University | 2026/2027
Section 1: Cellular Adaptation, Injury, and Neoplasia (Q1-Q12)
Q1: A 68-year-old patient with a history of prolonged immobility demonstrates decreased muscle mass in the
lower extremities. The nurse recognizes this cellular change as which type of adaptation?
A. Hyperplasia
B. Hypertrophy
C. Atrophy [CORRECT]
D. Metaplasia
Correct Answer: C
Rationale: Atrophy is a decrease in cell size that results from reduced workload, disuse, inadequate blood supply, or inadequate
nutrition. Prolonged immobility leads to disuse atrophy of skeletal muscle. Hypertrophy is an increase in cell size, hyperplasia is
an increase in cell number, and metaplasia is the replacement of one mature cell type with another. Herzing NSG 120 emphasizes
distinguishing atrophy from hypertrophy as a foundational concept in cellular adaptation.
Q2: A patient with chronic GERD develops columnar epithelium in the lower esophagus, replacing the normal
stratified squamous epithelium. This cellular adaptation is best described as:
A. Hyperplasia
B. Dysplasia
C. Metaplasia [CORRECT]
D. Anaplasia
Correct Answer: C
Rationale: Metaplasia is the reversible replacement of one mature cell type with another, often as an adaptive response to chronic
irritation. In Barrett esophagus, chronic acid exposure causes squamous epithelium to transform into columnar (intestinal-type)
epithelium. Dysplasia refers to abnormal cell growth with atypical appearance, and anaplasia refers to undifferentiated cells
seen in malignancy. This is a key Herzing NSG 120 concept for understanding precancerous changes.
Q3: A nurse is caring for a patient who experienced a myocardial infarction. The tissue death in the myocardium
is characterized by coagulative necrosis. Which of the following best describes the pathophysiology of coagulative
necrosis?
A. Liquefaction of tissue by hydrolytic enzymes, commonly seen in the brain
B. Protein denaturation with preserved cell outlines, commonly seen in the heart and kidneys
[CORRECT]
C. Caseous necrosis with a cheese-like appearance, typical of tuberculosis
D. Fat necrosis with saponification, commonly seen in acute pancreatitis
Correct Answer: B
Rationale: Coagulative necrosis occurs primarily in the heart, kidneys, and liver due to ischemic injury. It is characterized by
protein denaturation and cellular preservation of the basic structural outline, creating a firm, pale tissue. Liquefactive necrosis
involves enzymatic liquefaction typical of CNS infarcts. Caseous necrosis is associated with tuberculosis, and fat necrosis with
saponification occurs in pancreatic injury. Herzing curriculum distinguishes necrosis types by tissue appearance and organ
involvement.
Page 1
,NSG120 Nursing Pathophysiology Final Exam | Herzing University | 2026/2027
Q4: A patient is diagnosed with a benign tumor of the thyroid gland. Which of the following characteristics is
consistent with a benign neoplasm?
A. Poorly differentiated cells with rapid, invasive growth
B. Well-differentiated cells that are encapsulated and slow-growing [CORRECT]
C. Absence of a fibrous capsule with local tissue invasion
D. Metastasis to regional lymph nodes confirmed on biopsy
Correct Answer: B
Rationale: Benign neoplasms are characterized by well-differentiated cells that resemble the tissue of origin, a fibrous capsule
that separates them from surrounding tissue, slow and expansive (not invasive) growth, and absence of metastasis. Malignant
neoplasms are poorly differentiated, lack a capsule, invade locally, and metastasize via blood or lymphatic routes. Herzing NSG
120 emphasizes the clinical significance of distinguishing benign from malignant tumors for patient counseling and management
planning.
Q5: A patient presents with a gangrenous foot following untreated peripheral arterial disease. The nurse notes the
tissue is dry, shriveled, and dark brown. This type of gangrene is best classified as:
A. Wet gangrene with bacterial superinfection and liquefactive necrosis
B. Gas gangrene with Clostridium perfringens infection and crepitus
C. Dry gangrene from arterial occlusion with coagulative necrosis [CORRECT]
D. Internal gangrene with bowel ischemia and perforation
Correct Answer: C
Rationale: Dry gangrene results from gradual arterial occlusion, typically in the lower extremities, producing tissue that appears
dry, shriveled, and dark brown or black due to coagulative necrosis and slow dehydration. Wet gangrene involves bacterial
superinfection with liquefactive necrosis, producing a moist, foul-smelling appearance. Gas gangrene is caused by Clostridium
perfringens producing gas within tissues. Herzing curriculum highlights distinguishing gangrene types for prioritizing surgical
intervention.
Q6: A patient with lung cancer has a tumor staged as T3N1M0. The nurse understands that the M0 designation
indicates which of the following?
A. The primary tumor is less than 3 cm in size
B. There is involvement of one regional lymph node
C. There is no distant metastasis [CORRECT]
D. The tumor has metastasized to one distant organ
Correct Answer: C
Rationale: In the TNM staging system, T refers to the size and extent of the primary tumor, N refers to the number of regional
lymph nodes involved, and M refers to the presence or absence of distant metastasis. M0 indicates no distant metastasis, while M1
indicates distant metastasis is present. T3 describes a larger primary tumor with specific size or invasion criteria, and N1 indicates
regional lymph node involvement. Herzing NSG 120 emphasizes TNM staging as essential for treatment planning and prognosis.
Page 2
, NSG120 Nursing Pathophysiology Final Exam | Herzing University | 2026/2027
Q7: A researcher explains that a specific gene promotes uncontrolled cell division and is associated with an
increased risk of cancer. This type of gene is classified as:
A. A tumor suppressor gene such as p53
B. An oncogene that promotes cancer development [CORRECT]
C. A proto-oncogene in its normal, unmutated state
D. A DNA repair gene that corrects replication errors
Correct Answer: B
Rationale: Oncogenes are mutated or overexpressed versions of normal proto-oncogenes that promote uncontrolled cell division
and cancer development. Examples include HER2, BRAF, and RAS. Tumor suppressor genes such as p53 and BRCA1 normally
inhibit cell proliferation, and their inactivation removes this protective mechanism. DNA repair genes correct replication errors,
and their dysfunction increases mutation rates. Herzing curriculum stresses the distinction between oncogenes (gain-of-function)
and tumor suppressor genes (loss-of-function) in carcinogenesis.
Q8: A patient who suffered a cerebrovascular accident exhibits tissue death in the brain that appears soft and
liquefied. This necrosis pattern is classified as:
A. Coagulative necrosis due to protein denaturation in the myocardium
B. Liquefactive necrosis due to hydrolytic enzyme activity in the CNS [CORRECT]
C. Caseous necrosis due to mycobacterial granuloma formation
D. Fat necrosis due to pancreatic enzyme release
Correct Answer: B
Rationale: Liquefactive necrosis is characteristic of brain tissue injury (CVA) because neural tissue is rich in lysosomal enzymes
that rapidly digest dead cells, creating a soft, liquefied area. Coagulative necrosis is typical of heart and kidney ischemia.
Caseous necrosis is associated with tuberculosis granulomas, and fat necrosis results from pancreatic lipase activity on adipose
tissue. Herzing NSG 120 specifically links liquefactive necrosis to CNS injury as a key differentiator.
Q9: A nurse is teaching a patient about the three stages of carcinogenesis. The stage involving exposure to a
carcinogen that causes irreversible DNA mutation is termed:
A. Promotion, where altered cells proliferate under stimulation of promoting agents
B. Progression, where malignant transformation occurs with additional mutations
C. Initiation, where a carcinogen causes irreversible DNA damage [CORRECT]
D. Termination, where the immune system eliminates abnormal cells
Correct Answer: C
Rationale: Carcinogenesis occurs in three stages: initiation, promotion, and progression. Initiation involves exposure to a
carcinogen that causes irreversible DNA mutation in a single cell. Promotion involves clonal expansion of the initiated cells under
the influence of promoting agents. Progression involves additional genetic changes leading to malignant transformation,
including the ability to invade and metastasize. Herzing curriculum identifies initiation as the critical first step where DNA
damage becomes permanent.
Q10: A 55-year-old female marathon runner has an enlarged heart with increased myocardial cell size. This
adaptation is best described as:
A. Physiologic hypertrophy due to increased workload demand [CORRECT]
B. Pathologic hypertrophy due to hypertension or valve disease
C. Hyperplasia due to hormonal stimulation
D. Atrophy due to chronic ischemia
Correct Answer: A
Rationale: Physiologic hypertrophy is an adaptive increase in cell size in response to increased workload demand, such as the
enlarged heart of an athlete due to sustained aerobic exercise. Pathologic hypertrophy occurs in response to disease processes such
as hypertension or aortic stenosis. Hyperplasia involves an increase in cell number, not size. Atrophy is a decrease in cell size.
Herzing NSG 120 distinguishes physiologic from pathologic hypertrophy as a key concept in cellular adaptation.
Page 3
N U R S I N G PAT H O P H Y S I O L O G Y
NSG120 Final Examination
Comprehensive Exam Review
100 Questions with Verified Answers and Comprehensive Rationales
All Units Covered | 2026/2027 Curriculum Update
COURSE NSG 120
TOTAL QUESTIONS 100 Multiple Choice
SECTIONS 10 Content Areas
ACADEMIC YEAR 2026 - 2027
Latest 2026/2027 Update | Herzing University Curriculum Standards
,NSG120 Nursing Pathophysiology Final Exam | Herzing University | 2026/2027
Section 1: Cellular Adaptation, Injury, and Neoplasia (Q1-Q12)
Q1: A 68-year-old patient with a history of prolonged immobility demonstrates decreased muscle mass in the
lower extremities. The nurse recognizes this cellular change as which type of adaptation?
A. Hyperplasia
B. Hypertrophy
C. Atrophy [CORRECT]
D. Metaplasia
Correct Answer: C
Rationale: Atrophy is a decrease in cell size that results from reduced workload, disuse, inadequate blood supply, or inadequate
nutrition. Prolonged immobility leads to disuse atrophy of skeletal muscle. Hypertrophy is an increase in cell size, hyperplasia is
an increase in cell number, and metaplasia is the replacement of one mature cell type with another. Herzing NSG 120 emphasizes
distinguishing atrophy from hypertrophy as a foundational concept in cellular adaptation.
Q2: A patient with chronic GERD develops columnar epithelium in the lower esophagus, replacing the normal
stratified squamous epithelium. This cellular adaptation is best described as:
A. Hyperplasia
B. Dysplasia
C. Metaplasia [CORRECT]
D. Anaplasia
Correct Answer: C
Rationale: Metaplasia is the reversible replacement of one mature cell type with another, often as an adaptive response to chronic
irritation. In Barrett esophagus, chronic acid exposure causes squamous epithelium to transform into columnar (intestinal-type)
epithelium. Dysplasia refers to abnormal cell growth with atypical appearance, and anaplasia refers to undifferentiated cells
seen in malignancy. This is a key Herzing NSG 120 concept for understanding precancerous changes.
Q3: A nurse is caring for a patient who experienced a myocardial infarction. The tissue death in the myocardium
is characterized by coagulative necrosis. Which of the following best describes the pathophysiology of coagulative
necrosis?
A. Liquefaction of tissue by hydrolytic enzymes, commonly seen in the brain
B. Protein denaturation with preserved cell outlines, commonly seen in the heart and kidneys
[CORRECT]
C. Caseous necrosis with a cheese-like appearance, typical of tuberculosis
D. Fat necrosis with saponification, commonly seen in acute pancreatitis
Correct Answer: B
Rationale: Coagulative necrosis occurs primarily in the heart, kidneys, and liver due to ischemic injury. It is characterized by
protein denaturation and cellular preservation of the basic structural outline, creating a firm, pale tissue. Liquefactive necrosis
involves enzymatic liquefaction typical of CNS infarcts. Caseous necrosis is associated with tuberculosis, and fat necrosis with
saponification occurs in pancreatic injury. Herzing curriculum distinguishes necrosis types by tissue appearance and organ
involvement.
Page 1
,NSG120 Nursing Pathophysiology Final Exam | Herzing University | 2026/2027
Q4: A patient is diagnosed with a benign tumor of the thyroid gland. Which of the following characteristics is
consistent with a benign neoplasm?
A. Poorly differentiated cells with rapid, invasive growth
B. Well-differentiated cells that are encapsulated and slow-growing [CORRECT]
C. Absence of a fibrous capsule with local tissue invasion
D. Metastasis to regional lymph nodes confirmed on biopsy
Correct Answer: B
Rationale: Benign neoplasms are characterized by well-differentiated cells that resemble the tissue of origin, a fibrous capsule
that separates them from surrounding tissue, slow and expansive (not invasive) growth, and absence of metastasis. Malignant
neoplasms are poorly differentiated, lack a capsule, invade locally, and metastasize via blood or lymphatic routes. Herzing NSG
120 emphasizes the clinical significance of distinguishing benign from malignant tumors for patient counseling and management
planning.
Q5: A patient presents with a gangrenous foot following untreated peripheral arterial disease. The nurse notes the
tissue is dry, shriveled, and dark brown. This type of gangrene is best classified as:
A. Wet gangrene with bacterial superinfection and liquefactive necrosis
B. Gas gangrene with Clostridium perfringens infection and crepitus
C. Dry gangrene from arterial occlusion with coagulative necrosis [CORRECT]
D. Internal gangrene with bowel ischemia and perforation
Correct Answer: C
Rationale: Dry gangrene results from gradual arterial occlusion, typically in the lower extremities, producing tissue that appears
dry, shriveled, and dark brown or black due to coagulative necrosis and slow dehydration. Wet gangrene involves bacterial
superinfection with liquefactive necrosis, producing a moist, foul-smelling appearance. Gas gangrene is caused by Clostridium
perfringens producing gas within tissues. Herzing curriculum highlights distinguishing gangrene types for prioritizing surgical
intervention.
Q6: A patient with lung cancer has a tumor staged as T3N1M0. The nurse understands that the M0 designation
indicates which of the following?
A. The primary tumor is less than 3 cm in size
B. There is involvement of one regional lymph node
C. There is no distant metastasis [CORRECT]
D. The tumor has metastasized to one distant organ
Correct Answer: C
Rationale: In the TNM staging system, T refers to the size and extent of the primary tumor, N refers to the number of regional
lymph nodes involved, and M refers to the presence or absence of distant metastasis. M0 indicates no distant metastasis, while M1
indicates distant metastasis is present. T3 describes a larger primary tumor with specific size or invasion criteria, and N1 indicates
regional lymph node involvement. Herzing NSG 120 emphasizes TNM staging as essential for treatment planning and prognosis.
Page 2
, NSG120 Nursing Pathophysiology Final Exam | Herzing University | 2026/2027
Q7: A researcher explains that a specific gene promotes uncontrolled cell division and is associated with an
increased risk of cancer. This type of gene is classified as:
A. A tumor suppressor gene such as p53
B. An oncogene that promotes cancer development [CORRECT]
C. A proto-oncogene in its normal, unmutated state
D. A DNA repair gene that corrects replication errors
Correct Answer: B
Rationale: Oncogenes are mutated or overexpressed versions of normal proto-oncogenes that promote uncontrolled cell division
and cancer development. Examples include HER2, BRAF, and RAS. Tumor suppressor genes such as p53 and BRCA1 normally
inhibit cell proliferation, and their inactivation removes this protective mechanism. DNA repair genes correct replication errors,
and their dysfunction increases mutation rates. Herzing curriculum stresses the distinction between oncogenes (gain-of-function)
and tumor suppressor genes (loss-of-function) in carcinogenesis.
Q8: A patient who suffered a cerebrovascular accident exhibits tissue death in the brain that appears soft and
liquefied. This necrosis pattern is classified as:
A. Coagulative necrosis due to protein denaturation in the myocardium
B. Liquefactive necrosis due to hydrolytic enzyme activity in the CNS [CORRECT]
C. Caseous necrosis due to mycobacterial granuloma formation
D. Fat necrosis due to pancreatic enzyme release
Correct Answer: B
Rationale: Liquefactive necrosis is characteristic of brain tissue injury (CVA) because neural tissue is rich in lysosomal enzymes
that rapidly digest dead cells, creating a soft, liquefied area. Coagulative necrosis is typical of heart and kidney ischemia.
Caseous necrosis is associated with tuberculosis granulomas, and fat necrosis results from pancreatic lipase activity on adipose
tissue. Herzing NSG 120 specifically links liquefactive necrosis to CNS injury as a key differentiator.
Q9: A nurse is teaching a patient about the three stages of carcinogenesis. The stage involving exposure to a
carcinogen that causes irreversible DNA mutation is termed:
A. Promotion, where altered cells proliferate under stimulation of promoting agents
B. Progression, where malignant transformation occurs with additional mutations
C. Initiation, where a carcinogen causes irreversible DNA damage [CORRECT]
D. Termination, where the immune system eliminates abnormal cells
Correct Answer: C
Rationale: Carcinogenesis occurs in three stages: initiation, promotion, and progression. Initiation involves exposure to a
carcinogen that causes irreversible DNA mutation in a single cell. Promotion involves clonal expansion of the initiated cells under
the influence of promoting agents. Progression involves additional genetic changes leading to malignant transformation,
including the ability to invade and metastasize. Herzing curriculum identifies initiation as the critical first step where DNA
damage becomes permanent.
Q10: A 55-year-old female marathon runner has an enlarged heart with increased myocardial cell size. This
adaptation is best described as:
A. Physiologic hypertrophy due to increased workload demand [CORRECT]
B. Pathologic hypertrophy due to hypertension or valve disease
C. Hyperplasia due to hormonal stimulation
D. Atrophy due to chronic ischemia
Correct Answer: A
Rationale: Physiologic hypertrophy is an adaptive increase in cell size in response to increased workload demand, such as the
enlarged heart of an athlete due to sustained aerobic exercise. Pathologic hypertrophy occurs in response to disease processes such
as hypertension or aortic stenosis. Hyperplasia involves an increase in cell number, not size. Atrophy is a decrease in cell size.
Herzing NSG 120 distinguishes physiologic from pathologic hypertrophy as a key concept in cellular adaptation.
Page 3
