NSG 530 / NSG530 Exam 1 - Advanced Pathophysiology Guide (2026/2027)
NSG 530 / NSG530 n n n
Advanced Pathophysiology Exam 1 n n n
Questions and Answers with Rationales n n n n
NEW 2026/2027 Update | Wilkes University
n n n n n
100 Multiple-Choice Questions | Application and Analysis Level
n n n n n n n
Exam Format: 100 multiple-choice questions (single best answer, 4 options each)
n n n n n n n n n n
Content: Cellular Biology, Inflammation and Immunity, Neoplasia, Fluid/Electrolyte/Ac
n n n n n n n
id-
Base, Cardiovascular, Respiratory, Renal, Endocrine, Gastrointestinal/Hepatobiliary, Ne
n n n n n n
urology, Hematology n
Difficulty: Application and Analysis (graduate-level, NCLEX-style clinical reasoning)
n n n n n n n
Each question includes the correct answer and a detailed rationale explaining the pat
n n n n n n n n n n n n
hophysiology.
Question 1. A patient with a history of chronic alcohol abuse presents with jaundice, asc
n nn n n n n n n n n n n n n
ites, and confusion. Laboratory tests reveal elevated liver enzymes and prolonged PT/INR
n n n n n n n n n n n
. Which cellular adaptation is most likely occurring in the hepatocytes?
n n n n n n n n n n
A. Atrophy
B. Hypertrophy
C. Hyperplasia
D. Metaplasia
Correct Answer: A n n
Rationale: Atrophy is a reduction in cell size and number, often resulting from decreased
n n n n n n n n n n n n n n
workload, inadequate nutrition, or chronic injury. In chronic alcohol abuse, hepatocytes u
n n n n n n n n n n n
ndergo atrophy due to toxic injury and nutritional deficiency, leading to decreased liver fu
n n n n n n n n n n n n n
nction manifesting as jaundice (impaired bilirubin conjugation), ascites (decreased albu
n n n n n n n n n
NSG 530 Advanced Pathophysiology Exam 1 | Page 1
, NSG 530 / NSG530 Exam 1 - Advanced Pathophysiology Guide (2026/2027)
min synthesis), and coagulopathy (reduced clotting factor production). Hypertrophy refe
n n n n n n n n n
rs to an increase in cell size, not a decrease.
n n n n n n n n n
Hyperplasia is an increase in cell number. Metaplasia is the replacement of one cell type by
n n n n n n n n n n n n n n n
another.
n
Question 2. Which of the following is the most common cause of cellular injury from free r
n n n n n n n n n n n n n n n n
adicals?
A. Ionizingnradiation
B. Ischemia-reperfusionn injury
C. Chemicalntoxins
D. Allnofnthenabove
Correct Answer: D n n
Rationale: Free radicals are highly reactive molecules with unpaired electrons that can
n n n n n n n n n n n n
damage cellular components including lipids, proteins, and DNA. All the listed sources g
n n n n n n n n n n n n
enerate free radicals: ionizing radiation directly ionizes water and other molecules; ische
n n n n n n n n n n n
mia-
reperfusion injury generates reactive oxygen species (ROS) when blood flow is restored t
n n n n n n n n n n n n
o ischemic tissue; and many chemical toxins undergo metabolic activation to produce fr
n n n n n n n n n n n n
ee radical intermediates. The
n n n
NSG 530 Advanced Pathophysiology Exam 1 | Page 2
, NSG 530 / NSG530 Exam 1 - Advanced Pathophysiology Guide (2026/2027)
mitochondrial electron transport chain is also a major endogenous source of free radicals.
n n n n n n n n n n n n
Question 3. A biopsy of the bronchial epithelium from a long-
n n n n n n n n n n
term smoker reveals ciliated columnar epithelial cells being replaced by stratified squamou
n n n n n n n n n n n
s epithelium. This cellular change is best described as:
n n n n n n n n
A. Dysplasia
B. Metaplasia
C. Anaplasia
D. Hyperplasia
Correct Answer: B n n
Rationale: Metaplasia is the reversible replacement of one mature cell type by another, ty
n n n n n n n n n n n n n
pically in response to chronic irritation or stress. In smokers, the chronic irritation from cig
n n n n n n n n n n n n n n
arette smoke causes the normal ciliated columnar epithelium of the respiratory tract to tran
n n n n n n n n n n n n n
sform into stratified squamous epithelium, which is better able to withstand the noxious en
n n n n n n n n n n n n n
vironment but lacks mucociliary clearance function. Dysplasia refers to abnormal matur
n n n n n n n n n n
ation of cells within a tissue.
n n n n n
Anaplasia describes undifferentiated, pleomorphic cells seen in malignancy. Hyperplasia
n n n n n n n n
is an increase in the number of cells.
n n n n n n n n
Question 4. In cellular injury, which of the following organelles is most susceptible to isch
n n n n n n n n n n n n n n
emic damage? n
A. Nucleus
B. Cellnmembrane
C. Mitochondria
D. Ribosomes
Correct Answer: C n n
Rationale: Mitochondria are among the most susceptible organelles to ischemic injury bec
n n n n n n n n n n n
ause they depend on a continuous supply of oxygen for oxidative phosphorylation. During
n n n n n n n n n n n n n
ischemia, the lack of oxygen causes mitochondrial dysfunction, leading to decreased ATP
n n n n n n n n n n n
production, failure of the sodium-
n n n n n
potassium pump, cellular swelling, and ultimately cell death. Mitochondrial damage also
n n n n n n n n n n n
triggers the release of cytochrome c and activation of the apoptotic pathway. While all cell
n n n n n n n n n n n n n n
NSG 530 Advanced Pathophysiology Exam 1 | Page 3
, NSG 530 / NSG530 Exam 1 - Advanced Pathophysiology Guide (2026/2027)
ular components are eventually affected by prolonged ischemia, mitochondria are the ear
n n n n n n n n n n n
liest and most critically damaged organelles.
n n n n n
Question 5. A patient presents with pain, swelling, and redness in their right calf following
n n n n n n n n n n n n n n
a long-
n n
haul flight. Doppler ultrasound confirms a deep vein thrombosis. Which type of cellular i
n n n n n n n n n n n n n
njury is primarily responsible for the tissue damage?
n n n n n n n
A. Hypoxicninjury
B. Chemicalninjury
C. Immunologicninjury
D. Infectiousninjury
Correct Answer: A n n
Rationale: Deep vein thrombosis causes hypoxic injury to the downstream tissue by obst
n n n n n n n n n n n n
ructing venous outflow and impairing arterial inflow. The resulting ischemia leads to a c
n n n n n n n n n n n n n
ascade of cellular events: decreased ATP production, failure of Na+/K+-
n n n n n n n n n
ATPase pumps, cellular swelling, influx of calcium, activation of phospholipases and prot
n n n n n n n n n n n
eases, and generation of reactive oxygen species. This type of injury is purely hypoxic/isc
n n n n n n n n n n n n n
hemic in origin rather than chemical, immunologic, or infectious. Prolonged venous stas
n n n n n n n n n n n
is during long flights (Virchow triad) predisposes to thrombus formation.
n n n n n n n n n
NSG 530 Advanced Pathophysiology Exam 1 | Page 4
NSG 530 / NSG530 n n n
Advanced Pathophysiology Exam 1 n n n
Questions and Answers with Rationales n n n n
NEW 2026/2027 Update | Wilkes University
n n n n n
100 Multiple-Choice Questions | Application and Analysis Level
n n n n n n n
Exam Format: 100 multiple-choice questions (single best answer, 4 options each)
n n n n n n n n n n
Content: Cellular Biology, Inflammation and Immunity, Neoplasia, Fluid/Electrolyte/Ac
n n n n n n n
id-
Base, Cardiovascular, Respiratory, Renal, Endocrine, Gastrointestinal/Hepatobiliary, Ne
n n n n n n
urology, Hematology n
Difficulty: Application and Analysis (graduate-level, NCLEX-style clinical reasoning)
n n n n n n n
Each question includes the correct answer and a detailed rationale explaining the pat
n n n n n n n n n n n n
hophysiology.
Question 1. A patient with a history of chronic alcohol abuse presents with jaundice, asc
n nn n n n n n n n n n n n n
ites, and confusion. Laboratory tests reveal elevated liver enzymes and prolonged PT/INR
n n n n n n n n n n n
. Which cellular adaptation is most likely occurring in the hepatocytes?
n n n n n n n n n n
A. Atrophy
B. Hypertrophy
C. Hyperplasia
D. Metaplasia
Correct Answer: A n n
Rationale: Atrophy is a reduction in cell size and number, often resulting from decreased
n n n n n n n n n n n n n n
workload, inadequate nutrition, or chronic injury. In chronic alcohol abuse, hepatocytes u
n n n n n n n n n n n
ndergo atrophy due to toxic injury and nutritional deficiency, leading to decreased liver fu
n n n n n n n n n n n n n
nction manifesting as jaundice (impaired bilirubin conjugation), ascites (decreased albu
n n n n n n n n n
NSG 530 Advanced Pathophysiology Exam 1 | Page 1
, NSG 530 / NSG530 Exam 1 - Advanced Pathophysiology Guide (2026/2027)
min synthesis), and coagulopathy (reduced clotting factor production). Hypertrophy refe
n n n n n n n n n
rs to an increase in cell size, not a decrease.
n n n n n n n n n
Hyperplasia is an increase in cell number. Metaplasia is the replacement of one cell type by
n n n n n n n n n n n n n n n
another.
n
Question 2. Which of the following is the most common cause of cellular injury from free r
n n n n n n n n n n n n n n n n
adicals?
A. Ionizingnradiation
B. Ischemia-reperfusionn injury
C. Chemicalntoxins
D. Allnofnthenabove
Correct Answer: D n n
Rationale: Free radicals are highly reactive molecules with unpaired electrons that can
n n n n n n n n n n n n
damage cellular components including lipids, proteins, and DNA. All the listed sources g
n n n n n n n n n n n n
enerate free radicals: ionizing radiation directly ionizes water and other molecules; ische
n n n n n n n n n n n
mia-
reperfusion injury generates reactive oxygen species (ROS) when blood flow is restored t
n n n n n n n n n n n n
o ischemic tissue; and many chemical toxins undergo metabolic activation to produce fr
n n n n n n n n n n n n
ee radical intermediates. The
n n n
NSG 530 Advanced Pathophysiology Exam 1 | Page 2
, NSG 530 / NSG530 Exam 1 - Advanced Pathophysiology Guide (2026/2027)
mitochondrial electron transport chain is also a major endogenous source of free radicals.
n n n n n n n n n n n n
Question 3. A biopsy of the bronchial epithelium from a long-
n n n n n n n n n n
term smoker reveals ciliated columnar epithelial cells being replaced by stratified squamou
n n n n n n n n n n n
s epithelium. This cellular change is best described as:
n n n n n n n n
A. Dysplasia
B. Metaplasia
C. Anaplasia
D. Hyperplasia
Correct Answer: B n n
Rationale: Metaplasia is the reversible replacement of one mature cell type by another, ty
n n n n n n n n n n n n n
pically in response to chronic irritation or stress. In smokers, the chronic irritation from cig
n n n n n n n n n n n n n n
arette smoke causes the normal ciliated columnar epithelium of the respiratory tract to tran
n n n n n n n n n n n n n
sform into stratified squamous epithelium, which is better able to withstand the noxious en
n n n n n n n n n n n n n
vironment but lacks mucociliary clearance function. Dysplasia refers to abnormal matur
n n n n n n n n n n
ation of cells within a tissue.
n n n n n
Anaplasia describes undifferentiated, pleomorphic cells seen in malignancy. Hyperplasia
n n n n n n n n
is an increase in the number of cells.
n n n n n n n n
Question 4. In cellular injury, which of the following organelles is most susceptible to isch
n n n n n n n n n n n n n n
emic damage? n
A. Nucleus
B. Cellnmembrane
C. Mitochondria
D. Ribosomes
Correct Answer: C n n
Rationale: Mitochondria are among the most susceptible organelles to ischemic injury bec
n n n n n n n n n n n
ause they depend on a continuous supply of oxygen for oxidative phosphorylation. During
n n n n n n n n n n n n n
ischemia, the lack of oxygen causes mitochondrial dysfunction, leading to decreased ATP
n n n n n n n n n n n
production, failure of the sodium-
n n n n n
potassium pump, cellular swelling, and ultimately cell death. Mitochondrial damage also
n n n n n n n n n n n
triggers the release of cytochrome c and activation of the apoptotic pathway. While all cell
n n n n n n n n n n n n n n
NSG 530 Advanced Pathophysiology Exam 1 | Page 3
, NSG 530 / NSG530 Exam 1 - Advanced Pathophysiology Guide (2026/2027)
ular components are eventually affected by prolonged ischemia, mitochondria are the ear
n n n n n n n n n n n
liest and most critically damaged organelles.
n n n n n
Question 5. A patient presents with pain, swelling, and redness in their right calf following
n n n n n n n n n n n n n n
a long-
n n
haul flight. Doppler ultrasound confirms a deep vein thrombosis. Which type of cellular i
n n n n n n n n n n n n n
njury is primarily responsible for the tissue damage?
n n n n n n n
A. Hypoxicninjury
B. Chemicalninjury
C. Immunologicninjury
D. Infectiousninjury
Correct Answer: A n n
Rationale: Deep vein thrombosis causes hypoxic injury to the downstream tissue by obst
n n n n n n n n n n n n
ructing venous outflow and impairing arterial inflow. The resulting ischemia leads to a c
n n n n n n n n n n n n n
ascade of cellular events: decreased ATP production, failure of Na+/K+-
n n n n n n n n n
ATPase pumps, cellular swelling, influx of calcium, activation of phospholipases and prot
n n n n n n n n n n n
eases, and generation of reactive oxygen species. This type of injury is purely hypoxic/isc
n n n n n n n n n n n n n
hemic in origin rather than chemical, immunologic, or infectious. Prolonged venous stas
n n n n n n n n n n n
is during long flights (Virchow triad) predisposes to thrombus formation.
n n n n n n n n n
NSG 530 Advanced Pathophysiology Exam 1 | Page 4
