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NIGHTINGALE PATHOPHYSIOLOGY MIDTERM EXAM –
NIGHTINGALE COLLEGE 2026/2027 COMPLETE (140)
CURRENT TESTING QUESTIONS AND CORRECT
ANSWERS WITH DETAILED RATIONALES.
PATHOPHYSIOLOGY
Prepare effectively for the Nightingale Pathophysiology Midterm Exam with this
focused study resource. It supports review of disease processes, pathophysiological
mechanisms, cellular responses, clinical manifestations, and physiological changes
associated with illness. Use the material to reinforce your understanding, review key
topics, and identify areas that may require additional study. This resource is suited for
Nightingale College nursing students, healthcare learners, and candidates preparing
for their pathophysiology midterm examination.
MULTIPLE CHOICE.
DOMAIN 1 — Cellular Adaptation, Injury, and Death (Questions 1–14)
1. A chronic smoker develops a persistent cough and mucus
hypersecretion due to an increased number of mucus-secreting cells
replacing normal ciliated columnar epithelium in the airways. This
cellular change is BEST described as:
A. Atrophy
B. Hyperplasia
C. Metaplasia
D. Dysplasia
Answer: C. Metaplasia
Rationale: Metaplasia is a reversible replacement of one differentiated cell
type by another. In chronic smokers, the normal ciliated columnar epithelium
is replaced by squamous or mucus-secreting cells as an adaptive response to
chronic irritation.
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2. A patient with a history of hypertension develops an increase in the size
of cardiac muscle cells. Which cellular adaptation is responsible?
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Atrophy
Answer: B. Hypertrophy
Rationale: Hypertrophy is an increase in cell size in response to increased
workload or hormonal stimulation. Cardiac myocytes enlarge to handle
increased afterload from hypertension.
3. During ischemic injury to the heart muscle, which type of cell death will
occur?
A. Liquefactive necrosis
B. Coagulative necrosis
C. Caseous necrosis
D. Fat necrosis
Answer: B. Coagulative necrosis
Rationale: Coagulative necrosis is the hallmark of ischemic death in most
solid organs, including the heart. Tissue architecture is preserved for several
days because ischemia denatures structural proteins and inactivates
lysosomal enzymes.
4. A patient's biopsy reveals an increase in the number of cells in the
breast tissue. This is BEST described as:
A. Hypertrophy
B. Hyperplasia
C. Metaplasia
D. Dysplasia
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Answer: B. Hyperplasia
Rationale: Hyperplasia is an increase in the number of cells in an organ or
tissue. It can be physiologic (hormonal, compensatory) or pathologic.
5. Which cellular change is characteristic of reversible injury?
A. Karyorrhexis
B. Pyknosis
C. Cellular swelling
D. Karyolysis
Answer: C. Cellular swelling
Rationale: Cellular swelling (hydropic change) is a hallmark of reversible
injury caused by failure of the sodium-potassium pump, leading to
intracellular water accumulation. Karyorrhexis, pyknosis, and karyolysis are
features of irreversible injury and cell death.
6. A patient has a biopsy showing cells with large, hyperchromatic nuclei
and abnormal tissue architecture. This finding is MOST consistent with:
A. Atrophy
B. Metaplasia
C. Dysplasia
D. Hypertrophy
Answer: C. Dysplasia
Rationale: Dysplasia is characterized by disordered cellular growth, atypical
cell size and shape, and hyperchromatic nuclei. It is often a precursor to
malignancy and is not considered a true adaptive change.
7. Which cellular adaptation is characterized by a decrease in cell size?
A. Hypertrophy
B. Hyperplasia
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C. Atrophy
D. Metaplasia
Answer: C. Atrophy
Rationale: Atrophy is a decrease in cell size, often resulting from decreased
workload, loss of innervation, diminished blood supply, or aging.
8. A patient with tuberculosis has a lung biopsy showing necrotic tissue
with a cheese-like appearance. This is characteristic of:
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis
Answer: C. Caseous necrosis
Rationale: Caseous necrosis is a form of coagulative necrosis with a cheese-
like appearance, classically seen in tuberculosis. It results from
granulomatous inflammation and contains dead tissue and immune cells.
9. A patient with pancreatitis develops areas of necrotic fat in the
abdomen. This type of necrosis is called:
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis
Answer: D. Fat necrosis
Rationale: Fat necrosis occurs when pancreatic enzymes (lipases) break
down triglycerides in adipose tissue, releasing fatty acids that combine with
calcium to form soap-like deposits. It is classically seen in acute pancreatitis.
10. A patient with a stroke develops brain tissue that has become soft and
liquefied. This type of necrosis is called:
NIGHTINGALE PATHOPHYSIOLOGY MIDTERM EXAM –
NIGHTINGALE COLLEGE 2026/2027 COMPLETE (140)
CURRENT TESTING QUESTIONS AND CORRECT
ANSWERS WITH DETAILED RATIONALES.
PATHOPHYSIOLOGY
Prepare effectively for the Nightingale Pathophysiology Midterm Exam with this
focused study resource. It supports review of disease processes, pathophysiological
mechanisms, cellular responses, clinical manifestations, and physiological changes
associated with illness. Use the material to reinforce your understanding, review key
topics, and identify areas that may require additional study. This resource is suited for
Nightingale College nursing students, healthcare learners, and candidates preparing
for their pathophysiology midterm examination.
MULTIPLE CHOICE.
DOMAIN 1 — Cellular Adaptation, Injury, and Death (Questions 1–14)
1. A chronic smoker develops a persistent cough and mucus
hypersecretion due to an increased number of mucus-secreting cells
replacing normal ciliated columnar epithelium in the airways. This
cellular change is BEST described as:
A. Atrophy
B. Hyperplasia
C. Metaplasia
D. Dysplasia
Answer: C. Metaplasia
Rationale: Metaplasia is a reversible replacement of one differentiated cell
type by another. In chronic smokers, the normal ciliated columnar epithelium
is replaced by squamous or mucus-secreting cells as an adaptive response to
chronic irritation.
, Page 2 of 60
2. A patient with a history of hypertension develops an increase in the size
of cardiac muscle cells. Which cellular adaptation is responsible?
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Atrophy
Answer: B. Hypertrophy
Rationale: Hypertrophy is an increase in cell size in response to increased
workload or hormonal stimulation. Cardiac myocytes enlarge to handle
increased afterload from hypertension.
3. During ischemic injury to the heart muscle, which type of cell death will
occur?
A. Liquefactive necrosis
B. Coagulative necrosis
C. Caseous necrosis
D. Fat necrosis
Answer: B. Coagulative necrosis
Rationale: Coagulative necrosis is the hallmark of ischemic death in most
solid organs, including the heart. Tissue architecture is preserved for several
days because ischemia denatures structural proteins and inactivates
lysosomal enzymes.
4. A patient's biopsy reveals an increase in the number of cells in the
breast tissue. This is BEST described as:
A. Hypertrophy
B. Hyperplasia
C. Metaplasia
D. Dysplasia
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Answer: B. Hyperplasia
Rationale: Hyperplasia is an increase in the number of cells in an organ or
tissue. It can be physiologic (hormonal, compensatory) or pathologic.
5. Which cellular change is characteristic of reversible injury?
A. Karyorrhexis
B. Pyknosis
C. Cellular swelling
D. Karyolysis
Answer: C. Cellular swelling
Rationale: Cellular swelling (hydropic change) is a hallmark of reversible
injury caused by failure of the sodium-potassium pump, leading to
intracellular water accumulation. Karyorrhexis, pyknosis, and karyolysis are
features of irreversible injury and cell death.
6. A patient has a biopsy showing cells with large, hyperchromatic nuclei
and abnormal tissue architecture. This finding is MOST consistent with:
A. Atrophy
B. Metaplasia
C. Dysplasia
D. Hypertrophy
Answer: C. Dysplasia
Rationale: Dysplasia is characterized by disordered cellular growth, atypical
cell size and shape, and hyperchromatic nuclei. It is often a precursor to
malignancy and is not considered a true adaptive change.
7. Which cellular adaptation is characterized by a decrease in cell size?
A. Hypertrophy
B. Hyperplasia
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C. Atrophy
D. Metaplasia
Answer: C. Atrophy
Rationale: Atrophy is a decrease in cell size, often resulting from decreased
workload, loss of innervation, diminished blood supply, or aging.
8. A patient with tuberculosis has a lung biopsy showing necrotic tissue
with a cheese-like appearance. This is characteristic of:
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis
Answer: C. Caseous necrosis
Rationale: Caseous necrosis is a form of coagulative necrosis with a cheese-
like appearance, classically seen in tuberculosis. It results from
granulomatous inflammation and contains dead tissue and immune cells.
9. A patient with pancreatitis develops areas of necrotic fat in the
abdomen. This type of necrosis is called:
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis
Answer: D. Fat necrosis
Rationale: Fat necrosis occurs when pancreatic enzymes (lipases) break
down triglycerides in adipose tissue, releasing fatty acids that combine with
calcium to form soap-like deposits. It is classically seen in acute pancreatitis.
10. A patient with a stroke develops brain tissue that has become soft and
liquefied. This type of necrosis is called:
