NUR 2063 — Exam 1: Essentials of Pathophysiology Update | Grade A Review
EXAM 1: NUR2063 / NUR 2063 (LATEST UPDATE)
ESSENTIALS OF PATHOPHYSIOLOGY
Review Guide Questions and Verified Answers | 100% Correct | Grade A — Rasmussen
Examination Overview: This comprehensive examination contains 100 multiple-choice questions distributed across
seven core domains of pathophysiology aligned with the Rasmussen University NUR 2063 course syllabus and
NCLEX-RN Pathophysiology Standards (2026/2027 Edition). Each question presents four options (A–D) with exactly
one verified correct answer. Rationales incorporate pathophysiological mechanisms, clinical correlations, and
curriculum references to reinforce conceptual mastery. Cognitive distribution: approximately 20% recall, 50%
application, and 30% analysis. Approximately 75% of items are scenario-based clinical reasoning questions, and 25%
assess direct knowledge. Special emphasis is placed on laboratory value interpretation, diagnostic findings, and
pathophysiological mechanisms of disease.
Section Domain Q# Items
1 Cellular Injury, Adaptation, & Death Q1 – Q15 15
2 Inflammation & Wound Healing Q16 – Q30 15
3 Immunity & Immunopathology Q31 – Q45 15
4 Infection & Infectious Disease Q46 – Q57 12
5 Fluid, Electrolyte, & Acid-Base Imbalances Q58 – Q72 15
6 Cardiovascular Pathophysiology Q73 – Q87 15
7 Respiratory Pathophysiology Q88 – Q100 13
TOTAL Q1 – Q100 100
Instructions: Select the single best answer for each question. Verified answers and rationales follow each item. This review
guide is intended for study and self-assessment in preparation for the NUR 2063 Essentials of Pathophysiology course
examination.
Section 1: Cellular Injury, Adaptation, & Death (Q1 – Q15)
Page 1 | Rasmussen University — NUR 2063 Course Examination
,NUR 2063 — Exam 1: Essentials of Pathophysiology Update | Grade A Review
Q1: A 24-year-old male has worn a long-arm cast for 6 weeks after a radial fracture. On removal,
the affected forearm appears visibly smaller than the contralateral limb. Histologic examination
would most likely reveal which cellular adaptation?
A. Hypertrophy of skeletal muscle fibers
B. Atrophy of skeletal muscle fibers due to decreased workload *[CORRECT]*
C. Metaplasia of skeletal muscle to fibrous tissue
D. Dysplastic changes in muscle cell nuclei
Correct Answer: B
Rationale: Atrophy is the decrease in cell size and functional capacity in response to reduced workload, disuse, denervation,
or inadequate nutrition. Prolonged immobilization in a cast produces disuse atrophy of skeletal muscle fibers. Hypertrophy
(A) involves an increase in cell size from increased demand, which is the opposite of what occurs with immobilization.
Metaplasia (C) is the reversible replacement of one adult cell type with another, typically in epithelial tissues, not skeletal
muscle. Dysplasia (D) refers to disordered, atypical cellular proliferation and is considered a precancerous change, not a
physiologic adaptation to disuse.
Q2: A 58-year-old female with long-standing essential hypertension presents with worsening
exertional dyspnea. Echocardiography reveals a thickened left ventricular wall with preserved
cavity size. Which cellular adaptation best explains this finding?
A. Hyperplasia of cardiac myocytes
B. Metaplasia of myocardial tissue
C. Hypertrophy of cardiac myocytes in response to pressure overload *[CORRECT]*
D. Dysplastic enlargement of ventricular muscle cells
Correct Answer: C
Rationale: Cardiac myocytes are terminally differentiated cells incapable of mitotic division, so they respond to increased
workload (pressure overload from chronic hypertension) by undergoing hypertrophy — an increase in individual cell size.
This produces concentric hypertrophy of the left ventricular wall. Hyperplasia (A) is an increase in cell number and does not
occur in cardiac myocytes. Metaplasia (B) and dysplasia (D) are epithelial adaptations and do not apply to cardiac muscle.
The mechanism involves synthesis of additional contractile proteins and organelles in response to mechanical stress.
Q3: Following partial hepatectomy, the remaining hepatocytes proliferate to restore liver mass.
Which cellular adaptation is occurring?
A. Hypertrophy of remaining hepatocytes only
B. Metaplasia of hepatocytes to biliary epithelium
C. Compensatory hyperplasia of hepatocytes *[CORRECT]*
D. Atypical hyperplasia indicating premalignant change
Correct Answer: C
Rationale: Compensatory hyperplasia is an increase in cell number in response to loss of tissue mass, enabling organ
regeneration. The liver is the classic example — remaining hepatocytes re-enter the cell cycle and proliferate to restore
functional mass. Hypertrophy (A) alone would not adequately restore liver volume. Metaplasia (B) is the replacement of one
cell type by another and does not occur during liver regeneration. Atypical hyperplasia (D) implies dysplastic, premalignant
proliferation, which is not a normal physiologic regenerative response.
Page 2 | Rasmussen University — NUR 2063 Course Examination
,NUR 2063 — Exam 1: Essentials of Pathophysiology Update | Grade A Review
Q4: A 52-year-old male with a 20-year history of gastroesophageal reflux disease (GERD)
undergoes upper endoscopy. Biopsy of the distal esophagus reveals columnar goblet cells
replacing the normal stratified squamous epithelium. This finding represents which cellular
adaptation?
A. Hypertrophy of squamous epithelium
B. Dysplasia of esophageal mucosa
C. Metaplasia of squamous to columnar epithelium (Barrett esophagus) *[CORRECT]*
D. Hyperplasia of squamous epithelium
Correct Answer: C
Rationale: Metaplasia is the reversible replacement of one differentiated adult cell type with another. In chronic GERD,
chronic acid exposure injures the squamous epithelium, and the epithelium adapts by differentiating into acid-resistant
columnar (goblet) cells — the hallmark of Barrett esophagus. Although adaptive, this metaplasia increases the risk of
adenocarcinoma. Hypertrophy (A) and hyperplasia (D) involve increased cell size or number, not cell type conversion.
Dysplasia (B) refers to disordered proliferation of atypical cells and may follow metaplasia but is not the change described in
the stem.
Q5: A 31-year-old female undergoes routine cervical Pap screening. The pathology report reads
"high-grade squamous intraepithelial lesion." Which cellular adaptation is most consistent with
this finding?
A. Atrophy of cervical epithelium
B. Metaplasia without cellular atypia
C. Dysplasia with disordered, atypical cellular proliferation *[CORRECT]*
D. Simple hyperplasia of cervical glands
Correct Answer: C
Rationale: Dysplasia is characterized by disorderly proliferation of atypical cells with changes in size, shape, and nuclear
organization that remains confined to the epithelium (in situ). High-grade squamous intraepithelial lesions reflect
moderate-to-severe dysplasia, typically driven by high-risk HPV. It is considered a precancerous change. Atrophy (A) is a
decrease in cell size, metaplasia (B) is replacement of one cell type with another without atypia, and simple hyperplasia (D)
is increased cell number without atypia. Dysplasia differs from these because it involves deranged maturation with atypical
nuclei — a hallmark of premalignant transformation.
Page 3 | Rasmussen University — NUR 2063 Course Examination
, NUR 2063 — Exam 1: Essentials of Pathophysiology Update | Grade A Review
Q6: A patient experiences transient coronary artery occlusion lasting 15 minutes before
reperfusion. Cellular swelling, mitochondrial swelling, and dissociation of ribosomes from
rough endoplasmic reticulum are observed, but membrane integrity is preserved. Which
process best describes this state?
A. Irreversible injury with coagulative necrosis
B. Reversible injury due to hypoxia with ATP depletion *[CORRECT]*
C. Apoptosis triggered by caspase activation
D. Caseous necrosis of cardiac myocytes
Correct Answer: B
Rationale: Reversible cell injury is characterized by cellular swelling (hydropic change), mitochondrial swelling, ER
disruption, and ribosomal detachment — all consequences of ATP depletion that impairs the Na+/K+-ATPase. Critically, the
plasma membrane and mitochondrial outer membrane remain intact, allowing recovery if oxygenation is restored.
Irreversible injury (A) features severe membrane damage, lysosomal rupture, and mitochondrial permeability transition.
Apoptosis (C) is programmed cell death requiring caspase activation and is not the primary response to brief ischemia.
Caseous necrosis (D) is associated with TB infection, not acute ischemia.
Q7: A patient with severe anemia has normal coronary arteries but a hemoglobin of 5 g/dL.
Another patient has a coronary thrombosis with 90% occlusion but normal hemoglobin. Which
statement correctly distinguishes the underlying mechanisms of cellular injury?
A. Both patients are experiencing identical ischemic injuries.
B. The first patient has hypoxia without ischemia; the second has ischemia with hypoxia.
*[CORRECT]*
C. The first patient has ischemia without hypoxia; the second has hypoxia without ischemia.
D. Neither patient has cellular hypoxia because blood flow is the only determinant.
Correct Answer: B
Rationale: Hypoxia refers to inadequate oxygen delivery to tissues; ischemia refers to inadequate blood perfusion. The
anemic patient has hypoxia without ischemia because blood flow is preserved but oxygen content is low. The patient with
coronary thrombosis has ischemia (reduced blood flow) which inevitably causes hypoxia because oxygen is not delivered.
Ischemia is generally more damaging than hypoxia alone because it also impairs removal of metabolic waste. The two
conditions are not identical (A), and the distinction is central to understanding mechanisms of cell injury.
Page 4 | Rasmussen University — NUR 2063 Course Examination
EXAM 1: NUR2063 / NUR 2063 (LATEST UPDATE)
ESSENTIALS OF PATHOPHYSIOLOGY
Review Guide Questions and Verified Answers | 100% Correct | Grade A — Rasmussen
Examination Overview: This comprehensive examination contains 100 multiple-choice questions distributed across
seven core domains of pathophysiology aligned with the Rasmussen University NUR 2063 course syllabus and
NCLEX-RN Pathophysiology Standards (2026/2027 Edition). Each question presents four options (A–D) with exactly
one verified correct answer. Rationales incorporate pathophysiological mechanisms, clinical correlations, and
curriculum references to reinforce conceptual mastery. Cognitive distribution: approximately 20% recall, 50%
application, and 30% analysis. Approximately 75% of items are scenario-based clinical reasoning questions, and 25%
assess direct knowledge. Special emphasis is placed on laboratory value interpretation, diagnostic findings, and
pathophysiological mechanisms of disease.
Section Domain Q# Items
1 Cellular Injury, Adaptation, & Death Q1 – Q15 15
2 Inflammation & Wound Healing Q16 – Q30 15
3 Immunity & Immunopathology Q31 – Q45 15
4 Infection & Infectious Disease Q46 – Q57 12
5 Fluid, Electrolyte, & Acid-Base Imbalances Q58 – Q72 15
6 Cardiovascular Pathophysiology Q73 – Q87 15
7 Respiratory Pathophysiology Q88 – Q100 13
TOTAL Q1 – Q100 100
Instructions: Select the single best answer for each question. Verified answers and rationales follow each item. This review
guide is intended for study and self-assessment in preparation for the NUR 2063 Essentials of Pathophysiology course
examination.
Section 1: Cellular Injury, Adaptation, & Death (Q1 – Q15)
Page 1 | Rasmussen University — NUR 2063 Course Examination
,NUR 2063 — Exam 1: Essentials of Pathophysiology Update | Grade A Review
Q1: A 24-year-old male has worn a long-arm cast for 6 weeks after a radial fracture. On removal,
the affected forearm appears visibly smaller than the contralateral limb. Histologic examination
would most likely reveal which cellular adaptation?
A. Hypertrophy of skeletal muscle fibers
B. Atrophy of skeletal muscle fibers due to decreased workload *[CORRECT]*
C. Metaplasia of skeletal muscle to fibrous tissue
D. Dysplastic changes in muscle cell nuclei
Correct Answer: B
Rationale: Atrophy is the decrease in cell size and functional capacity in response to reduced workload, disuse, denervation,
or inadequate nutrition. Prolonged immobilization in a cast produces disuse atrophy of skeletal muscle fibers. Hypertrophy
(A) involves an increase in cell size from increased demand, which is the opposite of what occurs with immobilization.
Metaplasia (C) is the reversible replacement of one adult cell type with another, typically in epithelial tissues, not skeletal
muscle. Dysplasia (D) refers to disordered, atypical cellular proliferation and is considered a precancerous change, not a
physiologic adaptation to disuse.
Q2: A 58-year-old female with long-standing essential hypertension presents with worsening
exertional dyspnea. Echocardiography reveals a thickened left ventricular wall with preserved
cavity size. Which cellular adaptation best explains this finding?
A. Hyperplasia of cardiac myocytes
B. Metaplasia of myocardial tissue
C. Hypertrophy of cardiac myocytes in response to pressure overload *[CORRECT]*
D. Dysplastic enlargement of ventricular muscle cells
Correct Answer: C
Rationale: Cardiac myocytes are terminally differentiated cells incapable of mitotic division, so they respond to increased
workload (pressure overload from chronic hypertension) by undergoing hypertrophy — an increase in individual cell size.
This produces concentric hypertrophy of the left ventricular wall. Hyperplasia (A) is an increase in cell number and does not
occur in cardiac myocytes. Metaplasia (B) and dysplasia (D) are epithelial adaptations and do not apply to cardiac muscle.
The mechanism involves synthesis of additional contractile proteins and organelles in response to mechanical stress.
Q3: Following partial hepatectomy, the remaining hepatocytes proliferate to restore liver mass.
Which cellular adaptation is occurring?
A. Hypertrophy of remaining hepatocytes only
B. Metaplasia of hepatocytes to biliary epithelium
C. Compensatory hyperplasia of hepatocytes *[CORRECT]*
D. Atypical hyperplasia indicating premalignant change
Correct Answer: C
Rationale: Compensatory hyperplasia is an increase in cell number in response to loss of tissue mass, enabling organ
regeneration. The liver is the classic example — remaining hepatocytes re-enter the cell cycle and proliferate to restore
functional mass. Hypertrophy (A) alone would not adequately restore liver volume. Metaplasia (B) is the replacement of one
cell type by another and does not occur during liver regeneration. Atypical hyperplasia (D) implies dysplastic, premalignant
proliferation, which is not a normal physiologic regenerative response.
Page 2 | Rasmussen University — NUR 2063 Course Examination
,NUR 2063 — Exam 1: Essentials of Pathophysiology Update | Grade A Review
Q4: A 52-year-old male with a 20-year history of gastroesophageal reflux disease (GERD)
undergoes upper endoscopy. Biopsy of the distal esophagus reveals columnar goblet cells
replacing the normal stratified squamous epithelium. This finding represents which cellular
adaptation?
A. Hypertrophy of squamous epithelium
B. Dysplasia of esophageal mucosa
C. Metaplasia of squamous to columnar epithelium (Barrett esophagus) *[CORRECT]*
D. Hyperplasia of squamous epithelium
Correct Answer: C
Rationale: Metaplasia is the reversible replacement of one differentiated adult cell type with another. In chronic GERD,
chronic acid exposure injures the squamous epithelium, and the epithelium adapts by differentiating into acid-resistant
columnar (goblet) cells — the hallmark of Barrett esophagus. Although adaptive, this metaplasia increases the risk of
adenocarcinoma. Hypertrophy (A) and hyperplasia (D) involve increased cell size or number, not cell type conversion.
Dysplasia (B) refers to disordered proliferation of atypical cells and may follow metaplasia but is not the change described in
the stem.
Q5: A 31-year-old female undergoes routine cervical Pap screening. The pathology report reads
"high-grade squamous intraepithelial lesion." Which cellular adaptation is most consistent with
this finding?
A. Atrophy of cervical epithelium
B. Metaplasia without cellular atypia
C. Dysplasia with disordered, atypical cellular proliferation *[CORRECT]*
D. Simple hyperplasia of cervical glands
Correct Answer: C
Rationale: Dysplasia is characterized by disorderly proliferation of atypical cells with changes in size, shape, and nuclear
organization that remains confined to the epithelium (in situ). High-grade squamous intraepithelial lesions reflect
moderate-to-severe dysplasia, typically driven by high-risk HPV. It is considered a precancerous change. Atrophy (A) is a
decrease in cell size, metaplasia (B) is replacement of one cell type with another without atypia, and simple hyperplasia (D)
is increased cell number without atypia. Dysplasia differs from these because it involves deranged maturation with atypical
nuclei — a hallmark of premalignant transformation.
Page 3 | Rasmussen University — NUR 2063 Course Examination
, NUR 2063 — Exam 1: Essentials of Pathophysiology Update | Grade A Review
Q6: A patient experiences transient coronary artery occlusion lasting 15 minutes before
reperfusion. Cellular swelling, mitochondrial swelling, and dissociation of ribosomes from
rough endoplasmic reticulum are observed, but membrane integrity is preserved. Which
process best describes this state?
A. Irreversible injury with coagulative necrosis
B. Reversible injury due to hypoxia with ATP depletion *[CORRECT]*
C. Apoptosis triggered by caspase activation
D. Caseous necrosis of cardiac myocytes
Correct Answer: B
Rationale: Reversible cell injury is characterized by cellular swelling (hydropic change), mitochondrial swelling, ER
disruption, and ribosomal detachment — all consequences of ATP depletion that impairs the Na+/K+-ATPase. Critically, the
plasma membrane and mitochondrial outer membrane remain intact, allowing recovery if oxygenation is restored.
Irreversible injury (A) features severe membrane damage, lysosomal rupture, and mitochondrial permeability transition.
Apoptosis (C) is programmed cell death requiring caspase activation and is not the primary response to brief ischemia.
Caseous necrosis (D) is associated with TB infection, not acute ischemia.
Q7: A patient with severe anemia has normal coronary arteries but a hemoglobin of 5 g/dL.
Another patient has a coronary thrombosis with 90% occlusion but normal hemoglobin. Which
statement correctly distinguishes the underlying mechanisms of cellular injury?
A. Both patients are experiencing identical ischemic injuries.
B. The first patient has hypoxia without ischemia; the second has ischemia with hypoxia.
*[CORRECT]*
C. The first patient has ischemia without hypoxia; the second has hypoxia without ischemia.
D. Neither patient has cellular hypoxia because blood flow is the only determinant.
Correct Answer: B
Rationale: Hypoxia refers to inadequate oxygen delivery to tissues; ischemia refers to inadequate blood perfusion. The
anemic patient has hypoxia without ischemia because blood flow is preserved but oxygen content is low. The patient with
coronary thrombosis has ischemia (reduced blood flow) which inevitably causes hypoxia because oxygen is not delivered.
Ischemia is generally more damaging than hypoxia alone because it also impairs removal of metabolic waste. The two
conditions are not identical (A), and the distinction is central to understanding mechanisms of cell injury.
Page 4 | Rasmussen University — NUR 2063 Course Examination
