NSG 5140 Advanced Pathophysiology Final
Exam 2026-2027
Complete 200-Question Practice Exam with
Verified Answers and Detailed Rationales
South College Graduate Nursing Program
Prep Guide
SECTION 1: CELLULAR ADAPTATION, INJURY, AND DEATH
(Questions 1-30)
Question 1
A 62-year-old male with chronic heart failure presents with worsening dyspnea,
jugular venous distension, and peripheral edema. Which cellular adaptation is most
likely occurring in his myocardium as a compensatory mechanism?
A. Hyperplasia
B. Metaplasia
C. Hypertrophy
D. Dysplasia
Correct Answer: C. Hypertrophy
Rationale: Hypertrophy is an increase in cell size due to increased workload, as
seen in heart failure where myocytes enlarge to compensate for pressure or volume
overload. Hyperplasia (increase in cell number) is not typical in terminally
differentiated cardiac muscle. Metaplasia is replacement of one cell type with
another. Dysplasia is disordered cellular growth, often preneoplastic.
,Question 2
During ischemia, the switch from aerobic to anaerobic metabolism leads to which
immediate intracellular change?
A. Increased intracellular pH
B. Decreased intracellular sodium
C. Accumulation of lactic acid
D. Increased ATP production
Correct Answer: C. Accumulation of lactic acid
Rationale: Ischemia causes decreased oxygen supply, forcing cells to shift from
aerobic to anaerobic metabolism. This results in accumulation of lactic acid and
decreased intracellular pH (acidosis). ATP production decreases significantly.
Sodium accumulates intracellularly due to Na⁺/K⁺ ATPase pump failure.
Question 3
A patient's biopsy reveals an increase in the number of breast glandular cells due to
hormonal stimulation during pregnancy. What is this cellular adaptation called?
A. Hypertrophy
B. Hyperplasia
C. Metaplasia
D. Dysplasia
Correct Answer: B. Hyperplasia
Rationale: Hyperplasia is an increase in the number of cells in an organ or tissue,
typically in response to hormonal stimulation or increased functional demand.
Breast glandular cells proliferate in response to estrogen stimulation during
pregnancy. Unlike hypertrophy (increase in cell size), hyperplasia involves cell
division in tissues capable of mitotic activity.
Question 4
Which type of necrosis is characteristic of cerebral infarction following a stroke?
,A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis
Correct Answer: B. Liquefactive necrosis
Rationale: Liquefactive necrosis is characteristic of the central nervous system
(brain). It is caused by release of hydrolytic enzymes from dead cells and
inflammatory cells, dissolving tissue into a liquid, viscous mass. Coagulative
necrosis is typical of myocardial infarction; caseous necrosis is seen in
tuberculosis; fat necrosis occurs in breast or pancreatic tissue.
Question 5
Which cellular change is characteristic of reversible cell injury?
A. Nuclear pyknosis
B. Mitochondrial swelling
C. Myelin figures
D. Karyorrhexis
Correct Answer: B. Mitochondrial swelling
Rationale: Mitochondrial swelling and loss of microvilli are reversible changes.
Pyknosis (nuclear condensation), karyorrhexis (nuclear fragmentation), and myelin
figures are markers of irreversible injury/necrosis. In reversible injury, cellular
swelling occurs due to failure of ion pumps, but the cell can recover if the stressor
is removed.
Question 6
A patient with chronic hypertension develops left ventricular wall thickening.
Which mechanism best explains this adaptation?
A. Increased myocyte number due to cell division
B. Increased myocyte size due to increased workload
, C. Replacement of cardiac cells with fibrous tissue
D. Transformation of cardiac cells into smooth muscle
Correct Answer: B. Increased myocyte size due to increased workload
Rationale: Cardiac myocytes are terminally differentiated and cannot undergo
hyperplasia (increase in cell number). They respond to chronic pressure overload
through hypertrophy—an increase in individual cell size to generate greater
contractile force. This is an adaptive response to increased afterload. Fibrous tissue
replacement and metaplasia are not adaptive mechanisms in this scenario.
Question 7
Loss of adenosine triphosphate (ATP) during ischemic injury most directly leads
to:
A. Increased oxidative phosphorylation
B. Failure of the Na⁺/K⁺ ATPase pump
C. Enhanced protein synthesis
D. Decreased intracellular calcium
Correct Answer: B. Failure of the Na⁺/K⁺ ATPase pump
Rationale: ATP depletion leads to failure of the Na⁺/K⁺ ATPase pump, causing
accumulation of intracellular sodium and water (cellular swelling). This is a
hallmark of reversible cell injury. ATP is required for normal cellular function, and
its depletion initiates a cascade of cellular injury.
Question 8
A 45-year-old with chronic alcohol abuse presents with hepatomegaly. Liver
biopsy shows accumulation of lipid droplets in hepatocytes. This finding represents
which type of cellular adaptation?
A. Hydropic degeneration
B. Steatosis (fatty change)
C. Metaplasia
D. Dysplasia
Exam 2026-2027
Complete 200-Question Practice Exam with
Verified Answers and Detailed Rationales
South College Graduate Nursing Program
Prep Guide
SECTION 1: CELLULAR ADAPTATION, INJURY, AND DEATH
(Questions 1-30)
Question 1
A 62-year-old male with chronic heart failure presents with worsening dyspnea,
jugular venous distension, and peripheral edema. Which cellular adaptation is most
likely occurring in his myocardium as a compensatory mechanism?
A. Hyperplasia
B. Metaplasia
C. Hypertrophy
D. Dysplasia
Correct Answer: C. Hypertrophy
Rationale: Hypertrophy is an increase in cell size due to increased workload, as
seen in heart failure where myocytes enlarge to compensate for pressure or volume
overload. Hyperplasia (increase in cell number) is not typical in terminally
differentiated cardiac muscle. Metaplasia is replacement of one cell type with
another. Dysplasia is disordered cellular growth, often preneoplastic.
,Question 2
During ischemia, the switch from aerobic to anaerobic metabolism leads to which
immediate intracellular change?
A. Increased intracellular pH
B. Decreased intracellular sodium
C. Accumulation of lactic acid
D. Increased ATP production
Correct Answer: C. Accumulation of lactic acid
Rationale: Ischemia causes decreased oxygen supply, forcing cells to shift from
aerobic to anaerobic metabolism. This results in accumulation of lactic acid and
decreased intracellular pH (acidosis). ATP production decreases significantly.
Sodium accumulates intracellularly due to Na⁺/K⁺ ATPase pump failure.
Question 3
A patient's biopsy reveals an increase in the number of breast glandular cells due to
hormonal stimulation during pregnancy. What is this cellular adaptation called?
A. Hypertrophy
B. Hyperplasia
C. Metaplasia
D. Dysplasia
Correct Answer: B. Hyperplasia
Rationale: Hyperplasia is an increase in the number of cells in an organ or tissue,
typically in response to hormonal stimulation or increased functional demand.
Breast glandular cells proliferate in response to estrogen stimulation during
pregnancy. Unlike hypertrophy (increase in cell size), hyperplasia involves cell
division in tissues capable of mitotic activity.
Question 4
Which type of necrosis is characteristic of cerebral infarction following a stroke?
,A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis
Correct Answer: B. Liquefactive necrosis
Rationale: Liquefactive necrosis is characteristic of the central nervous system
(brain). It is caused by release of hydrolytic enzymes from dead cells and
inflammatory cells, dissolving tissue into a liquid, viscous mass. Coagulative
necrosis is typical of myocardial infarction; caseous necrosis is seen in
tuberculosis; fat necrosis occurs in breast or pancreatic tissue.
Question 5
Which cellular change is characteristic of reversible cell injury?
A. Nuclear pyknosis
B. Mitochondrial swelling
C. Myelin figures
D. Karyorrhexis
Correct Answer: B. Mitochondrial swelling
Rationale: Mitochondrial swelling and loss of microvilli are reversible changes.
Pyknosis (nuclear condensation), karyorrhexis (nuclear fragmentation), and myelin
figures are markers of irreversible injury/necrosis. In reversible injury, cellular
swelling occurs due to failure of ion pumps, but the cell can recover if the stressor
is removed.
Question 6
A patient with chronic hypertension develops left ventricular wall thickening.
Which mechanism best explains this adaptation?
A. Increased myocyte number due to cell division
B. Increased myocyte size due to increased workload
, C. Replacement of cardiac cells with fibrous tissue
D. Transformation of cardiac cells into smooth muscle
Correct Answer: B. Increased myocyte size due to increased workload
Rationale: Cardiac myocytes are terminally differentiated and cannot undergo
hyperplasia (increase in cell number). They respond to chronic pressure overload
through hypertrophy—an increase in individual cell size to generate greater
contractile force. This is an adaptive response to increased afterload. Fibrous tissue
replacement and metaplasia are not adaptive mechanisms in this scenario.
Question 7
Loss of adenosine triphosphate (ATP) during ischemic injury most directly leads
to:
A. Increased oxidative phosphorylation
B. Failure of the Na⁺/K⁺ ATPase pump
C. Enhanced protein synthesis
D. Decreased intracellular calcium
Correct Answer: B. Failure of the Na⁺/K⁺ ATPase pump
Rationale: ATP depletion leads to failure of the Na⁺/K⁺ ATPase pump, causing
accumulation of intracellular sodium and water (cellular swelling). This is a
hallmark of reversible cell injury. ATP is required for normal cellular function, and
its depletion initiates a cascade of cellular injury.
Question 8
A 45-year-old with chronic alcohol abuse presents with hepatomegaly. Liver
biopsy shows accumulation of lipid droplets in hepatocytes. This finding represents
which type of cellular adaptation?
A. Hydropic degeneration
B. Steatosis (fatty change)
C. Metaplasia
D. Dysplasia
