NR 507 Final Exam – Advanced Pathophysiology – (2026) Actual Questions &
Answers (Chamberlain) 100% Guarantee Pass
SECTION 1: CELLULAR ADAPTATION, INJURY & DEATH (Questions 1–30)
Question 1
Which cellular adaptation is characterized by an increase in the NUMBER of cells
in an organ or tissue?
A. Hypertrophy
B. Hyperplasia
C. Metaplasia
D. Atrophy
Correct Answer: B
Rationale: Hyperplasia is defined as an increase in the number of cells in a
tissue or organ, resulting in increased tissue mass. It occurs in tissues capable of
cell division (labile and stable cells). Hypertrophy (A) is an increase in cell SIZE.
Metaplasia (C) is the reversible replacement of one mature cell type with another.
Atrophy (D) is a decrease in cell size. Hyperplasia can be physiologic (e.g.,
hormonal breast changes during menstrual cycle) or pathologic (e.g., endometrial
hyperplasia from unopposed estrogen).
Question 2
A 68-year-old male with chronic GERD undergoes endoscopy revealing
intestinal-type columnar epithelium replacing the normal squamous epithelium
in the distal esophagus. This cellular adaptation is BEST described as:
A. Hyperplasia
B. Metaplasia
C. Dysplasia
D. Anaplasia
Correct Answer: B
,Rationale: Metaplasia is the reversible replacement of one differentiated
(mature) cell type with another differentiated cell type, typically as an adaptive
response to chronic stress or irritation. In Barrett esophagus, chronic acid
exposure causes squamous epithelium to be replaced by intestinal-type columnar
epithelium that is more resistant to acid. Hyperplasia (A) is increased cell number.
Dysplasia (C) is disordered growth with loss of uniformity and architectural
orientation (pre-malignant). Anaplasia (D) is lack of differentiation, characteristic
of malignancy.
Question 3
A patient's heart muscle increases in size due to chronic hypertension. This
cellular adaptation is called:
A. Atrophy
B. Hyperplasia
C. Hypertrophy
D. Metaplasia
Correct Answer: C
Rationale: Hypertrophy is an increase in cell SIZE, occurring in tissues
composed of cells that cannot divide (terminally differentiated cells like cardiac
and skeletal muscle). The increased workload from chronic hypertension forces
myocardial cells to enlarge to generate greater contractile force. Hyperplasia (B)
cannot occur in cardiac muscle because myocytes are permanent cells. Atrophy
(A) is shrinkage. Metaplasia (D) is cell type replacement.
Question 4
A 75-year-old patient has prolonged bedrest after a hip fracture. The affected
leg muscles decrease in size. This cellular change is called:
A. Atrophy
B. Hypertrophy
,C. Hyperplasia
D. Dysplasia
Correct Answer: A
Rationale: Atrophy is a decrease in cell SIZE due to decreased workload
(disuse), decreased blood supply, loss of innervation, inadequate nutrition, or loss
of hormonal stimulation. Prolonged bedrest results in disuse atrophy of skeletal
muscles. Hypertrophy (B) is increased cell size. Hyperplasia (C) is increased cell
number. Dysplasia (D) is disordered growth.
Question 5
A 25-year-old female presents with bilateral breast masses that enlarge during
the menstrual cycle and regress afterward. Biopsy shows increased number of
normal-appearing cells. This is an example of:
A. Hypertrophy
B. Hyperplasia
C. Metaplasia
D. Neoplasia
Correct Answer: B
Rationale: Hyperplasia is an increase in cell NUMBER in response to
hormonal stimulation or growth factors. Hormone-induced breast tissue changes
during the menstrual cycle represent physiologic hyperplasia. Hypertrophy (A) is
increased cell size. Metaplasia (C) is cell type replacement. Neoplasia (D) is
uncontrolled new growth (cancer).
Question 6
Which of the following BEST distinguishes apoptosis from necrosis?
A. Apoptosis involves cell swelling; necrosis involves cell shrinkage
B. Apoptosis is programmed cell death requiring ATP, with cell shrinkage and no
inflammation; necrosis is uncontrolled cell death with cell swelling, membrane
, rupture, and significant inflammation
C. Apoptosis always causes inflammation; necrosis never does
D. Apoptosis occurs only in pathological conditions
Correct Answer: B
Rationale: Apoptosis is energy-dependent (ATP-required) programmed
cell death characterized by cell shrinkage, chromatin condensation, membrane
blebbing, formation of apoptotic bodies, and NO inflammation (cells are quietly
phagocytosed). Necrosis is uncontrolled cell death characterized by cell swelling,
membrane rupture, contents spilling into extracellular space, and significant
inflammation. Apoptosis can be physiologic (development) or pathologic (DNA
damage).
Question 7
A pathologist examining a tissue specimen notes cell swelling, vacuolation, and
nuclear changes including pyknosis (nuclear condensation). These findings are
MOST consistent with:
A. Apoptosis
B. Reversible cell injury (early ischemic change)
C. Necrosis (late cell death with inflammation)
D. Normal cellular function
Correct Answer: B
Rationale: Cellular swelling (hydropic change) and vacuolation are
hallmarks of REVERSIBLE cell injury — early ischemic/hypoxic changes that can
resolve if oxygenation is restored. Pyknosis (chromatin condensation) may be
present early. Necrosis (C) is characterized by cell membrane rupture,
inflammation, and progressive nuclear changes (pyknosis → karyorrhexis →
karyolysis) with surrounding inflammation. Apoptosis (A) is programmed,
controlled cell death without inflammation.
Question 8
Answers (Chamberlain) 100% Guarantee Pass
SECTION 1: CELLULAR ADAPTATION, INJURY & DEATH (Questions 1–30)
Question 1
Which cellular adaptation is characterized by an increase in the NUMBER of cells
in an organ or tissue?
A. Hypertrophy
B. Hyperplasia
C. Metaplasia
D. Atrophy
Correct Answer: B
Rationale: Hyperplasia is defined as an increase in the number of cells in a
tissue or organ, resulting in increased tissue mass. It occurs in tissues capable of
cell division (labile and stable cells). Hypertrophy (A) is an increase in cell SIZE.
Metaplasia (C) is the reversible replacement of one mature cell type with another.
Atrophy (D) is a decrease in cell size. Hyperplasia can be physiologic (e.g.,
hormonal breast changes during menstrual cycle) or pathologic (e.g., endometrial
hyperplasia from unopposed estrogen).
Question 2
A 68-year-old male with chronic GERD undergoes endoscopy revealing
intestinal-type columnar epithelium replacing the normal squamous epithelium
in the distal esophagus. This cellular adaptation is BEST described as:
A. Hyperplasia
B. Metaplasia
C. Dysplasia
D. Anaplasia
Correct Answer: B
,Rationale: Metaplasia is the reversible replacement of one differentiated
(mature) cell type with another differentiated cell type, typically as an adaptive
response to chronic stress or irritation. In Barrett esophagus, chronic acid
exposure causes squamous epithelium to be replaced by intestinal-type columnar
epithelium that is more resistant to acid. Hyperplasia (A) is increased cell number.
Dysplasia (C) is disordered growth with loss of uniformity and architectural
orientation (pre-malignant). Anaplasia (D) is lack of differentiation, characteristic
of malignancy.
Question 3
A patient's heart muscle increases in size due to chronic hypertension. This
cellular adaptation is called:
A. Atrophy
B. Hyperplasia
C. Hypertrophy
D. Metaplasia
Correct Answer: C
Rationale: Hypertrophy is an increase in cell SIZE, occurring in tissues
composed of cells that cannot divide (terminally differentiated cells like cardiac
and skeletal muscle). The increased workload from chronic hypertension forces
myocardial cells to enlarge to generate greater contractile force. Hyperplasia (B)
cannot occur in cardiac muscle because myocytes are permanent cells. Atrophy
(A) is shrinkage. Metaplasia (D) is cell type replacement.
Question 4
A 75-year-old patient has prolonged bedrest after a hip fracture. The affected
leg muscles decrease in size. This cellular change is called:
A. Atrophy
B. Hypertrophy
,C. Hyperplasia
D. Dysplasia
Correct Answer: A
Rationale: Atrophy is a decrease in cell SIZE due to decreased workload
(disuse), decreased blood supply, loss of innervation, inadequate nutrition, or loss
of hormonal stimulation. Prolonged bedrest results in disuse atrophy of skeletal
muscles. Hypertrophy (B) is increased cell size. Hyperplasia (C) is increased cell
number. Dysplasia (D) is disordered growth.
Question 5
A 25-year-old female presents with bilateral breast masses that enlarge during
the menstrual cycle and regress afterward. Biopsy shows increased number of
normal-appearing cells. This is an example of:
A. Hypertrophy
B. Hyperplasia
C. Metaplasia
D. Neoplasia
Correct Answer: B
Rationale: Hyperplasia is an increase in cell NUMBER in response to
hormonal stimulation or growth factors. Hormone-induced breast tissue changes
during the menstrual cycle represent physiologic hyperplasia. Hypertrophy (A) is
increased cell size. Metaplasia (C) is cell type replacement. Neoplasia (D) is
uncontrolled new growth (cancer).
Question 6
Which of the following BEST distinguishes apoptosis from necrosis?
A. Apoptosis involves cell swelling; necrosis involves cell shrinkage
B. Apoptosis is programmed cell death requiring ATP, with cell shrinkage and no
inflammation; necrosis is uncontrolled cell death with cell swelling, membrane
, rupture, and significant inflammation
C. Apoptosis always causes inflammation; necrosis never does
D. Apoptosis occurs only in pathological conditions
Correct Answer: B
Rationale: Apoptosis is energy-dependent (ATP-required) programmed
cell death characterized by cell shrinkage, chromatin condensation, membrane
blebbing, formation of apoptotic bodies, and NO inflammation (cells are quietly
phagocytosed). Necrosis is uncontrolled cell death characterized by cell swelling,
membrane rupture, contents spilling into extracellular space, and significant
inflammation. Apoptosis can be physiologic (development) or pathologic (DNA
damage).
Question 7
A pathologist examining a tissue specimen notes cell swelling, vacuolation, and
nuclear changes including pyknosis (nuclear condensation). These findings are
MOST consistent with:
A. Apoptosis
B. Reversible cell injury (early ischemic change)
C. Necrosis (late cell death with inflammation)
D. Normal cellular function
Correct Answer: B
Rationale: Cellular swelling (hydropic change) and vacuolation are
hallmarks of REVERSIBLE cell injury — early ischemic/hypoxic changes that can
resolve if oxygenation is restored. Pyknosis (chromatin condensation) may be
present early. Necrosis (C) is characterized by cell membrane rupture,
inflammation, and progressive nuclear changes (pyknosis → karyorrhexis →
karyolysis) with surrounding inflammation. Apoptosis (A) is programmed,
controlled cell death without inflammation.
Question 8
