APPLIED PATHOPHYSIOLOGY FOR THE ADVANCED
PRACTICE NURSE 2ND EDITION BY DLUGASCH &
STORY – EXAM
STUDY GUIDE 2026/2027
ACCURATE QUESTIONS WITH CORRECT
DETAILED SOLUTIONS || 100%
GUARANTEED PASS NEWEST VERSION
Description: This revision set contains 100 multiple-choice questions covering the core
chapters of Applied Pathophysiology for the Advanced Practice Nurse, 2nd Edition.
Questions emphasize clinical application, disease mechanisms, and diagnostic reasoning
expected at the advanced practice level.
Keywords: applied pathophysiology, advanced practice nurse, Dlugasch Story test bank,
APRN exam prep, cellular adaptation, inflammation, cardiovascular pathophysiology,
pulmonary disorders, acid-base balance, endocrine disorders, renal function, neurologic
disorders, clinical reasoning
Chapter 1: Cellular Function (Questions 1–10)
Question 1
The organelle primarily responsible for generating ATP through oxidative
phosphorylation is:
A) Ribosome
B) Mitochondria ✅
,C) Golgi apparatus
D) Lysosome
Rationale: Mitochondria generate ATP via oxidative phosphorylation using oxygen and
metabolic substrates. Ribosomes synthesize proteins, the Golgi packages proteins, and
lysosomes degrade cellular debris.
Question 2
A patient with chronic hypertension develops increased left ventricular mass. This is an
example of:
A) Hyperplasia
B) Hypertrophy ✅
C) Metaplasia
D) Dysplasia
Rationale: Hypertrophy is an increase in cell size due to increased workload.
Hyperplasia is an increase in cell number, metaplasia is replacement of one cell type
with another, and dysplasia is disordered growth.
Question 3
During an ischemic event, the direct cause of intracellular fluid accumulation is:
A) Osmotic shifts from increased extracellular sodium
B) Failure of the ATP-dependent sodium-potassium pump ✅
C) Increased lymphatic drainage
D) Enhanced glucose uptake
Rationale: Ischemia depletes ATP, causing the Na⁺/K⁺ ATPase pump to fail. Sodium
accumulates intracellularly, drawing water in and causing cellular swelling.
Question 4
A chronic smoker's respiratory biopsy shows stratified squamous epithelium replacing
normal ciliated columnar cells. This is:
,A) Dysplasia
B) Anaplasia
C) Metaplasia ✅
D) Hyperplasia
Rationale: Metaplasia is the reversible replacement of one mature cell type by another
better suited to withstand chronic irritation. It is not yet dysplasia (disordered growth) or
anaplasia (lack of differentiation).
Question 5
Carbon monoxide causes cellular injury primarily through:
A) Direct membrane destruction
B) Binding hemoglobin with high affinity, causing systemic hypoxia ✅
C) Inhibiting antidiuretic hormone release
D) Inducing calcium extrusion
Rationale: Carbon monoxide binds hemoglobin with an affinity ~250 times that of
oxygen, forming carboxyhemoglobin and severely reducing oxygen delivery to tissues.
Question 6
Which intracellular event during ischemia promotes cell death by activating destructive
enzymes?
A) Decreased cytoplasmic calcium
B) Influx of extracellular calcium ✅
C) Alkalization of cytoplasm
D) Increased ATP synthesis
Rationale: Ischemia disrupts calcium regulation, causing calcium influx. Excess
cytoplasmic calcium activates proteases, phospholipases, and endonucleases that
degrade cellular structures.
, Question 7
Autophagy is best described as:
A) Extracellular microbe engulfment by dendritic cells
B) Degradation of the cell's own damaged proteins and organelles for survival ✅
C) Active calcium extrusion from the cytoplasm
D) Fusion of neighboring cells to share nutrients
Rationale: Autophagy is a survival mechanism where cells recycle damaged contents
during starvation or stress. It differs from phagocytosis, which involves engulfing
external material.
Question 8
During anaerobic glycolysis, which waste product accumulates and lowers intracellular
pH?
A) Pyruvate
B) Lactic acid ✅
C) Citric acid
D) Carbon dioxide
Rationale: Without oxygen, pyruvate is converted to lactic acid to regenerate NAD⁺.
Lactic acid accumulation lowers cellular pH.
Question 9
Matrix metalloproteinases (MMPs) are essential for:
A) Generating reactive oxygen species
B) Degrading extracellular matrix during remodeling ✅
C) Stimulating fibroblast proliferation
D) Inhibiting angiogenesis
Rationale: MMPs degrade extracellular matrix components during tissue remodeling,
wound healing, and angiogenesis.
PRACTICE NURSE 2ND EDITION BY DLUGASCH &
STORY – EXAM
STUDY GUIDE 2026/2027
ACCURATE QUESTIONS WITH CORRECT
DETAILED SOLUTIONS || 100%
GUARANTEED PASS NEWEST VERSION
Description: This revision set contains 100 multiple-choice questions covering the core
chapters of Applied Pathophysiology for the Advanced Practice Nurse, 2nd Edition.
Questions emphasize clinical application, disease mechanisms, and diagnostic reasoning
expected at the advanced practice level.
Keywords: applied pathophysiology, advanced practice nurse, Dlugasch Story test bank,
APRN exam prep, cellular adaptation, inflammation, cardiovascular pathophysiology,
pulmonary disorders, acid-base balance, endocrine disorders, renal function, neurologic
disorders, clinical reasoning
Chapter 1: Cellular Function (Questions 1–10)
Question 1
The organelle primarily responsible for generating ATP through oxidative
phosphorylation is:
A) Ribosome
B) Mitochondria ✅
,C) Golgi apparatus
D) Lysosome
Rationale: Mitochondria generate ATP via oxidative phosphorylation using oxygen and
metabolic substrates. Ribosomes synthesize proteins, the Golgi packages proteins, and
lysosomes degrade cellular debris.
Question 2
A patient with chronic hypertension develops increased left ventricular mass. This is an
example of:
A) Hyperplasia
B) Hypertrophy ✅
C) Metaplasia
D) Dysplasia
Rationale: Hypertrophy is an increase in cell size due to increased workload.
Hyperplasia is an increase in cell number, metaplasia is replacement of one cell type
with another, and dysplasia is disordered growth.
Question 3
During an ischemic event, the direct cause of intracellular fluid accumulation is:
A) Osmotic shifts from increased extracellular sodium
B) Failure of the ATP-dependent sodium-potassium pump ✅
C) Increased lymphatic drainage
D) Enhanced glucose uptake
Rationale: Ischemia depletes ATP, causing the Na⁺/K⁺ ATPase pump to fail. Sodium
accumulates intracellularly, drawing water in and causing cellular swelling.
Question 4
A chronic smoker's respiratory biopsy shows stratified squamous epithelium replacing
normal ciliated columnar cells. This is:
,A) Dysplasia
B) Anaplasia
C) Metaplasia ✅
D) Hyperplasia
Rationale: Metaplasia is the reversible replacement of one mature cell type by another
better suited to withstand chronic irritation. It is not yet dysplasia (disordered growth) or
anaplasia (lack of differentiation).
Question 5
Carbon monoxide causes cellular injury primarily through:
A) Direct membrane destruction
B) Binding hemoglobin with high affinity, causing systemic hypoxia ✅
C) Inhibiting antidiuretic hormone release
D) Inducing calcium extrusion
Rationale: Carbon monoxide binds hemoglobin with an affinity ~250 times that of
oxygen, forming carboxyhemoglobin and severely reducing oxygen delivery to tissues.
Question 6
Which intracellular event during ischemia promotes cell death by activating destructive
enzymes?
A) Decreased cytoplasmic calcium
B) Influx of extracellular calcium ✅
C) Alkalization of cytoplasm
D) Increased ATP synthesis
Rationale: Ischemia disrupts calcium regulation, causing calcium influx. Excess
cytoplasmic calcium activates proteases, phospholipases, and endonucleases that
degrade cellular structures.
, Question 7
Autophagy is best described as:
A) Extracellular microbe engulfment by dendritic cells
B) Degradation of the cell's own damaged proteins and organelles for survival ✅
C) Active calcium extrusion from the cytoplasm
D) Fusion of neighboring cells to share nutrients
Rationale: Autophagy is a survival mechanism where cells recycle damaged contents
during starvation or stress. It differs from phagocytosis, which involves engulfing
external material.
Question 8
During anaerobic glycolysis, which waste product accumulates and lowers intracellular
pH?
A) Pyruvate
B) Lactic acid ✅
C) Citric acid
D) Carbon dioxide
Rationale: Without oxygen, pyruvate is converted to lactic acid to regenerate NAD⁺.
Lactic acid accumulation lowers cellular pH.
Question 9
Matrix metalloproteinases (MMPs) are essential for:
A) Generating reactive oxygen species
B) Degrading extracellular matrix during remodeling ✅
C) Stimulating fibroblast proliferation
D) Inhibiting angiogenesis
Rationale: MMPs degrade extracellular matrix components during tissue remodeling,
wound healing, and angiogenesis.
