NR 547 Advanced Pathophysiology Exam
Questions and Answers 2026/2027
Complete Study Guide
NR 547 Advanced Pathophysiology —
1. Which cellular change is most characteristic of reversible cell injury?
A. Nuclear dissolution
B. Cellular swelling
C. Membrane rupture
D. Extensive mitochondrial destruction
Answer: B. Cellular swelling
Rationale: ATP depletion impairs the sodium-potassium pump, causing sodium and water to
enter the cell. Cellular swelling is an early, potentially reversible manifestation of injury.
2. A patient develops myocardial ischemia after coronary artery occlusion. What is the earliest
major consequence of inadequate oxygen delivery?
A. Increased oxidative phosphorylation
B. Increased ATP production
C. Decreased aerobic ATP production
D. Increased protein synthesis
Answer: C. Decreased aerobic ATP production
Rationale: Oxygen is required for oxidative phosphorylation. Ischemia therefore rapidly
decreases mitochondrial ATP generation, disrupting energy-dependent cellular processes.
3. Failure of the sodium-potassium ATPase during cellular injury causes:
A. Sodium to leave the cell
B. Potassium to enter the cell
C. Sodium to accumulate intracellularly
D. Calcium to leave the cell
,Answer: C. Sodium to accumulate intracellularly
Rationale: The sodium-potassium pump normally exports sodium and imports potassium. ATP
depletion causes intracellular sodium accumulation and subsequent water influx.
4. Which finding most strongly indicates irreversible cellular injury?
A. Mild cellular swelling
B. Fatty change
C. Ribosomal detachment
D. Loss of membrane integrity
Answer: D. Loss of membrane integrity
Rationale: Severe membrane damage is a defining feature of irreversible injury and permits
leakage of intracellular enzymes and other contents.
5. Apoptosis differs from necrosis because apoptosis:
A. Always causes extensive inflammation
B. Is an energy-dependent programmed process
C. Always results from infection
D. Causes immediate cell membrane rupture
Answer: B. Is an energy-dependent programmed process
Rationale: Apoptosis is regulated programmed cell death and usually occurs without the
extensive inflammatory response associated with necrosis.
6. A smoker develops replacement of normal ciliated columnar bronchial epithelium with
stratified squamous epithelium. This represents:
A. Hypertrophy
B. Hyperplasia
C. Metaplasia
D. Dysplasia
Answer: C. Metaplasia
Rationale: Metaplasia is the reversible replacement of one differentiated cell type with another
better able to tolerate chronic stress.
,7. Which cellular adaptation involves an increase in cell size rather than cell number?
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Atrophy
Answer: B. Hypertrophy
Rationale: Hypertrophy increases individual cell size, commonly in tissues such as cardiac
muscle subjected to chronic pressure overload.
8. Which process describes a decrease in cell size and functional activity?
A. Atrophy
B. Hyperplasia
C. Dysplasia
D. Metaplasia
Answer: A. Atrophy
Rationale: Atrophy occurs when cells decrease in size and metabolic activity, often because of
disuse, poor nutrition, reduced blood supply, or loss of hormonal stimulation.
9. Dysplasia is best described as:
A. Normal programmed cell death
B. Disorganized cellular growth with abnormal cell characteristics
C. Increased cell size from workload
D. Replacement of one mature cell type by another
Answer: B. Disorganized cellular growth with abnormal cell characteristics
Rationale: Dysplasia involves abnormal cellular size, shape, organization, and maturation and
can be associated with premalignant changes.
10. Which reactive oxygen species can contribute to oxidative cellular injury?
A. Superoxide
B. Albumin
C. Insulin
D. Fibrinogen
, Answer: A. Superoxide
Rationale: Reactive oxygen species such as superoxide and hydroxyl radicals can damage lipids,
proteins, and DNA.
11. Histamine contributes to acute inflammation primarily by causing:
A. Vasoconstriction and decreased permeability
B. Vasodilation and increased vascular permeability
C. Reduced leukocyte migration
D. Suppression of endothelial activity
Answer: B. Vasodilation and increased vascular permeability
Rationale: Histamine released from mast cells promotes vasodilation and increases vascular
permeability, contributing to redness, heat, and edema.
12. Which leukocyte is typically predominant during the early phase of acute bacterial
inflammation?
A. Neutrophil
B. Eosinophil
C. Lymphocyte
D. Plasma cell
Answer: A. Neutrophil
Rationale: Neutrophils are rapidly recruited to sites of acute inflammation and are particularly
important in bacterial infections.
13. Which cytokine is strongly associated with systemic inflammatory responses such as
fever?
A. IL-1
B. Insulin
C. Erythropoietin
D. Thyroxine
Answer: A. IL-1
Rationale: IL-1 is a major endogenous pyrogen. Along with TNF and IL-6, it contributes to
systemic manifestations of inflammation.
Questions and Answers 2026/2027
Complete Study Guide
NR 547 Advanced Pathophysiology —
1. Which cellular change is most characteristic of reversible cell injury?
A. Nuclear dissolution
B. Cellular swelling
C. Membrane rupture
D. Extensive mitochondrial destruction
Answer: B. Cellular swelling
Rationale: ATP depletion impairs the sodium-potassium pump, causing sodium and water to
enter the cell. Cellular swelling is an early, potentially reversible manifestation of injury.
2. A patient develops myocardial ischemia after coronary artery occlusion. What is the earliest
major consequence of inadequate oxygen delivery?
A. Increased oxidative phosphorylation
B. Increased ATP production
C. Decreased aerobic ATP production
D. Increased protein synthesis
Answer: C. Decreased aerobic ATP production
Rationale: Oxygen is required for oxidative phosphorylation. Ischemia therefore rapidly
decreases mitochondrial ATP generation, disrupting energy-dependent cellular processes.
3. Failure of the sodium-potassium ATPase during cellular injury causes:
A. Sodium to leave the cell
B. Potassium to enter the cell
C. Sodium to accumulate intracellularly
D. Calcium to leave the cell
,Answer: C. Sodium to accumulate intracellularly
Rationale: The sodium-potassium pump normally exports sodium and imports potassium. ATP
depletion causes intracellular sodium accumulation and subsequent water influx.
4. Which finding most strongly indicates irreversible cellular injury?
A. Mild cellular swelling
B. Fatty change
C. Ribosomal detachment
D. Loss of membrane integrity
Answer: D. Loss of membrane integrity
Rationale: Severe membrane damage is a defining feature of irreversible injury and permits
leakage of intracellular enzymes and other contents.
5. Apoptosis differs from necrosis because apoptosis:
A. Always causes extensive inflammation
B. Is an energy-dependent programmed process
C. Always results from infection
D. Causes immediate cell membrane rupture
Answer: B. Is an energy-dependent programmed process
Rationale: Apoptosis is regulated programmed cell death and usually occurs without the
extensive inflammatory response associated with necrosis.
6. A smoker develops replacement of normal ciliated columnar bronchial epithelium with
stratified squamous epithelium. This represents:
A. Hypertrophy
B. Hyperplasia
C. Metaplasia
D. Dysplasia
Answer: C. Metaplasia
Rationale: Metaplasia is the reversible replacement of one differentiated cell type with another
better able to tolerate chronic stress.
,7. Which cellular adaptation involves an increase in cell size rather than cell number?
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Atrophy
Answer: B. Hypertrophy
Rationale: Hypertrophy increases individual cell size, commonly in tissues such as cardiac
muscle subjected to chronic pressure overload.
8. Which process describes a decrease in cell size and functional activity?
A. Atrophy
B. Hyperplasia
C. Dysplasia
D. Metaplasia
Answer: A. Atrophy
Rationale: Atrophy occurs when cells decrease in size and metabolic activity, often because of
disuse, poor nutrition, reduced blood supply, or loss of hormonal stimulation.
9. Dysplasia is best described as:
A. Normal programmed cell death
B. Disorganized cellular growth with abnormal cell characteristics
C. Increased cell size from workload
D. Replacement of one mature cell type by another
Answer: B. Disorganized cellular growth with abnormal cell characteristics
Rationale: Dysplasia involves abnormal cellular size, shape, organization, and maturation and
can be associated with premalignant changes.
10. Which reactive oxygen species can contribute to oxidative cellular injury?
A. Superoxide
B. Albumin
C. Insulin
D. Fibrinogen
, Answer: A. Superoxide
Rationale: Reactive oxygen species such as superoxide and hydroxyl radicals can damage lipids,
proteins, and DNA.
11. Histamine contributes to acute inflammation primarily by causing:
A. Vasoconstriction and decreased permeability
B. Vasodilation and increased vascular permeability
C. Reduced leukocyte migration
D. Suppression of endothelial activity
Answer: B. Vasodilation and increased vascular permeability
Rationale: Histamine released from mast cells promotes vasodilation and increases vascular
permeability, contributing to redness, heat, and edema.
12. Which leukocyte is typically predominant during the early phase of acute bacterial
inflammation?
A. Neutrophil
B. Eosinophil
C. Lymphocyte
D. Plasma cell
Answer: A. Neutrophil
Rationale: Neutrophils are rapidly recruited to sites of acute inflammation and are particularly
important in bacterial infections.
13. Which cytokine is strongly associated with systemic inflammatory responses such as
fever?
A. IL-1
B. Insulin
C. Erythropoietin
D. Thyroxine
Answer: A. IL-1
Rationale: IL-1 is a major endogenous pyrogen. Along with TNF and IL-6, it contributes to
systemic manifestations of inflammation.
