NUR 634 Final Exam Actual Exam QUESTIONS
AND ANSWERS 2026 | Advanced
Pathophysiology | Complete Q&A Graded A+ |
Pass Guaranteed - A+ Graded
Question 1 A 58-year-old male smoker presents with a persistent cough. A lung biopsy reveals
replacement of normal ciliated columnar epithelium with stratified squamous epithelium. This
cellular adaptation is best described as:
A. Dysplasia
B. Metaplasia [CORRECT]
C. Hyperplasia
D. Anaplasia
Correct Answer: B
Rationale: Metaplasia is a reversible change in which one mature, differentiated cell type is
replaced by another mature, differentiated cell type, typically as an adaptive response to chronic
irritation or inflammation. In this case, chronic smoking irritation causes the normal respiratory
pseudostratified ciliated columnar epithelium to transform into stratified squamous epithelium
(squamous metaplasia). This is a protective adaptation (better withstands irritation) but increases
cancer risk. Dysplasia (A) involves abnormal cellular development with loss of uniformity and
architectural organization—this is not described. Hyperplasia (C) is an increase in cell number,
not cell type change. Anaplasia (D) is a loss of differentiation characteristic of malignancy, not a
reversible adaptation. The graduate-level understanding is that metaplasia is reversible if the
irritant is removed, but can progress to dysplasia and cancer if irritation continues.
Question 2 A patient with prolonged hypotension develops acute tubular necrosis. The primary
mechanism of cellular injury is:
A. Chemical injury
B. Hypoxic injury [CORRECT]
C. Infectious injury
D. Immunologic injury
Correct Answer: B
,Rationale: Prolonged hypotension leads to decreased renal perfusion and tissue hypoxia, causing
hypoxic injury (ischemic acute tubular necrosis). The sequence involves: (1) Decreased oxygen
delivery, (2) Switch to anaerobic glycolysis, (3) ATP depletion, (4) Failure of sodium-potassium
pumps, (5) Cellular swelling, (6) Calcium influx activating destructive enzymes, (7) Cell death.
Chemical injury (A) would involve nephrotoxins like aminoglycosides or contrast dye, which is
a different mechanism. Infectious (C) or immunologic (D) injuries have different
pathophysiological pathways. The graduate-level concept is understanding the ischemic cascade
and the vulnerability of renal tubular cells to hypoxia due to their high metabolic demand and
location in the outer medulla where oxygen tension is already low.
Question 3 Which type of necrosis is characterized by preservation of tissue architecture for
several days after cell death?
A. Liquefactive necrosis
B. Coagulative necrosis [CORRECT]
C. Caseous necrosis
D. Fat necrosis
Correct Answer: B
Rationale: Coagulative necrosis, typically caused by ischemia in solid organs (heart, kidney,
spleen), preserves the tissue architecture for several days because the structural proteins are
denatured but not digested. This creates a "ghost" outline of cells. It results from protein
denaturation that prevents enzymatic degradation. Liquefactive necrosis (A) occurs in the brain
(due to high lipid content and enzymes) and bacterial infections, resulting in complete tissue
digestion and liquid transformation. Caseous necrosis (C), seen in tuberculosis, has a cheese-like
appearance with complete structure loss. Fat necrosis (D) involves saponification of fats with
calcium deposition, creating chalky white deposits. The graduate-level understanding is that
coagulative necrosis reflects the balance between protein denaturation and enzymatic digestion
favoring preservation in ischemic solid organs.
Question 4 A patient with rheumatoid arthritis has autoantibodies against which self-antigen?
A. Acetylcholine receptors
B. IgG Fc portion [CORRECT]
C. Thyroid peroxidase
D. Islet cells
Correct Answer: B
,Rationale: Rheumatoid arthritis is characterized by rheumatoid factor (RF), which is an
autoantibody (usually IgM) directed against the Fc portion of IgG. Additionally, anti-cyclic
citrullinated peptide (anti-CCP) antibodies are highly specific. This creates immune complex
deposition in joints, activating complement and causing synovial inflammation. Acetylcholine
receptors (A) are targeted in myasthenia gravis. Thyroid peroxidase (C) is targeted in
Hashimoto's thyroiditis. Islet cells (D) are targeted in type 1 diabetes mellitus. The graduate-level
understanding includes recognizing that RF is not specific for RA (present in other diseases and
some healthy elderly), while anti-CCP is more specific, and both contribute to immune complex-
mediated inflammation in the synovium.
Question 5 A patient experiences anaphylaxis after receiving penicillin. Which type of
hypersensitivity reaction is this?
A. Type I [CORRECT]
B. Type II
C. Type III
D. Type IV
Correct Answer: A
Rationale: Anaphylaxis is a Type I (immediate) hypersensitivity reaction mediated by IgE
antibodies bound to mast cells and basophils. Upon re-exposure to antigen (penicillin), cross-
linking of IgE triggers degranulation, releasing histamine, leukotrienes, prostaglandins, and other
mediators, causing vasodilation, bronchospasm, and increased vascular permeability. Type II (B)
is cytotoxic antibody-mediated (e.g., hemolytic anemia). Type III (C) is immune complex-
mediated (e.g., serum sickness, SLE). Type IV (D) is delayed-type cell-mediated (e.g., contact
dermatitis, TB skin test). The graduate-level understanding includes knowing that penicillin acts
as a hapten, binding to proteins to form complete antigens, and that mast cell mediators cause the
rapid, systemic response of anaphylaxis.
Question 6 Granulomatous inflammation is characteristic of which condition?
A. Acute appendicitis
B. Tuberculosis [CORRECT]
C. Viral hepatitis
D. Bacterial pneumonia
Correct Answer: B
Rationale: Granulomatous inflammation is a specialized form of chronic inflammation
characterized by aggregates of activated macrophages (epithelioid cells), often with
, multinucleated giant cells and lymphocytes. Tuberculosis causes caseating granulomas with
central necrosis. Other causes include sarcoidosis (non-caseating), fungal infections, foreign
bodies, and Crohn's disease. Acute appendicitis (A) is acute suppurative inflammation. Viral
hepatitis (C) is characterized by hepatocyte injury and lymphocytic infiltration without
granulomas. Bacterial pneumonia (D) typically shows acute neutrophilic inflammation. The
graduate-level understanding is that granulomas form when cell-mediated immunity (Th1
response) attempts to wall off persistent antigens or foreign material that cannot be easily
eliminated.
Question 7 Which of the following is a key feature of apoptosis compared to necrosis?
A. Cell swelling and membrane rupture
B. Inflammation and tissue damage
C. Programmed cell death with intact membrane [CORRECT]
D. Random DNA fragmentation
Correct Answer: C
Rationale: Apoptosis is programmed cell death characterized by: cell shrinkage, chromatin
condensation, membrane blebbing, formation of apoptotic bodies, and phagocytosis without
inflammation. The plasma membrane remains intact during early phases, preventing release of
intracellular contents. Necrosis (A, B) involves cell swelling, membrane rupture, and
inflammation due to release of cellular contents. Apoptosis involves caspase activation and
controlled DNA fragmentation (D is incorrect—necrosis has random fragmentation). The
graduate-level understanding includes that apoptosis is ATP-dependent, requires gene activation,
and is essential for development, homeostasis, and eliminating damaged cells without triggering
inflammation.
Question 8 A patient with chronic venous insufficiency develops a lower extremity ulcer with
irregular borders and fibrinous base. The impaired wound healing is primarily due to:
A. Excessive collagen deposition
B. Chronic hypoxia and poor nutrient delivery [CORRECT]
C. Hyperactive immune response
D. Increased fibroblast proliferation
Correct Answer: B
Rationale: Chronic venous insufficiency causes venous hypertension, leading to edema, tissue
hypoxia, and impaired nutrient delivery to tissues. This creates a chronic wound environment
with persistent inflammation, failure to progress to proliferation and remodeling phases.
AND ANSWERS 2026 | Advanced
Pathophysiology | Complete Q&A Graded A+ |
Pass Guaranteed - A+ Graded
Question 1 A 58-year-old male smoker presents with a persistent cough. A lung biopsy reveals
replacement of normal ciliated columnar epithelium with stratified squamous epithelium. This
cellular adaptation is best described as:
A. Dysplasia
B. Metaplasia [CORRECT]
C. Hyperplasia
D. Anaplasia
Correct Answer: B
Rationale: Metaplasia is a reversible change in which one mature, differentiated cell type is
replaced by another mature, differentiated cell type, typically as an adaptive response to chronic
irritation or inflammation. In this case, chronic smoking irritation causes the normal respiratory
pseudostratified ciliated columnar epithelium to transform into stratified squamous epithelium
(squamous metaplasia). This is a protective adaptation (better withstands irritation) but increases
cancer risk. Dysplasia (A) involves abnormal cellular development with loss of uniformity and
architectural organization—this is not described. Hyperplasia (C) is an increase in cell number,
not cell type change. Anaplasia (D) is a loss of differentiation characteristic of malignancy, not a
reversible adaptation. The graduate-level understanding is that metaplasia is reversible if the
irritant is removed, but can progress to dysplasia and cancer if irritation continues.
Question 2 A patient with prolonged hypotension develops acute tubular necrosis. The primary
mechanism of cellular injury is:
A. Chemical injury
B. Hypoxic injury [CORRECT]
C. Infectious injury
D. Immunologic injury
Correct Answer: B
,Rationale: Prolonged hypotension leads to decreased renal perfusion and tissue hypoxia, causing
hypoxic injury (ischemic acute tubular necrosis). The sequence involves: (1) Decreased oxygen
delivery, (2) Switch to anaerobic glycolysis, (3) ATP depletion, (4) Failure of sodium-potassium
pumps, (5) Cellular swelling, (6) Calcium influx activating destructive enzymes, (7) Cell death.
Chemical injury (A) would involve nephrotoxins like aminoglycosides or contrast dye, which is
a different mechanism. Infectious (C) or immunologic (D) injuries have different
pathophysiological pathways. The graduate-level concept is understanding the ischemic cascade
and the vulnerability of renal tubular cells to hypoxia due to their high metabolic demand and
location in the outer medulla where oxygen tension is already low.
Question 3 Which type of necrosis is characterized by preservation of tissue architecture for
several days after cell death?
A. Liquefactive necrosis
B. Coagulative necrosis [CORRECT]
C. Caseous necrosis
D. Fat necrosis
Correct Answer: B
Rationale: Coagulative necrosis, typically caused by ischemia in solid organs (heart, kidney,
spleen), preserves the tissue architecture for several days because the structural proteins are
denatured but not digested. This creates a "ghost" outline of cells. It results from protein
denaturation that prevents enzymatic degradation. Liquefactive necrosis (A) occurs in the brain
(due to high lipid content and enzymes) and bacterial infections, resulting in complete tissue
digestion and liquid transformation. Caseous necrosis (C), seen in tuberculosis, has a cheese-like
appearance with complete structure loss. Fat necrosis (D) involves saponification of fats with
calcium deposition, creating chalky white deposits. The graduate-level understanding is that
coagulative necrosis reflects the balance between protein denaturation and enzymatic digestion
favoring preservation in ischemic solid organs.
Question 4 A patient with rheumatoid arthritis has autoantibodies against which self-antigen?
A. Acetylcholine receptors
B. IgG Fc portion [CORRECT]
C. Thyroid peroxidase
D. Islet cells
Correct Answer: B
,Rationale: Rheumatoid arthritis is characterized by rheumatoid factor (RF), which is an
autoantibody (usually IgM) directed against the Fc portion of IgG. Additionally, anti-cyclic
citrullinated peptide (anti-CCP) antibodies are highly specific. This creates immune complex
deposition in joints, activating complement and causing synovial inflammation. Acetylcholine
receptors (A) are targeted in myasthenia gravis. Thyroid peroxidase (C) is targeted in
Hashimoto's thyroiditis. Islet cells (D) are targeted in type 1 diabetes mellitus. The graduate-level
understanding includes recognizing that RF is not specific for RA (present in other diseases and
some healthy elderly), while anti-CCP is more specific, and both contribute to immune complex-
mediated inflammation in the synovium.
Question 5 A patient experiences anaphylaxis after receiving penicillin. Which type of
hypersensitivity reaction is this?
A. Type I [CORRECT]
B. Type II
C. Type III
D. Type IV
Correct Answer: A
Rationale: Anaphylaxis is a Type I (immediate) hypersensitivity reaction mediated by IgE
antibodies bound to mast cells and basophils. Upon re-exposure to antigen (penicillin), cross-
linking of IgE triggers degranulation, releasing histamine, leukotrienes, prostaglandins, and other
mediators, causing vasodilation, bronchospasm, and increased vascular permeability. Type II (B)
is cytotoxic antibody-mediated (e.g., hemolytic anemia). Type III (C) is immune complex-
mediated (e.g., serum sickness, SLE). Type IV (D) is delayed-type cell-mediated (e.g., contact
dermatitis, TB skin test). The graduate-level understanding includes knowing that penicillin acts
as a hapten, binding to proteins to form complete antigens, and that mast cell mediators cause the
rapid, systemic response of anaphylaxis.
Question 6 Granulomatous inflammation is characteristic of which condition?
A. Acute appendicitis
B. Tuberculosis [CORRECT]
C. Viral hepatitis
D. Bacterial pneumonia
Correct Answer: B
Rationale: Granulomatous inflammation is a specialized form of chronic inflammation
characterized by aggregates of activated macrophages (epithelioid cells), often with
, multinucleated giant cells and lymphocytes. Tuberculosis causes caseating granulomas with
central necrosis. Other causes include sarcoidosis (non-caseating), fungal infections, foreign
bodies, and Crohn's disease. Acute appendicitis (A) is acute suppurative inflammation. Viral
hepatitis (C) is characterized by hepatocyte injury and lymphocytic infiltration without
granulomas. Bacterial pneumonia (D) typically shows acute neutrophilic inflammation. The
graduate-level understanding is that granulomas form when cell-mediated immunity (Th1
response) attempts to wall off persistent antigens or foreign material that cannot be easily
eliminated.
Question 7 Which of the following is a key feature of apoptosis compared to necrosis?
A. Cell swelling and membrane rupture
B. Inflammation and tissue damage
C. Programmed cell death with intact membrane [CORRECT]
D. Random DNA fragmentation
Correct Answer: C
Rationale: Apoptosis is programmed cell death characterized by: cell shrinkage, chromatin
condensation, membrane blebbing, formation of apoptotic bodies, and phagocytosis without
inflammation. The plasma membrane remains intact during early phases, preventing release of
intracellular contents. Necrosis (A, B) involves cell swelling, membrane rupture, and
inflammation due to release of cellular contents. Apoptosis involves caspase activation and
controlled DNA fragmentation (D is incorrect—necrosis has random fragmentation). The
graduate-level understanding includes that apoptosis is ATP-dependent, requires gene activation,
and is essential for development, homeostasis, and eliminating damaged cells without triggering
inflammation.
Question 8 A patient with chronic venous insufficiency develops a lower extremity ulcer with
irregular borders and fibrinous base. The impaired wound healing is primarily due to:
A. Excessive collagen deposition
B. Chronic hypoxia and poor nutrient delivery [CORRECT]
C. Hyperactive immune response
D. Increased fibroblast proliferation
Correct Answer: B
Rationale: Chronic venous insufficiency causes venous hypertension, leading to edema, tissue
hypoxia, and impaired nutrient delivery to tissues. This creates a chronic wound environment
with persistent inflammation, failure to progress to proliferation and remodeling phases.
