RASMUSSEN PATHOPHYSIOLOGY
EXAM 1 ACTUAL EXAM 2026/2027 |
NUR2063 Edition | Comprehensive
Practice Test | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1: Cellular Biology, Injury & Adaptation (25
Questions)
Q1: A 68-year-old male with chronic obstructive pulmonary disease (COPD) has been on
long-term corticosteroid therapy. The nurse observes that his skin appears thin and fragile
with easy bruising. This cellular change is best described as:
A. Hypertrophy due to increased protein synthesis
B. Hyperplasia from hormonal stimulation
C. Atrophy from decreased cellular workload and protein catabolism [CORRECT]
D. Metaplasia from chronic irritation
Correct Answer: C
Rationale: Atrophy is a decrease in cell size due to reduced cellular workload, inadequate
nutrition, or hormonal stimulation. Long-term corticosteroid use causes protein catabolism
and inhibits protein synthesis, leading to dermal atrophy. This differs from hypertrophy
(increased cell size), hyperplasia (increased cell number), and metaplasia (change in cell
type).
Q2: A 45-year-old female presents with a uterine fibroid measuring 8 cm. The pathologist
notes the smooth muscle cells are enlarged with increased cytoplasmic organelles. This
represents which cellular adaptation?
A. Hyperplasia of myometrial cells
B. Hypertrophy of smooth muscle cells [CORRECT]
C. Metaplasia to fibrous tissue
D. Dysplasia with nuclear atypia
,Correct Answer: B
Rationale: Uterine leiomyomas (fibroids) demonstrate smooth muscle cell hypertrophy—an
increase in cell size rather than cell number. The enlarged cells contain increased
endoplasmic reticulum and mitochondria to support enhanced protein synthesis and cellular
function. This is a benign, reversible adaptation to estrogen stimulation.
Q3: A patient with chronic gastroesophageal reflux disease (GERD) undergoes endoscopy.
Biopsy reveals columnar epithelium replacing the normal squamous epithelium in the distal
esophagus. This adaptation is called:
A. Dysplasia with malignant potential
B. Hyperplasia from chronic irritation
C. Metaplasia as a protective adaptation [CORRECT]
D. Atrophy from decreased blood flow
Correct Answer: C
Rationale: Barrett's esophagus represents metaplasia—one mature cell type (squamous
epithelium) is replaced by another mature cell type (columnar epithelium) better suited to
withstand acidic environment. While this is a protective adaptation, it increases risk for
dysplasia and adenocarcinoma, requiring surveillance.
Q4: During a breast biopsy, pathologist notes epithelial cells with loss of uniformity,
disordered arrangement, and nuclear hyperchromasia. These changes are characteristic of:
A. Benign hyperplasia
B. Metaplasia from chronic inflammation
C. Dysplasia indicating abnormal cell growth [CORRECT]
D. Hypertrophy from hormonal stimulation
Correct Answer: C
Rationale: Dysplasia refers to disordered, defective cell growth with loss of uniformity and
tissue architecture. It represents a pre-neoplastic change that may progress to carcinoma in
situ or invasive cancer. Unlike metaplasia (reversible change in cell type), dysplasia involves
abnormal cellular maturation and is considered a precancerous lesion.
Q5: A 72-year-old patient with severe atherosclerosis experiences sudden onset of chest
pain. Cardiac catheterization reveals 95% occlusion of the left anterior descending artery. The
myocardial cells distal to the occlusion are most likely experiencing:
,A. Apoptosis from programmed cell death
B. Ischemia leading to reversible injury initially [CORRECT]
C. Coagulative necrosis immediately
D. Liquefactive necrosis from enzymatic digestion
Correct Answer: B
Rationale: Ischemia (inadequate blood supply) initially causes reversible cellular injury if
blood flow is restored within 20-40 minutes. ATP depletion leads to cellular swelling and loss
of membrane integrity. If ischemia persists beyond the critical window, irreversible injury and
necrosis occur. The timeline distinguishes reversible injury from necrosis.
Q6: Reperfusion injury following myocardial infarction is primarily caused by:
A. Restoration of oxygen leading to immediate healing
B. Formation of free radicals and calcium overload [CORRECT]
C. Increased collateral circulation preventing damage
D. Activation of anti-inflammatory cytokines only
Correct Answer: B
Rationale: Reperfusion injury occurs when oxygen is reintroduced to ischemic tissue,
generating reactive oxygen species (free radicals) through the xanthine oxidase pathway and
mitochondrial electron transport chain. These free radicals damage cell membranes,
proteins, and DNA. Calcium influx also contributes to cellular damage during reperfusion.
Q7: A patient presents with severe carbon monoxide poisoning. The pathophysiology of
cellular injury in this case primarily involves:
A. Direct membrane damage from toxin binding
B. Hypoxia from impaired oxygen transport and utilization [CORRECT]
C. Free radical generation only
D. Protein denaturation without oxygen deprivation
Correct Answer: B
Rationale: Carbon monoxide causes cellular injury primarily through hypoxia by binding to
hemoglobin with 240 times greater affinity than oxygen, forming carboxyhemoglobin. This
reduces oxygen-carrying capacity and shifts the oxyhemoglobin dissociation curve leftward,
impairing oxygen release to tissues. CO also binds cytochrome oxidase, impairing cellular
respiration.
, Q8: Which of the following is the MOST common cause of cellular injury in clinical practice?
A. Chemical toxicity from medications
B. Infectious agents and inflammation
C. Hypoxia and ischemia [CORRECT]
D. Physical trauma and radiation
Correct Answer: C
Rationale: Hypoxia (inadequate oxygen supply) and ischemia (loss of blood supply) are the
most common causes of cellular injury in clinical medicine. Ischemia is particularly
significant because it deprives cells of oxygen, glucose, and other nutrients while preventing
removal of metabolic wastes. This underlies myocardial infarction, stroke, and shock.
Q9: A 55-year-old diabetic patient presents with a black, dry, shriveled toe. This condition is
best described as:
A. Wet gangrene from bacterial infection
B. Dry gangrene from coagulative necrosis [CORRECT]
C. Gas gangrene from clostridial infection
D. Liquefactive necrosis from enzymatic digestion
Correct Answer: B
Rationale: Dry gangrene results from coagulative necrosis due to ischemia without bacterial
infection, typically in diabetic patients with peripheral vascular disease. The affected tissue
becomes dry, shrunken, and black (mummified) due to denatured proteins and cell outlines
preserved. It represents a form of coagulative necrosis with slow demarcation from viable
tissue.
Q10: A patient develops severe cellulitis with crepitus and foul-smelling drainage. Surgical
exploration reveals necrotic muscle with gas bubbles. This represents:
A. Dry gangrene from arterial insufficiency
B. Wet gangrene from venous congestion
C. Gas gangrene from anaerobic bacterial infection [CORRECT]
D. Coagulative necrosis from ischemia
Correct Answer: C
Rationale: Gas gangrene (clostridial myonecrosis) is caused by Clostridium perfringens and
other anaerobic bacteria producing toxins and gas through fermentation. Characterized by
EXAM 1 ACTUAL EXAM 2026/2027 |
NUR2063 Edition | Comprehensive
Practice Test | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1: Cellular Biology, Injury & Adaptation (25
Questions)
Q1: A 68-year-old male with chronic obstructive pulmonary disease (COPD) has been on
long-term corticosteroid therapy. The nurse observes that his skin appears thin and fragile
with easy bruising. This cellular change is best described as:
A. Hypertrophy due to increased protein synthesis
B. Hyperplasia from hormonal stimulation
C. Atrophy from decreased cellular workload and protein catabolism [CORRECT]
D. Metaplasia from chronic irritation
Correct Answer: C
Rationale: Atrophy is a decrease in cell size due to reduced cellular workload, inadequate
nutrition, or hormonal stimulation. Long-term corticosteroid use causes protein catabolism
and inhibits protein synthesis, leading to dermal atrophy. This differs from hypertrophy
(increased cell size), hyperplasia (increased cell number), and metaplasia (change in cell
type).
Q2: A 45-year-old female presents with a uterine fibroid measuring 8 cm. The pathologist
notes the smooth muscle cells are enlarged with increased cytoplasmic organelles. This
represents which cellular adaptation?
A. Hyperplasia of myometrial cells
B. Hypertrophy of smooth muscle cells [CORRECT]
C. Metaplasia to fibrous tissue
D. Dysplasia with nuclear atypia
,Correct Answer: B
Rationale: Uterine leiomyomas (fibroids) demonstrate smooth muscle cell hypertrophy—an
increase in cell size rather than cell number. The enlarged cells contain increased
endoplasmic reticulum and mitochondria to support enhanced protein synthesis and cellular
function. This is a benign, reversible adaptation to estrogen stimulation.
Q3: A patient with chronic gastroesophageal reflux disease (GERD) undergoes endoscopy.
Biopsy reveals columnar epithelium replacing the normal squamous epithelium in the distal
esophagus. This adaptation is called:
A. Dysplasia with malignant potential
B. Hyperplasia from chronic irritation
C. Metaplasia as a protective adaptation [CORRECT]
D. Atrophy from decreased blood flow
Correct Answer: C
Rationale: Barrett's esophagus represents metaplasia—one mature cell type (squamous
epithelium) is replaced by another mature cell type (columnar epithelium) better suited to
withstand acidic environment. While this is a protective adaptation, it increases risk for
dysplasia and adenocarcinoma, requiring surveillance.
Q4: During a breast biopsy, pathologist notes epithelial cells with loss of uniformity,
disordered arrangement, and nuclear hyperchromasia. These changes are characteristic of:
A. Benign hyperplasia
B. Metaplasia from chronic inflammation
C. Dysplasia indicating abnormal cell growth [CORRECT]
D. Hypertrophy from hormonal stimulation
Correct Answer: C
Rationale: Dysplasia refers to disordered, defective cell growth with loss of uniformity and
tissue architecture. It represents a pre-neoplastic change that may progress to carcinoma in
situ or invasive cancer. Unlike metaplasia (reversible change in cell type), dysplasia involves
abnormal cellular maturation and is considered a precancerous lesion.
Q5: A 72-year-old patient with severe atherosclerosis experiences sudden onset of chest
pain. Cardiac catheterization reveals 95% occlusion of the left anterior descending artery. The
myocardial cells distal to the occlusion are most likely experiencing:
,A. Apoptosis from programmed cell death
B. Ischemia leading to reversible injury initially [CORRECT]
C. Coagulative necrosis immediately
D. Liquefactive necrosis from enzymatic digestion
Correct Answer: B
Rationale: Ischemia (inadequate blood supply) initially causes reversible cellular injury if
blood flow is restored within 20-40 minutes. ATP depletion leads to cellular swelling and loss
of membrane integrity. If ischemia persists beyond the critical window, irreversible injury and
necrosis occur. The timeline distinguishes reversible injury from necrosis.
Q6: Reperfusion injury following myocardial infarction is primarily caused by:
A. Restoration of oxygen leading to immediate healing
B. Formation of free radicals and calcium overload [CORRECT]
C. Increased collateral circulation preventing damage
D. Activation of anti-inflammatory cytokines only
Correct Answer: B
Rationale: Reperfusion injury occurs when oxygen is reintroduced to ischemic tissue,
generating reactive oxygen species (free radicals) through the xanthine oxidase pathway and
mitochondrial electron transport chain. These free radicals damage cell membranes,
proteins, and DNA. Calcium influx also contributes to cellular damage during reperfusion.
Q7: A patient presents with severe carbon monoxide poisoning. The pathophysiology of
cellular injury in this case primarily involves:
A. Direct membrane damage from toxin binding
B. Hypoxia from impaired oxygen transport and utilization [CORRECT]
C. Free radical generation only
D. Protein denaturation without oxygen deprivation
Correct Answer: B
Rationale: Carbon monoxide causes cellular injury primarily through hypoxia by binding to
hemoglobin with 240 times greater affinity than oxygen, forming carboxyhemoglobin. This
reduces oxygen-carrying capacity and shifts the oxyhemoglobin dissociation curve leftward,
impairing oxygen release to tissues. CO also binds cytochrome oxidase, impairing cellular
respiration.
, Q8: Which of the following is the MOST common cause of cellular injury in clinical practice?
A. Chemical toxicity from medications
B. Infectious agents and inflammation
C. Hypoxia and ischemia [CORRECT]
D. Physical trauma and radiation
Correct Answer: C
Rationale: Hypoxia (inadequate oxygen supply) and ischemia (loss of blood supply) are the
most common causes of cellular injury in clinical medicine. Ischemia is particularly
significant because it deprives cells of oxygen, glucose, and other nutrients while preventing
removal of metabolic wastes. This underlies myocardial infarction, stroke, and shock.
Q9: A 55-year-old diabetic patient presents with a black, dry, shriveled toe. This condition is
best described as:
A. Wet gangrene from bacterial infection
B. Dry gangrene from coagulative necrosis [CORRECT]
C. Gas gangrene from clostridial infection
D. Liquefactive necrosis from enzymatic digestion
Correct Answer: B
Rationale: Dry gangrene results from coagulative necrosis due to ischemia without bacterial
infection, typically in diabetic patients with peripheral vascular disease. The affected tissue
becomes dry, shrunken, and black (mummified) due to denatured proteins and cell outlines
preserved. It represents a form of coagulative necrosis with slow demarcation from viable
tissue.
Q10: A patient develops severe cellulitis with crepitus and foul-smelling drainage. Surgical
exploration reveals necrotic muscle with gas bubbles. This represents:
A. Dry gangrene from arterial insufficiency
B. Wet gangrene from venous congestion
C. Gas gangrene from anaerobic bacterial infection [CORRECT]
D. Coagulative necrosis from ischemia
Correct Answer: C
Rationale: Gas gangrene (clostridial myonecrosis) is caused by Clostridium perfringens and
other anaerobic bacteria producing toxins and gas through fermentation. Characterized by
