Exam 2: NSG3280 / NSG 3280 ACTUAL
EXAM 2026/2027 | Pathophysiology for
Nurses I | Verified Q&A | Pass
Guaranteed - A+ Graded
SECTION 1: Cellular Adaptation, Injury, and Death (Q1–Q10)
Q1: A 68-year-old patient with a 40 pack-year smoking history develops squamous metaplasia in the
bronchial epithelium. The nurse understands this cellular change represents which type of
adaptation?
A. Hypertrophy
B. Hyperplasia
C. Metaplasia [CORRECT]
D. Dysplasia
Correct Answer: C
Rationale: Correct because metaplasia is the reversible replacement of one differentiated cell type with
another, often in response to chronic irritation—smoking irritates pseudostratified ciliated columnar
epithelium, causing it to transform into stratified squamous epithelium. A is wrong because hypertrophy
involves an increase in cell size, not cell type replacement. B is wrong because hyperplasia involves an
increase in cell number of the same cell type. D is wrong because dysplasia refers to disordered, pre-
neoplastic cellular growth with loss of uniformity and architecture, not a physiologic adaptive change.
Q2: A patient with chronic hypertension presents with left ventricular wall thickening on
echocardiogram. This finding demonstrates which cellular adaptation?
A. Atrophy
B. Hypertrophy [CORRECT]
C. Metaplasia
D. Apoptosis
Correct Answer: B
,Rationale: Correct because hypertrophy is the increase in cell size resulting in increased organ size; the
left ventricle hypertrophies to compensate for increased afterload from chronic hypertension. A is
wrong because atrophy is a decrease in cell size, the opposite of what occurs with chronic pressure
overload. C is wrong because metaplasia involves cell type transformation, not enlargement of existing
cells. D is wrong because apoptosis is programmed cell death, not an adaptive growth response.
Q3: A postmenopausal woman's breast tissue shows ductal shrinkage and fatty replacement. This
process is best described as:
A. Pathologic atrophy
B. Physiologic atrophy [CORRECT]
C. Metaplasia
D. Anaplasia
Correct Answer: B
Rationale: Correct because physiologic atrophy occurs as a normal response to decreased hormonal
stimulation; estrogen withdrawal after menopause causes normal breast ductal involution. A is wrong
because pathologic atrophy results from disease states such as malnutrition or denervation, not normal
hormonal changes. C is wrong because metaplasia involves transformation to a different cell type, not
shrinkage. D is wrong because anaplasia refers to loss of differentiation in malignant cells, a neoplastic
change.
Q4: During ischemic cell injury, which intracellular change occurs FIRST?
A. Mitochondrial swelling
B. Decreased ATP synthesis [CORRECT]
C. Plasma membrane rupture
D. Nuclear pyknosis
Correct Answer: B
Rationale: Correct because decreased ATP synthesis is the earliest biochemical event in ischemic injury;
without oxygen, oxidative phosphorylation fails immediately. A is wrong because mitochondrial swelling
occurs after ATP depletion causes ion pump failure and water influx. C is wrong because plasma
membrane rupture is a late, irreversible change occurring after severe ATP loss and calcium influx. D is
wrong because nuclear pyknosis (chromatin condensation) is a morphologic sign of irreversible injury or
apoptosis, occurring hours after the initial insult.
, Q5: A patient sustains a crushing injury to the thigh. Twelve hours later, the muscle tissue shows
coagulative necrosis with preserved tissue architecture. Which enzyme is MOST responsible for this
type of cell death?
A. Caspases
B. Phospholipases
C. Proteases from neutrophil infiltration
D. None—coagulative necrosis results from denaturation of structural and enzymatic proteins by
ischemia [CORRECT]
Correct Answer: D
Rationale: Correct because coagulative necrosis results from ischemia causing denaturation of proteins
and enzymes, preserving tissue architecture temporarily; it is not primarily enzyme-mediated like
liquefactive necrosis. A is wrong because caspases mediate apoptosis, characterized by cell shrinkage
and chromatin condensation without inflammation. B is wrong because phospholipases damage
membranes in irreversible injury but do not cause the characteristic coagulative pattern. C is wrong
because neutrophil proteases cause liquefactive necrosis in bacterial infections or late ischemic injury,
not the early coagulative pattern seen here.
Q6: A patient receiving chemotherapy develops tumor lysis syndrome. The massive cell death
occurring is primarily which mechanism?
A. Apoptosis
B. Necrosis
C. Both apoptosis and necrosis in varying degrees [CORRECT]
D. Autophagy
Correct Answer: C
Rationale: Correct because chemotherapy-induced tumor lysis involves both apoptosis (programmed
cell death triggered by DNA damage) and secondary necrosis (when apoptotic cells are not cleared and
membrane integrity is lost), releasing intracellular contents and causing electrolyte imbalances. A is
wrong because while apoptosis initiates the process, the massive cell death and inflammation indicate
necrosis is also occurring. B is wrong because primary necrosis alone does not explain the rapid, drug-
induced DNA fragmentation. D is wrong because autophagy is a survival mechanism involving lysosomal
degradation of cellular components, not the predominant mechanism of chemotherapy-induced cell
death.
Q7: A liver biopsy from an alcoholic patient reveals Mallory-Denk bodies and ballooning degeneration
of hepatocytes. These findings are characteristic of:
EXAM 2026/2027 | Pathophysiology for
Nurses I | Verified Q&A | Pass
Guaranteed - A+ Graded
SECTION 1: Cellular Adaptation, Injury, and Death (Q1–Q10)
Q1: A 68-year-old patient with a 40 pack-year smoking history develops squamous metaplasia in the
bronchial epithelium. The nurse understands this cellular change represents which type of
adaptation?
A. Hypertrophy
B. Hyperplasia
C. Metaplasia [CORRECT]
D. Dysplasia
Correct Answer: C
Rationale: Correct because metaplasia is the reversible replacement of one differentiated cell type with
another, often in response to chronic irritation—smoking irritates pseudostratified ciliated columnar
epithelium, causing it to transform into stratified squamous epithelium. A is wrong because hypertrophy
involves an increase in cell size, not cell type replacement. B is wrong because hyperplasia involves an
increase in cell number of the same cell type. D is wrong because dysplasia refers to disordered, pre-
neoplastic cellular growth with loss of uniformity and architecture, not a physiologic adaptive change.
Q2: A patient with chronic hypertension presents with left ventricular wall thickening on
echocardiogram. This finding demonstrates which cellular adaptation?
A. Atrophy
B. Hypertrophy [CORRECT]
C. Metaplasia
D. Apoptosis
Correct Answer: B
,Rationale: Correct because hypertrophy is the increase in cell size resulting in increased organ size; the
left ventricle hypertrophies to compensate for increased afterload from chronic hypertension. A is
wrong because atrophy is a decrease in cell size, the opposite of what occurs with chronic pressure
overload. C is wrong because metaplasia involves cell type transformation, not enlargement of existing
cells. D is wrong because apoptosis is programmed cell death, not an adaptive growth response.
Q3: A postmenopausal woman's breast tissue shows ductal shrinkage and fatty replacement. This
process is best described as:
A. Pathologic atrophy
B. Physiologic atrophy [CORRECT]
C. Metaplasia
D. Anaplasia
Correct Answer: B
Rationale: Correct because physiologic atrophy occurs as a normal response to decreased hormonal
stimulation; estrogen withdrawal after menopause causes normal breast ductal involution. A is wrong
because pathologic atrophy results from disease states such as malnutrition or denervation, not normal
hormonal changes. C is wrong because metaplasia involves transformation to a different cell type, not
shrinkage. D is wrong because anaplasia refers to loss of differentiation in malignant cells, a neoplastic
change.
Q4: During ischemic cell injury, which intracellular change occurs FIRST?
A. Mitochondrial swelling
B. Decreased ATP synthesis [CORRECT]
C. Plasma membrane rupture
D. Nuclear pyknosis
Correct Answer: B
Rationale: Correct because decreased ATP synthesis is the earliest biochemical event in ischemic injury;
without oxygen, oxidative phosphorylation fails immediately. A is wrong because mitochondrial swelling
occurs after ATP depletion causes ion pump failure and water influx. C is wrong because plasma
membrane rupture is a late, irreversible change occurring after severe ATP loss and calcium influx. D is
wrong because nuclear pyknosis (chromatin condensation) is a morphologic sign of irreversible injury or
apoptosis, occurring hours after the initial insult.
, Q5: A patient sustains a crushing injury to the thigh. Twelve hours later, the muscle tissue shows
coagulative necrosis with preserved tissue architecture. Which enzyme is MOST responsible for this
type of cell death?
A. Caspases
B. Phospholipases
C. Proteases from neutrophil infiltration
D. None—coagulative necrosis results from denaturation of structural and enzymatic proteins by
ischemia [CORRECT]
Correct Answer: D
Rationale: Correct because coagulative necrosis results from ischemia causing denaturation of proteins
and enzymes, preserving tissue architecture temporarily; it is not primarily enzyme-mediated like
liquefactive necrosis. A is wrong because caspases mediate apoptosis, characterized by cell shrinkage
and chromatin condensation without inflammation. B is wrong because phospholipases damage
membranes in irreversible injury but do not cause the characteristic coagulative pattern. C is wrong
because neutrophil proteases cause liquefactive necrosis in bacterial infections or late ischemic injury,
not the early coagulative pattern seen here.
Q6: A patient receiving chemotherapy develops tumor lysis syndrome. The massive cell death
occurring is primarily which mechanism?
A. Apoptosis
B. Necrosis
C. Both apoptosis and necrosis in varying degrees [CORRECT]
D. Autophagy
Correct Answer: C
Rationale: Correct because chemotherapy-induced tumor lysis involves both apoptosis (programmed
cell death triggered by DNA damage) and secondary necrosis (when apoptotic cells are not cleared and
membrane integrity is lost), releasing intracellular contents and causing electrolyte imbalances. A is
wrong because while apoptosis initiates the process, the massive cell death and inflammation indicate
necrosis is also occurring. B is wrong because primary necrosis alone does not explain the rapid, drug-
induced DNA fragmentation. D is wrong because autophagy is a survival mechanism involving lysosomal
degradation of cellular components, not the predominant mechanism of chemotherapy-induced cell
death.
Q7: A liver biopsy from an alcoholic patient reveals Mallory-Denk bodies and ballooning degeneration
of hepatocytes. These findings are characteristic of:
