NURS 6501 Advanced Pathophysiology Midterm || Walden University 2026-2027
NURS 6501 Advanced Pathophysiology
Midterm Exam — 100 Questions and Correct Answers
Latest 2026-2027 Walden University Midterm Examination
Aligned with Walden University NURS 6501 Curriculum and Advanced Practice Nursing Competencies
Total Questions: 100 | Cognitive Levels: 25% Recall, 55% Application, 20% Analysis
Question Style: 70% Scenario-Based | 20% Direct Recall | 10% Integrated Case Analysis
Target: FNP, AGNP, DNP, MSN Graduate Nursing Students
Section Topic Question Range
Section 1 Cellular Biology, Adaptation, and Injury Q1 - Q15
Section 2 Membrane Transport and Action Potentials Q16 - Q22
Section 3 Genetics and Chromosomal Disorders Q23 - Q35
Section 4 Immune System and Inflammation Q36 - Q45
Section 5 Fluid, Electrolyte, and Acid-Base Balance Q46 - Q52
Section 6 Endocrine Pathophysiology Q53 - Q65
Section 7 Cardiovascular System Disorders Q66 - Q78
Section 8 Respiratory and Renal Pathophysiology Q79 - Q86
Section 9 Hematologic Disorders Q87 - Q93
Section 10 Neurological and Musculoskeletal Pathophysiology Q94 - Q97
Section 11 Comprehensive Integrated Case Scenarios Q98 - Q100
Section 1: Cellular Biology, Adaptation, and Injury (Q1-Q15)
Q1: A 65-year-old chronic smoker undergoes bronchoscopy. Biopsy of the bronchial epithelium reveals
replacement of the normal ciliated pseudostratified columnar epithelium with stratified squamous epithelium.
This cellular adaptation is best described as:
A. Atrophy
B. Hypertrophy
C. Metaplasia (reversible replacement of one adult cell type with another) [CORRECT]
D. Dysplasia
Correct Answer: C
Rationale: Metaplasia is the reversible replacement of one differentiated cell type with another, often an adaptive
response to chronic irritation (e.g., squamous metaplasia in bronchi of smokers). Atrophy is decreased cell size;
hypertrophy is increased cell size; dysplasia is disordered growth with atypia (a precancerous change).
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,NURS 6501 Advanced Pathophysiology Midterm || Walden University 2026-2027
Q2: A patient with chronic hypertension develops an enlarged left ventricle due to increased workload. The
myocardial cells undergo which adaptive response?
A. Hyperplasia (increase in cell number)
B. Hypertrophy (increase in cell size) [CORRECT]
C. Atrophy
D. Metaplasia
Correct Answer: B
Rationale: Hypertrophy is the increase in cell size in response to increased workload or hormonal stimulation. Cardiac
myocytes cannot divide (no hyperplasia), so they enlarge. This is a compensatory mechanism in chronic hypertension
and volume overload.
Q3: A 70-year-old woman has a fractured femur immobilized in a cast for 8 weeks. The affected leg muscles
decrease in mass. This is an example of:
A. Hypertrophy
B. Atrophy (decrease in cell size due to disuse) [CORRECT]
C. Metaplasia
D. Dysplasia
Correct Answer: B
Rationale: Disuse atrophy is the decrease in cell size and tissue mass that occurs when an organ or muscle is not
used, as with immobilization. It is reversible with resumed activity. Hypertrophy is increase in size; metaplasia and
dysplasia are changes in cell type/growth pattern.
Q4: A liver regenerating after partial hepatectomy enlarges primarily through which process?
A. Hypertrophy
B. Hyperplasia (increase in cell number, characteristic of regenerative capacity of liver cells) [CORRECT]
C. Metaplasia
D. Dysplasia
Correct Answer: B
Rationale: Hyperplasia is an increase in cell number in response to injury or loss. Liver, epidermis, intestinal epithelium,
and bone marrow have this regenerative capacity. Hypertrophy alone does not restore cell number; metaplasia and
dysplasia are not regenerative responses.
Q5: The MOST common cause of cellular injury is:
A. Free radicals
B. Hypoxia (insufficient oxygen delivery to cells) [CORRECT]
C. Chemical agents
D. Physical agents
Correct Answer: B
Rationale: Hypoxia is the most common cause of cell injury, occurring when oxygen delivery is inadequate (ischemia,
anemia, CO poisoning, hypoxemia). It impairs oxidative phosphorylation, depleting ATP, leading to cellular swelling and
eventual necrosis if not corrected.
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, NURS 6501 Advanced Pathophysiology Midterm || Walden University 2026-2027
Q6: Which cellular finding is characteristic of irreversible cell injury?
A. Cellular swelling
B. Fatty change
C. Severe membrane damage with mitochondrial dysfunction and calcium influx [CORRECT]
D. Loss of microvilli
Correct Answer: C
Rationale: Irreversible injury is defined by severe membrane damage, mitochondrial dysfunction with calcium influx,
and nuclear changes (pyknosis, karyorrhexis, karyolysis). Cellular swelling, fatty change, ATP depletion, and microvilli
loss are features of reversible injury.
Q7: Apoptosis differs from necrosis in that apoptosis:
A. Causes inflammation and cellular swelling
B. Is energy-dependent, with cell shrinkage and no inflammation [CORRECT]
C. Results in membrane lysis and release of cellular contents
D. Is always pathologic
Correct Answer: B
Rationale: Apoptosis is programmed, energy-dependent cell death characterized by cell shrinkage, nuclear
fragmentation, and apoptotic bodies without inflammation. Necrosis is unprogrammed, with swelling, membrane lysis,
and inflammation. Apoptosis can be physiologic (e.g., embryologic remodeling) or pathologic.
Q8: A pathologist examining necrotic tissue from a patient with a pulmonary tuberculosis cavity finds
cheese-like, white debris. This pattern of necrosis is:
A. Liquefactive necrosis
B. Coagulative necrosis
C. Caseous necrosis [CORRECT]
D. Fat necrosis
Correct Answer: C
Rationale: Caseous necrosis ('cheese-like') is seen in tuberculosis infections and certain fungal infections. It is a variant
of coagulative necrosis surrounded by a granulomatous inflammatory response. Coagulative necrosis is typical of
ischemic injury in most tissues; liquefactive in brain; fat in pancreatic injury.
Q9: Following a cerebral artery occlusion, brain tissue undergoes enzymatic lysis with formation of a fluid-filled
cavity. This pattern of necrosis is:
A. Coagulative necrosis
B. Liquefactive necrosis [CORRECT]
C. Caseous necrosis
D. Fibrinoid necrosis
Correct Answer: B
Rationale: Liquefactive necrosis occurs when enzymatic digestion of cells produces a liquid mass, characteristic of
ischemic brain injury (no connective tissue scaffold) and bacterial abscesses. Coagulative necrosis is seen in solid
organs (heart, kidney) without brain involvement.
Graduate-Level Advanced Practice Nursing Page 3
NURS 6501 Advanced Pathophysiology
Midterm Exam — 100 Questions and Correct Answers
Latest 2026-2027 Walden University Midterm Examination
Aligned with Walden University NURS 6501 Curriculum and Advanced Practice Nursing Competencies
Total Questions: 100 | Cognitive Levels: 25% Recall, 55% Application, 20% Analysis
Question Style: 70% Scenario-Based | 20% Direct Recall | 10% Integrated Case Analysis
Target: FNP, AGNP, DNP, MSN Graduate Nursing Students
Section Topic Question Range
Section 1 Cellular Biology, Adaptation, and Injury Q1 - Q15
Section 2 Membrane Transport and Action Potentials Q16 - Q22
Section 3 Genetics and Chromosomal Disorders Q23 - Q35
Section 4 Immune System and Inflammation Q36 - Q45
Section 5 Fluid, Electrolyte, and Acid-Base Balance Q46 - Q52
Section 6 Endocrine Pathophysiology Q53 - Q65
Section 7 Cardiovascular System Disorders Q66 - Q78
Section 8 Respiratory and Renal Pathophysiology Q79 - Q86
Section 9 Hematologic Disorders Q87 - Q93
Section 10 Neurological and Musculoskeletal Pathophysiology Q94 - Q97
Section 11 Comprehensive Integrated Case Scenarios Q98 - Q100
Section 1: Cellular Biology, Adaptation, and Injury (Q1-Q15)
Q1: A 65-year-old chronic smoker undergoes bronchoscopy. Biopsy of the bronchial epithelium reveals
replacement of the normal ciliated pseudostratified columnar epithelium with stratified squamous epithelium.
This cellular adaptation is best described as:
A. Atrophy
B. Hypertrophy
C. Metaplasia (reversible replacement of one adult cell type with another) [CORRECT]
D. Dysplasia
Correct Answer: C
Rationale: Metaplasia is the reversible replacement of one differentiated cell type with another, often an adaptive
response to chronic irritation (e.g., squamous metaplasia in bronchi of smokers). Atrophy is decreased cell size;
hypertrophy is increased cell size; dysplasia is disordered growth with atypia (a precancerous change).
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,NURS 6501 Advanced Pathophysiology Midterm || Walden University 2026-2027
Q2: A patient with chronic hypertension develops an enlarged left ventricle due to increased workload. The
myocardial cells undergo which adaptive response?
A. Hyperplasia (increase in cell number)
B. Hypertrophy (increase in cell size) [CORRECT]
C. Atrophy
D. Metaplasia
Correct Answer: B
Rationale: Hypertrophy is the increase in cell size in response to increased workload or hormonal stimulation. Cardiac
myocytes cannot divide (no hyperplasia), so they enlarge. This is a compensatory mechanism in chronic hypertension
and volume overload.
Q3: A 70-year-old woman has a fractured femur immobilized in a cast for 8 weeks. The affected leg muscles
decrease in mass. This is an example of:
A. Hypertrophy
B. Atrophy (decrease in cell size due to disuse) [CORRECT]
C. Metaplasia
D. Dysplasia
Correct Answer: B
Rationale: Disuse atrophy is the decrease in cell size and tissue mass that occurs when an organ or muscle is not
used, as with immobilization. It is reversible with resumed activity. Hypertrophy is increase in size; metaplasia and
dysplasia are changes in cell type/growth pattern.
Q4: A liver regenerating after partial hepatectomy enlarges primarily through which process?
A. Hypertrophy
B. Hyperplasia (increase in cell number, characteristic of regenerative capacity of liver cells) [CORRECT]
C. Metaplasia
D. Dysplasia
Correct Answer: B
Rationale: Hyperplasia is an increase in cell number in response to injury or loss. Liver, epidermis, intestinal epithelium,
and bone marrow have this regenerative capacity. Hypertrophy alone does not restore cell number; metaplasia and
dysplasia are not regenerative responses.
Q5: The MOST common cause of cellular injury is:
A. Free radicals
B. Hypoxia (insufficient oxygen delivery to cells) [CORRECT]
C. Chemical agents
D. Physical agents
Correct Answer: B
Rationale: Hypoxia is the most common cause of cell injury, occurring when oxygen delivery is inadequate (ischemia,
anemia, CO poisoning, hypoxemia). It impairs oxidative phosphorylation, depleting ATP, leading to cellular swelling and
eventual necrosis if not corrected.
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, NURS 6501 Advanced Pathophysiology Midterm || Walden University 2026-2027
Q6: Which cellular finding is characteristic of irreversible cell injury?
A. Cellular swelling
B. Fatty change
C. Severe membrane damage with mitochondrial dysfunction and calcium influx [CORRECT]
D. Loss of microvilli
Correct Answer: C
Rationale: Irreversible injury is defined by severe membrane damage, mitochondrial dysfunction with calcium influx,
and nuclear changes (pyknosis, karyorrhexis, karyolysis). Cellular swelling, fatty change, ATP depletion, and microvilli
loss are features of reversible injury.
Q7: Apoptosis differs from necrosis in that apoptosis:
A. Causes inflammation and cellular swelling
B. Is energy-dependent, with cell shrinkage and no inflammation [CORRECT]
C. Results in membrane lysis and release of cellular contents
D. Is always pathologic
Correct Answer: B
Rationale: Apoptosis is programmed, energy-dependent cell death characterized by cell shrinkage, nuclear
fragmentation, and apoptotic bodies without inflammation. Necrosis is unprogrammed, with swelling, membrane lysis,
and inflammation. Apoptosis can be physiologic (e.g., embryologic remodeling) or pathologic.
Q8: A pathologist examining necrotic tissue from a patient with a pulmonary tuberculosis cavity finds
cheese-like, white debris. This pattern of necrosis is:
A. Liquefactive necrosis
B. Coagulative necrosis
C. Caseous necrosis [CORRECT]
D. Fat necrosis
Correct Answer: C
Rationale: Caseous necrosis ('cheese-like') is seen in tuberculosis infections and certain fungal infections. It is a variant
of coagulative necrosis surrounded by a granulomatous inflammatory response. Coagulative necrosis is typical of
ischemic injury in most tissues; liquefactive in brain; fat in pancreatic injury.
Q9: Following a cerebral artery occlusion, brain tissue undergoes enzymatic lysis with formation of a fluid-filled
cavity. This pattern of necrosis is:
A. Coagulative necrosis
B. Liquefactive necrosis [CORRECT]
C. Caseous necrosis
D. Fibrinoid necrosis
Correct Answer: B
Rationale: Liquefactive necrosis occurs when enzymatic digestion of cells produces a liquid mass, characteristic of
ischemic brain injury (no connective tissue scaffold) and bacterial abscesses. Coagulative necrosis is seen in solid
organs (heart, kidney) without brain involvement.
Graduate-Level Advanced Practice Nursing Page 3
