Pathophysiology Nursing Practice Exam – 200
Questions & Answers
Section 1: Cellular Adaptation and Injury
(Questions 1-20)
1. A patient with chronic hypoxia develops an increase in red blood cell production. This represents
which type of cellular adaptation?
A) Atrophy
B) Hypertrophy
C) Hyperplasia
D) Metaplasia
Answer: C) Hyperplasia
Rationale: Hyperplasia is an increase in the number of cells in response to a stimulus. Chronic hypoxia
stimulates erythropoietin production, leading to hyperplasia of erythrocyte-producing cells in the bone
marrow.
2. The nurse recognizes that reversible cellular injury is characterized by:
A) Cellular swelling and fatty changes
B) Nuclear fragmentation and karyolysis
C) Cell membrane rupture and inflammation
D) Apoptosis and phagocytosis
Answer: A) Cellular swelling and fatty changes
Rationale: Reversible cellular injury is characterized by cellular swelling (hydropic change) and fatty
changes (lipid accumulation), which are reversible if the cause is removed.
3. Which cellular change is considered irreversible and indicates cell death?
A) Cellular swelling
B) Fatty infiltration
C) Nuclear pyknosis
D) Endoplasmic reticulum dilation
,Answer: C) Nuclear pyknosis
Rationale: Nuclear pyknosis (nuclear shrinkage and condensation), karyorrhexis (nuclear fragmentation),
and karyolysis (nuclear dissolution) are irreversible changes indicating cell death (necrosis).
4. A patient with prolonged ischemia develops coagulative necrosis. Which organ is most commonly
affected by this type of necrosis?
A) Brain
B) Heart
C) Pancreas
D) Lungs
Answer: B) Heart
Rationale: Coagulative necrosis is the most common type of necrosis, typically affecting the heart,
kidneys, and adrenal glands following ischemia.
5. The nurse understands that liquefactive necrosis is most characteristic of:
A) Ischemic heart tissue
B) Tuberculous lung lesions
C) Brain tissue following stroke
D) Pancreatic tissue in pancreatitis
Answer: C) Brain tissue following stroke
Rationale: Liquefactive necrosis is characterized by enzymatic digestion and liquefaction of tissue, most
commonly seen in brain tissue following ischemic stroke or bacterial infections.
6. A patient with tuberculosis develops caseous necrosis. Which finding is characteristic of this type of
necrosis?
A) Purulent exudate
B) Cheesy, white appearance
C) Hemorrhagic appearance
D) Gritty, calcified tissue
Answer: B) Cheesy, white appearance
Rationale: Caseous necrosis has a cheesy, white appearance and is characteristic of tuberculosis and
fungal infections. It combines features of coagulative and liquefactive necrosis.
7. Which enzyme is released from damaged myocardial cells and is a marker for acute myocardial
infarction?
A) Alkaline phosphatase
B) Creatine kinase-MB
, C) Gamma-glutamyl transferase
D) Amylase
Answer: B) Creatine kinase-MB
Rationale: Creatine kinase-MB (CK-MB) is specific to myocardial tissue and is elevated within 4-6 hours
after acute MI, peaking at 24 hours.
8. The nurse recognizes that apoptosis is characterized by:
A) Cell swelling and membrane rupture
B) Inflammatory response and tissue damage
C) Programmed cell death without inflammation
D) Necrosis and cellular fragmentation
Answer: C) Programmed cell death without inflammation
Rationale: Apoptosis is programmed cell death that occurs without inflammation, involving cellular
shrinkage, chromatin condensation, and formation of apoptotic bodies.
9. A patient with chronic alcoholism develops fatty liver. This is an example of:
A) Atrophy
B) Hypertrophy
C) Fatty infiltration
D) Metaplasia
Answer: C) Fatty infiltration
Rationale: Fatty infiltration (steatosis) is the accumulation of lipids in cells, commonly seen in the liver of
patients with chronic alcohol use, obesity, or diabetes.
10. The nurse understands that metaplasia involves:
A) Increased cell size
B) Replacement of one cell type with another
C) Increased cell number
D) Cell death and tissue necrosis
Answer: B) Replacement of one cell type with another
Rationale: Metaplasia is the reversible replacement of one differentiated cell type with another, often in
response to chronic irritation. For example, Barrett's esophagus is metaplasia of squamous to columnar
epithelium.
11. Which factor is most likely to cause cellular atrophy?
A) Increased workload
, B) Decreased blood supply
C) Chronic inflammation
D) Excessive hormonal stimulation
Answer: B) Decreased blood supply
Rationale: Atrophy can result from decreased workload, decreased blood supply (ischemia), denervation,
or decreased hormonal stimulation.
12. A patient with prolonged immobility develops muscle atrophy. This is primarily due to:
A) Decreased workload
B) Increased metabolic demand
C) Decreased nutrient supply
D) Hormonal imbalance
Answer: A) Decreased workload
Rationale: Disuse atrophy occurs when muscles are not used, leading to decreased protein synthesis and
increased protein degradation.
13. The nurse recognizes that free radical injury can cause cellular damage through:
A) Inhibition of protein synthesis
B) DNA mutation and lipid peroxidation
C) Increased ATP production
D) Enhanced DNA repair
Answer: B) DNA mutation and lipid peroxidation
Rationale: Free radicals cause cellular damage by inducing lipid peroxidation of membranes, DNA
damage, and protein denaturation, leading to cell injury and death.
14. Which condition is associated with hypoxic injury to cells?
A) Hyperglycemia
B) Hyperthermia
C) Ischemia
D) Hyponatremia
Answer: C) Ischemia
Rationale: Ischemia is a major cause of hypoxic injury, resulting from reduced blood flow and oxygen
delivery to tissues.
15. The nurse understands that reperfusion injury occurs due to:
A) Restoration of blood flow
Questions & Answers
Section 1: Cellular Adaptation and Injury
(Questions 1-20)
1. A patient with chronic hypoxia develops an increase in red blood cell production. This represents
which type of cellular adaptation?
A) Atrophy
B) Hypertrophy
C) Hyperplasia
D) Metaplasia
Answer: C) Hyperplasia
Rationale: Hyperplasia is an increase in the number of cells in response to a stimulus. Chronic hypoxia
stimulates erythropoietin production, leading to hyperplasia of erythrocyte-producing cells in the bone
marrow.
2. The nurse recognizes that reversible cellular injury is characterized by:
A) Cellular swelling and fatty changes
B) Nuclear fragmentation and karyolysis
C) Cell membrane rupture and inflammation
D) Apoptosis and phagocytosis
Answer: A) Cellular swelling and fatty changes
Rationale: Reversible cellular injury is characterized by cellular swelling (hydropic change) and fatty
changes (lipid accumulation), which are reversible if the cause is removed.
3. Which cellular change is considered irreversible and indicates cell death?
A) Cellular swelling
B) Fatty infiltration
C) Nuclear pyknosis
D) Endoplasmic reticulum dilation
,Answer: C) Nuclear pyknosis
Rationale: Nuclear pyknosis (nuclear shrinkage and condensation), karyorrhexis (nuclear fragmentation),
and karyolysis (nuclear dissolution) are irreversible changes indicating cell death (necrosis).
4. A patient with prolonged ischemia develops coagulative necrosis. Which organ is most commonly
affected by this type of necrosis?
A) Brain
B) Heart
C) Pancreas
D) Lungs
Answer: B) Heart
Rationale: Coagulative necrosis is the most common type of necrosis, typically affecting the heart,
kidneys, and adrenal glands following ischemia.
5. The nurse understands that liquefactive necrosis is most characteristic of:
A) Ischemic heart tissue
B) Tuberculous lung lesions
C) Brain tissue following stroke
D) Pancreatic tissue in pancreatitis
Answer: C) Brain tissue following stroke
Rationale: Liquefactive necrosis is characterized by enzymatic digestion and liquefaction of tissue, most
commonly seen in brain tissue following ischemic stroke or bacterial infections.
6. A patient with tuberculosis develops caseous necrosis. Which finding is characteristic of this type of
necrosis?
A) Purulent exudate
B) Cheesy, white appearance
C) Hemorrhagic appearance
D) Gritty, calcified tissue
Answer: B) Cheesy, white appearance
Rationale: Caseous necrosis has a cheesy, white appearance and is characteristic of tuberculosis and
fungal infections. It combines features of coagulative and liquefactive necrosis.
7. Which enzyme is released from damaged myocardial cells and is a marker for acute myocardial
infarction?
A) Alkaline phosphatase
B) Creatine kinase-MB
, C) Gamma-glutamyl transferase
D) Amylase
Answer: B) Creatine kinase-MB
Rationale: Creatine kinase-MB (CK-MB) is specific to myocardial tissue and is elevated within 4-6 hours
after acute MI, peaking at 24 hours.
8. The nurse recognizes that apoptosis is characterized by:
A) Cell swelling and membrane rupture
B) Inflammatory response and tissue damage
C) Programmed cell death without inflammation
D) Necrosis and cellular fragmentation
Answer: C) Programmed cell death without inflammation
Rationale: Apoptosis is programmed cell death that occurs without inflammation, involving cellular
shrinkage, chromatin condensation, and formation of apoptotic bodies.
9. A patient with chronic alcoholism develops fatty liver. This is an example of:
A) Atrophy
B) Hypertrophy
C) Fatty infiltration
D) Metaplasia
Answer: C) Fatty infiltration
Rationale: Fatty infiltration (steatosis) is the accumulation of lipids in cells, commonly seen in the liver of
patients with chronic alcohol use, obesity, or diabetes.
10. The nurse understands that metaplasia involves:
A) Increased cell size
B) Replacement of one cell type with another
C) Increased cell number
D) Cell death and tissue necrosis
Answer: B) Replacement of one cell type with another
Rationale: Metaplasia is the reversible replacement of one differentiated cell type with another, often in
response to chronic irritation. For example, Barrett's esophagus is metaplasia of squamous to columnar
epithelium.
11. Which factor is most likely to cause cellular atrophy?
A) Increased workload
, B) Decreased blood supply
C) Chronic inflammation
D) Excessive hormonal stimulation
Answer: B) Decreased blood supply
Rationale: Atrophy can result from decreased workload, decreased blood supply (ischemia), denervation,
or decreased hormonal stimulation.
12. A patient with prolonged immobility develops muscle atrophy. This is primarily due to:
A) Decreased workload
B) Increased metabolic demand
C) Decreased nutrient supply
D) Hormonal imbalance
Answer: A) Decreased workload
Rationale: Disuse atrophy occurs when muscles are not used, leading to decreased protein synthesis and
increased protein degradation.
13. The nurse recognizes that free radical injury can cause cellular damage through:
A) Inhibition of protein synthesis
B) DNA mutation and lipid peroxidation
C) Increased ATP production
D) Enhanced DNA repair
Answer: B) DNA mutation and lipid peroxidation
Rationale: Free radicals cause cellular damage by inducing lipid peroxidation of membranes, DNA
damage, and protein denaturation, leading to cell injury and death.
14. Which condition is associated with hypoxic injury to cells?
A) Hyperglycemia
B) Hyperthermia
C) Ischemia
D) Hyponatremia
Answer: C) Ischemia
Rationale: Ischemia is a major cause of hypoxic injury, resulting from reduced blood flow and oxygen
delivery to tissues.
15. The nurse understands that reperfusion injury occurs due to:
A) Restoration of blood flow
