N U R S I N G P AT H O P H Y S I O L O G Y
NSG 120 Midterm Examination
Complete Study Guide
100 Verified Questions with Comprehensive Rationales Covering
All Units | 2026-2027 Curriculum Standards
Latest Update
Aligned with Current Nursing Pathophysiology Competencies
NSG120 100 Questions | 10 Sections
, NSG 120 Nursing Pathophysiology Midterm Exam | Complete Study Guide | 2026-2027
Section 1: Cellular Adaptation, Injury, and Neoplasia (Q1-15)
Q1: A patient with a fractured femur has been on bed rest for 3 weeks. The nurse observes decreased
muscle mass in the affected leg. Which cellular adaptation best describes this finding?
A. Hypertrophy of muscle cells due to increased workload
B. Hyperplasia of connective tissue in the immobilized limb
C. Atrophy of muscle cells due to disuse [CORRECT]
D. Metaplasia of muscle tissue to connective tissue
Correct Answer: C
Rationale: Atrophy is a decrease in cell size that occurs in response to reduced workload, disuse, denervation, ischemia,
malnutrition, or aging. In this case, prolonged immobilization leads to disuse atrophy of skeletal muscle cells. Hypertrophy (A)
is an increase in cell size, not a decrease. Hyperplasia (B) is an increase in cell number, which does not occur in skeletal
muscle. Metaplasia (D) is the replacement of one mature cell type with another, not a reduction in cell size.
Q2: A nurse is reviewing the laboratory results of a patient with chronic hypertension. The patient's left
ventricular wall has thickened. Which type of cellular adaptation is responsible for this change?
A. Physiologic hypertrophy due to exercise conditioning
B. Pathologic hypertrophy due to increased afterload [CORRECT]
C. Hyperplasia of cardiac muscle cells
D. Metaplastic transformation of myocardial tissue
Correct Answer: B
Rationale: Hypertrophy is an increase in cell size. Pathologic hypertrophy occurs in response to abnormal stressors such as
hypertension, where increased afterload causes the left ventricle to work harder, leading to myocardial cell enlargement.
Physiologic hypertrophy (A) occurs in response to normal stimuli like exercise and is reversible. Cardiac muscle cells (B) do
not undergo hyperplasia (C) because they are terminally differentiated. Metaplasia (D) involves replacement of one cell type
with another and does not describe cardiac wall thickening.
Q3: A 55-year-old patient with a long history of GERD is diagnosed with Barrett's esophagus. The nurse
understands that Barrett's esophagus is an example of which cellular adaptation?
A. Dysplasia of the esophageal squamous epithelium
B. Metaplasia from squamous to columnar epithelium [CORRECT]
C. Hyperplasia of the esophageal mucosal lining
D. Atrophy of the esophageal smooth muscle layer
Correct Answer: B
Rationale: Metaplasia is the replacement of one mature cell type with another mature cell type. In Barrett's esophagus,
chronic irritation from gastric acid reflux causes the normal squamous epithelium of the esophagus to be replaced by
intestinal-type columnar epithelium. While dysplasia (A) can develop as a later complication of Barrett's esophagus and
represents a precancerous change, the initial adaptation is metaplasia. Hyperplasia (C) is an increase in cell number, and
atrophy (D) is a decrease in cell size, neither of which describes the cell type replacement seen in Barrett's.
Page 1
, NSG 120 Nursing Pathophysiology Midterm Exam | Complete Study Guide | 2026-2027
Q4: A nurse is educating a patient about cervical cancer screening. The nurse explains that abnormal Pap
smear results showing dysplastic cervical cells indicate which of the following?
A. A reversible increase in cell number due to hormonal stimulation
B. An irreversible replacement of one cell type with another
C. Abnormal cell growth, size, and shape that is considered precancerous [CORRECT]
D. A programmed, controlled cell death that is part of normal physiology
Correct Answer: C
Rationale: Dysplasia is characterized by abnormal cell growth with changes in size, shape, and organization. It is considered
a precancerous change, often caused by chronic irritation such as HPV infection in the cervix. It is not simply an increase in
cell number (A), which describes hyperplasia. Dysplasia is also distinct from metaplasia (B), which is the replacement of one
mature cell type by another. Apoptosis (D) is programmed cell death, not abnormal growth.
Q5: A patient presents to the emergency department with an acute myocardial infarction. The nurse
understands that the primary cause of cellular injury in this patient is which of the following?
A. Free radical injury from reperfusion
B. Hypoxia due to interrupted blood flow [CORRECT]
C. Chemical injury from released enzymes
D. Immunologic injury from inflammatory mediators
Correct Answer: B
Rationale: Hypoxia is the most common cause of cellular injury and occurs when there is decreased oxygen supply to tissues.
In an MI, the interrupted coronary blood flow leads to hypoxia, which causes decreased ATP production, failure of the
sodium-potassium pump, cellular swelling, and ultimately cell death. While reperfusion injury (A) can occur after blood flow
is restored, the primary injury is from the initial hypoxia. Chemical and immunologic injuries (C, D) are secondary
mechanisms that contribute to damage but are not the primary cause of cellular injury in this scenario.
Q6: A nurse is caring for a patient who experienced a cardiac arrest and was successfully resuscitated.
The nurse notes worsening tissue damage despite the return of blood flow. This phenomenon is best
described as:
A. Ischemia-reperfusion injury causing oxidative stress [CORRECT]
B. Coagulative necrosis due to prolonged hypoxia
C. Apoptosis triggered by calcium influx
D. Liquefactive necrosis from enzymatic digestion
Correct Answer: A
Rationale: Reperfusion injury occurs when blood flow is restored to ischemic tissue, paradoxically causing additional
damage. The mechanism involves a burst of reactive oxygen species (free radicals) from mitochondria that overwhelms
antioxidant defenses, causing oxidative stress and lipid membrane damage. Coagulative necrosis (B) results from the original
ischemic injury, not the reperfusion. Apoptosis (C) can occur as a secondary event but does not explain the acute worsening.
Liquefactive necrosis (D) is typically seen in brain tissue or bacterial infections, not in reperfusion injury following cardiac
arrest.
Page 2
, NSG 120 Nursing Pathophysiology Midterm Exam | Complete Study Guide | 2026-2027
Q7: A patient with a long-standing history of smoking presents with a lung mass. A biopsy reveals poorly
differentiated cells that are invasive and have metastasized to nearby lymph nodes. Which of the following
characteristics best describes this tumor?
A. Benign tumor with well-differentiated cells and slow growth
B. Malignant tumor with anaplasia, invasion, and metastasis [CORRECT]
C. Premalignant dysplasia with abnormal cell organization
D. Hyperplastic growth with increased cell number only
Correct Answer: B
Rationale: Malignant tumors are characterized by poor differentiation (anaplasia), invasive growth into surrounding tissues,
rapid proliferation, and the ability to metastasize to distant sites. This patient's tumor shows all these features: poorly
differentiated cells, invasion, and lymph node metastasis. Benign tumors (A) are well-differentiated, encapsulated,
slow-growing, and do not invade or metastasize. Dysplasia (C) is precancerous but has not yet developed invasive or
metastatic capabilities. Hyperplasia (D) is simply an increase in cell number without the atypical features of malignancy.
Q8: A nurse is reviewing the pathology report of a patient diagnosed with colon cancer. The report
indicates the tumor is T3, N1, M0. The nurse understands that this staging system evaluates which of the
following?
A. Tumor grade, nodal involvement, and metastasis
B. Tumor size, node involvement, and metastasis [CORRECT]
C. Tumor type, nuclear grade, and margin status
D. Tumor stage, neoplasia type, and molecular markers
Correct Answer: B
Rationale: The TNM staging system evaluates three components: T (tumor size or extent of primary tumor), N (regional
lymph node involvement), and M (distant metastasis). In this case, T3 indicates a large primary tumor extending through the
muscularis, N1 indicates regional lymph node metastasis, and M0 indicates no distant metastasis. This system is used for most
solid tumors and guides treatment decisions and prognosis. Tumor grade (A) is a separate assessment of histologic
differentiation, not the T in TNM.
Q9: A nursing student asks the instructor about the difference between oncogenes and tumor suppressor
genes. Which response by the instructor is most accurate?
A. Oncogenes promote cell growth when mutated, while tumor suppressor genes normally restrain cell growth and
require loss of function to promote cancer. [CORRECT]
B. Both oncogenes and tumor suppressor genes promote cancer when activated, but oncogenes are inherited while
tumor suppressor genes are acquired.
C. Oncogenes prevent cancer by repairing DNA damage, while tumor suppressor genes cause cancer when they
become overactive.
D. Oncogenes and tumor suppressor genes function identically but are located on different chromosomes.
Correct Answer: A
Rationale: Oncogenes are mutated forms of normal proto-oncogenes that promote uncontrolled cell growth and proliferation
when activated. In contrast, tumor suppressor genes (such as p53, BRCA1/BRCA2, and Rb) normally function to restrain cell
growth, repair DNA, or promote apoptosis; cancer develops when these genes lose their function. The key difference is that
oncogenes act via gain of function (a single mutated allele can promote cancer), while tumor suppressor genes require loss of
function (both alleles must typically be inactivated, known as the two-hit hypothesis). Options B, C, and D contain inaccurate
descriptions of both gene types.
Page 3
NSG 120 Midterm Examination
Complete Study Guide
100 Verified Questions with Comprehensive Rationales Covering
All Units | 2026-2027 Curriculum Standards
Latest Update
Aligned with Current Nursing Pathophysiology Competencies
NSG120 100 Questions | 10 Sections
, NSG 120 Nursing Pathophysiology Midterm Exam | Complete Study Guide | 2026-2027
Section 1: Cellular Adaptation, Injury, and Neoplasia (Q1-15)
Q1: A patient with a fractured femur has been on bed rest for 3 weeks. The nurse observes decreased
muscle mass in the affected leg. Which cellular adaptation best describes this finding?
A. Hypertrophy of muscle cells due to increased workload
B. Hyperplasia of connective tissue in the immobilized limb
C. Atrophy of muscle cells due to disuse [CORRECT]
D. Metaplasia of muscle tissue to connective tissue
Correct Answer: C
Rationale: Atrophy is a decrease in cell size that occurs in response to reduced workload, disuse, denervation, ischemia,
malnutrition, or aging. In this case, prolonged immobilization leads to disuse atrophy of skeletal muscle cells. Hypertrophy (A)
is an increase in cell size, not a decrease. Hyperplasia (B) is an increase in cell number, which does not occur in skeletal
muscle. Metaplasia (D) is the replacement of one mature cell type with another, not a reduction in cell size.
Q2: A nurse is reviewing the laboratory results of a patient with chronic hypertension. The patient's left
ventricular wall has thickened. Which type of cellular adaptation is responsible for this change?
A. Physiologic hypertrophy due to exercise conditioning
B. Pathologic hypertrophy due to increased afterload [CORRECT]
C. Hyperplasia of cardiac muscle cells
D. Metaplastic transformation of myocardial tissue
Correct Answer: B
Rationale: Hypertrophy is an increase in cell size. Pathologic hypertrophy occurs in response to abnormal stressors such as
hypertension, where increased afterload causes the left ventricle to work harder, leading to myocardial cell enlargement.
Physiologic hypertrophy (A) occurs in response to normal stimuli like exercise and is reversible. Cardiac muscle cells (B) do
not undergo hyperplasia (C) because they are terminally differentiated. Metaplasia (D) involves replacement of one cell type
with another and does not describe cardiac wall thickening.
Q3: A 55-year-old patient with a long history of GERD is diagnosed with Barrett's esophagus. The nurse
understands that Barrett's esophagus is an example of which cellular adaptation?
A. Dysplasia of the esophageal squamous epithelium
B. Metaplasia from squamous to columnar epithelium [CORRECT]
C. Hyperplasia of the esophageal mucosal lining
D. Atrophy of the esophageal smooth muscle layer
Correct Answer: B
Rationale: Metaplasia is the replacement of one mature cell type with another mature cell type. In Barrett's esophagus,
chronic irritation from gastric acid reflux causes the normal squamous epithelium of the esophagus to be replaced by
intestinal-type columnar epithelium. While dysplasia (A) can develop as a later complication of Barrett's esophagus and
represents a precancerous change, the initial adaptation is metaplasia. Hyperplasia (C) is an increase in cell number, and
atrophy (D) is a decrease in cell size, neither of which describes the cell type replacement seen in Barrett's.
Page 1
, NSG 120 Nursing Pathophysiology Midterm Exam | Complete Study Guide | 2026-2027
Q4: A nurse is educating a patient about cervical cancer screening. The nurse explains that abnormal Pap
smear results showing dysplastic cervical cells indicate which of the following?
A. A reversible increase in cell number due to hormonal stimulation
B. An irreversible replacement of one cell type with another
C. Abnormal cell growth, size, and shape that is considered precancerous [CORRECT]
D. A programmed, controlled cell death that is part of normal physiology
Correct Answer: C
Rationale: Dysplasia is characterized by abnormal cell growth with changes in size, shape, and organization. It is considered
a precancerous change, often caused by chronic irritation such as HPV infection in the cervix. It is not simply an increase in
cell number (A), which describes hyperplasia. Dysplasia is also distinct from metaplasia (B), which is the replacement of one
mature cell type by another. Apoptosis (D) is programmed cell death, not abnormal growth.
Q5: A patient presents to the emergency department with an acute myocardial infarction. The nurse
understands that the primary cause of cellular injury in this patient is which of the following?
A. Free radical injury from reperfusion
B. Hypoxia due to interrupted blood flow [CORRECT]
C. Chemical injury from released enzymes
D. Immunologic injury from inflammatory mediators
Correct Answer: B
Rationale: Hypoxia is the most common cause of cellular injury and occurs when there is decreased oxygen supply to tissues.
In an MI, the interrupted coronary blood flow leads to hypoxia, which causes decreased ATP production, failure of the
sodium-potassium pump, cellular swelling, and ultimately cell death. While reperfusion injury (A) can occur after blood flow
is restored, the primary injury is from the initial hypoxia. Chemical and immunologic injuries (C, D) are secondary
mechanisms that contribute to damage but are not the primary cause of cellular injury in this scenario.
Q6: A nurse is caring for a patient who experienced a cardiac arrest and was successfully resuscitated.
The nurse notes worsening tissue damage despite the return of blood flow. This phenomenon is best
described as:
A. Ischemia-reperfusion injury causing oxidative stress [CORRECT]
B. Coagulative necrosis due to prolonged hypoxia
C. Apoptosis triggered by calcium influx
D. Liquefactive necrosis from enzymatic digestion
Correct Answer: A
Rationale: Reperfusion injury occurs when blood flow is restored to ischemic tissue, paradoxically causing additional
damage. The mechanism involves a burst of reactive oxygen species (free radicals) from mitochondria that overwhelms
antioxidant defenses, causing oxidative stress and lipid membrane damage. Coagulative necrosis (B) results from the original
ischemic injury, not the reperfusion. Apoptosis (C) can occur as a secondary event but does not explain the acute worsening.
Liquefactive necrosis (D) is typically seen in brain tissue or bacterial infections, not in reperfusion injury following cardiac
arrest.
Page 2
, NSG 120 Nursing Pathophysiology Midterm Exam | Complete Study Guide | 2026-2027
Q7: A patient with a long-standing history of smoking presents with a lung mass. A biopsy reveals poorly
differentiated cells that are invasive and have metastasized to nearby lymph nodes. Which of the following
characteristics best describes this tumor?
A. Benign tumor with well-differentiated cells and slow growth
B. Malignant tumor with anaplasia, invasion, and metastasis [CORRECT]
C. Premalignant dysplasia with abnormal cell organization
D. Hyperplastic growth with increased cell number only
Correct Answer: B
Rationale: Malignant tumors are characterized by poor differentiation (anaplasia), invasive growth into surrounding tissues,
rapid proliferation, and the ability to metastasize to distant sites. This patient's tumor shows all these features: poorly
differentiated cells, invasion, and lymph node metastasis. Benign tumors (A) are well-differentiated, encapsulated,
slow-growing, and do not invade or metastasize. Dysplasia (C) is precancerous but has not yet developed invasive or
metastatic capabilities. Hyperplasia (D) is simply an increase in cell number without the atypical features of malignancy.
Q8: A nurse is reviewing the pathology report of a patient diagnosed with colon cancer. The report
indicates the tumor is T3, N1, M0. The nurse understands that this staging system evaluates which of the
following?
A. Tumor grade, nodal involvement, and metastasis
B. Tumor size, node involvement, and metastasis [CORRECT]
C. Tumor type, nuclear grade, and margin status
D. Tumor stage, neoplasia type, and molecular markers
Correct Answer: B
Rationale: The TNM staging system evaluates three components: T (tumor size or extent of primary tumor), N (regional
lymph node involvement), and M (distant metastasis). In this case, T3 indicates a large primary tumor extending through the
muscularis, N1 indicates regional lymph node metastasis, and M0 indicates no distant metastasis. This system is used for most
solid tumors and guides treatment decisions and prognosis. Tumor grade (A) is a separate assessment of histologic
differentiation, not the T in TNM.
Q9: A nursing student asks the instructor about the difference between oncogenes and tumor suppressor
genes. Which response by the instructor is most accurate?
A. Oncogenes promote cell growth when mutated, while tumor suppressor genes normally restrain cell growth and
require loss of function to promote cancer. [CORRECT]
B. Both oncogenes and tumor suppressor genes promote cancer when activated, but oncogenes are inherited while
tumor suppressor genes are acquired.
C. Oncogenes prevent cancer by repairing DNA damage, while tumor suppressor genes cause cancer when they
become overactive.
D. Oncogenes and tumor suppressor genes function identically but are located on different chromosomes.
Correct Answer: A
Rationale: Oncogenes are mutated forms of normal proto-oncogenes that promote uncontrolled cell growth and proliferation
when activated. In contrast, tumor suppressor genes (such as p53, BRCA1/BRCA2, and Rb) normally function to restrain cell
growth, repair DNA, or promote apoptosis; cancer develops when these genes lose their function. The key difference is that
oncogenes act via gain of function (a single mutated allele can promote cancer), while tumor suppressor genes require loss of
function (both alleles must typically be inactivated, known as the two-hit hypothesis). Options B, C, and D contain inaccurate
descriptions of both gene types.
Page 3
