NSG 120
Nursing Pathophysiology
Midterm Examination
Latest Update
Comprehensive Exam Review Covering All Units
100 Questions with Verified Answers and Rationales
100 Multiple-Choice Questions | 10 Content Sections
Cognitive Levels: 25% Recall | 55% Application | 20% Analysis
NSG 120 Midterm Exam Review | Page 1
,Section 1: Cellular Adaptation, Injury, and Neoplasia
(Questions 1-15)
1. A patient with a casted leg after a fracture is found to have decreased muscle mass in the
immobilized limb. Which cellular adaptation best describes this finding?
A. Hyperplasia
B. Hypertrophy
C. Atrophy **[CORRECT]**
D. Metaplasia
Correct Answer: C
Rationale: Atrophy is a decrease in cell size resulting from reduced workload, disuse, denervation, or inadequate
nutrition. Immobilization of a limb leads to disuse atrophy as cells reduce their functional mass in response to
decreased demand. Hyperplasia is an increase in cell number, hypertrophy is an increase in cell size due to increased
workload (not decreased), and metaplasia is the replacement of one cell type with another.
2. A 55-year-old male with chronic hypertension is found to have an enlarged left ventricle. This is
an example of which cellular adaptation?
A. Pathologic hyperplasia
B. Physiologic hypertrophy
C. Pathologic hypertrophy **[CORRECT]**
D. Metaplasia
Correct Answer: C
Rationale: The enlarged left ventricle in chronic hypertension is pathologic hypertrophy, which involves an increase
in cell size in response to increased workload imposed by elevated systemic vascular resistance. Unlike physiologic
hypertrophy (e.g., enlarged muscles in an athlete), pathologic hypertrophy is driven by disease and can eventually
lead to ventricular failure. Hyperplasia refers to an increase in cell number, not size, and metaplasia involves a
change in cell type.
3. A pregnant woman develops enlargement of breast glandular tissue in preparation for
lactation. This is an example of:
A. Physiologic hyperplasia **[CORRECT]**
B. Pathologic hyperplasia
C. Physiologic hypertrophy
D. Compensatory hyperplasia
Correct Answer: A
Rationale: Breast glandular enlargement during pregnancy is physiologic hyperplasia, driven by hormonal
stimulation (estrogen and progesterone). It represents an increase in cell number that is a normal, expected response
to prepare for lactation. Pathologic hyperplasia would involve abnormal proliferation such as BPH. Physiologic
hypertrophy would be an increase in cell size, not number. Compensatory hyperplasia refers to regeneration of tissue
after injury, such as liver regeneration after partial hepatectomy.
NSG 120 Midterm Exam Review | Page 2
,4. A patient with chronic GERD develops Barrett esophagus on endoscopy. This represents which
cellular adaptation?
A. Hyperplasia
B. Dysplasia
C. Metaplasia **[CORRECT]**
D. Atrophy
Correct Answer: C
Rationale: Barrett esophagus is a classic example of metaplasia, in which the normal stratified squamous epithelium
of the esophagus is replaced by columnar epithelium (intestinal-type) due to chronic irritation from acid reflux. This
is an adaptive attempt to protect against injury but carries an increased risk of progression to dysplasia and
adenocarcinoma. Hyperplasia is an increase in cell number, dysplasia is abnormal cell growth with precancerous
changes, and atrophy is a decrease in cell size.
5. A patient with a Pap smear showing abnormal cervical cells is diagnosed with cervical
dysplasia. Which statement best describes dysplasia?
A. It is always reversible with treatment
B. It involves abnormal cell growth, size, and shape and is considered precancerous
**[CORRECT]**
C. It is a malignant transformation of normal cells
D. It is characterized by an increase in cell number only
Correct Answer: B
Rationale: Dysplasia is characterized by abnormal cell growth, size, and shape. It is considered a precancerous
change, often caused by chronic irritation or infection (such as HPV in cervical dysplasia). While mild dysplasia
can be reversible if the inciting stimulus is removed, severe dysplasia may progress to carcinoma in situ and invasive
cancer. It is not yet malignant but represents a critical warning sign. It involves changes in cell morphology, not
simply an increase in cell number.
6. A patient arrives to the emergency department with an acute myocardial infarction. The
cardiologist explains that the initial cellular injury is caused by decreased oxygen supply. What is
the most common cause of cellular injury?
A. Free radical injury
B. Hypoxia **[CORRECT]**
C. Chemical injury
D. Ischemia
Correct Answer: B
Rationale: Hypoxia is the most common cause of cellular injury. It results from decreased oxygen supply, leading to
decreased ATP production and failure of the sodium-potassium pump, which causes cellular swelling. While
ischemia (reduced blood flow) is a frequent cause of hypoxia, hypoxia can also result from other factors. Free
radical injury is a mechanism of damage but not the most common overall cause. Chemical injury is another
mechanism but is less prevalent than oxygen deprivation.
7. A stroke patient receives thrombolytic therapy. The nurse understands that restoration of blood
flow can cause additional tissue damage. What is this phenomenon called?
A. Apoptosis
NSG 120 Midterm Exam Review | Page 3
, B. Coagulative necrosis
C. Reperfusion injury **[CORRECT]**
D. Liquefactive necrosis
Correct Answer: C
Rationale: Reperfusion injury is tissue damage that occurs upon the restoration of blood flow after a period of
ischemia. The mechanism involves oxidative stress from the sudden influx of oxygen, which generates reactive
oxygen species (free radicals) that damage cell membranes, proteins, and DNA. While the goal of thrombolytic
therapy is to restore perfusion, the paradoxical damage from reperfusion is a recognized clinical concern. Apoptosis
is programmed cell death, coagulative necrosis results from ischemia, and liquefactive necrosis occurs in the CNS or
infections.
8. A patient with a brain abscess has tissue that has been liquefied. Which type of necrosis is most
likely present?
A. Coagulative necrosis
B. Liquefactive necrosis **[CORRECT]**
C. Caseous necrosis
D. Fat necrosis
Correct Answer: B
Rationale: Liquefactive necrosis is characterized by the complete digestion of dead cells, resulting in a liquid, creamy
material. It typically occurs in the central nervous system (CNS) and in bacterial or fungal infections, where
hydrolytic enzymes from neutrophils and microorganisms digest the tissue. Coagulative necrosis preserves cell
outlines and is typical of ischemic injury in most solid organs except the brain. Caseous necrosis is seen in
tuberculosis, and fat necrosis occurs in pancreatic disease.
9. A nurse is caring for a patient diagnosed with tuberculosis. The pathologist notes granuloma
formation with caseous necrosis. Which type of necrosis is characteristic of TB?
A. Coagulative
B. Liquefactive
C. Caseous **[CORRECT]**
D. Gangrenous
Correct Answer: C
Rationale: Caseous necrosis is the characteristic form of necrosis seen in tuberculosis. It appears as a soft,
cheese-like (caseous) material and is typically surrounded by a granulomatous inflammatory reaction consisting of
macrophages, epithelioid cells, and giant cells. Coagulative necrosis is seen in ischemic injury, liquefactive necrosis
in CNS and bacterial infections, and gangrenous necrosis involves tissue death, often in extremities due to vascular
compromise.
10. A patient with acute pancreatitis has elevated amylase and lipase. The nurse understands that
pancreatic enzymes are causing autodigestion of peripancreatic fat. Which type of necrosis is
occurring?
A. Coagulative necrosis
B. Fat necrosis **[CORRECT]**
C. Liquefactive necrosis
D. Caseous necrosis
NSG 120 Midterm Exam Review | Page 4
Nursing Pathophysiology
Midterm Examination
Latest Update
Comprehensive Exam Review Covering All Units
100 Questions with Verified Answers and Rationales
100 Multiple-Choice Questions | 10 Content Sections
Cognitive Levels: 25% Recall | 55% Application | 20% Analysis
NSG 120 Midterm Exam Review | Page 1
,Section 1: Cellular Adaptation, Injury, and Neoplasia
(Questions 1-15)
1. A patient with a casted leg after a fracture is found to have decreased muscle mass in the
immobilized limb. Which cellular adaptation best describes this finding?
A. Hyperplasia
B. Hypertrophy
C. Atrophy **[CORRECT]**
D. Metaplasia
Correct Answer: C
Rationale: Atrophy is a decrease in cell size resulting from reduced workload, disuse, denervation, or inadequate
nutrition. Immobilization of a limb leads to disuse atrophy as cells reduce their functional mass in response to
decreased demand. Hyperplasia is an increase in cell number, hypertrophy is an increase in cell size due to increased
workload (not decreased), and metaplasia is the replacement of one cell type with another.
2. A 55-year-old male with chronic hypertension is found to have an enlarged left ventricle. This is
an example of which cellular adaptation?
A. Pathologic hyperplasia
B. Physiologic hypertrophy
C. Pathologic hypertrophy **[CORRECT]**
D. Metaplasia
Correct Answer: C
Rationale: The enlarged left ventricle in chronic hypertension is pathologic hypertrophy, which involves an increase
in cell size in response to increased workload imposed by elevated systemic vascular resistance. Unlike physiologic
hypertrophy (e.g., enlarged muscles in an athlete), pathologic hypertrophy is driven by disease and can eventually
lead to ventricular failure. Hyperplasia refers to an increase in cell number, not size, and metaplasia involves a
change in cell type.
3. A pregnant woman develops enlargement of breast glandular tissue in preparation for
lactation. This is an example of:
A. Physiologic hyperplasia **[CORRECT]**
B. Pathologic hyperplasia
C. Physiologic hypertrophy
D. Compensatory hyperplasia
Correct Answer: A
Rationale: Breast glandular enlargement during pregnancy is physiologic hyperplasia, driven by hormonal
stimulation (estrogen and progesterone). It represents an increase in cell number that is a normal, expected response
to prepare for lactation. Pathologic hyperplasia would involve abnormal proliferation such as BPH. Physiologic
hypertrophy would be an increase in cell size, not number. Compensatory hyperplasia refers to regeneration of tissue
after injury, such as liver regeneration after partial hepatectomy.
NSG 120 Midterm Exam Review | Page 2
,4. A patient with chronic GERD develops Barrett esophagus on endoscopy. This represents which
cellular adaptation?
A. Hyperplasia
B. Dysplasia
C. Metaplasia **[CORRECT]**
D. Atrophy
Correct Answer: C
Rationale: Barrett esophagus is a classic example of metaplasia, in which the normal stratified squamous epithelium
of the esophagus is replaced by columnar epithelium (intestinal-type) due to chronic irritation from acid reflux. This
is an adaptive attempt to protect against injury but carries an increased risk of progression to dysplasia and
adenocarcinoma. Hyperplasia is an increase in cell number, dysplasia is abnormal cell growth with precancerous
changes, and atrophy is a decrease in cell size.
5. A patient with a Pap smear showing abnormal cervical cells is diagnosed with cervical
dysplasia. Which statement best describes dysplasia?
A. It is always reversible with treatment
B. It involves abnormal cell growth, size, and shape and is considered precancerous
**[CORRECT]**
C. It is a malignant transformation of normal cells
D. It is characterized by an increase in cell number only
Correct Answer: B
Rationale: Dysplasia is characterized by abnormal cell growth, size, and shape. It is considered a precancerous
change, often caused by chronic irritation or infection (such as HPV in cervical dysplasia). While mild dysplasia
can be reversible if the inciting stimulus is removed, severe dysplasia may progress to carcinoma in situ and invasive
cancer. It is not yet malignant but represents a critical warning sign. It involves changes in cell morphology, not
simply an increase in cell number.
6. A patient arrives to the emergency department with an acute myocardial infarction. The
cardiologist explains that the initial cellular injury is caused by decreased oxygen supply. What is
the most common cause of cellular injury?
A. Free radical injury
B. Hypoxia **[CORRECT]**
C. Chemical injury
D. Ischemia
Correct Answer: B
Rationale: Hypoxia is the most common cause of cellular injury. It results from decreased oxygen supply, leading to
decreased ATP production and failure of the sodium-potassium pump, which causes cellular swelling. While
ischemia (reduced blood flow) is a frequent cause of hypoxia, hypoxia can also result from other factors. Free
radical injury is a mechanism of damage but not the most common overall cause. Chemical injury is another
mechanism but is less prevalent than oxygen deprivation.
7. A stroke patient receives thrombolytic therapy. The nurse understands that restoration of blood
flow can cause additional tissue damage. What is this phenomenon called?
A. Apoptosis
NSG 120 Midterm Exam Review | Page 3
, B. Coagulative necrosis
C. Reperfusion injury **[CORRECT]**
D. Liquefactive necrosis
Correct Answer: C
Rationale: Reperfusion injury is tissue damage that occurs upon the restoration of blood flow after a period of
ischemia. The mechanism involves oxidative stress from the sudden influx of oxygen, which generates reactive
oxygen species (free radicals) that damage cell membranes, proteins, and DNA. While the goal of thrombolytic
therapy is to restore perfusion, the paradoxical damage from reperfusion is a recognized clinical concern. Apoptosis
is programmed cell death, coagulative necrosis results from ischemia, and liquefactive necrosis occurs in the CNS or
infections.
8. A patient with a brain abscess has tissue that has been liquefied. Which type of necrosis is most
likely present?
A. Coagulative necrosis
B. Liquefactive necrosis **[CORRECT]**
C. Caseous necrosis
D. Fat necrosis
Correct Answer: B
Rationale: Liquefactive necrosis is characterized by the complete digestion of dead cells, resulting in a liquid, creamy
material. It typically occurs in the central nervous system (CNS) and in bacterial or fungal infections, where
hydrolytic enzymes from neutrophils and microorganisms digest the tissue. Coagulative necrosis preserves cell
outlines and is typical of ischemic injury in most solid organs except the brain. Caseous necrosis is seen in
tuberculosis, and fat necrosis occurs in pancreatic disease.
9. A nurse is caring for a patient diagnosed with tuberculosis. The pathologist notes granuloma
formation with caseous necrosis. Which type of necrosis is characteristic of TB?
A. Coagulative
B. Liquefactive
C. Caseous **[CORRECT]**
D. Gangrenous
Correct Answer: C
Rationale: Caseous necrosis is the characteristic form of necrosis seen in tuberculosis. It appears as a soft,
cheese-like (caseous) material and is typically surrounded by a granulomatous inflammatory reaction consisting of
macrophages, epithelioid cells, and giant cells. Coagulative necrosis is seen in ischemic injury, liquefactive necrosis
in CNS and bacterial infections, and gangrenous necrosis involves tissue death, often in extremities due to vascular
compromise.
10. A patient with acute pancreatitis has elevated amylase and lipase. The nurse understands that
pancreatic enzymes are causing autodigestion of peripancreatic fat. Which type of necrosis is
occurring?
A. Coagulative necrosis
B. Fat necrosis **[CORRECT]**
C. Liquefactive necrosis
D. Caseous necrosis
NSG 120 Midterm Exam Review | Page 4
