NUR 2063 Essentials of Pathophysiology - Exam 1 (Modules 1-3)
NUR 2063 / NUR 2063 (Latest Update)
Essentials of Pathophysiology - Exam 1
Review Guide Questions and Verified Answers | 100% Correct | Grade A
Rasmussen University | Modules 1-3
75 Questions | 4 Sections
Section 1: Cellular Adaptation, Injury, and Neoplasia (Questions 1-20)
1. A 72-year-old patient with a fractured leg has been on bed rest for three weeks. The nurse observes a
decrease in muscle mass in the affected limb. Which cellular adaptation best describes this finding?
A. Hypertrophy, due to increased workload on the muscle cells
B. Hyperplasia, due to hormonal stimulation of muscle cells
C. Atrophy, due to decreased workload and disuse of the muscle [CORRECT]
D. Metaplasia, due to chronic irritation from immobilization
Correct Answer: C
Atrophy is a decrease in cell size that results from decreased workload, disuse, denervation, ischemia, malnutrition, or aging.
In this case, prolonged bed rest and disuse lead to muscle atrophy in the affected limb. Hypertrophy is an increase in cell size
from increased workload (not decreased), hyperplasia is an increase in cell number from hormonal stimulation, and
metaplasia is the replacement of one differentiated cell type with another due to chronic irritation. None of these other
adaptations explain the decrease in muscle mass seen with prolonged immobilization.
2. A 45-year-old male with a 15-year history of hypertension presents with shortness of breath. An
echocardiogram reveals thickening of the left ventricular wall. Which type of cellular adaptation has occurred
in the cardiac muscle cells?
A. Physiologic hypertrophy, as a normal response to exercise conditioning
B. Pathologic hypertrophy, due to increased afterload from chronic hypertension [CORRECT]
C. Hyperplasia, due to hormonal stimulation of cardiac muscle cells
D. Metaplasia, due to chronic vascular injury and irritation
Correct Answer: B
The left ventricular wall thickening represents pathologic hypertrophy, which is an increase in cell size resulting from
increased workload due to chronic hypertension (increased afterload). Unlike physiologic hypertrophy (e.g., skeletal muscle
enlargement from exercise), pathologic hypertrophy of cardiac muscle is a compensatory response to abnormal stress that
can eventually lead to heart failure. Hyperplasia does not occur in cardiac muscle cells because they are permanent cells with
limited regenerative capacity. Metaplasia involves the replacement of one cell type with another, which is not what is
happening in the myocardium.
3. A pregnant patient develops enlarged breast tissue as the mammary glands prepare for lactation. Which
cellular adaptation is primarily responsible for this change?
A. Hyperplasia, resulting from hormonal stimulation during pregnancy [CORRECT]
B. Hypertrophy, resulting from increased workload on existing glandular cells
C. Metaplasia, resulting from chronic hormonal irritation
D. Dysplasia, resulting from abnormal hormonal stimulation of breast tissue
Correct Answer: A
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,NUR 2063 Essentials of Pathophysiology - Exam 1 (Modules 1-3)
Hyperplasia is an increase in cell number resulting from hormonal stimulation and is a physiologic process during
pregnancy. The breast tissue enlarges primarily because of an increase in the number of glandular cells stimulated by
estrogen and progesterone, which is physiologic hyperplasia. Hypertrophy (increase in cell size) may also occur, but the
primary adaptation driving breast enlargement during pregnancy is hyperplasia. Metaplasia is the replacement of one cell
type with another, and dysplasia is abnormal cell growth and differentiation that is not a true adaptation and can progress to
cancer.
4. A 58-year-old patient with chronic gastroesophageal reflux disease (GERD) undergoes an endoscopy,
which reveals columnar epithelium replacing the normal stratified squamous epithelium in the lower
esophagus. The nurse identifies this finding as which cellular adaptation?
A. Hyperplasia of the squamous epithelial cells
B. Metaplasia from squamous to columnar epithelium (Barrett esophagus) [CORRECT]
C. Dysplasia with abnormal cell differentiation in the esophagus
D. Atrophy of the esophageal lining from chronic acid exposure
Correct Answer: B
The replacement of the normal stratified squamous epithelium with columnar epithelium in the lower esophagus is
metaplasia, specifically Barrett esophagus. Metaplasia is a reversible cellular adaptation to chronic irritation, in which one
differentiated cell type is replaced by another. In this case, chronic acid reflux (GERD) irritates the esophageal lining, and
the body adapts by replacing the fragile squamous cells with more acid-resistant columnar cells. Although metaplasia is
reversible and represents an adaptive protective mechanism, Barrett esophagus is a premalignant condition that increases the
risk of adenocarcinoma of the esophagus. Hyperplasia, dysplasia, and atrophy do not describe this specific cell-type
replacement.
5. Which statement best describes the key difference between dysplasia and metaplasia?
A. Dysplasia is a reversible adaptation, whereas metaplasia is irreversible
B. Metaplasia involves an increase in cell number, whereas dysplasia involves a decrease in cell size
C. Dysplasia involves abnormal cell growth and differentiation, whereas metaplasia is the
replacement of one differentiated cell type with another [CORRECT]
D. Metaplasia always progresses to cancer, whereas dysplasia is always benign
Correct Answer: C
Dysplasia is characterized by abnormal cell growth and differentiation with changes in cell size, shape, and organization. It
is not considered a true adaptive response and can be reversible, but it carries a risk of progressing to cancer (especially in
the cervix, respiratory tract, and esophagus). Metaplasia, in contrast, is a reversible adaptive response in which one fully
differentiated cell type is replaced by another in response to chronic irritation (e.g., squamous metaplasia in the respiratory
tract due to smoking). The key distinction is that metaplasia involves a controlled replacement of cell types, while dysplasia
involves disorganized, atypical cellular changes that may precede malignancy.
6. A patient is admitted with an acute myocardial infarction. The nurse understands that the initial cellular
injury to the myocardial cells is most likely caused by which mechanism?
A. Chemical injury from medications administered during treatment
B. Hypoxic injury from decreased oxygen delivery to the myocardial cells [CORRECT]
C. Free radical injury from excessive antioxidant production
D. Infectious injury from bacterial invasion of the myocardium
Correct Answer: B
Hypoxic injury is the most common cause of cellular injury and occurs when there is decreased oxygen delivery to tissues. In
an acute myocardial infarction, coronary artery occlusion leads to ischemia (reduced blood flow), which deprives
myocardial cells of oxygen and nutrients. This leads to ATP depletion, failure of the sodium-potassium pump, cellular
swelling, and a shift to anaerobic glycolysis that produces lactic acidosis. If ischemia persists, the injury becomes irreversible,
leading to cell death (necrosis). Chemical, free radical, and infectious injuries are other mechanisms of cellular injury but
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, NUR 2063 Essentials of Pathophysiology - Exam 1 (Modules 1-3)
are not the primary cause of myocardial cell death during an acute MI.
7. A patient who suffered a cardiac arrest was successfully resuscitated after 10 minutes. However, the nurse
notes that the patient is experiencing worsening tissue damage despite the restoration of blood flow. This
phenomenon is best described as which of the following?
A. Hypoxic injury due to persistent oxygen deprivation
B. Reperfusion injury from free radical formation and calcium overload upon restoration of blood
flow [CORRECT]
C. Ischemic injury due to continued reduction in blood supply
D. Chemical injury from medications used during resuscitation
Correct Answer: B
Reperfusion injury is tissue damage that occurs when blood flow is restored to previously ischemic tissue. Upon reperfusion,
there is a burst of reactive oxygen species (free radical formation) that causes lipid peroxidation of cell membranes, protein
damage, and DNA damage. Additionally, calcium overload occurs as the sodium-calcium exchange mechanism is
overwhelmed, leading to further cellular damage and inflammation. Although the restoration of blood flow is necessary, the
paradoxical worsening of injury through free radical-mediated damage and calcium overload defines reperfusion injury,
which is a critical concept in post-cardiac arrest care and myocardial infarction management.
8. A patient with carbon tetrachloride poisoning develops liver cell damage. The nurse understands that this
type of cellular injury occurs through which mechanism?
A. Direct damage from the toxin binding to cellular proteins
B. Conversion of the toxin to a reactive free radical metabolite that causes lipid peroxidation
[CORRECT]
C. Immune-mediated destruction of liver cells by cytotoxic T cells
D. Physical injury from thermal damage to hepatocytes
Correct Answer: B
Carbon tetrachloride (CCl4) is a classic example of chemical injury through metabolic activation. The liver converts CCl4
via the cytochrome P450 enzyme system into a highly reactive free radical metabolite (CCl3), which causes lipid
peroxidation of cellular membranes, leading to hepatocyte damage and necrosis (particularly centrilobular necrosis). This
mechanism illustrates how some chemicals are not directly toxic but become dangerous when metabolized by the liver into
reactive intermediates. Direct damage (A) describes chemicals like mercuric chloride that bind directly to cellular components
without metabolic conversion. Immune-mediated and physical injury mechanisms are not involved in carbon tetrachloride
toxicity.
9. A nurse is reviewing the medical record of a patient who died from a cerebrovascular accident (stroke). The
autopsy report describes liquefactive necrosis in the brain tissue. Which characteristic is most consistent with
liquefactive necrosis?
A. Preservation of tissue architecture with coagulative protein denaturation
B. Enzymatic digestion of cells resulting in soft, liquefied tissue and pus formation [CORRECT]
C. A cheese-like, granulomatous appearance associated with tuberculosis
D. Saponification of fat by pancreatic enzymes in the peritoneal cavity
Correct Answer: B
Liquefactive necrosis is characterized by enzymatic digestion of dead cells, resulting in soft, liquefied tissue that is commonly
seen in the central nervous system (brain infarction) and in bacterial infections (abscess formation). Unlike coagulative
necrosis, which preserves the basic tissue architecture (seen in ischemic injury to the kidney or heart), liquefactive necrosis
results in complete dissolution of tissue structure. Caseous necrosis (C) has a cheese-like appearance and is seen with
granulomatous inflammation in tuberculosis. Fat necrosis (D) involves saponification of fat by pancreatic enzymes and is
associated with acute pancreatitis.
Rasmussen University - 2026/2027 Page 3
NUR 2063 / NUR 2063 (Latest Update)
Essentials of Pathophysiology - Exam 1
Review Guide Questions and Verified Answers | 100% Correct | Grade A
Rasmussen University | Modules 1-3
75 Questions | 4 Sections
Section 1: Cellular Adaptation, Injury, and Neoplasia (Questions 1-20)
1. A 72-year-old patient with a fractured leg has been on bed rest for three weeks. The nurse observes a
decrease in muscle mass in the affected limb. Which cellular adaptation best describes this finding?
A. Hypertrophy, due to increased workload on the muscle cells
B. Hyperplasia, due to hormonal stimulation of muscle cells
C. Atrophy, due to decreased workload and disuse of the muscle [CORRECT]
D. Metaplasia, due to chronic irritation from immobilization
Correct Answer: C
Atrophy is a decrease in cell size that results from decreased workload, disuse, denervation, ischemia, malnutrition, or aging.
In this case, prolonged bed rest and disuse lead to muscle atrophy in the affected limb. Hypertrophy is an increase in cell size
from increased workload (not decreased), hyperplasia is an increase in cell number from hormonal stimulation, and
metaplasia is the replacement of one differentiated cell type with another due to chronic irritation. None of these other
adaptations explain the decrease in muscle mass seen with prolonged immobilization.
2. A 45-year-old male with a 15-year history of hypertension presents with shortness of breath. An
echocardiogram reveals thickening of the left ventricular wall. Which type of cellular adaptation has occurred
in the cardiac muscle cells?
A. Physiologic hypertrophy, as a normal response to exercise conditioning
B. Pathologic hypertrophy, due to increased afterload from chronic hypertension [CORRECT]
C. Hyperplasia, due to hormonal stimulation of cardiac muscle cells
D. Metaplasia, due to chronic vascular injury and irritation
Correct Answer: B
The left ventricular wall thickening represents pathologic hypertrophy, which is an increase in cell size resulting from
increased workload due to chronic hypertension (increased afterload). Unlike physiologic hypertrophy (e.g., skeletal muscle
enlargement from exercise), pathologic hypertrophy of cardiac muscle is a compensatory response to abnormal stress that
can eventually lead to heart failure. Hyperplasia does not occur in cardiac muscle cells because they are permanent cells with
limited regenerative capacity. Metaplasia involves the replacement of one cell type with another, which is not what is
happening in the myocardium.
3. A pregnant patient develops enlarged breast tissue as the mammary glands prepare for lactation. Which
cellular adaptation is primarily responsible for this change?
A. Hyperplasia, resulting from hormonal stimulation during pregnancy [CORRECT]
B. Hypertrophy, resulting from increased workload on existing glandular cells
C. Metaplasia, resulting from chronic hormonal irritation
D. Dysplasia, resulting from abnormal hormonal stimulation of breast tissue
Correct Answer: A
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,NUR 2063 Essentials of Pathophysiology - Exam 1 (Modules 1-3)
Hyperplasia is an increase in cell number resulting from hormonal stimulation and is a physiologic process during
pregnancy. The breast tissue enlarges primarily because of an increase in the number of glandular cells stimulated by
estrogen and progesterone, which is physiologic hyperplasia. Hypertrophy (increase in cell size) may also occur, but the
primary adaptation driving breast enlargement during pregnancy is hyperplasia. Metaplasia is the replacement of one cell
type with another, and dysplasia is abnormal cell growth and differentiation that is not a true adaptation and can progress to
cancer.
4. A 58-year-old patient with chronic gastroesophageal reflux disease (GERD) undergoes an endoscopy,
which reveals columnar epithelium replacing the normal stratified squamous epithelium in the lower
esophagus. The nurse identifies this finding as which cellular adaptation?
A. Hyperplasia of the squamous epithelial cells
B. Metaplasia from squamous to columnar epithelium (Barrett esophagus) [CORRECT]
C. Dysplasia with abnormal cell differentiation in the esophagus
D. Atrophy of the esophageal lining from chronic acid exposure
Correct Answer: B
The replacement of the normal stratified squamous epithelium with columnar epithelium in the lower esophagus is
metaplasia, specifically Barrett esophagus. Metaplasia is a reversible cellular adaptation to chronic irritation, in which one
differentiated cell type is replaced by another. In this case, chronic acid reflux (GERD) irritates the esophageal lining, and
the body adapts by replacing the fragile squamous cells with more acid-resistant columnar cells. Although metaplasia is
reversible and represents an adaptive protective mechanism, Barrett esophagus is a premalignant condition that increases the
risk of adenocarcinoma of the esophagus. Hyperplasia, dysplasia, and atrophy do not describe this specific cell-type
replacement.
5. Which statement best describes the key difference between dysplasia and metaplasia?
A. Dysplasia is a reversible adaptation, whereas metaplasia is irreversible
B. Metaplasia involves an increase in cell number, whereas dysplasia involves a decrease in cell size
C. Dysplasia involves abnormal cell growth and differentiation, whereas metaplasia is the
replacement of one differentiated cell type with another [CORRECT]
D. Metaplasia always progresses to cancer, whereas dysplasia is always benign
Correct Answer: C
Dysplasia is characterized by abnormal cell growth and differentiation with changes in cell size, shape, and organization. It
is not considered a true adaptive response and can be reversible, but it carries a risk of progressing to cancer (especially in
the cervix, respiratory tract, and esophagus). Metaplasia, in contrast, is a reversible adaptive response in which one fully
differentiated cell type is replaced by another in response to chronic irritation (e.g., squamous metaplasia in the respiratory
tract due to smoking). The key distinction is that metaplasia involves a controlled replacement of cell types, while dysplasia
involves disorganized, atypical cellular changes that may precede malignancy.
6. A patient is admitted with an acute myocardial infarction. The nurse understands that the initial cellular
injury to the myocardial cells is most likely caused by which mechanism?
A. Chemical injury from medications administered during treatment
B. Hypoxic injury from decreased oxygen delivery to the myocardial cells [CORRECT]
C. Free radical injury from excessive antioxidant production
D. Infectious injury from bacterial invasion of the myocardium
Correct Answer: B
Hypoxic injury is the most common cause of cellular injury and occurs when there is decreased oxygen delivery to tissues. In
an acute myocardial infarction, coronary artery occlusion leads to ischemia (reduced blood flow), which deprives
myocardial cells of oxygen and nutrients. This leads to ATP depletion, failure of the sodium-potassium pump, cellular
swelling, and a shift to anaerobic glycolysis that produces lactic acidosis. If ischemia persists, the injury becomes irreversible,
leading to cell death (necrosis). Chemical, free radical, and infectious injuries are other mechanisms of cellular injury but
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, NUR 2063 Essentials of Pathophysiology - Exam 1 (Modules 1-3)
are not the primary cause of myocardial cell death during an acute MI.
7. A patient who suffered a cardiac arrest was successfully resuscitated after 10 minutes. However, the nurse
notes that the patient is experiencing worsening tissue damage despite the restoration of blood flow. This
phenomenon is best described as which of the following?
A. Hypoxic injury due to persistent oxygen deprivation
B. Reperfusion injury from free radical formation and calcium overload upon restoration of blood
flow [CORRECT]
C. Ischemic injury due to continued reduction in blood supply
D. Chemical injury from medications used during resuscitation
Correct Answer: B
Reperfusion injury is tissue damage that occurs when blood flow is restored to previously ischemic tissue. Upon reperfusion,
there is a burst of reactive oxygen species (free radical formation) that causes lipid peroxidation of cell membranes, protein
damage, and DNA damage. Additionally, calcium overload occurs as the sodium-calcium exchange mechanism is
overwhelmed, leading to further cellular damage and inflammation. Although the restoration of blood flow is necessary, the
paradoxical worsening of injury through free radical-mediated damage and calcium overload defines reperfusion injury,
which is a critical concept in post-cardiac arrest care and myocardial infarction management.
8. A patient with carbon tetrachloride poisoning develops liver cell damage. The nurse understands that this
type of cellular injury occurs through which mechanism?
A. Direct damage from the toxin binding to cellular proteins
B. Conversion of the toxin to a reactive free radical metabolite that causes lipid peroxidation
[CORRECT]
C. Immune-mediated destruction of liver cells by cytotoxic T cells
D. Physical injury from thermal damage to hepatocytes
Correct Answer: B
Carbon tetrachloride (CCl4) is a classic example of chemical injury through metabolic activation. The liver converts CCl4
via the cytochrome P450 enzyme system into a highly reactive free radical metabolite (CCl3), which causes lipid
peroxidation of cellular membranes, leading to hepatocyte damage and necrosis (particularly centrilobular necrosis). This
mechanism illustrates how some chemicals are not directly toxic but become dangerous when metabolized by the liver into
reactive intermediates. Direct damage (A) describes chemicals like mercuric chloride that bind directly to cellular components
without metabolic conversion. Immune-mediated and physical injury mechanisms are not involved in carbon tetrachloride
toxicity.
9. A nurse is reviewing the medical record of a patient who died from a cerebrovascular accident (stroke). The
autopsy report describes liquefactive necrosis in the brain tissue. Which characteristic is most consistent with
liquefactive necrosis?
A. Preservation of tissue architecture with coagulative protein denaturation
B. Enzymatic digestion of cells resulting in soft, liquefied tissue and pus formation [CORRECT]
C. A cheese-like, granulomatous appearance associated with tuberculosis
D. Saponification of fat by pancreatic enzymes in the peritoneal cavity
Correct Answer: B
Liquefactive necrosis is characterized by enzymatic digestion of dead cells, resulting in soft, liquefied tissue that is commonly
seen in the central nervous system (brain infarction) and in bacterial infections (abscess formation). Unlike coagulative
necrosis, which preserves the basic tissue architecture (seen in ischemic injury to the kidney or heart), liquefactive necrosis
results in complete dissolution of tissue structure. Caseous necrosis (C) has a cheese-like appearance and is seen with
granulomatous inflammation in tuberculosis. Fat necrosis (D) involves saponification of fat by pancreatic enzymes and is
associated with acute pancreatitis.
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