NUR 376 Exam 1 – Applied Pathophysiology –
(2026) Actual Questions & Answers
(Concordia) 100% Guarantee Pass
SECTION 1: CELLULAR ADAPTATION & INJURY
1. A 55-year-old smoker develops squamous metaplasia in the bronchial
epithelium. What is the most accurate description of this process?
• A) Replacement of normal columnar epithelium with stratified squamous
epithelium
• B) Increased number of goblet cells in the airways
• C) Decreased size of bronchial epithelial cells
• D) Malignant transformation of bronchial cells
Answer: A) Replacement of normal columnar epithelium with stratified
squamous epithelium
Rationale: Metaplasia is a reversible change in which one differentiated cell type is
replaced by another cell type. In the respiratory tract of smokers, chronic irritation
causes the normal pseudostratified ciliated columnar epithelium to be replaced by
stratified squamous epithelium, which is more resistant to irritation but loses its
protective ciliary function.
2. A patient with chronic hypertension exhibits an enlarged heart on an
echocardiogram. This cellular change is best described as:
• A) Atrophy
• B) Hypertrophy
, • C) Hyperplasia
• D) Metaplasia
Answer: B) Hypertrophy
Rationale: Hypertrophy is an increase in the size of individual cells in response to
increased workload or stress. In hypertension, the heart muscle must pump
against higher resistance, causing the myocardial cells to enlarge. The heart
muscle does not increase in cell number (hyperplasia) in adults, but rather
increases in cell size.
3. Which cellular adaptation is characterized by a decrease in cell size and
function?
• A) Hypertrophy
• B) Hyperplasia
• C) Atrophy
• D) Metaplasia
Answer: C) Atrophy
Rationale: Atrophy is a decrease in cell size and function that can result from
disuse, denervation, ischemia, malnutrition, or aging. It represents a reduction in
cellular content and metabolic activity. Atrophic cells may contain increased
numbers of autophagic vacuoles and lipofuscin granules.
4. A pathology report describes organized, energy-dependent cell death that
does not trigger an inflammatory response. This is characteristic of:
• A) Necrosis
• B) Apoptosis
• C) Gangrene
, • D) Caseous necrosis
Answer: B) Apoptosis
Rationale: Apoptosis is programmed, orderly cell death. It involves cell shrinkage,
chromatin condensation, and DNA fragmentation via caspase enzymes, and it
does not trigger an inflammatory response. Necrosis is disorderly, causes cell
swelling and rupture, and triggers inflammation.
5. Once the point of irreversible cell injury is reached, which of the following
occurs?
• A) The cell can recover with appropriate intervention
• B) Cell death is inevitable regardless of intervention
• C) The cell will undergo hypertrophy
• D) The cell will undergo hyperplasia
Answer: B) Cell death is inevitable regardless of intervention
Rationale: Once the point of irreversible cell injury is reached, cell death is
inevitable regardless of intervention. This is a critical concept in understanding the
window of opportunity for interventions such as thrombolysis in myocardial
infarction.
6. A biopsy reveals proliferating cells that are well-differentiated, resemble
surrounding cells, and are contained within a well-defined area. This is most
consistent with:
• A) Malignant neoplasia
• B) Benign neoplasia
• C) Metastatic cancer
• D) Dysplasia
, Answer: B) Benign neoplasia
Rationale: Benign neoplasms are well-differentiated, grow slowly by expansion,
are encapsulated, and do not metastasize. Malignant neoplasms are poorly
differentiated, grow rapidly, invade surrounding tissues, and metastasize to distant
sites.
7. Ischemia deprives the cell of oxygen, halting oxidative phosphorylation and
ATP production. Without ATP, which of the following events occurs first?
• A) Activation of caspases and apoptosis
• B) Failure of the Na⁺/K⁺ pump, causing cellular swelling
• C) Release of inflammatory mediators
• D) DNA fragmentation
Answer: B) Failure of the Na⁺/K⁺ pump, causing cellular swelling
Rationale: Ischemia deprives the cell of oxygen, halting oxidative phosphorylation
and ATP production. Without ATP, the Na⁺/K⁺ pump fails, sodium and water rush
into the cell causing swelling, and calcium influx activates destructive enzymes,
leading to necrosis.
8. Cells that are atypical in size and shape but are not necessarily cancerous are
described as:
• A) Dysplastic
• B) Metaplastic
• C) Anaplastic
• D) Hyperplastic
Answer: A) Dysplastic
(2026) Actual Questions & Answers
(Concordia) 100% Guarantee Pass
SECTION 1: CELLULAR ADAPTATION & INJURY
1. A 55-year-old smoker develops squamous metaplasia in the bronchial
epithelium. What is the most accurate description of this process?
• A) Replacement of normal columnar epithelium with stratified squamous
epithelium
• B) Increased number of goblet cells in the airways
• C) Decreased size of bronchial epithelial cells
• D) Malignant transformation of bronchial cells
Answer: A) Replacement of normal columnar epithelium with stratified
squamous epithelium
Rationale: Metaplasia is a reversible change in which one differentiated cell type is
replaced by another cell type. In the respiratory tract of smokers, chronic irritation
causes the normal pseudostratified ciliated columnar epithelium to be replaced by
stratified squamous epithelium, which is more resistant to irritation but loses its
protective ciliary function.
2. A patient with chronic hypertension exhibits an enlarged heart on an
echocardiogram. This cellular change is best described as:
• A) Atrophy
• B) Hypertrophy
, • C) Hyperplasia
• D) Metaplasia
Answer: B) Hypertrophy
Rationale: Hypertrophy is an increase in the size of individual cells in response to
increased workload or stress. In hypertension, the heart muscle must pump
against higher resistance, causing the myocardial cells to enlarge. The heart
muscle does not increase in cell number (hyperplasia) in adults, but rather
increases in cell size.
3. Which cellular adaptation is characterized by a decrease in cell size and
function?
• A) Hypertrophy
• B) Hyperplasia
• C) Atrophy
• D) Metaplasia
Answer: C) Atrophy
Rationale: Atrophy is a decrease in cell size and function that can result from
disuse, denervation, ischemia, malnutrition, or aging. It represents a reduction in
cellular content and metabolic activity. Atrophic cells may contain increased
numbers of autophagic vacuoles and lipofuscin granules.
4. A pathology report describes organized, energy-dependent cell death that
does not trigger an inflammatory response. This is characteristic of:
• A) Necrosis
• B) Apoptosis
• C) Gangrene
, • D) Caseous necrosis
Answer: B) Apoptosis
Rationale: Apoptosis is programmed, orderly cell death. It involves cell shrinkage,
chromatin condensation, and DNA fragmentation via caspase enzymes, and it
does not trigger an inflammatory response. Necrosis is disorderly, causes cell
swelling and rupture, and triggers inflammation.
5. Once the point of irreversible cell injury is reached, which of the following
occurs?
• A) The cell can recover with appropriate intervention
• B) Cell death is inevitable regardless of intervention
• C) The cell will undergo hypertrophy
• D) The cell will undergo hyperplasia
Answer: B) Cell death is inevitable regardless of intervention
Rationale: Once the point of irreversible cell injury is reached, cell death is
inevitable regardless of intervention. This is a critical concept in understanding the
window of opportunity for interventions such as thrombolysis in myocardial
infarction.
6. A biopsy reveals proliferating cells that are well-differentiated, resemble
surrounding cells, and are contained within a well-defined area. This is most
consistent with:
• A) Malignant neoplasia
• B) Benign neoplasia
• C) Metastatic cancer
• D) Dysplasia
, Answer: B) Benign neoplasia
Rationale: Benign neoplasms are well-differentiated, grow slowly by expansion,
are encapsulated, and do not metastasize. Malignant neoplasms are poorly
differentiated, grow rapidly, invade surrounding tissues, and metastasize to distant
sites.
7. Ischemia deprives the cell of oxygen, halting oxidative phosphorylation and
ATP production. Without ATP, which of the following events occurs first?
• A) Activation of caspases and apoptosis
• B) Failure of the Na⁺/K⁺ pump, causing cellular swelling
• C) Release of inflammatory mediators
• D) DNA fragmentation
Answer: B) Failure of the Na⁺/K⁺ pump, causing cellular swelling
Rationale: Ischemia deprives the cell of oxygen, halting oxidative phosphorylation
and ATP production. Without ATP, the Na⁺/K⁺ pump fails, sodium and water rush
into the cell causing swelling, and calcium influx activates destructive enzymes,
leading to necrosis.
8. Cells that are atypical in size and shape but are not necessarily cancerous are
described as:
• A) Dysplastic
• B) Metaplastic
• C) Anaplastic
• D) Hyperplastic
Answer: A) Dysplastic
