APUS NURS315 Midterm Exam (pdf) | 2026/2027 | Pathophysiology
& Clinical Pharmacology Q&A | Pathophysiology
1. Which of the following best describes the process of atrophy?
A) An increase in the size of individual cells
B) A decrease in the size of a cell or organ
C) The replacement of one mature cell type by another
D) An abnormal change in the size, shape, and organization of cells
Correct Answer: A decrease in the size of a cell or organ
Rationale: Atrophy is the decrease in the size of a cell or organ, often due to
a reduced workload, loss of innervation, or inadequate nutrition. This
adaptive change can be physiologic or pathologic.
2. A patient with a history of chronic heart failure develops an enlarged
heart. This cellular adaptation is best described as:
A) Hyperplasia
B) Hypertrophy
C) Metaplasia
D) Dysplasia
Correct Answer: Hypertrophy
Rationale: Hypertrophy is an increase in the size of cells, resulting in an
enlarged organ. It occurs in response to increased workload or hormonal
stimulation, such as the cardiac muscle enlargement seen in heart failure.
3. The replacement of normal columnar epithelial cells in the esophagus with
squamous epithelial cells due to chronic acid reflux is an example of:
A) Dysplasia
B) Hyperplasia
C) Metaplasia
D) Anaplasia
,Correct Answer: Metaplasia
Rationale: Metaplasia is the reversible replacement of one differentiated cell
type with another, often in response to chronic irritation. Barrett esophagus,
where squamous epithelium replaces columnar epithelium, is a classic
example.
4. A biopsy report indicates "moderate to severe dysplasia." What is the
most significant clinical implication of this finding?
A) It is a benign, reversible cellular change.
B) It is a premalignant condition that requires close monitoring.
C) It is a sign of acute inflammation.
D) It is a normal finding in a postmenopausal woman.
Correct Answer: It is a premalignant condition that requires close monitoring.
Rationale: Dysplasia is an abnormal change in cell size, shape, and
organization and is considered a premalignant condition. Moderate to severe
dysplasia indicates a higher risk of progression to carcinoma in situ.
5. What is the primary mechanism of cellular injury in ischemia?
A) Direct damage by free radicals
B) Depletion of adenosine triphosphate (ATP)
C) Disruption of the cell membrane by toxins
D) Uncontrolled influx of calcium
Correct Answer: Depletion of adenosine triphosphate (ATP)
Rationale: Ischemia reduces oxygen and glucose delivery, leading to
decreased ATP production. ATP depletion impairs sodium-potassium pump
function, causing cellular swelling and initiating a cascade of injury.
6. A hallmark of irreversible cell injury is:
A) Cellular swelling
,B) Loss of microvilli
C) Nuclear pyknosis
D) Fatty change
Correct Answer: Nuclear pyknosis
Rationale: Nuclear pyknosis (nuclear shrinkage and condensation) is an
irreversible change indicating cell death. Cellular swelling, loss of microvilli,
and fatty change are reversible injuries.
7. A patient with a myocardial infarction shows coagulative necrosis on
histology. What is the defining characteristic of coagulative necrosis?
A) Liquefaction of tissue with pus formation
B) Preservation of the cell outline for several days
C) Formation of granulomas
D) Fatty acid accumulation in the cytoplasm
Correct Answer: Preservation of the cell outline for several days
Rationale: Coagulative necrosis is the most common type of necrosis,
typically seen in ischemic injury (e.g., MI). It is characterized by the
preservation of the basic cell and tissue architecture for several days after
cell death.
8. Which type of necrosis is associated with chronic inflammation and is
characterized by a collection of macrophages and fibroblasts forming a
nodular structure?
A) Coagulative necrosis
B) Liquefactive necrosis
C) Caseous necrosis
D) Granulomatous necrosis
Correct Answer: Granulomatous necrosis
, Rationale: Granulomatous necrosis is a form of necrosis associated with
chronic inflammation, where macrophages and fibroblasts aggregate to form
a granuloma. This is seen in conditions like tuberculosis and sarcoidosis.
9. Free radicals cause cellular injury primarily by:
A) Stabilizing cell membranes
B) Stealing electrons from other molecules
C) Promoting DNA repair
D) Enhancing ATP production
Correct Answer: Stealing electrons from other molecules
Rationale: Free radicals are highly reactive molecules with an unpaired
electron. They cause cellular injury by stealing electrons from other
molecules, initiating a chain reaction of oxidative damage to lipids, proteins,
and DNA.
10. The body's primary endogenous defense against reactive oxygen species
(ROS) is:
A) Vitamin C
B) Vitamin E
C) Superoxide dismutase
D) Iron
Correct Answer: Superoxide dismutase
Rationale: Superoxide dismutase (SOD) is an endogenous antioxidant
enzyme that catalyzes the conversion of superoxide radicals to hydrogen
peroxide, protecting cells from oxidative damage.
11. A patient with chronic kidney disease has a serum potassium level of 6.5
mEq/L. Which ECG change would the nurse practitioner expect?
A) Flattened T waves
B) Prominent U waves
& Clinical Pharmacology Q&A | Pathophysiology
1. Which of the following best describes the process of atrophy?
A) An increase in the size of individual cells
B) A decrease in the size of a cell or organ
C) The replacement of one mature cell type by another
D) An abnormal change in the size, shape, and organization of cells
Correct Answer: A decrease in the size of a cell or organ
Rationale: Atrophy is the decrease in the size of a cell or organ, often due to
a reduced workload, loss of innervation, or inadequate nutrition. This
adaptive change can be physiologic or pathologic.
2. A patient with a history of chronic heart failure develops an enlarged
heart. This cellular adaptation is best described as:
A) Hyperplasia
B) Hypertrophy
C) Metaplasia
D) Dysplasia
Correct Answer: Hypertrophy
Rationale: Hypertrophy is an increase in the size of cells, resulting in an
enlarged organ. It occurs in response to increased workload or hormonal
stimulation, such as the cardiac muscle enlargement seen in heart failure.
3. The replacement of normal columnar epithelial cells in the esophagus with
squamous epithelial cells due to chronic acid reflux is an example of:
A) Dysplasia
B) Hyperplasia
C) Metaplasia
D) Anaplasia
,Correct Answer: Metaplasia
Rationale: Metaplasia is the reversible replacement of one differentiated cell
type with another, often in response to chronic irritation. Barrett esophagus,
where squamous epithelium replaces columnar epithelium, is a classic
example.
4. A biopsy report indicates "moderate to severe dysplasia." What is the
most significant clinical implication of this finding?
A) It is a benign, reversible cellular change.
B) It is a premalignant condition that requires close monitoring.
C) It is a sign of acute inflammation.
D) It is a normal finding in a postmenopausal woman.
Correct Answer: It is a premalignant condition that requires close monitoring.
Rationale: Dysplasia is an abnormal change in cell size, shape, and
organization and is considered a premalignant condition. Moderate to severe
dysplasia indicates a higher risk of progression to carcinoma in situ.
5. What is the primary mechanism of cellular injury in ischemia?
A) Direct damage by free radicals
B) Depletion of adenosine triphosphate (ATP)
C) Disruption of the cell membrane by toxins
D) Uncontrolled influx of calcium
Correct Answer: Depletion of adenosine triphosphate (ATP)
Rationale: Ischemia reduces oxygen and glucose delivery, leading to
decreased ATP production. ATP depletion impairs sodium-potassium pump
function, causing cellular swelling and initiating a cascade of injury.
6. A hallmark of irreversible cell injury is:
A) Cellular swelling
,B) Loss of microvilli
C) Nuclear pyknosis
D) Fatty change
Correct Answer: Nuclear pyknosis
Rationale: Nuclear pyknosis (nuclear shrinkage and condensation) is an
irreversible change indicating cell death. Cellular swelling, loss of microvilli,
and fatty change are reversible injuries.
7. A patient with a myocardial infarction shows coagulative necrosis on
histology. What is the defining characteristic of coagulative necrosis?
A) Liquefaction of tissue with pus formation
B) Preservation of the cell outline for several days
C) Formation of granulomas
D) Fatty acid accumulation in the cytoplasm
Correct Answer: Preservation of the cell outline for several days
Rationale: Coagulative necrosis is the most common type of necrosis,
typically seen in ischemic injury (e.g., MI). It is characterized by the
preservation of the basic cell and tissue architecture for several days after
cell death.
8. Which type of necrosis is associated with chronic inflammation and is
characterized by a collection of macrophages and fibroblasts forming a
nodular structure?
A) Coagulative necrosis
B) Liquefactive necrosis
C) Caseous necrosis
D) Granulomatous necrosis
Correct Answer: Granulomatous necrosis
, Rationale: Granulomatous necrosis is a form of necrosis associated with
chronic inflammation, where macrophages and fibroblasts aggregate to form
a granuloma. This is seen in conditions like tuberculosis and sarcoidosis.
9. Free radicals cause cellular injury primarily by:
A) Stabilizing cell membranes
B) Stealing electrons from other molecules
C) Promoting DNA repair
D) Enhancing ATP production
Correct Answer: Stealing electrons from other molecules
Rationale: Free radicals are highly reactive molecules with an unpaired
electron. They cause cellular injury by stealing electrons from other
molecules, initiating a chain reaction of oxidative damage to lipids, proteins,
and DNA.
10. The body's primary endogenous defense against reactive oxygen species
(ROS) is:
A) Vitamin C
B) Vitamin E
C) Superoxide dismutase
D) Iron
Correct Answer: Superoxide dismutase
Rationale: Superoxide dismutase (SOD) is an endogenous antioxidant
enzyme that catalyzes the conversion of superoxide radicals to hydrogen
peroxide, protecting cells from oxidative damage.
11. A patient with chronic kidney disease has a serum potassium level of 6.5
mEq/L. Which ECG change would the nurse practitioner expect?
A) Flattened T waves
B) Prominent U waves
