APUS NURS315 Final Exam (pdf) | 2026/2027 | Pathophysiology &
Clinical Pharmacology Q&A | Pathophysiology
1. The cellular adaptation characterized by a decrease in cell size and a
reduction in the number of organelles is known as:
A) Hyperplasia
B) Hypertrophy
C) Metaplasia
D) Atrophy
Correct Answer: Atrophy
Rationale: Atrophy is a decrease in cell size and function due to reduced
protein synthesis and increased protein degradation, often from disuse,
denervation, or ischemia. It is a common adaptive response meant to reduce
cellular oxygen demand.
2. A patient with chronic heart failure develops an enlarged heart muscle.
Which cellular adaptation is most likely responsible for this change?
A) Hyperplasia
B) Hypertrophy
C) Atrophy
D) Dysplasia
Correct Answer: Hypertrophy
Rationale: Hypertrophy is an increase in cell size, often in response to
increased workload or hormonal stimulation, leading to organ enlargement.
In heart failure, the cardiac muscle cells enlarge to compensate for the
increased workload.
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 nurse practitioner observes a patient's cervical biopsy report showing
"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 and
requires further evaluation and monitoring.
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 that can
lead to cell death.
6. Reperfusion injury is characterized by an influx of which ion, leading to
mitochondrial damage and activation of destructive enzymes?
A) Sodium
B) Potassium
C) Calcium
D) Chloride
Correct Answer: Calcium
Rationale: During reperfusion, the sudden reintroduction of oxygen leads to
the generation of reactive oxygen species and a massive influx of calcium
into the cell. This calcium overload damages mitochondria and activates
proteases and endonucleases, contributing to cell death.
7. 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.
8. 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.
9. A patient with a brain injury develops liquefactive necrosis. Why does the
brain undergo this type of necrosis?
A) Because it has high lipid content and is rich in enzymes
B) Because it has a poor blood supply
C) Because it is prone to bacterial infection
D) Because it has a high concentration of collagen
Correct Answer: Because it has high lipid content and is rich in enzymes
Rationale: Liquefactive necrosis occurs in the brain because neural tissue has
high lipid content and is rich in hydrolytic enzymes. This leads to the
breakdown of dead cells into a liquid viscous mass.
10. 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.
Clinical Pharmacology Q&A | Pathophysiology
1. The cellular adaptation characterized by a decrease in cell size and a
reduction in the number of organelles is known as:
A) Hyperplasia
B) Hypertrophy
C) Metaplasia
D) Atrophy
Correct Answer: Atrophy
Rationale: Atrophy is a decrease in cell size and function due to reduced
protein synthesis and increased protein degradation, often from disuse,
denervation, or ischemia. It is a common adaptive response meant to reduce
cellular oxygen demand.
2. A patient with chronic heart failure develops an enlarged heart muscle.
Which cellular adaptation is most likely responsible for this change?
A) Hyperplasia
B) Hypertrophy
C) Atrophy
D) Dysplasia
Correct Answer: Hypertrophy
Rationale: Hypertrophy is an increase in cell size, often in response to
increased workload or hormonal stimulation, leading to organ enlargement.
In heart failure, the cardiac muscle cells enlarge to compensate for the
increased workload.
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 nurse practitioner observes a patient's cervical biopsy report showing
"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 and
requires further evaluation and monitoring.
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 that can
lead to cell death.
6. Reperfusion injury is characterized by an influx of which ion, leading to
mitochondrial damage and activation of destructive enzymes?
A) Sodium
B) Potassium
C) Calcium
D) Chloride
Correct Answer: Calcium
Rationale: During reperfusion, the sudden reintroduction of oxygen leads to
the generation of reactive oxygen species and a massive influx of calcium
into the cell. This calcium overload damages mitochondria and activates
proteases and endonucleases, contributing to cell death.
7. 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.
8. 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.
9. A patient with a brain injury develops liquefactive necrosis. Why does the
brain undergo this type of necrosis?
A) Because it has high lipid content and is rich in enzymes
B) Because it has a poor blood supply
C) Because it is prone to bacterial infection
D) Because it has a high concentration of collagen
Correct Answer: Because it has high lipid content and is rich in enzymes
Rationale: Liquefactive necrosis occurs in the brain because neural tissue has
high lipid content and is rich in hydrolytic enzymes. This leads to the
breakdown of dead cells into a liquid viscous mass.
10. 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.
