Applied Pathophysiology for the Advanced Practice Nurse
Original Practice Question Bank — Chapters 1–14
160 Multiple-Choice Questions with Expert Rationales
Q1. A cell exposed to chronic mechanical stress (e.g., pressure) undergoes an
increase in the number of cells rather than cell size. Which cellular
adaptation does this describe?
A. Hypertrophy
B. Hyperplasia
C. Atrophy
D. Metaplasia
Correct Answer: B
Rationale: Hyperplasia is an increase in the number of cells within a tissue
in response to a stimulus, distinct from hypertrophy, which is an increase
in individual cell size. Hyperplasia occurs only in tissues capable of mitotic
division.
,Q2. The columnar epithelium of a chronic smoker's bronchi is replaced by
stratified squamous epithelium. This reversible cellular change is best
classified as:
A. Dysplasia
B. Metaplasia
C. Anaplasia
D. Neoplasia
Correct Answer: B
Rationale: Metaplasia is the reversible replacement of one differentiated
cell type with another, typically a more resilient type, in response to
chronic irritation. It differs from dysplasia, which involves disordered cell
growth and atypia.
Q3. Which mechanism of cellular injury is primarily responsible for tissue
damage during reperfusion after a period of ischemia?
A. ATP depletion alone
B. Free radical generation
C. Loss of calcium influx
D. Decreased membrane permeability
Correct Answer: B
Rationale: Reperfusion injury occurs when oxygen is reintroduced to
previously ischemic tissue, generating a burst of reactive oxygen species
that damage lipids, proteins, and DNA beyond the injury caused by
ischemia alone.
Q4. A cell undergoing irreversible injury shows nuclear condensation and
fragmentation (karyorrhexis). This nuclear change is characteristic of which
process?
A. Apoptosis or necrosis
B. Hypertrophy
C. Metaplasia
D. Compensatory hyperplasia
, Correct Answer: A
Rationale: Karyorrhexis, along with pyknosis and karyolysis, represents
nuclear changes seen in cell death, occurring in both necrosis and the
later stages of apoptosis as chromatin condenses and fragments.
Q5. Liquefactive necrosis is most characteristically seen in which type of
tissue injury?
A. Myocardial infarction
B. Cerebral infarction
C. Tuberculosis granuloma
D. Pancreatic fat necrosis
Correct Answer: B
Rationale: Liquefactive necrosis occurs when hydrolytic enzymes digest
dead tissue, most commonly in the brain due to its high lipid content and
lack of substantial supportive stroma, converting tissue into a liquid
viscous mass.
Q6. Which form of cell death is characterized as an active, ATP-dependent,
genetically programmed process that does not typically incite an
inflammatory response?
A. Necrosis
B. Apoptosis
C. Gangrene
D. Caseous necrosis
Correct Answer: B
Rationale: Apoptosis is a controlled, energy-requiring process of
programmed cell death in which the cell membrane remains intact and
cellular contents are packaged into apoptotic bodies, avoiding the
inflammatory response typical of necrosis.
Q7. A patient's skeletal muscle decreases in size after prolonged
immobilization following a fracture. This cellular adaptation is termed:
A. Disuse atrophy
, B. Pathologic hypertrophy
C. Dysplasia
D. Aplasia
Correct Answer: A
Rationale: Disuse atrophy is a decrease in cell size resulting from reduced
workload or use, as occurs with prolonged immobilization; protein
synthesis decreases and protein degradation increases, shrinking the cell.
Q8. Free radical–mediated cellular injury primarily damages cell membranes
through which process?
A. Lipid peroxidation
B. Glycogenolysis
C. Oxidative phosphorylation uncoupling only
D. DNA methylation
Correct Answer: A
Rationale: Free radicals attack the double bonds of polyunsaturated fatty
acids in the plasma membrane, causing lipid peroxidation, which disrupts
membrane integrity and propagates further free radical formation.
Q9. Which of the following best explains why cellular hypoxia leads to an
early rise in intracellular sodium and water?
A. Increased mitochondrial ATP production
B. Failure of the sodium-potassium ATPase pump
C. Enhanced calcium efflux
D. Increased protein synthesis
Correct Answer: B
Rationale: Hypoxia impairs oxidative phosphorylation, reducing ATP
available to the sodium-potassium ATPase pump. Sodium accumulates
intracellularly, drawing water in by osmosis and producing cellular
(hydropic) swelling.
Q10. Dystrophic calcification differs from metastatic calcification in that
dystrophic calcification occurs:
Original Practice Question Bank — Chapters 1–14
160 Multiple-Choice Questions with Expert Rationales
Q1. A cell exposed to chronic mechanical stress (e.g., pressure) undergoes an
increase in the number of cells rather than cell size. Which cellular
adaptation does this describe?
A. Hypertrophy
B. Hyperplasia
C. Atrophy
D. Metaplasia
Correct Answer: B
Rationale: Hyperplasia is an increase in the number of cells within a tissue
in response to a stimulus, distinct from hypertrophy, which is an increase
in individual cell size. Hyperplasia occurs only in tissues capable of mitotic
division.
,Q2. The columnar epithelium of a chronic smoker's bronchi is replaced by
stratified squamous epithelium. This reversible cellular change is best
classified as:
A. Dysplasia
B. Metaplasia
C. Anaplasia
D. Neoplasia
Correct Answer: B
Rationale: Metaplasia is the reversible replacement of one differentiated
cell type with another, typically a more resilient type, in response to
chronic irritation. It differs from dysplasia, which involves disordered cell
growth and atypia.
Q3. Which mechanism of cellular injury is primarily responsible for tissue
damage during reperfusion after a period of ischemia?
A. ATP depletion alone
B. Free radical generation
C. Loss of calcium influx
D. Decreased membrane permeability
Correct Answer: B
Rationale: Reperfusion injury occurs when oxygen is reintroduced to
previously ischemic tissue, generating a burst of reactive oxygen species
that damage lipids, proteins, and DNA beyond the injury caused by
ischemia alone.
Q4. A cell undergoing irreversible injury shows nuclear condensation and
fragmentation (karyorrhexis). This nuclear change is characteristic of which
process?
A. Apoptosis or necrosis
B. Hypertrophy
C. Metaplasia
D. Compensatory hyperplasia
, Correct Answer: A
Rationale: Karyorrhexis, along with pyknosis and karyolysis, represents
nuclear changes seen in cell death, occurring in both necrosis and the
later stages of apoptosis as chromatin condenses and fragments.
Q5. Liquefactive necrosis is most characteristically seen in which type of
tissue injury?
A. Myocardial infarction
B. Cerebral infarction
C. Tuberculosis granuloma
D. Pancreatic fat necrosis
Correct Answer: B
Rationale: Liquefactive necrosis occurs when hydrolytic enzymes digest
dead tissue, most commonly in the brain due to its high lipid content and
lack of substantial supportive stroma, converting tissue into a liquid
viscous mass.
Q6. Which form of cell death is characterized as an active, ATP-dependent,
genetically programmed process that does not typically incite an
inflammatory response?
A. Necrosis
B. Apoptosis
C. Gangrene
D. Caseous necrosis
Correct Answer: B
Rationale: Apoptosis is a controlled, energy-requiring process of
programmed cell death in which the cell membrane remains intact and
cellular contents are packaged into apoptotic bodies, avoiding the
inflammatory response typical of necrosis.
Q7. A patient's skeletal muscle decreases in size after prolonged
immobilization following a fracture. This cellular adaptation is termed:
A. Disuse atrophy
, B. Pathologic hypertrophy
C. Dysplasia
D. Aplasia
Correct Answer: A
Rationale: Disuse atrophy is a decrease in cell size resulting from reduced
workload or use, as occurs with prolonged immobilization; protein
synthesis decreases and protein degradation increases, shrinking the cell.
Q8. Free radical–mediated cellular injury primarily damages cell membranes
through which process?
A. Lipid peroxidation
B. Glycogenolysis
C. Oxidative phosphorylation uncoupling only
D. DNA methylation
Correct Answer: A
Rationale: Free radicals attack the double bonds of polyunsaturated fatty
acids in the plasma membrane, causing lipid peroxidation, which disrupts
membrane integrity and propagates further free radical formation.
Q9. Which of the following best explains why cellular hypoxia leads to an
early rise in intracellular sodium and water?
A. Increased mitochondrial ATP production
B. Failure of the sodium-potassium ATPase pump
C. Enhanced calcium efflux
D. Increased protein synthesis
Correct Answer: B
Rationale: Hypoxia impairs oxidative phosphorylation, reducing ATP
available to the sodium-potassium ATPase pump. Sodium accumulates
intracellularly, drawing water in by osmosis and producing cellular
(hydropic) swelling.
Q10. Dystrophic calcification differs from metastatic calcification in that
dystrophic calcification occurs:
