NURS 5315 Exam 1: Comprehensive Pathophysiology
Review with Questions & Answers (2025/2026)
SECTION 1: CELLULAR ADAPTATION, INJURY & DEATH
Question 1:
Which cellular adaptation is most likely to occur in the myocardium of a patient with
long-standing, uncontrolled hypertension?
A. Hyperplasia of cardiac myocytes
B. Hypertrophy of cardiac myocytes
C. Metaplasia of cardiac muscle tissue
D. Dysplasia of the endocardium
Correct Answer: B. Hypertrophy of cardiac myocytes
Rationale: In response to the chronic increased workload (afterload) caused by
hypertension, the myocardium adapts through hypertrophy, an increase in the size of
individual cardiac muscle cells. Hyperplasia (A), an increase in cell number, is not a typical
,response in cardiac muscle as myocytes have limited mitotic capacity. Metaplasia (C), the
replacement of one cell type with another, does not occur in cardiac muscle.
Question 2:
A patient with chronic bronchitis due to smoking is most likely to exhibit which type of
epithelial adaptation in the airways?
A. Hyperplasia of goblet cells
B. Hypertrophy of ciliated cells
C. Squamous metaplasia of the respiratory epithelium
D. Dysplasia of the bronchial lining
Correct Answer: C. Squamous metaplasia of the respiratory epithelium
Rationale: Chronic irritation from smoking causes the normal, ciliated, pseudostratified
columnar epithelium of the airways to undergo squamous metaplasia, a reversible change
where one mature cell type is replaced by another better suited to handle the stress. This
adaptation results in the loss of cilia and a compromised mucus-clearing mechanism,
which is a hallmark of chronic bronchitis.
Question 3:
Which pathophysiologic mechanism best explains the development of cell swelling
during early reversible ischemic injury?
,A. Increased production of adenosine triphosphate (ATP)
B. Failure of the sodium-potassium ATPase pump due to ATP depletion
C. Increased permeability of the cell membrane to potassium
D. Activation of the renin-angiotensin-aldosterone system
Correct Answer: B. Failure of the sodium-potassium ATPase pump due to ATP
depletion
Rationale: Ischemia results in a lack of oxygen and glucose, leading to a decrease in ATP
production. The sodium-potassium ATPase pump, which maintains the electrochemical
gradient, is an energy-dependent process. Without sufficient ATP, the pump fails, causing
sodium to accumulate intracellularly. Water follows sodium, leading to the cellular
swelling characteristic of reversible injury.
Question 4:
A patient with tuberculosis is most likely to exhibit which type of necrosis in affected
lung tissue?
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis
Correct Answer: C. Caseous necrosis
Rationale: Tuberculosis is a classic example of a granulomatous infection. The necrotic
tissue within the granuloma undergoes caseous necrosis, which has a distinctive "cheese-
like" appearance. This is in contrast to coagulative necrosis (A), seen in myocardial
, infarction; liquefactive necrosis (B), seen in brain ischemia; and fat necrosis (D), seen in
acute pancreatitis.
Question 5:
Which type of cell death is characterized by cell shrinkage, chromatin condensation, and
the formation of apoptotic bodies?
A. Necrosis
B. Apoptosis
C. Autophagy
D. Pyroptosis
Correct Answer: B. Apoptosis
Rationale: Apoptosis, or programmed cell death, is a controlled, energy-dependent process.
Morphologically, it is characterized by cell shrinkage, chromatin condensation, nuclear
fragmentation, and the formation of membrane-bound apoptotic bodies that are
phagocytosed without eliciting an inflammatory response. This is a key protective
mechanism against aberrant cell growth.
Question 6:
Which adaptation is potentially reversible when the chronic irritation that caused it is
removed?
Review with Questions & Answers (2025/2026)
SECTION 1: CELLULAR ADAPTATION, INJURY & DEATH
Question 1:
Which cellular adaptation is most likely to occur in the myocardium of a patient with
long-standing, uncontrolled hypertension?
A. Hyperplasia of cardiac myocytes
B. Hypertrophy of cardiac myocytes
C. Metaplasia of cardiac muscle tissue
D. Dysplasia of the endocardium
Correct Answer: B. Hypertrophy of cardiac myocytes
Rationale: In response to the chronic increased workload (afterload) caused by
hypertension, the myocardium adapts through hypertrophy, an increase in the size of
individual cardiac muscle cells. Hyperplasia (A), an increase in cell number, is not a typical
,response in cardiac muscle as myocytes have limited mitotic capacity. Metaplasia (C), the
replacement of one cell type with another, does not occur in cardiac muscle.
Question 2:
A patient with chronic bronchitis due to smoking is most likely to exhibit which type of
epithelial adaptation in the airways?
A. Hyperplasia of goblet cells
B. Hypertrophy of ciliated cells
C. Squamous metaplasia of the respiratory epithelium
D. Dysplasia of the bronchial lining
Correct Answer: C. Squamous metaplasia of the respiratory epithelium
Rationale: Chronic irritation from smoking causes the normal, ciliated, pseudostratified
columnar epithelium of the airways to undergo squamous metaplasia, a reversible change
where one mature cell type is replaced by another better suited to handle the stress. This
adaptation results in the loss of cilia and a compromised mucus-clearing mechanism,
which is a hallmark of chronic bronchitis.
Question 3:
Which pathophysiologic mechanism best explains the development of cell swelling
during early reversible ischemic injury?
,A. Increased production of adenosine triphosphate (ATP)
B. Failure of the sodium-potassium ATPase pump due to ATP depletion
C. Increased permeability of the cell membrane to potassium
D. Activation of the renin-angiotensin-aldosterone system
Correct Answer: B. Failure of the sodium-potassium ATPase pump due to ATP
depletion
Rationale: Ischemia results in a lack of oxygen and glucose, leading to a decrease in ATP
production. The sodium-potassium ATPase pump, which maintains the electrochemical
gradient, is an energy-dependent process. Without sufficient ATP, the pump fails, causing
sodium to accumulate intracellularly. Water follows sodium, leading to the cellular
swelling characteristic of reversible injury.
Question 4:
A patient with tuberculosis is most likely to exhibit which type of necrosis in affected
lung tissue?
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis
Correct Answer: C. Caseous necrosis
Rationale: Tuberculosis is a classic example of a granulomatous infection. The necrotic
tissue within the granuloma undergoes caseous necrosis, which has a distinctive "cheese-
like" appearance. This is in contrast to coagulative necrosis (A), seen in myocardial
, infarction; liquefactive necrosis (B), seen in brain ischemia; and fat necrosis (D), seen in
acute pancreatitis.
Question 5:
Which type of cell death is characterized by cell shrinkage, chromatin condensation, and
the formation of apoptotic bodies?
A. Necrosis
B. Apoptosis
C. Autophagy
D. Pyroptosis
Correct Answer: B. Apoptosis
Rationale: Apoptosis, or programmed cell death, is a controlled, energy-dependent process.
Morphologically, it is characterized by cell shrinkage, chromatin condensation, nuclear
fragmentation, and the formation of membrane-bound apoptotic bodies that are
phagocytosed without eliciting an inflammatory response. This is a key protective
mechanism against aberrant cell growth.
Question 6:
Which adaptation is potentially reversible when the chronic irritation that caused it is
removed?
