NSG5140 Week 5 Midterm Exam Advanced
Pathophysiology – Complete Actual Exam Questions &
Answers with Detailed Rationales | 2026 Edition
COURSE OVERVIEW
NSG 5140 Advanced Pathophysiology is a graduate-level course for advanced
practice nursing students that focuses on exploring pathophysiologic conditions
occurring in individuals and populations across the lifespan. The course provides
a foundation for advanced practice nurses through development of knowledge and
application of advanced physiology and pathophysiologic cellular changes as well
as manifestations at the systems level. Implications of pathophysiologic processes
on clinical presentation and treatment are also explored. This midterm exam
assesses understanding of cellular adaptation, injury, inflammation, fluid balance,
genetic disorders, and systemic pathophysiology .
,SECTION 1: CELLULAR ADAPTATION & INJURY (Questions 1-12)
Question 1
A patient with chronic hypertension develops left ventricular wall thickening.
Which cellular adaptation BEST describes this response?
A. Hyperplasia of cardiac muscle cells
B. Hypertrophy of cardiac muscle cells
C. Metaplasia of cardiac tissue
D. Dysplasia of the myocardium
Correct answer: B
RATIONALE: Cardiac muscle cells are terminally differentiated and cannot
undergo hyperplasia (increase in cell number). In response to increased workload
from chronic hypertension, myocardial cells adapt through hypertrophy, which is
an increase in cell size. Metaplasia is the replacement of one differentiated cell
type with another, and dysplasia refers to abnormal cellular growth, neither of
which are adaptive responses in the heart .
Question 2
Which cellular organelle is primarily responsible for ATP production through
oxidative phosphorylation?
A. Ribosome
B. Golgi apparatus
C. Mitochondria
D. Endoplasmic reticulum
Correct answer: C
RATIONALE: Mitochondria are the primary site of ATP production through
oxidative phosphorylation. They contain the electron transport chain and ATP
synthase, which generate ATP from ADP and inorganic phosphate. Ribosomes are
,responsible for protein synthesis, the Golgi apparatus modifies and packages
proteins, and the endoplasmic reticulum is involved in protein synthesis and lipid
metabolism .
Question 3
Which of the following is the primary mechanism of cellular injury in hypoxic
conditions?
A. DNA mutation
B. ATP depletion leading to loss of ion homeostasis
C. Free radical formation
D. Protein misfolding
Correct answer: B
RATIONALE: Hypoxia limits oxidative phosphorylation, leading to decreased
ATP production. The Na⁺/K⁺ ATPase pump requires ATP to maintain ion
gradients; failure of this pump causes intracellular sodium accumulation, water
influx, and cellular swelling. This is the hallmark of hypoxic cellular injury .
Question 4
What is the hallmark of reversible cellular injury?
A. Nuclear pyknosis
B. Failure of ion pumps leading to cell swelling
C. Membrane rupture
D. Lysosomal enzyme release
Correct answer: B
RATIONALE: Reversible injury involves cellular swelling due to ion pump
failure. If the insult is removed, the cell can recover. Irreversible injury involves
membrane damage and nuclear changes such as pyknosis (nuclear shrinkage).
Membrane rupture and lysosomal enzyme release indicate irreversible
injury/necrosis .
, Question 5
Which statement best describes a characteristic of apoptosis?
A. Apoptosis involves programmed cell death of scattered single cells
B. Apoptosis is characterized by swelling of the nucleus and cytoplasm
C. Apoptosis involves unpredictable patterns of cell death
D. Apoptosis results in significant inflammation
Correct answer: A
RATIONALE: Apoptosis is a highly regulated, energy-dependent process of
programmed cell death affecting scattered individual cells. It is characterized by
cell shrinkage, chromatin condensation, and formation of apoptotic bodies without
triggering inflammation. Necrosis involves cell swelling and inflammation .
Question 6
A 65-year-old patient with a 40-pack-year smoking history develops a persistent
cough and hemoptysis. A biopsy reveals squamous cell carcinoma of the lung.
Which cellular change in the bronchial epithelium MOST likely preceded this
malignancy?
A. Hypertrophy
B. Squamous metaplasia
C. Hyperplasia
D. Atrophy
Correct answer: B
RATIONALE: Chronic irritation from cigarette smoke causes squamous
metaplasia of the normal pseudostratified ciliated columnar epithelium of the
bronchi. This metaplastic change is a protective adaptation but increases the risk of
malignant transformation. Squamous metaplasia is considered a precursor lesion
that can progress to dysplasia and eventually squamous cell carcinoma .
Question 7
Pathophysiology – Complete Actual Exam Questions &
Answers with Detailed Rationales | 2026 Edition
COURSE OVERVIEW
NSG 5140 Advanced Pathophysiology is a graduate-level course for advanced
practice nursing students that focuses on exploring pathophysiologic conditions
occurring in individuals and populations across the lifespan. The course provides
a foundation for advanced practice nurses through development of knowledge and
application of advanced physiology and pathophysiologic cellular changes as well
as manifestations at the systems level. Implications of pathophysiologic processes
on clinical presentation and treatment are also explored. This midterm exam
assesses understanding of cellular adaptation, injury, inflammation, fluid balance,
genetic disorders, and systemic pathophysiology .
,SECTION 1: CELLULAR ADAPTATION & INJURY (Questions 1-12)
Question 1
A patient with chronic hypertension develops left ventricular wall thickening.
Which cellular adaptation BEST describes this response?
A. Hyperplasia of cardiac muscle cells
B. Hypertrophy of cardiac muscle cells
C. Metaplasia of cardiac tissue
D. Dysplasia of the myocardium
Correct answer: B
RATIONALE: Cardiac muscle cells are terminally differentiated and cannot
undergo hyperplasia (increase in cell number). In response to increased workload
from chronic hypertension, myocardial cells adapt through hypertrophy, which is
an increase in cell size. Metaplasia is the replacement of one differentiated cell
type with another, and dysplasia refers to abnormal cellular growth, neither of
which are adaptive responses in the heart .
Question 2
Which cellular organelle is primarily responsible for ATP production through
oxidative phosphorylation?
A. Ribosome
B. Golgi apparatus
C. Mitochondria
D. Endoplasmic reticulum
Correct answer: C
RATIONALE: Mitochondria are the primary site of ATP production through
oxidative phosphorylation. They contain the electron transport chain and ATP
synthase, which generate ATP from ADP and inorganic phosphate. Ribosomes are
,responsible for protein synthesis, the Golgi apparatus modifies and packages
proteins, and the endoplasmic reticulum is involved in protein synthesis and lipid
metabolism .
Question 3
Which of the following is the primary mechanism of cellular injury in hypoxic
conditions?
A. DNA mutation
B. ATP depletion leading to loss of ion homeostasis
C. Free radical formation
D. Protein misfolding
Correct answer: B
RATIONALE: Hypoxia limits oxidative phosphorylation, leading to decreased
ATP production. The Na⁺/K⁺ ATPase pump requires ATP to maintain ion
gradients; failure of this pump causes intracellular sodium accumulation, water
influx, and cellular swelling. This is the hallmark of hypoxic cellular injury .
Question 4
What is the hallmark of reversible cellular injury?
A. Nuclear pyknosis
B. Failure of ion pumps leading to cell swelling
C. Membrane rupture
D. Lysosomal enzyme release
Correct answer: B
RATIONALE: Reversible injury involves cellular swelling due to ion pump
failure. If the insult is removed, the cell can recover. Irreversible injury involves
membrane damage and nuclear changes such as pyknosis (nuclear shrinkage).
Membrane rupture and lysosomal enzyme release indicate irreversible
injury/necrosis .
, Question 5
Which statement best describes a characteristic of apoptosis?
A. Apoptosis involves programmed cell death of scattered single cells
B. Apoptosis is characterized by swelling of the nucleus and cytoplasm
C. Apoptosis involves unpredictable patterns of cell death
D. Apoptosis results in significant inflammation
Correct answer: A
RATIONALE: Apoptosis is a highly regulated, energy-dependent process of
programmed cell death affecting scattered individual cells. It is characterized by
cell shrinkage, chromatin condensation, and formation of apoptotic bodies without
triggering inflammation. Necrosis involves cell swelling and inflammation .
Question 6
A 65-year-old patient with a 40-pack-year smoking history develops a persistent
cough and hemoptysis. A biopsy reveals squamous cell carcinoma of the lung.
Which cellular change in the bronchial epithelium MOST likely preceded this
malignancy?
A. Hypertrophy
B. Squamous metaplasia
C. Hyperplasia
D. Atrophy
Correct answer: B
RATIONALE: Chronic irritation from cigarette smoke causes squamous
metaplasia of the normal pseudostratified ciliated columnar epithelium of the
bronchi. This metaplastic change is a protective adaptation but increases the risk of
malignant transformation. Squamous metaplasia is considered a precursor lesion
that can progress to dysplasia and eventually squamous cell carcinoma .
Question 7
