NU 545 EXAM 1 /ACTUAL NU 545 PATHOPHYSIOLOGY EXAM 1
TEST BANK ACTUAL 2026/2027 PRACTICE QUESTIONS AND
STUDY GUIDE ACCURATE EXAM COMPLETE APPROVED
QUESTIONS WITH WELL ELABORATED SOLUTIONS AND
DETAILED RATIONALES (100% CORRECT VERIFIED ANSWERS)
SECTION 1: CELLULAR BIOLOGY AND INJURY (Questions 1-
40)
Question 1
A tissue biopsy from a patient with long-standing, untreated hypertension reveals
significant thickening of the left ventricular wall. Which cellular adaptation has occurred?
A) Hyperplasia
B) Metaplasia
C) Hypertrophy
D) Dysplasia
Correct Answer: C
Rationale: Hypertrophy is an increase in the size of individual cells, often caused by an
increased mechanical workload or stress, such as the heart pumping against high
systemic vascular resistance . Hyperplasia involves an increase in cell number; metaplasia
is the replacement of one mature cell type with another; dysplasia involves disordered
growth.
Question 2
A biopsy of a chronic smoker's bronchi reveals that normal ciliated columnar epithelial
cells have been replaced by stratified squamous epithelial cells. This is an example of
which process?
,A) Anaplasia
B) Hyperplasia
C) Metaplasia
D) Atrophy
Correct Answer: C
Rationale: Metaplasia is the reversible replacement of one mature cell type by another
mature cell type, usually as an adaptive response to chronic irritation or injury . Chronic
smoking causes bronchial metaplasia as a protective adaptation.
Question 3
During an ischemic event, a lack of oxygen leads to a decrease in cellular ATP
production. Which immediate consequence occurs within the cell?
A) Shrinkage of the nucleus
B) Failure of the sodium-potassium pump, leading to cellular swelling
C) Decreased intracellular calcium levels
D) Increased intracellular pH
Correct Answer: B
Rationale: Decreased ATP causes the Na⁺/K⁺ ATPase pump to fail. Sodium accumulates
inside the cell, pulling water in by osmosis, which results in acute cellular swelling . This
is a hallmark of reversible cell injury.
Question 4
A patient has been diagnosed with a condition that triggers premature, programmed
cellular suicide in specific healthy tissues. What is the medical term for this programmed
cell death?
A) Liquefactive necrosis
B) Coagulative necrosis
,C) Apoptosis
D) Infarction
Correct Answer: C
Rationale: Apoptosis is a highly regulated, distinct process of programmed cell death
designed to eliminate unwanted or damaged cells without triggering inflammation . It is
distinct from necrosis, which involves cell swelling and inflammation.
Question 5
A patient presents with acute ischemia to leg muscle. Biopsy shows pale, swollen
myocytes with intact cell membranes. Which cellular function failure most directly
explains the observed cellular swelling?
A) Failure of Na⁺/K⁺ ATPase leading to intracellular sodium accumulation
B) Loss of plasma membrane tight junctions between myocytes
C) Inhibition of ribosomal protein synthesis
D) Increased activity of mitochondrial cytochrome oxidase
Correct Answer: A
Rationale: Na⁺/K⁺ ATPase requires ATP to export Na⁺. ATP depletion causes pump
failure, resulting in intracellular Na⁺ and water accumulation, and cell swelling . Intact
cell membranes indicate the injury is still reversible at this stage.
Question 6
An ICU patient with severe sepsis has rising lactate, hypotension, and decreasing urine
output. Kidney biopsy shows cell swelling and loss of brush border with intact cell
membranes. Which injury type best describes these renal tubular changes?
A) Irreversible necrosis due to membrane rupture and inflammation
B) Reversible ischemic injury (cellular swelling) due to ATP depletion and Na⁺ influx
C) Apoptosis via caspase activation with apoptotic body formation
D) Autophagic preservation of organelles preventing cell death
, Correct Answer: B
Rationale: Early ischemic injury causes ATP depletion → failure of Na⁺/K⁺ pumps →
intracellular Na⁺ accumulation → osmotic water influx → cell swelling. Intact cell
membranes indicate the injury is still reversible at this stage .
Question 7
A 62-year-old man with long-standing gastroesophageal reflux reports progressive
dysphagia. Endoscopy shows columnar epithelium replacing normal stratified squamous
mucosa of the distal esophagus. Which pathophysiologic process best explains this
finding?
A) Hyperplasia — chronic acid exposure increases cell number causing carcinoma risk
B) Metaplasia — chronic irritation causes phenotypic change to a more protective cell
type with malignant potential
C) Dysplasia — reversible adaptive enlargement of existing squamous cells due to acid
exposure
D) Atrophy — loss of squamous cells from reduced perfusion leading to columnar
replacement
Correct Answer: B
Rationale: Metaplasia is the replacement of one differentiated cell type by another
better suited to withstand chronic stress (columnar epithelium replacing squamous in
Barrett esophagus). This finding is associated with increased risk of progression to
dysplasia and adenocarcinoma .
Question 8
A patient undergoes a tissue biopsy that reveals cellular death characterized by nuclear
dissolution, severe cell membrane rupture, and the release of intracellular contents
triggering local inflammation. What type of cell death is this?
TEST BANK ACTUAL 2026/2027 PRACTICE QUESTIONS AND
STUDY GUIDE ACCURATE EXAM COMPLETE APPROVED
QUESTIONS WITH WELL ELABORATED SOLUTIONS AND
DETAILED RATIONALES (100% CORRECT VERIFIED ANSWERS)
SECTION 1: CELLULAR BIOLOGY AND INJURY (Questions 1-
40)
Question 1
A tissue biopsy from a patient with long-standing, untreated hypertension reveals
significant thickening of the left ventricular wall. Which cellular adaptation has occurred?
A) Hyperplasia
B) Metaplasia
C) Hypertrophy
D) Dysplasia
Correct Answer: C
Rationale: Hypertrophy is an increase in the size of individual cells, often caused by an
increased mechanical workload or stress, such as the heart pumping against high
systemic vascular resistance . Hyperplasia involves an increase in cell number; metaplasia
is the replacement of one mature cell type with another; dysplasia involves disordered
growth.
Question 2
A biopsy of a chronic smoker's bronchi reveals that normal ciliated columnar epithelial
cells have been replaced by stratified squamous epithelial cells. This is an example of
which process?
,A) Anaplasia
B) Hyperplasia
C) Metaplasia
D) Atrophy
Correct Answer: C
Rationale: Metaplasia is the reversible replacement of one mature cell type by another
mature cell type, usually as an adaptive response to chronic irritation or injury . Chronic
smoking causes bronchial metaplasia as a protective adaptation.
Question 3
During an ischemic event, a lack of oxygen leads to a decrease in cellular ATP
production. Which immediate consequence occurs within the cell?
A) Shrinkage of the nucleus
B) Failure of the sodium-potassium pump, leading to cellular swelling
C) Decreased intracellular calcium levels
D) Increased intracellular pH
Correct Answer: B
Rationale: Decreased ATP causes the Na⁺/K⁺ ATPase pump to fail. Sodium accumulates
inside the cell, pulling water in by osmosis, which results in acute cellular swelling . This
is a hallmark of reversible cell injury.
Question 4
A patient has been diagnosed with a condition that triggers premature, programmed
cellular suicide in specific healthy tissues. What is the medical term for this programmed
cell death?
A) Liquefactive necrosis
B) Coagulative necrosis
,C) Apoptosis
D) Infarction
Correct Answer: C
Rationale: Apoptosis is a highly regulated, distinct process of programmed cell death
designed to eliminate unwanted or damaged cells without triggering inflammation . It is
distinct from necrosis, which involves cell swelling and inflammation.
Question 5
A patient presents with acute ischemia to leg muscle. Biopsy shows pale, swollen
myocytes with intact cell membranes. Which cellular function failure most directly
explains the observed cellular swelling?
A) Failure of Na⁺/K⁺ ATPase leading to intracellular sodium accumulation
B) Loss of plasma membrane tight junctions between myocytes
C) Inhibition of ribosomal protein synthesis
D) Increased activity of mitochondrial cytochrome oxidase
Correct Answer: A
Rationale: Na⁺/K⁺ ATPase requires ATP to export Na⁺. ATP depletion causes pump
failure, resulting in intracellular Na⁺ and water accumulation, and cell swelling . Intact
cell membranes indicate the injury is still reversible at this stage.
Question 6
An ICU patient with severe sepsis has rising lactate, hypotension, and decreasing urine
output. Kidney biopsy shows cell swelling and loss of brush border with intact cell
membranes. Which injury type best describes these renal tubular changes?
A) Irreversible necrosis due to membrane rupture and inflammation
B) Reversible ischemic injury (cellular swelling) due to ATP depletion and Na⁺ influx
C) Apoptosis via caspase activation with apoptotic body formation
D) Autophagic preservation of organelles preventing cell death
, Correct Answer: B
Rationale: Early ischemic injury causes ATP depletion → failure of Na⁺/K⁺ pumps →
intracellular Na⁺ accumulation → osmotic water influx → cell swelling. Intact cell
membranes indicate the injury is still reversible at this stage .
Question 7
A 62-year-old man with long-standing gastroesophageal reflux reports progressive
dysphagia. Endoscopy shows columnar epithelium replacing normal stratified squamous
mucosa of the distal esophagus. Which pathophysiologic process best explains this
finding?
A) Hyperplasia — chronic acid exposure increases cell number causing carcinoma risk
B) Metaplasia — chronic irritation causes phenotypic change to a more protective cell
type with malignant potential
C) Dysplasia — reversible adaptive enlargement of existing squamous cells due to acid
exposure
D) Atrophy — loss of squamous cells from reduced perfusion leading to columnar
replacement
Correct Answer: B
Rationale: Metaplasia is the replacement of one differentiated cell type by another
better suited to withstand chronic stress (columnar epithelium replacing squamous in
Barrett esophagus). This finding is associated with increased risk of progression to
dysplasia and adenocarcinoma .
Question 8
A patient undergoes a tissue biopsy that reveals cellular death characterized by nuclear
dissolution, severe cell membrane rupture, and the release of intracellular contents
triggering local inflammation. What type of cell death is this?
