NURS 231 Pathophysiology - Final Examination Portage Learning | 2026/2027 Edition
FINAL EXAM
PORTAGE LEARNING NURS 231 PATHOPHYSIOLOGY
FINAL EXAMINATION {LATEST UPDATE}
Comprehensive Final Examination | 150 Questions | Aligned with NCLEX-RN Pathophysiology Standards
Cognitive Distribution: 20% Recall | 50% Application | 30% Analysis • Format: 75% Scenario-Based | 25% Direct
Knowledge
Section 1: Cellular Injury, Adaptation, & Death
Q1: A 68-year-old male with long-standing hypertension has an echocardiogram demonstrating increased left
ventricular wall thickness without an increase in myocyte number. This cellular adaptation is best described as:
A. Atrophy
B. Hypertrophy [CORRECT]
C. Hyperplasia
D. Metaplasia
Correct Answer: B
Rationale: Hypertrophy is an increase in cell size in response to increased workload; in pressure-overloaded cardiac
myocytes (which are terminally differentiated and cannot divide), the ventricle thickens without myocyte hyperplasia.
Atrophy is a decrease in cell size; hyperplasia is an increase in cell number; metaplasia is reversible replacement of one
differentiated cell type by another.
Q2: A 45-year-old chronic smoker undergoes bronchoscopy. Biopsy of the bronchial epithelium reveals replacement
of normal ciliated columnar epithelium by stratified squamous epithelium. This adaptive change is:
A. Dysplasia
B. Metaplasia [CORRECT]
C. Anaplasia
D. Hyperplasia
Correct Answer: B
Rationale: Metaplasia is the reversible substitution of one differentiated cell type for another in response to chronic
irritation; in smokers, stratified squamous epithelium replaces ciliated columnar epithelium to better resist injury, though
it loses mucus-clearing function. Dysplasia implies disordered growth; anaplasia indicates malignant de-differentiation;
hyperplasia is increased cell number.
NURS 231 Final Exam Page 1 150 Questions - Total
,NURS 231 Pathophysiology - Final Examination Portage Learning | 2026/2027 Edition
Q3: A 55-year-old female presents with severe crushing substernal chest pain. Cardiac biomarkers and ECG confirm
an acute myocardial infarction. Six hours later, histologic examination of the infarcted myocardium would most
likely demonstrate:
A. Coagulative necrosis [CORRECT]
B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis
Correct Answer: A
Rationale: Coagulative necrosis is the pattern of cell death in solid organs undergoing ischemic injury (typical of MI), in
which cell outlines are preserved but the cytoplasm becomes eosinophilic and anucleate. Liquefactive necrosis occurs in
brain ischemia and bacterial abscesses; caseous necrosis is associated with tuberculosis; fat necrosis occurs in pancreatic
and breast tissue.
Q4: A 30-year-old male sustains a closed head injury with prolonged cerebral hypoxia. Four days later, CT imaging
reveals a cystic cavity in the affected cerebral cortex. The underlying mechanism producing this lesion is:
A. Coagulative necrosis with preservation of tissue architecture
B. Liquefactive necrosis due to enzymatic autolysis and neutrophil digestion [CORRECT]
C. Caseous necrosis with granulomatous inflammation
D. Fibrinoid necrosis involving vessel walls
Correct Answer: B
Rationale: In the brain, ischemic injury produces liquefactive necrosis because there is little connective tissue stroma, and
enzymatic digestion by neutrophils and microglia rapidly converts tissue to a liquid cystic cavity. Coagulative necrosis
(which preserves architecture) is typical of solid organs like heart and kidney; caseous and fibrinoid necrosis reflect
different etiologies.
Q5: A 22-year-old male presents with a pulmonary cavitary lesion; sputum acid-fast bacilli are positive. Histologic
examination of the lesion would most likely reveal:
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis [CORRECT]
D. Gangrenous necrosis
Correct Answer: C
Rationale: Caseous necrosis, characterized by a cheese-like, amorphous, granular debris surrounded by a granulomatous
reaction, is the hallmark of Mycobacterium tuberculosis infection. It represents a variant of coagulative necrosis with
macrophage-mediated destruction; liquefactive, coagulative, and gangrenous patterns occur in different clinical settings.
NURS 231 Final Exam Page 2 150 Questions - Total
,NURS 231 Pathophysiology - Final Examination Portage Learning | 2026/2027 Edition
Q6: A 58-year-old female with acute pancreatitis develops fat saponification in the peripancreatic tissue. This pattern
of cellular injury is best described as:
A. Coagulative necrosis
B. Caseous necrosis
C. Fat necrosis [CORRECT]
D. Fibrinoid necrosis
Correct Answer: C
Rationale: Fat necrosis occurs when lipase releases from damaged pancreatic or adipose cells hydrolyzes triglycerides
into free fatty acids, which complex with calcium to form calcium soaps (saponification), producing chalky white nodules.
This is specific to pancreatic and adipose tissue injury; coagulative, caseous, and fibrinoid patterns reflect other
etiologies.
Q7: A 41-year-old female with systemic lupus erythematosus undergoes renal biopsy. Vessels demonstrate smudgy
pink, amorphous deposition in vessel walls. The pattern of vascular injury is:
A. Fibrinoid necrosis [CORRECT]
B. Liquefactive necrosis
C. Coagulative necrosis
D. Fat necrosis
Correct Answer: A
Rationale: Fibrinoid necrosis is characterized by smudgy eosinophilic deposition of immune complexes and plasma
proteins (including fibrin) in vessel walls, typical of immune-mediated vasculitis such as SLE, polyarteritis nodosa, and
malignant hypertension. It is distinct from coagulative, liquefactive, and fat necrosis patterns.
Q8: A 60-year-old male with benign prostatic hyperplasia undergoes surgery. Exam of the enlarged prostate shows
an increased number of glandular epithelial cells. The cellular mechanism is:
A. Hypertrophy
B. Hyperplasia [CORRECT]
C. Metaplasia
D. Dysplasia
Correct Answer: B
Rationale: Hyperplasia is an increase in the number of cells in response to hormonal or growth factor stimulation;
androgen-driven benign prostatic hyperplasia is the classic example. Hypertrophy is an increase in cell size, metaplasia is
cell-type substitution, and dysplasia is disordered growth; none matches this clinical picture.
NURS 231 Final Exam Page 3 150 Questions - Total
, NURS 231 Pathophysiology - Final Examination Portage Learning | 2026/2027 Edition
Q9: A 72-year-old female with a fractured femur is immobilized for six weeks. The affected leg shows reduced
circumference. The cellular adaptation occurring in the disused skeletal muscle is:
A. Hypertrophy
B. Atrophy [CORRECT]
C. Apoptosis
D. Metaplasia
Correct Answer: B
Rationale: Atrophy, the shrinkage in cell size and number due to decreased workload, disuse, denervation, or reduced
trophic signals, characterizes skeletal muscle in immobilized limbs. Hypertrophy is the opposite response; apoptosis is
programmed cell death, not adaptive shrinkage; metaplasia involves cell-type conversion.
Q10: A 35-year-old female undergoes cervical biopsy that shows cells with pleomorphism, hyperchromatic nuclei,
and disordered maturation confined to the lower third of the epithelium. This finding is best classified as:
A. Mild dysplasia (CIN I) [CORRECT]
B. Severe dysplasia (CIN III)
C. Carcinoma in situ
D. Metaplasia
Correct Answer: A
Rationale: Dysplasia confined to the lower third of the epithelium is classified as CIN I (mild dysplasia), a potentially
reversible preneoplastic alteration. CIN III involves full-thickness atypia; carcinoma in situ shows full-thickness atypia
without basement membrane breach; metaplasia is reversible cell-type substitution without atypia.
Q11: A 50-year-old male receives chemotherapy targeting rapidly dividing cells. Several days later, hair follicle cells
undergo programmed cell death characterized by chromatin condensation, cell shrinkage, and apoptotic body
formation without significant inflammation. The mechanism is:
A. Coagulative necrosis
B. Apoptosis [CORRECT]
C. Autophagy
D. Liquefactive necrosis
Correct Answer: B
Rationale: Apoptosis is energy-dependent programmed cell death characterized by chromatin condensation, cell
shrinkage, membrane blebbing, and apoptotic body formation without inflammation. It is the pathway triggered by
DNA-damaging chemotherapy in rapidly dividing cells. Necrosis produces inflammation; autophagy is a
survival/degradation pathway involving lysosomes.
NURS 231 Final Exam Page 4 150 Questions - Total
FINAL EXAM
PORTAGE LEARNING NURS 231 PATHOPHYSIOLOGY
FINAL EXAMINATION {LATEST UPDATE}
Comprehensive Final Examination | 150 Questions | Aligned with NCLEX-RN Pathophysiology Standards
Cognitive Distribution: 20% Recall | 50% Application | 30% Analysis • Format: 75% Scenario-Based | 25% Direct
Knowledge
Section 1: Cellular Injury, Adaptation, & Death
Q1: A 68-year-old male with long-standing hypertension has an echocardiogram demonstrating increased left
ventricular wall thickness without an increase in myocyte number. This cellular adaptation is best described as:
A. Atrophy
B. Hypertrophy [CORRECT]
C. Hyperplasia
D. Metaplasia
Correct Answer: B
Rationale: Hypertrophy is an increase in cell size in response to increased workload; in pressure-overloaded cardiac
myocytes (which are terminally differentiated and cannot divide), the ventricle thickens without myocyte hyperplasia.
Atrophy is a decrease in cell size; hyperplasia is an increase in cell number; metaplasia is reversible replacement of one
differentiated cell type by another.
Q2: A 45-year-old chronic smoker undergoes bronchoscopy. Biopsy of the bronchial epithelium reveals replacement
of normal ciliated columnar epithelium by stratified squamous epithelium. This adaptive change is:
A. Dysplasia
B. Metaplasia [CORRECT]
C. Anaplasia
D. Hyperplasia
Correct Answer: B
Rationale: Metaplasia is the reversible substitution of one differentiated cell type for another in response to chronic
irritation; in smokers, stratified squamous epithelium replaces ciliated columnar epithelium to better resist injury, though
it loses mucus-clearing function. Dysplasia implies disordered growth; anaplasia indicates malignant de-differentiation;
hyperplasia is increased cell number.
NURS 231 Final Exam Page 1 150 Questions - Total
,NURS 231 Pathophysiology - Final Examination Portage Learning | 2026/2027 Edition
Q3: A 55-year-old female presents with severe crushing substernal chest pain. Cardiac biomarkers and ECG confirm
an acute myocardial infarction. Six hours later, histologic examination of the infarcted myocardium would most
likely demonstrate:
A. Coagulative necrosis [CORRECT]
B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis
Correct Answer: A
Rationale: Coagulative necrosis is the pattern of cell death in solid organs undergoing ischemic injury (typical of MI), in
which cell outlines are preserved but the cytoplasm becomes eosinophilic and anucleate. Liquefactive necrosis occurs in
brain ischemia and bacterial abscesses; caseous necrosis is associated with tuberculosis; fat necrosis occurs in pancreatic
and breast tissue.
Q4: A 30-year-old male sustains a closed head injury with prolonged cerebral hypoxia. Four days later, CT imaging
reveals a cystic cavity in the affected cerebral cortex. The underlying mechanism producing this lesion is:
A. Coagulative necrosis with preservation of tissue architecture
B. Liquefactive necrosis due to enzymatic autolysis and neutrophil digestion [CORRECT]
C. Caseous necrosis with granulomatous inflammation
D. Fibrinoid necrosis involving vessel walls
Correct Answer: B
Rationale: In the brain, ischemic injury produces liquefactive necrosis because there is little connective tissue stroma, and
enzymatic digestion by neutrophils and microglia rapidly converts tissue to a liquid cystic cavity. Coagulative necrosis
(which preserves architecture) is typical of solid organs like heart and kidney; caseous and fibrinoid necrosis reflect
different etiologies.
Q5: A 22-year-old male presents with a pulmonary cavitary lesion; sputum acid-fast bacilli are positive. Histologic
examination of the lesion would most likely reveal:
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis [CORRECT]
D. Gangrenous necrosis
Correct Answer: C
Rationale: Caseous necrosis, characterized by a cheese-like, amorphous, granular debris surrounded by a granulomatous
reaction, is the hallmark of Mycobacterium tuberculosis infection. It represents a variant of coagulative necrosis with
macrophage-mediated destruction; liquefactive, coagulative, and gangrenous patterns occur in different clinical settings.
NURS 231 Final Exam Page 2 150 Questions - Total
,NURS 231 Pathophysiology - Final Examination Portage Learning | 2026/2027 Edition
Q6: A 58-year-old female with acute pancreatitis develops fat saponification in the peripancreatic tissue. This pattern
of cellular injury is best described as:
A. Coagulative necrosis
B. Caseous necrosis
C. Fat necrosis [CORRECT]
D. Fibrinoid necrosis
Correct Answer: C
Rationale: Fat necrosis occurs when lipase releases from damaged pancreatic or adipose cells hydrolyzes triglycerides
into free fatty acids, which complex with calcium to form calcium soaps (saponification), producing chalky white nodules.
This is specific to pancreatic and adipose tissue injury; coagulative, caseous, and fibrinoid patterns reflect other
etiologies.
Q7: A 41-year-old female with systemic lupus erythematosus undergoes renal biopsy. Vessels demonstrate smudgy
pink, amorphous deposition in vessel walls. The pattern of vascular injury is:
A. Fibrinoid necrosis [CORRECT]
B. Liquefactive necrosis
C. Coagulative necrosis
D. Fat necrosis
Correct Answer: A
Rationale: Fibrinoid necrosis is characterized by smudgy eosinophilic deposition of immune complexes and plasma
proteins (including fibrin) in vessel walls, typical of immune-mediated vasculitis such as SLE, polyarteritis nodosa, and
malignant hypertension. It is distinct from coagulative, liquefactive, and fat necrosis patterns.
Q8: A 60-year-old male with benign prostatic hyperplasia undergoes surgery. Exam of the enlarged prostate shows
an increased number of glandular epithelial cells. The cellular mechanism is:
A. Hypertrophy
B. Hyperplasia [CORRECT]
C. Metaplasia
D. Dysplasia
Correct Answer: B
Rationale: Hyperplasia is an increase in the number of cells in response to hormonal or growth factor stimulation;
androgen-driven benign prostatic hyperplasia is the classic example. Hypertrophy is an increase in cell size, metaplasia is
cell-type substitution, and dysplasia is disordered growth; none matches this clinical picture.
NURS 231 Final Exam Page 3 150 Questions - Total
, NURS 231 Pathophysiology - Final Examination Portage Learning | 2026/2027 Edition
Q9: A 72-year-old female with a fractured femur is immobilized for six weeks. The affected leg shows reduced
circumference. The cellular adaptation occurring in the disused skeletal muscle is:
A. Hypertrophy
B. Atrophy [CORRECT]
C. Apoptosis
D. Metaplasia
Correct Answer: B
Rationale: Atrophy, the shrinkage in cell size and number due to decreased workload, disuse, denervation, or reduced
trophic signals, characterizes skeletal muscle in immobilized limbs. Hypertrophy is the opposite response; apoptosis is
programmed cell death, not adaptive shrinkage; metaplasia involves cell-type conversion.
Q10: A 35-year-old female undergoes cervical biopsy that shows cells with pleomorphism, hyperchromatic nuclei,
and disordered maturation confined to the lower third of the epithelium. This finding is best classified as:
A. Mild dysplasia (CIN I) [CORRECT]
B. Severe dysplasia (CIN III)
C. Carcinoma in situ
D. Metaplasia
Correct Answer: A
Rationale: Dysplasia confined to the lower third of the epithelium is classified as CIN I (mild dysplasia), a potentially
reversible preneoplastic alteration. CIN III involves full-thickness atypia; carcinoma in situ shows full-thickness atypia
without basement membrane breach; metaplasia is reversible cell-type substitution without atypia.
Q11: A 50-year-old male receives chemotherapy targeting rapidly dividing cells. Several days later, hair follicle cells
undergo programmed cell death characterized by chromatin condensation, cell shrinkage, and apoptotic body
formation without significant inflammation. The mechanism is:
A. Coagulative necrosis
B. Apoptosis [CORRECT]
C. Autophagy
D. Liquefactive necrosis
Correct Answer: B
Rationale: Apoptosis is energy-dependent programmed cell death characterized by chromatin condensation, cell
shrinkage, membrane blebbing, and apoptotic body formation without inflammation. It is the pathway triggered by
DNA-damaging chemotherapy in rapidly dividing cells. Necrosis produces inflammation; autophagy is a
survival/degradation pathway involving lysosomes.
NURS 231 Final Exam Page 4 150 Questions - Total
