NURS 399 Exam 1 Pathophysiology
and Pharmacology 2026/2027 Updated
Questions and Answers with Exam
Review Instant Download
SECTION I — Cellular Injury, Adaptation & Genetics (Q1–10)
1. A cell that undergoes prolonged hypoxia most likely first experiences which
event?
A. Increased ATP production
B. Failure of the sodium–potassium pump
C. Cellular hypertrophy
D. Enhanced protein synthesis
[CORRECT] B
[RATIONALE] Hypoxia reduces oxidative phosphorylation and ATP. The Na⁺/K⁺-
ATPase pump is ATP-dependent, so it fails early, causing sodium and water influx,
cell swelling, and eventually calcium influx and cell death.
2. Which finding best represents metaplasia?
A. Increase in cell size
B. Increase in cell number
C. Replacement of one mature cell type with another
D. Disordered, atypical cell growth
[CORRECT] C
[RATIONALE] Metaplasia is a reversible substitution of one differentiated cell
type for another (e.g., squamous replacing columnar in smokers' airways). A =
hypertrophy, B = hyperplasia, D = dysplasia.
3. SATA: Which are reversible cellular adaptations?
A. Atrophy
B. Hypertrophy
C. Hyperplasia
,D. Dysplasia
E. Metaplasia
[CORRECT] A, B, C, E
[RATIONALE] Atrophy, hypertrophy, hyperplasia, and metaplasia are reversible
adaptations. Dysplasia is disordered, atypical growth considered a precancerous
change, not a simple reversible adaptation.
4. A patient with chronic hypertension develops left ventricular thickening. This is:
A. Atrophy
B. Physiologic hyperplasia
C. Pathologic hypertrophy
D. Dysplasia
[CORRECT] C
[RATIONALE] Increased workload on cardiac muscle causes hypertrophy. In
hypertension it is pathologic and can progress to failure due to limited blood
supply to the enlarged myocardium.
5. Which electrolyte shift occurs in irreversible cell injury?
A. Potassium influx, calcium efflux
B. Calcium influx, potassium efflux
C. Sodium efflux, water efflux
D. Chloride efflux, magnesium influx
[CORRECT] B
[RATIONALE] Loss of membrane integrity and ATP allows calcium to flood in
and potassium to leak out. Calcium activates enzymes (proteases, phospholipases)
that destroy the cell.
6. Free radical injury is best prevented by:
A. Calcium channel blockers
B. Antioxidants such as glutathione and superoxide dismutase
C. Beta-blockers
D. Loop diuretics
,[CORRECT] B
[RATIONALE] Antioxidants neutralize reactive oxygen species. Examples
include glutathione, superoxide dismutase, catalase, and vitamins C and E.
7. Which is an autosomal recessive disorder?
A. Huntington disease
B. Marfan syndrome
C. Cystic fibrosis
D. Neurofibromatosis type 1
[CORRECT] C
[RATIONALE] Cystic fibrosis is autosomal recessive (CFTR mutation).
Huntington and Marfan and NF1 are autosomal dominant.
8. A patient with sickle cell trait (HbAS) is at risk for:
A. No symptoms under any condition
B. Sickling under severe hypoxia
C. Mandatory chronic anemia
D. Iron overload
[CORRECT] B
[RATIONALE] Sickle cell trait is usually asymptomatic, but extreme hypoxia,
dehydration, or severe acidosis can precipitate sickling.
9. Apoptosis differs from necrosis because apoptosis:
A. Causes inflammation
B. Is programmed and non-inflammatory
C. Always involves cell swelling
D. Is always pathologic
[CORRECT] B
[RATIONALE] Apoptosis is ATP-dependent, programmed, and does not trigger
inflammation. Necrosis causes cell swelling, lysis, and inflammation.
10. Lead poisoning primarily affects which system?
A. Only the skin
B. Nervous and hematopoietic systems
, C. Only the kidneys
D. Only the lungs
[CORRECT] B
[RATIONALE] Lead interferes with heme synthesis (anemia) and is neurotoxic
(encephalopathy, peripheral neuropathy), especially in children.
SECTION II — Inflammation, Wound Healing & Immunity (Q11–22)
11. Which cell is the first to arrive at an acute inflammatory site?
A. Macrophage
B. Neutrophil
C. Lymphocyte
D. Eosinophil
[CORRECT] B
[RATIONALE] Neutrophils arrive within minutes to hours and dominate the first
6–12 hours. Macrophages arrive later and dominate after 24 hours.
12. Which mediator causes vasodilation and increased vascular permeability in
acute inflammation?
A. Histamine
B. Heparin
C. Thrombin
D. Surfactant
[CORRECT] A
[RATIONALE] Histamine from mast cells causes vasodilation and increased
capillary permeability, producing redness, heat, swelling.
13. SATA: Which are classic signs of inflammation?
A. Redness
B. Heat
C. Swelling
D. Pain
E. Pallor
and Pharmacology 2026/2027 Updated
Questions and Answers with Exam
Review Instant Download
SECTION I — Cellular Injury, Adaptation & Genetics (Q1–10)
1. A cell that undergoes prolonged hypoxia most likely first experiences which
event?
A. Increased ATP production
B. Failure of the sodium–potassium pump
C. Cellular hypertrophy
D. Enhanced protein synthesis
[CORRECT] B
[RATIONALE] Hypoxia reduces oxidative phosphorylation and ATP. The Na⁺/K⁺-
ATPase pump is ATP-dependent, so it fails early, causing sodium and water influx,
cell swelling, and eventually calcium influx and cell death.
2. Which finding best represents metaplasia?
A. Increase in cell size
B. Increase in cell number
C. Replacement of one mature cell type with another
D. Disordered, atypical cell growth
[CORRECT] C
[RATIONALE] Metaplasia is a reversible substitution of one differentiated cell
type for another (e.g., squamous replacing columnar in smokers' airways). A =
hypertrophy, B = hyperplasia, D = dysplasia.
3. SATA: Which are reversible cellular adaptations?
A. Atrophy
B. Hypertrophy
C. Hyperplasia
,D. Dysplasia
E. Metaplasia
[CORRECT] A, B, C, E
[RATIONALE] Atrophy, hypertrophy, hyperplasia, and metaplasia are reversible
adaptations. Dysplasia is disordered, atypical growth considered a precancerous
change, not a simple reversible adaptation.
4. A patient with chronic hypertension develops left ventricular thickening. This is:
A. Atrophy
B. Physiologic hyperplasia
C. Pathologic hypertrophy
D. Dysplasia
[CORRECT] C
[RATIONALE] Increased workload on cardiac muscle causes hypertrophy. In
hypertension it is pathologic and can progress to failure due to limited blood
supply to the enlarged myocardium.
5. Which electrolyte shift occurs in irreversible cell injury?
A. Potassium influx, calcium efflux
B. Calcium influx, potassium efflux
C. Sodium efflux, water efflux
D. Chloride efflux, magnesium influx
[CORRECT] B
[RATIONALE] Loss of membrane integrity and ATP allows calcium to flood in
and potassium to leak out. Calcium activates enzymes (proteases, phospholipases)
that destroy the cell.
6. Free radical injury is best prevented by:
A. Calcium channel blockers
B. Antioxidants such as glutathione and superoxide dismutase
C. Beta-blockers
D. Loop diuretics
,[CORRECT] B
[RATIONALE] Antioxidants neutralize reactive oxygen species. Examples
include glutathione, superoxide dismutase, catalase, and vitamins C and E.
7. Which is an autosomal recessive disorder?
A. Huntington disease
B. Marfan syndrome
C. Cystic fibrosis
D. Neurofibromatosis type 1
[CORRECT] C
[RATIONALE] Cystic fibrosis is autosomal recessive (CFTR mutation).
Huntington and Marfan and NF1 are autosomal dominant.
8. A patient with sickle cell trait (HbAS) is at risk for:
A. No symptoms under any condition
B. Sickling under severe hypoxia
C. Mandatory chronic anemia
D. Iron overload
[CORRECT] B
[RATIONALE] Sickle cell trait is usually asymptomatic, but extreme hypoxia,
dehydration, or severe acidosis can precipitate sickling.
9. Apoptosis differs from necrosis because apoptosis:
A. Causes inflammation
B. Is programmed and non-inflammatory
C. Always involves cell swelling
D. Is always pathologic
[CORRECT] B
[RATIONALE] Apoptosis is ATP-dependent, programmed, and does not trigger
inflammation. Necrosis causes cell swelling, lysis, and inflammation.
10. Lead poisoning primarily affects which system?
A. Only the skin
B. Nervous and hematopoietic systems
, C. Only the kidneys
D. Only the lungs
[CORRECT] B
[RATIONALE] Lead interferes with heme synthesis (anemia) and is neurotoxic
(encephalopathy, peripheral neuropathy), especially in children.
SECTION II — Inflammation, Wound Healing & Immunity (Q11–22)
11. Which cell is the first to arrive at an acute inflammatory site?
A. Macrophage
B. Neutrophil
C. Lymphocyte
D. Eosinophil
[CORRECT] B
[RATIONALE] Neutrophils arrive within minutes to hours and dominate the first
6–12 hours. Macrophages arrive later and dominate after 24 hours.
12. Which mediator causes vasodilation and increased vascular permeability in
acute inflammation?
A. Histamine
B. Heparin
C. Thrombin
D. Surfactant
[CORRECT] A
[RATIONALE] Histamine from mast cells causes vasodilation and increased
capillary permeability, producing redness, heat, swelling.
13. SATA: Which are classic signs of inflammation?
A. Redness
B. Heat
C. Swelling
D. Pain
E. Pallor
