NSG3280 / NSG 3280 Exam 2: Pathophysiology for Nurses I
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Section 1: Cellular Adaptation, Injury & Death (Questions 1–16)
Q1: A patient with long-standing hypertension has an echocardiogram showing
thickening of the left ventricular wall. The myocardial cells have increased in size in
response to the increased workload. This adaptation is called:
A. Hyperplasia
B. Atrophy
C. Hypertrophy [CORRECT]
D. Dysplasia
Correct Answer: C
Rationale: Correct because hypertrophy is an increase in individual cell size in
response to increased workload, which is the typical response of cardiac muscle
cells because they cannot divide.
Q2: Following partial surgical removal of a liver, the remaining hepatic cells begin
dividing rapidly to restore organ mass. This compensatory response is:
A. Hypertrophy
B. Hyperplasia [CORRECT]
C. Metaplasia
D. Necrosis
Correct Answer: C
Rationale: Correct because hyperplasia is an increase in the number of cells through
mitotic division, and the liver is one of the few adult organs capable of significant
compensatory regeneration.
Q3: A longtime smoker's bronchial biopsy shows that the normal ciliated columnar
epithelium has been replaced by stratified squamous epithelium. This reversible
change is:
A. Hyperplasia
B. Hypertrophy
C. Metaplasia [CORRECT]
D. Apoptosis
Correct Answer: C
,Rationale: Correct because metaplasia is the reversible replacement of one mature
cell type by another better able to withstand chronic irritation, as occurs in smokers'
airways.
Q4: A routine Pap smear in a 29-year-old woman reveals cells with variation in size
and shape and increased mitotic activity. The change is classified as a precancerous
alteration. This finding is best described as:
A. Metaplasia
B. Hypertrophy
C. Dysplasia [CORRECT]
D. Atrophy
Correct Answer: C
Rationale: Correct because dysplasia is disordered cell growth with atypical size,
shape, and organization that is considered precancerous and requires follow-up
surveillance.
Q5: A patient's right leg is immobilized in a cast for six weeks, and the calf muscles
visibly shrink in size. This change is:
A. Dysplasia
B. Hyperplasia
C. Atrophy [CORRECT]
D. Metaplasia
Correct Answer: C
Rationale: Correct because disuse atrophy is the decrease in cell size and organ
mass that occurs when tissue workload is reduced, such as in an immobilized limb.
Q6: Which statement best distinguishes apoptosis from necrosis?
A. Apoptosis affects groups of cells and always triggers inflammation
B. Apoptosis is a pathological process, whereas necrosis is always physiologic
C. Apoptosis is programmed single-cell death that does not elicit inflammation
[CORRECT]
D. Apoptosis causes cell swelling and rupture of the plasma membrane
Correct Answer: C
Rationale: Correct because apoptosis is an energy-dependent, genetically
programmed form of single-cell death in which the cell fragments cleanly without
releasing contents or stimulating an inflammatory response.
Q7: When blood flow to a tissue is interrupted, which sequence of events most
accurately describes the earliest mechanism of ischemic cell injury?
A. Membrane rupture first, followed by ATP depletion and mitochondrial damage
B. Lysosomal enzyme release first, followed by nuclear pyknosis
C. Decreased ATP leads to failure of the sodium-potassium pump, causing cellular
swelling [CORRECT]
, D. Calcium influx occurs first, followed by decreased protein synthesis
Correct Answer: C
Rationale: Correct because ischemia deprives cells of oxygen, impairing oxidative
phosphorylation so ATP falls, the Na⁺/K⁺ pump fails, sodium and water accumulate,
and cellular swelling — the first sign of reversible injury — develops.
Q8: A patient with a myocardial infarction receives reperfusion therapy, yet some
heart cells die after blood flow is restored. The mechanism responsible for this
additional damage is:
A. Continued ATP depletion from the original ischemic event
B. Excessive potassium influx into reperfused cells
C. Free radical (reactive oxygen species) formation during reoxygenation [CORRECT]
D. Loss of electrolytes from the restored circulation
Correct Answer: C
Rationale: Correct because reintroduction of oxygen into previously ischemic tissue
generates reactive oxygen species and free radicals that damage membranes and
organelles, causing reperfusion injury.
Q9: An autopsy of heart tissue from a patient who died 5 days after a myocardial
infarction shows an area where dead cells have coagulated proteins but retain their
ghost-like cellular outline. This type of necrosis is:
A. Liquefactive necrosis
B. Caseous necrosis
C. Coagulative necrosis [CORRECT]
D. Fat necrosis
Correct Answer: C
Rationale: Correct because coagulative necrosis results from protein denaturation
with preservation of cellular architecture and typically occurs in ischemic tissue of
the heart, kidneys, and spleen.
Q10: A patient suffers a stroke, and CT imaging shows the infarcted brain region
softening into a liquid mass. Which type of necrosis characterizes brain infarcts?
A. Coagulative necrosis
B. Caseous necrosis
C. Liquefactive necrosis [CORRECT]
D. Fibrinoid necrosis
Correct Answer: C
Rationale: Correct because liquefactive necrosis occurs in the lipid-rich brain, where
hydrolytic enzymes digest dead tissue into a liquid, cyst-like mass.
Q11: A chest CT of a patient with active tuberculosis reveals a granuloma containing
soft, crumbly, cheese-like debris in the center. This distinctive necrosis is:
A. Fat necrosis
Review Actual Exam 2026/2027 Complete Exam-Style
Questions with Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
Section 1: Cellular Adaptation, Injury & Death (Questions 1–16)
Q1: A patient with long-standing hypertension has an echocardiogram showing
thickening of the left ventricular wall. The myocardial cells have increased in size in
response to the increased workload. This adaptation is called:
A. Hyperplasia
B. Atrophy
C. Hypertrophy [CORRECT]
D. Dysplasia
Correct Answer: C
Rationale: Correct because hypertrophy is an increase in individual cell size in
response to increased workload, which is the typical response of cardiac muscle
cells because they cannot divide.
Q2: Following partial surgical removal of a liver, the remaining hepatic cells begin
dividing rapidly to restore organ mass. This compensatory response is:
A. Hypertrophy
B. Hyperplasia [CORRECT]
C. Metaplasia
D. Necrosis
Correct Answer: C
Rationale: Correct because hyperplasia is an increase in the number of cells through
mitotic division, and the liver is one of the few adult organs capable of significant
compensatory regeneration.
Q3: A longtime smoker's bronchial biopsy shows that the normal ciliated columnar
epithelium has been replaced by stratified squamous epithelium. This reversible
change is:
A. Hyperplasia
B. Hypertrophy
C. Metaplasia [CORRECT]
D. Apoptosis
Correct Answer: C
,Rationale: Correct because metaplasia is the reversible replacement of one mature
cell type by another better able to withstand chronic irritation, as occurs in smokers'
airways.
Q4: A routine Pap smear in a 29-year-old woman reveals cells with variation in size
and shape and increased mitotic activity. The change is classified as a precancerous
alteration. This finding is best described as:
A. Metaplasia
B. Hypertrophy
C. Dysplasia [CORRECT]
D. Atrophy
Correct Answer: C
Rationale: Correct because dysplasia is disordered cell growth with atypical size,
shape, and organization that is considered precancerous and requires follow-up
surveillance.
Q5: A patient's right leg is immobilized in a cast for six weeks, and the calf muscles
visibly shrink in size. This change is:
A. Dysplasia
B. Hyperplasia
C. Atrophy [CORRECT]
D. Metaplasia
Correct Answer: C
Rationale: Correct because disuse atrophy is the decrease in cell size and organ
mass that occurs when tissue workload is reduced, such as in an immobilized limb.
Q6: Which statement best distinguishes apoptosis from necrosis?
A. Apoptosis affects groups of cells and always triggers inflammation
B. Apoptosis is a pathological process, whereas necrosis is always physiologic
C. Apoptosis is programmed single-cell death that does not elicit inflammation
[CORRECT]
D. Apoptosis causes cell swelling and rupture of the plasma membrane
Correct Answer: C
Rationale: Correct because apoptosis is an energy-dependent, genetically
programmed form of single-cell death in which the cell fragments cleanly without
releasing contents or stimulating an inflammatory response.
Q7: When blood flow to a tissue is interrupted, which sequence of events most
accurately describes the earliest mechanism of ischemic cell injury?
A. Membrane rupture first, followed by ATP depletion and mitochondrial damage
B. Lysosomal enzyme release first, followed by nuclear pyknosis
C. Decreased ATP leads to failure of the sodium-potassium pump, causing cellular
swelling [CORRECT]
, D. Calcium influx occurs first, followed by decreased protein synthesis
Correct Answer: C
Rationale: Correct because ischemia deprives cells of oxygen, impairing oxidative
phosphorylation so ATP falls, the Na⁺/K⁺ pump fails, sodium and water accumulate,
and cellular swelling — the first sign of reversible injury — develops.
Q8: A patient with a myocardial infarction receives reperfusion therapy, yet some
heart cells die after blood flow is restored. The mechanism responsible for this
additional damage is:
A. Continued ATP depletion from the original ischemic event
B. Excessive potassium influx into reperfused cells
C. Free radical (reactive oxygen species) formation during reoxygenation [CORRECT]
D. Loss of electrolytes from the restored circulation
Correct Answer: C
Rationale: Correct because reintroduction of oxygen into previously ischemic tissue
generates reactive oxygen species and free radicals that damage membranes and
organelles, causing reperfusion injury.
Q9: An autopsy of heart tissue from a patient who died 5 days after a myocardial
infarction shows an area where dead cells have coagulated proteins but retain their
ghost-like cellular outline. This type of necrosis is:
A. Liquefactive necrosis
B. Caseous necrosis
C. Coagulative necrosis [CORRECT]
D. Fat necrosis
Correct Answer: C
Rationale: Correct because coagulative necrosis results from protein denaturation
with preservation of cellular architecture and typically occurs in ischemic tissue of
the heart, kidneys, and spleen.
Q10: A patient suffers a stroke, and CT imaging shows the infarcted brain region
softening into a liquid mass. Which type of necrosis characterizes brain infarcts?
A. Coagulative necrosis
B. Caseous necrosis
C. Liquefactive necrosis [CORRECT]
D. Fibrinoid necrosis
Correct Answer: C
Rationale: Correct because liquefactive necrosis occurs in the lipid-rich brain, where
hydrolytic enzymes digest dead tissue into a liquid, cyst-like mass.
Q11: A chest CT of a patient with active tuberculosis reveals a granuloma containing
soft, crumbly, cheese-like debris in the center. This distinctive necrosis is:
A. Fat necrosis
