NSG 550 EXAM 1 ADVANCED PATHOPHYSIOLOGY 2026 | Actual
Questions & Detailed Rationales | Verified A+ Master Set (Latest
Update)
Question 1
A patient with severe dehydration develops tachycardia, hypotension, and
oliguria. Which mechanism best explains the decrease in urine output?
A. Increased renal perfusion
B. Activation of the renin-angiotensin-aldosterone system
C. Suppression of antidiuretic hormone release
D. Increased glomerular filtration rate
Correct Answer: B. Activation of the renin-angiotensin-aldosterone
system
Rationale: Reduced circulating volume decreases renal perfusion and
stimulates renin release. Renin initiates the renin-angiotensin-aldosterone
system, producing angiotensin II and aldosterone. These hormones promote
vasoconstriction and sodium and water retention, helping restore circulating
volume. Reduced renal blood flow also decreases glomerular filtration and
urine production.
Question 2
Which cellular adaptation occurs when a tissue is exposed to increased
workload?
A. Atrophy
B. Hypertrophy
C. Metaplasia
D. Dysplasia
Correct Answer: B. Hypertrophy
Rationale: Hypertrophy is an increase in the size of individual cells, resulting
in enlargement of the affected tissue or organ. It commonly occurs in skeletal
1
,and cardiac muscle when workload increases. Hyperplasia, in contrast,
involves an increase in the number of cells.
Question 3
A patient develops left ventricular hypertrophy as a consequence of chronic
hypertension. Which cellular adaptation is responsible?
A. Increased cellular size caused by increased workload
B. Replacement of cardiac muscle with epithelial cells
C. Decreased number of myocardial cells
D. Transformation of myocardial cells into malignant cells
Correct Answer: A. Increased cellular size caused by increased workload
Rationale: Chronic hypertension increases the workload against which the
left ventricle must pump. Cardiomyocytes respond primarily through
hypertrophy, increasing their size and contractile capacity. Over time,
excessive hypertrophy can become maladaptive and contribute to impaired
ventricular relaxation, ischemia, and eventually heart failure.
Question 4
Which finding most directly indicates cellular injury caused by impaired
oxygen delivery?
A. Increased ATP production
B. Increased oxidative phosphorylation
C. Failure of the sodium-potassium pump
D. Increased mitochondrial function
Correct Answer: C. Failure of the sodium-potassium pump
Rationale: Oxygen deprivation reduces oxidative phosphorylation and ATP
production. ATP depletion causes failure of energy-dependent membrane
pumps, particularly the sodium-potassium pump. Sodium and water then
2
,enter the cell, producing cellular swelling. Continued hypoxic injury can
progress to irreversible cell damage and necrosis.
Question 5
A patient experiences prolonged tissue ischemia. Which cellular change is
most likely to occur initially?
A. Cellular swelling
B. Nuclear fragmentation
C. Membrane rupture
D. Enzymatic digestion of the entire cell
Correct Answer: A. Cellular swelling
Rationale: Early reversible cellular injury commonly produces cellular
swelling because ATP depletion interferes with membrane ion pumps. Sodium
accumulates intracellularly, followed by water. If the underlying cause is
corrected, the cell may recover. Persistent or severe injury can progress to
irreversible injury and cell death.
Question 6
Which process describes programmed cell death that normally occurs without
causing significant inflammation?
A. Necrosis
B. Apoptosis
C. Autolysis
D. Ischemia
Correct Answer: B. Apoptosis
Rationale: Apoptosis is regulated, programmed cell death that removes
damaged, unnecessary, or aging cells. Cellular fragments are packaged into
apoptotic bodies and cleared by phagocytic cells, generally without
3
, substantial inflammation. Necrosis is uncontrolled cell death that commonly
causes membrane disruption and inflammation.
Question 7
A patient with severe tissue injury develops necrosis. Which finding is most
characteristic of necrotic cell death?
A. Cell shrinkage without membrane disruption
B. Membrane rupture and release of intracellular contents
C. Absence of inflammatory response
D. Controlled cellular fragmentation
Correct Answer: B. Membrane rupture and release of intracellular
contents
Rationale: Necrosis results from severe cellular injury and is characterized by
loss of membrane integrity. Intracellular enzymes and other cellular
components enter surrounding tissues and can trigger inflammation. Nuclear
changes may include pyknosis, karyorrhexis, and karyolysis.
Question 8
Which inflammatory mediator is primarily responsible for increasing vascular
permeability during acute inflammation?
A. Histamine
B. Insulin
C. Erythropoietin
D. Albumin
Correct Answer: A. Histamine
Rationale: Histamine is released primarily from mast cells and promotes
vasodilation and increased vascular permeability. Increased permeability
allows plasma proteins and fluid to move into the interstitial space,
4
Questions & Detailed Rationales | Verified A+ Master Set (Latest
Update)
Question 1
A patient with severe dehydration develops tachycardia, hypotension, and
oliguria. Which mechanism best explains the decrease in urine output?
A. Increased renal perfusion
B. Activation of the renin-angiotensin-aldosterone system
C. Suppression of antidiuretic hormone release
D. Increased glomerular filtration rate
Correct Answer: B. Activation of the renin-angiotensin-aldosterone
system
Rationale: Reduced circulating volume decreases renal perfusion and
stimulates renin release. Renin initiates the renin-angiotensin-aldosterone
system, producing angiotensin II and aldosterone. These hormones promote
vasoconstriction and sodium and water retention, helping restore circulating
volume. Reduced renal blood flow also decreases glomerular filtration and
urine production.
Question 2
Which cellular adaptation occurs when a tissue is exposed to increased
workload?
A. Atrophy
B. Hypertrophy
C. Metaplasia
D. Dysplasia
Correct Answer: B. Hypertrophy
Rationale: Hypertrophy is an increase in the size of individual cells, resulting
in enlargement of the affected tissue or organ. It commonly occurs in skeletal
1
,and cardiac muscle when workload increases. Hyperplasia, in contrast,
involves an increase in the number of cells.
Question 3
A patient develops left ventricular hypertrophy as a consequence of chronic
hypertension. Which cellular adaptation is responsible?
A. Increased cellular size caused by increased workload
B. Replacement of cardiac muscle with epithelial cells
C. Decreased number of myocardial cells
D. Transformation of myocardial cells into malignant cells
Correct Answer: A. Increased cellular size caused by increased workload
Rationale: Chronic hypertension increases the workload against which the
left ventricle must pump. Cardiomyocytes respond primarily through
hypertrophy, increasing their size and contractile capacity. Over time,
excessive hypertrophy can become maladaptive and contribute to impaired
ventricular relaxation, ischemia, and eventually heart failure.
Question 4
Which finding most directly indicates cellular injury caused by impaired
oxygen delivery?
A. Increased ATP production
B. Increased oxidative phosphorylation
C. Failure of the sodium-potassium pump
D. Increased mitochondrial function
Correct Answer: C. Failure of the sodium-potassium pump
Rationale: Oxygen deprivation reduces oxidative phosphorylation and ATP
production. ATP depletion causes failure of energy-dependent membrane
pumps, particularly the sodium-potassium pump. Sodium and water then
2
,enter the cell, producing cellular swelling. Continued hypoxic injury can
progress to irreversible cell damage and necrosis.
Question 5
A patient experiences prolonged tissue ischemia. Which cellular change is
most likely to occur initially?
A. Cellular swelling
B. Nuclear fragmentation
C. Membrane rupture
D. Enzymatic digestion of the entire cell
Correct Answer: A. Cellular swelling
Rationale: Early reversible cellular injury commonly produces cellular
swelling because ATP depletion interferes with membrane ion pumps. Sodium
accumulates intracellularly, followed by water. If the underlying cause is
corrected, the cell may recover. Persistent or severe injury can progress to
irreversible injury and cell death.
Question 6
Which process describes programmed cell death that normally occurs without
causing significant inflammation?
A. Necrosis
B. Apoptosis
C. Autolysis
D. Ischemia
Correct Answer: B. Apoptosis
Rationale: Apoptosis is regulated, programmed cell death that removes
damaged, unnecessary, or aging cells. Cellular fragments are packaged into
apoptotic bodies and cleared by phagocytic cells, generally without
3
, substantial inflammation. Necrosis is uncontrolled cell death that commonly
causes membrane disruption and inflammation.
Question 7
A patient with severe tissue injury develops necrosis. Which finding is most
characteristic of necrotic cell death?
A. Cell shrinkage without membrane disruption
B. Membrane rupture and release of intracellular contents
C. Absence of inflammatory response
D. Controlled cellular fragmentation
Correct Answer: B. Membrane rupture and release of intracellular
contents
Rationale: Necrosis results from severe cellular injury and is characterized by
loss of membrane integrity. Intracellular enzymes and other cellular
components enter surrounding tissues and can trigger inflammation. Nuclear
changes may include pyknosis, karyorrhexis, and karyolysis.
Question 8
Which inflammatory mediator is primarily responsible for increasing vascular
permeability during acute inflammation?
A. Histamine
B. Insulin
C. Erythropoietin
D. Albumin
Correct Answer: A. Histamine
Rationale: Histamine is released primarily from mast cells and promotes
vasodilation and increased vascular permeability. Increased permeability
allows plasma proteins and fluid to move into the interstitial space,
4
