Page 1 of 36
NURS 5315 ADVANCED PATHOPHYSIOLOGY EXAM PACK
2026 QUESTIONS WITH VERIFIED ANSWERS DETAILED
RATIONALES GRADED A+
NURS 5315 Advanced Pathophysiology — Exam Test Bank
SECTION 1: CELLULAR ADAPTATION & INJURY (Questions 1–10)
1. A patient presents with a decrease in the size of the left calf muscle after being in a cast for
six weeks. Which cellular adaptation has occurred?
A. Atrophy
B. Hypertrophy
C. Metaplasia
D. Dysplasia
Rationale: Atrophy is a decrease in cellular size caused by disuse, reduced blood supply, or loss
of stimulation. In this scenario, the cast leads to disuse atrophy of skeletal muscle. It is a
physiologic or pathologic attempt to reach a new equilibrium in response to reduced functional
demand.
2. A 62-year-old patient with long-standing uncontrolled hypertension develops increased left
ventricular wall thickness while individual cardiac muscle cells become larger rather than
increasing substantially in number. Which cellular adaptation best explains this?
A. Metaplasia
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B. Hypertrophy
C. Hyperplasia
D. Atrophy
Rationale: Adult cardiac myocytes have little capacity for division. Chronic pressure overload
enlarges existing cells, producing hypertrophy. Hyperplasia involves an increase in cell number,
which does not occur in cardiac muscle after birth.
3. A chronic smoker develops replacement of normal ciliated columnar epithelium with
stratified squamous epithelium in the airways. This cellular adaptation is best described as:
A. Hyperplasia
B. Dysplasia
C. Metaplasia
D. Hypertrophy
Rationale: Metaplasia is a reversible change where one mature cell type is replaced by another
that is better able to withstand chronic irritation. The chronic irritation from cigarette smoke
causes ciliated columnar epithelium to transform into stratified squamous epithelium, which
lacks mucociliary clearance function.
4. A patient with chronic gastroesophageal reflux disease develops replacement of the normal
distal esophageal squamous epithelium with specialized columnar epithelium containing
goblet cells. Which cellular adaptation is occurring?
A. Dysplasia
B. Hyperplasia
C. Metaplasia
D. Anaplasia
Rationale: Barrett's esophagus is an example of metaplasia, where normal squamous cells
change to columnar epithelium in response to chronic reflux (intestinal metaplasia). This is a
reversible adaptation to chronic stress.
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5. A patient with chronic tobacco exposure develops bronchial epithelial cells that show
pleomorphism, enlarged hyperchromatic nuclei, and disorganized cellular architecture. Which
pathologic cellular change is most concerning for progression toward malignancy?
A. Hypertrophy
B. Atrophy
C. Metaplasia
D. Dysplasia
Rationale: Dysplasia is characterized by abnormal changes in cell size, shape, and organization
(pleomorphism, hyperchromatic nuclei, increased nuclear-to-cytoplasmic ratio). It is considered
a premalignant change and is strongly associated with neoplastic transformation.
6. During reperfusion of ischemic myocardium, mitochondrial permeability transition pore
(mPTP) opening is triggered primarily by which combination of intracellular changes?
A. Rising ATP with cytosolic alkalosis and reduced matrix phosphate
B. Calcium overload with oxidative stress, ATP depletion, and matrix acidosis
C. Increased Bcl-2 activity with reduced cytochrome c release
D. Enhanced sarcoplasmic reticulum SERCA function with calcium sequestration
Rationale: mPTP opening during reperfusion requires calcium overload, reactive oxygen species,
adenine nucleotide depletion, and rapid normalization of matrix pH. This dissipates the proton
gradient and commits the cell to necrosis.
7. A cell placed in a hypotonic solution swells but does not lyse because of regulatory volume
decrease (RVD). Which transport event mediates RVD?
A. Activation of Na⁺/K⁺-ATPase with net KCl influx
B. Opening of volume-regulated anion channels with parallel K⁺ efflux and obligatory water loss
C. Stimulation of Na⁺/H⁺ exchange and Na⁺/HCO₃⁻ cotransport
D. Insertion of aquaporin-2 channels into the apical membrane
Rationale: RVD is achieved by activating volume-regulated anion channels (VRAC) and Ca²⁺-
activated K⁺ channels, causing efflux of KCl and osmotically obliged water, restoring cell volume.
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Na⁺/H⁺ exchange and aquaporin-2 insertion mediate regulatory volume increase or water
retention.
8. Which molecular alteration best explains the phenomenon of a “second hit” required for
manifestation of a hereditary cancer syndrome in a tumor suppressor gene?
A. Germline gain-of-function mutation in a proto-oncogene with somatic loss of the wild-type
allele
B. Germline loss-of-function mutation in one allele with somatic inactivation of the remaining
wild-type allele
C. Somatic mutation in one allele with germline amplification of the other allele
D. Germline epigenetic silencing of both alleles with no somatic mutation
Rationale: Knudson's two-hit hypothesis states that hereditary cancer syndromes require a
germline mutation in one allele of a tumor suppressor gene and a subsequent somatic
inactivation (mutation, deletion, or epigenetic silencing) of the second allele.
9. A patient with severe oxidative stress develops cellular injury caused by molecules that can
damage membrane lipids, proteins, DNA, and mitochondria. Which mechanism is most
directly responsible for this injury?
A. Increased glycogen storage
B. Reactive oxygen species
C. Increased lysosomal stabilization
D. Enhanced DNA repair
Rationale: Reactive oxygen species (free radicals) are highly reactive molecules with unpaired
electrons that cause oxidative stress, damaging cells through lipid peroxidation of membranes,
oxidative modification of proteins, and DNA breaks. This mechanism is central to aging and
various disease processes.
10. A patient with prolonged hypoxia develops cellular swelling followed by increasing
intracellular calcium, membrane damage, mitochondrial dysfunction, and inability to restore
normal cellular function. Which finding most strongly indicates that the injury has become
irreversible?
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NURS 5315 ADVANCED PATHOPHYSIOLOGY EXAM PACK
2026 QUESTIONS WITH VERIFIED ANSWERS DETAILED
RATIONALES GRADED A+
NURS 5315 Advanced Pathophysiology — Exam Test Bank
SECTION 1: CELLULAR ADAPTATION & INJURY (Questions 1–10)
1. A patient presents with a decrease in the size of the left calf muscle after being in a cast for
six weeks. Which cellular adaptation has occurred?
A. Atrophy
B. Hypertrophy
C. Metaplasia
D. Dysplasia
Rationale: Atrophy is a decrease in cellular size caused by disuse, reduced blood supply, or loss
of stimulation. In this scenario, the cast leads to disuse atrophy of skeletal muscle. It is a
physiologic or pathologic attempt to reach a new equilibrium in response to reduced functional
demand.
2. A 62-year-old patient with long-standing uncontrolled hypertension develops increased left
ventricular wall thickness while individual cardiac muscle cells become larger rather than
increasing substantially in number. Which cellular adaptation best explains this?
A. Metaplasia
1|Page
,Page 2 of 36
B. Hypertrophy
C. Hyperplasia
D. Atrophy
Rationale: Adult cardiac myocytes have little capacity for division. Chronic pressure overload
enlarges existing cells, producing hypertrophy. Hyperplasia involves an increase in cell number,
which does not occur in cardiac muscle after birth.
3. A chronic smoker develops replacement of normal ciliated columnar epithelium with
stratified squamous epithelium in the airways. This cellular adaptation is best described as:
A. Hyperplasia
B. Dysplasia
C. Metaplasia
D. Hypertrophy
Rationale: Metaplasia is a reversible change where one mature cell type is replaced by another
that is better able to withstand chronic irritation. The chronic irritation from cigarette smoke
causes ciliated columnar epithelium to transform into stratified squamous epithelium, which
lacks mucociliary clearance function.
4. A patient with chronic gastroesophageal reflux disease develops replacement of the normal
distal esophageal squamous epithelium with specialized columnar epithelium containing
goblet cells. Which cellular adaptation is occurring?
A. Dysplasia
B. Hyperplasia
C. Metaplasia
D. Anaplasia
Rationale: Barrett's esophagus is an example of metaplasia, where normal squamous cells
change to columnar epithelium in response to chronic reflux (intestinal metaplasia). This is a
reversible adaptation to chronic stress.
2|Page
,Page 3 of 36
5. A patient with chronic tobacco exposure develops bronchial epithelial cells that show
pleomorphism, enlarged hyperchromatic nuclei, and disorganized cellular architecture. Which
pathologic cellular change is most concerning for progression toward malignancy?
A. Hypertrophy
B. Atrophy
C. Metaplasia
D. Dysplasia
Rationale: Dysplasia is characterized by abnormal changes in cell size, shape, and organization
(pleomorphism, hyperchromatic nuclei, increased nuclear-to-cytoplasmic ratio). It is considered
a premalignant change and is strongly associated with neoplastic transformation.
6. During reperfusion of ischemic myocardium, mitochondrial permeability transition pore
(mPTP) opening is triggered primarily by which combination of intracellular changes?
A. Rising ATP with cytosolic alkalosis and reduced matrix phosphate
B. Calcium overload with oxidative stress, ATP depletion, and matrix acidosis
C. Increased Bcl-2 activity with reduced cytochrome c release
D. Enhanced sarcoplasmic reticulum SERCA function with calcium sequestration
Rationale: mPTP opening during reperfusion requires calcium overload, reactive oxygen species,
adenine nucleotide depletion, and rapid normalization of matrix pH. This dissipates the proton
gradient and commits the cell to necrosis.
7. A cell placed in a hypotonic solution swells but does not lyse because of regulatory volume
decrease (RVD). Which transport event mediates RVD?
A. Activation of Na⁺/K⁺-ATPase with net KCl influx
B. Opening of volume-regulated anion channels with parallel K⁺ efflux and obligatory water loss
C. Stimulation of Na⁺/H⁺ exchange and Na⁺/HCO₃⁻ cotransport
D. Insertion of aquaporin-2 channels into the apical membrane
Rationale: RVD is achieved by activating volume-regulated anion channels (VRAC) and Ca²⁺-
activated K⁺ channels, causing efflux of KCl and osmotically obliged water, restoring cell volume.
3|Page
, Page 4 of 36
Na⁺/H⁺ exchange and aquaporin-2 insertion mediate regulatory volume increase or water
retention.
8. Which molecular alteration best explains the phenomenon of a “second hit” required for
manifestation of a hereditary cancer syndrome in a tumor suppressor gene?
A. Germline gain-of-function mutation in a proto-oncogene with somatic loss of the wild-type
allele
B. Germline loss-of-function mutation in one allele with somatic inactivation of the remaining
wild-type allele
C. Somatic mutation in one allele with germline amplification of the other allele
D. Germline epigenetic silencing of both alleles with no somatic mutation
Rationale: Knudson's two-hit hypothesis states that hereditary cancer syndromes require a
germline mutation in one allele of a tumor suppressor gene and a subsequent somatic
inactivation (mutation, deletion, or epigenetic silencing) of the second allele.
9. A patient with severe oxidative stress develops cellular injury caused by molecules that can
damage membrane lipids, proteins, DNA, and mitochondria. Which mechanism is most
directly responsible for this injury?
A. Increased glycogen storage
B. Reactive oxygen species
C. Increased lysosomal stabilization
D. Enhanced DNA repair
Rationale: Reactive oxygen species (free radicals) are highly reactive molecules with unpaired
electrons that cause oxidative stress, damaging cells through lipid peroxidation of membranes,
oxidative modification of proteins, and DNA breaks. This mechanism is central to aging and
various disease processes.
10. A patient with prolonged hypoxia develops cellular swelling followed by increasing
intracellular calcium, membrane damage, mitochondrial dysfunction, and inability to restore
normal cellular function. Which finding most strongly indicates that the injury has become
irreversible?
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