NR 283 PATHOPHYSIOLOGY | 2026 PRACTICE STUDY GUIDE
NR 283 PATHOPHYSIOLOGY FINAL EXAM VERSION 1 -
2026 STUDY GUIDE
200 PRACTICE QUESTIONS, ANSWERS, AND DETAILED RATIONALES
CHAMBERLAIN UNIVERSITY COURSE-ALIGNED REVIEW
CORE DOMAINS
Foundations, Cellular Adaptation, Injury, And Genetics
Inflammation, Immunity, And Infection
Fluid, Electrolyte, And Acid-Base Balance
Cardiovascular Pathophysiology
Respiratory Pathophysiology
Renal And Urinary Pathophysiology
Endocrine And Metabolic Pathophysiology
Gastrointestinal, Hepatobiliary, And Pancreatic Pathophysiology
Neurologic And Musculoskeletal Pathophysiology
Hematology, Oncology, Reproductive, And Multisystem Disorders
INTRODUCTION
This study guide supports review of pathophysiologic processes, disease mechanisms, clinical manifestations,
complications, and the influences of environmental and lifestyle factors. The multiple-choice items integrate foundational
concepts with application and clinical reasoning across major body systems. Each question has four answer options, one
best answer, and a rationale that explains the mechanism and why the selected response fits the scenario. Use the
guide to identify knowledge gaps, practice interpreting patterns, and connect cellular changes to systemic
consequences. Numeric reference ranges can vary by laboratory and clinical context; interpret measurements alongside
symptoms, trends, and appropriate professional guidance.
Instructions: Select the single best answer for each question. The correct answer and rationale appear immediately after
each item for focused review.
FOUNDATIONS, CELLULAR ADAPTATION, INJURY, AND GENETICS
1. A tissue exposed to increased workload responds by increasing the size of existing cells. Which cellular
adaptation is occurring?
A. Hyperplasia
B. Atrophy
C. Metaplasia
D. Hypertrophy
Correct answer: D. Hypertrophy
Rationale: Hypertrophy is an increase in individual cell size, often caused by greater functional demand. Hyperplasia
increases cell number, while atrophy decreases cell size and metaplasia changes one mature cell type to another.
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, NR 283 PATHOPHYSIOLOGY | 2026 PRACTICE STUDY GUIDE
2. A patient has skeletal-muscle wasting after several weeks of immobilization. Which mechanism best explains
the finding?
A. Reduced workload causes cellular atrophy
B. Replacement by a different mature cell type causes metaplasia
C. Increased cell division causes hyperplasia
D. Uncontrolled cell proliferation causes dysplasia
Correct answer: A. Reduced workload causes cellular atrophy
Rationale: Disuse reduces protein synthesis and promotes protein breakdown, decreasing muscle-fiber size. This is
atrophy and may be partially reversible when normal activity is resumed, depending on duration and other health factors.
3. Long-term cigarette smoke exposure causes normal bronchial columnar epithelium to be replaced by
stratified squamous epithelium. This change is called:
A. Anaplasia
B. Hypertrophy
C. Physiologic hyperplasia
D. Metaplasia
Correct answer: D. Metaplasia
Rationale: Metaplasia is a potentially reversible replacement of one differentiated cell type by another better able to
tolerate chronic stress. Although protective initially, it can impair function and may increase neoplastic risk if the injurious
exposure continues.
4. Which feature most strongly distinguishes apoptosis from necrosis?
A. Apoptosis is regulated cell death that usually limits inflammation
B. Apoptosis invariably causes cell rupture and intense inflammation
C. Necrosis requires energy-dependent activation of a caspase cascade
D. Necrosis is always a normal programmed process
Correct answer: A. Apoptosis is regulated cell death that usually limits inflammation
Rationale: Apoptosis is an organized, energy-dependent process that packages cellular contents for removal, usually
with minimal inflammation. Necrosis commonly follows severe injury, with membrane disruption and release of
intracellular contents that provoke inflammation.
5. A cell exposed to a brief ischemic episode develops swelling but recovers after blood flow is restored. This is
best classified as:
A. Coagulative necrosis
B. Irreversible mitochondrial failure
C. Apoptosis caused by gene activation
D. Reversible cell injury
Correct answer: D. Reversible cell injury
Rationale: Cellular swelling can occur when ATP depletion impairs membrane ion pumps. If perfusion returns before
severe membrane and mitochondrial damage develops, the injury may be reversible and normal cellular function can
recover.
6. Why does sustained ischemia frequently cause tissue injury?
A. It prevents all intracellular calcium movement
B. Reduced oxygen limits oxidative phosphorylation and ATP production
C. It immediately increases DNA repair in every cell
D. It increases ATP production beyond cellular needs
Correct answer: B. Reduced oxygen limits oxidative phosphorylation and ATP production
Rationale: Oxygen is needed for oxidative phosphorylation, a major source of cellular ATP. ATP depletion disrupts ion
gradients, protein synthesis, and membrane integrity; prolonged ischemia can progress to irreversible injury and cell
death.
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, NR 283 PATHOPHYSIOLOGY | 2026 PRACTICE STUDY GUIDE
7. Which change is most directly associated with free-radical-mediated cellular injury?
A. Permanent activation of every antioxidant enzyme
B. Oxidation of membrane lipids and damage to proteins or DNA
C. Selective destruction of extracellular sodium only
D. Increased membrane stability in all tissues
Correct answer: B. Oxidation of membrane lipids and damage to proteins or DNA
Rationale: Reactive oxygen species can oxidize lipids, proteins, and nucleic acids. Antioxidant systems limit this
damage, but excessive production or impaired clearance can overwhelm defenses and contribute to inflammation, aging,
and tissue injury.
8. A mutation changes a codon so that it specifies a different amino acid. What type of mutation is this?
A. Nonsense mutation
B. Chromosomal nondisjunction
C. Silent mutation
D. Missense mutation
Correct answer: D. Missense mutation
Rationale: A missense mutation changes an amino acid in the encoded protein and may alter folding or function. A
nonsense mutation creates a premature stop codon, a silent mutation does not change the encoded amino acid, and
nondisjunction is chromosome-separation failure.
9. Two unaffected parents each carry one pathogenic autosomal-recessive allele. What is the probability that
each pregnancy will produce an affected child?
A. 25%
B. 50%
C. 75%
D. 0%
Correct answer: A. 25%
Rationale: For two heterozygous carriers, each pregnancy has a one-in-four probability of inheriting both pathogenic
alleles. The probability applies independently to each pregnancy and does not depend on the outcomes of previous
pregnancies.
10. A disorder is autosomal dominant. An affected heterozygous parent and an unaffected noncarrier parent
have a child. What is the probability the child inherits the disorder-causing allele?
A. 100%
B. 25%
C. 0%
D. 50%
Correct answer: D. 50%
Rationale: A heterozygous affected parent has one pathogenic and one typical allele, and either can be transmitted.
Each child therefore has a 50% chance of inheriting the pathogenic allele, assuming the other parent does not carry it.
11. Which statement correctly describes a sex-linked recessive condition associated with a gene on the X
chromosome?
A. An affected father transmits his X chromosome to all sons
B. Only males can inherit an X-linked allele
C. An affected father transmits his X chromosome to all daughters but not to his sons
D. Every daughter of a carrier mother must be affected
Correct answer: C. An affected father transmits his X chromosome to all daughters but not to his sons
Rationale: A father gives his X chromosome to daughters and his Y chromosome to sons. The clinical result in
daughters depends on the mother’s allele and the specific condition; sons receive their X chromosome from their mother.
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, NR 283 PATHOPHYSIOLOGY | 2026 PRACTICE STUDY GUIDE
12. A chromosome is present in three copies rather than the usual two. This is an example of:
A. Monosomy
B. Polygenic inheritance
C. Trisomy
D. Translocation only
Correct answer: C. Trisomy
Rationale: Trisomy is the presence of an extra copy of a chromosome. It commonly results from nondisjunction during
cell division; monosomy means a missing chromosome copy, while translocation involves rearrangement of
chromosomal material.
13. Which term describes the observable characteristics resulting from genotype and environmental influences?
A. Karyotype
B. Phenotype
C. Allele frequency
D. Genetic locus
Correct answer: B. Phenotype
Rationale: Phenotype refers to observable traits, which arise from genetic factors interacting with environmental
influences. Genotype refers to the genetic makeup, while a karyotype depicts chromosome number and structure.
14. A disease results from multiple genes interacting with nutrition, activity, and other exposures. It is best
described as:
A. Multifactorial
B. Always autosomal recessive
C. A condition caused only by a single chromosomal deletion
D. Strictly mitochondrial in every case
Correct answer: A. Multifactorial
Rationale: Multifactorial conditions reflect combined genetic and environmental influences rather than a single
inheritance pattern. Many common disorders have this pattern, so risk is informed by family history and modifiable
exposures, not by one gene alone.
15. Which mechanism most directly causes edema during increased capillary hydrostatic pressure?
A. Lymphatic drainage necessarily increases above capacity
B. Plasma proteins are synthesized faster than normal
C. Intracellular water is converted into plasma proteins
D. Fluid moves from capillaries into the interstitial space
Correct answer: D. Fluid moves from capillaries into the interstitial space
Rationale: Higher capillary hydrostatic pressure favors outward filtration of fluid into tissues. If lymphatic return cannot
compensate, interstitial fluid accumulates and edema develops, as may occur with venous congestion or heart failure.
16. A patient has severe hypoalbuminemia and peripheral edema. Which Starling-force change contributes most
directly?
A. Increased intracellular ATP concentration
B. Reduced interstitial fluid volume from greater lymph drainage
C. Increased plasma oncotic pressure
D. Reduced plasma oncotic pressure
Correct answer: D. Reduced plasma oncotic pressure
Rationale: Albumin is a major contributor to plasma colloid oncotic pressure, which helps retain water within the
circulation. When albumin falls, the inward osmotic force declines, favoring fluid movement into interstitial tissues.
NR 283 Practice Guide | Page 4
NR 283 PATHOPHYSIOLOGY FINAL EXAM VERSION 1 -
2026 STUDY GUIDE
200 PRACTICE QUESTIONS, ANSWERS, AND DETAILED RATIONALES
CHAMBERLAIN UNIVERSITY COURSE-ALIGNED REVIEW
CORE DOMAINS
Foundations, Cellular Adaptation, Injury, And Genetics
Inflammation, Immunity, And Infection
Fluid, Electrolyte, And Acid-Base Balance
Cardiovascular Pathophysiology
Respiratory Pathophysiology
Renal And Urinary Pathophysiology
Endocrine And Metabolic Pathophysiology
Gastrointestinal, Hepatobiliary, And Pancreatic Pathophysiology
Neurologic And Musculoskeletal Pathophysiology
Hematology, Oncology, Reproductive, And Multisystem Disorders
INTRODUCTION
This study guide supports review of pathophysiologic processes, disease mechanisms, clinical manifestations,
complications, and the influences of environmental and lifestyle factors. The multiple-choice items integrate foundational
concepts with application and clinical reasoning across major body systems. Each question has four answer options, one
best answer, and a rationale that explains the mechanism and why the selected response fits the scenario. Use the
guide to identify knowledge gaps, practice interpreting patterns, and connect cellular changes to systemic
consequences. Numeric reference ranges can vary by laboratory and clinical context; interpret measurements alongside
symptoms, trends, and appropriate professional guidance.
Instructions: Select the single best answer for each question. The correct answer and rationale appear immediately after
each item for focused review.
FOUNDATIONS, CELLULAR ADAPTATION, INJURY, AND GENETICS
1. A tissue exposed to increased workload responds by increasing the size of existing cells. Which cellular
adaptation is occurring?
A. Hyperplasia
B. Atrophy
C. Metaplasia
D. Hypertrophy
Correct answer: D. Hypertrophy
Rationale: Hypertrophy is an increase in individual cell size, often caused by greater functional demand. Hyperplasia
increases cell number, while atrophy decreases cell size and metaplasia changes one mature cell type to another.
NR 283 Practice Guide | Page 1
, NR 283 PATHOPHYSIOLOGY | 2026 PRACTICE STUDY GUIDE
2. A patient has skeletal-muscle wasting after several weeks of immobilization. Which mechanism best explains
the finding?
A. Reduced workload causes cellular atrophy
B. Replacement by a different mature cell type causes metaplasia
C. Increased cell division causes hyperplasia
D. Uncontrolled cell proliferation causes dysplasia
Correct answer: A. Reduced workload causes cellular atrophy
Rationale: Disuse reduces protein synthesis and promotes protein breakdown, decreasing muscle-fiber size. This is
atrophy and may be partially reversible when normal activity is resumed, depending on duration and other health factors.
3. Long-term cigarette smoke exposure causes normal bronchial columnar epithelium to be replaced by
stratified squamous epithelium. This change is called:
A. Anaplasia
B. Hypertrophy
C. Physiologic hyperplasia
D. Metaplasia
Correct answer: D. Metaplasia
Rationale: Metaplasia is a potentially reversible replacement of one differentiated cell type by another better able to
tolerate chronic stress. Although protective initially, it can impair function and may increase neoplastic risk if the injurious
exposure continues.
4. Which feature most strongly distinguishes apoptosis from necrosis?
A. Apoptosis is regulated cell death that usually limits inflammation
B. Apoptosis invariably causes cell rupture and intense inflammation
C. Necrosis requires energy-dependent activation of a caspase cascade
D. Necrosis is always a normal programmed process
Correct answer: A. Apoptosis is regulated cell death that usually limits inflammation
Rationale: Apoptosis is an organized, energy-dependent process that packages cellular contents for removal, usually
with minimal inflammation. Necrosis commonly follows severe injury, with membrane disruption and release of
intracellular contents that provoke inflammation.
5. A cell exposed to a brief ischemic episode develops swelling but recovers after blood flow is restored. This is
best classified as:
A. Coagulative necrosis
B. Irreversible mitochondrial failure
C. Apoptosis caused by gene activation
D. Reversible cell injury
Correct answer: D. Reversible cell injury
Rationale: Cellular swelling can occur when ATP depletion impairs membrane ion pumps. If perfusion returns before
severe membrane and mitochondrial damage develops, the injury may be reversible and normal cellular function can
recover.
6. Why does sustained ischemia frequently cause tissue injury?
A. It prevents all intracellular calcium movement
B. Reduced oxygen limits oxidative phosphorylation and ATP production
C. It immediately increases DNA repair in every cell
D. It increases ATP production beyond cellular needs
Correct answer: B. Reduced oxygen limits oxidative phosphorylation and ATP production
Rationale: Oxygen is needed for oxidative phosphorylation, a major source of cellular ATP. ATP depletion disrupts ion
gradients, protein synthesis, and membrane integrity; prolonged ischemia can progress to irreversible injury and cell
death.
NR 283 Practice Guide | Page 2
, NR 283 PATHOPHYSIOLOGY | 2026 PRACTICE STUDY GUIDE
7. Which change is most directly associated with free-radical-mediated cellular injury?
A. Permanent activation of every antioxidant enzyme
B. Oxidation of membrane lipids and damage to proteins or DNA
C. Selective destruction of extracellular sodium only
D. Increased membrane stability in all tissues
Correct answer: B. Oxidation of membrane lipids and damage to proteins or DNA
Rationale: Reactive oxygen species can oxidize lipids, proteins, and nucleic acids. Antioxidant systems limit this
damage, but excessive production or impaired clearance can overwhelm defenses and contribute to inflammation, aging,
and tissue injury.
8. A mutation changes a codon so that it specifies a different amino acid. What type of mutation is this?
A. Nonsense mutation
B. Chromosomal nondisjunction
C. Silent mutation
D. Missense mutation
Correct answer: D. Missense mutation
Rationale: A missense mutation changes an amino acid in the encoded protein and may alter folding or function. A
nonsense mutation creates a premature stop codon, a silent mutation does not change the encoded amino acid, and
nondisjunction is chromosome-separation failure.
9. Two unaffected parents each carry one pathogenic autosomal-recessive allele. What is the probability that
each pregnancy will produce an affected child?
A. 25%
B. 50%
C. 75%
D. 0%
Correct answer: A. 25%
Rationale: For two heterozygous carriers, each pregnancy has a one-in-four probability of inheriting both pathogenic
alleles. The probability applies independently to each pregnancy and does not depend on the outcomes of previous
pregnancies.
10. A disorder is autosomal dominant. An affected heterozygous parent and an unaffected noncarrier parent
have a child. What is the probability the child inherits the disorder-causing allele?
A. 100%
B. 25%
C. 0%
D. 50%
Correct answer: D. 50%
Rationale: A heterozygous affected parent has one pathogenic and one typical allele, and either can be transmitted.
Each child therefore has a 50% chance of inheriting the pathogenic allele, assuming the other parent does not carry it.
11. Which statement correctly describes a sex-linked recessive condition associated with a gene on the X
chromosome?
A. An affected father transmits his X chromosome to all sons
B. Only males can inherit an X-linked allele
C. An affected father transmits his X chromosome to all daughters but not to his sons
D. Every daughter of a carrier mother must be affected
Correct answer: C. An affected father transmits his X chromosome to all daughters but not to his sons
Rationale: A father gives his X chromosome to daughters and his Y chromosome to sons. The clinical result in
daughters depends on the mother’s allele and the specific condition; sons receive their X chromosome from their mother.
NR 283 Practice Guide | Page 3
, NR 283 PATHOPHYSIOLOGY | 2026 PRACTICE STUDY GUIDE
12. A chromosome is present in three copies rather than the usual two. This is an example of:
A. Monosomy
B. Polygenic inheritance
C. Trisomy
D. Translocation only
Correct answer: C. Trisomy
Rationale: Trisomy is the presence of an extra copy of a chromosome. It commonly results from nondisjunction during
cell division; monosomy means a missing chromosome copy, while translocation involves rearrangement of
chromosomal material.
13. Which term describes the observable characteristics resulting from genotype and environmental influences?
A. Karyotype
B. Phenotype
C. Allele frequency
D. Genetic locus
Correct answer: B. Phenotype
Rationale: Phenotype refers to observable traits, which arise from genetic factors interacting with environmental
influences. Genotype refers to the genetic makeup, while a karyotype depicts chromosome number and structure.
14. A disease results from multiple genes interacting with nutrition, activity, and other exposures. It is best
described as:
A. Multifactorial
B. Always autosomal recessive
C. A condition caused only by a single chromosomal deletion
D. Strictly mitochondrial in every case
Correct answer: A. Multifactorial
Rationale: Multifactorial conditions reflect combined genetic and environmental influences rather than a single
inheritance pattern. Many common disorders have this pattern, so risk is informed by family history and modifiable
exposures, not by one gene alone.
15. Which mechanism most directly causes edema during increased capillary hydrostatic pressure?
A. Lymphatic drainage necessarily increases above capacity
B. Plasma proteins are synthesized faster than normal
C. Intracellular water is converted into plasma proteins
D. Fluid moves from capillaries into the interstitial space
Correct answer: D. Fluid moves from capillaries into the interstitial space
Rationale: Higher capillary hydrostatic pressure favors outward filtration of fluid into tissues. If lymphatic return cannot
compensate, interstitial fluid accumulates and edema develops, as may occur with venous congestion or heart failure.
16. A patient has severe hypoalbuminemia and peripheral edema. Which Starling-force change contributes most
directly?
A. Increased intracellular ATP concentration
B. Reduced interstitial fluid volume from greater lymph drainage
C. Increased plasma oncotic pressure
D. Reduced plasma oncotic pressure
Correct answer: D. Reduced plasma oncotic pressure
Rationale: Albumin is a major contributor to plasma colloid oncotic pressure, which helps retain water within the
circulation. When albumin falls, the inward osmotic force declines, favoring fluid movement into interstitial tissues.
NR 283 Practice Guide | Page 4
