NURS 5315 Exam 1 Advanced Pathophysiology
Questions and Answers| Updated| Pass Guaranteed-
UTA
1. A patient's leg has been immobilized in a cast for 6 weeks. On
removal, the thigh muscle is visibly smaller. Which cellular process
best explains this finding?
A. Decreased cell size from reduced protein synthesis and increased
protein degradation (atrophy)
B. Decreased cell number from increased apoptosis only (hypoplasia)
C. Replacement of muscle cells by a different adult cell type (metaplasia)
D. Increased cell size from increased synthesis of structural components
(hypertrophy)
Answer: A. Decreased cell size from reduced protein synthesis and
increased protein degradation (atrophy)
Rationale: Atrophy is a reversible decrease in cell size due to disuse,
denervation, ischemia, malnutrition, or loss of hormonal stimulation. It
involves decreased protein synthesis and increased degradation via the
ubiquitin-proteasome pathway and autophagy. Muscle function usually
returns with renewed use.
2. A 58-year-old with long-standing uncontrolled hypertension has left
ventricular wall thickening. Which statement best explains this
adaptation?
A. Cardiac myocytes undergo rapid mitosis, increasing cell number
(hyperplasia)
B. Cardiac myocytes transform into fibroblasts (metaplasia)
C. Cardiac myocytes lose their organization and become pleomorphic
(dysplasia)
D. Cardiac myocytes are terminally differentiated and cannot divide, so
they enlarge (hypertrophy) in response to increased workload
Answer: D. Cardiac myocytes are terminally differentiated and cannot
divide, so they enlarge (hypertrophy) in response to increased
workload
NURS 5315 Exam 1 - Page 1
,Rationale: Cardiac and skeletal muscle cells have very limited mitotic
ability, so increased workload (e.g., afterload from hypertension) produces
hypertrophy via added contractile proteins. Persistent overload eventually
outstrips blood supply and can lead to heart failure.
3. A woman has endometrial thickening due to prolonged unopposed
estrogen exposure. This is an example of:
A. Hypertrophy, an increase in cell size only
B. Metaplasia, a reversible replacement of one mature cell type with
another
C. Hyperplasia, an increase in cell number in response to hormonal
stimulation
D. Anaplasia, a loss of cell differentiation
Answer: C. Hyperplasia, an increase in cell number in response to
hormonal stimulation
Rationale: Hyperplasia is an increase in cell NUMBER in tissues capable
of mitosis. Physiologic (hormonal, compensatory) and pathologic (excess
estrogen) forms exist. It is reversible when the stimulus is removed, but
pathologic hyperplasia can be a fertile ground for dysplasia and cancer.
4. A patient with chronic GERD has biopsy findings showing
intestinal-type columnar epithelium with goblet cells replacing the
normal squamous epithelium of the distal esophagus. This is:
A. Atrophy
B. Metaplasia (Barrett esophagus)
C. Hypertrophy
D. Carcinoma in situ
Answer: B. Metaplasia (Barrett esophagus)
Rationale: Metaplasia is a reversible replacement of one differentiated cell
type with another that is better suited to withstand chronic stress (here, acid
reflux). It results from reprogramming of stem cells. Persistent stimulus
raises risk of dysplasia and adenocarcinoma.
NURS 5315 Exam 1 - Page 2
,5. Which of the following best describes dysplasia?
A. Disordered cell growth with variation in size, shape, and organization;
potentially reversible and a possible precursor to cancer
B. An irreversible loss of cellular differentiation with invasion of basement
membrane
C. A physiologic increase in cell size due to hormonal stimulation
D. A decrease in cell size due to loss of innervation
Answer: A. Disordered cell growth with variation in size, shape, and
organization; potentially reversible and a possible precursor to
cancer
Rationale: Dysplasia (atypical hyperplasia) shows pleomorphism,
abnormal nuclear changes, and disorganized architecture. It is not cancer,
and mild forms may regress if the irritant is removed, but severe dysplasia
can progress to carcinoma in situ and invasive cancer.
6. Which cellular change is considered pre-neoplastic and is
commonly seen in the cervix of a patient with persistent HPV infection?
A. Physiologic hypertrophy
B. Disuse atrophy
C. Compensatory hyperplasia
D. Dysplasia
Answer: D. Dysplasia
Rationale: Cervical dysplasia (CIN) is caused by oncogenic HPV (E6
inactivates p53; E7 inactivates Rb). It is graded by the extent of epithelial
thickness involved and is the target of Pap/HPV screening.
7. The earliest cellular response to hypoxia that leads to cellular
swelling is:
A. Increased ATP production leading to excess calcium efflux
B. Activation of the sodium-potassium pump leading to potassium loss
C. Decreased ATP production causing failure of the Na+/K+-ATPase
pump, with sodium and water entering the cell
D. Increased protein synthesis from ribosomal detachment
Answer: C. Decreased ATP production causing failure of the Na+/K+-
ATPase pump, with sodium and water entering the cell
NURS 5315 Exam 1 - Page 3
, Rationale: Oxygen is needed for oxidative phosphorylation. Without it, ATP
falls, the Na+/K+-ATPase fails, intracellular Na+ and water rise, and the cell
swells (hydropic change). This is reversible if oxygen is restored.
8. Which finding is the EARLIEST and most common sign of
reversible cell injury?
A. Karyolysis
B. Cellular swelling
C. Pyknosis
D. Rupture of lysosomes
Answer: B. Cellular swelling
Rationale: Cellular swelling reflects impaired ion/water regulation and is
the first manifestation of nearly all forms of injury. Pyknosis (nuclear
shrinkage), karyorrhexis (fragmentation), and karyolysis (dissolution) are
nuclear changes seen with irreversible injury and necrosis.
9. In hypoxic cells, a switch to anaerobic glycolysis results in which
change?
A. Accumulation of lactic acid and a decrease in intracellular pH
B. Increased ATP yield (36 ATP per glucose)
C. Increased intracellular pH and alkalosis
D. Decreased glycogen synthesis with increased fatty acid oxidation
Answer: A. Accumulation of lactic acid and a decrease in intracellular
pH
Rationale: Anaerobic glycolysis yields only 2 ATP per glucose and
generates lactic acid, lowering intracellular pH. Low pH causes chromatin
clumping and impairs enzyme function.
10. Which event marks the transition from reversible to
IRREVERSIBLE cell injury?
A. Mild cellular swelling
B. Detachment of ribosomes from the endoplasmic reticulum
C. Formation of plasma membrane blebs
D. Inability to reverse mitochondrial dysfunction and severe
plasma/lysosomal membrane damage
Answer: D. Inability to reverse mitochondrial dysfunction and severe
plasma/lysosomal membrane damage
NURS 5315 Exam 1 - Page 4
Questions and Answers| Updated| Pass Guaranteed-
UTA
1. A patient's leg has been immobilized in a cast for 6 weeks. On
removal, the thigh muscle is visibly smaller. Which cellular process
best explains this finding?
A. Decreased cell size from reduced protein synthesis and increased
protein degradation (atrophy)
B. Decreased cell number from increased apoptosis only (hypoplasia)
C. Replacement of muscle cells by a different adult cell type (metaplasia)
D. Increased cell size from increased synthesis of structural components
(hypertrophy)
Answer: A. Decreased cell size from reduced protein synthesis and
increased protein degradation (atrophy)
Rationale: Atrophy is a reversible decrease in cell size due to disuse,
denervation, ischemia, malnutrition, or loss of hormonal stimulation. It
involves decreased protein synthesis and increased degradation via the
ubiquitin-proteasome pathway and autophagy. Muscle function usually
returns with renewed use.
2. A 58-year-old with long-standing uncontrolled hypertension has left
ventricular wall thickening. Which statement best explains this
adaptation?
A. Cardiac myocytes undergo rapid mitosis, increasing cell number
(hyperplasia)
B. Cardiac myocytes transform into fibroblasts (metaplasia)
C. Cardiac myocytes lose their organization and become pleomorphic
(dysplasia)
D. Cardiac myocytes are terminally differentiated and cannot divide, so
they enlarge (hypertrophy) in response to increased workload
Answer: D. Cardiac myocytes are terminally differentiated and cannot
divide, so they enlarge (hypertrophy) in response to increased
workload
NURS 5315 Exam 1 - Page 1
,Rationale: Cardiac and skeletal muscle cells have very limited mitotic
ability, so increased workload (e.g., afterload from hypertension) produces
hypertrophy via added contractile proteins. Persistent overload eventually
outstrips blood supply and can lead to heart failure.
3. A woman has endometrial thickening due to prolonged unopposed
estrogen exposure. This is an example of:
A. Hypertrophy, an increase in cell size only
B. Metaplasia, a reversible replacement of one mature cell type with
another
C. Hyperplasia, an increase in cell number in response to hormonal
stimulation
D. Anaplasia, a loss of cell differentiation
Answer: C. Hyperplasia, an increase in cell number in response to
hormonal stimulation
Rationale: Hyperplasia is an increase in cell NUMBER in tissues capable
of mitosis. Physiologic (hormonal, compensatory) and pathologic (excess
estrogen) forms exist. It is reversible when the stimulus is removed, but
pathologic hyperplasia can be a fertile ground for dysplasia and cancer.
4. A patient with chronic GERD has biopsy findings showing
intestinal-type columnar epithelium with goblet cells replacing the
normal squamous epithelium of the distal esophagus. This is:
A. Atrophy
B. Metaplasia (Barrett esophagus)
C. Hypertrophy
D. Carcinoma in situ
Answer: B. Metaplasia (Barrett esophagus)
Rationale: Metaplasia is a reversible replacement of one differentiated cell
type with another that is better suited to withstand chronic stress (here, acid
reflux). It results from reprogramming of stem cells. Persistent stimulus
raises risk of dysplasia and adenocarcinoma.
NURS 5315 Exam 1 - Page 2
,5. Which of the following best describes dysplasia?
A. Disordered cell growth with variation in size, shape, and organization;
potentially reversible and a possible precursor to cancer
B. An irreversible loss of cellular differentiation with invasion of basement
membrane
C. A physiologic increase in cell size due to hormonal stimulation
D. A decrease in cell size due to loss of innervation
Answer: A. Disordered cell growth with variation in size, shape, and
organization; potentially reversible and a possible precursor to
cancer
Rationale: Dysplasia (atypical hyperplasia) shows pleomorphism,
abnormal nuclear changes, and disorganized architecture. It is not cancer,
and mild forms may regress if the irritant is removed, but severe dysplasia
can progress to carcinoma in situ and invasive cancer.
6. Which cellular change is considered pre-neoplastic and is
commonly seen in the cervix of a patient with persistent HPV infection?
A. Physiologic hypertrophy
B. Disuse atrophy
C. Compensatory hyperplasia
D. Dysplasia
Answer: D. Dysplasia
Rationale: Cervical dysplasia (CIN) is caused by oncogenic HPV (E6
inactivates p53; E7 inactivates Rb). It is graded by the extent of epithelial
thickness involved and is the target of Pap/HPV screening.
7. The earliest cellular response to hypoxia that leads to cellular
swelling is:
A. Increased ATP production leading to excess calcium efflux
B. Activation of the sodium-potassium pump leading to potassium loss
C. Decreased ATP production causing failure of the Na+/K+-ATPase
pump, with sodium and water entering the cell
D. Increased protein synthesis from ribosomal detachment
Answer: C. Decreased ATP production causing failure of the Na+/K+-
ATPase pump, with sodium and water entering the cell
NURS 5315 Exam 1 - Page 3
, Rationale: Oxygen is needed for oxidative phosphorylation. Without it, ATP
falls, the Na+/K+-ATPase fails, intracellular Na+ and water rise, and the cell
swells (hydropic change). This is reversible if oxygen is restored.
8. Which finding is the EARLIEST and most common sign of
reversible cell injury?
A. Karyolysis
B. Cellular swelling
C. Pyknosis
D. Rupture of lysosomes
Answer: B. Cellular swelling
Rationale: Cellular swelling reflects impaired ion/water regulation and is
the first manifestation of nearly all forms of injury. Pyknosis (nuclear
shrinkage), karyorrhexis (fragmentation), and karyolysis (dissolution) are
nuclear changes seen with irreversible injury and necrosis.
9. In hypoxic cells, a switch to anaerobic glycolysis results in which
change?
A. Accumulation of lactic acid and a decrease in intracellular pH
B. Increased ATP yield (36 ATP per glucose)
C. Increased intracellular pH and alkalosis
D. Decreased glycogen synthesis with increased fatty acid oxidation
Answer: A. Accumulation of lactic acid and a decrease in intracellular
pH
Rationale: Anaerobic glycolysis yields only 2 ATP per glucose and
generates lactic acid, lowering intracellular pH. Low pH causes chromatin
clumping and impairs enzyme function.
10. Which event marks the transition from reversible to
IRREVERSIBLE cell injury?
A. Mild cellular swelling
B. Detachment of ribosomes from the endoplasmic reticulum
C. Formation of plasma membrane blebs
D. Inability to reverse mitochondrial dysfunction and severe
plasma/lysosomal membrane damage
Answer: D. Inability to reverse mitochondrial dysfunction and severe
plasma/lysosomal membrane damage
NURS 5315 Exam 1 - Page 4
