NURS 5433 Midterm Exam: Advanced
Pathophysiology
Section 1: Cellular Adaptation, Injury, and Death (Multiple Choice)
1. A patient with a history of chronic alcohol abuse presents with enlarged liver. Biopsy
reveals increased amounts of smooth endoplasmic reticulum and fatty changes. Which
of the following cellular adaptations has occurred?
A) Atrophy
B) Hypertrophy
C) Hyperplasia
D) Dysplasia
Answer: B) Hypertrophy
*Rationale:* Hypertrophy is an increase in cell size, often due to increased workload
or hormonal stimulation. In the case of chronic alcohol use, the liver cells adapt by
increasing smooth ER to metabolize the alcohol (leading to tolerance) and
accumulating fat (fatty change). Hyperplasia is an increase in cell number, atrophy is a
decrease in size, and dysplia is abnormal cell growth.
2. A patient suffers a myocardial infarction. Lab results show elevated levels of cardiac
troponin released into the bloodstream. Which type of cellular injury is primarily
responsible for this finding?
A) Reversible injury
B) Irreversible injury with necrosis
C) Apoptosis
D) Ischemic hypoxia
Answer: B) Irreversible injury with necrosis
, *Rationale:* The release of intracellular enzymes (like troponin, CK-MB, or LDH) into
the blood indicates severe damage to the cell membrane, which is the hallmark of
irreversible injury leading to necrosis.
3. Which of the following statements best describes apoptosis?
A) It always triggers a severe inflammatory response in surrounding tissues.
B) It is a pathological process usually caused by external toxins.
C) It is programmed cell death that eliminates damaged or unnecessary cells without
causing inflammation.
D) It results in cellular swelling and rupture of the plasma membrane.
Answer: C) It is programmed cell death that eliminates damaged or unnecessary cells
without causing inflammation.
*Rationale:* Apoptosis is an energy-dependent, tightly regulated process. Unlike
necrosis, it does not rupture the cell membrane or cause inflammation (no cellular
contents leak out). It is often physiological (e.g., embryonic development) but can be
pathological (e.g., viral infections).
Section 2: Fluids, Electrolytes, and Acid-Base Balance
4. A 65-year-old female with congestive heart failure presents with generalized
edema, weight gain, and a serum sodium level of 128 mEq/L. Which of the following
mechanisms best explains her hyponatremia?
A) Hypervolemic hyponatremia due to decreased effective circulating volume and
excess ADH secretion.
B) Hypovolemic hyponatremia due to severe diarrhea.
C) Euvolemic hyponatremia due to SIADH.
D) Hypervolemic hyponatremia due to primary hyperaldosteronism.
Answer: A) Hypervolemic hyponatremia due to decreased effective circulating volume
and excess ADH secretion.
Pathophysiology
Section 1: Cellular Adaptation, Injury, and Death (Multiple Choice)
1. A patient with a history of chronic alcohol abuse presents with enlarged liver. Biopsy
reveals increased amounts of smooth endoplasmic reticulum and fatty changes. Which
of the following cellular adaptations has occurred?
A) Atrophy
B) Hypertrophy
C) Hyperplasia
D) Dysplasia
Answer: B) Hypertrophy
*Rationale:* Hypertrophy is an increase in cell size, often due to increased workload
or hormonal stimulation. In the case of chronic alcohol use, the liver cells adapt by
increasing smooth ER to metabolize the alcohol (leading to tolerance) and
accumulating fat (fatty change). Hyperplasia is an increase in cell number, atrophy is a
decrease in size, and dysplia is abnormal cell growth.
2. A patient suffers a myocardial infarction. Lab results show elevated levels of cardiac
troponin released into the bloodstream. Which type of cellular injury is primarily
responsible for this finding?
A) Reversible injury
B) Irreversible injury with necrosis
C) Apoptosis
D) Ischemic hypoxia
Answer: B) Irreversible injury with necrosis
, *Rationale:* The release of intracellular enzymes (like troponin, CK-MB, or LDH) into
the blood indicates severe damage to the cell membrane, which is the hallmark of
irreversible injury leading to necrosis.
3. Which of the following statements best describes apoptosis?
A) It always triggers a severe inflammatory response in surrounding tissues.
B) It is a pathological process usually caused by external toxins.
C) It is programmed cell death that eliminates damaged or unnecessary cells without
causing inflammation.
D) It results in cellular swelling and rupture of the plasma membrane.
Answer: C) It is programmed cell death that eliminates damaged or unnecessary cells
without causing inflammation.
*Rationale:* Apoptosis is an energy-dependent, tightly regulated process. Unlike
necrosis, it does not rupture the cell membrane or cause inflammation (no cellular
contents leak out). It is often physiological (e.g., embryonic development) but can be
pathological (e.g., viral infections).
Section 2: Fluids, Electrolytes, and Acid-Base Balance
4. A 65-year-old female with congestive heart failure presents with generalized
edema, weight gain, and a serum sodium level of 128 mEq/L. Which of the following
mechanisms best explains her hyponatremia?
A) Hypervolemic hyponatremia due to decreased effective circulating volume and
excess ADH secretion.
B) Hypovolemic hyponatremia due to severe diarrhea.
C) Euvolemic hyponatremia due to SIADH.
D) Hypervolemic hyponatremia due to primary hyperaldosteronism.
Answer: A) Hypervolemic hyponatremia due to decreased effective circulating volume
and excess ADH secretion.
