NURS 231 FINAL EXAM (2026/2027) PATHOPHYSIOLOGY –
PORTAGE LEARNING
200 PRACTICE QUESTIONS WITH ANSWERS & EXPLANATIONS
CELLULAR PATHOPHYSIOLOGY & ADAPTATION (1–25)
1. A bodybuilder increases the size of their biceps through weightlifting. What cellular adaptation is
occurring?
A. Hyperplasia
B. Atrophy
C. Hypertrophy
D. Metaplasia
Answer: C
Explanation: Hypertrophy is an increase in the size of existing cells without increasing their number,
caused by increased workload (e.g., weightlifting). Hyperplasia would be an increase in cell number,
which does not occur in mature skeletal muscle.
2. A patient has an enlarged uterus due to pregnancy. This is an example of what cellular adaptation?
A. Hypertrophy
B. Hyperplasia
C. Atrophy
D. Metaplasia
Answer: B
Explanation: Pregnancy stimulates estrogen‑driven hyperplasia (increased cell number) of uterine
smooth muscle, combined with some hypertrophy. The dominant mechanism in early pregnancy is
hyperplasia.
3. True/False: A bodybuilder’s muscles will display hyperplasia.
A. True
B. False
,Answer: B
Explanation: False. Skeletal muscle fibers cannot divide; they only enlarge (hypertrophy). Hyperplasia
does not occur in mature skeletal muscle.
4. What is the primary difference between apoptosis and necrosis?
A. Necrosis is programmed; apoptosis is uncontrolled
B. Apoptosis triggers inflammation; necrosis does not
C. Apoptosis is programmed, energy‑dependent cell death that does not trigger inflammation
D. Both cause severe inflammation
Answer: C
Explanation: Apoptosis is an orderly, ATP‑requiring process that eliminates single cells without releasing
cellular contents, thus no inflammation. Necrosis is unregulated, swells cells, ruptures membranes, and
triggers inflammation.
5. True/False: Hypertrophy can occur under normal and pathological conditions.
A. True
B. False
Answer: A
Explanation: True. Physiological hypertrophy occurs in skeletal muscle with exercise; pathological
hypertrophy occurs in cardiac muscle due to hypertension.
6. A patient has chronic GERD. The esophageal cells change from stratified squamous to columnar
epithelium. What is this cellular adaptation called?
A. Dysplasia
B. Hyperplasia
C. Metaplasia
D. Hypertrophy
Answer: C
Explanation: Metaplasia is the reversible replacement of one differentiated cell type with another
(squamous → columnar) to better withstand chronic acid exposure. This is Barrett esophagus.
,7. Which of the following best defines hypertrophy?
A. Increase in cell number
B. Increase in cell size
C. Replacement of one cell type with another
D. Programmed cell death
Answer: B
Explanation: By definition, hypertrophy refers specifically to increased cell size, leading to organ
enlargement.
8. True/False: Barrett esophagus is an example of dysplasia.
A. True
B. False
Answer: B
Explanation: False. Barrett esophagus is metaplasia (squamous to columnar). Dysplasia is disordered cell
growth, often a precursor to cancer, but not the initial change in GERD.
9. What process describes a decrease in cell size due to loss of cellular substance?
A. Hyperplasia
B. Hypertrophy
C. Atrophy
D. Metaplasia
Answer: C
Explanation: Atrophy results from decreased workload, denervation, reduced blood supply, or
malnutrition, leading to smaller cell size and reduced function.
10. True/False: Persistent metaplasia can lead to dysplasia.
A. True
B. False
Answer: A
, Explanation: True. Chronic stress causes metaplasia; if the insult continues, the metaplastic epithelium
may undergo dysplastic changes, which are premalignant.
11. What is a key feature of apoptosis?
A. Causes significant inflammation
B. Eliminates damaged cells without inflammation
C. Always increases cell numbers
D. Occurs only in cancer cells
Answer: B
Explanation: Apoptosis eliminates unwanted or damaged cells (e.g., during development, immune
regulation) without releasing intracellular contents, so no inflammatory response is triggered.
12. A patient experiences a myocardial infarction. Ischemic cells show swelling due to influx of sodium
and water. What is this manifestation called?
A. Metaplasia
B. Hydropic swelling (oncosis)
C. Apoptosis
D. Dysplasia
Answer: B
Explanation: Hydropic swelling (or oncosis) is an early reversible change from ATP depletion → Na⁺/K⁺
pump failure → sodium and water enter the cell, causing swelling.
13. Which organelle contains enzymes that cause autodigestion if leaked?
A. Mitochondria
B. Ribosomes
C. Lysosome
D. Nucleus
Answer: C
Explanation: Lysosomes contain acid hydrolases that digest cellular components. If membranes rupture,
these enzymes cause autolysis (self‑digestion) of the cell.
PORTAGE LEARNING
200 PRACTICE QUESTIONS WITH ANSWERS & EXPLANATIONS
CELLULAR PATHOPHYSIOLOGY & ADAPTATION (1–25)
1. A bodybuilder increases the size of their biceps through weightlifting. What cellular adaptation is
occurring?
A. Hyperplasia
B. Atrophy
C. Hypertrophy
D. Metaplasia
Answer: C
Explanation: Hypertrophy is an increase in the size of existing cells without increasing their number,
caused by increased workload (e.g., weightlifting). Hyperplasia would be an increase in cell number,
which does not occur in mature skeletal muscle.
2. A patient has an enlarged uterus due to pregnancy. This is an example of what cellular adaptation?
A. Hypertrophy
B. Hyperplasia
C. Atrophy
D. Metaplasia
Answer: B
Explanation: Pregnancy stimulates estrogen‑driven hyperplasia (increased cell number) of uterine
smooth muscle, combined with some hypertrophy. The dominant mechanism in early pregnancy is
hyperplasia.
3. True/False: A bodybuilder’s muscles will display hyperplasia.
A. True
B. False
,Answer: B
Explanation: False. Skeletal muscle fibers cannot divide; they only enlarge (hypertrophy). Hyperplasia
does not occur in mature skeletal muscle.
4. What is the primary difference between apoptosis and necrosis?
A. Necrosis is programmed; apoptosis is uncontrolled
B. Apoptosis triggers inflammation; necrosis does not
C. Apoptosis is programmed, energy‑dependent cell death that does not trigger inflammation
D. Both cause severe inflammation
Answer: C
Explanation: Apoptosis is an orderly, ATP‑requiring process that eliminates single cells without releasing
cellular contents, thus no inflammation. Necrosis is unregulated, swells cells, ruptures membranes, and
triggers inflammation.
5. True/False: Hypertrophy can occur under normal and pathological conditions.
A. True
B. False
Answer: A
Explanation: True. Physiological hypertrophy occurs in skeletal muscle with exercise; pathological
hypertrophy occurs in cardiac muscle due to hypertension.
6. A patient has chronic GERD. The esophageal cells change from stratified squamous to columnar
epithelium. What is this cellular adaptation called?
A. Dysplasia
B. Hyperplasia
C. Metaplasia
D. Hypertrophy
Answer: C
Explanation: Metaplasia is the reversible replacement of one differentiated cell type with another
(squamous → columnar) to better withstand chronic acid exposure. This is Barrett esophagus.
,7. Which of the following best defines hypertrophy?
A. Increase in cell number
B. Increase in cell size
C. Replacement of one cell type with another
D. Programmed cell death
Answer: B
Explanation: By definition, hypertrophy refers specifically to increased cell size, leading to organ
enlargement.
8. True/False: Barrett esophagus is an example of dysplasia.
A. True
B. False
Answer: B
Explanation: False. Barrett esophagus is metaplasia (squamous to columnar). Dysplasia is disordered cell
growth, often a precursor to cancer, but not the initial change in GERD.
9. What process describes a decrease in cell size due to loss of cellular substance?
A. Hyperplasia
B. Hypertrophy
C. Atrophy
D. Metaplasia
Answer: C
Explanation: Atrophy results from decreased workload, denervation, reduced blood supply, or
malnutrition, leading to smaller cell size and reduced function.
10. True/False: Persistent metaplasia can lead to dysplasia.
A. True
B. False
Answer: A
, Explanation: True. Chronic stress causes metaplasia; if the insult continues, the metaplastic epithelium
may undergo dysplastic changes, which are premalignant.
11. What is a key feature of apoptosis?
A. Causes significant inflammation
B. Eliminates damaged cells without inflammation
C. Always increases cell numbers
D. Occurs only in cancer cells
Answer: B
Explanation: Apoptosis eliminates unwanted or damaged cells (e.g., during development, immune
regulation) without releasing intracellular contents, so no inflammatory response is triggered.
12. A patient experiences a myocardial infarction. Ischemic cells show swelling due to influx of sodium
and water. What is this manifestation called?
A. Metaplasia
B. Hydropic swelling (oncosis)
C. Apoptosis
D. Dysplasia
Answer: B
Explanation: Hydropic swelling (or oncosis) is an early reversible change from ATP depletion → Na⁺/K⁺
pump failure → sodium and water enter the cell, causing swelling.
13. Which organelle contains enzymes that cause autodigestion if leaked?
A. Mitochondria
B. Ribosomes
C. Lysosome
D. Nucleus
Answer: C
Explanation: Lysosomes contain acid hydrolases that digest cellular components. If membranes rupture,
these enzymes cause autolysis (self‑digestion) of the cell.
