NSG 5140 Midterm Exam Review: Advanced Pathophysiology
South College – 150 Practice Questions with Answers &
Rationales (2026/2027) Instant Pdf Download
About the NSG 5140 Midterm Exam
This comprehensive review is designed for graduate nursing students preparing for the
NSG 5140 Advanced Pathophysiology midterm at South College. The exam evaluates
understanding of disease mechanisms, clinical reasoning, and application to patient care
across ten core domains .
Core Domains Tested:
Cellular Adaptation and Injury
Inflammation and Immunity
Genetics and Genomic Disorders
Fluid, Electrolyte, and Acid-Base Balance
Neuropathophysiology
Cardiovascular Pathophysiology
Respiratory Pathophysiology
Renal and Urinary Tract Pathophysiology
Endocrine and Metabolic Disorders
Gastrointestinal and Hepatobiliary Pathophysiology
Section 1: Cellular Adaptation and Injury (Questions 1-20)
1. What is the primary mechanism of cellular injury in hypoxia?
A) Free radical damage
B) ATP depletion leading to loss of ion homeostasis
C) DNA mutation
D) Lipid peroxidation
,Answer: B
Rationale: Hypoxia limits oxidative phosphorylation, decreasing ATP production. This leads
to failure of the Na⁺/K⁺ ATPase pump, causing cellular swelling and eventual cell death .
2. A patient with chronic hypertension develops left ventricular wall thickening.
Which mechanism best explains this adaptation?
A) Increased myocyte number due to cell division
B) Increased myocyte size due to increased workload
C) Replacement of cardiac cells with fibrous tissue
D) Transformation of cardiac cells into smooth muscle
Answer: B
Rationale: Cardiac myocytes are terminally differentiated and respond to increased
workload (afterload) by hypertrophy (increased cell size), not hyperplasia .
3. Which of the following is the hallmark of reversible cell injury?
A) Nuclear pyknosis
B) Cellular swelling
C) Karyorrhexis
D) Apoptosis
Answer: B
Rationale: Reversible injury often involves failure of ion pumps leading to water influx and
cell swelling. This occurs before irreversible changes like nuclear pyknosis or karyorrhexis .
4. A 65-year-old male with chronic heart failure presents with worsening dyspnea and
peripheral edema. Which cellular adaptation is most likely occurring in his
myocardial tissue in response to prolonged pressure overload?
A) Hyperplasia
B) Atrophy
C) Metaplasia
D) Hypertrophy
Answer: D
Rationale: Hypertrophy is an increase in individual cell size due to increased workload, as
seen in myocardial cells responding to chronic pressure overload. Hyperplasia is increased
cell number, rare in cardiac muscle .
,5. Which organ is most susceptible to ischemia?
A) Liver
B) Kidney
C) Brain
D) Skeletal muscle
Answer: C
Rationale: The brain is highly metabolically active and has minimal energy stores, making it
the organ most vulnerable to ischemic injury .
6. In which organelle do the TCA cycle and fatty acid oxidation occur?
A) Nucleus
B) Ribosome
C) Mitochondrion
D) Golgi apparatus
Answer: C
Rationale: Mitochondria are known as the "powerhouse" of the cell due to their role in
oxidative phosphorylation, ATP generation, and housing the TCA cycle and fatty acid
oxidation pathways .
7. Which process best explains tissue enlargement caused by an increased number
of cells?
A) Hyperplasia
B) Atrophy
C) Dysplasia
D) Necrosis
Answer: A
Rationale: Hyperplasia is an increase in the number of cells, often in response to hormonal
or growth signals .
8. A patient with prolonged ischemia due to renal artery stenosis shows swelling of
mitochondria and dilation of the endoplasmic reticulum on electron microscopy.
Which phase of cell injury does this morphology represent, and what is the primary
underlying biochemical defect?
, A) Irreversible injury; massive calcium influx into mitochondria
B) Reversible injury; depletion of ATP leading to failure of ion pumps
C) Necroptosis; activation of receptor-interacting protein kinases
D) Apoptosis; cytochrome c release from mitochondria
Answer: B
Rationale: Cellular swelling with mitochondrial and ER changes is characteristic of
reversible injury, primarily due to ATP depletion causing failure of Na⁺/K⁺ ATPase and
subsequent intracellular edema. Calcium influx and mitochondrial damage are features of
irreversible injury .
9. Which of the following best describes apoptosis?
A) Uncontrolled cell death with inflammation
B) Programmed cell death with minimal inflammation
C) Necrosis due to ischemia
D) Cellular swelling leading to rupture
Answer: B
Rationale: Apoptosis is a controlled, energy-dependent process of cell death that removes
damaged or unnecessary cells without eliciting a significant inflammatory response .
10. A liver biopsy from a patient with nonalcoholic steatohepatitis (NASH) shows
hepatocytes with large fat vacuoles displacing the nucleus to the periphery. Which
cellular process is most directly responsible for this finding?
A) Hypertrophy due to increased metabolic demand
B) Intracellular accumulation of triglycerides secondary to impaired fatty acid
oxidation
C) Hyperplasia of hepatocytes following loss of neighboring cells
D) Metaplasia of hepatocytes to adipose-like cells
Answer: B
Rationale: Steatosis (fatty change) is an abnormal intracellular accumulation of
triglycerides, not a true adaptation like hypertrophy or hyperplasia. It results from
imbalances in lipid metabolism, such as increased influx or decreased oxidation .
11. Which type of necrosis is most commonly associated with myocardial infarction?
South College – 150 Practice Questions with Answers &
Rationales (2026/2027) Instant Pdf Download
About the NSG 5140 Midterm Exam
This comprehensive review is designed for graduate nursing students preparing for the
NSG 5140 Advanced Pathophysiology midterm at South College. The exam evaluates
understanding of disease mechanisms, clinical reasoning, and application to patient care
across ten core domains .
Core Domains Tested:
Cellular Adaptation and Injury
Inflammation and Immunity
Genetics and Genomic Disorders
Fluid, Electrolyte, and Acid-Base Balance
Neuropathophysiology
Cardiovascular Pathophysiology
Respiratory Pathophysiology
Renal and Urinary Tract Pathophysiology
Endocrine and Metabolic Disorders
Gastrointestinal and Hepatobiliary Pathophysiology
Section 1: Cellular Adaptation and Injury (Questions 1-20)
1. What is the primary mechanism of cellular injury in hypoxia?
A) Free radical damage
B) ATP depletion leading to loss of ion homeostasis
C) DNA mutation
D) Lipid peroxidation
,Answer: B
Rationale: Hypoxia limits oxidative phosphorylation, decreasing ATP production. This leads
to failure of the Na⁺/K⁺ ATPase pump, causing cellular swelling and eventual cell death .
2. A patient with chronic hypertension develops left ventricular wall thickening.
Which mechanism best explains this adaptation?
A) Increased myocyte number due to cell division
B) Increased myocyte size due to increased workload
C) Replacement of cardiac cells with fibrous tissue
D) Transformation of cardiac cells into smooth muscle
Answer: B
Rationale: Cardiac myocytes are terminally differentiated and respond to increased
workload (afterload) by hypertrophy (increased cell size), not hyperplasia .
3. Which of the following is the hallmark of reversible cell injury?
A) Nuclear pyknosis
B) Cellular swelling
C) Karyorrhexis
D) Apoptosis
Answer: B
Rationale: Reversible injury often involves failure of ion pumps leading to water influx and
cell swelling. This occurs before irreversible changes like nuclear pyknosis or karyorrhexis .
4. A 65-year-old male with chronic heart failure presents with worsening dyspnea and
peripheral edema. Which cellular adaptation is most likely occurring in his
myocardial tissue in response to prolonged pressure overload?
A) Hyperplasia
B) Atrophy
C) Metaplasia
D) Hypertrophy
Answer: D
Rationale: Hypertrophy is an increase in individual cell size due to increased workload, as
seen in myocardial cells responding to chronic pressure overload. Hyperplasia is increased
cell number, rare in cardiac muscle .
,5. Which organ is most susceptible to ischemia?
A) Liver
B) Kidney
C) Brain
D) Skeletal muscle
Answer: C
Rationale: The brain is highly metabolically active and has minimal energy stores, making it
the organ most vulnerable to ischemic injury .
6. In which organelle do the TCA cycle and fatty acid oxidation occur?
A) Nucleus
B) Ribosome
C) Mitochondrion
D) Golgi apparatus
Answer: C
Rationale: Mitochondria are known as the "powerhouse" of the cell due to their role in
oxidative phosphorylation, ATP generation, and housing the TCA cycle and fatty acid
oxidation pathways .
7. Which process best explains tissue enlargement caused by an increased number
of cells?
A) Hyperplasia
B) Atrophy
C) Dysplasia
D) Necrosis
Answer: A
Rationale: Hyperplasia is an increase in the number of cells, often in response to hormonal
or growth signals .
8. A patient with prolonged ischemia due to renal artery stenosis shows swelling of
mitochondria and dilation of the endoplasmic reticulum on electron microscopy.
Which phase of cell injury does this morphology represent, and what is the primary
underlying biochemical defect?
, A) Irreversible injury; massive calcium influx into mitochondria
B) Reversible injury; depletion of ATP leading to failure of ion pumps
C) Necroptosis; activation of receptor-interacting protein kinases
D) Apoptosis; cytochrome c release from mitochondria
Answer: B
Rationale: Cellular swelling with mitochondrial and ER changes is characteristic of
reversible injury, primarily due to ATP depletion causing failure of Na⁺/K⁺ ATPase and
subsequent intracellular edema. Calcium influx and mitochondrial damage are features of
irreversible injury .
9. Which of the following best describes apoptosis?
A) Uncontrolled cell death with inflammation
B) Programmed cell death with minimal inflammation
C) Necrosis due to ischemia
D) Cellular swelling leading to rupture
Answer: B
Rationale: Apoptosis is a controlled, energy-dependent process of cell death that removes
damaged or unnecessary cells without eliciting a significant inflammatory response .
10. A liver biopsy from a patient with nonalcoholic steatohepatitis (NASH) shows
hepatocytes with large fat vacuoles displacing the nucleus to the periphery. Which
cellular process is most directly responsible for this finding?
A) Hypertrophy due to increased metabolic demand
B) Intracellular accumulation of triglycerides secondary to impaired fatty acid
oxidation
C) Hyperplasia of hepatocytes following loss of neighboring cells
D) Metaplasia of hepatocytes to adipose-like cells
Answer: B
Rationale: Steatosis (fatty change) is an abnormal intracellular accumulation of
triglycerides, not a true adaptation like hypertrophy or hyperplasia. It results from
imbalances in lipid metabolism, such as increased influx or decreased oxidation .
11. Which type of necrosis is most commonly associated with myocardial infarction?
