NUR 376 Exam 1 Study Guide (2026/2027)
Concordia St. Paul – Practice Questions & Rationales
1. A client with a history of chronic hypertension
exhibits an enlarged heart on an echocardiogram.
This cellular change is best described as:
A) Atrophy
B) Hypertrophy
C) Hyperplasia
D) Metaplasia
Answer: B) Hypertrophy
Rationale: Hypertrophy is an increase in the size of
individual cells in response to increased workload or
stress. In hypertension, the heart muscle must
pump against higher resistance, causing the
myocardial cells to enlarge.
,2. A client with gastroesophageal reflux disease
(GERD) develops Barrett esophagus. This is an
example of which cellular adaptation?
A) Dysplasia
B) Metaplasia
C) Anaplasia
D) Hyperplasia
Answer: B) Metaplasia
Rationale: Metaplasia is the reversible replacement
of one mature cell type with another less mature
cell type. In Barrett esophagus, chronic acid
exposure causes the normal stratified squamous
epithelium of the esophagus to be replaced by
columnar epithelium (gastric type) to better
withstand the acid.
,3. Which type of cellular injury is primarily caused
by a lack of oxygen, leading to a failure of oxidative
phosphorylation and a decrease in ATP production?
A) Chemical injury
B) Ischemic injury
C) Immunologic injury
D) Infectious injury
Answer: B) Ischemic injury
Rationale: Ischemia (reduced blood flow) leads to
hypoxia (lack of oxygen). Without oxygen, the cell
cannot perform oxidative phosphorylation, causing
ATP depletion, failure of the sodium-potassium
pump, cellular swelling, and eventually necrosis.
4. What is the hallmark biochemical event that
distinguishes apoptosis from necrosis?
A) Cellular swelling and inflammation
B) Chromatin aggregation and caspase activation
, C) Rupture of the plasma membrane
D) Uncontrolled ATP depletion
Answer: B) Chromatin aggregation and caspase
activation
Rationale: Apoptosis is programmed, orderly cell
death. It involves cell shrinkage, chromatin
condensation, and DNA fragmentation via caspase
enzymes, without causing an inflammatory
response. Necrosis is disorderly, causes cell swelling
and rupture, and triggers inflammation.
5. A client develops elevated levels of unconjugated
bilirubin due to a hemolytic blood transfusion
reaction. Which organ is responsible for conjugating
this bilirubin?
A) Kidneys
B) Spleen
C) Liver
Concordia St. Paul – Practice Questions & Rationales
1. A client with a history of chronic hypertension
exhibits an enlarged heart on an echocardiogram.
This cellular change is best described as:
A) Atrophy
B) Hypertrophy
C) Hyperplasia
D) Metaplasia
Answer: B) Hypertrophy
Rationale: Hypertrophy is an increase in the size of
individual cells in response to increased workload or
stress. In hypertension, the heart muscle must
pump against higher resistance, causing the
myocardial cells to enlarge.
,2. A client with gastroesophageal reflux disease
(GERD) develops Barrett esophagus. This is an
example of which cellular adaptation?
A) Dysplasia
B) Metaplasia
C) Anaplasia
D) Hyperplasia
Answer: B) Metaplasia
Rationale: Metaplasia is the reversible replacement
of one mature cell type with another less mature
cell type. In Barrett esophagus, chronic acid
exposure causes the normal stratified squamous
epithelium of the esophagus to be replaced by
columnar epithelium (gastric type) to better
withstand the acid.
,3. Which type of cellular injury is primarily caused
by a lack of oxygen, leading to a failure of oxidative
phosphorylation and a decrease in ATP production?
A) Chemical injury
B) Ischemic injury
C) Immunologic injury
D) Infectious injury
Answer: B) Ischemic injury
Rationale: Ischemia (reduced blood flow) leads to
hypoxia (lack of oxygen). Without oxygen, the cell
cannot perform oxidative phosphorylation, causing
ATP depletion, failure of the sodium-potassium
pump, cellular swelling, and eventually necrosis.
4. What is the hallmark biochemical event that
distinguishes apoptosis from necrosis?
A) Cellular swelling and inflammation
B) Chromatin aggregation and caspase activation
, C) Rupture of the plasma membrane
D) Uncontrolled ATP depletion
Answer: B) Chromatin aggregation and caspase
activation
Rationale: Apoptosis is programmed, orderly cell
death. It involves cell shrinkage, chromatin
condensation, and DNA fragmentation via caspase
enzymes, without causing an inflammatory
response. Necrosis is disorderly, causes cell swelling
and rupture, and triggers inflammation.
5. A client develops elevated levels of unconjugated
bilirubin due to a hemolytic blood transfusion
reaction. Which organ is responsible for conjugating
this bilirubin?
A) Kidneys
B) Spleen
C) Liver
