NUR 376 Exam 1 – Applied Pathophysiology (2026)
Concordia University | Practice Questions & Rationales
1. A client with a history of chronic hypertension has an
enlarged heart on an echocardiogram. This cellular change is
best described as:
A) Atrophy
B) Hypertrophy
C) Hyperplasia
D) Metaplasia
<span style="color:red;">Answer: B) Hypertrophy</span>
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
<span style="color:red;">Answer: B) Metaplasia</span>
Rationale: Metaplasia is the reversible replacement of one
mature cell type with another less mature cell type. In Barrett
esophagus, chronic acid exposure causes normal stratified
squamous epithelium to be replaced by columnar epithelium 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
<span style="color:red;">Answer: B) Ischemic injury</span>
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
<span style="color:red;">Answer: B) Chromatin aggregation and
caspase activation</span>
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
, D) Gallbladder
<span style="color:red;">Answer: C) Liver</span>
Rationale: Unconjugated (indirect) bilirubin is a byproduct of
hemoglobin breakdown. It travels to the liver bound to albumin,
where hepatocytes conjugate it with glucuronic acid to make it
water-soluble for excretion in bile.
6. During acute inflammation, which leukocyte is typically the
first to arrive at the site of tissue injury?
A) Lymphocyte
B) Monocyte
C) Eosinophil
D) Neutrophil
<span style="color:red;">Answer: D) Neutrophil</span>
Rationale: Neutrophils are the "first responders" during the
acute phase of inflammation. They are highly mobile and
quickly migrate to the injury site to phagocytose bacteria and
cellular debris.
7. A client has a wound that heals by secondary intention.
Which characteristic is associated with this type of healing?
Concordia University | Practice Questions & Rationales
1. A client with a history of chronic hypertension has an
enlarged heart on an echocardiogram. This cellular change is
best described as:
A) Atrophy
B) Hypertrophy
C) Hyperplasia
D) Metaplasia
<span style="color:red;">Answer: B) Hypertrophy</span>
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
<span style="color:red;">Answer: B) Metaplasia</span>
Rationale: Metaplasia is the reversible replacement of one
mature cell type with another less mature cell type. In Barrett
esophagus, chronic acid exposure causes normal stratified
squamous epithelium to be replaced by columnar epithelium 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
<span style="color:red;">Answer: B) Ischemic injury</span>
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
<span style="color:red;">Answer: B) Chromatin aggregation and
caspase activation</span>
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
, D) Gallbladder
<span style="color:red;">Answer: C) Liver</span>
Rationale: Unconjugated (indirect) bilirubin is a byproduct of
hemoglobin breakdown. It travels to the liver bound to albumin,
where hepatocytes conjugate it with glucuronic acid to make it
water-soluble for excretion in bile.
6. During acute inflammation, which leukocyte is typically the
first to arrive at the site of tissue injury?
A) Lymphocyte
B) Monocyte
C) Eosinophil
D) Neutrophil
<span style="color:red;">Answer: D) Neutrophil</span>
Rationale: Neutrophils are the "first responders" during the
acute phase of inflammation. They are highly mobile and
quickly migrate to the injury site to phagocytose bacteria and
cellular debris.
7. A client has a wound that heals by secondary intention.
Which characteristic is associated with this type of healing?
