NUR 376 Final Exam Study Guide (2026/2027)
Applied Pathophysiology | Concordia St. Paul –
Comprehensive Practice Questions & Rationales
1. A client with chronic gastroesophageal reflux disease (GERD)
develops Barrett esophagus. This cellular adaptation is best
described as:
A) Hypertrophy
B) Hyperplasia
C) Metaplasia
D) Dysplasia
Answer: C) Metaplasia
Rationale: Metaplasia is the reversible replacement of one
mature cell type with another. In Barrett esophagus, chronic
acid exposure causes the normal stratified squamous
epithelium of the esophagus to be replaced by columnar
epithelium (which is more resistant to acid).
2. The fundamental pathophysiological event that initiates
irreversible cell injury during ischemia is:
A) Depletion of ATP and failure of the Na⁺/K⁺ pump
,B) Excessive production of glycogen
C) Activation of lysosomal enzymes
D) Cellular shrinkage
Answer: A) Depletion of ATP and failure of the Na⁺/K⁺ pump
Rationale: Ischemia deprives the cell of oxygen, halting
oxidative phosphorylation and ATP production. Without ATP,
the Na⁺/K⁺ pump fails, sodium and water rush into the cell
causing swelling, and calcium influx activates destructive
enzymes, leading to necrosis.
3. Which of the following is a hallmark biochemical event that
distinguishes apoptosis from necrosis?
A) Cellular swelling and rupture
B) Massive inflammatory response
C) Chromatin aggregation and caspase activation
D) Uncontrolled ATP depletion
Answer: C) Chromatin aggregation and caspase activation
Rationale: Apoptosis is programmed, orderly cell death. It
involves cell shrinkage, chromatin condensation, and DNA
fragmentation via caspase enzymes, and it does not trigger an
,inflammatory response. Necrosis is disorderly and causes
inflammation.
4. 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
Answer: D) Neutrophil
Rationale: Neutrophils are the "first responders" of the acute
inflammatory response. They are highly mobile and quickly
migrate to the injury site to phagocytose bacteria and cellular
debris.
5. A patient has a wound that heals by secondary intention.
Which characteristic is associated with this type of healing?
A) The wound edges are closely approximated.
B) There is minimal scar tissue formation.
C) The wound involves significant tissue loss and fills with
granulation tissue.
, D) The healing time is typically shorter than primary intention.
Answer: C) The wound involves significant tissue loss and fills
with granulation tissue.
Rationale: Secondary intention occurs when wound edges
cannot be approximated (e.g., large ulcers). The wound fills
from the bottom up with granulation tissue, resulting in a larger
scar and longer healing time.
6. A patient receives a mismatched blood transfusion and
experiences a massive hemolytic reaction. This is an example of
which type of hypersensitivity?
A) Type I (Anaphylactic)
B) Type II (Cytotoxic)
C) Type III (Immune complex)
D) Type IV (Delayed)
Answer: B) Type II (Cytotoxic)
Rationale: Type II hypersensitivity involves IgG or IgM
antibodies binding to antigens on the surface of target cells (like
RBCs), leading to cell lysis via complement activation or
phagocytosis.
Applied Pathophysiology | Concordia St. Paul –
Comprehensive Practice Questions & Rationales
1. A client with chronic gastroesophageal reflux disease (GERD)
develops Barrett esophagus. This cellular adaptation is best
described as:
A) Hypertrophy
B) Hyperplasia
C) Metaplasia
D) Dysplasia
Answer: C) Metaplasia
Rationale: Metaplasia is the reversible replacement of one
mature cell type with another. In Barrett esophagus, chronic
acid exposure causes the normal stratified squamous
epithelium of the esophagus to be replaced by columnar
epithelium (which is more resistant to acid).
2. The fundamental pathophysiological event that initiates
irreversible cell injury during ischemia is:
A) Depletion of ATP and failure of the Na⁺/K⁺ pump
,B) Excessive production of glycogen
C) Activation of lysosomal enzymes
D) Cellular shrinkage
Answer: A) Depletion of ATP and failure of the Na⁺/K⁺ pump
Rationale: Ischemia deprives the cell of oxygen, halting
oxidative phosphorylation and ATP production. Without ATP,
the Na⁺/K⁺ pump fails, sodium and water rush into the cell
causing swelling, and calcium influx activates destructive
enzymes, leading to necrosis.
3. Which of the following is a hallmark biochemical event that
distinguishes apoptosis from necrosis?
A) Cellular swelling and rupture
B) Massive inflammatory response
C) Chromatin aggregation and caspase activation
D) Uncontrolled ATP depletion
Answer: C) Chromatin aggregation and caspase activation
Rationale: Apoptosis is programmed, orderly cell death. It
involves cell shrinkage, chromatin condensation, and DNA
fragmentation via caspase enzymes, and it does not trigger an
,inflammatory response. Necrosis is disorderly and causes
inflammation.
4. 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
Answer: D) Neutrophil
Rationale: Neutrophils are the "first responders" of the acute
inflammatory response. They are highly mobile and quickly
migrate to the injury site to phagocytose bacteria and cellular
debris.
5. A patient has a wound that heals by secondary intention.
Which characteristic is associated with this type of healing?
A) The wound edges are closely approximated.
B) There is minimal scar tissue formation.
C) The wound involves significant tissue loss and fills with
granulation tissue.
, D) The healing time is typically shorter than primary intention.
Answer: C) The wound involves significant tissue loss and fills
with granulation tissue.
Rationale: Secondary intention occurs when wound edges
cannot be approximated (e.g., large ulcers). The wound fills
from the bottom up with granulation tissue, resulting in a larger
scar and longer healing time.
6. A patient receives a mismatched blood transfusion and
experiences a massive hemolytic reaction. This is an example of
which type of hypersensitivity?
A) Type I (Anaphylactic)
B) Type II (Cytotoxic)
C) Type III (Immune complex)
D) Type IV (Delayed)
Answer: B) Type II (Cytotoxic)
Rationale: Type II hypersensitivity involves IgG or IgM
antibodies binding to antigens on the surface of target cells (like
RBCs), leading to cell lysis via complement activation or
phagocytosis.
