NR 546 Advanced Pathophysiology Exam 1, 2 & Final Review |
Comprehensive Study Guide 2026/2027
Question 1 A client is diagnosed with metaplasia in the bronchial
epithelium. The nurse recognizes that this cellular adaptation:
• A. Is an irreversible process indicating imminent malignancy.
• B. Represents the replacement of one mature cell type with
another, often in response to chronic irritation.
• C. Results in a significant increase in the rate of DNA replication
and cell division.
• D. Is the direct result of a lack of oxygen to the bronchial tissue.
Correct Answer: B. Represents the replacement of one mature cell type
with another, often in response to chronic irritation.
Detailed Rationale: Metaplasia is a reversible cellular adaptation where
one adult cell type is replaced by another, usually better suited to
survive a stressor (e.g., columnar epithelium changing to squamous
epithelium in smokers).
Question 2 Which cellular adaptation involves a decrease in cell size and
functional capacity due to disuse, ischemia, or nutrient deprivation?
• A. Hypertrophy
• B. Hyperplasia
• C. Atrophy
• D. Dysplasia
,Correct Answer: C. Atrophy
Detailed Rationale: Atrophy is the shrinkage of cell size and reduction in
functional capacity in response to normal or pathological stimuli such as
reduced workload, aging, or diminished blood supply.
Question 3 A patient experiences myocardial hypertrophy due to
chronic hypertension. The underlying cellular mechanism of this
adaptation is:
• A. An increase in the total number of cells through accelerated
mitosis.
• B. An increase in protein synthesis and cellular components due to
increased workload.
• C. The replacement of injured myocardial muscle cells with fibrous
scar tissue.
• D. A temporary reduction in metabolic requirements to survive
hypoxia.
Correct Answer: B. An increase in protein synthesis and cellular
components due to increased workload.
Detailed Rationale: Hypertrophy involves an increase in the size of cells
and functional tissue mass resulting from increased workload or
mechanical stress, characterized by enhanced protein synthesis.
Question 4 Which type of necrosis is most commonly associated with
ischemic injury in the brain, characterized by enzymatic digestion and
liquefaction of tissue?
• A. Coagulative necrosis
, • B. Caseous necrosis
• C. Liquefactive necrosis
• D. Fat necrosis
Correct Answer: C. Liquefactive necrosis
Detailed Rationale: Liquefactive necrosis occurs when ischemic injury
leads to cellular breakdown by hydrolytic enzymes, creating a fluid-filled
lesion, commonly seen in the brain due to high lipid and enzyme
content.
Question 5 What is the primary pathological mechanism responsible for
cell injury during ischemia-reperfusion events?
• A. Depletion of intracellular ATP followed by a massive surge of
reactive oxygen species (ROS).
• B. Complete permanent cessation of all cellular enzymatic
reactions.
• C. Uncontrolled extracellular potassium accumulation leading to
hyperpolarization.
• D. Immediate activation of apoptosis via the extrinsic Fas ligand
pathway.
Correct Answer: A. Depletion of intracellular ATP followed by a massive
surge of reactive oxygen species (ROS).
Detailed Rationale: Restoration of blood flow to ischemic tissue
paradoxically damages cells by triggering a massive burst of reactive
oxygen species (ROS), causing oxidative stress, membrane lipid
peroxidation, and calcium overload.
, Question 6 During an acute inflammatory response, which vascular
event occurs first to facilitate leukocyte emigration?
• A. Vasoconstriction followed by rapid vasodilation and increased
vascular permeability.
• B. Permanent closure of post-capillary venules to prevent systemic
pathogen spread.
• C. Massive interstitial fluid absorption driven by high plasma
oncotic pressure.
• D. Immediate proliferation of endothelial lining cells to reinforce
vessel walls.
Correct Answer: A. Vasoconstriction followed by rapid vasodilation and
increased vascular permeability.
Detailed Rationale: Acute inflammation begins with transient arteriolar
vasoconstriction, immediately followed by sustained vasodilation
(causing redness and warmth) and increased vascular permeability
(causing exudation and edema).
Question 7 Which chemical mediator is primarily responsible for
inducing pain and fever during the inflammatory process?
• A. Histamine
• B. Prostaglandins
• C. Nitric oxide
• D. Complement protein C3b
Correct Answer: B. Prostaglandins
Comprehensive Study Guide 2026/2027
Question 1 A client is diagnosed with metaplasia in the bronchial
epithelium. The nurse recognizes that this cellular adaptation:
• A. Is an irreversible process indicating imminent malignancy.
• B. Represents the replacement of one mature cell type with
another, often in response to chronic irritation.
• C. Results in a significant increase in the rate of DNA replication
and cell division.
• D. Is the direct result of a lack of oxygen to the bronchial tissue.
Correct Answer: B. Represents the replacement of one mature cell type
with another, often in response to chronic irritation.
Detailed Rationale: Metaplasia is a reversible cellular adaptation where
one adult cell type is replaced by another, usually better suited to
survive a stressor (e.g., columnar epithelium changing to squamous
epithelium in smokers).
Question 2 Which cellular adaptation involves a decrease in cell size and
functional capacity due to disuse, ischemia, or nutrient deprivation?
• A. Hypertrophy
• B. Hyperplasia
• C. Atrophy
• D. Dysplasia
,Correct Answer: C. Atrophy
Detailed Rationale: Atrophy is the shrinkage of cell size and reduction in
functional capacity in response to normal or pathological stimuli such as
reduced workload, aging, or diminished blood supply.
Question 3 A patient experiences myocardial hypertrophy due to
chronic hypertension. The underlying cellular mechanism of this
adaptation is:
• A. An increase in the total number of cells through accelerated
mitosis.
• B. An increase in protein synthesis and cellular components due to
increased workload.
• C. The replacement of injured myocardial muscle cells with fibrous
scar tissue.
• D. A temporary reduction in metabolic requirements to survive
hypoxia.
Correct Answer: B. An increase in protein synthesis and cellular
components due to increased workload.
Detailed Rationale: Hypertrophy involves an increase in the size of cells
and functional tissue mass resulting from increased workload or
mechanical stress, characterized by enhanced protein synthesis.
Question 4 Which type of necrosis is most commonly associated with
ischemic injury in the brain, characterized by enzymatic digestion and
liquefaction of tissue?
• A. Coagulative necrosis
, • B. Caseous necrosis
• C. Liquefactive necrosis
• D. Fat necrosis
Correct Answer: C. Liquefactive necrosis
Detailed Rationale: Liquefactive necrosis occurs when ischemic injury
leads to cellular breakdown by hydrolytic enzymes, creating a fluid-filled
lesion, commonly seen in the brain due to high lipid and enzyme
content.
Question 5 What is the primary pathological mechanism responsible for
cell injury during ischemia-reperfusion events?
• A. Depletion of intracellular ATP followed by a massive surge of
reactive oxygen species (ROS).
• B. Complete permanent cessation of all cellular enzymatic
reactions.
• C. Uncontrolled extracellular potassium accumulation leading to
hyperpolarization.
• D. Immediate activation of apoptosis via the extrinsic Fas ligand
pathway.
Correct Answer: A. Depletion of intracellular ATP followed by a massive
surge of reactive oxygen species (ROS).
Detailed Rationale: Restoration of blood flow to ischemic tissue
paradoxically damages cells by triggering a massive burst of reactive
oxygen species (ROS), causing oxidative stress, membrane lipid
peroxidation, and calcium overload.
, Question 6 During an acute inflammatory response, which vascular
event occurs first to facilitate leukocyte emigration?
• A. Vasoconstriction followed by rapid vasodilation and increased
vascular permeability.
• B. Permanent closure of post-capillary venules to prevent systemic
pathogen spread.
• C. Massive interstitial fluid absorption driven by high plasma
oncotic pressure.
• D. Immediate proliferation of endothelial lining cells to reinforce
vessel walls.
Correct Answer: A. Vasoconstriction followed by rapid vasodilation and
increased vascular permeability.
Detailed Rationale: Acute inflammation begins with transient arteriolar
vasoconstriction, immediately followed by sustained vasodilation
(causing redness and warmth) and increased vascular permeability
(causing exudation and edema).
Question 7 Which chemical mediator is primarily responsible for
inducing pain and fever during the inflammatory process?
• A. Histamine
• B. Prostaglandins
• C. Nitric oxide
• D. Complement protein C3b
Correct Answer: B. Prostaglandins
