NSG 530 ADVANCED HEALTH ASSESSMENT (PDF) | 2026
EXAM QUESTIONS AND ANSWERS + RATIONALES | STUDY
GUIDE | 100% CORRECT
1. Which of the following cellular adaptations is most likely to occur in the bronchial
epithelium of a patient with chronic hypoxia from COPD?
A) Hyperplasia
B) Metaplasia
C) Dysplasia
D) Anaplasia
Correct Answer: Metaplasia
Rationale: Metaplasia is the reversible replacement of one differentiated cell type with another,
often in response to chronic irritation or hypoxia. In COPD, the normal pseudostratified
columnar ciliated epithelium is replaced by stratified squamous epithelium for protection.
Hyperplasia is an increase in cell number, dysplasia is disordered growth, and anaplasia indicates
malignancy .
2. What is the primary intracellular event that leads to cellular swelling in reversible cell
injury?
A) Increased activity of the Na+/K+ pump
B) Decreased activity of the Na+/K+ pump leading to sodium and water influx
C) Rupture of the lysosomal membrane
D) Activation of caspases
Correct Answer: Decreased activity of the Na+/K+ pump leading to sodium and water influx
Rationale: In reversible cell injury, ATP depletion from hypoxia impairs the Na+/K+ pump,
causing sodium to accumulate inside the cell. Water follows by osmosis, leading to cellular
swelling (hydropic change). Lysosomal rupture and caspase activation are associated with
irreversible injury and necrosis or apoptosis .
3. A defect in which organelle would most directly impair ATP production, leading to
cellular hypoxia and necrosis?
A) Ribosome
B) Golgi apparatus
C) Mitochondria
D) Endoplasmic reticulum
Correct Answer: Mitochondria
Rationale: Mitochondria are responsible for oxidative phosphorylation and ATP production.
Hypoxia impairs mitochondrial function, leading to decreased ATP, failure of the Na+/K+ pump,
cellular swelling, and eventually necrosis. Ribosomes, Golgi, and ER are involved in protein
synthesis and processing, not primary ATP production .
, 4. The "Philadelphia chromosome" seen in some leukemias is an example of which type of
genetic mutation?
A) Point mutation
B) Frameshift mutation
C) Chromosomal translocation
D) Trinucleotide repeat
Correct Answer: Chromosomal translocation
Rationale: A translocation involves the exchange of genetic material between non-homologous
chromosomes. The Philadelphia chromosome t(9;22) leads to the BCR-ABL fusion gene,
creating a constitutively active tyrosine kinase. Point mutations affect single nucleotides,
frameshifts alter reading frames, and trinucleotide repeats involve expanded sequences .
5. Which term describes a tumor that is poorly differentiated, rapidly growing, and invading
surrounding tissues?
A) Benign
B) Malignant
C) In situ
D) Dysplastic
Correct Answer: Malignant
Rationale: Malignant tumors are characterized by rapid growth, lack of encapsulation, invasion
of surrounding tissues, poor differentiation, and high mitotic index. Benign tumors grow slowly,
are encapsulated, and do not invade. In situ lesions are confined to the epithelium, and dysplasia
involves disordered growth .
6. The "Warburg effect" in cancer biology refers to which metabolic phenomenon?
A) Increased apoptosis in tumor cells
B) Enhanced DNA repair mechanisms
C) Aerobic glycolysis even in the presence of oxygen
D) Decreased angiogenesis due to hypoxia
Correct Answer: Aerobic glycolysis even in the presence of oxygen
Rationale: The Warburg effect describes the preference of cancer cells to utilize glycolysis for
energy production, even when oxygen is available. This metabolic shift supports rapid ATP
production and provides intermediates for biosynthesis. It is not associated with apoptosis, DNA
repair, or decreased angiogenesis .
7. A 65-year-old patient has a tumor that is well-encapsulated, slow-growing, and does not
metastasize. This tumor is best described as:
A) Malignant
B) Benign
C) In situ
D) Anaplastic
, Correct Answer: Benign
Rationale: Benign tumors are well-differentiated, grow slowly, are encapsulated, do not invade
surrounding tissues, and do not metastasize. Malignant tumors are poorly differentiated,
invasive, and metastasize. In situ cancers have not invaded surrounding tissue, and anaplasia
refers to the loss of differentiation seen in malignancy .
8. The cellular swelling seen in reversible cell injury is primarily due to:
A) Increased activity of the Na+/K+ pump
B) Decreased activity of the Na+/K+ pump leading to influx of sodium and water
C) Rupture of the lysosomal membrane
D) Activation of caspases
Correct Answer: Decreased activity of the Na+/K+ pump leading to influx of sodium and water
Rationale: ATP depletion impairs the Na+/K+ pump, causing sodium to accumulate
intracellularly. Water follows, leading to cellular swelling. Lysosomal rupture and caspase
activation are hallmarks of irreversible injury and necrosis or apoptosis, not reversible injury .
9. Which genetic test is most appropriate for identifying a single gene mutation, such as the
delta-F508 mutation in cystic fibrosis?
A) Karyotype
B) Fluorescence in situ hybridization (FISH)
C) Polymerase chain reaction (PCR) and sequencing
D) Microarray
Correct Answer: Polymerase chain reaction (PCR) and sequencing
Rationale: PCR amplifies specific DNA sequences, and sequencing identifies the exact
nucleotide changes, making it ideal for identifying single-gene mutations. Karyotype detects
chromosomal abnormalities, FISH detects specific chromosomal regions, and microarray
identifies copy number variations .
10. A patient with chronic bronchitis has undergone metaplasia of his bronchial epithelium.
What is the primary benefit of this change?
A) It restores normal ciliary function.
B) It provides a more resistant lining to chronic irritation.
C) It decreases the risk of malignant transformation.
D) It increases mucus production.
Correct Answer: It provides a more resistant lining to chronic irritation.
Rationale: Metaplasia is an adaptive change where one cell type is replaced by another that is
better suited to withstand chronic stress or irritation. In the airways, this provides a more
resistant but less functional lining. It does not restore ciliary function, may increase cancer risk if
dysplasia follows, and does not directly increase mucus production .
EXAM QUESTIONS AND ANSWERS + RATIONALES | STUDY
GUIDE | 100% CORRECT
1. Which of the following cellular adaptations is most likely to occur in the bronchial
epithelium of a patient with chronic hypoxia from COPD?
A) Hyperplasia
B) Metaplasia
C) Dysplasia
D) Anaplasia
Correct Answer: Metaplasia
Rationale: Metaplasia is the reversible replacement of one differentiated cell type with another,
often in response to chronic irritation or hypoxia. In COPD, the normal pseudostratified
columnar ciliated epithelium is replaced by stratified squamous epithelium for protection.
Hyperplasia is an increase in cell number, dysplasia is disordered growth, and anaplasia indicates
malignancy .
2. What is the primary intracellular event that leads to cellular swelling in reversible cell
injury?
A) Increased activity of the Na+/K+ pump
B) Decreased activity of the Na+/K+ pump leading to sodium and water influx
C) Rupture of the lysosomal membrane
D) Activation of caspases
Correct Answer: Decreased activity of the Na+/K+ pump leading to sodium and water influx
Rationale: In reversible cell injury, ATP depletion from hypoxia impairs the Na+/K+ pump,
causing sodium to accumulate inside the cell. Water follows by osmosis, leading to cellular
swelling (hydropic change). Lysosomal rupture and caspase activation are associated with
irreversible injury and necrosis or apoptosis .
3. A defect in which organelle would most directly impair ATP production, leading to
cellular hypoxia and necrosis?
A) Ribosome
B) Golgi apparatus
C) Mitochondria
D) Endoplasmic reticulum
Correct Answer: Mitochondria
Rationale: Mitochondria are responsible for oxidative phosphorylation and ATP production.
Hypoxia impairs mitochondrial function, leading to decreased ATP, failure of the Na+/K+ pump,
cellular swelling, and eventually necrosis. Ribosomes, Golgi, and ER are involved in protein
synthesis and processing, not primary ATP production .
, 4. The "Philadelphia chromosome" seen in some leukemias is an example of which type of
genetic mutation?
A) Point mutation
B) Frameshift mutation
C) Chromosomal translocation
D) Trinucleotide repeat
Correct Answer: Chromosomal translocation
Rationale: A translocation involves the exchange of genetic material between non-homologous
chromosomes. The Philadelphia chromosome t(9;22) leads to the BCR-ABL fusion gene,
creating a constitutively active tyrosine kinase. Point mutations affect single nucleotides,
frameshifts alter reading frames, and trinucleotide repeats involve expanded sequences .
5. Which term describes a tumor that is poorly differentiated, rapidly growing, and invading
surrounding tissues?
A) Benign
B) Malignant
C) In situ
D) Dysplastic
Correct Answer: Malignant
Rationale: Malignant tumors are characterized by rapid growth, lack of encapsulation, invasion
of surrounding tissues, poor differentiation, and high mitotic index. Benign tumors grow slowly,
are encapsulated, and do not invade. In situ lesions are confined to the epithelium, and dysplasia
involves disordered growth .
6. The "Warburg effect" in cancer biology refers to which metabolic phenomenon?
A) Increased apoptosis in tumor cells
B) Enhanced DNA repair mechanisms
C) Aerobic glycolysis even in the presence of oxygen
D) Decreased angiogenesis due to hypoxia
Correct Answer: Aerobic glycolysis even in the presence of oxygen
Rationale: The Warburg effect describes the preference of cancer cells to utilize glycolysis for
energy production, even when oxygen is available. This metabolic shift supports rapid ATP
production and provides intermediates for biosynthesis. It is not associated with apoptosis, DNA
repair, or decreased angiogenesis .
7. A 65-year-old patient has a tumor that is well-encapsulated, slow-growing, and does not
metastasize. This tumor is best described as:
A) Malignant
B) Benign
C) In situ
D) Anaplastic
, Correct Answer: Benign
Rationale: Benign tumors are well-differentiated, grow slowly, are encapsulated, do not invade
surrounding tissues, and do not metastasize. Malignant tumors are poorly differentiated,
invasive, and metastasize. In situ cancers have not invaded surrounding tissue, and anaplasia
refers to the loss of differentiation seen in malignancy .
8. The cellular swelling seen in reversible cell injury is primarily due to:
A) Increased activity of the Na+/K+ pump
B) Decreased activity of the Na+/K+ pump leading to influx of sodium and water
C) Rupture of the lysosomal membrane
D) Activation of caspases
Correct Answer: Decreased activity of the Na+/K+ pump leading to influx of sodium and water
Rationale: ATP depletion impairs the Na+/K+ pump, causing sodium to accumulate
intracellularly. Water follows, leading to cellular swelling. Lysosomal rupture and caspase
activation are hallmarks of irreversible injury and necrosis or apoptosis, not reversible injury .
9. Which genetic test is most appropriate for identifying a single gene mutation, such as the
delta-F508 mutation in cystic fibrosis?
A) Karyotype
B) Fluorescence in situ hybridization (FISH)
C) Polymerase chain reaction (PCR) and sequencing
D) Microarray
Correct Answer: Polymerase chain reaction (PCR) and sequencing
Rationale: PCR amplifies specific DNA sequences, and sequencing identifies the exact
nucleotide changes, making it ideal for identifying single-gene mutations. Karyotype detects
chromosomal abnormalities, FISH detects specific chromosomal regions, and microarray
identifies copy number variations .
10. A patient with chronic bronchitis has undergone metaplasia of his bronchial epithelium.
What is the primary benefit of this change?
A) It restores normal ciliary function.
B) It provides a more resistant lining to chronic irritation.
C) It decreases the risk of malignant transformation.
D) It increases mucus production.
Correct Answer: It provides a more resistant lining to chronic irritation.
Rationale: Metaplasia is an adaptive change where one cell type is replaced by another that is
better suited to withstand chronic stress or irritation. In the airways, this provides a more
resistant but less functional lining. It does not restore ciliary function, may increase cancer risk if
dysplasia follows, and does not directly increase mucus production .
