HERZING UNIVERSITY · NURSING PROGRAM
NSG 120
Nursing Pathophysiology
Final Examination
A comprehensive 150-question multiple-choice assessment covering
ten core pathophysiology domains. Questions are distributed across
recall, application, and analysis cognitive levels following NCLEX-style
clinical judgment format with detailed rationales for each item.
Course: NSG 120 Pathophysiology
Total Questions: 150 (Four-Choice MCQ)
Cognitive Levels: Recall 25% · Application 55% · Analysis 20%
Format: Section-Based with Answer Key and Rationales
C O M P R E H E N S I V E F I N A L E X A M I N AT I O N · A L L S E C T I O N S
,NSG 120 Nursing Pathophysiology Final Examination Herzing University
Section 1: Cell Adaptation, Injury, and Neoplasia
Questions Q1-Q18
1. [R] Which cellular adaptation involves an increase in cell size in response to increased workload?
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Dysplasia
Correct Answer: B
Rationale: Hypertrophy is defined as an increase in the size of individual cells, most commonly in response to increased
mechanical or metabolic demand. A classic example is the left ventricular hypertrophy that occurs in response to chronic
hypertension. Hyperplasia refers to an increase in the number of cells, metaplasia is the replacement of one cell type by another,
and dysplasia refers to abnormal cell growth and appearance.
2. [A] A patient with a long history of smoking presents with chronic cough. A bronchial biopsy reveals that the
normal ciliated columnar epithelium has been replaced by stratified squamous epithelium. The nurse understands
that this cellular change is called:
A. Hyperplasia
B. Metaplasia
C. Dysplasia
D. Anaplasia
Correct Answer: B
Rationale: Metaplasia is the reversible replacement of one mature cell type by another, less differentiated cell type. In the
respiratory tract, chronic irritation from cigarette smoke causes the normal ciliated columnar epithelium to be replaced by
stratified squamous epithelium, which is better able to withstand the insult. While metaplasia is an adaptive response, the new
tissue is less functional and the persistent stimulus increases the risk of progression to dysplasia and neoplasia.
3. [R] A nurse is reviewing laboratory results and notes that a patient has elevated creatine kinase (CK-MB) and
troponin levels. These findings are most consistent with which type of cellular injury?
A. Ischemic injury to cardiac muscle cells
B. Reversible injury to hepatocytes
C. Chemical injury to renal tubular cells
D. Radiation injury to epithelial cells
Correct Answer: A
Rationale: Elevated CK-MB and troponin are specific biomarkers of cardiac muscle cell injury, particularly from ischemia or
myocardial infarction. Troponin is highly specific to cardiac muscle and rises when the integrity of cardiac myocyte membranes is
compromised, allowing these intracellular proteins to leak into the bloodstream. CK-MB is also found in cardiac tissue and, while
less specific than troponin, confirms myocardial damage when elevated alongside troponin.
4. [A] A nurse is caring for a patient who sustained a crush injury to the lower extremity. The patient develops
myoglobinuria and rising serum potassium. Which pathological process is most likely occurring?
A. Coagulative necrosis
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,NSG 120 Nursing Pathophysiology Final Examination Herzing University
B. Liquefactive necrosis
C. Fat necrosis
D. Caseous necrosis
Correct Answer: A
Rationale: Crush injuries cause ischemic damage to skeletal muscle, leading to coagulative necrosis where the basic tissue
architecture is preserved but cells are dead. The rupture of damaged skeletal muscle cells releases myoglobin into the bloodstream
(myoglobinuria), which can cause acute kidney injury, and releases intracellular potassium, causing hyperkalemia. This is a
life-threatening scenario requiring aggressive fluid resuscitation and potentially dialysis.
5. [AN] A patient with a malignant tumor has been told that the cancer has spread to regional lymph nodes but not
to distant organs. The nurse understands that the staging classification for this patient is:
A. Carcinoma in situ (Tis N0 M0)
B. Localized disease (T1-2 N0 M0)
C. Regional spread (any T N1-3 M0)
D. Distant metastasis (any T any N M1)
Correct Answer: C
Rationale: The TNM staging system classifies tumors by Tumor size/invasion (T), regional Node involvement (N), and distant
Metastasis (M). When cancer has spread to regional lymph nodes, the N component becomes N1, N2, or N3 depending on the
number and location of affected nodes, while M remains M0 (no distant metastasis). This represents regional spread, which
generally carries a less favorable prognosis than localized disease but is more treatable than distant metastasis.
6. [A] A nurse is administering a chemotherapeutic agent that targets rapidly dividing cells. Which normal tissue is
most likely to be affected as a result of this mechanism of action?
A. Cardiac muscle
B. Bone marrow
C. Neurons
D. Adipose tissue
Correct Answer: B
Rationale: Chemotherapeutic agents that target rapidly dividing cells affect not only malignant cells but also normal tissues with
high mitotic rates. Bone marrow is one of the most rapidly dividing tissues in the body, continuously producing blood cells. This
explains why myelosuppression (anemia, leukopenia, thrombocytopenia) is one of the most common and significant adverse
effects of chemotherapy. Other rapidly dividing tissues include the gastrointestinal mucosa and hair follicles.
7. [R] Which of the following is a characteristic feature of benign tumors compared to malignant tumors?
A. They invade surrounding tissues
B. They metastasize to distant sites
C. They are well-differentiated and encapsulated
D. They have a high nuclear-to-cytoplasmic ratio
Correct Answer: C
Rationale: Benign tumors are characterized by well-differentiated cells that closely resemble the tissue of origin, slow growth
rates, and are typically enclosed within a fibrous capsule. They do not invade surrounding tissues and do not metastasize. In
contrast, malignant tumors are poorly differentiated, lack a capsule, invade surrounding tissues, and have the ability to
metastasize to distant sites through blood vessels, lymphatics, or body cavities.
Page 2
, NSG 120 Nursing Pathophysiology Final Examination Herzing University
8. [A] A patient who is being treated for cancer reports the new onset of numbness and tingling in the fingers and
toes. The nurse recognizes that this symptom is most likely associated with which type of treatment side effect?
A. Hematologic toxicity
B. Peripheral neuropathy
C. Mucositis
D. Nephrotoxicity
Correct Answer: B
Rationale: Peripheral neuropathy is a common side effect of certain chemotherapeutic agents, particularly vinca alkaloids
(vincristine, vinblastine), platinum compounds (cisplatin), and taxanes (paclitaxel). These agents damage peripheral nerves,
causing paresthesias (numbness and tingling), typically in a stocking-glove distribution starting in the distal extremities. Early
recognition and dose modification are important to prevent irreversible nerve damage.
9. [AN] A biopsy of a suspicious skin lesion reveals atypical cells confined to the epidermal layer with no invasion
of the basement membrane. The nurse understands that this finding indicates:
A. Invasive squamous cell carcinoma
B. Malignant melanoma
C. Carcinoma in situ
D. Actinic keratosis
Correct Answer: C
Rationale: Carcinoma in situ refers to a neoplastic proliferation of cells that displays cytologic features of malignancy but has not
yet penetrated the basement membrane to invade underlying connective tissue. Because the cells have not invaded, they cannot
metastasize. However, carcinoma in situ is considered a preinvasive lesion that carries a significant risk of progressing to invasive
cancer if left untreated. Removal at this stage is curative.
10. [A] A patient with end-stage renal disease on dialysis develops hard, nodular calcium deposits in the skin and
soft tissues. The nurse identifies this as which type of necrosis?
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis
Correct Answer: C
Rationale: Caseous necrosis is a distinctive form of necrosis associated with granulomatous diseases such as tuberculosis, but also
with certain metabolic conditions. In patients with end-stage renal disease, secondary hyperparathyroidism and elevated
calcium-phosphate product can lead to metastatic calcification, which may present as caseous-like necrotic deposits. However, the
best answer here is caseous necrosis, as it is classically described as a cheese-like, granular, white appearance. Fat necrosis
specifically refers to enzymatic destruction of fat cells, typically from acute pancreatitis.
11. [R] The process of programmed cell death that occurs normally during development and as a defense
mechanism to remove damaged cells is called:
A. Necrosis
B. Apoptosis
C. Autolysis
D. Heterolysis
Correct Answer: B
Page 3
NSG 120
Nursing Pathophysiology
Final Examination
A comprehensive 150-question multiple-choice assessment covering
ten core pathophysiology domains. Questions are distributed across
recall, application, and analysis cognitive levels following NCLEX-style
clinical judgment format with detailed rationales for each item.
Course: NSG 120 Pathophysiology
Total Questions: 150 (Four-Choice MCQ)
Cognitive Levels: Recall 25% · Application 55% · Analysis 20%
Format: Section-Based with Answer Key and Rationales
C O M P R E H E N S I V E F I N A L E X A M I N AT I O N · A L L S E C T I O N S
,NSG 120 Nursing Pathophysiology Final Examination Herzing University
Section 1: Cell Adaptation, Injury, and Neoplasia
Questions Q1-Q18
1. [R] Which cellular adaptation involves an increase in cell size in response to increased workload?
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Dysplasia
Correct Answer: B
Rationale: Hypertrophy is defined as an increase in the size of individual cells, most commonly in response to increased
mechanical or metabolic demand. A classic example is the left ventricular hypertrophy that occurs in response to chronic
hypertension. Hyperplasia refers to an increase in the number of cells, metaplasia is the replacement of one cell type by another,
and dysplasia refers to abnormal cell growth and appearance.
2. [A] A patient with a long history of smoking presents with chronic cough. A bronchial biopsy reveals that the
normal ciliated columnar epithelium has been replaced by stratified squamous epithelium. The nurse understands
that this cellular change is called:
A. Hyperplasia
B. Metaplasia
C. Dysplasia
D. Anaplasia
Correct Answer: B
Rationale: Metaplasia is the reversible replacement of one mature cell type by another, less differentiated cell type. In the
respiratory tract, chronic irritation from cigarette smoke causes the normal ciliated columnar epithelium to be replaced by
stratified squamous epithelium, which is better able to withstand the insult. While metaplasia is an adaptive response, the new
tissue is less functional and the persistent stimulus increases the risk of progression to dysplasia and neoplasia.
3. [R] A nurse is reviewing laboratory results and notes that a patient has elevated creatine kinase (CK-MB) and
troponin levels. These findings are most consistent with which type of cellular injury?
A. Ischemic injury to cardiac muscle cells
B. Reversible injury to hepatocytes
C. Chemical injury to renal tubular cells
D. Radiation injury to epithelial cells
Correct Answer: A
Rationale: Elevated CK-MB and troponin are specific biomarkers of cardiac muscle cell injury, particularly from ischemia or
myocardial infarction. Troponin is highly specific to cardiac muscle and rises when the integrity of cardiac myocyte membranes is
compromised, allowing these intracellular proteins to leak into the bloodstream. CK-MB is also found in cardiac tissue and, while
less specific than troponin, confirms myocardial damage when elevated alongside troponin.
4. [A] A nurse is caring for a patient who sustained a crush injury to the lower extremity. The patient develops
myoglobinuria and rising serum potassium. Which pathological process is most likely occurring?
A. Coagulative necrosis
Page 1
,NSG 120 Nursing Pathophysiology Final Examination Herzing University
B. Liquefactive necrosis
C. Fat necrosis
D. Caseous necrosis
Correct Answer: A
Rationale: Crush injuries cause ischemic damage to skeletal muscle, leading to coagulative necrosis where the basic tissue
architecture is preserved but cells are dead. The rupture of damaged skeletal muscle cells releases myoglobin into the bloodstream
(myoglobinuria), which can cause acute kidney injury, and releases intracellular potassium, causing hyperkalemia. This is a
life-threatening scenario requiring aggressive fluid resuscitation and potentially dialysis.
5. [AN] A patient with a malignant tumor has been told that the cancer has spread to regional lymph nodes but not
to distant organs. The nurse understands that the staging classification for this patient is:
A. Carcinoma in situ (Tis N0 M0)
B. Localized disease (T1-2 N0 M0)
C. Regional spread (any T N1-3 M0)
D. Distant metastasis (any T any N M1)
Correct Answer: C
Rationale: The TNM staging system classifies tumors by Tumor size/invasion (T), regional Node involvement (N), and distant
Metastasis (M). When cancer has spread to regional lymph nodes, the N component becomes N1, N2, or N3 depending on the
number and location of affected nodes, while M remains M0 (no distant metastasis). This represents regional spread, which
generally carries a less favorable prognosis than localized disease but is more treatable than distant metastasis.
6. [A] A nurse is administering a chemotherapeutic agent that targets rapidly dividing cells. Which normal tissue is
most likely to be affected as a result of this mechanism of action?
A. Cardiac muscle
B. Bone marrow
C. Neurons
D. Adipose tissue
Correct Answer: B
Rationale: Chemotherapeutic agents that target rapidly dividing cells affect not only malignant cells but also normal tissues with
high mitotic rates. Bone marrow is one of the most rapidly dividing tissues in the body, continuously producing blood cells. This
explains why myelosuppression (anemia, leukopenia, thrombocytopenia) is one of the most common and significant adverse
effects of chemotherapy. Other rapidly dividing tissues include the gastrointestinal mucosa and hair follicles.
7. [R] Which of the following is a characteristic feature of benign tumors compared to malignant tumors?
A. They invade surrounding tissues
B. They metastasize to distant sites
C. They are well-differentiated and encapsulated
D. They have a high nuclear-to-cytoplasmic ratio
Correct Answer: C
Rationale: Benign tumors are characterized by well-differentiated cells that closely resemble the tissue of origin, slow growth
rates, and are typically enclosed within a fibrous capsule. They do not invade surrounding tissues and do not metastasize. In
contrast, malignant tumors are poorly differentiated, lack a capsule, invade surrounding tissues, and have the ability to
metastasize to distant sites through blood vessels, lymphatics, or body cavities.
Page 2
, NSG 120 Nursing Pathophysiology Final Examination Herzing University
8. [A] A patient who is being treated for cancer reports the new onset of numbness and tingling in the fingers and
toes. The nurse recognizes that this symptom is most likely associated with which type of treatment side effect?
A. Hematologic toxicity
B. Peripheral neuropathy
C. Mucositis
D. Nephrotoxicity
Correct Answer: B
Rationale: Peripheral neuropathy is a common side effect of certain chemotherapeutic agents, particularly vinca alkaloids
(vincristine, vinblastine), platinum compounds (cisplatin), and taxanes (paclitaxel). These agents damage peripheral nerves,
causing paresthesias (numbness and tingling), typically in a stocking-glove distribution starting in the distal extremities. Early
recognition and dose modification are important to prevent irreversible nerve damage.
9. [AN] A biopsy of a suspicious skin lesion reveals atypical cells confined to the epidermal layer with no invasion
of the basement membrane. The nurse understands that this finding indicates:
A. Invasive squamous cell carcinoma
B. Malignant melanoma
C. Carcinoma in situ
D. Actinic keratosis
Correct Answer: C
Rationale: Carcinoma in situ refers to a neoplastic proliferation of cells that displays cytologic features of malignancy but has not
yet penetrated the basement membrane to invade underlying connective tissue. Because the cells have not invaded, they cannot
metastasize. However, carcinoma in situ is considered a preinvasive lesion that carries a significant risk of progressing to invasive
cancer if left untreated. Removal at this stage is curative.
10. [A] A patient with end-stage renal disease on dialysis develops hard, nodular calcium deposits in the skin and
soft tissues. The nurse identifies this as which type of necrosis?
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis
Correct Answer: C
Rationale: Caseous necrosis is a distinctive form of necrosis associated with granulomatous diseases such as tuberculosis, but also
with certain metabolic conditions. In patients with end-stage renal disease, secondary hyperparathyroidism and elevated
calcium-phosphate product can lead to metastatic calcification, which may present as caseous-like necrotic deposits. However, the
best answer here is caseous necrosis, as it is classically described as a cheese-like, granular, white appearance. Fat necrosis
specifically refers to enzymatic destruction of fat cells, typically from acute pancreatitis.
11. [R] The process of programmed cell death that occurs normally during development and as a defense
mechanism to remove damaged cells is called:
A. Necrosis
B. Apoptosis
C. Autolysis
D. Heterolysis
Correct Answer: B
Page 3
