NUR 376 Exam 4 – Applied Pathophysiology (2026)
Concordia University, St. Paul – Comprehensive
Practice Exam Questions with Detailed Rationales
SECTION 1: CELLULAR ADAPTATION & INJURY
1. A patient with chronic hypertension exhibits an enlarged heart on an
echocardiogram. This cellular change is best described as:
• A) Atrophy
• B) Hypertrophy
• C) Hyperplasia
• D) Metaplasia
Answer: B) Hypertrophy
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. The heart
muscle does not increase in cell number (hyperplasia) in adults, but rather
increases in cell size .
2. A patient with gastroesophageal reflux disease (GERD) develops Barrett
esophagus. This is an example of which cellular adaptation?
• A) Dysplasia
• B) Metaplasia
• C) Anaplasia
• D) Hyperplasia
,Answer: B) Metaplasia
Rationale: Metaplasia is the reversible replacement of one mature cell type with
another less mature cell type. In Barrett esophagus, chronic acid exposure causes
the normal stratified squamous epithelium of the esophagus to be replaced by
columnar epithelium (intestinal-type) to better withstand the acid. This is a
premalignant condition that increases the risk of esophageal adenocarcinoma .
3. A patient with chronic hypoxia develops an increase in the number of red
blood cells. This is an example of:
• A) Hypertrophy
• B) Hyperplasia
• C) Metaplasia
• D) Dysplasia
Answer: B) Hyperplasia
Rationale: Hyperplasia is an increase in the number of cells in an organ or tissue.
In response to chronic hypoxia, the bone marrow increases erythropoietin-
stimulated production of red blood cells (erythrocytosis), which is a physiologic
hyperplasia. This is an adaptive response to increase oxygen-carrying capacity .
4. Which cellular adaptation is characterized by a decrease in cell size and
function?
• A) Hypertrophy
• B) Hyperplasia
• C) Atrophy
• D) Metaplasia
Answer: C) Atrophy
,Rationale: Atrophy is a decrease in cell size and function that can result from
disuse, denervation, ischemia, malnutrition, or aging. It represents a reduction in
cellular content and metabolic activity. Atrophic cells may contain increased
numbers of autophagic vacuoles and lipofuscin granules .
5. A pathology report describes organized, energy-dependent cell death that
does not trigger an inflammatory response. This is characteristic of:
• A) Necrosis
• B) Apoptosis
• C) Gangrene
• D) Caseous necrosis
Answer: B) Apoptosis
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, causes cell
swelling and rupture, and triggers inflammation .
6. Which of the following is a hallmark biochemical event that distinguishes
apoptosis from necrosis?
• A) Cell swelling and rupture of the plasma membrane
• B) Uncontrolled ATP depletion
• C) Chromatin aggregation and caspase activation
• D) Massive inflammatory response
Answer: C) Chromatin aggregation and caspase activation
, Rationale: Apoptosis involves chromatin aggregation and activation of caspases
(proteolytic enzymes). Cell swelling and rupture, uncontrolled ATP depletion, and
massive inflammatory response are characteristic of necrosis, not apoptosis .
7. Cells that are atypical in size and shape but are not necessarily cancerous are
described as:
• A) Dysplastic
• B) Metaplastic
• C) Anaplastic
• D) Hyperplastic
Answer: A) Dysplastic
Rationale: Dysplasia refers to cells that are atypical in size and shape. Dysplasia
does not mean the cells are cancerous, but screening tests like Pap smears
examine tissues to determine if cellular changes are taking place. Dysplasia can be
reversible if the stimulus is removed .
8. Which of the following is a hallmark feature of carcinoma in situ (CIS)?
• A) Cells have invaded distant organs
• B) Cells have invaded immediate surrounding tissue
• C) Cells remain localized and have not breached the basement membrane
• D) Cellular and tissue alterations indicate dysplasia only
Answer: C) Cells remain localized and have not breached the basement
membrane
Rationale: Carcinoma in situ (CIS) refers to preinvasive epithelial malignant tumors
that are localized to the epithelium and have NOT broken through the local
Concordia University, St. Paul – Comprehensive
Practice Exam Questions with Detailed Rationales
SECTION 1: CELLULAR ADAPTATION & INJURY
1. A patient with chronic hypertension exhibits an enlarged heart on an
echocardiogram. This cellular change is best described as:
• A) Atrophy
• B) Hypertrophy
• C) Hyperplasia
• D) Metaplasia
Answer: B) Hypertrophy
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. The heart
muscle does not increase in cell number (hyperplasia) in adults, but rather
increases in cell size .
2. A patient with gastroesophageal reflux disease (GERD) develops Barrett
esophagus. This is an example of which cellular adaptation?
• A) Dysplasia
• B) Metaplasia
• C) Anaplasia
• D) Hyperplasia
,Answer: B) Metaplasia
Rationale: Metaplasia is the reversible replacement of one mature cell type with
another less mature cell type. In Barrett esophagus, chronic acid exposure causes
the normal stratified squamous epithelium of the esophagus to be replaced by
columnar epithelium (intestinal-type) to better withstand the acid. This is a
premalignant condition that increases the risk of esophageal adenocarcinoma .
3. A patient with chronic hypoxia develops an increase in the number of red
blood cells. This is an example of:
• A) Hypertrophy
• B) Hyperplasia
• C) Metaplasia
• D) Dysplasia
Answer: B) Hyperplasia
Rationale: Hyperplasia is an increase in the number of cells in an organ or tissue.
In response to chronic hypoxia, the bone marrow increases erythropoietin-
stimulated production of red blood cells (erythrocytosis), which is a physiologic
hyperplasia. This is an adaptive response to increase oxygen-carrying capacity .
4. Which cellular adaptation is characterized by a decrease in cell size and
function?
• A) Hypertrophy
• B) Hyperplasia
• C) Atrophy
• D) Metaplasia
Answer: C) Atrophy
,Rationale: Atrophy is a decrease in cell size and function that can result from
disuse, denervation, ischemia, malnutrition, or aging. It represents a reduction in
cellular content and metabolic activity. Atrophic cells may contain increased
numbers of autophagic vacuoles and lipofuscin granules .
5. A pathology report describes organized, energy-dependent cell death that
does not trigger an inflammatory response. This is characteristic of:
• A) Necrosis
• B) Apoptosis
• C) Gangrene
• D) Caseous necrosis
Answer: B) Apoptosis
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, causes cell
swelling and rupture, and triggers inflammation .
6. Which of the following is a hallmark biochemical event that distinguishes
apoptosis from necrosis?
• A) Cell swelling and rupture of the plasma membrane
• B) Uncontrolled ATP depletion
• C) Chromatin aggregation and caspase activation
• D) Massive inflammatory response
Answer: C) Chromatin aggregation and caspase activation
, Rationale: Apoptosis involves chromatin aggregation and activation of caspases
(proteolytic enzymes). Cell swelling and rupture, uncontrolled ATP depletion, and
massive inflammatory response are characteristic of necrosis, not apoptosis .
7. Cells that are atypical in size and shape but are not necessarily cancerous are
described as:
• A) Dysplastic
• B) Metaplastic
• C) Anaplastic
• D) Hyperplastic
Answer: A) Dysplastic
Rationale: Dysplasia refers to cells that are atypical in size and shape. Dysplasia
does not mean the cells are cancerous, but screening tests like Pap smears
examine tissues to determine if cellular changes are taking place. Dysplasia can be
reversible if the stimulus is removed .
8. Which of the following is a hallmark feature of carcinoma in situ (CIS)?
• A) Cells have invaded distant organs
• B) Cells have invaded immediate surrounding tissue
• C) Cells remain localized and have not breached the basement membrane
• D) Cellular and tissue alterations indicate dysplasia only
Answer: C) Cells remain localized and have not breached the basement
membrane
Rationale: Carcinoma in situ (CIS) refers to preinvasive epithelial malignant tumors
that are localized to the epithelium and have NOT broken through the local
