NUR 2063 / NUR2063 · FINAL EXAM REVIEW
STUDY GUIDE
Essentials of
Pathophysiology
A comprehensive 150-question final examination review aligned with the
Rasmussen University NUR 2063 course syllabus, NCLEX-RN
pathophysiology standards, and Essentials of Pathophysiology
competencies. Every question includes a verified answer key and an
evidence-based rationale spanning cellular injury, inflammation,
immunity, infection, fluid and electrolyte balance, acid-base disorders,
and all major body systems.
Rasmussen University
School of Nursing · Nursing Education & Pathophysiology Series
150 Questions | 4-Option Multiple Choice | Answer Key + Rationales
L ATE ST 2 0 2 0 2 7 E D I TI O N
,NUR 2063 - ESSENTIALS OF PATHOPHYSIOLOGY FINAL EXAM REVIEW STUDY GUIDE -
SUMMARY NUR 2063 / NUR2063:
ESSENTIALS OF PATHOPHYSIOLOGY
FINAL EXAM REVIEW STUDY GUIDE (LATEST )
RASMUSSEN
Aligned with the Rasmussen University NUR 2063 Course Syllabus, NCLEX-RN Pathophysiology Standards, and Essentials
of Pathophysiology Competencies ( Edition)
Section 1: Cellular Injury, Adaptation, & Death
Q1: A 58-year-old man with a 15-year history of uncontrolled hypertension undergoes echocardiography,
which reveals a markedly thickened left ventricular wall with normal chamber size. Which cellular adaptation
best explains this finding?
A. Hyperplasia, an increase in the number of cardiac muscle cells
B. Dysplasia, disordered growth and maturation of cardiac myocytes
C. Hypertrophy, an increase in the size of individual cardiac muscle cells *[CORRECT]*
D. Metaplasia, replacement of cardiac muscle by a fibrous cell type
Correct Answer: C
Rationale: Chronic pressure overload from hypertension forces the myocardium to work harder, and because cardiac
myocytes are terminally differentiated and cannot divide, the heart compensates by enlarging each cell through added
sarcomeres, which is hypertrophy (NUR 2063 cellular adaptation competency). Hyperplasia requires cell division and
cannot occur in cardiac muscle. Dysplasia is a premalignant, disordered proliferation rather than a purposeful
adaptation, and metaplasia is the reversible replacement of one mature cell type by another, which does not occur in
myocardial tissue under pressure load.
Q2: A 55-year-old man with a 30-pack-year smoking history undergoes bronchoscopy. Biopsy of the bronchus
shows that the normal pseudostratified ciliated columnar epithelium has been replaced by stratified squamous
epithelium. This change is best classified as which cellular adaptation?
A. Metaplasia *[CORRECT]*
B. Hyperplasia
C. Dysplasia
D. Atrophy
Correct Answer: A
Rationale: Metaplasia is the reversible replacement of one adult cell type by another cell type better able to
withstand the adverse environment; chronic tobacco smoke irritates the airway, so the fragile ciliated columnar
epithelium is replaced by tougher stratified squamous epithelium. Although protective, the substitution sacrifices
mucociliary clearance and predisposes the client to infection and, with persistence, to malignant transformation.
Hyperplasia would be an increase in cell number, dysplasia is disorganized atypical growth, and atrophy is a decrease
in cell size, none of which describes a cell type substitution.
Rasmussen University - School of Nursing 1
,NUR 2063 - ESSENTIALS OF PATHOPHYSIOLOGY FINAL EXAM REVIEW STUDY GUIDE -
Q3: A nursing student is comparing stages of cellular injury. Which finding indicates that an injured cell has
passed the point of reversibility and entered irreversible injury?
A. Cellular swelling with mild mitochondrial swelling
B. Decreased oxidative phosphorylation with reduced ATP
C. Clumping of nuclear chromatin
D. Rupture of the plasma membrane with release of intracellular enzymes *[CORRECT]*
Correct Answer: D
Rationale: The hallmark that separates irreversible from reversible injury is severe damage to cell membranes; when
the plasma membrane and lysosomal membranes rupture, hydrolytic enzymes flood the cytoplasm and leak into the
extracellular fluid, marking cell death. Cellular swelling, decreased ATP production, and chromatin clumping all
occur in reversible injury while the membrane remains intact. NUR 2063 emphasizes that membrane integrity is the
critical determinant of whether an injured cell can recover.
Q4: A 66-year-old woman dies 3 days after an acute myocardial infarction. Autopsy reveals a firm, pale area
of dead myocardium in which the basic tissue architecture is preserved and the dead cells show intense protein
denaturation. Which type of necrosis is this?
A. Liquefactive necrosis
B. Coagulative necrosis *[CORRECT]*
C. Caseous necrosis
D. Fat necrosis
Correct Answer: B
Rationale: Coagulative necrosis is the characteristic form of necrosis in the heart, kidney, and spleen following
ischemic infarction; protein denaturation fixes the structural proteins so the tissue remains firm and the cellular
outline persists for days. Liquefactive necrosis is typical of the brain and of pyogenic abscesses, where hydrolytic
enzymes digest tissue into liquid. Caseous necrosis is associated with tuberculosis and fat necrosis with enzymatic
digestion of adipose tissue in pancreatitis.
Q5: A 34-year-old recent immigrant presents with a chronic productive cough, drenching night sweats, and
unintentional weight loss. Chest imaging shows an upper-lobe cavitary lesion, and biopsy of a regional lymph
node reveals granulomas containing amorphous, crumbly, cheese-like debris. Which type of necrosis does this
describe?
A. Fibrinoid necrosis
B. Fat necrosis
C. Caseous necrosis *[CORRECT]*
D. Coagulative necrosis
Correct Answer: C
Rationale: The presentation is classic for pulmonary tuberculosis, and caseous necrosis is the signature necrotic
pattern of tuberculous granulomas, combining coagulative destruction with liquefactive breakdown to produce the
cheesy amorphous debris. Fibrinoid necrosis occurs in immune-mediated vascular injury such as malignant
hypertension, fat necrosis accompanies enzymatic lipase injury in pancreatitis, and coagulative necrosis preserves
tissue architecture as seen in ischemic infarcts rather than producing soft cheesy material.
Rasmussen University - School of Nursing 2
, NUR 2063 - ESSENTIALS OF PATHOPHYSIOLOGY FINAL EXAM REVIEW STUDY GUIDE -
Q6: A 72-year-old man develops a brain abscess following untreated otitis media. Imaging shows a cystic,
fluid-filled cavity where brain tissue has been digested away. Which type of necrosis is characteristic of this
cerebral injury?
A. Liquefactive necrosis *[CORRECT]*
B. Coagulative necrosis
C. Caseous necrosis
D. Gangrenous necrosis
Correct Answer: A
Rationale: The central nervous system is rich in hydrolytic enzymes and lipid but has little structural protein
scaffolding, so injured brain and pyogenic abscess cavities undergo liquefactive necrosis in which tissue is digested
into a liquid, cystic mass. Coagulative necrosis with preserved architecture is characteristic of ischemic infarcts in
solid organs such as the heart and kidney, not the brain. Caseous necrosis is specific to granulomatous infections such
as tuberculosis, and gangrene describes necrosis with superimposed bacterial decay, usually in limbs.
Q7: A 45-year-old woman with acute pancreatitis has a lipase level three times the upper limit of normal. CT
imaging demonstrates hazy peripancreatic fat with deposits of chalky white calcium soaps. Which type of
necrosis accounts for these findings?
A. Coagulative necrosis
B. Fat necrosis *[CORRECT]*
C. Caseous necrosis
D. Fibrinoid necrosis
Correct Answer: B
Rationale: In pancreatitis, released lipase digests peripancreatic adipose cell membranes, and liberated fatty acids
combine with calcium to form chalky calcium soaps, the process of saponification that defines fat necrosis.
Coagulative necrosis is an ischemic pattern that leaves firm protein-denatured tissue without soap formation. Caseous
necrosis belongs to tuberculosis, and fibrinoid necrosis describes immune complex deposition in vessel walls seen in
vasculitis and malignant hypertension.
Q8: A nursing instructor asks students to differentiate apoptosis from necrosis. Which statement about
apoptosis is correct?
A. Apoptosis is always a pathological process caused by external injury
B. Apoptosis produces cell swelling and lysis with an intense inflammatory response
C. Apoptosis results from ATP depletion and rupture of the plasma membrane
D. Apoptosis is an energy-dependent programmed cell death in which the cell shrinks and fragments without
inciting inflammation *[CORRECT]*
Correct Answer: D
Rationale: Apoptosis is a genetically programmed, energy-requiring form of programmed cell death used in normal
development, hormone-dependent tissue turnover, and removal of damaged cells; the cell shrinks, its chromatin
condenses, and it fragments into membrane-bound apoptotic bodies that are phagocytosed cleanly without
inflammation. The processes described in the incorrect options, cell swelling, membrane rupture, and inflammatory
response, define necrosis. Apoptosis is therefore not always pathological, since it serves essential physiologic roles
throughout the lifespan.
Rasmussen University - School of Nursing 3
STUDY GUIDE
Essentials of
Pathophysiology
A comprehensive 150-question final examination review aligned with the
Rasmussen University NUR 2063 course syllabus, NCLEX-RN
pathophysiology standards, and Essentials of Pathophysiology
competencies. Every question includes a verified answer key and an
evidence-based rationale spanning cellular injury, inflammation,
immunity, infection, fluid and electrolyte balance, acid-base disorders,
and all major body systems.
Rasmussen University
School of Nursing · Nursing Education & Pathophysiology Series
150 Questions | 4-Option Multiple Choice | Answer Key + Rationales
L ATE ST 2 0 2 0 2 7 E D I TI O N
,NUR 2063 - ESSENTIALS OF PATHOPHYSIOLOGY FINAL EXAM REVIEW STUDY GUIDE -
SUMMARY NUR 2063 / NUR2063:
ESSENTIALS OF PATHOPHYSIOLOGY
FINAL EXAM REVIEW STUDY GUIDE (LATEST )
RASMUSSEN
Aligned with the Rasmussen University NUR 2063 Course Syllabus, NCLEX-RN Pathophysiology Standards, and Essentials
of Pathophysiology Competencies ( Edition)
Section 1: Cellular Injury, Adaptation, & Death
Q1: A 58-year-old man with a 15-year history of uncontrolled hypertension undergoes echocardiography,
which reveals a markedly thickened left ventricular wall with normal chamber size. Which cellular adaptation
best explains this finding?
A. Hyperplasia, an increase in the number of cardiac muscle cells
B. Dysplasia, disordered growth and maturation of cardiac myocytes
C. Hypertrophy, an increase in the size of individual cardiac muscle cells *[CORRECT]*
D. Metaplasia, replacement of cardiac muscle by a fibrous cell type
Correct Answer: C
Rationale: Chronic pressure overload from hypertension forces the myocardium to work harder, and because cardiac
myocytes are terminally differentiated and cannot divide, the heart compensates by enlarging each cell through added
sarcomeres, which is hypertrophy (NUR 2063 cellular adaptation competency). Hyperplasia requires cell division and
cannot occur in cardiac muscle. Dysplasia is a premalignant, disordered proliferation rather than a purposeful
adaptation, and metaplasia is the reversible replacement of one mature cell type by another, which does not occur in
myocardial tissue under pressure load.
Q2: A 55-year-old man with a 30-pack-year smoking history undergoes bronchoscopy. Biopsy of the bronchus
shows that the normal pseudostratified ciliated columnar epithelium has been replaced by stratified squamous
epithelium. This change is best classified as which cellular adaptation?
A. Metaplasia *[CORRECT]*
B. Hyperplasia
C. Dysplasia
D. Atrophy
Correct Answer: A
Rationale: Metaplasia is the reversible replacement of one adult cell type by another cell type better able to
withstand the adverse environment; chronic tobacco smoke irritates the airway, so the fragile ciliated columnar
epithelium is replaced by tougher stratified squamous epithelium. Although protective, the substitution sacrifices
mucociliary clearance and predisposes the client to infection and, with persistence, to malignant transformation.
Hyperplasia would be an increase in cell number, dysplasia is disorganized atypical growth, and atrophy is a decrease
in cell size, none of which describes a cell type substitution.
Rasmussen University - School of Nursing 1
,NUR 2063 - ESSENTIALS OF PATHOPHYSIOLOGY FINAL EXAM REVIEW STUDY GUIDE -
Q3: A nursing student is comparing stages of cellular injury. Which finding indicates that an injured cell has
passed the point of reversibility and entered irreversible injury?
A. Cellular swelling with mild mitochondrial swelling
B. Decreased oxidative phosphorylation with reduced ATP
C. Clumping of nuclear chromatin
D. Rupture of the plasma membrane with release of intracellular enzymes *[CORRECT]*
Correct Answer: D
Rationale: The hallmark that separates irreversible from reversible injury is severe damage to cell membranes; when
the plasma membrane and lysosomal membranes rupture, hydrolytic enzymes flood the cytoplasm and leak into the
extracellular fluid, marking cell death. Cellular swelling, decreased ATP production, and chromatin clumping all
occur in reversible injury while the membrane remains intact. NUR 2063 emphasizes that membrane integrity is the
critical determinant of whether an injured cell can recover.
Q4: A 66-year-old woman dies 3 days after an acute myocardial infarction. Autopsy reveals a firm, pale area
of dead myocardium in which the basic tissue architecture is preserved and the dead cells show intense protein
denaturation. Which type of necrosis is this?
A. Liquefactive necrosis
B. Coagulative necrosis *[CORRECT]*
C. Caseous necrosis
D. Fat necrosis
Correct Answer: B
Rationale: Coagulative necrosis is the characteristic form of necrosis in the heart, kidney, and spleen following
ischemic infarction; protein denaturation fixes the structural proteins so the tissue remains firm and the cellular
outline persists for days. Liquefactive necrosis is typical of the brain and of pyogenic abscesses, where hydrolytic
enzymes digest tissue into liquid. Caseous necrosis is associated with tuberculosis and fat necrosis with enzymatic
digestion of adipose tissue in pancreatitis.
Q5: A 34-year-old recent immigrant presents with a chronic productive cough, drenching night sweats, and
unintentional weight loss. Chest imaging shows an upper-lobe cavitary lesion, and biopsy of a regional lymph
node reveals granulomas containing amorphous, crumbly, cheese-like debris. Which type of necrosis does this
describe?
A. Fibrinoid necrosis
B. Fat necrosis
C. Caseous necrosis *[CORRECT]*
D. Coagulative necrosis
Correct Answer: C
Rationale: The presentation is classic for pulmonary tuberculosis, and caseous necrosis is the signature necrotic
pattern of tuberculous granulomas, combining coagulative destruction with liquefactive breakdown to produce the
cheesy amorphous debris. Fibrinoid necrosis occurs in immune-mediated vascular injury such as malignant
hypertension, fat necrosis accompanies enzymatic lipase injury in pancreatitis, and coagulative necrosis preserves
tissue architecture as seen in ischemic infarcts rather than producing soft cheesy material.
Rasmussen University - School of Nursing 2
, NUR 2063 - ESSENTIALS OF PATHOPHYSIOLOGY FINAL EXAM REVIEW STUDY GUIDE -
Q6: A 72-year-old man develops a brain abscess following untreated otitis media. Imaging shows a cystic,
fluid-filled cavity where brain tissue has been digested away. Which type of necrosis is characteristic of this
cerebral injury?
A. Liquefactive necrosis *[CORRECT]*
B. Coagulative necrosis
C. Caseous necrosis
D. Gangrenous necrosis
Correct Answer: A
Rationale: The central nervous system is rich in hydrolytic enzymes and lipid but has little structural protein
scaffolding, so injured brain and pyogenic abscess cavities undergo liquefactive necrosis in which tissue is digested
into a liquid, cystic mass. Coagulative necrosis with preserved architecture is characteristic of ischemic infarcts in
solid organs such as the heart and kidney, not the brain. Caseous necrosis is specific to granulomatous infections such
as tuberculosis, and gangrene describes necrosis with superimposed bacterial decay, usually in limbs.
Q7: A 45-year-old woman with acute pancreatitis has a lipase level three times the upper limit of normal. CT
imaging demonstrates hazy peripancreatic fat with deposits of chalky white calcium soaps. Which type of
necrosis accounts for these findings?
A. Coagulative necrosis
B. Fat necrosis *[CORRECT]*
C. Caseous necrosis
D. Fibrinoid necrosis
Correct Answer: B
Rationale: In pancreatitis, released lipase digests peripancreatic adipose cell membranes, and liberated fatty acids
combine with calcium to form chalky calcium soaps, the process of saponification that defines fat necrosis.
Coagulative necrosis is an ischemic pattern that leaves firm protein-denatured tissue without soap formation. Caseous
necrosis belongs to tuberculosis, and fibrinoid necrosis describes immune complex deposition in vessel walls seen in
vasculitis and malignant hypertension.
Q8: A nursing instructor asks students to differentiate apoptosis from necrosis. Which statement about
apoptosis is correct?
A. Apoptosis is always a pathological process caused by external injury
B. Apoptosis produces cell swelling and lysis with an intense inflammatory response
C. Apoptosis results from ATP depletion and rupture of the plasma membrane
D. Apoptosis is an energy-dependent programmed cell death in which the cell shrinks and fragments without
inciting inflammation *[CORRECT]*
Correct Answer: D
Rationale: Apoptosis is a genetically programmed, energy-requiring form of programmed cell death used in normal
development, hormone-dependent tissue turnover, and removal of damaged cells; the cell shrinks, its chromatin
condenses, and it fragments into membrane-bound apoptotic bodies that are phagocytosed cleanly without
inflammation. The processes described in the incorrect options, cell swelling, membrane rupture, and inflammatory
response, define necrosis. Apoptosis is therefore not always pathological, since it serves essential physiologic roles
throughout the lifespan.
Rasmussen University - School of Nursing 3
