NUR 2063 Essentials of Pathophysiology | Final Exam | Latest 2026/2027 Update Grade A | 100% Verified Answers
FINAL EXAM: NUR2063 / NUR 2063
(LATEST UPDATE) ESSENTIALS OF
PATHOPHYSIOLOGY
REVIEW GUIDE QUESTIONS AND VERIFIED ANSWERS
100% CORRECT | GRADE A | RASMUSSEN UNIVERSITY
Examination Overview: 150 multiple-choice questions covering the twelve core domains of pathophysiology. Question
distribution: 75% scenario-based clinical reasoning and 25% direct knowledge. Cognitive distribution: 20% recall, 50%
application, 30% analysis. Includes 20 clinical reasoning scenarios, 15 laboratory interpretation questions, and 15
pathophysiological mechanism questions. Aligned with NUR 2063 Rasmussen course syllabus and NCLEX-RN
pathophysiology competencies.
Section 1: Cellular Injury, Adaptation, & Death
Q1: A 65-year-old patient with chronic hypertension has an echocardiogram demonstrating thickening
of the left ventricular wall. The nurse identifies this cellular adaptation as:
A. Atrophy of cardiac myocytes
B. Hypertrophy of cardiac myocytes *[CORRECT]*
C. Hyperplasia of cardiac myocytes
D. Metaplasia of cardiac myocytes
Correct Answer: B
Rationale: Hypertrophy is an increase in cell size in response to increased workload, exemplified by cardiac myocyte
enlargement in chronic hypertension. Cardiac muscle cells are terminally differentiated and cannot undergo hyperplasia
(cell number increase). Atrophy is decreased cell size, and metaplasia is replacement of one cell type with another.
Page 1 | Rasmussen University NUR 2063
,NUR 2063 Essentials of Pathophysiology | Final Exam | Latest 2026/2027 Update Grade A | 100% Verified Answers
Q2: A 48-year-old male with a 25-pack-year smoking history undergoes bronchoscopy. Biopsy reveals
that the normal ciliated pseudostratified columnar epithelium of the bronchus has been replaced by
stratified squamous epithelium. This adaptive change is best described as:
A. Dysplasia with atypical features
B. Anaplasia indicating malignancy
C. Metaplasia as a reversible adaptive response *[CORRECT]*
D. Hyperplasia due to inflammation
Correct Answer: C
Rationale: Metaplasia is the reversible replacement of one differentiated cell type with another, typically as an adaptive
response to chronic irritation such as cigarette smoke. Ciliated columnar epithelium converts to stratified squamous to
better withstand the insult. Dysplasia involves disordered growth, anaplasia is loss of differentiation in malignancy, and
hyperplasia is increased cell number.
Q3: A patient sustains an acute myocardial infarction. Six hours after the event, the myocardial tissue
undergoes cell death characterized by preservation of tissue architecture and protein denaturation.
Which type of necrosis is most likely present?
A. Liquefactive necrosis with tissue dissolution
B. Caseous necrosis with granuloma formation
C. Coagulative necrosis with preserved cell outlines *[CORRECT]*
D. Fat necrosis with saponification
Correct Answer: C
Rationale: Coagulative necrosis is the pattern seen in ischemic injury of most solid organs, including the heart. Protein
denaturation causes cell proteins to coagulate and cell outlines to be preserved. Liquefactive necrosis occurs in the brain
or bacterial infections, caseous necrosis is associated with tuberculosis, and fat necrosis occurs in pancreatic injury with
saponification.
Q4: A pathologist examines tissue from a patient with pulmonary tuberculosis and notes a cheese-like,
amorphous granular center surrounded by macrophages and lymphocytes. This finding is characteristic
of:
A. Coagulative necrosis with intact architecture
B. Liquefactive necrosis in brain tissue
C. Caseous necrosis within a granuloma *[CORRECT]*
D. Fibrinoid necrosis in vessel walls
Correct Answer: C
Rationale: Caseous necrosis (literally 'cheese-like') is encountered principally in tuberculosis infections and is a variant
of coagulative necrosis where the necrotic tissue appears as an amorphous granular debris enclosed within a
granulomatous inflammatory border. Coagulative preserves architecture, liquefactive dissolves tissue, and fibrinoid
occurs in immune-mediated vessel injury.
Page 2 | Rasmussen University NUR 2063
,NUR 2063 Essentials of Pathophysiology | Final Exam | Latest 2026/2027 Update Grade A | 100% Verified Answers
Q5: A 70-year-old patient had his arm immobilized in a cast for six weeks following a distal radius
fracture. Upon cast removal, the forearm muscles appear visibly smaller. The underlying mechanism of
this adaptation is:
A. Decreased cell size due to reduced metabolic demand *[CORRECT]*
B. Decreased cell number due to apoptosis
C. Replacement of muscle with adipose tissue
D. Cellular necrosis due to disuse
Correct Answer: A
Rationale: Disuse atrophy is the reduction in cell size due to decreased workload or physiologic demand, as occurs with
immobilization. Cells shrink as a result of decreased protein synthesis and increased proteolysis. The process is reversible
with resumed activity. It is not due to apoptosis, fat replacement, or necrosis.
Q6: Laboratory studies of cells exposed to hypoxia reveal ATP depletion, failure of the Na+/K+-ATPase
pump, and influx of sodium and water. Which morphologic change appears FIRST in this sequence of
reversible cell injury?
A. Nuclear chromatin clumping with pyknosis
B. Cellular swelling (hydropic change) *[CORRECT]*
C. Ribosomal detachment with vacuolation
D. Mitochondrial floccular densities
Correct Answer: B
Rationale: Cellular swelling (hydropic change) is the first and classic morphologic sign of reversible cell injury, resulting
from ATP depletion and failure of the Na+/K+-ATPase pump, allowing sodium and water to accumulate intracellularly.
Pyknosis and floccular densities are features of irreversible injury. Ribosomal detachment occurs later.
Q7: A patient with severe thermal burns develops oxidative stress and cellular damage from reactive
oxygen species. Which enzyme specifically neutralizes hydrogen peroxide by converting it to water and
oxygen?
A. Superoxide dismutase converting superoxide anions
B. Catalase decomposing hydrogen peroxide *[CORRECT]*
C. Glutathione peroxidase degrading lipid peroxides
D. Myeloperoxidase generating hypochlorous acid
Correct Answer: B
Rationale: Catalase is the enzyme located in peroxisomes that decomposes hydrogen peroxide (H2O2) into water and
oxygen, thereby neutralizing its toxicity. Superoxide dismutase converts superoxide anions to H2O2, glutathione
peroxidase also breaks down H2O2 and lipid peroxides but uses glutathione as a cofactor, and myeloperoxidase generates
reactive species in neutrophils.
Page 3 | Rasmussen University NUR 2063
, NUR 2063 Essentials of Pathophysiology | Final Exam | Latest 2026/2027 Update Grade A | 100% Verified Answers
Q8: A researcher studies a form of cell death characterized by caspase activation, chromatin
condensation, cell shrinkage, and formation of apoptotic bodies without eliciting an inflammatory
response. This process is:
A. Coagulative necrosis
B. Apoptosis (programmed cell death) *[CORRECT]*
C. Autophagy with lysosomal recycling
D. Liquefactive necrosis with neutrophil infiltration
Correct Answer: B
Rationale: Apoptosis is programmed cell death characterized by caspase cascade activation, chromatin condensation, cell
shrinkage, membrane blebbing, and formation of apoptotic bodies that are phagocytosed without inflammation. Necrosis
causes inflammation, and autophagy is a self-degradative process for nutrient recycling under stress.
Q9: A 60-year-old patient with chronic alcoholism has a liver biopsy showing hepatocytes with increased
numbers of smooth endoplasmic reticulum, an adaptation to metabolize the drug. This cellular change
represents:
A. Hypertrophy with organelle proliferation *[CORRECT]*
B. Hyperplasia with increased cell number
C. Metaplasia with cell type change
D. Dysplasia with disordered maturation
Correct Answer: A
Rationale: Hypertrophy includes an increase in cell size and proliferation of organelles (such as smooth ER) within cells,
often in response to drugs requiring metabolism. The barbiturate-alcohol induction system is the classic example.
Hyperplasia would require increased cell number, metaplasia is cell type substitution, and dysplasia is disordered growth.
Q10: A cervical biopsy in a 35-year-old woman reveals cells demonstrating disorder, pleomorphism, and
hyperchromatic nuclei confined to the epithelial layer without basement membrane invasion. The
pathologist classifies this as:
A. Metaplasia representing reversible substitution
B. Dysplasia representing disordered precancerous growth *[CORRECT]*
C. Anaplasia representing loss of differentiation
D. Neoplasia representing invasive malignancy
Correct Answer: B
Rationale: Dysplasia is characterized by disorder, pleomorphism, and hyperchromatic nuclei that remains within the
basement membrane (pre-invasive). It is considered a precancerous change that may progress to carcinoma in situ.
Metaplasia is reversible cell substitution, anaplasia is malignant loss of differentiation, and neoplasia with invasion
indicates cancer.
Page 4 | Rasmussen University NUR 2063
FINAL EXAM: NUR2063 / NUR 2063
(LATEST UPDATE) ESSENTIALS OF
PATHOPHYSIOLOGY
REVIEW GUIDE QUESTIONS AND VERIFIED ANSWERS
100% CORRECT | GRADE A | RASMUSSEN UNIVERSITY
Examination Overview: 150 multiple-choice questions covering the twelve core domains of pathophysiology. Question
distribution: 75% scenario-based clinical reasoning and 25% direct knowledge. Cognitive distribution: 20% recall, 50%
application, 30% analysis. Includes 20 clinical reasoning scenarios, 15 laboratory interpretation questions, and 15
pathophysiological mechanism questions. Aligned with NUR 2063 Rasmussen course syllabus and NCLEX-RN
pathophysiology competencies.
Section 1: Cellular Injury, Adaptation, & Death
Q1: A 65-year-old patient with chronic hypertension has an echocardiogram demonstrating thickening
of the left ventricular wall. The nurse identifies this cellular adaptation as:
A. Atrophy of cardiac myocytes
B. Hypertrophy of cardiac myocytes *[CORRECT]*
C. Hyperplasia of cardiac myocytes
D. Metaplasia of cardiac myocytes
Correct Answer: B
Rationale: Hypertrophy is an increase in cell size in response to increased workload, exemplified by cardiac myocyte
enlargement in chronic hypertension. Cardiac muscle cells are terminally differentiated and cannot undergo hyperplasia
(cell number increase). Atrophy is decreased cell size, and metaplasia is replacement of one cell type with another.
Page 1 | Rasmussen University NUR 2063
,NUR 2063 Essentials of Pathophysiology | Final Exam | Latest 2026/2027 Update Grade A | 100% Verified Answers
Q2: A 48-year-old male with a 25-pack-year smoking history undergoes bronchoscopy. Biopsy reveals
that the normal ciliated pseudostratified columnar epithelium of the bronchus has been replaced by
stratified squamous epithelium. This adaptive change is best described as:
A. Dysplasia with atypical features
B. Anaplasia indicating malignancy
C. Metaplasia as a reversible adaptive response *[CORRECT]*
D. Hyperplasia due to inflammation
Correct Answer: C
Rationale: Metaplasia is the reversible replacement of one differentiated cell type with another, typically as an adaptive
response to chronic irritation such as cigarette smoke. Ciliated columnar epithelium converts to stratified squamous to
better withstand the insult. Dysplasia involves disordered growth, anaplasia is loss of differentiation in malignancy, and
hyperplasia is increased cell number.
Q3: A patient sustains an acute myocardial infarction. Six hours after the event, the myocardial tissue
undergoes cell death characterized by preservation of tissue architecture and protein denaturation.
Which type of necrosis is most likely present?
A. Liquefactive necrosis with tissue dissolution
B. Caseous necrosis with granuloma formation
C. Coagulative necrosis with preserved cell outlines *[CORRECT]*
D. Fat necrosis with saponification
Correct Answer: C
Rationale: Coagulative necrosis is the pattern seen in ischemic injury of most solid organs, including the heart. Protein
denaturation causes cell proteins to coagulate and cell outlines to be preserved. Liquefactive necrosis occurs in the brain
or bacterial infections, caseous necrosis is associated with tuberculosis, and fat necrosis occurs in pancreatic injury with
saponification.
Q4: A pathologist examines tissue from a patient with pulmonary tuberculosis and notes a cheese-like,
amorphous granular center surrounded by macrophages and lymphocytes. This finding is characteristic
of:
A. Coagulative necrosis with intact architecture
B. Liquefactive necrosis in brain tissue
C. Caseous necrosis within a granuloma *[CORRECT]*
D. Fibrinoid necrosis in vessel walls
Correct Answer: C
Rationale: Caseous necrosis (literally 'cheese-like') is encountered principally in tuberculosis infections and is a variant
of coagulative necrosis where the necrotic tissue appears as an amorphous granular debris enclosed within a
granulomatous inflammatory border. Coagulative preserves architecture, liquefactive dissolves tissue, and fibrinoid
occurs in immune-mediated vessel injury.
Page 2 | Rasmussen University NUR 2063
,NUR 2063 Essentials of Pathophysiology | Final Exam | Latest 2026/2027 Update Grade A | 100% Verified Answers
Q5: A 70-year-old patient had his arm immobilized in a cast for six weeks following a distal radius
fracture. Upon cast removal, the forearm muscles appear visibly smaller. The underlying mechanism of
this adaptation is:
A. Decreased cell size due to reduced metabolic demand *[CORRECT]*
B. Decreased cell number due to apoptosis
C. Replacement of muscle with adipose tissue
D. Cellular necrosis due to disuse
Correct Answer: A
Rationale: Disuse atrophy is the reduction in cell size due to decreased workload or physiologic demand, as occurs with
immobilization. Cells shrink as a result of decreased protein synthesis and increased proteolysis. The process is reversible
with resumed activity. It is not due to apoptosis, fat replacement, or necrosis.
Q6: Laboratory studies of cells exposed to hypoxia reveal ATP depletion, failure of the Na+/K+-ATPase
pump, and influx of sodium and water. Which morphologic change appears FIRST in this sequence of
reversible cell injury?
A. Nuclear chromatin clumping with pyknosis
B. Cellular swelling (hydropic change) *[CORRECT]*
C. Ribosomal detachment with vacuolation
D. Mitochondrial floccular densities
Correct Answer: B
Rationale: Cellular swelling (hydropic change) is the first and classic morphologic sign of reversible cell injury, resulting
from ATP depletion and failure of the Na+/K+-ATPase pump, allowing sodium and water to accumulate intracellularly.
Pyknosis and floccular densities are features of irreversible injury. Ribosomal detachment occurs later.
Q7: A patient with severe thermal burns develops oxidative stress and cellular damage from reactive
oxygen species. Which enzyme specifically neutralizes hydrogen peroxide by converting it to water and
oxygen?
A. Superoxide dismutase converting superoxide anions
B. Catalase decomposing hydrogen peroxide *[CORRECT]*
C. Glutathione peroxidase degrading lipid peroxides
D. Myeloperoxidase generating hypochlorous acid
Correct Answer: B
Rationale: Catalase is the enzyme located in peroxisomes that decomposes hydrogen peroxide (H2O2) into water and
oxygen, thereby neutralizing its toxicity. Superoxide dismutase converts superoxide anions to H2O2, glutathione
peroxidase also breaks down H2O2 and lipid peroxides but uses glutathione as a cofactor, and myeloperoxidase generates
reactive species in neutrophils.
Page 3 | Rasmussen University NUR 2063
, NUR 2063 Essentials of Pathophysiology | Final Exam | Latest 2026/2027 Update Grade A | 100% Verified Answers
Q8: A researcher studies a form of cell death characterized by caspase activation, chromatin
condensation, cell shrinkage, and formation of apoptotic bodies without eliciting an inflammatory
response. This process is:
A. Coagulative necrosis
B. Apoptosis (programmed cell death) *[CORRECT]*
C. Autophagy with lysosomal recycling
D. Liquefactive necrosis with neutrophil infiltration
Correct Answer: B
Rationale: Apoptosis is programmed cell death characterized by caspase cascade activation, chromatin condensation, cell
shrinkage, membrane blebbing, and formation of apoptotic bodies that are phagocytosed without inflammation. Necrosis
causes inflammation, and autophagy is a self-degradative process for nutrient recycling under stress.
Q9: A 60-year-old patient with chronic alcoholism has a liver biopsy showing hepatocytes with increased
numbers of smooth endoplasmic reticulum, an adaptation to metabolize the drug. This cellular change
represents:
A. Hypertrophy with organelle proliferation *[CORRECT]*
B. Hyperplasia with increased cell number
C. Metaplasia with cell type change
D. Dysplasia with disordered maturation
Correct Answer: A
Rationale: Hypertrophy includes an increase in cell size and proliferation of organelles (such as smooth ER) within cells,
often in response to drugs requiring metabolism. The barbiturate-alcohol induction system is the classic example.
Hyperplasia would require increased cell number, metaplasia is cell type substitution, and dysplasia is disordered growth.
Q10: A cervical biopsy in a 35-year-old woman reveals cells demonstrating disorder, pleomorphism, and
hyperchromatic nuclei confined to the epithelial layer without basement membrane invasion. The
pathologist classifies this as:
A. Metaplasia representing reversible substitution
B. Dysplasia representing disordered precancerous growth *[CORRECT]*
C. Anaplasia representing loss of differentiation
D. Neoplasia representing invasive malignancy
Correct Answer: B
Rationale: Dysplasia is characterized by disorder, pleomorphism, and hyperchromatic nuclei that remains within the
basement membrane (pre-invasive). It is considered a precancerous change that may progress to carcinoma in situ.
Metaplasia is reversible cell substitution, anaplasia is malignant loss of differentiation, and neoplasia with invasion
indicates cancer.
Page 4 | Rasmussen University NUR 2063
