NUR 631 Final Exam and Study Guide 2026/2027 – Advanced
Physiology & Pathophysiology | Complete Questions &
Verified Answers with Rationales
I. Cellular Physiology, Genetics & Immunology
1. Which cellular change is most characteristic of reversible cell injury caused by
hypoxia?
A. Cellular swelling
B. Nuclear fragmentation
C. Membrane rupture
D. Lysosomal destruction
Answer: A
Rationale: ATP depletion impairs the sodium-potassium pump, causing
intracellular sodium and water accumulation and cellular swelling. Severe or
prolonged injury can progress to irreversible damage.
2. A patient experiences prolonged tissue ischemia. Which event most directly
contributes to irreversible cellular injury?
A. Increased ATP production
B. Mitochondrial dysfunction with inability to restore ATP
C. Increased protein synthesis
D. Increased intracellular glycogen
Answer: B
Rationale: Persistent mitochondrial damage prevents adequate ATP generation
and contributes to membrane disruption, calcium influx, and cell death.
3. Which process is characterized by programmed, energy-dependent cell death
without substantial inflammation?
,A. Necrosis
B. Apoptosis
C. Gangrene
D. Autolysis
Answer: B
Rationale: Apoptosis is regulated cell death involving cellular fragmentation and
phagocytosis with minimal surrounding inflammation.
4. Which feature best distinguishes necrosis from apoptosis?
A. Necrosis commonly causes inflammation
B. Necrosis requires ATP
C. Apoptosis causes membrane rupture immediately
D. Apoptosis always causes extensive inflammation
Answer: A
Rationale: Necrotic cell death commonly releases intracellular contents and
triggers inflammation, whereas apoptosis generally occurs in a controlled manner.
5. Which cellular adaptation occurs when a tissue increases the size of existing
cells?
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Dysplasia
Answer: B
Rationale: Hypertrophy is enlargement of individual cells, resulting in
enlargement of the tissue or organ.
6. Which adaptation involves an increase in the number of cells?
,A. Hypertrophy
B. Hyperplasia
C. Atrophy
D. Metaplasia
Answer: B
Rationale: Hyperplasia is an increase in cell number and may be physiologic or
pathologic.
7. A chronic irritant causes bronchial columnar epithelium to be replaced by
squamous epithelium. This is:
A. Dysplasia
B. Metaplasia
C. Hypertrophy
D. Necrosis
Answer: B
Rationale: Metaplasia is a potentially reversible substitution of one differentiated
cell type for another better able to tolerate the stress.
8. Dysplasia is best described as:
A. Normal programmed cell death
B. Disordered cellular growth and maturation
C. Increased cell size only
D. Complete tissue destruction
Answer: B
Rationale: Dysplasia involves abnormal cellular organization, size, shape, and
maturation and can represent a premalignant change.
9. Which organelle is primarily responsible for ATP production?
, A. Lysosome
B. Ribosome
C. Mitochondrion
D. Golgi apparatus
Answer: C
Rationale: Mitochondria generate most cellular ATP through oxidative
phosphorylation.
10. Free radicals contribute to cellular injury primarily by:
A. Stabilizing cell membranes
B. Damaging lipids, proteins, and DNA
C. Increasing ATP synthesis
D. Preventing oxidative stress
Answer: B
Rationale: Reactive oxygen species can cause lipid peroxidation, protein
modification, mitochondrial injury, and DNA damage.
11. Which process causes cellular injury through activation of enzymes that
degrade structural proteins and membranes?
A. Calcium influx
B. Glycogenesis
C. Protein synthesis
D. Osmosis only
Answer: A
Rationale: Excess intracellular calcium activates phospholipases, proteases,
endonucleases, and ATPases, promoting cellular destruction.
12. A mutation that activates a growth-promoting gene is most closely
associated with:
Physiology & Pathophysiology | Complete Questions &
Verified Answers with Rationales
I. Cellular Physiology, Genetics & Immunology
1. Which cellular change is most characteristic of reversible cell injury caused by
hypoxia?
A. Cellular swelling
B. Nuclear fragmentation
C. Membrane rupture
D. Lysosomal destruction
Answer: A
Rationale: ATP depletion impairs the sodium-potassium pump, causing
intracellular sodium and water accumulation and cellular swelling. Severe or
prolonged injury can progress to irreversible damage.
2. A patient experiences prolonged tissue ischemia. Which event most directly
contributes to irreversible cellular injury?
A. Increased ATP production
B. Mitochondrial dysfunction with inability to restore ATP
C. Increased protein synthesis
D. Increased intracellular glycogen
Answer: B
Rationale: Persistent mitochondrial damage prevents adequate ATP generation
and contributes to membrane disruption, calcium influx, and cell death.
3. Which process is characterized by programmed, energy-dependent cell death
without substantial inflammation?
,A. Necrosis
B. Apoptosis
C. Gangrene
D. Autolysis
Answer: B
Rationale: Apoptosis is regulated cell death involving cellular fragmentation and
phagocytosis with minimal surrounding inflammation.
4. Which feature best distinguishes necrosis from apoptosis?
A. Necrosis commonly causes inflammation
B. Necrosis requires ATP
C. Apoptosis causes membrane rupture immediately
D. Apoptosis always causes extensive inflammation
Answer: A
Rationale: Necrotic cell death commonly releases intracellular contents and
triggers inflammation, whereas apoptosis generally occurs in a controlled manner.
5. Which cellular adaptation occurs when a tissue increases the size of existing
cells?
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Dysplasia
Answer: B
Rationale: Hypertrophy is enlargement of individual cells, resulting in
enlargement of the tissue or organ.
6. Which adaptation involves an increase in the number of cells?
,A. Hypertrophy
B. Hyperplasia
C. Atrophy
D. Metaplasia
Answer: B
Rationale: Hyperplasia is an increase in cell number and may be physiologic or
pathologic.
7. A chronic irritant causes bronchial columnar epithelium to be replaced by
squamous epithelium. This is:
A. Dysplasia
B. Metaplasia
C. Hypertrophy
D. Necrosis
Answer: B
Rationale: Metaplasia is a potentially reversible substitution of one differentiated
cell type for another better able to tolerate the stress.
8. Dysplasia is best described as:
A. Normal programmed cell death
B. Disordered cellular growth and maturation
C. Increased cell size only
D. Complete tissue destruction
Answer: B
Rationale: Dysplasia involves abnormal cellular organization, size, shape, and
maturation and can represent a premalignant change.
9. Which organelle is primarily responsible for ATP production?
, A. Lysosome
B. Ribosome
C. Mitochondrion
D. Golgi apparatus
Answer: C
Rationale: Mitochondria generate most cellular ATP through oxidative
phosphorylation.
10. Free radicals contribute to cellular injury primarily by:
A. Stabilizing cell membranes
B. Damaging lipids, proteins, and DNA
C. Increasing ATP synthesis
D. Preventing oxidative stress
Answer: B
Rationale: Reactive oxygen species can cause lipid peroxidation, protein
modification, mitochondrial injury, and DNA damage.
11. Which process causes cellular injury through activation of enzymes that
degrade structural proteins and membranes?
A. Calcium influx
B. Glycogenesis
C. Protein synthesis
D. Osmosis only
Answer: A
Rationale: Excess intracellular calcium activates phospholipases, proteases,
endonucleases, and ATPases, promoting cellular destruction.
12. A mutation that activates a growth-promoting gene is most closely
associated with:
