NR 283 PATHOPHYSIOLOGY EXAM 2
WEEKS 3, 4 & 5 — 160+ REAL EXAM
QUESTIONS WITH CORRECT ANSWERS &
DETAILED RATIONALES (2026/2027
CHAMBERLAIN).
SECTION 1: CELLULAR ADAPTATION, INJURY, AND
NECROSIS (Questions 1–25)
1. A patient has had a leg cast for 6 weeks. Upon removal, the muscles appear
smaller. This is an example of:
a) Hypertrophy
b) Hyperplasia
c) Atrophy
d) Metaplasia
Answer: c) Atrophy. Rationale: Atrophy is a decrease in cell size due to disuse,
denervation, or reduced blood supply. The cast caused immobilization → reduced
workload → muscle cells shrink.
2. Which cellular adaptation is most likely to be reversible?
A) Dysplasia
b) Anaplasia
c) Necrosis
d) Atrophy
Answer: d) Atrophy. Rationale: Atrophy is reversible if the stimulus is removed (e.g.,
muscle regrowth after cast removal). Dysplasia and anaplasia are potentially pre-
malignant. Necrosis is irreversible cell death.
3. A chronic smoker develops a change in the respiratory tract where normal
ciliated columnar epithelium is replaced by stratified squamous epithelium. This
is known as:
,a) Hyperplasia
b) Metaplasia
c) Dysplasia
d) Anaplasia
Answer: b) Metaplasia. Rationale: Metaplasia is the reversible replacement of one
mature cell type by another mature cell type, usually as an adaptive response to
chronic irritation or injury.
4. A patient with long-standing, untreated hypertension undergoes an
echocardiogram. The results reveal significant thickening of the left ventricular
wall. Which cellular adaptation has occurred?
A. Hyperplasia
B. Metaplasia
C. Hypertrophy
D. Dysplasia
Correct Answer: C. Rationale: Hypertrophy is an increase in the size of individual cells,
often caused by an increased mechanical workload or stress, such as the heart
pumping against high systemic vascular resistance. Hyperplasia (A) is an increase in
cell number; metaplasia (B) is replacement of one cell type with another; dysplasia (D)
is disordered growth often preceding cancer.
5. During an ischemic event, a lack of oxygen leads to a decrease in cellular ATP
production. Which immediate consequence occurs within the cell?
A. Shrinkage of the nucleus
B. Failure of the sodium-potassium pump, leading to cellular swelling
C. Decreased intracellular calcium levels
D. Increased intracellular pH
Correct Answer: B. Rationale: Decreased ATP causes the Na+/K+ ATPase pump to fail.
Sodium accumulates inside the cell, pulling water in by osmosis, which results in acute
cellular swelling. Nuclear shrinkage (A) is a late, irreversible change; calcium levels
increase (C); pH decreases with lactic acid accumulation (D).
6. A patient has been diagnosed with a condition that triggers premature,
programmed cellular suicide in specific healthy tissues. What is the medical
term for this programmed cell death?
A. Liquefactive necrosis
B. Coagulative necrosis
C. Apoptosis
D. Infarction
,Correct Answer: C. Rationale: Apoptosis is a highly regulated, distinct process of
programmed cell death designed to eliminate unwanted or damaged cells without
triggering inflammation. Necrosis (A, B) causes inflammation; infarction (D) is tissue
death due to ischemia.
7. The most common cause of cellular injury is:
a) Bacterial infection
b) Hypoxia
c) Genetic mutation
d) Nutritional imbalance
Answer: b) Hypoxia. Rationale: Hypoxia (reduced oxygen) interferes with ATP
production, leading to sodium pump failure, cellular swelling, and eventual necrosis.
8. Programmed cell death that normally occurs during development and tissue
turnover is called:
a) Necrosis
b) Apoptosis
c) Gangrene
d) Autolysis
Answer: b) Apoptosis. Rationale: Apoptosis is a controlled, energy-dependent process
that eliminates damaged or unneeded cells without causing inflammation.
9. Coagulative necrosis is typical in hypoxic injury (except in the brain). Heart
muscle cells die but retain tissue structure for days due to:
a) Apoptosis
b) Coagulative necrosis
c) Liquefactive necrosis
d) Caseous necrosis
Answer: b) Coagulative necrosis. Rationale: Coagulative necrosis is typical in hypoxic
injury (except in the brain). Heart muscle cells die but retain tissue structure for days
due to protein denaturation.
10. A nurse is reviewing a biopsy report that describes a progressive decrease in
myocardial cell size in a patient with chronic severe ischemia. This is an example
of:
A) Hypertrophy
B) Atrophy
C) Dysplasia
D) Metaplasia
, Answer: B) Atrophy. Rationale: Atrophy is a decrease in cell size due to reduced blood
supply (ischemia), disuse, or denervation. The cells shrink as they receive less oxygen
and nutrients.
11. Which cellular adaptation involves an increase in the number of cells in a
tissue or organ?
A) Hypertrophy
B) Hyperplasia
C) Atrophy
D) Metaplasia
Answer: B) Hyperplasia. Rationale: Hyperplasia is an increase in cell number due to
increased mitotic activity. Increased hormonal stimulation can lead to hypertrophy or
hyperplasia.
12. A tissue biopsy reveals disordered growth with variations in cell size, shape,
and organization. This is most consistent with:
A) Anaplasia
B) Metaplasia
C) Hyperplasia
D) Dysplasia
Answer: D) Dysplasia. Rationale: Dysplasia involves abnormal variations in size, shape,
and organization. It is often a precancerous change. Anaplasia (A) is loss of
differentiation; metaplasia (B) is replacement of one mature cell type with another;
hyperplasia (C) is increased cell number.
13. Which of the following is a reversible cellular adaptation?
A) Necrosis
B) Apoptosis
C) Atrophy
D) Infarction
Answer: C) Atrophy. Rationale: Atrophy is reversible if the stimulus is removed (e.g.,
muscle regrowth after cast removal). Necrosis, apoptosis, and infarction are irreversible
cell death processes.
14. The primary role of ATP in the cell is to:
A) Store genetic information
B) Provide energy for cellular processes
C) Synthesize proteins
D) Regulate cell division
WEEKS 3, 4 & 5 — 160+ REAL EXAM
QUESTIONS WITH CORRECT ANSWERS &
DETAILED RATIONALES (2026/2027
CHAMBERLAIN).
SECTION 1: CELLULAR ADAPTATION, INJURY, AND
NECROSIS (Questions 1–25)
1. A patient has had a leg cast for 6 weeks. Upon removal, the muscles appear
smaller. This is an example of:
a) Hypertrophy
b) Hyperplasia
c) Atrophy
d) Metaplasia
Answer: c) Atrophy. Rationale: Atrophy is a decrease in cell size due to disuse,
denervation, or reduced blood supply. The cast caused immobilization → reduced
workload → muscle cells shrink.
2. Which cellular adaptation is most likely to be reversible?
A) Dysplasia
b) Anaplasia
c) Necrosis
d) Atrophy
Answer: d) Atrophy. Rationale: Atrophy is reversible if the stimulus is removed (e.g.,
muscle regrowth after cast removal). Dysplasia and anaplasia are potentially pre-
malignant. Necrosis is irreversible cell death.
3. A chronic smoker develops a change in the respiratory tract where normal
ciliated columnar epithelium is replaced by stratified squamous epithelium. This
is known as:
,a) Hyperplasia
b) Metaplasia
c) Dysplasia
d) Anaplasia
Answer: b) Metaplasia. Rationale: Metaplasia is the reversible replacement of one
mature cell type by another mature cell type, usually as an adaptive response to
chronic irritation or injury.
4. A patient with long-standing, untreated hypertension undergoes an
echocardiogram. The results reveal significant thickening of the left ventricular
wall. Which cellular adaptation has occurred?
A. Hyperplasia
B. Metaplasia
C. Hypertrophy
D. Dysplasia
Correct Answer: C. Rationale: Hypertrophy is an increase in the size of individual cells,
often caused by an increased mechanical workload or stress, such as the heart
pumping against high systemic vascular resistance. Hyperplasia (A) is an increase in
cell number; metaplasia (B) is replacement of one cell type with another; dysplasia (D)
is disordered growth often preceding cancer.
5. During an ischemic event, a lack of oxygen leads to a decrease in cellular ATP
production. Which immediate consequence occurs within the cell?
A. Shrinkage of the nucleus
B. Failure of the sodium-potassium pump, leading to cellular swelling
C. Decreased intracellular calcium levels
D. Increased intracellular pH
Correct Answer: B. Rationale: Decreased ATP causes the Na+/K+ ATPase pump to fail.
Sodium accumulates inside the cell, pulling water in by osmosis, which results in acute
cellular swelling. Nuclear shrinkage (A) is a late, irreversible change; calcium levels
increase (C); pH decreases with lactic acid accumulation (D).
6. A patient has been diagnosed with a condition that triggers premature,
programmed cellular suicide in specific healthy tissues. What is the medical
term for this programmed cell death?
A. Liquefactive necrosis
B. Coagulative necrosis
C. Apoptosis
D. Infarction
,Correct Answer: C. Rationale: Apoptosis is a highly regulated, distinct process of
programmed cell death designed to eliminate unwanted or damaged cells without
triggering inflammation. Necrosis (A, B) causes inflammation; infarction (D) is tissue
death due to ischemia.
7. The most common cause of cellular injury is:
a) Bacterial infection
b) Hypoxia
c) Genetic mutation
d) Nutritional imbalance
Answer: b) Hypoxia. Rationale: Hypoxia (reduced oxygen) interferes with ATP
production, leading to sodium pump failure, cellular swelling, and eventual necrosis.
8. Programmed cell death that normally occurs during development and tissue
turnover is called:
a) Necrosis
b) Apoptosis
c) Gangrene
d) Autolysis
Answer: b) Apoptosis. Rationale: Apoptosis is a controlled, energy-dependent process
that eliminates damaged or unneeded cells without causing inflammation.
9. Coagulative necrosis is typical in hypoxic injury (except in the brain). Heart
muscle cells die but retain tissue structure for days due to:
a) Apoptosis
b) Coagulative necrosis
c) Liquefactive necrosis
d) Caseous necrosis
Answer: b) Coagulative necrosis. Rationale: Coagulative necrosis is typical in hypoxic
injury (except in the brain). Heart muscle cells die but retain tissue structure for days
due to protein denaturation.
10. A nurse is reviewing a biopsy report that describes a progressive decrease in
myocardial cell size in a patient with chronic severe ischemia. This is an example
of:
A) Hypertrophy
B) Atrophy
C) Dysplasia
D) Metaplasia
, Answer: B) Atrophy. Rationale: Atrophy is a decrease in cell size due to reduced blood
supply (ischemia), disuse, or denervation. The cells shrink as they receive less oxygen
and nutrients.
11. Which cellular adaptation involves an increase in the number of cells in a
tissue or organ?
A) Hypertrophy
B) Hyperplasia
C) Atrophy
D) Metaplasia
Answer: B) Hyperplasia. Rationale: Hyperplasia is an increase in cell number due to
increased mitotic activity. Increased hormonal stimulation can lead to hypertrophy or
hyperplasia.
12. A tissue biopsy reveals disordered growth with variations in cell size, shape,
and organization. This is most consistent with:
A) Anaplasia
B) Metaplasia
C) Hyperplasia
D) Dysplasia
Answer: D) Dysplasia. Rationale: Dysplasia involves abnormal variations in size, shape,
and organization. It is often a precancerous change. Anaplasia (A) is loss of
differentiation; metaplasia (B) is replacement of one mature cell type with another;
hyperplasia (C) is increased cell number.
13. Which of the following is a reversible cellular adaptation?
A) Necrosis
B) Apoptosis
C) Atrophy
D) Infarction
Answer: C) Atrophy. Rationale: Atrophy is reversible if the stimulus is removed (e.g.,
muscle regrowth after cast removal). Necrosis, apoptosis, and infarction are irreversible
cell death processes.
14. The primary role of ATP in the cell is to:
A) Store genetic information
B) Provide energy for cellular processes
C) Synthesize proteins
D) Regulate cell division
