Page 1 of 86
NR 507 WITH VERIFIED ANSWERS DETAILED RATIONALES
GRADED A+
NR 507
SECTION 1: CELLULAR ADAPTATION, INJURY & DEATH (Questions 1–45)
Question 1. A 68-year-old patient with long-standing hypertension develops left ventricular wall
thickening without an increase in chamber size. Which cellular adaptive response does the
nurse practitioner recognize?
A) Hyperplasia of cardiac myocytes
B) Hypertrophy of cardiac myocytes
C) Metaplasia of cardiac tissue
D) Atrophy of the ventricular myocardium
Answer: B
Rationale: Chronic pressure overload from hypertension stimulates myocyte hypertrophy,
increasing cell size and wall thickness while chamber dimensions remain relatively stable.
Hyperplasia is limited in terminally differentiated cardiac myocytes.
Question 2. During a myocardial infarction, a zone of irreversibly injured myocytes exhibits
disrupted membrane integrity, mitochondrial swelling, and calcium influx. Which form of cell
death is primarily occurring?
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A) Apoptosis with orderly DNA fragmentation
B) Autophagy with lysosomal recycling of organelles
C) Necrosis with inflammatory sequelae
D) Senescence with permanent cell-cycle arrest
Answer: C
Rationale: Ischemic necrosis is characterized by loss of membrane integrity, organelle swelling,
and subsequent inflammation. Apoptosis is programmed and energy-dependent without early
membrane rupture.
Question 3. A patient with chronic GERD develops replacement of esophageal squamous
epithelium by columnar epithelium resembling intestinal mucosa. This adaptive change is best
classified as which process?
A) Metaplasia driven by chronic injury
B) Hyperplasia of residual squamous cells
C) Dysplasia with disordered maturation
D) Neoplastic transformation to adenocarcinoma
Answer: A
Rationale: Barrett esophagus exemplifies metaplasia, a reversible change in which one
differentiated cell type is replaced by another better suited to the altered environment.
Question 4. A pathologist examining a biopsy of cervical tissue notes that the cells appear
abnormal in size, shape, and organization but are confined to the epithelial surface. This finding
is most consistent with:
A) Metaplasia
B) Hyperplasia
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C) Dysplasia
D) Anaplasia
Answer: C
Rationale: Dysplasia refers to disorganized growth with abnormal cell morphology. It is
considered a preneoplastic condition and is graded from mild to severe.
Question 5. Which type of cellular adaptation involves an increase in the number of cells in
response to hormonal stimulation or increased functional demand?
A) Hypertrophy
B) Atrophy
C) Metaplasia
D) Hyperplasia
Answer: D
Rationale: Hyperplasia is characterized by an increase in cell number. Physiologic hyperplasia
occurs in response to hormonal stimulation (e.g., breast tissue during pregnancy), while
pathologic hyperplasia occurs in response to excessive hormonal stimulation.
Question 6. A patient with chronic gastroesophageal reflux disease (GERD) undergoes an
endoscopy, and the esophageal squamous epithelium has been replaced by columnar
epithelium. This finding is an example of:
A) Dysplasia
B) Metaplasia
C) Hyperplasia
D) Neoplasia
Answer: B
Rationale: Metaplasia is a reversible change where one differentiated cell type is replaced by
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another. In Barrett esophagus, the normal squamous epithelium of the esophagus is replaced by
columnar epithelium as a protective response to acid exposure.
Question 7. Necrosis differs from apoptosis in which of the following ways?
A) Necrosis is a programmed form of cell death
B) Necrosis causes cell swelling and rupture with an inflammatory response
C) Necrosis occurs in individual cells without affecting neighboring tissues
D) Necrosis is energy-dependent and requires ATP
Answer: B
Rationale: Necrosis causes cell swelling and rupture with an inflammatory response, whereas
apoptosis is programmed, energy-dependent, and does not incite inflammation.
Question 8. During prolonged ischemia, which sequence best explains the transition from
reversible to irreversible myocardial injury?
A) ATP depletion → Na+/K+-ATPase failure → calcium overload → mitochondrial permeability
transition pore opening
B) Reactive oxygen species generation → lysosomal rupture → DNA repair activation → cellular
recovery
C) Anaerobic glycolysis → intracellular alkalosis → protein synthesis arrest → apoptosis
D) Membrane pump failure → extracellular calcium efflux → caspase-independent necrosis
Answer: A
Rationale: Ischemic ATP depletion disables the Na+/K+-ATPase, causing sodium and calcium
accumulation; mitochondrial calcium overload opens the permeability transition pore,
collapsing oxidative phosphorylation and committing the cell to necrosis.
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NR 507 WITH VERIFIED ANSWERS DETAILED RATIONALES
GRADED A+
NR 507
SECTION 1: CELLULAR ADAPTATION, INJURY & DEATH (Questions 1–45)
Question 1. A 68-year-old patient with long-standing hypertension develops left ventricular wall
thickening without an increase in chamber size. Which cellular adaptive response does the
nurse practitioner recognize?
A) Hyperplasia of cardiac myocytes
B) Hypertrophy of cardiac myocytes
C) Metaplasia of cardiac tissue
D) Atrophy of the ventricular myocardium
Answer: B
Rationale: Chronic pressure overload from hypertension stimulates myocyte hypertrophy,
increasing cell size and wall thickness while chamber dimensions remain relatively stable.
Hyperplasia is limited in terminally differentiated cardiac myocytes.
Question 2. During a myocardial infarction, a zone of irreversibly injured myocytes exhibits
disrupted membrane integrity, mitochondrial swelling, and calcium influx. Which form of cell
death is primarily occurring?
1|Page
,Page 2 of 86
A) Apoptosis with orderly DNA fragmentation
B) Autophagy with lysosomal recycling of organelles
C) Necrosis with inflammatory sequelae
D) Senescence with permanent cell-cycle arrest
Answer: C
Rationale: Ischemic necrosis is characterized by loss of membrane integrity, organelle swelling,
and subsequent inflammation. Apoptosis is programmed and energy-dependent without early
membrane rupture.
Question 3. A patient with chronic GERD develops replacement of esophageal squamous
epithelium by columnar epithelium resembling intestinal mucosa. This adaptive change is best
classified as which process?
A) Metaplasia driven by chronic injury
B) Hyperplasia of residual squamous cells
C) Dysplasia with disordered maturation
D) Neoplastic transformation to adenocarcinoma
Answer: A
Rationale: Barrett esophagus exemplifies metaplasia, a reversible change in which one
differentiated cell type is replaced by another better suited to the altered environment.
Question 4. A pathologist examining a biopsy of cervical tissue notes that the cells appear
abnormal in size, shape, and organization but are confined to the epithelial surface. This finding
is most consistent with:
A) Metaplasia
B) Hyperplasia
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C) Dysplasia
D) Anaplasia
Answer: C
Rationale: Dysplasia refers to disorganized growth with abnormal cell morphology. It is
considered a preneoplastic condition and is graded from mild to severe.
Question 5. Which type of cellular adaptation involves an increase in the number of cells in
response to hormonal stimulation or increased functional demand?
A) Hypertrophy
B) Atrophy
C) Metaplasia
D) Hyperplasia
Answer: D
Rationale: Hyperplasia is characterized by an increase in cell number. Physiologic hyperplasia
occurs in response to hormonal stimulation (e.g., breast tissue during pregnancy), while
pathologic hyperplasia occurs in response to excessive hormonal stimulation.
Question 6. A patient with chronic gastroesophageal reflux disease (GERD) undergoes an
endoscopy, and the esophageal squamous epithelium has been replaced by columnar
epithelium. This finding is an example of:
A) Dysplasia
B) Metaplasia
C) Hyperplasia
D) Neoplasia
Answer: B
Rationale: Metaplasia is a reversible change where one differentiated cell type is replaced by
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, Page 4 of 86
another. In Barrett esophagus, the normal squamous epithelium of the esophagus is replaced by
columnar epithelium as a protective response to acid exposure.
Question 7. Necrosis differs from apoptosis in which of the following ways?
A) Necrosis is a programmed form of cell death
B) Necrosis causes cell swelling and rupture with an inflammatory response
C) Necrosis occurs in individual cells without affecting neighboring tissues
D) Necrosis is energy-dependent and requires ATP
Answer: B
Rationale: Necrosis causes cell swelling and rupture with an inflammatory response, whereas
apoptosis is programmed, energy-dependent, and does not incite inflammation.
Question 8. During prolonged ischemia, which sequence best explains the transition from
reversible to irreversible myocardial injury?
A) ATP depletion → Na+/K+-ATPase failure → calcium overload → mitochondrial permeability
transition pore opening
B) Reactive oxygen species generation → lysosomal rupture → DNA repair activation → cellular
recovery
C) Anaerobic glycolysis → intracellular alkalosis → protein synthesis arrest → apoptosis
D) Membrane pump failure → extracellular calcium efflux → caspase-independent necrosis
Answer: A
Rationale: Ischemic ATP depletion disables the Na+/K+-ATPase, causing sodium and calcium
accumulation; mitochondrial calcium overload opens the permeability transition pore,
collapsing oxidative phosphorylation and committing the cell to necrosis.
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