1
, 2
Applied Pathophysiology for the
Advanced Practice Nurse (Dlugasch &
Story) – Test Bank
Edition: 2nd (2021)
Chapters
1. Cellular Function
2. Immunity
3. Hematopoietic Function
4. Cardiovascular Function
5. Pulmonary Function
6. Fluid, Electrolyte, and Acid-Base Homeostasis
7. Urinary Function
8. Reproductive Function
9. Gastrointestinal Function
10. Endocrine Function
11. Neural Function
12. Musculoskeletal Function
13. Integumentary Function
14. Sensory Function
, 3
1. Cellular Function
Question 1. A hospitalized adult develops swollen cells after prolonged tissue
hypoxia. Which mechanism most directly explains the early reversible injury?
A. Failure of the sodium-potassium ATPase with intracellular sodium and water
accumulation
B. Activation of executioner caspases causing nuclear fragmentation
C. Massive calcium deposition in the mitochondrial matrix
D. Immediate rupture of lysosomal membranes with autodigestion
✅ Correct Answer: A
Rationale: Hypoxia lowers ATP production, so the sodium-potassium pump
cannot maintain ionic gradients. Sodium and water then move into the cell,
producing cellular swelling as an early reversible change. Apoptotic fragmentation,
calcification, and widespread lysosomal rupture are later or different injury
pathways rather than the classic first reversible event.
DIF: Moderate
TOP: Cellular injury and adaptation
MSC: Physiologic Adaptation
Question 2. A patient with chronic hypertension is found to have left ventricular
wall thickening. Which cellular adaptation best describes this response?
A. Hyperplasia
, 4
B. Hypertrophy
C. Metaplasia
D. Dysplasia
✅ Correct Answer: B
Rationale: Cardiac myocytes respond to sustained workload by increasing cell
size because they have limited ability to divide. The result is hypertrophy, not
hyperplasia. Metaplasia is replacement by another mature cell type, and dysplasia
reflects disordered growth often associated with premalignant change.
DIF: Easy
TOP: Adaptive responses to stress
MSC: Physiologic Adaptation
Question 3. A smoker develops replacement of normal ciliated bronchial
epithelium with stratified squamous cells. This change is best classified as:
A. Atrophy
B. Metaplasia
C. Neoplasia
D. Apoptosis
✅ Correct Answer: B
, 5
Rationale: Metaplasia is a reversible substitution of one differentiated cell type for
another that is better able to tolerate chronic irritation. In smokers, respiratory
epithelium may become squamous. It is not atrophy, which is decreased cell size;
neoplasia, which is autonomous growth; or apoptosis, which is programmed cell
death.
DIF: Easy
TOP: Cellular adaptation
MSC: Health Promotion
Question 4. A patient with severe acute pancreatitis develops fat necrosis. Which
enzyme process is most central to this tissue injury?
A. Protein cross-linking by ribosomes
B. Enzymatic destruction of adipocytes by lipase
C. Excess glycogen storage in adipose tissue
D. Failure of DNA repair without inflammation
✅ Correct Answer: B
Rationale: In pancreatitis, pancreatic lipases escape and digest fat, generating fatty
acids that combine with calcium in a process called saponification. This is an
enzymatic necrosis. Ribosomal protein synthesis, glycogen storage, and isolated
DNA repair failure do not explain classic fat necrosis.
DIF: Moderate
, 6
TOP: Necrosis patterns
MSC: Clinical Judgment
Question 5. Which finding most strongly supports apoptosis rather than necrosis?
A. Cell swelling with membrane rupture and inflammation
B. Leakage of intracellular enzymes into serum
C. Fragmentation into membrane-bound apoptotic bodies without marked
inflammation
D. Random digestion of surrounding tissue by released lysosomal enzymes
✅ Correct Answer: C
Rationale: Apoptosis is an energy-dependent, tightly regulated process in which
cells shrink and fragment into membrane-bound bodies that are rapidly removed by
phagocytes, usually without provoking notable inflammation. Necrosis, by contrast,
involves loss of membrane integrity, enzyme leakage, and inflammatory response.
DIF: Moderate
TOP: Cell death mechanisms
MSC: Clinical Judgment
Question 6. A patient with prolonged fasting has decreased skeletal muscle mass.
What process best explains the reduction?
A. Physiologic atrophy from decreased nutrient availability
, 7
B. Metaplastic conversion due to chronic irritation
C. Hyperplasia from increased demand
D. Dysplasia from abnormal maturation
✅ Correct Answer: A
Rationale: Atrophy can occur when cells decrease in size because of reduced
workload, denervation, diminished blood supply, poor nutrition, loss of endocrine
stimulation, or aging. Fasting causes reduced nutrient supply and increased protein
catabolism, leading to smaller muscle fibers rather than proliferation or altered cell
type.
DIF: Easy
TOP: Atrophy
MSC: Nutrition
Question 7. A liver biopsy from a patient with alcohol use disorder reveals
intracellular triglyceride accumulation. This change is termed:
A. Liquefactive necrosis
B. Hydropic change
C. Fatty change
D. Caseous necrosis
✅ Correct Answer: C
, 8
Rationale: Fatty change, or steatosis, reflects abnormal intracellular triglyceride
accumulation, especially in hepatocytes. Hydropic change refers to water
accumulation. Liquefactive and caseous necrosis are forms of cell death, not lipid
accumulation.
DIF: Easy
TOP: Intracellular accumulations
MSC: Clinical Judgment
Question 8. Which statement about free radicals is most accurate in
pathophysiology?
A. They damage only nuclear DNA
B. They are neutralized solely by sodium-potassium pumps
C. They can initiate lipid peroxidation in cell membranes
D. They are produced only during exposure to ionizing radiation
✅ Correct Answer: C
Rationale: Reactive oxygen species can injure cells by lipid peroxidation of
membranes, protein modification, and DNA damage. Antioxidants and enzymes
such as superoxide dismutase help neutralize them; the sodium-potassium pump
does not. They arise in many settings, including inflammation, ischemia-
reperfusion, and toxin exposure.
DIF: Moderate
, 2
Applied Pathophysiology for the
Advanced Practice Nurse (Dlugasch &
Story) – Test Bank
Edition: 2nd (2021)
Chapters
1. Cellular Function
2. Immunity
3. Hematopoietic Function
4. Cardiovascular Function
5. Pulmonary Function
6. Fluid, Electrolyte, and Acid-Base Homeostasis
7. Urinary Function
8. Reproductive Function
9. Gastrointestinal Function
10. Endocrine Function
11. Neural Function
12. Musculoskeletal Function
13. Integumentary Function
14. Sensory Function
, 3
1. Cellular Function
Question 1. A hospitalized adult develops swollen cells after prolonged tissue
hypoxia. Which mechanism most directly explains the early reversible injury?
A. Failure of the sodium-potassium ATPase with intracellular sodium and water
accumulation
B. Activation of executioner caspases causing nuclear fragmentation
C. Massive calcium deposition in the mitochondrial matrix
D. Immediate rupture of lysosomal membranes with autodigestion
✅ Correct Answer: A
Rationale: Hypoxia lowers ATP production, so the sodium-potassium pump
cannot maintain ionic gradients. Sodium and water then move into the cell,
producing cellular swelling as an early reversible change. Apoptotic fragmentation,
calcification, and widespread lysosomal rupture are later or different injury
pathways rather than the classic first reversible event.
DIF: Moderate
TOP: Cellular injury and adaptation
MSC: Physiologic Adaptation
Question 2. A patient with chronic hypertension is found to have left ventricular
wall thickening. Which cellular adaptation best describes this response?
A. Hyperplasia
, 4
B. Hypertrophy
C. Metaplasia
D. Dysplasia
✅ Correct Answer: B
Rationale: Cardiac myocytes respond to sustained workload by increasing cell
size because they have limited ability to divide. The result is hypertrophy, not
hyperplasia. Metaplasia is replacement by another mature cell type, and dysplasia
reflects disordered growth often associated with premalignant change.
DIF: Easy
TOP: Adaptive responses to stress
MSC: Physiologic Adaptation
Question 3. A smoker develops replacement of normal ciliated bronchial
epithelium with stratified squamous cells. This change is best classified as:
A. Atrophy
B. Metaplasia
C. Neoplasia
D. Apoptosis
✅ Correct Answer: B
, 5
Rationale: Metaplasia is a reversible substitution of one differentiated cell type for
another that is better able to tolerate chronic irritation. In smokers, respiratory
epithelium may become squamous. It is not atrophy, which is decreased cell size;
neoplasia, which is autonomous growth; or apoptosis, which is programmed cell
death.
DIF: Easy
TOP: Cellular adaptation
MSC: Health Promotion
Question 4. A patient with severe acute pancreatitis develops fat necrosis. Which
enzyme process is most central to this tissue injury?
A. Protein cross-linking by ribosomes
B. Enzymatic destruction of adipocytes by lipase
C. Excess glycogen storage in adipose tissue
D. Failure of DNA repair without inflammation
✅ Correct Answer: B
Rationale: In pancreatitis, pancreatic lipases escape and digest fat, generating fatty
acids that combine with calcium in a process called saponification. This is an
enzymatic necrosis. Ribosomal protein synthesis, glycogen storage, and isolated
DNA repair failure do not explain classic fat necrosis.
DIF: Moderate
, 6
TOP: Necrosis patterns
MSC: Clinical Judgment
Question 5. Which finding most strongly supports apoptosis rather than necrosis?
A. Cell swelling with membrane rupture and inflammation
B. Leakage of intracellular enzymes into serum
C. Fragmentation into membrane-bound apoptotic bodies without marked
inflammation
D. Random digestion of surrounding tissue by released lysosomal enzymes
✅ Correct Answer: C
Rationale: Apoptosis is an energy-dependent, tightly regulated process in which
cells shrink and fragment into membrane-bound bodies that are rapidly removed by
phagocytes, usually without provoking notable inflammation. Necrosis, by contrast,
involves loss of membrane integrity, enzyme leakage, and inflammatory response.
DIF: Moderate
TOP: Cell death mechanisms
MSC: Clinical Judgment
Question 6. A patient with prolonged fasting has decreased skeletal muscle mass.
What process best explains the reduction?
A. Physiologic atrophy from decreased nutrient availability
, 7
B. Metaplastic conversion due to chronic irritation
C. Hyperplasia from increased demand
D. Dysplasia from abnormal maturation
✅ Correct Answer: A
Rationale: Atrophy can occur when cells decrease in size because of reduced
workload, denervation, diminished blood supply, poor nutrition, loss of endocrine
stimulation, or aging. Fasting causes reduced nutrient supply and increased protein
catabolism, leading to smaller muscle fibers rather than proliferation or altered cell
type.
DIF: Easy
TOP: Atrophy
MSC: Nutrition
Question 7. A liver biopsy from a patient with alcohol use disorder reveals
intracellular triglyceride accumulation. This change is termed:
A. Liquefactive necrosis
B. Hydropic change
C. Fatty change
D. Caseous necrosis
✅ Correct Answer: C
, 8
Rationale: Fatty change, or steatosis, reflects abnormal intracellular triglyceride
accumulation, especially in hepatocytes. Hydropic change refers to water
accumulation. Liquefactive and caseous necrosis are forms of cell death, not lipid
accumulation.
DIF: Easy
TOP: Intracellular accumulations
MSC: Clinical Judgment
Question 8. Which statement about free radicals is most accurate in
pathophysiology?
A. They damage only nuclear DNA
B. They are neutralized solely by sodium-potassium pumps
C. They can initiate lipid peroxidation in cell membranes
D. They are produced only during exposure to ionizing radiation
✅ Correct Answer: C
Rationale: Reactive oxygen species can injure cells by lipid peroxidation of
membranes, protein modification, and DNA damage. Antioxidants and enzymes
such as superoxide dismutase help neutralize them; the sodium-potassium pump
does not. They arise in many settings, including inflammation, ischemia-
reperfusion, and toxin exposure.
DIF: Moderate
