NUR 2063: Essentials of Pathophysiology — Exam 1
Rasmussen University | 2026/2027 Edition | 50 Questions.
DOMAIN 1: CELLULAR BIOLOGY, ADAPTATION & INJURY (12 Questions
Sub-Topic: Cellular Adaptations (3 Questions)
Question 1 (Multiple-choice)
A 58-year-old male with a 20-year history of poorly controlled hypertension presents for a
routine physical examination. His echocardiogram reveals left ventricular wall thickening with a
normal chamber size. The nurse recognizes this cellular adaptation as which of the following?
A) Hyperplasia
B) Hypertrophy
C) Metaplasia
D) Dysplasia
[CORRECT: B]
Rationale: Hypertrophy is an increase in cell SIZE, not cell number, and occurs in cells with
limited capacity to divide such as cardiac myocytes. In response to chronic pressure overload
from hypertension, the left ventricle undergoes concentric hypertrophy to compensate for
increased afterload. This differs from hyperplasia (increase in cell number, seen in tissues
capable of division like the endometrium), metaplasia (replacement of one mature cell type
with another), and dysplasia (disordered, precancerous growth).
Question 2 (Select-all-that-apply)
A nursing student is studying cellular adaptations and their clinical significance. Which
statements accurately describe metaplasia? Select all that apply.
A) Metaplasia represents an increase in cell number in response to hormonal stimulation
B) Barrett's esophagus is a classic example of metaplasia resulting from chronic GERD
C) Metaplasia involves the replacement of one mature, differentiated cell type with another
mature cell type
D) Metaplasia is always considered a precancerous condition requiring immediate intervention
,E) Chronic irritation or inflammation is the primary stimulus for metaplastic change
F) Metaplasia occurs in cells capable of active mitotic division
[CORRECT: B, C, E, F]
Rationale: Metaplasia is defined as the replacement of one mature, differentiated cell type with
another mature cell type (C), typically in response to chronic irritation or inflammation (E).
Barrett's esophagus exemplifies this process, where chronic gastric acid exposure from GERD
causes squamous epithelium to be replaced by columnar epithelium (B). Metaplasia occurs in
cells with stem cell potential capable of division (F). It is not an increase in cell number (that is
hyperplasia, A), and while some metaplastic changes increase cancer risk (e.g., Barrett's), not all
metaplasia is immediately precancerous or requires intervention (D is incorrect).
Question 3 (Multiple-choice)
A 35-year-old female presents with abnormal vaginal bleeding. Her Pap smear reveals cervical
intraepithelial neoplasia (CIN) characterized by disordered cellular maturation, nuclear
hyperchromatism, and loss of normal tissue architecture. This cellular change is best classified
as:
A) Atrophy
B) Hyperplasia
C) Metaplasia
D) Dysplasia
[CORRECT: D]
Rationale: Dysplasia is characterized by abnormal, disordered cell growth with loss of
uniformity and tissue architecture. Cervical intraepithelial neoplasia represents dysplastic
changes in the cervical epithelium and is considered a precancerous condition. Unlike
metaplasia (replacement of one normal cell type with another), dysplasia involves truly
abnormal cellular development. Unlike hyperplasia (increased cell number with normal
morphology) or atrophy (decreased cell size), dysplasia carries significant malignant potential
and requires close monitoring or intervention.
Sub-Topic: Cell Injury Mechanisms (3 Questions)
Question 4 (Multiple-choice)
, A 72-year-old patient with severe peripheral arterial disease undergoes revascularization
surgery. Twelve hours post-procedure, the nurse notes dark, mottled tissue in the affected limb
with elevated creatine kinase and myoglobin levels. The nurse recognizes this as reperfusion
injury mediated primarily by which mechanism?
A) Accumulation of lactic acid from anaerobic metabolism
B) Generation of oxygen-derived free radicals
C) Direct thermal damage to cellular proteins
D) Excessive accumulation of intracellular glycogen
[CORRECT: B]
Rationale: Reperfusion injury occurs when oxygen is reintroduced to ischemic tissue, leading to
the generation of oxygen-derived free radicals (reactive oxygen species) that damage cellular
membranes, proteins, and DNA through lipid peroxidation. The sudden influx of oxygen to
previously hypoxic mitochondria causes incomplete reduction of O₂, generating superoxide
anions, hydrogen peroxide, and hydroxyl radicals. While lactic acid accumulation occurs during
ischemia (A), it is not the primary mechanism of reperfusion-specific injury. Free radical damage
explains the paradoxical worsening of tissue injury following restoration of blood flow.
Question 5 (Select-all-that-apply)
A patient presents with carbon monoxide poisoning following a house fire. The nurse is
reviewing the mechanisms of hypoxic cell injury. Which factors contribute to cellular damage in
this patient? Select all that apply.
A) Decreased oxygen delivery to tissues due to competitive binding of carbon monoxide to
hemoglobin
B) Leftward shift of the oxyhemoglobin dissociation curve, impairing oxygen release to tissues
C) Direct inhibition of cytochrome oxidase in the electron transport chain
D) Increased production of ATP through anaerobic glycolysis
E) Accumulation of intracellular calcium activating phospholipases and proteases
F) Cellular swelling due to failure of the sodium-potassium ATPase pump
[CORRECT: A, B, E, F]
Rationale: Carbon monoxide binds to hemoglobin with 240 times greater affinity than oxygen,
forming carboxyhemoglobin and decreasing oxygen delivery (A). This binding causes a leftward
shift of the oxyhemoglobin dissociation curve, further impairing oxygen release to tissues (B).
Hypoxia leads to ATP depletion, causing failure of the Na⁺/K⁺-ATPase pump with resultant
cellular swelling (F) and influx of calcium ions that activate destructive enzymes (E). While
Rasmussen University | 2026/2027 Edition | 50 Questions.
DOMAIN 1: CELLULAR BIOLOGY, ADAPTATION & INJURY (12 Questions
Sub-Topic: Cellular Adaptations (3 Questions)
Question 1 (Multiple-choice)
A 58-year-old male with a 20-year history of poorly controlled hypertension presents for a
routine physical examination. His echocardiogram reveals left ventricular wall thickening with a
normal chamber size. The nurse recognizes this cellular adaptation as which of the following?
A) Hyperplasia
B) Hypertrophy
C) Metaplasia
D) Dysplasia
[CORRECT: B]
Rationale: Hypertrophy is an increase in cell SIZE, not cell number, and occurs in cells with
limited capacity to divide such as cardiac myocytes. In response to chronic pressure overload
from hypertension, the left ventricle undergoes concentric hypertrophy to compensate for
increased afterload. This differs from hyperplasia (increase in cell number, seen in tissues
capable of division like the endometrium), metaplasia (replacement of one mature cell type
with another), and dysplasia (disordered, precancerous growth).
Question 2 (Select-all-that-apply)
A nursing student is studying cellular adaptations and their clinical significance. Which
statements accurately describe metaplasia? Select all that apply.
A) Metaplasia represents an increase in cell number in response to hormonal stimulation
B) Barrett's esophagus is a classic example of metaplasia resulting from chronic GERD
C) Metaplasia involves the replacement of one mature, differentiated cell type with another
mature cell type
D) Metaplasia is always considered a precancerous condition requiring immediate intervention
,E) Chronic irritation or inflammation is the primary stimulus for metaplastic change
F) Metaplasia occurs in cells capable of active mitotic division
[CORRECT: B, C, E, F]
Rationale: Metaplasia is defined as the replacement of one mature, differentiated cell type with
another mature cell type (C), typically in response to chronic irritation or inflammation (E).
Barrett's esophagus exemplifies this process, where chronic gastric acid exposure from GERD
causes squamous epithelium to be replaced by columnar epithelium (B). Metaplasia occurs in
cells with stem cell potential capable of division (F). It is not an increase in cell number (that is
hyperplasia, A), and while some metaplastic changes increase cancer risk (e.g., Barrett's), not all
metaplasia is immediately precancerous or requires intervention (D is incorrect).
Question 3 (Multiple-choice)
A 35-year-old female presents with abnormal vaginal bleeding. Her Pap smear reveals cervical
intraepithelial neoplasia (CIN) characterized by disordered cellular maturation, nuclear
hyperchromatism, and loss of normal tissue architecture. This cellular change is best classified
as:
A) Atrophy
B) Hyperplasia
C) Metaplasia
D) Dysplasia
[CORRECT: D]
Rationale: Dysplasia is characterized by abnormal, disordered cell growth with loss of
uniformity and tissue architecture. Cervical intraepithelial neoplasia represents dysplastic
changes in the cervical epithelium and is considered a precancerous condition. Unlike
metaplasia (replacement of one normal cell type with another), dysplasia involves truly
abnormal cellular development. Unlike hyperplasia (increased cell number with normal
morphology) or atrophy (decreased cell size), dysplasia carries significant malignant potential
and requires close monitoring or intervention.
Sub-Topic: Cell Injury Mechanisms (3 Questions)
Question 4 (Multiple-choice)
, A 72-year-old patient with severe peripheral arterial disease undergoes revascularization
surgery. Twelve hours post-procedure, the nurse notes dark, mottled tissue in the affected limb
with elevated creatine kinase and myoglobin levels. The nurse recognizes this as reperfusion
injury mediated primarily by which mechanism?
A) Accumulation of lactic acid from anaerobic metabolism
B) Generation of oxygen-derived free radicals
C) Direct thermal damage to cellular proteins
D) Excessive accumulation of intracellular glycogen
[CORRECT: B]
Rationale: Reperfusion injury occurs when oxygen is reintroduced to ischemic tissue, leading to
the generation of oxygen-derived free radicals (reactive oxygen species) that damage cellular
membranes, proteins, and DNA through lipid peroxidation. The sudden influx of oxygen to
previously hypoxic mitochondria causes incomplete reduction of O₂, generating superoxide
anions, hydrogen peroxide, and hydroxyl radicals. While lactic acid accumulation occurs during
ischemia (A), it is not the primary mechanism of reperfusion-specific injury. Free radical damage
explains the paradoxical worsening of tissue injury following restoration of blood flow.
Question 5 (Select-all-that-apply)
A patient presents with carbon monoxide poisoning following a house fire. The nurse is
reviewing the mechanisms of hypoxic cell injury. Which factors contribute to cellular damage in
this patient? Select all that apply.
A) Decreased oxygen delivery to tissues due to competitive binding of carbon monoxide to
hemoglobin
B) Leftward shift of the oxyhemoglobin dissociation curve, impairing oxygen release to tissues
C) Direct inhibition of cytochrome oxidase in the electron transport chain
D) Increased production of ATP through anaerobic glycolysis
E) Accumulation of intracellular calcium activating phospholipases and proteases
F) Cellular swelling due to failure of the sodium-potassium ATPase pump
[CORRECT: A, B, E, F]
Rationale: Carbon monoxide binds to hemoglobin with 240 times greater affinity than oxygen,
forming carboxyhemoglobin and decreasing oxygen delivery (A). This binding causes a leftward
shift of the oxyhemoglobin dissociation curve, further impairing oxygen release to tissues (B).
Hypoxia leads to ATP depletion, causing failure of the Na⁺/K⁺-ATPase pump with resultant
cellular swelling (F) and influx of calcium ions that activate destructive enzymes (E). While
