Page 1 of 198
GCU NUR 631 Final Exam Study Guide
2026/2027 | Updated Practice Questions
with Verified Answers & Detailed Rationales
| Comprehensive Review
Question 1
A patient with chronic anemia presents with an enlarged heart
on chest X-ray. Which cellular adaptation most likely explains
this finding?
A) Atrophy
B) Hyperplasia
C) Hypertrophy
D) Metaplasia
Answer: C (Hypertrophy)
Rationale: Increased workload due to chronic anemia
,Page 2 of 198
(decreased oxygen-carrying capacity) causes cardiac
myocytes to increase in size (hypertrophy) to generate more
contractile force. This is a compensatory mechanism.
Question 2
A 65-year-old smoker has columnar cells replacing the normal
squamous epithelium in his bronchi. This change is known as:
A) Dysplasia
B) Anaplasia
C) Hyperplasia
D) Metaplasia
Answer: D (Metaplasia)
Rationale: Metaplasia is the reversible replacement of one
differentiated cell type with another. Chronic irritation from
smoking causes squamous-to-columnar metaplasia in airways
(protective response, though abnormal).
Question 3 (SATA)
Which processes are REVERSIBLE cellular adaptations? (Select
,Page 3 of 198
all that apply)
A) Hypertrophy
B) Apoptosis
C) Atrophy
D) Necrosis
E) Hyperplasia
Answer: A, C, E
Rationale: Hypertrophy, atrophy, and hyperplasia are
reversible once the stimulus is removed. Apoptosis and necrosis
are forms of cell death (irreversible).
Question 4
A patient with a prolonged high fever develops cellular injury.
Which mechanism is the most common cause of hypoxic injury in
this case?
A) Free radical damage
B) Impaired calcium homeostasis
C) Reduced ATP production
D) Mitochondrial membrane mutation
, Page 4 of 198
Answer: C (Reduced ATP production)
Rationale: Hypoxic injury (lack of O2) impairs oxidative
phosphorylation → decreased ATP → failure of Na+/K+
pump → cell swelling. Fever increases metabolic demand,
worsening hypoxia.
Question 5
A pathologist notes “coagulative necrosis” in a kidney
specimen. This most likely resulted from:
A) Tuberculosis infection
B) Ischemia from arterial blockage
C) Pancreatic enzyme leakage
D) Hypocalcemia
Answer: B (Ischemia from arterial blockage)
Rationale: Coagulative necrosis (preserved tissue outline, no
lysosomal enzymes) is typical of ischemia in solid organs
(heart, kidney, liver) except the brain.
GCU NUR 631 Final Exam Study Guide
2026/2027 | Updated Practice Questions
with Verified Answers & Detailed Rationales
| Comprehensive Review
Question 1
A patient with chronic anemia presents with an enlarged heart
on chest X-ray. Which cellular adaptation most likely explains
this finding?
A) Atrophy
B) Hyperplasia
C) Hypertrophy
D) Metaplasia
Answer: C (Hypertrophy)
Rationale: Increased workload due to chronic anemia
,Page 2 of 198
(decreased oxygen-carrying capacity) causes cardiac
myocytes to increase in size (hypertrophy) to generate more
contractile force. This is a compensatory mechanism.
Question 2
A 65-year-old smoker has columnar cells replacing the normal
squamous epithelium in his bronchi. This change is known as:
A) Dysplasia
B) Anaplasia
C) Hyperplasia
D) Metaplasia
Answer: D (Metaplasia)
Rationale: Metaplasia is the reversible replacement of one
differentiated cell type with another. Chronic irritation from
smoking causes squamous-to-columnar metaplasia in airways
(protective response, though abnormal).
Question 3 (SATA)
Which processes are REVERSIBLE cellular adaptations? (Select
,Page 3 of 198
all that apply)
A) Hypertrophy
B) Apoptosis
C) Atrophy
D) Necrosis
E) Hyperplasia
Answer: A, C, E
Rationale: Hypertrophy, atrophy, and hyperplasia are
reversible once the stimulus is removed. Apoptosis and necrosis
are forms of cell death (irreversible).
Question 4
A patient with a prolonged high fever develops cellular injury.
Which mechanism is the most common cause of hypoxic injury in
this case?
A) Free radical damage
B) Impaired calcium homeostasis
C) Reduced ATP production
D) Mitochondrial membrane mutation
, Page 4 of 198
Answer: C (Reduced ATP production)
Rationale: Hypoxic injury (lack of O2) impairs oxidative
phosphorylation → decreased ATP → failure of Na+/K+
pump → cell swelling. Fever increases metabolic demand,
worsening hypoxia.
Question 5
A pathologist notes “coagulative necrosis” in a kidney
specimen. This most likely resulted from:
A) Tuberculosis infection
B) Ischemia from arterial blockage
C) Pancreatic enzyme leakage
D) Hypocalcemia
Answer: B (Ischemia from arterial blockage)
Rationale: Coagulative necrosis (preserved tissue outline, no
lysosomal enzymes) is typical of ischemia in solid organs
(heart, kidney, liver) except the brain.
