NCLEX-RN® Pathophysiology
Examination: 2026 Edition||Questions
And Answers With Rationales/Graded
A+/2026 Update/100% Correct
/Instant Download
Section 1: Cellular Adaptation & Injury (Questions 1-10)
1. A patient with chronic hepatitis B develops liver cell changes that are
reversible upon removal of the insult. Which cellular adaptation is most likely
present?
• A. Metaplasia
• B. Dysplasia
• C. Anaplasia
• D. Hyperplasia
Rationale: Dysplasia refers to abnormal changes in cell size, shape, and
organization. In chronic hepatitis, dysplasia is often reversible if the underlying
cause (e.g., virus) is treated. Metaplasia is a change from one cell type to another;
anaplasia is loss of differentiation (cancer); hyperplasia is increased cell number.
2. Which finding indicates that cellular injury has led to irreversible cell
death?
• A. Decreased ATP production
• B. Severe mitochondrial swelling with rupture
• C. Ribosomal detachment
• D. Transient sodium influx
Rationale: Irreversible cell death occurs when mitochondrial membranes are
disrupted, releasing cytochrome c and activating caspases. ATP depletion and
sodium influx can be reversible if corrected early.
, 3. During ischemia, which ion shift occurs first in myocardial cells?
• A. Calcium efflux
• B. Sodium influx
• C. Potassium influx
• D. Magnesium efflux
Rationale: Ischemia → anaerobic metabolism → decreased ATP → failure of
Na+/K+ pump → sodium accumulates intracellularly, followed by water and
calcium.
4. A pathologist notes caseous necrosis in a lung tissue sample. Which
condition is most likely?
• A. Ischemic limb
• B. Acute pancreatitis
• C. Tuberculosis
• D. Syphilis
Rationale: Caseous necrosis (cheese-like appearance) is characteristic of
tuberculosis. Ischemic limb → coagulative necrosis; pancreatitis → fat necrosis;
syphilis → gummatous necrosis.
5. Which cellular adaptation is considered a premalignant change?
• A. Physiologic hypertrophy
• B. Severe dysplasia
• C. Atrophy
• D. Physiologic hyperplasia
Rationale: Severe dysplasia, especially with loss of cellular polarity (carcinoma in
situ), is a precursor to malignancy. Other options are benign/adaptive.
6. A patient with chronic GERD develops Barrett’s esophagus. This is an
example of:
• A. Hyperplasia
• B. Metaplasia
Examination: 2026 Edition||Questions
And Answers With Rationales/Graded
A+/2026 Update/100% Correct
/Instant Download
Section 1: Cellular Adaptation & Injury (Questions 1-10)
1. A patient with chronic hepatitis B develops liver cell changes that are
reversible upon removal of the insult. Which cellular adaptation is most likely
present?
• A. Metaplasia
• B. Dysplasia
• C. Anaplasia
• D. Hyperplasia
Rationale: Dysplasia refers to abnormal changes in cell size, shape, and
organization. In chronic hepatitis, dysplasia is often reversible if the underlying
cause (e.g., virus) is treated. Metaplasia is a change from one cell type to another;
anaplasia is loss of differentiation (cancer); hyperplasia is increased cell number.
2. Which finding indicates that cellular injury has led to irreversible cell
death?
• A. Decreased ATP production
• B. Severe mitochondrial swelling with rupture
• C. Ribosomal detachment
• D. Transient sodium influx
Rationale: Irreversible cell death occurs when mitochondrial membranes are
disrupted, releasing cytochrome c and activating caspases. ATP depletion and
sodium influx can be reversible if corrected early.
, 3. During ischemia, which ion shift occurs first in myocardial cells?
• A. Calcium efflux
• B. Sodium influx
• C. Potassium influx
• D. Magnesium efflux
Rationale: Ischemia → anaerobic metabolism → decreased ATP → failure of
Na+/K+ pump → sodium accumulates intracellularly, followed by water and
calcium.
4. A pathologist notes caseous necrosis in a lung tissue sample. Which
condition is most likely?
• A. Ischemic limb
• B. Acute pancreatitis
• C. Tuberculosis
• D. Syphilis
Rationale: Caseous necrosis (cheese-like appearance) is characteristic of
tuberculosis. Ischemic limb → coagulative necrosis; pancreatitis → fat necrosis;
syphilis → gummatous necrosis.
5. Which cellular adaptation is considered a premalignant change?
• A. Physiologic hypertrophy
• B. Severe dysplasia
• C. Atrophy
• D. Physiologic hyperplasia
Rationale: Severe dysplasia, especially with loss of cellular polarity (carcinoma in
situ), is a precursor to malignancy. Other options are benign/adaptive.
6. A patient with chronic GERD develops Barrett’s esophagus. This is an
example of:
• A. Hyperplasia
• B. Metaplasia
