D236 PATHOPHYSIOLOGY OA AND PA WESTERN
GOVERNORS UNIVERSITY NURSING PROGRAMS, 2026/2027
– 100-QUESTION PATHOPHYSIOLOGY EXAMINATION WITH
VERIFIED SOLUTIONS
**1. A patient with chronic hypertension develops concentric left ventricular
thickening. This cellular adaptation is best described as:**
A. Atrophy
B. Hyperplasia
C. Metaplasia
D. Hypertrophy
**Correct Answer: D. Hypertrophy**
**Rationale:** Hypertrophy refers to an *increase in the size of individual cells*
due to increased workload or hormonal stimulation. In hypertension, the left
ventricle must pump against higher pressure, causing cardiac myocytes to
synthesize more proteins and enlarge, leading to a thicker heart wall. Atrophy is a
decrease in cell size; Hyperplasia is an increase in cell number; Metaplasia is a
change from one mature cell type to another.
**2. A nutritionally deficient child presents with generalized edema. According to
Starling’s Law of Capillary forces, what is the primary mechanism?**
A. Increased capillary hydrostatic pressure pushing fluid out
B. Decreased plasma oncotic pressure failing to pull fluid back
C. Increased interstitial osmotic pressure pulling fluid out
D. Blockage of the lymphatic ducts
**Correct Answer: B. Decreased plasma oncotic pressure failing to pull fluid back**
**Rationale:** Starling’s Law describes the balance between hydrostatic
pressure (pushing fluid out) and oncotic pressure (pulling fluid in via proteins like
albumin). A nutritionally deficient child has low plasma protein levels
(hypoalbuminemia). This decreases the oncotic pressure gradient, meaning the
, capillaries cannot effectively pull interstitial fluid back into the vascular space,
resulting in edema.
**3. A patient with chronic GERD has a biopsy showing that the normal squamous
epithelium of the esophagus has been replaced by columnar epithelium. This
change is called:**
A. Dysplasia
B. Metaplasia
C. Hyperplasia
D. Anaplasia
**Correct Answer: B. Metaplasia**
**Rationale:** Metaplasia is a reversible adaptation where one differentiated cell
type is replaced by another better suited to handle a persistent stressor (like
stomach acid). In Barrett's esophagus, the squamous cells change to columnar cells
because they are more resistant to acid. Dysplasia involves disordered growth and
is considered a precancerous change, but the specific substitution described here is
metaplasia.
**4. How does the Renin-Angiotensin-Aldosterone System (RAAS) increase blood
pressure?**
A. By decreasing systemic vascular resistance
B. By promoting vasodilation and diuresis
C. By causing vasoconstriction and sodium/water retention
D. By increasing heart rate directly
**Correct Answer: C. By causing vasoconstriction and sodium/water retention**
**Rationale:** When BP drops, kidneys release Renin. This converts
angiotensinogen to Angiotensin I, which ACE converts to Angiotensin II. Angiotensin
II is a potent **vasoconstrictor** (raising BP) and stimulates **Aldosterone**
release. Aldosterone causes the kidneys to retain **Sodium and Water**, increasing
blood volume and further raising BP.
GOVERNORS UNIVERSITY NURSING PROGRAMS, 2026/2027
– 100-QUESTION PATHOPHYSIOLOGY EXAMINATION WITH
VERIFIED SOLUTIONS
**1. A patient with chronic hypertension develops concentric left ventricular
thickening. This cellular adaptation is best described as:**
A. Atrophy
B. Hyperplasia
C. Metaplasia
D. Hypertrophy
**Correct Answer: D. Hypertrophy**
**Rationale:** Hypertrophy refers to an *increase in the size of individual cells*
due to increased workload or hormonal stimulation. In hypertension, the left
ventricle must pump against higher pressure, causing cardiac myocytes to
synthesize more proteins and enlarge, leading to a thicker heart wall. Atrophy is a
decrease in cell size; Hyperplasia is an increase in cell number; Metaplasia is a
change from one mature cell type to another.
**2. A nutritionally deficient child presents with generalized edema. According to
Starling’s Law of Capillary forces, what is the primary mechanism?**
A. Increased capillary hydrostatic pressure pushing fluid out
B. Decreased plasma oncotic pressure failing to pull fluid back
C. Increased interstitial osmotic pressure pulling fluid out
D. Blockage of the lymphatic ducts
**Correct Answer: B. Decreased plasma oncotic pressure failing to pull fluid back**
**Rationale:** Starling’s Law describes the balance between hydrostatic
pressure (pushing fluid out) and oncotic pressure (pulling fluid in via proteins like
albumin). A nutritionally deficient child has low plasma protein levels
(hypoalbuminemia). This decreases the oncotic pressure gradient, meaning the
, capillaries cannot effectively pull interstitial fluid back into the vascular space,
resulting in edema.
**3. A patient with chronic GERD has a biopsy showing that the normal squamous
epithelium of the esophagus has been replaced by columnar epithelium. This
change is called:**
A. Dysplasia
B. Metaplasia
C. Hyperplasia
D. Anaplasia
**Correct Answer: B. Metaplasia**
**Rationale:** Metaplasia is a reversible adaptation where one differentiated cell
type is replaced by another better suited to handle a persistent stressor (like
stomach acid). In Barrett's esophagus, the squamous cells change to columnar cells
because they are more resistant to acid. Dysplasia involves disordered growth and
is considered a precancerous change, but the specific substitution described here is
metaplasia.
**4. How does the Renin-Angiotensin-Aldosterone System (RAAS) increase blood
pressure?**
A. By decreasing systemic vascular resistance
B. By promoting vasodilation and diuresis
C. By causing vasoconstriction and sodium/water retention
D. By increasing heart rate directly
**Correct Answer: C. By causing vasoconstriction and sodium/water retention**
**Rationale:** When BP drops, kidneys release Renin. This converts
angiotensinogen to Angiotensin I, which ACE converts to Angiotensin II. Angiotensin
II is a potent **vasoconstrictor** (raising BP) and stimulates **Aldosterone**
release. Aldosterone causes the kidneys to retain **Sodium and Water**, increasing
blood volume and further raising BP.
