NURS 231 Module 10 Exam (2026/2027) | Pathophysiology |
Portage Learning Actual Exam 2026/2027: Complete Exam-Style
Questions with Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Cellular Pathophysiology & Adaptation | Q1 – Q10
Section 2 | Inflammation, Immunity & Infection | Q11 – Q20
Section 3 | Neoplasia & Genetic Disorders | Q21 – Q30
Section 4 | Fluid, Electrolyte & Acid-Base Imbalances | Q31 – Q40
Section 5 | Cardiovascular & Hematologic Pathophysiology | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
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SECTION 1: CELLULAR PATHOPHYSIOLOGY & ADAPTATION Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 72-year-old woman who recently fractured her hip and has been on bed rest for three
weeks is found to have markedly reduced muscle mass in her lower extremities on
physical exam. A biopsy of the quadriceps muscle reveals shrunken cells with increased
lipofuscin pigment. The cellular adaptation best describing these findings is:
A. Hypertrophy resulting from increased protein synthesis in response to load
B. Atrophy caused by decreased workload and reduced metabolic demand ✓ CORRECT
C. Hyperplasia driven by hormonal stimulation of satellite cells
D. Metaplasia involving replacement of muscle fibers by fibrous connective tissue
Correct Answer: B
,Rationale: Disuse atrophy occurs when cells decrease in size due to reduced workload,
as seen in prolonged immobilization. The increased lipofuscin is a classic hallmark of
aging and atrophic cells. Hypertrophy would involve cell enlargement, not shrinkage,
and hyperplasia requires cell division, which mature skeletal muscle fibers rarely
undergo.
Question 2 of 50
A 45-year-old male weightlifter presents with left ventricular hypertrophy confirmed by
echocardiogram. His cardiomyocytes demonstrate enlarged nuclei and increased
numbers of myofibrils. This type of cellular adaptation is classified as:
A. Hyperplasia from repeated mitotic division of cardiac myocytes
B. Metaplasia with transformation of cardiac cells into a different phenotype
C. Dysplasia showing disordered growth and loss of cellular orientation
D. Hypertrophy involving an increase in cell size without cell division ✓ CORRECT
Correct Answer: D
Rationale: Cardiac muscle cells are terminally differentiated and cannot divide, so
enlargement occurs through hypertrophy, an increase in individual cell size. Hyperplasia
is not possible in adult cardiac myocytes. Metaplasia involves one mature cell type
replacing another, and dysplasia refers to pre-neoplastic disordered growth.
Question 3 of 50
A 58-year-old man with a 30-year history of smoking presents with a chronic cough.
Bronchoscopy reveals that areas of normal pseudostratified ciliated columnar
epithelium in his bronchi have been replaced by stratified squamous epithelium. This
reversible change in cell type represents:
A. Metaplasia, an adaptive substitution of one differentiated cell type for another ✓
CORRECT
B. Dysplasia, a disordered pre-malignant alteration in cellular architecture
,C. Hyperplasia, a proliferation of the normal ciliated epithelial cell population
D. Anaplasia, a complete loss of cellular differentiation and orientation
Correct Answer: A
Rationale: Chronic irritation from cigarette smoke commonly causes squamous
metaplasia in the respiratory tract, where resilient squamous cells replace fragile
columnar cells. Dysplasia would show nuclear atypia and disordered maturation, and
anaplasia is a feature of malignant transformation, not a benign adaptive change.
Question 4 of 50
A 35-year-old man sustains a severe crush injury to his thigh in a motor vehicle
accident. Six hours later, the affected muscle tissue shows cellular swelling, loss of
microvilli, and clumping of nuclear chromatin, but the cell membranes remain intact.
These findings are most consistent with:
A. Coagulative necrosis with preserved tissue architecture and ghost outlines
B. Reversible cell injury characterized by hydropic change and organelle dysfunction ✓
CORRECT
C. Apoptosis demonstrating cell shrinkage and chromatin fragmentation
D. Liquefactive necrosis with enzymatic digestion and pus formation
Correct Answer: B
Rationale: Cellular swelling, blebbing, and clumped chromatin with intact membranes
are hallmarks of reversible injury before the point of no return. Coagulative necrosis
would show denatured proteins and loss of nuclei. Apoptosis produces shrunken,
eosinophilic cells without inflammation, and liquefactive necrosis involves complete
tissue dissolution.
Question 5 of 50
A 68-year-old man with a history of stable angina suddenly develops crushing chest
pain and dies within two hours. Autopsy reveals a pale, firm area of myocardial tissue
, with preserved cellular outlines but loss of nuclei and eosinophilic cytoplasm. The
pathologist identifies this pattern of cell death as:
A. Liquefactive necrosis typical of ischemic brain tissue
B. Coagulative necrosis resulting from protein denaturation in ischemic tissue ✓
CORRECT
C. Caseous necrosis associated with granulomatous inflammation
D. Fat necrosis caused by lipase activation in adipose tissue
Correct Answer: B
Rationale: Ischemia in most solid organs except the brain produces coagulative
necrosis, where architectural outlines persist but cells are dead. Liquefactive necrosis
occurs in the brain due to high lipid content and lack of structural proteins. Caseous
necrosis is seen in tuberculosis, and fat necrosis follows pancreatic enzyme release.
Question 6 of 50
A 28-year-old immigrant from Southeast Asia presents with a persistent cough,
hemoptysis, and low-grade fever. A chest CT shows a cavitary lesion in the right upper
lobe. Histology of the lesion reveals amorphous, granular, eosinophilic debris
surrounded by epithelioid macrophages and lymphocytes. The necrotic material in this
granuloma is best described as:
A. Coagulative necrosis with ghost outlines of destroyed alveolar tissue
B. Liquefactive necrosis from enzymatic digestion by neutrophils
C. Fat necrosis with chalky white deposits of calcium soaps
D. Caseous necrosis with a cheese-like gross appearance and no tissue architecture ✓
CORRECT
Correct Answer: D
Rationale: Tuberculosis produces caseous necrosis, characterized by completely
amorphous granular debris without preserved tissue architecture, surrounded by
Portage Learning Actual Exam 2026/2027: Complete Exam-Style
Questions with Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Cellular Pathophysiology & Adaptation | Q1 – Q10
Section 2 | Inflammation, Immunity & Infection | Q11 – Q20
Section 3 | Neoplasia & Genetic Disorders | Q21 – Q30
Section 4 | Fluid, Electrolyte & Acid-Base Imbalances | Q31 – Q40
Section 5 | Cardiovascular & Hematologic Pathophysiology | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: CELLULAR PATHOPHYSIOLOGY & ADAPTATION Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 72-year-old woman who recently fractured her hip and has been on bed rest for three
weeks is found to have markedly reduced muscle mass in her lower extremities on
physical exam. A biopsy of the quadriceps muscle reveals shrunken cells with increased
lipofuscin pigment. The cellular adaptation best describing these findings is:
A. Hypertrophy resulting from increased protein synthesis in response to load
B. Atrophy caused by decreased workload and reduced metabolic demand ✓ CORRECT
C. Hyperplasia driven by hormonal stimulation of satellite cells
D. Metaplasia involving replacement of muscle fibers by fibrous connective tissue
Correct Answer: B
,Rationale: Disuse atrophy occurs when cells decrease in size due to reduced workload,
as seen in prolonged immobilization. The increased lipofuscin is a classic hallmark of
aging and atrophic cells. Hypertrophy would involve cell enlargement, not shrinkage,
and hyperplasia requires cell division, which mature skeletal muscle fibers rarely
undergo.
Question 2 of 50
A 45-year-old male weightlifter presents with left ventricular hypertrophy confirmed by
echocardiogram. His cardiomyocytes demonstrate enlarged nuclei and increased
numbers of myofibrils. This type of cellular adaptation is classified as:
A. Hyperplasia from repeated mitotic division of cardiac myocytes
B. Metaplasia with transformation of cardiac cells into a different phenotype
C. Dysplasia showing disordered growth and loss of cellular orientation
D. Hypertrophy involving an increase in cell size without cell division ✓ CORRECT
Correct Answer: D
Rationale: Cardiac muscle cells are terminally differentiated and cannot divide, so
enlargement occurs through hypertrophy, an increase in individual cell size. Hyperplasia
is not possible in adult cardiac myocytes. Metaplasia involves one mature cell type
replacing another, and dysplasia refers to pre-neoplastic disordered growth.
Question 3 of 50
A 58-year-old man with a 30-year history of smoking presents with a chronic cough.
Bronchoscopy reveals that areas of normal pseudostratified ciliated columnar
epithelium in his bronchi have been replaced by stratified squamous epithelium. This
reversible change in cell type represents:
A. Metaplasia, an adaptive substitution of one differentiated cell type for another ✓
CORRECT
B. Dysplasia, a disordered pre-malignant alteration in cellular architecture
,C. Hyperplasia, a proliferation of the normal ciliated epithelial cell population
D. Anaplasia, a complete loss of cellular differentiation and orientation
Correct Answer: A
Rationale: Chronic irritation from cigarette smoke commonly causes squamous
metaplasia in the respiratory tract, where resilient squamous cells replace fragile
columnar cells. Dysplasia would show nuclear atypia and disordered maturation, and
anaplasia is a feature of malignant transformation, not a benign adaptive change.
Question 4 of 50
A 35-year-old man sustains a severe crush injury to his thigh in a motor vehicle
accident. Six hours later, the affected muscle tissue shows cellular swelling, loss of
microvilli, and clumping of nuclear chromatin, but the cell membranes remain intact.
These findings are most consistent with:
A. Coagulative necrosis with preserved tissue architecture and ghost outlines
B. Reversible cell injury characterized by hydropic change and organelle dysfunction ✓
CORRECT
C. Apoptosis demonstrating cell shrinkage and chromatin fragmentation
D. Liquefactive necrosis with enzymatic digestion and pus formation
Correct Answer: B
Rationale: Cellular swelling, blebbing, and clumped chromatin with intact membranes
are hallmarks of reversible injury before the point of no return. Coagulative necrosis
would show denatured proteins and loss of nuclei. Apoptosis produces shrunken,
eosinophilic cells without inflammation, and liquefactive necrosis involves complete
tissue dissolution.
Question 5 of 50
A 68-year-old man with a history of stable angina suddenly develops crushing chest
pain and dies within two hours. Autopsy reveals a pale, firm area of myocardial tissue
, with preserved cellular outlines but loss of nuclei and eosinophilic cytoplasm. The
pathologist identifies this pattern of cell death as:
A. Liquefactive necrosis typical of ischemic brain tissue
B. Coagulative necrosis resulting from protein denaturation in ischemic tissue ✓
CORRECT
C. Caseous necrosis associated with granulomatous inflammation
D. Fat necrosis caused by lipase activation in adipose tissue
Correct Answer: B
Rationale: Ischemia in most solid organs except the brain produces coagulative
necrosis, where architectural outlines persist but cells are dead. Liquefactive necrosis
occurs in the brain due to high lipid content and lack of structural proteins. Caseous
necrosis is seen in tuberculosis, and fat necrosis follows pancreatic enzyme release.
Question 6 of 50
A 28-year-old immigrant from Southeast Asia presents with a persistent cough,
hemoptysis, and low-grade fever. A chest CT shows a cavitary lesion in the right upper
lobe. Histology of the lesion reveals amorphous, granular, eosinophilic debris
surrounded by epithelioid macrophages and lymphocytes. The necrotic material in this
granuloma is best described as:
A. Coagulative necrosis with ghost outlines of destroyed alveolar tissue
B. Liquefactive necrosis from enzymatic digestion by neutrophils
C. Fat necrosis with chalky white deposits of calcium soaps
D. Caseous necrosis with a cheese-like gross appearance and no tissue architecture ✓
CORRECT
Correct Answer: D
Rationale: Tuberculosis produces caseous necrosis, characterized by completely
amorphous granular debris without preserved tissue architecture, surrounded by
