Applied Pathophysiology for the Advanced Practice
Nurse Second Edition | 2025/2026 update
Lucie Dlugasch, PhD,MSN, APRN, CNE, FAANP;
Lachel Story, PhD, RN
,Chapter 1 Cellular Function
Chapter 2 Immunity
Chapter 3 Hematopoietic Function
Chapter 4 Cardiovascular Function
Chapter 5 Pulmonary Function
Chapter 6 Fluid, Electrolyte, and Acid-Base Homeostasis
Chapter 7 Urinary Function
Chapter 8 Reproductive Function
Chapter 9 Gastrointestinal Function
Chapter 10 Endocrine Function
Chapter 11 Neural Function
Chapter 12 Musculoskeletal Function
Chapter 13 Integumentary Function
Chapter 14 Sensory Function
,CHAPTER 1: Cellular Function
1. A 54-year-old man with chronic hypertension is found to have left ventricular
hypertrophy on echocardiogram. Which cellular adaptation best describes this
process?
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Dysplasia
ANS: B
Rationale: Hypertrophy refers to an increase in cell size resulting from increased
workload, commonly seen in cardiac muscle due to elevated afterload from
hypertension. This adaptation enhances contractile function initially but can lead
to pathologic remodeling over time. Hyperplasia involves an increase in cell
number, while metaplasia and dysplasia indicate abnormal differentiation and
pre-malignant changes, respectively.
2. A nurse practitioner reviews a patient’s biopsy report that shows replacement
of normal columnar epithelium of the bronchial lining with stratified squamous
cells. Which adaptive response has occurred?
A. Dysplasia
B. Hyperplasia
C. Metaplasia
D. Hypertrophy
ANS: C
, Rationale: Metaplasia occurs when one mature cell type is replaced by another
that is better able to withstand environmental stress, such as smoking-induced
transformation of bronchial epithelium. Although protective initially, metaplasia
increases the risk of malignant transformation if the stressor persists.
3. A patient with long-standing gastroesophageal reflux disease (GERD) develops
Barrett’s esophagus, where squamous epithelium is replaced with columnar
cells. This change is an example of:
A. Dysplasia
B. Metaplasia
C. Anaplasia
D. Hyperplasia
ANS: B
Rationale: Chronic acid exposure stimulates metaplastic changes to columnar
cells that better tolerate the acidic environment. This process, though adaptive, is
a risk factor for esophageal adenocarcinoma due to potential dysplastic
transformation.
4. A patient presents with ischemic injury to cardiac tissue. Which cellular
process is responsible for irreversible damage?
A. Decreased ATP production
B. Membrane rupture and calcium influx
Nurse Second Edition | 2025/2026 update
Lucie Dlugasch, PhD,MSN, APRN, CNE, FAANP;
Lachel Story, PhD, RN
,Chapter 1 Cellular Function
Chapter 2 Immunity
Chapter 3 Hematopoietic Function
Chapter 4 Cardiovascular Function
Chapter 5 Pulmonary Function
Chapter 6 Fluid, Electrolyte, and Acid-Base Homeostasis
Chapter 7 Urinary Function
Chapter 8 Reproductive Function
Chapter 9 Gastrointestinal Function
Chapter 10 Endocrine Function
Chapter 11 Neural Function
Chapter 12 Musculoskeletal Function
Chapter 13 Integumentary Function
Chapter 14 Sensory Function
,CHAPTER 1: Cellular Function
1. A 54-year-old man with chronic hypertension is found to have left ventricular
hypertrophy on echocardiogram. Which cellular adaptation best describes this
process?
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Dysplasia
ANS: B
Rationale: Hypertrophy refers to an increase in cell size resulting from increased
workload, commonly seen in cardiac muscle due to elevated afterload from
hypertension. This adaptation enhances contractile function initially but can lead
to pathologic remodeling over time. Hyperplasia involves an increase in cell
number, while metaplasia and dysplasia indicate abnormal differentiation and
pre-malignant changes, respectively.
2. A nurse practitioner reviews a patient’s biopsy report that shows replacement
of normal columnar epithelium of the bronchial lining with stratified squamous
cells. Which adaptive response has occurred?
A. Dysplasia
B. Hyperplasia
C. Metaplasia
D. Hypertrophy
ANS: C
, Rationale: Metaplasia occurs when one mature cell type is replaced by another
that is better able to withstand environmental stress, such as smoking-induced
transformation of bronchial epithelium. Although protective initially, metaplasia
increases the risk of malignant transformation if the stressor persists.
3. A patient with long-standing gastroesophageal reflux disease (GERD) develops
Barrett’s esophagus, where squamous epithelium is replaced with columnar
cells. This change is an example of:
A. Dysplasia
B. Metaplasia
C. Anaplasia
D. Hyperplasia
ANS: B
Rationale: Chronic acid exposure stimulates metaplastic changes to columnar
cells that better tolerate the acidic environment. This process, though adaptive, is
a risk factor for esophageal adenocarcinoma due to potential dysplastic
transformation.
4. A patient presents with ischemic injury to cardiac tissue. Which cellular
process is responsible for irreversible damage?
A. Decreased ATP production
B. Membrane rupture and calcium influx
