WALDEN UNIVERSITY - COLLEGE OF NURSING
NURS 6501 Advanced Pathophysiology
Midterm Exam
Official Practice Exam - 2025/2026 Edition
Questions: 120 Minutes: 90 Passing Score: 80% Recertification: Required
TABLE OF CONTENTS
Section 1: Cellular Biology and Cellular Adaptation .......................... Questions 1 - 25
Section 2: Genetics and Genomics .......................... Questions 26 - 40
Section 3: Immunity, Inflammation, and Infection .......................... Questions 41 - 65
Section 4: Hematologic and Cardiovascular Disorders .......................... Questions 66 - 95
Section 5: Pulmonary and Renal Disorders .......................... Questions 96 - 120
Answer Key ................................................ Last Page
EXAM INSTRUCTIONS
This exam consists of 120 multiple-choice questions divided into 5 sections. You have 90 minutes to
complete the exam.
Each question has four answer choices (A, B, C, D). Select the single best answer for each question.
The passing score is 80%, which requires a minimum of 96 correct answers out of 120 questions.
Do not spend too much time on any single question. Mark difficult questions and return to them later.
All questions are weighted equally. There is no penalty for guessing, so answer every question.
Read each question stem carefully, noting the patient scenario, age, and clinical findings before selecting an
answer.
The correct answer and rationale are provided after each question for immediate feedback and learning.
NURS 6501 Advanced Pathophysiology -- 2025/2026 | Passing Score: 80% | Page 1 of 63
, SECTION 1: Cellular Biology and Cellular Adaptation -- 2025/2026
Q1 Question 1 of 120
Q1. A 58-year-old male with a 30-pack-year smoking history presents with chronic cough
and squamous cells found on sputum cytology despite the respiratory tract normally
being lined by pseudostratified columnar epithelium. What cellular adaptation has
occurred in this patient's airway?
A. Hyperplasia of the goblet cells
B. Squamous metaplasia of the bronchial epithelium
C. Dysplasia of the alveolar type I cells
D. Anaplasia of the bronchial smooth muscle
Correct Answer: B
Rationale:
The normal pseudostratified columnar epithelium has been replaced by squamous epithelium, which is the
definition of squamous metaplasia. Hyperplasia refers to an increase in cell number rather than a change in
cell type, and dysplasia involves disordered growth rather than a reversible substitution of one adult cell
type for another.
Q2 Question 2 of 120
Q2. A 42-year-old female presents with severe right upper quadrant pain after meals, and
imaging reveals gallstones obstructing the cystic duct. The affected gallbladder epithelial
cells show marked swelling of the endoplasmic reticulum and mitochondrial flocculent
densities. These findings are most consistent with which stage of cellular injury?
A. Reversible injury with cellular swelling
B. Irreversible injury with coagulative necrosis
C. Irreversible injury with liquefactive necrosis
D. Apoptosis with chromatin condensation
Correct Answer: A
Rationale:
Swelling of the endoplasmic reticulum and mitochondrial densities that remain flocculent rather than
amorphous indicate reversible cellular injury. Irreversible injury would be characterized by membrane
rupture, lysosomal enzyme release, and nuclear pyknosis or karyolysis, which are not described in this
scenario.
NURS 6501 Advanced Pathophysiology -- 2025/2026 | Passing Score: 80% | Page 1 of 63
,Q3 Question 3 of 120
Q3. A 67-year-old male who suffered a myocardial infarction three days ago now has
elevated cardiac enzymes and a region of the left ventricle that appears pale and firm on
gross examination. Microscopic examination reveals preserved tissue architecture with
loss of nuclei and intensely eosinophilic cytoplasm. This presentation is most
characteristic of which type of necrosis?
A. Liquefactive necrosis
B. Caseous necrosis
C. Coagulative necrosis
D. Fat necrosis
Correct Answer: C
Rationale:
Coagulative necrosis preserves the tissue architecture while the cells lose their nuclei and display
eosinophilic cytoplasm, which is the classic pattern seen after myocardial infarction. Liquefactive necrosis
destroys the architecture and is typical of brain infarcts and abscesses, while caseous necrosis is
associated with granulomatous inflammation.
Q4 Question 4 of 120
Q4. A 35-year-old female with systemic lupus erythematosus is found to have
autoantibodies against her own cellular components, and a skin biopsy reveals a
band-like deposit of immunoglobulin at the dermo-epidermal junction. This type of
hypersensitivity reaction is best classified as which mechanism?
A. Type I IgE-mediated hypersensitivity
B. Type II antibody-mediated cytotoxicity
C. Type III immune complex-mediated hypersensitivity
D. Type IV delayed-type cell-mediated hypersensitivity
Correct Answer: C
Rationale:
The deposition of antigen-antibody complexes at the dermo-epidermal junction is characteristic of a Type III
hypersensitivity reaction, which involves immune complex formation and complement activation. Type I
involves IgE and mast cell degranulation, Type II involves antibody directly binding to cell surfaces, and
Type IV is T-cell mediated without antibody involvement.
NURS 6501 Advanced Pathophysiology -- 2025/2026 | Passing Score: 80% | Page 2 of 63
, Q5 Question 5 of 120
Q5. A 72-year-old hospitalized patient develops a large decubitus ulcer over the sacrum
after prolonged bed rest. The wound shows extensive tissue destruction with neutrophil
infiltration, edema, and fibrin deposition. Which phase of the inflammatory response is
predominantly represented in this wound?
A. Vascular phase with hemodynamic changes
B. Exudative phase with neutrophil predominance
C. Proliferative phase with granulation tissue
D. Maturation phase with collagen remodeling
Correct Answer: B
Rationale:
Neutrophil infiltration, edema, and fibrin deposition are hallmarks of the acute exudative phase of
inflammation. The vascular phase precedes cellular infiltration, while the proliferative and maturation phases
involve fibroblast activity and collagen deposition that are not described in this presentation.
Q6 Question 6 of 120
Q6. A 44-year-old male construction worker presents with a firm, painless nodule on his
right hand that has been growing slowly for six months. Biopsy reveals a disorganized
mass of mature collagen fibers and fibroblasts with no mitotic figures. This mass is best
classified as which type of cellular adaptation?
A. Hyperplasia with atypical features
B. Benign neoplasia of fibrous tissue
C. Metaplasia of epithelial origin
D. Dysplasia with malignant potential
Correct Answer: B
Rationale:
A well-differentiated, disorganized mass of mature fibrous tissue with no mitotic figures is consistent with a
benign neoplasm such as a dermatofibroma or fibroma. Hyperplasia is a regulated increase in cell number,
metaplasia involves replacement of one cell type with another, and dysplasia shows atypical cellular
features not present here.
NURS 6501 Advanced Pathophysiology -- 2025/2026 | Passing Score: 80% | Page 3 of 63
NURS 6501 Advanced Pathophysiology
Midterm Exam
Official Practice Exam - 2025/2026 Edition
Questions: 120 Minutes: 90 Passing Score: 80% Recertification: Required
TABLE OF CONTENTS
Section 1: Cellular Biology and Cellular Adaptation .......................... Questions 1 - 25
Section 2: Genetics and Genomics .......................... Questions 26 - 40
Section 3: Immunity, Inflammation, and Infection .......................... Questions 41 - 65
Section 4: Hematologic and Cardiovascular Disorders .......................... Questions 66 - 95
Section 5: Pulmonary and Renal Disorders .......................... Questions 96 - 120
Answer Key ................................................ Last Page
EXAM INSTRUCTIONS
This exam consists of 120 multiple-choice questions divided into 5 sections. You have 90 minutes to
complete the exam.
Each question has four answer choices (A, B, C, D). Select the single best answer for each question.
The passing score is 80%, which requires a minimum of 96 correct answers out of 120 questions.
Do not spend too much time on any single question. Mark difficult questions and return to them later.
All questions are weighted equally. There is no penalty for guessing, so answer every question.
Read each question stem carefully, noting the patient scenario, age, and clinical findings before selecting an
answer.
The correct answer and rationale are provided after each question for immediate feedback and learning.
NURS 6501 Advanced Pathophysiology -- 2025/2026 | Passing Score: 80% | Page 1 of 63
, SECTION 1: Cellular Biology and Cellular Adaptation -- 2025/2026
Q1 Question 1 of 120
Q1. A 58-year-old male with a 30-pack-year smoking history presents with chronic cough
and squamous cells found on sputum cytology despite the respiratory tract normally
being lined by pseudostratified columnar epithelium. What cellular adaptation has
occurred in this patient's airway?
A. Hyperplasia of the goblet cells
B. Squamous metaplasia of the bronchial epithelium
C. Dysplasia of the alveolar type I cells
D. Anaplasia of the bronchial smooth muscle
Correct Answer: B
Rationale:
The normal pseudostratified columnar epithelium has been replaced by squamous epithelium, which is the
definition of squamous metaplasia. Hyperplasia refers to an increase in cell number rather than a change in
cell type, and dysplasia involves disordered growth rather than a reversible substitution of one adult cell
type for another.
Q2 Question 2 of 120
Q2. A 42-year-old female presents with severe right upper quadrant pain after meals, and
imaging reveals gallstones obstructing the cystic duct. The affected gallbladder epithelial
cells show marked swelling of the endoplasmic reticulum and mitochondrial flocculent
densities. These findings are most consistent with which stage of cellular injury?
A. Reversible injury with cellular swelling
B. Irreversible injury with coagulative necrosis
C. Irreversible injury with liquefactive necrosis
D. Apoptosis with chromatin condensation
Correct Answer: A
Rationale:
Swelling of the endoplasmic reticulum and mitochondrial densities that remain flocculent rather than
amorphous indicate reversible cellular injury. Irreversible injury would be characterized by membrane
rupture, lysosomal enzyme release, and nuclear pyknosis or karyolysis, which are not described in this
scenario.
NURS 6501 Advanced Pathophysiology -- 2025/2026 | Passing Score: 80% | Page 1 of 63
,Q3 Question 3 of 120
Q3. A 67-year-old male who suffered a myocardial infarction three days ago now has
elevated cardiac enzymes and a region of the left ventricle that appears pale and firm on
gross examination. Microscopic examination reveals preserved tissue architecture with
loss of nuclei and intensely eosinophilic cytoplasm. This presentation is most
characteristic of which type of necrosis?
A. Liquefactive necrosis
B. Caseous necrosis
C. Coagulative necrosis
D. Fat necrosis
Correct Answer: C
Rationale:
Coagulative necrosis preserves the tissue architecture while the cells lose their nuclei and display
eosinophilic cytoplasm, which is the classic pattern seen after myocardial infarction. Liquefactive necrosis
destroys the architecture and is typical of brain infarcts and abscesses, while caseous necrosis is
associated with granulomatous inflammation.
Q4 Question 4 of 120
Q4. A 35-year-old female with systemic lupus erythematosus is found to have
autoantibodies against her own cellular components, and a skin biopsy reveals a
band-like deposit of immunoglobulin at the dermo-epidermal junction. This type of
hypersensitivity reaction is best classified as which mechanism?
A. Type I IgE-mediated hypersensitivity
B. Type II antibody-mediated cytotoxicity
C. Type III immune complex-mediated hypersensitivity
D. Type IV delayed-type cell-mediated hypersensitivity
Correct Answer: C
Rationale:
The deposition of antigen-antibody complexes at the dermo-epidermal junction is characteristic of a Type III
hypersensitivity reaction, which involves immune complex formation and complement activation. Type I
involves IgE and mast cell degranulation, Type II involves antibody directly binding to cell surfaces, and
Type IV is T-cell mediated without antibody involvement.
NURS 6501 Advanced Pathophysiology -- 2025/2026 | Passing Score: 80% | Page 2 of 63
, Q5 Question 5 of 120
Q5. A 72-year-old hospitalized patient develops a large decubitus ulcer over the sacrum
after prolonged bed rest. The wound shows extensive tissue destruction with neutrophil
infiltration, edema, and fibrin deposition. Which phase of the inflammatory response is
predominantly represented in this wound?
A. Vascular phase with hemodynamic changes
B. Exudative phase with neutrophil predominance
C. Proliferative phase with granulation tissue
D. Maturation phase with collagen remodeling
Correct Answer: B
Rationale:
Neutrophil infiltration, edema, and fibrin deposition are hallmarks of the acute exudative phase of
inflammation. The vascular phase precedes cellular infiltration, while the proliferative and maturation phases
involve fibroblast activity and collagen deposition that are not described in this presentation.
Q6 Question 6 of 120
Q6. A 44-year-old male construction worker presents with a firm, painless nodule on his
right hand that has been growing slowly for six months. Biopsy reveals a disorganized
mass of mature collagen fibers and fibroblasts with no mitotic figures. This mass is best
classified as which type of cellular adaptation?
A. Hyperplasia with atypical features
B. Benign neoplasia of fibrous tissue
C. Metaplasia of epithelial origin
D. Dysplasia with malignant potential
Correct Answer: B
Rationale:
A well-differentiated, disorganized mass of mature fibrous tissue with no mitotic figures is consistent with a
benign neoplasm such as a dermatofibroma or fibroma. Hyperplasia is a regulated increase in cell number,
metaplasia involves replacement of one cell type with another, and dysplasia shows atypical cellular
features not present here.
NURS 6501 Advanced Pathophysiology -- 2025/2026 | Passing Score: 80% | Page 3 of 63
