NURS 231 Pathophysiology
Final Exam Actual Exam
2026/2027 – Complete Exam-
Style Questions | Detailed
Rationales – Pass Guaranteed
– A+ Graded
SECTION 1: CELLULAR ADAPTATION & INJURY (Questions 1-20)
Q1. A 65-year-old male with a 40-year history of hypertension presents with left ventricular
hypertrophy on echocardiogram. Which term best describes this cellular adaptation?
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Dysplasia
Answer: B
Rationale: Hypertrophy is an increase in cell size due to increased workload. In hypertension, the left
ventricle must work harder against increased afterload, leading to myocyte hypertrophy without an
increase in cell number .
Q2. A 25-year-old female smoker undergoes a bronchial biopsy showing replacement of normal
ciliated columnar epithelium with stratified squamous epithelium. This change is an example of:
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Dysplasia
Answer: C
, Rationale: Metaplasia is the reversible replacement of one differentiated cell type with another. In
smokers, the respiratory epithelium undergoes squamous metaplasia as an adaptive response to chronic
irritation, though this may progress to dysplasia and carcinoma .
Q3. A 55-year-old chronic alcoholic presents with jaundice and ascites. Liver biopsy shows hepatocyte
swelling with fat accumulation and necrosis. The most likely mechanism of cell injury is:
A. Hypoxia
B. Free radical formation (oxidative stress)
C. Physical injury
D. Genetic mutation
Answer: B
Rationale: Ethanol metabolism generates reactive oxygen species (ROS) and acetaldehyde, leading to
lipid peroxidation, protein damage, and DNA injury—causing fatty liver, alcoholic hepatitis, and cirrhosis
.
Q4. Which of the following is an early indicator of irreversible cell injury?
A. Cellular swelling
B. Nuclear pyknosis (nuclear shrinkage and chromatin condensation)
C. Loss of microvilli
D. Fatty change
Answer: B
Rationale: Irreversible cell injury is characterized by severe membrane damage and nuclear changes:
pyknosis (nuclear shrinkage), karyorrhexis (nuclear fragmentation), and karyolysis (nuclear dissolution) .
Q5. A patient with a myocardial infarction has elevated serum troponin I levels. Troponin is released
due to:
A. Reversible cell injury
B. Necrosis (irreversible cell injury)
C. Apoptosis
D. Cellular adaptation
Answer: B
Rationale: Cardiac troponins are intracellular proteins released into the bloodstream when cardiac
myocytes undergo necrosis (irreversible injury). Elevated troponin indicates myocardial cell death .
Q6. During ischemia, the switch from aerobic to anaerobic metabolism results in:
Final Exam Actual Exam
2026/2027 – Complete Exam-
Style Questions | Detailed
Rationales – Pass Guaranteed
– A+ Graded
SECTION 1: CELLULAR ADAPTATION & INJURY (Questions 1-20)
Q1. A 65-year-old male with a 40-year history of hypertension presents with left ventricular
hypertrophy on echocardiogram. Which term best describes this cellular adaptation?
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Dysplasia
Answer: B
Rationale: Hypertrophy is an increase in cell size due to increased workload. In hypertension, the left
ventricle must work harder against increased afterload, leading to myocyte hypertrophy without an
increase in cell number .
Q2. A 25-year-old female smoker undergoes a bronchial biopsy showing replacement of normal
ciliated columnar epithelium with stratified squamous epithelium. This change is an example of:
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Dysplasia
Answer: C
, Rationale: Metaplasia is the reversible replacement of one differentiated cell type with another. In
smokers, the respiratory epithelium undergoes squamous metaplasia as an adaptive response to chronic
irritation, though this may progress to dysplasia and carcinoma .
Q3. A 55-year-old chronic alcoholic presents with jaundice and ascites. Liver biopsy shows hepatocyte
swelling with fat accumulation and necrosis. The most likely mechanism of cell injury is:
A. Hypoxia
B. Free radical formation (oxidative stress)
C. Physical injury
D. Genetic mutation
Answer: B
Rationale: Ethanol metabolism generates reactive oxygen species (ROS) and acetaldehyde, leading to
lipid peroxidation, protein damage, and DNA injury—causing fatty liver, alcoholic hepatitis, and cirrhosis
.
Q4. Which of the following is an early indicator of irreversible cell injury?
A. Cellular swelling
B. Nuclear pyknosis (nuclear shrinkage and chromatin condensation)
C. Loss of microvilli
D. Fatty change
Answer: B
Rationale: Irreversible cell injury is characterized by severe membrane damage and nuclear changes:
pyknosis (nuclear shrinkage), karyorrhexis (nuclear fragmentation), and karyolysis (nuclear dissolution) .
Q5. A patient with a myocardial infarction has elevated serum troponin I levels. Troponin is released
due to:
A. Reversible cell injury
B. Necrosis (irreversible cell injury)
C. Apoptosis
D. Cellular adaptation
Answer: B
Rationale: Cardiac troponins are intracellular proteins released into the bloodstream when cardiac
myocytes undergo necrosis (irreversible injury). Elevated troponin indicates myocardial cell death .
Q6. During ischemia, the switch from aerobic to anaerobic metabolism results in:
