NSG 3280 EXAM 4 — PATHOPHYSIOLOGY
FOR NURSES I 200 Practice Questions
with Answers and Rationales
Course: NSG 3280 – Pathophysiology for Nurses I
Institution: Galen College of Nursing
Exam: Exam 4
Format: Multiple-choice, NCLEX-style questions
Key Topics: Hematologic Disorders, Immune System Dysfunction, Autoimmune Diseases,
Infectious Disease Pathophysiology, Neurologic Disorders, Endocrine Disorders, Renal
Disorders, Gastrointestinal Disorders, Musculoskeletal Disorders, Multisystem Disorders, and
Cellular Adaptation
SECTION 1: HEMATOLOGIC DISORDERS (Questions 1–35)
1. A patient with iron deficiency anemia is likely to exhibit which of the following laboratory
findings?
- A) Microcytic, hypochromic red blood cells
- B) Macrocytic, normochromic red blood cells
- C) Normocytic, normochromic red blood cells
- D) Microcytic, hyperchromic red blood cells
Answer: A
Rationale: Iron deficiency anemia results in microcytic (small) and hypochromic (pale) red blood
cells due to insufficient hemoglobin production. Macrocytic anemia is associated with vitamin B₁₂
or folate deficiency.
2. Which of the following best describes the pathophysiology of sickle cell anemia?
- A) Decreased production of erythropoietin
- B) Abnormal hemoglobin S causing red blood cells to become sickle-shaped
- C) Autoimmune destruction of red blood cells
,- D) Deficiency of intrinsic factor
Answer: B
Rationale: Sickle cell anemia is caused by a genetic mutation resulting in hemoglobin S. Under
low oxygen conditions, hemoglobin S polymerizes, causing red blood cells to become
sickle-shaped, leading to vaso-occlusion and hemolysis.
3. A patient with pernicious anemia is deficient in which vitamin?
- A) Vitamin B₆
- B) Vitamin B₁₂
- C) Folic acid
- D) Iron
Answer: B
Rationale: Pernicious anemia results from the inability to absorb vitamin B₁₂ due to a lack of
intrinsic factor produced by the gastric parietal cells. This leads to macrocytic anemia and
neurological symptoms.
4. In disseminated intravascular coagulation (DIC), which pathophysiological process occurs?
- A) Excessive bleeding only
- B) Excessive clotting only
- C) Simultaneous clotting and bleeding
- D) Decreased platelet production
Answer: C
Rationale: DIC is characterized by widespread activation of the coagulation cascade, leading to
microvascular thrombi. This consumes clotting factors and platelets, resulting in simultaneous
thrombosis and bleeding.
5. A patient with hemophilia A has a deficiency of which clotting factor?
- A) Factor VIII
- B) Factor IX
- C) Factor XI
- D) Factor VII
Answer: A
,Rationale: Hemophilia A is caused by a deficiency of clotting factor VIII. Hemophilia B
(Christmas disease) is caused by a deficiency of factor IX. Both are X-linked recessive
disorders.
6. Which of the following is a characteristic finding in polycythemia vera?
- A) Decreased red blood cell mass
- B) Increased red blood cell mass with elevated hematocrit
- C) Decreased white blood cell count
- D) Thrombocytopenia
Answer: B
Rationale: Polycythemia vera is a myeloproliferative disorder characterized by an increased red
blood cell mass, elevated hematocrit, and often elevated white blood cells and platelets. This
increases blood viscosity and risk of thrombosis.
7. A patient with aplastic anemia has which underlying pathophysiology?
- A) Excessive destruction of red blood cells
- B) Bone marrow failure resulting in pancytopenia
- C) Iron deficiency
- D) Vitamin B₁₂ deficiency
Answer: B
Rationale: Aplastic anemia is a condition of bone marrow failure resulting in pancytopenia
(deficiency of all blood cell types: red cells, white cells, and platelets). It can be caused by
exposure to toxins, drugs, radiation, or be idiopathic.
8. In hemolytic anemia, which laboratory finding is most characteristic?
- A) Decreased reticulocyte count
- B) Increased reticulocyte count
- C) Decreased bilirubin
- D) Increased ferritin
Answer: B
Rationale: In hemolytic anemia, the bone marrow compensates for red blood cell destruction by
increasing production, resulting in an elevated reticulocyte count (reticulocytosis). Bilirubin is
also elevated due to heme breakdown.
, 9. The pathophysiology of heparin-induced thrombocytopenia (HIT) involves:
- A) Decreased platelet production in the bone marrow
- B) Immune-mediated destruction of platelets
- C) Increased platelet destruction due to liver disease
- D) Vitamin K deficiency
Answer: B
Rationale: HIT is an immune-mediated reaction in which antibodies form against platelet factor 4
(PF4) complexed with heparin, leading to platelet activation, aggregation, and destruction,
resulting in thrombocytopenia and increased risk of thrombosis.
10. Which of the following is most consistent with the pathophysiology of thrombotic
thrombocytopenic purpura (TTP)?
- A) Decreased ADAMTS13 activity leading to accumulation of ultra-large von Willebrand factor
multimers
- B) Increased platelet production
- C) Deficiency of factor VIII
- D) Bone marrow failure
Answer: A
Rationale: TTP is caused by a severe deficiency of ADAMTS13, a protease that cleaves von
Willebrand factor. This leads to the accumulation of ultra-large von Willebrand factor multimers,
causing platelet aggregation, microthrombi, and thrombocytopenia.
11. A patient with sickle cell crisis is experiencing severe pain. The pathophysiology of this pain
is primarily due to:
- A) Bone marrow infarction
- B) Vaso-occlusion causing ischemia and tissue necrosis
- C) Hemolysis causing anemia
- D) Iron overload
Answer: B
Rationale: Sickle cell crisis pain is caused by vaso-occlusion, where sickle-shaped red blood
cells block small blood vessels, leading to ischemia, tissue necrosis, and severe pain.
12. The most common inherited bleeding disorder is:
- A) Hemophilia A
FOR NURSES I 200 Practice Questions
with Answers and Rationales
Course: NSG 3280 – Pathophysiology for Nurses I
Institution: Galen College of Nursing
Exam: Exam 4
Format: Multiple-choice, NCLEX-style questions
Key Topics: Hematologic Disorders, Immune System Dysfunction, Autoimmune Diseases,
Infectious Disease Pathophysiology, Neurologic Disorders, Endocrine Disorders, Renal
Disorders, Gastrointestinal Disorders, Musculoskeletal Disorders, Multisystem Disorders, and
Cellular Adaptation
SECTION 1: HEMATOLOGIC DISORDERS (Questions 1–35)
1. A patient with iron deficiency anemia is likely to exhibit which of the following laboratory
findings?
- A) Microcytic, hypochromic red blood cells
- B) Macrocytic, normochromic red blood cells
- C) Normocytic, normochromic red blood cells
- D) Microcytic, hyperchromic red blood cells
Answer: A
Rationale: Iron deficiency anemia results in microcytic (small) and hypochromic (pale) red blood
cells due to insufficient hemoglobin production. Macrocytic anemia is associated with vitamin B₁₂
or folate deficiency.
2. Which of the following best describes the pathophysiology of sickle cell anemia?
- A) Decreased production of erythropoietin
- B) Abnormal hemoglobin S causing red blood cells to become sickle-shaped
- C) Autoimmune destruction of red blood cells
,- D) Deficiency of intrinsic factor
Answer: B
Rationale: Sickle cell anemia is caused by a genetic mutation resulting in hemoglobin S. Under
low oxygen conditions, hemoglobin S polymerizes, causing red blood cells to become
sickle-shaped, leading to vaso-occlusion and hemolysis.
3. A patient with pernicious anemia is deficient in which vitamin?
- A) Vitamin B₆
- B) Vitamin B₁₂
- C) Folic acid
- D) Iron
Answer: B
Rationale: Pernicious anemia results from the inability to absorb vitamin B₁₂ due to a lack of
intrinsic factor produced by the gastric parietal cells. This leads to macrocytic anemia and
neurological symptoms.
4. In disseminated intravascular coagulation (DIC), which pathophysiological process occurs?
- A) Excessive bleeding only
- B) Excessive clotting only
- C) Simultaneous clotting and bleeding
- D) Decreased platelet production
Answer: C
Rationale: DIC is characterized by widespread activation of the coagulation cascade, leading to
microvascular thrombi. This consumes clotting factors and platelets, resulting in simultaneous
thrombosis and bleeding.
5. A patient with hemophilia A has a deficiency of which clotting factor?
- A) Factor VIII
- B) Factor IX
- C) Factor XI
- D) Factor VII
Answer: A
,Rationale: Hemophilia A is caused by a deficiency of clotting factor VIII. Hemophilia B
(Christmas disease) is caused by a deficiency of factor IX. Both are X-linked recessive
disorders.
6. Which of the following is a characteristic finding in polycythemia vera?
- A) Decreased red blood cell mass
- B) Increased red blood cell mass with elevated hematocrit
- C) Decreased white blood cell count
- D) Thrombocytopenia
Answer: B
Rationale: Polycythemia vera is a myeloproliferative disorder characterized by an increased red
blood cell mass, elevated hematocrit, and often elevated white blood cells and platelets. This
increases blood viscosity and risk of thrombosis.
7. A patient with aplastic anemia has which underlying pathophysiology?
- A) Excessive destruction of red blood cells
- B) Bone marrow failure resulting in pancytopenia
- C) Iron deficiency
- D) Vitamin B₁₂ deficiency
Answer: B
Rationale: Aplastic anemia is a condition of bone marrow failure resulting in pancytopenia
(deficiency of all blood cell types: red cells, white cells, and platelets). It can be caused by
exposure to toxins, drugs, radiation, or be idiopathic.
8. In hemolytic anemia, which laboratory finding is most characteristic?
- A) Decreased reticulocyte count
- B) Increased reticulocyte count
- C) Decreased bilirubin
- D) Increased ferritin
Answer: B
Rationale: In hemolytic anemia, the bone marrow compensates for red blood cell destruction by
increasing production, resulting in an elevated reticulocyte count (reticulocytosis). Bilirubin is
also elevated due to heme breakdown.
, 9. The pathophysiology of heparin-induced thrombocytopenia (HIT) involves:
- A) Decreased platelet production in the bone marrow
- B) Immune-mediated destruction of platelets
- C) Increased platelet destruction due to liver disease
- D) Vitamin K deficiency
Answer: B
Rationale: HIT is an immune-mediated reaction in which antibodies form against platelet factor 4
(PF4) complexed with heparin, leading to platelet activation, aggregation, and destruction,
resulting in thrombocytopenia and increased risk of thrombosis.
10. Which of the following is most consistent with the pathophysiology of thrombotic
thrombocytopenic purpura (TTP)?
- A) Decreased ADAMTS13 activity leading to accumulation of ultra-large von Willebrand factor
multimers
- B) Increased platelet production
- C) Deficiency of factor VIII
- D) Bone marrow failure
Answer: A
Rationale: TTP is caused by a severe deficiency of ADAMTS13, a protease that cleaves von
Willebrand factor. This leads to the accumulation of ultra-large von Willebrand factor multimers,
causing platelet aggregation, microthrombi, and thrombocytopenia.
11. A patient with sickle cell crisis is experiencing severe pain. The pathophysiology of this pain
is primarily due to:
- A) Bone marrow infarction
- B) Vaso-occlusion causing ischemia and tissue necrosis
- C) Hemolysis causing anemia
- D) Iron overload
Answer: B
Rationale: Sickle cell crisis pain is caused by vaso-occlusion, where sickle-shaped red blood
cells block small blood vessels, leading to ischemia, tissue necrosis, and severe pain.
12. The most common inherited bleeding disorder is:
- A) Hemophilia A
