NUR 376 Exam 2 V3 | NUR 376 Applied
Pathophysiology | Actual Q&A with
Rationale (NUR376 Exam 2) | Concordia
1. A 45-year-old female presents with fatigue and dyspnea on exertion. Laboratory results
reveal a hemoglobin of 9 g/dL, a low MCV, and a low MCHC. Which underlying
pathophysiological mechanism best explains these microcytic, hypochromic findings?
A. Vitamin B12 deficiency resulting in impaired DNA synthesis.
B. Chronic blood loss depleting iron stores and inhibiting hemoglobin production.
C. Folic acid deficiency leading to premature erythrocyte death.
D. Genetic mutation causing defective synthesis of the globin chains.
Correct Answer: B
Iron deficiency anemia is characterized by microcytic and hypochromic red blood cells
because iron is a central component of the heme group. Without sufficient iron, the body
cannot produce enough hemoglobin, leading to smaller cells with less color. Chronic occult
bleeding is a common cause of this condition in adults and must be investigated
thoroughly.
2. A patient is diagnosed with Pernicious Anemia. Which physiological process is primarily
disrupted in this condition?
A. Absorption of dietary iron in the duodenum.
,B. Secretion of intrinsic factor by gastric parietal cells.
C. Red blood cell survival time in the peripheral circulation.
D. Bone marrow response to erythropoietin stimulation.
Correct Answer: B
Pernicious anemia is a type of megaloblastic anemia caused by the lack of intrinsic factor,
which is necessary for the absorption of vitamin B12 in the terminal ileum. This condition
is often an autoimmune process where the body attacks the gastric parietal cells. Without
B12, DNA synthesis is impaired, leading to the formation of abnormally large macrocytic
cells.
3. Which of the following clinical manifestations is most specific to a vaso-occlusive crisis in a
patient with Sickle Cell Disease?
A. Generalized lymphadenopathy and night sweats.
B. Severe localized pain due to tissue ischemia.
C. Progressive cognitive decline and peripheral neuropathy.
D. Painless hepatomegaly and splenomegaly.
Correct Answer: B
Vaso-occlusive crisis occurs when sickled red blood cells obstruct capillary blood flow,
leading to downstream hypoxia and tissue infarction. The hallmark of this crisis is intense,
debilitating pain in the affected area, such as the chest, abdomen, or joints. Management
,focuses on aggressive hydration, oxygenation, and pain control to reverse the sickling
process.
4. A patient with Polycythemia Vera is at a significantly increased risk for which of the
following complications?
A. Spontaneous hemorrhage due to thrombocytopenia.
B. Thrombosis resulting from increased blood viscosity.
C. Iron overload syndrome and hepatic cirrhosis.
D. Bacterial infections due to neutropenia.
Correct Answer: B
Polycythemia Vera is a myeloproliferative disorder characterized by an overproduction of
red blood cells, which increases the total blood volume and viscosity. This thick, sluggish
blood flow predisposes the patient to the formation of clots in both the venous and arterial
systems. Nurses must monitor for signs of myocardial infarction, stroke, or deep vein
thrombosis in these patients.
5. Disseminated Intravascular Coagulation (DIC) is characterized by which paradoxical clinical
presentation?
A. Isolated factor VIII deficiency.
B. High platelet counts with prolonged prothrombin time.
C. Hypernatremia and metabolic alkalosis.
, D. Sudden hypertension and bradycardia.
E. Excessive clotting and simultaneous hemorrhage.
Correct Answer: E
DIC is a complex systemic thrombohemorrhagic disorder that involves the widespread
activation of the coagulation cascade. As clotting factors and platelets are consumed rapidly
by microthrombi formation, the patient subsequently loses the ability to clot, leading to
profuse bleeding. This cycle of widespread clotting and bleeding is usually triggered by
underlying conditions like sepsis or severe trauma.
6. The nurse is reviewing the laboratory reports of a patient suspected of having Acute
Lymphocytic Leukemia (ALL). Which finding is most consistent with this diagnosis?
A. A significant accumulation of undifferentiated lymphoblasts in the bone marrow.
B. Presence of the Philadelphia chromosome in mature neutrophils.
C. Increased levels of mature B-lymphocytes in the peripheral blood.
D. An absolute eosinophil count greater than 1500 cells/mcL.
Correct Answer: A
Acute Lymphocytic Leukemia is characterized by the rapid proliferation of immature, non-
functional lymphoblasts that crowd out healthy hematopoietic cells in the bone marrow.
This results in pancytopenia, causing symptoms like anemia, infection, and easy bruising.
ALL is the most common form of leukemia in children but can occur in adults with a more
guarded prognosis.
Pathophysiology | Actual Q&A with
Rationale (NUR376 Exam 2) | Concordia
1. A 45-year-old female presents with fatigue and dyspnea on exertion. Laboratory results
reveal a hemoglobin of 9 g/dL, a low MCV, and a low MCHC. Which underlying
pathophysiological mechanism best explains these microcytic, hypochromic findings?
A. Vitamin B12 deficiency resulting in impaired DNA synthesis.
B. Chronic blood loss depleting iron stores and inhibiting hemoglobin production.
C. Folic acid deficiency leading to premature erythrocyte death.
D. Genetic mutation causing defective synthesis of the globin chains.
Correct Answer: B
Iron deficiency anemia is characterized by microcytic and hypochromic red blood cells
because iron is a central component of the heme group. Without sufficient iron, the body
cannot produce enough hemoglobin, leading to smaller cells with less color. Chronic occult
bleeding is a common cause of this condition in adults and must be investigated
thoroughly.
2. A patient is diagnosed with Pernicious Anemia. Which physiological process is primarily
disrupted in this condition?
A. Absorption of dietary iron in the duodenum.
,B. Secretion of intrinsic factor by gastric parietal cells.
C. Red blood cell survival time in the peripheral circulation.
D. Bone marrow response to erythropoietin stimulation.
Correct Answer: B
Pernicious anemia is a type of megaloblastic anemia caused by the lack of intrinsic factor,
which is necessary for the absorption of vitamin B12 in the terminal ileum. This condition
is often an autoimmune process where the body attacks the gastric parietal cells. Without
B12, DNA synthesis is impaired, leading to the formation of abnormally large macrocytic
cells.
3. Which of the following clinical manifestations is most specific to a vaso-occlusive crisis in a
patient with Sickle Cell Disease?
A. Generalized lymphadenopathy and night sweats.
B. Severe localized pain due to tissue ischemia.
C. Progressive cognitive decline and peripheral neuropathy.
D. Painless hepatomegaly and splenomegaly.
Correct Answer: B
Vaso-occlusive crisis occurs when sickled red blood cells obstruct capillary blood flow,
leading to downstream hypoxia and tissue infarction. The hallmark of this crisis is intense,
debilitating pain in the affected area, such as the chest, abdomen, or joints. Management
,focuses on aggressive hydration, oxygenation, and pain control to reverse the sickling
process.
4. A patient with Polycythemia Vera is at a significantly increased risk for which of the
following complications?
A. Spontaneous hemorrhage due to thrombocytopenia.
B. Thrombosis resulting from increased blood viscosity.
C. Iron overload syndrome and hepatic cirrhosis.
D. Bacterial infections due to neutropenia.
Correct Answer: B
Polycythemia Vera is a myeloproliferative disorder characterized by an overproduction of
red blood cells, which increases the total blood volume and viscosity. This thick, sluggish
blood flow predisposes the patient to the formation of clots in both the venous and arterial
systems. Nurses must monitor for signs of myocardial infarction, stroke, or deep vein
thrombosis in these patients.
5. Disseminated Intravascular Coagulation (DIC) is characterized by which paradoxical clinical
presentation?
A. Isolated factor VIII deficiency.
B. High platelet counts with prolonged prothrombin time.
C. Hypernatremia and metabolic alkalosis.
, D. Sudden hypertension and bradycardia.
E. Excessive clotting and simultaneous hemorrhage.
Correct Answer: E
DIC is a complex systemic thrombohemorrhagic disorder that involves the widespread
activation of the coagulation cascade. As clotting factors and platelets are consumed rapidly
by microthrombi formation, the patient subsequently loses the ability to clot, leading to
profuse bleeding. This cycle of widespread clotting and bleeding is usually triggered by
underlying conditions like sepsis or severe trauma.
6. The nurse is reviewing the laboratory reports of a patient suspected of having Acute
Lymphocytic Leukemia (ALL). Which finding is most consistent with this diagnosis?
A. A significant accumulation of undifferentiated lymphoblasts in the bone marrow.
B. Presence of the Philadelphia chromosome in mature neutrophils.
C. Increased levels of mature B-lymphocytes in the peripheral blood.
D. An absolute eosinophil count greater than 1500 cells/mcL.
Correct Answer: A
Acute Lymphocytic Leukemia is characterized by the rapid proliferation of immature, non-
functional lymphoblasts that crowd out healthy hematopoietic cells in the bone marrow.
This results in pancytopenia, causing symptoms like anemia, infection, and easy bruising.
ALL is the most common form of leukemia in children but can occur in adults with a more
guarded prognosis.
