NUR 376 Exam 3 – Applied Pathophysiology
– Official Blueprint Replica
SECTION I: Hematologic Disorders (10 Questions)
Q1: A patient with iron deficiency anemia presents with fatigue, pallor, and spoon-
shaped nails (koilonychia). The primary pathophysiologic mechanism of this
anemia is:
A. Decreased erythropoietin production
B. Impaired hemoglobin synthesis due to insufficient iron [CORRECT]
C. Autoimmune destruction of red blood cells
D. Intrinsic factor deficiency with vitamin B12 malabsorption
Correct Answer: B
Rationale: Correct because iron deficiency impairs heme synthesis, resulting in
microcytic, hypochromic red blood cells with reduced oxygen-carrying capacity.
Q2: A patient with pernicious anemia presents with weakness, paresthesias, and
an elevated mean corpuscular volume (MCV). The underlying pathophysiologic
mechanism is:
A. Chronic blood loss from the gastrointestinal tract
B. Deficiency of intrinsic factor leading to vitamin B12 malabsorption [CORRECT]
C. Folate deficiency from poor dietary intake
D. Spleen sequestration of red blood cells
Correct Answer: B
Rationale: Correct because pernicious anemia is caused by autoimmune
destruction of gastric parietal cells, resulting in intrinsic factor deficiency and
impaired B12 absorption in the terminal ileum.
Q3: A patient with sickle cell disease develops a vaso-occlusive crisis with severe
bone pain. The primary mechanism leading to this crisis is:
A. Decreased red blood cell production
B. Hemolysis with release of free hemoglobin
C. Polymerization of hemoglobin S causing red cell sickling [CORRECT]
,D. Autoimmune destruction of sickle cells by macrophages
Correct Answer: C
Rationale: Correct because deoxygenation causes hemoglobin S to polymerize,
creating rigid, sickle-shaped erythrocytes that obstruct microcirculation and
cause ischemic pain.
Q4: A patient with hemophilia A develops spontaneous joint bleeding
(hemarthrosis) following minor trauma. The deficient clotting factor in this
disorder is:
A. Factor VIII [CORRECT]
B. Factor IX
C. Factor XI
D. Von Willebrand factor
Correct Answer: A
Rationale: Correct because hemophilia A is an X-linked recessive disorder caused
by deficiency of clotting factor VIII, leading to impaired intrinsic pathway
activation.
Q5: A patient with polycythemia vera has ruddy complexion, headache, and
pruritus after hot showers. The primary pathophysiologic mechanism is:
A. Autoimmune destruction of platelets
B. Increased erythropoietin production from renal hypoxia
C. Myeloproliferative neoplasm with overproduction of erythrocytes [CORRECT]
D. Chronic hypoxia from pulmonary disease
Correct Answer: C
Rationale: Correct because polycythemia vera is a myeloproliferative neoplasm
with a JAK2 mutation, causing uncontrolled erythrocyte production independent
of erythropoietin.
Q6: A patient with disseminated intravascular coagulation (DIC) has bleeding
from multiple sites and laboratory findings of prolonged PT, PTT, and low
fibrinogen. The pathophysiology of DIC involves:
A. Selective inhibition of platelet function
, B. Widespread activation of coagulation with consumption of clotting factors
[CORRECT]
C. Deficiency of vitamin K-dependent clotting factors
D. Massive release of tissue plasminogen activator
Correct Answer: B
Rationale: Correct because DIC involves systemic activation of coagulation,
generating microvascular thrombi and consuming clotting factors and platelets,
leading to hemorrhage.
Q7: A patient with immune thrombocytopenic purpura (ITP) presents with
petechiae, purpura, and a platelet count of 20,000/μL. The primary mechanism of
thrombocytopenia in ITP is:
A. Bone marrow failure with decreased platelet production
B. Splenic sequestration of platelets
C. Autoantibody-mediated destruction of platelets [CORRECT]
D. Drug-induced suppression of megakaryocytes
Correct Answer: C
Rationale: Correct because ITP is an autoimmune disorder with IgG antibodies
against platelet glycoproteins, leading to accelerated removal of platelets by
splenic macrophages.
Q8: A patient with anemia of chronic disease has a low serum iron, low total iron-
binding capacity (TIBC), and elevated ferritin. This pattern indicates:
A. Iron deficiency anemia
B. Anemia of chronic disease [CORRECT]
C. Sideroblastic anemia
D. Thalassemia trait
Correct Answer: B
Rationale: Correct because anemia of chronic disease is characterized by
decreased serum iron, low TIBC, and normal-to-elevated ferritin due to hepcidin-
mediated iron sequestration.
– Official Blueprint Replica
SECTION I: Hematologic Disorders (10 Questions)
Q1: A patient with iron deficiency anemia presents with fatigue, pallor, and spoon-
shaped nails (koilonychia). The primary pathophysiologic mechanism of this
anemia is:
A. Decreased erythropoietin production
B. Impaired hemoglobin synthesis due to insufficient iron [CORRECT]
C. Autoimmune destruction of red blood cells
D. Intrinsic factor deficiency with vitamin B12 malabsorption
Correct Answer: B
Rationale: Correct because iron deficiency impairs heme synthesis, resulting in
microcytic, hypochromic red blood cells with reduced oxygen-carrying capacity.
Q2: A patient with pernicious anemia presents with weakness, paresthesias, and
an elevated mean corpuscular volume (MCV). The underlying pathophysiologic
mechanism is:
A. Chronic blood loss from the gastrointestinal tract
B. Deficiency of intrinsic factor leading to vitamin B12 malabsorption [CORRECT]
C. Folate deficiency from poor dietary intake
D. Spleen sequestration of red blood cells
Correct Answer: B
Rationale: Correct because pernicious anemia is caused by autoimmune
destruction of gastric parietal cells, resulting in intrinsic factor deficiency and
impaired B12 absorption in the terminal ileum.
Q3: A patient with sickle cell disease develops a vaso-occlusive crisis with severe
bone pain. The primary mechanism leading to this crisis is:
A. Decreased red blood cell production
B. Hemolysis with release of free hemoglobin
C. Polymerization of hemoglobin S causing red cell sickling [CORRECT]
,D. Autoimmune destruction of sickle cells by macrophages
Correct Answer: C
Rationale: Correct because deoxygenation causes hemoglobin S to polymerize,
creating rigid, sickle-shaped erythrocytes that obstruct microcirculation and
cause ischemic pain.
Q4: A patient with hemophilia A develops spontaneous joint bleeding
(hemarthrosis) following minor trauma. The deficient clotting factor in this
disorder is:
A. Factor VIII [CORRECT]
B. Factor IX
C. Factor XI
D. Von Willebrand factor
Correct Answer: A
Rationale: Correct because hemophilia A is an X-linked recessive disorder caused
by deficiency of clotting factor VIII, leading to impaired intrinsic pathway
activation.
Q5: A patient with polycythemia vera has ruddy complexion, headache, and
pruritus after hot showers. The primary pathophysiologic mechanism is:
A. Autoimmune destruction of platelets
B. Increased erythropoietin production from renal hypoxia
C. Myeloproliferative neoplasm with overproduction of erythrocytes [CORRECT]
D. Chronic hypoxia from pulmonary disease
Correct Answer: C
Rationale: Correct because polycythemia vera is a myeloproliferative neoplasm
with a JAK2 mutation, causing uncontrolled erythrocyte production independent
of erythropoietin.
Q6: A patient with disseminated intravascular coagulation (DIC) has bleeding
from multiple sites and laboratory findings of prolonged PT, PTT, and low
fibrinogen. The pathophysiology of DIC involves:
A. Selective inhibition of platelet function
, B. Widespread activation of coagulation with consumption of clotting factors
[CORRECT]
C. Deficiency of vitamin K-dependent clotting factors
D. Massive release of tissue plasminogen activator
Correct Answer: B
Rationale: Correct because DIC involves systemic activation of coagulation,
generating microvascular thrombi and consuming clotting factors and platelets,
leading to hemorrhage.
Q7: A patient with immune thrombocytopenic purpura (ITP) presents with
petechiae, purpura, and a platelet count of 20,000/μL. The primary mechanism of
thrombocytopenia in ITP is:
A. Bone marrow failure with decreased platelet production
B. Splenic sequestration of platelets
C. Autoantibody-mediated destruction of platelets [CORRECT]
D. Drug-induced suppression of megakaryocytes
Correct Answer: C
Rationale: Correct because ITP is an autoimmune disorder with IgG antibodies
against platelet glycoproteins, leading to accelerated removal of platelets by
splenic macrophages.
Q8: A patient with anemia of chronic disease has a low serum iron, low total iron-
binding capacity (TIBC), and elevated ferritin. This pattern indicates:
A. Iron deficiency anemia
B. Anemia of chronic disease [CORRECT]
C. Sideroblastic anemia
D. Thalassemia trait
Correct Answer: B
Rationale: Correct because anemia of chronic disease is characterized by
decreased serum iron, low TIBC, and normal-to-elevated ferritin due to hepcidin-
mediated iron sequestration.
