NSG 530
EXAM 4
Advanced Pathophysiology
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
➢100 Exam Questions w/ Answers
➢Expert Rationales included
➢Exam 4 Comprehensive Study Guide
,Table of Contents
NSG 530 Exam 4 .................................................. 2
NSG 530 Exam 4 Study Guide .......................... 44
NSG 530 Exam 4
CASE: A 4-year-old child is brought to the pediatric clinic by his mother. She reports
that he has been increasingly irritable, has lost his appetite, and seems less active
than usual. On examination, the child appears pale. Laboratory studies reveal a
hemoglobin of 7.2 g/dL.
1. Based on the clinical presentation and laboratory findings, the nurse
practitioner suspects which type of anemia?
A. Pernicious anemia
B. Iron deficiency anemia
C. Hemolytic anemia
D. Anemia of chronic disease
Correct Answer: B
Rationale: Iron deficiency anemia presents with pallor, irritability, anorexia, and decreased
activity. Serum hemoglobin is decreased to 7 or 8 g/dL. It is caused by dietary deficiency,
impaired absorption, increased requirement, chronic blood loss, or chronic diarrhea.
Pernicious anemia is due to lack of intrinsic factor; hemolytic anemia involves mutations in
coagulation factors with bleeding episodes.
,2. A patient with iron deficiency anemia has been prescribed iron supplements.
The nurse correctly educates the patient that treatment should continue for at
least:
A. 1 month
B. 3 months
C. 6 weeks
D. 2 weeks
Correct Answer: B
Rationale: Iron supplements are needed for at least 3 months to replenish tissue stores in
iron deficiency anemia. Shorter durations are insufficient to restore depleted iron stores and
hemoglobin levels. The nurse should also educate about taking iron with vitamin C and
avoiding antacids.
CASE: A 68-year-old patient with long-standing iron deficiency anemia presents with
brittle, thin, coarsely rigid, and spoon-shaped nails, along with painful ulcerations in
the mouth and difficulty swallowing.
3. These findings represent which stage of iron deficiency anemia progression?
A. Early iron depletion
B. Iron-deficient erythropoiesis
C. Advanced iron deficiency with tissue changes
D. Recovery phase
Correct Answer: C
Rationale: Advanced iron deficiency anemia progression includes brittle, thin, coarsely rigid
and spoon-shaped nails (koilonychia), cheilosis, stomatitis, painful ulcerations in the mouth,
and dysphagia. These tissue changes result from prolonged severe iron deficiency affecting
epithelial tissues.
CASE: A 55-year-old patient presents with weakness, fatigue, difficulty walking,
paresthesias, loss of appetite, abdominal pain, weight loss, sore tongue, memory
loss, numbness, confusion, and cognitive decline. Laboratory studies reveal low
vitamin B12 levels.
4. The nurse understands that this patient most likely has:
, A. Iron deficiency anemia
B. Pernicious anemia
C. Thalassemia
D. Sickle cell anemia
Correct Answer: B
Rationale: Pernicious anemia is caused by a lack of intrinsic factor from gastric parietal
cells, resulting in vitamin B12 deficiency. Symptoms include weakness, fatigue, difficulty
walking, paresthesias, loss of appetite, abdominal pain, weight loss, sore tongue, memory
loss, numbness, confusion, cognitive decline, and labile mood or psychosis. Iron deficiency
does not cause neurological symptoms.
5. A patient with pernicious anemia asks why they cannot absorb vitamin B12. The
nurse's BEST explanation is:
A. The stomach does not produce enough hydrochloric acid
B. Gastric parietal cells fail to produce intrinsic factor, which is required for B12 absorption
C. The small intestine has damaged villi from chronic inflammation
D. The liver cannot store adequate amounts of vitamin B12
Correct Answer: B
Rationale: Pernicious anemia is specifically caused by a lack of intrinsic factor from gastric
parietal cells. Intrinsic factor binds to vitamin B12 in the ileum, allowing its absorption.
Without intrinsic factor, B12 cannot be absorbed, leading to megaloblastic anemia and
neurological complications from demyelination.
CASE: A 62-year-old patient with rheumatoid arthritis has a hemoglobin of 9.5 g/dL.
The patient has normal iron stores but shows decreased erythropoiesis and impaired
iron utilization.
6. This type of anemia is best classified as:
A. Iron deficiency anemia
B. Pernicious anemia
C. Anemia of chronic disease
D. Thalassemia
,Correct Answer: C
Rationale: Anemia of chronic disease is characterized by decreased erythropoiesis and
impaired iron utilization in chronic disease or inflammation. It results from decreased
erythrocyte life span, suppressed production of erythropoietin, ineffective bone marrow
response, and altered iron metabolism in macrophages. The patient has normal iron stores,
ruling out iron deficiency.
7. A patient with anemia of chronic disease has normal iron stores but still shows
anemia. The pathophysiology includes all of the following EXCEPT:
A. Decreased erythrocyte life span
B. Suppressed production of erythropoietin
C. Excessive dietary iron intake
D. Altered iron metabolism in macrophages
Correct Answer: C
Rationale: Anemia of chronic disease results from decreased erythrocyte life span,
suppressed erythropoietin production, ineffective bone marrow response, and altered iron
metabolism in macrophages. Excessive dietary iron intake is not part of the pathophysiology;
in fact, iron is sequestered in macrophages and not available for erythropoiesis.
CASE: A 3-year-old child of Mediterranean descent presents with severe anemia,
delayed growth, bone problems causing facial changes, splenomegaly, and requires
regular blood transfusions to survive.
8. This child most likely has:
A. Thalassemia minor
B. Thalassemia major (Cooley's Anemia)
C. Sickle cell trait
D. Iron deficiency anemia
Correct Answer: B
Rationale: Thalassemia major (Cooley's Anemia) is the homozygous form with severe
anemia requiring transfusions to survive. Complications include delayed growth, bone
problems causing facial changes, liver and gall bladder issues, splenomegaly, enlarged
kidneys, diabetes, hypothyroidism, and heart issues. Thalassemia minor (heterozygous) is
milder and generally does not require blood transfusions.
,9. A patient with thalassemia minor (heterozygous) presents with fatigue,
weakness, pale or jaundiced skin, slow growth, and ascites. The nurse
understands that treatment generally:
A. Requires monthly blood transfusions
B. Involves bone marrow transplantation
C. Does not involve blood transfusions
D. Requires lifelong chelation therapy
Correct Answer: C
Rationale: Thalassemia minor (heterozygous) is a milder form with symptoms including
fatigue, weakness, pale or jaundiced skin, slow growth, and ascites. Treatment generally
does not involve blood transfusions. Blood transfusions are reserved for thalassemia major,
which is life-threatening without them.
10. Thalassemia is inherited in which pattern?
A. Autosomal dominant
B. Autosomal recessive
C. X-linked recessive
D. Multifactorial inheritance
Correct Answer: B
Rationale: Thalassemia is an autosomal recessive trait that slows or defects the synthesis of
the globin chains of the hemoglobin molecule. Both parents must be carriers for a child to
have thalassemia major. It is most common in populations from the Mediterranean, Middle
East, and Southeast Asia.
CASE: A 4-year-old child has episodes of persistent bleeding from minor injuries. The
parents report that the child bruises easily and has had multiple episodes of
prolonged bleeding after dental procedures.
11. The nurse suspects which bleeding disorder?
A. Immune thrombocytopenic purpura (ITP)
B. Hemolytic anemia
, C. Hemophilia
D. Sickle cell anemia
Correct Answer: B
Rationale: Hemolytic anemia is described as a serious bleeding disorder involving mutations
in coagulation factors, with first signs by age 3-4 including episodes of persistent bleeding
from minor injuries. While the description overlaps with hemophilia, the study guide
specifically categorizes this presentation under hemolytic anemia in the context of this exam
material.
12. A patient with sickle cell anemia has abnormal hemoglobin leading to
misshapen red blood cells. The primary pathophysiological problem in sickle cell
disease is:
A. Decreased production of red blood cells
B. Abnormal hemoglobin causing red blood cells to sickle under low oxygen conditions
C. Excessive destruction of platelets
D. Lack of intrinsic factor for vitamin B12 absorption
Correct Answer: B
Rationale: Sickle cell anemia is an inherited disorder causing abnormal hemoglobin (HbS),
leading to misshapen red blood cells. Under low oxygen conditions, hemoglobin S
polymerizes, causing red blood cells to assume a sickle shape. These rigid cells occlude
small vessels, causing vaso-occlusive crises, tissue ischemia, and hemolysis.
CASE: A 7-year-old child presents with petechiae, easy bruising, and nosebleeds.
Laboratory studies reveal a platelet count of 45,000/µL.
13. The nurse understands that this child most likely has:
A. Leukemia
B. Immune thrombocytopenic purpura (ITP)
C. Iron deficiency anemia
D. Polycythemia vera
Correct Answer: B
Rationale: Immune thrombocytopenic purpura (ITP) is a bleeding disorder characterized by
low platelet count. It presents with petechiae, purpura, easy bruising, and mucosal bleeding.
,A platelet count of 45,000/µL is significantly below normal (150,000-400,000/µL). ITP is
caused by immune-mediated destruction of platelets.
CASE: A 5-year-old child presents with pallor, bleeding, bruising, fever, feeling weak,
and fatigue. Bone marrow biopsy reveals too many lymphoblasts.
14. This child most likely has:
A. Acute myelogenous leukemia (AML)
B. Acute lymphocytic leukemia (ALL)
C. Chronic myelogenous leukemia (CML)
D. Chronic lymphocytic leukemia (CLL)
Correct Answer: B
Rationale: Acute lymphocytic leukemia (ALL) is characterized by too many lymphoblasts
and mostly occurs in children. Symptoms include bleeding, bruising, pale skin, rashes, fever,
feeling weak, and fatigue. AML involves too many myeloblasts and is most common in
adults. CML and CLL are chronic leukemias that progress slowly and are more common in
adults.
CASE: A 58-year-old adult presents with fatigue, bleeding, fever, anorexia, and
neurologic symptoms. Bone marrow biopsy reveals too many myeloblasts.
15. This patient most likely has:
A. Acute lymphocytic leukemia (ALL)
B. Acute myelogenous leukemia (AML)
C. Chronic myelogenous leukemia (CML)
D. Chronic lymphocytic leukemia (CLL)
Correct Answer: B
Rationale: Acute myelogenous leukemia (AML) is characterized by too many myeloblasts
and is most common in adults. Symptoms include fatigue, bleeding, fever, anorexia, and
neurologic symptoms. ALL occurs mostly in children; CML and CLL are chronic leukemias
with mature but dysfunctional cells.
16. A patient with leukemia has a bone marrow biopsy showing predominantly
mature but dysfunctional cells. The disease is progressing slowly. This describes:
, A. Acute leukemia
B. Chronic leukemia
C. Acute lymphocytic leukemia
D. Acute myelogenous leukemia
Correct Answer: B
Rationale: Chronic leukemia is characterized by a predominant cell that is mature but does
not function normally, progressing slowly. Acute leukemia has undifferentiated or immature
cells (blast cells) and progresses rapidly. The presence of mature but dysfunctional cells
distinguishes chronic from acute leukemia.
CASE: A 45-year-old patient presents with fatigue, pale skin, bruising or bleeding,
poor appetite, night sweats, and headaches. Bone marrow studies show excessive
production of blood cells.
17. This patient most likely has:
A. Chronic myelogenous leukemia (CML)
B. Chronic lymphocytic leukemia (CLL)
C. Acute myelogenous leukemia (AML)
D. Multiple myeloma
Correct Answer: A
Rationale: Chronic myelogenous leukemia (CML) is characterized by too many blood cells
made in the bone marrow. Symptoms include fatigue, pale skin, bruising or bleeding, poor
appetite, night sweats, and headaches. Treatment includes chemotherapy and stem cell
transplants. CML is distinguished from CLL by the myeloid lineage of the proliferating cells.
CASE: A 70-year-old patient presents with frequent infections, bleeding and bruising,
night sweats, weight loss, fever, and lymphadenopathy. The disease is progressing
slowly, and the treatment plan involves observation with symptom management.
18. This patient most likely has:
A. Acute lymphocytic leukemia
B. Chronic lymphocytic leukemia (CLL)
C. Hodgkin lymphoma
EXAM 4
Advanced Pathophysiology
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
➢100 Exam Questions w/ Answers
➢Expert Rationales included
➢Exam 4 Comprehensive Study Guide
,Table of Contents
NSG 530 Exam 4 .................................................. 2
NSG 530 Exam 4 Study Guide .......................... 44
NSG 530 Exam 4
CASE: A 4-year-old child is brought to the pediatric clinic by his mother. She reports
that he has been increasingly irritable, has lost his appetite, and seems less active
than usual. On examination, the child appears pale. Laboratory studies reveal a
hemoglobin of 7.2 g/dL.
1. Based on the clinical presentation and laboratory findings, the nurse
practitioner suspects which type of anemia?
A. Pernicious anemia
B. Iron deficiency anemia
C. Hemolytic anemia
D. Anemia of chronic disease
Correct Answer: B
Rationale: Iron deficiency anemia presents with pallor, irritability, anorexia, and decreased
activity. Serum hemoglobin is decreased to 7 or 8 g/dL. It is caused by dietary deficiency,
impaired absorption, increased requirement, chronic blood loss, or chronic diarrhea.
Pernicious anemia is due to lack of intrinsic factor; hemolytic anemia involves mutations in
coagulation factors with bleeding episodes.
,2. A patient with iron deficiency anemia has been prescribed iron supplements.
The nurse correctly educates the patient that treatment should continue for at
least:
A. 1 month
B. 3 months
C. 6 weeks
D. 2 weeks
Correct Answer: B
Rationale: Iron supplements are needed for at least 3 months to replenish tissue stores in
iron deficiency anemia. Shorter durations are insufficient to restore depleted iron stores and
hemoglobin levels. The nurse should also educate about taking iron with vitamin C and
avoiding antacids.
CASE: A 68-year-old patient with long-standing iron deficiency anemia presents with
brittle, thin, coarsely rigid, and spoon-shaped nails, along with painful ulcerations in
the mouth and difficulty swallowing.
3. These findings represent which stage of iron deficiency anemia progression?
A. Early iron depletion
B. Iron-deficient erythropoiesis
C. Advanced iron deficiency with tissue changes
D. Recovery phase
Correct Answer: C
Rationale: Advanced iron deficiency anemia progression includes brittle, thin, coarsely rigid
and spoon-shaped nails (koilonychia), cheilosis, stomatitis, painful ulcerations in the mouth,
and dysphagia. These tissue changes result from prolonged severe iron deficiency affecting
epithelial tissues.
CASE: A 55-year-old patient presents with weakness, fatigue, difficulty walking,
paresthesias, loss of appetite, abdominal pain, weight loss, sore tongue, memory
loss, numbness, confusion, and cognitive decline. Laboratory studies reveal low
vitamin B12 levels.
4. The nurse understands that this patient most likely has:
, A. Iron deficiency anemia
B. Pernicious anemia
C. Thalassemia
D. Sickle cell anemia
Correct Answer: B
Rationale: Pernicious anemia is caused by a lack of intrinsic factor from gastric parietal
cells, resulting in vitamin B12 deficiency. Symptoms include weakness, fatigue, difficulty
walking, paresthesias, loss of appetite, abdominal pain, weight loss, sore tongue, memory
loss, numbness, confusion, cognitive decline, and labile mood or psychosis. Iron deficiency
does not cause neurological symptoms.
5. A patient with pernicious anemia asks why they cannot absorb vitamin B12. The
nurse's BEST explanation is:
A. The stomach does not produce enough hydrochloric acid
B. Gastric parietal cells fail to produce intrinsic factor, which is required for B12 absorption
C. The small intestine has damaged villi from chronic inflammation
D. The liver cannot store adequate amounts of vitamin B12
Correct Answer: B
Rationale: Pernicious anemia is specifically caused by a lack of intrinsic factor from gastric
parietal cells. Intrinsic factor binds to vitamin B12 in the ileum, allowing its absorption.
Without intrinsic factor, B12 cannot be absorbed, leading to megaloblastic anemia and
neurological complications from demyelination.
CASE: A 62-year-old patient with rheumatoid arthritis has a hemoglobin of 9.5 g/dL.
The patient has normal iron stores but shows decreased erythropoiesis and impaired
iron utilization.
6. This type of anemia is best classified as:
A. Iron deficiency anemia
B. Pernicious anemia
C. Anemia of chronic disease
D. Thalassemia
,Correct Answer: C
Rationale: Anemia of chronic disease is characterized by decreased erythropoiesis and
impaired iron utilization in chronic disease or inflammation. It results from decreased
erythrocyte life span, suppressed production of erythropoietin, ineffective bone marrow
response, and altered iron metabolism in macrophages. The patient has normal iron stores,
ruling out iron deficiency.
7. A patient with anemia of chronic disease has normal iron stores but still shows
anemia. The pathophysiology includes all of the following EXCEPT:
A. Decreased erythrocyte life span
B. Suppressed production of erythropoietin
C. Excessive dietary iron intake
D. Altered iron metabolism in macrophages
Correct Answer: C
Rationale: Anemia of chronic disease results from decreased erythrocyte life span,
suppressed erythropoietin production, ineffective bone marrow response, and altered iron
metabolism in macrophages. Excessive dietary iron intake is not part of the pathophysiology;
in fact, iron is sequestered in macrophages and not available for erythropoiesis.
CASE: A 3-year-old child of Mediterranean descent presents with severe anemia,
delayed growth, bone problems causing facial changes, splenomegaly, and requires
regular blood transfusions to survive.
8. This child most likely has:
A. Thalassemia minor
B. Thalassemia major (Cooley's Anemia)
C. Sickle cell trait
D. Iron deficiency anemia
Correct Answer: B
Rationale: Thalassemia major (Cooley's Anemia) is the homozygous form with severe
anemia requiring transfusions to survive. Complications include delayed growth, bone
problems causing facial changes, liver and gall bladder issues, splenomegaly, enlarged
kidneys, diabetes, hypothyroidism, and heart issues. Thalassemia minor (heterozygous) is
milder and generally does not require blood transfusions.
,9. A patient with thalassemia minor (heterozygous) presents with fatigue,
weakness, pale or jaundiced skin, slow growth, and ascites. The nurse
understands that treatment generally:
A. Requires monthly blood transfusions
B. Involves bone marrow transplantation
C. Does not involve blood transfusions
D. Requires lifelong chelation therapy
Correct Answer: C
Rationale: Thalassemia minor (heterozygous) is a milder form with symptoms including
fatigue, weakness, pale or jaundiced skin, slow growth, and ascites. Treatment generally
does not involve blood transfusions. Blood transfusions are reserved for thalassemia major,
which is life-threatening without them.
10. Thalassemia is inherited in which pattern?
A. Autosomal dominant
B. Autosomal recessive
C. X-linked recessive
D. Multifactorial inheritance
Correct Answer: B
Rationale: Thalassemia is an autosomal recessive trait that slows or defects the synthesis of
the globin chains of the hemoglobin molecule. Both parents must be carriers for a child to
have thalassemia major. It is most common in populations from the Mediterranean, Middle
East, and Southeast Asia.
CASE: A 4-year-old child has episodes of persistent bleeding from minor injuries. The
parents report that the child bruises easily and has had multiple episodes of
prolonged bleeding after dental procedures.
11. The nurse suspects which bleeding disorder?
A. Immune thrombocytopenic purpura (ITP)
B. Hemolytic anemia
, C. Hemophilia
D. Sickle cell anemia
Correct Answer: B
Rationale: Hemolytic anemia is described as a serious bleeding disorder involving mutations
in coagulation factors, with first signs by age 3-4 including episodes of persistent bleeding
from minor injuries. While the description overlaps with hemophilia, the study guide
specifically categorizes this presentation under hemolytic anemia in the context of this exam
material.
12. A patient with sickle cell anemia has abnormal hemoglobin leading to
misshapen red blood cells. The primary pathophysiological problem in sickle cell
disease is:
A. Decreased production of red blood cells
B. Abnormal hemoglobin causing red blood cells to sickle under low oxygen conditions
C. Excessive destruction of platelets
D. Lack of intrinsic factor for vitamin B12 absorption
Correct Answer: B
Rationale: Sickle cell anemia is an inherited disorder causing abnormal hemoglobin (HbS),
leading to misshapen red blood cells. Under low oxygen conditions, hemoglobin S
polymerizes, causing red blood cells to assume a sickle shape. These rigid cells occlude
small vessels, causing vaso-occlusive crises, tissue ischemia, and hemolysis.
CASE: A 7-year-old child presents with petechiae, easy bruising, and nosebleeds.
Laboratory studies reveal a platelet count of 45,000/µL.
13. The nurse understands that this child most likely has:
A. Leukemia
B. Immune thrombocytopenic purpura (ITP)
C. Iron deficiency anemia
D. Polycythemia vera
Correct Answer: B
Rationale: Immune thrombocytopenic purpura (ITP) is a bleeding disorder characterized by
low platelet count. It presents with petechiae, purpura, easy bruising, and mucosal bleeding.
,A platelet count of 45,000/µL is significantly below normal (150,000-400,000/µL). ITP is
caused by immune-mediated destruction of platelets.
CASE: A 5-year-old child presents with pallor, bleeding, bruising, fever, feeling weak,
and fatigue. Bone marrow biopsy reveals too many lymphoblasts.
14. This child most likely has:
A. Acute myelogenous leukemia (AML)
B. Acute lymphocytic leukemia (ALL)
C. Chronic myelogenous leukemia (CML)
D. Chronic lymphocytic leukemia (CLL)
Correct Answer: B
Rationale: Acute lymphocytic leukemia (ALL) is characterized by too many lymphoblasts
and mostly occurs in children. Symptoms include bleeding, bruising, pale skin, rashes, fever,
feeling weak, and fatigue. AML involves too many myeloblasts and is most common in
adults. CML and CLL are chronic leukemias that progress slowly and are more common in
adults.
CASE: A 58-year-old adult presents with fatigue, bleeding, fever, anorexia, and
neurologic symptoms. Bone marrow biopsy reveals too many myeloblasts.
15. This patient most likely has:
A. Acute lymphocytic leukemia (ALL)
B. Acute myelogenous leukemia (AML)
C. Chronic myelogenous leukemia (CML)
D. Chronic lymphocytic leukemia (CLL)
Correct Answer: B
Rationale: Acute myelogenous leukemia (AML) is characterized by too many myeloblasts
and is most common in adults. Symptoms include fatigue, bleeding, fever, anorexia, and
neurologic symptoms. ALL occurs mostly in children; CML and CLL are chronic leukemias
with mature but dysfunctional cells.
16. A patient with leukemia has a bone marrow biopsy showing predominantly
mature but dysfunctional cells. The disease is progressing slowly. This describes:
, A. Acute leukemia
B. Chronic leukemia
C. Acute lymphocytic leukemia
D. Acute myelogenous leukemia
Correct Answer: B
Rationale: Chronic leukemia is characterized by a predominant cell that is mature but does
not function normally, progressing slowly. Acute leukemia has undifferentiated or immature
cells (blast cells) and progresses rapidly. The presence of mature but dysfunctional cells
distinguishes chronic from acute leukemia.
CASE: A 45-year-old patient presents with fatigue, pale skin, bruising or bleeding,
poor appetite, night sweats, and headaches. Bone marrow studies show excessive
production of blood cells.
17. This patient most likely has:
A. Chronic myelogenous leukemia (CML)
B. Chronic lymphocytic leukemia (CLL)
C. Acute myelogenous leukemia (AML)
D. Multiple myeloma
Correct Answer: A
Rationale: Chronic myelogenous leukemia (CML) is characterized by too many blood cells
made in the bone marrow. Symptoms include fatigue, pale skin, bruising or bleeding, poor
appetite, night sweats, and headaches. Treatment includes chemotherapy and stem cell
transplants. CML is distinguished from CLL by the myeloid lineage of the proliferating cells.
CASE: A 70-year-old patient presents with frequent infections, bleeding and bruising,
night sweats, weight loss, fever, and lymphadenopathy. The disease is progressing
slowly, and the treatment plan involves observation with symptom management.
18. This patient most likely has:
A. Acute lymphocytic leukemia
B. Chronic lymphocytic leukemia (CLL)
C. Hodgkin lymphoma
