NSG 3280 Pathophysiology for Nurses –
Final Exam Practice Questions (2026/2027)
Instructions: Select the best answer for each question. The correct answer and its
rationale are provided below each question set.
Section 1: Cellular & Immune System Disorders
1. A patient with Rheumatoid Arthritis is prescribed a TNF-alpha inhibitor.
Which of the following pathophysiological actions best describes the
therapeutic effect of this medication?
a) It blocks the action of B-lymphocytes.
b) It inhibits the inflammatory response by reducing a key cytokine.
c) It suppresses the activity of the complement system.
d) It prevents the release of histamine from mast cells.
Answer: b) It inhibits the inflammatory response by reducing a key cytokine.
Rationale: TNF-alpha is a pro-inflammatory cytokine heavily involved in the
inflammatory process of RA. TNF-alpha inhibitors work by binding to and
inactivating this cytokine, thereby reducing inflammation, pain, and joint
destruction. Option a is the mechanism for Rituximab, c is not a primary action of
TNF inhibitors, and d is the action of antihistamines.
2. A patient with a severe allergic reaction to peanuts is treated with
epinephrine. Epinephrine is effective in this situation primarily because it:
a) Blocks the release of histamine from mast cells.
b) Causes vasodilation and increased capillary permeability.
c) Reverses bronchoconstriction and causes vasoconstriction.
d) Stimulates the parasympathetic nervous system.
Answer: c) Reverses bronchoconstriction and causes vasoconstriction.
Rationale: Epinephrine is a potent alpha- and beta-adrenergic agonist. In
anaphylaxis, it acts on beta-2 receptors in the lungs to cause bronchodilation, and
on alpha-1 receptors in blood vessels to cause vasoconstriction. This combats the
two most life-threatening effects: bronchospasm and severe hypotension. Option a
,is incorrect as it's a mast cell stabilizer. b is the opposite of what epinephrine does.
d is incorrect because it stimulates the sympathetic nervous system.
3. A patient is diagnosed with Systemic Lupus Erythematosus (SLE). The
nurse understands that the underlying pathology of this disease involves:
a) An overactive innate immune response causing tissue necrosis.
b) The failure of self-tolerance and production of autoantibodies against self-
antigens.
c) A deficiency in the production of T-helper cells.
d) An inability to produce antibodies against foreign pathogens.
Answer: b) The failure of self-tolerance and production of autoantibodies against
self-antigens.
Rationale: SLE is a classic type III hypersensitivity autoimmune disorder. The
hallmark is a loss of self-tolerance where the immune system fails to recognize the
body's own cells as "self," leading to the production of autoantibodies (e.g.,
antinuclear antibodies, anti-dsDNA). These autoantibodies form immune
complexes that deposit in tissues, causing systemic inflammation and damage.
4. A patient with HIV has a CD4+ T-cell count of 200 cells/mm3. This finding
indicates that the patient:
a) Is in the early, acute stage of HIV infection.
b) Has a normal immune function for their age.
c) Has progressed to AIDS and is at high risk for opportunistic infections.
d) Is at a low risk for transmitting the virus to others.
Answer: c) Has progressed to AIDS and is at high risk for opportunistic infections.
Rationale: A CD4+ count of less than 200 cells/mm3 is one of the diagnostic
criteria for AIDS (Acquired Immunodeficiency Syndrome). The progressive
destruction of CD4+ T-cells, the master regulators of the immune system, leaves
the patient severely immunocompromised and susceptible to opportunistic
infections (e.g., Pneumocystis jirovecii pneumonia, candidiasis, tuberculosis).
5. A cancer patient is receiving chemotherapy. The nurse reviews the lab
results and notes a significant decrease in neutrophils. Which of the following
is the priority nursing intervention for this patient?
a) Monitor the patient for signs of bleeding.
,b) Assess for fever, chills, and sore throat.
c) Encourage the patient to eat a high-protein diet.
d) Administer an antihistamine to prevent an allergic reaction.
Answer: b) Assess for fever, chills, and sore throat.
Rationale: A low neutrophil count (neutropenia) is a common side effect of
chemotherapy and indicates severe immunosuppression. Fever is often the first
sign of an infection, which can rapidly become life-threatening (neutropenic
sepsis). The nurse's priority is to monitor for and promptly treat any signs of
infection. Option a relates to thrombocytopenia (low platelets).
Section 2: Cardiovascular System Disorders
6. A patient is diagnosed with left-sided heart failure. The nurse understands
that this condition primarily leads to:
a) Jugular venous distention and peripheral edema.
b) Hepatomegaly and ascites.
c) Pulmonary congestion and shortness of breath.
d) Right upper quadrant pain and anorexia.
Answer: c) Pulmonary congestion and shortness of breath.
Rationale: Left-sided heart failure occurs when the left ventricle fails to
effectively pump blood out to the body. This causes blood to back up into the left
atrium and then into the pulmonary veins and capillaries, leading to pulmonary
congestion, increased hydrostatic pressure, and pulmonary edema. This manifests
as dyspnea, crackles, and orthopnea.
7. A patient with a history of atherosclerosis presents to the ER with sudden,
severe, "tearing" chest pain that radiates to the back. The blood pressure is
significantly different in each arm. These symptoms are most consistent with:
a) Myocardial infarction.
b) Pulmonary embolism.
c) Aortic dissection.
d) Pericarditis.
Answer: c) Aortic dissection.
Rationale: An aortic dissection is a tear in the intimal layer of the aorta, allowing
, blood to flow between the layers of the vessel wall. The classic presentation is
sudden, severe, "tearing" or "ripping" chest pain that radiates to the back. A blood
pressure differential between arms is also a key finding, as the dissection can
involve the subclavian artery.
8. A patient is diagnosed with a deep vein thrombosis (DVT) in the left leg.
The nurse understands that the primary danger of a DVT is the risk of:
a) Tissue necrosis and gangrene.
b) The clot becoming an embolus and traveling to the lungs.
c) Severe, chronic pain in the affected extremity.
d) Bleeding from the site of the clot.
Answer: b) The clot becoming an embolus and traveling to the lungs.
Rationale: A DVT is a blood clot that forms in a deep vein. The most serious
complication is a pulmonary embolism (PE), which occurs when a portion of the
thrombus breaks off and travels through the venous system to the pulmonary
arteries, lodging in the lungs and obstructing blood flow and gas exchange.
9. In a patient with hypertension, the nurse understands that the chronic
elevation in blood pressure can lead to target organ damage. Which of the
following is an example of this damage?
a) Renal failure and left ventricular hypertrophy.
b) Decreased risk of cerebrovascular accident.
c) Improved peripheral circulation.
d) Right ventricular failure and pulmonary edema.
Answer: a) Renal failure and left ventricular hypertrophy.
Rationale: Chronic hypertension puts excessive strain on the left ventricle, forcing
it to work harder to eject blood, leading to left ventricular hypertrophy (thickening
of the heart muscle). It also damages the small blood vessels in the kidneys
(nephrosclerosis), leading to impaired renal function and eventually renal failure.
10. The nurse is caring for a patient with peripheral arterial disease (PAD).
Which of the following assessment findings would the nurse expect?
a) Bounding pedal pulses and warm, pink extremities.
b) Pallor with elevation and dependent rubor.
Final Exam Practice Questions (2026/2027)
Instructions: Select the best answer for each question. The correct answer and its
rationale are provided below each question set.
Section 1: Cellular & Immune System Disorders
1. A patient with Rheumatoid Arthritis is prescribed a TNF-alpha inhibitor.
Which of the following pathophysiological actions best describes the
therapeutic effect of this medication?
a) It blocks the action of B-lymphocytes.
b) It inhibits the inflammatory response by reducing a key cytokine.
c) It suppresses the activity of the complement system.
d) It prevents the release of histamine from mast cells.
Answer: b) It inhibits the inflammatory response by reducing a key cytokine.
Rationale: TNF-alpha is a pro-inflammatory cytokine heavily involved in the
inflammatory process of RA. TNF-alpha inhibitors work by binding to and
inactivating this cytokine, thereby reducing inflammation, pain, and joint
destruction. Option a is the mechanism for Rituximab, c is not a primary action of
TNF inhibitors, and d is the action of antihistamines.
2. A patient with a severe allergic reaction to peanuts is treated with
epinephrine. Epinephrine is effective in this situation primarily because it:
a) Blocks the release of histamine from mast cells.
b) Causes vasodilation and increased capillary permeability.
c) Reverses bronchoconstriction and causes vasoconstriction.
d) Stimulates the parasympathetic nervous system.
Answer: c) Reverses bronchoconstriction and causes vasoconstriction.
Rationale: Epinephrine is a potent alpha- and beta-adrenergic agonist. In
anaphylaxis, it acts on beta-2 receptors in the lungs to cause bronchodilation, and
on alpha-1 receptors in blood vessels to cause vasoconstriction. This combats the
two most life-threatening effects: bronchospasm and severe hypotension. Option a
,is incorrect as it's a mast cell stabilizer. b is the opposite of what epinephrine does.
d is incorrect because it stimulates the sympathetic nervous system.
3. A patient is diagnosed with Systemic Lupus Erythematosus (SLE). The
nurse understands that the underlying pathology of this disease involves:
a) An overactive innate immune response causing tissue necrosis.
b) The failure of self-tolerance and production of autoantibodies against self-
antigens.
c) A deficiency in the production of T-helper cells.
d) An inability to produce antibodies against foreign pathogens.
Answer: b) The failure of self-tolerance and production of autoantibodies against
self-antigens.
Rationale: SLE is a classic type III hypersensitivity autoimmune disorder. The
hallmark is a loss of self-tolerance where the immune system fails to recognize the
body's own cells as "self," leading to the production of autoantibodies (e.g.,
antinuclear antibodies, anti-dsDNA). These autoantibodies form immune
complexes that deposit in tissues, causing systemic inflammation and damage.
4. A patient with HIV has a CD4+ T-cell count of 200 cells/mm3. This finding
indicates that the patient:
a) Is in the early, acute stage of HIV infection.
b) Has a normal immune function for their age.
c) Has progressed to AIDS and is at high risk for opportunistic infections.
d) Is at a low risk for transmitting the virus to others.
Answer: c) Has progressed to AIDS and is at high risk for opportunistic infections.
Rationale: A CD4+ count of less than 200 cells/mm3 is one of the diagnostic
criteria for AIDS (Acquired Immunodeficiency Syndrome). The progressive
destruction of CD4+ T-cells, the master regulators of the immune system, leaves
the patient severely immunocompromised and susceptible to opportunistic
infections (e.g., Pneumocystis jirovecii pneumonia, candidiasis, tuberculosis).
5. A cancer patient is receiving chemotherapy. The nurse reviews the lab
results and notes a significant decrease in neutrophils. Which of the following
is the priority nursing intervention for this patient?
a) Monitor the patient for signs of bleeding.
,b) Assess for fever, chills, and sore throat.
c) Encourage the patient to eat a high-protein diet.
d) Administer an antihistamine to prevent an allergic reaction.
Answer: b) Assess for fever, chills, and sore throat.
Rationale: A low neutrophil count (neutropenia) is a common side effect of
chemotherapy and indicates severe immunosuppression. Fever is often the first
sign of an infection, which can rapidly become life-threatening (neutropenic
sepsis). The nurse's priority is to monitor for and promptly treat any signs of
infection. Option a relates to thrombocytopenia (low platelets).
Section 2: Cardiovascular System Disorders
6. A patient is diagnosed with left-sided heart failure. The nurse understands
that this condition primarily leads to:
a) Jugular venous distention and peripheral edema.
b) Hepatomegaly and ascites.
c) Pulmonary congestion and shortness of breath.
d) Right upper quadrant pain and anorexia.
Answer: c) Pulmonary congestion and shortness of breath.
Rationale: Left-sided heart failure occurs when the left ventricle fails to
effectively pump blood out to the body. This causes blood to back up into the left
atrium and then into the pulmonary veins and capillaries, leading to pulmonary
congestion, increased hydrostatic pressure, and pulmonary edema. This manifests
as dyspnea, crackles, and orthopnea.
7. A patient with a history of atherosclerosis presents to the ER with sudden,
severe, "tearing" chest pain that radiates to the back. The blood pressure is
significantly different in each arm. These symptoms are most consistent with:
a) Myocardial infarction.
b) Pulmonary embolism.
c) Aortic dissection.
d) Pericarditis.
Answer: c) Aortic dissection.
Rationale: An aortic dissection is a tear in the intimal layer of the aorta, allowing
, blood to flow between the layers of the vessel wall. The classic presentation is
sudden, severe, "tearing" or "ripping" chest pain that radiates to the back. A blood
pressure differential between arms is also a key finding, as the dissection can
involve the subclavian artery.
8. A patient is diagnosed with a deep vein thrombosis (DVT) in the left leg.
The nurse understands that the primary danger of a DVT is the risk of:
a) Tissue necrosis and gangrene.
b) The clot becoming an embolus and traveling to the lungs.
c) Severe, chronic pain in the affected extremity.
d) Bleeding from the site of the clot.
Answer: b) The clot becoming an embolus and traveling to the lungs.
Rationale: A DVT is a blood clot that forms in a deep vein. The most serious
complication is a pulmonary embolism (PE), which occurs when a portion of the
thrombus breaks off and travels through the venous system to the pulmonary
arteries, lodging in the lungs and obstructing blood flow and gas exchange.
9. In a patient with hypertension, the nurse understands that the chronic
elevation in blood pressure can lead to target organ damage. Which of the
following is an example of this damage?
a) Renal failure and left ventricular hypertrophy.
b) Decreased risk of cerebrovascular accident.
c) Improved peripheral circulation.
d) Right ventricular failure and pulmonary edema.
Answer: a) Renal failure and left ventricular hypertrophy.
Rationale: Chronic hypertension puts excessive strain on the left ventricle, forcing
it to work harder to eject blood, leading to left ventricular hypertrophy (thickening
of the heart muscle). It also damages the small blood vessels in the kidneys
(nephrosclerosis), leading to impaired renal function and eventually renal failure.
10. The nurse is caring for a patient with peripheral arterial disease (PAD).
Which of the following assessment findings would the nurse expect?
a) Bounding pedal pulses and warm, pink extremities.
b) Pallor with elevation and dependent rubor.
