NURS-6501 Advanced Pathophysiology Midterm
Exam | Complete Actual Exam Questions with
Correct Detailed Answers and Rationales| Walden
University | Latest Edition- Updated 2026/2027
Question 1
A 4-year-old child appears listless for the last week. He complains of pain when he is
picked up by his mother, and he is irritable when touching his arms or legs. Several large
ecchymotic lesions have appeared on his right thigh and left shoulder. A complete blood
count reveals HgB = 10.2, Hct = 30.5%, MCV = 96 fL, platelet count of 45,000/µL, and
WBC count of 13,990/µL. Examination of the peripheral blood smear reveals numerous
blasts. The blasts lack peroxidase-positive granules but do contain periodic acid-Schiff
(PAS)-positive aggregates and stain positively for TdT. Flow cytometry shows the
phenotype of blasts to be CD19+, CD3-, and sIg-. What is the most likely diagnosis?
A. Acute lymphoblastic leukemia (ALL)
B. Chronic lymphocytic leukemia (CLL)
C. Acute myelogenous leukemia (AML)
D. Chronic myelogenous leukemia (CML)
Answer: A
Rationale: The blasts are PAS-positive, TdT-positive, and CD19+ (B-cell marker) with
CD3- (T-cell marker negative). These findings are characteristic of acute lymphoblastic
leukemia (ALL), specifically B-cell ALL. The lack of peroxidase-positive granules rules
out AML.
Question 2
A 3-year-old child of Italian ancestry presents with failure to thrive. Physical
examination indicates hepatosplenomegaly. His hemoglobin concentration is 6 g/dL,
and the peripheral blood smear reveals severely hypochromic microcytic red cells. Total
serum iron level is normal. The reticulocyte count is 10%. Hemoglobin electrophoresis
shows very little hemoglobin A. A radiograph of the skull shows maxillofacial
deformities. What is the principle cause of anemia and other abnormalities in this
patient?
A. Reduced synthesis of hemoglobin F
B. Reduced red blood cell survival from an imbalance in the production of alpha and
beta globin chains
pg. 1
,C. Relative deficiency of vitamin B12
D. Increased fragility of the erythrocyte membrane
Answer: B
Rationale: This presentation is classic for beta-thalassemia major (Cooley anemia) in a
child of Mediterranean ancestry. The principle cause is reduced red blood cell survival
from an imbalance in alpha and beta globin chain production, leading to ineffective
erythropoiesis and hemolysis.
Question 3
A 68-year-old previously healthy female has been feeling increasingly tired and weak for
several months. She states that she has had black, tarry stools for several weeks. She is
found to be anemic with a hemoglobin concentration of 9.3 g/dL. The peripheral blood
smear reveals microcytic and hypochromic blood cells. Which of the following
conditions should be suspected as the most likely cause of her condition as indicated by
the peripheral blood smear?
A. Aplastic anemia
B. Beta thalassemia
C. Gastrointestinal blood loss
D. Pernicious anemia
Answer: C
Rationale: Black, tarry stools (melena) indicate gastrointestinal bleeding, which leads
to iron deficiency anemia characterized by microcytic and hypochromic red blood cells.
Question 4
A 76-year-old female notices that small, pinpoint to blotchy areas of superficial
hemorrhage have appeared on her gums and on the skin of her arms and legs over
several weeks. She is found to have a normal prothrombin time (PT) and partial
thromboplastin time (PTT). Her CBC shows hemoglobin concentration of 12.7 g/dL,
hematocrit of 37.2%, MCV of 80 fL/red cell, platelet count of 276,000/µL, and WBC of
5600/µL. Her template bleeding time is 3 minutes. Her fibrinogen level is normal, and
there are no fibrin split products detectable. Which of the following conditions best
explains these findings?
A. Chronic renal failure
B. Macronodular cirrhosis
C. Vitamin B12 deficiency
D. Vitamin C deficiency
Answer: D
pg. 2
, Rationale: Petechiae and bleeding gums with normal PT, PTT, and platelet count
suggest vitamin C deficiency (scurvy), which causes defective collagen synthesis and
capillary fragility.
Question 5
A young adult patient has just been diagnosed with Von Willebrand disease. Which of
the following statements should you make to advise the patient of potential
consequences of this disease?
A. You may need an allogeneic bone marrow transplant
B. You may have excessive bleeding following tooth extraction
C. A splenectomy may be necessary to control the disease
D. Expect increasing difficulties with joint mobility
Answer: B
Rationale: Von Willebrand disease causes a bleeding disorder with prolonged bleeding
time due to defective platelet adhesion. Patients are at risk for excessive bleeding
following dental procedures, trauma, and surgery.
Question 6
Low dose aspirin is commonly used to reduce the risk of arterial thrombosis in patients
who have suffered a myocardial infarction. Which one of the following steps in
homeostasis is inhibited by aspirin?
A. Synthesis of von Willebrand factor
B. Aggregation of platelets
C. Activation of factor Xa
D. Synthesis of antithrombin III
Answer: B
Rationale: Aspirin irreversibly inhibits cyclooxygenase-1 (COX-1), reducing
thromboxane A2 production and preventing platelet aggregation.
Question 7
A 24-year-old presents to the office with fatigue. On physical exam, the NP notices that
she is unable with the following vital signs: HR 112, BP 98/64, resp 20, O2 sats 99%.
Her CBC shows: WBC 6,000, Hemoglobin 9.6, Hematocrit 30.2, MCV is decreased at
76. What is the most likely cause of this patient's anemia?
A. Iron deficiency anemia caused by menstruation
B. Beta Thalassemia of genetic origin
C. Pernicious anemia caused by dietary deficiency
pg. 3
Exam | Complete Actual Exam Questions with
Correct Detailed Answers and Rationales| Walden
University | Latest Edition- Updated 2026/2027
Question 1
A 4-year-old child appears listless for the last week. He complains of pain when he is
picked up by his mother, and he is irritable when touching his arms or legs. Several large
ecchymotic lesions have appeared on his right thigh and left shoulder. A complete blood
count reveals HgB = 10.2, Hct = 30.5%, MCV = 96 fL, platelet count of 45,000/µL, and
WBC count of 13,990/µL. Examination of the peripheral blood smear reveals numerous
blasts. The blasts lack peroxidase-positive granules but do contain periodic acid-Schiff
(PAS)-positive aggregates and stain positively for TdT. Flow cytometry shows the
phenotype of blasts to be CD19+, CD3-, and sIg-. What is the most likely diagnosis?
A. Acute lymphoblastic leukemia (ALL)
B. Chronic lymphocytic leukemia (CLL)
C. Acute myelogenous leukemia (AML)
D. Chronic myelogenous leukemia (CML)
Answer: A
Rationale: The blasts are PAS-positive, TdT-positive, and CD19+ (B-cell marker) with
CD3- (T-cell marker negative). These findings are characteristic of acute lymphoblastic
leukemia (ALL), specifically B-cell ALL. The lack of peroxidase-positive granules rules
out AML.
Question 2
A 3-year-old child of Italian ancestry presents with failure to thrive. Physical
examination indicates hepatosplenomegaly. His hemoglobin concentration is 6 g/dL,
and the peripheral blood smear reveals severely hypochromic microcytic red cells. Total
serum iron level is normal. The reticulocyte count is 10%. Hemoglobin electrophoresis
shows very little hemoglobin A. A radiograph of the skull shows maxillofacial
deformities. What is the principle cause of anemia and other abnormalities in this
patient?
A. Reduced synthesis of hemoglobin F
B. Reduced red blood cell survival from an imbalance in the production of alpha and
beta globin chains
pg. 1
,C. Relative deficiency of vitamin B12
D. Increased fragility of the erythrocyte membrane
Answer: B
Rationale: This presentation is classic for beta-thalassemia major (Cooley anemia) in a
child of Mediterranean ancestry. The principle cause is reduced red blood cell survival
from an imbalance in alpha and beta globin chain production, leading to ineffective
erythropoiesis and hemolysis.
Question 3
A 68-year-old previously healthy female has been feeling increasingly tired and weak for
several months. She states that she has had black, tarry stools for several weeks. She is
found to be anemic with a hemoglobin concentration of 9.3 g/dL. The peripheral blood
smear reveals microcytic and hypochromic blood cells. Which of the following
conditions should be suspected as the most likely cause of her condition as indicated by
the peripheral blood smear?
A. Aplastic anemia
B. Beta thalassemia
C. Gastrointestinal blood loss
D. Pernicious anemia
Answer: C
Rationale: Black, tarry stools (melena) indicate gastrointestinal bleeding, which leads
to iron deficiency anemia characterized by microcytic and hypochromic red blood cells.
Question 4
A 76-year-old female notices that small, pinpoint to blotchy areas of superficial
hemorrhage have appeared on her gums and on the skin of her arms and legs over
several weeks. She is found to have a normal prothrombin time (PT) and partial
thromboplastin time (PTT). Her CBC shows hemoglobin concentration of 12.7 g/dL,
hematocrit of 37.2%, MCV of 80 fL/red cell, platelet count of 276,000/µL, and WBC of
5600/µL. Her template bleeding time is 3 minutes. Her fibrinogen level is normal, and
there are no fibrin split products detectable. Which of the following conditions best
explains these findings?
A. Chronic renal failure
B. Macronodular cirrhosis
C. Vitamin B12 deficiency
D. Vitamin C deficiency
Answer: D
pg. 2
, Rationale: Petechiae and bleeding gums with normal PT, PTT, and platelet count
suggest vitamin C deficiency (scurvy), which causes defective collagen synthesis and
capillary fragility.
Question 5
A young adult patient has just been diagnosed with Von Willebrand disease. Which of
the following statements should you make to advise the patient of potential
consequences of this disease?
A. You may need an allogeneic bone marrow transplant
B. You may have excessive bleeding following tooth extraction
C. A splenectomy may be necessary to control the disease
D. Expect increasing difficulties with joint mobility
Answer: B
Rationale: Von Willebrand disease causes a bleeding disorder with prolonged bleeding
time due to defective platelet adhesion. Patients are at risk for excessive bleeding
following dental procedures, trauma, and surgery.
Question 6
Low dose aspirin is commonly used to reduce the risk of arterial thrombosis in patients
who have suffered a myocardial infarction. Which one of the following steps in
homeostasis is inhibited by aspirin?
A. Synthesis of von Willebrand factor
B. Aggregation of platelets
C. Activation of factor Xa
D. Synthesis of antithrombin III
Answer: B
Rationale: Aspirin irreversibly inhibits cyclooxygenase-1 (COX-1), reducing
thromboxane A2 production and preventing platelet aggregation.
Question 7
A 24-year-old presents to the office with fatigue. On physical exam, the NP notices that
she is unable with the following vital signs: HR 112, BP 98/64, resp 20, O2 sats 99%.
Her CBC shows: WBC 6,000, Hemoglobin 9.6, Hematocrit 30.2, MCV is decreased at
76. What is the most likely cause of this patient's anemia?
A. Iron deficiency anemia caused by menstruation
B. Beta Thalassemia of genetic origin
C. Pernicious anemia caused by dietary deficiency
pg. 3
