NSG 530
EXAM 2
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 2 Comprehensive Study Guide
,Table of Contents
NSG 530 Exam 2 ............................................................ 2
NSG 530 Exam 2 Study Guide................................46
NSG 530 Exam 2
1. A patient with systemic lupus erythematosus (SLE) has autoantibodies
attacking multiple organ systems. The nurse understands that the fundamental
defect in autoimmunity is:
A. The immune system fails to recognize self-antigens and mistakenly attacks them as
foreign
B. The immune system is completely suppressed and cannot mount any response
C. The body produces excessive antibodies against harmless environmental antigens
D. T cells are overproduced, causing lymphoproliferative disorders
Correct Answer: A
Rationale: Autoimmunity occurs when the body recognizes self-antigens as foreign. In
normal immune function, tolerance prevents the immune system from reacting to self-
antigens. Loss of self-tolerance leads to autoimmune diseases such as SLE, where the
immune system attacks the body's own tissues.
,2. A healthy individual does not develop autoimmune disease because the
immune system maintains:
A. Autoimmunity
B. Tolerance
C. Hypersensitivity
D. Immunodeficiency
Correct Answer: B
Rationale: Tolerance is the state in which the immune system does not react to self-
antigens. This is a fundamental mechanism preventing autoimmune disease. When
tolerance is lost, autoimmunity develops. Hypersensitivity involves exaggerated immune
responses to foreign antigens; immunodeficiency involves inadequate immune
responses.
CASE: A 28-year-old woman presents with fever, malaise, arthralgias, myalgias,
headache, loss of appetite, and weight loss. She has a butterfly-shaped rash
across her cheeks and nose. Laboratory studies reveal positive ANA and anti-
dsDNA antibodies.
3. This patient most likely has:
A. Rheumatoid arthritis
B. Systemic lupus erythematosus (SLE)
C. Multiple sclerosis
D. Hashimoto thyroiditis
Correct Answer: B
Rationale: Systemic lupus erythematosus is an autoimmune disorder presenting with
fever, malaise, arthralgias, myalgias, headache, and loss of appetite and weight. The
malar (butterfly) rash, positive ANA, and anti-dsDNA antibodies are classic diagnostic
features. SLE can affect multiple organ systems including skin, joints, kidneys, and CNS.
4. A patient with SLE asks about the pathophysiology of her disease. The nurse's
BEST explanation is:
A. Bacterial infection causes chronic inflammation of connective tissue
, B. Autoantibodies form immune complexes that deposit in tissues, causing
inflammation and organ damage
C. A virus directly infects and destroys T cells, causing immune deficiency
D. Excessive cortisol production suppresses normal immune function
Correct Answer: B
Rationale: In SLE, autoantibodies (such as anti-dsDNA) form immune complexes that
deposit in various tissues (skin, joints, kidneys, blood vessels), activating complement
and causing inflammation and organ damage. This is an autoimmune process, not
infectious or endocrine.
5. A child receives the measles, mumps, and rubella (MMR) vaccine. The nurse
understands that vaccines are:
A. Antibiotics that kill bacteria
B. Biologic preparations that stimulate antibody production and immunologic memory
C. Steroids that suppress the inflammatory response
D. Chemotherapy agents that destroy cancer cells
Correct Answer: B
Rationale: Vaccines are biologic preparations that stimulate antibody production and
create immunologic memory. They contain weakened or inactivated pathogens, toxoids,
or subunits that train the immune system to recognize and respond to future infections
without causing disease.
6. A patient receives a tetanus booster shot. The nurse understands that booster
injections are important because they:
A. Replace antibodies that were destroyed by the primary infection
B. Stimulate secondary immune response and memory cell production, creating
sustained protective antibody levels
C. Suppress the immune system to prevent allergic reactions
D. Are required because the primary vaccine was ineffective
Correct Answer: B
,Rationale: Booster injections stimulate the secondary immune response and memory
cell production. The secondary response is faster, stronger, and longer-lasting than the
primary response. It creates a larger number of memory cells and sustained protective
levels of antibody or T cells, providing long-term immunity.
7. A patient receives the hepatitis B vaccine for the first time. The nurse
understands that the primary immune response to this initial antigen exposure is:
A. Rapid, strong, and long-lasting
B. Short-lived and relatively weak compared to subsequent exposures
C. Nonexistent because the immune system has not seen this antigen before
D. Immediate and produces lifelong immunity after a single dose
Correct Answer: B
Rationale: The primary immune response to initial antigen exposure is short-lived and
relatively weak. It takes time for naive lymphocytes to proliferate and differentiate. The
secondary response (upon re-exposure or booster) is much faster, stronger, and longer-
lasting due to memory B and T cells.
CASE: A 30-year-old patient presents with chills, fever, malaise, sore throat,
nausea, rash, and headache. The patient reports these symptoms began 2 weeks
after a high-risk sexual encounter. HIV testing is positive.
8. These early manifestations of HIV most closely resemble:
A. Bacterial pneumonia
B. Infectious mononucleosis
C. Meningococcemia
D. Acute appendicitis
Correct Answer: B
Rationale: Early clinical manifestations of HIV resemble infectious mononucleosis
(mono), including chills, fever, malaise, sore throat, nausea, rash, and headache. This
acute retroviral syndrome occurs 2-4 weeks after infection as the immune system initially
responds to the virus. Later, atypical or opportunistic infections and debilitating chronic
disease develop.
,9. A patient with HIV has a CD4 T-cell count of 150 cells/µL. The nurse
understands that HIV primarily causes immune deficiency by:
A. Destroying B cells, preventing antibody production
B. Depleting T helper (Th) cells, causing general immune deficiency
C. Stimulating excessive macrophage activity, causing tissue destruction
D. Blocking neutrophil chemotaxis, preventing bacterial killing
Correct Answer: B
Rationale: HIV is a retrovirus that specifically targets and depletes CD4+ T helper (Th)
cells. Since Th cells coordinate the entire immune response, their depletion causes
general immune deficiency. A CD4 count below 200 cells/µL indicates AIDS and severe
immunosuppression, predisposing to opportunistic infections.
10. A nursing student is reviewing the structure of HIV. The virus contains genetic
information in the form of:
A. DNA packaged inside a capsid
B. RNA packaged inside a capsid encased in an envelope with reverse transcriptase,
integrase, and protease
C. Double-stranded DNA with surface glycoproteins gp120 and gp41
D. Single-stranded DNA with reverse transcriptase only
Correct Answer: B
Rationale: HIV is a retrovirus with genetic information in the form of RNA. The RNA is
packaged inside a capsid encased in an envelope, along with reverse transcriptase,
integrase, and protease. The envelope displays glycoproteins 120 and 41 (gp120 and
gp41), which bind to CD4 receptors and CCR5/CXCR4 co-receptors on T cells.
11. A patient with HIV is prescribed antiretroviral therapy. The nurse understands
that reverse transcriptase inhibitors work by:
A. Preventing the virus from attaching to CD4 receptors
B. Blocking the conversion of viral RNA to DNA
C. Preventing integration of viral DNA into host cell DNA
, D. Blocking the cleavage of viral polyproteins into functional proteins
Correct Answer: B
Rationale: Reverse transcriptase inhibitors block the conversion of viral RNA to DNA.
Reverse transcriptase is an enzyme unique to retroviruses that synthesizes DNA from
an RNA template. Integrase inhibitors prevent DNA integration; protease inhibitors block
polyprotein cleavage; entry inhibitors prevent viral attachment.
12. A patient with HIV has gp120 and gp41 glycoproteins on the viral envelope.
The nurse understands that gp120 functions to:
A. Convert viral RNA to DNA
B. Bind to CD4 receptors on T helper cells, initiating viral entry
C. Cleaving viral polyproteins into functional units
D. Integrating viral DNA into the host genome
Correct Answer: B
Rationale: The HIV envelope displays glycoproteins 120 and 41 (gp120 and gp41).
Gp120 binds to CD4 receptors on T helper cells and macrophages. This binding triggers
conformational changes that allow gp41 to mediate fusion of the viral envelope with the
host cell membrane, enabling viral entry.
CASE: A patient with AIDS develops Pneumocystis jirovecii pneumonia (PCP),
oral candidiasis, and Kaposi sarcoma. The nurse understands that these are:
13. These conditions represent:
A. Typical infections seen in immunocompetent individuals
B. Atypical or opportunistic infections and malignancies resulting from immune
deficiency
C. Side effects of antiretroviral medications
D. Autoimmune complications of HIV infection
Correct Answer: B
Rationale: Later manifestations of HIV/AIDS include atypical or opportunistic infections
(PCP, oral candidiasis, CMV, Mycobacterium avium complex) and malignancies (Kaposi
,sarcoma, lymphoma) that occur because of severe immune deficiency. These
pathogens normally do not cause disease in immunocompetent individuals.
14. A patient is diagnosed with AIDS based on CDC criteria. The nurse
understands that the diagnostic criterion includes:
A. CD4 T-cell count greater than 500 cells/µL
B. CD4 T-cell count less than 200 cells/µL or presence of an AIDS-defining illness
C. Positive HIV antibody test alone
D. Viral load greater than 1,000 copies/mL
Correct Answer: B
Rationale: AIDS is diagnosed when CD4 T cells decrease to less than 200 cells/µL or
when an AIDS-defining opportunistic infection or malignancy occurs. A positive HIV test
alone indicates HIV infection, not necessarily AIDS. Viral load measures treatment
response but does not define AIDS.
15. A patient with a breast lump undergoes biopsy. The pathologist reports that
the tumor is well-differentiated, encapsulated, grows slowly, and has a low mitotic
index. The nurse understands that this tumor is:
A. Malignant
B. Benign
C. In situ
D. Metastatic
Correct Answer: B
Rationale: Benign tumors grow slowly, are encapsulated, not invasive, well
differentiated, have a low mitotic index, and do not metastasize. Malignant tumors grow
rapidly, are not encapsulated, are invasive, poorly differentiated, have a high mitotic
index, and can metastasize. In situ refers to early-stage cancer that has not invaded
surrounding tissue.
16. A patient with colon cancer has a tumor that has invaded through the
muscularis mucosae but has not spread to lymph nodes or distant sites. This is
classified as:
, A. Stage I
B. Stage II
C. Stage III
D. Stage IV
Correct Answer: B
Rationale: Cancer staging: Stage I—no metastasis (confined to organ of origin); Stage
II—local invasion into surrounding tissue but no node involvement; Stage III—spread to
regional structures/lymph nodes; Stage IV—distant metastasis. This tumor has local
invasion (Stage II) without nodal or distant spread.
17. A patient with breast cancer has tumor cells detected in the axillary lymph
nodes and bone marrow. The nurse understands that cancer spread via lymphatic
channels or blood vessels is called:
A. Hyperplasia
B. Metastasis
C. Dysplasia
D. Metaplasia
Correct Answer: B
Rationale: Metastasis is the spread of cancer cells from the primary tumor to distant
sites via lymphatic channels or blood vessels. It is the hallmark of malignancy and the
primary cause of cancer-related death. Hyperplasia, dysplasia, and metaplasia are pre-
malignant or benign cellular adaptations.
18. A patient with cervical cancer has a tumor confined to the epithelium with no
invasion into the basement membrane. This is classified as:
A. Invasive carcinoma
B. In situ carcinoma
C. Metastatic carcinoma
D. Benign neoplasm
Correct Answer: B
EXAM 2
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 2 Comprehensive Study Guide
,Table of Contents
NSG 530 Exam 2 ............................................................ 2
NSG 530 Exam 2 Study Guide................................46
NSG 530 Exam 2
1. A patient with systemic lupus erythematosus (SLE) has autoantibodies
attacking multiple organ systems. The nurse understands that the fundamental
defect in autoimmunity is:
A. The immune system fails to recognize self-antigens and mistakenly attacks them as
foreign
B. The immune system is completely suppressed and cannot mount any response
C. The body produces excessive antibodies against harmless environmental antigens
D. T cells are overproduced, causing lymphoproliferative disorders
Correct Answer: A
Rationale: Autoimmunity occurs when the body recognizes self-antigens as foreign. In
normal immune function, tolerance prevents the immune system from reacting to self-
antigens. Loss of self-tolerance leads to autoimmune diseases such as SLE, where the
immune system attacks the body's own tissues.
,2. A healthy individual does not develop autoimmune disease because the
immune system maintains:
A. Autoimmunity
B. Tolerance
C. Hypersensitivity
D. Immunodeficiency
Correct Answer: B
Rationale: Tolerance is the state in which the immune system does not react to self-
antigens. This is a fundamental mechanism preventing autoimmune disease. When
tolerance is lost, autoimmunity develops. Hypersensitivity involves exaggerated immune
responses to foreign antigens; immunodeficiency involves inadequate immune
responses.
CASE: A 28-year-old woman presents with fever, malaise, arthralgias, myalgias,
headache, loss of appetite, and weight loss. She has a butterfly-shaped rash
across her cheeks and nose. Laboratory studies reveal positive ANA and anti-
dsDNA antibodies.
3. This patient most likely has:
A. Rheumatoid arthritis
B. Systemic lupus erythematosus (SLE)
C. Multiple sclerosis
D. Hashimoto thyroiditis
Correct Answer: B
Rationale: Systemic lupus erythematosus is an autoimmune disorder presenting with
fever, malaise, arthralgias, myalgias, headache, and loss of appetite and weight. The
malar (butterfly) rash, positive ANA, and anti-dsDNA antibodies are classic diagnostic
features. SLE can affect multiple organ systems including skin, joints, kidneys, and CNS.
4. A patient with SLE asks about the pathophysiology of her disease. The nurse's
BEST explanation is:
A. Bacterial infection causes chronic inflammation of connective tissue
, B. Autoantibodies form immune complexes that deposit in tissues, causing
inflammation and organ damage
C. A virus directly infects and destroys T cells, causing immune deficiency
D. Excessive cortisol production suppresses normal immune function
Correct Answer: B
Rationale: In SLE, autoantibodies (such as anti-dsDNA) form immune complexes that
deposit in various tissues (skin, joints, kidneys, blood vessels), activating complement
and causing inflammation and organ damage. This is an autoimmune process, not
infectious or endocrine.
5. A child receives the measles, mumps, and rubella (MMR) vaccine. The nurse
understands that vaccines are:
A. Antibiotics that kill bacteria
B. Biologic preparations that stimulate antibody production and immunologic memory
C. Steroids that suppress the inflammatory response
D. Chemotherapy agents that destroy cancer cells
Correct Answer: B
Rationale: Vaccines are biologic preparations that stimulate antibody production and
create immunologic memory. They contain weakened or inactivated pathogens, toxoids,
or subunits that train the immune system to recognize and respond to future infections
without causing disease.
6. A patient receives a tetanus booster shot. The nurse understands that booster
injections are important because they:
A. Replace antibodies that were destroyed by the primary infection
B. Stimulate secondary immune response and memory cell production, creating
sustained protective antibody levels
C. Suppress the immune system to prevent allergic reactions
D. Are required because the primary vaccine was ineffective
Correct Answer: B
,Rationale: Booster injections stimulate the secondary immune response and memory
cell production. The secondary response is faster, stronger, and longer-lasting than the
primary response. It creates a larger number of memory cells and sustained protective
levels of antibody or T cells, providing long-term immunity.
7. A patient receives the hepatitis B vaccine for the first time. The nurse
understands that the primary immune response to this initial antigen exposure is:
A. Rapid, strong, and long-lasting
B. Short-lived and relatively weak compared to subsequent exposures
C. Nonexistent because the immune system has not seen this antigen before
D. Immediate and produces lifelong immunity after a single dose
Correct Answer: B
Rationale: The primary immune response to initial antigen exposure is short-lived and
relatively weak. It takes time for naive lymphocytes to proliferate and differentiate. The
secondary response (upon re-exposure or booster) is much faster, stronger, and longer-
lasting due to memory B and T cells.
CASE: A 30-year-old patient presents with chills, fever, malaise, sore throat,
nausea, rash, and headache. The patient reports these symptoms began 2 weeks
after a high-risk sexual encounter. HIV testing is positive.
8. These early manifestations of HIV most closely resemble:
A. Bacterial pneumonia
B. Infectious mononucleosis
C. Meningococcemia
D. Acute appendicitis
Correct Answer: B
Rationale: Early clinical manifestations of HIV resemble infectious mononucleosis
(mono), including chills, fever, malaise, sore throat, nausea, rash, and headache. This
acute retroviral syndrome occurs 2-4 weeks after infection as the immune system initially
responds to the virus. Later, atypical or opportunistic infections and debilitating chronic
disease develop.
,9. A patient with HIV has a CD4 T-cell count of 150 cells/µL. The nurse
understands that HIV primarily causes immune deficiency by:
A. Destroying B cells, preventing antibody production
B. Depleting T helper (Th) cells, causing general immune deficiency
C. Stimulating excessive macrophage activity, causing tissue destruction
D. Blocking neutrophil chemotaxis, preventing bacterial killing
Correct Answer: B
Rationale: HIV is a retrovirus that specifically targets and depletes CD4+ T helper (Th)
cells. Since Th cells coordinate the entire immune response, their depletion causes
general immune deficiency. A CD4 count below 200 cells/µL indicates AIDS and severe
immunosuppression, predisposing to opportunistic infections.
10. A nursing student is reviewing the structure of HIV. The virus contains genetic
information in the form of:
A. DNA packaged inside a capsid
B. RNA packaged inside a capsid encased in an envelope with reverse transcriptase,
integrase, and protease
C. Double-stranded DNA with surface glycoproteins gp120 and gp41
D. Single-stranded DNA with reverse transcriptase only
Correct Answer: B
Rationale: HIV is a retrovirus with genetic information in the form of RNA. The RNA is
packaged inside a capsid encased in an envelope, along with reverse transcriptase,
integrase, and protease. The envelope displays glycoproteins 120 and 41 (gp120 and
gp41), which bind to CD4 receptors and CCR5/CXCR4 co-receptors on T cells.
11. A patient with HIV is prescribed antiretroviral therapy. The nurse understands
that reverse transcriptase inhibitors work by:
A. Preventing the virus from attaching to CD4 receptors
B. Blocking the conversion of viral RNA to DNA
C. Preventing integration of viral DNA into host cell DNA
, D. Blocking the cleavage of viral polyproteins into functional proteins
Correct Answer: B
Rationale: Reverse transcriptase inhibitors block the conversion of viral RNA to DNA.
Reverse transcriptase is an enzyme unique to retroviruses that synthesizes DNA from
an RNA template. Integrase inhibitors prevent DNA integration; protease inhibitors block
polyprotein cleavage; entry inhibitors prevent viral attachment.
12. A patient with HIV has gp120 and gp41 glycoproteins on the viral envelope.
The nurse understands that gp120 functions to:
A. Convert viral RNA to DNA
B. Bind to CD4 receptors on T helper cells, initiating viral entry
C. Cleaving viral polyproteins into functional units
D. Integrating viral DNA into the host genome
Correct Answer: B
Rationale: The HIV envelope displays glycoproteins 120 and 41 (gp120 and gp41).
Gp120 binds to CD4 receptors on T helper cells and macrophages. This binding triggers
conformational changes that allow gp41 to mediate fusion of the viral envelope with the
host cell membrane, enabling viral entry.
CASE: A patient with AIDS develops Pneumocystis jirovecii pneumonia (PCP),
oral candidiasis, and Kaposi sarcoma. The nurse understands that these are:
13. These conditions represent:
A. Typical infections seen in immunocompetent individuals
B. Atypical or opportunistic infections and malignancies resulting from immune
deficiency
C. Side effects of antiretroviral medications
D. Autoimmune complications of HIV infection
Correct Answer: B
Rationale: Later manifestations of HIV/AIDS include atypical or opportunistic infections
(PCP, oral candidiasis, CMV, Mycobacterium avium complex) and malignancies (Kaposi
,sarcoma, lymphoma) that occur because of severe immune deficiency. These
pathogens normally do not cause disease in immunocompetent individuals.
14. A patient is diagnosed with AIDS based on CDC criteria. The nurse
understands that the diagnostic criterion includes:
A. CD4 T-cell count greater than 500 cells/µL
B. CD4 T-cell count less than 200 cells/µL or presence of an AIDS-defining illness
C. Positive HIV antibody test alone
D. Viral load greater than 1,000 copies/mL
Correct Answer: B
Rationale: AIDS is diagnosed when CD4 T cells decrease to less than 200 cells/µL or
when an AIDS-defining opportunistic infection or malignancy occurs. A positive HIV test
alone indicates HIV infection, not necessarily AIDS. Viral load measures treatment
response but does not define AIDS.
15. A patient with a breast lump undergoes biopsy. The pathologist reports that
the tumor is well-differentiated, encapsulated, grows slowly, and has a low mitotic
index. The nurse understands that this tumor is:
A. Malignant
B. Benign
C. In situ
D. Metastatic
Correct Answer: B
Rationale: Benign tumors grow slowly, are encapsulated, not invasive, well
differentiated, have a low mitotic index, and do not metastasize. Malignant tumors grow
rapidly, are not encapsulated, are invasive, poorly differentiated, have a high mitotic
index, and can metastasize. In situ refers to early-stage cancer that has not invaded
surrounding tissue.
16. A patient with colon cancer has a tumor that has invaded through the
muscularis mucosae but has not spread to lymph nodes or distant sites. This is
classified as:
, A. Stage I
B. Stage II
C. Stage III
D. Stage IV
Correct Answer: B
Rationale: Cancer staging: Stage I—no metastasis (confined to organ of origin); Stage
II—local invasion into surrounding tissue but no node involvement; Stage III—spread to
regional structures/lymph nodes; Stage IV—distant metastasis. This tumor has local
invasion (Stage II) without nodal or distant spread.
17. A patient with breast cancer has tumor cells detected in the axillary lymph
nodes and bone marrow. The nurse understands that cancer spread via lymphatic
channels or blood vessels is called:
A. Hyperplasia
B. Metastasis
C. Dysplasia
D. Metaplasia
Correct Answer: B
Rationale: Metastasis is the spread of cancer cells from the primary tumor to distant
sites via lymphatic channels or blood vessels. It is the hallmark of malignancy and the
primary cause of cancer-related death. Hyperplasia, dysplasia, and metaplasia are pre-
malignant or benign cellular adaptations.
18. A patient with cervical cancer has a tumor confined to the epithelium with no
invasion into the basement membrane. This is classified as:
A. Invasive carcinoma
B. In situ carcinoma
C. Metastatic carcinoma
D. Benign neoplasm
Correct Answer: B
