NR 507 Final Exam (2026) - Advanced Pathophysiology
Chamberlain University College of Nursing Actual
Questions & Answers with Rationales
Section 1: Hematologic Disorders (Questions 1-40)
1. A 22-year-old African American male presents with fatigue and pallor.
Laboratory studies show hemoglobin 8.2 g/dL, MCV 75 fL, and peripheral
smear shows sickle cells. What is the underlying pathophysiologic defect in
this disorder?
A. Decreased iron absorption
B. Deficiency of intrinsic factor
C. Single nucleotide substitution in the beta-globin gene (GAG to GTG)
D. Deletion of alpha-globin genes
Answer: C. Single nucleotide substitution in the beta-globin gene (GAG to
GTG)
Rationale: Sickle cell disease results from a point mutation in the beta-globin
gene where glutamic acid is replaced by valine at position 6 (GAG to GTG).
This causes hemoglobin S polymerization under hypoxic conditions, leading
to RBC sickling and hemolysis .
2. A patient with sickle cell disease develops acute chest syndrome. Which of
the following is a characteristic of this complication?
A. Fever, chest pain, and new pulmonary infiltrate
B. Asymptomatic with normal chest X-ray
C. Isolated cough without fever
D. Pleural effusion only
Answer: A. Fever, chest pain, and new pulmonary infiltrate
Rationale: Acute chest syndrome is a leading cause of death in sickle cell
disease, characterized by fever, chest pain, cough, hypoxia, and new
pulmonary infiltrate on chest X-ray. It is often triggered by infection, fat
embolism, or vaso-occlusion .
,3. A 45-year-old female presents with fatigue, paresthesias, and difficulty
walking. Laboratory studies show hemoglobin 9.5 g/dL, MCV 110 fL, and
serum B12 150 pg/mL (normal >300). What is the most likely cause of this
patient's vitamin B12 deficiency?
A. Dietary deficiency
B. Pernicious anemia
C. Gastric bypass surgery
D. Chronic pancreatitis
Answer: B. Pernicious anemia
Rationale: Pernicious anemia is an autoimmune disorder characterized by
antibodies against intrinsic factor or gastric parietal cells, leading to
impaired vitamin B12 absorption. It causes macrocytic anemia and
neurologic symptoms (subacute combined degeneration) due to impaired
myelin synthesis .
4. Which of the following laboratory findings is characteristic of pernicious
anemia?
A. Elevated methylmalonic acid and homocysteine
B. Normal methylmalonic acid with elevated homocysteine
C. Decreased ferritin
D. Elevated TIBC
Answer: A. Elevated methylmalonic acid and homocysteine
Rationale: Vitamin B12 deficiency causes elevated methylmalonic acid
(MMA) and homocysteine. Folate deficiency causes elevated homocysteine
with normal MMA. MMA is more specific for B12 deficiency .
5. A patient with iron deficiency anemia would most likely have which of the
following laboratory findings?
A. Low ferritin, low serum iron, elevated TIBC
B. High ferritin, low serum iron, low TIBC
C. Low ferritin, high serum iron, low TIBC
D. High ferritin, high serum iron, elevated TIBC
,Answer: A. Low ferritin, low serum iron, elevated TIBC
Rationale: Iron deficiency anemia is characterized by low ferritin (most
specific), low serum iron, and elevated total iron-binding capacity (TIBC).
Transferrin saturation is low (<20%) .
6. A 28-year-old female with heavy menstrual bleeding presents with fatigue
and pale conjunctiva. Laboratory studies show hemoglobin 9.0 g/dL, MCV 72
fL, ferritin 8 ng/mL. Which of the following is the most appropriate next
step?
A. Vitamin B12 supplementation
B. Oral iron therapy
C. Blood transfusion
D. Bone marrow biopsy
Answer: B. Oral iron therapy
Rationale: Iron deficiency anemia from chronic blood loss (menorrhagia) is
treated with oral iron supplementation (ferrous sulfate). Response is
monitored by reticulocyte count in 1-2 weeks and hemoglobin in 4-6 weeks .
7. A patient with chronic kidney disease develops anemia. The primary
mechanism for this anemia is:
A. Iron deficiency
B. Vitamin B12 deficiency
C. Decreased erythropoietin production
D. Hemolysis
Answer: C. Decreased erythropoietin production
Rationale: Erythropoietin is produced by peritubular cells in the kidney. In
chronic kidney disease, decreased erythropoietin production leads to
normocytic normochromic anemia. Treatment includes erythropoiesis-
stimulating agents (ESAs) .
8. A 60-year-old male presents with fatigue and easy bruising. Laboratory
studies show hemoglobin 10.2 g/dL, MCV 98 fL, WBC 4,500/mm³, platelets
80,000/mm³. Peripheral smear shows macrocytes and hypersegmented
neutrophils. What is the most likely diagnosis?
, A. Iron deficiency anemia
B. Vitamin B12 deficiency
C. Aplastic anemia
D. Myelodysplastic syndrome
Answer: D. Myelodysplastic syndrome
Rationale: Myelodysplastic syndromes (MDS) present with cytopenias
(anemia, neutropenia, thrombocytopenia), macrocytic anemia, and
dysplastic features (hypersegmented neutrophils, abnormal
megakaryocytes). It is a clonal stem cell disorder with risk of progression to
acute myeloid leukemia .
9. Which of the following is a characteristic of hemolytic anemia?
A. Low reticulocyte count
B. Elevated indirect bilirubin
C. Decreased LDH
D. Normal haptoglobin
Answer: B. Elevated indirect bilirubin
Rationale: Hemolytic anemia causes increased RBC destruction, leading to
elevated indirect (unconjugated) bilirubin, elevated LDH, decreased
haptoglobin, and reticulocytosis (compensatory bone marrow response) .
10. A patient with glucose-6-phosphate dehydrogenase (G6PD) deficiency
develops hemolysis after taking an oxidant medication. Which of the
following best describes the pathophysiology of this disorder?
A. Defective synthesis of alpha-globin chains
B. Impaired ability to regenerate reduced glutathione
C. Deficiency of intrinsic factor
D. Autoimmune destruction of RBCs
Answer: B. Impaired ability to regenerate reduced glutathione
Rationale: G6PD deficiency impairs the pentose phosphate pathway,
reducing the ability to regenerate reduced glutathione. This leaves RBCs
vulnerable to oxidative stress from medications (sulfonamides, primaquine),
fava beans, or infections .
Chamberlain University College of Nursing Actual
Questions & Answers with Rationales
Section 1: Hematologic Disorders (Questions 1-40)
1. A 22-year-old African American male presents with fatigue and pallor.
Laboratory studies show hemoglobin 8.2 g/dL, MCV 75 fL, and peripheral
smear shows sickle cells. What is the underlying pathophysiologic defect in
this disorder?
A. Decreased iron absorption
B. Deficiency of intrinsic factor
C. Single nucleotide substitution in the beta-globin gene (GAG to GTG)
D. Deletion of alpha-globin genes
Answer: C. Single nucleotide substitution in the beta-globin gene (GAG to
GTG)
Rationale: Sickle cell disease results from a point mutation in the beta-globin
gene where glutamic acid is replaced by valine at position 6 (GAG to GTG).
This causes hemoglobin S polymerization under hypoxic conditions, leading
to RBC sickling and hemolysis .
2. A patient with sickle cell disease develops acute chest syndrome. Which of
the following is a characteristic of this complication?
A. Fever, chest pain, and new pulmonary infiltrate
B. Asymptomatic with normal chest X-ray
C. Isolated cough without fever
D. Pleural effusion only
Answer: A. Fever, chest pain, and new pulmonary infiltrate
Rationale: Acute chest syndrome is a leading cause of death in sickle cell
disease, characterized by fever, chest pain, cough, hypoxia, and new
pulmonary infiltrate on chest X-ray. It is often triggered by infection, fat
embolism, or vaso-occlusion .
,3. A 45-year-old female presents with fatigue, paresthesias, and difficulty
walking. Laboratory studies show hemoglobin 9.5 g/dL, MCV 110 fL, and
serum B12 150 pg/mL (normal >300). What is the most likely cause of this
patient's vitamin B12 deficiency?
A. Dietary deficiency
B. Pernicious anemia
C. Gastric bypass surgery
D. Chronic pancreatitis
Answer: B. Pernicious anemia
Rationale: Pernicious anemia is an autoimmune disorder characterized by
antibodies against intrinsic factor or gastric parietal cells, leading to
impaired vitamin B12 absorption. It causes macrocytic anemia and
neurologic symptoms (subacute combined degeneration) due to impaired
myelin synthesis .
4. Which of the following laboratory findings is characteristic of pernicious
anemia?
A. Elevated methylmalonic acid and homocysteine
B. Normal methylmalonic acid with elevated homocysteine
C. Decreased ferritin
D. Elevated TIBC
Answer: A. Elevated methylmalonic acid and homocysteine
Rationale: Vitamin B12 deficiency causes elevated methylmalonic acid
(MMA) and homocysteine. Folate deficiency causes elevated homocysteine
with normal MMA. MMA is more specific for B12 deficiency .
5. A patient with iron deficiency anemia would most likely have which of the
following laboratory findings?
A. Low ferritin, low serum iron, elevated TIBC
B. High ferritin, low serum iron, low TIBC
C. Low ferritin, high serum iron, low TIBC
D. High ferritin, high serum iron, elevated TIBC
,Answer: A. Low ferritin, low serum iron, elevated TIBC
Rationale: Iron deficiency anemia is characterized by low ferritin (most
specific), low serum iron, and elevated total iron-binding capacity (TIBC).
Transferrin saturation is low (<20%) .
6. A 28-year-old female with heavy menstrual bleeding presents with fatigue
and pale conjunctiva. Laboratory studies show hemoglobin 9.0 g/dL, MCV 72
fL, ferritin 8 ng/mL. Which of the following is the most appropriate next
step?
A. Vitamin B12 supplementation
B. Oral iron therapy
C. Blood transfusion
D. Bone marrow biopsy
Answer: B. Oral iron therapy
Rationale: Iron deficiency anemia from chronic blood loss (menorrhagia) is
treated with oral iron supplementation (ferrous sulfate). Response is
monitored by reticulocyte count in 1-2 weeks and hemoglobin in 4-6 weeks .
7. A patient with chronic kidney disease develops anemia. The primary
mechanism for this anemia is:
A. Iron deficiency
B. Vitamin B12 deficiency
C. Decreased erythropoietin production
D. Hemolysis
Answer: C. Decreased erythropoietin production
Rationale: Erythropoietin is produced by peritubular cells in the kidney. In
chronic kidney disease, decreased erythropoietin production leads to
normocytic normochromic anemia. Treatment includes erythropoiesis-
stimulating agents (ESAs) .
8. A 60-year-old male presents with fatigue and easy bruising. Laboratory
studies show hemoglobin 10.2 g/dL, MCV 98 fL, WBC 4,500/mm³, platelets
80,000/mm³. Peripheral smear shows macrocytes and hypersegmented
neutrophils. What is the most likely diagnosis?
, A. Iron deficiency anemia
B. Vitamin B12 deficiency
C. Aplastic anemia
D. Myelodysplastic syndrome
Answer: D. Myelodysplastic syndrome
Rationale: Myelodysplastic syndromes (MDS) present with cytopenias
(anemia, neutropenia, thrombocytopenia), macrocytic anemia, and
dysplastic features (hypersegmented neutrophils, abnormal
megakaryocytes). It is a clonal stem cell disorder with risk of progression to
acute myeloid leukemia .
9. Which of the following is a characteristic of hemolytic anemia?
A. Low reticulocyte count
B. Elevated indirect bilirubin
C. Decreased LDH
D. Normal haptoglobin
Answer: B. Elevated indirect bilirubin
Rationale: Hemolytic anemia causes increased RBC destruction, leading to
elevated indirect (unconjugated) bilirubin, elevated LDH, decreased
haptoglobin, and reticulocytosis (compensatory bone marrow response) .
10. A patient with glucose-6-phosphate dehydrogenase (G6PD) deficiency
develops hemolysis after taking an oxidant medication. Which of the
following best describes the pathophysiology of this disorder?
A. Defective synthesis of alpha-globin chains
B. Impaired ability to regenerate reduced glutathione
C. Deficiency of intrinsic factor
D. Autoimmune destruction of RBCs
Answer: B. Impaired ability to regenerate reduced glutathione
Rationale: G6PD deficiency impairs the pentose phosphate pathway,
reducing the ability to regenerate reduced glutathione. This leaves RBCs
vulnerable to oxidative stress from medications (sulfonamides, primaquine),
fava beans, or infections .
