Pathophysiology Exam 1 Practice

Problems
A patient is found to have liver disease, resulting in the removal of
a lobe of his liver. Adaptation to the reduced size of the liver leads
to ___________ of the remaining liver cells.

A. Metaplasia
B. Organ atrophy

✅✅-C
C. Compensatory hyperplasia
D. Physiologic hyperplasia -

An older adult patient comes to the clinic complaining of not being

able to do what he used to be able to. You know that normal
changes associated with aging include: (Select all that apply.)

A. Improved blood flow

B. Slowed metabolic rate
C. Decreased brain weight

✅✅
D. Improved nerve fiber conduction
E. Less respiratory capacity - -B, C, E

A 20-year-old college student has presented to her campus medical

clinic for a scheduled Pap smear. The clinician who will interpret
the smear will examine cell samples for evidence of:

A. Changes in cell shape, size, and organization

B. Presence of unexpected cell types

✅✅
C. Ischemic changes in cell sample
D. Abnormally high numbers of cells - -A

The parents of a 4-year-old girl have sought care because their

daughter has admitted to chewing and swallowing imported toy
figurines that have been determined to be made of lead. Which of
the following blood tests should the care team prioritize?

A. White blood cell levels with differential

B. Red blood cell levels and morphology

✅✅
C. Urea and creatinine levels
D. Liver function panel - -B
Lead -> anemia, RBC lysis

You know it's not A because there is no infection involved. C is

focused on kidney function while D is focused on liver function.
Both of these would be important in the case of lead poisoning BUT
the priority answer is B, because you need first to address the most
life-threatening patient needs. The little girl in this question can go
into shock or suffer permanent organ damage if her RBCs are low.

A patient with severe peripheral vascular disease has developed

signs of dry gangrene on the great toe of one foot. Which of the
following pathophysiologic processes most likely contributed to
this diagnosis?

A. Inappropriate activation of apoptosis

B. Bacterial invasion

✅✅
C. Impaired arterial blood supply
D. Metaplastic cellular changes - -B

Remember that it's not C because to have gangrene, you must have
infection

Although stress exposure initiates integrated responses by

multiple systems, the most important changes are first activated by
which system?

A. Pulmonary
B. Gastrointestinal

✅✅-C
C. Neuroendocrine
D. Cardiovascular -

Which manifestation of stress reflects the non-specific fight or

flight response?
A. Decreased pupillary light response
B. Increased GI motility

✅✅-D
C. Decreased short-term memory
D. Increased cardiopulmonary rates -

This would fall under physiologic responses to stress!! Slide 25 in

your lecture powerpoint

Stress-induced cortisol hormone secretion is associated with:

A. Increased growth hormone level

B. Regulation of the stress response

✅✅
C. Increased thyroid-stimulating hormone
D. Depressed adrenal gland function - -B

You know it's not A because I mentioned in an earlier slide that

growth hormone levels decrease with stress. We didn't mention
thyroid-stimulating hormone as one of the ones associated with the
stress repsonse so you can pretty much assume that's not right.
And we know adrenal function is not depressed because ACTH
from the anterior pituitary stimulates the adrenal glands to release
cortisol.

Which of the following factors are known to contribute to an

individual's ability to adapt to stress? (Select all that apply.)

A. Ethnicity
B. Age
C. Socioeconomic status

✅✅
D. Gender
E. Health status - -B, C, D, E

"Ability to adapt to stress" = mediating factors! Slide 28 of this

powerpoint
Two people experience the same stressor yet only one is able to
cope and adapt adequately. An example of the person with an
increased capacity to adapt is the one with:

A. A sense of purpose in life

B. Circadian rhythm disruption

✅✅-A
C. Age-related renal dysfunction
D. Excessive weight gain or loss -

Back to mediating factors. Which of these things do you think

would help a person deal with stress? Disruption in sleep cycle (B)
will definitely not help, age-related renal dysfunction (C) is an
indicator of poor health status which also would not help, and
excessive weight changes (D) are also likely to cause more stress
than alleviate it.

The characteristic, localized cardinal signs of acute inflammation

include: (Select all that apply.)

A. Redness
B. Fatigue
C. Swelling

✅✅-A, C, D
D. Warmth
E. Fever -

The cellular stage of acute inflammation is marked by the

movement of leukocytes into the area. Which of the following cells
arrives first and in great numbers?

A. Basophils
B. Lymphocytes

✅✅-C
C. Neutrophils
D. Platelets -

Which of the following mediators of inflammation causes increased

capillary permeability and pain?
A. Serotonin
B. Histamine

✅✅-C
C. Bradykinin
D. Nitric oxide -

An older adult patient has just sheared the skin on her elbow while
attempting to boost herself up in bed, an event that has
precipitated acute inflammation in the region surrounding the
wound. Which of the following events will occur during the
vascular stage of the patient's inflammation?

A. Outpouring of exudate into interstitial spaces

B. Chemotaxis

✅✅
C. Accumulation of leukocytes along epithelium
D. Phagocytosis of cellular debris - -A

Inflammatory exudates are a combination of several types. Which

of the following exudates is composed of a large accumulation of
leukocytes?

A. Serous
B. Purulent

✅✅-B
C. Fibrinous
D. Hemorrhagic -

Which of the following wounds is most likely to heal by secondary

intention?

A. A finger laceration received while cutting onions

B. A stage IV pressure ulcer that developed in a nursing home
C. A needlestick injury received while administering parenteral

✅✅
medication
D. An incision from an open appendectomy - -B

A patient underwent an open cholecystectomy 4 days ago and her

incision is now in the proliferative phase of healing. The nurse
knows that the next step in the process of wound healing is:
A. Inflammation
B. Maturation

✅✅-C
C. Remodeling
D. Coagulation -

A patient arrives at her follow-up appointment 1 month

post-hysterectomy and complains to the nurse that her scars do
not seem to be healing properly. Upon inspection, the nurse
notices that the scars are raised but still within the boundaries of
the original incisions. The nurse tells the patient this kind of
dysfunction wound healing is called:

A. Hypertrophic scarring
B. Dehiscence

✅✅
C. Contracture
D. A keloid - -A

A patient with an 18 pack per year history presents to a family

practice clinic complaining of painless hoarseness and inability to
clear mucus. A biopsy of respiratory tract cells is taken and shows
that these cells have been replaced by less mature squamous
epithelium cells. The nurse knows this type of change is referred to
as:
A. Dysplasia
B. Metaplasia

✅✅
C. Hyperplasia
D. Coagulation - -B

A report comes back indicating that muscular atrophy has

occurred. A nurse recalls that muscular atrophy involves a
decrease in muscle cell:

A. Number
B. Size

✅✅-B
C. Vacuoles
D. Lipofuscin -
During childhood, the thymus decreases in size, and this is referred
to as _____ atrophy.

A. Physiologic
B. Pathologic

✅✅-B
C. Disuse
D. Neurogenic -

When planning care for a cardiac patient, the nurse knows that in
response to an increased workload, cardiac myocardial cells will:

A. Increase in size
B. Decrease in length

✅✅-A
C. Increase in excitability
D. Increase in number -

A 75-year-old male presents with chest pain on exertion. The chest

pain is most likely due to hypoxic injury secondary to:

A. Malnutrition
B. Free radicals

✅✅-C
C. Ischemia
D. Chemical toxicity -

A patient has a heart attack that leads to progressive cell injury that
causes cell death with severe cell swelling and breakdown of
organelles. What term would the nurse use to define this process?

A. Adaptation
B. Pathologic calcification

✅✅
C. Apoptosis
D. Necrosis - -D

A group of prison inmates developed tuberculosis following

exposure to an infected inmate. On examination, tissues were soft
and granular (like clumped cheese). Which of the following is the
most likely cause?

A. Coagulative necrosis
B. Liquefactive necrosis

✅✅
C. Caseous necrosis
D. Autonecrosis - -C

When a nurse observes muscle stiffening occurring within 6 to 14

hours after death, the nurse should document this finding as _____
present.
A. Livor mortis
B. Gangrene

✅✅
C. Algor mortis
D. Rigor mortis - -D

Which of the following is responsible for initiating clonal selection?

A. B cells
B. T cells

✅✅-C
C. Antigens
D. Lymphocytes -

A 23-year-old pregnant female visits her primary care provider for

her final prenatal checkup. The primary care provider determines
that the fetus has developed an infection in utero. Which of the
following would be increased in the fetus at birth?

A. IgG
B. IgA

✅✅-C
C. IgM
D. IgD -

An experiment is designed to determine specific cell types involved

in cell-mediated immune response. The experimenter is interested
in finding cells that attack cells that have specific antigens. Which
cells should be isolated?
A. Lymphokine-producing cells
B. Cytotoxic T cells

✅✅
C. Helper T cells
D. Macrophages - -B

Which of the following statements indicates more teaching is

needed regarding secondary lymph organs? ________is/are a
secondary lymph organ.

A. The spleen
B. Peyer patches

✅✅
C. Adenoids
D. The liver - -D

After a patient is exposed to a specific antigen, B cells will

differentiate into:

A. B cytotoxic cells
B. Plasma cells

✅✅-B
C. Bursal cells
D. Clonal equivalents -

Direct effects of antibodies include (Select all that apply):

A. Neutralization
B. Agglutination
C. Precipitation

✅✅
D. Phagocytosis
E. Division - -A, B, C
Directly, antibodies can affect infectious agents or their toxic
products by ...
Neutralization (inactivating or blocking the binding of antigen to
receptors)
Agglutination (clumping insoluble particles that are in suspension)
Precipitation (making a soluble antigen into an insoluble
precipitate)
A 30-year-old male was diagnosed with HIV. Which of the following
treatments would be most effective?

A. Reverse transcriptase inhibitors

B. Protease inhibitors

✅✅-D
C. Entrance inhibitors
D. Highly active antiretroviral therapy -

DiGeorge syndrome is a primary immune deficiency caused by:

A. Failure of B cells to mature
B. Congenital lack of thymic tissue

✅✅
C. Failure of formed elements of blood to develop
D. Selective IgG deficiency - -B

Which is not an autoimmune disease?

A. Multiple sclerosis
B. Pernicious anemia

✅✅
C. Goodpasture syndrome
D. Transfusion reaction - -D

When a patient asks the nurse what hypersensitivity is, how should
the nurse respond? Hypersensitivity is best defined as:
A. A reduced immune response found in most pathologic states
B. A normal immune response to an infectious agent
C. An excessive or inappropriate response of immune system to

✅✅
sensitizing antigen
D. Antigenic desensitization - -C

A patient's anemia is described as having erythrocytes that

demonstrate anisocytosis. The nurse would recognize the
erythrocytes would be:
A. Pale in color
B. Present in various sizes

✅✅
C. Able to assume various shapes
D. Live only a few days - -B
A newborn is diagnosed with congenital intrinsic factor deficiency.
Which of the following types of anemia will the nurse see
documented on the chart?

A. Iron deficiency anemia

B. Sideroblastic anemia

✅✅-C
C. Pernicious anemia
D. Hemolytic anemia -

When a nurse is reviewing lab results and notices that the

erythrocytes contain an abnormally low concentration of
hemoglobin, the nurse calls these erythrocytes:

A. Hyperchromic
B. Hypochromic

✅✅-B
C. Macrocytic
D. Microcytic -

A 5-year-old male was diagnosed with normocytic-normochromic

anemia. Which of the following anemias does the nurse suspect the
patient has?

A. Sideroblastic anemia
B. Hemolytic anemia

✅✅-B
C. Pernicious anemia
D. Iron deficiency anemia -

A 35-year-old female is diagnosed with vitamin B12 deficiency

anemia (pernicious anemia). How should the nurse respond when
the patient asks what causes pernicious anemia? A decrease in
______ is the most likely cause.

A. Ferritin
B. Gastric enzymes

✅✅-C
C. Intrinsic factor
D. Erythropoietin -
How should the nurse prepare a patient who is to receive a
Schilling test for pernicious anemia?

A. Administer radioactive cobalamin and measure its excretion time

B. Measure antigen-antibody immune complexes
C. Measure serum ferritin and total iron-binding capacity

✅✅
D.Administer folate and evaluate folate content in a blood serum
sample - -A

A 21-year-old female was recently diagnosed with iron deficiency

anemia. In addition to fatigue and weakness, which of the following
clinical signs and symptoms would she most likely exhibit?

A. Hyperactivity
B. Spoon-shaped nails

✅✅
C. Gait problems
D. Petechiae - -B

A 50-year-old female was diagnosed with sideroblastic anemia.

Which of the following assessment findings would most likely
occur?

A. Bronze colored skin

B. Decreased iron

✅✅
C. Normochromic erythrocytes
D. Aplastic bone marrow - -A

A 57-year-old male presents to his primary care provider for red

face, hands, feet, ears, and headache and drowsiness. A blood
smear reveals an increased number of erythrocytes, indicating:

A. Leukemia
B. Sideroblastic anemia

✅✅-D
C. Hemosiderosis
D. Polycythemia vera -
A staff member asks what leukocytosis means. How should the
nurse respond? Leukocytosis can be defined as:

A. A normal leukocyte count

B. A high leukocyte count

✅✅-B
C. A low leukocyte count
D. Another term for leukopenia -

A 35-year-old male has enlarged lymph nodes in the neck and a

mediastinal mass. He was diagnosed with Hodgkin lymphoma.
Which of the following abnormal cells would the nurse expect to
find with this disease?

A. Merkel cell
B. Schwann cell

✅✅
C. Reed-Sternberg cell
D. Kupffer cell - -C

The first circulating immunoglobulin to appear in response to a

new antigen is:

A. IgA

B. IgG

C. IgE

D. IgM - ✅✅-D
IgM dominates primary immune response

A child's thymus gland is fully formed and proportionately larger

than an adult's. Which of the following processes that contribute to
immunity takes place in the thymus gland?
A. Differentiation of B cells

B. Production of natural killer (NK) cells

C. Proliferation of T cells

D. Filtration of antigens from the blood - ✅✅-C

T cell production and proliferation occurs in the thymus

Prior to leaving on a backpacking trip to Southeast Asia, a college

student has received a tetanus booster shot. This immunization
confers protection by way of what immune process?

A. Passive natural immunity

B. Active natural immunity

C. Passive artificial immunity

D. Active artificial immunity - ✅✅-D

Active artificial immunity includes immunizations

An example of passive natural immunity would be maternal IgG in

baby
An example of active natural immunity would be developing
immunity in response to infection (e.g., chickenpox)
An example of passive artificial immunity would be giving an
antitoxin for a snake bite

An immunology nurse is caring for a patient. While planning care,

which principle will the nurse remember? The primary role of IgA1
is to prevent infections in the:
A. Blood

B. Kidneys

C. Lungs

D. Mucous membranes - ✅✅-A

IgA1 found in blood, IgA2 found in secretions

A 10-year-old male is stung by a bee while playing in the yard. He

experiences a severe allergic reaction and has to go to the ER. The
nurse providing care realizes this reaction is the result of:

A. Toxoids

B. IgA

C. IgE

D. IgM - ✅✅-C
IgE is a mediator of many common allergic responses

A 5-month-old child is admitted to the hospital with recurring

respiratory infections. A possible cause of this condition is:

A. Hypergammaglobulinemia

B. Increased maternal IgG

C. Immune insufficiency

✅✅
D. Decreased maternal antibody breakdown, resulting in
hyposensitivity - -C
Remember, we are immunologically immature when born

While planning care for an elderly patient, the nurse remembers

that increased age is associated with (Select all that apply):

A. Increased T cell function

B. Decreased immune function

C. Increased production of antibodies

D. Increased levels of circulating autoantibodies

E. Decreased ability to fight infection - ✅✅-B, D, E

Decreased T cell function and antibody response

After teaching the students about B cells, which statement

indicates teaching was successful? B cells are originally derived
from cells of the:

A. Bone marrow

B. Lymph nodes

C. Gut-associated lymphoid tissue

D. Thymus - ✅✅-A
Humoral immunity is mediated by:

A. Natural killer cells

B. T cells

C. B cells

D. neutrophils - ✅✅-C
A secondary immune response differs from the primary immune
response in that:

A. It is more rapid than the primary response and results in higher

antibody levels

B. It is slower than the primary response and doesn't chance the

antibody levels

C. It occurs at the same time as the primary response but results in

a decrease in antibodies

✅✅
D. It only occurs in hyperallergic reactions and results in a
decrease in antibodies - -A

A 5-year-old female takes a hike through the woods during a school

field trip. Upon returning home, she hugs her father, and he later
develops poison ivy. Which of the following immune reactions is he
experiencing?

A. IgE-mediated

B. Tissue-specific

C. Immune complex

D. Cell-mediated - ✅✅-D - type IV hypersensitivity

A 10-year-old male is stung by a bee while playing in the yard. He
begins itching and develops pain, swelling, redness, and
respiratory difficulties. He is suffering from:

A. Immunodeficiency

B. Autoimmunity

C. Anaphylaxis

D. Tissue-specific hypersensitivity - ✅✅-C

A nurse recalls an example of an immune-complex-mediated
disease is:

A. Bronchial asthma

B. Contact dermatitis

C. Serum sickness

D. Rheumatoid arthritis - ✅✅-C

When a nurse cares for a patient with systemic lupus
erythematosus (SLE), the nurse remembers this disease is an
example of:

A. Autoimmunity

B. Alloimmunity

C. Homoimmunity

D. Alleimmunity - ✅✅-A
When a nurse notices that a patient has type O blood, she realizes
that anti-_____ antibodies are present in the patient's body.

A. A only

B. B only

C. A and B

D. O - ✅✅-C
A person is given an attenuated antigen as a vaccine. When the
person asks what was given in the vaccine, how should the nurse
respond? The antigen is:

A. Alive, but less infectious

B. Mutated, but highly infectious

C. Normal, but not infectious

D. Inactive ,but infectious - ✅✅-A

After studying about viruses, which information indicates the
student has a good understanding of viruses? Viruses:

A. Contain no RNA or DNA

B. Are capable of independent reproduction

C. Replicate their genetic material inside host cells

D. Are killed easily by antimicrobials - ✅✅-C

After studying about fungi, which information indicates a correct
understanding of fungi? Fungi causing deep or systemic
infections:

A. Are easily treated with penicillin

B. Are extremely rare

C. Never occur with other infections

D. Are commonly opportunistic - ✅✅-D

What common symptom should be assessed in individuals with
immunodeficiency?

A. Anemia

B. Recurrent infections

C. Hypersensitivity

D. Autoantibody production - ✅✅-B

A 22-year-old was recently diagnosed with acquired
immunodeficiency syndrome (AIDS). Which decreased lab finding
would be expected to accompany this virus?

A. CD4 helper T cells

B. CD8 helper T cells

C. CDC cells
D. CDC10 cells - ✅✅-A
Cellular swelling is:
A. irreversible
B. evident early in all types of cellular injury
C. manifested by decreased intracellular sodium

✅✅
D. none of the above is correct
E. both b and c are correct - -B

A patient with an 18 pack per year history presents to a family

practice clinic complaining of painless hoarseness and inability to
clear mucus. A biopsy of respiratory tract cells is taken and shows
that these cells have been replaced by less mature squamous
epithelium cells. The nurse knows this type of change is referred to
as:
A. dysplasia
B. metaplasia

✅✅
C. hyperplasia
D. coagulation - -B

Innate resistance or immunity:

A. involves "memory"
B. is a development of an individual's later years
C. is a relatively slow and specific process

✅✅
D. depends on physical, mechanical, and biochemical barriers -
-D

The inflammatory response:

A. prevents blood from entering the injured tissue
B. elevates body temp to prevent spread of infxn

✅✅
C. prevents formation of abscess
D. minimizes injury and promotes healing - -D

Swelling during acute inflammation is caused by:

A. collagenase
B. fluid exudate
C. lymphocytic margination
E. anaerobic glycolysis - ✅✅-B
The registered nurse is teaching a class on inflammation and
explains that which cell is the predominant phagocyte arriving early
at inflammatory and infection sites?
A. macrophages
B. mast cells

✅✅
C. monocytes
D. neutrophils - -D

Type of lymphocyte that recognizes and eliminates virus-infected

cells and cancerous cells:
A. neutrophils
B. macrophages

✅✅
C. Natural killer cells
D. Langerhans cells - -C

Antibodies are produced by:

A. B cells
B. T cells

✅✅
C. helper cells
E. memory cells - -A

Which immunoglobulin presents the first challenge to the antigen?

A. IgA
B. IgG

✅✅
C. IgM
D. IgE - -C

When the body produces antibodies against its own tissue, the
condition is called
A. alloimmunity
B. opsonization

✅✅
C. autoimmunity
D. hypersensitivity - -C

DiGeorge syndrome is a primary immune deficiency caused by:

A. failure of B cells to mature
B. congenital lack of thymic tissue
C. Failure of formed elements of blood to develop

✅✅
D. Selective IgG deficiency
E. Selective IgA deficiency - -B

A nurse is explaining to a pt the difference between primary and

secondary immunodeficiency disorders and explains that
secondary immunodeficiencies (select all that apply):
A. May develop after viral infections
B. Develop before birth
C. May develop following immunosuppressive therapies

✅✅
D. Are caused by superimposed conditions
E. Are not always readily evident - -A, C, D, E

A pt presents with a rash from poison ivy. The nurse knows that
this is which type of hypersensitivity?
A. Type I
B. Type II

✅✅
C. Type III
D. Type IV - -D

Which is not an autoimmune disease?

A. multiple sclerosis
B. pernicious anemia
C. ulcerative colitis

✅✅
D. transfusion reaction
E. goodpasture disease - -D

A nurse is teaching a class about immune deficiencies, and a

person from the audience asks which cells are affected by severe
combined immune deficiency (SCID) syndrome, and the nurse
answers:
A. B cell deficits
B. T cell deficits

✅✅
C. complement deficits
D. B and T cell deficits - -D
When a patient asks the nurse what hypersensitivity is, how should
the nurse respond? Hypersensitivity is best defined as:
A. a reduced immune response found in most pathologic states
B. a normal immune response to an infectious agent
C. an excessive or inappropriate response of immune system to

✅✅
sensitizing antigen
D. antigenic desensitization - -C

When the maternal immune system becomes sensitized against

antigens expressed by the fetus, what type of immune reaction
occurs?
A. autoimmune
B. anaphylaxis

✅✅
C. alloimmune
D. allergic - -C

Which information would indicate more teaching is needed

regarding hypersensitivity reactions? Type _______
hypersensitivity reactions involve an antibody response.
A. I
B. II

✅✅
C. III
D. IV - -D

A 10-year-old male presents to his primary care provider reporting

wheezing and difficulty breathing. History reveals that both of the
child's parents suffer from allergies. Which of the following terms
would be used to classify the child?
A. desensitized
B. atopic

✅✅
C. hyperactive
D. autoimmune - -B

In addition to matching ABO antigens, a blood transfusion must

also be matched for:
A. HLA type
B. Rh antigen

✅✅-B
C. immunoglobulins
D. platelet compatibility -

A 5-year-old male presents with low-set ears, a fish-shaped mouth,

and involuntary rapid muscular contraction. Laboratory testing
reveals decreased calcium levels. Which of the following diagnosis
is most likely:
A. B cell deficiency
B. T cell deficiency

✅✅
C. Combined immunologic deficiency
D. Complement deficiency - -B

Which of the following is a characteristic of the human

immunodeficiency virus (HIV), which causes AIDS?
A. HIV only infects B cells
B. HIV is a retrovirus

✅✅
C. Infection does not require a host cell receptor
D. After infection, cell death is immediate - -B