Applied Pathophysiology A Conceptual Approach 4th Edition Nath Braun TEST BANK

Test Generator Questions, Chapter 1, Introduction to Pathophysiology 1. Which term is defined as the study of the mechanisms of human body functioning?

A. Pathology B. Physiology C. Anatomy D. Pathophysiology Answer: B Rationale: Physiology is the study of the mechanisms of human body functioning.

Pathology is the study of changes in cells and tissues as a result of injury or disease.

Anatomy is the study of body structures. Pathophysiology is the study of mechanisms of disease.

Question format: Multiple Choice Chapter: 1 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 2, Defining Pathophysiology

2. Which statement best describes the health–illness continuum?

A. It is a dynamic entity.

B. It is based on objective data.

C. It represents two exclusive categories.

D. It is focused on physical well-being.

Answer: A

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Rationale: Health and illness are part of a dynamic continuum. It is based on one’s perceptions and is subjective. There are a variety of descriptions one can use along the continuum to describe their current state. These range from “extremely healthy” to “extremely ill.” Because it is a dynamic continuum, it represents more than two exclusive categories. The health–illness continuum includes the body, mind, and spirit, not just physical well-being.

Question format: Multiple Choice Chapter: 1 Cognitive Level (Bloom’s): Remember Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 4, Individual Health

3. Which concept is often equated with health?

A. Homeostasis B. Disease C. Objectivity D. An uneventful physical examination Answer: A Rationale: Homeostasis is an important body goal and is often reflected in the client’s perception of the health–illness continuum. Disease is the functional impairment of cells, tissues, organs, or organ systems. Because health is reflected in the client’s perception of the health–illness continuum, it is subjective, not objective. An uneventful physical examination would only be on aspect of health. The health–illness continuum includes the body, mind, and spirit.

Question format: Multiple Choice Chapter: 1 Cognitive Level (Bloom’s): Remember

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Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 4, Individual Health

4. Which term is defined as the functional impairment of cells, tissues, organs, or organ systems?

A. Injury B. Pathophysiology C. Disease D. Syndrome Answer: C Rationale: Disease is defined as the functional impairment of cells, tissues, organs, or organ systems. Injury causes changes to cells, pathophysiology refers to the study of mechanisms of disease, and syndrome is used to describe specific conditions with predictive patterns.

Question format: Multiple Choice Chapter: 1 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 5, Population Health

5. The nurse is planning education on the importance of wearing a helmet when riding a bike. What level of prevention is the nurse describing?

A. Primary B. Secondary

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C. Tertiary D. Quaternary Answer: A Rationale: Primary prevention, such as wearing a bike helmet focuses on protecting people from developing a disease or injury. Secondary prevention is the early detection of disease through screening and early treatment. Tertiary prevention focuses on rehabilitation after diagnosis of a disease or injury. Quaternary prevention relates to overmedicalization.

Question format: Multiple Choice Chapter: 1 Cognitive Level (Bloom’s): Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 5, Disease Prevention

6. A nurse in a rehabilitation unit is assisting a client who has had a stroke with relearning how to perform activities of daily living. What level of prevention is the nurse implementing?

A. Primary B. Secondary C. Tertiary D. Quaternary Answer: C Rationale: Tertiary prevention focuses on rehabilitation after diagnosis of a disease or injury, such as rehabilitation following a stroke. Primary prevention focuses on protecting people from developing a disease or injury. Secondary prevention is the

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early detection of disease through screening and early treatment. Quaternary prevention relates to overmedicalization.

Question format: Multiple Choice Chapter: 1 Cognitive Level (Bloom’s): Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 5, Disease Prevention

7. What term describes how a disease starts and develops, from onset to the point when the disease presents itself?

A. Etiology B. Pathophysiology C. Pathogenesis D. Pathology Answer: C Rationale: Pathogenesis is the term to describe how a disease starts and develops, from onset to the point when the disease presents itself. Etiology refers to the precise cause of a disease. Pathophysiology is the term used to define the mechanisms of human body functioning. Pathology refers to studying the causes and effects of disease.

Question format: Multiple Choice Chapter: 1 Cognitive Level (Bloom’s): Remember Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 2, Pathogenesis

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8. A client has been diagnosed with an illness and no one is sure of the cause. What term describes this condition?

A. Idiopathic B. Iatrogenic C. Nosocomial D. Etiologic Answer: A Rationale: Idiopathic is the term used to describe disease with an unknown etiology.

Iatrogenic disease is inadvertently caused by medical treatment. Nosocomial disease results from exposure in the healthcare environment. Etiologic disease has a precise cause.

Question format: Multiple Choice Chapter: 1 Cognitive Level (Bloom’s): Remember Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 2, Etiology

9. The nurse is caring for a client with a family history of cardiovascular disease.

Which finding would the nurse document as a symptom of cardiovascular disease?

A. Chest pain B. Elevated heart rate C. Fever D. Obesity Answer: A Rationale: Symptoms are indicators that are reported by the ill individual and are

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considered the subjective manifestations because they cannot be directly observed by the practitioner. Heart rate, fever, and weight can all be measured by the provider.

Chest pain is subjective and would be described by the client.

Question format: Multiple Choice Chapter: 1 Cognitive Level (Bloom’s): Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 2, Clinical Manifestations

10.What term describes the signs and symptoms associated with disease?

A. Clinical manifestations B. Precipitating factors C. Insidious D. Subacute Answer: A Rationale: Clinical manifestations include signs and symptoms associated with disease. Precipitating factors, also called triggers, promote the onset of clinical manifestations. Insidious is used to describe clinical manifestations that do not have a clear onset. Subacute refers to diseases with severity and duration that falls between acute and chronic.

Question format: Multiple Choice Chapter: 1 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 2, Clinical Manifestations

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11.Which assessment is effective in detecting asymptomatic disease?

A. Client history B. Screening tests C. Family pedigree D. Observation Answer: B Rationale: Screening tests are often used to identify disease that does not present with signs and symptoms. Family pedigree, observation, and eliciting client history are not used to identify asymptomatic disease. They may be used to collect data and determine the need for further screening but alone are not effective in detecting disease.

Question format: Multiple Choice Chapter: 1 Cognitive Level (Bloom’s): Remember Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 2, Clinical Manifestations

12.Which symptom is considered a local manifestation associated with a paper cut?

A. Fever B. Pain C. Headache D. Hypertension Answer: B Rationale: Local refers to those manifestations that are found directly at the site of

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disease and are confined to that specific area. Pain would be considered a local manifestation associated with a paper cut. The other signs and symptoms listed refer to systemic manifestations.

Question format: Multiple Choice Chapter: 1 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 2, Clinical Manifestations

13.Which symptom is a systemic manifestation of influenza?

A. Fever B. Chest pain C. Cough D. Runny nose Answer: A Rationale: Systemic manifestations present throughout the body and are not confined to one area. Fever would be an example of a systemic manifestation. The other options are manifestations that occur directly at the site; these are considered local manifestations.

Question format: Multiple Choice Chapter: 1 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 2, Clinical Manifestations

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14.Which term indicates the forecast or prediction of how an individual will proceed through the disease process?

A. Morbidity B. Prognosis C. Metastasis D. Remission Answer: B Rationale: The prognosis for a client is the forecast or prediction of how the individual will proceed through the disease process. Morbidity is a negative outcome of disease that affects quality of life. Metastasis refers to the spread of disease from one part of the body to another. Remission refers to the reduction or disappearance of signs and symptoms associated with a disease.

Question format: Multiple Choice Chapter: 1 Cognitive Level (Bloom’s): Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 3, Diagnosis and Treatment

15.While reviewing the history of a new client to the clinic, the nurse notes a strong family history of cardiac disease. To focus on minimizing this disease, which topic(s)/factor(s) will the nurse’s educational focus be during this visit? Select all that apply.

A. Analyzing typical dietary intake B. Controlling weight C. Encouraging activity D. Having the client discuss genetics with family E. Maintaining blood pressure within normal limits

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F. Focusing on a high-protein diet with minimal carbohydrates Answer: A, B, C, E Rationale: The presence of select risk factors increases a person’s chances of developing coronary heart disease. Modifiable (therefore teachable topics) factors include elevated blood cholesterol level, elevated blood pressure, cigarette smoking, obesity, and sedentary lifestyle. Nonmodifiable factors that cannot be changed by behavior include one’s genetic predisposition, family history, and gender. A high-protein with low-carbohydrate diet does not necessarily align with dietary approaches to stop hypertension (DASH), because many sources of protein are also high in fat and calories.

Question format: Multiple Select Chapter: 1 Cognitive Level (Bloom’s): Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 2, Understanding Pathophysiology

16.Which nurse’s statement best demonstrates understanding of the phrase, “People should not be defined by their pathophysiology?”

A. “My fractured tibia client in room 702.”

B. “The skull fracture child in room number 4.”

C. “The client admitted with uncontrolled hypertension.”

D. “The alcoholic client who has cirrhosis.”

Answer: C Rationale: An important thing to keep in mind when caring for individual clients is that people should not be defined by their pathophysiology. Calling a client by their disease

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state ignores the holistic physical, spiritual, emotional, and psychological components that comprise all of us. Health professionals should avoid calling clients “alcoholics” or “fractured tibia client in room 702” and replace these labels with “the client with alcohol use disorder” or “the client in room 702 with a fractured tibia.”

Question format: Multiple Choice Chapter: 1 Cognitive Level (Bloom’s): Apply Client Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 4, Applying Pathophysiology

17.The current statistics show that a U.S. state has 8,746 cases of an acute disease per 100,000 people. This number represents which epidemiologic finding?

A. Incidence B. Morbidity C. Prevalence D. Homeostasis Answer: A Rationale: Health statistics are an important aspect of population-focused healthcare.

Incidence is the number of new cases within a given time. Incidence represents the probability that a disease will occur in a certain population. Prevalence is the number or percentage of a population living with a particular disease at a given time. Morbidity refers to having a disease or a symptom of disease, or to the amount of disease within a population. Homeostasis is the tendency toward a relatively stable equilibrium between interdependent elements, especially as maintained by physiologic processes.

Question format: Multiple Choice Chapter: 1 Cognitive Level (Bloom’s): Understand

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Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 4, Applying Pathophysiology

18.The community health nurse provides a community clinic to provide education on proper infant car seat installation. Which type of disease prevention is the nurse practicing?

A. Primary B. Secondary C. Tertiary D. Mandatory Answer: A Rationale: Disease prevention may be described as primary, secondary, or tertiary.

Primary prevention prohibits a disease from occurring (i.e., proper installation of an infant car seat to prevent injury in case of a vehicle accident). Secondary prevention is the early detection of disease through screening and early treatment (i.e., annual screening for breast cancer). Tertiary prevention is rehabilitation of a client after detection of disease (i.e., physical therapy after stroke). Disease prevention is not mandatory; however, reporting of specific diseases is mandated by law for the purpose of preventing spread of those diseases.

Question format: Multiple Choice Chapter: 1 Cognitive Level (Bloom’s): Understand Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 4, Applying Pathophysiology

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19.What is epigenetics?

A. The study of how genetics began B. The study of epidemiology and genetics C. The study of genetic control by factors other than DNA sequencing D. The study of DNA sequencing and its impact on genetic control Answer: C Rationale: Epigenetics is the study of genetic control by factors other than DNA sequencing. Epigenetics controls the “on” and “off” switch of genes and which proteins are transcribed. The other answer choices do not reflect the definition of epigenetics.

Question format: Multiple Choice Chapter: 1 Cognitive Level (Bloom’s): Remember Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 4, Applying Pathophysiology

20.Which example best represents pathogenesis of disease?

A. Venous thrombosis leading to myocardial infarction B. Increased rates of stroke in those with hypertension C. The rate of influenza spread at any given time D. Liver cell destruction occurring long before cirrhosis of the liver Answer: D Rationale: Pathogenesis is best defined as the beginning of disease. It encompasses the time of when the disease process begins to the point of manifestation of the disease. Destruction of the liver cells long before cirrhosis is an example of pathogenesis. Incidence is the rate of occurrence of a disease at any given time.

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Etiology is the cause of a particular disease. Risk factors are those factors which increase the chance of a client having a disease.

Question format: Multiple Choice Chapter: 1 Cognitive Level (Bloom’s): Understand Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 2, Understanding Pathophysiology

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Test Generator Questions, Chapter 2, Altered Cells and Tissues 1. Which term indicates a fully differentiated body part with specialized functions?

A. Cell B. Organ C. Tissue D. Organ system Answer: B Rationale: Organs are defined as fully differentiated body parts with specialized functions. Organ systems are groups of organs working together for a specific function. Cells are the smallest structural and functional units of the human organism.

Tissues are groups of similar cell types that combine to form a specific function.

Question format: Multiple Choice Chapter: 2 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 9, Introduction

2. The charge nurse is educating a group of staff nurses about plasma membranes.

Which description of the plasma membrane is accurate?

A. Contains a single layer of lipids with polar heads B. Contains a single layer of lipids with nonpolar heads C. Contains a bilayer of lipids with polar heads D. Contains a bilayer of lipids with nonpolar heads Answer: C

Rationale: The plasma membrane represents an organized structure composed of lipids, carbohydrates, and proteins arranged in a bilayer. The lipid bilayers are mainly made up of phospholipids. The phosphate connected to the lipid structure is known as the “head.” The heads are polar or hydrophilic (having an affinity to water).

Question format: Multiple Choice Chapter: 2 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 10, Plasma (Cell) Membrane

3. Which proteins in the plasma membrane project into either the intracellular or the extracellular environment?

A. Transmembrane proteins B. Integral proteins C. Peripheral proteins D. Channel proteins Answer: C Rationale:

Peripheral proteins do not pass through the entire membrane, projecting

into either the intracellular or the extracellular environment. Proteins that pass through the entire membrane are known as transmembrane proteins, allowing communication and transport between the extracellular and intracellular environments. Integral proteins are a specific type of transmembrane protein that, because of the tight binding to lipid tails, becomes part of the membrane itself.

Integral proteins often form channels that allow for the transport of ions (atoms with an electrical charge) across the plasma membrane.

Question format: Multiple Choice Chapter: 2

Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 10, Plasma (Cell) Membrane

4. Which organelle is responsible for synthesis of proteins by bound ribosomes?

A. Rough endoplasmic reticulum B. Smooth endoplasmic reticulum C. Golgi apparatus D. Lysosome Answer: A Rationale: The rough endoplasmic reticulum contains ribosomes bound to its membrane that synthesize protein and produces lysosomal enzymes (acid hydrolyses). Smooth endoplasmic reticulum is responsible for the synthesis of lipids, lipoproteins, and steroid hormones, and the regulation of intracellular calcium. The Golgi apparatus prepares substances produced by the endoplasmic reticulum for secretion out of the cell. Lysosomes digest cellular debris with hydrolytic enzymes.

Question format: Multiple Choice Chapter: 2 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 11, Cytoplasm and Organelles

5. Which component is part of the cellular cytoskeleton?

A. Mitochondria

B. Gene C. Cytoplasm D. Actin Answer: D Rationale: The main cytoskeleton components include microtubules (thin protein structures composed of tubulin) and microfilaments. Thin microfilaments comprise the protein actin. Intermediate microfilaments comprise filaments with a diameter sized between thin and thick filaments. Thick microfilaments comprise the protein myosin. The cellular cytoskeleton does not include mitochondria, cytoplasm, or genes.

Question format: Multiple Choice Chapter: 2 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 12, Cytoskeleton

6. Which transport mechanism requires energy?

A. Diffusion B. Osmosis C. Facilitated diffusion D. Primary active transport Answer: D Rationale: Primary active transport requires the direct use of energy in the form of adenosine triphosphate (ATP) when transporting particles across the plasma membrane. Diffusion is the movement of particles from an area of higher

concentration to an area of lower concentration, which is an example of passive transport. Osmosis is the process by which water passively moves across the semipermeable plasma membrane. Facilitated diffusion is the movement of some substances across the plasma membrane aided by the use of transport proteins.

Question format: Multiple Choice Chapter: 2 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 12, Cellular Mechanisms of Transportation

7. Phagocytosis is an example of which type of cellular function?

A. Ingestion B. Respiration C. Communication D. Reproduction Answer: A Rationale: Phagocytosis is the process of ingesting large particles such as cells, bacteria, and damaged cellular components by cells called phagocytes. This is one of the specific processes of ingestion that allow the cell to ingest substances necessary for its own use into the cytoplasm. Phagocytosis is not an example of respiration, communication, or reproduction.

Question format: Multiple Choice Chapter: 2 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1

Page and Header: 13, Ingestion

8. Which form of signal transduction resulting from ligand–receptor binding has the potential to produce effects in the entire body system?

A. Endocrine B. Paracrine C. Autocrine D. Local mediation Answer: A Rationale: Endocrine signaling occurs when signal transduction affects cell behavior within the entire organism. Paracrine signaling is ligand binding to receptors that results in signal transduction with a local, rapid effect. Autocrine signaling and local mediation are not forms of cell-to-cell communication.

Question format: Multiple Choice Chapter: 2 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 15, Communication

9. What is the process that makes cells with the same genetic material develop into specific cell types?

A. Reproduction B. Differentiation C. Proliferation D. Stimulation

Answer: B Rationale: Cell division occurs at different times depending on the cell type and on the signals sent to the cell for division. Differentiation, or changes in physical and functional properties of cells, directs the cell to develop into specific cell types. As all cells contain identical genetic material, differentiation explains why one cell contributes to the development of one tissue while another can develop into a different tissue. This process occurs by the repression of certain genes in a cell and the expression of others in the same cell. Proliferation is the increase in cell number.

Differentiation and proliferation are components of cellular reproduction. Stimulation is not a component of cellular reproduction.

Question format: Multiple Choice Chapter: 2 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 15, Reproduction

10.Which cellular change is caused by a reduction in functional demand?

A. Atrophy B. Hypertrophy C. Hyperplasia D. Dysplasia Answer: A Rationale: Atrophy is the decrease in individual cell size, and it can occur for several reasons, including a decrease in the functional demand on a cell. Hypertrophy is an increase in cell size, and hyperplasia is an increase in cell number. Both hypertrophy and hyperplasia can be caused by hormone signaling and an increased

workload/functional demand. Dysplasia refers to the actual change in cell size, shape, uniformity, arrangement, and structure. Dysplasia is often a cell’s response to a chronic and persistent stressor and is likely to resolve when the stressor is removed.

Question format: Multiple Choice Chapter: 2 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 16, Atrophy

11.Which term indicates increased cell size caused by an increase in functional demand?

A. Atrophy B. Hypertrophy C. Hyperplasia D. Dysplasia Answer: B Rationale: Hypertrophy is an increase in cell size, and hyperplasia is an increase in cell number. Both hypertrophy and hyperplasia can be caused by hormone signaling and an increased workload/functional demand. Dysplasia refers to the actual change in cell size, shape, uniformity, arrangement, and structure; it is often a cell’s response to a chronic and persistent stressor. Atrophy is the decrease in individual cell size, and it can be caused by decreased functional demand on a cell.

Question format: Multiple Choice Chapter: 2 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning

Learning Objective: 2 Page and Header: 17, Hypertrophy

12.Which term indicates increased cell number caused by increased functional demand?

A. Atrophy B. Hypertrophy C. Hyperplasia D. Dysplasia Answer: C Rationale: Hyperplasia is an increase in cell number, and hypertrophy is an increase in cell size. Both hypertrophy and hyperplasia can be caused by hormone signaling and an increased workload/functional demand. Dysplasia refers to the actual change in cell size, shape, uniformity, arrangement, and structure; it is often a cell’s response to a chronic and persistent stressor. Atrophy is the decrease in individual cell size, and it can be caused by decreased functional demand on a cell.

Question format: Multiple Choice Chapter: 2 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 17, Hyperplasia

13.What process may cause columnar cells to turn into squamous cells as a method of adaptation to a persistent stressor?

A. Metaplasia B. Dysplasia

C. Apoptosis D. Hyperplasia Answer: A Rationale: Metaplasia refers to the changing of one cell type to another. This is one way that cells can adapt to a persistent stressor. Dysplasia refers to the actual change in cell size, shape, uniformity, arrangement, and structure. Hyperplasia is an increase in cell number. Apoptosis is programmed cell death prompted by a genetic signal and is designed to replace old cells with new.

Question format: Multiple Choice Chapter: 2 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 17, Metaplasia

14.Which term indicates cell death associated with inflammation?

A. Metaplasia B. Dysplasia C. Apoptosis D. Necrosis Answer: D Rationale: Cell death by necrosis is a disorderly process associated with inflammation.

Necrosis is death of cells related to cell injury. Metaplasia refers to the changing of one cell type to another. Dysplasia refers to the actual change in cell size, shape, uniformity, arrangement, and structure. Apoptosis is programmed cell death prompted by a genetic signal and is designed to replace old cells with new.

Question format: Multiple Choice Chapter: 2 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 19, Necrosis

15.Damage to cells resulting from frostbite is classified as which type of injury?

A. Mechanical B. Thermal C. Chemical D. Endogenous Answer: B Rationale: Thermal injury is caused by extremes of temperature, as occurs with burns and frostbite. Mechanical injury can be caused by impact of a body part causing direct injury, such as falling off a skateboard or a bike. Chemical toxins include both exogenous and endogenous forms. Endogenous toxins are toxins from within the body system that cause harm to cells. Exogenous toxins are toxins from the external environment that cause harm to cells.

Question format: Multiple Choice Chapter: 2 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 20, Causes of Cell Injury and Death

16.Which condition is most likely to be associated with atrophic changes in breast tissue?

A. Puberty B. Pregnancy C. Menopause D. Menarche Answer: C Rationale: The aging process can result in decreased cell size (atrophy), which translates into decreased organ size. Atrophy also can occur as a response to the removal of hormonal signals that stimulate growth, resulting in involution, or shrinkage, of tissues and organs. Atrophy may result in the manifestation of clinical signs and symptoms stemming from the decrease in size and function of the organ involved.

Question format: Multiple Choice Chapter: 2 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 16, Atrophy

17.While educating adolescents about menstruation, the nurse mentions that the sloughing off of the inner lining of the uterus (the endometrium) at the start of menstruation occurs by which physiologic process?

A. Apoptosis B. Necrosis C. Oxidative stress D. Dysplasia

Answer: A Rationale: Apoptosis can be both a physiologic and a pathologic cell response to cellular signals. Apoptosis is programmed cell death prompted by a genetic signal and is designed to replace old cells with new ones. Cells are programmed for death for many reasons, including damaged genetic material or mutation, old age of the cell, and an attempt to decrease the actual number of cells. Menstruation is the sloughing of the old lining of the uterus. Cell death by necrosis is a disorderly process associated with inflammation. Necrosis is the death of cells related to cell injury. Injury causes damage to cellular structures, including the mitochondria, thereby depleting adenosine triphosphate (ATP). Dysplasia refers to the actual change in cell size, shape, uniformity, arrangement, and structure. Dysplasia is often a cell’s response to a chronic and persistent stressor and is likely to resolve when the stressor is removed.

Oxidative stress involves exposure of cells to reactive oxygen species (ROS), toxic oxygen molecules or radicals that are formed by the reaction between oxygen (O2) and water (H2O) during mitochondrial respiration. Cell damage can result from too many ROS or not enough available enzymes, including catalase, to convert these radicals to less harmful substances.

Question format: Multiple Choice Chapter: 2 Cognitive Level (Bloom’s): Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 19, Mechanisms of Cell Death

18.Which client(s) is at risk for a deficit injury that can result in cellular injury and death? Select all that apply.

A. A middle-aged client with diabetes who is experiencing ischemia in the lower extremities

B. The client with a 40 pack-year history of cigarette smoking admitted with deep vein thrombosis C. Female, 6 months pregnant, who is experiencing severe nausea and vomiting D. Athlete who fell off a bike resulting in a fracture of the tibia E. Exercise coach who has pulled a muscle in the back and experiencing some acute pain F. The young client who has begun an intense exercise routine along with a decreased food intake after being called “fat” Answer: A, B, C, F Rationale: Damage to cells can result from deficit injury, in which the cell is deprived of oxygenation, hydration, and nutrition. This type of injury is commonly seen in conditions of ischemia (such as a client with diabetes and circulation issues in the lower legs or a client with deep vein thrombosis due to smoking), severe malnutrition (such as prolonged nausea/vomiting during pregnancy), and eating disorders such as anorexia nervosa (such as a client exercising intensely while minimizing food intake).

A pulled muscle or bone fracture from an accident does not necessarily cause a deficit injury.

Question format: Multiple Select Chapter: 2 Cognitive Level (Bloom’s): Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Learning Objective: 4 Page and Header: 20, Causes of Cell Injury and Death

19.Which statement(s) regarding testing a client for acromegaly is an accurate interpretation of the results? Select all that apply.

A. Growth hormone levels will need to be collected daily for an entire week.

B. The best time to collect growth hormone levels is during the middle of the night.

C. Growth hormone should be measured as a component of a glucose tolerance test.

D. Following ingestion of 75 g of glucose, it is normal for growth hormone levels to decrease.

E. An elevated growth hormone level 1 hour after the glucose ingestion indicates that the negative feedback regulation is normal.

Answer: C, D Rationale: Measurement of growth hormone is most accurate when measured as a component of a glucose tolerance test because growth hormone secretion is influenced by blood glucose levels. Under physiologic conditions, growth hormone levels decrease when blood glucose levels rise via negative feedback regulation.

Growth hormone levels can be tested after a glucose tolerance test to determine if there is an alteration in negative feedback, indicating pathologic secretion of growth hormone. Within 2 hours of ingestion of 75 g of glucose, growth hormone is suppressed to less than 1 ng/mL (1 µg/L) under physiologic conditions. An elevated growth hormone level 1 hour after the glucose ingestion indicates that glucose did not suppress growth hormone secretion, leading to the diagnosis of acromegaly.

Question format: Multiple Select Chapter: 2 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Learning Objective: 6 Page and Header: 25, Acromegaly

20.A woman is diagnosed with cervical intraepithelial neoplasia (CIN) with absent glandular cell involvement and no invasive squamous cell disease. When clarifying

treatment options and educating this client about the new diagnosis, which topic(s) will the nurse include in the discussion? Select all that apply.

A. Total hysterectomy B. Cryosurgery C. CO2 laser ablation D. Electrocoagulation diathermy ablation E. No surgical treatment options warranted at this time Answer: B, C, D Rationale: Treatment to remove superficial cells (ablative) is an option for women with cervical intraepithelial neoplasia (CIN) in the absence of glandular cell involvement or invasive squamous cell disease. Cryosurgery, a form of cold therapy that destroys mildly dysplastic cells, is a common ablative therapy for cervical dysplasia. Liquid nitrogen is applied to the dysplastic cells on the exocervix, identified by colposcopy via a probe placed in the desired area. CO2 laser ablation is accomplished by directing a laser toward the cervical lesion under colposcopic guidance, destroying the tissue by vaporization. Heat ablation methods include cold coagulation and electrocoagulation diathermy ablation, with variations in temperature and time of treatment associated with depth of cervical tissue destruction. In cases of carcinoma, a hysterectomy may be indicated.

Question format: Multiple Select Chapter: 2 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process Learning Objective: 7 Page and Header: 29, Cervical Metaplasia and Dysplasia

Test Generator Questions, Chapter 3, Inflammation and Tissue Inflammation and Tissue 1. Which characteristic best describes the inflammatory response?

A. Specific response to microorganisms B. Initiated by certain types of injury C. Hormone-mediated D. Regulated by chemical mediators Answer: D Rationale: The inflammatory response is orchestrated through the work of potent chemical, also known as inflammatory mediators. The inflammatory response involves many types of injuries and microorganisms. The response is chemical mediated, not hormone-mediated.

Question format: Multiple Choice Chapter: 3 Cognitive Level (Bloom’s): Understand Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 38, Vascular Response

2. The nurse is providing education to a client on the goals of the body’s inflammatory response. Which client statement indicates to the nurse that additional teaching is needed?

A. “A major goal of the inflammatory response is to increase blood flow to the site of injury.”

B. “A major goal of the inflammatory response is to form an antigen–antibody response.”

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C. “A major goal of the inflammatory response is to dilute harmful substances at the site of injury.”

D. “A major goal of the inflammatory response is to remove injured tissue.”

Answer: B Rationale: During the vascular response, there is an increase in blood flow to the site of injury. The increased blood and fluid at the site help to dilute harmful substances and remove injured tissue. The antigen–antibody response happens with an immune response, not an inflammatory response.

Question format: Multiple Choice Chapter: 3 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 36, Introduction

3. Which cell type produces inflammatory mediators?

A. Endothelial B. Basement membrane C. Epithelial D. Neural Answer: A Rationale: Inflammatory mediators are located in the blood plasma (fluid part of blood) and in many cells, including platelets, mast cells, polymorphonuclear neutrophils (PMNs), basophils, neutrophils, endothelial cells, monocytes, and macrophages. Epithelial cells line the surfaces of organs in the body and function as a protective barrier. Neural cells are located in the brain and are unrelated to

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inflammation. The basement membrane separates tissue to protect against mechanical stress.

Question format: Multiple Choice Chapter: 3 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 39, Inflammatory Mediators Within Cells

4. Which cell is most likely responsible for an immediate release of chemical mediators right at the site of injury?

A. Mast cell B. Platelet C. Eosinophil D. Endothelial Answer: A Rationale: Mast cells are important inflammatory mediators responsible for immediate release through degranulation. The other cells types are not immediately released in the same manner.

Question format: Multiple Choice Chapter: 3 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 39, Inflammatory Mediators Within White Blood Cells

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5. The client sprained the ankle and is told to take ibuprofen to reduce the inflammation. What is the mechanism of action for this drug?

A. Blocks chemokines B. Enhances mast cell activation C. Inhibits formation of prostaglandins D. Unknown Answer: C Rationale: Ibuprofen inhibits the conversion of arachidonic acid to prostaglandins to suppress inflammation. Chemokines are found in white blood cells and are not blocked by nonsteroidal anti-inflammatory drugs (NSAIDs). Mast cell activation is not affected by NSAIDs. Question format: Multiple Choice Chapter: 3 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 43, Table 3.5 Common Pharmacologic Agents Used to Treat Inflammation

6. Which plasma system is responsible for inducing opsonization?

A. Kinin B. Complement C. Clotting D. Cell lysis Answer: B Rationale: The primary role of complement is to destroy and remove microorganisms

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to prevent infection through opsonization (making bacteria vulnerable to phagocytosis) and cell lysis (destruction). Kinin amplifies the inflammatory response by triggering other inflammatory mediators. Clotting promotes coagulation through a cascade of clotting factors.

Question format: Multiple Choice Chapter: 3 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 41, Table 3.1 Continuously Circulating and Interrelated Plasma Systems That Regulate Inflammation

7. Which white blood cells are activated by chemical mediators to aid the body in clearing debris?

A. Basophils B. Eosinophils C. Neutrophils D. Monocytes Answer: C Rationale: Chemical mediators activate neutrophils to move into the injured area and begin the work of healing. Chemical mediators do not activate basophils, eosinophils, or monocytes to promote debris removal.

Question format: Multiple Choice Chapter: 3 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3

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Page and Header: 44, Clearing the Debris

8. The client asks the nurse, “When I squeeze acne pustules on my face, I notice clear fluid seeping from the opening. Should I be concerned?” Which response by the nurse is appropriate?

A. “The fluid you are noticing is pus.”

B. “The fluid you are noticing is water.”

C. “The fluid you are noticing is exudate.”

D. “The fluid you are noticing is plasma.”

Answer: C Rationale: Exudate is a watery fluid that accumulates at the site of injury and has a high protein and leukocyte concentration. Plasma is the yellow liquid component of blood. Pus is a thick fluid that may be yellow or green. Wounds do not contain water.

Question format: Multiple Choice Chapter: 3 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 38, Vascular Response

9. What is the role of exudate?

A. Carries proteins and leukocytes B. Promotes clotting C. Replaces epithelial cells D. Indicates edema in the underlying tissues Answer: A

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Rationale: Exudate is a watery fluid that accumulates at the site of injury and has a high protein and leukocyte concentration. Exudate does not promote clotting, cause epithelial cell replacement, or indicate edema in underlying tissues.

Question format: Multiple Choice Chapter: 3 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 38, Vascular Response

10.The nurse is providing education on the essential steps necessary for a successful cellular response. The nurse should include which step(s)? Select all that apply.

A. Migration B. Adherence C. Chemotaxis D. Degranulation E. Phagocytosis Answer: A, B, C Rationale: The cellular response is regulated by inflammatory mediators. Three steps are needed for a successful cellular response: (1) chemotaxis, (2) cellular adherence, and (3) cellular migration. Degranulation is the process by which mast cells break apart and release inflammatory mediators in the form of extracellular granules (grainlike particles). Phagocytosis is the process by which a cell uses its plasma membrane to engulf a large particle.

Question format: Multiple Select Chapter: 3 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation

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Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 41, Cellular Response

11.Without which process would leukocytes be unable to move across endothelial cells and get to the site of injury?

A. Diapedesis B. Separation C. Adherence D. Leukocytosis Answer: A Rationale: In the process of diapedesis, cells can move between and through endothelial junctions. Separation, adherence, and leukocytosis are not associated with leukocytes moving across endothelial cells.

Question format: Multiple Choice Chapter: 3 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 41, Cellular Response

12.The client visits the clinic for a possible infection. The client is told that the neutrophil count is high. What does this count imply?

A. The client has a streptococcal infection.

B. The client has an acute infection.

C. The client has a chronic infection.

D. The client does not have an infection.

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Answer: B Rationale: Neutrophils are the earliest phagocytic responders. They increase quickly in response to acute infections. Chronic infection is associated with increased monocytes, lymphocytes, and macrophages. Streptococcal infection cannot be characterized solely by increased neutrophils.

Question format: Multiple Choice Chapter: 3 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 51, Table 3.6 Comparison of Acute and Chronic Inflammation

13.The client has a clinic appointment for a possible infection and is told that they have a high monocyte count. What does this count imply?

A. The client has a streptococcal infection.

B. The client has an acute infection.

C. The client has a chronic infection.

D. The client does not have an infection.

Answer: C Rationale: Neutrophils are the earliest phagocytic responders. They increase quickly in response to acute infections. Chronic infection is associated with increased monocytes, lymphocytes, and macrophages. Streptococcal infection cannot be characterized solely by increased neutrophils.

Question format: Multiple Choice Chapter: 3 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation

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Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 51, Table 3.6 Comparison of Acute and Chronic Inflammation

14.How does the inflammatory response know when to retreat?

A. Feedback mechanisms regulated by plasma protein systems B. Multiple processes of cellular inhibition C. Inhibition is time-dependent, the inflammatory response lasts 72 hours D. When all microorganisms have been destroyed Answer: A Rationale: Once the offending agent has been destroyed and removed, feedback systems regulated by the three plasma protein systems (clotting, complement, and kinin), along with the relevant inflammatory mediators, deactivate the inflammatory response, allowing the tissue to heal. The inflammatory response is not time-dependent, doesn’t rely on cellular inhibition to stop, and doesn’t cease upon the destruction of microorganisms alone.

Question format: Multiple Choice Chapter: 3 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 43, Resolution of Acute Inflammation

15.A nurse is caring for a client who has a sprained ankle. The client notices that the ankle is swollen, red, and hot. Why did the ankle get hot?

A. Exudate accumulated at the site B. Increased blood flow to the site

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C. The ankle became infected D. A thermal injury occurred Answer: B Rationale: Vasodilation occurs in response to injury. Vasodilation causes blood flow to increase to the injured site and heat to occur. Thermal injuries, exudate, and infection are not the cause of local heat related to a sprained ankle.

Question format: Multiple Choice Chapter: 3 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 42, Table 3.3 Local Manifestations of Acute Inflammation

16.What factor causes extensive scarring in cases of chronic inflammation?

A. Fibroblast activity B. Degradation of collagen C. Proteinase activity D. Loss of labile cells Answer: A Rationale: Fibroblasts are active in chronic inflammation. Fibroblasts are responsible for collagen development, which contributes to the extensive scarring characteristic of chronic inflammation. Degradation of collagen, proteinase activity, and a loss of labile cells do not lead to extensive scarring caused by chronic inflammation.

Question format: Multiple Choice Chapter: 3 Cognitive Level (Bloom’s): Understand

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Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 51, Cells of Chronic Inflammation

17.Which tissue formations occur as a protective mechanism during some cases of chronic inflammation where an area is walled off in order to protect surrounding unaffected tissues?

A. Adenomas B. Granulomas C. Basement membranes D. Granulation tissues Answer: B Rationale: Granulomas typically form when the injury is too difficult to control by the usual inflammatory and immune mechanisms, such as with foreign bodies or certain microorganisms. In response to inflammatory mediators, granulomas form to wall off affected areas. Adenomas are benign tumors. Basement membranes create an anatomical wall where cells meet connective tissues. Granulation tissues is vascularized tissue that forms as chronic inflammation evolves.

Question format: Multiple Choice Chapter: 3 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 51, Granuloma Formation

18.Which complication of wound healing is caused by poor tissue perfusion?

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A. Keloid formation B. Wound dehiscence C. Adhesions D. Ulceration Answer: D Rationale: Poor perfusion can lead to ulceration. Ulcers are circumscribed, open, craterlike lesions of the skin or mucous membranes. These areas are necrotic and open to further invasion by microorganisms. Wound dehiscence is a problem of deficient scar formation, in which the wound splits or bursts open, often at a suture line. Keloid development is the opposite of dehiscence. Adhesions are fibrous connections between serous cavities and nearby tissues, which do not allow the surrounding tissues to move freely.

Question format: Multiple Choice Chapter: 3 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 50, Complications of Healing and Tissue Repair

19.Acute sinusitis is inflammation of the lining of the paranasal sinuses lasting how long?

A. 1 to 4 weeks B. 4 to 8 weeks C. 8 to 12 weeks D. 12 to 16 weeks Answer: B

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Rationale: Acute sinusitis is inflammation of the lining of the paranasal sinuses lasting 4 to 8 weeks. Subacute sinusitis lasts 8 to 12 weeks. Recurrent acute sinusitis occurs when the client has up to four episodes per year, with the sinus inflammation resolving completely between episodes.

Question format: Multiple Choice Chapter: 3 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 53, Acute Sinusitis

20.What condition causes most cases of chronic sinusitis?

A. Nasal congestion B. Nasal polyps C. Allergies D. Untreated acute sinusitis Answer: D Rationale: Similar to acute sinusitis, chronic sinusitis often begins as stasis of secretions inside the sinuses, which can be triggered by mucosal edema or obstruction of the ostia. Most cases of chronic sinusitis are due to acute sinusitis that either is untreated or does not respond to treatment. Nasal congestion is a symptom of acute sinusitis. Nasal polyps may or may not be present in chronic sinusitis.

Although chronic sinusitis can result from allergies, untreated acute sinusitis is more common.

Question format: Multiple Choice Chapter: 3 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation

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Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 54, Chronic Sinusitis

21.What type of burn can interrupt cardiac conduction and lead to sudden death?

A. Thermal B. Chemical C. Electrical D. Radiation Answer: C Rationale: Electrical currents can disrupt cardiac conduction and cause immediate death. Thermal burns, chemical burns, and burns caused by radiation do not alter the cardiac conduction system.

Question format: Multiple Choice Chapter: 3 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 55, Burns

22.A client has splashed scalding water on the arm while straining pasta. The area is red and painful, and blisters form. How is this burn classified?

A. Superficial burn B. Superficial partial-thickness burn C. Deep partial-thickness burn D. Full-thickness burn

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Answer: C Rationale: Deep partial-thickness burns damage the upper epidermis and penetrate into the lower dermis as seen with a burn from scalding water. Superficial burns damage only the epidermis. Superficial partial-thickness burns damage the upper dermis. Full-thickness burns damage the epidermis and dermis and can penetrate subcutaneous layers as well.

Question format: Multiple Choice Chapter: 3 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 55, Burns

23.The nurse is caring for a client with rheumatoid arthritis. Which categorize rheumatoid arthritis? Select all that apply.

A. Autoimmune processes against synovial cells B. Formation of immune complexes C. Genetic susceptibility and a triggering event D. Chronic inflammatory processes predominated by neutrophils E. Disease onset commonly between 30 and 50 years of age Answer: A, B, C, E Rationale: Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by chronic inflammation and hyperplasia of the synovial membranes with increased synovial exudate, leading to swelling and thickening of the synovial membranes, joint erosion, and pain. The onset of the disease typically occurs between the ages of 30 and 50 years. Although the exact cause of RA is unknown, the etiology is likely a combination of genetic susceptibility, an immune-triggering event, and the

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subsequent development of autoimmunity against synovial cell. Rheumatoid arthritis is not characterized by a predominance of neutrophils.

Question format: Multiple Select Chapter: 3 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 8 Page and Header: 60, Rheumatoid Arthritis

24.What type of granulation tissue forms over the inflamed synovium and cartilage in rheumatoid arthritis?

A. Matrix tissue B. Ankylosis C. Pannus D. Nodular Answer: C Rationale: Pannus is granulation tissue that forms over the inflamed synovium and cartilage as a result of accelerated angiogenesis caused by rheumatoid arthritis.

Nodules, matrix tissue, and ankylosis are not granulation tissues formed over inflamed synovium and cartilage.

Question format: Multiple Choice Chapter: 3 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 8 Page and Header: 60, Rheumatoid Arthritis

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25.What is the relationship between severe burns and the development of gastritis?

A. Burns shunt blood away from the stomach.

B. Eating spicy foods can burn the stomach.

C. Burns increase blood flow to the stomach.

D. Burns require the use of long-term analgesics, which irritate the stomach.

Answer: A Rationale: Restriction or loss of perfusion to this layer can be a cause of gastritis.

Altered tissue perfusion can occur in the case of burns when blood is shunted to vital organs and not to the stomach, causing the protective mucus barrier to form ulcers and perforate. Eating spicy foods, increased blood flow to the stomach, and long-term analgesics are not the reason that burns can cause gastritis.

Question format: Multiple Choice Chapter: 3 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 8 Page and Header: 62, Functions of the Stomach

26.What is a common cause of acute pancreatitis?

A. Blockage of ducts by gallstones B. Infection by Helicobacter pylori C. Smoking D. Radiation exposure Answer: A Rationale: Acute pancreatitis may occur when there is an injury to the acinar cells, zymogen, pancreatic duct, or protective digestive feedback mechanisms in the

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exocrine pancreas. Common causes include duct blockage by gallstones or excessive alcohol use. Smoking, Helicobacter pylori, and radiation exposure are not associated with acute pancreatitis.

Question format: Multiple Choice Chapter: 3 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 8 Page and Header: 65, Acute Pancreatitis

27.What is the most common cause of chronic pancreatitis?

A. Autoimmune disease B. Hereditary disease C. Alcohol use disorder D. Gallstones Answer: C Rationale: The common causes of chronic pancreatitis are alcohol use disorder (60% to 70%), autoimmune or hereditary disease (10%), and in 20% of cases the cause is unknown. Gallstones cause acute pancreatitis.

Question format: Multiple Choice Chapter: 3 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 8 Page and Header: 66, Chronic Pancreatitis

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Test Generator Questions, Chapter 4, Altered Immunity 1. The charge nurse is providing staff education on the topic of immunology.

Immunology is the study of which? Select all that apply.

A. Structure of the immune system B. Function of the immune system C. Phenomena of induced sensitivity and allergy D. Microscopic organisms E. Nature of disease Answer: A, B, C Rationale: Immunology is the study of the structure and function of the immune system, as well as immunity, induced sensitivity, and allergy.

Question format: Multiple Select Chapter: 4 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 74, Introduction

2. All blood cells are produced from which type of precursor cell?

A. Myeloid progenitor B. Lymphoid progenitor C. Pluripotent stem D. Neutrophil Answer: C

Rationale: The pluripotent hematopoietic stem cells originate in the bone marrow and produce two precursor cell types: the lymphoid progenitor and the myeloid progenitor. The immune cells of adaptive immunity all have a common origin in the pluripotent hematopoietic stem cells. Neutrophils are a type of granulocyte produced by myeloid progenitor cells.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 76, Immune Cell Origin

3. Which cells become differentiated in the bone marrow?

A. Cytotoxic T lymphocytes B. Helper T lymphocytes C. Plasma cells D. T-cell receptors Answer: C Rationale: The B lymphocytes, developed in the bone marrow, differentiate into plasma cells after antigen–BCR binding. Cytotoxic T lymphocytes direct destruction of antigen-carrying cells. Helper T lymphocytes enhance humoral and cell-mediated responses of the immune system. Each T lymphocyte has a unique receptor, or T-cell receptor (TCR), which is able to bind to antigens, promoting a specific immune response.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation

Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 76, Immune Cell Origin

4. Which characteristic explains why some pathogens do not cause disease in humans?

A. Receptor binding B. Pathogenicity C. Invasiveness D. Potency Answer: A Rationale: One way that antibodies protect cells from pathogens is by receptor binding. This involves the binding of the antigen to the antibody preventing the antigen from infecting cells. Pathogenicity, invasiveness, and potency explain why pathogens cause diseases in humans.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 8 Page and Header: 80, Humoral Immunity

5. Which type of granulocyte is present in the greatest number?

A. Basophil B. Eosinophil C. Monocyte D. Neutrophil

Answer: D Rationale: Neutrophils are present in the greatest number and are most important in the rapid response to bacterial infection. Eosinophils offer the greatest protection against parasites, whereas basophils complement the actions of mast cells, important in allergic reactions. Monocytes are not a type of granulocyte.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 76, Immune Cell Origin

6. What is another term for an activated monocyte?

A. Lymphocyte B. Macrophage C. Polymorphonuclear leukocyte D. Plasma cell Answer: B Rationale: Circulating monocytes become activated when in contact with an antigen, prompting differentiation into macrophages and movement out of the circulation into the tissues. The B lymphocytes differentiate into plasma cells after antigen–BCR binding. Leukocytes, also known as white blood cells, are the basic functional units of the immune system. Polymorphonuclear leukocytes are also known as granulocytes.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation

Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 76, Immune Cell Origin

7. What type of macrophage is specific to the liver?

A. Microglial cells B. Kupffer cells C. Langerhans cells D. Histiocytes Answer: B Rationale: Macrophages are known by different cell names that are determined by the location of tissues where they reside. These cell types include Kupffer cells (liver), microglial cells (brain), and histiocytes (loose connective tissue). Langerhans cells are immature dendritic cells in the skin.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 76, Immune Cell Origin

8. What is the primary cell type involved only in adaptive immunity?

A. B lymphocyte B. Neutrophil C. Macrophage D. Dendritic cells

Answer: A Rationale: The primary cell type involved in adaptive immunity is B lymphocytes.

Macrophages, neutrophils, and dendritic cells are the primary cell types involved in nonspecific, innate immunity.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 79, Adaptive Immunity

9. Antibodies are secreted from which cell type?

A. Macrophage B. Cytotoxic T lymphocyte C. Helper T lymphocytes D. Plasma cells Answer: D Rationale: Antibodies, essential components of adaptive immunity, were first identified in the plasma cells. Effector cells are plasma cells that secrete antibodies.

Macrophages are essential in mediating innate immunity. Cytotoxic T lymphocytes direct destruction of antigen-carrying cells. Helper T lymphocytes enhance humoral and cell-mediated responses of the immune system.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning

Learning Objective: 1 Page and Header: 80, Humoral Immunity

10.What is the primary cell type involved in cell-mediated immunity?

A. B lymphocyte B. Cytotoxic T lymphocyte C. Macrophage D. Dendritic cell Answer: B Rationale: The primary cell type involved in cell-mediated immunity is the cytotoxic T lymphocytes. B lymphocytes and dendritic cells are the primary cell types involved in adaptive immunity. Macrophages are essential cell types involved in innate immunity.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 81, Cell-Mediated Immunity

11.What membrane surface molecule is expressed on cytotoxic T lymphocytes?

A. CD8 B. CD4 C. TH1 D. TH2 Answer: A

Rationale: The molecule CD8 is expressed on the surface of cytotoxic T lymphocytes (CD8 T cells). Helper T lymphocytes express CD4 on their surfaces. TH1 and TH2 are the two primary classes of CD4 T lymphocytes.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 81, Cell-Mediated Immunity

12.The major histocompatibility complex (MHC) class I molecule is recognized by which cell type?

A. CD8 B. CD4 C. TH1 D. TH2 Answer: A Rationale: The MHC class I molecule is found on nucleated body cells and is recognized by the cytotoxic CD8 T lymphocytes. The MHC class II molecule is found on antigen-presenting cells (APCs) and is recognized by the helper CD4 T lymphocytes (TH1 or TH2).

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 81, Cell-Mediated Immunity

13.The nurse is caring for a client with an acute, bacterial infection. Which laboratory value does the nurse expect to be elevated?

A. Eosinophil count B. Neutrophil count C. Basophil count D. Monocyte count Answer: B Rationale: Neutrophils are present in the greatest number and are most important in the rapid response to bacterial infections. Basophils become elevated in allergic reactions. Eosinophils are elevated with parasitic infections. Monocytes are more likely to be elevated with chronic infections.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 77, Myeloid Progenitor Cells

14.Which antibody class is involved in hypersensitivity reactions?

A. IgA B. IgE C. IgG D. IgM Answer: B Rationale: Immediate hypersensitivity reactions are also known as type I reactions or IgE-mediated hypersensitivity responses to antigen challenges. Initial exposure to an

allergen in a vulnerable individual stimulates the production of IgE, an immunoglobulin important in the development of protective immunity. The other immunoglobulins are not involved in hypersensitivity reactions.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 85, Type I or Immediate Hypersensitivity Reaction

15.Which antibody class mediates the passive immunity obtained from pregnant parent to the fetus?

A. IgA B. IgE C. IgG D. IgM Answer: C Rationale: IgG is the only immunoglobulin that is able to cross the placenta, providing passive immunity to the developing fetus. IgA provides passive immunity from the birth parent to newborn through breast milk. IgM is the initial circulating antibody produced in response to antigen challenge and the first to be produced by the newborn. IgE on the cell surfaces of mast cells and basophils leads to cellular degranulation upon antigen binding, triggering the release of chemical mediators involved with inflammation and allergies.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation

Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 80, Humoral Immunity

16.What type of hypersensitivity reaction involves degranulation of basophils and mast cells when IgE binds to an allergen?

A. Immediate hypersensitivity B. Antibody-mediated C. Immune complex D. Autoimmune Answer: A Rationale: In an immediate hypersensitivity reaction, the initial exposure to an allergen in a vulnerable individual stimulates the production of IgE. When IgE encounters and binds an allergen, mast cells and basophils degranulate, release chemical mediators, and cause injury to cells, producing the symptoms associated with allergy. The reaction in antibody-mediated reactions is tissue specific, usually involving destruction of a target cell by antibody binding to antigen on the cell surface.

Immune complex reactions involve complement activation stimulated by deposition of bound antigen to antibody. An autoimmune reaction involves failure of the development of self-tolerance.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 85, Type I or Immediate Hypersensitivity Reaction

17.What type of hypersensitivity reaction involves failure of the development of self-tolerance?

A. Immediate hypersensitivity B. Antibody-mediated C. Immune complex D. Autoimmune Answer: D Rationale: One of the critical functions of the immune system is to distinguish “self” from “nonself.” When this recognition fails or is not controlled, an autoimmune reaction (directed at an individual’s own tissues) can develop. Immediate hypersensitivity reactions involve degranulation of basophils and mast cells when IgE binds to an allergen. The reaction in antibody-mediated reactions is tissue specific, usually involving destruction of a target cell by antibody binding to antigen on the cell surface. Immune complex reactions involve complement activation stimulated by deposition of bound antigen to antibody.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 88, Autoimmunity

18.What type of hypersensitivity reaction involves complement activation stimulated by deposition of bound antigen to antibody?

A. Immediate hypersensitivity B. Antibody-mediated C. Immune complex D. Autoimmune

Answer: C Rationale: Cellular and tissue damage caused by type III immune complex–mediated reactions are the indirect result of complement activation stimulated by antigen– antibody complexes. Immediate hypersensitivity reactions involve degranulation of basophils and mast cells when IgE binds to an allergen. The reaction in antibody-mediated reactions is tissue specific, usually involving destruction of a target cell by antibody binding to antigen on the cell surface. An autoimmune reaction involves failure of the development of self-tolerance.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 87, Type III Immune Complex-Mediated Reaction

19.What is a graft between unrelated individuals called?

A. Autograft B. Allograft C. Syngeneic graft D. Polymorphic graft Answer: B Rationale: An allograft is a graft between unrelated individuals. An autograft comes from different sites on the same person. A syngeneic graft is a graft between genetically identical individuals/monozygotic twins. Polymorphic does not refer to a graft type, rather describes the phenomena of major histocompatibility complex (MHC) molecules occurring in more than one form.

Question format: Multiple Choice

Chapter: 4 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 90, Graft Rejection

20.What type of drug is used to regulate the immune response through interference with DNA synthesis in dividing cells?

A. Cytotoxic drugs B. Anti-inflammatory medications C. Bacterial derivative drugs D. Fungal derivative drugs Answer: A Rationale: A common mechanism of cytotoxic drugs includes interference with DNA synthesis in dividing cells. Bacterial and fungal derivative drugs alter signal transduction pathways in T lymphocytes, reducing inflammation by altering the reproductive cell cycle. Anti-inflammatory medications reduce inflammation and suppress the immune response.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 91, Treatment of Maladaptive Immune Responses

21.What causes the loss of cell-mediated and humoral immunity in acquired

immunodeficiency syndrome (AIDS)?

A. Loss of CD4 lymphocytes B. Loss of CD8 lymphocytes C. Loss of plasma B lymphocytes D. Loss of memory B lymphocytes Answer: A Rationale: The hallmark of AIDS is the loss of cell-mediated and humoral immunity due to the loss of CD4 TH1 lymphocytes. Human immunodeficiency virus (HIV) is an enveloped retrovirus that infects CD4 helper T lymphocytes, dendritic cells, and macrophages. CD8, plasma B lymphocytes, and memory B lymphocytes are not infected by AIDS. Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 9 Page and Header: 93, Immune Maladaptation: AIDS

22.What is the rationale for AIDS treatment with antiretroviral therapy?

A. Monotherapy with reverse transcriptase inhibitors B. Monotherapy with protease inhibitors C. Monotherapy with integrase strand transfer inhibitors D. Triple therapy with reverse transcriptase, protease, and integrase strand transfer inhibitors Answer: D Rationale: Specific drugs included in antiretroviral therapy for AIDS treatment are

designed to delay disease progression by suppressing viral replication and addressing issues of drug resistance. These drugs can be categorized into classes known as nucleoside and nucleotide analog reverse transcriptase inhibitors (NRTIs), nonnucleotide reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), and integrase strand transfer inhibitors (INSTIs). The use of antiretroviral therapy has increased effectiveness over monotherapy or combined two-drug therapy.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 9 Page and Header: 95, Treatment

23.Systemic lupus erythematosus is an example of which type of hypersensitivity reaction?

A. Type I B. Type II C. Type III D. Type IV Answer: C Rationale: Systemic lupus erythematosus (SLE) is an example of a type III hypersensitivity reaction. SLE is an autoimmune disease and features responses from both the innate and humoral immune systems. Anaphylaxis is an example of a type 1 hypersensitivity reaction. Rh isoimmunization is an example of a type II hypersensitivity reaction. Direct cell-mediated cytotoxicity is an example of a type IV hypersensitivity reaction.

Question format: Multiple Choice Chapter: 4

Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 9 Page and Header: 97, Immune Maladaptation: Systemic Lupus Erythematosus

24.Anaphylaxis is mediated by which class of antibody?

A. IgA B. IgE C. IgG D. IgM Answer: B Rationale: Anaphylaxis can occur from exposure to drugs, environmental compounds, insect venom or stings, or food products that stimulate an exaggerated immune response. Reexposure to an allergen is responsible for triggering this IgE-mediated event. Anaphylaxis is not mediated by antibodies IgA, IgG, or IgM. Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 9 Page and Header: 95, Immune Maladaptation: Anaphylactic Reaction

25.Which condition is a fetal or newborn manifestation of Rh isoimmunization?

A. Arrhythmia B. Respiratory distress C. Anemia

D. Dehydration Answer: C Rationale: Fetuses suffering from Rh isoimmunization are at increased risk for the development of anemia, hydrops fetalis (swollen fetal tissues), and death. Severe hemolysis of fetal red blood cells can be worsened by increased erythropoiesis.

Arrhythmia, respiratory distress, and dehydration are not symptomatic of Rh isoimmunization.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 9 Page and Header: 95, Clinical Manifestations

Test Generator Questions, Chapter 5, Infection 1. Which is a characteristic of resident flora?

A. They live on sterile areas of the body.

B. They cause harm to the body.

C. They provide a type of specific immunity.

D. They compete with disease-producing microorganisms.

Answer: D Rationale: Resident flora are microorganisms that live on or within the body in nonsterile areas, such as the skin, mucous membranes, bowel, rectum, or vagina, without causing harm. Inflammatory and immune attacks are generally not waged against these inhabitants as long as the skin and mucosa remain intact. Resident flora compete with disease-causing microorganisms to protect the body against certain infections and to provide a type of natural immunity. They do not harm the body.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 105, Introduction

2. Which best describes why yeast infections are common in women on antibiotics?

A. Yeast grows well when exposed to the sugar, which is found as a carrier substance in most antibiotics.

B. Destroying one type of resident flora (bacteria) can allow overproliferation of another competing type (yeast).

C. Yeast prefers a warm, moist, and dark environment, such as that present in the

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female perineum.

D. Antibiotics allow yeast to access sterile environments in the body.

Answer: B Rationale: Antibiotics destroy the helpful resident bacteria living in nonsterile areas of the body. The resident fungi no longer have to compete with the destroyed resident bacteria. The fungi over proliferate, resulting in a fungal infection. The other options do not specifically attribute to yeast infection in women who are taking antibiotics.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 105, Introduction

3. The nurse is caring for a client with a communicable disease. Which is true about this type of disease? Select all that apply.

A. All infectious diseases are communicable.

B. Communicable diseases are spread from person to person.

C. Blood is a common carrier for communicable diseases.

D. Communicable diseases are caused by infections that live and reproduce in a human host.

E. Body fluids can carry communicable diseases from one person to another.

Answer: B, C, D, E Rationale: Not every infectious disease is communicable. Communicable diseases are spread from one person to another. Blood and body fluids are common carriers for communicable diseases. Communicable diseases are caused by infections that live

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and reproduce in a human host.

Question format: Multiple Select Chapter: 4 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 115, Communicable Disease

4. Which factor(s) affects the variability with which a pathogen is able to cause disease? Select all that apply.

A. Infectivity B. Virulence C. Superinfection D. Toxigenicity E. Antigenic variability Answer: A, B, C, D, E Rationale: The following factors affect the variability with which the pathogen is able to elicit disease: virulence, infectivity, toxigenicity, antigenicity, antigenic variability, pathogenic defense mechanisms, coinfection, and superinfection.

Question format: Multiple Select Chapter: 4 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 107, Pathogens

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5. Which is a mechanism(s) by which a pathogen causes disease in humans? Select all that apply.

A. Direct destruction of the host cell B. Interference with the host cell’s metabolic function C. Attack of the pathogen by the host cell’s immune cells D. Exposure of the host cell to toxins E. Potency of the pathogen Answer: A, B, D Rationale: The mechanisms by which the pathogen causes disease in the human host cell includes one or more of the following: direct destruction of the host cell by the pathogen, interference with the host cell’s metabolic function, and exposing the host cell to toxins produced by the pathogen. An attack of the pathogen by the host cell’s immune cells is a mechanism to prevent infection. The potency of the pathogen affects the pathogen’s success at causing disease but is not a direct cause of the disease itself.

Question format: Multiple Select Chapter: 4 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 107, Pathogens

6. What process is interrupted when antibacterial drugs disrupt the cell wall of a bacterium?

A. Protein and DNA synthesis B. Phagocytosis C. Motility D. Adherence

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Answer: A Rationale: Antibacterial drugs can inhibit synthesis of the bacterial cell wall, damage the cytoplasmic membrane, and disable nucleic acid metabolism and protein synthesis. Antibacterial drugs do not disrupt phagocytosis, motility, or adherence.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 119, Treatment Modalities

7. What is the likely clinical manifestation if a Gram-negative bacteria containing endotoxin in the bacterial cell envelope becomes pathogenic?

A. Constipation B. Leukopenia C. Fever D. Vomiting Answer: C Rationale: Endotoxin causes inflammatory mediators to be released, leading to a massive inflammatory response. This response can result in a state of septic shock accompanied by severe diarrhea, fever, and leukocytosis. Vomiting, leukopenia, and constipation are not likely responses to endotoxin.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation

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Integrated Process: Teaching/Learning Learning Objective: 8 Page and Header: 108, Bacteria

8. Which best explains why some viruses are capable of eliciting a chronic infection in the body?

A. Release of virions B. Immunocompetence C. Period of latency D. Receptor binding Answer: C Rationale: During the period of latency, the virus is integrating itself into the host cell’s genetic material. This period of latency is a characteristic associated with chronic infections. The release of virions results in infection of nearby cells. Receptor binding explains why some geographic locations have differences in human infection.

Immunocompetence refers to the ability of the body to produce a normal immune response.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 8 Page and Header: 110, Viruses

9. What condition is suspected in a client with a deep tissue fungal infection?

A. Immunocompromise B. Concurrent tinea infection

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C. Maceration D. Presence of resident microbes Answer: A Rationale: Deep tissue fungal infections are found almost exclusively in immunocompromised clients. Having a concurrent tinea infection, maceration, or the presence of resident microbes does not increase the risk of deep tissue fungal infection.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 8 Page and Header: 114, Fungi

10.Which precautions are taken in recognition that all blood and body fluids are potentially infected?

A. Transmission-based B. Infectious C. Handwashing D. Universal Answer: D Rationale: Universal precautions are a standard of healthcare that recognizes all blood and body fluids as potentially infected. Additional precautions such as transmission-based precautions, infectious precautions, and handwashing precautions are implemented depending on the mode of transmission.

Question format: Multiple Choice

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Chapter: 4 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 116, Mode of Transmission

11.Which is a complication of infection where pathogens of any type gain access to the blood?

A. Septicemia B. Bacteremia C. Septic shock D. Chronic infection Answer: A Rationale: Septicemia occurs when microorganisms gain access to the blood and circulate throughout the body. When bacteria is the cause of septicemia, the term to describe it is bacteremia. Septic shock is the process of systemic vasodilation due to severe infection. Chronic infection is an infection lasting for several weeks or longer.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 118, Complications of Infection

12.A client with streptococcal pharyngitis is prescribed an antibiotic and is instructed to take the antibiotic three times a day for 10 days. After the 4th day, the client is

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asymptomatic and decides not to finish the medication. What complication is likely to result?

A. Septicemia B. Bacteremia C. Septic shock D. Chronic infection Answer: D Rationale: Incomplete antibiotic treatments can result in only some of the pathogens being fully destroyed. When pathogens aren’t fully destroyed, a chronic infection may occur. Septicemia occurs when microorganisms gain access to the blood and circulate.

Bacteremia describes septicemia when the causative microorganism is bacteria.

Septic shock is a process of systemic vasodilation caused by severe infection.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 118, Complications of Infection

13.The nurse is caring for a client with a bacterial infection in the lungs. Which bacteria is most likely to have caused this infection?

A. Streptococcus pneumoniae B. Neisseria meningitidis C. Escherichia coli D. Pseudomonas aeruginosa Answer: A

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Rationale: Streptococcus pneumoniae bacteria is the common bacteria known to cause infections in the lungs. Neisseria meningitis bacteria is the common causes of infections in the brain. Escherichia coli bacteria is commonly found in the large intestine. Pseudomonas aeruginosa commonly causes infections in the urinary tract.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 118, Complications of Infection

14.The client believes that they have “athlete’s foot” because of burning and itching along with redness between the toes. The client looks in your bathroom drawer where medications are kept. The client pulls out the antibiotic ointment and applies this to the reddened areas. After 3 days of application, there is no improvement. Why is this medicine not working?

A. Topical medications usually take at least 7 days to be effective.

B. Antibacterial medications are not effective against fungi.

C. This type of infection requires oral antibiotics.

D. The client is probably immunocompromised.

Answer: B Rationale: Because bacteria do not contain the same components as fungal cells, antibacterial medications are not active against fungi, such as “athlete’s foot.” The problem relates to the class of medication and not the route or the client being immunocompromised.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Apply

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Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 10 Page and Header: 119, Treatment Modalities

15.The nurse is caring for a client with influenza. Which measure(s) is an appropriate action(s) to avoid contracting this infection? Select all that apply.

A. Immunization B. Analgesics C. Frequent handwashing D. Avoiding close contact with the client E. Antiviral drugs Answer: A, C, D Rationale: The best way to avoid viral infections is through prevention. Prevention strategies include handwashing, avoiding close contact, and annual vaccinations.

Analgesics and antiviral drugs will not prevent the nurse from contracting the illness.

These treatments may only lessen the symptoms once the nurse has contracted influenza.

Question format: Multiple Select Chapter: 4 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 10 Page and Header: 120, Influenza

16.Which process causes influenza viruses to gradually change genetic composition during replication in the human host cell?

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A. Reassortment B. Receptor binding C. Vaccination D. Trivalence Answer: A Rationale: Influenza viruses are well adapted to escape host defenses and gradually change genetic composition during replication in the human host cell in a process called reassortment. This process results in viral offspring with altered antigenic properties. Receptor binding, vaccination, and trivalence are not associated with changing genetic composition during replication in the human host cell.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Remember Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Learning Objective: 10 Page and Header: 120, Influenza

17.Who is at highest risk of significant morbidity and mortality with influenza infection?

A. Adolescents B. Older adults C. School-age children D. College-age individuals Answer: B Rationale: Young children (younger than 2 years of age), older adults (65 years of age and older), pregnant parents, and individuals with chronic cardiopulmonary, renal,

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metabolic, or immunodeficient conditions are predisposed to greater morbidity and mortality when infected with influenza.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 10 Page and Header: 120, Influenza

18.Which set of clinical manifestations is characteristic of influenza?

A. Diarrhea, stomach cramping, vomiting B. Nasal congestion, sneezing, watery eyes C. Headache, sinus pressure, fever D. Body aches, cough, sore throat Answer: D Rationale: The clinical manifestations of influenza are based on the inflammatory response and cell necrosis in the respiratory tract and include cough, sore throat, nasal congestion and drainage, and shortness of breath. Systemic signs of inflammation are also common and include chills, fever, body aches, weakness, and malaise. Nasal congestion, sneezing, watery eyes, headache, sinus pressure, and fever are symptoms of sinusitis. Diarrhea, stomach cramping, and vomiting are associated with gastrointestinal distress.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 8

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Page and Header: 120, Influenza

19.The nurse is caring for a client with cirrhosis. Cirrhosis can lead to liver failure by which mechanism(s)? Select all that apply.

A. Obstruction of portal circulation B. Diffuse hepatocyte damage C. Interference of blood flow to the liver D. Massive destruction of Kupffer cells E. Caseous necrosis Answer: A, B, C Rationale: Cirrhosis obstructs blood flow from portal circulation, exacerbates hypoxia and hepatocytes resulting in cell death, causes interference of blood flow to the liver, and causes blood and bile to back up into the liver causing further injury and inflammation. Kupffer cells are not destroyed by cirrhosis. Cirrhosis also does not cause caseous necrosis.

Question format: Multiple Select Chapter: 4 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 120, Pathophysiology

20.A client arrives at the clinic for evaluation. The client is visibly jaundiced and reports dark urine and clay-colored stools. The liver is enlarged and tender. The nurse suspects the client is experiencing acute hepatitis. Which phase of acute hepatitis does this presentation represent?

A. Prodrome

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B. Icterus C. Recovery D. Incubation Answer: B Rationale: Icterus is marked by the onset of jaundice, dark urine, and clay-colored stools. The liver is also enlarged and tender. Prodrome is a period of fatigue, anorexia, malaise, headache, and low-grade fever. Recovery is marked by the resolution of jaundice around 8 weeks after the initial exposure to the virus. Incubation is the period of time between exposure to the virus and emergence of symptoms.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 10 Page and Header: 121, Clinical Manifestations

21.Which laboratory result confirms the presence of acute hepatitis B for a client who is visibly jaundiced, reports dark urine and clay-colored stools, and has an enlarged and tender liver?

A. Positive IgM anti-HBc B. Positive IgG anti-HBe C. Positive IgM anti-HBs D. Decreased serum bilirubin levels Answer: A Rationale: Antibodies to the hepatitis B core antigen (IgM anti-HBc) are required for the diagnosis of acute hepatitis B infection. Positive anti-HBe results usually indicate

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inactivity of the hepatitis B virus and low infectivity. Positivity indicates recent infection with hepatitis B virus (less than 6 months). This client’s presenting symptoms suggest infection for more than 6 moths. Serum bilirubin levels increase in clients with hepatitis B infection.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 9 Page and Header: 121, Diagnostic Criteria

22.Why is a low-fat diet recommended for clients with hepatitis?

A. Fat emulsification and absorption and bile production may be impaired during liver disease.

B. Weight gain will exacerbate hepatocyte destruction.

C. Those with hepatitis are more vulnerable to the development of atherosclerosis.

D. Ascites, a complication of liver disease, can be alleviated with moderate weight loss.

Answer: A Rationale: A low-fat diet is recommended because bile helps with fat emulsification and absorption, and bile production may be impaired during liver disease. Weight gain is not a concern relative to hepatocyte destruction. Hepatitis does not increase risk of atherosclerosis, and weight loss does not directly alleviate ascites.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation

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Integrated Process: Teaching/Learning Learning Objective: 10 Page and Header: 121, Treatment

23.Urinary tract infections (UTIs) have which common characteristic?

A. UTIs are exclusive to female clients.

B. UTIs are ascending infections.

C. UTIs are caused by bile duct blockages.

D. UTIs cause diarrhea.

Answer: B Rationale: Urinary tract infections (UTIs) are ascending; that is, microorganisms enter at the distal urethra and move up toward the bladder. UTIs can also occur in male clients. Renal calculi can cause urinary tract infections, not bile duct blockages.

Diarrhea is not a clinical manifestation for urinary tract infractions.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 10 Page and Header: 128, Acute Pyelonephritis, Pathophysiology

24.Which clinical manifestation is characteristic of tinea versicolor?

A. Presents as hypopigmented patches B. Leads to hair loss and breakage at the site of infection C. Spreads circumferentially like a reddened bull’s-eye D. Leads to thickened, discolored, and dystrophic changes to the nails

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Answer: A Rationale: Tinea versicolor presents as patches of hypopigmentation on the skin of the trunk and extremities. Tinea capitis leads to hair loss and breakage. Tinea corporis causes a reddened bull’s-eye. Tinea unguium leads to changes in nails.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 10 Page and Header: 132, Tinea, Clinical Manifestations

25.Which clinical manifestation is commonly associated with weight loss, low-grade fever, and night sweats?

A. Viral hepatitis B. Influenza C. Tuberculosis D. Bacterial meningitis Answer: C Rationale: Clinical manifestations of tuberculosis include malaise, weight loss, fatigue, anorexia, low-grade fever, and possibly night sweats. These clinical manifestations are not commonly associated with viral hepatitis, influenza, or bacterial meningitis.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 8

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Page and Header: 126, Tuberculosis, Clinical Manifestations

26.Which clinical manifestation is a risk factor for developing pyelonephritis?

A. Erectile dysfunction B. Urinary obstruction by kidney stones C. Frequent urination D. Smoking Answer: B Rationale: Renal calculi (kidney stones) can obstruct the flow of urine and cause a back-up into the kidney. This back-up can result in pyelonephritis. Erectile dysfunction, frequent urination, and smoking are not risk factors leading to the development of pyelonephritis.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 8 Page and Header: 127, Urinary Tract Infection, Pathophysiology

27.Malaria is caused by which type of infection?

A. Bacterial B. Viral C. Protozoan D. Fungal Answer: C

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Rationale: Malarial infection is typically acquired in an endemic area following a mosquito bite. The Anopheles species of mosquito transmits plasmodia, contained in its saliva, into the host. Plasmodia enter circulating red blood cells and feed on hemoglobin and other proteins within the cells.

Question format: Multiple Choice Chapter: 4 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 8 Page and Header: 133, Malaria, Pathophysiology

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Test Generator Questions, Chapter 6, Genetic and Developmental Disorders 1. Which definition best describes a person’s phenotype?

A. The genetic makeup of an individual B. Traits that are observable or apparent C. Traits that are inherited in a recessive pattern D. Traits that are inherited in a dominant pattern Answer: B Rationale: A person’s phenotype refers to the traits that are apparent or observable.

A person’s genotype refers to the genetic makeup of an individual. Autosomal dominant traits are traits that are inherited in a dominant pattern. Autosomal recessive traits are traits that are inherited in a recessive pattern.

Question format: Multiple Choice Chapter: 6 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 143, Transmission and Expression of Genetic Traits

2. Which definition best describes a person’s genotype?

A. The genetic makeup of an individual B. Traits that are observable or apparent C. Traits that are inherited in a recessive pattern D. Traits that are inherited in a dominant pattern Answer: A

Rationale: A person’s genotype refers to the genetic makeup of an individual. A person’s phenotype refers to the traits that are apparent or observable. Autosomal dominant traits are traits that are inherited in a dominant pattern. Autosomal recessive traits are traits that are inherited in a recessive pattern.

Question format: Multiple Choice Chapter: 6 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 143, Transmission and Expression of Genetic Traits

3. Which condition follows a mendelian pattern of recessive inheritance?

A. Coronary artery disease B. Down syndrome C. Marfan syndrome D. Tay-Sachs disease Answer: D Rationale: Examples of autosomal recessive disorders are cystic fibrosis, Tay-Sachs disease, thalassemia, and sickle cell disease. Coronary artery disease follows a multifactorial pattern of inheritance. Marfan syndrome is an example of an autosomal dominant disorder, and Down syndrome results from an alteration in the chromosomal number.

Question format: Multiple Choice Chapter: 6 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2

Page and Header: 147, Autosomal Recessive Disorders

4. Which condition follows a multifactorial pattern of inheritance?

A. Coronary artery disease B. Down syndrome C. Marfan syndrome D. Tay-Sachs disease Answer: A Rationale: Coronary artery disease follows a multifactorial pattern of inheritance.

Tay-Sachs disease follows a mendelian pattern of recessive inheritance. Marfan syndrome is an example of an autosomal dominant disorder, and Down syndrome results from an alteration in the chromosomal number.

Question format: Multiple Choice Chapter: 6 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 148, Inheritance of Polygenic Disorders

5. Fortification of foods with folic acid has resulted in a significant reduction in the incidence of which condition?

A. Huntington disease B. Turner syndrome C. Neural tube defects D. Cleft lip and palate Answer: C

Rationale: Maternal folic acid deficiency is known to be a risk factor for the development of neural tube defects. The fortification of foods with folic acid is recognized as an important public health strategy in the prevention of such disorders.

Folic acid fortification does not impact the incidence of Huntington disease, Turner syndrome, or cleft lip and palate.

Question format: Multiple Choice Chapter: 6 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 165, Developmental Maladaptation: Neural Tube Defects

6. Which chromosomal abnormality can result in an inheritable form of trisomy?

A. Nondisjunction during meiosis B. Balanced translocation C. Insertion D. Deletion Answer: B Rationale: Balanced translocation in a parent is the only inheritable form of trisomy.

Nondisjunction results in an unequal number of chromosomes between cells.

Insertion and deletion errors are random, rather than inherited.

Question format: Multiple Choice Chapter: 6 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 160, Clinical Manifestations

7. Which hemoglobin type is produced during sickle cell crisis?

A. HbA B. HbF C. HbG D. HbS Answer: D Rationale: Hemoglobin S (HbS) is an abnormal type of hemoglobin found in people with sickle cell disease. These irregularly shaped hemoglobin cause damage to the endothelial cells that line blood vessels and to the red blood cells themselves. HbF refers to fetal hemoglobin; HbA refers to adult hemoglobin; and HbG is not discussed in relationship to sickle cell disease.

Question format: Multiple Choice Chapter: 6 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 156, Pathophysiology

8. Mitochondrial gene disorders are transmitted to which offspring?

A. Sons only B. Daughters only C. Both daughters and sons D. Neither daughters nor sons Answer: C Rationale: Mitochondrial gene disorders can be transmitted to both sons and daughters.

Question format: Multiple Choice Chapter: 6 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 146, Table 6.3 Patterns of Inheritance in Single Gene Disorders

9. Which process involves mitochondrial genes?

A. Energy production B. Growth C. Muscle development D. Nerve transmission Answer: A Rationale: The functions of mitochondrial genes are associated with the overall function of mitochondria and are often related to energy production. Mitochondrial genes do not produce proteins involved in growth, muscle development, or nerve transmission.

Question format: Multiple Choice Chapter: 6 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 147, Mitochondrial Diseases

10.Which symptom is a manifestation of Down syndrome?

A. Tall stature

B. Testicular agenesis C. Gynecomastia D. Epicanthal eye folds Answer: D Rationale: Facial features characteristic of Down syndrome include eyes that slant upward; epicanthal fold, which is an upper eyelid skin fold covering the inner corner; small, low-set ears that fold at the top; small mouth; flattened nose bridge; and short neck. Short stature, short fingers, simian crease, and decreased muscle tone are also characteristic outward manifestations of Down syndrome. Tall stature, gynecomastia, and testicular agenesis are not manifestations of Down syndrome.

Question format: Multiple Choice Chapter: 6 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 160, Clinical Manifestations

11.Which prenatal test diagnoses Down syndrome?

A. Nuchal translucency B. Serum hCG C. Karyotype D. Serum alpha-fetoprotein Answer: C Rationale: A second trimester amniocentesis (completed between 15 and 19 weeks of pregnancy) provides an opportunity to collect samples of amniotic fluid, grow fetal cells in culture, and evaluate the fetal karyotype to determine any chromosomal

abnormalities. Cell samples of fetal origin must be used to diagnose fetal abnormalities. Nuchal translucency, serum hCG, and serum alpha-fetoprotein are techniques that may suggest a risk of Down syndrome, but they are not diagnostic.

Question format: Multiple Choice Chapter: 6 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 153, Prenatal Screening and Diagnosis; 160, Diagnostic Criteria

12.What is the risk of a pregnant parent with the genetic mutation that causes Fragile X syndrome passing the gene on to offspring?

A. 100% of female offspring affected B. 50% of female offspring affected C. 100% of male offspring affected D. 50% of male offspring affected Answer: D Rationale: Fragile X syndrome is an example of a sex-linked disorder. When the pregnant parent is a carrier of a sex-linked disorder and passes the defective gene to the offspring, the female offspring will have a 50% chance of being a carrier, and the male offspring will have a 50% chance of being affected.

Question format: Multiple Choice Chapter: 6 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 147, Sex-Linked Disorders

13.Which chromosomal anomaly is incompatible with life?

A. Monosomy 21 B. Trisomy 21 C. Monosomy X D. Trisomy X Answer: A Rationale: Monosomy occurs when nondisjunction results in cells with one copy of a chromosome instead of two. If this occurs in autosomes (chromosomes other than X and Y), this defect is not compatible with life. Trisomy 21 (Down syndrome), monosomy X (Turner syndrome), and trisomy X (triple X syndrome) are compatible with life.

Question format: Multiple Choice Chapter: 6 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 149, Alterations in Chromosomal Number

14.Which condition affects female clients only?

A. Klinefelter syndrome B. Turner syndrome C. Down syndrome D. Fragile X syndrome Answer: B Rationale: Turner syndrome is the most common fetal monosomy in female clients and cannot occur in male clients. Klinefelter, Down, and Fragile X syndromes can

affect both male and female clients.

Question format: Multiple Choice Chapter: 6 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 161, Alteration in Sex Chromosome Number: Turner Syndrome and Klinefelter Syndrome

15.In cases of Huntington disease, which type of tissue is the target of damage?

A. Muscle B. Skin C. Nerve D. Connective Answer: C Rationale: The genetic mutation in Huntington disease generates a code for the abnormal huntingtin protein, which then accumulates to toxic levels and destroys nerve cells. Muscle tissue, connective tissue, and skin cells are not a target of damage in Huntington disease.

Question format: Multiple Choice Chapter: 6 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 156, Diagnostic Criteria

16.Which condition is detected using the maternal serum alpha-fetoprotein (MSAFP) test?

A. Cardiovascular disease B. Atherosclerosis C. Spina bifida D. Cleft palate Answer: C Rationale: Prenatally, when meninges are in communication with amniotic fluid, alpha-fetoprotein leaks from the cerebrospinal fluid into the amniotic fluid. Anatomic anomalies, including spina bifida, can be detected by the presence of maternal serum alpha-fetoprotein (MSAFP). This can be measured indirectly through determination of alpha-fetoprotein from a maternal blood sample. MSAFP does not detect the presence of cardiovascular disease, atherosclerosis, or cleft palate.

Question format: Multiple Choice Chapter: 6 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 166, Diagnostic Testing

17.Beckwith-Wiedemann syndrome is an example of which type of genetic inheritance?

A. Autosomal dominant B. Epigenetic C. Sex-linked D. Mitochondrial Answer: B

Rationale: Beckwith-Wiedemann syndrome is linked to genetic and epigenetic alterations.

Question format: Multiple Choice Chapter: 6 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 164, Epigenetic Inheritance: Beckwith–Wiedemann Syndrome

18.A female client has been trying to conceive by having sex with a male friend who wishes to remain anonymous. The female client has had three spontaneous abortions (miscarriages) in the past year, and the healthcare provider (HCP) has recommended karyotyping. Which information will the nurse provide the client?

Select all that apply.

A. “Testing of the aborted (miscarried) fetal tissue is needed for accurate karyotyping.”

B. “Your male friend can remain anonymous as long as your friend provides a genetic history.”

C. “Karyotyping must be combined with other prenatal testing to be diagnostic.”

D. “The test is being recommended to assess for chromosomal abnormalities.”

E. “We will need to collect a sample from your male friend as well as yourself.”

Answer: D, E Rationale: Karyotyping is a genetic testing procedure that produces a picture of the number and visual appearance of chromosomes. When using a karyotype to diagnose a genetic cause for repeated spontaneous abortion, cell samples from both biologic parents are needed, so the surrogate cannot remain anonymous as a sample needs to be collected. Genetic history alone would not produce a karyotype. Although other tests can be performed, karyotyping alone is used to conclusively diagnose

chromosomal abnormalities. Fetal tissue can be used for karyotyping, but this is not absolutely required if samples from both biologic parents are collected.

Question format: Multiple Select Chapter: 6 Cognitive Level (Bloom’s): Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 153, Prenatal Screening and Diagnosis

19.The nurse is assessing a client with Huntington disease who is displaying rapid, involuntary, and nonrepetitive movements. Which term will the nurse use to describe these movements?

A. Dyskinesia B. Chorea C. Essential tremor D. Ataxia Answer: B Rationale: Chorea is the term used for rapid, involuntary, nonrepetitive movements of the face, trunk, and limbs seen in Huntington disease. Dyskinesia refers to difficulty performing voluntary movements. Ataxia refers to an unsteady gait often related to cerebellar dysfunction. Essential tremor is a condition that the causes involuntary rhythmic movements often caused by unknown etiology.

Question format: Multiple Choice Chapter: 6 Cognitive Level (Bloom’s): Remember Client Needs: Safe and Effective Care Environment: Management of Care Integrated Process: Nursing Process Learning Objective: 1

Page and Header: 155, Huntington Disease—Clinical Manifestations

20.The nurse is caring for a client who is diagnosed as having sickle cell trait (SCT).

What is the nurse’s focus when providing care?

A. Teach the client how to avoid sickling crises.

B. Teach the client about genetic counseling options.

C. Assess the client’s current oxygen and hemoglobin levels.

D. Prevent infection and ensure up-to-date immunizations.

Answer: B Rationale: Sickle cell disease follows an autosomal recessive pattern of inheritance.

Because the client has sickle cell trait (SCT), this means that the client has inherited one sickle cell gene and one normal hemoglobin gene. Clients with SCT do not exhibit sickle cell disease and will not have sickling episodes. Because of this, the only relevant intervention is to teach the client about genetic counseling options. If the client conceives a child with another person with SCT, there is a 25% chance their offspring will inherit both hemoglobin S genes and develop sickle cell disease.

Question format: Multiple Choice Chapter: 6 Cognitive Level (Bloom’s): Apply Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process Learning Objective: 7 Page and Header: 156, Autosomal Recessive Disorder: Sickle Cell Disease—Pathophysiology

Test Generator Questions, Chapter 7, Altered Cellular Proliferation and Differentiation 1. Which characteristic best describes cell proliferation?

A. It is most often a process of meiosis.

B. It occurs exclusively during necrosis.

C. It promotes cell specificity.

D. It is under the control of genes.

Answer: D Rationale: Cell proliferation is controlled by genes, growth factors, nutrients, and stimulation from the external environment. Meiosis is a process of dividing germ cells, whereas mitosis is the division and proliferation of all other nongerm cells. Necrosis is not one of the factors affecting cell proliferation. Differentiation promotes cell specificity, not cell proliferation.

Question format: Multiple Choice Chapter: 7 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 172, The Impact of Cancer on the Cell

2. Which is a goal(s) of cell differentiation? Select all that apply.

A. Specificity B. Division C. Functionality D. Maturity E. Necrosis

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Answer: A, C, D Rationale: Cell differentiation refers to the orderly process of cellular maturation to achieve a specific function. Cell differentiation allows the cells to mature and achieve both specificity and functionality. Cell division is a goal of cell proliferation, not cell differentiation. Necrosis is not one of the factors affecting cell proliferation.

Question format: Multiple Select Chapter: 7 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 172, The Impact of Cancer on the Cell, Differentiation

3. Which type of cells is the least differentiated?

A. Stem B. Progenitor C. Daughter D. Precursor Answer: A Rationale: Stem cells are highly undifferentiated. They can be both flexible and adaptable. Stem cells divide into progenitor cells and then daughter cells. With each division, the cells become more differentiated. Precursor cells are already partially differentiated.

Question format: Multiple Choice Chapter: 7 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning

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Learning Objective: 1 Page and Header: 172, The Impact of Cancer on the Cell, Stem Cells

4. Which cell type is most likely to turn into a neoplasm?

A. Epithelial B. Hepatocyte C. Myocyte D. Neuron Answer: A Rationale: Cells that can divide rapidly are prone to turning into a neoplasm. Epithelial cells rapidly divide making them most likely to develop into a neoplasm. Hepatocytes, myocytes, and neurons are cells that do not divide, making them unlikely to form a neoplasm.

Question format: Multiple Choice Chapter: 7 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 172, Altered Cellular Proliferation and Differentiation

5. What type of factors lead to the formation of neoplasms?

A. Inherited B. Multifactorial C. Genetic D. Environmental Answer: C

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Rationale: Multifactorial, inherited, or environmental factors can lead to mutations.

The mutations that result in the formation of neoplasms are caused by genetic changes in the DNA of the cell itself.

Question format: Multiple Choice Chapter: 7 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 173, Carcinogenesis

6. Which mechanism is not one of the ways through which a polymorphism can cause epigenetic changes?

A. Blocking the effects of carcinogens B. DNA methylation C. Histone modification D. RNA interference Answer: A Rationale: Polymorphisms are gene variants that set the stage for cancer through epigenetic changes such as DNA methylation, histone modification, and RNA interference. Polymorphisms do not block the effects of carcinogens. Rather, they are likely to be influenced by carcinogens.

Question format: Multiple Choice Chapter: 7 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 175, Role of Gene Variants and Epigenetics

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7. Which gene categories, when mutated, will affect the cell’s ability to encode for the proteins involved in cell growth or regulation?

A. Carcinogens B. Mutator genes C. Oncogenes D. Tumor suppressor genes Answer: C Rationale: Oncogene transformation results in encoding proteins in the cell nucleus to alter the cell cycle resulting in changes related to cell growth and regulation.

Carcinogens interfere with molecular pathways, mutator genes repair DNA, and tumor suppressor genes prohibit overproliferation of cells and regulate apoptosis.

Question format: Multiple Choice Chapter: 7 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 174, Oncogenes

8. Anaplasia, under microscopic review, demonstrates which characteristic(s)? Select all that apply.

A. Variable cell sizes and shapes B. Enlarged nuclei C. Overproliferation D. Atypical mitosis E. Cellular necrosis Answer: A, B, D

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Rationale: Anaplasia, the loss of cell differentiation and function, is characterized under a microscope by wide variations in cell shapes and sizes, enlarged nuclei, and atypical mitosis. Overproliferation and cellular necrosis are not associated with anaplasia.

Question format: Multiple Select Chapter: 7 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 178, The Impact of Cancer on Tissues, Organs, and Organ Systems

9. Which characteristic of neoplasms allows the cell to degrade the extracellular matrix and move between cells?

A. Enzyme secretion B. Angiogenesis C. Apoptosis D. Growth factor secretion Answer: A Rationale: Neoplasms are characterized by enzyme secretions, which allow the cells to degrade the extracellular matrix and move between cells and into neighboring tissues. Growth factor secretion, angiogenesis, and apoptosis are not characteristics of neoplasms associated with extracellular matrix and movement between cells.

Question format: Multiple Choice Chapter: 7 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2

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Page and Header: 178, The Impact of Cancer on Tissues, Organs, and Organ Systems, Neoplasms exhibit several other distinct characteristics

10.Which type of syndrome describes when tumor cells secrete ectopic hormones alter homeostasis?

A. Carcinogenic B. Anaplastic C. Oversecretion D. Paraneoplastic Answer: D Rationale: Paraneoplastic syndromes are characterized by ectopic hormone secretion.

The other options do not describe tumor cells that secrete ectopic hormones.

Question format: Multiple Choice Chapter: 7 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 182, General Manifestations

11.What should a tumor be compared with to determine whether it is benign or malignant?

A. The tissue of origin B. Neighboring cells C. Other benign or malignant neoplasms D. The Manual of Cancerous Tumors Answer: A

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Rationale: Tumors are classed as benign or malignant based on the tumor location and appearance related to the tissue of origin (the unaffected tissue surrounding the neoplasm). Neighboring cells, other neoplasms, and the Manual of Cancerous Tumors are not used to identify tumor malignancy.

Question format: Multiple Choice Chapter: 7 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 179, The Impact of Cancer on Tissues, Organs, and Organ Systems, Benign Versus Malignant

12.Which is a mechanism(s) of tumor spread? Select all that apply.

A. Local spread B. Direct extension C. Seeding D. Metastases E. Angiogenesis Answer: A, B, C, D Rationale: Local spread, direct extension, metastases, and seeding are all mechanisms of tumor spread. Angiogenesis is the development of new blood vessels.

This does not result in the spreading of tumors but does assist in meeting the nutrient needs of tumor cells.

Question format: Multiple Select Chapter: 7 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning

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Learning Objective: 6 Page and Header: 180, The Impact of Cancer on Tissues, Organs, and Organ Systems, Cancer Spread

13.Which term indicates the lethal aspect of cancer?

A. Malignancy B. Metastasis C. Chemotherapy D. Seeding Answer: B Rationale: The lethal aspect of cancer is metastatic growth. Malignancy is the term used to describe the presence of cancer cells, chemotherapy is used to treat cancer, and seeding refers to a mechanism of tumor spread.

Question format: Multiple Choice Chapter: 7 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 180, The Impact of Cancer on Tissues, Organs, and Organ Systems, Cancer Spread

14.Five years after being diagnosed with colon cancer, a client learns that the cancer has spread to the liver. What term indicates the affinity of colon cancer to the liver?

A. Organ tropism B. Organogenesis C. Distant spread D. Local invasion

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Answer: A Rationale: Organ tropism describes the attraction of a primary tumor to a specific distant site. This is caused by the favorable environment the new tissue provides, molecule compatibility between the new and old tissue, and the path of blood flow. An example of tropisms is colon cancer that metastasizes in the liver. This is related to easy access of colon tumor cells through the veins of portal circulation, which travel directly to the liver. Organogenesis, distant spread, and local invasion are not terms used to describe why there is an attraction of a primary tumor to a specific distant site.

Question format: Multiple Choice Chapter: 7 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 180, The Impact of Cancer on Tissues, Organs, and Organ Systems, Cancer Spread

15.What process allows tumor cells to establish a nutrient network to support continued overproliferation?

A. Adherence B. Angiogenesis C. Enzyme secretion D. Seeding Answer: B Rationale: Angiogenesis is the rapid development of new blood vessels, which are necessary to provide nutrients to tumor cells. The continued blood supply provides the nutrients necessary for overproliferation to occur. Adherence, enzyme secretion, and

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seeding do not describe the nutrient network that supports the overproliferation of tumor cells.

Question format: Multiple Choice Chapter: 7 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 178, The Impact of Cancer on Tissues, Organs, and Organ Systems

16.A client is told that they have breast carcinoma “in situ.” What does this mean?

A. The client has a malignant form of breast carcinoma.

B. The breast carcinoma cannot be distinguished as benign or malignant.

C. The breast carcinoma can be detected only with a mammogram.

D. The breast carcinoma is confined to the epithelium.

Answer: D Rationale: Carcinoma in situ describes carcinomas confined to the epithelium that have not yet penetrated the basement membrane. The term “in situ” does not describe or indicate distinction between malignant cells and benign cells, nor does it indicate the or type of testing that will detect and diagnose breast cancer.

Question format: Multiple Choice Chapter: 7 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 180, Cancer Spread; 181, Cancer Nomenclature

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17.Which statement about tumor grading is true?

A. Tumors are graded using the tumor size, node involvement, metastases (TNM) system.

B. A higher grade equates to a poorer prognosis.

C. Grading determines the level of cellular autonomy.

D. Grade I signifies highly deviant tissue development.

Answer: B Rationale: Tumor grading is a process of differentiating the level of anaplasia depicted by the tumor. Tumors are graded from I (well differentiated) to IV (highly undifferentiated). As the grade increases, the cells become more deviant from the tissue of origin resulting in a poorer prognosis. The tumor size, node involvement, metastases (TNM) system is used to stage tumors (a process of classifying the extent or spread of neoplasms), not grade them.

Question format: Multiple Choice Chapter: 7 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 180, Cancer Spread; 181, Cancer Classifications

18.What systemic manifestation of cancer results from the release of chemical mediators and energy utilization by neoplastic cells?

A. Lymphadenopathy B. Fever C. Necrosis D. Cachexia Answer: D

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Rationale: Cachexia is thought to result from early feelings of fullness with eating coupled with the release of chemical mediators, such as tumor necrosis factor, that induce a lack of appetite. Fever, lymphadenopathy, and necrosis are not caused by the release of chemical mediators and energy utilization by neoplastic cells.

Question format: Multiple Choice Chapter: 7 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 8 Page and Header: 182, General Manifestations

19.What type of care is focused on treating cancer symptoms without curing the cancer?

A. Palliative B. Alternative C. Regressive D. Alleviative Answer: A Rationale: Palliative care refers to treating symptoms such as pain, fatigue, and nausea. Alternative, regressive, and alleviative are terms that are not associated with treating cancer symptoms.

Question format: Multiple Choice Chapter: 7 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 9 Page and Header: 182, General Manifestations

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20.In what way do childhood cancers differ from adult cancers?

A. Most often childhood cancers originate as solid organ tumors of epithelial tissues.

B. Childhood cancers are more common than adult cancers.

C. Childhood cancers follow a mendelian pattern of inheritance.

D. Commonly childhood cancers have a mesodermal germ layer origin.

Answer: D Rationale: Most childhood cancers originate in the ectodermal (for nervous system cancers) and mesodermal germ layers, not in the epithelial tissues. Childhood cancer is less common than adult cancer and does not follow a mendelian pattern of inheritance.

Question format: Multiple Choice Chapter: 7 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 8 Page and Header: 186, Children and Cancer

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Test Generator Questions, Chapter 8, Altered Fluid and Electrolyte Balance 1. Which represents the greatest percentage of water in the extracellular compartment?

A. Interstitial volume B. Plasma volume C. Transcellular volume D. Intracellular volume Answer: A Rationale: The small extracellular compartment contains 20% of body fluid (water).

Of this 20%, interstitial fluids accounts for 14%, plasma volume accounts for 5%, and transcellular fluid makes up the remaining less than 1%.

Question format: Multiple Choice Chapter: 8 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 204, Module 2 Fluid Imbalance

2. Which ion is an anion?

A. Sodium B. Hydrogen C. Chloride D. Potassium Answer: C

Rationale: Negatively charged ions are called anions and include chloride, bicarbonate, sulfate, and phosphate. Sodium, hydrogen, and potassium are positively charged cations.

Question format: Multiple Choice Chapter: 8 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 200, Module 1 Electrolyte Imbalance

3. Which combination of ions is most likely to bind, forming molecules?

A. Anion and anion B. Anion and cation C. Cation and cation D. Anion, anion, and cation Answer: B Rationale: Anions are negatively charged ions. Ions with a positive charge are called cations. Ions with opposite charges (cations and anions) are attracted to each other and form molecules. Based on electroneutrality, cations and anions must be balanced in the body; therefore, one cation and one anion are more likely to form than two anions combined with only one cation.

Question format: Multiple Choice Chapter: 8 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 200, Module 1 Electrolyte Imbalance

4. Which measurement best describes the concentration of solute in a particular volume of fluid based on electrolyte charge equivalency?

A. mg/dL B. dL C. mEq/L D. mEq Answer: C Rationale: The number of electrolytes in body fluids is the concentration of solute in a particular volume of fluid. Electrolytes can also be expressed in measurements of milliequivalents per liter (mEq/L), which considers the charge equivalency for a specific weight of electrolyte. Milligrams per deciliter (mg/dL) describes the solute weight in one tenth of a liter (dL).

Question format: Multiple Choice Chapter: 8 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 200, Module 1 Electrolyte Imbalance 5. What type of pressure is generated as water moves through a membrane?

A. Osmotic pressure B. Hydrostatic pressure C. Filtration pressure D. Lymphatic pressure Answer: A Rationale: Osmotic pressure is generated as water moves through the membrane.

Hydrostatic forces (pressure of fluid) can promote movement of fluid based on the

pressure gradient, also known as filtration pressure. The lymphatic system removes the small amount of fluid that remains in the interstitial fluid and returns it to circulation.

Question format: Multiple Choice Chapter: 8 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 204, Fluid Transport

6. What term indicates the protein-dependent forces that promote fluid movement into the intravascular space?

A. Capillary filtration pressure B. Interstitial filtration pressure C. Capillary osmotic pressure D. Tissue filtration pressure Answer: C Rationale: Capillary osmotic pressure caused by proteins or other molecules can pull fluid from the interstitial space into the intravascular space. Capillary filtration pressure, interstitial filtration pressure, and tissue filtration pressure do not promote fluid movement into the intravascular space.

Question format: Multiple Choice Chapter: 8 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 204, Fluid Transport

7. What term identifies the hypothalamic sensory neurons that promote thirst when stimulated?

A. Baroreceptors B. Chemoreceptors C. Thermoreceptors D. Osmoreceptors Answer: D Rationale: The sensory neurons known as osmoreceptors are in the hypothalamic thirst center and promote thirst when activated. Baroreceptors sense blood flow and blood pressure in the major blood vessels of the circulatory system.

Chemoreceptors detect changes in the levels of oxygen and carbon dioxide in the blood, as well as the pH level. Thermoreceptors detect changes in temperature.

Question format: Multiple Choice Chapter: 8 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 207, Mechanisms to Promote Fluid Intake

8. Which class of diuretics works in the distal convoluted tubule of the kidney by preventing reabsorption of sodium?

A. Thiazide diuretics B. Loop diuretics C. Potassium sparing diuretics D. Proximal diuretics Answer: A

Rationale: Thiazide diuretics prevent sodium reabsorption in the distal convoluted tubule, as compared to loop diuretics that reduce reabsorption of sodium in the thick ascending limb. Potassium sparing diuretics reduce sodium reabsorption in the distal tubule and the collecting duct. Proximal diuretics are not a class of diuretics discussed in this chapter.

Question format: Multiple Choice Chapter: 8 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 207, Mechanisms to Promote Fluid Excretion

9. Which type of solution has extracellular osmotic force greater than that of the intracellular environment?

A. Hypotonic B. Isotonic C. Hypertonic D. Hydrotonic Answer: C Rationale: Hypertonic solutions have a greater osmolality than the intracellular fluid (ICF). Conversely, hypotonic solutions have a lower osmolality than the ICF. Isotonic solutions have the same osmolality as the ICF. Hydrotonic is not a solution type.

Question format: Multiple Choice Chapter: 8 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning

Learning Objective: 4 Page and Header: 208, Tonicity

10.Hyponatremia is associated with which clinical manifestation(s)? Select all that apply.

A. Hypotension B. Oliguria C. Edema D. Bradycardia E. Weight gain Answer: A, B Rationale: Clinical manifestations of hyponatremia include muscle twitching, weakness, hypotension, tachycardia, and reduced urine output (oliguria). Weight gain, bradycardia, and edema are not associated with hyponatremia.

Question format: Multiple Select Chapter: 8 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 201, Hyponatremia

11.Which action is an example of sodium–potassium pump transport?

A. Transport of potassium out of the cell B. Transport of ATP out of the cell C. Transport of sodium into the cell D. Transport of sodium out of the cell

Answer: D Rationale: Transport of sodium out of the cell occurs against its concentration gradient, requiring active transport through the energy-dependent sodium– potassium pump.

Question format: Multiple Choice Chapter: 8 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 201, Altered Sodium Balance

12.Which mineral decreases in association with increases in calcium?

A. Sodium B. Phosphate C. Magnesium D. Potassium Answer: B Rationale: Based on electroneutrality, cations and anions must be balanced in the body. Because calcium is a cation and phosphate is an anion, they have an inverse relationship. If the calcium level increases, the phosphate level decreases. Sodium, magnesium, and potassium are all cations.

Question format: Multiple Choice Chapter: 8 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6

Page and Header: 200, Electrolyte Imbalance

13.A client was recently diagnosed with hypoparathyroidism. Which electrolytes should be decreased in the client’s laboratory results?

A. Sodium B. Calcium C. Chloride D. Potassium Answer: B Rationale: Reduction or loss of parathyroid function results in calcium level imbalances. The inability to increase calcium levels due to lack of parathyroid hormone leads to hypocalcemia. Sodium, chloride, and potassium levels are not involved with hypoparathyroidism.

Question format: Multiple Choice Chapter: 8 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 216, Altered Calcium Balance: Hypoparathyroidism

14.In the initial phases, portal hypertension leads to ascites due to which mechanism of fluid transport?

A. Increased hydrostatic pressure B. Increased osmotic pressure C. Reduced hydrostatic pressure D. Reduced osmotic pressure

Answer: A Rationale: In portal hypertension, there is an elevation in the portal pressure of the liver. This increased pressure promotes fluid movement out of the capillaries through hydrostatic mechanisms, resulting in ascites. Portal hypertension is not caused by osmotic pressure, which is generated as water moves through the membrane.

Question format: Multiple Choice Chapter: 8 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 213, Pathophysiology

15.Treatment of ascites is removal of fluid by which procedure?

A. Amniocentesis B. Thoracentesis C. Culdocentesis D. Paracentesis Answer: D Rationale: Paracentesis is the insertion of a cannula into the peritoneal cavity to remove ascitic fluid. The other types of fluid removal are not discussed in this chapter.

Question format: Multiple Choice Chapter: 8 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning

Learning Objective: 1 Page and Header: 214, Treatment

16.Which condition is a clinical manifestation of hypoparathyroidism?

A. Oily hair and skin B. Hyperactivity C. Difficulty breathing D. Tingling in the extremities Answer: D Rationale: Clinical manifestations of hypoparathyroidism in adults include hair dryness and loss, nail ridges and breakage, skin dryness, bone loss, tingling in extremities, visual changes, muscle cramps, seizures, and fatigue. Oily hair and skin, hyperactivity, and difficulty breathing are not associated with hypoparathyroidism.

Question format: Multiple Choice Chapter: 8 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 217, Clinical Manifestations

17.Which measurement would be helpful when assessing for ascites?

A. Height B. Abdominal girth C. Resting heart rate D. Blood pressure

Answer: B Rationale: Measurement of abdominal girth or circumference is useful in diagnosing ascites, the most common complication in cirrhosis. Height, resting heart rate, and blood pressure are not informative in diagnosing ascites.

Question format: Multiple Choice Chapter: 8 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 213, Diagnostic Criteria

18.How can fluid shifts in isonatremic dehydration be described?

A. Intravascular to extravascular B. Extravascular to intravascular C. Extravascular to interstitial D. Absent Answer: D Rationale: There are no fluid shifts in isonatremic dehydration because there is equal solute and water loss. Fluid shifts between the extravascular and intravascular spaces occur in hyponatremic and hypernatremic dehydration.

Question format: Multiple Choice Chapter: 8 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 215, Pathophysiology

19.The nurse is administering a hypotonic intravenous solution to a client who was admitted for treatment of dehydration. Which finding(s) will the nurse report as evidence of adverse effects from excess administration of a hypotonic intravenous solution? Select all that apply.

A. Hypertension B. Peripheral edema C. Decreased plasma sodium level D. Weight gain of 4.4 lb (2 kg) in 48 hours E. Increased output of dilute urine Answer: B, C, D Rationale: Excessive administration of hypotonic solutions such as 5% dextrose in water can lead to dilutional hyponatremia. Because this causes the plasma to have a lower tonicity compared to the intracellular environment, fluid moves into the cells and interstitial spaces, leading to edema. The accumulation of excess fluid in these spaces will lead to excessive weight gain. Because the fluid is moving out of the intravenous space and into the interstitial and intracellular spaces, the nurse would expect the client’s blood pressure to decrease, not increase. Similarly, the nurse would expect a decrease in urine output if the intravascular volume is decreased.

Question format: Multiple Select Chapter: 8 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Learning Objective: 6 Page and Header: 208, Tonicity

20.A client arrives at the emergency department with signs of acute hypovolemia.

Which diagnostic test will the nurse evaluate as most relevant to determining if

the hypovolemia is related to water loss or blood loss?

A. Urine sodium B. Plasma sodium C. Hematocrit D. Blood urea nitrogen Answer: C Rationale: The nurse will assess the client’s hematocrit, which is expected to be low if the client has experienced blood loss and high if the client has lost water from the intravascular space. Although bleeding leads to isotonic hypovolemia and water loss to hypertonic hypovolemia, both urine and plasma sodium levels are less specific to identifying hemorrhage compared with assessing the client’s volume of red blood cells. Blood urea nitrogen (BUN) may be elevated in acute kidney injury, resulting from decreased perfusion of the kidneys. This can happen as the result of both blood and water loss, so testing BUN does not help the nurse determine the cause of the hypovolemia.

Question format: Multiple Choice Chapter: 8 Cognitive Level (Bloom’s): Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Learning Objective: 4 Page and Header: 209, Altered Fluid Balance

Test Generator Questions, Chapter 9, Altered Acid–Base Balance 1. What substance donates hydrogen ions?

A. Anion B. Cation C. Acid D. Base Answer: C Rationale: Acids are substances that donate hydrogen ions. Bases accept hydrogen ions. Cations are positively charged ions, and anions are negatively charged ions.

Question format: Multiple Choice Chapter: 9 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 221, Regulation of Acid and Base

2. Which is the major measurable cation used in the clinical calculation of the anion gap?

A. Sodium B. Chloride C. Bicarbonate D. Phosphate Answer: A

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Rationale: The clinical calculation of the anion gap uses sodium as the major measurable cation. Chloride and bicarbonate are major measurable anions used in the clinical calculation of the anion gap. Phosphate is considered an unmeasurable anion in the clinical calculation of the anion gap.

Question format: Multiple Choice Chapter: 9 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 221, Regulation of Acid and Base

3. Which action describes the role of buffer systems?

A. Trade weaker acids and bases for stronger ones B. Trade stronger acids and bases for weaker ones C. Trade acids for bases D. Trade bases for acids Answer: B Rationale: Buffer systems mix acid and base to resist pH change. They are responsible for trading stronger acids and bases for weaker ones.

Question format: Multiple Choice Chapter: 9 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 222, Buffer Systems

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4. Which substance is amphoteric?

A. Carbohydrate B. Lipid C. Protein D. Mineral Answer: C Rationale: Proteins are amphoteric as they can both accept or donate H+ ions.

Carbohydrates, lipids, and minerals cannot function as both an acid and base.

Question format: Multiple Choice Chapter: 9 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 222, Protein Buffer System

5. Which buffer system helps maintain acid–base balance by either excreting or retaining CO2, as needed?

A. Plasma B. Bicarbonate C. Protein D. Respiratory Answer: D Rationale: The respiratory buffer system maintains acid–base balance by excreting or retaining CO2 as needed. This is accomplished by increasing or decreasing the respiratory rate. The protein buffer system accepts or donates H+ to achieve balance.

Bicarbonate is the primary extracellular buffer that uses the weak acid H2CO3 and the

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weak base sodium bicarbonate. The plasma buffer system responds to hydrogen ion concentration.

Question format: Multiple Choice Chapter: 9 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 222, Buffer Systems

6. Which organ is the primary regulator of the balance between acids and bases?

A. Lung B. Kidney C. Heart D. Pancreas Answer: B Rationale: The kidneys are the primary regulators of acid and base balance. Renal regulation of pH is accomplished through generating, buffering, and eliminating acids and bases. The other options have roles in the regulation of acids and bases but are not the organ used as the primary regulator of acid and base balance.

Question format: Multiple Choice Chapter: 9 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 223, Renal Buffer System

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7. Which laboratory findings are consistent with metabolic alkalosis?

A. pH of 7.31, HCO3− of 22 mEq/L (22 mmol/L) B. pH of 7.29, HCO3− of 35 mEq/L (35 mmol/L) C. pH of 7.47, HCO3− of 20 mEq/L (20 mmol/L) D. pH of 7.49, HCO3− of 33 mEq/L (33 mmol/L) Answer: D Rationale: Metabolic alkalosis is characterized by increased pH (greater than 7.45) and HCO3− greater than 31 mEq/L (greater than 31 mmol/L). Decreased pH (less than 7.35) and HCO3− less than 24 mEq/L (less than 24 mmol/L) indicate metabolic acidosis.

Question format: Multiple Choice Chapter: 9 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 224, Metabolic Alkalosis

8. Which symptom is a clinical manifestation of metabolic acidosis?

A. Nausea B. Diarrhea C. Hyperactivity D. Increased heart rate Answer: A Rationale: Metabolic acidosis clinical manifestations include anorexia, nausea, vomiting, weakness, lethargy, confusion, coma, vasodilation, decreased heart rate, and flushed skin. Metabolic acidosis does not manifest in hyperactivity, an increased

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heart rate, nor diarrhea.

Question format: Multiple Choice Chapter: 9 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 224, Metabolic Acidosis

9. A client has recently been diagnosed with metabolic acidosis resulting from hyperlactatemia. Which medication should the nurse look for in the client’s health history that could be causing this finding?

A. Selective serotonin reuptake inhibitor B. Nucleoside analog reverse transcriptase inhibitor C. Proton pump inhibitor D. Monoamine oxidase inhibitor Answer: B Rationale: The use of nucleoside reverse transcriptase inhibitors (NRTIs) can cause lactic acid to build up in the blood. Selective serotonin reuptake inhibitor, proton pump inhibitor, and monoamine oxidase inhibitor do not result in hyperlactatemia.

Question format: Multiple Choice Chapter: 9 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 225, Altered Acid-Base Balance: Highly Active Antiretroviral Therapy (HAART)-Associated Acidosis

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10.Most people with hyperlactatemia experience which sign or symptom?

A. Abdominal discomfort B. Hepatic steatosis C. Hepatomegaly D. No symptoms Answer: D Rationale: Most people develop no symptoms of hyperlactatemia. Mild hyperlactatemia can induce abdominal discomfort. Hepatic steatosis (fatty liver) is often associated with symptomatic hyperlactatemia, resulting from NRTI-stimulated fat deposition in the liver. Severe hyperlactatemia is the disease subtype associated with hepatomegaly (enlarged liver), elevated liver enzymes, and hepatic failure.

Question format: Multiple Choice Chapter: 9 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 225, Altered Acid-Base Balance: Highly Active Antiretroviral Therapy (HAART)-Associated Acidosis

11.Which clinical manifestation is expected in a client with Gitelman syndrome?

A. Excessive urine output B. Constipation C. Limited urine output D. Seizures Answer: A

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Rationale: Gitelman syndrome causes polyuria not decreased urine output. It is not manifested by constipation or seizures.

Question format: Multiple Choice Chapter: 9 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 226, Altered Acid-Base Balance: Renal Tubulopathy

12.Which buffer system is the most rapid acting?

A. Plasma buffer system B. Respiratory buffer system C. Renal buffer system D. Potassium–hydrogen exchange Answer: A Rationale: The plasma buffer system relies on a rapid response of the chemical systems in the extracellular and intracellular compartments. Its response is immediate causing major shifts in pH until the respiratory and renal buffer systems are activated.

Question format: Multiple Choice Chapter: 9 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 222, Plasma Buffer Systems

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13.For which condition should a client receiving parenteral nutrition be monitored?

A. Lactic acidosis B. Metabolic acidosis C. Metabolic alkalosis D. Hyperlactatemia Answer: B Rationale: Hydrochloric acid infused as a component of parenteral nutrition may increase blood chloride levels with a simultaneous reduction in base, promoting conditions that favor metabolic acidosis. Metabolic acidosis may also result from metabolism of amino acids, leading to increased H+ production and need for buffering

by HCO3−. Lactic acidosis, metabolic alkalosis, and hyperlactatemia are not caused by parenteral nutrition.

Question format: Multiple Choice Chapter: 9 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 227, Altered Acid-Base Balance: Metabolic Acidosis in Parenteral Nutrition

14.A client with a severe acid–base imbalance resulting from total parenteral nutrition is at risk for which major complication?

A. Heart attack B. Stroke C. Seizure D. Anaphylactic shock Answer: C

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Rationale: Clients suffering from severe acid–base imbalances from total parenteral nutrition are at risk for neurologic manifestations such as seizures. The acid–base imbalance does not lead to heart attack, stroke, or anaphylactic shock, which is associated with allergic reactions.

Question format: Multiple Choice Chapter: 9 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 227, Altered Acid-Base Balance: Metabolic Acidosis in Parenteral Nutrition

15.Which condition results from a deficit of HCO3– (bicarbonate)?

A. Metabolic acidosis B. Respiratory acidosis C. Metabolic alkalosis D. Respiratory alkalosis Answer: A Rationale: Metabolic acidosis is characterized by a base deficit of HCO3−. In metabolic acidosis, there are increased HCO3− ions. Respiratory acidosis and alkalosis are not caused by HCO3− deficits. Metabolic alkalosis is characterized by an excess of HCO3−.

Question format: Multiple Choice Chapter: 9 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 224, Metabolic Acidosis

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16.In renal tubulopathy, what condition occurs as a result of the loss of strong cations sodium and potassium?

A. Metabolic acidosis B. Respiratory acidosis C. Metabolic alkalosis D. Respiratory alkalosis Answer: C Rationale: Hypokalemic and sodium losing tubulopathies are a group of autosomal recessive disorders characterized by metabolic alkalosis. The loss of potassium and sodium in renal tubulopathies does not lead to metabolic acidosis, respiratory acidosis, or respiratory alkalosis.

Question format: Multiple Choice Chapter: 9 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 226, Altered Acid-Base Balance: Renal Tubulopathy

17.Which rare complication from highly active antiretroviral therapy drugs (HAART) is potentially life threatening?

A. Hyperlactatemia B. Lactic acidemia C. Lactic acidosis D. Lactic alkalosis Answer: C Rationale: Highly active antiretroviral therapy drugs can cause hyperlactatemia,

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which is also known as lactic acidemia. Lactic acidemia does not cause symptoms in clients. Some clients will suffer a rare and life-threatening form of metabolic acidosis known as lactic acidosis that results from hyperlactatemia. Lactic alkalosis is not a complication of HAART. Question format: Multiple Choice Chapter: 9 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 225, Altered Acid-Base Balance: Highly Active Antiretroviral Therapy (HAART)-Associated Acidosis

18.The nurse examines a client’s laboratory results and notes an anion gap of 22 mEq/L (mmol/L). The nurse interprets this finding as evidence of which pathophysiologic process?

A. There is an accumulation of excess unmeasurable anions in the client’s plasma.

B. The client is losing excess bicarbonate, leading to an excess of unmeasurable anions.

C. There is a deficit of sodium and other cations, leading to an excess of anions.

D. The client is producing an excess of lactic acid due to decreased organ perfusion.

Answer: A Rationale: The calculation of anion gap (AG) involves determining the difference between sodium (major measurable cation), chloride, and bicarbonate (major measurable anions). It reflects the difference between the unmeasurable anions, including phosphates, sulfates, organic acids, and proteins. The normal range is 10 to 14 mEq/L (10 to 14 mmol/L), making 22 mEq/L (22 mmol/L) an elevated AG. Although lactic acidosis will result in an elevated AG, the nurse cannot conclude this

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from the information provided because there are other forms of metabolic acidosis.

Losing excess bicarbonate can result in acidosis, but this would be non-AG acidosis, so this does not correlate with an elevated AG. A deficit of cations will result in a low AG, not an elevated AG. Question format: Multiple Choice Chapter: 9 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process Learning Objective: 3 Page and Header: 221, Regulation of Acid and Base

19.The nurse is examining the laboratory results of a client with lactic acidosis whose pH is 7.35. Which mechanism(s) has contributed to the pH being within normal range? Select all that apply.

A. Bicarbonate was retained by the kidneys.

B. Hydrochloric acid was converted to carbonic acid.

C. Proteins donated hydrogen ions in response to low pH. D. There was increased expiration of carbon dioxide.

E. Hydrogen was moved into the intracellular space.

Answer: A, B, D, E Rationale: Several buffer systems help maintain pH level in times of imbalance. The plasma buffer system includes the potassium–hydrogen exchange, which moves hydrogen into the intracellular space. In the plasma, the conversion of stronger acids into weaker ones, primarily carbonic acid (H2CO3), also helps maintain pH within normal range. The respiratory buffer system will respond by exhaling carbon dioxide to elevate pH to within normal range. Proteins are amphoteric and can receive or donate H+ ions. In cases of low pH, the proteins should receive and not donate H+, which would further decrease pH.

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Question format: Multiple Select Chapter: 9 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process Learning Objective: 6 Page and Header: 221, Regulation of Acid and Base

20.The nurse is caring for a client prescribed lamivudine, a nucleoside reverse transcriptase inhibitor (NRTI). The nurse notes a new, mild elevation in the client’s lactate level, but there is no evidence of lactic acidosis syndrome (LAS). Which information will the nurse apply when determining the best course of action? a. No action is needed related to the prescribing of NRTIs unless the client’s pH is < 7.3. b. NRTIs should be automatically discontinued when lactatemia develops. c. No change in treatment is needed since mild lactatemia is an expected finding with NRTIs. d. The NRTI prescription may need to be changed due to evidence of lactatemia.

Answer: D Rationale: The nurse should notify the healthcare provider (HCP) of this new finding after conducting a full assessment of the client. The client’s treatment decision will be individualized based on the HCP’s assessment of the risk versus benefit in this situation. Depending on the situation, the NRTI treatment may be stopped or altered when hyperlactatemia develops. The client does not have to develop signs of LAS, such as a pH < 7.3, because treatment may be altered to prevent this serious complication. The medication will not be automatically stopped or continued based on hyperlactatemia alone.

Question format: Multiple Choice

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Chapter: 9 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Learning Objective: 7 Page and Header: 225Altered Acid–Base Balance: Highly Active Antiretroviral Therapy (HAART)-Associated Acidosis—Treatment

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Test Generator Questions, Chapter 10, Altered Neural Function 1. Which nervous system is composed of the parasympathetic nervous system and the sympathetic nervous system?

A. Central B. Somatic C. Autonomic D. Thoracolumbar Answer: C Rationale: The two major divisions of the autonomic nervous system are the sympathetic nervous system and the parasympathetic nervous system. The autonomic nervous system and somatic nervous system together comprise the peripheral nervous system. The central nervous system is composed of the brain and spinal cord. Thoracolumbar nervous system is not a division of the nervous system.

Question format: Multiple Choice Chapter: 10 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 247, Autonomic Nervous System

2. Which assessment is not used to establish diagnosis of hydrocephalus?

A. Measuring head circumference B. Transillumination C. Apgar D. Magnetic resonance imaging (MRI)

Answer: C Rationale: Diagnosis of hydrocephalus may be made by the noninvasive techniques of measurement of head circumference and transillumination. Other diagnostic techniques include computed tomography (CT) or MRI of the head for examination of ventricle size and cerebrospinal fluid flow. Apgar scores are not used in the diagnosis of hydrocephalus.

Question format: Multiple Choice Chapter: 10 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 8 Page and Header: 259, Diagnostic Criteria

3. What term indicates neurons that provide connections between sensory and motor neurons?

A. Afferent neurons B. Efferent neurons C. Cranial nerves D. Interneurons Answer: D Rationale: Interneurons provide connections between motor and sensory neurons.

Efferent neurons are also known as motor neurons. Afferent neurons are also known as sensory neurons. Cranial nerves are not a category of neurons.

Question format: Multiple Choice Chapter: 10 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation

Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 233, Neurons

4. Which structure produces myelin on long, single axons of the peripheral nervous system?

A. Schwann cells B. Dendrites C. Axons D. Oligodendrocytes Answer: A Rationale: Schwann cells produce myelin on long, single axons of the peripheral nervous system. Dendrites are multiple, branched extensions of the cell body that transmit impulses to the cell. Axons carry impulses away from the cell.

Oligodendrocytes form multilayered myelin segments around axons in the CNS. Question format: Multiple Choice Chapter: 10 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 233, Supporting Cells

5. Which statement defines a polarized cell?

A. The inside of the cell is more negative compared to the outside of the cell.

B. The inside of the cell is more positive compared to the outside of the cell.

C. The inside and outside of the cell are equal in electrical charge.

D. The cell reaches threshold with increasingly negative internal charge.

Answer: A Rationale: Polarized cells have a more negative inside compared with the outside of the cell; the difference is measured at approximately −70 mV. Question format: Multiple Choice Chapter: 10 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 234, Neurotransmission

6. The density of voltage-gated channels is greatest in which component of the neuron?

A. Cell body B. Axon hillock C. Dendrite D. Soma Answer: B Rationale: Voltage-gated channels are found in the axon hillock, the point at which the axon is joined to the cell body. Cell bodies and dendrites have few voltage-gated channels, which results in changes in membrane potential that are not strong enough to trigger an action potential. Voltage-gated channels are not found in the soma.

Question format: Multiple Choice Chapter: 10 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2

Page and Header: 234, Neurotransmission

7. Which stores current that is released during the action potential when at rest?

A. Capacitor B. Axon hillock C. Dendrite D. Microglia Answer: C Rationale: A dendrites is multiple, branched extensions of the cell body that transmit impulses to the cell body. At rest, the neuron and surrounding space act as a capacitor, storing current, which is released during the action potential.

Voltage-gated channels are found in the axon hillock, the point at which the axon is joined to the cell body. Microglia mount an immune response to areas of injury.

Question format: Multiple Choice Chapter: 10 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 234, Neurotransmission

8. Release of neurotransmitter occurs at which location in the neuron?

A. Presynaptic terminal B. Axon hillock C. Synaptic cleft D. Postsynaptic membrane Answer: A

Rationale: Presynaptic terminals contain neurotransmitters packaged in vesicles, mitochondria, and other cellular organelles. The action potential generated at the axon hillock of the presynaptic neuron leads to release of neurotransmitter from the synaptic vesicle. Release of neurotransmitters permits diffusion of these neurotransmitters into the synaptic cleft. Neurotransmitters released from vesicles at the synaptic cleft are then available to bind with specific receptors on the postsynaptic membrane.

Question format: Multiple Choice Chapter: 10 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 234, Communication Between Neurons; 242, Table 10.3

9. Which lobe of the brain is responsible for functions of perception, memory, and recognition of auditory stimuli?

A. Frontal B. Parietal C. Temporal D. Occipital Answer: C Rationale: The functions of the temporal lobe include perception, memory, and recognition of auditory stimuli. The occipital lobe is responsible for vision. The functions of the frontal lobe include reasoning, planning, speech, and movement. The parietal lobe is responsible for perception of touch, pressure, temperature, and pain.

Question format: Multiple Choice Chapter: 10 Cognitive Level (Bloom’s): Remember

Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 9 Page and Header: 237, Brain

10.Which functions are controlled by the cerebral cortex?

A. Consciousness and higher-order functions B. Voluntary movement and establishes posture C. Appetite, temperature, and water balance D. Auditory and visual responses Answer: A Rationale: The cerebral cortex controls consciousness and higher-order functions, including language and information processing. The basal ganglia control voluntary movement and establish posture. The hypothalamus controls body temperature, appetite, and water balance. The tectum controls auditory and visual responses.

Question format: Multiple Choice Chapter: 10 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 9 Page and Header: 238, Table 10.2 Brain Structures and Functions

11.What is gray matter primarily composed of?

A. Axons B. Cell bodies C. Dendrites D. Denervated tissue

Answer: B Rationale: The tissue of the cerebral cortex, basal ganglia, hypothalamus, and thalamus is gray matter, primarily composed of cell bodies; whereas other brain structures are composed of white matter, tissue composed primarily of myelinated axons and dendrites.

Question format: Multiple Choice Chapter: 10 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 9 Page and Header: 237, Brain

12.Which structure produces cerebrospinal fluid?

A. Dura mater B. Arachnoid mater C. Pia mater D. Choroid plexus Answer: D Rationale: Cerebrospinal fluid (CSF) is produced by the choroid plexus, a structure located in the two lateral and single third and fourth ventricles of the brain. The other structures do not produce CSF. Question format: Multiple Choice Chapter: 10 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1

Page and Header: 240, Cerebrospinal Fluid

13.Where is cerebrospinal fluid produced? Select all that apply.

A. Axon hillock B. Third ventricle C. Fourth ventricle D. Corpus callosum E. Cap junctions Answer: B, C Rationale: Cerebrospinal fluid (CSF) is produced by the choroid plexus, a structure located in the two lateral and single third and fourth ventricles of the brain.

Question format: Multiple Select Chapter: 10 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 240, Cerebrospinal Fluid

14.Bronchial smooth muscle relaxation and vascular smooth muscle constriction are caused by the direct actions of which nervous system?

A. Parasympathetic B. Sympathetic C. Somatic D. Central Answer: B

Rationale: The sympathetic nervous system is responsible for increased heart rate and motility, smooth muscle relaxation of the bronchioles, decreased peristalsis of the gastrointestinal tract and constriction of the anal sphincter, decreased bladder tone and constriction of urinary sphincter, vasoconstriction and elevated blood pressure, increased respiratory rate, pupil dilation and ciliary muscle relaxation, reduced secretion of the pancreas, and increased sweat gland secretion. The parasympathetic, somatic, and central systems are not directly responsible for these actions.

Question format: Multiple Choice Chapter: 10 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 248, Sympathetic Nervous System

15.Which neurons are involved in reflex activity? Select all that apply.

A. Afferent neurons B. Interneurons C. Efferent neurons D. Sensory neurons E. Motor neurons Answer: A, B, C, D, E Rationale: A basic functional pathway of the nervous system, the reflex arc represents the process by which stimuli are received and interpreted, and in turn stimulate a response. This process involves afferent (sensory) neurons, efferent (motor) neurons, and interneurons. For example, the patellar reflex requires one sensory neuron and one motor neuron with a synapse in the central nervous system. A tap on the patellar tendon causes a sudden contraction of the anterior thigh muscles through conduction of the nerve impulse through the sensory afferent to the dorsal horn of the

spinal cord. There, the impulse is conducted to an interneuron, then to the motor neuron, and away to the peripheral target, which is the skeletal muscle spindle of the anterior thigh.

Question format: Multiple Select Chapter: 10 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 250, Reflex Arcs

16.Injury-induced swelling of a neuron is due to which process?

A. Chromatolysis B. Atrophy C. Neuronophagia D. Intraneuronal inclusion Answer: A Rationale: Chromatolysis is the swelling of a neuron because of injury. Atrophy is the decrease in neuron size. Neuronophagia involves phagocytosis and inflammatory responses caused by a dead neuron damaging neighboring cells. Intraneuronal inclusions are distinctive structures formed in the nucleus or cytoplasm.

Question format: Multiple Choice Chapter: 10 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 236, Processes of Neural Injury

17.Which cell type responds to injury by the formation of a glial scar?

A. Microglia B. Astrocyte C. Oligodendrocyte D. Schwann cell Answer: B Rationale: In the central nervous system, astrocytes respond to local tissue injury through proliferation, forming a “glial scar.” None of the other cell types respond to injury by forming a glial scar.

Question format: Multiple Choice Chapter: 10 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 241, CNS Cellular Injury

18.Distal axonopathy and wallerian degeneration are responses to injury in which component of the nervous system?

A. Spinal B. Central C. Peripheral D. Cerebral Answer: C Rationale: Distal axonopathy and wallerian degeneration are two responses to injury in the peripheral nervous system. These are not responses to injury in the central nervous system, which includes the brain and spinal cord. Cerebral refers to the brain.

The term cerebral nervous system is not used.

Question format: Multiple Choice Chapter: 10 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 250, Mechanisms of Injury to the Peripheral Nervous System

19.Which definition describes countrecoup injury?

A. Closed head injury in the area of impact B. Closed head injury opposite from the area of direct impact C. Infection resulting from exposed brain tissue from an open traumatic injury D. Closed spinal cord injury resulting from complete severing of neurons Answer: B Rationale: A countrecoup injury is a closed head injury to the opposite side of the skull as the area of direct impact. Countrecoup does not describe the other types of injuries described.

Question format: Multiple Choice Chapter: 10 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 241, Traumatic Brain Injury

20.Multiple sclerosis is characterized by which form of neuron damage?

A. Mononeuropathy

B. Polyneuropathy C. Aneuropathy D. Transneuropathy Answer: B Rationale: Peripheral nerve damage involving multiple axons is known as polyneuropathy. Polyneuropathy can occur secondary to disease processes such as multiple sclerosis (MS), diabetes mellitus, nutrient deficiency, and toxic agents (arsenic). When nerve trauma is limited to a single area (mononeuropathy), conditions such as nerve entrapment and compression may contribute to impaired functional responses. Aneuropathy and transneuropathy are not terms used for neuron damage.

Question format: Multiple Choice Chapter: 10 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 250, Traumatic Peripheral Nerve Injury

21.Neuronal transmission with increased neuron impulse frequency, intensity, or cascade of transmission is often seen as a result of which type of injury?

A. Ischemic B. Excitation C. Traumatic D. Pressure Answer: B Rationale: Neurons that are easily depolarized or hyperexcitable may cause altered

signal transmission. Increased neuron impulse frequency, intensity, or cascade of transmission can lead to pathologic consequences because of excitation injury. These characteristics are not often seen as a result of ischemic, traumatic, and pressure injuries.

Question format: Multiple Choice Chapter: 10 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 243, Excitation Injury

22.Brain tumors will likely lead to which type of injury?

A. Ischemic B. Excitation C. Traumatic D. Pressure Answer: D Rationale: Central nervous system tumors can promote pressure injury. Brain and spinal cord compression, tumor infiltration, altered blood flow, and edema are often the sequelae of pressure injuries resulting from tumors. Tumors may obstruct cerebrospinal fluid flow and promote brain displacement to an area of lower pressure.

The tumor location and site of pressure injury determine the specific signs and symptoms. Brain tumors are less likely to lead to ischemic, excitation, and traumatic injuries.

Question format: Multiple Choice Chapter: 10 Cognitive Level (Bloom’s): Analyze Client Needs: Physiological Integrity: Physiological Adaptation

Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 244, CNS Pressure Injury

23.Which structure or system is responsible for modulating motor function and results in loss of coordinated movement and balance when damaged?

A. Pyramidal structures B. Extrapyramidal structures C. Peripheral neurons D. Cranial nerves Answer: B Rationale: The extrapyramidal system modulates motor function, attenuating erratic motions and maintaining muscle tone and stability of the trunk. Movement disorders are characteristic of extrapyramidal disorders, such as loss of coordinated movement and balance. The pyramidal system (providing control of voluntary movement), the cranial nerves, and peripheral neurons are not responsible for the loss of coordinated movement and balance.

Question format: Multiple Choice Chapter: 10 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 238, Spinal Cord

24.What type of injury leads to seizure disorders in cerebral palsy?

A. Ischemic B. Excitation

C. Traumatic D. Pressure Answer: A Rationale: The development of seizures is often associated with cerebral palsy, especially when the underlying event results in hypoxic/ischemic insult. Traumatic, pressure, and excitation injuries are less likely to be associated in the development of seizures in cerebral palsy.

Question format: Multiple Choice Chapter: 10 Cognitive Level (Bloom’s): Analyze Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 253, Clinical Manifestations

25.What type of injury results from seizure disorders in cerebral palsy?

A. Ischemic B. Excitation C. Traumatic D. Pressure Answer: B Rationale: Excitotoxic injury of the brain caused by excessive glutamate-mediated transmission may represent sequelae of neonatal brain injury. The neonatal brain, still undergoing maturation, is extremely vulnerable to cell death because of this excitotoxic injury. Neonatal seizures may reflect the consequences of brain injury in cerebral palsy. Ischemic, traumatic, and pressure injuries are not a result of seizure disorders in cerebral palsy.

Question format: Multiple Choice Chapter: 10 Cognitive Level (Bloom’s): Analyze Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 353, Clinical Manifestations

26.Which current drug treatments for multiple sclerosis are designed to slow the progress of myelin degeneration?

A. Antidepressants B. Anticonvulsants C. Immunomodulators D. Antibiotics Answer: C Rationale: The immunomodulator class of drugs are forms of beta interferon (IFN-β) and are the mainstays of treatment for clients with multiple sclerosis. These disease-modifying drugs are designed to target symptoms and delay progression of the disease. Antidepressants, anticonvulsants, and antibiotics do not play a role in slowing the disease progression in clients with multiple sclerosis.

Question format: Multiple Choice Chapter: 10 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 8 Page and Header: 257, Treatment

27.Congenital hydrocephalus is most often caused by which condition?

A. Brain tumor B. Narrowed cerebral aqueduct C. Meningitis D. Intraventricular hemorrhage Answer: B Rationale: Congenital hydrocephalus is often identified during fetal life or at birth. It may be caused by neural tube defects, including spina bifida, or by an alteration in the structure of the cerebral aqueduct or choroid plexus. Meningitis, brain tumors, and intraventricular hemorrhage are common conditions resulting in acquired hydrocephalus.

Question format: Multiple Choice Chapter: 10 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 10 Page and Header: 257, Pathophysiology

28.Loss of involuntary function is expected with spinal injury at which level?

A. C1 to C2 B. C7 to T1 C. T9 to T12 D. S1 to S5 Answer: A Rationale: High injuries at the level of C1 to C2 may result in loss of involuntary function, including sweating, blood pressure regulation, and body temperature

regulation. C7 through T1 injuries allow individuals to straighten their arms, but they may result in impaired fine motor skills. Trunk and lower body control are lost at T1, with return of sitting balance and abdominal muscle control from T9 through T12.

Spinal injury at the level of S1 to S5 may result in impaired bowel and bladder function.

Question format: Multiple Choice Chapter: 10 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 9 Page and Header: 259, Clinical Manifestations

29.Which component of the brain degenerates as a result of Parkinson disease?

A. Cerebral cortex B. Hippocampus C. Amygdala D. Basal ganglia Answer: D Rationale: Parkinson disease is characterized by the degeneration of the nigrostriatal pathway, located within the basal ganglia. The basal ganglia are important in the control of movement through regulation of inhibitory and excitatory stimuli. Neural degeneration in this component of the brain results in the primary manifestations of Parkinson disease. Degeneration in the hippocampus, amygdala, or the cerebral cortex results directly in Parkinson disease.

Question format: Multiple Choice Chapter: 10 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation

Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 262, Pathophysiology

Test Generator Questions, Chapter 11, Altered Mood, Attention, and Behavior 1. What internal, subjective psychological state directs how a person feels and perceives the world?

A. Emotion B. Mood C. Temperament D. Behavior Answer: B Rationale: Mood is an internal, subjective psychological state, which directs how a person feels and perceives the world. Emotions are feelings, temperament describes personality, and behavior is how a person responds to a situation.

Question format: Multiple Choice Chapter: 11 Cognitive Level (Bloom’s): Remember Client Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 269, Module 1 Regulation of Mood, Attention, and Behavior

2. What term indicates a stable representation of outlook that is not likely to change over time?

A. Emotion B. Mood C. Temperament D. Behavior

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Answer: C Rationale: Temperament (personality) is a stable representation of outlook. Mood falls between emotion, which change quickly, and temperament, which is more stable. Behavior does not relate to outlook but is the response a person makes in a given situation.

Question format: Multiple Choice Chapter: 11 Cognitive Level (Bloom’s): Remember Client Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 269, Module 1 Regulation of Mood, Attention, and Behavior

3. Which brain structure primarily controls judgment, decision-making, and problem solving?

A. Hypothalamus B. Prefrontal cortex C. Amygdala D. Hippocampus Answer: B Rationale: The prefrontal cortex controls judgment, decision-making, and problem solving. The hypothalamus regulates the autonomic nervous system. The amygdala contains emotionally charged memories. The hippocampus helps to create longterm memories.

Question format: Multiple Choice Chapter: 11 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation

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Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 269, Regulation of Mood

4. Which brain structure is primarily responsible for storing emotionally charged memories, sensing danger, and controlling persistent negative thoughts?

A. Hypothalamus B. Prefrontal cortex C. Amygdale D. Hippocampus Answer: C Rationale: The amygdala contains emotionally charged memories, senses danger, and controls persistent negative thoughts. The prefrontal cortex controls judgment, decision-making, and problem solving. The hypothalamus regulates the autonomic nervous system. The hippocampus helps to create long-term memories.

Question format: Multiple Choice Chapter: 11 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 269, Regulation of Mood (see figure)

5. A nurse notices that an 8-year-old client is staring intently at a screen while playing a video game. Which type of attention is the client demonstrating?

A. Focused B. Alternating C. Selective

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D. Sustained Answer: D Rationale: Sustained attention results in prolonged concentration with vigilance over time. Focused attention relates to noticing and responding to one specific stimulus. Alternating attention moves between tasks, and selective attention allows one to respond to a stimulus and filter out distractions.

Question format: Multiple Choice Chapter: 11 Cognitive Level (Bloom’s): Apply Client Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 2, Regulation of Attention

6. A client who has generalized anxiety disorder is often restless and has trouble concentrating. Which area of the client’s brain is most likely responsible for responses to anxiety-provoking events?

A. Cingulate gyrus B. Anterior cingulate cortex C. Hypothalamus D. Amygdala Answer: D Rationale: The amygdala is responsible for helping to recognize danger. It is active during periods of stress, anxiety, and depression. The cingulate gyrus is involved in emotional reactions to pain and affects aggressive behavior. The anterior cingulate cortex is associated with empathy and impulse control. The hypothalamus regulates the autonomic nervous system.

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Question format: Multiple Choice Chapter: 11 Cognitive Level (Bloom’s): Apply Client Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 270, Regulation of Attention

7. Which treatment is currently most effective for generalized anxiety disorder?

A. Abdominal breathing B. Selective serotonin reuptake inhibitors C. Cognitive–behavioral therapy D. Electroconvulsive therapy Answer: C Rationale: Cognitive–behavioral therapy is the most effective treatment for generalized anxiety disorder. Abdominal breathing, selective serotonin reuptake inhibitors, and electroconvulsive therapy are treatment possibilities but are not considered the most effective methods.

Question format: Multiple Choice Chapter: 11 Cognitive Level (Bloom’s): Remember Client Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 273, Generalized Anxiety Disorder

8. Which symptom is a common clinical manifestation of posttraumatic stress disorder in children?

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A. Separation anxiety B. Persistent very low mood C. Mania D. Hallucinations Answer: A Rationale: Separation anxiety is a common clinical manifestation of posttraumatic stress disorder in children. Additional clinical manifestations include sleep problems, anger outbursts, and disruptive behaviors. Persistent very low mood, mania, and hallucinations are not associated with posttraumatic stress disorder in children.

Question format: Multiple Choice Chapter: 11 Cognitive Level (Bloom’s): Remember Client Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 275, Posttraumatic Stress Disorder

9. According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), clinical manifestations of posttraumatic stress disorder must be present for how long for a diagnosis to be made?

A. 1 month B. 3 months C. 6 months D. 12 months Answer: A Rationale: Posttraumatic stress disorder is diagnosed after at least 1 month of clinical manifestations. The other options exceed the Diagnostic and Statistical

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Manual of Mental Disorders, 5th edition (DSM-5) diagnostic criteria.

Question format: Multiple Choice Chapter: 11 Cognitive Level (Bloom’s): Remember Client Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 276, Posttraumatic Stress Disorder, Diagnostic Criteria

10.A client, who is a violinist, has been diagnosed with major depressive disorder and has stopped playing the violin. The client says, “There is just no joy in it for me anymore.” What symptom of depression is the client demonstrating?

A. Mania B. Impulsivity C. Anhedonia D. Regression Answer: C Rationale: Loss of interest in something that is usually enjoyed describes anhedonia. Mania refers to elevated mood or behavior, impulsivity describes actions without foresight, and regression relates to returning to a less developed state.

Question format: Multiple Choice Chapter: 11 Cognitive Level (Bloom’s): Apply Client Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 277, Major Depressive Disorder

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11.Genetic heritability is found to be a cause of major depressive disorder in what percentage of female clients?

A. 10% B. 20% C. 30% D. 40% Answer: D Rationale: Genetic heredity of major depressive disorder is estimated at 40% for female clients and 30% for male clients.

Question format: Multiple Choice Chapter: 11 Cognitive Level (Bloom’s): Remember Client Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 277, Major Depressive Disorder, Pathophysiology

12.What condition is believed to be a primary cause of major depressive disorder?

A. Neurotransmitter deficiency B. Exposure to a traumatic event C. Increased response in the amygdala to anxiety-provoking events D. Fetal exposure to teratogens Answer: A Rationale: Depression is believed to be a condition resulting from a deficiency in neurotransmitters or alterations in the synapses that use the neurotransmitters in critical areas of the brain. Although trauma, increased response in the amygdala to anxiety-provoking events, and fetal exposure to teratogens may lead to depressive

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disorder, they are not considered primary causes.

Question format: Multiple Choice Chapter: 11 Cognitive Level (Bloom’s): Remember Client Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 277, Major Depressive Disorder, Pathophysiology

13.Which symptom is a typical clinical manifestation of the manic phase of bipolar disorder?

A. Anhedonia B. Rapid and excessive speech C. Feelings of worthlessness D. Unrelenting fatigue Answer: B Rationale: The manic phase of bipolar disorder includes clinical manifestations such as rapid and excessive speech and elevation in mood or irritability. Anhedonia, fatigue, and feelings of worthlessness are associated with the depressive phase of bipolar disorder.

Question format: Multiple Choice Chapter: 11 Cognitive Level (Bloom’s): Remember Client Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 279, Bipolar Affective Disorder, Pathophysiology

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14.Which treatment is commonly used for bipolar affective disorder?

A. Language training B. Electroconvulsive therapy C. Amphetamine salts D. Lithium carbonate Answer: D Rationale: Bipolar disorder is treated with psychotherapy and medications. The medications used to treat bipolar disorder include lithium carbonate and sodium valproate, which are mood stabilizers. Electroconvulsive therapy, language training, and amphetamine salts are not treatment for bipolar disorders.

Question format: Multiple Choice Chapter: 11 Cognitive Level (Bloom’s): Remember Client Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 280, Bipolar Affective Disorder, Treatment

15.An underlying cause of attention-deficit hyperactivity disorder (ADHD) is genetic variants associated with which type of deficiency or impairment?

A. Dopamine B. Melatonin C. Serotonin D. Glutamate Answer: A Rationale: Attention-deficit hyperactivity disorder (ADHD) is associated with genetic variants causing impairment of dopamine. Glutamate, serotonin, and melatonin are

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not associated with ADHD. Question format: Multiple Choice Chapter: 11 Cognitive Level (Bloom’s): Understand Client Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 280, Attention-Deficit Hyperactivity Disorder, Pathophysiology

16.What are the three primary clinical manifestations of attention-deficit hyperactivity disorder (ADHD)?

A. Inattention, hyperactivity, and impulsivity B. Inattention, mania, and impulsivity C. Anhedonia, hyperactivity, and impulsivity D. Anxiety, hyperactivity, and hallucinations Answer: A Rationale: Clinical manifestations of attention-deficit hyperactivity disorder (ADHD) include inattention, hyperactivity, restlessness, impulsivity, disruptive behavior, difficulties in school or work, and difficulties in social situations. They do not include mania, anhedonia, anxiety, or hallucinations.

Question format: Multiple Choice Chapter: 11 Cognitive Level (Bloom’s): Remember Client Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 281, Attention-Deficit Hyperactivity Disorder, Clinical Manifestations

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17.Which treatment is commonly used for autism spectrum disorders?

A. Cognitive–behavioral therapy B. Selective serotonin reuptake inhibitors C. Electroconvulsive therapy D. Stimulants Answer: A Rationale: Cognitive–behavior therapy is commonly used to treat clients diagnosed with autism spectrum disorders. Stimulants, electroconvulsive therapy, and selective serotonin reuptake inhibitors are not used to treat autism spectrum disorders.

Question format: Multiple Choice Chapter: 11 Cognitive Level (Bloom’s): Remember Client Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 283, Autism Spectrum Disorders, Treatment

18.Which symptom is a common clinical manifestation of autism spectrum disorders?

A. Delusions B. Impaired social interaction C. Mania D. Persistent anxiety Answer: B Rationale: Clinical manifestations of the autism spectrum disorders include impaired social interaction such as lack of intuition, difficulty with imaginative play, or

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inattention to social cues. Delusions, mania, and persistent anxiety are not associated with autism spectrum disorders.

Question format: Multiple Choice Chapter: 11 Cognitive Level (Bloom’s): Remember Client Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 282, Autism Spectrum Disorders, Clinical Manifestations

19.Which symptom is a common clinical manifestation of schizophrenia?

A. Elevated mood B. Fatigue C. Delusions D. Flashbacks Answer: C Rationale: Delusions, hallucinations, and disorganized thoughts and speech are clinical manifestations associated with schizophrenia. Schizophrenia is not clinically manifested by flashbacks, fatigue, or elevated mood.

Question format: Multiple Choice Chapter: 11 Cognitive Level (Bloom’s): Remember Client Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 283, Schizophrenia, Clinical Manifestations

20.What factor is believed to be a significant cause of autism spectrum disorders?

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A. Neurotransmitter deficiency B. Exposure to a traumatic event C. Increased response in the amygdala to anxiety-provoking events D. Maternal exposure to teratogens Answer: D Rationale: Autism spectrum disorders have been linked to fetal exposure to teratogens, such as pollution, infections, heavy metals, and toxins. Autism spectrum disorders are not caused by exposure to a traumatic event, increased responsiveness of the amygdala, nor neurotransmitter deficiency.

Question format: Multiple Choice Chapter: 11 Cognitive Level (Bloom’s): Remember Client Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 281, Autism Spectrum Disorders, Pathophysiology

21.What treatment is likely to be effective for schizophrenia?

A. Antipsychotics B. Stimulants C. Lithium carbonate D. Selective serotonin reuptake inhibitors Answer: A Rationale: Schizophrenia is treated with antipsychotic medications and psychological and social support. It is not treated with stimulants, lithium carbonate, or selective serotonin reuptake inhibitors.

Question format: Multiple Choice

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Chapter: 11 Cognitive Level (Bloom’s): Remember Client Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 284, Schizophrenia, Treatment

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Test Generator Questions, Chapter 12, Altered Somatic and Special Sensory Function 1. Hair cells are classified as which type of receptor?

A. Mechanoreceptor B. Chemoreceptor C. Osmoreceptor D. Photoreceptor Answer: A Rationale: Hair follicles are an example of a mechanoreceptor cell type, serving the function of deep tissue sensation. Chemoreceptors include taste buds. Photoreceptors include rods and cones. Osmoreceptors are a type of mechanoreceptor responsible for cell stretch.

Question format: Multiple Choice Chapter: 12 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 290, Table 12.2 Sensory Receptor Forms and Functions

2. The sensation of taste is recognized by ligand binding to which receptor type?

A. Mechanoreceptor B. Chemoreceptor C. Osmoreceptor D. Photoreceptor Answer: B

Rationale: The sensation of taste is mediated by the chemoreceptors in the taste buds of the tongue. The functions of mechanoreceptors include sensation, hearing, and proprioception. Osmoreceptors are a type of mechanoreceptor responsible for cell stretch. Photoreceptors are responsible for vision.

Question format: Multiple Choice Chapter: 12 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 307, Taste

3. Vision in dim light is mediated through which type of receptor?

A. Mechanoreceptor B. Chemoreceptor C. Osmoreceptor D. Photoreceptor Answer: D Rationale: The two main photoreceptors are rods and cones. Rods produce a photopigment, rhodopsin, allowing vision in dim light. Chemoreceptors are responsible for the sensation of taste. The functions of mechanoreceptors include sensation, hearing, and proprioception. Osmoreceptors are a type of mechanoreceptor responsible for cell stretch.

Question format: Multiple Choice Chapter: 12 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2

Page and Header: 297, Visual Structures and Function

4. Signal transduction of an impulse to the thalamus for processing is accomplished by?

A. First-order neurons B. Second-order neurons C. Third-order neurons D. Fourth-order neurons Answer: B Rationale: Second-order neurons relay sensory input from reflex networks and sensory pathways directly to the thalamus. First-order neurons communicate sensory information from the periphery to the central nervous system. Third-order neurons communicate sensory information from the thalamus to the primary somatosensory cortex. Fourth-order neurons are not a category of neuron organization.

Question format: Multiple Choice Chapter: 12 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 290, Somatosensory Neuronal Organization

5. Signal transduction is fastest in which type of somatosensory nerve fiber?

A. Type A-alpha B. Type A-beta C. Type A-delta D. Type C

Answer: A Rationale: A-alpha nerve fibers are large, myelinated fibers that carry information related to proprioception. A-beta nerve fibers are medium-sized, myelinated fibers that carry information related to touch. A-delta nerve fibers are small, myelinated fibers that carry information related to mechanical stimuli, cold, and fast pain. C nerve fibers are small, unmyelinated fibers that carry information related to mechanical stimuli, heat, cold, itch, and slow pain.

Question format: Multiple Choice Chapter: 12 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 291, Dorsal Root Ganglia Fibers

6. Which subtype of fibers transmits signals that are interpreted and perceived as fast pain?

A. Alpha B. Beta C. Delta D. C nerve Answer: C Rationale: A-delta nerve fibers are small, myelinated fibers that carry information related to mechanical stimuli, cold, and fast pain. A-alpha nerve fibers are large, myelinated fibers that carry information related to proprioception. A-beta nerve fibers are medium-sized, myelinated fibers that carry information related to touch. C nerve fibers are small, unmyelinated fibers that carry information related to mechanical stimuli, heat, cold, itch, and slow pain.

Question format: Multiple Choice Chapter: 12 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 291, Dorsal Root Ganglia Fibers

7. Which type of nerve fiber carries information related to touch?

A. Type A B. Type B C. Type C D. Type D Answer: A Rationale: A-alpha nerve fibers are large, myelinated fibers that carry information related to proprioception. A-beta nerve fibers are medium-sized, myelinated fibers that carry information related to touch. A-delta nerve fibers are small, myelinated fibers that carry information related to mechanical stimuli, cold, and fast pain. C nerve fibers are small, unmyelinated fibers that carry information related to mechanical stimuli, heat, cold, itch, and slow pain.

Question format: Multiple Choice Chapter: 12 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 291, Dorsal Root Ganglia Fibers

8. Unmyelinated fibers with the slowest rate of signal transmission are known as: A. type A. B. type B. C. type C. D. type D. Answer: C Rationale: Type C nerve fibers have the smallest axon diameter, are unmyelinated, and conduct impulses the slowest. A-alpha nerve fibers are large, myelinated fibers that carry information related to proprioception. A-beta nerve fibers are medium-sized, myelinated fibers that carry information related to touch. A-delta nerve fibers are small, myelinated fibers that carry information related to mechanical stimuli, cold, and fast pain.

Question format: Multiple Choice Chapter: 12 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 291, Dorsal Root Ganglia Fibers

9. Which description of fiber type is likely to have the fastest rate of transmission?

A. Small diameter, unmyelinated B. Small diameter, myelinated C. Large diameter, unmyelinated D. Large diameter, myelinated Answer: D Rationale: A-alpha, A-beta, and A-delta nerve fibers have the largest axon diameter,

have myelin, and conduct impulses the fastest, while C nerve fibers have the smallest axon diameter, are unmyelinated, and conduct impulses the slowest. Type B and D fibers are not discussed in this chapter.

Question format: Multiple Choice Chapter: 12 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 291, Dorsal Root Ganglia Fibers

10.The ability to identify the specific location of skin touch in two different areas is communicated through which pathway?

A. Discriminative B. Anterior spinothalamic C. Lateral spinothalamic D. Posterior spinothalamic Answer: A Rationale: The discriminative pathway identifies an object based on touch or the location of skin touch in two different areas, known as two-point discrimination. The anterolateral pathway involves both the anterior and lateral spinothalamic pathways.

The sensations of pain, temperature, crude touch, and pressure not requiring the specific location of the origin of the stimulus are transmitted along this pathway. The posterior spinothalamic pathway is not discussed in this chapter.

Question format: Multiple Choice Chapter: 12 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning

Learning Objective: 3 Page and Header: 291, Dermatome Innervation

11.What term indicates skin receptors communicating the sensation of heavy and continuous touch and pressure?

A. Meissner corpuscles B. Merkel disks C. Hair follicle receptors D. Ruffini endings Answer: D Rationale: Ruffini endings are skin receptors that communicate the sensation of detecting heavy and continuous touch and pressure. Meissner corpuscles are skin receptors that communicate the highly developed sense of touch sensation. Merkel disks are skin receptors that communicate the sensation of movement of light objects over skin and vibration. Hair follicle receptors communicate the sensation of detecting movement on the body’s surface.

Question format: Multiple Choice Chapter: 12 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 291, Tactile Stimulation

12.Detection of movement on the surface of the body is mediated by which receptor type?

A. Meissner corpuscle B. Merkel discs

C. Hair follicle receptor D. Ruffini ending Answer: C Rationale: Hair follicle receptors communicate the sensation of detecting movement on the body’s surface. Ruffini endings are skin receptors that communicate the sensation of detecting heavy and continuous touch and pressure. Meissner corpuscles are skin receptors that communicate the highly developed sense of touch sensation.

Merkel disks are skin receptors that communicate the sensation of movement of light objects over skin and vibration.

Question format: Multiple Choice Chapter: 12 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 291, Tactile Stimulation

13.Which receptors initiate the transmission of the vibration sensation?

A. Meissner corpuscles B. Merkel discs C. Hair follicle receptors D. Ruffini endings Answer: B Rationale: Merkel disks are skin receptors that communicate the sensation of movement of light objects over skin and vibration. Hair follicle receptors communicate the sensation of detecting movement on the body’s surface. Ruffini endings are skin receptors that communicate the sensation of detecting heavy and continuous touch

and pressure. Meissner corpuscles are skin receptors that communicate the highly developed sense of touch sensation.

Question format: Multiple Choice Chapter: 12 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 291, Tactile Stimulation

14.Blurred vision and loss of fine-tuning of focus may be due to impaired function of which eye structure?

A. Lens B. Retina C. Trabecular network D. Lacrimal gland Answer: A Rationale: Light entering the eye contacts the clear lens, responsible for fine-tuning focus. The ability of the lens to change its shape, or accommodate, allows clear vision at a variety of distances. Impaired function of the lens would result in blurred vision and loss of fine-tuning of focus. The other visual structures are responsible for different aspects of vision.

Question format: Multiple Choice Chapter: 12 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 297, Visual Structures and Function

15.Loss of color vision is most likely due to damage to which structure?

A. Central retina B. Peripheral retina C. Lens D. Cornea Answer: A Rationale: The center of the retina, the macula, is the area responsible for central vision, color vision, and fine detail. Damage to the central retina could result in loss of color vision. The peripheral retina, lens, and cornea are not responsible for color vision.

Question format: Multiple Choice Chapter: 12 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 297, Visual Structures and Function

16.Loss of night vision is most likely due to damage to which structure?

A. Central retina B. Peripheral retina C. Lens D. Cornea Answer: B Rationale: The peripheral retina is highly concentrated with rods, which promote peripheral and night vision. Damage to the peripheral retina could result in loss of night vision. The central retina, lens, and cornea are not responsible for night vision.

Question format: Multiple Choice Chapter: 12 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 297, Visual Structures and Function

17.Which receptor type requires bright light for generation of nerve impulses?

A. Free nerve endings B. Hair cells C. Rods D. Cones Answer: D Rationale: The photoreceptors called cones provide the ability to see bright light and color. Cone photopigments require bright light for breakdown and generation of nerve impulses. The other receptor types do not require bright light for the generation of nerve impulses.

Question format: Multiple Choice Chapter: 12 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 297, Visual Structures and Function

18.Which condition is not a risk factor for glaucoma?

A. Advanced age

B. Diabetes C. Eye trauma D. Hypotension Answer: D Rationale: Hypotension is not a risk factor for glaucoma. Risk factors in the development of glaucoma include age (over 60 years), family history, diabetes, hypertension, sickle cell anemia, eye trauma, and long-term steroid use.

Question format: Multiple Choice Chapter: 12 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 9 Page and Header: 315, Clinical Manifestations

19.Which is generated from the absorption of light in receptors with differing combinations of retinene and opsin allowing for light absorption? Select all that apply.

A. Red B. Green C. Blue D. Yellow E. Violet Answer: A, B, C Rationale: There are three types of pigments in retinal cones: erythrolabe (red cones), chlorolabe (green cones), and cyanolabe (blue cones). Each pigment contains a different combination of retinene and opsin, which results in absorption of light of

different wavelengths and colors. These three cones produce the full spectrum of color; yellow and violet do not have specific cones.

Question format: Multiple Select Chapter: 12 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 297, Visual Structures and Function

20.Which term describes eye movement allowing the ability to smoothly follow an object?

A. Saccades B. Pursuit C. Convergence D. Divergence Answer: B Rationale: Pursuit is eye movement allowing the ability to smoothly follow an object.

Saccades is eye movement allowing the ability to look from object A to object B. Convergence/divergence is eye movement allowing the ability of both eyes to turn inward/both eyes to turn outward.

Question format: Multiple Choice Chapter: 12 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 298, Control of Eye Movement

21.The aqueous humor is released in which space of the eye chamber?

A. Between the cornea and the lens B. Between the iris and the lens C. Between the sclera and the lens D. Between the lens and the retina Answer: B Rationale: The aqueous humor is released in the space between the iris and the lens (the posterior chamber). It is not released in the anterior chamber.

Question format: Multiple Choice Chapter: 12 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 299, Aqueous Humor

22.What term describes the error in refraction resulting from altered focus on an image in front of the retina due to lens thickness?

A. Myopia B. Hyperopia C. Amblyopia D. Presbyopia Answer: A Rationale: Myopia is a common error in refraction in which the eye focuses an image in front of the retina due to lens thickness. Hyperopia is caused by the focusing of an image behind the retina, which alters the transmission of light. Amblyopia, commonly known as “lazy eye,” may result from strabismus, leading to the loss of visual detail

from uncoordinated eye movement and focus. Presbyopia, a condition of farsightedness associated with aging, results from the inability of the ciliary muscle and lens to accommodate for near vision.

Question format: Multiple Choice Chapter: 12 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 300, Errors in Refraction

23.What term indicates an ocular muscle imbalance resulting in “lazy eye?”

A. Myopia B. Hyperopia C. Amblyopia D. Presbyopia Answer: C Rationale: Amblyopia, commonly known as “lazy eye,” may result from strabismus, leading to the loss of visual detail from uncoordinated eye movement and focus.

Hyperopia is commonly referred to as farsightedness. Myopia is commonly known as nearsightedness. Presbyopia is a condition of farsightedness associated with aging.

Question format: Multiple Choice Chapter: 12 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 300, Alterations in Eye Movement

24.What is the most common type of cataract?

A. Nuclear B. Cortical C. Subcapsular D. Suprascapular Answer: A Rationale: Cataracts are classified into three types: nuclear, cortical, and subcapsular. The most common of the types is nuclear sclerotic. Suprascapular is not a classification of cataracts.

Question format: Multiple Choice Chapter: 12 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 301, Alterations in Protective Eye Structures

25.Otitis media is a condition of the: A. pinna.

B. middle ear.

C. inner ear.

D. cochlea.

Answer: B Rationale: Otitis media is an infection in the middle ear. It does not describe infection in other parts of the ear.

Question format: Multiple Choice Chapter: 12

Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 305, Alteration in Middle Ear Function

26.Otitis externa is a condition of the: A. outer ear.

B. ear canal.

C. inner ear.

D. eustachian tube.

Answer: A Rationale: Otitis externa, commonly known as “swimmer’s ear,” is the inflammation of the external ear. It does not describe inflammation of the other parts of the ear.

Question format: Multiple Choice Chapter: 12 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 305, Disorders of the External Ear

27.Mastoiditis is a complication of a common condition of which part of the ear?

A. Cartilage B. Middle ear C. Cochlea D. Auditory bulla

Answer: B Rationale: Mastoiditis may result as a complication of otitis media (infection of the middle ear). It does not commonly result from infections in the inner where the cochlea is located or outer ear where the auditory bulla and cartilage are located.

Question format: Multiple Choice Chapter: 12 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 10 Page and Header: 305, Alteration in Middle Ear Function

28.Which structure is not involved in balance and equilibrium?

A. Cochlea B. Semicircular canals C. Utricle D. Saccule Answer: A Rationale: The three semicircular canals and vestibule (containing the utricle and saccule, connected membranous sacs) are important for balance and equilibrium. The cochlea contains receptors responsible for the neural impulse that allows hearing.

Question format: Multiple Choice Chapter: 12 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 9 Page and Header: 304, Internal Ear

29.What symptom is a common result of labyrinthitis?

A. Conductive hearing loss B. Distorted central vision C. The sensation of deep, visceral pain D. Vertigo Answer: D Rationale: Labyrinthitis, or inflammation of the labyrinth of the internal ear, precipitates severe vertigo and sensorineural hearing loss. It does not result in conductive hearing loss, visceral pain, or central vision changes.

Question format: Multiple Choice Chapter: 12 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 305, Alteration in Internal Ear Function

30.Which terminology indicates hearing loss limited to processes involving the middle ear?

A. Mixed hearing loss B. Sensorineural hearing loss C. Conductive hearing loss D. Central auditory processing disorder Answer: C Rationale: Conductive hearing loss is localized to the outer or middle ear, and it may be temporary or permanent. The internal ear or the cochlear nerve is usually involved in sensorineural hearing loss. Mixed hearing loss refers to a combination of both sensorineural and conductive hearing loss. Central auditory processing disorder is a

disorder involving altered auditory signal processing in the brain.

Question format: Multiple Choice Chapter: 12 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 306, Hearing Evaluation

31.Hearing is optimally restored by cochlear implants in which type of hearing loss?

A. Mixed hearing loss B. Sensorineural hearing loss C. Conductive hearing loss D. Central auditory processing disorder Answer: B Rationale: Sensorineural hearing loss usually involves the internal ear or the cochlear nerve. Cochlear implants are artificial devices surgically placed behind the ear. Using electrical stimulation of nerve endings, electrodes implanted in the cochlea transmit sounds to the cochlear nerve, bypassing structures in the middle and external ear (which are involved in conductive and mixed hearing loss types). Cochlear implants do not restore hearing loss due to central auditory processing disorder.

Question format: Multiple Choice Chapter: 12 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 8 Page and Header: 307, Treatment of Alterations in Hearing

32.Pain originating outside the nervous system is known as: A. nociceptive.

B. neurogenic.

C. neuropathic.

D. radicular.

Answer: A Rationale: When the stimulus is initiated in skin, joints, muscles, bones, and other internal organs, but not within the central nervous system, the pain is characterized as nociceptive. Pain originating within the central nervous system is termed neurogenic or neuropathic. Pain that radiates from the back and hip into the legs is termed radicular.

Question format: Multiple Choice Chapter: 12 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 292, Characterization of Pain

33.Impulses along which type of fibers transmit dull and burning pain sensations?

A. Type A-alpha fibers B. Type A-delta fibers C. Type A-beta fibers D. Type C fibers Answer: D Rationale: Impulses along type C fibers produce a dull ache or burning general response. Impulses along type A fibers produce sensations of sharp, stinging, or

pin-prick–type local sensations.

Question format: Multiple Choice Chapter: 12 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 294, Box 12.1 Processes of Nociception

Test Generator Questions, Chapter 13, Altered Hormonal and Metabolic Regulation 1. Which structure is responsible for controlling the regulation of many hormones?

A. Paracrine pathway B. Neurotransmitters C. Limbic system D. Hypothalamic–pituitary axis Answer: D Rationale: The hypothalamic–pituitary axis controls the synthesis and secretion of many hormones including both releasing and inhibiting hormones.

Neurotransmitters are chemical messengers that rapidly stimulate a neural response. The limbic system is a structure in the central nervous system that regulates emotions. The paracrine pathway characterizes cell-to-cell communication.

Question format: Multiple Choice Chapter: 13 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 324, The Hypothalamic–Pituitary Axis

2. Which is true about the action of the hypothalamus on the posterior pituitary gland?

A. Hormones travel within blood vessels to this part of the pituitary.

B. Hypothalamus produces antidiuretic hormone released from this part of the pituitary.

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C. Hypothalamus stimulates releasing hormones from this part of the pituitary.

D. Hypothalamus bypasses the posterior pituitary.

Answer: B Rationale: The hypothalamus produces antidiuretic hormone and oxytocin, which travel along nerve axons to the posterior pituitary. Hormones travel through the hypophyseal portal system to the anterior pituitary gland. The hypothalamus stimulates releasing hormones from the anterior pituitary. The hypothalamus does not bypass the posterior pituitary gland.

Question format: Multiple Choice Chapter: 13 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 324, The Hypothalamic–Pituitary Axis

3. Hormones travel from the hypothalamus to the anterior pituitary via which route?

A. Hypophyseal portal system B. Nerve axons C. Lymphatic system D. Systemic circulation Answer: A Rationale: Hormones travel through the hypophyseal portal system to the anterior pituitary gland. Nerve axons serve as the primary transmission lines of the nervous system. The lymphatic system primarily moves lymph into the bloodstream.

Systemic circulation moves blood and its nutrients throughout the body.

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Question format: Multiple Choice Chapter: 13 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 324, The Hypothalamic–Pituitary Axis

4. What household tool functions in a similar way to that of the negative feedback loop?

A. Thermostat B. Dishwasher C. Microwave D. Toaster Answer: A Rationale: A thermostat is similar to the negative feedback loop. When the temperature gets too warm, the thermostat turns the heat source off, and when too cold, it activates the furnace. Likewise, the negative feedback loop stops or starts the stimulation, production, or secretion of hormones to maintain homeostasis. A dishwasher, microwave, and toaster are linear and do not use positive or feedback loops.

Question format: Multiple Choice Chapter: 13 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 325, Feedback Mechanisms

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5. Which process does not prevent the accumulation of hormones in the body?

A. Degradation by enzymes B. Inactivation by the liver C. Inhibition of hormone release by somatostatin D. Elimination through the urine or feces Answer: C Rationale: Degradation by enzymes, inactivation of the liver, and elimination through the urine or feces all prevent an accumulation of hormones in the body.

Somatostatin inhibits growth hormone and thyroid-stimulating hormones. If somatostatin is inhibited, it cannot decrease the accumulation of growth hormone or thyroid-stimulating hormone.

Question format: Multiple Choice Chapter: 13 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 324, The Hypothalamic–Pituitary Axis

6. Which best explains why hormones only act on certain parts of the body?

A. Receptor binding B. Negative feedback mechanisms C. Regulation by the hypothalamic–pituitary axis D. Tissue affinity Answer: A Rationale: Receptor binding allows hormones to act selectively on certain cells allowing only certain parts of the body to be affected. Negative feedback

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mechanisms, tissue affinity, and regulation by the hypothalamic–pituitary axis are not as selective allowing the affect to take place on certain parts of the body.

Question format: Multiple Choice Chapter: 13 Cognitive Level (Bloom’s): Analyze Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 327, Receptor Binding

7. Which hormone pathway is represented by cells in the body that are able to both receive hormone stimulation and secrete the hormone to receptive neighboring cells?

A. Paracrine pathway B. Endocrine pathway C. Autocrine pathway D. Synaptic pathway Answer: C Rationale: The autocrine pathway is represented by cells that can receive and secrete hormone stimulation to receptive neighboring cells. The paracrine pathway, endocrine pathway, and synaptic pathway do not allow for both the reception and secretion of hormones to neighboring cells.

Question format: Multiple Choice Chapter: 13 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 328, Mediating Cell-to-Cell Communication

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8. A nursing student is stressed about a pathophysiology final exam. What hormone, released from the hypothalamus, initiates the stress response?

A. Antidiuretic hormone B. Adrenocorticotropic hormone C. Corticotropin-releasing hormone D. Cortisol Answer: C Rationale: Corticotropin-releasing hormone is released in response to stress from the hypothalamus. Corticotropin-releasing hormone then stimulates the pituitary gland to secrete adrenocorticotropic hormone, which in turn stimulates the cortex of the adrenal gland to secrete cortisol. Cortisol increases metabolism, regulates blood glucose, and decreases inflammation. Antidiuretic hormone is used to retain fluid. This hormone is useful in the event of extreme physical stress to the body, not the type of stress associated with an exam.

Question format: Multiple Choice Chapter: 13 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 8 Page and Header: 328, The Stress Response

9. A hiker has encountered a bear and is about to be attacked. Which body response is not expected?

A. Decreased blood pressure B. Increased heart rate C. Activation of skeletal muscles D. Decreased digestion

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Answer: A Rationale: During a response to stress, the body will experience decreased digestion, activation of skeletal muscles, increase in heart rate, and increase (not decrease) in blood pressure.

Question format: Multiple Choice Chapter: 13 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 8 Page and Header: 328, Hormonal Response to Stress

10.Which action is not a beneficial function of cortisol in the alarm stage of the stress response?

A. Releasing lipids B. Increasing circulating blood glucose C. Breaking down proteins D. Inhibiting metabolism Answer: D Rationale: Cortisol increases metabolism by breaking down proteins, releasing lipids, and increasing circulating glucose during the alarm stage of the stress response.

Question format: Multiple Choice Chapter: 13 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5

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Page and Header: 330, General Adaptation Syndrome

11.What problematic condition is induced by persistent hypercortisolism?

A. Glucose intolerance B. Protein anabolism C. Autoimmunity D. An excessive inflammatory response Answer: A Rationale: Persistent hypercortisolism is detrimental, leading to exhaustion of inflammatory and immune responses, excessive loss of body proteins and breakdown of tissues, and glucose intolerance. Protein anabolism, autoimmunity, and excessive inflammatory response are not induced by hypercortisolism.

Question format: Multiple Choice Chapter: 13 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 330, General Adaptation Syndrome

12.A client’s cells are not receptive to hormone stimulation due to a hormone receptor problem. What factor might interfere with appropriate receptor function?

A. Too many receptors B. High sensitivity to the hormone C. A tumor that is secreting ectopic hormone D. Antibodies that are blocking the receptors

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Answer: D Rationale: Damage to cell receptors is caused by a decrease number of cell receptors, lack of receptor sensitivity to the hormone, the presence of antibodies that block receptor sites, or the percentage of tumor cells that deprive the unaffected cells of the hormone.

Question format: Multiple Choice Chapter: 13 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 8 Page and Header: 331, Damage to Cell Receptors

13.A nurse is caring for a client who has been diagnosed with renal failure. How would this diagnosis impact the client’s hormone levels?

A. There would be no effect on hormone levels.

B. The client would have much higher levels of circulating hormones.

C. The client would have much lower levels of circulating hormones.

D. Hormone levels would be dependent upon whether or not the client’s body adapts by eliminating all hormones through the feces.

Answer: B Rationale: The impaired ability to metabolize or eliminate hormones, such as that which may occur with liver or kidney disease, will result in excess circulating hormone.

Question format: Multiple Choice Chapter: 13 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation

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Integrated Process: Teaching/Learning Learning Objective: 8 Page and Header: 332, Damage to Metabolism and Elimination Mechanisms

14.What action does excessive antidiuretic hormone (ADH) secretion have on cellular fluid balance in syndrome of inappropriate antidiuretic hormone (SIADH) secretion?

A. Intracellular fluid retention B. Excessive water losses C. Excessive circulating blood volume D. Extracellular fluid retention Answer: A Rationale: Excessive antidiuretic hormone (ADH) secretion results in fluid excess resulting in intracellular fluid retention and alters cell function. With syndrome of inappropriate antidiuretic hormone (SIADH), excessive production and release of ADH occurs despite changes in serum osmolality and blood volume.

Question format: Multiple Choice Chapter: 13 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 333, Syndrome of Inappropriate Antidiuretic Hormone Secretion

15.Which laboratory indicator is found in diabetes insipidus?

A. Excessive antidiuretic hormone (ADH) levels B. Urine specific gravity less than 1.005 C. Serum hypoosmolality

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D. Serum hyponatremia Answer: B Rationale: Diabetes insipidus is diagnosed by clinical and laboratory findings may include polyuria, highly dilute (low specific gravity) urine, serum hyperosmolality, serum hypernatremia, and severe dehydration. In diabetes insipidus, there is insufficient, not excessive, antidiuretic hormone (ADH) levels.

Question format: Multiple Choice Chapter: 13 Cognitive Level (Bloom’s): Analyze Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 336, Diabetes Insipidus, Diagnostic Criteria

16.What is the reason for excessive thyroid gland stimulation in Graves disease?

A. Excessive thyroid-stimulating hormone (TSH) release from the pituitary B. Excessive thyrotropin-releasing hormone from the hypothalamus C. Suppression of thyroid-stimulating hormone (TSH) release from the pituitary D. Antibodies binding to gland receptors Answer: D Rationale: In Graves disease, immunoglobulin G antibodies bind to the thyroidstimulating hormone (TSH) receptor on thyrocytes (thyroid cells) and stimulate excessive thyroid hormone secretion, causing a state of thyrotoxicosis.

Question format: Multiple Choice Chapter: 13 Cognitive Level (Bloom’s): Analyze Client Needs: Physiological Integrity: Physiological Adaptation

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Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 336, Graves Disease, Pathophysiology

17.A client with a long history of hypothyroidism has boggy, nonpitting edema around the eyes. What condition is indicated by this symptom?

A. Myxedema B. Goiter C. Exophthalmos D. Mucositis Answer: A Rationale: Myxedema is characterized by boggy and nonpitting edema on the face and mucous membranes, hands, and feet. A goiter is a condition causing excess growth of the thyroid gland. Mucositis results in sores in the mouth and stomach.

Exophthalmos is the protrusion of the eyes as seen in those with hyperthyroidism.

Question format: Multiple Choice Chapter: 13 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 8 Page and Header: 337, Hypothyroidism, Clinical Manifestations

18.Which process does not lead to Cushing syndrome?

A. Long-term use of prednisone B. Excess adrenocorticotropic hormone (ACTH) secretion C. Tumors of the adrenal gland D. Ectopic production of antidiuretic hormone (ADH) Page 12

Answer: D Rationale: Cushing syndrome is caused by long-term administration of corticosteroid medications (like prednisone), tumors of the pituitary gland that stimulate excess adrenocorticotropic hormone (ACTH) production, tumors of the adrenal gland that stimulate excessive cortisol production, and ectopic production of ACTH (not antidiuretic hormone) or corticotrophin-releasing hormone from a tumor at a distant site.

Question format: Multiple Choice Chapter: 13 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 339, Cushing Syndrome, Pathophysiology

19.The nurse is assessing the laboratory findings for a client being assessed for Addison disease. The nurse reports which result(s) as evidence of Addison disease to the healthcare provider? Select all that apply.

A. Elevated adrenocorticotropic hormone B. Decreased aldosterone C. Decreased cortisol D. Decreased potassium E. Elevated blood glucose Answer: A, B, C Rationale: Addison disease, or primary adrenocortical insufficiency, results from decreased levels of cortisol and aldosterone. Adrenocorticotropic hormone levels are elevated in Addison disease in an attempt to increase the secretion of cortisol and aldosterone. Low levels of aldosterone lead to hyperkalemia, rather than low

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potassium levels. Because there is a deficit of cortisol, a counterregulatory hormone, the client may have low, rather than high, blood glucose levels.

Question format: Multiple Select Chapter: 13 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Learning Objective: 7 Page and Header: 340, Addison Disease, Pathophysiology

20.The nurse is assessing a client brought into the emergency department due to excessive urine output and thirst for the past 24 hours. Which diagnostic tests will the nurse request to determine if nephrogenic diabetes insipidus is the possible cause of the client’s symptoms? Select all that apply.

A. Serum calcium level B. Serum potassium level C. Lithium drug levels D. Serum creatinine level E. Computerized tomography scan of the head Answer: A, B, C, D Rationale: Diabetes insipidus (DI) can result from an underproduction of antidiuretic hormone (ADH), known as central DI; inadequate renal response to ADH, known as nephrogenic DI; or water intoxication. Risk factors for developing nephrogenic DI include chronic renal insufficiency, which can be assessed using serum creatinine levels. Lithium toxicity, hypercalcemia, and hypokalemia are also risk factors for developing nephrogenic DI, so these blood levels should be assessed. A CT scan of the head may be relevant in central DI, which can result from a head injury or tumor but would not confirm nephrogenic DI. Question format: Multiple Select

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Chapter: 13 Cognitive Level (Bloom’s): Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Nursing Process Learning Objective: 7 Page and Header: 334, Diabetes Insipidus, Pathophysiology

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Test Generator Questions, Chapter 14, Altered Reproductive Function 1. What physical changes might occur in a client who has been diagnosed with polycystic ovarian syndrome (PCOS)?

A. Increased dark facial hair growth B. Significant pain with menstruation C. Pregnancy D. Weight loss Answer: A Rationale: In polycystic ovarian syndrome (PCOS), excess androgen exposure results in hirsutism (abnormal growth of hair on face and body). Painful menstruation, pregnancy, and weight loss are not symptomatic of PCOS. Question format: Multiple Choice Chapter: 14 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 356, Polycystic Ovarian Syndrome

2. A client has been diagnosed with polycystic ovarian syndrome (PCOS). What should the nurse explain to the client is the cause of this condition?

A. Sexually transmitted infection B. Unknown, but probably genetics C. Previous miscarriage D. Previous ovarian surgery

Answer: B Rationale: The exact cause of polycystic ovarian syndrome (PCOS) is unknown. A genetic cause has been suggested, and those with PCOS are more likely to have a mother or sister also with PCOS. The other conditions do not cause PCOS. Question format: Multiple Choice Chapter: 14 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 356, Pathophysiology

3. What happens to the hormones in polycystic ovarian syndrome (PCOS)?

A. Excess androgen production from the ovaries results in multiple immature ovarian follicles.

B. Increased progesterone secretion promotes anovulation.

C. Decreased estrogen from the ovaries promotes cystic changes in the reproductive organs.

D. Excess androgens cause obesity, which promotes estrogen excess.

Answer: A Rationale: In polycystic ovarian syndrome (PCOS), excess androgen exposure results in multiple immature ovarian follicles. Increased progesterone secretion and decreased estrogen levels are not characteristic of PCOS. Obesity can be caused by conversion of androgens to estrogen in adipose tissues; excess androgens alone do not cause obesity.

Question format: Multiple Choice Chapter: 14 Cognitive Level (Bloom’s): Understand

Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 356, Polycystic Ovarian Syndrome

4. What finding would be typical of the menstrual cycle for a woman with polycystic ovarian syndrome (PCOS)?

A. Cycles lasting 21 to 28 days B. Cycles lasting fewer than 20 days C. More than 12 menstrual periods per year D. Cycles lasting more than 35 days Answer: D Rationale: Prolonged menstrual periods and menstrual intervals longer than 35 days or fewer than eight menstrual cycles per year are common in women with polycystic ovarian syndrome (PCOS). Women with PCOS do not commonly have more frequent or shortened menstrual cycles.

Question format: Multiple Choice Chapter: 14 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 357, Clinical Manifestations

5. What initial treatment is typically used to induce pregnancy in a client with polycystic ovarian syndrome (PCOS)?

A. Antiprogesterone medications B. Antiestrogen medications

C. Drugs to suppress ovulation D. Injectable follicle-stimulating hormone (FSH) and luteinizing hormone (LH) Answer: B Rationale: To induce pregnancy in a woman with polycystic ovarian syndrome (PCOS), treatment with antiestrogen medications to induce ovulation, such as clomiphene citrate, is needed. If clomiphene citrate is unsuccessful, injectable follicle-stimulating hormone (FSH) and luteinizing hormone (LH) may be used. In PCOS, the goal is to induce ovulation when pregnancy is desired; therefore, medications to suppress ovulation would not be therapeutic. Antiprogesterone medications would not be helpful for women with PCOS who desire pregnancy.

Progesterone is used to regulate menstrual periods if pregnancy is not desired.

Question format: Multiple Choice Chapter: 14 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 357, Treatment

6. Most medications prescribed to treat erectile dysfunction use which mechanism to promote arousal?

A. Promoting nerve signaling to penile vessels B. Trapping blood in the corporus cavernosa C. Eliminating depression or other psychological factors D. Increasing blood flow to the corporus cavernosa Answer: B Rationale: Medications used to treat erectile dysfunction act to promote smooth

muscle relaxation and vascular congestion in the corpora cavernosa, thereby maintaining an erection. Increasing the blood flow to the corporus cavernosa would not assist in maintaining an erection. The medications also have no effect on nerve signaling to the penile vessels. Psychological factors are treated by mental health professionals, rather than the ED medications.

Question format: Multiple Choice Chapter: 14 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 362, Treatment

7. Which hormone-based condition can contribute to erectile dysfunction?

A. Hyperthyroidism B. Spinal cord injury C. Hypogonadism D. Anxiety Answer: C Rationale: Hormonal factors that contribute to erectile dysfunction include hypogonadism, hypothyroidism (not hyperthyroidism), or adrenal cortical hormone dysfunction. Anxiety is a psychological factor that contributes to erectile dysfunction.

Spinal cord injury is a neurologic factor that contributes to erectile dysfunction.

Question format: Multiple Choice Chapter: 14 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3

Page and Header: 362, Clinical Manifestations

8. What term indicates the permanent cessation of menses?

A. Perimenopause B. Libido C. Menopause D. Menarche Answer: C Rationale: Menopause, the complete cessation of ovarian activity, is an expected biologic stage marking the end of a woman’s reproductive life. Perimenopause is the 4- to 5-year gradual transition between predictable reproductive cycles and menopause. Menarche is the time leading to the first menstrual cycle. Libido is the motivation to engage in sexual activities, which can be affected by menopause.

Question format: Multiple Choice Chapter: 14 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 359, Menopause

9. How does the hypothalamus respond to decreased secretion of ovarian hormones with menopause?

A. Increased secretion of gonadotropin-releasing hormone (GnRH) B. Decreased secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) C. Increased secretion of estrogen and progesterone D. The hypothalamus does not respond

Answer: A Rationale: During menopause, reduced release of ovarian hormones triggers the hypothalamus to increase secretion of gonadotropin-releasing hormone (GnRH). As a result, the anterior pituitary secretes additional luteinizing hormone (LH) and follicle-stimulating hormone (FSH). LH and FSH are not decreased. Aging ovaries also do not produce estrogen or progesterone; therefore, these levels do not increase.

Question format: Multiple Choice Chapter: 14 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 359, Pathophysiology

10.Which systems are affected by menopause? Select all that apply.

A. Reproductive B. Skin C. Bone D. Cardiovascular E. Digestive Answer: A, B, C, D Rationale: The full effects of estrogen deprivation, resulting from menopause, include menstrual cycle changes, bone demineralization, breast tenderness, moodiness, hot flashes, vaginal dryness, and sleep disturbances. Skin elasticity also reduces, as does body hair and subcutaneous fat levels. Markers of cardiovascular disease are increased. Changes in the digestive system are not specifically associated with menopause.

Question format: Multiple Select

Chapter: 14 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 359, Clinical Manifestations

11.What painful condition can be caused by vaginal atrophy in menopause?

A. Stress incontinence B. Dyspareunia C. Vasomotor instability D. Demineralization Answer: B Rationale: Dyspareunia is often a consequence of vaginal atrophy because these cells can no longer produce adequate amounts of lubrication for comfort. Stress incontinence is attributed to atrophy of bladder cells. Vasomotor instability, or hot flashes, is one of the many effects of estrogen deprivation. Bone demineralization occurs with advancing age and is more rapid after menopause; it results from the effects of cytokines without the protective effects of ovarian hormones.

Question format: Multiple Choice Chapter: 14 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 359, Clinical Manifestations

12.Women with vaginal atrophy should use which treatment?

A. Lubrication during intercourse B. Over-the-counter pain medications C. Drink plenty of water D. Increase the consumption of foods containing soy Answer: A Rationale: Dyspareunia is often a consequence of vaginal atrophy because these cells can no longer produce adequate amounts of lubrication for comfort. The use of water-based lubricants during intercourse may help minimize the discomfort associated with menopause. Treatment is best when individualized and targeted toward the specific concern; therefore, treating the underlying issue of decreased lubrication will be more effective than over-the-counter pain medications, increased oral intake, or increasing soy in the diet.

Question format: Multiple Choice Chapter: 14 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 359, Treatment

13.Why does bone loss occur with menopause?

A. From an excess of osteoblasts and deficiency of osteoclasts B. From poor calcium intake in older women C. From the effects of cytokines in the absence of ovarian hormones D. There is no known cause for bone loss in menopause Answer: C Rationale: Menopausal bone loss results from the effects of cytokines without the

protective effects of ovarian hormones. This imbalance promotes delayed apoptosis of osteoclasts and enhances apoptosis of osteoblasts. Bone loss does not occur as a result of excess osteoblasts or a deficiency in osteoclasts. It also does not occur due to poor calcium intake in older women.

Question format: Multiple Choice Chapter: 14 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 359, Clinical Manifestations

14.Why should women avoid menopausal treatment with estrogen only?

A. Need to replace many other hormones as well B. Increased risk for endometrial cancer C. Estrogen alone does not ameliorate the symptoms D. Estrogen will only treat hot flashes and not mood changes Answer: B Rationale: Research has since shown a lack of evidence to support the use of estrogen alone for the expected protective effects, and a higher risk for morbidity, such as the development of endometrial cancer. Current recommendations include using estrogen, progesterone, or both to treat menopausal symptoms. These are administered to decrease symptoms related to menopause, including both hot flashes and mood changes.

Question format: Multiple Choice Chapter: 14 Cognitive Level (Bloom’s): Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning

Learning Objective: 4 Page and Header: 360, Treatment

15.How can benign prostatic hyperplasia (BPH) and prostate cancer be distinguished?

A. Biopsy B. Prostate-specific antigen (PSA) level C. Clinical manifestations D. Family history Answer: A Rationale: Diagnosis of prostate cancer is confirmed through a cytologic analysis of prostate tissue (biopsy) via fine needle aspiration usually performed transrectally.

Common clinical manifestations are similar for both benign prostatic hyperplasia (BPH) and prostate cancer and cannot confirm the diagnosis of either.

Prostate-specific antigen (PSA) levels are used to screen for prostate cancer and BPH. Family history is a risk factor for prostate cancer but is not diagnostic.

Question format: Multiple Choice Chapter: 14 Cognitive Level (Bloom’s): Analyze Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 363, Diagnostic Criteria

16.What is the major purpose of the prostate?

A. Production of testosterone B. Increases acidity of seminal fluid C. Increases sperm motility D. Protects the urethra

Answer: C Rationale: The major role of the prostate is to secrete a fluid, which combines with semen, to increase sperm motility and decrease vaginal acidity. The role of the prostate does not include producing testosterone, protecting the urethra, or increasing the acidity of seminal fluid.

Question format: Multiple Choice Chapter: 14 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 362, Benign Prostatic Hyperplasia

17.What is a common clinical manifestation of benign prostatic hyperplasia (BPH)?

A. Urinary frequency B. Erectile dysfunction C. Renal failure D. Bladder infection Answer: A Rationale: Clinical manifestations of benign prostatic hyperplasia (BPH) are related to urethral obstruction from the enlarged prostate, which impedes the flow of urine from the bladder to the urethra. This results in urinary frequency, dribbling, hesitancy, incontinence, urgency, and retention. Complete obstruction of the prostate can lead to renal failure; however, this is not a common clinical manifestation. Erectile dysfunction and bladder infections are also not common clinical manifestations of BPH. Question format: Multiple Choice Chapter: 14

Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 362, Clinical Manifestations

18.How is benign prostatic hyperplasia (BPH) tissue often described?

A. Asymmetrical B. Soft C. Hard D. Cobblestonelike Answer: B Rationale: Benign enlargement of the prostate tissue is soft; malignant tissue is hard, asymmetrical, and often has a cobblestone texture.

Question format: Multiple Choice Chapter: 14 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 363, Diagnostic Criteria

19.What does pharmacologic treatment achieve with benign prostatic hyperplasia (BPH)?

A. Relaxes smooth muscle to relieve urinary obstruction B. Promotes erectile function C. Shrinks prostate tissue D. Eliminates causative bacterial infection

Answer: A Rationale: Pharmacologic treatments for BPH that relax the smooth muscles of the arteries, prostate, and bladder neck to relieve urinary obstruction are often prescribed. Pharmacologic treatments for BPH do not shrink prostate tissue, promote erectile function, or completely eliminate the bacterial infections.

Question format: Multiple Choice Chapter: 14 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 363, Treatment

20.What clinical manifestations are characteristic of ovarian cancer?

A. Severe menstrual bleeding B. Irregular menstrual periods C. Often asymptomatic D. Severe abdominal pain Answer: C Rationale: Ovarian cancer is often asymptomatic in the early stages. Vague abdominal bloating may be noticed in some. Severe abdominal pain, irregular menstrual periods, and severe menstrual bleeding are not clinical manifestations of ovarian cancer Question format: Multiple Choice Chapter: 14 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning

Learning Objective: 3 Page and Header: 358, Clinical Manifestations

21.What is the difference between seminomas and nonseminomas?

A. Seminomas are benign.

B. Seminomas resemble primitive sperm cells.

C. Seminomas are much more severe.

D. There is no difference.

Answer: B Rationale: Seminomas are malignant germ cells that resemble primitive sperm cells.

Nonseminomas are also malignant germ cells, but they do not resemble primitive sperm cells. Both types of testicular cancers are highly treatable and often highly curable; however, seminomas have a much high 5-year survival rate than nonseminomas.

Question format: Multiple Choice Chapter: 14 Cognitive Level (Bloom’s): Analyze Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 366, Pathophysiology

22.Which condition is a major risk factor for testicular cancer?

A. Cryptorchidism B. Advancing age C. Smoking D. High-fat diet

Answer: A Rationale: A major risk factor for testicular cancer is cryptorchidism. Those with cryptorchidism are 20 to 40 times more likely to develop testicular cancer. Testicular cancer is most commonly found in men between 20 and 40 years of age. Smoking and a high-fat diet are risk factors for prostate cancer, not testicular cancer.

Question format: Multiple Choice Chapter: 14 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 366, Pathophysiology

24.Which is the best-case scenario for a client with testicular cancer?

A. Carcinoma in situ B. Presence of primary mediastinal nonseminoma C. High serum tumor markers D. Presence of metastases Answer: A Rationale: Although testicular cancer is highly treatable and curable, the prognosis for testicular cancer is less favorable when the following factors exist: the presence of primary mediastinal nonseminoma, high serum tumor markers, or metastases to the lung, bone, liver, or brain. The carcinoma in situ common with testicular cancer is confined to the seminiferous tubule and has a more favorable prognosis than when the other factors exist.

Question format: Multiple Choice Chapter: 14 Cognitive Level (Bloom’s): Understand

Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 366, Pathophysiology

25.Which is a common clinical manifestation for testicular cancer?

A. Small, painless testicular mass B. Slight enlargement of the testicles C. Heaviness of the scrotum D. All of these Answer: D Rationale: Common clinical manifestations include a small painless testicular mass, slight enlargement of the testicle, heaviness or enlargement of the scrotum, and mild testicular discomfort.

Question format: Multiple Choice Chapter: 14 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 367, Clinical Manifestations

Test Generator Questions, Chapter 15, Altered Ventilation and Diffusion 1. What term refers to the exchange of oxygen and carbon dioxide at the alveolar capillary membranes?

A. Perfusion B. Respiration C. Ventilation D. Diffusion Answer: D Rationale: Diffusion is the process of moving and exchanging the oxygen acquired during ventilation with carbon dioxide waste across the alveolar capillary membranes. Ventilation is the process of moving air into and out of the trachea, bronchi, and lungs. Perfusion is a process of supplying oxygenated blood to the lungs and organ systems via the blood vessels. Respiration is a process in which cells throughout the body use oxygen aerobically to make energy.

Question format: Multiple Choice Chapter: 15 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 371, Introduction

2. What is the main purpose of oxygen?

A. Maintains acid–base balance in the body B. Necessary for cellular metabolism C. Triggers chemoreceptors in the body Page 1

D. To fill in the alveolar capillary junction Answer: B Rationale: Oxygen is necessary for cellular metabolism, which means that for the cell to expend energy efficiently and perform its designated function, there must be oxygen present. The main role of oxygen is not to maintain an acid–base balance, trigger chemoreceptors in the body, or to fill in the alveolar capillary junction.

Question format: Multiple Choice Chapter: 15 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 372, Ventilation

3. Which measure of ventilation is the maximal amount of air that can be moved in and out of the lungs with forced inhalation and exhalation?

A. Vital capacity B. Forced expiratory volume C. Tidal volume D. Total lung capacity Answer: A Rationale: Vital capacity is the maximal amount of air that can be moved in and out of the lungs with forced inhalation and exhalation. Forced expiratory volume is the maximum amount of air that can be expired from the lungs. Tidal volume is the amount of air that is exhaled after passive inspiration. Total lung capacity is the total amount of air in the lungs when they are maximally expanded.

Question format: Multiple Choice Chapter: 15 Page 2

Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 374, Measurement of Ventilation

4. What element increases the affinity of oxygen to hemoglobin?

A. Iron B. Heme C. Myoglobin D. Magnesium Answer: A Rationale: Iron is the magnet that pulls oxygen onto the hemoglobin molecule.

Heme, myoglobin, and magnesium do not increase the affinity of oxygen to hemoglobin.

Question format: Multiple Choice Chapter: 15 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 374, Measurement of Ventilation

5. Which term refers to cellular deprivation of oxygen?

A. Hypoxemia B. Hypercapnia C. Hypoxia D. Hemoptysis Page 3

Answer: C Rationale: Hypoxia occurs when cells are depraved of adequate oxygen. Hypoxemia is decreased oxygen in the arterial blood leading to a decrease in the partial pressure of oxygen. Hypercapnia refers to a state of increased carbon dioxide in the blood. Hemoptysis refers to a nosebleed.

Question format: Multiple Choice Chapter: 15 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 379, Hypoxemia and Hypoxia

6. What early sign suggests the presence of hypoxia, particularly in children?

A. Restlessness B. Cyanosis C. Lethargy D. Coma Answer: A Rationale: An early sign of hypoxia in children is restlessness. Cyanosis, lethargy, and coma are late signs of hypoxia in children.

Question format: Multiple Choice Chapter: 15 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 379, Hypoxemia and Hypoxia

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7. What condition can cause hypoxia without hypoxemia?

A. Asphyxiation B. Carbon monoxide poisoning C. Myocardial infarction D. Chronic obstructive pulmonary disease Answer: C Rationale: Although hypoxemia can lead to hypoxia, hypoxia can result even when there is adequate arterial oxygen as seen with myocardial infarction. Chronic obstructive pulmonary disease, carbon monoxide poisoning, and asphyxiation are associated with lack of oxygen caused by inadequate arterial oxygen supply.

Question format: Multiple Choice Chapter: 15 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 379, Hypoxemia and Hypoxia

8. What assessment is best for distinguishing between hypoxemia and hypercapnia?

A. Measuring oxygen saturations B. Performing pulmonary function testing C. Measuring arterial blood gases D. Observing for signs and symptoms Answer: C Rationale: Although physical symptoms, oxygen saturation levels, and pulmonary function tests provide clues related to hypoxemia and hypercapnia, the best way to determine either is by obtaining arterial blood gases.

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Question format: Multiple Choice Chapter: 15 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 379, Hypoxemia and Hypoxia

9. A client describes a sensation of shortness of breath and the inability to get enough air. How should the nurse document this finding?

A. Dyspnea B. Orthopnea C. Hemoptysis D. Aspiration Answer: A Rationale: Dyspnea refers to shortness of breath. Orthopnea relates to the need to be sitting or propped up to get enough air. Hemoptysis refers to coughing up blood.

Aspiration occurs when a foreign substance is inhaled.

Question format: Multiple Choice Chapter: 15 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 380, General Manifestations of Impaired Ventilation and Diffusion

10.What condition is the most likely cause of a barrel chest?

A. Smoking B. Chronic costochondritis Page 6

C. Chronic alveolar distention D. Hypoxia Answer: C Rationale: Barrel chest is associated with chronic lung disease and is caused by chronic dilation and distention of alveoli. Smoking may lead to chronic lung disease.

Costochondritis is the inflammation of costal cartilages not barrel chest. Hypoxia refers to decreased oxygenation.

Question format: Multiple Choice Chapter: 15 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 380, General Manifestations of Impaired Ventilation and Diffusion

11.Upon auscultation of a client’s lung sounds, the nurse notices a high-pitched wheezing sound. What condition is the likely cause of this sound?

A. Airway constriction B. Hemoptysis C. Empyema D. Pleural effusion Answer: A Rationale: Airway constriction is characterized by adventitious sounds (such as a high-pitched wheeze). Hemoptysis refers to coughing up blood. Empyema refers to a lung abscess, and pleural effusions refer to fluid in the pleural space. Hemoptysis, empyema, and pleural effusions do not cause a high-pitched wheeze.

Question format: Multiple Choice Chapter: 15 Cognitive Level (Bloom’s): Apply Page 7

Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 386, Clinical Manifestations

12.A 4-month-old client is diagnosed with gastroesophageal reflux. The client spits up frequently after feedings and is irritable for about 1 hour after eating. The healthcare provider has noted that the client is at risk for pneumonia. What is the most likely cause for this?

A. Prematurity B. Ineffective cough reflex C. Exposure to the influenza virus D. Aspiration Answer: D Rationale: Pneumonia can occur when aspirating, or inhaling, items not intended for the lungs, such as foods, fluids, and stomach contents. Prematurity, ineffective cough reflex, and influenza are not the most likely causes for pneumonia in a client with gastroesophageal reflux.

Question format: Multiple Choice Chapter: 15 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 384, Clinical Models, Pathophysiology

13.Which diagnostic finding is related to the accumulation of the products of inflammation during typical pneumonia?

A. Pneumothorax Page 8

B. Consolidation C. Hemoptysis D. Exudation Answer: B Rationale: Consolidation is a product of inflammation. It is associated with the accumulation of red blood cells, white blood cells, and fibrin in the lungs during typical pneumonia. Pneumothorax, hemoptysis, and exudation don’t refer to the accumulation of products of inflammation during typical pneumonia.

Question format: Multiple Choice Chapter: 15 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 384, Pneumonia

14.What condition is defined as an irreversible enlargement of the air spaces beyond the terminal bronchioles resulting in destruction of the alveolar walls and obstruction of airflow?

A. Chronic obstructive pulmonary disease B. Chronic bronchitis C. Asthma D. Emphysema Answer: D Rationale: Emphysema is described as an irreversible enlargement of the air spaces beyond the terminal bronchioles, most notably in the alveoli, resulting in destruction of the alveolar walls and obstruction of airflow. Asthma is a chronic inflammatory disorder of the airways that results in intermittent or persistent Page 9

airway obstruction. Chronic bronchitis is defined by the presence of a persistent, productive cough with excessive mucous production that last for 3 months or longer for 2 or more consecutive years. Chronic obstructive pulmonary disease (COPD) is a generic term that describes all chronic obstructive lung problems, including asthma, emphysema, and chronic bronchitis.

Question format: Multiple Choice Chapter: 15 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 387, Emphysema

15.Which condition is not a change in the bronchi and bronchioles related to chronic bronchitis?

A. Chronic inflammation in the airways B. Hypertrophy of bronchial mucous glands C. Fibrosis D. Squamous cell metaplasia Answer: B Rationale: Hyperplasia (not hypertrophy) of bronchial mucous glands occurs with chronic bronchitis. Chronic inflammation in the airways, fibrosis, and squamous cell metaplasia are associated with chronic bronchitis.

Question format: Multiple Choice Chapter: 15 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 389, Chronic Bronchitis Page 10

16.Which manifestation is more commonly found in chronic bronchitis than in emphysema?

A. Lymphadenopathy B. Cough C. Dyspnea D. Cyanosis Answer: D Rationale: Hypoxemia, hypercapnia, and cyanosis are more commonly found in those with chronic bronchitis compared to individuals with emphysema because of excessive bronchial mucus and obstructed ventilation.

Question format: Multiple Choice Chapter: 15 Cognitive Level (Bloom’s): Analyze Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 389, Chronic Bronchitis, Clinical Manifestations 17.What is the major problem at the cellular level in cystic fibrosis?

A. Electrolyte and water transport B. Mucous obstruction C. Infection D. Pancreatitis Answer: A Rationale: Cystic fibrosis (CF) is an autosomal recessive disorder of electrolytes and subsequently water transport that affects certain epithelial cells, such as those lining respiratory, digestive, and reproductive tracts. The disorder leads to the production of excessive and thick exocrine secretions (e.g., mucus) leading to Page 11

obstruction, inflammation, and infection. CF is also associated with impaired local immune defenses in the lungs as well as pancreatic insufficiency.

Question format: Multiple Choice Chapter: 15 Cognitive Level (Bloom’s): Analyze Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 394, Cystic Fibrosis

18.Which clinical manifestation, when found in newborns, may indicate the presence of cystic fibrosis?

A. Coughing B. Yellow, seedy, loose stools C. Cyanosis D. Meconium ileus Answer: D Rationale: Newborns with cystic fibrosis may present with intestinal obstruction (a meconium ileus) at birth with a delayed or absent passage of meconium stool. The other options are not associated with newborn manifestations of cystic fibrosis.

Question format: Multiple Choice Chapter: 15 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 395, Cystic Fibrosis, Clinical Manifestations

19.The nurse is caring for a client who presents with a respiratory rate of 26 Page 12

breaths/min, report of dyspnea, and an oxygen saturation (SaO2) of 99%. For which potential cause of the client’s acute symptoms does the nurse prioritize assessment?

A. Pneumonia B. Acute blood loss C. Acute respiratory distress syndrome D. Asthma attack Answer: B Rationale: Because oxygen saturation (SaO2) is not affected by blood volume or hemoglobin level, the nurse interprets the findings as best supporting acute blood loss. It is possible that an individual could have a severe hemorrhage and still measure an SaO2 of 100%. With acute blood loss, the decreased oxygen-carrying capacity due to loss of hemoglobin triggers a compensatory increase in respiratory rate, and the client may feel dyspneic and fatigued. Pneumonia, acute respiratory distress syndrome, and an asthma attack are all more likely to present with a decrease in SaO2.

Question format: Multiple Choice Chapter: 15 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process Learning Objective: 7 Page and Header: 375, Oxygen Diffusion and Transport

20.The nurse is assessing a client diagnosed with emphysema. Which finding(s) will the nurse document as aligned with this diagnosis? Select all that apply.

A. Anteroposterior to transverse (AP:T) diameter ratio of 1:2 B. Partial pressure of oxygen (PaO2) level of 70 mm Hg C. Partial pressure of carbon dioxide (PaCO2) level of 50 mm Hg D. Breath sounds with crackles Page 13

E. Prolonged expiratory phase Answer: B, C, E Rationale: Due to air trapping and impaired diffusion, the client with emphysema may experience both hypoxia (PaO2 less than 80 mm Hg) and hypercapnia (PaCO2 greater than 45 mm Hg). In an attempt to expel trapped air, the client develops a prolonged expiratory phase and may exhibit pursed-lip breathing. Over time, hyperinflation of alveoli leads to a barrel chest that is represented by an anteroposterior to transverse (AP:T) diameter ratio of 1:1; a ratio of 1:2 is normal.

In emphysema, inflammation of the airways can produce bronchoconstriction, which leads to wheezing rather than crackles. Crackles would be associated with bronchitis or pulmonary edema.

Question format: Multiple Select Chapter: 15 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Nursing Process Learning Objective: 5 Page and Header: 389, Emphysema, Diagnostic Criteria

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Test Generator Questions, Chapter 16, Altered Perfusion 1. Which factor does not affect cardiac performance?

A. Preload B. Afterload C. Myocardial contractility D. Blood pressure Answer: D Rationale: Major factors that affect cardiac output/performance include preload, afterload, cardiac contractility, heart rate, and blood volume. Blood pressure is a product of cardiac output and the amount of resistance in the arteries.

Question format: Multiple Choice Chapter: 16 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 410, Box 16.1 Major Factors Impacting Cardiac Output

2. Which condition does not cause altered cardiac tissue perfusion?

A. Imbalances of oxygen supply and demand B. Blood flow obstruction to the cardiac tissue C. Reduced cardiac stroke volume D. Development of collateral circulation Answer: D Rationale: Collateral circulation would facilitate cardiac tissue perfusion rather than

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alter or hinder perfusion. Major factors that can alter perfusion include a ventilation– perfusion mismatch (imbalance of oxygen supply and demand), impaired circulation (including blood flow obstruction), inadequate cardiac output (due to reduced cardiac stroke volume), and excessive perfusion mismatching.

Question format: Multiple Choice Chapter: 16 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 412, Altered Perfusion

3. Which disorder alters tissue perfusion by altering the blood volume or viscosity?

A. Heart failure B. Myocardial infarction C. Disseminated intravascular coagulation D. Structural heart defects Answer: C Rationale: Disseminated intravascular coagulation (DIC) is a condition of uncontrolled activation of clotting factors that results in widespread thrombi formation, followed by depletion of coagulation factors and platelets leading to massive hemorrhage. The imbalance between clotting and the dissolution of clots affects both blood volume and blood viscosity, resulting in altered tissue perfusion. Structural heart defects affect cardiac output by impairing the smooth, directional flow of blood through the heart chambers. Heart failure causes impaired ventricular pumping, leading to impaired cardiac output. Myocardial infarction alters tissue perfusion due to obstructed vessels.

Question format: Multiple Choice Chapter: 16 Cognitive Level (Bloom’s): Analyze

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Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 415, Inadequate Cardiac Output

4. When baroreceptors detect decreased blood pressure in the carotid arteries due to a client’s extensive blood loss, what action is initiated by the baroreceptors?

A. Stimulate the brain to form new red blood cells B. Increase sympathetic stimulation of the heart and blood vessels C. Increase parasympathetic stimulation of the heart and blood vessels D. Inhibit renin release from the kidneys to promote fluid retention Answer: B Rationale: Baroreceptors sense pressure changes in the arteries. When the blood pressure in the arteries is sensed as low, the baroreceptors alert the cardiac control center in the brainstem. The brainstem acts on the sympathetic nervous system to stimulate beta-1 receptors in the heart. Beta-1 receptors increase cardiac output.

Simultaneously, alpha-1 receptors in the blood vessels are stimulated, causing vasoconstriction. Baroreceptors do not stimulate the brain to form new red blood cells, increase parasympathetic stimulation, or inhibit renin release from the kidneys.

Question format: Multiple Choice Chapter: 16 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 410, Neural Control of Blood Pressure and Cardiovascular Adaptation

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5. Following extensive blood loss, why would a client’s systolic pressure reading be lower than usual while the diastolic pressure remains about the same?

A. Systemic vasoconstriction has maintained the diastolic pressure B. Stroke volume increased with blood loss C. Heart rate increased with blood loss D. Inadequate resistance in the aorta Answer: A Rationale: Systolic blood pressure is the amount of pressure exerted during contraction of the left ventricle and ejection of blood into the aorta. Diastolic blood pressure is the amount of pressure that remains in the aorta during the resting phase of the cardiac cycle. Convergence, or narrowing, of the systolic and diastolic pressure often reflects a loss of systolic pressure rather than an elevation in diastolic pressure.

For example, extensive blood loss decreases systolic pressure while diastolic pressure remains unchanged due to systemic vasoconstriction. Increased stroke volume and heart rate would lead to blood pressure increases, rather than decreased systolic pressure. Inadequate resistance in the aorta is associated with depressions in diastolic blood pressure.

Question format: Multiple Choice Chapter: 16 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 409, Blood Pressure

6. Cigarette smoking increases the risk for heart disease by what mechanism?

A. Promotes vasodilation and decreases peripheral resistance, thereby increasing cardiac workload B. Decreases serum lipid levels and increases inflammation, thereby promoting

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hyperlipidemia C. Injures the endothelial cells lining the blood vessels, thereby promoting thrombus development D. Increases serum high-density lipoprotein (HDL) levels, thereby promoting fat oxidation Answer: C Rationale: Smoking injures the endothelial cells lining the blood vessels, promoting the development of atherosclerosis and thrombus development. Smoking does not increase the risk of heart disease by promoting vasodilation, decreasing serum lipid levels, or increasing serum high-density lipoprotein (HDL) levels.

Question format: Multiple Choice Chapter: 16 Cognitive Level (Bloom’s): Understand Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 423, Pathophysiology

7. A client is reluctant to quit smoking. What measurable alteration in the client’s vital signs while smoking would demonstrate the immediate effects of smoking on the client’s health?

A. Elevated temperature B. Elevated blood pressure C. Decreased blood pressure D. Audible heart murmur Answer: B Rationale: Systolic blood pressure is the amount of pressure exerted during

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contraction of the left ventricle and ejection of blood into the aorta. Specific activities that can elevate systolic blood pressure include exercise, smoking, cardiovascular disease, and stress. Taking a blood pressure during smoking will reveal an increased systolic pressure. Smoking does not immediately affect temperature readings, pulse rate, or the development of heart murmurs.

Question format: Multiple Choice Chapter: 16 Cognitive Level (Bloom’s): Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 409, Blood Pressure

8. Which topic should a nurse address when educating a client about the modifiable risk factors for atherosclerosis?

A. Engaging in routine exercise B. Consuming more saturated and less unsaturated fats C. Testing for familial hypercholesterolemia D. Avoiding estrogen supplements after menopause Answer: A Rationale: Major risk factors for the development of atherosclerosis include family history, hypertension and smoking, blood cholesterol levels, concurrent diabetes mellitus, elevated C-reactive protein, and hyperhomocysteinemia. Sedentary lifestyle is an example of a modifiable risk factor for the development of both hypertension and atherosclerosis. Encouraging exercise would be an appropriate intervention to decrease this risk. Family history is an example of a nonmodifiable risk factor.

Estrogen is not a risk factor for the development of atherosclerosis. Saturated fat intake is a risk factor for hypertension and atherosclerosis; therefore, increasing saturated fat intake would not be an appropriate intervention.

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Question format: Multiple Choice Chapter: 16 Cognitive Level (Bloom’s): Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 423, Pathophysiology

9. A client is found to have a high low-density lipoprotein (LDL) level. The nurse explains that this constitutes a risk factor for coronary artery disease because of what characteristic of LDL? A. Has low cholesterol content B. Promotes atheromas and plaque development C. Transports cholesterol away from cells to the liver for excretion D. Is associated with a low intake of saturated fats Answer: B Rationale: Low-density lipoprotein (LDL) filters into the lining of the artery and becomes trapped along the injured intima. The lipoprotein becomes oxidized and engulfed by macrophages, producing foam cells. Foam cells accumulate and combine with additional lipids to form fatty streaks. These fatty streaks gradually become fibrous plaques. LDL is associated with a high intake of saturated fats, and a high LDL level indicates a high cholesterol content. LDL does not transport cholesterol away from the cells to the liver for excretion.

Question format: Multiple Choice Chapter: 16 Cognitive Level (Bloom’s): Apply Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Learning Objective: 4

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Page and Header: 412, Impaired Circulation

10.Several steps characterize the development of atherosclerosis. Which is the correct order in which fibrous plaques develop?

A. Lipoprotein oxidation, foam cells produced, fatty streaks accumulate, fibrous plaques develop, a thrombus forms B. Foam cells produced, vasospasm is induced, lipoproteins are oxidized, fibrous plaques develop C. Platelets adhere, aneurysms form, low-density lipoprotein (LDL) becomes trapped along intima, a thrombus forms D. Macrophages engulf low-density lipoproteins (LDLs), fibrous plaques develop, fatty streaks accumulate, platelets adhere Answer: A Rationale: The onset of atherosclerosis is theorized to begin as a process of injury to the intima (inner lining of the vessel). Low-density lipoprotein (LDL) filters into the lining of the artery and becomes trapped along the injured intima. The lipoprotein becomes oxidized and engulfed by macrophages, producing foam cells. Foam cells accumulate and combine with additional lipids to form fatty streaks. These fatty streaks gradually become fibrous plaques. Fibrous plaques accumulate at the sites of injury covered by platelet caps that continue to expand. These areas of atherosclerosis may eventually occlude the artery. The other steps listed do not correctly explain the development of atherosclerosis.

Question format: Multiple Choice Chapter: 16 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 412, Impaired Circulation

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11.Disseminated intravascular coagulation (DIC) can be initiated by an external event such as trauma. Once that event happens, what is the first pathologic body change that would indicate the presence of DIC? A. Clots form throughout the body, especially in small vessels B. Large amounts of bleeding occur C. Blood glucose levels immediately elevate D. Macrophages travel to the area of the initial trauma Answer: A Rationale: With disseminated intravascular coagulation (DIC), injury triggers an imbalance between clotting and fibrinolysis, the dissolution of clots. Clotting factors, thrombin, and platelets accumulate throughout the cardiovascular system. This is particularly problematic in the microcirculation, where the clots cause widespread tissue ischemia. Large amounts of bleeding can then occur due to the massive dissolution of clots. Increased blood glucose levels and macrophages at the site of injury are not initial pathologic body changes associated with DIC. Question format: Multiple Choice Chapter: 16 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 432, Pathophysiology

12.A 20-year-old college student has a pelvic fracture and a severed leg from a motorcycle accident. The client lost several units of blood at the accident scene.

When the client arrived in the emergency room, the blood pressure was very low, pulse was high, and the skin was pale. What caused altered tissue perfusion in this client?

A. Decreased blood volume

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B. Systemic blood vessel dilation C. Epinephrine secretion from the adrenal medulla D. Decreased pumping action of the heart muscle Answer: A Rationale: Changes in blood volume can affect cardiac output and result in altered perfusion. Blood volume is altered with conditions such as hemorrhage or a significant blood loss because of the motorcycle accident. Blood loss from the accident does not cause systemic blood vessel dilation, epinephrine secretion, or a decreased pumping action of the heart muscle.

Question format: Multiple Choice Chapter: 16 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 415, Inadequate Cardiac Output

13.A client being treated for a kidney infection developed a temperature of 104°F (40°C), in spite of treatment with antibiotics. The client’s pulse was high, blood pressure low, and skin hot, dry, and flushed. What caused altered tissue perfusion in this client?

A. Decreased vascular volume B. Systemic blood vessel dilation C. Epinephrine secretion from the adrenal medulla D. Decreased pumping action of the heart muscle Answer: B Rationale: Shock is often equated with hypotension (low blood pressure). Septic

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shock, caused by a severe infection, alters tissue perfusion due to massive systemic vasodilation. Ineffective cardiac pumping results from cardiogenic shock, and decreased vascular volume results from hypovolemic shock. Epinephrine has a vasoconstricting effect and does not result in hypotension related to shock.

Question format: Multiple Choice Chapter: 16 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 421, Shock

14.What explanation should the nurse provide to a client who asks how to distinguish angina pain from the pain of a myocardial infarction (MI)?

A. Angina only occurs during the day; myocardial infarction pain is more likely at night.

B. Angina only occurs at rest; myocardial infarction pain occurs only during a stressful time.

C. Angina pain is more severe and lasts longer than myocardial infarction pain.

D. Rest and intake of nitroglycerin relieves chest pain with angina but not with myocardial infarction.

Answer: D Rationale: With myocardial infarction, rest or nitroglycerin tablets do not alleviate pain as they would for angina. The presence of angina is exacerbated with increased cardiac workload, such as with exercise, and is typically reduced with rest. Angina pain can be similar in timing and severity regardless of whether a myocardial infarction has occurred.

Question format: Multiple Choice Chapter: 16

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Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 425, Clinical Manifestations

15.What statement best describes the basic pathophysiology of myocardial infarction?

A. Cardiac output is insufficient to meet the needs of the heart and body.

B. Temporary vasospasm occurs in a coronary artery.

C. Total obstruction of a coronary artery causes myocardial cell death.

D. Heart rate and force is irregular, reducing blood supply to the coronary arteries.

Answer: C Rationale: Myocardial infarction (MI), or heart attack, is the total occlusion of one or more coronary arteries resulting in ischemia and death of myocardial tissues.

Insufficient cardiac output, vasospasm in a coronary artery, and irregular heart rate and force do not describe the basic pathophysiology of an MI. Question format: Multiple Choice Chapter: 16 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 423, Pathophysiology

16.What are some of the early signs or symptoms of myocardial infarction?

A. Brief, substernal pain radiating to the right arm, with labored breathing B. Persistent chest pain radiating to the left arm, pallor, and shortness of breath

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C. Bradycardia, increased blood pressure, and severe dyspnea D. Flushed face, rapid respirations, left-side weakness and numbness Answer: B Rationale: The clinical manifestations of myocardial infarction are variable but may include chest pain, crushing pressure, and pain radiating to the left arm, shoulder, or jaw. Dizziness, sweating, indigestion (heartburn) pain, nausea, vomiting, fatigue, weakness, anxiety, cool and moist skin, pallor, or shortness of breath may also be reported. It is common for the individual to deny the chest pain as related to a myocardial infarction.

Question format: Multiple Choice Chapter: 16 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 425, Clinical Manifestations

17.What laboratory results would be expected following a myocardial infarction?

A. Elevated partial pressure of oxygen (PO2) B. Decreased erythrocyte sedimentation rate (ESR) C. Elevated creatine kinase–myocardial b fraction (CK-MB) D. Decreased partial pressure of carbon dioxide (PCO2) Answer: C Rationale: Only CK-MB is found entirely in cardiac cells and rises after myocardial injury. Four to nine hours after myocardial injury, CK-MB levels increase, peak at 24 hours, and return to baseline at 48 to 72 hours. Elevated partial pressure of oxygen (PO2), decreased erythrocyte sedimentation rate (ESR), and decreased partial

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pressure of carbon dioxide (PCO2) do not specifically pertain to a myocardial infarction (MI) diagnosis.

Question format: Multiple Choice Chapter: 16 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 425, Diagnostic Criteria

18.What early clinical manifestations are consistent with right heart failure?

A. Fatigue, vertigo, headache B. Weakness, palpitations, nausea C. Dyspnea, nausea, vomiting D. Peripheral edema, fatigue Answer: D Rationale: Early clinical manifestations in right heart failure can be absent or subtle, such as fatigue, exertional dyspnea, or syncope with exertion. In advanced stages, peripheral edema, anorexia, weight loss, gastric and right upper quadrant pain, and jaundice can result from fluid congestion in the gastrointestinal tract and liver.

Swelling in the extremities is also related to systemic edema.

Question format: Multiple Choice Chapter: 16 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 429, Clinical Manifestations

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19.What medical event can possibly lead to right heart failure?

A. Severe pneumonia B. Myocardial infarction C. Uncontrolled hypertension D. Hypertrophy of the heart Answer: A Rationale: Causes of right heart failure include any process that restricts blood flow into the lungs. Lung injury, infections, inflammation, and pulmonary edema are most often implicated. Myocardial infarction and uncontrolled hypertension are more likely to cause left heart failure. Hypertrophy of the heart muscle occurs in response to workload demands of the ventricles; it is a compensatory mechanism to right heart failure.

Question format: Multiple Choice Chapter: 16 Cognitive Level (Bloom’s): Analyze Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 427, Right Heart Failure

20.What clinical manifestations suggest developing left heart failure?

A. Dyspnea, cough, and lung crackles B. Fatigue, vertigo (dizziness), headache C. Weakness, palpitations, peripheral edema D. Diarrhea, nausea, vomiting Answer: A Rationale: When present, clinical manifestations specific to left heart failure are

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related to decreased cardiac output and pulmonary congestion from a failing left ventricle, which leads to poor tissue and organ perfusion. Fluid congestion in the lungs leads to shortness of breath, coughing, and lung crackles. Poor tissue and organ perfusion leads to cyanosis, exercise intolerance, poor urinary output, fluid and sodium retention, anorexia, and fatigue.

Question format: Multiple Choice Chapter: 16 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 429, Clinical Manifestations

21.Which statement describes the pathophysiology behind left heart failure?

A. The left ventricle is having problems pumping blood forward, which is causing blood to back up into the lungs.

B. The left ventricle is pumping excessive amounts of blood through the carotid arteries causing headache.

C. The left ventricle is having problems pumping blood forward so blood is backing up systemically causing edema in the feet.

D. The left ventricle is not adequately perfusing the gastrointestinal tract, leading to diarrhea and vomiting.

Answer: A Rationale: In left heart failure, the left ventricle is unable to effectively meet cardiovascular demands, forward movement of blood through the circulation is inhibited, and fluid accumulates in the lung tissues. The left ventricle pumping excessive amounts of blood or not adequately perfusing the gastrointestinal tract does not correctly explain the pathophysiology of left heart failure. Blood backing up systemically and causing edema in the feet is also not an accurate explanation of left

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heart failure.

Question format: Multiple Choice Chapter: 16 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 426, Left Heart Failure

22.What medical condition or event can possibly lead to left heart failure?

A. Pulmonary edema B. Hypotension C. Stroke D. Myocardial infarction Answer: D Rationale: Causes of left heart failure include any condition that (1) impairs left ventricular pumping, such as what occurs with myocardial infarction or (2) increases the workload on the left ventricle, such as valvular disorders and hypertension.

Hypotension, stroke, and pulmonary edema are unlikely causes of left heart failure.

Question format: Multiple Choice Chapter: 16 Cognitive Level (Bloom’s): Analyze Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 426, Left Heart Failure

23.What change to the myocardial cells results from the increased workload on the

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heart during left heart failure?

A. Hyperplasia B. Hypertrophy C. Atrophy D. Dysplasia Answer: B Rationale: Hypertrophy of the heart muscle occurs in response to workload demands of the ventricles. Hypertrophy is a compensatory mechanism that is triggered in heart failure to maintain as much oxygenation as possible. Hyperplasia, dysplasia, and atrophy of the myocardial cells do not result from the increased workload of the heart with left heart failure.

Question format: Multiple Choice Chapter: 16 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 427, Right Heart Failure

24.What condition is characterized by the presence of cardiac valve leaflets, or cusps, that are floppy and fail to shut completely, permitting blood flow even when the valve should be completely closed?

A. Valvular regurgitation B. Valvular stenosis C. Pericardial effusion D. Infective endocarditis Answer: A

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Rationale: Regurgitation is a problem of incompetence of the valve, in which it is unable to properly close, allowing reflux of blood. Valvular stenosis is a problem in which narrowing of the valve occurs, making the valve unable to open adequately.

Infective endocarditis and pericardial effusion are not related to valve function.

Question format: Multiple Choice Chapter: 16 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 415, Inadequate Cardiac Output

25.A client is experiencing low preload due to loss of blood volume. Optimal preload is dependent on what factor?

A. Blood ejected from each ventricle with each contraction B. Blood pumped by each ventricle in 1 minute C. Venous return to the heart D. Resistance to ventricular emptying Answer: C Rationale: Preload is the work imposed on the heart just before contraction. Optimal preload depends on adequate venous return to fill the heart with blood and adequate cardiac muscle stretching to promote a strong contraction. Blood ejected from each ventricle with each contraction refers to stroke volume. Cardiac output is the blood pumped by each ventricle in 1 minute. Resistance to ventricular emptying affects afterload rather than preload.

Question format: Multiple Choice Chapter: 16 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation

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Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 410, Box 16.1 Major Factors Impacting Cardiac Output

26.What result of anaphylactic shock quickly leads to severe hypoxia?

A. Generalized vasoconstriction reduces venous return.

B. Histamine release causes massive vasodilation.

C. Heart rate and contractility is reduced.

D. Metabolic rate is greatly increased.

Answer: B Rationale: Anaphylactic shock is the result of a massive immune (type 1 or IgE-mediated) hypersensitivity response. Anaphylaxis leads to massive vasodilation and increased vascular permeability.

Question format: Multiple Choice Chapter: 16 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 421, Pathophysiology

27.Which condition would put a client at risk of developing hypertension?

A. Retention of fluid in the intravascular space B. Decreased blood viscosity C. Vasodilation D. Decrease in heart rate Answer: A

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Rationale: Retention of fluid in the intravascular space increases both blood volume and in turn cardiac output. Hypertension is a manifestation of increased cardiac output or peripheral resistance. Peripheral resistance is elevated by things such as vasoconstriction and increased blood viscosity. Vasodilation, decreased blood viscosity, and decreased heart rate would all result in decreased blood pressure.

Question format: Multiple Choice Chapter: 16 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 419, Pathophysiology

28.Which permanent change in the vascular system is caused by prolonged hypertension?

A. Development of lipid plaques in large veins B. Recurrent infection in peripheral arteries C. Sclerosis of the arterial walls D. Increased systemic vasodilation Answer: C Rationale: Chronic hypertension damages the blood vessel walls through direct injury to the intima (inner lining) from prolonged vasoconstriction and high pressures. The inflammatory response increases systemic capillary permeability and further damages the vessel wall. The vessel walls adapt through hypertrophy and hyperplasia to withstand this stress. The vessel lumen permanently narrows.

Question format: Multiple Choice Chapter: 16 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation

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Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 419, Pathophysiology

29.What manifestation of hemorrhagic stroke leads to tissue death?

A. Blocked arteries B. Bleeding from an artery C. Bleeding from a vein D. Blocked neurologic pathway Answer: B Rationale: Stroke is often differentiated as thrombotic, embolic, or hemorrhagic to distinguish the process leading to altered cerebral perfusion. Hemorrhagic stroke is a result of cerebral artery bleeding, not bleeding from a vein. Thrombotic strokes and embolic strokes both result from blocked arteries. Blocked neurologic pathways are not associated with hemorrhagic stroke.

Question format: Multiple Choice Chapter: 16 Cognitive Level (Bloom’s): Analyze Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 430, Pathophysiology

30.A client has right-sided paralysis and aphasia resulting from an embolic stroke 2 days ago. What do these symptoms tell the nurse about the client’s stroke?

A. The damage was probably in both hemispheres of the brain.

B. The damage was probably in the left side of the cerebrum.

C. The damage was probably in the right side of the brain.

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D. The client will probably regain function quickly after this type of injury.

Answer: B Rationale: In the cerebrum, hemorrhage or occlusion on one side of the brain results in hemiparesis or hemiplegia (paralysis) on the opposite side of the body. Therefore, if the stroke manifests as right-sided paralysis, the obstruction or hemorrhage most likely exists on the left side of the cerebrum. These symptoms are not indicative of recovery time.

Question format: Multiple Choice Chapter: 16 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 431, Clinical Manifestations

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Test Generator Questions, Chapter 17, Altered Nutrition 1. Which nutrient is considered nonessential?

A. Water B. Iron C. Vitamin C D. Glucose Answer: D Rationale: Essential nutrients must be consumed regularly in the diet because the body is unable to synthesize the nutrient in quantities sufficient to meet its needs.

These include water, iron, and vitamin C. Glucose is important; however, lipids and proteins can provide the energy source that glucose provides. Thus, glucose is not an essential nutrient.

Question format: Multiple Choice Chapter: 17 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 437, Module 1 Nutrition

2. Which vitamin deficiency is most likely a result of the inability to absorb fats?

A. Vitamin C B. Vitamin A C. Vitamin B12 D. Vitamin B6 Answer: B Rationale: Fat intake is critical for fat-soluble vitamin absorption. Vitamin A is fatPage 1

soluble; vitamins C and B are not fat-soluble.

Question format: Multiple Choice Chapter: 17 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 451, Vitamin and Mineral Deficiencies

3. What dietary change would most benefit a client who has a healing wound?

A. Add orange juice with breakfast.

B. Remove all simple sugars from the diet.

C. Add butter to the morning toast.

D. Diet does not impact wound healing.

Answer: A Rationale: Orange juice contains vitamin C (ascorbic acid), which aids in wound healing. Removing simple sugars and adding fat will not promote wound healing.

Question format: Multiple Choice Chapter: 17 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 448, Absorption

4. Which factor has the greatest impact on caloric needs?

A. Lactation B. Pregnancy C. Older age Page 2

D. Gender Answer: A Rationale: Caloric needs increase by 500 kcal/day for lactation and by 300 kcal/day for pregnancy. Older age and gender are not associated with significant increase in caloric needs.

Question format: Multiple Choice Chapter: 17 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 443, Nutritional Intake Requirements

5. What substance must be secreted in order to neutralize stomach acid in the small intestine?

A. Pancreatic enzymes B. Hydrochloric acid C. Bicarbonate D. Bile salts Answer: C Rationale: Bicarbonate is needed to neutralize hydrochloric acid (stomach acid).

Bile salts and pancreatic enzymes are critical for fat digestion.

Question format: Multiple Choice Chapter: 17 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page 3

Page and Header: 444, Digestion

6. Which nutrient is nondigestible and prevents cholesterol absorption?

A. Fiber B. Monosaccharides C. Amino acids D. Water Answer: A Rationale: Fiber is a nondigestible complex carbohydrate that helps prevent cholesterol absorption. Amino acids are the simplest forms of proteins.

Monosaccharides are the simplest form of carbohydrates. Water is also in its simplest form.

Question format: Multiple Choice Chapter: 17 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 441, Micronutrients: Vitamins and Minerals

7. Loss of which part of the gastrointestinal tract would have the greatest impact on nutrient absorption?

A. Stomach B. Small intestine C. Large intestine D. Liver Answer: B

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Rationale: The small intestine is the major site for absorption in the gastrointestinal tract. Therefore, loss of small intestine will have a greater impact of nutrient absorption than loss of part of the stomach, large intestine, or liver.

Question format: Multiple Choice Chapter: 17 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 448, Figure 17.8

8. Which mineral deficiency would inhibit glucose absorption in the small intestine?

A. Calcium B. Magnesium C. Sodium D. Potassium Answer: C Rationale: Glucose requires the cotransport of sodium to be absorbed into the lumen of the small intestine. It doesn’t require magnesium, calcium, or potassium.

Question format: Multiple Choice Chapter: 17 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 448, Glucose and Fructose Absorption

9. Fat emulsification is inhibited by deprivation of what element?

A. Bile salts Page 5

B. Pancreatic enzymes C. Glycerol D. Cotransport molecules Answer: A Rationale: Emulsification promotes fat solubility and is accomplished via bile salts.

Pancreatic enzymes, glycerol, and cotransport molecules will not inhibit fat emulsification if absent.

Question format: Multiple Choice Chapter: 17 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 449, Fatty Acid and Glycerol Absorption

10.What term indicates a state where a mineral is unbound and must remain unbound in order to be absorbed, such as with calcium?

A. Active transport B. Passive diffusion C. Bioavailability D. Ionicity Answer: C Rationale: Bioavailability indicates that the mineral is unbound and must remain unbound to be absorbed (also called an ionic state). Active and passive transport describe mechanisms of moving substances across a cell membrane. Ionicity indicates a molecule breaking into a cation and an anion.

Question format: Multiple Choice Chapter: 17 Page 6

Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 449, Fatty Acid and Glycerol Absorption

11.Which dietary component is least likely to be underconsumed and lead to a state of undernutrition?

A. Carbohydrates B. Protein C. Iron D. Vitamins Answer: A Rationale: Proteins, iron, and vitamins are the most common nutrients that are inadequately consumed or in great demand in those presenting with undernutrition.

Question format: Multiple Choice Chapter: 17 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 451, Undernutrition 12.Effective adaptation to a state of starvation is dependent upon suppression of which hormone?

A. Growth hormone B. Glucagon C. Cortisol D. Insulin

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Answer: D Rationale: In a state of starvation (marasmus), dietary glucose is unavailable for glucose-dependent tissues, such as the brain and muscle tissue. If the body is to adapt to starvation effectively, insulin production must be suppressed to inhibit glucose uptake and gluconeogenesis, and another energy source must be used at a greater level than glucose. Suppression of growth hormone, glucagon, or cortisol will not support effective adaptation to starvation.

Question format: Multiple Choice Chapter: 17 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 451, Protein Energy Malnutrition

13.What element is the replacement source of energy in an effective adaptation to starvation?

A. Glucose B. Ketones C. Amino acids D. Monosaccharides Answer: B Rationale: Ketones are the replacement energy source that allows sparing of muscle catabolism. The brain and other glucose-dependent tissues prefer glucose but will use ketones for energy as an adaptive response. When ketones are used for energy, protein losses are minimized and muscle tissue is spared. Glucose is unavailable in a state of starvation, leading to the need for a replacement. Amino acids and monosaccharides do not replace glucose as an energy source to support effective adaptation to starvation.

Question format: Multiple Choice Page 8

Chapter: 17 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 451, Protein Energy Malnutrition

14.How long could a person survive in a state of starvation if that person is able to remain hydrated?

A. 1 month B. 10 days C. 1 year D. 3 months Answer: A Rationale: A state of starvation can be maintained for approximately 1 month in someone who maintains water intake.

Question format: Multiple Choice Chapter: 17 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 451, Protein Energy Malnutrition

15.What nutrient deficiency will likely lead to severe edema?

A. Water B. Proteins C. Carbohydrates D. Fats Page 9

Answer: B Rationale: A lack of protein intake leads to severe edema. Lack of water, carbohydrates, and fats do not lead to edema.

Question format: Multiple Choice Chapter: 17 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 451, Protein Energy Malnutrition

16.Which client is most likely to be diagnosed with a malabsorption syndrome?

A. A 24-year-old with lactose intolerance B. A 36-year-old with acute pancreatitis C. A 40-year-old with severe inflammatory bowel disease D. A 5-year-old on pancreatic enzymes for cystic fibrosis Answer: C Rationale: Malabsorption is linked to inflammatory conditions. Lactose intolerance, acute pancreatitis, and cystic fibrosis do not lead to fat and fat-soluble substances being inadequately absorbed.

Question format: Multiple Choice Chapter: 17 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 451, Protein Energy Malnutrition

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17.Why does carbohydrate malabsorption lead to abdominal distention, bloating, pain, diarrhea, and flatulence?

A. Chronic bowel inflammation B. Fermentation C. Fibrosis D. Bacterial flora overgrowth in the intestine Answer: B Rationale: Carbohydrate malabsorption results in an increase in fermentation, or breakdown, of carbohydrates by intestinal bacterial flora to convert these carbohydrates into short-chain fatty acids (for absorption) and gases. This leads to abdominal distention, bloating, pain, diarrhea, weight loss, and flatulence.

Carbohydrate malabsorption does not cause chronic bowel inflammation, fibrosis, nor bacteria flora overgrowth.

Question format: Multiple Choice Chapter: 17 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 455, Malabsorption

18.Which population of those listed is at the lowest risk for iron-deficiency anemia?

A. Infants B. Adolescents C. Pregnant clients D. Older male and female Answer: D Rationale: The body requires higher iron demands for infants, adolescents, and Page 11

pregnant or lactating clients, making them at higher risk for iron-deficiency anemia than older male and female clients.

Question format: Multiple Choice Chapter: 17 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 457, Iron-Deficiency Anemia, Pathophysiology

19.Those with clinical manifestations for iron-deficiency anemia often present with pallor of the skin and mucous membranes, fatigue, weakness, lightheadedness, breathlessness, palpitations, headache, tachycardia, and syncope. What is the cause of these manifestations?

A. Electrolyte imbalance B. Hypoxia C. Pagophagia D. Excessive blood loss Answer: B Rationale: Pallor, fatigue, weakness, lightheadedness, breathlessness, palpitations, headache, tachycardia, and syncope are all clinical manifestations of hypoxia, which can be caused by iron-deficiency anemia that is left untreated.

Question format: Multiple Choice Chapter: 17 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 457, Iron-Deficiency Anemia, Clinical Manifestations

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20.What symptom is not characteristic of those with anorexia nervosa?

A. Weight loss B. Body image distortions C. Ignoring hunger D. Hot flashes Answer: D Rationale: Anorexia nervosa is characterized by inability to maintain a healthy body weight, fear of gaining weight, relentless dietary habits to avoid gaining weight, and severe body image distortions. Individuals with anorexia nervosa get cold easily; hot flashes are not symptomatic of anorexia nervosa.

Question format: Multiple Choice Chapter: 17 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 458, Anorexia Nervosa

21.Which outcome is not caused by severe caloric restriction due to anorexia nervosa?

A. Micronutrient deficiencies B. Mobilization of lipid stores C. Protein catabolism D. Reduced metabolic rate Answer: A Rationale: Anorexia nervosa causes mobilization of lipid stores, protein catabolism, and a reduced metabolic rate. It causes a macronutrient deficiency, not a micronutrient deficiency.

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Question format: Multiple Choice Chapter: 17 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 457, Iron-Deficiency Anemia, Pathophysiology

22.What condition causes gluten malabsorption in celiac disease?

A. T-cell–mediated hypersensitivity B. Excessive intake of glutens C. Pancreatic enzyme deficiency D. Chronic inflammation Answer: A Rationale: In clients who are genetically predisposed to developing gluten malabsorption, there is a T-cell–mediated hypersensitivity marked by the inability to tolerate gliadin, the alcohol-soluble fraction of gluten. Excessive gluten intake, pancreatic enzyme deficiency, and chronic inflammation do not contribute to gluten malabsorption in celiac disease.

Question format: Multiple Choice Chapter: 17 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 460, Celiac Disease (Gluten-Sensitive Enteropathy)

23.What condition is the cause of phenylketonuria?

A. T-cell–mediated hypersensitivity Page 14

B. Dietary deficiency of protein C. Liver damage secondary to alcohol abuse D. Autosomal recessive genetic mutation Answer: D Rationale: Phenylketonuria is an autosomal recessive disorder caused by a mutation in the phenylalanine hydroxylase (PAH) gene, which provides the instructions for making the enzyme PAH. T-cell–mediated hypersensitivity, protein deficiency, and liver damage do not cause phenylketonuria.

Question format: Multiple Choice Chapter: 17 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 460, Celiac Disease (Gluten-Sensitive Enteropathy), Pathophysiology

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Test Generator Questions, Chapter 18, Altered Elimination 1. What characteristic of urine indicates adequate hydration?

A. Oliguria B. Strong smell C. Dark color D. Pale color Answer: D Rationale: Variations in urine color indicate hydration status. Concentrated, dark, strong-smelling urine may indicate dehydration, whereas dilute, pale-colored urine may indicate increased fluid volume. Oliguria indicates decreased urine output as a result of dehydration.

Question format: Multiple Choice Chapter: 18 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 472, Urine Characteristics

2. What term identifies the functional unit of the kidney?

A. Bladder B. Trigone C. Nephron D. Cecum Answer: C

Rationale: Nephrons are the functional units of the kidneys. The trigone serves as a functional sphincter, preventing urine from moving back into the ureter from the bladder. The bladder stores urine, and the cecum is part of the gastrointestinal system.

Question format: Multiple Choice Chapter: 18 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 468, Introduction

3. Which structure lies parallel to vasa recta?

A. Proximal tubules B. Loops of Henle C. Distal convoluted tubules D. Collecting ducts Answer: B Rationale: Vasa recta lies parallel to the loops of Henle. Movement of water and solutes between the vasa recta and loops of Henle in the juxtamedullary nephrons promotes concentration of urine. Vasa recta are not likely to be found in proximal tubules, collecting ducts, or distal convoluted tubules.

Question format: Multiple Choice Chapter: 18 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 471, Figure 18.2

4. What motor fibers stimulate detrusor contraction?

A. Sympathetic cholinergic B. Sympathetic adrenergic C. Parasympathetic cholinergic D. Parasympathetic adrenergic Answer: C Rationale: Contraction of the detrusor muscle is stimulated by parasympathetic cholinergic motor fibers. Detrusor contraction is not stimulated by adrenergic fibers or sympathetic cholinergic fibers.

Question format: Multiple Choice Chapter: 18 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 471, Urine Removal

5. What action stimulates micturition?

A. Bladder filling B. Rectal filling C. Mass movements D. Segmental movement Answer: A Rationale: Bladder filling stimulates the micturition reflex. Micturition is not stimulated by rectal filling, mass movements, or segmental movements.

Question format: Multiple Choice Chapter: 18

Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 473, Box 18.1

6. What substance creates the characteristic brown color of stool?

A. Urochrome B. Stercobilin C. Urea D. Hydrogen sulfide Answer: B Rationale: The characteristic brown color of stool is derived from the bilirubin pigment in bile, stercobilin. Stool color is not due to urochrome, urea, or hydrogen sulfide.

Question format: Multiple Choice Chapter: 18 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 480, Stool Characteristics

7. What plexus is the intrinsic enteric nervous system component that transmits sensory impulses through stretch receptors in the colon?

A. Myenteric plexus B. Auerbach plexus C. Meissner plexus D. Celiac plexus

Answer: C Rationale: The Meissner plexus transmits sensory impulses through stretch receptors, while the myenteric plexus (also known as the Auerbach plexus) transmits impulses that control gastrointestinal movement. The celiac plexus does not influence the stretch receptors in the colon.

Question format: Multiple Choice Chapter: 18 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 479, Stool Evacuation

8. The presence of epithelial cells in urinary casts indicates which pathophysiologic condition?

A. Glomerulonephritis B. Pyelonephritis C. Urinary tract infection D. Acute tubular necrosis Answer: D Rationale: Casts may form because of low flow rate, increased sodium concentration, and low pH; these are all factors favoring precipitation. Precipitation of urinary fluid components may cause blockage of essential renal structures. The specific type of cell trapped in the cast meshwork may provide information on the site of pathology.

Epithelial cells may indicate shedding of tubular cells causing acute tubular necrosis, whereas white blood cells may indicate pyelonephritis. Trapping of red blood cells within casts may indicate glomerulonephritis. Stasis of urine in the bladder may promote bacterial growth, leading to local and ascending infection in the kidneys.

Question format: Multiple Choice Chapter: 18 Cognitive Level (Bloom’s): Analyze Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 474, Alteration in Urinary Motility

9. What outcome may result from altered urinary neuromuscular function?

A. Urinary retention B. Urinary incontinence C. Impaired conscious control of timing of urinary elimination D. All of these Answer: D Rationale: Alteration in neuromuscular function in urinary elimination may result in urinary retention or incontinence. Conscious control of urinary elimination may be impaired as a consequence of altered mobility and the resulting reduction in toileting independence.

Question format: Multiple Choice Chapter: 18 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 474, Alteration in Urinary Neuromuscular Function

10.What condition results from obstruction in the renal tubules?

A. Dilation of structures proximal to the obstruction

B. Dilation of structures distal to the obstruction C. Constriction of structures proximal to the obstruction D. Constriction of structures distal to the obstruction Answer: A Rationale: Urine flow is impeded in the obstruction of the renal and urinary systems.

Obstruction in the renal tubules leads to the dilation of the structures proximal to the obstruction, which causes dilation and stasis, leading to infection and structural damage. Obstruction in the renal tubules does not cause any constriction of structures or dilation of structures distal to the obstruction.

Question format: Multiple Choice Chapter: 18 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 475, Alteration in Urinary Patency

11.Costovertebral angle (CVA) pain is a sign of what condition?

A. Bladder infection B. Kidney stones C. Appendicitis D. Bowel obstruction Answer: B Rationale: The most obvious clinical manifestation of kidney stones is pain. This pain is characterized as severe and shooting and is localized in the lateral aspect of the lower back (flank) at the costovertebral angle. Costovertebral angle (CVA) pain is not a sign of appendicitis, bowel obstruction, or bladder infection.

Question format: Multiple Choice Chapter: 18 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 486, Clinical Manifestations

12.Partial obstructions with manifestations of hard, solidly formed stool are most likely located in which colon segment?

A. Cecum B. Ascending colon C. Transverse colon D. Sigmoid colon Answer: D Rationale: The characteristics of fecal matter passed in the presence of partial obstruction may provide clues as to the location of the obstruction. Obstructions occurring closest to the cecum may allow watery stool to pass because the water content of the stool is high. Partial obstructions located at the distal end of the colon, such as the sigmoid colon, may allow the passage of small quantities of harder, more solidly formed stool. The ascending and transverse colon are less distal than the sigmoid colon.

Question format: Multiple Choice Chapter: 18 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 483, General Manifestations of Altered Bowel Elimination

13.Steatorrhea is most commonly associated with what condition?

A. Bowel obstruction B. Urolithiasis C. Malabsorption syndromes D. Encopresis Answer: C Rationale: Bile acids are absent in some malabsorption syndromes and are associated with large fat content, known as steatorrhea. Steatorrhea is not commonly associated with bowel obstruction, urolithiasis, or encopresis.

Question format: Multiple Choice Chapter: 18 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 483, General Manifestations of Altered Bowel Elimination

14.What term indicates blood in stool that cannot be seen with the naked eye?

A. Peritonitis B. Melena C. Steatorrhea D. Occult Answer: D Rationale: Occult blood is blood in the stool that is too small to be seen. Melena refers to black stool that signifies a bleeding concern. Peritonitis is inflammation of the peritoneal membrane. Steatorrhea is an enlarged fat content in stools.

Question format: Multiple Choice

Chapter: 18 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 484, Diagnosis of Bowel Conditions

15.What type of medications for diarrhea work by absorbing excess fluid in fecal matter in the colon?

A. Antimotility agents B. Adsorbents C. Bulk-forming agents D. Laxatives Answer: C Rationale: Bulk-forming agents firm the stool by absorbing excess fluid in the fecal matter. Antimotility agents work by promoting water removal from fecal matter.

Adsorbents pull out other essential products. Laxatives are used for constipation, not diarrhea.

Question format: Multiple Choice Chapter: 18 Cognitive Level (Bloom’s): Analyze Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 9 Page and Header: 485, Treatment of Altered Bowel Elimination

16.What element is the most common component of renal calculi?

A. Calcium oxalate

B. Uric acid C. Struvite D. Cystine Answer: A Rationale: Calcium (oxalate and phosphate) is the most common component of stones, which may also form because of magnesium ammonium phosphate (struvite), uric acid, or cystine.

Question format: Multiple Choice Chapter: 18 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 486, Pathophysiology

17.What characteristic is typical of colic pain?

A. Dull B. Steady C. Deep D. Excruciating Answer: D Rationale: Colic pain is characterized as acute, intermittent, radiating, and excruciating. Noncolic pain is characterized as dull and deep.

Question format: Multiple Choice Chapter: 18 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation

Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 486, Clinical Manifestations

18.What clinical manifestation is an indication for surgical stone removal?

A. Stone too small to pass B. Obstruction of urine flow C. Mild, intermittent pain for 1 day D. Small stone without evidence of size increase Answer: B Rationale: The indications for surgical stone removal include obstruction of urine flow, stones too large to pass, stones that cause ongoing urinary tract infections, stones causing kidney damage, stones causing constant pain, and stones continuing to grow in size.

Question format: Multiple Choice Chapter: 18 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 9 Page and Header: 486, Diagnostic Criteria

19.What term indicates inability to voluntarily prevent the discharge of urine?

A. Encopresis B. Enuresis C. Endoscopic D. Anuria

Answer: B Rationale: Pediatric urinary incontinence, or involuntary urination, is known as enuresis. Anuria is absent urine production. Encopresis is functional fecal incontinence, and endoscopic refers to a type of diagnostic testing.

Question format: Multiple Choice Chapter: 18 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 488, Urinary Incontinence

20.What type of incontinence is caused by exertional stimulus?

A. Urge incontinence B. Overactive bladder C. Functional incontinence D. Stress incontinence Answer: D Rationale: Stress incontinence occurs because of an exertional stimulus. Urge incontinence, also known as overactive bladder, refers to urine leaking that is accompanied by, or immediately preceded by, a strong urge to void. Functional incontinence is characterized by normal bladder control coupled with an impaired ability to transport to toilet facilities, such as with impaired mobility.

Question format: Multiple Choice Chapter: 18 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning

Learning Objective: 3 Page and Header: 488, Urinary Incontinence

21.What form of polycystic kidney disease (PKD) first manifests in the early infant period?

A. Autosomal dominant B. Autosomal recessive C. Acquired D. All of these Answer: B Rationale: Symptoms of polycystic kidney disease (PKD) appear early in the autosomal recessive form of PKD, usually in the early infant period or even during fetal life. Clinical manifestations of kidney disease usually appear between the ages of 30 and 40 years in the autosomal dominant form. Evidence of the acquired form of PKD does not present until much later in life and is more frequent among older individuals.

Question format: Multiple Choice Chapter: 18 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 489, Pathophysiology

22.What clinical manifestation characterizes polycystic kidney disease (PKD)?

A. Reduction in kidney size bilaterally B. Increase in kidney size bilaterally C. Reduction in kidney size unilaterally

D. Increase in kidney size unilaterally Answer: B Rationale: Polycystic kidney disease (PKD) is a condition characterized by growth of fluid-filled cysts in kidney tissue bilaterally, leading to progressive loss of nephrons.

Cysts begin to grow in the nephrons of the kidney, filling with glomerular filtrate, eventually growing larger and moving away into adjacent tissue. Kidney size increases in proportion to the size and number of cysts, which can number into the thousands. Kidney size reduction is not seen with PKD. Question format: Multiple Choice Chapter: 18 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 489, Pathophysiology

23.What term indicates a single outpouching of the colon wall?

A. Diverticula B. Diverticulum C. Diverticulosis D. Diverticulitis Answer: B Rationale: A single outpouching of the colon wall is called a diverticulum. More than one diverticulum is called diverticula. The presence of diverticula is referred to as diverticulosis. Fecal matter caught in sacs may promote the development of infection, known as diverticulitis.

Question format: Multiple Choice

Chapter: 18 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 492, Pathophysiology

24.Dietary strategies for prevention of calcium oxalate–based renal calculi include avoidance of which food or drink item?

A. Bananas B. High fat C. Nuts D. Rice Answer: C Rationale: Foods high in oxalate should be avoided in persons with calcium oxalate– based stones. These foods include beets, chocolate, coffee, cola, nuts, rhubarb, spinach, strawberries, tea, and wheat bran. Foods high in fat as well as bananas and rice are not associated with calcium oxalate–based stones.

Question format: Multiple Choice Chapter: 18 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 486, Diagnostic Criteria

25.What circumstance might cause retentive incontinence?

A. Fear of defecation

B. Organic bowel impairment C. Ineffective toilet-training management D. Anatomical defect Answer: A Rationale: Functional fecal incontinence may be classified as retentive or nonretentive. No anatomic or physiologic anomalies are associated with functional fecal incontinence. Instead, functional fecal incontinence demonstrates voluntary conscious control over defecation in neurologically competent individuals. The retentive form of functional fecal incontinence is associated with retentive posturing or excessive volitional (willful, deliberate) stool retention, history of hard or painful bowel movements, presence of large fecal mass in the rectum, or history of passing large diameter stool. Most cases of functional retentive fecal incontinence are caused by constipation. Constipation may result from the change in diet and, in older children, the stress or fear associated with defecation that leads to voluntary retention, amplifying the problem of constipation.

Question format: Multiple Choice Chapter: 18 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 495, Pathophysiology

26.How can abdominal pain be categorized?

A. Visceral, somatic, and referred B. Mechanical, inflammatory, and ischemic C. Colic and noncolic D. Acute and chronic

Answer: A Rationale: Abdominal pain can be categorized into three main types: visceral, somatic, and referred. Origins of pain include mechanical, inflammatory, or ischemic causes. Pain from kidney stones is described as colic or noncolic. Acute and chronic are not specific to abdominal pain.

Question format: Multiple Choice Chapter: 18 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 483, General Manifestations of Altered Bowel Elimination

Test Generator Questions, Chapter 19, Degenerative Changes in Aging 1. Which theory of aging links cumulative cellular damage with the production of reactive oxygen species as a major determinant of aging?

A. Evolution B. Free radical C. Accumulated mutations D. Antagonistic pleiotropy Answer: B Rationale: The free radical theory of aging links cellular damage with the production of reactive oxygen species (ROS). According to this theory, intracellular production of ROS contributes to the final determination of life expectancy. The antagonistic pleiotropy theory suggests that genes may have beneficial effects during early life but harmful effects as the individual ages. The accumulated mutations theory suggests that over time, the accumulation of genetic mutations during cell division may contribute to altered cellular function associated with aging. Evolution aging theory doesn’t link to cumulative cellular damage with the production of reactive oxygen species.

Question format: Multiple Choice Chapter: 19 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 500, Theories of Aging

2. Age-related melanin deficiency can lead to which manifestation?

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A. Age spots B. Wrinkled skin C. Graying hair D. Stooped posture Answer: C Rationale: Age-related changes in hair include loss, growth, distribution, and graying because of melanin deficiency in the hair follicle. Wrinkled skin, age spots, and stooped posture are not associated with melanin deficiency.

Question format: Multiple Choice Chapter: 19 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 2 Page and Header: 500, Theories of Aging

3. What change contributes to an age-associated decrease in total body water?

A. Increase in muscle mass B. Decrease in muscle mass C. Increase in lean mass D. Decrease in fat mass Answer: B Rationale: Aging is associated with changes in body mass characterized by a decrease in muscle and an increase in fat. These changes contribute to a decrease in total body water, further enhanced by the kidney’s diminished sodium and water balance regulation, which is important for maintaining extracellular fluid volume and tonicity.

Question format: Multiple Choice

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Chapter: 19 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 500, Theories of Aging

4. What change that occurs during the aging process causes alteration of immune function?

A. Increased hypersensitivity response B. Reduced autoimmune response C. Increased T-cell lymphocyte number D. Reduced T-cell lymphocyte activity Answer: D Rationale: As T-cell function is reduced with aging, the immune function is altered.

With aging, hypersensitivity is reduced, not increased; the autoimmune response is increased; and T-cell lymphocytes decrease.

Question format: Multiple Choice Chapter: 19 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 500, Developmental Theories

5. What structural change contributes to neurologic deficits in aging?

A. Increased brain mass B. Increased number of dendritic processes

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C. Decreased myelin D. Increased number of neurons Answer: C Rationale: Typical structural changes include a decrease in brain mass; enlargement of cerebral ventricles; decrease in the number of neurons, dendritic processes, and synapses; decrease in the myelin; and altered production of neurotransmitters.

Question format: Multiple Choice Chapter: 19 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 503, Neurologic Function

6. Neurofibrillary tangles are most commonly associated with what medical condition?

A. Alzheimer disease B. Parkinson disease C. Progeria D. Multiple sclerosis Answer: A Rationale: Neurofibrillary tangles are theorized to play an important role in the development of Alzheimer disease. Neurofibrillary tangles are not associated with Parkinson disease, progeria, or multiple sclerosis.

Question format: Multiple Choice Chapter: 19 Cognitive Level (Bloom’s): Remember

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Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 8 Page and Header: 511, Alzheimer Disease, Pathophysiology

7. What clinical manifestation is an example of age-related primary atrophy of skeletal tissue?

A. Osteopenia B. Senescent bone loss C. Menopausal bone loss D. Reduced bone calcification Answer: C Rationale: Menopausal bone loss is an example of age-related primary atrophy of skeletal tissue. It is perpetuated by inadequate levels of protective ovarian hormones.

Senescent bone loss is related to diminished bone remodeling. Reduced bone calcification is associated with osteoporosis.

Question format: Multiple Choice Chapter: 19 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 1 Page and Header: 504, Age-Related Proliferative Changes, Mobility

8. What condition is characterized by decreased size and number of skeletal muscle fibers?

A. Kyphosis B. Sarcoidosis

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C. Chondrocalcinosis D. Sarcopenia Answer: D Rationale: Sarcopenia, or loss of skeletal muscle, is a common age-related change that limits function. Kyphosis is an outward curvature of the thoracic spine.

Chondrocalcinosis is a calcification of cartilage. Sarcoidosis is a disease leading to inflammation, usually in the lungs, skin, and lymph nodes.

Question format: Multiple Choice Chapter: 19 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 504, Age-Related Proliferative Changes, Mobility

9. What vascular change results in increased cardiac afterload and hypertension in older adults?

A. Decreased elasticity in arterial connective tissue B. Increased elasticity in arterial connective tissue C. Decreased elasticity in venous connective tissue D. Increased elasticity in venous connective tissue Answer: A Rationale: Increased afterload caused by arterial stiffening and limited distention may alter cardiac output. Arterial changes are caused by a decrease in elasticity, not an increase. Venous connective tissue leads to hypertension, not a decrease in cardiac afterload.

Question format: Multiple Choice

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Chapter: 19 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 505, Age-Related Proliferative Changes, Perfusion and Ventilation

10.What condition is a potential metabolic alteration leading to osteoporosis in older adults?

A. Increased calcitonin B. Reduced parathyroid hormone C. Reduced vitamin D activation D. Enhanced intestinal absorption of calcium Answer: C Rationale: Calcium levels may be affected by age-related decreased intestinal absorption of calcium, a blunted response to vitamin D activation, and the age-related increase in PTH. Nutritional intake of calcium and vitamin D is also important in the regulation of calcium metabolism. Reduced vitamin D activation can lead to osteoporosis in older adults.

Question format: Multiple Choice Chapter: 19 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 505, Age-Related Proliferative Changes, Metabolic Processes

11.What condition may indicate the development of typical age-related changes in

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thyroid function?

A. Increased T3 levels B. Increased thyroid-stimulating hormones (TSH) levels C. Decreased thyroid-stimulating hormones (TSH) levels D. Hyperthyroidism Answer: C Rationale: Decreased T3 levels and elevated thyroid-stimulating hormone (TSH) levels characterize typical thyroid function alterations in older populations. These changes can cause hypothyroidism not hyperthyroidism.

Question format: Multiple Choice Chapter: 19 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 507, Age-Related Proliferative Changes, Nutrition and Elimination

12.What conditions might cause alterations in temperature regulation in older adults?

A. Increased number, size, and activity of sweat glands B. Impaired responsiveness to catecholamine-induced vasoconstriction C. Enhanced environmental temperature perception D. Enhanced ability to produce heat Answer: B Rationale: Temperature regulation is compromised. The ability to cool the body via sweating is impaired because of a decrease in the number, size, and activity of sweat glands, making older people particularly susceptible to heat stress. Frail individuals are especially at risk for hypothermia because of diminished cold perception, altered

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responsiveness to catecholamine-induced vasoconstriction and shiver, and limited ability to produce heat.

Question format: Multiple Choice Chapter: 19 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 505, Age-Related Proliferative Changes, Metabolic Processes

13.What condition is related to renal function impairment in aging?

A. Increased renal mass B. Reduced nephron number C. Increased glomerular filtration rate D. Reduced drug toxicity risk Answer: B Rationale: Reduction in nephron number may alter urine concentration, placing additional importance on the regulation of total water balance. Renal mass and glomerular filtration rate are reduced. Drug excretion may be impaired, increasing the risk of toxicity.

Question format: Multiple Choice Chapter: 19 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 507, Nutrition and Elimination

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14.Which age-related alteration in elimination often results in severe dehydration in older adults?

A. Constipation B. Diarrhea C. Fecal incontinence D. Urinary retention Answer: B Rationale: Impaired gastrointestinal elimination in older individuals is most frequently manifested as constipation, diarrhea, fecal incontinence, and impaction. The stress of fluid and electrolyte loss via diarrhea represents a significant threat to water balance, often resulting in severe dehydration.

Question format: Multiple Choice Chapter: 19 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 507, Nutrition and Elimination

15.What factor contributes to increased gender-based prevalence of osteoporosis in women compared with men?

A. Total bone mass B. Intestinal calcium absorption C. Renal calcium elimination D. Vitamin D activation Answer: A Rationale: Compared to women, men have fewer fractures associated with

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osteoporosis because of increased bone mass and strength. Reduced bone size and loss caused by cortical and trabecular thinning characterizes the development of bone fragility in males. Increased bone remodeling in older males is often caused by secondary hyperparathyroidism, calcium malabsorption, and vitamin D deficiency.

Question format: Multiple Choice Chapter: 19 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 510, Osteoporosis, Diagnosis

16.What type of fracture is common due to the high content of spongy bone?

A. Femur B. Hip C. Humerus D. Spine Answer: D Rationale: Because of the high quantity of spongy bone in the vertebrae, spinal fractures represent significant types of fractures associated with osteoporosis. The femur, hip, and humerus bones are primarily composed of compact bone.

Question format: Multiple Choice Chapter: 19 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 510, Osteoporosis, Clinical Manifestations

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17.What condition is the underlying cause of Hutchinson-Gilford progeria syndrome?

A. Imbalance in the bone remodeling process B. Autosomal dominant mutations in the LMNA (lamin AC) gene C. Plaque formation in the hippocampus and cerebral cortex D. Formation of neurofibrillary tangles Answer: B Rationale: Progeria is caused by an autosomal dominant mutation in the LMNA (lamin AC) gene coding for the lamin A protein. Imbalance in the bone remodeling processes, plaque formation in the hippocampus and cerebral cortex, and formation of neurofibrillary tangles are not underlying causes of Hutchinson-Gilford.

Question format: Multiple Choice Chapter: 19 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 508, Progeria (Hutchinson-Gilford Progeria Syndrome)

18.Which early manifestation of Hutchinson-Gilford progeria syndrome often presents within the first year of life?

A. Incomplete sexual maturation B. Hearing loss C. Scleroderma D. Skeletal dysplasia Answer: C Rationale: Clinical manifestations often presents within the first year of life when “sclerodermalike” skin over the buttocks, thighs, and lower abdomen; midfacial

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cyanosis; “sculptured” nose; and alopecia (hair loss) are first noted and when the infant fails to grow. Incomplete sexual maturation, hearing loss, and skeletal dysplasia appear by age 2 years, when children show prominent signs of early aging.

Question format: Multiple Choice Chapter: 19 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 508, Progeria (Hutchinson-Gilford Progeria Syndrome), Clinical Manifestations

19.Which neurodegenerative disorder affecting older adults is the most common?

A. Alzheimer disease B. Parkinson disease C. Multiple sclerosis D. Scleroderma Answer: A Rationale: Alzheimer disease is the most common neurodegenerative disorder and most frequent cause of dementia in older adults, affecting nearly 6 million people in the United States.

Question format: Multiple Choice Chapter: 19 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 508, Progeria (Hutchinson-Gilford Progeria Syndrome); 511, Alzheimer Disease

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20.Which issue is most characteristic of Alzheimer disease, rather than the typical changes in aging?

A. Difficulty with bill paying B. Forgetfulness of familiar words C. Misplacement of keys D. Forgetfulness of phone numbers Answer: A Rationale: Difficulty with bill paying is associated with stage 4 Alzheimer disease.

Changes associated with aging include mild forgetfulness, a decrease in vocabulary, and learning difficulties. These changes typically do not occur until the seventh decade of life. Forgetfulness of familiar words and phone numbers and misplacement of keys are associated with stage 2 Alzheimer disease.

Question format: Multiple Choice Chapter: 19 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 8 Page and Header: 511, Alzheimer Disease

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Test Generator Questions, Chapter 20, Integrated Pathophysiologic Concepts 1. What pathophysiologic characteristic is consistent with type 1 diabetes mellitus?

A. Enlarged pancreas B. Peak occurrence between ages 6 and 10 years C. Caused by a combination of environmental and genetic factors D. Hypoglycemia and hypoketonuria Answer: C Rationale: The etiology of type 1 diabetes is multifactorial and includes both genetic and environmental influences leading to autoimmune destruction of beta cells. The clinical manifestations of type 1 diabetes mellitus are related to severe hyperglycemia and hyperketonemia. This type of diabetes was previously known as insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes to reflect the most common treatment modality (insulin replacement) and age at diagnosis (approximately 10 to 14 years of age). Enlargement of the pancreas is not symptom of type 1 diabetes mellitus.

Question format: Multiple Choice Chapter: 20 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 520, Insulin Deficit: Type 1 Diabetes Mellitus

2. What description best explains the pathophysiology of type 1 diabetes?

A. Destruction of the pancreatic islet cells, which produce insulin B. Resistance of insulin-sensitive tissues to insulin

C. Decreased production of releasing hormones by the hypothalamus D. Stimulation by food intake of glucose production resulting in increased insulin production Answer: A Rationale: The etiology of type 1 diabetes is multifactorial and includes both genetic and environmental influences leading to autoimmune destruction of beta cells. Beta cells secrete insulin, promoting glucose utilization. Type 2 diabetes is caused by insulin resistance or impaired ability of tissues to use insulin. Severe hyperglycemia results from increased insulin resistance and excessive carbohydrate intake.

Question format: Multiple Choice Chapter: 20 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 520, Insulin Deficit: Type 1 Diabetes Mellitus

3. What factor is the origin of the pathophysiology in type 1 diabetes?

A. IgE-mediated hypersensitivity, which destroys the endocrine pancreas and impairs release of insulin B. IgA-mediated hypersensitivity, which affects the sensitivity of tissues to insulin C. B-lymphocyte autoimmunity against the endocrine pancreas beta cells D. T-lymphocyte autoimmunity against the endocrine pancreas beta cells Answer: D Rationale: The etiology of type 1 diabetes is multifactorial and includes both genetic and environmental influences leading to autoimmune destruction of beta cells.

Exposure to an environmental trigger, such as a virus or toxin, stimulates

cell-mediated destruction and a process of autoimmunity that destroys beta cells. The cell-mediated immune mechanisms involve the presence of cytotoxic T lymphocytes.

IgE- and IgA-mediated hypersensitivity and B-lymphocyte autoimmunity against the endocrine pancreas beta cells do not accurately describe the origin of the pathophysiology of type 1 diabetes.

Question format: Multiple Choice Chapter: 20 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 520, Insulin Deficit: Type 1 Diabetes Mellitus

4. What early signs and symptoms are typically exhibited in a client with type 1 diabetes?

A. Recurrent infections, visual changes, paresthesias B. Polydipsia, polyuria, polyphagia, weight loss C. Vomiting, abdominal pain, sweet, fruity breath D. Weakness, vomiting, hypotension, mental confusion Answer: B Rationale: The clinical manifestations most commonly associated with type 1 diabetes include polydipsia, polyuria, polyphagia, nocturia, fatigue, unexplained weight loss, and blurred vision. Abdominal pain, vomiting, fruity breath, dehydration, Kussmaul breathing, weakness, hypotension, and mental confusion are symptoms of diabetic ketoacidosis. Recurrent infections, visual changes, and paresthesias are chronic complications of diabetes.

Question format: Multiple Choice Chapter: 20 Cognitive Level (Bloom’s): Remember

Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 521, Clinical Manifestations

5. Which laboratory value would the nurse expect to find in an individual with type 1 diabetes?

A. An elevated blood glucose level B. An elevated insulin level C. An elevated white blood cell count D. An elevated hemoglobin level Answer: A Rationale: Individuals with type 1 diabetes typically have an elevation in the fasting blood glucose above 126 mg/dL or the random blood glucose level above 200 mg/dL. Type 1 diabetes destroys beta cells, lowering the insulin level. An elevated white blood cell count, an elevated hemoglobin level, and an elevated insulin level are not expected findings in an individual with type 1 diabetes.

Question format: Multiple Choice Chapter: 20 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 521, Diagnostic Criteria

6. A client with type 1 diabetes asks the nurse whether they will outgrow the diagnosis and eventually be cured. What response should the nurse provide?

A. “There is no cure at this time; you will need to take medication every day to

manage the diabetes.”

B. “There is no cure at this time, but if you lose some weight, it may correct itself.”

C. “As you get older, the disease will decrease in severity; you will be able to control it by diet only.”

D. “Type 1 diabetes is a childhood disease; by the time you have completed puberty, it will be gone.”

Answer: A Rationale: The autoimmune destruction of the pancreas in type 1 diabetes is not reversible; therefore, there is no cure at this time. Insulin replacement therapy is integral to the treatment plan for type 1 diabetes. Type 1 diabetes will not decrease in severity with age, after puberty, or as a result of weight loss.

Question format: Multiple Choice Chapter: 20 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 521, Treatment

7. After the client, age 12, was diagnosed with type 1 diabetes, his father John went for a physical and was diagnosed with type 2 diabetes. What led the practitioner to believe that John had type 2 diabetes? A client was recently diagnosed with type 2 diabetes. Which finding would lead the healthcare provider to this diagnosis?

A. The client’s fasting blood glucose was high.

B. The client was producing no insulin.

C. The client was overweight.

D. The client had a decrease in energy level.

Answer: A

Rationale: Type 2 diabetes is a disease of reduced insulin production and cellular insulin resistance; there is not a lack of insulin production. The subadequate levels of insulin and peripheral resistance to insulin uptake leads to increased blood glucose levels. The presence of obesity and decreased energy levels heightens suspicion that type 2 diabetes is present but is not indicative of diabetes.

Question format: Multiple Choice Chapter: 20 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 5 Page and Header: 524, Clinical Manifestations

8. Obesity is a major risk factor for the development of type 2 diabetes. What is the mechanism for this?

A. Obesity is a result of high sugar intake, which leads to hyperglycemia.

B. Obesity releases fatty acids and cytokines, which interfere with insulin receptors.

C. Obesity is associated with hypercholesterolemia, which impairs insulin circulation.

D. Obesity is associated with a mutation of the miR-21 gene, which is implicated in the development of insulin resistance.

Answer: B Rationale: Obesity promotes peripheral insulin resistance by releasing free fatty acids and cytokines from adipose cells. These chemicals interfere with insulin signals, disrupt insulin receptors on the target cell plasma membranes, and prohibit insulin from facilitating the entry of glucose into liver, muscle, and adipose tissues. High sugar intake, hypercholesterolemia, and mutation of the miR-21 gene do not correctly explain how obesity increases the risk of type 2 diabetes.

Question format: Multiple Choice Chapter: 20 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 524, Pathophysiology

9. A 14-year-old client is admitted with arterial pH 7.2, serum glucose 500 mg/dL (27.75 mmol/L), urine glucose, and ketones 4+/strong. The client has been sick with the “flu” for 1 week. What relationship do the laboratory values have to the client’s insulin deficiency?

A. Increased glucose utilization causes the shift of fluid from the intravascular to intracellular space.

B. Decreased insulin causes fatty acid use, ketone formation, metabolic acidosis, and osmotic diuresis.

C. Increased glucose and fatty acids stimulate renal diuresis, electrolyte loss, and metabolic alkalosis.

D. Increased insulin use results in protein catabolism, tissue wasting, respiratory acidosis, and electrolyte loss.

Answer: B Rationale: Bobby has developed diabetic ketoacidosis (DKA), which is a problem of deficient insulin and severe hyperglycemia leading to a state of metabolic acidosis and severe osmotic diuresis. The lack of insulin causes mobilization of fatty acids for energy, leading to an increased production of ketones. The kidneys are unable to excrete the ketones, and the cells are unable to use these byproducts, allowing ketones to accumulate in the blood. The other explanations do not explain the correct pathophysiology of DKA. Question format: Multiple Choice

Chapter: 20 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 528, Diabetic Ketoacidosis

10.What factor could cause a client with type 1 diabetes to develop diabetic ketoacidosis?

A. Skipping a meal B. Strenuous exercise C. Illness D. Insulin overdose Answer: C Rationale: Diabetic ketoacidosis typically is triggered by an increased demand for insulin, such as occurs with severe stress, infection, overconsumption of food, pregnancy, or inadequate insulin administration. Skipping a meal, strenuous exercise, and insulin overdose all lower blood glucose levels and the demand for insulin.

Question format: Multiple Choice Chapter: 20 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 528, Diabetic Ketoacidosis

11.If a client with type 1 diabetes presented in an unconscious state, how would the nurse know that the client was experiencing diabetic ketoacidosis?

A. Pale moist skin B. Thirst and poor skin turgor C. Deep rapid respirations and fruity breath odor D. Tremors and strong rapid pulse Answer: C Rationale: With the onset of acidosis in diabetic ketoacidosis, buffer systems are taxed and compensatory changes occur in an effort to improve the acid–base balance in the body. Kussmaul respirations are deep, rapid respirations that release excess acids through the lungs. The breath also has a sweet, fruity odor caused by the release of acetone, a volatile form of ketones. These symptoms would be the most indicative of diabetic ketoacidosis in an unconscious individual. The skin is not affected in diabetic ketoacidosis. Tremors are not present.

Question format: Multiple Choice Chapter: 20 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 528, Diabetic Ketoacidosis

12.What clinical manifestation of diabetic ketoacidosis causes loss of consciousness?

A. Toxic effects of excessive insulin B. Glucose deficit in the blood C. Acidosis effects on the central nervous system D. Lack of glucose to the central nervous system Answer: C Rationale: Acidosis triggers a decreased level of consciousness in diabetic

ketoacidosis, which can progress to coma and even death. Diabetic ketoacidosis is a problem of deficient insulin (not excessive) and severe hyperglycemia (not a glucose deficit).

Question format: Multiple Choice Chapter: 20 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 528, Diabetic Ketoacidosis

13.Which laboratory value does the nurse expect to see when a client with type 1 diabetes presents with ketoacidosis?

A. Increased serum bicarbonate B. Serum pH of 7.1 (normal range 7.35 to 7.45) C. Decreased serum potassium D. Urine pH 6.0 (normal range 4.5 to 8) Answer: D Rationale: The signs and symptoms of diabetic ketoacidosis are consistent with severe hyperglycemia, metabolic acidosis, and dehydration. Metabolic acidosis presents with a blood pH less than 7.3. Decreased blood pH would be more likely to indicate ketoacidosis than an increased serum bicarbonate, decreased serum potassium, or a urine pH within the normal range.

Question format: Multiple Choice Chapter: 20 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7

Page and Header: 528, Diabetic Ketoacidosis

14.A client with type 1 diabetes is on insulin. During gym class, the client experiences hunger, lightheadedness, tachycardia, pallor, headache, and confusion for the first time. What is the most probable cause of these symptoms?

A. Hyperglycemia due to incorrect insulin administration B. Hypoglycemia due to increased exercise C. Hyperglycemia due to not eating breakfast D. Hypoglycemia due to administering too little insulin that morning Answer: B Rationale: Hypoglycemia is a state of significantly low blood glucose that results in demonstrable clinical manifestations, such as weakness, pallor, or cool/clammy skin.

Other signs and symptoms include poor concentration, extreme hunger, blurred vision, dizziness and confusion, difficulty with speech, lack of coordination, staggering gait, and headache. Hypoglycemia is most commonly found in individuals with type 1 diabetes who are undergoing insulin replacement therapy. Causes of hypoglycemia include hyperinsulinemia, inadequate food intake or vomiting, frequent simple carbohydrate intake, infection, and strenuous exercise. Hypoglycemia is not caused from administering too little insulin. The symptoms described are not consistent with hyperglycemia.

Question format: Multiple Choice Chapter: 20 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 526, Hypoglycemia

15.A client with type 2 diabetes asks the nurse why insulin injections have not been prescribed. What response by the nurse would explain the difference between treatment for type 2 diabetes and type 1 diabetes?

A. Type 2 diabetes is a disease of reduced insulin production and cellular insulin resistance; there is not a lack of insulin production.

B. The client would be unable to metabolize insulin so taking insulin injections would not help.

C. The extra glucose in the client’s body is helpful; it would not be desirable to decrease it with insulin.

D. Older adults do not benefit from insulin injections as much as children.

Answer: A Rationale: Unlike type 1 diabetes, there is no autoimmune destruction of the pancreas. Rather, insulin resistance, or decreased sensitivity to insulin in metabolic tissues, such as the liver, skeletal muscle, and adipose, results in insufficient insulin usage. Individuals with type 2 diabetes also exhibit reduced insulin secretion in response to glucose exposure. The other explanations do not accurately reflect why insulin injections are not prescribed for type 2 diabetes.

Question format: Multiple Choice Chapter: 20 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 524, Pathophysiology

16.A client who has been diagnosed with type 1 diabetes has been instructed to maintain “tight” control of their diabetes to prevent which chronic complication(s)?

Select all that apply.

A. Hypoglycemia

B. Nephropathy C. Retinopathy D. Peripheral vascular disease E. Somatic neuropathy Answer: B, C, D Rationale: Chronic complications of diabetes mellitus are classified as microvascular, macrovascular, and neuropathies. Microvascular complications include retinopathy and nephropathy. Peripheral vascular disease is an example of a macrovascular complication. Somatic neuropathy is an example of a neuropathic complication.

Hypoglycemia is an acute, not chronic, complication of diabetes mellitus.

Question format: Multiple Select Chapter: 20 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 529, Chronic Complications of Diabetes Mellitus

17.What complication is more likely in an adult client with type 2 diabetes than in a child with type 1 diabetes?

A. Hypoglycemia B. Diabetic ketoacidosis C. Somogyi effect D. Hyperglycemic hyperosmolar nonketotic syndrome Answer: D Rationale: Hyperglycemic hyperosmolar nonketotic syndrome is primarily a problem of type 2 diabetes in older adults that presents with severe hyperglycemia caused

from increased insulin resistance and excessive carbohydrate intake. Diabetic ketoacidosis is a problem of deficient insulin and severe hyperglycemia leading to a state of metabolic acidosis and severe osmotic diuresis. It occurs most commonly in those with type 1 diabetes. Hypoglycemia is most commonly found in individuals with type 1 diabetes who are undergoing insulin replacement therapy. The Somogyi effect is rebound hyperglycemia as a reaction to insulin-induced hypoglycemia. Type 2 diabetes is most commonly controlled by diet, exercise, and oral medications.

Question format: Multiple Choice Chapter: 20 Cognitive Level (Bloom’s): Analyze Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 529, Hyperglycemic Hyperosmolar Nonketotic Syndrome

18.What clinical manifestations characterize the Somogyi effect?

A. Overnight hypoglycemia with rebound hyperglycemia in the morning B. Increased insulin resistance as weight increases C. Hyperglycemia in the absence of ketosis D. Massive osmotic diuresis and dehydration Answer: A Rationale: The Somogyi effect is rebound hyperglycemia as a reaction to insulin-induced hypoglycemia. Insulin-induced hypoglycemia triggers compensatory increases in catecholamines, glucagon, cortisol, and growth hormone in an effort to promote insulin resistance and increase circulating blood glucose levels.

Hypoglycemia, which often occurs during the night, is met with morning or daytime hyperglycemia. Increased insulin resistance with weight gain, hyperglycemia in the absence of ketosis, and osmotic diuresis and dehydration do not accurately explain the Somogyi effect.

Question format: Multiple Choice Chapter: 20 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 529, The Somogyi Effect and Dawn Phenomenon

19.The mechanism for the development of the dawn phenomenon is related to the release of what substance?

A. Inflammatory mediators B. Hormones C. Insulin D. Enzymes Answer: B Rationale: The dawn phenomenon is a situation in which an individual’s blood glucose level upon waking is higher than the level before going to bed in the evening. The dawn phenomenon is related to the release of hormones (growth hormone, cortisol, glucagon, and catecholamines), usually between 4 AM and 9 AM, which triggers insulin resistance and the release of glucose from the liver. The dawn phenomenon is not related to the release of inflammatory mediators, insulin, or enzymes.

Question format: Multiple Choice Chapter: 20 Cognitive Level (Bloom’s): Remember Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 529, The Somogyi Effect and Dawn Phenomenon

20.What clinical manifestation of diabetes can lead to visual impairment?

A. Abnormal metabolism in the lens B. Microvascular changes in the eye C. Cataract development D. Development of exophthalmos Answer: B Rationale: Microvascular complications are one complication of diabetes that is characterized by degenerative changes occurring in small vessels. The most notable small vessels affected are those in the retinas, resulting in a condition called retinopathy. In retinopathy, retinal ischemia related to obstruction, and rupture of capillaries can lead to blindness. Visual impairment does not develop as a result of cataracts, exophthalmos, or abnormal metabolism in the lens.

Question format: Multiple Choice Chapter: 20 Cognitive Level (Bloom’s): Analyze Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 6 Page and Header: 530, Microvascular Complications

21.When increased blood glucose levels stimulate increased secretion of insulin, this is an example of control by: A. releasing hormones.

B. ectopic hormones.

C. negative feedback.

D. positive feedback.

Answer: C

Rationale: With insulin, secretion is increased when there are elevations in (1) blood glucose; (2) amino acids; (3) potassium, phosphate, and magnesium; and (4) glucagon and gastrin. This is an example of control by the negative feedback mechanism. The release of hormones or ectopic hormones does not stimulate the increased secretion of insulin when blood glucose levels increase. The positive feedback mechanism was not discussed in this chapter.

Question format: Multiple Choice Chapter: 20 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 3 Page and Header: 519, Glucose, Insulin, Energy, and the Pancreas

22.What major difference distinguishes type 1 diabetes from type 2 diabetes?

A. Method of diagnosis B. Method of treatment C. Potential long-term complications D. Overall treatment goals Answer: B Rationale: Treatment of type 1 diabetes includes glycemic control, exercise, and insulin replacement therapy. Insulin replacement therapy is integral to the treatment plan for type 1 diabetes because the pancreas is no longer producing insulin. Type 2 diabetes is a problem of insulin resistance; therefore, insulin therapy is not an integral part of treatment. Treatment of type 2 diabetes begins with weight control through an individualized nutrition and exercise plan and can include oral glycemic agents or insulin replacement therapy (if needed). Diagnosis, treatment goals, and potential complications are similar for both type 1 and type 2 diabetes.

Question format: Multiple Choice

Chapter: 20 Cognitive Level (Bloom’s): Analyze Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 4 Page and Header: 525, Treatment

23.A client who has been diagnosed with type 2 diabetes has been encouraged to exercise at an increased level. Why is exercise encouraged in type 2 diabetes?

Select all that apply.

A. Exercise decreases stress.

B. Skeletal muscles can use glucose without a proportionate insulin amount.

C. Exercise decreases cardiovascular effects of excessive glucose.

D. Exercise decreases insulin sensitivity.

E. Exercise reduces the risk of long-term complications associated with diabetes.

Answer: A, B, C, E Rationale: Physical activity is advantageous in the treatment of type 2 diabetes because it increases the uptake of glucose by the muscles without increasing insulin needs. Exercise also improves insulin sensitivity. The other positive outcomes of physical activity, such as decreased body fat, increase in endorphins, improved cardiovascular health, and weight control, also lower the risk for some of the long-term complications of diabetes.

Question format: Multiple Select Chapter: 20 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 525, Treatment

24.A client with type 2 diabetes has been prescribed an oral glycemic medication. How does this medication act in the body?

A. As an insulin replacement B. To decrease the body’s need for glucose in body cells C. To prevent the formation of glucose D. To reduce insulin resistance Answer: D Rationale: Oral glycemic agents act to increase insulin release by the beta cells, increase glucose production by the liver, or increase the uptake of insulin by cells (reducing insulin resistance). Oral glycemic drugs do not prevent the formation of glucose, decrease the body’s need for glucose, or replace insulin.

Question format: Multiple Choice Chapter: 20 Cognitive Level (Bloom’s): Understand Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 525, Treatment

25.A client with type 1 diabetes indicates that their blood glucose has been around 100 to 120 mg/dL (5.55 to 6.66 mmol/L) and claims to have been fully participating in their diabetes management plan. What information suggests that the client has not been in tight control of their diabetes?

A. A reduced glycosylated hemoglobin level.

B. An elevated glycosylated hemoglobin level.

C. A random blood glucose of 150 mg/dL (8.32 mmol/L) performed in the clinic.

D. There is no method to determine whether or not the client is in tight control.

Answer: B

Rationale: Glycosylated hemoglobin (HbA1c) is a blood test that determines hemoglobin and red blood cell exposure to glucose over the previous 3 to 4 months.

In prolonged hyperglycemia, the hemoglobin that travels inside the red blood cell becomes irreversibly combined with glucose, a situation termed glycosylation, for the life of that red blood cell. HbA1c is therefore a useful determinant of “average” exposure of red blood cells to glucose over that period. The higher the HbA1c, the more hyperglycemic, or uncontrolled, the diabetes has been. A single random blood glucose of 150 mg/dL (8.32 mmol/L) is not indicative of an individual’s diabetes management over a period of time.

Question format: Multiple Choice Chapter: 20 Cognitive Level (Bloom’s): Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning Learning Objective: 7 Page and Header: 520, Pathophysiology