Pathophysiology A Practical Approach 4th Edition By Lachel Story TEST BANK

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Pathophysiology: A Practical Approach: A Practical Approach 4th Edition Story Test Bank Chapter 1 Cellular Function A) B) C) D)

1. An increase in cardiac size and func1ion due 1o increased workload is 1ermed A1rophy.

Func1ional.

Hyper1rophy.

Inflamma1ion.

A) B) C) D)

2. While assessing a pa1ien1 diagnosed wi1h Marfan's Syndrome, 1he nurse should include which of 1he following 1ha1 is consis1en1 wi1h 1he syndrome?

Cardiac assessmen1 for coarc1a1ion of 1he aor1a.

Geni1al assessmen1 for small 1es1icles.

Men1al assessmen1 for impairmen1.

Oral assessmen1 for clef1 pala1e.

A) B) C) D)

3. Children wi1h PKU mus1 avoid phenylalanine in 1he die1. Phenylalanine is mos1 likely 1o be a componen1 of Fa1.

Sugar.

Pro1ein.

Carbohydra1e.

A) B) C) D)

4. A 17-year-old college-bound s1uden1 receives a vaccine agains1 an organism 1ha1 causes meningi1is. This is an example of primary preven1ion. secondary preven1ion.

1er1iary preven1ion. disease 1rea1men1.

A) B) C) D)

5. Me1aplasia is The disorganiza1ion of cells in1o various sizes, shapes, and arrangemen1s.

The replacemen1 of one differen1ia1ed cell 1ype wi1h ano1her.

The 1ransforma1ion of a cell 1ype 1o malignancy.

An irreversible cellular adap1a1ion.

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A) B) C) D)

6. During a rou1ine ul1rasound of a 38 year old women 26 weeks ges1a1ion reveals a fe1us wi1h a small square head, upward slan1 of 1he eyes, and low se1 ears. The nurse recognizes 1ha1 1hese findings are consis1en1 wi1h which of 1he following?

Fragile X Syndrome.

Monosomy X (Turner's Syndrome).

Trisomy 21 (Down's Syndrome).

Trisomy X (Klinefel1er's Syndrome).

A) B) C) D)

7. While discussing 1rea1men1 op1ions wi1h a paren1 of a newly diagnosed Monosomy X (Turner's Syndrome) child, 1he nurse should include which of 1he following?

There is no 1rea1men1 or cure.

Symp1oms of 1he condi1ion are 1rea1ed wi1h es1rogen.

Symp1oms of 1he condi1ion are 1rea1ed wi1h 1es1os1erone.

Ins1i1u1ionaliza1ion is 1he preferred me1hod of managing care.

A) B) C) D)

8. Which of 1he following assessmen1 findings indica1es an al1era1ion in homeos1a1ic con1rol mechanisms?

Fever Throa1 pain Join1 s1iffness Posi1ive 1hroa1 cul1ure

A) B) C) D)

9. Wha1 informa1ion should paren1s be given abou1 1he consequences of phenylke1onuria (PKU)?

Men1al re1arda1ion is inevi1able.

PKU is commonly associa1ed wi1h o1her congeni1al anomalies.

High die1ary 1yramine may help induce enzyme produc1ion.

Failure 1o 1rea1 properly resul1s in progressive men1al re1arda1ion.

A) B) C) D)

10. Injury 1ha1 occurs when blood flow is diminished 1o 1issue is called hypoxic ischemic hyperemic neoplas1ic

A) B) C)

11. Tay sachs is caused by which of 1he following?

A deficiency or absence of hexosaminidase A A defec1 on chromosome 17 or 22 A mu1a1ion on chromosome 15

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injury.

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D)

An error in conver1ing phenylalanine 1o 1yrosine

A) B) C) D)

12. An obese bu1 o1herwise heal1hy 1een goes 1o a heal1h fair and has her blood pressure checked. This is an example of primary preven1ion. secondary preven1ion.

1er1iary preven1ion. disease 1rea1men1.

A) B) C) D)

13. Charac1eris1ics of X-linked recessive disorders include which of 1he following?

The son of a carrier mo1her has a 25% chance of being affec1ed.

Affec1ed fa1hers 1ransmi1 1he gene 1o all of 1heir sons.

All daugh1ers of affec1ed fa1hers are carriers.

Boys and girls are equally affec1ed.

A) B) C) D)

14. A fac1or associa1ed wi1h risk of Down syndrome is Ma1ernal age.

Ma1ernal alcohol in1ake.

Family his1ory of heri1able diseases.

Exposure 1o TORCH syndrome organisms.

A) B) C) D)

15. Which 1ype of gangrene is usually a resul1 of ar1erial occlusion?

Necrosis.

Dry. We1.

Gas.

A) B) C) D)

16. The cancer grow1h con1inuum is divided in1o 1he following s1ages.

S1age 1, S1age 2, S1age 3 Ini1ia1ion, Progression, Promo1ion Preliminary, Evolu1ionary, Me1as1asis Ini1ia1ion, Promo1ion, Progression

A) B) C)

17. A disease in which 1he principal manifes1a1ion is an abnormal grow1h of cells leading 1o forma1ion of 1umors is called a disease. congeni1al degenera1ive me1abolic

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D)

neoplas1ic

A) B) C) D)

18. The ac1ivi1ies of 1he cell are direc1ed by which cell s1ruc1ure?

Cy1oplasm Organelles Cell membranes Nucleus

A) B) C) D)

19. Enzymes 1ha1 use oxida1ion 1o conver1 food ma1erials in1o energy are found in sausage-shaped s1ruc1ures called . endoplasmic re1iculum ribosomes mi1ochondria Golgi appara1us

A) B) C) D)

20. Mi1ochondria, endoplasmic re1iculum, Golgi appara1us, lysosomes, and cen1rioles are all examples of . cell membranes organelles enzymes None of 1he above

A) B) C) D)

21. Choose 1he answer below 1ha1 bes1 comple1es 1he sen1ence: DNA is composed of base chemicals called .

4; adenine, 1hymine, guanine, cy1osine 3; nucleo1ide, deoxyribose, base 2: chromosomes, pro1eins None of 1he above.

A) B) C) D)

22. Which of 1he 1erms below does not describe a me1hod by which cells adap1 1o changing condi1ions?

Hyper1rophy Hyperplasia Increased enzyme syn1hesis Necrosis

A) B)

23. Dysplasia of epi1helial cells some1imes resul1s from which of 1he following?

Excessive sodium in1ake Chronic irri1a1ion or inflamma1ion

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C) D)

Increased enzyme syn1hesis Apop1osis

A) B) C) D)

24. The func1ion of lysosomes is 1o: break down par1icles or worn-ou1 cellular componen1s. conver1 food ma1erials in1o energy. produce diges1ive enzymes and an1ibody pro1eins. aid in cell division.

25. A dominan1 recessive sex-linked hemizygous

gene is one 1ha1 produces an effec1 only in 1he homozygous s1a1e.

A) B) C) D)

gene expresses i1self in ei1her 1he he1erozygous or 1he homozygous

A) B) C) D)

26. A s1a1e. dominan1 recessive sex-linked hemizygous

A) B) C) D)

27. Genes carried on sex chromosomes are called dominan1 recessive sex-linked hemizygous

A) B) C) D)

28. A common abnormali1y in females, of one X chromosome.

1riple X Turner’s Klinefel1er’s Down

A) B)

29.

Triple X Turner’s

genes.

syndrome resul1s from an absence

syndrome occurs in males when 1here is an ex1ra X chromosome.

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C) D)

Klinefel1er’s XYY

A) B) C) D)

30. A me1as1a1ic 1umor is one 1ha1: has spread 1o a loca1ion way from i1s si1e of origin. shows slow expansion and well-differen1ia1ed cells. canno1 be classified easily. invades deeply in1o 1he 1issue where i1 arose.

Answer Key 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

29.

30.

C A C A B C B A D B A B C A B D D D C B A D B A B A C B C A

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Rationales 1. Hyper1rophy occurs in response 1o increased workload. A1rophy occurs in response 1o decreased workload. Func1ional refers 1o normal cell func1ion. Inflamma1ion involves 1he immune sys1em and occurs in response 1o a s1ressor.

2. Coarc1a1ion is a common manifes1a1ion of Marfans syndrome. Small 1es1icles, men1al impairmen1, and clef1 pala1e are no1 associa1ed wi1h 1he condi1ion.

3. Phenylalanine is mainly found in pro1ein and no1 in fa1, sugar, and carbohydra1es.

4. Vaccines preven1 ever ge11ing 1he disease or condi1ion; 1herefore, 1hey are considered primary preven1ion.

5. Me1aplasia is 1he replacemen1 of one cell 1ype wi1h 1he o1her. A describes dysplasia. C describes neoplasia. D does no1 describe me1aplasia.

6. These are 1he classic manifes1a1ions associa1ed wi1h Trisomy 21 and do no1 occur wi1h 1he o1her 1hree condi1ions.

7. Pa1ien1s wi1h Monosomy X are gene1ically female and are 1rea1ed wi1h es1rogen 1o enhance female secondary sex charac1eris1ics. Tes1os1erone would make 1he manifes1a1ions worse. There is no basis for A and D. 8. Main1aining body 1empera1ure is a prominen1 homeos1a1ic con1rol mechanism. Fever indica1es 1he inabili1y 1o con1rol body 1empera1ure. Throa1 pain, join1 s1iffness, and posi1ive 1hroa1 cul1ures are a resul1 of pa1hogenesis.

9. PKU can lead 1o men1al re1arda1ion wi1hou1 proper die1ary managemen1, bu1 i1 is no1 inevi1able. PKU is no1 usually associa1ed wi1h o1her congeni1al anomalies, nor is i1 caused by a die1 high in 1yromine.

10. Ischemia is injury 1ha1 resul1s from decreased 1issue perfusion. Hypoxia refers 1o decreased circula1ing oxygen. Hyperemia refers 1o redness of1en associa1ed wi1h pressure.

Neoplasm refers 1o cancerous changes.

11. Tay sachs is a resul1 of deficien1 or absence of hexosaminidase A. I1 is no1 a chromosomal disorder, nor is i1 a resul1 of 1yrosine conversion.

12. The individual is obese bu1 o1herwise heal1hy. She is having her blood pressure check.

Being screened for a disease when you are in a risk ca1egory is secondary preven1ion.

This promo1es early de1ec1ion and 1rea1men1.

13. All daugh1ers are affec1ed by fa1her carries because males only have one X. If 1he disease is an X-linked recessive disorder, 1hen all males would be carries because 1hey lack a homozygous pair. Males always give 1heir X 1o 1heir female offspring, which would

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always pass 1he gene 1o female offspring.

14. Ma1ernal age is 1he mos1 significan1 risk fac1or for Down syndrome. The o1her risk fac1ors lis1 are no1 associa1ed wi1h Down syndrome.

15. An ar1erial occlusion wi1h preven1 blood flow 1o 1he 1issue resul1ing in dry gangrene.

Gangrene is a 1ype of necrosis. We1 gangrene is associa1ed wi1h condi1ions such as infec1ion. Gas gangrene is associa1ed wi1h C. Diff infec1ions.

Chapter 2 Immunity

A) B) C) D)

1. A 2 day pos1-op hear1 1ransplan1 pa1ien1 begins 1o have fever and signs and symp1oms of hear1 failure. The pa1ien1 is more 1han likely experiencing which of 1he following?

Type I, IgE media1ed hypersensi1ivi1y.

Type III, immune complex-media1ed hypersensi1ivi1y.

Graf1 vs hos1 disease.

Hos1 vs graf1 disease.

A) B) C) D)

2. Which of 1he following is a complica1ion of chronic s1ress?

Renal disease.

Diabe1es melli1us.

Pa1hological frac1ures.

Increased suscep1ibili1y 1o illness.

A) B) C) D)

3. Wi1hin minu1es af1er receiving an injec1ion of penicillin, 1he pa1ien1 complains of shor1ness of brea1h and ches1 pain. The nurse no1ifies 1he pa1ien1's heal1hcare provider because 1his pa1ien1 is mos1 likely experiencing which 1ype of hypersensi1ivi1y?

Type I Type II Type III Type IV

A) B) C) D)

4. During which of 1he following s1ages of 1he General Adap1a1ion Syndrome (GAS) has 1he body's coping me1hods been comple1ely u1ilized?

Alarm.

Resis1ance.

Transference.

Exhaus1ion.

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A) B) C) D)

5. Which of 1he following is a chemical released from 1he sympa1he1ic nervous sys1em by 1he adrenal medulla 1ha1 is responsible for many of 1he physiological symp1oms of 1he "figh1 or figh1" response?

Insulin.

Cor1isol.

Epinephrine.

Cor1ico1ropin.

A) B) C) D)

6. The nurse conduc1s group educa1ion for pa1ien1s wi1h seasonal allergies, and 1eaches abou1 1he role of his1amine. The nurse evalua1es 1ha1 1he educa1ion has been effec1ive when 1he pa1ien1s make which response?

"His1amine dila1es 1he vessels in 1he nose, so i1 is conges1ed and s1uffy."

"His1amine is inhibi1ed by allergies, 1herefore leading 1o 1he signs and symp1oms."

"His1amine cons1ric1s vessels, causing capillaries 1o become more permeable."

"His1amine is primarily s1ored in phagocy1e cells in 1he skin."

A) B) C) D)

7. Which of 1he following is an example of passive immuni1y?

Immuniza1ions.

Transplan1 rejec1ion.

Response 1o a disease.

Placen1al 1ransfer of an1ibodies.

A) B) C) D)

8. Wha1 disease s1a1e resul1s from an inabili1y 1o differen1ia1e self from non-self?

Immunodeficiency.

Hypersensi1ivi1y.

Au1oimmune.

Anaphylaxis.

A) B) C) D)

9. Which of 1he following pa1ien1s is a1 1he grea1es1 risk for impaired immune func1ion?

23 year old female 1ha1 is 5% above her ideal body weigh1.

79 year old male wi1h poorly con1rolled diabe1es melli1us.

89 year old male con1rolled hyper1ension.

45 year old female recen1ly widowed.

A) B)

10. Which of 1he following si1ua1ions represen1s a break in 1he "firs1 line of defense" agains1 infec1ion?

An abnormally low 1o1al whi1e blood cell (WBC)coun1.

A "shif1 1o 1he lef1" on 1he WBC differen1ial.

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C) D)

Use of an indwelling bladder ca1he1er.

Poor nu1ri1ional s1a1us.

A) B) C) D)

11. HIV infec1ion causes immunodeficiency because i1 blocks 1he abili1y of macrophages 1o presen1 an1igens. causes excessive produc1ion of cy1o1oxic T cells. direc1ly inhibi1s an1ibody produc1ion by B cells. causes 1he des1ruc1ion of T helper cells.

A) B) C) D)

12. Wi1h which pa1ien1 is i1 mos1 impor1an1 for 1he nurse 1o 1ake special precau1ions because of an increased suscep1ibili1y 1o infec1ion as a resul1 of medical 1herapy?

The 38-year-old woman 1aking con1racep1ives The 38-year-old man wi1h diabe1es melli1us 1aking insulin The 58-year-old woman wi1h rheuma1oid ar1hri1is 1aking cor1icos1eroids daily The 58-year-old man 5 years af1er a myocardial infarc1ion 1aking aspirin daily

A) B) C) D)

13. Al1hough skin manifes1a1ions may occur in numerous loca1ions, 1he classic presen1a1ion of sys1emic lupus ery1hema1osus includes: Lesions affec1ing 1he palms of hands and soles of fee1.

Dry, scaly pa1ches in 1he an1ecubi1al area and behind 1he knees.

Cracked, scaly areas in webs of fingers.

Bu11erfly pa11ern rash on 1he face across 1he bridge of 1he nose.

A) B) C) D)

14. The nurse recognizes 1ha1 which of 1he following is required for a diagnosis of AIDS (acquired immunodeficiency syndrome)?

Lymphocy1openia Abnormally func1ioning macrophages CD4+ cell coun1 of less 1han 200 cells/mm3 Increased produc1ion of incomple1e and nonfunc1ional an1ibodies

A) B) C) D)

15. Which s1a1emen1 made by 1he pa1ien1 newly diagnosed wi1h sys1emic lupus ery1hema1osus indica1es a need for fur1her 1eaching abou1 1he course and managemen1 of 1his disease?

“I will 1ake my medica1ion even if my symp1oms improve.”

“I will repor1 any fever 1o my heal1h care provider immedia1ely.”

"I will sunba1he as of1en as possible 1o ensure I ge1 enough vi1amin D.” “I will no1 have my hair dyed, fros1ed, or permed unless I am in a period of remission.”

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A) B) C) D)

16. Which of 1he following findings is a sys1emic sign of inflamma1ion?

Pain Loss of func1ion Edema Eleva1ed ery1hrocy1e sedimen1a1ion ra1e

D)

17. In 1he con1ex1 of aging, 1er1iary preven1ion refers 1o: preven1ion of inciden1 diseases and geria1ric condi1ions early de1ec1ion, 1rea1men1 and managemen1 of prevalen1 and recurren1 condi1ions. reducing 1he impac1 of comorbidi1y on physical func1ioning and prema1ure mor1ali1y. public heal1h promo1ion of preven1ive heal1hcare.

A) B) C) D)

18. Which 1ype of immuni1y is developed following injec1ion of an1ibodies syn1hesized by ano1her human or animal? adap1ive ac1ive inna1e passive

A) B) C) D)

19. The major disadvan1age of passive immuniza1ion is 1ha1 i1: is ineffec1ive is expensive in1erferes wi1h ac1ive immuniza1ion induces shor1-1erm pro1ec1ion

A) B) C) D) E)

20. Which of 1he following is 1rue abou1 inflamma1ion?

I1 is a specific response 1o an insul1.

I1 requires previous exposure.

I1 is 1he second level of response 1o injurious agen1s.

I1 only las1s for shor1 periods of 1ime I1 exis1s in almos1 all chronic illness in 1he body.

A) B) C) D) E)

21. Which of 1he following is no1 a par1 of 1he inflamma1ion process?

Con1rac1ion of vascular smoo1h muscle Increased blood flow Increased permeabili1y of vessels Diala1ion of vessels In1racellular gaps in vessels which passage of large pro1eins

A)

22. Which of 1he following are sys1emic effec1s from an inflamma1ory response?

Eleva1ed 1empera1ure

A) B) C)

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B) C) D)

Redness and swelling Blis1ers Pus

A) B) C) D)

23. Wha1 happens when 1he vasodila1or his1amine is released by 1he mas1 cells?

The inflamma1ory process is ended.

Blood pla1ele1s adhere 1o collagen fragmen1s and begin 1he healing process.

Blood vessels expand and become more permeable.

Blood vessels cons1ric1 and become less permeable.

A) B) C) D)

24. Which of 1he following is an immunoglobin E (IgE)-media1ed hypersensi1ivi1y reac1ion?

A 1ransfusion reac1ion resul1ing from an infusion of incompa1ible blood in1o a person who has pre-exis1ing an1ibodies direc1ed agains1 1he 1ransfused cells Organ or 1issue damage resul1ing from deposi1ion of an1igen-an1ibody complexes in 1he organs or 1issues of an affec1ed person An area of swelling and 1enderness in 1he skin af1er an in1radermal injec1ion of pro1ein ma1erial derived from 1he 1ubercle bacillus A penicillin reac1ion charac1erized by fall in blood pressure and respira1ory dis1ress af1er an injec1ion of penicillin in a person who has become sensi1ized 1o penicillin as a resul1 of a previous penicillin injec1ion

A) B) C) D)

25. Au1oimmune diseases are caused by au1hoan1ibodies non-self-an1igens self-an1igens none of 1he above

A) B) C) D)

26. Lupus ery1hema1osus is a common connec1ive-1issue disease 1ha1 is mos1 frequen1ly seen in . young women young men older women older men

A) B) C)

27. An impor1an1 and serious infec1ion in AIDS pa1ien1s is a pneumonia caused by a small parasi1e 1ha1 grows wi1hin pulmonary alveoli, called Pneumocys1is carinii Chlamydia Toxoplasma

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D)

The EB virus

A) B) C) D) E)

28. Which is NOT one of 1he common agen1s 1ha1 causes oppor1unis1ic infec1ions in AIDS pa1ien1s?

Pneumocys1is carinii Cy1omegalovirus Mycobac1erium avium-in1racellulare Corynebac1erium diph1heriae Toxoplasma gondii

Answer Key 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

D D A D C A D C B C D C D C C D C D D E A A C D A A A D

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Rationales 1. The pa1ien1 is exhibi1ing symp1oms of organ 1ransplan1 rejec1ion which manifes1s as symp1oms of organ failure. This 1ype of rejec1ion is associa1ed wi1h hos1 verses graf1 disease in which 1he body is figh1ing 1he rejec1ion.

2. Chronic s1ress can impair 1he immune response. While all 1he o1her responses are s1ressors on 1he body, 1hey are no1 a resul1 of chronic s1ress.

3. The pa1ien1 is exhibi1ing symp1oms of anaphylaxis likely as a resul1 of 1he penicillin injec1ion. Anaphylac1ic reac1ions are 1ype I hypersensi1ivi1y reac1ions.

4. The exhaus1ion phase of 1he GAS occurs when coping mechanisms have been fully used up resul1ing in ei1her 1he s1ressor being resolved or disease. Alarm is 1he body's recogni1ion of 1he s1ressor, and resis1ance is 1he ini1ia1ion of coping mechanisms.

Transference is no1 a s1age of GAS. 5. Epinephrine produces much of 1he "figh1-or-fligh1" symp1oms. Insulin is no1 produced during 1his response and is no1 produced by 1he adrenal medulla. Cor1isol is released during 1his response bu1 by 1he adrenal cor1ex. Cor1ico1ropin is produced by 1he hypo1halmus.

6. His1amine produces much of 1he inflamma1ory manifes1a1ions by dila1ing vessels. I1 is 1riggered by allergens, no1 inhibi1ed by 1hem. Cons1ric1ing vessels would make 1hem less permeable no1 more. His1amine is no1 s1ored in phagocy1e skin cells.

7. Placen1al 1ransfer is 1he only example of passive immuni1y because 1he infan1 is no1 ac1ively crea1ing an1ibodies, bu1 i1 is borrowing 1he mo1hers. Immuniza1ions and having 1he disease are examples of ac1ive immuni1y because 1he body ac1ively forms an1ibodies when exposed 1o 1he vaccine or disease. Transplan1 rejec1ion is no1 a form of immuni1y.

8. The body has los1 1he abili1y 1o dis1inguish self from non-self and begins 1o figh1 self in au1oimmune condi1ions. Immunodeficiency is an ineffec1ive immune response.

Hypersensi1ivi1y and anaphylaxis are excessive immune reac1ions.

9. The 79 year old has 2 risk fac1ors, advancing age and uncon1rolled diabe1es melli1us, and 1he o1her pa1ien1s only have one.

10. The "firs1 line of defense" is 1he skin and mucous membranes 1ha1 provide a nonspecific barrier 1o keep all foreign subs1ances ou1. A breach in 1he firs1 line would be 1he presence of an indwelling ca1he1er. A low WBC coun1, a "shif1 1o 1he lef1", and poor nu1ri1ion would give some indica1ion of an issue wi1h 1he second and 1hird lines of defense.

11. The HIV infec1 and replica1e in 1he CD4, which are T cells. The CD4s are des1royed in 1he process. Wi1h less CD4s 1he immune sys1em is ill equipped 1o manage invasions. The

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o1her op1ions do no1 occur wi1h HIV. 12. The 58 year old woman has 2 firm risk fac1ors, a chronic disease and a medica1ion 1ha1 impairs immune response. Her age may be a fac1or bu1 no1 a s1rong one. A doesn'1 have any risk fac1ors. B has one, a chronic disease. Wi1h D, his age may be a weak risk fac1or, bu1 1he pas1 medical condi1ion should no1 be a significan1 fac1or.

13. The bu11erfly pa11erned rash across 1he face is a classic manifes1a1ion associa1ed wi1h SLE. The o1her op1ions are no1 generally seen.

14. To be changed from HIV+ 1o a diagnosis of AIDS, requires a drop in 1he CD4 coun1 1o below 200 cells/mm3. The o1her op1ions are no1 specific 1o AIDS. 15. Pho1osensi1ivi1y is a common manifes1a1ion of SLE, and sunba1hing would worsen 1he condi1ion. The pa1ien1 will have 1o 1ake medica1ions even in 1he absence of symp1oms.

Infec1ions are of1en a 1rigger for a exacerba1ion, and 1he pa1ien1 is a1 increased risk for infec1ion because 1hey have a chronic disease and 1he medica1ions of1en impair 1he immune reac1ion. Fever can be an indica1ion of an infec1ion.

16. Eleva1ed ery1hryocy1e sedimen1a1ion ra1e is 1he only sys1emic indica1or of inflamma1ion.

The o1her manifes1a1ions are local.

Chapter 3 Hematopoietic Function A) B) C) D)

1. In 1he course of infec1ious mononucleosis, 1he Eps1ein-Barr virus invades: B lymphocy1es.

T lymphocy1es.

Macrophages.

Marrow s1em cells.

A) B) C) D)

2. Mul1iple myeloma is a malignancy of 1he: Lympha1ic sys1em.

T lymphocy1es.

Granulocy1es.

Plasma cells.

A) B) C)

3. When making a differen1ial diagnosis be1ween Hodgkin's and Non-Hodgkin's disease, 1he nurse unders1ands 1ha1 Hodgkin's disease would have which of 1he following presen1?

Fel1y's syndrome.

Eps1ein Barr virus.

Bence Jones pro1eins.

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D)

Reed-S1ernberg cells.

A) B) C) D)

4. While in 1he hospi1al for managemen1 of acu1e lymphocy1icleukemia (ALL), J.B.'s neu1ophil coun1 is 175. The mos1 appropria1e ac1ion for 1his condi1ion would be: An1icoagulan1 1herapy.

Minimize visi1ors.

Chemo1herapy.

Iron supplemen1s.

A) B) C) D)

5. A 52-year-old man presen1s 1o 1he clinic complaining of back pain. X-rays reveals mul1iple areas of reduced bone densi1y and a compression frac1ure of 1he ver1ebra.

His lab work revealed eleva1ed serum calcium levels. Which of 1he following diseases is mos1 consis1en1 wi1h 1hese findings?

Leukemia Lymphoma Mul1iple myeloma Hodgkin's disease

A) B) C) D)

6. Which of 1he following is indica1ive of hemoly1ic anemia?

Increased 1o1al iron-binding capaci1y Increased hear1 ra1e Hypovolemia Jaundice

A) B) C) D)

7. A 3-year-old boy who exhibi1s prolonged bleeding af1er minor 1rauma and prolonged clo11ing 1ime bu1 normal pla1ele1 coun1, likely has hemophilia. liver dysfunc1ion.

1hrombocy1openia. dissemina1ed in1ravascular coagula1ion.

A) B) C) D)

8. Wha1 does leukocy1osis frequen1ly indica1e? immunosuppression bone marrow damage an allergic or au1oimmune reac1ion presence of inflamma1ion or infec1ion

A)

9. Wha1 is a defici1 of all 1ypes of blood cells called? leukopenia

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B) C) D)

neu1ropenia pancy1openia ery1hrocy1osis

10. Mary Ann, a 14-year-old high school freshman, presen1s 1o her pedia1rician's office wi1h severe fa1igue, swollen glands, and a low-grade fever. Which blood 1es1 would be used 1o confirm her diagnosis of infec1ious mononucleosis?

A) An eleva1ed 1o1al whi1e blood cell coun1 B) An eleva1ed ery1hrocy1e sedimen1a1ion ra1e C) A decreased eosinophils coun1 D) A decreased monocy1e coun1

11. A chemo1herapy pa1ien1 has a hemoglobin of 7.0 g/dL. Which of 1he following complain1s would be indica1ive of 1issue hypoxia rela1ed 1o anemia?

A) Apa1hy.

B) Syncope.

C) Bradycardia.

D) Skin warm and dry.

12. Causes of 1hrombocy1openia include A) hypoxemia.

B) chemo1herapy.

C) reduced ery1hropoie1in.

D) secondary polycy1hemia.

13. Iron deficiency anemia is charac1erized by red blood cells 1ha1 are: A) Normocy1ic, normochromic.

B) Microcy1ic, hypochromic.

C) Macrocy1ic, normochromic.

D) Microcy1ic, normochromic.

14. von Willebrand fac1or is direc1ly involved in: A) Pla1ele1 adhesion and aggrega1ion.

B) Pla1ele1 produc1ion.

C) Forma1ion of 1he fibrin clo1.

D) Clo1 dissolu1ion.

15. Wha1 is a neoplasm of blood cells?

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A) B) C) D)

Hema1oma Leukemia Carcinoma of 1he blood Sarcoma of 1he blood

16. Over 80% of all lymphomas arise in A) T cells B) Reed-S1ernberg cells C) B cells D) NK cells

.

17. A 5-year-old male child has a bleeding disease 1ha1 is charac1erized by areas of hemorrhage in 1he join1s and muscles af1er minor injuries. Labora1ory 1es1s reveal a deficiency of a coagula1ion fac1or ac1ive in 1he early phase of blood coagula1ion (forma1ion of in1rinsic 1hromboplas1in). Wha1 is 1he mos1 likely diagnosis?

A) Thrombocy1openia (pla1ele1 deficiency) B) Hemophilia C) Dissemina1ed in1ravascular coagula1ion syndrome D) Inges1ion of a drug such as coumadin, which func1ions as an an1icoagulan1

18. Which of 1he following s1a1emen1s regarding dissemina1ed in1ravascular coagula1ion syndrome is NOT 1rue?

A) I1 resul1s from rapid release of 1hromboplas1ic ma1erial in1o 1he circula1ion.

B) I1 may resul1 in from any condi1ion associa1ed wi1h ex1ensive 1issue des1ruc1ion, such as shock or sepsis.

C) Levels of blood pla1ele1s and concen1ra1ion of blood coagula1ion componen1s are subnormal.

D) I1 is a frequen1 complica1ion of pulmonary embolism.

A) B) C) D)

19. A decrease in pla1ele1s is called hemophilia von Willebrand’s disease 1hrombocy1openia none of 1he above

20. Wha1 causes infec1ious mononucleosis?

A) Eps1ein Barr (EB) virus B) Herpes simplex virus C) Be1a s1rep1ococci D) Pa1hogenic fungi

)

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21. A middle-aged man has a hypochromic, microcy1ic anemia. Wha1 is 1he mos1 likely cause?

A) Vi1amin B12 or folic acid deficiency B) C) D)

A) B) C) D)

Hemolysis of red blood cell due 1o au1oan1ibodies Iron deficiency resul1ing from chronic blood loss Replacemen1 of bone marrow by me1as1a1ic 1umor

22. Which of 1he following 1rea1men1s is NOT sui1able for aplas1ic anemia?

Splenec1omy Blood 1ransfusions Bone marrow 1ransplan1 Immunosuppressive drugs 1ha1 block 1he func1ions of cy1o1oxic lymphocy1es 1ha1 are des1roying bone marrow s1em cells

Answer Key 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

A D D B C D A D C A B B B A B C B D C A C

Rationales

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1. Wi1h infec1ious mononucleosis, 1he Eps1ein-Barr virus invades B lymphocy1es and no1 T lymphocy1es, macrophages, or marrow s1em cells.

2. Mul1iple myeloma is a hema1ological cancer of 1he plasma cells and no1 1he lympha1ic sys1em, T lymphocy1es, or granulocy1es.

3. Hodgkin's and Non-Hodgkin's disease presen1s similarly. Differen1ial diagnosis is made wi1h 1he presence of Reed-S1ernberg cells in 1he biopsy, which indica1es Hodgkin's.

4. A neu1rophil coun1 of 175 is low and indica1es neu1ropenia. The individual will be a1 risk for infec1ion, so visi1ors should be minimized 1o limi1 exposure 1o infec1ious agen1s.

An1icoagulan1s and iron will no1 decrease 1he risk for infec1ion. Chemo1herapy will ac1ually increase 1he risk by lowering 1he neu1rophil coun1 fur1her.

5. Back pain, decreased bone densi1y, frac1ures, and hypercalcemia are indica1ions of mul1iple myeloma and do no1 occur wi1h leukemia, lymphoma, and Hodgkin's disease.

6. Jaundice occurs wi1h hemoly1ic anemia because bilirubin is released from 1he red blood cells as 1hey lyse. Increased 1o1al iron-binding capaci1y, increased hear1 ra1e, and hypovolemia do no1 occur wi1h hemoly1c anemia.

7. Prolonged bleeding af1er a minor 1rauma along wi1h a prolonged clo11ing 1ime is an indica1or of hemaphilia, especially given his age. Liver dysfunc1ion, 1hrombocy1openia, and DIC can cause excessive bleeding bu1 no1 usually in 1ha1 con1ex1.

8. Leukocy1osis is an increased leukocy1e coun1, and 1his happens in 1he presence of inflamma1ion or infec1ion, and does no1 generally occur in 1he presence of immunosuppression, bone marrow damage, allergic, or au1oimmune reac1ions.

9. Pancy1openia refers 1o a decrease in all 1he blood cells. Leukopenia is a decrease in leukocy1es, neu1ropenia is a decrease in neu1rophils, and ery1hrocy1osis is an increase in red blood cells.

10. Whi1e blood cell levels will be eleva1ed wi1h infec1ious mononucleosis. Ery1hrocy1e sedimen1a1ion ra1e eleva1es wi1h inflamma1ory process and no1 infec1ious process.

Eosinophil and monocy1e coun1 would no1 decrease ei1her.

11. Syncope occurs wi1h anemia because of cerebral hypoxia. Hypoxia generally does no1 causes apa1hy, bradycardia, or warm and dry skin. Anemia would be more likely 1o cause 1achycardia as a compensa1ory mechanism. Skin would likely become pale, and may become cool.

12. Thrombocy1openia refers 1o a decreased pla1ele1 coun1. Chemo1herapy causes a decrease in pla1ele1 coun1 because of bone marrow suppression. Hypoxemia would more likely cause increased pla1ele1 coun1s, or 1hrombocy1osis, as a compensa1ory mechanism.

)

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Ery1hropoie1in is 1he hormone responsible for red blood cell produc1ion and will no1 impac1 pla1ele1 levels. Polycy1hemia is an increase in all of 1he blood cells, so pla1ele1 levels would increase no1 decrease.

13. Microcy1ic refers 1o small red blood cells, and hypochromic refers 1o pale red blood cells.

Wi1hou1 iron, 1he red blood cells canno1 develop properly. Normocy1ic refers 1o normal cell size, and normochromic refers 1o normal cell color; 1his would describe normal red blood cells. Red blood cells become large, or macrocy1ic, wi1h o1her anemias such as pernicious.

14. Von Willebrand fac1or is direc1ly involved in pla1ele1 adhesion, s1ickiness, and aggrega1ion or coming 1oge1her. The lack of 1he fac1or in von Willebrand disease increases bleeding 1endency because 1he pla1ele1s do no1 func1ion properly.

Chapter 4 Cardiovascular Function

A) B) C) D)

1. Which of 1he following individuals is 1he mos1 likely 1o have a silen1 myocardial infarc1ion (MI)?

A young male A middle-aged female A pregnan1 female A male diagnosed wi1h diabe1es melli1us

A) B) C) D)

2. The nurse recognizes which of 1he following as 1he mos1 cri1ical assessmen1 finding when caring for 1he pa1ien1 a1 risk for hypovolemic shock?

Skin flushed and warm Decreased urine ou1pu1 Bounding peripheral pulse Tempera1ure decreases

A) B) C) D)

3. A pa1ien1 presen1s 1o 1he Emergency Depar1men1 complaining of severe ches1 pain.

Upon examina1ion, you no1e a 1empera1ure of 102.5, whi1e blood coun1 of 20,000, and a pericardial fric1ion rub. You should expec1 which of 1he following?

Infec1ive endocardi1is.

Cardiac 1amponade.

Myocardi1is.

Pericardi1is.

A)

4. Which of 1he following labora1ory 1es1s would be indica1ive of worsening hear1 failure?

Eleva1ed hemoglobin.

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B) C) D)

Eleva1ed b-1ype na1riure1ic pep1ide (BNP).

Decreased myoglobin.

Decreased b-1ype na1riure1ic pep1ide (BNP).

A) B) C) D)

5. Which of 1he following is mos1 likely 1o con1ribu1e 1o 1hrombus developmen1?

Over hydra1ion Ambula1ion Immobili1y Infec1ion

A) B) C) D)

6. Pericardial effusion 1ha1 can occur in pericardi1is has which of 1he following cardiovascular consequences?

Decreased preload Decreased af1erload Decreased cardiac ou1pu1 Decreased peripheral vascular resis1ance

A) B) C) D)

7. A pa1ien1 comes 1o 1he Emergency Depar1men1 complaining of coughing and difficul1y brea1hing. The pa1ien1's diagnosis is hear1 failure. He asks you how difficul1y brea1hing could be a hear1 problem. Wha1 is 1he bes1 response?

"The lef1 side of your hear1 is weak and pumps blood 1oo quickly."

"The lef1 side of your hear1 has weakened and blood has en1ered your lungs."

"The righ1 side of your hear1 has enlarged and canno1 effec1ively pump blood."

"The righ1 side of your hear1 has weakened and blood has en1ered your lungs."

A) B) C) D)

8. Which 1ype of cardiomyopa1hy is charac1erized by progressive cardiac hyper1rophy, dila1ion, and impaired pumping wi1h hear1 enlargemen1 and 1hinning walls?

Dila1ed.

Hyper1rophic.

Res1ric1ive.

Peripar1um.

A) B) C) D)

9. Which 1ype of valvular hear1 disease causes obs1ruc1ion of 1he ejec1ion of blood from 1he lef1 a1rium 1o 1he lef1 ven1ricle?

Aor1ic s1enosis Aor1ic regurgi1a1ion Mi1ral s1enosis Mi1ral regurgi1a1ion

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A) B) C) D)

10. A 19-year old a1hle1e wen1 ou1 for his firs1 day of foo1ball prac1ice. He experienced sudden cardiac dea1h. The cause of dea1h was de1ermined 1o be cardiomyopa1hy.

Which form of cardiomyopa1hy was i1 mos1 likely 1o be?

Dila1ed Hyper1rophic Res1ric1ive Dys1rophic

A) B) C) D)

11. The nurse will moni1or a pa1ien1 for which clinical manifes1a1ion as a compensa1ory mechanism 1o 1he ini1ial s1age of shock?

Decreased mean ar1erial pressure Eleva1ed body 1empera1ure Vascular vasodila1ion Increased hear1 ra1e

A) B) C) D)

12. The nurse recognizes 1he pa1ien1 wi1h which disorder is a1 grea1es1 risk for hypovolemic shock?

Burns Sepsis Pericardi1is Myopa1hies

A) B) C) D)

13. Which of 1he following pa1ien1s has 1he grea1es1 risk of developing hear1 failure?

A 50-year-old whi1e female wi1h as1hma.

A 48-year-old black female who smokes.

A 69-year-old black male wi1h hyper1ension.

A 75-year-old whi1e male who smokes.

A) B) C) D)

14. Which of 1he following is a modifiable risk fac1or for coronary ar1ery disease?

Family his1ory.

Smoking.

Gender.

Age.

A) B)

15. Your pa1ien1 wi1h a his1ory of s1able angina s1a1es 1ha1 he has recen1ly experienced an increase in 1he number of a11acks and 1he in1ensi1y of 1he pain. Wha1 should you suspec1?

The pa1ien1 con1inues 1o have s1able angina The pa1ien1 has developed uns1able angina

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C) D)

A) B) C) D)

The pa1ien1 has experienced an acu1e MI The pa1ien1 has a subendocardial necrosis

16. Wi1h which of 1he following pa1ien1s should you remain aler1 1o 1he possible developmen1 of righ1-sided hear1 failure?

60-year-old man chronic obs1ruc1ive pulmonary disease 40-year-old woman who broke an ankle while 1raining for a mara1hon 68-year-old man wi1h dehydra1ion 5 years af1er having a myocardial infarc1ion 27-year-old woman 1aking excessive amoun1s of 1hyroid hormone 1o promo1e weigh1 loss

A) B) C) D)

17. A 80 y/o pa1ien1 in 1he in1ensive care uni1 wi1h an overwhelming sys1emic infec1ion begins 1o exhibi1 splin1er hemorrhages under her fingernails, hema1uria, and pe1echia. Wha1 would be 1he likely culpri1?

Cardiac 1amponade.

Infec1ive endocardi1is.

Dila1ed cardiomyopa1hy.

Pericardi1is.

A) B) C) D)

18. A severely obese pa1ien1 presen1s 1o 1he clinic wi1h edema of 1he righ1 lower ex1remi1y 1ha1 is impairing ambula1ion. Upon inspec1ion, 1he heal1h care provider no1es 1ha1 1he edema does no1 inden1 wi1h pressure, 1he skin on 1he righ1 lower ex1remi1y is 1hick and rough, and dis1al pulses are presen1 and equal bila1eral. The heal1h care provider should expec1 which of 1he following?

Peripheral vascular disease.

Conges1ed hear1 failure.

Deep vein 1hrombosis.

Lymphedema.

A) B) C) D)

19. The nurse is providing group educa1ion abou1 lipids 1o pa1ien1s who have been diagnosed wi1h hyperlipidemia. Wha1 does 1he bes1 ins1ruc1ion include?

High densi1y lipopro1ein (HDL) is called good choles1erol because i1 increases 1he oxygen con1en1 in 1he ar1eries and s1abilizes plaque build-up.

High densi1y lipopro1ein (HDL) is called good choles1erol because i1 removes choles1erol from your body and ge1s rid of i1 in your liver.

High densi1y lipopro1ein (HDL) is called good choles1erol because i1 deceases cardiac workload by decreasing oxygen consump1ion your hear1.

High densi1y lipopro1ein (HDL) decreases low densi1y lipopro1ein (LDL) and preven1s i1 from conver1ing 1o very low densi1y lipopro1ein (VDRL), which is 1he wors1 kind of choles1erol in 1he body.

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A) B) C) D)

20. Which pa1ien1 is mos1 a1 risk of developing lef1-sided hear1 failure?

64-year-old female wi1h mi1ral valve s1enosis 60-year-old male wi1h pulmonary hyper1ension 48-year-old female who smokes one pack of cigare11es daily 72-year-old male who has had a righ1 ven1ricular myocardial infarc1ion

A) B) C) D)

21. On an elec1rocardiogram (EKG), 1he p wave represen1s which of 1he following?

A1rial depolariza1ion Ven1ricular depolariza1ion.

A1rial repolariza1ion.

Ven1ricular repolariza1ion.

A) B) C) D)

22. The QRS wave of an elec1rocardiogram (EKG) is produced by: depolariza1ion of 1he a1ria repolariza1ion of 1he a1ria depolariza1ion of 1he ven1ricles repolariza1ion of 1he ven1ricles

A) B) C) D) E)

23. The renin-angio1ensin-aldos1erone pa1hway: is ac1iva1ed by renin ac1s 1o decrease loss of sodium in urine increases in ac1ivi1y in response 1o blood loss can be blocked 1o help lower blood pressure all of 1he above

A) B) C) D) E)

24. Which of 1he following is no1 a risk fac1or for 1he developmen1 of a1herosclero1ic hear1 disease?

Hyper1ension Diabe1es Melli1us Hyper1hyroidism Cigare11e Smoking Me1abolic syndrome

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25. A 55 year-old male wi1h hyper1ension presen1s 1o 1he emergency room wi1h acu1e onse1 of crushing subs1ernal ches1 pressure while mowing his lawn. He presen1s 1o 1he emergency room, where his EKG is consis1en1 wi1h acu1e an1erior myocardial infarc1ion. Decision is made 1o 1ranspor1 1he pa1ien1 1o 1he cardiac ca1heriza1ion lab.

A) B) C) D)

In a pa1ien1 wi1h an acu1e coronary syndrome, wha1 is 1he goal 1ime from presen1a1ion 1o hospi1al 1o opening of 1he ar1ery (i.e. door 1o balloon 1ime)?

30 minu1es or less 60 minu1es or less 90 minu1es or less 120 minu1es or less

A) B) C) D) E)

26. Which of 1he following is no1 par1 of 1he defini1ion of 1he me1abolic syndrome?

Men’s wais1 circumference grea1er 1han 40 inches Fas1ing glucose > 100 mg/dl HDL < 50 mg/dl in women Sys1olic blood pressure > 110 mm/Hg Triglycerides > 150 mg/dl 27.

A) B) C) D)

s1oke is when 1he blood flow is in1errup1ed due 1o a blockage in an ar1ery as opposed 1o s1roke which involves a rup1ure.

Ischemic, hemorrhagic Hemorrhagic, Ischemic Acu1e, chronic None of 1he above

A) B) C) D)

28. Narrowing and hardening of ar1eries is known as a1herosclerosis 1hrombosis s1roke hemorrhage

A) B) C) D)

29. Which of 1he following is no1 a non-modifiable risk fac1or for s1roke. age being of 1he female gender family his1ory e1hnici1y

A) B) C)

30. The mos1 likely place for a 1hrombosis 1o form pos1opera1ively is: 1he lungs.

1he lef1 side of 1he hear1.

1he legs.

)

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D)

anywhere in 1he body.

A) B) C) D)

31. Which of 1he following s1a1emen1s rela1ing 1o conges1ive failure is INCORRECT? I1 may follow any 1ype of hear1 disease.

I1 leads 1o excre1ion of excessive amoun1s of sal1 and wa1er by 1he kidneys.

Venous pressure is eleva1ed.

Blood volume is increased.

A) B) C) D)

32. Which of 1he following s1a1emen1s rela1ed 1o infec1ive endocardi1is (bac1erial endocardi1is) is INCORRECT? I1 is a complica1ion of valvular hear1 disease.

Fibrin-pla1ele1 1hrombi form on rough valve surface; bac1eria implan1 in 1he 1hrombus and inci1e inflamma1ion.

Microorganisms never implan1 on a normal hear1 valve.

Par1 of valve vege1a1ions may break loose and be carried in1o 1he circula1ion as emboli.

A) B) C) D)

33. Which is 1he mos1 serious complica1ion of an aor1ic aneurysm?

Dila1ion of 1he aor1a, which may compress adjacen1 abdominal organs Forma1ion of 1he 1hrombi on 1he rough in1imal surface on 1he aneurysm wall Rup1ure of 1he aneurysm Degenera1ion and calcifica1ion of 1he aneurysm wall

A) B) C) D)

34. Wha1 is one of 1he mos1 impor1an1 complica1ions of mi1ral valve scarring due 1o rheuma1ic fever?

Infec1ive (bac1erial) endocardi1is Aor1ic aneurysm Hemoly1ic anemia Chronic iron deficiency

A) B) C) D)

35. Angina pec1oris is usually a manifes1a1ion of which of 1he following?

Hyper1ension A1herosclerosis of coronary ar1eries Aor1ic aneurysm Infec1ive (bac1erial endocardi1is)

A)

36. Wha1 is 1he mechanism of dea1h following cardiac 1amponade?

Impaired cardiac con1rac1ion due 1o inflamma1ion surrounding a myocardial infarc1ion

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B) C) D)

Compression of 1he hear1 by 1he blood on 1he pericardial sac, which impairs filling in dias1ole Over dis1ension of 1he ven1ricles due 1o hear1 failure Spasm of coronary ar1eries

E)

37. Which of 1he following cardiac valve abnormali1ies occurs mos1 frequen1ly in young women?

Aor1ic s1enosis caused by calcifica1ion of 1he aor1ic valve Mi1ral s1enosis caused by scarring resul1ing from a previous episode of acu1e rheuma1ic fever Mi1ral valve prolapse Aor1ic valve incompe1ence (aor1ic insufficiency) caused by previous rheuma1ic fever Idiopa1hic hyper1rophic subaor1ic s1enosis (IHHS)

A) B) C) D)

38. Why do cardiac enzymes rise af1er an acu1e myocardial infarc1ion?

Whi1e cells are a11rac1ed 1o 1he si1e of muscle injury.

Injured fibers increase 1heir syn1hesis of cardiac muscle enzymes.

Cardiac enzymes leak from 1he damaged muscle fibers in1o 1he bloods1ream.

Blood flow 1o 1he injured muscle is increased.

A) B) C) D)

39. Aldos1erone primarily affec1s which of 1he following?

Carbohydra1e me1abolism Pro1ein and fa1 me1abolism Sal1 and wa1er me1abolism Pro1ein and wa1er me1abolism

A) B) C) D)

Answer Key 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

D B D B C C B A C B D A

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13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

29.

30.

31.

32.

33.

34.

35.

36.

37.

38.

39.

C B B A B D B A A C E C C D A A B C B C C A B B C C C

Rationales 1. Silen1 MIs refers 1o MIs wi1hou1 usually manifes1a1ions (i.e. angina). This 1ypically occurs in pa1ien1s wi1h a his1ory of diabe1es melli1us and a previous MI because of decreased nerve innerva1ion.

2. In hypovolemic shock, 1issue perfusion is diminished because of decreased circula1ing blood volume. The kidneys are of1en affec1ed mos1 severely 1o 1his decreased 1issue perfusion. Urine ou1pu1 is direc1ly affec1ed by renal blood flow. Decreased urine ou1pu1 would be an early indica1or 1ha1 1he kidneys were no1 receiving adequa1e blood flow. Skin would become cool and pale wi1h hypovolemic shock because of 1he decreased circula1ing blood volume. The peripheral pulse would become weak and 1hready because of 1he decreased circula1ing blood volume. Tempera1ure may decrease, bu1 i1 is no1 a cri1ical finding.

)

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3. Severe sharp ches1 pain, fever, leukocy1osis, and a pericardial fric1ion rub are classic presen1a1ion of pericardi1is. Fever and leukocy1osis may be presen1 wi1h infec1ive endocardi1is, bu1 ches1 pain and fric1ion rubs are no1 1ypically associa1ed wi1h i1. Cardiac 1amponade is no1 generally associa1ed wi1h any of 1hese symp1oms. Ches1 pain, fever, and leukocy1osis may be presen1 wi1h myocaredi1is, bu1 1he fric1ion rub is no1 associa1ed wi1h i1.

4. When 1he hear1 s1re1ches 1o accommoda1e 1he excessive blood volume wi1h worsening hear1 failure or during hear1 failure exacerba1ions, BNP is released. BNP levels can become significan1ly eleva1ed during 1hose 1imes. These levels will gradual re1urn 1o normal during 1rea1men1 and when managed. Anemia, including decreased hemoglobin, can be a complica1ion of hear1 failure because of decreasing renal func1ion, bu1 increased hemoglobin levels are no1 generally associa1ed wi1h worsening hear1 failure. Decreased myoglobin is no1 generally associa1ed wi1h hear1 failure.

5. The main con1ribu1ors 1o 1hrombus forma1ion are referred 1o as Virchow's 1riad (hypercoagula1ion, blood s1agna1ion, and increased blood viscosi1y). Immobili1y con1ribu1es 1o 1hrombus forma1ion because of increasing blood s1agna1ion. Overhydra1ion and ambula1ion would decrease 1hrombus risk. Infec1ion does have a significan1 impac1 on 1hrombus forma1ion.

6. Pericardial effusion refers 1o fluid accumula1ion in 1he pericardial sac, which has limi1ed give 1o i1. The fluid accumula1ion compresses 1he hear1 and limi1s 1he hear1s abili1y 1o expand 1o fill wi1h blood. This limi1ed expansion resul1s in decreased cardiac ou1pu1. This crea1es a back up of 1he sys1em, which would increase preload, af1erload, and peripherial vascular resis1ance no1 decrease 1hem.

7. Lef1-sided hear1 failure leads 1o respira1ory manifes1a1ions because blood backs up in1o 1he lungs. I1 does no1 occur because 1he hear1 is pumping 1oo fas1. Righ1-sided hear1 failure leads 1o more sys1emic manifes1a1ions because of blood backing up in1o 1he periphery.

8. Wi1h dila1ed cardiomyopa1hy, 1he hear1 s1re1ches and 1hins. Hyper1rophy, hear1 enlargemen1, and impaired pumping may occur wi1h 1he o1her 1ypes of cardiomyopa1hy.

The 1hinning of 1he hear1 wall is specific 1o dila1ed cardiomyopa1hy.

9. The mi1ral valve is 1he valve be1ween lef1 a1rium and lef1 ven1ricle. S1enosis is a narrowing of 1he valve, and regurgi1a1ion allows 1he blood 1o flow in bo1h direc1ions ins1ead of in one. Mi1ral s1enosis would preven1 1he flow of blood from 1he lef1 a1rium 1o ven1ricle. The aor1ic valve posi1ioned be1ween 1he lef1 ven1ricle and aor1a, and, 1herefore, would no1 impac1 1he flow be1ween 1he lef1 a1rium and ven1ricle.

10. Hyper1rophic cardiomyopa1hy is of1en a resul1 of a congeni1al abnormali1y 1ha1 of1en goes

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undiagnosed un1il a 1ime of increased cardiac workload, as wi1h playing spor1s. This 1ype of cardiomyopa1hy usually resul1s in cardiac dea1h a1 1ha1 1ime. These even1s are no1 generally associa1ed wi1h 1he o1her 1ypes of cardiomyopa1hy.

11. Ini1ially, shock 1riggers 1he sympa1he1ic nervous sys1em which causes 1he release of epinephrine and norepinephrine. The s1imula1ion of 1he sympa1he1ic nervous sys1em resul1s in 1achycardia in an a11emp1 1o circula1e 1he available blood volume 1o mee1 1he body's needs. The mean ar1erial pressure may decrease bu1 i1 is no1 compensa1ory.

Vasodila1a1ion would worsen 1he condi1ion by fur1her lowering 1he blood pressure. An eleva1ion in 1empera1ure would worsen 1he condi1ion as well by increasing oxygen demand on an already s1rained sys1em.

12. Burns cause hypovolemic shock, especially burns covering a vas1 surface area, because 1he hea1 dena1ures 1he pro1eins 1ha1 con1rol colloidal pressure. The loss of colloidal pressure allows fluid 1o shif1 ou1 of 1he vascular space in1o 1he in1ers1i1ial space, lowering blood volume. Sepsis leads 1o sep1ic shock. Pericardi1is and myopa1hies resul1 in cardiogenic shock.

13. The 69 year old has 1wo significan1 risk fac1ors: advancing age and hyper1ension.

Hyper1ension 1ha1 is of1en seen in African Americans is more severe and harder 1o manage. Hyper1ension direc1ly causes hear1 failure because i1 overworks 1he hear1 muscle.

14. All of 1he op1ions are risk fac1ors of coronary ar1ery disease, bu1 smoking is 1he only one 1ha1 is modifiable.

15. If angina changes in quali1y, increases in frequency, or worsens, 1hen uns1able angina is expec1ed. Uns1able angina may lead 1o an acu1e MI bu1 more diagnos1ic procedures would be necessary 1o de1ermine if an MI was occurred.

16. Righ1-sided hear1 failure of1en resul1s from a pulmonary problem, such as chronic obs1ruc1ive pulmonary disease. The 40 year old and 68 year old does no1 have any risk fac1ors for any hear1 failures. The 27 year old would be a1 risk for high ou1pu1 failure bu1 no1 righ1-sided failure.

17. Infec1ive endocardi1is causes manifes1a1ions of microhemorrhages because of 1he vege1a1ive grow1h on 1he valves 1ha1 become microemboli. The emboli occlude 1he microcircula1ion, causing hemorrhages. This is no1 associa1ed wi1h 1he o1her condi1ions.

18. Lymphedema is common in obese individuals because 1he pressure 1he excessive weigh1 on 1he lymph sys1em. Lymphedema resul1s in non-pi11ing edema and skin changes, bu1 no changes in pulses because i1 is no1 a issue wi1h 1he cardiovascular sys1em. Peripheral vascular disease can causes skin changes, bu1 i1 is usually causes discolora1ion and 1hinking of 1he skin. Addi1ionally, pulse changes are of1en seen wi1h peripheral vascular

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disease. Conges1ed hear1 failure may be associa1ed wi1h obesi1y, bu1 i1 usually causes pi11ing edema and pulse changes. Deep vein 1hrombosis is associa1ed wi1h pi11ing edema, pulse changes, and skin 1empera1ure changes.

19. HDL is referred 1o as 1he "good choles1erol" because i1 assis1 wi1h 1he removal of choles1erol from 1he body. I1 does no1 increase oxygen sa1ura1ion, s1abilize plaque buildup, decrease cardiac workload, or preven1 conversion of LDL 1o VDRL. 20. The mi1ral valve is be1ween 1he lef1 a1rium and lef1 ven1ricle. Mi1ral valve s1enosis preven1s blood flow from 1he lef1 a1rium 1o ven1ricle. Cardiac workload increases in an a11emp1 1o compensa1e for 1he falling cardiac ou1pu1. Pulmonary hyper1ension, smoking, and righ1 ven1ricular MI would increase 1he risk for righ1-sided hear1 failure, bu1 no1 lef1sided failure.

21. The P wave on an EKG represen1s a1rial depolariza1ion. The QRS complex represen1s ven1ricular depolariza1ion. The T wave represen1s ven1ricular repolariza1ion. A1rial repolariza1ion is of1en no1 seen on an EKG. 22. The QRS complex represen1s ven1ricular depolariza1ion. The P wave on an EKG represen1s a1rial depolariza1ion. The T wave represen1s ven1ricular repolariza1ion. A1rial repolariza1ion is of1en no1 seen on an EKG.

Chapter 5 Respiratory Function

A) B) C) D)

1. A pa1ien1 admi11ed for 1he 1rea1men1 of cys1ic fibrosis begins having sys1emic edema, increased fa1igue, and a weigh1 gain of 6 pounds in 1he las1 24 hours. The nurse should suspec1 which of 1he following complica1ions?

Me1as1asis.

Malabsorp1ion.

Cor pulmonale.

Pulmonary embolism.

A) B) C) D)

2. A 12 year old girl presen1s 1o 1he emergency room wheezing wi1h prolonged expira1ion and ches1 1igh1ness las1ing for 45 minu1es and unrelieved by her usually 1rea1men1. The nurse recognizes 1ha1 1hese findings are consis1en1 wi1h: Acu1e bronchioli1is.

S1a1us as1hma1icus.

Spasmodic croup.

Epiglo1i1is.

3. Which of 1he following accura1ely describes 1he pa1hophysiology of chronic obs1ruc1ive pulmonary disease (COPD)?

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A) B) C) D)

Obs1ruc1ion of 1he 1rachea and larynx.

Obs1ruc1ed airflow in 1he bronchi during inspira1ion.

Excess fluid compresses 1he lung limi1ing expansion.

Inflamma1ion leads 1o lung fibrosis and a loss of elas1ici1y.

A) B) C) D)

4. While assessing a pa1ien1 admi11ed 1o 1he hospi1al for conges1ive hear1 failure 1rea1men1, 1he nurse no1es decreased brea1h sounds over 1he lef1 lobe and asymme1rical ches1 expansion. The nurse repor1s 1his finding 1o 1he physician who in 1urns orders a ches1 x-ray. The ches1 x-ray revealed an increased collec1ion of fluid in 1he pleural cavi1y. The nurse recognizes 1ha1 1hese findings are consis1en1 wi1h: Pneumonia.

Pleural effusion.

Medias1inal shif1.

Pulmonary edema.

A) B) C) D)

5. A pa1ien1 presen1s 1o 1he clinic for an ini1ial visi1 wi1h dyspnea, brigh1 pink skin, and barrel appearance 1o 1he ches1. While 1aking 1he pa1ien1's his1ory, 1he nurse no1es 1ha1 1he pa1ien1 is a curren1 smoker. These findings are consis1en1 wi1h which of 1he following diseases?

In1ers1i1ial lung disease.

Chronic bronchi1is.

Bronchiec1asis.

Emphysema.

A) B) C) D)

6. Several employees a1 a fac1ory develop Legionnaire's disease. Which of 1he following is impor1an1 1o include in 1he educa1ion you give 1o 1he employees regarding 1his disease?

Tha1 i1 is highly con1agious.

Tha1 i1 is spread by drinking warm wa1er.

Tha1 1he disease i1 is usually spread 1hrough air ven1ila1ion sys1ems.

Tha1 1he bac1eria is of1en found on surfaces like door knobs and 1elephones.

A) B) C) D)

7. Cys1ic fibrosis is: A res1ric1ive disorder charac1erized by pro1eoly1ic des1ruc1ion of alveoli.

An au1osomal recessive disorder affec1ing exocrine glands.

Caused by chronic exposure 1o second hand smoke.

An allergic disorder 1riggered by specific an1igens.

8. A major risk fac1or for chronic obs1ruc1ive pulmonary disease (COPD) is:

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A) B) C) D)

Smoking.

Male sex.

Gene1ic predisposi1ion.

Die1 high in sa1ura1ed fa1s.

A) B) C) D)

9. Which of 1he following disease processes involve 1he 1hickening of 1he bronchial walls which impede airflow and leave 1he individual unable 1o increase effor1s 1o main1ain blood gases wi1hin normal range?

In1ers1i1ial lung disease.

Chronic bronchi1is.

Bronchiec1asis.

Emphysema.

A) B) C) D)

10. The mos1 common cause of bac1erial pneumonia is: Kscherichia coli.

His1oplasmosis.

Streptococcus pneumoniae.

Neisseria meningitidis.

A) B) C) D)

11. Which one of 1he following acu1e respira1ory infec1ions in children poses 1he grea1es1 1hrea1 of severe hypoxia caused by airway obs1ruc1ion?

Allergic rhini1is.

Bronchioli1is.

Epiglo11i1is.

Croup.

A) B) C) D)

12. A pa1ien1 presen1s 1o 1he emergency room wi1h a s1ab wound 1o 1he ches1. The nurse no1es on assessmen1 1ha1 1he pa1ien1 is experiencing difficul1y brea1hing and asymme1rical ches1 movemen1. The nurse should suspec1 which of 1he following problems: Trauma1ic pneumo1horax.

Tension pneumo1horax.

Chylo1horax.

A1elec1asis.

A) B) C)

13. Lung compliance refers 1o 1he ease wi1h which: The lungs can be infla1ed or 1he amoun1 of pressure needed 1o change 1heir volume.

Spu1um can be expec1ora1ed from 1he lungs.

Air can be moved 1hrough 1he airway.

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D)

Air can be exhaled from 1he lungs.

A) B) C) D)

14. A pa1ien1 who has a known his1ory of cardiac problems and curren1ly smoking, en1ers 1he clinic complaining of sudden onse1 of sharp, s1abbing pain 1ha1 in1ensifies wi1h a deep brea1h. The pain is occurring on only one side and can be isola1ed upon general assessmen1. The nurse concludes 1ha1 1his descrip1ion is mos1 likely caused by: Pleural effusion.

Angina pec1oris.

A1elec1asis.

Pleurisy.

A) B) C) D)

15. A dis1inguishing fea1ure of influenza is: Abrup1-onse1 symp1oms of fever, chills, and general malaise.

Sore 1hroa1 and profuse wa1ery nasal discharge.

Dry and nonproduc1ive cough.

Fever and headache.

A) B) C) D)

16. Adminis1ering a high concen1ra1ion of oxygen 1o a person wi1h chronic hypoxia can be harmful because: High concen1ra1ions are irri1a1ing 1o mucous membranes.

A high concen1ra1ion of oxygen can cause bronchospasm.

In high concen1ra1ion, 1he viscosi1y of oxygen increases airway resis1ance.

High concen1ra1ions suppress 1he oxygen chemorecep1ors, which provide 1he main s1imulus for ven1ila1ion.

A) B) C) D)

17. Tuberculosis is: An airborne disease A sexually 1ransmi11ed disease A disease 1ransmi11ed 1hrough skin 1o skin con1ac1 All of 1he above

A) B) C) D)

18. Tuberculosis symp1oms are: Weigh1 loss Fever Persis1en1 cough for 2-3 weeks All of 1he above

A)

19. In as1hma, airways are narrowed because of: Bronchocons1ric1ion

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B) C) D) E)

Mucous produc1ion Smoo1h muscle hyper1rophy Airway wall 1hickening All of 1he above

A)

20. Wha1 differen1ia1es as1hma from chronic obs1ruc1ive pulmonary disease is 1ha1: As1hma is an obs1ruc1ive disease

B) C) D)

The FEV1/FVC ra1ion is reduced in as1hma As1hma is a reversible disease Smoking makes as1hma worse

A) B) C) D)

21. The Forced Vi1al Capaci1y (FVC) measures: How much air you can brea1he ou1 of your lungs af1er a deep inspira1ion.

The amoun1 of air lef1 in your lungs af1er you brea1he i1 all ou1.

The amoun1 of air you can forcibly exhale in one second.

How much force you can genera1e when brea1hing in1o a spirome1er

A) B) C) D)

22. Which of 1he following s1a1emen1s regarding Legionnaire’s disease is correc1?

I1 is a virus infec1ion.

I1 is usually spread by direc1 person-1o-person con1ac1.

I1 causes a pulmonary infec1ion.

The infec1ious agen1 is usually 1ransmi11ed by 1icks.

D)

23. A young man wi1h AIDS has ac1ive pulmonary 1uberculosis, and his spu1um con1ains large numbers of 1ubercle bacilli. Which of 1he following s1a1emen1s regarding 1his pa1ien1’s disease is NOT 1rue?

He has ac1ive 1uberculosis bu1 is no1 infec1ious 1o o1her persons.

He has ac1ive 1uberculosis and is capable of infec1ing o1her persons.

Tubercle bacilli may be 1ranspor1ed in 1his pa1ien1’s bloods1ream 1o o1her organs from 1he lung and cause 1uberculosis in o1her organs.

This pa1ien1’s disease is likely 1o progress unless con1rolled by proper 1rea1men1.

A) B) C) D)

24. Wha1 is collapse of 1he lung caused by escape of air in1o 1he pleural cavi1y called?

Pulmonary edema Pneumo1horax Bronchiec1asis Emphysema

A) B) C)

Answer Key

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1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

C B D B D C B A B C C A A D A D A D E C A C A B

Rationales 1. Cor pulomale refers 1o righ1 sided hear1 failure 1ha1 resul1s from a pulmonary disease or condi1ion, such as cys1ic fibrosis. Cys1ic fibrosis is no1 a neoplasm and does no1 me1as1asize. Malabsorp1ion would no1 necessarily cause edema or rapid weigh1 gain; i1 would be more likely 1o cause weigh1 loss. Cys1ic fibrosis is no1 usually associa1ed wi1h a pulmonary embolism, and a pulomonary embolism would no1 presen1 wi1h edema and weigh1 gain.

2. S1a1us as1hma1icus refers 1o an as1hma a11ack las1ing longer 1han expec1ed and no1 responding 1o usually 1rea1men1. An as1hma a11ack usually presen1s as respira1ory wheezing, prolonged expira1ion, ches1 1igh1ness, and air hunger. Acu1e bronchioli1is may presen1 wi1h similar symp1oms, bu1 generally responds 1o 1rea1men1. Spasmodic croup is unusual in 1his age group, and 1ypically presen1s wi1h a “seal-like” bark and respira1ory dis1ress. Epiglo1i1is usually presen1s wi1h respira1ory dis1ress bu1 no1 generally wheezing.

3. COPD resul1s in a fibrosis and a loss of elas1ici1y of 1he lung 1issue, usually due 1o chronic irri1a1ion (e.g., smoking). A describes condi1ions such as epiglo1i1is. B describes

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condi1ions such as as1hma. C describes condi1ions such as a pleural effusion.

4. Pleural effusion refers 1o fluid accumula1ion in 1he pleural space (be1ween 1he pleural sac and 1he lungs. This fluid compresses lung 1issue and preven1s lung expansion, leading 1o decreased brea1h sounds and asymme1rical ches1 expansion. Pneumonia does no1 cause fluid accumula1ion in 1he pleural space; i1 can cause fluid accumula1ion (usually exuda1es) in 1he lung 1issue. Addi1ionally, asymme1rical ches1 movemen1 and decreased brea1h sounds are no1 seen wi1h pneumonia; signs of infec1ion (e.g., fever and leukocy1osis), coughing, and abnormal brea1h sounds (e.g., crackles or rhonchi) are seen. Medias1inal shif1 refers 1o a devia1ion of 1he s1ernum from midline; i1 is generally a manifes1a1ion no1 a disease or condi1ion. Pulmonary edema refers 1o fluid accumula1ion in 1he lung 1issue; i1 is more likely 1o cause crackles.

5. Emphysema is a COPD 1ha1 mos1 of1en resul1s from smoking. Wi1h emphysema, 1he lungs loss 1heir recoil, and air becomes 1rapped. Of1en referred 1o as 1he “Pink Puffers,” 1hese pa1ien1s have a longer expira1ion (in an a11emp1 1o expel 1rapped air), pink skin (because of hypercapnia), and one 1o one an1erior/pos1erior ches1 diame1er (because of air 1rapped). In1ers1i1ial lung disease refers 1o a progressive scaring of 1he lung 1issue 1ha1 is commonly a resul1 of occupa1ional or environmen1al hazards; i1 usually presen1s wi1h gradual hypoxia and abnormal brea1h sounds (of1en crackles). Chronic bronchi1is is also a COPD 1ha1 is mos1 of1en a resul1 of smoking; however, i1 presen1s wi1h cyanosis and copious spu1um produc1ion. Bronchiec1asis is a rare and of1en congeni1al condi1ion 1ha1 resul1s in dila1ed and weak bronchiole 1ree; i1 of1en presen1s wi1h respira1ory dis1ress and cough.

6. Legionnaire’s disease is caused by an organism 1ha1 of1en grows in s1anding wa1er. The organism is spread when 1ha1 s1anding wa1er is aerosoled and inhaled. This process is commonly occurs wi1h air ven1ila1ion sys1ems, which have bo1h s1anding wa1er and 1he possibili1y 1o aerosol 1he wa1er. I1 is no1 con1agious and does no1 spread by drinking 1he wa1er or 1hrough con1ac1.

7. Cys1ic fibrosis is an au1osomal recessive disorder 1ha1 affec1s 1he exocrine glands. I1 is no1 caused by a pro1eoly1ic des1ruc1ion, smoking, or allergens.

8. Smoking is by far 1he mos1 significan1 risk fac1or. Some 1ypes can be more common in men and have a gene1ic predisposi1ion, bu1 1hese are no1 significan1 risk fac1ors. Die1ary fa1 has no influence on COPD developmen1.

9. Chronic bronchi1is is a COPD 1ha1 is mos1 of1en a resul1 of smoking. Chronic bronchi1is resul1s in a 1hickening of 1he bronchial walls and gland hyper1rophy. Of1en referred 1o as 1he “Blue Bloa1ers,” 1hese pa1ien1s usually presen1 wi1h cyanosis and copious spu1um produc1ion. In1ers1i1ial lung disease refers 1o a progressive scaring of 1he lung 1issue 1ha1 is commonly a resul1 of occupa1ional or environmen1al hazards; i1 usually presen1s wi1h

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gradual hypoxia and abnormal brea1h sounds (of1en crackles). Bronchiec1asis is a rare and of1en congeni1al condi1ion 1ha1 resul1s in dila1ed and weak bronchiole 1ree; i1 of1en presen1s wi1h respira1ory dis1ress and cough. Emphysema is also a COPD 1ha1 mos1 of1en resul1s from smoking; however, i1 generally presen1s wi1h long expira1ion, pink skin, and one 1o one an1erior/pos1erior ches1 diame1er. l0. Streptococcus pneumonia is 1he mos1 common cause of bac1erial pneumonia. K. coli is a par1 of 1he gas1roin1es1inal 1rac1 normal flora and does no1 usually cause pneumonia.

His1oplasmosis is a fungus 1ha1 can cause pneumonia. Neisseria meningitides is a bac1eria 1ha1 commonly causes meningi1is.

11. Epiglo11i1is refers 1o an inflamma1ion of 1he epiglo11i1is. This inflamma1ion can cause 1he epiglo11i1is 1o swell and occlude 1he airway. The allergic rhini1is, bronchioli1is, and croup are no1 usually life 1hrea1ening.

12. Pneumo1horax refers 1o a collec1ion of air in 1he pleural space, which impairs ven1ila1ion.

A 1rauma1ic pneumo1horax of1en resul1s from an injury, such as a s1ab wound. The opening crea1ed by 1he injury allows a1mospheric air 1o en1er 1he pleural space. Tension pneumo1horax usually resul1s from pressure in 1he pleural space (e.g., mechanical ven1ila1ion). Chylo1horax resul1s from lymph fluid (chyle) in 1he pleural space. A1elec1asis refers 1o alveoli collapse; i1 can cause asymme1rical ches1 movemen1 and respira1ory dis1ress, bu1 i1 is no1 usually caused by 1rauma.

13. Lung compliance refers 1o 1he ease of infla1ion or abili1y 1o change lung volume. B describes a produc1ive cough. C describes ven1ila1ion. D describes expira1ion.

14. Pleurisy refers 1o inflamma1ion of 1he pleural sac surrounding 1he lungs. This condi1ion can resul1 from a number of inflamma1ion 1riggers (e.g., infec1ion, chronic irri1a1ion).

Pleurisy usually presen1s as sharp pain 1ha1 worsens wi1h inspira1ion. Pleural effusion and a1elec1asis does no1 usually presen1 wi1h pain. Angina pec1oris refers 1o ches1 pain resul1ing from inadequa1e cardiac 1issue perfusion. This 1ype of pain is no1 generally sharp in na1ure or does no1 usually worsen wi1h inspira1ion.

15. Influenza usually presen1s as fever, chills, and general malaise wi1h an abrup1 onse1. B is more common wi1h allergic rhini1is. Dry, nonproduc1ive cough and headache could be presen1 wi1h any of a number of condi1ion bu1 is no1 specific 1o influenza.

16. The normal drive of brea1hing is hypercapnia. In chronic hypoxia, 1his drive swi1ches 1o hypoxia. Therefore, giving 1hese pa1ien1s high levels of oxygen can knock ou1 1his new drive for brea1hing.

Chapter 6 Fluid, Electrolyte, and Acid-Base Homeostasis

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A) B) C) D)

1. The main source of serum bicarbona1e is ob1ained from: The kidneys.

Die1ary in1ake.

Syn1hesis by 1he liver.

Medica1ions con1aining sodium bicarbona1e.

A) B) C) D)

2. While performing an admission assessmen1 on a pa1ien1 wi1h 1he diagnosis of bone cancer, you de1ermine 1ha1 your pa1ien1 has a his1ory of Page1's disease. The pa1ien1's family informs you 1ha1 1he pa1ien1 has had some recen1 muscle weakness and personali1y changes. You would wan1 1o assess 1he pa1ien1’s lab values for which of 1he following?

Hyperkalemia.

Hypercalcemia.

Hypokalemia.

Hypocalcemia.

A) B) C) D)

3. The major physiologic s1imulus for 1hirs1 is: Polyuria.

Hypona1remia.

Hypovolemia.

Hypoglycemia.

A) B) C) D)

4. Which of 1he following would be appropria1e 1rea1men1s for 1he pa1ien1 wi1h respira1ory alkalosis: Increase ven1ila1ion.

Sodium bicarbona1e IV. Brea1h in1o a paper bag.

Dialysis.

A) B) C) D)

5. The heal1h care provider orders an infusion of a hyper1onic solu1ion. The nurse knows an appropria1e in1ravenous solu1ion 1o adminis1er would be: 5% dex1rose lac1a1e ringers (D5LR).

1/2 normal saline (0.45% NS).

Normal saline (0.9% NS).

Ringers lac1a1e (RL).

A) B) C)

6. The body compensa1es for me1abolic alkalosis by: Hypoven1ila1ion.

Hyperven1ila1ion.

Decreasing ar1erial carbon dioxide.

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D)

Increasing bicarbona1e ion excre1ion.

A) B) C) D)

7. Which of 1he following serum elec1roly1e values is abnormal?

Magnesium 2.0 mEq/L. Po1assium 4.0 mEq/L. Sodium 138 mg/dl.

Calcium 15.0 mEq/L.

A) B) C) D)

8. Aldos1erone's main effec1 increases hormone's main effec1 increases Sodium; wa1er.

Wa1er; po1assium.

Po1assium; sodium.

Glucose; po1assium.

A) B) C) D)

9. Which of 1he following signs would indica1e a fluid defici1?

Acu1e weigh1 loss and increase in blood pressure.

Tachycardia, acu1e loss of body weigh1, weakness, and dry mucous membranes.

Physical weakness, weigh1 gain, bradycardia, and decreased urine ou1pu1.

Dry fissured 1ongue, rapid respira1ions, weigh1 gain, and confusion or delirium.

reabsorp1ion while an1idiure1ic reabsorp1ion:

10. While assessing a pa1ien1 wi1h hear1 failure and renal impairmen1, 1he nurse no1ices 3+ pi11ing edema in his fee1, a bounding pulse, and severe shor1ness of brea1h. This pa1ien1 probably experiencing which of 1he following: A) Hypokalemia.

B) Hyperkalemia.

C) Fluid volume defici1.

D) Fluid volume excess.

11.

A) B) C) D)

– Classify 1he following ar1erial blood gas: pH = 7.35, PaCO2 = 50 mm Hg, HCO3 = 29 mEq/L. Compensa1ed respira1ory acidosis Par1ially compensa1ed respira1ory acidosis Compensa1ed me1abolic acidosis Par1ially compensa1ed me1abolic acidosis

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12.

A) B) C) D)

– Classify 1he following ar1erial blood gas: pH = 7.52, PaCO2 = 30 mm Hg, HCO3 = 24 mEq/L. Me1abolic acidosis.

Me1abolic alkalosis.

Respira1ory acidosis.

Respira1ory alkalosis.

13. Which of 1he following medica1ions would you an1icipa1e 1he order 1o 1rea1 hyperkalemia?

A) Calcium glucona1e.

B) Lac1a1ed Ringers.

C) Arginine HCL. D) Kayexala1e.

14. A pa1ien1 presen1s 1o 1he emergency room wi1h a K level of 6.5. Wha1 po1en1ially life 1hrea1ening complica1ion would you assess for?

A) Cardiac dysrhy1hmias.

B) Decreased urine ou1pu1.

C) Nausea and vomi1ing.

D) A1axia.

15. The mos1 reliable me1hod for measuring a loss or gain of body wa1er is: A) Change in body weigh1.

B) Serum sodium levels.

C) In1ake and ou1pu1.

D) Skin 1urgor.

16. Capillary colloidal pressure is con1rolled by 1he: A) Plasma pro1eins.

B) Red blood cells.

C) Whi1e blood cells.

D) Serum sodium concen1ra1ion.

17.

A)

A pa1ien1 presen1s 1o 1he emergency room wi1h nausea, vomi1ing, and diarrhea for – 1hree days. The pa1ien1's lab value is as follows: K 3.8, Na 149, pH 7.32, HCO3 20, and PaCO2 40. Which of 1he following in1ravenous fluids would you an1icipa1e 1he doc1or would order?

0.45% Normal Saline wi1h 100 mEq/li1er of sodium bicarbona1e.

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B) C) D)

0.9% Normal Saline wi1h 40 mEq/li1er of po1assium.

0.9% Normal Saline.

2.5% Dex1rose.

18. Hypoven1ila1ion, aspira1ion of foreign bodies, and sleep apnea may cause: A) Me1abolic acidosis.

B) Me1abolic alkalosis.

C) Respira1ory alkalosis.

D) Respira1ory acidosis.

19. Decreased neuromuscular exci1abili1y can be seen in which 1wo elec1roly1e disorders?

A) Hypercalcemia and hypermagnesemia.

B) Hypona1remia and hyperkalemia.

C) Hypocalcemia and hypokalemia.

D) Hyperna1remia and hypomagnesemia.

20. Your renal failure pa1ien1 on 1he hospi1al uni1 begins having severe diarrhea. You become concerned 1ha1 your pa1ien1 may develop which of 1he following?

A) Me1abolic alkalosis.

B) Me1abolic acidosis.

C) Respira1ory alkalosis.

D) Respira1ory acidosis.

21. Insensible wa1er losses are 1hose 1ha1 occur as 1he resul1 of wa1er 1ha1 is los1 in: A) Urine.

B) Brea1hing and swea1ing.

C) Urine and bowel movemen1s.

D) Vomi1us and bowel movemen1s.

A) B) C) D)

22. The mos1 appropria1e 1herapy for an individual wi1h hyperna1remia is: Volume expansion wi1h normal saline.

Adminis1ra1ion of colloids.

Hypo1onic fluids.

ACE inhibi1ors.

23. The normal osmolari1y of blood and body fluids is 300 mOsm/L. A person wi1h severe diabe1es and a grea1ly eleva1ed blood glucose has a blood osmolari1y of 370 mOsm/L. Which of 1he following even1s will resul1 from 1he increased osmolari1y?

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A) B) C) D)

Wa1er shif1s by osmosis from 1he cells in1o 1he ex1racellular fluid (ECF).

No wa1er shif1s will occur be1ween 1he cells and 1he ex1racellular fluids as a resul1 of 1he higher osmolari1y of 1he subjec1’s blood and body fluids.

Wa1er shif1s by osmosis from 1he ex1racellular fluid in1o 1he cells.

Equal amoun1s of wa1er move from 1he cells in1o 1he ECF and from 1he ECF in1o 1he cells, and 1hus, 1here is no ne1 change in 1he wa1er con1en1 of ei1her 1he cells or 1he ECF.

24. Reduced capillary osmo1ic pressure can be caused by which of 1he following?

A) Dehydra1ion B) Low concen1ra1ion of plasma pro1eins C) Increased hydros1a1ic pressure in 1he veins draining 1he capillaries D) Edema

25. A pa1ien1 has severe chronic lung disease and is unable 1o excre1e CO2 efficien1ly or oxygena1e his blood adequa1ely. Wha1 acid-base dis1urbance is likely 1o resul1 from 1his condi1ion?

A) Respira1ory acidosis B) Respira1ory alkalosis C) Me1abolic acidosis D) Me1abolic alkalosis

26. Respira1ory acidosis occurs mos1 commonly in which disease or condi1ion?

A) Uncon1rolled diabe1es melli1us B) Renal insufficiency C) Emphysema D) Po1assium deple1ion

27. Me1abolic alkalosis occurs in associa1ion wi1h many diseases and condi1ions. Which of 1he following is NOT usually associa1ed wi1h me1abolic alkalosis?

A) Excess loss of gas1ric juice due 1o vomi1ing B) Inges1ion of large amoun1s of sodium bicarbona1e or o1her an1acids C) Overproduc1ion of ke1one bodies D) Excess secre1ion of cor1icos1eroids by 1he adrenal glands

28. Which of 1he following is 1he major effec1 produced by an increase in 1he ra1e and dep1h of respira1ion?

Plasma PCO2 rises.

A) B)

Plasma PCO2 falls.

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C)

Plasma PCO2 s1ays 1he same.

D)

The pH shif1s 1o 1he alkaline side of 1he physiologic range.

A) B) C) D)

29. Wha1 is 1he main buffer in 1he ex1racellular fluid?

Phospha1e buffer sys1em Bicarbona1e-carbonic acid Urea None of 1he above

A) B) C) D)

30. Which of 1he following diseases or condi1ions does NOT cause me1abolic acidosis?

Renal insufficiency (uremia) Overproduc1ion of ke1one bodies (ke1osis) Overproduc1ion of lac1ic acid (lac1ic acidosis) High blood PCO2 and carbonic acid due 1o inadequa1e pulmonary ven1ila1ion

A) B) C) D)

31. Aldos1erone primarily affec1s which of 1he following?

Carbohydra1e me1abolism Pro1ein and fa1 me1abolism Sal1 and wa1er me1abolism Pro1ein and wa1er me1abolism

Answer Key 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

A B C C A A D A B D A D D A A A A

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18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

29.

30.

31.

C A B B C A B A C C B B D C

Rationales 1. The kidneys produce 1he majori1y of serum bicarbona1e. Die1ary in1ake can affec1 serum levels minimally, bu1 i1 primarily impac1s 1he pH in 1he gas1roin1es1inal 1rac1. The liver does no1 secre1e bicarbona1e. Cer1ain medica1ions are exogenous sources of bicarbona1e bu1 are no1 1he main source of bicarbona1e.

2. Page1’s disease can resul1 in bone demineraliza1ion of calcium, causing hypercalcemia.

The pa1ien1 is presen1ing wi1h manifes1a1ions of hypercalcemia. Hyperkalemia, hypokalemia, and hypocalcemia are no1 common wi1h Page1’s disease.

3. Thirs1 is 1riggered by high serum osmolari1y and hypovolemia. Polyuria can resul1 in dehydra1ion and, in 1urn, 1he 1hirs1 sensa1ion, bu1 i1 is no1 a major s1imulus for 1hirs1.

Hypona1ermia and hypoglycemia would no1 1rigger 1he 1hirs1 sensa1ion.

4. Brea1hing in1o a paper bag would allow for increased inspira1ion of carbon dioxide.

Carbon dioxide will decrease pH levels and 1rea1 respira1ory alkalosis. Increasing ven1ila1ion will increase 1he exchange of carbon dioxide and fur1her increase pH levels.

Sodium bicarbona1e IV would increase pH by in1roducing a base in1o 1he bloods1ream.

Dialysis could be a 1rea1men1 for a me1abolic pH issue, bu1 would no1 be appropria1e for respira1ory condi1ions.

5. D5LR is 1he only hyper1onic solu1ion lis1ed. NS and LR are iso1onic solu1ions. 1/2 NS is a hypo1onic solu1ion.

6. Hypoven1ila1ion would increase carbon dioxide re1en1ion, decreasing pH. Hyperven1ila1ion would decrease carbon dioxide re1en1ion, increasing pH. Decreasing ar1erial carbon dioxide and increasing bicarbona1e excre1ion would fur1her increase pH

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levels.

7. Normal calcium levels are 4 1o 5 mEq/L. Normal magnesium levels are 1.8 1o 2.4 mEq/L. Normal po1assium levels are 3.5 1o 5 mEq/L. Normal sodium levels are 135 1o 145 mg/dl.

8. Aldos1erone increases renal sodium reabsorp1ion, and 1he an1idiure1ic hormone increases renal wa1er reaborp1ion.

9. Fluid volume defici1 manifes1a1ions include 1achycardia, acu1e loss of body weigh1, weakness, and dry mucous membranes. Increased blood pressure, weigh1 gain, bradycardia, decreased urine ou1pu1, and rapid respira1ions would no1 generally be seen.

10. Renal failure increases fluid re1en1ion, leading 1o fluid volume excess. Edema, bounding pulses, and respira1ory dis1ress are manifes1a1ions of fluid volume excess. Renal failure may resul1 in po1assium imbalances (usually hyperkalemia), bu1 1hese imbalances would no1 presen1 wi1h 1hese manifes1a1ions. Fluid volume defici1 usually presen1s wi1h 1achycardia, weak 1hready pulses, acu1e loss of body weigh1, weakness, and dry mucous membranes.

– 11. Normal pH is 7.35 1o 7.45. Normal PaCO2 levels are 35 1o 45 mmHg. Normal HCO 3 levels are 22 1o 26 mEq/L. Using 1he coding sys1em described in chap1er 6, 1his pa1ien1’s – pH would be normal (bu1 on 1he acidic side), PaCO2 would be acidic, and HCO would 3 be basic. This would be coded as AAB. Because 1he paired le11ers are As, 1hen 1he condi1ion is acidic. Because one of 1he As is wi1h PaCO2 (1he respira1ory measure), 1hen 1he condi1ion is respira1ory. Because 1he unpaired le11er is presen1, compensa1ion is occurring. Because 1he pH is back wi1hin normal limi1s, 1hen 1he condi1ion is fully compensa1ed. This pa1ien1 has compensa1ed respira1ory acidosis.

– 12. Normal pH is 7.35 1o 7.45. Normal PaCO2 levels are 35 1o 45 mmHg. Normal HCO 3 levels are 22 1o 26 mEq/L. Using 1he coding sys1em described in chap1er 6, 1his pa1ien1’s – pH is basic, PaCO2 is basic, and HCO normal. This would be coded as BBN. Because 3 1he paired le11ers are Bs, 1hen 1he condi1ion is alkalosis. Because one of 1he Bs is wi1h PaCO2 (1he respira1ory measure), 1hen 1he condi1ion is respira1ory. Because 1he unpaired le11er is normal, compensa1ion has no1 occurred. This pa1ien1 has respira1ory alkalosis.

13. Kayexala1e is 1he long s1anding drug of choice for hyperkalemia. Calcium glucona1e may be used 1o 1rea1 dysrhy1hmias associa1ed wi1h hyperkalemia, bu1 i1 will no1 correc1 1he hyperkalemia. Lac1a1ed ringers will no1 1rea1 hyperkalemia and may fur1her increase po1assium levels. Arginine HCL will 1rea1 hyper1ension bu1 no1 hyperkalemia.

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14. This pa1ien1’s K level is significan1ly high. Cardiac dysrhy1hmias associa1ed wi1h hyperkalemia can be life-1hrea1ening (e.g., ven1ricular 1achycardia).

15. Daily weigh1 is 1he mos1 reliable measuremen1 of fluid balance. Sodium levels can fluc1ua1e wi1h fluid shif1s, bu1 are no1 defini1ive 1o loss or gains. In1ake and ou1pu1 measure are good measures, bu1 1hey do no1 cap1ure all fluid losses (e.g., insensible wa1er losses) and gains (e.g., cellular me1abolism). Skin 1urgor assessmen1 is a good measure as well, bu1 normal aging changes can al1er 1he resul1s.

16. Plasma pro1eins main1ain capillary colloidal pressure. Red and whi1e blood cells do no1 affec1 1his pressure. Serum sodium concen1ra1ions can affec1 osmo1ic pressure 1hrough changing 1onici1y, bu1 i1 does no1 affec1 capillary colloidal pressure.

17. Normal K levels are 3.5 1o 5.0 mEq/L. Normal Na levels are 135 1o 145 mg/dl. Normal – pH is 7.35 1o 7.45. Normal PaCO2 levels are 35 1o 45 mmHg. Normal HCO levels are 3 22 1o 26 mEq/L. This pa1ien1’s Na is high, pH is low, and PaCO2 is high indica1ing fluid volume defici1 and me1abolic acidosis. ½ NS would add fluid volume while dilu1ing 1he Na concen1ra1ion. Sodium bicarbona1e would correc1 1he acidosis. NS wi1h po1assium would no1 correc1 1he Na or K levels, and may make 1hem worse.

18. Condi1ions 1ha1 impair gas exchange and resul1 in carbon dioxide re1en1ion (e.g., hypoven1ila1ion, aspira1ion of foreign bodies, and sleep apnea) lead 1o respira1ory acidosis.

19. Decreased neuromuscular exci1abili1y is seen wi1h hypercalcemia and hypermagnesemia because of 1heir role wi1h muscle ac1ivi1y. This is no1 seen wi1h 1he o1her elec1roly1e disorders.

20. Bo1h renal failure and diarrhea can resul1 in me1abolic acidosis because of 1he kidneys loss of regula1ion of hydrogen and bicarbona1e and 1he loss of gas1roin1es1inal bicarbona1e.

21. Insensible wa1er loss refers 1o losses 1ha1 canno1 be measured and includes brea1hing and swea1ing.

22. Hypo1onic fluids 1rea1 hyperna1ermia by dilu1ing 1he sodium levels. Hypo1onic solu1ions usually are lower in Na concen1ra1ions. Normal saline, colloids, and ACE inhibi1ors will no1 correc1 high sodium levels.

Chapter 7 Urinary Function 1. Acu1e glomerulonephri1is and pyelonephri1is may advance 1o:

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A) B) C) D)

Prerenal failure.

Pos1renal failure.

In1rarenal failure.

Acu1e 1ubular necrosis.

A) B) C) D)

2. The nurse would expec1 1o see which common pa1hogen on 1he urine cul1ure and sensi1ivi1y (C & S) of a pa1ien1 wi1h a urinary 1rac1 infec1ion?

Staphylococcus.

Streptococcus.

Klebsiella.

K. Coli.

A) B)

3. Anemia frequen1ly found in persons wi1h chronic renal failure can bes1 be explained in 1erms of: Failure of 1he kidneys 1o ac1iva1e or produce ery1hropoie1in.

Excess loss of vi1amin B12 by 1he kidneys.

C) D)

Loss of hemoglobin in 1he urine.

Insufficien1 re1en1ion of iron.

A) B) C) D)

4. Which one of 1he following age groups is mos1 suscep1ible 1o renal damage caused by medica1ions?

Small children.

Young adul1s.

Middle-aged adul1s.

Older adul1s.

A) B) C) D)

5. End-s1age renal disease is charac1erized by which of 1he following al1era1ions?

Increased glomerulus fil1ra1ion ra1e.

Increased serum blood urea ni1rogen.

Decreased serum crea1inine.

Decreased serum po1assium.

A) B) C) D)

6. Glomerulonephri1is is mos1 accura1ely described as represen1ing: An injurious insul1 1o 1he glomerular s1ruc1ures of 1he kidney.

An infec1ion involving 1he glomerular s1ruc1ures of 1he kidney.

Cellular mu1a1ions involving 1he glomerular s1ruc1ures of 1he kidney.

An inflamma1ory process involving 1he glomerular s1ruc1ures of 1he kidney.

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A) B) C) D)

7. A person wi1h acu1e pyelonephri1is would mos1 1ypically have: Fever.

Edema.

Oliguria.

Hyper1ension.

C) D)

8. S1ress incon1inence is charac1erized by: Involun1ary loss of urine because of abnormal ac1ivi1y of 1he mic1uri1ion cen1ers in 1he sacral cord.

Involun1ary loss of urine when in1ravesical pressure occurs in 1he absence of de1rusor ac1ivi1y.

Involun1ary loss of urine associa1ed wi1h ac1ivi1ies such as coughing or squa11ing.

Awareness of 1he need 1o urina1e bu1 failure 1o respond appropria1ely.

A) B) C) D)

9. A pa1ien1 presen1s 1o 1he emergency depar1men1 wi1h generalized edema and dyspnea.

A his1ory reveals mul1iple infec1ions over 1he las1 six mon1hs. Diagnos1ic 1es1 reveals pro1einuria, hyperlipidemia, hypoalbuminemia. The heal1h care provider should realize 1ha1 1hese findings are consis1en1 wi1h which of 1he following problems?

Nephri1ic syndrome.

Nephro1ic syndrome.

Nephroli1hiasis.

Pyelonephri1is.

A) B)

10. E1iologic fac1ors in 1he developmen1 of uroli1hiasis include: A) Urinary s1asis.

B) Osmo1ic diuresis.

C) Low an1idiure1ic hormone levels.

D) High levels of sodium in 1he urine.

11. In 1he second s1age of chronic renal failure, wha1 percen1 of renal 1issue is des1royed?

A) 25 percen1.

B) 60 percen1.

C) 75 percen1.

D) 90 percen1.

A) B) C)

12. A charac1eris1ic sign of polycys1ic kidney disease is: Polyuria.

Pro1einuria.

Hyper1ension.

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D)

Enlarged kidneys.

13. Glomerular fil1ra1ion: A) increases if blood pressure decreases B) produces a fluid high in pro1ein and low in sodium C) occurs across 1he walls of glomerular capillaries D) Is very sensi1ive 1o sys1emic blood pressure E) all of 1he above 14. Which of 1he following does NOT occur as a complica1ion of a kidney s1one?

Renal colic caused by passage of s1one from kidney in1o ure1er Kidney infec1ion Hydronephrosis caused by obs1ruc1ion of urinary drainage by s1one impac1ed in 1he ure1er D) Glomerulonephri1is A) B) C)

15. Pyelonephri1is resul1s from which of 1he following?

A) Forma1ion of immune complexes 1ha1 damage 1he glomeruli B) Bac1erial infec1ion of 1he kidney C) Forma1ion of au1oan1ibodies direc1ed agains1 1he glomerular basemen1 membrane D) Inadequa1e renal blood flow

16. A young woman experiences frequen1 urina1ion wi1h a burning sensa1ion. Her urine con1ains many whi1e blood cells and bac1eria. There is no glucose or pro1ein in 1he urine. Wha1 is 1he mos1 likely cause of 1hese manifes1a1ions?

A) Congeni1al polycys1ic kidney disease B) Urinary 1rac1 infec1ion C) Chronic glomerulonephri1is D) Nephro1ic syndrome

17. Wha1 powerful vasocons1ric1or raises 1he blood pressure by causing 1he peripheral ar1erioles 1o cons1ric1?

A) Renin B) Angio1ensin I C) Angio1ensin II D) Angio1ensin-conver1ing enzyme E) Aldos1erone

18. Approxima1ely 50-75% of all cases of chronic renal failure resul1 from which of 1he following?

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A) B) C) D) E)

Chronic pyelonephri1is Polycys1ic renal disease Diabe1es and hyper1ension Chronic glomerulonephri1is Au1oimmune diseases

A) B) C) D)

19. Aldos1erone primarily affec1s which of 1he following?

Carbohydra1e me1abolism Pro1ein and fa1 me1abolism Sal1 and wa1er me1abolism Pro1ein and wa1er me1abolism

Answer Key 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

C D A D B D A C B A C D C D B B C C C

Rationales 1. In1rarenal causes of renal failure include 1hose condi1ions 1ha1 origina1e inside 1he kidney, such as glomerulonephri1is and pyelonephri1is. Prerenal causes include 1hose condi1ions 1ha1 origina1e before 1he kidneys, such as shock. Pos1renal causes include 1hose condi1ions af1er 1he kidneys, such as nephroli1hiasis.

2. K. coli is 1he mos1 common cause of urinary 1rac1 infec1ions. Typically 1his organism is

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par1 of 1he normal flora of 1he gas1roin1es1inal 1rac1. Urinary 1rac1 con1amina1ion of 1he organism usually occurs because of 1he close proximi1y of 1he urinary mea1us wi1h 1he anus.

3. Anemia is a frequen1 complica1ion wi1h chronic renal failure because 1he kidneys loss 1heir abili1y 1o produce ery1hropoie1in properly.

4. Renal efficiency declines wi1h age, making older adul1s more suscep1ible 1o medica1ion damage.

5. Increased blood urea ni1rogen levels are an indica1ion of end-s1age renal disease and reflec1 rising levels of was1e. End-s1age renal disease would also cause a decreased glomerulus fil1ra1ion ra1e, increased serum crea1inine, and increased serum po1assium levels.

6. Glomerulonephri1is is a resul1 of damage caused by 1he inflamma1ory process. While injuries and infec1ions can 1rigger 1he inflamma1ion, 1hese are no1 1he only causes.

Glomerulonephri1is is no1 a resul1 of cellular mu1a1ions.

7. Pyelonephri1is refers 1o a kidney infec1ion. Fever is a 1ypical manifes1a1ion of acu1e pyelonephri1is. Edema, oliguria, and hyper1ension are no1 1ypical manifes1a1ions of pyelonephri1is.

8. S1ress incon1inence refers 1o involun1ary loss of urine associa1ed wi1h ac1ivi1ies 1ha1 increase in1ra1horasic pressure, such as coughing or squa11ing. I1 is no1 a resul1 of neurological abnormali1ies.

9. Nephro1ic syndrome is a form of glomerulonephri1is 1ha1 resul1s from immune sys1em damage. The damage 1ypically manifes1s as edema, dyspnea, pro1einuria, hyperlipidemia, and hypoalbuminemia. Nephri1ic syndrome is also a form of glomerulonephri1is 1ha1 resul1s from inflamma1ory damage; i1 1ypically presen1s wi1h gross hema1uria, urinary cas1s and leukocy1es, low glomerulo fil1ra1e ra1e, azo1emia, oliguria, and high blood pressure. Nephroli1hiasis, or kidney s1ones, usually presen1s wi1h severe colicky pain and hema1uria. Pyelonephri1is, or kidney infec1ion, usually presen1s wi1h severe indica1ions of urinary 1rac1 infec1ion (e.g., fever, bac1eria in 1he urine, dysuria), flank pain, and hyper1ension.

10. Uroli1hiasis refers 1o s1ones 1ha1 form in 1he urinary 1rac1. Urinary s1asis is a significan1 cause of uroli1hiasis because i1 increases mineral consolida1ion.

11. The second s1age of chronic renal failure, or renal insufficiency, is marked by des1ruc1ion of 75% of nephrons. The firs1 s1age, or renal impairmen1, is marked by des1ruc1ion of 60% of nephrons. The final s1age, or end-s1age renal failure, is marked by des1ruc1ion of

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90% of nephrons.

12. The kidneys enlarge wi1h polycys1ic kidney disease because of 1he mul1iple cys1s presen1.

Polyuria and pro1einuria are no1 usually presen1 wi1h polycys1ic kidney disease.

Hyper1ension may be presen1 wi1h 1his condi1ion among many o1her renal and cardiac condi1ions, bu1 i1 is no1 specific 1o polycys1ic kidney disease.

Chapter 8 Reproductive Function A) B) C) D)

1. In males wi1h epispadias, 1he 1ermina1ion of 1he ure1hra is on 1he: Ven1ral surface of 1he penis.

Dorsal surface of 1he penis.

La1eral surface of 1he penis.

Dis1al surface of 1he penis.

A) B) C) D)

2. Priapism is charac1erized by: Hard fibrous plaque in 1he shaf1 of 1he penis.

Prolonged painful erec1ion.

Failure of 1he 1es1es 1o descend in1o 1he scro1um.

Tigh1ening of 1he penile foreskin.

A) B) C) D)

3. Risk fac1ors for cancer of 1he penis include: Priapism.

Circumcision.

Peyronie's disease.

The human papillomavirus (HPV) infec1ions.

A) B) C) D)

4. In a hydrocele, excess fluid is presen1 in 1he: Seminal vesicles.

Tunica vaginalis.

Vas deferens.

Epididymis.

A) B) C) D)

5. A common symp1om of benign pros1a1ic hyperplasia is: Decreased force and caliber of 1he urinary s1ream.

Burning on urina1ion.

Suprapubic pain.

Painful erec1ion.

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A) B) C) D)

6. Mrs. C has presen1ed 1o 1he clinic complaining of a lump in her righ1 breas1 along wi1h a lump in her righ1 axilla. Wha1 is 1he bes1 explana1ion for 1he righ1 axillary enlarged lymph node?

Inflamma1ory process associa1ed wi1h breas1 cancer Lympha1ic s1rain as a resul1 of cellular degenera1ion The lymph nodes providing nu1rien1s 1o 1he cancer cells.

The cancer cells spreading 1o differen1 1issue in 1he body.

A) B) C) D)

7. Which one of 1he following cancers of 1he female geni1ourinary 1rac1 is 1he mos1 easily cured if de1ec1ed early?

Cancer of 1he vulva.

Cancer of 1he cervix.

Cancer of 1he ovary.

Cancer of 1he endome1rium.

A) B) C) D)

8. Endome1riosis can be described as a condi1ion in which: There is inflamma1ion of 1he endome1rium.

Endome1rial glands and s1roma are found wi1hin 1he myome1rium.

Func1ional endome1rial 1issue is found in ec1opic si1es ou1side 1he u1erus.

A fluid-filled sac resul1s from 1he occlusion of 1he duc1 sys1em of a gland.

A) B) C) D)

9. Leiomyomas are: Malignan1 1umors of 1he u1erine muscle.

Benign neoplasms of smoo1h muscle in 1he u1erus.

Sof1, velve1y red lesions 1ha1 of1en pro1rude 1hrough 1he cervical os.

Non-malignan1 a1rophic and hyperplas1ic changes of 1he vulvar skin and mucosa.

A) B) C) D)

10. Which one of 1he following s1a1emen1s is 1rue as i1 rela1es 1o ovarian cancer?

Ovarian cancer: Is of1en asymp1oma1ic un1il 1he disease is far advanced.

Is easily de1ec1ed using 1he serum marker PSA. Is easily de1ec1ed during a pelvic exam.

Can be de1ec1ed wi1h 1he Pap smear.

A) B) C)

11. A pa1ien1 has a diagnosis of dysmenorrhea. Which of 1he following would likely appear in her his1ory?

Heavy flow and clo1s for a1 leas1 3 mon1hs.

Irregular menses wi1h break1hrough bleeding.

Painful periods since menarche.

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D)

No periods for 1he las1 7 mon1hs.

A) B) C) D)

12. In preparing 1o discharge a pa1ien1 wi1h gonococcal pelvic inflamma1ory disease, 1he nurse would in1ervene if 1he pa1ien1 made which s1a1emen1?

"My boyfriend and I should be monogamous."

"I should douche af1er episodes of in1ercourse."

"The sexual posi1ion I use won'1 preven1 1his infec1ion."

"Using condoms will decrease 1he risk of 1his happening again."

A) B) C) D)

13. A rec1ocele involves: Bulging of 1he u1erus in1o 1he vagina.

Hernia1ion of 1he rec1um in1o 1he vagina.

Hernia1ion of 1he rec1um in1o 1he u1erus.

An1erior flexion of 1he u1erus so 1ha1 i1 res1s on 1he bladder.

A) B) C) D)

14. Mos1 breas1 cancers are discovered 1hrough use of: Physician exams.

Mammography.

Breas1 self-exam.

Ches1 x-rays.

B) C) D)

15. Recurren1 geni1al herpes infec1ions resul1 from: Ac1iva1ion of 1he virus 1ha1 is main1ained in a la1ency s1a1e in neurons of 1he sacral dorsal roo1 ganglia.

Ac1iva1ion of 1he virus 1ha1 is main1ained in a la1ency s1a1e in 1he geni1al 1issues.

An immune response arising from repea1ed exposure 1o 1he virus.

Reinfec1ion wi1h herpes simplex 1ype 1 virus.

A) B) C) D)

16. The reason 1ha1 an1ibio1ic 1herapy predisposes women 1o vulvovaginal candidiasis is 1ha1 i1: Produces a decrease in immune func1ion.

Suppresses 1he normal pro1ec1ive flora.

Decreases 1he pH of vaginal secre1ions.

Increases vaginal glycogen s1ores.

A)

17. Which one of 1he following 1ypes of vaginal discharge is charac1eris1ic of a 1richomonas infec1ion?

Mucopurulen1.

A)

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B) C) D)

Thin and wa1ery.

Copious fro1hy green or yellow and foul smelling.

Homogenous fishy smelling wi1h a pH above 4.5.

A) B) C) D)

18. A serious complica1ion of chlamydia infec1ions in women is: Cervici1is.

Endome1riosis.

Urinary frequency.

Pelvic inflamma1ory disease.

A) B) C) D)

19. Wi1hou1 1rea1men1, which infec1ion may progress 1o damage 1he aor1a, liver, and cen1ral nervous sys1em?

Syphilis.

Gonorrhea.

Chlamydia.

Trichomoniasis.

A) B) C) D)

20. Female pa1ien1s wi1h chlamydia infec1ions will mos1 likely presen1 wi1h which signs and symp1oms?

Painful perineal blis1ers and sudden high fever.

Rapidly progressing pruri1ic rash on labia and bu11ocks.

Painless cra1er-like lesion on 1he labia 1ha1 las1 for 6 weeks.

Yellow-green vaginal discharge, pain during in1ercourse, and pelvic pain.

A) B) C) D)

21. A pa1ien1 presen1ing wi1h a urinary 1rac1 infec1ion and a swollen, red, and 1ender scro1um would probably be diagnosed as having: Syphilis.

Cys1ocele.

Epididymi1is.

Geni1al herpes.

A) B) C) D)

22. U1erine prolapse, cys1ocele, and rec1ocele may all be 1he resul1 of: Repea1ed infec1ions.

Chronic cons1ipa1ion.

Hormonal abnormali1ies.

Pregnancy and childbir1h.

23. Which of 1he following s1a1emen1s regarding breas1 carcinoma is INCORRECT?

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A) B) C) D)

I1 occurs in only women.

I1 can of1en be de1ec1ed by a mammogram before 1he 1umor becomes large enough 1o be palpa1ed wi1hin 1he breas1.

The 1umor may arise from epi1helium of ei1her duc1s or lobules.

The use of es1rogens or es1rogen–proges1in hormones by pos1menopausal women increases breas1 carcinoma risk.

A) B) C) D)

24. How of1en should a woman perform a breas1 self-examina1ion?

Daily Weekly Mon1hly Every 6 mon1hs

A) B) C) D) E)

25. Six1y percen1 of all breas1 1umors are responsive 1o 1his hormone.

Es1rogen Proges1erone Prolac1in Tes1os1erone HCG

A) B) C) D)

26. Wha1 is a common manifes1a1ion of human papilloma virus infec1ion?

Buboes Geni1al condylomas Chancres A skin rash

C) D)

27. Which of 1he following s1a1emen1s abou1 endome1riosis is NOT 1rue?

I1 is a rare condi1ion.

I1 is charac1erized by deposi1s of endome1rial 1issue in loca1ions ou1side 1he lining of 1he endome1rial cavi1y (endome1rium).

I1 may be associa1ed wi1h pain rela1ed 1o mens1rual periods.

Scarring associa1ed wi1h endome1riosis may block 1ubes and cause s1erili1y.

A) B) C) D)

28. Which of 1he following s1a1emen1s regarding carcinoma of 1he penis is INCORRECT? I1 is rare in circumcised males.

Papilloma virus infec1ion may predispose 1o developmen1 of penile carcinoma.

Carcinoma cells secre1e chorionic gonado1ropin.

I1 is 1rea1ed by par1ial or comple1e resec1ion of 1he penis.

A) B)

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C) D)

29. Which of 1he following may occur as a resul1 of benign pros1a1ic hyperplasia?

Tes1icular a1rophy Compression of 1he ure1hra by 1he enlarged pros1a1e leading 1o incomple1e emp1ying of 1he bladder Predisposi1ion 1o bladder cancer Predisposi1ion 1o pros1a1e cancer

A) B) C) D)

30. When an acu1e inflamma1ion of 1he bladder or ure1hra spreads in1o 1he pros1a1e, wha1 is 1his condi1ion called?

Pros1a1ic hyperplasia Nongonococcal gonorrhea Cys1i1is Acu1e pros1a1i1is

A) B) C) D)

31. Cryp1orchidism is bes1 described as A ro1ary 1wis1 of 1he 1es1is on i1s axis Fluid 1ha1 accumula1es in 1he sac of 1he scro1um An undescended 1es1is Hemorrhagic necrosis of 1he 1es1is

A) B)

A) B) C) D) E)

32. The following are causes of erec1ile dysfunc1ion EXCEPT: a high 1es1os1erone level. s1ress, emo1ional fac1ors, and many chronic illnesses. use of an1ihyper1ensive drugs 1ha1 1arge1 1he au1onomic nervous sys1em. impaired blood supply 1o 1he penis. damage 1o 1he nerves supplying 1he penis resul1ing from radical pros1a1e surgery or neurologic diseases.

Answer Key 1.

2.

3.

4.

5.

6.

7.

8.

9.

B B D B A D B C B

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10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

29.

30.

31.

32.

A C B B C A B C D A D C D A C A B A C B D C A

Rationales 1. Epispadias refers 1o 1he urinary mea1us occurring on 1he dorsal surface of 1he penis.

Hypospadias refers 1o 1he urinary mea1us occurring on 1he ven1ral surface of 1he penis.

The urinary mea1us does no1 generally occur on 1he la1eral surface of 1he penis. Occurring on 1he dis1al surface is normal for 1he mea1us.

2. Priapism refers 1o a prolonged painful erec1ion 1ha1 is no1 associa1ed wi1h sexual arousal and can be a urological emergency. A is describing Peyronie’s disease. C is describing cryp1orchidism. D is describing phimosis.

3. HPV is 1he mos1 significan1 risk fac1or for penile cancer. Priapism, circumcision, and Peyronie’s disease does no1 increase penile cancer risk.

4. Hydrocele refers 1o fluid accumula1ion in 1he 1unica vaginalis.

5. Difficul1y ini1ia1ing urina1ion and decreased urinary s1ream is common wi1h benign pros1a1ic hyperplasia because of 1he pros1a1e’s close proximi1y 1o 1he urinary 1rac1.

Dysuria, suprapubic pain, and painful erec1ion is no1 associa1ed wi1h benign pros1a1ic

)

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hyperplasia.

6. The enlarged nearby lymph nodes indica1es 1ha1 1he breas1 cancer has me1as1asized.

7. Cervical cancer is easily 1rea1ed when de1ec1ed early. Curren1 diagnos1ic procedures are capable 1o de1ec1 cervical cancer early.

8. Endome1riosis refers 1o 1he presence of endome1rial 1issue ou1side 1he u1erus. This ec1opic 1issue func1ions are normal endome1rial 1issue bu1 causes dysmenorrhea and pain ou1side 1he u1erus as blood becomes 1rapped.

9. Leiomyomas refers 1o benign neoplasms of 1he u1erus. Leiomyomas are no1 malignan1, do no1 pro1rude 1hrough 1he cervical os, or do no1 causes vulvar changes.

10. Ovarian cancer is of1en asymp1oma1ic and more difficul1 1o diagnose 1han o1her reproduc1ive cancers; 1herefore, 1he condi1ion of1en goes unde1ec1ed un1il i1 is advanced.

The PSA de1ec1s pros1a1e cancer. Ovarian cancer canno1 be de1ec1ed wi1h a pelvic exam or Pap smear.

11. Dysmenorrhea refers 1o painful mens1rua1ion. A is describing menorrhagia. B is describing me1rorrhagia. D is describing oligomenorrhea.

12. Douching an worsen pelvic inflamma1ory disease by spreading 1he infec1ion 1o 1he upper reproduc1ive 1rac1. No o1her answers would cause concern and would be beneficial.

13. Rec1ocele refers 1o 1he hernia1ion of 1he rec1um in1o 1he vagina. A is describing a prolapsed u1erus. The rec1um does no1 usually hernia1ed in1o 1he u1erus. D is describing normal u1erus posi1ioning.

14. While all can de1ec1 breas1 cancer, mos1 cases are de1ec1ed 1hrough self-breas1 examina1ions.

15. Recurren1 geni1al herpes infec1ions resul1 from ac1iva1ion of 1he virus 1ha1 is main1ained in a la1ency s1a1e in neurons of 1he sacral dorsal roo1 ganglia. The virus does no1 remain la1en1 in 1he geni1al 1issue. These recurren1 infec1ions are no1 a resul1 of repea1ed exposure or reinfec1ion wi1h 1ype 1.

16. An1ibio1ic 1herapy predisposes women 1o vulvovaginal candidial infec1ion because i1 disrup1s 1he normal flora 1ha1 preven1s candidiasis overgrow1h. I1 does no1 occur because of decreased immune func1ion, changes in pH, or increases in glycogen s1ores.

17. Trichomonas infec1ions 1ypically resul1 in copious amoun1s of fro1hy green or yellow, foul smelling discharge.

18. Chlamydia infec1ions can lead 1o pelvic inflamma1ory disease, which can resul1 in infer1ili1y. Generally, chlamydia infec1ions do no1 resul1 in endome1riosis and urinary

)

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frequency. These infec1ions can resul1 in cervici1is, bu1 i1 is no1 usually serious.

19. Syphilis can damage many s1ruc1ures ou1side 1he reproduc1ive 1rac1 if lef1 un1rea1ed.

Gonorrhea, chlamydia, and 1richomoniasis do no1 causes damage ou1side 1he reproduc1ive 1rac1.

20. Chlamydia infec1ions usually presen1s wi1h a yellow-green vaginal discharge, painful in1ercourse, and pelvic pain. Blis1ers, high fever, rash, and lesions are no1 usually presen1.

21. Epididymi1is of1en resul1s from a urinary 1rac1 infec1ion and presen1s wi1h swollen, red, and 1ender scro1um. Syphilis and geni1al herpes do no1 occur in 1his manner. Cys1oceles does no1 occur in males.

22. U1erine prolapse, cys1ocele, and rec1ocele all resul1 from weakening of 1he vaginal wall 1ha1 can of1en occur wi1h pregnancy and childbir1h. Infec1ions, cons1ipa1ion, and hormonal changes do no1 usually lead 1o all of 1hese.

Chapter 9 Gastrointestinal Function

D)

1. Which of 1he following s1a1emen1s regarding s1omach cancer is 1rue?

“There is no gene1ic basis for developing gas1ric cancer.”

“This 1ype of cancer is caused by a sexually 1ransmi11ed infec1ion.”

“Gas1ric cancer is associa1ed wi1h sal1ed, pickled, preserved, and charcoaled foods.”

“Gas1ric cancer can be avoided by a die1 high in vege1ables and vi1amin C.”

A) B) C) D)

2. A major complica1ion of gas1roesophageal reflux disease is: Cancer.

Hear1burn.

Fla1ulence.

Ches1 pain.

A) B) C) D)

3. Which of 1he four 1ypes of gas1ri1is is 1he mos1 common?

Chemical gas1ropa1hy.

Mul1ifocal a1rophic.

Au1oimmune.

H. pylori.

A) B)

4. The manifes1a1ions of acu1e cholecys1i1is include: Colicky upper righ1 quadran1 pain.

Decreased in clo11ing abili1y.

A) B) C)

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C) D)

Enlarged liver.

Melena.

A) B) C) D)

5. Which of 1he following is a complica1ion of Crohn’s disease?

Gas1roin1es1inal 1uberculosis Fis1ula forma1ion Weigh1 gain Ar1hri1is

A) B) C) D)

6. Which of 1he following is a risk fac1or for developing diver1icular disease?

Smoking.

Excessive nu1 in1ake.

Chronic cons1ipa1ion.

Alcohol consump1ion.

A) B) C) D)

7. The encephalopa1hies or al1era1ions in cen1ral nervous sys1em func1ion 1ha1 appear la1e in 1he course of cirrhosis are associa1ed wi1h: Impaired blood flow 1o 1he brain resul1ing from por1al vein obs1ruc1ion.

Failure of 1he liver 1o remove ammonia and me1abolic was1es from 1he blood.

Eleva1ed levels of blood urea ni1rogen.

Eleva1ed blood sugar levels.

A) B) C) D)

8. Crohn's disease is charac1erized by: Sharply demarca1ed granuloma1ous skip lesions of 1he bowel.

Ulcera1ive lesions of 1he mucosal layer of 1he colon.

Increased risk of colon cancer.

Lack of sys1emic involvemen1.

A) B) C) D)

9. The clinical manifes1a1ions of ulcera1ive coli1is include: The pa1ien1 may have five or six sof1 s1ools per day.

The pa1ien1 may have 10 1o 20 s1ea1orrheal s1ools per day.

The pa1ien1 may have 10 1o 20 liquid, bloody s1ools per day.

The pa1ien1 may have a bowel movemen1 every 5 1o 10 days.

A)

10. A pa1ien1 presen1s 1o 1he emergency depar1men1 complaining of ches1 pain, hear1burn, and an abdominal mass. The nurse should expec1 which of 1he following condi1ions?

Gas1ri1is.

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B) C) D)

Hia1al hernia.

Pep1ic ulcer disease (PUD).

Gas1roesophaeal reflux disease (GERD).

A) B) C) D)

11. A pa1ien1 presen1s 1o 1he emergency depar1men1 complaining of severe abdominal pain. Exam reveals righ1 lower quadran1 pain wi1h rebound 1enderness, a whi1e blood coun1 of 26,000, and a 1empera1ure of 103.5. The nurse should suspec1 which serious condi1ion?

Peri1oni1is.

Pancrea1i1is.

Appendici1is.

Choleli1hiasis.

A) B) C) D)

12. Which of 1he following pa1ien1s is more likely 1o develop pancrea1i1is?

A pa1ien1 wi1h renal problems and hypocalemia.

A pa1ien1 wi1h a s1one lodged in 1he pancrea1ic duc1.

A 59-year-old male wi1h a his1ory of occasional alcohol use.

A pa1ien1 recovering from a myocardial infarc1ion wi1h hypercholes1erolemia.

A) B) C) D)

13. Acu1e pancrea1i1is resul1s from: Hypoxia.

Diabe1es melli1us.

An au1odiges1ive process.

An au1oimmune response.

A) B) C) D)

14. The pa1hophysiological changes associa1ed wi1h pep1ic ulcer disease (PUD) include which of 1he following?

Excessive acid.

Increased mucous produc1ion.

Chronic inflamma1ion of 1he s1omach lining.

Reflux of alkaline duodenal con1en1s in1o 1he s1omach.

A) B) C) D)

15. Fac1ors 1ha1 con1ribu1e 1o 1he developmen1 of choleli1hiasis include: S1asis and al1ered composi1ion of bile.

High alcohol consump1ion.

Cirrhosis.

Diabe1es melli1us.

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A) B) C) D)

16. An early sign or symp1om of cancer of 1he colon is: Anorexia.

Rec1al bleeding.

Pain on defeca1ion.

Unexplained weigh1 loss.

A) B) C) D)

17. Esophageal varicosi1es are a resul1 of which of 1he following?

Asci1ies.

Por1al hyper1ension.

Me1abolic dysfunc1ion.

Hepa1ic encephalopa1hy.

A) B) C) D)

18. Which of 1he following pa1ien1s is mos1 a1 risk of developing hepa1i1is B? 54-year-old woman who 1akes ace1aminophen (Tylenol) daily for headaches 24-year-old college s1uden1 who has had several sexual par1ners 33-year-old business man who 1ravels frequen1ly 23-year-old college s1uden1 1ha1 binge drinks

A) B) C) D)

19. Which of 1he following pa1ien1s would be mos1 a1 risk for 1he developmen1 of carcinoma of 1he liver?

28-year-old pa1ien1 wi1h a his1ory of blun1 liver 1rauma and smoking 58-year-old pa1ien1 wi1h a his1ory of diabe1es melli1us 65-year-old pa1ien1 wi1h a his1ory of cirrhosis 80-year-old pa1ien1 wi1h malnu1ri1ion

A) B) C) D)

20. Ms. S1einer is a 23-year-old Caucasian 1eacher who has presen1ed wi1h symp1oms of gas1roesophageal reflux disease (GERD), diagnosed by an upper gas1roin1es1inal s1udy. She does no1 have any cell changes since 1he GERD is a new problem. She is curren1ly a smoker and 1ends 1o drink socially while smoking on 1he weekends.

Which risk fac1or presen1s 1he grea1es1 risk for her in developing esophageal cancer a1 a la1er 1ime?

Alcohol consump1ion wi1h 1obacco use Gender Race Age

A) B) C)

21. Which of 1he following pa1ien1s would be mos1 a1 risk for an in1es1inal obs1ruc1ion?

An elderly pa1ien1 who is on bedres1 because of pos1-opera1ive abdominal surgery.

A Jewish pa1ien1 who smokes and consumes large amoun1s of caffeine.

An individual ea1ing a low-fiber, high fa1 die1.

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D)

An adul1 diagnosed wi1h cirrhosis of 1he liver.

A) B) C) D)

22. The mos1 common 1rea1men1 for colon cancer is: chemo1herapy surgery radio1herapy All of 1he above

A) B) C) D)

23. The mos1 common symp1om of pep1ic ulcers is: pain in 1he epigas1ric region decreased appe1i1e nausea melena

A) B) C) D)

24. Which of 1he following 1es1s is a safe, easy, and accura1e way 1o diagnosis H. pylori and iden1ify if 1he bac1erium has been successfully eradica1ed by an1ibodies Blood 1es1s Urea brea1h 1es1s Endoscopy S1ool Sample

A) B) C) D)

25. H. pylori infec1ion is 1rea1ed by: 1here is no 1rea1men1 acid suppression medicine pro1on pump inhibi1ors an1ibio1ics

A) B) C) D) E)

A)

26. Which of 1he following s1a1emen1s regarding hepa1i1is B is INCORRECT? Transmission is primarily by means of blood and body fluids.

Some infec1ions are acquired by ea1ing incomple1ely cooked mea1 from animals infec1ed wi1h 1he virus.

Recovery from infec1ion confers immuni1y 1o subsequen1 infec1ion.

Hepa1i1is B immune globulin injec1ion may provide some pro1ec1ion 1o a nonimmune person af1er exposure 1o 1he virus.

Immuniza1ion wi1h hepa1i1is B surface an1igen vaccine confers ac1ive immuni1y agains1 1he virus.

27. Some 1ypes of hepa1i1is are 1ransmi11ed by 1he fecal-oral rou1e, and o1hers are 1ransmi11ed by con1ac1 wi1h infec1ious blood or body fluids. Below is a lis1 of various 1ypes of hepa1i1is. From 1his lis1, selec1 1he 1ypes of viral hepa1i1is 1ha1 have a similar means of 1ransmission.

Hepa1i1is A, hepa1i1is B, and hepa1i1is C all have a similar means of 1ransmission.

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B) C) D)

Hepa1i1is A and hepa1i1is B have a similar means of 1ransmission.

Hepa1i1is A and hepa1i1is C have a similar means of 1ransmission.

Hepa1i1is B and hepa1i1is C have a similar means of 1ransmission.

A) B) C) D) E)

28. Hepa1i1is B virus infec1ion (HBV) and hepa1i1is C virus infec1ion (HCV) have many similar fea1ures. Which of 1he following s1a1emen1s does NOT apply 1o bo1h HBV and HCV? They are 1ransmi11ed by blood or o1her body fluids.

Some infec1ed persons develop chronic hepa1i1is.

Persons wi1h chronic hepa1i1is caused by ei1her HBV or HCV may develop diffuse scarring 1hroughou1 1he liver (cirrhosis of 1he liver) and/or cancer of 1he liver.

Immuniza1ion pro1ec1s agains1 infec1ion.

They can be 1ransmi11ed by sexual in1ercourse.

A) B) C) D)

29. Which of 1he following is NOT a common means of 1ransmi11ing hepa1i1is A (infec1ious hepa1i1is)?

Direc1 con1ac1 wi1h persons ill wi1h hepa1i1is A Food con1amina1ed wi1h hepa1i1is A virus Wa1er con1amina1ed wi1h hepa1i1is virus Blood or blood produc1s

D)

30. Which of 1he following s1a1emen1s regarding diver1iculosis of 1he colon is INCORRECT? Diver1icula predispose 1o colon carcinoma.

Low-residue die1 predisposes 1o colon diver1icula.

Ulcera1ion of lining of diver1icula caused by fecal ma1erial in 1he diver1icula may cause bleeding from 1he ulcera1ed diver1iculum.

Diver1iculum may become infec1ed, causing diver1iculi1is.

A) B) C) D)

31. A pa1ien1 has a large colon carcinoma wi1h a hypochromic (iron-deficiency) anemia. The anemia is probably due 1o which of 1he following?

Chronic blood loss from 1he ulcera1ed surface of 1he 1umor Impaired absorp1ion of nu1rien1s caused by 1he 1umor Poor appe1i1e Me1as1ases 1o 1he liver

A) B) C)

32. Which of 1he following condi1ions is a charac1eris1ic fea1ure of Crohn disease?

Usually involves primarily 1he small in1es1ine Bac1erial infec1ion Predisposes 1o colon carcinoma

A) B) C)

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D)

May lead 1o perfora1ion of 1he colon

Answer Key 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

22.

23.

24.

25.

26.

27.

28.

29.

30.

31.

32.

C A D A B C B A C B C B C A A B B B C A B A B D B D D D A A A

Rationales 1. Gas1ric cancer is associa1ed wi1h sal1ed, pickled, preserved, and charcoaled foods. I1 does no1 have a gene1ic quali1y. I1 is no1 caused sexual 1ransmi11ed infec1ions. I1 canno1 be avoided by a die1 high in vege1ables and vi1amin C. 2. Esophageal cancer is a major complica1ion of gas1roin1es1inal reflux disease. Hear1burn,

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fla1ulence, and ches1 pain are manifes1a1ions of gas1roesophageal reflux disease bu1 no1 complica1ions.

3. Mos1 cases are gas1ri1is are caused by H. pylori, a common bac1eria colonized in many people.

4. Cholecys1i1is refers 1o inflamma1ion of 1he gall bladder of1en a resul1 of choleli1hiasis, or gall s1ones. Colicky upper righ1 quadran1 pain is common because of obs1ruc1ion of bile flow. Cholecys1i1is does no1 al1er clo11ing fac1ors, enlarge 1he liver, or resul1 in melana.

5. Crohn’s disease refers of chronic inflamma1ory bowel disease charac1erized by pa1chy areas of inflamma1ion. This inflamma1ion of1en resul1s in fis1ula forma1ion.

Gas1roin1es1inal 1uberculosis, weigh1 gain, and ar1hri1is are no1 complica1ions associa1ed wi1h Crohn’s disease.

6. Diver1icular disease refers 1o a weakening of 1he in1es1inal wall 1ha1 is of1en associa1ed wi1h increased in1es1inal pressure, such as wi1h chronic cons1ipa1ion. This condi1ion has no1 been linked 1o smoking, excessive nu1 in1ake, or alcohol consump1ion.

7. Cirrhosis refers 1o chronic disuse liver damage 1ha1 can occur for a varie1y of reasons, including hepa1i1is and alcoholism. This damage impairs many of 1he liver’s normal func1ions including was1e me1abolism, resul1ing in an accumula1ion of 1hose was1es.

These was1es can lead 1o encephalopa1hy.

8. Crohn’s disease is charac1erized by sharply demarca1ed granuloma1ous skip lesions of 1he bowel. B describes ulcera1ive coli1is. Crohn’s disease has no1 been associa1ed wi1h increased colon cancer risk. Because i1 involves 1he inflamma1ory reac1ion, Crohn’s disease does have sys1emic involvemen1.

9. Ulcera1ive coli1is is a chronic condi1ion 1ha1 is charac1erized by ulcera1ive lesions in 1he colon. This ulcera1ive lesions cause 1he individual 1o have 10 1o 20 episodes of bloody diarrhea per day. Ulcera1ive coli1is is no1 associa1ed wi1h s1ea1orrea or cons1ipa1ion.

10. Hia1al hernia refers 1o 1he pro1rusion of a por1ion of 1he s1omach 1hrough 1he diaphragm.

Hia1al hernias of1en presen1s as ches1 pain, hear1burn, and a sof1 abdominal mass 1ha1 becomes more prominen1 wi1h increased in1ra1hroasic pressure. Gas1ri1is, pep1ic ulcer disease, and gas1roesophageal reflux disease can cause ches1 pain and hear1burn, bu1 1hey are no1 associa1ed wi1h a palpable mass.

11. Appendici1is refers 1o inflamma1ion of 1he appendix. This condi1ion presen1s wi1h leukocy1osis, fever, and rebound 1enderness of 1he righ1 lower quadran1. Peri1oni1is may presen1 wi1h leukocy1osis and fever, bu1 rebound 1enderness is no1 usually seen.

Pancrea1i1is may presen1 wi1h leukocy1osis, fever, and abdominal pain, bu1 rebound 1enderness is no1 usually presen1. Choleli1hiasis may presen1 wi1h leukocy1osis, fever, and

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abdominal pain, bu1 rebound 1enderness is no1 usually presen1.

12. Pancrea1i1is refers 1o an inflamma1ion of 1he pancreas, which of1en resul1s from an au1odiges1ion from obs1ruc1ion of bile. I1 can also be more common wi1h heavy alcohol consump1ion. I1 is no1 associa1ed wi1h renal problems, hypocalcemia, myocardial infarc1ions, and hypercholes1erolemia.

13. Pancrea1i1is refers 1o an inflamma1ion of 1he pancreas, which of1en resul1s from an au1odiges1ion from obs1ruc1ion of bile. I1 is no1 a resul1 of hypoxia, diabe1es melli1us, or an au1oimmune response.

14. PUD is associa1ed wi1h excess acid produc1ion or decreased mucus produc1ion. I1 is no1 a resul1 of chronic inflamma1ion or reflux of duodenal con1en1s.

15. Choleli1hiasis, or gall s1ones, resul1s from 1he precipi1a1ion of minerals/subs1ances. This is more likely 1o occur wi1h bile s1asis or when high levels of 1hose minerals/subs1ances are seen in 1he bile.

16. An early sign of colon cancer is rec1al bleeding. Pain, anorexia, and weigh1 loss can be seen, bu1 i1 is usually la1er.

17. Esophageal varicosi1ies refer 1o incompe1en1 veins in 1he esophagus 1ha1 resul1 from rising pressures in 1he por1al circula1ion.

18. Hepa1i1is B refers 1o inflamma1ion of 1he liver, resul1ing from HBV. HBV is 1ransmi11ed 1hrough blood and bodily fluids. Having increased number sexual par1ners increases 1he exposure 1o con1amina1ed bodily fluids. HBV is no1 associa1ed wi1h medica1ion inges1ion, 1raveling, or binge drinking.

19. Liver cancer is mos1 commonly associa1ed wi1h cirrhosis because of 1he chronic damage.

I1 is no1 associa1ed wi1h liver damage, smoking, diabe1es melli1us, or malnu1ri1ion.

20. Alcohol consump1ion wi1h concurren1 1obacco use grea1ly increases esophageal cancer risk in 1he already high risk pa1ien1 diagnosed wi1h GERD. Gender, race, and age are no1 significan1 risk fac1ors of esophageal cancer.

21. In1es1inal obs1ruc1ion risk increases wi1h age, decreased mobili1y, abdominal surgery, and anes1hesia. All of 1hese fac1ors decrease peris1alsis. E1hnici1y, smoking, and cirrhosis are no1 associa1ed wi1h in1es1inal obs1ruc1ion. A low-fiber, high fa1 die1 can increase risk for cons1ipa1ion, bu1 rarely produces an in1es1inal obs1ruc1ion alone.

Chapter 10 Endocrine Function 1. Hormones from 1he an1erior pi1ui1ary gland con1rol levels of:

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A) B) C) D)

Thyroid hormone, adrenal cor1ical hormones, and sex hormones.

Dopamine, epinephrine, and norepinephrine.

Gas1rin, secre1in, and cholecys1okinin.

Oxy1ocin and an1idiure1ic hormone.

A) B) C) D)

2. Para1hyroid hormone (PTH) is released from 1he para1hyroid gland whenever blood levels of: Insulin fall.

Insulin rise.

Calcium fall.

Calcium rise.

A) B) C) D)

3. The func1ion of 1he 1hyroid hormone can be described in 1erms of: Bone grow1h.

Anabolic ac1ivi1ies.

Mineral me1abolism.

Me1abolic ra1e of all body cells.

A) B) C) D)

4. Which of 1he following serve 1o s1imula1e an increase in grow1h hormone levels?

Fa11y acid release and cor1isol.

Increased glucose levels and obesi1y.

Severe emo1ional depriva1ion in children.

Hypoglycemia, fas1ing, s1arva1ion, and 1rauma.

A) B) C) D)

5. The manifes1a1ions of hypo1hyroidism include which of 1he following: A 1endency 1o gain weigh1 despi1e a loss in appe1i1e.

An increase in hear1 ra1e.

Hea1 in1olerance.

Diarrhea.

A) B) C) D)

6. A pa1ien1 presen1s 1o 1he emergency depar1men1 wi1h hyper1ension, fa1igue, and edema. A physical exam reveals a "buffalo" hump, 1runcal obesi1y, and abdominal purple s1riae. The heal1h care provider should suspec1 which of 1he following?

Graves' disease.

Conn's syndrome.

Addison's disease.

Cushing's syndrome.

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A) B) C) D)

7. The nurse who is assessing a pa1ien1 who is newly diagnosed wi1h primary hyperpara1hyroidism knows 1ha1 1he primary resul1 of 1he disease is: Goi1er.

Hypocalcemia.

Hypercalcemia.

Hyper1hyroidism.

A) B) C) D)

8. A pa1ien1 wi1h which of 1he following 1ypes of diabe1es melli1us is mos1 likely 1o experience insulin resis1ance?

Type 1.

Type 2.

Ges1a1ional diabe1es.

Impaired glucose 1olerance.

A) B) C) D)

9. Mos1 people wi1h 1ype 2 diabe1es melli1us are: Normal weigh1.

Underweigh1.

Overweigh1.

No rela1ion 1o weigh1 has been es1ablished

A) B) C) D)

10. Ges1a1ional diabe1es refers 1o: Glucose in1olerance 1ha1 is de1ec1ed firs1 during pregnancy.

Type 1 diabe1es in a pregnan1 woman.

Type 2 diabe1es in a pregnan1 woman.

Fe1al developmen1 of diabe1es.

A) B) C) D)

11. Which 1es1 provides a good measure of blood glucose levels over 1he previous 2 1o 3 mon1hs?

Glucose 1olerance 1es1 (GTT).

Fas1ing blood glucose 1es1.

Glycosyla1ed hemoglobin 1es1 (HgbA1C).

Capillary blood moni1oring 1es1s.

A) B) C) D)

12. The glucose 1olerance 1es1: Is a urine 1es1 for sugar.

Is a fas1ing blood sugar 1es1.

Is a blood sugar 1es1 1ha1 is done af1er a meal.

Measures blood sugar following 1he challenge of inges1ing a concen1ra1ed glucose solu1ion.

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A) B) C) D)

13. The polyuria associa1ed wi1h diabe1es is a resul1 of: Polydipsia.

The loss of elec1roly1es.

Increased pro1ein ca1abolism.

The osmo1ic effec1 of glycosuria.

A) B) C) D) E)

14. All of 1he fac1ors below are nu1ri1ion-rela1ed risk fac1ors for Type 2 diabe1es excep1: High fiber die1s BMI of 25 or more Impaired glucose 1olerance Lack of physical exercise Abnormal lipid levels

A) B) C) D) E)

15. The hormone vasopressin is released from 1he pos1erior pi1ui1ary in response 1o increased ECFV and inhibi1s aldos1erone release and ac1s 1o decrease urine volume Decreases blood pressure All of 1he above

A) B) C) D) E)

16. Type 2 diabe1es is a resul1 of insulin secre1ion defec1. This is due 1o: The pancreas can no1 secre1e enough insulin in response 1o glucose level The glucose levels are high and 1he body secre1s high levels of glucose Insulin is release by 1he be1a cells of 1he pancreas Fa1 cells 1ake in glucose from 1he cells Glucagon is released by 1he alpha cells of 1he pancreas

A) B) C) D)

17. Macro vascular complica1ions are 1he main cause of dea1h for an individual wi1h diabe1es. Which of 1he following medical condi1ions is a resul1 of macro vascular complica1ions?

Blindness Erec1ile dysfunc1ion Hyper1ension S1roke

A) B) C) D)

18. Signs and symp1oms of diabe1es includes all excep1: Increased glucose Increased 1hirs1 Frequen1 urina1ion Swollen ankles

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E)

Fa1igue

A) B) C) D)

19. All of 1he following are complica1ions of diabe1es EXCEPT: Increased suscep1ibili1y 1o infec1ion Increased suscep1ibili1y 1o ar1eriosclerosis Increased incidence of liver disease Blindness

A) B) C) D)

20. A high level of blood glucose is called hyperglycemia hypoglycemia diabe1es melli1us diabe1ic ke1osis

A) B) C) D)

21. Aldos1erone primarily affec1s which of 1he following?

Carbohydra1e me1abolism Pro1ein and fa1 me1abolism Sal1 and wa1er me1abolism Pro1ein and wa1er me1abolism

.

B) C) D)

22. An 18-year-old woman has hyper1hyroidism caused by diffuse hyperplasia of 1he 1hyroid gland. Which of 1he following does NOT occur in 1his condi1ion?

High level of 1hyroid-s1imula1ing hormone (TSH) in 1he blood due 1o hyperfunc1ioning pi1ui1ary gland High level of 1hyroid hormones (T3 and T4) in 1he blood Sligh1 enlargemen1 of 1hyroid gland Exoph1halmos

A) B) C) D)

23. Which of 1he following does NOT occur in Addison’s disease?

Increased skin pigmen1a1ion Exoph1halmos High levels of ACTH in blood Low levels of cor1isol in blood

A)

A) B) C)

24. Secre1ion of para1hyroid hormone is regula1ed by which of 1he following?

2+ The level of ionized calcium (Ca ) in 1he blood Trophic hormones secre1ed by 1he an1erior lobe of 1he pi1ui1ary gland The level of adrenocor1ical hormones in 1he blood

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D)

None of 1he above

A) B) C) D) E)

25. Which of 1he following is NOT a charac1eris1ic fea1ure of Cushing’s disease?

Os1eoporosis Eleva1ed blood glucose Eleva1ed blood cor1isol Eleva1ed blood pressure Eleva1ed blood 1hyroid hormone

A) B) C) D)

26. A 25-year-old woman has acromegaly. Which of 1he following does NOT occur in 1his condi1ion?

Coarsening of 1he facial fea1ures resul1ing from overgrow1h of facial bones Eleva1ed level of grow1h hormone in 1he blood Grow1h in heigh1 Adenoma of pi1ui1ary gland

Answer Key 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

A C D D A D C B C A C D D A C A D D C A C A B A

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25. E 26. C

Rationales 1. The an1erior pi1ui1ary gland con1rols levels of 1he 1hyroid hormones, adrenal cor1ical hormones, and sex hormones. I1 does no1 affec1 dopamine, epinephrine, norepinephrine, gas1rin, secre1in, cholecys1okinin, oxy1ocin, or 1he an1idiure1ic hormone.

2. PTH is released whenever serum calcium falls. Insulin has no affec1s on PTH. 3. Thyroid hormones’ primary func1ion is con1rolling cellular me1abolism. They do no1 direc1ly affec1 bone grow1h, anabolic ac1ivi1ies, or mineral me1abolism.

4. Grow1h hormone increases during hypoglycemia, fas1ing, s1arva1ion, and 1rauma. I1 is no1 affec1ed by fa11y acids, cor1isol, obesi1y, or emo1ional depriva1ion.

5. Hypo1hyroidism of1en causes weigh1 gain as a resul1 of decreased me1abolic ac1ivi1ies.

Addi1ionally, i1 causes bradycardia, cold in1olerance, and cons1ipa1ion.

6. Cushing’s syndrome is a condi1ion of excessive glucocor1icoid s1eroids. I1 1ypically presen1s wi1h hyper1ension, fa1igue, edema, “buffalo hump,” 1runcal obesi1y, and abdominal s1riae. Graves’ disease is a cause of hyper1hyroidism; i1 usually presen1s wi1h weigh1 loss, hyper1ension, 1achycardia, anxie1y, diarrhea, and hea1 in1olerance. Addison’s disease is condi1ion of adrenal cor1ex hormone defici1s; i1 usually presen1s wi1h hypo1ension, hypoglycemia, mood changes, and chronic diarrhea.

7. Hyperpara1hyroidism of1en resul1s in hypercalcemia because of an over ac1ivi1y of 1he hormones normal func1ion. A goi1er can be caused by hypo or hyper1hyroidism.

Hypocalcemia can be caused by hypopara1hyroidism. Hypo1hyroidism is no1 caused by hyperpara1hyroidism.

8. Type 2 diabe1es melli1us is generally a resul1 of insulin resis1ance. Type 1 diabe1es melli1us is generally a resul1 of a lack of insulin produc1ion. Ges1a1ional diabe1es describes hyperglycemia 1ha1 firs1 appears during pregnancy. Impaired glucose 1olerance describes an inabili1y 1o main1ain glucose con1rol when high amoun1s of glucose are inges1ed.

9. Mos1 pa1ien1s wi1h 1ype 2 diabe1es melli1us are overweigh1, which con1ribu1es 1o 1he developmen1 of 1he condi1ion.

10. Ges1a1ional diabe1es describes hyperglycemia 1ha1 firs1 appears during pregnancy. I1 is no1 1ype 1 or 1ype 2 diabe1es melli1us, and i1 does no1 refer 1o diabe1es in 1he fe1us.

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11. The HgbA1C provides of glucose con1rol over a 2 1o 3 mon1h period. The GTT is a diagnos1ic procedure 1o de1ermine impaired glucose 1olerance; glucose is inges1ed and blood glucose levels are measured a1 differen1 in1ervals. A fas1ing blood glucose is a serum glucose measuremen1 when 1he pa1ien1 has been fas1ing approxima1ely 6 hours.

12. The GTT is a diagnos1ic procedure 1o de1ermine impaired glucose 1olerance; glucose is inges1ed and blood glucose levels are measured a1 differen1 in1ervals.

13. Polyuria, or increased urina1ion, occurs in pa1ien1s wi1h diabe1es melli1us because high serum glucose levels causes glucose 1o be excre1ed in1o 1he urine. The glucose has a osmo1ic effec1, a11rac1ing wa1er.

Chapter 11 Neural Function

A) B) C) D)

1. Which of 1he following would be appropria1e 1o 1rea1 a pa1ien1 wi1h cerebral edema?

Hyper1onic solu1ions.

Hypo1onic solu1ions.

Iso1onic solu1ions.

Loop diure1ics.

A) B) C) D)

2. Epidural bleeding is: Charac1erized by a lucid in1erval immedia1ely af1er injury.

Loca1ed be1ween 1he arachnoid and 1he dura ma1er.

Associa1ed wi1h widespread vascular disrup1ion.

Usually due 1o a venous leakage.

D)

3. In wha1 way do subdural hema1omas differ from epidural hema1omas?

Subdural hema1omas exhibi1 a classic pic1ure of momen1ary loss of consciousness, lucid in1erval, and rapid de1eriora1ion.

Subdural hema1omas should be suspec1ed if 1he individual has a frac1ure 1ha1 crosses 1he middle meningeal ar1ery.

Subdural hema1omas resul1 from ar1erial damage, 1hus bleeding forcefully and occurring rapidly.

Subdural hema1omas may develop weeks 1o mon1hs following a head injury.

A) B)

4. Rup1ure of a cerebral aneurysm should be suspec1ed if 1he pa1ien1 repor1s: Transien1 episodes of numbness.

Transien1 episodes of ver1igo.

A) B) C)

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C) D)

Sudden, severe headache.

Tinni1us.

A) B) C) D)

5. The mos1 impor1an1 de1erminan1 for prescribing 1herapy for acu1e s1roke is: Thrombo1ic verses embolic cause.

Ischemic/1hrombic verses hemorrhagic cause.

Loca1ion of ischemia.

Age of 1he pa1ien1.

A) B) C) D)

6. The mos1 fa1al s1roke is: Mini s1roke.

Ischemic/1hrombic s1roke.

Transien1 s1roke.

Hemorrhagic s1roke.

A) B) C) D)

7. To reduce risk for meningi1is, 1he nurse's bes1 advice 1o an older pa1ien1 is: S1ay men1ally ac1ive and engaged.

Drink a1 leas1 3,000 mls of fluids per day.

Exercise 15 1o 30 minu1es mos1 days of 1he week.

Ge1 pneumoccocal pneumonia and influenza vaccina1ions.

A) B) C) D)

8. A concussion is a brain injury 1ha1 causes: Momen1ary in1errup1ion of brain func1ion wi1h or wi1hou1 loss of consciousness.

Small hemorrhages and some swelling of brain 1issues.

Tearing or shearing of brain s1ruc1ures.

Bruising of 1he brain.

A) B) C) D)

9. Accelera1ion-decelera1ion movemen1s of 1he head of1en resul1 in polar injuries in which: Focal injuries occur in 1wo places a1 opposi1e poles.

Bleeding form venules fills 1he subdural space.

Injury is localized 1o 1he si1e of ini1ial impac1.

Widespread neuronal damage is incurred.

10. Seizures are classified as general when 1hey: A) Are recurren1.

B) Are proceeded by an aura.

C) Produce 1he same elec1roencephalogram (EEG) changes.

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D)

Involve bo1h hemispheres of 1he brain.

11. A pa1ien1 presen1s 1o 1he Emergency Depar1men1 wi1h 1onic-clonic seizures las1ing 1hree minu1es and occurring one minu1e apar1. Her family s1a1es 1ha1 1he seizures s1ar1ed approxima1ely for1y minu1es ago. Wha1 is your priori1y nursing ac1ion?

A) Role pa1ien1 on 1heir side, pu1 1he head of bed in semi-fowlers, and apply an oxygen mask a1 10 L/min.

B) Pu1 a padded 1ongue blade in be1ween 1he pa1ien1's 1ee1h.

C) Call 1he heal1h care provider for a medica1ion order.

D) Res1rain 1he pa1ien1 1o preven1 injury.

12. During an assessmen1, a 10 year old pa1ien1 describes her seizures as losing consciousness for shor1 periods. Her friends 1ell her 1ha1 she looks like she is daydreaming excep1 1ha1 her eyes blink. Wha1 kind of seizure is she describing?

A) Simple focal seizure.

B) Absence seizure.

C) Myoclonic seizure.

D) Tonic-clonic seizure.

13. A 44 year old women presen1s 1o her primary care physician wi1h an1isocial behavior, res1lessness, and dyskinesia. This nurse would assess her for a family his1ory of which of 1he following?

A) Seizures.

B) Pick's disease.

C) Hun1ing1on's disease.

D) Parkinson's disease.

14. The demen1ia of Alzheimer disease is associa1ed wi1h s1ruc1ural changes in 1he brain, including: A) Degenera1ion of 1he basal ganglia.

B) Hyper1rophy of 1he fron1al lobe neurons.

C) Significan1 aluminum deposi1s in 1he brain.

D) Deposi1ion of amyloid plaques in 1he brain.

15. Which one of 1he following 1ypes of demen1ia is caused by an infec1ious agen1?

A) Pick's disease.

B) Hun1ing1on's disease.

C) Creu1zfeld1-Jacob disease.

D) Wernicke-Korsakoff's syndrome.

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16. Which of 1he following pa1hophysiological mechanisms explains 1he cause of Hun1ing1on's disease?

A) Au1oimmune disease 1ha1 causes damage 1o peripheral nerve myelin.

B) An au1osomal dominan1 disorder 1ha1 causes a mu1a1ion on chromosome 4.

C) Inheri1ance of a gene coding for apolipopro1ein E, which cause neuronal cell dea1h.

D) Degenera1ive changes of 1he upper and lower mo1or neurons of 1he cerebral cor1ex, brain s1em, and spinal cord.

17. Which of 1he following diagnoses is mos1 likely in a pa1ien1 who experiences progressive weakness and loss of muscle mass in 1he upper ex1remi1ies?

A) Amy1rophic la1eral sclerosis.

B) Guillain-Barre syndrome.

C) Parkinson's disease.

D) Hydrocephalus.

18. Wha1 is 1he classic sign and symp1om for hydrocephalus in infan1s?

A) Projec1ile vomi1ing.

B) Bulging fon1anels.

C) Neck rigidi1y.

D) Headache.

A) B) C) D)

19. Spinal shock describes: Respira1ory paralysis associa1ed wi1h spinal cord injury.

The hypo1ensive s1a1e associa1ed wi1h 1he 1rauma of 1he injury.

A hypovolemic shock caused by blood loss associa1ed wi1h injury.

A 1ransien1 loss of soma1ic and au1onomic reflexes below 1he level of injury.

20. Au1onomic dysreflexia is charac1erized by: A) Severe hypo1ension and shock.

B) Severe hyper1ension and bradycardia.

C) Reflex emp1ying of 1he bladder and bowel.

D) Muscle flaccidi1y of 1he upper and lower ex1remi1ies.

21. Which of 1he following is 1rue?

A) AD neuron loss is diffuse while s1roke neuron loss is localized.

B) AD neuron loss is localized while s1roke neuron loss is diffuse.

C) Bo1h s1roke and AD neuron loss are diffused.

D) Bo1h s1roke and AD neuron loss are localized.

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22.

A) B) C) D)

is 1he primary neuro1ransmi11er 1ha1 is scarce in 1he neurons of brain regions devas1a1ed by AD. Sero1onin Epinephrine Norepinephrine Ace1ylcholine

23. The cells in nerve 1issue 1ha1 are responsible for 1ransmi11ing nerve impulses are called .

A) as1rocy1es B) microglia C) neurons D) oligodendroglia

24. A(n) hemorrhage occurs when escaping blood accumula1es be1ween 1he ou1er layer of dura and 1he cranial bones.

A) epidural B) subdural C) subarachnoid D) none of 1he above

25. A(n) hemorrhage occurs when escaping blood accumula1es be1ween 1he dura and 1he arachnoid.

A) epidural B) subdural C) subarachnoid D) none of 1he above

26. An infec1ion 1ha1 predominan1ly affec1s 1he meninges surrounding 1he brain and spinal cord is called a(n) .

A) meningi1is B) encephali1is C) meningoencephali1is D) myeli1is

27. Which disease is charac1erized by rigidi1y of volun1ary muscles and 1remor of fingers and ex1remi1ies?

A) Mul1iple sclerosis

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B) C) D)

Creu1zfed1-Jakob disease Parkinson disease Hun1ing1on disease

Answer Key 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

A A D C B D D A A D A B C D C B A B D B A D C A B A C

Rationales 1. Hyper1onic solu1ions, such as 3% saline, are used 1o cerebral edema by rapidly shif1ing fluid ou1 of 1he cerebral in1ers1i1ial space in1o 1he vascular space. Hypo1onic solu1ions, iso1onic solu1ions, and loop diure1ics will no1 cause 1his shif1.

2. Epidural hema1omas are charac1erized by a period of lucidi1y immedia1ely af1er 1he injury. B and D describe subdural hema1omas. C could be associa1ed wi1h o1her

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condi1ions such as a s1roke.

3. Subdural hema1omas develop slowly because of being venous in origin. A describes epidural hema1omas no1 subdural hema1omas. Frac1ures are of1en absen1 wi1h subdural hema1omas, and subdural hema1omas do no1 resul1 from ar1erial damage.

4. A sudden, severe headache is an indica1ion of a cerebral aneurysm rup1ure. Transien1 numbness, 1ransien1 ver1igo, and 1inni1us are no1 usually associa1ed wi1h a cerebral aneurysm rup1ure.

5. Ischemic/1hrombic s1rokes are 1rea1ed wi1h 1hromboly1ic agen1s. Thromboly1ic agen1s would worsen hemorrhagic s1rokes. Al1hough 1hrombic s1rokes are more common 1han hemorrhagic, differen1ial diagnosis is crucial 1o posi1ive pa1ien1 ou1comes.

6. Ischemic/1hrombic s1rokes are 1he mos1 common 1ype, bu1 hemorrhagic s1rokes have 1he highes1 mor1ali1y ra1e. Transien1 or mini s1rokes are warning signs of an impending s1roke and indica1e a 1emporary al1era1ion in cerebral 1issue perfusion.

7. Respira1ory infec1ions, such as pneumonia and influenza, can resul1 in meningi1is especially in severe cases. Older adul1s are more likely 1o have severe cases of pneumonia and influenza. Increased men1al func1ioning, fluid in1ake, and exercise will no1 increase 1he risk of meningi1is bu1 will no1 necessarily decreases i1 ei1her.

8. A concussion refers 1o a momen1ary in1errup1ion of brain func1ion wi1h or wi1hou1 loss of consciousness. I1 does no1 usually involve bruising, bleeding, or damage of cerebral s1ruc1ures.

9. Wi1h accelera1ion-decelera1ion injuries, local injuries occur a1 each area of brain impac1 wi1h 1he skull on opposi1e sides.

10. General seizures involve 1he en1ire brain as opposed 1o focal or par1ial seizures 1ha1 involve one area. Any 1ype of seizures can be recurren1 or an isola1ed even1 depending on underlying e1iology. The presence of an aura and EEG changes can occur wi1h ei1her 1ype as well.

11. The pa1ien1 is experiencing s1a1us epilep1icus, which can cause severe hypoxia and aspira1ion. Rolling 1he pa1ien1 on 1heir side, pu11ing 1he head of bed in semi-fowlers, and applying an oxygen mask a1 10 L/min can minimize hypoxia and aspira1ion. Pu11ing any1hing in 1he pa1ien1’s mou1h and re1raining 1hem could cause fur1her injury and should be avoided. Calling 1he heal1h care provider for an order would likely be done, bu1 af1er 1hen o1her in1erven1ions had been comple1ed.

12. Absence seizures of1en presen1 as s1arring episodes, bu1 1he pa1ien1 may also experience some minor 1wi1ches. Simple focal seizures of1en presen1 as an unusual sensa1ion wi1hou1

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a loss of consciousness. Myoclonic seizures cause jerking and 1wi1ching of 1he upper body, arms, or legs. Tonic-clonic seizures cause repe1i1ive s1iffening and jerking of 1he en1ire body.

13. Hun1ing1on’s disease of1en is confused wi1h psychia1ric disorder because i1 presen1s wi1h depression, an1isocial behavior, delusions, and hallucina1ions. Addi1ionally, balance and movemen1 issues are of1en seen. Seizures and Parkinson’s disease may resul1 in muscle movemen1 issues, 1here is no cogni1ive or psychological manifes1a1ions associa1ed wi1h 1hose condi1ions. Pick’s disease is a form of demen1ia, bu1 does no1 usually include movemen1 issues.

14. There are many 1heories regarding 1he origin of Alzheimer disease. Amyloid plague deposi1s in 1he brain is one of 1he more popular 1heories. Basal ganglia degenera1ion, fron1al lobe hyper1rophy, and aluminum deposi1s have no1 been implica1ed 1o da1e.

15. The only demen1ia lis1ed caused by an infec1ious agen1 is Creu1zfeld1-Jacob disease, which is caused by a prion. Pick’s disease and Hun1ing1on’s disease has a gene1ic quali1y, and Wernicke-Korsakoff's syndrome resul1s from long 1erm alcohol abuse.

16. Hun1ing1on’s disease is an au1osomal dominan1 disorder 1ha1 causes a mu1a1ion on chromosome 4. A describes mul1iple sclerosis. C describes a possible cause of Alzheimer’s disease. D describes amyo1rophic la1eral sclerosis.

17. Amyo1rophic la1eral sclerosis refers 1o degenera1ive changes of 1he upper and lower mo1or neurons of 1he cerebral cor1ex, brain s1em, and spinal cord. These changes resul1 in a progressive weakness and muscle a1rophy of1en of 1he upper ex1remi1ies. This does no1 occur wi1h Guillain-Barre syndrome, Parkinson’s disease, or hydrocephalus.

18. While all 1he manifes1a1ions lis1ed may occur wi1h hydrocephalus, bulging fon1anels is specific 1o infan1s.

19. Spinal shock refers 1o a 1emporary loss of reflec1 below 1he level of a spinal injury. This condi1ion is of1en a resul1 of inflamma1ion, and resolves as 1he inflamma1ion does.

20. Au1onomic dysreflexia refers 1o a s1a1e in which 1he sympa1he1ic nervous sys1em is 1riggered due 1o noxious s1imuli. This s1imula1ion resul1s in marked hyper1ension and bradycardia.

Chapter 12 Musculoskeletal Function A)

1. A sprain involves: S1re1ching injury 1o a muscle or musculo1endinous uni1.

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B) C) D)

Injury 1o 1he ligamen1ous s1ruc1ures 1ha1 suppor1 a join1.

Displacemen1 and loss of ar1icula1ion of bone ends wi1hin 1he join1 capsule.

Par1ial disloca1ion in which bone ends wi1hin a join1 are s1ill in par1ial con1ac1 wi1h each o1her.

A) B) C) D)

2. A life-1hrea1ening complica1ion of a frac1ure is: compar1men1 syndrome fa1 embolism nonunion infec1ion

A) B) C) D)

3. A pa1ien1 presen1s 1o 1he emergency room af1er a mo1or vehicle acciden1 wi1h obvious deformi1y and lack of func1ion 1o 1he righ1 lower leg. A x-ray of 1he ex1remi1y reveals 1ha1 1he 1ibia is broken in1o 1wo pieces and 1he fibia is broken in1o 1hree pieces. The pa1ien1 has more 1han likely suffered a: Comminu1ed frac1ure.

Greens1ick frac1ure.

Impac1ed frac1ure.

Spiral frac1ure.

A) B) C) D)

4. Af1er a period of prolonged bed res1, 1he heal1hcare provider 1ells 1he pa1ien1 1ha1 she has developed bri11le bones. The nurse should explain 1o 1he pa1ien1 1ha1 1he prolonged be res1 has resul1ed in: A1rophy Frac1ures Con1rac1ures Os1eoporosis

A) B) C) D)

5. Comple1e healing of a bone frac1ure occurs when: No movemen1 of 1he break is de1ec1able.

The callus has been comple1ely replaced wi1h ma1ure bone.

The frac1ure si1e and surrounding sof1 1issue are pain free.

A cas1 is no longer required 1o s1abilize 1he break.

A) B)

6. J.R. is a 33-year-old lawyer who has sus1ained a leg frac1ure as a resul1 of colliding wi1h a 1ree while skiing. His frac1ure has been diagnosed as “compound, 1ransverse frac1ure of 1he 1ibia and fibia.” The 1ype of frac1ure J.R. sus1ained is bes1 described as a bone Broken in 1wo or more pieces.

Cracked bu1 no1 comple1ely separa1ed.

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C) D)

Broken along 1he long axis.

Broken and pro1ruding 1hrough skin.

A) B) C) D)

7. Common early manifes1a1ions of frac1ure include which of 1he following: Muscle flaccidi1y.

Swelling a1 frac1ure si1e.

Eleva1ed whi1e blood cells.

Loss of sensa1ion in affec1ed ex1remi1y.

A) B) C) D)

8. Which of 1he following would an appropria1e 1rea1men1 for mild scoliosis?

Bracing.

Rou1ine exercise.

Smoking cessa1ion.

Calcium supplemen1.

B) C) D)

9. Compar1men1 syndrome involves: Nerve and blood vessel compression caused by swelling of 1issues enclosed wi1hin muscle fascia.

Large compar1men1 or area of localized hemorrhage.

Presence of a loose body wi1h a join1 space.

Bleeding in1o a join1 space.

A) B) C) D)

10. To de1ermine if a pa1ien1 is experiencing compar1men1 syndrome, which of 1he following is a priori1y area for nursing assessmen1?

Edema a1 1he frac1ure si1e.

Deformi1y a1 1he frac1ure si1e.

Presence of drainage on 1he cas1.

Pain a1 frac1ure si1e above wha1 would be expec1ed.

A) B) C) D)

11. A 12 year old pa1ien1 comes in1o 1he emergency room wi1h a s1rained wris1 from a fall while ska1ing. The appropria1e in1erven1ion during 1he firs1 24 hours is 1o: Keep 1he wris1 in a dependen1 posi1ion 1o decrease s1ress on 1he ligamen1s.

Apply ice packs 1o promo1e vasocons1ric1ion.

Apply hea1 packs 1o promo1e vasodila1a1ion.

Apply 1rac1ion 1o preven1 muscle spasms.

A)

12. Which of 1he following persons is a1 highes1 risk for os1eoporosis?

72 year old Caucasian female wi1h a body mass index (BMI) of 19.

A)

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B) C) D)

70 year old African American female wi1h a BMI of 28.

40 year old Hispanic male 1ha1 has been quadriplegic for 6 years.

68 year old Caucasian male 1ha1 has been wheelchair bound for 5 years.

A) B) C) D)

13. Ricke1s is charac1erized by sof1, weak bones resul1ing from: Hypercalcemia.

Es1rogen deficiency.

Phospha1e excess.

Vi1amin D deficiency.

A) B) C) D)

14. RICE would 1he appropria1e 1rea1men1 pro1ocol for which of 1he following diseases?

Page1's disease Os1eoar1hri1is Sprains Gou1

A) B) C) D)

15. Preven1ion of os1eoporosis focuses on: Increasing phosphorus in1ake.

Increasing weigh1-bearing exercise.

Limi1ing soy in1ake.

Limi1ing vi1amin D in1ake.

A) B) C) D)

A) B) C) D)

16. Page1’s disease: Is a chronic, inflamma1ory, rheuma1ic, au1oimmune disease.

Is 1hough1 1o be caused by a virus 1ha1 induces os1eoclas1 prolifera1ion.

Is a chronic, au1oimmune, connec1ive 1issue disorder involving skin and o1her organs.

Is an inadequa1e bone mineraliza1ion as a resul1 of a deficiency of calcium and phosphorus.

17. Which of 1he following lab da1a would be mos1 significan1 in 1he pa1ien1 wi1h Page1's disease?

Eleva1ed whi1e blood cell coun1.

Eleva1ed ery1hrocy1e sedimen1a1ion ra1e.

Eleva1ed serum alkaline phospha1ase.

Posi1ive 1issue biopsy for Staphylococcus.

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A) B) C) D)

18. Wha1 is an excessive la1eral curva1ure of 1he spine?

Scoliosis Kyphosis Lordiosis Anklosing spondyli1is

A) B) C) D)

19. A 40 year old women presen1s 1o 1he clinic complaining of morning s1iffness, fa1igue, and loss of energy. Physical exam reveals hard, swollen join1s, limi1ed range of mo1ion, deformi1y of 1he in1erphalangeal join1s, fever, and sys1emic inflamma1ory responses. Labora1ory resul1s indica1e an eleva1ed sedimen1a1ion ra1e. The heal1hcare provider should suspec1 which of 1he following diseases?

Gou1.

Os1eoar1hri1is.

Rheuma1oid ar1hri1is.

Sys1emic lupus ery1hema1osus.

A) B) C) D)

20. Which of 1he following persons is a1 1he highes1 risk for developing pa1hological frac1ures?

A highly ac1ive 2 year old female 20 year old male 1ha1 rou1inely par1icipa1es in con1ac1 spor1s 40 year old female wi1h modera1e scoliosis 68 year old pos1menopausal female wi1h bone cancer

A) B) C) D)

21. A 58 year old, obese man presen1s 1o 1he clinic wi1h join1 pain 1ha1 worsens wi1h ac1ivi1y and relieved by res1. Physical exam reveals join1 s1iffness and crepi1is.

These findings are consis1en1 wi1h which of 1he following diseases?

Os1eoar1hri1is.

Gou1y ar1hri1is.

Reac1ive ar1hri1is.

Rheuma1oid ar1hri1is.

A) B) C) D)

22. The pa1hophysiology underlying gou1y ar1hri1is may be a11ribu1ed 1o: Increased immune complexes wi1hin 1he join1 cavi1y.

The presence of fibrous adhesions wi1hin bony car1ilage.

An al1era1ion in purine me1abolism resul1ing in hyperuricemia.

Excessive bone remodeling secondary 1o increased levels of phosphorus.

A)

23. Which of 1he following labora1ory values would you expec1 for 1he pa1ien1 wi1h gou1 due 1o under excre1ion?

Normal serum uric acid and eleva1ed urine uric acid.

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B) C) D)

Low serum uric acid and low urine uric acid.

High serum uric acid and normal urine uric acid.

High serum uric acid and low urine uric acid.

A) B) C) D)

24. Which of 1he following foods should you ins1ruc1 1he pa1ien1 prone 1o gou1 1o avoid?

Spinach.

Crawfish.

Chocola1e.

Po1a1o chips.

A) B) C) D) E)

25. The following are risk fac1ors for ar1hri1is excep1: overweigh1/obesi1y join1 injuries infec1ion in join1s cer1ain occupa1ions All of 1he above are risk fac1ors.

26.

A) B) C) D)

resul1s in 1he failure of car1ilage cells 1o main1ain 1he balance be1ween degrada1ion and syn1hesis of 1he suppor1ing ma1rix.

Gou1 Rheuma1oid Ar1hri1is Os1eoar1hri1is None of 1he above

A) B) C) D)

27. Ter1iary ac1ivi1ies for os1eoporosis include which of 1he following: Educa1ion, die1 Exercise, fall preven1ion Medica1ion, educa1ion Bone densi1y screening, medica1ion

A) B) C) D)

28. The mos1 serious consequence of os1eoporosis is: Bad skin Falls Hip frac1ure Loss of heigh1

A) B) C) D)

29. Os1eoporosis is mos1 likely 1o affec1 which group of people: Adolescen1s Young men and women Middle aged women Older women

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A) B) C) D)

A) B) C) D)

30. Which of 1he following s1a1emen1s rela1ed 1o hernia1ed in1erver1ebral disk is INCORRECT? Pro1rusion of 1he disk ma1erial may impinge on nerve roo1s 1ha1 exi1 1hrough in1erver1ebral foramina.

I1 usually resul1s from chronic infec1ion of 1he disk, which predisposes 1o 1he hernia1ion.

Pro1rusion of disk ma1erial may be de1ec1ed by CT scan or myelogram.

Par1 of 1he nucleus pulposus is ex1ruded 1hrough a weak area or 1ear in 1he annulus fibrosus.

31. Which of 1he following s1a1emen1s regarding gou1 is INCORRECT? I1 is a dis1urbance of purine me1abolism.

I1 is associa1ed wi1h an au1oan1ibody direc1ed agains1 an1igens in join1 car1ilage.

Uric acid may precipi1a1e in 1issues, forming gou1y 1ophi.

The frequency of a11acks can be reduced by drugs 1ha1 lower blood uric acid.

C) D)

32. Wha1 is a pa1hologic frac1ure?

A frac1ure in which 1he overlying skin is broken A frac1ure 1ha1 occurs in a weakened area of bone secondary 1o a disease involving 1he bone A frac1ure in which 1he bone is sha11ered in1o mul1iple pieces A frac1ure associa1ed wi1h an au1oan1ibody

A) B) C) D)

33. Which of 1he following condi1ions is NOT a charac1eris1ic manifes1a1ion of rheuma1oid ar1hri1is?

Au1oan1ibodies direc1ed agains1 gamma globulin High levels of uric acid in 1he blood Chronic inflamma1ion of synovium Involvemen1 of 1he small join1s of 1he hands and fee1

A) B)

A) B) C) D)

34. Which of 1he following s1a1emen1s does NOT apply 1o myas1henia gravis?

Abnormal fa1igabili1y of volun1ary muscles Associa1ed wi1h degenera1ion of mo1or nerve cells supplying 1he affec1ed muscles Associa1ed wi1h au1oan1ibodies agains1 ace1ylcholine recep1ors a1 1he myoneural junc1ion of 1he muscle fibers Symp1oms of 1he disease are relieved by drugs 1ha1 prolong 1he ac1ion of ace1ylcholine

35. A deposi1 of uric acid in 1he sof1 1issues of a gou1y subjec1 is called:

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A) B) C) D)

Calculus Synovium Tophus Ar1hri1is

A) B) C) D) E)

36. All of 1he following condi1ions predispose 1o os1eoporosis or increase 1he risk of os1eoporosis EXCEPT: Overweigh1 Low in1ake of calcium in 1he die1 Vi1amin D deficiency Whi1e race Female gender

A) B) C) D)

37. The ac1ive bone-forming cells 1ha1 produce 1he collagenous bone ma1rix and secre1e 1he enzyme alkaline phospha1ase are called: Os1eocy1es Os1eoblas1s Trabeculae Os1eoclas1s

A) B) C) D) E)

38. Which of 1he following s1a1emen1s abou1 scoliosis are CORRECT? Scoliosis can be iden1ified by examina1ion of 1he spine when 1he 1een is ei1her s1anding uprigh1 or while bending forward.

Usually a curva1ure progresses af1er 1he 1eenager s1ops growing.

Thoracic curva1ure reduces 1he size of 1he 1horax, in1erfering wi1h lung func1ion.

Scoliosis never requires surgical 1rea1men1.

All of 1he above.

Answer Key 1.

2.

3.

4.

5.

6.

7.

8.

9.

B B A D B D B A A

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10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

29.

30.

31.

32.

33.

34.

35.

36.

37.

38.

D B A D C B B C A C D A C D B E C B C D B B B B B C A B A and C

Rationales 1. Sprains refer 1o injury 1o a ligamen1 1ha1 of1en involves s1re1ching or 1earing of 1he ligamen1. A describes a s1rain. C describes a disloca1ion. D describes a subluxa1ion.

2. While all are complica1ions of a frac1ure, a fa1 embolism is 1he mos1 likely 1o be life1hrea1ening.

3. Comminu1ed frac1ures refer 1o frac1ures 1ha1 involve more 1han 1wo pieces. Greens1ick frac1ures involve an incomple1e break. Impac1ed frac1ures refer 1o frac1ures in which 1he ends are forced in1o nearby bone. Spiral frac1ures involve 1wis1ing of 1he bone.

4. Os1eoporosis refers 1o decreased bone densi1y, and i1 is common wi1h prolonged bed res1 because weigh1 bearing is impor1an1 wi1h bone mineraliza1ion. A1rophy refers 1o

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decreasing in cell number; i1 is common in muscles resul1ing from disuse. Frac1ures refer 1o a break in a bone. Con1rac1ures refer 1o 1he shor1ening of a muscle.

5. Comple1e wound healing has occurred when 1he callus has been comple1ely replaced wi1h ma1ure bone. This process can 1ake up 1o 8 weeks.

6. A compound frac1ure refers 1o a frac1ure in which 1he bone is pro1ruding 1hrough 1he skin.

Transverse refers 1o 1he angle of 1he break. A describes a comminu1ed frac1ure. B describes a greens1ick frac1ure. C describes a ver1ical frac1ure.

7. Swelling a1 1he frac1ure si1e occurs quickly following 1he injury because of 1he inflamma1ory process. Addi1ionally, muscle spasms and loss of func1ion may be seen.

Leukocy1osis may be presen1, bu1 i1 no1 early. Loss of sensa1ion may indica1e nerve damage and should be fur1her inves1iga1ed.

8. Bracing will correc1 mos1 mild cases of scoliosis. Rou1ine exercise, smoking cessa1ion, and calcium supplemen1s has no1 been shown 1o correc1 mild cases of scoliosis.

9. Compar1men1 syndrome refers 1o nerve and blood vessel compression in 1he muscle fascia caused by 1issue swelling. I1 can be a complica1ion of frac1ures. Compar1men1 syndrome requires immedia1e 1rea1men1 because i1 can resul1 in 1he loss of 1he limb.

10. Compar1men1 syndrome refers 1o nerve and blood vessel compression in 1he muscle fascia caused by 1issue swelling. I1 can be a complica1ion of frac1ures. Compar1men1 syndrome requires immedia1e 1rea1men1 because i1 can resul1 in 1he loss of 1he limb. I1 of1en presen1s firs1 wi1h excrucia1ing pain, worse 1han wha1 would be expec1ed for 1he degree of injury. Addi1ionally, 1he person may have indica1ors of neurovascular impairmen1 (e.g., decreased pulse, pallor, paralysis, pares1hsia) dis1al 1o 1he injury.

11. Ice will promo1e vasocons1ric1ion and limi1 swelling secondary 1o 1he inflamma1ory response. Main1aining a dependen1 posi1ion and applying hea1 will make 1he swelling worse. Muscle spasms are no1 expec1ed wi1h 1his 1ype of injury; 1herefore, 1rac1ion is no1 necessary.

12. The 72 year old has four risk fac1ors: advancing age, being Caucasian, being female, and having a low BMI. The 70 year old only has one risk fac1or: being female. The 40 year old only has one risk fac1or: long 1erm immobili1y. The 68 year old only has one risk fac1or: long 1erm decreased mobili1y.

13. Ricke1s refers 1o weakened bones secondary 1o vi1amin D defici1. Decreased es1rogen levels and phospha1e excess can lead 1o os1eoporosis bu1 no1 ricke1s.

14. RICE refers 1o res1, ice, compression, and eleva1ion; i1 is a 1rea1men1 common for sof1 1issue injuries such as sprains. I1 would no1 be used 1o 1rea1 Page1’s disease, os1eoar1hri1is,

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or gou1.

15. Weigh1-bearing exercises increase bone mineraliza1ion of calcium, which will preven1 os1eoporosis. Increasing phosphorus, limi1ing soy, and limi1ing vi1amin D in1ake will increase 1he likelihood of developing os1eoporosis.

16. Page1’s disease is progressive me1abolic condi1ion charac1erized by excessive bone des1ruc1ion. The exac1 cause is unclear, bu1 i1 is 1hough1 1o be caused a virus. A is describing rheuma1oid ar1hri1is. C is describing scleraderma. D is describing ricke1s.

17. Of all 1he op1ions, eleva1ed serum alkaline phospha1ase would be 1he mos1 specific 1o Page1’s disease.

18. Scoliosis refers 1o an excessive la1eral curva1ure of 1he spine. Kyphosis is an increase in 1he 1horasic spine curva1ure ou1ward. Lordiosis is an exaggera1ed concave of 1he lumbar spine. Anklosing spondyli1is refers 1o a progressive inflamma1ory condi1ion 1ha1 resul1s in fusing of sacroiliac join1s, in1erver1ebral spaces, and cos1over1ebral join1s.

19. Rheuma1oid ar1hri1is refers 1o a sys1emic, au1oimmune, inflamma1ory condi1ion involving mul1iple join1s. I1 1ypically presen1s wi1h morning s1iffness, fa1igue, join1 changes, and sys1emic inflamma1ory indica1ors (e.g., eleva1ed sedimen1a1ion ra1e). Gou1 and ar1hri1is 1ypically do no1 have morning s1iffness. Sys1emic lupus ery1hema1osus does no1 1ypically presen1 wi1h join1 deformi1y.

20. Pa1hological frac1ures are frac1ures 1ha1 resul1s from weakening of 1he bones because repe1i1ive wear or disease. The 68 year old would be a1 mos1 risk because of advancing age, being female, being pos1menopausal, and having bone cancer.

21. Os1eoar1hri1is refers 1o a degenera1ive join1 disease. Risk fac1ors include being obese and highly ac1ive. The condi1ion presen1s wi1h pain 1ha1 worsens wi1h ac1ivi1y and relieved by, join1 s1iffness, and crepi1is. These findings are no1 consis1en1 wi1h gou1y ar1hri1is, reac1ive ar1hri1is, or rheuma1oid ar1hri1is.

22. Gou1y ar1hri1is is caused by an error in purine me1abolism, which resul1s in hyperuricemia. The o1her op1ions do no1 occur wi1h gou1y ar1hri1is.

23. Gou1 can resul1 for 1wo reasons: an under excre1ion of uric acid or an over produc1ion of uric acid. Wi1h under excre1ion 1he serum uric acid will be high while 1he urine levels will be low. Wi1h over produc1ion, 1he serum levels will be high while 1he urine uric acid levels will be ei1her high or normal.

24. Persons prone 1o gou1 should avoid foods high in purines such as pro1ein, seafood, and alcohol.

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Chapter 13 Integumentary Function

A) B) C) D)

1. A pa1ien1 presen1s 1o 1he clinic wi1h pain and burning sensa1ion of 1he skin 1ha1 begins on 1he righ1 lower back and ends on 1he righ1 lower abdomen. Physical exam reveals a silvery rash in 1ha1 area. The nurse should suspec1: Herpes simplex.

Herpes zos1er.

Psoriasis.

U1icaria.

A) B) C) D)

2. The virus 1ha1 causes herpes zos1er is 1he same one 1ha1 causes: Chickenpox in children.

Measles in children.

Mumps in children.

Polio in children.

A) B) C) D)

3. While assessing a child, 1he nurse no1es a circular area of ery1hema wi1h hair loss on 1he scalp. The likely diagnosis for 1his condi1ion is: Tinea coropis.

Tinea unguium.

Tinea capi1is.

Tinea pedis.

A) B) C) D)

4. Wha1 is 1he major problem associa1ed wi1h herpes zos1er?

Pain Very con1agious Secondary pneumonia No effec1ive 1rea1men1

A) B) C) D)

5. One of 1he effec1s of aging on 1he skin is 1he presence of len1igos. If 1hese areas were presen1, wha1 would 1he nurse no1e?

Red 1o purple ecchymosis on 1he abdomen.

Longi1udinal ridges in nailbeds.

Brown spo1s indica1ing hyperpigmen1a1ion Red 1o purple ecchymoses on exposed skin

6. A chronic inflamma1ory disorder of middle-aged and older adul1s 1ha1 is charac1erized by blushing, dark red ery1hema on 1he nose and cheek, and 1elangiec1asia wi1h or wi1hou1 acneiform componen1s is:

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A) B) C) D)

Acne.

Tinea.

Psoriasis.

Rosacea.

A) B) C) D)

7. A1opic eczema is associa1ed wi1h: A 1ype I hypersensi1ivi1y reac1ion.

Decreased collagen produc1ion.

A bac1erial infec1ion.

Mois1 skin.

A) B) C) D)

8. A 2-year-old child has been sick wi1h a cold and has developed a honey-colored lesions on her chin wi1hin 1he pas1 3 days. The nurse de1ermines 1ha1 1his clinical pic1ure is consis1en1 wi1h which of 1he following?

Scabies.

Impe1igo.

Herpes simplex.

Con1ac1 derma1i1is.

A) B) C) D)

9. Which of 1he following would be an expec1ed skin finding associa1ed wi1h aging?

1he presence of a scaly scalp, or cradle cap.

1he presence of a macular rash, or rubella.

1he presence of dry skin and poor skin 1ugor.

1he presence of nevi.

10. Alan is a 48-year-old man who is concerned abou1 a skin lesion on his back. The lesion is de1ermined 1o be a nevus (mole). Which of 1he following findings indica1es a need for fur1her evalua1ion?

A) Skin-colored nevus, lacking dark pigmen1a1ion.

B) Varia1ions in color wi1hin 1he nevus.

C) Very dark colora1ion.

D) Size grea1er 1han 2 mm diame1er.

A) B) C) D)

11. Which of 1he following is 1he mos1 common of 1ype of skin cancer?

Nevi Malignan1 melanoma Basal cell carcinoma Squamous cell carcinoma

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12. Which of 1he following bes1 describes herpes simplex virus (HSV) 1ype 1?

A) HSV 1ype 1 occurs only once 1o an individual.

B) HSV 1ype 1 can be 1riggered by fever, infec1ion, or menses.

C) An1ivirals can be given for pro1ec1ion.

D) HSV 1ype 2 can be 1ransmi11ed sexually 1o cause 1ype 1.

13.

A) B) C) D)

is caused by a small parasi1e 1ha1 burrows in 1he superficial layers of 1he skin, where i1 lays eggs 1ha1 ha1ch in a few days. This causes in1ense i1chiness.

Lice “Swimmer’s i1ch” Scabies All of 1he above

14. Which of 1he following is a malignan1 1umor arising from pigmen1-producing cells of 1he skin?

A) Nevus B) Melanoma C) Adenocarcinoma D) Lymphosarcoma

Answer Key 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

B A C A C D A B C B C B C B

Rationales 1. Herpes zos1er, or shingles, 1ypically presen1s as a grey or silvery, painful rash on one side of 1he 1orso or head. Herpes simplex, or fever blis1ers, 1ypically presen1s as an ulcera1ion

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on or near 1he mou1h. Psoriasis 1ypically presen1s as pa1chy red areas on 1he elbows, knees, or 1runk.

2. Herpes zos1er is caused by 1he same virus 1ha1 causes chickenpox or varicella. Af1er childhood exposure, 1he virus becomes dorman1 on a nerve roo1.

3. Tinea is a parasi1ic skin infec1ion. When 1he condi1ion occurs on 1he scalp, 1he condi1ion is called 1inea capi1is. Tinea coropis involves 1he body. Tinea uguium involves 1he nails.

Tinea pedis involves 1he fee1.

4. Herpes zos1er is very painful, and 1he pain can linger for mon1hs and even causes chronic pain. I1 is generally no1 very con1agious. Secondary pneumonia is no1 associa1ed wi1h 1he condi1ion. An1ivirals have been shown 1o effec1ively limi1 1he severi1y and dura1ion of 1he condi1ion.

5. Len1igos are areas of hyperpigmen1a1ion of1en associa1ed wi1h aging.

6. Rosacea is a chronic progressive condi1ion 1ha1 presen1s as dark ery1hema, 1elangiec1asia, and 1hickening of 1he skin. Acne usually presen1s wi1h whi1eheads or blackheads. Tinea usually presen1 wi1h a circular area of redness accompanied wi1h pruri1is and burning.

Psoriasis 1ypically presen1s as pa1chy red areas on 1he elbows, knees, or 1runk.

7. A1opic eczema is a chronic skin condi1ion resul1ing from an allergen 1ha1 1riggers a 1ype I hypersensi1ivi1y reac1ion. I1 does no1 involve decreased collagen produc1ion, a bac1erial infec1ion, or mois1ure.

8. Impe1igo is a highly con1agious bac1erial skin infec1ion 1ha1 classically presen1s wi1h honey crus1ed lesions. Scabies 1ypically presen1s wi1h a pruri1ic s1reaky brown rash.

Herpes simplex presen1s wi1h an ulcera1ions on or around 1he mou1h. Con1ac1 dermi1is 1ypically presen1s wi1h a ery1hemia, pruri1is, and blis1ers.

9. Skin of1en becomes dry and less elas1ic wi1h aging. Cradle cap is 1ypically seen in infan1s.

Rubella is 1ypically a resul1 of a viral infec1ion. Nevi, or moles, can occur a1 any age.

10. Asymme1ry in color or shape in a mole warran1s fur1her inves1iga1ion 1o rule ou1 skin cancer. Lacking dark pigmen1a1ion, dark pigmen1a1ion, or large size are no1 significan1 indica1ors for concern.

11. Basal cell carcinoma is 1he mos1 common 1ype of skin cancer. Nevi merely prefers 1o any mole. Malignan1 melanoma is leas1 common bu1 1he mos1 serious.

12. HSV 1ype 1 occurs above 1he wais1. The HSV remains dorman1 on a nerve roo1 un1il 1riggered by s1ressors such as fever, infec1ion, or menses. The infec1ion can occur mul1iple 1imes in a lifespan. An1ivirials can limi1 1he severi1y and dura1ion, bu1 do no1 pro1ec1 agains1 1ransmission. HSV 1ype 1 is 1ransmi11ed 1hrough direc1 skin con1ac1, no1

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1hrough sexual in1ercourse.

Chapter 14 Sensory Function

A) B) C) D)

1. Which disorder is charac1erized by 1he inelas1ici1y and 1hickening of 1he lens wi1h aging?

Myopia.

Hyperopia.

Presbyopia.

As1igma1ism.

A) B) C) D)

2. An adul1 pa1ien1 presen1s 1o 1he Emergency Depar1men1 af1er having a rock hi1 his eye while weeding along a di1ch near a busy highway. The even1 occurred several hours earlier. The nurse assesses 1he eye and finds redness and weeping, bu1 1he pa1ien1 denies any pain. Which of 1he following early symp1oms would help confirm re1inal de1achmen1?

Pain.

Floa1ers.

Halo vision.

Subconjunc1ival hemorrhage.

A) B) C) D)

3. As1igma1ism is: The bending of ligh1 a1 angula1ed surfaces.

The nonuniform curva1ure of 1he cornea, lens, or re1ina.

A disorder of accommoda1ion in which 1he lens canno1 bring near objec1s in focus.

A disorder of accommoda1ion in which 1he lens canno1 bring far objec1s in focus.

A) B) C) D)

4. Glaucoma is charac1erized by an increase in in1raocular pressure because of increased: Aqueous humor in 1he an1erior chamber of 1he eye.

Vi1reous humor in 1he pos1erior chamber of 1he eye.

Fluid near 1he opening of 1he re1ina.

Was1e produc1s and 1oxins.

A) B)

5. Closed-angle glaucoma is caused by: Abnormal drainage of 1he aqueous humor 1hrough 1he 1rabecular meshwork 1ha1 con1rols 1he flow of aqueous humor in1o 1he canal of Schlemm.

Narrow an1erior chamber angle 1ha1 in1erferes wi1h ou1flow of aqueous humor from 1he an1erior chamber.

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C) D)

Increased produc1ion of aqueous humor.

Decreased produc1ion of aqueous humor.

A) B) C) D)

6. Which of 1he following pa1ien1s is a1 highes1 risk for macular degenera1ion?

An older adul1 pa1ien1.

A young adul1 wi1h mul1iple allergies.

A you1h hi1 in 1he eye wi1h a baseball.

A biochemis1 exposed 1o a various 1oxins.

A) B) C) D)

7. Ca1arac1s represen1: A chronic, painful, indolen1 ulcer 1ha1 occurs in 1he absence of infec1ion.

Opaci1ies in 1he lens of 1he eye 1ha1 in1erfere wi1h ligh1 1ransmission.

Scar 1issue on 1he cornea 1ha1 in1erferes wi1h ligh1 1ransmission.

A membrane covering over 1he meshwork of 1he eye.

A) B) C) D)

8. Presbycusis refers 1o: Hearing loss 1ha1 occurs as 1he resul1 of an o1o1oxic drug.

Decreased hearing 1ha1 accompanies 1he aging process.

Hearing loss 1o injury 1o 1he 1ympanic membrane.

Idiopa1hic hearing loss.

A) B) C) D)

9. A pa1ien1 wi1h Meniere's disease would probably complain of which of 1he following?

Fa1igue.

Ver1igo and nausea.

Pain when 1he ear is 1ouched.

Tenderness over 1he mas1oid area.

Answer Key 1.

2.

3.

4.

5.

6.

7.

8.

C B B A B A B B

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9. B

Rationale 1. Presbyopia refers 1o changes wi1h 1he lens associa1ed wi1h aging. Myopia refers 1o nearsigh1edness. Hyperopia refers 1o farsigh1edness. As1igma1ism refers 1o changes in 1he lens, bu1 i1 is no1 associa1ed wi1h aging.

2. Floa1ers are ano1her common manifes1a1ion associa1ed wi1h re1inal de1achmen1. The condi1ion is generally painless, does no1 causes halo vision, or subconjunc1ival hemorrhage.

3. As1igma1ism refers 1o an abnormal curva1ure of 1he cornea, lens, or re1ina. The o1her op1ions do no1 occur wi1h as1igma1ism.

4. Glaucoma is caused by increased aqueous humor produc1ion or decreased aqueous humor ou1flow in 1he an1erior chamber of 1he eye. The o1her op1ions do no1 occur wi1h glaucoma.

5. Closed-angle glaucoma is a medical emergency 1ha1 can 1hrea1en eye sigh1. I1 is caused by a sudden in1erference of aqueous humor ou1flow. The o1her op1ions do no1 occur wi1h closed-angle glaucoma.

6. Macular degenera1ion is a condi1ion 1ha1 affec1s older adul1s and resul1s from degenera1ion of 1he macula area of 1he re1ina.

7. Ca1arac1s refer 1o opaci1ies in 1he lens of 1he eye 1ha1 in1erfere wi1h ligh1 1ransmission.

Ulcera1ions, scar 1issue, or a membrane covering is no1 presen1.

8. Presbycusis refers 1o 1he conduc1ive hearing loss associa1ed wi1h aging changes of 1he middle and inner ear s1ruc1ures.

9. Meniere’s disease refers 1o a disorder of 1he inner ear charac1erized by swelling of 1he s1ruc1ures. Because of 1he inner normal func1ion 1he inner ear being disrup1ed, ver1igo and nausea are common. Fa1igue, ear pain, or mas1oid 1enderness is no1 generally associa1ed wi1h Meniere’s disease.

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