Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

Chapter 01: Introduction to Pathophysiology Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. C.Q. was recently exposed to group A hemolytic Streptococcus and subsequently developed a pharyngeal infection. His clinic examination reveals an oral temperature of 102.3F, skin rash, dysphagia, and reddened throat mucosa with multiple pustules. He complains of sore throat, malaise, and joint stiffness. A throat culture is positive for Streptococcus, and antibiotics have been prescribed. The etiology of C.Q.’s disease is a. a sore throat. b. streptococcal infection. c. genetic susceptibility. d. pharyngitis.

ANS: B Etiology refers to the proposed cause or causes of a particular disease process. A sore throat is the manifestation of the disease process. Genetic susceptibility refers to inherited tendency to develop a disease. Pharyngitis refers to inflammation of the throat and is also a clinical manifestation of the disease process.

2. A 17-year-old college-bound student receives a vaccine against an organism that causes meningitis. This is an example of a. primary prevention. b. secondary prevention. c. tertiary prevention.

NURSINGTB.COM d. disease treatment.

ANS: A Primary prevention is prevention of disease by altering susceptibility or reducing exposure for susceptible individuals by providing vaccination. Secondary prevention is the early detection, screening, and management of the disease. Tertiary prevention includes rehabilitative and supportive care and attempts to alleviate disability and restore effective functioning. Disease treatment involves management of the disease once it has developed.

3. An obese but otherwise healthy teen is given a prescription for a low-calorie diet and exercise program. This is an example of a. primary prevention. b. secondary prevention. c. tertiary prevention. d. disease treatment.

ANS: B Secondary prevention is the early detection, screening, and management of the disease such as prescribing diet and exercise for an individual who has already developed obesity.

Primary prevention is prevention of disease by altering susceptibility or reducing exposure for susceptible individuals. Tertiary prevention includes rehabilitative and supportive care and attempts to alleviate disability and restore effective functioning. Disease treatment involves management of the disease once it has developed.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

4. A patient with high blood pressure who is otherwise healthy is counseled to restrict sodium intake. This is an example of a. primary prevention. b. secondary prevention. c. tertiary prevention. d. disease treatment.

ANS: B Secondary prevention is the early detection, screening, and management of the disease, such as by prescribing sodium restriction for high blood pressure. Primary prevention is prevention of disease by altering susceptibility or reducing exposure for susceptible individuals. Tertiary prevention includes rehabilitative and supportive care and attempts to alleviate disability and restore effective functioning. Disease treatment involves management of the disease once it has developed.

5. After suffering a heart attack, a middle-aged man is counseled to take a cholesterol-lowering medication. This is an example of a. primary prevention. b. secondary prevention. c. tertiary prevention. d. disease treatment.

ANS: C Tertiary prevention includes rehabilitative and supportive care and attempts to alleviate disability and restore effective functioning such as prescribing a cholesterol-lowering medication following a heart attack. Primary prevention is prevention of disease by altering N R I oGr sT B.C M susceptibility or reducing e x pUo s uSr e fN usceptibOle individuals. Secondary prevention is the early detection, screening, and management of the disease. Disease treatment involves management of the disease once it has developed.

6. A patient has been exposed to meningococcal meningitis, but is not yet demonstrating signs of this disease. This stage of illness is called the stage. a. prodromal b. latent c. sequela d. convalescence ANS: B Incubation refers to the interval between exposure of a tissue to an injurious agent and the first appearance of signs and symptoms. In infectious diseases, this period is often called the incubation (latent) period. Prodromal refers to the appearance of the first signs and symptoms indicating the onset of a disease. These are often nonspecific, such as headache, malaise, anorexia, and nausea, which are associated with a number of different diseases.

Sequela refers to subsequent pathologic condition resulting from a disease. Convalescence is the stage of recovery after a disease, injury, or surgical operation.

7. A disease that is native to a particular region is called a. epidemic. b. endemic.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

c. pandemic. d. ethnographic.

ANS: B A disease that is native to a particular region is called endemic. An epidemic is a disease that spreads to many individuals at the same time. Pandemics are epidemics that affect large geographic regions, perhaps spreading worldwide.

8. In general, with aging, organ size and function a. increase. b. decrease. c. remain the same. d. are unknown.

ANS: B In general, with aging, organ size and function decrease.

9. The stage during which the patient functions normally, although the disease processes are well established, is referred to as a. latent. b. subclinical. c. prodromal. d. convalescence.

ANS: B The stage during which the patient functions normally, although the disease processes are well established, is called the subclinical stage. The interval between exposure of a tissue to an injurious agent and the fN irU st R apSpI eaNraGnT ceBo. fC sigOnM s and symptoms may be called a latent period or, in the case of infectious diseases, an incubation period. The prodromal period, or prodrome, refers to the appearance of the first signs and symptoms indicating the onset of a disease. Convalescence is the stage of recovery after a disease, injury, or surgical operation.

MULTIPLE RESPONSE 1. Your patient’s red blood cell is slightly elevated today. This might be explained by (Select all that apply.) a. gender difference. b. situational factors. c. normal variation. d. cultural variation. e. illness.

ANS: A, B, C, E Gender, situations (e.g., altitude), normal variations, and illness may all determine red blood cell count. Culture affects how manifestations are perceived (normal versus abnormal).

2. Socioeconomic factors influence disease development because of (Select all that apply.) a. genetics. b. environmental toxins. c. overcrowding.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

d. nutrition. e. hygiene.

ANS: B, C, D, E Socioeconomic factors influence disease development via exposure to environmental toxins (occupational) and overcrowding, nutrition (over- or undernutrition), and hygiene (e.g., in developing countries). Genetics is not influenced by socioeconomic factors.

TRUE/FALSE 1. When the cause is unknown, a condition is said to be idiopathic ANS: T Many diseases are idiopathic in nature.

2. The nurse is swabbing a patient’s throat to test for streptococcal pharyngitis. The nurse must understand that tests such as this differ in the probability that they will be positive for a condition when applied to a person with the condition; this probability is termed sensitivity.

ANS: T The sensitivity of any test refers to the probability that the test will be positive when applied to a person with the condition and will not provide a false negative result. In contrast, specificity is the probability that a test will be negative when applied to a person who does not have a given condition.

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Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

Chapter 02: Homeostasis, Allostasis, and Adaptive Responses to Stressors Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. Indicators that an individual is experiencing high stress include all the following except a. tachycardia. b. diaphoresis. c. increased peripheral resistance. d. pupil constriction.

ANS: D Pupils dilate during stress from the effects of catecholamines. Tachycardia, diaphoresis, and increased peripheral resistance are indicators of stress and also occur because of catecholamine release.

2. Which is not normally secreted in response to stress? a. Norepinephrine b. Cortisol c. Epinephrine d. Insulin ANS: D Insulin secretion is impaired during stress to promote energy from increased blood glucose.

Norepinephrine is secreted during stress as a mediator of stress and adaptation. Cortisol is secreted during stress as a mediator of stress and adaptation and stimulates gluconeogenesis N R I G oB.C Mnephrine is secreted during stress as a in the liver to supply the b o d U y wiSt h gNl u c T s e. EpiO mediator of stress and adaptation and increases glycogenolysis and the release of glucose from the liver.

3. Selye’s three phases of the stress response include all the following except a. allostasis. b. resistance. c. alarm. d. exhaustion.

ANS: A Allostasis is defined as the ability to successfully adapt to challenges. Allostasis may/may not occur in response to stress. Alarm, resistance, and exhaustion are the three phases of the stress response as described by Selye in the general adaptation syndrome.

4. Many of the responses to stress are attributed to activation of the sympathetic nervous system and are mediated by a. norepinephrine. b. cortisol. c. glucagon. d. ACTH. ANS: A

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

Norepinephrine is secreted in response to activation of the sympathetic nervous system during stress by the adrenal medulla. Cortisol is secreted by the adrenal cortex. Glucagon is secreted by the pancreas. ACTH is secreted by the pituitary gland.

5. The effects of excessive cortisol production include a. immune suppression. b. hypoglycemia. c. anorexia. d. inflammatory reactions.

ANS: A Cortisol suppresses immune function and inflammation and stimulates appetite. Cortisol leads to hyperglycemia by stimulating gluconeogenesis in the liver.

6. All the following stress-induced hormones increase blood glucose except a. aldosterone. b. cortisol. c. norepinephrine. d. epinephrine.

ANS: A Aldosterone results in water and sodium retention and potassium loss in the urine. It does not affect blood glucose. Cortisol is a glucocorticoid secreted by the adrenal cortex. Cortisol stimulates gluconeogenesis in the liver, thus increasing blood glucose. Norepinephrine inhibits insulin secretion, thus increasing blood sugar. Epinephrine increases glucose release from the liver and inhibits insulin secretion, thus increasing blood glucose.

7.

N R I G B.C M

O Allostasis is best defined as U S N T a. steady-state. b. a state of equilibrium, of balance within the organism. c. the process by which the body heals following disease. d. the overall process of adaptive change necessary to maintain survival and well-being.

ANS: D Allostasis refers to the overall process of adaptive change necessary to maintain survival and well-being.

8. The primary adaptive purpose of the substances produced in the alarm stage is a. energy and repair. b. invoke resting state. c. produce exhaustion. d. set a new baseline steady-state.

ANS: A These resources are used for energy and as building blocks, especially the amino acids, for the later growth and repair of the organism. The substances do not produce a resting state.

The substances can produce exhaustion if they continue, but that is not the adaptive purpose of these. Although a new baseline steady-state may result from the stress response that is not the adaptive purpose of the substances produced during the alarm stage.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

9. Persistence of the alarm stage will ultimately result in a. stress reduction. b. permanent damage and death. c. movement into the resistance stage. d. exhaustion of the sympathetic nervous system.

ANS: B If the alarm stage were to persist, the body would soon suffer undue wear and tear and become subject to permanent damage and even death. Actions taken by the individual during the resistance stage lead to stress reduction. The resistance stage may or may not occur following the alarm stage, based on resource availability. The sympathetic nervous system will continue to function, resulting in continued release of stress hormones.

10. The effect of stress on the immune system a. is unknown. b. has been demonstrated to be non-existent in studies. c. most often involves enhancement of the immune system. d. may involve enhancement or impairment the immune system.

ANS: D Many studies demonstrate that long-term stress impairs the immune system, but many researchers identify that short-term stress may enhance the immune system.

MULTIPLE RESPONSE 1. Aldosterone may increase during stress, leading to (Select all that apply.) a. decreased urinary outpuNt.URSINGTB.COM b. increased blood potassium. c. increased sodium retention. d. increased blood volume. e. decreased blood pressure.

ANS: A, C, D Aldosterone increases water and sodium reabsorption and potassium excretion by the renal distal tubules and collecting ducts, thus leading to decreased urinary output, sodium retention in the body, and increased extracellular fluid volume. Because it leads to potassium excretion, aldosterone leads to decreased blood potassium.

2. Chronic activation of stress hormones can lead to (Select all that apply.) a. cardiovascular disease. b. depression. c. impaired cognitive function. d. autoimmune disease. e. overactive immune function.

ANS: A, B, C, D

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

Excessive cortisol levels promote hypertension, atherosclerosis, and the development of cardiovascular disease. Chronic overactive stress hormones may result in atrophy and death of brain cells. Elevated levels of stress hormones are found in individuals with depressive disorders. Chronic stress leads to immune function impairment, rather than overactive immune function, and has been implicated in autoimmune disorders.

3. Events which occur during the alarm stage of the stress response include secretion of (Select all that apply.) a. catecholamines. b. ACTH. c. glucocorticoids. d. immune cytokines. e. TSH. ANS: A, B, C, D During the alarm stage, catecholamines (epinephrine, norepinephrine), ACTH, glucocorticoids, and immune cytokines are secreted. TSH is not secreted during the stress response.

NURSINGTB.COM

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

Chapter 03: Cell Structure and Function Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. Glycolysis is the metabolic process of breaking down a glucose molecule to form a. CO2 and H2O. b. 2 ATP and 2 pyruvate. c. 30 ATP. d. oxygen.

ANS: B Glycolysis produces a net gain of two ATP molecules and breaks down glucose modules to produce two pyruvate molecules. Oxidative phosphorylation produces CO2 and H2O. Oxidative phosphorylation produces 30 ATP molecules. Oxygen is not produced by glycolysis, but it is necessary for oxidative phosphorylation.

2. The benefit of glycolysis is that this second stage of catabolism supplies a. ATP to meet energy needs of the body. b. pyruvate to the citric acid cycle. c. energy for oxidative phosphorylation. d. lactate during anaerobic conditions.

ANS: B The benefit of glycolysis is to supply pyruvate to the citric acid cycle of cellular metabolism, which then produces much ATP. Glycolysis only produces two ATP modules, N R I G B.C M which is insufficient for enerU gy nSe e dNs . GTlycolysOis does not supply energy for oxidative phosphorylation. Lactate produced during prolonged anaerobic conditions builds up and can lead to lactic acidosis, which is an undesirable outcome.

3. Repolarization of a neuron after a depolarizing action potential is because of a. activation of the Na+-K+ pump. b. influx of calcium. c. efflux of potassium. d. influx of sodium.

ANS: C Repolarization is because of efflux of potassium from the cell. The Na+-K+ pump maintains cellular volume via osmotic pressure and helps to maintain resting membrane potential.

Calcium influx prolongs the action potential. Influx of sodium initiates depolarization.

4. Excitable cells are able to conduct action potentials because they have a. receptors for neurotransmitters. b. tight junctions. c. ligand-gated channels. d. voltage-gated channels.

ANS: D

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

Voltage-gated channels respond to changes in membrane potential and are responsible for conducting action potentials. Receptors for neurotransmitters allow neurotransmitters to bind to the cell membrane but are not directly responsible for action potentials in excitable cells. Tight junctions are intercellular connections that help segregate proteins on the cell membrane and are not involved in conducting action potentials. Ligand-gated channels respond to binding of a signaling molecule such as a neurotransmitter, but are not directly responsible for action potentials in excitable cells.

5. The resting membrane potential in nerve and skeletal muscle is determined primarily by a. extracellular sodium ion concentration. b. the ratio of intracellular to extracellular potassium ions. c. activation of voltage-gated sodium channels. d. activity of energy-dependent membrane pumps.

ANS: B The major determinant of the resting membrane potential is the difference in potassium ion concentration across the membrane. Extracellular sodium helps maintain cell volume and resting membrane potential, but it is not the primary determinant. Activation of voltage-gated sodium channels help initiate an action potential. Channels are not linked to an energy source; ions flow passively across the cell membrane.

6. An increase in extracellular potassium ion from 4.0 to 6.0 mEq/L would a. hyperpolarize the resting membrane potential. b. make it more difficult to reach threshold and produce an action potential. c. hypopolarize the resting membrane potential. d. alter the threshold potential.

N R I G B.C M

U S N T O ANS: C An increase in extracellular potassium hypopolarizes the cell (makes it less negative) because more K+ ions stay inside the cell owing to the reduced concentration gradient.

Hyperpolarization of the resting membrane potential (makes it more negative) is caused by a decrease in extracellular potassium. Hyperpolarization resulting from a decrease in extracellular potassium makes it more difficult to reach threshold and produce an action potential. The threshold for action potential does not change with a change in extracellular potassium.

7. GTP-binding proteins (G-proteins) function to a. activate receptors on the extracellular surface. b. degrade second-messenger molecules. c. activate intracellular enzyme systems. d. synthesize ATP. ANS: C G-proteins activate specific target enzymes within the cell and these enzymes then produce second-messenger molecules that trigger specific intracellular function. Membrane-bound G-protein channels are a component of the cell membrane; they do not activate other receptors on the extracellular surface. G-proteins do not degrade second messengers, but instead produce these. G-proteins do not synthesize ATP. 8. Phospholipids spontaneously form lipid bilayers, because they are

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

a. b. c. d.

polar. charged. insoluble. amphipathic.

ANS: D Phospholipids have a hydrophilic (water-loving) polar end and a hydrophobic (water-fearing) polar end. This amphipathic nature causes the lipids to form bilayers. It is the water-loving and water-fearing nature of the end rather than simply being polar, charged, or insoluble that forms the bilayers.

9. Cell-to-cell communication through secretion of chemical signals into the bloodstream to target cells throughout the body is called signaling. a. synaptic b. paracrine c. endocrine d. autocrine ANS: C Endocrine signaling is accomplished by specialized endocrine cells that secrete hormones that travel via the bloodstream to target cells throughout the body. Synaptic signaling occurs at specialized junctions between the nerve cell and its target cell; the neuron secretes a chemical neurotransmitter into a small space between the nerve and target cell. In paracrine signaling, chemicals are secreted into a localized area, and only those cells in the immediate area are affected. Autocrine signaling occurs when cells respond to signaling molecules that they secrete and provides feedback to that cell rather than other cells.

N R I G B.C M

10. Ribosomes are very i m p o r t anUt orS ganN elleT s withinOthe cell that have the function of a. detoxifying substances. b. synthesizing proteins. c. converting energy to forms that can be used. d. coding for protein synthesis.

ANS: B Ribosome’s primary function is the synthesis of proteins. Lysosomes and peroxisomes detoxify substances. Mitochondria convert energy to forms that can be used to drive cell reactions. The nucleus contains genomic DNA that codes for protein synthesis.

11. The cardiac drug digitalis enhances myocardial contraction, because it a. increases intracellular calcium level in cardiac cells. b. inhibits sodium from entering cardiac cells. c. enhances the sodium–potassium pump. d. increases the sodium gradient across the cell membrane.

ANS: A Digitalis inhibits the sodium–potassium pump and allows the accumulation of intracellular sodium, decreasing the sodium gradient across the cell membrane. This leads to less efficient calcium removal by the sodium-dependent calcium pump. Increased calcium inside the cardiac cell leads to more forceful cardiac muscle contraction to treat congestive heart failure caused by cardiac muscle weakness.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

12. The organelle that contains enzymes necessary for oxidative phosphorylation to produce ATP is the a. mitochondria. b. ribosome. c. lysosome. d. nucleus.

ANS: A The inner membrane of the mitochondria contains many enzymes that promote oxidative phosphorylation which produces ATP. Ribosomes synthesize proteins. Lysosomes and peroxisomes detoxify substances. The nucleus contains genomic DNA that codes for protein synthesis.

13. Ion channels open and close in response to all the following except a. mechanical pressure. b. ligand binding. c. voltage changes. d. temperature changes.

ANS: D No temperature change channels are present on the cell membrane. Mechanically gated channels respond to mechanical deformation. Ligand-gated channels respond to the binding of a signaling molecule (neurotransmitter or hormone). Voltage-gated channels respond to a change in membrane potential.

14. Gap junctions are connecting channels that allow passage of small molecules from one cell to the next and are especialN ly i m R poIrt anGt foBr .C M U S N T O a. distance signaling. b. tissues requiring synchronized function. c. communication within a cell. d. passage of large molecules.

ANS: B Gap junctions are especially important in tissues in which synchronized functions are required such as in cardiac muscle contraction. Gap junctions are channels between adjacent cells, not distant cells. Gap junctions function to promote communication not within a cell, but between adjacent cells. Gap junctions allow passage of small molecules, but not large molecules.

TRUE/FALSE 1. During conditions of prolonged insufficient oxygen availability (e.g., respiratory or cardiovascular disease) anaerobic glycolysis accumulated pyruvate can lead to lactic acidosis.

ANS: T Pyruvate is converted to lactate and released into the blood stream, resulting in lactic acidosis.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

2. The phase of cellular metabolism in which energy is released during breakdown of nutrient sources is anabolism.

ANS: F Catabolism involves energy release via breakdown of nutrient sources such as glucose to provide ATP to the cell. In contrast, anabolism refers to energy-using processes that result in complex molecules such as fats.

3. Some individuals inherit a gene that results in dangerously high blood cholesterol caused by impaired endocytosis of low-density lipoproteins (LDLs).

ANS: T The defective gene inhibits the synthesis of LDL protein receptors on the cell membrane.

This impairs endocytosis of LDL. High levels of LDL in the blood predispose to atherosclerosis.

NURSINGTB.COM

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

Chapter 04: Cell Injury, Aging, and Death Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. An increase in organ size and function caused by increased workload is termed a. atrophy. b. hypertrophy. c. metaplasia d. inflammation.

ANS: B Increased function of an organ such as the heart or skeletal muscle results in organ hypertrophy because of cellular enlargement. Atrophy refers to reduction in size of an organ because of cellular shrinkage. Metaplasia refers to replacement of one differentiated cell type with another. Inflammation results from immune response rather than workload.

2. Apoptosis is a process that results in cellular a. atrophy. b. death. c. proliferation. d. mutation.

ANS: B Apoptosis results in death of a cell when it is no longer needed. Atrophy refers to reduction in size of an organ because of cellular shrinkage. Proliferation refers to growth of new cells.

N R Ie n eGtTi cB.C M Mutation refers to alteration U in t hSe g N strucO ture of cellular DNA. 3. All these cellular responses are potentially reversible except a. necrosis. b. metaplasia. c. atrophy. d. hyperplasia.

ANS: A Necrosis refers to death of cells/tissue and is not reversible. Metaplasia refers to the replacement of one differentiated cell type with another from persistent injury and is reversible when the injury stops. Atrophy occurs because of lack of use of an organ and is reversible. Hyperplasia is an increase in the number of cells from increased physiologic demands or hormonal stimulation and is reversible.

4. Necrotic death of brain tissue usually produces a. coagulative b. caseous c. liquefactive d. fat ANS: C

necrosis.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

Liquefactive necrosis is produced when brain tissue dies, as it is rich in enzymes and has little connective tissue. Coagulative necrosis occurs from ischemic injury in any tissue.

Caseous necrosis occurs in lung tissue damaged by tuberculosis. Fat necrosis occurs in adipose (fat) tissue.

5. The cellular response indicative of injury because of faulty metabolism is a. hydropic swelling. b. lactate production. c. metaplasia. d. intracellular accumulations.

ANS: D Intracellular accumulations result from faulty metabolism of lipids, carbohydrates, glycogen, and proteins. Hydropic swelling results from malfunction of the sodium-potassium pump. Lactate production results from anaerobic glycolytic pathway.

Metaplasia occurs from persistent cell injury.

6. Metaplasia is a. the replacement of one differentiated cell type with another. b. the transformation of a cell type to malignancy. c. an irreversible cellular adaptation. d. the disorganization of cells into various sizes, shapes, and arrangements.

ANS: A Metaplasia is the replacement of one differentiated cell type with another secondary to persistent damage. Dysplasia transforms cells to preneoplastic lesions, which may become malignant. Metaplasia is reversible when the damage is stopped. Disorganization of cells N rang R I B.C M NemGTents into various sizes, shapes, a nU d arS occOurs in dysplasia.

7. The cellular change that is considered preneoplastic is a. anaplasia. b. dysplasia. c. metaplasia. d. hyperplasia.

ANS: B Dysplastic cells have the potential to become cancerous and are therefore referred to as preneoplastic. Anaplasia, metaplasia, and hyperplasia are not considered preneoplastic.

8. Somatic death refers to death a. of a body organ. b. of the entire organism. c. of nerve cells. d. secondary to brain damage.

ANS: B Somatic death refers to death of an entire organism. Somatic death is not simply death of one body organ. Somatic death involves death of all cells in the body. Brain death refers to death of the brain only, but organ systems can remain living with mechanical assistance.

9. Coagulative necrosis is caused by

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

a. b. c. d.

dissolving of dead cells and cyst formation. trauma or pancreatitis. lung tissue damage. interrupted blood supply.

ANS: D Coagulative necrosis results from interrupted blood supply leading to ischemic cell injury.

Liquefactive necrosis results from dissolving of dead cells and cyst formation. Fat necrosis is caused by trauma or pancreatitis. Caseous necrosis is caused by lung tissue damage such as that caused by tuberculosis.

10. Reperfusion injury to cells a. results in very little cellular damage. b. results from calcium deficiency in cells. c. occurs following nutritional injury. d. involves formation of free radicals.

ANS: D Free radicals are formed when high-energy electrons partially reduce oxygen in reperfusion injury. Reperfusion injury usually causes more cell damage than the original hypoxia. It results from calcium overload in the cells. Reperfusion injury results from hypoxic injury, rather than from nutritional injury.

11. Extreme cold injures cells by all the following except a. ischemic injury from vasoconstriction. b. peripheral nerve damage from rebound vasodilation. c. decreased blood viscosiNty. R I G B.C M d. crystallization of cellular UcomSpo N n entTs. O ANS: C Hypothermia causes increased blood viscosity, which can result in ischemic injury. Initial vasoconstriction causes ischemic injury. Rebound vasodilation leads to intense swelling which damages peripheral nerves. Crystallization of cellular components leads to rupture of these components.

12. The cellular component that is most susceptible to radiation injury is the a. membrane. b. DNA. c. RNA. d. ribosomes.

ANS: B Cellular DNA is particularly susceptible to damage from radiation via breakage of the bonds holding the linear DNA together. Cell membranes, RNA, and ribosomes are not the most susceptible to radiation injury.

13. The primary effect of aging on all body systems is a. decreased functional reserve. b. diseased function. c. programmed senescence. d. senility.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

ANS: A All body systems show age-related changes that can be generally described as a decrease in functional reserve; aging leads to inability to adapt to (internal and external) environmental changes. Not all effects of aging are considered disease; some are considered a normal part of aging. Programmed senescence is currently only a theory of aging that states cells have a preprogrammed number of cell divisions before they will die. Senility is an outdated term used to describe the cognitive changes associated with dementia; dementia is a disease and is not a normal part of aging.

14. Carbon monoxide injures cells by a. destruction of cellular membranes. b. reducing oxygen level on hemoglobin. c. promotion of free radicals. d. crystallization of cellular organelles.

ANS: B Carbon monoxide binds tightly to hemoglobin preventing the red blood cell from carrying adequate oxygen, leading to hypoxic injury. Other chemicals such as carbon tetrachloride promote free radicals, which injure cells and destroy cellular membranes. Crystallization of cellular organelles is caused by hypothermia.

15. Of the statements below, the accurate statement regarding nutrition and cellular health is a. the body can generally produce elements essential for nutritional balance. b. obese individuals are generally nutritionally healthy. c. deficient cellular uptake by one cell type may contribute to excess nutrient delivery to other cell types.

NURSINGTB.COM d. a normal BMI indicates nutritional health.

ANS: C Deficient cellular uptake by one cell type may contribute to excess nutrient delivery to other cell types such as in diabetes mellitus. Most of these essential nutrients must be obtained from external sources, because the cell is unable to manufacture them. Obesity involves an excess of caloric intake. The BMI is a measure for obesity, but does not indicate if a nutritional imbalance is present.

MULTIPLE RESPONSE 1. Bacteria cause injury to cells by (Select all that apply.) a. producing exotoxins. b. producing endotoxins. c. producing destructive enzymes. d. reproducing inside of host cells altering cellular function. e. evoking an immune reaction.

ANS: A, B, C, E

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

Bacteria function in multiple ways to cause cell injury, including producing exotoxins that interfere with cellular function, producing endotoxins that cause fever and circulatory shock when the bacteria are lysed, producing enzymes that digest cellular membranes, or evoking an immune response with release of chemicals (e.g., histamines, kinins, lymphokines) that can injure cells. Bacteria do not reproduce inside host cells.

2. Viruses differ from most bacteria in that they (Select all that apply.) a. enter the host cell. b. directly produce free radicals. c. use the host’s metabolic processes to survive and replicate. d. do not induce an immune response. e. do not produce toxins.

ANS: A, C, E Viruses are able to enter the host cell and use host metabolic processes to survive and replicate. Viruses do not produce toxins. Viruses do not directly produce free radicals, although these can be produced indirectly by the immune response that follows viral infection. Both viruses and bacteria produce an immune response.

3. Infectious injury often results from (Select all that apply.) a. exotoxins. b. endotoxins. c. self-destruction of cells. d. anti-inflammatory reactions. e. enzymes from white blood cells.

ANS: A, B, C, E NURSINGTB.COM Exotoxins produced by bacteria interfere with cellular functions. Endotoxins are a component of some bacteria; when the bacteria are lyses, endotoxins are released, causing fever and even circulatory shock. Virally infected cells may trigger their own destruction.

Enzymes from white blood cells can harm cells in the area of inflammation. Infectious injury promotes inflammation; inflammation can cause more damage than the infecting agent.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

Chapter 05: Genome Structure, Regulation, and Tissue Differentiation Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. Approximately what percentage of the human DNA chromosomes code for proteins? a. 1% b. 10% c. 50% d. 80% ANS: A

Only about 1.3% of chromosomal DNA codes for proteins.

2. Which tissue type is categorized as epithelial? a. Tendons and ligaments b. Blood cells c. Blood vessel endothelium d. Cartilage ANS: C

Epithelial cells line glands, blood vessels, and internal surfaces. Tendons, ligaments, blood cells, and cartilage are connective tissue.

3. An important difference between skeletal and cardiac muscle is that a. cardiac muscle is not striated. b. only skeletal muscle is deN pU enR deSnI t uNpG onTaBc. tinC-O mM y o s i n cross-bridging. c. calcium does not leave the sarcoplasmic reticulum in cardiac cells. d. cardiac muscle has calcium channels on the cell surface for calcium entry.

ANS: D

Only cardiac muscle has calcium channels on the cell surface for calcium entry into the cell.

Drugs called calcium channel blockers are used to decrease calcium entry into cardiac cells to reduce contractile force in treating hypertension. CCBs also relax smooth muscle in arterial blood vessels to treat hypertension. Both cardiac and skeletal muscle are striated, and both cardiac depend upon actin-myosin cross-bridging for contraction. Calcium leaves the sarcoplasmic reticulum in both cardiac and skeletal muscle.

4. The primary role of genes is to a. code for reproduction. b. direct the synthesis of proteins. c. determine differentiation. d. determine cellular apoptosis.

ANS: B

Protein synthesis holds a predominant place in understanding how genes direct cell structure and function. Although genes are involved in reproduction, differentiation, and apoptosis indirectly, the primary role of genes in the body is protein synthesis.

5. The differences in structure and function of cells in different body tissues are resulting from

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

a. b. c. d.

gene differences in tissue cells. expression of tissue-specific genes. transcriptional controls. translation of amino acids to proteins.

ANS: B

The expression of genes results in differences among cells, and thus tissue types. All cells in the body contain basically the same genes. Expression of genes is influenced by memory of cells regarding events prior to cell division, not differences in gene structure. As genes in all body cells/tissues are basically the same, transcription and translation do not influence cell/tissue differences.

6. Characteristics of smooth muscle include a. being under voluntary control. b. having striations. c. contraction being short-lived. d. being found in blood vessels.

ANS: D

Smooth muscle is found in blood vessels. It is not under voluntary control and is often controlled by the autonomic nervous system. Skeletal and cardiac muscle have striations.

Contraction can occur indefinitely; it is not short-lived, which is important in maintaining tone of blood vessels and, thus, blood pressure.

MULTIPLE RESPONSE 1. Characteristics of cellular d i fN f er eRn t i aIt i o nGi n cBl u.d C e whMich of the following? (Select all that

U S N T O apply.) a. Specialization for different functions b. Enhanced ability to replicate c. Influenced by memory of developmental events d. Dependent on cell-to-cell coordination e. Generally not reversible ANS: A, C, D, E

The cells of a multicellular organism specialize to perform particular functions in coordination with other cells in the body. Cells have genetic memory; they retain the effects of past influences and pass the memory on to their descendants. Continued interaction with nearby cells provides clues to guide the cell to its appropriate form and location. Once differentiated, a cell generally does not revert to earlier forms. Differentiation results in decreased capacity to replicate.

2. In DNA replication DNA polymerase functions to (Select all that apply.) a. pry DNA apart. b. unwind and separate the DNA strands. c. prevent tangling of DNA strands as they unwind. d. match appropriate bases to the template base. e. proofread the newly developed DNA for errors in base pairing.

ANS: D, E

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

DNA polymerase functions to match appropriate bases to the new template base following unwinding of the DNA strands and proofreads for errors after base pairing is completed.

Initiator proteins pry the DNA strands apart. DNA helicases unwind the DNA strands.

Topoisomerases keep the strands from becoming tangled.

3. Protein synthesis involves (Select all that apply.) a. direction from mRNA. b. amino acid movement into the nucleus. c. nucleotide triplets. d. RNA polymerase. e. removal of introns from the DNA template.

ANS: A, C, D, E

Messenger RNA (mRNA) is needed to carry the protein code to the cytoplasm where proteins are synthesized. Three nucleotides are need to code for each amino acid, the building blocks of protein. RNA polymerase directs the separation of the DNA strands and catalyzes the synthesis of mRNA from the DNA template after separation of the strands. Introns are removed from the DNA template to make particular proteins. Amino acids are moved from the nucleus to the cytoplasm, where protein synthesis occurs.

4. Characteristics of stem cells include that they (Select all that apply.) a. may differentiate into any type of cell. b. reside only in the bone marrow. c. have greater capacity to proliferate than more differentiated cells. d. are dependent upon environmental cues for proliferation. e. can die in the absence of an appropriate environment.

ANS: A, C, D, E

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Stem cells are pluripotent—they can differentiate into any type of cell. They can proliferate faster and longer than more differentiated cells if the environment is appropriate and can die if the environment in not appropriate. While most blood-forming stem cells reside in the bone marrow, others can move into tissues and produce cells as needed; for example, epithelial stem cells reside in the deepest layer of the epidermis and proliferate into epithelial cells when needed.

5. Calcium channel blocker drugs are often used to treat conditions associated with (Select all

that apply.) a. cardiac muscle. b. smooth muscle. c. epithelial tissue. d. nervous tissue. e. connective tissue.

ANS: A, B

Calcium channel blockers are often used to treat cardiac conditions in an effort to reduce the strength of contraction by stopping calcium influx into the cells. They are also used in smooth muscle of the blood vessels to relax the smooth muscle in the arterial blood vessels to cause vasodilation and reduce blood pressure. They are not useful for conditions involving epithelial, nervous, or connective tissue.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

Chapter 06: Genetic and Developmental Disorders Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. Characteristics of X-linked (sex-linked) recessive disorders include a. all daughters of affected fathers’ being carriers. b. boys’ and girls’ being equally affected. c. the son of a carrier female’s having a 25% chance of being affected. d. affected fathers’ transmitting the gene to all their sons.

ANS: A All daughters of affected fathers are carriers. X-linked (sex-linked) disorders affect primarily males. A carrier female has a 1 in 2 chance of producing an affected son. Affected fathers transmit the defective gene to none of their sons but to all their daughters.

2. A fetus is most vulnerable to environmental teratogens during a. birth. b. conception. c. the first trimester. d. the last trimester.

ANS: C Between the third and ninth week of gestation, the embryo is very vulnerable to teratogenesis, with the fourth and fifth week being the time of peak susceptibility. By birth, fetal development is complete and not vulnerable to environmental teratogens. Prior to the Nr eRxSp I G B.C M third week of gestation, eitheU o sN ure T to a teraOtogen generally damages so few cells that the embryo develops normally, or spontaneous abortion occurs because of major cell damage. Fetal insults occurring after the third month are more likely to result in growth retardation or injury to normally formed organs.

3. Results of biochemical tests indicate an infant has phenylketonuria (PKU). The parents ask what PKU means. Correct responses would include all the following except PKU a. is an enzyme deficiency resulting in the inability to metabolize phenylalanine. b. is an inborn error of metabolism. c. results from a chromosome abnormality called nondisjunction. d. is transmitted as an autosomal-recessive disorder.

ANS: C PKU is not a chromosome abnormality, but instead a single-gene abnormality often referred to as inborn errors of metabolism. The other answer choices are true statements regarding PKU. 4. The parents of a child with PKU are concerned about the risk of transmitting the disorder in future pregnancies. The correct assessment of the risk is a. each child has a 25% chance of being a carrier. b. each child has a 25% chance of being affected. c. since one child is already affected, the next three children will be unaffected. d. one cannot predict the risk for future pregnancies.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

ANS: B As an autosomal-recessive disorder, the mating of two carriers (heterozygous) results in a 1 in 4 chance of producing an affected offspring and a 2 in 4 chance of producing an offspring who carries the disease. The mating of two carriers (heterozygous) results in a 2 in 4 chance of producing an offspring who carries the disease. The mating of two carriers (heterozygous) results in a 1 in 4 chance of producing an affected offspring and a 2 in 4 chance of producing an offspring who carries the disease. One can predict the risk of future pregnancies.

5. Information parents should be given about the consequences of PKU includes a. high dietary phenylalanine may help induce enzyme production. b. PKU is commonly associated with other congenital anomalies. c. failure to avoid phenylalanine results in progressive mental retardation. d. mental retardation is inevitable.

ANS: C Failure to avoid phenylalanine results in progressive mental retardation. Phenylketonuria (PKU) results from an inability to metabolize the amino acid phenylalanine because of lack of the enzyme phenylalanine hydroxylase. Intake of phenylalanine will not help induce enzyme production. This disorder is not necessarily associated with other congenital anomalies. Mental retardation can be prevented or lessened with avoidance of phenylalanine.

6. Children with PKU must avoid phenylalanine in the diet. Phenylalanine is most likely to be a component of a. fat. b. sugar.

NURSINGTB.COM c. protein. d. carbohydrate.

ANS: C Phenylalanine is an amino acid found in protein. Most fats, sugars, and carbohydrates do not contain phenylalanine.

7. A point mutation a. results from the addition or loss of one or more bases. b. is because of the translocation of a chromosomal segment. c. always produces significant dysfunction. d. involves the substitution of a single base pair.

ANS: D A point mutation involves a single base pair substitution. A point mutation does not result from the addition or loss of bases, or from translocation of a chromosomal segment, but rather from a substitution. The inclusion of the abnormal amino acid in the sequence of the protein as a result of a point mutation may or may not be of clinical significance.

8. Males are more likely than females to be affected by a. X-linked b. autosomal-dominant c. autosomal-recessive

disorders.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

d. chromosomal nondisjunction ANS: A Males are more likely than females to be affected by X-linked disorders. Females express the X-linked disease only in the rare instance in which both X chromosomes carry the defective gene. Males, however, do not have the safety margin of two X chromosomes and express the disease if their one and only X chromosome is abnormal. Males and females are equally affected by autosomal-dominant and autosomal-recessive disorders. Chromosomal nondisjunction means that paired homologous chromosomes fail to separate normally during either the first or second meiotic division, resulting in germ cells that have an abnormal number of chromosomes. This can occur in both males and females equally.

9. The primary factor associated with the risk of Down syndrome is a. family history of heritable diseases. b. exposure to TORCH syndrome organisms. c. maternal alcohol intake. d. maternal age.

ANS: D Advanced maternal age is associated with Down syndrome in the most common form of the disease. A family history of heritable disease is not the primary factor and occurs in only 4% of cases. Exposure to TORCH syndrome organisms is not a risk factor for Down syndrome.

Maternal alcohol intake is not a risk factor for Down syndrome.

10. Cystic fibrosis is a single-gene disorder that primarily affects a. brain and heart. b. kidney and adrenals.

NURSINGTB.COM c. lungs and pancreas. d. liver and intestine.

ANS: C The alteration in chloride transport associated with cystic fibrosis is associated with production of abnormally thick secretions in glandular tissues. The lung bronchioles and pancreatic ducts are primarily affected, often resulting in progressive destruction of these organs. The brain, heart, kidneys, and liver are not the primary organs affected with cystic fibrosis.

11. Huntington disease is often transferred to offspring before a parent knows of the genetic possibility of this disease, because a. symptoms are so mild that they are not recognized. b. symptoms often do not occur until approximately 40 years of age. c. genetic testing for the disease is not possible. d. the genetic alteration is rarely expressed.

ANS: B Signs of mental deterioration and involuntary muscle movements do not appear until approximately age 40. The delayed onset means the parent may transmit the disorder to offspring before he or she knows they have the disorder. Symptoms of Huntington’s disease are not necessarily mild, and are not the reason for delayed identification of the genetic susceptibility. Genetic testing for the disease is possible. The genetic alteration is expressed if the triplet repeats are greater than 40.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

12. Huntington disease primarily affects the a. neurologic b. muscular c. gastrointestinal d. endocrine

system.

ANS: A Huntington disease primarily affects the neurologic system and leads to uncontrolled movement of the extremities. Huntington disease does not primarily affect the muscles, although the altered neural involvement secondarily causes involuntary movement of the arms and legs. It also does not affect the gastrointestinal and endocrine systems.

13. The risk period for maternal rubella infection leading to congenital problems begins a. prior to conception. b. during the last trimester. c. at birth. d. all through pregnancy.

ANS: A The risk period for maternal rubella infection begins prior to conception and extends to 20 weeks’ gestation, after which the virus rarely crosses the placenta. The virus rarely crosses the placenta after 20 weeks’ gestation. The virus does not cross the placenta at birth and would not cause congenital problems at this point. The risk period for maternal rubella infection begins prior to conception and extends to 20 weeks’ gestation, after which the virus rarely crosses the placenta.

MULTIPLE RESPONSE

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1. Characteristics of Marfan syndrome include that it (Select all that apply.) a. is a single-gene disorder. b. involves alterations in connective tissue. c. leads to skeletal and joint deformities. d. leads to short stocky build. e. results in dangerous cardiovascular disorders.

ANS: A, B, C, E Marfan syndrome is a single-gene disorder that involves alterations in connective tissue and leads to skeletal and joint deformities. The aorta weakens and may rupture and cardiac valves may malfunction. Individuals with Marfan syndrome are typically tall and slender, with long, thin arms and legs, rather than short and stocky.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

Chapter 07: Neoplasia Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. Proto-oncogenes a. are the same as oncogenes. b. are normal cellular genes that promote growth. c. lead to abnormal tumor-suppressor genes. d. result from severe mutational events.

ANS: B Proto-oncogenes are normal cellular genes that promote growth. Proto-oncogenes are not the same as oncogenes, which are mutant proto-oncogenes. They are different from tumor-suppressor genes and do not alter tumor-suppressor genes. Mutational events lead to oncogenes, a mutated proto-oncogene.

2. Familial retinoblastoma involves the transmission of what from parent to offspring? a. Mutant tumor-suppressor gene b. Cancer-causing virus c. Oncogene d. Extra chromosome ANS: A Familial retinoblastoma involves transmission of a mutant tumor-suppressor gene from parent to child. Familial retinoblastoma is not caused by a virus and does not involve an N Ri n I G B.C MOilial retinoblastoma is caused by a mutant extra chromosome, but ratherUa sS g lNe geTne. Fam tumor-suppressor gene, not an oncogene, which is a mutated proto-oncogene.

3. Your patient eats “lots of fat,” leads a “stressful” life, and has smoked “about two packs a day for the last 40 years.” Her chronic morning cough recently worsened, and she was diagnosed with a lung mass. The most likely contributing factor for development of lung cancer in this patient is a. high-fat diet. b. urban pollutants. c. stressful lifestyle. d. cigarette smoking.

ANS: D The most likely contributing factor for the development of lung cancer is cigarette smoking.

Tobacco smoke contains hundreds of compounds, many of which have known genotoxicity and probably serve as initiators. Tobacco smoke also contains promoters, which spur the mutant cells to proliferate. Although a high-fat diet, urban pollutants, and a stressful lifestyle have been implicated in some types of cancer, they are not the likely contributing factor in your patient’s lung cancer.

4. After bronchoscopy and histologic examination of a suspected tumor, your patient is diagnosed with primary bronchial carcinoma. Thus, the tumor a. is benign.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

b. is malignant. c. is secondary to cancer elsewhere in the body. d. has spread.

ANS: B Bronchial carcinoma is a malignant cancer of the epithelial lining of the bronchi. Carcinoma refers to a malignant tumor. Primary indicates that the cancer began in the lungs and did not metastasize from another site. A staging procedure must be done before knowing if the lung cancer has spread.

5. Your patient is scheduled for a staging procedure. She wants to know what that means. The correct response is which of the following? a. It is a procedure for determining the extent of tumor spread. b. It is a histologic examination of tissues to determine the degree of tumor differentiation. c. It is based on exploratory surgery. d. It is biochemical testing of tumor cells to determine the genetic basis of the tumor.

ANS: A Staging describes the location and pattern of spread of a tumor. Staging does not involve biochemical testing of tumor cells, or the histologic examination of tissues, which is done with cancer grading. CT, MRI, and PET imaging techniques have allowed for noninvasive cancer detection.

6. A patient with metastatic lung cancer wants to know her chances for survival. Which response is correct? a. “Lung cancer is alwaysNfataRl.” I G B.C M S s uNrv i T b. “Lung cancer has about aU15% v al rate.O” c. “Lung cancer is highly curable when diagnosed early.” d. “Lung cancer death rate has decreased significantly, as with all other cancers.”

ANS: B Lung cancer has a 15% survival rate. Lung cancer is not always fatal, but is not highly curable at any stage of diagnosis. The death rate from lung cancer has increased dramatically.

7. After surgery to remove a lung tumor, your patient is scheduled for chemotherapy, which will a. selectively kill tumor cells. b. stimulate immune cells to fight the cancer. c. have minimal side effects. d. kill rapidly dividing cells.

ANS: D Chemotherapy kills rapidly dividing cells. Chemotherapy does not selectively kill tumor cells, but affects all rapidly dividing cells. Chemotherapy has many damaging side effects.

Immunotherapy uses the power of the immune system and has the potential for targeting cancer cells.

8. The most common tumor-suppressor gene defect identified in cancer cells is a. Rb.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

b. P53. c. DCC. d. APC. ANS: B The most common tumor-suppressor gene defect identified in cancer cells involves P53.

More than half of all types of human tumors lack functional P53, which inhibits cell cycling.

Rb, DC, and APC are not the most common tumor-suppressor gene defects identified in cancer cells.

9. Breast cancer in women who have the breast cancer gene a. occurs at an earlier age. b. is more likely to be unilateral. c. is more common than non-inherited breast cancer. d. is more responsive to treatment.

ANS: A The age of onset of inherited breast cancer is earlier than the onset of non-inherited forms and the prevalence of bilateral breast cancer is higher. Breast cancer in women who have the breast cancer gene is less common (only 5% to 10% of all cases) than non-inherited breast cancer and is more likely to be bilateral. Response to treatment is not affected by whether the cancer gene is present.

10. Malignant neoplasms of epithelial origin are known as a. lymphoma. b. sarcomas. c. carcinomas.

NURSINGTB.COM d. adenomas.

ANS: C Carcinoma refers to malignant tumors of epithelial origin. Lymphoma refers to cancer of the lymphatic tissue. Sarcoma refers to malignant tumors of mesenchymal (nerve, bone, muscle) origin. Adenoma is a benign tumor of glandular tissue.

11. Retroviruses are associated with human cancers, including a. Burkitt lymphoma. b. Hodgkin’s lymphoma. c. pancreatic cancer. d. hepatic cancer.

ANS: A At least three retroviruses are thought to be causative factors in some human cancers: HIV Kaposi sarcoma, Epstein–Barr in Burkitt lymphoma, and human T-lymphocyte type I in T-cell leukemia–lymphoma. The other answer options are not associated with a retrovirus.

12. Cancer grading is based on a. tumor size. b. local invasion. c. cell differentiation. d. metastasis.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

ANS: C Grading refers to the histologic characterization of tumor cells and is basically a determination of the degree of anaplasia (lack of differentiation). The other answer options are associated with tumor staging.

13. The hypermetabolic state leading to cachexia in terminal cancer is thought to be because of a. tumor necrosis factor. b. angiogenesis. c. loss of ATP production. d. pain medications.

ANS: A Production of tumor necrosis factor (TNF) and other immune cytokines is thought to be important in producing the hypermetabolic state leading to cachexia in cancer. Angiogenesis is the development of new blood vessels to feed the tumor; it is not a cause of the hypermetabolic state leading to cachexia in terminal cancer. Loss of ATP production and pain medications is not causes of the hypermetabolic state leading to cachexia in terminal cancer.

14. Paraneoplastic syndromes in cancer involve excessive production of substances by multiple means. A common substance found in excessive amounts resulting from cancer paraneoplastic syndromes is a. insulin. b. tumor necrosis factor. c. potassium. d. calcium.

N R I G B.C M

U S N T O ANS: D Common paraneoplastic syndromes include hypercalcemia associated with abnormal production of parathyroid hormone-related protein by tumor cells. Insulin is a general growth factor for a number of tissues and may be implicated in development of some cancers, but it is not a cause of paraneoplastic syndromes. Tumor necrosis factor is associated with cachexia in cancer, but it is not associated with paraneoplastic disorders of cancer. Potassium is not found in excess amounts in cancer.

MULTIPLE RESPONSE 1. Deficits in immune system function occur in cancer as a result of (Select all that apply.) a. chemotherapy. b. cancer cells. c. cancer metastasis to bone marrow. d. immunotherapy. e. malnutrition.

ANS: A, B, C, E Cancer cells secrete substances that suppress the immune system. Bone marrow suppression may be because of invasion of blood-forming cells in the bone marrow, poor nutrition, and chemotherapeutic agents. By contrast, immunotherapy is a method of harnessing the immune system in the treatment of cancer.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

2. Tumor markers (Select all that apply.) a. are found only in the blood. b. are produced by normal cells. c. help determine cancer origin. d. help identify progression of cancer. e. include prostatic-specific antigen.

ANS: B, C, D, E Tumor markers are substances associated with tumor cells that may be helpful in identifying their tissue of origin and progression and proliferation of cancer cells. Most tumor markers are not very specific for cancer since normal cells in the tissue of origin also produce them.

Tumor markers include prostatic-specific antigen. Some tumor cell markers are released into the circulation, but others must be identified through biopsy of metastatic tissue.

3. Characteristics of telomerase include (Select all that apply.) a. repairs the end caps of chromosomes. b. contributes to cancer cell immortality. c. is deficient in cancer cells. d. activity allows a cell to replicate indefinitely.

ANS: A, B, D Telomerase functions to repair the end caps of chromosomes. It contributes to cancer cell immortality by allowing a cell to replicate indefinitely. Telomerase is present in cancer cells at higher than normal levels.

4. Side effects of chemotherapy include (Select all that apply.) a. anemia.

NURSINGTB.COM b. nausea. c. leukocytosis. d. bleeding. e. infections.

ANS: A, B, D, E Chemotherapy leads to anemia, bleeding, and infections from bone marrow suppression and deficient production of RBS, platelets, and WBCs, respectively. Chemotherapy also causes nausea, a frequent and debilitating side effect. Chemotherapy causes leukopenia (reduction of WBCs).

TRUE/FALSE 1. In general, a cancer cell that is more tissue-specific differentiated is more likely to be aggressive.

ANS: F The degree of tissue-specific differentiation predicts malignant potential. A lack of differentiated features in a cancer cell is called anaplasia, and a greater degree of anaplasia is correlated with a more aggressively malignant tumor.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

Chapter 08: Infectious Processes Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. An infectious disease that is common in a community is termed a. endemic. b. epidemic. c. pandemic. d. partdemic.

ANS: A An infectious disease that has a fairly constant presence in a community and changes little from year to year is classified as endemic. An epidemic is a significant increase in new infections in a certain population. A pandemic is an epidemic that has spread to a large geographic area, even worldwide. Partdemic is not a term that pertains to infectious diseases.

2. The most common method of disease transmission is a. airborne. b. droplet. c. vector. d. inoculant.

ANS: B The most common transmission occurs through the exchange of body fluids (droplet) from N R I ne G tT B.C Msion is not the most common method of kissing or sexual intercourse.UAirSborN ransmisO disease transmission. Vector is not the most common method of disease transmission.

Inoculant transmission is not the most common method of disease transmission.

3. Immune function is likely to be most effective in a a. newborn. b. 7-month-old infant. c. 30-year-old. d. 70-year-old.

ANS: C Immune function is most effective in middle life. Newborns have an immature immune system. In older infants, maternal IgG that crossed the placenta at birth begins to fade over the first 6 months of life, and these babies are at greater risk for serious infection. Immunity tends to decline in the elderly resulting in reduced antibody responses to new antigens. The very young and the very old are more susceptible to infection because of immature or degenerating immune functions.

4. A characteristic of some bacteria a. is intracellular parasite. b. is composed of RNA or DNA. c. contains cell wall endotoxin. d. cannot replicate extracellularly.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

ANS: C Some bacteria contain endotoxin in the cell wall. Viruses are intracellular parasites using host cell components to replicate; bacteria do not use host cell components to replicate.

Viruses are composed of RNA or DNA, as opposed to bacteria. Bacteria can replicate extracellularly.

5. The term used to describe fungal infections is a. sepsis. b. mycoses. c. amebiasis. d. Chlamydia.

ANS: B Infections caused by fungi are called mycoses. Sepsis means an overwhelming infection that may lead to shock, multiple organ failure, and death. Sepsis can be caused by any organism.

Amebiasis is an infection caused by a protozoan parasite. Chlamydia is a bacterial infection.

6. Drug resistance of microbes occurs secondary to a. patient allergy to a drug. b. mutation of the microbe. c. enhance pathogenicity of the microbe. d. using high doses of drugs.

ANS: B Drug resistance develops secondary to chance mutations of microbes in response to a change in the host’s environment. Patient allergy to a drug does not cause drug resistance.

Although drug resistance may lead to enhanced pathogenicity of a microbe, pathogenicity Nce.RS IngGl To B.C M does not lead to drug resistanU UsiN w dos eOs of a drug to treat infection leads to drug resistance.

MULTIPLE RESPONSE 1. Dietary zinc is an important defense against infection, because it maintains (Select all that apply.) a. natural killer cell function. b. lymphocyte activity. c. antioxidant activity. d. neutrophil activity. e. complement activity.

ANS: A, B, D, E Decreased availability of zinc results in a reduction in natural killer cell function, lymphocyte activity, neutrophil function, and complement activity. Zinc does not maintain antioxidant activity.

2. Characteristics of immunization include which of the following? (Select all that apply.) a. Giving injections of preformed antibodies provides immediate immunity. b. Immunization provides life-long immunity. c. Immunization with killed vaccines may lead to infection from the agent. d. Herd immunity controls disease without immunizing everyone in the population.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

e. Lack of immunization may lead to an epidemic.

ANS: A, D, E Injections of preformed antibodies to an organism provide immediate immunity to disease caused by that organism. Herd immunity controls disease, because a certain percentage of the population is no longer susceptible to the disease. Lack of immunization may lead to an epidemic. Immunization does not provide lifelong immunity. For example, immunization with preformed antibodies is temporary. The CDC monitors disease outbreaks and recommends additional boosters for some infectious diseases. Immunization with killed vaccines does not lead to infection from the agent, as the organism is no longer living.

3. Risk of infection is increased in (Select all that apply.) a. use of corticosteroids. b. diabetes mellitus. c. spleen removal. d. stomach removal. e. stress.

ANS: A, B, C, E Use of corticosteroids depresses immune function and increases risk of infection. Diabetes mellitus increases risk of infection resulting from high blood sugar, decreased resistance to infection, and inability to sense pain secondary to neuropathies. Spleen removal increases susceptibility to infection as one of its functions was phagocytosis of encapsulated bacteria.

Stress increases hormones that affect immune responsiveness. The stomach is not an organ that affects immune function; therefore, removal of the stomach does not increase the risk for infection.

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Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

Chapter 09: Inflammation and Immunity Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. Antigen-presenting cells function to a. display foreign antigen on their cell surfaces bound to MHC. b. stimulate cytokine production by macrophages. c. phagocytose and degrade foreign antigens. d. initiate the complement cascade by way of the alternative pathway.

ANS: A Antigen-presenting cells function to display foreign antigen on their cell surfaces bound to MHC for T-cell recognition. Antigen-presenting cells do not stimulate cytokine production or initiate the complement cascade. They also do not phagocytose and degrade foreign antigens, but instead present these to T cells for these functions.

2. The “classical pathway” for activation of the complement cascade is triggered by a. activation of C3. b. inflammation. c. first recognition of an antigen. d. antigen–antibody complexes.

ANS: D The classical pathway for activation of the complement cascade is triggered by the presence of IgG or IgM antigen–antibody complexes. Activation of C3 initiates the alternative NnotRSinit I Niate G TB.C M pathway. Inflammation does U the clasOsical pathway, but instead inflammation is enhanced by the complement cascade. First recognition of an antigen initiates the lectin pathway or the alternative pathway.

3. Proteins that are increased in the bloodstream during acute inflammation are called a. membrane attack complexes. b. selectin receptors. c. acute phase proteins. d. major histocompatibility complexes.

ANS: C Acute phase proteins are produced in the liver during acute inflammation and circulate in the bloodstream. Two of the most important acute phase proteins are C-reactive protein (CRP) and serum amyloid A. Membrane attack complexes are porelike structures that function within the complement system. Selectin receptors are receptors on neutrophils that help neutrophils stick to capillary endothelium. Major histocompatibility complexes are a cluster of genes on chromosome 6 involved in antigen presentation.

4. The membrane attack complex formed by complement is similar in function to a. CD4+. b. granzymes. c. CD8. d. perforin.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

ANS: D The membrane attack complex functions in a similar manner to perforin. CD4+ do not function similar to the membrane attack complex. Granzymes do not function similar to the membrane attack complex. CD8 does not function similar to the membrane attack complex.

5. Which clinical finding is most indicative of an acute bacterial infection? a. Increased (band) neutrophils b. Elevated temperature c. Elevated erythrocyte sedimentation rate d. Elevated WBC count ANS: A Neutrophils are early responders and most active in bacterial infections, and the number of neutrophil bands indicates the severity of the infection. Elevated temperature can occur in infection caused by any organism. The erythrocyte sedimentation rate is non-specific for the type of organism causing an infection. The total WBC count can increase in any infection.

The specific type of WBC that is elevated indicates the type of organism involved.

6. Interleukin-1, interleukin-6, and tumor necrosis factor- are inflammatory cytokines secreted by a. plasma cells. b. neutrophils. c. lymphocytes. d. macrophages.

ANS: D Macrophages secrete cytokines, including IL-1, IL-6, IL-12, and tumor necrosis factor- N RSI G B.C M that promote inflammation. PUl a s m a cNe l l sT, neutroOphils, and lymphocytes do not secrete inflammatory cytokines.

7. The spleen is an important defense against infection, because it a. activates the complement cascade. b. initiates inflammation. c. controls phagocytosis. d. filters the blood.

ANS: D The spleen filters the blood; macrophages in the spleen filter out foreign substances.

Lymphocytes activated in the spleen can be transported to other lymphoid tissue to fight infection. The spleen does not activate the complement cascade, initiate inflammation, or have a role in controlling phagocytosis.

8. Immunity to a specific organism can be determined by a. active phase protein count. b. antibody titer. c. erythrocyte sedimentation rate. d. WBC count.

ANS: B

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

Specific serum antibody concentration for a particular organism can be measured by a blood antibody titer. Active phase protein count indicates level of inflammation. Erythrocyte sedimentation rate indicates degree of inflammation. WBC count helps determine if infection with any organism is present.

9. Leukocytosis with a “shift to the left” refers to a. elevated segmented neutrophils. b. elevated immature neutrophils. c. decreased monocytes. d. decreased immature neutrophils.

ANS: B During acute inflammation, the bone marrow releases stored neutrophils. As they are consumed, the demand exceeds the production resulting in an immature (band) neutrophil.

Segmented neutrophils are mature neutrophils. Monocytes are immature macrophages and are only 5% of the total WBC. Leukocytosis with a “shift to the left” refers to increased immature leukocytes.

10. The primary function of eosinophils is to a. kill parasitic helminths (worms). b. kill bacteria. c. stop viral replication. d. phagocytize fungi.

ANS: A The primary function of eosinophils is to kill parasitic helminths (worms); this is evident by the elevation in eosinophil level in parasitic infections. Neutrophils, not eosinophils, NnopRShiIl sNG B.C Ml e in stopping viral replication. The primary function to kill bacteria. Eo s iU h avTe no r oO role of eosinophils does not involve phagocytizing fungi.

11. Functions of B cells include a. synthesizing antibodies. b. secreting cytokines. c. killing antigen-presenting cells. d. stimulating B cells. e. killing virally infected cells.

ANS: A B lymphocytes mature into plasma cells and synthesize antibodies. B cells do not secrete cytokines, kill antigen-presenting cells, or kill virally infected cells; T cells do these.

12. The primary function of kinins is a. phagocytosis of antigens. b. production of antibodies. c. to limit immune reactions. d. vasodilation to enhance inflammation.

ANS: D Kinins are especially active in inflammation via powerful vasodilation to bring immune cells to the site of infection. Kinins are not phagocytic, but bring phagocytes to an area of infection via vasodilation. B cells produce antibodies. Kinins do not limit immune reactions.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

MULTIPLE RESPONSE 1. Activation of the complement cascade results in (Select all that apply.) a. antibody production. b. inflammation. c. immunosuppression. d. autoimmunity. e. chemotaxis.

ANS: B, E Activation of the complement cascade result is enhanced inflammation and chemotaxis. The complement cascade does not result in antibody production or autoimmunity. It also does not result in immunosuppression; it enhances immune function.

2. Passive immunity is provided by (Select all that apply.) a. transfer of preformed human antibodies. b. injection of human immune globulin. c. injection with preformed animal antibodies. d. vaccines with dead or altered organisms. e. active infections.

ANS: A, B, C Passive immunity is provided by immunization with preformed antibodies from either humans or animals, and by injection of human immune globulin. Vaccination with dead or altered organisms provides active immunity. Active infection induces active immunity.

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3. Active immunity involves (Select all that apply.) a. injection of preformed human antibodies. b. injection of human immune globulin. c. injection with preformed animal antibodies. d. vaccines with dead or altered organisms. e. active infections.

ANS: D, E Active immunity is provided by vaccination with dead or altered organisms and by active infections. Injection of preformed antibodies from either humans or animals produces passive immunity. Injection of human immune globulin produces passive immunity.

4. Functions of antibodies include (Select all that apply.) a. antigen agglutination. b. antigen precipitation. c. opsonization. d. phagocytosis. e. complement activation.

ANS: A, B, C, E Antibody functions include antigen precipitation, agglutination, neutralization, and opsonization. Antibodies also activate complement. Antibodies do not phagocytize.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

5. Functions of T cells include (Select all that apply.) a. synthesizing antibodies. b. secreting cytokines. c. killing antigen-presenting cells. d. stimulating of B cells. e. killing virally infected cells.

ANS: B, C, D, E Certain types of T cells (T helper 2) secrete cytokines that stimulate B-cell proliferation.

Other T cells (cytotoxic T cells) kill antigen-presenting cells and recognize and destroy virally infected cells. T cells do not synthesize antibodies.

6. Characteristics of complement include (Select all that apply.) a. stimulating chemotaxis. b. lysing target cells. c. having multiple plasma proteins. d. being synthesized in the bone marrow. e. enhancing phagocytosis.

ANS: A, B, C, E Complement functions to stimulate chemotaxis and thereby enhance phagocytosis.

Complement consists of 20 plasma proteins that can lyse target cells. Complement proteins are synthesized in the liver and by macrophages and neutrophils, not in the bone marrow.

7. The mononuclear phagocyte system consists of (Select all that apply.) a. monocytes and tissue macrophages. b. dendritic cells.

NURSINGTB.COM c. bone marrow stem cells. d. antibody-secreting plasma cells. e. basophils.

ANS: A, B The mononuclear phagocyte system is composed of monocytes and macrophages, and dendritic cells that are widely distributed throughout body tissues. Monocytes from the circulating blood migrate to organs and tissues to become macrophages. The mononuclear phagocyte system does not include the bone marrow stem cells, antibody-secreting plasma cells, or basophils.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

Chapter 10: Alterations in Immune Function Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. Dramatic hypotension sometimes accompanies type I hypersensitivity reactions, because a. massive histamine release from mast cells leads to vasodilation. b. toxins released into the blood interfere with cardiac function. c. anaphylaxis results in large volume losses secondary to sweating. d. hypoxia resulting from bronchoconstriction impairs cardiac function.

ANS: A

Hypotension can occur in type I hypersensitivity resulting from massive histamine release leading to vasodilation. Toxins are not released during type I hypersensitivity reactions.

Sweating occurs as a reaction to shock from severe hypotension; the hypotension occurs first and is because of histamine release. Hypoxia occurs in anaphylaxis as a result of shock from severe hypotension; the hypotension occurs first and is because of histamine release.

2. Which disorder is associated with a type III hypersensitivity mechanism of injury? a. Systemic lupus erythematosus b. Graves disease c. Erythroblastosis fetalis d. Seasonal allergic rhinitis ANS: A

Systemic lupus erythematosus is a type III hypersensitivity disorder. Type III hypersensitivity GpTleBx.dCepOoM is characterized by antigen–aN ntU ibR odSyIcN om sition into tissues, with consequent activation of complement and a subsequent self-sustaining inflammatory reaction. Graves disease and erythroblastosis fetalis are type II hypersensitivity reactions. Seasonal allergic rhinitis is a type I hypersensitivity reaction.

3. A child with a history of recent strep throat infection develops glomerulonephritis. This is

most likely a type a. I b. II c. III d. IV

hypersensitivity reaction.

ANS: C

Immune complex glomerulonephritis (an inflammatory renal disorder) is an example of a type III hypersensitivity reaction. The circulating immune complex is then deposited in the glomerular capillary wall and mesangium. Glomerulonephritis secondary to strep throat is not a type I, II, or IV sensitivity reaction.

4. RhoGAM (an Rh antibody) would be appropriate in an Rh-

Rha. b. c. d.

antibody titer carrying an Rhnegative; positive; positive positive; negative; negative negative; negative; positive negative; negative; negative

fetus.

woman with an

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

ANS: C

If a woman is Rh-negative, RhoGAM is administered for prevention of Rh-positive antibodies. Erythroblastosis fetalis develops during pregnancy when an Rh-negative mother is sensitized to her fetus’s Rh-positive red cell group antigens because of exposure during her current or a previous pregnancy. RhoGAM contains antibodies against Rh antigens on fetal blood cells and is given to the mother to destroy fetal cells that may be present in her circulation before her immune system becomes activated and begins to produce anti-Rh antibodies. RhoGAM is not effective if the mother already has a positive antibody titer for fetal Rh antigens. An Rh-positive woman with negative Rh antibody titer carrying Rh-negative fetus does not require RhoGAM because the mother is Rh-positive and the fetus is Rh-negative.

5. Which disorder is considered a primary immunodeficiency disease? a. HIV/AIDS b. Malnutrition immunodeficiency c. Cancer immunodeficiency d. Radiation immunodeficiency ANS: A

HIV/AIDS is a primary immunodeficiency disease involving destruction of T helper cells.

Malnutrition immunodeficiency is a secondary immunodeficiency disorder and leads to T-cell destruction and dysfunction. Cancer immunodeficiency is a secondary immunodeficiency disorder caused by the destruction of rapidly proliferating cells from chemotherapeutic agents.

Radiation immunodeficiency is a secondary immunodeficiency disorder caused by the destruction of rapidly proliferating cells from the effects of radiation.

6. Patients with immunodeficieN n cUy RdiSsoIrdNeG rsTaB re.uC suOalMly first identified because they a. run high fevers. b. have unusually high WBC counts. c. develop brain infections. d. develop recurrent infections.

ANS: D

The first clinical indicators of immunodeficiency disorders are the signs and symptoms of infection, and the disorders are often first suspected when an individual has severe recurrent, unusual, or unmanageable infections. High fevers can occur in patients who have an intact immune system. Because of the immune deficiency, patients with immunodeficiency disorders may not demonstrate expected WBC counts with infection. Infections in patients with immunodeficiency disorders can occur anywhere in the body.

7. Severe combined immunodeficiency (SCID) syndrome is an example of a(n) a. deficient immune response. b. excessive immune response. c. primary acquired immunodeficiency. d. hypersensitivity reaction.

ANS: A

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

SCID syndrome is an example of a deficient immune response in which the immune response is ineffective because of disease-causing genotypes or secondary/acquired dysfunction. An excessive immune response includes disorders in which the immune system is overfunctioning or hyperfunctioning. HIV/AIDS is an example of a primary acquired immunodeficiency disorder. Hypersensitivity reactions are an excessive immune response.

8. Certain autoimmune diseases are associated with the presence of specific proteins on a

person’s cells. These proteins are called a. complement b. antibody receptor c. HLA or MHC d. TCR or BCR

proteins.

ANS: C

Human major histocompatibility complex (MHC) genes located on chromosome 6p21 (also called human leukocyte antigen (HLA) genes) are frequently associated with certain autoimmune disorders. Complement, antibody receptors, and TCR or BCR are not factors in development of autoimmune disease.

9. The most common primary immune deficiency that affects only B cells is a. DiGeorge. b. Bruton agammaglobulinemia. c. Wiskott–Aldrich. d. selective IgA. ANS: D

The most common B-cell primary immunodeficiency disorder is selective IgA deficiency.

This disorder affects 1:2000 N peU rsR onSsI .D GT eoB rg.eC isOaMT-cell primary immune deficiency.

NiG Bruton agammaglobulinemia is not the most common primary immune deficiency affecting B cells; frequency of disease is 1:250,000 males. Females are carriers. Wiskott–Aldrich affects both T cells and B cells.

10. Transfusion reactions involve RBC destruction caused by a. donor antigens. b. recipient antibodies. c. donor T cells. d. recipient T cells.

ANS: B

The recipient of the blood transfusion has antibodies to the donor’s red blood cell (RBC) antigens; the antibodies destroy large numbers of RBC. Donor antigens, donor T, and recipient T cells do not cause transfusion reactions.

11. The hypersensitivity reaction that does not involve antibody production is type a. I. b. II. c. III. d. IV. ANS: D

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

Type IV hypersensitivity reactions do not involve antibody production. The principal mediators are lymphocytes, including T helper cells (Th) that mediate the reaction by releasing lymphokines (cytokines) and/or antigen-sensitized cytotoxic T cells (Tc) that can directly kill cells. The other types involve antibody production. Type I involves IgE; type II involves IgM or IgG; type III involves IgG. 12. The principle Ig mediator of type I hypersensitivity reactions is a. IgA. b. IgG. c. IgM. d. IgE. ANS: D

Immunoglobulin E (IgE) is the principal antibody mediating type I hypersensitivity reactions.

IgA is not the primary Ig mediator of type I hypersensitivity reactions. IgG is involved in type II hypersensitivity reactions. IgM is involved in type II hypersensitivity reactions.

13. Myasthenia gravis is a type II hypersensitivity disorder that involves a. impaired muscle function. b. symptoms of hyperthyroidism. c. symptoms of arthritis or polyarthralgia. d. symptoms of glomerular disease.

ANS: A

Myasthenia gravis involves muscle weakness caused by loss of acetylcholine stimulation at the motor end-plate. Symptoms of hyperthyroidism occur in Graves disease. Symptoms of arthritis or polyarthralgia occur in systemic lupus erythematosus, a type II hypersensitivity disorder. Glomerular diseaseNc U a nRoS ccIuN r iG nT tyB pe.IC IIOhM ypersensitivity disorders.

14. A primary effector cell of the type I hypersensitivity response is a. monocytes. b. mast cells. c. neutrophils. d. cytotoxic cells.

ANS: B

Mast cells are a primary effector cell of the type I hypersensitivity response. Monocytes, neutrophils, and cytotoxic cells are not primary effectors of the type I hypersensitivity response.

15. An important mediator of a type I hypersensitivity reaction is a. complement. b. antigen–antibody immune complexes. c. T cells. d. histamine.

ANS: D

Histamine mediates type I hypersensitivity reactions. Complement mediates type II hypersensitivity reactions. Antigen–antibody immune complexes mediate type III hypersensitivity reactions. T cells mediate type IV hypersensitivity reactions.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

16. The effects of histamine release include a. vasoconstriction. b. bronchodilation. c. increased vascular permeability. d. decreased gut permeability.

ANS: C

Histamine release leads to increased vascular permeability, which fosters fluid movement out of capillaries and into tissues leading to the edema common in type I hypersensitivity.

Histamine leads to bronchoconstriction, increased gut permeability, and vasodilation (not vasoconstriction).

MULTIPLE RESPONSE 1. Autoimmune diseases result from (Select all that apply.) a. overactive immune function. b. increase in self-tolerance. c. failure of the immune system to differentiate self and nonself molecules. d. communicable infections.

ANS: A, C

Autoimmunity results from a functional increase in the activity of the immune system.

Breakdown of self-tolerance occurs. Genetic and environmental factors are thought to contribute to autoimmunity. Autoimmune disease results from failure of the immune system to differentiate self and nonself molecules; this results in immune reactions that attack normal tissue.

N R I G B.C M

Ns mTay be cOaused by (Select all that apply.)

2. Secondary immune deficiency U proS blem a. surgery. b. high blood sugar. c. corticosteroids. d. genetic disorders. e. low protein level.

ANS: A, B, C, E

Surgery leads to reduced B and T-cell counts. High blood sugar decreases WBC function.

Corticosteroids are immunosuppressive. Antibodies are composed of proteins; low protein level impairs antibody synthesis. Genetic abnormalities of immune components lead to primary immune deficiency problems.

3. Anaphylaxis may occur in certain hypersensitivity reactions, including type (Select all that

apply.) a. I. b. II. c. III. d. IV. ANS: A, B

Anaphylaxis can occur in type I and type II hypersensitivity reactions. Anaphylaxis does not occur in type III or type IV reactions.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

TRUE/FALSE 1. Seasonal allergic rhinitis is most involved in type II hypersensitivity reactions.

ANS: F

Seasonal allergic rhinitis is most involved in type I hypersensitivity reactions.

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Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

Chapter 11: Malignant Disorders of White Blood Cells Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. The major cause of death from leukemic disease is a. infection. b. malnutrition. c. hypovolemic shock. d. kidney failure.

ANS: A Infection is the most common cause of death in the immunocompromised patient, because it can become a life-threatening sepsis. Malnutrition can be a side effect of the disease process or the treatment. Hypovolemic shock is not generally associated with leukemic disease.

There is no direct connection between kidney failure and death in leukemia, although kidney failure may occur as a result of treatment.

2. A 58-year-old woman is seen in the clinic for reports of severe back pain. Her chest x-ray demonstrates generalized bone demineralization and compression fracture. Blood studies demonstrate elevated calcium levels. The most likely diagnosis is a. leukemia. b. myeloma. c. Hodgkin disease. d. back trauma.

N R I G B.C M

U S N T O ANS: B A diagnosis of plasma cell myeloma is confirmed by the presence of hypercalcemia, which can contribute to the compression fracture. Patients with leukemia diagnoses do not exhibit bone demineralization or elevated calcium levels. Lymphadenopathy is a more common manifestation of Hodgkin disease. Compression fractures can be the result of back trauma, but not in the presence of the other radiographic and laboratory results.

3. Renal insufficiency is a common complication of which disease? a. Chronic myeloid leukemia (CML) b. Chronic lymphoid leukemia (CLL) c. Myeloma d. Hodgkin disease ANS: C Renal insufficiency is seen in approximately 50% of patients with plasma cell myeloma, because of hyperproteinemia, Bence Jones protein, hypercalcemia, and hyperuricemia.

Chronic myeloid leukemia is manifested by splenomegaly. Chronic lymphoid leukemia is a disease that affects lymphoid tissues and bone marrow. Malignancy along lymphatic pathways is more typical of Hodgkin disease.

4. The patient is a 12-year-old boy diagnosed with acute lymphoid leukemia (ALL). As part of treatment, the patient must undergo several weeks of chemotherapy. The most serious complication of chemotherapy is

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

a. b. c. d.

vomiting. anemia. alopecia. infection.

ANS: D Infection is the most troublesome complication of chemotherapy for the immunosuppressed patient, and infection is a major cause of death in a leukemic patient. Nausea and vomiting are common findings in the treatment phase. While anemia is a common complication of the disease and treatment, it is not as serious as immunosuppression. Alopecia is an unfortunate side effect of chemotherapy, but is not a life-threatening complication.

5. While in the hospital for management of acute lymphoid leukemia (ALL), a patient develops severe thrombocytopenia. The most appropriate action for this condition is a. anticoagulant therapy. b. chemotherapy. c. activity restriction. d. isolation.

ANS: C Thrombocytopenia can produce a life-threatening hemorrhage. Patients with this condition should be protected from trauma and placed on activity restriction to reduce the risk of bleeding. Anticoagulant therapy in a patient with thrombocytopenia could actually cause the patient more bleeding. Thrombocytopenia is a complication of leukemia and chemotherapy.

Chemotherapy is not an appropriate treatment option for thrombocytopenia. Isolation is not effective in managing the risk of hemorrhage.

N R I G B.C M

6. The Philadelphia chromosomUe isSa bN alanT ced chrO omosome translocation that forms a new gene called a. bcr-abl. b. Rb. c. p53. d. ARA-c.

ANS: A bcr-abl is the translocation of chromosomes 9 and 22, which are known as the Philadelphia chromosome. Rb is a retinoblastoma protein, which is not associated with the Philadelphia chromosome. p53 is a tumor suppressor not associated with the Philadelphia chromosome.

ARA-c is a chemotherapeutic agent used to treat leukemia.

7. Which form of leukemia demonstrates the presence of the Philadelphia chromosome? a. ALL (acute lymphoid leukemia) b. CLL (chronic lymphoid leukemia) c. AML (acute myeloid leukemia) d. CML (chronic myeloid leukemia) ANS: D

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

The majority of CML cases are characterized by malignant granulocytes that carry the Philadelphia chromosome. ALL is manifested by the malignant transformation of B cells and some T cells. CLL is associated with T-cell transformation. The Philadelphia chromosome is not seen in CLL. AML is associated with a transformation of a myeloid stem cell.

8. In general, the best prognosis for long-term disease-free survival occurs with a. ALL (acute lymphoid leukemia). b. CLL (chronic lymphoid leukemia). c. AML (acute myeloid leukemia). d. CML (chronic myeloid leukemia).

ANS: A ALL is highly curable in the pediatric population with an 85% survival rate in children. The average age of patients with CLL is 65 to 70 years. Median survival rate is less than 8 years.

Patients younger than age 60 have a 4-year survival rate of 30% to 40% in AML. CML does not respond well to chemotherapy and carries a long-term survival rate of 50% to 60%.

9. Which type of leukemia primarily affects children? a. ALL (acute lymphoid leukemia) b. CLL (chronic lymphoid leukemia) c. AML (acute myeloid leukemia) d. CML (chronic myeloid leukemia) ANS: A ALL is primarily a disorder of children. The peak incidence occurs between the ages of 3 and 7 years. The average age of patients with CLL is about 65 to 70 years. The median age N R IAvGeTrB.C M of presentation of AML is 64UyeaSrs. N ag e onOset of CML is between 40 and 50 years.

10. Which group of clinical findings describes the typical presentation of ALL (acute lymphoid leukemia)? a. Pain in long bones, infection, fever, bruising b. Vertebral fracture, hypercalcemia, bone pain c. Elevated WBC count found on routine examination, asymptomatic d. Painless enlarged cervical lymph node, fever, weight loss ANS: A The onset of symptoms of ALL is abrupt and may begin when a child refuses to walk or begins to exhibit loss of appetite, fatigue, or abdominal pain. Bruising, fever, and infection are also common early findings. Vertebral fractures, elevated calcium levels, and bone pain are more frequently associated with plasma cell myeloma. Asymptomatic onset is generally found with CLL and is often found by accident on a routine blood count. Enlarged cervical lymph nodes are seen more commonly in Hodgkin disease.

11. What is the correct definition of complete remission (CR) of leukemia? a. CR is the absence of leukemic cells in the blood. b. CR is less than 5% blasts in marrow and normal CBC values. c. CR is absence of leukemic cells regardless of CBC values. d. CR is less than 5% leukemic cells in the blood.

ANS: B

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

Complete remission (CR) is a return to normal hematopoiesis. The bone marrow must have less than 5% blasts and must be maintained for at least 4 weeks in order to achieve CR. CR is an absence of leukemic cells, in addition to normal red cell, platelet, and neutrophil counts. CR must include normal hematopoiesis as well as an absence of leukemic cells. CR must include less than 5% blasts in marrow in addition to no detectible neoplastic cells.

12. Burkitt lymphoma is most closely associated with a. Epstein–Barr virus. b. radiation exposure. c. immunodeficiency syndromes. d. history of cigarette smoking.

ANS: A Epstein–Barr virus has been implicated in the development of Burkitt lymphoma. Radiation exposure is a factor in leukemia and lymphoma because of radiation damage.

Immunodeficiency syndrome has not been found to be associated with Burkitt lymphoma.

Carcinogens found in cigarette smoking are believed to predispose the emergence of malignancies, but are not directly associated with lymphoma.

13. Autologous stem cell transplantation is a procedure in which a. there is a high rejection rate. b. stem cells are transferred to the patient from an HLA-matched donor. c. stem cells are transferred to the patient from an identical twin. d. stem cells are harvested from the patient and then returned to the same patient.

ANS: D In autologous transplantation, the stem cells are collected from the patient’s own blood and N R I G tB.C M er chemotherapy and radiation. The use of then stored and reinfused in tUh e sSa m eNp aT i e n t aftO autologous transplants eliminates the problem of graft-versus-host disease. Transplant from a closely matched donor is known as allogeneic transplant. In autologous transplant, stem cells are used from the patient’s own blood.

14. A diagnostic laboratory finding in myeloma is a. Bence Jones proteins in the urine. b. decreased platelet count. c. increased IgM antibody titer. d. elevated blood glucose levels.

ANS: A Bence Jones protein in the urine is a common clinical manifestation of plasma cell myeloma. It is also known to accumulate in the kidneys and cause kidney damage.

Decreased platelet count is not usually a finding in plasma cell myeloma. IgM is not a factor in plasma cell myeloma. Glucose levels are not directly impacted in plasma cell myeloma.

15. A 5-year-old patient’s parents report loss of appetite and fatigue in their child. The parents also state that the child refuses to walk as a result of pain. The child’s most likely diagnosis is a. ALL (acute lymphoid leukemia) b. CLL (chronic lymphoid leukemia) c. AML (acute myeloid leukemia)

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

d. CML (chronic myeloid leukemia) ANS: A ALL is primarily a disorder of children with an abrupt onset of bone pain, bruising, fever, and infection. Children may refuse to walk and experience fatigue, loss of appetite, and abdominal pain. In CML, AML, and CLL, children do not complain of pain with walking.

Additionally, chronic leukemia is most commonly found in adults.

MULTIPLE RESPONSE 1. The patient is a 12-year-old boy with acute lymphoblastic leukemia (ALL). Manifestations of the patient’s leukemia prior to treatment may include (Select all that apply.) a. anemia. b. leukocytosis. c. leukopenia. d. thrombocytopenia. e. anuria.

ANS: A, B, D Accumulation of leukemic cells in the bone marrow crowds out the production of normal red blood cells, platelets, and leukocytes that leads to anemia, leukocytosis, and thrombocytopenia. Leukopenia is not a manifestation of ALL. Anuria is not a manifestation of ALL. 2. Which viruses have been implicated as cancer-causing agents? (Select all that apply.) a. Epstein–Barr b. Human T-cell leukemiaNURSINGTB.COM c. Human immunodeficiency d. Herpes e. Shingles ANS: A, B, C Epstein–Barr has been linked to Hodgkin disease and Burkitt lymphoma. Human T-cell leukemia virus is linked to the development of adult T-cell lymphoma and leukemia. HIV is linked to B-cell lymphomas. The herpesvirus has been long suspected as a mutagenic agent, but no definitive association has been found. Shingles has not been implicated as a cancer-causing agent.

3. A patient is diagnosed with CML (chronic myeloid leukemia). The patient may experience which of these symptoms? (Select all that apply.) a. Fatigue b. Weight loss c. Abdominal discomfort d. Joint pain e. Sweats ANS: A, B, C, E The usual clinical presentation of CML includes a high granulocyte count on the CBC and splenomegaly. Symptoms of CML include fatigue, weight loss, sweats, bleeding, and abdominal discomfort from the enlarged spleen. Joint pain is not a symptom of CML.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

4. A patient is diagnosed with stage IIA Hodgkin disease. This patient’s clinical stage was most likely determined by (Select all that apply.) a. patient history. b. lymph node biopsy. c. laparotomy results. d. CT scan. e. physical examination.

ANS: A, D, E The patient’s clinical stage is based on history, physical examination, and noninvasive procedures such as CT scanning. The patient’s pathologic stage is determined by the results of invasive procedures, such as laparotomy and tissue biopsy.

5. A patient is diagnosed with stage III non-Hodgkin lymphoma and is preparing to undergo treatment. Which treatments may be used to treat this patient’s cancer? (Select all that apply.) a. Radiation b. Bone marrow transplant c. Chemotherapy d. Lymph node transplant e. Monoclonal antibody therapy ANS: A, B, C, E Radiation, chemotherapy, tissue-specific therapies such as monoclonal antibodies, and bone marrow transplants may all be applicable in treating non-Hodgkin lymphoma. A lymph node transplant is not used N to t R r e a t In o nG- HoBd. gkCin lM ymphoma.

U S N T

O

6. A patient is diagnosed with myeloma. The nurse teaches the patient about the multiple tumor sites that can develop with this cancer. The possible tumor sites in myeloma include the (Select all that apply.) a. liver. b. spleen. c. stomach. d. pancreas. e. kidneys.

ANS: A, B, E Myeloma may invade bone, lymph nodes, liver, spleen, and kidneys. The stomach and pancreas are not usually tumor sites in myeloma.

7. A patient is diagnosed with hairy cell leukemia. The patient’s laboratory results would most likely indicate a decrease in (Select all that apply.) a. granulocytes. b. platelets. c. white blood cells. d. red blood cells. e. melanocytes.

ANS: A, B, D

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

At diagnosis, patients have hairy cells in the peripheral blood as well as reduced numbers of granulocytes, platelets, and red blood cells. White blood cells are not decreased in the presence of cancer. Melanocytes are pigment-producing cells of the skin.

TRUE/FALSE 1. The only known curative treatment for CML is allogeneic bone marrow transplantation from a suitable donor.

ANS: T Allogeneic bone marrow transplantation from a suitable donor is the only curative treatment for CML. 2. Two of the most serious oncology emergencies associated with non-Hodgkin lymphoma are obstruction of the superior vena cava and compression of the spinal cord.

ANS: T Compression of the spinal cord is one of the two most serious oncology emergencies associated with non-Hodgkin lymphoma.

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Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

Chapter 12: HIV Disease and AIDS Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. An effective HIV vaccine is difficult to produce, primarily because a. HIV is not immunogenic. b. B cells are unable to produce antibodies against HIV. c. HIV mutates frequently. d. reverse transcriptase cleaves to the vaccine.

ANS: C The variability between strains of HIV and the frequency of mutations makes it difficult to produce a vaccine. HIV infection does not overwhelm the immune system, because it is an immune deficiency. Research is still being conducted to develop a vaccine. Researchers are testing cloned T cells for response to new therapies. Reverse transcriptase is not proven to adhere to the vaccine.

2. An HIV-positive patient is hospitalized for evaluation of symptoms of progressive weakness, dyspnea, weight loss, and low-grade fever. A biopsy of lung tissue reveals Pneumocystis carinii pneumonia. This diagnosis means that the patient a. has AIDS. b. has less than 2 years to live. c. cannot be treated. d. was an intravenous drug abuser.

N R I G B.C M

U S N T O ANS: A Pneumocystis carinii pneumonia (PCP) is a common initial opportunistic infection in HIV and is an AIDS-defining diagnosis. A diagnosis of PCP is not associated with a life-expectancy of 2 years or less. PCP is treated with antibiotic therapy. PCP is a pulmonary manifestation of AIDS, which is not associated with intravenous drug abuse.

3. The immune system disorder associated with HIV is a. an overactive B-cell system. b. proliferation of immature WBCs (blasts). c. deficiency of T-helper lymphocytes. d. cancerous growth of lymph tissue.

ANS: C HIV has been identified as a type of retrovirus associated with a disorder of the T-helper lymphocytes. T cells have an interaction with B cells, but this relationship is not associated with HIV. Immature blast cells are not the deficiency that contributes to HIV. Cancerous growths of lymphatic tissue have not been found to be the source of HIV. 4. Which statement best describes the etiologic development and transmission of AIDS? a. AIDS is caused by a retrovirus and transmitted through body fluids. b. The mechanism of AIDS transmission is unknown; therefore, AIDS is considered to be highly contagious. c. AIDS is an autoimmune disease triggered by a homosexual lifestyle.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

d. AIDS is caused by a virus that can be transmitted only by sexual contact.

ANS: A AIDS is caused by an infection of HIV, which is proven to be transmitted through blood and body fluids. The mechanism of HIV transmission is known to be through blood and body fluid exposure, newborn infection from the mother, and unprotected sex with an infected partner. AIDS is not an autoimmune disease of the homosexual. HIV can be transmitted through unprotected intercourse. HIV is a virus that is transmitted through various routes, not sexual contact only.

5. HIV infection of T-helper cells is facilitated by attachment of the viral envelope protein gp120 to a. CD8 proteins on suppressor cells. b. reverse transcriptase. c. CD4 proteins on helper cells. d. the macrophage lipid bilayer.

ANS: C The HIV envelope protein gp120 specifically binds to the CD4 receptor. The receptor cells of the CD4 cells are attracted to virus changes. Reverse transcriptase is not found to be attracted to the gp120 protein at this time. The macrophage lipid bilayer is not associated with the CD4 receptor.

6. Which HIV-positive patient should be given a diagnosis of AIDS? a. One who has a CD4 count of 300/µL b. One who has neuropathy eriuRm tI ube G rculB os.isC M c. One who has MycobactN d. One who has genital herpUes S N T O ANS: C AIDS is a syndrome that is expressed in many ways. If a person has a CD4 count less than 200/mL along with an opportunistic infection such as Mycobacterium tuberculosis, then the person is diagnosed with AIDS. A patient is not diagnosed with AIDS until the CD4 count is less than 200/mL. Neuropathy would possibly be a sign or symptom associated with an opportunistic infection, but is not used to diagnose AIDS. Genital herpes is not used to diagnose AIDS. 7. A patient receiving zidovudine and a protease inhibitor to manage HIV infection is found to have an undetectable viral load. This means that the a. dosage of both agents should be reduced. b. zidovudine can be discontinued. c. therapy is effective. d. HIV virus has been eliminated.

ANS: C Protease inhibitors attack at a phase of the viral cycle and are used in conjunction with zidovudine. The goal of treatment is to suppress the viral load. Dosage of both agents would not be reduced, because the undetectable viral load means that the therapy is effective.

Zidovudine would not be discontinued, because it is deemed effective in creating an undetectable viral load in this case. The HIV virus has not been eliminated in the event of an undetectable viral load. Rather, HIV plasma is suppressed and disease progression delayed.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

8. Which statement about HIV testing is correct? a. Any patient can be tested for HIV with or without their informed consent. b. A negative HIV test ensures absence of infection. c. The false-negative rate for HIV testing is zero. d. Significant exposure to infected blood or body fluids requires HIV testing.

ANS: D After a significant exposure to HIV-infected blood or body fluids, health care workers should be treated according to post-exposure protocols. These include testing and possible prophylactic medications. Patients that need to be tested for HIV should always be given the opportunity to provide verbal or written consent according to state consent guidelines.

Negative HIV tests are not always indicative of negative status. False-negative tests can occur during the period before seroconversion. Initial HIV tests are highly sensitive but should always be confirmed with a Western blot test.

9. As of 2014, individuals worldwide have been infected with HIV infection. a. 100,000 b. 1 million c. slightly less than 16 million d. nearly 35 million ANS: D An estimated 36.9 million people were living with HIV worldwide as of 2014. Infection rates are calculated per 100,000 population. In the United States, more than 1 million people have been diagnosed with HIV and AIDS. Of the total number of people infected, women comprise 17.4 million.

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10. Which type of HIV virus causes most infections in the United States and Europe? a. HIV type 1 b. HIV type 2 c. HIV type A d. HIV type B ANS: A HIV-1 is the organism of most cases in Central Africa, the United States, Europe, and Australia. HIV-2 is found in West Africa or in countries with socioeconomic ties to West Africa. HIV type A is a subtype currently in research. HIV type B is a strain in research phases.

11. HIV infection causes immunodeficiency because it a. directly inhibits antibody production by B cells. b. causes the destruction of T-helper cells. c. causes excessive production of cytotoxic T cells. d. blocks the ability of macrophages to present antigens.

ANS: B The hallmark of HIV infection is defective cell-mediated immunity, with a decrease in CD4 or T-helper lymphocytes. HIV infection does not directly inhibit the production of antibodies by B cells. There is not an excessive production of cytotoxic T cells with HIV infection. HIV infection does not block the ability of macrophages to produce antigens.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

12. The clinical latency period after HIV infection is a time when no a. viral replication occurs. b. decline in CD4 lymphocytes occurs. c. virus is detectable in the blood. d. significant symptoms of immunodeficiency occur.

ANS: D This latency period is the time when no significant symptoms occur, although mild symptoms of lymphadenopathy, lack of energy, weight loss, frequent fevers, and sweats may occur. Viral reproduction occurs immediately after the latency period, and can last up to 18 months. A decline in the CD4 T-cell count is taking place during the time of rapid virus production. Seroconversion usually occurs between 3 weeks and 6 months after exposure.

13. HIV replicates very quickly from the onset of infection. What is the major site of HIV replication? a. Vaginal mucosa b. Anal mucosa c. GI tract d. Respiratory tract ANS: C HIV is primarily a mucosal disease that replicates very quickly from the onset of infection.

The GI tract is the major site of HIV replication because the infection replicates quickly in the GI tract and overwhelms the body’s defenses. The vaginal mucosa, anal mucosa, and respiratory tract may be i n vNol vR ed iI n HG I V rBe p.l iCc a t iM o n , but these are not the initial sites of U S N T O infection.

MULTIPLE RESPONSE 1. Which drugs are used for the management of HIV? (Select all that apply.) a. Nucleoside reverse transcriptase inhibitors b. DNA polymerase inhibitors c. Protease inhibitors d. Nonnucleoside reverse transcriptase inhibitors e. CD4 analogs ANS: A, C, D Nucleoside reverse transcriptase inhibitors are used to prevent replication by preventing HIV DNA synthesis. Protease inhibitors attack a phase in the viral life cycle by inhibiting the enzyme protease. Nonnucleoside reverse transcriptase inhibitors are potent antiretrovirals. DNA polymerase inhibitors are not used in the management of HIV. CD4 analogs are nonexistent as a pharmacologic agent.

2. Which modes of transmission occur with HIV infection? (Select all that apply.) a. Sexual transmission b. Parenteral transmission c. Fomite transmission to intact skin d. Perinatal transmission to fetus

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

e. Inhalant transmission ANS: A, B, D Unprotected sex with infected partners is a proven method of HIV transmission. Needle and syringe sharing between intravenous drug users is a proven HIV transmission method.

Transmission from an infected mother to her infant may occur in the intrauterine period or at the time of delivery. The risk of contracting HIV through the skin has only been found with a direct puncture. HIV is not known to be transmitted via aerosol routes.

3. Opportunistic infections are a hallmark of HIV and AIDS. Which infections are considered opportunistic? (Select all that apply.) a. Acinetobacter b. Cytomegalovirus c. Candida albicans d. Pneumocystis carinii e. Clostridium difficile ANS: B, C, D, E Cytomegalovirus is an opportunistic infection seen in AIDS. Candida albicans is an oropharyngeal manifestation seen in most patients with HIV. Pneumocystis carinii is a respiratory manifestation and a major source of morbidity and mortality in the AIDS patient.

Clostridium difficile is a gastrointestinal manifestation of HIV. The GI tract is the major target organ in HIV infection, and malnutrition is the leading cause of death among AIDS patients worldwide. Acinetobacter is not typically associated with HIV and AIDS. 4. A patient is infected with the retrovirus HIV. The patient may have contracted HIV as it was transmitted via (Select all tN hat R appI l y. ) G B.C M U S N T O a. saliva. b. tears. c. semen. d. cervical secretions. e. cerebrospinal fluid.

ANS: C, D HIV is transmitted in three ways: sexual transmission via semen or vaginal and cervical secretions through homosexual or heterosexual intercourse; parenteral transmission via blood, blood products, or blood-contaminated needles or syringes; and perinatal transmission in utero, during delivery, or in breast milk. HIV is known to be present in but has not been shown to be transmitted via urine, saliva, tears, cerebrospinal fluid, amniotic fluid, and feces. HIV is not known to be transmitted via aerosol routes.

5. The HIV nurse educator teaches a newly diagnosed patient about HIV. The nurse educator tells the patient that in the United States, those at greatest risk of HIV infection include (Select all that apply.) a. infants born to infected fathers. b. heterosexual women. c. homosexual men. d. restaurant workers. e. men over age 50.

ANS: B, C

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

In the United States, those at greatest risk of HIV infection include: men who have sex with other men (MSM), also called homosexual men; intravenous drug users who share needles or syringes; sexual partners of those in high risk groups, particularly heterosexual women; and infants born to infected mothers. Infants born to infected mothers, not infected fathers, are at greatest risk of HIV infection. Restaurant workers are not at greater risk of HIV infection solely because of their working in the restaurant industry. Using public restrooms, swimming in public swimming pools, touching or hugging someone who is HIV-positive, and eating with community utensils or in restaurants are safe practices. Approximately 10% to 11% of all HIV cases involve people over age 50, but this does not comprise the highest-risk group.

6. A nurse who works in an assisted living facility is preparing to teach the residents about safe sex practices. What resident criteria should the nurse take into consideration when creating a teaching plan? (Select all that apply.) a. Age b. Ethnicity c. Culture d. Sexual preference e. Mobility status ANS: A, B, C, D It is important that education regarding safe sex practices be tailored to appropriate age groups, ethnicity, culture, and sexual preference. Mobility status is not a consideration when teaching about safe sex practices.

7. In which type of cells is the CD4 found? (Select all that apply.) a. T cells NURSINGTB.COM b. Microglial cells c. Retinal cells d. Cervical cells e. Pacemaker cells ANS: A, B, C, D The CD4 receptor is found on many types of cells, including T cells, microglial cells, monocyte-macrophages, follicular dendritic cells, immortalized B cells, retinal cells, Langerhans cells in the skin, bone marrow stem cells, cervical cells, bone marrow–derived circulating dendritic cells, and enterochromaffin cells in the colon, duodenum, and rectum.

8. A patient presents to the clinic with flulike symptoms and a rash. The nurse knows that the type of rash associated with HIV may include (Select all that apply.) a. maculopapular. b. vesicular. c. impetigo. d. urticarial. e. psoriasis.

ANS: A, B, D The rash in HIV is not the same in every patient and may be maculopapular, vesicular, or urticarial. Impetigo and psoriasis are not rashes linked to HIV.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

9. The CDC defines three CD4+ T-cell categories of T cell ranges. Which values are correct?

(Select all that apply.) a. In category 1, the CD4+ T-cell count is greater than or equal to 500/mL. b. In category 1, the CD4+ T-cell counts range from 200 to 499/mL. c. In category 2, the CD4+ T-cell counts range from 200 to 499/mL. d. In category 3, the CD4+ T-cell count is less than 200/mL. e. In category 3, the CD4+ T-cell count is less than 300/mL. ANS: A, C, D In category 1, the CD4+ T-cell count is greater than or equal to 500/mL. In category 2, the CD4+ T-cell counts range from 200 to 499/mL. In category 3, the CD4+ T-cell count is less than 200/mL. TRUE/FALSE 1. Cleaning dirty needles prior to use helps prevent the spread of HIV. When using bleach, the user must rinse out all the blood first and then fill the needle and syringe with full-strength bleach three times for 10 to 20 seconds.

ANS: F After rinsing all the blood first, the user fills the needle and syringe with full-strength bleach at least three times for 30 to 60 seconds.

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Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

Chapter 13: Alterations in Oxygen Transport Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. The primary source of erythropoietin is provided by the a. bone marrow. b. kidney. c. lung. d. liver.

ANS: B Erythropoietin is a hormone that is secreted into the bloodstream by the kidney. Bone marrow is not responsible for the production of erythropoietin. Hypoxia from low hemoglobin levels causes a decrease in tissue oxygen tension in the kidney, thereby releasing the hormone erythropoietin. The liver is not associated with erythropoietin production.

2. Which condition is associated with an elevated reticulocyte count? a. Renal disease b. Aplastic anemia c. Hypertension d. Hemolytic anemia ANS: D Hemolytic anemia is associated with an increased number of circulating reticulocytes or N R iI G B.C M reticulocytosis. Anemia of c hUr o nS c reNnalTfailure Ois not associated with reticulocytosis.

Rather, it occurs from failure of the renal endocrine function. Aplastic anemia is a stem cell disorder that is characterized by pancytopenia, a decrease in red cells, white cells, and platelets. Hypertension is not related to reticulocytosis.

3. The strength of the bond between oxygen and hemoglobin is known as the a. Bohr effect. b. oxygen-hemoglobin affinity. c. dissociation curve. d. hemoglobin synthesis.

ANS: B The strength of the bond between oxygen and hemoglobin is called the oxygen-hemoglobin affinity. Hemoglobin saturation is higher when oxygen infinity is increased, and saturation is lower when affinity is decreased. The Bohr effect occurs when the oxyhemoglobin dissociation curve experiences a shift resulting from changes in PCO2 and H+ concentration.

The dissociation curve describes the relationship between the partial pressure of oxygen and hemoglobin saturation. Hemoglobin synthesis occurs in the immature red cell.

4. An increase in hemoglobin affinity for oxygen occurs with a. hyperthermia. b. shift to the right. c. elevated PCO2.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

d. shift to the left.

ANS: D An increase in oxygen affinity is known as a shift to the left on the dissociation curve.

Hyperthermia does not have an effect on the hemoglobin affinity. Elevation in PCO2 is seen with changes in pH. A decrease in the oxygen affinity is associated with a shift to the right on the oxyhemoglobin dissociation curve.

5. What is necessary for red blood cell production? a. Phosphate b. Iron c. Magnesium d. Calcium ANS: B Immature red blood cells produce hemoglobin, which is composed of two pairs of polypeptide chains, the globins. Each globin has an attached heme molecule that contains iron. Dietary iron is transported through the plasma on the RBC membrane. Phosphates are not a necessary component of red blood cell production. Magnesium is not a part of the production of red blood cells. Calcium is not involved in red blood cell production.

6. Red blood cells differ from other cell types in the body, because they a. contain cytoplasmic proteins. b. have no cytoplasmic organelles. c. have a longer life span. d. contain glycolytic enzymes.

NURSINGTB.COM ANS: B Red blood cells have no cytoplasmic organelles, nucleus, mitochondria, or ribosomes.

Therefore, RBCs cannot synthesize protein or carry out oxidative reactions. Red blood cells are not capable of synthesizing protein because of their lack of organelles. Red blood cells live for 80 to 120 days in the circulation and then die and are replaced. Red blood cells do not contain glycolytic enzymes.

7. Which characteristic is indicative of hemolytic anemia? a. Increased total iron-binding capacity b. Increased heart rate c. Hypovolemia d. Jaundice ANS: D Jaundice is a classic clinical manifestation of hemolytic anemia. The total iron-binding capacity in hemolytic anemia is not increased. Hemolytic anemia is not generally associated with an increased heart rate unless there is aplastic crisis associated with infection.

Hypovolemia is not an indication of hemolytic anemia.

8. A low mean corpuscular hemoglobin concentration (MCHC) and mean corpuscular volume (MCV) are characteristic of which type of anemia? a. Vitamin B12 deficiency b. Folate deficiency c. Iron deficiency

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

d. Erythropoietin deficiency ANS: C Iron-deficiency anemia is characterized by a low hemoglobin concentration and low mean corpuscular volume. Vitamin B12 deficiency anemia is characterized by a high concentration of MCV and a normal level of MCHC. Folate deficiency anemia is characterized by a normal mean corpuscular hemoglobin concentration and a high mean corpuscular volume.

Erythropoietin deficiency creates hypoxia from a low hemoglobin level.

9. The arterial oxygen content (CaO2) for a patient with PaO2 100 mm Hg, SaO2 95%, and hemoglobin 15 g/dL is mL oxygen/dL. a. 19.4 b. 1909.8 c. 210 d. 21.05 ANS: A A hemoglobin level of 15 divided by 100 equals 0.15. Multiply by 1.34 mL and then multiply by saturation on 95%. The result is 19.1% oxyhemoglobin. Then add 0.3% volume dissolved in plasma to get the total content of oxygen/dL. The arterial blood oxygen content is the amount of oxygen carried in the arterial blood. 1909.8 is an incorrect answer if the formula is followed correctly. 210 is incorrect when the formula is applied correctly. 21.05 is an incorrect response if the formula is applied correctly.

10. Most carbon dioxide is transported in the bloodstream as a. carboxyhemoglobin. b. bicarbonate ion.

NURSINGTB.COM c. dissolved carbon dioxide. d. carbonic acid.

ANS: B Approximately 90% of the CO2 in the arterial blood and 60% of the CO2 in the venous blood are transported as bicarbonate. Carbon dioxide is not transported as carboxyhemoglobin. Some of the remaining carbon dioxide binds with protein to form carbaminohemoglobin for CO2 transport, but dissolved carbon dioxide is not the primary means of bloodstream transportation. Carbonic acid is disassociated into hydrogen and bicarbonate ions for elimination by the lungs and kidneys.

11. The most appropriate treatment for secondary polycythemia is a. volume expansion with saline. b. measured to improve oxygenation. c. phlebotomy. d. chemotherapy.

ANS: B Secondary polycythemia is because of chronic hypoxemia with a resultant increase in erythropoietin production. The goal of treatment is aimed at measures to reduce hypoxemia and improve oxygenation by implementing oxygen therapy. IV fluids may be used to treat relative polycythemia, because it is related to dehydration. Phlebotomy or increases in laboratory studies do not have an effect on secondary polycythemia. Polycythemia is not treated with chemotherapeutic agents.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

12. A laboratory test finding helpful in confirming the diagnosis of iron-deficiency anemia is a. elevated total iron-binding capacity. b. elevated MCHC and MCV. c. elevated total and indirect bilirubin. d. positive direct or indirect Coombs test.

ANS: A In iron-deficiency anemia, the total iron-binding capacity is elevated. The red cell indices of MCHC and MCV are decreased in iron-deficiency anemia. Total and indirect bilirubin levels are not utilized in diagnosing iron-deficiency anemia. Coombs testing is not utilized in obtaining a diagnosis of iron-deficiency anemia.

13. Excessive red cell lysis can be detected by measuring the serum a. hemoglobin. b. methemoglobin. c. bilirubin. d. erythropoietin.

ANS: C Any condition causing increased red cell destruction increases the total load of bilirubin to be cleared, which leads to increased serum bilirubin levels and possible jaundice. Red cell destruction does not lead to changes in the hemoglobin level. Methemoglobin is formed when iron of the hemoglobin molecule is oxidized to the ferric state. Erythropoietin is secreted in response to hypoxia.

14. Red blood cells obtain nearN ly aRl l thIeir G enerBg. yC fromMmetabolism of U S N T O a. glucose. b. fats. c. proteins. d. acetyl coenzyme A. ANS: A For RBCs to survive and perform efficiently, they must have a source of energy. Essential for red blood cell viability is the glucose that is used for metabolism. RBC membrane structures are formed from double layer of phospholipids. Fats do not provide energy to red blood cells. A protein network on the surface of the membrane is important for cell structure, but does not provide energy for red blood cell production and maintenance. Acetyl coenzyme A is not a factor in providing energy to the red blood cells.

15. What laboratory finding is usually found in aplastic anemia? a. Leukocytosis b. Thrombocythemia c. Neutrophilia d. Pancytopenia ANS: D

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

Aplastic anemia is a stem cell disorder affecting the bone marrow mass. It is usually caused by toxic, radiant, or immunologic injury to the bone marrow stem cells, which causes a decrease in red cells, white cells, and platelets, or pancytopenia. Thrombocythemia causes an increased number of platelets and is not found in aplastic anemia. Leukocytosis indicates a higher white blood count and is not found in aplastic anemia. The presence of neutrophils in laboratory findings does not indicate a diagnosis of aplastic anemia.

16. The most effective therapy for anemia associated with kidney failure is a. iron administration. b. high-protein diet. c. erythropoietin administration. d. vitamin B12 and folate administration.

ANS: C Therapy in anemia of chronic renal failure consists of dialysis and erythropoietin administration. The use of erythropoietin stimulating agents is to increase hemoglobin values to ensure adequate oxygen-carrying capacity. Iron, folate, and vitamin B12 replacement are initiated if necessary. Iron administration is utilized in iron-deficiency anemia. A high-protein diet is not the treatment of choice in the patient with renal failure, and a high-protein diet may be contraindicated. Vitamin B12 and folate are prone to nutritional anemias and receive replacement to adequate levels if necessary. However, dialysis and erythropoietin are more effective.

17. Pernicious anemia is caused by a lack of a. iron. b. intrinsic factor. c. folate.

NURSINGTB.COM d. erythropoietin.

ANS: B The fundamental defect causing pernicious anemia is the lack of intrinsic factor. Without it, vitamin B12 cannot be absorbed. Iron deficiency does not lead to pernicious anemia. Rather, it is the most common cause of anemia and is the result of unavailability of iron for hemoglobin synthesis. Pernicious anemia and folate deficiency are similar in etiology. Both are caused by a disruption in DNA synthesis of blast cells in bone marrow. Erythropoietin is necessary for the production of red cells.

18. The cause of the most common form of anemia is a. acute bleeding. b. iron deficiency. c. protein malnutrition. d. chronic disease.

ANS: B Iron deficiency is the most common nutritional deficiency in the world and the most common cause of anemia. Acute blood loss anemia is the result of trauma or disease processes and is highly treatable. Plasma proteins formed in the liver are an essential factor in regulating blood volume. It is important to determine the underlying cause of the anemia so that treatment and control are effective.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

19. Thalassemia may be confused with iron-deficiency anemia, because they are both a. hyperchromic. b. microcytic. c. genetic. d. responsive to iron therapy.

ANS: B Both thalassemia and iron-deficiency anemia reveal hypochromic, microcytic red cells.

Thalassemia and iron-deficiency red cells are hypochromic. Genetics play a role in thalassemia, and are found primarily in Asian individuals. Iron-deficiency anemia is responsive to iron therapy, but thalassemia patients have increased iron absorption.

20. Patients who experience anemic episodes when exposed to certain drugs most likely have a. thalassemia. b. spherocytosis. c. sickle cell anemia. d. glucose-6-phosphate dehydrogenase deficiency.

ANS: D Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a RBC intracellular defect.

Usually this anemia is first recognized during or after an infectious illness or exposure to certain drugs. Thalassemia does not carry a manifestation associated with pharmacologic agents. Spherocytosis is a hereditary anemia with manifestations of jaundice. Episodes of sickle cell anemia are associated with recurrent painful episodes related to organ dysfunction.

MULTIPLE RESPONSE

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1. A patient is diagnosed with aplastic anemia. The nurse expects to find what patient symptoms upon assessment? (Select all that apply.) a. Lethargy b. Heart palpitations c. Transient murmurs d. Bradycardia e. Orthopnea ANS: A, B, C The symptoms of aplastic anemia are because of the gradual fall of red blood cells and include weakness, fatigue, lethargy, pallor, dyspnea, palpitations, onset of transient murmurs, and the tachycardia of anemia. Bradycardia is not a common symptom of aplastic anemia. Orthopnea is not a common symptom of aplastic anemia.

2. The nurse is educating a patient diagnosed with anemia of chronic renal failure about the disease. Which statements made by the nurse are correct regarding the patient’s treatment?

(Select all that apply.) a. “Since your glomerular filtration is 13 mL/min, you’ll be started on dialysis.” b. “Your hematocrit is 29%, so you’re going to start on erythropoietin therapy.” c. “Your hemoglobin is 9 g/dL, so you’ll need erythropoietin therapy.” d. “We need to get your hemoglobin up to at least 15 g/dL” e. “You’re going to need iron, folate, and B12 therapy to help improve your blood

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

counts.”

ANS: A, B, C, E Therapy for anemia of chronic renal failure consists of dialysis when the glomerular filtration rate is less than 15 mL/min, and erythropoietin is administered to achieve the target hematocrit of 33% to 36% and hemoglobin of 11 to 12 g/dL. Patient replacement of iron, folate, and B12 to adequate levels is also recommended. Using erythropoiesis-stimulating agents to increase hemoglobin values to greater than 12 g/dL is not routinely recommended.

3. Anemia related to vitamin B12 or folate deficiency is characterized by what laboratory features? (Select all that apply.) a. RBC counts of 775,000 to 900,000 cells/mm3 b. RBC counts of 500,000 to 750,000 cells/mm3 c. WBC counts of 3000 to 4000 cells/mm3 d. WBC counts of 4000 to 5000 cells/mm3 e. Platelet counts of 60,000 cells/mm3 ANS: B, D Anemia related to vitamin B12 or folate deficiency is characterized by low RBC counts of 500,000 to 750,000 cells/mm3. Anemia related to vitamin B12 or folate deficiency is characterized by low WBC counts of 4000 to 5000 cells/mm3. Anemia related to vitamin B12 or folate deficiency is characterized by low RBC counts of 500,000 to 750,000, not 775,000 to 900,000 cells/mm3. Anemia related to vitamin B12 or folate deficiency is characterized by low WBC counts of 4000 to 5000 cells/mm3, not 3000 to 4000 cells/mm3.

Anemia related to vitamin B12 or folate deficiency is characterized by low platelet counts of 50,000 cells/mm3.

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4. Regarding iron-deficiency anemia, what laboratory features are typically decreased? (Select all that apply.) a. MCV b. MCH c. MCHC d. WBC e. Thrombocytes ANS: A, B, C In iron-deficiency anemia, the red cells are smaller and paler than normal cells as a result of the decreased amount of hemoglobin and are described as hypochromic, microcytic red cells. The red cell indices MCV, MCH, and MCHC are decreased. White cell counts in iron-deficiency anemia are usually normal. Thrombocyte counts in iron-deficiency anemia are usually normal.

5. One of the cardinal features of sickle cell anemia includes acute and chronic dysfunction of which organs? (Select all that apply.) a. Spleen b. Bones c. Brain d. Lungs e. Stomach

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

ANS: A, B, C, D Acute and chronic organ dysfunction of the spleen, bones, brain, kidneys, lungs, skin, and heart are found in sickle cell anemia. Dysfunction of the stomach is not found in sickle cell anemia.

6. A newborn patient is diagnosed with hemolytic disease. The nurse may expect to find what signs and symptoms? (Select all that apply.) a. Petechial hemorrhages b. Hepatomegaly c. Splenomegaly d. Kernicterus e. Erythema ANS: A, B, C, D The clinical manifestations of hemolytic disease in the newborn are jaundice, petechial hemorrhages, hepatomegaly, splenomegaly, heart failure, kernicterus, and diffuse intervascular coagulation. Jaundice, not erythema, is found in the newborn diagnosed with hemolytic disease.

7. Hapten mechanisms are found in which medications? (Select all that apply.) a. Ibuprofen b. Narcotics c. Penicillin d. Cephalosporins e. Tetracycline ANS: C, D, E NURSINGTB.COM In the hapten mechanism, which is seen with penicillin, cephalosporins, and tetracycline, the drug combines with a component of the RBC membrane and an antibody is developed against the drug. Hapten mechanism is not seen in ibuprofen or narcotics.

TRUE/FALSE 1. The anemia resulting from a deficiency of either vitamin B12 (cobalamin) or folate is caused by a disruption in DNA synthesis of the blast cells in the bone marrow that produces very large abnormal bone marrow cells called megaloblasts.

ANS: T Megaloblasts are large abnormal bone marrow cells.

2. Vaccination for pneumococcal pneumonia should be performed before 1 year of age in patients with sickle cell anemia.

ANS: F Vaccination for pneumococcal pneumonia should be performed before 2 years of age in patients with sickle cell anemia and booster vaccinations given 3 to 5 years later.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

Chapter 14: Alterations in Homeostasis and Blood Coagulation Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. A normal bleeding time in association with normal platelet count, and increased prothrombin

time (PT) and INR, is indicative of a. vitamin K deficiency. b. hemophilia B. c. hemophilia A. d. idiopathic thrombocytopenia.

ANS: A

Vitamin K deficiency should be considered as the cause for bleeding when the PT and INR are increased but other coagulation studies are normal. Hemophilia B results from factor deficiency or the abnormal function of factor IX. Hemophilia A results from factor deficiency or the abnormal function of factor VIII. In idiopathic thrombocytopenia, a decreased platelet count is seen in prolonged bleeding times.

2. The final step in clot formation is a. conversion of prothrombin to thrombin. b. platelet degranulation and adhesion. c. conversion of fibrinogen to fibrin. d. clot retraction.

ANS: D

Clot retraction, the final s t a g N e oUfR clS otIfN orG mT atB io. n,CoO ccMurs when the components of the fibrin clot are compressed or contracted to form a firm clot. Platelets serve as a catalyst in accelerating the conversion of prothrombin to thrombin. Platelet degranulation is not involved in clot formation. The formation of a fibrin clot occurs when fibrinogen is converted to fibrin, usually at the site of an injury.

3. Dysfunction of which organ would lead to clotting factor deficiency? a. Liver b. Kidney c. Spleen d. Pancreas ANS: A

The liver is responsible for the synthesis of coagulation factors. A clotting factor deficiency is the result of liver dysfunction. Coagulation does not occur in the kidneys. About 25% of the total number of platelets can be found in the spleen. The pancreas is not a location where coagulation occurs.

4. The conversion of plasminogen to plasmin results in a. clot retraction. b. fibrinolysis. c. platelet aggregation. d. activation of thrombin.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

ANS: B

Fibrinolysis is the process of clot dissolution and occurs when plasminogen activators cleave plasminogen to plasmin. Clot retraction occurs when the components of the fibrin clot are compressed or contracted to form a clot. Factors released from platelets contribute to hemostasis by enhancing vasoconstriction, platelet aggregation, and vessel repair. Platelet aggregation is not the result of plasmin conversion. Thrombin cleaves fibrinogen to form a fibrin clot.

5. Activation of the extrinsic pathway of coagulation is initiated by a. platelet factors. b. collagen exposure. c. tissue thromboplastin. d. factor VII. ANS: C

The extrinsic pathway of coagulation begins when the vascular wall is traumatized. Tissue factor from injured tissue activates factors which in turn activate and convert into thrombin for clotting. Platelets play a major role in primary hemostasis as well as secondary hemostasis and clot retraction. Platelets accelerate the conversion of prothrombin to thrombin. Platelets adhere to collagen exposed by trauma and initiate degranulation. Factor VII is involved in the extrinsic pathway of coagulation when it is activated by tissue factor following a traumatic injury.

6. The prothrombin time (PT) and INR (international normalized ratio) measure the integrity of a. platelet function. b. extrinsic pathway. c. intrinsic pathway.

NURSINGTB.COM d. fibrinolysis.

ANS: B

The PT and INR assess the extrinsic pathway of coagulation. Platelet function is measured through a CBC. The aPTT assesses the intrinsic pathway of coagulation. The D-dimer assay reflects fibrinolysis.

7. The activated partial thromboplastin time (aPTT) is a measure of the integrity of a. the extrinsic pathway. b. the intrinsic pathway. c. factor VIII synthesis. d. plasminogen.

ANS: B

The intrinsic pathway is assessed through the aPTT. The extrinsic pathway is assessed through measurements of the PT and INR. An abnormal factor VIII function results in hemophilia A. The deficiency is verified by factor assay. The aPTT is not utilized to assess the integrity of plasminogen.

8. A commonly ingested substance associated with prolongation of the bleeding time is a. acetaminophen. b. tobacco. c. caffeine. d. aspirin.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

ANS: D

Many drugs are associated with prolonged bleeding times. Aspirin is known to alter normal platelet function. Acetaminophen is not associated with prolongation of bleeding time.

Tobacco does not interfere with bleeding times. Caffeine does not interfere with bleeding times.

9. The megakaryocyte is a precursor to a. factor IX. b. white blood cells. c. red blood cells. d. platelets.

ANS: D

Platelets are produced by bone marrow megakaryocytes. Production falls when the number of megakaryocytes is reduced or when the process of platelet production is ineffective. One major role in the formation of factor IX is the presence of calcium. White blood cells are not formed in response to megakaryocytes. Megakaryocytes are not a precursor to red blood cells.

10. A cause of thrombocytopenia includes a. hypoxemia. b. reduced erythropoietin. c. chemotherapy. d. secondary polycythemia.

ANS: C

Bone marrow suppression from chemotherapy, recent immunizations, and alcohol ingestion are common causes of platelet systemic diseases may be presently N production.

RS I NG Underlying B.C M U T O related to bleeding problems. H y p o x e m i a is not d irectly associated with thrombocytopenia. A reduction in erythropoietin is not associated with alterations in coagulation. Secondary polycythemia is not a cause of thrombocytopenia.

11. Widespread activation of the clotting cascade secondary to massive trauma is called a. hemophilia B. b. disseminated intravascular coagulation (DIC). c. Hageman disease. d. idiopathic thrombocytopenia purpura.

ANS: B

Widespread clotting in small vessels leads to consumption of the clotting factors and platelets, which in turn leads to bleeding. DIC is either acute or chronic and occurs secondary to malignancy, sepsis, snake bites, trauma, shock, burns, and many other factors. Hemophilia B results from factor deficiency or the abnormal function of factor IX. Massive trauma is unrelated to the development of Hageman disease. Immune thrombocytopenia, formerly called idiopathic thrombocytopenia purpura, is an acquired immune-mediated disorder.

12. A 3-year-old boy who exhibits prolonged bleeding after minor trauma and a prolonged aPTT,

but a normal platelet count, is likely to be diagnosed with a. hemophilia. b. liver dysfunction. c. disseminated intravascular coagulation.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

d. thrombocytopenia.

ANS: A

Hemophilia is rare, but it is the most common severe inherited coagulation disorder.

Prolonged bleeding from a minor trauma is a characteristic manifestation. Liver disease is commonly manifested by a decreased platelet count and prolonged coagulation studies. DIC is more often seen in adults as the result of trauma or sepsis. A very low platelet count is often seen in thrombocytopenia.

13. Treatment for hemophilia A includes a. heparin administration. b. factor IX replacement. c. factor VIII replacement. d. platelet transfusion.

ANS: C

Factor VIII administration is a common treatment choice for hemophilia A, particularly with dental procedures requiring local anesthesia. Heparin administration is typically highly contraindicated in an individual with a bleeding disorder although in some cases it is given to patients with DIC. Factor IX may be available as a treatment option for hemophilia B. A platelet transfusion is not of benefit in the hemophilia A patient.

14. Disseminated intravascular coagulation may be treated with heparin therapy to a. enhance fibrinolysis. b. inhibit clotting factor consumption. c. activate platelets. d. enhance liver synthesis of clotting factors.

ANS: B

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Although controversial, heparin may be used to minimize further consumption of clotting factors. Fibrinolysis is not enhanced by the use of heparin. The use of heparin does not activate platelets. Heparin is not known to enhance liver synthesis of clotting factors.

15. A deficiency of von Willebrand factor impairs a. activation of the coagulation cascade. b. platelet aggregation. c. platelet adhesion to injured tissue. d. platelet production.

ANS: C

Absence of platelet adhesion at the site of vascular injury and deficient factor VIII activity in the intrinsic coagulation pathway contribute to the bleeding seen in von Willebrand disease.

The coagulation cascade is not activated by a deficiency of von Willebrand factor. Platelet aggregation is not related to a deficiency of the von Willebrand factor. von Willebrand factor is necessary for normal adherence of platelets for damaged vascular endothelium.

16. A patient presents to the physician’s office with pinpoint hemorrhages on the skin. The patient

is most likely between the ages of a. 6 months and 2 b. 4 and 7 c. 15 and 18

years.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

d. 25 and 45 ANS: B

Allergic purpura is most often seen in children between the ages of 4 and 7 years. Allergic purpura is not often seen in infants, teenagers, or adults.

17. A patient is diagnosed with a tortuous blood vessel of the right hand that bleeds

spontaneously. This patient presents with a. petechiae. b. purpura. c. telangiectasia. d. thrombocytosis.

ANS: C

A telangiectasia is a dilated or tortuous small blood vessel found in the skin or mucous membranes that have a tendency to bleed spontaneously or following minor trauma. Petechiae are pinpoint hemorrhages. Purpura is a collection of petechiae. Thrombocytosis is a platelet count above 400,000/mm3.

18. A newborn has melena, bleeding from the umbilicus, and hematuria. The newborn most likely

experiencing a. vitamin K deficiency bleeding. b. acquired vitamin K deficiency. c. von Willebrand disease. d. disseminated intravascular coagulation.

ANS: A

Vitamin K deficiency bleedinNg isRfouInd G in nB ew bCornM s and includes melena, bleeding from the .O U S N T umbilicus, and hematuria. Acquired vitamin K deficiency may include gastrointestinal bleeding, ecchymoses, menorrhagia, and hematuria. von Willebrand disease presents as epistaxis, mucosal bleeding, ecchymoses, gastrointestinal bleeding, and menorrhagia.

Disseminated intravascular coagulation includes bleeding from orifices, petechiae, and ecchymoses on skin and mucous membranes.

MULTIPLE RESPONSE 1. What is involved in the release of plasminogen activators? (Select all that apply.) a. Factor X b. Factor XII c. HMWK d. Kallikrein e. Thrombin ANS: B, C, D, E

Factor XII, HMWK, kallikrein, and thrombin are involved in the release of plasminogen activators. Factor X initiates the common final pathway of coagulation.

2. Which involves bleeding associated with vascular or platelet defects? (Select all that apply.) a. Bleeding that occurs immediately after trauma b. Bleeding that involves skin or mucous membranes c. Bleeding that is brief in duration

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

d. Bleeding that is delayed e. Bleeding into muscles or joints ANS: A, B, C

Bleeding associated with vascular or platelet defects usually occurs immediately after trauma (e.g., dental extraction), involves skin or mucous membranes, and is brief. Delayed bleeding or bleeding into muscles or joints is more typical of a coagulation defect.

3. Which diseases may be associated with a bleeding problem? (Select all that apply.) a. Urinary retention b. Renal failure c. Cirrhosis d. Systemic lupus erythematosus e. Ovarian cancer ANS: B, C, D, E

Renal failure may be associated with a bleeding problem. Liver disease, such as cirrhosis, may be associated with a bleeding problem. Systemic lupus erythematosus may be associated with a bleeding problem. Malignancies, such as ovarian cancer, may be associated with a bleeding problem. Urinary retention is not a disease.

4. A male patient involved in a motor vehicle accident is brought to the emergency department

with acute flank pain. What additional signs of bleeding may the patient exhibit? (Select all that apply.) a. Hematuria b. Melena c. Hematemesis NURSINGTB.COM d. Menorrhagia e. Hemoptysis ANS: A, B, C, E

Blood in the urine is indicative of a bleeding disorder. Blood in the feces could indicate internal bleeding. Blood in vomit may signify a bleeding disorder. Menorrhea is excessive menstrual bleeding, which would not be seen in the male patient. Bloody sputum is a common symptom of a bleeding disorder.

TRUE/FALSE 1. The liver is responsible for the synthesis of coagulation factors, with the exception of part of

VIII. ANS: T

The liver is responsible for the synthesis of coagulation factors, with the exception of part of factor VIII. 2. Hemophilia B is also known as Christmas disease.

ANS: T

Hemophilia B is also known as Christmas disease.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

Chapter 15: Alterations in Blood Flow Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. Which vessel normally demonstrates the most rapid blood flow? a. An arteriole b. A capillary c. A venule d. The vena cava ANS: D

The vena cava has the most rapid rate of flow. Arterioles don’t offer the most rapid blood flow. Capillaries are composed of a single thickness of endothelial cells attached to a protein network called the basement membrane and don’t offer the most rapid blood flow. A venule begins where the arteriole ends and doesn’t offer the most rapid blood flow.

2. The movement of blood through the vascular system is opposed by the force of a. viscosity. b. the vessel length. c. the vessel radius. d. resistance.

ANS: D

The movement of blood through the vascular system is opposed by the force of resistance.

Three determinants of resistance are vessel length, vessel radius, and blood viscosity.

Viscosity is the thickness of N fluUidRaSnI dN haG sT anBe.ffC ecOt M on resistance. The length of the vessel does have an effect on the resistance. Vessel radius has an effect on resistance.

3. Which causes vasoconstriction? a. Norepinephrine b. Calcium channel blocker c. -Adrenergic antagonist d. Acetylcholine ANS: A

The release of norepinephrine results in arterial vasoconstriction via receptors located on the vascular smooth muscle walls. Calcium channel blockers produce vasodilation by interfering with calcium intake into the vascular smooth muscle cells. -Adrenergic antagonists do not cause vasoconstriction. Acetylcholine does not have an effect on vasoconstriction.

4. When systemic vascular resistance is decreased, blood flow a. increases. b. decreases. c. stays the same. d. moves to the extremities.

ANS: B

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

When SVR is pathologically decreased, the blood is spread over a larger area and blood flow slows dramatically. Individual organs, such as the kidney and brain, may not obtain sufficient blood flow to meet metabolic needs. Blood flow decreases in response to decreases in vascular resistance. When SVR is pathologically decreased, the blood is spread over a larger area and blood flow slows dramatically. Individual organs, such as the kidney and brain, may not obtain sufficient blood flow to meet metabolic needs. Blood flow is not diverted to the extremities when systemic vascular resistance is decreased. However, the vital organs may not have sufficient blood flow to maintain metabolic needs.

5. Blood flow is slow through capillaries because capillaries a. are so far away from the heart. b. have the largest total cross-sectional area. c. are so narrow. d. have no smooth muscle.

ANS: B

The increased cross-sectional area in the capillary bed results in a significant decrease in velocity compared to the arterial and venous networks. Blood flow through the capillaries is not affected by the distance to the heart. Capillaries do have a diameter that is very small, but they have spaces that permit constituents to pass in and out of the capillaries. In some tissues, one or two smooth muscle cells form a precapillary sphincter that controls flow through the vessel.

6. What is the effect on resistance if the radius of a vessel is halved? a. Resistance doubles. b. Resistance decreases by a factor of 16. c. Resistance decreases by hNalf.R I G B.C M U SofN16.T O d. Resistance increases by a factor ANS: D

Doubling the radius of a vessel on the flow of blood results in a 16 times greater blood flow that increases the vessel’s resistance by a factor of 16. The resistance is not doubled, it is increased by a factor of 16. The resistance is not decreased when the radius of a vessel is halved.

7. Clinical manifestations of chronic arterial obstruction include a. edema. b. intermittent claudication. c. decreased pressure proximal to the obstruction. d. distal hyperemia.

ANS: B

Arterial thrombosis is usually manifested by intermittent claudication (pain with activity) in the affected limb that improves with rest. Venous obstructions are manifested by edema.

Ischemia can occur distal to the point of the occlusion. An increase in blood flow causes hyperemia, which is located in the area proximal to the obstruction.

8. Peripheral edema is a result of a. arterial insufficiency. b. venous thrombosis. c. hypertension.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

d. atherosclerosis.

ANS: B

In the venous system, thrombosis alters venous return, impairing removal of metabolic wastes and producing edema. In arterial obstruction, distal flow results in ischemia. Hypertension does not cause peripheral edema. Atherosclerosis is not directly associated with peripheral edema.

9. The relationship of blood flow (Q), resistance (R), and pressure (P) in a vessel can be

expressed by which equation? a. Q = P/R b. Q = R/P c. R = PQ d. P = Q/R ANS: A

The relationship between the variables of pressure and resistance is expressed by Ohm’s law: Q = P/R. Q is the blood flow, P is the pressure difference, and R is the resistance. Ohm’s law is Q = P/R. R = PQ is not the expression for the relationship between blood flow, resistance, and pressure. P = Q/R is not the correct expression reflecting Ohm’s law.

10. Risk factors for atherosclerosis include a. female gender. b. hyperlipidemia. c. high-protein diet. d. low-fiber diet.

ANS: B

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Hyperlipidemia is a modifiable risk factor associated with atherosclerosis. Men have a higher incidence of atherosclerosis earlier in life than women. A high-protein diet is not associated with atherosclerosis. Dietary fats do play a role as a modifiable risk factor. A low-fiber diet is not a risk factor for atherosclerosis.

11. Which is not a manifestation of acute arterial obstruction? a. Pain b. Purpura c. Pallor d. Pulselessness ANS: B

Purpura is purple-colored spots on the skin, which are not a manifestation of acute arterial obstruction. Pain is intense, continuous, and unrelated to activity in an acute arterial obstruction. In an acute arterial obstruction, pallor is seen in the involved extremity.

Pulselessness may occur in the affected extremity of an acute arterial occlusion, although often a weak pulse may be noted by Doppler.

12. The goal of long term heparin for the management of a deep vein thrombosis is to a. relieve edema. b. prevent clot dislodgement. c. dissolve the thrombus. d. prevent further clot formation.

Test Bank pathophysiology 6th edition by Jacquelyn Lee L. Banasik & Lee – Ellen C. Copstead

ANS: D

Anticoagulation is utilized in deep vein thrombosis to prevent further clot formation. Heparin does not play a role in edema. Prevention of clot dislodgement is not the goal of therapy with the use of heparin. Heparin is not utilized to dissolve a thrombus.

13. Which condition enhances lymphatic flow? a. Increased tissue hydrostatic pressure b. Increased interstitial fluid colloid osmotic pressure c. Decreased capillary hydrostatic pressure d. Increased capillary oncotic pressure ANS: B

Lymphatic flow is controlled by increasing interstitial fluid colloid osmotic pressure and by the stimulation of the contractile fibers (often called lymphatic pumps) as they are stretched.

Increasing interstitial fluid colloid osmotic pressure enhances lymphatic flow. Lymphatic flow is not enhanced by decreased capillary hydrostatic pressure. Lymphatic flow is controlled by increases in osmotic pressure, not oncotic pressure.

14. Tissues are able to autoregulate their rate of blood flow by controlling a. perfusion pressure. b. arterial blood pressure. c. vascular resistance. d. venous return to the heart.

ANS: C

Systemic vascular resistance is used to determine the resistance of vessels, diseases, or drug therapies that affect vessels. Any condition that increases vascular resistance requires more work for the heart to overcomNeUthReSrI esN istG anTcB e. anCdOejM ect blood volume. Blood moves from an area of higher pressure to an area of lower pressure. The arterial and arteriolar walls with their muscular media coats provide the high-pressure end of the gradient. Seeking a lower pressure, blood moves toward the venous system. The thinner, more pliable walls of the venous bed furnish the low-pressure portion of the pressure gradient.

15. Blood flow throughout the periphery is regulated by a. cardiac output. b. the autonomic nervous system. c. velocity. d. hemodynamics.

ANS: B

Blood flow throughout the periphery is controlled by central mechanisms that are mediated by the autonomic nervous system, the venous and thoracic pumps, and intrinsic autoregulatory mechanisms. Cardiac output does not control peripheral blood flow. Velocity is the measure of distance traveled in a given interval. Hemodynamics is the principle that governs the quantity of blood passing by a given point at a certain period.

16. Venous obstruction leads to edema because it a. increases capillary oncotic b. increases arterial blood c. decreases tissue d. increases capillary hydrostatic

pressure.

Pathophysiology 6th Edition Banasik Test Bank

ANS: D

Increased fluid accumulation in the interstitial space also occurs when the lymphatic flow is impaired or when capillaries become more permeable and “leak” fluid. These pressure gradients lead to edema. Interstitial fluid colloid osmotic pressure increases play a role in edema. Arterial blood pressure does not lead to edema. Decreased tissue pressure does not lead to edema in venous obstruction.

17. A serious complication of deep vein thrombosis is a. stroke. b. hypertensive crisis. c. extremity necrosis. d. pulmonary embolus.

ANS: D

Deep vein thrombosis is treated aggressively, as it is the most frequent source of pulmonary embolus. Deep vein thrombosis is not the cause of a stroke. Hypertensive crisis is unrelated to deep vein thrombosis. Extremity necrosis could result from prolonged arterial occlusion.

18. Which is not considered to be a risk factor for thrombus formation? a. Thrombocytopenia b. Vascular trauma c. Stasis of blood flow d. Circulatory shock ANS: A

Thrombocytopenia is not involved in the development of thrombi. Thrombi may form in the chambers of the heart following a myocardial infarction N R ING T B.C MO or damage to the heart valves.

U S Venous stasis can be a risk fact or f o r t h ro m b u s fo rmation as a result of the alteration in blood flow to the extremity. Circulatory shock states occur when individual organs may not obtain sufficient blood flow to meet metabolic needs.

19. Which clinical finding is indicative of compartment syndrome? a. Peripheral edema b. Absent peripheral pulses c. Redness and swelling d. Atrophy of distal tissues ANS: B

Compartment syndrome creates an effective absence of arterial circulation to an extremity.

Swelling within a cast or tight dressing may contribute to the development of compartment syndrome. Compartment syndrome creates pallor in the affected extremity. Acute arterial occlusion is an emergency, and could result in profound ischemia in the involved limb.

20. Velocity of blood flow is measured in a. centimeters per second. b. millimeters per minute. c. yards per hour. d. kilometers per minute.

ANS: A

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Pathophysiology 6th Edition Banasik Test Bank Velocity of blood flow is measured in centimeters per second. Millimeters per minute is the not the measurement of the velocity of blood flow. Yards per hour is not a measurement of velocity. The velocity of blood flow is not measured in kilometers per minute.

21. When a patient is struck in the eye by a baseball, the result is redness and swelling. This

increase in blood flow to a localized area is called a. autoregulation. b. edema. c. hyperemia. d. hypoxia.

ANS: C

Hyperemia is a local increase in blood flow. Autoregulation is the ability of blood vessels within organs to maintain a constant blood flow. Edema is the swelling that results from hyperemia. Hypoxia is an insufficient supply of oxygen.

MULTIPLE RESPONSE 1. The pain characteristics of chronic venous insufficiency include (Select all that apply.) a. aching and cramping in the affected area. b. relief with elevation to the area. c. relief with ambulation if pain is in the legs. d. burning and prickling in the affected area. e. relief with massage to the area.

ANS: A, B, C

The pain characteristics associated N RSwith INGchronic B.Cvenous MO insufficiency include aching and U T cramping in the affected area; r e l i e f w i t h e l ev at i o n to the area; and relief with ambulation if pain is in the legs. Burning and prickling pain is not associated with chronic venous insufficiency. Massage to the affected area does not relieve pain in chronic venous insufficiency.

2. The primary functions of the circulatory system are (Select all that apply.) a. transport oxygen. b. transport nutrients. c. remove metabolic waste. d. reabsorb leaking fluid. e. return leukocytes to the circulation.

ANS: A, B, C

The circulatory system transports oxygen and nutrients and removes metabolic waste. The lymphatic system reabsorbs leaking fluid and, in conjunction with the circulatory system, returns lymph to the circulation.

3. Which changes in the circulatory system occur in the older adult? (Select all that apply.) a. Increased baroreceptor function b. Increased response to hypertensive stimuli c. Increased systemic vascular resistance (SVR) d. Decreased afterload e. Decreased elasticity of vessel walls

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Pathophysiology 6th Edition Banasik Test Bank ANS: C, E

The vessels become inflexible tubes that increase system vascular resistance. The vessel walls lose elastic flexibility and recoil, becoming stiffer and less compliant. Baroreceptor function is reduced because of decreased sensitivity of the receptors and diminished responsiveness of the vessels because of their rigidity. The rigid vessels decrease the body’s ability to respond to hypotensive and hypertensive stimuli. The decreased compliance of the systemic vascular system increases afterload.

4. Blood flow is measured as a given number of (Select all that apply.) a. liters. b. milliliters. c. nanoliters. d. cubic centimeters. e. cubic millimeters.

ANS: A, B, D

Blood flow is measured as a given number of liters, milliliters, or cubic centimeters per second, minute, or hour. Nanoliters is not a measurement of blood flow. Cubic millimeters is not a measurement of blood flow.

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Pathophysiology 6th Edition Banasik Test Bank

Chapter 16: Alterations in Blood Pressure Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. Pulse pressure is defined as a. two thirds of systolic pressure + diastolic pressure. b. systolic pressure + diastolic pressure. c. systolic pressure – diastolic pressure. d. systolic pressure  systemic resistance.

ANS: C

Pulse pressure is defined as the difference between systolic and diastolic blood pressure. Pulse pressure is the difference between systolic and diastolic pressure. Pulse pressure is not the sum of the systolic and diastolic pressures. Systemic resistance is not involved in determining the pulse pressure.

2. What results when systemic blood pressure is increased? a. Hypovolemia b. Decreased cardiac output c. Vasoconstriction d. Decreased vascular resistance ANS: C

At the smooth muscle of the arterial system, neurotransmitters bind to receptors to initiate vasoconstriction and increase systemic vascular resistance. An increase in vascular resistance causes the heart to work hardN erUaR ndStI huNsGinTcB re. asC esObM lood pressure. Hypovolemia does not result in an increase in blood pressure. Cardiac output is not decreased when systemic blood pressure is increased. Vascular resistance is actually increased when the systemic blood pressure is increased.

3. An erroneously low blood pressure measurement may be caused by a. positioning the arm above the heart level. b. using a cuff that is too small. c. positioning the arm at heart level. d. measuring blood pressure after exercise.

ANS: A

An erroneous blood pressure result could occur with the arm above the level of the heart. It is important to measure blood pressure with the appropriate size cuff. The arm should be positioned at the level of the heart for a more accurate reading. Measuring pressure after exercise yields a higher measurement.

4. Angiotensin-converting enzyme (ACE) inhibitors block the a. release of rennin. b. conversion of angiotensin I to angiotensin II. c. conversion of angiotensinogen to angiotensin I. d. effect of aldosterone on the kidney.

ANS: B

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Pathophysiology 6th Edition Banasik Test Bank Angiotensin I is converted into angiotensin II while it is circulating through the pulmonary vessels, by the angiotensin-converting enzyme. ACE inhibitors block the conversion of angiotension I to angiotension II. Renin plays a role in the regulation of arterial blood pressure. ACE inhibitors do not block the conversion of angiotensinogen to angiotensin or the effect of aldosterone on the kidney.

5. Which finding is indicative of orthostatic hypotension in a person with a supine blood

pressure (BP) of 110/70 and a heart rate (HR) of 100? a. Sitting BP 88/60, HR 118 b. Sitting BP 108/68, HR 102 c. Sitting BP 110/78, HR 98 d. Sitting BP 120/80, HR 100 ANS: A

The definition of orthostatic hypotension is a decrease in systolic blood pressure greater than 20 mm Hg or a decrease in systolic pressure that is greater than 10 mm Hg within 3 minutes of moving to an upright position. The measurements of BP 108/68, HR 102 and BP 110/78, HR 98 are not indicative of orthostatic hypotension. An increase in blood pressure do not occur with orthostatic hypotension.

6. A middle-aged patient has a follow up visit for a recorded blood pressure of 162/96 mm Hg

taken 3 weeks ago. The patient has no significant past medical history and takes no medications, but smokes 1 1/2 packs of cigarettes per day, drinks alcohol regularly, and exercises infrequently. The patient is about 40 lbs. overweight and admits to a high-fat, high-calorie diet. At the office visit today, the patient’s blood pressure is 150/92 mm Hg. What is the least appropriate intervention for this patient at this time? a. Begin lifestyle modificatiN onsR . I G B.C M U S N T O b. Begin antihypertensive drug therapy. c. Recheck blood pressure in 4 to 6 weeks. d. Encourage smoking cessation.

ANS: B

Antihypertensive drug therapy is not the first intervention in a person with modifiable risk factors. Therefore, lifestyle alterations are attempted first. Lifestyle alterations include exercise, smoking cessation, and weight loss. Blood pressure should be rechecked in 4 to 6 weeks. Smoking cessation counseling is an appropriate lifestyle alteration.

7. After being diagnosed with hypertension, a patient returns to the clinic 6 weeks later. The

patient reports “moderate” adherence to the recommended lifestyle changes and has experienced a decreased from 165/96 to 148/90 mm Hg in blood pressure. What is the most appropriate intervention for this patient at this time? a. Continue lifestyle modifications only. b. Continue lifestyle modifications plus diuretic therapy. c. Continue lifestyle modifications plus ACE inhibitor therapy. d. Continue lifestyle modifications plus -blocker therapy.

ANS: A

The patient should be encouraged to continue compliance with lifestyle changes since the patient has exhibited some positive response to his changes. Diuretics are not needed at this time. ACE inhibitors should not be added to the therapy yet. Beta-blockers are not required at this time.

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Pathophysiology 6th Edition Banasik Test Bank

8. High blood pressure increases the workload of the left ventricle, because it increases a. stroke volume. b. blood volume. c. preload. d. afterload.

ANS: D

Hypertension reflects an elevation in SVR; rising afterload increases myocardial oxygen demand and overall cardiac workload. The workload of the left ventricle does not increase the stroke volume, blood volume, or preload.

9. Which blood pressure reading is considered to be indicative of prehypertension according to

the JNC-7 criteria? a. 118/78 b. 128/82 c. 140/88 d. 138/94 ANS: B

In adults, a normal blood pressure is <120 mm Hg systolic and <80 mm Hg diastolic pressure.

Stage 1 hypertension begins with a systolic pressure of 140 mm Hg or a diastolic pressure of 90 mm Hg. Between these values, the individual is said to have prehypertension, and interventions related to lifestyle changes should be initiated for primary hypertension. 118/78 is considered normal. An individual with a reading of 140/88 or 138/94 may be considered to have stage 1 hypertension.

NteUsRisSrI Gm 10. Restriction of which electroly ecN om en. deCdOinMthe management of high blood pressure?

TB a. Calcium b. Potassium c. Sodium d. Magnesium ANS: C

The balance of the intake of water and sodium with their excretion by the kidney remains the central feature of long-term blood pressure maintenance. Sodium is not rapidly eliminated by the kidney like water and adds to the body’s fluid volume. It is not necessary to restrict the intake of calcium when managing high blood pressure. Potassium does not need to be restricted in the management of high blood pressure. Magnesium does not play a role in the management of high blood pressure.

11. Hypertension with a specific, identifiable cause is known as a. primary b. orthostatic c. secondary d. malignant ANS: C

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hypertension.

Pathophysiology 6th Edition Banasik Test Bank Secondary hypertension has a specific identifiable cause such as a specific pathology or a condition that results in hypertension. Primary hypertension does not have a clearly identifiable etiology and is therefore an idiopathic disorder. Positional changes do not generally result in hypertension. Malignant hypertension is a hypertensive crisis.

12. Critically ill patients may have parenterally administered vasoactive drugs that are adjusted

according to their a. systolic b. mean arterial c. diastolic d. pulse

pressure.

ANS: B

The mean arterial pressure is used to make incremental adjustments to vasoactive drugs. The MAP is the calculated average pressure within the circulatory system throughout the cardiac cycle. The systolic pressure is a part of the calculation but is not the data element used in adjustment of vasoactive medications. The diastolic reading is involved in calculating the MAP, but is not the number used in titration of vasoactive medications. The pulse pressure is the difference between the systolic and diastolic pressure.

13. The prevalence of high blood pressure is higher in a. non-Hispanic white adults. b. Mexican-American adults. c. non-Hispanic black adults. d. Asian children.

ANS: C

The prevalence of high bloodNpUreRssSuI reNreGmTaB in. sC hiO ghMer among non-Hispanic black adults.

Non-Hispanic white adults have a lower prevalence of high blood pressure.

Mexican-American adults have a lower prevalence than black adults. Asian children do not display a high prevalence for high blood pressure.

14. Hypertension is closely linked to a. obstructive sleep apnea. b. urinary tract infection. c. de Quervain syndrome. d. spinal stenosis.

ANS: A

Hypertension is present in 45% to 60% of those diagnosed with obstructive sleep apnea.

Urinary tract infection is not directly linked to hypertension. de Quervain syndrome is a type of tendonitis and is not linked to hypertension. Spinal stenosis is not closely associated with hypertension.

15. A patient presents to the emergency department with a diastolic blood pressure of 132 mm

Hg, retinopathy, and symptoms of an ischemic stroke. This symptomology is likely the result of a. arthrosclerosis. b. angina. c. myocardial infarction. d. hypertensive crisis.

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Pathophysiology 6th Edition Banasik Test Bank

ANS: D

Hypertensive crisis is characterized by a diastolic blood pressure of greater than 120 mm Hg, and symptoms of end-organ damage such as retinopathy and ischemic stroke. Blood pressure is not an indication of arthrosclerosis. Angina may accompany hypertensive crisis, but the question stem relates directly to hypertensive crisis. The patient may be having a myocardial infarction, but the addition of end-organ damage symptoms points to hypertensive crisis.

16. A patient has a history of falls, syncope, dizziness, and blurred vision. The patient’s

symptomology is most likely related to a. hypertension. b. hypotension. c. deep vein thrombosis. d. angina.

ANS: B

Hypotension is low blood pressure characterized by dizziness, blurred vision, syncope, and injury from falls. Hypertension is high blood pressure characterized by headache, confusion, chest pain, and difficulty breathing. Deep vein thrombosis is evidenced by calf pain or tenderness. Angina is characterized by chest, shoulder, or jaw pain.

MULTIPLE RESPONSE 1. It can be explained to a patient that high blood pressure increases the risk of (Select all that

apply.) a. stroke. b. renal disease. c. diabetes. d. ischemic heart disease. e. liver disease.

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ANS: A, B, D

Hypertension increases morbidity and mortality associated with stroke. Kidney disease or failure is associated with hypertension. Ischemic heart disease has an increase in morbidity and mortality when partnered with hypertension. Diabetes is not directly associated with hypertension. Liver disease is not linked with hypertension.

2. Atherosclerosis puts a patient at risk for (Select all that apply.) a. ischemic stroke. b. hemorrhagic stroke. c. retinal injury. d. renal impairment. e. liver disease.

ANS: A, C, D

Ischemic strokes are associated with atherosclerosis because of weakened blood vessels in the brain. Retinal injury and renal impairment may result because of changes in the microcirculation as a result of atherosclerosis. Hemorrhagic stroke is not associated with atherosclerosis. Liver disease is not associated with atherosclerosis.

3. Blood pressure is regulated on a short-term basis through (Select all that apply.)

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Pathophysiology 6th Edition Banasik Test Bank a. b. c. d. e.

interaction of carotid and aortic baroreceptors. vasomotor center in the brainstem. activation of SNS. inhibition of PSNS. activation of RAAS.

ANS: A, B, C, D

Blood pressure is regulated on a short-term basis through the interaction of the carotid and aortic baroreceptors, the vasomotor center in the brainstem, and the activation of the SNS and inhibition of the PSNS influences on the heart and smooth muscle in the arterioles. Activation of the RAAS affects fluid balance, but does not directly regulate short-term blood pressure.

4. Orthostatic hypotension is a risk factor for (Select all that apply.) a. stroke. b. cognitive impairment. c. death. d. myocardial infarction. e. urinary retention.

ANS: A, B, C

Orthostatic hypotension is associated with cardiovascular disease and is a risk factor for stroke, cognitive impairment, and death. Myocardial infarction is not as a result of orthostatic hypotension. Urinary retention is not associated with orthostatic hypotension.

TRUE/FALSE 1. New-organ damage is a funcN tionRof bIo t hGt h eBs . t aC g e oM f hypertension and its duration.

U S N T

O

ANS: F

End-organ damage is a function of both the stage of hypertension and its duration.

2. The most commonly recognized outcome of hypertension is pulmonary disease.

ANS: F

The most commonly recognized outcome of hypertension is cardiovascular disease.

3. The ingestion of certain drugs, foods, or chemicals can lead to secondary hypertension.

ANS: T

The ingestion of certain drugs, foods, or chemicals can lead to secondary hypertension.

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Pathophysiology 6th Edition Banasik Test Bank

Chapter 17: Cardiac Function Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. Which is true about the mitral valve? a. Opens during ventricular systole b. Is located between the right atrium and right ventricle c. Has three valve leaflets d. Allows blood to flow from the left atrium to the left ventricle ANS: D

The mitral valve directs blood flow from the left atrium to the left ventricle. Papillary muscles prevent the valve leaflets from opening during ventricular contraction. The mitral valve is located between the left atrium and left ventricle. The tricuspid valve has three leaflets; the mitral valve has two.

2. Blood is transported from the right ventricle to the lungs by the a. pulmonary veins. b. aorta. c. pulmonary artery. d. bronchial arteries.

ANS: C

Deoxygenated blood is received from the right side of the heart and pumps it through the lungs by way of the pulmonary artery. Blood is delivered to the left atrium by the pulmonary veins. The aorta supplies the N arU teR riS esIoN f tG hT e sBy. st C emOiM c circulation. Blood is not transported to the lungs by way of the bronchial arteries.

3. A vessel that normally contains desaturated (venous) blood is the a. bronchial artery. b. pulmonary artery. c. pulmonary vein. d. coronary artery.

ANS: B

The right side of the heart receives deoxygenated blood from the systemic circulation and pumps it through the lungs by way of the pulmonary artery. The bronchial artery is not involved in venous blood flow. The pulmonary vein carries oxygenated blood. Blood supply to the heart is provided by coronary arteries.

4. During which phase of the cardiac cycle is the mitral valve normally open? a. Atrial systole b. Isovolumic contraction c. Isovolumic relaxation d. Ventricular ejection ANS: A

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Pathophysiology 6th Edition Banasik Test Bank The mitral valve is open during the period of ventricular contraction, which is the period of systole. Isovolumic contraction is a period immediately following atrial systole. The isovolumic relaxation phase begins with semilunar valve closure in response to falling ventricular pressures and ends when the AV valves open to allow ventricular filling.

Ventricular contraction results in a rapid rise in ventricular pressure. As ventricular pressure exceeds aortic pressure (or pulmonic), the valve is forced open and a period of rapid ejection of blood from the ventricle follows.

5. The v wave of an atrial pressure tracing corresponds to a. atrial filling. b. ventricular systole. c. atrial systole. d. mitral valve closure.

ANS: A

The v wave of atrial pressure corresponds to atrial filling. The c wave corresponds to the AV valve bulging during ventricular contraction. The a wave corresponds to atrial contraction.

Mitral valve closure is not a measurement in atrial pressure tracing.

6. Which is true about blood flow from the atria? a. Occurs primarily during systole, because perfusion pressure is high b. Is controlled primarily by the autonomic nervous system c. Is increased with elevated right atrial pressure d. Occurs primarily during ventricular diastole ANS: D

During diastole the ventricles are relaxed and blood flows in from the atria through open AV valves. Blood flow from the N atU riaRoScI cuN rsGdT urB in. gC dO iaM stole. Blood flow through the heart is a part of the circulatory system. Atrial contraction helps to load the ventricle quickly, but blood flow is not increased with elevated pressure.

7. An increase in intracellular calcium ion results in myocardial contraction, because calcium a. activates membrane calcium pumps. b. binds troponin, causing actin-binding sites to be exposed. c. increases affinity of myosin for actin cross-bridge sites. d. promotes ATP synthesis.

ANS: B

Each troponin is composed of three subunits called troponins T, I, and C. Troponin T binds to tropomyosin, troponin I participates in the inhibitory actions of tropomyosin, and troponin C binds up to four molecules of Ca2+. Intracellular calcium ions do not activate membrane calcium pumps in myocardial contraction. Calcium ions do not increase the affinity of myosin for actin cross-bridge sites. Myosin cleaves to ATP to release energy for muscle contraction.

8. While caring for a geriatric patient, the changes in the heart that may be expected include a. increased oxygen consumption. b. increased coronary artery blood flow. c. decreased response to an elevated heart rate. d. cardiomyopathy.

ANS: C

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Pathophysiology 6th Edition Banasik Test Bank During stress or exercise, the aging heart is unable to respond quickly with an elevated rate, and the maximal heart rate elevation is reduced. Once the heart rate is elevated, it takes a much longer time for the heart to reach its resting level. Oxygen consumption in the myocardium is reduced, resulting in less efficient function when stressed. In the geriatric population, there is a decrease in coronary artery blood flow to the myocardium. With aging, the heart size generally does not change.

9. Creatine phosphate is a. a waste product of cellular metabolism. b. synthesized when ATP levels are high. c. enzymatically degraded to form creatine kinase. d. an indicator of myocardial cell damage.

ANS: B

Under conditions of ATP excess, myocardial cells are able to transfer energy to a storage form called creatine phosphate. Creatine phosphate provides an immediate source of energy when ATP levels drop. Creatine kinase is an enzyme that enhances transfer from ATP to creatine phosphate. Elevated levels of blood CK (creatine kinase) are indicative of myocardial damage.

10. Phase 0 of the cardiac muscle cell action potential is associated with a. opening of slow calcium ion b. opening of fast potassium ion c. opening of fast sodium ion d. closure of sodium leak

channels.

ANS: C

Phase 0 begins when the membrane potential approaches threshold and voltage-gated “fast” B.enCteOrsMthe cell during Phase 2. Potassium enters sodium channels open momeN ntU arR ilS y.I CN alG ciT um the cell during phase 1. Phase 0 of the cardiac muscle cell action is not associated with the closure of the slow sodium leak.

11. Automatic pacemaker cells spontaneously depolarize, because a. leak channels (If) allow calcium and sodium ions into the cell. b. they lack efficient sodium/potassium pumps. c. voltage-sensitive sodium channels open spontaneously. d. chloride leaks into the cell during rest.

ANS: A

Automatic pacemaker cells have an action potential that is characterized by a sloping phase 4.

Cell membrane channels automatically open as leak channels allow calcium and sodium to enter the cell. Automatic pacemaker cells allow an influx of calcium. The channels open and close quickly. Many channels open through autonomic neurotransmitters. Chloride does not leak into the cell during rest.

12. Parasympathetic stimulation of the heart generally leads to a decrease in heart rate, because

acetylcholine a. increases intracellular cAMP levels and opens calcium channels. b. opens potassium channels allowing potassium ion efflux. c. binds and blocks  receptors on the cell membrane. d. inhibits voltage-gated sodium channels in the membrane.

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Pathophysiology 6th Edition Banasik Test Bank ANS: B

Acetylcholine is the neurotransmitter released by parasympathetic nerve endings.

Acetylcholine binding to muscarinic receptors on heart cells inhibits cAMP production, and increases membrane permeability to potassium ions allowing them to leak from the cell.

Intracellular cAMP levels are decreased while potassium is allowed into the cell.  Receptors on heart muscle cell membranes increase the production of cAMP. Autonomic neurotransmitters inhibit voltage-gated sodium from entering the membrane.

13. One role of ATP in cardiac muscle contraction is a. providing energy to pump calcium into the cell. b. inducing a conformational change in tropomyosin. c. altering myosin affinity for actin-binding sites. d. releasing sequestered calcium from the sarcoplasmic reticulum.

ANS: C

ATP hydrolysis provides energy for contraction and affects the capability of myosin to bind actin. ATP does not provide energy to pump calcium into the cell. Tropomyosin is not changed by the addition of ATP. ATP does not release calcium during the cardiac muscle contraction.

14. In lead II of a normal electrocardiogram (ECG), the Q wave is a downward deflection

resulting from a. atrial b. apical c. lateral wall d. septal ANS: D

depolarization.

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Septal depolarization begins on the left septal surface and travels to the right resulting in a small negative deflection known as the Q wave in lead II. The P wave corresponds to atrial depolarization. A large upright R wave corresponds to a wave of depolarization traveling down the ventricles toward the apex. Lateral wall depolarization is not reflected as a downward deflection of the Q wave.

15. Which physiologic change increases cardiac work but does not enhance cardiac output? a. Increased preload b. Increased heart rate c. Increased contractility d. Increased afterload ANS: D

A major determinant of stroke volume is afterload, which refers to the impedance or resistance that must be overcome to eject blood from the chamber. The workload imposed on the heart chambers by preload is sometimes called the volume work of the heart. An increase in preload increases the volume work of the heart which must be met by increased oxygen uptake to maintain adequate ATP production. An increase in heart rate results in an increase in cardiac output. However, the increased heart rate is undermined by impaired pumping efficiency. Contractility is independent of fiber end-diastolic length and is therefore not affected by preload.

16. Which is a true statement about the affect of the Frank-Starling law on the heart?

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Pathophysiology 6th Edition Banasik Test Bank a. Increased diastolic stretching of myocardial fibers produces increased stroke

volume. b. Sympathetic activation leads to increased myocardial contractility and heart rate. c. An increase in heart chamber diameter increases myocardial wall tension. d. An increase in coronary artery diameter results in less rapid coronary blood flow.

ANS: A

The Frank-Starling law states that an increase in resting muscle fiber length results in a greater development of muscle tension that produces increased stroke volume. An increase in preload result in a greater force of contraction according to the Frank-Starling law. The Frank-Starling law does not state that an increase in heart chamber diameter will increase myocardial wall tension. According to the Frank-Starling law, increasing the coronary artery diameter does not create a decrease in coronary blood flow.

17. Myocardial cells are connected by gap junctions enabling them to a. all be stimulated simultaneously. b. function as a coordinated syncytium. c. be affected by the autonomic nervous system. d. share ATP. ANS: B

Cardiac cells are joined together by gap junctions, which allow the rapid passage of electrical impulses from one cell to the next. This functional syncytium is what allows the separate cells of the myocardium to work in a coordinated manner. The gap junctions allow the myocardial cells to work in a coordinated manner. Myocardial cells are not affected by the autonomic nervous system. ATP is a necessary requirement of the contractile elements and ion pumps.

18. Cardiac myosin has a high afN fiU niR tySfoIrN acGtiT nB w. heCnOthMe myosin has what molecule(s) bound to

it? a. b. c. d.

Calcium ATP ADP and phosphate Creatine phosphate

ANS: C

The affinity of the myosin head for actin depends on whether ATP is bound or ADP and phosphate are bound. Free myosin heads bind ATP and hydrolyze it to ADP and phosphate.

Calcium ions are needed for muscle contraction. Myosin has a high affinity for actin when ADP and phosphate are bound, and low affinity when ATP is bound. When there is an excess of ATP, myocardial cells transfer energy to a storage form called creatine phosphate.

19. At very high heart rates, cardiac output a. decreases. b. increases. c. stays the same. d. reverses.

ANS: A

At very high heart rates, cardiac output falls. At high heart rates (not very high heart rates), cardiac output increases. Cardiac output does not stay the same in the presence of very high heart rates. Cardiac output does not reverse in the presence of very high heart rates.

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Pathophysiology 6th Edition Banasik Test Bank

MULTIPLE RESPONSE 1. Which proteins are associated with the thin filament in the cardiac muscle? (Select all that

apply.) a. Actin b. Titin c. Nebulin d. Troponin e. Myosin ANS: A, C, D

Actin is the primary constituent of thin filaments. Thin filaments are composed of several different proteins including actin, nebulin, tropomyosin, and troponin. Troponin is one of the thin filaments composed of protein in cardiac muscle. Titin is a flexible protein that attaches the thick filament to the Z disk. Myosin filaments are larger and referred to as thick filaments.

2. Electrical currents that travel through the heart are called vectors because they include (Select

all that apply.) a. direction. b. polarity. c. magnitude. d. vascularity. e. ionic waves.

ANS: A, C

Electrical currents traveling through have M both direction and magnitude and are N R Ithe Gheart B.C U S N T described as vectors. Polarity, v a s c u l a ri t y, a n d ionOic waves are not the components of vectors.

3. The major wave complexes of an ECG include the (Select all that apply.) a. P wave. b. B wave. c. TUV complex. d. QRS complex. e. T wave.

ANS: A, D, E

P wave corresponds to atrial depolarization. QRS complex represents ventricular depolarization. T wave reflects ventricular repolarization. B wave is not part of the ECG. TUV complex is not part of the ECG. 4. The major factors that influence stroke volume are (Select all that apply.) a. pre-ejection. b. preload. c. resistance. d. contractility. e. afterload.

ANS: B, D, E

The three major factors that influence stroke volume are preload, contractility, and afterload.

Pre-ejection does not influence stroke volume. Resistance does not influence stroke volume.

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Pathophysiology 6th Edition Banasik Test Bank

5. Echocardiograms are used to help diagnose (Select all that apply.) a. heart enlargement. b. valvular disorders. c. cardiac tumors. d. left ventricular motion abnormalities. e. collection of fluid in lung bases.

ANS: A, B, C, D

Echocardiograms are useful for diagnosis of heart enlargement, valvular disorders, collections of fluid in the pericardial space, cardiac tumors, and abnormalities in left ventricular motion.

An echocardiogram detects collection of fluid in the pericardial space, not lung bases.

TRUE/FALSE 1. A requirement for rhythmicity is that the cell membrane has channels that automatically open

during phase 3.

ANS: F

A requirement for rhythmicity is that the cell membrane has channels that automatically open during phase 4.

2. The R wave is responsible for apical depolarization.

ANS: T

The R wave is responsible for apical depolarization.

3.

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A standard ECG has 13 leads . U ANS: F

A standard ECG has 12 leads.

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Pathophysiology 6th Edition Banasik Test Bank

Chapter 18: Alterations in Cardiac Function Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. The most reliable indicator that a person is experiencing an acute myocardial infarction (MI)

is a. b. c. d.

severe, crushing chest pain.

ST-segment elevation. dysrhythmias. pain radiating to the lower legs.

ANS: B

Injuries to cardiac tissue caused by myocardial ischemia and infarction are indicated on the ECG by ST-segment changes. ST-segment elevation on the ECG indicates that ischemic injury is ongoing and that efforts to improve perfusion or reduce oxygen demand may be effective in preserving myocardial muscle. In some instances, an MI is entirely asymptomatic.

Dysrhythmias that accompany MI are attributed to injured and ischemic cells that have not yet become necrotic. Pain radiating to the jaw and neck, not the lower legs, is symptomatic of an MI. 2. Primary treatment for myocardial infarction (MI) is directed at a. protecting the heart from further ischemia. b. decreasing myocardial oxygen demands. c. reducing heart rate and blood pressure. d. activating the parasympaN thetR ic syIsteG m. B.C M

U S N T

O

ANS: B

Reducing oxygen demand may be effective in preserving myocardial muscle. Decreasing demand increases myocardial oxygen supply. Once the cardiac muscle has been damaged, it is more important to preserve remaining muscle and prevent further loss of the myocardium.

Reduction in the heart rate and blood pressure is not the primary treatment goal in MI care.

Parasympathetic activation is not the primary treatment for myocardial infarction.

3. Rheumatic heart disease is most often a consequence of a. chronic intravenous drug abuse. b. viral infection with herpesvirus. c. -hemolytic streptococcal infection. d. cardiomyopathy.

ANS: C

Rheumatic heart disease is an uncommon but serious consequence of rheumatic fever.

Rheumatic fever is an acute inflammatory disease that follows infection with group A -hemolytic streptococci. Rheumatic heart disease is not associated with chronic IV drug abuse. Rheumatic fever is an acute inflammatory infectious disease. Cardiomyopathy does not cause rheumatic heart disease.

4. Patients presenting with symptoms of unstable angina and no ST segment elevation are treated

with a. cardiac catheterization.

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Pathophysiology 6th Edition Banasik Test Bank b. antiplatelet drugs. c. acute reperfusion therapy. d. cardiac biomarkers only.

ANS: B

Patients presenting with symptoms of unstable angina and no ST elevation on the ECG would be treated with antiplatelet drugs as a cornerstone of therapy. Coronary angiography may be used as an additional method of diagnosis but would not be the primary option. The patient with symptoms of unstable angina would not benefit from reperfusion strategies. Cardiac biomarkers may be assessed in the unstable angina patient, but are not the primary indicator.

5. An example of an acyanotic heart defect is a. tetralogy of Fallot. b. transposition of the great arteries. c. ventricular septal defect. d. all right-to-left shunt defects.

ANS: C

An example of an acyanotic heart defect is a ventricular septal defect. In this condition, blood from the left ventricle leaks into the right ventricle because of a defect in the ventricular wall.

This leakage causes extra pressure in the right ventricle resulting in pulmonary hypertension.

Tetralogy of Fallot is a cyanotic congenital defect. Transposition of the great vessels is a cyanotic congenital defect. The category of cyanotic congenital defects refers to those that are right-to-left shunts.

6. Patent ductus arteriosus is accurately described as a(n) a. opening between the atria.

C.OM b. stricture of the aorta that N imUpR edSeI s bNloGoT dB fl. ow c. communication between the aorta and the pulmonary artery. d. cyanotic heart defect associated with right-to-left shunt.

ANS: C

A patent ductus arteriosus is a normal channel between the pulmonary artery and the aorta that remains open during intrauterine life. A patent ductus arteriosus is not an opening or a stricture in the atria. Patent ductus arteriosus is an acyanotic congenital defect.

7. Hypotension, distended neck veins, and muffled heart sounds are classic manifestations of a. myocardial infarction. b. cardiac tamponade. c. congestive heart failure (CHF). d. cardiomyopathy.

ANS: B

The three classic symptoms of cardiac tamponade are hypotension, distended neck veins, and muffled heart sounds. There are many other manifestations as well. Myocardial infarction is not exhibited by the symptoms described. Classic symptoms of cardiac tamponade are hypotension, distended neck veins, and muffled heart sounds. Symptoms of CHF may include jugular venous distention. Cardiomyopathy is not exhibited by the symptoms described.

8. Constrictive pericarditis is associated with a. impaired cardiac filling.

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Pathophysiology 6th Edition Banasik Test Bank b. cardiac hypertrophy. c. increased cardiac preload. d. elevated myocardial oxygen consumption.

ANS: A

Constrictive pericarditis results in a fibrous scarred pericardium that restricts cardiac filling.

Chronic pericarditis may be the result of a previous cardiac surgery. Pericarditis is associated with increased workload of the heart because contraction is opposed by the surrounding structures. The constrictive process includes symptoms of exercise intolerance, weakness, and fatigue.

9. Mitral stenosis is associated with a. a prominent S4 heart sound. b. a pressure gradient across the mitral valve. c. left ventricular hypertrophy. d. a muffled second heart sound (S2).

ANS: B

Mitral stenosis is characterized by an abnormal left atrial–left ventricular pressure gradient during ventricular diastole. Mitral stenosis is not associated with an S4 heart sound. Mitral stenosis is associated with left atrial hypertrophy, not left ventricular hypertrophy. Mitral stenosis does not have a symptom of a muffled second heart sound.

10. Aortic regurgitation is associated with a. diastolic murmur. b. elevated left ventricular/aortic systolic pressure gradient. c. elevated systemic diastolic blood pressure. d. shortened ventricular ejecNtiU onRpShI asN e.GTB.COM ANS: A

Aortic regurgitation results from an incompetent aortic valve that allows blood to leak back from the aorta into the left ventricle during diastole. In aortic regurgitation, there is not an elevated left ventricular/aortic pressure gradient. Diastolic blood pressure is generally lower because of rapid runoff of blood into the ventricle. Aortic regurgitation is associated with a longer ventricular ejection phase.

11. Angina caused by coronary artery spasm is called a. stable b. classic c. unstable d. Prinzmetal variant

angina.

ANS: D

Variant, or Prinzmetal, angina is the term applied to vasospasm-initiated anginal symptoms caused by significant atherosclerotic plaques. These spasms usually respond promptly to vasodilating agents. Coronary artery spasm does not produce stable angina. Classic or typical angina is often associated with physical exertion. Unstable angina presents a similar clinical picture as myocardial infarction.

12. While hospitalized, an elderly patient with a history of myocardial infarction was noted to

have high levels of low-density lipoproteins (LDLs). What is the significance of this finding?

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Pathophysiology 6th Edition Banasik Test Bank a. Increased LDL levels are associated with increased risk of coronary artery disease. b. Measures to decrease LDL levels in the elderly would be unlikely to affect the

progression of this disease. c. Increased LDL levels are indicative of moderate alcohol intake, and patients

should be advised to abstain. d. Elevated LDL levels are an expected finding in the elderly and therefore are not

particularly significant.

ANS: A

High levels of low-density lipoproteins (LDLs), which are high in cholesterol, have been associated with the highest risk of coronary atherosclerosis. Even when lipid metabolism is normal, a high-fat diet can overwhelm the liver’s ability to clear LDL cholesterol from the circulation and result in hyperlipidemia. Dietary fat restriction may be beneficial in reducing cholesterol in this case. Increased LDL levels are not indicative of alcohol intake. Elevated LDL levels are not an expected finding in the elderly and should be treated.

13. What compensatory sign would be expected during periods of physical exertion in a patient

with limited ventricular stroke volume? a. Hypotension b. Bradycardia c. Aortic regurgitation d. Tachycardia ANS: D

An individual with reduced stroke volume would exhibit compensatory increases in heart rate.

Hypertension is associated with decreased ventricular stroke volume. An individual with reduced stroke volume would exhibit compensatory increases in heart rate; therefore, bradycardia would not be expNeU ctR edS .I AN orG ticTrB eg.uC rgO itM ation would not be an expected compensatory sign of limited stroke volume.

14. An elderly patient’s blood pressure is measured at 160/98. How would the patient’s left

ventricular function be affected by this level of blood pressure? a. This is an expected blood pressure in the elderly and has little effect on left ventricular function. b. Left ventricular workload is increased with high afterload. c. High blood pressure enhances left ventricular perfusion during systole. d. High-pressure workload leads to left ventricular atrophy.

ANS: B

Activation of the sympathetic nervous system increases the heart rate, contractility, blood pressure, and fluid retention by the kidney. Unfortunately, these compensatory efforts impose a greater workload on the heart. A blood pressure of 160/90 mm Hg is a higher than expected blood pressure in an elderly patient. High blood pressure does not enhance ventricular perfusion. Greater workload on the heart may contribute to further ischemic damage.

15. A patient with a history of myocardial infarction continues to complain of intermittent chest

pain brought on by exertion and relieved by rest. The likely cause of this pain is a. stable angina. b. myocardial infarction. c. coronary vasospasm. d. unstable angina.

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Pathophysiology 6th Edition Banasik Test Bank

ANS: A

Stable angina is the most common form of chest pain and is characterized by pain that is caused under conditions of increased myocardial workload, such as physical exertion or emotional strain. Pain related to myocardial infarction is not relieved by rest. Coronary vasospasm is characterized by unpredictable attacks of angina pain. A patient with unstable angina presents with symptoms similar to myocardial infarction.

16. The majority of cardiac cells that die after myocardial infarction do so because of a. cell rupture. b. insufficient glucose. c. thrombus. d. apoptosis.

ANS: D

MI results when prolonged or total disruption of blood flow to the myocardium causes cellular death by necrosis or apoptosis. Cardiac cells do not die as a result of cellular rupture.

Insufficient glucose is not associated with myocardial death. The initiating event of MI is believed to be related to thrombus, but the resulting disruption of flow to the myocardium is because of necrosis or apoptosis.

17. Which serum biomarker(s) are indicative of irreversible damage to myocardial cells? a. Elevated CK-MB, troponin I, and troponin T b. Markedly decreased CK-MB and troponin I c. Elevated LDL d. Prolonged coagulation time ANS: A

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Elevated cardiac biomarkers are one indication of myocardial necrosis. Cardiac biomarkers may not be utilized if a patient presents with chest pain and evidence of acute ischemia on the electrocardiogram. Cardiac biomarkers are elevated in the presence of MI. Elevated LDL is a risk factor for coronary atherosclerosis. Coagulation times are not used to assess myocardial damage.

18. A loud pansystolic murmur that radiates to the axilla is most likely a result of a. aortic regurgitation. b. aortic stenosis. c. mitral regurgitation. d. mitral stenosis.

ANS: C

The murmur of mitral regurgitation usually occurs throughout ventricular systole (pansystolic), radiates toward the left axilla, and has a high-pitched blowing character. Aortic insufficiency is characterized by a high-pitched blowing murmur during ventricular diastole.

A characteristic murmur of aortic stenosis occurs during ventricular systole and varies in intensity, progressively getting louder and then diminishing (crescendo-decrescendo). The murmur of aortic stenosis generally radiates to the neck. Blood rushing through the narrowed mitral valve during ventricular diastole can sometimes be heard as a low-pitched, rumbling diastolic murmur at the heart’s apex.

19. A patient with significant aortic stenosis is likely to experience

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Pathophysiology 6th Edition Banasik Test Bank a. b. c. d.

syncope. hypertension. increased pulse pressure. peripheral edema.

ANS: A

In the patient with aortic stenosis, syncope and “greying out” episodes may occur when cerebral perfusion is inadequate. Low systolic blood pressure is a common sign of aortic stenosis. Faint pulses are a common sign of aortic stenosis. Peripheral edema is not associated with aortic stenosis.

20. Myocarditis should be suspected in a patient who presents with a. chest pain and ST elevation. b. acute onset of left ventricular dysfunction. c. murmur and abnormal valves on echocardiogram. d. family history of cardiomyopathy.

ANS: B

Acute myocarditis is commonly characterized by left ventricular dysfunction or general dilation of all four heart chambers. Chest pain and ST elevation is indicative of myocardial infarction. Myocarditis is associated with viral infections. Dilated cardiomyopathy runs in families and has a genetic basis.

21. Atherosclerotic plaques with large lipid cores are prone to a. dislodgement. b. binding. c. rupture. d. attachment.

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ANS: C

Rupture of atherosclerotic plaques with large lipid cores initiates platelet aggregation and thrombus formation. Dislodgement is not an occurrence of atherosclerotic plaques with large lipid cores. Atherosclerotic plaques with large lipid cores are not prone to binding. Large lipid cores of atherosclerotic plaques are not prone to attachment.

MULTIPLE RESPONSE 1. Acute coronary syndrome in the presence of thrombosis may present as (Select all that apply.) a. unstable angina. b. MI. c. sudden cardiac arrest. d. bleeding. e. hypovolemia.

ANS: A, B, C

Thrombosis occurs suddenly and may partially or completely obstruct the artery and cause acute ischemia. Acute coronary syndrome may present as unstable angina, MI, or sudden cardiac arrest. Bleeding is not a presenting symptom of acute coronary syndrome.

Hypovolemia is not a presenting symptom of acute coronary syndrome.

2. Inflammatory disorders that may alter endothelial cell function include (Select all that apply.)

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Pathophysiology 6th Edition Banasik Test Bank a. b. c. d. e.

multiple sclerosis. lupus erythematosus.

Kawasaki syndrome. rheumatoid arthritis. polyarteritis nodosa.

ANS: B, C, E

Inflammatory disorders that may alter endothelial cell function include lupus erythematosus, Kawasaki syndrome, and polyarteritis nodosa. Multiple sclerosis is not an inflammatory disorder that may alter endothelial cell function. Rheumatoid arthritis is not an inflammatory disorder that may alter endothelial cell function.

3. Diagnostic tests used to diagnose or confirm MI include (Select all that apply.) a. electrocardiogram. b. cardiac catheterization. c. echocardiography. d. radionuclide scintigraphy. e. computed tomography.

ANS: A, B, C, D

Electrocardiogram, cardiac catheterization, echocardiography, and radionuclide scintigraphy are diagnostic tests used to confirm MI. Computed tomography is not used to confirm MI.

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Pathophysiology 6th Edition Banasik Test Bank

Chapter 19: Heart Failure and Dysrhythmias: Common Sequelae of Cardiac Diseases Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. Left-sided heart failure is characterized by a. pulmonary congestion. b. decreased systemic vascular resistance. c. jugular vein distention. d. peripheral edema.

ANS: A

Left-sided heart failure is characterized by pulmonary congestion and edema. Right-sided heart failure is characterized by congestion in the systemic venous system that increases systemic vascular resistance. Jugular vein distention is a classic sign of right-sided heart failure. Peripheral edema is seen in right-sided failure.

2. The therapy that most directly improves cardiac contractility in a patient with systolic heart

failure is a. afterload reduction. b. -antagonist agents. c. preload reduction. d. digitalis.

ANS: D

Digitalis may be used for symptom management of heart failure. Cardiac glycosides directly RpSI inhibit the sodium-potassiumNpU um prN esG enTt B in.thCeOcM ell membrane of all cells. The intracellular changes allow more calcium to remain in the cell, thus strengthening myocardial contraction.

Contractility is not improved through afterload reduction. Beta-blockers inhibit the effects of sympathetic activation and have the potential to reduce cardiac output. Preload reduction is not the therapy of choice in improving cardiac contractility.

3. Hypertrophy of the right ventricle is a compensatory response to a. aortic stenosis. b. aortic regurgitation. c. tricuspid stenosis. d. pulmonary stenosis.

ANS: D

Right ventricular hypertrophy is the direct result of pulmonary disorders that increase pulmonary vascular resistance and impose a high afterload on the right ventricle. Aortic stenosis does not lead to right ventricular hypertrophy. Aortic regurgitation is not associated with right ventricular hypertrophy. Hypertrophy of the right ventricle is not a compensatory response to tricuspid stenosis.

4. The common denominator in all forms of heart failure is a. poor diastolic filling. b. reduced cardiac output. c. pulmonary edema. d. tissue ischemia.

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Pathophysiology 6th Edition Banasik Test Bank

ANS: B

The common manifestation of all forms of heart failure is the failure of the heart to pump blood adequately. The clinical presentation may differ depending on which ventricle fails (left or right, or both). Poor diastolic filling is not seen in all forms of heart failure. Pulmonary edema is seen in left-sided failure. Tissue ischemia is directly related to myocardial infarction, which may induce heart failure.

5. Cor pulmonale refers to a. biventricular failure. b. left ventricular hypertrophy secondary to lung disease. c. right ventricular hypertrophy secondary to pulmonary hypertension. d. right ventricular failure secondary to right ventricular infarction.

ANS: C

Pulmonary disorders that result in increased pulmonary vascular resistance impose a high afterload on the right ventricle. The resultant right ventricular hypertrophy known as cor pulmonale may progress to right ventricular failure as the lung disease worsens. Biventricular failure is most often the result of primary left ventricular failure that progresses to the right.

Cor pulmonale is not associated with left ventricular hypertrophy. Only 3% of MIs occur in the right ventricle.

6. Lusitropic impairment refers to a. poor contractile force. b. impaired diastolic relaxation. c. altered action potential conduction rate. d. altered automaticity.

ANS: B

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Lusitropic impairment refers to an energy-requiring process that removes free calcium ions from the cytoplasm by pumping them back into the sarcoplasmic reticulum and across the cell membrane into the extracellular fluid. Ischemia interferes with this process in the active phase of diastolic relaxation. Poor contractile force is not associated with lusitropic impairment. The conduction rate is not associated with the energy-requiring process known as lusitropy.

Automaticity is not a factor in lusitropy.

7. First-degree heart block is characterized by a. prolonged PR interval. b. absent P waves. c. widened QRS complex. d. variable PR interval.

ANS: A

First-degree block is generally identified by a prolonged PR interval (more than 0.20 second) on ECG. P waves are not absent in first-degree heart block. A widened QRS complex is associated with a particular dysrhythmia, but not first-degree heart block. A variable PR interval is found in type I second-degree block.

8. Second-degree heart block type I (Wenckebach) is characterized by a. absent P waves. b. lengthening PR intervals and dropped P wave.

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Pathophysiology 6th Edition Banasik Test Bank c. constant PR interval and dropped QRS complexes. d. no correlation between P waves and QRS complexes.

ANS: B

Type I second-degree block is associated with progressively lengthening PR intervals until one P wave is not conducted and becomes a dropped beat. Second-degree block is not characterized by an absence of P waves. Type II second-degree block is associated with a consistent PR interval and dropped beats. The ECG of third-degree block shows regularly occurring P waves that are independent of the ventricular rhythm.

9. Which dysrhythmia is thought to be associated with reentrant mechanisms? a. Second-degree AV block b. Sinus bradycardia c. Junctional escape d. Preexcitation syndrome tachycardia (Wolf-Parkinson-White syndrome) ANS: D

Reentry is a complex process in which a cardiac impulse continues to depolarize in a part of the heart after the main impulse has finished its path and the majority of the fibers have repolarized. Wolff–Parkinson–White syndrome is caused by accessory pathways that originate in the atria, bypass the AV node, and enter a site in the ventricular myocardium. This causes the ventricles to contract prematurely, resulting in a reentrant tachycardia.

Second-degree block is a conduction failure between the sinus impulse and its ventricular response. Sinus bradycardia is a slowed impulse generation by the sinus node. A junctional escape rhythm originates in the AV node.

10. In which dysrhythmias should treatment be instituted immediately? a. Asymptomatic sinus bradN yU caR rdS iaIaN t aGhTeB ar. t rC atO eM of 50 beats/minute b. Fever-induced tachycardia at 122 beats/minute c. Premature atrial complexes occurring every 20 seconds d. Atrial fibrillation with a ventricular rate of 220 beats/minute ANS: D

Atrial fibrillation is a completely disorganized and irregular atrial rhythm accompanied by an irregular ventricular rhythm of variable rate. Atrial fibrillation causes the atria to quiver rather than to contract forcefully. This allows blood to become stagnant in the atria and may lead to formation of thrombi. This condition requires resuscitation because of the reduction in cardiac output. The cause of the bradycardia should be investigated, but is not treated emergently when an individual is not exhibiting any symptoms. Fever-induced tachycardia will correct itself once the fever is lowered. Dysrhythmias are treated if they produce significant symptoms or are expected to progress to a more serious level.

11. An abnormally wide (more than 0.10 second) QRS complex is characteristic of a. paroxysmal atrial tachycardia. b. supraventricular tachycardia. c. junctional escape rhythm. d. premature ventricular complexes.

ANS: D

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Pathophysiology 6th Edition Banasik Test Bank The QRS of the premature complex is prolonged (greater than 0.10 second) and bizarre in appearance. Paroxysmal atrial tachycardia does not display a QRS complex that is greater than 0.10 seconds. Supraventricular tachycardia does not display a wide QRS complex.

Escape rhythms may have a P wave that is inverted and located before, during, or after the QRS. 12. A laboratory test that should be routinely monitored in patients receiving digitalis therapy is a. serum sodium. b. albumin level. c. serum potassium. d. serum calcium.

ANS: C

Digitalis slows the heart rate through parasympathetic system activation and promotes sodium and water excretion through improved cardiac output to the kidney. Depletion of serum potassium (hypokalemia) may potentiate digitalis toxicity. Sodium and water excretion is activated through the parasympathetic system because of improved cardiac output to the kidneys. Albumin level is not affected by digitalis. Digitalis allows more calcium to remain in the cell through a slowing of the sodium-dependent calcium pump.

13. After sitting in a chair for an hour, an elderly patient develops moderate lower extremity

edema. His edema is most likely a consequence of a. arterial obstruction. b. isolated left-sided heart failure. c. right-sided heart failure. d. peripheral vascular disease.

ANS: C

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The backward effects of right-sided heart failure are as a result of congestion in the systemic venous system and lead to lower extremity edema. Arterial obstruction is not associated with dependent edema of the lower extremities. Left-sided heart failure is associated with pulmonary symptoms. Edema may be associated with peripheral vascular disease, but dependent edema over a 1-hour period is related to right-sided heart failure.

14. A patient is exhibiting severe dyspnea and anxiety. The patient also has bubbly crackles in all

lung fields with pink, frothy sputum. This patient is most likely experiencing a. right-sided heart failure. b. cardiomyopathy. c. a medication reaction. d. acute cardiogenic pulmonary edema.

ANS: D

Acute cardiogenic pulmonary edema is a life-threatening condition requiring immediate treatment. It is associated with left ventricular failure that severely impairs gas exchange, and produces dramatic signs and symptoms including anxiety, severe dyspnea, an upright posture to breathe effectively, and pink frothy sputum. Right-sided heart failure produces systemic venous congestion. Cardiomyopathy is not associated with bubbly crackles and pink frothy sputum. A medication reaction is not the reason for the patient to exhibit severe dyspnea, anxiety, bubbly crackles, and frothy sputum.

15. A patient with pure left-sided heart failure is likely to exhibit

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Pathophysiology 6th Edition Banasik Test Bank a. b. c. d.

jugular vein distention. pulmonary congestion with dyspnea. peripheral edema. hepatomegaly.

ANS: B

Left-sided heart failure is most often associated with left ventricular infarction and systemic hypertension. The ineffective pumping of the left ventricle results in an accumulation of blood within the pulmonary circulation. As a result, pulmonary congestion with dyspnea is an expected finding. Jugular vein distention is more often associated with right-sided failure.

Peripheral edema is associated with right-sided failure. Hepatomegaly is not seen in pure left-sided edema.

16. Beta-blockers are advocated in the management of heart failure because they a. increase cardiac output. b. reduce cardiac output. c. enhance sodium absorption. d. reduce blood flow to the kidneys.

ANS: B

Beta-blockers are advocated in the management of heart failure to inhibit the cardiac effects of sympathetic activation. These drugs are negative inotropes and have the potential to reduce cardiac output. The goal with the use of beta-blockers in heart failure is to reduce cardiac output. Beta-blockers do not affect sodium reabsorption. Angiotensin II and aldosterone enhance sodium and water reabsorption by the kidney, contributing to an elevated blood volume.

17. A patient with heart failure wNhU oR reS poIrtN sG i nT t eB r m.i tCt eOn tMs h o r t n e s s of breath during the night is

experiencing a. orthopnea. b. paroxysmal atrial tachycardia. c. sleep apnea. d. paroxysmal nocturnal dyspnea.

ANS: D

Dyspnea that occurs at night is known as paroxysmal nocturnal dyspnea. Orthopnea is known as dyspnea when lying down. Intermittent shortness of breath at night is not known as paroxysmal atrial tachycardia. Sleep apnea is an absence of breathing during sleep.

18. Low cardiac output to the kidneys stimulates the release of a. aldosterone b. norepinephrine c. angiotensinogen d. renin

from juxtaglomerular cells.

ANS: D

When cardiac output is reduced, juxtaglomerular cells in the kidney release renin and initiate the renin-angiotensin-aldosterone cascade leading to salt and water retention by the kidney.

Aldosterone is not released from juxtaglomerular cells. Norepinephrine is not released by cells within the kidney. Angiotensin is not involved in the process of cellular release within the kidneys.

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Pathophysiology 6th Edition Banasik Test Bank

19. Patients with structural evidence of heart failure who exhibit no signs or symptoms are

classified into which New York Heart Association heart failure class? a. Class I b. Class II c. Class III d. Class IV ANS: A

Patients who have structural heart disease but no signs or symptoms of heart failure are placed in Class I of the NYHA Classes. Class II patients have current or previous symptoms of heart failure. Class III patients have current or previous symptoms of heart failure, such as dyspnea or fatigue. Class IV patients have advanced structural heart disease and marked symptoms at rest.

20. The majority of tachydysrhythmias are believed to occur because of a. triggered activity. b. enhanced automaticity. c. defective gap junctions. d. reentry mechanisms.

ANS: D

Reentry is thought to be the culprit in most tachydysrhythmias. Reentry is a complex process in which a cardiac impulse continues to depolarize in a part of the heart after the main impulse has finished its path. Triggered activity occurs when an impulse is generated during or just after repolarization. Alterations in automaticity create electrolyte imbalances. Defective gap junctions are not related to tachydysrhythmias.

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21. A patient who reports dizziness and who has absent P waves, wide QRS complexes, and a

heart rate of 38 beats/minute on an ECG is most likely in which rhythm? a. Third-degree heart block b. Junctional tachycardia c. Ventricular escape rhythm d. Sinus bradycardia ANS: C

A ventricular escape rhythm originates in the Purkinje fibers, has a rate of 15 to 40 beats/minute, and is characterized by a wide QRS complex. An important clue to identifying escape rhythms is the absence of normal P waves and PR intervals. The rhythm involved in third-degree heart block includes regularly occurring P waves. Junctional tachycardia has a heart rate between 70 and 140 beats/minute. P waves are preceding, following, or buried in the QRS complex. Sinus bradycardia has a normal pattern on the ECG, but with a rate of less than 60 beats/minute.

22. A patient is diagnosed with heart failure with normal ejection fraction. This patient is most

likely characterized by a(n) a. elderly woman without a previous history of MI. b. middle-aged man with a previous history of MI. c. young female athlete with cardiomegaly. d. young sedentary male with a high-stress job.

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Pathophysiology 6th Edition Banasik Test Bank ANS: A

Heart failure with normal ejection fraction is particularly likely to develop in the elderly, in women, and in those without a history of MI. A middle-aged man with a previous history of MI may have heart failure, but the older woman fits the criteria of heart failure with normal ejection fraction. A young female athlete with cardiomegaly may experience heart failure, but is not the normal patient profile for this condition. A young sedentary male with a high-stress job may experience heart failure, but this patient does not fit the normal profile for this condition.

23. Increased preload of the cardiac chambers may lead to which patient symptom? a. Decreased heart rate b. Decreased respiratory rate c. Edema d. Excitability ANS: C

Preload reduces glomerular filtration resulting in fluid conservation, or edema. Increased preload may lead to an increased, not decreased, heart rate. Increased preload may lead to shortness of breath and an increased respiratory rate. Increased preload may lead to fatigue, not excitability, as the heart works harder to circulate blood.

MULTIPLE RESPONSE 1. Which statement is true about the incidence of heart failure? (Select all that apply.) a. Heart failure affects about 2 million Americans. b. Heart failure is the fastest-growing cardiac disorder. c. There are more than 400,N IN 00U0RnS ew caG seT sB o f.hCe aOr tMf a i l u r e diagnosed each year in the

United States.

d. The increasing incidence and hospitalization rates of heart failure reflect the aging

population in the United States. e. The incidence of heart failure is 10 per 1000 population after age 65.

ANS: B, D, E

Heart failure is the fastest-growing cardiac disorder at this time. The incidence and hospitalization rates associated with heart failure are reflective of the aging population in the United States. The incidence of heart failure is 10 per 1000 population in people over 65.

Heart failure affects about 5.7 million Americans. More than 550,000 new cases of heart failure are diagnosed in the United States each year.

2. Right-sided heart failure is usually a consequence of (Select all that apply.) a. elevated right ventricular afterload. b. right ventricular infarction. c. tricuspid valve defects. d. congenital anomalies.

ANS: A, B

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Pathophysiology 6th Edition Banasik Test Bank Because the right and left ventricles function in tandem, left ventricular failure eventually increases the workload on the right ventricle. Consequently, the right ventricle may fail causing infarction. Pulmonary disorders create a high afterload on the right ventricle and may cause a progression to right ventricular failure. Tricuspid valve defects are not the cause of right-sided heart failure. Congenital anomalies are not generally associated with right-sided failure.

3. A patient has heart failure with a normal ejection fraction. Which findings are most likely

found in this patient? (Select all that apply.) a. High cardiac output b. Pulmonary congestion c. Edema d. Ejection fraction greater than 50% e. Ejection fraction less than 45% ANS: B, C, D

Pulmonary congestion is a hallmark sign of heart failure. Edema is also a hallmark sign of heart failure. An ejection fraction greater than 50% indicates a normal ejection fraction. Low cardiac output, not high cardiac output, is a sign of heart failure. An ejection fraction of less than 45% indicates an abnormal ejection fraction.

4. The most common causes of heart failure are (Select all that apply.) a. myocardial ischemia. b. hypertension. c. dilated cardiomyopathy. d. high-fat diet. e. urinary retention.

N R I G B.C M

U S N T

O

ANS: A, B

The most common causes of heart failure are myocardial ischemia from coronary artery disease, followed by hypertension. Dilated cardiomyopathy is less common cause of heart failure. A high-fat diet can contribute to coronary artery disease, which is a contributor to heart failure, but a high-fat diet is not one of the most common causes of heart failure. Urinary retention is not a common cause of heart failure.

5. A patient with forward effects of heart failure may present with which symptoms? (Select all

that apply.) a. Impaired memory b. Mental fatigue c. Stupor d. Confusion e. Aggression ANS: A, B, D

The forward effects of heart failure cause inadequate perfusion of the brain and may lead to restlessness, mental fatigue, confusion, anxiety, impaired memory, generalized fatigue, activity intolerance, and lethargy. Stupor is not a symptom of the forward effects of heart failure. Aggression is not a symptom of the forward effects of heart failure.

6. Dysrhythmias are significant since they (Select all that apply.) a. are an indicator of life span.

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Pathophysiology 6th Edition Banasik Test Bank b. c. d. e.

can indicate an underlying disorder. can impair venous return. increase the severity of heart murmurs. can impair cardiac output.

ANS: B, E

Dysrhythmias can be indicative of an underlying pathophysiologic disorder. Dysrhythmias can impair normal cardiac output and lead to serious patient complications. Dysrhythmias are not an indicator of life span, but they may certainly shorten a patient’s life span. Dysrhythmias do not impair venous return, but they do impair cardiac output. Alone, dysrhythmias do not increase the severity of heart murmurs.

7. A patient’s ECG lacks recognizable waveforms and is deemed to be in sinus arrest. The

patient’s sinus arrest may be a result of (Select all that apply.) a. MI. b. electrical shock. c. electrolyte disturbance. d. acidosis. e. alkalosis.

ANS: A, B, C, D

Sinus arrest may result from MI, electrical shock, electrolyte disturbances, acidosis, and extreme parasympathetic activity. Alkalosis is not a cause of sinus arrest.

TRUE/FALSE 1. Chronic elevation of myocar N dial RwalI l t enGs i oB n. reC sultM s in atrophy.

U S N T

O

ANS: F

Chronic elevation of myocardial wall tension results in hypertrophy.

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Pathophysiology 6th Edition Banasik Test Bank

Chapter 20: Shock Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. The progressive stage of hypovolemic shock is characterized by a. tachycardia. b. hypertension. c. lactic acidosis. d. cardiac failure.

ANS: A

In the progressive stage of hypovolemic shock, the patient is anxious and confused, with decreased blood pressure and heart rate greater than 120 beats/minute. In this stage of shock, the blood pressure is decreased. Lactic acidosis does not occur in the progressive stage of hypovolemic shock. Cardiac failure is not likely to occur in the earlier stages of hemorrhagic shock.

2. Cardiogenic shock is characterized by a. hypovolemia. b. reduced systemic vascular resistance. c. reduced cardiac output. d. elevated SvO2.

ANS: C

Cardiogenic shock occurs primarily as a result of severe dysfunction of the left or right ventricles, or both, that resultNs U inRinSaI deNqG uaT teBc. arC diO acMpumping. The low cardiac output state is associated with a high left ventricular diastolic filling pressure. Cardiogenic shock is not manifested by hypovolemia. Sympathetic activation leads to increases in heart rate, vasoconstriction, and a narrow pulse pressure. Low cardiac output leads to reduced SvO2.

3. Low cardiac output in association with high preload is characteristic of a. hypovolemic b. cardiogenic c. anaphylactic d. septic

shock.

ANS: B

In cardiogenic shock, preload is high and cardiac output is low. In hypovolemic shock, preload and cardiac outputs are both low. In anaphylactic shock, blood volume may be normal. Septic shock is associated with infections.

4. Administration of which therapy is most appropriate for hypovolemic shock? a. Crystalloids b. Vasoconstrictor agents c. Inotropic agents d. 5% dextrose in water ANS: A

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Pathophysiology 6th Edition Banasik Test Bank Crystalloids are solutions that contain electrolytes. Isotonic solutions, such as lactated Ringers, are commonly used crystalloid solutions. These solutions are preferred for volume resuscitation, because they remain in the extracellular space and are more effective in increasing blood volume. Vasoconstrictor agents are contraindicated in hypovolemic shock.

Isotonic crystalloids are the most appropriate fluid for volume resuscitation. Isotonic fluids are preferred over glucose or hypotonic electrolyte solutions.

5. In contrast to all other types of shock, the hyperdynamic phase of septic shock is associated

with a. high afterload. b. low cardiac output. c. high cardiac output. d. reduced contractility.

ANS: C

In the hyperdynamic stage of septic shock, blood pressure falls because of the decreased systemic vascular resistance and decreased venous return. The heart rate and stroke volume increase and cardiac output is higher than normal. In the hyperdynamic phase of septic shock, afterload is not high. Cardiac output is high in the hyperdynamic stage of septic shock. The heart rate and stroke volume increase during the hyperdynamic stage of septic shock.

6. Improvement in a patient with septic shock is indicated by an increase in a. cardiac output. b. SvO2. c. systemic vascular resistance. d. serum lactate level.

ANS: C

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Systemic vascular resistance results in intravascular pooling in the venous system. Some portions of tissue are overperfused, and some are underperfused. Improvement in systemic vascular resistance is an indication of improvement in septic shock. In septic shock, the heart rate and stroke volume increase, and cardiac output is higher than normal. In septic shock, SvO2 levels may already be higher than normal. An increase in serum lactate levels may increase levels of acidosis and tissue hypoxia.

7. Hypotension associated with neurogenic and anaphylactic shock is because of a. hypovolemia. b. peripheral pooling of blood. c. poor cardiac contractility. d. high afterload.

ANS: B

Profound peripheral vasodilation of both arterioles and veins leads to peripheral pooling of blood and hypotension. Decreased venous return to the heart results in decreased cardiac output and hypotension. Hypovolemia is not the source of the hypotension involved in neurogenic and anaphylactic shock. Cardiac output is generally adequate in neurogenic and anaphylactic shock. Hypotension in neurogenic and anaphylactic shock is not related to high afterload.

8. A patient presenting with fever, hypotension, and lactic acidosis is most likely to be

experiencing what type of shock?

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank a. b. c. d.

Cardiogenic Septic Anaphylactic Neurogenic

ANS: B

Patients presenting with septic shock may have fever and hypotension. In addition, lactic acidosis may be present because of tissue hypoxemia. Presentation of cardiogenic shock is not inclusive of fever or lactic acidosis. Patients in anaphylactic shock do not have fever or lactic acidosis, and may have normal vital signs initially. Neurogenic shock may result from depression of the vasomotor center in the medulla.

9. In which stage of shock is a patient who has lost 1200 mL of blood, who has normal blood

pressure when supine, but who experiences orthostatic hypotension upon standing? a. Class I, Initial Stage b. Class II, Compensated Stage c. Class III, Progressive Stage d. Class IV, Refractory Stage ANS: B

In compensated stage hemorrhage (Class II), the blood loss is between 750 and 1500 mL. Blood pressure remains normal when the patient is supine but decreases upon standing. In initial stage hemorrhage (Class I) blood loss is up to 750 mL, and the patient’s vital signs remain normal. Class III hemorrhage (progressive stage) is blood loss of 1500 and 2000 mL. Vital signs are changing. Severe Class IV hemorrhage (refractory stage) occurs when more than 2000 mL is lost. The patient is lethargic, with severe hypotension.

GTaBtr. 10. A patient who was involved iN nUaR faS llIfrN om eeCbO ecMomes short of breath. The lung sounds are absent on one side. This patient is experiencing a. cardiogenic b. obstructive c. hypovolemic d. distributive

shock.

ANS: B

This type of obstructive shock is the result of a tension pneumothorax and is caused by shifting and compression of mediastinal structures including the heart, which compromise left ventricular filling. Accumulation of air in the pleural space may occur because of trauma.

Prompt relief of the obstructive event is necessary to restore cardiac output and prevent cardiovascular collapse. Cardiogenic shock is not related to a traumatic event. Hypovolemic shock results when circulating blood volume is inadequate to perfuse tissues. Distributive shock is characterized by an abnormally expanded vascular space caused by excessive vasodilation.

11. The majority of cases of anaphylactic shock occur when a sensitized individual comes in

contact with a. perfumes. b. incompatible blood products. c. animal proteins or dander. d. antibiotics.

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Pathophysiology 6th Edition Banasik Test Bank ANS: D

Anaphylactic shock is most frequently associated with antibiotic therapy. Contact with perfumes is not the most frequent cause of anaphylactic shock. Incompatible blood products do not lead to anaphylactic shock. Animal dander may lead to an anaphylactic reaction, but does so less commonly than antibiotics.

12. Overproduction of nitric oxide is an important aspect of the pathophysiologic process of what

type of shock? a. Cardiogenic b. Hypovolemic c. Anaphylactic d. Septic ANS: D

The overproduction of nitric oxide is seen in septic shock as a result of the release of immune cytokines. Nitric oxide is not seen in cardiogenic shock. Hypovolemic shock is not associated with the overproduction of nitric acid. The pathophysiologic process of anaphylactic shock is not associated with the overproduction of nitric oxide.

13. Massive release of histamine with consequent vasodilation and hypotension occurs with what

type of shock? a. Cardiogenic b. Hypovolemic c. Anaphylactic d. Neurogenic ANS: C

Mast cells and basophils to cross-link and Exposure to a specific antigeN nU caR usSeI s rN ecGeT ptB or. s C onOm activate histamine. The release of histamine along with other vasoactive chemicals produces bronchoconstriction. Cardiogenic shock is not associated with histamine release.

Hypovolemic shock is not associated with histamine release. Histamine release does not occur with neurogenic shock.

14. Administration of a vasodilator to a patient in shock would be expected to a. decrease vascular resistance. b. increase contractility. c. decrease left ventricular afterload. d. increase tissue perfusion.

ANS: C

Vasodilators are used to decrease the workload of the heart by decreasing left ventricular afterload. Nitroprusside and nitroglycerin are examples of vasodilators. Dobutamine is used to decrease vascular resistance. Positive inotropic drugs are used to increase contractility.

Positive inotropes include -adrenergic agonists, which have the ability to increase tissue perfusion.

15. The effect of nitric oxide on systemic arterioles is a. vasodilation. b. vasoconstriction. c. not significant. d. opposed by nitrate drugs.

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Pathophysiology 6th Edition Banasik Test Bank

ANS: A

Nitric oxide causes vasodilation in the systemic arterioles. Vasoconstriction is not associated with nitric oxide. There is a significant effect on the systemic arterioles related to nitric oxide.

The effects of nitric oxide are not known to be opposed by nitrate drugs.

16. Sepsis has been recently redefined as a. a systemic infection with viable organisms in the bloodstream. b. a systemic inflammatory response to ischemia. c. a systemic inflammatory response to infection. d. severe hypotension in an infected patient.

ANS: C

Systemic inflammatory response syndrome is the body’s response to infection or other insults, which result in systemic signs and symptoms of widespread inflammation. Sepsis results from the presence of microorganisms in the bloodstream (bacteremia). Sepsis occurs as a result of bacteremia and is defined as a systemic inflammatory response to infection. Severe hypotension may be the result of sepsis, but it is not the definition.

17. A patient with cold and edematous extremities, low cardiac output, and profound hypotension

is likely to be experiencing a progressive stage of a. cardiogenic b. hypovolemic c. obstructive d. septic

shock.

ANS: D

In the progressive stage of septic patients NU Rshock, I NGsome B.C MO deteriorate to a hypodynamic state.

S T This is characterized by decrea sed card iac output a n d cold, clammy skin as a result of narrowed pulse pressure. Profound hypotension generally occurs which is unresponsive to treatment. Cardiogenic shock is evidenced by decreased cardiac output, elevated left ventricular end-diastolic pressure, S3 heart sounds, and pulmonary edema. Hypotension occurs with hypovolemic shock, but extremities are not likely to be cold and edematous. Cold edematous extremities along with low cardiac output and profound hypotension are not manifestations of obstructive shock.

18. Tumor necrosis factor  and interleukin-1 contribute to shock states because they induce

production of a. catecholamines. b. clotting factors. c. nitric oxide. d. vasopressin.

ANS: C

In septic shock, tumor necrosis factor-, interleukin-1, and other inflammatory mediators induce vascular cells to produce excessive amounts of the vasodilator nitric oxide.

Catecholamines are not produced by TNF- and IL-1. The production of clotting factors is not induced by tumor necrosis factor- and interleukin-1. Vasopressin production is not induced

by TNF- and IL-1.

19. Tachycardia is an early sign of low cardiac output that occurs because of

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank a. b. c. d.

tissue hypoxia. anxiety. baroreceptor activity. acidosis.

ANS: C

A number of compensatory responses are set in motion to restore tissue perfusion and oxygenation in the early stage of shock. Baroreceptors located in the aorta and carotid arteries quickly sense the decrease in pressure and transmit signals to the vasomotor center in the brainstem medulla. The sympathetic nervous system stimulates 1 receptors, which respond by increasing the heart rate in an attempt to increase cardiac output. Tachycardia is not caused initially by tissue hypoxia. An early sign of low cardiac output is not anxiety. Tachycardia does not occur because of acidosis.

MULTIPLE RESPONSE 1. Which causes of shock are considered to be obstructive? (Select all that apply.) a. Ventricular rupture b. Pulmonary embolus c. Cardiac tamponade d. Tension pneumothorax e. Acute hemorrhage ANS: B, C, D

Pulmonary embolism is a mechanical obstruction of blood flow, which results in elevated right-sided heart pressures but left-sided pressures remain normal. Cardiac tamponade results from an accumulation of flui N d inRtheIperG icar d i al sac causing elevation of pressures on both U S N T B .OC M sides of the heart. Tension pneumothorax results in shifting and compression of mediastinal structures including the heart, which compromises left ventricular filling. Ventricular rupture is not associated with obstructive shock. Acute hemorrhage is associated with hypovolemic shock.

2. A patient experiencing shock may exhibit which signs and symptoms? (Select all that apply.) a. Warm, flushed skin b. Pinpoint pupils c. Pulse of more than 100 beats/minute d. Increased urinary output e. Fast and deep respirations ANS: C, E

A symptom of shock is tachycardia greater than 100 beats/minute. Fast and deep respirations are a compensatory mechanism of shock. Cool, clammy skin is a symptom of shock, not warm, flushed skin. Dilated pupils, not pinpoint pupils, are a symptom of shock. Decreased urinary output and increased urine specific gravity are symptoms of shock.

3. The urinary signs and symptoms of acute renal failure associated with the progressive stage of

shock are (Select all that apply.) a. polyuria. b. oliguria. c. decreased blood urea nitrogen.

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank d. increased serum creatinine. e. tachycardia.

ANS: B, D

Oliguria is a sign of acute renal failure found in the progressive stage of shock. Increased serum creatinine found in acute renal failure is associated with the progressive stage of shock.

Polyuria is not associated with the progressive stage of shock. Increased blood urea nitrogen, not decreased levels, is a sign of acute renal failure that is associated with the progressive stage of shock. Tachycardia is a symptom of the progressive stage of shock, but it is not a urinary symptom.

4. Positive inotropic drugs work by increasing (Select all that apply.) a. contractility. b. cardiac output. c. tissue perfusion. d. myocardial oxygen demand. e. vascular resistance.

ANS: A, B, C, D

Positive inotropic drugs are used to manage shock by increasing contractility, cardiac output, and tissue perfusion; these drugs also increase myocardial oxygen demand. These drugs may contribute to a decrease in vascular resistance, which decreases the workload of the heart.

5. A patient experiences anaphylactic shock. The nurse expects to observe which signs and

symptoms in the patient? (Select all that apply.) a. Stupor b. Hypotension NURSINGTB.COM c. Urticaria d. Angioedema e. Wheezing ANS: B, C, D, E

Anaphylactic shock causes increased heart rate and respiratory rate and hypotension.

Anaphylactic shock causes urticaria and pruritus. Angioedema is a symptom of anaphylactic shock. Bronchoconstriction causes wheezing and cyanosis, and laryngeal edema results in hoarseness and stridor. Stupor is not a sign or symptom of anaphylactic shock.

6. Septic shock is commonly associated with Gram-negative infections and Gram-positive

organisms that enter the body through the (Select all that apply.) a. eyes. b. genitourinary tract. c. gastrointestinal tract. d. respiratory tract. e. skin.

ANS: B, C, D, E

The most frequent portals of entry for the organisms that cause septic shock are the genitourinary tract, gastrointestinal tract, respiratory tract, and the skin. The eyes are not a common portal of entry.

TRUE/FALSE

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Pathophysiology 6th Edition Banasik Test Bank

1. A patient is diagnosed with cardiogenic shock. The patient is hyperventilating and is therefore

at risk for the respiratory complication of respiratory acidosis.

ANS: F

A patient diagnosed with cardiogenic shock who is hyperventilating is at risk for respiratory alkalosis.

2. Lactated Ringer solution and normal saline are commonly used crystalloid solutions that

contain electrolytes.

ANS: T

Lactated Ringer solution and normal saline are commonly used crystalloid solutions that contain electrolytes.

3. A type of shock that includes brain trauma that results in depression of the vasomotor center is

cardiogenic.

ANS: F

A type of shock that includes brain trauma that results in depression of the vasomotor center is neurogenic shock.

4. Disseminated intravascular coagulation is a serious complication of septic shock characterized

by abnormal clot formation in the microvasculature throughout the body.

ANS: T

Disseminated intravascular coagulation is a serious complication of septic shock characterized by abnormal clot formation in U tN he R S miI cN r oG v aTB.C s cu l a t uMO r e throughout the body.

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Pathophysiology 6th Edition Banasik Test Bank

Chapter 21: Respiratory Function and Alterations in Gas Exchange Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. The amount of gas remaining in the lungs after a maximal expiration is called the a. residual volume. b. functional residual capacity. c. expiratory reserve volume. d. vital capacity.

ANS: A

Residual volume is the amount of gas remaining in the lungs after a maximal expiration.

Functional residual capacity is the amount of gas left in the lungs at the end of a normal expiration. Expiratory reserve volume is the amount of gas expired beyond tidal volume. Vital capacity is the total volume of gas that can be exhaled during maximal expiration.

2. An increase in filtration of fluid from the pulmonary capillaries into the interstitium occurs

with pressure. a. increased capillary colloid b. increased capillary hydrostatic c. decreased capillary hydrostatic d. decreased interstitial colloid ANS: B

When capillary hydrostatic pressure exceeds capillary colloid osmotic pressure, fluid moves from the capillary to the interN stU itiR uS mI . IN ncGreTaB se. dC c aOp M i l l a r y colloid pressure, decreased capillary hydrostatic pressure, or decreased interstitial colloid pressure would all prevent fluid movement out of the capillaries.

3. The central chemoreceptors for respiratory control are a. located in the carotid artery. b. responsive primarily to changes in pH and CO2. c. responsive primarily to hypoxemia. d. less important than the peripheral chemoreceptors in maintaining respiration.

ANS: B

Central chemoreceptors for respiratory control are responsive primarily to changes in pH and CO2. The central chemoreceptors are located in the medullary center, are responsive to pH and CO2, and are more important than the peripheral chemoreceptors in controlling respirations.

4. The peripheral chemoreceptors a. are located in the medulla oblongata. b. lead to hypoventilation when stimulated. c. respond to the arterial oxygen level. d. are unresponsive to pH and CO2 levels.

ANS: C

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank The peripheral chemoreceptors respond to reduced arterial oxygen (hypoxemia). The peripheral chemoreceptors are located in the aortic arch and carotid bodies, lead to hyperventilation when stimulated, and respond to pH and CO2 levels in addition to arterial oxygen level.

5. Hypoxic pulmonary vasoconstriction a. diverts blood to hypoxic regions. b. increases blood flow to the base of the lung. c. can lead to secondary pulmonary hypertension. d. is always detrimental to the patient.

ANS: C

Increased resistance to blood flow resulting from hypoxic vasoconstriction can lead to secondary pulmonary hypertension. Hypoxic pulmonary vasoconstriction diverts blood to nonhypoxic regions, diverts blood to any area of the lung needed, and is helpful in maintaining adequate oxygenation.

6. Most of the carbon dioxide in blood is a. transported as bicarbonate. b. transported on the hemoglobin molecule. c. transported as carbonic acid. d. dissolved in plasma.

ANS: A

Sixty to seventy percent of carbon dioxide in blood is transported as bicarbonate. Only 20% to 30% is carried on the hemoglobin molecule. An insignificant amount of carbon dioxide in blood is transported as carbonic acid. Only 5% to 10% is dissolved in plasma.

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7. Shifts in the oxyhemoglobin dissociation curve represent the a. effect of carbonic anhydrase on the uptake of CO2. b. ability of blood to pick up more CO2 when PaO2 is low. c. amount of hydrogen in solution in the blood. d. changes in hemoglobin affinity for oxygen.

ANS: D

Shifts in the oxyhemoglobin dissociation curve represent the changes in hemoglobin affinity for oxygen. Shifts in the oxyhemoglobin dissociation curve do not represent the effect of carbonic anhydrase on the uptake of CO2, the ability of blood to pick up more CO2 when PaO2 is low, or the amount of hydrogen in solution in the blood.

8. Surfactant is a phospholipid that reduces a. pulmonary vascular capacitance. b. elastic recoil force. c. alveolar surface tension. d. pulmonary capillary fragility.

ANS: C

Surfactant reduces alveolar surface tension. Surfactant does not reduce pulmonary vascular capacitance, elastic recoil force, or pulmonary capillary fragility.

9. Secondary pulmonary hypertension is most often caused by

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank a. b. c. d.

increased pulmonary blood flow. increased pulmonary vascular resistance. increased left atrial pressure. decreased alveolar compliance.

ANS: B

Secondary pulmonary hypertension is most often caused by increased pulmonary vascular resistance. Although increased pulmonary blood flow and increased left atrial pressure can lead to secondary pulmonary hypertension, the most common cause is increased pulmonary vascular resistance. Decreased alveolar compliance does not cause pulmonary hypertension.

10. The pulmonary structure that has the least pulmonary blood flow is a. lung apex. b. middle lung. c. lower lung. d. zone 4.

ANS: A

Zone 1 (apex) has no perfusion and is equivalent to dead space. Zone 2 (middle lung) is intermittently perfused. Zone 3 (lower lung) is continuously perfused. There is no zone 4.

11. Autonomic nervous system stimulation effects on the respiratory system include a. parasympathetic stimulation dilates airways. b. sympathetic stimulation constricts airways. c. sympathetic stimulation relaxes bronchial smooth muscle. d. the autonomic system has no effect on the respiratory system.

ANS: C

NURSINGTB.COM

Sympathetic nervous system stimulation relaxes bronchial smooth muscle. Parasympathetic stimulation constricts airways. Sympathetic stimulation dilates airways. The autonomic nervous system does affect the respiratory system by relaxing the pulmonary blood vessels.

12. Primary pulmonary hypertension is a. more common in men. b. readily treatable. c. caused by genetic mutation. d. rapidly progressive.

ANS: D

Primary pulmonary hypertension is rapidly progressive. Primary pulmonary hypertension is more common in women and is not responsive to treatment. While primary pulmonary hypertension may be genetic in some individuals, the cause is unknown.

13. Hypoventilation causes a. hypoxemia. b. respiratory alkalosis. c. increased minute ventilation. d. decreased PaCO2.

ANS: A

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank Hypoventilation causes increased PaCO2 and resultant hypoxemia. Hypoventilation does not cause increased minute ventilation. Hyperventilation causes respiratory alkalosis and decreased PaCO2.

14. Which person is at greatest risk for developing a pulmonary embolism? a. A 25-year-old man with asthma b. A 28-year-old woman in the first trimester of a normal pregnancy c. A 42-year-old woman with a broken ankle d. A 67-year-old man with a deep vein thrombosis in the femoral vein ANS: D

The presence of deep vein thrombosis in the lower limbs is the most important risk factor for pulmonary embolism. Older age is also a risk factor. Asthma is not a specific risk factor for pulmonary embolism. The risk of developing blood clots and pulmonary emboli occurs later in pregnancy. Fractures of the pelvis or long bones can lead to fat emboli to the lung, but not fractures to small bones.

15. Chronic pulmonary hypertension can eventually cause which complication? a. Pulmonary emboli b. Respiratory acidosis c. Chronic obstructive pulmonary disease d. Right heart failure ANS: D

Increased right ventricular afterload from pulmonary hypertension can lead to right heart failure, also known as cor pulmonale. Chronic pulmonary hypertension is not a risk factor for pulmonary emboli. Chronic respiratory acidosis is a common cause of pulmonary hypertension, rather than a coNmUpR licSaI tioNnGoT fB it..CC hrOoM nic pulmonary hypertension does not cause chronic obstructive pulmonary disease; COPD may cause chronic pulmonary hypertension.

16. Virchow’s triad can result in a. decreased pulmonary arterial pressure. b. alveolar collapse. c. pulmonary embolus. d. bronchoconstriction.

ANS: C

Virchow’s triad consists of three physiologic factors that can predispose patients to thrombus formation, increasing the risk of PE. In Virchow’s triad, pulmonary arterial pressure increases.

Alveolar collapse and bronchoconstriction are not a result of Virchow’s triad.

17. Right-sided heart failure secondary to pulmonary hypertension is also called a. diastolic heart failure. b. high output failure. c. coronary disease. d. cor pulmonale.

ANS: D

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank Cor pulmonale is right-sided heart failure secondary to pulmonary hypertension. Cor pulmonale, not diastolic heart failure, is right-sided heart failure secondary to pulmonary hypertension. High output failure refers to left or biventricular failure caused by high output conditions such as sepsis or anemia. Coronary disease is atherosclerosis of the coronary arteries.

18. “My doctor said I have cor pul-something, which is a heart problem,” says Mr. Garabedian. “I

thought I just had these bad lungs that can’t be fixed. How can that make my heart go bad?”

Which mechanism leads to the development of cor pulmonale, which should serve as the basis for your response to Mr. Garabedian? a. Left ventricular failure causes pulmonary venous congestion and pulmonary edema. b. Pneumothorax causes compression atelectasis, decreased alveolar ventilation, and impaired oxygenation. c. Increased resistance to pulmonary arterial flow leads to compensatory right ventricular hypertrophy. d. Impaired ventilation causes decreased PaO2, which precipitates cardiac dysrhythmias.

ANS: C

Cor pulmonale is right ventricular hypertrophy that occurs as a compensatory response to chronically increased resistance to pulmonary arterial flow. Left ventricular failure, pneumothorax and compression atelectasis, and cardiac dysrhythmias are not part of the pathogenesis of cor pulmonale.

MULTIPLE RESPONSE

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1. Structure(s) that engage in exchange of respiratory gases include(s) the (Select all that apply.) a. trachea. b. bronchi. c. pulmonary artery. d. pulmonary capillaries. e. alveoli.

ANS: A, B, D, E

The trachea, bronchi, pulmonary capillaries, and alveoli are all involved in the respiratory gas exchange process. The pulmonary artery is not involved in gas exchange.

2. Which is true about lung compliance? (Select all that apply.) a. Represents lung expandability b. Decreases in the elderly c. Can be decreased by obesity, abdominal distention, pregnancy d. Is decreased in emphysema e. Is affected by body position ANS: A, B, C, E

Lung compliance is lung expandability; decreases in the elderly; can decrease in obesity, abdominal distention, and pregnancy; and is affected by body position. Lung compliance is increased in emphysema.

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank

Chapter 22: Obstructive Pulmonary Disorders Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. Allergic (extrinsic) asthma is associated with a. hyporesponsiveness of airways. b. unknown precipitating factors. c. IgE-mediated airway inflammation. d. irreversible airway obstruction.

ANS: C

Extrinsic (allergic) asthma is mediated by IgE triggers. Allergic (extrinsic) asthma involves hyperresponsiveness of the airways. Antigens are the precipitating factors. Airway obstruction is reversible.

2. Copious amounts of foul-smelling sputum are generally associated with a. emphysema. b. epiglottitis. c. pulmonary edema. d. bronchiectasis.

ANS: D

Copious, foul-smelling respiratory secretions are associated with bronchiectasis. Copious, foul-smelling respiratory secretions are not associated with emphysema, epiglottitis, or pulmonary edema.

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3. Emphysema results from destruction of alveolar walls and capillaries, which is because of a. release of proteolytic enzymes from immune cells. b. air trapping with resultant excessive alveolar pressure. c. excessive 1-antitrypsin. d. autoantibodies against pulmonary basement membrane.

ANS: A

The pathologic changes leading to alveolar destruction are associated with the release of proteolytic enzymes from inflammatory cells such as neutrophils and macrophages. While air trapping occurs in emphysema, the destruction of alveolar walls and capillaries is because of release of proteolytic enzymes. Lack of 1-antitrypsin can result in emphysema.

Autoantibodies are not involved in destruction of alveolar walls and capillaries in emphysema.

4. Chronic bronchitis often leads to cor pulmonale because of a. ventricular hypoxia. b. increased pulmonary vascular resistance. c. left ventricular strain. d. hypervolemia.

ANS: B

Chronic bronchitis often leads to cor pulmonale as a result of increased pulmonary vascular resistance when right ventricular end-diastolic pressure increases. Ventricular hypoxia, left ventricular strain, and hypervolemia do not lead to cor pulmonale.

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank

5. All obstructive pulmonary disorders are characterized by a. resistance to airflow. b. hyperresponsiveness. c. decreased residual volumes. d. decreased lung compliance.

ANS: A

Obstructive lung diseases are characterized by increased resistance to airflow. Only asthma is characterized by hyperresponsiveness. Increased residual volume is common in obstructive pulmonary disorders. Emphysema is characterized by increased lung compliance caused by a loss of alveoli and elastic tissue.

6. Asthma is categorized as a(n) a. restrictive pulmonary disorder. b. infective pulmonary disorder. c. obstructive pulmonary disorder. d. type of acute tracheobronchial obstruction.

ANS: C

Asthma is an obstructive pulmonary disorder. Asthma is not a restrictive pulmonary disorder or a type of tracheobronchial obstruction. Although asthma can be associated with infection, it is not an infective pulmonary disorder.

7. Which pulmonary function test result is consistent with a diagnosis of asthma? a. Reduced forced expiratory volume in 1 second (FEV1) b. Decreased functional residual capacity

NURSINGTB.COM c. Increased FEV1 d. Reduced total lung volume ANS: A

Forced expiratory volumes (FEV1) decrease during asthma attacks. Functional residual capacity is not used to diagnose asthma. Reduced (not increased) FEV1 is found in asthma.

Total lung volume is not used to diagnose asthma.

8. After evaluation, a child’s asthma is characterized as “extrinsic.” This means that the asthma

is a. b. c. d.

of unknown pathogenesis. associated with specific allergic triggers. associated with respiratory infections. induced by psychological factors (stress).

ANS: B

Extrinsic asthma is also referred to as allergic asthma, which is triggered by antigens. The underlying pathogenesis of extrinsic asthma is an allergic in nature. Intrinsic asthma is associated with respiratory infections. Intrinsic asthma is associated with psychological factors.

9. Cystic fibrosis is associated with a. asthma. b. chronic bronchitis.

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank c. bronchiectasis. d. emphysema.

ANS: C

Fifty percent of cases of bronchiectasis are associated with cystic fibrosis. Cystic fibrosis is not associated with asthma, chronic bronchitis, or emphysema.

10. Croup is characterized by a. a productive cough. b. a barking cough. c. an inability to cough. d. drooling, sore throat, and difficulty swallowing.

ANS: B

Croup is characterized by a barking cough with stridor. A productive cough is not characteristic of croup. Croup is associated with coughing. Drooling, sore throat, and difficulty swallowing are not characteristics of croup.

11. Obstructive disorders are associated with a. low residual volumes. b. low expiratory flow rates. c. increased expiratory reserve volume. d. decreased total lung capacity.

ANS: B

Obstructive disorders are associated with low expiratory flow rates. Obstructive disorders are associated with high residual volume. Increased expiratory reserve volume and decreased total lung capacity are not charact N e r i s tRi c oIf obGstruBct. ivCe diM sorders.

U

S N T

O

12. COPD leads to a barrel chest, because it causes a. pulmonary edema. b. muscle atrophy. c. prolonged inspiration. d. air trapping.

ANS: D

Destruction of alveolar walls reduces lung elastic recoil, which allows airway collapse during exhalation. Air enters the alveoli during inhalation, but has difficulty escaping during exhalation. When air is trapped in the alveoli, residual volume increases, causing a barrel chest. Destruction of alveolar walls does not cause pulmonary edema, muscle atrophy, or prolonged inspiration.

13. When exposed to inhaled allergens, a patient with asthma produces large quantities of a. IgG. b. IgE. c. IgA. d. IgM. ANS: B

During an allergic response, plasma cells produce large quantities of IgE. IgG, IgA, and IgM are not part of the pathophysiology of asthma.

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Pathophysiology 6th Edition Banasik Test Bank 14. In individuals who have asthma, exposure to an allergen to which they are sensitized leads to

which pathophysiologic event? a. Loss of alveolar elastin and premature closure of airways b. Pulmonary edema and decreased alveolar compliance c. Mast cell degranulation that causes decreased surfactant d. Inflammation, mucosal edema, and bronchoconstriction ANS: D

In asthma, exposure to an allergen causes mast cell degranulation and release of inflammatory mediators that trigger airway inflammation, mucosal edema, and bronchoconstriction. In asthma, exposure to an allergen does not cause loss of alveolar elastin, pulmonary edema and decreased alveolar compliance, or decreased surfactant.

15. Lack of -antitrypsin in emphysema causes a. chronic mucous secretion and airway fibrosis. b. destruction of alveolar tissue. c. pulmonary edema and increased alveolar compliance. d. bronchoconstriction and airway edema.

ANS: B

Lack of 1-antitrypsin in emphysema causes destruction of alveolar tissue, as it is a protective enzyme that prohibits proteolytic breakdown of alveolar tissue. Lack of alpha1-antitrypsin does not cause chronic mucous secretion and airway fibrosis, pulmonary edema and increased alveolar compliance, or bronchoconstriction and airway edema.

16. The hypersecretion of mucus resulting for chronic bronchitis is the result of a. recurrent infection. b. destruction of alveolar seN ptU a.RSINGTB.COM c. reduced inflammation. d. barrel chest.

ANS: A

Mucus provides a hospitable environment for bacterial colonization and recurrent infection.

Destruction of alveolar septa and reduced inflammation are not complications of chronic bronchitis. Hypersecretion of mucus does not contribute to barrel chest.

17. When preparing for the admission of a client diagnosed with bronchiectasis, the nurse will a. put a sputum cup and a box of tissues on the bedside table. b. remove the telephone to reduce myocardial oxygen demand. c. add a box of surgical masks to the nursing supplies near the door. d. remove the water pitcher to comply with anticipated fluid restrictions.

ANS: A

People who have bronchiectasis have a productive cough, usually with foul-smelling sputum.

Bronchiectasis is not contagious or a cardiac condition. Fluid restriction is not part of the treatment for bronchiectasis.

18. Which assessment would support a diagnosis of type A COPD rather than type B COPD a. Copious sputum, dyspnea, cor pulmonale b. Noisy breath sounds, fatigue, high PaCO2, overweight c. Normal PaCO2, scant sputum, accessory muscle use, barrel chest

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Pathophysiology 6th Edition Banasik Test Bank d. Barrel chest, productive cough, cyanosis, very decreased PaO2 ANS: C

Barrel chest and obvious respiratory effort that maintains near normal blood gases are consistent with type A COPD in the early stages. Copious sputum, dyspnea, and cor pulmonale are consistent with type B COPD. Noisy breath sounds, fatigue, high PaCO2, and overweight are consistent with type B COPD. Barrel chest, productive cough, cyanosis, and very decreased PaO2 are not consistent with type A COPD. 19. To best prevent emphysema, a patient is instructed to stop smoking since cigarette smoke a. impairs 1-antitrypsin, allowing elastase to predominate. b. paralyzes the cilia, causing impaired mucociliary clearance. c. predisposes to respiratory infections. d. introduces carcinogens into the lungs.

ANS: A

Cigarette smoking impairs 1-antitrypsin, allowing elastase to predominate and destroy lung tissue, causing emphysema. Although cigarette smoking does paralyze cilia, this action predisposes to respiratory infections rather than to emphysema. Although cigarette smoking does predispose to respiratory infections, that is not the mechanism that causes emphysema.

Carcinogens introduced by cigarette smoking increase the risk of developing lung cancer, but they are not responsible for emphysema.

20. When a client diagnosed with COPD type A asks, “Why is my chest so big and round?”, the

nurse responds that a. “Loss of elastic tissue in your lungs allows your airways to close and trap air, which makes your chest round.” b. “Swelling and mucus in yNoU urRaS irI waNyG sT caB us.eC s aOi rMt o be trapped in your lungs, which makes your chest round.” c. “Coughing caused by your condition has changed the structure of your airways, which makes your chest round.” d. “Scar tissue in your lungs makes them stiff and more full of air than usual, which makes your chest round.”

ANS: A

Loss of elastic tissue in the lungs allows premature airway closure, which traps air, creating a barrel chest. The other answer choices do not describe the pathophysiology that causes barrel chest in persons with COPD type A. 21. Which complication of asthma is life threatening? a. Exercise-induced asthma b. Late phase response c. Status asthmaticus d. Mast cell degranulation ANS: C

Status asthmaticus is a severe attack unresponsive to routine therapy and can be life threatening if not reversed. Exercise-induced asthma is a form of asthma, rather than a complication of it. The late phase response is part of the pathophysiology of asthma and is not always life threatening. Mast cell degranulation is part of the pathophysiology of asthma and in itself is not life threatening.

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank

22. Airway obstruction in chronic bronchitis is because of a. thick mucus, fibrosis, and smooth muscle hypertrophy. b. loss of alveolar elastin. c. pulmonary edema. d. hyperplasia and deformation of bronchial cartilage.

ANS: A

Airway obstruction in chronic bronchitis is as a result of thick mucus, fibrosis, and smooth muscle hypertrophy. Loss of alveolar elastin, pulmonary edema, and hyperplasia and deformation of bronchial cartilage are not part of the pathophysiology of chronic bronchitis.

23. Individuals who have chronic bronchitis most often have a. a productive cough. b. normal lung sounds. c. a barrel chest. d. substantial weight loss.

ANS: A

A productive cough for at least 3 months is the classic sign of chronic bronchitis. People who have chronic bronchitis commonly have abnormal lung sounds resulting from mucus in their airways. Barrel chest is a classic sign of emphysema. Substantial weight loss is characteristic of emphysema, but not of chronic bronchitis.

24. The increased anterior-posterior chest diameter associated with obstructive lung disease is

caused by a. increased pulmonary blood flow. b. increased expiratory flowNrU atR esS . INGTB.COM c. increased residual lung volumes. d. decreased chest wall compliance.

ANS: C

Increased residual lung volumes are because of air trapping in obstructive lung disease and cause a barrel chest. Increased pulmonary blood flow does not affect chest diameter. Increased expiratory flow rates would decrease air trapping rather than increase chest diameter.

Obstructive lung disease does not involve decreased chest wall compliance. It is increased as a result of loss of alveoli and elastic tissue.

25. The assessment findings of a 5-year-old with a history of asthma include extreme shortness of

breath, nasal flaring, coughing, pulsus paradoxus, and use of accessory respiratory muscles.

There is no wheezing and the chest is silent in many areas. How should you interpret your assessment? a. The child probably has consolidated pneumonia; oxygen should be started immediately. b. Since there is not wheezing, asthma is the problem, but oxygen should be started immediately anyway. c. The signs and symptoms are consistent with asthma; start oxygen and then check to see that your stethoscope is working properly. d. The child may be having such a severe asthma episode that the airways are closed, so start oxygen and get the doctor immediately.

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank ANS: D

The airway inflammation, edema, and bronchoconstriction of acute asthma may occlude small airways completely, so that no air is moving, which requires emergency intervention. Alicia has a history of asthma rather than pneumonia. Asthma can occur without wheezing. This is an emergency situation that requires you to start oxygen and notify the physician.

MULTIPLE RESPONSE 1. An acute asthma attack is associated with (Select all that apply.) a. bronchoconstriction. b. bronchial mucosal edema. c. hypersecretion of mucus. d. alveolar collapse. e. hypoxemia.

ANS: A, B, C, E

An acute asthma attack is associated with bronchoconstriction, bronchial mucosal edema, hypersecretion of mucus, and possible hypoxemia. Alveolar collapse does not occur in asthma.

2. When assessing an individual during an acute asthma episode, you should expect to find

(Select all that apply.) a. use of accessory breathing muscles. b. expiratory wheezing. c. foul-smelling sputum. d. coughing. e. feeling of chest tightness.NURSINGTB.COM ANS: A, B, D, E

Manifestations of an acute asthma episode include use of accessory breathing muscles, wheezing, coughing, and a feeling of tightness in the chest. Foul-smelling sputum is not characteristic of acute asthma.

3. Characteristics of asthma include (Select all that apply.) a. chronic inflammatory disorder. b. airway hyperresponsiveness. c. alveolar collapse. d. genetic susceptibility. e. airway remodeling.

ANS: A, B, D, E

Asthma is a chronic inflammatory disorder that involves interaction of genetic susceptibility with environmental factors. Inflammation in asthma causes hyperresponsive airways and eventual airway remodeling. The pathophysiology of asthma does not involve alveolar collapse. Asthma is a chronic inflammatory disorder that involves interaction of genetic susceptibility with environmental factors. Inflammation in asthma causes hyperresponsive airways and eventual airway remodeling.

4. Which is true about epiglottitis? (Select all that apply.) a. Is usually caused by H. influenzae type B b. Can be caused by bacterial infection

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank c. Usually occurs in children d. Is characterized by pain with swallowing e. Generally resolves without intervention ANS: A, B, C, D

Epiglottitis is usually caused by H. influenzae type B, but can be caused by bacteria. It usually occurs in children and is characterized by pain with swallowing. This condition is a medical emergency and requires immediate intervention.

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NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank

Chapter 23: Restrictive Pulmonary Disorders Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. Viral pneumonia is characterized by a. a productive cough. b. a dry cough. c. exudative consolidation. d. significant ventilation-perfusion imbalance.

ANS: B

No exudative fluids are produced. Viral pneumonia does not produce exudates, so the cough is non-productive. Ventilation-perfusion imbalance does not usually occur in viral pneumonia.

2. The characteristic x-ray findings in tuberculosis include a. diffuse white-out. b. Ghon tubercles. c. bibasilar infiltrates. d. tracheal deviation.

ANS: B

Tuberculosis results in Ghon tubercles that show up as nodules with infiltrates. Diffuse white-out, basilar infiltrates, and tracheal deviation are not characteristic x-ray findings in tuberculosis.

3. Widespread atelectasis, non-N caU rdR ioS gI enN icGpT ulB m. onCaO ryMedema, and diffuse, fluffy alveolar

infiltrates on chest radiograph are characteristic of a. acute respiratory distress syndrome. b. chronic obstructive pulmonary disease. c. asthma. d. cor pulmonale.

ANS: A

Acute respiratory distress syndrome is characterized by widespread atelectasis, non-cardiogenic pulmonary edema, and diffuse, fluffy alveolar infiltrates. These findings are not characteristics of chronic obstructive pulmonary disease, asthma, or cor pulmonale.

4. Which is indicative of a left tension pneumothorax? a. Course crackles throughout the left chest b. Tracheal deviation to the left c. Absent breath sounds on the left d. Respiratory acidosis ANS: C

A left pneumothorax results in absent breath sounds on the affected side. Crackles will not be heard because breath sounds are not present. Tracheal deviation occurs on the contralateral side. Pneumothorax results in acute respiratory alkalosis.

5. A patient exhibiting respiratory distress as well as a tracheal shift should be evaluated for

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank a. b. c. d.

pneumonia. pneumothorax. pulmonary edema. pulmonary embolus.

ANS: B

Pneumothorax leads to a tracheal shift to the side opposite the pneumothorax. Pneumonia, pulmonary edema, and pulmonary embolus do not lead to tracheal shift.

6. A patient with a productive cough and parenchymal infiltrates on x-ray is demonstrating

symptomology of a. bacterial pneumonia. b. viral pneumonia. c. tuberculosis. d. acute respiratory distress syndrome.

ANS: A

Bacterial pneumonia produces a productive cough and parenchymal infiltrates (white shadows) on x-ray. Viral pneumonia does not produce a productive cough. Tuberculosis may produce a productive cough but does not show parenchymal infiltrates (white shadows) on x-ray. Acute respiratory distress syndrome produces a non-productive cough.

7. The organism that causes pulmonary tuberculosis is a. Mycobacterium tuberculosis. b. Haemophilus tuberculosis. c. Tuberculosis tuberculoci. d. Mycococcidio tuberculosis.

ANS: A

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Mycobacterium tuberculosis causes pulmonary tuberculosis. Haemophilus tuberculosis, Tuberculosis tuberculoci, and Mycococcidio tuberculosis do not cause pulmonary tuberculosis.

8. Which clinical manifestation is not likely the result of a tuberculosis infection? a. Productive cough b. Low-grade fever c. Night sweats d. Cyanosis ANS: D

Cyanosis is not a typical manifestation of tuberculosis infection. A productive cough, low-grade fever, and night sweats are the typical manifestations of tuberculosis infection.

9. Which disorder is caused by inhalation of organic substances? a. Diffuse interstitial lung disease b. Hypersensitivity pneumonitis c. Sarcoidosis d. Acute respiratory distress syndrome ANS: B

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank Hypersensitivity pneumonitis is caused by inhalation of organic substances that produces an inflammatory immunologic reaction. Diffuse interstitial lung disease is probably related to an immune reaction but not from inhalation of organic substances. Sarcoidosis likely has an immunologic basis, but not from inhalation of organic substances. Acute respiratory distress syndrome is associated with severe trauma, sepsis, and shock.

10. The hallmark manifestation of acute respiratory distress syndrome is a. tachycardia. b. hypotension. c. frothy secretions. d. hypoxemia.

ANS: D

The hallmark of acute respiratory distress syndrome is hypoxemia caused by intrapulmonary shunting of blood. Tachycardia, hypotension, and frothy secretion occur in this disorder but are not hallmark.

11. The primary cause of infant respiratory distress syndrome is a. prematurity. b. lack of surfactant. c. maternal illegal drug use during pregnancy. d. umbilical cord compression.

ANS: B

The primary cause of this disorder is lack of surfactant. While premature infants may demonstrate this disorder, the actual cause is lack of surfactant. It is a syndrome seen in premature infants. Maternal illegal drug use during pregnancy and umbilical cord compression are not the primN arU yR caSuI seN sG ofTinBf. anC tO r eM s piratory distress syndrome.

12. Empyema is defined as an a. exudative bronchitis. b. infection in the pleural space. c. infection localized in the lung. d. infection in the blood.

ANS: B

Empyema is infection in the pleural space. Empyema is not exudative bronchitis, localized infection in the lung, or an infection in the blood.

13. A patient with flail chest will demonstrate a. absence of chest movement with breaths. b. no inspiratory breath sounds. c. fluttering chest movements on expirations. d. outward chest movement on expiration.

ANS: D

Flail chest is demonstrated by paradoxical inward movement on inspiration and outward movement on expiration. Flail chest is not demonstrated by absence of chest movement with breaths, no inspiratory breath sounds, or fluttering chest movements on expiration.

14. Obstructive sleep apnea would most likely be found in a patient diagnosed with

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Pathophysiology 6th Edition Banasik Test Bank a. b. c. d.

myasthenia gravis. poliomyelitis.

Pickwickian syndrome. pneumonia.

ANS: C

Pickwickian syndrome is hypoventilation caused by obesity. Sleep apnea is often a problem in obese individuals. Obstructive sleep apnea is not likely to be found in a patient with myasthenia gravis, poliomyelitis, or pneumonia.

15. Pneumocystitis is a term that refers to a a. fungal pneumonia secondary to HIV. b. viral pneumonia found in transplant recipients. c. non-infectious inflammation in the lung. d. pneumonia secondary to bladder infection.

ANS: A

Pneumocystitis is a fungal pneumonia secondary to HIV. Pneumocystitis is not a viral pneumonia found in transplant recipients, a non-infectious inflammation of the lung, or a pneumonia secondary to bladder infection.

16. The most definitive diagnostic method for active tuberculosis is acquired via a. sputum culture. b. Mantoux skin test. c. chest x-ray. d. blood culture.

ANS: A

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The most definitive diagnostic method for active tuberculosis is via sputum culture to identify the acid-fast bacillus. The Mantoux skin test does not distinguish between active infection and past infection. Although a chest x-ray will show characteristic nodules, a sputum culture is the most definitive diagnostic method for active tuberculosis. Unless a patient is septic (infection in the blood), the tuberculosis organism will not be found in the blood.

17. A major cause of treatment failure in tuberculosis is a. resistant organism. b. allergy to drugs used. c. noncompliance. d. immunosuppression.

ANS: C

The major cause of treatment failure in tuberculosis is non-adherence to drug therapy. The major cause of treatment failure in tuberculosis is not a resistant organism, drug allergy, or immunosuppression.

18. Neuromuscular disorders impair lung function primarily because of a. inflammatory events in the lung. b. secondary pneumonia. c. weak muscles of respiration. d. inactivity secondary to the disorder.

ANS: C

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Pathophysiology 6th Edition Banasik Test Bank Neuromuscular disorders weaken respiratory muscle function resulting in poor ventilation.

Inflammatory events in the lung, secondary pneumonia, and inactivity secondary to the disorder are not the primary reasons neuromuscular disorders impair lung function.

19. Legionnaires disease is characterized by a. presence of systemic illness. b. airborne mechanism of communicability. c. mild symptomatology. d. resolution with or without antimicrobial therapy.

ANS: A

Legionnaires disease produces system manifestations such as fever, diarrhea, abdominal pain, and pneumonia. The organism that causes Legionnaires disease is transmitted by means of contaminated water. Symptoms are severe, and the disease requires antimicrobial therapy.

20. Bacterial pneumonia leads to hypoxemia caused by a. cardiogenic pulmonary edema. b. upper airway obstruction. c. accumulation of alveolar exudates. d. interstitial edema.

ANS: C

The inflammatory response to bacterial pneumonia causes accumulation of exudates in the alveoli and impairs oxygenation. Bacterial pneumonia does not cause cardiogenic pulmonary edema. Pneumonia involves lower airway obstruction. Bacterial pneumonia does not lead to interstitial edema.

21. A common characteristic of vNirU alRpS nI euN mG onTiaBi. s COM a. high fever. b. alveolar infiltrates on a chest x-ray. c. increased white blood cell count. d. dry cough.

ANS: D

Viral pneumonia typically manifests with a dry cough. Viral infections usually do not cause high fever. Viral pneumonia typically does not produce alveolar infiltrates or leukocytosis.

22. A major risk factor for the development of active pulmonary tuberculosis (TB) disease is a. contaminated water. b. immunosuppression. c. being a male. d. overuse of antibiotics.

ANS: B

Immunosuppressed individuals, such as those with HIV, are at high risk for active TB disease.

Contaminated water and gender are not major risk factors for pulmonary tuberculosis.

Excessive use of antibiotics can lead to opportunistic yeast and fungal infections or cause bacterial resistance to available antibiotics, but it is not a major risk factor for TB. 23. Accumulation of fluid in the pleural space is called a. an abscess.

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Pathophysiology 6th Edition Banasik Test Bank b. pleurisy. c. flail chest. d. pleural effusion.

ANS: D

Pleural effusion is accumulation of fluid in the pleural space. A lung abscess is a circumscribed area of suppuration and lung tissue destruction. Pleurisy is inflammation of the pleura that often manifests with pain on inspiration, fever, and chills. Flail chest is the fracture of several consecutive ribs.

24. A restrictive respiratory disorder is characterized by a. increased total lung capacity. b. decreased residual volume. c. inspiratory wheezing. d. expiratory wheezing.

ANS: B

Restrictive respiratory disorders are characterized by decreased residual volume. Restrictive respiratory disorders are not characterized by increased residual volume. Inspiratory and expiratory wheezing are not characteristic of restrictive respiratory disorder.

25. Air that enters the pleural space during inspiration but is unable to exit during expiration

creates a condition called a. tension pneumothorax. b. open pneumothorax. c. pleural effusion. d. empyema.

ANS: A

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Air that enters the pleural space during inspiration but is unable to exit during expiration causes a tension pneumothorax. The question does not describe open pneumothorax, pleural effusion, or empyema.

26. When a parent of a toddler recently diagnosed with pneumococcal pneumonia asks why their

child is so much sicker than a classmate was when they were diagnosed with pneumonia, the nurse replies a. “It sounds as if the classmate was just lucky and less exposed at daycare.” b. “It sounds like your child has a case of bacterial pneumonia, while the classmate had viral pneumonia.” c. “It sounds as if your child is having a severe reaction to bacterial pneumonia. It hits some children harder than others.” d. “It sounds as if your child has a case of viral pneumonia, while the classmate had bacterial pneumonia.”

ANS: B

Viral pneumonia does not produce exudate so the cough is non-productive. In general, symptoms of viral pneumonia are less severe than those of bacterial pneumonia. The uncle’s case of viral pneumonia has less acute symptoms than the children’s case of bacterial pneumonia. Pneumococcal pneumonia is not necessarily more severe in children. The children most likely have bacterial pneumonia, which is why their symptoms are more acute than the classmate’s case of viral pneumonia.

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Pathophysiology 6th Edition Banasik Test Bank

MULTIPLE RESPONSE 1. It is true that diffuse interstitial lung disease (Select all that apply.) a. leads to loss of alveolar walls. b. may be immunologic in nature. c. produces a productive cough. d. is always reversible. e. shows on x-ray as a “honeycomb lung.”

ANS: A, B, E

Diffuse interstitial lung disease results in loss of alveolar walls, may be immunologic in nature, and shows a “honeycomb” appearance on x-ray. A non-productive cough is characteristic of this disorder. The disorder is not always reversible.

2. Common characteristics of sarcoidosis include (Select all that apply.) a. presence of CD4+ T cells. b. a non-productive cough. c. leukocytosis. d. granulomas in multiple body systems. e. fatigue, weight loss, and fever.

ANS: A, B, D, E

Common characteristics of sarcoidosis include the presence of CD4+ T cells; a non-productive cough; granulomas in lungs and other body systems; and fatigue, weight loss, and fever. Leukopenia is characteristic of this disorder.

N R I G B.C M

3. Clinical manifestations of pleuU ral eSffuN sionTincludeO(Select all that apply.) a. dyspnea. b. sharp pain in expiration. c. productive cough. d. diminished breath sounds. e. a tracheal shift, if large.

ANS: A, D, E

Clinical manifestations of pleural effusion include dyspnea, diminished breath sounds, and tracheal shift if a large amount of fluid is present. With pleural effusion, pain is worse on inspiration and the cough is non-productive. If productive, an infectious process within the lung is suspected.

4. Chronic occupational lung disease is characterized by (Select all that apply.) a. causation from long-term inhalation of inorganic material. b. a latent period before symptoms occur. c. hyperactive respiratory macrophages. d. a progressive cough and dyspnea with exercise. e. possible negative chest x-ray when symptom-free.

ANS: A, B, D, E

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Pathophysiology 6th Edition Banasik Test Bank Chronic occupational lung disease is caused by long-term inhalation of inorganic material. A latent period of 10 to 20 years may ensue before symptoms occur. One of the earliest manifestations is a progressive cough and dyspnea on exertion. The disease cannot be ruled out by a negative chest x-ray. Impairment of macrophage function is the primary mechanism through which inorganic particles initiate lung disease.

5. Restrictive respiratory disorders include (Select all that apply.) a. pneumothorax. b. emphysema. c. chronic asthma. d. type B COPD. e. ARDS. ANS: A, E

Pneumothorax is a restrictive respiratory disorder that involves the pleural space and ARDS is a restrictive respiratory disorder that involves lung parenchyma. Emphysema, chronic asthma, and type B COPD are obstructive respiratory diseases.

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Pathophysiology 6th Edition Banasik Test Bank

Chapter 24: Fluid and Electrolyte Homeostasis and Imbalances Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. Osmoreceptors located in the hypothalamus control the release of a. angiotensin. b. atrial natriuretic peptide. c. aldosterone. d. vasopressin (antidiuretic hormone, ADH).

ANS: D

Factors that increase secretion of ADH into the blood include increased osmolality of the blood, which is sensed by osmoreceptors in the hypothalamus. Release of angiotensin, atrial natriuretic peptide, and aldosterone is not controlled by osmoreceptors in the hypothalamus.

2. Decreased neuromuscular excitability is often the result of a. hypercalcemia and hypermagnesemia. b. hypomagnesemia and hyperkalemia. c. hypocalcemia and hypokalemia. d. hypernatremia and hypomagnesemia.

ANS: A

Hypercalcemia and hypermagnesemia result in decreased neuromuscular excitability.

Hypomagnesemia, hypocalcemia, and hypomagnesemia result in increased neuromuscular excitability.

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3. What is likely to lead to hyponatremia? a. Insufficient ADH secretion b. Excess aldosterone secretion c. Administration of intravenous normal saline d. Frequent nasogastric tube irrigation with water ANS: D

Sodium is lost from gastric secretions when nasogastric tubes are irrigated with water. The sodium diffuses into the irrigating water and is then lost when the aspirate is withdrawn.

Excessive ADH would lead to hyponatremia by retention of water in the body, thus diluting the sodium. Excess aldosterone would increase serum sodium. Normal saline is an isotonic solution and will not alter the serum sodium.

4. An increase in the resting membrane potential (hyperpolarized) is associated with a. hypokalemia. b. hyperkalemia. c. hypocalcemia. d. hypercalcemia.

ANS: A

Hypokalemia increases the resting membrane potential. Hyperkalemia results in hypopolarization. Hypocalcemia and hypercalcemia do not affect the resting membrane potential.

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Pathophysiology 6th Edition Banasik Test Bank

5. Abnormalities in intracellular regulation of enzyme activity and cellular production of ATP

are associated with a. hyponatremia. b. hypocalcemia. c. hypophosphatemia. d. hypokalemia.

ANS: C

Phosphate is an important component of ATP. Hypophosphatemia results in decreased ATP to cells. Hyponatremia, hypocalcemia, and hypokalemia do not affect ATP production.

6. The fraction of total body water (TBW) volume contained in the intracellular space in adults

is a. b. c. d.

three fourths. two thirds. one half. one third.

ANS: B

Approximately two thirds of TBW is contained inside the cells. Two thirds, not three fourths, of TBW is contained inside the cells. Two thirds, not one-half, of TBW is contained inside the cells. One-third of the TBW is extracellular in adults.

7. What age group has a larger volume of extracellular fluid than intracellular fluid? a. Infants b. Adolescents c. Young adults d. Older adults

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ANS: A

Infants have a larger volume of extracellular fluid than intracellular fluid. Adolescents, young adults, and older adults have a larger volume of intracellular fluid than extracellular fluid.

8. Clinical manifestations of severe symptomatic hypophosphatemia are caused by a. excess proteins. b. renal damage. c. deficiency of ATP. d. hypocalcemia.

ANS: C

Clinical manifestations of severe symptomatic hypophosphatemia are caused by a deficiency of ATP. Phosphate is an important component of ATP, which is the major source of energy for many cellular substances. Severe symptomatic hypophosphatemia does not cause excess protein accumulation, damage the kidneys, or cause hypocalcemia.

9. A person who overuses magnesium-aluminum antacids for a long period of time is likely to

develop a. hypokalemia. b. hyperkalemia. c. hypophosphatemia.

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Pathophysiology 6th Edition Banasik Test Bank d. hyperphosphatemia.

ANS: C

Antacid overuse for a long time can cause hypophosphatemia by binding phosphate in the gastrointestinal tract and preventing its absorption. Magnesium-aluminum antacids do not cause hypokalemia, hyperkalemia, or hyperphosphatemia.

10. The electrolyte that has a higher concentration in the extracellular fluid than in the

intracellular fluid is a. sodium b. phosphate c. magnesium d. potassium

ions.

ANS: A

Extracellular fluid has a higher sodium ion concentration than does intracellular fluid.

Intracellular fluid has a higher phosphate, magnesium, and potassium ion concentration than does extracellular fluid.

11. A person who has hyperparathyroidism is likely to develop a. hypokalemia. b. hyperkalemia. c. hypocalcemia. d. hypercalcemia.

ANS: D

A person who has hyperparathyroidism is likely to develop hypercalcemia, because parathyroid hormone causes N c a l cRi u mIt o com e . ouCt ofMthe bones and go to the ECF. G B U S N T O Hypokalemia, hyperkalemia, and hypocalcemia are not the result of hyperparathyroidism.

12. The inward-pulling force of particles in the vascular fluid is called a. capillary hydrostatic b. interstitial osmotic c. capillary osmotic d. interstitial hydrostatic

pressure.

ANS: C

Capillary osmotic pressure is the inward-pulling force of particles in the vascular fluid.

Capillary hydrostatic pressure is an outward-pulling. The question pertains to vascular fluid rather than interstitial fluid. Interstitial hydrostatic pressure is an outward-pulling force.

13. How do clinical conditions that increase vascular permeability cause edema? a. Through altering the negative charge on the capillary basement membrane, which

enables excessive fluid to accumulate in the interstitial compartment b. By causing movement of fluid from the vascular compartment into the intracellular compartment, which leads to cell swelling c. Through leakage of vascular fluid into the interstitial fluid, which increases interstitial fluid hydrostatic pressure d. By allowing plasma proteins to leak into the interstitial fluid, which draws in excess fluid by increasing the interstitial fluid osmotic pressure ANS: D

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Pathophysiology 6th Edition Banasik Test Bank Clinical conditions that increase vascular permeability cause edema by allowing plasma proteins to leak into the interstitial fluid, which draws in excess fluid by increasing the interstitial fluid osmotic pressure. The capillary basement membrane does not change its charge with increased vascular permeability. Increased vascular permeability does not move water into the cells. Increasing the interstitial fluid osmotic pressure would not cause edema.

14. Which alterations can lead to edema? a. Decreased capillary hydrostatic pressure b. Increased capillary colloid osmotic pressure c. Decreased lymphatic flow d. Decreased capillary membrane permeability ANS: C

Lymphatic obstruction prevents the drainage of accumulated interstitial fluid and proteins, which can lead to severe edema. Decreased capillary hydrostatic pressure would push less fluid into the interstitial space. Increased capillary colloid osmotic pressure would remove fluid from the interstitial space. Decreased capillary membrane permeability would allow less fluid movement into the interstitial space.

15. The process responsible for distribution of fluid between the interstitial and intracellular

compartments is a. filtration. b. osmosis. c. active transport. d. diffusion.

ANS: B

Distribution of fluid betweenNthUeRinSteIrsNtiG tiaTl B an.dCinOtrMacellular compartments occurs by the process of osmosis. Filtration is responsible for the distribution of fluid between the vascular and interstitial compartments. Active transport moves ions across membranes, but does not move water. Diffusion involves movement of particles, not movement of water.

16. Which electrolyte imbalances cause increased neuromuscular excitability? a. Hypokalemia and hyperphosphatemia b. Hyperkalemia and hypophosphatemia c. Hypocalcemia and hypomagnesemia d. Hypercalcemia and hypermagnesemia ANS: C

Hypocalcemia and hypomagnesemia both cause increased neuromuscular excitability.

Hypokalemia, hyperkalemia, hypophosphatemia, hypercalcemia, and hypermagnesemia do not cause increased neuromuscular excitability.

17. Excessive antidiuretic hormone (ADH) secretion can cause a. increased serum sodium b. decreased serum sodium c. increased serum potassium d. decreased serum potassium ANS: B

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concentration.

Pathophysiology 6th Edition Banasik Test Bank Excessive ADH stimulates excessive water reabsorption by the kidneys, which dilutes the blood, thus decreasing the serum sodium concentration. Excessive ADH secretion does not cause increased serum sodium or potassium concentrations, or decreased serum potassium concentration.

18. Causes of hypomagnesemia include a. hyperphosphatemia. b. chronic alcoholism. c. oliguric renal failure. d. clinical dehydration.

ANS: B

Hypomagnesemia is common with chronic alcoholism. Hyperphosphatemia causes hypocalcemia. Oliguric renal failure and clinical dehydration reduce magnesium excretion.

19. Signs and symptoms of clinical dehydration include a. decreased urine output. b. increased skin turgor. c. increased blood pressure. d. decreased heart rate.

ANS: A

One clinical manifestation of dehydration is decreased urine output. Skin turgor and blood pressure decrease in clinical dehydration. Heart rate increases in clinical dehydration.

20. Hypernatremia may be caused by a. decreased aldosterone secretion. b. decreased antidiuretic hoN rmUoR neSsI ecNreGtiT onB. .COM c. compulsive water drinking. d. excessive dietary potassium.

ANS: B

Decreased antidiuretic hormone secretion (diabetes insipidus) prevents water reabsorption in the kidneys, which creates large volumes of dilute urine and causes hypernatremia.

Aldosterone causes sodium and water retention. Compulsive water drinking that overwhelms the kidneys would dilute the blood, causing hyponatremia. Excessive dietary potassium would not affect the serum sodium concentration.

21. Clinical manifestations of hyponatremia include a. weak pulse, low blood pressure, and increased heart rate. b. thirst, dry mucous membranes, and diarrhea. c. confusion, lethargy, coma, and perhaps seizures. d. cardiac dysrhythmias, paresthesias, and muscle weakness.

ANS: C

Clinical manifestations of hyponatremia include confusion, lethargy, coma, and perhaps seizures, as they are manifestations of CNS dysfunction. Weak pulse, low blood pressure, and increased heart rate are characteristic of clinical dehydration. Hyponatremia does not cause thirst, dry mucous membranes, and diarrhea. Cardiac dysrhythmias, paresthesias, and muscle weakness are manifestations of electrolyte imbalances.

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Pathophysiology 6th Edition Banasik Test Bank 22. Clinical manifestations of extracellular fluid volume deficit include a. weak pulse, low blood pressure, and increased heart rate. b. thirst, dry mucous membranes, and diarrhea. c. confusion, lethargy, coma, and perhaps seizures. d. cardiac dysrhythmias, paresthesias, and muscle weakness.

ANS: A

Clinical manifestations of extracellular fluid volume deficit include weak pulse, low blood pressure, and increased heart rate. Extracellular fluid volume deficit does not cause diarrhea.

Confusion, lethargy, coma, and perhaps seizures are associated with osmolality imbalances such as hyponatremia. Cardiac dysrhythmias, paresthesias, and muscle weakness are manifestations of electrolyte imbalances.

23. The imbalance that occurs with oliguric renal failure is a. metabolic alkalosis. b. hyperkalemia. c. hypokalemia. d. hypophosphatemia.

ANS: B

Oliguric renal failure decreases potassium excretion, which causes hyperkalemia. Oliguric renal failure decreases acid excretion and causes metabolic acidosis (not alkalosis). Oliguric renal failure does not cause hypokalemia or hypophosphatemia.

24. A known cause of hypokalemia is a. oliguric renal failure. b. pancreatitis. c. insulin overdose. d. hyperparathyroidism.

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ANS: C

Insulin overdose causes hypokalemia by shifting potassium into cells. Oliguric renal failure decreases electrolyte excretion. Pancreatitis causes fat malabsorption, which binds calcium and magnesium, but not potassium, in the gastrointestinal tract. Hyperparathyroidism regulates calcium, not potassium.

25. Effects of hypernatremia on the central nervous system typically include a. confusion. b. excitation. c. insomnia. d. hallucinations.

ANS: A

Hypernatremia causes osmotic shrinking of brain cells, which manifests as confusion or coma.

Hypernatremia does not usually cause central nervous system excitation, insomnia, or hallucinations.

26. Total body water in older adults is a. increased because of decreased adipose tissue and decreased bone mass. b. increased because of decreased renal function and hormonal fluctuations. c. decreased because of increased adipose tissue and decreased muscle mass.

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Pathophysiology 6th Edition Banasik Test Bank d. decreased because of renal changes that cause diuresis with sodium excretion.

ANS: C

Older adults have decreased total body water because of increased adipose tissue and decreased muscle mass. Older adults have increased adipose tissue. Hormonal fluctuations and diuresis with sodium excretion are not characteristic of older adults.

27. Clinical manifestations of moderate to severe hypokalemia include a. muscle spasms and rapid respirations. b. muscle weakness and cardiac dysrhythmias. c. confusion and irritability. d. vomiting and diarrhea.

ANS: B

Hypokalemia causes muscle weakness (or paralysis) and cardiac dysrhythmias. Hypokalemia does not cause muscle spasms and rapid respirations or confusion and irritability. Vomiting and diarrhea can cause hypokalemia, but they are not signs and symptoms of it.

28. Signs and symptoms of extracellular fluid volume excess include a. tachycardia. b. increased serum sodium concentration. c. bounding pulse. d. increased hematocrit.

ANS: C

Bounding pulse is one of the signs of extracellular fluid volume excess. Tachycardia is one of the signs of extracellular fluid volume deficit. Increased serum sodium concentration is found in hypernatremia. HematocriN t canRbeIdecGreaB se. dC w ithMextracellular fluid volume excess.

U S N T

O

29. Hyperaldosteronism causes a. ECV deficit and hyperkalemia. b. ECV excess and hypokalemia. c. hyponatremia and hyperkalemia. d. excessive water reabsorption without affecting sodium concentration.

ANS: B

Hyperaldosteronism causes excessive renal retention of sodium and water and excessive potassium excretion, which lead to ECV excess and hypokalemia. Hyperaldosteronism does not cause ECV deficit, hyperkalemia, hyponatremia, or excessive water reabsorption without affecting sodium concentration.

30. The person at highest risk for developing hypernatremia is a person who a. self-administers a daily tap water enema to manage a partial bowel obstruction. b. receives tube feedings because he or she is comatose after a stroke. c. has ectopic production of ADH from small cell carcinoma of the lung. d. is receiving IV 0.9% NaCl at a fast rate.

ANS: B

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Pathophysiology 6th Edition Banasik Test Bank Tube feedings are associated with hypernatremia as a result of intake of highly concentrated solution that causes the kidneys to excrete extra water to remove the solute load. Absorption of excessive water from daily tap water enemas would cause hyponatremia. Uncontrolled secretion of ADH causes renal retention of water that leads to hyponatremia. An IV solution of 0.9% NaCl (normal saline) is isotonic.

31. When a parent asks how they will know if their 2-month-old baby, who is throwing up and

has frequent diarrhea, is dehydrated, the nurse’s best response is a. “Clinical dehydration is the combination of extracellular fluid volume deficit and hypernatremia, so those are the diagnostic criteria.” b. “If he doesn’t wet his diaper all afternoon and his neck veins look flat when he is lying down, then he is probably dehydrated.” c. “If he sleeps more than usual and acts tired when he is awake, then he is probably dehydrated.” d. “If the soft spot on the top of his head feels sunken in and his mouth is dry between his cheek and his gums, then he is probably dehydrated.”

ANS: D

Checking whether the head feels sunken and the mouth is dry between check and gums are useful assessments of ECV deficit in an infant, which is an important part of clinical dehydration. It is true that clinical dehydration is the combination of extracellular fluid volume deficit and hypernatremia, but it does not address the question Mr. Worry is asking.

Although the diaper information provides a useful assessment, neck veins are not a reliable assessment in an infant. Drowsiness and fatigue are not reliable assessments for dehydration.

32. A patient who reports an intestinal fistula also reports feeling “weak and dizzy” when she

stands. While taking her blo oNd p R r e s sI ure G she B be.cC omeMs temporarily unresponsive but quickly U S N T O regains consciousness when put into a supine position. What nursing interventions will the nurse implement before calling the physician? a. Sit her up again, with proper support, so you can have an accurate upright blood pressure and heart rate to report. b. Give her a drink of water or juice, talk with her to calm her down, and ask if she slept well last night. c. Give her water or juice and some salty crackers and ask if she has had any diarrhea or vomiting. d. Assess small vein filling time, look for ankle edema, and ask if she had any fluid to drink yet today.

ANS: C

Her substantial systolic postural blood pressure decreases with tachycardia and syncope when upright are indicators of ECV deficit and she needs salt and water. Your questions will provide information for her physician regarding the origin of the ECV deficit. She fainted the first time when she sat upright and is likely to faint again, given her upright systolic pressure of 77 mm Hg. She needs salt and water to increase her ECV and sleep quality is not directly related to ECV deficit. Ankle edema is a sign of ECV excess.

33. What form of oral rehydration, bottled water or salty broth, is best suited for a patient who is

demonstrating signs of clinical dehydration? a. Bottled water, because he is so weak that he might choke on the fluid when he swallows, and water would be less damaging to the lungs than salty soup

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Pathophysiology 6th Edition Banasik Test Bank b. Bottled water, because it will rehydrate his cells c. Salty soup, because he needs nutrition as well as fluid d. Salty soup, because it will provide some sodium to help hold the fluid in his blood

vessels and interstitial fluid ANS: D

This man has indicators of clinical dehydration and he needs salt to hold the water in his extracellular compartment. Replacing fluids and electrolytes is more important than meeting his nutritional needs now.

34. A patient diagnosed with chronic compensated heart failure reports that, “My feet swell if I

eat salt but I don’t understand why” The nurse’s best response is a. “Salt holds water in your blood and makes more pressure against your blood vessels, so fluid leaks out into your tissues and makes them swell.” b. “Gravity makes more pressure down by your feet than up at the top of your body, so more fluid leaks into your tissues at your feet and they swell.” c. “Salt makes your blood vessels relax and the blood does not flow as fast, so some of it leaks into your tissues and makes swelling.” d. “Salt binds to the proteins in your blood and changes the osmotic pressure so more fluid can leak out and stay in the tissues, causing swelling.”

ANS: A

Salt holds water in the ECV, thus increasing capillary hydrostatic pressure. Gravity leads to feet swelling, but it does not explain what the patient is asking. Salt does not cause vasodilation, nor does it bind to blood proteins and change osmotic pressure.

35. A patient, who is 8 months pregnant, has developed eclampsia and is receiving intravenous

magnesium sulfate to p r ev enN t sU eiR zuSreIsN . TGoTdB et. erC mO inM e if her infusion rate is too high, you should regularly a. check the patellar reflex; if it becomes more and more hyperactive, her infusion rate probably is too high and she is at risk for respiratory depression or cardiac arrest. b. check the patellar reflex; if it becomes weak or absent, her infusion rate probably is too high and she is at risk for respiratory depression or cardiac arrest. c. check the patellar reflex; if it stays the same, her infusion rate probably is too high and she is at risk for respiratory depression or cardiac arrest. d. check for seizure activity; if no seizures occur, her infusion rate is correct.

ANS: B

Hypermagnesemia causes decreased neuromuscular excitability and testing the patellar reflex can detect that. Hypermagnesemia causes decreased, not increased, neuromuscular excitability. If the patellar reflex stays the same, the infusion rate is therapeutic. Watching for seizure activity is a dangerous course of action. Hypermagnesemia can cause respiratory depression and cardiac arrest, so you need to assess for its development.

36. A patient has a positive Chvostek sign. The nurse interprets this as a sign of a. hypercalcemia. b. hypermagnesemia. c. decreased neuromuscular excitability. d. increased neuromuscular excitability.

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Pathophysiology 6th Edition Banasik Test Bank ANS: D

Positive Chvostek sign indicates increased neuromuscular excitability, which can be caused by hypocalcemia, hypomagnesemia, or other factors. Hypercalcemia and hypermagnesemia cause decreased neuromuscular excitability and do not cause positive Chvostek sign.

Hypokalemia and hyperkalemia cause skeletal muscle weakness and do not cause positive Chvostek sign.

37. Which change in a patient’s assessment has the greatest urgency? a. Serum potassium concentration is decreasing; abdominal distention, but denies any

difficulty breathing b. Serum calcium concentration is decreasing; reports constipation; is alert and denies

any discomfort c. Serum calcium concentration is increasing; reports constipation; is alert and denies any discomfort d. Serum potassium concentration is increasing; has developed cardiac dysrhythmias, but denies any difficulty breathing ANS: D

Cardiac dysrhythmias from hyperkalemia need rapid attention to prevent potentially life-threatening consequences and are therefore the highest priority for reporting. Certainly you will want to report this symptomatic hypokalemia, but it is not your most urgent priority, because abdominal distention is not rapidly life threatening and you have another patient with cardiac dysrhythmias, which can be life threatening. Certainly you will want to report this hypocalcemia, but it is not your most urgent priority, because there are no signs and symptoms of hypocalcemia and you have another patient with cardiac dysrhythmias, which can be life threatening. Certainly you will want to report this symptomatic hypercalcemia, but it is not your most urgent prioNrityR, b eIc auGs e cBo n.sC t i p a t i o n is not rapidly life threatening and you U dysrhythmias, S N T which O M have another patient with cardiac can be life threatening.

38. How is a patient hospitalized with a malignant tumor that secretes parathyroid

hormone–related peptide monitored for the resulting electrolyte imbalance? a. Serum calcium, Chvostek and Trousseau signs b. Serum calcium, bowel function, level of consciousness c. Serum potassium, Chvostek and Trousseau signs d. Serum potassium, bowel function, level of consciousness ANS: B

Parathyroid hormone increases the plasma calcium concentration, and constipation and lethargy are manifestations of hypercalcemia. Parathyroid hormone increases the plasma calcium concentration, but these are signs of increased neuromuscular excitability, which occurs with hypocalcemia. Parathyroid hormone affects plasma concentration of calcium, not potassium.

39. The nurse provides teaching regarding dietary intake of potassium to avoid an electrolyte

imbalance when a patient a. takes very large doses of vitamin D to supplement during chemotherapy for breast cancer. b. has fatty stools from taking an OTC weight loss product that decreases absorption of fat. c. has chronic heart failure that is treated with diuretics.

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Pathophysiology 6th Edition Banasik Test Bank d. experiences anorexia and chronic oliguric renal failure.

ANS: C

Chronic heart failure causes increased secretion of aldosterone, which often causes hypokalemia by increasing renal excretion of potassium; most diuretics used to treat heart failure also increase renal excretion of potassium. Vitamin D and malabsorption of fat decreases absorption of calcium, not potassium. Chronic oliguric renal failure causes decreased excretion of potassium. An anorexic patient with chronic oliguric renal failure should not increase dietary potassium.

40. What is the most likely explanation for a diagnosis of hypernatremia in an elderly patient

receiving tube feeding? a. Too much sodium in the feedings b. Excess of feedings c. Inadequate water intake d. Kidney failure ANS: C

Failure to provide adequate water when a patient is receiving tube feedings could result in hypernatremia. The feedings may have too much sodium, or the patient may be receiving too much feeding solution, but most likely the patient is not receiving enough water. Kidney failure is most likely not the cause of hypernatremia in this patient.

41. Manifestations from sodium imbalances occur primarily as a result of a. cellular fluid shifts. b. vascular collapse. c. hyperosmolarity. d. hypervolemia.

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ANS: A

Sodium imbalances alter osmolality of fluid compartment leading to osmosis of water from the hypo-osmolar compartment to the hyperosmolar compartment. In brain cells, this leads to swelling or shrinkage of cells, and associated manifestations.

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Pathophysiology 6th Edition Banasik Test Bank

Chapter 25: Acid-Base Homeostasis and Imbalances Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. Which acid are the kidneys unable to excrete? a. Metabolic b. Carbonic c. Bicarbonate d. Ammonia ANS: B

The kidneys can excrete any acid except carbonic acid. The kidneys are able to excrete metabolic acids and ammonia. The kidneys are able to excrete bicarbonate, but bicarbonate is a base, not an acid.

2. The body compensates for metabolic alkalosis by a. hypoventilation. b. decreasing arterial carbon dioxide. c. increasing bicarbonate ion excretion. d. hyperventilation.

ANS: A

In metabolic alkalosis, the lungs compensate by hypoventilation to conserve CO2 in the body.

Decreasing arterial carbon dioxide would worsen metabolic alkalosis. The respiratory system compensates for metabolic acid and base disturbances; the lungs do not increase bicarbonate RoSuI ion excretion. HyperventilatiN onUw ldNbG loT wBo. ffC CO OM 2 and cause respiratory alkalosis.

3. The arterial blood gas pH = 7.52, PaCO2 = 30 mm Hg, HCO3– = 24 mEq/L demonstrates a. metabolic acidosis. b. respiratory acidosis. c. respiratory alkalosis. d. mixed alkalosis.

ANS: C

The high pH, low PaCO2, and normal HCO3 indicate respiratory alkalosis. Metabolic and respiratory acidosis would decrease the pH. The HCO3– is normal, so no metabolic imbalance is indicated.

4. Two primary acid-base disorders that are present independently are referred to as a. metabolic acidosis. b. metabolic alkalosis. c. respiratory alkalosis. d. mixed acid-base imbalance.

ANS: D

Mixed acid-base disorders occur when two primary acid-base disorders are present independently. They may arise from simultaneous dysfunction of the respiratory system and kidneys. Metabolic acidosis is an acid disorder. Metabolic alkalosis and respiratory alkalosis are base disorders.

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Pathophysiology 6th Edition Banasik Test Bank

5. Diarrhea and other lower intestinal fluid losses will contribute to a. metabolic alkalosis. b. metabolic acidosis. c. respiratory acidosis. d. mixed acid-base disorders.

ANS: B

Diarrhea results in loss of bicarbonate and leads to metabolic acidosis. Loss of bicarbonate (a base) would not lead to metabolic alkalosis. Respiratory conditions lead to respiratory acid and base disturbances; diarrhea is not a respiratory condition. Bicarbonate loss through diarrhea would not lead to any respiratory acid/base disturbance.

6. Fully compensated respiratory acidosis is demonstrated by a. pH 7.36, PaCO2 55, HCO3– 36. b. pH 7.45, PaCO2 40, HCO3– 28. c. pH 7.26, PaCO2 60, HCO3– 26. d. pH 7.40, PaCO2 40, HCO3– 24.

ANS: A

Compensation for respiratory acidosis involves conservation of HCO3– in the body; an HCO3– of 36 is a key finding; the normal pH (7.36) indicates compensation. Low HCO3– is not indicative of compensated respiratory acidosis. Low pH indicates no compensation or only partial compensation. Values of pH 7.40, PaCO2 40, and HCO3– 24 are all normal.

7. Respiratory acidosis is associated with a. increased carbonic acid.

NURSINGTB.COM b. hypokalemia. c. increased neuromuscular excitability. d. increased pH. ANS: A

Respiratory acidosis causes an excess of carbonic acid that may be because of impaired gas exchange, inadequate neuromuscular function, and impairment of respiratory control of the brainstem. Hypokalemia is associated with alkalosis. Acidosis is associated with decreased neuromuscular excitability. Increased pH is associated with alkalosis; in acidosis the pH is low.

8. Vomiting of stomach contents or continuous nasogastric suctioning may predispose to

development of a. carbonic acid deficit. b. metabolic acid deficit. c. metabolic acidosis. d. carbonic acid excess.

ANS: B

Gastric contents are rich in hydrochloric acid; loss of this through suctioning or vomiting leads to a metabolic acid deficit and alkalosis. Carbonic acid is related to the respiratory system. Vomiting produces metabolic alkalosis as a result of loss of acid-rich gastric contents, it does not increase carbonic acid.

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Pathophysiology 6th Edition Banasik Test Bank 9. The finding of ketones in the blood suggests that a person may have a. metabolic acidosis. b. metabolic alkalosis. c. respiratory acidosis. d. respiratory alkalosis.

ANS: A

Ketones are produced from breakdown of fat in the body as a result of starvation or lack of ability to utilize glucose in diabetes mellitus. Ketoacids in the blood indicate a very high ketone level in the body, which leads to metabolic acidosis. Ketonuria from high ketones in the blood would not indicate metabolic alkalosis. The respiratory system does not influence ketone level.

10. A person with acute hypoxemia may hyperventilate and develop a. respiratory acidosis. b. respiratory alkalosis. c. metabolic alkalosis. d. metabolic acidosis.

ANS: B

Hyperventilation causes much carbonic acid to be blown off, resulting in respiratory alkalosis.

Respiratory acidosis is caused by hypoventilation and retention of carbonic acid.

Hyperventilation does not cause metabolic acid or base disturbances.

11. A person who experiences a panic attack and develops hyperventilation symptoms may

experience a. neuromuscular depression.

NURSINGTB.COM b. anxiety acidosis. c. numbness and tingling in the extremities. d. acute compensatory metabolic acidosis.

ANS: C

Numbness and tingling in the extremities occurs in alkalosis as a result of increased neuromuscular irritability. Numbness and tingling as a result of hyperventilation result from increased neuromuscular irritability, not neuromuscular depression. Acidosis depresses neuromuscular irritability and thus would not cause numbness and tingling, even in compensation.

12. The major buffer in the extracellular fluid is a. hemoglobin. b. albumin. c. bicarbonate. d. phosphate.

ANS: C

Bicarbonate is the major buffer in the extracellular fluid. Hemoglobin is in erythrocytes, which are in the vascular compartment, but not in the interstitial portion of extracellular fluid.

Albumin is in the vascular compartment, but not in the interstitial portion of extracellular fluid. Phosphate is an important buffer in urine and intracellular fluid.

13. Renal compensation for respiratory acidosis is evidenced by

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Pathophysiology 6th Edition Banasik Test Bank a. b. c. d.

decreased carbon dioxide. elevated carbon dioxide. decreased bicarbonate ion concentration. elevated bicarbonate ion concentration.

ANS: D

Elevated bicarbonate ion concentration is evidence of compensation for a respiratory acidosis.

The lungs manage the carbon dioxide concentration. Elevated carbon dioxide is evidence of respiratory acidosis, not of compensation for it. Decreased bicarbonate ion concentration would make acidosis worse.

14. Causes of metabolic acidosis include a. hyperventilation. b. massive blood transfusion. c. tissue anoxia. d. hypoventilation.

ANS: C

Tissue anoxia can cause metabolic acidosis resulting from lactic acid production during anaerobic metabolism. Hyperventilation causes excretion of too much carbonic acid and respiratory alkalosis. The liver metabolizes the citrate in transfused blood into bicarbonate.

Hypoventilation causes CO2 retention and respiratory acidosis.

15. Respiratory acidosis may be caused by a. hyperventilation. b. massive blood transfusion. c. tissue hypoxia. d. hypoventilation.

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ANS: D

Hypoventilation causes carbonic acid retention and respiratory acidosis. Hyperventilation causes excretion of too much carbonic acid and respiratory alkalosis. The liver metabolizes the citrate in transfused blood into bicarbonate. Tissue hypoxia causes lactic acid production during anaerobic metabolism and metabolic acidosis.

16. Emesis causes a. respiratory acidosis. b. respiratory alkalosis. c. metabolic acidosis. d. metabolic alkalosis.

ANS: D

Emesis causes metabolic alkalosis as the stomach is a major reservoir for acids. Emesis causes a metabolic acid-base imbalance as it is not related to the respiratory system. Emesis involves loss of gastric acid and fluid and causes an alkalotic disruption.

17. Diarrhea causes a. respiratory acidosis. b. respiratory alkalosis. c. metabolic acidosis. d. metabolic alkalosis.

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Pathophysiology 6th Edition Banasik Test Bank ANS: C

Diarrhea causes metabolic acidosis as the intestinal fluids are rich in bicarbonate ions.

Diarrhea causes a metabolic acid-base imbalance and is not related to the respiratory system.

Diarrhea involves increased excretion of bicarbonate and causes an acidic condition.

18. The system compensates for metabolic acidosis and alkalosis. a. gastrointestinal b. renal c. cardiovascular d. respiratory ANS: D

When metabolic acids are out of balance, the respiratory system compensates for the altered pH by adjusting the amount of carbon dioxide in the blood. The gastrointestinal system is not a major compensatory mechanism in acid-base imbalances. The kidneys are overwhelmed or dysfunctional in a metabolic acid-base imbalance. The cardiovascular system is not a major compensatory mechanism in acid-base imbalances.

19. Uncompensated metabolic alkalosis would result in a. increased pH, increased HCO3–. b. increased pH, decreased HCO3–. c. decreased pH, increased HCO3–. d. decreased pH, decreased HCO3–.

ANS: A

Metabolic alkalosis is characterized by increased HCO3– and increased pH. HCO3– is a base and would be increased. Decreased pH indicates an uncompensated or partially compensated NURSINGTB.COM acidosis.

20. Respiratory alkalosis is caused by a. hyperventilation. b. pneumonia. c. chest muscle weakness. d. pulmonary edema.

ANS: A

Hyperventilation causes respiratory alkalosis as a result of loss of carbonic acid. Pneumonia, chest muscle weakness, and pulmonary edema cause carbonic acid to accumulate in the blood and result in respiratory acidosis.

21. If an individual has a fully compensated metabolic acidosis, the blood pH is a. high. b. low. c. in the normal range. d. either high or low, depending on the type of compensation.

ANS: C

The blood pH is in the normal range if an individual has fully compensated for an acid-base imbalance. High blood pH indicates alkalosis. Low blood pH indicates uncompensated or partially compensated acidosis.

22. Early manifestations of a developing metabolic acidosis include

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Pathophysiology 6th Edition Banasik Test Bank a. b. c. d.

coma. headache. muscle cramps. short and shallow respirations.

ANS: B

Headache is an early manifestation of a developing metabolic acidosis. Coma is a very late symptom of metabolic acidosis. Muscle cramps are not characteristic of metabolic acidosis.

Deep rapid respirations are the compensatory mechanism for metabolic acidosis.

23. Metabolic alkalosis is often accompanied by a. hypernatremia. b. hyponatremia. c. hyperkalemia. d. hypokalemia.

ANS: D

Hypokalemia often accompanies metabolic alkalosis because it can cause metabolic alkalosis or be caused by it. Metabolic alkalosis and hypernatremia, hyponatremia, and hyperkalemia are not often associated with each other.

24. The patient who requires the most careful monitoring for development of metabolic acidosis is

a patient who a. is in the diuretic phase of acute renal failure. b. has had hypokalemia for over a week. c. has had diarrhea for over a week. d. has newly diagnosed Cushing syndrome.

ANS: C

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Diarrhea causes increased excretion of the base bicarbonate, which can lead to metabolic acidosis. Although the oliguric phase of acute renal failure causes metabolic acidosis, the diuretic phase does not, because the kidneys can still excrete metabolic acids. Hypokalemia is associated with metabolic alkalosis. Cushing syndrome is cortisol excess, which can cause metabolic alkalosis from increased renal excretion of hydrogen ions.

25. A patient has been hospitalized several times in 6 months with severe ECV depletion and

hypokalemia resulting from chronic laxative abuse. Which blood gas results should be relayed to the physician? a. pH in high part of normal range, PaO2 normal, PaCO2 normal, bicarbonate normal b. pH in high part of normal range, PaO2 normal, PaCO2 high, bicarbonate high c. pH in low part of normal range, PaO2 normal, PaCO2 low, bicarbonate low d. pH in low part of normal range, PaO2 normal, PaCO2 normal, bicarbonate normal ANS: B

The laboratory values of pH in high part of normal range, PaO2 normal, PaCO2 high, and bicarbonate high indicate compensated metabolic alkalosis, which is not consistent with increased excretion of bicarbonate in chronic diarrhea from laxative abuse, so you should page the physician. The laboratory values of pH in low part of normal range, PaO2 normal, PaCO2 low, and bicarbonate low indicate compensated metabolic acidosis, which is consistent with increased excretion of bicarbonate in chronic diarrhea from laxative abuse. The other answer options are normal laboratory values.

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Pathophysiology 6th Edition Banasik Test Bank

26. A 3-year-old is diagnosed with starvation ketoacidosis. What signs and symptoms should you

anticipate in your assessment? a. Slow, shallow breathing, belligerence, hyperexcitability b. Slow, shallow breathing, numbness and tingling around his mouth c. Rapid, deep breathing, lethargy, abdominal pain d. Rapid, deep breathing, tremors, elevated blood pressure ANS: C

Rapid, deep breathing, lethargy, and abdominal pain are clinical manifestations of metabolic acidosis and its respiratory compensation. The other answer options are not clinical manifestations of metabolic acidosis and its respiratory compensation.

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Pathophysiology 6th Edition Banasik Test Bank

Chapter 26: Renal Function Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. The primary selectivity barrier for glomerular filtration is the a. glomerular basement membrane. b. endothelial tight junctions. c. epithelial fenestra. d. mesangial cells.

ANS: A

The basement membrane is an important selectivity barrier of the glomerulus, preventing plasma proteins, RBCs, WBCs, and platelets from passing through the glomerulus.

Endothelial tight junctions, epithelial fenestra, and mesangial cells are not the primary selectivity barriers for glomerular filtration.

2. The glucose transporter in the proximal tubule a. has no transport maximum. b. does not depend on sodium reabsorption. c. is ATP-dependent. d. may be saturated at high filtered glucose loads.

ANS: D

The glucose transporter in the proximal tubule may be saturated at high filtered glucose loads; glycosuria then results. A transport maximum does exist beyond which glycosuria occurs. A sodium-dependent protein c oN- tU raR nsS poIrN teG r iT sB ne. edCeO d.MThe transporter is not ATP-dependent.

3. The primary function of the vasa recta is to a. secrete renin. b. reabsorb NaCl. c. reabsorb interstitial fluid. d. secrete urea.

ANS: C

The vasa recta are capillaries that surround the loops of Henle and collecting ducts and absorb interstitial fluid. The vasa recta do not secrete rennin or urea, nor do they reabsorb NaCl. 4. Approximately two thirds of the water and electrolytes filtered by the kidney are reabsorbed

by the a. loop of Henle. b. collecting tubule. c. distal tubule. d. proximal tubule.

ANS: D

Approximately two thirds of the water and electrolytes filtered by the kidney are reabsorbed by the proximal tubule. Two thirds of the water and electrolytes filtered by the kidney are not reabsorbed by the loop of Henle, collecting tubule, or distal tubule.

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Pathophysiology 6th Edition Banasik Test Bank 5. Which finding on urinalysis should prompt further evaluation? a. pH 4.5 b. Red blood cells 2 per high-power field c. Specific gravity of 1.015 d. White blood cells 20 per high-power field ANS: D

This many WBCs in the urine indicate urinary tract infection; 5 or more is not expected. 4.5 is a normal pH. Fewer than 5 RBCs is insignificant. 1.015 is a normal specific gravity.

6. Renin is released from a. the posterior pituitary gland. b. the liver. c. juxtaglomerular cells. d. macula densa cells.

ANS: C

Renin is released from the juxtaglomerular cells. Renin is not released from the posterior pituitary gland, liver, or macula densa cells.

7. It is true that glucose reabsorption in the tubules a. occurs passively. b. occurs in the proximal convoluted tubule. c. is unlimited. d. simply does not occur.

ANS: B

Glucose reabsorption occursNi n t hRe pI ro x iGm alBc.o nCv o lMu t e d tubule. Glucose reabsorption is not U S N T O is required. Glucose reabsorption in the passive; a sodium-dependent protein co-transporter tubules is limited by the number of co-transporters; a threshold exists beyond which glycosuria will result. Glucose reabsorption occurs in the proximal convoluted tubule with the assistance of a sodium-dependent protein co-transporter.

8. Serious renal impairment generally does not occur until

of the total nephrons have been

damaged. a. 20% b. 40% c. 60% d. 80% ANS: D

Serious renal impairment generally does not occur until 75% to 90% of the total nephrons have been damaged. The other answer options are incorrect.

9. An important sign of glomerular basement membrane dysfunction is a. proteinuria. b. hematuria. c. glycosuria. d. urinary casts.

ANS: A

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Pathophysiology 6th Edition Banasik Test Bank Proteinuria is an important sign of basement membrane dysfunction. Hematuria can be found in glomerular disorders but it is not specific to this; it can be caused by many disorders.

Glycosuria is found primarily in diabetes mellitus. Urinary casts do not necessarily mean basement membrane dysfunction.

10. The main driving force for glomerular filtration is a. oncotic pressure in the Bowman’s capsule. b. hydrostatic pressure in glomerular capillaries. c. permeability of the glomerular membrane. d. solute content of the blood in the glomerular capillaries.

ANS: B

Hydrostatic pressure within the glomerular capillaries is the main driving force for filtration.

A significant drop in blood pressure such as in shock severely reduces glomerular filtration.

Oncotic pressure in the Bowman’s capsule, permeability of the glomerular membrane, and solute content of the blood in the glomerular capillaries are not the main driving forces for filtration.

11. Factors that increase the glomerular filtration rate include a. fluid volume excess. b. increased hydrostatic pressure in the Bowman’s capsule. c. high oncotic pressure in glomerular capillary blood. d. obstruction in the renal tubules.

ANS: A

Fluid volume excess increases blood volume which increases glomerular filtration. Increased hydrostatic pressure in the Bowman’s capsule, high oncotic pressure in the glomerular capillary, and obstruction of N reU naR lS tuI buNleG sT opBp. osCeO fiM ltration.

12. The underlying mechanism which directly results in glycosuria is a. filtration of glucose from the glomerulus. b. exceeding the threshold for glucose reabsorption. c. secretion of glucose into the distal tubule. d. the mechanism is unknown.

ANS: B

Glucose is normally freely filtered but then reabsorbed from the tubules into the peritubular capillaries. If the threshold for reabsorption is exceeded as in uncontrolled diabetes mellitus, glycosuria results. Glucose is freely filtered from the glomerulus; this is not the direct cause of glycosuria. Glucose is not secreted into the distal tubule. The underlying mechanism that directly results in glycosuria is exceeding the threshold for glucose reabsorption.

13. Excess potassium is excreted from the body by the renal system primarily via a. glomerular filtration based on blood level of potassium. b. reabsorption based on blood level of potassium. c. secretion based on aldosterone level. d. an unknown mechanism.

ANS: C

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Pathophysiology 6th Edition Banasik Test Bank Potassium is secreted from the distal tubule and collecting ducts into the tubule lumen under the influence of aldosterone. Excess potassium is not excreted from the body by the renal system via glomerular filtration or the renal system based on the blood level of potassium, nor is it excreted from the body by the renal system based on the aldosterone level.

14. The glomerular filtration rate is most accurately reflected in the a. blood urea nitrogen level. b. urinary output. c. serum osmolality. d. serum creatinine level.

ANS: D

Serum creatinine is a fairly reliable indicator of glomerular filtration as it is stable. The blood urea nitrogen level, urinary output, and serum osmolality are affected by factors that make them less reliable as indicators of glomerular filtration.

15. Serum creatinine may be increased by a. carbohydrate intake. b. fat intake. c. muscle breakdown. d. fluid intake.

ANS: C

Creatinine is an end product of muscle metabolism; muscle breakdown will increase the serum creatinine level. Serum creatinine is not affected by carbohydrate, fat, or fluid intake.

Fluid volume deficit can increase the serum creatinine if it leads to acute renal failure.

MULTIPLE RESPONSE

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1. Hormones that increase sodium reabsorption from the tubular fluid include (Select all that

apply.) a. aldosterone. b. atrial natriuretic peptide. c. antidiuretic hormone. d. urodilatin. e. angiotensin II. ANS: A, E

Aldosterone and angiotensin II result in sodium reabsorption. Atrial natriuretic peptide and urodilatin decrease sodium reabsorption. Antidiuretic hormone does not affect sodium reabsorption.

2. The blood urea nitrogen (BUN) level is affected by (Select all that apply.) a. protein intake. b. fat intake. c. fluid intake. d. catabolism. e. renal function.

ANS: A, C, D, E

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Pathophysiology 6th Edition Banasik Test Bank The blood urea nitrogen is affected by protein intake, fluid intake, rate of catabolism, and renal function. Urea is not an end product of fat intake, and the blood urea nitrogen level is unaffected by fat intake.

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Pathophysiology 6th Edition Banasik Test Bank

Chapter 27: Intrarenal Disorders Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. Nephrotic syndrome does not usually cause a. hyperlipidemia. b. proteinuria. c. hematuria. d. generalized edema.

ANS: C

Nephrotic syndrome does not usually cause hematuria. Hyperlipidemia is often associated with nephrotic syndrome. Nephrotic syndrome causes proteinuria. Nephrotic syndrome is associated with generalized edema secondary to protein loss.

2. A person with acute pyelonephritis would most typically experience a. fever. b. oliguria. c. edema. d. hypertension.

ANS: A

Acute pyelonephritis often leads to fever. Acute pyelonephritis does not typically lead to oliguria, edema, or hypertension.

3. The organism most commonlN yUasRsS ocI iaN teG dT wB ith.aCcO utM e pyelonephritis is a. Streptococcus. b. Escherichia coli. c. Klebsiella. d. Enterobacter.

ANS: B

Escherichia coli is the most common cause of acute pyelonephritis. Streptococcus, Klebsiella, and Enterobacter are not the most common causes of acute pyelonephritis.

4. It is true that polycystic kidney disease is a. always rapidly fatal. b. caused by a streptococcal infection. c. associated with supernumerary kidney. d. genetically transmitted.

ANS: D

Polycystic kidney disease is genetically transmitted. Polycystic kidney disease is a chronic disorder that progresses for several years. It is not caused by a streptococcal infection and is not associated with supernumerary kidney.

5. The pathophysiologic basis of acute glomerulonephritis is a. renal ischemia. b. bacterial invasion of the glomerulus.

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Pathophysiology 6th Edition Banasik Test Bank c. an anaphylactic reaction. d. an immune complex reaction.

ANS: D

Acute glomerulonephritis is an immune complex reaction that involves IgG. Acute glomerulonephritis is not caused by renal ischemia, bacterial invasion, or anaphylactic reaction.

6. Signs consistent with a diagnosis of glomerulonephritis include a. anuria. b. proteinuria. c. red blood cell casts in the urine. d. foul-smelling urine.

ANS: B

Glomerulonephritis leads to proteinuria. Glomerulonephritis produces oliguria, not anuria.

Glomerulonephritis does not lead to red blood cell casts in the urine and does not produce foul-smelling urine.

7. The pain that accompanies kidney disorders is called a. nephritic. b. nephralgia. c. nephrotic. d. nephronitis.

ANS: B

Nephralgia is the term for pain that accompanies kidney disorders. Nephritic, nephrotic, and nephronitis are not terms for N painRthaIt acG comBp. anCiesMkidney disorders.

U S N T

O

8. Findings that should prompt an evaluation for renal cancer include a. bacteria in the urine. b. intermittent urinary colic. c. hematuria. d. red blood cell casts in the urine.

ANS: C

Hematuria is a frequent sign of renal cancer. Bacteria and protein in the urine are not associated with renal cancer. Intermittent urinary colic is associated with renal calculi. Red blood cell casts in the urine are associated with glomerulonephritis.

9. A patient with gouty arthritis develops renal calculi. The composition of these calculi is most

likely to be a. potassium oxalate. b. struvite. c. cysteine. d. uric acid crystals.

ANS: D

Gout may lead to uric acid crystals because of elevated serum uric acid levels. Calcium oxalate, not potassium oxalate, stones are associated with hypercalcemia. Struvite calculi are associated with urinary tract infections. Cysteine calculi are associated with a genetic defect.

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Pathophysiology 6th Edition Banasik Test Bank 10. The most common type of renal stone is a. uric acid. b. calcium. c. struvite. d. cysteine.

ANS: B

The most common type of renal stone is calcium oxalate (75%). Uric acid stones account for 7% to 10%. Struvite stones account for 7% to 10%. Cysteine stones account for 1% to 3%.

11. Calcium oxylate stone formation is facilitated by a. hypercalciuria. b. hypoparathyroidism. c. low urine pH. d. protein intake.

ANS: A

Hypercalciuria facilitates calcium oxylate stone formation. Hyperparathyroidism and high urine pH facilitate calcium stone formation. Protein intake does not facilitate calcium stone formation.

12. The most common sign/symptom of renal calculi is a. pain. b. vomiting. c. hematuria. d. oliguria.

ANS: A

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The most common sign/symptom of renal calculi is pain. Although nausea, vomiting, and hematuria may accompany renal colic, the most common sign/symptom of renal calculi is pain. Oliguria is not a frequent sign/symptom of renal calculi.

13. The most common direct cause of acute pyelonephritis is a. urine obstruction. b. systemic bacteremia. c. urethral catheterization. d. infection by E. coli.

ANS: D

Infection by E. coli is the most common cause of acute pyelonephritis. Although urine obstruction or reflux can cause acute pyelonephritis, the most common cause is infection by E. coli. Systemic bacteremia may lead to pyelonephritis, but it is not the most common direct cause. Urethral catheterization may cause infection, which could subsequently result in acute pyelonephritis, but catheterization is not the most common direct cause.

14. The major underlying factor leading to the edema associated with glomerulonephritis and

nephrotic syndrome is a. hematuria. b. bacteriuria. c. glycosuria. d. proteinuria.

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Pathophysiology 6th Edition Banasik Test Bank ANS: D

Proteinuria is the major factor underlying the edema associated with nephrotic syndrome and glomerulonephritis. Hematuria and bacteriuria are not the major factors underlying the edema associated with nephrotic syndrome and glomerulonephritis. Proteinuria is the major factor underlying the edema associated with nephrotic syndrome and glomerulonephritis.

15. Scrotal pain in males and labial pain in females may accompany renal pain as a result of a. associated infections. b. associated dermatomes. c. muscle tension. d. anxiety.

ANS: B

Dermatomes in the T10-L1 spinal cord segment can result in scrotal and labial pain in association with renal pain. Scrotal and labial pain in association with renal pain are not as a result of associated infection, muscle tension, or anxiety.

16. The consequence of an upper urinary tract obstruction in a single ureter is a. kidney stone formation. b. hydronephrosis. c. dilation of the urethra. d. anuria.

ANS: B

Dilation of the urinary tract occurs proximal to the obstruction. In this case, the proximal ureter and renal pelvis would enlarge, causing hydronephrosis. Kidney stones are causes, rather than consequences, of an upper urinary tract obstruction. Dilation of the urinary tract occurs proximal to the obstruN ctU ioR n.SUIrN inG eT prB od.uC ctO ioM n will continue to occur if one ureter is blocked.

17. A major modifiable risk factor for nephrolithiasis is a. positive family history. b. dehydration. c. smoking. d. drinking alcohol.

ANS: B

Dehydration is a major modifiable risk factor for nephrolithiasis. Family history is not modifiable. Smoking and alcohol consumption are not a major risk factors for nephrolithiasis.

18. In addition to E. coli, a risk factor for development of pyelonephritis is a. urinary retention and reflux. b. nephrotic syndrome. c. respiratory disease. d. glomerulonephritis.

ANS: A

When E. coli is present, urinary retention and reflux increase the risk of the infection ascending the ureter to the kidneys, causing pyelonephritis. Nephrotic syndrome, respiratory disease, and glomerulonephritis are not risk factors for pyelonephritis.

19. Nephrotic syndrome involves loss of large amounts of

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in the urine.

Pathophysiology 6th Edition Banasik Test Bank a. b. c. d.

blood sodium glucose protein

ANS: D

By definition, nephrotic syndrome involves loss of large amounts of protein in the urine.

Hematuria and glucose loss in urine are not characteristic of nephrotic syndrome. Sodium and water are reabsorbed in nephrotic syndrome.

20. One cause of an extrinsic renal system obstruction is a. clot. b. pelvic tumor. c. neurogenic bladder. d. papillary necrosis.

ANS: B

Pelvic tumor is one cause of an extrinsic renal system obstruction. Clot is not a cause of an extrinsic renal system obstruction. Neurogenic blander is not the cause of an extrinsic renal system obstruction. Papillary necrosis is not the cause of an extrinsic renal system obstruction.

21. Hyperlipidemia occurs in nephrotic syndrome because a. hepatocytes synthesize excessive lipids. b. lipids are not excreted in the urine. c. body fats are catabolized. d. muscles stop burning triglycerides for energy.

ANS: A

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Hyperlipidemia in nephrotic syndrome is caused by increased hepatic synthesis of lipids.

People who have nephrotic syndrome have both hyperlipidemia and lipiduria. Catabolized body fats and muscles not burning triglycerides for energy are not the causes of hyperlipidemia in nephritic syndrome.

22. The urea-splitting bacteria contribute to the formation of a. struvite b. calcium oxalate c. uric acid d. cystine

kidney stones.

ANS: A

Struvite kidney stones are caused by the urea-splitting bacteria. Calcium oxalate, uric acid, and cystine stones are not caused by the urea-splitting bacteria.

23. The main clinical manifestation of a kidney stone obstructing the ureter is a. oliguria. b. renal colic. c. urge incontinence. d. an abdominal mass.

ANS: B

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank Renal colic is the flank pain that occurs with obstruction of the proximal ureter or renal pelvis.

Oliguria may occur with kidney stone obstruction, but renal colic is the main clinical manifestation of this condition. Urge incontinence normally occurs when a kidney stone is obstructing the lower urinary tract. Kidney stones are small and located in a retroperitoneal position in the ureter, so they generally do not form a palpable mass.

24. Glomerular disorders include a. pyelonephritis. b. obstructive uropathy. c. interstitial cystitis. d. nephrotic syndrome.

ANS: D

The pathophysiology of nephrotic syndrome occurs at the glomerular membrane.

Pyelonephritis generally does not affect the glomerulus. Obstructive uropathy affects the upper and lower urinary tract but does not directly involve the glomerulus. Interstitial cystitis is a bladder disorder.

25. The major cause of glomerulonephritis is a. infection of the glomerular capsule secondary to a urinary tract infection. b. immune system damage to the glomeruli. c. hydronephrosis resulting from kidney stones. d. Streptococcus infection that migrates from the bloodstream to the glomerulus.

ANS: B

The major cause of glomerulonephritis is immune system damage to glomeruli.

Glomerulonephritis is not an infection, but an inflammatory glomerulopathy. Hydronephrosis does not cause glomerulonepN hrU itR is.SINGTB.COM 26. The infection frequently associated with development of postinfectious acute

glomerulonephritis is a. pneumonia. b. throat infection. c. endocarditis. d. urinary tract infection.

ANS: B

Group A B-hemolytic Streptococcus infection of the throat (strep throat) frequently is associated with development of postinfectious acute glomerulonephritis. Pneumonia, endocarditis, and urinary tract infection are not commonly associated with development of postinfectious acute glomerulonephritis.

27. A common component of renal calculi is a. calcium. b. cholesterol. c. creatinine. d. urobilirubin.

ANS: A

Renal calculi most commonly are formed from calcium oxalate. Cholesterol, creatinine, and urobilirubin are not common components of renal calculi.

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Pathophysiology 6th Edition Banasik Test Bank

28. Which condition is caused by a genetic defect? a. Acute pyelonephritis b. Hydroureter c. Incontinence d. Polycystic kidney disease ANS: D

Polycystic kidney disease is caused by a genetic defect. Acute pyelonephritis, hydroureter, and incontinence are not caused by genetic defects.

29. The type of glomerulonephritis which is most likely to result in a swift decline in renal

function that then progresses to acute kidney injury is a. acute glomerulonephritis. b. crescentic glomerulonephritis. c. post-streptococcal glomerulonephritis. d. chronic glomerulonephritis.

ANS: B

Crescentic glomerulonephritis results in a swift decline in renal function that progresses to acute renal injury. Acute glomerulonephritis, post-streptococcal glomerulonephritis, and chronic glomerulonephritis do not develop into acute renal injury.

30. The condition characterized by oliguria and hematuria is a. acute glomerulonephritis. b. polycystic kidney disease. c. cystitis. d. renal insufficiency.

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ANS: A

Acute glomerulonephritis is characterized by oliguria and hematuria. Polycystic kidney disease and renal insufficiency are not characterized by oliguria and hematuria. Cystitis is not characterized by oliguria.

31. A person who is diagnosed with nephrotic syndrome is also experiencing hypoalbuminemia.

This happens because a. hepatocyte failure decreases albumin synthesis. b. albumin is excreted in the urine. c. albumin leaks into the interstitial spaces. d. malnutrition is part of nephrotic syndrome.

ANS: B

Hypoalbuminemia in nephrotic syndrome is caused by massive albumin excretion in the urine.

Hepatocyte failure, malnutrition, and albumin leakage into the interstitial spaces are not characteristic of nephrotic syndrome.

32. The individual at highest risk of pyelonephritis who requires monitoring for signs of its

occurrence is the a. woman who is paraplegic. b. woman who is pregnant. c. man who has glomerulonephritis.

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Pathophysiology 6th Edition Banasik Test Bank d. man who has chronic urinary tract infections.

ANS: D

Anyone who has chronic urinary tract infections is at high risk of developing pyelonephritis.

Although pregnancy and stasis of urine with paraplegia do increase the risk of pyelonephritis, another individual has an even higher risk because of an active urinary tract infection.

Glomerulonephritis is not an infection.

33. When a patient experiencing nephrotic syndrome asks, “What causes my urine to be so full of

protein,” the nurse’s response is based on the knowledge that a. his glomeruli have been damaged by his own immune system. b. the glomerular membrane has increased permeability. c. his liver is extremely active in synthesizing protein. d. his renal tubules are full of cellular debris.

ANS: B

Massive proteinuria occurs in nephrotic syndrome because the glomerular membrane has increased permeability that causes the leakage of protein. Glomeruli being damaged by the immune system and cellular debris in the renal tubules are not pathophysiologies of the nephrotic syndrome. Although the liver is extremely active in synthesizing protein, it does not explain why massive proteinuria occurs in nephrotic syndrome.

34. A patient who reported a very painful sore throat 3 weeks ago is now diagnosed with acute

post-streptococcal glomerulonephritis. When asked, “Why is my urine the color of coffee?”, the nurse responds a. “Normally, red blood cells that enter the urine are taken back into the blood, but in glomerulonephritis, the kidney disease you have, they stay in the urine and make it NURSINGTB.COM coffee-colored.” b. “Your immune system was activated by your sore throat and has caused some damage in your kidneys that allows red blood cells to leak into the fluid that becomes urine and make it coffee-colored.” c. “The bacteria that caused your sore throat have traveled to your kidneys and are causing a little damage there that allows some red blood cells to leak into your urine and make it orange-colored.” d. “When parts of your kidneys stopped working, your blood kept flowing and broke some of your little blood vessels, so red blood cells are flowing into your urine and making it coffee-colored.”

ANS: B

The immune system damages glomeruli in post-streptococcal glomerulonephritis causing red blood cells to leak into the urine, making it coffee-colored. Red blood cells that enter the urine are not taken back into the blood. Red blood cells cause urine to turn coffee-colored, not orange. Capillary breakage is not the cause of the red blood cells entering the urine.

MULTIPLE RESPONSE 1. Renal stone formation is affected by (Select all that apply.) a. urine concentration. b. urine PH. c. metabolic/congenital conditions.

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank d. dietary intake. e. potassium level.

ANS: A, B, C, D

Concentrated urine enhances stone formation. Some stones are formed in acidic urine and others are formed in alkaline urine. Metabolic conditions such as gout increase the possibility of stone formation. High dietary intake of calcium enhances stone formation in susceptible people. Potassium level does not affect stone formation.

2. Risk factors for renal carcinoma include (Select all that apply.) a. genetics. b. hypotension. c. cigarette smoking. d. obesity. e. chemicals.

ANS: A, C, D, E

A small number of individuals have a genetic predisposition to renal carcinoma. Cigarette smoking and obesity are risk factors for renal carcinoma. Certain chemicals (e.g., trichloroethylene) may be associated with development of renal carcinoma. Hypertension is a risk factor for renal carcinoma.

3. The manifestations of acute pyelonephritis (Select all that apply.) a. are mild and insidious. b. can result in dehydration. c. often include symptoms of lower urinary tract infection. d. include fever, chills, and costovertebral angle tenderness. e. may include urosepsis.

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ANS: B, C, D, E

Vomiting and fever associated with acute pyelonephritis can result in dehydration. Since an ascending infection from the bladder often causes pyelonephritis, the patient often will show signs of bladder infection. Fever, chills, and costovertebral angle tenderness often accompany this disorder. Urosepsis (infection in the blood from urinary track origin) can result from acute pyelonephritis. The manifestations of acute pyelonephritis occur suddenly, and the patient is acutely ill.

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Pathophysiology 6th Edition Banasik Test Bank

Chapter 28: Acute Kidney Injury and Chronic Kidney Disease Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. The oliguric phase of acute tubular necrosis is characterized by a. fluid excess and electrolyte imbalance. b. fever and diminishing cognition. c. sodium retention and potassium loss in the urine. d. magnesium and phosphorous loss in the urine.

ANS: A

The oliguric phase of ATN is characterized by fluid excess and electrolyte imbalance. Fever and diminishing cognition are not typical manifestations of ATN oliguric phase. During this phase sodium is lost in the urine and potassium is not excreted, and magnesium and phosphorous are retained in the body.

2. Osteoporosis commonly occurs in patients with end-stage renal disease because of a. hyperparathyroidism. b. hypercalcemia. c. excess active vitamin D. d. phosphorous deficiency.

ANS: A

Osteoporosis commonly occurs in patients with end-stage renal disease because of hyperparathyroidism. Hypocalcemia occurs in end-stage renal disease. Insufficient active vitamin D would result in ostN eoUpR orS oI sisN. G PhToB sp. hC ateOiM s retained in end-stage renal disease.

3. Gastrointestinal drainage, perioperative and postoperative hypotension, and hemorrhage may

all contribute to renal failure by causing a. hydronephrosis. b. acute tubular necrosis. c. nephrosis. d. renal inflammation.

ANS: B

Gastrointestinal drainage, perioperative and postoperative hypotension, and hemorrhage may all contribute to renal failure by causing acute tubular necrosis. Gastrointestinal drainage, perioperative and postoperative hypotension, and hemorrhage do not cause hydronephrosis, nephrosis, or renal inflammation.

4. Appropriate therapy for prerenal kidney injury includes a. fluid administration. b. potassium supplementation. c. fluid restriction. d. protein restriction.

ANS: A

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank Appropriate therapy for prerenal oliguria includes fluid administration; most often prerenal kidney injury is because of fluid volume deficit. Potassium supplements are not appropriate in prerenal oliguria, as potassium is not being excreted. Appropriate therapy for prerenal oliguria includes fluid administration. Protein restriction is not indicated in prerenal oliguria.

5. A patient with renal disease is at risk for developing uremia as the nephrons progressively

deteriorate, because a. the basement membrane becomes increasingly permeable. b. filtration exceeds secretory and reabsorptive capacity. c. excessive solute and water are lost in the urine. d. GFR declines.

ANS: D

A patient with renal disease is at risk for developing uremia as his nephrons progressively deteriorate because GFR declines. The basement membrane does not become increasingly permeable. Filtration does not exceed secretory and reabsorptive capacity. Excessive solute and water are not lost in the urine.

6. The most likely cause of anemia in a patient with end-stage renal disease is a. insufficient erythropoietin. b. blood loss secondary to hematuria. c. vitamin B12 deficiency secondary to deficient intrinsic factor. d. iron deficiency.

ANS: A

The most likely cause of anemia in a patient with end-stage renal disease is insufficient erythropoietin secretion by the kidney, which is necessary for RBC production. Blood loss NiUn RBS secondary to hematuria, v i t a m dN efG icT ienBc. y Cs eOc oMn d a r y to deficient intrinsic factor, and 12I iron deficiency are not the most likely causes of anemia in a patient with end-stage renal disease.

7. The most likely cause of acidosis in a patient with end-stage renal disease is a. insufficient filtration of bicarbonate ions at the glomerulus. b. excessive production of respiratory and metabolic acids. c. insufficient metabolic acid excretion resulting from nephron loss. d. hypoventilation secondary to uremic central nervous system depression.

ANS: C

The most likely cause of acidosis in a patient with end-stage renal disease is insufficient metabolic acid excretion resulting from nephron loss. Insufficient filtration of bicarbonate at the glomerulus would lead to alkalosis, not acidosis. Excessive production of respiratory acids would lead to respiratory acidosis not metabolic acidosis. The problem is metabolic acids are not excreted. Hypoventilation secondary to uremic CNS depression may occur, but this would lead to respiratory acidosis, not metabolic acidosis.

8. The most helpful laboratory value in monitoring the progression of declining renal function is a. serum creatinine. b. serum potassium. c. blood urea nitrogen. d. mental status changes.

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Pathophysiology 6th Edition Banasik Test Bank ANS: A

Serum creatinine is the most stable and accurate reflection of renal function. Serum potassium is affected by many factors and thus not the most helpful value in monitoring the progression of this disease. Blood urea nitrogen is not as stable as serum creatinine; it is affected by muscle breakdown, protein intake, and so forth. Mental status changes can occur as a result of multiple factors other than renal function.

9. Appropriate management of end-stage renal disease includes a. potassium supplementation. b. a high-protein diet. c. erythropoietin administration. d. a high-phosphate diet.

ANS: C

Erythropoietin administration is appropriate, as the kidneys are not able to secrete erythropoietin. Potassium is not appropriate, as the kidneys are unable to excrete potassium. A high-protein diet is not appropriate, as the kidneys are unable to excrete urea. A high-phosphate diet is not appropriate, as the kidneys are unable to excrete phosphorous.

10. What problem is a patient likely to experience in end-stage renal disease? a. Hypokalemia b. Polyuria and nocturia c. Uremia d. Hematuria ANS: C

Uremia occurs in end-stage renal disease because the kidneys cannot excrete urea, the end N.UHRySpeIrkNaG product of protein metabolism leT mB ia.oC ccO urMs in end-stage renal disease. Polyuria and nocturia do not occur in end-stage renal disease; the kidneys are unable to excrete urine.

Hematuria does not generally occur unless another problem is causing it.

11. Which intervention has been found to retard the advancement of chronic kidney disease? a. Calcium supplementation b. Erythropoietin c. Insulin d. ACE inhibitors ANS: D

ACE inhibitors or A-II receptor blockers have been found to retard the advancement of chronic kidney disease by reducing proteinuria. Calcium supplementation, erythropoietin, and insulin have not been found to retard the advancement of chronic kidney disease.

12. In patients with polycystic kidney disease, renal failure is expected to progress over time as

the cystic process destroys more nephrons. At what point will a patient reach end-stage renal disease? a. Greater than 15% b. Greater than 25% nephron loss c. Greater than 50% nephron loss d. Greater than 90% nephron loss ANS: D

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Pathophysiology 6th Edition Banasik Test Bank End-stage renal disease occurs when greater than 90% of the nephrons have been lost.

End-stage renal disease is possible to predict based on nephron loss. It occurs when greater than 90% (not 15%, 25%, or 50%) of the nephrons have been lost.

13. At his most recent clinic visit, a patient with end-stage renal disease is noted to have edema,

congestive signs in the pulmonary system, and a pericardial friction rub. Appropriate therapy at this time would include a. initiation of dialysis. b. fluid restriction. c. antibiotics. d. phlebotomy.

ANS: A

Dialysis is the appropriate therapy at end-stage renal disease. Although fluid restriction may be appropriate at some point in renal failure, it will not correct the identified problems.

Antibiotics will not correct the problems identified and may further impair remaining renal function. Phlebotomy will not correct the identified problems.

14. The most common cause of intrinsic kidney injury is a. glomerular b. tubular c. interstitial d. vascular

injury.

ANS: B

Tubular injury (acute tubular necrosis) is the most common cause of acute kidney injury.

Glomerular, interstitial, and vascular injury are not the most common causes of acute kidney NURSINGTB.COM injury.

15. One of the most common causes of acute tubular necrosis (ATN) is a. ischemic conditions. b. cytotoxic agents. c. immune reaction. d. prolonged postrenal kidney injury.

ANS: A

Ischemia and nephrotoxic agents are the most common causes of ATN. Cytotoxic agents, immune reaction, and prolonged postrenal kidney injury are not the most common causes of ATN. 16. The most common cause of ischemic acute tubular necrosis (ATN) in the United States is a. hypotension. b. hypovolemia. c. renal artery stenosis. d. sepsis.

ANS: D

Sepsis is the most common cause of ischemic ATN in the United States. Hypotension, hypovolemia, and renal artery stenosis are not the most common causes of ischemic ATN.

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Pathophysiology 6th Edition Banasik Test Bank 17. The most common agent resulting in nephrotoxicity and subsequent acute tubular necrosis

(ATN) in hospitalized patients is a. contrast media. b. antibiotics. c. cancer chemotherapy. d. recreational drugs.

ANS: A

The most common agent resulting in nephrotoxicity and subsequent ATN is contrast media.

Contrast media, cancer chemotherapy, and recreational drugs are not the most common agents resulting in nephrotoxicity and subsequent ATN. 18. The risk for contrast media–induced acute tubular necrosis (ATN) is highest in a. a 70-year-old patient with heart failure. b. a 50-year-old patient post gallbladder surgery. c. a 12-year-old patient with recurrent bladder infections. d. a 30-year-old patient with appendicitis.

ANS: A

This patient with the highest risk has two risk factors for contrast media–induced ATN: age over 70 and co-existing heart failure. The other patients have no risk factors for contrast media–induced ATN. 19. If acute tubular necrosis (ATN) does not resolve and continued tubular dysfunction ensues,

the patient will then experience a. oliguria and sodium retention. b. infections and sepsis. c. magnesium and phosphorNuU s lR osSsI inNuG riT neB. .COM d. polyuria and sodium wasting.

ANS: D

If ATN does not resolve, the high blood urea nitrogen (BUN) creates osmotic diuresis; the urine is high in sodium content. Oliguria and sodium retention, infections and sepsis, and magnesium and phosphorous loss in the urine do not result from tubular necrosis and tubular dysfunction.

20. One of the most frequent causes of chronic kidney disease is a. hypertension. b. glomerulonephritis. c. chronic pyelonephritis. d. polycystic kidney disease.

ANS: A

Hypertension and diabetes are the most common causes of chronic kidney disease. Although glomerulonephritis, chronic pyelonephritis, and polycystic kidney disease can result in CKD, hypertension and diabetes are the most common causes of chronic kidney disease.

21. The patient most at risk for postrenal acute kidney injury is a(n) a. elderly patient with hypertrophy of the prostate. b. middle-aged woman with bladder infection. c. young child with reflux at the ureterovesical junction.

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank d. patient who has both hypertension and diabetes.

ANS: A

Postrenal acute kidney injury is caused by obstruction in the urinary tract below the level of the kidneys. Elderly men with prostatic hypertrophy are at risk for urinary retention. Bladder infection generally does not obstruct urine flow. Ureterovesical junction reflux is likely to cause pyelonephritis, but not obstruction. Diabetes and hypertension result in intra-renal disease.

22. The defining characteristic of severe acute kidney injury is a. proteinuria. b. oliguria. c. hematuria. d. diuresis.

ANS: B

Acute kidney injury is defined by oliguria or anuria. Proteinuria, hematuria, and diuresis are not defining characteristics of severe acute kidney injury.

23. A primary laboratory finding in end-stage chronic renal disease is a. decreased blood urea nitrogen (BUN). b. decreased serum sodium. c. metabolic alkalosis. d. increased serum creatinine.

ANS: D

End-stage chronic renal disease causes increased serum creatinine and blood urea nitrogen, because the dysfunctional k i dNn e yRs a rIe n oGt abBle.tC o exMcrete these metabolic waste products.

U S N T O Chronic renal failure causes increased blood urea nitrogen. Hyponatremia is not a primary laboratory finding in end-stage chronic renal disease. Metabolic alkalosis is not common with end-stage chronic renal disease.

24. The condition associated with end-stage chronic renal disease that is the most immediately life

threatening is a. azotemia. b. increased creatinine. c. hypertension. d. hyperkalemia.

ANS: D

Hyperkalemia from decreased renal excretion of potassium can cause dysrhythmias and cardiac arrest. While azotemia, increased creatinine, and hypertension are consequences of end-stage chronic renal disease, they usually are not acutely life threatening.

25. Renal insufficiency occurs when a. 25% b. 50% c. 75% to 90% d. more than 90%

of the nephrons are not functional.

ANS: C

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Pathophysiology 6th Edition Banasik Test Bank In renal insufficiency, 75% to 90% of the nephrons are not functional. When 25% to 50% of nephrons are not functional, it is decreased renal reserve. When 90% of nephrons are not functional, it is end-stage renal disease.

26. The effect on the renal tubules during the postoliguric phase of acute tubular necrosis involves a. reconstruction of the basement membrane. b. blocking the tubule lumens by dead cells. c. making the glomeruli patent again. d. regeneration of the renal tubular epithelium.

ANS: D

During the postoliguric phase of acute tubular necrosis, the renal tubular epithelium is regenerating. Disruption of basement membranes is not characteristic of acute tubular necrosis. Blockage of the tubule lumens would cause oliguria. The glomeruli are not clogged during acute tubular necrosis.

27. Prerenal acute kidney injury may be caused by a. severe hypotension. b. glomerulonephritis. c. bilateral kidney stones. d. acute tubular necrosis.

ANS: A

Prerenal acute kidney injury occurs when blood flow to the kidneys is compromised. Severe hypotension from heart failure, hypovolemia, or shock is a leading cause. Glomerulonephritis does not cause prerenal acute kidney injury, because the glomeruli are located within the kidneys. Bilateral kidney stones do not cause prerenal acute kidney injury, because they are located distal to the nephronsN. U AcRuS teItuNbG ulT arBn. ecCroOsM is does not cause prerenal acute kidney injury, because the renal tubules are located within the kidneys.

28. Postrenal acute kidney injury may be caused by a. severe hypotension. b. glomerulonephritis. c. bilateral kidney stones. d. acute tubular necrosis.

ANS: C

Bilateral kidney stones can cause postrenal acute kidney injury as a result of obstruction of normal outflow of urine from the kidneys. Severe hypotension causes prerenal acute kidney injury. Glomerulonephritis does not cause postrenal acute kidney injury, because the glomeruli are located within the kidneys. Acute tubular necrosis does not cause postrenal acute kidney injury, because the renal tubules are located within the kidneys.

29. Individuals with end-stage chronic renal disease are at risk for renal osteodystrophy and

spontaneous bone fractures, because a. excess potassium leaches calcium from bone. b. erythropoietin secretion is impaired. c. urea causes demineralization of bone. d. they are deficient in active vitamin D. ANS: D

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank Vitamin D, required for calcium absorption in the digestive tract, is activated in the kidneys.

With chronic renal failure, vitamin D is not activated. Hyperkalemia does not influence bone mineralization. Erythropoietin is important for red blood cell production. Urea does not cause renal osteodystrophy.

30. Anemia in people who have end-stage chronic renal disease is caused by a. chronic loss of blood in the urine. b. poor appetite, with lack of iron intake. c. decreased secretion of erythropoietin. d. increased secretion of aldosterone.

ANS: C

Decreased secretion of erythropoietin is the major cause of anemia in end-stage chronic renal disease. Hematuria is not a characteristic of end-stage chronic renal disease. Iron deficiency does not cause the anemia in end-stage chronic renal disease. Aldosterone levels do not contribute to anemia.

31. A patient being treated for acute tubular necrosis (ATN) develops mild polyuria. The nurse

responds to questions about why this occurring by stating a. “Since he was oliguric for so long, he probably has rebound polyuria. As long as his blood pressure is stable, he is not hypovolemic, so I would not worry.” b. “I am glad you noticed this change. It happened so gradually that we did not see it.

We should call the doctor and get him to measure ADH.” c. “His renal tubules are recovering, so he is making more urine, but he is not able to concentrate urine well, because he is not fully recovered.” d. “We had better measure his blood sugar. He may have developed diabetes, and what you see is osmotic dNiureRsis I from se inMthe urine.”

G glBuc.oC

U S N T

O

ANS: C

You have recognized the postoliguric phase of acute tubular necrosis. He does not have rebound polyuria. The polyuria is part of acute tubular necrosis and is not an ADH problem.

The polyuria is part of acute tubular necrosis and is not an osmotic diuresis.

32. A patient injured severely in a motor vehicle accident is hospitalized with acute kidney injury

as well as multiple broken bones and lacerations. When family members ask what is meant by the term ‘prerenal,’ the nurse responds a. “The doctors are not sure what caused your husband’s acute kidney injury, but they are working to help him recover.” b. “Your husband’s kidney injury did not start in the kidney itself, but rather in the blood flow to the kidney.” c. “Your husband’s kidney injury is only the beginning of the problems that are expected, so they are being vigilant.” d. “Acute kidney injury is a new term for what people used to call acute renal failure.”

ANS: B

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank The problem that triggers prerenal acute kidney injury occurs before the blood circulates to the kidney. Hypovolemia is a common cause of prerenal acute kidney injury. Providing the patient’s family with specific information is most effective. Telling the family that you don’t know what caused the injury does not alleviate anxiety in the family member. Speculating about the patient’s future without a clear prognosis causes anxiety in the patient. It is best to provide the family with specific information regarding the patient’s diagnosis and prognosis instead of offering general comments.

MULTIPLE RESPONSE 1. Signs of late chronic renal failure include (Select all that apply.) a. high-serum potassium levels. b. high-serum calcium. c. high-serum phosphorous. d. high-blood urea nitrogen. e. anemia.

ANS: A, C, D, E

In late chronic renal failure, high serum potassium and phosphorous levels are as a result of inability of the kidneys to excrete these elements. Blood urea also increases as a result of inability of the kidneys to excrete urea. Anemia occurs as a result of loss of erythropoietin secretion. The serum calcium is low in chronic renal failure because of the high serum phosphorous.

2. The diet for a patient with chronic kidney disease (CKD) should include (Select all that

apply.) a. high carbohydrates and faNtsU . RSINGTB.COM b. low sodium and potassium. c. high protein. d. low phosphorous. e. high calorie.

ANS: A, B, D, E

Patients with CKD are often malnourished especially at later stages. Patients require high carbohydrates and fats to maintain nutritional status. Sodium must be limited because of fluid retention and potassium must be limited because of failure of kidneys to excrete potassium.

Low phosphorous is necessary to prevent further hypocalcemia. High calories are needed to maintain energy needs. In general protein must be limited, as the kidneys cannot excrete urea, the end product of protein metabolism.

3. Acute tubular necrosis can occur from (Select all that apply.) a. increased ammonia levels from liver failure. b. contrast dyes used for radiologic studies. c. ischemia because of hypovolemia. d. antibiotics that are nephrotoxic.

ANS: B, C, D

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank Radiocontrast media used for radiologic studies occasionally can be nephrotoxic, causing acute tubular necrosis. Ischemia because of hypovolemia is an important cause of acute tubular necrosis. Certain antibiotics, including aminoglycosides, are nephrotoxic and can be a direct cause of acute tubular necrosis. Liver failure with elevated ammonia levels causes toxicity to the central nervous system but does not cause acute tubular necrosis.

4. When a patient misses two dialysis sessions numerous electrolyte imbalances resulted. The

patient will likely demonstrate (Select all that apply.) a. lethargy because of metabolic acidosis and increased BUN. b. skeletal muscle weakness and possible cardiac dysrhythmias because of hyperkalemia. c. positive Chvostek and Trousseau signs because of hypomagnesemia. d. weight gain of several pounds since her last dialysis session because of hypernatremia. e. deep rapid breathing because of compensatory mechanism for metabolic acidosis.

ANS: A, B, E

A person who needs dialysis and has missed two sessions will have metabolic acidosis and increased BUN, which cause lethargy; deep rapid breathing, which is a compensatory mechanism for metabolic acidosis; and hyperkalemia, which causes skeletal muscle weakness and cardiac dysrhythmias. Hypomagnesemia will not occur in this situation. Although the individual will gain several pounds of fluid without dialysis, the weight gain is as a result of extracellular fluid volume excess rather than to hypernatremia.

TRUE/FALSE 1. The best intervention for acuN teUkR idS neI yN inGjuTryB(.

AC KO I)Mis prevention.

ANS: T

The best intervention for acute kidney injury is prevention.

2. Hypotension is both a cause of chronic kidney disease and a result of chronic kidney disease.

ANS: F

Hypertension is both a cause of chronic kidney disease and a result of chronic kidney disease.

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Pathophysiology 6th Edition Banasik Test Bank

Chapter 29: Disorders of the Lower Urinary Tract Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. Activation of parasympathetic nerves to the bladder will cause a. bladder contraction. b. bladder relaxation. c. sphincter contraction. d. urine reflux.

ANS: A

Stimulation of the parasympathetic nerves to the bladder will cause bladder contraction.

Stimulation of the sympathetic nerves to the bladder will cause bladder relaxation and allow for storage of urine. Stimulation of the parasympathetic nerves to the bladder will cause bladder, not sphincter, contraction. Stimulation of the parasympathetic nerves to the bladder does not cause urine reflux.

2. Urinary retention with consistent or intermittent dribbling of urine is called a. mixed incontinence. b. enuresis. c. stress incontinence. d. overflow incontinence.

ANS: D

Urinary retention with consistent or intermittent dribbling of urine is called overflow incontinence. Mixed i n c o n t i nNe nUcRe S isI aN coGmTbB in. atC ioO nM of both stress and urge incontinence.

Enuresis is incontinence while asleep. Stress incontinence is involuntary loss of urine because of increases in intra-abdominal pressure.

3. Detrusor muscle overactivity can be improved by administration of a. alpha-receptor agonists. b. botulinum toxin. c. cholinergic agents. d. nonsteroidal antiinflammatory agents.

ANS: B

Detrusor muscle overactivity can be improved by administration of botulinum toxin.

Alpha-receptor agonists will not treat detrusor muscle overactivity. Anticholinergic drugs will treat this condition. NSAIDS are for pain, inflammation, and fever.

4. The direct cause of stress incontinence is a. the effect of aging. b. pelvic muscle weakness. c. neurologic conditions. d. detrusor muscle overactivity.

ANS: B

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank The primary cause of stress incontinence is loss of pelvic muscles and/or fascial support of the bladder and urethra. Although aging weakens the pelvic muscles, it is not the direct cause of stress incontinence. Neurologic conditions cause neurogenic bladder which can lead to incontinence, but this is not the same as stress incontinence. Overactivity of the detrusor muscle leads to urge incontinence.

5. Which group is at the highest risk for urinary tract infection? a. Infants and children b. Sexually active women c. Adult males d. Patients taking diuretics ANS: B

Sexually active women are at the highest risk for urinary tract infection. Infants and children, adult males, and patients taking diuretics are not at the highest risk for urinary tract infection.

6. In addition to renal colic pain, signs or symptoms of ureteral stones may frequently include a. hematuria. b. postrenal renal failure. c. urinary urgency. d. proteinuria.

ANS: A

Hematuria often occurs with ureteral stones as a result of irritation of the ureteral wall.

Postrenal renal failure, urinary urgency, and proteinuria do not generally occur with ureteral stones.

7. The normal post-void residuaNl U urR inS eI inNthGeTbB la. ddCeO r iM s a. less than 100 mL. b. 150 to 200 mL. c. 250 to 300 mL. d. none of these; no normal residual volume is identified.

ANS: A

The normal post-void residual urine in the bladder is less than 100 mL. The normal post-void residual urine in the bladder is not 150 to 200 or 250 to 300 mL. The normal post-void residual urine in the bladder is identifiable and is less than 100 mL. 8. A person is unaware that his bladder is full of urine, but complains that he is leaking urine

almost constantly. The most accurate term for this type of incontinence is a. overflow. b. stress. c. urge. d. mixed.

ANS: A

This type of incontinence is called overflow incontinence. Stress incontinence is because of increased intra-abdominal pressure. Urge incontinence is associated with a sudden need to void and involuntary leakage of urine. Mixed incontinence is a combination of both stress incontinence and urge incontinence.

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Pathophysiology 6th Edition Banasik Test Bank 9. Pelvic floor muscle training is appropriate for a. overflow incontinence. b. reflux prevention. c. urge incontinence. d. functional incontinence.

ANS: C

Pelvic floor muscle training is appropriate for urge incontinence. These exercises will help strengthen the pelvic muscles so the patient is able to hold urine in the bladder longer. Pelvic floor muscle training is not appropriate for overflow incontinence, reflux prevention, or functional incontinence.

10. A ureterocele is a. an abnormally placed ureter. b. an additional ureter. c. a cystic dilation of a ureter. d. fusion of both ureters at the bladder junction.

ANS: C

Ureterocele is a cystic dilation of a ureter at its distal end. An abnormally placed ureter is called ureteral ectopy. An additional ureter is called ureteral ectopy. A ureterocele is not a fusion of both ureters at the bladder junction.

11. The greatest risk factor for bladder cancer is a. smoking. b. recurrent bladder infections. c. low fluid intake.

d. family history of bladderN caUnR ceSr.INGTB.COM ANS: A

Smoking is the greatest risk factor for bladder cancer. Although recurrent bladder infections, low fluid intake, and a family history of bladder cancer increase the risk of cancer resulting from inflammation, these are not the greatest risk factor.

12. The most frequent initial symptom of bladder cancer is a. bladder infection. b. hematuria. c. sudden incontinence. d. dysuria.

ANS: B

Painless hematuria is usually the initial symptom of bladder cancer. Although bladder infection may occur with bladder cancer, this is not the most frequent initial symptom. Sudden incontinence is not associated with bladder cancer. Dysuria can occur with bladder cancer, but it is rare.

13. The urinalysis finding most indicative of cystitis includes the presence of a. WBCs and RBCs. b. nitrites. c. casts. d. bacteria.

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank ANS: B

Nitrites in the urine along with leukocyte esterase are definitive for cystitis. Urine may have a few WBCs and RBCs without the presence of cystitis. Casts may be present without cystitis.

A few bacteria in the urine is common without the presence of cystitis.

14. The patient reports persistent pelvic pain and urinary frequency and urgency. She says the

pain improves when she empties her bladder. She does not have a fever and her repeated urinalyses over the past months have been normal, although she has a history of frequent bladder infections. She also has a history of fibromyalgia and hypothyroidism. Based on her history and complaints, her symptoms are characteristic of a. neuroses. b. ureteral stone. c. neurogenic bladder. d. interstitial cystitis.

ANS: D

Interstitial cystitis results in urgency, frequency, and pelvic pain that is relieved when the bladder is emptied. It is associated with other pain syndromes such as fibromyalgia. This condition can be caused by damage to the bladder wall from inflammation, as with her history of recurrent bladder infections. A physiologic basis for this condition exists and it is not a result of psychological neuroses. These symptoms are not consistent with a ureteral stone.

This patient has no indications of neurogenic bladder.

15. A patient has ureteral colic. The manifestation that requires immediate notification of the

physician is a. severe flank pain. b. vomiting. c. pink-tinged urine. d. chills and fever.

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ANS: D

Chills and fever are not commonly associated with ureteral colic unless infection exists. This should be reported to the physician. Severe flank pain is common in ureteral colic. Nausea and vomiting are common with ureteral colic resulting from the common dermatomes. Pink-tinged urine is common in ureteral colic, as the stone irritates the ureteral wall and causes minor bleeding.

16. The most commonly ordered diagnostic test for evaluation of the urinary system is a. KUB. b. cystogram. c. ultrasonography. d. cystography.

ANS: C

The most commonly ordered diagnostic test for evaluation of the urinary system is ultrasonography because it provides excellent visualization of the urinary tract without the use of radiation or contrast media, and it is painless. KUB, cystogram, and cystography are not the most frequently ordered tests.

17. The disorder characterized by a neurologic lesion that affects bladder control is a. neurogenic bladder.

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Pathophysiology 6th Edition Banasik Test Bank b. detrusor inactivity. c. bladder prolapse. d. cystitis.

ANS: A

Neurogenic bladder is a condition in which neurologic lesions cause bladder dysfunction.

Neurologic lesions can be characteristic of detrusor overactivity, not detrusor inactivity.

Neurologic lesions are not characteristic of bladder prolapse. Neurologic lesions are not characteristic of cystitis, although stasis of urine as a result of neurologic lesions may increase the risk of cystitis.

18. The difference between stress incontinence and urge incontinence is that stress incontinence a. occurs in women, whereas urge incontinence occurs in both men and women. b. occurs during sleep, whereas urge incontinence occurs during the waking hours. c. is caused by a pelvic floor muscle problem, whereas urge incontinence is caused

by a problem with the detrusor muscle. d. is caused by a detrusor muscle problem, whereas urge incontinence is caused by a

neurologic problem.

ANS: C

Stress incontinence is caused by a pelvic floor muscle problem, whereas urge incontinence is caused by a problem with the detrusor muscle. Stress incontinence occurs in both women and men. Definitions of stress and urge incontinence are not defined by the time of day they may occur. Stress incontinence is not caused by a detrusor muscle problem.

19. Vesicoureteral reflux is associated with a. increased serum creatinine.

NURSINGTB.COM b. recurrent cystitis. c. polycystic renal disease. d. proteinuria.

ANS: B

Recurrent cystitis is associated with vesicoureteral reflux. Increased serum creatinine, polycystic renal disease, and proteinuria are not associated with vesicoureteral reflux.

20. The microorganism that causes the vast majority of urinary tract infections is a. Klebsiella. b. Escherichia coli. c. herpes simplex virus. d. Candida albicans.

ANS: B

80% of all UTIs are caused by Escherichia coli. Klebsiella, herpes simplex virus, and Candida albicans are not the most common infecting microorganisms in UTIs. 21. A patient who has difficulty walking without assistance is incontinent of urine when help

doesn’t get to her quickly enough. The term for this type of incontinence is a. extraurethral. b. functional. c. urge. d. stress.

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank ANS: B

Functional incontinence is secondary to a motor or cognitive deficit. Extraurethral incontinence occurs when an individual has a fistula. Urge incontinence involves immediate voiding after the urge occurs. Stress incontinence occurs from increased abdominal pressure and sphincter laxity.

22. A patient, age 3, has vesicoureteral reflux. “Why does that make him have so many bladder

infections?” asks his mother. The nurse’s best response is a. “When he urinates, the urine makes a fluid trail to the bladder, and if he does not clean himself well, bacteria will enter and make a bladder infection.” b. “When he urinates, urine runs back toward his kidneys and then into the bladder again, making it easy for bacteria to grow if they reach the bladder.” c. “When he urinates, urine leaks into his bowel and bacteria from the bowel leak into the bladder, where they grow and make a bladder infection.” d. “When he urinates, urine stays in his bladder and the normal bacteria that live in the bladder have a chance to grow and cause a bladder infection.”

ANS: B

Vesicoureteral reflux causes urine to reflux into the ureters during bladder contraction; the urine then falls into the bladder again, making it easy for bacteria to grow if they reach the bladder. A fluid trail to the bladder is not the cause of frequent bladder infections.

Vesicoureteral reflux does not cause urine to enter the bowel. Urine that remains in the bladder is not the cause of vesicoureteral reflux.

MULTIPLE RESPONSE 1. Urge incontinence is often beN cau (SG elT ecBt . alC l tO haMt apply.)

URseSoIf N a. aging. b. bladder infections. c. obesity. d. prostate enlargement. e. diuretics.

ANS: A, B, D, E

Aging is associated with urge incontinence. Bladder infections irritate the bladder wall and can result in urge incontinence. Prostate enlargement and diuretics also cause urge incontinence. Obesity often leads to stress incontinence as a result of increased intra-abdominal pressure.

2. Characteristics of vesicoureteral reflux in children include (Select all that apply.) a. possibly being genetic in nature. b. often leading to recurrent urinary tract infections. c. possibly resulting in hypertension. d. usually requiring surgical intervention.

ANS: A, B, C

Vesicoureteral reflux disorder may have a genetic basis, often leads to recurrent urinary tract infections, and can result in hypertension if the kidneys are affected. Vesicoureteral reflux resolves spontaneously in 80% of cases as the child grows.

3. Characteristics of cystitis include (Select all that apply.)

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Pathophysiology 6th Edition Banasik Test Bank a. b. c. d. e.

more common in women. less complicated in men. associated with catheterization of the bladder. fostered by stasis of urine. usually resolve without treatment.

ANS: A, C, D

Cystitis is more common in women as a result of a shorter urethra and other factors. It is associated with catheterization of the bladder and fostered by stasis of urine. Cystitis is more complicated in men and requires antimicrobial treatment.

4. Cystitis symptoms include (Select all that apply.) a. CVA tenderness. b. suprapubic pain. c. dysuria. d. fever.

ANS: B, C, D

Suprapubic pain, dysuria, and fever occur with cystitis. CVA (costovertebral angle) tenderness occurs only with pyelonephritis, because the kidneys are located at the costovertebral angle between the twelfth rib and the lumbar vertebrae.

TRUE/FALSE 1. Infection can lead to bladder stone formation.

ANS: T

N R I G B.COM

U Sformation.

N T Infection can lead to bladder stone

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Pathophysiology 6th Edition Banasik Test Bank

Chapter 30: Male Genital and Reproductive Function Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. In males, pituitary luteinizing hormone (LH) a. induces Leydig cells in the testes to produce testosterone. b. induces Sertoli cells to produce sperm. c. stimulates ejaculation of semen. d. has no known reproductive function.

ANS: A

In males, pituitary luteinizing hormone (LH) induces Leydig cells in the testes to produce testosterone. Pituitary luteinizing hormone does not induce Sertoli cells to produce sperm or stimulate ejaculation of semen. LH has the known reproductive function of inducing Leydig cells in the testes to produce testosterone.

2. An important function of the scrotum is to a. regulate the temperature of the testes. b. provide support to the prostate gland. c. regulate blood supply to the penis. d. supply antibacterial secretions.

ANS: A

An important function of the scrotum is to regulate the temperature of the testes. The prostate gland is just below the bladder. The pudendal arteries supply blood to the penis. The scrotum does not supply antibacterial NseUcR r eS t ioInN s. GTB.COM 3. Production of LH occurs in response to serum levels of a. estrogen. b. prostate-specific antigen. c. cortisol. d. testosterone.

ANS: D

Production of LH occurs in response to serum levels of testosterone and estradiol. Production of LH does not occur in response to serum levels of estrogen, prostate-specific antigen, or cortisol.

4. The male penis is innervated by the a. sciatic b. sacral c. pudendal d. caudal

nerve.

ANS: C

The male penis is innervated by the pudendal nerve. The sciatic, sacral, and caudal nerves do not innervate the penis.

5. The activation of sperm after they enter the vagina is called

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Pathophysiology 6th Edition Banasik Test Bank a. b. c. d.

flagellation. ejaculation. emission. capacitation.

ANS: D

The activation of sperm after they enter the vagina is called capacitation. The activation of sperm after they enter the vagina is not called flagellation, ejaculation, or emission.

6. The main function of the prostate is to a. produce sperm. b. produce seminal fluid to support sperm. c. secrete male hormones. d. provide innervation for erection.

ANS: B

The main function of the prostate is production of seminal fluid to support sperm. The testes are responsible for sperm production. The prostate does not secrete male hormones or provide innervation for erection.

7. The primary function of the epididymis is to a. house developing sperm. b. produce seminal fluid. c. produce sperm. d. secrete male hormones.

ANS: A

The primary function of the eNp i d R idym is G is toBh. oC use M developing sperm while they develop the I U S N T O ability to swim. Seminal fluid is produced in the prostate. Sperm is produced in the testes. The epididymis does not secrete male hormones.

8. The nerve most responsible for penile erection is the a. penile b. prepual c. pudendal d. prostatic

nerve.

ANS: C

The pudendal nerve, when stimulated, results in penile erection. Stimulation of the penile, prepual, or prostatic nerves does not result in penile erection.

9. Erectile function is most likely to be impaired if spinal cord injury occurs at a. L1-L2. b. L2-L3. c. S1-S2. d. S2-S4.

ANS: D

Parasympathetic fibers arising at S2-S4 initiate penile erection when stimulated by the pudendal nerve. The L1-L2, L2-L3, and S1-S2 areas are not responsible for initiating penile erection.

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Pathophysiology 6th Edition Banasik Test Bank 10. The capacitation process occurs in sperm a. after introduction into the vagina. b. before emission from the penis. c. after fertilization of the egg. d. before ejaculation from the penis.

ANS: A

The capacitation process occurs over a period of 1 to 10 hours and occurs in sperm only after they have been introduced into the vagina. Capacitation occurs after emission and ejaculation from the penis. Capacitation results in fertilization of the egg.

MULTIPLE RESPONSE 1. Characteristics of declining reproductive function in the aged male include (Select all that

apply.) a. decline in sperm production. b. reduced testosterone production. c. shrinking testes. d. increased penile sensation. e. reduction in size of the penis.

ANS: A, B, C, E

Characteristics of declining reproductive function in the aged male include a decline in the number of sperm produced; decreased number of Leydig cells that produce testosterone; increased connective tissue, fibrosis of the tubules, and decreased number of capillaries that lead to smaller testes; and sclerotic arteries and veins and an increase in fibroelastic tissue that lead to a reduction in penis siN ze. R PenI ile sG ensB at. ioC n d eMc r e a s e s with age.

U S N T

O

TRUE/FALSE 1. The parasympathetic nervous system mediates the process of ejaculation.

ANS: F

The sympathetic nervous system mediates the process of ejaculation.

2. The thick covering of the ovum is called the zona pellucid.

ANS: T

The thick covering of the ovum is called the zona pellucid.

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Pathophysiology 6th Edition Banasik Test Bank

Chapter 31: Alterations in Male Genital and Reproductive Function Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. A patient diagnosed with a micropenis must be evaluated for a. endocrine disorders. b. vascular abnormalities. c. female sex assignment. d. epispadias.

ANS: A

Penile development and growth are both testosterone-dependent. Patients with micropenis must be evaluated for endocrine abnormalities. Micropenis has been shown to be related to vascular disorders. Female sex assignment is considered only after treatment failure.

Epispadias is an abnormality of the urethral opening and unrelated to micropenis.

2. Sexual impotence is rarely because of a. drug side effects. b. psychological factors. c. primary causes. d. vascular diseases.

ANS: C

Primary impotence is rare and refers to the inability to attain an erection throughout life.

Impotence has been determined to be a side effect of certain medications. Several Ms of low desire, erectile failure, or psychological factors may beNm blO em UaRniSfeIstNedGaTs Bpr.oC premature ejaculation. Peripheral vascular disease and arterial insufficiency of the penis are recognized causes of impotency.

3. Phimosis is a disorder of the penis characterized by a. sustained, painful erection. b. inability to retract the foreskin. c. inability to achieve erection. d. malpositioning of the urinary meatus.

ANS: B

Phimosis is a disorder of the foreskin, associated with chronic inflammation, and results in a foreskin that cannot be retracted. A sustained, painful erection is known as priapism.

Impotence is the inability to achieve an erection. Malpositioning of the urinary meatus (hypospadias) is a congenital anomaly, while phimosis is an acquired anomaly.

4. Cryptorchidism is a. associated with an increased incidence of testicular cancer. b. an extremely uncommon disorder. c. rarely treated. d. a consequence of gonorrhea.

ANS: A

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Pathophysiology 6th Edition Banasik Test Bank Several studies have revealed an increased prevalence of testicular tumors in subjects with a history of cryptorchidism. The incidence of cryptorchidism is about 0.7% to 1.0% of male infants at 1 year of age. Because of the increased risk of malignancy and infertility, treatment at an early age to bring the testis into a normal scrotal position is recommended. The cause of the condition is uncertain but may be related to an intrinsic testicular defect or a subtle hormonal deficiency.

5. Sudden, severe testicular pain is indicative of a. prostatitis. b. testicular cancer. c. testicular torsion. d. epididymitis.

ANS: C

A twisting of the spermatic cord with subsequent testicular ischemia and infarction, testicular torsion, commonly presents with sudden onset of severe testicular pain. Prostatitis is manifested by a tender, swollen prostate. Testicular cancer has a slower, less dramatic presentation. Epididymitis can resemble testicular torsion, but usually presents with an enlarged, reddened, and tender scrotum, as opposed to a sudden onset of severe pain.

6. A progressive decrease in the force of the urinary stream, dribbling of urine, and difficulty

initiating the urinary stream are characteristic of a. prostatitis. b. urinary calculi. c. bladder carcinoma. d. prostatic enlargement.

ANS: D

NURSINGTB.COM

A decrease in the force of the urinary stream, hesitancy or difficulty in initiating a urinary stream, and interruption of the stream may occur with prostatic enlargement. Prostatitis presents with frequency, urgency, and dysuria. Urinary calculi cause sudden, severe onset of pain. Bladder carcinoma is usually characterized by hematuria, painful or frequent urination, and abdominal or back pain.

7. The condition in which the urethra opens on the dorsal aspect of the penis is known as a. hypospadias. b. urethral fistula. c. epispadias. d. priapism.

ANS: C

In epispadias, the urethra opens on the dorsal aspect of the penis at a point proximal to the glans. In hypospadias, the urethral meatus is located on the ventral undersurface of the penis or on the perineum. A urethral fistula is a failure of the urorectal septum to develop completely. Priapism is defined as a painful, persistent erection.

8. The pathology report for a patient with penile cancer has this statement: The tumor involves

the shaft of the penis. The cancer is at what stage? a. Stage I b. Stage II c. Stage III

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Pathophysiology 6th Edition Banasik Test Bank d. Stage IV ANS: B

Penile carcinoma is staged as follows: Stage I: The lesion is limited to the glans or foreskin.

Stage II: The tumor involves the shaft of the penis. Stage III: The inguinal nodes are involved, but the lesion is operable. Stage IV: Disseminated disease.

MULTIPLE RESPONSE 1. A patient presenting with a urethral stricture may experience (Select all that apply.) a. decreased urinary stream. b. urethral discharge. c. infection. d. urine retention. e. inability to retract the glans of the penis.

ANS: A, B, C, D

Signs and symptoms of urethral stricture include decreased urinary stream, urethral discharge, infection, and urine retention. Phimosis, the inability to retract the glans of the penis, is an unrelated condition.

TRUE/FALSE 1. The most common cause of urinary obstruction in male newborns and infants is urethral

valves.

ANS: T

NURSINGTB.COM

The most common cause of urinary obstruction in male newborns and infants is urethral valves.

2. The majority of penile cancer cases are classified as basal cell carcinoma.

ANS: F

The majority of penile cancer cases are classified as squamous cell carcinoma.

3. Erection requires the release of nitrous oxide into the corpus cavernosum during sexual

stimulation.

ANS: T

Erection requires the release of nitrous oxide into the corpus cavernosum during sexual stimulation.

4. The prognosis of penile carcinoma depends upon the stage of the disease.

ANS: T

The prognosis of penile carcinoma depends upon the stage of the disease.

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Pathophysiology 6th Edition Banasik Test Bank

Chapter 32: Female Genital and Reproductive Function Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. At the midpoint of the menstrual cycle, ovulation occurs in response to the a. increase in progesterone. b. increase in luteinizing hormone and FSH. c. decrease in estrogen. d. decrease in gonadotropin.

ANS: B

At the midpoint of the cycle, a burst of luteinizing hormone and a doubling of FSH secretion from the pituitary gland stimulate ovulation. Ovulation does not occur in response to an increase in progesterone. An increase in estrogen causes the anterior pituitary to release luteinizing hormone and FSH. Gonadotropin does not play a role in ovulation.

2. Ovulation occurs approximately how many days prior to the first day of menstruation? a. 7 b. 10 c. 14 d. 21 ANS: C

Ovulation occurs approximately 14 days before the next cycle begins; thus, in a 28-day cycle, ovulation occurs about day 14 of the cycle. Ovulation does not occur 7 days after menstruation, on day 10 of thNeU cyRcS leI , oNr G 21TdBa. ysCiO ntM o the menstrual cycle.

3. During the first 2 weeks of the menstrual cycle, the endometrium proliferates under the

influence of a. estrogen. b. testosterone. c. progesterone. d. hCG. ANS: A

In the preovulatory phase, also called the proliferative phase, theca and granulosa cells in the developing follicles in the ovary secrete estrogen. Testosterone is not secreted during the preovulatory phase. Progesterone is not related to the proliferation of the endometrium. The endometrium is not proliferated by the presence of hCG. 4. The corpus luteum a. is the site of implantation of a fertilized egg. b. secretes hCG. c. develops at the site of a ruptured ovarian follicle. d. is part of the human placenta.

ANS: C

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank During the luteal phase, the site of the ruptured follicle becomes a corpus luteum, which secretes estrogen and progesterone. The corpus luteum degenerates if pregnancy does not occur. The corpus luteum does not secrete hCG. The corpus luteum is not a part of the placenta.

5. The hormone released from the posterior pituitary gland during the milk ejection reflex is a. gonadotropin. b. prolactin. c. vasopressin. d. oxytocin.

ANS: D

Oxytocin is released from the posterior pituitary gland during lactation. Gonadotropin is not released during milk ejection. The hormone prolactin is released from the anterior pituitary gland and helps stimulate milk production. Vasopressin is not related to milk ejection.

6. Before the onset of menstruation, water retention and breast swelling are thought to be high

levels of a. estrogen b. progesterone c. hCG d. oxytocin

stimulating the secretory cells of the breast.

ANS: B

The water retention and subsequent swelling of breast tissue during this phase of the menstrual cycle are thought to be high levels of circulating progesterone stimulating the secretory cells of the breast. High levels of estrogen are not related to breast swelling. hCG levels are unrelated to s t i m u lN a tU i oR nS ofIsN ecG reT toB ry.cC elO lsM . Oxytocin is related to lactation.

7. The purpose of the placenta during pregnancy is to a. protect the developing fetus. b. provide nutrients to the mother. c. provide nutrients to the fetus and remove wastes. d. remove excess estrogen during pregnancy.

ANS: C

The placenta serves two basic functions. It is the organ of exchange between the developing fetus and the mother; it also provides nutrients to the fetus and removes wastes. The amniotic cavity provides protection to the fetus during pregnancy. The placenta does not provide any additional nutrients to the mother during pregnancy. The placenta secretes estrogen and progesterone.

8. From the time of fertilization until the end of the eighth week, the developing organism is

referred to as the a. zygote. b. fetus. c. infant. d. embryo.

ANS: D

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Pathophysiology 6th Edition Banasik Test Bank From fertilization to the end of the eighth week, the developing organism is referred to as an embryo. After fertilization, the zygote begins a series of divisions by mitosis. From the ninth week until birth, the developing baby is referred to as a fetus. The infant stage of growth occurs after delivery.

9. The heartbeat becomes audible through a stethoscope during which phase of fetal

development? a. First trimester b. Second trimester c. Third trimester d. Parturition ANS: B

The heartbeat of the fetus is audible during the second trimester, or months 4 to 6 of development. The heartbeat is not typically audible by stethoscope until the second trimester.

The heartbeat is audible via stethoscope before the third trimester. Parturition refers to the process by which the infant is born.

10. Which hormone is secreted to cause uterine contractions during labor and delivery? a. Progesterone b. Thyroxine c. Oxytocin d. Pitocin ANS: C

Oxytocin is a hormone secreted by the posterior pituitary gland that specifically causes uterine contraction and that is thought to have a major role in promoting increased uterine contractility during parturitioN n.UARnSinIcN reG asT edBr. atC ioOoM f estrogen to progesterone secretion may promote uterine contractility. Thyroxine is not associated with uterine contractions. Pitocin is not a hormone that is secreted during labor and delivery.

11. What is the average maternal weight gain during pregnancy? a. 7 lbs b. 12 lbs c. 24 lbs d. 40 lbs ANS: C

The average weight gain during pregnancy is about 24 lbs, with most of this gain occurring during the last two trimesters. Approximately 7 lbs of weight gain is related to the fetus.

Approximately 4 lbs of the increased weight is amniotic fluid, placenta, and fetal membranes.

Forty pounds is not an average amount of weight gained with pregnancy.

12. Pregnancy is associated with a. decreased oxygen consumption and ventilation. b. decreased basal metabolic rate. c. decreased absorption of sodium and water. d. increased cardiac output and blood volume.

ANS: D

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank Pregnancy is associated with many physiologic changes, including an increased cardiac output (30% to 40%) and blood volume (1 to 2 L). There is an increase in oxygen consumption and minute ventilation during pregnancy. Pregnancy is associated with an increased basal metabolic rate. There is an increase in glomerular filtration rate and tubular reabsorption of sodium and water during pregnancy.

13. A 48-year-old female who is having hot flashes, tachycardia, palpitations, and sleep

disturbance may be experiencing symptoms related to a. pregnancy. b. perimenopause. c. ovulation. d. endometriosis.

ANS: B

Perimenopause is the period between the ages of 45 and 52 years when estrogen and progesterone production declines and the woman experiences physiologic changes. Pregnancy is not the typical cause of hot flashes, tachycardia, and palpitations. Ovulation is not associated with the symptoms described. Endometriosis does not cause hot flashes and tachycardia.

MULTIPLE RESPONSE 1. Which organs are part of the female reproductive tract? (Select all that apply.) a. Ovaries b. Uterus c. Cervix d. Vagina e. Urethra

NURSINGTB.COM

ANS: A, B, C, D

The ovaries, uterus, cervix, and vagina are all considered to be organs of the female reproductive system. The urethra is located near the vagina but is a part of the urinary system.

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank

Chapter 33: Alterations in Female Genital and Reproductive Function Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. Uterine prolapse is caused by a relaxation of the a. cardinal ligaments. b. abdominal organs. c. cervix. d. vaginal musculature.

ANS: A

Alterations in uterine position and pelvic support may occur anytime during a woman’s reproductive years. The major support for the uterus and upper part of the vagina is provided by the thickenings of the endopelvic fascia known as the cardinal ligaments. If the support of the vaginal wall is also compromised, the pressure of the abdominal organs on the uterus will gradually force it downward through the vagina into the introitus. The relaxation of the cardinal ligaments permits the cervix to sag into the vagina. Uterine prolapse can occur when the supporting structures and the cardinal ligaments relax and allow the uterus to sag into the vagina.

2. Endometriosis is a condition in which a. the endometrium sloughs continuously. b. ectopic endometrial tissue is present. c. an abnormal Pap smear is diagnostic. d. the endometrium proliferN atesRandIdoG es nB ot.sC hedM .

U S N T

O

ANS: B

Endometriosis is the presence of endometrial tissue outside the lining of the uterine cavity.

The only normal location for endometrial tissue is the endometrial lining of the uterus, but with endometriosis, the tissue is found outside the uterine cavity. Endometriosis is not diagnosed with a Pap smear. Diagnosis is made by a physician based on symptoms. The most prominent symptom of endometriosis is dysmenorrheal.

3. A change occurring in a pregnant woman that is indicative of a potential disorder is a. increased metabolic rate. b. 30% to 40% increase in cardiac output. c. increased oxygen consumption. d. increased urinary protein.

ANS: D

Pregnancy-induced hypertension is characterized by a rapid rise in arterial blood pressure associated with the loss of large amounts of protein in the urine. An increased metabolic rate is a normal finding in a pregnant woman. Increased cardiac output would be an expected finding during pregnancy. Pregnant women are expected to have an increase in oxygen consumption during pregnancy.

4. Absence of menstruation is called a. amenorrhea. b. metrorrhagia.

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Pathophysiology 6th Edition Banasik Test Bank c. menorrhagia. d. dysmenorrhea.

ANS: A

Amenorrhea is the absence or suppression of menstruation in a female aged 16 or older.

Metrorrhagia is bleeding between menstrual periods. Menorrhagia is an often debilitating increase in the amount or duration of menstrual bleeding. Dysmenorrhea is menstruation that is painful enough to limit normal activity.

5. Dysfunctional uterine bleeding (DUB) is caused by a. endometrial inflammation. b. reproductive tract malignancies. c. endometrial fibroid tumors. d. absent or diminished levels of progesterone.

ANS: D

The term dysfunctional uterine bleeding is used to describe abnormal endometrial bleeding not associated with tumor, inflammation, pregnancy, trauma, or hormonal effects. Absent or diminished levels of progesterone will result in a thick and extremely vascular endometrium that lacks structural support. As a result of this fragile structure, spontaneous and superficial hemorrhage occurs randomly throughout the endometrium. Dysfunctional uterine bleeding is used to describe abnormal endometrial bleeding not associated with inflammation. DUB is used to describe abnormal bleeding not associated with tumors or malignancies. Fibroid tumors are not associated with the term dysfunctional uterine bleeding.

6. What reproductive tract disorder is most likely to be associated with urinary stress

incontinence? a. Rectocele b. Menopause c. Cystocele d. Cervicitis

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ANS: C

A cystocele is a protrusion of a portion of the urinary bladder into the anterior of the vagina at a weakened part of the vaginal musculature. In moderate to severe cases, a sensation of pressure can be felt in the vagina, along with dysuria, incontinence, and back pain. Clinical manifestations of rectocele would involve difficulties in bowel evacuation or constipation.

Urinary stress incontinence is not a manifestation of menopause. Cervicitis is not associated with urinary stress incontinence.

7. It is true that fibrocystic breast disease a. commonly progresses to breast cancer. b. may be exacerbated by methylxanthines. c. is characterized by painless breast lumps. d. is a contraindication for progesterone birth control pills.

ANS: B

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Pathophysiology 6th Edition Banasik Test Bank In fibrocystic breast disease, it is thought that methylxanthines tend to stimulate cyclic adenosine monophosphate and thus increase metabolic activity in the breast. Nutritional therapies have shown success in some women, particularly in avoidance of foods with methylxanthines such as tea, coffee, cola, and chocolate. Recent research has disproved the theory that fibrocystic breast disease leads to cancer. Fibrocystic breast disease is characterized by tenderness or pain in one or both breasts. Oral contraceptives have been recommended to control symptoms of fibrocystic breast disease.

8. A potential risk factor for breast cancer includes a. a history of fibrocystic breast disease. b. more than three pregnancies prior to age 35. c. malnourishment. d. early menarche and late first pregnancy.

ANS: D

It has been observed in many research studies that giving birth at a young age (less than 18 years) is associated with a decreased risk of breast cancer, and that giving birth for the first time aged 35 years or older increases the risk. Recent research has disproved the theory that fibrocystic breast disease leads to cancer. Parity (the number of children a woman has given birth to) has been associated with risk, with low parity increasing risk and high parity having a protective effect. It has been suggested that the amount of fat in the diet is a risk factor for breast cancer.

9. A 32-year-old female complaining of severe pain with menstruation and inability to

participate in her routine household activities is likely experiencing a. dysmenorrhea. b. menorrhagia.

NURSINGTB.COM c. amenorrhea. d. metrorrhagia.

ANS: A

Dysmenorrhea is menstruation that is painful enough to limit normal activity or to cause a woman to seek health care. Menorrhagia is an often debilitating increase in the amount or duration of menstrual bleeding. Amenorrhea is the absence or suppression of menstruation in a female aged 16 years or older; it occurs if a woman misses three or more periods in a row.

Metrorrhagia, or bleeding between menstrual periods, usually results from slight physiologic bleeding from the endometrium during ovulation, but may also result from other causes such as uterine malignancy, cervical erosions, and endometrial polyps or as a side effect of estrogen therapy.

10. Excessive vomiting in pregnant women is known as a. placenta previa. b. hyperemesis gravidarum. c. abruptio placentae. d. spontaneous abortion.

ANS: B

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank Hyperemesis gravidarum is a Latin term for excess of vomiting in pregnant women. Although transient nausea and vomiting occur in about half of women in the first trimester of pregnancy, in a few women these symptoms continue throughout the entire course of pregnancy. Placenta previa is a condition in which the placenta is implanted abnormally over the internal cervical os. Abruptio placentae is premature separation of the placenta before delivery of the fetus. Spontaneous abortion is expulsion of the products of conception from the uterus before the period of fetal viability.

11. The expected treatment of a pregnant woman with hyperemesis gravidarum is a. immediate cesarean section. b. seizure prophylaxis. c. surgical removal of uterine contents. d. intravenous therapy.

ANS: D

Intravenous therapy to correct metabolic and nutritional abnormalities, antiemetic agents, and supportive care in a hospital environment may be needed to resolve the symptoms of hyperemesis gravidarum. Therapeutic strategies for placenta previa and abruptio placentae include cesarean section for fetal distress or hemorrhage control. Seizure prophylaxis may be indicated in the presence of pregnancy-induced hypertension. If an incomplete abortion has occurred, it may be necessary to surgically remove the remaining uterine contents.

12. Treatment of a uterine prolapse may involve the insertion of a(n)

to hold the uterus

in place. a. catheter. b. IUD. c. pessary.

NURSINGTB.COM d. endopelvic mesh implant.

ANS: C

Uterine prolapse is one of the most common reasons for hysterectomy usually from the vaginal approach. In patients who are at poor risk for surgery or who choose not to have a hysterectomy, a pessary, which is a small supportive device, is inserted to hold the uterus in place. A urinary catheter is not useful in holding the uterus in place. An intrauterine device would not be useful in treating a uterine prolapse. Uterine prolapse is not treated with insertion of a mesh implant.

13. Cervical cancer can be detected in the early, curable stage by the a. Papanicolaou b. human papillomavirus c. gonorrhoeae d. vaginal pH

test.

ANS: A

Cancer of the uterine cervix is a neoplasm that can be detected in the early, curable stage by the Papanicolaou (Pap) test. The main cause of cervical cancer is certain human papillomavirus (HPV) types. Neisseria gonorrhoeae is a common causative agent in pelvic inflammatory disease. Changes in vaginal pH may be seen with vulvovaginitis.

14. The most common types of uterine tumors are known as a. ovarian cysts.

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Pathophysiology 6th Edition Banasik Test Bank b. endometriomas. c. hydatidiform moles. d. leiomyomas.

ANS: D

Benign fibroid tumors, or leiomyomas, are the most common uterine tumor, affecting about 20% of women older than 35 years. Ovarian cysts are sacs on an ovary that contain fluid or semisolid material. Endometriomas, or endometrial implants, usually occur in the pelvis.

Theca-lutein cysts are commonly bilateral and filled with clear, straw-colored fluid. Often their development is associated with hydatidiform moles.

15. A breast lump that is painless, hard, and unmoving is most likely a. fibrocystic breast disease. b. fibroadenoma. c. papilloma. d. carcinoma.

ANS: D

Malignant tumors are usually painless, hard, and poorly movable. Masses in fibrocystic breast disease are firm, mobile, and tender. Fibroadenomas are a benign breast disorder. Papillomas are a specific benign neoplasm of the breast.

16. A 52-year-old female had a surgical procedure in which the breast, lymphatics, and

underlying muscle were removed. The procedure performed was a a. radical mastectomy. b. modified radical mastectomy. c. mastectomy.

NURSINGTB.COM d. lumpectomy.

ANS: A

A radical mastectomy is a rare procedure in which the breast, lymphatic drainage, and underlying pectoral muscles are removed. A modified radical mastectomy occurs when the breast is removed and a portion of the axillary lymphatic system is dissected. Removal of the breast only is a simple mastectomy. A lumpectomy is the removal of the lesion only.

17. Infection by accounts for nearly half of all reported cases of vulvovaginitis. a. Chlamydia trachomatis b. Candida albicans c. Neisseria gonorrhoeae d. Pseudomonas ANS: B

Infection by Candida albicans (formerly called Monilia) accounts for approximately half of all reported cases of vulvovaginitis. Chlamydia trachomatis is a common cause of pelvic inflammatory disease. Neisseria gonorrhoeae is a common causative agent in PID, because it can penetrate the bacteriostatic barrier of cervical mucous. Pseudomonas may be associated with PID. 18. The HPV vaccine is recommended for 11- to 12-year-old girls, but can be administered to

girls as young as a. 7

years of age.

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Pathophysiology 6th Edition Banasik Test Bank b. 8 c. 9 d. 10 ANS: C

The HPV vaccine is recommended for 11- to 12-year-old girls, but can be administered to girls as young as 9 years of age. The HPV vaccine is recommended for girls above the age of 9. The HPV vaccine is not recommended for females under the age of 9. The vaccine also is recommended for 13- to 26-year-old females who have not yet received or completed the vaccine series.

MULTIPLE RESPONSE 1. Which symptom would be manifested in a woman diagnosed with pregnancy-induced

hypertension? (Select all that apply.) a. Excessive vomiting b. Proteinuria c. Peripheral edema d. Increased arterial pressure e. Hemorrhage ANS: B, C, D

Pregnancy-induced hypertension is characterized by salt and water retention by the kidneys, weight gain, and edema. There is a rapid rise in the arterial blood pressure associated with large amounts of protein loss in the urine. The severity of symptoms of PIH is closely related to the retention of salt and water and the degree of the increase in arterial pressure. Excessive vomiting is seen in hyperemeNsis R g r a vIi d aG r u m . H e m o r rh a ge is not associated with U S N T B .OC M pregnancy-induced hypertension.

2. Which pharmacologic treatments may be seen in a patient with breast cancer? (Select all that

apply.) a. Estrogen receptor modulators b. Estrogen antagonists c. Anti-inflammatory agents d. Estrogen/progesterone combination therapies e. Antineoplastic agents ANS: A, B, E

Selective estrogen receptor modulators (SERMS), estrogen antagonists, are the most common agents used in the treatment of breast cancer. Antineoplastic agents are given to control the spread of malignant cells. Anti-inflammatory agents would not be effective in the primary treatment of breast cancer. Recent data show that the risk of breast cancer may be greater for women taking estrogen/progesterone combination therapies than for women taking estrogen only therapies.

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Pathophysiology 6th Edition Banasik Test Bank

Chapter 34: Sexually Transmitted Infections Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. The organism most commonly associated with pelvic inflammatory disease is a. Neisseria gonorrhoeae. b. Treponema pallidum. c. Escherichia coli. d. Pseudomonas.

ANS: A

Pelvic inflammatory disease is usually the result of acute salpingitis caused by gonococcal or chlamydial infection that has extended into nearby pelvic tissue. Syphilis is acquired when T. pallidum penetrates intact mucous membrane or abraded skin during sexual contact.

Escherichia coli is not generally associated with pelvic inflammatory disease. Pelvic inflammatory disease is not associated with Pseudomonas infection.

2. A long asymptomatic latent phase is characteristic of which of the following sexually

transmitted infections? a. Gonorrhea b. Syphilis c. Chlamydia d. Hepatitis B ANS: B

The secondary stage of s y p h iNl i U s iR s S seI lfN -liG mT itiB n. g C anO dM is followed by a latent phase in which no symptoms are present. Infection with gonorrhea is not associated with a latent phase. After invasion of the mucosa by Chlamydia during sexual contact, a painless lesion appears on the genitalia after a 1- to 3-week incubation period. Hepatitis B infection is not characterized by a long latent phase.

3. A painless ulceration called a chancre is a lesion associated with infection by a. human papillomavirus. b. N. gonorrhoeae. c. C. trachomatis. d. T. pallidum.

ANS: D

The primary phase of syphilis begins with the formation of a chancre, a painless, ulcerative lesion that arises at the original portal of entry. Human papillomavirus is not associated with chancre lesions. In gonorrhea, chancres are not present. The symptoms of infection with Chlamydia are generally less severe than those of syphilis and are not evidenced by a chancre lesion.

4. Which infection can be a risk factor for cervical cancer? a. Human papillomavirus b. Molluscum contagiosum c. Granuloma inguinale d. Chancroid

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Pathophysiology 6th Edition Banasik Test Bank

ANS: A

Condylomata acuminata, or genital warts, are associated with infection by human papillomavirus. Persistent human papillomavirus infection is an important risk factor for cervical cancer. Molluscum contagiosum is associated with infection by a poxvirus. The disease is usually asymptomatic and self-limiting. Granuloma inguinale is caused by an intracellular bacterium. The initial papule is painless and subsequently ulcerates into a growing granulomatous ulcer resembling a tumor. Chancroid is caused by infection with an anaerobic bacillus. Lesions resemble those of syphilis; however, the lesions of syphilis are painless.

5. Which of the following infections is asymptomatic and self-limited and does not require

therapy? a. Syphilis b. Nongonococcal cervicitis c. Gonorrhea d. Molluscum contagiosum ANS: D

Molluscum contagiosum is a viral skin disease caused by a member of the poxvirus family.

The disease is usually asymptomatic, tends to be self-limiting, and lasts on average 2 years.

Treatment is required for syphilis infection. Nongonococcal cervicitis requires treatment because it may result in pelvic inflammatory disease. Infection related to gonorrhea does require treatment.

6. The first choice of treatment for the management of syphilis is a. penicillin G. b. doxycycline. c. antiviral agents. d. antimicrobial agents.

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ANS: A

Penicillin G is the first choice for the management of syphilis. If the affected person is allergic to penicillin, tetracycline or doxycycline is given. Doxycycline is indicated in the treatment of lymphogranuloma venereum. Antiviral agents are not indicated in the treatment of syphilis.

Antimicrobial agents would be utilized in treating gonorrhoeae.

7. A 23-year-old male presents with urethritis, dysuria, and purulent urethral discharge. The

suspected diagnosis would be a. gonorrhea. b. urinary tract infection. c. Chlamydia. d. syphilis.

ANS: A

In men, symptoms of urethritis, including dysuria and a purulent urethral discharge accompanied by redness and swelling at the site of infection, are all symptoms of gonorrhea.

Urinary tract infection would not be the initial source of disease. In men, nongonococcal urethritis refers to urethritis resulting from a pathogen other than the gonococcus, which is usually Chlamydia. In males, the chancre related to syphilis may form on the genitalia.

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Pathophysiology 6th Edition Banasik Test Bank 8. Transmission of Chlamydia during birth may result in

, or infection of the eyes in

the newborn. a. neonatal jaundice b. ophthalmia neonatorum c. neonatal conjunctivitis d. erythema neonatorum ANS: B

Transmission of chlamydia during birth may result in ophthalmia neonatorum, or infection of the eyes in the newborn. Neonatal jaundice is not associated with exposure to chlamydia at childbirth. Transmission of Chlamydia does not cause neonatal conjunctivitis. Erythema neonatorum is not a condition associated with Chlamydia.

9. The Centers for Disease Control estimate that there are

new sexually transmitted

infections every year. a. 300,000 b. 1.3 million c. 19 million d. 17 billion ANS: C

The CDC estimates that there are 19 million new infections every year. More than 300,000 cases are related to gonococcal infection. 1.3 million sexually transmitted diseases are related to chlamydia infections. It is estimated that sexually transmitted infections cost the health care system $17 billion every year.

10. The initial incubation period of syphilis lasts for a. b. c. d.

2 to 3 days.

10 to 90 days.

3 to 6 weeks.

40 years.

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ANS: B

The initial incubation period of syphilis is 10 to 90 days. The initial incubation period is more than 2 to 3 days with syphilis. Untreated chancres usually resolve in 3 to 6 weeks without treatment. The latent stage of syphilis may last more than 40 years.

11. Herpes lesions are fluid-filled vesicles that appear a. 1 to 2 b. 3 to 7 c. 7 to 10 d. 10 to 14

days after infection.

ANS: B

Genital infection with HSV type 2 is manifested by the appearance of fluid-filled vesicles after a 3- to 7-day incubation period. Herpes lesions do not appear until at least 3 days after infection. Lesions generally crust and heal within 10 days. The incubation period after infection with herpes is 3 to 7 days.

12. Central nervous system degeneration, blindness, and paresis are associated with untreated a. HSV.

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Pathophysiology 6th Edition Banasik Test Bank b. LGV. c. syphilis. d. gonorrhea.

ANS: C

Late syphilis is characterized by central nervous system degeneration, blindness, and paresis.

HSV types 1 and 2 are associated with genital herpes. LGV is a highly contagious systemic infection related to chlamydia. Infection may spread to lymph nodes. Gonorrhea is associated with pelvic inflammatory disease.

MULTIPLE RESPONSE 1. What systemic infections are potentially transmitted by sexual contact? (Select all that apply.) a. Cytomegalovirus b. Hepatitis A c. Hepatitis B d. HIV e. Herpes simplex virus ANS: A, B, C, D

Cytomegalovirus is a systemic infection that may be transmitted by sexual contact. Hepatitis A and B are both systemic infections that may be transmitted through sexual contact. Human immunodeficiency virus can be transmitted through sexual contact. Herpes simplex virus is not a systemic infection.

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Pathophysiology 6th Edition Banasik Test Bank Chapter 35: Gastrointestinal Function Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. The structure and secretions of the salivary gland most closely resemble those of the a. gastric gland. b. exocrine pancreas. c. liver. d. gallbladder.

ANS: B The salivary gland and the pancreas both secrete amylase. Gastric glands secrete pepsinogen. The liver and salivary gland do not resemble each other in the secretory process. The gallbladder secretes concentrated bile salts.

2. The primary stimulus for pancreatic secretion is a. gastrin. b. histamine. c. acetylcholine. d. secretin.

ANS: D Secretin, which is produced by the mucosa of the duodenum in response to the entry of acidic gastric juice from the stomach, stimulates pancreatic fluid. Gastrin is secreted by endocrine cells of the stomach mucosa in response to food entry. Histamine is not the N R I G B.C M primary stimulus for pancreaU tic sSe c r eNt i o nT. AcetyOlcholine is not associated with the secretion of pancreatic fluids.

3. The action of bile is to a. emulsify fats. b. digest cellulose. c. convert sucrose. d. release free amino acids.

ANS: A Bile is produced continuously in the liver and is responsible for emulsifying fats. Humans do not secrete an enzyme capable of digesting cellulose. Sucrase converts sucrose to glucose and fructose. Protein digestion involves the release of free amino acids.

4. The sympathetic nerve endings in the GI tract secrete a. acetylcholine. b. histamine. c. gastrin. d. norepinephrine.

ANS: D

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Pathophysiology 6th Edition Banasik Test Bank The sympathetic nerve endings in the GI tract secrete norepinephrine, which promotes the inhibitory effect of the sympathetic nervous system on the GI tract. Acetylcholine is not secreted by sympathetic nerve endings in the GI tract. Histamine stimulates parietal cell secretion. Gastrin is not secreted by sympathetic nerve endings in the GI tract.

5. Chief cells secrete a. pepsinogen. b. hydrogen chloride. c. intrinsic factor. d. gastrin.

ANS: A In the gastric glands, chief cells secrete pepsinogen. Parietal cells are responsible for secretion of hydrogen chloride. Intrinsic factor enhances vitamin B12 absorption. Gastrin is secreted into the bloodstream and increases gastric motility.

6. Parasympathetic stimulation of the stomach would a. decrease motility. b. decrease hydrogen chloride secretion. c. inhibit acidity. d. stimulate motility.

ANS: D The GI system has an intrinsic nervous system which controls most GI functions. Input from the sympathetic and parasympathetic nervous systems can strongly affect the activity of the intrinsic nervous system. In general, sympathetic stimulation decreases the activity of the intrinsic nervous system, whereas parasympathetic stimulation increases its activity. The N R It oG B.C Ms not decrease motility. Secretion of parasympathetic stimulation U of t hSe s N mT a c h d o eO hydrogen chloride is not decreased by parasympathetic stimulation. Acidity is not inhibited by parasympathetic stimulation of the stomach.

7. Most of the parasympathetic innervation of the GI tract is supplied by the a. hypoglossal nerves. b. enteric nervous system. c. vagus nerves. d. celiac ganglia.

ANS: C The parasympathetic supply to the GI tract is divided into cranial and sacral divisions.

Cranial parasympathetic stimulation is transmitted almost entirely by the vagus nerves.

Vagus nerves provide extensive supply to the esophagus, stomach, pancreas, and the first half of the large intestine. Parasympathetic fibers of the GI tract are not supplied by the enteric nervous system. The celiac ganglia is not responsible for innervation of the GI tract.

8. Most nutrient digestion and absorption occurs in the a. stomach. b. small intestine. c. large intestine. d. cecum.

ANS: B

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Pathophysiology 6th Edition Banasik Test Bank After intact food entering the mouth has been liquefied and partially digested in the stomach, it enters the small intestine, where the major part of digestion and absorption occurs. Food is liquefied and partially digested in the stomach. Nutrient digestion and absorption does not occur in the large intestine. Intestinal contents are stored in the cecum.

9. Brush-border enzymes are produced by a. pancreatic acinar b. gastric mucosa c. intestinal epithelial d. goblet

cells.

ANS: C The intestinal epithelium secretes brush-border enzymes. Bicarbonate-rich fluids are secreted by the pancreas. Gastric glands secrete pepsinogen by the chief cells. Goblet cells throughout the intestinal mucosa secrete large amounts of mucus.

10. Which statement regarding pepsin is true? a. It is secreted by parietal cells in gastric pits. b. It is secreted as an inactive proenzyme. c. It accomplishes most of the digestion of dietary protein. d. It is permanently denatured by a pH less than 4.0.

ANS: B Chief cells produce pepsinogen, the inactive form of the enzyme pepsin. Pepsin is not secreted by parietal cells. Pepsin reduces most protein to intermediate-sized polypeptides.

HCl activates pepsinogen to pepsin.

N R I G B. C M

11. Which is associated with conU tracS tionNof T the ga llO b l adder? a. Cholecystokinin b. Morphine c. Norepinephrine d. Gastrin ANS: A Cholecystokinin has an extremely strong effect on gallbladder contractility. This stimulation of gallbladder activity results in an outpouring of bile, which plays an important role in fat digestion and absorption. Morphine is not associated with gallbladder contraction.

Contraction of the gallbladder is not associated with norepinephrine. Gastrin does not affect the contraction of the gallbladder.

12. Which can be absorbed through the intestinal epithelia without further digestion? a. Sucrose b. Lactose c. Glucose d. Glycogen ANS: C Glucose and galactose are absorbed across the intestinal epithelia by a sodium-dependent cotransporter. Disaccharides are cleaved into monosaccharides by brush-border enzymes on the intestinal epithelia. Lactose is a disaccharide which is cleaved into a monosaccharide.

Glycogen is not absorbed through the intestinal epithelia without further digestion.

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Pathophysiology 6th Edition Banasik Test Bank

13. Which enzyme assists with protein digestion? a. Amylase b. Chymotrypsin c. Lactase d. Lipase ANS: B Pepsin is neutralized in the duodenum, and pancreatic trypsin, chymotrypsin, and carboxypeptidase take over protein digestion. Amylase initiates carbohydrate digestion.

Lactase is an enzyme that stimulates pancreatic secretion. Lipase is secreted in the pancreas.

14. Pancreatic secretions are high in a. hydrochloric acid. b. bicarbonate ions. c. intrinsic factor. d. secretin.

ANS: B The pancreas secretes bicarbonate-rich fluid containing amylase, trypsin, chymotrypsin, and lipase into the duodenum when stimulated by secretin. Pancreatic secretions are not high in hydrochloric acid. Intrinsic factor is found in gastric glands. Pancreatic secretions are not high in secretin.

15. Absorption of glucose and amino acids across the intestinal epithelium occurs by a. endocytosis. b. ATP-driven transporterN s. R I G B.C M c. sodium-dependent carrierUs. S N T O d. passive diffusion.

ANS: C The transport of sugars and amino acids across the intestinal epithelial cell occurs through the transport of sodium carriers. The absorption of glucose and amino acids does not occur through endocytosis. ATP-driven transporters do not carry glucose and amino acids across the intestinal epithelium. Passive diffusion is not the process of glucose and amino acid absorption.

16. Failure of normal partitioning between the foregut and midgut can lead to a congenital condition known as a. tracheoesophageal fistula. b. esophageal atresia. c. intestinal atresia. d. anal agenesis.

ANS: C Failure of normal partitioning between the foregut and midgut can lead to intestinal atresia, a condition in which the lumen of the small intestine is obliterated. Tracheoesophageal fistula is an anomaly characterized by an abnormal connection between the trachea and esophagus. Esophageal atresia is a condition where the esophagus is closed off in a blind pouch. Anal agenesis is a condition in which the rectal pouch ends blindly.

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Pathophysiology 6th Edition Banasik Test Bank 17. Older individuals may experience which change in the mouth? a. Increase in salivation b. Increase in taste for salt c. Increase in the number of papillae d. Increased exposure of dentin ANS: D As tooth enamel wears away, dentin is exposed, allowing development of caries. Older individuals also experience a decrease in the number of acinar cells in the salivary glands, leading to a reduction in salivary secretion. Of the four basic tastes, the elderly experience a particular decrease in salt and sugar tastes. Elderly people experience a decrease in the number of papillae.

18. The portion of the stomach that controls gastric emptying is the a. fundus. b. body. c. antrum. d. pylorus.

ANS: D The pylorus is a muscular sphincter between the stomach and duodenum that serves to control gastric emptying and limit the reflux of bile from the small intestine. The fundus is the part of the stomach that continues lateral to and above the cardia. The body of the stomach extends from the cardia to the antrum. The antrum differs markedly from the rest of the stomach in function and is distinguished by the absence of rugae.

19. How much fluid is secretedNfroR m tI h e inGtesB tin.aC l glaMnds daily?

U S N T O a. 1/2 L b. 1 L c. 2 L d. 4 L ANS: C The intestinal glands secrete about 2 L of fluid daily into the lumen of the intestine, but most of the fluid is quickly reabsorbed by the villi. The intestinal glands secrete about 2 L of fluid. About 2 L of fluid are secreted from the intestinal glands daily. The intestinal glands secrete 2 L, not 4 L, of fluid a day.

20. The propulsive movement of the GI tract is called a. peristalsis. b. transmission. c. contraction. d. constriction.

ANS: A The basic propulsive movement of the GI tract is called peristalsis. Peristalsis is an inherent property of any smooth muscle tube that, like the intestine, is a functional syncytium.

Transmission is not the propulsive movement of the GI tract. Segmental contractions do serve to keep the intestinal contents mixed on a constant basis. Nutrients are propelled by the slow advancement of a circular constriction that squeezes the materials in front of the constricted area forward.

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Pathophysiology 6th Edition Banasik Test Bank

21. Carbohydrates are absorbed in the form of a. polysaccharides. b. disaccharides. c. monosaccharides. d. monoglycerides.

ANS: C Carbohydrates are absorbed in the form of monosaccharides. Polysaccharides and disaccharides lack the capacity for absorption. The intestinal epithelium is impermeable to carbohydrates of such high molecular weight. Carbohydrates are not absorbed in the form of monoglycerides.

MULTIPLE RESPONSE 1. Which are major pairs of salivary glands? (Select all that apply.) a. Parotid b. Parietal c. Submandibular d. Sublingual e. Pituitary ANS: A, C, D As the food is manipulated and broken down, it is moistened by saliva secreted by three major pairs of salivary glands: the parotid, submandibular, and sublingual glands. The parietal gland is not a salivary gland. The pituitary gland is not salivary.

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Pathophysiology 6th Edition Banasik Test Bank Chapter 36: Gastrointestinal Disorders Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. Which symptom suggests the presence of a hiatal hernia? a. Nausea b. Heartburn c. Diarrhea d. Abdominal cramps ANS: B Individuals with hiatal hernia are predisposed to GERD and may experience symptoms such as heartburn, chest pain, and dysphagia. Nausea and abdominal cramps are not symptoms that suggest hiatal hernia. Hiatal hernia is not manifested by diarrhea.

2. Proton pump inhibitors may be used in the management of peptic ulcer disease to a. increase gastric motility. b. inhibit secretion of pepsinogen. c. neutralize gastric acid. d. decrease hydrochloric acid (HCl) secretion.

ANS: D Proton pump inhibitors are generally given to block acid secretion in individuals with peptic ulcer disease. The major treatment objectives for PUD are to encourage healing of the injured mucosa by reducing gastric acidity and to prevent recurrence. Proton pump N Rs e I G B.C M inhibitors are not used to inhiUbit S c rNe t i oTn of pepOsinogen. Gastric acid is not neutralized by the use of proton pump inhibitors.

3. Epigastric pain that is relieved by food is suggestive of a. pancreatitis. b. cardiac angina. c. gastric ulcer. d. dysphagia.

ANS: C Manifestations of peptic ulcer disease include epigastric burning pain that is usually relieved by the intake of food (especially dairy products) or antacids. Pancreatitis is not manifested by epigastric pain. Epigastric pain is not a symptom of cardiac angina. Dysphagia is not associated with epigastric pain relieved by food.

4. The most common cause of mechanical bowel obstruction is a. volvulus. b. intussusception. c. adhesions. d. fecal impaction.

ANS: C

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Pathophysiology 6th Edition Banasik Test Bank The most frequent contributing factors for bowel obstructions are previous abdominal surgery with adhesions and congenital abnormalities of the bowel. Intestinal obstruction can be caused by volvulus. Intussusception can be related to bowel obstruction, but the most common cause is surgical adhesions. Mechanical bowel obstructions can be related to fecal impaction, but this is not the most common cause.

5. Acute right lower quadrant pain associated with rebound tenderness and systemic signs of inflammation are indicative of a. appendicitis. b. peritonitis. c. cholecystitis. d. gastritis.

ANS: A The earliest manifestation of appendicitis is generalized periumbilical pain accompanied by nausea and, occasionally, diarrhea. The pain is often described as “migrating” or localizing to the lower right abdomen (McBurney’s point) because of distention of the serosa from inflammatory edema, at which time fever usually manifests. Acute localized pain with rebound tenderness is not associated with peritonitis. Cholecystitis is not manifested by lower quadrant pain. Gastritis is not associated with symptoms of right lower quadrant pain and systemic inflammation.

6. A silent abdomen 3 hours after bowel surgery most likely indicates a. peritonitis. b. mechanical bowel obstruction. c. perforated bowel. d. functional bowel obst r uNctUi oRn S . INGTB.COM ANS: D Functional obstruction or ileus refers to the loss of propulsive ability by the bowel and may occur after abdominal surgery or in association with hypokalemia, peritonitis, severe trauma, spinal fractures, ureteral distention, and the administration of medications such as narcotics. Peritonitis may be associated with functional obstruction. Mechanical obstructions are because of adhesions, hernia, tumors, impacted feces, volvulus (twisting), or intussusception (telescoping). Perforated bowel is a rare condition sometimes associated with Crohn disease.

7. Ulcerative colitis is commonly associated with a. bloody diarrhea. b. malabsorption of nutrients. c. fistula formation between loops of bowel. d. inflammation and scarring of the submucosal layer of the bowel.

ANS: A Ulcerative colitis (inflammation and ulceration of the colon and rectal mucosa) is manifested as bloody diarrhea and abdominal pain. Ulcerative colitis is not associated with malabsorption of nutrients. Fistula formation in the bowel is related to Crohn disease. Acute inflammation of the intestinal wall may manifest as pseudomembranous enterocolitis or necrotizing enterocolitis.

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Pathophysiology 6th Edition Banasik Test Bank 8. An early indicator of colon cancer is a. rectal pain. b. bloody diarrhea. c. a change in bowel habits. d. jaundice.

ANS: C The manifestations of colon cancer depend on the anatomic location and function of the bowel segment containing the tumor. Early manifestations may include a change in bowel habits. Later in the progression of tumor growth, a sensation of rectal fullness and a dull ache may be felt in the rectum or sacral region. Although no signs of obstruction are present, black, tarry stools, which signify bleeding into the intestinal lumen, are a significant finding.

Jaundice is not an early indicator of colon cancer.

9. A patient who should be routinely evaluated for peptic ulcer disease is one who is a. taking six to eight tablets of acetaminophen per day. b. being treated with high-dose oral glucocorticoids. c. experiencing chronic diarrhea. d. routinely drinking alcoholic beverages.

ANS: B Glucocorticoids released in response to stress may have a role in the promotion of excess acid production or the destruction of gastric mucosal defenses. Therefore, a patient taking high-dose glucocorticoids would be at higher risk of developing peptic ulcer disease.

Acetaminophen is not a risk factor for development of peptic ulcer disease. Chronic diarrhea is not a symptom of peptic ulcer disease. There is little evidence of a pathogenic role for alcohol, spicy foods, and c aNf f e iRn e iI n t hGe deBv. elC opmMent of peptic ulcer disease.

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O

10. Celiac sprue is a malabsorptive disorder associated with a. inflammatory reaction to gluten-containing foods. b. megacolon at regions of autonomic denervation. c. ulceration of the distal colon and rectum. d. deficient production of pancreatic enzymes.

ANS: A Celiac disease (also called celiac sprue) is characterized by intolerance of gluten, a protein in wheat and wheat products. Current research suggests that celiac sprue is an immune disorder. The main pathologic finding is villus atrophy, with a decrease in the activity and amount of surface epithelial enzymes. Celiac sprue is not associated with ulceration of the distal colon and rectum. Celiac disease is an intolerance of gluten.

11. What clinical finding would suggest an esophageal cause of a client’s report of dysphagia? a. Nasal regurgitation b. Airway obstruction with swallowing c. Chest pain during meals d. Coughing when swallowing ANS: C

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Pathophysiology 6th Edition Banasik Test Bank Two types of pain occur in the esophagus: (1) heartburn (also called pyrosis) and (2) pain located in the middle of the chest, which may mimic the pain of angina pectoris. Heartburn is caused by the reflux of gastric contents into the esophagus and is a substernal burning sensation that may radiate to the neck or throat. A person experiencing pharyngeal contractions may cough and expel the ingested food or fluids through their mouth and nose or aspirate when they attempt to swallow. Airway obstruction with swallowing would be an oropharyngeal cause of dysphagia. A person experiencing pharyngeal contractions may cough and expel the ingested food or fluids through his or her mouth and nose or aspirate when he or she attempts to swallow.

12. Barrett esophagus is a a. gastrin-secreting lesion. b. preneoplastic lesion. c. benign condition. d. gastrin-secreting tumor.

ANS: B Barrett esophagus is a complication of chronic GERD and represents columnar tissue replacing the normal squamous epithelium of the distal esophagus. It carries a significant risk for esophageal cancer. Patients with Barrett esophagus should undergo regular endoscopic screening for cancer, along with pharmacologic control of their reflux. Barrett esophagus carries a significant risk for esophageal cancer and does not secrete gastrin.

13. What finding should prompt further diagnostic testing in a child presenting with diarrhea? a. Periumbilical discomfort b. Greenish, watery diarrhea c. Frequent, large-volumeNdia URrrhe S IaN GTB.COM d. Blood and mucus in the stools ANS: D Both ulcerative colitis and Crohn disease have their onset most commonly in childhood and young adulthood, with obviously profound implications. Stools may contain blood or mucus. Periumbilical discomfort, watery diarrhea, and frequent, large-volume diarrhea are not causes for further diagnostic testing.

14. Fecal leukocyte screening would be indicated in a patient with suspected a. lactose intolerance. b. enterocolitis. c. laxative abuse. d. giardiasis.

ANS: B Enterocolitis is manifested by diarrhea (often bloody), abdominal pain, fever, leukocytosis, and rarely, colonic perforation. Lactose intolerance would not be a cause of leukocytosis.

Leukocyte screening would not be a factor in laxative use or abuse. Suspected giardiasis would not be a reason to screen fecal leukocytes.

15. What finding would rule out a diagnosis of irritable bowel syndrome in a patient with chronic diarrhea? a. Negative stool leukocytes

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Pathophysiology 6th Edition Banasik Test Bank b. Intermittent constipation c. Abdominal pain and distention d. Bloody stools ANS: D Bloody stools are not a symptom of irritable bowel syndrome. A person with irritable bowel syndrome would have negative stool leukocytes. The manifestations of IBS may vary greatly, with some persons experiencing only diarrhea or constipation and others experiencing an alternating pattern of both. In addition to cramping abdominal pain, manifestations such as nausea and mucus in the stool may also be present.

16. An urgent surgical consult is indicated for the patient with acute abdominal pain and a. vomiting. b. CVA tenderness. c. absent bowel sounds. d. borborygmi.

ANS: C Functional bowel obstructions are characterized by the absence of bowel sounds.

Uncorrected obstruction may lead to intestinal wall edema, ischemia, and necrosis.

Vomiting with abdominal pain is not a cause for urgent surgical consult. CVA tenderness in the presence of abdominal pain is not an indicator for urgent surgical consult. Acute abdominal pain with hyperactive bowel sounds does not indicate the need for an urgent surgical consultation.

17. Constipation in an elderly patient can be best treated by a. maintaining a low-fiberNdieR t. I G B.C M b. maintaining the current l eUvel Sof aNct i vTi t y. O c. fecal disimpaction. d. increasing fiber in the diet.

ANS: D The presence of cellulose, the carbohydrate component of dietary fiber that is indigestible in the human intestine, may be effective in promoting regular peristaltic movement in the GI tract by forming bulk within the intestinal lumen to stimulate propulsion. Dietary factors, particularly a diet low in fiber, have been shown to contribute to constipation. In elderly persons, the slowed rate of peristalsis that occurs with the aging process, coupled with a decreased level of physical activity, may promote chronic constipation. These factors may eventually contribute to the development of fecal impaction, a condition in which a firm, immovable mass of stool becomes stationary in the lower GI tract.

18. A patient receiving chemotherapy may be at greater risk for development of a. gastroesophageal reflux. b. stomatitis. c. esophageal varices. d. Mallory-Weiss syndrome.

ANS: B

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Pathophysiology 6th Edition Banasik Test Bank Stomatitis is defined as an ulcerative inflammation of the oral mucosa that may extend to the buccal mucosa, lips, and palate. Among its many causes are pathogenic organisms, including bacteria and viruses; mechanical trauma; exposure to such irritants as alcohol, tobacco, and other chemical substances; certain medications, particularly chemotherapeutic agents. Gastroesophageal reflux disease is not related to chemotherapy. Patients taking chemotherapy are not at greater risk for developing esophageal varices. Chemotherapy is not a risk factor for Mallory-Weiss syndrome.

19. Esophageal varices represent a complication of a. primary b. pregnancy-induced c. portal d. secondary

hypertension.

ANS: C Esophageal varices represent a complication of portal hypertension, which in Western society is generally the result of cirrhosis as a result of alcoholism or viral hepatitis. Primary hypertension is not manifested by esophageal varices. Pregnancy-induced hypertension is unrelated to esophageal varices. Esophageal varices are not a complication of secondary hypertension.

20. A patient with chronic gastritis would likely be tested for a. Helicobacter pylori. b. occult blood. c. lymphocytes. d. herpes simplex.

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U S N T O ANS: A It is now known that H. pylori causes chronic, superficial gastritis in virtually all infected persons. Once established in the gastric mucosa, H. pylori sets up a destructive pattern of persistent inflammation. The presence of bloody stools is not generally seen in chronic gastritis. Lymphocytes are not tested in the presence of chronic gastritis. Herpes simplex is not a manifestation of chronic gastritis.

21. Rupture of esophageal varices is a complication of cirrhosis with portal hypertension and carries a high rate. a. cure b. morbidity c. insurance d. mortality ANS: D Rupture of esophageal varices is a dreaded complication of cirrhosis with portal hypertension and carries a high mortality rate. Rupture of esophageal varices does not carry a high cure rate. Varices will affect more than half of cirrhotic patients, and approximately 30% of them experience an episode of variceal hemorrhage within 2 years of the diagnosis of varices. Insurance is not a factor in the rupture of esophageal varices.

22. Premature infants are at greater risk for developing a. necrotizing enterocolitis.

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Pathophysiology 6th Edition Banasik Test Bank b. pseudomembranous colitis. c. appendicitis. d. diverticular disease.

ANS: A Necrotizing enterocolitis (NEC) is a disorder occurring most often in premature infants (less than 34 weeks’ gestation) and infants with low birth weight (less than 5 lbs or 2.25 kg). This disorder is characterized by diffuse or patchy intestinal necrosis accompanied by sepsis.

Pseudomembranous colitis is an acute inflammation and necrosis of the large intestine caused by Clostridium difficile, usually affecting the mucosa but sometimes extending to other layers. The most common cause of emergency surgery on the abdomen, appendicitis is an inflammation of the vermiform appendix. The prevalence of diverticular disease increases with age.

23. Dumping syndrome is commonly seen after a. appendectomy b. intestinal biopsy c. colonoscopy d. gastric bypass

procedures.

ANS: D Dumping syndrome is a term used to describe the literal dumping of stomach contents into the proximal portion of the small intestine because of impaired gastric emptying.

Interestingly, dumping seems to occur only with Roux-en-Y gastric bypass procedures.

Dumping syndrome is not related to procedures involving appendectomy. Intestinal biopsies do not produce a dumping effect. Colonoscopies are not related to dumping syndrome.

MULTIPLE RESPONSE

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1. A disorder of the esophageal smooth muscle function where dysphagia is a symptom is (Select all that apply.) a. esophageal stricture. b. achalasia. c. esophageal tumors. d. Mallory-Weiss syndrome. e. hiatal hernia.

ANS: A, B, C Esophageal stricture, achalasia, and esophageal tumors are all disorders of the esophageal smooth muscle function that cause dysphagia. Manifestations of Mallory-Weiss syndrome include vomiting of blood and passing of large amounts of blood rectally after an episode of forceful vomiting. Hiatal hernia is a defect of the diaphragm, not the esophagus, even though hiatal hernia is associated with dysphagia.

2. Crohn disease is associated with what complications? (Select all that apply.) a. Perianal fissures b. Fistulae c. Green stool d. Abscesses e. Rectal pain

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Pathophysiology 6th Edition Banasik Test Bank

ANS: A, B, D Complications such as perianal fissures, fistulae, and abscesses are common in Crohn disease and may be the symptoms that lead individuals to seek health care. The stool may be bloody, and thus would be red or black, not green. In Crohn disease, abdominal pain is often constant and in the right lower quadrant of the abdomen.

3. What is a pathophysiologic mechanism involved in the development of diarrhea? (Select all that apply.) a. Osmotic diarrhea b. Excessive flatus c. Secretory diarrhea d. Exudative diarrhea e. Motility disturbances ANS: A, C, D, E Osmotic diarrhea is because of increased amounts of poorly absorbed solutes in the intestine. Secretory diarrhea is usually because of toxins that stimulate intestinal fluid secretion and impair absorption. Exudative diarrhea (mucus, blood, protein) results from inflammatory processes. A decreased transit time in the small intestine results in diarrhea because the absorptive capacity of the large intestine is exceeded. Excessive gas in the intestine is not a mechanism for developing diarrhea.

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Pathophysiology 6th Edition Banasik Test Bank Chapter 37: Alterations in Function of the Gallbladder and Exocrine Pancreas Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. Normal bile is composed of a. water, electrolytes, and organic solutes. b. proteins. c. bile acids. d. phospholipids.

ANS: A Normal bile is composed primarily of water, electrolytes, and organic solutes. Bile has a low protein content. The low amount of protein in bile contains bile acids, pigment, cholesterol, and phospholipids. Phospholipids are part of the low protein content in bile.

2. Patients with acute pancreatitis are generally made NPO and may require continuous gastric suctioning in order to a. prevent abdominal distention. b. remove the usual stimuli for pancreatic secretion. c. prevent hyperglycemia associated with loss of insulin secretion. d. prevent mechanical obstruction of the intestine.

ANS: B Conservative management is indicated for mild to moderate cases of acute pancreatitis. In general, withholding oral feedings, providing nasogastric suction, and providing careful N RdsIaNrGe i T B.C M volume replacement with IV UfluiS n dicatedO. Gastric suctioning is not indicated for preventing abdominal distention. Hyperglycemia is not influenced by the presence of gastric suctioning. Continuous gastric suctioning may be used in the presence of a significant ileus.

3. Most gallstones are composed of a. bile. b. cholesterol. c. calcium. d. uric acid salts.

ANS: B The majority of gallstones among patients are cholesterol stones. Cholesterol eventually precipitates from supersaturated bile. Most gallstones are not composed of calcium. Uric acid salts are not the primary composition of gallstones.

4. Elevated serum lipase and amylase levels are indicative of a. gallbladder disease. b. appendicitis. c. pancreatitis. d. peritonitis.

ANS: C

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Pathophysiology 6th Edition Banasik Test Bank The laboratory evaluation of acute pancreatitis begins with measurements of serum pancreatic enzymes. Serum lipase and amylase levels rise more or less in tandem. Elevated serum lipase and amylase levels are not indicative of gallbladder disease. Appendicitis is not related to lipase and amylase levels. Peritonitis is not caused by elevated serum lipase or amylase levels.

5. The definitive treatment for cholecystitis is a. lithotripsy of stones. b. chemical dissolution of stones. c. antibiotics and anti-inflammatories. d. cholecystectomy.

ANS: D Surgical removal of the gallbladder is the definitive treatment for cholecystitis.

Laparoscopic cholecystectomy is now the treatment of choice for symptomatic gallstones.

Extracorporeal shock wave lithotripsy (ESWL), which involves the breaking up of gallstones using shock waves, is a nonsurgical approach which could lead to recurrence of stones. Chemodissolution of stones has a low overall efficacy. Antibiotics are generally used with acute cholecystitis if infection is involved.

6. A biliary cause of acute pancreatitis is suggested by an elevation in which serum laboratory results? a. Lipase b. Amylase c. Glucose d. Alkaline phosphatase

N R I G B.C M

U S N T O ANS: D Marked elevation of the alkaline phosphatase and bilirubin levels suggest the possibility of biliary disease or obstruction, particularly by gallstones. Elevated serum lipase levels and elevated glucose levels do not suggest a biliary cause of pancreatitis. Acute pancreatitis is evidenced by elevated serum amylase and lipase levels, but does not indicate biliary disease.

7. A patient with pancreatitis may experience muscle cramps secondary to a. alkalosis. b. hyperglycemia. c. hypocalcemia. d. hypermagnesemia.

ANS: C Associated laboratory findings of acute pancreatitis include leukocytosis, hyperlipidemia, and hypocalcemia. Alkalosis is not associated with pancreatitis. Hyperglycemia would not be a cause for muscle cramps. Hypermagnesemia is not generally related to pancreatitis.

8. Chronic pancreatitis may lead to a. diabetes mellitus. b. Crohn disease. c. gallstones. d. celiac sprue.

ANS: A

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Pathophysiology 6th Edition Banasik Test Bank About 10% to 15% of patients will present not with pain, but rather with the sequelae of chronic pancreatitis, including diabetes mellitus, malabsorption, and weight loss. Chronic pancreatitis does not lead to Crohn disease. Increased incidence of gallstones is not the result of chronic pancreatitis. Celiac sprue is not related to chronic pancreatitis.

9. The most challenging aspect of treatment for chronic pancreatitis is a. pancreatectomy. b. strict dietary avoidance of fats. c. abstinence from alcohol. d. pain control.

ANS: D The treatment for chronic pancreatitis is directed toward pain control, exocrine and endocrine insufficiency, and management of complications. By far the most challenging is the management of pain. If endoscopic management fails or is not appropriate in a given patient, surgery may be indicated. Management of exocrine insufficiency can usually be accomplished with low-fat diets. Absolute abstention from alcohol is paramount to prevent worsening of symptoms.

10. The finding of hypotension, rigid abdomen, and absent bowel sounds in a patient with pancreatitis a. is an expected finding and requires no specific intervention. b. indicates peritonitis with substantial risk for sepsis and shock. c. requires immediate surgical intervention. d. is an unusual finding in pancreatitis and indicates misdiagnosis.

ANS: B NURSINGTB.COM In acute pancreatitis, fever is common but is usually low-grade initially. In more severe pancreatitis, hypotension, rigid abdomen, and absent bowel sounds are present.

Hypotension, rigid abdomen, and absent bowel sounds are unexpected findings. Pancreatic surgery is technically challenging and risky, and generally is only considered as a last resort.

Findings indicative of peritonitis do occur and should be treated promptly.

11. It is true that gallstones are a. a minimal risk for Native Americans. b. more common in women. c. more common in men. d. at highest risk among Asians.

ANS: B Gallstones are twice as common in women as in men. Native Americans, particularly the Pima Indians of North America, are markedly susceptible to gallstones. Gallstones are twice as common in women than in men. European Caucasians are intermediate in prevalence, and persons of Asian descent are at the lowest risk.

12. Untreated acute cholecystitis may lead to a. gangrene b. infection c. distention d. inflammation

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of the gallbladder wall.

Pathophysiology 6th Edition Banasik Test Bank ANS: A If left untreated, the inflammatory process often escalates, and gangrene of the gallbladder wall with rupture may occur. Acute cholecystitis is defined as acute inflammation of the gallbladder wall. Distention of the gallbladder wall is not a risk factor related to untreated cholecystitis. Acute cholecystitis is defined as acute inflammation of the gallbladder wall.

13. It is true that biliary cancer a. is most often cured by surgery. b. respond well to chemotherapy. c. are identifiable and treatable when diagnosed early. d. tend to be asymptomatic and progress insidiously.

ANS: D Biliary cancers tend to be asymptomatic and progress insidiously until well advanced.

Surgery for cure is a treatment option in fewer than 10% of cases. Chemotherapy and radiation therapy are indicted for palliation, and certain patients may benefit from stenting and other procedures to alleviate biliary obstruction. Cancers of the biliary system are relatively rare, accounting for only 1 to 2 cases per 100,000 per year. Unfortunately, they tend to be asymptomatic and progress insidiously until well advanced.

14. More than half of the initial cases of pancreatitis are associated with a. trauma. b. stones. c. alcoholism. d. high cholesterol.

ANS: C NURSINGTB.COM Up to 66% of first cases of pancreatitis are associated with alcoholism. Trauma is a possible mechanism for acinar cell injury. A prominent factor in pancreatitis is obstruction of the pancreatic duct by a stone. Hypertriglyceridemia is a predisposing factor for pancreatitis in the United States.

15. Narcotic administration should be administered carefully in patients with acute pancreatitis related to potential for a. respiratory depression. b. narcotic dependency. c. sphincter of Oddi dysfunction. d. allergic reaction.

ANS: C All narcotics should be used carefully because of the potential of sphincter of Oddi dysfunction, although recent studies show that no single agent is contraindicated.

Respiratory failure related to adult respiratory distress syndrome is a risk factor with severe pancreatitis. Narcotic dependency should not be a concern with acute pancreatitis. While patients should always be assessed for allergies, this is not the primary concern.

16. The pain associated with chronic pancreatitis is generally described as a. sharp and constant b. steady and boring c. intermittent and burning

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in nature.

Pathophysiology 6th Edition Banasik Test Bank d. intermittent and stabbing ANS: B The pain is often accompanied by nausea and is steady and boring in nature. The pain is usually located in the upper abdomen, particularly in the epigastrium, and radiates to the back in more than half of cases. Pain associated with pancreatitis is most often steady in nature. The pain of chronic pancreatitis is often the major form of debility. Nerve fibers from the pancreas pass to the celiac plexus and then to spinal sympathetic ganglia.

MULTIPLE RESPONSE 1. Patients who may be at risk for development of cholesterol gallstones include (Select all that apply.) a. high spinal cord injuries. b. patients receiving total parenteral nutrition. c. patients receiving chemotherapy. d. patients with rapid weight loss. e. pregnant women.

ANS: A, B, D, E A significant factor that promotes the continued growth of stones is hypomotility or stasis of bile within the gallbladder. Patients with high spinal cord injuries, patients receiving total parenteral nutrition, and persons who undergo prolonged fasting or rapid weight loss have impaired emptying and are at particular risk for development of cholesterol gallstones.

Other risk factors for cholelithiasis include pregnancy, oral contraceptives, obesity, and diabetes mellitus. Patients receiving chemotherapy are not at greater risk for developing gallstones.

NURSINGTB.COM 2. Chronic cholecystitis can lead to (Select all that apply.) a. biliary sepsis. b. calcified gallbladder. c. porcelain gallbladder. d. cirrhosis. e. diabetes mellitus.

ANS: A, B, C Chronic cholecystitis may lead to biliary sepsis, as well as a specific type of scarring known as a calcified or porcelain gallbladder. Chronic cholecystitis is associated with a higher risk of cancer, not cirrhosis which affects the liver. Diabetes mellitus is a predisposing factor of chronic cholecystitis. Chronic cholecystitis does not cause diabetes mellitus.

3. Which digestive enzyme is secreted from the intestinal mucosa during a meal? (Select all that apply.) a. Amylase b. Cholecystokinin c. Trypsinogen d. Lecithin e. Lipase f. Secretin

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Pathophysiology 6th Edition Banasik Test Bank ANS: B, F The release of digestive enzymes during a meal is controlled by hormones secreted from the small intestinal mucosa: cholecystokinin (CCK) and secretin. The juices themselves are composed of both active digestive enzymes (e.g., amylase, lipase) and precursor or proenzymes (e.g., trypsinogen). Trypsinogen is a proenzyme. Lecithin is unrelated to hormone release during meals.

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Pathophysiology 6th Edition Banasik Test Bank Chapter 38: Liver Diseases Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. Jaundice is a common manifestation of a. malabsorption syndromes. b. anemia. c. liver disease. d. cholecystitis.

ANS: C Jaundice results from impaired bilirubin metabolism and is one of the most characteristic signs of liver disease. Malabsorption syndromes are not manifested by jaundice. Anemia is not manifested by jaundice. Jaundice is not a common manifestation of cholecystitis.

2. Pathophysiologically, esophageal varices can be attributed to a. elevated bilirubin. b. diminished protein metabolism. c. fluid accumulation. d. portal hypertension.

ANS: D Esophageal varices result mainly from portal hypertension, which in Western society is generally the result of cirrhosis because of the chronic effects of alcoholism or viral hepatitis. Elevated bilirubin is not attributed to esophageal varices. Diminished protein N Ro es INoph G Tageal B.C vM Oarices. Increased vascular resistance in the metabolism does not contribuUte tS liver plays a prominent role in the formation of variceal esophageal veins.

3. Hepatitis B is usually transmitted by exposure to a. hepatitis vaccine. b. feces. c. blood or semen. d. contaminated food.

ANS: C Hepatitis B virus is highly prevalent worldwide. It is spread by parenteral contact with infected blood or blood products, including contaminated needles. HBV vaccine is a recombinant vaccine that is highly immunogenic. After the full course, the antibody response rate is 95% for normal hosts. Hepatitis A is spread by the fecal–oral route.

Hepatitis E is spread through contaminated water.

4. Hepatic encephalopathy is associated with a. hyperbilirubinemia. b. hyperuricemia. c. toxic effects of alcohol on brain cells. d. increased blood ammonia levels.

ANS: D

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Pathophysiology 6th Edition Banasik Test Bank Hepatic encephalopathy is associated with liver failure or liver disease. It is positively correlated with elevated arterial ammonia levels. Hyperbilirubinemia is not related to hepatic encephalopathy but is associated with hypokalemia, hyponatremia, alkalosis, hypoxia, and hypercarbia. Hyperuricemia is not associated with hepatic encephalopathy.

Hepatic encephalopathy is a complex neuropsychiatric syndrome characterized by symptoms ranging from mild confusion and lethargy to stupor and coma.

5. An increased urine bilirubin is associated with a. an increased indirect serum bilirubin. b. hemolytic reactions. c. Gilbert syndrome. d. hepatitis.

ANS: D In the presence of liver disease, the hepatic fraction of bilirubin decreases and the urinary fraction increases, thus accounting for a rise in urinary urobilinogen seen with liver dysfunction and hepatitis. An increase in indirect serum bilirubin is a sign of liver disease.

Hemolytic reactions do not cause an increase in urine bilirubin. Disorders of the bile acid transport will cause an increase in serum bilirubin.

6. Liver transaminase elevations in which aspartate aminotransferase (AST) is markedly greater than alanine aminotransferase (ALT) is characteristic of a. viral hepatitis. b. alcohol-induced injury. c. cirrhosis. d. acetaminophen toxicity.

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U S N T O ANS: B Alcoholic and other toxic hepatitides virtually always show the aspartate aminotransferase (AST) markedly elevated in comparison with the alanine aminotransferase (ALT). In viral hepatitis, the alanine aminotransferase (ALT) is markedly higher than the aspartate aminotransferase (AST). Jaundice in patients with cirrhosis often shows elevations in all parameters, reflecting the widespread liver dysfunction and obstruction of the bile canals and small vessels because of scarring. Acetaminophen toxicity will cause signs of hepatic injury within 24 to 48 hours, including abnormal liver enzyme levels.

7. A viral hepatitis screen with positive hepatitis B surface antigen (HBsAg) should be interpreted as hepatitis B. a. recovered from b. immunity to c. chronic active d. acute ANS: D With acute infection HBV core antigen (HBcAg) appears first, followed by seroconversion to core antibody (HBcAb). Presence of HBV surface antigen (HBsAg) indicates active infection. Conversion from surface antigen to surface antibody positivity can take as long as 1 year after acute infection. Development of surface antibody (HBsAb) points to resolution and immunity. In chronic infection, hepatitis B e antigen (HBeAg) is associated with viral replication and infectivity.

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Pathophysiology 6th Edition Banasik Test Bank

8. What laboratory data would support a diagnosis of hemochromatosis? a. Deficient protease inhibitor b. Elevated ferritin c. Elevated urine copper d. Positive antinuclear antibody ANS: B Serum iron and ferritin studies are performed to diagnose hemochromatosis. Protease inhibitor is not used to diagnose hemochromatosis. Copper in the urine is not indicative of hemochromatosis. Antinuclear antibody is not diagnostic of hemochromatosis.

9. What form of viral hepatitis is likely to be transmitted sexually? a. Hepatitis A b. Hepatitis B c. Hepatitis C d. Hepatitis E ANS: B Hepatitis B is spread by parenteral contact with infected blood or blood products, including contaminated needles, and by sexual contact. Hepatitis A virus (HAV) is usually spread by the fecal–oral route. The mode of transmission of hepatitis C closely resembles that of HBV, although sexual and perinatal transmission is much less likely. The majority of infections were acquired through IV drug abuse. Hepatitis E is an RNA virus spread via the fecal–oral route, especially through contaminated water.

10. Brain injury secondary to hNigh RseruIm bGilirB ub.inCis M called a. hepatic encephalopathy. U S N T O b. hepatic meningitis. c. kernicterus. d. encephalitis.

ANS: C Kernicterus refers to brain injury as a result of hyperbilirubinemia. It is a serious complication of the neonatal period, generally occurring in the setting of premature birth, neonatal jaundice, and especially hemolytic disease of the newborn. Hepatic encephalopathy is typically characterized by high ammonia levels in the blood. Meningitis is not associated with high serum bilirubin levels. Encephalitis may accompany viral hepatitis in children, but is not related to high serum bilirubin levels.

11. The most common causes of prehepatic jaundice are erythropoiesis. a. hemolysis b. metabolism c. fibrosis d. canalicular bilirubin transport ANS: A

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and ineffective

Pathophysiology 6th Edition Banasik Test Bank The most common causes of prehepatic jaundice are hemolysis and ineffective erythropoiesis. The reabsorption of large hematomas in patients with mild liver disease is a frequent and harmless cause of mild jaundice. Dysfunction of each of the hepatic steps in bilirubin metabolism may cause jaundice. Increased resistance from fibrosis may cause jaundice in the cholestatic pathway. At the canalicular posthepatocytic level, jaundice may occur as a result of conjugated hyperbilirubinemia.

12. A patient with a history of alcoholism presents with hematemesis and profound anemia. The expected diagnosis is a. ascites. b. cerebral edema. c. hepatic encephalopathy. d. gastroesophageal varices.

ANS: D Esophageal varices primarily result from portal hypertension because of chronic alcoholism or hepatitis. Initial symptoms are bleeding, anemia, and shock. Ascites is an accumulation of fluid in the abdominal cavity. Cerebral edema is swelling of the brain related to hepatic encephalopathy. Hepatic encephalopathy does not cause symptoms related to bleeding.

13. A patient admitted with bleeding related to esophageal varices could be expected to receive a continuous intravenous infusion of a. glucose. b. octreotide acetate. c. anticoagulants. d. proton pump inhibitors.

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U S N T O ANS: B Pharmacologic management is used to lower portal pressure by dilating collateral pathways and reducing splanchnic blood flow. Controlling bleeding is often accomplished using vasopressin, but side effects limit its use. Recently, octreotide acetate, a synthetic analog of the naturally occurring hormone somatostatin, has been effectively used as a replacement for vasopressin. Fluid resuscitation is carried out using normal saline. Anticoagulants are contraindicated in a patient with active bleeding. Intravenous proton pump inhibitors may be used, but not as a continuous infusion.

14. A patient being treated for hepatic encephalopathy could be expected to receive a(n) diet. a. low-protein and high-fiber b. high-protein and high-carbohydrate c. high-sodium d. unrestricted ANS: A Restriction of protein is indicated for chronic encephalopathy, along with enhanced elimination of toxic nitrogenous substances. High fiber intake may help decrease constipation. As ammonia levels drop, protein is reintroduced into the diet. When protein is restricted, carbohydrate levels should be at least 400 g. Excessive levels of sodium in the diet are contraindicated with renal insufficiency. Dietary restrictions are utilized in patients with hepatic encephalopathy.

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Pathophysiology 6th Edition Banasik Test Bank

15. An infusion of mannitol would be prescribed to treat a. varices. b. encephalopathy. c. peritonitis. d. cerebral edema.

ANS: D Cerebral edema is managed primarily by the intravenous infusion of mannitol, which by increasing serum osmolarity draws water from the brain and thus reduces the swelling.

Octreotide acetate is used in the management of varices. Hepatic encephalopathy would be treated with lactulose. Peritonitis is managed with the use of antimicrobial agents.

16. Hepatitis with the presence of autoantibodies and positive antinuclear antibodies (ANA) is a. hepatitis D. b. autoimmune hepatitis. c. hepatitis A. d. hepatitis B. ANS: B Autoimmune hepatitis is characterized by the presence of several autoantibodies as well as a polyclonal hypergammaglobulinemia. Antinuclear antibody (ANA) is generally positive at a high level. The diagnosis of hepatitis D is by anti-HDV IgM and IgG enzyme-linked immunosorbent assays. HAV infection is diagnosed through serologic testing. Presence of anti-HAV immune globulin G (IgG) indicates previous infection, and presence of immune globulin M (IgM) indicates acute infection. The serologic diagnosis for hepatitis B is complicated.

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17.

disease is a rare autosomal recessive disorder in which excessive amounts of copper accumulate in the liver. a. Kayser-Fleischer b. Wilson c. Reye d. Byler ANS: B Wilson disease, or hepatolenticular degeneration, is a rare autosomal recessive disorder in which excessive amounts of copper accumulate in the liver and other organs. As with hereditary hemochromatosis, it has now been linked to a specific abnormal protein, ATP7B, which results in retention of copper in the liver. Clinical signs and symptoms of Wilson disease include the presence of Kayser-Fleischer rings on the cornea. Reye syndrome is characterized by fatty infiltration of the liver with severe hepatic dysfunction, including encephalopathy, coagulopathy, and elevated levels of hepatocellular enzymes. Byler syndrome is caused by a single-gene mutation and traces back to an Amish kindred.

18. Steatohepatitis is caused by an accumulation of a. fat b. bile c. acetaminophen d. ferritin

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in the liver cells.

Pathophysiology 6th Edition Banasik Test Bank ANS: A Alcoholic fatty liver (alcoholic steatohepatitis) is an accumulation of fat in the liver cells. It is caused by more fat being delivered to the hepatocyte than it can normally metabolize or by a defect in fat metabolism within the cell. An accumulation of bile does not contribute to steatohepatitis. Steatohepatitis is not related to an accumulation of acetaminophen levels.

Serum ferritin levels are elevated in patients with hereditary hemochromatosis.

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Pathophysiology 6th Edition Banasik Test Bank Chapter 39: Endocrine Physiology and Mechanisms of Hypothalamic-Pituitary Regulation Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. It is true that lipid-soluble hormones are a. transported in a free state in the bloodstream. b. bound to receptors on the plasma membranes of target cells. c. diffused through cell membranes to activate intracellular receptors. d. activated by second-messenger cascades within the target cell.

ANS: C Once formed, lipid-soluble hormones simply diffuse through the plasma membrane and into the circulation. Lipid-soluble hormones are diffused through the plasma membrane for release into the circulation. Lipid-soluble hormones are not bound to receptors for release to target cells. Second-messenger cascades are not required for activation of lipid-soluble hormones.

2. An example of a lipid-soluble hormone is a. catecholamine. b. thyroid hormone. c. peptide hormone. d. pituitary hormone.

ANS: B Thyroid hormones are lipid-soluble. Catecholamines and peptide hormones are N R I G B.C Mo m the pituitary gland. water-soluble. Peptide hormoUnesSareNreleTased f rO 3. An example of a secondary endocrine disorder is a. pituitary hyposecretion of TSH. b. adrenal insufficiency following adrenalectomy. c. congenital adrenal hyperplasia. d. pheochromocytoma.

ANS: A Secondary endocrine disorder occurs when secretion of a tropic hormone such as TSH or ACTH is inadequate to cause the target gland to secrete adequate amounts of hormone.

Primary hyposecretion occurs when an endocrine gland, such as the thyroid or adrenal cortex, releases an inadequate amount of hormone to meet physiologic needs. Congenital adrenal hyperplasia is an example of a hypersecretion disorder. Pheochromocytoma is not a secondary endocrine disorder.

4. Up-regulation of target cell receptors results in a. decreased target cell sensitivity to hormone. b. reduced production of hormone. c. increased target cell responsiveness to hormone. d. an increased hormone half-life.

ANS: C

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Pathophysiology 6th Edition Banasik Test Bank Up-regulation would make the cell more sensitive to the hormone, and hormone-dependent cellular activity could occur at normal or nearly normal levels despite a lower than normal hormone concentration. Down-regulation would result in decreased target cell sensitivity. A reduction in hormone production does not occur with up-regulation. Up-regulation of target cell receptors does not result in an increased hormone half-life.

5. Growth hormone has several effects on the body, including a. decreasing plasma glucose level. b. increasing lean body mass. c. enhancing deposition of fat. d. depressing immune function.

ANS: B Growth hormone binds to receptors on muscle tissue to increase muscle mass. Growth hormone slows carbohydrate utilization and does not depress immune function. Growth hormone binds to receptors on adipose tissue and decreases fat mass by inducting lipolysis.

6. Growth hormone stimulates the liver to release a. ketones. b. insulin. c. bile. d. IGF-1.

ANS: D A major target for growth hormone is the liver, where IGF-1 is released. This is an anabolic hormone that increases the growth of bone and cartilage tissues of the body. Growth hormone is an amino acid protein that is similar to prolactin. Ketones are not released in N R ulin I NGis aT B.C Mrtant co-stimulator of growth factor. Bile is response to growth hormone.UInsS n impoO not produced in response to growth hormone.

7. Most endocrine hormones are water-soluble and exert their effects on target cells by a. binding to nuclear receptors. b. generating second messengers. c. binding to intracellular receptors. d. stimulating action potentials.

ANS: B Water-soluble hormones are unable to cross the plasma membrane to enter cells and must bind to receptors located on the surface of target cell membranes. Hormones exert their actions by binding to target cell receptor proteins. Water-soluble hormones bind to receptors on the surface of the target cell membranes. Endocrine hormones do not stimulate action potentials on target cells.

8. The release of prolactin is normally inhibited by a. dopamine. b. acetylcholine. c. somatostatin. d. somatomedin.

ANS: A

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Pathophysiology 6th Edition Banasik Test Bank The prolactin-inhibiting factor is dopamine produced in the hypothalamus. Acetylcholine does not inhibit the release of prolactin. Prolactin is not inhibited by somatostatin.

Somatomedin is not a prolactin-inhibiting factor.

9. What suppresses the normal secretion of growth hormone? a. Hypoglycemia b. Somatostatin c. Somatomedin d. Amino acids ANS: B GHRH binds to receptors on pituitary somatotropes and stimulates release of growth hormone (GH), whereas somatostatin inhibits GH release. Hypoglycemia stimulates the release of growth hormone. Somatomedin is an anabolic hormone that increases the growth of bone and cartilage tissues. A rise in amino acids in the blood stimulates the release of growth hormone, as do starvation and exercise.

10. A primary endocrine disorder occurs when a. the pituitary gland oversecretes hormones. b. the pituitary gland undersecretes hormones. c. exogenous hormones suppress endogenous production. d. the target gland is unresponsive to pituitary regulation.

ANS: D Primary endocrine disorder is because of dysfunction of the target glands. Hypersecretion disorders can be primary or secondary. Abnormal tropic signals from the pituitary gland are known as secondary disorder. Hyposecretion occurs when an endocrine gland is unable to Nhorm RSonINe toGTmeet B.CpOhysiologic M release adequate amounts of U needs. Hyporesponsiveness of the target tissues will cause the same response as that of hyposecretion.

11. Which hormone is regulated by releasing and inhibiting factors from the hypothalamus? a. Oxytocin b. Vasopressin c. Adrenocorticotropic hormone (ACTH) d. Aldosterone ANS: C ACTH is produced in the anterior pituitary gland in response to hypothalamic corticotrophin-releasing hormone. Oxytocin is a hormone of the posterior pituitary gland.

Vasopressin is antidiuretic hormone which is released by nerve terminals in the posterior pituitary gland. Aldosterone is a steroid hormone produced by the adrenal cortex.

12. An increase in serum osmolality would be expected to a. increase vasopressin b. decrease vasopressin c. decrease ADH d. decrease aldosterone ANS: A

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secretion.

Pathophysiology 6th Edition Banasik Test Bank An increase in serum osmolality stimulates the release of vasopressin, also referred to as antidiuretic hormone. Tubular epithelial cells allow free diffusion of water from the tubular fluid into the cell. The enhanced reabsorption conserves water in the body, creates concentrated urine, and reduces serum osmolality. ADH secretion is stimulated by baroreceptors in response to hypovolemia. When body fluids become too concentrated, ADH is released. Aldosterone is not decreased in response to serum osmolality.

13. In primary thyroid hormone deficiency, the TSH levels are a. high. b. low. c. undetectable. d. constantly fluctuating.

ANS: A In primary hypothyroidism, serum thyroid hormone would be low, but TSH levels high, because the anterior pituitary gland would not receive negative feedback from thyroid hormone. The serum thyroid hormone level, not the TSH level, is low in primary thyroid hormone deficiency. TSH levels are detectable at a high level in primary thyroid hormone deficiency. High TSH levels, not constantly fluctuating levels, are synonymous with primary thyroid hormone deficiency.

14. Which hormone is highly bound to carrier proteins in the bloodstream? a. Thyroid hormones b. Insulin c. Glucagon d. Parathyroid hormone

N R I G B.C M

U S N T O ANS: A Thyroid hormones are carried in the circulation bound to thyroid-binding proteins. Insulin is an important stimulator of growth hormone. Glucagon is not bound to carrier proteins in the bloodstream. Parathyroid hormones are not bound to carrier proteins in the bloodstream.

15. The endocrine system closely resembles the are coordinated at the level of the hypothalamus. a. nervous b. immune c. integumentary d. lymphatic

system because many of their actions

ANS: A The nervous and endocrine systems are closely integrated, and many of their actions are coordinated at the level of the hypothalamus. Endocrine systems are suited for regulating complex functions. The integumentary system does not resemble the endocrine system. The endocrine system and the lymphatic system do not resemble each other in actions.

16. Thyroid hormones are derived from a. peptides. b. tyrosine amino acids. c. globulin. d. catecholamines.

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Pathophysiology 6th Edition Banasik Test Bank ANS: B Thyroid hormones (T3 and T4) are derived from tyrosine amino acids to which iodine has been attached. The majority of endocrine hormones are peptides and are easily transported through the circulation. Thyroid hormones require globulins to convey them through the circulation. The catecholamine hormones are dopamine, epinephrine, and norepinephrine.

17. The most common mechanism regulating hormone production and secretion is a. positive feedback. b. negative feedback. c. positive reinforcement. d. negative reinforcement.

ANS: B The most common mechanism regulating hormone production and secretion is negative feedback control. In negative feedback control, some aspect of the secreted hormone is sensed and regulates further secretion. Positive reinforcement is not related to hormone production. Hormone production is not associated with negative reinforcement.

18. The tightness of the hormone-receptor bond is known as a. specificity. b. affinity. c. half-life. d. set-point.

ANS: B Affinity describes the degree of “tightness” of the hormone-receptor bond, or the inclination of the hormone to remain bound to the receptor. Specificity refers to the molecular “fit” of a N R I G B.C M-life describes the duration of hormone hormone within a receptor b iU n d i nSg pNo c kT e t . HalfO activity in the circulation. The negative feedback loop is a mechanism for maintaining hormone activity within a normal range or set-point of normal activity.

19. a. b. c. d.

is the hormone which causes uterine and milk duct contractions.

Vasopressin Prolactin Oxytocin Antidiuretic

ANS: C Oxytocin is released during sexual activity, childbirth, and breast feeding and causes uterine and milk duct contractions. Vasopressin is an antidiuretic hormone that responds to hypovolemia and low arterial blood pressure. Prolactin is known for its effects on breast tissue development and lactation and its ability to suppress reproductive function in men and women. Antidiuretic hormone is released in response to altered serum osmolality and hypotension and causes water retention by increasing water reabsorption by the renal collecting duct.

20. Cortisol is produced in the zona a. glomerulosa b. reticularis c. fasciculata

of the adrenal cortex.

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Pathophysiology 6th Edition Banasik Test Bank d. medulla ANS: C The middle zona fasciculata produces the glucocorticoid, cortisol, in response to stimulation of ACTH from the pituitary gland. The outer zona glomerulosa produces the mineralocorticoid, aldosterone, in response to stimulation by AII. The inner zona reticularis is adjacent to the adrenal medulla and produces the androgen, DHEAS. The inner zone is adjacent to the adrenal medulla.

21. Aldosterone secretion would be expected to produce which change? a. Decrease sodium reabsorption b. Decrease urine potassium c. Decrease blood pressure d. Increase blood pressure ANS: D Aldosterone secretion increases in response to low blood pressure and reduced perfusion of the kidney, which stimulate the renin-angiotensin-aldosterone cascade. Aldosterone increases sodium and water reabsorption in the distal tubule of the kidney and promotes the excretion of potassium in the urine. Aldosterone release would promote excretion of urine potassium. Aldosterone secretion would be expected to increase blood pressure.

22. Oversecretion of ACTH occurs in a. Cushing disease. b. hyperthyroidism. c. diabetes insipidus. d. hypoglycemia.

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ANS: A In Cushing disease, the pituitary gland becomes hyperactive and oversecretes ACTH, which induces the adrenal cortex to produce too much cortisol. Hyperthyroidism is not associated with oversecretion of ACTH. Diabetes insipidus is an example of kidney tubule resistance to the effect of ADH because of defective receptors on the tubular cells. Oversecretion of ACTH does not cause hypoglycemia.

23. Which hormone is responsible for regulation of immune and inflammatory reactions? a. Thyrotropin b. Androgen c. Aldosterone d. Cortisol ANS: D Cortisol affects nearly every tissue in the body and exhibits a broad range of effects on metabolism, including increasing plasma glucose, regulating immune and inflammatory reactions, and inhibiting bone and collagen synthesis. Stress, starvation, and infection reduce the secretion of thyrotropin releasing hormone. Androgens are a part of sex steroids and bind closely to cortisol. Aldosterone secretion increases in response to low blood pressure and reduced perfusion of the kidney.

MULTIPLE RESPONSE

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Pathophysiology 6th Edition Banasik Test Bank

1. Hormones that are released from the anterior pituitary gland include (Select all that apply.) a. luteinizing hormone. b. vasopressin. c. prolactin. d. oxytocin. e. follicle-stimulating hormone.

ANS: A, C, E The major hormones released by the anterior pituitary gland are luteinizing hormone (LH), prolactin, and follicle-stimulating hormone (FSH). Oxytocin and vasopressin are synthesized in hypothalamic neurons that send axons to the posterior pituitary gland.

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Pathophysiology 6th Edition Banasik Test Bank Chapter 40: Disorders of Endocrine Function Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. It is true that growth hormone excess in adults a. results in the condition of acromegaly. b. leads to abnormally tall stature. c. is associated with hypoglycemia. d. is usually asymptomatic.

ANS: A Growth hormone excess in adults is known as acromegaly. Acromegaly in adults causes an increase in bone density. Acromegaly may be clinically subtle and occurs with equal frequency in men and women. Growth hormone in adults is not associated with hypoglycemia.

2. An increase in ADH secretion occurs in response to a. decreased serum osmolality. b. dehydration. c. hypervolemia. d. hyponatremia.

ANS: B ADH is secreted in response to changes in blood osmolality. ADH increases membrane permeability to and reabsorption of water. An increase in serum osmolality causes an N R Iu ffic GTient B.CamO Mounts of ADH, urine cannot be concentrated increase in ADH secretion. WUithSins N and free water is lost, causing hyperosmolality. Not enough salt outside the cells would not cause ADH to be secreted.

3. Antidiuretic hormone (ADH) increases a. sodium reabsorption in the distal tubule of the kidney. b. potassium secretion in the distal tubule of the kidney. c. water reabsorption in the collecting tubule of the kidney. d. urinary output.

ANS: C ADH acts directly on the renal collecting ducts and distal tubules, increasing membrane permeability to and reabsorption of water. Hypernatremia would be related to insufficient amounts of ADH. ADH increases water reabsorption in the tubule of the kidney. With insufficient amounts of ADH, urine cannot be concentrated.

4. A clinical finding consistent with a diagnosis of syndrome of inappropriate ADH secretion (SIADH) is a. hypovolemia. b. hyponatremia. c. decreased osmolality. d. dehydration.

ANS: B

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Pathophysiology 6th Edition Banasik Test Bank SIADH is characterized by hyponatremia. Clinical manifestations of SIADH are as a result of hypotonicity of body fluids. Serum osmolality is low because of dilution by reabsorbed water. Inappropriate ADH secretion is not manifested by dehydration.

5. Diabetes insipidus is a condition that a. results from inadequate ADH secretion. b. is characterized by oliguria. c. is associated with anterior pituitary dysfunction. d. leads to glycosuria.

ANS: A Diabetes insipidus is a condition related to insufficient ADH activity. Diabetes insipidus is characterized by excessive loss of water in the urine. ADH is secreted by the posterior pituitary gland. A hallmark of DI is the presence of excessive urination and excessive drinking.

6. It is true that the synthesis of thyroid hormones a. is increased by thyrotropin-inhibiting factor. b. occurs in perifollicular C cells. c. is stimulated by ACTH. d. is inhibited by iodine deficiency.

ANS: D Lack of iodine prevents production of both T4 and T3 but does not stop the formation of thyroglobulin. Thyroid hormone synthesis is not associated with thyrotropin-inhibiting factor. Perifollicular C cells are not responsible for thyroid hormone synthesis. Synthesis of thyroid hormones does not NoccR ur t hIrouGgh B sti. mC ulatM ion of ACTH.

U S N T

O

7. Clinical manifestations of Graves disease may include a. tremor. b. cold intolerance. c. lethargy. d. weight gain.

ANS: A Symptoms of Graves disease include restlessness, tremors, and irritability. Graves disease is associated with heat intolerance. Hyperthyroidism is associated with insomnia. Increased basal metabolic rate may result in weight loss.

8. It is true that Graves disease is a. a secondary endocrine disorder. b. associated with autoantibodies to TSH receptors. c. characterized by high serum TSH levels. d. untreatable.

ANS: B Graves disease is an autoimmune disorder where autoantibodies cause the pituitary gland to stop producing TSH. Graves disease is an autoimmune disorder. Serum TSH levels fall to very low levels with Graves disease. Hyperthyroidism is treatable with medications, surgery, or other modalities.

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Pathophysiology 6th Edition Banasik Test Bank 9. Propylthiouracil may be used to treat hyperthyroidism, because it a. destroys thyroid gland cells. b. inhibits the release of TSH. c. suppresses production of autoantibodies. d. inhibits thyroid hormone synthesis.

ANS: D Antithyroid drugs called thionamides (propylthiouracil, methimazole) block the activities of the enzyme thyroid peroxidase and inhibit thyroid hormone production by follicular cells.

Antithyroid drugs do not destroy thyroid gland cells. Antithyroid drugs are used to inhibit release of T3 and T4. Treatment of hyperthyroidism is not aimed at suppression of autoantibodies.

10. Myxedema coma is a severe condition associated with a. hypothyroidism. b. hyperthermia. c. acute cortisol insufficiency. d. pheochromocytoma.

ANS: A Myxedema occurs with severe or prolonged thyroid deficiency. Individuals with myxedema usually present in an altered mental state, with alterations in thermoregulation. The accumulation of glycosaminoglycans causes the patient to have edematous skin.

Pheochromocytoma is not associated with myxedema coma.

11. Clinical manifestations of hypoparathyroidism a. are similar to those occurring with hypermagnesemia.

N R I Gr excitab B.COility.

M b. result from decreased n euUromSus cNul a T c. are similar to those occurring with hypokalemia. d. result from decreased serum ionized calcium.

ANS: D Clinical manifestations of hypoparathyroidism occur as a result of low serum calcium levels. Manifestations of hypoparathyroidism are not similar to those with hypermagnesemia. The manifestations of acute hypocalcemia may include paresthesias of the distal extremities. Non-specific EKG changes may occur in patients with hypoparathyroidism.

12. The formation of active vitamin D a. occurs in the skin. b. is impaired in renal failure. c. is dependent on oral intake of vitamin D. d. is necessary for normal potassium metabolism.

ANS: B Vitamin D is necessary for calcium absorption from the intestine and renal tubules and is impaired in conditions such as renal failure, in which active vitamin D is deficient. Vitamin D formation does not occur in the skin. Oral intake of vitamin D is not a dependent factor in its formation. The production of vitamin D is associated with calcium absorption.

13. Aldosterone secretion is regulated by the presence of

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in the circulation.

Pathophysiology 6th Edition Banasik Test Bank a. b. c. d.

progesterone corticoglobulin ACTH angiotensin II

ANS: D Aldosterone secretion is not regulated by the hypothalamic-pituitary system and is instead regulated by the presence of angiotensin II in the circulation. Aldosterone secretion is not regulated by progesterone. Corticoglubulin does not secrete aldosterone. ACTH does not regulate the secretion of aldosterone into the circulation.

14. A clinical finding that is consistent with a diagnosis of adrenocortical insufficiency is a. hypokalemia. b. hypoglycemia. c. hypertension. d. moon face.

ANS: B Hypoglycemia is associated with adrenal insufficiency. Early signs of electrolyte imbalance may occur with adrenal insufficiency. Hypotension is a symptom of adrenal insufficiency.

Moon face occurs with hypercortisolism.

15. What effect would adrenocortical insufficiency have on an individual’s response to surgical stress? a. More prone to hyperglycemia b. Decreased sensitivity to anesthesia ve cGri s i B s .C M c. More susceptible to hypNerteRnsiI d. More prone to hypotensioUn S N T O ANS: D Adrenal insufficiency may be associated with hypotension. If an individual experiences surgical stress, the adrenal gland will be unable to produce cortisol and the patient would be more prone to hypotension. The patient may be more prone to hypoglycemia, more sensitive to anesthesia, and more susceptible to hypotension.

16. Which response to an injection of ACTH indicates a primary adrenal insufficiency? a. No change in serum glucocorticoid level b. An increase in serum glucocorticoid level c. A decrease in serum glucose level d. An increase in serum ACTH level ANS: A Primary adrenal insufficiency would be indicated when the adrenal cortex fails to produce cortisol when synthetic ACTH is administered. Serum cortisol levels would increase following ACTH administration if the adrenal cortex is functioning properly. Primary adrenal insufficiency occurs when there is no change in the serum glucocorticoid level.

Serum levels of cortisol are measured after synthetic ACTH is given.

17. A laboratory finding that would help confirm the diagnosis of hyperaldosteronism is a. hypernatremia. b. hyperkalemia.

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Pathophysiology 6th Edition Banasik Test Bank c. hypokalemia. d. hyperglycemia.

ANS: C Hyperkalemia is a manifestation of primary adrenocortical insufficiency. Hypernatremia is not a manifestation of aldosterone deficiency. Aldosterone deficiency is manifested by hyperkalemia. Hypoglycemia is one of the manifestations of aldosterone deficiency.

18. The signs and symptoms of adrenocortical hormone excess may occur from either a primary or secondary disorder. A symptom associated with primary Cushing syndrome is a. hyperpigmentation. b. hypotension. c. hyperglycemia. d. hyperkalemia.

ANS: C In Cushing syndrome, cortisol increases tissue resistance to the effects of insulin and may contribute to glucose intolerance or hyperglycemia. Hyperpigmentation is related to Addison disease. Hypertension may develop as a consequence of the salt-retaining activity of cortisol and of the increased blood volume. A reduction in serum potassium is commonly found in Cushing syndrome.

19. Congenital adrenal hyperplasia (adrenogenital syndrome) results from a. cortisol excess. b. testosterone-secreting tumor. c. exogenous androgens. d. blocked cortisol producN tionR . I G B.C M

U S N T

O

ANS: D The syndrome of congenital adrenal hyperplasia is because of enzymatic defects in the biosynthesis of cortisol. A cortisol reduction would occur with adrenogenital syndrome. The lack of negative feedback results in overproduction of ACTH. The overproduction of ACTH leads to hyperplasia of the adrenal glands and excessive androgen secretion.

20. Surgical removal of a gland may result in a. hypersecretion. b. hyposecretion. c. hyporesponsiveness. d. tissue resistance.

ANS: B Hyposecretion may be as a result of failure or congenital absence of glandular tissue, autoimmune destruction, surgical removal of the gland, or lack of normal trophic signals.

Hypersecretion is usually as a result of secreting tumors, autoimmune disease, or excessive stimulation of the gland by trophic signals. Hyporesponsiveness is similar to hyposecretion and is because of target tissue dysfunction. Tissue resistance is not related to surgical removal of a gland.

21. Growth hormone-deficient infants would display a. low birth length and weight. b. normal birth length and weight.

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Pathophysiology 6th Edition Banasik Test Bank c. high birth length and weight. d. normal length and low weight.

ANS: B GH-deficient infants usually have normal birth length and weight. A birth history of prolonged labor or breech delivery is common, but GH deficiency may also be present in children who are born with midline craniocerebral defects. The association between GH deficiency and other midline abnormalities appears to occur because the pituitary gland is developing during the same stage of fetal life as the other midline structures. GH-deficient children generally fall below the third percentile in comparison with peers.

22. A thyroid gland that grows larger than normal is known as a. cretinism. b. myxedema. c. goiter. d. colloidosis.

ANS: C An enlarged thyroid that continues to grow larger is known as goiter. Cretinism is a congenital hypothyroidism. Myxedema is a condition in which severe or prolonged thyroid deficiency results in generalized edema. Colloidosis is not a condition associated with an enlarged thyroid gland.

23. A patient reporting vision changes, photophobia, and lid lag may be exhibiting signs of a. Addison disease. b. Cushing syndrome. c. myxedema.

NURSINGTB.COM d. Graves disease.

ANS: D Individuals with Graves disease may have spasm and retraction of the eyelids, lid lag, and other eye complaints such as vision changes and photophobia. Changes associated with the eyes are not related to Addison disease. Cushing syndrome is not manifested by changes in the eyes. Myxedema is associated with generalized non-pitting edema.

24. Radioactive iodine treatment is the therapy of choice in patients with Graves disease. The patient should be expected to a. achieve full recovery after treatment. b. need short-term thyroid replacement therapy. c. need lifelong thyroid replacement therapy. d. receive lifelong iodine treatment.

ANS: C Hypothyroidism occurs following radioactive iodine therapy in 50% to 80% of patients, so patients should be prepared for the likelihood of lifelong thyroid replacement therapy.

Patients should be informed about the likelihood of lifelong thyroid replacement therapy.

Lifelong thyroid replacement therapy is likely after iodine therapy. Radioactive iodine therapy is not a lifelong process.

25. A tumor which results in excessive production and release of catecholamines is a. goiter.

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Pathophysiology 6th Edition Banasik Test Bank b. pheochromocytoma. c. Conn syndrome. d. Cushing disease.

ANS: B Pheochromocytoma is a tumor of chromaffin tissue that results in the excessive production and release of catecholamines. It is usually benign. Goiter is an enlargement of the thyroid gland. Conn syndrome is usually related to adrenal tumor. Excess cortisol production as a result of pituitary hyperstimulation of the adrenal cortex is termed Cushing disease.

26. Calcitonin is produced by thyroid parafollicular cells and increases bone formation by a. homeostasis. b. osteoclasts. c. reabsorption. d. osteoblasts.

ANS: D Calcitonin increases bone formation by osteoblasts. The role of calcitonin in homeostasis is not clear, calcitonin tends to decrease blood calcium levels and promote conservation of hard bone matrix. Calcitonin inhibits bone breakdown by osteoclasts. Bone reabsorption is increased with hyperparathyroidism.

27. A patient presenting with muscle cramps, fatigue, anxiety, depression, and prolonged Q-T intervals on EKG may be showing symptoms of a. hyperparathyroidism. b. hypoparathyroidism. c. diabetes insipidus.

NURSINGTB.COM d. SIADH. ANS: B Clinical manifestations of hypoparathyroidism occur as a result of low serum calcium levels. The manifestations of acute hypocalcemia include muscle cramps, fatigue, hyperirritability, anxiety, depression, and prolongation of Q-T intervals on the electrocardiogram. The presentation of hyperparathyroidism is related to the level of hypercalcemia and the hyperparathyroid state. Hyperparathyroidism may present as asymptomatic hypercalcemia. Individuals are prone to kidney stones and to bone demineralization. Diabetes insipidus is manifested by polyuria and polydipsia. SIADH is characterized by hyponatremia.

MULTIPLE RESPONSE 1. Which are major classifications of deficiencies in growth hormone secretion? (Select all that apply.) a. Increased IGF-1 b. Decreased GH secretion c. Defective GH action d. Decreased IGG secretion e. Defective IGF-1 generation ANS: B, C, E

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Pathophysiology 6th Edition Banasik Test Bank Deficiencies in GH secretion can be classified into several major categories: (1) decreased GH secretion, (2) defective GH action (structurally abnormal GH or defective GH receptor), and (3) defective IGF-1 (somatomedin) generation. Increased IGF-1 is not a classification of growth hormone deficiency. IGG secretion is not related to growth hormone deficiency.

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Pathophysiology 6th Edition Banasik Test Bank Chapter 41: Diabetes Mellitus Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. The underlying pathogenic mechanism for type 1 diabetes is a. pancreatic -cell destruction. b. lack of insulin receptors. c. lack of exercise and chronic overeating. d. impaired glucose transport into cells.

ANS: A By definition, type 1 diabetes is characterized by destruction of the  cells of the pancreas.

Type 1 diabetes mellitus is characterized by an absolute insulin deficiency, and thus glucose cannot enter muscle and adipose tissue. Type 1 diabetes is unrelated to lack of exercise and chronic overeating. In type 1 diabetes, production of glucose by the liver is no longer opposed by insulin.

2. Insulin binding to its receptor on target cells results in a. increased active transport of glucose into the cell. b. glycogen breakdown within target cells. c. increased facilitated cellular diffusion of glucose. d. gluconeogenesis.

ANS: C The plasma membranes of N cellsRareIpermeable glucose, and the diffusion of glucose into G TB.Cto M U S N some cells is controlled by g l u c o s e t r ans porters.OActivated glucose transporters translocate to the cell membrane to facilitate diffusion of glucose. Glycogen breakdown does not occur when insulin binds to its receptor on target cells. Gluconeogenesis is not the result of insulin binding to target cells.

3. A clinical finding consistent with a hypoglycemic reaction is a. acetone breath. b. warm, dry skin. c. tremors. d. hyperventilation.

ANS: C Tremors are a sign of hypoglycemia. Acetone breath is not a sign of hypoglycemia.

Diaphoresis (excessive sweating) is a sign of hypoglycemia. Hyperventilation does not indicate hypoglycemia.

4. Type 2 diabetes mellitus is often associated with a. nonketotic hyperosmolality. b. childhood. c. autoimmune destruction of the pancreas. d. ketoacidosis.

ANS: A

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Pathophysiology 6th Edition Banasik Test Bank More common in type 2 diabetes mellitus, especially in older individuals, is nonketotic hyperglycemic hyperosmolar syndrome characterized by severe hyperglycemia with no or slight ketosis and striking dehydration. Type 1 diabetes is seen more in childhood than type 2. Type 2 diabetes is characterized by a lack of insulin. Ketoacidosis is found in type 1 diabetes.

5. What indicator is most helpful in evaluating long-term blood glucose management in patients with diabetes mellitus? a. Blood glucose levels b. Urine glucose levels c. Glycosylated hemoglobin levels (HbA1c) d. Clinical manifestations of hyperglycemia ANS: C HbA1c values are used clinically to estimate long-term control and to set and evaluate therapeutic goals. Monitoring of blood glucose levels is useful for monitoring short-term glycemic control. The blood glucose level at which glucose is measurable in the urine, the glycemic threshold, varies from individual to individual, is usually unacceptably high, and cannot be used to establish the presence of hypoglycemia. Clinical manifestations of hyperglycemia are not a useful method of evaluating long-term glucose management.

6. Diabetic neuropathy is thought to result from a. decreased myoinositol transport. b. elevated HbA1c. c. deficient neuronal insulin receptors. d. neuronal demyelination.

N R I G B.C M

U S N T O ANS: A Glucose appears to compete with myoinositol in transport into the cell. Degradation of glucose to sorbitol and fructose (the polyol pathway) occurs in the nerves in the presence of hyperglycemia and insulinopenia. Elevated HbA1c is not associated with diabetic neuropathy. Deficient neuronal insulin receptors are not responsible for neuropathy. Focal ischemic lesions of the nerves may have a role in diabetic neuropathy.

7. A type of insulin that would be most appropriate for acute management of hyperglycemia is a. NPH. b. Semilente. c. regular. d. Ultralente.

ANS: C Regular insulin is short-acting and would be used for acute hyperglycemia. NPH insulin is an intermediate-acting agent which would not be useful in acute hyperglycemia. Acute management of hyperglycemia is not accomplished with Semilente insulin. Ultralente insulin is not the most appropriate treatment for acute hyperglycemia.

8. In the United States, nearly a. 7 million b. 29.1 million c. 366 million

people have diabetes mellitus.

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Pathophysiology 6th Edition Banasik Test Bank d. 176 billion ANS: B In the United States, nearly 29.1 million people have diabetes. Diabetes affects much more than 7 million people in the United States. It is estimated that worldwide the number of people who have diabetes will rise to 366 million by 2015. The annual cost of diabetes to the U.S. medical care system was estimated to be $176 billion in 2007.

9. Diabetes mellitus is the the United States. a. first b. second c. fourth d. seventh

leading cause of death and a major cause of disability in

ANS: D Diabetes mellitus is the seventh leading cause of death and a major cause of disability in the United States. Diabetes is not the leading cause of death in the United States at this time.

The second leading cause of death in the United States is not diabetes. The fourth leading cause of death in the United States is not related to diabetes.

10. The breakdown of stored glycogen in the liver and muscles is called a. glycolysis. b. glycogenesis. c. glycogenolysis. d. gluconeogenesis.

NURSINGTB.COM ANS: C In the fasting state, glucose is produced by glycogenolysis (breakdown of stored glycogen) in the liver and muscles. Glycolysis is the process of oxidization for the energy needs of the cell. Glycogenesis is the production of glycogen in the muscle and liver. Gluconeogenesis is the production of glucose from amino acids and other substrates in the liver.

11. In type I diabetes, respiratory compensation may occur through a process of a. respiratory alkalosis. b. respiratory acidosis. c. metabolic acidosis. d. metabolic alkalosis.

ANS: A Respiratory compensation for the metabolic acidosis in the form of deep, labored respirations that are “fruity” in odor results in lowered PCO2 values from compensatory respiratory alkalosis. Respiratory acidosis is not the mechanism of respiratory compensation. In hyperglycemia, metabolic acidosis ensues as the bicarbonate concentration decreases, and diabetic ketoacidosis results. Metabolic alkalosis is not the compensatory mechanism for hyperglycemia.

12. The underlying pathogenic mechanism for type 2 diabetes is a. pancreatic -cell destruction. b. insulin resistance and -cell dysfunction. c. lack of exercise and chronic overeating.

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Pathophysiology 6th Edition Banasik Test Bank d. impaired glucose transport into cells.

ANS: B Type 2 diabetes is characterized by a relative lack of insulin. The processes instrumental in producing the relative lack of insulin are insulin resistance and -cell dysfunction. By definition, type 1 diabetes is characterized by destruction of the  cells of the pancreas.

Obesity is a major risk factor for the development of type 2 diabetes. Type 2 diabetes is not caused by an impaired transport of glucose.

13.

is the most powerful predictor of developing type 2 diabetes mellitus. a. b. c. d.

Aging Obesity Sedentary lifestyle Cardiovascular disease

ANS: B For type 2 diabetes mellitus, the most powerful predictor is obesity. Excessive abdominal fat introduces a greater threat of diabetes mellitus. Risk factors include aging and a sedentary lifestyle. Leading a sedentary lifestyle carries a greater risk of diabetes. The presence of cardiovascular disease is a risk factor in developing type 2 diabetes, but is not the primary factor.

14. The American Diabetes Association recommends a postprandial blood glucose level of mg/dL for adults with diabetes. a. less than 180 b. more than 180 c. 70 NURSINGTB.COM d. 130 ANS: A The American Diabetes Association recommends a postprandial blood glucose level less than 180 mg/dL for adults with diabetes. Blood glucose levels in adults with diabetes are recommended to be less than 180 mg/dL after meals. The American Diabetes Association recommends as goals a preprandial blood glucose level between 70 and 130 mg/dL. A preprandial blood glucose level between 70 and 130 mg/dL is recommended.

MULTIPLE RESPONSE 1. Which are clinical findings usually associated with type 1 diabetes mellitus? (Select all that apply.) a. Polyuria b. Polydipsia c. Polyphagia d. Obesity e. Weight gain ANS: A, B, C Classic manifestations of type 1 diabetes include polyuria, polydipsia, polyphagia, and weight loss. Obesity and weight gain are not typically associated with type 1 diabetes.

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Pathophysiology 6th Edition Banasik Test Bank 2. The therapies that would be appropriate for a patient with type 1 diabetes mellitus include (Select all that apply.) a. carbohydrate counting. b. high-protein diet. c. daily exercise. d. insulin. e. oral hypoglycemic agents.

ANS: A, C, D Current recommendations are for an individualized diet that includes carbohydrates from fruits, vegetables, whole grains, legumes, and low-fat milk. Carbohydrate intake can be monitored by carbohydrate counting, exchanges, or experienced estimation. Exercise can play a role in lowering blood glucose levels and promoting health maintenance. Insulin therapy is required in 100% of persons with type 1 diabetes. Chronic high-protein intake is linked to heightened glomerular flow rates and renal hypertrophy. It is thought that continued renal hyperfunction can lead to nephropathy in diabetic patients. Oral hypoglycemic agents are used with type 2 diabetes.

3. Which are hormones that increase serum glucose level? (Select all that apply.) a. Vasopressin b. Glucagon c. Growth hormone d. Catecholamine e. Corticosteroid ANS: B, C, D, E The production of catecholamines, glucagon, corticosteroids, and growth hormone causes an Nels.RSVas I Nopr G T B.C M increase in blood glucose levU essin doOes not increase serum glucose levels.

4. Which are complications of diabetes mellitus that are microvascular? (Select all that apply.) a. Cardiovascular disease b. Retinopathy c. Nephropathy d. Neuropathy e. Stroke ANS: B, C Retinopathy is a microvascular complication of diabetes and is the primary cause of new cases of blindness in adults. Nephropathy is a microvascular complication which accounts for end-stage renal disease in diabetics. Cardiovascular disease is a macrovascular complication. Diabetic neuropathy is a neuropathic complication which accounts for sensory dysfunction. Stroke is considered to be a macrovascular complication.

5. Which insulin types are most commonly used in the rapid-acting category? (Select all that apply.) a. NPH b. Aspart c. Glargine d. Lispro e. Regular

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank ANS: B, D Types of insulin are classified into four groups according to their duration of action: rapid acting, short acting, intermediate acting, and long acting. The most commonly used insulins in the rapid-acting category are aspart, glulisine, and lispro. Intermediate-acting agents include NPH and Lente. Glargine is in the category of long-acting. Regular insulin is considered short-acting.

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NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank Chapter 42: Alterations in Metabolism and Nutrition Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. The metabolic response to physiologic stress is characterized by a. loss of somatic protein. b. preservation of visceral protein. c. body weight less than 80% of ideal. d. stress-induced protein catabolism.

ANS: D During times of disease, stress, fever, or starvation or during the release of certain hormones such as thyroid hormone and cortisol, catabolism dominates the body’s metabolic processes.

Loss of somatic protein does not occur in response to physiologic stress. Tissue wasting associated with catabolism may lead to cellular injury. Body weight less than 80% of ideal is not characteristic of a metabolic response to stress.

2. Starvation is associated with a. loss of visceral protein. b. low serum albumin levels. c. loss of somatic fat and protein. d. generalized edema.

ANS: C With physiologic stress, conservation of lean body mass does not occur. The metabolic rate Nes,RaSnId N G B.C M increases rather than decreas U a h i gTh sustaOined rate of catabolism (breakdown of protein to meet energy needs) results. Adipose is not well used for energy. Starvation is associated with protein being used as an energy source. Low serum albumin levels are not associated with starvation. Retention of fluid and sodium occurs in the immediate phase of stress on the body.

3. What patient is most at risk for severe protein malnutrition? a. A postsurgical patient who has been NPO for 3 days b. A postburn patient who has a deep partial-thickness burn c. A febrile patient who has had a temperature of 102.6F for 3 days d. An immobile patient who has been in skeletal traction for 1 week ANS: B A burn is an extreme stressor that results in significant hypermetabolism. The energy needs of a burn patient increase 50% to 100% from the basal metabolic requirement. Burn wounds increase the negative nitrogen balance and burns leak soluble proteins from the wound. The postoperative energy requirement can increase from 10% to 35% above BMR. A combination of increased need with decreased intake can have a major impact on wound healing. The metabolic response to fever is both anabolic and catabolic, which greatly increases nutrient requirements. An effect of immobilization is nitrogen loss as tissue mass is decreased from diffuse atrophy.

4. Which condition is associated with an increase in basal metabolic rate?

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Pathophysiology 6th Edition Banasik Test Bank a. b. c. d.

Aging Fever Obesity Starvation

ANS: B Fever is a factor in increasing basal metabolic rate. The aging process decreases the metabolic rate. Calorie-restricted diets and reduced muscle-mass decrease basal metabolic rate. Starvation is associated with a reduction in the basal metabolic rate.

5. The process of metabolizing proteins to provide energy is called a. glycogenolysis. b. glycolysis. c. gluconeogenesis. d. proteolysis.

ANS: C Gluconeogenesis is the process by which glucose is formed from non-carbohydrate sources.

Glycogenolysis is the breakdown of glycogen to form glucose. Glycolysis is the metabolic sequence that converts glucose to pyruvate. The process of metabolizing proteins to provide energy is not known as proteolysis.

6. Acute physiologic stress is associated with a. preferential use of glycogen. b. catabolism of body proteins. c. decreased basal metabolic rate. d. conservation of body e nNe r gRy stI oresG . B.C M

U S N T

O

ANS: B With physiologic stress, two phases of catabolism occur. The immediate phase of catabolism is characterized by increased sympathetic nervous system stimulation with release of glucagon, glucocorticoids, and catecholamines. The adaptive phase occurs if the sympathetic nervous system response can selectively keep up with the stressors present. An increased production of insulin occurs with immediate physiologic stress. Acute physiologic stress is associated with an increase in basal metabolic rate. In catabolism, an energy deficit is created and alternative mechanisms of glucose production are required.

7. A patient with a fever of 3F above normal would be expected to have increased energy expenditure of a. 3%. b. 15%. c. 21%. d. 50%.

ANS: C Fever increases metabolic needs by 7% for each 1F increase (13% for each 1C increase).

Energy expenditure is increased by 15% to 30% in trauma patients. The energy needs of a burn patient increase by 50% to 100%.

8. The main source of energy for the body comes from a. proteins.

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Pathophysiology 6th Edition Banasik Test Bank b. fats. c. carbohydrates. d. water.

ANS: C Carbohydrates are the main source of energy for the body. Proteins are broken down into amino acids. Fats are the most concentrated form of energy. Water is not the main source of energy for the body.

9. During times of fasting, the body uses a. protein b. fat c. carbohydrates d. glucagon

as a source of energy.

ANS: B During times of fasting, the body reverts to the breakdown and use of fats as its energy source. Protein is not used as a source of energy during fasting. Carbohydrates are not an energy source during fasting. The body does not use glucagon as a source of energy during fasting.

10. A body mass index of 25.5 is considered to be a. morbidly obese. b. normal. c. overweight. d. obese.

NURSINGTB.COM ANS: C Overweight is defined with a BMI of 25 to 29.9 kg/m2. Morbid obesity is a BMI of 40 kg/m2 or more. Normal body weight is BMI less than 25. Obesity is defined as a BMI greater than 30 kg/m2.

11. The postoperative energy requirement can increase a. 7%. b. 10% to 35%. c. 15% to 30%. d. 50%.

above BMR.

ANS: B The postoperative energy requirement can increase from 10% to 35% above basal metabolic rate. Fever increases metabolic needs by 7% for each increase of 1 degree. Energy expenditure is increased by 15% to 30% in trauma patients. The energy needs of a burn patient increase 50% to 100% from basal metabolic requirement.

12. The nutritional effects of cancer can be severe and result in a. malnutrition. b. anorexia. c. cachexia. d. catabolism.

ANS: C

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Pathophysiology 6th Edition Banasik Test Bank The nutritional effects of cancer can be severe and result in what is commonly termed cancer cachexia. The cause of cachexia is inadequate nutritional intake relative to energy requirements and increased anaerobic glycolysis. The nutritional deficits associated with cancer are not known as malnutrition. A major cause of cachexia is anorexia associated with the malignancy and with the treatment. Catabolism is the degradative phase of metabolism and is not caused by cancer.

13. An immobile patient should be treated with an extra a. 2 to 4 b. 4 to 6 c. 7 to 9 d. 10 to 15

g of protein daily.

ANS: D An effect of immobilization is nitrogen loss as tissue mass is decreased from disuse atrophy.

This loss can total 2 to 3 g/kg per day and require up to 10 to 15 g of protein to replenish the daily loss. Immobility is associated with muscle atrophy and bone demineralization. Patients should be given an extra 10 to 15 g of protein. Patients require up to 10 to 15 g of protein to replenish daily loss. Ten to fifteen grams of protein are required daily in the immobile patient.

14. The metabolic response to fever is a. anabolic. b. catabolic. c. both anabolic and catabolic. d. related to gluconeogenesis.

N R I G B.C M

U S N T O ANS: C The metabolic response to fever is both anabolic and catabolic, which greatly increases nutrient requirements. The metabolic response to fever is not catabolic only.

Gluconeogenesis is increased in trauma patients.

MULTIPLE RESPONSE 1. Which patient is at highest risk for severe negative nitrogen balance? (Select all that apply.) a. Postsurgical patient b. Postburn patient c. Posttrauma patient d. Postsepsis patient ANS: B, C Negative nitrogen balance is increased by catabolism and by the use of amino acids to form stress proteins. In addition, burn wounds directly contribute to protein loss, because soluble proteins leak from the wound and proteolysis is activated. Because trauma is a sudden stress, catabolism is much greater than anabolism because the body has not had enough time to replenish the proteins lost. This dominance of catabolism results in excessive negative nitrogen balance and significant loss of skeletal muscle. Nitrogen loss through wounds can be large and create a greater need for increased protein intake. Catabolism is a protective mechanism that provides needed substrates for activation of the immune response to infection, such as in the postsepsis patient.

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Pathophysiology 6th Edition Banasik Test Bank

Chapter 43: Structure and Function of the Nervous System Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. Neurotransmitter binding to neuronal receptors occurs primarily at the dendrite and a. cell body. b. nucleus. c. axon hillock. d. axon terminal.

ANS: A

Neurotransmitters bind to receptors on the dendrite and cell body. The nucleus is not the location of neurotransmitter binding. The axon hillock is the point where the axon emerges from the cell body. Neurotransmitter is stored at the axon terminal.

2. In contrast to other cell types, nerve and muscle cells are able to conduct action potentials

because they a. are polarized to respond to membrane voltage. b. are permeable to potassium at rest. c. have voltage-gated ion channels. d. are impermeable to sodium at rest.

ANS: C

Voltage-gated ion channels allow the cell membranes of excitable cell types, like nerve and muscle, to open and close in response to fluctuations in membrane voltage. Potassium Membrane is permeable to potassium at channels allow for repol arizaN tioUnRoSf I ceN llG s. T TB he.cC elO lm rest. Fast sodium channels allow sodium influx during the upstroke of the action potential.

3. The resting membrane potential in nerve and skeletal muscle is determined primarily by a. extracellular sodium ion concentration. b. the ratio of intracellular to extracellular potassium ion. c. activation of voltage-gated sodium channels. d. activity of energy-dependent membrane ion pumps.

ANS: B

At equilibrium, the electrical gradient pulling K+ into the cell and the chemical gradient pulling it out are balanced. This equilibrium point leaves a few extra negatively charged ions inside the cell with no positive ion to neutralize them. The resting membrane potential in nerve and skeletal muscle is not determined by the extracellular sodium concentration. The membrane potential changes in response to potassium changes. Ion channels open and close in response to fluctuations in membrane voltage, but the resting membrane potential is not determined by the activity of membrane ion pumps.

4. Exocytosis of neurotransmitter in response to depolarization of the presynaptic nerve

membrane is mediated by a. neurotransmitter binding to presynaptic carrier proteins. b. potassium influx through voltage-gated channels. c. sodium-potassium ATPase. d. calcium influx through voltage-gated channels.

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Pathophysiology 6th Edition Banasik Test Bank

ANS: D

Calcium influx mediates exocytosis of neurotransmitter into the interneuronal synapse.

Neurotransmitter binds and activates specific receptors on the postsynaptic cell.

Depolarization opens voltage-gated calcium channels. Exocytosis is not mediated by sodium-potassium ATPase.

5. Acetylcholine is released into the synapse by a. passive reuptake of acetylcholine into the presynaptic neuron. b. active reuptake of acetylcholine into the presynaptic neuron. c. passive diffusion into the postsynaptic membrane. d. degradation by acetylcholinesterase.

ANS: D

When acetylcholine is released into the synapse, it is quickly degraded by acetylcholinesterase to limit the duration of action. Acetylcholine receptors provide a negative feedback loop. The presynaptic neuron monitors the amount of acetylcholine in the synapse. Acetylcholine is not cleared by passive diffusion.

6. Binding of neurotransmitter to receptors on the postsynaptic neuronal membrane results in a. a change in ion conductance through the membrane. b. the opening of voltage-gated calcium channels. c. an action potential. d. hyperpolarization.

ANS: A

Postsynaptic neurons have receptors for these neurotransmitters and respond by changing the flow of ions through channelsNinR theI cellGmembrane.

B.C O MAction potentials reaching the axon U S N T terminal open voltage-gated c a l c i u m c han nels. Depolarization of the neuronal membrane results in the generation of action potentials. Some neurotransmitters inhibit depolarization and may produce hyperpolarization of the postsynaptic membrane by opening Cl– or K+ channels.

7. A common inhibitory central nervous system (CNS) neurotransmitter is a. acetylcholine. b. norepinephrine. c. -aminobutyric acid (GABA). d. glutamate.

ANS: C

Glycine and GABA are inhibitory amino acids and are located throughout the spinal cord and brain. Acetylcholine is the sole neurotransmitter in its class. Norepinephrine is an amine that is involved in the limbic system, hypothalamus, and basal ganglia. Glutamate is a principal excitatory amino acid.

8. Axonal myelination generally increases the a. metabolic needs of the neuron. b. flow of ions across the neuronal membrane. c. sodium permeability. d. speed of action potential conduction.

ANS: D

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Pathophysiology 6th Edition Banasik Test Bank The speed at which an action potential travels is determined by axonal diameter and myelination. Larger and myelinated neurons conduct impulses more quickly. The metabolic needs of the neuron are not increased by axonal myelination. The flow of ions across the membrane occurs in response to membrane voltage. When neurotransmitters bind to receptors on the dendrite and cell body, sodium is allowed to leak in.

9. One component of the peripheral nervous system is the a. cerebral cortex. b. brainstem. c. spinal cord. d. spinal nerve.

ANS: D

The peripheral nervous system consists of 31 pairs of spinal nerves. The cerebral cortex is not a component of the peripheral nervous system. The brainstem is not a component of the peripheral nervous system. The spinal cord is not a part of the peripheral nervous system.

10. The entire human nervous system develops from the a. brainstem. b. neural ectoderm. c. mesoderm. d. telencephalon.

ANS: B

The nervous system starts to take shape during the third week of embryonic development. A thickened plate of ectoderm gives rise to the central nervous system and peripheral nervous system. The neural tube is the precursor of the future brain and spinal cord. The mesoderm and telencephalon are not theNpU riR mS arI yN soGuT rcB es.oC fO n eMr v o u s system development.

11. Blood flow to the brain is interrupted with the occlusion of which artery? a. Distal aortic b. Pulmonary c. Vertebral d. Left anterior descending ANS: C

Blood supply to the brain is provided by two pairs of arteries; the anterior circulation is supplied by the internal carotid arteries, and the posterior circulation is supplied by the vertebral arteries. The distal aortic artery does not supply blood to the brain. The pulmonary artery does not supply blood to the brain. Occlusion of the left anterior descending artery would not interrupt blood flow to the brain.

12. Activation of touch receptors on the left side of the body is transmitted primarily to the a. b. c. d.

cortex. right somatosensory occipital left temporal right motor

ANS: A

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Pathophysiology 6th Edition Banasik Test Bank Stimulation of points in the primary somatosensory cortex results in discrete sensations in the contralateral side of the body. The perception of sensation from the body occurs at the level of the cortex. The sensations of fine touch and pain are separated in the cord, they reunite in the somatosensory cortex that lies in the cerebral hemisphere opposite the site of sensory receptor origin. Corticospinal tract neurons originate in the primary motor cortex, which is arranged in a similar manner to the somatosensory cortex.

13. When nerve impulses travel up the

side of the cord, the sensations of touch,

pressure, and vibration are affected. a. anterolateral b. ipsilateral c. contralateral d. bilateral ANS: B

The well-localized sensations of touch, pressure, and vibration travel up the ipsilateral side of the cord. The sensations of pain, itch, and temperature usually cross over and travel to the brain on the contralateral side. Specifically, the anterolateral tract carries the impulses for these sensations. The contralateral side is responsible for the sensations of pain, itch, and temperature. The ipsilateral side is responsible for touch, pressure, and vibration.

14. The language center in most individuals is located in the a. frontal lobe. b. left hemisphere. c. right hemisphere. d. limbic area.

ANS: B

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Language expression and interpretation have been mapped to areas in the temporal lobe, in the left hemisphere. Damage to the frontal lobe interferes with the ability to use language. The right hemisphere is not the language center of the brain. The limbic system is associated with memory and emotion.

15. Voluntary fine-motor movements are produced by activation of the a. dorsal horn–lemniscal b. lateral corticospinal c. spinothalamic d. medial brainstem

tract(s).

ANS: B

Corticospinal neurons from the primary motor cortex activate  motor neurons to execute voluntary fine-motor commands. The dorsal column–medial lemniscal tract carries fine touch, vibration sense, and proprioception and remains ipsilateral until the level of the medulla. The anterolateral tract (previously called the spinothalamic tract) carries impulses for sensations of pain, itch, and temperature. Activation of the medial brainstem tracts is not associated with voluntary fine-motor movements.

16. A patient who is experiencing swings in heart rate and irregular breathing during sleep is most

likely in the stage of a. deep b. REM

sleep.

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Pathophysiology 6th Edition Banasik Test Bank c. alpha wave d. delta wave ANS: B

REM sleep is characterized by irregular breathing and heartbeat, rapid eye movements, depressed muscle tone, and active dreaming. Most sleep is of the restful, slow-wave type of deep sleep. Alpha waves predominate during a relaxed state with the eyes closed. Beta waves are apparent during the REM sleep phase.

17. Memories are stored in the nervous system by a. specific neurons in the cortex. b. rearrangement of synaptic contacts. c. selective apoptosis of neurons. d. changes in synaptic efficiency.

ANS: D

Memory is a synaptic phenomenon in which neurons in the memory trace or circuit alter the efficiency of synaptic transmission. Memories are not stored by specific neurons in the cortex.

Selective apoptosis of neurons is not the process of memory storage.

18. The primary function of the central nervous system is to a. process information to be relayed to muscles and glands. b. serve the afferent sensory system. c. serve the efferent motor system. d. mediate involuntary functions.

ANS: A

The CNS includes the brain aNn d R s p i nIa l cG o r d.BI. t s Cp r i m Mar y functions are receiving and U S N T O processing sensory information and creating appropriate responses to be relayed to muscles and glands. The peripheral nervous system serves both afferent sensory functions and efferent motor functions of the somatic and autonomic systems. The autonomic nervous system is composed of neurons in the CNS and PNS that mediate automatic or involuntary functions.

19. The protects the soft tissue of the brain. a. dural septa b. dura c. falx cerebri d. tentorium cerebella ANS: B

The tough dura protects the soft tissue of the brain. Support and stability are provided by dural septa. The falx cerebri is a thin wall of dura that folds down the cortical midline, separating the two hemispheres. The tentorium cerebelli is a septum that separates the cerebellum and brainstem from the rest of the cerebrum.

20. The integrity of the blood-brain barrier is maintained in part by CNS cells called a. ganglia. b. leptocytes. c. neurocytes. d. astrocytes.

ANS: D

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Pathophysiology 6th Edition Banasik Test Bank The integrity of the blood-brain barrier is maintained in part by CNS cells called astrocytes.

These specialized glial cells have foot processes that contact the brain capillaries and are thought to help regulate transport across the capillary endothelium. The ganglia are not associated with integrity of the blood-brain barrier. Leptocytes are not responsible for maintaining the integrity of the blood-brain barrier. The integrity of the blood-brain barrier is not maintained by neurocytes.

21. The pathologic process called hydrocephalus would be manifested by a. decreased CSF, increased b. increased CSF, increased c. decreased CSF, decreased d. increased CSF, decreased

ventricular size.

ANS: B

CSF will continue to be produced even when its path of circulation or absorption is blocked. If this occurs, the amount of CSF increases, as does the size of the ventricles. This pathologic process is called hydrocephalus. Although hydrocephalus is usually caused by blockage of CSF pathways, it can also be caused by overproduction and malabsorption of CSF. Hydrocephalus is associated with increases in CSF and an increase in the size of ventricles.

22. The peripheral nervous system contains a total of a. 12 b. 31 c. 24 d. 86

nerves.

ANS: D

The PNS consists of 31 p a i r sNoU f sRpS inI alNnG erT veBs . anCdO1M 2 pairs of cranial nerves. The total number is 86. There are a total of 24 cranial nerves.

23. Within the spinal nerves, there are a. 8 b. 12 c. 5 d. 2

pairs of thoracic nerves.

ANS: B

There are 12 pairs of thoracic nerves within the spinal nerves. There are 8 cervical nerves in the spinal vertebral segments. There are 5 lumbar and 5 sacral pairs of nerves in the spinal nerves.

24. Neurons with one dendrite and one axon are a. unipolar. b. bipolar. c. dipolar. d. multipolar.

ANS: B

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Pathophysiology 6th Edition Banasik Test Bank Bipolar neurons have only one dendrite and one axon extending from the cell body. These neurons are prevalent in the retina, cochlea, and olfactory structures, but are rare elsewhere.

Unipolar neurons have a single process protruding from the cell body, which splits to form a dendrite and axon. Neurons with one dendrite and one axon are known as bipolar. Multipolar neurons have a large number of dendrites extending from the cell body and one axon. Most neurons are of this type.

25. Pupil constriction is controlled by cranial nerve a. II. b. III. c. VIII. d. IX. ANS: B

Cranial nerve III mediates pupil constriction. Cranial nerve II conveys visual information from the retina to the brain. Cranial nerve VIII transmits auditory information from the cochlea and vestibular information from inner ear structures. Cranial nerve IX innervates tongue muscles and controls their action during speech and swallowing.

MULTIPLE RESPONSE 1. Which are functions of neuroglia? (Select all that apply.) a. Generation of action potential b. Modulation of ionic composition of extracellular fluid in the brain c. Production of CSF d. Phagocytosis of wastes within the CNS e. Slowing the rate of conduNcU tioRnStoItN heGnTeB rv. eC axO oM ns ANS: B, C, D

Astrocytes regulate ionic balance of the interstitial fluid and may influence the transfer of nutrients from capillaries to neurons. Ependymal cells line the ventricles and central canal of the spinal cord, producing CSF. Microglias provide phagocytic functions within the CNS. Glial cells in the nervous system are not capable of generating action potentials. The myelin sheath wraps around nerve axons to insulate and speed the rate of conduction.

2. Which are parts of the meninges? (Select all that apply.) a. Dura mater b. Pia mater c. Choroid d. Arachnoid e. Ganglia ANS: A, B, D

The dura mater is the outermost meningeal layer. The pia mater is the third meningeal layer.

The arachnoid layer is beneath and continuous with the dura. The choroid is not a part of the meninges. The ganglia are not considered to be part of the meninges.

3. It is true that an N-methyl-D-aspartate (NMDA) receptor (Select all that apply.) a. is activated by glutamate. b. is a ligand-gated calcium ion channels.

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank c. opens only when the membrane has been previously depolarized. d. blockade is associated with enhanced short-term memory. e. is blocked by a sodium ion.

ANS: A, B, C

NMDA receptors will not open unless they are bound to glutamine. The NMDA receptor is a ligand-gated calcium ion channel. The N-methyl-D-aspartate (NMDA) receptors are interesting, because they will not open unless the binding of glutamate is paired with a cotransmitter and concurrent depolarization of the membrane. The NMDA receptor is thought to be responsible for long-term memory. The NMDA receptor is blocked by a magnesium ion.

4. It is true that the arachnoid layer of the meninges (Select all that apply.) a. is thick and tough for support and protection. b. lies between the dura and the skull. c. contains spaces that are only evident in the presence of pathologic processes. d. is semitransparent and weblike. e. contains collagenous connective tissue.

ANS: C, D, E

Only in the presence of pathologic processes, notably epidural and subdural hemorrhages, do the potential spaces of the arachnoid layer become evident. It is semitransparent and weblike in appearance, hence its name. From the arachnoid layer come strands of collagenous connective tissue called trabeculae that extend down to the pia mater, forming a subarachnoid space. The arachnoid is a thin, delicate membrane. Beneath, and continuous with, the dura is the arachnoid layer. The spaces between the dura and the skull and between the dura mater and the arachnoid are potential spaces.

NURSINGTB.COM

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank Chapter 44: Acute Disorders of Brain Function Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. The physiologic change most likely to lead to an increase in intracranial pressure is a. cerebral vasodilation. b. hypernatremia. c. respiratory hyperventilation. d. REM sleep.

ANS: A Cerebral edema starts a cyclic process whereby fluid collection in the brain leads to compression of vessels, which results in inadequate blood and oxygen perfusion into the cells. This results in ischemia, which triggers vasodilation, increased capillary pressure, and increased edema. An increase in intracranial pressure is not associated with hypernatremia nor caused by respiratory hyperventilation. The physiologic change most likely to lead to increased intracranial pressure is not related to sleep.

2. Manifestations of acute brain ischemia (Cushing reflex) are due primarily to a. parasympathetic nervous system activation. b. sympathetic nervous system activation. c. autoregulation of body systems. d. loss of brainstem reflexes.

ANS: B NURSINGTB.COM An extreme increase in ICP can precipitate an intense reaction by the sympathetic nervous system as it attempts to maintain cerebral perfusion through the compressed blood vessels.

This has been termed an ischemic response or Cushing reflex. Manifestations of acute brain ischemia are because of sympathetic nervous system activation. The sympathetic nervous system activates to attempt to lower the intracranial pressure accompanied by acute brain ischemia. The Cushing reflex generally is viewed as a “last-ditch” effort by the brain to reestablish cerebral perfusion but is not as a result of loss of brainstem reflexes.

3. Which group of clinical findings indicates the poorest neurologic functioning? a. Spontaneous eye opening, movement to command, oriented to self only b. Eyes open to light touch on shoulder, pupils briskly reactive to light bilaterally c. Assumes decorticate posture with light touch, no verbal response d. No eye opening, responds to painful stimulus by withdrawing ANS: C Decorticate posturing is an abnormal flexor response of the arms and wrists, with legs and feet extended and internally rotated. This occurs as the neurologic functioning deteriorates.

Normal response occurs with spontaneous eye opening, movement on command and orientation to self. Eye opening to touch is not indicative of poor neurologic functioning. A lower neurologic functioning is indicated by a patient who is able to withdraw from painful stimulus and localize the source of pain.

4. Acceleration-deceleration movements of the head often result in polar injuries in which

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank a. b. c. d.

injury is localized to the site of initial impact. widespread neuronal damage is incurred. bleeding from venules fills the subdural space. focal injuries occur in two places at opposite poles.

ANS: D Polar injuries occur as a consequence of the brain shifting within the skull and meninges during the course of an acceleration-deceleration movement resulting in local injury at two opposite poles of the brain. Focal injuries are those that are localized to the site of impact to the skull. Diffuse injuries occur when movement of the brain causes widespread neuronal damage. An intracranial hematoma is a localized collection of blood within the cranium.

5. Secondary injury after head trauma refers to a. brain injury resulting from the initial trauma. b. focal areas of bleeding. c. brain injury resulting from the body’s response to tissue damage. d. injury as a result of medical therapy.

ANS: C Secondary injury is a consequence of the body’s response to the primary injury. Injury that is directly related to the initial impact is primary injury. A focal area of bleeding is related to primary injury. Injury that results from medical therapy is not known as secondary injury.

6. An example of inappropriate treatment for head trauma would be a. head elevation. b. free water restriction. c. hypoventilation.

NURSINGTB.COM d. bed rest.

ANS: C Hyperventilation, not hypoventilation, is indicated in the management of an acute elevation of intracranial pressure. Elevating the head is aimed at maintaining intracranial pressure and cerebral blood flow. Normal intravascular volume is indicated in the management of intracranial pressure. Bed rest would be indicated for the head trauma patient.

7. Risk factors for hemorrhagic stroke include a. atherosclerosis. b. dysrhythmias. c. acute hypertension. d. sedentary lifestyle.

ANS: C Intracerebral hemorrhage is a hemorrhage within the brain parenchyma and usually occurs in the context of severe and often longstanding hypertension. Risk factors for stroke are similar to those for other atherosclerotic vascular disease. Cardiac disease complicated by atrial fibrillation is an important risk factor for embolic stroke. Sedentary lifestyle is not a risk factor for hemorrhagic stroke.

8. The stroke etiology with the highest morbidity and mortality is a. intracranial hemorrhage. b. intracranial thrombosis.

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank c. intracranial embolization. d. cardiac arrest.

ANS: A Intracerebral hemorrhage is a hemorrhage within the brain parenchyma and usually occurs in the context of severe and often longstanding hypertension. It carries a 38% mortality, with death usually occurring within minutes to hours. Ischemic strokes are the most common and include thrombotic and embolic types. Embolic and ischemic strokes are the most common type. Stroke is the third leading cause of death in the United States. Cardiac arrest is not the stroke etiology with the highest morbidity and mortality.

9. Clinical manifestations of a stroke within the right cerebral hemisphere include a. cortical blindness. b. right visual field blindness. c. expressive and receptive aphasia. d. left-sided muscle weakness and neglect.

ANS: D Manifestations of ischemic stroke are related to the cerebral vasculature involved and the area of brain tissue the vessel supplies. Contralateral hemiplegia is a usual finding.

Contralateral hemiplegia, hemisensory loss, and contralateral visual field blindness are usual manifestations of stroke. Left visual blindness would be more indicative of a stroke affecting the right cerebral hemisphere. Aphasia is an integrative language disorder that occurs with brain damage to the dominant cerebral hemisphere (usually left) and involves all language modalities.

10. The most important prevenN tiveRmeI asurGe foBr . heCmoM rrhagic stroke is U S N T O a. anticoagulation. b. blood pressure control. c. thrombolytics. d. management of dysrhythmias.

ANS: B Hemorrhagic stroke is a hemorrhage that is usually the result of longstanding hypertension.

Blood pressure control is the most important preventive measure. Anticoagulation would be useful for preventing embolic stroke. Risk reduction strategies for thrombotic stroke are aimed at reducing atherosclerosis. Dysrhythmias are not related to a risk of hemorrhagic stroke.

11. In the acute phase of stroke, treatment is focused on a. stabilization of respiratory and cardiovascular function. b. risk factor modification. c. prevention of bedsores and contractures. d. neurologic rehabilitation.

ANS: A The primary consideration in the acute phase of stroke is assuring the patient’s airway, respiratory, and cardiovascular function. In the acute phase of stroke, risk factor modification is not appropriate. Treatment aimed at preventing bedsores and contractions is not a typical consideration in the acute phase. Neurologic rehabilitation is not the focus of treatment in the acute phase.

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank

12. Cerebral aneurysm is most frequently the result of a. embolic stroke. b. subarachnoid hemorrhage. c. subdural hemorrhage. d. meningitis.

ANS: B Although trauma is an important cause of subarachnoid hemorrhage, it is more commonly associated with rupture of cerebral aneurysms. Embolic stroke is usually from a cardiac source. Subdural hematomas are related to trauma. Meningitis is caused by microbial invasion of the CNS. 13. Leakage of CSF from the nose or ears is commonly associated with a. epidural hematoma. b. temporal skull fracture. c. basilar skull fracture. d. cerebral aneurysm.

ANS: C Sometimes fractures at the base of the skull are not visible on the routine CT scan, but allow drainage of CSF into the nasal sinuses. Head-injured patients who have drainage of clear fluid from the ears or nose should be evaluated for basilar skull fracture. Epidural hematomas are not associated with leakage of CSF from the nose or ears. Fracture of the temporal bone commonly results in an acute epidural hemorrhage. Cerebral aneurysm is not associated with leakage of cerebrospinal fluid.

N R I G B.C M

14. Rupture of a cerebral aneurysUm sShouN ld bTe suspeO cted if the patient reports a. ringing in the ears. b. transient episodes of numbness. c. transient episodes of vertigo. d. sudden, severe headache.

ANS: D Warning leaks may occur before an aneurysm ruptures and often produce severe headache, which is typically described by the patient as “the worst headache I have ever had.” Ringing in the ears is not a symptom associated with rupture of a cerebral aneurysm. Transient episodes of numbness are not indicative of a cerebral aneurysm rupture. Transient episodes of vertigo are not indicative of a cerebral aneurysm rupture.

15. Subarachnoid hemorrhage is usually managed with volume expansion and blood pressure support to enhance cerebral perfusion. This is necessary because subarachnoid hemorrhage predisposes to a. cerebral vasospasm. b. hypotension. c. excessive volume loss. d. increased intracranial pressure.

ANS: A

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank In patients experiencing subarachnoid hemorrhage as a consequence of ruptured aneurysm, the complications of cerebral vasospasm and hydrocephalus must be monitored and managed. Vasospasm can be managed by keeping blood volume and blood pressure at normal to high levels. Vasospasm is managed by keeping blood volume and blood pressure at normal to high levels. Subarachnoid hemorrhage does not predispose to excessive volume loss. Subarachnoid hemorrhage is not associated with predisposition to increases in intracranial pressure.

16. A college student living in a dormitory reports a stiff neck and headache and is found to have a fever of 102F. This information is most consistent with a. encephalitis. b. meningitis. c. skull fracture. d. cerebral ischemia.

ANS: B The combination of headache, fever, stiff neck, and signs of confusion are classic symptoms of meningitis. Clinical manifestations of encephalitis include fever, headache, and confusion that evolve over several days. Symptoms of a skull fracture are unrelated to fever and headache. Fever is not associated with cerebral ischemia.

17. It is true that encephalitis is usually a. because of a bacterial infection in the CNS. b. fatal. c. because of a viral infection in brain cells. d. asymptomatic.

N R I G B.C M

U S N T O ANS: C Encephalitis is an inflammation of the brain which is caused by a variety of agents. Viral causes account for the majority of encephalitis cases. Bacteria can be responsible for the inflammation of the brain associated with encephalitis. Death occurs in 5% to 20% of encephalitis cases. Clinical manifestations of HSV encephalitis typically evolve over several days.

18. It is true that epidural bleeding is a. associated with widespread vascular disruption. b. located between the arachnoid and the dura mater. c. usually because of venous leakage. d. characterized by a lucid interval immediately after injury.

ANS: D The source of bleeding in most epidural hematomas is arterial. The patient may suffer only a brief period of disturbed consciousness followed by a period of normal cognition (lucid interval). Then consciousness rapidly deteriorates as the epidural hematoma expands and compresses brain structures. As the epidural hematoma expands, pressure is placed on the brain structures. The bleeding associated with an epidural hematoma occurs between the inner surface of the skull and the dura mater. The source of bleeding in most epidural hematomas is arterial.

19. The most important determinant for prescribing therapy for acute stroke is

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank a. b. c. d.

location of ischemia. thrombotic versus embolic cause. ischemic versus hemorrhagic cause. age of the patient.

ANS: C Treatment pathways differ between ischemic and hemorrhagic stroke. The goals of therapy for ischemic stroke are to minimize infarct size and preserve neurologic function. Secondary prevention for thrombotic stroke includes lifestyle modification to address risk factors. It is critical to prevent further hypoxia or ischemia after ischemic stroke regardless of the age of the patient.

20. Intracranial pressure normally ranges from a. 0 to 15 b. 10 to 20 c. 15 to 25 d. 20 to 30

mm Hg.

ANS: A ICP is the pressure exerted by the contents of the cranium, and it normally ranges from 0 to 15 mm Hg. Normal ICP ranges from 0 to 15 mm Hg. Fifteen to 25 mm Hg is considered to be high. Elevated ICP may occur in most types of acute brain injury. ICP of 20 to 30 mm Hg is high and is associated with impaired neurologic function because of compression of brain structures.

21. a. b. c. d.

edema occurs when ischemic tissue swells because of cellular energy failure.

Interstitial NURSINGTB.COM Osmotic Vasogenic Cytotoxic

ANS: D Cytotoxic edema occurs when ischemic tissue swells because of cellular energy failure. A lack of ATP allows Na+ to accumulate in the cell, creating an osmotic force to draw in water. Interstitial edema is usually secondary to increased capillary pressure, damage to the capillary endothelium from a chemical injury, or sudden increase in vascular pressure beyond autoregulatory limits. A lack of ATP allows Na+ to accumulate in the cell, creating an osmotic force to draw in water. Vasogenic edema is a consequence of stroke, ischemia, and severe hypertension, and may occur surrounding brain tumors.

22. A severe complication of elevated intracranial pressure is a. Cushing reflex. b. brain herniation. c. burr hole. d. hydrocephalus.

ANS: B

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank A dreaded complication of elevated ICP is brain compression and herniation. Compression of midbrain and brainstem structures is associated with rapid neurologic demise unless corrected quickly. An extreme increase in ICP precipitates a reaction by the sympathetic nervous system as it attempts to maintain perfusion. Cushing reflex is the brain’s effort to reestablish cerebral perfusion. A burr hole is an opening in the skull which is used to monitor ICP. A cause of increased ICP is an excessive accumulation of CSF (hydrocephalus).

23. A tool used to assess levels of consciousness is a. magnetic resonance imaging (MRI). b. intracranial pressure (ICP) monitoring. c. Glasgow Coma Scale (GCS). d. central perfusion pressure (CPP).

ANS: C The Glasgow Coma Scale (GCS) is a standardized tool developed for the purpose of assessing the level of consciousness in acutely brain-injured patients. An MRI is useful in evaluating a patient with an increase in ICP or change in mental status. ICP monitoring is useful in monitoring and treating patients with head trauma or other sources of excessive CSF. Central perfusion pressure is a useful tool in guiding therapy along with ICP. 24. The first indication of brain compression from increasing intracranial pressure (ICP) may be a. decorticate posturing. b. absence of verbalization. c. sluggish pupil response to light. d. Glasgow Coma Scale score of 13.

N R I G B.C M

U S N T O ANS: C Careful monitoring of the pupillary response to light during the acute phase is critical, as a failing response may be the first indication of brain compression from increasing ICP. Mild dilation of a pupil with sluggish or absent light response is ominous. Decorticate posturing is related to a deteriorating motor status. Absence of verbalization is not the first indication of brain compression. A GCS score of 13 is not the first indication of brain compression.

Although, acute changes in level of consciousness should be further investigated.

25. A level of a. 3 b. 8 c. 12 d. 15

on the Glasgow Coma Scale indicates likely fatal damage.

ANS: A On the GCS, the lowest total score of 3 indicates likely fatal damage, especially if both pupils fail to respond to light and oculovestibular responses are absent; however, the severity and prognosis are predicted more accurately by also considering diagnostic imaging and other factors. A GCS level of 8 indicates severe damage. A GCS level of 12 or higher indicates mild damage. A GCS level of 15 is considered to be normal.

26.

occurs when a brainstem impaired patient exhibits a persistent rhythmic or jerky movement in one or both eyes.

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank a. b. c. d.

Nystagmus Dysconjugate movement Ocular palsy Doll’s eye

ANS: A Nystagmus is a persistent rhythmic or jerky movement in one or both eyes. Dysconjugate movements occur when the eyes do not move together in the same direction. Ocular palsies occur when one or more cranial nerves are dysfunctional such that motor paralysis of the eye muscles impairs movements in one or more directions. The doll’s-eyes test is performed by holding open the patient’s eyelids and rotating the head from one side to the other. If the brainstem is intact, the eyes will turn in a direction opposite to the direction of head rotation.

MULTIPLE RESPONSE 1. Which brain disorders are a cause of acute brain injury? (Select all that apply.) a. Seizure disorders b. Brain trauma c. Dementias d. Brain hemorrhage e. Central nervous system infections ANS: B, D, E Brain trauma is a primary cause of acute brain injury. Brain hemorrhage is a primary cause of acute brain injury. Early detection and prompt management are necessary to prevent death and minimize morbidity. CNS infections are an acute cause of brain injury and progress rapidly. Seizure diN soUrR deS rsIaN ndGdTeB m. enC tiO asMare chronic aspects of neurologic diseases.

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank Chapter 45: Chronic Disorders of Neurologic Function Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. Seizures that involve both hemispheres at the outset are termed a. partial. b. complex. c. focal. d. generalized.

ANS: D Episodes in which the entire brain is involved from the onset of the seizure are referred to as generalized seizures. Partial seizures are those in which activity is restricted to one brain hemisphere. Complex partial seizures are restricted to one area of the brain. Focal seizures are classified as partial.

2. The primary reason that prolonged seizure activity predisposes to ischemic brain damage is that a. neurons are unable to transport glucose. b. cardiovascular regulation is impaired. c. the brainstem is depressed. d. the lack of airway maintenance can lead to hypoxia.

ANS: D Status epilepticus is a continuing series of seizures without a period of recovery between N R inIdNaGm B.C M possible death from hypoxia, cardiac seizure episodes. IrreversibleUbraS aTg e andO arrhythmias, or lactic acidosis can occur if the airway is not maintained and seizure activity is not halted. Prolonged seizure activity is unrelated to glucose transportation by neurons.

Status epilepticus can cause cardiac arrhythmias, but the primary concern of prolonged seizure activity is maintaining a proper airway. Brainstem depression is not the primary reason that prolonged seizure activity causes ischemic brain damage.

3. The dementia of Alzheimer disease is associated with structural changes in the brain, including a. deposition of amyloid plaques in the brain. b. degeneration of basal ganglia. c. hypertrophy of frontal lobe neurons. d. significant aluminum deposits in the brain.

ANS: A The hallmark pathophysiologic changes associated with Alzheimer disease include intracellular neurofibrillary tangles and extracellular amyloid plaques. Degeneration of the basal ganglia is not associated with dementia of Alzheimer disease. Brain atrophy occurs as a result of the amyloid plaques in the brain. Aluminum deposits in the brain are not responsible for dementia of Alzheimer disease.

4. Before making a diagnosis of Alzheimer disease a. a brain biopsy demonstrating organic changes is necessary.

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank b. biochemical tests for aluminum toxicity must be positive. c. other potential causes of dementia must be ruled out. d. increased protein is found in a lumbar puncture.

ANS: C All manageable causes for dementia or delirium should be ruled out before diagnosing Alzheimer disease. Neuroimaging may be useful in ruling out other neurologic diagnoses. A brain biopsy is not indicated. Evaluation of blood chemistry does not include the presence of aluminum. Increased protein in a lumbar puncture is not indicative of Alzheimer dementia.

5. Parkinson disease is associated with a. demyelination of CNS neurons. b. a pyramidal nerve tract lesion. c. insufficient production of acetylcholine in the basal ganglia. d. a deficiency of dopamine in the substantia nigra.

ANS: D Parkinson disease results from degeneration of the pigmented dopaminergic neurons found in the substantia nigra. Demyelination of CNS neurons is not associated with Parkinson disease. Parkinson disease is not associated with a pyramidal nerve tract lesion. Decreased acetylcholine synthesis has been found in some studies related to Alzheimer disease.

6. Dopamine precursors and anticholinergics are all used in the management of Parkinson disease, because they a. increase dopamine activity in the basal ganglia. b. induce regeneration of neurons in the basal ganglia. c. prevent progression of N the R diseI ase.G B.C M d. produce excitation of basU al gS an g N l i a sT tructureOs. ANS: A The mainstay of Parkinson therapy has been aimed at increasing the level of dopamine in the CNS. Anticholinergics and dopamine precursors are not related to regeneration of neurons. Preventing the progression of Parkinson disease is not the mechanism of action in medications used to treat the disease. Excitation of basal ganglia structures is not produced with dopamine precursors and anticholinergics.

7. The classic manifestations of Parkinson disease include a. intention tremor and akinesia. b. rest tremor and skeletal muscle rigidity. c. ataxia and intention tremor. d. skeletal muscle rigidity and intention tremor.

ANS: B Tremor is often the first symptom of Parkinson disease that prompts patients to seek treatment. The tremor is generally at rest, unilateral affecting distal extremities. Difficulty initiating and controlling movements results in akinesia, tremor, and rigidity. The clinical manifestations of cerebellar disorders primarily include ataxia, hypotonia, intention tremors, and disturbances of gait and balance. Skeletal muscle rigidity and intention tremors are not the classic manifestations of Parkinson disease.

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank 8. What effect do demyelinating disorders such as multiple sclerosis have on neurotransmission? a. Slower rate of action potential conduction b. Increased rate of action potential conduction c. Facilitation of action potential initiation d. Faster rate of repolarization ANS: A The inflammation and scarring that occur with MS slow or interrupt the conduction of nerve impulses. Multiple sclerosis does not have an increased rate of action potential conduction on neurotransmission. Action potential initiation is not facilitated in demyelinating disorders. There is not a faster rate of repolarization in demyelinating disorders such as MS. 9. Steroids may be used in the management of acute exacerbation of symptoms in patients with multiple sclerosis, because a. viral damage can be inhibited. b. demyelination is mediated by immune mechanisms. c. steroids reverse the progression of the disease. d. steroids inhibit synaptic degradation of neurotransmitters.

ANS: B In the treatment of MS, corticosteroids such as prednisone are used to reduce edema and the inflammatory response in acute exacerbations. Steroids are not used to inhibit viral damage in patients with MS. Recovery may be hastened by the use of steroids, but the extent of recovery is unchanged. Steroids are not utilized as synaptic degradation inhibitors.

10. Upper extremity weaknessN in aR ssocIiatiG on w Bi.thCdegMeneration of CNS neurons is characteristic U S N T O of a. multiple sclerosis. b. Guillain-Barré syndrome. c. myasthenia gravis. d. amyotrophic lateral sclerosis.

ANS: D Amyotrophic lateral sclerosis (ALS) is a progressive degenerative disease affecting both the upper and lower motor neurons characterized by muscle wasting and atrophy of the hands, arms, and legs. Symptoms of multiple sclerosis include double vision, weakness, poor coordination, and sensory deficits. Patients with Guillain-Barré syndrome have progressive ascending weakness or paralysis that usually begins in the legs. Upper extremity weakness associated with degeneration of CNS neurons is not characteristic of myasthenia gravis.

11. Ascending paralysis with no loss of sensation is characteristic of a. multiple sclerosis. b. Guillain-Barré syndrome. c. myasthenia gravis. d. amyotrophic lateral sclerosis.

ANS: B

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank Patients with Guillain-Barré syndrome have progressive ascending weakness or paralysis. It usually begins in the legs, spreading often to the arms and face. Symptoms of multiple sclerosis include double vision, weakness, poor coordination, and sensory deficits.

Ascending paralysis is not characteristic of myasthenia gravis. Amyotrophic lateral sclerosis (ALS) is a progressive degenerative disease affecting both the upper and lower motor neurons characterized by muscle wasting and atrophy of the hands, arms, and legs.

12. The stage of spinal shock that follows spinal cord injury is characterized by a. reflex urination and defecation. b. autonomic dysreflexia. c. absent spinal reflexes below the level of injury. d. motor spasticity and hyperreflexia below the level of injury.

ANS: C Spinal shock may occur after injury to the spinal cord, and can last from a few hours to a few weeks. Symptoms below the level of injury include flaccid paralysis of all skeletal muscles; loss of all spinal reflexes; loss of pain, proprioception, and other sensations; bowel and bladder dysfunction with paralytic ileus; and loss of thermoregulation. Bowel and bladder dysfunction may occur with spinal shock. Spinal shock is not characterized by autonomic dysreflexia. Spinal shock is generally associated with flaccid paralysis and loss of spinal reflexes.

13. Autonomic dysreflexia is characterized by a. hypertension and bradycardia. b. hypotension and shock. c. pallor and vasoconstriction above the level of injury. d. extreme pain below theNleUvR elSoI f iN njG urTyB . .COM ANS: A Autonomic dysreflexia is a potentially life-threatening complication that may occur any time after spinal shock has resolved. It is characterized by a sudden episode of hypertension, headache, bradycardia, upper-body flushing and lower body vasoconstriction, piloerection, and sweating. Autonomic dysreflexia is associated with hypertension and lower body vasoconstriction. Extreme pain below the level of injury is not characteristic of autonomic dysreflexia.

14. It is true that Bell palsy is a a. permanent facial paralysis after stroke. b. painful neuropathic pain affecting the trigeminal nerve. c. paralysis of the muscles innervated by the facial nerve. d. herpetic outbreak in a facial dermatome.

ANS: C Bell palsy is an acute idiopathic paresis or paralysis of the facial nerve involving an inflammatory reaction. Bell palsy patients generally recover facial nerve function spontaneously within 3 weeks. Patients with Bell palsy may complain of a heavy sensation in their face. Bell palsy is not related to a herpetic outbreak.

15. A patient who experiences early symptoms of muscle twitching, cramping, and stiffness of the hands may be demonstrating signs of

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank a. b. c. d.

Guillain-Barré syndrome. amyotrophic lateral sclerosis.

Parkinson disease. hydrocephalus.

ANS: B Most patients with ALS demonstrate muscle weakness and atrophy. The earliest symptoms may be muscle twitching, cramping, and stiffness. Often the hands or upper extremities are affected first. Guillain-Barré syndrome is characterized by ascending weakness that usually begins in the legs. Tremors at rest are usually the earliest symptoms of Parkinson disease.

Hydrocephalus is characterized by abnormal accumulation of CSF in the cerebral ventricular system.

16. What type of seizure usually occurs in children and is characterized by brief staring spells? a. Epileptic b. Idiopathic c. Partial d. Absence ANS: D Absence or petite mal seizures usually occur only in children. They are very brief (2 to 10 seconds), and episodes are characterized by staring spells that last only seconds. Epilepsy refers to recurrent seizures. Idiopathic seizures are those that have no explanation for the disorder. Partial seizures are those in which activity is restricted to one brain hemisphere.

17. The initial treatment of an individual experiencing a seizure is concentrated on a. maintaining an airway.

NURSmedication.

INGTB.COM b. administering anticonvulsant c. documenting the seizure pattern. d. obtaining an EEG. ANS: A Treatment of an individual experiencing a seizure is concentrated on maintaining an airway and protecting the individual from injury. If the seizures are because of irreversible or unidentifiable factors, anticonvulsant medications specific to the type of seizure are the best management. Recording the course of the seizure episode is useful, but is not the initial focus of care. EEG studies may be useful in determining abnormalities which elicit the pathologic mechanism.

18.

is a form of spina bifida in which a saclike cyst filled with CSF protrudes through the spinal defect but does not involve the spinal cord. a. Spina bifida occulta b. Meningocele c. Myelomeningocele d. Meningomyelocele ANS: B

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank In the meningocele form of spina bifida cystica, a saclike cyst filled with CSF protrudes through the spinal defect but does not involve the spinal cord. In spina bifida occulta, the posterior vertebral laminae have failed to fuse. A myelomeningocele or meningomyelocele deformity contains meninges, CSF, and a portion of the spinal cord that protrudes from the vertebral defect in a cystlike sac.

19. It is recommended that women of childbearing age take folic acid daily for prevention of a. neural tube defects. b. seizure disorders. c. cerebral palsy. d. hydrocephalus.

ANS: A The use of folic acid during the period prior to conception has been shown to significantly decrease the risk of having a child with a neural tube defect. Folic acid does not prevent seizure disorders. An etiologic factor in the development of cerebral palsy is mechanical trauma before, during, or after birth. Hydrocephalus is not prevented with the use of folic acid.

20. Which neurologic disorder is commonly referred to as Lou Gehrig disease? a. Multiple sclerosis b. Parkinson disease c. Alzheimer disease d. Amyotrophic lateral sclerosis ANS: D ALS is also known as Lou Gehrig disease, after the famed “Iron Man” of the New York N R I G B.C M Yankees, who died from the U diseSase.NMuTltiple sO clerosis, Parkinson disease, and Alzheimer disease are not named after Lou Gehrig.

21. Which statement is true about the incidence of multiple sclerosis? a. The age of onset ranges from 20 to 50 years. b. MS is more common in men than women. c. There is a higher incidence of MS in military veterans. d. There is a higher rate of MS in African-Americans.

ANS: A The age of onset of MS ranges from 20 to 50 years. MS is two to three times more common in women than in men. There is a higher incidence of ALS in military veterans, especially those of the Persian Gulf. MS occurs at a higher rate among individuals from Caucasian northern European descent and those who live in northern latitudes.

22. Orthostatic hypotension may be a manifestation of a. Alzheimer disease. b. multiple sclerosis. c. Parkinson disease. d. amyotrophic lateral sclerosis.

ANS: C

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank In patients with Parkinson disease, involvement of the autonomic nervous system may result in orthostatic hypotension. Alzheimer disease is not typically associated with orthostatic hypotension. Orthostatic hypotension is not associated with multiple sclerosis. Amyotrophic lateral sclerosis is not manifested by orthostatic hypotension.

MULTIPLE RESPONSE 1. Which conditions are risk factors for the development of cerebral palsy? (Select all that apply.) a. Birth trauma b. Seizure disorder c. Kernicterus d. Prenatal maternal infection e. Scoliosis ANS: A, C, D Mechanical trauma to the head before, during, or after birth is a factor in cerebral palsy.

Kernicterus is an etiologic factor associated with cerebral palsy. Etiologic factors associated with cerebral palsy include prenatal infections or diseases of the mother. Seizure disorder is not associated with the development of cerebral palsy. Scoliosis may contribute to health decline in older individuals with cerebral palsy.

2. Which are common causes of acquired parkinsonism? (Select all that apply.) a. Degeneration of dopaminergic neurons b. History of infection c. History of intoxication NURSINGTB.COM d. History of trauma e. Seizure disorder ANS: B, C, D Common causes of acquired parkinsonism include infection, intoxication, and trauma.

Typically, parkinsonism caused by drug toxicity evolves rapidly, unlike the slow, insidious onset of the idiopathic disease. Parkinson disease results from degeneration of the pigmented dopaminergic neurons found in the substantia nigra. Acquired parkinsonism is not related to seizure disorder.

NURSINGTB.COM

Pathophysiology 6th Edition Banasik Test Bank Chapter 46: Alterations in Special Sensory Function Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. It is true that a conductive hearing loss a. cannot be corrected. b. is as a result of damage to hair cells in the inner ear. c. usually results from chronic exposure to loud noise. d. is because of dysfunction of outer and middle ear structures.

ANS: D Conductive hearing loss is caused by dysfunction in the external or middle ear. Conductive hearing loss is generally correctable with medical or surgical therapy. Damage to hair cells in the inner ear is not the cause of conductive hearing loss. Acquired sensorineural hearing loss is caused by chronic, repeated exposure to loud sounds.

2. Ménière disease is characterized by a. bilateral hearing impairment. b. vertigo in association with hearing loss. c. middle ear infection. d. ossification of bones in the middle ear.

ANS: B Clinical manifestations of Ménière disease include tinnitus, fluctuating sensorineural hearing loss, vertigo, and sensations of ear fullness. In the early stages, hearing loss N R I G B.C M fluctuates and is usually in t hUe l oSw t oNn e sT. ManyOinfections have been suggested as causative agents, but the precise cause cannot be established in most cases. Ménière disease is characterized by a degeneration of the neural end organs of the cochlea.

3. Myopia is as a result of an error of light refraction in which a. light rays are scattered as they pass through the cornea. b. the focal point of an image is behind the retina. c. far vision is impaired. d. accommodation is impaired.

ANS: C Myopia or nearsightedness is frequently seen in late childhood or early adolescence, and individuals with myopia are unable to see distant objects clearly. If the eye is elongated, the image focuses in front of the retina rather than on it. Myopia is not related to scattered light rays as they pass through the cornea. Myopia is not related to a focal point being behind the retina. Presbyopia is the loss of accommodative capacity.

4. Opacification of the lens is commonly referred to as a. hyperopia. b. glaucoma. c. presbyopia. d. cataract.

ANS: D

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Pathophysiology 6th Edition Banasik Test Bank Cataracts are a clouding or opacity of the lens that leads to gradual blurring of vision and eventual loss of sight. In hyperopia, light rays are focused behind the retina. Glaucoma is characterized by increased intraocular pressure and progressive loss of vision. Presbyopia is the loss of accommodative capacity.

5. A sudden onset of eye pain and impaired vision associated with pupil dilation is characteristic of a. narrow-angle glaucoma. b. open-angle glaucoma. c. cataract. d. retinal detachment.

ANS: A Primary acute angle closure glaucoma is caused by abnormality of the angle between the pupil and lateral cornea. This angle is narrow and blocks outflow of aqueous humor when the pupil is dilated. Open-angle glaucoma has an insidious onset with no symptoms in the early stages. Cataracts are a painless blurring of vision. Retinal detachment is usually spontaneous and secondary to trauma.

6. Hearing loss associated with aminoglycosides is known as a. sensorineural. b. conductive. c. presbycusis. d. otosclerosis.

ANS: A Drug toxicity is an increasingly important cause of sensorineural hearing loss. Conductive N R tioInNGin tB.C MOrnal or middle ear. Presbycusis is a Th e exte hearing loss is related to dys fUuncS sensorineural hearing loss and is most common in older adults. Otosclerosis is a progressive conductive, sensorineural, or mixed hearing impairment caused most often by stapedial fixation.

7. Expected management of acute otitis media includes a. surgical removal of debris in the middle ear. b. placement of ventilation tubes in the tympanic membrane. c. antibiotic therapy. d. adenoidectomy.

ANS: C Antibiotic therapy and control of fever is the recommended approach for some cases of acute otitis media. Management of chronic otitis media generally includes surgical removal of debris in the middle ear, placement of ventilation tubes in the tympanic membrane, and adenoidectomy to assist with eustachian tube function. Ventilation tubes may be done in cases of recurrent otitis media. Adenoidectomy in chronic otitis media may be useful in assisting with Eustachian tube function.

8. When dealing with an elderly patient with hearing loss, the nurse should a. speak loudly so that the patient can hear better. b. stand to the side of the patient, speaking into the dominant ear. c. speak at a normal rate, rhythm, and volume.

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Pathophysiology 6th Edition Banasik Test Bank d. use long sentences and draw pictures.

ANS: C Speech should be at a normal rate and rhythm and at normal volume. Shouting can distort sounds and actually make them more difficult to hear. To improve communication, adequate visual contact should be made. Lighting and positioning should be such that the individual can see the speaker’s lips. The speaker should use shorter sentences and gestures such as pointing, when appropriate.

9. A condition of ocular misalignment that causes a cross-eyed appearance is referred to as a. strabismus. b. amblyopia. c. cataract. d. retinopathy.

ANS: A Strabismus, also called squint or cross-eyedness, is a condition of ocular misalignment. The eyes appear misaligned on examination. Amblyopia is poor vision, even with the proper optical correction, in one or both eyes. Cataracts are a clouding or opacity of the lens.

Retinopathy is any disorder of the retina.

10. a. b. c. d.

is one of the most common complications of diabetes.

Cataract Diabetic retinopathy Macular degeneration Glaucoma

NURSINGTB.COM ANS: B Diabetic retinopathy is one of the most common complications of diabetes, afflicting about 20% of adults with the disease. Symptoms increase in prevalence and severity with increasing duration of illness and poorer blood sugar control. Cataract development is associated with the aging process. Age-related macular degeneration is the leading cause of blindness among people aged 55 and older. Glaucoma is an increase in intraocular pressure and is more common in people with diabetes.

11. The nurse caring for an individual with vision impairment should be prepared to a. keep the patient on bed rest to avoid injury. b. speak to the patient with a clear, loud voice. c. announcing himself or herself at all interactions. d. provide as much bright light as possible.

ANS: C Behavioral techniques for the health care professional and visually impaired individuals can promote client comfort, safety, and independence. Such techniques for the professional include announcing oneself at all interactions and explaining sensory occurrences.

Encouraging independence and social interaction often benefits individuals with vision impairment. The nurse should speak to the patient in a normal manner and announce himself or herself at all interactions. Individuals should be discouraged from using bright light, to reduce glare.

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Pathophysiology 6th Edition Banasik Test Bank 12. Nerve fibers of the system have their cell bodies in the mucous membrane of the upper and posterior parts of the nasal cavity. a. visual b. auditory c. gustatory d. olfactory ANS: D Nerve fibers of the olfactory system have their cell bodies in the mucous membrane of the upper and posterior parts of the nasal cavity. The sense of smell begins with chemical stimulation of these cells. The nerve fibers of the visual system are not found in the nasal cavity. The organ of Corti is associated with sensory fibers for hearing. The gustatory sensory receptors are related to taste.

13. A vestibular disorder that is manifested by the sensation of motion without actual motion is referred to as a. equilibrium. b. nystagmus. c. vertigo. d. effusion.

ANS: C Vertigo is a common symptom of vestibular disorders rather than a well-defined disease. It is either a sensation of motion without any actual motion or an exaggerated sense of motion.

The sense of equilibrium is responsible for balance. Nystagmus is a condition which may accompany vertigo. Effusion is an excessive accumulation of fluid.

MULTIPLE RESPONSE

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1. Which structures make up the middle ear? (Select all that apply.) a. Cerumen b. Malleus c. Incus d. Scala media e. Stapes ANS: B, C, E The tympanic membrane is connected to the first of the ossicles, the malleus (hammer), followed by the incus (anvil) and stapes (stirrup). The ossicles further amplify the sound waves and then transfer airborne sound waves to the fluid-filled inner ear at the oval window. Along the ear canal are glands that secrete cerumen. This brown, waxlike substance coats the hairs in the canal to prevent foreign bodies from entering. The scala media is one of the tubes of the cochlea, which is in the inner ear.

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Pathophysiology 6th Edition Banasik Test Bank Chapter 47: Pain Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. Pain is thought of as a. a subjective experience that is difficult to measure objectively. b. associated with changes in vital signs reflecting its intensity. c. experienced in the same way by all individuals. d. always the result of tissue damage that activates nociceptors.

ANS: A Because pain is a subjective experience, defining and assessing it are difficult. Pain is not always associated with a change in vital signs. Pain is whatever the experiencing person says it is, and may vary according to each individual. Most pain begins in the periphery when free nerve endings called nociceptors are stimulated.

2. The gate control theory of pain transmission predicts that activity in touch receptors will a. enhance perception of pain. b. decrease pain signal transmission in the spinal cord. c. activate opioid receptors in the CNS. d. increase secretion of substance P in the spinal cord.

ANS: B The gate control theory is used to explain how stimulation of large “touch” neurons could inhibit the transmission of nociceptor impulses. Central to the gate control theory is the N R I G B.C M capacity for interneurons in t U h e sSp i n aNl coTrd to mOodify the transmission of nociceptor impulses. The gate control theory is not based on a theory that activity in touch receptors will enhance perception of pain. Opioid receptors are thought to be the mediators of presynaptic inhibition. One way to inhibit synaptic transmission is through presynaptic inhibition of substance P release from nociceptor neurons.

3. Referred pain may be perceived at some distance from the area of tissue injury, but generally felt a. on the same side of the body. b. with slightly less intensity. c. within the same dermatome. d. within 10 to 15 cm area.

ANS: C Referred pain is perceived in an area other than the site of the injury. It is often felt at some distance from the point of nociceptor activation. Pain is generally referred to other structures in the same sensory dermatome. The brain cannot differentiate the two sources of pain signals and tends to attribute the visceral pain to a body surface location regardless of on which side of the body the injury occurs and on which side of the body the referred pain is felt. Referred pain is not felt with less intensity. Referred pain is not perceived at a distance that is within 10 to 15 cm.

4. Slow pain sensation is transmitted primarily by

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Pathophysiology 6th Edition Banasik Test Bank a. b. c. d.

group Ia afferents.  motor neurons. unmyelinated C fibers.

A fibers.

ANS: C The majority of pain sensations travel via C fibers and project to areas of the brain that evoke emotional responses such as displeasure and anxiety. Unmyelinated C fibers transmit pain more slowly. Pain transmitted by C fibers is poorly localized and has a dull or aching quality that lingers long after the initial sharp pain abates. Group Ia afferents are not the source of slow pain sensation. Slow pain sensation is not transmitted by  motor neurons.

The nature of the pain carried by the fast-traveling A fibers is characterized as sharp, stinging, and highly localized.

5. Which treatment is helpful in neuropathic pain but not used for acute pain? a. Narcotic analgesics b. Nonsteroidal anti-inflammatory drugs and aspirin c. Anticonvulsants d. Nonnarcotic analgesics ANS: C Management of pain associated with neuralgia includes antiseizure medications. Narcotic analgesics are discouraged for long-term therapy. NSAIDs and aspirin are not indicated for treatment of neuropathic pain. Management of neuralgia includes topical and systemic therapies.

6. The physiologic mechanism e pCain Ns inRUvolSIvedNGinTtBh. OMphenomenon are termed a. nociception. b. sensitization. c. neurotransmission. d. proprioception.

ANS: A The physiologic mechanisms involved in the pain phenomenon are termed nociception.

Sensitization is not the physiologic mechanism of pain phenomena. Neurotransmission is not related to the physiologic pain mechanism. The physiologic mechanisms involved in the pain phenomenon are not known as proprioception.

7. It is useful to conceptualize pain physiology according to the four stages because each stage provides an opportunity for a. education. b. stimulation. c. intervention. d. documentation.

ANS: C

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Pathophysiology 6th Edition Banasik Test Bank It is clinically useful to conceptualize pain physiology according to these four processes, because each stage provides an opportunity for intervention in the pain experience. It is more useful to provide intervention for the patient experiencing pain. Stimulation may actually increase the pain level for the patient. Documentation of findings is appropriate, but taking measures to reduce or stop the pain is more advantageous.

8. Most sensory afferent pain fibers enter the spinal cord by way of the a. anterior b. posterior c. C fiber d. anterolateral

nerve roots.

ANS: B Most sensory afferent pain fibers enter the spinal cord by way of the posterior nerve roots.

The cell bodies of pain neurons are located in the dorsal root ganglion. Sensory afferent pain fibers do not enter the spinal cord by way of anterior nerve roots. Pain transmitted by C fibers is poorly localized and transmitted slowly. Many neurons originating in lamina I cross the spinal cord to activate neurons in the anterolateral tract.

9. The is the level of painful stimulation required to be perceived. a. perception b. tolerance c. expression d. threshold ANS: D Pain threshold is the level of painful stimulation required to be perceived and is remarkably N R Ie r .GPTercepti B.C O Mon includes an awareness and interpretation similar from one individual tU o a nSo t h N of the meaning of the sensation. Pain perception is influenced by attention, distraction, anxiety, fear, fatigue, and previous experience and expectations. Pain tolerance is the degree of pain that one is willing to bear before seeking relief. Pain tolerance varies widely among individuals and within the same individual under differing conditions. Pain expression is the way in which the pain experience is communicated to others. Pacing, writhing, jaw clenching, facial grimacing, muscle guarding, crying, moaning, groaning, and verbal descriptions may be used to express pain.

10. Modulation of pain signals is thought to be mediated by the release of a. histamine. b. endorphins. c. cholecystokinin. d. glutamine.

ANS: B Pain modulation occurs not only at the cord level but also in the brain itself. Opioids such as endorphins produced in the brain are thought to be important modulators of pain perception.

Histamine is a chemical mediator of pain which is involved in the transduction phase.

Cholecystokinin is a substance involved in synaptic transmission in the spinal cord. The excitatory neurotransmitter glutamate is involved in carrying the nociceptive message from primary afferent fibers to secondary neurons.

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Pathophysiology 6th Edition Banasik Test Bank 11. One of the most common causes of acute pain is a. headache. b. fibromyalgia. c. malignancy. d. trigeminal neuralgia.

ANS: A Headache is one of the most common causes of acute pain, accounting for approximately 13 million visits each year in the Unites States to physician’s offices, urgent care clinics, and emergency departments. Fibromyalgia syndrome is a chronic pain syndrome. Cancer pain is a subcategory of chronic pain, although it may be acute. Trigeminal neuralgia is a form of neuropathic pain.

12. A patient presenting with a severe, pounding headache accompanied by nausea and photophobia is likely experiencing a headache. a. tension b. migraine c. sinus d. chronic ANS: B Typical signs of a migraine headache include severe unilateral pounding or throbbing pain that may be accompanied by nausea, vomiting, photophobia, phonophobia, and lacrimation.

A severe, pounding headache with nausea and photophobia is likely to be a migraine headache. A sinus headache is not typically associated with nausea and photophobia. Pain is considered chronic when it lasts more than several months beyond the expected healing time.

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13. Pain that waxes and wanes and is exacerbated by physical exertion is likely related to a. neuralgia. b. intermittent claudication. c. fibromyalgia syndrome. d. neuropathy.

ANS: C Patients complain of pain that waxes and wanes and that does not follow a dermatomal pattern in fibromyalgia syndrome. The pain tends to be exacerbated by physical exertion.

Trigeminal neuralgia is a form of neuropathic pain that can be quite disabling for patients. It is sudden, momentary, but excruciating pains along the second and third divisions of the trigeminal nerve. In the early stages, intermittent claudication is associated with physical activity and alleviated with rest and has a cramping quality. In severe cases, ischemic neuropathy may ensue and cause a more consistent burning, shooting pain in the leg or foot.

In pain related to neuropathy, patients complain of burning pain in the distal bilateral lower extremities that is frequently worse at night.

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Pathophysiology 6th Edition Banasik Test Bank Chapter 48: Neurobiology of Psychotic Illnesses Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. Schizophrenia is characterized by a. generalized anxiety. b. depression. c. disorganized thinking. d. eating disorders.

ANS: C Schizophrenia is now correctly understood as a split or separation among normally well-synchronized brain functions. This loss of synchronized brain functioning leads to thoughts, behaviors, and feelings that are disordered, disorganized, and disconnected from reality. Generalized anxiety and eating disorders are not associated with schizophrenia.

Schizophrenia is not characterized by depression.

2. The usual age of onset for schizophrenia in men is a. before puberty. b. 15 to 25 years. c. 40 to 65 years. d. after 65 years.

ANS: B The most common age of onset and diagnosis is between 15 and 25 years for men. Women Ne enRS25IaNG B.C Ms. Most persons first diagnosed with are typically diagnosed betw U nd T 35 yearO schizophrenia are between the ages of 15 and 54 years. The usual age of onset of schizophrenia occurs before the age of 25.

3. Which manifestation is characteristic of the “positive” symptoms of schizophrenia? a. Social withdrawal b. Flat affect c. Lack of speech d. Hallucinations ANS: D Positive symptoms include the psychotic dimension, or distortions in thought content (delusions) and perception (hallucinations), as well as the disorganization dimension, or disorganization in speech and behavior. Asociality is considered a negative symptom. Flat affect is considered to be a cognitive symptom. Lack of speech is not considered to be a positive symptom of schizophrenia.

4. It is true that the “negative” symptoms of schizophrenia a. are more easily managed than the positive symptoms. b. are thought to be mediated by D1 receptors in the brain. c. include rambling speech and delusional thoughts. d. are as a result of a deficiency of brain dopamine.

ANS: B

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Pathophysiology 6th Edition Banasik Test Bank Negative symptoms of schizophrenia are thought to be associated with dopamine D1 receptor activity in the brain. Negative symptoms can be more difficult to recognize than positive symptoms. Rambling speech and delusional thoughts are positive symptoms. The positive symptoms of schizophrenia are thought to result from excessive dopamine D2 receptor activity in the brain.

5. Depression is thought to be associated with a. abnormal personality development. b. early childhood emotional trauma. c. deficient brain norepinephrine and serotonin. d. excessive stimulation of D1 and D2 receptors in the brain.

ANS: C Depression is thought to occur when serotonin and norepinephrine activity in the brain is low. Depression is not associated with abnormal personality development. Early childhood emotional trauma is not necessarily associated with depression. Symptoms associated with schizophrenia are thought to be related to dopamine receptors.

6. Mania and depression are both characterized by a. high energy and hyperactivity. b. poor appetite. c. hopelessness. d. altered decision making ability.

ANS: D Depression is manifested by reduced decision making capacity and mania is manifested by an inability to concentrate. High energy and hyperactivity is seen in mania only. Depression Ne, wRSh eIrNeGa s T B.C Ms associated with an increased appetite. is manifested by poor appetitU mania iO Hopelessness is associated with depression.

7. Lithium is used to manage mania because it a. inhibits norepinephrine and serotonin activity in the brain. b. is a CNS sedative. c. is converted to catecholamines within the brain. d. blocks D2 receptors in the brain.

ANS: A The management of mania is accomplished with the use of lithium because it inhibits the action of norepinephrine and serotonin in the brain. Mania is not managed with the use of a CNS sedative. The mechanism of lithium is not related to a conversion of catecholamine in the brain. Lithium does not have a mechanism of action where D2 receptors in the brain are blocked.

8. Drugs that inhibit reuptake of norepinephrine or serotonin may be helpful in the management of a. schizophrenia. b. panic attacks. c. depression. d. delusional disorder.

ANS: C

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Pathophysiology 6th Edition Banasik Test Bank The management of major depressive disorder is aimed at increasing norepinephrine and serotonin activity in the brain. The goal of therapy in the management of schizophrenia is to alleviate some of the negative symptoms by blocking D1 receptors. Drugs that inhibit the reuptake of norepinephrine or serotonin are not useful in managing panic attacks. Delusional disorder is not managed with drugs that inhibit the reuptake of norepinephrine or serotonin.

9. A client who reported hearing voices, some of them saying bad and hurtful things, will now eat only food from unopened sealed packages. The behaviors described indicate that the patient may be experiencing symptoms. a. bipolar b. obsessive-compulsive c. personality d. psychotic ANS: D Psychosis associated with MDD is thought to result from extreme symptoms of a prolonged duration. Auditory hallucinations, delusions, and disorganization may become prominent symptoms. Bipolar disorder is characterized by recurring symptoms of depression and elation. Obsessive-compulsive disorder is not typically evidenced by withdrawn behavior or auditory hallucinations. Withdrawn behavior and auditory hallucinations are symptoms of psychosis.

10. The symptoms of hallucinations and paranoia that accompany schizophrenia are thought to be as result of altered neurotransmitter activity in the brain, which results in excessive receptor activation. a. D2 b. serotonin NURSINGTB.COM c. -adrenergic d. acetylcholine ANS: A The positive symptoms of schizophrenia are thought to result from excessive dopamine D2 receptor activity in the brain. Depression is thought to be related to decreases in serotonin.

Hallucinations and paranoia that accompany schizophrenia are not the result on excessive -adrenergic receptor activation. Excessive acetylcholine receptor activation is not the cause of hallucinations or paranoia.

11. The assessment of a client recently diagnosed with schizophrenia confirms good cognitive function and reveals affect that is animated. The client is open about describing the voices and the content of their comments, but demonstrates a disorganized thought process. These findings suggest that a. “negative” psychotic symptoms predominate. b. there is a high risk for suicidal behaviors. c. drug therapy is likely to be ineffective. d. “positive” psychotic symptoms predominate.

ANS: D

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Pathophysiology 6th Edition Banasik Test Bank Positive symptoms of schizophrenia include the psychotic dimension and distortions of thought and perception, as well as the disorganization dimension. Auditory hallucinations are commonly experienced as voices. Negative symptoms are considered to be restricted affect, or asociality. The patient in this scenario does not appear to be at high risk for suicidal behaviors. The findings suggested do not indicate that the patient has ineffective drug therapy.

12. Drug therapy with a dopamine receptor antagonist is initiated to manage a patient’s symptoms of schizophrenia. The goal of treatment is to a. increase dopamine activity. b. reduce serotonin activity. c. stabilize dopamine activity. d. effect serotonin and norepinephrine neurotransmitters.

ANS: C The aim for effective antipsychotic medication is to stabilize, rather than reduce, dopamine activity. The newest medications show greater affinity for serotonin receptors (negative symptoms) and moderate affinity for dopamine and norepinephrine receptors (positive symptoms).

13. A mild form of hyperactivity in which social functioning is not significantly impaired is called a. anhedonia. b. dysphoria. c. dysthymia. d. hypomania.

N R I G B.C M

U S N T O ANS: D The individual experiencing hypomania has a sudden onset of increased energy, expanded self-esteem, and decreased anxiety; these typically are reported to have improved his or her productivity and are experienced as an acceptable natural high. Anhedonia is a loss of pleasure. Dysphoria is not a condition in which social functioning is not impaired.

Depression with one or two symptoms that last 2 years or more is commonly referred to as dysthymia.

14. In youth, it is estimated that ages of 13 and 18 years. a. 5% b. 26.2% c. 46.3% d. 75%

will be diagnosed with serious mental illness between the

ANS: C In youth, 46.3% will be diagnosed with serious mental illness between the ages of 13 and 18 years. In the United States today, approximately 5% of all adults meet criteria for serious mental illness. 26.2% of the U.S. adult population will have experienced an SMI in the previous year. 75% of youth are not diagnosed with serious mental illness.

15.

is a term used to describe a serious and debilitating mental state. a. Psychosis

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Pathophysiology 6th Edition Banasik Test Bank b. Schizophrenia c. Major depressive disorder d. Dysthymia ANS: A Psychosis is a term used to describe a serious and debilitating mental state. The narrowest definition refers to delusions and prominent hallucinations. Schizophrenia refers to a chronic, remitting, and relapsing psychotic disorder. Major depressive disorder involves a complex diagnosis which encompasses depression symptoms. Dysthymia is associated with long-term depression.

16. Childlike silliness in a patient with schizophrenia is known as a. delusions. b. disorganized thinking. c. grossly disorganized behavior. d. asociality.

ANS: C Grossly disorganized behavior can range from childlike silliness to unpredictable agitation, and impairs tasks of daily living. Delusions, or systematic, fixed, false beliefs, usually involve themes of persecution, REF, somatization, religiosity, or grandiosity. Disorganized thinking is usually evaluated by an individual’s speech, and is frequently characterized by frequent derailment or loose associations, invented words, tangential idea, and, when most severe, incomprehensible speech. Asociality is a negative symptom of schizophrenia.

17. The schizophrenia category which indicates that the disturbance has continued but the active-phase symptoms areNno R l o n gIe r m Ge t Bis.thCe M Type. a. Residual U S N T O b. Undifferentiated c. Paranoid d. Disorganized ANS: A The Residual Type indicates that the disturbance has continued but the active-phase symptoms are no longer met. The Undifferentiated Type is essentially a catch-all category where the individual does not meet criteria for any of the other subtypes. The Paranoid and Disorganized Types are the least severe (in that order). The Paranoid and Disorganized Types are the least severe (in that order).

18. Researchers suggest a mediating role between the later development of schizophrenia and a. prenatal radiation exposure. b. prenatal influenza exposure. c. childhood vaccinations. d. childhood chickenpox.

ANS: B

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Pathophysiology 6th Edition Banasik Test Bank Researchers have suggested that delivery complications could be a factor, playing a mediating role between prenatal influenza exposure and later development of schizophrenia.

Prenatal radiation exposure is not a suggested mediator in the development of schizophrenia. The development of later schizophrenia is not suggested to be associated with childhood vaccinations. It is not suggested that childhood chickenpox is related to the development of schizophrenia.

19. The action of most antidepressants currently available is to a. improve brain norepinephrine and serotonin activity. b. inhibit norepinephrine and serotonin activity. c. convert into catecholamines in the brain. d. block D2 receptors in the brain.

ANS: A Most currently available antidepressants act by improving brain norepinephrine and serotonin activity. Earlier generations of antidepressants had less specific effects on these neurotransmitters and significantly more side effects. The action of antidepressants is unrelated to conversion of catecholamines in the brain. D2 receptors in the brain are not blocked by antidepressants.

20. Which statement is true about the incidence of mental illness? a. There are minimal differences in how cultures view mental health. b. Women have twice the risk of experiencing anxiety disorders than men. c. Men are more likely to suffer from depression and anxiety than women are. d. Mood disorders are not likely to occur after the age of 65.

ANS: B NURSINGTB.COM Women are more than twice as likely to suffer from depression (including unipolar depression, dysthymia) and anxiety disorders (including panic disorder, post-traumatic stress disorder, generalized anxiety disorder, social anxiety, and phobias) than men. There are known differences in how cultures and regions around the world view mental health, and thus in how they express concerns about the body, self, and emotions. Reproductive hormones may play a role in exacerbating anxiety and depression in women. Mood disorders in the elderly are likely to be associated with concomitant illnesses or treatment.

21. An elderly patient is taking antipsychotic drugs and begins to develop involuntary chewing motions. The patient is likely exhibiting signs of a. dementia. b. Parkinson disease. c. tardive dyskinesia. d. dysthymia.

ANS: C Older patients may suffer side effects such as tardive dyskinesia, a disorder related to antipsychotic drug dosage and duration and characterized by involuntary chewing motions and darting of the tongue. It is generally accepted practice that antidepressants should be prescribed at lower dosages and titrated upward more slowly in the elderly. Antipsychotic medication use is not related to the development of dementia. Parkinson disease is not diagnosed by involuntary chewing motions. Dysthymia is related to major depressive disorder.

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Pathophysiology 6th Edition Banasik Test Bank

MULTIPLE RESPONSE 1. When a client is diagnosed with schizophrenia and asks what could have caused the disorder, the statements that could serve as a basis for answering include which of the following? (Select all that apply.) a. Schizophrenia may be related to abnormal cerebral structure. b. Schizophrenia is inherited as an autosomal recessive gene defect. c. Schizophrenia often develops in the absence of family psychopathology. d. Chronic prolonged stress may contribute to development of schizophrenia. e. Symptoms of schizophrenia may be associated with smoking.

ANS: A, C, D A groundbreaking study showed that the neurochemical basis of schizophrenia might involve two processes: dopamine neurotransmission dysregulation and abnormal cerebral structure. Schizophrenia can and does develop in persons with no family history. In MRI studies of persons with schizophrenia, a link was found when psychological stress was placed on an individual. Genetic studies have found that the percentage of offspring who do and do not develop schizophrenia is about equal. Tobacco dependence is a common secondary disorder with schizophrenia.

2. Which symptoms would support a diagnosis of major depressive disorder? (Select all that apply.) a. Diminished interest or pleasure b. Incomprehensible speech c. Altered reality NURSINGTB.COM d. Psychomotor agitation or retardation e. Appetite disturbance ANS: A, D, E To be diagnosed with MDD, an individual must experience five (or more) specified symptoms during the same 2-week period; this must also represent a change from previous functioning. In addition, at least one of the symptoms must be either depressed mood or loss of interest or pleasure. Symptoms include depressed mood, diminished interest or pleasure, appetite disturbance, insomnia, hypersomnia, psychomotor agitation, or retardation.

Incomprehensible speech is associated with a positive symptom of schizophrenia. Altered reality is a symptom of psychosis.

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Pathophysiology 6th Edition Banasik Test Bank Chapter 49: Neurobiology of Nonpsychotic Illnesses Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. Tachycardia is a common finding in individuals with a. panic attacks. b. generalized anxiety disorder. c. obsessive-compulsive disorder. d. bipolar disorder.

ANS: A Physical symptoms of panic disorder include heart palpitations and tachycardia in addition to chest pains. Palpitations may occur in generalized anxiety disorder. The hallmarks of OCD are obsessions and compulsions. Bipolar disorder is not typically associated with cardiac symptoms.

2. Individuals with obsessive-compulsive disorder a. are not aware that obsessive thoughts are from their own brains. b. may become highly anxious if prevented from performing rituals. c. have disordered thinking and poor reality orientation. d. have a severe, unmanageable psychotic illness.

ANS: B Anxiety is frequently associated with the symptoms of OCD, and yielding to compulsions decreases anxiety temporarily. People with OCD typically strive to avoid disclosing their Ns, aRSn dIhNeGa l tB.C Th profeMO symptoms to relatives, friendU ssionals. Disordered thinking and poor reality orientation are not associated with OCD patients. Individuals with OCD do not have severe psychotic illness.

3. The fearful expectation of panic anxiety is known as a. a nervous breakdown. b. anticipatory anxiety. c. a phobia. d. avoidance anxiety.

ANS: B Anticipatory anxiety refers to fearful expectation of panic anxiety onset. Patients may seek medical attention for what they perceive as a nervous breakdown. Panic attacks can be situational. Avoidance anxiety refers to personal strategies used to increase feelings of control and thereby decrease the risk of panic anxiety.

4. It is true that panic disorders a. are diagnosed more often in women. b. are diagnosed more often in men. c. generally occur after age 45. d. are common in the elderly.

ANS: A

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Pathophysiology 6th Edition Banasik Test Bank Depending on the subtype, panic disorder is diagnosed two to three times more often in women than in men. Panic disorders are diagnosed more often in women. Initial onset usually occurs in late adolescence or young adulthood, with a mean age of onset of 26.6 years. Initial symptom onset in older age adults is less typical.

5. Early treatment of panic anxiety disorder focuses on a. the use of sedative agents. b. cognitive-behavioral therapy. c. dopamine antagonistic medications. d. the use of respiratory stimulants.

ANS: B Panic anxiety disorder can be effectively managed with cognitive-behavioral therapy aimed at reducing fearful thinking and desensitization of cognitive and physical stress responses.

When panic symptoms are disabling, medication for symptom management is recommended. Long-acting benzodiazepines, such as clonazepam, are the sedatives of choice when short-term calming and symptom relief are mandatory. Many atypical psychiatric medications that can target serotonin, dopamine, or norepinephrine receptors have been clinically tested and shown to be effective treatment for anxiety symptoms.

Respiratory stimulants have not been found to be effective in early treatment of panic anxiety disorders.

6. A patient who experiences sudden-onset, acute fearfulness for no apparent reason has a disorder called a. generalized anxiety disorder. b. phobia. c. panic disorder.

NURSINGTB.COM d. posttraumatic stress disorder.

ANS: C Panic disorder is characterized by acute episodes of anxiety symptoms that are unexpected, sudden, recurrent, and generate intense feelings of fear. Generalized anxiety disorder is characterized by chronic, persistent worry. Phobias are not related to anxiety, which occurs for no apparent reason. While PTSD is an anxiety disorder it has a known traumatic cause.

7. Persistent, intrusive, uncontrollable thoughts that an individual recognizes as a product of his or her own mind are called a. compulsions. b. delusions. c. obsessions. d. hallucinations.

ANS: C Obsessions are strong, persistent, intrusive, uncontrollable thoughts. Compulsions are repetitive, ritualistic behaviors (e.g., handwashing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person performs with urgency and rigidly. Delusions are not persistent, intrusive, uncontrollable thoughts. Hallucinations are not persistent, intrusive, uncontrollable thoughts that an individual recognizes as a product of his or her own mind.

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Pathophysiology 6th Edition Banasik Test Bank 8. An anxiety disorder that is precipitated by a traumatic event is known as a. generalized anxiety disorder. b. posttraumatic stress disorder. c. panic disorder. d. phobia.

ANS: B PTSD is currently classified as an anxiety disorder and is related to a traumatic event.

Generalized anxiety disorder is not precipitated by a traumatic event. Panic disorder is characterized by acute episodes of anxiety symptoms. Phobias are not related to traumatic events.

9. Repetitive or ritualistic acts that a person performs with urgency are referred to as a. obsessions. b. delusions. c. hallucinations. d. compulsions.

ANS: D Compulsions are repetitive, ritualistic behaviors (e.g., handwashing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person performs with urgency and rigidly. Obsessions are strong, persistent, intrusive, uncontrollable thoughts.

Delusions are not acts that are performed by a person in a ritualistic manner. Hallucinations are not repetitive or ritualistic acts performed with urgency.

10. In individuals dealing with obsessive-compulsive disorder, obsessions and compulsionN s. R I G B.C M U S N T O a. 20% b. 28% c. 50% d. 90%

are most bothered by both

ANS: C Fifty percent of people with OCD are most bothered by both obsessions and compulsions.

Twenty percent are bothered by compulsions only. Twenty-eight percent of people with OCD are bothered by obsessions only. Ninety percent of patients have features of both obsessions and compulsions.

11. A person who frequently spends hours each day attending to hand hygiene is referred to as a a. hoarder. b. washer. c. checker. d. counter.

ANS: B “Washers” constitute 25% to 50% of the OCD samples and are concerned with dirt, contaminants, and germs; the person frequently spends hours each day washing hands or showering. “Hoarding,” the inability to dispossess meaningless, worthless objects, is one example of more complex compulsions. “Checkers” compulsively check to see if they have done something, such as run over someone with a car or left the door unlocked. One syndrome of OCD is related to excessive counting or ordering.

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Pathophysiology 6th Edition Banasik Test Bank

12. PET scans performed on the brains of individuals diagnosed with obsessive-compulsive disorder (OCD) have shown a. decreases in glucose metabolism. b. increases in glucose metabolism. c. increases in serotonin activity. d. decreases in serotonin activity.

ANS: B OCD studies using PET brain scans have shown significant increases in glucose metabolism rates in the frontal lobes, caudate nucleus, and cingulate gyrus regions of the brain. OCD studies using PET scans have shown increases in glucose metabolism. Serotonin activity is related to generalized anxiety disorder. OCD studies have not revealed a correlation in serotonin activity.

13. The first-line treatment for posttraumatic stress disorder (PTSD) is a. adrenergic blockers. b. benzodiazepines c. tricyclic antidepressants. d. selective serotonin reuptake inhibitors.

ANS: D SSRIs are the first-line treatment for PTSD and are associated with marked improvement.

Adrenergic blockers show some improvement with both PTSD and acute stress disorder symptoms. Benzodiazepines are not the first-line treatment for PTSD. TCAs have not been reported to be very effective in the management of PTSD.

N R I G B.C M

NnitT 14. As many as of childrenUin tS he U ed StateO s a g e d 3 to 17 years are affected by some type of neurodevelopmental disorder. a. 5% b. 12% c. 25% d. 30% ANS: B As many as 12% of children in the United States aged 3 to 17 years are affected by at least one neurodevelopmental disorder, such as ADHD, a learning disorder, or an intellectual disability. More than 5% of children in the United States are affected by some type of neurodevelopmental disorder. Less than 25% of children are affected by neurodevelopmental disorders. Less than 30% of children in the United States are affected by some type of neurodevelopmental disorder.

15. Studies on brain neuroanatomy and neurocircuitry suggest that posttraumatic stress disorder (PTSD) patients show left hippocampus volumes compared with control subjects. a. decreased right and b. increased right and c. decreased right and increased d. increased right and decreased ANS: A

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Pathophysiology 6th Edition Banasik Test Bank Multiple studies on brain neuroanatomy and neurocircuitry suggest that PTSD patients show decreased right and left hippocampus volumes compared to traumatized and nontraumatized control subjects. It remains unclear about whether hippocampi size plays a role in contributing to vulnerability to PTSD. Limited research is available to compare before and after PTSD treatment. Multiple studies on brain neuroanatomy and neurocircuitry suggest that PTSD patients show decreased right and left hippocampus volumes compared to traumatized and nontraumatized control subjects.

16. The most common childhood psychiatric disorder is a. bipolar disorder. b. attention-deficit hyperactivity disorder. c. autism spectrum disorder. d. psychosis.

ANS: B ADHD is the most common childhood psychiatric disorder. It typically begins in childhood and continues throughout adolescence and adulthood. The most common childhood psychiatric disorder is not bipolar disorder. Autism spectrum disorder is not the most common childhood psychiatric disorder. Psychosis is not the most common childhood psychiatric disorder.

17. Children with social or communication deficits, fixated interests, and repetitive behaviors are likely exhibiting symptoms of a. attention deficient hyperactivity disorder (ADHD). b. a learning disorder. c. inattention. d. autism spectrum disordN erU . RSINGTB.COM ANS: D Autism spectrum disorder is defined by a common set of behaviors: social/communication deficits and fixated interests and repetitive behaviors. ADHD is characterized by difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity). Learning disorders are a form of neurodevelopmental disorders in children.

Inattention is not exhibited by social or communication deficits.

MULTIPLE RESPONSE 1. Which disorders are classified as anxiety related? (Select all that apply.) a. Panic b. Generalized anxiety c. Obsessive-compulsive d. Borderline personality e. Attention-deficit hyperactivity disorder ANS: A, B, C Panic disorder is characterized by acute episodes of anxiety. Generalized anxiety disorder is considered to be anxiety related. Obsessive-compulsive disorder is considered to be an anxiety disorder. Borderline personality is not associated with anxiety disorders. ADHD is a common childhood psychiatric disorder.

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Pathophysiology 6th Edition Banasik Test Bank 2. Which statements are true about posttraumatic stress disorder (PTSD)? (Select all that apply.) a. PTSD occurs up to 1 month after an event. b. PTSD is an acute condition. c. Remission may take as long as 3 to 4 years. d. Women appear to take longer to recover from PTSD than men. e. Acute stress disorder and PTSD are precipitated by a traumatic event.

ANS: D, E Women appear to take four times longer to recover from PTSD than men, and are two times more likely to meet the criteria for PTSD than men. Acute stress disorder is very similar to PTSD, as both are precipitated by a traumatic event. Acute stress disorder occurs up to 1 month after the event; PTSD occurs beyond 1 month. PTSD is typically a chronic condition.

One longitudinal study with young adults reported that more than half of the sample showed no signs of remission after a 3- to 4-year period.

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Pathophysiology 6th Edition Banasik Test Bank Chapter 50: Structure and Function of the Musculoskeletal System Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. Osteoclast activity leads to a. hardening of the bones. b. resorption of bone. c. deposition of bone. d. arthritis.

ANS: B Osteoclast activity leads to resorption of bone. Osteoclast activity does not lead to hardening of the bones, deposition of bone, or arthritis.

2. Osteoblastic activity is greatest a. in areas of increased mechanical stress. b. during menopause. c. with vitamin D deficiency. d. with disuse because of immobility.

ANS: A Osteoblastic activity is greatest in areas of increased mechanical stress. Decreased estrogen during menopause decreases osteoblastic activity. Vitamin D deficiency and disuse because of immobility increase bone resorption.

3.

N R I G B.C M

O Diarthroses are joints that U S N T a. hold the skull bones together. b. allow little or no joint movement. c. contain synovial fluid. d. connect bony segments by a fibrocartilaginous plate.

ANS: C Diarthroses are joints that contain synovial fluid. Suture joints are found in the skull. A fibrous joint allows for little or no movement. A symphysis joint connects bony segments by a fibrocartilaginous plate.

4. Articular cartilage is avascular and a. completely incapable of regeneration. b. nonliving. c. nourished by synovial fluid. d. rarely damaged.

ANS: C Articular cartilage is avascular and nourished by synovial fluid. Articular cartilage is very limited in its ability to regenerate. Articular cartilage is living material and is frequently damaged.

5. The primary determinant of tendon strength is a. collagen cross-linking.

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Pathophysiology 6th Edition Banasik Test Bank b. actin-myosin cross-bridging. c. elastin composition. d. calcium balance.

ANS: A The primary determinant of tendon strength is collagen cross-linking. The primary determinant of tendon strength is not actin-myosin cross-bridging or calcium balance.

Tendons contain very little elastin.

6. Troponin is a muscle protein that a. binds the myosin protein to form cross-bridges. b. forms the noncontractile Z lines. c. binds calcium and regulates tropomyosin. d. hydrolyzes ATP to provide energy for contraction.

ANS: C Troponin is a muscle protein that binds calcium and regulates tropomyosin. Troponin does not bind the myosin protein to form cross-bridges, form the noncontractile Z lines, or hydrolyze ATP to provide energy for contraction.

7. The neurotransmitter released from the -motor neuron at the motor end-plate is a. norepinephrine. b. epinephrine. c. serotonin. d. acetylcholine.

ANS: D The neurotransmitter releasNedUfRroSmItNheGT-B m. otC orOnM euron at the motor end-plate is acetylcholine, which then stimulates muscle fibers to shorten during muscle contraction.

Norepinephrine, epinephrine, and serotonin are not the neurotransmitters released from the -motor neuron at the motor end-plate.

8. A concentric contraction results in a. muscle shortening. b. no change in muscle length. c. muscle lengthening. d. muscle damage.

ANS: A A concentric contraction results in muscle shortening. An isometric contraction results in no change in muscle length. An eccentric contraction results in muscle lengthening. Concentric contraction does not result in muscle damage.

9. Moderate stretching of a muscle at rest results in a(n) a. more forceful contraction when stimulated. b. inefficient use of ATP. c. more rapid onset of muscle fatigue. d. reduced force of contraction.

ANS: A

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Pathophysiology 6th Edition Banasik Test Bank Moderate stretching of a muscle at rest results in a more forceful contraction when stimulated. Moderate stretching of a muscle at rest is not an inefficient use of ATP. Fatigue results when ATP is depleted faster than it can be replaced. Moderate stretching of a muscle at rest results in a more forceful contraction, not a weaker contraction, when stimulated.

10. When oxygen for muscle activity from the respiratory vascular systems is insufficient for muscle activity, the body breaks down glucose, which results in a. hypoglycemia. b. lactic acid buildup in muscle. c. a large energy source. d. exhaustion.

ANS: B During strenuous exercise, when oxygen supplies become insufficient, glucose is broken down for energy and lactic acid builds up in the muscle, which leads to muscle aching.

Hypoglycemia may develop during strenuous exercise as glucose moves into skeletal muscle cells, but this does not answer the given question. The energy provided from break down of glucose is minimal, but instead the breakdown leads to lactic acid buildup in a muscle. Exhaustion may result from continued strenuous exercise, but not from breakdown of glucose to meet energy needs.

11. The largest component of bone is a. calcium. b. water. c. vitamin D. d. osteoblasts.

N R I G B.C M

U S N T O ANS: A Seventy percent of bone weight is calcium, along with phosphate. Water accounts for only 5% of bone weight. Vitamin D assists in absorption of dietary calcium and other functions, but it is not a component of bone. Osteoblasts are a component of the organic matrix of bone, which comprises only 25% of bone.

12. The epiphyseal plate a. provides support to long bones. b. prevents overactivity of osteoblasts. c. allows for continued bone lengthening during maturation. d. has an unknown function.

ANS: C The epiphyseal plate allows for continued bone lengthening during growth. The epiphyseal plate does not provide support to long bones or prevent overactivity of osteoblasts. The epiphyseal plate has a known function of allowing for continued bone lengthening during growth.

13. The correct sequence of bone healing following fracture is a. hematoma formation, callous formation, fibrocartilage formation, ossification, remodeling. b. hematoma formation, callous formation, fibrocartilage formation, remodeling, ossification.

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Pathophysiology 6th Edition Banasik Test Bank c. callous formation, hematoma formation, fibrocartilage formation, ossification, remodeling. d. hematoma formation, fibrocartilage formation, callous formation, ossification, remodeling.

ANS: D The correct sequence of bone healing is hematoma formation, fibrocartilage formation, callous formation, ossification, remodeling.

14. Menisci facilitate the rotation of the a. neck. b. elbow. c. knee. d. spine.

ANS: C Menisci facilitate rotation of the knee and can be torn during sporting activities. Menisci facilitate rotation of the knee, not the neck. The elbow bends like a hinge and is not capable of rotating. Intervertebral disks allow slight movement of the spine.

15. Radicular pain is pain caused by a a. tissue injury. b. compressed nerve. c. fracture of long bones. d. meniscal tear.

ANS: B RpSrI Radicular pain is pain fromNcU om esN seG dT neBrv.eCfiO bM ers secondary to spinal disk displacement.

Radicular pain is not from fractures of long bones, meniscal tears, or tissue injury.

16. It is true that synovial fluid a. is found in spinal disks. b. provides protection. c. is reduced in volume with injury. d. becomes thinner with aging.

ANS: B Synovial fluid provides protection within joints by reducing friction between the joint capsule and joint surfaces. Synovial fluid is found in joints, not spinal disks. The fluid increases in volume with injury or inflammation. Synovial fluid thickens with aging.

17. The structures that connect muscle to bone are referred to as a. ligaments. b. tendons. c. trabeculae. d. synovial sheaths.

ANS: B The structures that connect muscle to bone are tendons. Ligaments connect bone to bone.

Trabeculae are thin plates of bone within the center of long bones. Synovial sheaths are a covering of synovial joints.

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Pathophysiology 6th Edition Banasik Test Bank

18. The electrolyte that must be present in cellular cytoplasm for muscle contraction to occur is a. potassium. b. sodium. c. magnesium. d. calcium.

ANS: D Calcium must be present in the cellular cytoplasm for muscle contraction to occur because without it cross-bridging cannot occur. Calcium, not potassium, must be present in the cellular cytoplasm for muscle contraction to occur. Sodium does not affect muscle contraction. Magnesium does not need to be present in the cellular cytoplasm for muscle contraction to occur.

MULTIPLE RESPONSE 1. The parathyroid gland functions to facilitate (Select all that apply.) a. calcium absorption from the gut. b. bone resorption. c. calcium reabsorption in the kidneys. d. vitamin C action. e. osteoblast production.

ANS: A, B, C Parathyroid hormone facilitates calcium absorption from the gut, bone resorption to maintain a normal serum calcium level, and calcium reabsorption in the kidneys based on body need. The p ara t h yr oi dNgUl aRn S dI doNeG s nToB t f. acCilO itaMte vitamin C action, but instead facilitates vitamin D action. The parathyroid gland does not facilitate osteoblast production.

2. Skeletal changes with increased age include (Select all that apply.) a. hypertrophy of cartilage. b. decreased bone mass. c. imbalance in bone resorption and formation. d. loss of bone marrow. e. dehydration of intervertebral disks.

ANS: B, C, D, E Aging changes in the skeletal system include a decrease in bone mass, an imbalance in bone resorption and formation, loss of bone marrow, and dehydration of intervertebral disks.

Cartilage thins with aging.

3. It is true that articular cartilage (Select all that apply.) a. is comprised of mostly protein. b. dries out with aging. c. spreads weight load. d. needs synovial fluid lubrication. e. has limited regeneration ability.

ANS: B, C, D, E

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Pathophysiology 6th Edition Banasik Test Bank Articular cartilage provides a protective function between bone ends by spreading the weight load and preventing friction between bone ends. It requires the lubricating function of synovial fluid. Articular cartilage has limited regeneration ability and dries out with aging. Articular cartilage is 65% to 80% water.

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Pathophysiology 6th Edition Banasik Test Bank Chapter 51: Alterations in Musculoskeletal Function: Trauma, Infection, and Disease Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. Complete healing of a bone fracture occurs when a. no movement of the break is detectable. b. the callus has been completely replaced with mature bone. c. the fracture site and surrounding soft tissue are pain free. d. a cast is no longer required to stabilize the break.

ANS: B Complete healing of a bone fracture occurs when the callus has been completely replaced with mature bone. A lack of detectable movement of the break does not indicate that the fracture is healed. Even when a bone fracture is healed, pain at the fracture site and surrounding soft tissue may be present. The patient may progress from a cast to a splint, sling, or brace as the bone fracture continues to heal.

2. Rickets is characterized by soft, weak bones resulting from a deficiency of a. calcium. b. estrogen. c. phosphate. d. vitamin D. ANS: D Rickets is characterized by soft, weak bones resulting from vitamin D deficiency. Rickets is Nn t aRkSeIorNGphT B.C M not caused by poor calcium i U osphateOdeficiency. Estrogen deficiency is related to osteoporosis, not rickets.

3. In older women, osteoporosis is thought to be primarily because of a. dietary inadequacies. b. estrogen deficiency. c. malabsorption syndrome. d. inactivity.

ANS: B In older women, osteoporosis is thought to be primarily because of estrogen deficiency.

Although dietary inadequacies and inactivity play roles, the primary cause of osteoporosis in older women is thought to be because of estrogen deficiency. Malabsorption is not the primary cause of osteoporosis in older women.

4. Pain with passive stretching of a muscle is indicative of a. noncontractile tissue injury. b. contractile tissue injury. c. vascular insufficiency. d. skeletal muscle damage.

ANS: A

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Pathophysiology 6th Edition Banasik Test Bank Pain with passive stretching of a muscle is indicative of noncontractile tissue injury. Pain with passive stretching of a muscle is not an indication of a contractile tissue injury, vascular insufficiency, or skeletal muscle damage.

5. Muscular dystrophy includes a number of muscle disorders that are a. genetically transmitted. b. easily prevented and managed. c. autoimmune in nature. d. demyelinating focused.

ANS: A Muscular dystrophy includes a number of muscle disorders that are genetically transmitted.

Muscular dystrophy is not easily prevented or managed. It is not an autoimmune disease or a demyelinating disease.

6. Myasthenia gravis is an autoimmune disease in which a. neuronal demyelination disrupts nerve transmission. b. muscles become increasingly bulky but weakened. c. acetylcholine receptors are destroyed or dysfunctional. d. acetylcholine release from motor neurons is disrupted.

ANS: C Myasthenia gravis is an autoimmune disease in which acetylcholine receptors are destroyed or dysfunctional. Multiple sclerosis is an autoimmune disease in which neuronal demyelination disrupts nerve transmission. Muscles become weak, but not bulky, in myasthenia gravis. Acetylcholine receptors are destroyed or dysfunction in myasthenia gravis.

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7. Anticholinesterase inhibitors may be used to manage a. muscular dystrophy. b. myasthenia gravis. c. fibromyalgia. d. rheumatoid arthritis.

ANS: B Anticholinesterase inhibitors may be used to manage myasthenia gravis. Anticholinesterase agents are not used to manage muscular dystrophy, fibromyalgia, or rheumatoid arthritis.

8. A compound, transverse fracture is best described as a bone that is a. broken in two or more pieces. b. cracked but not completely separated. c. broken along the long axis. d. broken and protruding through the skin.

ANS: D The type of fracture described is broken and protruding through the skin. A comminuted fracture is one that is broken in two or more pieces. An incomplete fracture is cracked but not completely separated. A longitudinal fracture is broken along the long axis.

9. The complication which is not likely to result from a compound, transverse fracture of the tibia and fibula is

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Pathophysiology 6th Edition Banasik Test Bank a. b. c. d.

bone infection. fat emboli. air embolus. compartment syndrome.

ANS: C Air embolus is not likely to occur secondary to this fracture. Bone infection is likely, because it is an open fracture. Fat emboli are likely because the fracture is in a long bone.

Compartment syndrome is likely because of the extent of soft-tissue injury.

10. Assessment of an extremity six hours after surgical alignment and casting demonstrates pulselessness and pallor. The priority action to take is to a. increase the administration his pain medication. b. initiate action to have the cast split or removed. c. note the increase in pain in his chart, and recheck the extremity in 30 minutes. d. elevate the extremity to relieve swelling.

ANS: B The priority action is to have the cast split or removed because these are signs of compartment syndrome and emergent decompression is needed. While increasing pain medication may be appropriate, it is not the priority action. It is not the priority action to note pain increases in the chart. In compartment syndrome, extremity is not to be elevated above the heart, as that may lower venous pressure and slow arterial perfusion.

11. Following a bone fracture, the most likely event to occur is a. development of a blood clot beneath the periosteum. b. leukocyte infiltration inNto bRoneItissGue. B.C M c. blood vessel growth at t h U e fraSctuN re s T i te. O d. migration of osteoblasts to the fracture site.

ANS: A The first step in bone healing is hematoma formation. Leukocyte infiltration into bone tissue, blood vessel growth at the fracture site, and migration of osteoblasts to the fracture site are not the first steps in bone healing.

12. Bone healing may be impaired by a. excessive vitamin C. b. nicotine use. c. a high-protein diet. d. immobilization.

ANS: B Nicotine can delay bone healing. Vitamin C, protein, and immobilization are necessary for bone healing.

13. A unique characteristic feature of fibromyalgia is the presence of a. tender point pain. b. head pain. c. contractures. d. muscle atrophy.

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Pathophysiology 6th Edition Banasik Test Bank ANS: A Tender point pain is a unique characteristic feature of fibromyalgia. Headache, contractures, and muscle atrophy are not unique characteristic features of fibromyalgia.

14. A fracture in which bone breaks into two or more fragments is referred to as a. comminuted. b. open. c. greenstick. d. stress.

ANS: A A fracture in which the bone breaks into two or more fragments is called a comminuted fracture. Open fractures, greenstick fractures, and stress fractures do not involve two or more bone fragments.

15. What type of fracture generally occurs in children? a. Greenstick b. Stress c. Nightstick d. Colles ANS: A Greenstick fractures occur most often in the growing bones of children. Stress fractures can occur at any age. Nightstick and Colles fractures occur most often in adults.

16. Most muscle strains are caused by a. a tear in an adjoining t eNn d oRn . I G B.C M b. abnormal muscle contracU O tionS .N T c. muscle asymmetry. d. bleeding into the muscle.

ANS: B Most muscle strains are caused by abnormal muscle contraction. A muscle strain can be caused by a tear in the muscle. A tendon strain can be as a result of a tear in the tendon.

Muscle asymmetry is not the cause of muscle strains. Muscle strains are not caused by bleeding into the muscle.

17. People who have osteoporosis are at risk for a. rhabdomyolysis. b. osteomyelitis. c. osteomalacia. d. bone fractures.

ANS: D Osteoporosis weakens the bone structure and increases the risk of bone fractures.

Rhabdomyolysis, osteomyelitis, and osteomalacia are completely different conditions.

18. A risk factor for osteoporosis is a. endometriosis. b. early menopause. c. late menopause.

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Pathophysiology 6th Edition Banasik Test Bank d. ovarian cysts.

ANS: B Early menopause and late menarche are risk factors for osteoporosis. Endometriosis, late menopause, and ovarian cysts are not risk factors for osteoporosis.

19. Which disorder usually causes skeletal pain and involves significant bone demineralization from vitamin D deficiency? a. Osteomalacia b. Osteopenia c. Osteomyelitis d. Osteoporosis ANS: A Osteomalacia is inadequate mineralization of bone tissue, most commonly caused by vitamin D deficiency, and it usually causes skeletal pain. Osteopenia, osteomyelitis, and osteoporosis are not caused by vitamin D deficiency.

20. Healing of a fractured bone with a poor alignment is called a. malunion. b. nonunion. c. disunion. d. delayed union.

ANS: A Malunion is a complication that occurs when the bone fails to align correctly during the healing process. Nonunion and delayed union are different complications of bone healing.

Disunion is not the term usN edUfR orSfI raN ctG urT eB he. alC inO gM with poor alignment.

21. The displacement of two bones in which the articular surfaces partially lose contact with each other is called a. subluxation. b. subjugation c. sublimation. d. dislocation.

ANS: A Subluxation is partial dislocation of a joint. Subjugation, sublimation, and dislocation are not the terms for partial loss of contact of articular surfaces.

22. The pathophysiology of osteomalacia involves a. increased osteoclast activity. b. collagen breakdown in the bone matrix. c. crowding of cells in the osteoid. d. inadequate mineralization in the osteoid.

ANS: D Osteomalacia is characterized by inadequate or delayed mineralization in the osteoid.

Osteomalacia does not involve increased osteoclast activity, collagen breakdown in the bone matrix, or crowding of cells in the osteoid.

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Pathophysiology 6th Edition Banasik Test Bank 23. The disease that is similar to osteomalacia and occurs in growing children is a. rickets. b. osteosarcoma. c. Paget disease. d. osteopenia.

ANS: A Rickets is similar to osteomalacia in that it is caused by vitamin D deficiency and leads to soft, deformable bones. Rickets occurs in growing children. Osteosarcoma, Paget disease, and osteopenia are not similar to osteomalacia.

24. Pain in fibromyalgia involves a. muscle inflammation. b. autoimmune destruction of muscle tissue. c. nerve inflammation. d. changes in pain transmission in the spinal cord.

ANS: D Pain in fibromyalgia involves changes in pain transmission in the spinal cord that are called central sensitization. Muscle inflammation, nerve inflammation, and autoimmune destruction of muscle tissue do not cause the pain in fibromyalgia.

25. A malignant bone-forming tumor is referred to as a(n) a. rhabdosarcoma. b. liposarcoma. c. osteosarcoma. d. chondrosarcoma.

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ANS: C An osteosarcoma is a malignant bone-forming tumor. Rhabdo- refers to skeletal muscle.

Lipo- refers to fat. Chondro- refers to cartilage.

26. Inflammation of the sacs that overlie bony prominences is called a. epicondylitis. b. arthritis. c. tendinitis. d. bursitis.

ANS: D Bursitis is inflammation of the bursal sacs that protect the skin over bony protuberances.

Epicondylitis is inflammation of an epicondyle. Arthritis is inflammation of one or more joints. Tendinitis is inflammation of a tendon.

27. The disorders characterized by softening and then enlargement of bones is referred to as a. osteomyelitis. b. osteoporosis. c. Paget disease. d. rickets.

ANS: C

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Pathophysiology 6th Edition Banasik Test Bank Paget disease is characterized by excessive bone resorption and formation, causing fractures and deformities. Osteomyelitis, osteoporosis, and rickets do not involve softening and then enlargement of bones.

28. The person at highest risk of a greenstick fracture from falling off a tall ladder is age a. 68. b. 44. c. 8. d. 23.

ANS: C Greenstick fractures occur primarily in children. The adults are not at high risk for greenstick fracture.

29. A bone disorder that results from insufficient vitamin D is referred to as a. rickets. b. osteoporosis. c. osteomalacia. d. subluxation.

ANS: C Osteomalacia is caused by vitamin D deficiency in adults. Rickets is caused by vitamin D deficiency in children. Osteoporosis is related to decreased estrogen. Subluxation refers to a bone displacement.

30. The most common source of osteomyelitis is a. an infection that migratN es vRi a t hIe bG loodBs. treCamM . b. direct invasion from a fraUct u rSe. N T O c. surgical contamination. d. a joint prosthesis.

ANS: A Hematogenous osteomyelitis (via the blood stream) is the most common type of osteomyelitis. Direct invasion of infection from a fracture, infection of a bone resulting from surgical contamination, and a joint prosthesis are not the most common sources of osteomyelitis.

31. A patient diagnosed with diabetes, smokes a pack of cigarettes daily and eats very few green leafy vegetables. After experiencing a fractured toe, this patient is at risk for a. delayed healing. b. malunion. c. nonunion. d. dysunion.

ANS: A Fracture healing that does occur but takes longer than expected is called delayed healing.

The situation is not an example of malunion or nonunion. Dysunion is not a term used to describe healing complications.

32. Paget’s disease is characterized by a. overactivity of osteoblasts leading to multiple bone tumors.

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Pathophysiology 6th Edition Banasik Test Bank b. excessive bone resorption followed by excessive formation of fragile bone. c. inflammatory disorder resulting in fusion of spine joints. d. failure of resorption by osteoclasts resulting in hard bones.

ANS: B Paget’s disease is characterized by excessive bone resorption followed by excessive formation of fragile bone. Overactivity of osteoblasts that lead to multiple bone tumors is not the cause of Paget’s disease. Paget’s disease is not characterized by the fusion of spine joints. Fragile bone, not hard bone, is a characteristic of Paget’s disease.

33. The most common site affected in Paget’s disease is the a. lower spine. b. skull. c. pelvis. d. joints.

ANS: A The lower spine is the most common site affected in Paget’s disease. The skull and pelvis are affected, but are not the most common sites. Joints are not affected in Paget’s disease.

34. The most common type of osteomyelitis is a. hematogenous. b. contiguous focus. c. Brodie abscess. d. direct invasion.

ANS: A .mCoOnMt ype of osteomyelitis. Contiguous focus Hematogenous ost eom yel i tNi sUi sRtS heImNoGstTcB om osteomyelitis is not the most common type. Brodie abscess is when an infection becomes enclosed by fibrotic tissue. Osteomyelitis may be caused by a direct invasion of organisms into the bone, but this is not the most common cause.

35. Compartment syndrome occurs secondary to a. bone infarction. b. soft-tissue damage. c. muscle necrosis. d. breakdown of RBCs. ANS: B Compartment syndrome occurs because of severe soft-tissue damage. Bone infarction and the breakdown of RBCs do not cause compartment syndrome. Muscle necrosis does not cause compartment syndrome, but can result from it.

36. The most common symptom of multiple myeloma is a. pathologic fracture. b. fever. c. bone pain. d. osteomyelitis.

ANS: C

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Pathophysiology 6th Edition Banasik Test Bank The most common symptom of multiple myeloma is bone pain. Although pathologic fractures occur in multiple myeloma, bone pain is the most common symptom. Fever and osteomyelitis are not common in multiple myeloma.

MULTIPLE RESPONSE 1. Manifestations of fibromyalgia often include (Select all that apply.) a. generalized pain. b. sensitivity to heat. c. headaches. d. fatigue. e. sleep disturbance.

ANS: A, C, D, E Common manifestations of fibromyalgia include generalized pain, headaches, fatigue, and difficulty sleeping. Sensitivity to cold (not heat) is common.

2. Characteristics of scoliosis include (Select all that apply.) a. involvement of lateral curvature of the spine. b. increase during periods of rapid growth. c. more common in boys. d. identifiable by uneven shoulders or scapular prominence. e. possibility of leading to respiratory complications.

ANS: A, B, D, E Scoliosis involves a lateral curvature of the spine that increases during times of rapid growth. It is evidenced by uNnU evReS nI shN ouGlde TBrs.oCr sOc Ma p u l a r prominence. If severe and untreated, it can lead to respiratory and other complications in later age. Scoliosis is more common in girls.

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Pathophysiology 6th Edition Banasik Test Bank Chapter 52: Alterations in Musculoskeletal Function: Rheumatic Disorders Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. Gouty arthritis is a complication of a. group A streptococcal infection. b. autoimmune destruction of joint collagen. c. excessive production of urea. d. inadequate renal excretion of uric acid.

ANS: D Gouty arthritis is a complication of inadequate renal excretion of uric acid. Rheumatic fever– related arthritis is related to group A streptococcal infection. Gout is not an autoimmune disorder. Gout is because of inadequate renal excretion of uric acid, not excessive production of urea.

2. A clinical finding consistent with a diagnosis of rheumatoid arthritis would be a. systemic manifestations of inflammation. b. localized pain in weight-bearing joints. c. reduced excretion of uric acid by the kidney. d. firm, crystallized nodules or “tophi” at the affected joints.

ANS: A Systemic manifestations of inflammation are a clinical finding consistent with rheumatoid arthritis. The pain of rheumatoid arthritis is not localized to weight-bearing joint. Uric acid N R I G B.C M is not a causative factor in t h U i s diSsordNer. TGout caOuses firm, crystallized nodules, or “tophi,” at the affected joints.

3. Rheumatoid arthritis is commonly associated with the presence of rheumatoid factor autoantibodies in the bloodstream. This indicates that rheumatoid arthritis is likely to be a. caused by bacterial infection. b. an autoimmune process. c. an infective process. d. because of an enzymatic defect.

ANS: B The presence of rheumatoid factor autoantibodies indicates that RA is an autoimmune process. The presence of rheumatoid factor autoantibodies does not indicate infection, an infective process, or an enzymatic defect.

4. In contrast to osteoarthritis, rheumatoid arthritis may be associated with a. debilitating joint pain and stiffness. b. improvement in symptoms with aspirin therapy. c. changes in activities of daily living. d. systemic aching in the musculoskeletal system.

ANS: D

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Pathophysiology 6th Edition Banasik Test Bank Rheumatoid arthritis is associated with systemic aching in the musculoskeletal system, but osteoarthritis is not. Osteoarthritis also causes debilitating joint pain and stiffness. Aspirin therapy will improve symptoms in both disorders. Both disorders can lead to changes in activities of daily living.

5. Systemic lupus erythematosus (SLE) is a rheumatic disease attributed to a. wear and tear on weight-bearing joints. b. septic joint inflammation and necrosis. c. unknown etiologic factors. d. autoimmune mechanisms.

ANS: D Systemic lupus erythematosus (SLE) is a rheumatic disease attributed to autoimmune mechanisms. Wear and tear on weight-bearing joints and septic joint inflammation and necrosis do not lead to SLE. SLE is known to be attributed to autoimmune mechanisms.

6. Individuals diagnosed with systemic lupus erythematosus (SLE) are at risk for developing numerous complications of various organs because of a. excessive production of connective tissue. b. formation of osteophytes in tissues. c. immune injury to basement membranes. d. impaired tissue oxygen transport.

ANS: C The immune injury to basement membranes in SLE leads to numerous complications. SLE does not involve excessive production of connective tissue or formation of osteophytes in tissues. SLE does not impaN ir o xRyg eIn trG ansB po.rtC . M

U S N T

O

7. A laboratory test result that helps confirm the diagnosis of systemic lupus erythematosus (SLE) is a. elevated serum calcium level. b. elevated monoclonal antibody titer. c. positive antinuclear antibodies. d. positive microsomal antibodies.

ANS: C A positive antinuclear antibody test helps confirm the diagnosis of SLE. SLE is not confirmed by elevated serum calcium level, elevated monoclonal antibody titer, or positive microsomal antibodies.

8. To avoid the progression of cutaneous lesions, a patient diagnosed with systemic lupus erythematosus (SLE) should a. avoid sun exposure. b. avoid excessive use of moisturizers. c. refrain from washing the affected areas. d. apply warm, wet compresses daily.

ANS: A To avoid the progression of cutaneous lesions, a patient with SLE should avoid sun exposure. Avoiding excessive use of moisturizers, refraining from washing the affected areas, and applying warm, wet compresses daily will not deter the progression of lesions.

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Pathophysiology 6th Edition Banasik Test Bank

9. Although skin manifestations may occur in numerous locations, the classic presentation of systemic lupus erythematosus (SLE) includes a. lesions affecting the palms of hands and the soles of feet. b. dry, scaly patches in the antecubital area and behind the knees. c. cracked, scaly areas in the webs of fingers. d. a butterfly pattern rash on the face across the bridge of the nose.

ANS: D The classic presentation of SLE includes a butterfly pattern rash on the face across the bridge of the nose. The classic presentation does not involve lesions affecting the palms of the hands and the soles of the feet; dry, scaly patches in the antecubital area and behind the knees; or cracked, scaly areas in the webs of the fingers.

10. Ankylosing spondylitis is characterized by a. inflammation, stiffness, and fusion of spinal joints. b. loss of articular cartilage in weight-bearing joints. c. excessive bone remodeling leading to soft bone. d. immune mechanisms leading to widespread joint inflammation.

ANS: A Ankylosing spondylitis is characterized by inflammation, stiffness, and fusion of spinal joints. Osteoarthritis involves loss of articular cartilage in weight-bearing joints. Paget’s disease involves excessive bone remodeling leading to soft bone. RA involves immune mechanisms leading to widespread joint inflammation. s t oI ftenGbecB au.sC e ofM 11. Prosthetic joint infection i sNm oR a. defective replacement m aUt eriS N T O al . b. injury to the joint. c. hematogenous transfer. d. arthritis.

ANS: C Prosthetic joint infection is often because of bacterial spread to the joint via the blood stream. Defective replacement material is not the cause of prosthetic joint infection. Injury to the joint may lead to the implementation of a prosthetic joint, but the injury itself is not the cause of prosthetic joint infection. Arthritis may lead to the need for a prosthetic joint, but arthritis is not the cause of prosthetic joint infection.

12. It is true that scleroderma involves a. inflammation and fibrosis of connective tissue. b. autoantibodies against acetylcholine receptors. c. infection by beta-hemolytic streptococcus. d. inflammation caused by antigenic fragments of dead organisms.

ANS: A Scleroderma involves fibrosis of connective tissue. Myasthenia gravis involves autoantibodies against acetylcholine receptors. Rheumatic fever involves infection by beta-hemolytic streptococcus. Lyme disease is thought to involve inflammation caused by antigenic fragments of dead organisms.

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Pathophysiology 6th Edition Banasik Test Bank 13. The earliest manifestation of scleroderma is a. thick, tight, shiny skin. b. skin hyper/hypopigmentation. c. renal impairment. d. Raynaud phenomenon.

ANS: D Raynaud phenomenon with blanching of the digits in response to cold is the earliest manifestation. Thick, tight, shiny skin and hyper/hypopigmentation are not the earliest manifestation. Renal impairment is a late manifestation.

14. The most common presenting sign/symptom with rheumatic fever is a. cardiac murmur. b. polyarthritis. c. rash. d. painless nodules.

ANS: B Polyarthritis is the most common presenting symptom of RF. A cardiac murmur is only present if carditis ensues, and this is a late sign. The rash and the painless nodules of RF are not the earliest signs/symptoms.

15. Enteropathic arthritis is associated with a. irritable bowel syndrome. b. inflammatory bowel disease. c. chronic constipation. d. chronic diarrhea.

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ANS: B Enteropathic arthritis is associated with inflammatory bowel disease (Crohn disease and ulcerative colitis). Irritable bowel syndrome, chronic constipation, and chronic diarrhea are not symptoms of enteropathic arthritis.

16. The pain of nonarticular rheumatism (“growing pain”) is worse a. during activity. b. following strenuous exercise. c. upon awakening. d. during the night.

ANS: D Growing pains are worse at night in the calves, shins, and thighs. Growing pains are not worse during activity or following strenuous exercise. Growing pains are worse at night, not upon awakening.

17. Rheumatoid arthritis involves joint inflammation caused by a. bacterial infection. b. trauma. c. autoimmune injury. d. congenital hypermobility.

ANS: C

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Pathophysiology 6th Edition Banasik Test Bank Rheumatoid arthritis is caused by autoimmune injury to synovial joints. Rheumatoid arthritis is not a joint infection, is not caused by trauma, and is not caused by congenital hypermobility.

18. Systemic disorders include a. adhesive capsulitis. b. verrucae. c. osteoarthritis. d. rheumatoid arthritis.

ANS: D Systemic manifestations of rheumatoid arthritis include fever, malaise, and lymphadenopathy. Adhesive capsulitis and osteoarthritis are not systemic diseases. Verrucae are warts, and they are not systemic.

19. Tophi are a. renal calculi composed of uric acid. b. deposits of urate crystals in tissues. c. painful edematous joints. d. spots that coalesce in a malar rash.

ANS: B Tophi are deposits of urate crystals in tissues that occur in gout. Tophi are not renal calculi, painful edematous joints, or a type of rash.

20. The final stage of gout, characterized by crystalline deposits in cartilage, synovial membranes, and soft tissueN , is R c a l l eId G B.C M U S N T O a. tophaceous gout. b. gouty arthritis. c. complicated gout. d. asymptomatic hyperuricemia.

ANS: A The final chronic stage of gout is called tophaceous gout. Gouty arthritis and complicated gout are not the final stages. Asymptomatic hyperuricemia is the first stage of gout.

21. The pathophysiology of rheumatoid arthritis involves a. immune cells accumulating in pannus and destroying articular cartilage. b. free radicals attaching to the synovial membrane and tunneling into articular cartilage. c. excessive wear and tear and microtrauma that damage articular cartilage. d. cysts developing in subchondral bone and creating fissures in articular cartilage.

ANS: A In rheumatoid arthritis, immune cells accumulate in pannus and destroy articular cartilage.

Free radicals do not attach to membranes; they damage them by removing electrons from them. Rheumatoid arthritis is not caused by excessive wear and tear. Subchondral cysts and fissures in articular cartilage are not characteristic of rheumatoid arthritis.

22. “Tell me again the name of that chemical that makes crystals when my gout flares up,” asks the client. The nurse’s best response is

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Pathophysiology 6th Edition Banasik Test Bank a. b. c. d.

calcium phosphate. urea. uric acid. beta-hydroxybutyric acid.

ANS: C Gout occurs when uric acid crystals form in joints. Calcium phosphate and beta-hydroxybutyric acid do not lead to crystal formation in gout. Uric acid, not urea, leads to crystal formation in gout.

23. Ankylosing spondylitis causes a. intervertebral joint fusion. b. instability of synovial joints. c. costal cartilage degeneration. d. temporomandibular joint degeneration.

ANS: A Ankylosing spondylitis causes joint fibrosis, ossification, and fusion, most commonly of the intervertebral and sacroiliac joints. Ankylosing spondylitis does not cause instability of synovial joints, degeneration of cartilage, or temporomandibular joint degeneration.

24. The chief pathologic features of osteoarthritis are a. stress fractures of the epiphysis, inflammation of the diaphysis, and accumulation of excessive synovial fluid. b. autoimmune damage to the synovium, destruction of articular cartilage by pannus, and thickening of synovial fluid. c. degeneration of articulaN r caRrtilaIge, Gd esB tr . ucC tionMof the bone under the cartilage, and U S N T O thickening of the synoviu m. d. thinning of the joint capsule, resorption of bone, excessive formation of new bone, and formation of bone spurs.

ANS: C The chief pathologic features of osteoarthritis are degeneration of articular cartilage, destruction of the bone under the cartilage, and thickening of the synovium. Although osteoarthritis does involve formation of bone spurs, all the other answer choices listed do not occur with osteoarthritis.

25. “Please explain the pathophysiology of osteoarthritis to me,” says another nurse. “Is it just wear and tear so that the cartilage wears out?” Your best response is a. “Yes; repeated use just wears out the cartilage, until it becomes thin and denuded.

That causes pain and will eventually cause joint inflammation.” b. “Yes; with increasing age, the inflammation from repeated joint use accumulates and causes the cartilage to get thin and ragged until it disappears.” c. “No; cells in bone, cartilage, and the synovial membrane all get activated and secrete inflammatory mediators that destroy cartilage and damage bone.” d. “No; autoimmune cells infiltrate the joint and collect on the cartilage in a mass called ‘pannus’ that eventually thins and destroys the cartilage.”

ANS: C

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Pathophysiology 6th Edition Banasik Test Bank Osteoarthritis involves a complex interaction between osteoclasts, osteoblasts, chondrocytes, and synoviocytes that eventually destroy cartilage and damage subchondral bone. Repeated use of a joint and pannus are not the causes of osteoarthritis. Inflammatory mediators, not inflammation from repeated joint use, are the cause of osteoarthritis.

MULTIPLE RESPONSE 1. Characteristics of gout include (Select all that apply.) a. disturbed uric acid metabolism. b. crystalline deposits in bony and connective tissue. c. onset before menopause in women. d. cardiac involvement. e. renal involvement.

ANS: A, B, D, E Gout is caused by a disturbance in uric acid metabolism and leads to crystalline deposits in bony and connective tissue (tophi). Tophi can deposit in cardiac and renal tissue. In women the onset is post-menopause.

2. Manifestations of osteoarthritis include (Select all that apply.) a. nodules on joints of the hands. b. crepitus with joint movement. c. pain that is worse upon arising in the morning. d. stiffness that worsens with joint use. e. narrowing of joint spaces.

NURSINGTB.COM ANS: A, B, E Osteoarthritis results in nodules on the joints of hands (Heberden and Bouchard) and crepitus with joint movement. Radiologic examination demonstrates narrowing of joint spaces. The pain is worse with activity and is relieved with rest. Stiffness is relieved with joint use.

3. Signs/symptoms of Lyme disease include (Select all that apply.) a. fever and chills. b. migratory rash. c. arthritic pain. d. headache. e. myalgia.

ANS: A, C, D, E Manifestations of Lyme disease include fever and chills, arthritic pain, headache, and myalgia. A migratory rash does not occur in Lyme disease. A single characteristic lesion at the site of the tick bite is annular in nature.

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Pathophysiology 6th Edition Banasik Test Bank Chapter 53: Alterations in the Integumentary System Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. Atopic dermatitis (eczema) is caused by a. parasitic infestation of the skin. b. superficial staphylococcal infection. c. superficial fungal infection. d. contact with skin allergens.

ANS: D Atopic dermatitis (eczema) is caused by contact with skin allergens (atopic = allergy).

Atopic dermatitis is not a parasitic infestation of the skin, a superficial staphylococcal infection, or a superficial fungal infection.

2. Itchy linear burrows on the hands and wrists are associated with a. tick bites. b. Rocky Mountain spotted fever. c. scabies. d. contact dermatitis.

ANS: C Itchy linear burrows on the hands and wrists are associated with scabies. Itchy linear burrows on the hands and wrists are not associated with tick bites, Rocky Mountain spotted fever, or contact dermatitis.

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3. It is true that vitiligo a. occurs as a result of a genetic lack of melanin production. b. is a depigmented patch of skin. c. occurs most commonly in light-skinned individuals. d. is a warning sign for malignant melanoma.

ANS: B Vitiligo is a depigmented patch of skin. Vitiligo is not a genetic disorder. It occurs less often in light-skinned people and is associated with diabetes mellitus, hyperthyroidism, and pernicious anemia.

4. Deep pressure ulcers usually a. appear first as reddened areas that do not blanch. b. begin in the dermal and epidermal skin layers. c. result from thrombosis of deep vessels. d. are an unavoidable consequence of immobility.

ANS: C Deep pressure ulcers result from thrombosis of deep vessels. Superficial, not deep, pressure ulcers appear first as reddened areas that do not blanch. Deep pressure ulcers begin in the deep vessels of the tissue and are not always an unavoidable consequence of immobility.

5. The cancer considered to be the most malignant is

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Pathophysiology 6th Edition Banasik Test Bank a. b. c. d.

hyperkeratosis. basal cell carcinoma. squamous cell carcinoma. melanoma.

ANS: D Melanoma is the cancer considered to be most malignant. Hyperkeratosis is not a cancer.

Basal cell carcinoma and squamous cell carcinoma are not the most malignant skin cancers.

6. The presence of a widely distributed pruritic maculopapular rash and erythema is commonly associated with a. psoriasis. b. drug reaction. c. scleroderma. d. bedbug bites.

ANS: B Drug reaction results in a widely distributed pruritic maculopapular rash and erythema.

Psoriatic rash, scleroderma rash, and bedbug bites rash are not widely distributed or pruritic maculopapular in nature.

7. At puberty when sebaceous gland secretion increases, follicle obstruction and infection may occur, resulting in a. psoriasis. b. eczema. c. acne vulgaris. d. pemphigus.

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ANS: C At puberty when sebaceous gland secretion increases, follicle obstruction and infection may occur, resulting in acne vulgaris. Psoriasis, eczema, and pemphigus do not result from sebaceous gland secretion increases, follicle obstruction, and infection.

8. Acute, painful inflammation with vesicles along the distribution of a spinal nerve (dermatome) is characteristic of a. herpes zoster. b. herpes simplex. c. human papillomavirus. d. tinea.

ANS: A Herpes zoster results in painful inflammation with vesicles along the distribution of a spinal nerve (dermatome). Herpes simplex produces painful inflammation with vesicles, but it does not follow the distribution of a spinal nerve. This skin reaction is not characteristic of human papillomavirus or tinea.

9. A topical therapy that would tend to dry the skin because it is an astringent is a. lotion. b. gel. c. cream. d. ointments.

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Pathophysiology 6th Edition Banasik Test Bank

ANS: B Gels tend to dry the skin because they are astringent. Lotions, creams, and ointments do not tend to dry the skin.

10. Corticosteroids are commonly administered for the management of skin disorders because they a. are analgesics. b. prevent infection. c. enhance collagen production. d. reduce inflammation.

ANS: D Corticosteroids are commonly administered for the management of skin disorders because they reduce inflammation. Corticosteroids are steroids, not analgesics. Corticosteroids do not prevent infection or enhance collagen production.

11. A 4-year-old is brought to the clinic for evaluation of dry, scaly, itchy patches on the face, antecubital areas, and behind the ears and knees. The skin is dry overall, and there is evidence of scratching. This is likely a case of a. impetigo. b. atopic dermatitis. c. psoriasis. d. scabies.

ANS: B The most likely cause of dry, scaly, itchy patches on the face, antecubital areas, and behind the ears and knees is atopicNdU erR mS atI itN is G (eT czBe. mC a)O . IM mpetigo, psoriasis, and scabies do not produce dry, scaly, itchy patches on the face and antecubital areas and behind the ears and knees.

12. Which finding indicates a need for further evaluation of a nevus mole? a. The presence of light pigmentation b. Variations in color within the nevus c. Very dark coloration of the mole d. Diameter less than 2 mm ANS: B A mole that has variations in color needs further evaluation. A skin-colored nevus lacking dark pigmentation does not indicate melanoma. Very dark coloration of a nevus does not indicate melanoma. A very small nevus does not indicate melanoma.

13. Manifestations of herpes zoster include a. multiple fluid-filled vesicles on the lips, tongue, and hands. b. generalized, painful maculopapular rash. c. red, itchy palms and soles of feet. d. a dermatomal distribution of lesions and pain.

ANS: D

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Pathophysiology 6th Edition Banasik Test Bank Manifestations of herpes zoster include a dermatomal distribution of lesions and pain.

Herpes zoster manifestation includes fluid-filled vesicles along dermal planes. Herpes zoster is not a generalized, painful maculopapular rash and does not manifest as a red, itchy rash of the palms and soles of the feet.

14. Impetigo is a skin infection caused by a. fungus. b. yeast. c. bacteria. d. parasite.

ANS: C Impetigo is a skin infection caused by bacteria. Impetigo is a skin infection caused by bacteria, not fungus. Yeast and parasites do not cause impetigo.

15. Scleroderma is characterized by a. large, weeping, open sores. b. thickening and decreased elasticity of the skin. c. butterfly rash on the face. d. hair loss and ulcer formation on the extremities.

ANS: B Scleroderma is characterized by thickening and decreased elasticity of the skin. Scleroderma is not characterized by large, weeping, open sores or by hair loss and ulcer formation on the extremities. Lupus is characterized by a butterfly rash of the face.

16. Which type of dermatitis isNassR ociaItedGwitB h. crC adleMcap in newborns?

U S N T O a. Irritant b. Seborrheic c. Atopic d. Stasis ANS: B Seborrheic dermatitis is associated with cradle cap in newborns and dandruff in adolescents and adults. Irritant, atopic, and stasis dermatitis are not associated with cradle cap.

17. Impetigo is usually caused by a a. virus. b. fungus. c. protozoan. d. bacteria.

ANS: D Impetigo is caused by bacteria, usually strep or staph. Impetigo is not caused by a virus, a fungus, or a protozoan.

18. What is the most common, benign form of skin cancer? a. Basal b. Squamous c. Melanoma d. Actinic keratosis

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Pathophysiology 6th Edition Banasik Test Bank

ANS: A Basal cell cancer is the most common and benign skin cancer. Neither squamous cell cancer nor melanoma is the most common and benign skin cancer. Actinic keratosis is a pre-cancerous condition.

19. What is the most deadly form of skin cancer? a. Basal b. Squamous c. Melanoma d. Actinic keratosis ANS: C Melanoma is the most deadly skin cancer. Neither basal cell cancer nor squamous cell cancer is the most deadly skin cancer. Actinic keratosis is a pre-cancerous condition.

20. Shingles is caused by the same virus that causes a. measles. b. mumps. c. chickenpox. d. rubella.

ANS: C Shingles is caused by the chickenpox virus. Measles, mumps, and rubella are not caused by the chickenpox virus.

21. Which skin disorder is thought to be caused by an autoimmune reaction and is characterized NURSINGTB.COM by bullous eruptions? a. Pemphigus b. Psoriasis c. Pityriasis rosea d. Lichen planus ANS: A Pemphigus is a skin disorder thought to be caused by an autoimmune reaction and is characterized by bullous eruptions. Psoriasis, pityriasis, and lichen planus are not characterized by bullous eruptions.

22. A post-infective painful neuralgia can occur as a complication of a. shingles. b. herpes simplex. c. impetigo. d. verrucae.

ANS: A Shingles can lead to a painful post-herpetic neuralgia. Herpes simplex, impetigo, and verrucae do not lead to a painful post-herpetic neuralgia.

23. Which finding is characteristic of oral candidiasis? a. Silvery plaques on the skin b. Itching, oozing rash

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Pathophysiology 6th Edition Banasik Test Bank c. Thickened, discolored nails d. Whitish coating on the tongue ANS: D Oral candidiasis is characterized by whitish coating on the tongue. Oral candidiasis does not involve silvery plaques on the skin; itching, oozing rash; or thickened, discolored nails.

24. A major difference between a vesicle and a wheal is that vesicles a. contain fluid, but wheals are edematous tissue. b. are palpable, but a wheal is not. c. are larger than wheals. d. are smaller than wheals.

ANS: A A vesicle is filled with fluid, whereas a wheal is edematous tissue. Both vesicles and wheals are palpable. The major difference between a vesicle and a wheal is not their size.

25. The difference between chickenpox and measles is that chickenpox a. is caused by a virus, whereas measles is caused by a bacterium. b. causes a widespread rash, whereas measles causes a macular rash. c. is a childhood infection, but measles can evolve into shingles in adults. d. causes vesicles that scab, whereas measles remains a macular rash.

ANS: D Chickenpox causes vesicles that scab, whereas measles remains a macular rash. Both chickenpox and measles are caused by viruses. The rash is widespread in both chickenpox and measles. Measles does not evolve into shingles.

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26. Psoriasis is characterized by a. silvery scale on the skin. b. itching, oozing rash. c. thickened, discolored nails. d. whitish coating on the tongue.

ANS: A Psoriasis is characterized by silvery scale on the skin. Psoriasis does not involve an itching, oozing rash or a whitish coating on the tongue. Psoriasis may cause pitting of nails, but it is not characterized by thickened, discolored nails.

27. Conditions caused by a virus include a. athlete’s foot. b. boils. c. warts. d. impetigo.

ANS: C A virus causes warts. A fungus causes athlete’s foot. Bacteria cause boils and impetigo.

28. Onycholysis is characterized by a. silvery plaques on the skin. b. itching, oozing rash.

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Pathophysiology 6th Edition Banasik Test Bank c. destruction of the nails. d. whitish coating on the tongue.

ANS: C Onycholysis is characterized by destruction of the nails. Onycholysis does not involve silvery plaques on the skin, itching, oozing rash, or a whitish coating on the tongue.

MULTIPLE RESPONSE 1. Herpes simplex I infection (Select all that apply.) a. causes both oral and genital infections. b. begins with a burning or tingling sensation. c. reactivates with stress, sun exposure, menses. d. is painless. e. remains latent in spinal ganglia between outbreaks.

ANS: B, C, E Herpes simplex I outbreak begins with a burning or tingling sensation in the area of later eruption. The virus reactivates with stress, sun exposure, and sometimes menses, but between outbreaks remains latent in spinal cord ganglia. Herpes simplex II causes most genital infections. Herpes simplex outbreaks are very painful.

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Pathophysiology 6th Edition Banasik Test Bank Chapter 54: Burn Injuries Banasik: Pathophysiology, 6th Edition MULTIPLE CHOICE 1. It is true that second-degree, superficial partial-thickness burns a. are less painful than third-degree burns. b. involve only the epidermis. c. usually heal in 7 to 21 days. d. are rarely associated with scar formation.

ANS: C Second-degree, superficial partial-thickness burns usually heal in 7 to 21 days.

Second-degree burns are more painful than third-degree burns, involve damage to the dermis, and can be associated with scar formation.

2. The first priority when rescuing a burned individual is a. establishing a patent airway. b. removing his or her clothing. c. eliminating the source of the burn. d. covering the wounds with wet sheets.

ANS: C The first priority in rescuing a burned individual is eliminating the source of the burn. The next priority is to establish a patent airway. Removing the clothing is not recommended; however, dry, clean sheets or dressings should be placed over the burns. Covering the N Ry I G hypoth B.C O M wound is not advised, as t hi s Um a S caN use T ermia.

3. Burn shock is the direct result of a. hypovolemia. b. cardiac depression. c. infection. d. increased capillary permeability.

ANS: D Burn shock results from systemic capillary permeability with leakage of fluids throughout all tissues; the result is massive edema. Hypovolemia is not the direct cause of burn shock.

Burn shock does not result from cardiac depression or infection.

4. Electrical injury may cause extensive damage to low-resistance tissues, particularly a. bone and muscle. b. nerves and blood vessels. c. epidermis. d. dermis and subcutaneous tissue.

ANS: B Electrical injury may cause extensive damage to low-resistance tissues, particularly nerves and blood vessels. Bone and muscle, and dermis and subcutaneous tissue, are not low-resistance tissues. Skin is a high-resistance tissue.

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Pathophysiology 6th Edition Banasik Test Bank 5. The time between the end of burn shock and closure of the burn to less than 20% of total body surface area is called the phase. a. postshock b. rehabilitation c. critical d. emergent ANS: D The time between the end of burn shock and closure of the burn to less than 20% of total body surface area is called the emergent phase. Postshock is not a phase of burn wound healing. The rehabilitation phase begins when the burn size is reduced to less than 20% TBSA and the patient is able to assume self-care. There is not a critical phase of burn wound healing.

6. The primary aim of burn wound management is to prevent a. trauma to burned tissue. b. microbial colonization of the wound. c. the wound from drying out. d. premature wound closure.

ANS: B The primary aim of burn wound management is to prevent microbial colonization of the wound. A goal of wound management is to minimize further destruction of viable tissue. It is not possible to prevent the trauma after injury, since it has already occurred. Keeping the wound dry is not a primary aim of burn wound management. Preventing premature wound closure is not a goal of burn wound management.

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7. The third element essential toUs u S r v ivN al aT f te r majO or burn injury is a. excision of the burn followed by skin grafting. b. frequent wound debridement to encourage wound healing. c. hyperbaric oxygen therapy. d. continuous topical antibiotic therapy.

ANS: A The third element essential to survival after major burn injury is excision of the burn followed by skin grafting. Frequent wound debridement, hyperbaric oxygen therapy, and continuous topical antibiotic therapy are not the third element essential to survival after major burn injury.

8. The most common cause of burn injuries in children is a. house fires. b. cigarette burns. c. scalding with hot water. d. contact with chemical agents.

ANS: C The most common cause of burn injuries in children is scalding with hot water. House fires, cigarette burns, and contact with chemical agents are not the most common causes of burn injuries in children.

9. The goal of nutritional support of the burned individual is to

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Pathophysiology 6th Edition Banasik Test Bank a. b. c. d.

limit the glucose available to infectious organisms. create a positive nitrogen balance. protect the kidney from excessive protein intake. avoid hyperlipidemia.

ANS: B The goal of nutritional support of the burned individual is to create a positive nitrogen balance. Limiting the glucose available to infectious organisms, protecting the kidney from excessive protein intake, and avoiding hyperlipidemia are not the goals of nutritional support of the burn patient.

10. A necessary intervention when managing burns associated with automobile airbag injury include a. irrigation with water. b. application of steroid cream. c. IV infusion of antibiotics. d. debridement of skin.

ANS: A Management of burns associated with automobile airbag injury is irrigation with copious amounts of water. Application of steroid cream, IV antibiotics, and debridement are not necessary for airbag burns.

11. The majority of electrical burns in children are caused by a. playing with electrical outlets. b. playing with defective electrical cords. c. biting on extension cordNs. R I G B.C M d. putting fingers in electricU O al soSckeNts. T ANS: C The majority of electrical burns in children are caused by biting on extension cords. Playing with electrical outlets, playing with defective electrical cords, and putting fingers in electrical sockets are not the causes of the majority of electrical burns in children.

12. It is true that covering a burn with cool wet sheets a. promotes comfort. b. facilitates healing. c. prevents fluid loss. d. promotes hypothermia.

ANS: D Cool wet sheets quickly become cold wet sheets that promote hypothermia as the skin’s ability to regulate body temperature is lost. Although cool wet sheets may initially promote comfort, they may be the cause of hypothermia the longer the sheets remain in contact with the burned skin. Cool wet sheets do not facilitate burn healing or prevent fluid loss.

13. The immediate management of a thermal burn victim once the fire has been extinguished is to a. cover with blankets to prevent shock. b. monitor for signs of respiratory impairment. c. apply lubricant to the burn area.

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Pathophysiology 6th Edition Banasik Test Bank d. start an IV line.

ANS: B Excessive heat to the respiratory tract could result in obstruction; therefore, respiratory status is the main priority. Do not cover with blankets, as this will prevent underlying heat from escaping. Do not apply anything but water to a burn. An IV line may be started after management of respiratory status.

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