Applied Pathophysiology A Conceptual Approach to the Mechanisms of Disease 3rd Edition Braun TEST BA

Applied Pathophysiology A Conceptual Approach to the Mechanisms of Disease 3rd Edition Braun Test Bank Chapter 1Introduction to Pathophysiology 1. The nucleus _________, which is essential for function and survival of the cell.

A)

is the site of protein synthesis

B)

contains the genetic code

C)

transforms cellular energy

D)

initiates aerobic metabolism

2. Although energy is not made in mitochondria, they are known as the power plants of the cell because they: A)

contain RNA for protein synthesis.

B)

utilize glycolysis for oxidative energy.

C)

extract energy from organic compounds.

D)

store calcium bonds for muscle contractions.

3. Although the basic structure of the cell plasma membrane is formed by a lipid bilayer, most of the specific membrane functions are carried out by: A)

bound and transmembrane proteins.

B)

complex, long carbohydrate chains.

C)

surface antigens and hormone receptors.

D)

a gating system of selective ion channels.

4. To effectively relay signals, cell-to-cell communication utilizes chemical messenger systems that: A)

displace surface receptor proteins.

B)

accumulate within cell gap junctions.

C)

bind to contractile microfilaments.

D)

release secretions into extracellular fluid.

5. Aerobic metabolism, also known as oxidative metabolism, provides energy by:

A)

removing the phosphate bonds from ATP.

B)

combining hydrogen and oxygen to form water.

C)

activating pyruvate stored in the cytoplasm.

D)

breaking down glucose to form lactic acid.

6. Exocytosis, the reverse of endocytosis, is important in _______ into the extracellular fluid.

A)

Engulfing and ingesting fluid and proteins for transport

B)

Killing, degrading, and dissolving harmful microorganisms

C)

Removing cellular debris and releasing synthesized substances

D)

Destruction of particles by lysosomal enzymes for secretion

7. The process responsible for generating and conducting membrane potentials is: A)

diffusion of current-carrying ions.

B)

millivoltage of electrical potential.

C)

polarization of charged particles.

D)

ion channel neurotransmission.

8. Epithelial tissues are classified according to the shape of the cells and the number of layers. Which of the following is a correctly matched description and type of epithelial tissue?

A)

Simple epithelium: cells in contact with intercellular matrix; some do not extend to surface

B)

Stratified epithelium: single layer of cells; all cells rest on basement membrane

C)

Glandular epithelium: arise from surface epithelia and underlying connective tissue

D)

Pseudostratified epithelium: multiple layers of cells; deepest layer rests on basement membrane

9. Connective tissue contains fibroblasts that are responsible for: A)

providing a fibrous framework for capillaries.

B)

synthesis of collagen, elastin, and reticular fibers.

C)

forming tendons and the fascia that covers muscles.

D)

filling spaces between tissues to keep organs in place.

10. Although all muscle tissue cells have some similarities, smooth muscle (also known as involuntary muscle) differs by: A)

having dense bodies attached to actin filaments.

B)

containing sarcomeres between Z lines and M bands.

C)

having rapid contractions and abundant cross-striations.

D)

contracting in response to increased intracellular calcium.

11. Which of the following aspects of the function of the nucleus is performed by ribosomal RNA (rRNA)?

A)

Copying and carrying DNA instructions for protein synthesis

B)

Carrying amino acids to the site of protein synthesis

C)

Providing the site where protein synthesis occurs

D)

Regulating and controlling protein synthesis

12. Breakdown and removal of foreign substances and worn-out cell parts are performed by which of the following organelles?

A)

Lysosomes

B)

Golgi apparatus

C)

Ribosomes

D)

Endoplasmic reticulum (ER)

13. Impairment in the function of peroxisomes would result in: A)

inadequate sites for protein synthesis.

B)

an inability to transport cellular products across the cell membrane.

C)

insufficient energy production within a cell.

D)

accumulation of free radicals in the cytoplasm.

14. After several months of trying to conceive, a couple is undergoing fertility testing. Semen analysis indicates that the mans sperm have decreased motility, a finding that is thought to underlie the couples inability to become pregnant.

Which of the following cellular components may be defective within the mans sperm?

A)

Ribosomes

B)

Microtubules

C)

Mitochondria

D)

Microfilaments

15. Which of the following statements is true of glycolysis?

A)

Glycolysis requires oxygen.

B)

Glycolysis occurs in cells without mitochondria.

C)

Glycolysis provides the majority of the bodys energy needs.

D)

Glycolysis produces energy, water, and carbon dioxide.

16. Which of the following membrane transport mechanisms requires the greatest amount of energy?

A)

Facilitated diffusion

B)

Passive transport

C)

Vesicular transport

D)

Simple diffusion

17. A male patient with a diagnosis of type 1 diabetes mellitus is experiencing hyperglycemia because he lacks sufficient insulin to increase the availability of glucose transporters in his cell membranes. Consequently, his cells lack intracellular glucose and it accumulates in his blood. Which of the following processes would best allow glucose to cross his cell membranes?

A)

Facilitated diffusion

B)

Simple diffusion

C)

Secondary active transport

D)

Endocytosis

18. Which of the following statements is true of skeletal muscle cells?

A)

Skeletal muscle cells each have an apical, lateral, and basal surface.

B)

They are closely apposed and are joined by cell-to-cell adhesion molecules.

C)

Their basal surface is attached to a basement membrane.

D)

Skeletal muscle is multinucleated, lacking true cell boundaries.

19. Which of the following body tissues exhibits the highest rate of turnover and renewal?

A)

The squamous epithelial cells of the skin

B)

The connective tissue supporting blood vessels

C)

The skeletal muscle that facilitates movement

D)

The nervous tissue that constitutes the central nervous system

20. A patient with a pathophysiologic condition that affects the desmosomes is most likely to exhibit: A)

impaired contraction of skeletal and smooth muscle.

B)

weakness of the collagen and elastin fibers in the extracellular space.

C)

impaired communication between neurons and effector organs.

D)

separation at the junctions between epithelial cells.

Answer Key 1. B 2. C 3. A 4. D 5. B 6. C 7. A 8. C 9. B 10. A

11. C 12. A 13. D 14. B 15. B 16. C 17. A 18. D 19. A 20. D Chapter 2 Altered Cells and Tissues 1. Ischemia and other toxic injuries increase the accumulation of intracellular calcium as a result of: A)

release of stored calcium from the mitochondria.

B)

improved intracellular volume regulation.

C)

decreased influx across the cell membrane.

D)

attraction of calcium to fatty infiltrates.

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

A)

metaplasia

B)

organ atrophy

C)

compensatory hyperplasia

D)

physiologic hypertrophy

3. A person eating peanuts starts choking and collapses. His airway obstruction is partially cleared, but he remains hypoxic until he reaches the hospital. The prolonged cell hypoxia caused a cerebral infarction and resulting __________ in the brain.

A)

caspase activation

B)

coagulation necrosis

C)

rapid phagocytosis

D)

protein p53 deficiency

4. Bacteria and viruses cause cell damage by _______, which is unique from the intracellular damage caused by other injurious agents.

A)

disrupting the sodium/potassium ATPase pump

B)

interrupting oxidative metabolism processes

C)

replicating and producing continued injury

D)

decreasing protein synthesis and function

5. The patient has a prolonged interruption in arterial blood flow to his left kidney, causing hypoxic cell injury and the release of free radicals. Free radicals damage cells by: A)

destroying phospholipids in the cell membrane.

B)

altering the immune response of the cell.

C)

disrupting calcium storage in the cell.

D)

inactivation of enzymes and mitochondria.

6. Injured cells have impaired flow of substances through the cell membrane as a result of: A)

increased fat load.

B)

altered permeability.

C)

altered glucose utilization.

D)

increased surface receptors.

7. Reversible adaptive intracellular responses are initiated by: A)

stimulus overload.

B)

genetic mutations.

C)

chemical messengers.

D)

mitochondrial DNA.

8. Injured cells become very swollen as a result of: A)

increased cell protein synthesis.

B)

altered cell volume regulation.

C)

passive entry of potassium into the cell.

D)

bleb formation in the plasma membrane.

9. A diabetic patient has impaired sensation, circulation, and oxygenation of his feet. He steps on a piece of glass, the wound does not heal, and the area tissue becomes necrotic. The necrotic cell death is characterized by: A)

rapid apoptosis.

B)

cellular rupture.

C)

shrinkage and collapse.

D)

chronic inflammation.

10. A 99-year-old woman has experienced the decline of cell function associated with age. A group of theories of cellular aging focus on programmed: A)

changes with genetic influences.

B)

elimination of cell receptor sites.

C)

insufficient telomerase enzyme.

D)

DNA mutation or faulty repair.

11. An 89-year-old female patient has experienced significant decreases in her mobility and stamina during a 3-week hospital stay for the treatment of a femoral head fracture. Which of the following phenomena most likely accounts for the patients decrease in muscle function that underlies her reduced mobility?

A)

Impaired muscle cell metabolism resulting from metaplasia

B)

Dysplasia as a consequence of inflammation during bone remodeling

C)

Disuse atrophy of muscle cells during a prolonged period of immobility

D)

Ischemic atrophy resulting from vascular changes while on bedrest

12. A 20-year-old college student has presented to her campus medical clinic for a scheduled Papanicolaou (Pap) smear. The clinician who will interpret the smear will examine cell samples for evidence of:

A)

changes in cell shape, size, and organization.

B)

the presence of unexpected cell types.

C)

ischemic changes in cell samples.

D)

abnormally high numbers of cells in a specified field.

13. Which of the following pathophysiologic processes is most likely to result in metastatic calcification?

A)

Benign prostatic hyperplasia

B)

Liver cirrhosis

C)

Impaired glycogen metabolism

D)

Hyperparathyroidism

14. Despite the low levels of radiation used in contemporary radiologic imaging, a radiology technician is aware of the need to minimize her exposure to ionizing radiation. What is the primary rationale for the technicians precautions?

A)

Radiation stimulates pathologic cell hypertrophy and hyperplasia.

B)

Radiation results in the accumulation of endogenous waste products in the cytoplasm.

C)

Radiation interferes with DNA synthesis and mitosis.

D)

Radiation decreases the action potential of rapidly dividing cells.

15. The parents of a 4-year-old girl have sought care because their daughter has admitted to chewing and swallowing imported toy figurines that have been determined to be made of lead. Which of the following blood tests should the care team prioritize?

A)

White blood cell levels with differential

B)

Red blood cell levels and morphology

C)

Urea and creatinine levels

D)

Liver function panel

16. A 70-year-old male patient has been admitted to a hospital for the treatment of a recent hemorrhagic stroke that has left him with numerous motor and sensory deficits. These deficits are most likely the result of which of the following mechanisms of cell injury?

A)

Free radical injury

B)

Hypoxia and ATP depletion

C)

Interference with DNA synthesis

D)

Impaired calcium homeostasis

17. Which of the following processes associated with cellular injury is most likely to be reversible?

A)

Cell damage resulting from accumulation of fat in the cytoplasm

B)

Cellular changes as a result of ionizing radiation

C)

Cell damage from accumulation of free radicals

D)

Apoptosis

18. The extrinsic pathway of apoptosis can be initiated by: A)

damage to cellular DNA.

B)

decreased ATP levels.

C)

activation of the p53 protein.

D)

activation of death receptors on the cell surface.

19. A patient with severe peripheral vascular disease has developed signs of dry gangrene on the great toe of one foot. Which of the following pathophysiologic processes most likely contributed to this diagnosis?

A)

Inappropriate activation of apoptosis

B)

Bacterial invasion

C)

Impaired arterial blood supply

D)

Metaplastic cellular changes

20. Which of the following facts underlies the concept of replicative senescence?

A)

Genes controlling longevity are present or absent in varying quantities among different individuals.

B)

Telomeres become progressively shorter in successive generations of a cell.

C)

The damaging influence of free radicals increases exponentially in later generations of a cell.

D)

Aging produces mutations in DNA and deficits in DNA repair.

Answer Key 1. A 2. C 3. B 4. C 5. A 6. B 7. C 8. B 9. B 10. A 11. C 12. A 13. D 14. C 15. B 16. B 17. A 18. D 19. C 20. B Chapter 3 Inflammation and Tissue Repair 1. The characteristic, localized cardinal signs of acute inflammation include: A)

fever.

B)

fatigue.

C)

redness.

D)

granuloma.

2. The vascular, hemodynamic stage of acute inflammation is initiated by momentary vasoconstriction followed by vasodilation that causes localized: A)

bleeding.

B)

congestion.

C)

pale skin.

D)

coolness.

3. The cellular stage of acute inflammation is marked by the movement of leukocytes into the area. Which of the following cells arrives early in great numbers?

A)

Basophils

B)

Lymphocytes

C)

Neutrophils

D)

Platelets

4. The phagocytosis process involves three distinct steps. What is the initial step in the process?

A)

Engulfment

B)

Intracellular killing

C)

Antigen margination

D)

Recognition and adherence

5. Which of the following mediators of inflammation causes increased capillary permeability and pain?

A)

Serotonin

B)

Histamine

C)

Bradykinin

D)

Nitric oxide

6. Inflammatory exudates are a combination of several types. Which of the following exudates is composed of enmeshed necrotic cells?

A)

Serous

B)

Fibrinous

C)

Suppurative

D)

Membranous

7. The acute-phase systemic response usually begins within hours of the onset of inflammation and includes: A)

fever and lethargy.

B)

decreased C-reactive protein.

C)

positive nitrogen balance.

D)

low erythrocyte sedimentation rate.

8. In contrast to acute inflammation, chronic inflammation is characterized by which of the following phenomena?

A)

Profuse fibrinous exudation

B)

A shift to the left of granulocytes

C)

Metabolic and respiratory alkalosis

D)

Lymphocytosis and activated macrophages

9. Exogenous pyrogens (interleukin-1) and the presence of bacteria in the blood lead to the release of endogenous pyrogens that: A)

stabilize thermal control in the brain.

B)

produce leukocytosis and anorexia.

C)

block viral replication in cells.

D)

inhibit prostaglandin release.

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

A)

Outpouring of exudate into interstitial spaces

B)

Chemotaxis

C)

Accumulation of leukocytes along the epithelium

D)

Phagocytosis of cellular debris

11. Which of the following individuals most likely has the highest risk of experiencing chronic inflammation?

A)

A patient who has recently been diagnosed with type 2 diabetes

B)

A patient who is a carrier of an antibiotic-resistant organism

C)

A patient who is taking oral antibiotics for an upper respiratory infection

D)

A patient who is morbidly obese and who has a sedentary lifestyle

12. Which of the following core body temperatures is within normal range?

A)

35.9C (96.6F)

B)

38.0C (100.4F)

C)

35.5C (95.9F)

D)

37.3C (99.1F)

13. A postsurgical patient who is recovering in the postanesthetic recovery unit states that she is freezing cold. Which of the following measures is likely to be initiated in the patients hypothalamus in an effort to reduce heat loss?

A)

Opening of arteriovenous (AV) shunts

B)

Reduced exhalation of warmed air

C)

Contraction of pilomotor muscles

D)

Decreased urine production

14. An elderly patient is dressed only in a hospital gown and complains of a draft in her room. Consequently, she has requested a warm blanket while she sits in her wheelchair. Which of the following mechanisms of heat loss is most likely the primary cause of her request?

A)

Evaporation and conduction

B)

Radiation and convection

C)

Conduction and convection

D)

Convection and evaporation

15. Which of the following pathophysiologic processes are capable of inducing the production of pyrogens? Select all that apply.

A)

Acute inflammation

B)

Obesity

C)

Myocardial infarction

D)

Malignancy

E)

Renal failure

16. Which of the following patients is most likely to be susceptible to developing a neurogenic fever?

A)

A patient who has stage II Alzheimer disease

B)

A patient who has sustained a head injury in a bicycle crash

C)

A patient who has become delirious after the administration of a benzodiazepine

D)

A patient who has begun taking a selective serotonin-reuptake inhibitor (SSRI) for the treatment of depression

17. Patients are commonly administered antipyretics when their oral temperature exceeds 37.5C (99.5F). Which of the following statements related to the rationale for this action is most accurate?

A)

Temperatures in excess of 37.5C (99.5F) can result in seizure activity.

B)

Lower temperatures inhibit the protein synthesis of bacteria.

C)

There is little empirical evidence for this treatment modality.

D)

Most common antipyretics have been shown to have little effect on core temperature.

18. A patient has sought care because of recent malaise and high fever. Upon assessment, the patient states that his current fever began two days earlier, although he states that for the last 2 weeks he is in a cycle of high fever for a couple of days followed by a day or two of normal temperature. Which of the following fever patterns is this patient experiencing?

A)

Recurrent fever

B)

Remittent fever

C)

Sustained fever

D)

Intermittent fever

19. A febrile, 3-week-old infant has been brought to the emergency department by his parents and is currently undergoing a diagnostic workup to determine the cause of his fever. Which of the following statements best conveys the rationale for this careful examination?

A)

The immature hypothalamus is unable to perform normal thermoregulation.

B)

Infants are susceptible to serious infections because of their decreased immune function.

C)

Commonly used antipyretics often have no effect on the core temperature of infants.

D)

Fever in neonates is often evidence of a congenital disorder rather than an infection.

20. An 84-year-old patients blood cultures have come back positive, despite the fact that his oral temperature has remained within normal range. Which of the following phenomena underlies the alterations in fever response that occur in the elderly?

A)

Disturbance in the functioning of the thermoregulatory center

B)

Increased heat loss by evaporation

C)

The presence of comorbidities that are associated with lowered core temperature

D)

Persistent closure of arteriovenous shunts

Answer Key 1. C 2. B 3. C 4. D 5. C

6. D 7. A 8. D 9. B 10. A 11. D 12. D 13. C 14. B 15. A, C, D 16. B 17. C 18. D 19. B 20. A Chapter 4 Altered Immunity 1. The mediators involved in type I hypersensitivity allergic responses are released from: A)

mast cells.

B)

plasma cells.

C)

monocytes.

D)

arachidonic acid.

2. A genetically determined hypersensitivity to common environmental allergens causes ___________ reactions, such as: A)

atopic; urticaria.

B)

autoimmune; diarrhea.

C)

IgM-mediated; infections.

D)

delayed; poison ivy rash:

3. Mismatched blood transfusion reaction with hemolysis of blood cells is an example of type II, _____ mediated hypersensitivity reaction.

A)

T-cell

B)

antibody

C)

leukotriene

D)

complement

4. Type III hypersensitivity immune responses can be harmful when immune complex deposits in tissue activate ___________ that can directly damage area tissues.

A)

inflammation

B)

autoantibodies

C)

cytotoxic cells

D)

immunoglobulins

5. The mechanism by which humans recognize self-cells from non-self (antigens)cells is _________.

A)

autoimmunity

B)

self-tolerance

C)

non-self anergy

D)

immunocompatibility

6. Organ rejection is a complication of organ transplantation caused by recipient immune cells: A)

destroying the host T cells.

B)

attack on the donor cells.

C)

combining with grafts HLA.

D)

being recognized as foreign.

7. The leading cause of death for people with HIV is opportunistic ____________.

A)

leukemia

B)

tuberculosis

C)

pneumonia

D)

toxoplasmosis

8. Wasting syndrome, an AIDS-defining illness, is characterized by involuntary weight loss of at least 10% of baseline body weight in the presence of: A)

diarrhea.

B)

hypermetabolism.

C)

weakness and fever.

D)

glucose intolerance.

9. The window period of HIV infection refers to the period of time between infection and: A)

transmission.

B)

seroconversion.

C)

initial symptoms.

D)

antibody screening.

10. HIV-positive persons that display manifestations of laboratory category 3 or clinical category C are considered to have: A)

zero viral load.

B)

seroconversion.

C)

complete remission.

D)

AIDS-defining illnesses.

11. Contact with poison ivy has resulted in intense pruritus, erythema, and weeping on a patients forearm. Which of the following processes resulted in the patients signs and symptoms?

A)

IgE-mediated mast cell degranulation

B)

Formation of antigen-antibody complexes

C)

Cytokine release by sensitized T cells

D)

Formation of antibodies against cell surface antigens

12. A patient with a long history of hay fever has recently begun a series of immunotherapy (allergy shots). How will this treatment potentially achieve a therapeutic effect?

A)

By blocking cytokine release from sensitized mast cells

B)

By preventing mast cells from becoming sensitized

C)

By causing T cells to be sequestered in the thymus for longer periods

D)

By stimulating production of IgG to combine with antigens

13. A patient with a diagnosis of cirrhosis has experienced an acute rejection of a donor liver. Which of the following cells is central to the rejection of the patients transplanted organ?

A)

Natural killer cells

B)

Mast cells

C)

T cells

D)

Neutrophils

14. A patient with a diagnosis of aplastic anemia has undergone allogenic bone marrow transplantation. Which of the following signs and symptoms would most clearly suggest the existence of graft-versus-host disease (GVHD)?

A)

Shortness of breath, audible crackles, and decreasing PaO2

B)

Presence of a pruritic rash that has begun to slough off

C)

Development of metabolic acidosis

D)

Diaphoresis, fever, and anxiety

15. A patient has developed pericarditis after developing acute glomerulonephritis, a development that may be attributable to the presence of similar epitopes on group A, b-hemolytic streptococci and the antigens in the patients heart tissue.

Which of the following has most likely accounted for this patients autoimmune response?

A)

Breakdown of T-cell anergy

B)

Release of sequestered antigens

C)

Superantigens

D)

Molecular mimicry

16. A 70-year-old female patient has had her mobility and independence significantly reduced by rheumatoid arthritis. Which of the following processes likely contributed to the development of her health problem?

A)

Delayed-type hypersensitivity (DTH) reaction

B)

Proliferation of cytotoxic T cells

C)

Failure of normal self-tolerance

D)

Deletion of autoreactive B cells

17. Which of the following would constitute a normal assessment finding in a neonate?

A)

Minimal or absent levels of IgA and IgM

B)

Absence of plasma cells in the lymph nodes and spleen

C)

Undetectable levels of all immunoglobulins

D)

Absence of mature B cells with normal T-cell levels and function

18. A patient was diagnosed as HIV positive several years ago. Which of the following blood tests is most clinically useful for determining the stage and severity of her disease?

A)

Plasma levels

B)

CD4+ cell counts

C)

Viral load

D)

White blood cell count with differential

19. A patient has been admitted to the hospital for the treatment of HIV infection, which has recently progressed to overt AIDS. Which of the following nursing actions should the nurse prioritize when providing care for this patient?

A)

Frequent neurologic vital signs and thorough skin care

B)

Hemodynamic monitoring and physical therapy

C)

Careful monitoring of fluid balance and neurologic status

D)

Astute infection control and respiratory assessments

20. Shortly after being diagnosed with HIV, a patient has begun highly active antiretroviral therapy (HAART). What is the primary goal of the patients drug regimen?

A)

To limit the latent period of HIV

B)

To slow the progression of the disease

C)

To minimize opportunities for transmission

D)

To prevent seroconversion

Answer Key 1. A 2. A 3. B 4. A 5. B 6. B 7. B 8. A 9. B 10. D 11. C 12. D 13. C 14. B 15. D 16. C 17. A 18. B 19. D 20. B

Chapter 5 Infection 1. Although growth rate is variable among types of bacteria, the growth of bacteria is dependent on: A)

biofilm communication.

B)

availability of nutrients.

C)

an intact protein capsid.

D)

individual cell motility.

2. Treponema pallidum, the cause of syphilis, is a spirochete bacterium that is spread from human to human by: A)

tick or lice vector bites.

B)

direct physical contact.

C)

exposure to infected urine.

D)

inhaling airborne particles.

3. Chlamydiaceae, a rather common sexually transmitted infectious organism, has characteristics of both viruses and bacteria. The infectious form of this organisms life cycle is _______ until it enters the host cell.

A)

an elementary body

B)

adhered to cholesterol

C)

propelled by filaments

D)

encapsulated hyphae

4. Because dermatophytes are capable of growing _________, the infection is mainly found on cutaneous surfaces of the body.

A)

a powdery colony

B)

in moist skin folds

C)

on cooler tissue

D)

branching filaments

5. Although both eukaryotes and prokaryotes are capable of causing infectious diseases in humans, eukaryotes are unique because they have a distinct:

A)

organized nucleus.

B)

circular plasmid DNA.

C)

cytoplasmic membrane.

D)

variation of shape and size.

6. Whatever the mechanism of entry, the human-to-human transmission of infectious agents is directly related to the: A)

source of contact.

B)

site of infection.

C)

number of pathogens absorbed.

D)

virulence factors.

7. The course of any infectious disease progresses through several distinct stages after the pathogen enters the host. Although the duration may vary, the hallmark of the prodromal stage is: A)

tissue inflammation and damage.

B)

initial appearance of symptoms.

C)

progressive pathogen elimination.

D)

containment of infectious pathogens.

8. Although bacterial toxins vary in their activity and effects on host cells, a small amount of gram-negative bacteria endotoxin: A)

is released during cell growth.

B)

inactivates key cellular functions.

C)

uses protein to activate enzymes.

D)

in the cell wall activates inflammation.

9. Serology testing includes the measurement of which of the following?

A)

Antibody titers

B)

Culture growth

C)

Direct antigens

D)

DNA sequencing

10. Prions cause transmissible neurodegenerative diseases and are characterized by: A)

a lack of reproductive capacity.

B)

hypermetabolism.

C)

enzyme production.

D)

chronic inflammation.

11. Which of the following individuals is experiencing a health problem that is the result of a parasite?

A)

A college student who contracted Chlamydia trachomatis during an unprotected sexual encounter

B)

A man who acquired malaria while on a tropical vacation

C)

A hospital patient who has developed postoperative pneumonia

D)

A woman who developed hepatitis A from eating at an unhygienic restaurant

12. Which of the following traits is characteristic of saprophytes?

A)

They derive energy from decaying organic matter.

B)

They are beneficial components of human microflora.

C)

They have RNA or DNA, but never both.

D)

They are capable of spore production.

13. A hospital patient was swabbed on admission for antibiotic-resistant organisms and has just been informed that methicillin-resistant Staphylococcus aureus (MRSA) is present in his groin. The patient has a normal core temperature and white blood cell count. This patient is experiencing which of the following?

A)

Infection

B)

Proliferation

C)

Colonization

D)

Inflammation

14. A 33-year-old patient who is a long-term intravenous user of heroin has been recently diagnosed with hepatitis C. Which of the following portals of entry most likely led to the patients infection?

A)

Direct contact

B)

Vertical transmission

C)

Ingestion

D)

Penetration

15. A 9-month-old infant has been diagnosed with botulism after he was fed honey.

The childs mother was prompted to seek care because of this childs sudden onset of neuromuscular deficits, which were later attributed to the release of substances by Clostridium botulinum bacteria. Which virulence factor contributed to this childs illness?

A)

Endotoxins

B)

Adhesion factors

C)

Exotoxins

D)

Evasive factors

16. A patient with a long-standing diagnosis of Crohn disease has developed a perianal abscess. Which of the following treatments will this patient most likely require?

A)

Antiviral therapy

B)

Antibiotic therapy

C)

Surgical draining

D)

Pressure dressing

17. A patients primary care provider has ordered direct antigen detection in the care of a patient with a serious symptomatology of unknown origin. Which of the following processes will be conducted?

A)

Detecting DNA sequences that are unique to the suspected pathogen

B)

Growth of biofilms on various media in the laboratory setting

C)

Quantification of IgG and IgM antibodies in the patients blood

D)

Introduction of monoclonal antibodies to a blood sample from the patient

18. A patient has begun taking acyclovir, an antiviral medication, to control herpes simplex outbreaks. What is this drugs mechanism of action?

A)

Inhibition of viral adhesion to cells

B)

Elimination of exotoxin production

C)

Antagonism of somatic cell binding sites

D)

Interference with viral replication processes

19. International travel has contributed to increased prevalence and incidence of nonindigenous diseases by increasing which of the following?

A)

Portals of entry

B)

Sources of infection

C)

Virulence

D)

Disease course

20. A public health nurse should recognize that sexually transmitted infections (STIs) are typically spread by which of the following mechanisms?

A)

Penetration

B)

Vertical transmission

C)

Direct contact

D)

Ingestion

Answer Key 1. B 2. B 3. A 4. C 5. A 6. C 7. B 8. D 9. A 10. A

11. B 12. A 13. C 14. D 15. C 16. C 17. D 18. D 19. B 20. C Chapter 6 Genetic and Developmental Disorders 1. Genetic disorders that involve a single gene trait are characterized by: A)

multifactorial gene mutations.

B)

chromosome rearrangements.

C)

Mendelian patterns of transmission.

D)

abnormal numbers of chromosomes.

2. In addition to having a 50% chance of inheriting an autosomal dominant disorder from an affected parent, such a disorder is characterized by: A)

aneuploidy of genes in all cells.

B)

deficiencies in enzyme synthesis.

C)

affected X transmission to daughters.

D)

varied gene penetration and expression.

3. Autosomal recessive disorders are characterized by: A)

age of onset later in life.

B)

abnormal protein structure.

C)

inborn errors of metabolism.

D)

one in two risk of a carrier child.

4. When a male child inherits an X-linked disorder from his heterozygous carrier mother, A)

his sons will be carriers.

B)

his father has the disorder.

C)

some of his sisters will be carriers.

D)

his daughters will have the disorder.

5. Multifactorial inheritance disorders, such as cleft palate, are often caused by____________ during fetal development.

A)

multiple gene mutations

B)

dominant gene expression

C)

X-linked crossover problem

D)

polyploidy of chromosomes

6. The newborn has the distinctive physical features of trisomy 21, Down syndrome, which includes: A)

upward slanting of eyes.

B)

large, protruding ears.

C)

thin lips and small tongue.

D)

long fingers with extra creases.

7. Aneuploidy of the X chromosome can result in a monosomy or polysomy disorder. The manifestations of monosomy X, Turner syndrome, differ from polysomy X disorders in numerous ways that include: A)

short-stature female individual..

B)

mental retardation.

C)

enlarged breasts.

D)

early onset puberty.

8. A teratogenic environmental agent can cause birth defects when: A)

inherited as a recessive trait.

B)

intense exposure occurs at birth.

C)

disjunction occurs during meiosis.

D)

retained during early pregnancy.

9. Fetal alcohol syndrome (FAS) is unlike other teratogens in that the harmful effects on the fetus: A)

directly result in liver damage.

B)

extend throughout the pregnancy.

C)

is most noticeable in adulthood.

D)

cause death in early childhood.

10. Prenatal diagnosis methods include the use of ultrasonography for identifying ________ abnormalities.

A)

cytogenic

B)

skeletal

C)

chromosomal

D)

a-fetoprotein

11. A woman who is a carrier for which of the following diseases possesses the greatest likelihood of passing the disease to her future children when heterozygous pairing exists?

A)

Phenylketonuria (PKU)

B)

Tay-Sachs disease

C)

Neurofibromatosis

D)

Cystic fibrosis

12. Which of the following statements is true of autosomal recessive disorders?

A)

Onset is typically late in childhood or early in adulthood.

B)

Symptomatology is less uniform than with autosomal dominant disorders.

C)

Mitochondrial DNA is normally the site of genetic alteration.

D)

Effects are typically the result of alterations in enzyme function.

13. The parents of a newborn infant are relieved that their baby was born healthy, with the exception of a cleft lip that will be surgically corrected in 10 or 12 weeks. Which of the nurses following statements to the parents best conveys the probable cause of the infants cleft lip?

A)

Though you are both healthy, you likely both carry the gene for a cleft lip.

B)

Provided one of you had the gene for a cleft lip, your baby likely faced a 50/50 chance of having one.

C)

Your childs cleft lip likely results from the interplay between environment and genes.

D)

A cleft lip can sometimes result from taking prescription drugs, even when theyre taken as ordered.

14. Which of the following practitioners is most likely to be of assistance in the early care of an infant with a cleft lip?

A)

Lactation consultant

B)

Respiratory therapist

C)

Occupational therapist

D)

Social worker

15. A 41-year-old woman has made the recent decision to start a family, and is eager to undergo testing to mitigate the possibility of having a child with Down syndrome. Which of the following tests is most likely to provide the data the woman seeks?

A)

Genetic testing of the woman

B)

Genetic testing of the woman and the father

C)

Prenatal blood tests

D)

Ultrasonography

16. Genetic testing has revealed that a male infant has been born with an extra X chromosome. What are the most likely implications of this finding?

A)

The child is unlikely to survive infancy

B)

The child is likely to have no manifestations of this chromosomal abnormality

C)

The child will have significant neurological and cognitive defects

D)

The child will be unable to reproduce

17. Which of the following variables determine the extent of teratogenic drug effects? Select all that apply.

A)

Maternal health history

B)

Molecular weight of the drug

C)

Stage of pregnancy when the drug was taken

D)

Duration of drug exposure

E)

Fetal blood type

18. A woman who has just learned that she is pregnant for the first time has sought advice from her healthcare provider about the safe use of alcohol during pregnancy. What advice should the clinician provide to the woman?

A)

Its likely best to eliminate alcohol from your diet while youre pregnant.

B)

Moderation in alcohol use is critical while you are pregnant.

C)

You should limit yourself to a maximum of one drink daily while youre pregnant.

D)

You should drink no alcohol until you are in your second trimester.

19. Which of the following health problems may be identified by a TORCH screening test?

A)

Rubella and herpes

B)

Tenovaginitis and human papillomavirus

C)

Rhinovirus and Ormond disease

D)

Chlamydia and rickets

20. Ultrasonography is most likely to detect which of the following fetal abnormalities?

A)

Neural tube defects

B)

Skeletal abnormalities

C)

Chromosomal defects

D)

Single-gene disorders

Answer Key 1. C 2. D 3. C 4. C 5. A 6. A 7. A 8. D 9. B 10. B 11. C 12. D 13. C 14. A 15. C 16. B 17. B, C, D 18. A 19. A 20. B Chapter 7 Altered Cellular Proliferation and Differentiation 1. Epithelialization, the first component of the proliferative phase of wound healing, is delayed in open wounds until after ________ has formed.

A)

granulation tissue

B)

fibrinous meshwork

C)

capillary circulation

D)

collagenous layers

2. A mutation has occurred during mitosis of an individuals bone marrow cell.

This event may be the result of the failure of which of the following?

A)

Progenitor cells

B)

Fibroblasts

C)

Stem cells

D)

Cyclins

3. A patient has experienced a myocardial infarction with accompanying necrosis of cardiac muscle, a permanent tissue. What are the ramifications of the fact that cardiac muscle is a permanent tissue?

A)

The cardiac muscle cells will remain perpetually in the G1 stage of mitosis.

B)

Regeneration of the patients cardiac muscle will be exceptionally slow.

C)

The necrotic cells will be replaced with muscle cells that have limited metabolism.

D)

The cells will not proliferate and will be replaced with scar tissue.

4. A couple have chosen to pay for the harvesting and storage of umbilical cord blood after the delivery of their child to secure a future source of embryonic stem cells. What is the most likely rationale for the couples decision?

A)

The stem cells may be able to produce a wide range of body cells.

B)

The embryonic stem cells allow stable and permanent tissues to enter mitosis.

C)

The stem cells can change the proliferative capacity of other cells.

D)

The embryonic stem cells remove cyclin-dependent kinase inhibitors from the body.

5. The basement membrane surrounding a patients foot wound remains intact, a fact that bodes well for the wound-healing process. Which of the following components constitute this form of the extracellular matrix? Select all that apply.

A)

Prostaglandins

B)

Fibrous structural proteins

C)

Lymphocytes

D)

Water-hydrated gels

E)

Glycoproteins

6. A nursing student is cleaning and changing the dressing on a patients sacral ulcer. The student has vigorously cleansed the wound bed to remove all traces of the beefy, red tissue that existed in the wound bed. The student has most likely removed: A)

Necrotic tissue

B)

Granulation tissue

C)

Stem cells

D)

The extracellular matrix

7. A 12-year-old boys severe wound that he received from a dog bite has begun to heal and currently shows no signs of infection. Which of the following processes occurred first during this process of repair by connective tissue deposition?

A)

Reorganization of fibrous tissue

B)

Angiogenesis

C)

Emigration of fibroblasts to the wound site

D)

Deposition of the extracellular matrix

8. Which of the following wounds is most likely to heal by secondary intention?

A)

A finger laceration that a cook received while cutting up onions

B)

A boys road rash that he got by falling off his bicycle

C)

A needlestick injury that a nurse received when injecting a patients medication

D)

The incision from a teenagers open appendectomy

9. A patient underwent an open cholecystectomy 4 days ago and her incision is now in the proliferative phase of healing. What is the dominant cellular process that characterizes this phase of the patients healing?

A)

Hemostasis and vasoconstriction

B)

Keloid formation

C)

Collagen secretion by fibroblasts

D)

Phagocytosis by neutrophils

10. Which of the following surgical patients is most likely to experience enhanced wound healing as a result of his or her diet?

A)

A patient who eats a high-calorie diet and large amounts of red meat

B)

A patient who is a vegetarian and who eats organic foods whenever possible

C)

A patient who practices carefully calorie control and who avoids animal fats

D)

A patient who is receiving total parenteral nutrition due to recurrent nausea

11. Which of the following patients is most likely to experience impaired wound healing?

A)

A patient with a diagnosis of type 1 diabetes and a history of poor blood sugar control

B)

A child whose severe cleft lip and palate have required a series of surgeries over several months

C)

A patient who takes nebulized bronchodilators several times daily to treat chronic obstructive pulmonary disease

D)

A patient with persistent hypertension who takes a b-adrenergic blocker and a potassium-wasting diuretic daily

Answer Key 1. A 2. D 3. D 4. A 5. B, D, E 6. B

7. B 8. B 9. C 10. A 11. A Chapter 8 Altered Fluid, Electrolyte, and Acid-Base Balance 1. An injured patient develops interstitial edema as a result of decreased: A)

vascular volume.

B)

hydrostatic pressure.

C)

capillary permeability.

D)

colloidal osmotic pressure.

2. The most reliable method for measuring body water or fluid volume increase is by assessing: A)

tissue turgor.

B)

intake and output.

C)

body weight change.

D)

serum sodium levels.

3. The syndrome of inappropriate ADH is characterized by: A)

increased osmolality.

B)

excessive water thirst.

C)

copious dilute urination.

D)

dilutional hyponatremia.

4. In isotonic fluid volume deficit, changes in total body water are accompanied by: A)

intravascular hypotonicity.

B)

increased intravascular water.

C)

increases in intracellular sodium.

D)

proportionate losses of sodium.

5. Hyponatremia can be caused by ______and manifested by _______.

A)

hypovolemia; dehydration

B)

third spacing; hypertonicity

C)

water retention; hypotonicity

D)

aldosterone excess; low ADH

6. One of the major causes of hyperkalemia is ____________, which alters potassium elimination.

A)

renal dysfunction

B)

aldosterone excess

C)

metabolic alkalosis

D)

plasma albumin deficit

7. Hypoparathyroidism causes hypocalcemia by: A)

increasing serum magnesium.

B)

increasing phosphate excretion.

C)

blocking bone release of calcium.

D)

blocking action of intestinal vitamin D.

8. Magnesium is important for the overall function of the body because of its direct role in: A)

cell membrane permeability.

B)

somatic cell growth control.

C)

sodium and tonicity regulation.

D)

DNA replication and transcription.

9. A patient has acidosis that is suspected to be respiratory in etiology. Which of the following is the major cause of acute primary respiratory acidosis?

A)

Decreased CO2 retention

B)

Increased metabolic acids

C)

Renal bicarbonate retention

D)

Impaired alveolar ventilation

10. As other mechanisms prepare to respond to a pH imbalance, immediate buffering is a result of increased: A)

intracellular albumin.

B)

hydrogen/potassium binding.

C)

sodium/phosphate anion absorption.

D)

bicarbonate/carbonic acid regulation.

11. A patient with a diagnosis of liver cirrhosis secondary to alcohol use has a distended abdomen as a result of fluid accumulation in his peritoneal cavity (ascites). Which of the following pathophysiologic processes contributes to this third spacing?

A)

Abnormal increase in transcellular fluid volume

B)

Increased capillary colloidal osmotic pressure

C)

Polydipsia

D)

Impaired hormonal control of fluid volume

12. A patient has been receiving intravenous normal saline at a rate of 125 mL per hour since her surgery 2 days earlier. As a result of her consequent increase in vascular volume, she has become edematous. Which of the following phenomena accounts for this patients edema?

A)

Obstruction of lymph flow

B)

Increased capillary permeability

C)

Decreased capillary colloidal osmotic pressure

D)

Increased capillary filtration pressure

13. A patient with a diagnosis of schizophrenia has been admitted to the emergency department after ingesting more than 2 gallons of water. Which of the following pathophysiologic processes may result from the sudden water gain?

A)

Hypernatremia

B)

Water movement from the extracellular to intracellular compartment

C)

Syndrome of inappropriate secretion of ADH (SIADH)

D)

Isotonic fluid excess in the extracellular fluid compartment

14. Which of the following patients would likely be at highest risk of developing hyperkalemia?

A)

A patient who has been admitted for the treatment of acute renal failure following a drug overdose

B)

A patient who has experienced an ischemic stroke with multiple sensory and motor losses

C)

An elderly patient who is experiencing vomiting and diarrhea as a result of influenza

D)

A patient whose thyroidectomy resulted in the loss of his parathyroid gland

15. A female patient with a history of chronic renal failure has developed hypocalcemia. Which of the following assessment findings would provide potential confirmation of this diagnosis?

A)

The patient experiences shortness of breath on exertion with decreased oxygen saturation levels.

B)

The patient is difficult to rouse and is disoriented to time and place.

C)

The patients heart rate is 120 beats per minute and she is diaphoretic (sweaty).

D)

The patient has muscle spasms and complains of numbness around her mouth.

16. Which of the following assessments should be prioritized in the care of a patient who is being treated for hypokalemia?

A)

Detailed fluid balance monitoring

B)

Arterial blood gases

C)

Cardiac monitoring

D)

Monitoring of hemoglobin levels and oxygen saturation

17. Magnesium is an important component of which of the following processes that are integral to the maintenance of homeostasis? Select all that apply.

A)

Intracellular and extracellular buffering

B)

Cellular energy metabolism

C)

Function of the sodium-potassium pump

D)

Nerve conduction

E)

Cell membrane function

18. A 77-year-old woman has been brought to the emergency department by her daughter because of a sudden and unprecedented onset of confusion. The patient admits to ingesting large amounts of baking soda since the morning in an effort to treat indigestion. How will the womans body attempt to resolve this disruption in acid-base balance?

A)

Hyperventilation

B)

Increasing renal H+ excretion

C)

Increased renal HCO3 reabsorption

D)

Hypoventilation

19. Arterial blood gases of a patient with a diagnosis of acute renal failure reveal a pH of 7.25 (low), HCO3-of 21 mEq/L (low), decreased PCO2 accompanied by a respiratory rate of 32 (high). What disorder of acid-base balance is the patient most likely experiencing?

A)

Metabolic acidosis

B)

Metabolic alkalosis

C)

Respiratory acidosis

D)

Respiratory alkalosis

20. A nurse who is providing care for a patient with a diagnosis of diabetes insipidus should prioritize the close monitoring of serum levels of which of the following electrolytes?

A)

Potassium

B)

Sodium

C)

Magnesium

D)

Calcium

Answer Key 1. D 2. C

3. D 4. D 5. C 6. A 7. C 8. D 9. D 10. D 11. A 12. D 13. B 14. A 15. D 16. C 17. B, C, D, E 18. D 19. A 20. B Chapter 9 Altered Neuronal Transmission 1. The somatic nervous system provides sensory and motor innervation for: A)

peripheral nerves.

B)

abdominal viscera.

C)

secretory glands.

D)

smooth muscle.

2. The proteins and other materials used by the axon are synthesized _____ and then flow down the axon through its cytoplasm.

A)

in the cell body

B)

by Nissl bodies

C)

through dendrites

D)

across synapses

3. Supporting cells of the nervous system, such as Schwann cells, satellite cells, and types of glial cells, function to provide neurons with: A)

local protection.

B)

control functions.

C)

membrane permeability.

D)

integrative metabolism.

4. Neurons are characterized by the ability to communicate with other neurons and body cells through: A)

astrocytes.

B)

axon hillocks.

C)

nodes of Ranvier.

D)

action potentials.

5. Chemical synapses rely on ____ in order to provide communication between neurons.

A)

diffusion

B)

gap junctions

C)

satellite cells

D)

transmitter molecules

6. The blood-brain and CSF-brain barriers control the chemical environment of the brain by allowing easy entrance to only a few chemicals that include: A)

oxygen.

B)

protein.

C)

glutamate.

D)

potassium.

7. The perception of where a stimulus is in space and in relation to body parts is a function of the: A)

occipital lobe.

B)

parietal lobe.

C)

hypothalamus.

D)

prefrontal cortex.

8. The pia mater is a connective tissue sheath that covers the spinal cord and also contains: A)

spinal fluid.

B)

fibrocartilage.

C)

blood vessels.

D)

segmental nerves.

9. Which of the following is the neurotransmitter for most postganglion sympathetic neurons?

A)

Enkephalin

B)

Glutamic acid

C)

Catecholamines

D)

Acetylcholine

10. In contrast to the sympathetic nervous system, the functions of the parasympathetic nervous system include: A)

sweating.

B)

anabolism.

C)

pupil dilation.

D)

vasoconstriction.

11. Which of the following substances provides the majority of the fuel needs of the neurologic system?

A)

Glycogen

B)

Glucose

C)

Amino acids

D)

Triglycerides

12. A 60-year-old woman has been recently diagnosed with multiple sclerosis, a disease in which the oligodendrocytes of the patients central nervous system (CNS) are progressively destroyed. Which physiologic process within the neurologic system is most likely be affected by this disease process?

A)

Oxygen metabolism

B)

Neurotransmitter synthesis

C)

Nerve conduction

D)

Production of cerebrospinal fluid

13. A neuron has been hyperpolarized. How will this affect the excitability of the neuron?

A)

The neuron will have a membrane potential farther from the threshold.

B)

The neuron will be more difficult to repolarize after firing.

C)

The membrane potential of the neuron will be closer to the threshold.

D)

The neurons excitability will be significantly increased.

14. A pregnant womans most recent ultrasound is suggestive of spina bifida, and her primary care provider has subsequently order further diagnostic testing. The pathophysiologic effects of this disease are due to: A)

malformation of the mesoderm.

B)

abnormal closure of the neural tube.

C)

lesions in the dorsal root ganglia.

D)

hypertrophy of the primary vesicles.

15. Which of the following messages is most likely to be carried by general somatic afferent (GSA) neurons?

A)

The sensation of cold when touching ice

B)

The message to move a finger and thumb

C)

The message to move the larynx during speech

D)

Information about the position of a joint

16. Which of the following processes is most likely to occur as a result of a spinal reflex?

A)

Peristalsis of the small and large bowel

B)

Control of oculomotor function in changing light levels

C)

Pain sensation from a potentially damaging knee movement

D)

Withdrawal of a hand from a hot stove element

17. A patient has required mechanical ventilation following a traumatic head injury sustained in a motorcycle crash, during which he sustained damage to his respiratory center. Which of the patients brain structures has been injured?

A)

Brain stem

B)

Midbrain

C)

Diencephalon

D)

Frontal lobe

18. A patient with a diagnosis of epilepsy has required surgical removal of part of her prefrontal cortex. Which of the following effects should her family and care team anticipate?

A)

Lapses in balance and coordination

B)

Deficits in regulation of the endocrine system

C)

Sensory losses

D)

Changes in behavior and judgment

19. A patients primary care provider has prescribed a b-adrenergic receptor blocker. Which of the following therapeutic effects do the patient and care provider likely seek?

A)

Reduction in heart rate and blood pressure

B)

Slowing of gastrointestinal motility

C)

Increase in mental acuity

D)

Decreased production of gastric acid

20. Neurotrophic factors contribute to the maintenance of homeostasis in which of the following ways?

A)

By catalyzing the effects of neurotransmitters

B)

By increasing the sensitivity of receptors on postsynaptic cells

C)

By promoting the growth and survival of neurons

D)

By selectively increasing or decreasing the release of neurotransmitters

Answer Key 1. A 2. A 3. A 4. D 5. D 6. A 7. B 8. C 9. C 10. B 11. B 12. C 13. A 14. B 15. A 16. D 17. A 18. D 19. A 20. C

Chapter 10 Altered Sensory Function and Pain Perception 1. The somatosensory system consists of three types of sensory neurons. The special somatic type of afferent sensory neurons has receptors that sense: A)

muscle position.

B)

visceral fullness.

C)

temperature.

D)

painful touch.

2. Proprioceptive somatosensory information from the limbs and trunk is transmitted by the: A)

reflexive networks.

B)

dorsal root ganglion neurons.

C)

anterolateral pathway.

D)

trigeminal sensory neurons.

3. Full localization, discrimination of intensity, and interpretation of somatosensory stimuli requires processing by the: A)

somatosensory cortex.

B)

autonomic nervous system.

C)

Ruffini end-organ receptors.

D)

Pacinian corpuscle receptors.

4. What pain theory proposes that pain receptors share pathways with other sensory modalities and that different activity patterns of the same neurons can be used to signal painful or nonpainful stimuli?

A)

Pattern

B)

Specificity

C)

Gate control

D)

Neuromatrix

5. Nociceptors are sensory receptors that are activated by: A)

cortisol.

B)

noxious stimuli.

C)

pressure and touch.

D)

sudden movements.

6. When a person is stung on the index finger by a bee, the thalamus interprets the pain as: A)

somewhere on the hand.

B)

a spot on the index finger.

C)

attributable to a bee stung.

D)

similar to a previous bee sting.

7. Pain assessment is likely to be most challenging when providing care for which of the following older adult patients?

A)

A 90-year-old patient who takes multiple medications for cardiac and respiratory conditions

B)

A 77-year-old man who has sustained burns on the lower part of his body

C)

An 82-year-old woman who has been diagnosed with diabetes and an anxiety disorder

D)

An 87-year-old man with vascular dementia and numerous other health problems

8. In contrast to acute pain, persistent chronic pain: A)

serves as a warning system.

B)

raises the pain threshold.

C)

imposes physiologic stresses.

D)

causes secondary reflexive spasms.

9. The sites of referred pain are determined by: A)

intensity-coding receptors.

B)

location of the noxious stimuli.

C)

visceral embryonic development.

D)

stimulation that activates C fibers.

10. Complex regional pain syndrome is characterized by: A)

repetitious dermatome pain attacks.

B)

trigeminal neuralgia with facial tics.

C)

severe limb pain after amputation.

D)

disproportionate pain with mobility.

11. An otherwise-healthy patient has been referred to a pain clinic because she claims to experience exquisite pain from the friction of her clothes on her torso.

This patient is likely to be diagnosed with which of the following health problems?

A)

Visceral pain

B)

Hypoalgesia

C)

Allodynia

D)

Primary hyperalgesia

12. A woman has cut her finger while dicing onions in the kitchen, causing her to drop her knife in pain. Which of the following components of this pain signal was transmitted by a third-order neuron?

A)

The neurons between the womans finger and the womans spinal cord

B)

The neurons between the thalamus and the cortex

C)

The neurons between the CNS and the thalamus

D)

The neurons of the efferent pathway that causes muscle contraction

13. A patient with a diagnosis of lung cancer has developed bone metastases resulting in severe and protracted pain. Which of the following assessment components should the nurse prioritize when assessing the patients pain?

A)

The appearance of grimacing, guarding, or wincing

B)

The presence of changes in vital signs that correspond to pain

C)

The patients subjective report of the character and severity of pain

D)

The results of a detailed neurologic assessment

14. A hospital patient has been reluctant to accept morphine sulfate despite visible signs of pain. Upon questioning, the patient reveals that he is afraid of

becoming addicted to the drug. How can a member of the care team best respond to the patients concern?

A)

You might become addicted, but there are excellent resources available in the hospital to deal with that development.

B)

You should likely prioritize the control of your pain over any fears of addiction that you have.

C)

If you start needing higher doses to control your pain, then well address those concerns.

D)

Theres only a minute chance that you will become addicted to these painkillers.

15. Which of the following patients may be experiencing the effects of neuropathic pain?

A)

A girl whose playground accident resulted in an arm fracture

B)

A man with pain secondary to his poorly controlled diabetes

C)

An elderly woman with a stage III pressure ulcer

D)

A man whose pain is caused by gastric cancer

16. Which of the following statements is true of migraine headaches?

A)

Non-pharmacologic treatments and lifestyle modifications can control migraines in most patients.

B)

Surgical treatments for migraines are indicated if pharmacologic treatments are unsuccessful.

C)

Migraines may have a hormonal etiology in some patients.

D)

Opioid analgesics achieve adequate pain control in most patients.

17. Which of the following pain disorders is a manifestation of a disruption of cranial nerve function?

A)

Trigeminal neuralgia

B)

Complex regional pain syndrome

C)

Phantom limb pain

D)

Temporomandibular joint (TMJ) syndrome

18. Which of the following characteristics differentiates a migraine with aura from a migraine without aura?

A)

Gastrointestinal involvement in the hours leading up to the headache

B)

A decrease in mood and affect prior to the headache

C)

Lack of response to non-pharmacologic treatments

D)

Visual symptoms that precede the headache

19. A 44-year-old woman has sought care for the treatment of headaches that have been increasing in severity and frequency, and has been subsequently diagnosed with migraines. Which of the following teaching points should her care provider emphasize?

A)

Weight loss and exercise are very important components of your treatment.

B)

Stopping all of your current medications, even temporarily, should provide some relief.

C)

It would be helpful for you to take control of your diet, sleep schedule, and stress levels.

D)

Your headaches are likely a result of nerve disorder and, unfortunately, cannot be treated successfully.

20. Which of the following principles should underlie the pain control strategy in the care of a child with a diagnosis of cancer?

A)

Opioids should be avoided in order to prevent liver and kidney insult.

B)

Dosing and timing should aim for a steady serum level of the drug that is chosen.

C)

Doses of analgesia should be given only when the patients pain becomes severe.

D)

Drugs from numerous classifications should be used to maximize pain control.

Answer Key 1. A 2. B

3. A 4. A 5. B 6. A 7. D 8. C 9. C 10. D 11. C 12. B 13. C 14. D 15. B 16. C 17. A 18. D 19. C 20. B Chapter 11 Altered Hormonal and Metabolic Regulation 1. A predominant effect of a prolonged excessive growth hormone level is: A)

short stature with obesity.

B)

high androgen hormone levels.

C)

increased blood glucose levels.

D)

insulin-like growth factor (IGF) depletion.

2. The most common cause of hypothyroidism is: A)

goiter.

B)

myxedema.

C)

thyroidectomy.

D)

autoimmune thyroiditis.

3. Thyroid hormone deficit ___________, which alters the function of all major organs in the body.

A)

decreases metabolism

B)

increases protein synthesis

C)

causes vitamin deficiencies

D)

enhances absorption of glucose

4. The most common cause of thyrotoxicosis is Graves disease, which has the distinguishing characteristic of _____ in addition to a diffuse goiter.

A)

muscle fatigue

B)

facial myxedema

C)

ophthalmopathy

D)

decreased cholesterol

5. The major adrenal cortical hormones are steroids and are synthesized from acetate and: A)

ACTH.

B)

albumin.

C)

amino acids.

D)

cholesterol.

6. Primary adrenal insufficiency is manifested by: A)

truncal obesity and edema.

B)

hypokalemia and hypervolemia.

C)

hyponatremia and hypoglycemia.

D)

hypopigmentation and hypertension.

7. One of the earliest signs of Cushing syndrome is the loss of variable diurnal secretion of cortisol-releasing hormone (CRH) and:

A)

GH.

B)

TSH.

C)

DHEA.

D)

ACTH.

8. The iatrogenic form of Cushing syndrome is caused by: A)

long-term cortisone therapy.

B)

pituitary tumor-secreting ACTH.

C)

benign or malignant adrenal tumor.

D)

ectopic ACTH secreting lung tumor.

9. The major manifestations of Cushing syndrome include: A)

excessive salt loss.

B)

muscle hypertrophy.

C)

overt diabetes mellitus.

D)

hair and weight loss.

10. The immune suppressive and anti-inflammatory effects of cortisol cause: A)

moderate insulin resistance.

B)

increased capillary permeability.

C)

increased cell-mediated immunity.

D)

inhibition of prostaglandin synthesis.

11. Which of the following individuals is experiencing the effects of a primary endocrine disorder?

A)

A patient with adrenal cortical insufficiency due to pituitary hyposecretion of ACTH

B)

A patient who has hypothyroidism as a result of low TSH production

C)

A patient whose dysfunctional hypothalamus has resulted in endocrine imbalances

D)

A patient who has low calcium levels because of the loss of his parathyroid gland

12. Which of the following physiologic processes is a direct effect of the release of growth hormone by the anterior pituitary?

A)

Development of cartilage and bone

B)

Production of insulin-like growth factors (IGFs) by the liver

C)

Increase in overall metabolic rate and cardiovascular function

D)

Positive feedback of the hypothalamic-pituitary-thyroid feedback system

13. Which of the following individuals displays the precursors to acromegaly?

A)

An adult with an excess of growth hormone due to an adenoma

B)

A girl who has been diagnosed with precocious puberty

C)

An adult who has a diagnosis of Cushing syndrome

D)

A patient who has recently developed primary adrenal carcinoma

14. Which of the following residents of a long-term facility is exhibiting signs and symptoms that are indicative of hypothyroidism?

A)

An 80-year-old woman who has uncharacteristically lost her appetite of late and often complains of feeling cold

B)

A 90-year-old woman with a history of atrial fibrillation whose arrhythmia has recently become more severe

C)

An 88-year-old man with a history of Alzheimer disease who has become increasingly agitated and is wandering more frequently

D)

A 91-year-old man with a chronic venous ulcer and a sacral ulcer who has developed sepsis

15. Abnormal stimulation of the thyroid gland by TSH-receptor antibodies is implicated in cases of: A)

Cushing syndrome.

B)

Graves disease.

C)

Addison disease.

D)

Cushing disease.

16. A patient has developed the facial appearance that is characteristic of myxedema, along with an enlarged tongue, bradycardia, and voice changes.

Which of the following treatment modalities is most likely to benefit this patient?

A)

Synthetic preparations of T3 or T4

B)

b-Adrenergic blocking drugs and antithyroid drugs

C)

Corticosteroid replacement therapy

D)

Oral or parenteral cortisol replacement

17. A 33-year-old patient has been admitted to the hospital for the treatment of Graves disease. Which of the following assessments should the patients care team prioritize?

A)

Assessment of the patients level of consciousness and neurologic status

B)

Assessment of the patients peripheral vascular system and assessing for thromboembolism

C)

Assessment of the patients vision and oculomotor function

D)

Cardiac monitoring and assessment of peripheral perfusion

18. A patient who has been taking 80 mg of prednisone, a glucocorticoid, each day has been warned by his primary care provider to carefully follow a plan for the gradual reduction of the dose rather than stopping the drug suddenly. What is the rationale for this directive?

A)

Sudden changes in glucocorticoid dosing may reverse the therapeutic effects of the drug.

B)

Stopping the drug suddenly may shock the HPA axis into overactivity.

C)

Sudden cessation of a glucocorticoid can result in adrenal gland necrosis.

D)

Stopping the drug suddenly may cause adrenal insufficiency.

19. The signs and symptoms of abrupt cessation of pharmacologic glucocorticoids closely resemble those of: A)

Addison disease.

B)

Cushing disease.

C)

Cushing syndrome.

D)

Graves disease.

20. Which of the following pathophysiologic phenomena may result in a diagnosis of Cushing disease?

A)

Hypopituitarism

B)

Excess ACTH production by a pituitary tumor

C)

Autoimmune destruction of the adrenal cortex

D)

Malfunction of the HPA system

Answer Key 1. C 2. D 3. A 4. C 5. D 6. C 7. D 8. A 9. C 10. D 11. D 12. B 13. A 14. A 15. B 16. A 17. C 18. D 19. A

20. B Chapter 12 Altered Reproductive Function 1. Acute cervicitis is an inflammation of the cervix characterized by: A)

abscess formation.

B)

mucopurulent drainage.

C)

thick gray-white plaques.

D)

persistent pruritic vulvitis.

2. Carcinoma of the cervix is often considered to be a sexually transmitted disease associated with_____ viral infection.

A)

Chlamydia trachomatis

B)

herpes simplex

C)

human papilloma

D)

varicella zoster

3. Pelvic inflammatory disease, an inflammation of the female upper reproductive tract, is caused by: A)

chronic endometriosis.

B)

ruptured tubal pregnancy.

C)

STD polymicrobial infection.

D)

serous luteal ovarian cysts.

4. Endometriosis is characterized by painful hemorrhagic lesions in the pelvis and complications that include: A)

pelvic adhesions.

B)

endometrial cancer.

C)

candidiasis vaginitis.

D)

bladder herniation.

5. Leiomyomas are smooth muscle fibroid tumors that usually develop in: A)

fibrocystic breasts.

B)

postmenopause.

C)

uterosacral ligaments.

D)

the corpus of the uterus.

6. Symptoms of difficulty in emptying the bladder, frequency, and urgency of urination are common in women with: A)

rectocele.

B)

cystocele.

C)

endometritis.

D)

prolapsed uterus.

7. Although there are no effective screening methods for ovarian cancer, and early symptoms are usually absent, there are high-risk indicators that include: A)

nulliparity.

B)

lactation.

C)

mammary duct ectasia.

D)

oral contraceptive use.

8. Polycystic ovary syndrome (PCOS) is ovarian dysfunction caused by a combination of hormone imbalances that include______ levels.

A)

absent FSH

B)

insulin deficit

C)

elevated LH

D)

low androgen

9. In the lactating woman, mastitis is usually the result of: A)

intraductal papillomas.

B)

secretory cell hyperplasia.

C)

fibrocystic tissue changes.

D)

ascending bacterial infection.

10. Women are screened regularly for risk factors and manifestations of breast cancer. High-risk women may have a history of:

A)

late menopause.

B)

leiomyoma tumors.

C)

STDs and vaginitis.

D)

multiple pregnancies.

11. Which of the following signs and symptoms is most likely to accompany a diagnosis of vulvodynia?

A)

Vulvar pain

B)

Purulent discharge

C)

Urinary incontinence

D)

Open lesions on the surface of the vulva

12. A 21-year-old college student has sought care because of the vaginal burning, itching, and redness that have become worse in recent weeks. Which of the clinicians assessment questions is most likely to apply to a diagnosis of vaginitis?

A)

Have your periods been regular in the last few months?

B)

Have you ever had a sexually transmitted infection?

C)

Are you using oral contraceptives?

D)

Have you ever been pregnant?

13. A 29-year-old patient had a Papanicolaou smear performed during her most recent visit to her primary care provider. This diagnostic procedure aims to identify: A)

dysplastic cervical cells.

B)

human papillomavirus (HPV) antibodies.

C)

cervical polyps.

D)

lesions at the transformation zone.

14. Which of the following physiologic processes is caused by estrogens?

A)

Increased release of gonadotropin-releasing hormone (GnRH)

B)

Stimulation of lactation in the postpartum period

C)

Promotion of ovarian follicle growth

D)

Progesterone synthesis

15. Which of the following disorders of the female genitourinary system is most likely to result from a disruption in normal endocrine function?

A)

Ovarian cancer

B)

Pelvic inflammatory disease (PID)

C)

Polycystic ovary syndrome (PCOS)

D)

Cervicitis

16. Which of the following complaints by middle-aged women should prompt a care provider to rule out the possibility of ovarian cancer?

A)

Im having a lot of vaginal discharge lately and its quite foul.

B)

My periods have become quite irregular since last winter.

C)

I have a sharp, stabbing pain on my side for the last few days.

D)

Im having a lot of indigestion and bloating, which are both new to me.

17. A nurse is conducting a healthy living workshop to a group of younger women.

Which of the following screening recommendations should the nurse provide to the participants?

A)

Monthly breast self-examination (BSE)

B)

BSE or mammography each year starting at age 40

C)

Annual clinical breast examination until age 65

D)

Mammography and clinical breast examination every 3 years until age 40

18. Which of the following processes is a component of the pathogenesis of proliferative breast lesions without atypia?

A)

Growth of ductile or lobular epithelial cells

B)

Cystic dilation of terminal ducts

C)

Increase in fibrous breast tissue

D)

Fat necrosis leading to lesion formation

19. Which of the following physiologic changes results in menopause?

A)

Changes in anterior pituitary function that alter ovarian hormone production

B)

Gradual resistance of ovarian target cells to LH and FSH stimulation

C)

Cessation of ovarian function and decreased estrogen levels

D)

Decreased levels of gonadotropin-releasing hormone (GnRH)

20. A 59-year-old woman with a recent diagnosis of breast cancer has begun a course of hormone therapy. What is the goal of this pharmacologic treatment?

A)

Blocking the effects of progesterone on tumor growth

B)

Increasing serum hormone levels to promote tumor cell lysis

C)

Blocking the entry of malignant cells into the axillary lymph nodes

D)

Blocking receptors on the surface of malignant cells

21. Smooth muscle relaxation and shunting of blood into the sinusoids is mediated by _______ and results in a penile erection.

A)

norepinephrine

B)

nitroglycerine

C)

nitric oxide

D)

nicotinic acid

22. Priapism is a condition that causes ischemia as a result of: A)

circumcision trauma.

B)

failure of detumescence.

C)

tight retracted foreskin.

D)

fibrous plaque in the penis.

23. Common risk factors for erectile dysfunction due to generalized penile arterial insufficiency include: A)

cryptorchidism.

B)

cigarette smoking.

C)

testicular torsion.

D)

benign prostate hypertrophy.

24. Squamous cell cancer of the penis is more likely to develop in men with chronic: A)

erectile dysfunction.

B)

herpes ulcerations.

C)

Peyronie disease.

D)

smegma accumulation.

25. In a hydrocele, excess fluid is present in the: A)

epididymis.

B)

tunica vaginalis.

C)

pampiniform plexus.

D)

vas deferens ampulla.

26. Testicular torsion, a serious disorder affecting young male individuals, causes: A)

inguinal herniation.

B)

cancer of the scrotum.

C)

dartos muscle atrophy.

D)

loss of testicular perfusion.

27. Men older than age 50 are at high risk for prostatic hypertrophy with complications that include: A)

hypospadias.

B)

scrotal edema.

C)

urine retention.

D)

testicular cancer.

28. The major cause of acute prostatitis is: A)

prostate hyperplasia.

B)

acute pyelonephritis.

C)

gram negative

D)

mucous gland overgrowth.

E)

coli.

29. The most important factor in the evaluation and treatment of benign prostatic hypertrophy (BPH) is considered to be: A)

frequency of erectile dysfunction.

B)

testosterone level management.

C)

prostate cancer prevention measures.

D)

subjective symptoms reported by the patient.

30. Cryptorchidism, or undescended testes, is a direct cause of: A)

infertility.

B)

paraphimosis.

C)

prostate cancer.

D)

low testosterone.

31. Which of the following physiologic processes results from the synthesis and release of testosterone?

A)

Protein catabolism

B)

Musculoskeletal growth

C)

Release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH)

D)

Prostatic hyperplasia

32. A 41-year-old patient has undergone a vasectomy. What is the physiologic basis for this contraception technique?

A)

Spermatogenesis is inhibited because sex hormones may no longer stimulate the Sertoli cells.

B)

Spermatozoa can no longer reach the epididymis and do not survive.

C)

The rete testis becomes inhospitable to sperm.

D)

Sperm can no longer pass through the ductus deferens.

33. A patient has been diagnosed with an anterior pituitary tumor, and synthesis and release of follicle-stimulating hormone has become deranged. What are the potential consequences of this alteration in endocrine function?

A)

Dysfunction of spermatogenesis

B)

Overproduction of luteinizing hormone

C)

Inhibition of testosterone synthesis

D)

Impaired detumescence

34. Which of the following factors constitutes the most significant risk for balanitis xerotica obliterans?

A)

Multiple sexual partners

B)

Androgen deficiency

C)

Uncircumcised penis

D)

Chronic prostatitis

35. Which of the following disorders of the male genitourinary system creates the most urgent need for prompt and aggressive medical treatment?

A)

Spermatocele

B)

Benign prostatic hyperplasia (BPH)

C)

Intravaginal testicular torsion

D)

Erectile dysfunction

36. A 30-year-old man has been diagnosed with mumps orchitis, a disease that has the potential to result in: A)

hematuria.

B)

hematocele.

C)

sterility.

D)

penile atrophy.

37. After seeking care due to recent history of testicular enlargement and scrotal pain, a 22-year-old college student has been diagnosed with testicular cancer.

Which of the patients following statements indicates the need for further teaching?

A)

I cant shake this feeling like Ive received a death sentence.

B)

I have to admit that the prospect of losing a testicle is a bit overwhelming.

C)

I really hope the cancer hasnt spread anywhere, because Ive read that its a possibility.

D)

I guess theres some solace in the fact that this cancer wasnt a result of an unhealthy lifestyle.

38. Which of the following assessments is most likely to reveal a potential exacerbation in a 70-year-old patients diagnosis of benign prostatic hyperplasia (BPH)?

A)

Urine testing for microalbuminuria

B)

Blood test for white blood cells and differential

C)

Bladder ultrasound

D)

Sperm morphology testing

39. Which of the following statements about screening for prostate cancer is most accurate?

A)

Digital rectal examination detects the majority of new cases of prostate cancer.

B)

A positive prostate-specific antigen (PSA) test is definitive for prostate cancer.

C)

BPH and prostatitis can confound prostate screening results.

D)

Digital rectal examination and PSA testing have been proven ineffective.

40. Which of the following diagnoses is most likely to require surgical correction?

A)

Hypospadias

B)

Orchitis

C)

Erectile dysfunction

D)

Spermatocele

Answer Key 1.

B 2.

C

3.

C

4.

A

5.

D

6.

B

7.

A

8.

C

9.

D

10.

A

11.

A

12.

B

13.

A

14.

C

15.

C

16.

D

17.

D

18.

A

19.

C

20.

D

21.

C

22.

B

23.

B

24.

D

25.

B

26.

D

27.

C

28.

C

29.

D

30.

A

31.

B

32.

D

33.

A

34.

C

35.

C

36.

C

37.

A

38.

C

39.

C

40.

A

Chapter 13 Altered Ventilation and Diffusion 1. Pleuritic chest pain associated with respiratory movements is usually described as: A)

bilateral.

B)

localized.

C)

continuous.

D)

substernal.

2. A man sustained a puncture injury to his chest that caused a tension pneumothorax to form. This is a life-threatening condition because: A)

expired air exits the bleeding wound.

B)

trapped, inspired air collapses the lung.

C)

the opposite lung hyperinflates.

D)

blebs on the lung surface rupture.

3. Atelectasis is most commonly caused by: A)

airway obstruction.

B)

pulmonary embolism.

C)

inflammation of the pleura.

D)

chronic forceful coughing.

4. Acute onset bronchial asthma causes wheezing and breathlessness as a result of: A)

airway inflammation.

B)

alveolar collapse.

C)

compression atelectasis.

D)

pulmonary hypertension.

5. Emphysema is characterized by hyperinflation of the lungs that produces increased: A)

total lung capacity.

B)

alveolar wall thickness.

C)

a1-antitrypsin enzyme.

D)

submucosal gland hypertrophy.

6. As a result of hypoxemia and polycythemia, persons with chronic obstructive bronchitis are prone to: A)

breakdown of elastin.

B)

left-sided heart failure.

C)

pulmonary hypertension.

D)

expiratory airway collapse.

7. With bronchiectasis, persistent airway obstruction and chronic infection results in bronchial: A)

dilation.

B)

rupture.

C)

infarction.

D)

thickening.

8. Cystic fibrosis (CF), the major cause of severe chronic respiratory disease in children, is characterized by: A)

constipation.

B)

salt depletion.

C)

watery mucus.

D)

high cholesterol.

9. The adverse effects of emboli on the pulmonary circulation and airways include: A)

excess surfactant.

B)

area bronchodilation.

C)

local vasoconstriction.

D)

lower lobe consolidation.

10. The common results of respiratory failure are hypoxemia and: A)

hypercapnia.

B)

bradycardia.

C)

vasoconstriction.

D)

pulmonary emboli.

11. A patient with a history of emphysema is experiencing hypoxemia after a taxing physical therapy appointment. Which of the following physiologic phenomena will occur as a consequence of hypoxemia?

A)

Peripheral vasodilation

B)

Necrosis

C)

Hypoventilation

D)

Increased heart rate

12. An elderly patient who has been restricted to bed by numerous comorbidities for several weeks has been diagnosed with a large pleural effusion. Which of the following treatment modalities is most likely to resolve the patients most recent health problem?

A)

Thoracentesis

B)

Supplementary oxygen therapy

C)

Administration of corticosteroids

D)

Administration of bronchodilators

13. A motor vehicle accident has resulted in a tension pneumothorax for the driver of the car. Which of the following manifestations is associated with tension pneumothorax?

A)

Audible friction rub over the affected lung

B)

Mediastinal shift

C)

Metabolic alkalosis

D)

Atrial fibrillation

14. A patient has just been admitted to the postsurgical unit following a below-theknee amputation. Which of the following measures should her care team prioritize to prevent atelectasis during the patients immediate recovery?

A)

Bedrest and supplementary oxygen by nasal cannula

B)

Administration of bronchodilators by nebulizer

C)

Deep-breathing exercises and early mobilization

D)

Adequate hydration and a high-humidity environment

15. Which of the following manifestations typically accompanies an asthmatic attack?

A)

Decreased residual volume

B)

Decreased pulmonary arterial pressure

C)

Prolonged inspiration

D)

Hyperinflation of the lungs

16. A 51-year-old man has been diagnosed with chronic bronchitis after a long history of recurrent coughing. Which of the mans following statements demonstrates a sound understanding of his new diagnosis?

A)

If I had quit smoking earlier than I did, I think I could have avoided getting bronchitis.

B)

Im pretty sure that I first caught bronchitis from the person who has the cubicle next to mine at work.

C)

I read on the Internet that I might have got bronchitis because I was born with an enzyme deficiency.

D)

I think that I probably could have prevented this if I had got in the habit of exercising more when I was younger.

17. Which of the following individuals is experiencing a disorder of ventilation that has a restrictive rather than obstructive etiology?

A)

A 30-year-old African American man who has been diagnosed with sarcoidosis

B)

An infant whose routine screening is suggestive of cystic fibrosis

C)

An elderly, lifelong smoker who has been admitted to hospital with emphysema

D)

A 16-year-old girl who must limit her activity to prevent asthmatic attacks

18. Prolonged immobility is implicated in the development of which of the following disorders?

A)

Bronchitis and bronchiectasis

B)

Sarcoidosis and idiopathic pulmonary fibrosis

C)

Atelectasis and pulmonary embolism

D)

Pulmonary hypertension and cor pulmonale

19. Which of the following is most likely to precipitate an asthmatic attack in a child with a diagnosis of extrinsic, or atopic, asthma?

A)

Pet dander

B)

Cold weather

C)

Stress

D)

Respiratory tract infections

20. Pain is an expected assessment finding in patients who have which of the following lung diseases?

A)

Asthma

B)

Pleural effusion

C)

Pulmonary arterial hypertension (PAH)

D)

Pleuritis

Answer Key 1. B 2. B

3. A 4. A 5. A 6. C 7. A 8. B 9. C 10. A 11. D 12. A 13. B 14. C 15. D 16. A 17. A 18. C 19. A 20. D Chapter 14 Altered Perfusion 1. The pathophysiology of heart failure involves an interaction between decreased pumping ability and the ________ to maintain cardiac output.

A)

aortic hypertrophy

B)

compensatory mechanisms

C)

electrical conductivity

D)

parasympathetic system

2. Cardiac output is the ________ each minute.

A)

volume load

B)

blood pumped

C)

stroke volume

D)

force generated

3. One of the principal mechanisms by which the heart compensates for increased workload is: A)

myocardial hypertrophy.

B)

sodium and water retention.

C)

endothelin vasoconstrictors.

D)

ventricular wall tension increase.

4. In right-sided heart failure, peripheral edema is evidenced by: A)

weight gain.

B)

copious urination.

C)

shortness of breath.

D)

decreased blood pressure.

5. The most common causes of left-sided heart failure include: A)

acute myocardial infarction.

B)

chronic pulmonary disease.

C)

impaired renal blood flow.

D)

tricuspid valve regurgitation.

6. Hypovolemic shock occurs as a result of: A)

myocardial infarction.

B)

excessive vasoconstriction.

C)

chronic intracellular fluid shift.

D)

acute intravascular volume loss.

7. In shock, one of the best indicators of blood flow to vital organs is: A)

warm legs.

B)

urine output.

C)

blood pressure.

D)

consciousness.

8. Anaphylactic shock is directly associated with: A)

loss of blood volume.

B)

bacterial blood infection.

C)

failure of the heart as a pump.

D)

type I hypersensitivity response.

9. Severe shock can be followed by acute lung injury/acute respiratory distress syndrome (ALI/ARDS) characterized by: A)

hyperventilation.

B)

excessive surfactant.

C)

hyperinflated alveolar sacs.

D)

ventilation-perfusion mismatch.

10. A common symptom of the ischemia associated with gastrointestinal redistribution of blood flow is: A)

gastric bleeding.

B)

nausea and vomiting.

C)

irritable bowel syndrome.

D)

copious high volume diarrhea.

11. A patient has been experiencing increasing fatigue in recent months, a trend that has prompted an echocardiogram. Results of this diagnostic test suggest that the patients end-diastolic volume is insufficient. Which of the following parameters of cardiac performance will directly decrease as a result of this?

A)

Inotropy

B)

Cardiac contractility

C)

Preload

D)

Afterload

12. Which of the following health problems is associated with heart failure as a result of diastolic dysfunction?

A)

Uncontrolled hypertension

B)

Chronic bradycardia

C)

Ischemic heart disease

D)

Myocardial hypertrophy

13. Assessment of an elderly female patient reveals the presence of bilateral pitting edema of the patients feet and ankles and pedal pulses that are difficult to palpate. Auscultation of the patients lungs reveals clear air entry to bases, and the patients oxygen saturation level is 93% and vital signs are within reference ranges. What is this patients most likely health problem?

A)

Right-sided heart failure

B)

Left-sided heart failure

C)

Cardiogenic shock

D)

Cor pulmonale

14. The most recent blood work of a patient with a diagnosis of heart failure indicates increased levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP). What are the most likely effects of these peptides on the patients physiology?

A)

Water retention

B)

Increased tubular sodium reabsorption

C)

Inhibition of the renin-angiotensin-aldosterone system

D)

Sympathetic nervous stimulation

15. A nurse is performing patient health education with a 68-year-old man who has recently been diagnosed with heart failure. Which of the following statements demonstrates an accurate understanding of his new diagnosis?

A)

Ill be sure to take my beta blocker whenever I feel short of breath.

B)

Im going to avoid as much physical activity as I can so that I preserve my strength.

C)

I know its healthy to drink a lot of water, and Im going to make sure I do this from now on.

D)

Im trying to think of ways that I can cut down the amount of salt that I usually eat.

16. Electrical burns over a large surface area of a patients body have resulted in hypovolemic shock after the loss of large amounts of blood and plasma. Which of the following mechanisms is the patients body likely to implement to compensate for this loss of fluid?

A)

Increased heart rate

B)

Vasodilation

C)

Diuresis

D)

Inhibition of ADH

17. A patient who developed a deep vein thrombosis during a prolonged period of bedrest has deteriorated as the clot has dislodged and resulted in a pulmonary embolism. Which of the following types of shock is this patient at risk of experiencing?

A)

Cardiogenic shock

B)

Hypovolemic shock

C)

Obstructive shock

D)

Distributive shock

18. For which of the following types of shock might intravenous antibiotic therapy be indicated?

A)

Obstructive shock

B)

Distributive shock

C)

Cardiogenic shock

D)

Hypovolemic shock

19. An 86-year-old male patient is disappointed to learn that he has class II heart failure despite a lifelong commitment to exercise and healthy eating. Which of the following age-related changes predisposes older adults to developing heart failure?

A)

Increased vascular stiffness

B)

Orthostatic hypotension

C)

Increased cardiac contractility

D)

Loss of action potential

20. A patient with a diagnosis of heart failure has returned from a visit with his primary care provider with a prescription for a change in his daily medication regimen. Which of the following drugs is likely to improve the patients cardiac function by increasing the force and strength of ventricular contractions?

A)

A b-adrenergic blocker

B)

A diuretic

C)

A cardiac glycoside

D)

An ACE inhibitor

Answer Key 1. B 2. B 3. A 4. A 5. A 6. D 7. B 8. D 9. D 10. A 11. C 12. D 13. A 14. C 15. D 16. A

17. C 18. B 19. A 20. C Chapter 15 Altered Nutrition 1. The adipocytes in adipose tissue not only serve as a storage sites, they also: A)

produce linoleic fatty acid.

B)

synthesize triglycerides.

C)

increase glucagon release.

D)

degrade fat-soluble vitamins.

2. Protein contains nitrogen. A negative nitrogen balance represents: A)

more protein consumed than excreted.

B)

a reduced need for nitrogen as protein.

C)

more nitrogen excreted than consumed.

D)

less use of nitrogen for protein synthesis.

3. Natural appetite suppression mechanisms, necessary for food intake control, include : A)

ketoacid deficiency.

B)

cholecystokinin storage.

C)

decreased blood glucose.

D)

leptin receptor stimulation.

4. Body weight should be used in combination with other measurements to establish if a person is underweight or overweight. Obesity is indicated by: A)

female body fat of 20% and 30%.

B)

body mass index (BMI) of 30 to 40.

C)

relative body weight of 70% to 100%.

D)

abdominal fat/ hip ratio of 0.8 to 1.0.

5. A patient with upper body obesity also has central fat distribution. This body fat configuration places the patient at greater risk for _____________ than a patient with lower body obesity.

A)

osteoporosis

B)

renal disease

C)

cardiometabolic disorders

D)

chronic anemia

6. As the problem of childhood and adolescent obesity increases, an increase in the incidence of ____________ is occurring in this obese population.

A)

type 2 diabetes mellitus

B)

attention deficit disorder

C)

juvenile rheumatoid arthritis

D)

antibiotic-resistant bacterial infections

7. A diet deficient in calories and protein causes marasmus, which is characterized by: A)

discolored hair.

B)

bradycardia.

C)

enlarged liver.

D)

pitting edema.

8. Protein-calorie malnutrition with loss of lean tissues and muscle mass results in: A)

respiratory muscle stimulation.

B)

excessive blood cell production.

C)

diarrhea.

D)

increased cardiac contractility.

9. Similarities between girls or women with anorexia nervosa and bulimia nervosa include: A)

periodontal disease.

B)

low estrogen level.

C)

electrolyte imbalances.

D)

enlarged parotid gland.

10. Both binge-eating and bulimia nervosa patients consume excessive amounts of foods secretively. A major difference is that binge-eaters: A)

remain overweight.

B)

eat when not hungry.

C)

are substance abusers.

D)

experience depression.

11. A large, high-calorie meal has resulted in the intake of far more energy than a person requires. What will the individuals body do with the excess carbohydrates provided by this meal?

A)

Convert them into glucose and store them in the liver and muscles

B)

Excrete most of the excess polysaccharides through the kidneys

C)

Convert the carbohydrates into amino acids in preparation for long-term storage

D)

Create structural proteins from some of the carbohydrates and store the remainder as triglycerides

12. Which of the following patients is most likely to be in positive nitrogen balance?

A)

A patient who is receiving treatment for sepsis

B)

A patient whose diagnosis of pneumonia is causing a fever

C)

A woman who has been admitted to the hospital in early labor

D)

A patient who sustained extensive burns in a recent industrial accident

13. In addition to facilitating bowel movements, a diet that is high in fiber confers which of the following benefits?

A)

Lowering cholesterol and blood glucose

B)

Removing toxins and metabolic byproducts

C)

Lowering blood pressure and resting heart rate

D)

Increasing intestinal absorption of vitamins and minerals

14. Which of the following statements best conveys the endocrine function of adipose tissue?

A)

Adipose tissue antagonizes the effects of insulin on cell membranes.

B)

Adipose tissue produces ghrelin, which stimulates both appetite and eating.

C)

Adipose tissue produces and secretes cholecystokinin (CCK), which stimulates the hypothalamic feeding center.

D)

Adipose tissue produces leptin, which mediates body weight.

15. Chronic inflammation as a result of excess adipose tissue is implicated in the etiology of which of the following health problems?

A)

Osteoporosis

B)

Type 2 diabetes

C)

Rheumatoid arthritis

D)

Systemic lupus erythematosus (SLE)

16. A public health nurse has noted a significant increase in the number of schoolaged children who are obese. Which of the following factors is most significant predictor of childhood obesity?

A)

Low socioeconomic status

B)

Low self-esteem

C)

Having obese parents

D)

Living in a rural or inner-city neighborhood

17. Which of the following measures should a school nurse prioritize in the treatment and prevention of childhood obesity?

A)

Group cognitive therapy

B)

Use of selective serotonin-reuptake inhibitors (SSRIs)

C)

Education on exercise and nutrition

D)

High-protein, low-carbohydrate diet

18. Which of the following characteristics distinguishes kwashiorkor from marasmus?

A)

Impairment of immune function

B)

Lack of dietary fat intake

C)

High intake of carbohydrates

D)

Impaired pigment synthesis

19. A frail, 87-year-old female patient has been admitted to a hospital after a fall and has been diagnosed with failure to thrive. Which of the following laboratory values would suggest that the patient may be experiencing malnutrition?

A)

Low prealbumin

B)

High C-reactive protein

C)

High bilirubin

D)

Low fasting blood sugar

20. Which of the following assessments should be prioritized in the care of a patient with anorexia nervosa?

A)

Serum electrolyte levels

B)

Chest auscultation

C)

White blood cell count with differential

D)

Blood pressure monitoring

Answer Key 1. B 2. C 3. D 4. B 5. C 6. A 7. B 8. C 9. C

10. A 11. A 12. C 13. A 14. D 15. B 16. C 17. C 18. C 19. A 20. D Chapter 16 Altered Elimination 1. A major complication of persistent gastroesophageal reflux is: A)

strictures.

B)

heartburn.

C)

chest pain.

D)

hoarseness.

2. Acute gastritis refers to a transient inflammation of the gastric mucosa that is most commonly associated with: A)

diarrhea.

B)

food allergies.

C)

gastric reflux.

D)

alcohol intake.

3. The Helicobacter pylori protobacteria cause peptic ulceration by producing: A)

acids

B)

toxins

C)

ischemia

D)

bleeding

4. A hallmark of irritable bowel syndrome is abdominal pain: A)

relieved by defecation.

B)

most severe at night.

C)

with blood in the stool.

D)

after and between meals.

5. Inflammatory bowel diseases are accompanied by systemic manifestations that include: A)

autoimmune anemia.

B)

rheumatoid arthritis.

C)

thrombocytopenia.

D)

lactose intolerance.

6. Crohns type of inflammatory bowel disease is characterized by: A)

granulomatous lesions.

B)

ulcerative erosions.

C)

fibrotic smooth muscle.

D)

necrotic crypt abscesses.

7. Unlike the Crohn type of inflammatory bowel disease, the ulcerative colitis type is characterized by: A)

skip lesions.

B)

steatorrhea.

C)

gastric ulcers.

D)

pseudopolyps.

8. Diverticulitis, a complication of diverticulosis, is manifested by acute: A)

rectal bleeding.

B)

abdominal distention.

C)

large-volume diarrhea.

D)

lower left quadrant pain.

9. Major causes of mechanical bowel obstruction include: A)

chemical irritation.

B)

ruptured appendix.

C)

abdominal distention.

D)

postoperative adhesions.

10. As a protective measure to keep abdominal inflammation and infection localized, the peritoneum: A)

constricts bowel contents.

B)

secretes fibrous exudate.

C)

increases intestinal motility.

D)

abdominal vasoconstriction.

11. Which of the following signs and symptoms most clearly suggests the need for endoscopy to rule out esophageal cancer?

A)

Heartburn after an individual consumes high-fat meals

B)

Dysphagia in an individual with no history of neurologic disease

C)

A new onset of gastroesophageal reflux in a previously healthy individual

D)

Recurrent episodes of gastritis that do not respond to changes in diet

12. A 60-year-old male patient has presented to his primary care provider to follow up with his ongoing treatment for peptic ulcer disease. What is the most likely goal of this patients pharmacologic treatment?

A)

Inhibiting gastric acid production

B)

Promoting hypertrophy of the gastric mucosa

C)

Increasing the rate of gastric emptying

D)

Increasing muscle tone of the cardiac sphincter

13. Which of the following individuals most likely faces the greatest risk of developing Clostridium difficile colitis?

A)

A 55-year-old man who takes proton pump inhibitors for the treatment of peptic ulcers

B)

A 79-year-old hospital patient who is being treated with broad-spectrum antibiotics

C)

A premature neonate who has developed hyperbilirubinemia and is receiving phototherapy

D)

A 30-year-old patient who has a history of Crohn disease and has been admitted to a hospital to treat a recent flare-up

14. A 66-year-old woman has been diagnosed with diverticular disease based on her recent complaints and the results of a computed tomography (CT) scan.

Which of the patients following statements demonstrates an accurate understanding of this diagnosis?

A)

From now on, Im going to stick to an organic diet and start taking more supplements.

B)

I think this might have happened because Ive used enemas and laxatives too much.

C)

Ive always struggled with heartburn and indigestion, and I guess I shouldnt have ignored those warning signs.

D)

I suppose I should try to eat more fiber and become a bit more active.

15. An ultrasound has confirmed appendicitis as the cause of a 20-year-old mans sudden abdominal pain. Which of the following etiologic processes is implicated in the development of appendicitis?

A)

Obstruction of the intestinal lumen

B)

Elimination of normal intestinal flora

C)

Sloughing of the intestinal mucosa

D)

Increased osmolality of intestinal contents

16. Which of the following characteristics differentiates inflammatory diarrhea from the noninflammatory type?

A)

Larger volume of diarrhea

B)

Electrolyte imbalances

C)

Absence of blood in the stool

D)

Infection of intestinal cells

17. Which of the following patients should the nurse observe most closely for the signs and symptoms of paralytic ileus?

A)

A patient who is postoperative day 1 following gall bladder surgery

B)

A patient whose acute diarrhea has necessitated the use of antidiarrheal medications

C)

An obese patient who refuses to ambulate because he complains of shortness of breath

D)

A patient with a longstanding diagnosis of irritable bowel syndrome

18. Which of the following meals is most likely to exacerbate an individuals celiac disease?

A)

Spaghetti with meatballs and garlic bread

B)

Stir-fried chicken and vegetables with rice

C)

Oatmeal with milk, brown sugar, and walnuts

D)

Barbecued steak and a baked potato with sour cream

19. Which of the following statements is true of colorectal cancer?

A)

Aspirin and NSAIDs are implicated in the etiology.

B)

It is one of the few cancers that is known to sometimes have an infectious etiology.

C)

Most cases are quite advanced before symptoms become apparent.

D)

Survival rates for colorectal cancer are less than 20%, but are increasing.

20. Following the analysis of a recent barium enema and colonoscopy with biopsy, a patient has been diagnosed with colorectal cancer. Which of the following treatment modalities will be the mainstay of this patients treatment?

A)

Chemotherapy

B)

Radiation therapy

C)

Pharmacologic therapies

D)

Surgery

Answer Key

1. A 2. D 3. B 4. A 5. A 6. A 7. D 8. D 9. D 10. B 11. B 12. A 13. B 14. D 15. A 16. D 17. A 18. A 19. C 20. D Chapter 17 Degenerative Changes in Aging 1. The nurse keeps the environment warmer for older adults because they are more sensitive to cold because of the age-related changes in their: a. metabolism rate. b. subcutaneous tissue. c. musculoskeletal system.

d. peripheral vascular system.

ANS: B The reduction of subcutaneous tissue as an age-related change causes sensitivity to cold because it is the main insulator of the body.

2. The nurse reassures the distressed 75-year-old male that the wartlike dark macules with distinct borders are not melanomas, but the skin lesions of: a. senile lentigo. b. cutaneous papillomas. c. seborrheic keratoses. d. xerosis.

ANS: C Dark, slightly raised macules are seborrheic keratoses, which may be mistaken for melanomas.

3. The nurse is accompanying a group of older adults on a July 4th outing to monitor heat prostration. Older adults are intolerant of heat because of an age-related reduction of: a. melanin. b. perspiration. c. body temperature. d. capillary fragility.

ANS: B Reduction in perspiration related to reduced sweat gland function results in possible heat intolerance from an inability to cool the body by evaporation.

4. The nurse cautions the CNAs to use care when transferring or handling older adults because their vascular fragility will cause:

a. altered blood pressure. b. pressure ulcers. c. pruritus. d. senile purpura.

ANS: D Increased capillary fragility results in subcutaneous hemorrhage or senile purpura from incautious handling by caregivers.

5. The nurse assesses a stage I pressure ulcer on an older adults coccyx by the appearance of a: a. clear blister. b. nonblanchable area of erythema. c. scaly abraded area. d. painful reddened area.

ANS: B A red nonblanchable area is indicative of a stage I pressure ulcer.

6. The CNA caring for an older adult asks if the yellow, waxy, crusty lesions on the patients axilla and groin are contagious. The nurses most helpful response is: a. Yes. It is cellulitis caused by bacteria. b. No. It is seborrheic dermatitis caused by excessive sebum. c. Yes. It is an indication of scabies. d. No. It is the lesion seen with basal cell carcinoma.

ANS: B Seborrheic dermatitis is a bothersome skin condition resulting from an excess of sebum.

7. The nurse leads a group of postmenopausal older women on a daily 15-minute walking tour through the long-term care facility to: a. improve bone strength. b. orient them to their surroundings. c. improve their socialization. d. increase their appetite.

ANS: A Stress to long bones by weight-bearing and walking will increase bone strength.

8. When the perplexed 70-year-old woman asks, How in the world can my bones be brittle when I eat all the right foods? the nurses most informative reply is: a. Calcium loss is expected in the older adult. b. Calcium is continuously withdrawn from bone for nerve and muscle function. c. Smoking and alcohol consumption speed calcium loss from the bones. d. Walking and standing increase calcium loss from the bone.

ANS: B Calcium is constantly withdrawn from the bone for nerve and muscle function and clotting needs.

9. When the 70-year-old woman complains, I weigh exactly the same as I did when I wore a size 10 and now I can barely squeeze into a size 16, the nurse explains: a. Metabolism in the older adult creates increased adipose tissue. b. Postmenopausal women gain adipose tissue related to loss of calcium. c. Decrease in muscle mass is replaced with adipose tissue. d. Kyphosis causes a redistribution of weight.

ANS: C

Decrease in muscle mass is replaced with adipose tissue, which frequently changes the appearance of the body, but not the weight.

10. When the 70-year-old postmenopausal woman asks whether her hormone replacement therapy (HRT) will prevent bone loss, the nurses most helpful response is: a. No. HRT is not helpful after the age of 60. b. Yes. HRT will prevent bone loss but can cause a stroke, heart attack, or breast cancer. c. No. HRT is reliant on some natural estrogen production from the ovaries. d. Yes. HRT is a widely accepted therapy for prevention of bone loss.

ANS: B HRT is helpful to prevent bone loss, but the risks of cardiovascular complications and cancer have made the choice of HRT controversial.

11. An 80-year-old-woman who has osteoarthritis complains of how ugly her hands have become since she has developed Heberden nodes, which are: a. yellow longitudinal lines in the nails. b. thickened discolored fingernails. c. darkened areas under the fingernail. d. bony enlargements of distal joints of the fingers.

ANS: D Heberden nodes are bony enlargements of the distal joints of the fingers associated with osteoarthritis.

12. The nurse modifies the nursing care plan for a 62-year-old woman in an extendedcare facility who is suffering a flare in her rheumatoid arthritis to include interventions to: a. increase fluid intake.

b. schedule several rest periods to balance activity. c. reduce salt in the diet. d. assist with rigorous finger extension exercises.

ANS: B Balancing rest and activity allows the resident to remain relatively flexible. Joints may be splinted to reduce contracture.

13. The nurse explains that emphysema is a chronic obstructive pulmonary disease characterized by the pathophysiology of: a. constriction of the bronchial tree, excessive mucus, and nonproductive cough. b. calcification of the alveoli and a dry cough. c. overinflation of the alveoli, making them ineffective for gas exchange. d. inflammation of the trachea and bronchioles, excessive mucus, and productive cough.

ANS: C Emphysema causes overinflation of the nonelastic alveoli, which disallows gas exchange in the affected alveoli and results in reduced oxygenation.

14. The nurse explains that the pathophysiology of a myocardial infarct is that: a. a portion of the myocardium necroses and scars over. b. the coronary vessels are narrowed during the attack. c. the ischemic myocardium causes pain during the attack but is able to regenerate. d. there is damage to the myocardium but no serious alteration of cardiac output.

ANS: A The myocardium necroses and scars and does not regenerate. The degree of heart damage is related to the amount of necrosis.

15. The nurse is aware that the cardinal signs and symptoms of congestive heart failure are: a. dyspnea and edema. b. myocardial pain and hypotension. c. ventricular arrhythmias and cyanosis. d. atrial arrhythmias and polycythemia.

ANS: A Dyspnea and generalized edema are the cardinal signs and symptoms of congestive heart failure.

16. The nurse explains that pernicious anemia is caused by: a. an iron deficiency. b. a deficiency of vitamin B12. c. inadequate nutrition. d. blood loss.

ANS: B Pernicious anemia results from a deficiency of vitamin B12.

17. The nurse alters the nursing care plan for a patient with a hiatal hernia and resultant gastrointestinal reflux to include interventions for: a. encouraging the patient to lie down after meals. b. drinking two full glasses of liquid after the evening meal. c. eating smaller, more frequent meals. d. using caffeine drinks to assist with digestion.

ANS: C Eating smaller and more frequent meals does not enlarge the stomach.

18. The nurse suspects that the pale, edematous, listless diabetic patient who has a blood urea nitrogen (BUN) level of 35 mg/dL and a creatinine level of 4 mg/dL has: a. diverticulitis. b. congestive heart failure. c. chronic renal failure. d. benign prostatic hypertrophy.

ANS: C The increased BUN and creatinine levels indicate renal failure.

19. The most appropriate intervention added to the nursing care plan for a person with Parkinson disease with a nursing diagnosis of Nutrition, less than body requirements related to difficulty swallowing, would be to: a. feed the patient at each meal. b. place the patient in a semi-Fowler position for mealtime. c. offer a thick, high-nutrition shake as a snack. d. encourage the patient to drink a sip of water after each bite of solid food.

ANS: C Thick shakes are easier to swallow without aspiration and will also improve nutrition.

20. The nurse would anticipate that a person with a hemorrhagic CVA to the left hemisphere would exhibit: a. language disturbances. b. poor impulse control. c. inappropriate affect. d. confabulation.

ANS: A

A left hemisphere CVA would most likely cause language disturbances such as aphasia, agraphia, or alexia.

Chapter 18 Integrated Pathophysiologic Concepts: Diabetes Mellitus 1. Type 1 diabetes mellitus results from destruction of the pancreatic beta cells by two mechanisms. The mechanism for type 1A diabetes is _______ destruction.

A)

genetic

B)

resistant

C)

idiopathic

D)

autoimmune

2. The metabolic abnormalities that lead to type 2 diabetes include: A)

chronic overeating.

B)

insulin resistance.

C)

acute pancreatitis.

D)

recurrent hypoglycemia.

3. Which test provides a way to monitor fluctuations of blood glucose levels over the previous 6 to 12 weeks?

A)

Glucose tolerance test

B)

Fasting blood glucose

C)

Capillary blood glucose

D)

Glycosylated hemoglobin

4. Diabetic ketoacidosis (DKA) more commonly occurs in patients with type 1 diabetes, when the lack of insulin leads to the mobilization of _____ that causes excess ketone production by the liver.

A)

cortisol

B)

fatty acids

C)

potassium

D)

bicarbonate

5. Factors that contribute to the severe hyperglycemia that precipitates hyperglycemic hyperosmolar state (HHS) include: A)

fluid retention and edema.

B)

thromboembolism formation.

C)

insulin overdose.

D)

glycosuria and water loss.

6. A change in the circadian rhythm for glucose tolerance and an inappropriate increase in counterregulatory hormones can lead to _______ in diabetics.

A)

hypoglycemia

B)

Somogyi effect

C)

hyperinsulinemia

D)

dawn phenomenon

7. In people with type 1 diabetes, the beneficial effects of exercise also carry an increased risk of: A)

rapid weight loss.

B)

respiratory disorders.

C)

rebound hyperglycemia.

D)

profound hypoglycemia.

8. One of the first renal manifestations of diabetic nephropathy is: A)

microalbuminuria.

B)

oliguria.

C)

hypertension.

D)

hyperlipidemia.

9. Diabetic retinopathy, the leading cause of acquired blindness in the United States, is characterized by retinal: A)

glaucoma.

B)

hemorrhages.

C)

dehydration.

D)

infections.

10. Impaired and delayed healing in a person with diabetes is caused by chronic complications that include: A)

ketoacidosis.

B)

Somogyi effect.

C)

fluid imbalances.

D)

chronic neuropathies.

11. A hospital patient with a diagnosis of type 1 diabetes has been administered a scheduled dose of regular insulin. Which of the following effects will result from the action of insulin?

A)

Promotion of fat breakdown

B)

Promotion of glucose uptake by target cells

C)

Promotion of gluconeogenesis and protein synthesis

D)

Initiation of glycogenolysis

12. A patient with longstanding type 2 diabetes is surprised at his high blood sugar readings while recovering from an emergency surgery. Which of the following factors may have contributed to the patients inordinately elevated blood glucose levels?

A)

The tissue trauma of surgery resulted in gluconeogenesis.

B)

Illness inhibited the release and uptake of glucagon.

C)

The stress of the event caused the release of cortisol.

D)

Sleep disruption in the hospital precipitated the dawn effect.

13. The results of a 44-year-old obese mans recent diagnostic workup have culminated in a new diagnosis of type 2 diabetes. Which of the following pathophysiologic processes underlies the patients new diagnosis?

A)

Beta-cell exhaustion due to long-standing insulin resistance

B)

Destruction of beta cells that is not attributable to autoimmunity

C)

T-lymphocytemediated hypersensitivity reactions

D)

Actions of insulin autoantibodies (IAAs) and islet cell autoantibodies (ICAs)

14. Which of the following assessment findings of a male patient constitutes a criterion for a diagnosis of metabolic syndrome?

A)

The patient states that he does less than 30 minutes of strenuous physical activity each week.

B)

The patients resting heart rate is typically 85 to 95 beats per minute.

C)

The patients blood pressure is consistently in the range of 140/90 mm Hg.

D)

The patient has a family history of type 2 diabetes.

15. Which of the following pregnant women likely faces the greatest risk of developing gestational diabetes?

A)

A patient who was diagnosed with placenta previa early in her pregnancy.

B)

A patient who is gravida five (in her fifth pregnancy)

C)

A patient who has hypertension and elevated triglycerides

D)

A patient who is morbidly obese

16. A patients primary care provider has ordered an oral glucose tolerance test (OGTT) as a screening measure for diabetes. Which of the following instructions should the patient be given?

A)

The lab tech will give you a sugar solution and then measure your blood sugar levels at specified intervals.

B)

Youll have to refrain from eating after midnight and then go to the lab to have your blood taken first thing in the morning.

C)

Theyll take a blood sample and see how much sugar is attached to your red blood cells.

D)

You can go to the lab at any time; just tell the technician when you last ate before they draw a blood sample.

17. Which of the following insulin-administration regimens is most likely to result in stable blood glucose levels for a patient with a diagnosis of type 1 diabetes?

A)

One large dose of long-acting insulin each day before breakfast

B)

Intermediate-acting insulin at 8:00 AM and 8:00 PM with rapid-acting insulin before each meal

C)

Six to eight small doses of rapid-acting insulin each day, with capillary monitoring before each

D)

Long-acting insulin twice daily (breakfast and bedtime), with intermediateacting insulin in the afternoon

18. A hospital patient has been complaining of increasing fatigue for several hours and his nurse has entered his room to find him unarousable. The nurse immediately checked the patients blood glucose level, which is 22 mg/dL (1.2 mmol/L). The nurse should prepare to administer which of the following?

A)

A snack that combines simple sugars, protein, and complex carbohydrates

B)

A 50% glucose solution intravenously

C)

Infusion of rapid-acting insulin

D)

Oral solution containing glucagon and simple sugars

19. A diabetic patients most recent blood work indicated a decreased glomerular filtration rate and urine testing revealed microalbuminuria. Which of the following self-care measures should the patients care team suggest to the patient?

A)

Use of over-the-counter diuretics

B)

Increased fluid intake

C)

Decreased oral sugar intake

D)

Measures to lower blood pressure

20. Which of the following comorbidities represents the greatest risk for the development of foot ulcers in a diabetic patient?

A)

Distal symmetric neuropathy

B)

Previous incidents of diabetic ketoacidosis

C)

Diabetic nephropathy

D)

Autonomic neuropathy

Answer Key 1. D 2. B 3. D

4. B 5. D 6. D 7. D 8. A 9. B 10. D 11. B 12. C 13. A 14. C 15. D 16. A 17. B 18. B 19. D 20. A