TEST BANK for Advanced Physiology & Pathophysiology:Clinical Practice 2nd Edition by Tkacs & Herrman

TEST BANK

TEST BANK

Chapter 1 The Foundational Concepts of Clinical Practice Chapter 2 Chemical and Biochemical Foundations Chapter 3 Molecular Biology, Genetics, and Genetic Diseases Chapter 4 Cell Physiology and Pathophysiology Chapter 5 Infectious Disease Chapter 6 The Immune System and Leukocyte Function Chapter 7 Neoplasia Chapter 8 Blood and Clotting Chapter 9 Circulation Chapter 10 Heart Chapter 11 Lungs Chapter 12 Kidneys Chapter 13 Gastrointestinal Tract Chapter 14 Liver Chapter 15 Nervous System Chapter 16 Musculoskeletal System Chapter 17 Endocrine System

Chapter 1. The foundational Concepts of Clinical Practice MULTIPLE CHOICE 1. The type of control system that can sometimes cause instability and vicious cycles is called A) negative feedback.

B) feed-forward control.

C) positive feedback.

D) adaptive feedback.

E) delayed negative feedback.

ANS: C Feedback: Positive feedback amplifies a change in the system, often leading to instability or vicious cycles.

For example, in certain pathological conditions, positive feedback can exacerbate the problem rather than stabilizing it, unlike negative feedback systems, which promote homeostasis.

2. Which of the following is an example of positive feedback in the body?

A) Return of blood pressure toward normal after a hemorrhage B) Generation of action potentials in nerves C) Increased respiration rate caused by accumulation of carbon dioxide in the blood D) Decreased sympathetic nervous system activity that occurs in response to increased blood pressure ANS: B Feedback: Positive feedback in nerve action potentials occurs when the depolarization of the membrane causes sodium channels to open, leading to further depolarization. Other options, such as the return of blood pressure to normal after hemorrhage, are examples of negative feedback.

3. 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.

ANS: B Feedback: Vasodilation increases blood flow to the injured area, causing localized congestion, which is the accumulation of blood in the vessels. This leads to redness and warmth. Bleeding and coolness are not typical of the hemodynamic stage, and pale skin would result from vasoconstriction, not vasodilation.

4. 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 ANS: C Feedback: Neutrophils are the first leukocytes to arrive at the site of acute inflammation in large numbers.

They play a key role in phagocytosing pathogens and cellular debris. Basophils and lymphocytes are not the primary responders in acute inflammation, and platelets are involved in clotting rather than leukocyte infiltration.

5. Which of the following is an example of a “feed-forward” control system?

A) The arterial baroreceptor system B) The progressive nature of uterine contractions during childbirth C) Control of skeletal muscle movements by the brain D) Generation of an action potential ANS: C Feedback: Feed-forward control systems anticipate a change and initiate a response before it occurs. The brain controlling skeletal muscle movement is an example, as it predicts the required actions and adjusts muscle control accordingly. Other examples, such as uterine contractions during childbirth, are positive feedback systems.

6. 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 ANS: D Feedback: Phagocytosis begins with the recognition and adherence of pathogens or debris by phagocytic cells, such as neutrophils or macrophages. This is followed by engulfment and intracellular killing. Antigen margination is not a recognized step in phagocytosis.

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

A) Serotonin B) Histamine C) Bradykinin D) Nitric oxide

ANS: C Feedback: Bradykinin is a potent inflammatory mediator that increases capillary permeability and induces pain. While histamine and serotonin also increase permeability, they do not directly cause pain.

Nitric oxide is involved in vasodilation but not in pain mediation.

8. 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 ANS: D Feedback: Membranous exudates are characterized by necrotic cells enmeshed in a fibrinous matrix, often forming on mucosal surfaces. Suppurative exudates (pus) are rich in neutrophils, while serous and fibrinous exudates are associated with clear fluid and fibrin, respectively.

9. 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.

ANS: A Feedback: The acute-phase response is mediated by cytokines such as IL-1, IL-6, and TNF-α, which act on the hypothalamus to induce fever and on other systems to cause lethargy. This response also involves an increase in C-reactive protein and erythrocyte sedimentation rate, not a decrease.

10. The characteristic, localized cardinal signs of acute inflammation include: A) fever.

B) fatigue.

C) redness.

D) granuloma.

ANS: C

Feedback: The cardinal signs of acute inflammation are localized redness (rubor), swelling (tumor), heat (calor), pain (dolor), and loss of function. Redness occurs due to vasodilation and increased blood flow to the injured area, which is a hallmark of the inflammatory response. Fever and fatigue, while associated with inflammation, are systemic rather than localized signs, and granuloma formation is characteristic of chronic inflammation.

11. 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 ANS: D Feedback: Chronic inflammation involves the recruitment of lymphocytes and macrophages, which become activated and contribute to tissue remodeling and fibrosis. Acute inflammation is characterized by neutrophils and exudation, whereas fibrinous exudation, granulocyte shifts, and alkalosis are not hallmarks of chronic inflammation.

12. 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.

ANS: B Feedback: Endogenous pyrogens like IL-1 and TNF-α induce systemic responses such as fever, leukocytosis, and anorexia. They act on the hypothalamus to modulate temperature and on other tissues to mediate inflammation. They do not stabilize thermal control, block viral replication, or inhibit prostaglandin release.

13. 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

ANS: A Feedback: During the vascular stage of inflammation, increased vascular permeability leads to the outpouring of protein-rich exudate into interstitial spaces, contributing to swelling. Chemotaxis and leukocyte accumulation occur in the cellular stage, and phagocytosis is a subsequent step.

14. 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 ANS: D Feedback: Chronic inflammation is strongly associated with obesity and a sedentary lifestyle due to the persistent release of pro-inflammatory cytokines from adipose tissue. In contrast, type 2 diabetes, antibiotic resistance, or short-term antibiotic use may be linked to inflammation but are not as directly associated with chronic inflammatory processes.

15. 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) ANS: D Feedback: The normal range for core body temperature is typically 36.1°C to 37.5°C (97°F to 99.5°F). A temperature of 37.3°C falls within this range, while the other options either fall below or exceed it, indicating hypothermia or fever.

16. 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 ANS: C

Feedback: Contraction of pilomotor muscles causes "goosebumps," which helps trap a layer of air close to the skin, reducing heat loss. Opening AV shunts increases heat loss, and reduced exhalation or decreased urine production are not thermoregulatory responses to cold.

17. When a person is at rest, how much time is required for the blood in the circulation to traverse the entire circulatory circuit?

A) 1 second B) 1 minute C) 3 minutes D) 4 minutes E) 5 minutes ANS: B Feedback: At rest, the human circulatory system is designed to complete a full cycle of blood circulation in approximately one minute. This reflects the cardiac output and the speed at which the heart pumps blood through systemic and pulmonary circuits.

18. 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 ANS: B Feedback: Heat is lost through radiation to cooler objects in the environment and convection when air currents remove heat from the body surface. Conduction and evaporation are less relevant in this scenario.

19. 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 ANS: A, C, D

Feedback: Acute inflammation, myocardial infarction, and malignancy trigger the release of endogenous pyrogens, such as IL-1 and TNF-α, which stimulate fever. Obesity and renal failure may contribute to inflammation but are not primary inducers of pyrogen production.

20. 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 ANS: B Feedback: Neurogenic fever results from damage to the hypothalamus, often due to head trauma or injury.

Alzheimer’s disease, delirium from benzodiazepines, or SSRIs are less likely to disrupt hypothalamic thermoregulation directly.

21. 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.

ANS: C Feedback: While antipyretics are commonly used, there is limited evidence to support their efficacy in treating fever or improving outcomes. Other statements are incorrect, as moderate fever does not typically cause seizures, and antipyretics do effectively lower core temperature.

22. 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

ANS: D Feedback: Recurrent (or relapsing) fever is characterized by alternating periods of fever and normal temperature over several days. This distinguishes it from remittent fever, sustained fever, or intermittent fever (which fluctuates within 24 hours).

23. 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.

ANS: B Feedback: Neonates have immature immune systems, making them highly susceptible to infections that can cause fever. The hypothalamus can regulate temperature normally, and fever in neonates is more often infectious than congenital.

24. 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 ANS: A Feedback: Aging impairs the hypothalamus’s ability to regulate temperature, resulting in a blunted fever response even during severe infections. Increased heat loss, comorbidities, or AV shunt closure are less likely explanations.

25. Which of the following is an example of negative feedback?

Example 1: Arterial baroreceptor control of blood pressure Example 2: Excitation of the respiratory center by increased blood carbon dioxide concentration Example 3: Hemorrhagic shock caused by severe blood loss A) Example 1 only B) Example 2 only C) Example 3 only D) Examples 1 and 2, but not 3 E) Examples 1, 2, and 3

ANS: D Feedback: Examples 1 and 2 are classic negative feedback mechanisms, where changes in blood pressure or carbon dioxide levels are detected and corrected to maintain homeostasis. Hemorrhagic shock, however, is a pathological condition where the body fails to stabilize itself, often leading to positive feedback loops and further deterioration.

Chapter 2. Chemical and biochemical foundations

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.

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. Molecular biology, genetics, and genetic diseases

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.

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 4. Cell Physiology And Pathophysiology

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)

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?

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 5. Infectious Disease

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 mainly found on cutaneous surfaces of the body.

A)

a powdery colony

B)

in moist skin folds

C)

on cooler tissue

, the infection is

D)

5.

branching filaments

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 methicillinresistant 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. The Immune System and Leukocyte Function

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 7. Neoplasia

1.

Unlike the tissue growth that occurs with hypertrophy and hyperplasia, the growth of a malignancy is:

A)

adaptive.

B)

specialized.

C)

predictable.

D)

autonomous.

2.

In contrast to malignancies, benign tumors are characterized by:

A)

a fibrous capsule.

B)

distant infiltration.

C)

rapid replication.

D)

undifferentiated cells.

3.

Because of their rapid growth, malignant tumors affect area tissues by:

A)

increasing tissue blood flow.

B)

providing essential nutrients.

C)

liberating enzymes and toxins.

D)

forming fibrous membranes.

4.

The metastatic spread of tumor cells is facilitated by invasion and movement to distant tissues.

A)

cell cohesiveness

B)

enzyme secretion

C)

contact inhibition

D)

cell-to-cell signaling

that enables

5.

The angiogenesis process, which allows tumors to develop new blood vessels, is triggered and regulated by tumor-secreted:

A)

procoagulants.

B)

growth factors.

C)

attachment factors.

D)

proteolytic enzymes.

6.

Cancerous transformation of a cell requires the activation of:

A)

cell cycle apoptosis.

B)

multiple mutations.

C)

a single gene mutation.

D)

tumor suppressor genes.

7.

Although clinical manifestations vary with the type of cancer and organs involved, abnormal tumor growth causes general manifestations that include:

A)

copious lymph flow.

B)

sleep disturbances.

C)

involuntary weight gain.

D)

visceral organ expansion.

8.

Paraneoplastic syndromes are manifestations of cancer that often result from:

A)

radiation and chemotherapy.

C)

tumor-related tissue necrosis.

D)

inappropriate hormone release.

9.

A)

Although both grading and staging are methods for classifying cancer and selecting a treatment plan, staging is used to determine the: number of mitoses.

B)

tissue characteristics.

C)

level of differentiation.

D)

extent of disease spread.

10 .

Early diagnosis of childhood cancers is often difficult because the signs and symptoms are:

A)

already present at birth.

B)

absent until the late stage.

C)

similar to those of other childhood diseases.

D)

seen as developmental delays.

11 .

A lung biopsy and magnetic resonance imaging have confirmed the presence of a benign lung tumor in a patient. Which of the following characteristics are associated with this patients neoplasm?

A)

The tumor will grow by expansion and is likely encapsulated.

B)

The cells that constitute the tumor are undifferentiated, with atypical structure.

C)

If left untreated, the patients tumor is likely to metastasize.

D)

The tumor is likely to infiltrate the lung tissue that presently surrounds it.

12 .

Which of the following processes characterizes an epigenetic contribution to oncogenesis?

A)

A DNA repair mechanism is disrupted.

B)

A tumor suppressor gene is present, but it is not expressed.

D)

Regulation of apoptosis in impaired, resulting in accumulation of cancer cells.

13 .

A farmers long-term exposure to pesticides has made the cells in his alveoli and bronchial tree susceptible to malignancy. Which of the following processes has taken place in the farmers lungs?

A)

Promotion

B)

Progression

C)

Initiation

D)

Differentiation

14 .

Genetic screening may be indicated for individuals who have a family history of which of the following neoplasms?

A)

Liver cancer

B)

Multiple myeloma

C)

Leukemia

D)

Breast cancer

15 .

A public health nurse has cited a reduction in cancer risk among the many benefits of maintaining a healthy body-mass index. Which of the following facts underlies the relationship between obesity and cancer?

A)

Obesity can cause inflammation and hormonal changes that are associated with cancer.

B)

Adipose tissue is more susceptible to malignancy than other types of connective tissue.

C)

Increased cardiac workload and tissue hypoxia can interfere with normal cell differentiation.

D)

Increased numbers of body cells increase the statistical chances of neoplastic cell changes.

16 .

Which of the following dietary guidelines should a nurse provide to a group of older adults to possibly decrease their risks of developing colon cancer?

A)

As much as possible, try to eat organic foods.

B)

Regular vitamin supplements and a low-carbohydrate diet are beneficial.

C)

Try to minimize fat and maximize fiber when youre planning your meals.

D)

Eat enough fiber in your diet that you have bowel movement at least once daily.

17 .

A male patient with a diagnosis of liver cancer has been recently admitted to a palliative care unit following his recent development of bone metastases.

Despite his familys encouragement, the patient has experienced precipitous weight loss in recent weeks. Which of the following factors may underlie the patients loss of fat and muscle mass?

A)

The action of cytokines and consequent inflammation

B)

Loss of appetite due to fatigue and pain

C)

Changes in peptide hormone levels

D)

Production of onconeural antigens by cancerous cells

18 .

A 51-year-old patient has been diagnosed with stage IV breast cancer with lung metastases. Which of the following treatment options is most likely to treat both her primary and distant cancer sites?

A)

Radiation therapy

B)

Chemotherapy

C)

Surgery

D)

Hormone therapy

19 .

A patients oncologist has presented the possibility of implementing biotherapy in the treatment of the patients brain tumor. Which of the following mechanisms of action provide the therapeutic effects of biotherapy? Select all that apply.

A)

Stimulating the immune response to tumor cells

B)

Inhibiting tumor protein synthesis

C)

Reversing angiogenesis

D)

Altering the hormonal environment of tumor cells

E)

Causing breaks in the DNA of tumor cells

20 .

A 5-year-old girls diagnosis of bone cancer required an aggressive treatment regimen. Which of the following considerations forms the most significant threat to her future health?

A)

Retention of chemotherapeutic drugs in the healthy bone matrix

B)

Unwanted effects of chemotherapy and radiation therapy

C)

Resistance to chemotherapy and radiation if required later in life

D)

Risk for recurrence of the primary neoplasm after puberty

Answer Key

1.

D

2.

A

3.

C

4.

B

5.

B

6.

B

7.

B

8.

D

9.

D

10 .

C

11 .

A

12 .

B

13 .

C

14 .

D

15 .

A

16 .

C

17 .

A

18 .

B

19 .

A, B

20 .

B

Chapter 8. Blood and Clotting

1.

With the exception of the first two steps, what is required in all steps of the clotting process?

A)

Calcium

B)

Prothrombin

C)

Tissue factor

D)

Plasminogen

2.

The first step of hemostasis occurs as a:

A)

fibrin clot.

B)

platelet plug.

C)

clot retraction.

D)

vessel spasm.

3.

To form a platelet plug, platelets are attracted to the damaged vessel, and then platelet occurs.

B)

fibrinolysis

C)

thrombosis

D)

thromboxane A2

4.

Blood coagulation is initiated by either of two pathways. The intrinsic pathway requires circulating to begin the step-wise coagulation cascade.

A)

protein C

B)

thrombin

C)

factor XII

D)

tissue factor

5.

Increased platelet function, and consequent hypercoagulability, can be caused by:

A)

factor V mutation.

B)

platelet insensitivity.

C)

vascular wall damage.

D)

decreased platelet numbers.

6.

Immune thrombocytopenia purpura (ITP) is a/an destroys .

A)

allergic; fibrinogen

B)

alloimmune; factor VIII

C)

autoimmune; platelets

D)

immunoglobulin; B cells

7.

Thrombotic thrombocytopenic purpura (TTP) causes which of the following manifestations? Select all that apply.

A)

Purpura

B)

Jaundice

C)

Petechiae

D)

Erythema

E)

Confusion

8.

Hemophilia A is a hereditary blood disorder caused by inadequate activity or absent:

A)

factor VIII.

B)

prothrombin.

C)

vWF complex.

D)

intrinsic factor.

9.

A)

disorder that

Disseminated intravascular coagulation (DIC) is characterized by: headaches.

B)

platelet loss.

C)

hypertension.

D)

hemorrhage.

10 .

In persons with a bleeding disorder caused by vascular defects, laboratory tests will most often reveal:

A)

normal values.

B)

hypocalcemia.

C)

polycythemia.

D)

thrombocytopenia.

11 .

Removal of a patients peripheral intravenous catheter resulted in brief bleeding and the loss of a small amount of blood. Which of the following processes occurred during the formation of the platelet plug that helped to stop blood flow?

A)

Activation of factor X

B)

Conversion of prothrombin to thrombin

C)

Release of von Willebrand factor from the epithelium

D)

Conversion of fibrinogen to fibrin threads

12 .

A 69-year-old patient who is obese and has a diagnosis of angina pectoris has been prescribed clopidogrel (Plavix) by his primary care provider. The patients medication achieves its therapeutic effect in which of the following ways?

A)

Prevention of platelet aggregation

B)

Activation of plasminogen

C)

Inhibition of the intrinsic clotting pathway

D)

Deactivation of factor X

13 .

A public health nurse is conducting a health promotion campaign under the auspices of the local community center. Which of the following measures that the nurse is promoting are likely to influence the participants risk of hypercoagulability disorders? Select all that apply.

A)

Smoking cessation

B)

Blood glucose screening

C)

Weight management

D)

Cholesterol screening and management

E)

Blood pressure screening and management

14 .

During a patients admission assessment prior to reduction mammoplasty surgery, the nurse notes a reference to a Leiden mutation in the patients history. The nurse would recognize the patients increased risk for

A)

Hemorrhage

B)

Myocardial infarction

C)

Hemophilia A or B

D)

Deep vein thrombosis

15 .

The most recent blood work of a patient with a diagnosis of acute myelogenous leukemia (AML) reveals thrombocytopenia. Where is the patient most likely to experience abnormal bleeding as a result of low platelets?

A)

In the brain

B)

Skin and mucous membranes

C)

Sclerae of the eyes

D)

Nephrons and ureters

16 .

A patient was started on a protocol for the prevention of deep vein thrombosis shortly after admission, and has been receiving 5000 units of heparin twice daily for the last 5 days. An immune response to this treatment may increase the patients chance of developing which health problem?

A)

Antiphospholipid syndrome

B)

Disseminated intravascular coagulation (DIC)

C)

Von Willebrand disease

D)

17 .

Thrombocytopenia

In light of the presence of numerous risk factors for coronary artery disease, a patients primary care provider has recommended that he take low-dose aspirin once daily. Doing so will reduce the patients risk of myocardial infarction by altering which of the following stages of hemostasis?

A)

Vessel spasm

B)

Platelet plug formation

C)

Blood coagulation

D)

Clot lysis

18 .

A 23-year-old female patient has been diagnosed with von Willebrand disease following a long history of heavy periods and occasional nosebleeds.

Which of the patients following statements demonstrates a sound understanding of her new diagnosis?

A)

Im really disappointed that I wont be able to do sports anymore.

B)

I read on a website that I might have to get blood transfusions from time to time.

C)

Ill make sure to take Tylenol instead of aspirin when I get aches and pains.

D)

I hope my insurance covers the injections that Ill need to help my blood clot.

19 .

Which of the following patients likely faces the highest risk of an acquired hypocoagulation disorder and vitamin K deficiency?

A)

A patient who has a diagnosis of liver failure secondary to alcohol abuse

B)

A patient who has chronic renal failure as a result of type 1 diabetes mellitus

C)

A patient who is immunocompromised as a result of radiation therapy for the treatment of lung cancer

D)

A patient with dehydration and hypokalemia that have resulted from Clostridium difficileassociated diarrhea

20 .

A healthy, primiparous (first-time) mother delivered a healthy infant several hours ago, but the mother has experienced postpartum hemorrhage. Which of the following disorders is most likely to underlie the patients excessive bleeding after delivery?

A)

Disseminated intravascular coagulation

B)

Hemophilia A

C)

Von Willebrand disease

D)

Thrombotic thrombocytopenic purpura (TTP)

Answer Key

1.

A

2.

D

3.

A

4.

C

5.

C

6.

C

7.

A, C, E

8.

A

9.

D

10 .

A

11 .

C

12 .

A

13 .

A, B, C, D, E

14 .

D

15 .

B

16 .

D

17 .

B

18 .

C

19 .

A

20 .

A

Chapter 9. Circulation

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

A)

volume load

B)

blood pumped

C)

stroke volume

D)

force generated

3.

each minute.

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)

14 .

Cor pulmonale

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 10. Heart

1.

Chronic stable angina, associated with inadequate blood flow to meet the metabolic demands of the myocardium, is caused by:

A)

fixed coronary obstruction.

B)

increased collateral circulation.

C)

intermittent vessel vasospasms.

D)

excessive endothelial relaxing factors.

2.

Atherosclerotic plaque is most likely to be unstable and vulnerable to rupture when the plaque has a thin fibrous cap over a:

A)

red thrombus.

B)

large lipid core.

C)

calcified lesion.

D)

vessel wall injury.

3.

Cardiac tamponade and pericardial effusion can be life-threatening when the pericardial sac and the heart.

A)

ruptures; releases

B)

thickens; stretches

C)

contracts; friction rubs

D)

fills rapidly; compresses

4.

In adults, sudden death from an acute myocardial infarction is usually caused by:

A)

acute myocarditis.

B)

high troponin levels.

C)

acute ventricular arrhythmia.

D)

hypertrophic cardiomyopathy.

5.

On the second or third day after an acute myocardial infarction, the area of necrosis is:

A)

soft and yellow.

B)

acutely inflamed.

C)

granulation tissue.

D)

fibrous scar tissue.

6.

In aortic regurgitation, failure of aortic valve closure during diastole causes an abnormal drop in diastolic pressure. This change in pressure causes decreased:

A)

stroke volume.

B)

left ventricular size.

C)

coronary perfusion.

D)

arterial pulse pressure.

7.

Patients with ischemic coronary vessel disease and acute coronary syndrome (ACS) are classified as low or high risk for acute myocardial infarction based on characteristics that include significant:

A)

heart murmurs.

B)

ECG changes.

C)

pulmonary disease.

D)

pericardial effusion.

8.

Dilated cardiomyopathy with left ventricular dysfunction is characterized by increased wall:

A)

rigidity.

B)

thinning.

C)

thickness.

D)

contractility.

9.

Endocarditis and rheumatic heart disease are both cardiac complications of systemic infections. Characteristics include a new or changed heart murmur caused by:

A)

chronic atrial fibrillation.

B)

myocardial inflammation.

C)

left ventricle hypertrophy.

D)

vegetative valve destruction.

10 .

Congenital heart defects can cause a right heart to left heart shunting of blood that results in increased:

A)

pulmonary blood volume.

B)

right ventricle workload.

C)

unoxygenated blood flow.

D)

right atrial blood volume.

11 .

Which of the following assessment findings of a cardiac patient would be suggestive of cardiac tamponade?

A)

Increasing PaCO2 and decreasing PaO2

B)

Audible crackles on chest auscultation and presence of frothy sputum

C)

20 mm Hg Drop in systolic blood pressure during respiration

D)

Normal ECG combined with complaints of chest pain and shortness of breath

12 .

The plaques in a patients coronary arteries are plentiful and most have smallto moderate-sized lipid cores with thick fibrous caps. This form of atherosclerosis is most closely associated with which of the following diagnoses?

A)

Stable angina

B)

Non-ST-segment elevation MI

C)

ST-Segment elevation MI

D)

Unstable angina

13 .

Which of the following individuals is suffering the effects of acute coronary syndrome (ACS)?

A)

A patient whose most recent ECG indicates that silent myocardial ischemia has occurred

B)

A patient who occasionally experiences persistent and severe chest pain when at rest

C)

A patient who sometimes experiences chest pain when climbing stairs

D)

A patient who has recently been diagnosed with variant (vasospastic) angina

14 .

Coronary artery bypass grafting (CABG) is a relevant treatment modality for which of the following disorders of cardiac function?

A)

Atherosclerosis with history of MI

B)

Pericardial effusion and cardiac tamponade

C)

Dilated cardiomyopathies

D)

Aortic valve regurgitation and aortic stenosis

15 .

Football fans at a college have been shocked to learn of the sudden death of a star player, an event that was attributed in the media to an enlarged heart.

Which of the following disorders was the players most likely cause of death?

A)

Takotsubo cardiomyopathy

B)

Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D)

C)

Hypertrophic cardiomyopathy (HCM)

D)

Dilated cardiomyopathy (DCM)

16 .

Implantation of a pacemaker is most likely to benefit a patient with which of the following cardiomyopathies?

A)

Myocarditis

B)

Takotsubo cardiomyopathy

C)

Dilated cardiomyopathy (DCM)

D)

Primary restrictive cardiomyopathy

17 .

A childs history of a recurrent sore throat followed by severe knee and ankle pain has resulted in a diagnostic workup and a diagnosis of rheumatic fever.

What are the treatment priorities for this child?

A)

Cardiac catheterization and corticosteroid therapy

B)

Implanted pacemaker and b-adrenergic blockers

C)

Antibiotics and anti-inflammatories

D)

Pain control and oxygen therapy

18 .

An elderly female patient with complaints of increasing fatigue has been diagnosed with aortic stenosis, a disease which her primary care provider believes may have been long-standing. Which of the following compensatory mechanisms has most likely maintained the womans ejection fraction until recently?

A)

Left ventricular hypertrophy

B)

Increased blood pressure

C)

Increased heart rate and stroke volume

D)

Aortic dilation

19 .

Persistent cyanosis has led an infants care team to suspect a congenital heart defect. Which of the following assessment findings would suggest coarctation of the infants aorta?

A)

The child has a split S2 heart sound on auscultation.

B)

ECG reveals atrial fibrillation.

C)

The child experiences apneic spells after feeding.

D)

Blood pressure in the childs legs is lower than in the arms.

20 .

Which of the following assessment findings of a cyanotic infant is incongruent with a diagnosis of tetralogy of Fallot?

A)

The child has ventricular septal defect.

B)

The infants pulmonary outflow channel is narrowed.

C)

The child has right ventricular hypertrophy.

D)

The infants aorta is narrowed.

Answer Key

1.

A

2.

B

3.

D

4.

C

5.

B

6.

C

7.

B

8.

B

9.

D

10 .

C

11 .

C

12 .

A

13 .

B

14 .

A

15 .

C

16 .

C

17 .

C

18 .

A

19 .

D

20 .

D

Chapter 11. Lungs

1.

A distinguishing feature of viral influenza is:

A)

direct contact transmission.

B)

abrupt-onset, profound malaise.

C)

constant pounding headache.

D)

profuse watery nasal discharge.

2.

A common cause of bacterial pneumonia in both community and hospital setting is:

A)

E. coli

B)

S. aureus.

C)

Enterobacter.

D)

S. pneumoniae.

3.

Legionnaire disease is a form of bronchopneumonia caused by an organism frequently found in:

A)

warm, standing water.

B)

public restrooms.

C)

fermenting yogurt.

D)

potted plant dirt.

4.

The pathogenic capacity of the tubercle bacillus is related to:

A)

formation of a Ghons focus lesion.

B)

its inherent destructive capabilities.

C)

rapid viral replication in host cells.

D)

the initiation of a cell-mediated immune response.

5.

People infected with HIV and tuberculosis lack a hypersensitivity response to the tuberculin test as a result of:

A)

inherent anergy.

B)

host cell depletion.

C)

poor lung perfusion.

D)

boosting phenomenon.

6.

Which of the four categories of bronchogenic carcinoma has the greatest association with tobacco smoking and tends to metastasize to the brain?

A)

Small cell

B)

Large cell

C)

Squamous cell

D)

Adenocarcinoma

7.

Increased upper airway resistance and decreased airflow into the lungs in neonates (0 to 4 weeks of age) can result from:

A)

frequent crying.

B)

sleeping supine.

C)

nasal congestion.

D)

productive coughing.

8.

Most respiratory disorders in infants produce a decrease in:

A)

lung compliance.

B)

airway resistance.

C)

oxygen demand.

D)

respiratory rate.

9.

A)

Which of the following acute respiratory infections in children poses the greatest threat of severe hypoxia caused by inflammatory edema?

Croup

C)

Epiglottitis

D)

Bronchiolitis

10 .

The cold viruses are rapidly spread from person to person. The greatest source of spread is:

A)

fingers.

B)

sneezing.

C)

plastic toys.

D)

eye mucosa.

11 .

A college student is lamenting the fact that she has developed a cold on the weekend prior to exam week. Which of the following statements shows that the student has an accurate understanding of her upper respiratory infection?

A)

Im just going to try to rest as much as I can until these bacteria clear up.

B)

I think Ill go to the campus clinic and see if I can get a prescription for antibiotics.

C)

I suppose I should have been washing my hands more in the past few days.

D)

If I can just start some antihistamines as soon as possible I bet Ill get over this faster.

12 .

A patient has presented to an ambulatory clinic complaining of a persistent headache. What assessments should the clinician conduct to differentiate between rhinosinusitis and alternative health problems?

A)

Take a sputum sample for culture and sensitivity.

B)

Compare the patients oral, tympanic, and axillary temperatures and order a white blood cell count.

C)

Palpate the patients lymph nodes and inspect the ears with an otoscope.

D)

Perform transillumination and ask the patient if bending forward exacerbates the headache.

13 .

Which of the following individuals should be prioritized for receiving a seasonal influenza vaccination?

A)

An 81-year-old resident of a long-term care facility

B)

A 19-year-old man who was admitted to a hospital for an appendectomy

C)

A neonate who was born in a busy, inner-city hospital in late October

D)

An 86-year-old patient whose flu symptoms have required hospitalization

14 .

A patient has been admitted to a medical unit of a hospital for the treatment of pneumonia that is attributable to S. pneumonia. Which of the following considerations is the priority in this patients treatment?

A)

Maintaining the patients activities of daily living

B)

Maintaining the patients airway

C)

Monitoring and treating the patients pain

D)

Preventing and treating the patients fever

15 .

A nurse who provides weekly care in a homeless shelter has unknowingly inhaled airborneMycobacterium tuberculosis bacteria and has subsequently developed latent tuberculosis infection. Which of the following is true of this nurse?

A)

The nurse is likely asymptomatic.

B)

The nurse is now immune to more severe tuberculosis infection.

C)

The nurse can spread tuberculosis to others.

D)

The nurse has active tuberculosis infection.

16 .

Which of the following types of lung cancer is associated with the best prognosis in the majority of patients?

A)

Small cell lung cancer

B)

Adenocarcinoma

C)

Squamous cell carcinoma

D)

Large cell carcinoma

17 .

Which of the following individuals is most clearly in need of diagnostic testing for lung cancer?

A)

A patient who has required hospitalization with a fever and the production of copious lung secretions

B)

A patient with a history of secondary tuberculosis who failed to complete his prescribed course of antibiotics

C)

A woman who complains of recurrent lower respiratory infections and who has sought care for increasing shortness of breath

D)

A man who demonstrates wasting of the pelvic and shoulder muscles combined with signs of hypercalcemia

18 .

Which of the following characteristics of the lungs of infants and small children creates an increased risk of respiratory disorders?

A)

Type II alveoli in children may overproduce surfactant.

B)

Smaller airways create a susceptibility to changes in airway resistance and airflow.

C)

The pneumotaxic center in the pons in underdeveloped until 8 years of age.

D)

There are fewer chemoreceptors in the young medulla.

19 .

Which of the following respiratory infections in children is associated with the poorest outcomes?

A)

Viral croup

B)

Rhinosinusitis

C)

Epiglottitis

D)

Spasmodic croup

20 .

A 6-month-old infant has been hospitalized with acute bronchiolitis. Which of the following treatments should be prioritized in the infants care?

A)

Supplementary oxygen therapy

B)

Intravenous antibiotics

C)

Transfusion of fresh frozen plasma

D)

Tracheotomy

Answer Key

1.

B

2.

B

3.

A

4.

D

5.

A

6.

A

7.

C

8.

A

9.

C

10 .

A

11 .

C

12 .

D

13 .

A

14 .

B

15 .

A

16 .

C

17 .

D

18 .

B

19 .

C

20 .

A

Chapter 12. Kidneys

1.

The most common indicator of acute renal failure is:

A)

anemia.

B)

uremia.

C)

edema.

D)

azotemia.

2.

A patient had excessive blood loss and prolonged hypotension during surgery. His postoperative urine output is sharply decreased and his blood urea nitrogen (BUN) is elevated. The most likely cause for the change is acute:

A)

prerenal inflammation.

B)

bladder outlet obstruction.

C)

ischemic tubular necrosis.

D)

intrarenal nephrotoxicity.

3.

A patient is beginning to recover from acute tubular necrosis. The recovery phase of ATN is characterized by:

A)

edema.

B)

diuresis.

C)

proteinuria.

D)

hypokalemia.

4.

Regardless of the cause, chronic kidney disease results in progressive permanent loss of nephrons, glomerular filtration and renal:

A)

tubule dysplasia.

B)

vascular pressure.

C)

endocrine functions.

D)

5.

hypophosphatemia.

As chronic kidney disease progresses, the second stage (renal insufficiency) is identified by:

A)

isotonic polyuria.

B)

metabolic acidosis.

C)

hyperparathyroidism.

D)

diminished renal reserve.

6.

Both high-turnover and low-turnover renal osteodystrophy, the skeletal complications of chronic kidney disease, are manifested by abnormal and defective bone .

A)

shape; joint motion

B)

absorption; remodeling

C)

matrix density; marrow

D)

parathyroid hormone; surface

7.

Impaired skin integrity and skin manifestations are common in persons with chronic kidney disease. Pale skin and subcutaneous bruising are often present as a result of:

A)

thrombocytopenia.

B)

anticoagulant therapy.

C)

decreased vascular volume.

D)

impaired platelet function.

8.

When acute tubular necrosis (ATN) has occurred instead of prerenal azotemia, laboratory test findings will show the presence of excessive urine:

A)

protein.

B)

glucose.

C)

calcium.

D)

9.

sodium.

Manifestations of childhood renal disease are varied and may differ from adult onset renal failure. Features of childhood chronic kidney disease include:

A)

mental retardation.

B)

developmental delays.

C)

bladder incontinence.

D)

early sexual maturity.

10 .

Reduced glomerular filtration rate (GFR), with a serum creatinine level that remains in the normal range, is associated with aging because is reduced in elderly persons.

A)

calcium intake

B)

muscle mass

C)

drug tolerance

D)

renal perfusion

11 .

An 86-year-old female patient has been admitted to the hospital for the treatment of dehydration and hyponatremia after she curtailed her fluid intake to prevent urinary incontinence. The patients most recent laboratory results are suggestive of acute renal failure. How would this patients renal failure be categorized?

A)

Prerenal

B)

Postrenal

C)

Intrinsic

D)

Intrarenal

12 .

A patient with significant burns on his lower body has developed sepsis on the third day following his accident. Which of the following developments is most clearly suggestive of ischemic acute tubular necrosis rather than prerenal failure?

A)

The patient exhibits pulmonary and peripheral edema.

B)

The patients GFR does not increase after restoration of renal blood flow.

C)

Emergency hemodialysis does not result in decreased BUN and creatinine.

D)

The patient exhibits oliguria and frank hematuria.

13 .

Which of the following individuals likely faces the greatest risk for the development of chronic kidney disease?

A)

A first-time mother who recently lost 1.5 L of blood during a postpartum hemorrhage

B)

A patient whose diagnosis of thyroid cancer necessitated a thyroidectomy

C)

A patient who experienced a hemorrhagic stroke and now has sensory and motor deficits

D)

A patient with a recent diagnosis of type 2 diabetes who does not monitor his blood sugars or control his diet

14 .

The primary care provider for a newly admitted hospital patient has added the glomerular filtration rate (GFR) to the blood work scheduled for this morning. The patients GFR will be extrapolated from serum levels of:

A)

urea.

B)

protein.

C)

creatinine.

D)

myoglobin.

15 .

The nurse is providing care for a patient who has a diagnosis of kidney failure. Which of the following laboratory findings is consistent with this patients diagnosis?

A)

Metabolic alkalosis

B)

Hypophosphatemia

D)

Hypokalemia

16 .

A patient with a recent diagnosis of renal failure that will require hemodialysis is being educated in the dietary management of the disease.

Which of the patients following statements shows an accurate understanding of this component of treatment?

A)

Ive made a list of high-phosphate foods so that I can try to avoid them.

B)

Im making a point of trying to eat lots of bananas and other food rich in potassium.

C)

Im going to try a high-protein, low-carbohydrate diet.

D)

I dont think Ive been drinking enough, so I want to include 8 to 10 glasses of water each day.

17 .

A patient with a diagnosis of chronic kidney disease (CKD) may require the administration of which of the following drugs to treat the consequences of CKD?

A)

Antihypertensive medications

B)

Antiarrhythmic medications

C)

Opioid analgesics

D)

Nonsteroidal anti-inflammatory drugs (NSAIDs)

18 .

A patient with a longstanding diagnosis of chronic kidney disease has been experiencing increasing fatigue, lethargy, and activity intolerance in recent weeks. His care team has established that his GFR remains at a low, but stable, level. Which of the following assessments is most likely to inform a differential diagnosis?

A)

Blood work for white cells and differential

B)

Cystoscopy and ureteroscopy

C)

Assessment of pancreatic exocrine and endocrine function

D)

Blood work for hemoglobin, red blood cells, and hematocrit

19 .

Which of the following descriptions is true of peritoneal dialysis?

A)

Vascular access is achieved through an internal arteriovenous fistula or an external arteriovenous shunt.

B)

Treatments typically occur three times each week for three to four hours.

C)

The dialyzer is usually a hollow cylinder composed of bundles of capillary tubes.

D)

Treatment involves the introduction of a sterile dialyzing solution, which is drained after a specified time.

20 .

Which of the following integumentary problems most often accompanies chronic kidney disease?

A)

Dry skin and pruritus

B)

Petechiae and purpura

C)

Hirsutism and psoriasis

D)

Alopecia

Answer Key

1.

D

2.

C

3.

B

4.

C

5.

A

6.

B

7.

D

8.

A

9.

B

10 .

B

11 .

A

12 .

B

13 .

D

14 .

C

15 .

C

16 .

A

17 .

A

18 .

D

19 .

D

20 .

A

Chapter 13. Gastrointestinal Tract

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

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 14. Liver

1.

Abnormally high accumulation of bilirubin in the blood causes:

A)

jaundice.

B)

cholestasis.

C)

xanthomas.

D)

biliary cirrhosis.

2.

The mechanisms of liver damage in viral hepatitis include:

A)

direct cellular injury.

B)

fatty liver changes.

C)

disrupted bile flow.

D)

bile duct inflammation.

3.

Alcoholic liver disease manifests in three stages. The intermediate stage, alcoholic hepatitis, is characterized by liver cell:

A)

necrosis.

B)

nodules.

C)

atrophy.

D)

hypertrophy.

4.

A major factor in the development of hepatic encephalopathy is:

A)

hypersplenism.

B)

high sodium level.

C)

neurotoxin accumulation.

D)

steroid hormone deficiency.

5.

Kupffer cells function as to remove harmful substances or cells from the portal blood as it moves through the venous sinusoids.

A)

filters

B)

channels

C)

phagocytes

D)

cytotoxic cells

6.

Both prehepatic and posthepatic causes of portal hypertension include the formation of:

A)

fibrous nodules.

B)

venous thrombosis.

C)

collateral circulation.

D)

portosystemic shunts.

7.

The late manifestations of cirrhosis are related to liver failure and:

A)

hepatomegaly.

B)

diffuse liver fibrosis.

C)

portal hypertension.

D)

hepatorenal syndrome.

8.

Factors that contribute to the formation of gallstones, or acute cholelithiasis, include:

A)

chronic pancreatitis.

B)

rapid elimination of bile.

C)

gallbladder inflammation.

D)

excessive alcohol intake.

9.

The patient has right upper quadrant pain caused by acute choledocholithiasis. If the common bile duct becomes obstructed, manifestations will also include:

A)

ascites.

B)

vomiting.

C)

bilirubinuria.

D)

hemorrhage.

10 .

Acute pancreatitis involves activated pancreatic enzymes that escape into surrounding tissues to cause .

A)

fatty deposits

B)

autodigestion

C)

bowel obstruction

D)

abscess formation

11 .

Individuals with liver disease often experience the effects of excess serum ammonia as a result of impairment of the livers ability to process ammonia.

How does the liver process ammonia in healthy individuals?

A)

By converting it into bilirubin which is then excreted intestinally

B)

By processing ammonia into nitrogen and hydrogen ions for excretion

C)

By processing it into urea and releasing it into the circulation

D)

By combining it with oxygen to create ammonium oxide

12 .

A patients longstanding diagnosis of congenital hemolytic anemia often manifests itself with jaundice. What type of jaundice does this patient most likely experience?

A)

Prehepatic

B)

Intrahepatic

C)

Posthepatic

D)

Infectious

13 .

A decrease in the serum level of which of the following substances is suggestive of liver injury?

A)

g-Glutamyltransferase (GGT)

B)

Albumin

C)

Alanine aminotransferase (ALT)

D)

14 .

Alkaline phosphatase

Antibody testing has confirmed that a man is positive for hepatitis A virus (HAV). Which of the patients statements suggests that he understands his new diagnosis?

A)

I guess Im an example of why you should always use condoms.

B)

Im embarrassed that Ill be a carrier of hepatitis from now on.

C)

Im still trying to deal with the fact that this will forever change my life.

D)

I dont know why I didnt bother to get vaccinated against this.

15 .

A 16-year-old girl has been admitted to the emergency department after ingesting 20 g of acetaminophen (Tylenol) in a suicide attempt. The care team would recognize that this patient faces a severe risk of:

A)

acute fulminant hepatitis.

B)

hepatitis D virus infection.

C)

secondary biliary cirrhosis.

D)

portal hypertension.

16 .

Which of the following factors accounts for the poor prognosis that typically accompanies a diagnosis of primary hepatocellular cancer?

A)

Surgical options do not exist because removal of all or part of the liver is a threat to health.

B)

Liver cancer typically metastasizes at a much earlier stage than other cancers.

C)

Liver tumors are poorly differentiated due to the low density of hepatic tissue.

D)

17 .

The nonspecific symptomatology of liver cancer means that diagnosis often happens at a late stage.

Which of the following factors is most strongly associated with the pathogenesis of gallstones?

A)

Excess serum ammonia and urea levels

B)

Portal hypertension

C)

Abnormalities or stasis of bile

D)

High cholesterol diet

18 .

Which of the following individuals most likely faces the highest risk of developing chronic pancreatitis?

A)

A woman who has six to eight drinks each evening

B)

A man who has become profoundly ill during a tropical vacation

C)

A woman who takes two Tylenol tablets five to six times a day

D)

An obese man who has a high-fat diet and has a sedentary lifestyle

19 .

The nurse who is providing care for a patient with pancreatic cancer should prioritize which of the following assessments?

A)

Assessment for ascites and close monitoring of fluid balance

B)

Respiratory assessment and monitoring of arterial blood gases

C)

Vigilant monitoring of blood glucose levels

D)

Assessment for deep vein thrombosis

20 .

Which of the following signs and symptoms is most suggestive of acute cholecystitis?

A)

Upper right quadrant or epigastric pain

B)

Fever and sudden abdominal distention

C)

Appearance of undigested fat in feces

D)

Nausea resulting in greenish vomitus

Answer Key

1.

A

2.

A

3.

A

4.

C

5.

C

6.

B

7.

C

8.

C

9.

C

10 .

B

11 .

C

12 .

A

13 .

B

14 .

D

15 .

A

16 .

A

17 .

C

18 .

A

19 .

D

20 .

A

Chapter 15. Nervous System

1.

The intracranial volume that is most capable of compensating for increasing intracranial pressure is the:

A)

brain cell tissue.

B)

intravascular blood.

C)

surface sulci fluid.

D)

cerebrospinal fluid.

2.

A late indicator of increased intracranial pressure is:

A)

tachycardia.

B)

right-sided heart failure.

C)

narrow pulse pressure.

D)

high mean arterial pressure.

3.

Extreme cerebral edema may cause the brain to herniate into another compartment. Upward herniation from the infratentorial compartment against the aqueduct of Sylvius causes:

A)

hydrocephalus.

B)

cardiac arrest.

C)

tissue infarction.

D)

intracranial bleeding.

4.

Coup and contrecoup cerebral contusion caused by blunt head trauma against a fixed object results in:

A)

diffuse axonal injuries.

B)

cerebrovascular infarction.

C)

momentary unconsciousness.

D)

permanent brain tissue damage.

5.

An intracranial epidural hematoma causes focal symptoms that can include:

A)

ipsilateral pupil dilation.

B)

ipsilateral hemiparesis.

C)

diffuse venous bleeding.

D)

commuting hydrocephalus.

6.

The earliest signs of decreased level of consciousness include:

A)

stupor.

B)

lethargy.

C)

delirium.

D)

inattention.

7.

Metabolic factors that increase cerebral blood flow include:

A)

increased oxygen saturation.

B)

increased carbon dioxide level.

C)

decreased serum sodium level.

D)

decreased hydrogen ion concentration.

8.

Transient ischemic attacks (TIAs) are characterized by ischemic cerebral neurologic deficits that:

A)

indicate aneurysm leakage.

B)

cause minor residual deficits.

C)

affect diffuse cerebral functions.

D)

resolve within one hour of onset.

9.

Common manifestations of acute meningococcal meningitis, a highly contagious and lethal form of meningitis, include:

A)

diplopia.

B)

petechiae.

C)

papilledema.

D)

focal paralysis.

10 .

The moderate stage of the progressive degenerative Alzheimer-type dementia is manifested by behaviors that include:

A)

confusion.

B)

incontinence.

C)

decreased level of consciousness.

D)

social withdrawal.

11 .

A patients recent computed tomography (CT) scan has revealed the presence of hydrocephalus. Which of the following treatment measures is most likely to resolve this health problem?

A)

Aggressive diuresis

B)

Placement of a shunt

C)

Administration of hypertonic intravenous solution

D)

Lumbar puncture

12 .

A high school senior sustained a concussion during a football game. Which of the following signs and symptoms would indicate the presence of postconcussion syndrome in the days and weeks following his injury?

A)

Headaches and memory lapses

B)

Recurrent nosebleeds and hypersomnia

C)

Unilateral weakness and decreased coordination

D)

Neck pain and decreased neck range of motion

13 .

An elderly male patient has been brought to the emergency department after experiencing stroke-like symptoms a few hours ago, and has been subsequently diagnosed with an ischemic stroke. The care team is eager to restore cerebral perfusion despite the likely death of the brain cells directly affected by the stroke. What is the rationale for the care teams emphasis on restoring circulation?

A)

Failure to restore blood flow creates a severe risk for future transient ischemic attacks.

B)

Necrosis will continue unabated throughout the brain unless blood flow is restored.

C)

Cells of the penumbra may be saved from hypoxic damage if blood flow is promptly restored.

D)

Unless blood flow is restored, the patient faces the risk of progressing to hemorrhagic stroke.

14 .

A patients emergency magnetic resonance imaging (MRI) has been examined by the physician and tPA has been administered to the patient.

What was this patients most likely diagnosis?

A)

Status epilepticus

B)

Subarachnoid hemorrhage

C)

Ischemic stroke

D)

Encephalitis

15 .

A patient has been diagnosed with a cerebral aneurysm and placed under close observation before treatment commences. Which of the following pathophysiologic conditions has contributed to this patients diagnosis?

A)

Weakness in the muscular wall of an artery

B)

Impaired synthesis of clotting factors

C)

Deficits in the autonomic control of blood pressure

D)

Increased levels of cerebrospinal fluid

16 .

Which of the following pathophysiologic processes occurs in cases of bacterial meningitis?

A)

Infection in the cerebrospinal fluid causes vasoconstriction and cerebral hypoxia.

B)

Trauma introduces skin-borne pathogens to the cerebrospinal fluid.

C)

Infection in the cerebrospinal fluid causes spinal cord compression and neurologic deficits.

D)

Inflammation allows pathogens to cross into the cerebrospinal fluid.

17 .

Which of the following individuals has the highest chance of having a medulloblastoma?

A)

An 88-year-old man who has begun displaying signs and symptoms of increased ICP

B)

A 60-year-old woman who is soon to begin radiation therapy for the treatment of breast cancer

C)

A 4-year-old child who has become uncoordinated in recent months

D)

A 68-year-old man who is a smoker and has a family history of cancer

18 .

A patient with a history of a seizure disorder has been observed suddenly and repetitively patting his knee. After stopping this repetitive action, the patient appears confused and is oriented to person and place but not time.

What type of seizure did this patient most likely experience?

A)

Simple partial seizure

B)

Atonic seizure

C)

Myoclonic seizure

D)

Complex partial seizure

19 .

A patient with a long history of cigarette smoking and poorly controlled hypertension has experienced recent psychomotor deficits as a result of hemorrhagic brain damage. The patients psychomotor deficits are likely the result of:

A)

Alzheimer disease.

B)

frontotemporal dementia (FTD).

C)

vascular dementia.

D)

Wernicke-Korsakoff syndrome.

20 .

Which of the following statements by the husband of a patient with Alzheimer disease demonstrates an accurate understanding of his wifes medication regimen?

A)

Im really hoping these medications will slow down her mental losses.

B)

Were both holding out hope that this medication will cure her Alzheimers.

C)

I know that this wont cure her, but we learned that it might prevent a bodily decline while she declines mentally.

D)

I learned that if we are vigilant about her medication schedule, she may not experience the physical effects of her disease.

Answer Key

2.

D

3.

A

4.

D

5.

A

6.

D

7.

B

8.

D

9.

B

10 .

A

11 .

B

12 .

A

13 .

C

14 .

C

15 .

A

16 .

D

17 .

C

18 .

D

19 .

C

20 .

A

Chapter 16. Musculoskeletal System

1.

Characteristics of a patient that is at high risk for falling and fracturing a hip include:

A)

obesity and short stature.

B)

excessive sugar intake.

C)

hearing impairment.

D)

chronic osteoporosis.

2.

A pathologic stress fracture occurs in bones subjected to:

A)

sudden direct force.

B)

weakening by disease.

C)

repeated excessive use.

D)

massive muscle contraction.

3.

Shortly after a closed fracture has occurred, early manifestations include localized:

A)

tetany.

B)

deformity.

C)

necrosis.

D)

numbness.

4.

In order to initiate the cellular events essential to bone healing, there must be formation at the fracture site.

A)

callous

B)

hematoma

C)

ossification

D)

fibrin meshwork

5.

In contrast to structural scoliosis, postural scoliosis:

A)

compresses vertebrae.

B)

corrects with bending.

C)

is apparent at birth.

D)

becomes painful.

6.

Factors that may adversely affect bone healing include

A)

immobilization

B)

weight bearing

C)

delayed union

D)

tight alignment

7.

The distinguishing characteristic of chronic osteomyelitis is the presence of:

A)

sequestrum bone.

B)

abscess formation.

C)

severe bone pain.

D)

external drainage.

8.

Developmental dysplasia of the hip (DDH), formerly known as congenital hip dislocation, is suspected when an infant has:

A)

gluteal fold asymmetry.

B)

lengthening of the thigh.

C)

joint capsule tightness.

D)

delay of knee crawling.

9.

of the bone.

Osteonecrosis is most often caused by:

B)

bacterial infection.

C)

synovial inflammation.

D)

bone marrow ischemia.

10 .

The patient has a fractured tibia. After the cast is applied he is at high risk for compartment syndrome caused by:

A)

inflammation.

B)

joint immobility.

C)

muscle atrophy.

D)

extremity elevation.

11 .

A college baseball player has seen his season cut short by a rotator cuff injury. Rotator cuff injuries are frequent because of:

A)

the inherent instability of the shoulder.

B)

the absence of ligaments at the glenohumeral joint.

C)

the vulnerability of the shoulder menisci.

D)

the large mass of the humeral head.

12 .

A patients clavicular fracture has healed in the weeks following a bicycle accident. Which of the following events takes place in the remodelling stage of bone healing?

A)

Formation of granulation tissue

B)

Development of fibrocartilage that resembles the appearance of the original bone

C)

Deposition of mineral salts into the callus

D)

Reduction in the size of the callus

13 .

A child has been hospitalized for the treatment of hematogenous osteomyelitis. The defining characteristic of this type of osteomyelitis is:

A)

the presence of dead bone tissue.

B)

introduction of microorganisms from the bloodstream.

D)

destruction of the vascular network in the endosteum.

14 .

Following a lengthy series of diagnostic tests, a patients chronic hip pain has been attributed to advanced osteonecrosis. What treatment is this patient most likely to require?

A)

Joint replacement surgery

B)

Intravenous antibiotics

C)

Injections of corticosteroids into the synovial space

D)

Transfusion of packed red blood cells

15 .

Which of the following neoplasms of the skeletal system is likely to require the most timely and aggressive treatment?

A)

Exostosis

B)

Osteochondroma

C)

Endochondroma

D)

Osteosarcoma

16 .

A patient with a diagnosis of small cell lung carcinoma has developed bone metastases, a finding that has prompted a series of new interventions. What are the primary goals of the treatment regimen for this patients bone cancer?

A)

Prevention of brain metastasis and early identification of osteonecrosis

B)

Promotion of bone remodeling at tumor sites through calcium and vitamin D supplements

C)

Prevention of pathologic fractures and maximization of function

D)

Pain management and prevention of osteomyelitis

17 .

Metastatic bone disease is most closely associated with:

A)

cervical cancer and ovarian cancer.

B)

acute myelogenous leukemia (AML) and malignant melanoma.

D)

breast cancer and prostate cancer.

18 .

A couple has just learned that their newborn infant has been diagnosed with osteogenesis imperfecta, and they have responded by seeking out as much information as possible about their childs diagnosis. What should the clinician teach the couple about their childs health problem?

A)

This is something that your child may have inherited from one or both or you.

B)

This might have been caused by something you were exposed to during the early part of your pregnancy.

C)

Youll have to be vigilant of your childs safety for the next few years, but the disease often resolves spontaneously.

D)

With aggressive treatment, most children with osteogenesis imperfecta are cured within several months.

19 .

A child with a diagnosis of Legg-Calv-Perthes disease will exhibit:

A)

defective synthesis of type I collagen.

B)

congenital dislocation of the acetabulofemoral joint.

C)

necrosis of the proximal femoral head.

D)

intoeing due to metatarsus adductus.

20 .

Assessment of a newborn infant reveals the presence of developmental dysplasia of the hip (DDH) that is currently demonstrated by subluxation of the babys hip joint and a general laxity in the babys ligaments. What measures should be emphasized in this infants treatment?

A)

Corticosteroid therapy

B)

Close observation

C)

Open reduction

D)

Joint reconstruction

Answer Key

1.

D

2.

B

3.

D

4.

B

5.

B

6.

C

7.

A

8.

A

9.

D

10 .

A

11 .

A

12 .

D

13 .

B

14 .

A

15 .

D

16 .

C

17 .

D

18 .

A

19 .

C

20 .

B

Chapter 17. Endocrine system

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 organs in the body.

A)

decreases metabolism

B)

increases protein synthesis

C)

causes vitamin deficiencies

D)

enhances absorption of glucose

4.

, which alters the function of all major

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