Applied Pathophysiology for the Advanced Practice Nurse 1st Edition Dlugasch Story Test Bank.pdf

Applied Pathophysiology for the Advanced Practice Nurse 1st Edition Dlugasch Story Test Bank

1. TEST BANK
Applied Pathophysiology for the Advanced Practice Nurse |
1st Edition | Dlugasch | Story

TEST BANK

2. TEST BANK APPLIED PATHOPHYSIOLOGY FOR THE
ADVANCED PRACTICE NURSE 1ST EDITION BY LUCIE
DLUGASCH, STORY TEST BANK ISBN -9781284150452

Complete Test bank for applied pathophysiology for the advanced practice nurse 1st edition by
Dlugasch. Test Questions and Answer Key to help you prepare and study better for Exams Test
Bank for Applied Pathophysiology for The Advanced Practice Nurse 1st Edition by Dlugasch.

Table of Contents:
Chapter 1: Cellular Function
Chapter 2: Immunity
Chapter 3: Hematopoietic Function
Chapter 4: Cardiovascular Function
Chapter 5: Respiratory Function
Chapter 6: Fluid, Electrolyte, and Acid-Base Homeostasis
Chapter 7: Urinary Function
Chapter 8: Reproductive Function
Chapter 9: Gastrointestinal Function
Chapter 10: Endocrine Function
Chapter 11: Neural Function
Chapter 12: Musculoskeletal Function
Chapter 13: Integumentary Function
Chapter 14: Sensory Function

3. Applied Pathophysiology for the Advanced Practice Nurse
1st Edition Dlugasch | Story Test Bank
Chapter 1 Cellular Function



1. The nucleus , which is essential for function and survival of the
cell.
A) is the site of protein synthesis
B) contains the genetic code
C) transforms cellular energy
D) initiates aerobic metabolism

2. Although energy is not made in mitochondria, they are known as the power
plants of the cell because they:
A) contain RNA for protein synthesis.
B) utilize glycolysis for oxidative energy.
C) extract energy from organic compounds.
D) store calcium bonds for muscle contractions.

3. Although the basic structure of the cell plasma membrane is formed by a
lipid bilayer, most of the specific membrane functions are carried out by:
A) bound and transmembrane proteins.
B) complex, long carbohydrate chains.
C) surface antigens and hormone receptors.
D) a gating system of selective ion channels.

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

4. B) accumulate within cell gap junctions.
C) bind to contractile microfilaments.
D) release secretions into extracellular fluid.

5. Aerobic metabolism, also known as oxidative metabolism, provides energy
by:
A) removing the phosphate bonds from ATP.
B) combining hydrogen and oxygen to form water.
C) activating pyruvate stored in the cytoplasm.
D) breaking down glucose to form lactic acid.

6. Exocytosis, the reverse of endocytosis, is important in into the
extracellular fluid.
A) Engulfing and ingesting fluid and proteins for transport
B) Killing, degrading, and dissolving harmful microorganisms
C) Removing cellular debris and releasing synthesized substances
D) Destruction of particles by lysosomal enzymes for secretion

7. The process responsible for generating and conducting membrane potentials
is:
A) diffusion of current-carrying ions.
B) millivoltage of electrical potential.
C) polarization of charged particles.
D) ion channel neurotransmission.

8. Epithelial tissues are classified according to the shape of the cells and the
number of layers. Which of the following is a correctly matched description
and type of epithelial tissue?
A) Simple epithelium: cells in contact with intercellular matrix; some do not
extend to surface

5. B) Stratified epithelium: single layer of cells; all cells rest on basement
membrane
C) Glandular epithelium: arise from surface epithelia and underlying
connective tissue
D) Pseudostratified epithelium: multiple layers of cells; deepest layer rests on
basement membrane

9. Connective tissue contains fibroblasts that are responsible for:
A) providing a fibrous framework for capillaries.
B) synthesis of collagen, elastin, and reticular fibers.
C) forming tendons and the fascia that covers muscles.
D) filling spaces between tissues to keep organs in place.

10 Although all muscle tissue cells have some similarities, smooth muscle (also
. known as involuntary muscle) differs by:
A) having dense bodies attached to actin filaments.
B) containing sarcomeres between Z lines and M bands.
C) having rapid contractions and abundant cross-striations.
D) contracting in response to increased intracellular calcium.

11 Which of the following aspects of the function of the nucleus is performed
. by ribosomal RNA (rRNA)?
A) Copying and carrying DNA instructions for protein synthesis
B) Carrying amino acids to the site of protein synthesis
C) Providing the site where protein synthesis occurs
D) Regulating and controlling protein synthesis

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

6. B) Golgi apparatus
C) Ribosomes
D) Endoplasmic reticulum (ER)

13 Impairment in the function of peroxisomes would result in:
.
A) inadequate sites for protein synthesis.
B) an inability to transport cellular products across the cell membrane.
C) insufficient energy production within a cell.
D) accumulation of free radicals in the cytoplasm.

14 After several months of trying to conceive, a couple is undergoing fertility
. testing. Semen analysis indicates that the mans sperm have decreased
motility, a finding that is thought to underlie the couples inability to become
pregnant. Which of the following cellular components may be defective
within the mans sperm?
A) Ribosomes
B) Microtubules
C) Mitochondria
D) Microfilaments

15 Which of the following statements is true of glycolysis?
.
A) Glycolysis requires oxygen.
B) Glycolysis occurs in cells without mitochondria.
C) Glycolysis provides the majority of the bodys energy needs.
D) Glycolysis produces energy, water, and carbon dioxide.

16 Which of the following membrane transport mechanisms requires the
. greatest amount of energy?
A) Facilitated diffusion

7. B) Passive transport
C) Vesicular transport
D) Simple diffusion

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

18 Which of the following statements is true of skeletal muscle cells?
.
A) Skeletal muscle cells each have an apical, lateral, and basal surface.
B) They are closely apposed and are joined by cell-to-cell adhesion
molecules.
C) Their basal surface is attached to a basement membrane.
D) Skeletal muscle is multinucleated, lacking true cell boundaries.

19 Which of the following body tissues exhibits the highest rate of turnover and
. renewal?
A) The squamous epithelial cells of the skin
B) The connective tissue supporting blood vessels
C) The skeletal muscle that facilitates movement
D) The nervous tissue that constitutes the central nervous system

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

8. A) impaired contraction of skeletal and smooth muscle.
B) weakness of the collagen and elastin fibers in the extracellular space.
C) impaired communication between neurons and effector organs.
D) separation at the junctions between epithelial cells.
Answer Key


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

9. 17 A
.
18 D
.
19 A
.
20 D
.

Chapter 2 Immunity



1. Innate immunity, also called natural or native immunity, consists of
mechanisms that respond specifically to:
A) self-cells.
B) microbes.
C) antibodies.
D) inflammation.

2. Adaptive immune responses, also called acquired or specific immunity, are
composed of and their products.
A) granulocytes
B) lymphocytes
C) epithelial cells
D) Toll-like receptors

3. The effector cells of the immune system have the primary function of:
A) activating phagocytic cells.
B) eliminating the antigens.
C) processing antigen into epitopes.
D) controlling the immune response.

10. 4. Activation of lymphocytes is dependent upon the and
of the antigens by macrophages.
A) memory; clustering
B) capture; destruction
C) recognition; grouping
D) processing; presentation

5. Major histocompatibility complex (MHC) molecules, with human leukocyte
antigens (HLAs), are markers on all nucleated cells and have an important
role in:
A) identifying blood types.
B) cell membrane transport.
C) suppressing viral replication.
D) avoiding transplant rejections.

6. Dendritic cells, found in skin tissues and lymphoid tissues, are important for:
A) initiation of adaptive immunity.
B) deep-tissue phagocytosis.
C) disposal of dead cells.
D) delaying inflammation.

7. Once T helper cells are activated, they secrete that activate
and regulate nearly all of the other cells of the immune system.
A) complement proteins
B) cytokines
C) leukotrienes
D) bradykinins

11. 8. The first circulating immunoglobulin to appear in response to a new antigen
is:
A) IgG.
B) IgM.
C) IgA.
D) IgD.

9. The effector function of activated members of the complement system
includes all of the following EXCEPT:
A) chemotaxis.
B) opsonization.
C) pathogen lysis.
D) phagocytosis.

10 During the latent period before antibodies are detected in the humoral
. immune response, B cells differentiate into cells.
A) plasma
B) cytotoxic
C) stem
D) helper

11 Which of the following would participate in the innate immune response to
. an infectious microorganism?
A) T lymphocytes
B) Antibodies
C) B lymphocytes
D) Neutrophils

12. 12 A patient has recently received a pneumococcal vaccine and the patients B
. cells are consequently producing antibodies. Which of the following cells
may enhance this production of antibodies?
A) Helper T cells
B) Regulatory T cells
C) Cytotoxic T cells
D) Natural killer cells

13 A childs thymus gland is fully formed and proportionately larger than an
. adults. Which of the following processes that contribute to immunity takes
place in the thymus gland?
A) Differentiation of B cells
B) Production of natural killer (NK) cells
C) Proliferation of T cells
D) Filtration of antigens from the blood

14 A patients exposure to an antibiotic-resistant microorganism while in the
. hospital has initiated an immune response, a process that is mediated and
regulated by cytokines. Which of the following statements is true of
cytokines?
A) They are stored in the peripheral lymphoid tissues until required.
B) They have a long half-life that contributes to an ongoing immune
response.
C) They are normally released at cell-to-cell interfaces, binding to specific
receptors.
D) They are capable of performing phagocytosis in the response to viral
invasion.

15 The entrance of a microbe into an individuals vascular space has initiated
. opsonization. Which of the following processes is involved in opsonization?
A) Stimulation of B cells by helper T cells
B) Coating of a microbe to aid phagocyte recognition

13. C) Release of proteins that stimulate cell production by the bone marrow
D) Lysis of intracellular microbes by cytotoxic T cells

16 Bacteria on a sliver in a boys finger have initiated an adaptive immune
. response. The boys lymphocytes and antibodies recognize immunologically
active sites on the bacterial surfaces known as:
A) Toll-like receptors.
B) opsonins.
C) chemokines.
D) epitopes.

17 Histocompatability molecules are of primary importance to which of the
. following aspects of immunity?
A) Induction of T-cell immunity
B) T-cell maturation
C) NK cell activation
D) Phagocytosis by neutrophils

18 Prior to leaving on a backpacking trip to Southeast Asia, a college student
. has received a tetanus booster shot. This immunization confers protection by
way of what immune process?
A) Secondary humoral response
B) Cell-mediated immune response
C) Primary humoral response
D) Innate immunity

19 A patients cell-mediated immune response has resulted in the release of
. regulator T cells. These cells will perform which of the following roles?
A) Suppressing the immune response to limit proliferation of potentially
harmful lymphocytes
B) Presenting antigens to B cells to facilitate the production of antibodies

14. C) Differentiating into subpopulations of helper T cells
D) Destroying target cells by releasing cytolytic enzymes and other toxins

20 A 1-day-old infant was exposed to an infectious microorganism prior to
. discharge home from the hospital, but was able to effect a sufficient immune
response in the hours and days following exposure. This immune response
may have been due to the presence of which of the following
immunoglobulins from the infants mother?
A) IgA
B) IgG
C) IgM
D) IgD
Answer Key


1. B
2. B
3. B
4. D
5. D
6. A
7. B
8. B
9. D
10 A
.
11 D
.
12 A
.

15. 13 B
.
14 C
.
15 B
.
16 D
.
17 A
.
18 A
.
19 A
.
20 B
.
Disorders and Immune Response



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:

16. 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.

17. 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.

18. 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

19. 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

20. 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

21. 10 D
.
11 C
.
12 D
.
13 C
.
14 B
.
15 D
.
16 C
.
17 A
.
18 B
.
19 D
.
20 B
.

Chapter 3 Hematopoietic Function



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

22. 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.
A) adhesion
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 disorder that
destroys .

23. 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. Disseminated intravascular coagulation (DIC) is characterized by:
A) 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.

24. 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

25. 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) Thrombocytopenia

17 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

26. 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)

27. 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
.

28. 20 A
.
Red Blood Cell Disorders



1. Sue is fatigued and some blood tests are done. Her results include Hct 40%;
Hgb 8g/dL; WBC 8,000; platelets 175,000. The nurse should interpret Sues
blood work as indicative of:
A) high platelets/thrombocytosis.
B) low WBC count/granulocytopenia.
C) low hemoglobin/anemia.
D) high hematocrit/polycythemia.

2. Manifestations of anemia that are directly due to the diminished oxygen-
carrying capacity of hemoglobin include:
A) fatigue.
B) bleeding.
C) bone pain.
D) pale skin.

3. When an Rh-negative mother has been sensitized and is pregnant with an
Rh-positive fetus, what happens to the fetus?
A) Bilirubin deficiency
B) Nothing, this is normal
C) Plasma volume depletion
D) Profound red cell hemolysis

4. The patient is an average-sized adult and has abnormal microcytic
hypochromic red blood cells due to a long-term, chronic disease. Which of
the following CBC results is characteristic of her type of anemia?
A) Hematocrit 44%

29. B) Reticulocytes 1.5%
C) Band cells 3,000/mL
D) Hemoglobin 8 g/dL

5. Megaloblastic anemias caused by folic acid or vitamin B12 deficiencies can
seriously affect RBC production. This is because both are necessary for
synthesis and .
A) iron; hemoglobin adhesion
B) DNA; red blood cell maturation
C) thrombin; platelet aggregation
D) protein; reticulocyte maturation

6. Polycythemia develops in patients with lung disease as a result of:
A) hyperventilation.
B) chronic hypoxia.
C) decreased blood viscosity.
D) excessive respiratory fluid loss.

7. Which of the following types and characteristics of anemia are correctly
matched?
A) Hemolytic; abnormal iron uptake
B) Iron deficiency; early RBC death
C) Folate; decreased erythropoiesis
D) Blood loss; bone marrow expansion

8. Conditions that predispose to sickling of hemoglobin in persons with sickle
cell anemia include:
A) impaired red blood cell maturation.
B) increased iron content of blood.
C) decreased oxygen saturation.

30. D) increased intravascular volume.

9. An elevated level of unconjugated bilirubin, due to hemolysis of RBCs,
results in a high level of iron released and:
A) diarrhea.
B) cyanosis.
C) numbness.
D) jaundice.

10 Hemolytic anemia is characterized by excessive red blood cell destruction
. and compensatory:
A) hypoactive bone marrow.
B) increased erythropoiesis.
C) iron retention in the body.
D) shrinkage of the spleen.

11 A 48-year-old male patient, who normally enjoys good health, has been
. admitted to the hospital for the treatment of polycythemia vera. The nurse
who is providing care for the patient should prioritize assessments aimed at
the early identification of which of the following health problems?
A) Orthostatic hypotension
B) Hyperventilation and respiratory alkalosis
C) Vasculitis
D) Thromboembolism

12 Which of the following patients is most susceptible to experiencing the
. effects of inadequate erythropoiesis?
A) A patient who has developed renal failure as a result of longstanding
hypertension
B) A patient who recently experienced an ischemic stroke and who remains
bedridden

31. C) A patient whose heavy alcohol use has culminated in a diagnosis of
pancreatitis
D) A patient whose estimated blood loss during recent surgery was 700 mL.

13 A 72-year-old woman with complaints of increasing fatigue has completed a
. series of fecal occult blood tests that indicate the presence of blood in her
stool. Which of the following health problems is likely to accompany this
patients gastrointestinal bleed?
A) Hemolytic anemia
B) Aplastic anemia
C) Iron-deficiency anemia
D) Megaloblastic anemia

14 Hemoglobin solubility results and hemoglobin electrophoresis have resulted
. in a diagnosis of sickle cell anemia in an African American infant. The
parents of the child should be aware that their child is at a significant risk for
which of the following health problems? Select all that apply.
A) Acute pain
B) Stroke
C) Respiratory disease
D) Autoimmune diseases
E) Fractures

15 The pathologic effects of the thalassemias are primarily due to which of the
. following pathophysiologic processes?
A) Impaired hemoglobin synthesis
B) Impaired folic acid absorption
C) Erythropoietin deficiency
D) Loss of iron

32. 16 Which of the following individuals likely faces the highest risk of
. megaloblastic anemia?
A) A 69-year-old woman who takes ASA four times daily to treat her
arthritis
B) A 44-year-old man who lost approximately 500 mL of blood in a
workplace accident
C) A 21-year-old college student who lives a vegan lifestyle
D) An infant who is exclusively fed commercial baby formula

17 For which of the following health problems is stem cell transplantation likely
. to be of therapeutic benefit?
A) Aplastic anemia
B) b-Thalassemias
C) Chronic disease anemias
D) Secondary polycythemia

18 A 68-year-old patient with an 80 pack/year history of smoking was
. diagnosed with emphysema 18 months ago. The patients most recent
scheduled blood work showed red blood cell indices, a problem that suggests
the need for which of the following interventions?
A) Vitamin B12 supplements
B) Increased supplementary oxygen therapy
C) Hemodialysis or peritoneal dialysis
D) Scheduled erythropoietin injections

19 Which of the following trends in the hematologic status of a 6-week-old
. infant most clearly warrants medical intervention?
A) Decreasing red blood cell counts
B) Increasing HgA levels
C) Decreasing hematocrit and mean corpuscular volume (MCV)
D) Increasing white blood cell counts

33. 20 A mother has brought her 2-week-old infant to the emergency department
. due to the babys persistent and increasing jaundice. Blood testing reveals
that the infants unconjugated bilirubin level is 28 mg/dL and assessment
does not reveal neurologic deficits. The infants weight is normal and the
mother claims to have had no significant difficulty feeding the infant. The
most likely treatment for this infant will be:
A) phototherapy.
B) packed red blood cell transfusion.
C) phlebotomy.
D) intravenous antibiotics.
Answer Key


1. C
2. A
3. D
4. D
5. B
6. B
7. C
8. C
9. D
10 B
.
11 D
.
12 A
.
13 C
.

34. 14 A, B, C
.
15 A
.
16 C
.
17 A
.
18 B
.
19 D
.
20 A
.

Chapter 4 Cardiovascular Function



1. In the arterial-venous circulatory system, pressure is inversely related to:
A) velocity.
B) volume.
C) tension.
D) viscosity.

2. Turbulent blood flow can be caused by a number of factors, including:
A) increased velocity.
B) short vessel length.
C) high blood viscosity.
D) layering of blood cells.

3. Heart muscle differs from skeletal muscle tissue by being able to generate:

35. A) contractions.
B) calcium influx.
C) action potentials.
D) sarcomere binding.

4. During ventricular systole, closure of the atrioventricular (AV) valves
coincides with:
A) atrial chamber filling.
B) aortic valve opening.
C) isovolumetric contraction.
D) semilunar valves opening.

5. The difference between the end-diastolic and end-systolic volumes is the:
A) stroke volume.
B) cardiac output.
C) ejection fraction.
D) cardiac reserve.

6. Preload represents the volume work of the heart and is largely determined
by:
A) venous blood return.
B) vascular resistance.
C) force of contraction.
D) ventricular emptying.

7. A large increase in heart rate can cause:
A) increased blood viscosity.
B) loss of action potential.
C) decreased stroke volume.

36. D) reduced cardiac contractility.

8. Long-term autoregulation of local blood flow in the microcirculation is
mediated by:
A) collateral circulation.
B) arteriovenous shunting.
C) autonomic nervous system.
D) metabolic needs of the tissues.

9. The tissue factor that contributes to humoral control of blood flow by
causing vasoconstriction is:
A) histamine.
B) bradykinin.
C) serotonin.
D) nitric oxide.

10 The parasympathetic nervous system causes a slowing of the heart rate by
. increasing:
A) norepinephrine.
B) vessel constriction.
C) vagus nerve activity.
D) smooth muscle tone.

11 A patient has entered hypovolemic shock after massive blood loss in a car
. accident. Many of the patients peripheral blood vessels have consequently
collapsed. How does the Laplace law account for this pathophysiologic
phenomenon?
A) Blood pressure is no longer able to overcome vessel wall tension.
B) Decreasing vessel radii have caused a decrease in blood pressure.
C) Wall thickness of small vessels has decreased due to hypotension.

37. D) Decreases in wall tension and blood pressure have caused a sudden
increase in vessel radii.

12 In the days following a tooth cleaning and root canal, a patient has
. developed an infection of the thin, three-layered membrane that lines the
heart and covers the valves. What is this patients most likely diagnosis?
A) Pericarditis
B) Endocarditis
C) Myocarditis
D) Vasculitis

13 Following several weeks of increasing fatigue and a subsequent diagnostic
. work-up, a patient has been diagnosed with mitral valve regurgitation.
Failure of this heart valve would have which of the following consequences?
A) Backup of blood from the right atrium into the superior vena cava
B) Backflow from the right ventricle to the right atrium during systole
C) Inhibition of the SA nodes normal action potential
D) Backflow from the left ventricle to left atrium

14 Harmful effects on cardiac action potential are most likely to result from a
. deficit of which of the following electrolytes?
A) Magnesium (Mg2+)
B) Chloride (Cl)
C) Potassium (K+)
D) Hydrogen carbonate (HCO3)

15 A male patient with a history of angina has presented to the emergency
. department with uncharacteristic chest pain and his subsequent ECG reveals
T-wave elevation. This finding suggests an abnormality with which of the
following aspects of the cardiac cycle?
A) Atrial depolarization

38. B) Ventricular depolarization
C) Ventricular repolarization
D) Depolarization of the AV node, bundle branches, and Purkinje system

16 A patient with a history of heart failure has been referred for an
. echocardiogram. Results of this diagnostic test reveal the following findings:
heart rate 80 beats per minute; end-diastolic volume 120 mL; end-systolic
volume 60 mL. What is this patients ejection fraction?
A) 200 mL
B) 50%
C) .80
D) 180 mL

17 A patient with a diagnosis of secondary hypertension has begun to
. experience signs and symptoms that are ultimately suggestive of decreased
cardiac output. Which of the following factors that determine cardiac output
is hypertension likely to affect most directly?
A) Preload
B) Afterload
C) Contractility
D) Heart rate

18 A patient who lives with a diagnosis of angina pectoris has taken a
. sublingual dose of nitroglycerin to treat the chest pain he experienced while
mowing his lawn. This drug has resulted in a release of nitric oxide, which
will have what effect?
A) Smooth muscle relaxation of vessels
B) Decreased heart rate and increased stroke volume
C) Increased preload
D) Reduction of cardiac refractory periods

39. 19 Release of which of the following humoral factors will result in
. vasodilation?
A) Norepinephrine
B) Angiotensin II
C) Serotonin
D) Histamine

20 Which of the following factors is the primary governor of the local control of
. blood flow?
A) Action potential
B) The nutritional needs of the tissue involved
C) Cardiac contractility and preload
D) Feedback from arterial baroreceptors and chemoreceptors
Answer Key


1. B
2. A
3. C
4. C
5. A
6. A
7. C
8. A
9. C
10 C
.
11 A
.

40. 12 B
.
13 D
.
14 C
.
15 C
.
16 B
.
17 B
.
18 A
.
19 D
.
20 B
.

Chapter 5 Respiratory Function



1. The function of the mucociliary blanket that lines the conducting airways is
to:
A) dehumidify inhaled air.
B) remove foreign materials.
C) warm the moving gases.
D) spread antibacterial enzymes.

2. Above the glottis that opens and closes for speech, the epiglottis functions to
the larynx during swallowing.
A) open

41. B) cover
C) collapse
D) constrict

3. In addition to being the site of gas exchange, the lungs also:
A) activate vasoactive substances.
B) contain cells that produce heparin.
C) empty extra blood volume into the left heart.
D) use water vapor pressure to inflate alveoli.

4. Bronchial circulation differs from the pulmonary circulation by providing
blood for the:
A) conducting airways.
B) alveolar gas exchange.
C) mediastinum and pleural space.
D) intrapulmonary pressure balance.

5. Lung compliance is a measure of the change in that occurs with a
change in intrapulmonary pressure.
A) elastic recoil
B) surface tension
C) lung volume
D) vital capacity

6. Generalized acute hypoxia in lung tissue, when alveolar oxygen levels drop
below 60 mm Hg, causes pulmonary:
A) vasospasms.
B) hypertension.
C) emboli formation.

42. D) vasoconstriction.

7. Diffusion of gases in the lung is decreased, as in pulmonary edema or
pneumonia, by causing an increase in alveolar:
A) gas pressure difference.
B) size and surface area.
C) anatomic shunting of blood.
D) capillary membrane thickness.

8. Respiratory movement of air that does not participate in alveolar gas
exchange is known as alveolar dead space. Dead space increases when
alveoli:
A) carbon dioxide level is high.
B) air supply exceeds blood flow.
C) contain pulmonary edema fluid.
D) collapse onto the capillary bed.

9. The oxyhemoglobin buffer system changes with the metabolic needs of the
tissues. When the change causes a shift to the right in the dissociation curve,
it is often the result of:
A) decreased CO2 levels.
B) increase tissue metabolism.
C) decreased body temperature.
D) increase red blood cell volume.

10 The carbon dioxide content in the blood affects the regulation of ventilation
. through its effect on the of the brain.
A) cerebrospinal fluid pH
B) peripheral chemoreceptors
C) afferent impulse regulation

43. D) motor and premotor cortex

11 A patient who is in a room at one atmosphere (760 mm Hg) is receiving
. supplementary oxygen therapy that is being delivered at a concentration of
50%. What is the consequent PO2?
A) 38,000 mm Hg
B) More data are needed
C) 380 mm Hg
D) 15.2 mm Hg

12 A patients recent history of emphysema has resulted in the functional loss of
. many alveoli. Which of the following physiologic functions is the primary
role of type II alveoli?
A) Facilitation of bronchial circulation
B) Production of surfactant
C) Gas exchange
D) Production of macrophages

13 Which of the following respiratory pressures is always negative in relation to
. alveolar pressure?
A) Airway pressure
B) Intrapleural pressure
C) Intrathoracic pressure
D) Intrapulmonary pressure

14 A respiratory therapist has asked a patient to breathe in as deeply as possible
. during a pulmonary function test. Inspiration is normally the result of which
of the following phenomena?
A) Decreased intrapulmonary pressure
B) Increased airway pressure
C) Increased intrapleural pressure

44. D) Decreased intrathoracic pressure

15 According to Poiseuille law, airway resistance would be largest in which of
. the following?
A) The trachea
B) A bronchus
C) A bronchiole
D) An alveolus

16 A patient with a history of chronic obstructive pulmonary disease (COPD) is
. undergoing pulmonary function testing. Which of the following instructions
should the technician provide in order to determine the patients forced vital
capacity (FVC)?
A) Ill ask you to breathe in as deep as you can, and then blow out as much of
that air as possible.
B) Id like you to take a deep breath, and then blow out as much air as you
can during one second.
C) I want you to breathe as normally as possible and Im going to measure
how much air goes in and out with each breath.
D) Breathe normally, and then exhale as much as you possibly can when I
tell you.

17 Completion of a patients pulmonary function study has yielded the following
. data: tidal volume: 500 mL; inspiratory reserve: 3100 mL; expiratory
reserve: 1200 mL; residual volume: 1200 mL; functional residual capacity:
2400 mL. What is this patients inspiratory capacity?
A) 5500 mL
B) 2600 mL
C) More data are needed
D) 3600 mL

45. 18 A patient with a diagnosis of community-acquired pneumonia is producing
. copious secretions that are physically obstructing her airway. Which of the
following pathophysiologic processes will result from this condition?
A) Compensatory vasoconstriction
B) Ventilation without perfusion
C) Dead air space
D) Perfusion without ventilation

19 Which of the following forms accounts for the greatest percentage of carbon
. dioxide transport?
A) Free CO2
B) Bicarbonate
C) Dissolved CO2
D) Attached to hemoglobin

20 A patient has experienced a bout of coughing after aspirating some of his
. secretions. The patients coughing was triggered by which of the following?
A) Sudden ventilation-perfusion mismatch
B) Sudden rise in PCO2
C) Signals from receptors in the tracheobronchial wall
D) Signals from central chemoreceptors
Answer Key


1. B
2. B
3. B
4. A
5. C
6. D

46. 7. D
8. B
9. B
10 A
.
11 C
.
12 B
.
13 B
.
14 D
.
15 C
.
16 A
.
17 D
.
18 D
.
19 B
.
20 C
.
Disorders



1. A distinguishing feature of viral influenza is:
A) direct contact transmission.
B) abrupt-onset, profound malaise.
C) constant pounding headache.

47. 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.

48. 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. Which of the following acute respiratory infections in children poses the
greatest threat of severe hypoxia caused by inflammatory edema?
A) Croup
B) Asthma
C) Epiglottitis
D) Bronchiolitis

10 The cold viruses are rapidly spread from person to person. The greatest
. source of spread is:
A) fingers.

49. 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

50. 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

51. 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

52. 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
.

53. Chapter 6 Fluid, Electrolyte, and Acid-Base Homeostasis



1. An injured patient develops interstitial edema as a result of decreased:
A) vascular volume.
B) hydrostatic pressure.
C) capillary permeability.
D) colloidal osmotic pressure.

2. The most reliable method for measuring body water or fluid volume increase
is by assessing:
A) tissue turgor.
B) intake and output.
C) body weight change.
D) serum sodium levels.

3. The syndrome of inappropriate ADH is characterized by:
A) increased osmolality.
B) excessive water thirst.
C) copious dilute urination.
D) dilutional hyponatremia.

4. In isotonic fluid volume deficit, changes in total body water are
accompanied by:
A) intravascular hypotonicity.
B) increased intravascular water.
C) increases in intracellular sodium.
D) proportionate losses of sodium.

5. Hyponatremia can be caused by and manifested by .

54. A) hypovolemia; dehydration
B) third spacing; hypertonicity
C) water retention; hypotonicity
D) aldosterone excess; low ADH

6. One of the major causes of hyperkalemia is , which alters
potassium elimination.
A) renal dysfunction
B) aldosterone excess
C) metabolic alkalosis
D) plasma albumin deficit

7. Hypoparathyroidism causes hypocalcemia by:
A) increasing serum magnesium.
B) increasing phosphate excretion.
C) blocking bone release of calcium.
D) blocking action of intestinal vitamin D.

8. Magnesium is important for the overall function of the body because of its
direct role in:
A) cell membrane permeability.
B) somatic cell growth control.
C) sodium and tonicity regulation.
D) DNA replication and transcription.

9. A patient has acidosis that is suspected to be respiratory in etiology. Which
of the following is the major cause of acute primary respiratory acidosis?
A) Decreased CO2 retention
B) Increased metabolic acids

55. C) Renal bicarbonate retention
D) Impaired alveolar ventilation

10 As other mechanisms prepare to respond to a pH imbalance, immediate
. buffering is a result of increased:
A) intracellular albumin.
B) hydrogen/potassium binding.
C) sodium/phosphate anion absorption.
D) bicarbonate/carbonic acid regulation.

11 A patient with a diagnosis of liver cirrhosis secondary to alcohol use has a
. distended abdomen as a result of fluid accumulation in his peritoneal cavity
(ascites). Which of the following pathophysiologic processes contributes to
this third spacing?
A) Abnormal increase in transcellular fluid volume
B) Increased capillary colloidal osmotic pressure
C) Polydipsia
D) Impaired hormonal control of fluid volume

12 A patient has been receiving intravenous normal saline at a rate of 125 mL
. per hour since her surgery 2 days earlier. As a result of her consequent
increase in vascular volume, she has become edematous. Which of the
following phenomena accounts for this patients edema?
A) Obstruction of lymph flow
B) Increased capillary permeability
C) Decreased capillary colloidal osmotic pressure
D) Increased capillary filtration pressure

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

56. A) Hypernatremia
B) Water movement from the extracellular to intracellular compartment
C) Syndrome of inappropriate secretion of ADH (SIADH)
D) Isotonic fluid excess in the extracellular fluid compartment

14 Which of the following patients would likely be at highest risk of developing
. hyperkalemia?
A) A patient who has been admitted for the treatment of acute renal failure
following a drug overdose
B) A patient who has experienced an ischemic stroke with multiple sensory
and motor losses
C) An elderly patient who is experiencing vomiting and diarrhea as a result
of influenza
D) A patient whose thyroidectomy resulted in the loss of his parathyroid
gland

15 A female patient with a history of chronic renal failure has developed
. hypocalcemia. Which of the following assessment findings would provide
potential confirmation of this diagnosis?
A) The patient experiences shortness of breath on exertion with decreased
oxygen saturation levels.
B) The patient is difficult to rouse and is disoriented to time and place.
C) The patients heart rate is 120 beats per minute and she is diaphoretic
(sweaty).
D) The patient has muscle spasms and complains of numbness around her
mouth.

16 Which of the following assessments should be prioritized in the care of a
. patient who is being treated for hypokalemia?
A) Detailed fluid balance monitoring
B) Arterial blood gases
C) Cardiac monitoring

57. D) Monitoring of hemoglobin levels and oxygen saturation

17 Magnesium is an important component of which of the following processes
. that are integral to the maintenance of homeostasis? Select all that apply.
A) Intracellular and extracellular buffering
B) Cellular energy metabolism
C) Function of the sodium-potassium pump
D) Nerve conduction
E) Cell membrane function

18 A 77-year-old woman has been brought to the emergency department by her
. daughter because of a sudden and unprecedented onset of confusion. The
patient admits to ingesting large amounts of baking soda since the morning
in an effort to treat indigestion. How will the womans body attempt to
resolve this disruption in acid-base balance?
A) Hyperventilation
B) Increasing renal H+ excretion
C) Increased renal HCO3 reabsorption
D) Hypoventilation

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

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

58. A) Potassium
B) Sodium
C) Magnesium
D) Calcium
Answer Key


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

59. 17 B, C, D, E
.
18 D
.
19 A
.
20 B
.

Chapter 7 Urinary Function



1. Although urinary obstruction and urinary incontinence have almost opposite
effects on urination, they can both result from:
A) bladder structure changes.
B) bladder wall atrophy.
C) micturition reflex spasms.
D) bladder distensibility loss.

2. The body compensates for obstructed urine outflow. Compensatory changes
to chronic obstruction include:
A) bladder spasms.
B) urinary frequency.
C) high residual volume.
D) overflow incontinence.

3. A patient fell off a ladder and sustained a spinal cord injury that has resulted
in bladder dysfunction. During the period immediately after the spinal
injury, spinal shock develops and the bladder has function.
A) atonic
B) spasmodic

60. C) uninhibited
D) hyperactive

4. In men, the condition of nonrelaxing external sphincter with urine retention
is commonly caused by:
A) psychosocial disorders.
B) prostate enlargement.
C) chronic stress response.
D) pelvic inflammatory disease.

5. In women, pelvic floor weakness may cause which type of incontinence?
A) Urge
B) Stress
C) Overflow
D) Overactive

6. Many factors contribute to the incontinence that is common among the
elderly. A major factor is increased:
A) detrusor muscle function.
B) intake of liquids and water.
C) urethral closing pressure.
D) use of multiple medications.

7. Dysfunction of the muscle contraction can disrupt the ability to expel
urine from the bladder.
A) trigone
B) sphincter
C) detrusor
D) trabeculae

61. 8. Neurologic control of bladder function consists of three main levels or
centers. The lower motor neuron spinal cord centers control micturition:
A) reflexes.
B) backflow.
C) inhibition.
D) coordination.

9. Prolonged urethral outlet obstruction causes chronic high bladder pressure
and overdistension, resulting in the formation of:
A) detrusor dyssynergia.
B) cellules.
C) interstitial cystitis.
D) sphincter dystonia.

10 The most common sign of epithelial cell bladder cancer is:
.
A) severe oliguria.
B) hyperproteinuria.
C) hyperphosphaturia.
D) painless hematuria.

11 Most common uncomplicated urinary tract infections are caused by
. that enter through the urethra.
A) Pseudomonas
B) Escherichia coli
C) Staphylococcus aureus
D) Group B Streptococcus

12 Although the distal portion of the urethra often contains pathogens, the urine
. formed in the kidney and found in the bladder is sterile because of the:

62. A) alkaline urine.
B) glomerular filtering.
C) warm temperature.
D) washout phenomenon.

13 An elderly patient who experiences chronic pain takes opioid analgesics on a
. regular basis, a practice that has resulted in frequent constipation and
occasional bowel obstructions. Which of the following problems may
directly result from these gastrointestinal disorders?
A) Urinary tract infections
B) Overflow urinary incontinence
C) Bladder cancer
D) Neurogenic bladder

14 After reviewing the 24-hour intake and output of a hospital patient, the nurse
. suspects that the patient may be experiencing flaccid bladder dysfunction.
Which of the following diagnostic methods is most likely to confirm or rule
out whether the patient is retaining urine?
A) Blood test for creatinine, blood urea nitrogen, and glomerular filtration
rate
B) Urine test for culture and sensitivity
C) Routine urinalysis
D) Measurement of postvoid residual (PVR) by ultrasound

15 A pregnant woman who is beginning her third trimester has been diagnosed
. with a urinary tract infection (UTI). Which of the following factors most
likely predisposed this patient to the development of a UTI?
A) Increased urine alkalinity during pregnancy
B) Hypertrophy of the bladder wall
C) Dilation of the upper urinary structures
D) Spastic peristalsis of the ureters

63. 16 Which of the following signs and symptoms in a 2-year-old child should
. prompt assessment for a urinary tract infection?
A) Unexplained fever and anorexia
B) Decreased urine output and irritability
C) Production of concentrated urine and recurrent nausea
D) Frank hematuria

17 Which of the following patients is likely at the greatest risk of developing a
. urinary tract infection?
A) A pregnant woman who has been experiencing urinary frequency
B) A patient with a diagnosis of chronic kidney disease who requires regular
hemodialysis
C) A 79-year-old patient with an indwelling catheter
D) A confused, 81-year-old patient who is incontinent of urine

18 A woman has sought care because of recurrent urinary tract infections,
. which have been increasing in both frequency and severity. Which of the
following factors is likely to contribute to recurrent UTIs?
A) Reflux flow of urine
B) Fluctuations in urine pH
C) Urethral trauma
D) Inadequate fluid intake

19 A public health nurse is conducting a health promotion class for a group of
. older adults. Which of the participants following statements demonstrates an
accurate understanding of the risk factors for bladder cancer?
A) I suppose I should listen to my doctor and drink more cranberry juice.
B) More than ever, I guess it would worthwhile for me to quit smoking.
C) I can see that preventing bladder cancer is one more benefit of a healthy
diet.

64. D) I think I should be okay because theres no history or bladder cancer in my
family that Im aware of.

20 Which of the following events would suggest that an individuals physiologic
. response to an obstruction has progressed beyond the compensatory stage
and is now in the decompensatory stage?
A) The bladder muscle hypertrophies.
B) The detrusor loses its power of contraction.
C) The ability to suppress urination is diminished.
D) The individual experiences urgency.
Answer Key


1. A
2. B
3. A
4. B
5. B
6. D
7. C
8. A
9. B
10 D
.
11 B
.
12 D
.
13 B
.

65. 14 D
.
15 C
.
16 A
.
17 C
.
18 A
.
19 B
.
20 B
.

Chapter 8 Reproductive Function
Male Reproductive

1. Smooth muscle relaxation and shunting of blood into the sinusoids is
mediated by and results in a penile erection.
A) norepinephrine
B) nitroglycerine
C) nitric oxide
D) nicotinic acid

2. Priapism is a condition that causes ischemia as a result of:
A) circumcision trauma.
B) failure of detumescence.
C) tight retracted foreskin.
D) fibrous plaque in the penis.

66. 3. Common risk factors for erectile dysfunction due to generalized penile
arterial insufficiency include:
A) cryptorchidism.
B) cigarette smoking.
C) testicular torsion.
D) benign prostate hypertrophy.

4. Squamous cell cancer of the penis is more likely to develop in men with
chronic:
A) erectile dysfunction.
B) herpes ulcerations.
C) Peyronie disease.
D) smegma accumulation.

5. In a hydrocele, excess fluid is present in the:
A) epididymis.
B) tunica vaginalis.
C) pampiniform plexus.
D) vas deferens ampulla.

6. Testicular torsion, a serious disorder affecting young male individuals,
causes:
A) inguinal herniation.
B) cancer of the scrotum.
C) dartos muscle atrophy.
D) loss of testicular perfusion.

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

67. A) hypospadias.
B) scrotal edema.
C) urine retention.
D) testicular cancer.

8. The major cause of acute prostatitis is:
A) prostate hyperplasia.
B) acute pyelonephritis.
C) gram negative
D) mucous gland overgrowth.
E) coli.

9. The most important factor in the evaluation and treatment of benign prostatic
hypertrophy (BPH) is considered to be:
A) frequency of erectile dysfunction.
B) testosterone level management.
C) prostate cancer prevention measures.
D) subjective symptoms reported by the patient.

10 Cryptorchidism, or undescended testes, is a direct cause of:
.
A) infertility.
B) paraphimosis.
C) prostate cancer.
D) low testosterone.

11 Which of the following physiologic processes results from the synthesis and
. release of testosterone?
A) Protein catabolism

68. B) Musculoskeletal growth
C) Release of luteinizing hormone (LH) and follicle-stimulating hormone
(FSH)
D) Prostatic hyperplasia

12 A 41-year-old patient has undergone a vasectomy. What is the physiologic
. basis for this contraception technique?
A) Spermatogenesis is inhibited because sex hormones may no longer
stimulate the Sertoli cells.
B) Spermatozoa can no longer reach the epididymis and do not survive.
C) The rete testis becomes inhospitable to sperm.
D) Sperm can no longer pass through the ductus deferens.

13 A patient has been diagnosed with an anterior pituitary tumor, and synthesis
. and release of follicle-stimulating hormone has become deranged. What are
the potential consequences of this alteration in endocrine function?
A) Dysfunction of spermatogenesis
B) Overproduction of luteinizing hormone
C) Inhibition of testosterone synthesis
D) Impaired detumescence

14 Which of the following factors constitutes the most significant risk for
. balanitis xerotica obliterans?
A) Multiple sexual partners
B) Androgen deficiency
C) Uncircumcised penis
D) Chronic prostatitis

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

69. B) Benign prostatic hyperplasia (BPH)
C) Intravaginal testicular torsion
D) Erectile dysfunction

16 A 30-year-old man has been diagnosed with mumps orchitis, a disease that
. has the potential to result in:
A) hematuria.
B) hematocele.
C) sterility.
D) penile atrophy.

17 After seeking care due to recent history of testicular enlargement and scrotal
. pain, a 22-year-old college student has been diagnosed with testicular
cancer. Which of the patients following statements indicates the need for
further teaching?
A) I cant shake this feeling like Ive received a death sentence.
B) I have to admit that the prospect of losing a testicle is a bit overwhelming.
C) I really hope the cancer hasnt spread anywhere, because Ive read that its a
possibility.
D) I guess theres some solace in the fact that this cancer wasnt a result of an
unhealthy lifestyle.

18 Which of the following assessments is most likely to reveal a potential
. exacerbation in a 70-year-old patients diagnosis of benign prostatic
hyperplasia (BPH)?
A) Urine testing for microalbuminuria
B) Blood test for white blood cells and differential
C) Bladder ultrasound
D) Sperm morphology testing

70. 19 Which of the following statements about screening for prostate cancer is
. most accurate?
A) Digital rectal examination detects the majority of new cases of prostate
cancer.
B) A positive prostate-specific antigen (PSA) test is definitive for prostate
cancer.
C) BPH and prostatitis can confound prostate screening results.
D) Digital rectal examination and PSA testing have been proven ineffective.

20 Which of the following diagnoses is most likely to require surgical
. correction?
A) Hypospadias
B) Orchitis
C) Erectile dysfunction
D) Spermatocele
Answer Key


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

71. 12 D
.
13 A
.
14 C
.
15 C
.
16 C
.
17 A
.
18 C
.
19 C
.
20 A
.
Female Reproductive



1. Acute cervicitis is an inflammation of the cervix characterized by:
A) abscess formation.
B) mucopurulent drainage.
C) thick gray-white plaques.
D) persistent pruritic vulvitis.

2. Carcinoma of the cervix is often considered to be a sexually transmitted
disease associated with viral infection.
A) Chlamydia trachomatis
B) herpes simplex
C) human papilloma

72. D) varicella zoster

3. Pelvic inflammatory disease, an inflammation of the female upper
reproductive tract, is caused by:
A) chronic endometriosis.
B) ruptured tubal pregnancy.
C) STD polymicrobial infection.
D) serous luteal ovarian cysts.

4. Endometriosis is characterized by painful hemorrhagic lesions in the pelvis
and complications that include:
A) pelvic adhesions.
B) endometrial cancer.
C) candidiasis vaginitis.
D) bladder herniation.

5. Leiomyomas are smooth muscle fibroid tumors that usually develop in:
A) fibrocystic breasts.
B) postmenopause.
C) uterosacral ligaments.
D) the corpus of the uterus.

6. Symptoms of difficulty in emptying the bladder, frequency, and urgency of
urination are common in women with:
A) rectocele.
B) cystocele.
C) endometritis.
D) prolapsed uterus.

73. 7. Although there are no effective screening methods for ovarian cancer, and
early symptoms are usually absent, there are high-risk indicators that
include:
A) nulliparity.
B) lactation.
C) mammary duct ectasia.
D) oral contraceptive use.

8. Polycystic ovary syndrome (PCOS) is ovarian dysfunction caused by a
combination of hormone imbalances that include levels.
A) absent FSH
B) insulin deficit
C) elevated LH
D) low androgen

9. In the lactating woman, mastitis is usually the result of:
A) intraductal papillomas.
B) secretory cell hyperplasia.
C) fibrocystic tissue changes.
D) ascending bacterial infection.

10 Women are screened regularly for risk factors and manifestations of breast
. cancer. High-risk women may have a history of:
A) late menopause.
B) leiomyoma tumors.
C) STDs and vaginitis.
D) multiple pregnancies.

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

74. A) Vulvar pain
B) Purulent discharge
C) Urinary incontinence
D) Open lesions on the surface of the vulva

12 A 21-year-old college student has sought care because of the vaginal
. burning, itching, and redness that have become worse in recent weeks.
Which of the clinicians assessment questions is most likely to apply to a
diagnosis of vaginitis?
A) Have your periods been regular in the last few months?
B) Have you ever had a sexually transmitted infection?
C) Are you using oral contraceptives?
D) Have you ever been pregnant?

13 A 29-year-old patient had a Papanicolaou smear performed during her most
. recent visit to her primary care provider. This diagnostic procedure aims to
identify:
A) dysplastic cervical cells.
B) human papillomavirus (HPV) antibodies.
C) cervical polyps.
D) lesions at the transformation zone.

14 Which of the following physiologic processes is caused by estrogens?
.
A) Increased release of gonadotropin-releasing hormone (GnRH)
B) Stimulation of lactation in the postpartum period
C) Promotion of ovarian follicle growth
D) Progesterone synthesis

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

75. A) Ovarian cancer
B) Pelvic inflammatory disease (PID)
C) Polycystic ovary syndrome (PCOS)
D) Cervicitis

16 Which of the following complaints by middle-aged women should prompt a
. care provider to rule out the possibility of ovarian cancer?
A) Im having a lot of vaginal discharge lately and its quite foul.
B) My periods have become quite irregular since last winter.
C) I have a sharp, stabbing pain on my side for the last few days.
D) Im having a lot of indigestion and bloating, which are both new to me.

17 A nurse is conducting a healthy living workshop to a group of younger
. women. Which of the following screening recommendations should the
nurse provide to the participants?
A) Monthly breast self-examination (BSE)
B) BSE or mammography each year starting at age 40
C) Annual clinical breast examination until age 65
D) Mammography and clinical breast examination every 3 years until age 40

18 Which of the following processes is a component of the pathogenesis of
. proliferative breast lesions without atypia?
A) Growth of ductile or lobular epithelial cells
B) Cystic dilation of terminal ducts
C) Increase in fibrous breast tissue
D) Fat necrosis leading to lesion formation

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

76. A) Changes in anterior pituitary function that alter ovarian hormone
production
B) Gradual resistance of ovarian target cells to LH and FSH stimulation
C) Cessation of ovarian function and decreased estrogen levels
D) Decreased levels of gonadotropin-releasing hormone (GnRH)

20 A 59-year-old woman with a recent diagnosis of breast cancer has begun a
. course of hormone therapy. What is the goal of this pharmacologic
treatment?
A) Blocking the effects of progesterone on tumor growth
B) Increasing serum hormone levels to promote tumor cell lysis
C) Blocking the entry of malignant cells into the axillary lymph nodes
D) Blocking receptors on the surface of malignant cells
Answer Key


1. B
2. C
3. C
4. A
5. D
6. B
7. A
8. C
9. D
10 A
.
11 A
.
12 B
.

77. 13 A
.
14 C
.
15 C
.
16 D
.
17 D
.
18 A
.
19 C
.
20 D
.

Chapter 9 Gastrointestinal Function



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.

78. 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.

79. 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

80. 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.

81. 15 An ultrasound has confirmed appendicitis as the cause of a 20-year-old mans
. sudden abdominal pain. Which of the following etiologic processes is
implicated in the development of appendicitis?
A) Obstruction of the intestinal lumen
B) Elimination of normal intestinal flora
C) Sloughing of the intestinal mucosa
D) Increased osmolality of intestinal contents

16 Which of the following characteristics differentiates inflammatory diarrhea
. from the noninflammatory type?
A) Larger volume of diarrhea
B) Electrolyte imbalances
C) Absence of blood in the stool
D) Infection of intestinal cells

17 Which of the following patients should the nurse observe most closely for
. the signs and symptoms of paralytic ileus?
A) A patient who is postoperative day 1 following gall bladder surgery
B) A patient whose acute diarrhea has necessitated the use of antidiarrheal
medications
C) An obese patient who refuses to ambulate because he complains of
shortness of breath
D) A patient with a longstanding diagnosis of irritable bowel syndrome

18 Which of the following meals is most likely to exacerbate an individuals
. celiac disease?
A) Spaghetti with meatballs and garlic bread
B) Stir-fried chicken and vegetables with rice
C) Oatmeal with milk, brown sugar, and walnuts
D) Barbecued steak and a baked potato with sour cream

82. 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
.

83. 11 B
.
12 A
.
13 B
.
14 D
.
15 A
.
16 D
.
17 A
.
18 A
.
19 C
.
20 D
.

Chapter 10 Endocrine Function



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.

84. B) myxedema.
C) thyroidectomy.
D) autoimmune thyroiditis.

3. Thyroid hormone deficit , which alters the function of all major
organs in the body.
A) decreases metabolism
B) increases protein synthesis
C) causes vitamin deficiencies
D) enhances absorption of glucose

4. The most common cause of thyrotoxicosis is Graves disease, which has the
distinguishing characteristic of in addition to a diffuse goiter.
A) muscle fatigue
B) facial myxedema
C) ophthalmopathy
D) decreased cholesterol

5. The major adrenal cortical hormones are steroids and are synthesized from
acetate and:
A) ACTH.
B) albumin.
C) amino acids.
D) cholesterol.

6. Primary adrenal insufficiency is manifested by:
A) truncal obesity and edema.
B) hypokalemia and hypervolemia.
C) hyponatremia and hypoglycemia.

85. 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.

86. 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

87. 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

88. 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

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

Chapter 11 Neural Function



1. More complex patterns of movements, such as throwing a ball or picking up a
fork, are controlled by the cortex in the frontal lobe.

90. A) premotor
B) primary motor
C) reflexive
D) supplementary

2. Disorders of the pyramidal tracts, such as a stroke, are characterized by:
A) paralysis.
B) hypotonia.
C) muscle rigidity.
D) involuntary movements.

3. Myasthenia gravis is characterized by muscle weakness caused by antibody-
mediated destruction of:
A) periorbital muscles.
B) thymus gland cells.
C) skeletal muscle fibers.
D) acetylcholine receptors.

4. A patient has wrist inflammation causing compression of the median nerve
in the carpal tunnel. Manifestations of this syndrome include:
A) little finger numbness.
B) forearm paresthesia.
C) loss of tendon reflexes.
D) precision grip weakness.

5. The cardinal symptoms of Parkinson disease include:
A) hypotonia.
B) bradykinesia.
C) paresthesia.

91. D) lack of sweating.

6. The patient has a traumatic complete spinal cord transection at the C5 level.
Intact motor and somatosensory function will include control.
A) bladder
B) finger flexion
C) diaphragm
D) trunk muscle

7. Unlike disorders of the motor cortex and corticospinal (pyramidal) tract,
lesions of the basal ganglia disrupt movement:
A) without causing paralysis.
B) posture and muscle tone.
C) and cortical responses.
D) of upper motor neurons.

8. The demyelination and degeneration of nerve fibers characteristic of
multiple sclerosis is the result of:
A) decreased oligodendrocytes.
B) corticospinal injuries.
C) atherosclerotic destruction.
D) oligodendrocytic infection.

9. A sudden traumatic complete transection of the spinal cord results in
below the level of injury.
A) flaccid paralysis
B) vasoconstriction
C) deep visceral pain
D) 3+ tendon reflexes

92. 10 Autonomic dysreflexia (autonomic hyperreflexia) is characterized by:
.
A) severe spinal shock.
B) tachycardia and pale skin.
C) lack of sweat above injury level.
D) vasospasms and hypertension.

11 A clinician is assessing the muscle tone of a patient who has been diagnosed
. with a lower motor neuron (LMN) lesion. Which of the following
assessment findings is congruent with the patients diagnosis?
A) Hypotonia
B) Spasticity
C) Tetany
D) Rigidity

12 An elderly patient has been brought to his primary care provider by his wife
. who is concerned about his recent decrease in coordination. Upon
assessment, his primary care provider notes that the patients gait is wide-
based, unsteady, and lacking in fluidity, although his muscle tone appears
normal. This patient requires further assessment for which of the following
health problems?
A) Muscle atrophy
B) Cerebellar disorders
C) Impaired spinal reflexes
D) Lower motor neuron lesions

13 Knowing that she is a carrier for Duchene muscular dystrophy (DMD), a
. pregnant woman arranged for prenatal genetic testing, during which her
child was diagnosed with DMD. As her son develops, the woman should
watch for which of the following early signs that the disease is progressing?
A) Impaired sensory perception and frequent wounds
B) Spasticity and hypertonic reflexes

93. C) Muscle atrophy with decreased coordination
D) Frequent falls and increased muscle size

14 A patient with a diagnosis of myasthenia gravis has required a mastectomy
. for the treatment of breast cancer. The surgery has been deemed a success,
but the patient has gone into a myasthenic crisis on postoperative day one.
Which of the following measures should the care team prioritize in this
patients immediate care?
A) Positioning the patient to minimize hypertonia and muscle rigidity
B) Seizure precautions
C) Respiratory support and protection of the patients airway
D) Monitoring the patient for painful dyskinesias

15 Which of the following disorders of neuromuscular function typically has
. the most rapid onset?
A) Duchenne muscular dystrophy (DMD)
B) Guillain-Barr syndrome
C) Parkinson disease
D) Myasthenia gravis

16 A patient who experienced a traumatic head injury from a severe blow to the
. back of his head now lives with numerous function deficits, including an
inability to maintain steady posture while he is in a standing position,
although he is steadier when walking. Which of the following disorders most
likely resulted from his injury?
A) Cerebellar dystaxia
B) Cerebellar tremor
C) A lower motor neuron lesion
D) A vestibulocerebellar disorder

94. 17 A patients recent diagnosis of Parkinson disease has prompted his care
. provider to promptly begin pharmacologic therapy. The drugs that are
selected will likely influence the patients levels of:
A) dopamine.
B) acetylcholine.
C) serotonin.
D) adenosine.

18 A patient is devastated to receive a diagnosis of amyotrophic lateral sclerosis
. (ALS). The symptomatology of this disease is a result of its effects on:
A) upper motor neurons.
B) the vestibulocerebellar system.
C) upper and lower motor neurons.
D) neuromuscular junctions.

19 Restoration of the integrity of myelin sheaths would likely result in a
. slowing or stopping of the progression of:
A) Amyotrophic lateral sclerosis (ALS)
B) Multiple sclerosis (MS)
C) Duchenne muscular dystrophy (DMD)
D) Paralysis caused by Clostridium botulinum

20 A patient with a spinal cord injury at T8 would likely retain normal motor
. and somatosensory function of her:
A) arms.
B) bowels.
C) bladder.
D) perineal musculature.
Answer Key

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

96. Brain Disorders



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.

97. 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.

98. 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?

99. 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.

100. 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?

101. 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


1. D
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
.

102. 16 D
.
17 C
.
18 D
.
19 C
.
20 A
.

Chapter 12 Musculoskeletal Function



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.

103. 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 of the bone.
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.

104. 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. Osteonecrosis is most often caused by:
A) stress fractures.
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?

105. 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.
C) bacterial proliferation in the absence of the classic signs of infection.
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?

106. 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.
C) non-Hodgkin lymphoma and bladder cancer.
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.

107. 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
.

108. 15 D
.
16 C
.
17 D
.
18 A
.
19 C
.
20 B
.
Skeletal



1. Disorders that affect cortical bone typically result in:
A) fractures of long bones.
B) impaired collagen synthesis.
C) infection.
D) vertebral fractures.

2. The condition that contributes to the pathology of all metabolic bone
diseases is:
A) impaired vitamin D synthesis.
B) osteosarcoma.
C) infection.
D) osteopenia.

3. In contrast to osteoporosis, osteomalacia causes without the loss of
bone matrix.
A) stress fractures

109. B) calcium excretion
C) bone cortex thinning
D) defective mineralization

4. Rheumatoid arthritis is a systemic inflammatory disease with joint
manifestations described as:
A) dysplasia.
B) polyarticular.
C) asymmetrical.
D) osteophytes.

5. A feature of rheumatoid arthritis that differentiates it from other forms of
inflammatory arthritis is the development of:
A) pannus tissue.
B) tophi deposits.
C) subluxations.
D) autoantibodies.

6. HLA-B27 antigen may be linked to other genes that determine the
pathologic autoimmune phenomenon in:
A) gout syndrome.
B) rheumatoid arthritis.
C) osteoarthritis syndrome.
D) ankylosing spondylitis.

7. Osteoarthritis is a degenerative form of joint disease that is often evidenced
by:
A) spongy joints.
B) cartilage hypertrophy.
C) crepitus and grinding.

110. D) systemic inflammation.

8. Systemic sclerosis (scleroderma) is an autoimmune disease of connective
tissue characterized by:
A) fibrosis.
B) thin fragile skin.
C) collagen deficiency.
D) avascular necrosis.

9. The most commonly occurring early symptoms of systemic lupus
erythematosus (SLE) include:
A) arthralgia.
B) tendon rupture.
C) facial hair growth.
D) pyelonephritis.

10 Premature osteoporosis is being seen increasingly in female athletes because
. of an increased prevalence of:
A) amenorrhea.
B) high protein intake.
C) abnormal body fat.
D) osteoarthritis.

11 For many patients, the first indication that they have osteoporosis is:
.
A) bone pain that is not alleviated by rest.
B) a bone fracture.
C) craving high-calcium foods.
D) decreased range of motion in the hip and knee joints.

111. 12 Which of the following measures should a public health nurse recommend to
. middle-aged women to reduce their chances of developing osteoporosis later
in life?
A) Weight-control and daily use of low-dose corticosteroids
B) Genetic testing and range of motion exercises
C) Calcium supplementation and regular physical activity
D) Increased fluid intake and use of vitamin D supplements

13 A 77-year-old woman has been admitted to the geriatric medical unit of the
. hospital for the treatment of pneumonia. The nurse providing care for the
patient notes the presence of nasal calcitonin, vitamin D, and calcium
chloride on the patients medication administration record. The nurse should
conclude that this patient likely has a history of:
A) scleroderma.
B) osteoarthritis.
C) rheumatoid arthritis.
D) osteoporosis.

14 An elderly resident of an assisted-living facility has had his mobility and
. independence significantly impaired by the progression of his rheumatoid
arthritis (RA). What is the primary pathophysiologic process that has
contributed to this patients decline in health?
A) A mismatch between bone resorption and remodeling
B) Immunologically mediated joint inflammation
C) Excessive collagen production and deposition
D) Cytokine release following mechanical joint injury

15 Which of the following signs and symptoms should prompt a 29-year-old
. womans primary care provider to assess for systemic lupus erythematosus
(SLE)?
A) Chronic nausea and vomiting that is unresponsive to antiemetics
B) Joint pain and increased creatinine and blood urea nitrogen

112. C) A history of thromboembolic events and varicose veins
D) Dysmenorrhea and recent spontaneous abortion

16 A 26-year-old woman has sought care for increasing pain at the back of her
. ankle and the bottom of her foot over the past 2 weeks. The patient states
that she is generally in good health, although she completed a course of
antibiotics for a chlamydial infection 6 weeks earlier. This patients recent
history suggests the possibility of:
A) systemic sclerosis.
B) ankylosing spondylitis.
C) osteoarthritis.
D) reactive arthritis.

17 A 55-year-old male patient has reported joint pain in his feet. Which of the
. following blood work results should prompt further testing to rule out
primary gout?
A) Increased C-reactive protein (CRP)
B) Increased serum uric acid
C) Increased polymorphonuclear leukocytes
D) Increased serum cortisol

18 Despite differences in onset, involvement, and symptomatology, all of the
. spondyloarthropathies involve:
A) sacroiliitis.
B) calcinosis.
C) excessive bone turnover.
D) autoimmune etiology.

19 The clinical course of osteoarthritis (OA) culminates in:
.
A) osteonecrosis and loss of synovial fluid.

113. B) formation of tophi in the synovial space.
C) osteophyte formation and erosion of cartilage.
D) separation of the epiphyseal plate.

20 Which of the following disorders of the skeletal system occurs exclusively in
. older adults?
A) Polymyalgia rheumatica
B) Psoriatic arthritis
C) Reiter syndrome
D) Ankylosing spondylitis
Answer Key


1. A
2. D
3. D
4. B
5. A
6. D
7. C
8. A
9. A
10 A
.
11 B
.
12 C
.
13 D
.

114. 14 B
.
15 B
.
16 D
.
17 B
.
18 A
.
19 C
.
20 A
.

Chapter 13 Integumentary Function



1. The basal lamina, between the epidermis and dermis, is involved in skin
disorders that cause:
A) blister formation.
B) conical projections.
C) prickle cell lesions.
D) hyperpigmentation.

2. Cells that form a network to bind and process antigens in the epidermis are
known as:
A) Merkel cells.
B) reticular dermis.
C) Langerhans cells.
D) dermal dendrocytes.

115. 3. The pilosebaceous unit of the skin consists of:
A) eccrine secretions.
B) sebaceous glands.
C) keratinized plates.
D) connective tissues.

4. The are the skin structures that become inflamed in acne.
A) follicular bulbs
B) dermal papillae
C) apocrine glands
D) sebaceous glands

5. Unlike hair, nails grow:
A) strata.
B) outward.
C) cyclically.
D) continuously.

6. Lichenification is caused by:
A) epidermal breakage.
B) repeated scratching.
C) chronic area pressure.
D) decreased skin shedding.

7. In addition to keratinocytes, the epidermis has cells that protect
against damage from ultraviolet radiation.
A) melanocyte
B) Langerhans
C) subcutaneous

116. D) protein granule

8. Sebaceous glands secrete sebum, which is a:
A) skin lubricant.
B) fibrous protein.
C) watery secretion.
D) nutritional source.

9. The basement membrane between the epidermis and dermis provides for
adhesion and serves as a:
A) selective filter.
B) nutritional source.
C) ground substance.
D) pressure receptor.

10 Pruritus, a symptom common of many skin disorders, is a(an):
.
A) temporary rash.
B) itching sensation.
C) nociceptor response.
D) result of repeated scratching.

11 Mitosis that results in the production of new epidermal cells occurs in which
. of the following layers of the epidermis?
A) Stratum lucidum
B) Stratum granulosum
C) Stratum germinativum
D) Stratum spinosum

117. 12 Which of the following statements about the structure of the skin is correct?
.
A) Nerve fibers originate in the dermis and terminate in the stratum corneum
of the epidermis.
B) All five layers of the epidermis lack a blood supply.
C) The epidermis is composed of connective tissue.
D) The dermis is composed of skeletal muscle tissue.

13 What is physiologic basis for albinism?
.
A) Accelerated keratinization
B) Lack of tyrosinase
C) Lichenification
D) Separation of the epidermis from the dermis

14 Which of the following skin disorders is likely to result from the localized
. lack of melanin production by melanocytes?
A) Rash
B) Bullae
C) Vitiligo
D) Melasma

15 Due to the increasing dryness of her skin in recent years, a 70-year-old
. woman has needed to reduce the number of baths that she takes. Which of
the following factors has resulted in this age-related change in skin function?
A) Slower keratinization
B) Changes in sebaceous secretions
C) Dehydration of epidermal cells
D) Increased production of bile salts

118. 16 Dark skin tone is genetically determined and is primarily the result of:
.
A) high production of melanin.
B) dense distribution of melanosomes.
C) superficial distribution of melanocytes.
D) high levels of tyrosinase.

17 Which of the following skin lesions is categorized as a type of blister?
.
A) Bulla
B) Wheal
C) Nodule
D) Plaque

18 A 22-year-old male college student has presented to his campus medical
. clinic distraught at the emergence of numerous small blisters on the shaft of
his penis. On examination, the clinician notes that the lesions are between 2
and 4 mm in diameter and are filled with serous fluid. The clinician would
document the presence of:
A) pustules.
B) macules.
C) vesicles.
D) papules.

19 Which of the following characteristics differentiates apocrine sweat glands
. from eccrine sweat glands?
A) Apocrine secretions contain oils.
B) Apocrine secretions help maintain skin pH.
C) Apocrine glands are more numerous and widely distributed than eccrine
glands.
D) Apocrine glands are primarily thermoregulatory .

119. 20 Most of the bodys hair follicles are paired with:
.
A) a Langerhans cell.
B) an eccrine sweat gland.
C) a nerve ending.
D) a sebaceous gland.
Answer Key


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

120. 16 A
.
17 A
.
18 C
.
19 A
.
20 D
.
Disorders



1. Manifestations of superficial dermatophytosis of the skin include:
A) scaling.
B) erythema.
C) vesicles.
D) infiltration.

2. Onychomycosis initially causes the toenail to appear as the fungus
digests the nail keratin.
A) black
B) cracked
C) opaque
D) eroded

3. A yeast-like Candida albicans fungal infection can be differentiated from a
tinea fungal infection by the presence of:
A) circular patches.
B) satellite lesions.
C) fungal spores.

121. D) raised borders.

4. Warts develop when are invaded by human papillomavirus (HPV).
A) melanocytes
B) keratinocytes
C) sebaceous glands
D) subcutaneous cells

5. Allergic and hypersensitivity dermatoses are characterized by:
A) target lesions.
B) dark erythema.
C) epidermal edema.
D) silver-white scale.

6. Papulosquamous dermatoses, such as psoriasis, are a group of skin disorders
characterized by:
A) scaling papules.
B) granular scabbing.
C) raised red borders.
D) nodular ulcerations.

7. A thermal burn described as involving the entire epidermis and dermis is
classified as:
A) full third-degree.
B) deep first-degree.
C) partial second-degree.
D) full-thickness second-degree.

122. 8. The main cause of decubitus ulcers (bedsores) is that impairs the
flow of blood and lymph.
A) external pressure
B) shearing forces
C) tissue edema
D) thrombosis

9. Dysplastic nevi are precursors of malignant melanoma that are:
A) larger than other nevi.
B) oval epidermal nests.
C) dermal cords of cells.
D) brown rounded papules.

10 Which one of the following skin disorders seen in elderly persons is
. considered a premalignant lesion?
A) Cherry angiomas
B) Actinic keratosis
C) Solar lentigines
D) Telangiectases

11 Which of the following disorders of the skin is most likely to respond to
. treatment with systemic antibiotics?
A) Acne vulgaris
B) Urticaria
C) Atopic dermatitis
D) Verrucae

12 Dry, itchy plaques on her elbows and knees have prompted a 23-year-old
. woman to seek care. The clinician has subsequently diagnosed the patient
with psoriasis, a disorder that results from:

123. A) increased epidermal cell turnover.
B) an IgE-mediated immune reaction.
C) hormonal influences on sebaceous gland activity.
D) human papillomaviruses (HPV).

13 A patient has been admitted to the intensive care unit of the hospital after
. developing toxic epidermal necrolysis (TEN) consequent to the
administration of a sulfonamide antibiotic. What pathophysiologic
phenomenon is likely the greatest immediate threat to this patients health?
A) The development of bacterial cellulitis on compromised skin surfaces
B) Fluid and electrolyte imbalances resulting from the loss skin integrity
C) A cascading autoimmune response that may result in shock
D) The presence of diffuse lesions and skin sloughing on the patients mucous
membranes

14 A mans winter vacation to a tropical destination has been accompanied by
. repeated sunburns. What process accounts for the damaging effects of the
suns radiation?
A) Initiation of an autoimmune response
B) Compensatory increases in melanin production
C) Damage to epidermal cell DNA and free radical production
D) Hyperkeratinization and the formation of microscopic, subcutaneous
lesions

15 A 44-year-old man has been brought to the emergency department by
. emergency medical services with severe electrical burns resulting from a
workplace accident. The most immediate threat to this patients survival at
this time is:
A) infection.
B) hemodynamic instability.
C) acute pain.

124. D) decreased protein synthesis and impaired healing.

16 A 79-year-old patient has been confined to bed after a severe hemorrhagic
. stroke that has caused hemiplegia. Which of the following measures should
his care team prioritize in the prevention of pressure ulcers?
A) Prophylactic antibiotics
B) Repositioning the patient on a scheduled basis
C) Applying protective dressings to vulnerable areas
D) Parenteral nutrition

17 Which of the following actions involves the greatest risk of skin shearing?
.
A) Inserting a peripheral intravenous catheter
B) Rolling the patient from a supine to side-lying position
C) Pulling the patient up in bed
D) Helping the patient ambulate after surgery

18 What neoplasm of the skin is associated with the poorest prognosis?
.
A) Malignant melanoma
B) Basal cell carcinoma
C) Intraepidermal squamous cell carcinoma
D) Invasive squamous cell carcinoma

19 The transition of a melanoma from radial growth to vertical growth is
. associated with:
A) failure of the integrity of the basement membrane.
B) involvement of the nonkeratinizing cells.
C) spontaneous resolution.
D) an increased risk of metastasis.

125. 20 A 5-year-old girl has been presented for care by her father due to her recent
. development of macules on her trunk, extremities, and mucous membranes.
The child is mildly febrile but her primary symptom is extreme pruritus.
What disorder of the skin should the clinician who is assessing the child first
suspect?
A) Varicella
B) Lichen planus
C) Rosacea
D) Impetigo
Answer Key


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

126. 15 B
.
16 B
.
17 C
.
18 A
.
19 D
.
20 A
.

Chapter 14 Sensory Function



1. During accommodation, pupillary dilation partially compensates for the
reduced size of the retinal image by:
A) thickening the lens.
B) contracting the ciliary muscle.
C) increasing light entering the pupil.
D) narrowing the palpebral opening.

2. With aging, progressive inelasticity and thickening of the lens causes which
accommodation disorder?
A) Cataracts
B) Hyperopia
C) Presbyopia
D) Astigmatism

3. In order to maintain fixation on stable objects during head rotation,
compensatory movements occur.

127. A) vertigo
B) nystagmus
C) conjugate gaze
D) eyelid vacillation

4. The red eyes of bacterial conjunctivitis are accompanied by ,
which differentiates it from the red eyes of acute glaucoma.
A) mydriasis and headaches
B) blurred or iridescent vision
C) tearing, itching and burning
D) cloudy, painful corneas

5. An acute episode of angle-closure glaucoma is preceded by:
A) central visual field loss.
B) prolonged pupil dilation.
C) corneal surface trauma.
D) vitreous humor fluid loss.

6. Diabetic and hypertensive retinopathy are both characterized by the
appearance of:
A) macular edema.
B) cloudy corneas.
C) microinfarctions.
D) intraretinal hemorrhages.

7. Although both vertigo and dizziness can result from peripheral or central
vestibular disorders, vertigo is distinctly different because it causes:
A) light-headedness.
B) an illusion of motion.

128. C) loss of consciousness.
D) permanent hearing loss.

8. One of the causes of conductive hearing loss is:
A) sudden loud noise.
B) ototoxic medication.
C) auditory nerve damage.
D) excess middle ear fluid.

9. With otosclerosis, early hearing loss is identified by an inability to hear:
A) whispering.
B) ones own voice.
C) on the cell phone.
D) in a noisy environment.

10 In comparison to children with acute otitis media (AOM), those with otitis
. media with effusion (OME) have:
A) systemic infection.
B) earache and fever.
C) excess middle ear fluid.
D) sensorineural hearing loss.

11 Which of the following vision disorders is most likely to have an infectious
. etiology?
A) Keratitis
B) Cataracts
C) Glaucoma
D) Macular degeneration

129. 12 A 78-year-old female patient has been scheduled for outpatient cataract
. surgery. Which of the following signs and symptoms most likely prompted
the patient to initially seek care?
A) Unilateral redness and purulent exudate
B) Eye pain coupled with photosensitivity
C) Bilateral blurred vision and visual distortion
D) Lack of accommodation and increased intraocular pressure

13 A 60-year-old patients long history of poorly controlled hypertension has
. culminated in a diagnosis of retinal detachment. What type of retinal
detachment is this patient most likely to have experienced?
A) Rhegmatogenous detachment
B) Exudative retinal detachment
C) Posterior vitreous detachment
D) Traction retinal detachment

14 An elderly woman has been diagnosed with macular degeneration following
. a visit to an ophthalmologist. Which of the womans following statements
best demonstrates an accurate understanding of her new diagnosis?
A) I suppose this goes to show that I should have controlled my blood
pressure better.
B) I think this is something that I might have caught from my husband.
C) My friend had this problem and a transplant did wonders for her vision.
D) I suppose that this might be one of those things that happens when you get
older.

15 Which of the following characteristics differentiates open-angle glaucoma
. from angle-closure glaucoma?
A) The potential for consequent blindness
B) Dysfunction of the aqueous humor drainage system
C) The presence of optic nerve cupping

130. D) Infectious etiology

16 Which of the following visual deficits would be categorized as homonymous
. hemianopia?
A) Loss of the same side of the visual field in each eye
B) Bilateral loss of peripheral vision
C) Loss of vision in the right side of the left eye and the left side of the right
eye
D) Equal loss of central vision in each eye

17 Which of the following vision deficits is a clinician justified in attributing to
. the normal aging process?
A) Conjunctivitis
B) Presbyopia
C) Strabismus
D) Angle-closure glaucoma

18 Frustrated by her worsening tinnitus, a 55-year-old female patient has sought
. care. Which of the following teaching points should the clinician provide to
the patient?
A) I know this can be very difficult to live with, but it normally fades over
time.
B) I will prescribe some medication that will probably help quite well.
C) This might be a sign of a more serious neurologic problem that we will
assess for.
D) Initially, there are some changes in your diet that you should implement.

19 A female patient with rheumatoid arthritis has taken high doses of aspirin for
. several years, a practice that has resulted in damage to her hearing due to the
drugs ototoxic effects. What type of hearing loss has this patient
experienced?
A) Conductive hearing loss

131. B) Sensorineural hearing loss
C) Presbycusis
D) Mixed hearing loss

20 Which of the following signs and symptoms is most indicative of Mnire
. disease?
A) Rotary vertigo and tinnitus
B) Nausea and vomiting
C) Progressive hearing loss and frequent falls
D) Otalgia and recurrent otitis media
Answer Key


1. C
2. C
3. B
4. C
5. B
6. D
7. B
8. D
9. A
10 C
.
11 A
.
12 C
.
13 B
.

132. 14 D
.
15 B
.
16 A
.
17 B
.
18 D
.
19 B
.
20 A
.