Porth Pathophysiology Concepts of Altered Health States 2nd Canadian
Edition Test Bank
Chapter 01: Concepts of Health and Disease
MULTIPLE CHOICE
1. Which of the following would be the most likely cause of an iatrogenic disease?
An inherited disorder
b.
A combination of specific etiological factors
c.
An unwanted effect of a prescribed drug
d.
Prolonged exposure to toxic chemicals in the environment
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ta
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a.
ANS: C REF: 6
2. The manifestations of a disease are best defined as the:
subjective feelings of discomfort during a chronic illness.
b.
signs and symptoms of a disease.
c.
factors that precipitate an acute episode of a chronic illness.
d.
early indicators of the prodromal stage of infection.
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st
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a.
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ANS: B REF: 6
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3. The best definition of the term prognosis is the:
a.
precipitating factors causing an acute episode.
b.
number of remissions to be expected during the course of a chronic illness.
c.
predicted outcome or likelihood of recovery from a specific disease.
d.
exacerbations occurring during chronic illness.
ANS: C REF: 7
b.
Fever
c.
Pain in the neck
d.
Red rash on the face
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Swelling of the knee
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a.
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4. Which of the following is considered a systemic sign of disease?
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ta
ANS: B REF: 6
5. Etiology is defined as the study of the:
causes of a disease.
b.
course of a disease.
c.
expected complications of a disease.
d.
manifestations of a disease.
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ANS: A REF: 5
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ba
a.
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a.
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6. A type of cellular adaptation in which there is a decrease in cell size is referred to as:
hypertrophy.
b.
metaplasia.
c.
anaplasia.
d.
atrophy.
ANS: D REF: 8
a.
metaplasia.
b.
atrophy.
c.
dysplasia.
d.
hypertrophy.
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7. A change in a tissue marked by cells that vary in size and shape and show increased mitotic
figures would be called:
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ANS: C REF: 8
apoptosis.
b.
ischemia.
c.
hypertrophy.
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ta
a.
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8. A deficit of oxygen in the cells usually due to respiratory or circulatory problems is called:
necrosis.
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d.
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ANS: B REF: 9
9. When a group of cells in the body dies, the change is called:
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b.
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a.
ischemia.
gangrene.
c.
hypoxia.
d.
necrosis.
ANS: D REF: 10
10. Rigorous weight lifting/body building regimens may result in the skeletal muscle cells
undergoing:
hypertrophy.
b.
dysplasia.
c.
atrophy.
d.
regeneration.
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a.
ANS: A REF: 8
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11. The term cancer refers to:
dysplasia.
b.
hyperplasia.
c.
metaplasia.
d.
malignant neoplasm.
ba
nk
ta
nk
a.
st
ANS: D REF: 9
12. To which of the following does the term apoptosis refer?
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c.
Ischemic damage to cells
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b.
Increased rate of mitosis by certain cells
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a.
d.
Liquefaction of necrotic tissue
Preprogrammed cell self-destruction
ANS: D REF: 9
13. Which of the following statements is TRUE?
a.
Alteration of DNA does not change cell function.
b.
Damaged cells may be able to repair themselves.
c.
All types of cells die at the same rate.
d.
Mild ischemia causes immediate cell death.
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ANS: B REF: 10
14. Caseation necrosis refers to an area where:
cell proteins have been denatured.
b.
cell are liquefied by enzymes.
c.
dead cells form a thick cheesy substance.
d.
bacterial invasion has occurred.
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ta
nk
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a.
ba
ANS: C REF: 10
15. Routine application of sun block to skin would be an example of:
an iatrogenic cause of cancer.
b.
a preventive measure.
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a predisposing condition.
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d.
a precipitating factor.
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c.
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a.
ANS: B REF: 6
16. A circumstance that causes a sudden acute episode of a chronic disease to occur is termed:
a.
latent stage.
b.
predisposing factor.
c.
incidence.
d.
precipitating factor.
ANS: D REF: 7
b.
maintenance of a stable internal environment.
c.
a condition that triggers an acute episode.
d.
a collection of signs and symptoms.
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the causative factors in a particular disease.
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ta
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a.
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17. The term homeostasis refers to:
ANS: B REF: 2
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18. Which term is used to describe a new and secondary or additional problem that arises after
the original disease has been established?
Symptoms
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a.
Occurrence
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b.
Complication
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d.
Manifestations
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c.
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ANS: D REF: 7
19. Pathophysiology involves the study of:
a.
the structure of the human body.
b.
the functions of various organs in the body.
c.
functional or structural changes resulting from disease processes.
d.
various cell structures and related functions.
ANS: C REF: 2
20. Which of the following is the best definition of epidemiology?
The science of tracking the occurrence and distribution of diseases
b.
The relative number of deaths resulting from a particular disease
c.
Identification of a specific disease through evaluation of signs and symptoms
d.
The global search for emerging diseases
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.c
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a.
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ta
ANS: A REF: 7
21. Which of the following can cause cell injury or death?
1. Hypoxia
2. Exposure to excessive cold
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3. Excessive pressure on a tissue
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4. Chemical toxins
1, 2
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a.
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c.
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b.
d.
2, 4
1, 3, 4
1, 2, 3, 4
ANS: D REF: 9
22. All of the following are part of the Seven Steps to Health EXCEPT:
a.
follow cancer screening guidelines.
b.
use sun block agents whenever exposed.
c.
participate in strenuous exercise on a regular daily basis.
d.
choose high fiber, lower fat foods.
ANS: C REF: 2
23. The term disease refers to:
the period of recovery and return to a normal healthy state.
b.
a deviation from the normal state of health and function.
c.
the treatment measures used to promote recovery.
d.
a basic collection of signs and symptoms.
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ta
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a.
ANS: B REF: 2
a.
acute disease.
b.
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24. A collection of signs and symptoms, often affecting more than one organ or system, that
usually occur together in response to a certain condition is referred to as a (an):
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multiorgan disorder.
manifestation.
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d.
syndrome.
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c.
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ANS: C REF: 7
25. All of the following statements are correct about cell damage EXCEPT:
a.
The initial stage of cell damage often causes an alteration in metabolic reactions.
b.
If the factor causing the damage is removed quickly, the cell may be able to recover and return to its
normal state.
c.
If the noxious factor remains for an extended period of time, the damage becomes irreversible and the c
dies.
d.
Initially, cell damage does not change cell metabolism, structure, or function.
ANS: D REF: 9
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26. Which of the following conditions distinguishes double blind studies used in health research?
Neither the members of the control group or the experimental group nor the person administering the
treatment knows who is receiving the experimental therapy.
b.
Both groups of research subjects and the person administering the treatment know who is receiving the
experimental therapy.
c.
The research subjects do not know, but the person administering the treatment knows who is receiving
placebo or standard therapy.
d.
Only members of the control group know they are receiving standard therapy.
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ta
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a.
ANS: A REF: 3 | 4
st
27. If the data collected from the research process confirm that the new treatment has increased
effectiveness and is safe, this is called:
the placebo effect.
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a.
blind research studies.
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c.
evidence-based research.
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b.
d.
approval for immediate distribution.
ANS: B REF: 4
28. A short-term illness that develops very quickly with perhaps a high fever or severe pain is
called:
a.
acute.
b.
latent.
c.
chronic.
d.
manifestation.
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ANS: A REF: 6
29. The term prognosis refers to the:
period of recovery and return to a normal state.
b.
expected outcome of the disease.
c.
mortality and morbidity rates for a given population.
d.
typical collection of signs and symptoms.
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ta
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a.
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ANS: B REF: 7
st
30. When prolonged ischemia occurs to an area of the heart, the resulting damage is referred to
as:
atrophy.
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a.
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d.
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c.
liquefactive necrosis.
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b.
apoptosis.
infarction.
ANS: D REF: 10
31. During the evaluation process for a new therapys effectiveness and safety, a double blind
study may be conducted during:
a.
the first stage.
b.
the second stage.
c.
the third stage.
d.
any of these stages.
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ANS: C REF: 3
b.
To determine treatments
c.
To develop preventive measures
d.
To develop morbidity statistics
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To predict the prognosis
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a.
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32. Why are the predisposing factors for a specific disease important to health professionals?
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ANS: C REF: 3
33. Cell damage may be caused by exogenous sources such as:
abnormal metabolic processes.
b.
certain food additives.
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w
localized hypoxia.
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d.
genetic defects.
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c.
st
a.
ANS: B REF: 9 | 10
34. Which of the following is usually included in a medical history?
1. Past illnesses or surgeries
2. Current illnesses, acute and chronic
3. Prescribed medication or other treatments
4. Nonprescription drugs and herbal remedies
a.
1, 3
b.
2, 4, 5
c.
1, 3, 4
d.
1, 2, 3, 4, 5
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5. Current allergies
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ANS: D REF: 4 | 5
epidemic.
b.
exacerbation.
c.
morbidity.
ba
nk
ta
a.
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35. A situation when there is a higher than expected number of cases of an infectious disease
within a given area is called a/an:
pandemic.
st
d.
.te
ANS: A REF: 7
36. The term pathogenesis refers to:
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the determination of the cause(s) involved in the development of a malignant neoplasm.
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b.
the development of a disease or sequence of events related to tissue changes involved in the disease
process.
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a.
c.
the specific signs and symptoms involved in the change from an acute disease to a chronic disease.
d.
the changes in cells of affected tissue that result in necrosis.
Chapter 02: Concepts of Altered Health in Children
MULTIPLE CHOICE
1. The biological changes associated with adolescence are stimulated primarily by:
the peripheral nervous system.
b.
the thalamus.
c.
increased secretion of estrogen and progesterone.
d.
the pituitary gland.
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a.
Lordosis
b.
Kyphosis
c.
Scoliosis
ba
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ta
a.
nk
2. What is a lateral curvature of the spine called?
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ANS: D REF: 592
Kyphoscoliosis
ANS: C REF: 595
st
d.
.te
3. How is scoliosis identified?
w
c.
Unevenly aligned hips and shoulders
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b.
Bowed or hunched-over position of head and shoulders
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a.
d.
A swayback posture
One arm and leg shorter than the other
ANS: B REF: 595
4. What are common local signs of osteomyelitis?
a.
Joint swelling, limited movement
b.
Deformity of a limb, pain at rest
c.
Fever, leukocytosis, and malaise
d.
A red, swollen area, pain increasing with movement
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ANS: D REF: 597
5. Which of the following comprise typical early signs of Stills disease, a form of juvenile
rheumatoid arthritis?
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1. Presence of rheumatoid factor in the blood
3. Swollen painful knees, wrists, and elbows
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ta
4. Deformity of the hands and feet
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2. High fever and skin rash
a.
1, 3
1, 4
ba
b.
st
c.
.te
d.
2, 3
2, 4
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ANS: C REF: 597
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a.
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6. Which of the following might fluid and electrolyte deficits cause in a patient with anorexia
nervosa?
Cardiac arrhythmias
b.
Weight loss
c.
Dental caries and esophagitis
d.
Amenorrhea
ANS: A REF: 598
7. Bulimia nervosa is characterized by:
a refusal to eat.
b.
extreme weight loss.
c.
alternating binge eating and purging.
d.
chronic diarrhea.
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om
a.
ANS: C REF: 598
sweat glands of the upper body.
b.
dermis and epidermis of the skin.
c.
apocrine glands.
d.
sebaceous glands and hair follicles.
.te
ANS: D REF: 599
st
ba
nk
ta
a.
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8. Acne vulgaris can best be described as an infection involving the:
9. Infectious mononucleosis can be diagnosed by the presence of:
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w
b.
sore throat, fever, and lymphadenopathy.
w
a.
abnormal lymphocytes and positive antibody test.
c.
the causative bacteria in the saliva.
d.
extreme fatigue and malaise.
ANS: B REF: 599-600
10. Which statement applies to testicular cancer?
It often develops in untreated, undescended testes.
b.
It is related to chromosome abnormalities such as monosomy X.
c.
The tumor presents as a painful red lump in the scrotum.
d.
The cancer usually causes sterility.
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a.
ANS: A REF: 600
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11. An autoimmune disease that causes chronic inflammation in the joints of children is:
lordosis.
b.
juvenile rheumatoid arthritis (JRA).
c.
osteomyelitis.
d.
metabolic syndrome.
ba
nk
ta
nk
a.
st
ANS: B REF: 597
12. Which of the following would confirm reduced normal linear growth during adolescence?
Levels of androgens
b.
Abnormally thin epiphyseal plate seen on X-ray
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Lack of a broader pelvis in males
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c.
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a.
d.
Development of kyphosis
ANS: B REF: 593
13. Obesity in adolescents is:
a.
determined by calculating body mass index (BMI).
b.
a significant factor in a teens self-image.
c.
related to increased intake of high fat and high carbohydrate snacks, fast foods.
d.
All of the above
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ANS: D REF: 593-594
14. Three factors common to metabolic syndrome include:
presence of significant abdominal fat mass, changes in glucose metabolism, and changes in lipoprotein
metabolism.
b.
increased fat mass throughout the body, changes in glucose metabolism, and delayed sexual maturation
c.
significant increase of fat on hips and thighs, delayed linear growth, and change in calcium and vitamin
metabolism.
d.
BMI at the 85th percentile, type 2 diabetes mellitus, and hypertension.
ba
nk
ta
nk
.c
a.
ANS: A REF: 594
st
15. Infectious mononucleosis is characterized by all EXCEPT:
sore throat, fever, fatigue, malaise, and rash on trunk.
b.
enlarged lymph nodes (lymphadenopathy) and spleen (splenomegaly).
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w
increased occurrence in infants and young children.
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c.
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a.
d.
the presence of atypical T lymphocytes.
Chapter 03: Concepts of Altered Health in Older Adults
MULTIPLE CHOICE
1. All of the following changes are associated with aging EXCEPT:
a.
loss of elastic fibers.
b.
decreased metabolic rate.
c.
decreased secretion of all hormones.
d.
degenerative vascular changes.
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ANS: C REF: 604
2. Predisposing factors to osteoporosis in older women include all of the following EXCEPT:
decreased estrogen secretion.
b.
genetic factors.
c.
sedentary lifestyle.
d.
decreased parathyroid hormone.
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ta
nk
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a.
ba
ANS: D REF: 606
3. Lung expansion in the elderly may be reduced because of decreased:
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1. tissue elasticity.
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2. rib mobility.
3. control by the respiratory center.
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w
a.
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4. skeletal muscle strength.
1, 3
b.
1, 4
c.
2, 3, 4
d.
1, 2, 4
ANS: D REF: 607
a.
presbyopia.
b.
cataracts.
c.
glaucoma.
d.
damage to the retina.
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4. Vision in the elderly may be impaired when the eyeball becomes less elastic, thus preventing
accommodation and resulting in:
.c
ANS: A REF: 608
nk
5. What is a major factor leading to increased occurrence of cancer in the elderly?
Widespread vascular degeneration
b.
Cumulative exposure to carcinogens
c.
Hereditary factors
d.
Increased immune surveillance
st
ba
nk
ta
a.
.te
ANS: B REF: 609
6. Senescence refers to the period of time when:
apoptosis is reduced.
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b.
mitosis is accelerated.
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a.
c.
aging changes become apparent.
d.
cell death exceeds cell replacement.
ANS: D REF: 603
7. Theories about the causes of aging include:
apoptosis.
b.
wear and tear.
c.
altered protein (amyloid) accumulation.
d.
All the above
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a.
ANS: D REF: 604
Reduced cognitive and social activities
b.
Improved living conditions
c.
Better nutrition
d.
Advancements in health care
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ta
ba
st
ANS: A REF: 603
nk
a.
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8. Which of the following does NOT contribute to the increasing life span of the general
population?
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9. The term given to the change that occurs in women at around age 50 with the cessation of the
menstrual cycle is:
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w
b.
menopause.
w
a.
dysmenorrhea.
c.
amenorrhea.
d.
menarche.
ANS: A REF: 604
10. Recommendations to reduce the risk factors and the progression of osteoporosis with aging
include:
reducing vitamin D intake.
b.
maintaining walking and weight-bearing exercise.
c.
increasing bone resorption.
d.
maintaining glucocorticoid therapy.
ANS: B REF: 607
.c
11. All are physiological changes that occur with aging EXCEPT:
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a.
reduced skeletal muscle mass.
b.
degeneration of fibrocartilage in intervertebral discs in the spine.
c.
increased basal metabolic rate (BMR).
d.
reduced bladder capacity and incomplete bladder emptying.
ba
nk
ta
nk
a.
st
ANS: C REF: 607 | 609
12. With advancing age, the major change in the cardiovascular system involves:
irregular impulse conduction in the heart.
b.
a reduced number of collagen fibers to support cardiac muscle.
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vascular degeneration, leading to arteriosclerosis and atherosclerosis.
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c.
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a.
d.
the heart valves becoming thin and weak.
ANS: C REF: 605
13. Which of the following factors lead to delayed wound healing in the elderly?
1. Reduced rate of mitosis
2. Inadequate circulation
3. High risk of infection
1, 2
b.
1, 3
c.
2, 4
d.
1, 2, 3
.c
a.
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4. More effective immune system
nk
ANS: D REF: 609
nk
ta
14. Which of the following may develop in an elderly patient who has several medical problems
and is markedly obese?
Osteoarthritis and cardiovascular complications
b.
Decreased activity and diabetes mellitus
c.
Undesirable interactions with multiple prescription drugs and over-the-counter (OTC) medications
d.
A, B, and C
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st
ba
a.
A)
is the site of protein synthesis
contains the genetic code
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B)
The nucleus _________, which is essential for function and survival of the cell.
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1.
w
Chapter 04: Cell and Tissue Characteristics
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.
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.
To effectively relay signals, cell-to-cell communication utilizes chemical messenger systems that:
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4.
displace surface receptor proteins.
B)
accumulate within cell gap junctions.
C)
bind to contractile microfilaments.
D)
release secretions into extracellular fluid.
5.
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A)
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3.
Aerobic metabolism, also known as oxidative metabolism, provides energy by:
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.
ba
Exocytosis, the reverse of endocytosis, is important in _______ into the extracellular fluid.
Engulfing and ingesting fluid and proteins for transport
B)
Killing, degrading, and dissolving harmful microorganisms
C)
Removing cellular debris and releasing synthesized substances
D)
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A)
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6.
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ta
A)
Destruction of particles by lysosomal enzymes for secretion
7.
polarization of charged particles.
w
C)
millivoltage of electrical potential.
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B)
diffusion of current-carrying ions.
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A)
The process responsible for generating and conducting membrane potentials is:
D)
8.
ion channel neurotransmission.
Epithelial tissues are classified according to the shape of the cells and the number of layers. Which of
following is a correctly matched description and type of epithelial tissue?
A)
Simple epithelium: cells in contact with intercellular matrix; some do not extend to surface
B)
Stratified epithelium: single layer of cells; all cells rest on basement membrane
C)
Glandular epithelium: arise from surface epithelia and underlying connective tissue
D)
Pseudostratified epithelium: multiple layers of cells; deepest layer rests on basement membrane
9.
Connective tissue contains fibroblasts that are responsible for:
A)
providing a fibrous framework for capillaries.
B)
synthesis of collagen, elastin, and reticular fibers.
C)
forming tendons and the fascia that covers muscles.
D)
filling spaces between tissues to keep organs in place.
10.
Although all muscle tissue cells have some similarities, smooth muscle (also known as involuntary
muscle) differs by:
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.
Which of the following aspects of the function of the nucleus is performed by ribosomal RNA (rRN
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11.
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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.
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ta
nk
A)
Breakdown and removal of foreign substances and worn-out cell parts are performed by which of th
following organelles?
Lysosomes
B)
Golgi apparatus
C)
Ribosomes
D)
Endoplasmic reticulum (ER)
st
Impairment in the function of peroxisomes would result in:
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13.
A)
inadequate sites for protein synthesis.
an inability to transport cellular products across the cell membrane.
w
B)
insufficient energy production within a cell.
w
C)
accumulation of free radicals in the cytoplasm.
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 coupl
inability to become pregnant. Which of the following cellular components may be defective within t
mans sperm?
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D)
ba
A)
14.
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.
Which of the following membrane transport mechanisms requires the greatest amount of energy?
Facilitated diffusion
B)
Passive transport
C)
Vesicular transport
D)
Simple diffusion
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A)
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16.
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17.
A male patient with a diagnosis of type 1 diabetes mellitus is experiencing hyperglycemia because h
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?
Facilitated diffusion
B)
Simple diffusion
C)
Secondary active transport
D)
Endocytosis
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18.
nk
ta
A)
Which of the following statements is true of skeletal muscle cells?
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.
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st
A)
D)
Skeletal muscle is multinucleated, lacking true cell boundaries.
The connective tissue supporting blood vessels
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C)
The squamous epithelial cells of the skin
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A)
B)
Which of the following body tissues exhibits the highest rate of turnover and renewal?
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19.
D)
20.
The skeletal muscle that facilitates movement
The nervous tissue that constitutes the central nervous system
A patient with a pathophysiologic condition that affects the desmosomes is most likely to exhibit:
A)
impaired contraction of skeletal and smooth muscle.
B)
weakness of the collagen and elastin fibers in the extracellular space.
C)
impaired communication between neurons and effector organs.
D)
Answer Key
separation at the junctions between epithelial cells.
4.
D
5.
B
6.
C
7.
A
8.
C
9.
B
10.
A
11.
C
12.
A
13.
D
14.
B
15.
B
16.
C
17.
A
18.
D
19.
A
20.
D
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A
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3.
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C
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ta
2.
ba
B
st
1.
improved intracellular volume regulation.
w
C)
release of stored calcium from the mitochondria.
w
A)
B)
Ischemia and other toxic injuries increase the accumulation of intracellular calcium as a result of:
w
1.
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Chapter 05: Cellular Adaptation, Injury, and Death
D)
2.
decreased influx across the cell membrane.
attraction of calcium to fatty infiltrates.
The patient is found to have liver disease, resulting in the removal of a lobe of his liver. Adaptation to
reduced size of the liver leads to ___________ of the remaining liver cells.
A)
metaplasia
B)
organ atrophy
C)
compensatory hyperplasia
D)
physiologic hypertrophy
A)
caspase activation
B)
coagulation necrosis
C)
rapid phagocytosis
D)
protein p53 deficiency
4.
Bacteria and viruses cause cell damage by _______, which is unique from the intracellular damage
caused by other injurious agents.
disrupting the sodium/potassium ATPase pump
B)
interrupting oxidative metabolism processes
C)
replicating and producing continued injury
D)
decreasing protein synthesis and function
nk
The patient has a prolonged interruption in arterial blood flow to his left kidney, causing hypoxic cell
injury and the release of free radicals. Free radicals damage cells by:
nk
ta
5.
.c
A)
destroying phospholipids in the cell membrane.
B)
altering the immune response of the cell.
C)
disrupting calcium storage in the cell.
D)
inactivation of enzymes and mitochondria.
ba
A)
Injured cells have impaired flow of substances through the cell membrane as a result of:
increased fat load.
B)
altered permeability.
C)
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A)
.te
6.
altered glucose utilization.
D)
increased surface receptors.
w
stimulus overload.
genetic mutations.
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B)
Reversible adaptive intracellular responses are initiated by:
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7.
A)
om
3.
A person eating peanuts starts choking and collapses. His airway obstruction is partially cleared, but h
remains hypoxic until he reaches the hospital. The prolonged cell hypoxia caused a cerebral infarction
and resulting __________ in the brain.
C)
chemical messengers.
D)
mitochondrial DNA.
8.
Injured cells become very swollen as a result of:
A)
increased cell protein synthesis.
B)
altered cell volume regulation.
C)
passive entry of potassium into the cell.
D)
bleb formation in the plasma membrane.
A)
rapid apoptosis.
B)
cellular rupture.
C)
shrinkage and collapse.
D)
chronic inflammation.
changes with genetic influences.
B)
elimination of cell receptor sites.
C)
insufficient telomerase enzyme.
D)
DNA mutation or faulty repair.
An 89-year-old female patient has experienced significant decreases in her mobility and stamina dur
a 3-week hospital stay for the treatment of a femoral head fracture. Which of the following phenome
most likely accounts for the patients decrease in muscle function that underlies her reduced mobility
nk
ta
11.
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A)
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10.
A 99-year-old woman has experienced the decline of cell function associated with age. A group of
theories of cellular aging focus on programmed:
nk
9.
A diabetic patient has impaired sensation, circulation, and oxygenation of his feet. He steps on a piece
glass, the wound does not heal, and the area tissue becomes necrotic. The necrotic cell death is
characterized by:
Impaired muscle cell metabolism resulting from metaplasia
B)
Dysplasia as a consequence of inflammation during bone remodeling
C)
Disuse atrophy of muscle cells during a prolonged period of immobility
D)
Ischemic atrophy resulting from vascular changes while on bedrest
ba
A)
A 20-year-old college student has presented to her campus medical clinic for a scheduled Papanicola
(Pap) smear. The clinician who will interpret the smear will examine cell samples for evidence of:
st
12.
changes in cell shape, size, and organization.
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A)
B)
the presence of unexpected cell types.
ischemic changes in cell samples.
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C)
abnormally high numbers of cells in a specified field.
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D)
13.
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A)
Which of the following pathophysiologic processes is most likely to result in metastatic calcification
Benign prostatic hyperplasia
B)
Liver cirrhosis
C)
Impaired glycogen metabolism
D)
Hyperparathyroidism
14.
A)
Despite the low levels of radiation used in contemporary radiologic imaging, a radiology technician
aware of the need to minimize her exposure to ionizing radiation. What is the primary rationale for t
technicians precautions?
Radiation stimulates pathologic cell hypertrophy and hyperplasia.
B)
Radiation results in the accumulation of endogenous waste products in the cytoplasm.
C)
Radiation interferes with DNA synthesis and mitosis.
D)
Radiation decreases the action potential of rapidly dividing cells.
15.
The parents of a 4-year-old girl have sought care because their daughter has admitted to chewing and
swallowing imported toy figurines that have been determined to be made of lead. Which of the
following blood tests should the care team prioritize?
White blood cell levels with differential
B)
Red blood cell levels and morphology
C)
Urea and creatinine levels
D)
Liver function panel
.c
A 70-year-old male patient has been admitted to a hospital for the treatment of a recent hemorrhagic
stroke that has left him with numerous motor and sensory deficits. These deficits are most likely the
result of which of the following mechanisms of cell injury?
Free radical injury
B)
Hypoxia and ATP depletion
C)
Interference with DNA synthesis
D)
Impaired calcium homeostasis
17.
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ta
A)
nk
16.
om
A)
Which of the following processes associated with cellular injury is most likely to be reversible?
Cell damage resulting from accumulation of fat in the cytoplasm
B)
Cellular changes as a result of ionizing radiation
C)
Cell damage from accumulation of free radicals
D)
Apoptosis
18.
.te
st
ba
A)
The extrinsic pathway of apoptosis can be initiated by:
A)
damage to cellular DNA.
activation of death receptors on the cell surface.
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D)
activation of the p53 protein.
w
C)
decreased ATP levels.
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B)
19.
A patient with severe peripheral vascular disease has developed signs of dry gangrene on the great to
of one foot. Which of the following pathophysiologic processes most likely contributed to this
diagnosis?
A)
Inappropriate activation of apoptosis
B)
Bacterial invasion
C)
Impaired arterial blood supply
D)
Metaplastic cellular changes
20.
Which of the following facts underlies the concept of replicative senescence?
A)
Genes controlling longevity are present or absent in varying quantities among different
individuals.
B)
Telomeres become progressively shorter in successive generations of a cell.
C)
The damaging influence of free radicals increases exponentially in later generations of a cell.
A
6.
B
7.
C
8.
B
9.
B
10.
A
11.
C
12.
A
13.
D
14.
C
15.
B
16.
B
17.
A
18.
D
C
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19.
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5.
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C
nk
4.
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ta
B
ba
3.
st
C
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2.
Aging produces mutations in DNA and deficits in DNA repair.
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D)
Answer Key
1.
A
B
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20.
Chapter 06: Genetic Control of Cell Function and Inheritance
1.
Triplet codes of three bases are the genetic codes used in transmitting genetic information necessary f
A)
chromatin formation.
B)
protein synthesis.
C)
enzyme activation.
D)
nucleotide bonding.
Unlike messenger RNA (mRNA) and transfer RNA (tRNA), ribosomal RNA (rRNA):
A)
is produced in the nucleolus.
B)
delivers activated amino acids.
C)
is formed by transcription.
D)
coordinates RNA translation.
3.
Splicing of mRNA during processing permits a cell to:
form different proteins.
B)
increase DNA content.
C)
stop copying DNA onto RNA.
D)
add nucleic acid end pieces.
nk
When an infant is born with gene mutations in his/her cells, the errors may be a result of all of the
following except _____________ of base pairs.
A)
deletion
B)
substitution
C)
differentiation
D)
rearrangement
5.
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ta
4.
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A)
Identifying the genetic sex of a child is based on finding intracellular Barr bodies that consist of:
inactive chromatin material.
B)
male-specific chromosomes.
C)
homologous chromosomes.
D)
excess autosomal material.
6.
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st
ba
A)
Multifactorial inheritance is similar to polygenic inheritance because both involve:
A)
environmental effects on alleles.
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predictable somatic allele effects.
homozygous pairing of two alleles.
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D)
multiple alleles at different loci.
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B)
C)
7.
Crossing over of chromatid segments during meiosis division 1 results in:
A)
spontaneous gene mutations.
B)
initial DNA synthesis.
C)
bivalent X and Y genes.
D)
new gene combinations.
8.
A)
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2.
During the transcription process, RNA:
polymerase attaches to DNA.
B)
exon sequences are reversed.
C)
delivers activated amino acids.
D)
reverses redundant base pairs.
A)
mutation of normal suppressor genes.
B)
induction by an external influence.
C)
repression of internal penetrance.
D)
activation of growth control genes.
Gene therapy, insertion of genes into the genome of multicellular organisms, is accomplished by:
A)
restriction enzymes.
B)
transferring genes.
C)
DNA fragment separation.
D)
cross-over gene exchange.
Which of the following statements is true of genetic mutations?
nk
ta
11.
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10.
om
The process of gene expression is increased by:
nk
9.
Errors in DNA duplication are normally irreparable.
B)
Mutations that occur in somatic cells are inheritable.
C)
Mutations may result from extrinsic factors or from spontaneous error.
D)
Errors in DNA replication are most often fatal.
12.
Individual differences in appearance, behavior, and disease susceptibility are a result of:
karyotyping.
B)
mutations.
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st
A)
C)
DNA repair.
a haplotype.
mRNA is produced in the nucleolus.
mRNA provides the template for protein synthesis.
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B)
Which of the following statements is true of messenger RNA (mRNA)?
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13.
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D)
A)
ba
A)
C)
Each mRNA molecule has two recognition sites.
D)
mRNA delivers the activated form of an amino acid to the protein being synthesized.
14.
Prenatal genetic testing that counts the number of Barr bodies in a chromosome is able to determine:
A)
the genetic sex of a child.
B)
susceptibility to hemophilia B.
C)
the presence of fragile X syndrome.
D)
fetal viability.
15.
The gene responsible for a particular congenital cardiac anomaly is said to have complete penetrance
What are the clinical implications of this fact?
A)
The anomaly is a result of polygenetic inheritance.
B)
The heart defect does not result from any other gene.
C)
Multiple alleles contribute to the defect.
D)
All the individuals who possess the gene will exhibit the anomaly.
16.
A dominant genetic trait:
is expressed only in a heterozygous pairing.
B)
is expressed in either a homozygous or heterozygous pairing.
C)
is expressed only in a homozygous pairing.
D)
is expressed in some carriers.
A)
Hybridization studies
B)
Haplotype mapping
C)
Linkage studies
D)
Gene dosage studies
18.
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nk
Which of the following methods of genetic mapping focuses on the measurement of enzyme activity
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ta
17.
om
A)
Which of the following facts underlies the application of RNA interference in the treatment of disea
Restriction enzymes are able to cleave genetic molecules at predictable sites.
B)
It is possible to produce proteins that have therapeutic properties.
C)
Faulty gene activity that produces unwanted proteins can sometimes be stopped.
D)
Individual differences are attributable to a very small percentage of the genes in the human bo
19.
.te
st
ba
A)
Although the majority of cellular DNA exists in the cell nucleus, part of the cell DNA is located in t
A)
mitochondria.
microfilaments.
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D)
smooth endoplasmic reticulum.
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C)
Golgi apparatus.
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B)
20.
Which of the following is an application of recombinant DNA technology?
A)
Production of human insulin
B)
DNA fingerprinting
C)
Gene dosage studies
D)
Answer Key
1.
B
2.
A
Somatic cell hybridization
A
6.
B
7.
D
8.
A
9.
B
10.
B
11.
C
12.
D
13.
B
14.
A
15.
D
16.
B
17.
D
18.
C
19.
A
20.
A
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5.
.c
C
nk
4.
nk
ta
A
ba
3.
Genetic disorders that involve a single gene trait are characterized by:
.te
1.
st
Chapter 07: Genetic and Congenital Disorders
A)
multifactorial gene mutations.
chromosome rearrangements.
w
B)
abnormal numbers of chromosomes.
In addition to having a 50% chance of inheriting an autosomal dominant disorder from an affected pa
such a disorder is characterized by:
w
D)
Mendelian patterns of transmission.
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C)
2.
A)
aneuploidy of genes in all cells.
B)
deficiencies in enzyme synthesis.
C)
affected X transmission to daughters.
D)
varied gene penetration and expression.
3.
A)
Autosomal recessive disorders are characterized by:
age of onset later in life.
B)
abnormal protein structure.
C)
inborn errors of metabolism.
D)
one in two risk of a carrier child.
A)
his sons will be carriers.
B)
his father has the disorder.
C)
some of his sisters will be carriers.
D)
his daughters will have the disorder.
Multifactorial inheritance disorders, such as cleft palate, are often caused by____________ during fet
development.
multiple gene mutations
B)
dominant gene expression
C)
X-linked crossover problem
D)
polyploidy of chromosomes
6.
nk
ta
A)
The newborn has the distinctive physical features of trisomy 21, Down syndrome, which includes:
upward slanting of eyes.
B)
large, protruding ears.
C)
thin lips and small tongue.
D)
long fingers with extra creases.
ba
A)
Aneuploidy of the X chromosome can result in a monosomy or polysomy disorder. The manifestation
monosomy X, Turner syndrome, differ from polysomy X disorders in numerous ways that include:
st
7.
short-stature female individual..
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A)
B)
mental retardation.
enlarged breasts.
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C)
early onset puberty.
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D)
8.
A teratogenic environmental agent can cause birth defects when:
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A)
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5.
om
When a male child inherits an X-linked disorder from his heterozygous carrier mother,
nk
4.
inherited as a recessive trait.
B)
intense exposure occurs at birth.
C)
disjunction occurs during meiosis.
D)
retained during early pregnancy.
9.
Fetal alcohol syndrome (FAS) is unlike other teratogens in that the harmful effects on the fetus:
A)
directly result in liver damage.
B)
extend throughout the pregnancy.
C)
is most noticeable in adulthood.
D)
cause death in early childhood.
Prenatal diagnosis methods include the use of ultrasonography for identifying ________ abnormaliti
A)
cytogenic
B)
skeletal
C)
chromosomal
D)
a-fetoprotein
11.
A woman who is a carrier for which of the following diseases possesses the greatest likelihood of
passing the disease to her future children when heterozygous pairing exists?
Phenylketonuria (PKU)
B)
Tay-Sachs disease
C)
Neurofibromatosis
D)
Cystic fibrosis
nk
12.
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A)
om
10.
Which of the following statements is true of autosomal recessive disorders?
Onset is typically late in childhood or early in adulthood.
B)
Symptomatology is less uniform than with autosomal dominant disorders.
C)
Mitochondrial DNA is normally the site of genetic alteration.
D)
Effects are typically the result of alterations in enzyme function.
nk
ta
A)
ba
13.
The parents of a newborn infant are relieved that their baby was born healthy, with the exception of
cleft lip that will be surgically corrected in 10 or 12 weeks. Which of the nurses following statement
the parents best conveys the probable cause of the infants cleft lip?
Though you are both healthy, you likely both carry the gene for a cleft lip.
B)
Provided one of you had the gene for a cleft lip, your baby likely faced a 50/50 chance of havi
one.
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st
A)
C)
Your childs cleft lip likely results from the interplay between environment and genes.
w
A cleft lip can sometimes result from taking prescription drugs, even when theyre taken as
ordered.
w
D)
Which of the following practitioners is most likely to be of assistance in the early care of an infant w
a cleft lip?
w
14.
A)
Lactation consultant
B)
Respiratory therapist
C)
Occupational therapist
D)
Social worker
15.
A 41-year-old woman has made the recent decision to start a family, and is eager to undergo testing
mitigate the possibility of having a child with Down syndrome. Which of the following tests is most
likely to provide the data the woman seeks?
A)
Genetic testing of the woman
B)
Genetic testing of the woman and the father
C)
Prenatal blood tests
D)
Ultrasonography
16.
Genetic testing has revealed that a male infant has been born with an extra X chromosome. What are
most likely implications of this finding?
The child is unlikely to survive infancy
B)
The child is likely to have no manifestations of this chromosomal abnormality
C)
The child will have significant neurological and cognitive defects
D)
The child will be unable to reproduce
Which of the following variables determine the extent of teratogenic drug effects? Select all that app
.c
17.
om
A)
Maternal health history
B)
Molecular weight of the drug
C)
Stage of pregnancy when the drug was taken
D)
Duration of drug exposure
E)
Fetal blood type
nk
ta
A woman who has just learned that she is pregnant for the first time has sought advice from her
healthcare provider about the safe use of alcohol during pregnancy. What advice should the clinician
provide to the woman?
ba
18.
nk
A)
Its likely best to eliminate alcohol from your diet while youre pregnant.
B)
Moderation in alcohol use is critical while you are pregnant.
C)
You should limit yourself to a maximum of one drink daily while youre pregnant.
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st
A)
D)
You should drink no alcohol until you are in your second trimester.
Tenovaginitis and human papillomavirus
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C)
Rubella and herpes
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A)
B)
Which of the following health problems may be identified by a TORCH screening test?
w
19.
D)
20.
Rhinovirus and Ormond disease
Chlamydia and rickets
Ultrasonography is most likely to detect which of the following fetal abnormalities?
A)
Neural tube defects
B)
Skeletal abnormalities
C)
Chromosomal defects
D)
Answer Key
Single-gene disorders
C
2.
D
3.
C
4.
C
5.
A
6.
A
7.
A
8.
D
9.
B
10.
B
11.
C
12.
D
13.
C
14.
A
15.
C
16.
B
17.
B, C, D
18.
A
19.
A
20.
B
.te
Chapter 08: Neoplasia
st
ba
nk
ta
nk
.c
om
1.
w
w
a.
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MULTIPLE CHOICE
1. What is a benign neoplasm originating from adipose tissue called?
Adenoma
b.
Lipoma
c.
Fibrosarcoma
d.
Adenocarcinoma
ANS: B REF: 550
a.
Carcinomas
b.
Sarcomas
c.
Melanomas
d.
Fibromas
om
2. What are malignant neoplasms arising from connective tissue cells called?
It is unencapsulated and invasive.
b.
It consists of undifferentiated cells.
c.
It exerts systemic effects.
d.
Cells appear relatively normal.
ba
nk
ta
a.
nk
3. Which of the following is a characteristic of a benign tumor?
.c
ANS: B REF: 550
st
ANS: D REF: 550
.te
4. Which factor provides the basis for the grading of newly diagnosed malignant tumors?
Degree of differentiation of the cells
w
c.
Number of metastases
w
b.
Size of the tumor
w
a.
d.
Number of lymph nodes involved
ANS: C REF: 551
5. A warning sign of possible cancer would be any of the following EXCEPT:
a.
persistent, unusual bleeding.
b.
a change in bowel habits.
c.
sudden development of fever, nausea, and diarrhea.
d.
a change in shape, color, or surface of a skin lesion.
6. The common local effects of an expanding tumor mass include:
1. obstruction of a tube or duct.
.c
2. anemia and weight loss.
om
ANS: C REF: 552
nk
3. cell necrosis and ulceration.
nk
ta
4. tumor markers in the circulation.
a.
1, 2
1, 3
ba
b.
st
c.
3, 4
.te
d.
2, 4
ANS: B REF: 552
w
The effects of substances such as hormones secreted by the tumor cells
w
a.
w
7. Which of the following does paraneoplastic syndrome refer to?
b.
Severe weight loss and cachexia associated with advanced cancer
c.
The decreased resistance to infection resulting from malignant tumors
d.
The effects of multiple metastatic tumors
ANS: A REF: 553
8. Which term refers to the spread of malignant cells through blood and lymph to distant sites?
Invasiveness
b.
Seeding
c.
Metastasis
d.
Systemic effect
om
a.
ANS: C REF: 554
.c
9. One reason for staging a malignant tumor at the time of diagnosis is to:
identify the original cell from which the tumor developed.
b.
locate and identify the primary tumor.
c.
decide the initiating factor for a particular tumor.
d.
determine the best treatment and prognosis.
ba
nk
ta
nk
a.
st
ANS: D REF: 556
10. The process of carcinogenesis usually begins with:
exposure to promoters causing dysplasia.
b.
development of defective genes.
w
w
an irreversible change in the cell DNA.
w
c.
.te
a.
d.
a single exposure to a known risk factor causing temporary cell damage.
ANS: C REF: 557
11. What would be an external source of ionizing radiation?
a.
A needle containing a radioisotope implanted beside the tumor
b.
Gamma rays delivered by a cobalt machine
c.
A dose of a radioactive drug to be ingested
d.
A fluid containing radioactive material instilled in a body cavity
om
ANS: B REF: 560
b.
the cells in the center of the tumor.
c.
primarily rapidly dividing cells.
d.
radioresistant cells.
ba
ANS: C REF: 560
nk
all cells in the tumor at one time.
nk
ta
a.
.c
12. Radiation therapy destroys:
13. The most critical adverse effects of chemotherapy and radiation therapy are:
thrombocytopenia and leucopenia.
b.
headache and lethargy.
.te
w
alopecia and weight loss.
w
d.
nausea and constipation.
w
c.
st
a.
ANS: A REF: 567
14. Chemotherapy usually involves a combination of drugs in order to:
1. reduce the adverse effects.
2. guarantee that all cancer cells are destroyed.
3. be effective in more phases of the cell cycle.
4. totally block the mitotic stage.
1, 3
b.
1, 4
c.
2, 3
d.
3, 4
om
a.
ANS: A REF: 561
.c
15. Why does ovarian cancer have a poor prognosis?
The ovaries are inaccessible for examination.
b.
Specific signs rarely appear until after secondary tumors have developed.
c.
The same tumor markers are present with many types of cancer.
d.
No effective treatment is available.
ba
nk
ta
nk
a.
st
ANS: B REF: 565
16. Select the correct pair representing a malignant tumor and its marker:
colon cancer: carcinoembryonic antigen (CEA)
b.
hepatic cancer: CA125, AFP
w
w
prostate cancer: human chorionic gonadotropin (hCG)
w
c.
.te
a.
d.
testicular cancer: Philadelphia chromosome
ANS: A REF: 553
17. Antiangiogenesis drugs act on a malignant tumor by:
a.
promoting the immune response and removal of abnormal tumor cells.
b.
blocking hormonal stimulation of tumor cells.
c.
reducing blood flow and nutrient supply to tumor cells.
d.
transporting radioisotopes into the tumor.
om
ANS: C REF: 563
18. The development of neutropenia during chemotherapy for cancer means:
the cancer cells are being destroyed quickly.
b.
the patient is likely to hemorrhage.
c.
higher doses of chemotherapy could be tolerated by this patient.
d.
the patient is at high risk for infection.
nk
ta
nk
.c
a.
19. Malignant brain tumors:
ba
ANS: D REF: 562
metastasize quickly to all parts of the body.
b.
spread first to lungs and bone.
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w
do not metastasize anywhere at any time.
w
d.
spread to other parts of CNS.
w
c.
st
a.
ANS: C REF: 565-566
20. Identify the common dose-limiting factor for chemotherapy:
a.
Alopecia
b.
Bone marrow depression
c.
Nausea and vomiting
d.
Weight loss
ANS: B REF: 562
21. Glucocorticoids are often prescribed during a course of chemotherapy and radiation because:
glucocorticoids greatly potentiate the effect of chemotherapy.
b.
the immune system is stimulated.
c.
skeletal muscle atrophy will be decreased.
d.
inflammation around the tumor may be reduced.
nk
ta
nk
.c
om
a.
ANS: D REF: 563
22. Vomiting frequently follows a chemotherapy treatment because:
the gastrointestinal tract is irritated.
b.
the chemicals stimulate the emetic center.
c.
the drugs have an unpleasant odor.
st
.te
w
A and B
w
d.
ba
a.
ANS: D REF: 562
w
23. What type of normal cells are often damaged during chemotherapy and radiation treatments?
a.
Epithelial cells
b.
Skeletal muscle cells
c.
Nerve tissue
d.
Collagen and fibrous tissue
ANS: A REF: 561
chemotherapy cannot be used.
b.
signs and symptoms are absent.
c.
complications are evident.
d.
metastases occur.
nk
.c
a.
om
24. Remission for cancer is generally defined as a period in which:
nk
ta
ANS: B REF: 564
25. All of the following are correct statements about skin cancers EXCEPT:
They are difficult to diagnose and treat.
b.
They usually develop slowly on the head, neck, or back of individuals with fair skin.
c.
The number of skin cancer cases is increasing.
d.
Basal cell carcinoma is the most common form of skin cancer.
.te
st
ba
a.
w
ANS: A REF: 564
w
26. High risk factors for cancer include:
w
1. human papilloma virus.
2. chronic irritation and inflammation.
3. repeated sun exposure.
4. high family incidence.
a.
1, 3
b.
3, 4
c.
1, 2, 4
d.
1, 2, 3, 4
ANS: D REF: 556 | 557
27. The term apoptosis refers to:
programmed cell death.
b.
abnormal or immature cells.
c.
degree of differentiation of cells.
d.
the development of new capillaries in a tumor.
ANS: A REF: 549
nk
ta
nk
.c
om
a.
28. The warning signs for cancer include:
unusual bleeding.
b.
change in a wart or mole (e.g., color).
c.
a new solid lump, often painless.
st
.te
w
All the above
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d.
ba
a.
ANS: D REF: 552
w
29. A classification process that applies to a specific malignant tumor and describes the extent of
the disease at a given time is called:
a.
seeding.
b.
mutation.
c.
staging.
d.
grading.
ANS: C REF: 556
30. Benign tumors can often be differentiated from malignant tumors because benign tumors:
often have systemic effects.
b.
contain cells showing increased mitosis and atypical rapid growth.
c.
are encapsulated and slow-growing.
d.
can metastasize or invade nearby tissue.
nk
.c
om
a.
nk
ta
ANS: C REF: 550
31. Benign tumors in the brain are often life-threatening because they:
metastasize early in their development.
b.
create excessive pressure within the skull.
c.
cannot be removed.
d.
cause serious systemic effects.
.te
st
ba
a.
w
ANS: B REF: 565
w
a.
w
32. Drugs or agents that augment the natural immune response in the body to improve
identification and removal of abnormal cells are called:
biological response modifiers.
b.
angiogenesis stimulators.
c.
analgesic complements.
d.
targeted receptor modifiers.
ANS: A REF: 563
radiation therapy.
b.
thermolysis intervention.
c.
brachytherapy.
d.
radiofrequency ablation.
.c
a.
om
33. The method that can be used as an alternative to surgical removal of a tumor by using heat
generated by a needle inserted into the tumor is referred to as:
nk
ANS: D REF: 559
nk
ta
34. Staging systems used to classify a malignant tumor at the time of diagnosis are based on
which of the following factors?
Size of the tumor, involvement of lymph nodes, metastases
b.
Location of tumor, size, type of cellular abnormality
c.
Size, encapsulated or non-encapsulated, invasion into neighboring tissue
d.
Type of cellular abnormality, size of secondary tumors, location/tissue affected
.te
st
ba
a.
ANS: A REF: 556
w
w
a.
w
35. One of the general effects of a malignant cancer is cachexia, which is:
severe bleeding.
b.
severe tissue wasting.
c.
severe fatigue.
d.
multiple opportunistic infections.
Chapter 09: Stress and Adaptation
MULTIPLE CHOICE
1. Hans Selye defined his general adaptation syndrome concept, which is also known as:
fight or flight.
b.
compensate or compromise.
c.
restrain or release.
d.
avoid and flee.
om
a.
.c
ANS: A REF: 618
nk
2. Improved function of the heart and brain during a stress response results from:
1. glycogenesis.
nk
ta
2. bronchodilation.
3. vasoconstriction in the skin and viscera.
ba
4. decreased metabolic rate.
a.
.te
st
b.
2, 3
2, 4
3, 4
w
d.
w
c.
1, 2
w
ANS: B REF: 619
3. In which of the following situations would the stress response be used to prevent blood
pressure from dropping too low?
a.
Increasing anger during an argument
b.
Writing a final examination
c.
Fear about a medical diagnosis
d.
Internal hemorrhage from injuries in a car accident
ANS: D REF: 619
4. During the stress response, endorphins act as:
pain blockers.
b.
cerebral function depressors.
c.
stimulators of increased secretion of aldosterone and insulin.
d.
an enhancer of the immune response.
nk
.c
om
a.
nk
ta
ANS: A REF: 619
5. Severe, prolonged stress may cause acute renal failure or stress ulcers to develop as a result of:
a deficit of glucose and oxygen in the body.
b.
the development of decompensated acidosis.
c.
prolonged vasoconstriction and ischemia.
d.
the supply of hormones having been exhausted.
.te
st
ba
a.
w
ANS: C REF: 621
w
a.
w
6. Selye defined three stages in the stress response. The third stage is designated as the:
alarm stage.
b.
resistance stage.
c.
stage of exhaustion.
d.
maladaptive stage.
ANS: C REF: 619
7. The stress response involves the integrated action of the:
1. hypothalamus.
2. hypophysis.
3. sympathetic nervous system.
2, 3
c.
1, 2, 4
d.
1, 2, 3, 4
.c
b.
nk
1, 3
nk
ta
a.
om
4. adrenal glands.
ANS: D REF: 619
ba
8. Possible complications caused by prolonged, severe stress include all of the following
EXCEPT:
hypertension.
b.
tension headache.
.te
st
a.
blindness.
w
d.
diabetes mellitus.
w
c.
w
ANS: D REF: 620-621
9. A serious consequence of a major disaster, first recognized in war veterans is:
a.
stress ulcers.
b.
delayed tissue healing.
c.
posttraumatic stress disorder (PTSD).
d.
cancer.
ANS: C REF: 622
10. Which of the following may alter a persons perception of a stressor?
The presence of several stressors at the same time
b.
Past experiences
c.
Lack of effective coping mechanisms
d.
A, B, and C
nk
ta
Chapter 10: Alterations in Temperature Regulation
nk
.c
om
a.
b.
Brainstem
c.
Hypothalamus
ba
1. When the nurse is taking a patients temperature, which principle should the nurse remember?
Regulation of body temperature primarily occurs in the:
a.
Cerebrum
w
w
w
.te
st
d.
Pituitary gland
ANS: C
Temperature regulation (thermoregulation) is mediated primarily by the hypothalamus.
Temperature regulation (thermoregulation) is mediated primarily by the hypothalamus, not the
cerebrum.
Temperature regulation (thermoregulation) is mediated primarily by the hypothalamus, not the
brainstem.
Temperature regulation (thermoregulation) is mediated primarily by the hypothalamus, not the
pituitary gland.
10. When the nurse is discussing the patients cyclical temperature fluctuation occurring on a
daily basis, what term should the nurse use?
a.
Thermogenesis cycle
b.
Thermoconductive phases
c.
Adaptive pattern
d.
Circadian rhythm
ANS: D
Internal temperature varies in response to activity, environmental temperature, and daily
fluctuation (circadian rhythm).
Temperature fluctuation is related to circadian rhythm, not thermogenesis cycle.
Temperature fluctuation is related to circadian rhythm, not thermoconductive phases.
Temperature fluctuation is related to circadian rhythm, not adaptive pattern.
2. A nurse wants to teach about one of the primary organs responsible for heat production.
Which organ should the nurse include?
a.
Pancreas
b.
Liver
c.
Adrenal gland
ba
nk
ta
nk
.c
om
d.
Heart
ANS: C
The adrenal gland is one of the organs responsible for heat production because thyroxine acts on
the adrenal medulla causing the release of epinephrine into the bloodstream. Epinephrine causes
vasoconstriction that increases metabolic rates, thus increasing heat production.
The pancreas does not play a role in heat production; the adrenal gland does as it releases
epinephrine. which increases metabolic rates and increases heat production.
The liver does not play a role in heat production; the adrenal gland does as it releases
epinephrine, which increases metabolic rates and increases heat production.
The heart does not play a role in heat production; the adrenal gland does as it releases
epinephrine, which increases metabolic rates and increases heat production.
3. Which statement by a patient indicates teaching was successful for heat loss? Heat loss from
the body via convection occurs by:
a.
Evaporation of electromagnetic waves
b.
Transfer of heat through currents of liquids or gas
c.
Dilation of blood vessels bringing blood to skin surfaces
w
w
w
.te
st
d.
Direct heat loss from molecule-to-molecule transfer
ANS: B
Convection occurs by transfer of heat through currents of gases or liquids, exchanging warmer
air at the bodys surface with cooler air in surrounding space.
Convection occurs by transfer of heat through gases or liquids, not electromagnetic waves.
Convection occurs by transfer of heat through gases or liquids, not dilation of blood vessels
bringing blood to skin surfaces.
Convection occurs by transfer of heat through gases or liquids, not direct heat loss from
molecule-to-molecule transfer.
4. For evaporation to function effectively as a means of dissipating excess body heat, which one
of the following conditions must be present?
a.
Moisture
b.
Fever
c.
Pyrogens
d.
ANS: A
Trauma
b.
Increased skeletal muscle tone
c.
Increased heat production
om
Moisture must be present because heat is lost through evaporation from the surface of skin and
lining of mucous membranes, a major source of heat reduction connected with increased
sweating in warmer surroundings.
Fever is not required for evaporation to occur, but moisture is.
Pyrogens are heat producers and do not assist with evaporation, but moisture is required.
Trauma is not a portion of the evaporative process of heat loss.
5. A 25-year-old female received a prescription for a weight loss pill. One effect of the pills is to
increase the release of epinephrine. Which of the following would be expected to also occur?
a.
Decreased vascular tone
nk
ta
nk
.c
d.
Decreased basal metabolic rate
ANS: C
Epinephrine causes vasoconstriction, stimulates glycolysis, and increases metabolic rates, thus
increasing heat production.
Epinephrine increases vascular tone, but this does not lead to heat production.
Epinephrine does not increase skeletal muscle tone.
Epinephrine increases metabolic rate.
6. When a patient has a fever, which of the following thermoregulatory mechanisms is activated?
a.
The bodys thermostat is adjusted to a lower temperature.
Temperature is raised above the set point.
c.
Bacteria directly stimulate peripheral thermogenesis.
ba
b.
Endotoxins
w
b.
w
w
.te
st
d.
The bodys thermostat is reset to a higher level.
ANS: D
Fever (febrile response) is a temporary resetting of the hypothalamic thermostat to a higher level
in response to endogenous or exogenous pyrogens.
Fever is the result of the bodys attempt to raise temperature, not adjust it to a lower level.
When fever occurs, the temperature is raised, but the rise is due to a reset of the thermostat.
Bacteria do not stimulate peripheral thermogenesis, but their endotoxins do.
7. A patient has researched exogenous pyrogens on the Internet. Which information indicates the
patient has a good understanding? Exogenous pyrogens are:
a.
Interleukins
c.
Prostaglandins
d.
Corticotropin-releasing factors
ANS: B
Exogenous pyrogens are endotoxins.
Exogenous pyrogens are endotoxins, not interleukins.
Exogenous pyrogens are endotoxins, not prostaglandins.
Exogenous pyrogens are endotoxins, not corticotropin-releasing factors.
8. Hikers are attempting to cross the Arizona desert with a small supply of water. The
temperatures cause them to sweat profusely and become dehydrated. The hikers are
experiencing:
a.
Heat cramping
b.
Heat exhaustion
c.
Heat stroke
ba
nk
ta
nk
.c
om
d.
Malignant hyperthermia
ANS: B
Heat exhaustion results from prolonged high core or environmental temperatures, which cause
profound vasodilation and profuse sweating, leading to dehydration, decreased plasma volumes,
hypotension, decreased cardiac output, and tachycardia. Symptoms include weakness, dizziness,
confusion, nausea, and fainting.
Heat cramping is severe, spasmodic cramps in the abdomen and extremities that follow
prolonged sweating and associated sodium loss. Heat cramping usually occurs in those not
accustomed to heat or those performing strenuous work in very warm climates.
Heat stroke is a potentially lethal result of an overstressed thermoregulatory center. With very
high core temperatures (>40 C; 104 F), the regulatory center ceases to function, and the bodys
heat loss mechanisms fail.
Malignant hyperthermia is a potentially lethal complication of a rare inherited muscle disorder
that may be triggered by inhaled anesthetics and depolarizing muscle relaxants.
9. A 10-year-old male sneaks into a meat freezer at the local supermarket. Fearing he will get
caught if he comes out, he decides to stay in there for several hours until the store closes. While
in the cooler his body is most likely experiencing:
a.
Increased respirations
Ischemic tissue damage
c.
CNS excitation
st
b.
w
w
w
.te
d.
Increased cellular metabolism
ANS: B
Hypothermia (marked cooling of core temperature) produces depression of the central nervous
and respiratory systems, vasoconstriction, alterations in microcirculation, coagulation, and
ischemic tissue damage.
Hypothermia does not lead to increased respirations; it leads to ischemia.
Hypothermia does not lead to CNS excitation; it leads to ischemia.
Hypothermia does not lead to increased cellular metabolism; it leads to ischemia.
10. Which finding indicates the patient is having complications from heat stroke?
a.
Mild elevation of core body temperatures
b.
Cerebral edema and degeneration of the CNS
c.
Spasmodic cramping in the abdomen and extremities
d.
ANS: B
Alterations in calcium uptake
b.
Hypothyroidism
c.
Reimplantation surgery
.c
om
Symptoms of heat stroke include high core temperature, absence of sweating, rapid pulse,
confusion, agitation, coma, and complications include cerebral edema and degeneration of the
CNS.
Characteristics of heat stroke include cerebral edema and degeneration of CNS, not mild
elevation of core body temperature.
Characteristics of heat stroke include cerebral edema and degeneration of the CNS, not
cramping.
Characteristics of heat stroke include cerebral edema and degeneration of the CNS, not
alterations in calcium uptake.
11. For which patient would the primary care provider order therapeutic hypothermia? A patient
with:
a.
Malnutrition
nk
ta
nk
d.
Parkinson disease
ANS: C
Therapeutic hypothermia is seen with reimplantation surgery.
Therapeutic hypothermia is seen with reimplantation surgery, not malnutrition.
Therapeutic hypothermia is seen with reimplantation surgery, not hypothyroidism.
Therapeutic hypothermia is seen with reimplantation surgery, not Parkinson disease.
ba
Chapter 11: Activity Tolerance and Fatigue
st
MULTIPLE CHOICE
w
.te
1.The nurse working on an orthopedic unit has to assist many of the patients because of limited
mobility. The nurses goal is to maintain a position that most favors function, requires the least
muscular work to maintain, and places the least strain on muscles, ligaments, and bones. What is
the term that best describes this goal?
w
b.
w
a.
Body alignment
Posture
c.
Center of gravity
d.
Balance
ANS: B
The term posture means maintaining optimal body position. It means a position that most favors
function, requires the least muscular work to maintain, and places the least strain on muscles,
ligaments, and bones. Center of gravity refers to the term that describes how body balance is
achieved, over a wide stable base of support. Body alignment refers to the relationship of one
body part to another body part along a horizontal or vertical line. Correct alignment reduces
strain on musculoskeletal structures, maintains adequate muscle tone, and contributes to balance.
OBJ: Describe the role of the skeleton, skeletal muscles, and nervous system in the regulation of
movement. TOP: Nursing Process: Assessment
om
MSC: Client Needs: Safe and Effective Care Environment
b.
Trochanter rolls to the feet
c.
Foot boots as ordered
d.
Pillows to elevate the feet
nk
Pillows to dorsiflex the foot
ba
nk
ta
a.
.c
2.The nurse is taking care of a 78-year-old comatose patient. The nurse has placed the patient in
a supine position. To prevent foot drop, the nurse applies which of the following?
ANS: C
w
.te
st
Avoid pressure on the back of the legs and heelspillows elevating the feet or dorsiflexing the foot
may cause increased pressure. Use a foot boot to prevent footdrop, maintain proper alignment,
and provide freedom of movement for the feet. When a patient is immobile, use pillows,
trochanter rolls, and hand rolls or arm splints to increase comfort and reduce injury to the skin or
musculoskeletal system.
w
OBJescribe the interventions for maintaining proper alignment, assisting a patient in moving up
in bed, repositioning a patient needing assistance, and transferring a patient from a bed to a
chair.TOP:Nursing Process: Implementation
w
MSC: Client Needs: Safe and Effective Care Environment
3.A nurse who works on the orthopedic unit knows that in addition to providing support, bones
perform other functions in the body. Besides support, which of the following is an important
bone function used during activity and exercise?
a.
Hematopoiesis
b.
Protection
c.
Mineral storage
d.
Movement
ANS: D
.c
om
Bones perform five functions in the body: support, protection, movement, mineral storage, and
hematopoiesis (blood cell formation). Two of these functionssupport and movementare most
important during activity and exercise. In support, bones serve as the framework and contribute
to the shape, alignment, and positioning of the body parts. In movement, bones with their
joints constitute levers for muscle attachment. Hematopoiesis and mineral storage are not
involved with bone function during activity and exercise.
nk
OBJ: Describe the role of the skeleton, skeletal muscles, and nervous system in the regulation of
movement. TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment
nk
ta
4.The patient has been diagnosed with a progressive neuromuscular disease and is having
difficulty walking and has decreased awareness of the bodys position. What is the term that best
describes this phenomenon?
Balance
ba
a.
Proprioception
st
b.
Posture
.te
c.
Hemiplegia
w
ANS: B
w
d.
w
Proprioception is the awareness of the position of the body and its parts and is dependent on
impulses from the inner ear and from receptors in joints and ligaments. The nervous system also
regulates posture. Posture is incorrect because it requires coordination of proprioception and
balance. Balance is incorrect because it is controlled by the inner ear and the cerebellum.
Hemiplegia is incorrect because this term is used to describe paralysis on one side of the body.
OBJ: Describe the role of the skeleton, skeletal muscles, and nervous system in the regulation of
movement. TOP: Nursing Process: Assessment
MSC:Client Needs: Physiological Integrity
b.
Cerebrum
c.
Cerebellum
d.
Hypothalamus
.c
Pons
nk
a.
om
5.As the result of a brain tumor, a patient is having trouble with balance. The patients significant
other is concerned and asks the nurse how a tumor could affect the patients balance. The nurse
explains that the tumor is growing in the part of the brain that is responsible for balance. The
significant other asks, Which part of the brain controls balance? The nurses response would be
which of the following?
ANS: C
ba
nk
ta
The cerebellum and the inner ear control balance through the nervous system. The major
function of the cerebellum is to coordinate all voluntary movement. The pons deals with levels of
arousal, consciousness, and sleep. The cerebrum controls thoughts, memory, decision making,
and communication. The hypothalamus controls the autonomic functions of the peripheral
nervous system.
OBJ: Describe the role of the skeleton, skeletal muscles, and nervous system in the regulation of
movement. TOP: Nursing Process: Assessment
st
MSC:Client Needs: Physiological Integrity
.te
6.Which group of muscles is involved with joint stabilization?
w
w
b.
Skeletal muscles
w
a.
Antigravity muscles
c.
Synergistic muscles
d.
Antagonistic muscles
ANS: B
Antigravity muscles are involved with joint stabilization. Skeletal muscles support posture and
carry out voluntary movement. Antagonistic muscles bring about movement at the joint.
Synergistic muscles contract to accomplish the same movement. When you flex your arm, you
increase the strength of the contraction of the biceps brachii by contraction of the synergistic
muscle, the brachialis.
OBJ: Describe the role of the skeleton, skeletal muscles, and nervous system in the regulation of
movement. TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment
om
7.The patient is a 46-year-old woman who is a devout Muslim and who is being evaluated for
weight-loss surgery. One aspect of the comprehensive bariatric program is that clients begin an
exercise program. The patient is self-conscious about her weight and concerned about
maintaining her modesty. Which of the following exercise programs would be the best choice for
the nurse to suggest?
A private trainer at a local fitness center
b.
An aerobics class at the local YMCA
c.
The evening yoga class at a local country club
d.
Walking 30 minutes a day at the mall with a friend
nk
ta
nk
.c
a.
ba
ANS: D
w
.te
st
Exercise and physical fitness are beneficial to all people. When developing a physical fitness
program for culturally diverse populations, consider what motivates individuals to exercise and
what activities will be appropriate and enjoyable. Modesty and discretion are highly valued in
the Muslim culture. Public aerobics and yoga classes may make the devout Muslim
uncomfortable and violate her sense of modesty. Based on her religious and cultural background,
the use of a private trainer, an aerobics class at the local YMCA, or yoga classes at the local
country club are incorrect choices for this patient.
w
OBJ: Write a nursing care plan for a patient with impaired body alignment and activity.
w
TOP:Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
8.A small business owner has noted an increase in back injuries at his company in recent years.
During a discussion with an occupational health nurse, knowledge of statistical information
regarding this trend throughout the country is exchanged. The occupational health nurse explains
that the most common back injury is caused by a strain to which of the following muscle groups?
a.
Lumbar
b.
Cervical
c.
Thoracic
d.
Trapezius
om
ANS: A
nk
.c
The most common back injury is strain on the lumbar muscle group, which includes the muscles
around the lumbar vertebrae. Injury to these areas affects the ability to bend forward, backward,
and side to side. This also decreases the ability to rotate the hips and lower back. The cervical
response is incorrect because it refers to the neck region of the back. The thoracic response is
incorrect because it refers to the rib/chest area of the back which has decreased movement. The
trapezius is incorrect because it refers to a muscle in the back over the scapula.
nk
ta
OBJiscuss the physiological and pathological influences on body alignment and joint
mobility.TOP:Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
ba
9.The nurse is assigned to a 79-year-old patient who has decreased mobility resulting from a
stroke. The nurse understands the interventions to prevent skin breakdown for this bedfast patient
is to include repositioning of the patient at least every _____ hour(s).
st
a.
.te
b.
w
2
3
4
w
d.
w
c.
1
ANS: B
In general, you reposition patients as needed and at least every 2 hours if they are in bed and
every 1 hour if they are sitting in a chair.
OBJ: Evaluate the nursing care plan for maintaining body alignment and activity.
TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity
10.The nurse is assigned to take care of a 56-year-old patient with COPD. The patient does not
tolerate a supine position for sleeping. In what position should the nurse place the patient?
Lateral
b.
Prone
c.
Semi-Fowlers
d.
Sims
om
a.
ANS: C
nk
ta
nk
.c
In semi-Fowlers position the head of the bed is at a 30-degree angle. Use this position for
patients who cannot tolerate a supine position, such as those with cardiac and respiratory
problems. Prone position is incorrect because it can compromise lung expansion. Lateral position
is incorrect because patients who are obese or older do not tolerate this position for any length of
time. Sims position is incorrect because it is a semi-prone position that can compromise lung
expansion.
OBJ: Write a nursing care plan for a patient with impaired body alignment and activity.
TOP:Nursing Process: Implementation
ba
MSC: Client Needs: Health Promotion and Maintenance
st
11.The nurse is assigned to a 67-year-old comatose patient. To minimize the risk for aspiration,
the nurse should avoid placing the patient in what position?
Semi-Fowlers
.te
a.
w
w
c.
Sims
w
b.
d.
Supine
Lateral
ANS: C
The risk for aspiration is greater in the supine position; thus avoid this position when the patient
is confused, agitated, experiencing a decreased level of consciousness, or is at risk for aspiration.
Semi-Fowlers is an incorrect answer because that is the position of choice to prevent aspiration.
Sims is incorrect because it is a semi-prone position that would allow the stomach contents to
exit the body if the patient experienced emesis. Lateral is incorrect because the patient would be
placed on his or her side, which would promote the exit of stomach contents if the patient
experiences emesis.
PTS:1DIF:Cognitive Level: Applying (Application)
OBJescribe the interventions for maintaining proper alignment, assisting a patient in moving up
in bed, repositioning a patient needing assistance, and transferring a patient from a bed to a
chair.TOP:Nursing Process: Implementation
MSC:Client Needs: Reduction of Risk Potential
b.
Weight-bearing exercises
c.
Aerobic exercises
d.
Passive range-of-motion exercises
nk
Active range-of-motion exercises
ba
nk
ta
a.
.c
om
12.A 19-year-old patient with cerebral palsy has been admitted to the hospital with pneumonia.
The patient has limited voluntary motor control. The student nurse caring for this patient, knows
that the easiest intervention to maintain joint mobility would be to perform which of the
following exercises?
st
ANS: D
.te
For the patient who does not have voluntary motor controls, passive range-of-motion exercises
are the exercises of choice. Because of limited voluntary motor control, active range of motion
exercises, aerobic exercises, and weight-bearing exercises are incorrect responses for this patient.
w
PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
w
OBJiscuss the physiological and pathological influences on body alignment and joint
mobility.TOP:Nursing Process: Planning
w
MSC: Client Needs: Health Promotion and Maintenance
13.A patient has been hospitalized for 5 days after pancreatic surgery. The nurse is preparing the
patient to ambulate for the first time. What is the best action for the nurse to perform to prevent
the patient from suffering orthostatic hypotension?
a.
Have him sit up in bed for a few minutes before standing.
b.
Have him sit up with his legs dangling over the side of his bed for a few minutes before standing.
c.
Place him in a high-Fowlers position for a few minutes before standing.
d.
Place him in a low-Fowlers position for a few minutes before standing.
ANS: B
.c
om
When preparing a patient for ambulation, dangling is an important technique. You assist the
patient to a sitting position with the legs dangling off the side of the bed and have the patient rest
for 1 to 2 minutes before standing. When the patient has been flat for extended periods, blood
pressure drops when the patient stands. Dangling helps to prevent this. Sitting up in bed or
placing the patient in high- or low-Fowlers position does not allow for the changes in circulation
to occur before ambulation.
PTS:1DIF:Cognitive Level: Applying (Application)
nk
ta
nk
OBJescribe the interventions for maintaining proper alignment, assisting a patient in moving up
in bed, repositioning a patient needing assistance, and transferring a patient from a bed to a
chair.TOP:Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment
ba
14.A student nurse is assisting a patient who is ambulating with a new walker. Which of the
following is appropriate information for student nurse to provide to the patient?
The top of the walker should line up with the crease on the inside of your elbows.
b.
You should walk behind the walker to maintain balance.
c.
You should lean forward over the walker to maintain balance.
d.
When walking, you should take a step, move the walker forward, and take another step.
w
w
.te
st
a.
w
ANS: D
When the person relaxes the arms at the side of their body, the top of the walker should line up
with the crease on the inside of the wrist. A walker is fitted correctly by having the patient step
inside the walker. The persons elbow should bend comfortably, about 30 degrees, while holding
onto the grips. When walking, the patient holds the handgrips on the upper bars, takes a step,
moves the walker forward, and takes another step. The patient should not lean over the walker or
walk behind it; otherwise he or she might lose balance and fall.
PTS:1DIF:Cognitive Level: Applying (Application)
OBJescribe the interventions for maintaining proper alignment, assisting a patient in moving up
in bed, repositioning a patient needing assistance, and transferring a patient from a bed to a
chair.TOP:Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment
15.A student nurse is caring for 67-year-old patient who is experiencing left-sided weakness
caused by a stroke. The student nurse is providing patient teaching regarding the use of a quadcane for ambulation. Which of the following statements is correct?
You should use the cane on the stronger side of the body.
b.
Move the stronger leg with the cane.
c.
When walking, advance the weaker leg past the cane.
d.
Your body weight should be supported by the cane and stronger leg.
nk
ta
nk
.c
om
a.
ANS: A
ba
Make sure the patient keeps the cane on the stronger side of the body. The patient moves the
weaker leg to the cane, which divides body weight between the cane and the stronger leg. The
patient then advances the stronger leg past the cane so the weaker leg and the body weight is
supported by the cane and weaker leg.
st
PTS:1DIF:Cognitive Level: Applying (Application)
.te
OBJescribe the interventions for maintaining proper alignment, assisting a patient in moving up
in bed, repositioning a patient needing assistance, and transferring a patient from a bed to a
chair.TOP:Nursing Process: Implementation
w
MSC: Client Needs: Health Promotion and Maintenance
w
w
16.Which of the following statements is appropriate for a nurse to teach a patient regarding the
use of crutches?
a.
The axillae should support all your body weight.
b.
Your elbows should be straight when your hands are on the crutch handgrips.
c.
The distance between the crutch pad and axillae should be three to four finger widths.
d.
Your elbows should be flexed about 45 degrees when the handgrip position is correct.
ANS: C
om
Make sure you position the handgrips so the axillae do not support all patients body weight.
Pressure on the axillae increases risk to underlying nerves, which sometimes results in partial
paralysis of the arm. You determine the correct position of the handgrips with the patient upright,
supporting weight by the handgrips with the elbows slightly flexed (20 to 25 degrees). You
verify elbow flexion with a goniometer. When you have determined the height and placement of
the handgrips, you again verify that the distance between the crutch pad and the patients axilla is
three to four finger widths.
.c
PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)
nk
OBJiscuss the physiological and pathological influences on body alignment and joint
mobility.TOP:Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment
Four-point gait
b.
Three-point gait
c.
Two-point gait
.te
st
ba
a.
nk
ta
17.A nurse is teaching a crutch walking technique that requires weight bearing on both legs.
Each leg is moved alternately with each opposing crutch so that three points of support are on the
floor at all times. What is the term for this gait?
Three-point alternating gait
w
ANS: A
w
d.
w
Four-point alternating or four-point gait gives stability to the patient but requires weight bearing
on both legs. Each leg is moved alternately with each opposing crutch so that three points of
support are on the floor at all times. The two-point gait requires at least partial weight bearing on
each foot. Three-point alternating or three-point gait requires the patient to bear all of the weight
on one foot. In a three-point gait, the patient puts weight on both crutches and then on the
uninvolved leg, and then repeats the sequence. The affected leg does not touch the ground during
the early phase of the three-point gait. Gradually the patient progresses to touchdown and full
weight bearing on the affected leg.
PTS:1DIF:Cognitive Level: Applying (Application)
OBJiscuss the physiological and pathological influences on body alignment and joint
mobility.TOP:Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment
18.The nurse is in charge of caring for five orthopedic patients during ashift. Nursing assistive
personnel are available to assist the nurse with care of the patients. Which of the following tasks
is most appropriate for the nurse to delegate to the nursing assistive personnel?
Moving a 45-year-old patient who had a CVA toward the head of the bed
b.
Transferring an 85-year-old patient for the first time after a total hip replacement
c.
Providing discharge teaching for a 49-year-old patient who had a stroke
d.
Preparing a 77-year-old patient for hip replacement surgery
nk
ta
nk
.c
om
a.
ANS: A
ba
The skill of moving and positioning patients in bed can be delegated to nursing assistive
personnel. Patients whom you are transferring for the first time after prolonged bed rest,
extensive surgery, critical illness, or spinal cord trauma require supervision by professional
nurses. Nursing assistive personnel are unable to give preoperative teaching or discharge
teaching to a patient.
st
PTS:1DIF:Cognitive Level: Applying (Application)
.te
OBJiscuss the physiological and pathological influences on body alignment and joint
mobility.TOP:Nursing Process: Implementation
w
MSC: Client Needs: Safe and Effective Care Environment
w
w
19.A nurse and another staff member are preparing to reposition a patient in bed. To prevent
back strain, these two health care providers must do which of the following?
a.
Keep their knees stiff to enhance their lifting strength potential.
b.
Keep the weight of the patient as close to their bodies as possible.
c.
Loosen their stomach muscles to keep from injuring the pelvic region.
d.
Twist their upper torsos to enhance the use and strength of their upper extremities.
ANS: B
To prevent lifting-related injuries, always follow these steps:
1.
2.
3.
4.
Keep weight as close to the body as possible.
Bend at the knees.
Tighten abdominal muscles, and tuck pelvis.
Maintain the trunk erect and knees bent.
PTS:1DIF:Cognitive Level: Applying (Application)
.c
MSC: Client Needs: Safe and Effective Care Environment
om
OBJescribe the interventions for maintaining proper alignment, assisting a patient in moving up
in bed, repositioning a patient needing assistance, and transferring a patient from a bed to a
chair.TOP:Nursing Process: Implementation
Sims
nk
ta
a.
nk
20.A nurse is caring for a patient who has pneumonia. To facilitate respiration and lung drainage
this patient should be placed in what position?
b.
Prone
Lateral
ba
c.
st
d.
.te
ANS: B
Supine
w
w
w
When prone, the patient is in the face-down position. This facilitates respiration and drainage of
oral secretions. Place a pillow under the head for comfort and relief from pressure. The Sims
position is used to place the patient in a semiprone position on the right or left side with the
opposite arm, thigh, and knee flexed and resting on the bed. In the lateral position, the patient is
placed in a side-lying position, supported on the right or left side. This position can compromise
chest expansion. In the supine position the patient rests on the back. The risk for aspiration is
greater with this position; thus avoid the supine position when the patient is confused, agitated,
experiencing a decreased level of consciousness, or at risk for aspiration.
Chapter 12: Blood Cells and the Hematopoietic System
1.
A)
Cytokines that affect hematopoiesis in bone marrow are called colony-stimulating factors (CSFs) base
on their ability to:
support lymphocytes.
B)
differentiate red cells.
C)
regulate blood cells.
D)
stimulate lymphocytes.
Leukocytes consist of three categories of cells that have different roles in the inflammatory and immu
responses. Which of the following leukocytes is correctly matched with its function?
A)
Lymphocyte; phagocytosis
B)
Eosinophils; allergic reactions
C)
Basophils; engulf antigens
D)
Monocytes; release heparin
Epstein-Barr virus.
B)
Kostmann syndrome.
C)
drug reactions.
D)
skin infections.
4.
nk
ta
A)
.c
The patient has an abnormally low neutrophil count. Neutropenia is most commonly caused by:
nk
3.
The 16-year-old boy has enlarged lymph nodes and a sore throat. His girlfriend was recently diagnose
with infectious mononucleosis, which is caused by ________ and commonly transmitted in ________
heterophil antibodies; blood
B)
Epstein Barr virus; saliva
C)
T-cell infection; plasma
D)
bacterial infection; monocytes
The patient is diagnosed with Hodgkin type of lymphoma based on the results of laboratory tests and
study of the tumor cells. A distinct characteristic of Hodgkin lymphoma is the presence of:
.te
5.
st
ba
A)
A)
Reed-Sternberg cells.
Bence Jones proteins.
w
B)
M-type protein antibodies.
Philadelphia chromosome.
w
C)
D)
Manifestations of Hodgkin lymphoma that distinguish it from non-Hodgkin lymphoma include:
w
6.
A)
noncontiguous nodal spread.
B)
superficial lymphadenopathy.
C)
pruritus and night fevers.
D)
poor humoral antibody response.
7.
A)
om
2.
Leukemias are classified according to the predominant cell type. The myelogenous cell type of leukem
can:
interfere with thrombocyte cell maturation.
B)
originate in marrow and infiltrate nodes.
C)
affect B and T stem cells in bone marrow.
D)
transform mature cells into immature ones.
infections due to neutropenia.
B)
fatigue due to RBC deficiency.
C)
hypogammaglobulinemia.
D)
bleeding due to thrombocytopenia.
In contrast to acute leukemias, chronic leukemias are malignancies involving abnormal
_________________ blood cells in the marrow.
production of undifferentiated
B)
proliferation of well-differentiated
C)
uncontrolled growth of immature
D)
replication of pluripotent precursor
10.
nk
ta
A)
Multiple myeloma is a malignancy of:
plasma cells.
B)
bone osteoblasts.
C)
T-cell lymphocytes.
D)
immunoglobulin A.
Which of the following statements accurately describes a component of the hematopoietic system?
.te
11.
st
ba
A)
A)
Lymphocytes lack cytoplasmic granules.
Neutrophils are agranulocytes.
w
B)
Colony-forming units (CFUs) promote the growth of hematopoietic cell colonies.
Neutrophils are the most prevalent lymphocytes.
w
C)
Which of the following parts of the body are considered to be parts of the lymphatic system? Select
that apply.
w
D)
.c
9.
om
A)
nk
8.
A child has Down syndrome and has recently experienced unexplained nose bleeds. His blood tests
identify blast cells in the peripheral smear. In addition to nose bleeds, his acute leukemia will typicall
manifest all of the following EXCEPT:
12.
A)
Thyroid gland
B)
Thymus
C)
Spleen
D)
Kupffer cells
E)
Myelin
13.
A patient with a long-standing diagnosis of human immunodeficiency virus (HIV) has recently
developed neutropenia and been admitted to a hospital. Which of the following measures should be
prioritized by the nurses who are providing his care?
A)
Administration of prophylactic antibiotics
B)
Supplementary oxygen and administration of bronchodilators
C)
Administration of antiretroviral medications
D)
Vigilant infection control and handwashing
om
Auscultating the patients lungs
B)
Palpating the patients lymph nodes
C)
Assessing the patients cranial nerve reflexes
D)
Assessing the patient for bone pain
Which of the following factors differentiates chronic leukemias from acute leukemias?
nk
ta
15.
nk
A)
.c
14.
A 16-year-old girl has been brought to her primary care provider by her mother due to the daughters
recent malaise and lethargy. Which of the following assessments should the clinician perform in an
effort to confirm or rule out infectious mononucleosis?
Leukemic cells are disseminated throughout the body by the circulatory system.
B)
The leukemic cells are more fully differentiated than in acute leukemias.
C)
The prevalence among individuals with Down syndrome is high.
D)
They are cancers of the hematopoietic progenitor cells.
ba
A)
st
16.
Following peripheral blood testing and a bone marrow biopsy, a patient has been diagnosed with
chronic myelogenous leukemia. Which of the following is most likely to have preceded the patients
diagnosis?
The presence of a Philadelphia chromosome
.te
A)
B)
Down syndrome
Radiation exposure
w
C)
Exposure to the Epstein-Barr virus
w
D)
A patient has been diagnosed with non-Hodgkin lymphoma (NHL), a form of malignancy that most
likely originated in which of the following sites?
w
17.
A)
Thymus
B)
Spleen
C)
Bone marrow
D)
Lymph nodes
18.
A)
A young adult is preparing to begin treatment for non-Hodgkin lymphoma (NHL), a disease that has
disseminated widely. What is the most likely treatment regimen for this patient?
Antiviral medications
B)
Surgery and whole blood transfusion
C)
Radiation and chemotherapy
D)
Bone marrow or stem cell transplantation
19.
Which of the following patient complaints should prompt a clinician to order a diagnostic work-up f
multiple myeloma?
Lately my bones just seem to ache so bad, and nothing seems to help.
B)
Every morning my joints are so stiff that it takes me 10 or 15 minutes just to get going.
C)
I feel so weak and the last few days Ive actually fallen asleep on my coffee break at work.
D)
I vomited yesterday evening and it looked like coffee grounds mixed with some fresh blood.
Which of the following abnormal blood work results is most closely associated with a diagnosis of
multiple myeloma?
.c
20.
om
A)
Decreased hemoglobin, hematocrit, and red blood cells
B)
Extremely high levels of abnormal lymphocytes
C)
Low glomerular filtration rate and high calcium levels
nk
ta
nk
A)
C
4.
B
5.
A
6.
C
7.
A
8.
C
9.
B
A
w
10.
st
3.
.te
B
w
2.
Low potassium levels and increased blood urea nitrogen
ba
D)
Answer Key
1.
C
A
12.
B, C
13.
D
14.
B
15.
B
16.
A
17.
D
18.
C
w
11.
19.
A
20.
C
Chapter 13: Disorders of Hemostasis
A)
Calcium
B)
Prothrombin
C)
Tissue factor
D)
Plasminogen
The first step of hemostasis occurs as a:
.c
2.
fibrin clot.
B)
platelet plug.
C)
clot retraction.
D)
vessel spasm.
nk
ta
A)
3.
To form a platelet plug, platelets are attracted to the damaged vessel, and then platelet ___________
occurs.
adhesion
B)
fibrinolysis
C)
thrombosis
D)
thromboxane A2
st
.te
Blood coagulation is initiated by either of two pathways. The intrinsic pathway requires circulating
________ to begin the step-wise coagulation cascade.
A)
protein C
thrombin
w
B)
factor XII
w
C)
D)
ba
A)
4.
tissue factor
Increased platelet function, and consequent hypercoagulability, can be caused by:
w
5.
A)
factor V mutation.
B)
platelet insensitivity.
C)
vascular wall damage.
D)
decreased platelet numbers.
6.
A)
om
With the exception of the first two steps, what is required in all steps of the clotting process?
nk
1.
Immune thrombocytopenia purpura (ITP) is a/an ________ disorder that destroys ________.
allergic; fibrinogen
B)
alloimmune; factor VIII
C)
autoimmune; platelets
D)
immunoglobulin; B cells
A)
Purpura
B)
Jaundice
C)
Petechiae
D)
Erythema
E)
Confusion
.c
Hemophilia A is a hereditary blood disorder caused by inadequate activity or absent:
A)
factor VIII.
B)
prothrombin.
C)
vWF complex.
D)
intrinsic factor.
Disseminated intravascular coagulation (DIC) is characterized by:
headaches.
B)
platelet loss.
C)
hypertension.
D)
hemorrhage.
In persons with a bleeding disorder caused by vascular defects, laboratory tests will most often revea
.te
10.
st
A)
A)
normal values.
B)
hypocalcemia.
polycythemia.
w
C)
w
thrombocytopenia.
Removal of a patients peripheral intravenous catheter resulted in brief bleeding and the loss of a sma
amount of blood. Which of the following processes occurred during the formation of the platelet plu
that helped to stop blood flow?
w
D)
ba
9.
nk
8.
om
Thrombotic thrombocytopenic purpura (TTP) causes which of the following manifestations? Select al
that apply.
nk
ta
7.
11.
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
om
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 influen
the participants risk of hypercoagulability disorders? Select all that apply.
Smoking cessation
B)
Blood glucose screening
C)
Weight management
D)
Cholesterol screening and management
E)
Blood pressure screening and management
nk
nk
ta
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 increa
risk for
Hemorrhage
B)
Myocardial infarction
C)
Hemophilia A or B
D)
Deep vein thrombosis
st
ba
A)
In the brain
w
A)
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 res
of low platelets?
.te
15.
Skin and mucous membranes
w
B)
Sclerae of the eyes
w
C)
.c
A)
D)
16.
Nephrons and ureters
A patient was started on a protocol for the prevention of deep vein thrombosis shortly after admissio
and has been receiving 5000 units of heparin twice daily for the last 5 days. An immune response to
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 patien
risk of myocardial infarction by altering which of the following stages of hemostasis?
A)
Vessel spasm
B)
Platelet plug formation
C)
Blood coagulation
D)
Clot lysis
om
18.
A 23-year-old female patient has been diagnosed with von Willebrand disease following a long histo
of heavy periods and occasional nosebleeds. Which of the patients following statements demonstrate
sound understanding of her new diagnosis?
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.
nk
.c
A)
nk
ta
19.
Which of the following patients likely faces the highest risk of an acquired hypocoagulation disorde
and vitamin K deficiency?
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 lun
cancer
D)
A patient with dehydration and hypokalemia that have resulted from Clostridium
difficileassociated diarrhea
st
ba
A)
Disseminated intravascular coagulation
w
A)
Hemophilia A
w
B)
C)
.te
20.
A healthy, primiparous (first-time) mother delivered a healthy infant several hours ago, but the moth
has experienced postpartum hemorrhage. Which of the following disorders is most likely to underlie
patients excessive bleeding after delivery?
Von Willebrand disease
w
D)
Answer Key
1.
A
2.
D
3.
A
4.
C
5.
C
6.
C
Thrombotic thrombocytopenic purpura (TTP)
A, C, E
8.
A
9.
D
10.
A
11.
C
12.
A
13.
A, B, C, D, E
14.
D
15.
B
16.
D
17.
B
18.
C
19.
A
20.
A
nk
ta
nk
.c
om
7.
Chapter 14: Disorders of Red Blood Cells
ba
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:
high platelets/thrombocytosis.
B)
low WBC count/granulocytopenia.
C)
low hemoglobin/anemia.
D)
st
A)
.te
1.
high hematocrit/polycythemia.
B)
bleeding.
w
C)
fatigue.
w
A)
w
2.
Manifestations of anemia that are directly due to the diminished oxygen-carrying capacity of hemoglo
include:
D)
3.
bone pain.
pale skin.
When an Rh-negative mother has been sensitized and is pregnant with an Rh-positive fetus, what hap
to the fetus?
A)
Bilirubin deficiency
B)
Nothing, this is normal
C)
Plasma volume depletion
D)
Profound red cell hemolysis
A)
Hematocrit 44%
B)
Reticulocytes 1.5%
C)
Band cells 3,000/mL
D)
Hemoglobin 8 g/dL
Megaloblastic anemias caused by folic acid or vitamin B12 deficiencies can seriously affect RBC
production. This is because both are necessary for _______ synthesis and _______.
iron; hemoglobin adhesion
B)
DNA; red blood cell maturation
C)
thrombin; platelet aggregation
D)
protein; reticulocyte maturation
6.
nk
A)
Polycythemia develops in patients with lung disease as a result of:
hyperventilation.
B)
chronic hypoxia.
C)
decreased blood viscosity.
D)
excessive respiratory fluid loss.
nk
ta
A)
Which of the following types and characteristics of anemia are correctly matched?
ba
7.
Hemolytic; abnormal iron uptake
B)
Iron deficiency; early RBC death
C)
Folate; decreased erythropoiesis
D)
Blood loss; bone marrow expansion
8.
impaired red blood cell maturation.
increased iron content of blood.
w
B)
decreased oxygen saturation.
w
D)
Conditions that predispose to sickling of hemoglobin in persons with sickle cell anemia include:
w
A)
.te
st
A)
C)
om
5.
.c
4.
The patient is an average-sized adult and has abnormal microcytic hypochromic red blood cells due to
long-term, chronic disease. Which of the following CBC results is characteristic of her type of anemia
9.
increased intravascular volume.
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.
Orthostatic hypotension
B)
Hyperventilation and respiratory alkalosis
C)
Vasculitis
D)
Thromboembolism
Which of the following patients is most susceptible to experiencing the effects of inadequate
erythropoiesis?
nk
12.
.c
A)
om
11.
A 48-year-old male patient, who normally enjoys good health, has been admitted to the hospital for
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 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
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.
nk
ta
A)
ba
13.
A 72-year-old woman with complaints of increasing fatigue has completed a series of fecal occult bl
tests that indicate the presence of blood in her stool. Which of the following health problems is likel
accompany this patients gastrointestinal bleed?
Hemolytic anemia
B)
Aplastic anemia
C)
Iron-deficiency anemia
.te
st
A)
D)
Megaloblastic anemia
w
Acute pain
w
A)
w
14.
Hemoglobin solubility results and hemoglobin electrophoresis have resulted in a diagnosis of sickle
anemia in an African American infant. The parents of the child should be aware that their child is at
significant risk for which of the following health problems? Select all that apply.
B)
Stroke
C)
Respiratory disease
D)
Autoimmune diseases
E)
Fractures
15.
A)
The pathologic effects of the thalassemias are primarily due to which of the following pathophysiolo
processes?
Impaired hemoglobin synthesis
B)
Impaired folic acid absorption
C)
Erythropoietin deficiency
D)
Loss of iron
16.
Which of the following individuals likely faces the highest risk of megaloblastic anemia?
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
For which of the following health problems is stem cell transplantation likely to be of therapeutic
benefit?
Aplastic anemia
B)
b-Thalassemias
C)
Chronic disease anemias
D)
Secondary polycythemia
nk
ta
18.
.c
A)
nk
17.
om
A)
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?
Vitamin B12 supplements
B)
Increased supplementary oxygen therapy
C)
Hemodialysis or peritoneal dialysis
D)
Scheduled erythropoietin injections
st
ba
A)
Which of the following trends in the hematologic status of a 6-week-old infant most clearly warrants
medical intervention?
.te
19.
A)
Decreasing red blood cell counts
Increasing white blood cell counts
w
D)
Decreasing hematocrit and mean corpuscular volume (MCV)
w
C)
Increasing HgA levels
w
B)
20.
A mother has brought her 2-week-old infant to the emergency department due to the babys persisten
and increasing jaundice. Blood testing reveals that the infants unconjugated bilirubin level is 28 mg/
and assessment does not reveal neurologic deficits. The infants weight is normal and the mother clai
to have had no significant difficulty feeding the infant. The most likely treatment for this infant will
A)
phototherapy.
B)
packed red blood cell transfusion.
C)
phlebotomy.
D)
intravenous antibiotics.
Answer Key
1.
C
A
3.
D
4.
D
5.
B
6.
B
7.
C
8.
C
9.
D
10.
B
11.
D
12.
A
13.
C
14.
A, B, C
15.
A
16.
C
17.
A
18.
B
19.
D
20.
A
.te
st
ba
nk
ta
nk
.c
om
2.
A)
support lymphocytes.
w
B)
Cytokines that affect hematopoiesis in bone marrow are called colony-stimulating factors (CSFs) base
on their ability to:
w
1.
w
Chapter 15: Disorders of White Blood Cells and Lymphoid Tissues
differentiate red cells.
C)
regulate blood cells.
D)
stimulate lymphocytes.
2.
Leukocytes consist of three categories of cells that have different roles in the inflammatory and immu
responses. Which of the following leukocytes is correctly matched with its function?
A)
Lymphocyte; phagocytosis
B)
Eosinophils; allergic reactions
C)
Basophils; engulf antigens
D)
Monocytes; release heparin
The patient has an abnormally low neutrophil count. Neutropenia is most commonly caused by:
A)
Epstein-Barr virus.
B)
Kostmann syndrome.
C)
drug reactions.
D)
skin infections.
heterophil antibodies; blood
B)
Epstein Barr virus; saliva
C)
T-cell infection; plasma
D)
bacterial infection; monocytes
The patient is diagnosed with Hodgkin type of lymphoma based on the results of laboratory tests and
study of the tumor cells. A distinct characteristic of Hodgkin lymphoma is the presence of:
nk
ta
5.
nk
A)
Reed-Sternberg cells.
B)
Bence Jones proteins.
C)
M-type protein antibodies.
D)
Philadelphia chromosome.
ba
A)
6.
Manifestations of Hodgkin lymphoma that distinguish it from non-Hodgkin lymphoma include:
noncontiguous nodal spread.
B)
superficial lymphadenopathy.
C)
pruritus and night fevers.
.te
st
A)
D)
poor humoral antibody response.
w
interfere with thrombocyte cell maturation.
w
B)
Leukemias are classified according to the predominant cell type. The myelogenous cell type of leukem
can:
w
7.
A)
om
4.
The 16-year-old boy has enlarged lymph nodes and a sore throat. His girlfriend was recently diagnose
with infectious mononucleosis, which is caused by ________ and commonly transmitted in ________
.c
3.
originate in marrow and infiltrate nodes.
C)
affect B and T stem cells in bone marrow.
D)
transform mature cells into immature ones.
8.
A child has Down syndrome and has recently experienced unexplained nose bleeds. His blood tests
identify blast cells in the peripheral smear. In addition to nose bleeds, his acute leukemia will typicall
manifest all of the following EXCEPT:
A)
infections due to neutropenia.
B)
fatigue due to RBC deficiency.
C)
hypogammaglobulinemia.
D)
bleeding due to thrombocytopenia.
In contrast to acute leukemias, chronic leukemias are malignancies involving abnormal
_________________ blood cells in the marrow.
A)
production of undifferentiated
B)
proliferation of well-differentiated
C)
uncontrolled growth of immature
D)
replication of pluripotent precursor
A)
plasma cells.
B)
bone osteoblasts.
C)
T-cell lymphocytes.
D)
immunoglobulin A.
Which of the following statements accurately describes a component of the hematopoietic system?
nk
ta
11.
.c
Multiple myeloma is a malignancy of:
nk
10.
om
9.
Lymphocytes lack cytoplasmic granules.
B)
Neutrophils are agranulocytes.
C)
Colony-forming units (CFUs) promote the growth of hematopoietic cell colonies.
D)
Neutrophils are the most prevalent lymphocytes.
Which of the following parts of the body are considered to be parts of the lymphatic system? Select
that apply.
st
12.
ba
A)
Thyroid gland
B)
Thymus
.te
A)
C)
Spleen
Kupffer cells
w
D)
Myelin
w
E)
w
A patient with a long-standing diagnosis of human immunodeficiency virus (HIV) has recently
developed neutropenia and been admitted to a hospital. Which of the following measures should be
prioritized by the nurses who are providing his care?
13.
A)
Administration of prophylactic antibiotics
B)
Supplementary oxygen and administration of bronchodilators
C)
Administration of antiretroviral medications
D)
Vigilant infection control and handwashing
14.
A 16-year-old girl has been brought to her primary care provider by her mother due to the daughters
recent malaise and lethargy. Which of the following assessments should the clinician perform in an
effort to confirm or rule out infectious mononucleosis?
A)
Auscultating the patients lungs
B)
Palpating the patients lymph nodes
C)
Assessing the patients cranial nerve reflexes
D)
Assessing the patient for bone pain
15.
Which of the following factors differentiates chronic leukemias from acute leukemias?
Leukemic cells are disseminated throughout the body by the circulatory system.
B)
The leukemic cells are more fully differentiated than in acute leukemias.
C)
The prevalence among individuals with Down syndrome is high.
D)
They are cancers of the hematopoietic progenitor cells.
om
A)
.c
nk
16.
Following peripheral blood testing and a bone marrow biopsy, a patient has been diagnosed with
chronic myelogenous leukemia. Which of the following is most likely to have preceded the patients
diagnosis?
The presence of a Philadelphia chromosome
B)
Down syndrome
C)
Radiation exposure
D)
Exposure to the Epstein-Barr virus
A patient has been diagnosed with non-Hodgkin lymphoma (NHL), a form of malignancy that most
likely originated in which of the following sites?
ba
17.
Thymus
B)
Spleen
C)
Bone marrow
D)
Lymph nodes
18.
Antiviral medications
w
Surgery and whole blood transfusion
Radiation and chemotherapy
w
C)
A young adult is preparing to begin treatment for non-Hodgkin lymphoma (NHL), a disease that has
disseminated widely. What is the most likely treatment regimen for this patient?
w
A)
.te
st
A)
B)
nk
ta
A)
D)
19.
Bone marrow or stem cell transplantation
Which of the following patient complaints should prompt a clinician to order a diagnostic work-up f
multiple myeloma?
A)
Lately my bones just seem to ache so bad, and nothing seems to help.
B)
Every morning my joints are so stiff that it takes me 10 or 15 minutes just to get going.
C)
I feel so weak and the last few days Ive actually fallen asleep on my coffee break at work.
D)
I vomited yesterday evening and it looked like coffee grounds mixed with some fresh blood.
20.
Which of the following abnormal blood work results is most closely associated with a diagnosis of
multiple myeloma?
A)
Decreased hemoglobin, hematocrit, and red blood cells
B)
Extremely high levels of abnormal lymphocytes
C)
Low glomerular filtration rate and high calcium levels
Low potassium levels and increased blood urea nitrogen
om
D)
Answer Key
1.
C
B
3.
C
4.
B
5.
A
6.
C
7.
A
8.
C
9.
B
10.
A
11.
A
12.
B, C
13.
D
14.
B
15.
B
16.
A
17.
D
nk
nk
ta
ba
st
.te
w
C
w
18.
.c
2.
A
20.
C
w
19.
Chapter 16: Mechanisms of Infectious Disease
1.
Although growth rate is variable among types of bacteria, the growth of bacteria is dependent on:
A)
biofilm communication.
B)
availability of nutrients.
C)
an intact protein capsid.
D)
individual cell motility.
2.
Treponema pallidum, the cause of syphilis, is a spirochete bacterium that is spread from human to hum
by:
A)
tick or lice vector bites.
B)
direct physical contact.
C)
exposure to infected urine.
D)
inhaling airborne particles.
adhered to cholesterol
C)
propelled by filaments
D)
encapsulated hyphae
4.
om
B)
.c
an elementary body
nk
A)
Because dermatophytes are capable of growing _________, the infection is mainly found on cutaneou
surfaces of the body.
a powdery colony
B)
in moist skin folds
C)
on cooler tissue
D)
branching filaments
ba
A)
nk
ta
3.
Chlamydiaceae, a rather common sexually transmitted infectious organism, has characteristics of both
viruses and bacteria. The infectious form of this organisms life cycle is _______ until it enters the hos
cell.
st
5.
Although both eukaryotes and prokaryotes are capable of causing infectious diseases in humans,
eukaryotes are unique because they have a distinct:
organized nucleus.
.te
A)
B)
circular plasmid DNA.
cytoplasmic membrane.
w
C)
variation of shape and size.
w
D)
Whatever the mechanism of entry, the human-to-human transmission of infectious agents is directly
related to the:
w
6.
A)
source of contact.
B)
site of infection.
C)
number of pathogens absorbed.
D)
virulence factors.
7.
A)
The course of any infectious disease progresses through several distinct stages after the pathogen ente
the host. Although the duration may vary, the hallmark of the prodromal stage is:
tissue inflammation and damage.
B)
initial appearance of symptoms.
C)
progressive pathogen elimination.
D)
containment of infectious pathogens.
Although bacterial toxins vary in their activity and effects on host cells, a small amount of gram-nega
bacteria endotoxin:
A)
is released during cell growth.
B)
inactivates key cellular functions.
C)
uses protein to activate enzymes.
D)
in the cell wall activates inflammation.
Antibody titers
B)
Culture growth
C)
Direct antigens
D)
DNA sequencing
10.
nk
A)
.c
Serology testing includes the measurement of which of the following?
nk
ta
9.
Prions cause transmissible neurodegenerative diseases and are characterized by:
a lack of reproductive capacity.
B)
hypermetabolism.
C)
enzyme production.
D)
chronic inflammation.
ba
A)
Which of the following individuals is experiencing a health problem that is the result of a parasite?
st
11.
A college student who contracted Chlamydia trachomatis during an unprotected sexual encou
.te
A)
B)
A man who acquired malaria while on a tropical vacation
C)
A hospital patient who has developed postoperative pneumonia
A woman who developed hepatitis A from eating at an unhygienic restaurant
Which of the following traits is characteristic of saprophytes?
w
12.
w
D)
They derive energy from decaying organic matter.
w
A)
om
8.
B)
They are beneficial components of human microflora.
C)
They have RNA or DNA, but never both.
D)
They are capable of spore production.
13.
A)
A hospital patient was swabbed on admission for antibiotic-resistant organisms and has just been
informed that methicillin-resistant Staphylococcus aureus (MRSA) is present in his groin. The patie
has a normal core temperature and white blood cell count. This patient is experiencing which of the
following?
Infection
B)
Proliferation
C)
Colonization
D)
Inflammation
A 33-year-old patient who is a long-term intravenous user of heroin has been recently diagnosed wit
hepatitis C. Which of the following portals of entry most likely led to the patients infection?
Direct contact
B)
Vertical transmission
C)
Ingestion
D)
Penetration
.c
A 9-month-old infant has been diagnosed with botulism after he was fed honey. The childs mother w
prompted to seek care because of this childs sudden onset of neuromuscular deficits, which were late
attributed to the release of substances by Clostridium botulinum bacteria. Which virulence factor
contributed to this childs illness?
A)
Endotoxins
B)
Adhesion factors
C)
Exotoxins
D)
Evasive factors
A patient with a long-standing diagnosis of Crohn disease has developed a perianal abscess. Which o
the following treatments will this patient most likely require?
ba
16.
Antiviral therapy
B)
Antibiotic therapy
C)
Surgical draining
D)
Pressure dressing
Detecting DNA sequences that are unique to the suspected pathogen
w
A)
Growth of biofilms on various media in the laboratory setting
w
C)
A patients primary care provider has ordered direct antigen detection in the care of a patient with a
serious symptomatology of unknown origin. Which of the following processes will be conducted?
w
17.
.te
st
A)
B)
nk
15.
om
A)
nk
ta
14.
D)
18.
Quantification of IgG and IgM antibodies in the patients blood
Introduction of monoclonal antibodies to a blood sample from the patient
A patient has begun taking acyclovir, an antiviral medication, to control herpes simplex outbreaks.
What is this drugs mechanism of action?
A)
Inhibition of viral adhesion to cells
B)
Elimination of exotoxin production
C)
Antagonism of somatic cell binding sites
D)
Interference with viral replication processes
A)
Portals of entry
B)
Sources of infection
C)
Virulence
D)
Disease course
A public health nurse should recognize that sexually transmitted infections (STIs) are typically sprea
by which of the following mechanisms?
A)
Penetration
B)
Vertical transmission
C)
Direct contact
C
5.
A
6.
C
7.
B
8.
D
9.
A
10.
A
11.
B
12.
A
C
w
13.
nk
4.
nk
ta
A
ba
3.
st
B
w
2.
Ingestion
.te
D)
Answer Key
1.
B
D
15.
C
16.
C
17.
D
18.
D
19.
B
20.
C
w
14.
om
20.
.c
19.
International travel has contributed to increased prevalence and incidence of nonindigenous diseases
increasing which of the following?
Chapter 17: Innate and Adaptive Immunity
A)
self-cells.
B)
microbes.
C)
antibodies.
D)
inflammation.
2.
om
Innate immunity, also called natural or native immunity, consists of mechanisms that respond specific
to:
Adaptive immune responses, also called acquired or specific immunity, are composed of __________
and their products.
granulocytes
B)
lymphocytes
C)
epithelial cells
D)
Toll-like receptors
nk
ta
3.
.c
A)
nk
1.
The effector cells of the immune system have the primary function of:
activating phagocytic cells.
B)
eliminating the antigens.
C)
processing antigen into epitopes.
D)
controlling the immune response.
ba
A)
st
4.
Activation of lymphocytes is dependent upon the ________ and ________ of the antigens by
macrophages.
memory; clustering
.te
A)
B)
capture; destruction
recognition; grouping
w
C)
processing; presentation
w
D)
Major histocompatibility complex (MHC) molecules, with human leukocyte antigens (HLAs), are
markers on all nucleated cells and have an important role in:
w
5.
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.
Once T helper cells are activated, they secrete ____________ that activate and regulate nearly all of th
other cells of the immune system.
complement proteins
B)
cytokines
C)
leukotrienes
D)
bradykinins
A)
IgG.
B)
IgM.
C)
IgA.
D)
IgD.
9.
.c
The first circulating immunoglobulin to appear in response to a new antigen is:
nk
8.
om
A)
The effector function of activated members of the complement system includes all of the following
EXCEPT:
chemotaxis.
B)
opsonization.
C)
pathogen lysis.
D)
phagocytosis.
During the latent period before antibodies are detected in the humoral immune response, B cells
differentiate into ________ cells.
st
10.
ba
A)
nk
ta
7.
plasma
.te
A)
B)
cytotoxic
stem
w
C)
helper
Which of the following would participate in the innate immune response to an infectious
microorganism?
w
D)
w
11.
A)
T lymphocytes
B)
Antibodies
C)
B lymphocytes
D)
Neutrophils
12.
A)
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?
Helper T cells
B)
Regulatory T cells
C)
Cytotoxic T cells
D)
Natural killer cells
A childs thymus gland is fully formed and proportionately larger than an adults. Which of the follow
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
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?
.c
14.
om
13.
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.
nk
ta
nk
A)
The entrance of a microbe into an individuals vascular space has initiated opsonization. Which of th
following processes is involved in opsonization?
Stimulation of B cells by helper T cells
B)
Coating of a microbe to aid phagocyte recognition
C)
Release of proteins that stimulate cell production by the bone marrow
D)
Lysis of intracellular microbes by cytotoxic T cells
16.
Toll-like receptors.
chemokines.
w
D)
opsonins.
w
B)
C)
Bacteria on a sliver in a boys finger have initiated an adaptive immune response. The boys lymphoc
and antibodies recognize immunologically active sites on the bacterial surfaces known as:
w
A)
.te
st
ba
A)
17.
epitopes.
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 boo
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
A patients cell-mediated immune response has resulted in the release of regulator T cells. These cell
will perform which of the following roles?
om
19.
Suppressing the immune response to limit proliferation of potentially harmful lymphocytes
B)
Presenting antigens to B cells to facilitate the production of antibodies
C)
Differentiating into subpopulations of helper T cells
D)
Destroying target cells by releasing cytolytic enzymes and other toxins
nk
.c
A)
IgA
B)
IgG
C)
IgM
3.
B
4.
D
D
w
5.
st
B
w
2.
IgD
.te
D)
Answer Key
1.
B
nk
ta
A)
ba
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 exposu
This immune response may have been due to the presence of which of the following immunoglobuli
from the infants mother?
A
7.
B
8.
B
9.
D
10.
A
11.
D
12.
A
13.
B
14.
C
w
6.
15.
B
16.
D
17.
A
18.
A
19.
A
20.
B
granulation tissue
B)
fibrinous meshwork
C)
capillary circulation
D)
collagenous layers
2.
A mutation has occurred during mitosis of an individuals bone marrow cell. This event may be the res
of the failure of which of the following?
Progenitor cells
B)
Fibroblasts
C)
Stem cells
D)
Cyclins
st
.te
A patient has experienced a myocardial infarction with accompanying necrosis of cardiac muscle, a
permanent tissue. What are the ramifications of the fact that cardiac muscle is a permanent tissue?
A)
The cardiac muscle cells will remain perpetually in the G1 stage of mitosis.
Regeneration of the patients cardiac muscle will be exceptionally slow.
w
B)
The necrotic cells will be replaced with muscle cells that have limited metabolism.
w
C)
The cells will not proliferate and will be replaced with scar tissue.
A couple have chosen to pay for the harvesting and storage of umbilical cord blood after the delivery
their child to secure a future source of embryonic stem cells. What is the most likely rationale for the
couples decision?
w
D)
ba
A)
3.
nk
A)
.c
Epithelialization, the first component of the proliferative phase of wound healing, is delayed in open
wounds until after ________ has formed.
nk
ta
1.
om
Chapter 18: Inflammation, Tissue Repair, and Wound Healing
4.
A)
The stem cells may be able to produce a wide range of body cells.
B)
The embryonic stem cells allow stable and permanent tissues to enter mitosis.
C)
The stem cells can change the proliferative capacity of other cells.
D)
The embryonic stem cells remove cyclin-dependent kinase inhibitors from the body.
Prostaglandins
B)
Fibrous structural proteins
C)
Lymphocytes
D)
Water-hydrated gels
E)
Glycoproteins
A nursing student is cleaning and changing the dressing on a patients sacral ulcer. The student has
vigorously cleansed the wound bed to remove all traces of the beefy, red tissue that existed in the wou
bed. The student has most likely removed:
.c
6.
om
A)
Necrotic tissue
B)
Granulation tissue
C)
Stem cells
D)
The extracellular matrix
7.
nk
ta
A)
nk
5.
The basement membrane surrounding a patients foot wound remains intact, a fact that bodes well for
wound-healing process. Which of the following components constitute this form of the extracellular
matrix? Select all that apply.
A 12-year-old boys severe wound that he received from a dog bite has begun to heal and currently sho
no signs of infection. Which of the following processes occurred first during this process of repair by
connective tissue deposition?
Reorganization of fibrous tissue
B)
Angiogenesis
C)
Emigration of fibroblasts to the wound site
D)
Deposition of the extracellular matrix
st
Which of the following wounds is most likely to heal by secondary intention?
.te
8.
A)
A finger laceration that a cook received while cutting up onions
A boys road rash that he got by falling off his bicycle
w
B)
A needlestick injury that a nurse received when injecting a patients medication
w
C)
The incision from a teenagers open appendectomy
A patient underwent an open cholecystectomy 4 days ago and her incision is now in the proliferative
phase of healing. What is the dominant cellular process that characterizes this phase of the patients
healing?
w
D)
ba
A)
9.
A)
Hemostasis and vasoconstriction
B)
Keloid formation
C)
Collagen secretion by fibroblasts
D)
Phagocytosis by neutrophils
10.
Which of the following surgical patients is most likely to experience enhanced wound healing as a
result of his or her diet?
A)
A patient who eats a high-calorie diet and large amounts of red meat
B)
A patient who is a vegetarian and who eats organic foods whenever possible
C)
A patient who practices carefully calorie control and who avoids animal fats
D)
A patient who is receiving total parenteral nutrition due to recurrent nausea
11.
Which of the following patients is most likely to experience impaired wound healing?
A patient with a diagnosis of type 1 diabetes and a history of poor blood sugar control
B)
A child whose severe cleft lip and palate have required a series of surgeries over several mont
C)
A patient who takes nebulized bronchodilators several times daily to treat chronic obstructive
pulmonary disease
nk
.c
A patient with persistent hypertension who takes a b-adrenergic blocker and a potassium-wast
diuretic daily
D
3.
D
4.
A
5.
B, D, E
6.
B
7.
B
8.
B
9.
C
10.
A
11.
A
.te
st
ba
2.
nk
ta
D)
Answer Key
1.
A
om
A)
w
w
Chapter 19: Disorders of the Immune Response
1.
w
A)
The mediators involved in type I hypersensitivity allergic responses are released from:
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:
A)
T-cell
B)
antibody
C)
leukotriene
D)
complement
A)
inflammation
B)
autoantibodies
C)
cytotoxic cells
D)
immunoglobulins
5.
The mechanism by which humans recognize self-cells from non-self (antigens)-cells is _________.
autoimmunity
B)
self-tolerance
C)
non-self anergy
D)
immunocompatibility
ba
A)
Organ rejection is a complication of organ transplantation caused by recipient immune cells:
st
6.
.c
Type III hypersensitivity immune responses can be harmful when immune complex deposits in tissue
activate ___________ that can directly damage area tissues.
nk
4.
om
Mismatched blood transfusion reaction with hemolysis of blood cells is an example of type II, _____
mediated hypersensitivity reaction.
nk
ta
3.
destroying the host T cells.
B)
attack on the donor cells.
.te
A)
C)
combining with grafts HLA.
being recognized as foreign.
A)
leukemia
w
B)
The leading cause of death for people with HIV is opportunistic ____________.
w
7.
w
D)
tuberculosis
C)
pneumonia
D)
toxoplasmosis
8.
Wasting syndrome, an AIDS-defining illness, is characterized by involuntary weight loss of at least 1
of baseline body weight in the presence of:
A)
diarrhea.
B)
hypermetabolism.
C)
weakness and fever.
D)
glucose intolerance.
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.
om
10.
HIV-positive persons that display manifestations of laboratory category 3 or clinical category C are
considered to have:
zero viral load.
B)
seroconversion.
C)
complete remission.
D)
AIDS-defining illnesses.
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?
nk
ta
11.
nk
A)
.c
9.
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.
ba
A)
A patient with a long history of hay fever has recently begun a series of immunotherapy (allergy sho
How will this treatment potentially achieve a therapeutic effect?
By blocking cytokine release from sensitized mast cells
B)
By preventing mast cells from becoming sensitized
.te
st
A)
C)
By causing T cells to be sequestered in the thymus for longer periods
By stimulating production of IgG to combine with antigens
Natural killer cells
w
A)
A patient with a diagnosis of cirrhosis has experienced an acute rejection of a donor liver. Which of
following cells is central to the rejection of the patients transplanted organ?
w
13.
w
D)
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-versu
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
Breakdown of T-cell anergy
B)
Release of sequestered antigens
C)
Superantigens
D)
Molecular mimicry
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?
.c
16.
om
A)
nk
15.
A patient has developed pericarditis after developing acute glomerulonephritis, a development that m
be attributable to the presence of similar epitopes on group A, b-hemolytic streptococci and the antig
in the patients heart tissue. Which of the following has most likely accounted for this patients
autoimmune response?
Delayed-type hypersensitivity (DTH) reaction
B)
Proliferation of cytotoxic T cells
C)
Failure of normal self-tolerance
D)
Deletion of autoreactive B cells
17.
nk
ta
A)
Which of the following would constitute a normal assessment finding in a neonate?
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
st
ba
A)
A patient was diagnosed as HIV positive several years ago. Which of the following blood tests is mo
clinically useful for determining the stage and severity of her disease?
.te
18.
Plasma levels
w
A)
C)
Viral load
w
D)
CD4+ cell counts
w
B)
19.
White blood cell count with differential
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
B
6.
B
7.
B
8.
A
9.
B
10.
D
11.
C
12.
D
13.
C
14.
B
15.
D
16.
C
17.
A
B
w
18.
om
5.
.c
A
nk
4.
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ta
B
ba
3.
st
A
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2.
To prevent seroconversion
.te
D)
Answer Key
1.
A
D
20.
B
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19.
Chapter 20: Acquired Immunodeficiency Syndrome
MULTIPLE CHOICE
1.When assigned to a newly admitted patient with AIDS, the nurse says, Im pregnant. It is not
safe for me or my baby if I am assigned to his case. Which is the most appropriate response by
the charge nurse?
a.
This patient would not be a risk for your baby if you use standard precautions and avoid direct contact w
blood or body fluids.
b.
You should ask for a transfer to another unit because contact with this patient would put you and your b
at risk for AIDS.
c.
Wear a mask, gown, and gloves every time you go into his room and use disposable trays, plates, and
utensils to serve his meals.
d.
We should recommend that this patient be transferred to an isolation unit.
om
ANS: A
.c
HIV is transmitted from human to human through infected blood, semen, cervicovaginal
secretions, and breast milk. The use of Standard Precautions by all staff members for all patients
all the time simplifies this issue.
MSC:NCLEX: Safe, Effective Care Environment
nk
KEY:Nursing Process Step: Implementation
nk
ta
2.The anxious male patient is fearful that he has been exposed to a person with an HIV infection.
He states he does not want to go to a laboratory for the ELISA tests because he does not want to
be identified. What would be the nurses most helpful response?
There really is not an option, you will need to get the Western blot test first.
b.
There is an FDA-approved home test called OraQuick.
c.
The rapid test Reveal can identify all the HIV strains.
d.
You can be tested anonymously for ELISA. If you are seronegative, your concerns are over.
st
ba
a.
.te
ANS: B
w
The OraQuick is a home OTC test approved by the FDA. One seronegative on the ELISA is not
evidence because seroconversion may not have taken place. The Western blot test follows if the
ELISA is positive.
Sexual history, risk reduction measures, and testing for HIV
w
a.
w
3.The patient, age 21, has been treated for chlamydia and has a history of recurrent herpes. What
should the nurse counsel this patient about?
b.
Getting an appointment at a family planning clinic
c.
Testing for HIV and what the test results mean
d.
Abstinence and a monogamous relationship
ANS: A
Chlamydia is considered a sexually transmitted disease (STD). As such it requires further testing
and a sexual history to advise the sexual partners.
KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance
4.A patient has just been diagnosed as HIV-positive. He asks the nurse, Does this mean I have
AIDS? Which response would be most informative?
Most people get AIDS within 3 to 12 weeks after they are infected with HIV.
b.
Dont worry. You may never get AIDS if you eat properly, exercise, and get plenty of rest.
c.
It varies with every individual, but the average time is 8 to 10 years from the time a person is infected, a
some go much longer.
d.
You can expect to develop signs and symptoms of AIDS within 6 months.
om
a.
ANS: C
MSC: NCLEX: Physiological Integrity
nk
ta
KEY:Nursing Process Step: Implementation
nk
.c
Typical progress of HIV includes a period of relative clinical latency, occurring immediately
after the primary infection, which can last for several years. Long-term nonprogressors remain
symptom-free for 8 to10 years.
5.Which of the following is a CDC criterion for the progression of HIV infection to AIDS?
Increase in viral load
b.
Decreased ratio of CD8 to CD4
c.
Increase in white blood cells
d.
Increased reactivity to skin tests
st
ba
a.
.te
ANS: A
w
AIDS is the end stage of an HIV infection. The CDC has developed criteria for the diagnosis of
AIDS, which are: increase in viral load even with pharmacologic interventions, increase in the
ratio of CD8 to CD4, decline in the WBCs, and a decreased reactivity to skin tests.
w
KEY:Nursing Process Step: Implementation
w
MSC: NCLEX: Physiological Integrity
6.What should the nurse look for when reviewing a patients chart to determine whether she has
progressed from HIV disease to AIDS?
a.
CD4+ count below 500, chronic fatigue, night sweats
b.
HIV-positive test result, CD4+ count below 200, history of opportunistic disease
c.
Weight loss, persistent generalized lymphadenopathy, chronic diarrhea
d.
Fever, chills, CD4+ count below 200
ANS: B
Patients who have progressed from HIV disease to AIDS will have the condition in which the
CD4+ cell count drops to less than 200 cells/mm3 and have a history of opportunistic diseases.
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
7.A male patient is advised to receive HIV antibody testing because of his multiple sexual
partners and injectable drug use. What should the nurse inform the patient to ensure
understanding?
The blood is tested with the highly sensitive test called the Western blot.
b.
The blood is tested with an ELISA; if positive, it is tested again with an ELISA, followed by a Western
if the second ELISA is positive.
c.
A series of HIV tests is performed to confirm if the patient has AIDS.
d.
If the HIV tests are seronegative, the patient can be assured that he is not infected.
.c
om
a.
nk
ANS: B
nk
ta
The individuals blood is tested with ELISA or enzyme immunoassay (ELA), antibody tests that
detect the presence of HIV antibodies. If the ELA is positive for HIV, then the same blood is
tested a second time. If the second ELA is positive, a more specific confirming test such as the
Western blot is done. Blood that is reactive or positive in all three steps is reported to be HIVpositive. A seronegative is not an assurance that the individual is free of infection since
seroconversion may not have yet occurred.
ba
KEY:Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance
.te
st
8.A 28-year-old married attorney with one child is in the first trimester of her second pregnancy.
The patient states that she is at no risk for HIV, so she would not need to be counseled about
testing for HIV. Which is the most appropriate response?
Shes a professional woman in a monogamous relationship. She obviously is not at risk.
b.
Women are not at great risk. The greatest risk is with gay men.
c.
The fastest-growing segment of the population with AIDS is women and children. We need to assess he
risks.
w
We need to review her chart to determine if her first child was infected.
w
d.
w
a.
ANS: C
Increases in AIDS cases in women and heterosexuals and a slowing of cases in the men who
have sex with men (MSM) category are a direct reflection of early educational efforts directed at
the MSM population, who were believed to be the only population at risk. Women need to be
assessed for different manifestations of HIV infection. It is the current recommendation for
voluntary HIV testing for all pregnant women.
KEY:Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance
9.A young gay patient being treated for his third sexually transmitted disease does not see why
he should use condoms, because they dont work. Which is the most appropriate response?
Condoms may not provide 100% protection, but when used correctly and consistently with every act of
sexual intercourse they reduce your risk of getting infected with HIV or other sexually transmitted disea
b.
You are correct. Condoms dont always work, so your best protection is to limit your number of partners
c.
Condoms do not provide 100% protection, so you should always discuss with your sexual partners their
HIV status or ask if they have any STD.
d.
Condoms do not provide 100% protection, but when used with a spermicide you can be assured of
complete protection against HIV and other STDs.
om
a.
.c
ANS: A
nk
ta
nk
Risk-reducing sexual activities decrease the risk of contact with HIV through the use of barriers.
The most commonly used barrier is the male condom. Although not 100% effective, when used
correctly and consistently, male condoms are very effective in the prevention of HIV
transmission.
KEY:Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance
st
ba
10.A 21-year-old male who has been an IV heroin user has been experiencing fever, weight loss,
and diarrhea and has been diagnosed as having AIDS. At this time, he has a low-grade fever,
severe diarrhea, and a productive cough. He is admitted with Pneumocystis jiroveci. What should
the nurse do when caring for the patient?
a.
Use a gown, mask, and gloves when assisting the patient with his bath
Wear a gown when assisting the patient to use the bedpan
c.
Use a gown, mask, and gloves to administer oral medications
d.
Use a mask when taking the patients temperature
w
ANS: A
w
.te
b.
w
The use of Standard Precautions and body substance isolation has been shown not only to reduce
the risk of blood-borne pathogens, but also to reduce the risk of transmission of other disease
between the patient and the health care worker.
KEY:Nursing Process Step: Implementation
MSC:NCLEX: Safe, Effective Care Environment
11.The nurse should instruct the patient who is diagnosed with AIDS to report signs of Kaposi
sarcoma, which include:
a.
Reddish-purple skin lesions
b.
Open, bleeding skin lesions
c.
Blood-tinged sputum
d.
Watery diarrhea
ANS: A
om
Kaposi sarcoma is a rare cancer of the skin and mucous membranes characterized by blue, red, or
purple raised lesions seen mainly in Mediterranean men. Kaposi sarcoma: firm, flat, raised or
nodular, hyperpigmented, multicentric lesions on the skin and mucous membranes.
KEY:Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance
nk
.c
12.A patient states that he feels terrific, but a blood test shows that he is HIV-positive. It is
important for the nurse to discuss with him that HIV may remain dormant for several years.
What is true of the patient during this time?
He is not dangerous to anyone.
b.
He experiences minor symptoms only.
c.
He experiences decreased immunity.
d.
He is contagious.
ba
ANS: D
nk
ta
a.
.te
st
A prolonged period in which HIV is not readily detectable in the blood follows within a few
weeks or months of the initial infection. This titer, or viral load, falls dramatically as the immune
system responds and controls the HIV infection, and it may last 10 to 12 years. During this
period, there are few clinical symptoms of HIV infection, although an individual is still capable
of transmitting HIV to others.
w
KEY:Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
w
w
13.To be diagnosed as having AIDS, the patient must be HIV-positive, have a compromised
immune system without known immune system disease or recent organ transplant, and present
with which of the following?
a.
Opportunistic infection
b.
A positive ELISA or Western blot test
c.
Weight loss, fever, and generalized lymphedema
d.
CD4+ lymphocyte count less than 200 mm3
ANS: D
The 1993 expanded case definition of AIDS includes all HIV-infected people who have CD4+,
T-lymphocyte counts of less than 200 cells/mm3; this includes all people who have one or more
of these three clinical conditions: pulmonary tuberculosis, recurrent pneumonia, or invasive
cervical cancer, and it retains the 23 clinical conditions listed in the 1987 AIDS case definition.
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
14.Why should interventions such as promotion of nutrition, exercise, and stress reduction be
undertaken by the nurse for patients who have HIV infection?
They will promote a feeling of well-being in the patient.
b.
They will improve immune function.
c.
They will prevent transmission of the virus to others.
d.
They will increase the patients strength and ability to care for himself or herself.
.c
om
a.
nk
ANS: B
nk
ta
HIV disease progression may be delayed by promoting a healthy immune system. Useful
interventions for HIV-infected patients include the following: nutritional changes that maintain
lean body mass, regular exercise, and stress reduction.
KEY:Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance
ba
15.A male patient is concerned about telling others he has HIV infection. What should the nurse
stress when discussing his concerns?
Care providers and sexual partners should be told about his diagnosis.
b.
There is no reason to hide his disease.
c.
Secrecy is a poor idea because it will lower his self-esteem.
d.
His diagnosis will be obvious to most people with whom he will come into contact.
w
ANS: A
w
.te
st
a.
w
Nurses have a responsibility to assess each patients risk for HIV infection and counsel those at
risk about HIV testing and the behaviors that put them at risk, and about how to reduce or
eliminate those risks. The diagnosis needs to be carefully protected and shared only with
caregivers who need to know for the purpose of assessment and treatment.
MSC: NCLEX: Health Promotion and Maintenance
16.The HIV patient asks the nurse about what to expect in terms of disease progression. The
nurse tells this patient that although the disease can vary greatly among individuals, the usual
pattern of progression includes:
a.
viremia, clinical latency, opportunistic diseases, and death.
b.
asymptomatic phase, clinical latency, ARC, and AIDS.
c.
acute retroviral syndrome, early infection, early symptomatic disease, and AIDS.
d.
transitional viral syndrome, inactive disease, early symptomatic infection, and opportunistic diseases.
ANS: C
om
The progression from HIV to AIDS includes initial exposure, primary HIV infection,
asymptomatic HIV infection, early HIV disease, and AIDS.
KEY:Nursing Process Step: Implementation
.c
MSC: NCLEX: Physiological Integrity
nk
17.While teaching community groups about AIDS, what should the nurse indicate as the most
common method of transmission of the HIV virus?
Sexual contact with an HIV-infected partner
b.
Perinatal transmission
c.
Exposure to contaminated blood
d.
Nonsexual exposure to saliva and tears
ba
ANS: A
nk
ta
a.
.te
st
Modes of transmission have remained constant throughout the course of the HIV pandemic. It is
also important for health care providers to remember that transmission of HIV occurs through
sexual practices, not sexual preferences. Worldwide, sexual intercourse is by far the most
common mode of HIV transmission.
KEY:Nursing Process Step: Implementation
w
MSC: NCLEX: Health Promotion and Maintenance
Reduction of red cells
w
a.
w
18.What do the activated monocytes and macrophages produce in the presence of an
inflammatory process?
b.
Increase in WBCs
c.
Neopterin
d.
Increase in T-helper cells increase natural killer (NK) cells
ANS: C
Neopterin is produced in the presence of an inflammatory reaction and is increased in HIV
disease.
MSC: NCLEX: Physiological Integrity
19.For most people who are HIV-positive, marker antibodies are usually present 10 to 12 weeks
after exposure. What is the development of these antibodies called?
a.
Immunocompetence
b.
Seroconversion
c.
Opportunistic infection
d.
Immunodeficiency
om
ANS: B
.c
Seroconversion is the development of antibodies from HIV, which takes place approximately 5
days to 3 months after exposure, generally within 1 to 3 weeks. Although the conversion has
taken place, the patient is not yet immunodeficient.
KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance
nk
20.What should the nurse emphasize when counseling an anxious HIV-positive mother about the
care of her HIV-positive infant?
The baby will develop AIDS and refer her to a local AIDS support group. The baby will remain HIVpositive for the rest of its life.
b.
Although infants of HIV-infected mothers may test positive for HIV antibodies, not all infants are infec
with the virus.
c.
She has not yet developed AIDS, and that it is possible the baby will not develop AIDS for many years.
d.
If the infant is started on zidovudine (AZT) within the first month after delivery, AIDS can be prevented
ba
nk
ta
a.
st
ANS: B
w
w
.te
The decline in pediatric AIDS incidence is associated with the increased compliance with
universal counseling and testing of pregnant women and the use of zidovudine by HIV-infected
pregnant women and their newborn infants. Infants born to HIV-infected mothers will have
positive HIV antibody results as long as 15 to 18 months after birth. This is caused by maternal
antibodies that cross the placenta during gestation and remain in the infants circulatory system.
w
Chapter 21: Structure and Function of the Cardiovascular System
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.
A)
contractions.
B)
calcium influx.
C)
action potentials.
D)
sarcomere binding.
During ventricular systole, closure of the atrioventricular (AV) valves coincides with:
.c
4.
om
Heart muscle differs from skeletal muscle tissue by being able to generate:
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:
stroke volume.
B)
cardiac output.
C)
ejection fraction.
D)
cardiac reserve.
ba
A)
st
Preload represents the volume work of the heart and is largely determined by:
A)
venous blood return.
B)
.te
6.
vascular resistance.
force of contraction.
D)
w
C)
ventricular emptying.
A large increase in heart rate can cause:
w
7.
increased blood viscosity.
w
A)
nk
ta
A)
nk
3.
B)
loss of action potential.
C)
decreased stroke volume.
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.
The tissue factor that contributes to humoral control of blood flow by causing vasoconstriction is:
A)
histamine.
B)
bradykinin.
C)
serotonin.
D)
nitric oxide.
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.
nk
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 fo
this pathophysiologic phenomenon?
nk
ta
11.
om
10.
.c
9.
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.
D)
Decreases in wall tension and blood pressure have caused a sudden increase in vessel radii.
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?
st
12.
ba
A)
Pericarditis
.te
A)
B)
Endocarditis
C)
Myocarditis
Vasculitis
w
D)
w
Following several weeks of increasing fatigue and a subsequent diagnostic work-up, a patient has be
diagnosed with mitral valve regurgitation. Failure of this heart valve would have which of the follow
consequences?
w
13.
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.
A)
Harmful effects on cardiac action potential are most likely to result from a deficit of which of the
following electrolytes?
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 uncharacter
chest pain and his subsequent ECG reveals T-wave elevation. This finding suggests an abnormality
which of the following aspects of the cardiac cycle?
Atrial depolarization
B)
Ventricular depolarization
C)
Ventricular repolarization
D)
Depolarization of the AV node, bundle branches, and Purkinje system
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 t
are ultimately suggestive of decreased cardiac output. Which of the following factors that determine
cardiac output is hypertension likely to affect most directly?
Preload
B)
Afterload
C)
Contractility
.te
st
A)
D)
Heart rate
w
A patient who lives with a diagnosis of angina pectoris has taken a sublingual dose of nitroglycerin t
treat the chest pain he experienced while mowing his lawn. This drug has resulted in a release of nitr
oxide, which will have what effect?
w
18.
Smooth muscle relaxation of vessels
w
A)
nk
ta
A)
nk
.c
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 12
mL; end-systolic volume 60 mL. What is this patients ejection fraction?
ba
16.
om
A)
B)
Decreased heart rate and increased stroke volume
C)
Increased preload
D)
Reduction of cardiac refractory periods
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
A
6.
A
7.
C
8.
A
9.
C
10.
C
11.
A
12.
B
13.
D
14.
C
15.
C
16.
B
17.
B
A
w
18.
om
5.
.c
C
nk
4.
nk
ta
C
ba
3.
st
A
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2.
Feedback from arterial baroreceptors and chemoreceptors
.te
D)
Answer Key
1.
B
D
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19.
20.
B
Chapter 22: Disorders of Blood Flow in the Systemic Circulation
1.
Because cholesterol is insoluble in plasma, it is mainly carried by the lipoprotein:
A)
IDL.
B)
HDL.
C)
LDL.
D)
VLDL.
A major cause of secondary hyperlipoproteinemia is _______, which increases the production of VLD
and conversion to LDL.
A)
high-calorie diet
B)
diabetes mellitus
C)
bile-binding resin
D)
cholesterol ingestion
om
The most important complication of atherosclerosis is _________, which may cause occlusion of sma
heart vessels.
ulceration
B)
thrombosis
C)
fatty streaks
D)
fibrous plaque
4.
.c
A)
A serum marker for systemic inflammation, _______, is now considered a major risk factor marker fo
atherosclerosis, and vascular disease.
leukocytosis
B)
homocysteine
C)
serum lipoprotein
D)
C-reactive protein
ba
A)
5.
Small-vessel vasculitides, a group of vascular disorders that cause vasculitis, are mainly mediated by:
infectious agents.
B)
tissue necrosis.
.te
st
A)
C)
mononuclear cells.
hypersensitivity reactions.
Atherosclerotic peripheral vascular disease is symptomatic with at least 50% occlusion. The primary
peripheral symptom, due to ischemia, is:
w
6.
w
D)
edema.
w
A)
nk
3.
nk
ta
2.
B)
calf pain.
C)
varicosities.
D)
strong pulse.
7.
Although both are characterized by ischemia, Raynaud phenomenon is caused by _________, and
thromboangiitis obliterans is caused by:
A)
occlusion; compression.
B)
thrombi; vasoconstriction.
C)
vasculitides; hypertension.
D)
vasospasm; inflammation.
Because of its location, the presence of an abdominal aortic aneurysm may first be noticed as:
A)
constipation.
B)
indigestion.
C)
a pulsating mass.
D)
mid-abdominal pain.
129; 85
B)
138; 89
C)
140; 90
D)
155; 95
10.
.c
A)
om
By definition, hypertension is systolic blood pressure of ____ mm Hg or higher or diastolic blood
pressure of ____ mm Hg or higher.
nk
9.
The patient is immobilized following a hip injury and has begun demonstrating lower leg discolorati
with edema, pain, tenderness, and increased warmth in the mid-calf area. He has many of the
manifestations of:
nk
ta
8.
stasis ulcerations.
B)
arterial insufficiency.
C)
primary varicose veins.
D)
deep vein thrombosis.
ba
A)
st
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11.
A 52-year-old man who is moderately obese has recently been diagnosed with hypertension by his
primary care provider. Which of the patients following statements indicates a need for further health
promotion teaching?
A)
Ive starting going to the gym before work three times a week.
Im trying to cut back on the amount of salt that I cook with and add to my food.
w
B)
Im planning to lose 15 pounds before the end of this year.
A patient with a diagnosis of chronic renal failure secondary to diabetes has seen a gradual increase
her blood pressure over the past several months, culminating in a diagnosis of secondary hypertensio
Which of the following has most likely resulted in the patients increased blood pressure?
w
D)
Im resolving to eat organic foods from now on and to drink a lot more water.
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C)
12.
A)
Increased levels of adrenocortical hormones
B)
Activation of the renin-angiotensin-aldosterone mechanism
C)
Increased sympathetic stimulation by the autonomic nervous system (ANS)
D)
Coarctation of the patients aorta
13.
Which of the following physiologic processes contributes most to the long-term regulation of blood
pressure?
A)
Actions of the renin-angiotensin-aldosterone system
B)
Release of antidiuretic hormone (vasopressin) by the posterior pituitary
C)
Renal monitoring and adjustment of extracellular fluid volume
D)
Integration and modulation of autonomic nervous system (ANS)
Which of the following is a nonmodifiable risk factor for the development of primary hypertension?
African American race
B)
High salt intake
C)
Male gender
D)
Obesity
A patient with persistent, primary hypertension remains apathetic about his high blood pressure, stat
I dont feel sick, and it doesnt seem to be causing me any problems that I can tell. How could a clinic
best respond to this patients statement?
nk
15.
.c
A)
om
14.
Actually, high blood pressure makes you very susceptible to getting diabetes in the future.
B)
Thats true, but its an indicator that youre not taking very good care of yourself.
C)
You may not sense any problems, but it really increases your risk of heart disease and stroke.
D)
Youre right, but its still worthwhile to monitor it in case you do develop problems.
16.
ba
nk
ta
A)
A patients primary care provider has added 20 mg of Lasix (furosemide) to his medication regimen t
treat his primary hypertension. How does this diuretic achieve its therapeutic effect?
By decreasing vascular volume by increasing sodium and water excretion
B)
By blocking the release of antidiuretic hormone from the posterior pituitary
.te
st
A)
C)
By inhibiting the conversion of angiotensin I to angiotensin II.
D)
By inhibiting the movement of calcium into arterial smooth muscle cells
w
w
A 29-year-old woman who considers herself active and health conscious is surprised to have been
diagnosed with preeclampsia-eclampsia in her second trimester. What should her care provider teach
her about this change in her health status?
17.
w
A)
We dont really understand why some women get high blood pressure when theyre pregnant.
B)
This is likely a result of your nervous system getting overstimulated by pregnancy.
C)
Hypertension is a common result of all the hormonal changes that happen during pregnancy.
D)
Even though youre a healthy person, it could be that you have an underlying heart condition.
18.
A)
Which of the following patients should most likely be assessed for orthostatic hypotension?
A 78-year-old woman who has begun complaining of frequent headaches unrelieved by over-t
counter analgesics.
B)
A patient whose vision has become much less acute in recent months and who has noticed
swelling in her ankles.
C)
An elderly patient who has experienced two falls since admission while attempting to ambulat
the bathroom.
D)
A patient who has a history of poorly controlled type 1 diabetes.
B)
Deep vein thrombosis
C)
Varicose veins
D)
Peripheral arterial disease
A postsurgical patients complaints of calf pain combined with the emergence of swelling and rednes
the area have culminated in a diagnosis of deep vein thrombosis. What treatment options will be of
greatest benefit to this patient?
nk
ta
20.
om
Chronic venous insufficiency
nk
A)
.c
19.
A patient is receiving homecare for the treatment of a wound on the inside of her lower leg which is
cm in diameter with a yellow wound bed and clear exudate. Assessment of the patients legs reveals
edema and a darkened pigmentation over the ankles and shins of both legs. What is this patients mos
likely diagnosis?
A)
Analgesics and use of a pneumatic compression device
B)
Massage followed by vascular surgery
C)
Frequent ambulation and the use of compression stockings
3.
B
4.
D
5.
D
ba
B
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6.
st
A
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2.
Anticoagulation therapy and elevation of the leg
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D)
Answer Key
1.
C
D
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7.
8.
C
9.
C
10.
D
11.
C
12.
B
13.
C
14.
A
15.
C
16.
A
17.
A
18.
C
19.
A
20.
D
om
Chapter 23: Disorders of Blood Pressure Regulation
MULTIPLE CHOICE
nk
.c
1.Which of the following should the nurse instruct a client who is newly diagnosed with
hypertension?
It is a lifelong process.
2.
It can be managed easily.
3.
It is a short-term problem.
4.
It happens only in the very poor and treatment is expensive.
st
ba
nk
ta
1.
ANS: 1
.te
Treatment of hypertension is a lifelong process. It requires lifestyle modification and occurs in
all racial and economical groups. Hypertension can either be easy or difficult to manage.
w
PTS: 1 DIF: Apply REF: Introduction
w
w
2.A client is diagnosed with isolated systolic hypertension. The nurse realizes that this diagnosis
means the client is experiencing a systolic pressure:
1.
greater than 140 mmHg and a diastolic pressure greater than 90 mmHg.
2.
greater than 90 mmHg and a diastolic pressure greater than 60 mmHg.
3.
greater than 140 mmHg and a diastolic pressure lower than 90 mmHg.
4.
lower than 140 mmHg and a diastolic pressure greater than 90 mmHg.
ANS: 3
The likelihood of developing isolated systolic hypertension is greater with age and is confirmed
with a systolic pressure greater than 140 mmHg while the diastolic pressure remains less than 90
mmHg.
PTS: 1 DIF: Analyze REF: Hypertension: Nonmodifiable Risk Factors
om
3.The nurse is instructing a client on the impact of cigarette smoking and the development of
hypertension. Which of the following would not be appropriate for the nurse to include in these
instructions?
Tobacco damages the lining of the artery walls.
2.
Tobacco temporarily constricts blood vessels, increasing pulse and blood pressure.
3.
Tobacco thins the blood and makes the person at risk for bleeding.
4.
Carbon monoxide in tobacco smoke replaces the oxygen in the blood, forcing the heart to work harder t
supply oxygen.
nk
ta
nk
.c
1.
ANS: 3
st
ba
Tobacco and smoking have been shown to increase heart rate and blood pressure because of
vasoconstriction and the accumulation of plaque on the artery walls. Because of the replacement
of oxygen with carbon monoxide from tobacco smoke, the heart has to work harder to supply
oxygen to the organs. There is no evidence that smoking thins the blood and causes bleeding.
.te
PTS: 1 DIF: Apply REF: Hypertension: Modifiable Risk Factors
w
w
1.
w
4.The nurse is assessing a clients pulse pressure. His blood pressure reading is 130/82 mmHg.
Which of the following is the correct pulse pressure?
40
2.
48
3.
130
4.
82
ANS: 2
The pulse pressure is the difference between the systolic and diastolic pressure: 130 82 = 48. The
other choices represent miscalculations or not understanding the correct way to calculate pulse
pressure.
PTS: 1 DIF: Apply REF: Hypertension: Pathophysiology
pain.
3.
headache.
4.
fear.
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2.
nk
nausea.
nk
ta
1.
om
5.A client is surprised to learn that she has high blood pressure. Which of the following should
the nurse assess in this client? The presence or occurrence of:
ANS: 3
ba
With very elevated blood pressure, headache is the most commonly reported symptom. Although
pain and nausea may be reported, they are not the most common. Fear is not commonly
associated with hypertension though it may occur with an onset of pain or nausea.
PTS:1DIF:Apply
st
REF: Hypertension: Assessment with Clinical Manifestations
.te
6.A clients blood pressure has been measured at 130/86 mmHg on two separate occasions. The
nurse realizes this clients blood pressure reading would be categorized as being:
w
w
2.
w
1.
normal.
prehypertension.
3.
stage 1 hypertension.
4.
stage 2 hypertension.
ANS: 2
Prehypertension is a new designation used to identify individuals at high risk for the
development of hypertension. Systolic blood pressure of 120 to 139 and diastolic blood pressure
of 80 to 90 are values for prehypertension. A normal blood pressure is less than or equal to 120
mmHg systolic and less than or equal to 80 mmHg diastolic. Stage 1 hypertension is a systolic
blood pressure between 140 to 159 and a diastolic pressure between 90 to 99. Stage 2
hypertension is a systolic reading greater than or equal to 160 and a diastolic pressure of greater
than or equal to 100 mmHg.
PTS:1DIF:Analyze
REF:Table 28-6 JNC VII Classification of Blood Pressure in Adults
om
7.The nurse uses a blood pressure cuff that is too small for the circumference of the clients arm.
How will this size of blood pressure cuff affect the clients blood pressure measurement?
Falsely low
2.
Falsely high
3.
Not clearly heard
4.
More time consuming
nk
ta
nk
.c
1.
ANS: 2
.te
PTS:1DIF:Analyze
st
ba
The blood pressure cuff must be the appropriate size to get an accurate reading. A cuff that is too
small could result in a falsely high reading. A blood pressure cuff that is too large could result in
a falsely low reading. The cuff size may not affect the nurses ability to hear the blood pressure
sounds. An incorrect blood pressure cuff size will not be more time consuming to use.
REF:Table 28-2 Factors Causing False Blood Pressure Readings
w
1.
w
w
8.A client diagnosed with hypertension should be instructed by the nurse to avoid which of the
following foods?
Cold cuts
2.
Bananas
3.
Milk
4.
Oatmeal
ANS: 1
Cold cuts are processed meats that are usually high in sodium and may cause water retention and
an increase in blood pressure. The rest of the foods really have no effect on blood pressure.
PTS:1DIF:Apply
REF: Hypertension: Planning and Implementation: Evidence-Based Care
1000 mg a day.
3.
2500 mg a day.
4.
4500 mg a day.
.c
2.
nk
500 mg a day.
nk
ta
1.
om
9.A client is instructed to reduce his intake of daily sodium intake so that the total amount is
what his body needs. The nurse should instruct the client to reduce sodium intake to:
ANS: 1
ba
A human body needs about 500 mg of sodium each day. The average intake of sodium for
individuals in the United States is between 4000 to 6000 mg a day.
PTS:1DIF:Apply
st
REF: Hypertension: Planning and Implementation: Evidence-Based Care
.te
10.A client asks the nurse why she should be concerned about the amount of sodium in ice
cream. Which of the following should the nurse respond to this client?
Sodium is used to emulsify the ice cream.
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w
2.
Sodium is used to enhance the flavor.
w
1.
3.
Sodium is used to prevent mold.
4.
Sodium is used as a preservative.
ANS: 2
Sodium is used in ice cream as an emulsifier. Sodium in canned or processed foods is used to
enhance flavor. Sodium is used to prevent mold in cheese, breads, and cakes. Sodium is used as a
preservative in cured meats and sausages.
PTS: 1 DIF: Apply REF: Table 28-6 Sodium-Based Food Additives
11.Which of the following should the nurse instruct a client who desires to reduce his blood
pressure through increasing physical activity?
Regular exercise can lower the blood pressure by 5 to 10 mmHg.
2.
Regular exercise must be done 7 days a week.
3.
Regular exercise has to be done for at least 2 hours each day.
4.
Regular exercise is the participation in aerobic activities.
.c
om
1.
nk
ANS: 1
nk
ta
Regular exercise can lower blood pressure by 5 to 10 mmHg. Regular exercise should be done 5
days a week for 60 minutes or 20 minutes of vigorous exercise at least 3 times a week to be
effective. Regular exercise includes aerobic activity, flexibility, and strengthening exercises.
PTS:1DIF:Apply
ba
REF: Hypertension: Planning and Implementation: Evidence-Based Care
st
12.A client is prescribed Spironolactone (Aldactone) for blood pressure control. Which of the
following should the nurse assess in this client as a potential side effect?
Hypokalemia
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1.
Hyperkalemia
w
2.
w
4.
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3.
Hyponatremia
Hypernatremia
ANS: 2
Spironolactone (Aldactone) is a potassium-sparing diuretic. Side effects include hyperkalemia.
Hypokalemia and hyponatremia are side effects of the thiazide diuretics. Hypernatremia is not a
known side effect of any antihypertensive medication.
PTS:1DIF:Apply
REF: Table 28-9 Pharmacologic Management of Hypertension
Tachycardia
2.
Constipation
3.
Bizarre dreams
4.
Persistent dry cough
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1.
om
13.A client is prescribed an ACE inhibitor for management of hypertension. Which of the
following side effects should the nurse instruct the client as being expected with this medication?
ANS: 4
nk
ta
nk
One side effect of ACE inhibitors that is expected with this medication is a persistent dry cough.
Tachycardia, constipation, and bizarre dreams are not side effects associated with ACE
inhibitors.
PTS:1DIF:Apply
REF: Table 28-9 Pharmacologic Management of Hypertension
ba
MULTIPLE RESPONSE
st
1.The nurse is considering the risk factors for a clients development of primary hypertension.
Which of the following would be considered nonmodifiable risk factors for the client? (Select all
that apply.)
w
w
3.
Stress
w
2.
Age
.te
1.
Gender
4.
Ethnicity
5.
Regular exercise
6.
Limits fat and salt in diet
ANS: 1, 3, 4
Nonmodifiable risk factors are those thing we cannot change or control, such as age, gender, and
ethnicity. Stress, exercise, and diet are considered modifiable risk factors or those the client can
control.
PTS: 1 DIF: Analyze REF: Hypertension: Risk Factors
2.Which of the following should the nurse tell a client when instructing on ways to reduce the
risk factors for hypertension? (Select all that apply.)
Smoking
2.
Diet
3.
Exercise
4.
Family history
5.
Race
6.
Stress
ba
nk
ta
nk
.c
om
1.
ANS: 1, 2, 3, 6
.te
st
Modifiable risk factors can be changed or modified to help control hypertension. Smoking, diet,
stress, and exercise can be changed to affect blood pressure. Persons with more risk factors have
a greater chance of having hypertension during their lives. Family history and race cannot be
modified.
w
PTS: 1 DIF: Apply REF: Hypertension: Risk Factors
w
w
3.Which of the following assessment questions would be appropriate for the nurse to use when
assessing a client for hypertension? (Select all that apply.)
1.
Do you consume alcohol products? How much? How long?
2.
Do you use nicotine products? How much? How long?
3.
Do you experience nosebleeds?
4.
Do you get hungry at night?
5.
Do you experience cold sweats?
6.
Do you experience headaches?
ANS: 1, 2, 3, 6
om
The nurse will often ask the client questions about risks of hypertension. Asking about alcohol
and nicotine product use will tell you about increased risk factors. Nosebleeds and headaches are
often associated with hypertension. Although cold sweats and hunger are symptoms a patient
may report, they are not indicative of hypertension.
.c
PTS: 1 DIF: Apply REF: Box 28-2 Hypertension Assessment
nk
4.The blood pressure measurement for a client is very different from the one that was assessed a
few hours previously. The nurse should suspect that the blood pressure measurement is false
when which of the following is assessed in the client?
Client needs to void.
2.
Client smoked a cigarette 10 minutes prior to the measurement.
3.
The examination room is very warm.
4.
Doors are slamming and children are crying in the environment.
5.
Client just had lunch.
6.
Client slept for 8 hours the previous night.
w
w
.te
st
ba
nk
ta
1.
ANS: 1, 2, 3, 4
w
Factors that cause false blood pressure readings include anxiety, full urinary bladder, excessively
warm room, recent tobacco use, and loud or repetitive noises. Eating a meal or having 8 hours of
sleep are not known to cause a false blood pressure reading.
PTS:1DIF:Analyze
REF:Table 28-2 Factors Causing False Blood Pressure Readings
5.A client is planning to use nicotine gum to aid with cigarette cessation. Which of the following
should the nurse instruct the client as adverse effects of using nicotine gum? (Select all that
apply.)
Rapid heart rate may result.
2.
Mild headaches can occur.
3.
A sore mouth and throat are possible.
4.
Abnormal dreams are common.
5.
Pruritis is possible.
6.
Nausea can occur.
nk
.c
om
1.
ANS: 1, 2, 3, 6
nk
ta
Adverse effects associated with the use of nicotine chewing gum include tachycardia, mild
headache, sore mouth and throat, and nausea. Abnormal dreams and pruritis are adverse effects
of nicotine patches, nicotine nasal spray, and nicotine inhalers.
st
Chronic stable angina, associated with inadequate blood flow to meet the metabolic demands of the
myocardium, is caused by:
A)
fixed coronary obstruction.
B)
.te
1.
ba
Chapter 24: Disorders of Cardiac Function
increased collateral circulation.
C)
intermittent vessel vasospasms.
excessive endothelial relaxing factors.
w
D)
w
A)
Atherosclerotic plaque is most likely to be unstable and vulnerable to rupture when the plaque has a th
fibrous cap over a:
w
2.
red thrombus.
B)
large lipid core.
C)
calcified lesion.
D)
vessel wall injury.
3.
Cardiac tamponade and pericardial effusion can be life-threatening when the pericardial sac _______
______ the heart.
A)
ruptures; releases
B)
thickens; stretches
C)
contracts; friction rubs
D)
fills rapidly; compresses
4.
In adults, sudden death from an acute myocardial infarction is usually caused by:
A)
acute myocarditis.
B)
high troponin levels.
C)
acute ventricular arrhythmia.
D)
hypertrophic cardiomyopathy.
B)
acutely inflamed.
C)
granulation tissue.
D)
fibrous scar tissue.
6.
In aortic regurgitation, failure of aortic valve closure during diastole causes an abnormal drop in diast
pressure. This change in pressure causes decreased:
stroke volume.
B)
left ventricular size.
C)
coronary perfusion.
D)
arterial pulse pressure.
ba
A)
Patients with ischemic coronary vessel disease and acute coronary syndrome (ACS) are classified as l
or high risk for acute myocardial infarction based on characteristics that include significant:
st
7.
heart murmurs.
B)
ECG changes.
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A)
C)
pulmonary disease.
pericardial effusion.
rigidity.
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B)
Dilated cardiomyopathy with left ventricular dysfunction is characterized by increased wall:
w
8.
w
D)
A)
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soft and yellow.
nk
A)
om
On the second or third day after an acute myocardial infarction, the area of necrosis is:
nk
ta
5.
thinning.
C)
thickness.
D)
contractility.
9.
Endocarditis and rheumatic heart disease are both cardiac complications of systemic infections.
Characteristics include a new or changed heart murmur caused by:
A)
chronic atrial fibrillation.
B)
myocardial inflammation.
C)
left ventricle hypertrophy.
D)
vegetative valve destruction.
Congenital heart defects can cause a right heart to left heart shunting of blood that results in increase
A)
pulmonary blood volume.
B)
right ventricle workload.
C)
unoxygenated blood flow.
D)
right atrial blood volume.
11.
Which of the following assessment findings of a cardiac patient would be suggestive of cardiac
tamponade?
om
10.
Increasing PaCO2 and decreasing PaO2
B)
Audible crackles on chest auscultation and presence of frothy sputum
C)
20 mm Hg Drop in systolic blood pressure during respiration
D)
Normal ECG combined with complaints of chest pain and shortness of breath
The plaques in a patients coronary arteries are plentiful and most have small- to moderate-sized lipid
cores with thick fibrous caps. This form of atherosclerosis is most closely associated with which of t
following diagnoses?
nk
ta
12.
nk
.c
A)
Stable angina
B)
Non-ST-segment elevation MI
C)
ST-Segment elevation MI
D)
Unstable angina
13.
ba
A)
Which of the following individuals is suffering the effects of acute coronary syndrome (ACS)?
A patient whose most recent ECG indicates that silent myocardial ischemia has occurred
B)
A patient who occasionally experiences persistent and severe chest pain when at rest
.te
st
A)
C)
A patient who sometimes experiences chest pain when climbing stairs
A patient who has recently been diagnosed with variant (vasospastic) angina
Atherosclerosis with history of MI
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A)
Coronary artery bypass grafting (CABG) is a relevant treatment modality for which of the following
disorders of cardiac function?
w
14.
w
D)
B)
Pericardial effusion and cardiac tamponade
C)
Dilated cardiomyopathies
D)
Aortic valve regurgitation and aortic stenosis
15.
Football fans at a college have been shocked to learn of the sudden death of a star player, an event th
was attributed in the media to an enlarged heart. Which of the following disorders was the players m
likely cause of death?
A)
Takotsubo cardiomyopathy
B)
Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D)
C)
Hypertrophic cardiomyopathy (HCM)
D)
Dilated cardiomyopathy (DCM)
Implantation of a pacemaker is most likely to benefit a patient with which of the following
cardiomyopathies?
A)
Myocarditis
B)
Takotsubo cardiomyopathy
C)
Dilated cardiomyopathy (DCM)
D)
Primary restrictive cardiomyopathy
17.
A childs history of a recurrent sore throat followed by severe knee and ankle pain has resulted in a
diagnostic workup and a diagnosis of rheumatic fever. What are the treatment priorities for this child
Cardiac catheterization and corticosteroid therapy
B)
Implanted pacemaker and b-adrenergic blockers
C)
Antibiotics and anti-inflammatories
D)
Pain control and oxygen therapy
nk
ta
18.
nk
.c
A)
An elderly female patient with complaints of increasing fatigue has been diagnosed with aortic steno
a disease which her primary care provider believes may have been long-standing. Which of the
following compensatory mechanisms has most likely maintained the womans ejection fraction until
recently?
Left ventricular hypertrophy
B)
Increased blood pressure
C)
Increased heart rate and stroke volume
D)
Aortic dilation
st
ba
A)
Persistent cyanosis has led an infants care team to suspect a congenital heart defect. Which of the
following assessment findings would suggest coarctation of the infants aorta?
.te
19.
The child has a split S2 heart sound on auscultation.
w
A)
The child experiences apneic spells after feeding.
w
D)
ECG reveals atrial fibrillation.
w
B)
C)
om
16.
20.
Blood pressure in the childs legs is lower than in the arms.
Which of the following assessment findings of a cyanotic infant is incongruent with a diagnosis of
tetralogy of Fallot?
A)
The child has ventricular septal defect.
B)
The infants pulmonary outflow channel is narrowed.
C)
The child has right ventricular hypertrophy.
D)
Answer Key
The infants aorta is narrowed.
4.
C
5.
B
6.
C
7.
B
8.
B
9.
D
10.
C
11.
C
12.
A
13.
B
14.
A
15.
C
16.
C
17.
C
18.
A
19.
D
20.
D
om
D
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3.
nk
B
nk
ta
2.
ba
A
st
1.
.te
Chapter 25: Disorders of Cardiac Conduction and Rhythm
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MULTIPLE CHOICE
w
w
1.A client is experiencing an alteration in heart rate. The nurse realizes this client is experiencing
a disorder of which part of the heart?
1.
Atrioventricular node
2.
Bundle branches
3.
Purkinje fibers
4.
Sinoatrial node
ANS: 4
The sinoatrial node is the dominant pacemaker of the heart. The sinoatrial node has an inherent
rate of 60 to 100 bpm. The atrioventricular node has an intrinsic rate of 40 to 60 bpm. The
impulse enters the right and left bundle branches and then enters the Purkinje fibers. Impulses at
this level are at 15 to 40 times per minute.
PTS: 1 DIF: Analyze REF: Anatomy and Physiology
Arterial blood gases
3.
Cardiac angiogram
4.
Cardiac enzymes
.c
2.
nk
12-lead electrocardiogram
nk
ta
1.
om
2.A client is suspected of having cardiac damage. The nurse realizes that which of the following
diagnostic tests is most commonly used to help diagnose this clients possible cardiac damage or
disease?
ba
ANS: 1
st
A 12-lead electrocardiogram is a quick and accurate diagnostic tool used to evaluate heart
damage and disease. The other diagnostic tests require a longer time for results and/or are
invasive procedures requiring some preparation.
.te
PTS:1DIF:AnalyzeREF:ECG Monitoring
w
w
1.
w
3.The nurse is analyzing a clients electrocardiogram tracing. Which of the following complexes
is not normally seen on an electrocardiogram tracing?
P wave
2.
QRS complex
3.
T wave
4.
U wave
ANS: 4
A U wave is not always seen and can be very small. It can indicate electrolyte imbalance,
medication effects, and ischemia. The P wave, QRS complex, and T wave are normally seen in
the electrocardiogram tracing.
PTS:1DIF:Analyze
REF: The Normal ECG Complex; Figure 26-1 Conduction System of the Heart
0.12 second.
3.
0.20 second.
4.
0.40 second.
.c
2.
nk
0.04 second.
nk
ta
1.
om
4.The nurse is analyzing a clients electrocardiogram tracing and realizes that each small square
on the paper is equal to:
ANS: 1
ba
The small square on the ECG graph paper equals 0.04 second. The large square equals 0.20
second. The PR interval is 0.12 to 0.20 second. Two large squares would be equal to 0.40
second.
st
PTS: 1 DIF: Analyze REF: Calculating Heart Rate
.te
5.The nurse is reading an ECG rhythm strip and notes that there are nine QRS complexes in a 6second strip. The heart rate is:
w
w
2.
w
1.
36.
54.
3.
81.
4.
90.
ANS: 4
A heart rate can be determined by multiplying the QRS complexes in a 6-second strip by 10. The
heart rate is 90. This method of calculating the heart rate is the most common method used
because it is quick and can be used when the heart rate is irregular.
PTS: 1 DIF: Apply REF: Calculating Heart Rate
2.
second-degree AV block type I.
3.
second-degree AV block type II.
4.
complete heart block.
.c
first-degree AV block.
nk
1.
om
6.The nurse notes that on a clients electrocardiogram tracing, there is one P wave for every QRS
complex and a delay in the impulse transmission at the AV node. This regular rhythm is
identified as:
ANS: 1
nk
ta
First-degree atrioventricular (AV) block occurs when there is a delay in the impulse transmission
at the AV node. This delay occurs with every impulse and can be seen on every beat on the
recorded rhythm strip. Second-degree and complete heart block have differences with the P wave
and the associated QRS complexes.
ba
PTS: 1 DIF: Analyze REF: First-Degree Heart Block
.te
st
7.A client is unresponsive and has no pulse. The nurse notes that the electrocardiogram tracing
shows continuous large and bizarre QRS complexes measured greater than 0.12 each. This
rhythm is identified as:
1.
premature ventricular complexes.
w
w
3.
torsades de pointes.
w
2.
4.
ventricular fibrillation.
ventricular tachycardia.
ANS: 4
Ventricular tachycardia occurs when the patient experiences sustained consecutive premature
ventricular complexes. Torsades de pointes is characterized by a wide-to-narrow pattern of the
QRS complexes. Ventricular fibrillation shows a coarse wavy baseline.
PTS: 1 DIF: Analyze REF: Ventricular Tachycardia
Oxygen therapy
2.
Analgesics
3.
Antibiotics
4.
Pacemaker insertion
.c
1.
om
8.An elderly client is demonstrating a change in heart rate that occurs with respirations. When
planning care for the client, the nurse knows that treatment may include:
ANS: 4
PTS:1DIF:ApplyREF:Sinus Arrhythmia
nk
ta
nk
A change in heart rate that occurs with respirations defines a sinus arrhythmia. If the client
becomes symptomatic during periods of bradycardia, treatment will include atropine sulfate or
pacemaker insertion. Treatment for sinus arrhythmia might include oxygen if the client is
symptomatic. Treatment for this arrhythmia does not include analgesics or antibiotics.
ba
9.A clients electrocardiogram tracing shows a sawtooth pattern with F waves. The nurse realizes
this client is demonstrating:
atrial flutter.
2.
atrial fibrillation.
.te
st
1.
w
4.
premature atrial contractions.
w
3.
atrial tachycardia.
w
ANS: 1
Atrial flutter is characterized by F waves that occur in a characteristic sawtooth pattern. Atrial
fibrillation is characterized by coarse waves with the baseline between the QRS complexes as
being rough and uneven. Premature atrial contractions occur when an electrical impulse is
generated in an area of the atria outside of the SA node. Atrial tachycardia is three or more
premature atrial contractions. Neither premature atrial contractions or atrial tachycardia have an
F wave on the tracing.
PTS:1DIF:AnalyzeREF:Atrial Arrhythmias
Administer oxygen
2.
Increase intravenous fluids
3.
Check on the serum digoxin level
4.
Assist the client to a side-lying position
.c
1.
om
10.The electrocardiogram tracing for a client shows premature junctional complexes. Which of
the following should the nurse do to assist this client?
ANS: 3
nk
ta
nk
The most common cause of premature junctional complexes is digitalis toxicity. The nurse
should check on the clients serum digoxin level. Oxygen, intravenous fluids, or position changes
will not help treat this rhythm.
PTS: 1 DIF: Apply REF: Premature Junctional Complexes
ba
11.Which of the following should the nurse instruct a client who has been diagnosed with an
arrhythmia?
Exercise level
2.
Avoidance of calorie-dense foods
.te
st
1.
How to take his own pulse
w
3.
Reasons why fatigue is expected
w
4.
w
ANS: 3
Instructions for a client diagnosed with an arrhythmia include symptom management, how to
take own pulse, and substances to avoid the onset of an arrhythmia. The nurse may or may not
instruct on exercise level. The client does not need to avoid calorie-dense foods. Fatigue is a
symptom that should be reported to a health care provider.
PTS:1DIF:Apply
REF:Table 26-2 Nursing Management for the Patient with Arrhythmias
12.A client is diagnosed with supraventricular tachycardia. The nurse should prepare to
administer which of the following medications?
Procainamide
2.
Amiodarone
3.
Verapamil
4.
Adenosine
om
1.
ANS: 4
nk
.c
Adenosine has a short half-life, is given intravenous push, and is used to abruptly stop
supraventricular tachycardia. Procainamide is used for tachyarrhythmias and ventricular ectopy.
Amiodarone is helpful to treat ventricular fibrillation. Verapamil helps slow the heart rate with
atrial fibrillation.
nk
ta
PTS:1DIF:ApplyREFharmacology
13.A client is recovering from insertion of a pacemaker to pace the activity of the ventricles. At
which point on the electrocardiogram tracing will the nurse assess pacer spikes?
Before the QRS complex
2.
Before the P wave
3.
After the QRS complex
.te
st
ba
1.
After the P wave
w
ANS: 1
w
4.
w
If the ventricles are being paced, there will be a pacer spike just prior to the QRS complex. If the
atria are being paced, there will be a pacer spike just before the P wave. Pacer spikes that occur
after the QRS complex or P wave would indicate pacemaker malfunction and should be
addressed immediately.
PTS: 1 DIF: Apply REF: Permanent Pacing; Pacemaker Malfunction
MULTIPLE RESPONSE
1.A client with a heart rate of 40 who is experiencing shortness of breath and nausea is diagnosed
with second-degree AV block type II. Which of the following will be included in this clients
treatment? (Select all that apply.)
Administer antiemetic
3.
Administer atropine sulfate
4.
Insert external pacemaker
5.
Decrease intravenous fluids
6.
Lower the head of the bed
om
2.
.c
Administer digoxin
nk
1.
ANS: 3, 4
ba
nk
ta
For second-degree AV block type II, treatment will almost always consist of external pacemaker
insertion. Atropine sulfate may be used to increase the heart rate until the pacemaker can be
inserted. Digitalis toxicity can cause this heart rhythm so digoxin should not be administered to
this client. An antiemetic will not solve the clients underlying problem. The client may or may
not need additional fluids. Lowering the head of the bed could compromise this clients
respiratory status and should not be done.
PTS: 1 DIF: Apply REF: Second-Degree AV Block Type II
Assess for power to the monitor.
Assess the strip for possible fine ventricular fibrillation.
w
3.
w
2.
Assess for loose leads.
w
1.
.te
st
2.A clients electrocardiogram rhythm strip is a straight line. Which of the following should the
nurse do to help this client? (Select all that apply.)
4.
Begin cardiopulmonary resuscitation once verified the client has no pulse.
5.
Raise the head of the bed.
6.
Stop intravenous fluid infusion.
ANS: 1, 2, 3, 4
The absence of electrical activity will create the rhythm of asystole. The rhythm strip is a straight
line. The nurse should confirm that the straight line is not due to another reason such as loose
leads, lack of power to the monitor, or fine ventricular fibrillation. Once it is confirmed that the
client has no pulse, cardiopulmonary resuscitation should be implemented. Raising the head of
the bed or stopping intravenous fluid infusions is not going to help the client experiencing
asystole.
PTS: 1 DIF: Apply REF: Asystole
3.
Hypothermia
4.
Tamponade
5.
om
Hypoxia
.c
2.
nk
Hypovolemia
nk
ta
1.
ba
3.The nurse is assessing a client who is diagnosed with pulseless electrical activity. Which of the
following will the nurse include in this assessment? (Select all that apply.)
Thrombosis
Throat pain
.te
st
6.
ANS: 1, 2, 3, 4, 5
w
w
Assessment of pulseless electrical activity includes a review of the 5 Hs and the 5 Ts. The 5 Hs
are: hypovolemia, hypoxia, hydrogen ion status, hyperkalemia/hypokalemia, and hypothermia.
The 5 Ts include tablets, tamponade, tension pneumothorax, thrombosis coronary, and
thrombosis pulmonary. Throat pain does not cause pulseless electrical activity.
w
PTS: 1 DIF: Apply REF: Pulseless Electrical Activity
4.Which of the following should be implemented to ensure the safe use of a defibrillator? (Select
all that apply.)
1.
Do not place over monitoring electrodes.
2.
Do not place over an implanted pacemaker.
Place the paddles at inch from the implanted pacemaker site.
4.
Apply transdermal medication to the chest before using the paddles.
5.
Insert an oral airway before using the paddles.
6.
Have another person hold the clients airway open while using the paddles.
om
3.
ANS: 1, 2
nk
.c
The safe use of defibrillator paddles include: do not place over monitoring electrodes or
implanted devices. Paddles should be at least 1 inch away from an implanted device.
Transdermal medication should be removed from the clients chest before using the paddles. An
oral airway is not needed before using the paddles. No one should be touching the client when
using the paddles.
nk
ta
PTS: 1 DIF: Apply REF: Red Flag: Safe Use of Defibrillator Pads
5.Which of the following interventions would be appropriate for a client recovering from a
pacemaker insertion? (Select all that apply.)
Monitor vital signs every 15 minutes until stable.
2.
Assess for chest pain.
3.
Restrict movement of affected extremity.
4.
Monitor electrocardiogram every 8 hours.
st
.te
w
w
w
5.
ba
1.
6.
Begin intravenous fluid infusion at 150 mL/hr.
Reinforce dressing with excessive bleeding.
ANS: 1, 2, 3
Interventions appropriate for a client recovering from a pacemaker insertion include monitoring
vital signs every 15 minutes until stable, assessing for chest pain, restricting movement of the
affected extremity, monitoring electrocardiogram ongoing and post a strip every 4 hours, and
report excessive bleeding from the surgical site to the health care provider. Intravenous fluids at
the rate of 150 mL/hr may or may not be needed.
Chapter 26: Heart Failure and Circulatory Shock
The pathophysiology of heart failure involves an interaction between decreased pumping ability and t
________ to maintain cardiac output.
A)
aortic hypertrophy
B)
compensatory mechanisms
C)
electrical conductivity
D)
parasympathetic system
A)
volume load
B)
blood pumped
C)
stroke volume
D)
force generated
One of the principal mechanisms by which the heart compensates for increased workload is:
nk
ta
3.
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Cardiac output is the ________ each minute.
nk
2.
myocardial hypertrophy.
B)
sodium and water retention.
C)
endothelin vasoconstrictors.
D)
ventricular wall tension increase.
ba
A)
In right-sided heart failure, peripheral edema is evidenced by:
weight gain.
B)
copious urination.
C)
st
A)
.te
4.
shortness of breath.
decreased blood pressure.
acute myocardial infarction.
chronic pulmonary disease.
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B)
The most common causes of left-sided heart failure include:
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5.
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D)
A)
om
1.
C)
impaired renal blood flow.
D)
tricuspid valve regurgitation.
6.
Hypovolemic shock occurs as a result of:
A)
myocardial infarction.
B)
excessive vasoconstriction.
C)
chronic intracellular fluid shift.
D)
acute intravascular volume loss.
In shock, one of the best indicators of blood flow to vital organs is:
A)
warm legs.
B)
urine output.
C)
blood pressure.
D)
consciousness.
8.
Anaphylactic shock is directly associated with:
loss of blood volume.
B)
bacterial blood infection.
C)
failure of the heart as a pump.
D)
type I hypersensitivity response.
Severe shock can be followed by acute lung injury/acute respiratory distress syndrome (ALI/ARDS)
characterized by:
nk
9.
.c
A)
hyperventilation.
B)
excessive surfactant.
C)
hyperinflated alveolar sacs.
D)
ventilation-perfusion mismatch.
nk
ta
A)
10.
A common symptom of the ischemia associated with gastrointestinal redistribution of blood flow is:
gastric bleeding.
B)
nausea and vomiting.
C)
irritable bowel syndrome.
D)
copious high volume diarrhea.
w
Inotropy
Cardiac contractility
w
B)
A patient has been experiencing increasing fatigue in recent months, a trend that has prompted an
echocardiogram. Results of this diagnostic test suggest that the patients end-diastolic volume is
insufficient. Which of the following parameters of cardiac performance will directly decrease as a re
of this?
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11.
.te
st
ba
A)
A)
om
7.
C)
Preload
D)
Afterload
12.
Which of the following health problems is associated with heart failure as a result of diastolic
dysfunction?
A)
Uncontrolled hypertension
B)
Chronic bradycardia
C)
Ischemic heart disease
D)
Myocardial hypertrophy
13.
Assessment of an elderly female patient reveals the presence of bilateral pitting edema of the patient
feet and ankles and pedal pulses that are difficult to palpate. Auscultation of the patients lungs revea
clear air entry to bases, and the patients oxygen saturation level is 93% and vital signs are within
reference ranges. What is this patients most likely health problem?
Right-sided heart failure
B)
Left-sided heart failure
C)
Cardiogenic shock
D)
Cor pulmonale
The most recent blood work of a patient with a diagnosis of heart failure indicates increased levels o
atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP). What are the most likely effects
these peptides on the patients physiology?
.c
14.
om
A)
Water retention
B)
Increased tubular sodium reabsorption
C)
Inhibition of the renin-angiotensin-aldosterone system
D)
Sympathetic nervous stimulation
15.
nk
ta
nk
A)
A nurse is performing patient health education with a 68-year-old man who has recently been diagno
with heart failure. Which of the following statements demonstrates an accurate understanding of his
new diagnosis?
Ill be sure to take my beta blocker whenever I feel short of breath.
B)
Im going to avoid as much physical activity as I can so that I preserve my strength.
C)
I know its healthy to drink a lot of water, and Im going to make sure I do this from now on.
D)
Im trying to think of ways that I can cut down the amount of salt that I usually eat.
B)
Vasodilation
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C)
Increased heart rate
w
A)
Electrical burns over a large surface area of a patients body have resulted in hypovolemic shock afte
the loss of large amounts of blood and plasma. Which of the following mechanisms is the patients bo
likely to implement to compensate for this loss of fluid?
w
16.
.te
st
ba
A)
D)
17.
Diuresis
Inhibition of ADH
A patient who developed a deep vein thrombosis during a prolonged period of bedrest has deteriorat
as the clot has dislodged and resulted in a pulmonary embolism. Which of the following types of sho
is this patient at risk of experiencing?
A)
Cardiogenic shock
B)
Hypovolemic shock
C)
Obstructive shock
D)
Distributive shock
For which of the following types of shock might intravenous antibiotic therapy be indicated?
A)
Obstructive shock
B)
Distributive shock
C)
Cardiogenic shock
D)
Hypovolemic shock
Increased vascular stiffness
B)
Orthostatic hypotension
C)
Increased cardiac contractility
D)
Loss of action potential
A patient with a diagnosis of heart failure has returned from a visit with his primary care provider w
prescription for a change in his daily medication regimen. Which of the following drugs is likely to
improve the patients cardiac function by increasing the force and strength of ventricular contractions
nk
ta
20.
A b-adrenergic blocker
B)
A diuretic
C)
A cardiac glycoside
3.
A
4.
A
st
B
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2.
An ACE inhibitor
.te
D)
Answer Key
1.
B
ba
A)
A
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5.
om
A)
.c
19.
An 86-year-old male patient is disappointed to learn that he has class II heart failure despite a lifelon
commitment to exercise and healthy eating. Which of the following age-related changes predisposes
older adults to developing heart failure?
nk
18.
D
7.
B
8.
D
9.
D
10.
A
11.
C
12.
D
13.
A
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6.
C
15.
D
16.
A
17.
C
18.
B
19.
A
20.
C
om
14.
Chapter 27: Structure and Function of the Respiratory System
dehumidify inhaled air.
B)
remove foreign materials.
C)
warm the moving gases.
D)
spread antibacterial enzymes.
Above the glottis that opens and closes for speech, the epiglottis functions to _______ the larynx duri
swallowing.
open
B)
cover
C)
collapse
D)
constrict
In addition to being the site of gas exchange, the lungs also:
.te
3.
st
A)
A)
activate vasoactive substances.
contain cells that produce heparin.
w
B)
empty extra blood volume into the left heart.
use water vapor pressure to inflate alveoli.
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C)
D)
ba
2.
nk
ta
A)
Bronchial circulation differs from the pulmonary circulation by providing blood for the:
w
4.
A)
conducting airways.
B)
alveolar gas exchange.
C)
mediastinum and pleural space.
D)
intrapulmonary pressure balance.
5.
A)
.c
The function of the mucociliary blanket that lines the conducting airways is to:
nk
1.
Lung compliance is a measure of the change in ________that occurs with a change in intrapulmonary
pressure.
elastic recoil
B)
surface tension
C)
lung volume
D)
vital capacity
A)
vasospasms.
B)
hypertension.
C)
emboli formation.
D)
vasoconstriction.
Diffusion of gases in the lung is decreased, as in pulmonary edema or pneumonia, by causing an incre
in alveolar:
gas pressure difference.
B)
size and surface area.
C)
anatomic shunting of blood.
D)
capillary membrane thickness.
8.
nk
ta
A)
Respiratory movement of air that does not participate in alveolar gas exchange is known as alveolar d
space. Dead space increases when alveoli:
carbon dioxide level is high.
B)
air supply exceeds blood flow.
C)
contain pulmonary edema fluid.
D)
collapse onto the capillary bed.
st
ba
A)
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:
.te
9.
A)
decreased CO2 levels.
w
decreased body temperature.
increase red blood cell volume.
w
D)
increase tissue metabolism.
w
B)
C)
.c
7.
om
Generalized acute hypoxia in lung tissue, when alveolar oxygen levels drop below 60 mm Hg, causes
pulmonary:
nk
6.
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
D)
motor and premotor cortex
11.
A patient who is in a room at one atmosphere (760 mm Hg) is receiving supplementary oxygen thera
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
Facilitation of bronchial circulation
B)
Production of surfactant
C)
Gas exchange
D)
Production of macrophages
Which of the following respiratory pressures is always negative in relation to alveolar pressure?
.c
13.
Airway pressure
B)
Intrapleural pressure
C)
Intrathoracic pressure
D)
Intrapulmonary pressure
nk
ta
A)
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?
Decreased intrapulmonary pressure
B)
Increased airway pressure
C)
Increased intrapleural pressure
D)
Decreased intrathoracic pressure
According to Poiseuille law, airway resistance would be largest in which of the following?
.te
15.
st
ba
A)
A)
The trachea
A bronchus
w
B)
A bronchiole
w
C)
An alveolus
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 determ
the patients forced vital capacity (FVC)?
w
D)
om
A)
nk
12.
A patients recent history of emphysema has resulted in the functional loss of many alveoli. Which o
following physiologic functions is the primary role of type II alveoli?
16.
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 a
out with each breath.
D)
Breathe normally, and then exhale as much as you possibly can when I tell you.
A)
5500 mL
B)
2600 mL
C)
More data are needed
D)
3600 mL
Compensatory vasoconstriction
B)
Ventilation without perfusion
C)
Dead air space
D)
Perfusion without ventilation
Which of the following forms accounts for the greatest percentage of carbon dioxide transport?
nk
ta
19.
Free CO2
B)
Bicarbonate
C)
Dissolved CO2
D)
Attached to hemoglobin
ba
A)
A patient has experienced a bout of coughing after aspirating some of his secretions. The patients
coughing was triggered by which of the following?
st
20.
om
A)
.c
18.
A patient with a diagnosis of community-acquired pneumonia is producing copious secretions that a
physically obstructing her airway. Which of the following pathophysiologic processes will result fro
this condition?
nk
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; functio
residual capacity: 2400 mL. What is this patients inspiratory capacity?
Sudden ventilation-perfusion mismatch
B)
Sudden rise in PCO2
C)
.te
A)
Signals from receptors in the tracheobronchial wall
Signals from central chemoreceptors
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w
D)
Answer Key
1.
B
B
3.
B
4.
A
5.
C
6.
D
7.
D
8.
B
9.
B
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2.
C
12.
B
13.
B
14.
D
15.
C
16.
A
17.
D
18.
D
19.
B
20.
C
om
11.
.c
A
nk
10.
Chapter 28: Respiratory Tract Infections, Neoplasms, and Childhood Disorders
A distinguishing feature of viral influenza is:
nk
ta
1.
direct contact transmission.
B)
abrupt-onset, profound malaise.
C)
constant pounding headache.
D)
profuse watery nasal discharge.
A common cause of bacterial pneumonia in both community and hospital setting is:
st
2.
ba
A)
E. coli
B)
S. aureus.
.te
A)
C)
Enterobacter.
S. pneumoniae.
A)
warm, standing water.
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B)
Legionnaire disease is a form of bronchopneumonia caused by an organism frequently found in:
w
3.
w
D)
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.
A)
inherent anergy.
B)
host cell depletion.
C)
poor lung perfusion.
D)
boosting phenomenon.
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 ag
can result from:
frequent crying.
B)
sleeping supine.
C)
nasal congestion.
D)
productive coughing.
ba
A)
8.
Most respiratory disorders in infants produce a decrease in:
lung compliance.
B)
airway resistance.
C)
oxygen demand.
.te
st
A)
D)
respiratory rate.
w
Croup
Asthma
w
B)
Which of the following acute respiratory infections in children poses the greatest threat of severe hypo
caused by inflammatory edema?
w
9.
A)
.c
A)
om
Which of the four categories of bronchogenic carcinoma has the greatest association with tobacco
smoking and tends to metastasize to the brain?
nk
6.
nk
ta
5.
People infected with HIV and tuberculosis lack a hypersensitivity response to the tuberculin test as a
result of:
C)
Epiglottitis
D)
Bronchiolitis
10.
The cold viruses are rapidly spread from person to person. The greatest source of spread is:
A)
fingers.
B)
sneezing.
C)
plastic toys.
D)
eye mucosa.
11.
A college student is lamenting the fact that she has developed a cold on the weekend prior to exam
week. Which of the following statements shows that the student has an accurate understanding of he
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.
om
12.
A patient has presented to an ambulatory clinic complaining of a persistent headache. What assessm
should the clinician conduct to differentiate between rhinosinusitis and alternative health problems?
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.
Which of the following individuals should be prioritized for receiving a seasonal influenza vaccinati
nk
ta
13.
nk
.c
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
ba
A)
st
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?
Maintaining the patients activities of daily living
.te
A)
B)
Maintaining the patients airway
Monitoring and treating the patients pain
w
C)
Preventing and treating the patients fever
w
D)
w
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?
15.
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.
A)
Which of the following types of lung cancer is associated with the best prognosis in the majority of
patients?
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?
B)
A patient with a history of secondary tuberculosis who failed to complete his prescribed cours
antibiotics
C)
A woman who complains of recurrent lower respiratory infections and who has sought care fo
increasing shortness of breath
D)
A man who demonstrates wasting of the pelvic and shoulder muscles combined with signs of
hypercalcemia
.c
om
A)
A patient who has required hospitalization with a fever and the production of copious lung
secretions
Which of the following characteristics of the lungs of infants and small children creates an increased
risk of respiratory disorders?
nk
18.
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.
Which of the following respiratory infections in children is associated with the poorest outcomes?
ba
19.
nk
ta
A)
Viral croup
B)
Rhinosinusitis
C)
Epiglottitis
D)
Spasmodic croup
Intravenous antibiotics
w
C)
Supplementary oxygen therapy
w
A)
B)
A 6-month-old infant has been hospitalized with acute bronchiolitis. Which of the following treatme
should be prioritized in the infants care?
w
20.
.te
st
A)
D)
Answer Key
1.
B
2.
B
3.
A
4.
D
5.
A
Transfusion of fresh frozen plasma
Tracheotomy
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
om
C
.c
7.
nk
A
nk
ta
6.
1.
Pleuritic chest pain associated with respiratory movements is usually described as:
bilateral.
B)
localized.
C)
continuous.
.te
st
A)
D)
substernal.
w
expired air exits the bleeding wound.
trapped, inspired air collapses the lung.
w
B)
A man sustained a puncture injury to his chest that caused a tension pneumothorax to form. This is a l
threatening condition because:
w
2.
A)
ba
Chapter 29: Disorders of Ventilation and Gas Exchange
C)
the opposite lung hyperinflates.
D)
blebs on the lung surface rupture.
3.
Atelectasis is most commonly caused by:
A)
airway obstruction.
B)
pulmonary embolism.
C)
inflammation of the pleura.
D)
chronic forceful coughing.
Acute onset bronchial asthma causes wheezing and breathlessness as a result of:
A)
airway inflammation.
B)
alveolar collapse.
C)
compression atelectasis.
D)
pulmonary hypertension.
Emphysema is characterized by hyperinflation of the lungs that produces increased:
total lung capacity.
B)
alveolar wall thickness.
C)
a1-antitrypsin enzyme.
D)
submucosal gland hypertrophy.
6.
.c
A)
As a result of hypoxemia and polycythemia, persons with chronic obstructive bronchitis are prone to:
breakdown of elastin.
B)
left-sided heart failure.
C)
pulmonary hypertension.
D)
expiratory airway collapse.
B)
rupture.
C)
infarction.
D)
thickening.
st
dilation.
Cystic fibrosis (CF), the major cause of severe chronic respiratory disease in children, is characterized
by:
.te
8.
A)
constipation.
salt depletion.
w
B)
w
watery mucus.
high cholesterol.
w
D)
ba
With bronchiectasis, persistent airway obstruction and chronic infection results in bronchial:
A)
C)
nk
ta
A)
7.
9.
The adverse effects of emboli on the pulmonary circulation and airways include:
A)
excess surfactant.
B)
area bronchodilation.
C)
local vasoconstriction.
D)
lower lobe consolidation.
10.
A)
om
5.
nk
4.
The common results of respiratory failure are hypoxemia and:
hypercapnia.
B)
bradycardia.
C)
vasoconstriction.
D)
pulmonary emboli.
Peripheral vasodilation
B)
Necrosis
C)
Hypoventilation
D)
Increased heart rate
An elderly patient who has been restricted to bed by numerous comorbidities for several weeks has b
diagnosed with a large pleural effusion. Which of the following treatment modalities is most likely t
resolve the patients most recent health problem?
.c
12.
om
A)
Thoracentesis
B)
Supplementary oxygen therapy
C)
Administration of corticosteroids
D)
Administration of bronchodilators
A motor vehicle accident has resulted in a tension pneumothorax for the driver of the car. Which of
following manifestations is associated with tension pneumothorax?
ba
13.
nk
ta
A)
nk
11.
A patient with a history of emphysema is experiencing hypoxemia after a taxing physical therapy
appointment. Which of the following physiologic phenomena will occur as a consequence of
hypoxemia?
Audible friction rub over the affected lung
B)
Mediastinal shift
C)
Metabolic alkalosis
D)
Atrial fibrillation
.te
st
A)
Bedrest and supplementary oxygen by nasal cannula
Administration of bronchodilators by nebulizer
w
B)
w
A)
w
14.
A patient has just been admitted to the postsurgical unit following a below-the-knee amputation. Wh
of the following measures should her care team prioritize to prevent atelectasis during the patients
immediate recovery?
C)
Deep-breathing exercises and early mobilization
D)
Adequate hydration and a high-humidity environment
15.
Which of the following manifestations typically accompanies an asthmatic attack?
A)
Decreased residual volume
B)
Decreased pulmonary arterial pressure
C)
Prolonged inspiration
D)
Hyperinflation of the lungs
16.
A 51-year-old man has been diagnosed with chronic bronchitis after a long history of recurrent
coughing. Which of the mans following statements demonstrates a sound understanding of his new
diagnosis?
If I had quit smoking earlier than I did, I think I could have avoided getting bronchitis.
B)
Im pretty sure that I first caught bronchitis from the person who has the cubicle next to mine a
work.
C)
I read on the Internet that I might have got bronchitis because I was born with an enzyme
deficiency.
D)
I think that I probably could have prevented this if I had got in the habit of exercising more wh
I was younger.
Which of the following individuals is experiencing a disorder of ventilation that has a restrictive rath
than obstructive etiology?
.c
17.
om
A)
A 30-year-old African American man who has been diagnosed with sarcoidosis
B)
An infant whose routine screening is suggestive of cystic fibrosis
C)
An elderly, lifelong smoker who has been admitted to hospital with emphysema
D)
A 16-year-old girl who must limit her activity to prevent asthmatic attacks
18.
nk
ta
nk
A)
Prolonged immobility is implicated in the development of which of the following disorders?
Bronchitis and bronchiectasis
B)
Sarcoidosis and idiopathic pulmonary fibrosis
C)
Atelectasis and pulmonary embolism
D)
Pulmonary hypertension and cor pulmonale
Which of the following is most likely to precipitate an asthmatic attack in a child with a diagnosis of
extrinsic, or atopic, asthma?
.te
19.
st
ba
A)
A)
Pet dander
Cold weather
w
B)
C)
Respiratory tract infections
w
D)
Stress
Pain is an expected assessment finding in patients who have which of the following lung diseases?
w
20.
A)
Asthma
B)
Pleural effusion
C)
Pulmonary arterial hypertension (PAH)
D)
Answer Key
1.
B
2.
B
Pleuritis
A
6.
C
7.
A
8.
B
9.
C
10.
A
11.
D
12.
A
13.
B
14.
C
15.
D
16.
A
17.
A
18.
C
19.
A
20.
D
om
5.
.c
A
nk
4.
nk
ta
A
ba
3.
st
Chapter 30: Structure and Function of the Kidney
pressure; adequate output
w
A)
filtration rate; concentration
w
D)
electrolyte loss; acidic pH
w
B)
C)
.te
1.
When the kidneys have decreased perfusion or increased sympathetic nervous system stimulation, ren
blood flow goes mainly to the medulla in order to decrease ______ while maintaining the ______ of
urine.
2.
buffer loss; glucose level
Although an average of ____ glomerular filtrate is formed each minute, only _____ is excreted as urin
and the rest is reabsorbed in the tubules.
A)
250 mL; 15 mL
B)
125 mL; 1 mL
C)
200 mL; 5 mL
D)
175 mL; 10 mL
A)
renal corpuscle
B)
Bowmans capsule
C)
peritubular network
D)
basement membrane
When the glomerular transport maximum for a substance such as blood glucose is exceeded and its re
threshold has been reached, the substance will:
reabsorb quickly.
B)
spill into the urine.
C)
counter-transport sodium.
D)
attach to protein carriers.
In contrast to the descending limb, the ascending limb of the loop of Henle is impermeable to _____ a
the tubular filtrate becomes more _____ as a result.
potassium; acidic
B)
water; hypoosmolar
C)
sodium; concentrated
D)
chloride; reabsorbed
The major sites of aldosterone action on sodium and potassium, potassium regulation, and the final
concentration of sodium in urine are the _______ tubule and the _________ tubule.
late distal; cortical collecting
B)
thin ascending; thick ascending
C)
st
A)
.te
6.
ba
A)
nk
ta
5.
nk
A)
proximal; thin descending segment
D)
juxtamedullary; elbow diluting segment
w
hydrogen (H+)
w
B)
Only the kidneys can eliminate ____ from the body as a means of regulating body acid-base balance,
when urine buffers are present.
w
7.
A)
om
4.
.c
3.
Alterations in the structure and function of the glomerular _________ are responsible for protein and
blood cell leakage into the filtrate that occurs in many forms of glomerular disease.
potassium (K+)
C)
ammonia (NH3)
D)
phosphate (HPO4)
8.
The kidney assists in blood pressure regulation by releasing_______ from the juxtaglomerular cells in
response to decreased renal blood flow, resulting in efferent arteriole vasoconstriction.
A)
renin
B)
angiotensin II
C)
aldosterone
D)
angiotensin I
9.
In addition to regulating body fluids and electrolytes, the kidneys function in maintaining bone calciu
levels by:
A)
activating vitamin D.
B)
excreting bicarbonate.
C)
stimulating bone marrow.
D)
synthesizing erythropoietin.
Blood protein
B)
Serum creatinine
C)
Serum ammonia
D)
Blood urea nitrogen
As glomerular filtrate exits Bowmans capsule, it will enter the ___________, followed by the
___________ and then the _______________.
nk
ta
11.
.c
A)
om
Which one of the following blood tests reflects the glomerular filtration rate (GFR) and is used to
estimate renal function?
nk
10.
Proximal tubule; loop of Henle; distal tubule
B)
Ascending limb of the loop of Henle; descending limb of the loop of Henle; distal tubule
C)
Glomerulus; proximal tubule; distal tubule
D)
Collecting tubule; distal tubule; loop of Henle
Reabsorption of electrolytes such as Na+, K+, Cl, and bicarbonate (HCO3) from glomerular filtrate
takes place primarily in which of the following locations?
st
12.
ba
A)
Descending limb of the loop of Henle
.te
A)
B)
Ascending limb of the loop of Henle
C)
Bowmans capsule
Proximal convoluted tubule
w
D)
w
A)
An athlete has become dehydrated during a long race in hot weather. Which of the following
physiologic processes will occur in an attempt to protect the athletes extracellular fluid volume?
w
13.
Dilation of the afferent and efferent arterioles
B)
Release of ADH from the posterior pituitary
C)
Increased water reabsorption in the ascending limb of the loop of Henle
D)
Increased water reabsorption in the distal convoluted tubule
14.
A patients most recent blood work reveals a blood urea nitrogen (BUN) level of 36 mg/dL (normal
range 8 to 25 mg/dL). Which of the following factors may have contributed to this finding?
A)
Increased salt intake
B)
Action of ADH
C)
Dehydration
D)
Parasympathetic nervous stimulation
15.
Which of the following physiologic processes is performed by the kidneys and contributes to increas
blood pressure?
Catalysis of the conversion of angiotensin I to angiotensin II
B)
Production and release of renin
C)
Secretion of aldosterone
D)
Conversion of aldosterone to angiotensin
Anemia
B)
Leukocytosis
C)
Thrombocytopenia
D)
Leukopenia
17.
nk
ta
A)
.c
A patient has a diagnosis of chronic renal failure secondary to diabetic nephropathy. Which of the
following hematologic changes may result from this patients kidney disorder?
nk
16.
om
A)
A patient has provided a routine urine sample during a scheduled visit to his primary care provider.
Which of the following results is an expected finding in a healthy individual?
Low to moderate amount of glucose in the urine
B)
Urine specific gravity of 1.020
C)
Presence of moderate amounts of albumin with the absence of other proteins
D)
Presence of urinary casts
Which of the following factors is likely to result in decreased renal blood flow?
st
18.
ba
A)
Action of dopamine
.te
A)
B)
Release of nitric oxide
Action of prostaglandins
D)
Sympathetic nervous stimulation
Which of the following aspects of kidney function is performed by the juxtaglomerular complex?
w
w
19.
A)
w
C)
Regulating urine concentration
B)
Facilitating active transport to reabsorb electrolytes
C)
Regulating sodium and potassium elimination
D)
Matching changes in GFR with renal blood flow
20.
Which of the following components of glomerular filtrate can cross the tubular epithelial cell memb
passively?
A)
Sodium
B)
Potassium
Urea
5.
B
6.
A
7.
A
8.
A
9.
A
10.
B
11.
A
12.
D
13.
B
14.
C
15.
B
16.
A
17.
B
18.
D
19.
D
20.
C
om
B
.c
4.
nk
D
nk
ta
3.
ba
B
w
2.
Glucose
st
D)
Answer Key
1.
C
.te
C)
w
Chapter 31: Disorders of Fluid and Electrolyte Balance
An injured patient develops interstitial edema as a result of decreased:
w
1.
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.
The syndrome of inappropriate ADH is characterized by:
A)
increased osmolality.
B)
excessive water thirst.
C)
copious dilute urination.
D)
dilutional hyponatremia.
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 _______.
hypovolemia; dehydration
B)
third spacing; hypertonicity
C)
water retention; hypotonicity
D)
aldosterone excess; low ADH
nk
ta
A)
ba
One of the major causes of hyperkalemia is ____________, which alters potassium elimination.
renal dysfunction
B)
aldosterone excess
C)
metabolic alkalosis
D)
st
A)
.te
6.
plasma albumin deficit
increasing serum magnesium.
increasing phosphate excretion.
w
A)
blocking bone release of calcium.
w
C)
Hypoparathyroidism causes hypocalcemia by:
w
7.
B)
om
In isotonic fluid volume deficit, changes in total body water are accompanied by:
.c
4.
nk
3.
D)
8.
blocking action of intestinal vitamin D.
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.
A)
Decreased CO2 retention
B)
Increased metabolic acids
C)
Renal bicarbonate retention
D)
Impaired alveolar ventilation
As other mechanisms prepare to respond to a pH imbalance, immediate buffering is a result of
increased:
om
10.
intracellular albumin.
B)
hydrogen/potassium binding.
C)
sodium/phosphate anion absorption.
D)
bicarbonate/carbonic acid regulation.
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 pathophysiolog
processes contributes to this third spacing?
nk
ta
11.
nk
A)
.c
9.
A patient has acidosis that is suspected to be respiratory in etiology. Which of the following is the ma
cause of acute primary respiratory acidosis?
Abnormal increase in transcellular fluid volume
B)
Increased capillary colloidal osmotic pressure
C)
Polydipsia
D)
Impaired hormonal control of fluid volume
ba
A)
st
12.
A patient has been receiving intravenous normal saline at a rate of 125 mL per hour since her surger
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?
Obstruction of lymph flow
.te
A)
B)
Increased capillary permeability
Decreased capillary colloidal osmotic pressure
w
C)
Increased capillary filtration pressure
w
D)
w
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 resu
from the sudden water gain?
13.
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.
A)
Which of the following patients would likely be at highest risk of developing hyperkalemia?
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?
The patient experiences shortness of breath on exertion with decreased oxygen saturation leve
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.
Which of the following assessments should be prioritized in the care of a patient who is being treate
for hypokalemia?
.c
16.
om
A)
Detailed fluid balance monitoring
B)
Arterial blood gases
C)
Cardiac monitoring
D)
Monitoring of hemoglobin levels and oxygen saturation
nk
ta
17.
nk
A)
Magnesium is an important component of which of the following processes that are integral to the
maintenance of homeostasis? Select all that apply.
Intracellular and extracellular buffering
B)
Cellular energy metabolism
C)
Function of the sodium-potassium pump
D)
Nerve conduction
E)
Cell membrane function
.te
st
ba
A)
A)
w
Hyperventilation
w
B)
w
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 baki
soda since the morning in an effort to treat indigestion. How will the womans body attempt to resolv
this disruption in acid-base balance?
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
A nurse who is providing care for a patient with a diagnosis of diabetes insipidus should prioritize th
close monitoring of serum levels of which of the following electrolytes?
A)
Potassium
B)
Sodium
C)
Magnesium
5.
C
6.
A
7.
C
8.
D
9.
D
10.
D
11.
A
12.
D
13.
B
14.
A
15.
D
C
w
16.
.c
D
nk
4.
nk
ta
D
ba
3.
st
C
w
2.
Calcium
.te
D)
Answer Key
1.
D
om
20.
B, C, D, E
18.
D
19.
A
20.
B
w
17.
Chapter 32: Disorders of Acid—Base Balance
MULTIPLE CHOICE
1.The nurse is concerned that a client can become dehydrated when which of the following is
assessed?
History of arthritis
2.
Appendicitis diagnosis 3 years ago
3.
Age 30
4.
Obese female
om
1.
ANS: 4
nk
.c
An adult female has 50% of body weight that is fluid. Adipose cells contain less fluid than other
cells. Females have more fat cells than males. Overweight people have less body fluid than thin
people. A history of arthritis and appendicitis does not predispose the client to dehydration.
PTS:1DIF:AnalyzeREF:Fluid Balance
nk
ta
2.A client has lost a significant amount of blood. The nurse realizes that the fluid compartment
most effected with the blood loss will be:
intracellular.
ba
1.
interstitial.
st
2.
intravascular.
.te
3.
transcellular.
ANS: 3
w
4.
w
w
Intravascular fluid is the fluid in the bloodstream. Intracellular fluid is the fluid inside each cell.
Interstitial fluid is the fluid between cells. Transcellular fluid is the fluid outside all of the other
fluid compartments, and it includes cerebrospinal fluid, joint fluid, and fluid within the
gastrointestinal tract.
PTS:1DIF:AnalyzeREF:Fluid Balance
3.A client is diagnosed with chronic renal failure. Which of the following electrolytes should the
nurse monitor for this client?
1.
Hydrogen
2.
Phosphorus
3.
Calcium
4.
Vitamin D
om
ANS: 1
.c
The kidneys contribute to the regulation of electrolyte levels. Two electrolytes regulated by the
kidneys are hydrogen and bicarbonate. The kidneys do not directly influence a clients
phosphorus level. The kidneys affect calcium by activation of vitamin D; however, the kidneys
do not regulate calcium levels. Vitamin D is not an electrolyte.
nk
PTS: 1 DIF: Analyze REF: Control of Fluid and Electrolyte Balance
nk
ta
4.A client had a 2 kg weight loss in one day. The nurse realizes this change in weight is due to:
fluid loss.
2.
poor appetite.
ba
1.
medications.
st
3.
bed rest.
.te
4.
ANS: 1
w
w
A weight loss of more than 0.5 kg over 24 hours generally is the result of fluid loss and not of
body mass. The client would not lose 2 kgs of body weight because of poor appetite,
medications, or bed rest.
w
PTS:1DIF:Analyze
REF:Fluid Imbalances: Assessment with Clinical Manifestations
5.A client has a serum sodium level of 129 mEq/L. The nurse should prepare to administer which
of the following intravenous solutions?
1.
Dextrose 5% and Lactated Ringer
2.
Dextrose 5% and 0.45% Normal Saline
3.
0.9% Normal Saline
4.
Dextrose 5% and 0.9% Normal Saline
ANS: 3
om
Normal saline (0.9%) is commonly provided to restore extracellular fluid volume and increase
sodium levels. Dextrose 5% and Lactated Ringers, Dextrose 5% and 0.45% Normal Saline, and
Dextrose 5% and 0.9% Normal Saline are hypertonic solutions, and they will move water from
the cells into the bloodstream.
.c
PTS:1DIF:Apply
REF: Table 12-3 Isotonic IV Solutions; Table 12-4 Hypertonic IV Solutions
Poor skin turgor
2.
Jugular vein distention
3.
Dry mouth
4.
ba
1.
st
nk
ta
nk
6.A client is diagnosed with fluid volume excess. Which of the following will the nurse most
likely assess in this client?
.te
Increased heart rate
ANS: 2
w
w
Excess fluid in the intravascular space causes an elevation in blood pressure, and increased
jugular venous pressure may be visible in distended neck veins. Poor skin turgor, dry mouth, and
increased heart rate are findings consistent with fluid volume deficit.
w
PTS:1DIF:Apply
REF:Fluid Volume Excess: Assessment with Clinical Manifestations
7.A client is demonstrating dizziness and lightheadedness upon standing. The nurse is concerned
the client is experiencing postural hypotension when which of the following is assessed?
1.
Lying BP 120/70 mmHg, P 70; standing BP 116/78 mmHg, P 78
2.
Lying BP 116/64 mmHg, P 62; standing BP 94/58 mmHg, P 78
3.
Lying BP 130/80 mmHg, P 84; standing BP 118/72 mmHg, P 90
4.
Lying BP 126/74 mmHg, P 74; standing BP 108/62 mmHg, P 84
ANS: 2
om
A decrease in systolic blood pressure of more than 20 mmHg when going from lying to standing,
along with an increase in heart rate of 10 beats per minute or a decrease in diastolic blood
pressure of more than 10 mmHg, along with a 10 beats per minute increase in heart rate, is
considered postural hypotension. The other vital sign measurements do not support the criteria
for postural hypotension.
.c
PTS:1DIF:Analyze
nk
REF:Fluid Imbalances: Assessment with Clinical Manifestations
nk
ta
8.The nurse assesses a client to have mild pitting edema of the lower extremities. The nurse
would document this finding as being:
1.
0+.
1+.
ba
2.
st
3.
3+.
.te
4.
2+.
w
ANS: 2
w
Mild pitting edema is documented as being +1. No pitting edema would be documented as 0+.
Moderate pitting edema would be documented as 2+. Moderately severe pitting edema would be
documented as 3+.
w
PTS: 1 DIF: Apply REF: Figure 12-4 Pitting Edema Grading Scale
9.An elderly client is demonstrating new signs of confusion. Which of the following should the
nurse consider when caring for this client?
1.
Assess for signs of elevated sodium level.
2.
Restrict fluids.
3.
Administer prescribed diuretic medication.
4.
Monitor daily weights.
ANS: 1
om
Elderly clients who develop a new onset of confusion should have their serum sodium levels
checked for an elevated serum sodium level. Restricting fluids, administering diuretics, and
monitoring daily weights are all interventions appropriate for a client with a low-serum sodium
level.
.c
PTS:1DIF:Apply
REF:Excess Sodium Ion: Assessment with Clinical Manifestations
nk
ta
nk
10.A client diagnosed with hypokalemia should have which of the following electrolytes also
assessed?
Sodium
2.
Calcium
ba
1.
Bicarbonate
st
3.
Magnesium
.te
4.
ANS: 4
w
w
Clients with hypokalemia often have concurrent hypomagnesemia. Hypokalemia is resistant to
treatment unless the hypomagnesemia is corrected. Sodium, calcium, and bicarbonate changes
are not associated with hypokalemia.
w
PTS:1DIF:Apply
REF: Deficient Potassium Ion: Planning and Implementation
11.A client is diagnosed with hypophosphatemia. The nurse realizes that this electrolyte
imbalance is most likely associated with:
1.
diabetes mellitus.
2.
congestive heart failure.
3.
arthritis.
4.
chronic alcoholism.
ANS: 4
om
A diet deficient in phosphorous may cause hypophosphatemia and reduced absorption of
phosphorous occurs with chronic alcoholism. Hypophosphatemia is not associated with diabetes
mellitus, congestive heart failure, or arthritis.
PTS: 1 DIF: Analyze REF: Deficient Phosphorus Ion: Etiology
Hyperkalemia
2.
Hyponatremia
3.
Hypocalcemia
4.
Hypermagnesemia
st
ba
nk
ta
1.
nk
.c
12.A client diagnosed with chronic renal failure is experiencing muscle weakness, paresthesias,
and depression. Which of the following do these assessment findings suggest to the nurse?
ANS: 4
w
.te
Signs and symptoms of hypermagnesemia are similar to those seen with hypercalcemia and
include paresthesias, muscle weakness, anorexia, nausea, diminished bowel sounds, and
constipation. Confusion, depression, lethargy, and coma can also occur. Muscle weakness,
paresthesias, and depression are not seen in hyperkalemia, hyponatremia, or hypocalcemia.
w
PTS:1DIF:Analyze
w
REF:Excess Magnesium Ion: Assessment with Clinical Manifestations
13.A client begins rapid breathing and demonstrates anxiety after learning of a diagnosis of
breast cancer. After a short while, the client complains of tingling lips and fingers. Which of the
following should the nurse do to assist this client?
1.
Provide oxygen.
2.
Coach the client in the use of an incentive spirometer.
3.
Help the client slow the respiratory rate or breathe into a paper bag.
4.
Administer intravenous fluids.
ANS: 3
PTS:1DIF:ApplyREF:Respiratory Alkalosis
nk
MULTIPLE RESPONSE
.c
om
With the clients rapid respirations, too much carbon dioxide is being excreted. This leads to
alkalosis. Symptoms of respiratory alkalosis include tingling of the lips and fingers. If the client
is unable to control the respiratory rate, the nurse may have the client breathe into a paper bag,
which forces the rebreathing of carbon dioxide. Providing oxygen, using an incentive spirometer,
and intravenous fluids is not going to help correct the clients rapid respiratory rate and
respiratory alkalosis.
nk
ta
1.A client is diagnosed with hyponatremia. Which of the following assessment findings would
cause the nurse to become concerned? (Select all that apply.)
Confusion
2.
Poor appetite
ba
1.
Restlessness
.te
st
3.
Seizures
Coma
w
6.
w
5.
Lethargy
w
4.
ANS: 1, 3, 4, 5, 6
The change in osmolality that occurs with hyponatremia causes fluid to shift into the intracellular
space. Signs and symptoms associated with an expanded intracellular compartment include
confusion, restlessness, lethargy, seizures, and coma. Poor appetite is not an assessment finding
of hyponatremia.
PTS:1DIF:Analyze
REFeficient Sodium Ion: Assessment with Clinical Manifestations
Tall peaked T-waves
2.
Short QRS complex
3.
Dysrhythmias
4.
Wide QRS complex
5.
Bradycardia
6.
Tachycardia
nk
ta
nk
.c
1.
om
2.After reviewing a clients most recent electrocardiogram, the nurse suspects the client is
experiencing hyperkalemia. Which of the following did the nurse assess on the clients rhythm
strip? (Select all that apply.)
ANS: 1, 3
ba
Tall peaked T-waves and dysrhythmias are seen on the electrocardiogram of a client
experiencing hyperkalemia. The other choices are not seen with hyperkalemia.
PTS: 1 DIF: Analyze REF: Excess Potassium Ion: Diagnostic Tests
.te
st
3.A client has a serum potassium level of 2.9 mEq/L. Which of the following should be done to
assist this client? (Select all that apply.)
w
3.
Check for an elevated ST segment.
w
2.
Implement continuous cardiac monitoring.
w
1.
Assess muscle strength, tone, and reflexes.
4.
Monitor digoxin levels.
5.
Monitor for seizure activity.
ANS: 1, 3, 4
Interventions for a patient with hypokalemia are continuous cardiac monitoring; assessing for
flattening T-waves; monitoring for digoxin toxicity, which may cause dysrhythmias; and
assessing muscle strength, tone, and reflexes. Seizure activity is a sign of a sodium imbalance.
PTS:1DIF:Apply
REF: Deficient Potassium Ion: Assessment with Clinical Manifestations
2.
Chvosteks sign
3.
Percussion of the abdomen
4.
Auscultation of the lungs
5.
Trousseaus sign
6.
Palpation of the neck
nk
Allen test
ba
nk
ta
1.
.c
om
4.Which of the following assessment techniques can the nurse use to determine if a client is
experiencing hypocalcemia? (Select all that apply.)
st
ANS: 2, 5
w
.te
Trousseaus sign is assessed by inflating a blood pressure cuff for up to 4 minutes and assessing
for hand spasms as a sign of hypocalcemia. Chvosteks sign is done by tapping on the facial nerve
and assessing for a spasm of the facial muscle on the same side as evidence of hypocalcemia.
The Allens test, percussion of the abdomen, auscultation of the lungs, and palpation of the neck
are not performed specifically for hypocalcemia.
w
PTS:1DIF:Apply
w
REFeficient Calcium Ion: Assessment with Clinical Manifestations
5.A client is diagnosed with a serum calcium level of 11.2 mEq/L. Which of the following
interventions would be appropriate for this client? (Select all that apply.)
1.
Administer diuretics as prescribed.
2.
Restrict fluids.
Administer intravenous fluids as prescribed.
4.
Continuous cardiac monitoring.
5.
Administer intravenous sodium as prescribed.
6.
Change to a low fat diet.
om
3.
ANS: 1, 3, 4, 5
nk
.c
Management of hypercalcemia is focused on removing calcium, which is accomplished by
administering diuretics, administering intravenous fluids, and administering intravenous sodium.
Continuous cardiac monitoring is needed for clients at risk for developing dysrhythmias.
Restricting fluids and changing to a low-fat diet are not used to treat hypercalcemia.
nk
ta
PTS: 1 DIF: Apply REF: Excess Calcium Ion: Planning and Implementation
6.Which of the following components of the arterial blood gas will the nurse focus when on
determining a clients acid-base status? (Select all that apply.)
pH
ba
1.
2.
st
PO2
.te
3.
w
w
5.
w
4.
6.
PCO2
HCO3
O2 Sat
Hgb
ANS: 1, 3, 4
Interpretation of the clients acid-base status involves the evaluation of three components of the
arterial blood gas: pH, PCO2 and HCO3-.. PO2 and O2 Sat are not used to evaluate the clients acidbase status. Hgb level is not a component of the arterial blood gas.
Chapter 33: Disorders of Renal Function
A characteristic manifestation of polycystic kidney disease is:
A)
massive proteinuria.
B)
renal colic.
C)
alkaline urine.
D)
hypertension.
A)
hyperuricemia.
B)
hydronephrosis.
C)
high urine calcium.
D)
urinary tract infections.
nk
The most damaging effects of urinary obstruction are the result of _____ and unrelieved obstruction o
urine outflow.
A)
urinary stasis
B)
concentrated urine
C)
kidney hyperplasia
D)
renal hypertension
Glomerulonephritis is usually caused by:
ba
4.
nk
ta
3.
vesicoureteral reflux.
B)
catheter-induced infection.
C)
antigen-antibody complexes.
D)
glomerular membrane viruses.
5.
obstruction and reflux.
salt and water retention.
w
B)
inability to concentrate urine.
w
D)
The edema that develops in persons with glomerulonephritis and nephrotic syndrome reflects:
w
A)
.te
st
A)
C)
om
2.
Of the four types of kidney stones, the formation of magnesium ammonium phosphate (struvite) stone
directly associated with:
.c
1.
6.
decreased glomerular permeability.
The initiating event in the development of nephrotic syndrome is a derangement in the glomerular
membrane that causes increased permeability to:
A)
red blood cells.
B)
plasma proteins.
C)
inflammatory cells.
D)
antibody complexes.
7.
Chronic pyelonephritis, a significant cause of renal failure, is most commonly caused by:
A)
viral organisms.
B)
intrarenal reflux.
C)
renal hyperplasia.
D)
abscess formation.
A)
heavy smoking.
B)
inherited renal disease.
C)
adrenal medulla tumors.
D)
anorexia/bulimia disorder.
9.
om
High-risk factors for development of adult renal cell cancer include:
Which of the following assessment findings is most suggestive of nephrotic syndrome?
.c
8.
Hematuria and anemia
B)
Proteinuria and generalized edema
C)
Renal colic and increased serum sodium
D)
Increased creatinine with normal blood urea nitrogen
nk
ta
10.
The most recent assessment of a patient with a diagnosis of type 1 diabetes indicates a heightened ri
of diabetic nephropathy. Which of the following assessment findings is most suggestive of this
increased risk?
Microalbuminuria
B)
Hematuria
C)
Orthostatic hypotension
D)
Diabetic retinopathy
st
The patient was diagnosed with type 2 diabetes several years earlier.
w
A)
An elderly female patient has been hospitalized for the treatment of acute pyelonephritis. Which of t
following characteristics of the patient is most likely implicated in the etiology of her current health
problem?
.te
11.
w
The patient takes a diuretic and an ACE inhibitor each day for the treatment of hypertension.
The patient recently had a urinary tract infection.
w
C)
ba
A)
B)
nk
A)
D)
12.
The patient has peripheral vascular disease.
Which of the following disorders of renal function primarily affects the proximal and distal tubules?
A)
Chronic pyelonephritis
B)
Polycystic kidney disease
C)
Acute nephritic disease
D)
Renal calculi
13.
An adult patient has been diagnosed with polycystic kidney disease. Which of the patients following
statements demonstrates an accurate understanding of this diagnosis?
A)
I suppose I really should have paid more attention to my blood pressure.
B)
Ive always been prone to getting UTIs, and now I know why.
C)
I suppose I should be tested to see if my children might inherit this.
D)
I had a feeling that I was taking too many medications, and now I know the damage they can d
Rehydration therapy
B)
Total parenteral nutrition
C)
Prophylactic antibiotics
D)
Respiratory support
nk
A)
om
An infant has been diagnosed with autosomal recessive polycystic kidney disease (ARPKD). Which
the following treatments is the priority in the care of this child?
.c
14.
nk
ta
15.
An obese, male patient with a history of gout and a sedentary lifestyle has been advised by his prima
care provider to avoid organ meats, certain fish, and other foods that are high in purines. The care
provider is demonstrating an awareness of the patients susceptibility to which of the following types
kidney stones?
Calcium stones
B)
Magnesium ammonium phosphate stones
C)
Uric acid stones
D)
Cystine stones
ba
A)
st
.te
16.
A patient has recently undergone successful extracorporeal shock wave lithotripsy (ESWL) for the
treatment of renal calculi. Which of the following measures should the patient integrate into his lifes
to reduce the risk of recurrence?
A)
Increased fluid intake and dietary changes
Weight loss and blood pressure control
w
B)
Increased physical activity and use of over-the-counter diuretics
A young child has been diagnosed with Wilms tumor after his mother discovered an unusual mass,
prompting a diagnostic workup. Which of the following characteristics is typical of Wilms tumor?
w
D)
Regular random blood glucose testing
w
C)
17.
A)
The tumor is usually asymptomatic.
B)
The tumor is usually self-limiting.
C)
The tumor is usually a secondary neoplasm.
D)
The tumor is usually encapsulated.
18.
A)
Which of the following patient complaints most clearly suggests a need for diagnostic testing to rule
renal cell carcinoma?
Urinary urgency
B)
Hematuria
C)
Oliguria
5.
B
6.
B
7.
B
8.
A
9.
B
10.
A
11.
C
12.
A
13.
C
14.
D
15.
C
16.
A
17.
D
18.
B
om
C
.c
4.
nk
A
nk
ta
3.
ba
D
st
2.
Cloudy urine
.te
D)
Answer Key
1.
D
anemia.
w
A)
The most common indicator of acute renal failure is:
w
1.
w
Chapter 34: Acute Renal Injury and Chronic Kidney Disease
B)
uremia.
C)
edema.
D)
azotemia.
2.
A patient had excessive blood loss and prolonged hypotension during surgery. His postoperative urine
output is sharply decreased and his blood urea nitrogen (BUN) is elevated. The most likely cause for t
change is acute:
A)
prerenal inflammation.
B)
bladder outlet obstruction.
C)
ischemic tubular necrosis.
D)
intrarenal nephrotoxicity.
A)
edema.
B)
diuresis.
C)
proteinuria.
D)
hypokalemia.
A)
tubule dysplasia.
B)
vascular pressure.
C)
endocrine functions.
D)
hypophosphatemia.
5.
.c
Regardless of the cause, chronic kidney disease results in progressive permanent loss of nephrons,
glomerular filtration and renal:
nk
4.
om
A patient is beginning to recover from acute tubular necrosis. The recovery phase of ATN is
characterized by:
nk
ta
3.
As chronic kidney disease progresses, the second stage (renal insufficiency) is identified by:
isotonic polyuria.
B)
metabolic acidosis.
C)
hyperparathyroidism.
D)
diminished renal reserve.
Both high-turnover and low-turnover renal osteodystrophy, the skeletal complications of chronic kidn
disease, are manifested by abnormal _________ and defective bone __________.
st
6.
ba
A)
shape; joint motion
.te
A)
B)
absorption; remodeling
matrix density; marrow
w
C)
parathyroid hormone; surface
Impaired skin integrity and skin manifestations are common in persons with chronic kidney disease. P
skin and subcutaneous bruising are often present as a result of:
w
D)
w
7.
A)
thrombocytopenia.
B)
anticoagulant therapy.
C)
decreased vascular volume.
D)
impaired platelet function.
8.
A)
When acute tubular necrosis (ATN) has occurred instead of prerenal azotemia, laboratory test finding
will show the presence of excessive urine:
protein.
B)
glucose.
C)
calcium.
D)
sodium.
A)
mental retardation.
B)
developmental delays.
C)
bladder incontinence.
D)
early sexual maturity.
A)
calcium intake
B)
muscle mass
C)
drug tolerance
D)
renal perfusion
An 86-year-old female patient has been admitted to the hospital for the treatment of dehydration and
hyponatremia after she curtailed her fluid intake to prevent urinary incontinence. The patients most
recent laboratory results are suggestive of acute renal failure. How would this patients renal failure b
categorized?
Prerenal
B)
Postrenal
C)
Intrinsic
D)
Intrarenal
.te
st
A)
w
The patient exhibits pulmonary and peripheral edema.
The patients GFR does not increase after restoration of renal blood flow.
w
B)
A patient with significant burns on his lower body has developed sepsis on the third day following h
accident. Which of the following developments is most clearly suggestive of ischemic acute tubular
necrosis rather than prerenal failure?
w
12.
A)
ba
11.
.c
Reduced glomerular filtration rate (GFR), with a serum creatinine level that remains in the normal
range, is associated with aging because _______ is reduced in elderly persons.
nk
10.
om
Manifestations of childhood renal disease are varied and may differ from adult onset renal failure.
Features of childhood chronic kidney disease include:
nk
ta
9.
C)
Emergency hemodialysis does not result in decreased BUN and creatinine.
D)
The patient exhibits oliguria and frank hematuria.
13.
Which of the following individuals likely faces the greatest risk for the development of chronic kidn
disease?
A)
A first-time mother who recently lost 1.5 L of blood during a postpartum hemorrhage
B)
A patient whose diagnosis of thyroid cancer necessitated a thyroidectomy
C)
A patient who experienced a hemorrhagic stroke and now has sensory and motor deficits
A patient with a recent diagnosis of type 2 diabetes who does not monitor his blood sugars or
control his diet
D)
urea.
B)
protein.
C)
creatinine.
D)
myoglobin.
A)
Metabolic alkalosis
B)
Hypophosphatemia
C)
Hypocalcemia
D)
Hypokalemia
16.
.c
The nurse is providing care for a patient who has a diagnosis of kidney failure. Which of the followi
laboratory findings is consistent with this patients diagnosis?
nk
15.
om
A)
nk
ta
14.
The primary care provider for a newly admitted hospital patient has added the glomerular filtration r
(GFR) to the blood work scheduled for this morning. The patients GFR will be extrapolated from se
levels of:
A patient with a recent diagnosis of renal failure that will require hemodialysis is being educated in
dietary management of the disease. Which of the patients following statements shows an accurate
understanding of this component of treatment?
Ive made a list of high-phosphate foods so that I can try to avoid them.
B)
Im making a point of trying to eat lots of bananas and other food rich in potassium.
C)
Im going to try a high-protein, low-carbohydrate diet.
D)
I dont think Ive been drinking enough, so I want to include 8 to 10 glasses of water each day.
st
ba
A)
.te
17.
A patient with a diagnosis of chronic kidney disease (CKD) may require the administration of which
the following drugs to treat the consequences of CKD?
Antihypertensive medications
w
A)
C)
Opioid analgesics
Nonsteroidal anti-inflammatory drugs (NSAIDs)
w
D)
Antiarrhythmic medications
w
B)
18.
A patient with a longstanding diagnosis of chronic kidney disease has been experiencing increasing
fatigue, lethargy, and activity intolerance in recent weeks. His care team has established that his GFR
remains at a low, but stable, level. Which of the following assessments is most likely to inform a
differential diagnosis?
A)
Blood work for white cells and differential
B)
Cystoscopy and ureteroscopy
C)
Assessment of pancreatic exocrine and endocrine function
D)
Blood work for hemoglobin, red blood cells, and hematocrit
19.
Which of the following descriptions is true of peritoneal dialysis?
A)
Vascular access is achieved through an internal arteriovenous fistula or an external arterioveno
shunt.
B)
Treatments typically occur three times each week for three to four hours.
C)
The dialyzer is usually a hollow cylinder composed of bundles of capillary tubes.
D)
Treatment involves the introduction of a sterile dialyzing solution, which is drained after a
specified time.
A)
Dry skin and pruritus
B)
Petechiae and purpura
C)
Hirsutism and psoriasis
C
5.
A
6.
B
7.
D
8.
A
9.
B
10.
B
11.
A
12.
B
D
w
13.
nk
4.
nk
ta
B
ba
3.
st
C
w
2.
Alopecia
.te
D)
Answer Key
1.
D
C
15.
C
16.
A
17.
A
18.
D
19.
D
20.
A
w
14.
om
Which of the following integumentary problems most often accompanies chronic kidney disease?
.c
20.
Chapter 35: Disorders of the Bladder and Lower Urinary Tract
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:
bladder spasms.
B)
urinary frequency.
C)
high residual volume.
D)
overflow incontinence.
nk
ta
B)
spasmodic
C)
uninhibited
D)
hyperactive
st
atonic
.te
In men, the condition of nonrelaxing external sphincter with urine retention is commonly caused by:
A)
psychosocial disorders.
prostate enlargement.
w
B)
chronic stress response.
pelvic inflammatory disease.
w
C)
D)
In women, pelvic floor weakness may cause which type of incontinence?
w
5.
A)
Urge
B)
Stress
C)
Overflow
D)
Overactive
6.
A)
ba
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)
4.
.c
A)
3.
om
Although urinary obstruction and urinary incontinence have almost opposite effects on urination, they
can both result from:
nk
1.
Many factors contribute to the incontinence that is common among the elderly. A major factor is
increased:
detrusor muscle function.
B)
intake of liquids and water.
C)
urethral closing pressure.
D)
use of multiple medications.
A)
trigone
B)
sphincter
C)
detrusor
D)
trabeculae
A)
reflexes.
B)
backflow.
C)
inhibition.
D)
coordination.
9.
.c
Neurologic control of bladder function consists of three main levels or centers. The lower motor neuro
spinal cord centers control micturition:
nk
8.
om
Dysfunction of the _____ muscle contraction can disrupt the ability to expel urine from the bladder.
Prolonged urethral outlet obstruction causes chronic high bladder pressure and overdistension, resultin
in the formation of:
detrusor dyssynergia.
B)
cellules.
C)
interstitial cystitis.
D)
sphincter dystonia.
10.
st
ba
A)
The most common sign of epithelial cell bladder cancer is:
severe oliguria.
.te
A)
B)
hyperproteinuria.
hyperphosphaturia.
w
C)
painless hematuria.
w
D)
11.
Most common uncomplicated urinary tract infections are caused by ____ that enter through the ureth
w
A)
nk
ta
7.
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 a
found in the bladder is sterile because of the:
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 practic
that has resulted in frequent constipation and occasional bowel obstructions. Which of the following
problems may directly result from these gastrointestinal disorders?
Urinary tract infections
B)
Overflow urinary incontinence
C)
Bladder cancer
D)
Neurogenic bladder
After reviewing the 24-hour intake and output of a hospital patient, the nurse suspects that the patien
may be experiencing flaccid bladder dysfunction. Which of the following diagnostic methods is mos
likely to confirm or rule out whether the patient is retaining urine?
.c
14.
om
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
nk
ta
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 developm
of a UTI?
ba
15.
nk
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
Decreased urine output and irritability
Production of concentrated urine and recurrent nausea
w
C)
Unexplained fever and anorexia
w
A)
B)
Which of the following signs and symptoms in a 2-year-old child should prompt assessment for a
urinary tract infection?
w
16.
.te
st
A)
D)
17.
Frank hematuria
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 i
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
om
19.
A public health nurse is conducting a health promotion class for a group of older adults. Which of th
participants following statements demonstrates an accurate understanding of the risk factors for blad
cancer?
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.
D)
I think I should be okay because theres no history or bladder cancer in my family that Im awar
of.
nk
.c
A)
nk
ta
20.
Which of the following events would suggest that an individuals physiologic response to an obstruct
has progressed beyond the compensatory stage and is now in the decompensatory stage?
The bladder muscle hypertrophies.
B)
The detrusor loses its power of contraction.
C)
The ability to suppress urination is diminished.
3.
A
4.
B
B
w
5.
st
B
w
2.
The individual experiences urgency.
.te
D)
Answer Key
1.
A
ba
A)
D
7.
C
8.
A
9.
B
10.
D
11.
B
12.
D
13.
B
14.
D
w
6.
C
16.
A
17.
C
18.
A
19.
B
20.
B
Chapter 36: Structure and Function of the Gastrointestinal System
ileum
B)
antrum
C)
jejunum
D)
duodenum
2.
nk
A)
.c
Bile and pancreatic juices enter the ______ through the common bile duct and the pancreatic duct.
The digestive tract is a four-layered tube. Which layer consists of connective tissue and contains nerv
blood vessels, and structures for secreting the digestive juices?
nk
ta
1.
Mucosal
B)
Peritoneum
C)
Submucosal
D)
Circular muscle
ba
A)
What body part is the largest serous membrane in the body, constitutes the outer wall of the intestine,
contains a serous fluid between its two layers?
st
3.
om
15.
Mesentery
.te
A)
B)
Omentum
Haustration
w
C)
Peritoneum
w
D)
w
4.
Motility along the length of the gut, control of function, and communication of each segment are
innervated by the ______ neurons of the enteric nervous system.
A)
intramural
B)
vasovagal
C)
sympathetic
D)
preganglionic
5.
The patient chews an apple and starts the three phases of swallowing. As food enters the patients
esophagus, stretching and _____ nerve impulses initiate _______ that are controlled by the swallowin
center.
A)
phrenic; gag reflexes
B)
vagus; peristaltic waves
C)
hypoglossal; contractions
D)
trigeminal; tactile receptors
during bile secretion.
B)
between contractions.
C)
with a mucosal surface.
D)
under gaseous pressure.
Because intestinal secretions are mainly ______ and are derived from the extracellular fluid, excessiv
secretion or impaired absorption can lead to extracellular _____.
nk
7.
nitrogen; acidosis
B)
water; dehydration
C)
anaerobic; hypotonicity
D)
electrolytes; hypervolemia
ba
The stomach is the source of two hormones produced by the gastrointestinal tract: gastrin and ghrelin.
Ghrelin is a peptide hormone produced in the mucosal layer that has an important role in regulation of
________ secretion.
gastric acid fluid
B)
growth hormone
C)
biliary bicarbonate
.te
st
A)
D)
pancreatic enzyme
w
vehicle for absorption.
w
B)
In addition to mucus, the intestinal mucosa produces two other types of secretions. Copious amounts o
the serous type fluid are secreted to act as a:
w
9.
A)
nk
ta
A)
8.
om
A)
.c
6.
In the stomach, chyme is churned by peristalsis into the antrum, which contracts, reverses the flow, an
allows more churning. Because the pylorus is contracted during antral contraction, gastric content
empties into the duodenum:
enzyme that splits sugars.
C)
protection from acid content.
D)
parasympathetic stimulation.
10.
The intestinal absorption of glucose and amino acids is facilitated by a ________ transport system.
A)
bile-salt micelles
B)
fat emulsification
C)
sodium-dependent
D)
brush border enzyme
Parasympathetic stimulation results in which of the following gastrointestinal effects?
A)
Increase in smooth muscle tone
B)
Enhancement of sphincter function
C)
Decrease in gastrointestinal motility
D)
Increase in enteric nervous system activity
Which of the following functions is performed by saliva?
A)
Antimicrobial protection
B)
Promotion of intestinal flora
C)
Buffering of gastric secretions
D)
Catalysis of brush border enzymes
13.
om
12.
.c
11.
Gastrin production, a task that is performed by the stomach, results in which of the following effects
Simulation of pancreatic enzyme secretions
B)
Stimulation of HCl secretions by parietal cells
C)
Conversion of polysaccharides to monosaccharides
D)
Release of insulin in response to glucose load
A patient who is quadriplegic following a motor vehicle accident adheres to a bowel protocol to
promote regular bowel movements and prevent constipation. Which of the following actions perform
by the patients caregiver is likely to promote defecation?
ba
14.
nk
ta
nk
A)
Digital stimulation of the patients rectum
B)
Massage of the patients abdomen
C)
Seating the patient in an upright position
D)
Administration of large amounts of free water
15.
w
w
A patient who is taking a broad-spectrum antibiotic to treat a urinary tract infection
w
C)
Which of the following patients likely faces the greatest risk of a gastrointestinal bleed?
A man whose hypertension requires him to take a diuretic, an ACE inhibitor, and a b-adrenerg
blocker
A)
B)
.te
st
A)
D)
16.
A patient with a history of anxiety who takes benzodiazepines several times daily
A patient who takes aspirin with each meal to control symptoms of osteoarthritis
A patients complex and worsening pressure ulcer has necessitated the use of numerous antibiotics ov
the last several months. Which of the following consequences may result from this patients medicati
regimen?
A)
Impaired mucus production
B)
Vitamin K deficiency
C)
Impaired protein metabolism
D)
Excessive release of pepsin
17.
Which of the following aspects of gastrointestinal function is performed by the brush border enzyme
the villus structures?
A)
Fat metabolism
B)
Vitamin A synthesis
C)
Digestion of carbohydrates
D)
Maintenance of fluid and electrolyte balance
B)
Impaired glucose metabolism
C)
Inadequate gastric acid production
D)
Impaired digestion of fats
A child who is experiencing the signs and symptoms of influenza has vomited frequently over the la
24 hours. Vomiting results from stimulation of what site in the neurologic system?
nk
ta
19.
Myenteric plexus
B)
Intramural plexus
C)
Vagus nerve
D)
Chemoreceptor trigger zone
ba
A)
A patient has been diagnosed with an incompetent pyloric sphincter. This patient will experience
abnormal communication between which of the following components of the gastrointestinal tract?
st
20.
Stomach and duodenum
.te
A)
B)
Esophagus and stomach
Rectum and anus
w
C)
om
Incomplete digestion of starches
.c
A)
nk
18.
A patient has been diagnosed with cholecystitis (gall bladder inflammation) that has impaired the
normal release of bile. Which of the following gastrointestinal consequences is this patient likely to
experience?
Small intestine and colon
w
w
D)
Answer Key
1.
D
2.
A
3.
D
4.
A
5.
B
6.
B
7.
B
8.
B
C
11.
D
12.
A
13.
B
14.
A
15.
D
16.
B
17.
C
18.
D
19.
D
20.
A
om
10.
.c
A
A major complication of persistent gastroesophageal reflux is:
strictures.
B)
heartburn.
C)
chest pain.
D)
hoarseness.
Acute gastritis refers to a transient inflammation of the gastric mucosa that is most commonly associa
with:
.te
2.
st
A)
A)
diarrhea.
food allergies.
w
B)
gastric reflux.
alcohol intake.
w
C)
D)
ba
1.
nk
ta
Chapter 37: Disorders of Gastrointestinal Function
nk
9.
The Helicobacter pylori protobacteria cause peptic ulceration by producing:
w
3.
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.
Inflammatory bowel diseases are accompanied by systemic manifestations that include:
A)
autoimmune anemia.
B)
rheumatoid arthritis.
C)
thrombocytopenia.
D)
lactose intolerance.
A)
granulomatous lesions.
B)
ulcerative erosions.
C)
fibrotic smooth muscle.
D)
necrotic crypt abscesses.
Unlike the Crohn type of inflammatory bowel disease, the ulcerative colitis type is characterized by:
A)
skip lesions.
B)
steatorrhea.
C)
gastric ulcers.
D)
pseudopolyps.
ba
Diverticulitis, a complication of diverticulosis, is manifested by acute:
rectal bleeding.
B)
abdominal distention.
C)
large-volume diarrhea.
D)
st
A)
.te
8.
lower left quadrant pain.
chemical irritation.
ruptured appendix.
w
A)
abdominal distention.
w
C)
Major causes of mechanical bowel obstruction include:
w
9.
B)
nk
ta
7.
om
Crohns type of inflammatory bowel disease is characterized by:
.c
6.
nk
5.
D)
10.
postoperative adhesions.
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 ou
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
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
nk
Which of the following individuals most likely faces the greatest risk of developing Clostridium
difficile colitis?
nk
ta
13.
.c
A)
om
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 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 t
treat a recent flare-up
ba
A)
st
.te
14.
A 66-year-old woman has been diagnosed with diverticular disease based on her recent complaints a
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.
I think this might have happened because Ive used enemas and laxatives too much.
w
B)
Ive always struggled with heartburn and indigestion, and I guess I shouldnt have ignored those
warning signs.
I suppose I should try to eat more fiber and become a bit more active.
w
D)
w
C)
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 noninflammato
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 o
paralytic ileus?
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
Which of the following meals is most likely to exacerbate an individuals celiac disease?
.c
18.
om
A)
Spaghetti with meatballs and garlic bread
B)
Stir-fried chicken and vegetables with rice
C)
Oatmeal with milk, brown sugar, and walnuts
D)
Barbecued steak and a baked potato with sour cream
19.
nk
ta
nk
A)
Which of the following statements is true of colorectal cancer?
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.
st
ba
A)
.te
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
this patients treatment?
Chemotherapy
w
A)
B)
Pharmacologic therapies
w
C)
Radiation therapy
w
D)
Answer Key
1.
A
2.
D
3.
B
4.
A
5.
A
6.
A
Surgery
9.
D
10.
B
11.
B
12.
A
13.
B
14.
D
15.
A
16.
D
17.
A
18.
A
19.
C
20.
D
om
D
.c
8.
nk
D
nk
ta
7.
Chapter 38: Disorders of Hepatobiliary and Exocrine Pancreas Function
ba
Abnormally high accumulation of bilirubin in the blood causes:
jaundice.
B)
cholestasis.
C)
xanthomas.
D)
st
A)
.te
1.
biliary cirrhosis.
fatty liver changes.
disrupted bile flow.
w
C)
direct cellular injury.
w
A)
B)
The mechanisms of liver damage in viral hepatitis include:
w
2.
D)
3.
bile duct inflammation.
Alcoholic liver disease manifests in three stages. The intermediate stage, alcoholic hepatitis, is
characterized by liver cell:
A)
necrosis.
B)
nodules.
C)
atrophy.
D)
hypertrophy.
4.
A major factor in the development of hepatic encephalopathy is:
A)
hypersplenism.
B)
high sodium level.
C)
neurotoxin accumulation.
D)
steroid hormone deficiency.
B)
channels
C)
phagocytes
D)
cytotoxic cells
Both prehepatic and posthepatic causes of portal hypertension include the formation of:
A)
fibrous nodules.
B)
venous thrombosis.
C)
collateral circulation.
D)
portosystemic shunts.
7.
The late manifestations of cirrhosis are related to liver failure and:
hepatomegaly.
B)
diffuse liver fibrosis.
C)
portal hypertension.
D)
hepatorenal syndrome.
8.
.te
st
ba
A)
Factors that contribute to the formation of gallstones, or acute cholelithiasis, include:
A)
chronic pancreatitis.
w
gallbladder inflammation.
excessive alcohol intake.
w
D)
rapid elimination of bile.
w
B)
C)
nk
6.
om
filters
.c
A)
nk
ta
5.
Kupffer cells function as ______ to remove harmful substances or cells from the portal blood as it mo
through the venous sinusoids.
9.
The patient has right upper quadrant pain caused by acute choledocholithiasis. If the common bile duc
becomes obstructed, manifestations will also include:
A)
ascites.
B)
vomiting.
C)
bilirubinuria.
D)
hemorrhage.
10.
Acute pancreatitis involves activated pancreatic enzymes that escape into surrounding tissues to cau
_______.
A)
fatty deposits
B)
autodigestion
C)
bowel obstruction
D)
abscess formation
11.
Individuals with liver disease often experience the effects of excess serum ammonia as a result of
impairment of the livers ability to process ammonia. How does the liver process ammonia in healthy
individuals?
By converting it into bilirubin which is then excreted intestinally
B)
By processing ammonia into nitrogen and hydrogen ions for excretion
C)
By processing it into urea and releasing it into the circulation
D)
By combining it with oxygen to create ammonium oxide
Prehepatic
B)
Intrahepatic
C)
Posthepatic
D)
Infectious
13.
nk
ta
A)
nk
A patients longstanding diagnosis of congenital hemolytic anemia often manifests itself with jaundic
What type of jaundice does this patient most likely experience?
A decrease in the serum level of which of the following substances is suggestive of liver injury?
ba
12.
.c
om
A)
g-Glutamyltransferase (GGT)
B)
Albumin
C)
Alanine aminotransferase (ALT)
D)
Alkaline phosphatase
14.
Im embarrassed that Ill be a carrier of hepatitis from now on.
Im still trying to deal with the fact that this will forever change my life.
w
C)
I guess Im an example of why you should always use condoms.
w
B)
Antibody testing has confirmed that a man is positive for hepatitis A virus (HAV). Which of the
patients statements suggests that he understands his new diagnosis?
w
A)
.te
st
A)
D)
15.
I dont know why I didnt bother to get vaccinated against this.
A 16-year-old girl has been admitted to the emergency department after ingesting 20 g of
acetaminophen (Tylenol) in a suicide attempt. The care team would recognize that this patient faces
severe risk of:
A)
acute fulminant hepatitis.
B)
hepatitis D virus infection.
C)
secondary biliary cirrhosis.
D)
portal hypertension.
16.
Which of the following factors accounts for the poor prognosis that typically accompanies a diagnos
of primary hepatocellular cancer?
A)
Surgical options do not exist because removal of all or part of the liver is a threat to health.
B)
Liver cancer typically metastasizes at a much earlier stage than other cancers.
C)
Liver tumors are poorly differentiated due to the low density of hepatic tissue.
D)
The nonspecific symptomatology of liver cancer means that diagnosis often happens at a late
stage.
Which of the following factors is most strongly associated with the pathogenesis of gallstones?
Excess serum ammonia and urea levels
B)
Portal hypertension
C)
Abnormalities or stasis of bile
D)
High cholesterol diet
nk
18.
.c
A)
om
17.
Which of the following individuals most likely faces the highest risk of developing chronic pancreat
A woman who has six to eight drinks each evening
B)
A man who has become profoundly ill during a tropical vacation
C)
A woman who takes two Tylenol tablets five to six times a day
D)
An obese man who has a high-fat diet and has a sedentary lifestyle
nk
ta
A)
The nurse who is providing care for a patient with pancreatic cancer should prioritize which of the
following assessments?
ba
19.
Assessment for ascites and close monitoring of fluid balance
B)
Respiratory assessment and monitoring of arterial blood gases
C)
Vigilant monitoring of blood glucose levels
.te
st
A)
D)
Assessment for deep vein thrombosis
A)
Fever and sudden abdominal distention
w
C)
Upper right quadrant or epigastric pain
w
B)
Which of the following signs and symptoms is most suggestive of acute cholecystitis?
w
20.
D)
Answer Key
1.
A
2.
A
3.
A
4.
C
5.
C
Appearance of undigested fat in feces
Nausea resulting in greenish vomitus
8.
C
9.
C
10.
B
11.
C
12.
A
13.
B
14.
D
15.
A
16.
A
17.
C
18.
A
19.
D
20.
A
om
C
.c
7.
nk
B
nk
ta
6.
1.
ba
Chapter 39: Alterations in Nutritional Status
The adipocytes in adipose tissue not only serve as a storage sites, they also:
produce linoleic fatty acid.
B)
synthesize triglycerides.
C)
increase glucagon release.
.te
st
A)
D)
degrade fat-soluble vitamins.
a reduced need for nitrogen as protein.
w
C)
more protein consumed than excreted.
w
A)
B)
Protein contains nitrogen. A negative nitrogen balance represents:
w
2.
D)
3.
more nitrogen excreted than consumed.
less use of nitrogen for protein synthesis.
Natural appetite suppression mechanisms, necessary for food intake control, include :
A)
ketoacid deficiency.
B)
cholecystokinin storage.
C)
decreased blood glucose.
D)
leptin receptor stimulation.
4.
Body weight should be used in combination with other measurements to establish if a person is
underweight or overweight. Obesity is indicated by:
A)
female body fat of 20% and 30%.
B)
body mass index (BMI) of 30 to 40.
C)
relative body weight of 70% to 100%.
D)
abdominal fat/ hip ratio of 0.8 to 1.0.
osteoporosis
B)
renal disease
C)
cardiometabolic disorders
D)
chronic anemia
6.
.c
A)
om
A patient with upper body obesity also has central fat distribution. This body fat configuration places
patient at greater risk for _____________ than a patient with lower body obesity.
nk
5.
As the problem of childhood and adolescent obesity increases, an increase in the incidence of
____________ is occurring in this obese population.
type 2 diabetes mellitus
B)
attention deficit disorder
C)
juvenile rheumatoid arthritis
D)
antibiotic-resistant bacterial infections
7.
ba
nk
ta
A)
A diet deficient in calories and protein causes marasmus, which is characterized by:
discolored hair.
B)
bradycardia.
C)
enlarged liver.
.te
st
A)
D)
pitting edema.
excessive blood cell production.
w
C)
respiratory muscle stimulation.
w
A)
B)
Protein-calorie malnutrition with loss of lean tissues and muscle mass results in:
w
8.
D)
9.
diarrhea.
increased cardiac contractility.
Similarities between girls or women with anorexia nervosa and bulimia nervosa include:
A)
periodontal disease.
B)
low estrogen level.
C)
electrolyte imbalances.
D)
enlarged parotid gland.
10.
Both binge-eating and bulimia nervosa patients consume excessive amounts of foods secretively. A
major difference is that binge-eaters:
A)
remain overweight.
B)
eat when not hungry.
C)
are substance abusers.
D)
experience depression.
A large, high-calorie meal has resulted in the intake of far more energy than a person requires. What
will the individuals body do with the excess carbohydrates provided by this meal?
om
11.
Convert them into glucose and store them in the liver and muscles
B)
Excrete most of the excess polysaccharides through the kidneys
C)
Convert the carbohydrates into amino acids in preparation for long-term storage
D)
Create structural proteins from some of the carbohydrates and store the remainder as triglyceri
12.
nk
.c
A)
Which of the following patients is most likely to be in positive nitrogen balance?
A patient who is receiving treatment for sepsis
B)
A patient whose diagnosis of pneumonia is causing a fever
C)
A woman who has been admitted to the hospital in early labor
D)
A patient who sustained extensive burns in a recent industrial accident
nk
ta
A)
In addition to facilitating bowel movements, a diet that is high in fiber confers which of the followin
benefits?
ba
13.
Lowering cholesterol and blood glucose
B)
Removing toxins and metabolic byproducts
C)
Lowering blood pressure and resting heart rate
.te
st
A)
D)
Increasing intestinal absorption of vitamins and minerals
Adipose tissue antagonizes the effects of insulin on cell membranes.
Adipose tissue produces ghrelin, which stimulates both appetite and eating.
w
A)
B)
Which of the following statements best conveys the endocrine function of adipose tissue?
w
14.
Adipose tissue produces and secretes cholecystokinin (CCK), which stimulates the hypothalam
feeding center.
D)
Adipose tissue produces leptin, which mediates body weight.
w
C)
15.
Chronic inflammation as a result of excess adipose tissue is implicated in the etiology of which of th
following health problems?
A)
Osteoporosis
B)
Type 2 diabetes
C)
Rheumatoid arthritis
D)
Systemic lupus erythematosus (SLE)
16.
A public health nurse has noted a significant increase in the number of school-aged children who are
obese. Which of the following factors is most significant predictor of childhood obesity?
A)
Low socioeconomic status
B)
Low self-esteem
C)
Having obese parents
D)
Living in a rural or inner-city neighborhood
Which of the following measures should a school nurse prioritize in the treatment and prevention of
childhood obesity?
om
17.
Group cognitive therapy
B)
Use of selective serotonin-reuptake inhibitors (SSRIs)
C)
Education on exercise and nutrition
D)
High-protein, low-carbohydrate diet
Impairment of immune function
B)
Lack of dietary fat intake
C)
High intake of carbohydrates
D)
Impaired pigment synthesis
st
A frail, 87-year-old female patient has been admitted to a hospital after a fall and has been diagnosed
with failure to thrive. Which of the following laboratory values would suggest that the patient may b
experiencing malnutrition?
A)
Low prealbumin
B)
.te
19.
ba
A)
High C-reactive protein
C)
High bilirubin
Low fasting blood sugar
Which of the following assessments should be prioritized in the care of a patient with anorexia nervo
w
20.
w
D)
Serum electrolyte levels
w
A)
nk
Which of the following characteristics distinguishes kwashiorkor from marasmus?
nk
ta
18.
.c
A)
B)
Chest auscultation
C)
White blood cell count with differential
D)
Answer Key
1.
B
Blood pressure monitoring
2.
C
3.
D
A
7.
B
8.
C
9.
C
10.
A
11.
A
12.
C
13.
A
14.
D
15.
B
16.
C
17.
C
18.
C
19.
A
20.
D
om
6.
.c
C
nk
5.
nk
ta
B
ba
4.
1.
st
Chapter 40: Mechanisms of Endocrine Control
Hormones are chemical messengers that:
regulate body functions.
.te
A)
B)
initiate immune reactions.
transport fatty acids and lipids.
w
C)
cause one specific tissue effect.
The release of insulin from the pancreatic beta cells can inhibit its further release from the same cells.
This is an example of _______ hormone action.
w
D)
w
2.
A)
retinoid
B)
autocrine
C)
juxtaposed
D)
arachidonic
3.
Several hormones, including steroids and thyroid hormone, are bound to and carried by:
A)
proteins.
B)
target cells.
C)
cholesterol.
D)
prohormones.
4.
Hormones exert their action by binding to high-affinity receptors on the surface or inside of the target
cell. The response of the target cell varies with the _____ and _____ of the receptors present.
numbers; affinity
B)
hormone size; location
C)
permeability; ionization
D)
saturation level; rate
Release and synthesis of anterior pituitary hormones are mainly regulated by the inhibiting or releasin
actions of the:
cell receptors.
B)
thymus gland.
C)
hypothalamus.
D)
adrenal gland.
nk
ta
6.
.c
A)
When sensors detect a change in a hormone level, the hormonal response is regulated by _________
mechanisms that will return the level to within normal range.
metabolic
B)
feedback
C)
production
D)
action potential
.te
st
When hypofunction of an endocrine organ is suspected, a hormone ____________ test can be
administered to measure and assess target gland response.
A)
stimulation
B)
24-hour urine
agglutination
w
C)
antibody-binding
w
D)
Hormones are usually divided into four categories according to their:
w
8.
A)
function.
B)
precursor.
C)
structure.
D)
receptor.
9.
A)
ba
A)
7.
nk
5.
om
A)
Although both autocrine and paracrine hormonal actions occur without entering the blood stream,
paracrine actions differ because they affect ______ cells.
self-
B)
local
C)
stored
D)
target
A)
free receptor sites.
B)
stimulate production.
C)
prevent accumulation.
D)
absorb metabolic waste.
Hormones that cause the subsequent stimulation or release of another hormone, such as thyroidstimulating hormone and corticotropin-releasing hormone, typically belong to which of the followin
structural classifications?
Amines and amino acids
B)
Peptides and proteins
C)
Steroids
D)
Fatty acid derivatives
12.
nk
ta
A)
.c
11.
om
As part of maintaining homeostasis, hormones secreted by endocrine cells are inactivated continuou
to:
nk
10.
Paracrine action involves which of the following characteristics?
Action on a distant target cell
B)
Autoregulation
C)
Action on the same cells that produced the hormone
D)
Action on nearby target cells
st
ba
A)
Insulin
w
A)
Testosterone
w
D)
Cortisol
w
B)
C)
.te
13.
A hormone has been synthesized in the rough endoplasmic reticulum of an endocrine cell after whic
has moved into the Golgi complex, been packaged in a vesicle, and been released into circulation. W
hormone is synthesized and released in this manner?
14.
Estrogen
Cyclic adenosine monophosphate (cAMP) performs which of the following roles in the functioning
the endocrine system?
A)
Mediating hormone synthesis by nonvesicle-mediated pathways
B)
Acting as a high-affinity receptor on the surface of target cells
C)
Inactivating hormones to prevent excess accumulation
D)
Acting as a second messenger to mediate hormone action on target cells
15.
Which of the following statement best describes the relationship between the hypothalamus and the
posterior pituitary in the normal functioning of the endocrine system?
B)
The posterior pituitary gland regulates the release of hypothalamic hormones.
C)
Posterior pituitary hormones are produced in the hypothalamus but released from the pituitary
gland.
D)
The hypothalamus regulates the production and release of posterior pituitary hormones by the
pituitary gland.
Thyroid gland
B)
Pituitary gland
C)
Adrenal cortex
D)
Pancreas
17.
nk
ta
A)
.c
Which of the following structures controls the functions of the greatest number of target glands and
cells?
nk
16.
om
A)
Posterior pituitary hormones are constituted from components of both the hypothalamus and t
pituitary gland itself.
Which of the following physiologic processes best exemplifies a positive feedback mechanism?
The increase in prolactin secretion that occurs with more frequent breast-feeding
B)
The regulation of blood glucose levels by insulin
C)
The release of parathyroid hormone in response to decreased serum calcium levels
D)
The release of antidiuretic hormone when sodium levels are higher than normal
ba
A)
st
.te
18.
A patient has received an injection containing thyrotropin-releasing hormone (TRH) and is now bein
assessed for levels of thyroid-stimulating hormone (TSH). This patient has undergone which of the
following diagnostic tests?
A)
Suppression testing
Radioimmunoassay (RIA)
w
B)
Stimulation testing
Thyroid and steroid hormones, which exert their effect on target cells by way of nuclear receptors, h
which of the following characteristics?
w
D)
Autoantibody testing
w
C)
19.
A)
The selective use of a second messenger
B)
The ability to cross the cell membrane of target cells
C)
The ability to regulate surface receptor affinity
D)
Both lipid-solubility and water-solubility
20.
A)
Which of the following hormones is produced by the anterior pituitary gland?
Growth hormone (GH)
B)
Oxytocin
C)
Corticotropin-releasing hormone (CRH)
C
6.
B
7.
A
8.
C
9.
B
10.
C
11.
B
12.
C
13.
A
14.
D
15.
C
16.
B
17.
A
18.
D
19.
B
20.
A
om
5.
.c
A
nk
4.
nk
ta
A
ba
3.
st
B
w
2.
Norepinephrine
.te
D)
Answer Key
1.
A
w
w
Chapter 41: Disorders of Endocrine Control of Growth and Metabolism
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.
A)
The most common cause of hypothyroidism is:
goiter.
B)
myxedema.
C)
thyroidectomy.
D)
autoimmune thyroiditis.
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
muscle fatigue
B)
facial myxedema
C)
ophthalmopathy
D)
decreased cholesterol
The major adrenal cortical hormones are steroids and are synthesized from acetate and:
A)
ACTH.
B)
albumin.
C)
amino acids.
D)
cholesterol.
st
Primary adrenal insufficiency is manifested by:
A)
truncal obesity and edema.
B)
.te
6.
ba
5.
nk
ta
A)
.c
The most common cause of thyrotoxicosis is Graves disease, which has the distinguishing characteris
of _____ in addition to a diffuse goiter.
nk
4.
hypokalemia and hypervolemia.
C)
hyponatremia and hypoglycemia.
hypopigmentation and hypertension.
w
D)
One of the earliest signs of Cushing syndrome is the loss of variable diurnal secretion of cortisolreleasing hormone (CRH) and:
w
7.
w
A)
om
3.
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.
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:
moderate insulin resistance.
B)
increased capillary permeability.
C)
increased cell-mediated immunity.
D)
inhibition of prostaglandin synthesis.
Which of the following individuals is experiencing the effects of a primary endocrine disorder?
nk
11.
om
A)
.c
9.
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
Which of the following physiologic processes is a direct effect of the release of growth hormone by
anterior pituitary?
ba
12.
nk
ta
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
.te
st
A)
D)
Positive feedback of the hypothalamic-pituitary-thyroid feedback system
13.
An adult who has a diagnosis of Cushing syndrome
w
C)
A girl who has been diagnosed with precocious puberty
w
B)
An adult with an excess of growth hormone due to an adenoma
w
A)
Which of the following individuals displays the precursors to acromegaly?
D)
14.
A patient who has recently developed primary adrenal carcinoma
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 compla
of feeling cold
B)
A 90-year-old woman with a history of atrial fibrillation whose arrhythmia has recently becom
more severe
C)
An 88-year-old man with a history of Alzheimer disease who has become increasingly agitate
and is wandering more frequently
D)
A 91-year-old man with a chronic venous ulcer and a sacral ulcer who has developed sepsis
A)
Cushing syndrome.
B)
Graves disease.
C)
Addison disease.
D)
Cushing disease.
16.
om
Abnormal stimulation of the thyroid gland by TSH-receptor antibodies is implicated in cases of:
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 mo
likely to benefit this patient?
.c
15.
Synthetic preparations of T3 or T4
B)
b-Adrenergic blocking drugs and antithyroid drugs
C)
Corticosteroid replacement therapy
D)
Oral or parenteral cortisol replacement
nk
ta
17.
nk
A)
A 33-year-old patient has been admitted to the hospital for the treatment of Graves disease. Which o
the following assessments should the patients care team prioritize?
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
st
ba
A)
.te
18.
A patient who has been taking 80 mg of prednisone, a glucocorticoid, each day has been warned by
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?
Sudden changes in glucocorticoid dosing may reverse the therapeutic effects of the drug.
w
A)
C)
Sudden cessation of a glucocorticoid can result in adrenal gland necrosis.
w
D)
Stopping the drug suddenly may shock the HPA axis into overactivity.
w
B)
19.
Stopping the drug suddenly may cause adrenal insufficiency.
The signs and symptoms of abrupt cessation of pharmacologic glucocorticoids closely resemble thos
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
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
B
w
20.
om
5.
.c
C
nk
4.
nk
ta
A
ba
3.
st
D
w
2.
Malfunction of the HPA system
.te
D)
Answer Key
1.
C
w
Chapter 42: Diabetes Mellitus and the Metabolic Syndrome
1.
Type 1 diabetes mellitus results from destruction of the pancreatic beta cells by two mechanisms. The
mechanism for type 1A diabetes is _______ destruction.
A)
genetic
B)
resistant
C)
idiopathic
D)
autoimmune
The metabolic abnormalities that lead to type 2 diabetes include:
A)
chronic overeating.
B)
insulin resistance.
C)
acute pancreatitis.
D)
recurrent hypoglycemia.
A)
Glucose tolerance test
B)
Fasting blood glucose
C)
Capillary blood glucose
D)
Glycosylated hemoglobin
nk
Diabetic ketoacidosis (DKA) more commonly occurs in patients with type 1 diabetes, when the lack o
insulin leads to the mobilization of _____ that causes excess ketone production by the liver.
A)
cortisol
B)
fatty acids
C)
potassium
D)
bicarbonate
Factors that contribute to the severe hyperglycemia that precipitates hyperglycemic hyperosmolar stat
(HHS) include:
ba
5.
nk
ta
4.
fluid retention and edema.
B)
thromboembolism formation.
C)
insulin overdose.
.te
st
A)
D)
glycosuria and water loss.
w
hypoglycemia
Somogyi effect
w
B)
A change in the circadian rhythm for glucose tolerance and an inappropriate increase in counterregula
hormones can lead to _______ in diabetics.
w
6.
A)
om
3.
Which test provides a way to monitor fluctuations of blood glucose levels over the previous 6 to 12
weeks?
.c
2.
C)
hyperinsulinemia
D)
dawn phenomenon
7.
In people with type 1 diabetes, the beneficial effects of exercise also carry an increased risk of:
A)
rapid weight loss.
B)
respiratory disorders.
C)
rebound hyperglycemia.
D)
profound hypoglycemia.
One of the first renal manifestations of diabetic nephropathy is:
A)
microalbuminuria.
B)
oliguria.
C)
hypertension.
D)
hyperlipidemia.
B)
hemorrhages.
C)
dehydration.
D)
infections.
10.
om
glaucoma.
.c
A)
Impaired and delayed healing in a person with diabetes is caused by chronic complications that inclu
A)
ketoacidosis.
B)
Somogyi effect.
C)
fluid imbalances.
D)
chronic neuropathies.
A hospital patient with a diagnosis of type 1 diabetes has been administered a scheduled dose of reg
insulin. Which of the following effects will result from the action of insulin?
ba
11.
nk
9.
Diabetic retinopathy, the leading cause of acquired blindness in the United States, is characterized by
retinal:
nk
ta
8.
Promotion of fat breakdown
B)
Promotion of glucose uptake by target cells
C)
Promotion of gluconeogenesis and protein synthesis
D)
Initiation of glycogenolysis
The tissue trauma of surgery resulted in gluconeogenesis.
Illness inhibited the release and uptake of glucagon.
w
B)
w
A)
A patient with longstanding type 2 diabetes is surprised at his high blood sugar readings while
recovering from an emergency surgery. Which of the following factors may have contributed to the
patients inordinately elevated blood glucose levels?
w
12.
.te
st
A)
C)
The stress of the event caused the release of cortisol.
D)
Sleep disruption in the hospital precipitated the dawn effect.
13.
The results of a 44-year-old obese mans recent diagnostic workup have culminated in a new diagnos
of type 2 diabetes. Which of the following pathophysiologic processes underlies the patients new
diagnosis?
A)
Beta-cell exhaustion due to long-standing insulin resistance
B)
Destruction of beta cells that is not attributable to autoimmunity
C)
T-lymphocytemediated hypersensitivity reactions
D)
Actions of insulin autoantibodies (IAAs) and islet cell autoantibodies (ICAs)
14.
Which of the following assessment findings of a male patient constitutes a criterion for a diagnosis o
metabolic syndrome?
A)
The patient states that he does less than 30 minutes of strenuous physical activity each week.
B)
The patients resting heart rate is typically 85 to 95 beats per minute.
C)
The patients blood pressure is consistently in the range of 140/90 mm Hg.
D)
The patient has a family history of type 2 diabetes.
Which of the following pregnant women likely faces the greatest risk of developing gestational
diabetes?
om
15.
A patient who was diagnosed with placenta previa early in her pregnancy.
B)
A patient who is gravida five (in her fifth pregnancy)
C)
A patient who has hypertension and elevated triglycerides
D)
A patient who is morbidly obese
A patients primary care provider has ordered an oral glucose tolerance test (OGTT) as a screening
measure for diabetes. Which of the following instructions should the patient be given?
nk
ta
16.
nk
.c
A)
The lab tech will give you a sugar solution and then measure your blood sugar levels at specif
intervals.
B)
Youll have to refrain from eating after midnight and then go to the lab to have your blood take
first thing in the morning.
C)
Theyll take a blood sample and see how much sugar is attached to your red blood cells.
D)
You can go to the lab at any time; just tell the technician when you last ate before they draw a
blood sample.
st
ba
A)
.te
17.
Which of the following insulin-administration regimens is most likely to result in stable blood gluco
levels for a patient with a diagnosis of type 1 diabetes?
One large dose of long-acting insulin each day before breakfast
w
A)
Six to eight small doses of rapid-acting insulin each day, with capillary monitoring before eac
w
C)
Intermediate-acting insulin at 8:00 AM and 8:00 PM with rapid-acting insulin before each me
w
B)
D)
18.
Long-acting insulin twice daily (breakfast and bedtime), with intermediate-acting insulin in th
afternoon
A hospital patient has been complaining of increasing fatigue for several hours and his nurse has
entered his room to find him unarousable. The nurse immediately checked the patients blood glucos
level, which is 22 mg/dL (1.2 mmol/L). The nurse should prepare to administer which of the followi
A)
A snack that combines simple sugars, protein, and complex carbohydrates
B)
A 50% glucose solution intravenously
C)
Infusion of rapid-acting insulin
D)
Oral solution containing glucagon and simple sugars
A)
Use of over-the-counter diuretics
B)
Increased fluid intake
C)
Decreased oral sugar intake
D)
Measures to lower blood pressure
20.
Which of the following comorbidities represents the greatest risk for the development of foot ulcers
diabetic patient?
Distal symmetric neuropathy
B)
Previous incidents of diabetic ketoacidosis
C)
Diabetic nephropathy
4.
B
5.
D
6.
D
7.
D
8.
A
9.
B
10.
D
11.
B
C
w
12.
A
w
13.
14.
C
15.
D
16.
A
17.
B
18.
B
19.
D
20.
A
nk
nk
ta
D
ba
3.
st
B
w
2.
Autonomic neuropathy
.te
D)
Answer Key
1.
D
.c
A)
om
19.
A diabetic patients most recent blood work indicated a decreased glomerular filtration rate and urine
testing revealed microalbuminuria. Which of the following self-care measures should the patients ca
team suggest to the patient?
Chapter 43: Structure and Function of the Male Genitourinary System
A)
norepinephrine
B)
nitroglycerine
C)
nitric oxide
D)
nicotinic acid
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.
Common risk factors for erectile dysfunction due to generalized penile arterial insufficiency include:
nk
ta
3.
cryptorchidism.
B)
cigarette smoking.
C)
testicular torsion.
D)
benign prostate hypertrophy.
ba
A)
Squamous cell cancer of the penis is more likely to develop in men with chronic:
erectile dysfunction.
B)
herpes ulcerations.
C)
st
A)
.te
4.
Peyronie disease.
smegma accumulation.
epididymis.
tunica vaginalis.
w
B)
In a hydrocele, excess fluid is present in the:
w
5.
w
D)
A)
.c
2.
om
Smooth muscle relaxation and shunting of blood into the sinusoids is mediated by _______ and result
a penile erection.
nk
1.
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.
Men older than age 50 are at high risk for prostatic hypertrophy with complications that include:
A)
hypospadias.
B)
scrotal edema.
C)
urine retention.
D)
testicular cancer.
The major cause of acute prostatitis is:
prostate hyperplasia.
B)
acute pyelonephritis.
C)
gram negative
D)
mucous gland overgrowth.
E)
coli.
9.
.c
A)
om
8.
The most important factor in the evaluation and treatment of benign prostatic hypertrophy (BPH) is
considered to be:
nk
7.
frequency of erectile dysfunction.
B)
testosterone level management.
C)
prostate cancer prevention measures.
D)
subjective symptoms reported by the patient.
ba
Cryptorchidism, or undescended testes, is a direct cause of:
infertility.
B)
paraphimosis.
C)
prostate cancer.
D)
st
A)
.te
10.
nk
ta
A)
low testosterone.
11.
Release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH)
w
C)
Musculoskeletal growth
w
B)
Protein catabolism
w
A)
Which of the following physiologic processes results from the synthesis and release of testosterone?
D)
12.
Prostatic hyperplasia
A 41-year-old patient has undergone a vasectomy. What is the physiologic basis for this contraceptio
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 folliclestimulating 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
Which of the following factors constitutes the most significant risk for balanitis xerotica obliterans?
Multiple sexual partners
B)
Androgen deficiency
C)
Uncircumcised penis
D)
Chronic prostatitis
nk
15.
.c
A)
Which of the following disorders of the male genitourinary system creates the most urgent need for
prompt and aggressive medical treatment?
Spermatocele
B)
Benign prostatic hyperplasia (BPH)
C)
Intravaginal testicular torsion
D)
Erectile dysfunction
B)
hematocele.
C)
sterility.
.te
st
hematuria.
D)
penile atrophy.
w
After seeking care due to recent history of testicular enlargement and scrotal pain, a 22-year-old coll
student has been diagnosed with testicular cancer. Which of the patients following statements indica
the need for further teaching?
w
17.
I cant shake this feeling like Ive received a death sentence.
w
B)
ba
A 30-year-old man has been diagnosed with mumps orchitis, a disease that has the potential to resul
A)
A)
nk
ta
A)
16.
om
14.
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
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.
A)
Hypospadias
B)
Orchitis
C)
Erectile dysfunction
D
5.
B
6.
D
7.
C
8.
C
9.
D
10.
A
11.
B
12.
D
A
w
13.
nk
4.
nk
ta
B
ba
3.
st
B
w
2.
Spermatocele
.te
D)
Answer Key
1.
C
om
Which of the following diagnoses is most likely to require surgical correction?
.c
20.
C
w
14.
15.
C
16.
C
17.
A
18.
C
19.
C
20.
A
Chapter 44: Disorders of the Male Genitourinary System
MULTIPLE CHOICE
1.The nurse is instructing a client diagnosed with acute prostatitis. Which of the following
instructions would be the least beneficial to the client?
Avoid alcohol and caffeine.
2.
Sex should be avoided during the acute phase.
3.
Sit for as long as you can.
4.
Sitz baths may provide comfort.
.c
om
1.
nk
ANS: 3
The patient should be encouraged to use sitz baths for comfort but not to sit in them for long
periods of time. Caffeine, alcohol, and sex should be avoided during the acute phase.
nk
ta
PTS: 1 DIF: Apply REF: Prostatitis: Patient and Family Teaching
2.The nurse is documenting the health history of a client diagnosed with benign prostatic
hyperplasia (BPH). In which of the following areas would the nurse take a careful history?
Bowel patterns
2.
Eating patterns
.te
st
ba
1.
3.
Sleeping patterns
Urinary patterns
w
w
4.
ANS: 4
w
A careful history on urinary patterns should be taken by the nurse. The ease with which the
stream of urine is started, the strength of the stream, and the perceived amount of urine
eliminated with each voiding, along with the patients sense about whether the bladder is
completely emptied and the presence of nocturia or dribbling, should be noted. The clients
bowel, eating, and sleeping patterns are also important; however, they are not as important as the
urinary patterns.
PTS:1DIF:Apply
REF: Benign Prostatic Hyperplasia: Assessment with Clinical Manifestations
3.A client, diagnosed with benign prostatic hyperplasia (BPH), should be instructed to do which
of the following?
Do nothing since this disorder does not require any follow-up.
2.
Decrease water intake to avoid dribbling.
3.
Void every 2 to 3 hours.
4.
Wear scrotal support.
.c
om
1.
ANS: 3
nk
ta
nk
Clients with BPH should void every 2 to 3 hours to flush the urinary tract. Water should not be
decreased because this will irritate the urinary mucosa. Scrotal support is not necessary, and BPH
does require follow-up visits.
PTS:1DIF:Apply
REF:Benign Prostatic Hyperplasia: Patient and Family Teaching
st
ba
4.A client, recovering from a transurethral resection of the prostate (TURP) with a continuous
bladder irrigation system to a three-way indwelling urinary catheter, tells the nurse he has to
void. What nursing intervention should the nurse perform?
Call the physician.
.te
1.
Increase the flow of the irrigant.
w
2.
Tell the client to void.
w
4.
Irrigate the catheter.
w
3.
ANS: 3
After a TURP, clots that can occlude the catheter and create a sensation to void in the client are
common. The nurse should irrigate the catheter to allow the urine to flow. The nurse does not
need to phone the physician, increase the flow of the irrigant, or tell the client to void.
PTS: 1 DIF: Apply REF: Benign Prostatic Hyperplasia: Surgery
5.A client who is 12 hours postoperative after a transurethral resection of the prostate (TURP) is
concerned about the blood clots in the catheter and urinary collection bag. How should the nurse
respond?
I need to call your physician.
2.
I will need to stop the bladder irrigation.
3.
Blood clots are common during this time frame and will start to decrease in a day.
4.
You need to stop moving and irritating the catheter.
.c
om
1.
nk
ANS: 3
nk
ta
Blood clots are common during the first 36 hours following a TURP. The irrigant should not be
stopped because it is flushing the clots out of the urinary system. A large amount of bright red
blood would be an indication of hemorrhage. The nurse does not need to call the physician.
PTS: 1 DIF: Apply REF: Benign Prostatic Hyperplasia: Surgery
ba
6.A client is being screened for prostate cancer. What tests would be completed at this time?
Digital rectal examination and transrectal ultrasonography
2.
Biopsy of the prostate and magnetic resonance imagery
3.
Complete blood cell count and prostate-specific antigen
w
.te
st
1.
Prostate-specific antigen (PSA) and digital rectal examination
w
4.
w
ANS: 4
Early screening for prostate cancer includes a digital rectal examination and a PSA test. Other
tests may be ordered later if either the PSA or digital rectal examination are abnormal.
PTS:1DIF:Analyze
REFrostate Cancer: Assessment with Clinical Manifestations
7.The nurse is instructing a client about testicular self-examination (TSE). Which of the
following would not be included in these instructions?
The testis should feel smooth and egg-shaped.
2.
Perform TSE after a bath or shower.
3.
TSE should be performed monthly by every male older than age 40.
4.
Any lumps and changes in the testicles should be reported.
om
1.
ANS: 3
nk
.c
The highest risk group for testicular cancer is young men 15 to 35 years of age. TSE should be
taught and performed monthly from the teenage years. The other choices are appropriate for the
nurse to instruct the client.
PTS: 1 DIF: Apply REF: Testicular Cancer: Planning and Implementation
nk
ta
8.A male client is diagnosed with orchitis. The nurse should assess the client for which of the
following?
Recent infection with mumps
2.
Recent diagnosis of prostatitis
3.
History of type 2 diabetes mellitus
.te
st
ba
1.
Diagnosis of renal insufficiency
ANS: 1
w
4.
w
w
Mumps is the most common viral cause of orchitis, with the orchitis occurring 4 to 7 days after
the onset of mumps. Orchitis is not associated with prostatitis, type 2 diabetes mellitus, or renal
insufficiency.
PTS: 1 DIF: Apply REF: Orchitis
9.A client is diagnosed with a spermatocele. The nurse should instruct the client on which of the
following?
1.
The use of heat to reduce the size of the inflamed area
2.
The potential need for surgery to correct the disorder
3.
The use of ice packs to reduce the size of the inflamed area
4.
The importance of using antibiotics to treat the disorder
om
ANS: 2
.c
Spermatoceles may become significantly uncomfortable and require treatment. Surgical
correction may be done if infertility is associated with the spermatocele. Surgical removal of the
spermatocele is performed under local anesthesia. Heat, ice, and antibiotics are not the first line
treatments for the disorder.
nk
PTS:1DIF:Apply
REF: Hydrocele, Hematocele, and Spermatocele: Surgery
nk
ta
10.A client is diagnosed with a varicocele. The nurse realizes that this client is likely to develop:
hydrocele.
2.
prostate cancer.
ba
1.
prostatitis.
st
3.
infertility.
w
ANS: 4
.te
4.
w
w
Infertility or subinfertility often occurs in conjunction with varicocele because the increased
blood flow in the varicocele raises the scrotal temperature about 93.2F, which is the ideal
temperature for spermatogenesis. The client is not likely to develop a hydrocele, prostate cancer,
or prostatitis from a varicocele.
PTS: 1 DIF: Analyze REF: Varicocele: Pathophysiology
11.A newborn male child is diagnosed with cryptorchidism. The nurse should prepare to
administer which of the following to this client?
1.
Intravenous fluids
2.
Antipyretic medication
3.
Human chorionic gonadotropin medication
4.
Antibiotics
om
ANS: 3
.c
Human chorionic gonadotropin may be given intramuscularly to promote bilateral testicular
descent. This medication is provided 2 to 3 times a week for up to 6 weeks. Intravenous fluids,
antipyretics, or antibiotics are not indicated in the treatment of this disorder.
PTS: 1 DIF: Apply REF: Cryptorchidism: Planning and Implementation
nk
ta
nk
12.A client is experiencing priapism. Which of the following should the nurse do first to help the
client?
Apply ice packs to the perineum.
2.
Prepare for emergency surgery.
3.
Prepare for an aspiration of blood from the penis.
4.
Apply heat to the perineum.
.te
st
ba
1.
ANS: 1
w
w
w
The goal of treating priapism is to resolve the condition before permanent damage occurs that
leaves the client unable to achieve an erection in the future. Ice packs to the perineum will
resolve some cases of the disorder. This is what the nurse should do first. The client does not
need emergency surgery. The client may need blood aspirated from the penis. Heat should not be
applied to the perineum.
PTS: 1 DIF: Apply REF: Priapism: Planning and Implementation
MULTIPLE RESPONSE
1.A client is diagnosed with testicular torsion. Which of the following might be indicated for this
client? (Select all that apply.)
1.
Manually untwist the testicle
Orchiopexy
3.
Testicle removal
4.
Pain management
5.
Application of ice and a scrotal support
6.
Prescribe medication
.c
om
2.
ANS: 1, 2, 3, 4, 5
nk
ta
nk
The goal of the treatment for testicular torsion is to untwist the spermatic cord and reestablish
normal blood flow to the testicle. The testicle may be manually untwisted to promote blood flow.
If this is unsuccessful, the client may need an orchiopexy or a surgical procedure to untwist the
testicle. If surgical treatment occurs within 6 hours of the onset of pain, the testicle is salvaged. If
treatment is delayed for 12 hours or more, the testicle will begin to necrose and will need to be
removed. Pain medication is needed for this disorder. Ice and a scrotal support are used for this
disorder. No medications alone will cure this disorder.
ba
PTS: 1 DIF: Apply REF: Testicular Torsion: Planning and Implementation
st
2.A client is diagnosed with epididymitis. The nurse should instruct the client on which of the
following as treatment for the disorder? (Select all that apply.)
Broad spectrum antibiotics
.te
1.
w
w
3.
NSAIDs
w
2.
Bed rest
4.
Elevate the scrotum
5.
Apply cold packs
6.
Apply heat
ANS: 1, 2, 3, 4, 5
Treatment for epididymitis includes broad spectrum antibiotics, NSAIDs, bed rest, elevation of
the scrotum, and application of cold packs. Heat is not recommended as treatment for this
disorder.
PTS: 1 DIF: Apply REF: Epididymitis
3.Which of the following should the nurse instruct a client who is recovering from a vasectomy?
(Select all that apply.)
Use ice packs to control postoperative bleeding.
2.
Wear cotton jockey type briefs for scrotal support.
3.
Use warm sitz baths to aid in comfort.
4.
Recognize the signs and symptoms of postoperative infection.
5.
A vasectomy protects the client from sexually transmitted illnesses.
6.
Ejaculate will be reduced after the procedure.
ba
nk
ta
nk
.c
om
1.
ANS: 1, 2, 3, 4
.te
st
The client recovering from a vasectomy should be instructed to use ice packs to control
postoperative bleeding, wear cotton jockey type briefs for scrotal support, use warm sitz baths to
aid in comfort, and recognize the signs and symptoms of postoperative infection. A vasectomy
does not protect the client from sexually transmitted illnesses. Ejaculate will not be reduced after
the procedure.
w
PTS: 1 DIF: Apply REF: Vasectomy: Patient and Family Teaching
w
w
4.The nurse is assessing a client diagnosed with balanitis and posthitis. Which of the following
will the nurse most likely assess in this client? (Select all that apply.)
1.
Penile discharge
2.
Hematuria
3.
Pain
4.
Erythema
5.
Flank pain
6.
Edema
om
ANS: 1, 3, 4, 6
The typical manifestations for balanitis and posthitis include penile discharge, pain, erythema,
and edema. Hematuria and flank pain are not associated with this disorder.
.c
PTS:1DIF:Apply
nk
REF:Balanitis and Posthitis: Assessment with Clinical Manifestations
nk
ta
5.The nurse is assessing a client who is experiencing erectile dysfunction. For which of the
following should the nurse assess the client? (Select all that apply.)
Diagnosis of diabetes mellitus
2.
Thyroid disease
3.
Chronic renal failure
4.
Multiple sclerosis
.te
st
ba
1.
Gastroesophageal reflux disease
w
6.
Parkinsons disease
w
5.
w
ANS: 1, 2, 3, 4, 5
Erectile dysfunction has been associated with diabetes mellitus, thyroid disease, chronic renal
failure, multiple sclerosis, and Parkinsons disease. Erectile dysfunction has not been associated
with gastroesophageal reflux disease.
Chapter 45: Structure and Function of the Female Reproductive System
MULTIPLE CHOICE
dysmenorrhea.
2.
menorrhagia.
3.
metrorrhagia.
4.
polymenorrhea.
.c
1.
om
1.A client tells the nurse that she experiences heavy menstrual bleeding. The nurse would
document this condition as being:
ANS: 2
nk
ta
nk
Menorrhagia is heavy menstrual bleeding. Metrorrhagia is bleeding between menses.
Dysmenorrhea is pain during the menstrual cycle, and polymenorrhea is having menstrual cycles
at 2- to 3-week intervals.
PTS: 1 DIF: Apply REF: Dysmenorrhea; Dysfunctional Uterine Bleeding
1.
dysmenorrhea.
2.
st
ba
2.A client tells the nurse that she has not had menstrual cycles for 2 months since she has been
training for a marathon. The nurse would document this clients lack of regular menstrual cycles
as being:
.te
primary amenorrhea.
w
4.
oligomenorrhea.
w
3.
secondary amenorrhea.
w
ANS: 4
Secondary amenorrhea is when a woman has normal menstrual cycles but then stops.
Dysmenorrhea is pain during the menstrual cycle, and oligomenorrhea is the absence of
menstrual cycles for 3 months or longer. Primary amenorrhea is the lack of a menstrual cycle by
age 16.
PTS: 1 DIF: Apply REF: Amenorrhea
3.The nurse is documenting that a female client is menopausal because the client has not had a
menstrual cycle in:
6 months.
2.
9 months.
3.
12 months.
4.
15 months.
om
1.
ANS: 3
.c
Women are considered menopausal if they have not had a menstrual cycle for 12 months. A
perimenopausal state may exist prior to actual menopause.
nk
PTS: 1 DIF: Apply REF: Menopause
nk
ta
4.A female client is prescribed estrogen (Alora) for hot flashes associated with menopause.
Which of the following should the nurse instruct this client regarding this medication?
Hot flashes can increase.
2.
Weight gain can occur.
3.
Breast tenderness and spotting are side effects.
4.
Abdominal pain is to be expected.
w
ANS: 3
.te
st
ba
1.
w
w
The nurse should instruct the client prescribed estrogen (Alora) that side effects include breast
tenderness, nausea, depression, headache, and spotting (bleeding). Hot flashes do not increase
with this medication. Weight gain is not a documented side effect of this medication. Abdominal
pain is not an expected side effect of this medication.
PTS:1DIF:Apply
REF:Table 62-1 Medications Used to Treat Menstrual Disorders
5.The nurse is caring for a female client recovering from surgery to remove the uterus, cervix,
ovaries, and fallopian tubes using a traditional approach. The nurse realizes this client has had a:
1.
complete hysterectomy.
2.
laparoscopically assisted vaginal hysterectomy.
3.
partial hysterectomy.
4.
total abdominal hysterectomy and bilateral salpingo-oophorectomy.
om
ANS: 4
.c
Removal of the uterus, ovaries, and fallopian tubes through an abdominal incision is called a
total abdominal hysterectomy and bilateral salpingo-oophorectomy. A hysterectomy performed
vaginally via laparoscope is a laparoscopically assisted vaginal hysterectomy. A partial
hysterectomy removes the body of the uterus without the cervix, and a complete hysterectomy is
the removal of the entire uterus.
nk
PTS:1DIF:Analyze
nk
ta
REF: Dysfunctional Uterine Bleeding: Planning and Implementation: Surgery
6.A female client, experiencing vulvar itching and discomfort, is diagnosed with Candida. What
would the nurse expect to find when assessing this client?
Foul, fishy odor
2.
Gray, thin, watery discharge
3.
Thick, white discharge
.te
st
ba
1.
Yellow, green discharge
w
ANS: 3
w
4.
w
Candida typically produces a thick, white discharge. Bacterial vaginosis causes a white or gray,
thin, watery discharge and an odor. Trichomoniasis has a frothy, green/yellow/white discharge.
PTS:1DIF:ApplyREF:Infections: Vaginitis
7.A female client who has been menstruating has a temperature of 103.5F, blood pressure 88/56
mmHg, and a diffuse rash. The nurse realizes that this client is most likely experiencing:
1.
pelvic inflammatory disease.
2.
herpes simplex virus.
3.
human papillomavirus.
4.
toxic shock syndrome.
ANS: 4
om
Toxic shock syndrome is an acute illness associated with menstruation and tampon use.
Symptoms include a high fever, a diffuse rash, falling blood pressure, nausea, vomiting, diarrhea,
myalgia, disorientation, and coma. Herpes simplex virus usually results in a genital sore or ulcer.
The human papillomavirus is associated with genital warts. Pelvic inflammatory disease is an
inflammatory condition of the female pelvic organs.
.c
PTS: 1 DIF: Analyze REF: Toxic Shock Syndrome
nk
8.The nurse is teaching a group of young adults about prevention of sexually transmitted
infections (STIs). Which of the following instructions would not be included during teaching?
Abstinence is the only way to completely prevent STIs.
2.
Condoms provide some protection against STIs.
3.
Make sure you and your partner finish the entire treatment regimen.
4.
Once one STI is diagnosed, you are less likely to have an infection with another STI.
st
ba
nk
ta
1.
.te
ANS: 4
w
w
Once one STI is diagnosed, an individual is more likely to have an infection with another STI.
The person should be tested for all STIs. The other choices would be appropriate for the nurse to
instruct regarding STIs.
PTS:1DIF:Apply
w
REF: Sexually Transmitted Infection: Planning and Implementation: Population-Based Care
9.A 52-year-old female client had been treated for human papillomavirus. After 3 years of
testing, the clients Pap smears are normal. The nurse realizes that the clients next Pap smear
should be in:
1.
2 years
2.
3 years
3.
5 years
4.
10 years
ANS: 2
om
If the client is between the ages of 30 to 70 and has three normal Pap smear results, the client
does not need to have another Pap smear for 3 years. If the client is between the ages of 21 to 30
and has normal Pap smear results, the client needs another Pap smear in 2 years. If the client is
over the age of 70 and the last three Pap smear results were normal, within 10 years, the Pap
smears can be discontinued.
.c
PTS: 1 DIF: Analyze REF: Table 62-3 Changes in Pap Smear Guidelines
nk
10.A female client has had a type 1 female circumcision. The nurse realizes that which of the
following has been surgically removed on the client?
Clitoris
2.
Clitoris and labia minora
3.
Clitoris, labia minora, inner surface of labia majora, and suturing of the vagina
4.
Clitoris and uterus
st
ba
nk
ta
1.
.te
ANS: 1
w
w
Type 1 female circumcision is the removal of the clitoris. Type II includes the removal of the
clitoris and labia minora. Type III is the removal of the clitoris, labia minora, inner surface of the
labia majora, and suturing of the labia majora together to cover the urethra and vagina. There is
not a type that is the removal of the clitoris and uterus.
w
PTS:1DIF:AnalyzeREF:Female Circumcision
11.The nurse determines that a female client is at risk for developing a gynecological malignancy
because which of the following is assessed?
1.
Alcohol intake of one drink every week
2.
Currently overweight
3.
Smoking history
4.
History of constipation
ANS: 3
om
Smoking increases the female clients risk of developing gynecological malignancies. Alcohol
intake, being overweight, and having a history of constipation do not increase a clients risk of
developing the disorder.
PTS:1DIF:AnalyzeREF:Malignancies
nk
.c
12.A female client diagnosed with infertility is prescribed medication. The nurse would provide
instruction regarding which of the following medications?
Viagra
2.
Delatestryl
3.
Testim
4.
Clomiphene citrate
st
ba
nk
ta
1.
ANS: 4
w
.te
Clomiphene citrate is used to induce ovulation. When used, most pregnancies occur within the
first 3 cycles of use and almost all pregnancies occur within 6 months of use. The other
medications are used to treat sexual dysfunction and not infertility.
PTS: 1 DIF: Apply REF: Infertility: Pharmacology
w
MULTIPLE RESPONSE
w
1.A female client is diagnosed with premenstrual dysphoric disorder. Which of the following
will the nurse most likely assess in this client? (Select all that apply.)
1.
Feeling sad or hopeless
2.
Feeling anxious
3.
Mood swings
4.
Increased sleep
5.
Anger
6.
Thirst
om
ANS: 1, 2, 3, 4, 5
.c
To diagnose premenstrual dysphoric disorder, five or more symptoms must be present most of
the time during the last week of the menstrual luteal phase: feeling sad or hopeless; feeling
anxious; mood swings; increased sleep; and anger. Thirst is not a symptom of this disorder.
PTS:1DIF:Apply
nk
REFremenstrual Syndrome and Premenstrual Dysphoric Disorder
nk
ta
2.A female client, diagnosed with pelvic inflammatory disease, is being considered for inpatient
treatment. Which of the following would indicate that the client should be admitted to the
hospital for care of this disorder? (Select all that apply.)
The client is pregnant.
2.
The client will not adhere to the prescribed antibiotic therapy.
3.
The clients temperature is 103 degreesF.
4.
The client is experiencing symptoms of a tubo-ovarian abscess.
st
.te
w
The client has purulent cervical discharge.
w
6.
The clients blood pressure is 120/80 mmHg.
w
5.
ba
1.
ANS: 1, 2, 3, 4
Criteria for admission to treat pelvic inflammatory disease includes pregnancy, inability to
comply with outpatient therapy, failure of outpatient therapy, temperature greater than 102.2F,
and suspected tubo-ovarian abscess. Blood pressure and purulent cervical discharge are not
criteria for admission to treat pelvic inflammatory disease.
PTS: 1 DIF: Analyze REF: Box 62-1 Criteria for Inpatient Treatment of PID
HPV
3.
HIV
4.
Chlamydia
5.
Gonorrhea
6.
Syphilis
.c
2.
nk
Bacteria vaginitis
nk
ta
1.
om
3.A client is diagnosed with a sexually transmitted infection that the nurse needs to report to the
local health department. Which of the following sexually transmitted infections need to be
reported by the nurse? (Select all that apply.)
ANS: 3, 4, 5, 6
ba
Syphilis, gonorrhea, chlamydia, and HIV are infections that need to be reported to the local
health department in every state. Bacteria vaginitis and HPV do not need to be reported to the
local health department.
st
PTS: 1 DIF: Apply REF: Health Care Resources
.te
4.A female client is diagnosed with a cystocele. The nurse should prepare to instruct the client on
which of the following? (Select all that apply.)
w
w
2.
Kegel exercises
w
1.
Pessary insertion
3.
Use of estrogen cream
4.
Operative repair
5.
Hysterectomy
6.
Antibiotics
ANS: 1, 2, 3
Treatment of a cystocele includes Kegels exercises, insertion of a pessary, and use of estrogen
cream. Operative repair, hysterectomy, and antibiotics are not treatments associated with this
disorder.
PTS:1DIF:ApplyREFelvic Relaxation
Abnormal bleeding not responsive to other therapy
2.
Weight gain of 10 lbs over the last 3 months
3.
Growth of fibroids after menopause
4.
Chronic constipation
5.
Client unable to conceive
6.
Diagnosed with iron deficiency anemia
ba
nk
ta
nk
.c
1.
om
5.A client is diagnosed with uterine fibroids. Which of the following would indicate that surgery
is needed for this client? (Select all that apply.)
st
ANS: 1, 3, 5, 6
w
.te
Indications for surgical management of fibroids include abnormal bleeding that is not responding
to medical therapy, growth of fibroids after menopause, infertility, and iron deficiency anemia.
Weight gain and chronic constipation are not indications for surgery to remove uterine fibroids.
w
Chapter 46: Disorders of the Female Reproductive System
Acute cervicitis is an inflammation of the cervix characterized by:
w
1.
A)
abscess formation.
B)
mucopurulent drainage.
C)
thick gray-white plaques.
D)
persistent pruritic vulvitis.
2.
A)
Carcinoma of the cervix is often considered to be a sexually transmitted disease associated with_____
viral infection.
Chlamydia trachomatis
B)
herpes simplex
C)
human papilloma
D)
varicella zoster
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.
pelvic adhesions.
B)
endometrial cancer.
C)
candidiasis vaginitis.
D)
bladder herniation.
5.
nk
A)
.c
Endometriosis is characterized by painful hemorrhagic lesions in the pelvis and complications that
include:
nk
ta
4.
om
3.
Leiomyomas are smooth muscle fibroid tumors that usually develop in:
fibrocystic breasts.
B)
postmenopause.
C)
uterosacral ligaments.
D)
the corpus of the uterus.
ba
A)
Symptoms of difficulty in emptying the bladder, frequency, and urgency of urination are common in
women with:
st
6.
rectocele.
.te
A)
B)
cystocele.
endometritis.
w
C)
prolapsed uterus.
w
D)
w
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.
A)
Polycystic ovary syndrome (PCOS) is ovarian dysfunction caused by a combination of hormone
imbalances that include______ levels.
absent FSH
B)
insulin deficit
C)
elevated LH
D)
low androgen
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.
late menopause.
B)
leiomyoma tumors.
C)
STDs and vaginitis.
D)
multiple pregnancies.
11.
nk
A)
.c
Women are screened regularly for risk factors and manifestations of breast cancer. High-risk women
may have a history of:
nk
ta
10.
om
9.
Which of the following signs and symptoms is most likely to accompany a diagnosis of vulvodynia?
Vulvar pain
B)
Purulent discharge
C)
Urinary incontinence
D)
Open lesions on the surface of the vulva
ba
A)
st
.te
12.
A 21-year-old college student has sought care because of the vaginal burning, itching, and redness th
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?
Have you ever had a sexually transmitted infection?
w
B)
Have you ever been pregnant?
A 29-year-old patient had a Papanicolaou smear performed during her most recent visit to her prima
care provider. This diagnostic procedure aims to identify:
w
D)
Are you using oral contraceptives?
w
C)
13.
A)
dysplastic cervical cells.
B)
human papillomavirus (HPV) antibodies.
C)
cervical polyps.
D)
lesions at the transformation zone.
14.
A)
Which of the following physiologic processes is caused by estrogens?
Increased release of gonadotropin-releasing hormone (GnRH)
B)
Stimulation of lactation in the postpartum period
C)
Promotion of ovarian follicle growth
D)
Progesterone synthesis
Which of the following disorders of the female genitourinary system is most likely to result from a
disruption in normal endocrine function?
A)
Ovarian cancer
B)
Pelvic inflammatory disease (PID)
C)
Polycystic ovary syndrome (PCOS)
D)
Cervicitis
Which of the following complaints by middle-aged women should prompt a care provider to rule ou
the possibility of ovarian cancer?
.c
16.
om
15.
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.
nk
ta
nk
A)
A nurse is conducting a healthy living workshop to a group of younger women. Which of the follow
screening recommendations should the nurse provide to the participants?
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
st
ba
A)
Which of the following processes is a component of the pathogenesis of proliferative breast lesions
without atypia?
.te
18.
A)
Growth of ductile or lobular epithelial cells
Fat necrosis leading to lesion formation
w
D)
Increase in fibrous breast tissue
w
C)
Cystic dilation of terminal ducts
w
B)
19.
Which of the following physiologic changes results in menopause?
A)
Changes in anterior pituitary function that alter ovarian hormone production
B)
Gradual resistance of ovarian target cells to LH and FSH stimulation
C)
Cessation of ovarian function and decreased estrogen levels
D)
Decreased levels of gonadotropin-releasing hormone (GnRH)
20.
A 59-year-old woman with a recent diagnosis of breast cancer has begun a course of hormone therap
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
6.
B
7.
A
8.
C
9.
D
10.
A
11.
A
12.
B
13.
A
14.
C
15.
C
16.
D
17.
D
18.
A
19.
C
D
w
20.
om
5.
.c
A
nk
4.
nk
ta
C
ba
3.
st
C
w
2.
Blocking receptors on the surface of malignant cells
.te
D)
Answer Key
1.
B
w
Chapter 47: Sexually Transmitted Infections
1.
Human papillomavirus (HPV) infection is directly associated with:
A)
testicular cancer.
B)
cervical dysplasia.
C)
genital herpes lesions.
D)
urinary tract infections.
2.
The vaginal discharge characteristic of trichomoniasis is described as:
A)
thick cheesy.
B)
frothy green.
C)
fishy smelling.
D)
mucopurulent.
A)
candidiasis.
B)
gonorrhea.
C)
chancroid.
D)
trichomoniasis.
.c
A sexually transmitted infection that is caused by a microorganism with two morphologically distinct
forms is:
nk
4.
om
3.
In men, urethral pain and a creamy yellow, bloody discharge from the penis is characteristic of the
sexually transmitted infection:
chancroid.
B)
candidiasis.
C)
Trichomonas vaginalis.
D)
Chlamydia.
5.
nk
ta
A)
Gonorrhea is caused by Neisseria gonorrhoeae, a gram-negative diplococcus, and is characterized by
purulent exudates.
B)
painful small vesicles.
C)
cauliflower-shaped lesions.
D)
persistent perianal itching.
Symptomatic tertiary syphilis is characterized by:
.te
6.
st
ba
A)
A)
necrotic gummas.
chancre papules.
w
B)
maculopapular rash.
As with other ulcerative sexually transmitted infections (STIs), genital herpes (herpes simplex virus ty
2, HSV-2) increases the risk of:
w
D)
condylomata lata.
w
C)
7.
A)
cervical cancer.
B)
HIV transmission.
C)
localized necrosis.
D)
urinary tract infection.
8.
A)
While in its dormant state, herpes simplex virus resides and replicates in the:
local lymph nodes.
B)
subcutaneous tissue.
C)
mucous membrane.
D)
dorsal root ganglia.
A serious complication of chlamydial infections in women is:
A)
uterine cancer.
B)
fallopian tube damage.
C)
amenorrhea.
D)
nongonococcal urethritis.
A)
candidiasis.
B)
trichomoniasis.
C)
vulvovaginitis.
D)
bacterial vaginosis.
Which of the following phenomena is thought to underlie the decreased reported incidence of some
STIs?
nk
ta
11.
.c
The most likely vaginal infection to be spread through sexual contact is:
nk
10.
om
9.
Increased knowledge of the correct use of condoms
B)
Increased public funding for health promotion activities
C)
Decreased reporting of cases of certain STIs
D)
Decreased numbers of sexual partners among young adults
ba
A)
A 22-year-old patient has presented to her primary care provider for her scheduled Pap smear.
Abnormal results of this diagnostic test may imply infection with:
st
12.
human papillomavirus (HPV).
.te
A)
B)
Chlamydia trachomatis.
Candida albicans.
w
C)
Trichomonas vaginalis.
w
D)
w
A female college student is distressed at the recent appearance of genital warts, an assessment findin
that her care provider has confirmed as attributable to human papillomavirus (HPV) infection. Whic
the following information should the care provider give the patient?
13.
A)
There is a chance that these will clear up on their own without any treatment.
B)
Its important to start treatment soon, so I will prescribe you pills today.
C)
Unfortunately, this is going to greatly increase your chance of developing pelvic inflammatory
disease.
D)
Id like to give you an HPV vaccination if thats okay with you.
14.
Which of the following processes occurs in the pathophysiology of infection by herpes simplex viru
(HSV)?
A)
Replication of the squamous epithelium
B)
Periods of latency in the nervous system
C)
Inhibition of cell-mediated immunity
D)
Production of exotoxins
15.
Which of the following signs and symptoms is most clearly suggestive of primary genital herpes in a
male patient?
Presence of purulent, whitish discharge from the penis
B)
Emergence of hard, painless nodules on the shaft of the penis
C)
Itching, pain, and the emergence of pustules on the penis
D)
Production of cloudy, foul-smelling urine
.c
Which of the following STIs is most likely to respond to treatment with the antibiotics tetracycline o
doxycycline?
nk
16.
om
A)
Human papillomavirus (HPV) infection
B)
Herpes simplex virus type 2 (HSV-2) infection
C)
Candidiasis
D)
Lymphogranuloma venereum (LGV)
Which of the following assessment questions is most likely to address the causation of a womans ne
case of candidiasis?
ba
17.
nk
ta
A)
Have you recently begun a new sexual relationship?
B)
Have you been on antibiotics recently?
C)
Have you noticed any new growths on your vagina in recent months?
D)
Do you use condoms during sexual activity?
18.
.te
st
A)
Infected men may harbor ___________ but they are always asymptomatic.
Trichomonas vaginalis
w
A)
C)
Neisseria gonorrhoeae.
w
D)
Chlamydia trachomatis
w
B)
19.
Treponema pallidum
Which of the following events is associated with the primary stage of syphilis?
A)
Development of gummas
B)
Development of central nervous system lesions
C)
Palmar rash
D)
Genital chancres
20.
Which of the following sexually transmitted infections (STIs) is associated with an increased risk of
infertility in women due to asymptomatic infection?
A)
Chlamydial infection
B)
Herpes simplex virus
C)
Gonorrhea
A
6.
A
7.
B
8.
D
9.
B
10.
B
11.
C
12.
A
13.
A
14.
B
15.
C
16.
D
17.
B
18.
A
19.
D
A
w
20.
om
5.
.c
D
nk
4.
nk
ta
B
ba
3.
st
B
w
2.
Syphilis
.te
D)
Answer Key
1.
B
w
Chapter 48: Organization and Control of Neural Function
1.
The somatic nervous system provides sensory and motor innervation for:
A)
peripheral nerves.
B)
abdominal viscera.
C)
secretory glands.
D)
smooth muscle.
A)
in the cell body
B)
by Nissl bodies
C)
through dendrites
D)
across synapses
Supporting cells of the nervous system, such as Schwann cells, satellite cells, and types of glial cells,
function to provide neurons with:
local protection.
B)
control functions.
C)
membrane permeability.
D)
integrative metabolism.
Neurons are characterized by the ability to communicate with other neurons and body cells through:
A)
astrocytes.
B)
axon hillocks.
C)
nodes of Ranvier.
D)
action potentials.
Chemical synapses rely on ____ in order to provide communication between neurons.
ba
5.
diffusion
B)
gap junctions
C)
satellite cells
D)
transmitter molecules
oxygen.
protein.
w
w
A)
C)
The blood-brain and CSF-brain barriers control the chemical environment of the brain by allowing ea
entrance to only a few chemicals that include:
w
6.
.te
st
A)
B)
nk
ta
4.
nk
A)
om
3.
.c
2.
The proteins and other materials used by the axon are synthesized _____ and then flow down the axon
through its cytoplasm.
D)
7.
glutamate.
potassium.
The perception of where a stimulus is in space and in relation to body parts is a function of the:
A)
occipital lobe.
B)
parietal lobe.
C)
hypothalamus.
D)
prefrontal cortex.
8.
The pia mater is a connective tissue sheath that covers the spinal cord and also contains:
A)
spinal fluid.
B)
fibrocartilage.
C)
blood vessels.
D)
segmental nerves.
A)
Enkephalin
B)
Glutamic acid
C)
Catecholamines
D)
Acetylcholine
.c
In contrast to the sympathetic nervous system, the functions of the parasympathetic nervous system
include:
A)
sweating.
B)
anabolism.
C)
pupil dilation.
D)
vasoconstriction.
11.
Which of the following substances provides the majority of the fuel needs of the neurologic system?
Glycogen
B)
Glucose
C)
Amino acids
D)
Triglycerides
st
A 60-year-old woman has been recently diagnosed with multiple sclerosis, a disease in which the
oligodendrocytes of the patients central nervous system (CNS) are progressively destroyed. Which
physiologic process within the neurologic system is most likely be affected by this disease process?
.te
12.
Oxygen metabolism
w
A)
Neurotransmitter synthesis
Nerve conduction
w
w
B)
D)
ba
A)
C)
nk
10.
om
Which of the following is the neurotransmitter for most postganglion sympathetic neurons?
nk
ta
9.
13.
Production of cerebrospinal fluid
A neuron has been hyperpolarized. How will this affect the excitability of the neuron?
A)
The neuron will have a membrane potential farther from the threshold.
B)
The neuron will be more difficult to repolarize after firing.
C)
The membrane potential of the neuron will be closer to the threshold.
D)
The neurons excitability will be significantly increased.
A)
malformation of the mesoderm.
B)
abnormal closure of the neural tube.
C)
lesions in the dorsal root ganglia.
D)
hypertrophy of the primary vesicles.
15.
Which of the following messages is most likely to be carried by general somatic afferent (GSA)
neurons?
om
14.
A pregnant womans most recent ultrasound is suggestive of spina bifida, and her primary care provi
has subsequently order further diagnostic testing. The pathophysiologic effects of this disease are du
to:
The sensation of cold when touching ice
B)
The message to move a finger and thumb
C)
The message to move the larynx during speech
D)
Information about the position of a joint
nk
16.
.c
A)
Which of the following processes is most likely to occur as a result of a spinal reflex?
Peristalsis of the small and large bowel
B)
Control of oculomotor function in changing light levels
C)
Pain sensation from a potentially damaging knee movement
D)
Withdrawal of a hand from a hot stove element
A patient has required mechanical ventilation following a traumatic head injury sustained in a
motorcycle crash, during which he sustained damage to his respiratory center. Which of the patients
brain structures has been injured?
st
17.
ba
nk
ta
A)
Brain stem
B)
Midbrain
.te
A)
C)
Diencephalon
Frontal lobe
w
D)
w
18.
w
A)
A patient with a diagnosis of epilepsy has required surgical removal of part of her prefrontal cortex.
Which of the following effects should her family and care team anticipate?
Lapses in balance and coordination
B)
Deficits in regulation of the endocrine system
C)
Sensory losses
D)
Changes in behavior and judgment
19.
A patients primary care provider has prescribed a b-adrenergic receptor blocker. Which of the follow
therapeutic effects do the patient and care provider likely seek?
A)
Reduction in heart rate and blood pressure
B)
Slowing of gastrointestinal motility
C)
Increase in mental acuity
D)
Decreased production of gastric acid
20.
Neurotrophic factors contribute to the maintenance of homeostasis in which of the following ways?
A)
By catalyzing the effects of neurotransmitters
B)
By increasing the sensitivity of receptors on postsynaptic cells
C)
By promoting the growth and survival of neurons
D
6.
A
7.
B
8.
C
9.
C
10.
B
11.
B
12.
C
13.
A
14.
B
15.
A
16.
D
A
w
17.
om
5.
.c
D
nk
4.
nk
ta
A
ba
3.
st
A
w
2.
By selectively increasing or decreasing the release of neurotransmitters
.te
D)
Answer Key
1.
A
D
w
18.
19.
A
20.
C
Chapter 50: Disorders of Motor Function
MULTIPLE CHOICE
1. A neurologists explains that arousal is mediated by the:
a.
Cerebral cortex
b.
Medulla oblongata
c.
Reticular activating system
Brainstem
c.
Spinal cord
nk
b.
.c
om
d.
Cingulate gyrus
ANS: C
Arousal is mediated by the reticular activating system, which regulates aspects of attention and
information processing and maintains consciousness.
Arousal is mediated by the reticular activating system; the cerebral cortex affects movement.
Arousal is mediated by the reticular activating system; the medulla oblongata controls things
such as hiccups and vomiting.
Arousal is mediated by the reticular activating system; the cingulate gyrus plays other roles in
response.
2. A 20-year-old male suffers a severe closed head injury in a motor vehicle accident. He
remains in a vegetative state (VS) 1 month after the accident. Which of the following structures
is most likely keeping him in a vegetative state?
a.
Cerebral cortex
st
ba
nk
ta
d.
Cerebellum
ANS: B
When a person loses cerebral function, the reticular activating system and brainstem can
maintain a crude waking state known as a VS. Cognitive cerebral functions, however, cannot
occur without a functioning reticular activating system.
A VS is associated with the brainstem, not the cerebral cortex.
A VS is associated with the brainstem, not the spinal cord.
A VS is associated with the brainstem, not the cerebellum.
Structurally induced coma
w
c.
Metabolically induced coma
w
b.
.te
3. A 16-year-old male took a recreational drug that altered his level of arousal. Physical exam
revealed a negative Babinski sign, equal and reactive pupils, and roving eye movements. Which
of the following diagnosis will the nurse most likely see on the chart?
a.
Psychogenic arousal alteration
w
d.
Structural arousal alteration
ANS: B
Persons with metabolically induced coma generally retain ocular reflexes even when other signs
of brainstem damage are present.
Psychogenic arousal activation demonstrates a general psychiatric disorder.
Structurally induced coma is manifested by asymmetric responses.
Structural arousal alteration does not have drug use as its etiology.
4. The breathing pattern that reflects respirations based primarily on carbon dioxide (CO2) levels
in the blood is:
a.
Cheyne-Stokes
b.
Ataxic
c.
Central neurogenic
Thalamus
c.
Medulla oblongata
.c
b.
om
d.
Normal
ANS: A
Cheyne-Stokes respirations occur as a result of CO2 levels in the blood.
Ataxic breathing occurs as a result of dysfunction of the medullary neurons.
Central neurogenic patterns occur as a result of uncal herniation.
Normal respirations are based on the levels of oxygen (O2) in the blood.
5. A 45-year-old female presents to the emergency room (ER) reporting excessive vomiting. A
CT scan of the brain reveals a mass in the:
a.
Skull fractures
Coma
c.
Obtundation
.te
b.
st
ba
nk
ta
nk
d.
Frontal lobe
ANS: C
Vomiting is due to disruptions in the medulla oblongata.
Vomiting is due to disruptions in the medulla oblongata. Skull fractures can result in vomiting,
but would not be related to the mass.
Vomiting is due to disruptions in the medulla oblongata, not the thalamus, which controls other
things such as temperature.
Vomiting is due to disruption in the medulla oblongata, not the frontal lobe. The frontal lobe
deals with emotions.
6. A teenage boy sustains a severe closed head injury following an all-terrain vehicle (ATV)
accident. He is in a state of deep sleep that requires vigorous stimulation to elicit eye opening.
How should the nurse document this in the chart?
a.
Confusion
w
w
w
d.
Stupor
ANS: D
Stupor is a condition of deep sleep or unresponsiveness from which the person may be aroused
or caused to open eyes only by vigorous and repeated stimulation.
Confusion is the loss of the ability to think rapidly and clearly and is characterized by impaired
judgment and decision making.
Coma is a condition in which there is no verbal response to the external environment or to any
stimuli; noxious stimuli such as deep pain or suctioning do not yield motor movement.
Obtundation is a mild to moderate reduction in arousal (awakeness) with limited response to the
environment.
7. A 50-year-old male suffers a severe head injury when his motorcycle hits a tree. His breathing
becomes deep and rapid but with normal pattern. What term should the nurse use for this
condition?
a.
Gasping
b.
Ataxic breathing
c.
Apneusis
Cerebral contusions
c.
Compression of the hypothalamus
nk
b.
.c
om
d.
Central neurogenic hyperventilation
ANS: D
Central neurogenic hyperventilation is a sustained, deep, rapid, but regular, pattern (hyperpnea)
of breathing.
Gasping is a pattern of deep all-or-none breaths accompanied by a slow respiratory rate.
Ataxic breathing is completely irregular breathing that occurs with random shallow and deep
breaths and irregular pauses.
Apneusis is manifested by a prolonged inspiratory pause alternating with an end-expiratory
pause.
8. When a student asks what can cause dilated, fixed pupils, what is the nurses best response?
Dilated fixed pupils can be caused by:
a.
Brainstem hypoxia
ba
nk
ta
d.
Spinal shock
ANS: A
Dilated fixed pupils are caused by brainstem hypoxia.
Dilated fixed pupils are caused by brainstem hypoxia, not cerebral contusions.
Dilated fixed pupils are caused by brainstem hypoxia, not compression of the hypothalamus.
Dilated fixed pupils are caused by brainstem hypoxia, not spinal shock.
9. An attorney spoke to the nurses regarding brain death. Which statement indicates the nurses
understood brain death? For legal purposes, brain death is defined as:
a.
Cessation of brain function
Lack of cortical function
c.
A VS
.te
st
b.
w
w
w
d.
Death of the brainstem
ANS: A
Brain death occurs when there is cessation of function of the entire brain, including the brainstem
and cerebellum.
Brain death occurs when there is cessation of function of the entire brain; lack of cortical
function is not enough to define brain death.
A VS is complete unawareness of the self or surrounding environment and complete loss of
cognitive function.
Brain death occurs when there is cessation of function of the entire brain, including the brainstem
and cerebellum, not just the brainstem.
10. When thought content and arousal level are intact but a patient cannot communicate, the
patient has:
a.
Cerebral death
b.
Locked-in syndrome
c.
Dysphagia
b.
Seizure
c.
Inattentiveness
nk
.c
om
d.
Cerebellar motor syndrome
ANS: B
Locked-in syndrome occurs when the individual cannot communicate through speech or body
movement but is fully conscious, with intact cognitive function.
Locked-in syndrome occurs when the individual cannot communicate through speech or body
movement but is fully conscious, with intact cognitive function. In cerebral death the person is in
a coma with eyes closed.
Dysphagia is difficulty speaking
Cerebellar motor syndrome is characterized by problems with coordinated movement.
11. A 10-year-old female was brought to the ER following a sudden onset of convulsions. The
primary care provider thinks that she experienced an explosive, disorderly discharge of cerebral
neurons referred to as:
a.
Reflex
st
ba
nk
ta
d.
Brain death
ANS: B
An explosive disorderly discharge of neurons is a seizure.
A reflex is an expected response.
Inattentiveness is a form of neglect.
Brain death is a cessation of function.
12. A 30-year-old female had a seizure that started with her fingers and progressive1y spread up
her arm and then extended to her leg, with no loss of consciousness. How should the nurse chart
this?
a.
Myoclonic seizure
Tonic-clonic seizure
c.
Focal motor seizure
.te
b.
w
w
w
d.
Atonic seizure
ANS: C
A focal motor seizure involves the extremities and the patient does not experience loss of
consciousness.
A myoclonic seizure involves symmetrical movements of selected extremities.
A tonic-clonic seizure involves all body parts and loss of consciousness.
An atonic seizure is without muscle tone.
13. A 20-year-old male was at the supermarket when he fell to the ground. Bystanders reported
that he lost consciousness and his body tensed up then relaxed, then tensed and relaxed several
times. He most likely was experiencing a(n):
a.
Partial seizure
b.
Absence seizure
c.
Myoclonic seizure
b.
Agnosia
c.
Spasm
om
d.
Tonic-clonic seizure
ANS: D
A tonic-clonic seizure involves repeated contraction and relaxation.
A partial seizure involves only one body part.
An absence seizure is without movement.
A myoclonic seizure is a simple seizure with minimal jerking present.
14. When a patient has a peculiar sensation that immediately precedes a seizure, what term
should the nurse use to describe this sensation?
a.
Prodroma
Anterograde amnesia
c.
Retrograde amnesia
ba
b.
nk
ta
nk
.c
d.
Aura
ANS: D
An aura is a peculiar sensation that immediately precedes a seizure.
A prodroma is a manifestation that occurs hours preceding a seizure.
Agnosia is an inability to recognize objects.
A spasm is a jerking action.
15. A patient has memory loss of events that occurred before a head injury. What cognitive
disorder does the nurse suspect the patient is experiencing?
a.
Selective memory deficit
w
w
w
.te
st
d.
Executive memory deficit
ANS: C
Retrograde amnesia is manifested by loss of memory of past personal history memories or past
factual memories.
In selective memory deficit, the person reports inability to focus attention and has failure to
perceive objects and other stimuli.
Anterograde amnesia is a loss of the ability to form new memories.
Executive memory deficit involves the failure to stay alert and oriented to stimuli.
16. A 65-year-old male recently suffered a cerebral vascular accident. He is now unable to
recognize and identify objects by touch because of injury to the sensory cortex. How should the
nurse document this finding?
a.
Hypomimesis
b.
Agnosia
c.
Dysphasia
d.
Echolalia
ANS: B
Agnosia is the failure to recognize the form and nature of objects.
Hypomimesis is a disorder of communication.
Dysphasia is an impairment of comprehension of language.
Echolalia is the ability to repeat.
17. A 75-year-old female suffers a stroke and now has difficulty writing and production of
language. This condition is most likely caused by occlusion of the:
a.
Anterior communicating artery
b.
Posterior communicating artery
c.
Circle of Willis
Echolalia
c.
Dementia
ba
b.
nk
ta
nk
.c
om
d.
Middle cerebral artery
ANS: D
Occlusion of the left middle cerebral artery leads to the inability to find words and difficulty
writing.
Occlusion of the left middle cerebral artery, not the anterior communicating artery, leads to the
inability to find words and difficulty writing.
Occlusion of the left middle cerebral artery, not the posterior communicating artery, leads to the
inability to find words and difficulty writing.
Occlusion of the left middle cerebral artery, not the circle of Willis, leads to the inability to find
words and difficulty writing.
18. A patient with an addiction to alcohol checked into a rehabilitation center. He experiences
delirium, inability to concentrate, and is easily distracted. From which of the following is he
most likely suffering?
a.
Acute confusional state
Hyperactivity
w
b.
w
w
.te
st
d.
Dysphagia
ANS: A
Delirium and the inability to concentrate are characteristics of acute confusional state.
Echolalia is the repeating of words and phrases.
Dementia is characterized by loss of recent and remote memory.
Dysphagia is difficulty speaking.
19. A nurse thinks a patient may be experiencing dementia. Which assessment finding will most
help support this diagnosis?
a.
Violent behavior
c.
Depression
d.
Loss of recent and remote memory
ANS: D
Dementia is characterized by loss of recent and remote memory.
Dementia is characterized by loss of memory. Patients with dementia may demonstrate
aggressive behavior, but this is not its manifestation.
Dementia is characterized by loss of memory, not hyperactivity.
Dementia is characterized by loss of memory, not depression.
20. The progress notes read: the cerebellar tonsil has shifted through the foramen magnum due to
increased pressure within the posterior fossa. The nurse would identify this note as a description
of _____ herniation.
a.
Supratentorial
b.
Central
c.
Cingulated gyrus
b.
Intracranial hypotension
c.
Ventricular swelling
nk
ta
nk
.c
om
d.
Infratentorial
ANS: D
In infratentorial herniation, the cerebellar tonsil shifts through the foramen magnum because of
increased pressure within the posterior fossa.
Supratentorial herniation involves temporal lobe and hippocampal gyrus shifting from the middle
fossa to posterior fossa.
Central herniation is a type of supratentorial herniation and is the straight downward shift of the
diencephalon through the tentorial notch.
Gyrus herniation occurs when the cingulate gyrus shifts under the falx cerebri. Little is known
about its clinical manifestations.
21. The patient is experiencing an increase in intracranial pressure. This increase results in:
a.
Brain tissue hypoxia
Vasodilation
w
b.
w
w
.te
st
ba
d.
Expansion of the cranial vault
ANS: A
Brain tissue hypoxia occurs as a result of increased intracranial pressure as it places pressure on
the brain.
Increased intracranial pressure leads to intracranial hypertension.
Ventricular swelling may lead to increased intracranial pressure, but increased pressure does not
lead to ventricular swelling.
Expansion of the cranial vault may lead to increased intracranial pressure, but increased pressure
does not lead to expansion of the vault.
22. A compensatory alteration in the diameter of cerebral blood vessels in response to increased
intracranial pressure is called:
a.
Herniation
c.
Autoregulation
d.
Amyotrophy
ANS: C
Autoregulation is the compensatory alteration in the diameter of the intracranial blood vessels
designed to maintain a constant blood flow during changes in cerebral perfusion pressure.
Herniation is the downward protrusion of the brainstem.
Vasodilation is an enlargement in vessel diameter and a part of autoregulation, but the vessels
should not dilate in the presence of increased intracranial pressure.
Amyotrophy is involved with the anterior horn cells of the spinal cord and not related to
autoregulation.
23. The primary care provider states that the patient has vasogenic edema. The nurse realizes
vasogenic edema is clinically important because:
a.
It usually has an infectious cause.
b.
The blood-brain barrier is disrupted.
c.
Increased intracranial pressure (ICP) is excessively high.
b.
Decerebrate posturing
c.
Caloric posturing
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d.
It always causes herniation.
ANS: B
Vasogenic edema is clinically important because the blood-brain barrier (selective permeability
of brain capillaries) is disrupted, and plasma proteins leak into the extracellular spaces.
Vasogenic does not have an infectious cause.
ICP is increased, but not more so than other forms of edema.
Vasogenic edema disrupts the blood-brain barrier, but it does not always cause herniation.
24. A 51-year-old male is admitted to the neurological critical care unit with a severe closed head
injury. All four extremities are in rigid extension, his forearm is hyperpronated, and his legs are
in plantar extension. How should the nurse chart this condition?
a.
Decorticate posturing
Normal
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c.
Lower than normal
w
b.
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d.
Excitation posturing
ANS: B
The description is of a patient in decerebrate posturing.
The patient is in decerebrate posturing, not decorticate.
The patient is in decerebrate posturing, not caloric.
The patient is in decerebrate posturing, not excitation.
25. A 20-year-old male is admitted to the neurological critical care unit with a severe closed head
injury. When an intraventricular catheter is inserted, the ICP is recorded at 24 mm Hg. How
should the nurse interpret this reading? This reading is:
a.
Higher than normal
d.
Borderline
ANS: A
Normal ICP is 5 to 15 mm Hg; at 24 mm Hg, the patients is higher than normal.
Normal ICP is 5 to 15 mm Hg; at 24 mm Hg, the patients is higher than normal, not lower.
Normal ICP is 5 to 15 mm Hg; the patients is higher than normal.
Normal ICP is 5 to 15 mm Hg; at 24 mm Hg, the patients is higher than normal, not borderline.
26. A 70-year-old female is being closely monitored in the neurological critical care unit for a
severe closed head injury. After 48 hours, her condition begins to deteriorate. Her pupils are
small and sluggish, pulse pressure is widening, and she is bradycardic. These clinical findings
are evidence of what stage of intracranial hypertension?
a.
Stage 1
b.
Stage 2
c.
Stage 3
Interstitial edema
c.
Vasogenic edema
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b.
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d.
Stage 4
ANS: C
Stage 3 is characterized by decreasing levels of arousal or central neurogenic hyperventilation,
widened pulse pressure, bradycardia, and pupils that become small and sluggish.
Stage 1 is characterized by an ICP that may not change because of the effective compensatory
mechanisms, and there may be few symptoms.
Stage 2 is characterized by subtle and transient symptoms, including episodes of confusion,
restlessness, drowsiness, and slight pupillary and breathing changes.
Stage 4 is characterized by cessation of cerebral blood flow.
27. An infant is diagnosed with noncommunicating hydrocephalus. What is an immediate
priority concern for this patient?
a.
Metabolic edema
c.
Intercellular edema
Elevated arterial blood pressure
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b.
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d.
Ischemic edema
ANS: B
An immediate concern for the infant with noncommunicating hydrocephalus is interstitial edema.
Interstitial edema, not metabolic edema, is seen most often with noncommunicating
hydrocephalus.
Interstitial edema, not vasogenic edema, is seen most often with noncommunicating
hydrocephalus.
Interstitial edema, not ischemic edema, is seen most often with noncommunicating
hydrocephalus.
28. An adult has hydrocephalus. When the patient asks the nurse what caused this, how should
the nurse respond? Hydrocephalus in adults is most often caused by:
a.
Overproduction of CSF
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d.
Defective CSF reabsorption
ANS: D
Hydrocephalus occurs because of defective reabsorption of the fluid.
Hydrocephalus can occur because of overproduction of CSF, but in adults it occurs most often
because of defective reabsorption of the fluid.
Hydrocephalus is not due to intercellular edema.
Hydrocephalus does not occur due to elevated arterial blood pressure.
29. A 16-year-old male fell off the bed of a pickup truck and hit his forehead on the road. He
now has resistance to passive movement that varies proportionally with the force applied. He is
most likely suffering from:
a.
Spasticity
b.
Gegenhalten
c.
Rigidity
Quadriplegia
c.
Infraparaplegia
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b.
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d.
Dystonia
ANS: B
Gegenhalten is manifested by resistance to passive movement that varies in direct proportion to
force applied.
Spasticity is manifested by a gradual increase in tone causing increased resistance until tone
suddenly reduces.
Rigidity is manifested by muscle resistance to passive movement of a rigid limb that is uniform
in both flexion and extension throughout the motion.
Dystonia is manifested by sustained involuntary twisting movement.
30. A patient has paralysis of both legs. What type of paralysis does the patient have?
a.
Paraplegia
Akinesia
c.
Hyperkinesia
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b.
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d.
Paresthesia
ANS: A
Paraplegia is the paralysis of both legs.
Quadriplegia is the paralysis of all four extremities.
Infraparaplegia is not a description of paralysis.
Paresthesia is a loss of sensation, not paralysis.
31. A patient has excessive movement. What disorder will the nurse see documented on the
chart?
a.
Hypokinesia
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d.
Dyskinesia
ANS: C
Excessive movement is the definition of hyperkinesia.
Hypokinesia is decreased movement.
Akinesia is loss of movement.
Dyskinesia is abnormal movement.
32. Which principle should the nurse remember while planning care for a patient with spinal
shock? Spinal shock is characterized by:
a.
Loss of voluntary motor function with preservation of reflexes
b.
Cessation of spinal cord function below the lesion
c.
Loss of spinal cord function at the level of the lesion only
d.
ANS: B
Temporary loss of spinal cord function above the lesion
b.
Huntington disease
c.
Hypokinesia
om
Spinal shock is the complete cessation of spinal cord function below the lesion.
The reflexes are not preserved in spinal shock.
Spinal shock is the complete cessation of spinal cord function below the lesion, not at the lesion
only.
Spinal shock is the complete cessation of spinal cord function below the lesion.
33. A 40-year-old male complains of uncontrolled excessive movement and progressive
dysfunction of intellectual and thought processes. He is experiencing movement problems that
begin in the face and arms that eventually affect the entire body. The most likely diagnosis is:
a.
Tardive dyskinesia
st
ba
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nk
.c
d.
Alzheimer disease
ANS: B
Huntington disease is manifested by chorea, abnormal movement that begins in the face and
arms, eventually affecting the entire body. There is progressive dysfunction of intellectual and
thought processes.
Tardive dyskinesia is manifested by rapid, repetitive, stereotypic movements. Most characteristic
is continual chewing with intermittent protrusions of the tongue, lip smacking, and facial
grimacing.
Hypokinesia is loss of voluntary movement despite preserved consciousness and normal
peripheral nerve and muscle function.
Alzheimer disease is manifested by cognitive deficits and not movement problems; motor
impairments will occur in the later stages.
34. A nurse notes that a patient walks with the leg extended and held stiff, causing a scraping
over the floor surface. What type of gait is the patient experiencing?
a.
Spastic gait
Cerebellar gait
c.
Basal ganglion gait
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b.
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w
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d.
Scissors gait
ANS: A
An individual who walks with the leg extended and held stiff, causing a scraping over the floor
surface, is experiencing a spastic gait.
A cerebellar gait is wide-based with the feet apart and often turned outward or inward for greater
stability.
A basal ganglion gait occurs when the person walks with small steps and a decreased arm swing.
A scissors gait is associated with bilateral injury and spasticity. The legs are abducted so they
touch each other.
35. A male patient complains of tiring easily, has difficulty rising from a sitting position, and
cannot stand on his toes. The nurse would expect a diagnosis of:
a.
Parkinson disease
b.
Hypotonia
c.
Huntington disease
d.
Paresis
ANS: B
Individuals with hypotonia tire easily (asthenia) or are weak. They may have difficulty rising
from a sitting position, sitting down without using arm support, and walking up and down stairs,
as well as an inability to stand on their toes.
Individuals with Parkinson disease have rigidity and stiffness.
Symptoms of Huntington disease include irregular, uncontrolled, and excessive movement.
Paresis, or weakness, is partial paralysis with incomplete loss of muscle power.
brain cell tissue.
B)
intravascular blood.
C)
surface sulci fluid.
D)
cerebrospinal fluid.
2.
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A)
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The intracranial volume that is most capable of compensating for increasing intracranial pressure is th
A late indicator of increased intracranial pressure is:
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1.
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Chapter 51: Disorders of Brain Function
tachycardia.
B)
right-sided heart failure.
C)
narrow pulse pressure.
D)
high mean arterial pressure.
st
Extreme cerebral edema may cause the brain to herniate into another compartment. Upward herniatio
from the infratentorial compartment against the aqueduct of Sylvius causes:
A)
hydrocephalus.
B)
.te
3.
ba
A)
cardiac arrest.
tissue infarction.
D)
intracranial bleeding.
Coup and contrecoup cerebral contusion caused by blunt head trauma against a fixed object results in:
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4.
diffuse axonal injuries.
w
A)
w
C)
B)
cerebrovascular infarction.
C)
momentary unconsciousness.
D)
permanent brain tissue damage.
5.
An intracranial epidural hematoma causes focal symptoms that can include:
A)
ipsilateral pupil dilation.
B)
ipsilateral hemiparesis.
C)
diffuse venous bleeding.
D)
commuting hydrocephalus.
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:
increased oxygen saturation.
B)
increased carbon dioxide level.
C)
decreased serum sodium level.
D)
decreased hydrogen ion concentration.
Transient ischemic attacks (TIAs) are characterized by ischemic cerebral neurologic deficits that:
indicate aneurysm leakage.
B)
cause minor residual deficits.
C)
affect diffuse cerebral functions.
D)
resolve within one hour of onset.
ba
Common manifestations of acute meningococcal meningitis, a highly contagious and lethal form of
meningitis, include:
diplopia.
B)
petechiae.
C)
papilledema.
D)
st
A)
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9.
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ta
A)
focal paralysis.
incontinence.
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C)
confusion.
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A)
The moderate stage of the progressive degenerative Alzheimer-type dementia is manifested by
behaviors that include:
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10.
B)
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8.
om
A)
.c
6.
D)
11.
decreased level of consciousness.
social withdrawal.
A patients recent computed tomography (CT) scan has revealed the presence of hydrocephalus. Whi
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 an
symptoms would indicate the presence of postconcussion syndrome in the days and weeks following
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
om
13.
An elderly male patient has been brought to the emergency department after experiencing stroke-lik
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
the stroke. What is the rationale for the care teams emphasis on restoring circulation?
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.
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ta
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.c
A)
A patients emergency magnetic resonance imaging (MRI) has been examined by the physician and t
has been administered to the patient. What was this patients most likely diagnosis?
Status epilepticus
B)
Subarachnoid hemorrhage
C)
Ischemic stroke
D)
Encephalitis
st
ba
A)
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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
Impaired synthesis of clotting factors
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B)
Increased levels of cerebrospinal fluid
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D)
Deficits in the autonomic control of blood pressure
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C)
16.
Which of the following pathophysiologic processes occurs in cases of bacterial meningitis?
A)
Infection in the cerebrospinal fluid causes vasoconstriction and cerebral hypoxia.
B)
Trauma introduces skin-borne pathogens to the cerebrospinal fluid.
C)
Infection in the cerebrospinal fluid causes spinal cord compression and neurologic deficits.
D)
Inflammation allows pathogens to cross into the cerebrospinal fluid.
17.
A)
Which of the following individuals has the highest chance of having a medulloblastoma?
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 cance
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
Simple partial seizure
B)
Atonic seizure
C)
Myoclonic seizure
D)
Complex partial seizure
A patient with a long history of cigarette smoking and poorly controlled hypertension has experience
recent psychomotor deficits as a result of hemorrhagic brain damage. The patients psychomotor defi
are likely the result of:
.c
19.
Alzheimer disease.
B)
frontotemporal dementia (FTD).
C)
vascular dementia.
D)
Wernicke-Korsakoff syndrome.
nk
ta
A)
Which of the following statements by the husband of a patient with Alzheimer disease demonstrates
accurate understanding of his wifes medication regimen?
ba
20.
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A)
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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?
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.
I learned that if we are vigilant about her medication schedule, she may not experience the
physical effects of her disease.
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D)
Answer Key
1.
D
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st
A)
D
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2.
3.
A
4.
D
5.
A
6.
D
7.
B
8.
D
9.
B
B
12.
A
13.
C
14.
C
15.
A
16.
D
17.
C
18.
D
19.
C
20.
A
om
11.
.c
A
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10.
Chapter 52: Sleep and Sleep Disorders
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MULTIPLE CHOICE
1. Which assessment observation would not support a diagnosis of narcolepsy?
a.
Sleep study reports excessive, loud snoring.
Sleep study shows evidence of sleep paralysis.
c.
Patient reports needing to drink pots of coffee to stay awake at work.
ba
b.
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d.
Patient reports, When I get sleepy I actually see things that arent really there.
ANS: A
Snoring is a characteristic obstructive sleep apnea, not narcolepsy. Classic symptoms of
narcolepsy include excessive daytime sleepiness, sleep paralysis, and hallucinations
DIF: Cognitive Level: Application
TOP: Nursing Process: Assessment
MSC: NCLEX: Patient Need: Physiological Integrity: Basic Care and Comfort: Rest and Sleep
2. An adult patient diagnosed with narcolepsy is being educated on the medication therapy that is
prescribed. Which explanation is provided for the central nervous system stimulant
dextroamphetamine (Dexedrine)?
a.
The apnea will be lessened by this medication.
b.
It will help control the sporadic loss of muscle tone.
c.
This medication will minimize the daytime sleepiness.
d.
Dexedrine will manage the inflammation that causes the snoring.
ANS: C
Central nervous system stimulants such as dextroamphetamine (Dexedrine, Dextrostat) may be
prescribed to manage excessive daytime sleepiness. This medication has no affect on cataplexy,
apnea, or snoring. Apnea and snoring are not symptoms of narcolepsy.
DIF: Cognitive Level: Application
TOP: Nursing Process: Implementation
MSC: NCLEX: Patient Need: Physiological Integrity: Basic Care and Comfort: Rest and Sleep
3. A pediatric patient has been diagnosed with obstructive sleep apnea (OSA). Which statement
would the nurse use as a basis for explaining the etiology of this disorder?
a.
Melatonin is not being released in sufficient quantity.
b.
This condition is often due to adenotonsillar hypertrophy.
c.
Children have a high ratio of REM sleep that can result in frequent gasping.
nk
.c
om
d.
This can be related to a sleep position which compromises chest movement.
ANS: B
When OSA is found in children, it is usually the result of adenotonsillar hypertrophy,
craniofacial abnormalities, and neuromuscular conditions, all of which result in airway
obstruction during sleep. There is no research on OSA related to melatonin insufficiency,
dreaming, or a particular sleep position.
DIF: Cognitive Level: Application TOP: Nursing Process: Planning
MSC: NCLEX: Patient Need: Physiological Integrity: Basic Care and Comfort: Rest and Sleep
4. Which outcome is appropriate for an adult patient recently diagnosed with primary insomnia?
a.
Demonstrate an understanding of the cerebral stimulants prescribed.
Recognize that the prescribed flurazepam (Dalmane) can be used for up to 2 months.
c.
Demonstrate the proper use of continuous positive airway pressure (CPAP) ventilation.
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ta
b.
c.
Safety issues such as sleeping in the ground level bedroom
The likely connection between sleepwalking and narcolepsy
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b.
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d.
Recognize physical and psychosocial stressors that exacerbate the sleep disturbance.
ANS: D
The patient should identify physical and psychosocial stressors that exacerbate the sleep
disturbance in order to attempt successful self-management of the problem. Neither stimulants
nor CPAP therapy are prescribed for this disorder. The duration of flurazepam therapy is
considerably shorter.
DIF: Cognitive Level: Application TOP: Nursing Process: Planning
MSC: NCLEX: Patient Need: Physiological Integrity: Basic Care and Comfort: Rest and Sleep
5. A 10-year-old is diagnosed with somnambulism as a result of frequent episodes of
sleepwalking. Which topic should be included when considering patient and family education?
a.
Medication therapy seldom prescribed for this disorder
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d.
The need for short-term cognitive and behavioral therapy
ANS: B
Safety is a primary concern when managing sleepwalking since injury is quite likely as a result
of the patients inability to be aware of danger. Drugs that suppress stages 3 and 4 sleep, such as
benzodiazepine hypnotics, have been used for the management of this disorder. There is no
research to support a connection between this disorder and narcolepsy. This disorder is not
treated with either of these therapies.
DIF: Cognitive Level: Application TOP: Nursing Process: Planning
MSC: NCLEX: Patient Need: Physiological Integrity: Basic Care and Comfort: Rest and Sleep
6. Which patient statement would support a diagnosis of a circadian rhythm sleep disturbance?
a.
I just started on the night shift at work.
b.
My mother was seriously depressed for years.
c.
I wake up gasping for breath, and it is really scary.
b.
Raccoon eyes
c.
Enlarged nasal nares
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.c
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d.
I dont think I drink any more than my buddies do.
ANS: A
The shift worktype of circadian sleep disorder is usually the result of night shift work or
frequently rotating shift work. Depression, breathing problems, and drinking indicate other types
of sleep disturbances.
DIF: Cognitive Level: Application
TOP: Nursing Process: Assessment
MSC: NCLEX: Patient Need: Physiological Integrity: Basic Care and Comfort: Rest and Sleep
7. Which physical assessment finding is supportive of a diagnosis of obstructive sleep apnea?
a.
Barrel chest
.te
st
ba
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ta
d.
Large neck circumference
ANS: D
Persons with obstructive sleep apnea often have a large neck circumference that appears to be
related to pressure being applied to the trachea. Neither an enlarged chest nor enlarged nostrils
would cause the airway obstruction associated with this disorder. Blackened eyes are related to
trauma or allergies.
DIF: Cognitive Level: Application
TOP: Nursing Process: Assessment
MSC: NCLEX: Patient Need: Physiological Integrity: Basic Care and Comfort: Rest and Sleep
8. When the family of a child diagnosed with a nightmare disorder asks the nurse about
prognosis, the nurse replies with the knowledge that:
a.
The disorder is frequently self-limiting in children.
If the child is obese, it is likely the nightmares will continue.
c.
High doses of diazepam (Valium) are needed to cure the disorder.
w
b.
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d.
With the use of antipsychotic medication, the disorder will not worsen.
ANS: A
A child who is experiencing nightmares usually outgrows the disorder as he or she ages.
Medications are not generally prescribed for this disorder. There is no research to support a
correlation between obesity and nightmares.
DIF: Cognitive Level: Application
TOP: Nursing Process: Implementation
MSC: NCLEX: Patient Need: Physiological Integrity: Basic Care and Comfort: Rest and Sleep
9. Which of the statements made by the patient would be most indicative of dyssomnia?
a.
I think I am seeing things when I wake up.
b.
My wife says I snore and even stop breathing.
c.
I go to sleep okay but then wake up several times at night.
om
d.
My wife says I sit straight up in bed at 2 AM and then say strange things.
ANS: C
The dyssomnia known as insomnia is characterized by a predominant complaint of difficulty
initiating or maintaining sleep. Snoring is a characteristic of obstructive sleep apnea. The other
options are seen in narcolepsy.
DIF: Cognitive Level: Application
TOP: Nursing Process: Assessment
MSC: NCLEX: Patient Need: Physiological Integrity: Basic Care and Comfort: Rest and Sleep
10. A patient with obstructive sleep apnea (OSA) is being discharged. What patient statement
indicates the need for further teaching?
a.
I hope to lose some weight.
My antidepressants seem to be helping.
c.
I will try the oral appliance that the doctor suggested.
nk
.c
b.
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ta
d.
A glass of wine at bedtime will help relax my airways.
ANS: D
Health care providers usually discourage patients with this disorder from using sedating
substances such as alcohol, because these types of sedatives often exacerbate the problem by
relaxing the airway, thus increasing the risk of longer apneic episodes throughout the night. The
remaining options are all positive strategies to help with OSA.
ba
Chapter 53: Disorders of Thought, Mood, and Memory
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MULTIPLE CHOICE
1. The nurse learns at report that a newly admitted manic patient is demonstrating grandiosity.
Which statement would be most consistent with this symptom?
a.
I cant do anything anymore.
Im the worlds most astute financier.
c.
I can understand why my wife is upset that I overspend.
w
b.
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d.
I cant understand where all the money in our family goes.
ANS: B
An individual who is demonstrating grandiosity has an exaggerated view of his abilities. The
other options are more moderate statements and lack that element of exaggeration.
DIF: Cognitive Level: Application
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
2. The nurse will base a discussion of dysthymia on the fact that the condition:
a.
Typically has an acute onset
b.
Involves delusional thinking
c.
Is chronic low-level depression
d.
ANS: C
Does not include suicidal ideation
Dysthymia is identified as a chronic low-level depression frequently lasting over a period of
several years without remitting. Dysthymia has a slow, insidious onset. Delusional thinking is
not a common manifestation of dysthymia. Suicidal thoughts are seen among dysthymic patients.
DIF: Cognitive Level: Comprehension
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
3. What is the priority nursing diagnosis for a patient exhibiting signs of acute mania that include
exaggerated physical activity, agitation, insomnia, and anorexia?
a.
Risk for injury
Chronic low self-esteem
c.
Noncompliance
om
b.
Leaden paralysis
c.
Psychomotor agitation
ba
b.
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ta
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.c
d.
Insomnia
ANS: A
Risk for injury is the priority diagnosis. Possible injuries include dehydration, which may result
from not drinking and trauma, which may result from bumping into objects or from physical
altercations. The other options are valid diagnoses, but not of highest priority.
DIF: Cognitive Level: Analysis TOP: Nursing Process: Diagnosis
MSC: NCLEX: Psychosocial Integrity
4. A patient has been admitted with a diagnosis of atypical depression. In planning interventions,
the nurse would expect to consider the characteristic symptom of:
a.
Seasonal episodes
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.te
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d.
Increased depression in the morning
ANS: B
Behavioral characteristics of atypical depression include the feeling that ones limbs are so heavy
they cannot be lifted or moved (leaden paralysis). Seasonal mood changes are characteristic of
seasonal affective disorder. Psychomotor agitation and depression that is greater in the morning
than in the evening are characteristics more likely to be observed in patients with melancholic
depression.
DIF: Cognitive Level: Application TOP: Nursing Process: Planning
MSC: NCLEX: Psychosocial Integrity
5. An inappropriately dressed patient has not slept for 3 days while making excessive, expensive
long-distance phone calls. When the patient can be heard singing loudly in the examining room,
the nurse makes initial plans to focus on:
a.
Assessing needs for food, liquids, and rest
b.
Setting strict limits on dress and behavior
c.
Conducting an in-depth suicide assessment
d.
Obtaining a complete psychosocial assessment
ANS: A
Patients with mania frequently ignore their basic physiologic needs, as evidenced by not sleeping
for 3 days, thus making these assessments the priority. Limits, although appropriate to consider,
are not the priority. The manic state precludes a thorough assessment initially. Suicide
assessment is not a priority at this time but reckless behavior could result in personal injury.
DIF: Cognitive Level: Application TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
6. Which statement by the patient would indicate the need for additional education regarding the
prescribed lithium treatment regimen?
a.
I will restrict my daily salt intake.
I will take my medications with food.
c.
I will have my blood drawn on schedule.
om
b.
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ta
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.c
d.
I will drink 8 to 12 glasses of liquids daily.
ANS: A
Patients taking lithium must maintain a normal sodium intake or risk symptoms of lithium
toxicity. The patient should have 2 to 3 liters of fluid daily. Taking lithium with food minimizes
gastrointestinal side effects. Regular monitoring of lithium levels is important to prevent toxicity.
DIF: Cognitive Level: Application
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
7. The nurse would evaluate that patient education regarding lithium therapy for an individual
with bipolar disorder as effective if the patient states:
a.
I can stop my lithium when I feel better.
b.
I can continue with my diuretic and cardiac medications.
c.
I will probably need to take the lithium for the rest of my life.
w
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ba
d.
I will taper my lithium when a therapeutic serum level is achieved.
ANS: C
Most patients with bipolar disorder require long-term maintenance on lithium or other antimanic
medication. Patients should never stop medication without consulting the physician. When a
therapeutic level is achieved, the patient will continue on maintenance doses of lithium. Diuretics
are contraindicated for the patient on lithium.
DIF: Cognitive Level: Application TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity
8. A patient who has been taking lithium carbonate 300 mg tid comes to the Outpatient
Department with a list of medications he is taking. Which of the medications on the list would
require re-evaluation of lithium dosage?
a.
HydroDIURIL daily
b.
Navane bid
c.
Ativan at bedtime
d.
Cefobid daily
ANS: A
Diuretics alter fluid and electrolyte balance, increasing risk for lithium toxicity; therefore
HydroDIURIL is correct. Antipsychotic medications are frequently prescribed concurrently with
lithium to manage acute symptoms of mania, so no re-evaluation of lithium dose is necessary for
Navane. Antianxiety drugs are not contraindicated with concurrent lithium use, so no lithium
dose re-evaluation is necessary for Ativan. Antibiotics do not alter fluid and electrolyte balance,
so readjustment of lithium dosage is not required for Cefobid.
DIF: Cognitive Level: Analysis
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
9. Which outcomes would be appropriate to determine early favorable response to antidepressant
medication?
a.
The patient will complete own self-care activities.
The patient will demonstrate assertive communication skills.
c.
The patient will describe signs and symptoms of major depression.
om
b.
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ta
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.c
d.
The patient will make plans to attend one community social activity a week.
ANS: A
Ability to manage basic ADLs demonstrates improvement in major depression. Understanding
the disorder may occur later when patient cognition has improved enough to be able to process
information. Initiation of community social activity occurs when the patient has increased
energy. Assertive communication is learned and practiced after the depression lifts.
DIF: Cognitive Level: Application TOP: Nursing Process: Evaluation
MSC: NCLEX: Psychosocial Integrity
10. Prior to initiating medication therapy with phenelzine (Nardil), the nurse should plan to
determine the patients:
a.
Mood and affect
Activity level
c.
Cognitive ability to understand information about the medication
ba
b.
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st
d.
Support network and its members willingness to participate in treatment
ANS: C
Phenelzine (Nardil) administration requires strict adherence to a restricted diet. The patient must
have the cognitive ability to understand the food and medication interactions that may cause a
serious reaction.
DIF: Cognitive Level: Application TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
11. A patient who has a history of bipolar disorder recently underwent orthopedic surgery and
was discharged to return home. When visited by the home care nurse, the nurse documented the
following: slow and soft speech; sad facial expression; and patient crying when describing
extreme fatigue, low mood, and the feeling that he will never get well. He has refused to bathe
and perform ADLs for several days. Which nursing diagnosis would be appropriate?
a.
Self-care deficit secondary to possible depression
b.
Situational low self-esteem related to immobility
c.
Deficient knowledge related to depression and surgery
d.
Disturbed thought processes related to bipolar disorder
ANS: A
Refusal to perform tasks of bathing, grooming, and other ADLs provides evidence of a self-care
deficit. The other symptoms documented by the nurse are characteristic of depression. No data
are present to suggest the diagnoses given in the other options.
DIF: Cognitive Level: Application TOP: Nursing Process: Diagnosis
MSC: NCLEX: Psychosocial Integrity
12. The nurse caring for an extremely withdrawn patient with depression wants to assist her to
become more interactive. The best approach would be to say:
a.
I know youll feel better if you leave your room.
b.
You look so gloomy sitting here all by yourself.
c.
Lets explore how it feels to sit alone here all day and feel sad.
b.
Ineffective coping
c.
Risk for self-injury
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ta
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.c
om
d.
I need another person for a card game and Id like you to be my partner.
ANS: D
This direct approach invites the patient to participate in a kind, but firm manner. The patient is
not given an option to simply say yes or no. It is not therapeutic to give false reassurance. The
remaining options focus too intensively on negative thoughts and feelings.
DIF: Cognitive Level: Application
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
13. Which nursing diagnosis would relate to the primary nursing concern related to a recently
written prescription for amitriptyline (Elavil) 50 mg tid?
a.
Anxiety
Amitriptyline will help re-establish your ability to think clearly again.
w
c.
This medication is expected to improve brain chemical imbalance.
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b.
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ba
d.
Chronic low self-esteem
ANS: C
Patients with depression are at increased risk for suicide when they have been on antidepressant
medication for 2 weeks, because they are regaining some energy but may not have achieved full
therapeutic effect with mood improvement. Poor coping is important but it is not the priority.
Evidence of noncompliance is lacking. The medication is not prescribed for anxiety disorders.
DIF: Cognitive Level: Analysis TOP: Nursing Process: Diagnosis
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
14. What information concerning amitriptyline (Elavil) 50 mg tid would the nurse give the
patient regarding the expected outcome of this medication therapy?
a.
Complying with this therapy will cure your depression.
d.
Elavil will be particularly effective at assisting you in regaining your independence.
ANS: B
Antidepressant medication works by re-establishing the balance of neurotransmitters in the brain,
particularly serotonin and norepinephrine. Antidepressants do not promise a cure for depression.
Cognitive therapy, rather than antidepressants, addresses thinking issues. Learned helplessness is
addressed by cognitive therapy.
DIF: Cognitive Level: Application
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
15. Which principle should the nurse apply when planning nursing care for a patient who was
voluntarily admitted after a suicide attempt?
a.
Patients who attempt suicide and fail will not try again.
b.
The more specific the plan, the greater the risk for suicide.
c.
Patients who talk about suicide are less likely to attempt it.
nk
.c
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d.
Patients who attempt suicide and fail do not really want to die.
ANS: B
Patients whose suicidal ideation includes a vague, diffuse plan or no plan at all are not at as high
a risk for attempting suicide as an individual who has a well-developed plan and the means to
carry it out. The nurse will need to continually reassess the patient. None of the remaining
options are true statements concerning suicide attempts.
DIF: Cognitive Level: Application TOP: Nursing Process: Planning
MSC: NCLEX: Psychosocial Integrity
16. An appropriate nursing strategy to assist a patient who was involuntarily admitted after a
suicide attempt is::
a.
Avoiding any focus on the topic of suicide
Encouraging patient to verbalize personal feelings
c.
Supporting patient focus on others rather than self
nk
ta
b.
Increasing stimulation tends to encourage the patient to focus.
w
c.
Decreasing stimulation tends to diminish symptoms.
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b.
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st
ba
d.
Discussing the impact of suicidal thoughts on the family
ANS: B
Verbalization helps relieve pent-up feelings and emotional pain. Avoidance of the topic is
nontherapeutic for a suicidal patient. The remaining options may serve to increase the patients
feelings of guilt.
DIF: Cognitive Level: Application
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
17. Which principle should the nurse apply when planning care for a patient who is diagnosed
with bipolar disorder and currently in the manic phase?
a.
Manic patients respond well to peer pressure.
w
d.
Detailed activities will facilitate the patients ability to self control behavior.
ANS: D
The only statement that is a valid principle is the option related to activity and its impact on
controlling behavior. The other statements are inaccurate.
DIF: Cognitive Level: Application TOP: Nursing Process: Planning
MSC: NCLEX: Psychosocial Integrity
18. Which nursing intervention is most therapeutic when the nurse is managing the aggressive,
disruptive behaviors of a manic patient whose attempts to control the milieu has been rejected by
the other patients?
a.
Advising that the patient to accept the wishes of the group
b.
Suggesting that the patient either quiet down or leave the room
c.
Accompanying the patient to a quieter part of the unit
.c
om
d.
Ignoring the patients outbursts because they are surly related to the mania
ANS: C
Escorting the patient to a less stimulating environment will assist the patient to remain in control
of behavior. It is unlikely that the patient would respond to verbal suggestions to leave the area
unaccompanied or accept the groups wishes and would likely see the suggestions as a threat that
would further escalate the impending loss of control. The behavior cannot be ignored since it will
likely lead to an acceleration of the mania.
DIF: Cognitive Level: Application
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
19. What information would serve as the basis for the nurses reply when asked whether the
cycling of moods from depressed to manic is a constant pattern seen in bipolar disorders?
a.
Clinical observation tells us that mood disorders tend to remit and recur.
Most cyclic behavior can be managed with the appropriate forms of therapy.
c.
Mood disorders generally see a decrease in cyclic affecting within 5 years of onset.
nk
b.
st
ba
nk
ta
d.
Persons with higher cognitive abilities will generally exhibit fewer cyclic episodes.
ANS: A
Mood disorders tend to remit and recur throughout the patients lifetime. There is no current
research to support the other options.
DIF: Cognitive Level: Application
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
20. The individual who displays the history and symptoms most consistent with a medical
diagnosis of seasonal affective disorder (SAD) is:
26 years of age and complains of 3 consecutive years of depressed mood beginning in November and
a.
remitting in April
c.
46 years of age and complains of dysphoric mood for 3 years, poor concentration, loss of interest in
social activities, indecision, low energy, and low self-esteem
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.te
b.
64 years of age and complains of anhedonia, early morning awakening, psychomotor retardation, wei
loss, and excessive feelings of guilt
w
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38 years of age and complains of sadness, loss of ability to react to positive stimuli, weight gain,
d.
hypersomnia, leaden paralysis of limbs, and sensitivity to interpersonal rejection
ANS: A
Marked seasonal changes in mood typify seasonal affective disorder. Depression begins in
October or November and lifts in March or April and must occur for at least 2 consecutive years.
The other options are lacking in the identifying period of time when the symptoms are exhibited.
Chapter 54: Disorders of Visual Function
MULTIPLE CHOICE
1.A client is diagnosed with strabismus. Which of the following will the client most likely
experience with this disorder?
Nystagmus
2.
Diplopia
3.
Aphakic vision
4.
Ptosis
om
1.
ANS: 2
nk
.c
Diplopia, or double vision, is the primary symptom of strabismus. Nystagmus is a disorder that
causes involuntarily rhythmic movements in the eye. Aphakic vision occurs when the lens of the
eye is removed. Ptosis is drooping of the eyelid.
PTS: 1 DIF: Analyze REF: Ocular Movement Disorders: Strabismus
glaucoma.
2.
cataracts.
st
ba
1.
nk
ta
2.A client is experiencing a gradual blurring of vision in both eyes not associated with any pain.
The nurse suspects the client is experiencing:
macular degeneration.
.te
3.
retinal detachment.
ANS: 2
w
4.
w
w
Cataracts occur as the opacity of the lens becomes cloudy, blurring the vision. It occurs in both
eyes but is usually worse in one eye. Gradual eye blurring is not associated with glaucoma,
macular degeneration, or retinal detachment.
PTS: 1 DIF: Analyze REF: Cataracts: Pathophysiology
3.The nurse should instruct a client, diagnosed with glaucoma, that the purpose of medication is
to:
1.
help dry up excess secretions.
2.
lower the intraocular pressure.
3.
strengthen the muscles of the eye.
4.
improve the vision in the eye.
om
ANS: 2
.c
Glaucoma is a disease that relates to the increase of intraocular pressure. The medication given
will decrease this intraocular pressure. Medication for glaucoma is not used to help dry up excess
secretions, strengthen the eye muscles, or improve vision.
PTS: 1 DIF: Apply REF: Glaucoma: Pharmacology
nk
4.After surgery to remove a cataract, which of the following should the nurse instruct the client?
Be sure to follow the schedule for the prescribed eyedrop medication.
2.
Sleep on the right side to promote drainage.
3.
It is okay to rub the eye because the surgery was on the inside.
4.
This is an outpatient procedure, and there are no instructions for the patient.
st
ba
nk
ta
1.
.te
ANS: 1
w
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Client education is extremely important in the aftercare of cataract surgery. There is a need to
emphasize the postoperative care of eyedrop instillation. The client should not place any pressure
near or on the eye. Postoperative instructions are highly important for the client having an
outpatient surgical procedure.
w
PTS: 1 DIF: Apply REF: Cataracts: Planning and Implementation
5.A tonometry test has been performed with a client and the results are 25 mmHg. The nurse
know that:
1.
the reading is low and there is no problem.
2.
the reading is normal and nothing needs to be done at this time.
3.
the results are high and follow-up readings and tests are needed.
4.
the results are high and there is no cure to bring the pressure down.
ANS: 3
om
Several reading need to be taken throughout the day to establish the highest reading to be the
treated pressure. Normal intraocular pressure ranges from 12 to 16 mmHg. The reading of 25
mmHg is not low or normal. Medication can be prescribed to reduce the pressure.
PTS:1DIF:Analyze
.c
REF: Glaucoma: Assessment with Clinical Manifestations and Diagnostic Tests
nk
6.A client has been diagnosed with cataracts. The nurse realizes that the only treatment for this
disorder is?
Medical management with eyedrops
2.
Surgical removal of the lens
3.
Cryopexy
4.
Phototherapy
st
ba
nk
ta
1.
.te
ANS: 2
w
Surgical treatment for cataracts begins when vision is sufficiently impaired. The lens is removed
and the replacement artificial intraocular lens is put in place. Cataracts cannot be treated with
medication alone. Cryopexy and phototherapy are not used to treat cataracts.
w
PTS:1DIF:AnalyzeREF:Cataracts: Surgery
w
7.Which of the following should the nurse assess in a client diagnosed with open-angle
glaucoma?
1.
Degree of lost vision
2.
Severity of headaches
3.
Amount of blurred vision
4.
Date of onset
ANS: 1
Open-angle glaucoma is characterized by a gradual increase in pressure and a gradual loss of
vision. Closed-angle glaucoma presents with a sudden onset causing headache, blurred vision,
and eye pain.
om
PTS: 1 DIF: Apply REF: Glaucoma: Pathophysiology
8.A client is experiencing little flashes of lights and things floating in the visual field. The nurse
suspects:
cataracts.
2.
glaucoma.
3.
conjunctivitis.
4.
retinal detachment.
ba
nk
ta
nk
.c
1.
ANS: 4
.te
PTS:1DIF:Analyze
st
Retinal detachment is clinically manifested by flashes and floaters in the visual field. Flashes of
light and floaters are not associated with cataracts, glaucoma, or conjunctivitis.
REF:Retinal Detachment: Assessment with Clinical Manifestations
Instruct the client to return home to rest in bed.
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1.
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9.A client tells the nurse that she sees a shadow that is slowing getting worse in her left eye.
Which of the following should the nurse do?
2.
Encourage the client to continue with normal daily activities.
3.
Notify an ophthalmologist.
4.
Encourage fluids and normal saline eyedrops.
ANS: 3
The nurse should notify an ophthalmologist with the clients symptoms. The onset of a shadow in
the field of vision that will not dissipate is an indication of a detached retina. Retinal
detachments rarely self-repair, and the client will need surgery. The nurse should not instruct the
client to return home to rest in bed. The client should not be encouraged to continue with normal
daily activities. Fluids and saline eyedrops will not help a detached retina.
PTS:1DIF:Apply
om
REF:Retinal Detachment: Assessment with Clinical Manifestations
detached retina syndrome.
2.
nystagmus.
3.
macular degeneration.
4.
conjunctivitis.
ba
nk
ta
nk
1.
.c
10.A client is experiencing a loss of central vision but not a loss of peripheral vision. The nurse
realizes the client should be evaluated for:
ANS: 3
.te
st
Macular degeneration is a deterioration of part of the retina, causing loss of central vision but not
affecting peripheral vision. The loss of central vision is not typically seen in a detached retina,
nystagmus, or conjunctivitis.
PTS: 1 DIF: Analyze REF: Macular Degeneration: Pathophysiology
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1.
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11.A client is experiencing redness, burning, itching, and pain of the eyes. The nurse suspects the
client is experiencing:
blepharitis.
2.
conjunctivitis.
3.
keratitis.
4.
iritis.
ANS: 2
Clinical manifestations of conjunctivitis (pink eye) include watery eyes, redness, itching, and
burning pain. Blepharitis is associated with a sticky exudate. Keratitis is associated with
photophobia. Iritis is associated with blurred vision and photophobia.
PTS: 1 DIF: Analyze REF: Inflammatory and Infectious Eye Conditions
20/200 or less in the better eye with correction.
2.
20/200 or less in the worse eye without correction.
3.
20/100 or less in the better eye without correction.
4.
20/100 or less in the worse eye with correction.
nk
.c
1.
om
12.A client has been diagnosed as being legally blind. The nurse realizes this clients vision is:
nk
ta
ANS: 1
ba
Legal blindness is defined as vision of 20/200 or less on a Snellen chart in the better eye with
correction. The eye needs to have correction in order to be diagnosed as legally blind; therefore,
the choice of 20/200 in the worse eye without correction would be incorrect. The vision
measurements of the other choices can be corrected with lenses and would not be categorized as
legal blindness.
st
PTS: 1 DIF: Analyze REF: Low Vision and Blindness
.te
13.The nurse realizes that the best medication treatment for open-angle glaucoma would be:
timolol (Timoptic) eyedrops.
w
1.
timolol (Timoptic) and Latanoprost (Xalatan) eyedrops.
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3.
latanoprost (Xalatan) eyedrops.
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2.
4.
metoprolol oral medication.
ANS: 3
For the best effect in the treatment of open-angle glaucoma, timolol (Timoptic) and latanoprost
(Xalatan) should be prescribed together. Metoprolol is not prescribed for open-angle glaucoma.
PTS: 1 DIF: Analyze REF: Glaucoma: Pharmacology
MULTIPLE RESPONSE
There is greater risk as people age.
2.
Women are at greater risk than men.
3.
African Americans are at greater risk than Caucasians.
4.
Family history of macular degeneration increases risk.
5.
Smoking does not increase risk.
6.
Alcohol prevents the onset of this disorder.
nk
ta
nk
.c
1.
om
1.A client tells the nurse that he does not want to develop macular degeneration like his mother.
Which of the following should the nurse instruct the client as being risk factors for the
development of this disorder? (Select all that apply.)
ANS: 1, 2, 4
st
ba
Recent statistics show that macular degeneration is age related and that women are at greater risk
than men. Family history and smoking are also significant risk factors. Caucasians are at greater
risk than African Americans. Alcohol does not prevent the onset of this disorder.
PTS: 1 DIF: Apply REF: Macular Degeneration
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2.
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1.
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2.A client is receiving tests to diagnose glaucoma. Which of the following diagnostic tests will
be used to identify this disorder in the client? (Select all that apply.)
Visual acuity
Visual field test
3.
Tonometry
4.
Weber test
5.
Rinne test
6.
Electroencephalogram
ANS: 1, 2, 3
Glaucoma is determined through a comprehensive eye exam including a visual acuity test, visual
fields test, dilated eye exam, and tonometry. The Weber and Rinne tests are used in an ear
assessment. An electroencephalogram is not used to diagnose glaucoma.
om
PTS:1DIF:Analyze
REF: Glaucoma: Assessment with Clinical Manifestations and Diagnostic Tests
Enucleation
2.
Laser surgery
3.
Plaque brachytherapy
4.
Block incision
5.
Trabeculoplasty
st
ba
nk
ta
1.
nk
.c
3.A client is diagnosed with ocular cancer. The nurse realizes this client could be treated with:
(Select all that apply.)
Trabeculectomy
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ANS: 1, 3, 4
.te
6.
w
w
Surgical options for a client diagnosed with ocular cancer include enucleation, plaque
brachytherapy, or block incision. Laser surgery, trabeculoplasty, and trabeculectomy would be
used to treat glaucoma.
PTS: 1 DIF: Analyze REF: Ocular Cancer: Surgery
4.A client, diagnosed with keratoconus, asks the nurse what caused the disorder to develop. The
nurse should instruct the client on which of the following as risk factors for the development of
this disorder? (Select all that apply.)
1.
Sun exposure
Ocular allergies
3.
Wearing rigid contact lenses
4.
Vigorous eye rubbing
5.
Herpes simplex virus
6.
Dry eyes
.c
om
2.
ANS: 2, 3, 4
nk
ta
nk
Risk factors for the development of keratoconus include ocular allergies, rigid contact lens wear,
and vigorous eye rubbing. Sun exposure, herpes simplex virus, and dry eyes are not risk factors
for this disorder.
PTS: 1 DIF: Apply REF: Corneal Disorders: Keratoconus
ba
5.The nurse is planning instruction for a client experiencing dry eyes. Which of the following
should be included in these instructions? (Select all that apply.)
Drink 8 to 10 glasses of water each day.
2.
Apply petroleum jelly to the eyelids.
.te
st
1.
w
5.
Avoid sun exposure.
w
4.
Blink more frequently.
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3.
6.
Avoid rubbing the eyes.
Avoid dry air.
ANS: 1, 3, 5, 6
Interventions to improve dry eyes include drink 8 to 10 glasses of water each day; blink more
frequently; avoid rubbing the eyes; and know that dry air makes the condition worse. Petroleum
jelly is not a treatment for dry eyes. Avoiding the sun is good advice; however, it is not proven to
help with dry eyes.
PTS: 1 DIF: Apply REF: Patient Playbook: Treatment of Dry Eyes
6.Which of the following should the nurse instruct a client diagnosed with type 2 diabetes
mellitus regarding vision care? (Select all that apply.)
Maintain good glucose control.
2.
Stop smoking.
3.
Limit exercise.
4.
Reduce reading.
5.
Frequently rest the eyes.
6.
Rub eyes daily.
.c
nk
nk
ta
ANS: 1, 2
om
1.
st
ba
To preserve vision and reduce the onset of diabetic retinopathy, the nurse should instruct the
client to control blood glucose level, manage other complications, and stop smoking. The client
should not be instructed to limit exercise, reduce reading, rest the eyes, or rub the eyes to prevent
the onset of diabetic retinopathy.
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Chapter 55: Disorders of Hearing and Vestibular Function
MULTIPLE CHOICE
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1.
w
w
1.A client is not able to successfully pass the whisper test. Which of the following would be
indicated for this client?
Head CT scan
2.
Audiometry
3.
MRI of the brain
4.
Electroencephalogram
ANS: 2
Failure to pass the whisper test would indicate the need for formal audiometry testing. The client
would not need a head CT or MRI at this time. An electroencephalogram is not necessary.
PTS:1DIF:Analyze
REF:Auditory Dysfunction: Assessment with Clinical Manifestations
om
2.A client is prescribed a medication that is ototoxic. The nurse realizes that this medication may
cause:
permanent or temporary vision loss.
2.
permanent or temporary hearing loss.
3.
nausea and vomiting.
4.
central nervous system (CNS) depression.
nk
ta
nk
.c
1.
ANS: 2
st
PTS:1DIF:Analyze
ba
Although many drugs cause nausea and vomiting and central nervous system (CNS) depression,
ototoxic drugs cause hearing loss and the risks must be considered prior to suggesting these types
of medications.
.te
REF: Auditory Dysfunction: Ototoxic Medications and Auditory Dysfunction
write down all of the message.
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1.
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3.The nurse is trying to communicate with a hearing-impaired client. The best way to do this is
to:
2.
shout in the impaired ear.
3.
speak slowly and clearly while facing the client.
4.
talk in a regular voice in the good ear.
ANS: 3
When trying to communicate with the hearing-impaired client, the nurse should speak slowly and
clearly while facing the client to give her the opportunity to see and hear the words being spoken.
The nurse should not write down all of the messages. Shouting in the impaired ear will not
improve the clients hearing. Talking in a regular voice into the good ear will not improve
hearing.
PTS:1DIF:Apply
REF:Nursing Strategy: Communicating with the Hearing Impaired
brain damage.
3.
otitis media.
4.
otosclerosis.
.c
2.
nk
cerumen.
nk
ta
1.
om
4.A client is diagnosed with a conductive hearing loss. The nurse realizes type of hearing loss
is not associated with:
ANS: 2
st
ba
Conductive hearing loss results in a blockage of sound waves in the external or middle portions
of the ear. Wax (cerumen) buildup and infections are a large part of conductive hearing loss.
Otosclerosis is associated with conductive hearing loss. Brain damage is not a cause of
conductive hearing loss.
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PTS: 1 DIF: Analyze REF: Conductive Hearing Loss
w
w
1.
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5.A client is complaining of dizziness, unilateral ringing in the ear, feeling of pressure or fullness
in the ear, and unilateral hearing loss. The nurse would suspect the client is experiencing:
Mnires disease.
2.
osteosclerosis.
3.
otitis media.
4.
mastoiditis.
ANS: 1
All of the clients complaints are signs and symptoms of Mnires disease. Although hearing
disorders may have similar signs and symptoms, they do not include all of them.
PTS:1DIF:AnalyzeREF:Menieres Disease
2.
Add mineral oil to kill the insect.
3.
Add lidocaine to kill the insect.
4.
Call an otologist for a referral.
nk
ta
ANS: 1
.c
Add water to flush out the insect.
nk
1.
om
6.A client complains of a slight itching, slight pain, and a scratching sound in the ear. The nurse
suspects that an insect may have entered the ear. Which of the following should not be done?
Avoid placing water in the ear canal, which will only make the insect swell, thereby making it
more difficult to remove. An otologist should be called for the removal. The audiologist may
prescribe mineral oil or lidocaine to be applied to the ear canal.
ba
PTS:1DIF:ApplyREF:Foreign Body
st
7.The hearing of an unresponsive client needs to be assessed. Which of the following will be
used to assess the hearing of this client?
Audiometer
2.
Brainstem auditory evoked responses (BAER) test
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Rinne test
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w
3.
.te
1.
4.
Weber test
ANS: 2
The BAER test calculates the ability to hear in a client who is unresponsive. The BAER
measures the sound impulse needed to evoke a brain response, which will indicate the clients
ability to hear. The other tests need the cooperation of the client and cannot be done at this time.
PTS: 1 DIF: Apply REF: Brainstem Auditory Evoked Response Test
8.The nurse is planning to assess a client diagnosed with conductive hearing loss. When
performing the Weber test, the nurse would expect which of the following findings?
The sound will be louder in the affected ear.
2.
The sound will be louder in the good ear.
3.
Air conduction is shorter than bone conduction.
4.
No sounds will be heard.
.c
om
1.
ANS: 1
nk
ta
nk
During a Weber test, which tests bone conduction, a client with a conductive hearing loss hears
louder sounds on the affected side. Hearing louder sounds on the unaffected side is sensorineural
loss. The Rinne test compares bone with air conduction. The client will hear sounds louder in the
affected ear.
PTS: 1 DIF: Apply REF: Rinne and Weber Tests
ba
9.The nurse is performing postoperative teaching with a client recovering from a stapedectomy.
Which of the following instructions would the nurse want to include in the teaching?
It is okay to resume exercise the next day.
2.
It is okay to resume work the same day.
3.
It is okay to shower and shampoo the next day.
.te
w
It is okay to blow the nose gently one side at a time.
w
4.
st
1.
w
ANS: 4
Care must be taken not to disturb the ossicles from their position, so exercise and work should
not be resumed until healing is complete. It is also important to keep the ear dry. The client
should be taught to blow the nose gently on one side at a time so as not to increase the pressure
in the ear.
PTS: 1 DIF: Apply REF: Repair of Inner Ear Disorders
10.After a mastoidectomy, the most important complication for the nurse to assess for is:
vomiting.
2.
headache.
3.
fever.
4.
stiff neck.
om
1.
ANS: 3
nk
.c
All are complications that can occur following this type of surgery. Fever is of extra importance
because of its possible link to infection. The mastoid bone is in direct contact with the brain, and
therefore any infection can travel to the brain.
PTS: 1 DIF: Analyze REF: Repair of Inner Ear Disorders
nk
ta
11.When instructing a client on cleaning the ear, the nurse should instruct the client to clean:
only the outer ear.
2.
all the way to the middle ear.
3.
all parts of the ear outer, middle, and inner ear.
4.
just the tympanic membrane.
w
ANS: 1
.te
st
ba
1.
w
Only the outer portion of the ear should be cleaned. Inserting different objects into the ear canal
may result in injury and damage.
w
PTS: 1 DIF: Apply REF: Planning and Implementation
12.Which of the following would prohibit an elderly client from wanting to obtain and use a
hearing aid?
1.
Fears sounds will be too loud
2.
Thinks not necessary for a temporary problem
3.
Fears the cost
4.
Prefers silence
ANS: 3
om
Some of the problems encountered by clients obtaining hearing aids include appearance, cost,
education, unrealistic expectations, and difficulty with the care and maintenance of the hearing
aids. The other choices are not problems encountered by clients obtaining hearing aids.
PTS:1DIF:AnalyzeREF:Hearing Aids
Keep the appliance turned on at all times.
2.
Store the hearing aid in a warm, moist place.
3.
Batteries last for at least 1 month.
4.
Clean ear molds at least once a week.
ba
nk
ta
nk
1.
.c
13.Which of the following should the nurse instruct a client who is being fitted for a hearing aid?
st
ANS: 4
.te
The nurse should instruct the client to turn off the appliance when not in use; store in a cool, dry
place; change the batteries at least once per week; and clean ear molds at least once per week.
PTS: 1 DIF: Apply REF: Patient Playbook: Care of Hearing Aids
w
MULTIPLE RESPONSE
w
w
1.The nurse is instructing a client diagnosed with otitis media on management during the acute
phase. Which of the following should the nurse include in the teaching? (Select all that apply.)
1.
Take the antibiotics as ordered.
2.
Take over-the-counter analgesics for mild pain as recommended.
3.
It is okay to go swimming.
4.
It is okay to go on vacation and trips that require flying.
5.
If excruciating pain develops, seek medical care.
6.
Limit fluids.
om
ANS: 1, 2, 5
.c
Clients must complete the medication as ordered to kill the infection. Mild analgesics for pain
are often needed. If excruciating ear pain develops, the client should seek medical care to rule
out perforation of the eardrum. It is important to keep the ear dry, so the client should not swim
at this time. Flying is not recommended at this time. Limiting fluids is not necessary with otitis
media.
nk
PTS: 1 DIF: Apply REF: Otitis Media
nk
ta
2.When caring for a client with total hearing loss, the nurse is instructing the client about the
many options that are available to function in a hearing world. Which of the following should the
nurse include? (Select all that apply.)
Flashing lights for alarms
2.
TV with closed captions
3.
Talking computer
.te
st
ba
1.
w
6.
Cell phones with headsets
w
5.
Lip reading and sign language
w
4.
Loud ringers on telephones
ANS: 1, 2, 4
Patients who have no hearing have access to various mechanisms to alert them to various sounds.
Flashing lights for alarms to phones and doorbells, TV with closed captions for the hearing
impaired, and classes in lip reading and sign language are some options. Talking computers and
cell phones with headsets are advancements for the hearing, not for the hearing impaired. Loud
ringers on telephones would also be helpful to the client with some hearing and not a total
hearing loss.
PTS: 1 DIF: Apply REF: Communication Tools
Natal infections
3.
Physical deformities
4.
Noise levels
5.
Maternal ototoxic drugs
6.
Maternal TORCH infections
.c
2.
nk
Genetics
nk
ta
1.
om
3.A client is diagnosed with a congenital hearing loss. Which causes does the nurse realize are
reasons for this type of hearing loss? (Select all that apply.)
ANS: 1, 2, 3, 5, 6
st
ba
Congenital hearing loss can be derived from genetics, natal infections, or physical deformities of
the ear in addition to maternal ototoxic drug use and maternal TORCH infections that include
toxoplasmosis, rubella, cytomegalovirus, and herpes virus type 2. Noise levels do not cause a
congenital hearing loss.
PTS: 1 DIF: Analyze REF: Auditory Dysfunction: Genetics
Turn down radio and television volume.
w
w
1.
w
.te
4.A client with a family history of hearing loss asks the nurse what he can do to prevent this
disorder as he ages. Which of the following should the nurse instruct this client? (Select all that
apply.)
2.
Avoid noisy areas such as rock concerts.
3.
Wear protective devices.
4.
Use plain cotton balls in the ears.
5.
Avoid sun exposure.
6.
Flush the ears daily with mineral oil.
ANS: 1, 2, 3
om
Measures to prevent hearing loss include turning down the volume on the radio and television,
avoiding noisy areas such as rock concerts, and wearing protective devices. Using cotton balls in
the ears does not decrease noise from reaching the middle ear. Sun exposure does not impact
hearing. Flushing the ears daily with mineral oil might decrease the buildup of cerumen;
however, it will not improve hearing.
PTS:1DIF:ApplyREFrimary Prevention
.c
5.Which of the following are indications that a client has been exposed to excessive noise?
(Select all that apply.)
Raising the voice to talk in normal conversation
2.
Clear drainage from the ears
3.
Inability to hear a conversation 2 feet away
4.
Sounds are muffled
5.
Ringing of the ears
6.
Short periods of pain in the ears
.te
st
ba
nk
ta
nk
1.
w
ANS: 1, 3, 4, 5, 6
w
w
Warning signs of excessive noise exposure include raising the voice to talk in normal
conversation, inability to hear a conversation 2 feet away, muffled sounds, ear ringing, and short
periods of ear pain. Clear drainage from the ears does not occur with excessive noise exposure.
Chapter 56: Structure and Function of the Musculoskeletal System
1.
Skeletal tissue contains intercellular collagen fibers that provide ______ for tendons and ligaments.
A)
elastic recoil
B)
shape flexibility
C)
tensile strength
D)
inorganic calcium
2.
Cartilage is a firm but flexible type of connective tissue that is essential for:
A)
calcium salt storage.
B)
growth of long bones.
C)
bone surface perfusion.
D)
reduced friction on tendons.
calcitonin
C)
prolactin
D)
phosphate
4.
om
B)
.c
vitamin D
nk
A)
Cancellous bone is relatively light, but its lattice-like structure gives it:
A)
rigidity.
B)
thickness.
C)
a growth plate.
D)
tensile strength.
ba
To maintain adequate serum calcium levels, parathyroid hormone reduces:
activation of vitamin D.
B)
serum phosphate levels.
C)
calcium release from bone.
D)
st
A)
.te
5.
nk
ta
3.
Whereas PTH increases blood calcium levels, the hormone _____ lowers blood calcium levels and
decreases bone resorption.
intestinal absorption of calcium.
6.
connective tissue.
w
C)
hyaline cartilage.
w
B)
a joint capsule.
w
A)
In contrast to synarthroses joints, synovial joints are linked to the bone by:
D)
7.
interosseous ligaments.
The joint capsule consists of an outer fibrous layer and an inner synovium, which ______ to facilitate
movement.
A)
senses position
B)
connects to tendons
C)
secretes synovial fluid
D)
covers articular cartilage
A)
autonomic nerve fibers
B)
supporting bursa sacs
C)
reflexive proprioception
D)
elastic articular cartilage
In growing bone, severe vitamin C deficiency slows bone growth by impairing:
A)
organic matrix formation.
B)
calcification of new bone.
C)
growth plate separation.
D)
widening of the cortex.
A)
canaliculi
B)
endosteum
C)
synovial
D)
periosteum
11.
nk
Bones are covered, except at their articular ends, by a ______ membrane.
nk
ta
10.
Which of the following is the primary role of fibrocartilage?
Absorption of physical shock
B)
Provision of flexibility
C)
Facilitation of long bone growth
D)
Tissue hydration
12.
.te
st
ba
A)
Which of the following characteristics differentiates cartilage from bone?
A)
Secretion of an extracellular matrix
w
Low tensile strength
Rapid healing
w
D)
Avascularity
w
B)
C)
om
9.
.c
8.
The tendons and ligaments of the joint capsule are sensitive to position and movement as a result of
having _______ to help maintain muscle support.
13.
A long bone, such as the humerus of the upper arm, has which of the following structural
characteristics?
A)
A perichondrium that overlies most of the bone surface
B)
A durable outer shell made of cancellous bone
C)
A diaphysis at each end
D)
An endosteum composed of osteogenic cells
14.
Which of the following statements most accurately describes the anatomy and physiology of the bon
marrow?
A)
Hematopoiesis takes place in red bone marrow.
B)
Yellow bone marrow predominates in infants.
C)
By adulthood, all red bone marrow has been replaced by yellow bone marrow.
D)
Yellow bone marrow is hematopoietically active in infants, but not in adults.
A)
Differentiation into mature bone cells
B)
Synthesis and secretion of bone matrix
C)
Maintenance of calcium balance
D)
Resorption of the bone matrix
16.
An increase in the level of RANKL would result in:
om
What role do osteoblasts play in the physiology of bone tissue?
.c
15.
fusing of the epiphysis and metaphysic in long bones.
B)
changes in the rate of bone remodeling.
C)
decreased production of PTH.
D)
increased vitamin D activation.
nk
ta
17.
nk
A)
How are the oxygenation needs of the articulating areas in a synovial joint met?
Capillaries release oxygenated blood into the synovial cavity at a controlled rate.
B)
The cartilage of the articulating areas uses anaerobic metabolism exclusively.
C)
Oxygen is provided to the articulating areas by synovial fluid rather than by blood.
D)
The epiphyses of long bones provide oxygen to the articulating areas.
ba
A)
st
Magnetic resonance imaging of a patients knee has revealed the presence of bursitis. What is the
primary purpose of bursae?
.te
18.
A)
To maintain close articulation between the two long bones at a synovial joint
B)
To strengthen the attachment between skeletal muscles and bones
w
To prevent friction at a tendon in a synovial joint
A basketball player fell awkwardly when attempting to claim a rebound, a mishap that resulted in a t
to the anterior cruciate ligament of his left knee. What characteristic of ligaments makes them
particularly susceptible to injury?
w
D)
To strengthen the integrity of the articulating capsule
w
C)
19.
A)
Ligaments are incapable of accommodating lateral movement.
B)
Ligaments are exclusive to the knee, which is the most frequently injured joint.
C)
Ligaments are superficial to the synovial capsule and are consequently vulnerable to impacts.
D)
Ligaments are incapable of stretching when exposed to unusual stress.
20.
A)
Which of the following joints is classified as a synarthrosis?
The joint between two vertebrae
B)
The joint between the femur and the pelvis
C)
The joint between the humerus and the radius and ulna
B
6.
A
7.
C
8.
C
9.
A
10.
D
11.
A
12.
B
13.
D
14.
A
15.
B
16.
B
17.
C
18.
D
19.
D
20.
A
om
5.
.c
D
nk
4.
nk
ta
B
ba
3.
st
B
w
2.
An interphalangeal joint of the hand (knuckle)
.te
D)
Answer Key
1.
C
w
w
Chapter 57: Disorders of Musculoskeletal Function: Trauma, Infection, and Neoplasms
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)
A pathologic stress fracture occurs in bones subjected to:
sudden direct force.
B)
weakening by disease.
C)
repeated excessive use.
D)
massive muscle contraction.
A)
tetany.
B)
deformity.
C)
necrosis.
D)
numbness.
In order to initiate the cellular events essential to bone healing, there must be ________ formation at t
fracture site.
callous
B)
hematoma
C)
ossification
D)
fibrin meshwork
5.
.c
A)
In contrast to structural scoliosis, postural scoliosis:
compresses vertebrae.
B)
corrects with bending.
C)
is apparent at birth.
D)
becomes painful.
ba
A)
st
Factors that may adversely affect bone healing include______ of the bone.
A)
immobilization
B)
.te
6.
weight bearing
C)
delayed union
tight alignment
The distinguishing characteristic of chronic osteomyelitis is the presence of:
w
7.
w
D)
sequestrum bone.
w
A)
nk
4.
om
Shortly after a closed fracture has occurred, early manifestations include localized:
nk
ta
3.
B)
abscess formation.
C)
severe bone pain.
D)
external drainage.
8.
Developmental dysplasia of the hip (DDH), formerly known as congenital hip dislocation, is suspecte
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.
B)
joint immobility.
C)
muscle atrophy.
D)
extremity elevation.
A college baseball player has seen his season cut short by a rotator cuff injury. Rotator cuff injuries
frequent because of:
nk
ta
11.
om
inflammation.
nk
A)
.c
10.
The patient has a fractured tibia. After the cast is applied he is at high risk for compartment syndrom
caused by:
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.
ba
A)
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?
Formation of granulation tissue
B)
Development of fibrocartilage that resembles the appearance of the original bone
.te
st
A)
C)
Deposition of mineral salts into the callus
Reduction in the size of the callus
the presence of dead bone tissue.
w
A)
A child has been hospitalized for the treatment of hematogenous osteomyelitis. The defining
characteristic of this type of osteomyelitis is:
w
13.
w
D)
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
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
A patient with a diagnosis of small cell lung carcinoma has developed bone metastases, a finding tha
has prompted a series of new interventions. What are the primary goals of the treatment regimen for
patients bone cancer?
.c
16.
om
15.
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.
nk
ta
nk
A)
Metastatic bone disease is most closely associated with:
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.
ba
A)
st
.te
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 diagnosi
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.
w
This might have been caused by something you were exposed to during the early part of your
pregnancy.
Youll have to be vigilant of your childs safety for the next few years, but the disease often
resolves spontaneously.
w
C)
w
B)
D)
19.
With aggressive treatment, most children with osteogenesis imperfecta are cured within severa
months.
A child with a diagnosis of Legg-Calv-Perthes disease will exhibit:
A)
defective synthesis of type I collagen.
B)
congenital dislocation of the acetabulofemoral joint.
C)
necrosis of the proximal femoral head.
D)
intoeing due to metatarsus adductus.
20.
Assessment of a newborn infant reveals the presence of developmental dysplasia of the hip (DDH) t
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
B
6.
C
7.
A
8.
A
9.
D
10.
A
11.
A
12.
D
13.
B
14.
A
15.
D
16.
C
17.
D
A
w
18.
om
5.
.c
B
nk
4.
nk
ta
D
ba
3.
st
B
w
2.
Joint reconstruction
.te
D)
Answer Key
1.
D
C
20.
B
w
19.
Chapter 58: Disorders of Musculoskeletal Function: Developmental and Metabolic Disorders
1.
Disorders that affect cortical bone typically result in:
A)
fractures of long bones.
B)
impaired collagen synthesis.
C)
infection.
D)
vertebral fractures.
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.
stress fractures
B)
calcium excretion
C)
bone cortex thinning
D)
defective mineralization
dysplasia.
B)
polyarticular.
C)
asymmetrical.
D)
osteophytes.
A feature of rheumatoid arthritis that differentiates it from other forms of inflammatory arthritis is the
development of:
pannus tissue.
B)
tophi deposits.
C)
subluxations.
D)
st
A)
.te
5.
nk
ta
A)
nk
Rheumatoid arthritis is a systemic inflammatory disease with joint manifestations described as:
ba
4.
autoantibodies.
rheumatoid arthritis.
w
C)
gout syndrome.
w
A)
HLA-B27 antigen may be linked to other genes that determine the pathologic autoimmune phenomen
in:
w
6.
B)
om
A)
.c
2.
D)
7.
osteoarthritis syndrome.
ankylosing spondylitis.
Osteoarthritis is a degenerative form of joint disease that is often evidenced by:
A)
spongy joints.
B)
cartilage hypertrophy.
C)
crepitus and grinding.
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.
A)
arthralgia.
B)
tendon rupture.
C)
facial hair growth.
D)
pyelonephritis.
.c
Premature osteoporosis is being seen increasingly in female athletes because of an increased prevale
of:
A)
amenorrhea.
B)
high protein intake.
C)
abnormal body fat.
D)
osteoarthritis.
11.
nk
10.
om
The most commonly occurring early symptoms of systemic lupus erythematosus (SLE) include:
nk
ta
9.
For many patients, the first indication that they have osteoporosis is:
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.
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?
.te
12.
st
ba
A)
A)
Weight-control and daily use of low-dose corticosteroids
Genetic testing and range of motion exercises
w
B)
Increased fluid intake and use of vitamin D supplements
A 77-year-old woman has been admitted to the geriatric medical unit of the hospital for the treatmen
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 th
this patient likely has a history of:
w
D)
Calcium supplementation and regular physical activity
w
C)
13.
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
om
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)?
Chronic nausea and vomiting that is unresponsive to antiemetics
B)
Joint pain and increased creatinine and blood urea nitrogen
C)
A history of thromboembolic events and varicose veins
D)
Dysmenorrhea and recent spontaneous abortion
nk
.c
A)
nk
ta
16.
A 26-year-old woman has sought care for increasing pain at the back of her ankle and the bottom of
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 hist
suggests the possibility of:
systemic sclerosis.
B)
ankylosing spondylitis.
C)
osteoarthritis.
D)
reactive arthritis.
A 55-year-old male patient has reported joint pain in his feet. Which of the following blood work re
should prompt further testing to rule out primary gout?
.te
17.
st
ba
A)
A)
Increased C-reactive protein (CRP)
Increased serum uric acid
w
B)
Increased serum cortisol
Despite differences in onset, involvement, and symptomatology, all of the spondyloarthropathies
involve:
w
D)
Increased polymorphonuclear leukocytes
w
C)
18.
A)
sacroiliitis.
B)
calcinosis.
C)
excessive bone turnover.
D)
autoimmune etiology.
19.
A)
The clinical course of osteoarthritis (OA) culminates in:
osteonecrosis and loss of synovial fluid.
B)
formation of tophi in the synovial space.
C)
osteophyte formation and erosion of cartilage.
D)
separation of the epiphyseal plate.
Which of the following disorders of the skeletal system occurs exclusively in older adults?
A)
Polymyalgia rheumatica
B)
Psoriatic arthritis
C)
Reiter syndrome
5.
A
6.
D
7.
C
8.
A
9.
A
10.
A
11.
B
12.
C
13.
D
14.
B
15.
B
D
w
16.
.c
B
nk
4.
nk
ta
D
ba
3.
st
D
w
2.
Ankylosing spondylitis
.te
D)
Answer Key
1.
A
om
20.
B
w
17.
18.
A
19.
C
20.
A
Chapter 59: Disorders of Musculoskeletal Function: Rheumatic Disorders
MULTIPLE CHOICE
1.A client is diagnosed with osteoarthritis. The nurse would not expect to find which of the
following during assessment?
Bouchards nodes
2.
Crepitus
3.
Heberdens nodes
4.
Symmetrical joint involvement
om
1.
ANS: 4
.c
Symmetrical joint involvement is seen with rheumatoid arthritis, not osteoarthritis. Bouchards
nodes, Heberdens nodes and crepitus are all assessment findings consistent with osteoarthritis.
nk
PTS:1DIF:Apply
nk
ta
REF: Osteoarthritis: Assessment with Clinical Manifestations
2.The nurse is instructing a client diagnosed with osteoarthritis. Which of the following
statements indicates that the client understands these instructions?
Exercise will not be of help because it will stress my joints.
2.
I will need to lose weight; my doctor says about 20 pounds.
3.
I will take my medications only if the pain is very bad.
4.
I can still go on my marathon shopping trips with my daughter.
w
ANS: 2
w
.te
st
ba
1.
w
Exercise and weight reduction help maintain joint mobility and muscle strength. Walking can be
done at home and is low stress to the joints. Scheduled medications should be taken to relieve
inflammation, and pain medications should be taken before the pain gets very bad. The client
should schedule rest periods with activity so as not to do too much at one time.
PTS:1DIF:Analyze
REF: Osteoarthritis: Collaborative Management; Evaluation of Outcomes
3.A client diagnosed with gout is concerned about the formation of nodules. The nurse should
explain that these nodules are called:
Bouchards nodes.
2.
cysts.
3.
Heberdens nodes.
4.
tophi.
om
1.
ANS: 4
PTS: 1 DIF: Apply REF: Gout: Pathophysiology
nk
.c
A tophus is the characteristic nodule that develops in the patient with gout. A tophus consists of
uric acid crystals. Bouchards and Heberdens nodes are present in patients with osteoarthritis.
Cysts are fluid-filled areas.
nk
ta
4.A client is experiencing an acute attack of gout. The nurse should be prepared to provide which
of the following medications as prescribed?
Allopurinol
ba
1.
Colchicine
st
2.
Probenecid
.te
3.
Sulfinpyrazone
ANS: 2
w
4.
w
w
Colchicine is used for the acute attack phase. The other medications would be used for further
treatment of the gout.
PTS:1DIF:ApplyREF:Gout: Pharmacology
5.A client is going to have tender points examined to determine the diagnosis of fibromyalgia.
The nurse should instruct the client the number of tender points that must be positive for the
diagnosis would be:
1.
11.
2.
13.
3.
15.
4.
17.
om
ANS: 1
The presence of at least 11 of 18 tender points is considered diagnostic for fibromyalgia. The
other higher numbers would just be useful to confirm the diagnosis.
nk
REF: Fibromyalgia: Assessment with Clinical Manifestations
.c
PTS:1DIF:Apply
nk
ta
6.The nurse is teaching a group of community members at the senior center about osteoporosis.
Which of the following clinical manifestations should the nurse instruct as not being related to
the disorder?
Decrease in height
2.
Fractures
3.
Kyphosis
st
ba
1.
Pain
.te
4.
w
ANS: 4
w
w
Pain is a symptom of osteoarthritis. A person with osteoporosis may not know she has
osteoporosis until height and bone changes have already occurred. Kyphosis or hunchback is a
symptom of osteoporosis. A person might not know that they have osteoporosis until they
experience a fracture.
PTS:1DIF:Apply
REF: Osteoporosis: Assessment with Clinical Manifestations
7.During an assessment, the nurse determines that a client has a forward curvature of the thoracic
spine. Which of the following terms would the nurse use to document this assessment finding?
1.
Kyphosis
2.
Lordosis
3.
Scoliosis
4.
Spondylolisthesis
om
ANS: 1
.c
Kyphosis is the forward curvature of the thoracic spine also known as humpback. Lordosis, or
swayback, is an inward curvature of the lumbar spine. Scoliosis is a sideway curvature of the
spine. Spondylolisthesis is when a vertebra slips over the one below.
PTS:1DIF:ApplyREF:Spinal Disorders
nk
ta
nk
8.A client is being evaluated for generalized skeletal pain and pain in the hips, ribs, and feet. The
nurse observes that the client walks with a waddling gait. Because of this information, which of
the following should the nurse suspect is occurring with this client?
Osteomalacia
2.
Osteomyelitis
ba
1.
Osteosarcoma
st
3.
Pagets disease
.te
4.
w
ANS: 1
w
w
Osteomalacia is a metabolic disease that causes poor and delayed mineralization of the bone cells
in mature bones. The main cause of osteomalacia is a vitamin D deficiency. Osteomalacia
presents with generalized skeletal pain and pain in the hips, ribs, and feet. Pagets disease is a
chronic bone disorder with no definitive cure. Osteomyelitis is a serious infection of the bone.
Osteosarcoma is the most common type of primary bone cancer.
PTS: 1 DIF: Analyze REF: Osteomalacia: Pathophysiology
9.A young client has been diagnosed with a soft tissue tumor resembling striated muscle in the
neck. The nurse realizes that this type of tumor would be considered:
1.
chondrosarcoma.
2.
Ewings sarcoma.
3.
neurofibrosarcoma.
4.
rhabdomyosarcoma.
om
ANS: 4
.c
Rhabdomyosarcoma is a soft tissue tumor resembling striated muscle, and it is seen in the
extremities, head, neck, urinary tract, or reproductive organs. Chondrosarcoma is a bone tumor
most commonly seen in the knees, shoulders, and pelvis. Ewings sarcoma is a bone tumor found
in the diaphysis of the femur and the flat bones of the pelvic girdle. Neurofibrosarcoma is a soft
tissue tumor found in nerve sheaths.
nk
PTS: 1 DIF: Analyze REF: Tumors of the Musculoskeletal System
nk
ta
10.When assessing a client diagnosed with ankylosing spondylitis, which of the following
clinical manifestations will the nurse most likely assess?
Small irregular pupil
2.
Heel pain
3.
Onycholysis
.te
st
ba
1.
Respiratory depression
ANS: 1
w
4.
w
w
Other problems that occur with ankylosing spondylitis include uveitis that manifests as edema of
the upper eyelid, excessive lacrimation, small irregular pupil, and swollen iris. Heel pain is a
symptom of reactive arthritis. Onycholysis is seen in psoriatic arthritis. Respiratory depression is
a manifestation of polymyositis.
PTS:1DIF:Analyze
REF:Ankylosing Spondylitis: Assessment with Clinical Manifestations
11.A client is surprised to learn that she has been diagnosed with osteoporosis since she does not
smoke, is not underweight, and exercises. The nurse should assess if the client has any secondary
conditions which could cause the disorder, including:
diabetes mellitus.
2.
heart failure.
3.
fibromyalgia.
4.
lactose intolerance.
om
1.
ANS: 4
nk
.c
Mild malabsorption syndrome as seen with lactose intolerance is a contributing factor to
secondary osteoporosis. Secondary osteoporosis is not associated with diabetes mellitus, heart
failure, or fibromyalgia.
PTS:1DIF:Apply
nk
ta
REF:Table 59-2 Contributing Factors to Secondary Osteoporosis
Chest x-ray
2.
Hand x-ray
3.
st
1.
.te
ba
12.The nurse is assessing a client who is demonstrating clinical manifestations of Pagets disease.
The nurse realizes that which of the following diagnostic tests will aid in the diagnosis of this
disorder?
w
Serum albumin level
Serum alkaline phosphatase level
w
4.
w
ANS: 4
An increase in serum alkaline phosphatase is often the first indication that the clients symptoms
are associated with Pagets disease. Values of two to three times normal indicates the disease. Xrays of the long bones and skull aid in the diagnosis of the disorder, not x-rays of the chest or
hands. Serum albumin level is not used to diagnose Pagets disease.
PTS: 1 DIF: Analyze REF: Pagets Disease: Diagnostic Tests
13.A client diagnosed with Pagets disease is prescribed alendronate (Fosamax). Which of the
following should the nurse instruct the client regarding this medication?
Do not eat anything for 30 minutes after taking a dose.
2.
Take the medication on a full stomach.
3.
Go to the physicians office for the medication to be provided intravenously.
4.
Expect to stay on this medication for only 6 months.
om
1.
ANS: 1
nk
ta
nk
.c
Instructions regarding alendronate (Fosamax) should include Do not eat anything for 30 minutes
after taking a dose, Take on an empty stomach with 6 to 8 ounces of water in the morning, and
Do not lie down for 30 minutes after taking the medication. This medication is not to be taken on
a full stomach. This medication is provided orally; the client does not need to go to the
physicians office for intravenous administration of the medication. This medication can be taken
for longer than 6 months.
PTS:1DIF:Apply
REF: Table 59-4 Biphosphonates used with Pagets Disease
ba
MULTIPLE RESPONSE
st
1.The nurse is assessing a client who is diagnosed with gout. Which of the following findings
will the nurse most likely assess in this client? (Select all that apply.)
Decreased range of motion
.te
1.
Elevated uric acid levels
w
w
3.
Edema in a joint
w
2.
4.
Pain that develops over many weeks
5.
Fever
6.
Headache
ANS: 1, 2, 3, 5, 6
Assessment findings consistent with a client diagnosed with gout include a rapid development of
pain and edema of one joint caused by increased uric acid levels. Swelling, pain, decreased range
of motion in the affected joint, fever, and headache can also be present. Pain that develops over
many weeks is likely to be caused by another condition.
PTS: 1 DIF: Analyze REF: Gout: Assessment with Clinical Manifestations
3.
Scallops
4.
White bread
5.
Alcohol
6.
om
Milk
.c
2.
nk
Avocados
nk
ta
1.
ba
2.The nurse is instructing a client diagnosed with gout about a low-purine diet. Which of the
following foods would be identified as those to avoid when following this diet? (Select all that
apply.)
Bacon
st
ANS: 3, 5, 6
.te
Food high in purine include scallops and bacon. Alcohol is also high in purine. Avocados, milk,
and white bread are low-purine foods.
w
PTS:1DIF:ApplyREF:Gout: Nutrition
w
w
3.During an assessment, the nurse determines that a client has risk factors for the development of
osteoporosis. Which of the following are considered risk factors for this disorder? (Select all that
apply.)
1.
Balanced diet
2.
Corticosteroid therapy
3.
Low body weight
4.
Smoker
5.
Impaired vision
6.
Alcohol intake is one drink per month
om
ANS: 2, 3, 4, 5
.c
Risk factors for the development of osteoporosis include corticosteroid therapy, low body
weight, smoking, and impaired vision. A balanced diet does increase a clients risk for developing
the disorder. Alcohol intake of more than two drinks per day would increase the clients risk, but
one drink per month would not.
nk
PTS:1DIF:Analyze
REF: Red Flag: Risk Factors for Developing Osteoporosis and Related Fractures
nk
ta
4.A client is experiencing symptoms associated with the second-stage of Lyme disease. Which of
the following will the nurse most likely assess in this client? (Select all that apply.)
Erythema migrans
2.
Numbness and pain in the arms and legs
3.
Paralysis of facial muscles
.te
st
ba
1.
w
6.
Knee pain and swelling
w
5.
Meningitis
w
4.
Memory loss
ANS: 2, 3, 4
Symptoms of the second-stage of Lyme disease include numbness and pain in the arms and legs,
paralysis of facial muscles, and meningitis. Erythema migrans is a symptom of the first stage of
the disease. Knee pain and swelling and memory loss are symptoms of the third-stage of the
disease.
Chapter 60: Structure and Function of the Skin
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.
Merkel cells.
B)
reticular dermis.
C)
Langerhans cells.
D)
dermal dendrocytes.
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.
follicular bulbs
B)
dermal papillae
C)
apocrine glands
D)
sebaceous glands
Unlike hair, nails grow:
.te
5.
st
ba
A)
A)
strata.
outward.
w
B)
cyclically.
continuously.
w
C)
D)
Lichenification is caused by:
w
6.
A)
epidermal breakage.
B)
repeated scratching.
C)
chronic area pressure.
D)
decreased skin shedding.
7.
A)
.c
A)
om
Cells that form a network to bind and process antigens in the epidermis are known as:
nk
2.
nk
ta
1.
In addition to keratinocytes, the epidermis has _____ cells that protect against damage from ultraviole
radiation.
melanocyte
B)
Langerhans
C)
subcutaneous
D)
protein granule
A)
skin lubricant.
B)
fibrous protein.
C)
watery secretion.
D)
nutritional source.
A)
selective filter.
B)
nutritional source.
C)
ground substance.
D)
pressure receptor.
10.
.c
The basement membrane between the epidermis and dermis provides for adhesion and serves as a:
nk
9.
om
Sebaceous glands secrete sebum, which is a:
Pruritus, a symptom common of many skin disorders, is a(an):
nk
ta
8.
temporary rash.
B)
itching sensation.
C)
nociceptor response.
D)
result of repeated scratching.
st
Mitosis that results in the production of new epidermal cells occurs in which of the following layers
the epidermis?
A)
Stratum lucidum
B)
.te
11.
ba
A)
Stratum granulosum
C)
Stratum germinativum
Stratum spinosum
Nerve fibers originate in the dermis and terminate in the stratum corneum of the epidermis.
w
A)
Which of the following statements about the structure of the skin is correct?
w
12.
w
D)
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
Which of the following skin disorders is likely to result from the localized lack of melanin productio
by melanocytes?
A)
Rash
B)
Bullae
C)
Vitiligo
D)
Melasma
om
A)
Slower keratinization
B)
Changes in sebaceous secretions
C)
Dehydration of epidermal cells
D)
Increased production of bile salts
Dark skin tone is genetically determined and is primarily the result of:
nk
ta
16.
.c
15.
Due to the increasing dryness of her skin in recent years, a 70-year-old woman has needed to reduce
number of baths that she takes. Which of the following factors has resulted in this age-related chang
skin function?
nk
14.
high production of melanin.
B)
dense distribution of melanosomes.
C)
superficial distribution of melanocytes.
D)
high levels of tyrosinase.
Which of the following skin lesions is categorized as a type of blister?
Bulla
B)
Wheal
.te
A)
st
17.
ba
A)
C)
Nodule
Plaque
w
D)
w
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 t
the lesions are between 2 and 4 mm in diameter and are filled with serous fluid. The clinician would
document the presence of:
w
18.
A)
pustules.
B)
macules.
C)
vesicles.
D)
papules.
19.
Which of the following characteristics differentiates apocrine sweat glands from eccrine sweat gland
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 .
20.
Most of the bodys hair follicles are paired with:
A)
a Langerhans cell.
B)
an eccrine sweat gland.
C)
a nerve ending.
D
6.
B
7.
A
8.
A
9.
A
10.
B
11.
C
12.
B
13.
B
14.
C
15.
B
16.
A
A
w
17.
om
5.
.c
D
nk
4.
nk
ta
B
ba
3.
st
C
w
2.
a sebaceous gland.
.te
D)
Answer Key
1.
A
C
w
18.
19.
A
20.
D
Chapter 61: Disorders of Skin Integrity and Function
1.
Manifestations of superficial dermatophytosis of the skin include:
A)
scaling.
B)
erythema.
C)
vesicles.
D)
infiltration.
Onychomycosis initially causes the toenail to appear ____ as the fungus digests the nail keratin.
A)
black
B)
cracked
C)
opaque
D)
eroded
circular patches.
B)
satellite lesions.
C)
fungal spores.
D)
raised borders.
4.
Warts develop when _____ are invaded by human papillomavirus (HPV).
melanocytes
B)
keratinocytes
C)
sebaceous glands
D)
subcutaneous cells
ba
A)
Allergic and hypersensitivity dermatoses are characterized by:
target lesions.
B)
dark erythema.
C)
st
A)
.te
5.
epidermal edema.
D)
silver-white scale.
w
scaling papules.
granular scabbing.
w
B)
Papulosquamous dermatoses, such as psoriasis, are a group of skin disorders characterized by:
w
6.
A)
.c
A)
om
A yeast-like Candida albicans fungal infection can be differentiated from a tinea fungal infection by t
presence of:
nk
3.
nk
ta
2.
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.
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:
larger than other nevi.
B)
oval epidermal nests.
C)
dermal cords of cells.
D)
brown rounded papules.
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?
Acne vulgaris
B)
Urticaria
C)
Atopic dermatitis
D)
Verrucae
st
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:
increased epidermal cell turnover.
w
A)
.te
12.
an IgE-mediated immune reaction.
w
B)
hormonal influences on sebaceous gland activity.
w
D)
ba
A)
C)
nk
Which one of the following skin disorders seen in elderly persons is considered a premalignant lesio
nk
ta
10.
.c
A)
om
8.
13.
human papillomaviruses (HPV).
A patient has been admitted to the intensive care unit of the hospital after developing toxic epiderma
necrolysis (TEN) consequent to the administration of a sulfonamide antibiotic. What pathophysiolog
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
om
15.
A 44-year-old man has been brought to the emergency department by emergency medical services w
severe electrical burns resulting from a workplace accident. The most immediate threat to this patien
survival at this time is:
infection.
B)
hemodynamic instability.
C)
acute pain.
D)
decreased protein synthesis and impaired healing.
nk
.c
A)
nk
ta
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?
Prophylactic antibiotics
B)
Repositioning the patient on a scheduled basis
C)
Applying protective dressings to vulnerable areas
D)
Parenteral nutrition
Which of the following actions involves the greatest risk of skin shearing?
st
17.
ba
A)
Inserting a peripheral intravenous catheter
B)
Rolling the patient from a supine to side-lying position
.te
A)
C)
Pulling the patient up in bed
Helping the patient ambulate after surgery
A)
Malignant melanoma
w
B)
What neoplasm of the skin is associated with the poorest prognosis?
w
18.
w
D)
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.
20.
A 5-year-old girl has been presented for care by her father due to her recent development of macules
her trunk, extremities, and mucous membranes. The child is mildly febrile but her primary symptom
extreme pruritus. What disorder of the skin should the clinician who is assessing the child first suspe
A)
Varicella
B)
Lichen planus
C)
Rosacea
C
6.
A
7.
D
8.
A
9.
A
10.
B
11.
A
12.
A
13.
D
14.
C
15.
B
16.
B
C
w
17.
om
5.
.c
B
nk
4.
nk
ta
B
ba
3.
st
C
w
2.
Impetigo
.te
D)
Answer Key
1.
A
A
19.
D
20.
A
w
18.