Pathophysiology: A Practical Approach: A Practical Approach 4th
Edition Story Test Bank
Chapter 1 Cellular Function
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___ 1. An increase in cardiac size and function due to increased workload is termed
A)
Atrophy.
B)
Functional.
C)
Hypertrophy.
D)
Inflammation.
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___ 2. While assessing a patient diagnosed with Marfan's Syndrome, the nurse should
include which of the following that is consistent with the syndrome?
A)
Cardiac assessment for coarctation of the aorta.
B)
Genital assessment for small testicles.
C)
Mental assessment for impairment.
D)
Oral assessment for cleft palate.
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___ 3. Children with PKU must avoid phenylalanine in the diet. Phenylalanine is most
likely to be a component of
A)
Fat.
B)
Sugar.
C)
Protein.
D)
Carbohydrate.
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___ 4. A 17-year-old college-bound student receives a vaccine against an organism that
causes meningitis. This is an example of
A)
primary prevention.
B)
secondary prevention.
C)
tertiary prevention.
D)
disease treatment.
___ 5. Metaplasia is
A)
The disorganization of cells into various sizes, shapes, and arrangements.
B)
The replacement of one differentiated cell type with another.
C)
The transformation of a cell type to malignancy.
D)
An irreversible cellular adaptation.
___ 6. During a routine ultrasound of a 38 year old women 26 weeks gestation reveals a
fetus with a small square head, upward slant of the eyes, and low set ears. The
nurse recognizes that these findings are consistent with which of the following?
A)
Fragile X Syndrome.
B)
Monosomy X (Turner's Syndrome).
C)
Trisomy 21 (Down's Syndrome).
D)
Trisomy X (Klinefelter's Syndrome).
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___ 7. While discussing treatment options with a parent of a newly diagnosed Monosomy
X (Turner's Syndrome) child, the nurse should include which of the following?
A)
There is no treatment or cure.
B)
Symptoms of the condition are treated with estrogen.
C)
Symptoms of the condition are treated with testosterone.
D)
Institutionalization is the preferred method of managing care.
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___ 8. Which of the following assessment findings indicates an alteration in homeostatic
control mechanisms?
A)
Fever
B)
Throat pain
C)
Joint stiffness
D)
Positive throat culture
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___ 9. What information should parents be given about the consequences of
phenylketonuria (PKU)?
A)
Mental retardation is inevitable.
B)
PKU is commonly associated with other congenital anomalies.
C)
High dietary tyramine may help induce enzyme production.
D)
Failure to treat properly results in progressive mental retardation.
___ 10. Injury that occurs when blood flow is diminished to tissue is called _____ injury.
A)
hypoxic
B)
ischemic
C)
hyperemic
D)
neoplastic
___ 11. Tay sachs is caused by which of the following?
A)
A deficiency or absence of hexosaminidase A
B)
A defect on chromosome 17 or 22
C)
A mutation on chromosome 15
D)
An error in converting phenylalanine to tyrosine
___ 11. Tay sachs is caused by which of the following?
A)
A deficiency or absence of hexosaminidase A
B)
A defect on chromosome 17 or 22
C)
A mutation on chromosome 15
D)
An error in converting phenylalanine to tyrosine
___ 12. An obese but otherwise healthy teen goes to a health fair and has her blood
pressure checked. This is an example of
A)
primary prevention.
B)
secondary prevention.
C)
tertiary prevention.
D)
disease treatment.
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___ 13. Characteristics of X-linked recessive disorders include which of the following?
A)
The son of a carrier mother has a 25% chance of being affected.
B)
Affected fathers transmit the gene to all of their sons.
C)
All daughters of affected fathers are carriers.
D)
Boys and girls are equally affected.
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___ 14. A factor associated with risk of Down syndrome is
A)
Maternal age.
B)
Maternal alcohol intake.
C)
Family history of heritable diseases.
D)
Exposure to TORCH syndrome organisms.
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___ 15. Which type of gangrene is usually a result of arterial occlusion?
A)
Necrosis.
B)
Dry.
C)
Wet.
D)
Gas.
___ 16. The cancer growth continuum is divided into the following stages.
A)
Stage 1, Stage 2, Stage 3
B)
Initiation, Progression, Promotion
C)
Preliminary, Evolutionary, Metastasis
D)
Initiation, Promotion, Progression
___ 17. A disease in which the principal manifestation is an abnormal growth of cells
leading to formation of tumors is called a __________ disease.
A)
congenital
B)
degenerative
C)
metabolic
D)
neoplastic
___ 17. A disease in which the principal manifestation is an abnormal growth of cells
leading to formation of tumors is called a __________ disease.
A)
congenital
B)
degenerative
C)
metabolic
D)
neoplastic
___ 18. The activities of the cell are directed by which cell structure?
A)
Cytoplasm
B)
Organelles
C)
Cell membranes
D)
Nucleus
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___ 19. Enzymes that use oxidation to convert food materials into energy are found in
sausage-shaped structures called __________.
A)
endoplasmic reticulum
B)
ribosomes
C)
mitochondria
D)
Golgi apparatus
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___ 20. Mitochondria, endoplasmic reticulum, Golgi apparatus, lysosomes, and centrioles
are all examples of __________.
A)
cell membranes
B)
organelles
C)
enzymes
D)
None of the above
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___ 21. Choose the answer below that best completes the sentence: DNA is composed of
__________ base chemicals called __________.
A)
4; adenine, thymine, guanine, cytosine
B)
3; nucleotide, deoxyribose, base
C)
2: chromosomes, proteins
D)
None of the above.
___ 22. Which of the terms below does not describe a method by which cells adapt to
changing conditions?
A)
Hypertrophy
B)
Hyperplasia
C)
Increased enzyme synthesis
D)
Necrosis
___ 23. Dysplasia of epithelial cells sometimes results from which of the following?
A)
Excessive sodium intake
B)
Chronic irritation or inflammation
C)
Increased enzyme synthesis
D)
Apoptosis
___ 23. Dysplasia of epithelial cells sometimes results from which of the following?
A)
Excessive sodium intake
B)
Chronic irritation or inflammation
C)
Increased enzyme synthesis
D)
Apoptosis
___ 24. The function of lysosomes is to:
A)
break down particles or worn-out cellular components.
B)
convert food materials into energy.
C)
produce digestive enzymes and antibody proteins.
D)
aid in cell division.
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___ 25. A __________ gene is one that produces an effect only in the homozygous state.
A)
dominant
B)
recessive
C)
sex-linked
D)
hemizygous
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___ 26. A __________ gene expresses itself in either the heterozygous or the homozygous
state.
A)
dominant
B)
recessive
C)
sex-linked
D)
hemizygous
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___ 27. Genes carried on sex chromosomes are called __________ genes.
A)
dominant
B)
recessive
C)
sex-linked
D)
hemizygous
___ 28. A common abnormality in females, __________ syndrome results from an absence
of one X chromosome.
A)
triple X
B)
Turner’s
C)
Klinefelter’s
D)
Down
___ 29. __________ syndrome occurs in males when there is an extra X chromosome.
A)
Triple X
B)
Turner’s
C)
Klinefelter’s
D)
XYY
___ 29. __________ syndrome occurs in males when there is an extra X chromosome.
A)
Triple X
B)
Turner’s
C)
Klinefelter’s
D)
XYY
___ 30. A metastatic tumor is one that:
A)
has spread to a location way from its site of origin.
B)
shows slow expansion and well-differentiated cells.
C)
cannot be classified easily.
D)
invades deeply into the tissue where it arose.
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A
C
A
B
C
B
A
D
B
A
B
C
A
B
D
D
D
C
B
A
D
B
A
B
A
C
B
C
A
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2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
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Answer Key
Rationales
1. Hypertrophy occurs in response to increased workload. Atrophy occurs in response to
decreased workload. Functional refers to normal cell function. Inflammation involves the
immune system and occurs in response to a stressor.
2. Coarctation is a common manifestation of Marfans syndrome. Small testicles, mental
impairment, and cleft palate are not associated with the condition.
3. Phenylalanine is mainly found in protein and not in fat, sugar, and carbohydrates.
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4. Vaccines prevent ever getting the disease or condition; therefore, they are considered
primary prevention.
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5. Metaplasia is the replacement of one cell type with the other. A describes dysplasia. C
describes neoplasia. D does not describe metaplasia.
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6. These are the classic manifestations associated with Trisomy 21 and do not occur with the
other three conditions.
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7. Patients with Monosomy X are genetically female and are treated with estrogen to
enhance female secondary sex characteristics. Testosterone would make the
manifestations worse. There is no basis for A and D.
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8. Maintaining body temperature is a prominent homeostatic control mechanism. Fever
indicates the inability to control body temperature. Throat pain, joint stiffness, and
positive throat cultures are a result of pathogenesis.
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9. PKU can lead to mental retardation without proper dietary management, but it is not
inevitable. PKU is not usually associated with other congenital anomalies, nor is it caused
by a diet high in tyromine.
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10. Ischemia is injury that results from decreased tissue perfusion. Hypoxia refers to
decreased circulating oxygen. Hyperemia refers to redness often associated with pressure.
Neoplasm refers to cancerous changes.
11. Tay sachs is a result of deficient or absence of hexosaminidase A. It is not a chromosomal
disorder, nor is it a result of tyrosine conversion.
12. The individual is obese but otherwise healthy. She is having her blood pressure check.
Being screened for a disease when you are in a risk category is secondary prevention.
This promotes early detection and treatment.
13. All daughters are affected by father carries because males only have one X. If the disease
is an X-linked recessive disorder, then all males would be carries because they lack a
homozygous pair. Males always give their X to their female offspring, which would
always pass the gene to female offspring.
14. Maternal age is the most significant risk factor for Down syndrome. The other risk factors
list are not associated with Down syndrome.
15. An arterial occlusion with prevent blood flow to the tissue resulting in dry gangrene.
Gangrene is a type of necrosis. Wet gangrene is associated with conditions such as
infection. Gas gangrene is associated with C. Diff infections.
Chapter 2 Immunity
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___ 1. A 2 day post-op heart transplant patient begins to have fever and signs and
symptoms of heart failure. The patient is more than likely experiencing which of
the following?
A)
Type I, IgE mediated hypersensitivity.
B)
Type III, immune complex-mediated hypersensitivity.
C)
Graft vs host disease.
D)
Host vs graft disease.
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___ 2. Which of the following is a complication of chronic stress?
A)
Renal disease.
B)
Diabetes mellitus.
C)
Pathological fractures.
D)
Increased susceptibility to illness.
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___ 3. Within minutes after receiving an injection of penicillin, the patient complains of
shortness of breath and chest pain. The nurse notifies the patient's healthcare
provider because this patient is most likely experiencing which type of
hypersensitivity?
A)
Type I
B)
Type II
C)
Type III
D)
Type IV
___ 4. During which of the following stages of the General Adaptation Syndrome (GAS)
has the body's coping methods been completely utilized?
A)
Alarm.
B)
Resistance.
C)
Transference.
D)
Exhaustion.
___ 5. Which of the following is a chemical released from the sympathetic nervous
system by the adrenal medulla that is responsible for many of the physiological
symptoms of the "fight or fight" response?
A)
Insulin.
B)
Cortisol.
C)
Epinephrine.
D)
Corticotropin.
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___ 6. The nurse conducts group education for patients with seasonal allergies, and
teaches about the role of histamine. The nurse evaluates that the education has
been effective when the patients make which response?
A)
"Histamine dilates the vessels in the nose, so it is congested and stuffy."
B)
"Histamine is inhibited by allergies, therefore leading to the signs and symptoms."
C)
"Histamine constricts vessels, causing capillaries to become more permeable."
D)
"Histamine is primarily stored in phagocyte cells in the skin."
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___ 7. Which of the following is an example of passive immunity?
A)
Immunizations.
B)
Transplant rejection.
C)
Response to a disease.
D)
Placental transfer of antibodies.
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___ 8. What disease state results from an inability to differentiate self from non-self?
Immunodeficiency.
Hypersensitivity.
Autoimmune.
Anaphylaxis.
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A)
B)
C)
D)
___ 9. Which of the following patients is at the greatest risk for impaired immune
function?
A)
23 year old female that is 5% above her ideal body weight.
B)
79 year old male with poorly controlled diabetes mellitus.
C)
89 year old male controlled hypertension.
D)
45 year old female recently widowed.
___ 10. Which of the following situations represents a break in the "first line of defense"
against infection?
A)
An abnormally low total white blood cell (WBC)count.
B)
A "shift to the left" on the WBC differential.
C)
Use of an indwelling bladder catheter.
D)
Poor nutritional status.
___ 10. Which of the following situations represents a break in the "first line of defense"
against infection?
A)
An abnormally low total white blood cell (WBC)count.
B)
A "shift to the left" on the WBC differential.
C)
Use of an indwelling bladder catheter.
D)
Poor nutritional status.
___ 11. HIV infection causes immunodeficiency because it
A)
blocks the ability of macrophages to present antigens.
B)
causes excessive production of cytotoxic T cells.
C)
directly inhibits antibody production by B cells.
D)
causes the destruction of T helper cells.
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___ 12. With which patient is it most important for the nurse to take special precautions
because of an increased susceptibility to infection as a result of medical therapy?
A)
The 38-year-old woman taking contraceptives
B)
The 38-year-old man with diabetes mellitus taking insulin
C)
The 58-year-old woman with rheumatoid arthritis taking corticosteroids daily
D)
The 58-year-old man 5 years after a myocardial infarction taking aspirin daily
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___ 13. Although skin manifestations may occur in numerous locations, the classic
presentation of systemic lupus erythematosus includes:
A)
Lesions affecting the palms of hands and soles of feet.
B)
Dry, scaly patches in the antecubital area and behind the knees.
C)
Cracked, scaly areas in webs of fingers.
D)
Butterfly pattern rash on the face across the bridge of the nose.
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___ 14. The nurse recognizes that which of the following is required for a diagnosis of
AIDS (acquired immunodeficiency syndrome)?
A)
Lymphocytopenia
B)
Abnormally functioning macrophages
C)
CD4+ cell count of less than 200 cells/mm3
D)
Increased production of incomplete and nonfunctional antibodies
___ 15. Which statement made by the patient newly diagnosed with systemic lupus
erythematosus indicates a need for further teaching about the course and
management of this disease?
A)
“I will take my medication even if my symptoms improve.”
B)
“I will report any fever to my health care provider immediately.”
C)
"I will sunbathe as often as possible to ensure I get enough vitamin D.”
D)
“I will not have my hair dyed, frosted, or permed unless I am in a period of
remission.”
___ 16. Which of the following findings is a systemic sign of inflammation?
A)
Pain
B)
Loss of function
C)
Edema
D)
Elevated erythrocyte sedimentation rate
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___ 17. In the context of aging, tertiary prevention refers to:
A)
prevention of incident diseases and geriatric conditions
B)
early detection, treatment and management of prevalent and recurrent conditions.
C)
reducing the impact of comorbidity on physical functioning and premature
mortality.
D)
public health promotion of preventive healthcare.
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___ 18. Which type of immunity is developed following injection of antibodies
synthesized by another human or animal?
A)
adaptive
B)
active
C)
innate
D)
passive
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___ 19. The major disadvantage of passive immunization is that it:
A)
is ineffective
B)
is expensive
C)
interferes with active immunization
D)
induces short-term protection
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___ 20. Which of the following is true about inflammation?
A)
It is a specific response to an insult.
B)
It requires previous exposure.
C)
It is the second level of response to injurious agents.
D)
It only lasts for short periods of time
E)
It exists in almost all chronic illness in the body.
___ 21. Which of the following is not a part of the inflammation process?
A)
Contraction of vascular smooth muscle
B)
Increased blood flow
C)
Increased permeability of vessels
D)
Dialation of vessels
E)
Intracellular gaps in vessels which passage of large proteins
___ 22. Which of the following are systemic effects from an inflammatory response?
A)
Elevated temperature
B)
Redness and swelling
C)
Blisters
D)
Pus
___ 22. Which of the following are systemic effects from an inflammatory response?
A)
Elevated temperature
B)
Redness and swelling
C)
Blisters
D)
Pus
___ 23. What happens when the vasodilator histamine is released by the mast cells?
A)
The inflammatory process is ended.
B)
Blood platelets adhere to collagen fragments and begin the healing process.
C)
Blood vessels expand and become more permeable.
D)
Blood vessels constrict and become less permeable.
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___ 24. Which of the following is an immunoglobin E (IgE)-mediated hypersensitivity
reaction?
A)
A transfusion reaction resulting from an infusion of incompatible blood into a
person who has pre-existing antibodies directed against the transfused cells
B)
Organ or tissue damage resulting from deposition of antigen-antibody complexes
in the organs or tissues of an affected person
C)
An area of swelling and tenderness in the skin after an intradermal injection of
protein material derived from the tubercle bacillus
D)
A penicillin reaction characterized by fall in blood pressure and respiratory
distress after an injection of penicillin in a person who has become sensitized to
penicillin as a result of a previous penicillin injection
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___ 25. Autoimmune diseases are caused by __________.
A)
authoantibodies
B)
non-self-antigens
C)
self-antigens
D)
none of the above
___ 26. Lupus erythematosus is a common connective-tissue disease that is most
frequently seen in __________.
A)
young women
B)
young men
C)
older women
D)
older men
___ 27. An important and serious infection in AIDS patients is a pneumonia caused by a
small parasite that grows within pulmonary alveoli, called
A)
Pneumocystis carinii
B)
Chlamydia
C)
Toxoplasma
D)
The EB virus
___ 27. An important and serious infection in AIDS patients is a pneumonia caused by a
small parasite that grows within pulmonary alveoli, called
A)
Pneumocystis carinii
B)
Chlamydia
C)
Toxoplasma
D)
The EB virus
___ 28. Which is NOT one of the common agents that causes opportunistic infections in
AIDS patients?
A)
Pneumocystis carinii
B)
Cytomegalovirus
C)
Mycobacterium avium-intracellulare
D)
Corynebacterium diphtheriae
E)
Toxoplasma gondii
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D
D
A
D
C
A
D
C
B
C
D
C
D
C
C
D
C
D
D
E
A
A
C
D
A
A
A
D
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1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
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Answer Key
Rationales
1. The patient is exhibiting symptoms of organ transplant rejection which manifests as
symptoms of organ failure. This type of rejection is associated with host verses graft
disease in which the body is fighting the rejection.
2. Chronic stress can impair the immune response. While all the other responses are
stressors on the body, they are not a result of chronic stress.
3. The patient is exhibiting symptoms of anaphylaxis likely as a result of the penicillin
injection. Anaphylactic reactions are type I hypersensitivity reactions.
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4. The exhaustion phase of the GAS occurs when coping mechanisms have been fully used
up resulting in either the stressor being resolved or disease. Alarm is the body's
recognition of the stressor, and resistance is the initiation of coping mechanisms.
Transference is not a stage of GAS.
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5. Epinephrine produces much of the "fight-or-flight" symptoms. Insulin is not produced
during this response and is not produced by the adrenal medulla. Cortisol is released
during this response but by the adrenal cortex. Corticotropin is produced by the
hypothalmus.
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6. Histamine produces much of the inflammatory manifestations by dilating vessels. It is
triggered by allergens, not inhibited by them. Constricting vessels would make them less
permeable not more. Histamine is not stored in phagocyte skin cells.
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7. Placental transfer is the only example of passive immunity because the infant is not
actively creating antibodies, but it is borrowing the mothers. Immunizations and having
the disease are examples of active immunity because the body actively forms antibodies
when exposed to the vaccine or disease. Transplant rejection is not a form of immunity.
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8. The body has lost the ability to distinguish self from non-self and begins to fight self in
autoimmune conditions. Immunodeficiency is an ineffective immune response.
Hypersensitivity and anaphylaxis are excessive immune reactions.
9. The 79 year old has 2 risk factors, advancing age and uncontrolled diabetes mellitus, and
the other patients only have one.
10. The "first line of defense" is the skin and mucous membranes that provide a nonspecific
barrier to keep all foreign substances out. A breach in the first line would be the presence
of an indwelling catheter. A low WBC count, a "shift to the left", and poor nutrition
would give some indication of an issue with the second and third lines of defense.
11. The HIV infect and replicate in the CD4, which are T cells. The CD4s are destroyed in
the process. With less CD4s the immune system is ill equipped to manage invasions. The
other options do not occur with HIV.
12. The 58 year old woman has 2 firm risk factors, a chronic disease and a medication that
impairs immune response. Her age may be a factor but not a strong one. A doesn't have
any risk factors. B has one, a chronic disease. With D, his age may be a weak risk factor,
but the past medical condition should not be a significant factor.
13. The butterfly patterned rash across the face is a classic manifestation associated with
SLE. The other options are not generally seen.
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14. To be changed from HIV+ to a diagnosis of AIDS, requires a drop in the CD4 count to
below 200 cells/mm3. The other options are not specific to AIDS.
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15. Photosensitivity is a common manifestation of SLE, and sunbathing would worsen the
condition. The patient will have to take medications even in the absence of symptoms.
Infections are often a trigger for a exacerbation, and the patient is at increased risk for
infection because they have a chronic disease and the medications often impair the
immune reaction. Fever can be an indication of an infection.
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16. Elevated erythryocyte sedimentation rate is the only systemic indicator of inflammation.
The other manifestations are local.
Chapter 3 Hematopoietic Function
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1. In the course of infectious mononucleosis, the Epstein-Barr virus invades:
B lymphocytes.
T lymphocytes.
Macrophages.
Marrow stem cells.
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A)
B)
C)
D)
2. Multiple myeloma is a malignancy of the:
A)
Lymphatic system.
B)
T lymphocytes.
C)
Granulocytes.
D)
Plasma cells.
3. When making a differential diagnosis between Hodgkin's and Non-Hodgkin's
disease, the nurse understands that Hodgkin's disease would have which of the
following present?
A)
Felty's syndrome.
B)
Epstein Barr virus.
C)
Bence Jones proteins.
D)
Reed-Sternberg cells.
A)
B)
C)
D)
disease, the nurse understands that Hodgkin's disease would have which of the
following present?
Felty's syndrome.
Epstein Barr virus.
Bence Jones proteins.
Reed-Sternberg cells.
4. While in the hospital for management of acute lymphocyticleukemia (ALL), J.B.'s
neutophil count is 175. The most appropriate action for this condition would be:
A)
Anticoagulant therapy.
B)
Minimize visitors.
C)
Chemotherapy.
D)
Iron supplements.
A)
B)
C)
D)
6. Which of the following is indicative of hemolytic anemia?
Increased total iron-binding capacity
Increased heart rate
Hypovolemia
Jaundice
A)
B)
C)
D)
7. A 3-year-old boy who exhibits prolonged bleeding after minor trauma and prolonged
clotting time but normal platelet count, likely has
hemophilia.
liver dysfunction.
thrombocytopenia.
disseminated intravascular coagulation.
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A)
B)
C)
D)
5. A 52-year-old man presents to the clinic complaining of back pain. X-rays reveals
multiple areas of reduced bone density and a compression fracture of the vertebra.
His lab work revealed elevated serum calcium levels. Which of the following
diseases is most consistent with these findings?
Leukemia
Lymphoma
Multiple myeloma
Hodgkin's disease
8. What does leukocytosis frequently indicate?
A)
immunosuppression
B)
bone marrow damage
C)
an allergic or autoimmune reaction
D)
presence of inflammation or infection
A)
B)
C)
D)
9. What is a deficit of all types of blood cells called?
leukopenia
neutropenia
pancytopenia
erythrocytosis
9. What is a deficit of all types of blood cells called?
A)
leukopenia
B)
neutropenia
C)
pancytopenia
D)
erythrocytosis
A)
B)
C)
D)
11. A chemotherapy patient has a hemoglobin of 7.0 g/dL. Which of the following
complaints would be indicative of tissue hypoxia related to anemia?
Apathy.
Syncope.
Bradycardia.
Skin warm and dry.
A)
B)
C)
D)
12. Causes of thrombocytopenia include
hypoxemia.
chemotherapy.
reduced erythropoietin.
secondary polycythemia.
A)
B)
C)
D)
13. Iron deficiency anemia is characterized by red blood cells that are:
Normocytic, normochromic.
Microcytic, hypochromic.
Macrocytic, normochromic.
Microcytic, normochromic.
A)
B)
C)
D)
14. von Willebrand factor is directly involved in:
Platelet adhesion and aggregation.
Platelet production.
Formation of the fibrin clot.
Clot dissolution.
A)
B)
C)
D)
15. What is a neoplasm of blood cells?
Hematoma
Leukemia
Carcinoma of the blood
Sarcoma of the blood
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A)
B)
C)
D)
10. Mary Ann, a 14-year-old high school freshman, presents to her pediatrician's office
with severe fatigue, swollen glands, and a low-grade fever. Which blood test would
be used to confirm her diagnosis of infectious mononucleosis?
An elevated total white blood cell count
An elevated erythrocyte sedimentation rate
A decreased eosinophils count
A decreased monocyte count
15. What is a neoplasm of blood cells?
Hematoma
Leukemia
Carcinoma of the blood
Sarcoma of the blood
A)
B)
C)
D)
16. Over 80% of all lymphomas arise in __________.
T cells
Reed-Sternberg cells
B cells
NK cells
A)
B)
C)
D)
17. A 5-year-old male child has a bleeding disease that is characterized by areas of
hemorrhage in the joints and muscles after minor injuries. Laboratory tests reveal a
deficiency of a coagulation factor active in the early phase of blood coagulation
(formation of intrinsic thromboplastin). What is the most likely diagnosis?
Thrombocytopenia (platelet deficiency)
Hemophilia
Disseminated intravascular coagulation syndrome
Ingestion of a drug such as coumadin, which functions as an anticoagulant
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A)
B)
C)
D)
A)
B)
C)
D)
19. A decrease in platelets is called __________.
hemophilia
von Willebrand’s disease
thrombocytopenia
none of the above
A)
B)
C)
D)
20. What causes infectious mononucleosis?
Epstein Barr (EB) virus
Herpes simplex virus
Beta streptococci
Pathogenic fungi
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C)
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A)
B)
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D)
18. Which of the following statements regarding disseminated intravascular coagulation
syndrome is NOT true?
It results from rapid release of thromboplastic material into the circulation.
It may result in from any condition associated with extensive tissue destruction, such
as shock or sepsis.
Levels of blood platelets and concentration of blood coagulation components are
subnormal.
It is a frequent complication of pulmonary embolism.
21. A middle-aged man has a hypochromic, microcytic anemia. What is the most likely
cause?
A)
Vitamin B12 or folic acid deficiency
B)
C)
D)
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22. Which of the following treatments is NOT suitable for aplastic anemia?
Splenectomy
Blood transfusions
Bone marrow transplant
Immunosuppressive drugs that block the functions of cytotoxic lymphocytes that are
destroying bone marrow stem cells
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A)
B)
C)
D)
Hemolysis of red blood cell due to autoantibodies
Iron deficiency resulting from chronic blood loss
Replacement of bone marrow by metastatic tumor
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A
D
D
B
C
D
A
D
C
A
B
B
B
A
B
C
B
D
C
A
C
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2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
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Answer Key
Rationales
1. With infectious mononucleosis, the Epstein-Barr virus invades B lymphocytes and not T
lymphocytes, macrophages, or marrow stem cells.
2. Multiple myeloma is a hematological cancer of the plasma cells and not the lymphatic
system, T lymphocytes, or granulocytes.
3. Hodgkin's and Non-Hodgkin's disease presents similarly. Differential diagnosis is made
with the presence of Reed-Sternberg cells in the biopsy, which indicates Hodgkin's.
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4. A neutrophil count of 175 is low and indicates neutropenia. The individual will be at risk
for infection, so visitors should be minimized to limit exposure to infectious agents.
Anticoagulants and iron will not decrease the risk for infection. Chemotherapy will
actually increase the risk by lowering the neutrophil count further.
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5. Back pain, decreased bone density, fractures, and hypercalcemia are indications of
multiple myeloma and do not occur with leukemia, lymphoma, and Hodgkin's disease.
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6. Jaundice occurs with hemolytic anemia because bilirubin is released from the red blood
cells as they lyse. Increased total iron-binding capacity, increased heart rate, and
hypovolemia do not occur with hemolytc anemia.
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7. Prolonged bleeding after a minor trauma along with a prolonged clotting time is an
indicator of hemaphilia, especially given his age. Liver dysfunction, thrombocytopenia,
and DIC can cause excessive bleeding but not usually in that context.
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8. Leukocytosis is an increased leukocyte count, and this happens in the presence of
inflammation or infection, and does not generally occur in the presence of
immunosuppression, bone marrow damage, allergic, or autoimmune reactions.
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9. Pancytopenia refers to a decrease in all the blood cells. Leukopenia is a decrease in
leukocytes, neutropenia is a decrease in neutrophils, and erythrocytosis is an increase in
red blood cells.
10. White blood cell levels will be elevated with infectious mononucleosis. Erythrocyte
sedimentation rate elevates with inflammatory process and not infectious process.
Eosinophil and monocyte count would not decrease either.
11. Syncope occurs with anemia because of cerebral hypoxia. Hypoxia generally does not
causes apathy, bradycardia, or warm and dry skin. Anemia would be more likely to cause
tachycardia as a compensatory mechanism. Skin would likely become pale, and may
become cool.
12. Thrombocytopenia refers to a decreased platelet count. Chemotherapy causes a decrease
in platelet count because of bone marrow suppression. Hypoxemia would more likely
cause increased platelet counts, or thrombocytosis, as a compensatory mechanism.
Erythropoietin is the hormone responsible for red blood cell production and will not
impact platelet levels. Polycythemia is an increase in all of the blood cells, so platelet
levels would increase not decrease.
13. Microcytic refers to small red blood cells, and hypochromic refers to pale red blood cells.
Without iron, the red blood cells cannot develop properly. Normocytic refers to normal
cell size, and normochromic refers to normal cell color; this would describe normal red
blood cells. Red blood cells become large, or macrocytic, with other anemias such as
pernicious.
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14. Von Willebrand factor is directly involved in platelet adhesion, stickiness, and
aggregation or coming together. The lack of the factor in von Willebrand disease
increases bleeding tendency because the platelets do not function properly.
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Chapter 4 Cardiovascular Function
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___ 1. Which of the following individuals is the most likely to have a silent myocardial
infarction (MI)?
A)
A young male
B)
A middle-aged female
C)
A pregnant female
D)
A male diagnosed with diabetes mellitus
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___ 2. The nurse recognizes which of the following as the most critical assessment
finding when caring for the patient at risk for hypovolemic shock?
A)
Skin flushed and warm
B)
Decreased urine output
C)
Bounding peripheral pulse
D)
Temperature decreases
___ 3. A patient presents to the Emergency Department complaining of severe chest pain.
Upon examination, you note a temperature of 102.5, white blood count of 20,000,
and a pericardial friction rub. You should expect which of the following?
A)
Infective endocarditis.
B)
Cardiac tamponade.
C)
Myocarditis.
D)
Pericarditis.
___ 4. Which of the following laboratory tests would be indicative of worsening heart
failure?
A)
Elevated hemoglobin.
B)
Elevated b-type natriuretic peptide (BNP).
C)
Decreased myoglobin.
D)
Decreased b-type natriuretic peptide (BNP).
___ 4. Which of the following laboratory tests would be indicative of worsening heart
failure?
A)
Elevated hemoglobin.
B)
Elevated b-type natriuretic peptide (BNP).
C)
Decreased myoglobin.
D)
Decreased b-type natriuretic peptide (BNP).
___ 5. Which of the following is most likely to contribute to thrombus development?
A)
Over hydration
B)
Ambulation
C)
Immobility
D)
Infection
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___ 6. Pericardial effusion that can occur in pericarditis has which of the following
cardiovascular consequences?
A)
Decreased preload
B)
Decreased afterload
C)
Decreased cardiac output
D)
Decreased peripheral vascular resistance
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___ 7. A patient comes to the Emergency Department complaining of coughing and
difficulty breathing. The patient's diagnosis is heart failure. He asks you how
difficulty breathing could be a heart problem. What is the best response?
A)
"The left side of your heart is weak and pumps blood too quickly."
B)
"The left side of your heart has weakened and blood has entered your lungs."
C)
"The right side of your heart has enlarged and cannot effectively pump blood."
D)
"The right side of your heart has weakened and blood has entered your lungs."
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___ 8. Which type of cardiomyopathy is characterized by progressive cardiac
hypertrophy, dilation, and impaired pumping with heart enlargement and thinning
walls?
A)
Dilated.
B)
Hypertrophic.
C)
Restrictive.
D)
Peripartum.
___ 9. Which type of valvular heart disease causes obstruction of the ejection of blood
from the left atrium to the left ventricle?
A)
Aortic stenosis
B)
Aortic regurgitation
C)
Mitral stenosis
D)
Mitral regurgitation
___ 10. A 19-year old athlete went out for his first day of football practice. He experienced
sudden cardiac death. The cause of death was determined to be cardiomyopathy.
Which form of cardiomyopathy was it most likely to be?
A)
Dilated
B)
Hypertrophic
C)
Restrictive
D)
Dystrophic
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___ 11. The nurse will monitor a patient for which clinical manifestation as a
compensatory mechanism to the initial stage of shock?
A)
Decreased mean arterial pressure
B)
Elevated body temperature
C)
Vascular vasodilation
D)
Increased heart rate
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___ 12. The nurse recognizes the patient with which disorder is at greatest risk for
hypovolemic shock?
A)
Burns
B)
Sepsis
C)
Pericarditis
D)
Myopathies
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___ 13. Which of the following patients has the greatest risk of developing heart failure?
A)
A 50-year-old white female with asthma.
B)
A 48-year-old black female who smokes.
C)
A 69-year-old black male with hypertension.
D)
A 75-year-old white male who smokes.
___ 14. Which of the following is a modifiable risk factor for coronary artery disease?
A)
Family history.
B)
Smoking.
C)
Gender.
D)
Age.
___ 15. Your patient with a history of stable angina states that he has recently experienced
an increase in the number of attacks and the intensity of the pain. What should you
suspect?
A)
The patient continues to have stable angina
B)
The patient has developed unstable angina
C)
The patient has experienced an acute MI
D)
The patient has a subendocardial necrosis
___ 15. Your patient with a history of stable angina states that he has recently experienced
an increase in the number of attacks and the intensity of the pain. What should you
suspect?
A)
The patient continues to have stable angina
B)
The patient has developed unstable angina
C)
The patient has experienced an acute MI
D)
The patient has a subendocardial necrosis
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___ 16. With which of the following patients should you remain alert to the possible
development of right-sided heart failure?
A)
60-year-old man chronic obstructive pulmonary disease
B)
40-year-old woman who broke an ankle while training for a marathon
C)
68-year-old man with dehydration 5 years after having a myocardial infarction
D)
27-year-old woman taking excessive amounts of thyroid hormone to promote
weight loss
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___ 17. A 80 y/o patient in the intensive care unit with an overwhelming systemic infection
begins to exhibit splinter hemorrhages under her fingernails, hematuria, and
petechia. What would be the likely culprit?
A)
Cardiac tamponade.
B)
Infective endocarditis.
C)
Dilated cardiomyopathy.
D)
Pericarditis.
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___ 18. A severely obese patient presents to the clinic with edema of the right lower
extremity that is impairing ambulation. Upon inspection, the health care provider
notes that the edema does not indent with pressure, the skin on the right lower
extremity is thick and rough, and distal pulses are present and equal bilateral. The
health care provider should expect which of the following?
A)
Peripheral vascular disease.
B)
Congested heart failure.
C)
Deep vein thrombosis.
D)
Lymphedema.
___ 19. The nurse is providing group education about lipids to patients who have been
diagnosed with hyperlipidemia. What does the best instruction include?
A)
High density lipoprotein (HDL) is called good cholesterol because it increases the
oxygen content in the arteries and stabilizes plaque build-up.
B)
High density lipoprotein (HDL) is called good cholesterol because it removes
cholesterol from your body and gets rid of it in your liver.
C)
High density lipoprotein (HDL) is called good cholesterol because it deceases
cardiac workload by decreasing oxygen consumption your heart.
D)
High density lipoprotein (HDL) decreases low density lipoprotein (LDL) and
prevents it from converting to very low density lipoprotein (VDRL), which is the
worst kind of cholesterol in the body.
___ 20. Which patient is most at risk of developing left-sided heart failure?
A)
64-year-old female with mitral valve stenosis
B)
60-year-old male with pulmonary hypertension
C)
48-year-old female who smokes one pack of cigarettes daily
D)
72-year-old male who has had a right ventricular myocardial infarction
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___ 21. On an electrocardiogram (EKG), the p wave represents which of the following?
A)
Atrial depolarization
B)
Ventricular depolarization.
C)
Atrial repolarization.
D)
Ventricular repolarization.
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___ 22. The QRS wave of an electrocardiogram (EKG) is produced by:
A)
depolarization of the atria
B)
repolarization of the atria
C)
depolarization of the ventricles
D)
repolarization of the ventricles
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___ 23. The renin-angiotensin-aldosterone pathway:
A)
is activated by renin
B)
acts to decrease loss of sodium in urine
C)
increases in activity in response to blood loss
D)
can be blocked to help lower blood pressure
E)
all of the above
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___ 24. Which of the following is not a risk factor for the development of atherosclerotic
heart disease?
A)
Hypertension
B)
Diabetes Mellitus
C)
Hyperthyroidism
D)
Cigarette Smoking
E)
Metabolic syndrome
___ 25. A 55 year-old male with hypertension presents to the emergency room with acute
onset of crushing substernal chest pressure while mowing his lawn. He presents
to the emergency room, where his EKG is consistent with acute anterior
myocardial infarction. Decision is made to transport the patient to the cardiac
catherization lab.
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A)
B)
C)
D)
In a patient with an acute coronary syndrome, what is the goal time from
presentation to hospital to opening of the artery (i.e. door to balloon time)?
30 minutes or less
60 minutes or less
90 minutes or less
120 minutes or less
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___ 26. Which of the following is not part of the definition of the metabolic syndrome?
A)
Men’s waist circumference greater than 40 inches
B)
Fasting glucose > 100 mg/dl
C)
HDL < 50 mg/dl in women
D)
Systolic blood pressure > 110 mm/Hg
E)
Triglycerides > 150 mg/dl
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___ 27. ________ stoke is when the blood flow is interrupted due to a blockage in an
artery as opposed to ________ stroke which involves a rupture.
A)
Ischemic, hemorrhagic
B)
Hemorrhagic, Ischemic
C)
Acute, chronic
D)
None of the above
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___ 28. Narrowing and hardening of arteries is known as ________________.
A)
atherosclerosis
B)
thrombosis
C)
stroke
D)
hemorrhage
___ 29. Which of the following is not a non-modifiable risk factor for stroke.
A)
age
B)
being of the female gender
C)
family history
D)
ethnicity
___ 30. The most likely place for a thrombosis to form postoperatively is:
A)
the lungs.
B)
the left side of the heart.
C)
the legs.
D)
anywhere in the body.
___ 30. The most likely place for a thrombosis to form postoperatively is:
A)
the lungs.
B)
the left side of the heart.
C)
the legs.
D)
anywhere in the body.
___ 31. Which of the following statements relating to congestive failure is INCORRECT?
A)
It may follow any type of heart disease.
B)
It leads to excretion of excessive amounts of salt and water by the kidneys.
C)
Venous pressure is elevated.
D)
Blood volume is increased.
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___ 32. Which of the following statements related to infective endocarditis (bacterial
endocarditis) is INCORRECT?
A)
It is a complication of valvular heart disease.
B)
Fibrin-platelet thrombi form on rough valve surface; bacteria implant in the
thrombus and incite inflammation.
C)
Microorganisms never implant on a normal heart valve.
D)
Part of valve vegetations may break loose and be carried into the circulation as
emboli.
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___ 33. Which is the most serious complication of an aortic aneurysm?
A)
Dilation of the aorta, which may compress adjacent abdominal organs
B)
Formation of the thrombi on the rough intimal surface on the aneurysm wall
C)
Rupture of the aneurysm
D)
Degeneration and calcification of the aneurysm wall
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___ 34. What is one of the most important complications of mitral valve scarring due to
rheumatic fever?
A)
Infective (bacterial) endocarditis
B)
Aortic aneurysm
C)
Hemolytic anemia
D)
Chronic iron deficiency
___ 35. Angina pectoris is usually a manifestation of which of the following?
A)
Hypertension
B)
Atherosclerosis of coronary arteries
C)
Aortic aneurysm
D)
Infective (bacterial endocarditis)
___ 36. What is the mechanism of death following cardiac tamponade?
A)
Impaired cardiac contraction due to inflammation surrounding a myocardial
infarction
B)
Compression of the heart by the blood on the pericardial sac, which impairs filling
in diastole
C)
Over distension of the ventricles due to heart failure
D)
Spasm of coronary arteries
___ 36. What is the mechanism of death following cardiac tamponade?
A)
Impaired cardiac contraction due to inflammation surrounding a myocardial
infarction
B)
Compression of the heart by the blood on the pericardial sac, which impairs filling
in diastole
C)
Over distension of the ventricles due to heart failure
D)
Spasm of coronary arteries
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___ 37. Which of the following cardiac valve abnormalities occurs most frequently in
young women?
A)
Aortic stenosis caused by calcification of the aortic valve
B)
Mitral stenosis caused by scarring resulting from a previous episode of acute
rheumatic fever
C)
Mitral valve prolapse
D)
Aortic valve incompetence (aortic insufficiency) caused by previous rheumatic
fever
E)
Idiopathic hypertrophic subaortic stenosis (IHHS)
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___ 38. Why do cardiac enzymes rise after an acute myocardial infarction?
A)
White cells are attracted to the site of muscle injury.
B)
Injured fibers increase their synthesis of cardiac muscle enzymes.
C)
Cardiac enzymes leak from the damaged muscle fibers into the bloodstream.
D)
Blood flow to the injured muscle is increased.
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Answer Key
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___ 39. Aldosterone primarily affects which of the following?
A)
Carbohydrate metabolism
B)
Protein and fat metabolism
C)
Salt and water metabolism
D)
Protein and water metabolism
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
D
B
D
B
C
C
B
A
C
B
D
A
C
B
B
A
B
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Rationales
A
C
B
D
A
C
B
B
A
B
D
B
A
A
C
E
C
C
D
A
A
B
C
B
C
C
A
B
B
C
C
C
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8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
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1. Silent MIs refers to MIs without usually manifestations (i.e. angina). This typically
occurs in patients with a history of diabetes mellitus and a previous MI because of
decreased nerve innervation.
2. In hypovolemic shock, tissue perfusion is diminished because of decreased circulating
blood volume. The kidneys are often affected most severely to this decreased tissue
perfusion. Urine output is directly affected by renal blood flow. Decreased urine output
would be an early indicator that the kidneys were not receiving adequate blood flow. Skin
would become cool and pale with hypovolemic shock because of the decreased
circulating blood volume. The peripheral pulse would become weak and thready because
of the decreased circulating blood volume. Temperature may decrease, but it is not a
critical finding.
3. Severe sharp chest pain, fever, leukocytosis, and a pericardial friction rub are classic
presentation of pericarditis. Fever and leukocytosis may be present with infective
endocarditis, but chest pain and friction rubs are not typically associated with it. Cardiac
tamponade is not generally associated with any of these symptoms. Chest pain, fever, and
leukocytosis may be present with myocareditis, but the friction rub is not associated with
it.
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4. When the heart stretches to accommodate the excessive blood volume with worsening
heart failure or during heart failure exacerbations, BNP is released. BNP levels can
become significantly elevated during those times. These levels will gradual return to
normal during treatment and when managed. Anemia, including decreased hemoglobin,
can be a complication of heart failure because of decreasing renal function, but increased
hemoglobin levels are not generally associated with worsening heart failure. Decreased
myoglobin is not generally associated with heart failure.
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5. The main contributors to thrombus formation are referred to as Virchow's triad
(hypercoagulation, blood stagnation, and increased blood viscosity). Immobility
contributes to thrombus formation because of increasing blood stagnation. Overhydration
and ambulation would decrease thrombus risk. Infection does have a significant impact
on thrombus formation.
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6. Pericardial effusion refers to fluid accumulation in the pericardial sac, which has limited
give to it. The fluid accumulation compresses the heart and limits the hearts ability to
expand to fill with blood. This limited expansion results in decreased cardiac output. This
creates a back up of the system, which would increase preload, afterload, and peripherial
vascular resistance not decrease them.
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7. Left-sided heart failure leads to respiratory manifestations because blood backs up into
the lungs. It does not occur because the heart is pumping too fast. Right-sided heart
failure leads to more systemic manifestations because of blood backing up into the
periphery.
8. With dilated cardiomyopathy, the heart stretches and thins. Hypertrophy, heart
enlargement, and impaired pumping may occur with the other types of cardiomyopathy.
The thinning of the heart wall is specific to dilated cardiomyopathy.
9. The mitral valve is the valve between left atrium and left ventricle. Stenosis is a
narrowing of the valve, and regurgitation allows the blood to flow in both directions
instead of in one. Mitral stenosis would prevent the flow of blood from the left atrium to
ventricle. The aortic valve positioned between the left ventricle and aorta, and, therefore,
would not impact the flow between the left atrium and ventricle.
10. Hypertrophic cardiomyopathy is often a result of a congenital abnormality that often goes
undiagnosed until a time of increased cardiac workload, as with playing sports. This type
of cardiomyopathy usually results in cardiac death at that time. These events are not
generally associated with the other types of cardiomyopathy.
11. Initially, shock triggers the sympathetic nervous system which causes the release of
epinephrine and norepinephrine. The stimulation of the sympathetic nervous system
results in tachycardia in an attempt to circulate the available blood volume to meet the
body's needs. The mean arterial pressure may decrease but it is not compensatory.
Vasodilatation would worsen the condition by further lowering the blood pressure. An
elevation in temperature would worsen the condition as well by increasing oxygen
demand on an already strained system.
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12. Burns cause hypovolemic shock, especially burns covering a vast surface area, because
the heat denatures the proteins that control colloidal pressure. The loss of colloidal
pressure allows fluid to shift out of the vascular space into the interstitial space, lowering
blood volume. Sepsis leads to septic shock. Pericarditis and myopathies result in
cardiogenic shock.
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13. The 69 year old has two significant risk factors: advancing age and hypertension.
Hypertension that is often seen in African Americans is more severe and harder to
manage. Hypertension directly causes heart failure because it overworks the heart
muscle.
14. All of the options are risk factors of coronary artery disease, but smoking is the only one
that is modifiable.
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15. If angina changes in quality, increases in frequency, or worsens, then unstable angina is
expected. Unstable angina may lead to an acute MI but more diagnostic procedures
would be necessary to determine if an MI was occurred.
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16. Right-sided heart failure often results from a pulmonary problem, such as chronic
obstructive pulmonary disease. The 40 year old and 68 year old does not have any risk
factors for any heart failures. The 27 year old would be at risk for high output failure but
not right-sided failure.
17. Infective endocarditis causes manifestations of microhemorrhages because of the
vegetative growth on the valves that become microemboli. The emboli occlude the
microcirculation, causing hemorrhages. This is not associated with the other conditions.
18. Lymphedema is common in obese individuals because the pressure the excessive weight
on the lymph system. Lymphedema results in non-pitting edema and skin changes, but no
changes in pulses because it is not a issue with the cardiovascular system. Peripheral
vascular disease can causes skin changes, but it is usually causes discoloration and
thinking of the skin. Additionally, pulse changes are often seen with peripheral vascular
disease. Congested heart failure may be associated with obesity, but it usually causes
pitting edema and pulse changes. Deep vein thrombosis is associated with pitting edema,
pulse changes, and skin temperature changes.
19. HDL is referred to as the "good cholesterol" because it assist with the removal of
cholesterol from the body. It does not increase oxygen saturation, stabilize plaque
buildup, decrease cardiac workload, or prevent conversion of LDL to VDRL.
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20. The mitral valve is between the left atrium and left ventricle. Mitral valve stenosis
prevents blood flow from the left atrium to ventricle. Cardiac workload increases in an
attempt to compensate for the falling cardiac output. Pulmonary hypertension, smoking,
and right ventricular MI would increase the risk for right-sided heart failure, but not leftsided failure.
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21. The P wave on an EKG represents atrial depolarization. The QRS complex represents
ventricular depolarization. The T wave represents ventricular repolarization. Atrial
repolarization is often not seen on an EKG.
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22. The QRS complex represents ventricular depolarization. The P wave on an EKG
represents atrial depolarization. The T wave represents ventricular repolarization. Atrial
repolarization is often not seen on an EKG.
Chapter 5 Respiratory Function
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___ 1. A patient admitted for the treatment of cystic fibrosis begins having systemic
edema, increased fatigue, and a weight gain of 6 pounds in the last 24 hours. The
nurse should suspect which of the following complications?
A)
Metastasis.
B)
Malabsorption.
C)
Cor pulmonale.
D)
Pulmonary embolism.
___ 2. A 12 year old girl presents to the emergency room wheezing with prolonged
expiration and chest tightness lasting for 45 minutes and unrelieved by her usually
treatment. The nurse recognizes that these findings are consistent with:
A)
Acute bronchiolitis.
B)
Status asthmaticus.
C)
Spasmodic croup.
D)
Epiglotitis.
___ 3. Which of the following accurately describes the pathophysiology of chronic
obstructive pulmonary disease (COPD)?
A)
Obstruction of the trachea and larynx.
B)
Obstructed airflow in the bronchi during inspiration.
C)
Excess fluid compresses the lung limiting expansion.
D)
Inflammation leads to lung fibrosis and a loss of elasticity.
___ 3. Which of the following accurately describes the pathophysiology of chronic
obstructive pulmonary disease (COPD)?
A)
Obstruction of the trachea and larynx.
B)
Obstructed airflow in the bronchi during inspiration.
C)
Excess fluid compresses the lung limiting expansion.
D)
Inflammation leads to lung fibrosis and a loss of elasticity.
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___ 4. While assessing a patient admitted to the hospital for congestive heart failure
treatment, the nurse notes decreased breath sounds over the left lobe and
asymmetrical chest expansion. The nurse reports this finding to the physician who
in turns orders a chest x-ray. The chest x-ray revealed an increased collection of
fluid in the pleural cavity. The nurse recognizes that these findings are consistent
with:
A)
Pneumonia.
B)
Pleural effusion.
C)
Mediastinal shift.
D)
Pulmonary edema.
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___ 5. A patient presents to the clinic for an initial visit with dyspnea, bright pink skin,
and barrel appearance to the chest. While taking the patient's history, the nurse
notes that the patient is a current smoker. These findings are consistent with which
of the following diseases?
A)
Interstitial lung disease.
B)
Chronic bronchitis.
C)
Bronchiectasis.
D)
Emphysema.
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___ 6. Several employees at a factory develop Legionnaire's disease. Which of the
following is important to include in the education you give to the employees
regarding this disease?
A)
That it is highly contagious.
B)
That it is spread by drinking warm water.
C)
That the disease it is usually spread through air ventilation systems.
D)
That the bacteria is often found on surfaces like door knobs and telephones.
___ 7. Cystic fibrosis is:
A)
A restrictive disorder characterized by proteolytic destruction of alveoli.
B)
An autosomal recessive disorder affecting exocrine glands.
C)
Caused by chronic exposure to second hand smoke.
D)
An allergic disorder triggered by specific antigens.
A)
B)
C)
D)
___ 8. A major risk factor for chronic obstructive pulmonary disease (COPD) is:
Smoking.
Male sex.
Genetic predisposition.
Diet high in saturated fats.
A)
B)
C)
D)
___ 8. A major risk factor for chronic obstructive pulmonary disease (COPD) is:
Smoking.
Male sex.
Genetic predisposition.
Diet high in saturated fats.
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___ 10. The most common cause of bacterial pneumonia is:
A)
Escherichia coli.
B)
Histoplasmosis.
C)
Streptococcus pneumoniae.
D)
Neisseria meningitidis.
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___ 9. Which of the following disease processes involve the thickening of the bronchial
walls which impede airflow and leave the individual unable to increase efforts to
maintain blood gases within normal range?
A)
Interstitial lung disease.
B)
Chronic bronchitis.
C)
Bronchiectasis.
D)
Emphysema.
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___ 11. Which one of the following acute respiratory infections in children poses the
greatest threat of severe hypoxia caused by airway obstruction?
A)
Allergic rhinitis.
B)
Bronchiolitis.
C)
Epiglottitis.
D)
Croup.
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___ 12. A patient presents to the emergency room with a stab wound to the chest. The
nurse notes on assessment that the patient is experiencing difficulty breathing and
asymmetrical chest movement. The nurse should suspect which of the following
problems:
A)
Traumatic pneumothorax.
B)
Tension pneumothorax.
C)
Chylothorax.
D)
Atelectasis.
___ 13. Lung compliance refers to the ease with which:
A)
The lungs can be inflated or the amount of pressure needed to change their
volume.
B)
Sputum can be expectorated from the lungs.
C)
Air can be moved through the airway.
D)
Air can be exhaled from the lungs.
___ 13. Lung compliance refers to the ease with which:
A)
The lungs can be inflated or the amount of pressure needed to change their
volume.
B)
Sputum can be expectorated from the lungs.
C)
Air can be moved through the airway.
D)
Air can be exhaled from the lungs.
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___ 14. A patient who has a known history of cardiac problems and currently smoking,
enters the clinic complaining of sudden onset of sharp, stabbing pain that
intensifies with a deep breath. The pain is occurring on only one side and can be
isolated upon general assessment. The nurse concludes that this description is most
likely caused by:
A)
Pleural effusion.
B)
Angina pectoris.
C)
Atelectasis.
D)
Pleurisy.
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___ 15. A distinguishing feature of influenza is:
A)
Abrupt-onset symptoms of fever, chills, and general malaise.
B)
Sore throat and profuse watery nasal discharge.
C)
Dry and nonproductive cough.
D)
Fever and headache.
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___ 16. Administering a high concentration of oxygen to a person with chronic hypoxia
can be harmful because:
A)
High concentrations are irritating to mucous membranes.
B)
A high concentration of oxygen can cause bronchospasm.
C)
In high concentration, the viscosity of oxygen increases airway resistance.
D)
High concentrations suppress the oxygen chemoreceptors, which provide the main
stimulus for ventilation.
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___ 17. Tuberculosis is:
A)
An airborne disease
B)
A sexually transmitted disease
C)
A disease transmitted through skin to skin contact
D)
All of the above
___ 18. Tuberculosis symptoms are:
A)
Weight loss
B)
Fever
C)
Persistent cough for 2-3 weeks
D)
All of the above
___ 19. In asthma, airways are narrowed because of:
A)
Bronchoconstriction
B)
Mucous production
C)
Smooth muscle hypertrophy
D)
Airway wall thickening
E)
All of the above
___ 19. In asthma, airways are narrowed because of:
A)
Bronchoconstriction
B)
Mucous production
C)
Smooth muscle hypertrophy
D)
Airway wall thickening
E)
All of the above
___ 20. What differentiates asthma from chronic obstructive pulmonary disease is that:
A)
Asthma is an obstructive disease
B)
C)
D)
The FEV1/FVC ration is reduced in asthma
Asthma is a reversible disease
Smoking makes asthma worse
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___ 21. The Forced Vital Capacity (FVC) measures:
A)
How much air you can breathe out of your lungs after a deep inspiration.
B)
The amount of air left in your lungs after you breathe it all out.
C)
The amount of air you can forcibly exhale in one second.
D)
How much force you can generate when breathing into a spirometer
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___ 22. Which of the following statements regarding Legionnaire’s disease is correct?
A)
It is a virus infection.
B)
It is usually spread by direct person-to-person contact.
C)
It causes a pulmonary infection.
D)
The infectious agent is usually transmitted by ticks.
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___ 23. A young man with AIDS has active pulmonary tuberculosis, and his sputum
contains large numbers of tubercle bacilli. Which of the following statements
regarding this patient’s disease is NOT true?
A)
He has active tuberculosis but is not infectious to other persons.
B)
He has active tuberculosis and is capable of infecting other persons.
C)
Tubercle bacilli may be transported in this patient’s bloodstream to other organs
from the lung and cause tuberculosis in other organs.
D)
This patient’s disease is likely to progress unless controlled by proper treatment.
___ 24. What is collapse of the lung caused by escape of air into the pleural cavity called?
A)
Pulmonary edema
B)
Pneumothorax
C)
Bronchiectasis
D)
Emphysema
Answer Key
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C
B
D
B
D
C
B
A
B
C
C
A
A
D
A
D
A
D
E
C
A
C
A
B
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1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
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Rationales
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1. Cor pulomale refers to right sided heart failure that results from a pulmonary disease or
condition, such as cystic fibrosis. Cystic fibrosis is not a neoplasm and does not
metastasize. Malabsorption would not necessarily cause edema or rapid weight gain; it
would be more likely to cause weight loss. Cystic fibrosis is not usually associated with a
pulmonary embolism, and a pulomonary embolism would not present with edema and
weight gain.
2. Status asthmaticus refers to an asthma attack lasting longer than expected and not
responding to usually treatment. An asthma attack usually presents as respiratory
wheezing, prolonged expiration, chest tightness, and air hunger. Acute bronchiolitis may
present with similar symptoms, but generally responds to treatment. Spasmodic croup is
unusual in this age group, and typically presents with a “seal-like” bark and respiratory
distress. Epiglotitis usually presents with respiratory distress but not generally wheezing.
3. COPD results in a fibrosis and a loss of elasticity of the lung tissue, usually due to
chronic irritation (e.g., smoking). A describes conditions such as epiglotitis. B describes
conditions such as asthma. C describes conditions such as a pleural effusion.
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4. Pleural effusion refers to fluid accumulation in the pleural space (between the pleural sac
and the lungs. This fluid compresses lung tissue and prevents lung expansion, leading to
decreased breath sounds and asymmetrical chest expansion. Pneumonia does not cause
fluid accumulation in the pleural space; it can cause fluid accumulation (usually exudates)
in the lung tissue. Additionally, asymmetrical chest movement and decreased breath
sounds are not seen with pneumonia; signs of infection (e.g., fever and leukocytosis),
coughing, and abnormal breath sounds (e.g., crackles or rhonchi) are seen. Mediastinal
shift refers to a deviation of the sternum from midline; it is generally a manifestation not
a disease or condition. Pulmonary edema refers to fluid accumulation in the lung tissue; it
is more likely to cause crackles.
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5. Emphysema is a COPD that most often results from smoking. With emphysema, the
lungs loss their recoil, and air becomes trapped. Often referred to as the “Pink Puffers,”
these patients have a longer expiration (in an attempt to expel trapped air), pink skin
(because of hypercapnia), and one to one anterior/posterior chest diameter (because of air
trapped). Interstitial lung disease refers to a progressive scaring of the lung tissue that is
commonly a result of occupational or environmental hazards; it usually presents with
gradual hypoxia and abnormal breath sounds (often crackles). Chronic bronchitis is also a
COPD that is most often a result of smoking; however, it presents with cyanosis and
copious sputum production. Bronchiectasis is a rare and often congenital condition that
results in dilated and weak bronchiole tree; it often presents with respiratory distress and
cough.
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6. Legionnaire’s disease is caused by an organism that often grows in standing water. The
organism is spread when that standing water is aerosoled and inhaled. This process is
commonly occurs with air ventilation systems, which have both standing water and the
possibility to aerosol the water. It is not contagious and does not spread by drinking the
water or through contact.
7. Cystic fibrosis is an autosomal recessive disorder that affects the exocrine glands. It is not
caused by a proteolytic destruction, smoking, or allergens.
8. Smoking is by far the most significant risk factor. Some types can be more common in
men and have a genetic predisposition, but these are not significant risk factors. Dietary
fat has no influence on COPD development.
9. Chronic bronchitis is a COPD that is most often a result of smoking. Chronic bronchitis
results in a thickening of the bronchial walls and gland hypertrophy. Often referred to as
the “Blue Bloaters,” these patients usually present with cyanosis and copious sputum
production. Interstitial lung disease refers to a progressive scaring of the lung tissue that
is commonly a result of occupational or environmental hazards; it usually presents with
gradual hypoxia and abnormal breath sounds (often crackles). Bronchiectasis is a rare and
often congenital condition that results in dilated and weak bronchiole tree; it often
presents with respiratory distress and cough. Emphysema is also a COPD that most often
results from smoking; however, it generally presents with long expiration, pink skin, and
one to one anterior/posterior chest diameter.
10. Streptococcus pneumonia is the most common cause of bacterial pneumonia. E. coli is a
part of the gastrointestinal tract normal flora and does not usually cause pneumonia.
Histoplasmosis is a fungus that can cause pneumonia. Neisseria meningitides is a bacteria
that commonly causes meningitis.
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11. Epiglottitis refers to an inflammation of the epiglottitis. This inflammation can cause the
epiglottitis to swell and occlude the airway. The allergic rhinitis, bronchiolitis, and croup
are not usually life threatening.
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12. Pneumothorax refers to a collection of air in the pleural space, which impairs ventilation.
A traumatic pneumothorax often results from an injury, such as a stab wound. The
opening created by the injury allows atmospheric air to enter the pleural space. Tension
pneumothorax usually results from pressure in the pleural space (e.g., mechanical
ventilation). Chylothorax results from lymph fluid (chyle) in the pleural space. Atelectasis
refers to alveoli collapse; it can cause asymmetrical chest movement and respiratory
distress, but it is not usually caused by trauma.
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13. Lung compliance refers to the ease of inflation or ability to change lung volume. B
describes a productive cough. C describes ventilation. D describes expiration.
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14. Pleurisy refers to inflammation of the pleural sac surrounding the lungs. This condition
can result from a number of inflammation triggers (e.g., infection, chronic irritation).
Pleurisy usually presents as sharp pain that worsens with inspiration. Pleural effusion and
atelectasis does not usually present with pain. Angina pectoris refers to chest pain
resulting from inadequate cardiac tissue perfusion. This type of pain is not generally
sharp in nature or does not usually worsen with inspiration.
15. Influenza usually presents as fever, chills, and general malaise with an abrupt onset. B is
more common with allergic rhinitis. Dry, nonproductive cough and headache could be
present with any of a number of condition but is not specific to influenza.
16. The normal drive of breathing is hypercapnia. In chronic hypoxia, this drive switches to
hypoxia. Therefore, giving these patients high levels of oxygen can knock out this new
drive for breathing.
Chapter 6 Fluid, Electrolyte, and Acid-Base Homeostasis
1. The main source of serum bicarbonate is obtained from:
A)
The kidneys.
B)
Dietary intake.
C)
Synthesis by the liver.
D)
Medications containing sodium bicarbonate.
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2. While performing an admission assessment on a patient with the diagnosis of bone
cancer, you determine that your patient has a history of Paget's disease. The patient's
family informs you that the patient has had some recent muscle weakness and
personality changes. You would want to assess the patient’s lab values for which of
the following?
A)
Hyperkalemia.
B)
Hypercalcemia.
C)
Hypokalemia.
D)
Hypocalcemia.
3. The major physiologic stimulus for thirst is:
Polyuria.
Hyponatremia.
Hypovolemia.
Hypoglycemia.
A)
B)
C)
D)
4. Which of the following would be appropriate treatments for the patient with
respiratory alkalosis:
Increase ventilation.
Sodium bicarbonate IV.
Breath into a paper bag.
Dialysis.
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A)
B)
C)
D)
5. The health care provider orders an infusion of a hypertonic solution. The nurse
knows an appropriate intravenous solution to administer would be:
A)
5% dextrose lactate ringers (D5LR).
B)
1/2 normal saline (0.45% NS).
C)
Normal saline (0.9% NS).
D)
Ringers lactate (RL).
A)
B)
C)
D)
6. The body compensates for metabolic alkalosis by:
Hypoventilation.
Hyperventilation.
Decreasing arterial carbon dioxide.
Increasing bicarbonate ion excretion.
A)
B)
C)
D)
6. The body compensates for metabolic alkalosis by:
Hypoventilation.
Hyperventilation.
Decreasing arterial carbon dioxide.
Increasing bicarbonate ion excretion.
7. Which of the following serum electrolyte values is abnormal?
A)
Magnesium 2.0 mEq/L.
B)
Potassium 4.0 mEq/L.
C)
Sodium 138 mg/dl.
D)
Calcium 15.0 mEq/L.
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8. Aldosterone's main effect increases ___________ reabsorption while antidiuretic
hormone's main effect increases _____________ reabsorption:
A)
Sodium; water.
B)
Water; potassium.
C)
Potassium; sodium.
D)
Glucose; potassium.
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A)
B)
C)
D)
10. While assessing a patient with heart failure and renal impairment, the nurse notices
3+ pitting edema in his feet, a bounding pulse, and severe shortness of breath. This
patient probably experiencing which of the following:
Hypokalemia.
Hyperkalemia.
Fluid volume deficit.
Fluid volume excess.
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A)
B)
C)
D)
9. Which of the following signs would indicate a fluid deficit?
Acute weight loss and increase in blood pressure.
Tachycardia, acute loss of body weight, weakness, and dry mucous membranes.
Physical weakness, weight gain, bradycardia, and decreased urine output.
Dry fissured tongue, rapid respirations, weight gain, and confusion or delirium.
11. Classify the following arterial blood gas: pH = 7.35, PaCO = 50 mm Hg, HCO – =
2
3
A)
B)
C)
D)
29 mEq/L.
Compensated respiratory acidosis
Partially compensated respiratory acidosis
Compensated metabolic acidosis
Partially compensated metabolic acidosis
12.
A)
B)
C)
D)
–
Classify the following arterial blood gas: pH = 7.52, PaCO2 = 30 mm Hg, HCO3 =
24 mEq/L.
Metabolic acidosis.
Metabolic alkalosis.
Respiratory acidosis.
Respiratory alkalosis.
A)
B)
C)
D)
14. A patient presents to the emergency room with a K level of 6.5. What potentially life
threatening complication would you assess for?
Cardiac dysrhythmias.
Decreased urine output.
Nausea and vomiting.
Ataxia.
A)
B)
C)
D)
15. The most reliable method for measuring a loss or gain of body water is:
Change in body weight.
Serum sodium levels.
Intake and output.
Skin turgor.
A)
B)
C)
D)
16. Capillary colloidal pressure is controlled by the:
Plasma proteins.
Red blood cells.
White blood cells.
Serum sodium concentration.
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A)
B)
C)
D)
13. Which of the following medications would you anticipate the order to treat
hyperkalemia?
Calcium gluconate.
Lactated Ringers.
Arginine HCL.
Kayexalate.
17. A patient presents to the emergency room with nausea, vomiting, and diarrhea for
three days. The patient's lab value is as follows: K 3.8, Na 149, pH 7.32, HCO3– 20,
and PaCO2 40. Which of the following intravenous fluids would you anticipate the
A)
B)
C)
D)
doctor would order?
0.45% Normal Saline with 100 mEq/liter of sodium bicarbonate.
0.9% Normal Saline with 40 mEq/liter of potassium.
0.9% Normal Saline.
2.5% Dextrose.
–
three days. The patient's lab value is as follows: K 3.8, Na 149, pH 7.32, HCO3 20,
and PaCO2 40. Which of the following intravenous fluids would you anticipate the
A)
B)
C)
D)
doctor would order?
0.45% Normal Saline with 100 mEq/liter of sodium bicarbonate.
0.9% Normal Saline with 40 mEq/liter of potassium.
0.9% Normal Saline.
2.5% Dextrose.
A)
B)
C)
D)
19. Decreased neuromuscular excitability can be seen in which two electrolyte disorders?
Hypercalcemia and hypermagnesemia.
Hyponatremia and hyperkalemia.
Hypocalcemia and hypokalemia.
Hypernatremia and hypomagnesemia.
A)
B)
C)
D)
20. Your renal failure patient on the hospital unit begins having severe diarrhea. You
become concerned that your patient may develop which of the following?
Metabolic alkalosis.
Metabolic acidosis.
Respiratory alkalosis.
Respiratory acidosis.
A)
B)
C)
D)
21. Insensible water losses are those that occur as the result of water that is lost in:
Urine.
Breathing and sweating.
Urine and bowel movements.
Vomitus and bowel movements.
A)
B)
C)
D)
22. The most appropriate therapy for an individual with hypernatremia is:
Volume expansion with normal saline.
Administration of colloids.
Hypotonic fluids.
ACE inhibitors.
A)
B)
C)
D)
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A)
B)
C)
D)
18. Hypoventilation, aspiration of foreign bodies, and sleep apnea may cause:
Metabolic acidosis.
Metabolic alkalosis.
Respiratory alkalosis.
Respiratory acidosis.
23. The normal osmolarity of blood and body fluids is 300 mOsm/L. A person with
severe diabetes and a greatly elevated blood glucose has a blood osmolarity of 370
mOsm/L. Which of the following events will result from the increased osmolarity?
Water shifts by osmosis from the cells into the extracellular fluid (ECF).
No water shifts will occur between the cells and the extracellular fluids as a result of
the higher osmolarity of the subject’s blood and body fluids.
Water shifts by osmosis from the extracellular fluid into the cells.
Equal amounts of water move from the cells into the ECF and from the ECF into the
cells, and thus, there is no net change in the water content of either the cells or the
A)
B)
C)
D)
23. The normal osmolarity of blood and body fluids is 300 mOsm/L. A person with
severe diabetes and a greatly elevated blood glucose has a blood osmolarity of 370
mOsm/L. Which of the following events will result from the increased osmolarity?
Water shifts by osmosis from the cells into the extracellular fluid (ECF).
No water shifts will occur between the cells and the extracellular fluids as a result of
the higher osmolarity of the subject’s blood and body fluids.
Water shifts by osmosis from the extracellular fluid into the cells.
Equal amounts of water move from the cells into the ECF and from the ECF into the
cells, and thus, there is no net change in the water content of either the cells or the
ECF.
A)
B)
C)
D)
25. A patient has severe chronic lung disease and is unable to excrete CO2 efficiently or
oxygenate his blood adequately. What acid-base disturbance is likely to result from
this condition?
Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis
A)
B)
C)
D)
26. Respiratory acidosis occurs most commonly in which disease or condition?
Uncontrolled diabetes mellitus
Renal insufficiency
Emphysema
Potassium depletion
A)
B)
C)
D)
27. Metabolic alkalosis occurs in association with many diseases and conditions. Which
of the following is NOT usually associated with metabolic alkalosis?
Excess loss of gastric juice due to vomiting
Ingestion of large amounts of sodium bicarbonate or other antacids
Overproduction of ketone bodies
Excess secretion of corticosteroids by the adrenal glands
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A)
B)
C)
D)
24. Reduced capillary osmotic pressure can be caused by which of the following?
Dehydration
Low concentration of plasma proteins
Increased hydrostatic pressure in the veins draining the capillaries
Edema
28. Which of the following is the major effect produced by an increase in the rate and
depth of respiration?
A)
Plasma PCO2 rises.
B)
Plasma PCO2 falls.
C)
Plasma PCO2 stays the same.
D)
The pH shifts to the alkaline side of the physiologic range.
28. Which of the following is the major effect produced by an increase in the rate and
depth of respiration?
A)
Plasma PCO2 rises.
B)
Plasma PCO2 falls.
C)
Plasma PCO2 stays the same.
D)
The pH shifts to the alkaline side of the physiologic range.
A)
B)
C)
D)
30. Which of the following diseases or conditions does NOT cause metabolic acidosis?
Renal insufficiency (uremia)
Overproduction of ketone bodies (ketosis)
Overproduction of lactic acid (lactic acidosis)
High blood PCO2 and carbonic acid due to inadequate pulmonary ventilation
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A)
B)
C)
D)
29. What is the main buffer in the extracellular fluid?
Phosphate buffer system
Bicarbonate-carbonic acid
Urea
None of the above
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___ 31. Aldosterone primarily affects which of the following?
A)
Carbohydrate metabolism
B)
Protein and fat metabolism
C)
Salt and water metabolism
D)
Protein and water metabolism
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A
B
C
C
A
A
D
A
B
D
A
D
D
A
A
A
A
C
A
B
B
C
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1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
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Answer Key
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D
A
A
A
A
C
A
B
B
C
A
B
A
C
C
B
B
D
C
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13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
Rationales
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1. The kidneys produce the majority of serum bicarbonate. Dietary intake can affect serum
levels minimally, but it primarily impacts the pH in the gastrointestinal tract. The liver
does not secrete bicarbonate. Certain medications are exogenous sources of bicarbonate
but are not the main source of bicarbonate.
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2. Paget’s disease can result in bone demineralization of calcium, causing hypercalcemia.
The patient is presenting with manifestations of hypercalcemia. Hyperkalemia,
hypokalemia, and hypocalcemia are not common with Paget’s disease.
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3. Thirst is triggered by high serum osmolarity and hypovolemia. Polyuria can result in
dehydration and, in turn, the thirst sensation, but it is not a major stimulus for thirst.
Hyponatermia and hypoglycemia would not trigger the thirst sensation.
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4. Breathing into a paper bag would allow for increased inspiration of carbon dioxide.
Carbon dioxide will decrease pH levels and treat respiratory alkalosis. Increasing
ventilation will increase the exchange of carbon dioxide and further increase pH levels.
Sodium bicarbonate IV would increase pH by introducing a base into the bloodstream.
Dialysis could be a treatment for a metabolic pH issue, but would not be appropriate for
respiratory conditions.
5. D5LR is the only hypertonic solution listed. NS and LR are isotonic solutions. 1/2 NS is a
hypotonic solution.
6. Hypoventilation would increase carbon dioxide retention, decreasing pH.
Hyperventilation would decrease carbon dioxide retention, increasing pH. Decreasing
arterial carbon dioxide and increasing bicarbonate excretion would further increase pH
levels.
7. Normal calcium levels are 4 to 5 mEq/L. Normal magnesium levels are 1.8 to 2.4 mEq/L.
Normal potassium levels are 3.5 to 5 mEq/L. Normal sodium levels are 135 to 145 mg/dl.
8. Aldosterone increases renal sodium reabsorption, and the antidiuretic hormone increases
renal water reaborption.
9. Fluid volume deficit manifestations include tachycardia, acute loss of body weight,
weakness, and dry mucous membranes. Increased blood pressure, weight gain,
bradycardia, decreased urine output, and rapid respirations would not generally be seen.
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10. Renal failure increases fluid retention, leading to fluid volume excess. Edema, bounding
pulses, and respiratory distress are manifestations of fluid volume excess. Renal failure
may result in potassium imbalances (usually hyperkalemia), but these imbalances would
not present with these manifestations. Fluid volume deficit usually presents with
tachycardia, weak thready pulses, acute loss of body weight, weakness, and dry mucous
membranes.
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11. Normal pH is 7.35 to 7.45. Normal PaCO2 levels are 35 to 45 mmHg. Normal HCO3–
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levels are 22 to 26 mEq/L. Using the coding system described in chapter 6, this patient’s
pH would be normal (but on the acidic side), PaCO2 would be acidic, and HCO3– would
be basic. This would be coded as AAB. Because the paired letters are As, then the
condition is acidic. Because one of the As is with PaCO2 (the respiratory measure), then
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the condition is respiratory. Because the unpaired letter is present, compensation is
occurring. Because the pH is back within normal limits, then the condition is fully
compensated. This patient has compensated respiratory acidosis.
–
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12. Normal pH is 7.35 to 7.45. Normal PaCO2 levels are 35 to 45 mmHg. Normal HCO3
levels are 22 to 26 mEq/L. Using the coding system described in chapter 6, this patient’s
–
pH is basic, PaCO2 is basic, and HCO3 normal. This would be coded as BBN. Because
the paired letters are Bs, then the condition is alkalosis. Because one of the Bs is with
PaCO2 (the respiratory measure), then the condition is respiratory. Because the unpaired
letter is normal, compensation has not occurred. This patient has respiratory alkalosis.
13. Kayexalate is the long standing drug of choice for hyperkalemia. Calcium gluconate may
be used to treat dysrhythmias associated with hyperkalemia, but it will not correct the
hyperkalemia. Lactated ringers will not treat hyperkalemia and may further increase
potassium levels. Arginine HCL will treat hypertension but not hyperkalemia.
14. This patient’s K level is significantly high. Cardiac dysrhythmias associated with
hyperkalemia can be life-threatening (e.g., ventricular tachycardia).
15. Daily weight is the most reliable measurement of fluid balance. Sodium levels can
fluctuate with fluid shifts, but are not definitive to loss or gains. Intake and output
measure are good measures, but they do not capture all fluid losses (e.g., insensible water
losses) and gains (e.g., cellular metabolism). Skin turgor assessment is a good measure as
well, but normal aging changes can alter the results.
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16. Plasma proteins maintain capillary colloidal pressure. Red and white blood cells do not
affect this pressure. Serum sodium concentrations can affect osmotic pressure through
changing tonicity, but it does not affect capillary colloidal pressure.
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17. Normal K levels are 3.5 to 5.0 mEq/L. Normal Na levels are 135 to 145 mg/dl. Normal
pH is 7.35 to 7.45. Normal PaCO2 levels are 35 to 45 mmHg. Normal HCO3– levels are
22 to 26 mEq/L. This patient’s Na is high, pH is low, and PaCO2 is high indicating fluid
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volume deficit and metabolic acidosis. ½ NS would add fluid volume while diluting the
Na concentration. Sodium bicarbonate would correct the acidosis. NS with potassium
would not correct the Na or K levels, and may make them worse.
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18. Conditions that impair gas exchange and result in carbon dioxide retention (e.g.,
hypoventilation, aspiration of foreign bodies, and sleep apnea) lead to respiratory
acidosis.
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19. Decreased neuromuscular excitability is seen with hypercalcemia and hypermagnesemia
because of their role with muscle activity. This is not seen with the other electrolyte
disorders.
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20. Both renal failure and diarrhea can result in metabolic acidosis because of the kidneys
loss of regulation of hydrogen and bicarbonate and the loss of gastrointestinal
bicarbonate.
21. Insensible water loss refers to losses that cannot be measured and includes breathing and
sweating.
22. Hypotonic fluids treat hypernatermia by diluting the sodium levels. Hypotonic solutions
usually are lower in Na concentrations. Normal saline, colloids, and ACE inhibitors will
not correct high sodium levels.
Chapter 7 Urinary Function
A)
B)
C)
D)
1. Acute glomerulonephritis and pyelonephritis may advance to:
Prerenal failure.
Postrenal failure.
Intrarenal failure.
Acute tubular necrosis.
A)
B)
C)
D)
1. Acute glomerulonephritis and pyelonephritis may advance to:
Prerenal failure.
Postrenal failure.
Intrarenal failure.
Acute tubular necrosis.
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2. The nurse would expect to see which common pathogen on the urine culture and
sensitivity (C & S) of a patient with a urinary tract infection?
A)
Staphylococcus.
B)
Streptococcus.
C)
Klebsiella.
D)
E. Coli.
Loss of hemoglobin in the urine.
Insufficient retention of iron.
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4. Which one of the following age groups is most susceptible to renal damage caused by
medications?
Small children.
Young adults.
Middle-aged adults.
Older adults.
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B)
C)
D)
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C)
D)
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3. Anemia frequently found in persons with chronic renal failure can best be explained
in terms of:
A)
Failure of the kidneys to activate or produce erythropoietin.
B)
Excess loss of vitamin B12 by the kidneys.
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5. End-stage renal disease is characterized by which of the following alterations?
A)
Increased glomerulus filtration rate.
B)
Increased serum blood urea nitrogen.
C)
Decreased serum creatinine.
D)
Decreased serum potassium.
A)
B)
C)
D)
6. Glomerulonephritis is most accurately described as representing:
An injurious insult to the glomerular structures of the kidney.
An infection involving the glomerular structures of the kidney.
Cellular mutations involving the glomerular structures of the kidney.
An inflammatory process involving the glomerular structures of the kidney.
7. A person with acute pyelonephritis would most typically have:
A)
Fever.
B)
Edema.
C)
Oliguria.
D)
Hypertension.
8. Stress incontinence is characterized by:
Involuntary loss of urine because of abnormal activity of the micturition centers in
the sacral cord.
B)
Involuntary loss of urine when intravesical pressure occurs in the absence of
detrusor activity.
C)
Involuntary loss of urine associated with activities such as coughing or squatting.
D)
Awareness of the need to urinate but failure to respond appropriately.
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A)
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9. A patient presents to the emergency department with generalized edema and dyspnea.
A history reveals multiple infections over the last six months. Diagnostic test reveals
proteinuria, hyperlipidemia, hypoalbuminemia. The health care provider should
realize that these findings are consistent with which of the following problems?
A)
Nephritic syndrome.
B)
Nephrotic syndrome.
C)
Nephrolithiasis.
D)
Pyelonephritis.
A)
B)
C)
D)
11. In the second stage of chronic renal failure, what percent of renal tissue is destroyed?
25 percent.
60 percent.
75 percent.
90 percent.
A)
B)
C)
D)
12. A characteristic sign of polycystic kidney disease is:
Polyuria.
Proteinuria.
Hypertension.
Enlarged kidneys.
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A)
B)
C)
D)
10. Etiologic factors in the development of urolithiasis include:
Urinary stasis.
Osmotic diuresis.
Low antidiuretic hormone levels.
High levels of sodium in the urine.
A)
B)
C)
D)
12. A characteristic sign of polycystic kidney disease is:
Polyuria.
Proteinuria.
Hypertension.
Enlarged kidneys.
A)
B)
C)
D)
E)
13. Glomerular filtration:
increases if blood pressure decreases
produces a fluid high in protein and low in sodium
occurs across the walls of glomerular capillaries
Is very sensitive to systemic blood pressure
all of the above
A)
B)
C)
D)
15. Pyelonephritis results from which of the following?
Formation of immune complexes that damage the glomeruli
Bacterial infection of the kidney
Formation of autoantibodies directed against the glomerular basement membrane
Inadequate renal blood flow
A)
B)
C)
D)
16. A young woman experiences frequent urination with a burning sensation. Her urine
contains many white blood cells and bacteria. There is no glucose or protein in the
urine. What is the most likely cause of these manifestations?
Congenital polycystic kidney disease
Urinary tract infection
Chronic glomerulonephritis
Nephrotic syndrome
A)
B)
C)
D)
E)
17. What powerful vasoconstrictor raises the blood pressure by causing the peripheral
arterioles to constrict?
Renin
Angiotensin I
Angiotensin II
Angiotensin-converting enzyme
Aldosterone
A)
B)
C)
D)
E)
18. Approximately 50-75% of all cases of chronic renal failure result from which of the
following?
Chronic pyelonephritis
Polycystic renal disease
Diabetes and hypertension
Chronic glomerulonephritis
Autoimmune diseases
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A)
B)
C)
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D)
14. Which of the following does NOT occur as a complication of a kidney stone?
Renal colic caused by passage of stone from kidney into ureter
Kidney infection
Hydronephrosis caused by obstruction of urinary drainage by stone impacted in the
ureter
Glomerulonephritis
A)
B)
C)
D)
E)
18. Approximately 50-75% of all cases of chronic renal failure result from which of the
following?
Chronic pyelonephritis
Polycystic renal disease
Diabetes and hypertension
Chronic glomerulonephritis
Autoimmune diseases
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___ 19. Aldosterone primarily affects which of the following?
A)
Carbohydrate metabolism
B)
Protein and fat metabolism
C)
Salt and water metabolism
D)
Protein and water metabolism
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C
D
A
D
B
D
A
C
B
A
C
D
C
D
B
B
C
C
C
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1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
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Answer Key
Rationales
1. Intrarenal causes of renal failure include those conditions that originate inside the kidney,
such as glomerulonephritis and pyelonephritis. Prerenal causes include those conditions
that originate before the kidneys, such as shock. Postrenal causes include those conditions
after the kidneys, such as nephrolithiasis.
2. E. coli is the most common cause of urinary tract infections. Typically this organism is
part of the normal flora of the gastrointestinal tract. Urinary tract contamination of the
organism usually occurs because of the close proximity of the urinary meatus with the
anus.
3. Anemia is a frequent complication with chronic renal failure because the kidneys loss
their ability to produce erythropoietin properly.
4. Renal efficiency declines with age, making older adults more susceptible to medication
damage.
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5. Increased blood urea nitrogen levels are an indication of end-stage renal disease and
reflect rising levels of waste. End-stage renal disease would also cause a decreased
glomerulus filtration rate, increased serum creatinine, and increased serum potassium
levels.
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6. Glomerulonephritis is a result of damage caused by the inflammatory process. While
injuries and infections can trigger the inflammation, these are not the only causes.
Glomerulonephritis is not a result of cellular mutations.
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7. Pyelonephritis refers to a kidney infection. Fever is a typical manifestation of acute
pyelonephritis. Edema, oliguria, and hypertension are not typical manifestations of
pyelonephritis.
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8. Stress incontinence refers to involuntary loss of urine associated with activities that
increase intrathorasic pressure, such as coughing or squatting. It is not a result of
neurological abnormalities.
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9. Nephrotic syndrome is a form of glomerulonephritis that results from immune system
damage. The damage typically manifests as edema, dyspnea, proteinuria, hyperlipidemia,
and hypoalbuminemia. Nephritic syndrome is also a form of glomerulonephritis that
results from inflammatory damage; it typically presents with gross hematuria, urinary
casts and leukocytes, low glomerulo filtrate rate, azotemia, oliguria, and high blood
pressure. Nephrolithiasis, or kidney stones, usually presents with severe colicky pain and
hematuria. Pyelonephritis, or kidney infection, usually presents with severe indications of
urinary tract infection (e.g., fever, bacteria in the urine, dysuria), flank pain, and
hypertension.
10. Urolithiasis refers to stones that form in the urinary tract. Urinary stasis is a significant
cause of urolithiasis because it increases mineral consolidation.
11. The second stage of chronic renal failure, or renal insufficiency, is marked by destruction
of 75% of nephrons. The first stage, or renal impairment, is marked by destruction of
60% of nephrons. The final stage, or end-stage renal failure, is marked by destruction of
90% of nephrons.
12. The kidneys enlarge with polycystic kidney disease because of the multiple cysts present.
Polyuria and proteinuria are not usually present with polycystic kidney disease.
Hypertension may be present with this condition among many other renal and cardiac
conditions, but it is not specific to polycystic kidney disease.
Chapter 8 Reproductive Function
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___ 2. Priapism is characterized by:
Hard fibrous plaque in the shaft of the penis.
Prolonged painful erection.
Failure of the testes to descend into the scrotum.
Tightening of the penile foreskin.
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A)
B)
C)
D)
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___ 1. In males with epispadias, the termination of the urethra is on the:
A)
Ventral surface of the penis.
B)
Dorsal surface of the penis.
C)
Lateral surface of the penis.
D)
Distal surface of the penis.
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___ 3. Risk factors for cancer of the penis include:
A)
Priapism.
B)
Circumcision.
C)
Peyronie's disease.
D)
The human papillomavirus (HPV) infections.
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___ 4. In a hydrocele, excess fluid is present in the:
A)
Seminal vesicles.
B)
Tunica vaginalis.
C)
Vas deferens.
D)
Epididymis.
A)
B)
C)
D)
___ 5. A common symptom of benign prostatic hyperplasia is:
Decreased force and caliber of the urinary stream.
Burning on urination.
Suprapubic pain.
Painful erection.
___ 6. Mrs. C has presented to the clinic complaining of a lump in her right breast along
with a lump in her right axilla. What is the best explanation for the right axillary
enlarged lymph node?
A)
Inflammatory process associated with breast cancer
B)
Lymphatic strain as a result of cellular degeneration
C)
The lymph nodes providing nutrients to the cancer cells.
D)
The cancer cells spreading to different tissue in the body.
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___ 7. Which one of the following cancers of the female genitourinary tract is the most
easily cured if detected early?
A)
Cancer of the vulva.
B)
Cancer of the cervix.
C)
Cancer of the ovary.
D)
Cancer of the endometrium.
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___ 9. Leiomyomas are:
Malignant tumors of the uterine muscle.
Benign neoplasms of smooth muscle in the uterus.
Soft, velvety red lesions that often protrude through the cervical os.
Non-malignant atrophic and hyperplastic changes of the vulvar skin and mucosa.
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B)
C)
D)
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___ 8. Endometriosis can be described as a condition in which:
A)
There is inflammation of the endometrium.
B)
Endometrial glands and stroma are found within the myometrium.
C)
Functional endometrial tissue is found in ectopic sites outside the uterus.
D)
A fluid-filled sac results from the occlusion of the duct system of a gland.
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___ 10. Which one of the following statements is true as it relates to ovarian cancer?
Ovarian cancer:
A)
Is often asymptomatic until the disease is far advanced.
B)
Is easily detected using the serum marker PSA.
C)
Is easily detected during a pelvic exam.
D)
Can be detected with the Pap smear.
___ 11. A patient has a diagnosis of dysmenorrhea. Which of the following would likely
appear in her history?
A)
Heavy flow and clots for at least 3 months.
B)
Irregular menses with breakthrough bleeding.
C)
Painful periods since menarche.
D)
No periods for the last 7 months.
___ 11. A patient has a diagnosis of dysmenorrhea. Which of the following would likely
appear in her history?
A)
Heavy flow and clots for at least 3 months.
B)
Irregular menses with breakthrough bleeding.
C)
Painful periods since menarche.
D)
No periods for the last 7 months.
___ 12. In preparing to discharge a patient with gonococcal pelvic inflammatory disease,
the nurse would intervene if the patient made which statement?
A)
"My boyfriend and I should be monogamous."
B)
"I should douche after episodes of intercourse."
C)
"The sexual position I use won't prevent this infection."
D)
"Using condoms will decrease the risk of this happening again."
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___ 13. A rectocele involves:
A)
Bulging of the uterus into the vagina.
B)
Herniation of the rectum into the vagina.
C)
Herniation of the rectum into the uterus.
D)
Anterior flexion of the uterus so that it rests on the bladder.
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___ 14. Most breast cancers are discovered through use of:
A)
Physician exams.
B)
Mammography.
C)
Breast self-exam.
D)
Chest x-rays.
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___ 15. Recurrent genital herpes infections result from:
A)
Activation of the virus that is maintained in a latency state in neurons of the sacral
dorsal root ganglia.
B)
Activation of the virus that is maintained in a latency state in the genital tissues.
C)
An immune response arising from repeated exposure to the virus.
D)
Reinfection with herpes simplex type 1 virus.
___ 16. The reason that antibiotic therapy predisposes women to vulvovaginal candidiasis
is that it:
A)
Produces a decrease in immune function.
B)
Suppresses the normal protective flora.
C)
Decreases the pH of vaginal secretions.
D)
Increases vaginal glycogen stores.
___ 17. Which one of the following types of vaginal discharge is characteristic of a
trichomonas infection?
A)
Mucopurulent.
B)
Thin and watery.
C)
Copious frothy green or yellow and foul smelling.
D)
Homogenous fishy smelling with a pH above 4.5.
___ 17. Which one of the following types of vaginal discharge is characteristic of a
trichomonas infection?
A)
Mucopurulent.
B)
Thin and watery.
C)
Copious frothy green or yellow and foul smelling.
D)
Homogenous fishy smelling with a pH above 4.5.
___ 18. A serious complication of chlamydia infections in women is:
A)
Cervicitis.
B)
Endometriosis.
C)
Urinary frequency.
D)
Pelvic inflammatory disease.
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___ 19. Without treatment, which infection may progress to damage the aorta, liver, and
central nervous system?
A)
Syphilis.
B)
Gonorrhea.
C)
Chlamydia.
D)
Trichomoniasis.
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___ 20. Female patients with chlamydia infections will most likely present with which
signs and symptoms?
A)
Painful perineal blisters and sudden high fever.
B)
Rapidly progressing pruritic rash on labia and buttocks.
C)
Painless crater-like lesion on the labia that last for 6 weeks.
D)
Yellow-green vaginal discharge, pain during intercourse, and pelvic pain.
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___ 21. A patient presenting with a urinary tract infection and a swollen, red, and tender
scrotum would probably be diagnosed as having:
A)
Syphilis.
B)
Cystocele.
C)
Epididymitis.
D)
Genital herpes.
___ 22. Uterine prolapse, cystocele, and rectocele may all be the result of:
A)
Repeated infections.
B)
Chronic constipation.
C)
Hormonal abnormalities.
D)
Pregnancy and childbirth.
___ 23. Which of the following statements regarding breast carcinoma is INCORRECT?
A)
It occurs in only women.
B)
It can often be detected by a mammogram before the tumor becomes large enough
to be palpated within the breast.
C)
The tumor may arise from epithelium of either ducts or lobules.
D)
The use of estrogens or estrogen–progestin hormones by postmenopausal women
increases breast carcinoma risk.
___ 23. Which of the following statements regarding breast carcinoma is INCORRECT?
A)
It occurs in only women.
B)
It can often be detected by a mammogram before the tumor becomes large enough
to be palpated within the breast.
C)
The tumor may arise from epithelium of either ducts or lobules.
D)
The use of estrogens or estrogen–progestin hormones by postmenopausal women
increases breast carcinoma risk.
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___ 24. How often should a woman perform a breast self-examination?
A)
Daily
B)
Weekly
C)
Monthly
D)
Every 6 months
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___ 25. Sixty percent of all breast tumors are responsive to this hormone.
A)
Estrogen
B)
Progesterone
C)
Prolactin
D)
Testosterone
E)
HCG
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___ 26. What is a common manifestation of human papilloma virus infection?
A)
Buboes
B)
Genital condylomas
C)
Chancres
D)
A skin rash
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___ 27. Which of the following statements about endometriosis is NOT true?
A)
It is a rare condition.
B)
It is characterized by deposits of endometrial tissue in locations outside the lining
of the endometrial cavity (endometrium).
C)
It may be associated with pain related to menstrual periods.
D)
Scarring associated with endometriosis may block tubes and cause sterility.
___ 28. Which of the following statements regarding carcinoma of the penis is
INCORRECT?
A)
It is rare in circumcised males.
B)
Papilloma virus infection may predispose to development of penile carcinoma.
C)
Carcinoma cells secrete chorionic gonadotropin.
D)
It is treated by partial or complete resection of the penis.
___ 29. Which of the following may occur as a result of benign prostatic hyperplasia?
A)
Testicular atrophy
B)
Compression of the urethra by the enlarged prostate leading to incomplete
emptying of the bladder
C)
Predisposition to bladder cancer
D)
Predisposition to prostate cancer
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___ 31. Cryptorchidism is best described as
A)
A rotary twist of the testis on its axis
B)
Fluid that accumulates in the sac of the scrotum
C)
An undescended testis
D)
Hemorrhagic necrosis of the testis
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___ 30. When an acute inflammation of the bladder or urethra spreads into the prostate,
what is this condition called?
A)
Prostatic hyperplasia
B)
Nongonococcal gonorrhea
C)
Cystitis
D)
Acute prostatitis
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___ 32. The following are causes of erectile dysfunction EXCEPT:
A)
a high testosterone level.
B)
stress, emotional factors, and many chronic illnesses.
C)
use of antihypertensive drugs that target the autonomic nervous system.
D)
impaired blood supply to the penis.
E)
damage to the nerves supplying the penis resulting from radical prostate surgery
or neurologic diseases.
Answer Key
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
B
B
D
B
A
D
B
C
B
A
C
B
B
C
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A
D
B
C
B
A
C
B
B
C
A
B
C
D
A
D
C
D
A
C
A
B
A
C
B
D
C
A
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5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
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Rationales
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1. Epispadias refers to the urinary meatus occurring on the dorsal surface of the penis.
Hypospadias refers to the urinary meatus occurring on the ventral surface of the penis.
The urinary meatus does not generally occur on the lateral surface of the penis. Occurring
on the distal surface is normal for the meatus.
2. Priapism refers to a prolonged painful erection that is not associated with sexual arousal
and can be a urological emergency. A is describing Peyronie’s disease. C is describing
cryptorchidism. D is describing phimosis.
3. HPV is the most significant risk factor for penile cancer. Priapism, circumcision, and
Peyronie’s disease does not increase penile cancer risk.
4. Hydrocele refers to fluid accumulation in the tunica vaginalis.
5. Difficulty initiating urination and decreased urinary stream is common with benign
prostatic hyperplasia because of the prostate’s close proximity to the urinary tract.
Dysuria, suprapubic pain, and painful erection is not associated with benign prostatic
hyperplasia.
6. The enlarged nearby lymph nodes indicates that the breast cancer has metastasized.
7. Cervical cancer is easily treated when detected early. Current diagnostic procedures are
capable to detect cervical cancer early.
8. Endometriosis refers to the presence of endometrial tissue outside the uterus. This ectopic
tissue functions are normal endometrial tissue but causes dysmenorrhea and pain outside
the uterus as blood becomes trapped.
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9. Leiomyomas refers to benign neoplasms of the uterus. Leiomyomas are not malignant, do
not protrude through the cervical os, or do not causes vulvar changes.
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10. Ovarian cancer is often asymptomatic and more difficult to diagnose than other
reproductive cancers; therefore, the condition often goes undetected until it is advanced.
The PSA detects prostate cancer. Ovarian cancer cannot be detected with a pelvic exam
or Pap smear.
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11. Dysmenorrhea refers to painful menstruation. A is describing menorrhagia. B is
describing metrorrhagia. D is describing oligomenorrhea.
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12. Douching an worsen pelvic inflammatory disease by spreading the infection to the upper
reproductive tract. No other answers would cause concern and would be beneficial.
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13. Rectocele refers to the herniation of the rectum into the vagina. A is describing a
prolapsed uterus. The rectum does not usually herniated into the uterus. D is describing
normal uterus positioning.
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14. While all can detect breast cancer, most cases are detected through self-breast
examinations.
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15. Recurrent genital herpes infections result from activation of the virus that is maintained
in a latency state in neurons of the sacral dorsal root ganglia. The virus does not remain
latent in the genital tissue. These recurrent infections are not a result of repeated exposure
or reinfection with type 1.
16. Antibiotic therapy predisposes women to vulvovaginal candidial infection because it
disrupts the normal flora that prevents candidiasis overgrowth. It does not occur because
of decreased immune function, changes in pH, or increases in glycogen stores.
17. Trichomonas infections typically result in copious amounts of frothy green or yellow,
foul smelling discharge.
18. Chlamydia infections can lead to pelvic inflammatory disease, which can result in
infertility. Generally, chlamydia infections do not result in endometriosis and urinary
frequency. These infections can result in cervicitis, but it is not usually serious.
19. Syphilis can damage many structures outside the reproductive tract if left untreated.
Gonorrhea, chlamydia, and trichomoniasis do not causes damage outside the reproductive
tract.
20. Chlamydia infections usually presents with a yellow-green vaginal discharge, painful
intercourse, and pelvic pain. Blisters, high fever, rash, and lesions are not usually present.
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21. Epididymitis often results from a urinary tract infection and presents with swollen, red,
and tender scrotum. Syphilis and genital herpes do not occur in this manner. Cystoceles
does not occur in males.
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Chapter 9 Gastrointestinal Function
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22. Uterine prolapse, cystocele, and rectocele all result from weakening of the vaginal wall
that can often occur with pregnancy and childbirth. Infections, constipation, and
hormonal changes do not usually lead to all of these.
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___ 1. Which of the following statements regarding stomach cancer is true?
A)
“There is no genetic basis for developing gastric cancer.”
B)
“This type of cancer is caused by a sexually transmitted infection.”
C)
“Gastric cancer is associated with salted, pickled, preserved, and charcoaled
foods.”
D)
“Gastric cancer can be avoided by a diet high in vegetables and vitamin C.”
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___ 2. A major complication of gastroesophageal reflux disease is:
A)
Cancer.
B)
Heartburn.
C)
Flatulence.
D)
Chest pain.
___ 3. Which of the four types of gastritis is the most common?
A)
Chemical gastropathy.
B)
Multifocal atrophic.
C)
Autoimmune.
D)
H. pylori.
A)
B)
C)
D)
___ 4. The manifestations of acute cholecystitis include:
Colicky upper right quadrant pain.
Decreased in clotting ability.
Enlarged liver.
Melena.
___ 4. The manifestations of acute cholecystitis include:
A)
Colicky upper right quadrant pain.
B)
Decreased in clotting ability.
C)
Enlarged liver.
D)
Melena.
A)
B)
C)
D)
___ 5. Which of the following is a complication of Crohn’s disease?
Gastrointestinal tuberculosis
Fistula formation
Weight gain
Arthritis
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___ 6. Which of the following is a risk factor for developing diverticular disease?
A)
Smoking.
B)
Excessive nut intake.
C)
Chronic constipation.
D)
Alcohol consumption.
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___ 7. The encephalopathies or alterations in central nervous system function that appear
late in the course of cirrhosis are associated with:
A)
Impaired blood flow to the brain resulting from portal vein obstruction.
B)
Failure of the liver to remove ammonia and metabolic wastes from the blood.
C)
Elevated levels of blood urea nitrogen.
D)
Elevated blood sugar levels.
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___ 8. Crohn's disease is characterized by:
A)
Sharply demarcated granulomatous skip lesions of the bowel.
B)
Ulcerative lesions of the mucosal layer of the colon.
C)
Increased risk of colon cancer.
D)
Lack of systemic involvement.
___ 9. The clinical manifestations of ulcerative colitis include:
A)
The patient may have five or six soft stools per day.
B)
The patient may have 10 to 20 steatorrheal stools per day.
C)
The patient may have 10 to 20 liquid, bloody stools per day.
D)
The patient may have a bowel movement every 5 to 10 days.
___ 10. A patient presents to the emergency department complaining of chest pain,
heartburn, and an abdominal mass. The nurse should expect which of the following
conditions?
A)
Gastritis.
B)
Hiatal hernia.
C)
Peptic ulcer disease (PUD).
D)
Gastroesophaeal reflux disease (GERD).
___ 10. A patient presents to the emergency department complaining of chest pain,
heartburn, and an abdominal mass. The nurse should expect which of the following
conditions?
A)
Gastritis.
B)
Hiatal hernia.
C)
Peptic ulcer disease (PUD).
D)
Gastroesophaeal reflux disease (GERD).
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___ 11. A patient presents to the emergency department complaining of severe abdominal
pain. Exam reveals right lower quadrant pain with rebound tenderness, a white
blood count of 26,000, and a temperature of 103.5. The nurse should suspect
which serious condition?
A)
Peritonitis.
B)
Pancreatitis.
C)
Appendicitis.
D)
Cholelithiasis.
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___ 12. Which of the following patients is more likely to develop pancreatitis?
A)
A patient with renal problems and hypocalemia.
B)
A patient with a stone lodged in the pancreatic duct.
C)
A 59-year-old male with a history of occasional alcohol use.
D)
A patient recovering from a myocardial infarction with hypercholesterolemia.
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___ 13. Acute pancreatitis results from:
A)
Hypoxia.
B)
Diabetes mellitus.
C)
An autodigestive process.
D)
An autoimmune response.
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___ 14. The pathophysiological changes associated with peptic ulcer disease (PUD)
include which of the following?
A)
Excessive acid.
B)
Increased mucous production.
C)
Chronic inflammation of the stomach lining.
D)
Reflux of alkaline duodenal contents into the stomach.
___ 15. Factors that contribute to the development of cholelithiasis include:
A)
Stasis and altered composition of bile.
B)
High alcohol consumption.
C)
Cirrhosis.
D)
Diabetes mellitus.
___ 16. An early sign or symptom of cancer of the colon is:
A)
Anorexia.
B)
Rectal bleeding.
C)
Pain on defecation.
D)
Unexplained weight loss.
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___ 17. Esophageal varicosites are a result of which of the following?
A)
Ascities.
B)
Portal hypertension.
C)
Metabolic dysfunction.
D)
Hepatic encephalopathy.
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___ 18. Which of the following patients is most at risk of developing hepatitis B?
A)
54-year-old woman who takes acetaminophen (Tylenol) daily for headaches
B)
24-year-old college student who has had several sexual partners
C)
33-year-old business man who travels frequently
D)
23-year-old college student that binge drinks
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___ 19. Which of the following patients would be most at risk for the development of
carcinoma of the liver?
A)
28-year-old patient with a history of blunt liver trauma and smoking
B)
58-year-old patient with a history of diabetes mellitus
C)
65-year-old patient with a history of cirrhosis
D)
80-year-old patient with malnutrition
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___ 20. Ms. Steiner is a 23-year-old Caucasian teacher who has presented with symptoms
of gastroesophageal reflux disease (GERD), diagnosed by an upper gastrointestinal
study. She does not have any cell changes since the GERD is a new problem. She
is currently a smoker and tends to drink socially while smoking on the weekends.
Which risk factor presents the greatest risk for her in developing esophageal cancer
at a later time?
A)
Alcohol consumption with tobacco use
B)
Gender
C)
Race
D)
Age
___ 21. Which of the following patients would be most at risk for an intestinal obstruction?
A)
An elderly patient who is on bedrest because of post-operative abdominal surgery.
B)
A Jewish patient who smokes and consumes large amounts of caffeine.
C)
An individual eating a low-fiber, high fat diet.
D)
An adult diagnosed with cirrhosis of the liver.
___ 21. Which of the following patients would be most at risk for an intestinal obstruction?
A)
An elderly patient who is on bedrest because of post-operative abdominal surgery.
B)
A Jewish patient who smokes and consumes large amounts of caffeine.
C)
An individual eating a low-fiber, high fat diet.
D)
An adult diagnosed with cirrhosis of the liver.
___ 23. The most common symptom of peptic ulcers is:
A)
pain in the epigastric region
B)
decreased appetite
C)
nausea
D)
melena
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___ 22. The most common treatment for colon cancer is:
A)
chemotherapy
B)
surgery
C)
radiotherapy
D)
All of the above
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___ 24. Which of the following tests is a safe, easy, and accurate way to diagnosis H.
pylori and identify if the bacterium has been successfully eradicated by antibodies
A)
Blood tests
B)
Urea breath tests
C)
Endoscopy
D)
Stool Sample
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___ 25. H. pylori infection is treated by:
A)
there is no treatment
B)
acid suppression medicine
C)
proton pump inhibitors
D)
antibiotics
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___ 26. Which of the following statements regarding hepatitis B is INCORRECT?
A)
Transmission is primarily by means of blood and body fluids.
B)
Some infections are acquired by eating incompletely cooked meat from animals
infected with the virus.
C)
Recovery from infection confers immunity to subsequent infection.
D)
Hepatitis B immune globulin injection may provide some protection to a
nonimmune person after exposure to the virus.
E)
Immunization with hepatitis B surface antigen vaccine confers active immunity
against the virus.
___ 27. Some types of hepatitis are transmitted by the fecal-oral route, and others are
transmitted by contact with infectious blood or body fluids. Below is a list of
various types of hepatitis. From this list, select the types of viral hepatitis that have
a similar means of transmission.
A)
Hepatitis A, hepatitis B, and hepatitis C all have a similar means of transmission.
B)
Hepatitis A and hepatitis B have a similar means of transmission.
C)
Hepatitis A and hepatitis C have a similar means of transmission.
D)
Hepatitis B and hepatitis C have a similar means of transmission.
___ 27. Some types of hepatitis are transmitted by the fecal-oral route, and others are
transmitted by contact with infectious blood or body fluids. Below is a list of
various types of hepatitis. From this list, select the types of viral hepatitis that have
a similar means of transmission.
A)
Hepatitis A, hepatitis B, and hepatitis C all have a similar means of transmission.
B)
Hepatitis A and hepatitis B have a similar means of transmission.
C)
Hepatitis A and hepatitis C have a similar means of transmission.
D)
Hepatitis B and hepatitis C have a similar means of transmission.
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___ 28. Hepatitis B virus infection (HBV) and hepatitis C virus infection (HCV) have
many similar features. Which of the following statements does NOT apply to both
HBV and HCV?
A)
They are transmitted by blood or other body fluids.
B)
Some infected persons develop chronic hepatitis.
C)
Persons with chronic hepatitis caused by either HBV or HCV may develop diffuse
scarring throughout the liver (cirrhosis of the liver) and/or cancer of the liver.
D)
Immunization protects against infection.
E)
They can be transmitted by sexual intercourse.
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___ 29. Which of the following is NOT a common means of transmitting hepatitis A
(infectious hepatitis)?
A)
Direct contact with persons ill with hepatitis A
B)
Food contaminated with hepatitis A virus
C)
Water contaminated with hepatitis virus
D)
Blood or blood products
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___ 30. Which of the following statements regarding diverticulosis of the colon is
INCORRECT?
A)
Diverticula predispose to colon carcinoma.
B)
Low-residue diet predisposes to colon diverticula.
C)
Ulceration of lining of diverticula caused by fecal material in the diverticula may
cause bleeding from the ulcerated diverticulum.
D)
Diverticulum may become infected, causing diverticulitis.
___ 31. A patient has a large colon carcinoma with a hypochromic (iron-deficiency)
anemia. The anemia is probably due to which of the following?
A)
Chronic blood loss from the ulcerated surface of the tumor
B)
Impaired absorption of nutrients caused by the tumor
C)
Poor appetite
D)
Metastases to the liver
___ 32. Which of the following conditions is a characteristic feature of Crohn disease?
A)
Usually involves primarily the small intestine
B)
Bacterial infection
C)
Predisposes to colon carcinoma
D)
May lead to perforation of the colon
___ 32. Which of the following conditions is a characteristic feature of Crohn disease?
A)
Usually involves primarily the small intestine
B)
Bacterial infection
C)
Predisposes to colon carcinoma
D)
May lead to perforation of the colon
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C
A
D
A
B
C
B
A
C
B
C
B
C
A
A
B
B
B
C
A
B
A
B
D
B
D
D
D
A
A
A
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1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
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Answer Key
Rationales
1. Gastric cancer is associated with salted, pickled, preserved, and charcoaled foods. It does
not have a genetic quality. It is not caused sexual transmitted infections. It cannot be
avoided by a diet high in vegetables and vitamin C.
2. Esophageal cancer is a major complication of gastrointestinal reflux disease. Heartburn,
flatulence, and chest pain are manifestations of gastroesophageal reflux disease but not
complications.
3. Most cases are gastritis are caused by H. pylori, a common bacteria colonized in many
people.
4. Cholecystitis refers to inflammation of the gall bladder often a result of cholelithiasis, or
gall stones. Colicky upper right quadrant pain is common because of obstruction of bile
flow. Cholecystitis does not alter clotting factors, enlarge the liver, or result in melana.
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5. Crohn’s disease refers of chronic inflammatory bowel disease characterized by patchy
areas of inflammation. This inflammation often results in fistula formation.
Gastrointestinal tuberculosis, weight gain, and arthritis are not complications associated
with Crohn’s disease.
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6. Diverticular disease refers to a weakening of the intestinal wall that is often associated
with increased intestinal pressure, such as with chronic constipation. This condition has
not been linked to smoking, excessive nut intake, or alcohol consumption.
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7. Cirrhosis refers to chronic disuse liver damage that can occur for a variety of reasons,
including hepatitis and alcoholism. This damage impairs many of the liver’s normal
functions including waste metabolism, resulting in an accumulation of those wastes.
These wastes can lead to encephalopathy.
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8. Crohn’s disease is characterized by sharply demarcated granulomatous skip lesions of the
bowel. B describes ulcerative colitis. Crohn’s disease has not been associated with
increased colon cancer risk. Because it involves the inflammatory reaction, Crohn’s
disease does have systemic involvement.
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9. Ulcerative colitis is a chronic condition that is characterized by ulcerative lesions in the
colon. This ulcerative lesions cause the individual to have 10 to 20 episodes of bloody
diarrhea per day. Ulcerative colitis is not associated with steatorrea or constipation.
10. Hiatal hernia refers to the protrusion of a portion of the stomach through the diaphragm.
Hiatal hernias often presents as chest pain, heartburn, and a soft abdominal mass that
becomes more prominent with increased intrathroasic pressure. Gastritis, peptic ulcer
disease, and gastroesophageal reflux disease can cause chest pain and heartburn, but they
are not associated with a palpable mass.
11. Appendicitis refers to inflammation of the appendix. This condition presents with
leukocytosis, fever, and rebound tenderness of the right lower quadrant. Peritonitis may
present with leukocytosis and fever, but rebound tenderness is not usually seen.
Pancreatitis may present with leukocytosis, fever, and abdominal pain, but rebound
tenderness is not usually present. Cholelithiasis may present with leukocytosis, fever, and
abdominal pain, but rebound tenderness is not usually present.
12. Pancreatitis refers to an inflammation of the pancreas, which often results from an
autodigestion from obstruction of bile. It can also be more common with heavy alcohol
consumption. It is not associated with renal problems, hypocalcemia, myocardial
infarctions, and hypercholesterolemia.
13. Pancreatitis refers to an inflammation of the pancreas, which often results from an
autodigestion from obstruction of bile. It is not a result of hypoxia, diabetes mellitus, or
an autoimmune response.
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14. PUD is associated with excess acid production or decreased mucus production. It is not a
result of chronic inflammation or reflux of duodenal contents.
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15. Cholelithiasis, or gall stones, results from the precipitation of minerals/substances. This is
more likely to occur with bile stasis or when high levels of those minerals/substances are
seen in the bile.
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16. An early sign of colon cancer is rectal bleeding. Pain, anorexia, and weight loss can be
seen, but it is usually later.
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17. Esophageal varicosities refer to incompetent veins in the esophagus that result from rising
pressures in the portal circulation.
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18. Hepatitis B refers to inflammation of the liver, resulting from HBV. HBV is transmitted
through blood and bodily fluids. Having increased number sexual partners increases the
exposure to contaminated bodily fluids. HBV is not associated with medication ingestion,
traveling, or binge drinking.
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19. Liver cancer is most commonly associated with cirrhosis because of the chronic damage.
It is not associated with liver damage, smoking, diabetes mellitus, or malnutrition.
20. Alcohol consumption with concurrent tobacco use greatly increases esophageal cancer
risk in the already high risk patient diagnosed with GERD. Gender, race, and age are not
significant risk factors of esophageal cancer.
21. Intestinal obstruction risk increases with age, decreased mobility, abdominal surgery, and
anesthesia. All of these factors decrease peristalsis. Ethnicity, smoking, and cirrhosis are
not associated with intestinal obstruction. A low-fiber, high fat diet can increase risk for
constipation, but rarely produces an intestinal obstruction alone.
Chapter 10 Endocrine Function
___ 1. Hormones from the anterior pituitary gland control levels of:
A)
Thyroid hormone, adrenal cortical hormones, and sex hormones.
B)
Dopamine, epinephrine, and norepinephrine.
C)
Gastrin, secretin, and cholecystokinin.
D)
Oxytocin and antidiuretic hormone.
A)
B)
C)
D)
___ 1. Hormones from the anterior pituitary gland control levels of:
Thyroid hormone, adrenal cortical hormones, and sex hormones.
Dopamine, epinephrine, and norepinephrine.
Gastrin, secretin, and cholecystokinin.
Oxytocin and antidiuretic hormone.
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___ 3. The function of the thyroid hormone can be described in terms of:
Bone growth.
Anabolic activities.
Mineral metabolism.
Metabolic rate of all body cells.
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B)
C)
D)
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___ 2. Parathyroid hormone (PTH) is released from the parathyroid gland whenever
blood levels of:
A)
Insulin fall.
B)
Insulin rise.
C)
Calcium fall.
D)
Calcium rise.
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___ 4. Which of the following serve to stimulate an increase in growth hormone levels?
A)
Fatty acid release and cortisol.
B)
Increased glucose levels and obesity.
C)
Severe emotional deprivation in children.
D)
Hypoglycemia, fasting, starvation, and trauma.
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___ 5. The manifestations of hypothyroidism include which of the following:
A)
A tendency to gain weight despite a loss in appetite.
B)
An increase in heart rate.
C)
Heat intolerance.
D)
Diarrhea.
___ 6. A patient presents to the emergency department with hypertension, fatigue, and
edema. A physical exam reveals a "buffalo" hump, truncal obesity, and abdominal
purple striae. The health care provider should suspect which of the following?
A)
Graves' disease.
B)
Conn's syndrome.
C)
Addison's disease.
D)
Cushing's syndrome.
___ 7. The nurse who is assessing a patient who is newly diagnosed with primary
hyperparathyroidism knows that the primary result of the disease is:
A)
Goiter.
B)
Hypocalcemia.
C)
Hypercalcemia.
D)
Hyperthyroidism.
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___ 8. A patient with which of the following types of diabetes mellitus is most likely to
experience insulin resistance?
A)
Type 1.
B)
Type 2.
C)
Gestational diabetes.
D)
Impaired glucose tolerance.
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___ 9. Most people with type 2 diabetes mellitus are:
A)
Normal weight.
B)
Underweight.
C)
Overweight.
D)
No relation to weight has been established
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___ 10. Gestational diabetes refers to:
A)
Glucose intolerance that is detected first during pregnancy.
B)
Type 1 diabetes in a pregnant woman.
C)
Type 2 diabetes in a pregnant woman.
D)
Fetal development of diabetes.
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___ 11. Which test provides a good measure of blood glucose levels over the previous 2 to
3 months?
A)
Glucose tolerance test (GTT).
B)
Fasting blood glucose test.
C)
Glycosylated hemoglobin test (HgbA1C).
D)
Capillary blood monitoring tests.
___ 12. The glucose tolerance test:
A)
Is a urine test for sugar.
B)
Is a fasting blood sugar test.
C)
Is a blood sugar test that is done after a meal.
D)
Measures blood sugar following the challenge of ingesting a concentrated glucose
solution.
___ 13. The polyuria associated with diabetes is a result of:
A)
Polydipsia.
B)
The loss of electrolytes.
C)
Increased protein catabolism.
D)
The osmotic effect of glycosuria.
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___ 14. All of the factors below are nutrition-related risk factors for Type 2 diabetes
except:
A)
High fiber diets
B)
BMI of 25 or more
C)
Impaired glucose tolerance
D)
Lack of physical exercise
E)
Abnormal lipid levels
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___ 15. The hormone vasopressin is released from the posterior pituitary
A)
in response to increased ECFV
B)
and inhibits aldosterone release
C)
and acts to decrease urine volume
D)
Decreases blood pressure
E)
All of the above
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___ 16. Type 2 diabetes is a result of insulin secretion defect. This is due to:
A)
The pancreas can not secrete enough insulin in response to glucose level
B)
The glucose levels are high and the body secrets high levels of glucose
C)
Insulin is release by the beta cells of the pancreas
D)
Fat cells take in glucose from the cells
E)
Glucagon is released by the alpha cells of the pancreas
___ 17. Macro vascular complications are the main cause of death for an individual with
diabetes. Which of the following medical conditions is a result of macro vascular
complications?
A)
Blindness
B)
Erectile dysfunction
C)
Hypertension
D)
Stroke
___ 18. Signs and symptoms of diabetes includes all except:
A)
Increased glucose
B)
Increased thirst
C)
Frequent urination
D)
Swollen ankles
E)
Fatigue
___ 18. Signs and symptoms of diabetes includes all except:
A)
Increased glucose
B)
Increased thirst
C)
Frequent urination
D)
Swollen ankles
E)
Fatigue
___ 19. All of the following are complications of diabetes EXCEPT:
A)
Increased susceptibility to infection
B)
Increased susceptibility to arteriosclerosis
C)
Increased incidence of liver disease
D)
Blindness
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___ 20. A high level of blood glucose is called __________.
A)
hyperglycemia
B)
hypoglycemia
C)
diabetes mellitus
D)
diabetic ketosis
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___ 21. Aldosterone primarily affects which of the following?
A)
Carbohydrate metabolism
B)
Protein and fat metabolism
C)
Salt and water metabolism
D)
Protein and water metabolism
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___ 22. An 18-year-old woman has hyperthyroidism caused by diffuse hyperplasia of the
thyroid gland. Which of the following does NOT occur in this condition?
A)
High level of thyroid-stimulating hormone (TSH) in the blood due to
hyperfunctioning pituitary gland
B)
High level of thyroid hormones (T3 and T4) in the blood
C)
Slight enlargement of thyroid gland
D)
Exophthalmos
___ 23. Which of the following does NOT occur in Addison’s disease?
A)
Increased skin pigmentation
B)
Exophthalmos
C)
High levels of ACTH in blood
D)
Low levels of cortisol in blood
___ 24. Secretion of parathyroid hormone is regulated by which of the following?
A)
The level of ionized calcium (Ca2+) in the blood
B)
C)
D)
Trophic hormones secreted by the anterior lobe of the pituitary gland
The level of adrenocortical hormones in the blood
None of the above
___ 24. Secretion of parathyroid hormone is regulated by which of the following?
A)
2+
The level of ionized calcium (Ca ) in the blood
B)
Trophic hormones secreted by the anterior lobe of the pituitary gland
C)
The level of adrenocortical hormones in the blood
D)
None of the above
___ 25. Which of the following is NOT a characteristic feature of Cushing’s disease?
A)
Osteoporosis
B)
Elevated blood glucose
C)
Elevated blood cortisol
D)
Elevated blood pressure
E)
Elevated blood thyroid hormone
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___ 26. A 25-year-old woman has acromegaly. Which of the following does NOT occur in
this condition?
A)
Coarsening of the facial features resulting from overgrowth of facial bones
B)
Elevated level of growth hormone in the blood
C)
Growth in height
D)
Adenoma of pituitary gland
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A
C
D
D
A
D
C
B
C
A
C
D
D
A
C
A
D
D
C
A
C
A
B
A
E
C
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2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
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Answer Key
20.
21.
22.
23.
24.
25.
26.
A
C
A
B
A
E
C
Rationales
1. The anterior pituitary gland controls levels of the thyroid hormones, adrenal cortical
hormones, and sex hormones. It does not affect dopamine, epinephrine, norepinephrine,
gastrin, secretin, cholecystokinin, oxytocin, or the antidiuretic hormone.
2. PTH is released whenever serum calcium falls. Insulin has no affects on PTH.
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3. Thyroid hormones’ primary function is controlling cellular metabolism. They do not
directly affect bone growth, anabolic activities, or mineral metabolism.
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4. Growth hormone increases during hypoglycemia, fasting, starvation, and trauma. It is not
affected by fatty acids, cortisol, obesity, or emotional deprivation.
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5. Hypothyroidism often causes weight gain as a result of decreased metabolic activities.
Additionally, it causes bradycardia, cold intolerance, and constipation.
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6. Cushing’s syndrome is a condition of excessive glucocorticoid steroids. It typically
presents with hypertension, fatigue, edema, “buffalo hump,” truncal obesity, and
abdominal striae. Graves’ disease is a cause of hyperthyroidism; it usually presents with
weight loss, hypertension, tachycardia, anxiety, diarrhea, and heat intolerance. Addison’s
disease is condition of adrenal cortex hormone deficits; it usually presents with
hypotension, hypoglycemia, mood changes, and chronic diarrhea.
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7. Hyperparathyroidism often results in hypercalcemia because of an over activity of the
hormones normal function. A goiter can be caused by hypo or hyperthyroidism.
Hypocalcemia can be caused by hypoparathyroidism. Hypothyroidism is not caused by
hyperparathyroidism.
8. Type 2 diabetes mellitus is generally a result of insulin resistance. Type 1 diabetes
mellitus is generally a result of a lack of insulin production. Gestational diabetes
describes hyperglycemia that first appears during pregnancy. Impaired glucose tolerance
describes an inability to maintain glucose control when high amounts of glucose are
ingested.
9. Most patients with type 2 diabetes mellitus are overweight, which contributes to the
development of the condition.
10. Gestational diabetes describes hyperglycemia that first appears during pregnancy. It is not
type 1 or type 2 diabetes mellitus, and it does not refer to diabetes in the fetus.
11. The HgbA1C provides of glucose control over a 2 to 3 month period. The GTT is a
diagnostic procedure to determine impaired glucose tolerance; glucose is ingested and
blood glucose levels are measured at different intervals. A fasting blood glucose is a
serum glucose measurement when the patient has been fasting approximately 6 hours.
12. The GTT is a diagnostic procedure to determine impaired glucose tolerance; glucose is
ingested and blood glucose levels are measured at different intervals.
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13. Polyuria, or increased urination, occurs in patients with diabetes mellitus because high
serum glucose levels causes glucose to be excreted into the urine. The glucose has a
osmotic effect, attracting water.
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Chapter 11 Neural Function
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2. Epidural bleeding is:
Characterized by a lucid interval immediately after injury.
Located between the arachnoid and the dura mater.
Associated with widespread vascular disruption.
Usually due to a venous leakage.
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A)
B)
C)
D)
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1. Which of the following would be appropriate to treat a patient with cerebral edema?
A)
Hypertonic solutions.
B)
Hypotonic solutions.
C)
Isotonic solutions.
D)
Loop diuretics.
3. In what way do subdural hematomas differ from epidural hematomas?
A)
Subdural hematomas exhibit a classic picture of momentary loss of consciousness,
lucid interval, and rapid deterioration.
B)
Subdural hematomas should be suspected if the individual has a fracture that crosses
the middle meningeal artery.
C)
Subdural hematomas result from arterial damage, thus bleeding forcefully and
occurring rapidly.
D)
Subdural hematomas may develop weeks to months following a head injury.
A)
B)
C)
D)
4. Rupture of a cerebral aneurysm should be suspected if the patient reports:
Transient episodes of numbness.
Transient episodes of vertigo.
Sudden, severe headache.
Tinnitus.
4. Rupture of a cerebral aneurysm should be suspected if the patient reports:
A)
Transient episodes of numbness.
B)
Transient episodes of vertigo.
C)
Sudden, severe headache.
D)
Tinnitus.
A)
B)
C)
D)
5. The most important determinant for prescribing therapy for acute stroke is:
Thrombotic verses embolic cause.
Ischemic/thrombic verses hemorrhagic cause.
Location of ischemia.
Age of the patient.
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6. The most fatal stroke is:
A)
Mini stroke.
B)
Ischemic/thrombic stroke.
C)
Transient stroke.
D)
Hemorrhagic stroke.
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8. A concussion is a brain injury that causes:
Momentary interruption of brain function with or without loss of consciousness.
Small hemorrhages and some swelling of brain tissues.
Tearing or shearing of brain structures.
Bruising of the brain.
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A)
B)
C)
D)
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7. To reduce risk for meningitis, the nurse's best advice to an older patient is:
A)
Stay mentally active and engaged.
B)
Drink at least 3,000 mls of fluids per day.
C)
Exercise 15 to 30 minutes most days of the week.
D)
Get pneumoccocal pneumonia and influenza vaccinations.
9. Acceleration-deceleration movements of the head often result in polar injuries in
which:
A)
Focal injuries occur in two places at opposite poles.
B)
Bleeding form venules fills the subdural space.
C)
Injury is localized to the site of initial impact.
D)
Widespread neuronal damage is incurred.
A)
B)
C)
D)
10. Seizures are classified as general when they:
Are recurrent.
Are proceeded by an aura.
Produce the same electroencephalogram (EEG) changes.
Involve both hemispheres of the brain.
A)
B)
C)
D)
10. Seizures are classified as general when they:
Are recurrent.
Are proceeded by an aura.
Produce the same electroencephalogram (EEG) changes.
Involve both hemispheres of the brain.
B)
C)
D)
11. A patient presents to the Emergency Department with tonic-clonic seizures lasting
three minutes and occurring one minute apart. Her family states that the seizures
started approximately forty minutes ago. What is your priority nursing action?
Role patient on their side, put the head of bed in semi-fowlers, and apply an oxygen
mask at 10 L/min.
Put a padded tongue blade in between the patient's teeth.
Call the health care provider for a medication order.
Restrain the patient to prevent injury.
A)
B)
C)
D)
12. During an assessment, a 10 year old patient describes her seizures as losing
consciousness for short periods. Her friends tell her that she looks like she is
daydreaming except that her eyes blink. What kind of seizure is she describing?
Simple focal seizure.
Absence seizure.
Myoclonic seizure.
Tonic-clonic seizure.
A)
B)
C)
D)
13. A 44 year old women presents to her primary care physician with antisocial behavior,
restlessness, and dyskinesia. This nurse would assess her for a family history of
which of the following?
Seizures.
Pick's disease.
Huntington's disease.
Parkinson's disease.
A)
B)
C)
D)
14. The dementia of Alzheimer disease is associated with structural changes in the brain,
including:
Degeneration of the basal ganglia.
Hypertrophy of the frontal lobe neurons.
Significant aluminum deposits in the brain.
Deposition of amyloid plaques in the brain.
A)
B)
C)
D)
15. Which one of the following types of dementia is caused by an infectious agent?
Pick's disease.
Huntington's disease.
Creutzfeldt-Jacob disease.
Wernicke-Korsakoff's syndrome.
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A)
A)
B)
C)
D)
16. Which of the following pathophysiological mechanisms explains the cause of
Huntington's disease?
Autoimmune disease that causes damage to peripheral nerve myelin.
An autosomal dominant disorder that causes a mutation on chromosome 4.
Inheritance of a gene coding for apolipoprotein E, which cause neuronal cell death.
Degenerative changes of the upper and lower motor neurons of the cerebral cortex,
brain stem, and spinal cord.
A)
B)
C)
D)
18. What is the classic sign and symptom for hydrocephalus in infants?
Projectile vomiting.
Bulging fontanels.
Neck rigidity.
Headache.
A)
B)
C)
D)
19. Spinal shock describes:
Respiratory paralysis associated with spinal cord injury.
The hypotensive state associated with the trauma of the injury.
A hypovolemic shock caused by blood loss associated with injury.
A transient loss of somatic and autonomic reflexes below the level of injury.
A)
B)
C)
D)
20. Autonomic dysreflexia is characterized by:
Severe hypotension and shock.
Severe hypertension and bradycardia.
Reflex emptying of the bladder and bowel.
Muscle flaccidity of the upper and lower extremities.
A)
B)
C)
D)
21. Which of the following is true?
AD neuron loss is diffuse while stroke neuron loss is localized.
AD neuron loss is localized while stroke neuron loss is diffuse.
Both stroke and AD neuron loss are diffused.
Both stroke and AD neuron loss are localized.
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A)
B)
C)
D)
17. Which of the following diagnoses is most likely in a patient who experiences
progressive weakness and loss of muscle mass in the upper extremities?
Amytrophic lateral sclerosis.
Guillain-Barre syndrome.
Parkinson's disease.
Hydrocephalus.
A)
B)
C)
D)
23. The cells in nerve tissue that are responsible for transmitting nerve impulses are
called __________.
astrocytes
microglia
neurons
oligodendroglia
A)
B)
C)
D)
24. A(n) __________ hemorrhage occurs when escaping blood accumulates between the
outer layer of dura and the cranial bones.
epidural
subdural
subarachnoid
none of the above
A)
B)
C)
D)
25. A(n) __________ hemorrhage occurs when escaping blood accumulates between the
dura and the arachnoid.
epidural
subdural
subarachnoid
none of the above
A)
B)
C)
D)
26. An infection that predominantly affects the meninges surrounding the brain and
spinal cord is called a(n) __________.
meningitis
encephalitis
meningoencephalitis
myelitis
A)
B)
C)
D)
27. Which disease is characterized by rigidity of voluntary muscles and tremor of fingers
and extremities?
Multiple sclerosis
Creutzfedt-Jakob disease
Parkinson disease
Huntington disease
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A)
B)
C)
D)
22. _______ is the primary neurotransmitter that is scarce in the neurons of brain regions
devastated by AD.
Serotonin
Epinephrine
Norepinephrine
Acetylcholine
A)
B)
C)
D)
27. Which disease is characterized by rigidity of voluntary muscles and tremor of fingers
and extremities?
Multiple sclerosis
Creutzfedt-Jakob disease
Parkinson disease
Huntington disease
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A
A
D
C
B
D
D
A
A
D
A
B
C
D
C
B
A
B
D
B
A
D
C
A
B
A
C
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1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
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Answer Key
Rationales
1. Hypertonic solutions, such as 3% saline, are used to cerebral edema by rapidly shifting
fluid out of the cerebral interstitial space into the vascular space. Hypotonic solutions,
isotonic solutions, and loop diuretics will not cause this shift.
2. Epidural hematomas are characterized by a period of lucidity immediately after the
injury. B and D describe subdural hematomas. C could be associated with other
conditions such as a stroke.
3. Subdural hematomas develop slowly because of being venous in origin. A describes
epidural hematomas not subdural hematomas. Fractures are often absent with subdural
hematomas, and subdural hematomas do not result from arterial damage.
4. A sudden, severe headache is an indication of a cerebral aneurysm rupture. Transient
numbness, transient vertigo, and tinnitus are not usually associated with a cerebral
aneurysm rupture.
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5. Ischemic/thrombic strokes are treated with thrombolytic agents. Thrombolytic agents
would worsen hemorrhagic strokes. Although thrombic strokes are more common than
hemorrhagic, differential diagnosis is crucial to positive patient outcomes.
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6. Ischemic/thrombic strokes are the most common type, but hemorrhagic strokes have the
highest mortality rate. Transient or mini strokes are warning signs of an impending stroke
and indicate a temporary alteration in cerebral tissue perfusion.
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7. Respiratory infections, such as pneumonia and influenza, can result in meningitis
especially in severe cases. Older adults are more likely to have severe cases of
pneumonia and influenza. Increased mental functioning, fluid intake, and exercise will
not increase the risk of meningitis but will not necessarily decreases it either.
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8. A concussion refers to a momentary interruption of brain function with or without loss of
consciousness. It does not usually involve bruising, bleeding, or damage of cerebral
structures.
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9. With acceleration-deceleration injuries, local injuries occur at each area of brain impact
with the skull on opposite sides.
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10. General seizures involve the entire brain as opposed to focal or partial seizures that
involve one area. Any type of seizures can be recurrent or an isolated event depending on
underlying etiology. The presence of an aura and EEG changes can occur with either type
as well.
11. The patient is experiencing status epilepticus, which can cause severe hypoxia and
aspiration. Rolling the patient on their side, putting the head of bed in semi-fowlers, and
applying an oxygen mask at 10 L/min can minimize hypoxia and aspiration. Putting
anything in the patient’s mouth and retraining them could cause further injury and should
be avoided. Calling the health care provider for an order would likely be done, but after
then other interventions had been completed.
12. Absence seizures often present as starring episodes, but the patient may also experience
some minor twitches. Simple focal seizures often present as an unusual sensation without
a loss of consciousness. Myoclonic seizures cause jerking and twitching of the upper
body, arms, or legs. Tonic-clonic seizures cause repetitive stiffening and jerking of the
entire body.
13. Huntington’s disease often is confused with psychiatric disorder because it presents with
depression, antisocial behavior, delusions, and hallucinations. Additionally, balance and
movement issues are often seen. Seizures and Parkinson’s disease may result in muscle
movement issues, there is no cognitive or psychological manifestations associated with
those conditions. Pick’s disease is a form of dementia, but does not usually include
movement issues.
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14. There are many theories regarding the origin of Alzheimer disease. Amyloid plague
deposits in the brain is one of the more popular theories. Basal ganglia degeneration,
frontal lobe hypertrophy, and aluminum deposits have not been implicated to date.
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15. The only dementia listed caused by an infectious agent is Creutzfeldt-Jacob disease,
which is caused by a prion. Pick’s disease and Huntington’s disease has a genetic quality,
and Wernicke-Korsakoff's syndrome results from long term alcohol abuse.
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16. Huntington’s disease is an autosomal dominant disorder that causes a mutation on
chromosome 4. A describes multiple sclerosis. C describes a possible cause of
Alzheimer’s disease. D describes amyotrophic lateral sclerosis.
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17. Amyotrophic lateral sclerosis refers to degenerative changes of the upper and lower
motor neurons of the cerebral cortex, brain stem, and spinal cord. These changes result in
a progressive weakness and muscle atrophy often of the upper extremities. This does not
occur with Guillain-Barre syndrome, Parkinson’s disease, or hydrocephalus.
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18. While all the manifestations listed may occur with hydrocephalus, bulging fontanels is
specific to infants.
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19. Spinal shock refers to a temporary loss of reflect below the level of a spinal injury. This
condition is often a result of inflammation, and resolves as the inflammation does.
20. Autonomic dysreflexia refers to a state in which the sympathetic nervous system is
triggered due to noxious stimuli. This stimulation results in marked hypertension and
bradycardia.
Chapter 12 Musculoskeletal Function
___ 1. A sprain involves:
A)
Stretching injury to a muscle or musculotendinous unit.
B)
Injury to the ligamentous structures that support a joint.
C)
Displacement and loss of articulation of bone ends within the joint capsule.
D)
Partial dislocation in which bone ends within a joint are still in partial contact
with each other.
___ 1. A sprain involves:
A)
Stretching injury to a muscle or musculotendinous unit.
B)
Injury to the ligamentous structures that support a joint.
C)
Displacement and loss of articulation of bone ends within the joint capsule.
D)
Partial dislocation in which bone ends within a joint are still in partial contact
with each other.
___ 2. A life-threatening complication of a fracture is:
compartment syndrome
fat embolism
nonunion
infection
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A)
B)
C)
D)
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___ 3. A patient presents to the emergency room after a motor vehicle accident with
obvious deformity and lack of function to the right lower leg. A x-ray of the
extremity reveals that the tibia is broken into two pieces and the fibia is broken
into three pieces. The patient has more than likely suffered a:
A)
Comminuted fracture.
B)
Greenstick fracture.
C)
Impacted fracture.
D)
Spiral fracture.
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___ 4. After a period of prolonged bed rest, the healthcare provider tells the patient that
she has developed brittle bones. The nurse should explain to the patient that the
prolonged be rest has resulted in:
A)
Atrophy
B)
Fractures
C)
Contractures
D)
Osteoporosis
___ 5. Complete healing of a bone fracture occurs when:
A)
No movement of the break is detectable.
B)
The callus has been completely replaced with mature bone.
C)
The fracture site and surrounding soft tissue are pain free.
D)
A cast is no longer required to stabilize the break.
___ 6. J.R. is a 33-year-old lawyer who has sustained a leg fracture as a result of colliding
with a tree while skiing. His fracture has been diagnosed as “compound, transverse
fracture of the tibia and fibia.” The type of fracture J.R. sustained is best described
as a bone
A)
Broken in two or more pieces.
B)
Cracked but not completely separated.
C)
Broken along the long axis.
D)
Broken and protruding through skin.
A)
B)
C)
D)
A)
B)
C)
D)
with a tree while skiing. His fracture has been diagnosed as “compound, transverse
fracture of the tibia and fibia.” The type of fracture J.R. sustained is best described
as a bone
Broken in two or more pieces.
Cracked but not completely separated.
Broken along the long axis.
Broken and protruding through skin.
___ 7. Common early manifestations of fracture include which of the following:
Muscle flaccidity.
Swelling at fracture site.
Elevated white blood cells.
Loss of sensation in affected extremity.
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___ 8. Which of the following would an appropriate treatment for mild scoliosis?
A)
Bracing.
B)
Routine exercise.
C)
Smoking cessation.
D)
Calcium supplement.
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___ 9. Compartment syndrome involves:
A)
Nerve and blood vessel compression caused by swelling of tissues enclosed
within muscle fascia.
B)
Large compartment or area of localized hemorrhage.
C)
Presence of a loose body with a joint space.
D)
Bleeding into a joint space.
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___ 10. To determine if a patient is experiencing compartment syndrome, which of the
following is a priority area for nursing assessment?
A)
Edema at the fracture site.
B)
Deformity at the fracture site.
C)
Presence of drainage on the cast.
D)
Pain at fracture site above what would be expected.
___ 11. A 12 year old patient comes into the emergency room with a strained wrist from a
fall while skating. The appropriate intervention during the first 24 hours is to:
A)
Keep the wrist in a dependent position to decrease stress on the ligaments.
B)
Apply ice packs to promote vasoconstriction.
C)
Apply heat packs to promote vasodilatation.
D)
Apply traction to prevent muscle spasms.
___ 12. Which of the following persons is at highest risk for osteoporosis?
A)
72 year old Caucasian female with a body mass index (BMI) of 19.
B)
70 year old African American female with a BMI of 28.
C)
40 year old Hispanic male that has been quadriplegic for 6 years.
D)
68 year old Caucasian male that has been wheelchair bound for 5 years.
___ 12. Which of the following persons is at highest risk for osteoporosis?
A)
72 year old Caucasian female with a body mass index (BMI) of 19.
B)
70 year old African American female with a BMI of 28.
C)
40 year old Hispanic male that has been quadriplegic for 6 years.
D)
68 year old Caucasian male that has been wheelchair bound for 5 years.
___ 13. Rickets is characterized by soft, weak bones resulting from:
A)
Hypercalcemia.
B)
Estrogen deficiency.
C)
Phosphate excess.
D)
Vitamin D deficiency.
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___ 14. RICE would the appropriate treatment protocol for which of the following
diseases?
A)
Paget's disease
B)
Osteoarthritis
C)
Sprains
D)
Gout
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___ 15. Prevention of osteoporosis focuses on:
A)
Increasing phosphorus intake.
B)
Increasing weight-bearing exercise.
C)
Limiting soy intake.
D)
Limiting vitamin D intake.
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___ 16. Paget’s disease:
A)
Is a chronic, inflammatory, rheumatic, autoimmune disease.
B)
Is thought to be caused by a virus that induces osteoclast proliferation.
C)
Is a chronic, autoimmune, connective tissue disorder involving skin and other
organs.
D)
Is an inadequate bone mineralization as a result of a deficiency of calcium and
phosphorus.
___ 17. Which of the following lab data would be most significant in the patient with
Paget's disease?
A)
Elevated white blood cell count.
B)
Elevated erythrocyte sedimentation rate.
C)
Elevated serum alkaline phosphatase.
D)
Positive tissue biopsy for Staphylococcus.
___ 18. What is an excessive lateral curvature of the spine?
A)
Scoliosis
B)
Kyphosis
C)
Lordiosis
D)
Anklosing spondylitis
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___ 19. A 40 year old women presents to the clinic complaining of morning stiffness,
fatigue, and loss of energy. Physical exam reveals hard, swollen joints, limited
range of motion, deformity of the interphalangeal joints, fever, and systemic
inflammatory responses. Laboratory results indicate an elevated sedimentation
rate. The healthcare provider should suspect which of the following diseases?
A)
Gout.
B)
Osteoarthritis.
C)
Rheumatoid arthritis.
D)
Systemic lupus erythematosus.
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___ 20. Which of the following persons is at the highest risk for developing pathological
fractures?
A)
A highly active 2 year old female
B)
20 year old male that routinely participates in contact sports
C)
40 year old female with moderate scoliosis
D)
68 year old postmenopausal female with bone cancer
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___ 21. A 58 year old, obese man presents to the clinic with joint pain that worsens with
activity and relieved by rest. Physical exam reveals joint stiffness and crepitis.
These findings are consistent with which of the following diseases?
A)
Osteoarthritis.
B)
Gouty arthritis.
C)
Reactive arthritis.
D)
Rheumatoid arthritis.
___ 22. The pathophysiology underlying gouty arthritis may be attributed to:
A)
Increased immune complexes within the joint cavity.
B)
The presence of fibrous adhesions within bony cartilage.
C)
An alteration in purine metabolism resulting in hyperuricemia.
D)
Excessive bone remodeling secondary to increased levels of phosphorus.
___ 23. Which of the following laboratory values would you expect for the patient with
gout due to under excretion?
A)
Normal serum uric acid and elevated urine uric acid.
B)
Low serum uric acid and low urine uric acid.
C)
High serum uric acid and normal urine uric acid.
D)
High serum uric acid and low urine uric acid.
___ 23. Which of the following laboratory values would you expect for the patient with
gout due to under excretion?
A)
Normal serum uric acid and elevated urine uric acid.
B)
Low serum uric acid and low urine uric acid.
C)
High serum uric acid and normal urine uric acid.
D)
High serum uric acid and low urine uric acid.
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___ 25. The following are risk factors for arthritis except:
A)
overweight/obesity
B)
joint injuries
C)
infection in joints
D)
certain occupations
E)
All of the above are risk factors.
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___ 24. Which of the following foods should you instruct the patient prone to gout to
avoid?
A)
Spinach.
B)
Crawfish.
C)
Chocolate.
D)
Potato chips.
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___ 26. __________ results in the failure of cartilage cells to maintain the balance between
degradation and synthesis of the supporting matrix.
A)
Gout
B)
Rheumatoid Arthritis
C)
Osteoarthritis
D)
None of the above
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___ 27. Tertiary activities for osteoporosis include which of the following:
A)
Education, diet
B)
Exercise, fall prevention
C)
Medication, education
D)
Bone density screening, medication
___ 28. The most serious consequence of osteoporosis is:
A)
Bad skin
B)
Falls
C)
Hip fracture
D)
Loss of height
___ 29. Osteoporosis is most likely to affect which group of people:
A)
Adolescents
B)
Young men and women
C)
Middle aged women
D)
Older women
___ 30. Which of the following statements related to herniated intervertebral disk is
INCORRECT?
A)
Protrusion of the disk material may impinge on nerve roots that exit through
intervertebral foramina.
B)
It usually results from chronic infection of the disk, which predisposes to the
herniation.
C)
Protrusion of disk material may be detected by CT scan or myelogram.
D)
Part of the nucleus pulposus is extruded through a weak area or tear in the annulus
fibrosus.
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___ 31. Which of the following statements regarding gout is INCORRECT?
A)
It is a disturbance of purine metabolism.
B)
It is associated with an autoantibody directed against antigens in joint cartilage.
C)
Uric acid may precipitate in tissues, forming gouty tophi.
D)
The frequency of attacks can be reduced by drugs that lower blood uric acid.
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___ 32. What is a pathologic fracture?
A)
A fracture in which the overlying skin is broken
B)
A fracture that occurs in a weakened area of bone secondary to a disease
involving the bone
C)
A fracture in which the bone is shattered into multiple pieces
D)
A fracture associated with an autoantibody
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___ 33. Which of the following conditions is NOT a characteristic manifestation of
rheumatoid arthritis?
A)
Autoantibodies directed against gamma globulin
B)
High levels of uric acid in the blood
C)
Chronic inflammation of synovium
D)
Involvement of the small joints of the hands and feet
___ 34. Which of the following statements does NOT apply to myasthenia gravis?
A)
Abnormal fatigability of voluntary muscles
B)
Associated with degeneration of motor nerve cells supplying the affected muscles
C)
Associated with autoantibodies against acetylcholine receptors at the myoneural
junction of the muscle fibers
D)
Symptoms of the disease are relieved by drugs that prolong the action of
acetylcholine
___ 35. A deposit of uric acid in the soft tissues of a gouty subject is called:
A)
Calculus
B)
Synovium
C)
Tophus
D)
Arthritis
___ 35. A deposit of uric acid in the soft tissues of a gouty subject is called:
A)
Calculus
B)
Synovium
C)
Tophus
D)
Arthritis
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___ 36. All of the following conditions predispose to osteoporosis or increase the risk of
osteoporosis EXCEPT:
A)
Overweight
B)
Low intake of calcium in the diet
C)
Vitamin D deficiency
D)
White race
E)
Female gender
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___ 37. The active bone-forming cells that produce the collagenous bone matrix and
secrete the enzyme alkaline phosphatase are called:
A)
Osteocytes
B)
Osteoblasts
C)
Trabeculae
D)
Osteoclasts
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___ 38. Which of the following statements about scoliosis are CORRECT?
A)
Scoliosis can be identified by examination of the spine when the teen is either
standing upright or while bending forward.
B)
Usually a curvature progresses after the teenager stops growing.
C)
Thoracic curvature reduces the size of the thorax, interfering with lung function.
D)
Scoliosis never requires surgical treatment.
E)
All of the above.
Answer Key
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
B
B
A
D
B
D
B
A
A
D
B
A
D
C
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B
D
B
A
A
D
B
A
D
C
B
B
C
A
C
D
A
C
D
B
E
C
B
C
D
B
B
B
B
B
C
A
B
A and C
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5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
Rationales
1. Sprains refer to injury to a ligament that often involves stretching or tearing of the
ligament. A describes a strain. C describes a dislocation. D describes a subluxation.
2. While all are complications of a fracture, a fat embolism is the most likely to be lifethreatening.
3. Comminuted fractures refer to fractures that involve more than two pieces. Greenstick
fractures involve an incomplete break. Impacted fractures refer to fractures in which the
ends are forced into nearby bone. Spiral fractures involve twisting of the bone.
4. Osteoporosis refers to decreased bone density, and it is common with prolonged bed rest
because weight bearing is important with bone mineralization. Atrophy refers to
decreasing in cell number; it is common in muscles resulting from disuse. Fractures refer
to a break in a bone. Contractures refer to the shortening of a muscle.
5. Complete wound healing has occurred when the callus has been completely replaced with
mature bone. This process can take up to 8 weeks.
6. A compound fracture refers to a fracture in which the bone is protruding through the skin.
Transverse refers to the angle of the break. A describes a comminuted fracture. B
describes a greenstick fracture. C describes a vertical fracture.
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7. Swelling at the fracture site occurs quickly following the injury because of the
inflammatory process. Additionally, muscle spasms and loss of function may be seen.
Leukocytosis may be present, but it not early. Loss of sensation may indicate nerve
damage and should be further investigated.
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8. Bracing will correct most mild cases of scoliosis. Routine exercise, smoking cessation,
and calcium supplements has not been shown to correct mild cases of scoliosis.
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9. Compartment syndrome refers to nerve and blood vessel compression in the muscle
fascia caused by tissue swelling. It can be a complication of fractures. Compartment
syndrome requires immediate treatment because it can result in the loss of the limb.
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10. Compartment syndrome refers to nerve and blood vessel compression in the muscle
fascia caused by tissue swelling. It can be a complication of fractures. Compartment
syndrome requires immediate treatment because it can result in the loss of the limb. It
often presents first with excruciating pain, worse than what would be expected for the
degree of injury. Additionally, the person may have indicators of neurovascular
impairment (e.g., decreased pulse, pallor, paralysis, paresthsia) distal to the injury.
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11. Ice will promote vasoconstriction and limit swelling secondary to the inflammatory
response. Maintaining a dependent position and applying heat will make the swelling
worse. Muscle spasms are not expected with this type of injury; therefore, traction is not
necessary.
12. The 72 year old has four risk factors: advancing age, being Caucasian, being female, and
having a low BMI. The 70 year old only has one risk factor: being female. The 40 year
old only has one risk factor: long term immobility. The 68 year old only has one risk
factor: long term decreased mobility.
13. Rickets refers to weakened bones secondary to vitamin D deficit. Decreased estrogen
levels and phosphate excess can lead to osteoporosis but not rickets.
14. RICE refers to rest, ice, compression, and elevation; it is a treatment common for soft
tissue injuries such as sprains. It would not be used to treat Paget’s disease, osteoarthritis,
or gout.
15. Weight-bearing exercises increase bone mineralization of calcium, which will prevent
osteoporosis. Increasing phosphorus, limiting soy, and limiting vitamin D intake will
increase the likelihood of developing osteoporosis.
16. Paget’s disease is progressive metabolic condition characterized by excessive bone
destruction. The exact cause is unclear, but it is thought to be caused a virus. A is
describing rheumatoid arthritis. C is describing scleraderma. D is describing rickets.
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17. Of all the options, elevated serum alkaline phosphatase would be the most specific to
Paget’s disease.
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18. Scoliosis refers to an excessive lateral curvature of the spine. Kyphosis is an increase in
the thorasic spine curvature outward. Lordiosis is an exaggerated concave of the lumbar
spine. Anklosing spondylitis refers to a progressive inflammatory condition that results in
fusing of sacroiliac joints, intervertebral spaces, and costovertebral joints.
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19. Rheumatoid arthritis refers to a systemic, autoimmune, inflammatory condition involving
multiple joints. It typically presents with morning stiffness, fatigue, joint changes, and
systemic inflammatory indicators (e.g., elevated sedimentation rate). Gout and arthritis
typically do not have morning stiffness. Systemic lupus erythematosus does not typically
present with joint deformity.
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20. Pathological fractures are fractures that results from weakening of the bones because
repetitive wear or disease. The 68 year old would be at most risk because of advancing
age, being female, being postmenopausal, and having bone cancer.
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21. Osteoarthritis refers to a degenerative joint disease. Risk factors include being obese and
highly active. The condition presents with pain that worsens with activity and relieved by,
joint stiffness, and crepitis. These findings are not consistent with gouty arthritis, reactive
arthritis, or rheumatoid arthritis.
22. Gouty arthritis is caused by an error in purine metabolism, which results in
hyperuricemia. The other options do not occur with gouty arthritis.
23. Gout can result for two reasons: an under excretion of uric acid or an over production of
uric acid. With under excretion the serum uric acid will be high while the urine levels will
be low. With over production, the serum levels will be high while the urine uric acid
levels will be either high or normal.
24. Persons prone to gout should avoid foods high in purines such as protein, seafood, and
alcohol.
Chapter 13 Integumentary Function
1. A patient presents to the clinic with pain and burning sensation of the skin that begins
on the right lower back and ends on the right lower abdomen. Physical exam reveals
a silvery rash in that area. The nurse should suspect:
A)
Herpes simplex.
B)
Herpes zoster.
C)
Psoriasis.
D)
Uticaria.
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2. The virus that causes herpes zoster is the same one that causes:
A)
Chickenpox in children.
B)
Measles in children.
C)
Mumps in children.
D)
Polio in children.
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3. While assessing a child, the nurse notes a circular area of erythema with hair loss on
the scalp. The likely diagnosis for this condition is:
A)
Tinea coropis.
B)
Tinea unguium.
C)
Tinea capitis.
D)
Tinea pedis.
A)
B)
C)
D)
5. One of the effects of aging on the skin is the presence of lentigos. If these areas were
present, what would the nurse note?
Red to purple ecchymosis on the abdomen.
Longitudinal ridges in nailbeds.
Brown spots indicating hyperpigmentation
Red to purple ecchymoses on exposed skin
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A)
B)
C)
D)
4. What is the major problem associated with herpes zoster?
Pain
Very contagious
Secondary pneumonia
No effective treatment
6. A chronic inflammatory disorder of middle-aged and older adults that is characterized
by blushing, dark red erythema on the nose and cheek, and telangiectasia with or
without acneiform components is:
A)
Acne.
B)
Tinea.
C)
Psoriasis.
D)
Rosacea.
6. A chronic inflammatory disorder of middle-aged and older adults that is characterized
by blushing, dark red erythema on the nose and cheek, and telangiectasia with or
without acneiform components is:
A)
Acne.
B)
Tinea.
C)
Psoriasis.
D)
Rosacea.
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7. Atopic eczema is associated with:
A)
A type I hypersensitivity reaction.
B)
Decreased collagen production.
C)
A bacterial infection.
D)
Moist skin.
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9. Which of the following would be an expected skin finding associated with aging?
the presence of a scaly scalp, or cradle cap.
the presence of a macular rash, or rubella.
the presence of dry skin and poor skin tugor.
the presence of nevi.
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A)
B)
C)
D)
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8. A 2-year-old child has been sick with a cold and has developed a honey-colored
lesions on her chin within the past 3 days. The nurse determines that this clinical
picture is consistent with which of the following?
A)
Scabies.
B)
Impetigo.
C)
Herpes simplex.
D)
Contact dermatitis.
A)
B)
C)
D)
11. Which of the following is the most common of type of skin cancer?
Nevi
Malignant melanoma
Basal cell carcinoma
Squamous cell carcinoma
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A)
B)
C)
D)
10. Alan is a 48-year-old man who is concerned about a skin lesion on his back. The
lesion is determined to be a nevus (mole). Which of the following findings indicates a
need for further evaluation?
Skin-colored nevus, lacking dark pigmentation.
Variations in color within the nevus.
Very dark coloration.
Size greater than 2 mm diameter.
A)
B)
C)
D)
13. __________ is caused by a small parasite that burrows in the superficial layers of the
skin, where it lays eggs that hatch in a few days. This causes intense itchiness.
Lice
“Swimmer’s itch”
Scabies
All of the above
A)
B)
C)
D)
14. Which of the following is a malignant tumor arising from pigment-producing cells of
the skin?
Nevus
Melanoma
Adenocarcinoma
Lymphosarcoma
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A)
B)
C)
D)
12. Which of the following best describes herpes simplex virus (HSV) type 1?
HSV type 1 occurs only once to an individual.
HSV type 1 can be triggered by fever, infection, or menses.
Antivirals can be given for protection.
HSV type 2 can be transmitted sexually to cause type 1.
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A
C
A
C
D
A
B
C
B
C
B
C
B
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2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
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Answer Key
Rationales
1. Herpes zoster, or shingles, typically presents as a grey or silvery, painful rash on one side
of the torso or head. Herpes simplex, or fever blisters, typically presents as an ulceration
on or near the mouth. Psoriasis typically presents as patchy red areas on the elbows,
knees, or trunk.
2. Herpes zoster is caused by the same virus that causes chickenpox or varicella. After
childhood exposure, the virus becomes dormant on a nerve root.
3. Tinea is a parasitic skin infection. When the condition occurs on the scalp, the condition
is called tinea capitis. Tinea coropis involves the body. Tinea uguium involves the nails.
Tinea pedis involves the feet.
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4. Herpes zoster is very painful, and the pain can linger for months and even causes chronic
pain. It is generally not very contagious. Secondary pneumonia is not associated with the
condition. Antivirals have been shown to effectively limit the severity and duration of the
condition.
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5. Lentigos are areas of hyperpigmentation often associated with aging.
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6. Rosacea is a chronic progressive condition that presents as dark erythema, telangiectasia,
and thickening of the skin. Acne usually presents with whiteheads or blackheads. Tinea
usually present with a circular area of redness accompanied with pruritis and burning.
Psoriasis typically presents as patchy red areas on the elbows, knees, or trunk.
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7. Atopic eczema is a chronic skin condition resulting from an allergen that triggers a type I
hypersensitivity reaction. It does not involve decreased collagen production, a bacterial
infection, or moisture.
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8. Impetigo is a highly contagious bacterial skin infection that classically presents with
honey crusted lesions. Scabies typically presents with a pruritic streaky brown rash.
Herpes simplex presents with an ulcerations on or around the mouth. Contact dermitis
typically presents with a erythemia, pruritis, and blisters.
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9. Skin often becomes dry and less elastic with aging. Cradle cap is typically seen in infants.
Rubella is typically a result of a viral infection. Nevi, or moles, can occur at any age.
10. Asymmetry in color or shape in a mole warrants further investigation to rule out skin
cancer. Lacking dark pigmentation, dark pigmentation, or large size are not significant
indicators for concern.
11. Basal cell carcinoma is the most common type of skin cancer. Nevi merely prefers to any
mole. Malignant melanoma is least common but the most serious.
12. HSV type 1 occurs above the waist. The HSV remains dormant on a nerve root until
triggered by stressors such as fever, infection, or menses. The infection can occur
multiple times in a lifespan. Antivirials can limit the severity and duration, but do not
protect against transmission. HSV type 1 is transmitted through direct skin contact, not
through sexual intercourse.
Chapter 14 Sensory Function
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1. Which disorder is characterized by the inelasticity and thickening of the lens with
aging?
A)
Myopia.
B)
Hyperopia.
C)
Presbyopia.
D)
Astigmatism.
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2. An adult patient presents to the Emergency Department after having a rock hit his
eye while weeding along a ditch near a busy highway. The event occurred several
hours earlier. The nurse assesses the eye and finds redness and weeping, but the
patient denies any pain. Which of the following early symptoms would help confirm
retinal detachment?
A)
Pain.
B)
Floaters.
C)
Halo vision.
D)
Subconjunctival hemorrhage.
A)
B)
C)
D)
4. Glaucoma is characterized by an increase in intraocular pressure because of
increased:
Aqueous humor in the anterior chamber of the eye.
Vitreous humor in the posterior chamber of the eye.
Fluid near the opening of the retina.
Waste products and toxins.
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A)
B)
C)
D)
3. Astigmatism is:
The bending of light at angulated surfaces.
The nonuniform curvature of the cornea, lens, or retina.
A disorder of accommodation in which the lens cannot bring near objects in focus.
A disorder of accommodation in which the lens cannot bring far objects in focus.
5. Closed-angle glaucoma is caused by:
Abnormal drainage of the aqueous humor through the trabecular meshwork that
controls the flow of aqueous humor into the canal of Schlemm.
B)
Narrow anterior chamber angle that interferes with outflow of aqueous humor from
the anterior chamber.
C)
Increased production of aqueous humor.
D)
Decreased production of aqueous humor.
A)
5. Closed-angle glaucoma is caused by:
A)
Abnormal drainage of the aqueous humor through the trabecular meshwork that
controls the flow of aqueous humor into the canal of Schlemm.
B)
Narrow anterior chamber angle that interferes with outflow of aqueous humor from
the anterior chamber.
C)
Increased production of aqueous humor.
D)
Decreased production of aqueous humor.
A)
B)
C)
D)
6. Which of the following patients is at highest risk for macular degeneration?
An older adult patient.
A young adult with multiple allergies.
A youth hit in the eye with a baseball.
A biochemist exposed to a various toxins.
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7. Cataracts represent:
A)
A chronic, painful, indolent ulcer that occurs in the absence of infection.
B)
Opacities in the lens of the eye that interfere with light transmission.
C)
Scar tissue on the cornea that interferes with light transmission.
D)
A membrane covering over the meshwork of the eye.
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8. Presbycusis refers to:
A)
Hearing loss that occurs as the result of an ototoxic drug.
B)
Decreased hearing that accompanies the aging process.
C)
Hearing loss to injury to the tympanic membrane.
D)
Idiopathic hearing loss.
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9. A patient with Meniere's disease would probably complain of which of the
following?
A)
Fatigue.
B)
Vertigo and nausea.
C)
Pain when the ear is touched.
D)
Tenderness over the mastoid area.
Answer Key
1.
2.
3.
4.
5.
6.
7.
8.
9.
C
B
B
A
B
A
B
B
B
4.
5.
6.
7.
8.
9.
A
B
A
B
B
B
Rationale
1. Presbyopia refers to changes with the lens associated with aging. Myopia refers to
nearsightedness. Hyperopia refers to farsightedness. Astigmatism refers to changes in the
lens, but it is not associated with aging.
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2. Floaters are another common manifestation associated with retinal detachment. The
condition is generally painless, does not causes halo vision, or subconjunctival
hemorrhage.
3. Astigmatism refers to an abnormal curvature of the cornea, lens, or retina. The other
options do not occur with astigmatism.
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4. Glaucoma is caused by increased aqueous humor production or decreased aqueous humor
outflow in the anterior chamber of the eye. The other options do not occur with glaucoma.
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5. Closed-angle glaucoma is a medical emergency that can threaten eye sight. It is caused by
a sudden interference of aqueous humor outflow. The other options do not occur with
closed-angle glaucoma.
6. Macular degeneration is a condition that affects older adults and results from
degeneration of the macula area of the retina.
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7. Cataracts refer to opacities in the lens of the eye that interfere with light transmission.
Ulcerations, scar tissue, or a membrane covering is not present.
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8. Presbycusis refers to the conductive hearing loss associated with aging changes of the
middle and inner ear structures.
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9. Meniere’s disease refers to a disorder of the inner ear characterized by swelling of the
structures. Because of the inner normal function the inner ear being disrupted, vertigo and
nausea are common. Fatigue, ear pain, or mastoid tenderness is not generally associated
with Meniere’s disease.