Prepare for the HESI Pathophysiology exam with these practice questions and answers. This guide covers disease processes, mechanisms, and clinical manifestations.
Q: A decrease in workload, use, pressure, or blood supply appropriately describes:A. physiologic atrophy.B. pathologic atrophy.C. hypertrophy.D. hyperplasia.
Answer: B. pathologic atrophy.Pathologic atrophy is a decrease in cell size due to decreased use. Physiologic atrophy usually occurs early in development; for example, the thymus gland atrophies during childhood. Hypertrophy is an increase in cell size. Hyperplasia is an increase in the number of cells.
Q: The appropriate term for the reversible replacement of one mature cell by another is:A. metaplasia.B. hyperplasia.C. dysplasia.D. atypical hyperplasia.
Answer: A. metaplasia.The term metaplasia refers to one cell type being replaced by another. Hyperplasia is an increase in the number of cells, not a change in their type. Dysplasia, also referred to as atypical hyperplasia, refers to abnormal changes in the size, shape, and organization of cells.
Q: The ability to increase intracellular calcium concentrations and affect the nervous and hematopoietic systems is a characteristic of:A. carbon monoxide.B. carbon tetrachloride.C. lead.D. mercury.
Answer: C. lead.Lead is able to increase intracellular calcium concentrations and may also become a calcium substitute. It affects the hematopoietic system. It is often found in paint, dirt, and pottery. Carbon tetrachloride, formerly used in dry cleaning, is converted into a highly toxic free radical that damages the liver. Carbon monoxide is an asphyxiate gas that interrupts respiration. Mercury is a heavy metal and can worsen chronic diseases like Alzheimer disease and multiple sclerosis.
Q: A patient with a collection of blood that is located between the skull and the dura is diagnosed with a condition referred to as a(n):A. epidural hematoma.B. contusion.C. subdural hematoma.D. abrasion.
Answer: A. epidural hematoma.An epidural hematoma is a collection of blood between the inner surface of the skull and the dura. A subdural hematoma is a collection of blood between the surface of the dura and the brain. A contusion is a bruise or bleeding into the skin and underlying tissue. Abrasion is a scrape caused by removal of the superficial layers of the skin.
Q: A tear or rip of the skin with a jagged and irregular edge is described as a(n):A. abrasion.B. incision.C. laceration.D. avulsion.
Answer: C. laceration.Lacerations occur when the tensile strength of the skin is exceeded. An incision is a precise cut with an instrument that leaves regular clean edges. In a laceration, edges are often jagged and irregular. An abrasion results from the removal of the superficial layers of the skin caused by friction between the skin and the injuring object. An avulsion is an injury in which an area of tissue is pulled away, creating a flap.
Q: A characteristic of a stab wound includes:A. the injury is deeper than it is long.B. the injury is longer than it is deep.C. there is a broken bone.D. there is significant crush injury.
Answer: A. the injury is deeper than it is long.The injury is deeper than it is long. There is little crush injury because the object used is sharp and it makes a clean entrance. An injury that is longer than it is deep is considered an incised wound. A broken bone is a fracture.
Q: The appropriate term for fragments of burning or unburned pieces of gunpowder that are embedded in the epidermis is:A. exit wound.B. stippling.C. blowback.D. tattooing.
Answer: D. tattooing.Tattooing results from fragments of burning or unburned pieces of gunpowder exiting the barrel and striking the skin surface with enough force to be driven into the epidermis. Stippling results when fragments of gunpowder strike the skin with enough force to abrade the skin but not actually penetrate the surface. An exit wound is where the bullet exits the body. Blowback is disruption of the tissues resulting in large, gaping, and jagged appearance to the wound.
Q: Which term describes oxygen failing to reach the blood?A. SuffocationB. StrangulationC. DrowningD. Petechiae
Answer: A. SuffocationSuffocation occurs when oxygen fails to reach the blood. It is a subgroup of asphyxial injuries. Strangulation is caused by compression and closure of the blood vessels and air passages by external pressure on the neck. Drowning occurs when water or fluid alters delivery of oxygen. Petechiae are found on the neck of a victim who is strangled. It is the result of compression of soft tissue and the breakage of blood vessels.
Q: The pigment that is correctly paired with its color is:A. melanin-brown-black.B. hemosiderin-green-black.C. blue nevus-brown-black.D. bilirubin-yellow-brown.
Answer: A. melanin-brown-black.Melanin is brown-black pigment. This is what causes a suntan. Hemosiderin is a yellow-brown pigment and is derived from hemoglobin. Blue nevus is a benign mole that is dark blue-black in color. Bilirubin is yellow-green in color and is derived from bile.
Q: The appropriate term to identify the nuclear dissolution and destruction of chromatin by action of hydrolytic enzymes is:A. autolysis.B. pyknosis.C. karyorrhexis.D. karyolysis.
Answer: D. karyolysis.Karyolysis is the nuclear dissolution and lysis of chromatin. Autolysis is a term for autodigestion. In pyknosis, the nucleus shrinks and becomes a small, dense mass of genetic material. Karyorrhexis means fragmentation of the nucleus into smaller particles, or “nuclear dust.”
Q: A TRUE statement regarding calcium in cells is:A. calcium salts accumulate in healthy, living cells with normal body function.B. dystrophic calcification occurs in chronic tuberculosis.C. metastatic calcification occurs in damaged tissue.D. psammoma bodies are individual calcium molecules.
Answer: B. dystrophic calcification occurs in chronic tuberculosis.Dystrophic calcification occurs in dead or dying tissues and chronic tuberculosis and is usually found in lungs and lymph nodes. Calcium accumulation normally occurs in dead or dying tissues. Psammoma bodies are several layers of calcium that clump together and form grains. Metastatic calcification consists of mineral deposits that occur in undamaged tissue as a result of hypercalcemia.
Q: Tuberculous infections are likely to result in a form of necrosis called:A. coagulative.B. liquefactive.C. fat.D. caseous.
Answer: D. caseous.Caseous necrosis is normally found in the lung from infection by Mycobacterium tuberculosis. It is a combination of liquefactive and coagulation necrosis. Coagulative necrosis occurs primarily in the kidneys, heart, and adrenal glands due to protein degradation. Liquefactive necrosis occurs commonly in the neurons and glial cells. Fat necrosis occurs in the breast, pancreas, and other abdominal structures and is caused from cellular dissolution by enzymes called lipases.
Q: A correct concept related to aging is:A. the maximal life span on humans is 80 to 100 years.B. men outlive women in most countries.C. the maximal life span changes every decade.D. the concept of aging is well understood and documented.
Answer: A. the maximal life span on humans is 80 to 100 years.The maximal life span is 80 to 100 years and has not changed over time. The average life span, however, has changed. Women outlive men in most areas of the world. The concept of aging is not completely understood.
Q: The term apoptosis is appropriately defined as:A. second messenger system.B. autostimulation.C. programmed cell death.D. pass-it-on signal.
Answer: C. programmed cell death.Another term for apoptosis is programmed cell death. Autostimulation is when a cell releases a signal that actually affects the cell of origin. A pass-it-on signal is a description for a second messenger system. A second messenger system is a means by which a ligand binds with receptors of a membrane system and then triggers a second system/reaction.
Q: The process of atrophy is a result of: Select all that apply:A. aging.B. lack of blood supply.C. work demand.D. hormonal stimulation.E. need to replace lost cells.
Answer: A. aging.B. lack of blood supply.D. hormonal stimulation.Atrophy is a decrease in cellular size caused by aging, disuse or lack of blood supply, hormonal stimulation, or neural stimulation. Hypertrophy is an increase in the size of cells caused by increased work demands or hormonal stimulation. Hyperplasia is an increase in the number of cells caused by an increased rate of cellular division. Normal hyperplasia is stimulated by hormones or the need to replace lost tissues.
Q: When discussing body fluid, it is correct to state that:A. two-thirds of the body’s water is intracellular.B. one-fourth of the body’s fluid is extracellular.C. the two main extracellular compartments are interstitial and intracellular.D. standard total body water is 40% of body weight.
Answer: A. two-thirds of the body’s water is intracellular.Two-thirds of the body’s water is intracellular. One-third is extracellular. There are two components of the extracellular compartment: interstitial and intravascular. Total body water is about 60% of body weight.
Q: Which of the following statements is TRUE? When discussing body fluid movement, it is correct to state that:A. potassium is the most abundant extracellular fluid (ECF) ion.B. sodium maintains the osmotic balance of the intracellular fluid (ICF) space.C. water moves freely across membranes.D. aquaporins block water movement across the membrane.
Answer: C. water moves freely across membranes.Water moves freely across the capillary or cell membrane. Aquaporins are a family of water channel proteins that provide permeability to water at the capillary membrane. Sodium is the major ECF cation, and potassium is the major ICF cation; this is due to the sodium-potassium pump.
Q: When discussing aldosterone, it is correct to state that:A. it is a hormone that is secreted when sodium levels are depressed.B. it is a hormone that is secreted when potassium levels are depressed.C. its action is to decrease the retention of sodium.D. its action is to decrease the secretion of potassium.
Answer: A. it is a hormone that is secreted when sodium levels are depressed.Aldosterone is a minerocorticoid secreted from the adrenal gland that is located on the kidney. Aldosterone is secreted when potassium is increased or sodium is decreased. Therefore, it makes sense that aldosterone increases sodium reabsorption to increase a depleted supply. It also increases potassium secretion.
Q: When discussing hyperchloremia (elevated serum chlorine), it is correct to state that it:A. occurs with a deficit of sodium.B. arises with an excess of bicarbonate.C. has specific symptoms such as thirst.D. is a result of an underlying disorder.
Answer: D. is a result of an underlying disorder.Hyperchloremia is usually related to an underlying disorder, and therefore, treatment is centered on the underlying disorder. It usually occurs with an increase in sodium and a deficit of bicarbonate. There are normally no specific symptoms associated with this syndrome.
Q: When discussing hyponatremia (low serum sodium), it is correct to state that it is generally:A. a result of inadequate sodium intake.B. a result of a decrease in total body water (TBW).C. an outcome of serious burns, vomiting, or diarrhea.D. an outcome of serum sodium levels dropping below 145 mEq/L.
Answer: C. an outcome of serious burns, vomiting, or diarrhea.Hyponatremia occurs when the serum sodium drops below 135 mEq/L. It can occur due to burns, vomiting, diarrhea, or gastrointestinal suctioning. It can also occur with an increase in TBW. Inadequate sodium intake can cause hyponatremia, but it is uncommon.
Q: Which of the following is a TRUE statement regarding hyperkalemia (elevated serum potassium)?A. Dietary excesses are commonly the cause.B. It often occurs in acidosis.C. There is an increased in the renal secretion of potassium.D. Increased aldosterone levels are noted.
Answer: B. It often occurs in acidosis.Hyperkalemia (high potassium) often occurs with acidosis. During acidosis, hydrogen is taken up in the cell. When this occurs, it is exchanged for potassium and serum potassium rises. Dietary excesses are uncommon. An increase in aldosterone would cause hypokalemia, rather than hyperkalemia, because aldosterone increases Na+ reabsorption while increasing K+ secretion into the renal tubule.
Q: A patient has deep and rapid respirations. Laboratory tests reveal decreased pH and bicarbonate. This patient is experiencing:A. metabolic acidosis.B. metabolic alkalosis.C. respiratory acidosis.D. respiratory alkalosis.
Answer: A. metabolic acidosis.A decrease in pH and bicarbonate occur with metabolic acidosis. Additionally, metabolic acidosis causes deep and rapid breathing, as the body tries to compensate by removing carbon dioxide. Metabolic alkalosis occurs if pH and bicarbonate levels are elevated. Respiratory acidosis occurs when pH is decreased and carbon dioxide is elevated, whereas respiratory alkalosis occurs when pH is elevated and carbon dioxide is decreased.
Q: A common cause of the increased filtration of fluid from capillaries and lymph into surrounding tissues (edema) includes: Select all that apply.A. increased hydrostatic pressure.B. decreased plasma oncotic pressure.C. increased capillary membrane permeability.D. lymphatic obstruction.E. increased barometric pressure.
Answer: A. increased hydrostatic pressure.B. decreased plasma oncotic pressure.C. increased capillary membrane permeability.D. lymphatic obstruction.There are four common causes of increased edema: increased hydrostatic pressure, decreased plasma oncotic pressure, increased capillary membrane permeability, and lymphatic obstruction. Barometric pressure (Atmospheric pressure) is the force per unit area exerted against a surface by the weight of air above that surface in the Earth’s atmosphere.
Q: When discussing causes of hypernatremia (elevated serum sodium), it is correct to include: Select all that apply.A. excessive free water intake.B. inappropriate administration of hypertonic saline solution.C. oversecretion of the hormone aldosterone.D. Cushing syndrome.E. ingesting large amounts of dietary sodium.
Answer: B. inappropriate administration of hypertonic saline solution.C. oversecretion of the hormone aldosterone.D. Cushing syndrome.High sodium can be caused by inappropriate administration of hypertonic saline (sodium bicarbonate in cardiac arrest), oversecretion of aldosterone, and Cushing syndrome (increased secretion of ACTH). An excessive free water intake will actually cause hyponatremia, or low sodium, due to sodium dilution in the blood. High amounts of dietary sodium rarely cause hypernatremia.
Q: When discussing common clinical manifestations of hypokalemia (low serum potassium), it is correct to state that: Select all that apply.A. carbohydrate metabolism is affected due to decreased insulin secretion.B. renal function is impaired.C. neuromuscular excitability is decreased.D. skeletal muscle contractility is increased.E. smooth muscle tone is increased.
Answer: A. carbohydrate metabolism is affected due to decreased insulin secretion.B. renal function is impaired.C. neuromuscular excitability is decreased.Carbohydrate metabolism is affected secondary to decreased insulin secretion. Renal function may be impaired, and renal tubular atrophy and fibrosis may occur. Skeletal muscle will be weak, as neuromuscular excitability is decreased. Loss of smooth muscle tone is manifested by constipation, intestinal distention, anorexia, nausea, vomiting, and paralytic ileus (paralysis of the intestinal muscles).
Q: An example of a physical barrier is:A. antibacterial fatty acids.B. lysozymes in tears.C. epithelial cells.D. ear wax.
Answer: C. epithelial cells.Epithelial cells form tight junctions that act as physical barriers to entry of organisms. Lysozymes, antibacterial fatty acids, and ear wax are biochemical barriers.
Q: The complement factor that causes pores to form in the bacterial membrane is:A. C1.B. C3.C. C5b-C9.D. C5.
Answer: C. C5b-C9.The C5b-C9 complex causes pores to form in the bacterial membrane through which water may enter the cell and cause cell lysis and destruction. C1 has six sites and combines with antibodies. The alternative pathway is activated by several substances found on the surface of infectious organisms. This pathway uses unique proteins (factor B, factor D, and properdin) to form a complex that activates C3. C3 activation leads to C5 activation and convergence with the classical pathway.
Q: An example of a complement factor that is considered an anaphylatoxin is:A. C3a.B. C5b.C. C7.D. C9.
Answer: A. C3a.C3a, C5a, and C4a are all anaphylatoxins, and they can induce rapid degranulation when histamine is released from mast cells. The C5b-C9 complex causes pores to form in the bacterial membrane through which water may enter the cell and cause cell lysis and destruction.
Q: A biochemical substance that attracts leukocytes to the site of inflammation is a(n):A. carboxypeptidase.B. chemotactic factor.C. fibrin.D. opsonin.
Answer: B. chemotactic factor.A chemotactic factor is a biochemical substance that attracts leukocytes to the site of inflammation. Carboxypeptidase is a plasma enzyme that removes a terminal arginine on both peptides. Fibrin is an insoluble protein that is the end product of the coagulation cascade. An opsonin tags pathogenic molecules for destruction.
Q: It is true that mast cells:A. release histamine that causes vasoconstriction.B. are found only in blood vessels.C. release histamine that causes inflammation.D. are not involved in allergic reactions.
Answer: C. release histamine that causes inflammation.Mast cells release histamine that causes vasodilation and slowed circulation in nearby vessels, as well as a change in cell shape. This change in cell shape causes fluid to leak from the blood into the tissues, thereby causing swelling. Mast cells are found in loose connective tissue close to blood vessels and are involved in initiating many allergic reactions.
Q: An acidic, sulfur-containing lipid that produces effects similar to histamine is a(n):A. leukotriene.B. prostaglandin.C. adhesion molecule.D. phagocyte.
Answer: A. leukotriene.Leukotrienes act like histamine and cause smooth muscle contraction, increased vascular permeability, and chemotaxis. Prostaglandins cause increased vascular permeability, chemotaxis, and pain. Adhesion molecules increase the stickiness between cells. Phagocytes are cells that ingest and dispose of foreign material.
Q: It is true that neutrophils:A. contain no granules.B. are the predominant phagocytes in the early inflammatory site.C. are the largest blood cells.D. enter a wound site after lymphocytes and macrophages.
Answer: B. are the predominant phagocytes in the early inflammatory site.Neutrophils are the predominant early phagocytes. They arrive before lymphocytes and macrophages and contain granules. Monocytes are the largest blood cells.
Q: Biochemical messengers produced by macrophages and lymphocytes in response to a pathogen are called:A. interleukins.B. interferons.C. chemokines.D. tumor necrosis factor.
Answer: A. interleukins.Interleukins are biochemical messengers produced by macrophages and lymphocytes in response to a pathogen. Interferons protect against viral infections. Chemokines induce leukocyte chemotaxis. Tumor necrosis factor induces a multitude of proinflammatory effects, including the enhancement of endothelial cell adhesion.
Q: Which cytokine is secreted by macrophages and mast cells and acts to induce fever?A. Interleukin-1B. Interleukin-6C. InterferonsD. Tumor necrosis factor-alpha
Answer: D. Tumor necrosis factor-alphaTumor necrosis factor-alpha is secreted by macrophages when Toll-like receptors recognize foreign materials or by mast cells. They are proinflammatory molecules that increase adherence of neutrophils, induce chemokine production, cause fever, increase synthesis of inflammation-related serum proteins by the liver, and cause muscle wasting. IL-1 causes fever and phagocyte and lymphocyte activation and acts as a growth factor. IL-6 acts to induce hepatocytes to produce proteins needed in inflammation. Interferons protect against viral infections.
Q: Natural barriers include: Select all that apply.A. physical.B. mechanical.C. biochemical.D. resistance.E. inflammation.
Answer: A. physical.B. mechanical.C. biochemical.E. inflammation.Resistance is a means by which the body may avoid being infected, but it is not a natural barrier. The natural barriers include physical, mechanical, biochemical, and inflammation.
Q: A patient is being evaluated for a leg injury involving vascular injury and inflammation. In a patient experiencing inflammation, observable characteristic(s) would include: Select all that apply.A. redness.B. coolness to the touch.C. increased swelling.D. pain.E. numbness.
Answer: A. redness.C. increased swelling.D. pain.The four characteristics that are observable for inflammation in vascular tissue are redness, heat to the touch, swelling, and pain. Numbness is not a recognized characteristic of the inflammatory process.
Q: The activation of the complement system includes: Select all that apply.A. antigen.B. classical.C. lectin.D. alternative.E. antibody.
Answer: B. classical.C. lectin.D. alternative.The three different ways the complement pathway may be activated include classical, lectin, and alternative. The antigen-antibody complex is the beginning of the activation of the classical system. The antigen and antibody react, initiating the complement system.
Q: The clotting system at the site of injury or inflammation includes the following function(s): Select all that apply.A. preventing the spread of infection to adjacent tissues.B. keeping microorganisms at the site of greatest inflammatory cell activity.C. forming constant bleeding to flush out the microorganism.D. providing a framework for future repair and healing.E. disposing of foreign material at the site of a wound.
Answer: B. keeping microorganisms at the site of greatest inflammatory cell activity.D. providing a framework for future repair and healing.The clotting system actually forms a clot, which will help stop bleeding. This allows the microorganism to remain at the site for destruction. Phagocytosis is the process by which a cell ingests and disposes of foreign material, including microorganisms. The other descriptions are all correct and are important functions of the clotting cascade.
Q: The reconstructive phase of wound healing includes: Select all that apply.A. fibroblast proliferationB. collagen synthesis.C. neutrophil production.D. epithelialization.E. wound contraction.
Answer: A. fibroblast proliferationB. collagen synthesis.D. epithelialization.E. wound contraction.The reconstructive phase begins 3 to 4 days after injury and continues for up to 2 weeks. During this phase, fibroblasts proliferate and synthesize collagen. The wound is sealed and contracts. Neutrophil production is not included in the reconstructive phase.
Q: It is accurate to state that:A. allergy means deleterious effects of hypersensitivity.B. immunity means an altered immunologic response.C. hypersensitivity means the protective response to an antigen.D. autoimmunity is the normal response to foreign antigens.
Answer: A. allergy means deleterious effects of hypersensitivity.Allergy means the deleterious effects of a hypersensitivity reaction. The correct definition of immunity is the protective response to antigens. The correct definition of hypersensitivity is the altered immunologic response to an antigen. Autoimmunity is a disturbance in the immunologic tolerance of self-antigens.
Q: An accurate description of a type I reaction would be that it:A. is mediated by IgA.B. is generally allergic in nature.C. most often occurs against medications.D. seldom contributes to autoimmune diseases.
Answer: B. is generally allergic in nature.Most type I reactions are allergic. They are mediated by IgE. Most occur against environmental antigens and do contribute to some autoimmune diseases.
Q: Atopic individuals:A. have a 4% chance that offspring will have allergies, if only one parent has allergies.B. have a 50% chance that offspring will have allergies, if both parents have allergies.C. tend to produce higher quantities of IgE.D. have no genes associated with an atopic state.
Answer: C. tend to produce higher quantities of IgE.There are higher quantities of IgE in these individuals. If one parent has an allergy, the individual has a 40% of having allergies; with two parents, it is 80%. Multiple genes have been associated with the atopic state.
Q: Serum sickness is:A. caused by the formation of immune complexes.B. the deposition of complexes in the blood vessels.C. a result of cytotoxic T cells.D. created by the binding of the antigen to the cell surface.
Answer: A. caused by the formation of immune complexes.Serum sickness reactions are caused by the formation of immune complexes in the blood and their deposition in target tissues. An Arthus reaction deposits complexes into the walls of blood vessels. Type IV mechanisms occur through either cytotoxic T lymphocytes or lymphokine-producing Th1 cells. Antigen is bound to the cell surface in type II reactions.
Q: A type IV allergic reaction will:A. be immediate in its action.B. result in an infiltration of B cells.C. create a red, soft-centered lesion.D. be transferred by cells.
Answer: D. be transferred by cells.Type IV hypersensitivity reactions can be transferred by cells, but not by serum. They are delayed as their onset takes from 24 to 72 hours. The site is infiltrated with T-lymphocytes and macrophages. There is a clear hard center with surrounding erythema (redness).
Q: A patient who presents with systemic lupus erythematosus (SLE) is likely to:A. be male.B. be Caucasian.C. report symptoms of arthritis.D. experience memory loss.
Answer: C. report symptoms of arthritis.SLE is characterized by an autoimmune disease, such as arthritis, and is more common in woman and in African-Americans. Memory loss is not generally associated with this disorder.
Q: Which of the following is TRUE regarding organ transplant rejection?A. It is a type IV hypersensitivity.B. Hyperacute rejection is common.C. Acute rejection occurs within months to years.D. Without drugs, it takes years for rejection.
Answer: A. It is a type IV hypersensitivity.This is a type IV-mediated hypersensitivity reaction. Hyperacute rejection is rare. Acute rejection occurs within days to months. Rejection may occur in 2 weeks if immunosuppressive drugs are not used.
Q: Which is true for a patient who is transfused with a unit of unmatched packed RBCs? The unit:A. now has only three different RBC antigens.B. is type AB blood and will have anti-A and anti-B antibodies.C. is type O blood and will have neither A nor B antigens.D. is type A blood and will have anti-O antibodies.
Answer: C. is type O blood and will have neither A nor B antigens.Type O blood does not contain A or B antigens. There are 80 major different red cell antigens. A patient with A blood carries anti-B antibodies. A patient with B blood carries anti-A antibodies. A patient with type AB blood lacks both anti-A and anti-B antibodies. Those with type O blood have both anti-A and anti-B antibodies.
Q: A patient who is a type AB+ blood will:A. produce no anti-D antibodies.B. have one genotype, DD.C. have the dd genotype.D. be among 15% of the population.
Answer: A. produce no anti-D antibodies.Positive blood types may be DD or Dd in genotype and do not have any D antibodies. The dd genotype is for negative blood, and 85% of the population is Rh positive.
Q: Hypersensitivity reactions include: Select all that apply.A. type I IgE allergic reactions.B. type II tissue-specific reactions.C. type III immune complex reactions.D. type IV cell mediated reactions.E. type V autoimmune reactions.
Answer: A. type I IgE allergic reactions.B. type II tissue-specific reactions.C. type III immune complex reactions.D. type IV cell mediated reactions.
Q: The action of histamine results in the: Select all that apply.A. relaxation of smooth muscle.B. increase of vascular permeability.C. formation of edema.D. increase of blood flow into the affected area.E. bronchoconstriction.
Answer: B. increase of vascular permeability.C. formation of edema.D. increase of blood flow into the affected area.E. bronchoconstriction.Histamine contracts bronchial smooth muscle, and this causes bronchoconstriction. There is also increased vascular permeability, edema, and vasodilatation.
Q: Urticaria is also known as: Select all that apply.A. rhinitis.B. hives.C. wheal/flare.D. bleb.E. dermal skin reaction.
Answer: B. hives.C. wheal/flare.E. dermal skin reaction.Hives, wheal/flare, and dermal skin reaction are all other names for urticaria. This skin condition is common in type I reactions. Rhinitis is another name for inflammation of the nasal passages. A bleb is a large, serous-filled blister.
Q: The mechanism by which a type II hypersensitivity reaction affects cells includes which of the following? Select all that apply.A. The cell is destroyed by antibody and complement.B. Antibody may cause phagocytosis.C. Components of neutrophils will release their granules.D. Antigen-mediated cytotoxicity.E. Antibody-dependent cell-mediated cytotoxicity.
Answer: A. The cell is destroyed by antibody and complement.B. Antibody may cause phagocytosis.C. Components of neutrophils will release their granules.E. Antibody-dependent cell-mediated cytotoxicity.There are five mechanisms by which type II hypersensitivity reactions can affect cells. First, the cell is destroyed by antibody and complement. Second, antibodies may cause damage through phagocytosis. Third, neutrophil granules, as well as several toxic oxygen products, will damage tissue. A fourth mechanism is antibody-dependent cell-mediated cytotoxicity. The fifth mechanism causes cell malfunction, not death. Antigen-mediated cytotoxicity is not a recognized mechanism.
Q: An example of type IV sensitivity reactions would include: Select all that apply.A. graft rejection.B. skin test for tuberculosis.C. Arthus reactions.D. autoimmune processes.E. poison ivy blebs.
Answer: A. graft rejection.B. skin test for tuberculosis.D. autoimmune processes.E. poison ivy blebs.Graft rejection, skin test for tuberculosis, allergic reactions such as those caused by poison ivy and oak, and autoimmune responses may all be type IV reactions. The Arthus reaction is a type III hypersensitivity reaction.
Q: The definition of reactive response includes mounting a response:A. in anticipation to a stressor.B. in reaction to a stressor.C. to a learned stressor.D. to physical stressor.
Answer: B. in reaction to a stressor.A reactive response is a psychological response to a stressor. An anticipatory response is a psychological response to an anticipated stressor. A learned response is a psychological response to specific stimuli that may be physical and has been negative in the past.
Q: When experiencing stress, the effects of the epinephrine circulating in body will result in:A. bradycardia.B. decreased heart contractility.C. increased skeletal muscle blood supply.D. hyperglycemia.
Answer: D. hyperglycemia.It will cause transient hyperglycemia. The epinephrine will increase heart rate and contractility. There will be increased venous return to the heart and, thus, increased cardiac output and blood pressure. Epinephrine dilates blood vessels of the muscles.
Q: When the release of cortisol is a result of ACTH activation, it is true that:A. plasma is bound to corticotropin.B. gluconeogenesis is halted.C. cortisol increases blood glucose.D. cortisol decreases protein synthesis.
Answer: C. cortisol increases blood glucose.Cortisol has many actions that include the stimulation of gluconeogenesis, resulting in the increase of glucose production. Plasma will bind to a protein called transcortin, and protein synthesis is increased.
Q: It is TRUE that the immune system will respond to stress:A. with an increase in Th1.B. through a shift in Th1.C. with little or no change.D. through the effects of cortisol.
Answer: D. through the effects of cortisol.Stress can activate an excessive immune response through cortisol. It can cause suppression of Th1 and a Th2 shift.
Q: CRH (corticotropin-releasing hormone) influences the immune system through:A. its release from peripheral inflammatory sites.B. vasoconstriction.C. decreased vascular permeability.D. targeting red blood cells at peripheral targets.
Answer: A. its release from peripheral inflammatory sites.CRH is released from the hypothalamus and peripherally at inflammatory sites. Because this hormone is proinflammatory, it causes vasodilation and increased vascular permeability. The primary target of peripheral CRH is the mast cell.
Q: Which of the following is a TRUE statement regarding stress and the immune system?A. There are no known immune-related conditions.B. Cardiovascular disease is one condition that is related to stress.C. There is a decreased level of proinflammatory cytokines.D. Negative emotions cause no alterations in the immune system.
Answer: B. Cardiovascular disease is one condition that is related to stress.Cardiovascular disease, aging, cancer, osteoporosis, arthritis, type 2 diabetes mellitus, and COPD are all associated with prolonged presence of proinflammatory cytokines. There is an increase in these proinflammatory cytokines. Negative emotions and stress are directly associated with the increased level of these proinflammatory cytokines and so affect the immune system.
Q: The stages in the development of general adaptation syndrome include: Select all that apply.A. alarm.B. resistance.C. termination.D. exhaustion.E. adaptation.
Answer: A. alarm.B. resistance.D. exhaustion.E. adaptation.The three successive stages in the development of the general adaptation syndrome are alarm, resistance (also referred to as adaptation), and exhaustion.
Q: Research has shown that an elderly adult’s mortality is affected when a spouse or partner is hospitalized in the areas of: Select all that apply.A. emotional stress.B. financial stress.C. physical support.D. psychological support.E. self-esteem.
Answer: A. emotional stress.B. financial stress.C. physical support.D. psychological support.For elderly people whose spouse had been hospitalized, the short-term risk of dying approaches that of an elderly person after his or her spouse’s death. The researchers commented that a spouse’s illness or death can increase a partner’s mortality by causing severe stress and removing a primary source of emotional, psychological, practical, and financial support. Self-esteem is not generally seen as affecting mortality.
Q: It is correct to assume that Cheyne-Stokes respirations (CSR):A. involve a pathologically increased ventilatory response.B. result in hypocapnia and increased ventilatory stimulus.C. cause changes in PaO2 that produce irregular breathing.D. increase PaCO2 level when overbreathing occurs.
Answer: A. involve a pathologically increased ventilatory response.The pathophysiology of CSR includes an increased ventilatory response to carbon dioxide stimulation. This causes hypercapnia and diminished ventilatory stimulus. Changes in PaCO2 produce irregular breathing, not changes in PaO2. The PaCO2 level decreases to below normal when overbreathing occurs.
Q: A patient experiences no nausea but significant vomiting with a CNS injury when the trauma:A. impinges directly on the floor of the third ventricle.B. causes a decrease in intracranial pressure.C. involves the vestibular nuclei.D. also involves the abdominal area.
Answer: C. involves the vestibular nuclei.Vomiting associated with CNS injuries involves the vestibular nuclei. It can also be caused by impingement on the fourth ventricle or an increase in intracranial pressure. Vomiting with no associated nausea indicates direct involvement of the central neural mechanisms regardless of abdominal trauma.
Q: Pinhole-sized pupils can be a result of an overdose of:A. atropine.B. scopolamine.C. opiates.D. amphetamines.
Answer: C. opiates.Opiates (heroin and morphine) cause pinhole or constricted pupils. The other choices cause large dilated pupils.
Q: A patient has sustained a traumatic brain injury but is able to follow simple commands and can manipulate objects. The term used to describe this state is:A. comaB. vegetativeC. minimally consciousD. locked-in syndrome
Answer: C. minimally consciousThe term minimally conscious refers to severely altered consciousness in which the person demonstrates minimal but defined behavioral evidence of self or environmental awareness. The clinical features include following simple commands, manipulation of objects, gestural or verbal yes/no responses, intelligible verbalization, and stereotypical movements. Locked-in syndrome describes an individual who has both the content of thought and the level of arousal intact. The efferent pathways are disrupted, which means the individual cannot communicate through speech or body movement. Coma is a state of neurobehavioral unresponsiveness. Vegetative state is a wakeful unconscious state.
Q: A patient who is experiencing difficulty in recognizing a pattern’s form and the nature of objects is exhibiting characteristics of:A. agnosia.B. aphasia.C. dysphasia.D. Alzheimer disease.
Answer: A. agnosia.Agnosia is a defect of pattern recognition. Aphasia is the complete absence of speech. Dysphasia is impairment of comprehension or production of language. Alzheimer disease is a disease of dementia.
Q: A patient who is experiencing a loss of comprehension or the production of language is described as having:A. dysphasia.B. aphasia.C. expressive dysphasia.D. transcortical dysphasia.
Answer: A. dysphasia.Aphasia is complete inability to speak. Dysphasia is impairment in comprehension or production of language. Expressive dysphasia is characterized primarily by deficits in expression, but comprehension may be present. Transcortical dysphasia involves the ability to repeat and to recite.
Q: A patient who fell and hit his head 2 days ago is now restless and irritable. This scenario is characteristic of:A. Alzheimer disease.B. dementia.C. delirium.D. coma.
Answer: C. delirium.Delirium is an acute state of confusion. It is abrupt in its onset. The patient may have difficulty in concentration, restlessness, irritability, tremulousness, insomnia, and poor appetite. Dementia is a more chronic problem in which there is progressive failure of many cerebral functions. Alzheimer disease is a type of dementia. A coma is a loss of consciousness.
Q: It is TRUE that Alzheimer disease is:A. an uncommon neurologic disorder.B. not believed to have a genetic relationship.C. a result of neuronal proteins becoming distorted and tangled.D. the cause of plaques increasing nerve impulse transmission.
Answer: C. a result of neuronal proteins becoming distorted and tangled.Neurofibrillary tangles occur when the proteins in neurons become tangled and distorted. There is a genetic relationship in late-onset familial Alzheimer dementia. It is a common neurologic disorder; nearly 6 million Americans had the disease in 2000. With the formation of plaques, there is decreased nerve impulse transmission.
Q: The term used to describe a patient who sustains a cerebrovascular accident and is paralyzed on the left side is:A. hemiplegia.B. paraplegia.C. diplegia.D. quadriplegia.
Answer: A. hemiplegia.Hemiplegia means loss of motor function on one side of the body. Paraplegia refers to loss of motor function of the lower extremities. Diplegia is the paralysis of both upper or both lower extremities as a result of cerebral hemisphere injuries. Quadriplegia refers to paralysis of all four extremities.
Q: A patient who exhibits involuntary twisting movements caused by slow muscle contraction on the right side of the body is experiencing:A. hypertonia.B. spasticity.C. hemidystonia.D. paratonia.
Answer: C. hemidystonia.Injury to the putamen or its outflow tracts would result in hemidystonia. Hypertonia is increased muscle tone. Spasticity results from hyperexcitability of the stretch reflexes. Paratonia is resistance to passive movement that is proportional to the force applied.
Q: A basic neural system to cognitive function would include: Select all that apply.A. attentional systems.B. memory systems.C. affective or emotive systems.D. sensory systems.E. language systems.
Answer: A. attentional systems.B. memory systems.C. affective or emotive systems.E. language systems.In this case, sensory systems are not related to cognitive function.
Q: Abnormal findings in which of the following evaluations would indicate possible neurological dysfunction? Select all that apply.A. Level of consciousnessB. Pattern of breathingC. Heart rateD. Eye positionE. Skeletal muscle motor responses
Answer: A. Level of consciousnessB. Pattern of breathingD. Eye positionE. Skeletal muscle motor responsesThe five categories that are critical for the evaluation process for neurologic function include: (1) level of consciousness (LOC), (2) pattern of breathing, (3) size and reactivity of pupils, (4) eye position and reflexive response, and (5) skeletal muscle motor responses. Although heart rate is a vital sign, it is not always indicative of neurologic status.
Q: A characteristic of Alzheimer disease includes: Select all that apply.A. rapid onset of symptomology.B. short-term memory loss.C. increased irritability and agitation.D. anxiety and depression.E. remissions resulting in cognitive clarity.
Answer: B. short-term memory loss.C. increased irritability and agitation.D. anxiety and depression.Alzheimer disease is characterized with short-term memory loss, increased irritability and agitation, as well as anxiety and depression. Its onset of symptoms is gradual, and there are no remissions that allow for cognitive clarity.
Q: The person at highest risk for traumatic brain injury (TBI) is:A. African American and economically disadvantaged.B. male and disabled.C. female and 20 years of age.D. an economically advantaged young adult.
Answer: A. African American and economically disadvantaged.Those at highest risk for TBI are children 0 to 4 years of age, older adolescents aged 15 to 19 years, and adults aged 65 years and older. Males have the highest incidence in every age group. TBI is highest among African Americans and in lower- and median-income families.
Q: The most common cause of TBI is:A. motor vehicle accidents.B. falls.C. sports-related events.D. violence.
Answer: A. motor vehicle accidents.Motor vehicle accidents account for 50%. Falls account for 21%. Sports-related events and violence account for 10% and 12%, respectively.
Q: A trauma patient diagnosed with a brain contusion experiences changes in attention, memory, affect, and emotion. In which region of the brain is the contusion most likely located?A. CerebralB. FrontalC. CerebellumD. Midbrain
Answer: B. FrontalContusions are most commonly found in the frontal lobes, particularly at the poles and along the inferior orbital surfaces. They result in changes in attention, memory, and executive attentional functioning.
Q: An elderly alcoholic man falls and experiences a hematoma that is on the top of his brain. The hematoma is most likely a:A. subdural.B. epidural.C. extradural.D. intracerebral.
Answer: A. subdural.Subdural hematomas are commonly found in the elderly and persons who abuse alcohol. The remaining options are injuries not generally observed in this population after experiencing an alcohol-induced fall.
Q: A 23-year-old patient is hit in the temporal portion of his skull during an altercation. Although he initially loses consciousness, he soon awakens and is conversant. Three hours later he is experiencing vomiting, drowsiness, and confusion. These symptoms are most likely related to which type of brain injury?A. Diffuse axonalB. IntracerebralC. SubduralD. Epidural
Answer: D. EpiduralThe classic presentation of an epidural hematoma is a person hit in the temporal area with damage to the middle meningeal artery. The patient will lose consciousness at the time of injury, but there may be a period where consciousness is regained. The patient will then become more confused and drowsy. This scenario is not typical with the other types of brain injury.
Q: A patient experiences a vertebral fracture in which the C1 vertebra is fractured into several fragments. This type of fracture can be described as:A. simple.B. compressed.C. comminuted.D. dislocation.
Answer: C. comminuted.A comminuted fracture is also called a burst fracture, in which the vertebral body is shattered into several fragments. A simple fracture is a single break usually affecting the transverse or spinous process. A compressed fracture is also called a wedge. This occurs when there is a crush type of injury and the vertebrae loses height. A dislocation is when two bones at a joint are no longer in alignment.
Q: It is TRUE that spinal shock:A. is characterized by an incomplete loss of reflex function.B. involves all skeletal muscles.C. causes increased muscle tone below the lesion.D. results in no disruption of thermal control.
Answer: B. involves all skeletal muscles.Spinal shock does involve function of skeletal muscles resulting in paralysis and flaccidity. Such an injury is characterized by a complete loss of reflex function below the level of the lesion, and impairment of control of thermal regulation is observed.
Q: A patient is experiencing pain that courses over the buttocks and into the calf and ankle. This is suggestive of a herniated disc at which vertebral level?A. CervicalB. ThoracicC. LumbarD. Coccyx
Answer: C. LumbarA herniated disc in the lumbosacral area is associated with pain that radiates along the sciatic nerve and courses over the buttock and into the calf and ankle. Both a cervical and thoracic injury would indicate pain that originated higher on the body. A herniated coccyx vertebrate would result in pain beginning a point lower than that described.
Q: It is true that an acute cerebrovascular accident (CVA) is:A. the leading cause of disability in the United States.B. the fifth most common cause of death in the United States.C. likely to be followed by a second stroke within 1 year.D. experienced by 2 million individuals each year.
Answer: A. the leading cause of disability in the United States.CVAs are the leading cause of disability and the third leading cause of death. There are 500,000 stroke victims a year, and 5% to 14% have a second stroke within 1 year.
Q: It is TRUE that a hemorrhagic stroke:A. is the most common cause of CVA.B. accounts for 50% of all CVA.C. is commonly caused by hypertension.D. is often caused by a microinfarct.
Answer: C. is commonly caused by hypertension.Chronic, untreated hypertension is generally the cause of hemorrhagic stroke. Hemorrhagic stroke is the third most common cause of CVA. It accounts for 10% to 15% of strokes in whites and 30% in blacks and Asians. An infarct is a type of occlusive stroke.
Q: It is correct to assume that a subarachnoid hemorrhage is:A. a risk for individuals with an intracranial aneurysm.B. seldom experienced in individuals with hypertension.C. not caused by trauma to the head.D. rarely fatal.
Answer: A. a risk for individuals with an intracranial aneurysm.Individuals with intracranial aneurysms are at risk for subarachnoid hemorrhage. Hypertension and trauma are also risk factors. The mortality is over 50%.
Q: A patient experiences demyelination of the peripheral nerves with sparing of the axons. This is characteristic of:A. Alzheimer disease.B. Guillain-Barré.C. myasthenia gravis.D. amyotrophic lateral sclerosis (ALS).
Answer: B. Guillain-Barré.Guillain-Barré is an idiopathic polyneuritis with acute inflammatory demyelinating characteristics. There is demyelination of the peripheral nerves with relative sparing of the axons. Alzheimer disease is a form of dementia caused by tangles. Myasthenia gravis is due to anti-acetylcholine-receptor antibodies. ALS is a degenerative disorder diffusely involving lower and upper motor neurons, resulting in progressive muscle weakness.
Q: A patient is brought to the emergency room following a motor vehicle accident in which he sustained diffuse brain injury. Which of the following symptoms would be expected to accompany his injury? Select all that apply.A. Memory deficitsB. Swallowing disordersC. AgitationD. FatigueE. Short attention span
Answer: A. Memory deficitsB. Swallowing disordersC. AgitationE. Short attention spanDiffuse brain injury can produce, memory deficits, dysphagia, agitation, and short attention span. Fatigue is not part of diffuse brain injury.
Q: Risk factors for a CVA includes: Select all that apply.A. obesity.B. smoking.C. diabetes.D. arterial hypertension.E. atrial fibrillation.
Answer: B. smoking.C. diabetes.D. arterial hypertension.E. atrial fibrillation.Obesity may indirectly cause other risk factors but is not a direct risk factor for CVA. The other risk factors for CVAs include arterial hypertension, smoking, diabetes, insulin resistance, polycythemia, increased lipoprotein A, impaired cardiac function, hyperhomocysteinemia, and atrial fibrillation.
Q: A cause of a cerebral aneurysm includes: Select all that applyA. arteriosclerosis.B. heroin abuse.C. congenital anomaly.D. trauma.E. cocaine abuse.
Answer: A. arteriosclerosis.B. heroin abuse.C. congenital anomaly.D. trauma.E. cocaine abuse.Meningiomas are located most commonly in the olfactory grooves, on the wings of the sphenoid bone (at the base of the skull), in the tuberculum sellae (a structure next to the sella turcica), on the superior surface of the cerebellum, and in the cerebellopontine angle and spinal cord
Q: The term that describes “obvious changes in cell function that result from stimulation by a particular hormone” is:A. upregulation.B. downregulation.C. direct effects.D. permissive effects.
Answer: C. direct effects.Direct effects are obvious changes in cell function that specifically result from stimulation by a particular hormone. Permissive effects are less obvious and facilitate the maximal response or functioning of a cell. Upregulation is when low concentrations of hormone increase the number of receptors per cell. Downregulation occurs when high concentrations of hormone decrease the number of receptors.
Q: It is TRUE that the hypothalamus is:A. divided into two nuclei.B. connected to the anterior pituitary by a single membrane.C. connected to the posterior pituitary by blood vessels.D. made up of neurosecretory neurons that secrete releasing hormones.
Answer: D. made up of neurosecretory neurons that secrete releasing hormones.It is true that the hypothalamus comprises neurosecretory neurons that secrete releasing hormones. The hypothalamus is divided into numerous nuclei, while being connected to the anterior pituitary by blood vessels and to the posterior pituitary by a nerve tract.
Q: Which hormone is secreted by the posterior pituitary?A. OxytocinB. CalcitoninC. Thyroid-stimulating (TSH)D. Parathyroid (PTH)
Answer: A. OxytocinOxytocin is secreted by the posterior pituitary. Calcitonin is secreted by the thyroid gland. TSH is secreted by the anterior pituitary. PTH is secreted by the parathyroid glands.
Q: Which hormone is secreted by the anterior pituitary?A. AndrogenB. ProlactinC. ThyroidD. Oxytocin
Answer: B. ProlactinProlactin is secreted by the anterior pituitary. Androgen is secreted by the adrenal glands and gonads. Thyroid hormone is secreted by the thyroid gland. Oxytocin is secreted by the posterior pituitary.
Q: It is TRUE that the parathyroid gland:A. is made up of at least 6 to 10 pairs of glands.B. is large and makes up the majority of the thyroid gland.C. influences the production of thyroid hormone.D. secretes the most important factor in Ca++ regulation.
Answer: D. secretes the most important factor in Ca++ regulation.PTH is the most important regulator of Ca++. While there are two pairs of parathyroid glands normally present, there may be two to six. They are small and located behind the thyroid gland. Thyroid hormone is produced by the thyroid gland and is unaffected by the parathyroid gland.
Q: A patient is diagnosed with type 1 diabetes and is unable to produce insulin. The pancreatic cells that are most likely damaged are the:A. beta.B. alpha.C. C-peptide.D. delta.
Answer: A. beta.The beta cells synthesize insulin. The alpha cells secrete glucagon. The delta cells secrete somatostatin and gastrin. C-peptide is the bond that connects the two peptides of proinsulin.
Q: If the outer two layers of the adrenal cortex are removed, the patient will experience:A. hypernatremia.B. hyperkalemia.C. hyperglycemia.D. decreased epinephrine.
Answer: B. hyperkalemia.The outer two layers of the adrenal cortex produce aldosterone and glucocorticoids. Aldosterone deficiency would cause hyponatremia and hyperkalemia. A deficiency in glucocorticoids would result in hypoglycemia. Epinephrine would only decrease if the adrenal medulla was damaged or removed.
Q: The posterior pituitary gland secretes:A. antidiuretic hormone (ADH).B. prolactin-releasing factor (PRF).C. thyrotropin-releasing hormone (TRH).D. gonadotropin-releasing hormone (GnRH).
Answer: A. antidiuretic hormone (ADH).ADH is secreted by the posterior pituitary gland. The hypothalamus secretes the remaining substances.
Q: A characteristic of a hormone includes: Select all that apply.A. having specific rates and rhythms of secretion.B. operating independently of feedback systems.C. affecting only cells with appropriate receptors.D. being excreted by the kidneys.E. having little integration with the nervous system.
Answer: A. having specific rates and rhythms of secretion.C. affecting only cells with appropriate receptors.D. being excreted by the kidneys.Hormones do operate within feedback systems that may be positive or negative in nature. Hormones convey specific regulatory information between cells and organs and are integrated with the nervous system to maintain communication and control.
Q: The posterior pituitary is composed of the: Select all that apply.A. median eminence.B. isthmus.C. stalk.D. pars distallis.E. infundibular process.
Answer: A. median eminence.C. stalk.E. infundibular process.The median eminence, stalk, and infundibular process are parts of the posterior pituitary. The pars distallis is part of the anterior pituitary, while the isthmus is found in the thyroid gland.
Q: The thyroid gland contains: Select all that apply.A. C-cells.B. follicles.C. isthmus.D. somatostatin.E. chromophils.
Answer: A. C-cells.B. follicles.C. isthmus.E. chromophils.C-cells secrete calcitonin and somatostatin. Follicles secrete thyroid hormone. The isthmus joins the two lobes of the thyroid. Chromophils are found in the anterior pituitary.
Q: The effects of glucocorticoids includes: Select all that apply.A. metabolicB. hypertensive.C. anti-inflammatory.D. growth suppression.E. tumor growth.
Answer: A. metabolicC. anti-inflammatory.D. growth suppression.The hypertensive response and tumor growth are not a result of glucocorticoids. The other three answers are all effects of glucocorticoids.
Q: Abnormalities in endocrine function may be caused by a(n):A. decrease in hormone levels.B. altered metabolism of the hormones.C. absence of antibodies against specific receptors.D. faulty feedback systems.E. hormone production by nonendocrine tissue.
Answer: C. absence of antibodies against specific receptors.Elevated or depressed hormone levels result from: (a) faulty feedback systems, (b) dysfunction of the gland, (c) altered metabolism of hormones, or (d) production of hormones from nonendocrine tissues. There is actually a presence of antibodies against specific receptors that either reduce available binding sites or mimic hormone action.
Q: A symptom of SIADH is:A. hyponatremia.B. hypernatremia.C. hyperosmolality (serum).D. hypoosmolality (urine).
Answer: A. hyponatremia.The cardinal features of SIADH are symptoms of water intoxication. These include hyponatremia (low serum sodium), serum hypoosmolality, and urine that is inappropriately concentrated (hyperosmolar) with respect to serum osmolality.
Q: It is true that DI:A. results from low levels of ADH.B. occurs with organic lesion of the hypothalamus or pituitary.C. may be demonstrated by excessively concentrated urine.D. is caused by low levels of ADH.
Answer: B. occurs with organic lesion of the hypothalamus or pituitary.The neurogenic form of DI occurs when a lesion of the hypothalamus, pituitary stalk, or posterior pituitary interferes with ADH synthesis, transport, or release. While the neurogenic form is caused by low levels of ADH, the nephrogenic form is caused by inadequate response of the renal tubules to available ADH. Urine is usually very diluted.
Q: A patient experiences nausea, vomiting, loss of body hair, fatigue, weakness, and hypoglycemia. The hormone deficiency the patient is most likely experiencing is that of:A. TSH.B. ACTH.C. FSH.D. LH.
Answer: B. ACTH.Within 2 weeks of complete absence of ACTH, symptoms of nausea, vomiting, anorexia, fatigue, and weakness develop. With absence of TSH, there is cold intolerance, dry skin, mild myxedema, lethargy, and decreased metabolic rate. FSH and LH deficiencies are associated with amenorrhea, atrophic vagina, uterus, breasts, decrease in body hair, and diminished libido.
Q: It is correct to assume that pituitary adenomas:A. will experience rapid growth.B. are generally metastatic.C. arise from the anterior pituitary.D. have a pathogenesis due to infarction.
Answer: C. arise from the anterior pituitary.They arise from the anterior pituitary, are benign, and are usually slow growing in nature. The pathogenesis is not a result of infarction.
Q: A patient with visual changes that begin in one eye then progress to the second eye is likely experiencing:A. pituitary infarct.B. ACTH insufficiency.C. Growth hormone (GH) insufficiency.D. pituitary adenoma.
Answer: D. pituitary adenoma.With a pituitary adenoma, there can be increased pressure on the optic chiasm, and growth of the tumor can cause visual changes in both eyes. The other conditions do not present with optic nerve involvement.Awarded 0.0 points out of 1.0 possible poi
Q: It is correct to assume that acromegaly:A. occurs due to excessive levels of ACTH.B. is the result of a GH-secreting pituitary adenoma.C. occurs more frequently in men.D. is a relatively common condition.
Answer: B. is the result of a GH-secreting pituitary adenoma.Acromegaly is a condition caused by excess of GH, not ACTH, as a result of GH-secreting pituitary adenoma. It occurs more commonly in women and is a relatively uncommon condition occurring in about 40 per 1 million.
Q: A symptom of a prolactinoma would include:A. galactorrhea.B. alopecia.C. excessive menses.D. pregnancy.
Answer: A. galactorrhea.Galactorrhea is the spontaneous flow of milk from the breast, unassociated with childbirth or nursing. Amenorrhea (absence of menses), hirsutism (excessive body hair), and osteopenia can all be caused by a prolactinoma. Pregnancy is a normal cause of galactorrhea.
Q: Symptoms of Graves disease includes:A. hypothyroid.B. goiter.C. sunken eyeballs.D. atrial fibrillation.
Answer: B. goiter.Graves disease is an autoimmune disease that can cause hyperthyroidism, goiter (diffuse thyroid enlargement), and ophthalmopathy (protruding eyeballs). Atrial fibrillation is not generally viewed as a symptom of Graves disease.
Q: Two siblings are diagnosed with a thyroid disorder due to destruction of thyroid tissue by lymphocytes and circulating thyroid autoantibodies. This pathology is likely the result of:A. subacute thyroiditis.B. Hashimoto disease.C. painless thyroiditis.D. postpartum thyroiditis.
Answer: B. Hashimoto disease.Hashimoto disease is also called autoimmune thyroiditis. It results in the gradual destruction of thyroid tissue by infiltration or lymphocytes and circulating thyroid autoantibodies. Painless thyroiditis has a similar course to subacute thyroiditis, but is pathologically identical to Hashimoto disease. Subacute thyroiditis is a nonbacterial inflammation of thyroid often preceded by a viral infection. Postpartum thyroiditis generally occurs within 6 months of delivery and occurs in up to 7% of all women.
Q: Myxedema coma is generally associated with:A. hyperthyroidism.B. hyperthermia.C. lactic acidosis.D. hyperglycemia.
Answer: C. lactic acidosis.Myxedema coma is a medical emergency involving lactic acidosis. It is associated with a diminished level of consciousness due to severe hypothyroidism. Signs and symptoms include hypothermia, hypoventilation, hypotension, hypoglycemia, and lactic acidosis.
Q: It is correct to assume that primary hypothyroidism:A. is commonly observed.B. occurs in children aged 5 to 10 years.C. is the result of absent thyroid tissue.D. occurs more frequently in male infants.
Answer: C. is the result of absent thyroid tissue.Primary hypothyroidism is a rare form of hypothyroidism caused by the absence of thyroid tissue. It occurs in infants, and more commonly in female infants.
Q: Diabetic ketoacidosis (DKA) is a result of:A. an increase in insulin production.B. a decrease in catecholamine secretion.C. impaired metabolism seen in the elderly.D. increased fat mobilization.
Answer: D. increased fat mobilization.DKA develops when there is an absolute or relative deficiency of insulin or increase in insulin counterregulatory hormones and fat is burned for fuel. This includes an increase in catecholamines, cortisol, glucagon, and GH. Emotional factors and stress, especially in children, can contribute to the development of DKA, and there is increased glucose production, decreased peripheral glucose usage, and increased fat mobilization.
Q: A patient develops severe dehydration and hyperglycemia in the absence of ketosis. Which of the following conditions does this patient have?A. Hyperosmolar hyperglycemic nonketotic syndrome (HHNKS)B. DKAC. HypoglycemiaD. Somogyi effect
Answer: A. Hyperosmolar hyperglycemic nonketotic syndrome (HHNKS)HHNKS is different from DKA in the degree of insulin deficiency and fluid deficiency. It is also characterized by a lack of ketosis. Somogyi effect occurs when hypoglycemia stimulates glucose counterregulation of hormones, causing a rebound hyperglycemia.
Q: A newly diagnosed diabetic patient will exhibit symptoms of: Select all that apply.A. polydipsia.B. anuria.C. polyphagia.D. weight loss.E. loss of muscle mass.
Answer: A. polydipsia.C. polyphagia.D. weight loss.Excessive thirst and hunger as well as weight loss will likely be seen in a diabetic patient. Polyuria, not anuria, is seen. Loss of muscle mass is not a symptom of diabetes mellitus.
Q: Risk factors for insulin resistance include: Select all that apply.A. obesity.B. inactivity.C. low-fat diet.D. age.E. medications.
Answer: A. obesity.B. inactivity.D. age.E. medications.Resistance of the receptors to insulin is heightened by obesity, inactivity, illnesses, medications, and age. A carbohydrate-rich diet, not low-fat, puts an obese person at risk for insulin resistance.
Q: Complications experienced by patients with chronic uncontrolled type 2 diabetes are: Select all that apply.A. peripheral vascular disease.B. orthostatic hypotension.C. thickened capillary membranes.D. increased glomerular filtration rate (GFR).E. visual difficulties.
Answer: A. peripheral vascular disease.B. orthostatic hypotension.C. thickened capillary membranes.E. visual difficulties.GFR decreases due to destruction of the nephrons and thickening of the filtration barrier. All other options occur with uncontrolled hyperglycemia.
Q: Which form of anemia is caused by altered heme synthesis in erythroid cells?A. Iron deficiencyB. Microcytic-hypochromicC. SideroblasticD. Megaloblastic
Answer: C. SideroblasticSideroblastic anemias are a heterogeneous group of disorders characterized by anemia of varying severity due to a dysfunction in the erythroid cells that results in a faulty production of heme. Iron deficiency anemia is usually a result of pregnancy or caused by a continuous loss of blood. Microcytic-hypochromic anemia is caused by small erythrocytes that contain reduced amounts of hemoglobin. Megaloblastic anemia is caused by unusually large erythrocytes.
Q: Which term refers to an abnormally high production of red blood cells?A. AnemiaB. Hemolytic crisisC. PolycythemiaD. Apoferritin
Answer: C. PolycythemiaPolycythemia is the medical term for abnormally high production of red blood cells. Anemia is a decrease in the number of red blood cells. Hemolytic crisis is fulminate hemolytic anemia and can present with shock. Apoferritin is a protein implicated in altered iron metabolism.
Q: Which statement regarding lymphoma is true?A. The malignancy occurs in the bone marrow.B. It is the result of injury to the RNA of a lymphocyte.C. Palpable, tender lymph nodes are present.D. Lymphomas are the second most common cause of cancer death.
Answer: C. Palpable, tender lymph nodes are present.Lymphomas are initially identified by the presence of tender, lymph nodes that are enlarged enough to be palpated. They are the sixth most common cause of cancer death and are the result of injury to the DNA of the lymphoid tissue. Malignancy within the lymphatic tissue in the bone marrow is termed lymphocytic leukemia.
Q: Spontaneous bleeding without trauma is possible when the platelet count is:A. greater than 100,000.B. between 60,000 and 75,000.C. between 20,000 and 50,000.D. less than 10,000.
Answer: D. less than 10,000.With a platelet count of less than 10,000, severe bleeding without trauma may result. It is unlikely that such a bleeding will occur at the other levels.
Q: Which statement regarding iron deficiency anemia is true?A. Caucasians are more commonly affected.B. Incidence is most common in those children older than 2 years.C. It is common in children due to their extremely high need for iron for normal growth.D. There is decreased risk in children of homeless women.
Answer: C. It is common in children due to their extremely high need for iron for normal growth.It is common in children due to their extremely high need for iron for growth. Incidence is not related to race but is increased in the children of homeless women most likely due to poor nutrition. It is most commonly found between the ages of 6 months and 2 years.
Q: Which statement regarding iron deficiency is true?A. Splenomegaly is present in 90% of those affected.B. Hemoglobin of 7 g/dl to 8 g/dl may be accompanied by pallor.C. Hemoglobin of 10 g/dl is generally accompanied by tachycardia.D. Widening of sutures is an early sign of iron deficiency.
Answer: B. Hemoglobin of 7 g/dl to 8 g/dl may be accompanied by pallor.Splenomegaly is evident in only 10% to 15% of children with iron deficiency anemia. If the condition is longstanding, the sutures may widen. Mild to moderate iron deficiency (hemoglobin 6 g/dl to 10 g/dl) may show some cellular changes. Hemoglobin less than 8 g/dl can demonstrate pallor, tachycardia, and a systolic murmur.
Q: Microcytic-hypochromic anemia is known to be a result of disorders involving: Select all that apply.A. iron metabolism.B. porphyrin synthesis.C. globin synthesis.D. vitamin B12 absorption.E. heme production.
Answer: A. iron metabolism.B. porphyrin synthesis.C. globin synthesis.E. heme production.Research supports that microcytic-hypochromic anemia is a result of disorders involving iron metabolism, porphyrin synthesis, heme production, and globin synthesis. The inability to absorb vitamin B12 results in pernicious anemia, which is a microcytic-normochromic anemia.
Q: Which factors involved in blood clotting are regulated by vitamin K? Select all that apply.A. IIB. VIIC. VIIID. IXE. X
Answer: A. IIB. VIID. IXE. X
Q: Which situation is a characteristic of the triad of Virchow? Select all that apply.A. Injury to endotheliumB. Abnormalities of blood flowC. Hypercoagulability of the bloodD. Decreased clotting factorsE. Impaired vitamin A absorption
Answer: A. Injury to endotheliumB. Abnormalities of blood flowC. Hypercoagulability of the blood
Q: Which statement regarding anemia in children is TRUE?A. The most common cause of sickle cell disease is anemia.B. Anemia is the most common blood disorder in children.C. There is only one cause of hemolytic anemia.D. Children rarely present with iron deficiency anemia.
Answer: B. Anemia is the most common blood disorder in children.Anemia, not sickle cell disease, is the most common blood disorder in children. The most common cause of anemia is iron deficiency. There are two large categories for hemolytic anemia, including increased destruction and disorders related to damaging extraerythrocytic factors.
Q: Which statement regarding maternal antibodies is TRUE?A. Placental detachment does not result in fetal erythrocytes crossing the placenta.B. The first Rh-incompatible pregnancy usually presents with severe complications.C. Anti-Rh antibodies are formed only in the response to transfusion.D. ABO incompatibility can cause hemolytic disease without erythrocytes escaping maternal circulation.
Answer: D. ABO incompatibility can cause hemolytic disease without erythrocytes escaping maternal circulation.Anti-Rh antibodies are formed only in response to the presence of incompatible (Rh-positive) erythrocytes in the blood of an Rh-negative mother. Sources of exposure include fetal blood that is mixed with the mother’s blood at the time of delivery, transfused blood, and, rarely, previous sensitization of the mother by her own mother’s incompatible blood. ABO incompatibility can cause hemolytic disease of the newborn without erythrocytes escaping maternal circulation. Placental detachment results in a large number of fetal erythrocytes entering the mother’s bloodstream. The first Rh-incompatible pregnancy usually presents with no difficulties. Anti-Rh antibodies are formed in response to the presence of incompatible (Rh-positive) erythrocytes in the blood of an Rh-negative mother.
Q: Which statement regarding a Coombs test is accurate?A. Indirect Coombs confirms the diagnosis of antibody-mediated hemolytic disease.B. Indirect Coombs measures antibodies to the mother’s circulation.C. Direct Coombs indicates if the fetus is at risk for hemolytic disease.D. Direct Coombs measures free antibodies.
Answer: B. Indirect Coombs measures antibodies to the mother’s circulation.The indirect Coombs measures antibody in the mother’s circulation and indicates if the fetus is at risk for hemolytic disease. The direct Coombs test measures antibodies already bound to the surfaces of fetal erythrocytes and is used primarily to confirm the diagnosis of antibody-mediated hemolytic disease.
Q: Which condition is defined as the “profound anemia caused by decreased erythropoiesis”?A. Vaso-occlusive crisisB. Aplastic crisisC. Sequestration crisisD. Hyperhemolytic crisis
Answer: B. Aplastic crisisAplastic crisis is a profound anemia caused by diminished erythropoiesis despite an increased need for new erythrocytes. Vaso-occlusive crisis may develop spontaneously or be precipitated by infection, cold temperatures, dehydration, or low pH. This is when the cells clump and occlude vessels. Sequestration crisis is when large amounts of the blood become pooled in the liver and spleen. Hyperhemolytic crisis is unusual and often occurs with G6PD.
Q: Congenital deficiency in which plasma clotting factors is most likely to cause hemophilia?A. VB. VIC. IXD. X
Answer: C. IXAbout 90% to 95% of hemorrhagic bleeding disorders are caused by clotting factors VIII, IX, and XI. There is no current research to support the role of the other options in the development of hemophilia.
Q: Which statements regarding hemophilia are accurate? Select all that apply.A. There is a dangerous tendency to bleed.B. Transmission of the disorder to sons occurs via the father.C. It is considered a hereditary disorder.D. Blood coagulation is chronically impaired.E. Women are carriers of the disorder.
Answer: A. There is a dangerous tendency to bleed.C. It is considered a hereditary disorder.D. Blood coagulation is chronically impaired.E. Women are carriers of the disorder.Hemophilia is a condition characterized by impairment of the coagulation of blood and a subsequent tendency to bleed. The classic disease is hereditary and limited to males, being transmitted through the female to the second generation.
Q: Which clinical manifestation is suggestive of leukemia? Select all that apply.A. Sudden onsetB. Fever presentC. FatigueD. Hemoglobin less than 7 g/dlE. Unaffected white blood counts
Answer: B. Fever presentC. FatigueD. Hemoglobin less than 7 g/dl
Q: Which artery travels in the coronary sulcus between the left atrium and the left ventricle?A. Left anterior descendingB. CircumflexC. Right coronaryD. Left coronary
Answer: B. CircumflexThe circumflex travels in the coronary sulcus. The left anterior descending travels down the anterior surface of the interventricular septum. The right coronary artery originates from an ostium behind the right aortic cusp and travels behind the pulmonary artery. The left coronary artery passes between the left atrial appendage and the pulmonary artery and generally divides into two branches.
Q: Which part of the heart is responsible for electrical impulse stimulation?A. Atrioventricular (AV) nodeB. Sinoatrial (SA) nodeC. Bundle of HisD. Right bundle branch
Answer: B. Sinoatrial (SA) nodeThe SA node contains P cells and is the site of impulse formation. The atrioventricular node is the junction of the electrical transmission between the atria and the ventricles. The bundle of His is the next stop, and then the transmission branches to the right and left bundle branches. The terminal branches are the Purkinje fibers.
Q: Which of the following represents the measure of time from the onset of atrial activation to the onset of ventricular activation?A. PR intervalB. QRS complexC. ST intervalD. QT interval
Answer: A. PR intervalThe PR interval measures the time of onset of atrial activation to the onset of ventricular activation. The QRS complex represents the sum of all ventricular muscle cell depolarizations. The ST interval is the time when the entire ventricular myocardium is depolarized. The QT interval is often called the electrical systole.
Q: Which drugs have a major effect in decreasing the strength of cardiac contraction?A. Calcium channel blockersB. Narcotics (morphine)C. AdenosineD. Aspirin
Answer: A. Calcium channel blockersCalcium channel blockers block the calcium channel, prohibiting the movement of calcium into the myocardial cell. Calcium is necessary for the activation of excitation-contraction coupling; blocking this will decrease the strength of contraction. The other drugs are not known to have that relationship to calcium blocking.
Q: Which items are related in the Frank-Starling law of the heart?A. Resting sarcomere length to tension generationB. Resting sarcomere length to end-diastolic volumeC. Tension generation and left ventricular pressureD. Tension generation and diastolic filling pressures
Answer: A. Resting sarcomere length to tension generationThe Frank-Starling law of the heart relates to resting sarcomere length (expressed as the volume of blood in the heart at the end of diastole or end-diastolic volume) to tension generation (development of left ventricular pressure). In summary, this means the volume of blood in the heart at the end of diastole is directly related to the force of contraction of the next systole. The other options do not relate to this law.
Q: Which phrase is the definition of cardiac preload?A. Impedance to ejection of blood from the left ventricleB. Wall tension related to internal blood vessel radiusC. A lower than normal tension curveD. Pressure generated by the end-diastolic volume
Answer: D. Pressure generated by the end-diastolic volumePreload is the pressure generated in the left ventricle at the end of diastole. Afterload is the resistance or impedance to ejection of blood from the left ventricle. A tension curve lower than normal is characteristic of congestive heart failure. Wall tension is directly related to the product of the intraventricular pressure and internal radius and inversely to the wall thickness (Laplace Law).
Q: Which describes the cardio-inhibitory center?A. Sympathetic excitatory neuronsB. Parasympathetic excitatory neuronsC. Bainbridge reflexD. Baroreceptor reflex
Answer: B. Parasympathetic excitatory neuronsParasympathetic excitation slows heart rate and is often referred to as the cardioinhibitory center. Sympathetic stimulation is often called the cardioexcitation center because the heart rate increases. The Bainbridge reflex causes the heart rate to increase after intravenous infusions of blood or fluid. The baroreceptor reflex facilitates blood pressure changes and heart rate changes.
Q: Which hormone is released from heart tissue in response to increases in blood volume?A. EpinephrineB. NorepinephrineC. Thyroid hormoneD. Natriuretic peptide
Answer: D. Natriuretic peptideAtrial natriuretic peptide is released from atrial tissue in response to increases in blood volume. Epinephrine and norepinephrine are catecholamines and part of the sympathetic system. Thyroid hormone enhances sympathetic activity.
Q: What two factors determine cardiac output?A. Parasympathetic and sympathetic activityB. Preload and afterloadC. Heart rate and stroke volumeD. Right and left atrial pressure
Answer: C. Heart rate and stroke volumeCardiac output is directly related to heart rate and stroke volume. Changes in either variable affect the cardiac output. The remaining options are not involved in determining cardiac output.
Q: The only action that would not cause a release on renin is the:A. increase in blood pressure at the renal artery.B. decrease in the amount of sodium delivered to the kidney.C. beta-adrenergic stimuli.D. low potassium concentration.
Answer: A. increase in blood pressure at the renal artery.A decrease in blood pressure at the renal artery causes increased renin release. The remaining options are not related to this action.
Q: What is the effect of angiotensin II?A. VasodilationB. VasoconstrictionC. Inhibition of aldosteroneD. Excretion of sodium at the kidney
Answer: B. VasoconstrictionAngiotensin II is a potent vasoconstrictor, not a dilator, and causes the stimulation of aldosterone. Aldosterone causes reabsorption of the sodium from the kidneys.
Q: Which peptide has the function of regulating sodium and water balance?A. Atrial natriuretic peptide (ANP)B. Brain natriuretic peptide (BNP)C. C-type natriuretic peptideD. Urodilantin peptide
Answer: D. Urodilantin peptideUrodilantin is a natriuretic peptide isolated from urine. It acts as a paracrine intrarenal regulator for sodium and water balance. BNP is a proposed marker for left ventricular dysfunction. ANP is an indicator of blood pressure elevation. C-type natriuretic peptide is expressed throughout the vasculature.
Q: Which statement regarding autoregulation is TRUE? Select all that apply.A. Blood vessels regulate their own blood flow.B. In coronary circulation, pressure is between 60 mmHg and 180 mmHg.C. Mechanism is well documented and is related to the sympathetic system.D. Autoregulation ensures constant coronary blood flow.E. It is proposed that this process originates in vascular smooth muscles of the arterioles.
Answer: A. Blood vessels regulate their own blood flow.B. In coronary circulation, pressure is between 60 mmHg and 180 mmHg.D. Autoregulation ensures constant coronary blood flow.E. It is proposed that this process originates in vascular smooth muscles of the arterioles.The mechanism is not well understood. Autoregulation ensures adequate coronary blood flow between 60 mmHg and 180 mmHg. The blood vessels regulate their own flow through arteriolar resistance, resulting from the smooth muscle constriction of those vessels.Awarded 0.0 points out of 4.0 possible points.
Q: Which statement regarding arteriosclerosis is TRUE? Arteriosclerosis is:A. an acute process of heart muscle degeneration.B. thickening and hardening of the vessel wall.C. plaque caused by neutrophils.D. fatty streaks and foam cells that are identical
Answer: B. thickening and hardening of the vessel wall.Arteriosclerosis is a chronic degeneration of blood vessel walls. A plaque is caused by collagen over a fatty streak that is composed of a large number of lipid-laden foam cells that deposit on the vessel wall.
Q: A patient experiences an elevated systolic pressure accompanied by normal diastolic pressure (below 90 mmHg). Which is the correct term for this condition?A. Primary hypertensionB. Secondary hypertensionC. Tertiary hypertensionD. Isolated systolic hypertension
Answer: D. Isolated systolic hypertensionIsolated systolic hypertension is an elevated systolic pressure with a normal diastolic pressure. Primary hypertension has no known cause. Secondary hypertension is caused by altered hemodynamics. There is no tertiary hypertension.
Q: A condition in which blood has pooled, producing distended and palpable vessels, is referred to as a:A. thrombus.B. venous stasis ulcers.C. varicose veins.D. deep vein thrombosis.
Answer: C. varicose veins.Varicose veins are distended and palpable vessels. Thrombus is a blood clot that remains attached to a vessel wall. Venous stasis ulcers are caused by cell death and necrosis secondary to trauma or pressure-induced oxygen deficiency. Deep vein thrombosis is a thrombus formation occurring mainly in the lower extremities.
Q: Which complication occurs secondary to hypertension?A. Cardiovascular muscle atrophyB. HypoglycemiaC. Congestive heart failureD. Decreased demand for coronary perfusion
Answer: C. Congestive heart failureComplications of hypertension include ventricular hypertrophy, angina pectoris, congestive heart failure, coronary artery disease, myocardial infarction, and sudden death. There is no research to support the remaining options as occurring as a result of hypertension.
Q: Which term describes the occlusion of a blood vessel from a bolus of circulating matter in the bloodstream?A. ThrombusB. EmbolusC. ThrombophlebitisD. Foam cell
Answer: B. EmbolusAn embolus detaches from the wall of a vessel and circulates within the vascular system until it reaches a vessel small enough for it to occlude. A thrombus is a blood clot that remains attached to the vessel wall. Thrombophlebitis is the inflammation caused by a thrombus. Foam cells are lipid-laden cells that contribute to fatty streaks.
Q: Which conditions are associated with dyslipidemia?A. High-density lipoprotein (HDL) – triglycerides and fat packagesB. Very low-density lipoproteins (VLDL) – triglycerides and proteinsC. Low-density lipoproteins (LDL) – phospholipids and proteinsD. Chylomicrons – triglycerides and phospholipids
Answer: B. Very low-density lipoproteins (VLDL) – triglycerides and proteinsVLDL is associated with triglycerides and protein. LDL is associated with cholesterol and protein. HDL is associated with phospholipids and protein. Chylomicrons are dietary fat packages.
Q: Which statement regarding cigarette smoke is correct? Cigarette smoking produces:A. decreased LDL .B. increased HDL .C. increased thrombotic state.D. decreased inflammatory state.
Answer: C. increased thrombotic state.There is an increased LDL level and thrombotic and inflammatory state and decreased HDL.
Q: A patient presents with chest pain that occurs at rest. Abnormal vasospasm of the coronary arteries is detected. Which is the most likely cause of the chest pain?A. Stable anginaB. Prinzmetal anginaC. Silent ischemiaD. Angina pectoris
Answer: B. Prinzmetal anginaPrinzmetal angina is an abnormal vasospasm of the coronary vessels. It typically produces pain at rest and is common in women. Stable angina occurs with activity and is often limited and resolves with rest. Silent ischemia is occlusion of the coronary arteries without pain. Angina pectoris is chest pain, usually substernal chest discomfort.
Q: Which statement regarding cellular injury of the myocardium is correct?A. Cardiac cells can withstand ischemic conditions for about 40 minutes.B. ECG changes are visible after approximately 120 seconds.C. Myocardial cells remain viable if blood flow returns within 20 minutes.D. After 20 seconds of decreased blood flow, myocardial cells become cooler.
Answer: C. Myocardial cells remain viable if blood flow returns within 20 minutes.Cardiac cells can withstand ischemic conditions for about 20 minutes. ECG changes are visible after 30 to 60 seconds of hypoxia. After 8 to 10 seconds of blood flow, the myocardial cells are already cooler.
Q: Which is the MOST common complication of an AMI?A. Dressler syndromeB. ArrhythmiaC. PericarditisD. Heart failure
Answer: B. ArrhythmiaAll of these answer choices are true complications of AMI; however, the most common is arrhythmia.
Q: A patient experiences spinal cord damage following a motorcycle accident. Which type of shock would most likely result?A. HypovolemicB. VasogenicC. AnaphylacticD. Septic
Answer: B. VasogenicVasogenic shock results from an increase in parasympathetic nervous stimulation and a decrease in sympathetic nervous stimulation. Hypovolemic shock results from a decrease in blood volume due to hemorrhage. Anaphylactic shock is a hypersensitivity usually due to penicillin, latex, and food allergies. Septic shock is due to infection.
Q: Which characteristic is associated with hypertension? Select all that apply.A. Family history positive for hypertensionB. Asian raceC. High dietary sodiumD. Glucose intoleranceE. Obesity
Answer: A. Family history positive for hypertensionC. High dietary sodiumD. Glucose intoleranceE. ObesityHypertension is associated with positive family history, gender (men younger than 55 and women after menopause), black race (not Asian), high dietary sodium, glucose intolerance, cigarette smoking, obesity, heavy alcohol consumption, and low dietary intake of minerals.
Q: A patient is being transferred from another medical facility with a diagnosis of acute myocardial infarction (AMI). Which symptom is typically observed with the presences of an AMI? Select all that apply.A. CoughB. FeverC. DiaphoresisD. Substernal painE. Cool, clammy skin
Answer: B. FeverC. DiaphoresisD. Substernal painE. Cool, clammy skinA patient may experience substernal chest pressure or pain, nausea, vomiting, abdominal pain, or indigestion. Fever, sweating, and cool and clammy skin are also typical. A cough is not considered a sign of an MI.
Q: Which enzyme is released by damaged myocardial muscle tissue? Select all that apply.A. CK-MBB. LDHC. ASTD. Troponin IE. ALT
Answer: A. CK-MBB. LDHD. Troponin IAST and ALT are liver enzymes that indicate damage to the liver cells. The other three are all indicators of myocardial damage. Although LDH is also measured in liver function, it also has a purpose for AMI.
Q: Which of the following is the appropriate name for the connection between the aorta and pulmonary artery?A. Ductus arteriosusB. Ligamentum venosumC. Foramen ovaleD. Bulbus cordis
Answer: A. Ductus arteriosusThe ductus arteriosus is the communication between the aorta and pulmonary artery. The foramen ovale is the flapped orifice that allows right-to-left shunting necessary for fetal circulation. The ligamentum venosum is the result of the evolution of the ductus venosus. The bulbus cordis is the conal portion of the ventricular septum that separates the aorta from the pulmonary artery.
Q: Which statement is correct regarding features of cardiac function of the newborn?A. Heart rate is 220 to 280.B. Cardiac output is low.C. Oxygen consumption doubles.D. Cardiovascular system is small compared with body surface area.
Answer: C. Oxygen consumption doubles.The normal heart rate is 100 to 180. Cardiac output is high, and oxygen consumption doubles. The cardiovascular system is large compared with the body surface area.
Q: Which statement regarding the epidemiology of congenital heart defects in children is TRUE?A. There are 95 types of congenital heart disease.B. Congenital heart disease is the leading cause of death.C. Fifty percent of deaths due to congenital heart disease occur in the first year of life.D. The underlying cause of congenital heart defect is known in 90% of cases.
Answer: B. Congenital heart disease is the leading cause of death.Congenital heart disease is the leading cause of death in the first year of life. There are 35 documented types of congenital heart disease. Thirty-five percent of deaths caused by congenital heart disease occur in the first year of life. The underlying cause is known in only 10% of cases.
Q: Which is a sign of left ventricular heart failure in an infant?A. Nasal flaringB. Failure to thriveC. CoughingD. Mottled skin
Answer: B. Failure to thrivePoor feeding or poor sucking is often found in left ventricular failure and leads to failure to thrive. Right ventricular failure is representative of the remaining options.
Q: Which statement regarding an atrial septal defect is accurate?A. A sinus venosus defect is an opening in the center of the septum.B. An ostium secundum defect is found low in the septum.C. An ostium primum defect is found low in the septum.D. An ostium primum is the most common defect found.
Answer: C. An ostium primum defect is found low in the septum.There are three major types of defects. An ostium primum defect is found low in the septum. An ostium secundum defect is an opening in the center of the septum and is the most common. A sinus venosus defect is an opening that occurs high up in the atrial septum near the SVC-RA junction.
Q: An infant born with a congenital heart defect experiences sudden onset of dyspnea, cyanosis, and restlessness. Which condition will be considered as the cause of these symptoms?A. Tet spell associated with tetralogy of FallotB. VSDC. Onset of Eisenmenger syndromeD. Atrial septal defect
Answer: A. Tet spell associated with tetralogy of FallotA Tet spell is a hypoxic spell associated with the tetralogy of Fallot. A VSD is a component of the tetralogy of Fallot, but does not cause these spells on its own. Onset of Eisenmenger syndrome is reversal of the shunt. Tricuspid atresia is another congenital defect. Atrial septal defects often go undetected until a routine physical examination.
Q: A child has been noted to have hypertension with decreased pulses in the lower extremities. Which condition is the most likely congenital cause for this finding?A. Tricuspid atresiaB. Atrial septal defectC. Pulmonary stenosisD. Coarctation of the aorta
Answer: D. Coarctation of the aortaCoarctation of the aorta is a narrowing of the lumen of the aorta that impedes blood flow. This is often found with hypertension and diminished or absent lower extremity pulses. Children with pulmonary stenosis may have a systolic ejection murmur. There may be exertional dyspnea and fatigability. Atrial septal defects have a murmur. With tricuspid atresia there may be cyanosis, growth failure, and dyspnea.
Q: Hypoxemia and cyanosis are generally caused by: Select all that apply.A. lesions that cause right ventricular outflow tract obstruction.B. defects involving mixing of saturated and unsaturated blood.C. constriction of the ductus arteriosus.D. transposition of the great arteries.E. deoxygenated blood flowing into systemic circulation.
Answer: A. lesions that cause right ventricular outflow tract obstruction.B. defects involving mixing of saturated and unsaturated blood.D. transposition of the great arteries.E. deoxygenated blood flowing into systemic circulation.The ductus arteriosus normally constricts within the first hours of life. This is a normal physiologic response. The other four options are causes of hypoxemia and cyanosis.
Q: Which structure is a part of the upper airway?A. TracheaB. NasopharynxC. LarynxD. Bronchi
Answer: B. NasopharynxThe nasopharynx and oropharynx are the structures of the upper airway. The larynx divides the upper and lower airways. The trachea and bronchi are in the lower airway.
Q: Which statement regarding the lower airway is accurate?A. The trachea bifurcates at the larynx.B. The trachea has no supportive structure.C. The right and left main bronchi enter the lungs at the hila.D. The goblet cells are air-filled cells.
Answer: C. The right and left main bronchi enter the lungs at the hila.The right and left main bronchi enter the lungs at the hila. The trachea bifurcates at the carina and has supportive U-shaped cartilaginous rings. The goblet cells secrete mucus.
Q: What is the process called where carbon dioxide (CO2) is exchanged for oxygen?A. VentilationB. RespirationC. CirculationD. Alveolar ventilation
Answer: B. RespirationVentilation is the mechanical movement of gas or air into and out of the lungs. Ventilation often is misnamed respiration. Respiration is the exchange of CO2 for oxygen. Circulation refers to actual blood flow and oxygen delivery. Alveolar ventilation refers to the amount of air delivered to the alveoli.
Q: Which receptor monitors pH, PaCO2, and PaO2 of arterial blood?A. Stretch receptorsB. Irritant receptorC. J receptorsD. Chemoreceptors
Answer: D. ChemoreceptorsChemoreceptors monitor arterial blood indirectly by sensing changes in the pH of CSF. Irritant receptors are found in the epithelium of conducting airways. They are sensitive to noxious aerosols, gases, and particles. Stretch receptors are located in smooth muscle and are sensitive to increases in the size or volume of the lungs. J receptors are located near the capillaries in the alveolar septa. They are sensitive to increased capillary pressure.
Q: Which of the following would shift the oxyhemoglobin dissociation curve to the left?A. AcidosisB. HypocapniaC. Increased H+ ionD. Increased metabolic activity
Answer: B. HypocapniaOnly hypocapnia would shift the curve to the left. The other options either have no affect or result in a shift to the right.
Q: Which are steps in the process of gas exchange? Select all that apply.A. VentilationB. SighingC. DiffusionD. PerfusionE. Rebreathing
Answer: A. VentilationC. DiffusionD. PerfusionVentilation, diffusion, and perfusion are the three steps involved in gas exchange in the lungs. The remaining options are not involved in the process of gas exchange.
Q: The respiratory center is correctly identified as: Select all that apply.A. being located in the brain stem.B. affecting the respiratory muscles ability to contract and relax.C. containing one major type of neuron.D. transmitting impulses that bring about the physical act of breathing.E. being influenced by emotions and pain.
Answer: A. being located in the brain stem.B. affecting the respiratory muscles ability to contract and relax.D. transmitting impulses that bring about the physical act of breathing.E. being influenced by emotions and pain.The respiratory center in the brain stem controls respiration by transmitting impulses to the respiratory muscles, causing them to contract and relax. The respiratory center is composed of several groups of neurons: the dorsal respiratory group (DRG), the ventral respiratory group (VRG), the pneumotaxic center, and the apneustic center. The pattern of breathing can be influenced by emotion, pain, and disease.
Q: Which statement appropriately defines hypoventilation? Hypoventilation is:A. inadequate alveolar ventilation in relation to metabolic demands.B. rapid breathing with little to no expiratory pause.C. difficulty breathing due to body position.D. the feeling of not getting enough air.
Answer: A. inadequate alveolar ventilation in relation to metabolic demands.Inadequate alveolar ventilation in relation to metabolic demands correctly defines hypoventilation. Hyperpnea is rapid breathing with little to no expiratory pause. Orthopnea is difficulty breathing due to body position. Dyspnea is the feeling of not getting enough air.
Q: Which classic breathing pattern is generally identified with Cheyne-Stokes respirations?A. A lack of expiratory pauseB. Presence of occasional sighsC. Rapid cycle of inspirations and expirationsD. Alternating periods of deep and shallow breathing
Answer: D. Alternating periods of deep and shallow breathingCheyne-Stokes respirations are characterized by alternating periods of deep and shallow breathing. Apnea lasting from 15 to 60 seconds is followed by ventilations that increase in volume until a peak is reached; then ventilation (tidal volume) decreases again to apnea. Kussmaul respiration (hyperpnea) is characterized by a slightly increased ventilatory rate, very large tidal volumes, and no expiratory pause. Normal breathing (eupnea) is rhythmic and effortless with an occasional deeper breath, or sighs. A rapid ventilatory rate is referred to as tachypnea.
Q: Which pathology most commonly results in pulmonary edema?A. The inhalation of organic particles causing an inflammatory responseB. Increasing pressure in the left chambers of the heartC. Inflammatory obstruction of small airwaysD. The permanent enlargement of acini
Answer: B. Increasing pressure in the left chambers of the heartThe most common cause of pulmonary edema is left-sided heart disease. When the left ventricle fails, filling pressures on the left side of the heart increase. Inhalation of organic dusts can result in an allergic inflammatory response called extrinsic allergic alveolitis, or hypersensitivity pneumonitis. Bronchiolitis is a diffuse, inflammatory obstruction of the small airways or bronchioles. Emphysema is abnormal permanent enlargement of gas-exchange airways (acini) accompanied by destruction of alveolar walls without obvious fibrosis.
Q: Which statement regarding chronic bronchitis is TRUE?A. Hypersecretion of mucus is a characteristic.B. It features a chronic productive cough that lasts at least 6 months.C. Symptoms occur for at least 5 consecutive years.D. Is one of the few respiratory diseases not exacerbated by smoking.
Answer: A. Hypersecretion of mucus is a characteristic.There is hypersecretion of mucus. This mucus will hold on to bacteria. There is a chronic productive cough that lasts for at least 3 months and 2 consecutive years. It is increased in smokers.
Q: A patient is born with a α-antitrypsin deficiency. Which of the following conditions will most likely manifest?A. AsthmaB. Primary emphysemaC. Pulmonary fibrosisD. ARDS
Answer: B. Primary emphysemaPrimary emphysema is the only option that involves a α-antitrypsin deficiency.
Q: Which pathogen is consistent associated with nosocomial pneumonia?A. Streptococcus pneumoniaeB. Mycoplasma pneumoniaeC. Haemophilus influenzaeD. Pseudomonas aeruginosa
Answer: D. Pseudomonas aeruginosaAll of the other choices are community acquired. Pseudomonas is commonly acquired in a hospital or nursing home.
Q: Which condition can cause of hypercapnia? Select all that apply.A. Disease of the medullaB. Large airway obstructionC. Increased respiratory driveD. Thoracic cage abnormalitiesE. Depression of the respiratory center
Answer: A. Disease of the medullaB. Large airway obstructionD. Thoracic cage abnormalitiesE. Depression of the respiratory centerIncreased respiratory drive will not result in hypercapnia but rather hypocapnia. The remaining options all result in hypercapnia.
Q: What information will the nurse include when educating a client regarding their diagnosis of empyema? Select all that apply.A. Symptoms include bloody sputum.B. It is the presence of pus in the pleural space.C. A complication of respiratory infection often occurs.D. Diagnosis is made by thoracentesis and sputum culture.E. Breath sounds are increased directly over affected area.
Answer: B. It is the presence of pus in the pleural space.C. A complication of respiratory infection often occurs.D. Diagnosis is made by thoracentesis and sputum culture.Empyema is the presence of pus in the pleural space and is a complication of respiratory infection. Empyema occurs most commonly in older adults and children and usually develops as a complication of pneumonia. Breath sounds are decreased directly over the empyema. Diagnosis is made by chest radiographs, thoracentesis, and sputum culture.
Q: Which client has an increased risk for developing a pulmonary embolus (PE)? Select all that apply.A. The adult in traction for a fractured femurB. The woman taking birth control pillsC. The child with exercise-induced asthmaD. The teenager receiving intravenous chemotherapyE. The man with a prothrombin gene mutation
Answer: A. The adult in traction for a fractured femurB. The woman taking birth control pillsD. The teenager receiving intravenous chemotherapyE. The man with a prothrombin gene mutationRisk factors for PE include conditions and disorders that promote blood clotting as a result of venous stasis (immobilization, heart failure), hypercoagulability (inherited coagulation disorders, malignancy, hormone replacement, oral contraceptives), and injuries to the endothelial cells that line the vessels (trauma, caustic intravenous infusions). Genetic risks include factor V Leiden, antithrombin II, protein S, protein C, and prothrombin gene mutations.
Q: Which medical condition places a client at high risk for developing chronic upper airway obstruction? Select all that apply.A. Congenital malformationB. InfectionC. AngioedemaD. Facial traumaE. Subglottic stenosis
Answer: A. Congenital malformationE. Subglottic stenosisInfection, foreign body aspiration, angioedema, and trauma are all causes of acute upper airway obstruction. Chronic airway obstruction is associated with congenital malformations, cartilaginous weakness, vocal cord paralysis, and subglottic stenosis.
Q: Which statement regarding hypocapnia is TRUE? Select all that apply.A. Severe cases sometimes result in disorientationB. Should be assessed for in clients experiencing severe anxietyC. Caused by inadequate alveolar ventilationD. Results in respiratory alkalosisE. The condition confirmed by a PaCO2 less than 36 mm Hg
Answer: B. Should be assessed for in clientsD. Results in respiratory alkalosisE. The condition confirmed by a PaCO2 less than 36 mm HgHyperventilation is alveolar ventilation exceeding metabolic demands. The lungs remove CO2 faster than it is produced by cellular metabolism, resulting in decreased PaCO2, or hypocapnia (PaCO2 less than 36 mm Hg). Hypocapnia results in a respiratory alkalosis that also can interfere with tissue function. Increased respiratory rate or tidal volume can occur with severe anxiety, acute head injury, pain, and in response to conditions that cause insufficient oxygenation of the blood. Hypoventilation is inadequate alveolar ventilation in relation to metabolic demands, and pronounced hypoventilation can cause somnolence or disorientation.
Q: Which statement regarding stridor is supported by medical research?A. Inspiratory stridor occurs with obstruction of the intrathoracic airway.B. Expiratory stridor is also called a monophonic wheeze.C. Intrathoracic airway is above the thoracic inlet.D. Biphasic stridor is often caused at the lower trachea.
Answer: B. Expiratory stridor is also called a monophonic wheeze.Stridor is a harsh, vibratory sound of variable pitch due to turbulent flow through the partially obstructed airway. Inspiratory stridor is generated with obstruction of the extrathoracic airway (above the thoracic inlet). Expiratory stridor, or a monophonic wheeze, may be generated by an obstruction to the intrathoracic airway (the mid to lower trachea and central bronchi). Biphasic stridor typically reflects obstruction at the glottis.
Q: Which statement regarding the airway of an infant is TRUE?A. Airway obstruction is most likely to occur in an infant.B. An infant’s cartilage is less likely to collapse.C. Comparatively speaking, infants’ airways have large diameters.D. Coughing in an infant is generally a benign condition.
Answer: A. Airway obstruction is most likely to occur in an infant.Airway obstruction occurs earlier in infants than in older children. This is due to their smaller airway and smaller diameter. They also have more cartilage and collapse easily. A cough can be a sign of infection, foreign body, or obstruction.
Q: Which statement is correct and should be included in information regarding the function of surfactant? Surfactant: Select all that apply.A. is a lipid protein mix produced by type II cells.B. functions to inhibit normal gas exchange.C. is found in the lining of the alveoli.D. reduces surface tension.E. prevents the collapse of air cells during inhalation.
Answer: A. is a lipid protein mix produced by type II cells.C. is found in the lining of the alveoli.D. reduces surface tension.Surfactant is a lipid-protein mix produced by type II cells. It is critical for maintaining alveolar expansion and allows for normal gas exchange. It lines the alveoli and reduces surface tension, preventing alveolar collapse at the end of each exhalation.
Q: Which medical condition places a client at a higher risk for developing chronic upper airway obstruction? Select all that apply.A. Congenital malformationB. InfectionC. AngioedemaD. Facial traumaE. Subglottic stenosis
Answer: A. Congenital malformationE. Subglottic stenosisInfection, foreign body aspiration, angioedema, and trauma are all causes of acute upper airway obstruction. Chronic airway obstruction is associated with congenital malformations, cartilaginous weakness, vocal cord paralysis, and subglottic stenosis.
Q: Which childhood population is associated with a high risk for asthma? Select all that apply.A. African-AmericanB. FemalesC. HispanicD. Urban dwellersE. Middle socioeconomic class
Answer: A. African-AmericanC. HispanicD. Urban dwellersAsthma is the most prevalent chronic disease in childhood, affecting 10% of U.S. children between 5 and 17 years of age, with boys more often affected than girls. Populations most affected include black and Hispanic children, those living in an urban setting, ethnic minorities, and those of low socioeconomic status.
Q: Which statement regarding respiratory distress syndrome (RDS) of the newborn is TRUE? Select all that apply.A. The major predisposing factor is birth prior to 36 weeks.B. There is increased incidence in American newborns.C. It is more frequently seen in infants of diabetic mothers.D. Birth by elective cesarean section increases risk.E. It is more commonly observed in newborn females.
Answer: A. The major predisposing factor is birth prior to 36 weeks.B. There is increased incidence in American newborns.C. It is more frequently seen in infants of diabetic mothers.D. Birth by elective cesarean section increases risk.RDS occurs almost exclusively in premature infants, and the incidence has increased in the U.S. over the past two decades. RDS occurs in 50% to 60% of infants born at 29 weeks gestation and decreases significantly by 36 weeks. Infants of diabetic mothers and those with cesarean delivery (especially elective C-section) also are more likely to develop RDS. It is more common in boys than girls and more common in whites than non-whites.
Q: In the distal tubule, which cells reabsorb sodium and water but secrete potassium?A. DistalB. ProximalC. PrincipalD. Intercalated
Answer: C. PrincipalIntercalated cells secrete hydrogen and reabsorb bicarbonate and potassium. Principal cells reabsorb sodium and water and secrete potassium. Distal and proximal cells refer to the tubules.
Q: Which muscle lies between the two openings of the ureter and urethra?A. MicturitionB. DetrusorC. TrigoneD. Urethra
Answer: C. TrigoneThe location described in the stem is that of the trigone muscle. The detrusor muscle distends as the bladder fills with urine and is composed of smooth muscle fibers that weave around the bladder bag. Micturition is another term for urination. Urethra is the term for the tube that connects the bladder to the outside of the body.
Q: Which statement regarding renal blood flow is correct?A. The kidneys receive 1000 ml to 1200 ml of blood per minute.B. 50% of cardiac output is filtered by the kidney.C. The glomerular filtration rate (GFR) is not related to renal blood flow.D. No autoregulation is found in renal blood flow.
Answer: A. The kidneys receive 1000 ml to 1200 ml of blood per minute.The kidneys are vascular organs and receive 1000 ml to 1200 ml of blood per minute and 20% to 25% of cardiac output. The GFR is related to renal blood flow, and autoregulation is found in renal blood flow.
Q: When a patient experiences hypotension, which enzyme is primarily being released?A. ReninB. Angiotensin IC. Angiotensin IID. Angiotensin III
Answer: A. ReninRenin is an enzyme released during hypotension. It starts a cascade of events that leads to the production of the angiotensin enzyme. The other options are not involved in this process.
Q: What is the appropriate term for when fluid moves from the tubular lumen to the peritubular capillary plasma?A. UltrafiltrationB. Tubular reabsorptionC. Tubular secretionD. Excretion
Answer: B. Tubular reabsorptionTubular reabsorption is the movement of fluids and solute from the tubular lumen to the peritubular capillary plasma. Tubular secretion refers to substances moving from the plasma of the capillary to the tubular lumen. Excretion is the elimination of the substance in the final urine. Ultrafiltration is the process of filtration across the glomerular capillaries.
Q: Which finding is expected in a normal urinalysis?A. 16 mg/dl to 30 mg/dl of glucoseB. Dark yellow colorC. Specific gravity 1.016 to 1.022D. Two to five red blood cells
Answer: C. Specific gravity 1.016 to 1.022Normal specific gravity of urine is identified in the correct option. The pH is generally 5.0 to 6.5, the color is light yellow, and there are no white or red blood cells or glucose.
Q: A patient has a posterior pituitary tumor that is producing excess antidiuretic hormone. Her blood volume and blood pressure increase. What other increased hormonal alteration would be expected?A. Angiotensin IB. AldosteroneC. Atrial natriuretic peptide (ANP)D. Angiotensin II
Answer: C. Atrial natriuretic peptide (ANP)ANP is released in response to elevated blood volume and pressure and acts to increase water and sodium excretion. Angiotensin I and II and aldosterone would decrease in response to elevated blood volume and pressure.
Q: Which of the following is a type of nephron? Select all that apply.A. SuperficialB. MidcorticalC. JuxtamedullaryD. GlomerularE. Mesangial
Answer: A. SuperficialB. MidcorticalC. JuxtamedullaryNephrons are the functional unit of the kidney. The three types include superficial, midcortical, and juxtamedullary. Glomerular refers to tufts of capillaries, while mesangial refers to the cells that support the capillaries.
Q: With which bacteria is acute glomerulonephritis associated?A. E. coliB. StaphylococcusC. Group A streptococcusD. Klebsiella
Answer: C. Group A streptococcusGlomerulonephritis is an inflammation of the glomeruli and is often caused by a streptococcal infection. It usually occurs 7 to 10 days after the infection.
Q: A diabetic child with 4.0 grams of protein in her urine each day is experiencing edema and vitamin D deficiency. Which is the most likely diagnosis?A. Nephritic syndromeB. Nephrotic syndromeC. Acute renal failureD. Rapidly progressive glomerulonephritis
Answer: B. Nephrotic syndromeNephrotic syndrome is characterized by excretion of 3.5 grams or more of protein in the urine per day due to glomerular injury. Nephritic syndrome is characterized by blood in the urine with red and white cell casts and varying degrees of protein. Acute renal failure presents with oliguria and a reduction in GFR and BUN. Rapidly progressive glomerulonephritis usually affects adults in their 50s and 60s and presents with hematuria.
Q: Kussmaul respirations can be a result of: Select all that apply.A. Pulmonary edemaB. Metabolic alkalosisC. Metabolic acidosisD. DehydrationE. Impaired protein metabolism
Answer: A. Pulmonary edemaC. Metabolic acidosisPulmonary edema and metabolic acidosis can cause Kussmaul respirations. The other options are not typically related to this respiratory pattern.
Q: A 6-year-old has just recovered from streptococcal pharyngitis. Which statement regarding this child’s acute post-streptococcal glomerulonephritis is true?A. Antibody-antigen complexes of IgM, IgG, and IgA are deposited.B. The exact mechanism of immune complexes is unknown.C. There is decreased vascular permeability.D. No signs of inflammation are present.
Answer: B. The exact mechanism of immune complexes is unknown.The exact mechanism is unknown, and there are signs of inflammation and glomerular injury and increased vascular permeability.
Q: Which statement is TRUE regarding breast cancer?A. The older the age at a woman’s first childbirth, the lower the risk.B. It is the second most common cause of cancer in women.C. The incidence has been declining since 1955.D. African-American women have the highest mortality rate.
Answer: D. African-American women have the highest mortality rate.African-American women in all age groups experience the highest mortality rate. It has been on the rise since 1955. It is the most common cause of cancer in women. Early childbirth lowers the risk of having cancer.
Q: Which is the most important difference between proliferative and non-proliferative breast tissue changes?A. Genetic aberrations are more common in non-proliferative lesions.B. Cancer prognosis is better for non-proliferative breast tissue changes.C. Non-proliferative breast lesions do not increase the risk of breast cancer.D. Cancer resulting from non-proliferative breast lesions has a higher cure rate.
Answer: C. Non-proliferative breast lesions do not increase the risk of breast cancer.Non-proliferative breast lesions do not increase the risk of breast cancer. The remaining statements are not true of this type of breast tissue change.
Q: Which statement is true regarding gynecomastia in men?A. It may begin as a palpable mass anywhere on the chest.B. It affects less than 3% of the male population.C. Incidence is greatest among adolescents and older men.D. It generally indicates cancer.
Answer: C. Incidence is greatest among adolescents and older men.Incidence is greatest among adolescents and men older than 50 years. It has an incidence of 32% to 40% in the male population. It is usually starts as a 2-cm mass in the subareolar area. It is not generally viewed as an indicator of cancer.
Q: Which of the following genes have been linked with the development of breast cancer? Select all that apply.A. BRCA1B. BRCA2C. p53D. PSAE. Her-2/neu
Answer: A. BRCA1B. BRCA2C. p53E. Her-2/neuThe most important of the dominant genes are the breast cancer susceptibility genes (BRCA1, BRCA2). Another suppressor gene, p53, is mutated in approximately 20% to 40% of individuals with breast cancer. Her-2/neu, another oncogene, is over-expressed in 25% to 30% of breast cancer cells. PSA is related to prostatic cancer in men.
Q: A patient experiences abdominal pain that is very localized and intense. Which type of pain does this describe?A. ParietalB. VisceralC. ReferredD. Phantom
Answer: A. ParietalParietal pain arises from the parietal peritoneum and is more localized and intense than visceral pain. Visceral pain is often poorly localized and dull and arises from the organs themselves. Referred pain is well-localized visceral pain felt at some distance from a diseased or an affected organ. Phantom pain does not refer to abdominal pain. It is felt after the loss of a limb.
Q: A client is diagnosed with hematochezia. Which assessment finding confirms this diagnosis?A. Bloody vomitusB. Bright red rectal bleedingC. Presence of tarry stoolsD. Positive testing for occult blood
Answer: B. Bright red rectal bleedingHematemesis is blood in the vomitus. Hematochezia is bright red or burgundy-colored blood from the rectum. Melena is the description for dark or tarry stools. Occult bleeding is usually caused by slow, chronic bleeding, and it is not obvious.
Q: A patient is diagnosed with portal hypertension due to liver disease. Which assessment observation supports this diagnosis?A. HematemesisB. Abdominal pain from splenomegalyC. AscitesD. Altered mental status
Answer: A. HematemesisThe most common clinical manifestation of portal hypertension is vomiting of blood (hematemesis) from bleeding esophageal varices. The other options are not associated with this disorder.
Q: A patient experiences a large hematoma from a motor vehicle accident. The patient develops jaundice due to increased breakdown (hemolysis) of red blood cells. Which statement the pathophysiology of hemolysis regarding this patient’s condition is true?A. There is a decrease in conjugated bilirubin.B. Increased amounts of unconjugated bilirubin occur.C. Bilirubin is excreted in the urine.D. Hemolysis is identical to obstructive jaundice.
Answer: B. Increased amounts of unconjugated bilirubin occur.Hemolysis increases the unconjugated bilirubin, which is not water soluble so it cannot be excreted in the urine. This does not affect the conjugated bilirubin, which is increased in obstructive jaundice.
Q: A client presents with epigastric pain and vomiting. He is hyperglycemic and tachycardic. Client reports he is “a heavy drinker but never had problems like this before.” Which disease process is supported by this client’s symptoms?A. CholelithiasisB. CholecystitisC. Acute pancreatitisD. Appendicitis
Answer: C. Acute pancreatitisThe classic presenting symptom of pancreatitis is midepigastric pain and vomiting. This patient admits to heavy alcohol consumption, which can lead to pancreatitis. The history and assessment do not support the other options.
Q: Which statement is TRUE regarding cancer of the colon?A. It is the most frequent cause of cancer death.B. It accounts for 25% of all cancer deaths.C. It tends to occur in young individuals less than 40 years of age.D. Treatment will include surgical resection of the colon.
Answer: D. Treatment will include surgical resection of the colon.Treatment for cancer of the colon is always surgical. Colorectal cancer is the second most frequent cause of cancer death in the United States; it accounts for 10% to 15% of all cancer deaths. It also occurs in individuals older than 50 years.
Q: Chronic constipation may be a result of: Select all that apply.A. low-residue dietB. sedentary lifestyleC. hyperthyroidismD. opiates useE. aging
Answer: A. low-residue dietB. sedentary lifestyleD. opiates useE. agingChronic constipation can be caused by a low-residue diet (the habitual consumption of highly refined foods), which decreases the volume and number of stools and causes constipation. A sedentary lifestyle and lack of regular exercise are other common causes of constipation. Aging may result in changes in neuromuscular function causing constipation. Opiates, particularly codeine, tend to inhibit bowel motility. Conditions associated with constipation include hypothyroidism, not hyperthyroidism.
Q: Which statement regarding cirrhosis is true? Select all that apply.A. Cirrhosis develops rapidly.B. The causes are not clearly understood.C. Portal hypertension is a complication.D. Severity is determined by amount of the toxin.E. Prognosis is poor even when contaminant is removed.
Answer: B. The causes are not clearly understood.C. Portal hypertension is a complication.D. Severity is determined by amount of the toxin.The causes are not clearly understood, but alcohol and other toxins have been linked to cirrhosis. The severity is determined by the amount of toxin. Portal hypertension is one of the complications of cirrhosis. Removal of the toxin/contaminant slows the progression of liver damage and enhances the process of regeneration. Cirrhosis is a process of cellular injury that develops over years.
Q: Risk factors for esophageal carcinoma would include: Select all that apply.A. alcohol abuse.B. tobacco use.C. thin body habitus.D. zinc deficiency.E. sliding hiatal hernia.
Answer: A. alcohol abuse.B. tobacco use.D. zinc deficiency.E. sliding hiatal hernia.The risk factors for esophageal carcinoma include tobacco use, alcoholism, deficiencies of trace elements and vitamins, and sliding hiatal hernia. Obesity, rather than a thin body structure, is also considered a risk factor for this disease.
Q: What is the appropriate term for the gelatinous material found in bone?A. CollagenB. CalciumC. ProteinD. Ground substance
Answer: D. Ground substanceMature rigid bone is composed of rigid connective tissue consisting of cells, fibers, ground substance, and minerals. The ground substance is the gelatinous material.
Q: What is the major resorptive cell found in bone?A. OsteoblastsB. OsteoidC. OsteoclastsD. Osteocytes
Answer: C. OsteoclastsOsteoclasts are the major resorptive cells of bone. Osteoid is the non-mineralized bone matrix. Osteoblasts are cells derived from mesenchymal stem cells that produce type I collagen. An osteocyte is a transformed osteoblast that is trapped in osteoid and has little function.
Q: What is the function of osteocalcin?A. Forms compression-resistant networks between collagen fibrilsB. Controls collagen interactions that lead to fibril formationC. Plays a part in bone resorption by recruiting osteoclastsD. Transports essential elements such as hormones
Answer: C. Plays a part in bone resorption by recruiting osteoclastsOsteocalcin is a calcium-binding protein that binds preferentially to calcium that has already crystallized. The roles include the inhibition of calcium phosphate precipitation and a part in bone resorption by recruiting osteoclasts. Proteoglycans are responsible for forming compression-resistant networks between the collagen fibrils. Glycoproteins control the collagen interactions that lead to fibril formation. Bone albumin is identical to serum albumin.
Q: An elderly woman is diagnosed with osteoporosis. Which cell would be most active in her bones?A. OsteocytesB. OsteoblastsC. OsteoclastsD. Lacuna
Answer: C. OsteoclastsOsteoclasts are the cells that resorb or break down bone and subsequently cause osteoporosis. Osteocytes are osteoblasts that became entrapped in the osteoid and become relatively nonfunctional. Osteoblasts are the cells that form bone. Lacuna are the spaces in hardened bone where osteocytes are located.
Q: The phase of bone remodeling during which the osteoclasts resorb bone and leave a resorption cavity is referred to as:A. Phase 1B. Phase 2C. Phase 3D. Phase 4
Answer: B. Phase 2Phase 1 is activation of the osteoclasts. Phase 2 is osteoclast resorption of bone and creation of resorption cavities. Phase 3 occurs when osteoblasts line the walls of the resorption cavity and lay new bone. Phase 4 does not exist.
Q: Which type of joint has two bony surfaces that are united by a ligament or membrane?A. SyndesmosisB. GomphosisC. Fibrous jointD. Synchondrosis
Answer: A. SyndesmosisSyndesmosis is a joint that has two bony surfaces united by a ligament of membrane. Gomphosis is a special type of fibrous joint in which a conical projection fits into a complementary socket and held by a ligament. A fibrous joint describes when bone is connected to bone by fibrous connective tissue. Synchondrosis is a joint in which hyaline cartilage connects the two bones (instead of fibrocartilage).
Q: What inorganic component is a major element of bone? Select all that apply.A. CalciumB. PhosphateC. MagnesiumD. SodiumE. Potassium
Answer: A. CalciumB. PhosphatePhosphate and calcium are present in sufficient quantities to be considered the major inorganic components in bone matrix.
Q: Which term is used to identify a stage of wound healing in bone? Select all that apply.A. Hematoma formationB. Procallus formationC. Callus formationD. Hematoma reabsorptionE. Remodeling
Answer: A. Hematoma formationB. Procallus formationC. Callus formationE. RemodelingThe steps, in order, for bone wound healing are hematoma formation, procallus formation, callus formation, callus replacement, and remodeling. Hematoma reabsorption is not a recognized stage of bone healing.
Q: Which term is used to describe a bone fracture that results in two or more fragments?A. CompleteB. OpenC. ComminutedD. Oblique
Answer: C. ComminutedA comminuted fracture is one in which the bone breaks into two or more fragments. An oblique fracture is one that is slanted in relation to the shaft of the bone. An open fracture is when the skin is broken. A complete fracture is one in which the bone is broken all the way through.
Q: What is the appropriate term for the failure of the bone ends to grow together?A. NonunionB. Delayed unionC. MalunionD. Dislocation
Answer: A. NonunionNonunion is when the bone ends do not grow together. A delayed union is a union that takes 8 to 9 months to heal. A malunion is the healing of a bone in a nonanatomic position. Dislocation is the displacement of one or more bones in a joint in which the opposing joint surfaces lose contact entirely.
Q: At what age does age-related bone loss begin?A. 20B. 30C. 40D. 50
Answer: C. 40After age 30, bone resorption slowly exceeds bone formation.
Q: A patient has a disease in which there is inadequate and delayed mineralization of osteoid in mature compact bone. This description describes which disease?A. OsteomalaciaB. OsteoporosisC. Paget diseaseD. Osteomyelitis
Answer: A. OsteomalaciaOsteomalacia is the inadequate and delayed mineralization in mature compact and spongy bone. Osteoporosis is a disease in which bone tissue is normally mineralized but the mass density of the bone is decreased. Osteomyelitis is an infection of the bone. Paget disease is a state of increased metabolic activity in bone characterized by abnormal and excessive bone remodeling.
Q: A middle-aged female presents with painful, tender joints. Laboratory testing reveals elevated IgM and IgG. Which of the following is the most likely diagnosis?A. Inflammatory joint diseaseB. Rheumatoid arthritisC. Caplan syndromeD. Ankylosing spondylitis
Answer: B. Rheumatoid arthritisRheumatoid arthritis is characterized by the presence of rheumatoid factors, typically IgM and IgG. Inflammatory joint disease is arthritis and is due to inflammatory damage or destruction of the synovial membrane or articular cartilage. Caplan syndrome occurs with the presence of pulmonary nodules and pneumoconiosis in rheumatoid patients. Ankylosing spondylitis is a chronic, inflammatory joint disease characterized by stiffening and fusion of the spine and sacroiliac joints.
Q: A deficiency of which substances have been associated with osteoporosis? Select all that apply.A. IronB. EstrogenC. CalciumD. Vitamin DE. Magnesium
Answer: B. EstrogenC. CalciumD. Vitamin DE. MagnesiumOsteoporosis is linked to a decreased of inadequate dietary calcium intake and lack of vitamin D, as well as possibly decreased magnesium. It can occur in middle-aged and older women because of estrogen deficiency, as well as estrogen-independent age-related mechanisms. Iron levels have not been linked to this disorder.
Q: Which structure is located in the greatest number on the palms and soles of the feet?A. Sebaceous glandB. Apocrine sweat glandC. Eccrine sweat glandD. Papillary capillarie
Answer: C. Eccrine sweat glandEccrine sweat glands are distributed all over the body, with the greatest numbers in the palms of the hands, soles of the feet, and forehead. The apocrine sweat glands are fewer in number and are located in the axillae, scalp, face, abdomen, and genital area.
Q: When referring to skin trauma resulting in pressure ulcers, which stage correctly matches the description?A. Stage III¾partial-thickness skin loss involving epidermis or dermisB. Stage II¾full-thickness skin loss involving damage or necrosisC. Stage I¾non-blanchable erythema of intact skinD. Stage IV¾partial thickness involving damage and necrosis of subcutaneous tissue
Answer: C. Stage I¾non-blanchable erythema of intact skinThe stages and their correct descriptions are as follows:Stage I¾non-blanchable erythema of intact skinStage II¾partial-thickness skin loss involving epidermis or dermisStage III¾full-thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend to, but not through, underlying fasciaStage IV¾full-thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures
Q: Which form of dermatitis is common in infancy and childhood?A. AtopicB. StasisC. IrritantD. Seborrheic
Answer: A. AtopicAtopic dermatitis is common in infancy and childhood. The other options are seen in various age groups.