Robbins Basic Pathophysiology 10th Edition Test Bank by QuentinAxel

Robbins Basic Pathology 10th Edition Kymar Abbas Test Bank Chapter 1. The Cell as a Unit of Health and Disease

1 A)

The nucleus , which is essential for function and survival of the cell. is the site of protein synthesis

contains the genetic code

C) D)

transforms cellular energy initiates aerobic metabolism

Although energy is not made in mitochondria, they are known as the power plants of the cell because they:

A) B)

contain RNA for protein synthesis. utilize glycolysis for oxidative energy.

C) D)

extract energy from organic compounds. store calcium bonds for muscle contractions.

Although the basic structure of the cell plasma membrane is formed by a lipid bilayer, most of the specific membrane functions are carried out by: bound and transmembrane proteins.

A) B)

complex, long carbohydrate chains.

C) D)

surface antigens and hormone receptors. a gating system of selective ion channels.

To effectively relay signals, cell-to-cell communication utilizes chemical messenger systems that:

A) B)

displace surface receptor proteins. accumulate within cell gap junctions.

bind to contractile microfilaments.

release secretions into extracellular fluid. NURSING TEST BANK

5 A) B) C) D) 6 A) B) C) D) 7 A)

Aerobic metabolism, also known as oxidative metabolism, provides energy by: removing the phosphate bonds from ATP. combining hydrogen and oxygen to form water. activating pyruvate stored in the cytoplasm. breaking down glucose to form lactic acid. Exocytosis, the reverse of endocytosis, is important in into the extracellular fluid. Engulfing and ingesting fluid and proteins for transport Killing, degrading, and dissolving harmful microorganisms Removing cellular debris and releasing synthesized substances Destruction of particles by lysosomal enzymes for secretion The process responsible for generating and conducting membrane potentials is: diffusion of current-carrying ions.

millivoltage of electrical potential.

polarization of charged particles.

ion channel neurotransmission.

Epithelial tissues are classified according to the shape of the cells and the number of layers. Which of the following is a correctly matched description and type of epithelial tissue?

Simple epithelium: cells in contact with intercellular matrix; some do not extend to surface NURSING TEST BANK

Stratified epithelium: single layer of cells; all cells rest on basement membrane

C) D)

Glandular epithelium: arise from surface epithelia and underlying connective tissue Pseudostratified epithelium: multiple layers of cells; deepest layer rests on basement membrane

9 A)

Connective tissue contains fibroblasts that are responsible for: providing a fibrous framework for capillaries.

synthesis of collagen, elastin, and reticular fibers.

forming tendons and the fascia that covers muscles. filling spaces between tissues to keep organs in place.

D) 10

A) B) C) D) 11 A)

Although all muscle tissue cells have some similarities, smooth muscle (also known as involuntary muscle) differs by: having dense bodies attached to actin filaments. containing sarcomeres between Z lines and M bands. having rapid contractions and abundant crossstriations. contracting in response to increased intracellular calcium. Which of the following aspects of the function of the nucleus is performed by ribosomal RNA (rRNA)? Copying and carrying DNA instructions for protein synthesis NURSING TEST BANK

Carrying amino acids to the site of protein synthesis

Providing the site where protein synthesis occurs Regulating and controlling protein synthesis

D) 12

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

Golgi apparatus

C) D)

Ribosomes Endoplasmic reticulum (ER)

Impairment in the function of peroxisomes would result in:

inadequate sites for protein synthesis.

B) C)

an inability to transport cellular products across the cell membrane. insufficient energy production within a cell.

accumulation of free radicals in the cytoplasm.

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

A) B)

Microtubules

Mitochondria

Microfilaments

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Which of the following statements is true of glycolysis?

A) B)

Glycolysis requires oxygen.

Glycolysis provides the majority of the bodys energy needs. Glycolysis produces energy, water, and carbon dioxide.

D) 16

Glycolysis occurs in cells without mitochondria.

Which of the following membrane transport mechanisms requires the greatest amount of energy?

A) B)

Facilitated diffusion Passive transport

C) D)

Vesicular transport Simple diffusion

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

Simple diffusion

Secondary active transport

Endocytosis

18 A)

Which of the following statements is true of skeletal muscle cells? Skeletal muscle cells each have an apical, lateral, and basal surface. NURSING TEST BANK

They are closely apposed and are joined by cell-to-cell adhesion molecules.

Their basal surface is attached to a basement membrane. Skeletal muscle is multinucleated, lacking true cell boundaries.

D) 19 A)

Which of the following body tissues exhibits the highest rate of turnover and renewal? The squamous epithelial cells of the skin

The connective tissue supporting blood vessels

C) D)

The skeletal muscle that facilitates movement The nervous tissue that constitutes the central nervous system

A patient with a pathophysiologic condition that affects the desmosomes is most likely to exhibit: impaired contraction of skeletal and smooth muscle.

A) B)

weakness of the collagen and elastin fibers in the extracellular space. impaired communication between neurons and effector organs.

C) D)

separation at the junctions between epithelial cells.

Answer Key

1 2

B C

B NURSING TEST BANK

A C

8 9 10

B A

D B

14 15 16

B C

A D

Chapter 2 . Cell Injury, Cell Death, and Adaptations

1 A)

Ischemia and other toxic injuries increase the accumulation of intracellular calcium as a result of: release of stored calcium from the mitochondria.

improved intracellular volume regulation.

decreased influx across the cell membrane.

attraction of calcium to fatty infiltrates.

The patient is found to have liver disease, resulting in the removal of a lobe of his liver. Adaptation to the reduced size of the liver leads to of the remaining liver cells. metaplasia NURSING TEST BANK

organ atrophy

C) D)

compensatory hyperplasia physiologic hypertrophy

A person eating peanuts starts choking and collapses. His airway obstruction is partially cleared, but he remains hypoxic until he reaches the hospital. The prolonged cell hypoxia caused a cerebral infarction and resulting in the brain. caspase activation

A) B)

coagulation necrosis

C) D)

rapid phagocytosis protein p53 deficiency

Bacteria and viruses cause cell damage by , which is unique from the intracellular damage caused by other injurious agents. disrupting the sodium/potassium ATPase pump

B) C)

interrupting oxidative metabolism processes replicating and producing continued injury

decreasing protein synthesis and function

A) B)

The patient has a prolonged interruption in arterial blood flow to his left kidney, causing hypoxic cell injury and the release of free radicals. Free radicals damage cells by: destroying phospholipids in the cell membrane. altering the immune response of the cell.

disrupting calcium storage in the cell.

inactivation of enzymes and mitochondria.

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6 A) B)

Injured cells have impaired flow of substances through the cell membrane as a result of: increased fat load. altered permeability.

C) D)

altered glucose utilization. increased surface receptors.

Reversible adaptive intracellular responses are initiated by:

A) B)

stimulus overload. genetic mutations.

C) D)

chemical messengers. mitochondrial DNA.

Injured cells become very swollen as a result of: increased cell protein synthesis.

A) B)

altered cell volume regulation.

passive entry of potassium into the cell.

bleb formation in the plasma membrane.

A diabetic patient has impaired sensation, circulation, and oxygenation of his feet. He steps on a piece of glass, the wound does not heal, and the area tissue becomes necrotic. The necrotic cell death is characterized by:

rapid apoptosis.

cellular rupture.

shrinkage and collapse.

chronic inflammation.

A 99-year-old woman has experienced the decline of cell function associated with age. A group of theories of cellular aging focus on programmed: NURSING TEST BANK

changes with genetic influences.

B) C)

elimination of cell receptor sites. insufficient telomerase enzyme.

DNA mutation or faulty repair.

An 89-year-old female patient has experienced significant decreases in her mobility and stamina during a 3-week hospital stay for the treatment of a femoral head fracture. Which of the following phenomena most likely accounts for the patients decrease in muscle function that underlies her reduced mobility?

Impaired muscle cell metabolism resulting from metaplasia

Dysplasia as a consequence of inflammation during bone remodeling Disuse atrophy of muscle cells during a prolonged period of immobility

C) D)

Ischemic atrophy resulting from vascular changes while on bedrest

A 20-year-old college student has presented to her campus medical clinic for a scheduled Papanicolaou (Pap) smear. The clinician who will interpret the smear will examine cell samples for evidence of:

A) B)

changes in cell shape, size, and organization. the presence of unexpected cell types.

ischemic changes in cell samples.

abnormally high numbers of cells in a specified field.

Which of the following pathophysiologic processes is most likely to result in metastatic calcification?

NURSING TEST BANK

Benign prostatic hyperplasia

B) C)

Liver cirrhosis Impaired glycogen metabolism

Hyperparathyroidism

Despite the low levels of radiation used in contemporary radiologic imaging, a radiology technician is aware of the need to minimize her exposure to ionizing radiation. What is the primary rationale for the technicians precautions?

Radiation stimulates pathologic cell hypertrophy and hyperplasia.

Radiation results in the accumulation of endogenous waste products in the cytoplasm. Radiation interferes with DNA synthesis and mitosis.

C) D) 15

Radiation decreases the action potential of rapidly dividing cells. The parents of a 4-year-old girl have sought care because their daughter has admitted to chewing and swallowing imported toy figurines that have been determined to be made of lead. Which of the following blood tests should the care team prioritize?

A) B)

White blood cell levels with differential Red blood cell levels and morphology

Urea and creatinine levels

Liver function panel

A 70-year-old male patient has been admitted to a hospital for the treatment of a recent hemorrhagic stroke that has left him with numerous motor and sensory deficits. These deficits are most likely the result of which of the following mechanisms of cell injury? NURSING TEST BANK

Free radical injury

B) C)

Hypoxia and ATP depletion Interference with DNA synthesis

Impaired calcium homeostasis

Which of the following processes associated with cellular injury is most likely to be reversible?

Cell damage resulting from accumulation of fat in the cytoplasm

Cellular changes as a result of ionizing radiation Cell damage from accumulation of free radicals

C) D)

Apoptosis

The extrinsic pathway of apoptosis can be initiated by:

A) B)

damage to cellular DNA. decreased ATP levels.

activation of the p53 protein.

activation of death receptors on the cell surface.

A patient with severe peripheral vascular disease has developed signs of dry gangrene on the great toe of one foot. Which of the following pathophysiologic processes most likely contributed to this diagnosis? Inappropriate activation of apoptosis

Bacterial invasion

Impaired arterial blood supply

Metaplastic cellular changes

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Which of the following facts underlies the concept of replicative senescence?

Genes controlling longevity are present or absent in varying quantities among different individuals. Telomeres become progressively shorter in successive generations of a cell.

B) C)

The damaging influence of free radicals increases exponentially in later generations of a cell. Aging produces mutations in DNA and deficits in DNA repair.

D) Answer Key

A B

6 7 8

C B

B NURSING TEST BANK

A D

18 19 20

C B

Chapter 3. Inflammation and Repair

1 A)

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

fatigue.

redness.

granuloma.

The vascular, hemodynamic stage of acute inflammation is initiated by momentary vasoconstriction followed by vasodilation that causes localized: bleeding.

congestion.

pale skin.

coolness.

The cellular stage of acute inflammation is marked by the movement of leukocytes into the area. Which of the following cells arrives early in great numbers?

Basophils

Lymphocytes

Neutrophils

Platelets

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4 A) B)

The phagocytosis process involves three distinct steps. What is the initial step in the process? Engulfment Intracellular killing

C) D)

Antigen margination Recognition and adherence

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

A) B)

Serotonin Histamine

C) D)

Bradykinin Nitric oxide

Inflammatory exudates are a combination of several types. Which of the following exudates is composed of enmeshed necrotic cells? Serous

Fibrinous

Suppurative

Membranous

The acute-phase systemic response usually begins within hours of the onset of inflammation and includes:

fever and lethargy.

decreased C-reactive protein.

positive nitrogen balance.

low erythrocyte sedimentation rate.

In contrast to acute inflammation, chronic inflammation is characterized by which of the following phenomena? NURSING TEST BANK

Profuse fibrinous exudation

B) C)

A shift to the left of granulocytes Metabolic and respiratory alkalosis

Lymphocytosis and activated macrophages

Exogenous pyrogens (interleukin-1) and the presence of bacteria in the blood lead to the release of endogenous pyrogens that:

stabilize thermal control in the brain.

B) C)

produce leukocytosis and anorexia. block viral replication in cells.

inhibit prostaglandin release.

An older adult patient has just sheared the skin on her elbow while attempted to boost herself up in bed, an event that has precipitated acute inflammation in the region surrounding the wound. Which of the following events will occur during the vascular stage of the patients inflammation?

A) B)

Outpouring of exudate into interstitial spaces Chemotaxis

Accumulation of leukocytes along the epithelium

Phagocytosis of cellular debris

Which of the following individuals most likely has the highest risk of experiencing chronic inflammation?

A patient who has recently been diagnosed with type 2 diabetes

A patient who is a carrier of an antibioticresistant organism

A patient who is taking oral antibiotics for an upper respiratory infection NURSING TEST BANK

D) 12

A patient who is morbidly obese and who has a sedentary lifestyle Which of the following core body temperatures is within normal range?

A) B)

35.9C (96.6F) 38.0C (100.4F)

35.5C (95.9F)

37.3C (99.1F)

A postsurgical patient who is recovering in the postanesthetic recovery unit states that she is freezing cold. Which of the following measures is likely to be initiated in the patients hypothalamus in an effort to reduce heat loss?

Opening of arteriovenous (AV) shunts

Reduced exhalation of warmed air

Contraction of pilomotor muscles

Decreased urine production

An elderly patient is dressed only in a hospital gown and complains of a draft in her room. Consequently, she has requested a warm blanket while she sits in her wheelchair. Which of the following mechanisms of heat loss is most likely the primary cause of her request? Evaporation and conduction

B) C)

Radiation and convection Conduction and convection

Convection and evaporation

Which of the following pathophysiologic processes are capable of inducing the production of pyrogens? Select all that apply. Acute inflammation

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Obesity

C) D)

Myocardial infarction Malignancy

Renal failure

Which of the following patients is most likely to be susceptible to developing a neurogenic fever?

A patient who has stage II Alzheimer disease

A patient who has sustained a head injury in a bicycle crash A patient who has become delirious after the administration of a benzodiazepine

C) D)

A patient who has begun taking a selective serotonin-reuptake inhibitor (SSRI) for the treatment of depression

Patients are commonly administered antipyretics when their oral temperature exceeds 37.5C (99.5F). Which of the following statements related to the rationale for this action is most accurate?

Temperatures in excess of 37.5C (99.5F) can result in seizure activity. Lower temperatures inhibit the protein synthesis of bacteria.

B) C)

There is little empirical evidence for this treatment modality.

Most common antipyretics have been shown to have little effect on core temperature.

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A) B) C) D) 19

A) B) C) D) 20

A) B)

A patient has sought care because of recent malaise and high fever. Upon assessment, the patient states that his current fever began two days earlier, although he states that for the last 2 weeks he is in a cycle of high fever for a couple of days followed by a day or two of normal temperature. Which of the following fever patterns is this patient experiencing? Recurrent fever Remittent fever Sustained fever Intermittent fever A febrile, 3-week-old infant has been brought to the emergency department by his parents and is currently undergoing a diagnostic workup to determine the cause of his fever. Which of the following statements best conveys the rationale for this careful examination? The immature hypothalamus is unable to perform normal thermoregulation. Infants are susceptible to serious infections because of their decreased immune function. Commonly used antipyretics often have no effect on the core temperature of infants. Fever in neonates is often evidence of a congenital disorder rather than an infection. An 84-year-old patients blood cultures have come back positive, despite the fact that his oral temperature has remained within normal range. Which of the following phenomena underlies the alterations in fever response that occur in the elderly? Disturbance in the functioning of the thermoregulatory center Increased heat loss by evaporation NURSING TEST BANK

The presence of comorbidities that are associated with lowered core temperature Persistent closure of arteriovenous shunts

D) Answer Key

2 3

B C

D B

9 10 11

A D

A, C, D

Chapter 4. Hemodynamic Disorders, Thromboembolism, and Shock

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

Calcium

B) C)

Prothrombin Tissue factor

Plasminogen

The first step of hemostasis occurs as a:

fibrin clot.

B) C)

platelet plug. clot retraction.

vessel spasm.

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

A) B)

adhesion fibrinolysis

thrombosis

thromboxane A2

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

thrombin

factor XII

tissue factor

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

factor V mutation.

platelet insensitivity.

vascular wall damage. NURSING TEST BANK

D) 6

decreased platelet numbers. Immune thrombocytopenia purpura (ITP) is a/an disorder that destroys .

A) B)

allergic; fibrinogen alloimmune; factor VIII

autoimmune; platelets

immunoglobulin; B cells

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

Purpura

Jaundice

Petechiae

D) E)

Erythema Confusion

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

A) B)

factor VIII. prothrombin.

vWF complex.

intrinsic factor.

Disseminated intravascular coagulation (DIC) is characterized by:

A) B)

headaches. platelet loss.

hypertension.

hemorrhage.

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10 A) B) C) D) 11

A) B) C) D) 12

In persons with a bleeding disorder caused by vascular defects, laboratory tests will most often reveal: normal values. hypocalcemia. polycythemia. thrombocytopenia. Removal of a patients peripheral intravenous catheter resulted in brief bleeding and the loss of a small amount of blood. Which of the following processes occurred during the formation of the platelet plug that helped to stop blood flow? Activation of factor X Conversion of prothrombin to thrombin Release of von Willebrand factor from the epithelium Conversion of fibrinogen to fibrin threads

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

Activation of plasminogen

Inhibition of the intrinsic clotting pathway

Deactivation of factor X

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

Blood glucose screening

C) D)

Weight management Cholesterol screening and management

Blood pressure screening and management

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

Hemorrhage

B) C)

Myocardial infarction Hemophilia A or B

Deep vein thrombosis

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

A) B)

In the brain Skin and mucous membranes

Sclerae of the eyes

Nephrons and ureters

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

Disseminated intravascular coagulation (DIC)

Von Willebrand disease

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D) 17

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

A) B)

Vessel spasm Platelet plug formation

Blood coagulation

Clot lysis

A 23-year-old female patient has been diagnosed with von Willebrand disease following a long history of heavy periods and occasional nosebleeds. Which of the patients following statements demonstrates a sound understanding of her new diagnosis?

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

I read on a website that I might have to get blood transfusions from time to time. Ill make sure to take Tylenol instead of aspirin when I get aches and pains.

C) D)

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

Which of the following patients likely faces the highest risk of an acquired hypocoagulation disorder and vitamin K deficiency? A patient who has a diagnosis of liver failure secondary to alcohol abuse

A) B)

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

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

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

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

Hemophilia A

Von Willebrand disease

Thrombotic thrombocytopenic purpura (TTP)

Answer Key

4 5

C C

A, C, E

8 9

A D

A NURSING TEST BANK

A, B, C, D, E

D B

15 16 17

D B

Chapter 5 . Diseases of the Immune System

1 A) B) C) D) 2

A) B)

The mediators involved in type I hypersensitivity allergic responses are released from: mast cells. plasma cells. monocytes. arachidonic acid. A genetically determined hypersensitivity to common environmental allergens causes reactions, such as: atopic; urticaria. autoimmune; diarrhea.

IgM-mediated; infections.

delayed; poison ivy rash:

Mismatched blood transfusion reaction with hemolysis of blood cells is an example of type II, mediated hypersensitivity reaction.

T-cell

antibody NURSING TEST BANK

leukotriene

complement

Type III hypersensitivity immune responses can be harmful when immune complex deposits in tissue activate that can directly damage area tissues. inflammation

autoantibodies

cytotoxic cells

immunoglobulins

5 A)

The mechanism by which humans recognize self-cells from non-self (antigens)-cells is . autoimmunity

self-tolerance

C) D)

non-self anergy immunocompatibility

Organ rejection is a complication of organ transplantation caused by recipient immune cells:

A) B)

destroying the host T cells. attack on the donor cells.

combining with grafts HLA.

being recognized as foreign.

The leading cause of death for people with HIV is opportunistic .

A) B)

leukemia tuberculosis

pneumonia

toxoplasmosis NURSING TEST BANK

A) B) C) D) 9

Wasting syndrome, an AIDS-defining illness, is characterized by involuntary weight loss of at least 10% of baseline body weight in the presence of: diarrhea. hypermetabolism. weakness and fever. glucose intolerance. The window period of HIV infection refers to the period of time between infection and:

A) B)

transmission. seroconversion.

C) D)

initial symptoms. antibody screening.

10 A)

HIV-positive persons that display manifestations of laboratory category 3 or clinical category C are considered to have: zero viral load.

seroconversion.

complete remission.

AIDS-defining illnesses.

Contact with poison ivy has resulted in intense pruritus, erythema, and weeping on a patients forearm. Which of the following processes resulted in the patients signs and symptoms?

IgE-mediated mast cell degranulation

Formation of antigen-antibody complexes

Cytokine release by sensitized T cells

Formation of antibodies against cell surface antigens NURSING TEST BANK

A patient with a long history of hay fever has recently begun a series of immunotherapy (allergy shots). How will this treatment potentially achieve a therapeutic effect?

By blocking cytokine release from sensitized mast cells By preventing mast cells from becoming sensitized

B) C) D) 13

A) B) C) D) 14

By causing T cells to be sequestered in the thymus for longer periods By stimulating production of IgG to combine with antigens A patient with a diagnosis of cirrhosis has experienced an acute rejection of a donor liver. Which of the following cells is central to the rejection of the patients transplanted organ? Natural killer cells Mast cells T cells Neutrophils A patient with a diagnosis of aplastic anemia has undergone allogenic bone marrow transplantation. Which of the following signs and symptoms would most clearly suggest the existence of graft-versus-host disease (GVHD)? Shortness of breath, audible crackles, and decreasing PaO2

Presence of a pruritic rash that has begun to slough off

Development of metabolic acidosis

Diaphoresis, fever, and anxiety

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A) B) C) D) 16

A patient has developed pericarditis after developing acute glomerulonephritis, a development that may be attributable to the presence of similar epitopes on group A, b-hemolytic streptococci and the antigens in the patients heart tissue. Which of the following has most likely accounted for this patients autoimmune response? Breakdown of T-cell anergy Release of sequestered antigens Superantigens Molecular mimicry

A) B)

A 70-year-old female patient has had her mobility and independence significantly reduced by rheumatoid arthritis. Which of the following processes likely contributed to the development of her health problem? Delayed-type hypersensitivity (DTH) reaction Proliferation of cytotoxic T cells

C) D)

Failure of normal self-tolerance Deletion of autoreactive B cells

Which of the following would constitute a normal assessment finding in a neonate? Minimal or absent levels of IgA and IgM

A) B)

Absence of plasma cells in the lymph nodes and spleen

Undetectable levels of all immunoglobulins

Absence of mature B cells with normal T-cell levels and function

A patient was diagnosed as HIV positive several years ago. Which of the following blood tests is most clinically useful for determining the stage and severity of her disease? NURSING TEST BANK

Plasma levels

B) C)

CD4+ cell counts Viral load

White blood cell count with differential

A patient has been admitted to the hospital for the treatment of HIV infection, which has recently progressed to overt AIDS. Which of the following nursing actions should the nurse prioritize when providing care for this patient?

Frequent neurologic vital signs and thorough skin care

Hemodynamic monitoring and physical therapy Careful monitoring of fluid balance and neurologic status

C) D) 20

Astute infection control and respiratory assessments Shortly after being diagnosed with HIV, a patient has begun highly active antiretroviral therapy (HAART). What is the primary goal of the patients drug regimen?

A) B)

To limit the latent period of HIV To slow the progression of the disease

To minimize opportunities for transmission

To prevent seroconversion

Answer Key

B NURSING TEST BANK

B A

8 9 10

B D

C B

14 15 16

D C

D B

Chapter 6 . Neoplasia

1 A)

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

specialized.

predictable.

autonomous.

2 A) B)

In contrast to malignancies, benign tumors are characterized by: a fibrous capsule. distant infiltration. NURSING TEST BANK

rapid replication.

undifferentiated cells.

3 A)

Because of their rapid growth, malignant tumors affect area tissues by: increasing tissue blood flow.

providing essential nutrients.

liberating enzymes and toxins.

forming fibrous membranes.

4 A)

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

enzyme secretion

C) D)

contact inhibition cell-to-cell signaling

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

A) B)

procoagulants. growth factors.

attachment factors.

proteolytic enzymes.

Cancerous transformation of a cell requires the activation of:

A) B)

cell cycle apoptosis. multiple mutations.

a single gene mutation.

tumor suppressor genes.

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A) B) C) D)

Although clinical manifestations vary with the type of cancer and organs involved, abnormal tumor growth causes general manifestations that include: copious lymph flow. sleep disturbances. involuntary weight gain. visceral organ expansion.

Paraneoplastic syndromes are manifestations of cancer that often result from:

A) B)

radiation and chemotherapy. compression of area vessels.

C) D)

tumor-related tissue necrosis. inappropriate hormone release.

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

A) B)

tissue characteristics.

level of differentiation.

extent of disease spread.

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

already present at birth.

absent until the late stage.

similar to those of other childhood diseases.

seen as developmental delays.

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A) B) C) D) 12

A lung biopsy and magnetic resonance imaging have confirmed the presence of a benign lung tumor in a patient. Which of the following characteristics are associated with this patients neoplasm? The tumor will grow by expansion and is likely encapsulated. The cells that constitute the tumor are undifferentiated, with atypical structure. If left untreated, the patients tumor is likely to metastasize. The tumor is likely to infiltrate the lung tissue that presently surrounds it. Which of the following processes characterizes an epigenetic contribution to oncogenesis?

A) B)

A DNA repair mechanism is disrupted. A tumor suppressor gene is present, but it is not expressed.

C) D)

Cells lose their normal contact inhibition. Regulation of apoptosis in impaired, resulting in accumulation of cancer cells.

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

A) B)

Progression

Initiation

Differentiation

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14 A) B) C) D) 15

A) B)

C) D) 16

Genetic screening may be indicated for individuals who have a family history of which of the following neoplasms? Liver cancer Multiple myeloma Leukemia Breast cancer A public health nurse has cited a reduction in cancer risk among the many benefits of maintaining a healthy body-mass index. Which of the following facts underlies the relationship between obesity and cancer? Obesity can cause inflammation and hormonal changes that are associated with cancer. Adipose tissue is more susceptible to malignancy than other types of connective tissue. Increased cardiac workload and tissue hypoxia can interfere with normal cell differentiation. Increased numbers of body cells increase the statistical chances of neoplastic cell changes. Which of the following dietary guidelines should a nurse provide to a group of older adults to possibly decrease their risks of developing colon cancer? As much as possible, try to eat organic foods.

Regular vitamin supplements and a lowcarbohydrate diet are beneficial.

Try to minimize fat and maximize fiber when youre planning your meals. Eat enough fiber in your diet that you have bowel movement at least once daily.

NURSING TEST BANK

A) B)

A male patient with a diagnosis of liver cancer has been recently admitted to a palliative care unit following his recent development of bone metastases. Despite his familys encouragement, the patient has experienced precipitous weight loss in recent weeks. Which of the following factors may underlie the patients loss of fat and muscle mass? The action of cytokines and consequent inflammation Loss of appetite due to fatigue and pain

C) D)

Changes in peptide hormone levels

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

A) B) C) D) 19

Production of onconeural antigens by cancerous cells

Surgery Hormone therapy A patients oncologist has presented the possibility of implementing biotherapy in the treatment of the patients brain tumor. Which of the following mechanisms of action provide the therapeutic effects of biotherapy? Select all that apply. Stimulating the immune response to tumor cells

Inhibiting tumor protein synthesis

Reversing angiogenesis

Altering the hormonal environment of tumor cells NURSING TEST BANK

E) 20

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

Retention of chemotherapeutic drugs in the healthy bone matrix

Unwanted effects of chemotherapy and radiation therapy

Resistance to chemotherapy and radiation if required later in life

Risk for recurrence of the primary neoplasm after puberty

Answer Key

5 6

B B

9 10

D C

C D

NURSING TEST BANK

C A

17 18 19

B A, B

Chapter 7. Genetic and Pediatric Diseases

Genetic disorders that involve a single gene trait are characterized by:

multifactorial gene mutations.

chromosome rearrangements.

C) D)

Mendelian patterns of transmission. abnormal numbers of chromosomes.

In addition to having a 50% chance of inheriting an autosomal dominant disorder from an affected parent, such a disorder is characterized by: aneuploidy of genes in all cells.

deficiencies in enzyme synthesis.

C) D)

affected X transmission to daughters. varied gene penetration and expression.

3 A)

Autosomal recessive disorders are characterized by: age of onset later in life.

abnormal protein structure.

inborn errors of metabolism.

one in two risk of a carrier child.

When a male child inherits an X-linked disorder from his heterozygous carrier mother, NURSING TEST BANK

his sons will be carriers.

B) C)

his father has the disorder. some of his sisters will be carriers.

his daughters will have the disorder.

Multifactorial inheritance disorders, such as cleft palate, are often caused by during fetal development.

multiple gene mutations

B) C)

dominant gene expression X-linked crossover problem

polyploidy of chromosomes

The newborn has the distinctive physical features of trisomy 21, Down syndrome, which includes:

A) B)

upward slanting of eyes. large, protruding ears.

thin lips and small tongue.

long fingers with extra creases.

Aneuploidy of the X chromosome can result in a monosomy or polysomy disorder. The manifestations of monosomy X, Turner syndrome, differ from polysomy X disorders in numerous ways that include: short-stature female individual..

A) B)

mental retardation.

enlarged breasts.

early onset puberty.

A teratogenic environmental agent can cause birth defects when:

inherited as a recessive trait. NURSING TEST BANK

intense exposure occurs at birth.

C) D)

disjunction occurs during meiosis. retained during early pregnancy.

9 A)

Fetal alcohol syndrome (FAS) is unlike other teratogens in that the harmful effects on the fetus: directly result in liver damage.

extend throughout the pregnancy.

C) D)

is most noticeable in adulthood. cause death in early childhood.

10 A)

Prenatal diagnosis methods include the use of ultrasonography for identifying abnormalities. cytogenic

B) C)

skeletal chromosomal

a-fetoprotein

A woman who is a carrier for which of the following diseases possesses the greatest likelihood of passing the disease to her future children when heterozygous pairing exists? Phenylketonuria (PKU)

Tay-Sachs disease

Neurofibromatosis

Cystic fibrosis

12 A) B)

Which of the following statements is true of autosomal recessive disorders? Onset is typically late in childhood or early in adulthood. Symptomatology is less uniform than with autosomal dominant disorders. NURSING TEST BANK

Mitochondrial DNA is normally the site of genetic alteration.

Effects are typically the result of alterations in enzyme function.

The parents of a newborn infant are relieved that their baby was born healthy, with the exception of a cleft lip that will be surgically corrected in 10 or 12 weeks. Which of the nurses following statements to the parents best conveys the probable cause of the infants cleft lip? Though you are both healthy, you likely both carry the gene for a cleft lip.

A) B)

Provided one of you had the gene for a cleft lip, your baby likely faced a 50/50 chance of having one.

Your childs cleft lip likely results from the interplay between environment and genes.

A cleft lip can sometimes result from taking prescription drugs, even when theyre taken as ordered.

14 A)

Which of the following practitioners is most likely to be of assistance in the early care of an infant with a cleft lip? Lactation consultant

Respiratory therapist

C) D)

Occupational therapist Social worker

A 41-year-old woman has made the recent decision to start a family, and is eager to undergo testing to mitigate the possibility of having a child with Down syndrome. Which of the following tests is most likely to provide the data the woman seeks? NURSING TEST BANK

Genetic testing of the woman

B) C)

Genetic testing of the woman and the father Prenatal blood tests

Ultrasonography

Genetic testing has revealed that a male infant has been born with an extra X chromosome. What are the most likely implications of this finding?

The child is unlikely to survive infancy

The child is likely to have no manifestations of this chromosomal abnormality The child will have significant neurological and cognitive defects

C) D)

The child will be unable to reproduce

Which of the following variables determine the extent of teratogenic drug effects? Select all that apply.

A) B)

Maternal health history Molecular weight of the drug

Stage of pregnancy when the drug was taken

Duration of drug exposure

Fetal blood type

A woman who has just learned that she is pregnant for the first time has sought advice from her healthcare provider about the safe use of alcohol during pregnancy. What advice should the clinician provide to the woman?

Its likely best to eliminate alcohol from your diet while youre pregnant.

Moderation in alcohol use is critical while you are pregnant.

NURSING TEST BANK

You should limit yourself to a maximum of one drink daily while youre pregnant.

You should drink no alcohol until you are in your second trimester.

19 A)

Which of the following health problems may be identified by a TORCH screening test? Rubella and herpes

Tenovaginitis and human papillomavirus

Rhinovirus and Ormond disease

Chlamydia and rickets

20 A)

Ultrasonography is most likely to detect which of the following fetal abnormalities? Neural tube defects

Skeletal abnormalities

C) D)

Chromosomal defects Single-gene disorders

Answer Key

2 3

D C

B NURSING TEST BANK

D C

13 14 15

A C

B, C, D

18 19

A A

Chapter 8. Environmental and Nutritional Diseases

The adipocytes in adipose tissue not only serve as a storage sites, they also:

A) B)

produce linoleic fatty acid. synthesize triglycerides.

increase glucagon release.

degrade fat-soluble vitamins.

Protein contains nitrogen. A negative nitrogen balance represents: more protein consumed than excreted.

a reduced need for nitrogen as protein.

C) D)

more nitrogen excreted than consumed. less use of nitrogen for protein synthesis.

3 A)

Natural appetite suppression mechanisms, necessary for food intake control, include : ketoacid deficiency.

NURSING TEST BANK

cholecystokinin storage.

C) D)

decreased blood glucose. leptin receptor stimulation.

Body weight should be used in combination with other measurements to establish if a person is underweight or overweight. Obesity is indicated by: female body fat of 20% and 30%.

A) B)

body mass index (BMI) of 30 to 40.

C) D)

relative body weight of 70% to 100%. abdominal fat/ hip ratio of 0.8 to 1.0.

A patient with upper body obesity also has central fat distribution. This body fat configuration places the patient at greater risk for than a patient with lower body obesity. osteoporosis

B) C)

renal disease cardiometabolic disorders

chronic anemia

As the problem of childhood and adolescent obesity increases, an increase in the incidence of occurring in this obese population. type 2 diabetes mellitus

attention deficit disorder

juvenile rheumatoid arthritis

antibiotic-resistant bacterial infections

7 A)

A diet deficient in calories and protein causes marasmus, which is characterized by: discolored hair. NURSING TEST BANK

bradycardia.

C) D)

enlarged liver. pitting edema.

8 A)

Protein-calorie malnutrition with loss of lean tissues and muscle mass results in: respiratory muscle stimulation.

excessive blood cell production.

C) D)

diarrhea. increased cardiac contractility.

Similarities between girls or women with anorexia nervosa and bulimia nervosa include: periodontal disease.

A) B) C)

low estrogen level. electrolyte imbalances.

enlarged parotid gland.

Both binge-eating and bulimia nervosa patients consume excessive amounts of foods secretively. A major difference is that binge-eaters: remain overweight.

eat when not hungry.

are substance abusers.

experience depression.

A large, high-calorie meal has resulted in the intake of far more energy than a person requires. What will the individuals body do with the excess carbohydrates provided by this meal? Convert them into glucose and store them in the liver and muscles

NURSING TEST BANK

Excrete most of the excess polysaccharides through the kidneys

Convert the carbohydrates into amino acids in preparation for long-term storage Create structural proteins from some of the carbohydrates and store the remainder as triglycerides

12 A)

Which of the following patients is most likely to be in positive nitrogen balance? A patient who is receiving treatment for sepsis

A patient whose diagnosis of pneumonia is causing a fever

A woman who has been admitted to the hospital in early labor A patient who sustained extensive burns in a recent industrial accident

D) 13 A)

In addition to facilitating bowel movements, a diet that is high in fiber confers which of the following benefits? Lowering cholesterol and blood glucose

B) C)

Removing toxins and metabolic byproducts Lowering blood pressure and resting heart rate

Increasing intestinal absorption of vitamins and minerals

14 A) B)

Which of the following statements best conveys the endocrine function of adipose tissue? Adipose tissue antagonizes the effects of insulin on cell membranes. Adipose tissue produces ghrelin, which stimulates both appetite and eating. NURSING TEST BANK

Adipose tissue produces and secretes cholecystokinin (CCK), which stimulates the hypothalamic feeding center.

Adipose tissue produces leptin, which mediates body weight.

Chronic inflammation as a result of excess adipose tissue is implicated in the etiology of which of the following health problems? Osteoporosis

Type 2 diabetes

Rheumatoid arthritis

Systemic lupus erythematosus (SLE)

A public health nurse has noted a significant increase in the number of school-aged children who are obese. Which of the following factors is most significant predictor of childhood obesity? Low socioeconomic status

Low self-esteem

C) D)

Having obese parents Living in a rural or inner-city neighborhood

A) B)

Which of the following measures should a school nurse prioritize in the treatment and prevention of childhood obesity?

Group cognitive therapy Use of selective serotonin-reuptake inhibitors (SSRIs) Education on exercise and nutrition

High-protein, low-carbohydrate diet

NURSING TEST BANK

18 A) B)

Which of the following characteristics distinguishes kwashiorkor from marasmus? Impairment of immune function Lack of dietary fat intake

C) D)

High intake of carbohydrates Impaired pigment synthesis

A frail, 87-year-old female patient has been admitted to a hospital after a fall and has been diagnosed with failure to thrive. Which of the following laboratory values would suggest that the patient may be experiencing malnutrition? Low prealbumin High C-reactive protein

A) B) C) D) 20 A)

High bilirubin Low fasting blood sugar Which of the following assessments should be prioritized in the care of a patient with anorexia nervosa? Serum electrolyte levels

Chest auscultation

White blood cell count with differential

Blood pressure monitoring

Answer Key

B NURSING TEST BANK

C A

10 11 12

A C

B C

16 17 18

C C

Chapter 9. General Pathology of Infectious Diseases

Although growth rate is variable among types of bacteria, the growth of bacteria is dependent on:

biofilm communication.

availability of nutrients.

an intact protein capsid.

individual cell motility.

2 A)

Treponema pallidum, the cause of syphilis, is a spirochete bacterium that is spread from human to human by: tick or lice vector bites.

B) C)

direct physical contact. exposure to infected urine.

inhaling airborne particles. NURSING TEST BANK

A) B) C) D) 4

A) B) C) D) 5

Chlamydiaceae, a rather common sexually transmitted infectious organism, has characteristics of both viruses and bacteria. The infectious form of this organisms life cycle is until it enters the host cell. an elementary body adhered to cholesterol propelled by filaments encapsulated hyphae Because dermatophytes are capable of growing , the infection is mainly found on cutaneous surfaces of the body. a powdery colony in moist skin folds on cooler tissue branching filaments Although both eukaryotes and prokaryotes are capable of causing infectious diseases in humans, eukaryotes are unique because they have a distinct: organized nucleus.

circular plasmid DNA.

cytoplasmic membrane.

variation of shape and size.

Whatever the mechanism of entry, the human-to-human transmission of infectious agents is directly related to the:

source of contact.

site of infection.

number of pathogens absorbed.

virulence factors. NURSING TEST BANK

A) B) C) D) 8

A) B) C) D) 9 A)

The course of any infectious disease progresses through several distinct stages after the pathogen enters the host. Although the duration may vary, the hallmark of the prodromal stage is: tissue inflammation and damage. initial appearance of symptoms. progressive pathogen elimination. containment of infectious pathogens. Although bacterial toxins vary in their activity and effects on host cells, a small amount of gram-negative bacteria endotoxin: is released during cell growth. inactivates key cellular functions. uses protein to activate enzymes. in the cell wall activates inflammation. Serology testing includes the measurement of which of the following? Antibody titers

Culture growth

Direct antigens

DNA sequencing

Prions cause transmissible neurodegenerative diseases and are characterized by:

a lack of reproductive capacity.

hypermetabolism.

enzyme production.

chronic inflammation.

NURSING TEST BANK

Which of the following individuals is experiencing a health problem that is the result of a parasite?

A college student who contracted Chlamydia trachomatis during an unprotected sexual encounter A man who acquired malaria while on a tropical vacation

B) C) D) 12 A) B) C) D) 13

A hospital patient who has developed postoperative pneumonia A woman who developed hepatitis A from eating at an unhygienic restaurant Which of the following traits is characteristic of saprophytes? They derive energy from decaying organic matter. They are beneficial components of human microflora. They have RNA or DNA, but never both. They are capable of spore production. A hospital patient was swabbed on admission for antibioticresistant organisms and has just been informed that methicillin-resistant Staphylococcus aureus (MRSA) is present in his groin. The patient has a normal core temperature and white blood cell count. This patient is experiencing which of the following? Infection

Proliferation

Colonization

Inflammation

NURSING TEST BANK

A) B) C) D) 15

A) B) C) D) 16

A 33-year-old patient who is a long-term intravenous user of heroin has been recently diagnosed with hepatitis C. Which of the following portals of entry most likely led to the patients infection? Direct contact Vertical transmission Ingestion Penetration A 9-month-old infant has been diagnosed with botulism after he was fed honey. The childs mother was prompted to seek care because of this childs sudden onset of neuromuscular deficits, which were later attributed to the release of substances by Clostridium botulinum bacteria. Which virulence factor contributed to this childs illness? Endotoxins Adhesion factors Exotoxins Evasive factors A patient with a long-standing diagnosis of Crohn disease has developed a perianal abscess. Which of the following treatments will this patient most likely require? Antiviral therapy

Antibiotic therapy

Surgical draining

Pressure dressing

A patients primary care provider has ordered direct antigen detection in the care of a patient with a serious symptomatology of unknown origin. Which of the following processes will be conducted? NURSING TEST BANK

Detecting DNA sequences that are unique to the suspected pathogen

Growth of biofilms on various media in the laboratory setting Quantification of IgG and IgM antibodies in the patients blood

C) D) 18

Introduction of monoclonal antibodies to a blood sample from the patient A patient has begun taking acyclovir, an antiviral medication, to control herpes simplex outbreaks. What is this drugs mechanism of action?

Inhibition of viral adhesion to cells

B) C)

Elimination of exotoxin production Antagonism of somatic cell binding sites

Interference with viral replication processes

International travel has contributed to increased prevalence and incidence of nonindigenous diseases by increasing which of the following?

A) B)

Portals of entry Sources of infection

Virulence

Disease course

A public health nurse should recognize that sexually transmitted infections (STIs) are typically spread by which of the following mechanisms? Penetration

Vertical transmission

Direct contact

NURSING TEST BANK

Ingestion

Answer Key

3 4

A C

A A

10 11 12

B A

Chapter 10. Blood Vessels

1 A)

Because cholesterol is insoluble in plasma, it is mainly carried by the lipoprotein: IDL. NURSING TEST BANK

HDL.

C) D)

LDL. VLDL.

A major cause of secondary hyperlipoproteinemia is , which increases the production of VLDL and conversion to LDL. high-calorie diet

diabetes mellitus

C) D)

bile-binding resin cholesterol ingestion

The most important complication of atherosclerosis is , which may cause occlusion of small heart vessels. ulceration

B) C)

thrombosis fatty streaks

fibrous plaque

A serum marker for systemic inflammation, , is now considered a major risk factor marker for atherosclerosis, and vascular disease. leukocytosis

homocysteine

serum lipoprotein

C-reactive protein

5 A) B)

Small-vessel vasculitides, a group of vascular disorders that cause vasculitis, are mainly mediated by: infectious agents. tissue necrosis. NURSING TEST BANK

mononuclear cells.

hypersensitivity reactions.

Atherosclerotic peripheral vascular disease is symptomatic with at least 50% occlusion. The primary peripheral symptom, due to ischemia, is: edema.

A) B)

calf pain.

varicosities.

strong pulse.

Although both are characterized by ischemia, Raynaud phenomenon is caused by , and thromboangiitis obliterans is caused by: occlusion; compression.

thrombi; vasoconstriction.

C) D)

vasculitides; hypertension. vasospasm; inflammation.

Because of its location, the presence of an abdominal aortic aneurysm may first be noticed as:

A) B)

constipation. indigestion.

a pulsating mass.

mid-abdominal pain.

By definition, hypertension is systolic blood pressure of mm Hg or higher or diastolic blood pressure of mm Hg or higher.

A) B)

129; 85 138; 89

140; 90 NURSING TEST BANK

D) 10

155; 95 The patient is immobilized following a hip injury and has begun demonstrating lower leg discoloration with edema, pain, tenderness, and increased warmth in the mid-calf area. He has many of the manifestations of:

A) B)

stasis ulcerations. arterial insufficiency.

primary varicose veins.

deep vein thrombosis.

A 52-year-old man who is moderately obese has recently been diagnosed with hypertension by his primary care provider. Which of the patients following statements indicates a need for further health-promotion teaching?

Ive starting going to the gym before work three times a week.

Im trying to cut back on the amount of salt that I cook with and add to my food. Im resolving to eat organic foods from now on and to drink a lot more water.

C) D)

Im planning to lose 15 pounds before the end of this year.

A patient with a diagnosis of chronic renal failure secondary to diabetes has seen a gradual increase in her blood pressure over the past several months, culminating in a diagnosis of secondary hypertension. Which of the following has most likely resulted in the patients increased blood pressure? Increased levels of adrenocortical hormones

A) B)

Activation of the renin-angiotensinaldosterone mechanism

NURSING TEST BANK

C) D) 13

Increased sympathetic stimulation by the autonomic nervous system (ANS) Coarctation of the patients aorta Which of the following physiologic processes contributes most to the long-term regulation of blood pressure?

Actions of the renin-angiotensin-aldosterone system

Release of antidiuretic hormone (vasopressin) by the posterior pituitary

Renal monitoring and adjustment of extracellular fluid volume

Integration and modulation of autonomic nervous system (ANS)

14 A)

Which of the following is a nonmodifiable risk factor for the development of primary hypertension? African American race

High salt intake

C) D)

Male gender Obesity

A patient with persistent, primary hypertension remains apathetic about his high blood pressure, stating, I dont feel sick, and it doesnt seem to be causing me any problems that I can tell. How could a clinician best respond to this patients statement?

Actually, high blood pressure makes you very susceptible to getting diabetes in the future. Thats true, but its an indicator that youre not taking very good care of yourself.

NURSING TEST BANK

You may not sense any problems, but it really increases your risk of heart disease and stroke.

Youre right, but its still worthwhile to monitor it in case you do develop problems.

A patients primary care provider has added 20 mg of Lasix (furosemide) to his medication regimen to treat his primary hypertension. How does this diuretic achieve its therapeutic effect? By decreasing vascular volume by increasing sodium and water excretion

A) B)

By blocking the release of antidiuretic hormone from the posterior pituitary

By inhibiting the conversion of angiotensin I to angiotensin II.

By inhibiting the movement of calcium into arterial smooth muscle cells

A 29-year-old woman who considers herself active and health conscious is surprised to have been diagnosed with preeclampsia-eclampsia in her second trimester. What should her care provider teach her about this change in her health status?

We dont really understand why some women get high blood pressure when theyre pregnant. This is likely a result of your nervous system getting overstimulated by pregnancy.

B) C)

Hypertension is a common result of all the hormonal changes that happen during pregnancy. Even though youre a healthy person, it could be that you have an underlying heart condition.

NURSING TEST BANK

18 A)

D) 19

A) B) C) D) 20

A) B)

Which of the following patients should most likely be assessed for orthostatic hypotension? A 78-year-old woman who has begun complaining of frequent headaches unrelieved by over-the-counter analgesics. A patient whose vision has become much less acute in recent months and who has noticed swelling in her ankles. An elderly patient who has experienced two falls since admission while attempting to ambulate to the bathroom. A patient who has a history of poorly controlled type 1 diabetes. A patient is receiving homecare for the treatment of a wound on the inside of her lower leg which is 3 cm in diameter with a yellow wound bed and clear exudate. Assessment of the patients legs reveals edema and a darkened pigmentation over the ankles and shins of both legs. What is this patients most likely diagnosis? Chronic venous insufficiency Deep vein thrombosis Varicose veins Peripheral arterial disease A postsurgical patients complaints of calf pain combined with the emergence of swelling and redness in the area have culminated in a diagnosis of deep vein thrombosis. What treatment options will be of greatest benefit to this patient? Analgesics and use of a pneumatic compression device Massage followed by vascular surgery NURSING TEST BANK

Frequent ambulation and the use of compression stockings

Anticoagulation therapy and elevation of the leg

Answer Key

2 3

A B

C C

9 10 11

D C

Chapter 11. Heart

NURSING TEST BANK

A) B) C) D) 2

A) B) C) D) 3

Chronic stable angina, associated with inadequate blood flow to meet the metabolic demands of the myocardium, is caused by: fixed coronary obstruction. increased collateral circulation. intermittent vessel vasospasms. excessive endothelial relaxing factors. Atherosclerotic plaque is most likely to be unstable and vulnerable to rupture when the plaque has a thin fibrous cap over a: red thrombus. large lipid core. calcified lesion. vessel wall injury. Cardiac tamponade and pericardial effusion can be lifethreatening when the pericardial sac and the heart. ruptures; releases

thickens; stretches

contracts; friction rubs

fills rapidly; compresses

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

acute myocarditis.

high troponin levels.

acute ventricular arrhythmia.

hypertrophic cardiomyopathy.

NURSING TEST BANK

5 A) B) C) D) 6

A) B) C) D) 7

On the second or third day after an acute myocardial infarction, the area of necrosis is: soft and yellow. acutely inflamed. granulation tissue. fibrous scar tissue. In aortic regurgitation, failure of aortic valve closure during diastole causes an abnormal drop in diastolic pressure. This change in pressure causes decreased: stroke volume. left ventricular size. coronary perfusion. arterial pulse pressure. Patients with ischemic coronary vessel disease and acute coronary syndrome (ACS) are classified as low or high risk for acute myocardial infarction based on characteristics that include significant: heart murmurs.

ECG changes.

pulmonary disease.

pericardial effusion.

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

rigidity.

thinning.

thickness.

contractility.

NURSING TEST BANK

A) B)

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

C) D)

left ventricle hypertrophy. vegetative valve destruction.

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

A) B)

pulmonary blood volume. right ventricle workload.

C) D)

unoxygenated blood flow. right atrial blood volume.

Which of the following assessment findings of a cardiac patient would be suggestive of cardiac tamponade? Increasing PaCO2 and decreasing PaO2

A) B)

Audible crackles on chest auscultation and presence of frothy sputum

20 mm Hg Drop in systolic blood pressure during respiration Normal ECG combined with complaints of chest pain and shortness of breath

D) 12

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

Stable angina

Non-ST-segment elevation MI

NURSING TEST BANK

ST-Segment elevation MI

Unstable angina

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

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

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

A patient who sometimes experiences chest pain when climbing stairs

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

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

Pericardial effusion and cardiac tamponade

C) D)

Dilated cardiomyopathies Aortic valve regurgitation and aortic stenosis

Football fans at a college have been shocked to learn of the sudden death of a star player, an event that was attributed in the media to an enlarged heart. Which of the following disorders was the players most likely cause of death?

A) B) C)

Takotsubo cardiomyopathy Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) Hypertrophic cardiomyopathy (HCM)

Dilated cardiomyopathy (DCM)

NURSING TEST BANK

16 A) B)

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

C) D)

Dilated cardiomyopathy (DCM) Primary restrictive cardiomyopathy

A childs history of a recurrent sore throat followed by severe knee and ankle pain has resulted in a diagnostic workup and a diagnosis of rheumatic fever. What are the treatment priorities for this child? Cardiac catheterization and corticosteroid therapy Implanted pacemaker and b-adrenergic blockers

A) B) C) D) 18

Antibiotics and anti-inflammatories Pain control and oxygen therapy An elderly female patient with complaints of increasing fatigue has been diagnosed with aortic stenosis, a disease which her primary care provider believes may have been long-standing. Which of the following compensatory mechanisms has most likely maintained the womans ejection fraction until recently? Left ventricular hypertrophy

Increased blood pressure

Increased heart rate and stroke volume

Aortic dilation

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

The child has a split S2 heart sound on auscultation. ECG reveals atrial fibrillation.

B) C)

The child experiences apneic spells after feeding.

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

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

The child has ventricular septal defect.

B) C)

The infants pulmonary outflow channel is narrowed. The child has right ventricular hypertrophy.

The infants aorta is narrowed.

Answer Key

2 3

B D

6 7

C B

C C

11 12 13

A B NURSING TEST BANK

C C

16 17 18

C A

Chapter 12. Hematopoietic and Lymphoid Systems

Cytokines that affect hematopoiesis in bone marrow are called colony-stimulating factors (CSFs) based on their ability to:

support lymphocytes.

B) C)

differentiate red cells. regulate blood cells.

stimulate lymphocytes.

Leukocytes consist of three categories of cells that have different roles in the inflammatory and immune responses. Which of the following leukocytes is correctly matched with its function?

Lymphocyte; phagocytosis

B) C)

Eosinophils; allergic reactions Basophils; engulf antigens

Monocytes; release heparin

3 A)

The patient has an abnormally low neutrophil count. Neutropenia is most commonly caused by: Epstein-Barr virus.

Kostmann syndrome. NURSING TEST BANK

drug reactions.

skin infections.

The 16-year-old boy has enlarged lymph nodes and a sore throat. His girlfriend was recently diagnosed with infectious mononucleosis, which is caused by and commonly transmitted in . heterophil antibodies; blood

Epstein Barr virus; saliva

T-cell infection; plasma

bacterial infection; monocytes

The patient is diagnosed with Hodgkin type of lymphoma based on the results of laboratory tests and study of the tumor cells. A distinct characteristic of Hodgkin lymphoma is the presence of: Reed-Sternberg cells.

A) B)

Bence Jones proteins.

C) D)

M-type protein antibodies. Philadelphia chromosome.

Manifestations of Hodgkin lymphoma that distinguish it from non-Hodgkin lymphoma include:

A) B)

noncontiguous nodal spread. superficial lymphadenopathy.

pruritus and night fevers.

poor humoral antibody response.

Leukemias are classified according to the predominant cell type. The myelogenous cell type of leukemia can:

A) B)

interfere with thrombocyte cell maturation. originate in marrow and infiltrate nodes. NURSING TEST BANK

affect B and T stem cells in bone marrow.

transform mature cells into immature ones.

A child has Down syndrome and has recently experienced unexplained nose bleeds. His blood tests identify blast cells in the peripheral smear. In addition to nose bleeds, his acute leukemia will typically manifest all of the following EXCEPT: infections due to neutropenia.

fatigue due to RBC deficiency.

hypogammaglobulinemia.

bleeding due to thrombocytopenia.

In contrast to acute leukemias, chronic leukemias are malignancies involving abnormal blood cells in the marrow. production of undifferentiated

proliferation of well-differentiated

C) D)

uncontrolled growth of immature replication of pluripotent precursor

Multiple myeloma is a malignancy of:

A) B)

plasma cells. bone osteoblasts.

T-cell lymphocytes.

immunoglobulin A.

Which of the following statements accurately describes a component of the hematopoietic system?

A) B)

Lymphocytes lack cytoplasmic granules. Neutrophils are agranulocytes.

NURSING TEST BANK

Colony-forming units (CFUs) promote the growth of hematopoietic cell colonies.

Neutrophils are the most prevalent lymphocytes.

Which of the following parts of the body are considered to be parts of the lymphatic system? Select all that apply. Thyroid gland

A) B)

Thymus

Spleen

D) E)

Kupffer cells Myelin

A) B)

A patient with a long-standing diagnosis of human immunodeficiency virus (HIV) has recently developed neutropenia and been admitted to a hospital. Which of the following measures should be prioritized by the nurses who are providing his care? Administration of prophylactic antibiotics

Supplementary oxygen and administration of bronchodilators Administration of antiretroviral medications

Vigilant infection control and handwashing

A 16-year-old girl has been brought to her primary care provider by her mother due to the daughters recent malaise and lethargy. Which of the following assessments should the clinician perform in an effort to confirm or rule out infectious mononucleosis? Auscultating the patients lungs

Palpating the patients lymph nodes

Assessing the patients cranial nerve reflexes NURSING TEST BANK

D) 15

Assessing the patient for bone pain Which of the following factors differentiates chronic leukemias from acute leukemias?

Leukemic cells are disseminated throughout the body by the circulatory system.

The leukemic cells are more fully differentiated than in acute leukemias.

The prevalence among individuals with Down syndrome is high.

They are cancers of the hematopoietic progenitor cells.

Following peripheral blood testing and a bone marrow biopsy, a patient has been diagnosed with chronic myelogenous leukemia. Which of the following is most likely to have preceded the patients diagnosis?

The presence of a Philadelphia chromosome

Down syndrome

Radiation exposure

Exposure to the Epstein-Barr virus

A patient has been diagnosed with non-Hodgkin lymphoma (NHL), a form of malignancy that most likely originated in which of the following sites? Thymus

B) C)

Spleen Bone marrow

Lymph nodes

NURSING TEST BANK

A) B) C) D) 19

A) B) C)

D) 20 A)

A young adult is preparing to begin treatment for nonHodgkin lymphoma (NHL), a disease that has disseminated widely. What is the most likely treatment regimen for this patient? Antiviral medications Surgery and whole blood transfusion Radiation and chemotherapy Bone marrow or stem cell transplantation Which of the following patient complaints should prompt a clinician to order a diagnostic work-up for multiple myeloma? Lately my bones just seem to ache so bad, and nothing seems to help. Every morning my joints are so stiff that it takes me 10 or 15 minutes just to get going. I feel so weak and the last few days Ive actually fallen asleep on my coffee break at work. I vomited yesterday evening and it looked like coffee grounds mixed with some fresh blood. Which of the following abnormal blood work results is most closely associated with a diagnosis of multiple myeloma? Decreased hemoglobin, hematocrit, and red blood cells

Extremely high levels of abnormal lymphocytes

Low glomerular filtration rate and high calcium levels Low potassium levels and increased blood urea nitrogen

NURSING TEST BANK

Answer Key

1 2

C B

7 8

A C

11 12

A B, C

D C

18 19 20

A C

Chapter 13. Lung

1 A) B)

Pleuritic chest pain associated with respiratory movements is usually described as: bilateral. localized. NURSING TEST BANK

continuous.

substernal.

A man sustained a puncture injury to his chest that caused a tension pneumothorax to form. This is a life-threatening condition because: expired air exits the bleeding wound.

trapped, inspired air collapses the lung.

the opposite lung hyperinflates.

blebs on the lung surface rupture.

Atelectasis is most commonly caused by:

airway obstruction.

pulmonary embolism.

C) D)

inflammation of the pleura. chronic forceful coughing.

Acute onset bronchial asthma causes wheezing and breathlessness as a result of:

A) B)

airway inflammation. alveolar collapse.

compression atelectasis.

pulmonary hypertension.

Emphysema is characterized by hyperinflation of the lungs that produces increased:

A) B)

total lung capacity. alveolar wall thickness.

a1-antitrypsin enzyme.

submucosal gland hypertrophy.

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6 A) B)

As a result of hypoxemia and polycythemia, persons with chronic obstructive bronchitis are prone to: breakdown of elastin. left-sided heart failure.

C) D)

pulmonary hypertension. expiratory airway collapse.

With bronchiectasis, persistent airway obstruction and chronic infection results in bronchial:

A) B)

dilation. rupture.

C) D)

infarction. thickening.

8 A)

Cystic fibrosis (CF), the major cause of severe chronic respiratory disease in children, is characterized by: constipation.

salt depletion.

watery mucus.

high cholesterol.

The adverse effects of emboli on the pulmonary circulation and airways include:

excess surfactant.

area bronchodilation.

local vasoconstriction.

lower lobe consolidation.

The common results of respiratory failure are hypoxemia and:

hypercapnia.

bradycardia. NURSING TEST BANK

vasoconstriction.

pulmonary emboli.

A patient with a history of emphysema is experiencing hypoxemia after a taxing physical therapy appointment. Which of the following physiologic phenomena will occur as a consequence of hypoxemia? Peripheral vasodilation

Necrosis

Hypoventilation

Increased heart rate

An elderly patient who has been restricted to bed by numerous comorbidities for several weeks has been diagnosed with a large pleural effusion. Which of the following treatment modalities is most likely to resolve the patients most recent health problem? Thoracentesis

Supplementary oxygen therapy

C) D)

Administration of corticosteroids Administration of bronchodilators

A motor vehicle accident has resulted in a tension pneumothorax for the driver of the car. Which of the following manifestations is associated with tension pneumothorax?

A) B)

Audible friction rub over the affected lung Mediastinal shift

Metabolic alkalosis

Atrial fibrillation

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A patient has just been admitted to the postsurgical unit following a below-the-knee amputation. Which of the following measures should her care team prioritize to prevent atelectasis during the patients immediate recovery?

Bedrest and supplementary oxygen by nasal cannula Administration of bronchodilators by nebulizer

B) C) D) 15

Deep-breathing exercises and early mobilization Adequate hydration and a high-humidity environment Which of the following manifestations typically accompanies an asthmatic attack?

A) B)

Decreased residual volume Decreased pulmonary arterial pressure

C) D)

Prolonged inspiration Hyperinflation of the lungs

A 51-year-old man has been diagnosed with chronic bronchitis after a long history of recurrent coughing. Which of the mans following statements demonstrates a sound understanding of his new diagnosis? If I had quit smoking earlier than I did, I think I could have avoided getting bronchitis.

Im pretty sure that I first caught bronchitis from the person who has the cubicle next to mine at work.

I read on the Internet that I might have got bronchitis because I was born with an enzyme deficiency.

NURSING TEST BANK

I think that I probably could have prevented this if I had got in the habit of exercising more when I was younger.

Which of the following individuals is experiencing a disorder of ventilation that has a restrictive rather than obstructive etiology?

A 30-year-old African American man who has been diagnosed with sarcoidosis

An infant whose routine screening is suggestive of cystic fibrosis

An elderly, lifelong smoker who has been admitted to hospital with emphysema

A 16-year-old girl who must limit her activity to prevent asthmatic attacks

Prolonged immobility is implicated in the development of which of the following disorders?

Bronchitis and bronchiectasis

Sarcoidosis and idiopathic pulmonary fibrosis

Atelectasis and pulmonary embolism

Pulmonary hypertension and cor pulmonale

Which of the following is most likely to precipitate an asthmatic attack in a child with a diagnosis of extrinsic, or atopic, asthma? Pet dander

A) B) C)

Cold weather Stress

Respiratory tract infections

Pain is an expected assessment finding in patients who have which of the following lung diseases? NURSING TEST BANK

Asthma

B) C)

Pleural effusion Pulmonary arterial hypertension (PAH)

Pleuritis

Answer Key

C A

7 8 9

B C

18 19

C A

Chapter 14. Kidney and Its Collecting System

NURSING TEST BANK

A characteristic manifestation of polycystic kidney disease is:

A) B)

massive proteinuria. renal colic.

C) D)

alkaline urine. hypertension.

A) B) C) D) 3 A)

Of the four types of kidney stones, the formation of magnesium ammonium phosphate (struvite) stones is directly associated with: hyperuricemia. hydronephrosis. high urine calcium. urinary tract infections. The most damaging effects of urinary obstruction are the result of and unrelieved obstruction of urine outflow. urinary stasis

concentrated urine

kidney hyperplasia

renal hypertension

Glomerulonephritis is usually caused by:

vesicoureteral reflux.

catheter-induced infection.

antigen-antibody complexes.

glomerular membrane viruses.

The edema that develops in persons with glomerulonephritis and nephrotic syndrome reflects:

obstruction and reflux.

salt and water retention. NURSING TEST BANK

inability to concentrate urine.

decreased glomerular permeability.

The initiating event in the development of nephrotic syndrome is a derangement in the glomerular membrane that causes increased permeability to: red blood cells.

plasma proteins.

inflammatory cells.

antibody complexes.

7 A)

Chronic pyelonephritis, a significant cause of renal failure, is most commonly caused by: viral organisms.

intrarenal reflux.

C) D)

renal hyperplasia. abscess formation.

High-risk factors for development of adult renal cell cancer include:

A) B)

heavy smoking. inherited renal disease.

adrenal medulla tumors.

anorexia/bulimia disorder.

Which of the following assessment findings is most suggestive of nephrotic syndrome?

A) B)

Hematuria and anemia Proteinuria and generalized edema

Renal colic and increased serum sodium

NURSING TEST BANK

Increased creatinine with normal blood urea nitrogen

The most recent assessment of a patient with a diagnosis of type 1 diabetes indicates a heightened risk of diabetic nephropathy. Which of the following assessment findings is most suggestive of this increased risk?

A) B)

Microalbuminuria Hematuria

Orthostatic hypotension

Diabetic retinopathy

An elderly female patient has been hospitalized for the treatment of acute pyelonephritis. Which of the following characteristics of the patient is most likely implicated in the etiology of her current health problem?

The patient was diagnosed with type 2 diabetes several years earlier.

The patient takes a diuretic and an ACE inhibitor each day for the treatment of hypertension. The patient recently had a urinary tract infection.

C) D) 12 A)

The patient has peripheral vascular disease. Which of the following disorders of renal function primarily affects the proximal and distal tubules? Chronic pyelonephritis

B) C)

Polycystic kidney disease Acute nephritic disease

Renal calculi

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An adult patient has been diagnosed with polycystic kidney disease. Which of the patients following statements demonstrates an accurate understanding of this diagnosis?

I suppose I really should have paid more attention to my blood pressure. Ive always been prone to getting UTIs, and now I know why.

B) C) D)

A) B) C) D) 15

I suppose I should be tested to see if my children might inherit this. I had a feeling that I was taking too many medications, and now I know the damage they can do. An infant has been diagnosed with autosomal recessive polycystic kidney disease (ARPKD). Which of the following treatments is the priority in the care of this child? Rehydration therapy Total parenteral nutrition Prophylactic antibiotics Respiratory support An obese, male patient with a history of gout and a sedentary lifestyle has been advised by his primary care provider to avoid organ meats, certain fish, and other foods that are high in purines. The care provider is demonstrating an awareness of the patients susceptibility to which of the following types of kidney stones? Calcium stones

Magnesium ammonium phosphate stones

Uric acid stones

Cystine stones

NURSING TEST BANK

A) B)

A patient has recently undergone successful extracorporeal shock wave lithotripsy (ESWL) for the treatment of renal calculi. Which of the following measures should the patient integrate into his lifestyle to reduce the risk of recurrence? Increased fluid intake and dietary changes Weight loss and blood pressure control

C) D) 17

A) B)

Regular random blood glucose testing Increased physical activity and use of over-thecounter diuretics A young child has been diagnosed with Wilms tumor after his mother discovered an unusual mass, prompting a diagnostic workup. Which of the following characteristics is typical of Wilms tumor? The tumor is usually asymptomatic. The tumor is usually self-limiting.

C) D)

The tumor is usually a secondary neoplasm. The tumor is usually encapsulated.

Which of the following patient complaints most clearly suggests a need for diagnostic testing to rule out renal cell carcinoma? Urinary urgency

A) B)

Hematuria

Oliguria

Cloudy urine

Answer Key

C NURSING TEST BANK

B B

7 8 9

A B

A C

13 14 15

D C

Chapter 15. Oral Cavities and Gastrointestinal Tract

A major complication of persistent gastroesophageal reflux is:

strictures.

heartburn.

chest pain.

hoarseness.

Acute gastritis refers to a transient inflammation of the gastric mucosa that is most commonly associated with:

A) B)

diarrhea. food allergies.

gastric reflux.

alcohol intake. NURSING TEST BANK

3 A) B) C) D) 4

The Helicobacter pylori protobacteria cause peptic ulceration by producing: acids toxins ischemia bleeding A hallmark of irritable bowel syndrome is abdominal pain:

A) B)

relieved by defecation. most severe at night.

C) D)

with blood in the stool. after and between meals.

5 A)

Inflammatory bowel diseases are accompanied by systemic manifestations that include: autoimmune anemia.

rheumatoid arthritis.

thrombocytopenia.

lactose intolerance.

Crohns type of inflammatory bowel disease is characterized by:

granulomatous lesions.

ulcerative erosions.

fibrotic smooth muscle.

necrotic crypt abscesses.

Unlike the Crohn type of inflammatory bowel disease, the ulcerative colitis type is characterized by:

skip lesions.

steatorrhea. NURSING TEST BANK

gastric ulcers.

pseudopolyps.

8 A)

Diverticulitis, a complication of diverticulosis, is manifested by acute: rectal bleeding.

abdominal distention.

large-volume diarrhea.

lower left quadrant pain.

Major causes of mechanical bowel obstruction include:

chemical irritation.

ruptured appendix.

C) D)

abdominal distention. postoperative adhesions.

As a protective measure to keep abdominal inflammation and infection localized, the peritoneum:

A) B)

constricts bowel contents. secretes fibrous exudate.

increases intestinal motility.

abdominal vasoconstriction.

Which of the following signs and symptoms most clearly suggests the need for endoscopy to rule out esophageal cancer?

A) B) C)

Heartburn after an individual consumes highfat meals Dysphagia in an individual with no history of neurologic disease A new onset of gastroesophageal reflux in a previously healthy individual NURSING TEST BANK

Recurrent episodes of gastritis that do not respond to changes in diet

A 60-year-old male patient has presented to his primary care provider to follow up with his ongoing treatment for peptic ulcer disease. What is the most likely goal of this patients pharmacologic treatment?

A) B)

Inhibiting gastric acid production Promoting hypertrophy of the gastric mucosa

Increasing the rate of gastric emptying

Increasing muscle tone of the cardiac sphincter

Which of the following individuals most likely faces the greatest risk of developing Clostridium difficile colitis?

A 55-year-old man who takes proton pump inhibitors for the treatment of peptic ulcers

A 79-year-old hospital patient who is being treated with broad-spectrum antibiotics A premature neonate who has developed hyperbilirubinemia and is receiving phototherapy

A 30-year-old patient who has a history of Crohn disease and has been admitted to a hospital to treat a recent flare-up A 66-year-old woman has been diagnosed with diverticular disease based on her recent complaints and the results of a computed tomography (CT) scan. Which of the patients following statements demonstrates an accurate understanding of this diagnosis? From now on, Im going to stick to an organic diet and start taking more supplements.

NURSING TEST BANK

I think this might have happened because Ive used enemas and laxatives too much.

Ive always struggled with heartburn and indigestion, and I guess I shouldnt have ignored those warning signs. I suppose I should try to eat more fiber and become a bit more active.

D) 15

An ultrasound has confirmed appendicitis as the cause of a 20-year-old mans sudden abdominal pain. Which of the following etiologic processes is implicated in the development of appendicitis? Obstruction of the intestinal lumen

Elimination of normal intestinal flora

C) D)

Sloughing of the intestinal mucosa Increased osmolality of intestinal contents

Which of the following characteristics differentiates inflammatory diarrhea from the noninflammatory type? Larger volume of diarrhea

A) B) C)

Electrolyte imbalances Absence of blood in the stool

Infection of intestinal cells

17 A) B)

Which of the following patients should the nurse observe most closely for the signs and symptoms of paralytic ileus? A patient who is postoperative day 1 following gall bladder surgery A patient whose acute diarrhea has necessitated the use of antidiarrheal medications

NURSING TEST BANK

An obese patient who refuses to ambulate because he complains of shortness of breath

A patient with a longstanding diagnosis of irritable bowel syndrome

18 A)

Which of the following meals is most likely to exacerbate an individuals celiac disease? Spaghetti with meatballs and garlic bread

Stir-fried chicken and vegetables with rice

Oatmeal with milk, brown sugar, and walnuts

Barbecued steak and a baked potato with sour cream

19 A) B) C) D) 20

Which of the following statements is true of colorectal cancer? Aspirin and NSAIDs are implicated in the etiology. It is one of the few cancers that is known to sometimes have an infectious etiology. Most cases are quite advanced before symptoms become apparent. Survival rates for colorectal cancer are less than 20%, but are increasing. Following the analysis of a recent barium enema and colonoscopy with biopsy, a patient has been diagnosed with colorectal cancer. Which of the following treatment modalities will be the mainstay of this patients treatment?

A) B)

Chemotherapy Radiation therapy

Pharmacologic therapies

Surgery NURSING TEST BANK

Answer Key

1 2

A D

7 8

D D

11 12

B A

A A

18 19 20

C D

Chapter 16. Liver and Gallbladder

1 A) B)

Abnormally high accumulation of bilirubin in the blood causes: jaundice. cholestasis. NURSING TEST BANK

xanthomas.

biliary cirrhosis.

The mechanisms of liver damage in viral hepatitis include:

direct cellular injury.

fatty liver changes.

disrupted bile flow.

bile duct inflammation.

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

nodules.

C) D)

atrophy. hypertrophy.

A major factor in the development of hepatic encephalopathy is:

A) B)

hypersplenism. high sodium level.

neurotoxin accumulation.

steroid hormone deficiency.

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

A) B)

filters channels

phagocytes

cytotoxic cells NURSING TEST BANK

6 A) B) C) D) 7

Both prehepatic and posthepatic causes of portal hypertension include the formation of: fibrous nodules. venous thrombosis. collateral circulation. portosystemic shunts. The late manifestations of cirrhosis are related to liver failure and:

A) B)

hepatomegaly. diffuse liver fibrosis.

C) D)

portal hypertension. hepatorenal syndrome.

8 A)

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

rapid elimination of bile.

gallbladder inflammation.

excessive alcohol intake.

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

ascites.

vomiting.

bilirubinuria.

hemorrhage.

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

fatty deposits

B) C)

autodigestion bowel obstruction

abscess formation

Individuals with liver disease often experience the effects of excess serum ammonia as a result of impairment of the livers ability to process ammonia. How does the liver process ammonia in healthy individuals?

By converting it into bilirubin which is then excreted intestinally

By processing ammonia into nitrogen and hydrogen ions for excretion By processing it into urea and releasing it into the circulation

C) D) 12

By combining it with oxygen to create ammonium oxide A patients longstanding diagnosis of congenital hemolytic anemia often manifests itself with jaundice. What type of jaundice does this patient most likely experience?

A) B)

Prehepatic Intrahepatic

Posthepatic

Infectious

13 A)

A decrease in the serum level of which of the following substances is suggestive of liver injury? g-Glutamyltransferase (GGT)

Albumin

Alanine aminotransferase (ALT)

NURSING TEST BANK

Alkaline phosphatase

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

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

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

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

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

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

acute fulminant hepatitis.

hepatitis D virus infection.

secondary biliary cirrhosis.

portal hypertension.

A) B) C)

Which of the following factors accounts for the poor prognosis that typically accompanies a diagnosis of primary hepatocellular cancer? Surgical options do not exist because removal of all or part of the liver is a threat to health. Liver cancer typically metastasizes at a much earlier stage than other cancers. Liver tumors are poorly differentiated due to the low density of hepatic tissue.

NURSING TEST BANK

The nonspecific symptomatology of liver cancer means that diagnosis often happens at a late stage. Which of the following factors is most strongly associated with the pathogenesis of gallstones?

A) B)

Excess serum ammonia and urea levels Portal hypertension

Abnormalities or stasis of bile

High cholesterol diet

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

A woman who has six to eight drinks each evening

A man who has become profoundly ill during a tropical vacation A woman who takes two Tylenol tablets five to six times a day

C) D)

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

The nurse who is providing care for a patient with pancreatic cancer should prioritize which of the following assessments? Assessment for ascites and close monitoring of fluid balance

A) B) C)

Respiratory assessment and monitoring of arterial blood gases Vigilant monitoring of blood glucose levels

Assessment for deep vein thrombosis

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

Upper right quadrant or epigastric pain

B) C)

Fever and sudden abdominal distention Appearance of undigested fat in feces

Nausea resulting in greenish vomitus

Answer Key

B C

7 8 9

C C

18 19

A D

Chapter 17. Pancreas

NURSING TEST BANK

Hormones are chemical messengers that:

A) B)

regulate body functions. initiate immune reactions.

C) D)

transport fatty acids and lipids. cause one specific tissue effect.

A) B) C) D) 3 A)

The release of insulin from the pancreatic beta cells can inhibit its further release from the same cells. This is an example of hormone action. retinoid autocrine juxtaposed arachidonic Several hormones, including steroids and thyroid hormone, are bound to and carried by: proteins.

target cells.

cholesterol.

prohormones.

Hormones exert their action by binding to high-affinity receptors on the surface or inside of the target cell. The response of the target cell varies with the and the receptors present.

numbers; affinity

hormone size; location

permeability; ionization

saturation level; rate

Release and synthesis of anterior pituitary hormones are mainly regulated by the inhibiting or releasing actions of the: NURSING TEST BANK

cell receptors.

B) C)

thymus gland. hypothalamus.

adrenal gland.

When sensors detect a change in a hormone level, the hormonal response is regulated by mechanisms that will return the level to within normal range.

metabolic

B) C)

feedback production

action potential

When hypofunction of an endocrine organ is suspected, a hormone test can be administered to measure and assess target gland response.

A) B)

stimulation 24-hour urine

agglutination

antibody-binding

8 A)

Hormones are usually divided into four categories according to their: function.

precursor.

structure.

receptor.

Although both autocrine and paracrine hormonal actions occur without entering the blood stream, paracrine actions differ because they affect cells. selfNURSING TEST BANK

local

C) D)

stored target

10 A)

As part of maintaining homeostasis, hormones secreted by endocrine cells are inactivated continuously to: free receptor sites.

stimulate production.

C) D)

prevent accumulation. absorb metabolic waste.

Hormones that cause the subsequent stimulation or release of another hormone, such as thyroid-stimulating hormone and corticotropin-releasing hormone, typically belong to which of the following structural classifications? Amines and amino acids

B) C)

Peptides and proteins Steroids

Fatty acid derivatives

Paracrine action involves which of the following characteristics? Action on a distant target cell

A) B)

Autoregulation

Action on the same cells that produced the hormone Action on nearby target cells

NURSING TEST BANK

A) B) C) D) 14

A) B) C) D) 15

A hormone has been synthesized in the rough endoplasmic reticulum of an endocrine cell after which it has moved into the Golgi complex, been packaged in a vesicle, and been released into circulation. What hormone is synthesized and released in this manner? Insulin Cortisol Testosterone Estrogen Cyclic adenosine monophosphate (cAMP) performs which of the following roles in the functioning of the endocrine system? Mediating hormone synthesis by nonvesiclemediated pathways Acting as a high-affinity receptor on the surface of target cells Inactivating hormones to prevent excess accumulation Acting as a second messenger to mediate hormone action on target cells Which of the following statement best describes the relationship between the hypothalamus and the posterior pituitary in the normal functioning of the endocrine system? Posterior pituitary hormones are constituted from components of both the hypothalamus and the pituitary gland itself. The posterior pituitary gland regulates the release of hypothalamic hormones.

NURSING TEST BANK

Posterior pituitary hormones are produced in the hypothalamus but released from the pituitary gland.

The hypothalamus regulates the production and release of posterior pituitary hormones by the pituitary gland.

16 A)

Which of the following structures controls the functions of the greatest number of target glands and cells? Thyroid gland

Pituitary gland

Adrenal cortex

Pancreas

17 A) B) C) D) 18

Which of the following physiologic processes best exemplifies a positive feedback mechanism? The increase in prolactin secretion that occurs with more frequent breast-feeding The regulation of blood glucose levels by insulin The release of parathyroid hormone in response to decreased serum calcium levels The release of antidiuretic hormone when sodium levels are higher than normal A patient has received an injection containing thyrotropinreleasing hormone (TRH) and is now being assessed for levels of thyroid-stimulating hormone (TSH). This patient has undergone which of the following diagnostic tests?

A) B)

Suppression testing Radioimmunoassay (RIA)

Autoantibody testing NURSING TEST BANK

D) 19

Stimulation testing Thyroid and steroid hormones, which exert their effect on target cells by way of nuclear receptors, have which of the following characteristics?

A) B)

The selective use of a second messenger

The ability to cross the cell membrane of target cells The ability to regulate surface receptor affinity

Both lipid-solubility and water-solubility

Which of the following hormones is produced by the anterior pituitary gland?

Growth hormone (GH)

Oxytocin

Corticotropin-releasing hormone (CRH)

Norepinephrine

Answer Key

3 4

A A

B NURSING TEST BANK

A D

14 15 16

C B

B A

Chapter 18. Male Genital System and Lower Urinary Tract

Smooth muscle relaxation and shunting of blood into the sinusoids is mediated by and results in a penile erection. norepinephrine

B) C)

nitroglycerine nitric oxide

nicotinic acid

2 A)

Priapism is a condition that causes ischemia as a result of: circumcision trauma.

failure of detumescence.

tight retracted foreskin.

fibrous plaque in the penis.

3 A)

Common risk factors for erectile dysfunction due to generalized penile arterial insufficiency include: cryptorchidism.

cigarette smoking.

NURSING TEST BANK

testicular torsion.

benign prostate hypertrophy.

Squamous cell cancer of the penis is more likely to develop in men with chronic: erectile dysfunction.

A) B)

herpes ulcerations.

Peyronie disease.

smegma accumulation.

In a hydrocele, excess fluid is present in the:

epididymis.

tunica vaginalis.

C) D)

pampiniform plexus. vas deferens ampulla.

Testicular torsion, a serious disorder affecting young male individuals, causes:

A) B)

inguinal herniation. cancer of the scrotum.

dartos muscle atrophy.

loss of testicular perfusion.

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

A) B)

hypospadias. scrotal edema.

urine retention.

testicular cancer.

The major cause of acute prostatitis is:

NURSING TEST BANK

prostate hyperplasia.

B) C)

acute pyelonephritis. gram negative

D) E)

mucous gland overgrowth. coli.

The most important factor in the evaluation and treatment of benign prostatic hypertrophy (BPH) is considered to be:

A) B)

frequency of erectile dysfunction. testosterone level management.

C) D)

prostate cancer prevention measures. subjective symptoms reported by the patient.

Cryptorchidism, or undescended testes, is a direct cause of: infertility.

A) B)

paraphimosis.

prostate cancer.

low testosterone.

Which of the following physiologic processes results from the synthesis and release of testosterone?

Protein catabolism

Musculoskeletal growth

Release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH)

Prostatic hyperplasia

A 41-year-old patient has undergone a vasectomy. What is the physiologic basis for this contraception technique?

NURSING TEST BANK

Spermatogenesis is inhibited because sex hormones may no longer stimulate the Sertoli cells.

Spermatozoa can no longer reach the epididymis and do not survive. The rete testis becomes inhospitable to sperm.

C) D)

Sperm can no longer pass through the ductus deferens.

A patient has been diagnosed with an anterior pituitary tumor, and synthesis and release of follicle-stimulating hormone has become deranged. What are the potential consequences of this alteration in endocrine function?

Dysfunction of spermatogenesis

B) C)

Overproduction of luteinizing hormone Inhibition of testosterone synthesis

Impaired detumescence

Which of the following factors constitutes the most significant risk for balanitis xerotica obliterans?

A) B)

Multiple sexual partners Androgen deficiency

Uncircumcised penis

Chronic prostatitis

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

Benign prostatic hyperplasia (BPH)

Intravaginal testicular torsion

NURSING TEST BANK

D) 16

Erectile dysfunction A 30-year-old man has been diagnosed with mumps orchitis, a disease that has the potential to result in:

A) B)

hematuria. hematocele.

sterility.

penile atrophy.

After seeking care due to recent history of testicular enlargement and scrotal pain, a 22-year-old college student has been diagnosed with testicular cancer. Which of the patients following statements indicates the need for further teaching?

I cant shake this feeling like Ive received a death sentence.

I have to admit that the prospect of losing a testicle is a bit overwhelming. I really hope the cancer hasnt spread anywhere, because Ive read that its a possibility.

I guess theres some solace in the fact that this cancer wasnt a result of an unhealthy lifestyle.

Which of the following assessments is most likely to reveal a potential exacerbation in a 70-year-old patients diagnosis of benign prostatic hyperplasia (BPH)? Urine testing for microalbuminuria

A) B) C)

Blood test for white blood cells and differential Bladder ultrasound

Sperm morphology testing NURSING TEST BANK

Which of the following statements about screening for prostate cancer is most accurate?

Digital rectal examination detects the majority of new cases of prostate cancer. A positive prostate-specific antigen (PSA) test is definitive for prostate cancer.

B) C)

BPH and prostatitis can confound prostate screening results. Digital rectal examination and PSA testing have been proven ineffective.

D) 20

Which of the following diagnoses is most likely to require surgical correction?

A) B)

Hypospadias Orchitis

C) D)

Erectile dysfunction Spermatocele

Answer Key

1 2

C B

5 6

B D

9 10

D A

B NURSING TEST BANK

A C

14 15 16

C C

C A

Chapter 19. Female Genital System and Breast

1 A)

Acute cervicitis is an inflammation of the cervix characterized by: abscess formation.

B) C)

mucopurulent drainage. thick gray-white plaques.

persistent pruritic vulvitis.

2 A)

Carcinoma of the cervix is often considered to be a sexually transmitted disease associated with viral infection. Chlamydia trachomatis

herpes simplex

human papilloma

varicella zoster

3 A) B)

Pelvic inflammatory disease, an inflammation of the female upper reproductive tract, is caused by: chronic endometriosis. ruptured tubal pregnancy.

NURSING TEST BANK

STD polymicrobial infection.

serous luteal ovarian cysts.

Endometriosis is characterized by painful hemorrhagic lesions in the pelvis and complications that include: pelvic adhesions.

A) B)

endometrial cancer.

candidiasis vaginitis.

bladder herniation.

5 A)

Leiomyomas are smooth muscle fibroid tumors that usually develop in: fibrocystic breasts.

postmenopause.

C) D)

uterosacral ligaments. the corpus of the uterus.

Symptoms of difficulty in emptying the bladder, frequency, and urgency of urination are common in women with:

A) B)

rectocele. cystocele.

endometritis.

prolapsed uterus.

Although there are no effective screening methods for ovarian cancer, and early symptoms are usually absent, there are highrisk indicators that include:

A) B)

nulliparity. lactation.

mammary duct ectasia.

oral contraceptive use. NURSING TEST BANK

A) B) C) D)

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

In the lactating woman, mastitis is usually the result of:

A) B)

intraductal papillomas. secretory cell hyperplasia.

C) D)

fibrocystic tissue changes. ascending bacterial infection.

Women are screened regularly for risk factors and manifestations of breast cancer. High-risk women may have a history of: late menopause.

A) B)

leiomyoma tumors.

STDs and vaginitis.

multiple pregnancies.

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

Vulvar pain

Purulent discharge

Urinary incontinence

Open lesions on the surface of the vulva

NURSING TEST BANK

A 21-year-old college student has sought care because of the vaginal burning, itching, and redness that have become worse in recent weeks. Which of the clinicians assessment questions is most likely to apply to a diagnosis of vaginitis?

Have your periods been regular in the last few months? Have you ever had a sexually transmitted infection?

B) C) D)

Are you using oral contraceptives? Have you ever been pregnant?

A) B)

A 29-year-old patient had a Papanicolaou smear performed during her most recent visit to her primary care provider. This diagnostic procedure aims to identify: dysplastic cervical cells. human papillomavirus (HPV) antibodies.

C) D)

cervical polyps. lesions at the transformation zone.

14 A)

Which of the following physiologic processes is caused by estrogens? Increased release of gonadotropin-releasing hormone (GnRH)

Stimulation of lactation in the postpartum period

Promotion of ovarian follicle growth

Progesterone synthesis

Which of the following disorders of the female genitourinary system is most likely to result from a disruption in normal endocrine function? Ovarian cancer NURSING TEST BANK

Pelvic inflammatory disease (PID)

C) D)

Polycystic ovary syndrome (PCOS) Cervicitis

Which of the following complaints by middle-aged women should prompt a care provider to rule out the possibility of ovarian cancer? Im having a lot of vaginal discharge lately and its quite foul.

My periods have become quite irregular since last winter.

I have a sharp, stabbing pain on my side for the last few days. Im having a lot of indigestion and bloating, which are both new to me.

D) 17

A) B) C) D) 18

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

Which of the following processes is a component of the pathogenesis of proliferative breast lesions without atypia? Growth of ductile or lobular epithelial cells

Cystic dilation of terminal ducts NURSING TEST BANK

Increase in fibrous breast tissue

Fat necrosis leading to lesion formation

Which of the following physiologic changes results in menopause?

Changes in anterior pituitary function that alter ovarian hormone production

Gradual resistance of ovarian target cells to LH and FSH stimulation

Cessation of ovarian function and decreased estrogen levels

Decreased levels of gonadotropin-releasing hormone (GnRH)

A 59-year-old woman with a recent diagnosis of breast cancer has begun a course of hormone therapy. What is the goal of this pharmacologic treatment?

Blocking the effects of progesterone on tumor growth Increasing serum hormone levels to promote tumor cell lysis

B) C)

Blocking the entry of malignant cells into the axillary lymph nodes Blocking receptors on the surface of malignant cells

D) Answer Key

2 3

C C

D NURSING TEST BANK

A C

8 9 10

D A

A C

14 15 16

C D

Chapter 20. Endocrine System

1 A)

A predominant effect of a prolonged excessive growth hormone level is: short stature with obesity.

high androgen hormone levels.

increased blood glucose levels.

insulin-like growth factor (IGF) depletion.

The most common cause of hypothyroidism is:

goiter.

myxedema.

thyroidectomy. NURSING TEST BANK

autoimmune thyroiditis.

Thyroid hormone deficit , which alters the function of all major organs in the body.

A) B)

decreases metabolism increases protein synthesis

causes vitamin deficiencies

enhances absorption of glucose

The most common cause of thyrotoxicosis is Graves disease, which has the distinguishing characteristic of in addition to a diffuse goiter.

muscle fatigue

facial myxedema

ophthalmopathy

decreased cholesterol

5 A)

The major adrenal cortical hormones are steroids and are synthesized from acetate and: ACTH.

B) C)

albumin. amino acids.

cholesterol.

6 A)

Primary adrenal insufficiency is manifested by: truncal obesity and edema.

B) C)

hypokalemia and hypervolemia. hyponatremia and hypoglycemia.

hypopigmentation and hypertension.

NURSING TEST BANK

A) B) C) D) 8

One of the earliest signs of Cushing syndrome is the loss of variable diurnal secretion of cortisol-releasing hormone (CRH) and: GH. TSH. DHEA. ACTH. The iatrogenic form of Cushing syndrome is caused by:

A) B)

long-term cortisone therapy. pituitary tumor-secreting ACTH.

C) D)

benign or malignant adrenal tumor. ectopic ACTH secreting lung tumor.

9 A)

The major manifestations of Cushing syndrome include: excessive salt loss.

muscle hypertrophy.

overt diabetes mellitus.

hair and weight loss.

The immune suppressive and anti-inflammatory effects of cortisol cause:

moderate insulin resistance.

increased capillary permeability.

increased cell-mediated immunity.

inhibition of prostaglandin synthesis.

11 A)

Which of the following individuals is experiencing the effects of a primary endocrine disorder? A patient with adrenal cortical insufficiency due to pituitary hyposecretion of ACTH NURSING TEST BANK

A patient who has hypothyroidism as a result of low TSH production

A patient whose dysfunctional hypothalamus has resulted in endocrine imbalances A patient who has low calcium levels because of the loss of his parathyroid gland

D) 12

Which of the following physiologic processes is a direct effect of the release of growth hormone by the anterior pituitary? Development of cartilage and bone

Production of insulin-like growth factors (IGFs) by the liver

Increase in overall metabolic rate and cardiovascular function Positive feedback of the hypothalamicpituitary-thyroid feedback system

D) 13 A) B) C) D) 14

Which of the following individuals displays the precursors to acromegaly? An adult with an excess of growth hormone due to an adenoma A girl who has been diagnosed with precocious puberty An adult who has a diagnosis of Cushing syndrome A patient who has recently developed primary adrenal carcinoma Which of the following residents of a long-term facility is exhibiting signs and symptoms that are indicative of hypothyroidism?

NURSING TEST BANK

An 80-year-old woman who has uncharacteristically lost her appetite of late and often complains of feeling cold

A 90-year-old woman with a history of atrial fibrillation whose arrhythmia has recently become more severe An 88-year-old man with a history of Alzheimer disease who has become increasingly agitated and is wandering more frequently

D) 15

A 91-year-old man with a chronic venous ulcer and a sacral ulcer who has developed sepsis Abnormal stimulation of the thyroid gland by TSH-receptor antibodies is implicated in cases of:

Cushing syndrome.

B) C)

Graves disease. Addison disease.

Cushing disease.

A patient has developed the facial appearance that is characteristic of myxedema, along with an enlarged tongue, bradycardia, and voice changes. Which of the following treatment modalities is most likely to benefit this patient?

A) B)

Synthetic preparations of T3 or T4

Corticosteroid replacement therapy

Oral or parenteral cortisol replacement

b-Adrenergic blocking drugs and antithyroid drugs

A 33-year-old patient has been admitted to the hospital for the treatment of Graves disease. Which of the following assessments should the patients care team prioritize? NURSING TEST BANK

Assessment of the patients level of consciousness and neurologic status

Assessment of the patients peripheral vascular system and assessing for thromboembolism Assessment of the patients vision and oculomotor function

C) D)

Cardiac monitoring and assessment of peripheral perfusion

A patient who has been taking 80 mg of prednisone, a glucocorticoid, each day has been warned by his primary care provider to carefully follow a plan for the gradual reduction of the dose rather than stopping the drug suddenly. What is the rationale for this directive?

Sudden changes in glucocorticoid dosing may reverse the therapeutic effects of the drug.

Stopping the drug suddenly may shock the HPA axis into overactivity. Sudden cessation of a glucocorticoid can result in adrenal gland necrosis.

C) D) 19

Stopping the drug suddenly may cause adrenal insufficiency. The signs and symptoms of abrupt cessation of pharmacologic glucocorticoids closely resemble those of:

A) B)

Addison disease. Cushing disease.

Cushing syndrome.

Graves disease.

Which of the following pathophysiologic phenomena may result in a diagnosis of Cushing disease?

NURSING TEST BANK

Hypopituitarism

B) C)

Excess ACTH production by a pituitary tumor Autoimmune destruction of the adrenal cortex

Malfunction of the HPA system

Answer Key

C D

7 8 9

A C

18 19

D A

Chapter 21. Bones, Joints, and Soft Tissue Tumors

NURSING TEST BANK

1 A) B) C) D) 2

Skeletal tissue contains intercellular collagen fibers that provide for tendons and ligaments. elastic recoil shape flexibility tensile strength inorganic calcium Cartilage is a firm but flexible type of connective tissue that is essential for:

A) B)

calcium salt storage. growth of long bones.

C) D)

bone surface perfusion. reduced friction on tendons.

Whereas PTH increases blood calcium levels, the hormone lowers blood calcium levels and decreases bone resorption. vitamin D

A) B)

calcitonin

prolactin

phosphate

Cancellous bone is relatively light, but its lattice-like structure gives it:

rigidity.

thickness.

a growth plate.

tensile strength.

To maintain adequate serum calcium levels, parathyroid hormone reduces: NURSING TEST BANK

activation of vitamin D.

B) C)

serum phosphate levels. calcium release from bone.

intestinal absorption of calcium.

In contrast to synarthroses joints, synovial joints are linked to the bone by:

a joint capsule.

B) C)

hyaline cartilage. connective tissue.

interosseous ligaments.

The joint capsule consists of an outer fibrous layer and an inner synovium, which to facilitate movement.

A) B)

senses position connects to tendons

secretes synovial fluid

covers articular cartilage

The tendons and ligaments of the joint capsule are sensitive to position and movement as a result of having to help maintain muscle support. autonomic nerve fibers

supporting bursa sacs

reflexive proprioception

elastic articular cartilage

In growing bone, severe vitamin C deficiency slows bone growth by impairing:

organic matrix formation.

calcification of new bone. NURSING TEST BANK

growth plate separation.

widening of the cortex.

Bones are covered, except at their articular ends, by a membrane. canaliculi

A) B)

endosteum

synovial

periosteum

Which of the following is the primary role of fibrocartilage?

Absorption of physical shock

Provision of flexibility

C) D)

Facilitation of long bone growth Tissue hydration

Which of the following characteristics differentiates cartilage from bone?

A) B)

Secretion of an extracellular matrix Avascularity

Low tensile strength

Rapid healing

A long bone, such as the humerus of the upper arm, has which of the following structural characteristics?

A) B)

A perichondrium that overlies most of the bone surface A durable outer shell made of cancellous bone

A diaphysis at each end

An endosteum composed of osteogenic cells

NURSING TEST BANK

14 A) B) C) D) 15

Which of the following statements most accurately describes the anatomy and physiology of the bone marrow? Hematopoiesis takes place in red bone marrow. Yellow bone marrow predominates in infants. By adulthood, all red bone marrow has been replaced by yellow bone marrow. Yellow bone marrow is hematopoietically active in infants, but not in adults. What role do osteoblasts play in the physiology of bone tissue?

A) B)

Differentiation into mature bone cells Synthesis and secretion of bone matrix

C) D)

Maintenance of calcium balance Resorption of the bone matrix

An increase in the level of RANKL would result in:

fusing of the epiphysis and metaphysic in long bones.

changes in the rate of bone remodeling.

decreased production of PTH.

increased vitamin D activation.

How are the oxygenation needs of the articulating areas in a synovial joint met?

Capillaries release oxygenated blood into the synovial cavity at a controlled rate.

The cartilage of the articulating areas uses anaerobic metabolism exclusively. Oxygen is provided to the articulating areas by synovial fluid rather than by blood.

NURSING TEST BANK

The epiphyses of long bones provide oxygen to the articulating areas.

Magnetic resonance imaging of a patients knee has revealed the presence of bursitis. What is the primary purpose of bursae?

To maintain close articulation between the two long bones at a synovial joint

To strengthen the attachment between skeletal muscles and bones

To strengthen the integrity of the articulating capsule

To prevent friction at a tendon in a synovial joint

A basketball player fell awkwardly when attempting to claim a rebound, a mishap that resulted in a tear to the anterior cruciate ligament of his left knee. What characteristic of ligaments makes them particularly susceptible to injury?

Ligaments are incapable of accommodating lateral movement.

Ligaments are exclusive to the knee, which is the most frequently injured joint. Ligaments are superficial to the synovial capsule and are consequently vulnerable to impacts.

Ligaments are incapable of stretching when exposed to unusual stress.

20 A)

Which of the following joints is classified as a synarthrosis? The joint between two vertebrae

The joint between the femur and the pelvis

NURSING TEST BANK

The joint between the humerus and the radius and ulna An interphalangeal joint of the hand (knuckle)

D) Answer Key

2 3

B B

C A

9 10 11

D A

Chapter 22. Peripheral Nerves and Muscles

NURSING TEST BANK

A) B) C) D) 2

More complex patterns of movements, such as throwing a ball or picking up a fork, are controlled by the cortex in the frontal lobe. premotor primary motor reflexive supplementary Disorders of the pyramidal tracts, such as a stroke, are characterized by:

A) B)

paralysis. hypotonia.

C) D)

muscle rigidity. involuntary movements.

Myasthenia gravis is characterized by muscle weakness caused by antibody-mediated destruction of: periorbital muscles.

A) B)

thymus gland cells.

skeletal muscle fibers.

acetylcholine receptors.

A patient has wrist inflammation causing compression of the median nerve in the carpal tunnel. Manifestations of this syndrome include:

little finger numbness.

forearm paresthesia.

loss of tendon reflexes.

precision grip weakness.

The cardinal symptoms of Parkinson disease include: NURSING TEST BANK

hypotonia.

B) C)

bradykinesia. paresthesia.

lack of sweating.

The patient has a traumatic complete spinal cord transection at the C5 level. Intact motor and somatosensory function will include control.

bladder

B) C)

finger flexion diaphragm

trunk muscle

Unlike disorders of the motor cortex and corticospinal (pyramidal) tract, lesions of the basal ganglia disrupt movement:

A) B)

without causing paralysis. posture and muscle tone.

and cortical responses.

of upper motor neurons.

8 A)

The demyelination and degeneration of nerve fibers characteristic of multiple sclerosis is the result of: decreased oligodendrocytes.

corticospinal injuries.

atherosclerotic destruction.

oligodendrocytic infection.

A sudden traumatic complete transection of the spinal cord results in below the level of injury.

flaccid paralysis NURSING TEST BANK

vasoconstriction

C) D)

deep visceral pain 3+ tendon reflexes

Autonomic dysreflexia (autonomic hyperreflexia) is characterized by: severe spinal shock.

A) B)

tachycardia and pale skin.

C) D)

lack of sweat above injury level. vasospasms and hypertension.

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

A) B) C)

Spasticity Tetany

Rigidity

An elderly patient has been brought to his primary care provider by his wife who is concerned about his recent decrease in coordination. Upon assessment, his primary care provider notes that the patients gait is wide-based, unsteady, and lacking in fluidity, although his muscle tone appears normal. This patient requires further assessment for which of the following health problems? Muscle atrophy

Cerebellar disorders

Impaired spinal reflexes

Lower motor neuron lesions

NURSING TEST BANK

Knowing that she is a carrier for Duchene muscular dystrophy (DMD), a pregnant woman arranged for prenatal genetic testing, during which her child was diagnosed with DMD. As her son develops, the woman should watch for which of the following early signs that the disease is progressing?

Impaired sensory perception and frequent wounds Spasticity and hypertonic reflexes

C) D)

Muscle atrophy with decreased coordination Frequent falls and increased muscle size

A) B) C) D) 15 A)

A patient with a diagnosis of myasthenia gravis has required a mastectomy for the treatment of breast cancer. The surgery has been deemed a success, but the patient has gone into a myasthenic crisis on postoperative day one. Which of the following measures should the care team prioritize in this patients immediate care? Positioning the patient to minimize hypertonia and muscle rigidity Seizure precautions Respiratory support and protection of the patients airway Monitoring the patient for painful dyskinesias Which of the following disorders of neuromuscular function typically has the most rapid onset? Duchenne muscular dystrophy (DMD)

Guillain-Barr syndrome

C) D)

Parkinson disease Myasthenia gravis

NURSING TEST BANK

A) B)

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

C) D)

A lower motor neuron lesion A vestibulocerebellar disorder

A patients recent diagnosis of Parkinson disease has prompted his care provider to promptly begin pharmacologic therapy. The drugs that are selected will likely influence the patients levels of: dopamine. acetylcholine.

A) B) C) D) 18

serotonin. adenosine.

A patient is devastated to receive a diagnosis of amyotrophic lateral sclerosis (ALS). The symptomatology of this disease is a result of its effects on: upper motor neurons.

the vestibulocerebellar system.

upper and lower motor neurons.

neuromuscular junctions.

Restoration of the integrity of myelin sheaths would likely result in a slowing or stopping of the progression of:

Amyotrophic lateral sclerosis (ALS)

Multiple sclerosis (MS) NURSING TEST BANK

Duchenne muscular dystrophy (DMD)

Paralysis caused by Clostridium botulinum

A patient with a spinal cord injury at T8 would likely retain normal motor and somatosensory function of her: arms.

A) B)

bowels.

bladder.

perineal musculature.

Answer Key

4 5

D B

8 9

A A

B D

13 14 15

C B

C NURSING TEST BANK

Page 1 Chapter 23. Central Nervous System

1 A) B)

The intracranial volume that is most capable of compensating for increasing intracranial pressure is the: brain cell tissue. intravascular blood.

surface sulci fluid.

cerebrospinal fluid.

A late indicator of increased intracranial pressure is:

tachycardia.

right-sided heart failure.

C) D)

narrow pulse pressure. high mean arterial pressure.

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

A) B)

hydrocephalus. cardiac arrest.

tissue infarction.

intracranial bleeding.

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

A) B)

diffuse axonal injuries. cerebrovascular infarction.

momentary unconsciousness. NURSING TEST BANK

permanent brain tissue damage.

An intracranial epidural hematoma causes focal symptoms that can include:

A) B)

ipsilateral pupil dilation. ipsilateral hemiparesis.

diffuse venous bleeding.

commuting hydrocephalus.

The earliest signs of decreased level of consciousness include:

stupor.

lethargy.

delirium.

inattention.

7 A)

Metabolic factors that increase cerebral blood flow include: increased oxygen saturation.

B) C)

increased carbon dioxide level. decreased serum sodium level.

decreased hydrogen ion concentration.

Transient ischemic attacks (TIAs) are characterized by ischemic cerebral neurologic deficits that: indicate aneurysm leakage.

A) B) C)

cause minor residual deficits. affect diffuse cerebral functions.

resolve within one hour of onset.

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

NURSING TEST BANK

petechiae.

C) D)

papilledema. focal paralysis.

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

incontinence.

C) D)

decreased level of consciousness. social withdrawal.

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

B) C)

Placement of a shunt

Lumbar puncture

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

Recurrent nosebleeds and hypersomnia

Unilateral weakness and decreased coordination Neck pain and decreased neck range of motion

NURSING TEST BANK

A) B) C)

D) 14

A) B) C) D) 15

A) B)

An elderly male patient has been brought to the emergency department after experiencing stroke-like symptoms a few hours ago, and has been subsequently diagnosed with an ischemic stroke. The care team is eager to restore cerebral perfusion despite the likely death of the brain cells directly affected by the stroke. What is the rationale for the care teams emphasis on restoring circulation? Failure to restore blood flow creates a severe risk for future transient ischemic attacks. Necrosis will continue unabated throughout the brain unless blood flow is restored. Cells of the penumbra may be saved from hypoxic damage if blood flow is promptly restored. Unless blood flow is restored, the patient faces the risk of progressing to hemorrhagic stroke. A patients emergency magnetic resonance imaging (MRI) has been examined by the physician and tPA has been administered to the patient. What was this patients most likely diagnosis? Status epilepticus Subarachnoid hemorrhage Ischemic stroke Encephalitis A patient has been diagnosed with a cerebral aneurysm and placed under close observation before treatment commences. Which of the following pathophysiologic conditions has contributed to this patients diagnosis? Weakness in the muscular wall of an artery Impaired synthesis of clotting factors NURSING TEST BANK

C) D) 16

Deficits in the autonomic control of blood pressure Increased levels of cerebrospinal fluid Which of the following pathophysiologic processes occurs in cases of bacterial meningitis?

Infection in the cerebrospinal fluid causes vasoconstriction and cerebral hypoxia.

Trauma introduces skin-borne pathogens to the cerebrospinal fluid.

Infection in the cerebrospinal fluid causes spinal cord compression and neurologic deficits. Inflammation allows pathogens to cross into the cerebrospinal fluid.

D) 17

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

An 88-year-old man who has begun displaying signs and symptoms of increased ICP A 60-year-old woman who is soon to begin radiation therapy for the treatment of breast cancer

C) D) 18

A 4-year-old child who has become uncoordinated in recent months A 68-year-old man who is a smoker and has a family history of cancer A patient with a history of a seizure disorder has been observed suddenly and repetitively patting his knee. After stopping this repetitive action, the patient appears confused and is oriented to person and place but not time. What type of seizure did this patient most likely experience? NURSING TEST BANK

Simple partial seizure

B) C)

Atonic seizure Myoclonic seizure

Complex partial seizure

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

Alzheimer disease.

B) C)

frontotemporal dementia (FTD). vascular dementia.

Wernicke-Korsakoff syndrome.

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

Im really hoping these medications will slow down her mental losses. Were both holding out hope that this medication will cure her Alzheimers.

B) C)

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

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

Answer Key

A NURSING TEST BANK

A D

6 7 8

B D

B A

12 13 14

C C

C D

18 19 20

C A

Chapter 24. Skin

1 A)

Manifestations of superficial dermatophytosis of the skin include: scaling.

erythema.

vesicles.

infiltration.

Onychomycosis initially causes the toenail to appear the fungus digests the nail keratin. NURSING TEST BANK

black

B) C)

cracked opaque

eroded

A yeast-like Candida albicans fungal infection can be differentiated from a tinea fungal infection by the presence of:

circular patches.

B) C)

satellite lesions. fungal spores.

raised borders.

Warts develop when papillomavirus (HPV).

are invaded by human

A) B)

melanocytes keratinocytes

sebaceous glands

subcutaneous cells

Allergic and hypersensitivity dermatoses are characterized by:

target lesions.

dark erythema.

epidermal edema.

silver-white scale.

Papulosquamous dermatoses, such as psoriasis, are a group of skin disorders characterized by:

scaling papules.

granular scabbing.

raised red borders.

nodular ulcerations. NURSING TEST BANK

7 A) B)

A thermal burn described as involving the entire epidermis and dermis is classified as: full third-degree. deep first-degree.

C) D)

partial second-degree. full-thickness second-degree.

The main cause of decubitus ulcers (bedsores) is impairs the flow of blood and lymph.

A) B)

external pressure shearing forces

C) D)

tissue edema thrombosis

9 A)

Dysplastic nevi are precursors of malignant melanoma that are: larger than other nevi.

oval epidermal nests.

dermal cords of cells.

brown rounded papules.

Which one of the following skin disorders seen in elderly persons is considered a premalignant lesion?

Cherry angiomas

Actinic keratosis

Solar lentigines

Telangiectases

11 A)

that

Which of the following disorders of the skin is most likely to respond to treatment with systemic antibiotics? Acne vulgaris NURSING TEST BANK

Urticaria

C) D)

Atopic dermatitis Verrucae

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

an IgE-mediated immune reaction.

hormonal influences on sebaceous gland activity. human papillomaviruses (HPV).

D) 13

A) B) C)

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

The presence of diffuse lesions and skin sloughing on the patients mucous membranes

A mans winter vacation to a tropical destination has been accompanied by repeated sunburns. What process accounts for the damaging effects of the suns radiation? Initiation of an autoimmune response

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Compensatory increases in melanin production

Damage to epidermal cell DNA and free radical production Hyperkeratinization and the formation of microscopic, subcutaneous lesions

D) 15

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

hemodynamic instability.

C) D)

acute pain. decreased protein synthesis and impaired healing.

A 79-year-old patient has been confined to bed after a severe hemorrhagic stroke that has caused hemiplegia. Which of the following measures should his care team prioritize in the prevention of pressure ulcers? Prophylactic antibiotics

B) C)

Repositioning the patient on a scheduled basis

Parenteral nutrition

17 A)

Applying protective dressings to vulnerable areas Which of the following actions involves the greatest risk of skin shearing? Inserting a peripheral intravenous catheter

Rolling the patient from a supine to side-lying position

Pulling the patient up in bed NURSING TEST BANK

Helping the patient ambulate after surgery

What neoplasm of the skin is associated with the poorest prognosis?

A) B)

Malignant melanoma Basal cell carcinoma

Intraepidermal squamous cell carcinoma

Invasive squamous cell carcinoma

The transition of a melanoma from radial growth to vertical growth is associated with:

A) B)

failure of the integrity of the basement membrane. involvement of the nonkeratinizing cells.

spontaneous resolution.

an increased risk of metastasis.

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

A) B) C)

Lichen planus Rosacea

Impetigo

Answer Key

1 2

A C

B NURSING TEST BANK

C A

6 7 8

D A

A A

12 13 14

D C

C A

18 19 20

D A

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