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Applied Pathophysiology A Conceptual Approach to the Mechanisms of Disease 3rd Edition Braun TEST BANK

Applied Pathophysiology A Conceptual Approach to the
Mechanisms of Disease 3rd Edition Braun Test Bank
Chapter 1Introduction to Pathophysiology
1. The nucleus _________, which is essential for function and survival of the cell.
A) is the site of protein synthesis
B) contains the genetic code
C) transforms cellular energy
D) initiates aerobic metabolism
2. Although energy is not made in mitochondria, they are known as the power
plants of the cell because they:
A) contain RNA for protein synthesis.
B) utilize glycolysis for oxidative energy.
C) extract energy from organic compounds.
D) store calcium bonds for muscle contractions.
3. Although the basic structure of the cell plasma membrane is formed by a lipid
bilayer, most of the specific membrane functions are carried out by:
A) bound and transmembrane proteins.
B) complex, long carbohydrate chains.
C) surface antigens and hormone receptors.
D) a gating system of selective ion channels.
4. To effectively relay signals, cell-to-cell communication utilizes chemical
messenger systems that:
A) displace surface receptor proteins.
B) accumulate within cell gap junctions.
C) bind to contractile microfilaments.
D) release secretions into extracellular fluid.
5. Aerobic metabolism, also known as oxidative metabolism, provides energy by:
A) removing the phosphate bonds from ATP.
B) combining hydrogen and oxygen to form water.
C) activating pyruvate stored in the cytoplasm.
D) breaking down glucose to form lactic acid.
6. Exocytosis, the reverse of endocytosis, is important in _______ into the
extracellular fluid.
A) Engulfing and ingesting fluid and proteins for transport
B) Killing, degrading, and dissolving harmful microorganisms
C) Removing cellular debris and releasing synthesized substances
D) Destruction of particles by lysosomal enzymes for secretion
7. The process responsible for generating and conducting membrane potentials is:
A) diffusion of current-carrying ions.
B) millivoltage of electrical potential.
C) polarization of charged particles.
D) ion channel neurotransmission.
8. Epithelial tissues are classified according to the shape of the cells and the
number of layers. Which of the following is a correctly matched description
and type of epithelial tissue?
A) Simple epithelium: cells in contact with intercellular matrix; some do not
extend to surface
B) Stratified epithelium: single layer of cells; all cells rest on basement
C) Glandular epithelium: arise from surface epithelia and underlying
connective tissue
D) Pseudostratified epithelium: multiple layers of cells; deepest layer rests on
basement membrane
9. Connective tissue contains fibroblasts that are responsible for:
A) providing a fibrous framework for capillaries.
B) synthesis of collagen, elastin, and reticular fibers.
C) forming tendons and the fascia that covers muscles.
D) filling spaces between tissues to keep organs in place.
10. Although all muscle tissue cells have some similarities, smooth muscle (also
known as involuntary muscle) differs by:
A) having dense bodies attached to actin filaments.
B) containing sarcomeres between Z lines and M bands.
C) having rapid contractions and abundant cross-striations.
D) contracting in response to increased intracellular calcium.
11. Which of the following aspects of the function of the nucleus is performed by
ribosomal RNA (rRNA)?
A) Copying and carrying DNA instructions for protein synthesis
B) Carrying amino acids to the site of protein synthesis
C) Providing the site where protein synthesis occurs
D) Regulating and controlling protein synthesis
12. Breakdown and removal of foreign substances and worn-out cell parts are
performed by which of the following organelles?
A) Lysosomes
B) Golgi apparatus
C) Ribosomes
D) Endoplasmic reticulum (ER)
13. Impairment in the function of peroxisomes would result in:
A) inadequate sites for protein synthesis.
B) an inability to transport cellular products across the cell membrane.
C) insufficient energy production within a cell.
D) accumulation of free radicals in the cytoplasm.
14. After several months of trying to conceive, a couple is undergoing fertility
testing. Semen analysis indicates that the mans sperm have decreased motility,
a finding that is thought to underlie the couples inability to become pregnant.
Which of the following cellular components may be defective within the mans
A) Ribosomes
B) Microtubules
C) Mitochondria
D) Microfilaments
15. Which of the following statements is true of glycolysis?
A) Glycolysis requires oxygen.
B) Glycolysis occurs in cells without mitochondria.
C) Glycolysis provides the majority of the bodys energy needs.
D) Glycolysis produces energy, water, and carbon dioxide.
16. Which of the following membrane transport mechanisms requires the greatest
amount of energy?
A) Facilitated diffusion
B) Passive transport
C) Vesicular transport
D) Simple diffusion
17. A male patient with a diagnosis of type 1 diabetes mellitus is experiencing
hyperglycemia because he lacks sufficient insulin to increase the availability of
glucose transporters in his cell membranes. Consequently, his cells lack
intracellular glucose and it accumulates in his blood. Which of the following
processes would best allow glucose to cross his cell membranes?
A) Facilitated diffusion
B) Simple diffusion
C) Secondary active transport
D) Endocytosis
18. Which of the following statements is true of skeletal muscle cells?
A) Skeletal muscle cells each have an apical, lateral, and basal surface.
B) They are closely apposed and are joined by cell-to-cell adhesion
C) Their basal surface is attached to a basement membrane.
D) Skeletal muscle is multinucleated, lacking true cell boundaries.
19. Which of the following body tissues exhibits the highest rate of turnover and
A) The squamous epithelial cells of the skin
B) The connective tissue supporting blood vessels
C) The skeletal muscle that facilitates movement
D) The nervous tissue that constitutes the central nervous system
20. A patient with a pathophysiologic condition that affects the desmosomes is
most likely to exhibit:
A) impaired contraction of skeletal and smooth muscle.
B) weakness of the collagen and elastin fibers in the extracellular space.
C) impaired communication between neurons and effector organs.
D) separation at the junctions between epithelial cells.
Answer Key
1. B
2. C
3. A
4. D
5. B
6. C
7. A
8. C
9. B
10. A
11. C
12. A
13. D
14. B
15. B
16. C
17. A
18. D
19. A
20. D
Chapter 2 Altered Cells and Tissues
1. Ischemia and other toxic injuries increase the accumulation of intracellular
calcium as a result of:
A) release of stored calcium from the mitochondria.
B) improved intracellular volume regulation.
C) decreased influx across the cell membrane.
D) attraction of calcium to fatty infiltrates.
2. 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.
A) metaplasia
B) organ atrophy
C) compensatory hyperplasia
D) physiologic hypertrophy
3. 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.
A) caspase activation
B) coagulation necrosis
C) rapid phagocytosis
D) protein p53 deficiency
4. Bacteria and viruses cause cell damage by _______, which is unique from the
intracellular damage caused by other injurious agents.
A) disrupting the sodium/potassium ATPase pump
B) interrupting oxidative metabolism processes
C) replicating and producing continued injury
D) decreasing protein synthesis and function
5. 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:
A) destroying phospholipids in the cell membrane.
B) altering the immune response of the cell.
C) disrupting calcium storage in the cell.
D) inactivation of enzymes and mitochondria.
6. Injured cells have impaired flow of substances through the cell membrane as a
result of:
A) increased fat load.
B) altered permeability.
C) altered glucose utilization.
D) increased surface receptors.
7. Reversible adaptive intracellular responses are initiated by:
A) stimulus overload.
B) genetic mutations.
C) chemical messengers.
D) mitochondrial DNA.
8. Injured cells become very swollen as a result of:
A) increased cell protein synthesis.
B) altered cell volume regulation.
C) passive entry of potassium into the cell.
D) bleb formation in the plasma membrane.
9. 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:
A) rapid apoptosis.
B) cellular rupture.
C) shrinkage and collapse.
D) chronic inflammation.
10. A 99-year-old woman has experienced the decline of cell function associated
with age. A group of theories of cellular aging focus on programmed:
A) changes with genetic influences.
B) elimination of cell receptor sites.
C) insufficient telomerase enzyme.
D) DNA mutation or faulty repair.
11. 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
A) Impaired muscle cell metabolism resulting from metaplasia
B) Dysplasia as a consequence of inflammation during bone remodeling
C) Disuse atrophy of muscle cells during a prolonged period of immobility
D) Ischemic atrophy resulting from vascular changes while on bedrest
12. 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) changes in cell shape, size, and organization.
B) the presence of unexpected cell types.
C) ischemic changes in cell samples.
D) abnormally high numbers of cells in a specified field.
13. Which of the following pathophysiologic processes is most likely to result in
metastatic calcification?
A) Benign prostatic hyperplasia
B) Liver cirrhosis
C) Impaired glycogen metabolism
D) Hyperparathyroidism
14. 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?
A) Radiation stimulates pathologic cell hypertrophy and hyperplasia.
B) Radiation results in the accumulation of endogenous waste products in the
C) Radiation interferes with DNA synthesis and mitosis.
D) Radiation decreases the action potential of rapidly dividing cells.
15. The parents of a 4-year-old girl have sought care because their daughter has
admitted to chewing and swallowing imported toy figurines that have been
determined to be made of lead. Which of the following blood tests should the
care team prioritize?
A) White blood cell levels with differential
B) Red blood cell levels and morphology
C) Urea and creatinine levels
D) Liver function panel
16. 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?
A) Free radical injury
B) Hypoxia and ATP depletion
C) Interference with DNA synthesis
D) Impaired calcium homeostasis
17. Which of the following processes associated with cellular injury is most likely
to be reversible?
A) Cell damage resulting from accumulation of fat in the cytoplasm
B) Cellular changes as a result of ionizing radiation
C) Cell damage from accumulation of free radicals
D) Apoptosis
18. The extrinsic pathway of apoptosis can be initiated by:
A) damage to cellular DNA.
B) decreased ATP levels.
C) activation of the p53 protein.
D) activation of death receptors on the cell surface.
19. 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?
A) Inappropriate activation of apoptosis
B) Bacterial invasion
C) Impaired arterial blood supply
D) Metaplastic cellular changes
20. Which of the following facts underlies the concept of replicative senescence?
A) Genes controlling longevity are present or absent in varying quantities
among different individuals.
B) Telomeres become progressively shorter in successive generations of a
C) The damaging influence of free radicals increases exponentially in later
generations of a cell.
D) Aging produces mutations in DNA and deficits in DNA repair.
Answer Key
1. A
2. C
3. B
4. C
5. A
6. B
7. C
8. B
9. B
10. A
11. C
12. A
13. D
14. C
15. B
16. B
17. A
18. D
19. C
20. B
Chapter 3 Inflammation and Tissue Repair
1. The characteristic, localized cardinal signs of acute inflammation include:
A) fever.
B) fatigue.
C) redness.
D) granuloma.
2. The vascular, hemodynamic stage of acute inflammation is initiated by
momentary vasoconstriction followed by vasodilation that causes localized:
A) bleeding.
B) congestion.
C) pale skin.
D) coolness.
3. 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
A) Basophils
B) Lymphocytes
C) Neutrophils
D) Platelets
4. The phagocytosis process involves three distinct steps. What is the initial step
in the process?
A) Engulfment
B) Intracellular killing
C) Antigen margination
D) Recognition and adherence
5. Which of the following mediators of inflammation causes increased capillary
permeability and pain?
A) Serotonin
B) Histamine
C) Bradykinin
D) Nitric oxide
6. Inflammatory exudates are a combination of several types. Which of the
following exudates is composed of enmeshed necrotic cells?
A) Serous
B) Fibrinous
C) Suppurative
D) Membranous
7. The acute-phase systemic response usually begins within hours of the onset of
inflammation and includes:
A) fever and lethargy.
B) decreased C-reactive protein.
C) positive nitrogen balance.
D) low erythrocyte sedimentation rate.
8. In contrast to acute inflammation, chronic inflammation is characterized by
which of the following phenomena?
A) Profuse fibrinous exudation
B) A shift to the left of granulocytes
C) Metabolic and respiratory alkalosis
D) Lymphocytosis and activated macrophages
9. Exogenous pyrogens (interleukin-1) and the presence of bacteria in the blood
lead to the release of endogenous pyrogens that:
A) stabilize thermal control in the brain.
B) produce leukocytosis and anorexia.
C) block viral replication in cells.
D) inhibit prostaglandin release.
10. 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) Outpouring of exudate into interstitial spaces
B) Chemotaxis
C) Accumulation of leukocytes along the epithelium
D) Phagocytosis of cellular debris
11. Which of the following individuals most likely has the highest risk of
experiencing chronic inflammation?
A) A patient who has recently been diagnosed with type 2 diabetes
B) A patient who is a carrier of an antibiotic-resistant organism
C) A patient who is taking oral antibiotics for an upper respiratory infection
D) A patient who is morbidly obese and who has a sedentary lifestyle
12. Which of the following core body temperatures is within normal range?
A) 35.9C (96.6F)
B) 38.0C (100.4F)
C) 35.5C (95.9F)
D) 37.3C (99.1F)
13. 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?
A) Opening of arteriovenous (AV) shunts
B) Reduced exhalation of warmed air
C) Contraction of pilomotor muscles
D) Decreased urine production
14. 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?
A) Evaporation and conduction
B) Radiation and convection
C) Conduction and convection
D) Convection and evaporation
15. Which of the following pathophysiologic processes are capable of inducing the
production of pyrogens? Select all that apply.
A) Acute inflammation
B) Obesity
C) Myocardial infarction
D) Malignancy
E) Renal failure
16. Which of the following patients is most likely to be susceptible to developing a
neurogenic fever?
A) A patient who has stage II Alzheimer disease
B) A patient who has sustained a head injury in a bicycle crash
C) A patient who has become delirious after the administration of a
D) A patient who has begun taking a selective serotonin-reuptake inhibitor
(SSRI) for the treatment of depression
17. 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?
A) Temperatures in excess of 37.5C (99.5F) can result in seizure activity.
B) Lower temperatures inhibit the protein synthesis of bacteria.
C) There is little empirical evidence for this treatment modality.
D) Most common antipyretics have been shown to have little effect on core
18. 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?
A) Recurrent fever
B) Remittent fever
C) Sustained fever
D) Intermittent fever
19. 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?
A) The immature hypothalamus is unable to perform normal
B) Infants are susceptible to serious infections because of their decreased
immune function.
C) Commonly used antipyretics often have no effect on the core temperature
of infants.
D) Fever in neonates is often evidence of a congenital disorder rather than an
20. 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?
A) Disturbance in the functioning of the thermoregulatory center
B) Increased heat loss by evaporation
C) The presence of comorbidities that are associated with lowered core
D) Persistent closure of arteriovenous shunts
Answer Key
1. C
2. B
3. C
4. D
5. C
6. D
7. A
8. D
9. B
10. A
11. D
12. D
13. C
14. B
15. A, C, D
16. B
17. C
18. D
19. B
20. A
Chapter 4 Altered Immunity
1. The mediators involved in type I hypersensitivity allergic responses are
released from:
A) mast cells.
B) plasma cells.
C) monocytes.
D) arachidonic acid.
2. A genetically determined hypersensitivity to common environmental allergens
causes ___________ reactions, such as:
A) atopic; urticaria.
B) autoimmune; diarrhea.
C) IgM-mediated; infections.
D) delayed; poison ivy rash:
3. Mismatched blood transfusion reaction with hemolysis of blood cells is an
example of type II, _____ mediated hypersensitivity reaction.
A) T-cell
B) antibody
C) leukotriene
D) complement
4. Type III hypersensitivity immune responses can be harmful when immune
complex deposits in tissue activate ___________ that can directly damage area
A) inflammation
B) autoantibodies
C) cytotoxic cells
D) immunoglobulins
5. The mechanism by which humans recognize self-cells from non-self (antigens)-
cells is _________.
A) autoimmunity
B) self-tolerance
C) non-self anergy
D) immunocompatibility
6. Organ rejection is a complication of organ transplantation caused by recipient
immune cells:
A) destroying the host T cells.
B) attack on the donor cells.
C) combining with grafts HLA.
D) being recognized as foreign.
7. The leading cause of death for people with HIV is opportunistic ____________.
A) leukemia
B) tuberculosis
C) pneumonia
D) toxoplasmosis
8. Wasting syndrome, an AIDS-defining illness, is characterized by involuntary
weight loss of at least 10% of baseline body weight in the presence of:
A) diarrhea.
B) hypermetabolism.
C) weakness and fever.
D) glucose intolerance.
9. The window period of HIV infection refers to the period of time between
infection and:
A) transmission.
B) seroconversion.
C) initial symptoms.
D) antibody screening.
10. HIV-positive persons that display manifestations of laboratory category 3 or
clinical category C are considered to have:
A) zero viral load.
B) seroconversion.
C) complete remission.
D) AIDS-defining illnesses.
11. Contact with poison ivy has resulted in intense pruritus, erythema, and weeping
on a patients forearm. Which of the following processes resulted in the patients
signs and symptoms?
A) IgE-mediated mast cell degranulation
B) Formation of antigen-antibody complexes
C) Cytokine release by sensitized T cells
D) Formation of antibodies against cell surface antigens
12. A patient with a long history of hay fever has recently begun a series of
immunotherapy (allergy shots). How will this treatment potentially achieve a
therapeutic effect?
A) By blocking cytokine release from sensitized mast cells
B) By preventing mast cells from becoming sensitized
C) By causing T cells to be sequestered in the thymus for longer periods
D) By stimulating production of IgG to combine with antigens
13. A patient with a diagnosis of cirrhosis has experienced an acute rejection of a
donor liver. Which of the following cells is central to the rejection of the
patients transplanted organ?
A) Natural killer cells
B) Mast cells
C) T cells
D) Neutrophils
14. A patient with a diagnosis of aplastic anemia has undergone allogenic bone
marrow transplantation. Which of the following signs and symptoms would
most clearly suggest the existence of graft-versus-host disease (GVHD)?
A) Shortness of breath, audible crackles, and decreasing PaO2
B) Presence of a pruritic rash that has begun to slough off
C) Development of metabolic acidosis
D) Diaphoresis, fever, and anxiety
15. A patient has developed pericarditis after developing acute glomerulonephritis,
a development that may be attributable to the presence of similar epitopes on
group A, b-hemolytic streptococci and the antigens in the patients heart tissue.
Which of the following has most likely accounted for this patients autoimmune
A) Breakdown of T-cell anergy
B) Release of sequestered antigens
C) Superantigens
D) Molecular mimicry
16. A 70-year-old female patient has had her mobility and independence
significantly reduced by rheumatoid arthritis. Which of the following processes
likely contributed to the development of her health problem?
A) Delayed-type hypersensitivity (DTH) reaction
B) Proliferation of cytotoxic T cells
C) Failure of normal self-tolerance
D) Deletion of autoreactive B cells
17. Which of the following would constitute a normal assessment finding in a
A) Minimal or absent levels of IgA and IgM
B) Absence of plasma cells in the lymph nodes and spleen
C) Undetectable levels of all immunoglobulins
D) Absence of mature B cells with normal T-cell levels and function
18. A patient was diagnosed as HIV positive several years ago. Which of the
following blood tests is most clinically useful for determining the stage and
severity of her disease?
A) Plasma levels
B) CD4+
cell counts
C) Viral load
D) White blood cell count with differential
19. A patient has been admitted to the hospital for the treatment of HIV infection,
which has recently progressed to overt AIDS. Which of the following nursing
actions should the nurse prioritize when providing care for this patient?
A) Frequent neurologic vital signs and thorough skin care
B) Hemodynamic monitoring and physical therapy
C) Careful monitoring of fluid balance and neurologic status
D) Astute infection control and respiratory assessments
20. Shortly after being diagnosed with HIV, a patient has begun highly active
antiretroviral therapy (HAART). What is the primary goal of the patients drug
A) To limit the latent period of HIV
B) To slow the progression of the disease
C) To minimize opportunities for transmission
D) To prevent seroconversion
Answer Key
1. A
2. A
3. B
4. A
5. B
6. B
7. B
8. A
9. B
10. D
11. C
12. D
13. C
14. B
15. D
16. C
17. A
18. B
19. D
20. B
Chapter 5 Infection
1. Although growth rate is variable among types of bacteria, the growth of
bacteria is dependent on:
A) biofilm communication.
B) availability of nutrients.
C) an intact protein capsid.
D) individual cell motility.
2. Treponema pallidum, the cause of syphilis, is a spirochete bacterium that is
spread from human to human by:
A) tick or lice vector bites.
B) direct physical contact.
C) exposure to infected urine.
D) inhaling airborne particles.
3. Chlamydiaceae, a rather common sexually transmitted infectious organism, has
characteristics of both viruses and bacteria. The infectious form of this
organisms life cycle is _______ until it enters the host cell.
A) an elementary body
B) adhered to cholesterol
C) propelled by filaments
D) encapsulated hyphae
4. Because dermatophytes are capable of growing _________, the infection is
mainly found on cutaneous surfaces of the body.
A) a powdery colony
B) in moist skin folds
C) on cooler tissue
D) branching filaments
5. Although both eukaryotes and prokaryotes are capable of causing infectious
diseases in humans, eukaryotes are unique because they have a distinct:
A) organized nucleus.
B) circular plasmid DNA.
C) cytoplasmic membrane.
D) variation of shape and size.
6. Whatever the mechanism of entry, the human-to-human transmission of
infectious agents is directly related to the:
A) source of contact.
B) site of infection.
C) number of pathogens absorbed.
D) virulence factors.
7. 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:
A) tissue inflammation and damage.
B) initial appearance of symptoms.
C) progressive pathogen elimination.
D) containment of infectious pathogens.
8. Although bacterial toxins vary in their activity and effects on host cells, a small
amount of gram-negative bacteria endotoxin:
A) is released during cell growth.
B) inactivates key cellular functions.
C) uses protein to activate enzymes.
D) in the cell wall activates inflammation.
9. Serology testing includes the measurement of which of the following?
A) Antibody titers
B) Culture growth
C) Direct antigens
D) DNA sequencing
10. Prions cause transmissible neurodegenerative diseases and are characterized by:
A) a lack of reproductive capacity.
B) hypermetabolism.
C) enzyme production.
D) chronic inflammation.
11. Which of the following individuals is experiencing a health problem that is the
result of a parasite?
A) A college student who contracted Chlamydia trachomatis during an
unprotected sexual encounter
B) A man who acquired malaria while on a tropical vacation
C) A hospital patient who has developed postoperative pneumonia
D) A woman who developed hepatitis A from eating at an unhygienic
12. Which of the following traits is characteristic of saprophytes?
A) They derive energy from decaying organic matter.
B) They are beneficial components of human microflora.
C) They have RNA or DNA, but never both.
D) They are capable of spore production.
13. A hospital patient was swabbed on admission for antibiotic-resistant organisms
and has just been informed that methicillin-resistant Staphylococcus aureus
(MRSA) is present in his groin. The patient has a normal core temperature and
white blood cell count. This patient is experiencing which of the following?
A) Infection
B) Proliferation
C) Colonization
D) Inflammation
14. 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?
A) Direct contact
B) Vertical transmission
C) Ingestion
D) Penetration
15. 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?
A) Endotoxins
B) Adhesion factors
C) Exotoxins
D) Evasive factors
16. 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
A) Antiviral therapy
B) Antibiotic therapy
C) Surgical draining
D) Pressure dressing
17. 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?
A) Detecting DNA sequences that are unique to the suspected pathogen
B) Growth of biofilms on various media in the laboratory setting
C) Quantification of IgG and IgM antibodies in the patients blood
D) Introduction of monoclonal antibodies to a blood sample from the patient
18. A patient has begun taking acyclovir, an antiviral medication, to control herpes
simplex outbreaks. What is this drugs mechanism of action?
A) Inhibition of viral adhesion to cells
B) Elimination of exotoxin production
C) Antagonism of somatic cell binding sites
D) Interference with viral replication processes
19. International travel has contributed to increased prevalence and incidence of
nonindigenous diseases by increasing which of the following?
A) Portals of entry
B) Sources of infection
C) Virulence
D) Disease course
20. A public health nurse should recognize that sexually transmitted infections
(STIs) are typically spread by which of the following mechanisms?
A) Penetration
B) Vertical transmission
C) Direct contact
D) Ingestion
Answer Key
1. B
2. B
3. A
4. C
5. A
6. C
7. B
8. D
9. A
10. A
11. B
12. A
13. C
14. D
15. C
16. C
17. D
18. D
19. B
20. C
Chapter 6 Genetic and Developmental Disorders
1. Genetic disorders that involve a single gene trait are characterized by:
A) multifactorial gene mutations.
B) chromosome rearrangements.
C) Mendelian patterns of transmission.
D) abnormal numbers of chromosomes.
2. In addition to having a 50% chance of inheriting an autosomal dominant
disorder from an affected parent, such a disorder is characterized by:
A) aneuploidy of genes in all cells.
B) deficiencies in enzyme synthesis.
C) affected X transmission to daughters.
D) varied gene penetration and expression.
3. Autosomal recessive disorders are characterized by:
A) age of onset later in life.
B) abnormal protein structure.
C) inborn errors of metabolism.
D) one in two risk of a carrier child.
4. When a male child inherits an X-linked disorder from his heterozygous carrier
A) his sons will be carriers.
B) his father has the disorder.
C) some of his sisters will be carriers.
D) his daughters will have the disorder.
5. Multifactorial inheritance disorders, such as cleft palate, are often caused
by____________ during fetal development.
A) multiple gene mutations
B) dominant gene expression
C) X-linked crossover problem
D) polyploidy of chromosomes
6. The newborn has the distinctive physical features of trisomy 21, Down
syndrome, which includes:
A) upward slanting of eyes.
B) large, protruding ears.
C) thin lips and small tongue.
D) long fingers with extra creases.
7. 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:
A) short-stature female individual..
B) mental retardation.
C) enlarged breasts.
D) early onset puberty.
8. A teratogenic environmental agent can cause birth defects when:
A) inherited as a recessive trait.
B) intense exposure occurs at birth.
C) disjunction occurs during meiosis.
D) retained during early pregnancy.
9. Fetal alcohol syndrome (FAS) is unlike other teratogens in that the harmful
effects on the fetus:
A) directly result in liver damage.
B) extend throughout the pregnancy.
C) is most noticeable in adulthood.
D) cause death in early childhood.
10. Prenatal diagnosis methods include the use of ultrasonography for identifying
________ abnormalities.
A) cytogenic
B) skeletal
C) chromosomal
D) a-fetoprotein
11. A woman who is a carrier for which of the following diseases possesses the
greatest likelihood of passing the disease to her future children when
heterozygous pairing exists?
A) Phenylketonuria (PKU)
B) Tay-Sachs disease
C) Neurofibromatosis
D) Cystic fibrosis
12. Which of the following statements is true of autosomal recessive disorders?
A) Onset is typically late in childhood or early in adulthood.
B) Symptomatology is less uniform than with autosomal dominant disorders.
C) Mitochondrial DNA is normally the site of genetic alteration.
D) Effects are typically the result of alterations in enzyme function.
13. 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?
A) Though you are both healthy, you likely both carry the gene for a cleft lip.
B) Provided one of you had the gene for a cleft lip, your baby likely faced a
50/50 chance of having one.
C) Your childs cleft lip likely results from the interplay between environment
and genes.
D) A cleft lip can sometimes result from taking prescription drugs, even when
theyre taken as ordered.
14. Which of the following practitioners is most likely to be of assistance in the
early care of an infant with a cleft lip?
A) Lactation consultant
B) Respiratory therapist
C) Occupational therapist
D) Social worker
15. A 41-year-old woman has made the recent decision to start a family, and is
eager to undergo testing 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?
A) Genetic testing of the woman
B) Genetic testing of the woman and the father
C) Prenatal blood tests
D) Ultrasonography
16. Genetic testing has revealed that a male infant has been born with an extra X
chromosome. What are the most likely implications of this finding?
A) The child is unlikely to survive infancy
B) The child is likely to have no manifestations of this chromosomal
C) The child will have significant neurological and cognitive defects
D) The child will be unable to reproduce
17. Which of the following variables determine the extent of teratogenic drug
effects? Select all that apply.
A) Maternal health history
B) Molecular weight of the drug
C) Stage of pregnancy when the drug was taken
D) Duration of drug exposure
E) Fetal blood type
18. 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?
A) Its likely best to eliminate alcohol from your diet while youre pregnant.
B) Moderation in alcohol use is critical while you are pregnant.
C) You should limit yourself to a maximum of one drink daily while youre
D) You should drink no alcohol until you are in your second trimester.
19. Which of the following health problems may be identified by a TORCH
screening test?
A) Rubella and herpes
B) Tenovaginitis and human papillomavirus
C) Rhinovirus and Ormond disease
D) Chlamydia and rickets
20. Ultrasonography is most likely to detect which of the following fetal
A) Neural tube defects
B) Skeletal abnormalities
C) Chromosomal defects
D) Single-gene disorders
Answer Key
1. C
2. D
3. C
4. C
5. A
6. A
7. A
8. D
9. B
10. B
11. C
12. D
13. C
14. A
15. C
16. B
17. B, C, D
18. A
19. A
20. B
Chapter 7 Altered Cellular Proliferation and Differentiation
1. Epithelialization, the first component of the proliferative phase of wound
healing, is delayed in open wounds until after ________ has formed.
A) granulation tissue
B) fibrinous meshwork
C) capillary circulation
D) collagenous layers
2. A mutation has occurred during mitosis of an individuals bone marrow cell.
This event may be the result of the failure of which of the following?
A) Progenitor cells
B) Fibroblasts
C) Stem cells
D) Cyclins
3. A patient has experienced a myocardial infarction with accompanying necrosis
of cardiac muscle, a permanent tissue. What are the ramifications of the fact
that cardiac muscle is a permanent tissue?
A) The cardiac muscle cells will remain perpetually in the G1 stage of mitosis.
B) Regeneration of the patients cardiac muscle will be exceptionally slow.
C) The necrotic cells will be replaced with muscle cells that have limited
D) The cells will not proliferate and will be replaced with scar tissue.
4. A couple have chosen to pay for the harvesting and storage of umbilical cord
blood after the delivery of their child to secure a future source of embryonic
stem cells. What is the most likely rationale for the couples decision?
A) The stem cells may be able to produce a wide range of body cells.
B) The embryonic stem cells allow stable and permanent tissues to enter
C) The stem cells can change the proliferative capacity of other cells.
D) The embryonic stem cells remove cyclin-dependent kinase inhibitors from
the body.
5. The basement membrane surrounding a patients foot wound remains intact, a
fact that bodes well for the wound-healing process. Which of the following
components constitute this form of the extracellular matrix? Select all that
A) Prostaglandins
B) Fibrous structural proteins
C) Lymphocytes
D) Water-hydrated gels
E) Glycoproteins
6. A nursing student is cleaning and changing the dressing on a patients sacral
ulcer. The student has vigorously cleansed the wound bed to remove all traces
of the beefy, red tissue that existed in the wound bed. The student has most
likely removed:
A) Necrotic tissue
B) Granulation tissue
C) Stem cells
D) The extracellular matrix
7. A 12-year-old boys severe wound that he received from a dog bite has begun to
heal and currently shows no signs of infection. Which of the following
processes occurred first during this process of repair by connective tissue
A) Reorganization of fibrous tissue
B) Angiogenesis
C) Emigration of fibroblasts to the wound site
D) Deposition of the extracellular matrix
8. Which of the following wounds is most likely to heal by secondary intention?
A) A finger laceration that a cook received while cutting up onions
B) A boys road rash that he got by falling off his bicycle
C) A needlestick injury that a nurse received when injecting a patients
D) The incision from a teenagers open appendectomy
9. A patient underwent an open cholecystectomy 4 days ago and her incision is
now in the proliferative phase of healing. What is the dominant cellular process
that characterizes this phase of the patients healing?
A) Hemostasis and vasoconstriction
B) Keloid formation
C) Collagen secretion by fibroblasts
D) Phagocytosis by neutrophils
10. Which of the following surgical patients is most likely to experience enhanced
wound healing as a result of his or her diet?
A) A patient who eats a high-calorie diet and large amounts of red meat
B) A patient who is a vegetarian and who eats organic foods whenever
C) A patient who practices carefully calorie control and who avoids animal
D) A patient who is receiving total parenteral nutrition due to recurrent nausea
11. Which of the following patients is most likely to experience impaired wound
A) A patient with a diagnosis of type 1 diabetes and a history of poor blood
sugar control
B) A child whose severe cleft lip and palate have required a series of surgeries
over several months
C) A patient who takes nebulized bronchodilators several times daily to treat
chronic obstructive pulmonary disease
D) A patient with persistent hypertension who takes a b-adrenergic blocker
and a potassium-wasting diuretic daily
Answer Key
1. A
2. D
3. D
4. A
5. B, D, E
6. B
7. B
8. B
9. C
10. A
11. A
Chapter 8 Altered Fluid, Electrolyte, and Acid-Base Balance
1. An injured patient develops interstitial edema as a result of decreased:
A) vascular volume.
B) hydrostatic pressure.
C) capillary permeability.
D) colloidal osmotic pressure.
2. The most reliable method for measuring body water or fluid volume increase is
by assessing:
A) tissue turgor.
B) intake and output.
C) body weight change.
D) serum sodium levels.
3. The syndrome of inappropriate ADH is characterized by:
A) increased osmolality.
B) excessive water thirst.
C) copious dilute urination.
D) dilutional hyponatremia.
4. In isotonic fluid volume deficit, changes in total body water are accompanied
A) intravascular hypotonicity.
B) increased intravascular water.
C) increases in intracellular sodium.
D) proportionate losses of sodium.
5. Hyponatremia can be caused by ______and manifested by _______.
A) hypovolemia; dehydration
B) third spacing; hypertonicity
C) water retention; hypotonicity
D) aldosterone excess; low ADH
6. One of the major causes of hyperkalemia is ____________, which alters
potassium elimination.
A) renal dysfunction
B) aldosterone excess
C) metabolic alkalosis
D) plasma albumin deficit
7. Hypoparathyroidism causes hypocalcemia by:
A) increasing serum magnesium.
B) increasing phosphate excretion.
C) blocking bone release of calcium.
D) blocking action of intestinal vitamin D.
8. Magnesium is important for the overall function of the body because of its
direct role in:
A) cell membrane permeability.
B) somatic cell growth control.
C) sodium and tonicity regulation.
D) DNA replication and transcription.
9. A patient has acidosis that is suspected to be respiratory in etiology. Which of
the following is the major cause of acute primary respiratory acidosis?
A) Decreased CO2 retention
B) Increased metabolic acids
C) Renal bicarbonate retention
D) Impaired alveolar ventilation
10. As other mechanisms prepare to respond to a pH imbalance, immediate
buffering is a result of increased:
A) intracellular albumin.
B) hydrogen/potassium binding.
C) sodium/phosphate anion absorption.
D) bicarbonate/carbonic acid regulation.
11. A patient with a diagnosis of liver cirrhosis secondary to alcohol use has a
distended abdomen as a result of fluid accumulation in his peritoneal cavity
(ascites). Which of the following pathophysiologic processes contributes to this
third spacing?
A) Abnormal increase in transcellular fluid volume
B) Increased capillary colloidal osmotic pressure
C) Polydipsia
D) Impaired hormonal control of fluid volume
12. A patient has been receiving intravenous normal saline at a rate of 125 mL per
hour since her surgery 2 days earlier. As a result of her consequent increase in
vascular volume, she has become edematous. Which of the following
phenomena accounts for this patients edema?
A) Obstruction of lymph flow
B) Increased capillary permeability
C) Decreased capillary colloidal osmotic pressure
D) Increased capillary filtration pressure
13. A patient with a diagnosis of schizophrenia has been admitted to the emergency
department after ingesting more than 2 gallons of water. Which of the
following pathophysiologic processes may result from the sudden water gain?
A) Hypernatremia
B) Water movement from the extracellular to intracellular compartment
C) Syndrome of inappropriate secretion of ADH (SIADH)
D) Isotonic fluid excess in the extracellular fluid compartment
14. Which of the following patients would likely be at highest risk of developing
A) A patient who has been admitted for the treatment of acute renal failure
following a drug overdose
B) A patient who has experienced an ischemic stroke with multiple sensory
and motor losses
C) An elderly patient who is experiencing vomiting and diarrhea as a result of
D) A patient whose thyroidectomy resulted in the loss of his parathyroid gland
15. A female patient with a history of chronic renal failure has developed
hypocalcemia. Which of the following assessment findings would provide
potential confirmation of this diagnosis?
A) The patient experiences shortness of breath on exertion with decreased
oxygen saturation levels.
B) The patient is difficult to rouse and is disoriented to time and place.
C) The patients heart rate is 120 beats per minute and she is diaphoretic
D) The patient has muscle spasms and complains of numbness around her
16. Which of the following assessments should be prioritized in the care of a
patient who is being treated for hypokalemia?
A) Detailed fluid balance monitoring
B) Arterial blood gases
C) Cardiac monitoring
D) Monitoring of hemoglobin levels and oxygen saturation
17. Magnesium is an important component of which of the following processes that
are integral to the maintenance of homeostasis? Select all that apply.
A) Intracellular and extracellular buffering
B) Cellular energy metabolism
C) Function of the sodium-potassium pump
D) Nerve conduction
E) Cell membrane function
18. A 77-year-old woman has been brought to the emergency department by her
daughter because of a sudden and unprecedented onset of confusion. The
patient admits to ingesting large amounts of baking soda since the morning in
an effort to treat indigestion. How will the womans body attempt to resolve this
disruption in acid-base balance?
A) Hyperventilation
B) Increasing renal H+ excretion
C) Increased renal HCO3 reabsorption
D) Hypoventilation
19. Arterial blood gases of a patient with a diagnosis of acute renal failure reveal a
pH of 7.25 (low), HCO3-of 21 mEq/L (low), decreased PCO2 accompanied by a
respiratory rate of 32 (high). What disorder of acid-base balance is the patient
most likely experiencing?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
20. A nurse who is providing care for a patient with a diagnosis of diabetes
insipidus should prioritize the close monitoring of serum levels of which of the
following electrolytes?
A) Potassium
B) Sodium
C) Magnesium
D) Calcium
Answer Key
1. D
2. C
3. D
4. D
5. C
6. A
7. C
8. D
9. D
10. D
11. A
12. D
13. B
14. A
15. D
16. C
17. B, C, D, E
18. D
19. A
20. B
Chapter 9 Altered Neuronal Transmission
1. The somatic nervous system provides sensory and motor innervation for:
A) peripheral nerves.
B) abdominal viscera.
C) secretory glands.
D) smooth muscle.
2. The proteins and other materials used by the axon are synthesized _____ and
then flow down the axon through its cytoplasm.
A) in the cell body
B) by Nissl bodies
C) through dendrites
D) across synapses
3. Supporting cells of the nervous system, such as Schwann cells, satellite cells,
and types of glial cells, function to provide neurons with:
A) local protection.
B) control functions.
C) membrane permeability.
D) integrative metabolism.
4. Neurons are characterized by the ability to communicate with other neurons
and body cells through:
A) astrocytes.
B) axon hillocks.
C) nodes of Ranvier.
D) action potentials.
5. Chemical synapses rely on ____ in order to provide communication between
A) diffusion
B) gap junctions
C) satellite cells
D) transmitter molecules
6. The blood-brain and CSF-brain barriers control the chemical environment of
the brain by allowing easy entrance to only a few chemicals that include:
A) oxygen.
B) protein.
C) glutamate.
D) potassium.
7. The perception of where a stimulus is in space and in relation to body parts is a
function of the:
A) occipital lobe.
B) parietal lobe.
C) hypothalamus.
D) prefrontal cortex.
8. The pia mater is a connective tissue sheath that covers the spinal cord and also
A) spinal fluid.
B) fibrocartilage.
C) blood vessels.
D) segmental nerves.
9. Which of the following is the neurotransmitter for most postganglion
sympathetic neurons?
A) Enkephalin
B) Glutamic acid
C) Catecholamines
D) Acetylcholine
10. In contrast to the sympathetic nervous system, the functions of the
parasympathetic nervous system include:
A) sweating.
B) anabolism.
C) pupil dilation.
D) vasoconstriction.
11. Which of the following substances provides the majority of the fuel needs of
the neurologic system?
A) Glycogen
B) Glucose
C) Amino acids
D) Triglycerides
12. A 60-year-old woman has been recently diagnosed with multiple sclerosis, a
disease in which the oligodendrocytes of the patients central nervous system
(CNS) are progressively destroyed. Which physiologic process within the
neurologic system is most likely be affected by this disease process?
A) Oxygen metabolism
B) Neurotransmitter synthesis
C) Nerve conduction
D) Production of cerebrospinal fluid
13. A neuron has been hyperpolarized. How will this affect the excitability of the
A) The neuron will have a membrane potential farther from the threshold.
B) The neuron will be more difficult to repolarize after firing.
C) The membrane potential of the neuron will be closer to the threshold.
D) The neurons excitability will be significantly increased.
14. A pregnant womans most recent ultrasound is suggestive of spina bifida, and
her primary care provider has subsequently order further diagnostic testing. The
pathophysiologic effects of this disease are due to:
A) malformation of the mesoderm.
B) abnormal closure of the neural tube.
C) lesions in the dorsal root ganglia.
D) hypertrophy of the primary vesicles.
15. Which of the following messages is most likely to be carried by general
somatic afferent (GSA) neurons?
A) The sensation of cold when touching ice
B) The message to move a finger and thumb
C) The message to move the larynx during speech
D) Information about the position of a joint
16. Which of the following processes is most likely to occur as a result of a spinal
A) Peristalsis of the small and large bowel
B) Control of oculomotor function in changing light levels
C) Pain sensation from a potentially damaging knee movement
D) Withdrawal of a hand from a hot stove element
17. A patient has required mechanical ventilation following a traumatic head injury
sustained in a motorcycle crash, during which he sustained damage to his
respiratory center. Which of the patients brain structures has been injured?
A) Brain stem
B) Midbrain
C) Diencephalon
D) Frontal lobe
18. A patient with a diagnosis of epilepsy has required surgical removal of part of
her prefrontal cortex. Which of the following effects should her family and care
team anticipate?
A) Lapses in balance and coordination
B) Deficits in regulation of the endocrine system
C) Sensory losses
D) Changes in behavior and judgment
19. A patients primary care provider has prescribed a b-adrenergic receptor
blocker. Which of the following therapeutic effects do the patient and care
provider likely seek?
A) Reduction in heart rate and blood pressure
B) Slowing of gastrointestinal motility
C) Increase in mental acuity
D) Decreased production of gastric acid
20. Neurotrophic factors contribute to the maintenance of homeostasis in which of
the following ways?
A) By catalyzing the effects of neurotransmitters
B) By increasing the sensitivity of receptors on postsynaptic cells
C) By promoting the growth and survival of neurons
D) By selectively increasing or decreasing the release of neurotransmitters
Answer Key
1. A
2. A
3. A
4. D
5. D
6. A
7. B
8. C
9. C
10. B
11. B
12. C
13. A
14. B
15. A
16. D
17. A
18. D
19. A
20. C
Chapter 10 Altered Sensory Function and Pain Perception
1. The somatosensory system consists of three types of sensory neurons. The
special somatic type of afferent sensory neurons has receptors that sense:
A) muscle position.
B) visceral fullness.
C) temperature.
D) painful touch.
2. Proprioceptive somatosensory information from the limbs and trunk is
transmitted by the:
A) reflexive networks.
B) dorsal root ganglion neurons.
C) anterolateral pathway.
D) trigeminal sensory neurons.
3. Full localization, discrimination of intensity, and interpretation of
somatosensory stimuli requires processing by the:
A) somatosensory cortex.
B) autonomic nervous system.
C) Ruffini end-organ receptors.
D) Pacinian corpuscle receptors.
4. What pain theory proposes that pain receptors share pathways with other
sensory modalities and that different activity patterns of the same neurons can
be used to signal painful or nonpainful stimuli?
A) Pattern
B) Specificity
C) Gate control
D) Neuromatrix
5. Nociceptors are sensory receptors that are activated by:
A) cortisol.
B) noxious stimuli.
C) pressure and touch.
D) sudden movements.
6. When a person is stung on the index finger by a bee, the thalamus interprets the
pain as:
A) somewhere on the hand.
B) a spot on the index finger.
C) attributable to a bee stung.
D) similar to a previous bee sting.
7. Pain assessment is likely to be most challenging when providing care for which
of the following older adult patients?
A) A 90-year-old patient who takes multiple medications for cardiac and
respiratory conditions
B) A 77-year-old man who has sustained burns on the lower part of his body
C) An 82-year-old woman who has been diagnosed with diabetes and an
anxiety disorder
D) An 87-year-old man with vascular dementia and numerous other health
8. In contrast to acute pain, persistent chronic pain:
A) serves as a warning system.
B) raises the pain threshold.
C) imposes physiologic stresses.
D) causes secondary reflexive spasms.
9. The sites of referred pain are determined by:
A) intensity-coding receptors.
B) location of the noxious stimuli.
C) visceral embryonic development.
D) stimulation that activates C fibers.
10. Complex regional pain syndrome is characterized by:
A) repetitious dermatome pain attacks.
B) trigeminal neuralgia with facial tics.
C) severe limb pain after amputation.
D) disproportionate pain with mobility.
11. An otherwise-healthy patient has been referred to a pain clinic because she
claims to experience exquisite pain from the friction of her clothes on her torso.
This patient is likely to be diagnosed with which of the following health
A) Visceral pain
B) Hypoalgesia
C) Allodynia
D) Primary hyperalgesia
12. A woman has cut her finger while dicing onions in the kitchen, causing her to
drop her knife in pain. Which of the following components of this pain signal
was transmitted by a third-order neuron?
A) The neurons between the womans finger and the womans spinal cord
B) The neurons between the thalamus and the cortex
C) The neurons between the CNS and the thalamus
D) The neurons of the efferent pathway that causes muscle contraction
13. A patient with a diagnosis of lung cancer has developed bone metastases
resulting in severe and protracted pain. Which of the following assessment
components should the nurse prioritize when assessing the patients pain?
A) The appearance of grimacing, guarding, or wincing
B) The presence of changes in vital signs that correspond to pain
C) The patients subjective report of the character and severity of pain
D) The results of a detailed neurologic assessment
14. A hospital patient has been reluctant to accept morphine sulfate despite visible
signs of pain. Upon questioning, the patient reveals that he is afraid of
becoming addicted to the drug. How can a member of the care team best
respond to the patients concern?
A) You might become addicted, but there are excellent resources available in
the hospital to deal with that development.
B) You should likely prioritize the control of your pain over any fears of
addiction that you have.
C) If you start needing higher doses to control your pain, then well address
those concerns.
D) Theres only a minute chance that you will become addicted to these
15. Which of the following patients may be experiencing the effects of neuropathic
A) A girl whose playground accident resulted in an arm fracture
B) A man with pain secondary to his poorly controlled diabetes
C) An elderly woman with a stage III pressure ulcer
D) A man whose pain is caused by gastric cancer
16. Which of the following statements is true of migraine headaches?
A) Non-pharmacologic treatments and lifestyle modifications can control
migraines in most patients.
B) Surgical treatments for migraines are indicated if pharmacologic
treatments are unsuccessful.
C) Migraines may have a hormonal etiology in some patients.
D) Opioid analgesics achieve adequate pain control in most patients.
17. Which of the following pain disorders is a manifestation of a disruption of
cranial nerve function?
A) Trigeminal neuralgia
B) Complex regional pain syndrome
C) Phantom limb pain
D) Temporomandibular joint (TMJ) syndrome
18. Which of the following characteristics differentiates a migraine with aura from
a migraine without aura?
A) Gastrointestinal involvement in the hours leading up to the headache
B) A decrease in mood and affect prior to the headache
C) Lack of response to non-pharmacologic treatments
D) Visual symptoms that precede the headache
19. A 44-year-old woman has sought care for the treatment of headaches that have
been increasing in severity and frequency, and has been subsequently
diagnosed with migraines. Which of the following teaching points should her
care provider emphasize?
A) Weight loss and exercise are very important components of your treatment.
B) Stopping all of your current medications, even temporarily, should provide
some relief.
C) It would be helpful for you to take control of your diet, sleep schedule, and
stress levels.
D) Your headaches are likely a result of nerve disorder and, unfortunately,
cannot be treated successfully.
20. Which of the following principles should underlie the pain control strategy in
the care of a child with a diagnosis of cancer?
A) Opioids should be avoided in order to prevent liver and kidney insult.
B) Dosing and timing should aim for a steady serum level of the drug that is
C) Doses of analgesia should be given only when the patients pain becomes
D) Drugs from numerous classifications should be used to maximize pain
Answer Key
1. A
2. B
3. A
4. A
5. B
6. A
7. D
8. C
9. C
10. D
11. C
12. B
13. C
14. D
15. B
16. C
17. A
18. D
19. C
20. B
Chapter 11 Altered Hormonal and Metabolic Regulation
1. A predominant effect of a prolonged excessive growth hormone level is:
A) short stature with obesity.
B) high androgen hormone levels.
C) increased blood glucose levels.
D) insulin-like growth factor (IGF) depletion.
2. The most common cause of hypothyroidism is:
A) goiter.
B) myxedema.
C) thyroidectomy.
D) autoimmune thyroiditis.
3. Thyroid hormone deficit ___________, which alters the function of all major
organs in the body.
A) decreases metabolism
B) increases protein synthesis
C) causes vitamin deficiencies
D) enhances absorption of glucose
4. The most common cause of thyrotoxicosis is Graves disease, which has the
distinguishing characteristic of _____ in addition to a diffuse goiter.
A) muscle fatigue
B) facial myxedema
C) ophthalmopathy
D) decreased cholesterol
5. The major adrenal cortical hormones are steroids and are synthesized from
acetate and:
B) albumin.
C) amino acids.
D) cholesterol.
6. Primary adrenal insufficiency is manifested by:
A) truncal obesity and edema.
B) hypokalemia and hypervolemia.
C) hyponatremia and hypoglycemia.
D) hypopigmentation and hypertension.
7. One of the earliest signs of Cushing syndrome is the loss of variable diurnal
secretion of cortisol-releasing hormone (CRH) and:
A) GH.
8. The iatrogenic form of Cushing syndrome is caused by:
A) long-term cortisone therapy.
B) pituitary tumor-secreting ACTH.
C) benign or malignant adrenal tumor.
D) ectopic ACTH secreting lung tumor.
9. The major manifestations of Cushing syndrome include:
A) excessive salt loss.
B) muscle hypertrophy.
C) overt diabetes mellitus.
D) hair and weight loss.
10. The immune suppressive and anti-inflammatory effects of cortisol cause:
A) moderate insulin resistance.
B) increased capillary permeability.
C) increased cell-mediated immunity.
D) inhibition of prostaglandin synthesis.
11. Which of the following individuals is experiencing the effects of a primary
endocrine disorder?
A) A patient with adrenal cortical insufficiency due to pituitary hyposecretion
B) A patient who has hypothyroidism as a result of low TSH production
C) A patient whose dysfunctional hypothalamus has resulted in endocrine
D) A patient who has low calcium levels because of the loss of his parathyroid
12. Which of the following physiologic processes is a direct effect of the release of
growth hormone by the anterior pituitary?
A) Development of cartilage and bone
B) Production of insulin-like growth factors (IGFs) by the liver
C) Increase in overall metabolic rate and cardiovascular function
D) Positive feedback of the hypothalamic-pituitary-thyroid feedback system
13. Which of the following individuals displays the precursors to acromegaly?
A) An adult with an excess of growth hormone due to an adenoma
B) A girl who has been diagnosed with precocious puberty
C) An adult who has a diagnosis of Cushing syndrome
D) A patient who has recently developed primary adrenal carcinoma
14. Which of the following residents of a long-term facility is exhibiting signs and
symptoms that are indicative of hypothyroidism?
A) An 80-year-old woman who has uncharacteristically lost her appetite of
late and often complains of feeling cold
B) A 90-year-old woman with a history of atrial fibrillation whose arrhythmia
has recently become more severe
C) An 88-year-old man with a history of Alzheimer disease who has become
increasingly agitated and is wandering more frequently
D) A 91-year-old man with a chronic venous ulcer and a sacral ulcer who has
developed sepsis
15. Abnormal stimulation of the thyroid gland by TSH-receptor antibodies is
implicated in cases of:
A) Cushing syndrome.
B) Graves disease.
C) Addison disease.
D) Cushing disease.
16. A patient has developed the facial appearance that is characteristic of
myxedema, along with an enlarged tongue, bradycardia, and voice changes.
Which of the following treatment modalities is most likely to benefit this
A) Synthetic preparations of T3 or T4
B) b-Adrenergic blocking drugs and antithyroid drugs
C) Corticosteroid replacement therapy
D) Oral or parenteral cortisol replacement
17. A 33-year-old patient has been admitted to the hospital for the treatment of
Graves disease. Which of the following assessments should the patients care
team prioritize?
A) Assessment of the patients level of consciousness and neurologic status
B) Assessment of the patients peripheral vascular system and assessing for
C) Assessment of the patients vision and oculomotor function

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