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Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function1 Table of Contents Table of Contents 1 Chapter 01 - Cell Structure and Function Chapter 02 - Cellular Responses to Stress, Injury, and Aging Chapter 03 - Inflammation, the Inflammatory Response, and Fever Chapter 04 - Cell Proliferation, Tissue Regeneration, and Repair Chapter 05 - Genetic Control of Cell Function and Inheritance Chapter 06 - Genetic and Congenital Disorders Chapter 07 - Neoplasia Chapter 08 - Disorders of Fluid, Electrolyte, and Acid-Base Balance Chapter 09 - Stress and Adaptation Chapter 10 - Disorders of Nutritional Status Chapter 11 - Disorders of White Blood Cells and Lymphoid Tissues Chapter 12 - Disorders of Hemostasis Chapter 13 - Disorders of Red Blood Cells Chapter 14 - Mechanisms of Infectious Disease Chapter 15 - Innate and Adaptive Immunity Chapter 16 - Disorders of the Immune Response Chapter 17 - Control of Cardiovascular Function Chapter 18 - Disorders of Blood Flow and Blood Pressure Chapter 19 - Disorders of Cardiac Function Chapter 20 - Heart Failure and Circulatory Shock Chapter 21 - Control of Respiratory Function Chapter 22 - Respiratory Tract Infections, Neoplasms, and Childhood Disorders Chapter 23 - Disorders of Ventilation and Gas Exchange Chapter 24 - Structure and Function of the Kidney Chapter 25 - Disorders of Renal Function Chapter 26 - Acute Kidney Injury and Chronic Kidney Disease Chapter 27 - Disorders of the Bladder and Lower Urinary Tract Chapter 28 - Structure and Function of the Gastrointestinal System Chapter 29 - Disorders of Gastrointestinal Function Chapter 30 - Disorders of Hepatobiliary and Exocrine Pancreatic Function Chapter 31 - Mechanisms of Endocrine Control Chapter 32 - Disorders of Endocrine Control of Growth and Metabolism Chapter 33 - Diabetes Mellitus and the Metabolic Syndrome Chapter 34 - Organization and Control of Neural Function Chapter 35 - Somatosensory Function, Pain, and Headache Chapter 36 - Disorders of Neuromuscular Function Chapter 37 - Disorders of Brain Function Chapter 38 - Disorders of Special Sensory Function Chapter 39 - Disorders of the Male Genitourinary System Chapter 40 - Disorders of the Female Genitourinary System Chapter 41 - Sexually T r a n s m i t t e d I n f e c t i o n s C h a p t e r 4 2 - S t r u c t u r e a n d Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function2 Function of the Skeletal System Chapter 43 - Disorders of the Skeletal System Chapter 44 - Disorders of the Skeletal System Chapter 45 - Structure and Function of the Integumentum Chapter 46 - Disorders of Skin Integrity and Function 2 8 15 22 26 32 38 45 52 59 65 72 79 86 93 100 107 113 120 127 134 140 147 153 160 166 173 180 187 193 199 206 212 219 225 231 238 245 251 257 263 269 275 282 288 294 5 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function 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: 6 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function 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 man’s sperm have decreased motility, a finding that is thought to underlie the couple’s inability to become pregnant. Which of the following cellular components may be defective within the man’s sperm? 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 body’s 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 7 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function 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 molecules. 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 renewal? 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 10 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function 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. 11 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function 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 patient’s decrease in muscle function that underlies her reduced mobility? 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. 12 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function 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 technician’s precautions? A) Radiation stimulates pathologic cell hypertrophy and hyperplasia. B) Radiation results in the accumulation of endogenous waste products in the cytoplasm. C) Radiation interferes with DNA synthesis and mitosis. D) Radiation decreases the action potential of rapidly dividing cells. 15. The parents of a 4-year-old girl have sought care because their daughter has admitted to chewing and swallowing imported toy figurines that have been determined to be made of lead. Which of the following blood tests should the care team prioritize? 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 15 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function 20. B 16 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function Chapter 03 - Inflammation, the Inflammatory Response, and Fever 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 numbers? 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 17 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function 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) Membran us 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 20 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function C) A patient who has become delirious after the administration of a benzodiazepine 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 37.5°C (99.5°F). Which of the following statements related to the rationale for this action is most accurate? A) Temperatures in excess of 37.5°C (99.5°F) 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 temperature. 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 thermoregulation. 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 infection. 20. An 84-year-old patient’s 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? 21 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function 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 temperature 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 22 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function 18. D 19. B 20. A 25 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function A) A finger laceration that a cook received while cutting up onions B) A boy’s road rash that he got by falling off his bicycle C) A needlestick injury that a nurse received when injecting a patient’s medication D) The incision from a teenager’s 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 patient’s 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 possible C) A patient who practices carefully calorie control and who avoids animal fats D) A patient who is receiving total parenteral nutrition due to recurrent nausea 11. Which of the following patients is most likely to experience impaired wound healing? A) 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 26 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function 1. A 2. D 3. D 4. A 5. B, D, E 6. B 7. B 8. B 9. C 10. A 11. A 27 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function Chapter 05 - Genetic Control of Cell Function and Inheritance 1. Triplet codes of three bases are the genetic codes used in transmitting genetic information necessary for: A) chromatin formation. B) protein synthesis. C) enzyme activation. D) nucleotide bonding. 2. Unlike messenger RNA (mRNA) and transfer RNA (tRNA), ribosomal RNA (rRNA): A) is produced in the nucleolus. B) delivers activated amino acids. C) is formed by transcription. D) coordinates RNA translation. 3. Splicing of mRNA during processing permits a cell to: A) form different proteins. B) increase DNA content. C) stop copying DNA onto RNA. D) add nucleic acid end pieces. 4. When an infant is born with gene mutations in his/her cells, the errors may be a result of all of the following except of base pairs. A) deletion B) substitution C) differentiation 30 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function B) mRNA provides the template for protein synthesis. C) Each mRNA molecule has two recognition sites. D) mRNA delivers the activated form of an amino acid to the protein being synthesized. 14. Prenatal genetic testing that counts the number of Barr bodies in a chromosome is able to determine: A) the genetic sex of a child. B) susceptibility to hemophilia B. C) the presence of fragile X syndrome. D) fetal viability. 15. The gene responsible for a particular congenital cardiac anomaly is said to have complete penetrance. What are the clinical implications of this fact? A) The anomaly is a result of polygenetic inheritance. B) The heart defect does not result from any other gene. C) Multiple alleles contribute to the defect. D) All the individuals who possess the gene will exhibit the anomaly. 16. A dominant genetic trait: A) is expressed only in a heterozygous pairing. B) is expressed in either a homozygous or heterozygous pairing. C) is expressed only in a homozygous pairing. D) is expressed in some carriers. 17. Which of the following methods of genetic mapping focuses on the measurement of enzyme activity? A) Hybridization studies B) Haplotype mapping 31 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function C) Linkage studies D) Gene dosage studies 18. Which of the following facts underlies the application of RNA interference in the treatment of disease? A) Restriction enzymes are able to cleave genetic molecules at predictable sites. B) It is possible to produce proteins that have therapeutic properties. C) Faulty gene activity that produces unwanted proteins can sometimes be stopped. D) Individual differences are attributable to a very small percentage of the genes in the human body. 19. Although the majority of cellular DNA exists in the cell nucleus, part of the cell DNA is located in the: A) mitochondria. B) Golgi apparatus. C) smooth endoplasmic reticulum. D) microfilaments. 20. Which of the following is an application of recombinant DNA technology? A) Production of human insulin B) DNA fingerprinting C) Gene dosage studies D) Somatic cell hybridization Answer Key 1. B 2. A 3. A 4. C 32 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function 5. A 6. B 7. D 8. A 9. B 10. B 11. C 12. D 13. B 14. A 15. D 16. B 17. D 18. C 19. A 20. A 35 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function 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 nurse’s following statements to the parents best conveys the probable cause of the infant’s cleft lip? 36 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function 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 child’s cleft lip likely results from the interplay between environment and genes. D) A cleft lip can sometimes result from taking prescription drugs, even when they’re 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 abnormality C) The child will have significant neurological and cognitive defects D) The child will be unable to reproduce 37 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function 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) It’s likely best to eliminate alcohol from your diet while you’re 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 you’re pregnant. 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 abnormalities? A) Neural tube defects B) Skeletal abnormalities C) Chromosomal defects D) Single-gene disorders 40 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function 5. The angiogenesis process, which allows tumors to develop new blood vessels, is triggered and regulated by tumor-secreted: A) procoagulants. B) growth factors. C) attachment factors. D) proteolytic enzymes. 6. Cancerous transformation of a cell requires the activation of: A) cell cycle apoptosis. B) multiple mutations. C) a single gene mutation. D) tumor suppressor genes. 7. Although clinical manifestations vary with the type of cancer and organs involved, abnormal tumor growth causes general manifestations that include: A) copious lymph flow. B) sleep disturbances. C) involuntary weight gain. D) visceral organ expansion. 8. Paraneoplastic syndromes are manifestations of cancer that often result from: A) radiation and chemotherapy. B) compression of area vessels. C) tumor-related tissue necrosis. D) inappropriate hormone release. 41 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function 9. Although both grading and staging are methods for classifying cancer and selecting a treatment plan, staging is used to determine the: A) number of mitoses. B) tissue characteristics. C) level of differentiation. D) extent of disease spread. 10. Early diagnosis of childhood cancers is often difficult because the signs and symptoms are: A) already present at birth. B) absent until the late stage. C) similar to those of other childhood diseases. D) seen as developmental delays. 11. A lung biopsy and magnetic resonance imagi g have confirmed the presence of a beni n lung tumor in a patient. Which of the following characteristics are associated with this patient’s neoplasm? A) The tumor will grow by expansion and is likely encapsulated. B) The cells that constitute the tumor are undifferentiated, with atypical structure. C) If left untreated, the patient’s tumor is likely to metastasize. D) The tumor is likely to infiltrate the lung tissue that presently surrounds it. 12. Which of the following processes characterizes an epigenetic contribution to oncogenesis? A) A DNA repair mechanism is disrupted. B) A tumor suppressor gene is present, but it is not expressed. C) Cells lose their normal contact inhibition. D) Regulation of apoptosis in impaired, resulting in accumulation of cancer cells. 13. A farmer’s 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 farmer’s lungs? 42 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function A) Promotion B) Progression C) Initiation D) Differentiation 14. Genetic screening may be indicated for individuals who have a family history of which of the following neoplasms? A) Liver cancer B) Multiple myeloma C) Leukemia D) Breast cancer 15. 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? A) Obesity can cause inflammation and hormonal changes that are associated with cancer. B) Adipose tissue is more susceptible to malignancy than other types of connective tissue. C) Increased cardiac workload and tissue hypoxia can interfere with normal cell differentiation. D) Increased numbers of body cells increase the statistical chances of neoplastic cell changes. 16. 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? A) As much as possible, try to eat organic foods. B) Regular vitamin supplements and a low-carbohydrate diet are beneficial. C) Try to minimize fat and maximize fiber when you’re planning your meals. D) Eat enough fiber in your diet that you have bowel movement at least once daily. 17. A male patient with a diagnosis of liver cancer has been recently admitted to a palliative care unit 45 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function 20. B 46 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function Chapter 08 - Disorders of 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 by: A) intravascular hypotonicity. B) increased intravascular water. C) increases in intracellular sodium. D) proportionate losses of sodium. 47 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function 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? 50 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function 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 woman’s 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 51 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function 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 52 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function 20. B 55 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function 9. The patient recently returned from a year of military battle duty and has posttraumatic stress disorder (PTSD). This disorder includes an intrusion state that is experienced as: A) excessive anxiety and safety concerns. B) repeated relived memories as nightmares. C) loss of concentration and increased vigilance. D) emotional numbing and feelings of depression. 10. A patient is extremely anxious about his impending surgery. Which of the following measures should the nurse implement to create an atmosphere for effective use of relaxation techniques? A) A quiet, dim environment B) A soothing, warm foot soak C) Gentle muscle stroking D) Repetitive questioning 11. A patient is experiencing significant stress while awaiting the results of her recent lymph node biopsy. Among the hormonal contributors to this response is a release of aldosterone, resulting in which of the following physiologic effects? A) Decreased release of insulin B) Increased cardiac contractility C) Potentiation of epinephrine D) Increased sodium absorption 12. A patient is experiencing stress as a nurse prepares to insert a peripheral intravenous catheter into his forearm. The patient’s locus ceruleus (LC) is consequently producing which of the following hormones? A) Norepinephrine (NE) B) Corticotropin-releasing factor (CRF) C) Antidiuretic hormone (ADH) 56 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function D) Adrenocorticotropic hormone (ACTH) 13. A college student has just learned that her latest Pap smear revealed atypical cells, a fact that has resulted in stress and an accompanying release of angiotensin II. How would the effects of this hormone be objectively demonstrated? A) Increased respiratory rate B) Increased blood pressure C) Decreased oxygen saturation D) Decreased blood sugar 14. A nursing student’s current clinical placement has been a source of stress due to high patient acuity combined with interpersonal conflict with some of the unit staff. At the same time, the student has been fighting a cold for more than 2 weeks and has been unable to regain a normal feeling of health. How might these two phenomena be related? A) Epinephrine and norepinephrine inhibit the release and action of lymphocytes. B) Stress and illness lack a statistical correlation, though they are often thought to coexist. C) The effects of stress on the cerebellum initiate a decrease in immunity. D) Endocrine-immune interactions may suppress the student’s immune response. 15. Which of the following factors are known to contribute to an individual’s ability to adapt to stress? Select all that apply. A) Ethnicity B) Age C) Socioeconomic status D) Gender E) Health status 16. A student is participating in an extended fast as part of a charitable fundraising effort. Which of the following is an example of the physiologic reserve that will facilitate the student’s adaptation to the stress of this sudden change in diet? A) The student has experience in demonstrating perseverance from previous participation in 57 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function competitive sports. B) The student’s adipose tissue contains large and accessible stores of energy. C) The student is young, male, and has no pre-existing medical conditions. D) The student is utilizing guided imagery to achieve a sense of mind over matter. 17. A 70-year-old patient admitted to a hospital for a prostatectomy is surprised to learn that his physician has prescribed insulin on a sliding scale, despite the fact that the patient successfully manages his type 2 diabetes using diet and oral antihyperglycemics when at home. Which of the following facts may underlie the physician’s action? A) The stress of illness stimulates the hypothalamus to release corticotropin-releasing factor (CRF). B) Stress-induced release of vasopressin increases serum blood glucose. C) Stress and illness can increase glycogenolysis and insulin resistance. D) Increased levels of epinephrine and norepinephrine cause alterations in glucose metabolism. 18. A female patient experienced a random assault several months earlier, and her recent vigilance around her own safety is described as obsessive by her friends and family. Which of the following aspects of posttraumatic stress disorder (PTSD) characterizes the patient’s behavior? A) Avoidance B) Intrusion C) Hyperarousal D) Flashbacks 19. An occupational therapist is preparing to begin a relaxation program on the oncology unit of a hospital. Which of the following variables is most likely to determine the success or failure of the program? A) Rapport between the therapist and patients B) The therapist’s own ability to relax C) A quiet and therapeutic environment D) Appropriate use of pharmacologic techniques 60 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function Chapter 10 - Disorders of Nutritional Status 1. The adipocytes in adipose tissue not only serve as a storage sites, they also: A) produce linoleic fatty acid. B) synthesize triglycerides. C) increase glucagon release. D) degrade fat-soluble vitamins. 2. Protein contains nitrogen. A negative nitrogen balance represents: A) more protein consumed than excreted. B) a reduced need for nitrogen as protein. C) more nitrogen excreted than consumed. D) less use of nitrogen for protein synthesis. 3. Natural appetite suppression mechanisms, necessary for food intake control, include : A) ketoacid deficiency. B) cholecystokinin storage. C) decreased blood glucose. D) leptin receptor stimulation. 4. Body weight should be used in combination with other measurements to establish if a person is underweight or overweight. Obesity is indicated by: A) female body fat of 20% and 30%. B) body mass index (BMI) of 30 to 40. C) relative body weight of 70% to 100%. D) abdominal fat/ hip ratio of 0.8 to 1.0. 61 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function 5. 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. A) osteoporosis B) renal disease C) cardiometabolic disorders D) chronic anemia 6. As the problem of childhood and adolescent obesity increases, an increase in the incidence of is occurring in this obese population. A) type 2 diabetes mellitus B) attention deficit disorder C) juvenile rheumatoid arthritis D) antibiotic-resistant bacterial infectio s 7. A diet deficient in calories and protein causes marasmus, which is characterized by: A) discolored hair. B) bradycardia. C) enlarged liver. D) pitting edema. 8. Protein-calorie malnutrition with loss of lean tissues and muscle mass results in: A) respiratory muscle stimulation. B) excessive blood cell production. C) diarrhea. D) increased cardiac contractility. 62 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function 9. Similarities between girls or women with anorexia nervosa and bulimia nervosa include: A) periodontal disease. B) low estrogen level. C) electrolyte imbalances. D) enlarged parotid gland. 10. Both binge-eating and bulimia nervosa patients consume excessive amounts of foods secretively. A major difference is that binge-eaters: A) remain overweight. B) eat when not hungry. C) are substance abusers. D) experience depression. 11. A large, high-calorie meal has resulted in the intake of far more energy than a person requires. What will the individual’s body do with the excess carbohydrates provided by this meal? A) Convert them into glucose and store them in the liver and muscles B) Excrete most of the excess polysaccharides through the kidneys C) Convert the carbohydrates into amino acids in preparation for long-term storage D) Create structural proteins from some of the carbohydrates and store the remainder as triglycerides 12. Which of the following patients is most likely to be in positive nitrogen balance? A) A patient who is receiving treatment for sepsis B) A patient whose diagnosis of pneumonia is causing a fever C) A woman who has been admitted to the hospital in early labor D) A patient who sustained extensive burns in a recent industrial accident 13. In addition to facilitating bowel movements, a diet that is high in fiber confers which of the following benefits? 65 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function 1. B 2. C 3. D 4. B 5. C 6. A 7. B 8. C 9. C 10. A 11. A 12. C 13. A 14. D 15. B 16. C 17. C 18. C 19. A 20. D 66 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function Chapter 11 - Disorders of White Blood Cells and Lymphoid Tissues 1. Cytokines that affect hematopoiesis in bone marrow are called colony-stimulating factors (CSFs) based on their ability to: A) support lymphocytes. B) differentiate red cells. C) regulate blood cells. D) stimulate lymphocytes. 2. Leukocytes consist of three categories of cells that have different roles in the inflammatory and immune responses. Which of the following leukocytes is correctly matched with its function? A) Lymphocyte; phagocytosis B) Eosinophils; allergic reactions C) Basophils; engulf antigens D) Monocytes; release heparin 3. The patient has an abnormally low neutrophil count. Neutropenia is most commonly caused by: A) Epstein-Barr virus. B) Kostmann syndrome. C) drug reactions. D) skin infections. 4. 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 . A) heterophil antibodies; blood B) Epstein Barr virus; saliva C) T-cell infection; plasma 67 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function D) bacterial infection; monocytes 5. 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: A) Reed-Sternberg cells. B) Bence Jones proteins. C) M-type protein antibodies. D) Philadelphia chromosome. 6. Manifestations of Hodgkin lymphoma that distinguish it from non-Hodgkin lymphoma include: A) noncontiguous nodal spread. B) superficial lymphadenopathy. C) pruritus and night fevers. D) poor humoral antibody response. 7. Leukemias are classified according to the predominant cell type. The myelogenous cell type of leukemia can: A) interfere with thrombocyte cell maturation. B) originate in marrow and infiltrate nodes. C) affect B and T stem cells in bone marrow. D) transform mature cells into immature ones. 8. A child has Down syndrome and has recently experienced unexplained nose bleeds. His blood tests identify blast cells in the peripheral smear. In addition to nose bleeds, his acute leukemia will typically manifest all of the following EXCEPT: A) infections due to neutropenia. B) fatigue due to RBC deficiency. C) hypogammaglobulinemia. 70 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function C) Radiation exposure D) Exposure to the Epstein-Barr virus 17. A patient has been diagnosed with non-Hodgkin lymphoma (NHL), a form of malignancy that most likely originated in which of the following sites? A) Thymus B) Spleen C) Bone marrow D) Lymph nodes 18. A young adult is preparing to begin treatment for non-Hodgkin lymphoma (NHL), a disease that has disseminated widely. What is the most likely treatment regimen for this patient? A) Antiviral medications B) Surgery and whole blood transfusion C) Radiation and chemotherapy D) Bone marrow or stem cell transplantation 19. Which of the following patient complaints should prompt a clinician to order a diagnostic work-up for multiple myeloma? A) Lately my bones just seem to ache so bad, and nothing seems to help. B) Every morning my joints are so stiff that it takes me 10 or 15 minutes just to get going. C) I feel so weak and the last few days I’ve actually fallen asleep on my coffee break at work. D) I vomited yesterday evening and it looked like coffee grounds mixed with some fresh blood. 20. Which of the following abnormal blood work results is most closely associated with a diagnosis of multiple myeloma? A) Decreased hemoglobin, hematocrit, and red blood cells B) Extremely high levels of abnormal lymphocytes 71 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function C) Low glomerular filtration rate and high calcium levels D) Low potassium levels and increased blood urea nitrogen Answer Key 1. C 2. B 3. C 4. B 5. A 6. C 7. A 8. C 9. B 10. A 11. A 12. B, C 13. D 14. B 15. B 16. A 17. D 18. C 19. A 72 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function 20. C 75 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function D) intrinsic factor. 9. Disseminated intravascular coagulation (DIC) is characterized by: A) headaches. B) platelet loss. C) hypertension. D) hemorrhage. 10. In persons with a bleeding disorder caused by vascular defects, laboratory tests will most often reveal: A) normal values. B) hypocalcemia. C) polycythemia. D) thrombocytopenia. 11. Removal of a patient’s 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? A) Activation of factor X B) Conversion of prothrombin to thrombin C) Release of von Willebrand factor from the epithelium D) Conversion of fibrinogen to fibrin threads 12. A 69-year-old patient who is obese and has a diagnosis of angina pectoris has been prescribed clopidogrel (Plavix) by his primary care provider. The patient’s medication achieves its therapeutic effect in which of the following ways? A) Prevention of platelet aggregation B) Activation of plasminogen C) Inhibition of the intrinsic clotting pathway 76 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function D) Deactivation of factor X 13. A public health nurse is conducting a health promotion campaign under the auspices of the local community center. Which of the following measures that the nurse is promoting are likely to influence the participants’ risk of hypercoagulability disorders? Select all that apply. A) Smoking cessation B) Blood glucose screening C) Weight management D) Cholesterol screening and management E) Blood pressure screening and management 14. During a patient’s admission assessment prior to reduction mammoplasty surgery, the nurse notes a reference to a Leiden mutation in the patient’s history. The nurse would recognize the patient’s increased risk for A) Hemorrhage B) Myocardial infarction C) Hemophilia A or B D) Deep vein thrombosis 15. 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) In the brain B) Skin and mucous membranes C) Sclerae of the eyes D) Nephrons and ureters 16. 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 patient’s chance of developing which health problem? A) Antiphospholipid syndrome 77 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function B) Disseminated intravascular coagulation (DIC) C) Von Willebrand disease D) Thrombocytopenia 17. In light of the presence of numerous risk factors for coronary artery disease, a patient’s primary care provider has recommended that he take low-dose aspirin once daily. Doing so will reduce the patient’s risk of myocardial infarction by altering which of the following stages of hemostasis? A) Vessel spasm B) Platelet plug formation C) Blood coagulation D) Clot lysis 18. 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 patient’s following statements demonstrates a sound understanding of her new diagnosis? A) I’m really disappointed that I won’t be able to do sports anymore. B) I read on a website that I might have to get blood transfusions from time to time. C) I’ll make sure to take Tylenol instead of aspirin when I get aches and pains. D) I hope my insurance covers the injections that I’ll need to help my blood clot. 19. Which of the following patients likely faces the highest risk of an acquired hypocoagulation disorder and vitamin K deficiency? A) A patient who has a diagnosis of liver failure secondary to alcohol abuse B) A patient who has chronic renal failure as a result of type 1 diabetes mellitus C) A patient who is immunocompromised as a result of radiation therapy for the treatment of lung cancer D) A patient with dehydration and hypokalemia that have resulted from Clostridium difficileassociated diarrhea 20. A healthy, primiparous (first-time) mother delivered a healthy infant several hours ago, but the mother 80 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function Chapter 13 - Disorders of Red Blood Cells 1. Sue is fatigued and some blood tests are done. Her results include Hct 40%; Hgb 8g/dL; WBC 8,000; platelets 175,000. The nurse should interpret Sue’s blood work as indicative of: A) high platelets/thrombocytosis. B) low WBC count/granulocytopenia. C) low hemoglobin/anemia. D) high hematocrit/polycythemia. 2. Manifestations of anemia that are directly due to the diminished oxygen-carrying capacity of hemoglobin include: A) fatigue. B) bleeding. C) bone pain. D) pale skin. 3. When an Rh-negative mother has been sensitized and is pregnant with an Rh-positive fetus, what happens to the fetus? A) Bilirubin deficiency B) Nothing, this is normal C) Plasma volume depletion D) Profound red cell hemolysis 4. The patient is an average-sized adult and has abnormal microcytic hypochromic red blood cells due to a long-term, chronic disease. Which of the following CBC results is characteristic of her type of anemia? A) Hematocrit 44% B) Reticulocytes 1.5% 81 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function C) Band cells 3,000/mL D) Hemoglobin 8 g/dL 5. Megaloblastic anemias caused by folic acid or vitamin B12 deficiencies can seriously affect RBC production. This is because both are necessary for synthesis and . A) iron; hemoglobin adhesion B) DNA; red blood cell maturation C) thrombin; platelet aggregation D) protein; reticulocyte maturation 6. Polycythemia develops in patients with lung disease as a result of: A) hyperventilation. B) chronic hypoxia. C) decreased blood viscosity. D) excessive respiratory fluid loss. 7. Which of the following types and characteristics of anemia are correctly matched? A) Hemolytic; abnormal iron uptake B) Iron deficiency; early RBC death C) Folate; decreased erythropoiesis D) Blood loss; bone marrow expansion 8. Conditions that predispose to sickling of hemoglobin in persons with sickle cell anemia include: A) impaired red blood cell maturation. B) increased iron content of blood. C) decreased oxygen saturation. 82 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function D) increased intravascular volume. 9. An elevated level of unconjugated bilirubin, due to hemolysis of RBCs, results in a high level of iron released and: A) diarrhea. B) cyanosis. C) numbness. D) jaundice. 10. Hemolytic anemia is characterized by excessive red blood cell destruction and compensatory: A) hypoactive bone marrow. B) increased erythropoiesis. C) iron retention in the body. D) shrinkage of the spleen. 11. A 48-year-old male patient, who normally enjoys good health, has been admitted to the hospital for the treatment of polycythemia vera. The nurse who is providing care for the patient should prioritize assessments aimed at the early identification of which of the following health problems? A) Orthostatic hypotension B) Hyperventilation and respiratory alkalosis C) Vasculitis D) Thromboembolism 12. Which of the following patients is most susceptible to experiencing the effects of inadequate erythropoiesis? A) A patient who has developed renal failure as a result of longstanding hypertension B) A patient who recently experienced an ischemic stroke and who remains bedridden C) A patient whose heavy alcohol use has culminated in a diagnosis of pancreatitis 85 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function A) phototherapy. B) packed red blood cell transfusion. C) phlebotomy. D) intravenous antibiotics. Answer Key 1. C 2. A 3. D 4. D 5. B 6. B 7. C 8. C 9. D 10. B 11. D 12. A 13. C 14. A, B, C 15. A 16. C 17. A 86 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function 18. B 19. D 20. A 87 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function Chapter 14 - Mechanisms of Infectious Disease 1. Although growth rate is variable among types of bacteria, the growth of bacteria is dependent on: A) biofilm communication. B) availability of nutrients. C) an intact protein capsid. D) individual cell motility. 2. Treponema pallidum, the cause of syphilis, is a spirochete bacterium that is spread from human to 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 organism’s 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 90 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function 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 patient’s 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 child’s mother was prompted to seek care because of this child’s sudden onset of neuromuscular deficits, which were later attributed to the release of substances by Clostridium botulinum bacteria. Which virulence factor contributed to this child’s 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 require? A) Antiviral therapy B) Antibiotic therapy 91 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function C) Surgical draining D) Pressure dressing 17. A patient’s 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 patient’s 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 drug’s 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 92 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function 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 95 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function D) processing; presentation 5. Major histocompatibility complex (MHC) molecules, with human leukocyte antigens (HLAs), are markers on all nucleated cells and have an important role in: A) identifying blood types. B) cell membrane transport. C) suppressing viral replication. D) avoiding transplant rejections. 6. Dendritic cells, found in skin tissues and lymphoid tissues, are important for: A) initiation of adaptive immunity. B) deep-tissue phagocytosis. C) disposal of dead cells. D) delaying inflammation. 7. Once T helper cells are activated, they secrete that activate and regulate nearly all of the other cells of the immune system. A) complement proteins B) cytokines C) leukotrienes D) bradykinins 8. The first circulating immunoglobulin to appear in response to a new antigen is: A) IgG. B) IgM. C) IgA. D) IgD. 96 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function 9. The effector function of activated members of the complement system includes all of the following EXCEPT: A) chemotaxis. B) opsonization. C) pathogen lysis. D) phagocytosis. 10. During the latent period before antibodies are detected in the humoral immune response, B cells differentiate into cells. A) plasma B) cytotoxic C) stem D) helper 11. Which of the following would participate in the innate immune response to an infectious microorganism? A) T lymphocytes B) Antibodies C) B lymphocytes D) Neutrophils 12. A patient has recently received a pneumococcal vaccine and the patient’s B cells are consequently producing antibodies. Which of the following cells may enhance this production of antibodies? A) Helper T cells B) Regulatory T cells C) Cytotoxic T cells D) Natural killer cells 97 Chapter 46 - Disorders of Skin Integrity and FunctionChapter 46 - Disorders of Skin Integrity and Function 13. A child’s thymus gland is fully formed and proportionately larger than an adult’s. Which of the following processes that contribute to immunity takes place in the thymus gland? A) Differentiation of B cells B) Production of natural killer (NK) cells C) Proliferation of T cells D) Filtration of antigens from the blood 14. A patient’s exposure to an antibiotic-resistant microorganism while in the hospital has initiated an immune response, a process that is mediated and regulated by cytokines. Which of the following statements is true of cytokines? A) They are stored in the peripheral lymphoid tissues until required. B) They have a long half-life that contributes to an ongoing immune response. C) They are normally released at cell-to-cell interfaces, binding to specific receptors. D) They are capable of performing phagocytosis in the response to viral invasion. 15. The entrance of a microbe into an individual’s vascular space has initiated opsonization. Which of the following processes is involved in opsonization? A) Stimulation of B cells by helper T cells B) Coating of a microbe to aid phagocyte recognition C) Release of proteins that stimulate cell production by the bone marrow D) Lysis of intracellular microbes by cytotoxic T cells 16. Bacteria on a sliver in a boy’s finger have initiated an adaptive immune response. The boy’s lymphocytes and antibodies recognize immunologically active sites on the bacterial surfaces known as: A) Toll-like receptors. B) opsonins. C) chemokines.