NR 507 Advanced Pathophysiology Midterm Exam LATEST 2022/2023 GRADED A+, Exams of Nursing

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NR 507 Midterm Exam.

NR 507 Advanced Pathophysiology Midterm Exam

LATEST 2022/2023 GRADED A+

Score for this quiz: 118 out of 120

The lung is innervated by the parasympathetic nervous system via which nerve? Vagus Phrenic Brachial Pectoral Fibers of the parasympathetic division of the autonomic nervous system (ANS) travel only in the vagus nerve to the lung. What is the action of urodilatin? Urodilatin causes vasoconstriction of afferent arterioles. It causes vasodilation of the efferent arterioles.

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Page 2 of Urodilatin inhibits antidiuretic hormone secretion.

Page 3 of It inhibits salt and water reabsorption. Urodilatin (a natriuretic peptide) inhibits sodium and water reabsorption from the medullary part of collecting duct, thereby producing diuresis. It is not involved in the actions described by the other options. What is the direct action of atrial natriuretic hormone? Sodium retention Sodium excretion Water retention Water excretion Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) inhibit the secretion of renin, inhibit angiotensin-induced secretion of aldosterone, vasodilate the afferent and constrict the efferent glomerular arterioles, and inhibit sodium and water absorption by kidney tubules. The other actions are not a result of the atrial natriuretic hormone. Which statement best describes a Schilling test? Question 3

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Administration of radioactive cobalamin and the measurement of its excretion in the urine^ to^ test for^ vitamin^ B 12 deficiency Page 3 of Measurement of antigen-antibody immune complexes in the blood to test for hemolytic anemia Measurement of serum ferritin and total iron-binding capacity in the blood to test for iron deficiency anemia Administration of folate and measurement in 2 hours of its level in a blood sample to test for folic acid deficiency anemia. The Schilling test indirectly evaluates vitamin B 12 absorption by administering radioactive B 12 and measuring excretion in the urine. This selection is the only option that accurately (^) describes a Schilling test. Hemolytic disease of the newborn (HDN) can occur if the mother: Is Rh-positive and the fetus is Rh-negative Is Rh-negative and the fetus is Rh-positive Has type A blood and the fetus has type O Has type AB blood and the fetus has type B HDN can occur only if antigens on fetal erythrocytes differ from antigens on maternal erythrocytes. Maternal-fetal incompatibility exists only if the mother and fetus differ in ABO blood type or if the fetus is Rh-positive and the mother is Rh-negative. This erythrocyte incompatibility does not exist in any of the other options. Question 5

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Page 4 of Which T-lymphocyte phenotype is the key determinant of childhood asthma? Cluster of differentiation (CD) 4 T-helper Th 1 lymphocytes CD 4 T-helper Th 2 lymphocytes CD8 cytotoxic T lymphocytes Memory T lymphocytes Asthma develops because the Th 2 response (in which CD 4 T-helper cells produce (^) specific cytokines, such as interleukin [IL]–4, IL-5, and IL-13) promotes an atopic and allergic response in the airways. This selection is the only option that accurately identifies the appropriate T-lymphocyte phenotype. Perceived stress elicits an emotional, anticipatory response that begins where? Prefrontal cortex Anterior pituitary Limbic system Question 6

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Page 5 of Hypothalamus Perceived stressors elicit an anticipatory response that begins in the limbic system of the brain, the only option responsible for emotions and cognition. Hypersensitivity is best defined as a(an): Disturbance in the immunologic tolerance of self-antigens Immunologic reaction of one person to the tissue of another person Altered immunologic response to an antigen that results in disease Undetectable immune response in the presence of antigens Hypersensitivity is an altered immunologic response to an antigen that results in disease or damage to the host. The other options are not accurate definitions of hypersensitivity. It has been determined that a tumor is in stage 2. What is the meaning of this finding? Cancer is confined to the organ of origin. Cancer has spread to regional structures. Question 8

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Page 6 of Cancer is locally invasive. Cancer has spread to distant sites Cancer confined to the organ of origin is stage 1; cancer that is locally invasive is stage2; cancer that has spread to regional structures, such as the lymph nodes, is stage 3; and cancer that has spread to distant sites, such as a liver cancer spreading to the lungor a prostate cancer spreading to bone, is stage 4. An infant has a loud, harsh, holosystolic murmur and systolic thrill that can be detected at the left lower sternal border that radiates to the neck. These clinical findings are consistent with which congenital heart defect? Atrial septal defect (ASD) Ventricular septal defect (VSD) Patent ductus arteriosus (PDA) Atrioventricular canal (AVC) defect On physical examination, a loud, harsh, holosystolic murmur and systolic thrill can be detected at the left lower sternal border. The intensity of the murmur reflects the pressure gradient across the VSD. An apical diastolic rumble may be present with a moderate-to-large defect, reflecting increased flow across the mitral valve. The

Page 7 of presentations of the other congenital heart defects are not consistent with the described symptoms. Which statement concerning exotoxins is true? Exotoxins are contained in cell walls of gram-negative bacteria. Exotoxins are released during the lysis of bacteria. Exotoxins are able to initiate the complement and coagulation cascades. Exotoxins are released during bacterial growth. Exotoxins are proteins released during bacterial growth. The other options are not true of exotoxins. The function of the foramen ovale in a fetus allows what to occur? Right-to-left blood shunting Left-to-right blood shunting Blood flow from the umbilical cord Question 11

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Page 8 of Blood flow to the lungs The nonfused septum secundum and ostium secundum result in the formation of aflapped orifice known as the foramen ovale , which allows the right-to-left shunting necessary for fetal circulation. The foramen ovale is not involved in the blood flow described by the other options. Which laboratory test is considered adequate for an accurate and reliable diagnosis of gonococcal urethritis in a symptomatic man? Ligase chain reaction (LCR) Gram-stain technique Polymerase chain reaction (PCR) DNA testing Microscopic evaluation of Gram-stained slides of clinical specimens is deemed positive for Neisseria gonorrhoeae if gram-negative diplococci with the typical “kidney bean” morphologic appearance are found inside polymorphonuclear leukocytes. Such a finding is considered adequate for the diagnosis of gonococcal urethritis in a symptomatic man. The other options are not relevant to the diagnosis of this condition. Which manifestations of vasoocclusive crisis are associated with sickle cell disease (SCD) in infants?

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Page 9 of Atelectasis and pneumonia Edema of the hands and feet Stasis ulcers of the hands, ankles, and feet Splenomegaly and hepatomegaly Symmetric, painful swelling of the hands and feet (hand-foot syndrome) caused by infarction in the small vessels of the extremities is often the initial manifestation of SCD in infants. This selection is the only option that accurately identifies the manifestations ofa vasoocclusive crisis associated with SCD in infancy. Which statement concerning benign tumors is true? The resulting pain is severe. Benign tumors are not encapsulated. Benign tumors are fast growing. The cells are well-differentiated.

Page 10 of Abenign tumor is well-differentiated with its tissue appearing similar to the tissue from which it arose. The other options are characteristic of a malignant tumor. Which primary characteristic is unique for the immune response? The immune response is similar each time it is activated. The immune response is specific to the antigen that initiates it. The response to a specific pathogen is short term. The response is innate, rather than acquired. Unlike inflammation, which is nonspecifically activated by cellular damage and pathogenic microorganisms, the immune response is primarily designed to afford long- term specific protection (i.e., immunity) against particular invading microorganisms; that is, it has a memory function. The other options are not unique characteristics of the immune response. Which criterion is used to confirm a diagnosis of asthma in an 8-year-old child? Parental history of asthma Serum testing that confirms increased immunoglobulin E (IgE) and eosinophil levels Question 16

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Plasma Icells Question 19

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Page 11 of Reduced expiratory flow rates confirmed by spirometry testing Improvement on a trial of asthma medication Confirmation of the diagnosis of asthma relies on pulmonary function testing using spirometry, which can be accomplished only after the child is 5 to 6 years of age. Reduced expiratory flow rates that are reversible in response to an inhaled bronchodilator would be characteristic abnormalities. For younger children, an empiric trial of asthma medications is commonly initiated. The remaining options are major historical and physical factors that contribute but do not confirm the diagnosis of asthma in children. Where are antibodies produced? Helper T lymphocytes Thymus gland Correct Answer Bone marrow An antibody or immunoglobulin is a serum glycoprotein produced only by plasma cells in response to a challenge by an immunogen. Question 18

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Page 12 of How much urine accumulates in the bladder before the mechanoreceptors sense bladder fullness? 75 to 100 ml 100 to 150 ml 250 to 300 ml 350 to 400 ml When the bladder accumulates 250 to 300 ml of urine, it contracts and the internalurethral sphincter relaxes through activation of the spinal reflex arc (known as the micturition reflex ). Which disorder results in decreased erythrocytes and platelets with changes in leukocytes and has clinical manifestations of pallor, fatigue, petechiae, purpura, bleeding, and fever? Idiopathic thrombocytopenic purpura (ITP) Acute lymphocytic leukemia (ALL) Non-Hodgkin lymphoma (NHL)

Page 13 of Iron deficiency anemia (IDA) Pallor, fatigue, petechiae, purpura, bleeding, and fever are generally present with the most common symptoms reflecting the consequence of bone marrow failure, which results in decreased red blood cells and platelets and changes in white blood cells. This selection is the only option that correctly identifies the disease with the symptoms described. Carcinoma in situ is characterized by which changes? Cells have broken through the local basement membrane. Cells have invaded immediate surrounding tissue. Cells remain localized in the glandular or squamous cells. Cellular and tissue alterations indicate dysplasia. Carcinoma in situ (CIS) refers to preinvasive epithelial malignant tumors of glandular or squamous cell origin. These early stage cancers are localized to the epithelium and have not broken through the local basement membrane or invaded the surrounding tissue. Dysplasia refers to changes in mature cell structure. What is the life span of platelets (in days)? Question 21

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A platelet circulates for approximately 10 days and ages. Macrophages of the mononuclear phagocyte system, mostly in the spleen, remove platelets. What is the primary cause of respiratory distress syndrome (RDS) of the newborn? Immature immune system Small alveoli Surfactant deficiency Anemia RDS is primarily caused by surfactant deficiency and secondarily by a deficiency in alveolar surface area for gas exchange. None of the other options are related to the cause of RDS. Question 23

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Page 15 of What is the life span of an erythrocyte (in days)? 20 to 30 60 to 90 100 to 120 200 to 240 Because it cannot undergo mitotic division, the erythrocyte has a limited life span of approximately 120 days. Low plasma albumin causes edema as a result of a reduction in which pressure? Capillary hydrostatic Interstitial hydrostatic Plasma oncotic Question 24

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Page 16 of Interstitial oncotic Losses or diminished production of plasma albumin is the only option that contributes toa decrease in plasma oncotic pressure. Which blood cell type is elevated at birth but decreases to adult levels during the first year of life? Monocytes Platelets Neutrophils Lymphocytes Only monocyte counts are high in the first year of life and then decrease to adult levels. Which organ is stimulated during the alarm phase of the general adaptation syndrome (GAS)? Adrenal cortex Hypothalamus

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Page 17 of Anterior pituitary Limbic system The alarm phase of the GAS begins when a stressor triggers the actions of the hypothalamus and the sympathetic nervous system (SNS) (see Figure 11-1). The other organs are not stimulated by the alarm phase of GAS. Phagocytosis involves neutrophils actively attacking, engulfing, and destroying which microorganisms? Bacteria Fungi Viruses Yeasts Invasion is the direct confrontation with an individual’s primary defense mechanisms against only bacteria, which include the complement system, antibodies, and phagocytes, such as neutrophils and macrophages. What part of the kidney controls renal blood flow, glomerular filtration, and reninsecretion?

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Page 18 of Macula densa Visceral epithelium Juxtaglomerular apparatus (JGA) Filtration slits Control of renal blood flow, glomerular filtration, and renin secretion occur at the JGA. Together, the juxtaglomerular cells and macula densa cells form the JGA. The control of renal blood flow, glomerular filtration, and renin secretion is not directed by any of the other options. The risk for respiratory distress syndrome (RDS) decreases for premature infants when they are born between how many weeks of gestation? 16 and 20 20 and 24 24 and 30 30 and 36

Page 19 of Surfactant is secreted into fetal airways between 30 and 36 weeks. The other options are not true regarding the timeframe when the risk for RDS decreases. What is the functional unit of the kidney called? Glomerulus Nephron Collecting duct Pyramid The nephron is the functional unit of the kidney. Although the other options are alsolocated in the kidney, they are not its functional units. Which hepatitis virus is known to be sexually transmitted? A Question 31

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B

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Only hepatitis B virus (HBV) is known to be sexually transmitted. Which statement is true concerning the IgM? IgM is the first antibody produced during the initial response to an antigen. IgM mediates many common allergic responses. IgM is the most abundant class of immunoglobulins. IgM is capable of crossing the human placenta. Typically, IgM is produced first (primary immune response), followed by IgG against the same antigen. The other options are not true statements regarding IgM. Apoptosis is a(an): Question 33

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C

Page 22 of Normal mechanism for cells to self-destruct when growth is excessive

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Antigrowth signal activated by the tumor-suppressor gene Rb Page 23 of Mutation of cell growth stimulated by the TP53 gene Transformation of cells from dysplasia to anaplasia Normal cells have a mechanism that causes them to self-destruct when growth is excessive and cell cycle checkpoints have been ignored. Diverse stimuli, including normal development and excessive growth, trigger this self-destruct mechanism, called apoptosis. The remaining options do not describe apoptosis. What are the abnormalities in cytokines found in children with cystic fibrosis (CF)? Deficit of interleukin (IL)–1 and an excess of IL-4, IL-12, and interferon-alpha (IFN-α) Deficit of IL-6 and an excess of IL-2, IL-8, and granulocyte colony-stimulating factor (G- CSF) Deficit of IL-10 and an excess of IL-1, IL-8, and TNF-α Deficit of IL-3 and an excess of IL-14, IL-24, and colony-stimulating factor (CSF) Abnormal cytokine profiles have been documented in CF airway fluids, including deficient IL-10 and excessive IL-1, IL-8, and TNF-α, all changes conducive to promoting inflammation. This selection is the only option that accurately identifies the abnormalities in cytokines observed in children with CF. Research supports the premise that exercise has a probable impact on reducing the riskof which cancer? Question 35

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Page 24 of Liver Endometrial Stomach Colon The World Cancer Research Fund summarizes the effects as convincing for cancers of the colon and probable for postmenopausal breast cancer and endometrial cancer. The relationship is not supported for the remaining options. Why is nasal congestion a serious threat to young infants? Infants are obligatory nose breathers. Their noses are small in diameter. Infants become dehydrated when mouth breathing. Their epiglottis is proportionally greater than the epiglottis of an adult’s. Question 37

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