NR507 Week 4 Midterm Exam ( Version 7) / NR 507 Week 4 Midterm Exam ( Newest ): Advanced P, Study Guides, Projects, Research of Nursing

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1. Question : What is the final stage of the infectious process? Student Answer: Colonization Invasion Multiplication Spread Instructor Explanation: From the perspective of the microorganisms that cause disease, the infectious process undergoes four separate stages of progression: (1) colonization, (2) invasion, (3) multiplication, and (4) spread. Points Received: 2 of 2 Comments: Question 2. Question : Where in the respiratory tract do the majority of foreign objects aspirated by children finally lodge? Student Answer: Trachea Left lung Bronchus Bronchioles Instructor Explanation: Approximately 75% of aspirated foreign bodies lodge in a bronchus. The other options are not locations where children aspirate the majority of foreign objects. Points Received: 0 of 2 Comments: Question 3. Question : What is the primary cause of respiratory distress syndrome (RDS) of the newborn?

Student Answer: Immature immune system Small alveoli Surfactant deficiency Anemia Instructor Explanation: 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. Points Received: 2 of 2 Comments: Question 4. Question : Which statement concerning benign tumors is true? Student Answer: The resulting pain is severe. Benign tumors are not encapsulated. Benign tumors are fast growing. The cells are well-differentiated. Instructor Explanation: A benign 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. Points Received: 2 of 2 Comments: Question 5. Question : Which compensatory mechanism is spontaneously used by children diagnosed with tetralogy of Fallot to relieve hypoxic spells? Student Answer: Lying on their left side Performing the Valsalva maneuver

Squatting Hyperventilating Instructor Explanation: Squatting is a spontaneous compensatory mechanism used by older children to alleviate hypoxic spells. Squatting and its variants increase systemic resistance while decreasing venous return to the heart from the inferior vena cava. The other options would not result in these changes. Points Received: 2 of 2 Comments: Question 6. Question : Which cytokines initiate the production of corticotropin-releasing hormone (CRH)? Student Answer: IL–1 and IL- IL-2 and TNF- IFN and IL- TNF-ß and IL- Instructor Explanation: Although a number of stress factors initiate the production of CRH, of the options available, only high levels of IL-1 and IL-6 initiate such a response. Points Received: 2 of 2 Comments: Question 7. Question : Hemolytic disease of the newborn (HDN) can occur if the mother: Student Answer: 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

Instructor Explanation: 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. Points Received: 2 of 2 Comments: Question 8. Question : Decreased lung compliance means that the lungs are demonstrating which characteristic? Student Answer: Difficult deflation Easy inflation Stiffness Inability to diffuse oxygen Instructor Explanation: A decrease in compliance indicates that the lungs or chest wall is abnormally stiff or difficult to inflate. This selection is the only option that accurately identifies the meaning of decreased compliance. Points Received: 2 of 2 Comments: Question 9. Question : Which statement concerning exotoxins is true? Student Answer: 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. Instructor Explanation: Exotoxins are proteins released during bacterial growth. The other options are not true of exotoxins.

Points Received: 2 of 2 Comments: Question 10. Question : What is the ratio of coronary capillaries to cardiac muscle cells? Student Answer: 1:1 (one capillary per one muscle cell) 1:2 (one capillary per two muscle cells) 1:4 (one capillary per four muscle cells) 1:10 (one capillary per ten muscle cells) Instructor Explanation: The heart has an extensive capillary network, with approximately 3300 capillaries per square millimeter (ca/mm^2 ) or approximately one capillary per one muscle cell (muscle fiber). Points Received: 2 of 2 Comments: Question 11. Question : How high does the plasma glucose have to be before the threshold for glucose is achieved? Student Answer: 126 mg/dl 150 mg/dl 180 mg/dl 200 mg/dl Instructor Explanation: When the plasma glucose reaches 180 mg/dl, as occurs in the individual with uncontrolled diabetes mellitus, the threshold for glucose is achieved. Points Received: 0 of 2 Comments:

Question 12. Question : What is the chief predisposing factor for respiratory distress syndrome (RDS) of the newborn? Student Answer: Low birth weight Alcohol consumption during pregnancy Premature birth Smoking during pregnancy Instructor Explanation: RDS of the newborn, also known as hyaline membrane disease (HMD), is a major cause of morbidity and mortality in premature newborns. None of the other options are considered the chief predisposing factors for RDS. Points Received: 2 of 2 Comments: Question 13. Question : Perceived stress elicits an emotional, anticipatory response that begins where? Student Answer: Prefrontal cortex Anterior pituitary Limbic system Hypothalamus Instructor Explanation: Perceived stressors elicit an anticipatory response that begins in the limbic system of the brain, the only option responsible for emotions and cognition. Points Received: 0 of 2 Comments: Question 14. Question : Causes of hyperkalemia include:

Student Answer: Hyperparathyroidism and malnutrition Vomiting and diarrhea Renal failure and Addison disease Hyperaldosteronism and Cushing disease Instructor Explanation: Hyperkalemia should be investigated when a history of renal disease, massive trauma, insulin deficiency, Addison disease, use of potassium salt substitutes, or metabolic acidosis exists. The other options are not known to be causes of hyperkalemia. Points Received: 2 of 2 Comments: Question 15. Question : Between which months of age does sudden infant death syndrome (SIDS) most often occur? Student Answer: 0 and 1 2 and 4 5 and 6 6 and 7 Instructor Explanation: The incidence of SIDS is low during the first month of life but sharply increases in the second month of life, peaking at 2 to 4 months and is unusual after 6 months of age. Points Received: 2 of 2 Comments: Question 16. Question : What is the fundamental physiologic manifestation of anemia? Student Answer: Hypotension

Hyperesthesia Hypoxia Ischemia Instructor Explanation: The fundamental physiologic manifestation of anemia is a reduced oxygen- carrying capacity of the blood, resulting in tissue hypoxia. Points Received: 2 of 2 Comments: Question 17. Question : What is the life span of platelets (in days)? Student Answer:

Instructor Explanation: A platelet circulates for approximately 10 days and ages. Macrophages of the mononuclear phagocyte system, mostly in the spleen, remove platelets. Points Received: 2 of 2 Comments: Question 18. Question : What part of the kidney controls renal blood flow, glomerular filtration, and renin secretion? Student Answer: Macula densa Visceral epithelium Juxtaglomerular apparatus (JGA)

Filtration slits Instructor Explanation: 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. Points Received: 2 of 2 Comments: Question 19. Question : 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? Student Answer: Atrial septal defect (ASD) Ventricular septal defect (VSD) Patent ductus arteriosus (PDA) Atrioventricular canal (AVC) defect Instructor Explanation: 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 presentations of the other congenital heart defects are not consistent with the described symptoms. Points Received: 2 of 2 Comments: Question 20. Question : The coronary ostia are located in the: Student Answer: Left ventricle Aortic valve Coronary sinus

Aorta Instructor Explanation: Coronary arteries receive blood through openings in the aorta, called the coronary ostia. Points Received: 2 of 2 Comments: Question 21. Question : The only surface inside the nephron where cells are covered with microvilli to increase the reabsorptive surface area is called the: Student Answer: Proximal convoluted tubules Distal tubules Ascending loop of Henle Descending loop of Henle Instructor Explanation: The only surface inside the nephron where the cells are covered with microvilli (a brush border) is called the proximal convoluted tubules. This proximal convoluted tubular lumen consists of one layer of cuboidal cells with a surface layer of microvilli that increases the reabsorptive surface area. Points Received: 2 of 2 Comments: Question 22. Question : The drug heparin acts in hemostasis by which processes? Student Answer: Inhibiting thrombin and antithrombin III (AT-III) Preventing the conversion of prothrombin to thrombin Shortening the fibrin strands to retract the blood clot Degrading the fibrin within blood clots Instructor Explanation: Clinically administered heparin or heparin sulfate (on the surface of endothelial cells) binds to AT-III and induces a conformational change that greatly enhances

its activity. Under normal conditions, the presence of endothelial cell heparin sulfate and available AT-III in the circulation cooperate to protect the vessels from the effects of spontaneously activated thrombin. The other options do not accurately describe the role heparin plays in hemostasis. Points Received: 2 of 2 Comments: Question 23. Question : Which immunoglobulin (Ig) is present in childhood asthma? Student Answer: IgM IgG IgE IgA Instructor Explanation: Included in the long list of asthma-associated genes are those that code for increased levels of immune and inflammatory mediators (e.g., interleukin [IL]–4, IgE, leukotrienes), nitric oxide, and transmembrane proteins in the endoplasmic reticulum. None of the other options are associated with childhood asthma. Points Received: 2 of 2 Comments: Question 24. Question : Immunoglobulin E (IgE) is associated with which type of hypersensitivity reaction? Student Answer:

I

II

III

IV

Instructor Explanation: Hypersensitivity reactions have been divided into four distinct types: type I (IgE- mediated) hypersensitivity reactions, type II (tissue-specific) hypersensitivity reactions, type III (immune complex–mediated) hypersensitivity reactions, and type

IV (cell-mediated) hypersensitivity reactions. Points Received: 0 of 2 Comments: Question 25. Question : Which organ is stimulated during the alarm phase of the general adaptation syndrome (GAS)? Student Answer: Adrenal cortex Hypothalamus Anterior pituitary Limbic system Instructor Explanation: 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. Points Received: 0 of 2 Comments: Question 26. Question : Which congenital heart defects occur in trisomy 13, trisomy 18, and Down syndrome? Student Answer: Coarctation of the aorta (COA) and pulmonary stenosis (PS) Tetralogy of Fallot and persistent truncus arteriosus Atrial septal defect (ASD) and dextrocardia Ventricular septal defect (VSD) and patent ductus arteriosus (PDA) Instructor Explanation: Congenital heart defects that are related to dysfunction of trisomy 13, trisomy 18, and Down syndrome include VSD and PDA (see Table 33-2). The other defects are not associated with dysfunction of trisomy 13, trisomy 18, and Down syndrome.

Points Received: 0 of 2 Comments: Question 27. Question : What substance stimulates renal hydroxylation in the process of producing vitamin D? Student Answer: Erythropoietin Thyroid hormone Calcitonin Parathyroid hormone Instructor Explanation: Parathyroid hormone stimulates renal hydroxylation in the process of producing vitamin D. The first step occurs in the liver with hydroxylation at the 25th carbon (calcifediol); the second step in hydroxylation occurs at the first carbon position in the kidneys. The other options are not involved in this process. Points Received: 0 of 2 Comments: Question 28. Question : Which term is used to identify the movement of gas and air into and out of the lungs? Student Answer: Perfusion Ventilation Respiration Diffusion Instructor Explanation: Of the options available, ventilation is the only term used to identify the mechanical movement of gas or air into and out of the lungs. Points Received: 2 of 2 Comments:

Question 29. Question : Where are antibodies produced? Student Answer: Helper T lymphocytes Thymus gland Plasma cells Bone marrow Instructor Explanation: An antibody or immunoglobulin is a serum glycoprotein produced only by plasma cells in response to a challenge by an immunogen. Points Received: 0 of 2 Comments: Question 30. Question : What is the most common cause of insufficient erythropoiesis in children? Student Answer: Folic acid deficiency Iron deficiency Hemoglobin abnormality Erythrocyte abnormality Instructor Explanation: Similar to the anemias of adulthood, ineffective erythropoiesis or premature destruction of erythrocytes causes the anemias of childhood. The most common cause of insufficient erythropoiesis is iron deficiency. The other options may be causes but are not common ones. Points Received: 2 of 2 Comments: Question 31. Question : In a normal, nonmutant state, an oncogene is referred to as a:

Student Answer: Basal cell Target cell Caretaker gene Proto-oncogene Instructor Explanation: In its normal nonmutant state, an oncogene is referred to as a proto-oncogene. The other options are not terms used to identify a nonmutant oncogene. Points Received: 0 of 2 Comments: Question 32. Question : Which manifestations of vasoocclusive crisis are associated with sickle cell disease (SCD) in infants? Student Answer: Atelectasis and pneumonia Edema of the hands and feet Stasis ulcers of the hands, ankles, and feet Splenomegaly and hepatomegaly Instructor Explanation: 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 of a vasoocclusive crisis associated with SCD in infancy. Points Received: 0 of 2 Comments: Question 33. Question : What is the life span of an erythrocyte (in days)? Student Answer: 20 to 30

60 to 90 100 to 120 200 to 240 Instructor Explanation: Because it cannot undergo mitotic division, the erythrocyte has a limited life span of approximately 120 days. Points Received: 2 of 2 Comments: Question 34. Question : Which term is used to describe a muscle cell showing a reduced ability to form new muscle while appearing highly disorganized? Student Answer: Dysplasia Hyperplasia Myoplasia Anaplasia Instructor Explanation: Anaplasia is defined as the loss of cellular differentiation, irregularities of the size and shape of the nucleus, and the loss of normal tissue structure. In clinical specimens, anaplasia is recognized by a loss of organization and a significant increase in nuclear size with evidence of ongoing proliferation. The remaining options refer to specific changes in the cell. Points Received: 2 of 2 Comments: Question 35. Question : Which hepatitis virus is known to be sexually transmitted? Student Answer:

A

B

C

D

Instructor Explanation: Only hepatitis B virus (HBV) is known to be sexually transmitted. Points Received: 2 of 2 Comments: Question 36. Question : What is the primary problem resulting from respiratory distress syndrome (RDS) of the newborn? Student Answer: Consolidation Pulmonary edema Atelectasis Bronchiolar plugging Instructor Explanation: The primary problem is atelectasis, which causes significant hypoxemia and is difficult for the neonate to overcome because a significant negative inspiratory pressure is required to open the alveoli with each breath. None of the other options are considered a primary problem associated with RDS. Points Received: 0 of 2 Comments: Question 37. Question : What is the action of urodilatin? Student Answer: Urodilatin causes vasoconstriction of afferent arterioles. It causes vasodilation of the efferent arterioles. Urodilatin inhibits antidiuretic hormone secretion. It inhibits salt and water reabsorption.

Instructor Explanation: 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. Points Received: 0 of 2 Comments: Question 38. Question : Erythrocyte life span of less than 120 days, ineffective bone marrow response to erythropoietin, and altered iron metabolism describe the pathophysiologic characteristics of which type of anemia? Student Answer: Aplastic Sideroblastic Anemia of chronic disease Iron deficiency Instructor Explanation: Anemia of chronic disease results from a combination of (1) decreased erythrocyte life span, (2) suppressed production of erythropoietin, (3) ineffective bone marrow erythroid progenitor response to erythropoietin, and (4) altered iron metabolism and iron sequestration in macrophages. This result is not true of the other options. Points Received: 0 of 2 Comments: Question 39. Question : The function of the foramen ovale in a fetus allows what to occur? Student Answer: Right-to-left blood shunting Left-to-right blood shunting Blood flow from the umbilical cord Blood flow to the lungs Instructor Explanation: The nonfused septum secundum and ostium secundum result in the formation of a flapped 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. Points Received: 2 of 2 Comments: Question 40. Question : What is the most abundant class of plasma protein? Student Answer: Globulin Albumin Clotting factors Complement proteins Instructor Explanation: Albumin (approximately 60% of total plasma protein at a concentration of about 4 g/dl) is the most abundant plasma protein. Points Received: 2 of 2 Comments: Question 41. Question : When a patient has small, vesicular lesions that last between 10 and 20 days, which sexually transmitted infection is suspected? Student Answer: Genital herpes Chancroid Syphilis Chlamydia Instructor Explanation: If symptoms occur, the individual may have small (1 to 2 mm), multiple, vesicular lesions that are generally located on the labia minora, fourchette, or penis. They may also appear on the cervix, buttocks, and thighs and are often painful and pruritic. These lesions usually last approximately 10 to 20 days. The other options do not demonstrate these symptoms. Points Received: 2 of 2

Comments: Question 42. Question : During an IgE-mediated hypersensitivity reaction, which leukocyte is activated? Student Answer: Neutrophils Monocytes Eosinophils T lymphocytes Instructor Explanation: Of the options provided, only eosinophils are activated during IgE-mediated hypersensitivity reactions. Points Received: 2 of 2 Comments: Question 43. Question : What effect do natriuretic peptides have during heart failure when the heart dilates? Student Answer: Stimulates antidiuretic hormones. Inhibits antidiuretic hormones. Stimulates renin and aldosterone. Inhibits renin and aldosterone. Instructor Explanation: Natriuretic peptides inhibit renin and aldosterone during heart failure when the heart dilates. These make up a group of peptide hormones, including atrial natriuretic peptide (ANP), secreted from myocardial cells in the atria and brain natriuretic peptide (BNP) secreted from myocardial cells in the cardiac ventricles. When the heart dilates during volume expansion or heart failure, ANP and BNP inhibit sodium and water absorption by kidney tubules, inhibit the secretion of renin and aldosterone, vasodilate the afferent arterioles, and constrict the efferent arterioles. The result is increased urine formation, leading to decreased blood volume and blood pressure. Points Received: 2 of 2

Comments: Question 44. Question : Blood vessels of the kidneys are innervated by the: Student Answer: Vagus nerve Sympathetic nervous system Somatic nervous system Parasympathetic nervous system Instructor Explanation: The blood vessels of the kidney are innervated by the sympathetic noradrenergic fibers that cause arteriolar vasoconstriction and reduce renal blood flow. The other options are not involved in this process. Points Received: 2 of 2 Comments: Question 45. Question : What is the first stage in the infectious process? Student Answer: Invasion Colonization Spread Multiplication Instructor Explanation: From the perspective of the microorganisms that cause disease, the infectious process undergoes four separate stages of progression: (1) colonization, (2) invasion, (3) multiplication, and (4) spread. Points Received: 2 of 2 Comments: Question 46. Question : Which drug may be prescribed orally for outbreak management of

herpes simplex viral (HSV) infections? Student Answer: Acyclovir (Zovirax) 5-Fluorouracil (5-FU) Zidovudine (AZT) (Retrovir) Bichloroacetic acid (BCA) Instructor Explanation: Although no curative treatment for HSV infection is known, only oral acyclovir, valacyclovir, penciclovir, and famciclovir are used for primary and periodic outbreaks and to prevent recurrences. Points Received: 2 of 2 Comments: Question 47. Question : What is the most common cause of iron deficiency anemia (IDA)? Student Answer: Decreased dietary intake Chronic blood loss Vitamin deficiency Autoimmune disease Instructor Explanation: The most common cause of IDA in well-developed countries is pregnancy and chronic blood loss. Points Received: 2 of 2 Comments: Question 48. Question : Causes of hyperkalemia include: Student Answer: Hyperparathyroidism and malnutrition

Vomiting and diarrhea Renal failure and Addison disease Hyperaldosteronism and Cushing disease Instructor Explanation: Hyperkalemia should be investigated when a history of renal disease, massive trauma, insulin deficiency, Addison disease, use of potassium salt substitutes, or metabolic acidosis exists. The other options are not known to be causes of hyperkalemia. Points Received: 2 of 2 Comments: Question 49. Question : A person with type O blood is considered to be the universal blood donor because type O blood contains which of the following? Student Answer: No antigens No antibodies Both A and B antigens Both A and B antibodies Instructor Explanation: Because individuals with type O blood lack both types of antigens, they are considered universal donors, meaning that anyone can accept their red blood cells. Type O individuals, who have neither A or B antigen but have both anti-A and anti-B antibodies, cannot accept blood from any of the other three types. Points Received: 2 of 2 Comments: Question 50. Question : Which type of antibody is involved in type I hypersensitivity reaction? Student Answer: IgA IgE

IgG IgM Instructor Explanation: Type I reactions are only mediated by antigen-specific IgE and the products of tissue mast cells (see Figure 9-1). Points Received: 2 of 2 Comments: Question 51. Question : Which cardiac chamber has the thinnest wall and why? Student Answer: The right and left atria; they are low-pressure chambers that serve as storage units and conduits for blood. The right and left atria; they are not directly involved in the preload, contractility, or afterload of the heart. The left ventricle; the mean pressure of blood coming into this ventricle is from the lung, which has a low pressure. The right ventricle; it pumps blood into the pulmonary capillaries, which have a lower pressure compared with the systemic circulation. Instructor Explanation: The two atria have the thinnest walls because they are low-pressure chambers that serve as storage units and conduits for blood that is emptied into the ventricles. This selection is the only option that correctly identifies which heart chambers have the thinnest walls and why that helps cardiac function. Points Received: 2 of 2 Comments: Question 52. Question : Which criterion is used to confirm a diagnosis of asthma in an 8-year- old child? Student Answer: Parental history of asthma Serum testing that confirms increased immunoglobulin E (IgE)

and eosinophil levels Reduced expiratory flow rates confirmed by spirometry testing Improvement on a trial of asthma medication Instructor Explanation: 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. Points Received: 2 of 2 Comments: Question 53. Question : The lung is innervated by the parasympathetic nervous system via which nerve? Student Answer: Vagus Phrenic Brachial Pectoral Instructor Explanation: Fibers of the parasympathetic division of the autonomic nervous system (ANS) travel only in the vagus nerve to the lung. Points Received: 2 of 2 Comments: Question 54. Question : The generation of clonal diversity occurs primarily during which phase of life? Student Answer: Fetal Neonatal