Download Pathophysiology Exam Review: Immune System and Cancer and more Exams Nursing in PDF only on Docsity! NURS 611 EXAM 2 PATHO ACTUAL EXAM AND TEST BANK COMPLETE 150+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES Review: the parasympathetic system is all about what? - correct answer Conserving energy, digesting, metabolism, and rest The sympathetic nervous system primarily serves to protect an individual by doing? - correct answer Increases blood sugar levels, increases body temperature, and increases blood pressure. In general, sympathetic stimulation promotes responses that are concerned with the protection of the individual, which include increasing glucose, body temp, and BP. Review: the sympathetic system is all about what? - correct answer It's all about mobilizing energy stores, for instance glucose to muscles, decreased release of insulin, redirects blood supply from the gut to the muscles, heart, and lungs. Which characteristic is the most critical index of nervous system dysfunction? - correct answer Level of consciousness. LOC is the most critical clinical index of nervous system function or dysfunction. An alteration in consciousness indicates either improvement or deterioration of a person's condition. Thought and goal-oriented behaviors are functions of which area of the brain? - correct answer Prefrontal lobe. The prefrontal area is responsible for goal-oriented behavior such as the ability to concentrate, short-term or recall memory, and the elaboration of thought and inhibition on the limbic (emotional) areas of the CNS. Where is the region responsible for the motor aspects? - correct answer Broca area in the frontal lobe. Broca speech area is the only region responsible for the motor aspects of speech. Parkinson and Huntington diseases are associated with defects in which area of the brain? - correct answer Basal ganglia Maintenance of a constant internal environment and the implementation of behavioral patterns are main functions of which area of the brain? - correct answer Hypothalamus. Hypothalamic function falls into 2 major areas: 1) maintenance of a constant internal environment, and 2) implementation of behavioral patterns. What parts of the brain mediate the expression of affect, both emotional and behavioral states? - correct answer Limbic system and prefrontal cortex Reflex activities concerned with heart rate, blood pressure, respirations, sneezing, swallowing, and coughing are controlled by which area of the brain? - correct answer Medulla oblongata. The medulla oblongata makes up the myelencephalon and is the lowest portion of the brainstem. Which area of the brain assumes the responsibility for conscious and unconscious muscle synergy and for maintaining balance and posture? - correct answer Cerebellum The brain receives approximately what percentage of the cardiac output? - correct answer 20% or 800 to 1000 ml of blood flow per minute What evidence does the nurse expect to see when a patient experiences trauma to the hypothalamus? - correct answer Uneven expression of mood, unstable blood glucose levels, and poor temp regulation. The hypothalamus forms the base of the diencephalon. Hypothalamic function controls autonomic nervous system function, regulation of body temp, endocrine function (glucose levels), and regulation of emotional expression. What is the first defense of our bodies? - correct answer Skin and mucous membranes Which action is the purpose of the inflammatory process? - correct answer To prevent infection of the injured tissue. If the epithelial barrier is damaged, then a highly efficient local and system response (inflammation) is mobilized to limit the extent of damage, to protect against infection, and to initiate the repair of damaged tissue. What are the 4 cardinal signs of infection? - correct answer Edema (tumor), warmth (calor), redness (rubor), and pain (dolar). There is a 5th sign known as loss of function (functio laesa) Which type of white blood cell is first to arrive at the site of infection? - correct answer Leukocytes What causes the edema that occurs during the inflammatory process? - correct answer Increased capillary permeability. The increased flow and capillary permeability result in a leakage of plasma from the vessels, causing swelling in the surrounding tissue and is solely responsible for inflammation-induced edema. What process causes heat and redness to occur during the inflammatory process? - correct answer Vasodilation of blood vessels. The increased blood flow, as a result of vasodilation and increasing concentration of red cells at the site of inflammation cause locally increased warmth and redness. The chemotactic factor affects the inflammatory process by? - correct answer Directing leukocytes to the inflamed area Two chemotactic factors, neutrophil chemotactic factor (NCF) and eosinophil chemotactic factor of anaphylaxis (ECF-A), are released during mast cell degranulation. NCF attracts neutrophils (a type of leukocytes), and ECF-A attracts eosinophils to the site of inflammation. What is pain mediated by? - correct answer Histamines, bradykinins, leukotrienes, and prostaglandins The main function of NK cells is to recognize and eliminate cells infected with viruses, although they are also somewhat effective at eliminating other abnormal host cells, specifically cancer cells. What type of immunity is produced when an immunoglobulin crosses the placenta? - correct answer Passive-acquired immunity Passive-acquired immunity (passive immunity) does not involve the host's immune response at all. Rather, passive immunity occurs when preformed antibodies or T lymphocytes are transferred from a donor to the recipient. This transfer can occur naturally, as in the passage of maternal antibodies across the placenta to the fetus, or artificially, as in a clinic using immunotherapy for a specific disease. When antigens are administered to produce immunity, why are different routes of administration considered? - correct answer Each route stimulates a different lymphocyte- containing tissue, resulting in different types of cellular and humoral immunity. Each route preferentially stimulates a different set of lymphocyte-containing (lymphoid) tissues and therefore results in the induction of different types of cell-mediated or humoral immune responses. Which immunoglobulin is present in blood, saliva, breast milk, and respiratory secretions? - correct answer IgA IgA can be divided into two subclasses, IgA1 and IgA2. IgA1 molecules are predominately found in the blood, whereas IgA2 is the predominant class of antibody found in normal body secretions. Which antibody initially indicates a typical primary immune response? - correct answer IgM Typically, IgM is produced first (primary immune response), followed by IgG against the same antigen. An individual is more susceptible to infections of mucous membranes when he or she has a seriously low level of which immunoglobulin antibody? - correct answer IgA The IgA molecules found in bodily secretions are dimers anchored together through a J chain and secretory piece. This secretory piece is attached to the IgA antibodies inside the mucosal epithelial cells and may function to protect these immunoglobulin antibodies against degradation by enzymes also found in the secretions, thus decreasing the risk of infections in the mucous membrane. Which is an example of an endogenous antigen? - correct answer Cancer cells When a person is exposed to most antigens, antibodies can be usually detected in his or her circulation within? - correct answer 6 days After only approximately 5-7 days is an IgM antibody specific for that antigen detected in the circulation. Vaccinations are able to provide protection against certain microorganisms because of the? - correct answer Level of protection provided by IgG IgG production is considerably increased, making it the predominant antibody class of the secondary response. IgG is often present in concentrations several times larger than those of IgM, and levels of circulating IgG specific for that antigen may remain elevated for an extended period of time. How does the aging process of the T-cell activity affect older adults? - correct answer Tendency to develop various infections T-cell activity is deficient in older adults, and a shift in the balance of T-cell subsets is observed. These changes may result in increased susceptibility to infection. A hypersensitivity reaction that produces an allergic response is called? - correct answer Anaphylaxis Examples of systemic anaphylaxis are allergic reactions to bee stings, peanuts, and fish. The common hay fever allergy is expressed through a reaction that is mediate by which class of immunoglobins? - correct answer IgE Type I reactions are mediated by antigen-specific IgE and the products of tissue mast cells. The most common allergies (pollen allergies) are type I reactions. In addition, most type I reactions occur against environmental antigens and are therefore allergic. Which type of antibody is involved in type I hypersensitivity reaction? - correct answer IgE Blood transfusion reactions are an example of? - correct answer Alloimmunity/ type 2 Only alloimmunity (also termed isoimmunity) occurs when the immune system of one individual produces an immunologic reaction against tissues of another individual. What is the mechanism that results in type II hypersensitivity reactions? - correct answer Antibodies bind to the antigens on the cell surface The mechanism that results in a type II hypersensitivity reaction begins with antibody binding to tissue-specific antigens or antigens that have attached to particular tissues. The cell can be destroyed by antibody IgG or IgM and activation of the complement cascade through the classical pathway. When mismatched blood is administered causing an ABO incompatibility the erythrocytes are destroyed by? - correct answer Complement-mediated cell lysis Erythrocytes are destroyed by complement-mediated lysis in individuals with automimmune hemolytic anemia or as a result of an alloimmune reaction to ABO mismatched transfused blood cells. When antibodies are formed against red blood cell antigens of the Rh system, the blood cells are destroyed by? - correct answer Phagocytosis in the spleen Antibodies against platelet-specific antigens or against red blood cell antigens of the Rh system coat those cells at low density, resulting in their preferential removal by phagocytosis in the spleen, rather than by complement-mediated lysis. How are target cells destroyed in a type II hypersensitivity reaction? - correct answer Natural killer cells The mechanism that results in a type II hypersensitivity reaction involves a subpopulation of cytotoxic cells that are not antigen specific (natural killer [NK] cells). Antibody on the target cell is recognized by Fc receptors on the NK cells, which releases toxic substances that destroy the target cell. Graves disease (hyperthyroidism) is an example of which type II hypersensitivity reaction? - correct answer Modulation Graves disease is a result of? - correct answer Autoantibodies binding to thyroid-stimulating hormone (TSH)-receptor sites Type III hypersensitivity reactions are a result of which action? - correct answer Antibodies binding to soluble antigens that were released into body fluids and the immune complexes being deposited in the tissues. Antigen-antibody (immune) complexes that are formed in the circulation and then deposited later in vessel walls or extravascular tissues cause most type III hypersensitivity diseases. Reyaud phenomenon is an example of which type of hypersensitivity? - correct answer Type III Raynaud phenomenon is a condition caused by the temperature-dependent deposition of immune complexes in the capillary beds of the peripheral circulation. A person with type O blood is considered to be the universal blood donor because type O blood contains which of the following? - correct answer No Antigens 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 blood types. Immunoglobulin E (IgE) is associated with which type of hypersensitivity? - correct answer Type I Which hormone prompts increased anxiety, vigilance, and arousal during a stress response? - correct answer Norepinephrine Only the release of norepinephrine promotes arousal, increased vigilance, increased anxiety, and other protective emotional responses. What is the effect that low-serum albumin has on the central stress response? - correct answer Impaired circulation of epinephrine and norepinephrine Low-serum albumin impairs circulation of both epinephrine and norepinephrine since both bind to plasma protein albumin. Stress-age syndrome directly results in depressed function of which system? - correct answer Immune system-we just discussed this Stress-induced norepinephrine results in? - correct answer Peripheral vasoconstriction During stress, norepinephrine raises blood pressure by constricting peripheral vessels; it dilates the pupils of the eye, causes piloerection, and increases sweat gland action in the armpits and palms. The most influential factor in whether a person will experience a stress reaction is his or her? - correct answer Ability to cope In other words, a person does not have a stress reaction unless the stress exceeds his or her coping abilities. What constricts peripheral vessels to increase blood pressure - correct answer Norepinephrine What increases gastric secretions? - correct answer Cortisol-think of that ulcer we are all working on, increased stress leads to increased cortisol, increased gastic acid and bam-you got an ulcer!! What increases cardiac output by increasing heart rate and myocardial contractility? - correct answer Epinephrine 86. Cortisol is an important player in the stress response. Cortisol ____ that initial inflammatory effect and it acts to _____ the activity of those helper T cells. Cortisol also ________ resolution of healing. So in a nutshell, cortisol actually acts to ______ the activities of those cytotoxic T cells. - correct answer inhibits, suppress, promotes, suppress A reduction is an individual's number of natural killer (NK) cells appears to correlate with an increased risk for the development of? - correct answer Depression A meta-analysis of studies shows a relationship between depression and the reduction in lymphocyte proliferation and natural killer cell activity. The increased production of proinflammatory cytokines is associated with which considerations? - correct answer Elevated anxiety levels and age/gender Increased levels of proinflammatory cytokines has been shown to have a possible link between stress and immune functions Which organ is stimulated during the alarm phase of the general adaptation syndrome (GAS)? - correct answer Hypothalamus The alarm phase of the GAS begins when a stressor triggers the actions of the hypothalamus and the sympathetic nervous system. What is the difference between benign and malignant? - correct answer Benign=cell's appearance is well differentiated and slow growing and typically avascular, growth is expansive (pushing on other structures and cells. Malignant=the cell is a mess because the cells have gone rogue! And they spread rapidly, invasive, vascular, and metastasizing. Which cytokines initiate the production of corticotropin-releasing hormone (CRH)? - correct answer IL-1 and IL-6 Although a number of stress factors initiate the production of CRH, only high levels of IL-1 and IL-6 initiate a response. What is the most common route for distant metastasis? - correct answer Blood and lymphatic vessels-the Autobaun for cancer cells! 93. Staging of cancer provides a _______ to determine treatment. - correct answer framework Staging system of cancer is as follows (example of breast cancer): - correct answer T1=within the breast tissue T2=still within the breast tissue but getting larger T3=start of invasion, either skin or chest wall T4=metastasis to other organs Node involvement means: - correct answer N2=fixed nodes involved What are tumor cell markers? - correct answer Hormones, enzymes, antigens, and antibodies that are produced by cancer cells Tumor (biologic) markers are substances produced by both benign and malignant cells that are found either in or on the tumor cells or in the blood, spinal fluid, or urine. Tumor markers may include hormones, enzymes, genes, antigens, and antibodies. The function of the tumor cell marker is to? - correct answer Screen individuals at high risk for cancer Screening and identifying individuals at high risk for cancer are ways tumor markers can be used. Keep in mind these markers are not used to definitively diagnosis or treat cancer and are not useful in predicting specific sites of cancer development. Autocrine stimulation is the ability of cancer cells to? - correct answer Secrete growth factors that stimulate their own growth Cancer cells must have mutations that enable them to proliferate in the absence of external growth signals. To achieve this, some cancers acquire the ability to secrete growth factors that stimulate their own growth, a process known as autocrine stimulation. Which cancers are all associated with chronic inflammation? - correct answer Colon, thyroid gland, and urinary bladder Some organs appear to be more susceptible to the oncogenic effects of chronic inflammation; for example, the GI tract, prostate, thyroid gland, pancreas, urinary bladder, pleura, and skin. One large study found a 66% increase in the risk of lung cancer among women with chronic asthma, an inflammatory disease of the airways. Chronic inflammation causes cancer by? - correct answer Releasing compounds such as reactive oxygen species that promote mutations Inflammatory cells release compounds such as reactive oxygen species (ROS) and other reactive molecules, that can promote mutations and block the cellular response to DNA damage. It has been determined that a tumor is in stage 2. What is the meaning of this finding? - correct answer Cancer is locally invasive Cancer confined to the organ of origin is stage 1; cancer that is locally invasive is stage 2; 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 lung or a prostate cancer spreading to bone is stage 4. Many cancers create a mutation of ras. Ras is a? - correct answer Intracellular-signaling protein that regulates cell growth Up to 1/3 of all cancers have an activating mutation in the gene for an intracellular signaling protein called ras. This mutant ras stimulates cell growth even when growth factors are missing. The ras gene converts from a proto-oncogene to an oncogene by? - correct answer Altering one or more nucleotide base pairs A point mutation is the alteration of one or a few nucleotide base pairs. This type of mutation can have profound effects on the activity of proteins. A point mutation in the ras gene converts Delirium is associated with autonomic nervous system over-activity and typically develops in 2 to 3 days, most commonly in ICUs, post-surgically, or during withdrawal from CNS depressants (alcohol, narcotic agents). What is the normal intracranial pressure (in mm Hg)? - correct answer 5 to 15 mm Hg- Wunderlich did not elaborate on specifics related to increased ICP but I decided to include this question. Dementia is commonly characterized by the deterioration in which abilities? • Decision making • Memory • Balance • Speech • Sociability - correct answer Memory, speech, and decision making Dementia is the progressive failure (an acquired deterioration) of many cerebral functions that include impairment of intellectual function with a decrease in orienting, memory, language, executive attentional functions, and alterations in behavior. 121. Delirium is ______, comes on ______ with the onset of disorientation, incoherent, delusional, and usually caused by a ____. - correct answer acute, suddenly, uti 122. Dementia is _____ and usually affects ___ populations - correct answer insidious, older The only way Alzheimer's Disease can be definitively diagnosed is ____. - correct answer post- mortem Neurofibrillary tangles characterize which neurologic disorder? - correct answer alzheimer Disease-amyloid plaques, neurofibrillary tangles, as well as neuronal and synaptic losses in the brain. Most common type of stroke is? - correct answer Ischemic Contributing factors for stroke include? - correct answer Diabetes, hypertension, ethnicity (African-American), high cholesterol, atrial fibrillation 127. Most common location of strokes is in the __. Most dysphasias are associated with cerebrovascular accidents involving which artery? - correct answer middle cerebral, Dysphasias are usually associated with a CVA involving the middle cerebral artery or one of its many branches. Interesting fact about the middle cerebral artery (MCA) is, contralateral homophonous and hemi-agnosia...if the right side, the contralateral sort they have right-sided homonymous agnosia, if they have right-sided think about what would be the left vision (it would be fine). So it is usually just on that one side that it is going to be affected. - correct answer 129. Contralateral hemiparesis or hemiplegia is on the _____ side of the brain that is going to be affected. - correct answer opposite A right embolic CVA has resulted in left-sided paralysis and reduced sensation of the left foot and leg. Which cerebral artery is most likely affected by the emboli? - correct answer Anterior cerebral Symptoms of an embolic stroke in only the right anterior cerebral artery would include left- sided contralateral paralysis or paresis (greater in the foot and thigh) and mild upper extremity weakness with mild contralateral lower extremity sensory deficiency with loss of vibratory and/or position sense and loss of two-point discrimination. Atrial fibrillation, rheumatic heart disease, and valvular prosthetics are risk factors for which type of stroke? - correct answer Embolic High-risk sources for the onset of embolic stroke are a atrial fibrillation (15% to 25% of strokes), left ventricular aneurysm or thrombus, left atrial thrombus, recent myocardial infarction, rheumatic valvular disease, mechanical prosthetic valve, nonbacterial thrombotic endocarditis, bacterial endocarditis, patent foramen ovale, and primary intracardiac tumors. Since his cerebrovascular accident, a man has been denying his left hemiplegia. What term is used to describe this finding? - correct answer Anosognosia, is ignorance or denial of the existence of disease What term describes the loss of the comprehension or production of language? - correct answer Aphasia With receptive dysphasia (fluent), the individual is able to? - correct answer Comprehend speech, but not verbally respond After a cerebrovascular accident, a man is unable to either feel or identify a comb with his eyes closed. This is an example of? - correct answer Tactile agnosia Tactile agnosia is related to injury of which area of the brain? - correct answer Parietal Tactile agnosia (astereognosis) is the inability to recognize objects by touch as a result of damage to the parietal lobe. Guillain-Barre Syndrome is an _____ disease that is triggered by some type of bacterial or viral infection - correct answer autoimmune 138. GB typically starts from an upper respiratory infection. Some studies are showing that it is linked to the _____ virus. - correct answer Zika Multiple sclerosis is another _____ disease marked by ______ and ___. - correct answer automimmune, exacerbations, remissions What is the central component of the pathogenic model of multiple sclerosis? - correct answer Demyelination of nerve fibers in the CNS MS is an automimmune disorder diffusely involving the degeneration of CNS myelin and loss of axons. Multiple sclerosis is best described as a? - correct answer Central nervous system demyelination possibly from an immunogenetic virus MS is describe as occurring when a previous infectious insult to the CNS has occurred in a genetically susceptible individual with a subsequent abnormal immune response in the CNS. Multiple sclerosis and Guillain-Barre syndrome are similar in that they are both? - correct answer Result from demyelination by an immune reaction Acute inflammatory demyelinating polyneuropathy (AIDP) accounts for most occurrences of Guillain-Barre syndrome and MS is an autoimmune disorder diffusely involving degeneration of CNS myelin and loss of axons. Myasthenia gravis is also an __ disease characterized by antibodies attacking __ receptors. - correct answer automimmune, acetylcholine Acetylcholine is one of our neuromuscular enzymes, hormones that help the muscles to ___. - correct answer contract 145. MG can be _____, marked by ________ fatigue. - correct answer insidious, exertional Individuals with myasthenia gravis begin to have _____ which leads to chronic respiratory infections. - correct answer microaspirations As myasthenia gravis progresses, individuals will display? - correct answer Bouts of pneumonia; ptosis (drooping of eyelids); facial drooping; difficulty chewing/swallowing; and weight loss Clinical manifestations of Parkinson disease are caused by a deficit in which of the brain's neurotransmitters? - correct answer Dopamine Parkinson disease is a commonly occurring degenerative disorder involving deficits of dopamine. Tremors at rest, rigidity, akinesia, and postural abnormalities are a result of the atrophy of neurons in the brain's what? - correct answer Substantia nigra that produces dopamine