Porth’s Essentials of Pathophysiology 5th Edition Test bank, Exams of Pathophysiology

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Porth’s Essentials of Pathophysiology 5th Edition Test Bank

1. While attending an international nursing conference, many discussions and break-out sessions focused on the World Health Organization's (WHO) views on health. Of the following comments made by nurses during a discussion session, which statements would be considered a good representation of the WHO definition? Select all that apply. A. Interests in keeping the older adult population engaged in such activities as book reviews and word games during social time B. Increase in the number of chair aerobics classes provided in the skilled care facilities C. Interventions geared toward keeping the older adult population diagnosed with diabetes mellitus under tight blood glucose control by providing in-home cooking classes D. Providing transportation for renal dialysis clients to and from their hemodialysis sessions E. Providing handwashing teaching sessions to a group of young children Answer: A, B, C, E Rationale: WHO definition of health is defined as "a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity." Engaging in book reviews facilitates mental and social well-being; chair aerobics helps facilitate physical well-being; and assisting with tight control of diabetes helps with facilitating physical well-being (even though the person has a chronic disease). Handwashing is vital in the prevention of disease and spread of germs. Question format: Multiple Select CHAPTER 1 Concepts of Health and DiseaseCognitive Level: Apply Client Needs: Safe, Effective Care Environment: Management of Care Reference: p. 2
2. A community health nurse is teaching a group of recent graduates about the large variety of factors that influence an individual's health or lack thereof. The nurse is referring to the Healthy People 2020 report from the U.S. Department of Health and Human Services as a teaching example. Of the following aspects discussed, which would be considered a determinant of health that is outside the focus of this report? A. The client has a diverse background by being of Asian and Native American/First Nation descent and practices various alternative therapies to minimize effects of stress. B. The client has a family history of cardiovascular disease related to hypercholesterolemia and remains noncompliant with the treatment regime. C. The client has a good career with exceptional preventive health care benefits. D. The client lives in an affluent, clean, suburban community with access to many health care facilities. Answer: B

Rationale: In Healthy People 2020 , the focus is to promote good health to all (such as using alternative therapies to minimize effects of stress); achieving health equity and promoting health for all (which includes having good health care benefits); and promoting good health (which includes living in a clean community with good access to health care). Being noncompliant with treatments to control high cholesterol levels with a family history to CV disease does not meet the "attaining lives free of preventable disease and premature death" goal/objective. Question format: Multiple Choice Chapter 1: Concepts of Health and Disease Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 2

3. A member of the health care team is researching the etiology and pathogenesis of a number of clients who are under his care in a hospital context. Which aspect of clients' situations best characterizes pathogenesis rather than etiology? A. A client who has been exposed to the mycobacterium tuberculosis bacterium. B. A client who is has increasing serum ammonia levels due to liver cirrhosis. C. A client who was admitted with the effects of methyl alcohol poisoning. D. A client with multiple skeletal injuries secondary to a motor vehicle accident. Answer: B Rationale: Pathogenesis refers to the progressive and evolutionary course of disease, such as the increasing ammonia levels that accompany liver disease. Bacteria, poisons, and traumatic injuries are examples of etiologic factors. Question format: Multiple Choice Chapter 1: Concepts of Health and Disease Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 3
4. A new client who suffered a myocardial infarction requires angioplasty and stent placement. He has arrived to his first cardiac rehabilitation appointment. In this first session, a review of the pathogenesis of coronary artery disease is addressed. Which statement by the client verifies to the nurse that he has understood the nurse's teachings about coronary artery disease? A. "All I have to do is stop smoking and then I won't have any more heart attacks." B. "My artery was clogged by fat so I will need to stop eating fatty foods like french fries every day." C. "Sounds like this began because of inflammation inside my artery that made it easy to form fatty streaks which led to my clogged artery." D. " If you do not exercise regularly to get your heart rate up, blood pools in the veins causing a clot which stops blood flow to the muscle and you have a heart attack." Answer: C

Rationale: The true etiology/cause of coronary artery disease (CAD) is unknown; however, the pathogenesis of the disorder relates to the progression of the inflammatory process from a fatty streak to the occlusive vessel lesion seen in people with coronary artery disease. Risk factors for CAD revolve around cigarette smoking, diet high in fat, and lack of exercise. Question format: Multiple Choice Chapter 1: Concepts of Health and Disease Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 3

5. A 77-year-old man is a hospital inpatient admitted for exacerbation of his chronic obstructive pulmonary disease (COPD), and a respiratory therapist (RT) is assessing the client for the first time. Which aspect of the client's current state of health would be best characterized as a symptom rather than a sign? A. The client's oxygen saturation is 83% by pulse oximetry. B. The client notes that he has increased work of breathing when lying supine. C. The RT hears diminished breath sounds to the client's lower lung fields bilaterally. D. The client's respiratory rate is 31 breaths per minute. Answer: B Rationale: Symptoms are subjective reports by the person experiencing the health problem, such as reports of breathing difficulty. Oxygen levels, listening to breath sounds, and respiratory rate are all objective, observable signs of disease. Question format: Multiple Choice Chapter 1: Concepts of Health and Disease Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 5
6. Which situation would be classified as a complication of a disease or outcome from the treatment regimen? Select all that apply. A. Massive pulmonary emboli following diagnosis of new onset atrial fibrillation. B. Burning, intense incision pain following surgery to remove a portion of colon due to intestinal aganglionosis. C. Development of pulmonary fibrosis following treatment with bleomycin, an antibiotic chemotherapy agent used in treatment of lymphoma. D. Gradual deterioration in ability to walk unassisted for a client diagnosed with Parkinson disease. E. Loss of short-term memory in a client diagnosed with Alzheimer disease. Answer: A, C Rationale: Development of pulmonary emboli and pulmonary fibrosis following chemotherapy are both examples of a complication (adverse extensions of a disease or outcome from treatment). It is normal to expect incisional pain following

surgery. As Parkinson disease progresses, the ability to walk independently is expected to decrease. This is a normal progression for people diagnosed with Parkinson disease. Loss of short-term memory in a client diagnosed with Alzheimer disease is an expected finding. Question format: Multiple Select Chapter 1: Concepts of Health and Disease Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 3

7. Laboratory testing is ordered for a male client during a clinic visit for routine follow-up assessment of hypertension. When interpreting lab values, the nurse knows: A. a normal value represents the test results that fall within the bell curve. B. if the lab result is above the 50% distribution, the result is considered elevated. C. all lab values are adjusted for gender and weight. D. if the result of a very sensitive test is negative, that does not mean the person is disease free. Answer: A Rationale: What is termed a normal value for a laboratory test is established statistically from results obtained from a selected sample of people. A normal value represents the test results that fall within the bell curve or the 95% distribution. Some lab values (like hemoglobin) are adjusted for gender, other comorbidities, or age. If the result of a very sensitive test is negative, it tells us the person does not have the disease and the disease has been ruled out or excluded. Question format: Multiple Choice Chapter 1: Concepts of Health and Disease Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 1
8. The laboratory technologists are a discussing a new blood test that helps establish a differential diagnosis between shortness of breath with a cardiac etiology and shortness of breath with a respiratory/pulmonary etiology. A positive result is purported to indicate a cardiac etiology. The marketers of the test report that 99.8% of clients who have confirmed cardiac etiologies test positive in the test. However, 1.3% of clients who do not have cardiac etiologies for their shortness of breath also test positive. Which statement best characterizes this blood test? A. Low validity; high reliability B. High sensitivity, low specificity C. High specificity; low reliability D. High sensitivity; low reliability Answer: B

Rationale: A large number of clients would receive the correct positive diagnosis (high sensitivity), while a significant number would receive a false-positive diagnosis (low specificity). The information given does not indicate low reliability or low validity. Question format: Multiple Choice Chapter 1: Concepts of Health and Disease Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 4

9. As part of a screening program for prostate cancer, men at a senior citizens center are having their blood levels of prostate-specific antigen (PSA) measured. Which statement would best characterize high positive predictive value but low negative predictive value for this screening test? A. All of the men who had high PSA levels developed prostate cancer; several men who had low PSA levels also developed prostate cancer. B. All of the men who had low PSA levels were cancer-free; several men who had high levels also remained free of prostate cancer. C. Men who had low PSA levels also displayed false positive results for prostate cancer; men with high levels were often falsely diagnosed with prostate cancer. D. The test displayed low sensitivity but high specificity. Answer: A Rationale: The test's inability to rule out cancer with a low PSA level indicates low negative predictive value. The answer "All of the men who had low PSA levels were cancer-free; several men who had high levels also remained free of prostate cancer" suggests high negative predictive value. The answer "Men who had low PSA levels also displayed false positive results for prostate cancer; men with high levels were often falsely diagnosed with prostate cancer" indicates low positive predictive value. High positive predictive value is associated with high sensitivity. Question format: Multiple Choice Chapter 1: Concepts of Health and Disease Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Reference: p. 5
10. A male international business traveler has returned from a trip to Indonesia. While there, he hired a prostitute for companionship and engaged in unprotected sex on more than one occasion. Unbeknownst to him, this prostitute harbored the hepatitis C virus. Upon return to the U.S., he exhibited no symptoms and returned to his usual activities. During this period of no outward symptoms, the disease would be classified as being in: A. the preclinical stage of disease. B. remission and unlikely to develop hepatitis C. C. the clinical disease stage of hepatitis C. D. the chronic phase of hepatitis C.

Answer: A Rationale: During the preclinical stage, the disease is not clinically evident but is destined to progress to clinical disease. Question format: Multiple Choice Chapter 1: Concepts of Health and Disease Cognitive Level: Analyze Client Needs: Safe, Effective Care Environment: Management of Care Reference: p. 5

11. As of Nov. 1, 2012, there were a total of 10 confirmed cases of hantavirus infection in people who were recent visitors (mid-June to end of August, 2012) to Yosemite National Park. Three visitors with confirmed cases died. Health officials believe that 9 out of the 10 cases of hantavirus were exposed while staying in Curry Village in the Signature Tent Cabins. This is an example of: A. what the anticipated mortality rate would be if a family of five were planning to vacation in Yosemite National Park. B. the prevalence of hantavirus one can anticipate if he or she is going to vacation in Yosemite National Park. C. the low rate of morbidity one can expect while traveling to Yosemite National Park. D. the incidence of people who are at risk for developing hantavirus while staying in Yosemite National Park. Answer: D Rationale: The incidence reflects the number of new cases arising in a population at risk during a specified time. Question format: Multiple Choice Chapter 1: Concepts of Health and Disease Cognitive Level: Analyze Client Needs: Safe, Effective Care Environment: Management of Care Reference: p. 6
12. A particular disease has a debilitating effect on the ability of sufferers to perform their activities of daily living, and is a significant cause of decreased quality of life. However, few people die as a result of the disease's direct effects. There are hundreds of thousands of Americans living with the disease but relatively few new cases in recent years. Which statement best conveys an accurate epidemiologic characterization of the disease? A. Low mortality; high morbidity; low prevalence; high incidence. B. Low mortality; high morbidity; high incidence; low prevalence. C. High mortality; low morbidity; high incidence; low prevalence. D. High morbidity; low mortality; high prevalence, low incidence. Answer: D

Rationale: Morbidity is associated with quality of life, while mortality is indicative of causation of death. In this case, morbidity is high and mortality low. Prevalence refers to the number of cases present in a population, while incidence refers to the number of new cases. In this case, prevalence is high while incidence is low. Question format: Multiple Choice Chapter 1: Concepts of Health and Disease Cognitive Level: Analyze Client Needs: Safe, Effective Care Environment: Management of Care Reference: p. 6

13. An epidemiologist is conducting a program of research aimed at identifying factors associated with incidence and prevalence of congenital cardiac defects in infants. The researcher has recruited a large number of mothers whose infants were born with cardiac defects as well as mothers whose infants were born with healthy hearts. The researcher is comparing the nutritional habits of all the mothers while their babies were in utero. Which type of study is the epidemiologist most likely conducting? A. Cohort study B. Cross-sectional study C. Case–control study D. Risk factor study Answer: C Rationale: In this study, the mothers with cardiac-affected babies would be the case group, while the mothers of healthy infants would serve as a control. This study does not possess the characteristics of a cohort or cross-sectional study, and risk factor study is not an existing methodology. Question format: Multiple Choice Chapter 1: Concepts of Health and Disease Cognitive Level: Understand Client Needs: Health Promotion and Maintenance Reference: p. 6 - 7
14. A nurse practitioner is working in a crowded neighborhood where the population is primarily immigrants from China. The nurse has designed a research study to follow children from kindergarten to the age of 25. She is going to be looking at their diet, successful progression in school, health practices, and development of disease, to name a few items. This type of research is known as: A. Cohort study B. Cross-sectional study C. Case–control study D. Epidemiologic study Answer: A Rationale: In this cohort study, a group of people who were born at approximately the same time or share some characteristics of interest is the focus of the research.

This study does not possess the characteristics of a case–control or cross-sectional study. Epidemiologic study is not an existing methodology. Question format: Multiple Choice Chapter 1: Concepts of Health and Disease Cognitive Level: Understand Client Needs: Health Promotion and Maintenance Reference: p. 7

15. As part of a community class, student nurses are developing curriculum to teach expectant parents the importance of having their child properly secured in a child safety seat. During the class, the students are going to have a safety officer examine the car seats that the parents have installed in their vehicle. This is an example of which type of prevention? A. Primary prevention B. Secondary prevention C. Tertiary prevention D. Prognosis enhancement Answer: A Rationale: Primary prevention is directed at keeping disease from occurring by removing risk factors. Some primary prevention is often mandated by law, like child safety seats. Secondary prevention focuses on screening and early disease identification, whereas tertiary prevention is directed at interventions to prevent complications of a disease. Question format: Multiple Choice Chapter 1: Concepts of Health and Disease Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 7
16. A multidisciplinary healthcare team operates a program aimed at the prevention, identification, and treatment of diabetes on a large Indian reservation. Which aspect of the program would most likely be classified as secondary prevention? A. Regularly scheduled wound dressing changes for clients who have foot ulcers secondary to peripheral neuropathy and impaired wound healing. B. Teaching school children how a nutritious, traditional diet can lessen their chances of developing adult-onset diabetes. C. Staffing a booth where community residents who are attending a baseball tournament can have their blood glucose levels checked. D. Administering oral antihyperglycemic medications to clients who have a diagnosis of diabetes. Answer: C Rationale: Secondary prevention focuses on screening and early disease identification, such as checking the blood glucose levels of a large number of

individuals to identify potential cases of diabetes. Wound treatment and medication administration would be considered tertiary interventions, and education would be considered primary prevention. Question format: Multiple Choice Chapter 1: Concepts of Health and Disease Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 7

17. An occupational therapist conducts a group therapy program called MindWorks with older adults who have diagnoses of dementia and Alzheimer's disease. The goal of the group is to slow the cognitive decline of clients by engaging them in regular, organized mental activity such as reading maps and solving puzzles. How would the program most likely be characterized? A. Primary prevention B. Secondary prevention C. Tertiary prevention D. Prognosis enhancement Answer: C Rationale: Interventions aimed at slowing the course of an already-diagnosed disease characterize tertiary prevention. Question format: Multiple Choice Chapter 1: Concepts of Health and Disease Cognitive Level: Understand Client Needs: Health Promotion and Maintenance Reference: p. 7 - 8
18. The clinical educator of a hospital medical unit has the mandate of establishing evidence-based practice guidelines for the nursing care on the unit. Which statement most accurately captures a guiding principle of the nurse's task? A. Evidence-based practice guidelines will be rooted in research rather than nurses' subjective practice preferences and experiences. B. Guidelines are synonymous with systematic research reviews. C. The need for continuity and standardization of guidelines will mean that they will be fixed rather than changeable. D. The guidelines will combine individual expertise with external systematic evidence. Answer: D Rationale: Evidence-based guidelines are a result of the combination of empirical, published evidence and the expertise of accomplished practitioners. They are not the same as systematic reviews of the literature and they are fluid and modifiable in the face of new evidence. Question format: Multiple Choice Chapter 1: Concepts of Health and Disease

Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Reference: p. 8

19. The neuroscience nursing unit has developed a set of step-by-step directions of what should occur if a nursing assessment reveals the client may be exhibiting clinical manifestations of a cerebrovascular accident (CVA). Which statement about clinical practice guidelines are accurate? Select all that apply. A. Step-by-step guidelines are usually developed and based primarily on "how it has always been done before." B. The development of evidence-based practice guidelines require a research review from different studies to develop the most accurate diagnostic method to implement. C. Once developed, practice guidelines only need to be reviewed if a national committee sends out an update on new research. D. When developing a CVA set of step-by-step directions, the nursing unit should ask for assistance from experts in the neuroscience field. The potential users of the guidelines should pilot test it for further feedback. E. A meta-analysis could be utilized to combine evidence from different studies to produce a more accurate diagnostic method. Answer: B, D, E Rationale: Clinical practice guidelines are systematically developed and intended to inform practitioners in making decisions about health care for CVA clients. They should be developed using research and review by experts in the clinical content. Potential users should also participate and provide feedback prior to implementation. The purpose of the guidelines is to review EBP articles and develop new practice guidelines rather that continuing practicing primarily on "how it has always been done before." Once developed, the guidelines must be continually reviewed and changed to keep pace with new research findings. A meta-analysis could be utilized to combine evidence from different studies to produce a more accurate diagnostic method or the effects of an intervention method. Question format: Multiple Select Chapter 1: Concepts of Health and Disease Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Reference: p. 8
20. A nurse is investigating the epidemiologic factors influencing breast cancer for women in a population. What information should the nurse include? Select all that apply. A. How cancer cells divide and multiply in breast tissue B. The geographic location of women diagnosed with breast cancer C. The currently known incidence and prevalence for this population D. The age of women at the time of diagnosis E. The number of women whose diagnosis was assisted by the use of mammography

Answer: B, D Rationale: Epidemiology refers to the study of disease in populations. It looks for patterns such as age, race, geographic location, and dietary habits of people who are affected with a particular disorder. While this data will be compared and reveal patterns of greater or lesser incidence, the focus is on people diagnosed with the condition and should not be influenced by previously calculated statistics. Neither how the condition was diagnosed, nor the pathogenesis of it once present, are part of epidemiology. Question format: Multiple Select Chapter 1: Concepts of Health and Disease Cognitive Level: Understand Client Needs: Health Promotion and Maintenance Reference: p. 6

21. A nurse researcher is interested in the natural history of a disease being studied. What should the nurse focus on to best understand the condition's natural history? A. Following client cases from initial diagnosis and throughout treatment B. Examining outcomes across a wide variety of treatment approaches C. Focusing on clients who did not receive treatment for the condition D. Interviewing clients for their first-hand experience with the condition Answer: C Rationale: The natural history of a disease refers to the progression and projected outcome of the disease without medical intervention. For this reason, following clients who have had any level of treatment will be less valuable at establishing natural history than focusing on only those who have had no treatment. Client experience with the condition will not inform how the disease progresses from a pathogenesis perspective. Question format: Multiple Choice Chapter 1: Concepts of Health and Disease Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Reference: p. 7
22. A clinical nurse specialist is interested in developing a research study focused on clients living with the sequelae of ischemic stroke. Which clients should the nurse include? Select all that apply. The nurse should include clients with: A. aspiration pneumonia. B. unilateral weakness. C. dysphagia (difficulty swallowing). D. falls. E. vision changes. Answer: B, C, E

Rationale: Sequelae are lesions or impairments that follow or are caused by a disease. In ischemic stroke, the condition causes neurologic impairment, which may result in trouble swallowing, vision changes, or weakness. Falls are not a result of the disease process itself. Aspiration pneumonia would be a complication of stroke that is associated with having difficulty swallowing. Question format: Multiple Select Chapter 1: Concepts of Health and Disease Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 4

23. A nurse is considering setting up a screening program for a specific health condition in a population. What characteristic of the condition would need to be true for the nurse to justify screening a population? The condition should: A. be asymptomatic at an early stage. B. have a noninvasive diagnostic test available. C. be curable with available treatment. D. have a high mortality rate. Answer: A Rationale: Screening a population for a condition helps direct secondary prevention and is designed to detect disease when it is early in development, asymptomatic, and only if treatment measures can effect a cure or stop the disease from progressing. While a condition does not need to be curable, it should be treatable. Mortality rate can factor into justifying the importance of screening, but even conditions with low mortality rates may be targeted for secondary prevention. Some screening tests such as colonoscopy are invasive. Question format: Multiple Choice Chapter 1: Concepts of Health and Disease Cognitive Level: Apply Client Needs: Health Promotion and Maintenance Reference: p. 7
24. The nurse is questioning the validity of oxygen saturation readings from the new oximeters on the unit. Which action should the nurse take to best determine if the results from the oximeter are valid? A. Compare clients' results to measurements taken using arterial blood gas analyses. B. Repeat the test on the same client to determine if the oximeter offers the same results. C. Review the literature about this brand of oximeter provided by the company. D. Compare the findings with all clients' results on the unit to determine if there is a trend in the results. Answer: A

Rationale: Validity refers to the extent to which a measurement tool measures what it is intended to measure. The best way to confirm validity is to compare the measurement against those from another test that measures the same data. Oxygen saturation levels and PaO 2 are both reported on arterial blood gas (ABG) results. The results from any client who had an ABG done concurrent with an oxygen saturation measurement with the new oximeter could be compared for discrepancy. Repeating the test with the same device would provide information about reliability. Reviewing the literature may provide the nurse with the company's interpretation of the validity of the oximeter brand, but this does not guarantee perfect functioning of the unit in question. If the results are inaccurate, comparing these inaccurate results to one another will not help determine validity of the measurement. Question format: Multiple Choice Chapter 1: Concepts of Health and Disease Cognitive Level: Apply Client Needs: Safe, Effective Care Environment: Safety and Infection Control Reference: p. 4

25. The public health nurse is designing a course about risk factors for various chronic illnesses. For risk factors about which chronic illness will the nurse consult the Framingham study? A. Cardiovascular disease B. Breast cancer C. Chronic obstructive pulmonary disease (COPD) D. Type 2 diabetes mellitus Answer: A Rationale: The Framingham Study is a longitudinal, or cohort, study which began in 1950 to study the characteristics of people who would later develop coronary heart disease. Though data has been collected about cancer diagnoses and other health conditions from this cohort, that data has not been used to create definitive risk factor data as it has been for cardiovascular disease. Question format: Multiple Choice Chapter 1: Concepts of Health and Disease Cognitive Level: Understand Client Needs: Health Promotion and Maintenance Reference: p. 7

CHAPTER TWO

1. During a discussion on cellular components and their function, a student asked the instructor the purpose of messenger RNA (mRNA). Of the following, which is the most accurate answer? A. To transport amino acids to the site of protein synthesis. B. Acts as an inner nuclear support membranes for a rigid network of protein filaments that binds DNA to the nucleus. C. Performs an active role of protein synthesis, where mRNA molecules direct the assembly of proteins on ribosomes to the cytoplasm. D. Assists cells in forming neoplastic progression by altering the response of chromatin in the nuclear matrix. Answer: C Rationale: The nucleus is the site for the synthesis of 3 types of RNA that move to the cytoplasm and carry out the actual synthesis of proteins. Messenger RNA copies and carries the DNA instructions for protein synthesis to the cytoplasm. Ribosomal RNA is the site of actual protein synthesis; transfer RNA transports amino acids to the site of protein synthesis. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Understand Client Needs: Physiological Integrity: Basic Care and Comfort Reference: p. 12
2. The nurse is providing care for a client with a diagnosis of cirrhosis, and she notes that the client's sclerae are jaundiced. The nurse recalls that jaundice is a pigment that can accumulate in which part of the cell? A. Nucleus B. Cytoplasm C. Golgi apparatus D. Rough endoplasmic reticulum (ER) Answer: B Rationale: Pigments such as bilirubin and melanin can accumulate in the cytoplasm, resulting in the characteristic yellow skin tones associated with jaundice. Pigments do not tend to accumulate in the nucleus, Golgi apparatus, or rough ER. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Remember Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 13
3. A 14-year-old female has been experiencing severe internal cramps in the region of the pelvis along with weight loss. She has been admitted with rectal bleeding. The physician has diagnosed her with inflammatory bowel disease (IBD). She asks the nurse what causes this disease. Which pathophysiologic basis will guide the nurse's response to this adolescent?

A. Liver involvement in faulty glycogen stores B. Endoplasmic reticulum stress in the gastrointestinal system C. Over secretion of insulin from the beta cells in the pancreas D. Infiltration of the gastrointestinal track by bacterial toxins Answer: B Rationale: Researchers are determining links between endoplasmic reticulum (ER) and various disease processes. For examples, ER stress in the GI system has been found to be related to intestinal inflammations like the ones that occur with inflammatory bowel disease. Smooth ER of the liver is involved in glycogen stores. Insulin is synthesized as a large, inactive proinsulin molecule cut apart to produce a smaller, active insulin molecule within the Golgi complex of the beta cells. Bacterial toxins have exploited the retrograde transport mechanism. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Understand Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 13

4. A professor is teaching a group of students about the role of mitochondria within the cell. Which statement is true of mitochondria? A. They are the site of adenosine triphosphate (ATP) production. B. The number of mitochondria in a cell is equal to the number of nuclei. C. They are replicated within the smooth endoplasmic reticulum (ER). D. Mitochondrial DNA is inherited patrilineally. Answer: A Rationale: Consistent with their characterization as the "power plants" of the cell, mitochondria are the site of ATP synthesis for the cell. There are a varying number in each cell, according to the energy demands of the particular cell. They are self- replicating rather than being produced in the smooth ER and they are inherited matrilineally. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Understand Client Needs: Safe, Effective Care Environment: Management of Care Reference: p. 15
5. A client has been diagnosed with a neurodegenerative disease called multiple sclerosis (MS). The physician explains to the client that this disease may be caused by dysregulated apoptosis. Later that day, the client asks the nurse what this means. The nurse should reply: A. The cells around your nerves don't know how to die correctly. B. The cytoplasm should neutralize the various apoptotic inhibitors but isn't working correctly.

C. Dysregulated apoptosis has caused an excessive rate of programmed cell death along the neuro-pathways. D. There is an inappropriately low rate of apoptosis occurring within the cells. Answer: C Rationale: Dysregulated apoptosis can mean too little or too much and has been implicated in neurodegenerative disease, in which there is an increased or excessive rate of apoptosis. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 15

6. A client experiencing immotile cilia syndrome (Kartagener syndrome) should be frequently assessed by the nurse for which priority complication? A. Epistaxis resulting from loss of cilia in the nasal passageway. B. Bronchiectasis due to interferences with clearance of inhaled bacteria along the respiratory tract. C. Sterility caused by inability of sperm to swim downstream. D. Inability to hear soft sounds related to kinocilium on the hair cells in the inner ear. Answer: B Rationale: Immotile cilia syndrome immobilizes the cilia of the respiratory tract, thus interfering with clearance of inhaled bacteria, leading to the chronic lung disease called bronchiectasis. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Reference: p. 15
7. The nurse is explaining the workings of selective serotonin reuptake inhibitors (SSRIs) to a client with a diagnosis of depression. Within the teaching, the nurse mentions that in the nervous system, the transmission of information by neurotransmitters is: A. synaptic signaling. B. endocrine signaling. C. autocrine signaling. D. paracrine signaling. Answer: A Rationale: Synaptic signaling occurs in the nervous system, where neurotransmitters act only on adjacent nerve cells through special contact areas

called synapses. Endocrine signaling relies on hormones carried in the bloodstream to cells throughout the body. Autocrine signaling occurs when a cell releases a chemical into the extracellular fluid that affects its own activity. With paracrine signaling, enzymes rapidly metabolize the chemical mediators and therefore act mainly on nearby cells. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Remember Client Needs: Psychosocial Integrity Reference: p. 17

8. The nurse is teaching a group of colleagues about the cell division cycle as background to caring for oncology clients. Which statement is true of the cell cycle? A. Some^ cells^ lack^ a^ G 0 phase. B. Mitosis is a process that occurs in steps over 1 to 2 days. C. The two broad phases of the cell cycle are mitosis and synthesis. D. Nondividing^ cells^ such^ as^ nerve^ cells^ are^ said^ to^ be^ in^ the^ S 0 phase. Answer: C Rationale: While consisting of several stages, cell division can be broadly divided into the two phases of mitosis and synthesis. Some cells lack a G 1 stage, not a G 0 phase, and mitosis is a fluid and continuous process over 1 to 1.5 hours. Nondividing cells are said to be in the G 0 phase. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Understand Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 19
9. A 62-year-old male collapsed while unloading a truck of heavy sacks of feed for his cattle. When he arrived in the emergency department, blood gases revealed a slightly acidic blood sample. The nurse caring for this client is not surprised with this result based on which pathophysiologic rationale? A. The skeletal muscles are producing large amounts of lactic acid and release it into the bloodstream during heavy work/exercise. B. During exercise, catabolism will break down stored nutrients and body tissues to produce energy. C. Large amounts of free energy is released when ATP is hydrolyzed and then converted into adenosine diphosphate. D. Within the mitochondria, energy from reduction of oxygen is used for phosphorylation of ADP to ATP. Answer: A Rationale: Heart muscle is efficient in converting lactic acid to pyruvic acid and then using the pyruvic acid for fuel. Pyruvic acid is an important source of fuel for the heart during heavy exercise, when the skeletal muscles are producing large

amounts of lactic acid and releasing it into the bloodstream. Therefore, the blood sample would be acidic by nature. Catabolism will break down stored nutrients and body tissues to produce energy. ATP conversion into ADP and phosphorylation of ADP to ATP are both aerobic metabolism processes. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 20

10. The health caregiver is explaining the rationale for administering a hypotonic intravenous solution (lower concentration of solutes in its surroundings) to a client. Which mechanism of membrane transport most likely underlies this action? A. Facilitated diffusion B. Active transport C. Diffusion D. Osmosis Answer: D Rationale: The fact that body cells are permeable to water but not all solute particles, and the amount of solute relative to water content, underlies the choice of intravenous fluid in health care. Water moves through water channels in a semipermeable membrane along a concentration gradient, moving from an area of higher to one of lower concentration. This is the essence of osmosis, and the other mechanisms of membrane transport do not have as significant a bearing on the nurse's action. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Remember Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 24
11. A nurse is teaching a client with a recent diagnosis of diabetes about the roles that glucose and insulin play in the disease pathology and the fact that glucose must enter the body cell in order to provide energy for the client. The nurse knows that which process allows glucose to enter body cells? A. Osmosis B. Facilitated diffusion C. Active transport D. Diffusion Answer: B Rationale: Facilitated diffusion involves the movement of a substance like glucose from an area of high concentration, such as the bloodstream, to an area of low concentration, such as the intracellular space through the use of a transport

protein. Osmosis, active transport, and diffusion do bring about the movement of glucose into body cells. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Remember Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 23

12. A student asks the instructor about the origins of different tissues and their cellular origins during the process of development. Which statement by the instructor best describes the process of cell differentiation? A. "Cells of the hematopoietic system produce the appropriate body cells that are required at each stage of development." B. "A single stem cell differentiates into approximately 200 different types of cells." C. "A fertilized ovum undergoes a series of divisions, yielding many different cell types." D. "Cells differentiate into necessary body cells peaking after conception and ceasing near the time of birth." Answer: C Rationale: Cell differentiation and consequent tissue types are the outcome of the series of cell divisions that occur in the fertilized ovum. It originates neither with a single stem cell nor in the hematopoietic system. Stem cells allow for limited differentiation throughout the lifespan, not only antepartum. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Understand Client Needs: Health Promotion and Maintenance Reference: p. 30
13. A nurse is providing care for a client with a diagnosis of Crohn's disease. The nurse recognizes the fact that the disease involves the inflammation and irritation of the intestinal lining. Which type of tissue is most likely involved in the client's pathology? A. Simple columnar epithelium B. Glandular epithelium C. Simple cuboidal epithelium D. Stratified epithelium Answer: A Rationale: Simple columnar epithelium lines the intestine and its cilia and mucus- secreting goblet cells. The intestinal tract does not consist of glandular epithelium, simple cuboidal epithelium, or stratified epithelium. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Analyze

Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 32

14. During a crime scene investigation, the coroner confirms that rigor mortis has set in. This helps to confirm an approximate time of death. The forensic nurse can explain this process (rigor mortis) to a group of students based on the fact that: A. troponin is being prevented from forming a cross-bridge between the actin and myosin. B. when activated by ATP, cross-bridges become attached to the actin filament. C. the myosin head catalyzes the breakdown of ATP to provide the energy need so that a cross-bridge can be formed. D. at death, the body is unable to complete the actin/myosin cycle and release the coupling between the myosin and actin, creating a state of muscular contraction. Answer: D Rationale: As the muscle begins to degenerate after death, the sarcoplasmic cisternae release their calcium ions, which enable the myosin heads to combine with their sites on the actin molecule. As ATP supplies diminish, no energy source is available to start the normal interaction between actin and myosin; therefore, the muscle is in a state of rigor until further degeneration destroys the cross-bridges between actin and myosin. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Reference: p. 35
15. The home care nurse is making a home visit to a 51-year-old female client with a longstanding diagnosis of multiple sclerosis. The nurse knows that the muscle wasting and weakness associated with the disease process is ultimately manifested as a failure of what normal process in muscle tissue? A. The contraction of the epimysium. B. The surrounding of fascicles by perimysium. C. Thick myosin and thin actin filaments sliding over each other. D. The contraction of fascicles within myofibrils. Answer: C Rationale: The contraction of skeletal muscle tissue can be characterized as the sliding action of myosin and actin. Epimysium surrounds and plays a supportive role in skeletal muscle, and perimysium similarly provides support but does not actively produce locomotion. Myofibrils are found within fascicles, not the opposite. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Analyze Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 16

16. A caregiver is working with a client who is having poorly controlled pain due to shingles. The associated pain travels to the client's nervous system via: A. synapses. B. axons. C. afferent neurons. D. efferent neurons. Answer: C Rationale: Afferent or sensory neurons carry information toward the CNS; they are involved in the reception of sensory information from the external environment and from within the body. Efferent or motor neurons carry information away from the CNS; they are needed for control of muscle fibers and endocrine and exocrine glands. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Understand Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 37
17. The nurse is administering a calcium channel blocker to a client with a cardiac dysrhythmia. For what side effect should the nurse assess? A. Constipation B. Tachycardia C. Hypertension D. Polyuria Answer: A Rationale: Smooth muscle cells in the gastrointestinal tract rely on extracellular calcium entering cells and the release of calcium from the sarcoplasmic reticulum for muscle contraction, or peristalsis. This can contribute to constipation. Calcium- blocking drugs reduce heart rate and vasoconstriction, which will lower blood pressure. These drugs do not increase urine output. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Reference: p. 36 - 37
18. A client has been told she has elevated levels of low-density lipoproteins (LDL). The client says, "I have always followed a low-cholesterol diet, so how could it be elevated?" How should the nurse respond? A. LDL needs to be taken up into the intracellular space and this process does not work well in some people, causing LDL elevations in the blood. B. We should review your low-cholesterol diet. There are many hidden sources you may not have been aware you were eating.

C. This type of cholesterol is protective for your blood vessels, so having it elevated is good for your cardiovascular health. D. Diet does not really influence LDL levels; the levels depend solely on internal processes in the liver, which is determined by genetics. Answer: A Rationale: LDL is considered "bad" cholesterol and contributes to atherosclerosis. It enters cells by receptor-mediated endocytosis, which requires substances to bind to a cell-surface receptor to stimulate endocytosis. Problems with these receptors can keep LDL from entering cells, increasing LDL in the bloodstream. Diet can influence LDL levels in combination with genetic influences. Because the client has already tried the dietary approach, the nurse should provide the client with reasons as to why success with this approach can be limited. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 25

19. The nurse is caring for a client whose potassium level is 5.9 mEq/L (5.9 mmol/L). Which treatment should the nurse be prepared to administer? A. Medication to promote the movement of potassium into the intracellular space B. Intravenous fluids to dilute the quantity of potassium in the plasma C. Magnesium infusion to counteract the effects of high potassium levels on cells D. An aldosterone antagonist to alter renal excretion of potassium Answer: A Rationale: Potassium ions are higher inside the cell and, when in an imbalance, an excess amount of these ions will be outside the cell, resulting in hyperkalemia. The primary treatment for this is using medications to promote the movement of potassium back into the intracellular space. Intravenous fluids will not alter the degree of hyperkalemia and magnesium does not counteract the effects of potassium. An aldosterone antagonist would cause greater reabsorption of potassium from the renal tubules, making hyperkalemia worse. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 24
20. A nurse is teaching clients about the benefits of smoking cessation. What should the nurse include as the most accurate reason for the development of a chronic "smoker's cough"? A. Damage to cilia in the respiratory tract make it necessary to cough to clear the airway. B. Smoke is an irritant that chronically triggers the coughing centers in the brain.

C. Build-up of fluids in the alveolar spaces promotes a cough in an attempt to clear secretions. D. Substances in the smoke interfere with gas exchange and hypoxia triggers a cough response. Answer: A Rationale: In the respiratory tract, cilia function in the mucociliary escalator, where they help move materials such as bacteria and dust up from the airways into the mouth so they can be swallowed. Damage to cilia causes a cough, which is then used to help remove these substances from airways. While smoke is an irritant, this would trigger a cough when actively smoking rather than the chronic cough experienced by smokers. A cough is stimulated by substances in the airway rather than imbalances in gas exchange. Smoking does not lead to pulmonary edema, which is fluid in the alveoli. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Reference: p. 15

21. The nurse is caring for an 8-year-old client who has cystic fibrosis. What aspect of client care should the nurse prioritize? A. Nutritional status B. Airway clearance C. Infection control D. Pain control Answer: B Rationale: Cystic fibrosis involves an abnormal chloride channel, which causes the epithelial cell membrane to be impermeable to the chloride ion. The defective chloride secretion with excessive sodium and water causes abnormally thick and viscid respiratory secretions, blocking airways. Therefore, the airway clearance is the priority; subsequent priorities are infection control, nutritional status, and pain control based on most serious potential harm to the client. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Analyze Client Needs: Safe, Effective Care Environment: Management of Care Reference: p. 17
22. A community health care worker is explaining to a group of factory workers the importance of wearing gloves when working with strong chemicals such as turpentine and paint thinner. Which characteristics of cell membranes underlies the nurse's teaching? A. Impermeability of cell membranes to all but lipid-soluble substances. B. Cell membranes have a hydrophilic head and a hydrophobic tail.

C. Receptors for hormones and biologically active substances are found on cell membranes. D. A disorder within the water channel of the cell membrane can result in cancer formation. Answer: A Rationale: Because cell membranes are soluble to some lipid-soluble substances such as organic solvents, such substances should be kept from direct contact with skin cells. The facts that cell membranes have a hydrophilic head and a hydrophobic tail and contain receptors for hormones and biologically active substances do not have a bearing on the nurse's teaching. While transmembrane proteins can indeed pass into the intracellular environment, the nurse is not referring to proteins in the teaching. Question format: Multiple Choice Chapter 2: Cell and Tissue Characteristics Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Reference: p. 16

23. The parents of a child newly diagnosed with Tay-Sachs disease asks what signs and symptoms they will see if the disease is progressing. Which response(s) by the nurse is most accurate? Select all that apply. A. hyperactivity in lower limbs B. loss of motor skills like turning over C. chronic constipation D. vision loss E. skin rashes Answer: B, D Rationale: In Tay-Sachs disease, an autosomal recessive disorder, cells do not make a lysosomal enzyme called hexosaminidase A, which is needed to degrade the GM 2 ganglioside found in nerve cell membranes. Although GM 2 ganglioside builds up in many tissues, such as heart, lver, and spleen, its accumulation in the nervous system and retina of the eye causes the most damage. Therefore, vision loss and loss of motor skills, including turning over, crawling and sitting up are the first signs of Tay-Sachs disease. Question format: Multiple Select Chapter 2: Cell and Tissue Characteristics Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Reference: p. 14
24. When discussing the function of the cell membrane during pathophysiology class, which statement(s) by the faculty is accurate? Select all that apply. A. responsible for helping cytoplasm and cell membrane movement during endocytosis