UNDERSTANDING PATHOPHYSIOLOGY 6TH EDITION HUETHER TEST BANK Chapter 01: Cellular Biology H, Exams of Nursing

Download UNDERSTANDING PATHOPHYSIOLOGY 6TH EDITION HUETHER TEST BANK Chapter 01: Cellular Biology H and more Exams Nursing in PDF only on Docsity! UNDERSTANDING PATHOPHYSIOLOGY 6TH EDITION HUETHER TEST BANK Chapter 01: Cellular Biology Huether & McCance: Understanding Pathophysiology, 6th Edition Inclusive and 100% Verfied Questions and Answers. Best Examination Study Guide 2023 MULTIPLE CHOICE 1. A student is observing a cell under the microscope. It is observed to have supercoiled DNA with histones. Which of the following would also be observed by the student? a. A single circular chromosome b. A nucleus c. Free-floating nuclear material d. No organelles ANS: B The cell described is a eukaryotic cell, so it has histones and a supercoiled DNA within its nucleus; thus, the nucleus should be observed. A single circular chromosome called a prokaryote contains free-floating nuclear material but has no organelles. REF: p. 2 2. A nurse is instructing the staff about cellular functions. Which cellular function is the nurse describing when an isolated cell absorbs oxygen and uses it to transform nutrients to energy? a. Metabolic absorption b. Communication c. Secretion d. Respiration ANS: D The cell’s ability to absorb oxygen is referred to as respiration while its communication ability involves maintenance of a steady dynamic state, metabolic absorption provides nutrition, and secretion allows for the synthesizing of new substances. REF: p. 2 3. A eukaryotic cell is undergoing DNA replication. In which region of the cell would most of the genetic information be contained? a. Mitochondria b. Ribosome c. Nucleolus d. Nucleus Cytoplasm ANS: C The region of the cell that contains genetic material, including a large amount of ribonucleic acid, most of the DNA, and DNA-binding proteins, is the nucleolus, which is located within the cell’s nucleus. Mitochondria is associated with cellular respiration, while ribosomes are involved with protein manufacturing. Cytoplasm is a fluid filling that is a component of the cell. REF: p. 2 4. Which of the following can remove proteins attached to the cell’s bilayer by dissolving the layer itself? a. Peripheral membrane proteins b. Integral membrane proteins c. Glycoproteins d. Cell adhesion molecules ANS: B Proteins directly attached to the membrane bilayer can be removed by the action of integral membrane proteins that dissolve the bilayer. Peripheral membrane proteins reside at the surface while cell adhesion molecules are on the outside of the membrane. Glycoprotein marks cells and does not float. REF: p. 7 5. Which of the following can bind to plasma membrane receptors? a. Oxygen b. Ribosomes c. Amphipathic lipids d. Ligands ANS: D Ligands are the only specific molecules that can bind with receptors on the cell membrane. REF: p. 9 e. Decreased fibronectin f. Increased collagen g. Decreased elastin h. Increased glycoproteins ANS: A Only a reduced amount of fibronectin is found in some types of cancerous cells, allowing them to travel or metastasize. REF: p. 10 6. Which form of cell communication is used to relate to other cells in direct physical contact? a. Cell junction b. Gap junction c. Desmosome d. Tight junction ANS: A Cell junctions hold cells together and permit molecules to pass from cell to cell. Gap junctions allow for cellular communication between cells. Neither desmosomes nor tight junctions are associated with cellular communication. REF: p. 11 d. Electrically charged molecules ANS: D Electrolytes are electrically charged molecules. They are not lipid soluble, they are not made up of protein, and they do not play a role in ATP production. REF: p. 18 15. A nurse is reading a chart and sees the term oncotic pressure. The nurse recalls that oncotic pressure (colloid osmotic pressure) is determined by: a. the concentration of sodium. b. plasma proteins. c. hydrostatic pressure. d. the availability of membrane transporter proteins. ANS: B Oncotic pressure is determined by the effect of colloids or plasma proteins. The concentration of sodium plays a role in tonicity. Hydrostatic pressure is the force within a vessel. Membrane transporter proteins are involved in active transport within a concentration gradient. REF: p. 20 16. A patient has a body fluid of 300 mOsm/kg. This lab result is measuring: a. osmolality. b. osmolarity. c. osmotic pressure. d. oncotic pressure. ANS: A Osmolality measures the number of milliosmoles per kilogram of water, or the concentration of molecules per weight of water, while osmolarity measures the number of milliosmoles per liter of solution, or the concentration of molecules per volume of solution. Osmotic pressure is the amount of hydrostatic pressure required to oppose the osmotic movement of water. Oncotic pressure is from plasma proteins, not body fluids. REF: p. 19 17. A nurse is discussing the movement of fluid across the arterial end of capillary membranes into the interstitial fluid surrounding the capillary. Which process of fluid movement is the nurse describing? a. Hydrostatic pressure b. Osmosis c. Diffusion d. Active transport ANS: A Blood reaching the capillary bed has a hydrostatic pressure of 25–30 mm Hg, which is sufficient force to push water across the thin capillary membranes into the interstitial space. Osmosis involves the movement of fluid from an area of higher concentration to an area of lower concentration. It does not involve pressure or force. Diffusion is the passive movement of a solute from an area of higher solute concentration to an area of lower solute concentration. Active transport involves movement up a concentration gradient. REF: p. 19 18. How are potassium and sodium transported across plasma membranes? a. By passive electrolyte channels b. By coupled channels c. By adenosine triphosphate enzyme (ATPase) d. By diffusion ANS: C The transporter protein ATPase is directly related to sodium and potassium transport via active transport. Electrolyte movements require energy and do not move passively, nor are they transported by diffusion. Enzymes, not electrolytes, are passed via coupled channels. REF: p. 21 19. The ion transporter that moves Na+ and Ca2+ simultaneously in the same direction is an example of which of the following types of transport? a. Biport b. Uniport c. Antiport d. Symport ANS: D When ions are transported in one direction, it is termed symport. There is no such term as biport. Uniport refers to the movement of a single molecule. Antiport refers to the movement of molecules in the opposite direction. REF: p. 19, Figure 1-22 20. During which process are bacteria engulfed for ingestion? a. Endocytosis b. Pinocytosis c. Phagocytosis d. Exocytosis ANS: C Phagocytosis (cell eating) involves the ingestion of large particles, such as bacteria, through the formation of large vesicles. Endocytosis involves the formation of vesicles to facilitate movement into the cell. Pinocytosis is a type of endocytosis in which fluids and solute molecules are ingested through the formation of small vesicles. Exocytosis occurs when coated pits invaginate and internalize ligand-receptor complexes in coated vesicles. REF: p. 22 21. Some cancer drugs work during the cell cycle phase where nuclear and cytoplasmic divisions occur. What is this cell cycle phase called? a. G1 b. S c. M d. G2 ANS: C The M phase includes both nuclear and cytoplasmic divisions. The G1 phase includes the period between the M phase and the start of DNA synthesis. The S phase includes synthesis of DNA in the cell nucleus. The G2 phase includes RNA and protein synthesis. REF: pp. 25-26 22. Which causes the rapid change in the resting membrane potential that initiates an action potential? a. Potassium gates open, and potassium rushes into the cell, changing the membrane potential from negative to positive. b. Sodium gates open, and sodium rushes into the cell, changing the membrane potential from negative to positive. c. Sodium gates close, allowing potassium into the cell to change the membrane potential from positive to negative. d. Potassium gates close, allowing sodium into the cell to change the membrane potential from positive to negative. ANS: B When the threshold is reached, the cell will continue to depolarize with no further stimulation. The sodium gates open, and sodium rushes into the cell, causing the membrane potential to reduce to zero and then become positive (depolarization). Sodium is involved in creating the action potential, not potassium. The sodium gate and channel must be open, not closed. The action potential is not affected by a change in the potassium gate. REF: pp. 24-25 23. A cell is isolated, and that the resting membrane potential is 70 mV. The predominant intracellular ion is Na+, and the predominant extracellular ion is K+. With voltage change, which of the following would result in an action potential? a. K+ rushing into the cell b. Na+ rushing into the cell c. Na+ rushing out of the cell d. K+ rushing out of the cell ANS: A With voltage change, potassium rushes into, not out of, the cell. Sodium movement is not related to this process. REF: pp. 24-25 24. A nurse teaching the staff about platelet-derived growth factor includes information that platelet-derived growth factor (PDGF) stimulates the production of: a. platelets. b. epidermal cells. c. connective tissue cells. d. fibroblast cells. ANS: C Different types of cells require different growth factors; for example, PDGF stimulates the production of connective tissue cells, but not platelets, epidermal cells, or fibroblast cells. Chapter 02: Genes and Genetic Diseases Huether & McCance: Understanding Pathophysiology, 6th Edition MULTIPLE CHOICE 1. A nurse recalls the basic components of DNA are: a. pentose sugars and four phosphate bases. b. a phosphate molecule, deoxyribose, and four nitrogenous bases. c. adenine, guanine, and purine. d. codons, oxygen, and cytosine. ANS: B The three basic components of DNA are deoxyribose; a phosphate molecule; and four types of nitrogenous, not phosphate, bases. DNA does not contain condone. REF: p. 38 2. Which of the following mutations have the most significant effect on protein synthesis? a. Base pair substitutions b. Silent mutations c. Intron mutations d. Frameshift mutations ANS: D The frameshift mutation involves the insertion or deletion of one or more base pairs of the DNA molecule. This greatly alters the amino acid sequence, which affects protein synthesis. The base pair substitution is Na tUypReSoIf NmGutTatBio.n CinOwMhich one base pair replaces another. Silent mutations do not change amino acids or protein synthesis. Intron mutations are part of RNA sequencing. REF: p. 39 3. The base components of DNA are: a. A, G, C, and U. b. P, G, C, and T. c. A, G, C, and T. d. X, XX, XY, and YY. ANS: C The four base components of DNA are cytosine, thymine, adenine, and guanine, and are commonly represented by their first letters (A, C, T, and G) and not components identified as P or U. X, XX, XY, and YY are components of human chromosomes. REF: p. 38 4. A DNA strand has a region with the sequence ATCGGAT. Which of the following would be a complementary strand? a. CGATACGT b. TAGCCTAG c. TUGCCTUG d. UAGCCUAG ANS: B The consistent pairing of adenine with thymine and of guanine with cytosine is known as complementary base pairing; thus, A complements to T and C to G and vice versa throughout the strand. A complements to T; thus, the first letter must be a T. U does not represent a complement in the sequence. REF: p. 39 5. A biologist is explaining how RNA directs the synthesis of protein. Which process is the biologist describing? a. Termination b. Transcription c. Translocation d. Translation ANS: D In translation, RNA directs the synthesis of a polypeptide, interacting with transfer RNA (tRNA), a cloverleaf-shaped strand of about 80 nucleotides. Termination does not involve synthesis of protein. Transcription is the process by which DNA specifies a sequence of messenger RNA (mRNA). Translocation is the interchange of genetic material between nonhomologous chromosomes. REF: p. 41 6. What is the result of homologous chromosomes failing to separate during meiosis? a. Neurofibromatosis b. Nondisjunction c. Polyploidy d. Conjoined twins ANS: B Nondisjunction is an error in which homologous chromosomes or sister chromatids fail to separate normally during meiosis or mitosis. Neurofibromatosis is not due to chromosome failure during meiosis. Polyploidy occurs when a euploid cell has more than the diploid number of chromosomes. Conjoined twins are not due to chromosome failure during meiosis. REF: p. 45 7. A cell that does not contain a multiple of 23 chromosomes is called a cell. a. diploid b. euploid c. polyploid d. haploid ANS: C A polyploid cell is one in which a euploid cell has more than 23 pairs of chromosomes. A diploid cell is when the somatic cell nucleus has 46 chromosomes in 23 pairs. A euploid cell is a cell with multiples of the normal number of chromosomes. A haploid cell has only one member of each chromosome pair, for a total of 23 chromosomes. U S N T O REF: p. 42 8. A 20-year-old pregnant female gives birth to a stillborn child. Autopsy reveals that the fetus has 92 chromosomes. What term may be on the autopsy report to describe this condition? a. Biploidy b. Triploidy c. Tetraploidy d. Aneuploidy ANS: C Tetraploidy is a condition in which euploid cells have 92 chromosomes. Biploidy is a euploid cell with two times more chromosomes, or 46. Triploidy is a zygote that has three copies of each chromosome, rather than the usual two. Aneuploidy is when an aneuploid cell does not contain a multiple of 23 chromosomes. REF: p. 42 9. The condition in which an extra portion of a chromosome is present in each cell is called: a. reciprocal translocation. b. partial trisomy. c. inversion. d. Down syndrome. ANS: B Partial trisomy is a condition in which only an extra portion of a chromosome is present in each cell. A reciprocal translocation occurs when breaks take place in two different chromosomes and the material is exchanged. An inversion occurs when two breaks take place on a chromosome, followed bNy thRe rIeinsGertioBn.oCf thMe missing fragment at its original site, but in inverted order. Down syndrome is an aneuploidy of the twenty-first chromosome. REF: p. 46 10. After a geneticist talks to a patient about being a chromosomal mosaic, the patient asks the nurse what that means. How should the nurse respond? You may genetic disease(s). a. only be a carrier of the b. have a mild form of the c. have two d. be sterile as a result of the ANS: B A chromosomal mosaic means the body has two or more different cell lines, each of which has a different karyotype; thus, the person has a mild form of the disease. Mosaics are not only carriers; they have the disease; they have two different lines but not two different diseases; and they are not necessarily sterile. REF: p. 46 11. What is the most common cause of Down syndrome? a. Paternal nondisjunction b. Maternal translocations c. Maternal nondisjunction c. an autosomal dominant trait. d. a sex-linked trait. ANS: A Prader-Willi, an example of gene imprinting, is not associated with any autosomal sex-linked abnormality. REF: p. 52 19. A patient, age 9, is admitted to a pediatric unit with Duchenne muscular dystrophy. When planning care the nurse recalls the patient inherited this condition through a trait that is: a. X-linked dominant. b. X-influenced. c. X-limited. d. X-linked recessive. ANS: D Duchenne muscular dystrophy is a relatively common X-linked recessive, not dominant, disorder. While it is sex linked, it is not X-limited or X-influenced. REF: p. 55 20. A child is diagnosed with cystic fibrosis. History reveals that the child’s parents are siblings. Cystic fibrosis was most likely the result of: a. X-inactivation. b. genomic imprinting. c. consanguinity. d. obligate carriers. ANS: C Consanguinity refers to the mating of two related individuals, and the offspring of such matings are said to be inbred. Consanguineous matings produce a significant increase in recessive disorders and are seen most often in pedigrees for rare recessive disorders. X-inactivation occurs when one X chromosome in the somatic cells of females is permanently inactivated. Genomic imprinting is related to methylation and other changes. Obligate carriers are those who have an affected parent and affected children and, therefore, must themselves carry the mutation. REF: p. 54 21. A 12-year-old male is diagnosed with Klinefelter syndrome. His karyotype would reveal which of the following? a. XY b. XX c. XYY d. XXY ANS: D A person with Klinefelter syndrome has an XXY karyotype. An XY is a normal male. An XX is a normal female. An XYY is an aneuploid karyotype. REF: p. 47 22. To express a polygenic trait: a. genes must interact with the environment. b. several genes must act together. c. multiple mutations must occur in the same family. d. penetrance must occur. ANS: B Polygenic traits are those that result from several genes acting together. When environmental factors influence the expression of the trait, the term multifactorial inheritance is used. When multiple mutations occur in the same family, the mechanism most likely responsible is termed germline mosaicism. Penetrance of a trait is the percentage of individuals with a specific genotype who also exhibit the expected phenotype. REF: pp. 57-58 23. What is the diagnosis of a 13-year-old female who has a karyotype that reveals an absent homologous X chromosome with only a single X chromosome present? Her features include a short stature, widely spaced nipples, and a reduced carrying angle at the elbow. a. Down syndrome b. Cri du chat syndrome c. Turner syndrome d. Klinefelter syndrome ANS: C Turner syndrome is characterized by short stature, female genitalia, webbed neck, shield-like chest with underdeveloped breasts and widely spaced nipples, and imperfectly developed ovaries. Down syndrome is cNhaUraRcSteIrizNeGd TbyBd.isCtiOncMtive characteristics: low nasal bridge, epicanthal folds, protruding tongue, and low-set ears. Cri du chat syndrome is characterized by low birth weight, severe mental retardation, microcephaly (smaller than normal head size), and heart defects. Klinefelter syndrome is characterized by small testes, some development of the breasts, sparse body hair, and long limbs. REF: p. 46, Table 2-1 24. The gradual increase in height among the human population over the past 100 years is an example of: a. a polygenic trait. b. a multifactorial trait. c. crossing over. d. recombination. ANS: B The gradual increase in height is an example of multifactorial traits influenced by genes and also by environment. Polygenic traits result from several genes acting together. Crossing over is an abnormal chromosome structure. Recombination results from new arrangements of alleles. REF: p. 58 25. When discussing DNA replication, which enzyme is most important? a. RNA polymerase b. Transfer RNA c. Messenger RNA d. DNA polymerase ANS: D DNA polymerase, not RNA polymerase, is the primary enzyme involved in replication. It adds bases to the new DNA strand and performs “proofreading” functions. Neither messenger RNA nor transfer RNA is as important to DNA replication. REF: p. 39 26. The regions of the heterogeneous nuclear RNA that must be spliced out to form functional RNA are called: a. promoter sites. b. introns. c. exons. d. anticodon. ANS: B When the mRNA is first transcribed from the DNA template, it reflects exactly the base sequence of the DNA. In eukaryotes, many RNA sequences are removed by nuclear enzymes, and the remaining sequences are spliced together to form the functional mRNA that migrates to the cytoplasm. The excised sequences are called introns (intervening sequences), and the sequences that are left to code for proteins are called exons. In translation, RNA directs the synthesis of a polypeptide, a cloverleaf-shaped strand of about 80 nucleotides. The tRNA molecule has a site where an amino acid attaches. The three-nucleotide sequence at the opposite side of the cloverleaNf UisRcaSllIedNtGheTaBn.ticCoOdoMn. REF: p. 41 27. A 50-year-old male was recently diagnosed with Huntington disease. Transmission of this disease is associated with: a. penetrance of a trait. b. recurrence risk. c. expressivity. d. delayed age of onset. ANS: D A key feature of Huntington disease is its delayed age of onset such that symptoms are not seen until 40 years of age or later. The penetrance of a trait is the percentage of individuals with a specific genotype who also exhibit the expected phenotype. Recurrence risk is the percentage of family members who will inherit the disease. Expressivity is the extent of variation in phenotype associated with a particular genotype. REF: p. 51 28. What type of mutation does not change the amino acid sequence and thus has no observable consequence? a. Frameshift b. Spontaneous Chapter 03: Epigenetics and Disease Huether & McCance: Understanding Pathophysiology, 6th Edition MULTIPLE CHOICE 1. When considering abnormal epigenetic modifications, what factor is currently being viewed as strongly associated with the development of some cancers? a. Family genetics b. Lifestyle choices c. Environmental stressors d. Emotional coping skills ANS: C Environmental stressors can markedly increase the risk of aberrant epigenetic modification and are strongly associated with some cancers. While genetics, lifestyle choices, and coping skills can affect the development and management of cancer, they are not currently considered as being the primary factors in the epigenetic modification that occurs. REF: p. 62 2. Housekeeping genes are vital to the function and maintenance of all the body’s cells. What characteristic is associated with these genes? a. They lack encoding histones. b. They are transcriptionally active. c. Ribosomal RNA genes are absent. d. Epigenetic silencing has NoccuRrreId. ANS: B A small percentage of genes, termed housekeeping genes, are necessary for the function and maintenance of all cells. These genes escape epigenetic silencing and remain transcriptionally active in all or nearly all cells. Housekeeping genes include encoding histones, DNA and RNA polymerases, and ribosomal RNA genes. REF: p. 64 3. What characteristic of Prader-Willi syndrome is not a characteristic of Angelman syndrome? a. It is inherited from the father. b. Mental retardation is observable. c. Imprinting of an abnormal chromosome 15. d. Seizure disorder is present. ANS: A A well-known disease example of imprinting is associated with a deletion of about 4 million base (Mb) pairs of the long arm of chromosome 15. When this deletion is inherited from the father, the child manifests Prader-Willi syndrome, whose features include short stature, hypotonia, small hands and feet, obesity, mild to moderate mental retardation, and hypogonadism. The same 4 Mb deletion, when inherited from the mother, causes Angelman syndrome, which is characterized by severe mental retardation, seizures, and an ataxic gait. REF: p. 65 4. Research has demonstrated that neural stem cells have an impaired ability to differentiate into functional neurons when subjected to: a. ethanol. b. marijuana. c. insufficient nutrients. d. poor oxygenation. ANS: A It has been found that treating cultured neural stem cells with ethanol impairs their ability to differentiate to functional neurons; this impairment seems to be correlated with aberrant, dense methylation at loci that are active in normal neuronal tissue. The research does not support the effects of marijuana, insufficient nutrition, or poor oxygenation on the stem cell’s ability to differentiate appropriately. REF: p. 67 5. What is the role of inactive MLH1 in the development of some forms of inherited colon cancer? a. Deletion of a nucleotide repeat in the DUX4 gene. b. DNA damage is left unrepaired. c. Expansion in the number of cytosine-guanine (CG) dinucleotide. d. Abnormalities of chromosome 11p15.5 that lead to downregulation of IGF2. ANS: B A major cause of one form of inherited colon cancer (hereditary nonpolyposis colorectal cancer [HNPCC]) is the methylation of the promoter region of a gene, MLH1, whose protein product repairs damaged DNNAU. WRSheInNMGLTHB1 .beCcoOmMes inactive, DNA damage accumulates, eventually resulting in colon tumors. Facioscapulohumeral muscular dystrophy (FSHMD) is associated with the DUX4 gene. Fragile X is associated with the cytosine-guanine (CG) dinucleotide. Downregulation of IGF2 is associated with Russell-Silver syndrome. REF: p. 69 6. Mutations in the encoding of histone-modifying proteins have been shown to influence the development of what congenial condition? a. Cleft palate b. Acephalous c. Heart disease d. Webbed digits ANS: C Mutations in genes that encode histone-modifying proteins have been implicated in congenital heart disease. Research has yet to provide a relationship between abnormal histone-modifying proteins and cleft palate, acephalous, and webbed digits. REF: p. 64 7. Which embryonic stem cell characteristic is referred to as totipotent? a. Ability to differentiate into any type of somatic cell. b. Ability to repair its own damaged DNA. c. Ability to determine which parental chromosome copy it will imprint. d. Ability to minimize the impact of poor in utero nutrition. ANS: A Each of the cells in the very early embryo has the potential to give rise to a somatic cell of any type. These embryonic stem cells are therefore said to be totipotent (“possessing all powers”). The term totipotent does not infer the ability to repair damaged DNA, select specific chromosome copies, or adjust for poor in utero nutrition. REF: p. 64 8. 5-Azacytidine has demonstrated promise in the treatment of which form of cancer? a. Liver b. Colon c. Gallbladder d. Pancreatic ANS: D Though associated with various side effects, including digestive disturbance, 5-azacytidine has shown promise in the treatment of pancreatic cancer. There is no support for its use in the treatment of liver, colon, or gallbladder cancers. REF: p. 70 9. During which stage of human development does the role of epigenetics have the greatest impact on the development of epigenetic abnormalities? a. Infancy b. Puberty c. In utero d. Middle age ANS: C Conditions encountered in utero, during childhood, and even during adolescence or later can have long-term impacts on epigenetic states, which sometimes can be transmitted across generations. The impact is not supported for the periods of infancy, puberty, and middle age. REF: p. 66 10. What comorbid condition does an individual diagnosed with Beckwith-Wiedemann syndrome have an increased risk of developing? a. Cancer b. Diabetes c. Depression d. Food allergies ANS: A Beckwith-Wiedemann syndrome is accompanied by an increased predisposition to cancer. There is no current correlation between Beckwith-Wiedemann syndrome and diabetes, depression, or food allergies. REF: p. 65 4. A 55-year-old male with a 30-year history of smoking is examined for respiratory disturbance. Examination of his airway (bronchial) reveals that stratified squamous epithelial cells have replaced the normal columnar ciliated cells. This type of cellular adaptation is called: a. anaplasia. b. hyperplasia. c. metaplasia. d. dysplasia. ANS: C Metaplasia is the reversible replacement of one mature cell type by another, sometimes a less differentiated cell type. Anaplasia is loss of cellular differentiation. Hyperplasia is an increase in the number of cells resulting from an increased rate of cellular division. Dysplasia refers to abnormal changes in the size, shape, and organization of mature cells. REF: p. 77 5. When planning care for the pregnant patient, the nurse will recall that the mammary glands enlarge as a consequence of: a. compensatory hyperplasia. b. hormonal hyperplasia. c. hormonal anaplasia. d. compensatory anaplasia. ANS: B An increase in the mammary glands during pregnancy is a result of hormonal changes. The number of mammary cells increases in response to increased hormone levels, not as a compensatory mechanism. Anaplasia is a reversal to less mature cells. REF: p. 76 6. A 24-year-old female presents with excessive menstrual bleeding. The physician identified endometrial changes that are due to hormonal imbalances. These cellular changes would be referred to as: a. dysplasia. b. pathologic dysplasia. c. hyperplasia. d. pathologic hyperplasia. ANS: D Because the changes are due to an imbalance, they would be considered pathologic hyperplasia, a term more descriptive than simple hyperplasia. The endometrial changes were not abnormal in size and shape; thus, it is not dysplasia regardless of cause. REF: pp. 76-77 7. A 55-year-old male is diagnosed with hepatocellular cancer secondary to hepatitis C. If the cancerous region of the liver is removed, the remaining cells would undergo: a. pathologic hyperplasia. b. pathologic metaplasia. c. compensatory hyperplasia. d. compensatory aplasia. ANS: C Compensatory hyperplasia is an adaptive, not pathologic, mechanism that enables certain organs to regenerate. Metaplasia is the reversible replacement of one mature cell type by another, sometimes less differentiated, cell type. Aplasia is not a compensatory mechanism. REF: p. 76 8. A 40-year-old female’s Pap smear indicates abnormal changes in the shape and organization of cervical cells. Which term would be used to identify this type of change? a. Metaplasia b. Atrophy c. Hypertrophy d. Dysplasia ANS: D When cervical cells undergo dysplasia, there is a change in their size, shape, and organization. Metaplasia is the reversible replacement of one mature cell type. The cells have not decreased in size; therefore, atrophy is incorrect. The cells have not increased in size in response to stimuli; therefore, they have not hypertrophied. REF: p. 77 9. A 75-year-old male presents with chest pain on exertion. The chest pain is most likely due to hypoxic injury secondary to: a. malnutrition. b. free radicals. c. ischemia. d. chemical toxicity. ANS: C The cardiac cells are deprived of oxygen, leading to ischemia, a reduction in blood supply to tissues. The cells are deprived of oxygen; they are not malnourished. Free radicals are electrically uncharged atoms or groups of atoms that have an unpaired electron. Chemical toxicity is not a factor in the chest pain. REF: pp. 78-79 10. A patient has a heart attack that leads to progressive cell injury that causes cell death with severe cell swelling and breakdown of organelles. What term would the nurse use to define this process? a. Adaptation b. Calcification c. Apoptosis d. Necrosis ANS: D Necrosis is the sum of cellular changes after local cell death. Cellular adaptation is a reversible, structural, or functional response to both normal or physiologic conditions and adverse or pathologic conditions. Calcification is an accumulation of calcium salts. Apoptosis is an active process of cellular self-destruction. REF: p. 78, Table 4-1 11. Sodium and water accumulation in an injured cell are a direct result of: a. decreased ATP production. b. karyorrhexis. c. ribosome detachment. d. dehydration. ANS: A A reduction in ATP levels causes the plasma membrane’s sodium-potassium (Na+-K+) pump and sodium-calcium exchange to fail. Sodium and water can then enter the cell freely. Karyorrhexis means fragmentation of the nucleus into smaller particles or “nuclear dust.” Ribosome detachment reduces protein synthesis. Dehydration leads to loss of sodium and water. REF: p. 80 12. The early dilation (swelling) of the cell’s endoplasmic reticulum results in: a. increased aerobic metabolism. b. failure of DNA. c. reduced protein synthesis. d. increased Na+-K+ pump function. ANS: C Early dilation of the endoplasmic reticulum causes the ribosomes to detach from the rough endoplasmic reticulum, reducing protein synthesis. Aerobic metabolism is a normal process and would not lead to swelling. Cellular swelling will not alter cellular DNA. A reduction in the Na+-K+ pump leads to an intracellular accumulation of sodium and calcium and diffusion of potassium out of the cell. SNoUdRiuSmIaNndGwTaBte.r cCaOn Mthen enter the cell freely, and cellular swelling results. REF: p. 80 13. A 52-year-old male suffered a myocardial infarction secondary to atherosclerosis and ischemia. Once blood flow is returned to the damaged heart, reperfusion injury occurs as a result of: a. oxidation stress. b. vacuolation. c. decreased intracellular calcium. d. lipid acceptor proteins. ANS: A Reperfusion injury can result from oxidative stress, increased intracellular calcium, inflammation, or complement activation. Oxidative stress causes the formation of radicals that cause further membrane damage and mitochondrial calcium overload. Vacuolation leads to cellular swelling but is not associated with reperfusion. An increase of intracellular calcium is a cause of reperfusion injury. Lipid acceptor proteins bind with triglycerides to create fatty liver, and they do not affect the myocardium. REF: p. 81 20. A 55-year-old male has swelling of the feet. Which of the following aided in the development of swelling? a. Increased ATP b. Chloride movement out of the cell c. Na+ movement into the cell d. Decreased oncotic pressure ANS: C When sodium and water enter the cell freely, cellular swelling, as well as early dilation of the endoplasmic reticulum, results. Decreased ATP would lead to swelling. Chloride movement out of the cell would affect muscle contraction but does not lead to swelling. Increased oncotic pressure would not affect swelling. REF: p. 97 21. A 35-year-old female is diagnosed with multiple myeloma. Biopsy of the tumor reveals Russell bodies, and laboratory testing reveals kidney dysfunction. Which substance should the nurse monitor as it is accumulating in the patient’s body? a. Glycogen b. Protein c. Pigment d. Melanin ANS: B Russell bodies occur due to excess aggregates of protein. Excess glycogen would affect blood glucose. Increased pigment would not lead to kidney dysfunction. Melanin accumulates in epithelial cells (keratinocytes) of the skin and retina. REF: p. 99 22. A newborn male is diagnosed with albinism based on skin, eye, and hair appearance. Which finding will support this diagnosis? a. Increased melanin b. Increased hemoproteins c. Inability to convert tyrosine to DOPA (3,4-dihydroxyphenylalanine) d. Inability to convert bile to bilirubin ANS: C The person with albinism is unable to convert tyrosine to DOPA, an intermediate in melanin biosynthesis. An increase in melanin would cause skin to be darker. Hemoprotein accumulations in cells are caused by excessive storage of iron, which is transferred to the cells from the bloodstream. An inability to convert bile to bilirubin would not lead to albinism. REF: p. 100 23. A 23-year-old male develops a black eye following a fight. When the aide asks the nurse why this occurred, the nurse’s best response is that the bruising is due to an accumulation of: a. transferrin. b. bilirubin. c. albumin. d. hemosiderin. ANS: D Hemosiderin is responsible for the color changes in a black eye. Transferrin is a transport protein responsible for iron transport. Bilirubin is the normal, yellow-to-green pigment of bile derived from the porphyrin structure of hemoglobin. Albumin is the protein in the serum, responsible for cellular integrity. REF: p. 100 24. Liquefactive necrosis occurs in the brain because: a. debris is not digested by hydrolases. b. of protein denaturation. c. it is rich in hydrolytic enzymes and lipids. d. ischemia results in chemical injury. ANS: C Liquefactive necrosis is due to enzymatic action and because cells of the brain are rich in enzymes. Protein denaturation occurs primarily in the kidneys. Liquefactive necrosis is due to enzymatic reaction and not to hypoxia or hydrolases. REF: p. 103 25. A 2-year-old swallowed watch batteries. Following ingestion, kidney function was impaired, and the heart began to fail. Which of the following was the most likely cause? a. Karyorrhexis b. Coagulative necrosis c. Ammonia accumulation d. Caseous necrosis ANS: B Coagulative necrosis occurs primarily in the kidneys, heart, and adrenal glands and commonly results from hypoxia. Karyorrhexis means fragmentation of the nucleus into smaller particles or “nuclear dust.” Ammonia accumulation is not associated with this toxicity. Caseous necrosis results from tuberculosis pulmonary infection. REF: pp. 102-103 26. A group of prison inmates developed tuberculosis following exposure to an infected inmate. On examination, tissues were soft and granular (like clumped cheese). Which of the following is the most likely cause? a. Coagulative necrosis b. Liquefactive necrosis c. Caseous necrosis d. Autonecrosis ANS: C Caseous necrosis results from tuberculosis pulmonary infection. Coagulative necrosis occurs primarily in the kidneys, heart, and adrenal glands, and commonly results from hypoxia. Liquefactive necrosis results from ischemic injury to neurons and glial cells in the brain. Autonecrosis is a process of cellular self-digestion and is not due to infection such as tuberculosis. REF: p. 103 27. A 50-year-old female became infected with Clostridium bacteria and died a week later. Examination of her red blood cells revealed lysis of membranes. Which of the following was the most likely cause of her death? a. Fat necrosis b. Wet gangrene c. Gangrenous necrosis d. Gas gangrene ANS: D Gas gangrene is a special type of gangrene caused by infection of injured tissue by one of many species of Clostridium. Fat necrosis is cellular dissolution caused by powerful enzymes, called lipases, that occur in the breast, pancreas, and other abdominal structures. Wet gangrene develops when neutrophils invade the site, causing liquefactive necrosis. Gangrenous necrosis is due to death of tissue and results from severe hypoxic injury. REF: p. 104 28. While reading a textbook, a student reads the term apoptosis. The student recalls that apoptosis is a condition in which cells program themselves to: a. atrophy. b. die. c. regenerate. d. age. ANS: B In apoptosis, cells are programmed to die. Apoptosis is not associated with cell atrophy, regeneration, or aging. REF: p. 104 29. A 50-year-old male intravenous drug user is diagnosed with hepatitis C. Examination of the liver reveals cell death secondary to: a. fat necrosis. b. physiologic apoptosis. c. infection-induced apoptosis. d. pyknosis. ANS: C With hepatitis C, the liver will demonstrate apoptosis that is a result of the viral infection. Fat necrosis occurs with enzymatic action due to lipases. Apoptosis is not a normal physiological process. Pyknosis occurs when the nucleus shrinks and becomes a small, dense mass of genetic material. REF: p. 104 30. What principle should the nurse remember when trying to distinguish aging from diseases? a. It is difficult to tell the difference because both processes are believed to result from cell injury. b. It is easy to tell normal processes from abnormal processes. c. Disease, unlike aging, has a genetic component. f. Hematopoietic ANS: D, E, F The organ systems primarily affected by lead ingestion include the nervous system (brain), the hematopoietic system (tissues that produce blood cells), and the kidneys. The heart, liver, and lungs are not affected. REF: p. 89 Chapter 05: Fluids and Electrolytes, Acids and Bases Huether & McCance: Understanding Pathophysiology, 6th Edition MULTIPLE CHOICE 1. A nurse is reviewing lab reports. The nurse recalls blood plasma is located in which of the following fluid compartments? a. Intracellular fluid (ICF) b. Extracellular fluid (ECF) c. Interstitial fluid d. Intravascular fluid ANS: D Blood plasma is the intravascular fluid. ICF is fluid in the cells. ECF is all the fluid outside the cells. Interstitial fluid is fluid between the cells and outside the blood vessels. REF: p. 114 2. A 35-year-old male weighs 70 kg. Approximately how much of this weight is considered the total volume of body water? a. 5 L b. 10 L c. 28 L d. 42 L ANS: D The total volume of body waNteUr fRoSr aI7N0G-kTg Bpe.rsCoOn Mis about 42 L or two thirds of 70 kg. REF: p. 114 3. While planning care for elderly individuals, the nurse remembers the elderly are at a higher risk for developing dehydration because they have: a. a higher total body water volume. b. decreased muscle mass. c. increased thirst. d. an increased tendency toward developing edema. ANS: B The elderly are at higher risk for dehydration due to a decrease in muscle mass. The elderly have a decrease in total body water and thirst. The increased tendency to develop edema is not related to dehydration. REF: p. 131, Geriatric Considerations 4. Which of the following patients should the nurse assess for decreased oncotic pressure in the capillaries? A patient with: a. a high-protein diet. b. liver failure. c. low blood pressure. d. low blood glucose. ANS: B Liver failure leads to lost or diminished plasma albumin production, and this contributes to decreased plasma oncotic pressure. A high-protein diet would provide albumin for the maintenance of oncotic pressure. Low blood pressure would lead to decreased hydrostatic pressure. Decreased glucose does not affect oncotic pressure. REF: p. 116 5. Water movement between the ICF and ECF compartments is determined by: a. osmotic forces. b. plasma oncotic pressure. c. antidiuretic hormone. d. buffer systems. ANS: A Osmotic forces determine water movement between the ECF and ICF compartments. Oncotic pressure pulls water at the end of the capillary, which makes it move between intra and extra as interstitial is considered extra. The antidiuretic hormone regulates water balance, which would make water move between the intra- and extracellular spaces. Buffer systems help regulate acid balance. REF: p. 115 6. An experiment was designed to test the effects of the Starling forces on fluid movement. Which of the following alterations would result in fluid moving into the interstitial space? a. Increased capillary oncotic pressure. b. Increased interstitial hydrostatic pressure. c. Decreased capillary hydrNosUtaRticSpIreNsGsuTreB. . d. Increased interstitial oncotic pressure. ANS: D Increased interstitial oncotic pressure would attract water from the capillary into the interstitial space. Increased capillary oncotic pressure would attract water from the interstitial space back into the capillary. Increased interstitial hydrostatic pressure would attract movement of water from the interstitial spaces into the capillary. Decreased capillary hydrostatic pressure would move water into the capillaries. REF: p. 115 7. When planning care for a dehydrated patient, the nurse remembers that the principle of water balance is closely related to the balance of: a. potassium. b. chloride. c. bicarbonate. d. sodium. ANS: D Because water follows the osmotic gradients established by changes in salt concentration, water balance is tied to sodium balance, not that of potassium, chloride, or bicarbonate. REF: pp. 116-117 | p. 118, Figure 5-5 15. Which of the following patients is the most at risk for developing hypernatremia? A patient with: a. vomiting. b. diuretic use. c. dehydration. d. hypoaldosteronism. ANS: C Dehydration leads to hypernatremia because an increase in sodium occurs with a net loss in water. Vomiting and diuretic use leads to hyponatremia. Hypoaldosteronism leads to hyponatremia. REF: p. 119 16. Which of the following conditions would cause the nurse to monitor for hyperkalemia? a. Excess aldosterone b. Acute acidosis c. Insulin usage d. Metabolic alkalosis ANS: B In acidosis, ECF hydrogen ions shift into the cells in exchange for ICF potassium and sodium; hyperkalemia and acidosis therefore often occur together. Acidosis does not cause excess aldosterone. Insulin would help treat hyperkalemia, not cause it. Alkalosis does not lead to hyperkalemia. REF: p. 124 17. Which organ system should the nurse monitor when the patient has long-term potassium deficits? a. Central nervous system (CNS) b. Lungs c. Kidneys d. Gastrointestinal tract ANS: C Long-term potassium deficits lasting more than 1 month may damage renal tissue, with interstitial fibrosis and tubular atrophy. Long-term potassium deficits are not associated with damage to the CNS, GI tract, or lungs. REF: pp. 123-124 18. A 42-year-old female presents to her primary care provider reporting muscle weakness and cardiac abnormalities. Laboratory tests indicate that she is hypokalemic. Which of the following could be the cause of her condition? a. Respiratory acidosis b. Constipation c. Hypoglycemia d. Laxative abuse ANS: D Losses of potassium from body stores are usually caused by gastrointestinal and renal disorders. Diarrhea, intestinal drainage tubes or fistulae, and laxative abuse also result in hypokalemia. Acidosis is related to hyperkalemia, not hypokalemia. Constipation can occur with hypokalemia but does not cause it. Hypoglycemia is not related to muscle weakness. REF: p. 123 19. A 19-year-old male presents to his primary care provider reporting restlessness, muscle cramping, and diarrhea. Lab tests reveal that he is hyperkalemic. Which of the following could have caused his condition? a. Primary hyperaldosteronism b. Acidosis c. Insulin secretion d. Diuretic use ANS: B During acute acidosis, hydrogen ions accumulate in the ICF and potassium shifts out of the cell to the ECF, causing hyperkalemia. Primary hyperaldosteronism is associated with hypokalemia, not hyperkalemia. Insulin secretion helps reduce potassium levels in the cell; it does not cause hyperkalemia. Diuretics would cause hypokalemia, not hyperkalemia. REF: p. 122 20. A 60-year-old female is diagnosed with hyperkalemia. Which assessment finding should the nurse expect to observe? a. Weak pulse b. Excessive thirst c. Oliguria d. Constipation ANS: C Hyperkalemia is manifested by oliguria. Hypokalemia is manifested by a weak pulse; it is not caused by hyperkalemia. Hypokalemia is manifested by excessive thirst. Diarrhea, not constipation, is a manifestation of hyperkalemia. REF: p. 124, Table 5-6 21. Which of the following buffer pairs is considered the major plasma buffering system? a. Protein/fat b. Carbonic acid/bicarbonate c. Sodium/potassium d. Amylase/albumin ANS: B The carbonic acid/bicarbonate buffer pair operates in both the lung and the kidney and is a major extracellular buffer. Protein and fat are nutrients not related to the buffering system. Sodium and potassium are electrolytes for fluid and electrolyte balance, not the major plasma buffering system for acid-base balance. Amylase is a carbohydrate enzyme, and albumin is a protein; neither is a buffering system. REF: p. 125 22. A nurse recalls that regulation of acid-base balance through removal or retention of volatile acids is accomplished by the: a. buffer systems. b. skin. c. lungs. d. liver. ANS: C The volatile acid is carbonic acid (H2CO3), which readily dissociates into carbon dioxide (CO2) and water (H2O). The CO2 is then eliminated by the lungs. Buffer systems are throughout the body and operate in the extracellular and intracellular systems. Neither the liver nor the skin regulates acid-base balance. REF: p. 125 23. Which patient is most prone to metabolic alkalosis? A patient with: a. retention of metabolic acids. b. hypoaldosteronism. c. excessive loss of chloride (Cl). d. hyperventilation. ANS: C When acid loss is caused by vomiting, renal compensation is not very effective because loss of Cl stimulates renal retention of bicarbonate, leading to alkalosis. Retention of metabolic acids would lead to acidosis, not alkalosis. Hypoaldosteronism leads to hyponatremia and does not cause alkalosis. Hyperventilation leads to respiratory alkalosis, not metabolic alkalosis. REF: p. 127 24. Which patient should the nurse assess for both hyperkalemia and metabolic acidosis? A patient diagnosed with: a. diabetes insipidus. b. pulmonary disorders. c. Cushing syndrome. d. renal failure. ANS: D Renal failure is associated with hyperkalemia and metabolic acidosis. Diabetes insipidus results in hypernatremia. Pulmonary disorders are a cause of respiratory acidosis or alkalosis but do not affect hyperkalemia. Cushing syndrome results in hypernatremia. REF: p. 124 | p. 127 25. For a patient experiencing metabolic acidosis, the body will compensate by: a. excreting H+ through the kidneys. b. hyperventilating. c. retaining CO2 in the lungs. d. secreting aldosterone. ANS: B Chapter 06: Innate Immunity: Inflammation and Wound Healing Huether & McCance: Understanding Pathophysiology, 6th Edition MULTIPLE CHOICE 1. A public health nurse is teaching the community about health promotion. Which information should the nurse include for innate immunity? Innate immunity is gained: a. following an illness. b. at birth. c. via injection of specific antibodies. d. in adulthood. ANS: B Innate immunity is present at birth. It is not dependent on illness or injection. REF: p. 134 2. Which statement indicates teaching was successful regarding collectins? Collectins are produced by the: a. kidneys. b. bowel. c. lungs. d. integument. ANS: C Collectins are produced by the lungs. Collectins are not associated with the kidneys, bowel, or integumentary system. REF: p. 135 3. A 20-year-old male received a knife wound to the arm during an altercation. Which of the following types of immunity was compromised? a. Innate immunity b. Inflammatory response c. Adaptive immunity d. Specific immunity ANS: A The epithelial cells of the skin are a part of innate immunity. The inflammatory response is not a type of immunity. Adaptive immunity is represented by the normal flora of the bowel. Specific immunity is a type of adaptive immunity and is not associated with a break in skin integrity. REF: pp. 134-135 4. Biochemical secretions that trap and kill microorganisms include: a. hormones. b. neurotransmitters. c. earwax. d. gastric acid. ANS: C Epithelial cells secrete several substances that protect against infection, including earwax. Hormones do not contain biochemical secretions that trap and kill microorganisms. Neurotransmitters carry important messages, and gastric acid helps break down food into its component parts, but neither contains biochemical secretions. REF: p. 135 5. A 25-year-old female presents to her primary care provider reporting vaginal discharge of a white, viscous, and foul-smelling substance. She reports that she has been taking antibiotics for the past 6 months. Which finding will the nurse most likely see on the microorganism report? a. Clostridium difficile overgrowth b. Decreased Lactobacillus c. Streptococcus overgrowth d. Decreased Candida albicans ANS: B Diminished colonization with Lactobacillus that occurs as a result of prolonged antibiotic treatment increases the risk for vaginal infections, such as vaginosis. Clostridium difficile and Candida albicans occur in the colon, not the vagina. Streptococcus overgrowth will occur in the mouth. REF: p. 136 6. When an aide asks the nurse about the purpose of the inflammatory process, how should the nurse respond? a. To provide specific responsUes tSowaNrd aTntigensO. b. To lyse cell membranes of microorganisms. c. To prevent infection of the injured tissue. d. To create immunity against subsequent tissue injury. ANS: C One purpose of the inflammatory process is to prevent infection and further damage by contaminating microorganisms. Specific response toward antigens is a part of the complement system that assists in the inflammatory response, but not its purpose. Lysis of cell membranes is part of the process of phagocytosis, which removes foreign material. Immunity cannot be achieved against future tissue injury. REF: p. 137 7. A child fell off a swing and scraped his right knee. The injured area becomes painful. What else will the nurse observe upon assessment? a. Vasoconstriction at injured site b. Decreased RBC concentration at injured site c. Pale skin at injured site d. Edema at injured site ANS: D Increased vascular permeability and leakage of fluid out of the vessel cause edema at the site of injury. Vasodilation occurs, bringing increased RBCs to the site and causing redness. REF: p. 137 8. A nurse recalls the mast cell, a major activator of inflammation, initiates the inflammatory response through the process of: a. chemotaxis. b. endocytosis. c. degranulation. d. opsonization. ANS: C Degranulation of mast cells is a major cellular component of inflammation. Chemotaxis is the process of white cell migration. Endocytosis and opsonization are parts of phagocytosis but are not factors in mast cell response. REF: pp. 144-145 9. Which of the following individuals would be at greatest risk for an opportunistic infection? a. 18-year-old with diabetes b. 70-year-old with congestive heart failure c. 24-year-old who is immunocompromised d. 30-year-old with pneumonia ANS: C Opportunistic microorganisms can cause disease if the individual’s defenses are compromised. Diabetes, congestive heart failure, and pneumonia are not associated with immunocompromised disorders. REF: p. 137 10. The directional migration of leukocytes along a chemical gradient is termed: a. chemotaxis. b. endocytosis. c. margination. d. diapedesis. ANS: A Chemotaxis is the process by which leukocytes undergo directed migration. Endocytosis is a form of engulfment and a part of phagocytosis. Margination occurs when leukocytes adhere to endothelial cells in the walls of vessels. Diapedesis is the emigration of the cells through cell junctions that have loosened in response to inflammatory mediators. REF: p. 147 11. A 20-year-old male shoots his hand with a nail gun while replacing roofing shingles. Which of the following cell types would be the first to aid in killing bacteria to prevent infection in his hand? a. Eosinophils b. Neutrophils c. Leukotrienes d. Monocytes U S N T O b. fibrin. c. collagen. d. factor X. ANS: B The end product of the clotting system is fibrin. Plasmin activates the complement cascade. Collagen plays a factor in wound healing. Factor X is a first step in the clotting system. REF: p. 139 20. A 5-year-old male is diagnosed with a bacterial infection. Cultures of the bacteria revealed lipopolysaccharides on the bacterial cell surface. Which of the complement pathways would be activated in this case? a. Classical pathway b. Lectin pathway c. Alternative pathway d. Kinin pathway ANS: C The alternative pathway is activated by several substances found on the surface of infectious organisms, such as those containing lipopolysaccharides. The classical pathway is primarily activated by antibodies that are proteins of the acquired immune system. The lectin pathway is similar to the classical pathway but is independent of antibody. It is activated by several plasma proteins. The kinin pathway is involved in coagulation. REF: p. 139 21. An 8-year-old female presenNts wRith eIdemGa oBf .thCe cuMtaneous and mucosal tissue layers. Her mother reports that the condition is recurrent and seems to occur more often during stressful situations. The child is diagnosed with hereditary angioedema. Which of the following is deficient in this child? a. C1 esterase inhibitor b. Carboxypeptidase c. Neutrophils d. Plasmin ANS: A A genetic defect in C1 esterase inhibitor (C1 INH deficiency) results in hereditary angioedema. Hereditary angioedema is due to C1 esterase inhibitor, not neutrophils. Carboxypeptidase degrades kinins. Plasmin is associated with clots. REF: p. 141 22. A nurse is preparing to teach on the subject of opsonins. Which information should the nurse include? Opsonins are molecules that: a. are composed of fatty acids. b. regulate inflammation. c. degranulate mast cells. d. enhance phagocytosis. ANS: D Opsonins coat the surface of bacteria and increase their susceptibility to being phagocytized. Opsonins are not associated with fatty acids, the regulation of the inflammatory process, or the degranulation of mast cells. REF: p. 138 23. A 10-year-old male is diagnosed with a parasite. Which lab result should the nurse check for a response to the parasite? a. Monocytes b. Eosinophils c. Neutrophils d. Macrophages ANS: B Eosinophils serve as the body’s primary defense against parasites. Monocytes and neutrophils are phagocytic. Macrophages are not active against parasites; they act as long-term defense against infections. REF: p. 146 24. A 65-year-old female is diagnosed with metastatic breast cancer. She has developed muscle wasting. Which of the following substances would be produced in large quantities to eliminate the tumor cells and cause muscle wasting? a. Interleukin-6 b. Eosinophils c. Tumor necrosis factor-alpha d. Platelets ANS: C Tumor necrosis factor causes muscle wasting. Interleukin-6 stimulates growth and differentiation of blood cells. Eosinophils are stimulated by parasites. Platelets stimulate clotting. REF: p. 144 25. When phagocytes begin to stick avidly to capillary walls, which process is occurring? a. Margination b. Exudation c. Integration d. Emigration ANS: A Both leukocytes and endothelial cells secrete substances that increase adhesion, or stickiness, causing the leukocytes to adhere more avidly to the endothelial cells in the walls of the capillaries and venules in a process called margination. Exudation is the process of pus formation and does not result in stickiness. Integration occurs in cells but is not a major function and does not lead to stickiness. Emigration is similar to diapedesis and is not associated with increased stickiness. REF: p. 147 26. An infant develops a fever secondary to a bacterial infection. Which of the following most likely triggered the fever? a. Interleukin-1 b. Interleukin-6 c. Interleukin-10 d. Interferons (IFNs) ANS: A Interleukin-1 is responsible for fever production. Interleukin-6 stimulates growth and differentiation of blood cells. Interleukin-10 helps decrease the immune response. INFs are members of a family of cytokines that protect against viral infections. REF: p. 143, Figure 6-6 27. A 54-year-old male intravenous (IV) drug user is diagnosed with chronic hepatitis C. Testing revealed that he is a candidate for treatment. Which of the following could be used to treat his condition? a. Interleukin-1 b. Interleukin-6 c. Interleukin-10 d. INFs ANS: D INFs are members of a family of cytokines that protect against viral infections. Interleukin-1 is responsible for fever production. Interleukin-6 stimulates growth and differentiation of blood cells. Interleukin-10 helps decrease the immune response. REF: p. 144 28. A 35-year-old male is diagnosed with lobar pneumonia (lung infection). Which of the following exudates would be present in highest concentration at the site of this advanced inflammatory response? a. Serous b. Purulent c. Hemorrhagic d. Fibrinous ANS: D Fibrinous exudates occur in the lungs of individuals with pneumonia. Serous fluid is watery fluid, as in a blister. Purulent is characterized by an abscess, such as pus. Hemorrhagic occurs when the exudates are filled with erythrocytes. REF: p. 149 29. During inflammation, the liver is stimulated to release plasma proteins, collectively known as: a. opsonins. b. acute phase reactants. c. antibodies. d. phagolysosomes. ANS: B 1. A nurse remembers that the primary actions of the complement cascade include: (select all that apply) a. increased vascular permeability. b. vasoconstriction. c. chemotaxis. d. opsonization. e. cell killing. f. increased clotting. ANS: A, C, D, E The actions of the complement cascade include increased vascular permeability and vasodilation, chemotaxis, opsonization, and cell killing. They do not involve vasoconstriction or increased clotting. REF: pp. 138-139 2. The nurse is assessing a patient with a diagnosis of inflammation. The nurse would expect to find which of the following signs and symptoms consistent with acute inflammation? (select all that apply) a. Heat b. Erythema c. Pain d. Swelling e. Paleness f. Loss of function ANS: A, B, C, D, F The classic symptoms of acuNteUinRflSamImNaGtiTonBi.ncCluOdMe redness (erythema), heat, swelling, pain, and loss of function. Paleness would indicate poor circulation, not inflammation. REF: p. 137 3. The nurse identified each of the following clinical manifestations of inflammation. Which would the nurse classify as a local response? (select all that apply) a. Fever b. Redness c. Swelling d. Heat e. Pain ANS: B, C, D, E Local manifestations of inflammation are the result of the vascular changes associated with the inflammatory process, including vasodilation and increased capillary permeability. The symptoms include redness, heat, swelling, and pain. Fever is a symptom of infection. REF: p. 149 4. Physical barriers that offer the body protection from damage and infection are located in the: (select all that apply) a. gastrointestinal tract. b. genitourinary tract. c. respiratory tract. d. lymph system. e. hematopoietic system. ANS: A, B, C The physical barriers that cover the external parts of the human body offer considerable protection from damage and infection. These barriers are composed of tightly associated epithelial cells of the skin and of the linings of the gastrointestinal, genitourinary, and respiratory tracts. REF: p. 135 Chapter 07: Adaptive Immunity Huether & McCance: Understanding Pathophysiology, 6th Edition MULTIPLE CHOICE 1. Which of the following is responsible for initiating clonal selection? a. T cells b. B cells c. Antigens d. Lymphocytes ANS: C The lymphocytes remain dormant until an antigen initiates clonal selection. T cells do not initiate clonal selection. B cells are antibodies. Lymphocytes are released into the circulation as immature cells that react with antigens. REF: p. 159 2. Which patient will develop active immunity? A patient who: a. has natural exposure to an antigen or receives an immunization. b. receives preformed antibodies or T cells from a donor. c. has T cells that become B cells. d. receives immunoglobulin. ANS: A Active immunity occurs either after natural exposure to an antigen or after immunization, not with preformed antibodies orNthUeRtrSanIsNfoGrmTaBti.onCoOf MT cells into B cells or as a result of receiving immunoglobulin. REF: p. 159 3. An experiment is designed to determine specific cell types involved in cell-mediated immune response. The experimenter is interested in finding cells that attack cells that have specific antigens. Which cells should be isolated? a. Lymphokine-producing cells b. T-cytotoxic cells c. Helper T cells d. Macrophages ANS: B Cell-mediated immunity is driven by T-cytotoxic (Tc) cells that attack antigens directly and destroy cells that bear foreign antigens. Lymphokine-producing cells, helper T cells, and macrophages do not attack antigens directly and destroy cells that bear foreign antigens. REF: p. 159 4. A 6-year-old female is diagnosed with a bacterial infection of the respiratory system. Which of the following will most likely try to fight the antigen? a. Antibodies b. Cytotoxic T cells 12. A 10-year-old male is stung by a bee while playing in the yard. He experiences a severe allergic reaction and has to go to the ER. The nurse providing care realizes this reaction is the result of: a. toxoids. b. IgA. c. IgE. d. IgM. ANS: C IgE is normally at low concentrations in the circulation. It has very specialized functions as a mediator of many common allergic responses. Neither toxoids, IgA, nor IgM is the mediator of common allergic response. REF: p. 164 13. A patient has done research on monoclonal antibodies on the Internet. Which statement indicates a correct understanding? Pure monoclonal antibodies are produced by: a. T lymphocytes. b. bone marrow. c. laboratories. d. fetuses. ANS: C Monoclonal antibodies are produced in the laboratory from one B cell that has been cloned; thus, the entire antibody is of the same class, specificity, and function. Pure monoclonal antibodies are not produced by T lymphocytes, bone marrow, or fetuses. REF: p. 164, Box 7-1 14. Which of the following statements indicates more teaching is needed regarding secondary lymph organs? is/are a secondary lymphoid organ. a. The spleen b. Peyer patches c. Adenoids d. The liver ANS: D The liver is not a secondary lymph organ. The spleen, Peyer patches, and adenoids are secondary lymphoid organs. REF: p. 161, Figure 7-3 15. A 20-year-old female is applying for nursing school and is required to be tested for immunity against several illnesses. Testing that looks at which of the following would be the best to determine immunity? a. Culture and sensitivity b. Agglutination c. Precipitation d. Titer ANS: D U S N T O The amount of antibody in a serum sample is referred to as the titer; a higher titer indicates more antibodies. Culture determines the type of organism that causes an infection, and sensitivity identifies the antibody it is sensitive to. The terms agglutination and precipitation are not used to identify a test to determine immunity. REF: p. 167 16. A macrophage was isolated and analyzed for major histocompatibility complex. Which of the following would be expected? a. MHC I only b. MHC II only c. MHC I and II d. Neither MHC I nor MHC II ANS: C MHC I and II would be expected. REF: p. 168 17. A 5-month-old child is admitted to the hospital with recurring respiratory infections. A possible cause of this condition is: a. hypergammaglobulinemia. b. increased maternal IgG. c. immune insufficiency. d. decreased maternal antibody breakdown, resulting in hyposensitivity. ANS: C Normal human infants are imNmuRnoloIgicGallyBim.mCatuMre when born, with deficiencies in antibody production, phagocytic activity, and complement activity, especially components of alternative pathways. They do not possess hypergammaglobulinemia. Possessing increased maternal IgG would not lead to recurring infections. The recurrent infections are due to decreased immunity, not maternal antibody breakdown. REF: p. 173, Pediatric Considerations MULTIPLE RESPONSE 1. While planning care for an elderly patient, the nurse remembers that increased age is associated with: (select all that apply) a. increased T-cell function. b. decreased immune function. c. increased production of antibodies. d. decreased numbers of circulating immune complexes. e. decreased ability to fight infection. ANS: B, D, E Increased age is associated with diminished T-cell function, decreased immune function, diminished production of antibody responses, decreased circulating immune complexes, and decreased ability to fight infection. REF: p. 173, Geriatric Considerations 2. When a patient asks about secondary lymph organs, how should the nurse respond? Secondary lymph organs include: (select all that apply) a. the spleen. b. Peyer patches. c. adenoids. d. the liver. e. bone marrow. f. the appendix. ANS: A, B, C, F The secondary lymphoid organs include the spleen, lymph nodes, adenoids, tonsils, Peyer patches (intestines), and appendix. The liver and bone marrow are not secondary lymph organs. REF: p. 161, Figure 7-3 3. Direct effects of antibodies include: (select all that apply) a. neutralization. b. agglutination. c. precipitation. d. phagocytosis. e. division. ANS: A, B, C Directly, antibodies can affect infectious agents or their toxic products by neutralization (inactivating or blocking the binding of antigen to receptors), agglutination (clumping insoluble particles that are inNsuUsRpeSnIsioNnG),ToBr p.reCcOipMitation (making a soluble antigen into an insoluble precipitate). Indirectly, antibodies activate components of innate resistance, including complement and phagocytes. Antibodies are generally a mixed population of classes, specificities, and capacity to provide the functions listed above. REF: p. 162 Understanding Pathophysiology 6th Edition Huether Test Bank REF: p. 208 NURSINGTB.COM ANS: D The Arthus reaction is a model of localized or cutaneous reactions. Serum sickness-type reactions are caused by the formation of immune complexes in the blood and their subsequent generalized deposition in target tissues. Typically affected tissues are the blood vessels, joints, and kidneys. Raynaud phenomenon is a condition caused by the temperature-dependent deposition of immune complexes in the capillary beds of the peripheral circulation. Antibody-dependent cytotoxicity is a type II form. REF: pp. 205-206 8. A nurse recalls that an example of an immune-complex-mediated disease is: a. bronchial asthma. b. contact dermatitis. c. serum sickness. d. rheumatoid arthritis. ANS: C Immune-complex disease can be a systemic reaction, such as serum sickness, and related to type III reactions. Bronchial asthma is not an immune-complex-mediated disease and is related to type I reactions. Neither contact dermatitis nor rheumatoid arthritis is related to type III reactions. REF: p. 205 9. When a nurse cares for a patient with systemic lupus erythematosus (SLE), the nurse remembers this disease is an example of: a. autoimmunity. b. alloimmunity. c. homoimmunity. d. alleimmunity. ANS: A SLE is the most common, complex, and serious of the autoimmune disorders. SLE is not identified as alloimmune, homoimmune, or alleimmune. REF: p. 208 10. A 30-year-old female complains of fatigue, arthritis, rash, and changes in urine color. Laboratory testing reveals anemia, lymphopenia, and kidney inflammation. Assuming a diagnosis of SLE, which of the following is also likely to be present? a. Anti-LE antibodies b. Autoantibodies c. Antiherpes antibodies d. Anti-CMV antibodies ANS: B The presence of autoantibodies is a diagnostic criterion for SLE. Diagnostic criterion for SLE would include positive LE. Neither antiherpes nor anti-CMV antibodies are associated with a diagnosis SLE. Understanding Pathophysiology 6th Edition Huether Test Bank O 11. A 40-year-old female is diagnosed with SLE. Which of the following findings would be considered a symptom of this disease? a. Gastrointestinal ulcers b. Decreased glomerular filtration rate c. Rash on trunk and extremities d. Photosensitivity ANS: D Photosensitivity is one of the 11 common clinical findings in SLE. Gastrointestinal ulcers are not a finding in SLE. Proteinuria is a symptom of SLE. A rash on the face is a symptom, but not a rash on the body. REF: p. 208 12. What is the chance that two siblings share both HLA haplotypes, making them a good match for an organ transplant from one to the other? a. 100% b. 75% c. 50% d. 25% ANS: D Odds dictate that children will share one haplotype with half their siblings and either no haplotypes or both haplotypes with a quarter of their siblings. Thus, the chance of finding a match among siblings is much higher (25%) than the general population. REF: p. 210 13. When a nurse notices that a patient has type O blood, the nurse realizes that anti- antibodies are present in the patient’s body. a. A only b. B only c. A and B d. O ANS: C Type O individuals have both anti-A and anti-B antibodies but not O. REF: p. 209 14. In addition to matching ABO antigens, a blood transfusion must also be matched for: a. HLA type. b. Rh antigen. c. immunoglobulins. d. platelet compatibility. ANS: B Blood transfusions must also be matched for the Rh antigen. Blood transfusions do not need to be matched to HLA, immunoglobulins, or platelet compatibility. REF: p. 209 Understanding Pathophysiology 6th Edition Huether Test Bank O 15. A 15-year-old male suffers from severe hemorrhage following a motor vehicle accident. He is given a blood transfusion, but shortly afterward the red blood cells are destroyed by agglutination and lysis. Which of the following blood type transfusion type matches would cause this? a. A-A b. B-O c. AB-O d. A-AB ANS: D A person with type A blood also has circulating antibodies to the B carbohydrate antigen. If this person receives blood from a type AB or B individual, a severe transfusion reaction occurs, and the transfused erythrocytes are destroyed by agglutination or complement-mediated lysis. Type A can receive type A blood. Type B and type AB can receive type O. REF: p. 209 16. A person is given an attenuated antigen as a vaccine. When the person asks what was given in the vaccine, how should the nurse respond? The antigen is: a. alive, but less infectious. b. mutated, but highly infectious. c. normal, but not infectious. d. inactive, but infectious. ANS: A Attenuated vaccines are alive, but less infectious. Attenuated vaccines are not mutated or highly infectious. Inactive inNfeUrsRthSeIvNiruGsTisBk.illCedO.M REF: p. 188 17. An immunologist is discussing endotoxin production. Which information should the immunologist include? Endotoxins are produced by: a. gram-negative bacteria. b. gram-positive bacteria. c. gram-negative fungi. d. gram-positive fungi. ANS: A Endotoxins are produced by gram-negative bacteria. They are not produced by gram-positive bacteria or any type of fungi. REF: p. 181 18. A 5-year-old male becomes ill with a severe cough. Histologic examination reveals a bacterial infection, and further laboratory testing reveals cell membrane damage and decreased protein synthesis. Which of the following is the most likely cause of this illness? a. Endotoxin b. Exotoxin c. Hemolysis d. Septicemia Understanding Pathophysiology 6th Edition Huether Test Bank O U S N T O REF: p. 189 26. A 5-year-old male presents with low-set ears, a fish-shaped mouth, and involuntary rapid muscular contraction. Laboratory testing reveals decreased calcium levels. Which of the following diagnosis is most likely? a. B-lymphocyte deficiency b. T-lymphocyte deficiency c. Combined immunologic deficiency d. Complement deficiency ANS: B DiGeorge syndrome results in greatly decreased T cell numbers and function and is evidenced by abnormal development of facial features that are controlled by the same embryonic pouches; these include low-set ears, fish-shaped mouth, and other altered features. B-lymphocyte deficiency is not manifested by these symptoms. Neither combined immunologic deficiency nor complement deficiency is manifested by these symptoms. REF: p. 191 27. A 22-year-old was recently diagnosed with acquired immunodeficiency syndrome (AIDS). Which decreased lab finding would be expected to accompany this virus? a. CD4+ T-helper b. CD8 T-helper c. CDC cells d. CDC10 cells ANS: A The major immunologic findNing Rin AIIDSGis Bth.e CstrikMing decrease in the number of CD4+ T cells. The change occurs in CD4 cells, not CD8. Neither CDC nor CDC 10 is a type of cell. REF: p. 194 28. Which of the following is a characteristic of the human immunodeficiency virus (HIV), which causes AIDS? a. HIV only infects B cells. b. HIV is a retrovirus. c. Infection does not require a host cell receptor. d. After infection, cell death is immediate. ANS: B AIDS is an acquired dysfunction of the immune system caused by a retrovirus (HIV) that infects and destroys CD4+ lymphocytes (T-helper cells). HIV infection begins when a virion binds to CD4, not a B cell. Infection requires a host cell receptor. The cell remains dormant but does not die. REF: p. 194 29. A 30-year-old male was diagnosed with HIV. Which of the following treatments would be most effective? a. Reverse transcriptase inhibitors b. Protease inhibitors Understanding Pathophysiology 6th Edition Huether Test Bank O U c. Entrance inhibitors d. Antiretroviral therapy (ART) ANS: D The current regimen for treatment of HIV infection is a combination of drugs, termed antiretroviral therapy (ART). The remaining options are individual components of the ART treatment format. REF: p. 197 30. When the immunologist says that pathogens possess infectivity, what is the immunologist explaining? Infectivity allows pathogens to: a. spread from one individual to others and cause disease. b. induce an immune response. c. invade and multiply in the host. d. damage tissue. ANS: C Infectivity is the ability of the pathogen to invade and multiply in the host. Communication is the ability to spread from one individual to others and cause disease. Immunogenicity is the ability of pathogens to induce an immune response. Damaging tissues is the pathogen’s mechanism of action. REF: p. 177 31. When the immunologist says that pathogens possess virulence, what does virulence mean? a. Spreads from one individual to others and causes disease. b. Induces an immune respoNnseR. c. Damages tissue. ANS: C Virulence is the capacity of a pathogen to cause severe disease—for example, measles virus is of low virulence; rabies virus is highly virulent. Communication is the ability to spread from one individual to others and cause disease. Immunogenicity is the ability of pathogens to induce an immune response. Damaging tissues is the pathogen’s mechanism of action. REF: p. 177 32. The nurse would correctly respond that the etiology of a congenital immune deficiency is due to a(n): a. negative response to an immunization. b. adverse response to a medication. c. renal failure. d. genetic defect. ANS: D A primary (congenital) immune deficiency is caused by a genetic defect. A primary (congenital) immune deficiency is not a response to an immunization, an adverse response to a medication, or due to renal failure. REF: p. 189 Understanding Pathophysiology 6th Edition Huether Test Bank O 33. An infant is experiencing hemolytic disease of the newborn. Which of the following would the nurse expect to find in the infant’s history and physical? a. The mother was exposed to measles. b. The father was exposed to Agent Orange. c. The baby is Rh positive. d. The baby was born 6 weeks prematurely. ANS: C Hemolytic disease of the newborn was most commonly caused by IgG anti-D alloantibody produced by Rh-negative mothers against erythrocytes of their Rh-positive fetuses. This disorder is not due to the mother’s exposure to measles, the father’s exposure to Agent Orange, or the baby’s prematurity. REF: p. 209 MULTIPLE RESPONSE 1. A 30-year-old female is diagnosed with systemic lupus erythematosus (SLE). Which symptoms are a result of a type II hypersensitivity? a. Anemia b. Seizures c. Lymphopenia d. Facial rash e. Photosensitivity ANS: A, C The patient is experiencing type II hypersensitivity when experiencing anemia and lymphopenia. Seizures, facial rash, and photosensitivity are not associated with type II hypersensitivity reactions. REF: p. 208 Understanding Pathophysiology 6th Edition Huether Test Bank O The catecholamines are epinephrine and norepinephrine. Neither aldosterone nor cortisol is a catecholamine. REF: p. 221 8. A nurse recalls that stress-induced stimulation of the adrenal cortex causes it to secrete: a. estrogen. b. cortisol. c. parathyroid hormone. d. adrenocorticotropin hormone (ACTH). ANS: B The adrenal cortex secretes cortisol, not estrogen, parathyroid hormone, or ACTH. REF: p. 218 9. Stress-induced catecholamine release from the adrenal medulla may result in: a. decreased blood flow to the brain. b. elevated blood pressure. c. decreased glycogen synthesis. d. decreased muscle contraction. ANS: B Catecholamine release results in elevated blood pressure as a result of vasoconstriction. Catecholamine release results in increased blood flow to the brain and increased glucose production. Catecholamine release results in increased muscle contraction. REF: p. 222, Table 9-3 10. When a patient is diagnosed with a hormone-secreting tumor of the adrenal cortex, which physiological response would be expected? a. Decreased blood pressure b. Increased incidence of gastric ulcers c. Increased lipogenesis of extremities d. Decreased gastric secretion ANS: B Increased release of cortisol leads to increased gastric secretions, and therefore an increased incidence of gastric ulcers. Hypertension is a result of increased cortisol. The increase of gastric secretions causes lipolysis, not lipogenesis. REF: pp. 218-219 11. When assessing the effects of elevated β-endorphins in a patient, which of the following should the nurse monitor? a. Peripheral vasoconstriction b. Hyperglycemia c. Pain inhibition d. Decreased immune cell activity ANS: C Understanding Pathophysiology 6th Edition Huether Test Bank O Elevated β-endorphins activate endorphin (opiate) receptors on peripheral sensory nerves, leading to pain relief or analgesia. None of the other options result from the effects of elevated β-endorphins. REF: p. 224, Table 9-4 12. After teaching about coping, which information indicates a correct understanding? Coping is best defined as the process of: a. adjusting to disease. b. preventing psychological distress. c. mediating anger. d. managing stressful challenges. ANS: D Coping is the process of managing, not adjusting to, stressful challenges that tax the individual’s resources. Coping is not preventing psychological distress, nor does it mediate anger. REF: p. 226 MULTIPLE RESPONSE 1. When teaching about the stress-age syndrome, what information should the nurse include? (select all that apply) a. Decreased cortisol secretion b. Decreased thyroxine c. Immunodepression d. Increased catecholamine secretion e. Hypercoagulation of the blood f. Free-radical damage ANS: B, C, D, E, F The stress-age syndrome includes alterations in the excitability of structures of the limbic system and hypothalamus; rise of the blood concentration of catecholamines, ADH, ACTH, and cortisol; decrease in testosterone, thyroxine, and others; alterations of opioid peptides; immunodepression and pattern of chronic inflammation; alterations in lipoproteins; hypercoagulation of the blood; and free-radical damage of cells. REF: p. 228, Geriatric Considerations 2. When a patient uses repression to deal with psychological stress, which of the following assessment findings should the nurse monitor for? (select all that apply) a. Decreased monocyte counts b. Increased eosinophil counts c. Decreased serum glucose d. Increased pulse rates e. Increased medication reactions ANS: A, B, E Understanding Pathophysiology 6th Edition Huether Test Bank O Repression is associated with lower monocyte counts, higher eosinophil counts, higher serum glucose, and more self-reported medication reactions in medical outpatients. It is not associated with increased pulse rates and glucose increases, rather than decreases. REF: p. 227 Understanding Pathophysiology 6th Edition Huether Test Bank O 8. A 52-year-old male with hepatitis C recently developed hepatic cancer. Which of the following markers should be increased? a. Alpha-fetoprotein (AFP) b. Catecholamines c. Prostate-specific antigen d. Homovanillic acid ANS: A Liver and germ cell tumors secrete a protein known as AFP, not catecholamines. Prostate tumors secrete prostate-specific antigen. Homovanillic acid is a catecholamine marker. REF: p. 259, Table 10-7 9. Which information should the nurse include when teaching about angiogenic factors? In cancer, angiogenic factors stimulate: a. release of growth factors. b. tumor regression. c. apoptosis. d. new blood vessel growth. ANS: D Cancers can secrete multiple factors that stimulate new blood vessel growth called angiogenesis, not release of growth factors or tumor regression. Apoptosis is cell death. REF: pp. 245-246 10. What is the effect of telomere caps on cancer cells? a. Repeated divisions b. Clonal distinction c. Limited mitosis d. Mutation abilities ANS: A The presence of telomere caps gives cancer cells the ability to divide over and over again, thus cancer cells have unlimited mitosis. Telomere caps do not give cells clonal distinction. Mutation capability is a characteristic of cancer cells, but this property is not related to telomeres. REF: p. 245 11. Which of the following indicates a nurse understands a proto-oncogene? A proto-oncogene is best defined as a(n) _ gene. a. normal b. altered c. inactive d. tumor-suppressor ANS: A In its normal, nonmutant state, an oncogene is referred to as a proto-oncogene. A proto-oncogene is not an altered gene, an inactive gene, or a tumor-suppressor gene. REF: p. 240 Understanding Pathophysiology 6th Edition Huether Test Bank O 12. Which genetic change causes alterations in only one or a few nucleotide bases? a. Insertions b. Deletions c. Point mutations d. Amplification mutations ANS: C Genetic changes may occur by both mutational and epigenetic mechanisms. Mutation generally means an alteration in the DNA sequence affecting expression or function of a gene. Mutations include small-scale changes in DNA, such as point mutations, which are the alteration of one or a few nucleotide base pairs. The process involved with insertions, deletions, or amplification mutations is different. REF: p. 237 13. A 45-year-old female was recently diagnosed with cervical cancer. Which of the following is the most likely cause of her cancer? a. Herpes virus b. Rubella virus c. Human papillomavirus (HPV) d. Hepatitis B virus ANS: C The presence of HPV is a factor in cervical cancer. The presence of herpes virus, rubella virus, or hepatitis B virus is not a factor in cervical cancer. REF: p. 250 14. A 30-year-old male with HIV is diagnosed with Epstein-Barr virus. After 2 months, the virus is still active. Based upon the Epstein-Barr virus, which of the following cancers is most likely to develop in this patient? a. B-cell lymphoma b. Kaposi sarcoma c. T-cell leukemia d. T-cell lipoma ANS: A Epstein-Barr virus is associated with B-cell lymphoma. Kaposi sarcoma is associated with HIV. Retroviruses are associated with leukemia. Lipomas are not associated with HIV. REF: p. 250 15. A 45-year-old male presents with persistent, severe stomach pain. Testing reveals a peptic ulcer. Further laboratory tests reveal the presence of Helicobacter pylori. Which of the following is of concern for this patient? a. Gastric cancer b. Leukemia c. Lung cancer d. Adenocarcinoma of the colon ANS: A Understanding Pathophysiology 6th Edition Huether Test Bank O U S N T O The presence of Helicobacter pylori is associated with gastric cancer, not leukemia, lung cancer, or colon cancer. REF: p. 249 16. Which statement indicates the patient has a correct understanding of metastasis? The most common route of metastasis is through the blood vessels and: a. lung tissue. b. body cavities. c. lymphatics. d. connective tissues. ANS: C The most common route of metastasis is through the lymphatics, not lung tissue, body cavities, or connective tissues. REF: p. 253 17. A nurse is giving an example of inflammation as an etiology for cancer development. What is the best example the nurse should give? a. Pneumonia and lung cancer b. Ulcerative colitis and colon cancer c. Prostatic hypertrophy and prostate cancer d. Hypercholesterolemia and leukemia ANS: B Individuals with a 10+ year history of ulcerative colitis have a 30-fold increase in developing colon cancer. There is no relaNtionRshiIp beGtweBen.pCneuMmonia and lung cancer; between prostatic hypertrophy and cancer of the prostate; and between hypercholesterolemia and leukemia. REF: pp. 248-249 18. A patient asks when adjuvant chemotherapy is used. How should the nurse respond? Adjuvant chemotherapy treatment is used: a. as the primary treatment. b. before radiation therapy. c. after surgical removal of a tumor. d. in cancer with little risk of metastasis. ANS: C Adjuvant chemotherapy is given after surgical excision of a cancer with the goal of eliminating micrometastases. Adjuvant chemotherapy is not given as the primary treatment or before radiation therapy. Adjuvant chemotherapy is indicated in the treatment of individuals with metastasis. REF: p. 261 MULTIPLE RESPONSE 1. Brachytherapy is being used to treat cancer in a patient. What types of cancers respond well to brachytherapy? (select all that apply) Understanding Pathophysiology 6th Edition Huether Test Bank O b. Adenoma c. Basal cell carcinoma d. Leukemia ANS: C Basal cell carcinoma is related to UV radiation primarily from the sun. Neither lymphoma, adenoma, nor leukemia is related to sunbathing. REF: p. 287 5. A nurse recalls physical activity was shown to definitely reduce the risk of which of the following types of cancer? a. Prostate b. Lung c. Bone d. Colon ANS: D Physical activity has been proven to reduce the risk for breast and colon cancers, but its effect in reducing prostate, lung, or bone cancer is not as strong. REF: p. 276 6. A 65-year-old patient recently diagnosed with cancer retired from construction work. Which cancer is likely to develop secondarily to occupational hazards? a. Mesothelioma b. Bladder cancer c. Prostate cancer d. Bone cancer ANS: A One notable occupational factor is asbestos, which increases the risk of mesothelioma, lung cancer, and possibly others. The same risk of bladder, prostate, or bone cancer does not exist. REF: p. 293 7. A patient asks why indoor pollution is worse than outdoor pollution. How should the nurse respond? Indoor pollution is considered worse than outdoor pollution because of cigarette smoke and: a. fireplace wood smoke. b. radon. c. benzene. d. chlorine. ANS: B Indoor pollution is related to cigarette smoke and radon. Indoor pollution is not related to fireplace smoke, benzene, or chlorine. REF: pp. 292-293 8. A water test recently revealed arsenic levels above 200 mcg/L. Which of the following cancers would be most likely to develop in those who consistently drank the water? Understanding Pathophysiology 6th Edition Huether Test Bank O U S N T a. Liver b. Skin c. Colon d. Kidney ANS: B Evidence indicates an increased risk of bladder, skin, and lung cancers following consumption of water with high levels of arsenic. Evidence for cancers of the liver, colon, and kidney is weaker following consumption of water with high levels of arsenic. REF: p. 293 9. When an oncologist is teaching about how radiation induces genomic instability, which topic should the oncologist discuss? a. Increasing hypersensitivity b. Facilitating new mutations c. Promoting cell death d. Enhancing mitosis ANS: B Radiation induces genomic instability because it facilitates new mutations but it does not promote hypersensitivity. Radiation may promote cell death, but this is not its role in inducing genomic instability. Radiation does not enhance mitosis but halts it. REF: p. 286 10. Which of the following patients would be at greatest risk for basal cell carcinoma? a. Dark complexion, light eNyes,RundIerwGeigBht. b. Light complexion, dark eyes, overweight c. Medium complexion, light eyes, smoker d. Light complexion, light eyes, fair hair ANS: D Individuals at risk for basal cell carcinoma have light complexions, light eyes, and fair hair. REF: p. 287 11. The role of physical activity in the prevention of colon cancer is identified by which of the following? a. It increases fluid loss, leading to thirst and increased fluid intake, hydrating the colon. b. It increases blood supply, thereby increasing oxygen to the colon. c. It increases gut motility, thereby decreasing the time the bowel is exposed to mutagens. d. It increases the secretion of hydrochloric acid, thereby killing mutants. ANS: C Physical activity increases gut motility, thereby decreasing exposure to mutagens. Physical activity does increase fluid loss and blood supply, but neither effect prevents mutagens. Physical activity does not increase hydrochloric acid. REF: p. 283 Understanding Pathophysiology 6th Edition Huether Test Bank O MULTIPLE RESPONSE 1. A 50-year-old female confirms chronic alcohol intake. This practice places the patient at risk for cancer in which organs? (select all that apply) a. Larynx b. Esophagus c. Liver d. Lung e. Brain f. Breast ANS: A, B, C, F Chronic alcohol consumption is a strong risk factor for colorectal cancer and cancer of the oral cavity, pharynx, hypopharynx, larynx, esophagus, liver, and breast. It is not associated with lung or brain cancer. REF: p. 281 Understanding Pathophysiology 6th Edition Huether Test Bank O b. Cytotoxic agents c. Anabolic steroids d. A viral infection ANS: C A history of anabolic steroids, not immunosuppressive or cytotoxic agents, places the patient at risk for hepatocellular carcinoma. A viral infection does not place the patient at risk for hepatocellular carcinoma. REF: p. 305, Table 12-5 9. The most common type of tissue cancer occurring between ages 15 and 19 is: a. sarcoma. b. squamous cell. c. carcinoma. d. neuroma. ANS: C The most common type of tissue cancer after adolescence is carcinoma, not sarcoma, squamous cell, or neuroma. REF: p. 301 MULTIPLE RESPONSE 1. When an aide asks why carcinomas rarely occur in childhood, how should the nurse respond? (select all that apply) a. Carcinomas cannot developUin San iNmmTunosupOpressed environment. b. Carcinomas need a long time from exposure to occurrence. c. Carcinomas are due to environmental exposures. d. Carcinomas occur primarily in secondary sexual organs. e. Carcinomas are mesodermal. ANS: B, C Carcinomas rarely occur in children because these cancers most commonly result from environmental carcinogens and require a long period from exposure to the appearance of the carcinoma. REF: p. 301 Understanding Pathophysiology 6th Edition Huether Test Bank O Chapter 13: Structure and Function of the Neurologic System Huether & McCance: Understanding Pathophysiology, 6th Edition MULTIPLE CHOICE 1. When a patient asks what the somatic nervous system controls, how should the nurse respond? It controls: a. the heart. b. the spinal cord. c. skeletal muscle. d. smooth muscle organs. ANS: C The somatic nervous system consists of pathways that regulate voluntary motor control, the skeletal muscle system. The somatic nervous system does not control the heart; the autonomic nervous system controls the heart, the spinal cord, and the smooth muscle organs. REF: p. 307 2. A nurse is preparing to teach about nerves. Which information should the nurse include? The axon leaves the cell body at the: a. axon hillock. b. Nissl body. c. node of Ranvier. d. myelin sheath. ANS: A The axon hillock is the cone-shaped process where the axon leaves the cell body. The Nissl body is involved in protein synthesis. Axons branch at the node of Ranvier. The myelin sheath covers the entire membrane. REF: p. 308 3. When a student asks in which region of the neuron do nerve impulses travel the fastest, how should the nurse respond? The: a. large axon. b. axon hillock. c. cell body. d. dendrites. ANS: A Large axons transmit impulses at a faster rate than cell bodies. The axon hillock has a low threshold level. The dendrites carry impulses toward the cell body, but not as quickly as large axons. REF: p. 308 4. A neurologist is teaching the staff about motor neurons. Which structural classification identifies motor neurons? a. Unipolar Understanding Pathophysiology 6th Edition Huether Test Bank O b. Pseudounipolar c. Bipolar d. Multipolar ANS: D A motor neuron is typically multipolar. Unipolar neurons are found in the retina. Pseudounipolar neurons have one process; the dendritic portion of each of these neurons extends away from the CNS, and the axon portion projects into the CNS. Bipolar neurons are found in the eye. REF: p. 308 5. An experiment looking at an isolated neuron revealed a sensory nerve with one process containing a dendritic portion extending away from the CNS and an axon extending toward the CNS. Which of the following classifications would this neuron fall into? a. Bipolar b. Multipolar c. Pseudounipolar d. Interpolar ANS: C Pseudounipolar neurons have one process; the dendritic portion of each of these neurons extends away from the CNS, and the axon portion projects into the CNS. Bipolar neurons have two distinct processes arising from the cell body. Multipolar neurons are the most common and have multiple processes capable of extensive branching. A motor neuron is typically multipolar. Interpolar is not a type of neuron. REF: p. 308 Understanding Pathophysiology 6th Edition Huether Test Bank O U S N T O b. Dopamine c. Acetylcholine d. Substance P ANS: D Substance P is a neurotransmitter in pain transmission pathways. Blocking the release of substance P by morphine reduces pain. The opiates morphine and heroin bind to endorphin and enkephalin receptors on presynaptic neurons. Dopamine is a neurotransmitter involved in activity. Acetylcholine plays a role in nerve conduction presynaptically. REF: p. 312, Table 13-2 11. A 19-year-old college student reports to his primary care provider that he cannot stay awake in class regardless of how much sleep he gets. Under-stimulation of which area of the brain is likely the site of the problem? a. Corpora quadrigemina b. Reticular activating system c. Cerebellum d. Hypothalamus ANS: B The reticular activating system is responsible for wakefulness, not the corpora quadrigemina, the cerebellum, or the hypothalamus. REF: p. 313 12. After rehabilitation for severe brain damage following a motor vehicle accident, a patient reports that her thought proceNsseRs anId abGilityBt.oCconMcentrate are impaired. Which area does the nurse suspect is damaged? a. Thalamus b. Limbic c. Prefrontal d. Occipital ANS: C The prefrontal area is responsible for goal-oriented behavior (e.g., ability to concentrate), short-term or recall memory, the elaboration of thought, and inhibition of the limbic areas of the CNS. Goal-oriented behavior is not the function of the thalamus, limbic system, or occipital area. REF: p. 313 13. A neurologist is teaching about the region responsible for motor aspects of speech. Which area is the neurologist discussing? a. Wernicke area b. Broca area c. Brodmann area 4 d. Brodmann area 6 ANS: B The Broca area is responsible for the motor aspects of speech. Motor aspects of speech are not the function of the Wernicke area or Brodmann areas 4 and 6. Understanding Pathophysiology 6th Edition Huether Test Bank O REF: p. 314 14. A patient is looking at a picture of the brain and points to the convolutions on the surface of the cerebrum. The nurse should tell the patient these are called: a. sulci. b. fissures. c. reticular formations. d. gyri. ANS: D The surface of the cerebrum (cerebral cortex) is covered with convolutions called gyri, which greatly increase the cortical surface area and the number of neurons. Neither sulci, fissures, nor reticular formations cover the cerebrum in a fashion that increases its surface. REF: p. 313 15. Where is the primary visual cortex of the brain located? a. Frontal lobe b. Temporal lobe c. Occipital lobe d. Parietal lobe ANS: C The visual cortex is located in the occipital lobe. REF: p. 314 16. A nurse is preparing to homeostasis and instinctive behavioral patterns. Which area of the brain is the nurse discussing? a. Thalamus b. Medulla c. Cerebellum d. Hypothalamus ANS: D The hypothalamus functions to maintain a constant internal environment and instinctive behavioral patterns. The thalamus serves as a relay center for information from the basal ganglia and cerebellum to the appropriate motor area. The medulla controls reflex activities, such as heart rate, respiration, blood pressure, coughing, sneezing, swallowing, and vomiting. The cerebellum is responsible for reflexive, involuntary fine-tuning of motor control, for maintaining balance and posture through extensive neural connections. REF: p. 317, Box 13-2 17. When a nurse is teaching about the transverse fiber tract that connects the two cerebral hemispheres, what term should the nurse use? a. Peduncle b. Corpus callosum c. Basal ganglia d. Pons Understanding Pathophysiology 6th Edition Huether Test Bank O ANS: B The corpus callosum connects the two cerebral hemispheres and is essential in coordinating activities between hemispheres. The peduncle is made up of efferent fibers of the corticospinal, corticobulbar, and corticopontocerebellar tracts. The basal ganglia is a portion of the pyramidal system. The pons (bridge) is easily recognized by its bulging appearance below the midbrain and above the medulla. REF: p. 315 18. A student nurse asks the nurse what controls reflex activities concerned with heart rate and blood pressure. What is the nurse’s best response? These reflex activities are controlled by the: a. medulla oblongata. b. pons. c. midbrain. d. cerebrum. ANS: A The medulla oblongata, not the pons, controls reflex activities, such as heart rate, respiration, blood pressure, coughing, sneezing, swallowing, and vomiting. The midbrain is primarily a relay center for motor and sensory tracts, as well as a center for auditory and visual reflexes. The cerebrum plays a role in the transfer of information. REF: p. 317 19. Blockage of which of the following would cause hydrocephalus? a. Cerebral aqueduct b. Inferior colliculi c. Red nucleus d. Tegmentum ANS: A Blockage of the cerebral aqueduct leads to hydrocephalus. Hydrocephalus is not a result of dysfunction of the inferior colliculi, red nucleus, or tegmentum. REF: p. 317 20. A patient presents with altered respiratory patterns following head trauma. Based on the symptoms, which of the following areas does the nurse suspect is injured? a. Cerebrum b. Cerebellum c. Midbrain d. Reticular formation ANS: D The reticular formation is a large network of diffuse nuclei that control vital reflexes, such as those controlling cardiovascular function and respiration. Respiratory function is not controlled by the cerebrum, cerebellum, or midbrain. REF: p. 313 21. A nurse recalls that characteristics of upper motor neurons include: