APPLIED PATHOPHYSIOLOGY A CONCEPTUAL APPROACH TO THE MECHANISMS OF DISEASE 3RD EDITION BRAUN TEST BANK

APPLIED PATHOPHYSIOLOGY A CONCEPTUAL APPROACH TO THE MECHANISMS OF DISEASE 3RD EDITION BRAUN TEST BANK APPLIED PATHOPHYSIOLOGY A CONCEPTUAL APPROACH TO THE MECHANISMS OF DISEASE 3RD EDITION BRAUN TEST BANK Applied Pathophysiology A Conceptual Approach to the Mechanisms of Disease 3rd Edition Braun Test Bank Chapter 1Introduction to Pathophysiology 1. The nucleus , which is essential for function and survival of the cell. A) is the site of protein synthesis B) contains the genetic code C) transforms cellular energy D) initiates aerobic metabolism 2. Although energy is not made in mitochondria, they are known as the power plants of the cell because they: A) contain RNA for protein synthesis. B) utilize glycolysis for oxidative energy. C) extract energy from organic compounds. D) store calcium bonds for muscle contractions. 3. Although the basic structure of the cell plasma membrane is formed by a lipid bilayer, most of the specific membrane functions are carried out by: A) bound and transmembrane proteins. B) complex, long carbohydrate chains. C) surface antigens and hormone receptors. D) a gating system of selective ion channels. 4. To effectively relay signals, cell-to-cell communication utilizes chemical messenger systems that: A) displace surface receptor proteins. B) accumulate within cell gap junctions. C) bind to contractile microfilaments. D) release secretions into extracellular fluid. 5. Aerobic metabolism, also known as oxidative metabolism, provides energy by: A) removing the phosphate bonds from ATP. B) combining hydrogen and oxygen to form water. C) activating pyruvate stored in the cytoplasm. D) breaking down glucose to form lactic acid. 6. Exocytosis, the reverse of endocytosis, is important in into the extracellular fluid. A) Engulfing and ingesting fluid and proteins for transport B) Killing, degrading, and dissolving harmful microorganisms C) Removing cellular debris and releasing synthesized substances D) Destruction of particles by lysosomal enzymes for secretion 7. The process responsible for generating and conducting membrane potentials is: A) diffusion of current-carrying ions. B) millivoltage of electrical potential. C) polarization of charged particles. D) ion channel neurotransmission. 8. Epithelial tissues are classified according to the shape of the cells and the number of layers. Which of the following is a correctly matched description and type of epithelial tissue? A) Simple epithelium: cells in contact with intercellular matrix; some do not extend to surface B) Stratified epithelium: single layer of cells; all cells rest on basement membrane C) Glandular epithelium: arise from surface epithelia and underlying connective tissue D) Pseudostratified epithelium: multiple layers of cells; deepest layer rests on basement membrane 9. Connective tissue contains fibroblasts that are responsible for: A) providing a fibrous framework for capillaries. B) synthesis of collagen, elastin, and reticular fibers. C) forming tendons and the fascia that covers muscles. D) filling spaces between tissues to keep organs in place. 10. Although all muscle tissue cells have some similarities, smooth muscle (also known as involuntary muscle) differs by: A) having dense bodies attached to actin filaments. B) containing sarcomeres between Z lines and M bands. C) having rapid contractions and abundant cross-striations. D) contracting in response to increased intracellular calcium. 11. Which of the following aspects of the function of the nucleus is performed by ribosomal RNA (rRNA)? A) Copying and carrying DNA instructions for protein synthesis B) Carrying amino acids to the site of protein synthesis C) Providing the site where protein synthesis occurs D) Regulating and controlling protein synthesis 12. Breakdown and removal of foreign substances and worn-out cell parts are performed by which of the following organelles? A) Lysosomes B) Golgi apparatus C) Ribosomes D) Endoplasmic reticulum (ER) 13. Impairment in the function of peroxisomes would result in: A) inadequate sites for protein synthesis. B) an inability to transport cellular products across the cell membrane. C) insufficient energy production within a cell. D) accumulation of free radicals in the cytoplasm. 14. After several months of trying to conceive, a couple is undergoing fertility testing. Semen analysis indicates that the mans sperm have decreased motility, a finding that is thought to underlie the couples inability to become pregnant. Which of the following cellular components may be defective within the mans sperm? A) Ribosomes B) Microtubules C) Mitochondria D) Microfilaments 15. Which of the following statements is true of glycolysis? A) Glycolysis requires oxygen. B) Glycolysis occurs in cells without mitochondria. C) Glycolysis provides the majority of the bodys energy needs. D) Glycolysis produces energy, water, and carbon dioxide. 16. Which of the following membrane transport mechanisms requires the greatest amount of energy? A) Facilitated diffusion B) Passive transport C) Vesicular transport D) Simple diffusion 17. A male patient with a diagnosis of type 1 diabetes mellitus is experiencing hyperglycemia because he lacks sufficient insulin to increase the availability of glucose transporters in his cell membranes. Consequently, his cells lack intracellular glucose and it accumulates in his blood. Which of the following processes would best allow glucose to cross his cell membranes? A) Facilitated diffusion B) Simple diffusion C) Secondary active transport D) Endocytosis 18. Which of the following statements is true of skeletal muscle cells? A) Skeletal muscle cells each have an apical, lateral, and basal surface. B) They are closely apposed and are joined by cell-to-cell adhesion molecules. C) Their basal surface is attached to a basement membrane. D) Skeletal muscle is multinucleated, lacking true cell boundaries. 19. Which of the following body tissues exhibits the highest rate of turnover and renewal? A) The squamous epithelial cells of the skin B) The connective tissue supporting blood vessels C) The skeletal muscle that facilitates movement D) The nervous tissue that constitutes the central nervous system 20. A patient with a pathophysiologic condition that affects the desmosomes is most likely to exhibit: A) impaired contraction of skeletal and smooth muscle. B) weakness of the collagen and elastin fibers in the extracellular space. C) impaired communication between neurons and effector organs. D) separation at the junctions between epithelial cells. Answer Key 1. B 2. C 3. A 4. D 5. B 6. C 7. A 8. C 9. B 10. A 11. C 12. A 13. D 14. B 15. B 16. C 17. A 18. D 19. A 20. D Chapter 2 Altered Cells and Tissues 1. Ischemia and other toxic injuries increase the accumulation of intracellular calcium as a result of: A) release of stored calcium from the mitochondria. B) improved intracellular volume regulation. C) decreased influx across the cell membrane. D) attraction of calcium to fatty infiltrates. 2. The patient is found to have liver disease, resulting in the removal of a lobe of his liver. Adaptation to the reduced size of the liver leads to of the remaining liver cells. A) metaplasia B) organ atrophy C) compensatory hyperplasia D) physiologic hypertrophy 3. A person eating peanuts starts choking and collapses. His airway obstruction is partially cleared, but he remains hypoxic until he reaches the hospital. The prolonged cell hypoxia caused a cerebral infarction and resulting in the brain. A) caspase activation B) coagulation necrosis C) rapid phagocytosis D) protein p53 deficiency 4. Bacteria and viruses cause cell damage by , which is unique from the intracellular damage caused by other injurious agents. A) disrupting the sodium/potassium ATPase pump B) interrupting oxidative metabolism processes C) replicating and producing continued injury D) decreasing protein synthesis and function 5. The patient has a prolonged interruption in arterial blood flow to his left kidney, causing hypoxic cell injury and the release of free radicals. Free radicals damage cells by: A) destroying phospholipids in the cell membrane. B) altering the immune response of the cell. C) disrupting calcium storage in the cell. D) inactivation of enzymes and mitochondria. 6. Injured cells have impaired flow of substances through the cell membrane as a result of: A) increased fat load. B) altered permeability. C) altered glucose utilization. D) increased surface receptors. 7. Reversible adaptive intracellular responses are initiated by: A) stimulus overload. B) genetic mutations. C) chemical messengers. D) mitochondrial DNA. 8. Injured cells become very swollen as a result of: A) increased cell protein synthesis. B) altered cell volume regulation. C) passive entry of potassium into the cell. D) bleb formation in the plasma membrane. 9. A diabetic patient has impaired sensation, circulation, and oxygenation of his feet. He steps on a piece of glass, the wound does not heal, and the area tissue becomes necrotic. The necrotic cell death is characterized by: A) rapid apoptosis. B) cellular rupture. C) shrinkage and collapse. D) chronic inflammation. 10. A 99-year-old woman has experienced the decline of cell function associated with age. A group of theories of cellular aging focus on programmed: A) changes with genetic influences. B) elimination of cell receptor sites. C) insufficient telomerase enzyme. D) DNA mutation or faulty repair. 11. An 89-year-old female patient has experienced significant decreases in her mobility and stamina during a 3-week hospital stay for the treatment of a femoral head fracture. Which of the following phenomena most likely accounts for the patients decrease in muscle function that underlies her reduced mobility? A) Impaired muscle cell metabolism resulting from metaplasia B) Dysplasia as a consequence of inflammation during bone remodeling C) Disuse atrophy of muscle cells during a prolonged period of immobility D) Ischemic atrophy resulting from vascular changes while on bedrest 12. A 20-year-old college student has presented to her campus medical clinic for a scheduled Papanicolaou (Pap) smear. The clinician who will interpret the smear will examine cell samples for evidence of: A) changes in cell shape, size, and organization. B) the presence of unexpected cell types. C) ischemic changes in cell samples. D) abnormally high numbers of cells in a specified field. 13. Which of the following pathophysiologic processes is most likely to result in metastatic calcification? A) Benign prostatic hyperplasia B) Liver cirrhosis C) Impaired glycogen metabolism D) Hyperparathyroidism 14. Despite the low levels of radiation used in contemporary radiologic imaging, a radiology technician is aware of the need to minimize her exposure to ionizing radiation. What is the primary rationale for the technicians precautions? A) Radiation stimulates pathologic cell hypertrophy and hyperplasia. B) Radiation results in the accumulation of endogenous waste products in the cytoplasm. C) Radiation interferes with DNA synthesis and mitosis. D) Radiation decreases the action potential of rapidly dividing cells. 15. The parents of a 4-year-old girl have sought care because their daughter has admitted to chewing and swallowing imported toy figurines that have been determined to be made of lead. Which of the following blood tests should the care team prioritize? A) White blood cell levels with differential B) Red blood cell levels and morphology C) Urea and creatinine levels D) Liver function panel 16. A 70-year-old male patient has been admitted to a hospital for the treatment of a recent hemorrhagic stroke that has left him with numerous motor and sensory deficits. These deficits are most likely the result of which of the following mechanisms of cell injury? A) Free radical injury B) Hypoxia and ATP depletion C) Interference with DNA synthesis D) Impaired calcium homeostasis 17. Which of the following processes associated with cellular injury is most likely to be reversible? A) Cell damage resulting from accumulation of fat in the cytoplasm B) Cellular changes as a result of ionizing radiation C) Cell damage from accumulation of free radicals D) Apoptosis 18. The extrinsic pathway of apoptosis can be initiated by: A) damage to cellular DNA. B) decreased ATP levels. C) activation of the p53 protein. D) activation of death receptors on the cell surface. 19. A patient with severe peripheral vascular disease has developed signs of dry gangrene on the great toe of one foot. Which of the following pathophysiologic processes most likely contributed to this diagnosis? A) Inappropriate activation of apoptosis B) Bacterial invasion C) Impaired arterial blood supply D) Metaplastic cellular changes 20. Which of the following facts underlies the concept of replicative senescence? A) Genes controlling longevity are present or absent in varying quantities among different individuals. B) Telomeres become progressively shorter in successive generations of a cell. C) The damaging influence of free radicals increases exponentially in later generations of a cell. D) Aging produces mutations in DNA and deficits in DNA repair. Answer Key 1. A 2. C 3. B 4. C 5. A 6. B 7. C 8. B 9. B 10. A 11. C 12. A 13. D 14. C 15. B 16. B 17. A 18. D 19. C 20. B Chapter 3 Inflammation and Tissue Repair 1. The characteristic, localized cardinal signs of acute inflammation include: A) fever. B) fatigue. C) redness. D) granuloma. 2. The vascular, hemodynamic stage of acute inflammation is initiated by momentary vasoconstriction followed by vasodilation that causes localized: A) bleeding. B) congestion. C) pale skin. D) coolness. 3. The cellular stage of acute inflammation is marked by the movement of leukocytes into the area. Which of the following cells arrives early in great numbers? A) Basophils B) Lymphocytes C) Neutrophils D) Platelets 4. The phagocytosis process involves three distinct steps. What is the initial step in the process? A) Engulfment B) Intracellular killing C) Antigen margination D) Recognition and adherence 5. Which of the following mediators of inflammation causes increased capillary permeability and pain? A) Serotonin B) Histamine C) Bradykinin D) Nitric oxide 6. Inflammatory exudates are a combination of several types. Which of the following exudates is composed of enmeshed necrotic cells? A) Serous B) Fibrinous C) Suppurative D) Membranous 7. The acute-phase systemic response usually begins within hours of the onset of inflammation and includes: A) fever and lethargy. B) decreased C-reactive protein. C) positive nitrogen balance. D) low erythrocyte sedimentation rate. 8. In contrast to acute inflammation, chronic inflammation is characterized by which of the following phenomena? A) Profuse fibrinous exudation B) A shift to the left of granulocytes C) Metabolic and respiratory alkalosis D) Lymphocytosis and activated macrophages 9. Exogenous pyrogens (interleukin-1) and the presence of bacteria in the blood lead to the release of endogenous pyrogens that: A) stabilize thermal control in the brain. B) produce leukocytosis and anorexia. C) block viral replication in cells. D) inhibit prostaglandin release. 10. An older adult patient has just sheared the skin on her elbow while attempted to boost herself up in bed, an event that has precipitated acute inflammation in the region surrounding the wound. Which of the following events will occur during the vascular stage of the patients inflammation? A) Outpouring of exudate into interstitial spaces B) Chemotaxis C) Accumulation of leukocytes along the epithelium D) Phagocytosis of cellular debris 11. Which of the following individuals most likely has the highest risk of experiencing chronic inflammation? A) A patient who has recently been diagnosed with type 2 diabetes B) A patient who is a carrier of an antibiotic-resistant organism C) A patient who is taking oral antibiotics for an upper respiratory infection D) A patient who is morbidly obese and who has a sedentary lifestyle 12. Which of the following core body temperatures is within normal range? A) 35.9C (96.6F) B) 38.0C (100.4F) C) 35.5C (95.9F) D) 37.3C (99.1F) 13. A postsurgical patient who is recovering in the postanesthetic recovery unit states that she is freezing cold. Which of the following measures is likely to be initiated in the patients hypothalamus in an effort to reduce heat loss? A) Opening of arteriovenous (AV) shunts B) Reduced exhalation of warmed air C) Contraction of pilomotor muscles D) Decreased urine production 14. An elderly patient is dressed only in a hospital gown and complains of a draft in her room. Consequently, she has requested a warm blanket while she sits in her wheelchair. Which of the following mechanisms of heat loss is most likely the primary cause of her request? A) Evaporation and conduction B) Radiation and convection C) Conduction and convection D) Convection and evaporation 15. Which of the following pathophysiologic processes are capable of inducing the production of pyrogens? Select all that apply. A) Acute inflammation B) Obesity C) Myocardial infarction D) Malignancy E) Renal failure 16. Which of the following patients is most likely to be susceptible to developing a neurogenic fever? A) A patient who has stage II Alzheimer disease B) A patient who has sustained a head injury in a bicycle crash C) A patient who has become delirious after the administration of a benzodiazepine D) A patient who has begun taking a selective serotonin-reuptake inhibitor (SSRI) for the treatment of depression 17. Patients are commonly administered antipyretics when their oral temperature exceeds 37.5C (99.5F). Which of the following statements related to the rationale for this action is most accurate? A) Temperatures in excess of 37.5C (99.5F) can result in seizure activity. B) Lower temperatures inhibit the protein synthesis of bacteria. C) There is little empirical evidence for this treatment modality. D) Most common antipyretics have been shown to have little effect on core temperature. 18. A patient has sought care because of recent malaise and high fever. Upon assessment, the patient states that his current fever began two days earlier, although he states that for the last 2 weeks he is in a cycle of high fever for a couple of days followed by a day or two of normal temperature. Which of the following fever patterns is this patient experiencing? A) Recurrent fever B) Remittent fever C) Sustained fever D) Intermittent fever 19. A febrile, 3-week-old infant has been brought to the emergency department by his parents and is currently undergoing a diagnostic workup to determine the cause of his fever. Which of the following statements best conveys the rationale for this careful examination? A) The immature hypothalamus is unable to perform normal thermoregulation. B) Infants are susceptible to serious infections because of their decreased immune function. C) Commonly used antipyretics often have no effect on the core temperature of infants. D) Fever in neonates is often evidence of a congenital disorder rather than an infection. 20. An 84-year-old patients blood cultures have come back positive, despite the fact that his oral temperature has remained within normal range. Which of the following phenomena underlies the alterations in fever response that occur in the elderly? A) Disturbance in the functioning of the thermoregulatory center B) Increased heat loss by evaporation C) The presence of comorbidities that are associated with lowered core temperature D) Persistent closure of arteriovenous shunts Answer Key 1. C 2. B 3. C 4. D 5. C 6. D 7. A 8. D 9. B 10. A 11. D 12. D 13. C 14. B 15. A, C, D 16. B 17. C 18. D 19. B 20. A Chapter 4 Altered Immunity 1. The mediators involved in type I hypersensitivity allergic responses are released from: A) mast cells. B) plasma cells. C) monocytes. D) arachidonic acid. 2. A genetically determined hypersensitivity to common environmental allergens causes reactions, such as: A) atopic; urticaria. B) autoimmune; diarrhea. C) IgM-mediated; infections. D) delayed; poison ivy rash: 3. Mismatched blood transfusion reaction with hemolysis of blood cells is an example of type II, mediated hypersensitivity reaction. A) T-cell B) antibody C) leukotriene D) complement 4. Type III hypersensitivity immune responses can be harmful when immune complex deposits in tissue activate that can directly damage area tissues. A) inflammation B) autoantibodies C) cytotoxic cells D) immunoglobulins 5. The mechanism by which humans recognize self-cells from non-self (antigens)- cells is . A) autoimmunity B) self-tolerance C) non-self anergy D) immunocompatibility 6. Organ rejection is a complication of organ transplantation caused by recipient immune cells: A) destroying the host T cells. B) attack on the donor cells. C) combining with grafts HLA. D) being recognized as foreign. 7. The leading cause of death for people with HIV is opportunistic . A) leukemia B) tuberculosis C) pneumonia D) toxoplasmosis 8. Wasting syndrome, an AIDS-defining illness, is characterized by involuntary weight loss of at least 10% of baseline body weight in the presence of: A) diarrhea. B) hypermetabolism. C) weakness and fever. D) glucose intolerance. 9. The window period of HIV infection refers to the period of time between infection and: A) transmission. B) seroconversion. C) initial symptoms. D) antibody screening. 10. HIV-positive persons that display manifestations of laboratory category 3 or clinical category C are considered to have: A) zero viral load. B) seroconversion. C) complete remission. D) AIDS-defining illnesses. 11. Contact with poison ivy has resulted in intense pruritus, erythema, and weeping on a patients forearm. Which of the following processes resulted in the patients signs and symptoms? A) IgE-mediated mast cell degranulation B) Formation of antigen-antibody complexes C) Cytokine release by sensitized T cells D) Formation of antibodies against cell surface antigens 12. A patient with a long history of hay fever has recently begun a series of immunotherapy (allergy shots). How will this treatment potentially achieve a therapeutic effect? A) By blocking cytokine release from sensitized mast cells B) By preventing mast cells from becoming sensitized C) By causing T cells to be sequestered in the thymus for longer periods D) By stimulating production of IgG to combine with antigens 13. A patient with a diagnosis of cirrhosis has experienced an acute rejection of a donor liver. Which of the following cells is central to the rejection of the patients transplanted organ? A) Natural killer cells B) Mast cells C) T cells D) Neutrophils 14. A patient with a diagnosis of aplastic anemia has undergone allogenic bone marrow transplantation. Which of the following signs and symptoms would most clearly suggest the existence of graft-versus-host disease (GVHD)? A) Shortness of breath, audible crackles, and decreasing PaO2 B) Presence of a pruritic rash that has begun to slough off C) Development of metabolic acidosis D) Diaphoresis, fever, and anxiety 15. A patient has developed pericarditis after developing acute glomerulonephritis, a development that may be attributable to the presence of similar epitopes on group A, b-hemolytic streptococci and the antigens in the patients heart tissue. Which of the following has most likely accounted for this patients autoimmune response? A) Breakdown of T-cell anergy B) Release of sequestered antigens C) Superantigens D) Molecular mimicry 16. A 70-year-old female patient has had her mobility and independence significantly reduced by rheumatoid arthritis. Which of the following processes likely contributed to the development of her health problem? A) Delayed-type hypersensitivity (DTH) reaction B) Proliferation of cytotoxic T cells C) Failure of normal self-tolerance D) Deletion of autoreactive B cells 17. Which of the following would constitute a normal assessment finding in a neonate? A) Minimal or absent levels of IgA and IgM B) Absence of plasma cells in the lymph nodes and spleen C) Undetectable levels of all immunoglobulins D) Absence of mature B cells with normal T-cell levels and function 18. A patient was diagnosed as HIV positive several years ago. Which of the following blood tests is most clinically useful for determining the stage and severity of her disease? A) Plasma levels B) CD4+ cell counts C) Viral load D) White blood cell count with differential 19. A patient has been admitted to the hospital for the treatment of HIV infection, which has recently progressed to overt AIDS. Which of the following nursing actions should the nurse prioritize when providing care for this patient? A) Frequent neurologic vital signs and thorough skin care B) Hemodynamic monitoring and physical therapy C) Careful monitoring of fluid balance and neurologic status D) Astute infection control and respiratory assessments 20. Shortly after being diagnosed with HIV, a patient has begun highly active antiretroviral therapy (HAART). What is the primary goal of the patients drug regimen? A) To limit the latent period of HIV B) To slow the progression of the disease C) To minimize opportunities for transmission D) To prevent seroconversion Answer Key 1. A 2. A 3. B 4. A 5. B 6. B 7. B 8. A 9. B 10. D 11. C 12. D 13. C 14. B 15. D 16. C 17. A 18. B 19. D 20. B Chapter 5 Infection 1. Although growth rate is variable among types of bacteria, the growth of bacteria is dependent on: A) biofilm communication. B) availability of nutrients. C) an intact protein capsid. D) individual cell motility. 2. Treponema pallidum, the cause of syphilis, is a spirochete bacterium that is spread from human to human by: A) tick or lice vector bites. B) direct physical contact. C) exposure to infected urine. D) inhaling airborne particles. 3. Chlamydiaceae, a rather common sexually transmitted infectious organism, has characteristics of both viruses and bacteria. The infectious form of this organisms life cycle is until it enters the host cell. A) an elementary body B) adhered to cholesterol C) propelled by filaments D) encapsulated hyphae 4. Because dermatophytes are capable of growing , the infection is mainly found on cutaneous surfaces of the body. A) a powdery colony B) in moist skin folds C) on cooler tissue D) branching filaments 5. Although both eukaryotes and prokaryotes are capable of causing infectious diseases in humans, eukaryotes are unique because they have a distinct: A) organized nucleus. B) circular plasmid DNA. C) cytoplasmic membrane. D) variation of shape and size. 6. Whatever the mechanism of entry, the human-to-human transmission of infectious agents is directly related to the: A) source of contact. B) site of infection. C) number of pathogens absorbed. D) virulence factors. 7. The course of any infectious disease progresses through several distinct stages after the pathogen enters the host. Although the duration may vary, the hallmark of the prodromal stage is: A) tissue inflammation and damage. B) initial appearance of symptoms. C) progressive pathogen elimination. D) containment of infectious pathogens. 8. Although bacterial toxins vary in their activity and effects on host cells, a small amount of gram-negative bacteria endotoxin: A) is released during cell growth. B) inactivates key cellular functions. C) uses protein to activate enzymes. D) in the cell wall activates inflammation. 9. Serology testing includes the measurement of which of the following? A) Antibody titers B) Culture growth C) Direct antigens D) DNA sequencing 10. Prions cause transmissible neurodegenerative diseases and are characterized by: A) a lack of reproductive capacity. B) hypermetabolism. C) enzyme production. D) chronic inflammation. 11. Which of the following individuals is experiencing a health problem that is the result of a parasite? A) A college student who contracted Chlamydia trachomatis during an unprotected sexual encounter B) A man who acquired malaria while on a tropical vacation C) A hospital patient who has developed postoperative pneumonia D) A woman who developed hepatitis A from eating at an unhygienic restaurant 12. Which of the following traits is characteristic of saprophytes? A) They derive energy from decaying organic matter. B) They are beneficial components of human microflora. C) They have RNA or DNA, but never both. D) They are capable of spore production. 13. A hospital patient was swabbed on admission for antibiotic-resistant organisms and has just been informed that methicillin-resistant Staphylococcus aureus (MRSA) is present in his groin. The patient has a normal core temperature and white blood cell count. This patient is experiencing which of the following? A) Infection B) Proliferation C) Colonization D) Inflammation 14. A 33-year-old patient who is a long-term intravenous user of heroin has been recently diagnosed with hepatitis C. Which of the following portals of entry most likely led to the patients infection? A) Direct contact B) Vertical transmission C) Ingestion D) Penetration 15. A 9-month-old infant has been diagnosed with botulism after he was fed honey. The childs mother was prompted to seek care because of this childs sudden onset of neuromuscular deficits, which were later attributed to the release of substances by Clostridium botulinum bacteria. Which virulence factor contributed to this childs illness? A) Endotoxins B) Adhesion factors C) Exotoxins D) Evasive factors 16. A patient with a long-standing diagnosis of Crohn disease has developed a perianal abscess. Which of the following treatments will this patient most likely require? A) Antiviral therapy B) Antibiotic therapy C) Surgical draining D) Pressure dressing 17. A patients primary care provider has ordered direct antigen detection in the care of a patient with a serious symptomatology of unknown origin. Which of the following processes will be conducted? A) Detecting DNA sequences that are unique to the suspected pathogen B) Growth of biofilms on various media in the laboratory setting C) Quantification of IgG and IgM antibodies in the patients blood D) Introduction of monoclonal antibodies to a blood sample from the patient 18. A patient has begun taking acyclovir, an antiviral medication, to control herpes simplex outbreaks. What is this drugs mechanism of action? A) Inhibition of viral adhesion to cells B) Elimination of exotoxin production C) Antagonism of somatic cell binding sites D) Interference with viral replication processes 19. International travel has contributed to increased prevalence and incidence of nonindigenous diseases by increasing which of the following? A) Portals of entry B) Sources of infection C) Virulence D) Disease course 20. A public health nurse should recognize that sexually transmitted infections (STIs) are typically spread by which of the following mechanisms? A) Penetration B) Vertical transmission C) Direct contact D) Ingestion Answer Key 1. B 2. B 3. A 4. C 5. A 6. C 7. B 8. D 9. A 10. A 11. B 12. A 13. C 14. D 15. C 16. C 17. D 18. D 19. B 20. C Chapter 6 Genetic and Developmental Disorders 1. Genetic disorders that involve a single gene trait are characterized by: A) multifactorial gene mutations. B) chromosome rearrangements. C) Mendelian patterns of transmission. D) abnormal numbers of chromosomes. 2. In addition to having a 50% chance of inheriting an autosomal dominant disorder from an affected parent, such a disorder is characterized by: A) aneuploidy of genes in all cells. B) deficiencies in enzyme synthesis. C) affected X transmission to daughters. D) varied gene penetration and expression. 3. Autosomal recessive disorders are characterized by: A) age of onset later in life. B) abnormal protein structure. C) inborn errors of metabolism. D) one in two risk of a carrier child. 4. When a male child inherits an X-linked disorder from his heterozygous carrier mother, A) his sons will be carriers. B) his father has the disorder. C) some of his sisters will be carriers. D) his daughters will have the disorder. 5. Multifactorial inheritance disorders, such as cleft palate, are often caused by during fetal development. A) multiple gene mutations B) dominant gene expression C) X-linked crossover problem D) polyploidy of chromosomes 6. The newborn has the distinctive physical features of trisomy 21, Down syndrome, which includes: A) upward slanting of eyes. B) large, protruding ears. C) thin lips and small tongue. D) long fingers with extra creases. 7. Aneuploidy of the X chromosome can result in a monosomy or polysomy disorder. The manifestations of monosomy X, Turner syndrome, differ from polysomy X disorders in numerous ways that include: A) short-stature female individual.. B) mental retardation. C) enlarged breasts. D) early onset puberty. 8. A teratogenic environmental agent can cause birth defects when: A) inherited as a recessive trait. B) intense exposure occurs at birth. C) disjunction occurs during meiosis. D) retained during early pregnancy. 9. Fetal alcohol syndrome (FAS) is unlike other teratogens in that the harmful effects on the fetus: A) directly result in liver damage. B) extend throughout the pregnancy. C) is most noticeable in adulthood. D) cause death in early childhood. 10. Prenatal diagnosis methods include the use of ultrasonography for identifying abnormalities. A) cytogenic B) skeletal C) chromosomal D) a-fetoprotein 11. A woman who is a carrier for which of the following diseases possesses the greatest likelihood of passing the disease to her future children when heterozygous pairing exists? A) Phenylketonuria (PKU) B) Tay-Sachs disease C) Neurofibromatosis D) Cystic fibrosis 12. Which of the following statements is true of autosomal recessive disorders? A) Onset is typically late in childhood or early in adulthood. B) Symptomatology is less uniform than with autosomal dominant disorders. C) Mitochondrial DNA is normally the site of genetic alteration. D) Effects are typically the result of alterations in enzyme function. 13. The parents of a newborn infant are relieved that their baby was born healthy, with the exception of a cleft lip that will be surgically corrected in 10 or 12 weeks. Which of the nurses following statements to the parents best conveys the probable cause of the infants cleft lip? A) Though you are both healthy, you likely both carry the gene for a cleft lip. B) Provided one of you had the gene for a cleft lip, your baby likely faced a 50/50 chance of having one. C) Your childs cleft lip likely results from the interplay between environment and genes. D) A cleft lip can sometimes result from taking prescription drugs, even when theyre taken as ordered. 14. Which of the following practitioners is most likely to be of assistance in the early care of an infant with a cleft lip? A) Lactation consultant B) Respiratory therapist C) Occupational therapist D) Social worker 15. A 41-year-old woman has made the recent decision to start a family, and is eager to undergo testing to mitigate the possibility of having a child with Down syndrome. Which of the following tests is most likely to provide the data the woman seeks? A) Genetic testing of the woman B) Genetic testing of the woman and the father C) Prenatal blood tests D) Ultrasonography 16. Genetic testing has revealed that a male infant has been born with an extra X chromosome. What are the most likely implications of this finding? A) The child is unlikely to survive infancy B) The child is likely to have no manifestations of this chromosomal abnormality C) The child will have significant neurological and cognitive defects D) The child will be unable to reproduce 17. Which of the following variables determine the extent of teratogenic drug effects? Select all that apply. A) Maternal health history B) Molecular weight of the drug C) Stage of pregnancy when the drug was taken D) Duration of drug exposure E) Fetal blood type 18. A woman who has just learned that she is pregnant for the first time has sought advice from her healthcare provider about the safe use of alcohol during pregnancy. What advice should the clinician provide to the woman? A) Its likely best to eliminate alcohol from your diet while youre pregnant. B) Moderation in alcohol use is critical while you are pregnant. C) You should limit yourself to a maximum of one drink daily while youre pregnant. D) You should drink no alcohol until you are in your second trimester. 19. Which of the following health problems may be identified by a TORCH screening test? A) Rubella and herpes B) Tenovaginitis and human papillomavirus C) Rhinovirus and Ormond disease D) Chlamydia and rickets 20. Ultrasonography is most likely to detect which of the following fetal abnormalities? A) Neural tube defects B) Skeletal abnormalities C) Chromosomal defects D) Single-gene disorders Answer Key 1. C 2. D 3. C 4. C 5. A 6. A 7. A 8. D 9. B 10. B 11. C 12. D 13. C 14. A 15. C 16. B 17. B, C, D 18. A 19. A 20. B Chapter 7 Altered Cellular Proliferation and Differentiation 1. Epithelialization, the first component of the proliferative phase of wound healing, is delayed in open wounds until after has formed. A) granulation tissue B) fibrinous meshwork C) capillary circulation D) collagenous layers 2. A mutation has occurred during mitosis of an individuals bone marrow cell. This event may be the result of the failure of which of the following? A) Progenitor cells B) Fibroblasts C) Stem cells D) Cyclins 3. A patient has experienced a myocardial infarction with accompanying necrosis of cardiac muscle, a permanent tissue. What are the ramifications of the fact that cardiac muscle is a permanent tissue? A) The cardiac muscle cells will remain perpetually in the G1 stage of mitosis. B) Regeneration of the patients cardiac muscle will be exceptionally slow. C) The necrotic cells will be replaced with muscle cells that have limited metabolism. D) The cells will not proliferate and will be replaced with scar tissue. 4. A couple have chosen to pay for the harvesting and storage of umbilical cord blood after the delivery of their child to secure a future source of embryonic stem cells. What is the most likely rationale for the couples decision? A) The stem cells may be able to produce a wide range of body cells. B) The embryonic stem cells allow stable and permanent tissues to enter mitosis. C) The stem cells can change the proliferative capacity of other cells. D) The embryonic stem cells remove cyclin-dependent kinase inhibitors from the body. 5. The basement membrane surrounding a patients foot wound remains intact, a fact that bodes well for the wound-healing process. Which of the following components constitute this form of the extracellular matrix? Select all that apply. A) Prostaglandins B) Fibrous structural proteins C) Lymphocytes D) Water-hydrated gels E) Glycoproteins 6. A nursing student is cleaning and changing the dressing on a patients sacral ulcer. The student has vigorously cleansed the wound bed to remove all traces of the beefy, red tissue that existed in the wound bed. The student has most likely removed: A) Necrotic tissue B) Granulation tissue C) Stem cells D) The extracellular matrix 7. A 12-year-old boys severe wound that he received from a dog bite has begun to heal and currently shows no signs of infection. Which of the following processes occurred first during this process of repair by connective tissue deposition? A) Reorganization of fibrous tissue B) Angiogenesis C) Emigration of fibroblasts to the wound site D) Deposition of the extracellular matrix 8. Which of the following wounds is most likely to heal by secondary intention? A) A finger laceration that a cook received while cutting up onions B) A boys road rash that he got by falling off his bicycle C) A needlestick injury that a nurse received when injecting a patients medication D) The incision from a teenagers open appendectomy 9. A patient underwent an open cholecystectomy 4 days ago and her incision is now in the proliferative phase of healing. What is the dominant cellular process that characterizes this phase of the patients healing? A) Hemostasis and vasoconstriction B) Keloid formation C) Collagen secretion by fibroblasts D) Phagocytosis by neutrophils 10. Which of the following surgical patients is most likely to experience enhanced wound healing as a result of his or her diet? A) A patient who eats a high-calorie diet and large amounts of red meat B) A patient who is a vegetarian and who eats organic foods whenever possible C) A patient who practices carefully calorie control and who avoids animal fats D) A patient who is receiving total parenteral nutrition due to recurrent nausea 11. Which of the following patients is most likely to experience impaired wound healing? A) A patient with a diagnosis of type 1 diabetes and a history of poor blood sugar control B) A child whose severe cleft lip and palate have required a series of surgeries over several months C) A patient who takes nebulized bronchodilators several times daily to treat chronic obstructive pulmonary disease D) A patient with persistent hypertension who takes a b-adrenergic blocker and a potassium-wasting diuretic daily Answer Key 1. A 2. D 3. D 4. A 5. B, D, E 6. B 7. B 8. B 9. C 10. A 11. A Chapter 8 Altered Fluid, Electrolyte, and Acid-Base Balance 1. An injured patient develops interstitial edema as a result of decreased: A) vascular volume. B) hydrostatic pressure. C) capillary permeability. D) colloidal osmotic pressure. 2. The most reliable method for measuring body water or fluid volume increase is by assessing: A) tissue turgor. B) intake and output. C) body weight change. D) serum sodium levels. 3. The syndrome of inappropriate ADH is characterized by: A) increased osmolality. B) excessive water thirst. C) copious dilute urination. D) dilutional hyponatremia. 4. In isotonic fluid volume deficit, changes in total body water are accompanied by: A) intravascular hypotonicity. B) increased intravascular water. C) increases in intracellular sodium. D) proportionate losses of sodium. 5. Hyponatremia can be caused by and manifested by . A) hypovolemia; dehydration B) third spacing; hypertonicity C) water retention; hypotonicity D) aldosterone excess; low ADH 6. One of the major causes of hyperkalemia is , which alters potassium elimination. A) renal dysfunction B) aldosterone excess C) metabolic alkalosis D) plasma albumin deficit 7. Hypoparathyroidism causes hypocalcemia by: A) increasing serum magnesium. B) increasing phosphate excretion. C) blocking bone release of calcium. D) blocking action of intestinal vitamin D. 8. Magnesium is important for the overall function of the body because of its direct role in: A) cell membrane permeability. B) somatic cell growth control. C) sodium and tonicity regulation. D) DNA replication and transcription. 9. A patient has acidosis that is suspected to be respiratory in etiology. Which of the following is the major cause of acute primary respiratory acidosis? A) Decreased CO2 retention B) Increased metabolic acids C) Renal bicarbonate retention D) Impaired alveolar ventilation 10. As other mechanisms prepare to respond to a pH imbalance, immediate buffering is a result of increased: A) intracellular albumin. B) hydrogen/potassium binding. C) sodium/phosphate anion absorption. D) bicarbonate/carbonic acid regulation. 11. A patient with a diagnosis of liver cirrhosis secondary to alcohol use has a distended abdomen as a result of fluid accumulation in his peritoneal cavity (ascites). Which of the following pathophysiologic processes contributes to this third spacing? A) Abnormal increase in transcellular fluid volume B) Increased capillary colloidal osmotic pressure C) Polydipsia D) Impaired hormonal control of fluid volume 12. A patient has been receiving intravenous normal saline at a rate of 125 mL per hour since her surgery 2 days earlier. As a result of her consequent increase in vascular volume, she has become edematous. Which of the following phenomena accounts for this patients edema? A) Obstruction of lymph flow B) Increased capillary permeability C) Decreased capillary colloidal osmotic pressure D) Increased capillary filtration pressure 13. A patient with a diagnosis of schizophrenia has been admitted to the emergency department after ingesting more than 2 gallons of water. Which of the following pathophysiologic processes may result from the sudden water gain? A) Hypernatremia B) Water movement from the extracellular to intracellular compartment C) Syndrome of inappropriate secretion of ADH (SIADH) D) Isotonic fluid excess in the extracellular fluid compartment