NURSING NR TESTBANKS|NR 283

Chapter 09: Musculoskeletal Disorders 1. Which of the following cells produce new bone? a. Osteocytes b. Osteoblasts c. Osteoclasts d. Stem cells from the bone marrow ANS: B REF: 159 2. What is the chemical transmitter released at the neuromuscular junction? a. Norepinephrine b. GABA c. Serotonin d. Acetylcholine ANS: D REF: 161 3. What are the two types of bone tissue? a. Vascular and nonvascular b. Spongy and calcified c. Compact and cancellous d. Dense and pliable ANS: C REF: 159 4. Which of the following would identify an open or compound fracture? a. The skin and soft tissue are exposed at the fracture site. b. A bone is crushed into many small pieces. c. The bone appears bent with a partial fracture line. d. One end of a bone is forced into an adjacent bone. ANS: A REF: 164 5. Which of the following describes a Colles’ fracture? a. The distal radius is broken. b. The distal fibula is broken. c. A vertebra appears crushed. d. A spontaneous fracture occurs in weakened bone. ANS: A REF: 165 6. During the fracture healing process, the hematoma: a. is broken down and absorbed immediately. b. provides the base for bone cells to produce new bone. c. is the structure into which granulation tissue grows. d. produces fibroblasts to lay down new cartilage. ANS: C REF: 166 7. When a fracture is healing, the procallus or fibrocartilaginous callus: a. can bear weight. b. serves as a splint across the fracture site. c. is the tissue that lays down new cartilage. d. is made up of new bone. ANS: B REF: 166 8. The inflammation surrounding a fracture site during the first few days may complicate healing by causing: a. excessive bone movement. b. severe ischemia and tissue necrosis. c. malunion or nonunion. d. fat emboli to form. ANS: B REF: 166-167 9. What is a sign of a dislocation? a. Crepitus b. Pain and tenderness c. Increased range of motion at a joint d. Deformity at a joint ANS: D REF: 168 10. All of the following predispose to osteoporosis EXCEPT: a. weight-bearing activity. b. a sedentary lifestyle. c. long-term intake of glucocorticoids. d. calcium deficit. ANS: A REF: 169 11. Which of the following statements does NOT apply to osteoporosis? a. Bone resorption is greater than bone formation. b. It causes compression fractures of the vertebrae. c. Osteoporosis is always a primary disorder. d. It often leads to kyphosis and loss of height. ANS: C REF: 169 12. Which of the following best describes the typical bone pain caused by osteogenic sarcoma? a. Intermittent, increasing with activity b. Sharp, increased with joint movement c. Mild, aching when weight-bearing d. Steady, severe, and persisting with rest ANS: D REF: 171 13. How is Duchenne’s muscular dystrophy inherited? a. Autosomal recessive gene b. X-linked recessive gene c. Autosomal dominant gene d. Codominant gene ANS: B REF: 172 14. Which of the following is true about Duchenne’s muscular dystrophy? a. There is difficulty climbing stairs or standing up at 2 to 3 years of age. b. It involves only the legs and pelvis. c. Skeletal muscle atrophy can be seen in the legs of a toddler. d. It cannot be detected in any carriers. ANS: A REF: 172 15. The most common type of joint, which are freely movable, are called: a. Synarthroses b. Amphiarthroses c. Anarthroses d. Diarthroses ANS: D REF: 163 16. Which of the following is characteristic of osteoarthritis? a. Inflammation and fibrosis develop at the joints. b. Degeneration of articulating cartilage occurs in the large joints. c. It progresses bilaterally through the small joints. d. There are no changes in the bone at the affected joints. ANS: B REF: 173-174 17. What is a typical characteristic of the pain caused by osteoarthritis? a. Decreases over time b. Quite severe in the early stages c. Aggravated by general muscle aching d. Increased with weight-bearing and activity ANS: D REF: 174 18. What limits joint movement in osteoarthritis? a. The osteophytes and irregular cartilage surface b. The wider joint space c. Decreased amount of synovial fluid in the cavity d. Fibrosis involving the joint capsule and ligaments ANS: A REF: 174 19. Joints affected by osteoarthritis can sometimes affect healthy joints by: a. causing enzymes to be released that travel to other joints. b. bacteria traveling from the affected join to a healthy one through the bloodstream. c. inflammation and edema affecting the entire limb. d. the affected individual’s exerting stress on the normal joint to protect the damaged one. ANS: D REF: 174 20. What is the typical joint involvement with rheumatoid arthritis? a. Random single joints, progressing to involve other joints b. Bilateral small joints, symmetrical progression to other joints c. Abused or damaged joints first, then joints damaged by compensatory movement d. Progressive degeneration in selected joints ANS: B REF: 177 21. What is the basic pathology of rheumatoid arthritis? a. Degenerative disorder involving the small joints b. Chronic inflammatory disorder affecting all joints c. Systemic inflammatory disorder due to an autoimmune reaction d. Inflammatory disorder causing damage to many organs ANS: C REF: 175-177 22. How is the articular cartilage damaged in rheumatoid arthritis? a. Enzymatic destruction by the pannus b. Inflamed synovial membrane covers the cartilage c. Fibrous tissue connects the ends of the bones d. Blood supply to the cartilage is lost ANS: A REF: 175 23. How does the joint appear during an exacerbation of rheumatoid arthritis? a. Relatively normal b. Enlarged, firm, crepitus with movement c. Deformed, pale, and nodular d. Red, warm, swollen, and tender to touch ANS: D REF: 177 24. Ankylosis and deformity develop in rheumatoid arthritis because: a. skeletal muscle hypertrophies. b. fibrosis occurs in the joint. c. replacement cartilage changes alignment. d. ligaments and tendons shorten. ANS: A REF: 176 25. Systemic effects of rheumatoid arthritis are manifested as: a. nodules in various tissues, severe fatigue, and anorexia. b. headache, leukopenia, and high fever. c. swelling and dysfunction in many organs. d. progressive damage to a joint. ANS: A REF: 176 26. What is a common effect of long-term use of glucocorticoids to treat rheumatoid arthritis? a. Leukocytosis b. Osteoporosis c. Severe anemia d. Orthostatic hypotension ANS: B REF: 177 27. Juvenile rheumatoid arthritis (JRA) differs from the adult form in that: a. only small joints are affected. b. rheumatoid factor is not present in JRA, but systemic effects are more severe. c. onset is more insidious in JRA. d. deformity and loss of function occur in most children with JRA. ANS: B REF: 177 28. Which of the following distinguishes septic arthritis? a. Multiple joints that are swollen, red, and painful at one time b. Presence of mild fever, fatigue, and leukocytosis c. Purulent synovial fluid present in a single, swollen joint d. Presence of many antibodies in the blood ANS: C REF: 178 29. Which of the following may precipitate an attack of gout? a. A sudden increase in serum uric acid levels b. Severe hypercalcemia c. Mild trauma to the toes d. Development of a tophus ANS: A REF: 178 30. Where does inflammation usually begin in an individual with ankylosing spondylitis? a. Costovertebral joints with progression down the spine b. Cervical and thoracic vertebrae, causing kyphosis c. Sacroiliac joints with progression up the spine d. Peripheral joints and then proceeds to the vertebrae ANS: C REF: 178 31. What is a common outcome of fibrosis, calcification, and fusion of the spine in ankylosing spondylitis? a. Damage to the spinal nerves and loss of function b. Frequent fractures of long bones c. Impaired heart function d. Rigidity, postural changes, and osteoporosis ANS: D REF: 178-179 32. Which statement applies to menisci? a. They are found in the hip joints. b. They are secretory membranes in joints. c. They prevent excessive movement of joints. d. They are found in the shoulder joint. ANS: C REF: 163 33. Which factors delay healing of bone fractures? 1. Lack of movement of the bone 2. Prolonged inflammation and ischemia 3. Presence of osteomyelitis 4. Close approximation of bone ends a. 1, 2 b. 1, 3 c. 2, 3 d. 3, 4 ANS: C REF: 166-167 34. What is the likely immediate result of fat emboli from a broken femur? a. Additional ischemia in the broken bone b. Nonunion or malunion of the fracture c. Pulmonary inflammation and obstruction d. Abscess and infection at a distant site ANS: C REF: 167 35. A sprain is a tear in a: a. ligament. b. tendon. c. skeletal muscle. d. meniscus. ANS: A REF: 168 36. Therapeutic measures for osteoporosis include: a. non–weight-bearing exercises. b. dietary supplements of calcium and vitamin D. c. transplants of osteoblasts. d. avoidance of all hormones. ANS: B REF: 170 37. What is the distinguishing feature of primary fibromyalgia syndrome? a. Joint pain and stiffness throughout the body b. Degeneration and atrophy of skeletal muscles in back and lower limbs c. Localized areas of constant pain d. Specific trigger points for pain and tenderness ANS: D REF: 173 38. Ewing’s sarcoma metastasizes at an early stage to the: a. brain. b. liver. c. lungs. d. other bones. ANS: C REF: 171 39. Immovable joints are called: a. amphiarthroses. b. synarthroses. c. diarthroses. d. synovial joints. ANS: B REF: 163 40. Rickets results from: a. excessive bone resorption by osteoclasts. b. a deficit of vitamin D and phosphates. c. replacement of bone by fibrous tissue. d. hyperparathyroidism. ANS: B REF: 170 41. Paget’s disease often leads to which of the following? a. A reduction in bone fractures b. Decreased intracranial pressure c. Cardiovascular disease d. Disintegration of joint cartilage ANS: C REF: 170 42. Bones classified as “irregular” would include: a. skull bones. b. the mandible. c. wrist bones. d. the femur. ANS: B REF: 159 43. A dislocation is: a. the tearing of a tendon in the joint. b. the separation of bones in the joint with a loss of contact. c. the twisting of a joint, causing excessive inflammation of the surrounding tissue. d. the overstressing of ligaments, causing loss of elasticity. ANS: B REF: 167 44. A diagnostic test that measures the electrical charge of muscle contraction and can help differentiate muscle disorders from neurological disease is a/an: a. electromyogram. b. arthroscopy. c. radiograph. d. electroencephalograph. ANS: A REF: 164 45. The type of compound fracture in which there are multiple fracture lines and bone fragments is referred to as a/an: a. compression fracture. b. greenstick fracture. c. simple fracture. d. comminuted fracture. ANS: D REF: 164 46. Fluid-filled sacs composed of synovial membrane located between structures such as tendons and ligaments and act as additional cushions are called: a. articular capsules. b. bursae. c. synovial sacs. d. hyaline chambers. ANS: B REF: 179 Chapter 16 Endocrine-System Disorders 1. What kind of control mechanism is indicated when increased blood glucose levels stimulate increased secretion of insulin? a. Control by releasing hormones b. Control by tropic hormones c. Negative feedback control d. Hypothalamus/hypophysis coordination ANS: C REF: 403-404 2. What is the most common cause of endocrine disorders? a. Malignant neoplasm b. Infection c. Congenital defect d. Benign tumor ANS: D REF: 406 3. Choose the statement that applies to type 1 diabetes mellitus. a. Onset often occurs during childhood. b. Relative insufficiency of insulin or insulin resistance develops. c. It can be treated by diet, weight control and exercise, or oral hypoglycemics. d. Complications rarely occur. ANS: A REF: 406 4. Why does polyuria develop with diabetes mellitus? a. Increased thirst and hypoglycemia b. Ketoacidosis c. Osmotic pressure due to glucose d. Diabetic nephropathy ANS: C REF: 407 5. What is the cause of diabetic ketoacidosis? a. Excess insulin in the body b. Loss of glucose in the urine c. Failure of the kidney to excrete sufficient acids d. Increased catabolism of fats and proteins ANS: D REF: 408 6. What is a precipitating factor for diabetic ketoacidosis? a. Skipping a meal b. Anorexia c. Serious infection d. Insulin overdose ANS: C REF: 410 7. Which of the following may cause insulin shock to develop? a. Strenuous exercise b. Missing an insulin dose c. Eating excessively large meals d. Sedentary lifestyle ANS: A REF: 409 8. Which of the following indicates hypoglycemia in a diabetic? a. Deep, rapid respirations b. Flushed dry skin and mucosa c. Thirst and oliguria d. Staggering gait, disorientation, and confusion ANS: D REF: 409 9. Which of the following are signs of diabetic ketoacidosis in an unconscious person? a. Pale moist skin b. Thirst and poor skin turgor c. Deep rapid respirations and fruity breath odor d. Tremors and strong rapid pulse ANS: C REF: 410 10. Immediate treatment for insulin shock may include: a. administration of bicarbonates. b. consumption of fruit juice or candy. c. induced vomiting. d. consumption of large amounts of water. ANS: B REF: 409 11. What causes loss of consciousness in a person with diabetic ketoacidosis? a. Toxic effects of excessive insulin b. Excessive glucose in the blood c. Metabolic acidosis d. Lack of glucose in brain cells ANS: C REF: 411 12. Which of the following does NOT usually develop as a complication of diabetes? a. Osteoporosis b. Nephropathy c. Impotence d. Peripheral neuropathy ANS: A REF: 412-413 13. How do many oral hypoglycemic drugs act? a. To replace insulin in patients with insulin-dependent diabetes mellitus (IDDM) b. To transport glucose into body cells c. To prevent gluconeogenesis d. To stimulate the pancreas to produce more insulin ANS: D REF: 409 14. Diabetes may cause visual impairment through damage to the lens; this is referred to as: a. cataracts. b. macular degeneration. c. myopia. d. strabismus. ANS: A REF: 415 15. Which of the following applies to diabetic macro-angiography? 1. It affects the small arteries and arterioles. 2. It is related to elevated serum lipids. 3. It leads to increased risk of myocardial infarction and peripheral vascular disease. 4. It frequently causes damage to the kidneys. a. 1, 3 b. 1, 4 c. 2, 3 d. 2, 4 ANS: C REF: 412 16. Why is amputation frequently a necessity in diabetics? a. Necrosis and gangrene in the feet and legs b. Lack of glucose to the cells in the feet and legs c. Severe dehydration in the tissues d. Elevated blood glucose increasing blood viscosity ANS: A REF: 412 17. A type of diabetes that may develop during pregnancy and disappear after delivery is called: a. temporary maternal diabetes. b. fetal diabetes. c. acute developmental diabetes. d. gestational diabetes. ANS: D REF: 407 18. Which one of the following develops hypoglycemia more frequently? a. Type 1 diabetic patients b. Type 2 diabetic patients c. Patients with a poor stress response d. Patients with a regular exercise and meal plan ANS: A REF: 406 19. Which of the following hormonal imbalances causes Addison’s disease? a. Increased glucocorticoids b. Decreased glucocorticoids c. Deficit of antidiuretic hormone (ADH) d. Deficit of T3 and T4 ANS: B REF: 423 20. Which of the following hormonal imbalances causes myxedema? a. Increased glucocorticoids b. Decreased glucocorticoids c. Deficit of ADH d. Deficit of T3 and T4 ANS: D REF: 422 21. Which of the following hormonal imbalances causes diabetes insipidus? a. Increased insulin b. Decreased glucocorticoids c. Deficit of ADH d. Deficit of T3 and T4 ANS: C REF: 407 22. What is caused by hyperparathyroidism? a. Hypocalcemia b. Tetany c. Bone demineralization d. Deficit of vitamin D ANS: C REF: 416 23. What is caused by hypocalcemia due to hypoparathyroidism? 1. Skeletal muscle twitching or spasm 2. Weak cardiac contraction 3. Increased secretion of parathyroid hormone (PTH) 4. Decreased serum phosphate level a. 1, 2 b. 1, 3 c. 2, 3 d. 3, 4 ANS: A REF: 415 24. Which of the following applies to acromegaly? a. It occurs in infants and children. b. It causes excessive longitudinal bone growth. c. It results from excessive secretion of growth hormone (GH). d. It does not change soft tissue growth. ANS: C REF: 416 25. Which of the following may cause goiter? 1. Hyperthyroidism 2. Hypothyroidism 3. Lack of iodine in the diet 4. Pheochromocytoma a. 1, 4 b. 2, 3 c. 1, 2, 3 d. 1, 2, 3, 4 ANS: C REF: 419 26. Which signs are typical of Graves’ disease? a. Facial puffiness, bradycardia, and lethargy b. Exophthalmos and tachycardia c. delayed physical and intellectual development d. Goiter and decreased basal metabolic rate (BMR) ANS: B REF: 420 27. Characteristics of Cushing’s syndrome include all of the following EXCEPT: a. Heavy body and round face b. Atrophied skeletal muscle in the limbs c. Staring eyes with infrequent blinking d. Atrophy of the lymph nodes ANS: C REF: 422-423 28. Which of the following is an effect of long-term glucocorticoid therapy? a. Decreased secretion from the adrenal cortex gland b. An increased inflammatory response to irritants c. Hypotension and poor circulation d. Increased number of hypersensitivity reactions ANS: A REF: 422 29. Which of the following is an effect of Addison’s disease? a. Elevated blood glucose levels b. High blood pressure c. Low serum potassium levels d. Poor stress response ANS: D REF: 423 30. What is the most common cause of type 1 diabetes mellitus? a. Increased glucose production in the liver b. Destruction of pancreatic cells by an autoimmune reaction c. Increased resistance of body cells to insulin action d. Chronic obesity ANS: B REF: 406 31. Why does glucosuria occur in diabetics? a. Excess ketoacids displace glucose into the filtrate. b. Excess water in the filtrate draws more glucose into the urine. c. The amount of glucose in the filtrate exceeds the renal tubule transport limit. d. Sufficient insulin is not available for glucose reabsorption. ANS: C REF: 407 32. Which of the following are common early signs of a pituitary adenoma? 1. Persistent headaches 2. Hemianopia 3. Hypertension 4. Papilledema a. 1, 4 b. 2, 3 c. 1, 2 d. 1, 3, 4 ANS: C REF: 422 33. Which of the following does NOT apply to inappropriate ADH syndrome? a. The cause is excess ADH secretion. b. Severe hyponatremia results. c. Excessive sodium is retained. d. Fluid retention increases. ANS: C REF: 418 34. What is/are the effect(s) of thyrotoxic crisis? a. Hyperthermia and heart failure b. Hypotension and hypoglycemia c. Toxic goiter and hypometabolism d. Decreased stress response ANS: A REF: 420 35. Which of the following conditions may precipitate or exacerbate hyperglycemia? a. Hypothyroidism b. Cushing’s disease c. Addison’s disease d. Growth hormone deficit ANS: B REF: 423 36. Which of the following conditions may cause immunosuppression? a. Graves’ disease b. Acromegaly c. Cushing’s disease d. Diabetes insipidus ANS: C REF: 423 37. Hyperosmolar hyperglycemic nonketotic coma (HHNC) more frequently develops in patients with: a. type 1 diabetes. b. type 2 diabetes. c. Grave’s disease. d. hyperparathyroidism. ANS: B REF: 411 38. Which of the following is recommended for immediate treatment of hypoglycemic shock? 1. If conscious, immediately give sweet fruit juice, honey, candy, or sugar. 2. If unconscious, give nothing by mouth (require intravenous glucose 50%). 3. Treat immediately with insulin. 4. Give large quantity of clear fluids for shock. a. 1, 2 b. 1, 3 c. 2, 3 d. 1, 3, 4 ANS: A REF: 410 39. All these tissues use glucose without the aid of insulin EXCEPT: a. liver. b. digestive system. c. exercising skeletal muscle. d. brain. ANS: A REF: 406 40. Differences between type 1 and type 2 diabetes include which of the following? a. Type 1 diabetes weight gain is common, and type 2 weight loss often occurs. b. Type 1 diabetes leads to fewer complications than does type 2 diabetes. c. Type 1 diabetes may be controlled by adjusting dietary intake and exercise, but type 2 diabetes requires insulin replacement. d. Type 1 diabetes occurs more frequently in children and adolescents, and type 2 diabetes occurs more often in adults. ANS: D REF: 406-407 41. Complications of diabetes mellitus include: a. peripheral neuropathy. b. frequent infections. c. cataracts. d. A, B, and C. ANS: D REF: 412-413 42. Which of the following often causes hyperparathyroidism? a. A malignant tumor in the parathyroid glands b. End-stage renal failure c. Osteoporosis d. Radiation involving the thyroid gland and neck area ANS: D REF: 416 43. Dwarfism is caused by: a. excessive levels of somatotropin (GH). b. a deficit of somatotropin (GH). c. excessive levels of insulin. d. excessive levels of parathyroid hormone. ANS: B REF: 416 44. Which of the following results from a deficit of antidiuretic hormone (ADH)? a. Inappropriate ADH syndrome b. Gigantism c. Diabetes insipidus d. Myxedema ANS: C REF: 418 45. Goiters occur more frequently in persons living in the: a. Great Lakes or mountainous regions. b. southwest United States. c. temperate regions. d. areas bordering the oceans. ANS: A REF: 419 46. Which of the following is caused by Graves’ disease? a. Hypermetabolism b. Decreased size of thyroid gland c. Bradycardia and hypothermia d. Decreased blood levels of T3, T4, and TSH ANS: A REF: 420 47. Goiters may be caused by: a. hypothyroid conditions only. b. either hypothyroid or hyperthyroid conditions. c. hyperthyroid conditions only. d. fungal infections such as candidiasis. ANS: B REF: 419 48. Severe impairment of all aspects of growth and development, including difficulty feeding, mental retardation, and stunted skeletal growth, are associated with: a. myxedema. b. Cushing’s syndrome. c. diabetes insipidus. d. cretinism. e. Graves’ disease. ANS: D REF: 422 49. A benign tumor of the adrenal medulla that secretes epinephrine and norepinephrine is called: a. pheochromocytoma. b. Cushing’s syndrome. c. Graves’ disease. d. Addison’s disease. ANS: A REF: 422 50. The anterior pituitary gland secretes all of the following hormones EXCEPT: a. prolactin (PRL). b. glucagon. c. adrenocorticotropic hormone (ACTH). d. growth hormone (GH). ANS: B REF: 403 51. Which of the following applies to oxytocin? 1. It stimulates contraction of the uterus after delivery. 2. It stimulates ejection of breast milk during lactation. 3. It stimulates mammary gland production of milk. 4. It is released from the adenohypophysis. a. 1, 2 b. 1, 4 c. 1, 3, 4 d. 1, 2, 3, 4 ANS: A REF: 404 52. Which of the following is a major function of the hormone norepinephrine? a. Inhibition of an excessive stress response b. Visceral and cutaneous vasoconstriction c. Increased force of heart contraction d. Vasodilation in skeletal muscle ANS: B REF: 404 53. Early signs of hyperglycemia include polyphagia, which means: a. thirst. b. increased urine output. c. hunger. d. glucose in the urine. ANS: C REF: 411 54. Which of the following hormones is involved in both the stress response and the anti-inflammatory response? a. Aldosterone b. Norepinephrine c. Thyroxine d. Cortisol ANS: D REF: 404 55. Polydipsia occurs with diabetes mellitus when: a. lack of insulin causes hunger. b. ketone levels rise in the blood. c. polyuria causes dehydration. d. glucosuria causes ketoacidosis. ANS: C REF: 407 56. Metabolic syndrome is marked by: a. abnormal lipid and glucose metabolism. b. periodic hypotension. c. deficit of glucagon. d. early onset of type 1 diabetes mellitus. ANS: A REF: 407 57. Compensation mechanisms occurring in the early stage of diabetic ketoacidosis include: a. Kussmaul’s respirations. b. polydipsia. c. ketonuria. d. seizures. ANS: A REF: 410 58. Which of the following may occur with a pituitary adenoma? a. Low blood pressure and bradycardia b. Headache and seizures c. Vomiting and diarrhea d. Loss of vision in one eye ANS: B REF: 416 59. Which of the following may cause hypertension? a. Hypoparathyroidism b. Hypoglycemia c. Pheochromocytoma d. Addison’s disease ANS: C REF: 422 60. Catabolic effects of Cushing’s syndrome include: a. osteoporosis. b. hypertension. c. increased erythrocyte production. d. moon face and buffalo hump. ANS: A REF: 423 61. Blood glucose levels are increased by: 1. glucocorticoids. 2. glucagon. 3. epinephrine. 4. norepinephrine. 5. parathyroid hormone (PTH) a. 1, 2 b. 1, 2, 3 c. 2, 4, 5 d. 1, 3, 4, 5 ANS: B REF: 403 62. Which of the following are likely present in a patient immobilized for a long period of time? a. Hypocalcemia and low serum parathyroid hormone (PTH) levels b. Hypocalcemia and high serum PTH levels c. Hypercalcemia and low serum PTH levels d. Hypercalcemia and high serum PTH levels ANS: C REF: 416 63. Which of the following may cause high serum levels of parathyroid hormone? a. Hypoparathyroidism b. Chronic renal failure c. Hypercalcemia d. Adenoma in the thyroid gland ANS: B REF: 416 64. Diabetic retinopathy results from: a. degeneration of large blood vessels supplying the eye. b. abnormal metabolism in the lens of the eye. c. neuropathy affecting the optic nerve. d. obstruction or rupture of retinal blood vessels. ANS: D REF: 412 65. Why does hypocalcemia cause tetany? a. Skeletal muscle contractions are weaker. b. Nerves to skeletal muscle are more excitable. c. Calcium is not stored in skeletal muscle cells. d. Serum phosphate levels are low. ANS: B REF: 415 Chapter 17 Digestive- System Disorders 1. Which of the following cells in the gastric mucosa produce intrinsic factor and hydrochloric acid? a. Parietal cells b. Chief cells c. Mucous cells d. Gastrin cells ANS: A REF: 433 2. Which of the following is the primary site for absorption of nutrients? a. Stomach b. Duodenum c. Ileum d. Ascending colon ANS: C REF: 434 3. When highly acidic chyme enters the duodenum, which hormone stimulates the release of pancreatic secretions that contains very high bicarbonate ion content? a. Gastrin b. Secretin c. Cholecystokinin d. Histamine ANS: B REF: 435-436 4. Which of the following breaks protein down into peptides? a. Amylase b. Peptidase c. Lactase d. Trypsin ANS: D REF: 432 5. In which structure is oxygenated blood (arterial) mixed with unoxygenated blood (venous) so as to support the functions of the structure? a. Pancreas b. Liver c. Small intestine d. Spleen ANS: B REF: 433 6. Which of the following stimulates increased peristalsis and secretions in the digestive tract? a. Sympathetic nervous system b. Vagus nerve c. Increased saliva d. Absence of food in the system ANS: B REF: 435 7. Which of the following is contained in pancreatic exocrine secretions? a. Bicarbonate ion b. Hydrochloric acid c. Activated digestive enzymes d. Insulin ANS: A REF: 435 8. The presence of food in the intestine stimulates intestinal activity but inhibits gastric activity through the: a. defecation reflex. b. enterogastric reflex. c. vomiting reflex. d. autodigestive reflex. ANS: B REF: 435 9. Which of the following processes is likely to occur in the body immediately after a meal? a. Lipolysis b. Ketogenesis c. Gluconeogenesis d. Glycogenesis ANS: D REF: 433 10. What does the term gluconeogenesis refer to? a. Breakdown of glycogen to produce glucose b. Conversion of excess glucose into glycogen for storage c. Formation of glucose from protein and fat d. Breakdown of glucose into carbon dioxide and water ANS: C REF: 433 11. Normally, proteins or amino acids are required to produce all of the following EXCEPT: a. peptide hormones. b. clotting factors and antibodies. c. cellular energy. d. hemoglobin. ANS: C REF: 434 12. Which of the following statements applies to bile salts? a. They give feces the characteristic brown color. b. They are enzymes used to break down fats into free fatty acids. c. They emulsify lipids and lipid-soluble vitamins. d. They are excreted in the feces. ANS: C REF: 434 13. The visceral peritoneum: a. lines the abdominal wall. b. hangs from the stomach over the loops of small intestine. c. contains many pain receptors. d. forms the outer covering of the stomach. ANS: D REF: 430 14. The early stage of vomiting causes: a. metabolic alkalosis. b. metabolic acidosis. c. increased respirations. d. increased excretion of hydrogen ions. ANS: A REF: 440 15. Yellow or greenish stained vomitus usually indicates the presence of: a. bile. b. blood. c. protein. d. bacteria. ANS: A REF: 438 16. Small, hidden amounts of blood in stool are referred to as: a. melena. b. occult blood. c. frank blood. d. hematemesis. ANS: B REF: 439 17. Severe vomiting can lead to metabolic acidosis because of increased: a. ketones produced. b. CO2 retained in the lungs and kidneys. c. hypovolemia and lactic acid production. d. metabolic rate. ANS: C REF: 440 18. Which of the following applies to the act of swallowing? a. It requires coordination of cranial nerves V, IX, X, and XII. b. It is entirely voluntary. c. It is controlled by a center in the hypothalamus. d. It does not affect respiration. ANS: A REF: 432 19. What does the defecation reflex require? a. Stimulation by the sympathetic nervous system b. Contraction of the internal anal sphincter c. Coordination through the sacral spinal cord d. Voluntary relaxation of pelvic muscles ANS: C REF: 435 20. What is the definition of dysphagia? a. A herniation of the gastric mucosa through a segment of weakened muscle b. Recurrent reflux of chyme into the esophagus c. Absence of a connection of the esophagus to the stomach d. Difficulty in swallowing ANS: D REF: 448 21. What does congenital esophageal atresia cause? a. Direct passage of saliva and food from the mouth into the trachea b. Repeated reflux of gastric secretions into the esophagus c. No fluid or food entering the stomach d. Gastric distention and cramps ANS: C REF: 448-449 22. Which of the following applies to cleft palate? a. The mandibular processes do not fuse. b. The hard and soft palates do not fuse during the first trimester of pregnancy. c. Exposure to environmental factors in the last trimester causes the defect. d. Speech and eating are not affected. ANS: B REF: 444 23. Oral candidiasis is considered to: a. be a common bacterial infection in infants and young children. b. cause painful ulcerations in the mucosa and tongue. c. cause white patches in the mucosa that cannot be scraped off. d. be an opportunistic fungal infection of the mouth. ANS: D REF: 444 24. Why does herpes simplex infection tend to recur? a. Active infection is usually asymptomatic. b. The virus builds up a resistance. c. The virus persists in latent form in sensory nerve ganglia. d. The virus mutates; therefore, no effective immunity develops. ANS: C REF: 444 25. What does the term periodontitis refer to? a. Erosion of the enamel tooth surface b. Bacterial damage to the teeth and surrounding alveolar bone c. Inflammation and infection of the gingivae d. Formation of calcified plaque on the tooth ANS: B REF: 446 26. What is/are common location(s) for oral cancer? a. Floor of the mouth or tongue borders b. Mucosa lining the cheeks c. Hard and soft palate d. Gingivae near the teeth ANS: A REF: 448 27. What is a common cause of hiatal hernia? a. An abnormally long esophagus b. Increased intra-abdominal pressure c. Stenosis of the hiatus in the diaphragm d. A small fundus in the stomach ANS: B REF: 450-451 28. What is a common sign of acute gastritis? a. Colicky right upper quadrant pain b. Vomiting and anorexia c. Projectile vomiting after eating d. Diarrhea with abdominal distention ANS: B REF: 451 29. What does the pathophysiology of chronic gastritis include? a. Atrophy of the gastric mucosa with decreased secretions b. Hyperchlorhydria and chronic peptic ulcers c. Frequent vomiting and diarrhea d. Episodes of acute inflammation and edema of the mucosa ANS: A REF: 451 30. What is a common cause of gastroenteritis due to Salmonella? a. Unrefrigerated custards or salad dressings b. Poorly canned foods c. Raw or undercooked poultry or eggs d. Contaminated water ANS: C REF: 452 31. Which of the following individuals is likely to develop acute gastritis? a. A long-term, heavy cigarette smoker b. Patient with arthritis taking enteric-coated aspirin on a daily basis c. A person with an autoimmune reaction in the gastric mucosa d. An individual with an allergy to shellfish ANS: D REF: 451-452 32. What does congenital pyloric stenosis involve? a. Absence of peristalsis in the lower section of the stomach b. Failure of an opening to develop between the stomach and duodenum c. Hypertrophy of smooth muscle in the pylorus d. Thickening of the gastric wall due to chronic inflammation ANS: C REF: 457 33. A patient with acquired pyloric stenosis would likely: a. have an increase in appetite. b. have chronic diarrhea. c. develop severe colicky pains. d. vomit undigested food from previous meals. ANS: D REF: 457 34. Prolonged or severe stress predisposes to peptic ulcer disease because: a. of reduced blood flow to the gastric wall and mucous glands. b. of reduced bicarbonate content in bile and pancreatic secretions. c. stress increases the number of acid- and pepsinogen-secreting cells. d. increased epinephrine increases motility. ANS: A REF: 455 35. The pathophysiology of peptic ulcer disease may involve any of the following EXCEPT: a. decreased resistance of the mucosal barrier. b. increased stimulation of pepsin and acid secretions. c. infection by H. pylori. d. increased stimulation of mucus-producing glands. ANS: D REF: 453-455 36. Which of the following would a perforated gastric ulcer likely cause? a. Severe anemia b. Chemical peritonitis c. Severe gastric hemorrhage d. Pyloric obstruction ANS: B REF: 455 37. What is frequently the first manifestation of stress ulcers? a. Abdominal discomfort between meals and at night b. Nausea and diarrhea c. Hematemesis d. Sharp colicky pain with food intake ANS: C REF: 456 38. What would be the result of chronic bleeding from gastric carcinoma? a. Occult blood in the stool and anemia b. Hematemesis and shock c. Abdominal pain and distention d. Red blood on the surface of the stool ANS: A REF: 457 39. Following gastric resection, the onset of nausea, cramps, and dizziness immediately after meals indicates: a. a large volume of chyme has entered the intestines, causing distention. b. severe hypoglycemia has developed. c. the pylorus is restricting the flow of chyme. d. bile and pancreatic secretions are irritating the small intestine. ANS: A REF: 457-458 40. Bilirubin is a product of: a. hemolysis of red blood cells (RBCs) and breakdown of hemoglobin. b. production of excess chyme and bile. c. mixing of undigested food and gastric secretions. d. accumulation of white blood cells (WBCs) due to infection. ANS: A REF: 460 41. Why does mild hyperbilirubinemia occur in newborns? a. Blood incompatibility between mother and child b. Damage to many erythrocytes during the birth process c. Poor circulation and albumin transport for bilirubin d. Immature liver cannot process bilirubin quickly enough ANS: D REF: 460 42. Predisposing factors to cholelithiasis include excessive: a. bilirubin or cholesterol concentration in the bile. b. water content in the bile. c. bile salts in the bile. d. bicarbonate ions in the bile. ANS: A REF: 488 43. What is the major effect when a gallstone obstructs the cystic duct? a. Intrahepatic jaundice b. Acute pancreatitis c. Severe colicky pain in upper right quadrant d. Inflammation and infection in the gallbladder ANS: C REF: 488 44. Obstruction of the biliary tract by gallstones is referred to as: a. cholelithiasis. b. cholecystitis. c. cholangitis. d. choledocholithiasis. ANS: D REF: 458 45. Which of the following applies to hepatitis A infection? a. It is also called serum hepatitis. b. It is transmitted by the fecal-oral route. c. It contains a double strand of DNA. d. It frequently leads to chronic hepatitis. ANS: B REF: 462 46. What can be concluded if the hepatitis B antigen level remains high in the serum? a. Acute infection is present. b. Chronic infection has developed. c. Liver failure is in progress. d. The usual prolonged recovery from any viral infection is occurring. ANS: B REF: 462 47. What is the most common type of hepatitis transmitted by blood transfusion? a. HAV b. HBV c. HCV d. HEV ANS: C REF: 464 48. During the course of a hepatitis B infection, the onset of jaundice occurs in the: a. incubation period. b. preicteric stage. c. icteric stage. d. posticteric stage. ANS: C REF: 464 49. What is the likely effect of long-term exposure to a hepatotoxin? a. Full recovery to normal tissue after the toxic material has been removed b. Acute onset of vomiting, steatorrhea, and jaundice c. Continued mild inflammation of the liver without permanent damage d. Gradual irreversible damage to the liver and cirrhosis ANS: D REF: 465 50. What indicates the presence of third-stage alcohol hepatitis? a. Below normal blood levels of AST and ALT b. Upper left quadrant tenderness and dull pain c. A small, firm, nodular liver and portal hypertension d. Decreased production of blood clotting factors ANS: D REF: 466 51. A factor that may precipitate encephalopathy with cirrhosis is the elevated: a. serum urea. b. conjugated bilirubin. c. serum ammonia. d. serum pH. ANS: C REF: 466 52. In patients with cirrhosis, serum ammonia may increase when: a. ingesting excessive lipids. b. bleeding occurs in the digestive tract. c. an increase in unconjugated bilirubin occurs in the serum. d. less bile is produced. ANS: B REF: 466 53. What is the primary cause of esophageal varices? a. Increased hydrostatic pressure in the veins b. Alcohol irritating the mucosa c. Failure to inactivate estrogen d. Poor nutritional status ANS: A REF: 466-467 54. What is the primary cause of increased bleeding tendencies associated with cirrhosis? a. Anemia and leucopenia b. Jaundice and pruritus c. Recurrent infections d. Deficit of vitamin K and prothrombin ANS: D REF: 466 55. Which factors contribute to ascites in patients with cirrhosis? a. Increased aldosterone and deficit of albumin b. Severe anemia and increased serum bilirubin c. Hypokalemia and increased serum ammonia d. Hyperproteinemia and persistent hypotension ANS: A REF: 466 56. Which of the following is a major cause of primary hepatocellular cancer? a. Metastatic tumors b. Acute hepatitis c. Long-term exposure to certain chemicals d. Chronic cholelithiasis ANS: C REF: 469 57. What causes massive inflammation and necrosis in acute pancreatitis? a. Formation of multiple thrombi and ischemia b. Infection by intestinal microbes c. Immune complex reaction d. Autodigestion of tissue by pancreatic enzymes ANS: D REF: 470 58. How does chemical peritonitis and shock frequently result from acute pancreatitis? a. Inflammation and increased vascular permeability of the peritoneum affect fluid balance. b. Erosion in the intestinal wall causes release of bacteria. c. Fat necrosis and hypocalcemia develop. d. Secretions from the pancreas and intestine become more acidic. ANS: A REF: 470 59. Malnutrition may develop in children with celiac disease because of: a. damage to the intestinal villi. b. obstruction in the pancreatic ducts. c. acidosis, preventing activation of digestive enzymes. d. insufficient bile for absorption. ANS: A REF: 471 60. Which of the following best describes steatorrhea? a. A light gray-colored stool b. A tarry black stool c. Bulky, fatty, foul-smelling stools d. Watery stools with mucus and blood ANS: C REF: 439 61. What is the dietary requirement for a child with celiac disease? a. Low sodium, high fat b. High carbohydrate, low protein c. High calorie with vitamin supplements d. Gluten-free ANS: D REF: 441 62. What are the typical changes occurring with Crohn’s disease? a. Degeneration and flattening of the villi in the small intestine b. Multiple herniations of the mucosa through weak areas of the muscularis c. A continuous area of mucosal inflammation and ulceration in the rectum and colon d. Inflamed areas of the wall of the ileum alternating with thick fibrotic or normal areas ANS: D REF: 471-474 63. Stools that are more liquid and contain mucus and frank blood are typical of: a. diverticulitis. b. ulcerative colitis. c. Crohn’s disease. d. celiac disease. ANS: B REF: 474 64. How may a fistula form with Crohn’s disease? a. Lack of peristalsis, leading to dilated areas of intestine b. Fibrosis and thickening of the wall, causing obstruction c. Erosion of the mucosa, causing bleeding d. Recurrent inflammation, necrosis, and fibrosis, forming a connection between intestinal loops ANS: D REF: 473 65. How does iron deficiency anemia frequently develop with ulcerative colitis? a. Loss of surface area for absorption in the ileum b. Bone marrow depression by toxic wastes c. Chronic blood loss in stools d. Insufficient hydrochloric acid for iron absorption ANS: C REF: 474 66. What is the cause of inflammatory bowel disease? a. Physical and emotional stress b. An autoimmune reaction c. A combination of recessive genes d. Idiopathic ANS: D REF: 475 67. What pain is typical of diverticulitis? a. Lower left quadrant b. Lower right quadrant c. Sharp, colicky, periumbilical d. Lower abdominal pain, radiating into the groin ANS: A REF: 478 68. What usually initiates acute appendicitis? a. Infection in the appendix b. An episode of severe diarrhea c. Obstruction of the lumen of the appendix d. Eating a low-fiber diet ANS: C REF: 475 69. With acute appendicitis, localized pain and tenderness in the lower right quadrant results from: a. increased peristalsis in the adjacent colon. b. inflammation and stretching of the appendiceal wall. c. increased gas and fluid inside the appendix. d. local inflammation of the parietal peritoneum. ANS: D REF: 476 70. How does localized peritonitis develop from acute appendicitis before rupture? a. The omentum walls off the inflamed area. b. Intestinal bacteria escape through the necrotic appendiceal wall. c. The obstructing object inside the appendix causes edema. d. Bacteria escape into the circulating blood. ANS: B REF: 476 71. What is a typical early sign of cancer in the ascending colon? a. Change in shape of the stool b. Incomplete emptying c. Mild but persistent pain in the lower left quadrant d. Occult blood in the stool ANS: D REF: 480 72. To which site does colon cancer usually first metastasize? a. Lungs b. Stomach c. Liver d. Spleen ANS: C REF: 479 73. How does a volvulus cause localized gangrene in the intestine? a. Hypotension and shock cause ischemia. b. The mesenteric arteries are compressed in the twisted section of intestine. c. A section of intestine herniates between the muscles of the abdominal wall. d. The distention of the intestinal wall causes increased permeability of the tissue. ANS: B REF: 476 74. Which of the following is a typical indicator of an intestinal obstruction caused by paralytic ileus? a. Excessive audible bowel sounds b. Intermittent colicky pain c. Severe steady abdominal pain d. Visible peristalsis ANS: C REF: 484 75. A congenital condition in which parasympathetic innervation is missing from a section of the colon, impairing motility is referred to as: a. diverticulitis. b. Crohn’s disease. c. irritable bowel syndrome. d. Hirschsprung’s disease. ANS: D REF: 484 76. What causes hypovolemic shock to develop with intestinal obstruction? a. Continued vomiting and fluid shift into the intestine b. Hemorrhage into the intestine c. Rupture of the intestinal wall d. Repeated bouts of severe diarrhea ANS: A REF: 485 77. What causes the characteristic rigid abdomen found in the patient with peritonitis? a. Increased fluid and gas, causing abdominal distention b. Inflammation of the peritoneum and organs, causing a firm mass in the abdomen c. Inflamed peritoneum, resulting in reflex abdominal muscle spasm d. Voluntary contraction of the abdominal muscles as a protective mechanism ANS: C REF: 486 78. What would be the likely outcome from chemical peritonitis related to a perforated gallbladder? a. Leakage of intestinal bacteria into blood and the peritoneal cavity b. Massive hemorrhage and shock c. Breakdown of the gallstones d. Increasing peristalsis with intermittent painful spasms ANS: A REF: 485 79. How does pelvic inflammatory disease frequently lead to bacterial peritonitis? a. Chemical irritation by excessive ovarian and uterine secretions causes inflammation. b. Ulceration and perforation of the uterus allow the bacteria to spread. c. Infection spreads through the fallopian tubes directly into the peritoneal cavity. d. Gangrene in the uterine wall spreads through into the pelvic cavity. ANS: C REF: 484-485 80. Choose the significant change in arterial blood gases expected with prolonged severe vomiting: a. Increased bicarbonate ion, increased PCO2, serum pH 7.4 b. Decreased bicarbonate ion, decreased PCO2, serum pH 7.35 c. Increased bicarbonate ion, decreased PCO2, serum pH 7.35 d. Decreased bicarbonate ion, increased PCO2, serum pH 7.45 ANS: B REF: 440 81. When dehydration reduces the compensation possible for acidosis resulting from prolonged diarrhea, what significant change in arterial blood gases indicates this? a. Serum pH would rise above 7.45. b. Serum bicarbonate levels would increase, and serum pH would remain in normal range. c. Serum bicarbonate levels would decrease, and serum pH would drop below 7.35. d. Serum PCO2 would rise, and serum pH would be around 7.4. ANS: C REF: 438-439 82. Bile pigment gallstones are more common in individuals dealing with: a. obesity. b. high cholesterol levels. c. alcoholic cirrhosis. d. use of oral contraceptives. ANS: C REF: 459 83. Dehydration limits compensation available for an acid-base imbalance resulting from prolonged vomiting and diarrhea because: a. hypovolemia limits renal function. b. increased respirations cannot remove more H+. c. increased ADH blocks secretion of H+. d. more sodium and potassium ions are retained. ANS: A REF: 439-440 84. Which of the following is the most frequent location of peptic ulcers? a. Lower esophagus b. Antrum of the stomach c. Proximal duodenum d. Distal duodenum ANS: C REF: 453-454 85. In peptic ulcer disease, which of the following does NOT decrease the resistance of the mucosal barrier? a. Prolonged vasoconstriction b. Excessive glucocorticoid intake c. Proteases and cytotoxins from H. pylori d. Decreased vagal stimulation ANS: D REF: 453-454 86. An individual with peptic ulcer disease exhibits hematemesis. What does this probably indicate? a. Perforation b. Obstruction c. Erosion of a large blood vessel d. Development of malignancy ANS: C REF: 455 87. What does the term melena mean? a. Blood in a dark-colored stool b. Occult blood in the stool c. Blood in the sputum d. Blood in vomitus ANS: A REF: 439 88. Which of the following is NOT a common predisposing factor to gastric carcinoma? a. Ingestion of smoked foods b. Genetic factors c. Ingestion of foods preserved with nitrates d. Anti-inflammatory medications such as ASA ANS: D REF: 457 89. Which of the following frequently occurs 2 to 3 hours after meals in post-gastrectomy patients? a. Hypoglycemia b. Hypovolemia c. Abdominal cramps and distention d. Increased peristalsis and diarrhea ANS: A REF: 457 90. Which term refers to an inflammation usually related to infection of the bile ducts? a. Cholelithiasis b. Cholecystitis c. Cholangitis d. Choledocholithiasis ANS: C REF: 458 91. Which of the following is NOT usually present during the icteric stage of viral hepatitis? a. Hepatomegaly b. Elevated serum liver enzymes c. Esophageal varices d. Lighter-colored stools ANS: C REF: 464 92. Which of the following statement(s) about jaundice is/are true? 1. It is often the first manifestation of hepatitis. 2. Jaundice indicates permanent liver damage. 3. Individuals with hepatitis are always jaundiced. 4. Jaundice usually develops with hepatocellular carcinoma. a. 1 only b. 4 only c. 1, 3 d. 2, 4 ANS: B REF: 460 | 464 93. Which type(s) of hepatitis increase(s) the risk of hepatocellular carcinoma? a. HBV b. HCV c. HBV and HCV d. Neither HBV nor HCV ANS: C REF: 461 | 464 94. Which of the following is/are related to post-hepatic jaundice? a. Pruritic skin and light-colored stools b. Dark-colored stools and urine c. Increased serum levels of unconjugated bilirubin d. Loss of all metabolic functions ANS: A REF: 464 95. Which of the following occurs with hepatitis B? a. The liver is inflamed and enlarged. b. Blood clotting delays are apparent at onset. c. Hepatocytes cannot regenerate when the virus is present. d. Infection is self-limiting. ANS: A REF: 462 | 464 96. Identify a major reason making it difficult to prevent the spread of hepatitis B. a. A vaccine is not available. b. The incubation period is too short to track contacts. c. Infection is often asymptomatic. d. Antibodies are not produced. ANS: C REF: 462 97. What is the initial pathological change in alcoholic liver disease? a. Formation of nodules with shrinkage of the liver b. Inflammation with necrosis c. Development of fibrous bands of tissue d. Accumulation of fat in hepatocytes with hepatomegaly ANS: D REF: 465 98. How does serum bilirubin change with cirrhosis? a. Increased unconjugated bilirubin b. Increased conjugated bilirubin c. Increased conjugated and unconjugated bilirubin d. Decreased conjugated and unconjugated bilirubin ANS: C REF: 466 99. Which type of hepatitis virus requires the presence of hepatitis B virus so as to replicate? a. HAV b. HCV c. HDV d. HEV ANS: C REF: 464 100. At what stage of alcoholic liver disease can the damage be reversed? a. It can never be reversed b. Initial stage c. Alcoholic hepatitis stage d. End-stage cirrhosis ANS: B REF: 465 101. Although many factors may precipitate pancreatitis, the two major causes are: a. obesity and smoking. b. high-fat diet and hypertension. c. congenital defects and drug abuse. d. gallstones and alcohol abuse. ANS: D REF: 470 102. Which factor(s) appear(s) to have a role in the etiology of inflammatory bowel diseases? a. Dietary factors b. Environmental toxins c. Genetic and immunological factors d. Chronic alcoholism ANS: C REF: 471-472 103. Gastroesophageal reflux disease involves: a. periodic flow of gastric contents into the esophagus. b. constant flow of intestinal and gastric contents into the esophagus. c. spasmodic and violent vomiting of gastric contents. d. violent spasming of the esophagus, causing choking. ANS: A REF: 451 104. When a portion of the proximal stomach and the paraesophageal junction move above the diaphragm, this is called a: a. dysphagia. b. rolling hernia. c. sliding hernia. d. pyloric stenosis. ANS: C REF: 450-451 105. Which of the following applies to gastric cancer? a. It usually appears as polyp or protruding mass. b. Most cases involve an adenocarcinoma of the mucous glands. c. Genetics or geographical area does not affect the incidence. d. It is usually diagnosed in an early stage because of pyloric obstruction. ANS: B REF: 456 106. Pancreatic cancer may be diagnosed early if obstruction of bile or pancreatic secretions develops when the tumor is located: a. at the head of the pancreas. b. in the body of the pancreas. c. in the tail of the pancreas. d. in the endocrine glands of the pancreas. ANS: A REF: 471 107. “A gluten-free diet as required” for the client with celiac disease means avoiding: a. products containing lactose. b. any trans-fat. c. certain grains. d. proteins containing certain amino acids. ANS: C REF: 471 108. The telescoping of one section of bowel inside another section is called: a. volvulus. b. hernia. c. adhesion. d. intussusceptions. ANS: D REF: 482 | 484 109. A viral infection of the parotid gland is commonly known as: a. tonsillitis. b. mumps. c. chickenpox. d. scarlet fever. ANS: B REF: 448 Chapter 18 Urinary System Disorders 1. Which of the following structures is most likely to be located in the renal medulla? a. Proximal convoluted tubule b. Glomerulus c. Loop of Henle d. Afferent arteriole ANS: C REF: 492-493 2. Which of the following is NOT a function of the kidney? a. Regulation of body fluid concentrations b. Removal of nitrogenous and acidic wastes c. Activation of vitamin D d. Production of albumin ANS: D REF: 491 3. Which of the following describes the correct flow of blood in the kidney? a. Afferent arteriole to the peritubular capillaries to the venule b. Efferent arteriole to the glomerular capillaries to the peritubular capillaries c. Peritubular capillaries to the glomerular capillaries to the venule d. Afferent arteriole to the glomerular capillaries to the efferent arteriole ANS: D REF: 494 4. Which of the following describes the flow of filtrate in the kidney? a. The collecting duct to the distal convoluted tubule to the renal pelvis b. Bowman’s capsule to the proximal convoluted tubule to the loop of Henle c. The loop of Henle to the collecting duct to Bowman’s capsule d. The distal convoluted tubule to the loop of Henle to the collecting duct ANS: B REF: 492 5. Which of the following describes the normal flow of urine? a. Collecting duct to the renal pelvis to the ureter to the bladder b. Renal pelvis to the urethra to the bladder to the ureter c. Ureter to the renal pelvis to the urethra to the bladder d. Collecting duct to the ureter to the urethra ANS: A REF: 496 6. Which statement about the bladder is TRUE? a. The bladder wall lacks rugae. b. Three openings from the urinary bladder form the trigone. c. It contracts when stimulated by the sympathetic nervous system. d. Continuous peristalsis in the bladder wall promotes urine flow. ANS: B REF: 496 7. Which of the following increases glomerular filtration rate? a. Increased plasma osmotic pressure b. Dilation of the efferent arteriole c. Increased hydrostatic pressure in the glomerular capillaries d. Constriction of the afferent arteriole ANS: C REF: 495 8. By what process is water reabsorbed from the filtrate? a. Osmosis b. Active transport c. Cotransport d. Capillary action ANS: A REF: 492 9. Which substance directly controls the reabsorption of water from the collecting ducts? a. Renin b. Aldosterone c. Angiotensin d. Antidiuretic hormone ANS: D REF: 492 10. Under what circumstances do cells in the kidneys secrete renin? a. The urine pH decreases. b. Blood flow in the afferent arteriole decreases. c. Serum potassium levels are high. d. Serum osmotic pressure increases. ANS: B REF: 495 11. Which of the following should be present in the filtrate in the proximal convoluted tubule? a. Plasma proteins b. Erythrocytes c. Sodium ions d. Leukocytes ANS: C REF: 492 12. From the following, choose the substance likely to appear in the urine when the glomerulus is inflamed. a. Albumin b. Urea c. Sodium d. Creatinine ANS: A REF: 497 13. Involuntary urination by a child after age 4 or 5, when bladder control is expected, is referred to as: a. enuresis. b. stress incontinence. c. micturition. d. overflow incontinence. ANS: A REF: 496 14. When a respiratory infection with high fever is present in the body, how would the kidney tubules maintain normal pH of body fluids? a. Increase the flow of filtrate. b. Secrete more acids and reabsorb more bicarbonate ions. c. Excrete a larger volume of more dilute urine. d. Retain more potassium ions in exchange for sodium ions. ANS: B REF: 502-503 15. When comparing normal kidney function with dialysis, which of the following mechanisms is not possible in dialysis? a. Diffusion b. Osmosis c. Ultrafiltration d. Active transport ANS: D REF: 500 16. What is the cause of most cases of pyelonephritis? a. An ascending infection by E. coli b. Abnormal immune response, causing inflammation c. Dialysis or other invasive procedure d. Severe pH imbalance of urine ANS: A REF: 500 17. Which disease is manifested by dysuria and pyuria? a. Nephrotic syndrome b. Cystitis c. Glomerulonephritis d. Urolithiasis ANS: B REF: 502 18. Why may acute pyelonephritis and cystitis follow untreated prostatitis? a. Microbes spread through the circulation. b. Antibodies have not yet formed. c. There is no effective treatment. d. There is a continuous mucosa along the involved structures. ANS: D REF: 502 19. Pyelonephritis may be distinguished from cystitis by the presence in pyelonephritis of: a. microbes, leukocytes, and pus in the urine. b. painful micturition. c. urgency and frequency. d. urinary casts and flank pain. ANS: D REF: 502 20. In a case of acute pyelonephritis, what is the cause of flank pain? a. Inflammation, causing ischemia in the tubules b. Inflammation, stretching the renal capsule c. Increasing glomerular permeability, creating an increased volume of filtrate in the kidney d. Microbes irritating the tissues ANS: B REF: 502 21. Which pathophysiological process applies to acute post-streptococcal glomerulonephritis? a. Streptococcal infection affects both the glomerular and tubule functions b. Ischemic damage occurs in the tubules, causing obstruction and decreased glomerular filtration rate (GFR) c. Immune complexes deposit in glomerular tissue, causing inflammation d. Increased glomerular permeability for unknown reasons ANS: C REF: 502-503 22. What causes the dark urine associated with acute post-streptococcal glomerulonephritis? a. Blood and protein leaking through the capillary into the filtrate b. Proteinuria and microscopic hematuria from the inflammation c. Pyuria from inflammatory exudate d. Bleeding from ulcerations in the kidneys ANS: A REF: 503 23. Renal disease frequently causes hypertension because: a. albuminuria increases vascular volume. b. congestion and ischemia stimulate release of renin. c. antidiuretic hormone (ADH) secretion is decreased. d. damaged tubules absorb large amounts of filtrate. ANS: B REF: 503 24. Urinary casts are present with acute post-streptococcal glomerulonephritis because: a. large numbers of microbes and leukocytes enter the filtrate. b. ruptured capillaries release debris into the tubules. c. normal reabsorption of cells and proteins cannot take place. d. inflamed tubules compress red blood cells (RBCs) and protein into a typical mass. ANS: D REF: 508 25. Which disease would cause an increased ASO titer and elevated serum ASK? a. Nephrotic syndrome b. Acute post-streptococcal glomerulonephritis c. Pyelonephritis d. Polycystic kidney ANS: B REF: 503-504 26. Why does metabolic acidosis develop with bilateral kidney disease? a. Tubule exchanges are impaired. b. GFR is increased. c. Serum urea is increased. d. More bicarbonate ion is produced. ANS: A REF: 510 27. What is the first indicator in the arterial blood gases of acidosis caused by glomerulonephritis? a. Increased carbonic acid b. Increased bicarbonate ion c. A pH less than 7.35 d. Decreased bicarbonate ion ANS: D REF: 503 28. What would be the long-term effects of chronic infection or inflammation of the kidneys? a. Dehydration and hypovolemia b. Gradual necrosis, fibrosis, and development of uremia c. Sudden anuria and azotemia d. Severe back or flank pain ANS: B REF: 504 29. What factors contribute to headache, anorexia, and lethargy with kidney disease? 1. Increased blood pressure 2. Elevated serum urea 3. Anemia 4. Acidosis a. 1 only b. 2, 4 c. 1, 3, 4 d. 1, 2, 3, 4 ANS: D REF: 513 30. What are the significant signs of nephrotic syndrome? a. Hyperlipidemia and lipiduria b. Pyuria and leucopenia c. Hypertension and heart failure d. Gross hematuria and pyuria ANS: A REF: 504 31. Why does blood pressure often remain near normal in patients with nephrotic syndrome? a. Massive amounts of fluid are lost from the body with polyuria. b. Renin and aldosterone are no longer secreted. c. Tubules do not respond to ADH and aldosterone. d. Hypovolemia results from fluid shift to the interstitial compartment. ANS: D REF: 504 32. Common causes of urolithiasis include all of the following EXCEPT: a. hypercalcemia. b. hyperlipidemia. c. inadequate fluid intake. d. hyperuricemia. ANS: B REF: 506 33. Which of the following results from obstruction of the left ureter by a renal calculus? a. Mild flank pain on the affected side b. Hydronephrosis in both kidneys c. Immediate cessation of urine production d. An attack of renal colic ANS: D REF: 506 34. What does hydronephrosis lead to? a. Ischemia and necrosis in the compressed area b. Multiple hemorrhages in the kidney c. Severe colicky pain radiating into the groin d. Increased GFR ANS: A REF: 507 35. Which of the following is a predisposing factor to bladder cancer? a. Prostatic cancer b. Hormonal abnormalities c. Exposure to chemicals and cigarette smoke d. Presence of embryonic tissue ANS: C REF: 508 36. What is the common initial sign of adenocarcinoma of the kidney? a. Gross hematuria b. Microscopic hematuria c. Sharp flank pain d. Oliguria ANS: B REF: 507 37. Which of the following does NOT usually result from nephrosclerosis? a. Secondary hypertension b. Chronic renal failure c. Acute renal failure d. Increased renin and aldosterone secretions ANS: C REF: 508 38. Which of the following relates to polycystic kidney disease? a. It affects only one of the kidneys. b. It results in gradual degeneration and chronic renal failure. c. The kidneys are displaced and the ureters are twisted. d. The prognosis is good because there is adequate reserve for normal life. ANS: B REF: 510 39. Which of the following is related to Wilms’ tumor? a. Direct exposure to carcinogens b. Hormonal imbalance c. Repeated infections d. A genetic defect ANS: D REF: 509 40. With severe kidney disease, either hypokalemia or hyperkalemia may occur and cause: a. cardiac arrhythmias. b. encephalopathy. c. hypervolemia. d. skeletal muscle twitch or spasm. ANS: A REF: 513 41. Which of the following indicates the early stage of acute renal failure? a. Polyuria with urine of fixed and low specific gravity b. Hypotension and increased urine output c. Development of decompensated acidosis d. Very low GFR and increased serum urea ANS: D REF: 510 42. What is/are a cause(s) of acute tubule necrosis and acute renal failure? a. Prolonged circulatory shock b. Sudden significant exposure to nephrotoxins c. Crush injuries or burns d. All of the above ANS: D REF: 510 43. Which of the following would likely cause chronic renal failure? a. Cystitis with pyelonephritis in the right kidney b. Circulatory shock c. Diabetes d. Obstruction of a ureter by a renal calculus ANS: C REF: 510 44. What causes polyuria during the stage of renal insufficiency? a. Loss of tubule function b. Increased blood pressure c. Decreased aldosterone secretion d. Increased GFR ANS: A REF: 510 45. What is the primary reason for hypocalcemia developing during end-stage renal failure or uremia? a. Decreased parathyroid hormone secretion b. Insufficient calcium in the diet c. Excessive excretion of calcium ions in the urine d. A deficit of activated vitamin D and hyperphosphatemia ANS: D REF: 513 46. Cystitis is more common in females because: a. the mucosa in the urinary tract is continuous. b. the urethra is short, wide, and adjacent to areas with resident flora. c. the pH of urine is more acidic in females. d. females have a higher incidence of congenital anomalies. ANS: B REF: 500 47. Which of the following indicate a decreased GFR? a. Increased serum urea and decreased serum bicarbonate b. Urine with low specific gravity and dark color c. Albuminuria and hematuria d. Hyponatremia and hypokalemia ANS: A REF: 497 48. Which of the following is NOT likely to lead to hydronephrosis? a. Renal calculi b. Pyelonephritis c. Nephrosclerosis d. Benign prostatic hypertrophy ANS:CREF:502 | 506 | 507 | 515 49. Which of the following congenital defects is a common cause of cystitis in young children? a. Polycystic kidney b. Horseshoe kidney c. Hypoplasia of the kidney d. Vesicoureteral reflux ANS: D REF: 500 50. Which factor contributes to severe anemia in individuals with chronic renal failure? a. Increased erythropoietin secretion b. Limited protein intake c. Compensatory increase