TEST BANK SUE E. HUETHER, KATHRYN L. MCCANCE - TEST BANK FOR UNDERSTANDING PATHOPHYSIOLOGY 6TH EDITION

TEST BANK SUE E. HUETHER, KATHRYN L. MCCANCE - TEST BANK FOR UNDERSTANDING PATHOPHYSIOLOGY 6TH EDITIONTable of Contents Chapter 01: Cellular Biology ....................................................................................................................................................... 2 Chapter 02: Genes and Genetic Diseases ............................................................................................................................. 10 Chapter 03: Epigenetics and Disease..................................................................................................................................... 19 Chapter 04: Altered Cellular and Tissue Biology ............................................................................................................... 23 Chapter 05: Fluids and Electrolytes, Acids and Bases ...................................................................................................... 35 Chapter 06: Innate Immunity: Inflammation and Wound Healing ............................................................................. 43 Chapter 07: Adaptive Immunity ............................................................................................................................................. 54 Chapter 08: Infection and Defects in Mechanisms of Defense .................................................................................... 60 Chapter 09: Stress and Disease .............................................................................................................................................. 70 Chapter 10: Biology, Clinical Manifestations, and Treatment of Cancer.................................................................... 74 Chapter 11: Cancer Epidemiology .......................................................................................................................................... 80 Chapter 12: Cancer in Children ............................................................................................................................................... 83 Chapter 13: Structure and Function of the Neurologic System ................................................................................... 86 Chapter 14: Pain, Temperature, Sleep, and Sensory Function...................................................................................... 96 Chapter 15: Alterations in Cognitive Systems, Cerebral Hemodynamics, and Motor Function ........................ 107 Chapter 16: Disorders of the Central and Peripheral Nervous Systems and the Neuromuscular Junction ... 116 Chapter 17: Alterations of Neurologic Function in Children ....................................................................................... 128 Chapter 18: Mechanisms of Hormonal Regulation ........................................................................................................ 136 Chapter 19: Alterations of Hormonal Regulation ............................................................................................................ 144 Chapter 20: Structure and Function of the Hematologic System ............................................................................. 157 Chapter 21: Alterations of Hematologic Function .......................................................................................................... 164 Chapter 22: Alterations of Hematologic Function in Children ................................................................................... 179 Chapter 23: Structure and Function of the Cardiovascular and Lymphatic Systems .......................................... 186 Chapter 24: Alterations of Cardiovascular Function ...................................................................................................... 196 Chapter 25: Alterations of Cardiovascular Function in Children ............................................................................... 215 Chapter 26: Structure and Function of the Pulmonary System .................................................................................222 Chapter 27: Alterations of Pulmonary Function ..............................................................................................................230 Chapter 28: Alterations of Pulmonary Function in Children ...................................................................................... 242 Chapter 29: Structure and Function of the Renal and Urologic Systems ...............................................................250 Chapter 30: Alterations of Renal and Urinary Tract Function ..................................................................................... 257 Chapter 31: Alterations of Renal and Urinary Tract Function in Children .............................................................. 264 Chapter 32: Structure and Function of the Reproductive Systems ..........................................................................269 Chapter 33: Alterations of the Female Reproductive System ..................................................................................... 277 Chapter 34: Alterations of the Male Reproductive System .........................................................................................282 Chapter 35: Structure and Function of the Digestive System .................................................................................... 287 Chapter 36: Alterations of Digestive Function .................................................................................................................293 Chapter 37: Alterations of Digestive Function in Children ...........................................................................................306 1 | P a g eChapter 38: Structure and Function of the Musculoskeletal System ....................................................................... 314 Chapter 39: Alterations of Musculoskeletal Function ....................................................................................................322 Chapter 40: Alterations of Musculoskeletal Function in Children ............................................................................. 331 Chapter 41: Structure, Function, and Disorders of the Integument..........................................................................336 Chapter 42: Alterations of the Integument in Children ............................................................................................... 345 Chapter 01: Cellular Biology MULTIPLE CHOICE 1. A student is observing a cell under the microscope. It is observed to have supercoiled DNA with histones. Which of the following would also be observed by the student? a. A single circular chromosome b. A nucleus c. Free-floating nuclear material d. No organelles ANS: B The cell described is a eukaryotic cell, so it has histones and a supercoiled DNA within its nucleus; thus, the nucleus should be observed. A single circular chromosome called a prokaryote contains free-floating nuclear material but has no organelles. REF: p. 2 2. A nurse is instructing the staff about cellular functions. Which cellular function is the nurse describing when an isolated cell absorbs oxygen and uses it to transform nutrients to energy? a. Metabolic absorption b. Communication c. Secretion d. Respiration ANS: D The cell’s ability to absorb oxygen is referred to as respiration while its communication ability involves maintenance of a steady dynamic state, metabolic absorption provides nutrition, and secretion allows for the synthesizing of new substances. REF: p. 2 3. A eukaryotic cell is undergoing DNA replication. In which region of the cell would most of the genetic information be contained? a. Mitochondria b. Ribosome c. Nucleolus d. Nucleus Cytoplasm ANS: C The region of the cell that contains genetic material, including a large amount of ribonucleic acid, most of the DNA, and DNA-binding proteins, is the nucleolus, which is located within the 2 | P a g ecell’s nucleus. Mitochondria is associated with cellular respiration, while ribosomes are involved with protein manufacturing. Cytoplasm is a fluid filling that is a component of the cell. REF: p. 2 4. Which of the following can remove proteins attached to the cell’s bilayer by dissolving the layer itself? a. Peripheral membrane proteins b. Integral membrane proteins c. Glycoproteins d. Cell adhesion molecules ANS: B Proteins directly attached to the membrane bilayer can be removed by the action of integral membrane proteins that dissolve the bilayer. Peripheral membrane proteins reside at the surface while cell adhesion molecules are on the outside of the membrane. Glycoprotein marks cells and does not float. REF: p. 7 5. Which of the following can bind to plasma membrane receptors? a. Oxygen b. Ribosomes c. Amphipathic lipids d. Ligands ANS: D Ligands are the only specific molecules that can bind with receptors on the cell membrane. REF: p. 9 6. A nurse is reviewing a report from a patient with metastatic cancer. What alternation in the extracellular matrix would support the diagnosis of metastatic cancer? a. Decreased fibronectin b. Increased collagen c. Decreased elastin d. Increased glycoproteins ANS: A Only a reduced amount of fibronectin is found in some types of cancerous cells, allowing them to travel or metastasize. REF: p. 10 7. Which form of cell communication is used to relate to other cells in direct physical contact? a. Cell junction b. Gap junction c. Desmosome d. Tight junction ANS: A Cell junctions hold cells together and permit molecules to pass from cell to cell. Gap junctions allow for cellular communication between cells. Neither desmosomes nor tight 3 | P a g ejunctions are associated with cellular communication. REF: p. 11 8. Pancreatic beta cells secrete insulin, which inhibits secretion of glucagon from neighboring alpha cells. This action is an example of which of the following signaling types? a. Paracrine b. Autocrine c. Neurohormonal d. Hormonal ANS: A Paracrine signaling involves the release of local chemical mediators that are quickly taken up, destroyed, or immobilized, as in the case of insulin and the inhibition of the secretion of glucagon. None of the other options involve signaling that is associated with a local chemical mediator like insulin. REF: p. 12 9. In cellular metabolism, each enzyme has a high affinity for a: a. solute. b. substrate. c. receptor. d. ribosome. ANS: B Each enzyme has a high affinity for a substrate, a specific substance converted to a product of the reaction. Cellular metabolism is not dependent on an attraction between an enzyme and any of the remaining options. REF: p. 16 10. An athlete runs a marathon, after which his muscles feel fatigued and unable to contract. The athlete asks the nurse why this happened. The nurse’s response is based on the knowledge that the problem is result of a deficiency of: a. GTP b. AMP c. ATP d. GMP ANS: C When ATP is deficient, impaired muscle contraction results. None of the other options are involved in muscle contraction. REF: p. 16 11. Which phase of catabolism produces the most ATP? a. Digestion b. Glycolysis c. Oxidation d. Citric acid cycle 4 | P a g eANS: D While some ATP is produced during the oxidation and glycolysis phases, most of the ATP is generated during the citric acid cycle. Digestion does not produce any ATP. REF: p. 16 12. A nurse is teaching the staff about the phases of cellular catabolism. Which phases should the nurse include? a. Digestion, glycolysis, oxidation, and the citric acid cycle b. Diffusion, osmosis, and mediated transport c. S phase, G phase, and M phase d. Metabolic absorption, respiration, and excretion ANS: A Only digestion, glycolysis, oxidation, and the citric acid cycle are the phases of cellular catabolism. REF: p. 16 13. A runner has depleted all the oxygen available for muscle energy. Which of the following will facilitate his continued muscle performance? a. Electron-transport chain b. Aerobic glycolysis c. Anaerobic glycolysis d. Oxidative phosphorylation ANS: C When no oxygen is available, anaerobic glycolysis occurs. The electron-transport chain is part of the citric acid cycle. Aerobic glycolysis involves the presence of oxygen. Oxidative phosphorylation is the mechanism by which the energy produced from carbohydrates, fats, and proteins is transferred to ATP. It is not part of muscle performance. REF: p. 16 14. A faculty member asks a student to identify the appropriate term for the movement of a solute from an area of greater to lesser concentration. Which answer indicates the nursing student understood the teaching? a. Osmosis b. Diffusion c. Hydrostatic pressure d. Active transport ANS: B Diffusion is the movement of a solute molecule from an area of greater solute concentration to an area of lesser solute concentration through a permeable membrane. Osmosis is the movement of water across a semipermeable membrane from a region of higher water concentration to one of lower concentration. Hydrostatic pressure is the force of fluid against a cell membrane. In active transport, molecules move up a concentration gradient. REF: p. 19 5 | P a g e15. Which description accurately describes electrolytes? a. Small lipid-soluble molecules b. Large protein molecules c. Micronutrients used to produce ATP d. Electrically charged molecules ANS: D Electrolytes are electrically charged molecules. They are not lipid soluble, they are not made up of protein, and they do not play a role in ATP production. REF: p. 18 16. A nurse is reading a chart and sees the term oncotic pressure. The nurse recalls that oncotic pressure (colloid osmotic pressure) is determined by: a. the concentration of sodium. b. plasma proteins. c. hydrostatic pressure. d. the availability of membrane transporter proteins. ANS: B Oncotic pressure is determined by the effect of colloids or plasma proteins. The concentration of sodium plays a role in tonicity. Hydrostatic pressure is the force within a vessel. Membrane transporter proteins are involved in active transport within a concentration gradient. REF: p. 20 17. A patient has a body fluid of 300 mOsm/kg. This lab result is measuring: a. osmolality. b. osmolarity. c. osmotic pressure. d. oncotic pressure. ANS: A Osmolality measures the number of milliosmoles per kilogram of water, or the concentration of molecules per weight of water, while osmolarity measures the number of milliosmoles per liter of solution, or the concentration of molecules per volume of solution. Osmotic pressure is the amount of hydrostatic pressure required to oppose the osmotic movement of water. Oncotic pressure is from plasma proteins, not body fluids. REF: p. 19 18. A nurse is discussing the movement of fluid across the arterial end of capillary membranes into the interstitial fluid surrounding the capillary. Which process of fluid movement is the nurse describing? a. Hydrostatic pressure b. Osmosis c. Diffusion d. Active transport ANS: A Blood reaching the capillary bed has a hydrostatic pressure of 25–30 mm Hg, which is sufficient force to push water across the thin capillary membranes into the interstitial space. 6 | P a g eOsmosis involves the movement of fluid from an area of higher concentration to an area of lower concentration. It does not involve pressure or force. Diffusion is the passive movement of a solute from an area of higher solute concentration to an area of lower solute concentration. Active transport involves movement up a concentration gradient. REF: p. 19 19. How are potassium and sodium transported across plasma membranes? a. By passive electrolyte channels b. By coupled channels c. By adenosine triphosphate enzyme (ATPase) d. By diffusion ANS: C The transporter protein ATPase is directly related to sodium and potassium transport via active transport. Electrolyte movements require energy and do not move passively, nor are they transported by diffusion. Enzymes, not electrolytes, are passed via coupled channels. REF: p. 21 20. The ion transporter that moves Na+ and Ca2+ simultaneously in the same direction is an example of which of the following types of transport? a. Biport b. Uniport c. Antiport d. Symport ANS: D When ions are transported in one direction, it is termed symport. There is no such term as biport. Uniport refers to the movement of a single molecule. Antiport refers to the movement of molecules in the opposite direction. REF: p. 19, Figure 1-22 21. During which process are bacteria engulfed for ingestion? a. Endocytosis b. Pinocytosis c. Phagocytosis d. Exocytosis ANS: C Phagocytosis (cell eating) involves the ingestion of large particles, such as bacteria, through the formation of large vesicles. Endocytosis involves the formation of vesicles to facilitate movement into the cell. Pinocytosis is a type of endocytosis in which fluids and solute molecules are ingested through the formation of small vesicles. Exocytosis occurs when coated pits invaginate and internalize ligand-receptor complexes in coated vesicles. REF: p. 22 22. Some cancer drugs work during the cell cycle phase where nuclear and cytoplasmic divisions 7 | P a g eoccur. What is this cell cycle phase called? a. G1 b. S c. M d. G2 ANS: C The M phase includes both nuclear and cytoplasmic divisions. The G1 phase includes the period between the M phase and the start of DNA synthesis. The S phase includes synthesis of DNA in the cell nucleus. The G2 phase includes RNA and protein synthesis. REF: pp. 25-26 23. Which causes the rapid change in the resting membrane potential that initiates an action potential? a. Potassium gates open, and potassium rushes into the cell, changing the membrane potential from negative to positive. b. Sodium gates open, and sodium rushes into the cell, changing the membrane potential from negative to positive. c. Sodium gates close, allowing potassium into the cell to change the membrane potential from positive to negative. d. Potassium gates close, allowing sodium into the cell to change the membrane potential from positive to negative. ANS: B When the threshold is reached, the cell will continue to depolarize with no further stimulation. The sodium gates open, and sodium rushes into the cell, causing the membrane potential to reduce to zero and then become positive (depolarization). Sodium is involved in creating the action potential, not potassium. The sodium gate and channel must be open, not closed. The action potential is not affected by a change in the potassium gate. REF: pp. 24-25 24. A cell is isolated, and electrophysiologystudiesreveal that the resting membrane potential is 70 mV. The predominant intracellular ion is Na+, and the predominant extracellular ion is K+. With voltage change, which of the following would result in an action potential? a. K+ rushing into the cell b. Na+ rushing into the cell c. Na+ rushing out of the cell d. K+ rushing out of the cell ANS: A With voltage change, potassium rushes into, not out of, the cell. Sodium movement is not related to this process. REF: pp. 24-25 25. A nurse teaching the staff about platelet-derived growth factor includes information that platelet-derived growth factor (PDGF) stimulates the production of: a. platelets. b. epidermal cells. c. connective tissue cells. 8 | P a g ed. fibroblast cells. ANS: C Different types of cells require different growth factors; for example, PDGF stimulates the production of connective tissue cells, but not platelets, epidermal cells, or fibroblast cells. REF: p. 27 26. The phase of the cell cycle during which the centromeres split and the sister chromatids are pulled apart is referred to as: a. anaphase. b. telophase. c. prophase. d. metaphase. ANS: A Anaphase begins when the centromeres split and the sister chromatids are pulled apart. During telophase, a new nuclear membrane is formed around each group of 46 chromosomes, the spindle fibers disappear, and the chromosomes begin to uncoil. During prophase, the first appearance of chromosomes occurs. Metaphase occurs when two centrioles located at opposite poles of the cell pull the chromosomes to opposite sides of the cell. REF: p. 26 27. What is the role of cytokines in cell reproduction? a. Provide growth factor for tissue growth and development. b. Block progress of cell reproduction through the cell cycle. c. Restrain cell growth and development. d. Provide nutrients for cell growth and development. ANS: A Cytokines play a major role in the regulation of tissue growth and development but do not restrain it. Cytokines help overcomeintracellular braking mechanisms that restrain cell growth and promote cell growth, but they do not provide nutrients. U S N T O REF: p. 26 28. A biopsy of the lung bronchi revealed ciliated epithelial cells that are capable of secretion and absorption. These cells are called columnar epithelium. a. simple b. ciliated simple c. stratified d. pseudostratified ciliated ANS: B Ciliated simple columnar epithelium is found in the lungs. Simple columnar epithelium is found from the stomach to the anus. Stratified columnar epithelium is found in the lining of the epiglottis, part of the pharynx, the anus, and the male urethra. Pseudostratified ciliate columnar epithelium is found in the lining of the large ducts of some glands (parotid, salivary), male urethra, respiratory passages, and Eustachian tubes of the ears. REF: p. 30, Table 1-6 9 | P a g e29. A student is reviewing functions of the cell. The student would be correct in identifying a chief function of the nerve cell as: a. sensory interpretation. b. conductivity. c. maintenance of homeostasis. d. communication. ANS: B Conductivity, not sensory interpretation, homeostasis, or communication, is one of the eight chief functions of nerve cells. REF: p. 2 MULTIPLE RESPONSE 1. A nurse recalls that the basic types of tissues are: (select all that apply) a. nerve. b. epithelial. c. mucosal. d. connective. e. skeletal. f. muscle. ANS: A, B, D, F The basic tissue types include nerve, epithelial, connective, and muscle. Mucosal is a type of epithelial cell, while skeletal is a type of connective tissue. REF: p. 27 2. Characteristics of prokaryotes include which of the following? (select all that apply) a. They contain no organelles. b. Their nuclear material is not encasedbyanuclear membrane. c. They contain a distinct nucleus. d. They contain histones. e. They contain a cellular membrane. ANS: A, B The prokaryotes lack a cellular membrane that encases nuclear material, thus they have no distinct nucleus; organelles and histones are also missing. REF: p. 1 Chapter 02: Genes and Genetic Diseases MULTIPLE CHOICE 1. A nurse recalls the basic components of DNA are: a. pentose sugars and four phosphate bases. b. a phosphate molecule, deoxyribose, and four nitrogenous bases. c. adenine, guanine, and purine. d. codons, oxygen, and cytosine. 10 | P a g eANS: B The three basic components of DNA are deoxyribose; a phosphate molecule; and four types of nitrogenous, not phosphate, bases. DNA does not contain condone. REF: p. 38 2. Which of the following mutations have the most significant effect on protein synthesis? a. Base pair substitutions b. Silent mutations c. Intron mutations d. Frameshift mutations ANS: D The frameshift mutation involves the insertion or deletion of one or more base pairs of the DNA molecule. This greatly alters the amino acid sequence, which affects protein synthesis. The base pair substitution is a typeof mutation inwhich one base pair replaces another. Silent mutations do not change amino acids or protein synthesis. Intron mutations are part of RNA sequencing. REF: p. 39 3. The base components of DNA are: a. A, G, C, and U. b. P, G, C, and T. c. A, G, C, and T. d. X, XX, XY, and YY. ANS: C The four base components of DNA are cytosine, thymine, adenine, and guanine, and are commonly represented by their first letters (A, C, T, and G) and not components identified as P or U. X, XX, XY, and YY are components of human chromosomes. REF: p. 38 4. A DNA strand has a region with the sequence ATCGGAT. Which of the following would be a complementary strand? a. CGATACGT b. TAGCCTAG c. TUGCCTUG d. UAGCCUAG ANS: B The consistent pairing of adenine with thymine and of guanine with cytosine is known as complementary base pairing; thus, A complements to T and C to G and vice versa throughout the strand. A complements to T; thus, the first letter must be a T. U does not represent a complement in the sequence. REF: p. 39 5. A biologist is explaining how RNA directs the synthesis of protein. Which process is the biologist describing? a. Termination 11 | P a g eb. Transcription c. Translocation d. Translation ANS: D In translation, RNA directs the synthesis of a polypeptide, interacting with transfer RNA (tRNA), a cloverleaf-shaped strand of about 80 nucleotides. Termination does not involve synthesis of protein. Transcription is the process by which DNA specifies a sequence of messenger RNA (mRNA). Translocation is the interchange of genetic material between nonhomologous chromosomes. REF: p. 41 6. What is the result of homologous chromosomes failing to separate during meiosis? a. Neurofibromatosis b. Nondisjunction c. Polyploidy d. Conjoined twins ANS: B Nondisjunction is an error in which homologous chromosomes or sister chromatids fail to separate normally during meiosis or mitosis. Neurofibromatosis is not due to chromosome failure during meiosis. Polyploidy occurs when a euploid cell has more than the diploid number of chromosomes. Conjoined twins are not due to chromosome failure during meiosis. REF: p. 45 7. A cell that does not contain a multiple of 23 chromosomes is called a a. diploid b. euploid c. polyploid d. haploid ANS: C A polyploid cell is one in which a euploid cell has more than 23 pairs of chromosomes. A diploid cell is when the somatic cell nucleus has 46 chromosomes in 23 pairs. A euploid cell is a cell with multiples of the normal number of chromosomes. A haploid cell has only one member of each chromosome pair, for a total of 23 chromosomes. REF: p. 42 8. A 20-year-old pregnant female gives birth to a stillborn child. Autopsy reveals that the fetus has 92 chromosomes. What term may be on the autopsy report to describe this condition? a. Biploidy b. Triploidy c. Tetraploidy d. Aneuploidy ANS: C Tetraploidy is a condition in which euploid cells have 92 chromosomes. Biploidy is a euploid cell with two times more chromosomes, or 46. Triploidy is a zygote that has three copies of each chromosome, rather than the usual two. Aneuploidy is when an aneuploid cell does not 12 | P a g e in a multiple of 23 chromosomes. REF: p. 42 9. The condition in which an extra portion of a chromosome is present in each cell is called: a. reciprocal translocation. b. partial trisomy. c. inversion. d. Down syndrome. ANS: B Partial trisomy is a condition in which only an extra portion of a chromosome is present in each cell. A reciprocal translocation occurs when breaks take place in two different chromosomes and the material is exchanged. An inversion occurs when two breaks take place on a chromosome, followed by the reinsertionof the missing fragment at its original site, but in inverted order. Down syndrome is an aneuploidy of the twenty-first chromosome. U S N T O REF: p. 46 10. After a geneticist talks to a patient about being a chromosomal mosaic, the patient asks the nurse what that means. How should the nurse respond? You may genetic disease(s). a. only be a carrier of the b. have a mild form of the c. have two d. be sterile as a result of the ANS: B A chromosomal mosaic means the body has two or more different cell lines, each of which has a different karyotype; thus, the person has a mild form of the disease. Mosaics are not only carriers; they have the disease; they have two different lines but not two different diseases; and they are not necessarily sterile. REF: p. 46 11. What is the most common cause of Down syndrome? a. Paternal nondisjunction b. Maternal translocations c. Maternal nondisjunction d. Paternal translocations ANS: C The most common cause of Down syndrome is maternal, not paternal, nondisjunction. Translocation is not a cause of this syndrome. REF: p. 46, Table 2-1 12. A patient wants to know the risk factors for Down syndrome. What is the nurse’s best response? a. Fetal exposure to mutagens in the uterus. b. Increased paternal age. c. Family history of Down syndrome. d. Pregnancy in women over age 35. 13 | P a g eANS: D The primary risk for Down syndrome is pregnancy in women over 35. Down syndrome is a trisomy and not due to fetal exposure or paternal age. Down syndrome is a chromosomal abnormality and is not related to family history. REF: pp. 46-47 13. A 13-year-old girl has a karyotype that reveals an absent homologous X chromosome with only a single X chromosome present. What medical diagnosis will the nurse observe on the chart? a. Down syndrome b. Cri du chat syndrome c. Turner syndrome d. Fragile X syndrome ANS: C A condition with the presence of a single X chromosome and no homologous X or Y chromosome, so the individual has a total of 45 chromosomes, is known as Turner syndrome. Down syndrome is a change in one arm of a chromosome. Cri du chat syndrome is due to a chromosome deletion. Fragile X syndrome is due to a break or a gap in a chromosome. REF: p. 47 14. What genetic disorder is the result if an individual possesses an XXY chromosome configuration? a. Turner b. Klinefelter c. Down d. Fragile X ANS: B Individuals with at least two X chromosomes and one Y chromosome in each cell (47 XXY karyotype) have a disorder known as Klinefelter syndrome. A condition with the presence of a single X chromosome and no homologous X or Y chromosome, so the individual has a total of 45 chromosomes, is known as Turner syndrome. Down syndrome is a trisomy. Fragile X syndrome is due to a break or a gap in a chromosome, not an extra chromosome. REF: p. 47 15. A patient demonstrates severe mental retardation caused by a deletion of part of chromosome 5. What genetic disorder will the nurse see documented in the chart? a. Prader-Willi syndrome b. Down syndrome c. Cri du chat syndrome d. Trisomy X ANS: C Cri du chat syndrome means “cry of the cat” and describes the characteristic cry of the affected child. Another symptom of the disorder is mental retardation. The disease is caused by a deletion of part of the short arm of chromosome 5. Prader-Willi syndrome is characterized by short stature, obesity, and hypogonadism. Down syndrome does cause mental retardation but is due to chromosome 21, not chromosome 5. Trisomy X can result in 14 | P a g emental retardation but is due to an extra X chromosome. REF: p. 48 16. An aide asks the nurse why people who have neurofibromatosis will show varying degrees of the disease. Which genetic principle should the nurse explain to the aide? a. Penetrance b. Expressivity c. Dominance d. Recessiveness ANS: B Expressivity is the extent of variation inphenotypeassociated with a particular genotype. For neurofibromatosis, a variety of manifestations occur among individuals. The penetrance of a trait is the percentage of individuals with a specific genotype who also exhibit the expected phenotype. Dominance refers to observable traits and risk of transmission. Recessiveness refers to silent strains with reduced risk of occurrence. U S N T O REF: p. 51 17. Cystic fibrosis is caused by what gene abnormality? a. X-linked dominant b. X-linked recessive c. Autosomal dominant d. Autosomal recessive ANS: D Cystic fibrosis is an autosomal recessive disorder. It is not a result of X links or dominant pathology. REF: p. 52 18. A 15-year-old female is diagnosed with Prader-Willi syndrome. This condition is an example of: a. genomic imprinting. b. an autosomal recessive trait. c. an autosomal dominant trait. d. a sex-linked trait. ANS: A Prader-Willi, an example of gene imprinting, is not associated with any autosomal sex-linked abnormality. REF: p. 52 19. A patient, age 9, is admitted to a pediatric unit with Duchenne muscular dystrophy. When planning care the nurse recalls the patient inherited this condition through a trait that is: a. X-linked dominant. b. X-influenced. c. X-limited. d. X-linked recessive. ANS: D Duchenne muscular dystrophy is a relatively common X-linked recessive, not dominant, 15 | P a g edisorder. While it is sex linked, it is not X-limited or X-influenced. REF: p. 55 20. A child is diagnosed with cystic fibrosis. History reveals that the child’s parents are siblings. Cystic fibrosis was most likely the result of: a. X-inactivation. b. genomic imprinting. c. consanguinity. d. obligate carriers. ANS: C Consanguinity refers to the mating of two related individuals, and the offspring of such matings are said to be inbred. Consanguineous matings produce a significant increase in recessive disorders and are seen most often in pedigrees for rare recessive disorders. X-inactivation occurs when one X chromosome in the somatic cells of females is permanently inactivated. Genomic imprinting is related to methylation and other changes. Obligate carriers are those who have an affected parent and affected children and, therefore, must themselves carry the mutation. REF: p. 54 21. A 12-year-old male is diagnosed with Klinefelter syndrome. His karyotype would reveal which of the following? a. XY b. XX c. XYY d. XXY ANS: D A person with Klinefelter syndrome has an XXY karyotype. An XY is a normal male. An XX is a normal female. An XYY is an aneuploid karyotype. REF: p. 47 22. To express a polygenic trait: a. genes must interact with the environment. b. several genes must act together. c. multiple mutations must occur in the same family. d. penetrance must occur. ANS: B Polygenic traits are those that result from several genes acting together. When environmental factors influence the expression of the trait, the term multifactorial inheritance is used. When multiple mutations occur in the same family, the mechanism most likely responsible is termed germline mosaicism. Penetrance of a trait is the percentage of individuals with a specific genotype who also exhibit the expected phenotype. REF: pp. 57-58 16 | P a g e23. What is the diagnosis of a 13-year-old female who has a karyotype that reveals an absent homologous X chromosome with only a single X chromosome present? Her features include a short stature, widely spaced nipples, and a reduced carrying angle at the elbow. a. Down syndrome b. Cri du chat syndrome c. Turner syndrome d. Klinefelter syndrome ANS: C Turner syndrome is characterized by short stature, female genitalia, webbed neck, shield-like chest with underdeveloped breasts and widely spaced nipples, and imperfectly developed ovaries. Down syndrome is characterized bydistinctive characteristics: low nasal bridge, epicanthal folds, protruding tongue, and low-set ears. Cri du chat syndrome is characterized by low birth weight, severe mental retardation, microcephaly (smaller than normal head size), and heart defects. Klinefelter syndrome is characterized by small testes, some development of the breasts, sparse body hair, and long limbs. REF: p. 46, Table 2-1 24. The gradual increase in height among the human population over the past 100 years is an example of: a. a polygenic trait. b. a multifactorial trait. c. crossing over. d. recombination. ANS: B The gradual increase in height is an example of multifactorial traits influenced by genes and also by environment. Polygenic traits result from several genes acting together. Crossing over is an abnormal chromosome structure. Recombination results from new arrangements of alleles. REF: p. 58 25. When discussing DNA replication, which enzyme is most important? a. RNA polymerase b. Transfer RNA c. Messenger RNA d. DNA polymerase ANS: D DNA polymerase, not RNA polymerase, is the primary enzyme involved in replication. It adds bases to the new DNA strand and performs “proofreading” functions. Neither messenger RNA nor transfer RNA is as important to DNA replication. REF: p. 39 26. The regions of the heterogeneous nuclear RNA that must be spliced out to form functional RNA are called: a. promoter sites. b. introns. c. exons. d. anticodon. 17 | P a g eANS: B When the mRNA is first transcribed from the DNA template, it reflects exactly the base sequence of the DNA. In eukaryotes, many RNA sequences are removed by nuclear enzymes, and the remaining sequences are spliced together to form the functional mRNA that migrates to the cytoplasm. The excised sequences are called introns (intervening sequences), and the sequences that are left to code for proteins are called exons. In translation, RNA directs the synthesis of a polypeptide, a cloverleaf-shaped strand of about 80 nucleotides. The tRNA molecule has a site where an amino acid attaches. The three-nucleotide sequence at the opposite side of the cloverleaf iscalledtheanticodon. REF: p. 41 27. A 50-year-old male was recently diagnosed with Huntington disease. Transmission of this disease is associated with: a. penetrance of a trait. b. recurrence risk. c. expressivity. d. delayed age of onset. ANS: D A key feature of Huntington disease is its delayed age of onset such that symptoms are not seen until 40 years of age or later. The penetrance of a trait is the percentage of individuals with a specific genotype who also exhibit the expected phenotype. Recurrence risk is the percentage of family members who will inherit the disease. Expressivity is the extent of variation in phenotype associated with a particular genotype. REF: p. 51 28. What type of mutation does not change the amino acid sequence and thus has no observable consequence? a. Frameshift b. Spontaneous c. Silent d. Missense ANS: C Silent mutations do not change the amino acid sequence and therefore have no consequences. Frameshift mutations involve the insertion or deletion of one or more base pairs of the DNA molecule. They alter the amino acid sequence. Spontaneous mutations occur in the absence of exposure to a mutagen and produce changes in the amino acid sequence. Missense mutations, a form of base pair substitution, alter amino acids, which produce a change (i.e., the “sense”) in a single amino acid. REF: p. 39 29. A nurse is reviewing the pedigree chart. When checking for a proband, what is the nurse looking for? a. The person who is first diagnosed with a genetic disease. b. The individual who has a disease gene but is phenotypically normal. c. The phenotype of genetic material. d. The codominance. 18 | P a g eANS: A The pedigree chart summarizes family relationships and shows which members of a family are affected by a genetic disease. The pedigree begins with the proband. The person who has a disease gene but is phenotypically normal is a carrier. The phenotype is the result of both genotype and environment; it is not a proband. Codominance is not represented by a proband, but it occurs when the heterozygote is distinguishable from both homozygotes. REF: p. 50 30. Which of the following disorders is manifested primarily in males? a. Cystic fibrosis b. Neurofibromatosis c. Muscular dystrophy d. Klinefelter syndrome ANS: C Muscular dystrophy is manifested primarily in males. Cystic fibrosis, neurofibromatosis, and Klinefelter syndrome are manifested in both males and females. REF: p. 55 MULTIPLE RESPONSE 1. When the nurse is teaching the staff about X-linked recessive disorders, which information should the nurse include? (select all that apply) a. The trait is seen much more often in females than in males. b. The trait is never transmitted from father to son. c. The gene can be transmitted through a series of carrier females. d. The gene is passed from an affected father to all his daughters. e. The trait never skips generations. ANS: B, C, D The principles of X-linked recessive inheritance include: the trait is seen much more often in males than in females; the trait is never transmitted from father to son; the gene can be transmitted through a series of carrier females; the gene is passed from an affected father to all his daughters, who, as phenotypically normal carriers, transmit it to approximately half their sons, who are affected. X-linked recessive disorders can skip generations since it is a one in four chance. REF: p. 55 Chapter 03: Epigenetics and Disease 19 | P a g eMULTIPLE CHOICE 1. When considering abnormal epigenetic modifications, what factor is currently being viewed as strongly associated with the development of some cancers? a. Family genetics b. Lifestyle choices c. Environmental stressors d. Emotional coping skills ANS: C Environmental stressors can markedly increase the risk of aberrant epigenetic modification and are strongly associated with some cancers. While genetics, lifestyle choices, and coping skills can affect the development and management of cancer, they are not currently considered as being the primary factors in the epigenetic modification that occurs. REF: p. 62 2. Housekeeping genes are vital to the function and maintenance of all the body’s cells. What characteristic is associated with these genes? a. They lack encoding histones. b. They are transcriptionally active. c. Ribosomal RNA genes are absent. d. Epigenetic silencing has occurred. ANS: B A small percentage of genes, termed housekeeping genes, are necessary for the function and maintenance of all cells. These genes escape epigenetic silencing and remain transcriptionally active in all or nearly all cells. Housekeeping genes include encoding histones, DNA and RNA polymerases, and ribosomal RNA genes. REF: p. 64 3. What characteristic of Prader-Willi syndrome is not a characteristic of Angelman syndrome? a. It is inherited from the father. b. Mental retardation is observable. c. Imprinting of an abnormal chromosome 15. d. Seizure disorder is present. ANS: A A well-known disease example of imprinting is associated with a deletion of about 4 million base (Mb) pairs of the long arm of chromosome 15. When this deletion is inherited from the father, the child manifests Prader-Willi syndrome, whose features include short stature, hypotonia, small hands and feet, obesity, mild to moderate mental retardation, and hypogonadism. The same 4 Mb deletion, when inherited from the mother, causes Angelman syndrome, which is characterized by severe mental retardation, seizures, and an ataxic gait. REF: p. 65 20 | P a g e4. Research has demonstrated that neural stem cells have an impaired ability to differentiate into functional neurons when subjected to: a. ethanol. b. marijuana. c. insufficient nutrients. d. poor oxygenation. ANS: A It has been found that treating cultured neural stem cells with ethanol impairs their ability to differentiate to functional neurons; this impairment seems to be correlated with aberrant, dense methylation at loci that are active in normal neuronal tissue. The research does not support the effects of marijuana, insufficient nutrition, or poor oxygenation on the stem cell’s ability to differentiate appropriately. REF: p. 67 5. What is the role of inactive MLH1 in the development of some forms of inherited colon cancer? a. Deletion of a nucleotide repeat in the DUX4 gene. b. DNA damage is left unrepaired. c. Expansion in the number of cytosine-guanine (CG) dinucleotide. d. Abnormalities of chromosome 11p15.5 that lead to downregulation of IGF2. ANS: B A major cause of one form of inherited colon cancer (hereditary nonpolyposis colorectal cancer [HNPCC]) is the methylation of the promoter region of a gene, MLH1, whose protein product repairs damaged DNA. WhenMLH1 becomes inactive, DNA damage accumulates, eventually resulting in colon tumors. Facioscapulohumeral muscular dystrophy (FSHMD) is associated with the DUX4 gene. Fragile X is associated with the cytosine-guanine (CG) dinucleotide. Downregulation of IGF2 is associated with Russell-Silver syndrome. REF: p. 69 6. Mutations in the encoding of histone-modifying proteins have been shown to influence the development of what congenial condition? a. Cleft palate b. Acephalous c. Heart disease d. Webbed digits ANS: C Mutations in genes that encode histone-modifying proteins have been implicated in congenital heart disease. Research has yet to provide a relationship between abnormal histone-modifying proteins and cleft palate, acephalous, and webbed digits. REF: p. 64 7. Which embryonic stem cell characteristic is referred to as totipotent? a. Ability to differentiate into any type of somatic cell. b. Ability to repair its own damaged DNA. c. Ability to determine which parental chromosome copy it will imprint. d. Ability to minimize the impact of poor in utero nutrition. 21 | P a g eANS: A Each of the cells in the very early embryo has the potential to give rise to a somatic cell of any type. These embryonic stem cells are therefore said to be totipotent (“possessing all powers”). The term totipotent does not infer the ability to repair damaged DNA, select specific chromosome copies, or adjust for poor in utero nutrition. REF: p. 64 8. 5-Azacytidine has demonstrated promise in the treatment of which form of cancer? a. Liver b. Colon c. Gallbladder d. Pancreatic ANS: D Though associated with various side effects, including digestive disturbance, 5-azacytidine has shown promise in the treatment of pancreatic cancer. There is no support for its use in the treatment of liver, colon, or gallbladder cancers. REF: p. 70 9. During which stage of human development does the role of epigenetics have the greatest impact on the development of epigenetic abnormalities? a. Infancy b. Puberty c. In utero d. Middle age ANS: C Conditions encountered in utero, during childhood, and even during adolescence or later can have long-term impacts on epigenetic states, which sometimes can be transmitted across generations. The impact is not supported for the periods of infancy, puberty, and middle age. REF: p. 66 10. What comorbid condition does an individual diagnosed with Beckwith-Wiedemann syndrome have an increased risk of developing? a. Cancer b. Diabetes c. Depression d. Food allergies ANS: A Beckwith-Wiedemann syndrome is accompanied by an increased predisposition to cancer. There is no current correlation between Beckwith-Wiedemann syndrome and diabetes, depression, or food allergies. REF: p. 65 MULTIPLE RESPONSE 22 | P a g e1. Screening tools that are epigenetically based have shown promise in diagnosing which types of cancer? (select all that apply) a. Colon b. Breast c. Skin d. Bladder e. Prostate ANS: A, B, D, E Monitoring for misregulation of miRNAs has shown promise as a tool for early diagnosis of cancers of the colon, breast, and prostate. Other epigenetics-based screening approaches have shown promise for detection of cancers of the bladder, lung, and prostate. Such screenings have not yet been developed for skin cancers. REF: p. 69 2. Research has provided support for the theory that epigenetic modifications can result from deficient in utero nutrition causing which chronic disease? (select all that apply) a. Obesity b. Asthma c. Cardiovascular disease d. Diabetes e. Crohn’s disease ANS: A, C, D When researchers sought to investigate how exposure to famine in utero had impacted individuals born in a historically prosperous country whose nutritional intake was dramatically impacted by WWII, they found that individuals who suffered nutritional deprivation in utero were more likely to suffer from obesity and diabetes as adults than individuals who had not experienced nutritional deprivation during gestation. Other data sets reveal elevated risk of cardiovascular and metabolic disease for offspring of individuals exposed during early development to fluctuations in agricultural yields. The research does support the development of asthma or Crohn’s disease. REF: p. 66 Chapter 04: Altered Cellular and Tissue Biology MULTIPLE CHOICE 1. A report comes back indicating that muscular atrophy has occurred. A nurse recalls that muscular atrophy involves a decrease in muscle cell: a. number. b. size. c. vacuoles. d. lipofuscin. ANS: B Atrophy is a decrease or shrinkage in cellular size. Hyperplasia is an increase in the number of cells. Vacuoles are membrane-bound vesicles within the cell that contain cellular debris and hydrolytic enzymes. Lipofuscin is the yellow-brown age pigment. 23 | P a g eREF: p. 74 2. During childhood, the thymus decreases in size, and this is referred to as what type of atrophy? a. Physiologic b. Pathologic c. Disuse d. Neurogenic ANS: A A normal decrease in cell size is physiologic atrophy. Atrophy can result from disease (pathologic), disuse, or nerve injury (neurogenic). REF: p. 74 3. When planning care for a cardiac patient, the nurse knows that in response to an increased workload, cardiac myocardial cells will experience hypertrophy which is an: a. increase in size. b. decrease in length. c. increase in excitability. d. decrease in number. ANS: A Hypertrophy is a compensatory increase in the size of cells in response to mechanical stimuli (also called mechanical load or stress, such as from stretching, repetitive, chronic, pressure, or volume overload) and consequently increases the size of the affected organ. The cells of the heart and kidneys are particularly prone to enlargement. A decrease in length is not associated with hypertrophy. A deficiency of electrolytes or minerals could lead to an increase in excitability; it is not due to increased workload or related to hypertrophy. A decrease in cell numbers is referred to as hypoplasia. REF: p. 75 4. A 55-year-old male with a 30-year history of smoking is examined for respiratory disturbance. Examination of his airway (bronchial) reveals that stratified squamous epithelial cells have replaced the normal columnar ciliated cells. This type of cellular adaptation is called: a. anaplasia. b. hyperplasia. c. metaplasia. d. dysplasia. ANS: C Metaplasia is the reversible replacement of one mature cell type by another, sometimes a less differentiated cell type. Anaplasia is loss of cellular differentiation. Hyperplasia is an increase in the number of cells resulting from an increased rate of cellular division. Dysplasia refers to abnormal changes in the size, shape, and organization of mature cells. REF: p. 77 5. When planning care for the pregnant patient, the nurse will recall that the mammary glands enlarge as a consequence of: a. compensatory hyperplasia. 24 | P a g eb. hormonal hyperplasia. c. hormonal anaplasia. d. compensatory anaplasia. ANS: B An increase in the mammary glands during pregnancy is a result of hormonal changes. The number of mammary cells increases in response to increased hormone levels, not as a compensatory mechanism. Anaplasia is a reversal to less mature cells. REF: p. 76 6. A 24-year-old female presents with excessive menstrual bleeding. The physician identified endometrial changes that are due to hormonal imbalances. These cellular changes would be referred to as: a. dysplasia. b. pathologic dysplasia. c. hyperplasia. d. pathologic hyperplasia. ANS: D Because the changes are due to an imbalance, they would be considered pathologic hyperplasia, a term more descriptive than simple hyperplasia. The endometrial changes were not abnormal in size and shape; thus, it is not dysplasia regardless of cause. REF: pp. 76-77 7. A 55-year-old male is diagnosed with hepatocellular cancer secondary to hepatitis C. If the cancerous region of the liver is removed, the remaining cells would undergo: a. pathologic hyperplasia. b. pathologic metaplasia. c. compensatory hyperplasia. d. compensatory aplasia. ANS: C Compensatory hyperplasia is an adaptive, not pathologic, mechanism that enables certain organs to regenerate. Metaplasia is the reversible replacement of one mature cell type by another, sometimes less differentiated, cell type. Aplasia is not a compensatory mechanism. REF: p. 76 8. A 40-year-old female’s Pap smear indicates abnormal changes in the shape and organization of cervical cells. Which term would be used to identify this type of change? a. Metaplasia b. Atrophy c. Hypertrophy d. Dysplasia ANS: D When cervical cells undergo dysplasia, there is a change in their size, shape, and organization. Metaplasia is the reversible replacement of one mature cell type. The cells have not decreased in size; therefore, atrophy is incorrect. The cells have not increased in size in response to stimuli; therefore, they have not hypertrophied. 25 | P a g eREF: p. 77 9. A 75-year-old male presents with chest pain on exertion. The chest pain is most likely due to hypoxic injury secondary to: a. malnutrition. b. free radicals. c. ischemia. d. chemical toxicity. ANS: C The cardiac cells are deprived of oxygen, leading to ischemia, a reduction in blood supply to tissues. The cells are deprived of oxygen; they are not malnourished. Free radicals are electrically uncharged atoms or groups of atoms that have an unpaired electron. Chemical toxicity is not a factor in the chest pain. REF: pp. 78-79 10. A patient has a heart attack that leads to progressive cell injury that causes cell death with severe cell swelling and breakdown of organelles. What term would the nurse use to define this process? a. Adaptation b. Calcification c. Apoptosis d. Necrosis ANS: D Necrosis is the sum of cellular changes after local cell death. Cellular adaptation is a reversible, structural, or functional response to both normal or physiologic conditions and adverse or pathologic conditions. Calcification is an accumulation of calcium salts. Apoptosis is an active process of cellular self-destruction. REF: p. 78, Table 4-1 11. Sodium and water accumulation in an injured cell are a direct result of: a. decreased ATP production. b. karyorrhexis. c. ribosome detachment. d. dehydration. ANS: A A reduction in ATP levels causes the plasma membrane’s sodium-potassium (Na+-K+) pump and sodium-calcium exchange to fail. Sodium and water can then enter the cell freely. Karyorrhexis means fragmentation of the nucleus into smaller particles or “nuclear dust.” Ribosome detachment reduces protein synthesis. Dehydration leads to loss of sodium and water. REF: p. 80 12. The early dilation (swelling) of the cell’s endoplasmic reticulum results in: a. increased aerobic metabolism. 26 | P a g eb. failure of DNA. c. reduced protein synthesis. d. increased Na+-K+ pump function. ANS: C Early dilation of the endoplasmic reticulum causes the ribosomes to detach from the rough endoplasmic reticulum, reducing protein synthesis. Aerobic metabolism is a normal process and would not lead to swelling. Cellular swelling will not alter cellular DNA. A reduction in the Na+-K+ pump leads to an intracellular accumulation of sodium and calcium and diffusion of potassium out of the cell. Sodiumandwater can then enter the cell freely, and cellular swelling results. REF: p. 80 13. A 52-year-old male suffered a myocardial infarction secondary to atherosclerosis and ischemia. Once blood flow is returned to the damaged heart, reperfusion injury occurs as a result of: a. oxidation stress. b. vacuolation. c. decreased intracellular calcium. d. lipid acceptor proteins. ANS: A Reperfusion injury can result from oxidative stress, increased intracellular calcium, inflammation, or complement activation. Oxidative stress causes the formation of radicals that cause further membrane damage and mitochondrial calcium overload. Vacuolation leads to cellular swelling but is not associated with reperfusion. An increase of intracellular calcium is a cause of reperfusion injury. Lipid acceptor proteins bind with triglycerides to create fatty liver, and they do not affect the myocardium. REF: p. 81 14. A family presents to their primary care provider reporting headache, nausea, weakness, tinnitus, and vomiting. Which of the following would be the most likely explanation for these symptoms? a. Lead exposure b. Carbon monoxide poisoning c. Ethanol exposure d. Mercury poisoning ANS: B Symptoms related to carbon monoxide poisoning include headache, giddiness, tinnitus (ringing in the ears), nausea, weakness, and vomiting. Although nausea and vomiting can occur with lead exposure, lead toxicity is primarily manifested by convulsions and delirium and, with peripheral nerve involvement, wrist, finger, and sometimes foot paralysis. Ethanol exposure has CNS effects and would not affect the whole family. Mercury poisoning is manifested by CNS effects and would not lead to nausea and vomiting. REF: p. 90 15. A common pathway of irreversible cell injury involves increased intracellular: a. sodium. b. potassium. 27 | P a g ec. magnesium. d. calcium. ANS: D Increased intracellular calcium levels activate cell enzymes (caspases) that promote cell death by apoptosis. Persistent ischemia is associated with irreversible injury and necrosis. Irreversible injury is associatedstructurally withsevere swelling of the mitochondria, severe damage to plasma membranes, and swelling of lysosomes. Cellular injury is not associated with sodium, potassium, or magnesium levels. REF: p. 81 16. A 50-year-old male sustained a closed head injury as a result of a motor vehicle accident. CT scan revealed a collection of blood between the inner surface of the dura mater and the surface of the brain. Which type of injury will the nurse be caring for? a. Subdural hematoma b. Epidural hematoma c. Contusion d. Abrasion ANS: A A subdural hematoma occurs when blood is between the inner surface of the dura mater and the surface of the brain; it can result from blows, falls, or sudden acceleration/deceleration of the head. An epidural hematoma is a collection of blood between the inner surface of the skull and the dura; it is most often associated with a skull fracture. A contusion is bleeding into the skin or underlying tissues. An abrasion (scrape) results from removal of the superficial layers of the skin caused by friction between the skin and injuring object. REF: p. 94, Table 4-8 17. A 20-year-old male presents to the emergency department with a jagged sharp-force injury that is longer than it is deep. Which type of wound will the nurse be caring for? a. Stab wound b. Incised wound c. Puncture wound d. Chopping wound ANS: B An incised wound is a cut that is longer than it is deep. A stab wound is a penetrating sharp-force injury that is deeper than it is long. A puncture wound is without sharp edges and is made with an instrument like a nail. Heavy, edged instruments (axes, hatchets, propeller blades) produce wounds with a combination of sharp and blunt force characteristics. REF: p. 94, Table 4-8 18. A 30-year-old female presents with a gunshot wound to the head. The wound has seared edges and a deep penetration of smoke and gunpowder fragments. This wound would be documented as a(n): a. exit. b. intermediate range entrance. c. contact range entrance. d. indeterminate range entrance. ANS: C 28 | P a g eA contact range entrance wound is a distinctive type of wound that happens when a gun is held so the muzzle rests on or presses into the skin surface; in addition to the hole, there is searing of the edges of the wound from flame and soot or smoke on the edges of the wound. It is unlikely it is an exit woundsincethereis onlyone wound and it has seared edges and gunpowder fragments. An intermediate range entrance wound is surrounded by gunpowder tattooing or stippling. An indeterminate range entrance wound occurs when flame, soot, or gunpowder does not reach the skin surface but the bullet does. REF: p. 95, Table 4-8 19. A 15-year-old female presents to the ER following a physical assault. She has internal damage to the neck with deep bruising. X-ray reveals fractures of the hyoid bone and tracheal and cricoid cartilage. Which of the following most likely caused her injuries? a. Chemical asphyxiation b. Choking asphyxiation c. Ligature strangulation d. Manual strangulation ANS: D Squeezing of the neck as with strangulation would fraction the hyoid bone. Chemical asphyxiation would lead to breathing problems but would not result in fracture. Choking asphyxiation would lead to swelling of tissues but would not result in fracture. In ligature strangulation, the mark on the neck is horizontal without the inverted V pattern seen in hangings. It would not lead to fracture. REF: p. 96 20. A 55-year-old male has swelling of the feet. Which of the following aided in the development of swelling? a. Increased ATP b. Chloride movement out of the cell c. Na+ movement into the cell d. Decreased oncotic pressure ANS: C When sodium and water enter the cell freely, cellular swelling, as well as early dilation of the endoplasmic reticulum, results. Decreased ATP would lead to swelling. Chloride movement out of the cell would affect muscle contraction but does not lead to swelling. Increased oncotic pressure would not affect swelling. REF: p. 97 21. A 35-year-old female is diagnosed with multiple myeloma. Biopsy of the tumor reveals Russell bodies, and laboratory testing reveals kidney dysfunction. Which substance should the nurse monitor as it is accumulating in the patient’s body? a. Glycogen b. Protein c. Pigment d. Melanin ANS: B Russell bodies occur due to excess aggregates of protein. Excess glycogen would affect blood glucose. Increased pigment would not lead to kidney dysfunction. Melanin accumulates in 29 | P a g eepithelial cells (keratinocytes) of the skin and retina. REF: p. 99 22. A newborn male is diagnosed with albinism based on skin, eye, and hair appearance. Which finding will support this diagnosis? a. Increased melanin b. Increased hemoproteins c. Inability to convert tyrosine to DOPA (3,4-dihydroxyphenylalanine) d. Inability to convert bile to bilirubin ANS: C The person with albinism is unable to convert tyrosine to DOPA, an intermediate in melanin biosynthesis. An increase in melanin would cause skin to be darker. Hemoprotein accumulations in cells are caused by excessive storage of iron, which is transferred to the cells from the bloodstream. An inability to convert bile to bilirubin would not lead to albinism. REF: p. 100 23. A 23-year-old male develops a black eye following a fight. When the aide asks the nurse why this occurred, the nurse’s best response is that the bruising is due to an accumulation of: a. transferrin. b. bilirubin. c. albumin. d. hemosiderin. ANS: D Hemosiderin is responsible for the color changes in a black eye. Transferrin is a transport protein responsible for iron transport. Bilirubin is the normal, yellow-to-green pigment of bile derived from the porphyrin structure of hemoglobin. Albumin is the protein in the serum, responsible for cellular integrity. REF: p. 100 24. Liquefactive necrosis occurs in the brain because: a. debris is not digested by hydrolases. b. of protein denaturation. c. it is rich in hydrolytic enzymes and lipids. d. ischemia results in chemical injury. ANS: C Liquefactive necrosis is due to enzymatic action and because cells of the brain are rich in enzymes. Protein denaturation occurs primarily in the kidneys. Liquefactive necrosis is due to enzymatic reaction and not to hypoxia or hydrolases. REF: p. 103 25. A 2-year-old swallowed watch batteries. Following ingestion, kidney function was impaired, and the heart began to fail. Which of the following was the most likely cause? a. Karyorrhexis b. Coagulative necrosis c. Ammonia accumulation d. Caseous necrosis 30 | P a g eANS: B Coagulative necrosis occurs primarily in the kidneys, heart, and adrenal glands and commonly results from hypoxia. Karyorrhexis means fragmentation of the nucleus into smaller particles or “nuclear dust.” Ammonia accumulation is not associated with this toxicity. Caseous necrosis results from tuberculosis pulmonary infection. REF: pp. 102-103 26. A group of prison inmates developed tuberculosis following exposure to an infected inmate. On examination, tissues were soft and granular (like clumped cheese). Which of the following is the most likely cause? a. Coagulative necrosis b. Liquefactive necrosis c. Caseous necrosis d. Autonecrosis ANS: C Caseous necrosis results from tuberculosis pulmonary infection. Coagulative necrosis occurs primarily in the kidneys, heart, and adrenal glands, and commonly res