Sample Chapter



 Essentials Of Pathophysiology 3rd Edition By Carol Mattson Porth – Test Bank 


1. The nucleus _________, which is essential for function and survival of the cell.
A) is the site of protein synthesis
B) contains the genetic code
C) transforms cellular energy
D) initiates aerobic metabolism



2. Although energy is not made in mitochondria, they are known as the “power plants” of the cell because they:
A) contain RNA for protein synthesis.
B) utilize glycolysis for oxidative energy.
C) extract energy from organic compounds.
D) store calcium bonds for muscle contractions.



3. Although the basic structure of the cell plasma membrane is formed by a lipid bilayer, most of the specific membrane functions are carried out by:
A) bound and transmembrane proteins.
B) complex, long carbohydrate chains.
C) surface antigens and hormone receptors.
D) a gating system of selective ion channels.



4. To effectively relay signals, cell-to-cell communication utilizes chemical messenger systems  that:
A) displace surface receptor proteins.
B) accumulate within cell gap junctions.
C) bind to contractile microfilaments.
D) release secretions into extracellular fluid.



5. Aerobic metabolism, also known as oxidative metabolism, provides energy by:
A) removing the phosphate bonds from ATP.
B) combining hydrogen and oxygen to form water.
C) activating pyruvate stored in the cytoplasm.
D) breaking down glucose to form lactic acid.



6. Exocytosis, the reverse of endocytosis, is important in _______ into the extracellular fluid.
A) Engulfing and ingesting fluid and proteins for transport
B) Killing, degrading, and dissolving harmful microorganisms
C) Removing cellular debris and releasing synthesized substances
D) Destruction of particles by lysosomal enzymes for secretion



7. The process responsible for generating and conducting membrane potentials is:
A) diffusion of current-carrying ions.
B) millivoltage of electrical potential.
C) polarization of charged particles.
D) ion channel neurotransmission.



8. Epithelial tissues are classified according to the shape of the cells and the number of layers. Which of the following is a correctly matched description and type of epithelial tissue?
A) Simple epithelium: cells in contact with intercellular matrix; some do not extend to surface
B) Stratified epithelium: single layer of cells; all cells rest on basement membrane
C) Glandular epithelium: arise from surface epithelia and underlying connective tissue
D) Pseudostratified epithelium: multiple layers of cells; deepest layer rests on basement membrane



9. Connective tissue contains fibroblasts that are responsible for:
A) providing a fibrous framework for capillaries.
B) synthesis of collagen, elastin, and reticular fibers.
C) forming tendons and the fascia that covers muscles.
D) filling spaces between tissues to keep organs in place.



10. Although all muscle tissue cells have some similarities, smooth muscle (also known as involuntary muscle) differs by:
A) having dense bodies attached to actin filaments.
B) containing sarcomeres between Z lines and M bands.
C) having rapid contractions and abundant cross-striations.
D) contracting in response to increased intracellular calcium.



11. Which of the following aspects of the function of the nucleus is performed by ribosomal RNA (rRNA)?
A) Copying and carrying DNA instructions for protein synthesis
B) Carrying amino acids to the site of protein synthesis
C) Providing the site where protein synthesis occurs
D) Regulating and controlling protein synthesis



12. Breakdown and removal of foreign substances and worn-out cell parts are performed by which of the following organelles?
A) Lysosomes
B) Golgi apparatus
C) Ribosomes
D) Endoplasmic reticulum (ER)



13. Impairment in the function of peroxisomes would result in:
A) inadequate sites for protein synthesis.
B) an inability to transport cellular products across the cell membrane.
C) insufficient energy production within a cell.
D) accumulation of free radicals in the cytoplasm.



14. After several months of trying to conceive, a couple is undergoing fertility testing. Semen analysis indicates that the man’s sperm have decreased motility, a finding that is thought to underlie the couple’s inability to become pregnant. Which of the following cellular components may be defective within the man’s sperm?
A) Ribosomes
B) Microtubules
C) Mitochondria
D) Microfilaments



15. Which of the following statements is true of glycolysis?
A) Glycolysis requires oxygen.
B) Glycolysis occurs in cells without mitochondria.
C) Glycolysis provides the majority of the body’s energy needs.
D) Glycolysis produces energy, water, and carbon dioxide.



16. Which of the following membrane transport mechanisms requires the greatest amount of energy?
A) Facilitated diffusion
B) Passive transport
C) Vesicular transport
D) Simple diffusion



17. A male patient with a diagnosis of type 1 diabetes mellitus is experiencing hyperglycemia because he lacks sufficient insulin to increase the availability of glucose transporters in his cell membranes. Consequently, his cells lack intracellular glucose and it accumulates in his blood. Which of the following processes would best allow glucose to cross his cell membranes?
A) Facilitated diffusion
B) Simple diffusion
C) Secondary active transport
D) Endocytosis



18. Which of the following statements is true of skeletal muscle cells?
A) Skeletal muscle cells each have an apical, lateral, and basal surface.
B) They are closely apposed and are joined by cell-to-cell adhesion molecules.
C) Their basal surface is attached to a basement membrane.
D) Skeletal muscle is multinucleated, lacking true cell boundaries.



19. Which of the following body tissues exhibits the highest rate of turnover and renewal?
A) The squamous epithelial cells of the skin
B) The connective tissue supporting blood vessels
C) The skeletal muscle that facilitates movement
D) The nervous tissue that constitutes the central nervous system



20. A patient with a pathophysiologic condition that affects the desmosomes is most likely to exhibit:
A) impaired contraction of skeletal and smooth muscle.
B) weakness of the collagen and elastin fibers in the extracellular space.
C) impaired communication between neurons and effector organs.
D) separation at the junctions between epithelial cells.




1. Ischemia and other toxic injuries increase the accumulation of intracellular calcium as a result of:
A) release of stored calcium from the mitochondria.
B) improved intracellular volume regulation.
C) decreased influx across the cell membrane.
D) attraction of calcium to fatty infiltrates.



2. The patient is found to have liver disease, resulting in the removal of a lobe of his liver. Adaptation to the reduced size of the liver leads to ___________ of the remaining liver cells.
A) metaplasia
B) organ atrophy
C) compensatory hyperplasia
D) physiologic hypertrophy



3. A person eating peanuts starts choking and collapses. His airway obstruction is partially cleared, but he remains hypoxic until he reaches the hospital. The prolonged cell hypoxia caused a cerebral infarction and resulting __________ in the brain.
A) caspase activation
B) coagulation necrosis
C) rapid phagocytosis
D) protein p53 deficiency



4. Bacteria and viruses cause cell damage by _______, which is unique from the intracellular damage caused by other injurious agents.
A) disrupting the sodium/potassium ATPase pump
B) interrupting oxidative metabolism processes
C) replicating and producing continued injury
D) decreasing protein synthesis and function



5. The patient has a prolonged interruption in arterial blood flow to his left kidney, causing hypoxic cell injury and the release of free radicals. Free radicals damage cells by:
A) destroying phospholipids in the cell membrane.
B) altering the immune response of the cell.
C) disrupting calcium storage in the cell.
D) inactivation of enzymes and mitochondria.



6. Injured cells have impaired flow of substances through the cell membrane as a result of:
A) increased fat load.
B) altered permeability.
C) altered glucose utilization.
D) increased surface receptors.



7. Reversible adaptive intracellular responses are initiated by:
A) stimulus overload.
B) genetic mutations.
C) chemical messengers.
D) mitochondrial DNA.



8. Injured cells become very swollen as a result of:
A) increased cell protein synthesis.
B) altered cell volume regulation.
C) passive entry of potassium into the cell.
D) bleb formation in the plasma membrane.



9. A diabetic patient has impaired sensation, circulation, and oxygenation of his feet. He steps on a piece of glass, the wound does not heal, and the area tissue becomes necrotic. The necrotic cell death is characterized by:
A) rapid apoptosis.
B) cellular rupture.
C) shrinkage and collapse.
D) chronic inflammation.



10. A 99-year-old woman has experienced the decline of cell function associated with age. A group of theories of cellular aging focus on programmed:
A) changes with genetic influences.
B) elimination of cell receptor sites.
C) insufficient telomerase enzyme.
D) DNA mutation or faulty repair.



11. An 89-year-old female patient has experienced significant decreases in her mobility and stamina during a 3-week hospital stay for the treatment of a femoral head fracture. Which of the following phenomena most likely accounts for the patient’s decrease in muscle function that underlies her reduced mobility?
A) Impaired muscle cell metabolism resulting from metaplasia
B) Dysplasia as a consequence of inflammation during bone remodeling
C) Disuse atrophy of muscle cells during a prolonged period of immobility
D) Ischemic atrophy resulting from vascular changes while on bedrest



12. A 20-year-old college student has presented to her campus medical clinic for a scheduled Papanicolaou (Pap) smear. The clinician who will interpret the smear will examine cell samples for evidence of:
A) changes in cell shape, size, and organization.
B) the presence of unexpected cell types.
C) ischemic changes in cell samples.
D) abnormally high numbers of cells in a specified field.



13. Which of the following pathophysiologic processes is most likely to result in metastatic calcification?
A) Benign prostatic hyperplasia
B) Liver cirrhosis
C) Impaired glycogen metabolism
D) Hyperparathyroidism



14. Despite the low levels of radiation used in contemporary radiologic imaging, a radiology technician is aware of the need to minimize her exposure to ionizing radiation. What is the primary rationale for the technician’s precautions?
A) Radiation stimulates pathologic cell hypertrophy and hyperplasia.
B) Radiation results in the accumulation of endogenous waste products in the cytoplasm.
C) Radiation interferes with DNA synthesis and mitosis.
D) Radiation decreases the action potential of rapidly dividing cells.



15. The parents of a 4-year-old girl have sought care because their daughter has admitted to chewing and swallowing imported toy figurines that have been determined to be made of lead. Which of the following blood tests should the care team prioritize?
A) White blood cell levels with differential
B) Red blood cell levels and morphology
C) Urea and creatinine levels
D) Liver function panel



16. A 70-year-old male patient has been admitted to a hospital for the treatment of a recent hemorrhagic stroke that has left him with numerous motor and sensory deficits. These deficits are most likely the result of which of the following mechanisms of cell injury?
A) Free radical injury
B) Hypoxia and ATP depletion
C) Interference with DNA synthesis
D) Impaired calcium homeostasis



17. Which of the following processes associated with cellular injury is most likely to be reversible?
A) Cell damage resulting from accumulation of fat in the cytoplasm
B) Cellular changes as a result of ionizing radiation
C) Cell damage from accumulation of free radicals
D) Apoptosis



18. The extrinsic pathway of apoptosis can be initiated by:
A) damage to cellular DNA.
B) decreased ATP levels.
C) activation of the p53 protein.
D) activation of death receptors on the cell surface.



19. A patient with severe peripheral vascular disease has developed signs of dry gangrene on the great toe of one foot. Which of the following pathophysiologic processes most likely contributed to this diagnosis?
A) Inappropriate activation of apoptosis
B) Bacterial invasion
C) Impaired arterial blood supply
D) Metaplastic cellular changes



20. Which of the following facts underlies the concept of replicative senescence?
A) Genes controlling longevity are present or absent in varying quantities among different individuals.
B) Telomeres become progressively shorter in successive generations of a cell.
C) The damaging influence of free radicals increases exponentially in later generations of a cell.
D) Aging produces mutations in DNA and deficits in DNA repair.




1. The characteristic, localized cardinal signs of acute inflammation include:
A) fever.
B) fatigue.
C) redness.
D) granuloma.



2. The vascular, hemodynamic stage of acute inflammation is initiated by momentary vasoconstriction followed by vasodilation that causes localized:
A) bleeding.
B) congestion.
C) pale skin.
D) coolness.



3. The cellular stage of acute inflammation is marked by the movement of leukocytes into the area. Which of the following cells arrives early in great numbers?
A) Basophils
B) Lymphocytes
C) Neutrophils
D) Platelets



4. The phagocytosis process involves three distinct steps. What is the initial step in the process?
A) Engulfment
B) Intracellular killing
C) Antigen margination
D) Recognition and adherence



5. Which of the following mediators of inflammation causes increased capillary permeability and pain?
A) Serotonin
B) Histamine
C) Bradykinin
D) Nitric oxide



6. Inflammatory exudates are a combination of several types. Which of the following exudates is composed of enmeshed necrotic cells?
A) Serous
B) Fibrinous
C) Suppurative
D) Membranous



7. The acute-phase systemic response usually begins within hours of the onset of inflammation and includes:
A) fever and lethargy.
B) decreased C-reactive protein.
C) positive nitrogen balance.
D) low erythrocyte sedimentation rate.



8. In contrast to acute inflammation, chronic inflammation is characterized by which of the following phenomena?
A) Profuse fibrinous exudation
B) A “shift to the left” of granulocytes
C) Metabolic and respiratory alkalosis
D) Lymphocytosis and activated macrophages



9. Exogenous pyrogens (interleukin-1) and the presence of bacteria in the blood lead to the release of endogenous pyrogens that:
A) stabilize thermal control in the brain.
B) produce leukocytosis and anorexia.
C) block viral replication in cells.
D) inhibit prostaglandin release.



10. An older adult patient has just sheared the skin on her elbow while attempted to boost herself up in bed, an event that has precipitated acute inflammation in the region surrounding the wound. Which of the following events will occur during the vascular stage of the patient’s inflammation?
A) Outpouring of exudate into interstitial spaces
B) Chemotaxis
C) Accumulation of leukocytes along the epithelium
D) Phagocytosis of cellular debris



11. Which of the following individuals most likely has the highest risk of experiencing chronic inflammation?
A) A patient who has recently been diagnosed with type 2 diabetes
B) A patient who is a carrier of an antibiotic-resistant organism
C) A patient who is taking oral antibiotics for an upper respiratory infection
D) A patient who is morbidly obese and who has a sedentary lifestyle



12. Which of the following core body temperatures is within normal range?
A) 35.9°C (96.6°F)
B) 38.0°C (100.4°F)
C) 35.5°C (95.9°F)
D) 37.3°C (99.1°F)



13. A postsurgical patient who is recovering in the postanesthetic recovery unit states that she is “freezing cold.” Which of the following measures is likely to be initiated in the patient’s hypothalamus in an effort to reduce heat loss?
A) Opening of arteriovenous (AV) shunts
B) Reduced exhalation of warmed air
C) Contraction of pilomotor muscles
D) Decreased urine production



14. An elderly patient is dressed only in a hospital gown and complains of a draft in her room. Consequently, she has requested a warm blanket while she sits in her wheelchair. Which of the following mechanisms of heat loss is most likely the primary cause of her request?
A) Evaporation and conduction
B) Radiation and convection
C) Conduction and convection
D) Convection and evaporation



15. Which of the following pathophysiologic processes are capable of inducing the production of pyrogens? Select all that apply.
A) Acute inflammation
B) Obesity
C) Myocardial infarction
D) Malignancy
E) Renal failure



16. Which of the following patients is most likely to be susceptible to developing a neurogenic fever?
A) A patient who has stage II Alzheimer disease
B) A patient who has sustained a head injury in a bicycle crash
C) A patient who has become delirious after the administration of a benzodiazepine
D) A patient who has begun taking a selective serotonin-reuptake inhibitor (SSRI) for the treatment of depression



17. Patients are commonly administered antipyretics when their oral temperature exceeds 37.5°C (99.5°F). Which of the following statements related to the rationale for this action is most accurate?
A) Temperatures in excess of 37.5°C (99.5°F) can result in seizure activity.
B) Lower temperatures inhibit the protein synthesis of bacteria.
C) There is little empirical evidence for this treatment modality.
D) Most common antipyretics have been shown to have little effect on core temperature.



18. A patient has sought care because of recent malaise and high fever. Upon assessment, the patient states that his current fever began two days earlier, although he states that for the last 2 weeks he is in a cycle of high fever for a couple of days followed by a day or two of normal temperature. Which of the following fever patterns is this patient experiencing?
A) Recurrent fever
B) Remittent fever
C) Sustained fever
D) Intermittent fever



19. A febrile, 3-week-old infant has been brought to the emergency department by his parents and is currently undergoing a diagnostic workup to determine the cause of his fever. Which of the following statements best conveys the rationale for this careful examination?
A) The immature hypothalamus is unable to perform normal thermoregulation.
B) Infants are susceptible to serious infections because of their decreased immune function.
C) Commonly used antipyretics often have no effect on the core temperature of infants.
D) Fever in neonates is often evidence of a congenital disorder rather than an infection.



20. An 84-year-old patient’s blood cultures have come back positive, despite the fact that his oral temperature has remained within normal range. Which of the following phenomena underlies the alterations in fever response that occur in the elderly?
A) Disturbance in the functioning of the thermoregulatory center
B) Increased heat loss by evaporation
C) The presence of comorbidities that are associated with lowered core temperature
D) Persistent closure of arteriovenous shunts
1. Epithelialization, the first component of the proliferative phase of wound healing, is delayed in open wounds until after ________ has formed.
A) granulation tissue
B) fibrinous meshwork
C) capillary circulation
D) collagenous layers



2. A mutation has occurred during mitosis of an individual’s bone marrow cell. This event may be the result of the failure of which of the following?
A) Progenitor cells
B) Fibroblasts
C) Stem cells
D) Cyclins



3. A patient has experienced a myocardial infarction with accompanying necrosis of cardiac muscle, a permanent tissue. What are the ramifications of the fact that cardiac muscle is a permanent tissue?
A) The cardiac muscle cells will remain perpetually in the G1 stage of mitosis.
B) Regeneration of the patient’s cardiac muscle will be exceptionally slow.
C) The necrotic cells will be replaced with muscle cells that have limited metabolism.
D) The cells will not proliferate and will be replaced with scar tissue.



4. A couple have chosen to pay for the harvesting and storage of umbilical cord blood after the delivery of their child to secure a future source of embryonic stem cells. What is the most likely rationale for the couple’s decision?
A) The stem cells may be able to produce a wide range of body cells.
B) The embryonic stem cells allow stable and permanent tissues to enter mitosis.
C) The stem cells can change the proliferative capacity of other cells.
D) The embryonic stem cells remove cyclin-dependent kinase inhibitors from the body.



5. The basement membrane surrounding a patient’s foot wound remains intact, a fact that bodes well for the wound-healing process. Which of the following components constitute this form of the extracellular matrix? Select all that apply.
A) Prostaglandins
B) Fibrous structural proteins
C) Lymphocytes
D) Water-hydrated gels
E) Glycoproteins



6. A nursing student is cleaning and changing the dressing on a patient’s sacral ulcer. The student has vigorously cleansed the wound bed to remove all traces of the beefy, red tissue that existed in the wound bed. The student has most likely removed:
A) Necrotic tissue
B) Granulation tissue
C) Stem cells
D) The extracellular matrix



7. A 12-year-old boy’s severe wound that he received from a dog bite has begun to heal and currently shows no signs of infection. Which of the following processes occurred first during this process of repair by connective tissue deposition?
A) Reorganization of fibrous tissue
B) Angiogenesis
C) Emigration of fibroblasts to the wound site
D) Deposition of the extracellular matrix



8. Which of the following wounds is most likely to heal by secondary intention?
A) A finger laceration that a cook received while cutting up onions
B) A boy’s “road rash” that he got by falling off his bicycle
C) A needlestick injury that a nurse received when injecting a patient’s medication
D) The incision from a teenager’s open appendectomy



9. A patient underwent an open cholecystectomy 4 days ago and her incision is now in the proliferative phase of healing. What is the dominant cellular process that characterizes this phase of the patient’s healing?
A) Hemostasis and vasoconstriction
B) Keloid formation
C) Collagen secretion by fibroblasts
D) Phagocytosis by neutrophils



10. Which of the following surgical patients is most likely to experience enhanced wound healing as a result of his or her diet?
A) A patient who eats a high-calorie diet and large amounts of red meat
B) A patient who is a vegetarian and who eats organic foods whenever possible
C) A patient who practices carefully calorie control and who avoids animal fats
D) A patient who is receiving total parenteral nutrition due to recurrent nausea



11. Which of the following patients is most likely to experience impaired wound healing?
A) A patient with a diagnosis of type 1 diabetes and a history of poor blood sugar control
B) A child whose severe cleft lip and palate have required a series of surgeries over several months
C) A patient who takes nebulized bronchodilators several times daily to treat chronic obstructive pulmonary disease
D) A patient with persistent hypertension who takes a b-adrenergic blocker and a potassium-wasting diuretic daily


1. Triplet codes of three bases are the genetic codes used in transmitting genetic information necessary for:
A) chromatin formation.
B) protein synthesis.
C) enzyme activation.
D) nucleotide bonding.



2. Unlike messenger RNA (mRNA) and transfer RNA (tRNA), ribosomal RNA (rRNA):
A) is produced in the nucleolus.
B) delivers activated amino acids.
C) is formed by transcription.
D) coordinates RNA translation.



3. Splicing of mRNA during processing permits a cell to:
A) form different proteins.
B) increase DNA content.
C) stop copying DNA onto RNA.
D) add nucleic acid end pieces.



4. When an infant is born with gene mutations in his/her cells, the errors may be a result of all of the following except _____________ of base pairs.
A) deletion
B) substitution
C) differentiation
D) rearrangement



5. Identifying the genetic sex of a child is based on finding intracellular Barr bodies that consist of:
A) inactive chromatin material.
B) male-specific chromosomes.
C) homologous chromosomes.
D) excess autosomal material.



6. Multifactorial inheritance is similar to polygenic inheritance because both involve:
A) environmental effects on alleles.
B) multiple alleles at different loci.
C) predictable somatic allele effects.
D) homozygous pairing of two alleles.



7. Crossing over of chromatid segments during meiosis division 1 results in:
A) spontaneous gene mutations.
B) initial DNA synthesis.
C) bivalent X and Y genes.
D) new gene combinations.



8. During the transcription process, RNA:
A) polymerase attaches to DNA.
B) exon sequences are reversed.
C) delivers activated amino acids.
D) reverses redundant base pairs.



9. The process of gene expression is increased by:
A) mutation of normal suppressor genes.
B) induction by an external influence.
C) repression of internal penetrance.
D) activation of growth control genes.



10. Gene therapy, insertion of genes into the genome of multicellular organisms, is accomplished by:
A) restriction enzymes.
B) transferring genes.
C) DNA fragment separation.
D) cross-over gene exchange.



11. Which of the following statements is true of genetic mutations?
A) Errors in DNA duplication are normally irreparable.
B) Mutations that occur in somatic cells are inheritable.
C) Mutations may result from extrinsic factors or from spontaneous error.
D) Errors in DNA replication are most often fatal.



12. Individual differences in appearance, behavior, and disease susceptibility are a result of:
A) karyotyping.
B) mutations.
C) DNA repair.
D) a haplotype.



13. Which of the following statements is true of messenger RNA (mRNA)?
A) mRNA is produced in the nucleolus.
B) mRNA provides the template for protein synthesis.
C) Each mRNA molecule has two recognition sites.
D) mRNA delivers the activated form of an amino acid to the protein being synthesized.



14. Prenatal genetic testing that counts the number of Barr bodies in a chromosome is able to determine:
A) the genetic sex of a child.
B) susceptibility to hemophilia B.
C) the presence of fragile X syndrome.
D) fetal viability.



15. The gene responsible for a particular congenital cardiac anomaly is said to have complete penetrance. What are the clinical implications of this fact?
A) The anomaly is a result of polygenetic inheritance.
B) The heart defect does not result from any other gene.
C) Multiple alleles contribute to the defect.
D) All the individuals who possess the gene will exhibit the anomaly.



16. A dominant genetic trait:
A) is expressed only in a heterozygous pairing.
B) is expressed in either a homozygous or heterozygous pairing.
C) is expressed only in a homozygous pairing.
D) is expressed in some carriers.



17. Which of the following methods of genetic mapping focuses on the measurement of enzyme activity?
A) Hybridization studies
B) Haplotype mapping
C) Linkage studies
D) Gene dosage studies



18. Which of the following facts underlies the application of RNA interference in the treatment of disease?
A) Restriction enzymes are able to cleave genetic molecules at predictable sites.
B) It is possible to produce proteins that have therapeutic properties.
C) Faulty gene activity that produces unwanted proteins can sometimes be stopped.
D) Individual differences are attributable to a very small percentage of the genes in the human body.



19. Although the majority of cellular DNA exists in the cell nucleus, part of the cell DNA is located in the:
A) mitochondria.
B) Golgi apparatus.
C) smooth endoplasmic reticulum.
D) microfilaments.



20. Which of the following is an application of recombinant DNA technology?
A) Production of human insulin
B) DNA fingerprinting
C) Gene dosage studies
D) Somatic cell hybridization



1. Genetic disorders that involve a single gene trait are characterized by:
A) multifactorial gene mutations.
B) chromosome rearrangements.
C) Mendelian patterns of transmission.
D) abnormal numbers of chromosomes.



2. In addition to having a 50% chance of inheriting an autosomal dominant disorder from an affected parent, such a disorder is characterized by:
A) aneuploidy of genes in all cells.
B) deficiencies in enzyme synthesis.
C) affected X transmission to daughters.
D) varied gene penetration and expression.



3. Autosomal recessive disorders are characterized by:
A) age of onset later in life.
B) abnormal protein structure.
C) inborn errors of metabolism.
D) one in two risk of a carrier child.



4. When a male child inherits an X-linked disorder from his heterozygous carrier mother,
A) his sons will be carriers.
B) his father has the disorder.
C) some of his sisters will be carriers.
D) his daughters will have the disorder.



5. Multifactorial inheritance disorders, such as cleft palate, are often caused by____________ during fetal development.
A) multiple gene mutations
B) dominant gene expression
C) X-linked crossover problem
D) polyploidy of chromosomes



6. The newborn has the distinctive physical features of trisomy 21, Down syndrome, which includes:
A) upward slanting of eyes.
B) large, protruding ears.
C) thin lips and small tongue.
D) long fingers with extra creases.



7. Aneuploidy of the X chromosome can result in a monosomy or polysomy disorder. The manifestations of monosomy X, Turner syndrome, differ from polysomy X disorders in numerous ways that include:
A) short-stature female individual..
B) mental retardation.
C) enlarged breasts.
D) early onset puberty.



8. A teratogenic environmental agent can cause birth defects when:
A) inherited as a recessive trait.
B) intense exposure occurs at birth.
C) disjunction occurs during meiosis.
D) retained during early pregnancy.



9. Fetal alcohol syndrome (FAS) is unlike other teratogens in that the harmful effects on the fetus:
A) directly result in liver damage.
B) extend throughout the pregnancy.
C) is most noticeable in adulthood.
D) cause death in early childhood.



10. Prenatal diagnosis methods include the use of ultrasonography for identifying ________ abnormalities.
A) cytogenic
B) skeletal
C) chromosomal
D) a-fetoprotein



11. A woman who is a carrier for which of the following diseases possesses the greatest likelihood of passing the disease to her future children when heterozygous pairing exists?
A) Phenylketonuria (PKU)
B) Tay-Sachs disease
C) Neurofibromatosis
D) Cystic fibrosis



12. Which of the following statements is true of autosomal recessive disorders?
A) Onset is typically late in childhood or early in adulthood.
B) Symptomatology is less uniform than with autosomal dominant disorders.
C) Mitochondrial DNA is normally the site of genetic alteration.
D) Effects are typically the result of alterations in enzyme function.



13. The parents of a newborn infant are relieved that their baby was born healthy, with the exception of a cleft lip that will be surgically corrected in 10 or 12 weeks. Which of the nurse’s following statements to the parents best conveys the probable cause of the infant’s cleft lip?
A) “Though you are both healthy, you likely both carry the gene for a cleft lip.”
B) “Provided one of you had the gene for a cleft lip, your baby likely faced a 50/50 chance of having one.”
C) “Your child’s cleft lip likely results from the interplay between environment and genes.”
D) “A cleft lip can sometimes result from taking prescription drugs, even when they’re taken as ordered.”



14. Which of the following practitioners is most likely to be of assistance in the early care of an infant with a cleft lip?
A) Lactation consultant
B) Respiratory therapist
C) Occupational therapist
D) Social worker



15. A 41-year-old woman has made the recent decision to start a family, and is eager to undergo testing to mitigate the possibility of having a child with Down syndrome. Which of the following tests is most likely to provide the data the woman seeks?
A) Genetic testing of the woman
B) Genetic testing of the woman and the father
C) Prenatal blood tests
D) Ultrasonography



16. Genetic testing has revealed that a male infant has been born with an extra X chromosome. What are the most likely implications of this finding?
A) The child is unlikely to survive infancy
B) The child is likely to have no manifestations of this chromosomal abnormality
C) The child will have significant neurological and cognitive defects
D) The child will be unable to reproduce



17. Which of the following variables determine the extent of teratogenic drug effects? Select all that apply.
A) Maternal health history
B) Molecular weight of the drug
C) Stage of pregnancy when the drug was taken
D) Duration of drug exposure
E) Fetal blood type



18. A woman who has just learned that she is pregnant for the first time has sought advice from her healthcare provider about the safe use of alcohol during pregnancy. What advice should the clinician provide to the woman?
A) “It’s likely best to eliminate alcohol from your diet while you’re pregnant.”
B) “Moderation in alcohol use is critical while you are pregnant.”
C) “You should limit yourself to a maximum of one drink daily while you’re pregnant.”
D) “You should drink no alcohol until you are in your second trimester.”



19. Which of the following health problems may be identified by a TORCH screening test?
A) Rubella and herpes
B) Tenovaginitis and human papillomavirus
C) Rhinovirus and Ormond disease
D) Chlamydia and rickets



20. Ultrasonography is most likely to detect which of the following fetal abnormalities?
A) Neural tube defects
B) Skeletal abnormalities
C) Chromosomal defects
D) Single-gene disorders


1. Unlike the tissue growth that occurs with hypertrophy and hyperplasia, the growth of a malignancy is:
A) adaptive.
B) specialized.
C) predictable.
D) autonomous.



2. In contrast to malignancies, benign tumors are characterized by:
A) a fibrous capsule.
B) distant infiltration.
C) rapid replication.
D) undifferentiated cells.



3. Because of their rapid growth, malignant tumors affect area tissues by:
A) increasing tissue blood flow.
B) providing essential nutrients.
C) liberating enzymes and toxins.
D) forming fibrous membranes.



4. The metastatic spread of tumor cells is facilitated by _______ that enables invasion and movement to distant tissues.
A) cell cohesiveness
B) enzyme secretion
C) contact inhibition
D) cell-to-cell signaling



5. The angiogenesis process, which allows tumors to develop new blood vessels, is triggered and regulated by tumor-secreted:
A) procoagulants.
B) growth factors.
C) attachment factors.
D) proteolytic enzymes.



6. Cancerous transformation of a cell requires the activation of:
A) cell cycle apoptosis.
B) multiple mutations.
C) a single gene mutation.
D) tumor suppressor genes.



7. Although clinical manifestations vary with the type of cancer and organs involved, abnormal tumor growth causes general manifestations that include:
A) copious lymph flow.
B) sleep disturbances.
C) involuntary weight gain.
D) visceral organ expansion.



8. Paraneoplastic syndromes are manifestations of cancer that often result from:
A) radiation and chemotherapy.
B) compression of area vessels.
C) tumor-related tissue necrosis.
D) inappropriate hormone release.



9. Although both grading and staging are methods for classifying cancer and selecting a treatment plan, staging is used to determine the:
A) number of mitoses.
B) tissue characteristics.
C) level of differentiation.
D) extent of disease spread.



10. Early diagnosis of childhood cancers is often difficult because the signs and symptoms are:
A) already present at birth.
B) absent until the late stage.
C) similar to those of other childhood diseases.
D) seen as developmental delays.



11. A lung biopsy and magnetic resonance imaging have confirmed the presence of a benign lung tumor in a patient. Which of the following characteristics are associated with this patient’s neoplasm?
A) The tumor will grow by expansion and is likely encapsulated.
B) The cells that constitute the tumor are undifferentiated, with atypical structure.
C) If left untreated, the patient’s tumor is likely to metastasize.
D) The tumor is likely to infiltrate the lung tissue that presently surrounds it.



12. Which of the following processes characterizes an epigenetic contribution to oncogenesis?
A) A DNA repair mechanism is disrupted.
B) A tumor suppressor gene is present, but it is not expressed.
C) Cells lose their normal contact inhibition.
D) Regulation of apoptosis in impaired, resulting in accumulation of cancer cells.



13. A farmer’s long-term exposure to pesticides has made the cells in his alveoli and bronchial tree susceptible to malignancy. Which of the following processes has taken place in the farmer’s lungs?
A) Promotion
B) Progression
C) Initiation
D) Differentiation



14. Genetic screening may be indicated for individuals who have a family history of which of the following neoplasms?
A) Liver cancer
B) Multiple myeloma
C) Leukemia
D) Breast cancer



15. A public health nurse has cited a reduction in cancer risk among the many benefits of maintaining a healthy body-mass index. Which of the following facts underlies the relationship between obesity and cancer?
A) Obesity can cause inflammation and hormonal changes that are associated with cancer.
B) Adipose tissue is more susceptible to malignancy than other types of connective tissue.
C) Increased cardiac workload and tissue hypoxia can interfere with normal cell differentiation.
D) Increased numbers of body cells increase the statistical chances of neoplastic cell changes.



16. Which of the following dietary guidelines should a nurse provide to a group of older adults to possibly decrease their risks of developing colon cancer?
A) “As much as possible, try to eat organic foods.”
B) “Regular vitamin supplements and a low-carbohydrate diet are beneficial.”
C) “Try to minimize fat and maximize fiber when you’re planning your meals.”
D) “Eat enough fiber in your diet that you have bowel movement at least once daily.”



17. A male patient with a diagnosis of liver cancer has been recently admitted to a palliative care unit following his recent development of bone metastases. Despite his family’s encouragement, the patient has experienced precipitous weight loss in recent weeks. Which of the following factors may underlie the patient’s loss of fat and muscle mass?
A) The action of cytokines and consequent inflammation
B) Loss of appetite due to fatigue and pain
C) Changes in peptide hormone levels
D) Production of onconeural antigens by cancerous cells



18. A 51-year-old patient has been diagnosed with stage IV breast cancer with lung metastases. Which of the following treatment options is most likely to treat both her primary and distant cancer sites?
A) Radiation therapy
B) Chemotherapy
C) Surgery
D) Hormone therapy



19. A patient’s oncologist has presented the possibility of implementing biotherapy in the treatment of the patient’s brain tumor. Which of the following mechanisms of action provide the therapeutic effects of biotherapy? Select all that apply.
A) Stimulating the immune response to tumor cells
B) Inhibiting tumor protein synthesis
C) Reversing angiogenesis
D) Altering the hormonal environment of tumor cells
E) Causing breaks in the DNA of tumor cells



20. A 5-year-old girl’s diagnosis of bone cancer required an aggressive treatment regimen. Which of the following considerations forms the most significant threat to her future health?
A) Retention of chemotherapeutic drugs in the healthy bone matrix
B) Unwanted effects of chemotherapy and radiation therapy
C) Resistance to chemotherapy and radiation if required later in life
D) Risk for recurrence of the primary neoplasm after puberty


1. An injured patient develops interstitial edema as a result of decreased:
A) vascular volume.
B) hydrostatic pressure.
C) capillary permeability.
D) colloidal osmotic pressure.



2. The most reliable method for measuring body water or fluid volume increase is by assessing:
A) tissue turgor.
B) intake and output.
C) body weight change.
D) serum sodium levels.



3. The syndrome of inappropriate ADH is characterized by:
A) increased osmolality.
B) excessive water thirst.
C) copious dilute urination.
D) dilutional hyponatremia.



4. In isotonic fluid volume deficit, changes in total body water are accompanied by:
A) intravascular hypotonicity.
B) increased intravascular water.
C) increases in intracellular sodium.
D) proportionate losses of sodium.



5. Hyponatremia can be caused by ______and manifested by _______.
A) hypovolemia; dehydration
B) third spacing; hypertonicity
C) water retention; hypotonicity
D) aldosterone excess; low ADH



6. One of the major causes of hyperkalemia is ____________, which alters potassium elimination.
A) renal dysfunction
B) aldosterone excess
C) metabolic alkalosis
D) plasma albumin deficit



7. Hypoparathyroidism causes hypocalcemia by:
A) increasing serum magnesium.
B) increasing phosphate excretion.
C) blocking bone release of calcium.
D) blocking action of intestinal vitamin D.



8. Magnesium is important for the overall function of the body because of its direct role in:
A) cell membrane permeability.
B) somatic cell growth control.
C) sodium and tonicity regulation.
D) DNA replication and transcription.



9. A patient has acidosis that is suspected to be respiratory in etiology. Which of the following is the major cause of acute primary respiratory acidosis?
A) Decreased CO2 retention
B) Increased metabolic acids
C) Renal bicarbonate retention
D) Impaired alveolar ventilation



10. As other mechanisms prepare to respond to a pH imbalance, immediate buffering is a result of increased:
A) intracellular albumin.
B) hydrogen/potassium binding.
C) sodium/phosphate anion absorption.
D) bicarbonate/carbonic acid regulation.



11. A patient with a diagnosis of liver cirrhosis secondary to alcohol use has a distended abdomen as a result of fluid accumulation in his peritoneal cavity (ascites). Which of the following pathophysiologic processes contributes to this third spacing?
A) Abnormal increase in transcellular fluid volume
B) Increased capillary colloidal osmotic pressure
C) Polydipsia
D) Impaired hormonal control of fluid volume



12. A patient has been receiving intravenous normal saline at a rate of 125 mL per hour since her surgery 2 days earlier. As a result of her consequent increase in vascular volume, she has become edematous. Which of the following phenomena accounts for this patient’s edema?
A) Obstruction of lymph flow
B) Increased capillary permeability
C) Decreased capillary colloidal osmotic pressure
D) Increased capillary filtration pressure



13. A patient with a diagnosis of schizophrenia has been admitted to the emergency department after ingesting more than 2 gallons of water. Which of the following pathophysiologic processes may result from the sudden water gain?
A) Hypernatremia
B) Water movement from the extracellular to intracellular compartment
C) Syndrome of inappropriate secretion of ADH (SIADH)
D) Isotonic fluid excess in the extracellular fluid compartment



14. Which of the following patients would likely be at highest risk of developing hyperkalemia?
A) A patient who has been admitted for the treatment of acute renal failure following a drug overdose
B) A patient who has experienced an ischemic stroke with multiple sensory and motor losses
C) An elderly patient who is experiencing vomiting and diarrhea as a result of influenza
D) A patient whose thyroidectomy resulted in the loss of his parathyroid gland



15. A female patient with a history of chronic renal failure has developed hypocalcemia. Which of the following assessment findings would provide potential confirmation of this diagnosis?
A) The patient experiences shortness of breath on exertion with decreased oxygen saturation levels.
B) The patient is difficult to rouse and is disoriented to time and place.
C) The patient’s heart rate is 120 beats per minute and she is diaphoretic (sweaty).
D) The patient has muscle spasms and complains of numbness around her mouth.



16. Which of the following assessments should be prioritized in the care of a patient who is being treated for hypokalemia?
A) Detailed fluid balance monitoring
B) Arterial blood gases
C) Cardiac monitoring
D) Monitoring of hemoglobin levels and oxygen saturation



17. Magnesium is an important component of which of the following processes that are integral to the maintenance of homeostasis? Select all that apply.
A) Intracellular and extracellular buffering
B) Cellular energy metabolism
C) Function of the sodium-potassium pump
D) Nerve conduction
E) Cell membrane function



18. A 77-year-old woman has been brought to the emergency department by her daughter because of a sudden and unprecedented onset of confusion. The patient admits to ingesting large amounts of baking soda since the morning in an effort to treat indigestion. How will the woman’s body attempt to resolve this disruption in acid-base balance?
A) Hyperventilation
B) Increasing renal H+ excretion
C) Increased renal HCO3 reabsorption
D) Hypoventilation



19. Arterial blood gases of a patient with a diagnosis of acute renal failure reveal a pH of 7.25 (low), HCO3-of 21 mEq/L (low), decreased PCO2 accompanied by a respiratory rate of 32 (high). What disorder of acid-base balance is the patient most likely experiencing?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis



20. A nurse who is providing care for a patient with a diagnosis of diabetes insipidus should prioritize the close monitoring of serum levels of which of the following electrolytes?
A) Potassium
B) Sodium
C) Magnesium
D) Calcium


1. According to Walter B. Cannon, homeostasis is a stable internal environment achieved through a system of:
A) interdependent system-wide adaptive responses.
B) variable internal and external conditioning factors.
C) coordinated physiologic processes that oppose change.
D) compatibility between cells and the internal environment.



2. Allostasis is characterized by:
A) organ-specific physiologic responses.
B) interactive physiologic changes in numerous systems.
C) systems that detect psychologic function.
D) future expectations as a catalyst for change.



3. According to Hans Selye, the first stage of the general adaptation syndrome (GAS) is:
A) alarm.
B) exhaustion.
C) resistance.
D) anticipation.



4. Although stress exposure initiates integrated responses by multiple systems, the functional changes are first manifested by which system?
A) Pulmonary
B) Gastrointestinal
C) Cardiovascular
D) Neuroendocrine



5. Which manifestation of stress reflects the nonspecific “fight-or-flight” response?
A) Decreased pupillary light response
B) Increased gastrointestinal motility
C) Decreased short-term memory
D) Increased cardiopulmonary rates



6. Stress-induced cortisol hormone secretion is associated with:
A) increased growth hormone level.
B) regulation of the stress response.
C) increased thyroid-stimulating hormone.
D) depressed adrenal gland function.



7. Two people experience the same stressor yet only one is able to cope and adapt adequately. An example of the person with an increased capacity to adapt is the one with:
A) a sense of purpose in life.
B) circadian rhythm disruption.
C) age-related renal dysfunction.
D) excessive weight gain or loss.



8. Acute stress is characterized by:
A) a time-limited fight or flight response.
B) recurrent exposure to a stressor.
C) negative feedback overactivity.
D) system impairment and fatigue.



9. The patient recently returned from a year of military battle duty and has posttraumatic stress disorder (PTSD). This disorder includes an “intrusion” state that is experienced as:
A) excessive anxiety and safety concerns.
B) repeated relived memories as nightmares.
C) loss of concentration and increased vigilance.
D) emotional numbing and feelings of depression.



10. A patient is extremely anxious about his impending surgery. Which of the following measures should the nurse implement to create an atmosphere for effective use of relaxation techniques?
A) A quiet, dim environment
B) A soothing, warm foot soak
C) Gentle muscle stroking
D) Repetitive questioning



11. A patient is experiencing significant stress while awaiting the results of her recent lymph node biopsy. Among the hormonal contributors to this response is a release of aldosterone, resulting in which of the following physiologic effects?
A) Decreased release of insulin
B) Increased cardiac contractility
C) Potentiation of epinephrine
D) Increased sodium absorption



12. A patient is experiencing stress as a nurse prepares to insert a peripheral intravenous catheter into his forearm. The patient’s locus ceruleus (LC) is consequently producing which of the following hormones?
A) Norepinephrine (NE)
B) Corticotropin-releasing factor (CRF)
C) Antidiuretic hormone (ADH)
D) Adrenocorticotropic hormone (ACTH)



13. A college student has just learned that her latest Pap smear revealed atypical cells, a fact that has resulted in stress and an accompanying release of angiotensin II. How would the effects of this hormone be objectively demonstrated?
A) Increased respiratory rate
B) Increased blood pressure
C) Decreased oxygen saturation
D) Decreased blood sugar



14. A nursing student’s current clinical placement has been a source of stress due to high patient acuity combined with interpersonal conflict with some of the unit staff. At the same time, the student has been fighting a cold for more than 2 weeks and has been unable to regain a normal feeling of health. How might these two phenomena be related?
A) Epinephrine and norepinephrine inhibit the release and action of lymphocytes.
B) Stress and illness lack a statistical correlation, though they are often thought to coexist.
C) The effects of stress on the cerebellum initiate a decrease in immunity.
D) Endocrine-immune interactions may suppress the student’s immune response.



15. Which of the following factors are known to contribute to an individual’s ability to adapt to stress? Select all that apply.
A) Ethnicity
B) Age
C) Socioeconomic status
D) Gender
E) Health status



16. A student is participating in an extended fast as part of a charitable fundraising effort. Which of the following is an example of the physiologic reserve that will facilitate the student’s adaptation to the stress of this sudden change in diet?
A) The student has experience in demonstrating perseverance from previous participation in competitive sports.
B) The student’s adipose tissue contains large and accessible stores of energy.
C) The student is young, male, and has no pre-existing medical conditions.
D) The student is utilizing guided imagery to achieve a sense of “mind over matter.”



17. A 70-year-old patient admitted to a hospital for a prostatectomy is surprised to learn that his physician has prescribed insulin on a sliding scale, despite the fact that the patient successfully manages his type 2 diabetes using diet and oral antihyperglycemics when at home. Which of the following facts may underlie the physician’s action?
A) The stress of illness stimulates the hypothalamus to release corticotropin-releasing factor (CRF).
B) Stress-induced release of vasopressin increases serum blood glucose.
C) Stress and illness can increase glycogenolysis and insulin resistance.
D) Increased levels of epinephrine and norepinephrine cause alterations in glucose metabolism.



18. A female patient experienced a random assault several months earlier, and her recent vigilance around her own safety is described as “obsessive” by her friends and family. Which of the following aspects of posttraumatic stress disorder (PTSD) characterizes the patient’s behavior?
A) Avoidance
B) Intrusion
C) Hyperarousal
D) Flashbacks



19. An occupational therapist is preparing to begin a relaxation program on the oncology unit of a hospital. Which of the following variables is most likely to determine the success or failure of the program?
A) Rapport between the therapist and patients
B) The therapist’s own ability to relax
C) A quiet and therapeutic environment
D) Appropriate use of pharmacologic techniques



20. A patient’s primary care provider has recommended biofeedback in an effort to address her chronic stress and reduce the potential for complications. What will be the goal of this intervention?
A) Using exercise to control the patient’s endocrine function
B) Helping the patient to accommodate continued nervous stimulation
C) Relieving tension by using tactile stimulation
D) Teaching the patient to consciously control her own body functioning



1. The adipocytes in adipose tissue not only serve as a storage sites, they also:
A) produce linoleic fatty acid.
B) synthesize triglycerides.
C) increase glucagon release.
D) degrade fat-soluble vitamins.



2. Protein contains nitrogen. A negative nitrogen balance represents:
A) more protein consumed than excreted.
B) a reduced need for nitrogen as protein.
C) more nitrogen excreted than consumed.
D) less use of nitrogen for protein synthesis.



3. Natural appetite suppression mechanisms, necessary for food intake control, include :
A) ketoacid deficiency.
B) cholecystokinin storage.
C) decreased blood glucose.
D) leptin receptor stimulation.



4. Body weight should be used in combination with other measurements to establish if a person is underweight or overweight. Obesity is indicated by:
A) female body fat of 20% and 30%.
B) body mass index (BMI) of 30 to 40.
C) relative body weight of 70% to 100%.
D) abdominal fat/ hip ratio of 0.8 to 1.0.



5. A patient with upper body obesity also has central fat distribution. This body fat configuration places the patient at greater risk for _____________ than a patient with lower body obesity.
A) osteoporosis
B) renal disease
C) cardiometabolic disorders
D) chronic anemia



6. As the problem of childhood and adolescent obesity increases, an increase in the incidence of ____________ is occurring in this obese population.
A) type 2 diabetes mellitus
B) attention deficit disorder
C) juvenile rheumatoid arthritis
D) antibiotic-resistant bacterial infections



7. A diet deficient in calories and protein causes marasmus, which is characterized by:
A) discolored hair.
B) bradycardia.
C) enlarged liver.
D) pitting edema.



8. Protein-calorie malnutrition with loss of lean tissues and muscle mass results in:
A) respiratory muscle stimulation.
B) excessive blood cell production.
C) diarrhea.
D) increased cardiac contractility.



9. Similarities between girls or women with anorexia nervosa and bulimia nervosa include:
A) periodontal disease.
B) low estrogen level.
C) electrolyte imbalances.
D) enlarged parotid gland.



10. Both binge-eating and bulimia nervosa patients consume excessive amounts of foods secretively. A major difference is that binge-eaters:
A) remain overweight.
B) eat when not hungry.
C) are substance abusers.
D) experience depression.



11. A large, high-calorie meal has resulted in the intake of far more energy than a person requires. What will the individual’s body do with the excess carbohydrates provided by this meal?
A) Convert them into glucose and store them in the liver and muscles
B) Excrete most of the excess polysaccharides through the kidneys
C) Convert the carbohydrates into amino acids in preparation for long-term storage
D) Create structural proteins from some of the carbohydrates and store the remainder as triglycerides



12. Which of the following patients is most likely to be in positive nitrogen balance?
A) A patient who is receiving treatment for sepsis
B) A patient whose diagnosis of pneumonia is causing a fever
C) A woman who has been admitted to the hospital in early labor
D) A patient who sustained extensive burns in a recent industrial accident



13. In addition to facilitating bowel movements, a diet that is high in fiber confers which of the following benefits?
A) Lowering cholesterol and blood glucose
B) Removing toxins and metabolic byproducts
C) Lowering blood pressure and resting heart rate
D) Increasing intestinal absorption of vitamins and minerals



14. Which of the following statements best conveys the endocrine function of adipose tissue?
A) Adipose tissue antagonizes the effects of insulin on cell membranes.
B) Adipose tissue produces ghrelin, which stimulates both appetite and eating.
C) Adipose tissue produces and secretes cholecystokinin (CCK), which stimulates the hypothalamic feeding center.
D) Adipose tissue produces leptin, which mediates body weight.



15. Chronic inflammation as a result of excess adipose tissue is implicated in the etiology of which of the following health problems?
A) Osteoporosis
B) Type 2 diabetes
C) Rheumatoid arthritis
D) Systemic lupus erythematosus (SLE)



16. A public health nurse has noted a significant increase in the number of school-aged children who are obese. Which of the following factors is most significant predictor of childhood obesity?
A) Low socioeconomic status
B) Low self-esteem
C) Having obese parents
D) Living in a rural or inner-city neighborhood



17. Which of the following measures should a school nurse prioritize in the treatment and prevention of childhood obesity?
A) Group cognitive therapy
B) Use of selective serotonin-reuptake inhibitors (SSRIs)
C) Education on exercise and nutrition
D) High-protein, low-carbohydrate diet



18. Which of the following characteristics distinguishes kwashiorkor from marasmus?
A) Impairment of immune function
B) Lack of dietary fat intake
C) High intake of carbohydrates
D) Impaired pigment synthesis



19. A frail, 87-year-old female patient has been admitted to a hospital after a fall and has been diagnosed with failure to thrive. Which of the following laboratory values would suggest that the patient may be experiencing malnutrition?
A) Low prealbumin
B) High C-reactive protein
C) High bilirubin
D) Low fasting blood sugar



20. Which of the following assessments should be prioritized in the care of a patient with anorexia nervosa?
A) Serum electrolyte levels
B) Chest auscultation
C) White blood cell count with differential
D) Blood pressure monitoring
1. Cytokines that affect hematopoiesis in bone marrow are called colony-stimulating factors (CSFs) based on their ability to:
A) support lymphocytes.
B) differentiate red cells.
C) regulate blood cells.
D) stimulate lymphocytes.



2. Leukocytes consist of three categories of cells that have different roles in the inflammatory and immune responses. Which of the following leukocytes is correctly matched with its function?
A) Lymphocyte; phagocytosis
B) Eosinophils; allergic reactions
C) Basophils; engulf antigens
D) Monocytes; release heparin



3. The patient has an abnormally low neutrophil count. Neutropenia is most commonly caused by:
A) Epstein-Barr virus.
B) Kostmann syndrome.
C) drug reactions.
D) skin infections.



4. The 16-year-old boy has enlarged lymph nodes and a sore throat. His girlfriend was recently diagnosed with infectious mononucleosis, which is caused by ________ and commonly transmitted in ________.
A) heterophil antibodies; blood
B) Epstein Barr virus; saliva
C) T-cell infection; plasma
D) bacterial infection; monocytes



5. The patient is diagnosed with Hodgkin type of lymphoma based on the results of laboratory tests and study of the tumor cells. A distinct characteristic of Hodgkin lymphoma is the presence of:
A) Reed-Sternberg cells.
B) Bence Jones proteins.
C) M-type protein antibodies.
D) Philadelphia chromosome.



6. Manifestations of Hodgkin lymphoma that distinguish it from non-Hodgkin lymphoma include:
A) noncontiguous nodal spread.
B) superficial lymphadenopathy.
C) pruritus and night fevers.
D) poor humoral antibody response.



7. Leukemias are classified according to the predominant cell type. The myelogenous cell type of leukemia can:
A) interfere with thrombocyte cell maturation.
B) originate in marrow and infiltrate nodes.
C) affect B and T stem cells in bone marrow.
D) transform mature cells into immature ones.



8. A child has Down syndrome and has recently experienced unexplained nose bleeds. His blood tests identify blast cells in the peripheral smear. In addition to nose bleeds, his acute leukemia will typically manifest all of the following EXCEPT:
A) infections due to neutropenia.
B) fatigue due to RBC deficiency.
C) hypogammaglobulinemia.
D) bleeding due to thrombocytopenia.



9. In contrast to acute leukemias, chronic leukemias are malignancies involving abnormal _________________ blood cells in the marrow.
A) production of undifferentiated
B) proliferation of well-differentiated
C) uncontrolled growth of immature
D) replication of pluripotent precursor



10. Multiple myeloma is a malignancy of:
A) plasma cells.
B) bone osteoblasts.
C) T-cell lymphocytes.
D) immunoglobulin A.



11. Which of the following statements accurately describes a component of the hematopoietic system?
A) Lymphocytes lack cytoplasmic granules.
B) Neutrophils are agranulocytes.
C) Colony-forming units (CFUs) promote the growth of hematopoietic cell colonies.
D) Neutrophils are the most prevalent lymphocytes.



12. Which of the following parts of the body are considered to be parts of the lymphatic system? Select all that apply.
A) Thyroid gland
B) Thymus
C) Spleen
D) Kupffer cells
E) Myelin



13. A patient with a long-standing diagnosis of human immunodeficiency virus (HIV) has recently developed neutropenia and been admitted to a hospital. Which of the following measures should be prioritized by the nurses who are providing his care?
A) Administration of prophylactic antibiotics
B) Supplementary oxygen and administration of bronchodilators
C) Administration of antiretroviral medications
D) Vigilant infection control and handwashing



14. A 16-year-old girl has been brought to her primary care provider by her mother due to the daughter’s recent malaise and lethargy. Which of the following assessments should the clinician perform in an effort to confirm or rule out infectious mononucleosis?
A) Auscultating the patient’s lungs
B) Palpating the patient’s lymph nodes
C) Assessing the patient’s cranial nerve reflexes
D) Assessing the patient for bone pain



15. Which of the following factors differentiates chronic leukemias from acute leukemias?
A) Leukemic cells are disseminated throughout the body by the circulatory system.
B) The leukemic cells are more fully differentiated than in acute leukemias.
C) The prevalence among individuals with Down syndrome is high.
D) They are cancers of the hematopoietic progenitor cells.



16. Following peripheral blood testing and a bone marrow biopsy, a patient has been diagnosed with chronic myelogenous leukemia. Which of the following is most likely to have preceded the patient’s diagnosis?
A) The presence of a Philadelphia chromosome
B) Down syndrome
C) Radiation exposure
D) Exposure to the Epstein-Barr virus



17. A patient has been diagnosed with non-Hodgkin lymphoma (NHL), a form of malignancy that most likely originated in which of the following sites?
A) Thymus
B) Spleen
C) Bone marrow
D) Lymph nodes



18. A young adult is preparing to begin treatment for non-Hodgkin lymphoma (NHL), a disease that has disseminated widely. What is the most likely treatment regimen for this patient?
A) Antiviral medications
B) Surgery and whole blood transfusion
C) Radiation and chemotherapy
D) Bone marrow or stem cell transplantation



19. Which of the following patient complaints should prompt a clinician to order a diagnostic work-up for multiple myeloma?
A) “Lately my bones just seem to ache so bad, and nothing seems to help.”
B) “Every morning my joints are so stiff that it takes me 10 or 15 minutes just to get going.”
C) “I feel so weak and the last few days I’ve actually fallen asleep on my coffee break at work.”
D) “I vomited yesterday evening and it looked like coffee grounds mixed with some fresh blood.”



20. Which of the following abnormal blood work results is most closely associated with a diagnosis of multiple myeloma?
A) Decreased hemoglobin, hematocrit, and red blood cells
B) Extremely high levels of abnormal lymphocytes
C) Low glomerular filtration rate and high calcium levels
D) Low potassium levels and increased blood urea nitrogen
1. With the exception of the first two steps, what is required in all steps of the clotting process?
A) Calcium
B) Prothrombin
C) Tissue factor
D) Plasminogen



2. The first step of hemostasis occurs as a:
A) fibrin clot.
B) platelet plug.
C) clot retraction.
D) vessel spasm.



3. To form a platelet plug, platelets are attracted to the damaged vessel, and then platelet ___________ occurs.
A) adhesion
B) fibrinolysis
C) thrombosis
D) thromboxane A2



4. Blood coagulation is initiated by either of two pathways. The intrinsic pathway requires circulating ________ to begin the step-wise coagulation cascade.
A) protein C
B) thrombin
C) factor XII
D) tissue factor



5. Increased platelet function, and consequent hypercoagulability, can be caused by:
A) factor V mutation.
B) platelet insensitivity.
C) vascular wall damage.
D) decreased platelet numbers.



6. Immune thrombocytopenia purpura (ITP) is a/an ________ disorder that destroys ________.
A) allergic; fibrinogen
B) alloimmune; factor VIII
C) autoimmune; platelets
D) immunoglobulin; B cells



7. Thrombotic thrombocytopenic purpura (TTP) causes which of the following manifestations? Select all that apply.
A) Purpura
B) Jaundice
C) Petechiae
D) Erythema
E) Confusion



8. Hemophilia A is a hereditary blood disorder caused by inadequate activity or absent:
A) factor VIII.
B) prothrombin.
C) vWF complex.
D) intrinsic factor.



9. Disseminated intravascular coagulation (DIC) is characterized by:
A) headaches.
B) platelet loss.
C) hypertension.
D) hemorrhage.



10. In persons with a bleeding disorder caused by vascular defects, laboratory tests will most often reveal:
A) normal values.
B) hypocalcemia.
C) polycythemia.
D) thrombocytopenia.



11. Removal of a patient’s peripheral intravenous catheter resulted in brief bleeding and the loss of a small amount of blood. Which of the following processes occurred during the formation of the platelet plug that helped to stop blood flow?
A) Activation of factor X
B) Conversion of prothrombin to thrombin
C) Release of von Willebrand factor from the epithelium
D) Conversion of fibrinogen to fibrin threads



12. A 69-year-old patient who is obese and has a diagnosis of angina pectoris has been prescribed clopidogrel (Plavix) by his primary care provider. The patient’s medication achieves its therapeutic effect in which of the following ways?
A) Prevention of platelet aggregation
B) Activation of plasminogen
C) Inhibition of the intrinsic clotting pathway
D) Deactivation of factor X



13. A public health nurse is conducting a health promotion campaign under the auspices of the local community center. Which of the following measures that the nurse is promoting are likely to influence the participants’ risk of hypercoagulability disorders? Select all that apply.
A) Smoking cessation
B) Blood glucose screening
C) Weight management
D) Cholesterol screening and management
E) Blood pressure screening and management



14. During a patient’s admission assessment prior to reduction mammoplasty surgery, the nurse notes a reference to a Leiden mutation in the patient’s history. The nurse would recognize the patient’s increased risk for
A) Hemorrhage
B) Myocardial infarction
C) Hemophilia A or B
D) Deep vein thrombosis



15. The most recent blood work of a patient with a diagnosis of acute myelogenous leukemia (AML) reveals thrombocytopenia. Where is the patient most likely to experience abnormal bleeding as a result of low platelets?
A) In the brain
B) Skin and mucous membranes
C) Sclerae of the eyes
D) Nephrons and ureters



16. A patient was started on a protocol for the prevention of deep vein thrombosis shortly after admission, and has been receiving 5000 units of heparin twice daily for the last 5 days. An immune response to this treatment may increase the patient’s chance of developing which health problem?
A) Antiphospholipid syndrome
B) Disseminated intravascular coagulation (DIC)
C) Von Willebrand disease
D) Thrombocytopenia



17. In light of the presence of numerous risk factors for coronary artery disease, a patient’s primary care provider has recommended that he take low-dose aspirin once daily. Doing so will reduce the patient’s risk of myocardial infarction by altering which of the following stages of hemostasis?
A) Vessel spasm
B) Platelet plug formation
C) Blood coagulation
D) Clot lysis



18. A 23-year-old female patient has been diagnosed with von Willebrand disease following a long history of “heavy periods” and occasional nosebleeds. Which of the patient’s following statements demonstrates a sound understanding of her new diagnosis?
A) “I’m really disappointed that I won’t be able to do sports anymore.”
B) “I read on a website that I might have to get blood transfusions from time to time.”
C) “I’ll make sure to take Tylenol instead of aspirin when I get aches and pains.”
D) “I hope my insurance covers the injections that I’ll need to help my blood clot.”



19. Which of the following patients likely faces the highest risk of an acquired hypocoagulation disorder and vitamin K deficiency?
A) A patient who has a diagnosis of liver failure secondary to alcohol abuse
B) A patient who has chronic renal failure as a result of type 1 diabetes mellitus
C) A patient who is immunocompromised as a result of radiation therapy for the treatment of lung cancer
D) A patient with dehydration and hypokalemia that have resulted from Clostridium difficile–associated diarrhea



20. A healthy, primiparous (first-time) mother delivered a healthy infant several hours ago, but the mother has experienced postpartum hemorrhage.  Which of the following disorders is most likely to underlie the patient’s excessive bleeding after delivery?
A) Disseminated intravascular coagulation
B) Hemophilia A
C) Von Willebrand disease
D) Thrombotic thrombocytopenic purpura (TTP)


1. Sue is fatigued and some blood tests are done. Her results include Hct 40%; Hgb 8g/dL; WBC 8,000; platelets 175,000. The nurse should interpret Sue’s blood work as indicative of:
A) high platelets/thrombocytosis.
B) low WBC count/granulocytopenia.
C) low hemoglobin/anemia.
D) high hematocrit/polycythemia.



2. Manifestations of anemia that are directly due to the diminished oxygen-carrying capacity of hemoglobin include:
A) fatigue.
B) bleeding.
C) bone pain.
D) pale skin.



3. When an Rh-negative mother has been sensitized and is pregnant with an Rh-positive fetus, what happens to the fetus?
A) Bilirubin deficiency
B) Nothing, this is normal
C) Plasma volume depletion
D) Profound red cell hemolysis



4. The patient is an average-sized adult and has abnormal microcytic hypochromic red blood cells due to a long-term, chronic disease. Which of the following CBC results is characteristic of her type of anemia?
A) Hematocrit 44%
B) Reticulocytes 1.5%
C) Band cells 3,000/mL
D) Hemoglobin 8 g/dL



5. Megaloblastic anemias caused by folic acid or vitamin B12 deficiencies can seriously affect RBC production. This is because both are necessary for _______ synthesis and _______.
A) iron; hemoglobin adhesion
B) DNA; red blood cell maturation
C) thrombin; platelet aggregation
D) protein; reticulocyte maturation



6. Polycythemia develops in patients with lung disease as a result of:
A) hyperventilation.
B) chronic hypoxia.
C) decreased blood viscosity.
D) excessive respiratory fluid loss.



7. Which of the following types and characteristics of anemia are correctly matched?
A) Hemolytic; abnormal iron uptake
B) Iron deficiency; early RBC death
C) Folate; decreased erythropoiesis
D) Blood loss; bone marrow expansion



8. Conditions that predispose to sickling of hemoglobin in persons with sickle cell anemia include:
A) impaired red blood cell maturation.
B) increased iron content of blood.
C) decreased oxygen saturation.
D) increased intravascular volume.



9. An elevated level of unconjugated bilirubin, due to hemolysis of RBCs, results in a high level of iron released and:
A) diarrhea.
B) cyanosis.
C) numbness.
D) jaundice.



10. Hemolytic anemia is characterized by excessive red blood cell destruction and compensatory:
A) hypoactive bone marrow.
B) increased erythropoiesis.
C) iron retention in the body.
D) shrinkage of the spleen.



11. A 48-year-old male patient, who normally enjoys good health, has been admitted to the hospital for the treatment of polycythemia vera. The nurse who is providing care for the patient should prioritize assessments aimed at the early identification of which of the following health problems?
A) Orthostatic hypotension
B) Hyperventilation and respiratory alkalosis
C) Vasculitis
D) Thromboembolism



12. Which of the following patients is most susceptible to experiencing the effects of inadequate erythropoiesis?
A) A patient who has developed renal failure as a result of longstanding hypertension
B) A patient who recently experienced an ischemic stroke and who remains bedridden
C) A patient whose heavy alcohol use has culminated in a diagnosis of pancreatitis
D) A patient whose estimated blood loss during recent surgery was 700 mL.



13. A 72-year-old woman with complaints of increasing fatigue has completed a series of fecal occult blood tests that indicate the presence of blood in her stool. Which of the following health problems is likely to accompany this patient’s gastrointestinal bleed?
A) Hemolytic anemia
B) Aplastic anemia
C) Iron-deficiency anemia
D) Megaloblastic anemia



14. Hemoglobin solubility results and hemoglobin electrophoresis have resulted in a diagnosis of sickle cell anemia in an African American infant. The parents of the child should be aware that their child is at a significant risk for which of the following health problems? Select all that apply.
A) Acute pain
B) Stroke
C) Respiratory disease
D) Autoimmune diseases
E) Fractures



15. The pathologic effects of the thalassemias are primarily due to which of the following pathophysiologic processes?
A) Impaired hemoglobin synthesis
B) Impaired folic acid absorption
C) Erythropoietin deficiency
D) Loss of iron



16. Which of the following individuals likely faces the highest risk of megaloblastic anemia?
A) A 69-year-old woman who takes ASA four times daily to treat her arthritis
B) A 44-year-old man who lost approximately 500 mL of blood in a workplace accident
C) A 21-year-old college student who lives a vegan lifestyle
D) An infant who is exclusively fed commercial baby formula



17. For which of the following health problems is stem cell transplantation likely to be of therapeutic benefit?
A) Aplastic anemia
B) b-Thalassemias
C) Chronic disease anemias
D) Secondary polycythemia



18. A 68-year-old patient with an 80 pack/year history of smoking was diagnosed with emphysema 18 months ago. The patient’s most recent scheduled blood work showed red blood cell indices, a problem that suggests the need for which of the following interventions?
A) Vitamin B12 supplements
B) Increased supplementary oxygen therapy
C) Hemodialysis or peritoneal dialysis
D) Scheduled erythropoietin injections



19. Which of the following trends in the hematologic status of a 6-week-old infant most clearly warrants medical intervention?
A) Decreasing red blood cell counts
B) Increasing HgA levels
C) Decreasing hematocrit and mean corpuscular volume (MCV)
D) Increasing white blood cell counts



20. A mother has brought her 2-week-old infant to the emergency department due to the baby’s persistent and increasing jaundice. Blood testing reveals that the infant’s unconjugated bilirubin level is 28 mg/dL and assessment does not reveal neurologic deficits. The infant’s weight is normal and the mother claims to have had no significant difficulty feeding the infant. The most likely treatment for this infant will be:
A) phototherapy.
B) packed red blood cell transfusion.
C) phlebotomy.
D) intravenous antibiotics.
1. Although growth rate is variable among types of bacteria, the growth of bacteria is dependent on:
A) biofilm communication.
B) availability of nutrients.
C) an intact protein capsid.
D) individual cell motility.



2. Treponema pallidum, the cause of syphilis, is a spirochete bacterium that is spread from human to human by:
A) tick or lice vector bites.
B) direct physical contact.
C) exposure to infected urine.
D) inhaling airborne particles.



3. Chlamydiaceae, a rather common sexually transmitted infectious organism, has characteristics of both viruses and bacteria. The infectious form of this organism’s life cycle is _______ until it enters the host cell.
A) an elementary body
B) adhered to cholesterol
C) propelled by filaments
D) encapsulated hyphae



4. Because dermatophytes are capable of growing _________, the infection is mainly found on cutaneous surfaces of the body.
A) a powdery colony
B) in moist skin folds
C) on cooler tissue
D) branching filaments



5. Although both eukaryotes and prokaryotes are capable of causing infectious diseases in humans, eukaryotes are unique because they have a distinct:
A) organized nucleus.
B) circular plasmid DNA.
C) cytoplasmic membrane.
D) variation of shape and size.



6. Whatever the mechanism of entry, the human-to-human transmission of infectious agents is directly related to the:
A) source of contact.
B) site of infection.
C) number of pathogens absorbed.
D) virulence factors.



7. The course of any infectious disease progresses through several distinct stages after the pathogen enters the host. Although the duration may vary, the hallmark of the prodromal stage is:
A) tissue inflammation and damage.
B) initial appearance of symptoms.
C) progressive pathogen elimination.
D) containment of infectious pathogens.



8. Although bacterial toxins vary in their activity and effects on host cells, a small amount of gram-negative bacteria endotoxin:
A) is released during cell growth.
B) inactivates key cellular functions.
C) uses protein to activate enzymes.
D) in the cell wall activates inflammation.



9. Serology testing includes the measurement of which of the following?
A) Antibody titers
B) Culture growth
C) Direct antigens
D) DNA sequencing



10. Prions cause transmissible neurodegenerative diseases and are characterized by:
A) a lack of reproductive capacity.
B) hypermetabolism.
C) enzyme production.
D) chronic inflammation.



11. Which of the following individuals is experiencing a health problem that is the result of a parasite?
A) A college student who contracted Chlamydia trachomatis during an unprotected sexual encounter
B) A man who acquired malaria while on a tropical vacation
C) A hospital patient who has developed postoperative pneumonia
D) A woman who developed hepatitis A from eating at an unhygienic restaurant



12. Which of the following traits is characteristic of saprophytes?
A) They derive energy from decaying organic matter.
B) They are beneficial components of human microflora.
C) They have RNA or DNA, but never both.
D) They are capable of spore production.



13. A hospital patient was swabbed on admission for antibiotic-resistant organisms and has just been informed that methicillin-resistant Staphylococcus aureus (MRSA) is present in his groin. The patient has a normal core temperature and white blood cell count. This patient is experiencing which of the following?
A) Infection
B) Proliferation
C) Colonization
D) Inflammation



14. A 33-year-old patient who is a long-term intravenous user of heroin has been recently diagnosed with hepatitis C. Which of the following portals of entry most likely led to the patient’s infection?
A) Direct contact
B) Vertical transmission
C) Ingestion
D) Penetration



15. A 9-month-old infant has been diagnosed with botulism after he was fed honey. The child’s mother was prompted to seek care because of this child’s sudden onset of neuromuscular deficits, which were later attributed to the release of substances by Clostridium botulinum bacteria. Which virulence factor contributed to this child’s illness?
A) Endotoxins
B) Adhesion factors
C) Exotoxins
D) Evasive factors



16. A patient with a long-standing diagnosis of Crohn disease has developed a perianal abscess. Which of the following treatments will this patient most likely require?
A) Antiviral therapy
B) Antibiotic therapy
C) Surgical draining
D) Pressure dressing



17. A patient’s primary care provider has ordered direct antigen detection in the care of a patient with a serious symptomatology of unknown origin. Which of the following processes will be conducted?
A) Detecting DNA sequences that are unique to the suspected pathogen
B) Growth of biofilms on various media in the laboratory setting
C) Quantification of IgG and IgM antibodies in the patient’s blood
D) Introduction of monoclonal antibodies to a blood sample from the patient



18. A patient has begun taking acyclovir, an antiviral medication, to control herpes simplex outbreaks. What is this drug’s mechanism of action?
A) Inhibition of viral adhesion to cells
B) Elimination of exotoxin production
C) Antagonism of somatic cell binding sites
D) Interference with viral replication processes



19. International travel has contributed to increased prevalence and incidence of nonindigenous diseases by increasing which of the following?
A) Portals of entry
B) Sources of infection
C) Virulence
D) Disease course



20. A public health nurse should recognize that sexually transmitted infections (STIs) are typically spread by which of the following mechanisms?
A) Penetration
B) Vertical transmission
C) Direct contact
D) Ingestion


1. Innate immunity, also called natural or native immunity, consists of mechanisms that respond specifically to:
A) self-cells.
B) microbes.
C) antibodies.
D) inflammation.



2. Adaptive immune responses, also called acquired or specific immunity, are composed of _____________ and their products.
A) granulocytes
B) lymphocytes
C) epithelial cells
D) Toll-like receptors



3. The effector cells of the immune system have the primary function of:
A) activating phagocytic cells.
B) eliminating the antigens.
C) processing antigen into epitopes.
D) controlling the immune response.



4. Activation of lymphocytes is dependent upon the ________ and ________ of the antigens by macrophages.
A) memory; clustering
B) capture; destruction
C) recognition; grouping
D) processing; presentation



5. Major histocompatibility complex (MHC) molecules, with human leukocyte antigens (HLAs), are markers on all nucleated cells and have an important role in:
A) identifying blood types.
B) cell membrane transport.
C) suppressing viral replication.
D) avoiding transplant rejections.



6. Dendritic cells, found in skin tissues and lymphoid tissues, are important for:
A) initiation of adaptive immunity.
B) deep-tissue phagocytosis.
C) disposal of dead cells.
D) delaying inflammation.



7. Once T helper cells are activated, they secrete ____________ that activate and regulate nearly all of the other cells of the immune system.
A) complement proteins
B) cytokines
C) leukotrienes
D) bradykinins



8. The first circulating immunoglobulin to appear in response to a new antigen is:
A) IgG.
B) IgM.
C) IgA.
D) IgD.



9. The effector function of activated members of the complement system includes all of the following EXCEPT:
A) chemotaxis.
B) opsonization.
C) pathogen lysis.
D) phagocytosis.



10. During the latent period before antibodies are detected in the humoral immune response, B cells differentiate into ________ cells.
A) plasma
B) cytotoxic
C) stem
D) helper



11. Which of the following would participate in the innate immune response to an infectious microorganism?
A) T lymphocytes
B) Antibodies
C) B lymphocytes
D) Neutrophils



12. A patient has recently received a pneumococcal vaccine and the patient’s B cells are consequently producing antibodies. Which of the following cells may enhance this production of antibodies?
A) Helper T cells
B) Regulatory T cells
C) Cytotoxic T cells
D) Natural killer cells



13. A child’s thymus gland is fully formed and proportionately larger than an adult’s. Which of the following processes that contribute to immunity takes place in the thymus gland?
A) Differentiation of B cells
B) Production of natural killer (NK) cells
C) Proliferation of T cells
D) Filtration of antigens from the blood



14. A patient’s exposure to an antibiotic-resistant microorganism while in the hospital has initiated an immune response, a process that is mediated and regulated by cytokines. Which of the following statements is true of cytokines?
A) They are stored in the peripheral lymphoid tissues until required.
B) They have a long half-life that contributes to an ongoing immune response.
C) They are normally released at cell-to-cell interfaces, binding to specific receptors.
D) They are capable of performing phagocytosis in the response to viral invasion.



15. The entrance of a microbe into an individual’s vascular space has initiated opsonization. Which of the following processes is involved in opsonization?
A) Stimulation of B cells by helper T cells
B) Coating of a microbe to aid phagocyte recognition
C) Release of proteins that stimulate cell production by the bone marrow
D) Lysis of intracellular microbes by cytotoxic T cells



16. Bacteria on a sliver in a boy’s finger have initiated an adaptive immune response. The boy’s lymphocytes and antibodies recognize immunologically active sites on the bacterial surfaces known as:
A) Toll-like receptors.
B) opsonins.
C) chemokines.
D) epitopes.



17. Histocompatability molecules are of primary importance to which of the following aspects of immunity?
A) Induction of T-cell immunity
B) T-cell maturation
C) NK cell activation
D) Phagocytosis by neutrophils



18. Prior to leaving on a backpacking trip to Southeast Asia, a college student has received a tetanus booster shot. This immunization confers protection by way of what immune process?
A) Secondary humoral response
B) Cell-mediated immune response
C) Primary humoral response
D) Innate immunity



19. A patient’s cell-mediated immune response has resulted in the release of regulator T cells. These cells will perform which of the following roles?
A) Suppressing the immune response to limit proliferation of potentially harmful lymphocytes
B) Presenting antigens to B cells to facilitate the production of antibodies
C) Differentiating into subpopulations of helper T cells
D) Destroying target cells by releasing cytolytic enzymes and other toxins



20. A 1-day-old infant was exposed to an infectious microorganism prior to discharge home from the hospital, but was able to effect a sufficient immune response in the hours and days following exposure. This immune response may have been due to the presence of which of the following immunoglobulins from the infant’s mother?
A) IgA
B) IgG
C) IgM
D) IgD
1. The mediators involved in type I hypersensitivity allergic responses are released from:
A) mast cells.
B) plasma cells.
C) monocytes.
D) arachidonic acid.



2. A genetically determined hypersensitivity to common environmental allergens causes ___________ reactions, such as:
A) atopic; urticaria.
B) autoimmune; diarrhea.
C) IgM-mediated; infections.
D) delayed; poison ivy rash:



3. Mismatched blood transfusion reaction with hemolysis of blood cells is an example of type II, _____ mediated hypersensitivity reaction.
A) T-cell
B) antibody
C) leukotriene
D) complement



4. Type III hypersensitivity immune responses can be harmful when immune complex deposits in tissue activate ___________ that can directly damage area tissues.
A) inflammation
B) autoantibodies
C) cytotoxic cells
D) immunoglobulins



5. The mechanism by which humans recognize self-cells from non-self (antigens)-cells is _________.
A) autoimmunity
B) self-tolerance
C) non-self anergy
D) immunocompatibility



6. Organ rejection is a complication of organ transplantation caused by recipient immune cells:
A) destroying the host T cells.
B) attack on the donor cells.
C) combining with grafts HLA.
D) being recognized as foreign.



7. The leading cause of death for people with HIV is opportunistic ____________.
A) leukemia
B) tuberculosis
C) pneumonia
D) toxoplasmosis



8. Wasting syndrome, an AIDS-defining illness, is characterized by involuntary weight loss of at least 10% of baseline body weight in the presence of:
A) diarrhea.
B) hypermetabolism.
C) weakness and fever.
D) glucose intolerance.



9. The “window period” of HIV infection refers to the period of time between infection and:
A) transmission.
B) seroconversion.
C) initial symptoms.
D) antibody screening.



10. HIV-positive persons that display manifestations of laboratory category 3 or clinical category C are considered to have:
A) zero viral load.
B) seroconversion.
C) complete remission.
D) AIDS-defining illnesses.



11. Contact with poison ivy has resulted in intense pruritus, erythema, and weeping on a patient’s forearm. Which of the following processes resulted in the patient’s signs and symptoms?
A) IgE-mediated mast cell degranulation
B) Formation of antigen-antibody complexes
C) Cytokine release by sensitized T cells
D) Formation of antibodies against cell surface antigens



12. A patient with a long history of “hay fever” has recently begun a series of immunotherapy (allergy shots). How will this treatment potentially achieve a therapeutic effect?
A) By blocking cytokine release from sensitized mast cells
B) By preventing mast cells from becoming sensitized
C) By causing T cells to be sequestered in the thymus for longer periods
D) By stimulating production of IgG to combine with antigens



13. A patient with a diagnosis of cirrhosis has experienced an acute rejection of a donor liver. Which of the following cells is central to the rejection of the patient’s transplanted organ?
A) Natural killer cells
B) Mast cells
C) T cells
D) Neutrophils



14. A patient with a diagnosis of aplastic anemia has undergone allogenic bone marrow transplantation. Which of the following signs and symptoms would most clearly suggest the existence of graft-versus-host disease (GVHD)?
A) Shortness of breath, audible crackles, and decreasing PaO2
B) Presence of a pruritic rash that has begun to slough off
C) Development of metabolic acidosis
D) Diaphoresis, fever, and anxiety



15. A patient has developed pericarditis after developing acute glomerulonephritis, a development that may be attributable to the presence of similar epitopes on group A, b-hemolytic streptococci and the antigens in the patient’s heart tissue. Which of the following has most likely accounted for this patient’s autoimmune response?
A) Breakdown of T-cell anergy
B) Release of sequestered antigens
C) Superantigens
D) Molecular mimicry



16. A 70-year-old female patient has had her mobility and independence significantly reduced by rheumatoid arthritis. Which of the following processes likely contributed to the development of her health problem?
A) Delayed-type hypersensitivity (DTH) reaction
B) Proliferation of cytotoxic T cells
C) Failure of normal self-tolerance
D) Deletion of autoreactive B cells



17. Which of the following would constitute a normal assessment finding in a neonate?
A) Minimal or absent levels of IgA and IgM
B) Absence of plasma cells in the lymph nodes and spleen
C) Undetectable levels of all immunoglobulins
D) Absence of mature B cells with normal T-cell levels and function



18. A patient was diagnosed as HIV positive several years ago. Which of the following blood tests is most clinically useful for determining the stage and severity of her disease?
A) Plasma levels
B) CD4+ cell counts
C) Viral load
D) White blood cell count with differential



19. A patient has been admitted to the hospital for the treatment of HIV infection, which has recently progressed to overt AIDS. Which of the following nursing actions should the nurse prioritize when providing care for this patient?
A) Frequent neurologic vital signs and thorough skin care
B) Hemodynamic monitoring and physical therapy
C) Careful monitoring of fluid balance and neurologic status
D) Astute infection control and respiratory assessments



20. Shortly after being diagnosed with HIV, a patient has begun highly active antiretroviral therapy (HAART). What is the primary goal of the patient’s drug regimen?
A) To limit the latent period of HIV
B) To slow the progression of the disease
C) To minimize opportunities for transmission
D) To prevent seroconversion



1. In the arterial-venous circulatory system, pressure is inversely related to:
A) velocity.
B) volume.
C) tension.
D) viscosity.



2. Turbulent blood flow can be caused by a number of factors, including:
A) increased velocity.
B) short vessel length.
C) high blood viscosity.
D) layering of blood cells.



3. Heart muscle differs from skeletal muscle tissue by being able to generate:
A) contractions.
B) calcium influx.
C) action potentials.
D) sarcomere binding.



4. During ventricular systole, closure of the atrioventricular (AV) valves coincides with:
A) atrial chamber filling.
B) aortic valve opening.
C) isovolumetric contraction.
D) semilunar valves opening.



5. The difference between the end-diastolic and end-systolic volumes is the:
A) stroke volume.
B) cardiac output.
C) ejection fraction.
D) cardiac reserve.



6. Preload represents the volume work of the heart and is largely determined by:
A) venous blood return.
B) vascular resistance.
C) force of contraction.
D) ventricular emptying.



7. A large increase in heart rate can cause:
A) increased blood viscosity.
B) loss of action potential.
C) decreased stroke volume.
D) reduced cardiac contractility.



8. Long-term autoregulation of local blood flow in the microcirculation is mediated by:
A) collateral circulation.
B) arteriovenous shunting.
C) autonomic nervous system.
D) metabolic needs of the tissues.



9. The tissue factor that contributes to humoral control of blood flow by causing vasoconstriction is:
A) histamine.
B) bradykinin.
C) serotonin.
D) nitric oxide.



10. The parasympathetic nervous system causes a slowing of the heart rate by increasing:
A) norepinephrine.
B) vessel constriction.
C) vagus nerve activity.
D) smooth muscle tone.



11. A patient has entered hypovolemic shock after massive blood loss in a car accident. Many of the patient’s peripheral blood vessels have consequently collapsed. How does the Laplace law account for this pathophysiologic phenomenon?
A) Blood pressure is no longer able to overcome vessel wall tension.
B) Decreasing vessel radii have caused a decrease in blood pressure.
C) Wall thickness of small vessels has decreased due to hypotension.
D) Decreases in wall tension and blood pressure have caused a sudden increase in vessel radii.



12. In the days following a tooth cleaning and root canal, a patient has developed an infection of the thin, three-layered membrane that lines the heart and covers the valves. What is this patient’s most likely diagnosis?
A) Pericarditis
B) Endocarditis
C) Myocarditis
D) Vasculitis



13. Following several weeks of increasing fatigue and a subsequent diagnostic work-up, a patient has been diagnosed with mitral valve regurgitation. Failure of this heart valve would have which of the following consequences?
A) Backup of blood from the right atrium into the superior vena cava
B) Backflow from the right ventricle to the right atrium during systole
C) Inhibition of the SA node’s normal action potential
D) Backflow from the left ventricle to left atrium



14. Harmful effects on cardiac action potential are most likely to result from a deficit of which of the following electrolytes?
A) Magnesium (Mg2+)
B) Chloride (Cl)
C) Potassium (K+)
D) Hydrogen carbonate (HCO3)



15. A male patient with a history of angina has presented to the emergency department with uncharacteristic chest pain and his subsequent ECG reveals T-wave elevation. This finding suggests an abnormality with which of the following aspects of the cardiac cycle?
A) Atrial depolarization
B) Ventricular depolarization
C) Ventricular repolarization
D) Depolarization of the AV node, bundle branches, and Purkinje system



16. A patient with a history of heart failure has been referred for an echocardiogram. Results of this diagnostic test reveal the following findings: heart rate 80 beats per minute; end-diastolic volume 120 mL; end-systolic volume 60 mL. What is this patient’s ejection fraction?
A) 200 mL
B) 50%
C) .80
D) 180 mL



17. A patient with a diagnosis of secondary hypertension has begun to experience signs and symptoms that are ultimately suggestive of decreased cardiac output. Which of the following factors that determine cardiac output is hypertension likely to affect most directly?
A) Preload
B) Afterload
C) Contractility
D) Heart rate



18. A patient who lives with a diagnosis of angina pectoris has taken a sublingual dose of nitroglycerin to treat the chest pain he experienced while mowing his lawn. This drug has resulted in a release of nitric oxide, which will have what effect?
A) Smooth muscle relaxation of vessels
B) Decreased heart rate and increased stroke volume
C) Increased preload
D) Reduction of cardiac refractory periods



19. Release of which of the following humoral factors will result in vasodilation?
A) Norepinephrine
B) Angiotensin II
C) Serotonin
D) Histamine



20. Which of the following factors is the primary governor of the local control of blood flow?
A) Action potential
B) The nutritional needs of the tissue involved
C) Cardiac contractility and preload
D) Feedback from arterial baroreceptors and chemoreceptors



1. Because cholesterol is insoluble in plasma, it is mainly carried by the lipoprotein:



2. A major cause of secondary hyperlipoproteinemia is _______, which increases the production of VLDL and conversion to LDL.
A) high-calorie diet
B) diabetes mellitus
C) bile-binding resin
D) cholesterol ingestion



3. The most important complication of atherosclerosis is _________, which may cause occlusion of small heart vessels.
A) ulceration
B) thrombosis
C) fatty streaks
D) fibrous plaque



4. A serum marker for systemic inflammation, _______, is now considered a major risk factor marker for atherosclerosis, and vascular disease.
A) leukocytosis
B) homocysteine
C) serum lipoprotein
D) C-reactive protein



5. Small-vessel vasculitides, a group of vascular disorders that cause vasculitis, are mainly mediated by:
A) infectious agents.
B) tissue necrosis.
C) mononuclear cells.
D) hypersensitivity reactions.



6. Atherosclerotic peripheral vascular disease is symptomatic with at least 50% occlusion. The primary peripheral symptom, due to ischemia, is:
A) edema.
B) calf pain.
C) varicosities.
D) strong pulse.



7. Although both are characterized by ischemia, Raynaud phenomenon is caused by _________, and thromboangiitis obliterans is caused by:
A) occlusion; compression.
B) thrombi; vasoconstriction.
C) vasculitides; hypertension.
D) vasospasm; inflammation.



8. Because of its location, the presence of an abdominal aortic aneurysm may first be noticed as:
A) constipation.
B) indigestion.
C) a pulsating mass.
D) mid-abdominal pain.



9. By definition, hypertension is systolic blood pressure of ____ mm Hg or higher or diastolic blood pressure of ____ mm Hg or higher.
A) 129; 85
B) 138; 89
C) 140; 90
D) 155; 95



10. The patient is immobilized following a hip injury and has begun demonstrating lower leg discoloration with edema, pain, tenderness, and increased warmth in the mid-calf area. He has many of the manifestations of:
A) stasis ulcerations.
B) arterial insufficiency.
C) primary varicose veins.
D) deep vein thrombosis.



11. A 52-year-old man who is moderately obese has recently been diagnosed with hypertension by his primary care provider. Which of the patient’s following statements indicates a need for further health-promotion teaching?
A) “I’ve starting going to the gym before work three times a week.”
B) “I’m trying to cut back on the amount of salt that I cook with and add to my food.”
C) “I’m resolving to eat organic foods from now on and to drink a lot more water.”
D) “I’m planning to lose 15 pounds before the end of this year.”



12. A patient with a diagnosis of chronic renal failure secondary to diabetes has seen a gradual increase in her blood pressure over the past several months, culminating in a diagnosis of secondary hypertension. Which of the following has most likely resulted in the patient’s increased blood pressure?
A) Increased levels of adrenocortical hormones
B) Activation of the renin-angiotensin-aldosterone mechanism
C) Increased sympathetic stimulation by the autonomic nervous system (ANS)
D) Coarctation of the patient’s aorta



13. Which of the following physiologic processes contributes most to the long-term regulation of blood pressure?
A) Actions of the renin-angiotensin-aldosterone system
B) Release of antidiuretic hormone (vasopressin) by the posterior pituitary
C) Renal monitoring and adjustment of extracellular fluid volume
D) Integration and modulation of autonomic nervous system (ANS)



14. Which of the following is a nonmodifiable risk factor for the development of primary hypertension?
A) African American race
B) High salt intake
C) Male gender
D) Obesity



15. A patient with persistent, primary hypertension remains apathetic about his high blood pressure, stating, “I don’t feel sick, and it doesn’t seem to be causing me any problems that I can tell.” How could a clinician best respond to this patient’s statement?
A) “Actually, high blood pressure makes you very susceptible to getting diabetes in the future.”
B) “That’s true, but it’s an indicator that you’re not taking very good care of yourself.”
C) “You may not sense any problems, but it really increases your risk of heart disease and stroke.”
D) “You’re right, but it’s still worthwhile to monitor it in case you do develop problems.”



16. A patient’s primary care provider has added 20 mg of Lasix (furosemide) to his medication regimen to treat his primary hypertension. How does this diuretic achieve its therapeutic effect?
A) By decreasing vascular volume by increasing sodium and water excretion
B) By blocking the release of antidiuretic hormone from the posterior pituitary
C) By inhibiting the conversion of angiotensin I to angiotensin II.
D) By inhibiting the movement of calcium into arterial smooth muscle cells



17. A 29-year-old woman who considers herself active and health conscious is surprised to have been diagnosed with preeclampsia-eclampsia in her second trimester. What should her care provider teach her about this change in her health status?
A) “We don’t really understand why some women get high blood pressure when they’re pregnant.”
B) “This is likely a result of your nervous system getting overstimulated by pregnancy.”
C) “Hypertension is a common result of all the hormonal changes that happen during pregnancy.”
D) “Even though you’re a healthy person, it could be that you have an underlying heart condition.”



18. Which of the following patients should most likely be assessed for orthostatic hypotension?
A) A 78-year-old woman who has begun complaining of frequent headaches unrelieved by over-the-counter analgesics.
B) A patient whose vision has become much less acute in recent months and who has noticed swelling in her ankles.
C) An elderly patient who has experienced two falls since admission while attempting to ambulate to the bathroom.
D) A patient who has a history of poorly controlled type 1 diabetes.



19. A patient is receiving homecare for the treatment of a wound on the inside of her lower leg which is 3 cm in diameter with a yellow wound bed and clear exudate. Assessment of the patient’s legs reveals edema and a darkened pigmentation over the ankles and shins of both legs. What is this patient’s most likely diagnosis?
A) Chronic venous insufficiency
B) Deep vein thrombosis
C) Varicose veins
D) Peripheral arterial disease



20. A postsurgical patient’s complaints of calf pain combined with the emergence of swelling and redness in the area have culminated in a diagnosis of deep vein thrombosis. What treatment options will be of greatest benefit to this patient?
A) Analgesics and use of a pneumatic compression device
B) Massage followed by vascular surgery
C) Frequent ambulation and the use of compression stockings
D) Anticoagulation therapy and elevation of the leg


1. Chronic stable angina, associated with inadequate blood flow to meet the metabolic demands of the myocardium, is caused by:
A) fixed coronary obstruction.
B) increased collateral circulation.
C) intermittent vessel vasospasms.
D) excessive endothelial relaxing factors.



2. Atherosclerotic plaque is most likely to be unstable and vulnerable to rupture when the plaque has a thin fibrous cap over a:
A) red thrombus.
B) large lipid core.
C) calcified lesion.
D) vessel wall injury.



3. Cardiac tamponade and pericardial effusion can be life-threatening when the pericardial sac _______ and ______ the heart.
A) ruptures; releases
B) thickens; stretches
C) contracts; friction rubs
D) fills rapidly; compresses



4. In adults, sudden death from an acute myocardial infarction is usually caused by:
A) acute myocarditis.
B) high troponin levels.
C) acute ventricular arrhythmia.
D) hypertrophic cardiomyopathy.



5. On the second or third day after an acute myocardial infarction, the area of necrosis is:
A) soft and yellow.
B) acutely inflamed.
C) granulation tissue.
D) fibrous scar tissue.



6. In aortic regurgitation, failure of aortic valve closure during diastole causes an abnormal drop in diastolic pressure. This change in pressure causes decreased:
A) stroke volume.
B) left ventricular size.
C) coronary perfusion.
D) arterial pulse pressure.



7. Patients with ischemic coronary vessel disease and acute coronary syndrome (ACS) are classified as low or high risk for acute myocardial infarction based on characteristics that include significant:
A) heart murmurs.
B) ECG changes.
C) pulmonary disease.
D) pericardial effusion.



8. Dilated cardiomyopathy with left ventricular dysfunction is characterized by increased wall:
A) rigidity.
B) thinning.
C) thickness.
D) contractility.



9. Endocarditis and rheumatic heart disease are both cardiac complications of systemic infections. Characteristics include a new or changed heart murmur caused by:
A) chronic atrial fibrillation.
B) myocardial inflammation.
C) left ventricle hypertrophy.
D) vegetative valve destruction.



10. Congenital heart defects can cause a right heart to left heart shunting of blood that results in increased:
A) pulmonary blood volume.
B) right ventricle workload.
C) unoxygenated blood flow.
D) right atrial blood volume.



11. Which of the following assessment findings of a cardiac patient would be suggestive of cardiac tamponade?
A) Increasing PaCO2 and decreasing PaO2
B) Audible crackles on chest auscultation and presence of frothy sputum
C) 20 mm Hg Drop in systolic blood pressure during respiration
D) Normal ECG combined with complaints of chest pain and shortness of breath



12. The plaques in a patient’s coronary arteries are plentiful and most have small- to moderate-sized lipid cores with thick fibrous caps. This form of atherosclerosis is most closely associated with which of the following diagnoses?
A) Stable angina
B) Non-ST-segment elevation MI
C) ST-Segment elevation MI
D) Unstable angina



13. Which of the following individuals is suffering the effects of acute coronary syndrome (ACS)?
A) A patient whose most recent ECG indicates that silent myocardial ischemia has occurred
B) A patient who occasionally experiences persistent and severe chest pain when at rest
C) A patient who sometimes experiences chest pain when climbing stairs
D) A patient who has recently been diagnosed with variant (vasospastic) angina



14. Coronary artery bypass grafting (CABG) is a relevant treatment modality for which of the following disorders of cardiac function?
A) Atherosclerosis with history of MI
B) Pericardial effusion and cardiac tamponade
C) Dilated cardiomyopathies
D) Aortic valve regurgitation and aortic stenosis



15. Football fans at a college have been shocked to learn of the sudden death of a star player, an event that was attributed in the media to “an enlarged heart.” Which of the following disorders was the player’s most likely cause of death?
A) Takotsubo cardiomyopathy
B) Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D)
C) Hypertrophic cardiomyopathy (HCM)
D) Dilated cardiomyopathy (DCM)



16. Implantation of a pacemaker is most likely to benefit a patient with which of the following cardiomyopathies?
A) Myocarditis
B) Takotsubo cardiomyopathy
C) Dilated cardiomyopathy (DCM)
D) Primary restrictive cardiomyopathy



17. A child’s history of a recurrent sore throat followed by severe knee and ankle pain has resulted in a diagnostic workup and a diagnosis of rheumatic fever. What are the treatment priorities for this child?
A) Cardiac catheterization and corticosteroid therapy
B) Implanted pacemaker and b-adrenergic blockers
C) Antibiotics and anti-inflammatories
D) Pain control and oxygen therapy



18. An elderly female patient with complaints of increasing fatigue has been diagnosed with aortic stenosis, a disease which her primary care provider believes may have been long-standing. Which of the following compensatory mechanisms has most likely maintained the woman’s ejection fraction until recently?
A) Left ventricular hypertrophy
B) Increased blood pressure
C) Increased heart rate and stroke volume
D) Aortic dilation



19. Persistent cyanosis has led an infant’s care team to suspect a congenital heart defect. Which of the following assessment findings would suggest coarctation of the infant’s aorta?
A) The child has a split S2 heart sound on auscultation.
B) ECG reveals atrial fibrillation.
C) The child experiences apneic spells after feeding.
D) Blood pressure in the child’s legs is lower than in the arms.



20. Which of the following assessment findings of a cyanotic infant is incongruent with a diagnosis of tetralogy of Fallot?
A) The child has ventricular septal defect.
B) The infant’s pulmonary outflow channel is narrowed.
C) The child has right ventricular hypertrophy.
D) The infant’s aorta is narrowed.



1. The pathophysiology of heart failure involves an interaction between decreased pumping ability and the ________ to maintain cardiac output.
A) aortic hypertrophy
B) compensatory mechanisms
C) electrical conductivity
D) parasympathetic system



2. Cardiac output is the ________ each minute.
A) volume load
B) blood pumped
C) stroke volume
D) force generated



3. One of the principal mechanisms by which the heart compensates for increased workload is:
A) myocardial hypertrophy.
B) sodium and water retention.
C) endothelin vasoconstrictors.
D) ventricular wall tension increase.



4. In right-sided heart failure, peripheral edema is evidenced by:
A) weight gain.
B) copious urination.
C) shortness of breath.
D) decreased blood pressure.



5. The most common causes of left-sided heart failure include:
A) acute myocardial infarction.
B) chronic pulmonary disease.
C) impaired renal blood flow.
D) tricuspid valve regurgitation.



6. Hypovolemic shock occurs as a result of:
A) myocardial infarction.
B) excessive vasoconstriction.
C) chronic intracellular fluid shift.
D) acute intravascular volume loss.



7. In shock, one of the best indicators of blood flow to vital organs is:
A) warm legs.
B) urine output.
C) blood pressure.
D) consciousness.



8. Anaphylactic shock is directly associated with:
A) loss of blood volume.
B) bacterial blood infection.
C) failure of the heart as a pump.
D) type I hypersensitivity response.



9. Severe shock can be followed by acute lung injury/acute respiratory distress syndrome (ALI/ARDS) characterized by:
A) hyperventilation.
B) excessive surfactant.
C) hyperinflated alveolar sacs.
D) ventilation-perfusion mismatch.



10. A common symptom of the ischemia associated with gastrointestinal redistribution of blood flow is:
A) gastric bleeding.
B) nausea and vomiting.
C) irritable bowel syndrome.
D) copious high volume diarrhea.



11. A patient has been experiencing increasing fatigue in recent months, a trend that has prompted an echocardiogram. Results of this diagnostic test suggest that the patient’s end-diastolic volume is insufficient. Which of the following parameters of cardiac performance will directly decrease as a result of this?
A) Inotropy
B) Cardiac contractility
C) Preload
D) Afterload



12. Which of the following health problems is associated with heart failure as a result of diastolic dysfunction?
A) Uncontrolled hypertension
B) Chronic bradycardia
C) Ischemic heart disease
D) Myocardial hypertrophy



13. Assessment of an elderly female patient reveals the presence of bilateral pitting edema of the patient’s feet and ankles and pedal pulses that are difficult to palpate. Auscultation of the patient’s lungs reveals clear air entry to bases, and the patient’s oxygen saturation level is 93% and vital signs are within reference ranges. What is this patient’s most likely health problem?
A) Right-sided heart failure
B) Left-sided heart failure
C) Cardiogenic shock
D) Cor pulmonale



14. The most recent blood work of a patient with a diagnosis of heart failure indicates increased levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP). What are the most likely effects of these peptides on the patient’s physiology?
A) Water retention
B) Increased tubular sodium reabsorption
C) Inhibition of the renin-angiotensin-aldosterone system
D) Sympathetic nervous stimulation



15. A nurse is performing patient health education with a 68-year-old man who has recently been diagnosed with heart failure. Which of the following statements demonstrates an accurate understanding of his new diagnosis?
A) “I’ll be sure to take my beta blocker whenever I feel short of breath.”
B) “I’m going to avoid as much physical activity as I can so that I preserve my strength.”
C) “I know it’s healthy to drink a lot of water, and I’m going to make sure I do this from now on.”
D) “I’m trying to think of ways that I can cut down the amount of salt that I usually eat.”



16. Electrical burns over a large surface area of a patient’s body have resulted in hypovolemic shock after the loss of large amounts of blood and plasma. Which of the following mechanisms is the patient’s body likely to implement to compensate for this loss of fluid?
A) Increased heart rate
B) Vasodilation
C) Diuresis
D) Inhibition of ADH



17. A patient who developed a deep vein thrombosis during a prolonged period of bedrest has deteriorated as the clot has dislodged and resulted in a pulmonary embolism. Which of the following types of shock is this patient at risk of experiencing?
A) Cardiogenic shock
B) Hypovolemic shock
C) Obstructive shock
D) Distributive shock



18. For which of the following types of shock might intravenous antibiotic therapy be indicated?
A) Obstructive shock
B) Distributive shock
C) Cardiogenic shock
D) Hypovolemic shock



19. An 86-year-old male patient is disappointed to learn that he has class II heart failure despite a lifelong commitment to exercise and healthy eating. Which of the following age-related changes predisposes older adults to developing heart failure?
A) Increased vascular stiffness
B) Orthostatic hypotension
C) Increased cardiac contractility
D) Loss of action potential



20. A patient with a diagnosis of heart failure has returned from a visit with his primary care provider with a prescription for a change in his daily medication regimen. Which of the following drugs is likely to improve the patient’s cardiac function by increasing the force and strength of ventricular contractions?
A) A b-adrenergic blocker
B) A diuretic
C) A cardiac glycoside
D) An ACE inhibitor