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Understanding Pathophysiology 5th Edition by Huether and McCance

 

 

SAMPLE QUESTIONS

 

Huether and McCance: Understanding Pathophysiology, 5th Edition

 

Chapter 03: Altered Cellular and Tissue Biology

 

Test Bank

 

MULTIPLE CHOICE

 

  1. A report comes back indicating that muscular atrophy has occurred. A nurse recalls that muscular atrophy involves a decrease in muscle cell:
a. Number
b. Size
c. Vacuoles
d. Lipofuscin

 

 

ANS:   B

Atrophy is a decrease or shrinkage in cellular size.

Hyperplasia is an increase in the number of cells.

Vacuoles are membrane-bound vesicles within the cell that contain cellular debris and hydrolytic enzymes.

Lipofuscin is the yellow-brown age pigment.

 

REF:    p. 61

 

  1. During childhood, the thymus decreases in size, and this is referred to as _____ atrophy.
a. Physiologic
b. Pathologic
c. Disuse
d. Neurogenic

 

 

ANS:   A

A normal decrease in cell size is physiologic atrophy.

When cell size decrease due to disease, it is termed pathologic atrophy.

When cells undergo disuse, the cells shrink in size, and this is disuse atrophy.

Neurogenic atrophy is injury or disease affecting the nerves that connect to the muscle.

 

REF:    p. 61

 

  1. When planning care for a cardiac patient, the nurse knows that in response to an increased workload, cardiac myocardial cells will:
a. Increase in size
b. Decrease in length
c. Increase in excitability
d. Increase in number

 

 

ANS:   A

Organ cells respond to increased workload by increasing in size, much as a muscle when it is exercised.

Organ cells increase in size with increased workload; they do not decrease in length.

A deficiency of electrolytes or minerals could lead to an increase in excitability; it is not due to increased workload.

Increase in cell numbers is referred to as hyperplasia and is not related to increased workload.

 

REF:    p. 62

 

  1. A 55-year-old male with a 30-year history of smoking is examined for respiratory disturbance. Examination of his airway (bronchial) reveals that stratified squamous epithelial cells have replaced the normal columnar ciliated cells. This type of cellular adaptation is called:
a. Anaplasia
b. Hyperplasia
c. Metaplasia
d. Dysplasia

 

 

ANS:   C

Metaplasia is the reversible replacement of one mature cell type by another, sometimes a less differentiated cell type.

Anaplasia is loss of cellular differentiation.

Hyperplasia is an increase in the number of cells resulting from an increased rate of cellular division.

Dysplasia refers to abnormal changes in the size, shape, and organization of mature cells.

 

REF:    p. 63

 

  1. When planning care for the pregnant patient, the nurse will recall that the mammary glands enlarge as a consequence of:
a. Compensatory hyperplasia
b. Hormonal hyperplasia
c. Hormonal anaplasia
d. Compensatory anaplasia

 

 

ANS:   B

An increase in the mammary glands during pregnancy is a result of hormonal changes. The number of mammary cells increases in response to increased hormone levels.

Hyperplasia is correct, but it is not a compensatory response, but a hormonal response.

Hormonal is correct, but the growth is due to an increased number of cells, not enlargement.

Compensatory is not correct, nor is anaplasia, a reversal to more immature cells. Mammary enlargement is a normal response.

 

REF:    p. 62

 

  1. A 24-year-old female presents with excessive menstrual bleeding. The physician identified endometrial changes that are due to hormonal imbalances. These cellular changes would be referred to as:
a. Dysplasia
b. Pathologic dysplasia
c. Hyperplasia
d. Pathologic hyperplasia

 

 

ANS:   D

Because the changes are due to an imbalance, they would be considered pathologic hyperplasia.

The endometrial changes were not abnormal in size and shape; thus, it is not dysplasia.

The description of alteration in hormone levels is pathologic.

Hyperplasia is not as accurate as pathologic because there is an imbalance of hormone levels.

 

REF:    p. 63

 

  1. A 55-year-old male is diagnosed with hepatocellular cancer secondary to hepatitis C. If the cancerous region of the liver were removed, the remaining cells would undergo:
a. Pathologic hyperplasia
b. Pathologic metaplasia
c. Compensatory hyperplasia
d. Compensatory aplasia

 

 

ANS:   C

Compensatory hyperplasia is an adaptive mechanism that enables certain organs to regenerate.

The cells become compensatory and would not be pathologic.

Metaplasia is the reversible replacement of one mature cell type by another, sometimes less differentiated, cell type.

Aplasia is not a compensatory mechanism.

 

REF:    p. 62

 

  1. A 40-year-old female is diagnosed with cervical cancer after a Pap smear. Which of the following cellular changes would the nurse most likely see on the report?
a. Metaplasia
b. Atrophy
c. Hypertrophy
d. Dysplasia

 

 

ANS:   D

When cervical cells become cancerous, they have undergone dysplasia, a change in the size and shape of cells.

The cells have changed; they have not been replaced, so metaplasia is not the correct choice.

The cells have not decreased in size; therefore, atrophy is incorrect.

The cells have not increased in size; therefore, they have not hypertrophied.

 

REF:    p. 63

 

  1. A 75-year-old male presents with chest pain on exertion. The chest pain is most likely due to hypoxic injury secondary to:
a. Malnutrition
b. Free radicals
c. Ischemia
d. Chemical toxicity

 

 

ANS:   C

The cardiac cells are deprived of oxygen leading to ischemia, a reduction in blood supply to tissues.

The cells are deprived of oxygen; they are not malnourished.

Free radicals are electrically uncharged atoms or groups of atoms that have an unpaired electron.

Chemical toxicity is not a factor in the chest pain; the pain is related to a lack of oxygen.

 

REF:    p. 65

 

  1. A patient has a heart attack that leads to progressive cell injury that causes cell death with severe cell swelling and breakdown of organelles. What term would the nurse use to define this process?
a. Adaptation
b. Pathologic calcification
c. Apoptosis
d. Necrosis

 

 

ANS:   D

Necrosis is the sum of cellular changes after local cell death.

Cellular adaptation is a reversible, structural, or functional response to both normal or physiologic conditions and adverse or pathologic conditions.

Calcification is an accumulation of calcium salts.

Apoptosis is an active process of cellular self-destruction.

 

REF:    p. 67

 

  1. Sodium and water accumulation in an injured cell are a direct result of:
a. Decreased ATP production
b. Karyorrhexis
c. Ribosome detachment
d. Dehydration

 

 

ANS:   A

A reduction in ATP levels causes the plasma membrane’s sodium-potassium (Na+-K+) pump and sodium-calcium exchange to fail. Sodium and water can then enter the cell freely.

Karyorrhexis means fragmentation of the nucleus into smaller particles or “nuclear dust.”

Ribosome detachment reduces protein synthesis.

Dehydration leads to loss of sodium and water.

 

REF:    p. 66

 

  1. The early dilation (swelling) of the cell’s endoplasmic reticulum results in:
a. Increased aerobic metabolism
b. Failure of DNA
c. Reduced protein synthesis
d. Decreased Na+-K+ pump function

 

 

ANS:   C

Early dilation of the endoplasmic reticulum causes the ribosomes to detach from the rough endoplasmic reticulum, reducing protein synthesis.

Aerobic metabolism is a normal process and would not lead to swelling.

Cellular swelling will not alter cellular DNA.

A reduction, not an increase, in the Na+-K+ pump leads to an intracellular accumulation of sodium and calcium and diffusion of potassium out of the cell. Sodium and water can then enter the cell freely, and cellular swelling results.

 

REF:    p. 66

 

  1. A 52-year-old male suffered a myocardial infarction secondary to atherosclerosis and ischemia. Once oxygen returned to the damaged heart, reperfusion injury occurred as a result of:
a. Free radical formation
b. Vacuolation
c. Increased metabolic state
d. Lipid acceptor proteins

 

 

ANS:   A

Reperfusion injury results from radicals that cause further membrane damage and mitochondrial calcium overload.

Vacuolation leads to cellular swelling and is not associated with reperfusion.

Lactic acid increases as a result of damage due to necrosis, and necrosis would interfere with reperfusion, not initiate it.

Lipid acceptor proteins bind with triglycerides to create fatty liver, and they do not affect the myocardium.

 

REF:    p. 67

 

  1. A family presents to their primary care provider reporting headache, nausea, weakness, and vomiting. Which of the following would be the most likely explanation for these symptoms?
a. Lead exposure
b. Carbon monoxide poisoning
c. Ethanol exposure
d. Mercury poisoning

 

 

ANS:   B

Symptoms related to carbon monoxide poisoning include headache, giddiness, tinnitus (ringing in the ears), nausea, weakness, and vomiting.

Although nausea and vomiting can occur with lead exposure, lead toxicity is primarily manifested by convulsions and delirium and, with peripheral nerve involvement, wrist, finger, and sometimes foot paralysis.

Ethanol exposure has CNS effects and would not affect the whole family.

Mercury poisoning is manifested by CNS effects and would not lead to nausea and vomiting.

 

REF:    p. 72

 

  1. A common pathway of irreversible cell injury involves increased intracellular:
a. Sodium
b. Potassium
c. Magnesium
d. Calcium

 

 

ANS:   D

Irreversible cellular injury is due to increased intracellular calcium and loss of calcium steady state.

It is calcium, not sodium, that is involved in cellular injury.

It is calcium, not potassium, that is involved in cellular injury.

It is calcium, not magnesium, that is involved in cellular injury.

 

REF:    p. 71

 

  1. A 50-year-old male sustained a closed head injury as a result of a motor vehicle accident. CT scan revealed a collection of blood between the inner surface of the dura mater and the surface of the brain. Which type of injury will the nurse be caring for?
a. Subdural hematoma
b. Epidural hematoma
c. Contusion
d. Abrasion

 

 

ANS:   A

A subdural hematoma occurs when blood is between the inner surface of the dura mater and the surface of the brain; it can result from blows, falls, or sudden acceleration/deceleration of the head.

An epidural hematoma is a collection of blood between the inner surface of the skull and the dura; it is most often associated with a skull fracture.

A contusion is bleeding into the skin or underlying tissues.

An abrasion (scrape) results from removal of the superficial layers of the skin caused by friction between the skin and injuring object.

 

REF:    p. 78

 

  1. A 20-year-old male presents to the emergency department with a jagged sharp-force injury that is longer than it is deep. Which type of wound will the nurse be caring for?
a. Stab wound
b. Incised wound
c. Puncture wound
d. Chopping wound

 

 

ANS:   B

An incised wound is a cut that is longer than it is deep.

A stab wound is a penetrating sharp-force injury that is deeper than it is long.

A puncture wound is without sharp edges and is made with an instrument like a nail.

Heavy, edged instruments (axes, hatchets, propeller blades) produce wounds with a combination of sharp and blunt force characteristics.

 

REF:    p. 78

 

  1. A 30-year-old female presents with a gunshot wound to the head. The wound has seared edges and a deep penetration of smoke and gunpowder fragments. This wound would be documented as a(n) _____ wound.
a. Exit
b. Intermediate range entrance
c. Contact range entrance
d. Indeterminate range entrance

 

 

ANS:   C

Contact range entrance wound is a distinctive type of wound when the gun is held so the muzzle rests on or presses into the skin surface; in addition to the hole, there is searing of the edges of the wound from flame and soot or smoke on the edges of the wound.

It is unlikely it is an exit wound since there is only one wound and it has seared edges and gunpowder fragments.

Intermediate range entrance wound is surrounded by gunpowder tattooing or stippling.

Indeterminate range entrance wound occurs when flame, soot, or gunpowder does not reach the skin surface, but the bullet does.

 

REF:    p. 79

 

  1. A 15-year-old female presents to the ER following a physical assault. She has internal damage to the neck with deep bruising. X-ray reveals fractures of the hyoid bone and tracheal and cricoid cartilage. Which of the following most likely caused her injuries?
a. Chemical asphyxiation
b. Choking asphyxiation
c. Ligature strangulation
d. Manual strangulation

 

 

ANS:   D

Squeezing of the neck as with strangulation would fraction the hyoid bone.

Chemical asphyxiation would lead to breathing problems but would not result in fracture.

Choking asphyxiation would lead to swelling of tissues but would not result in fracture.

In ligature strangulation, the mark on the neck is horizontal without the inverted V pattern seen in hangings. It would not lead to fracture.

 

REF:    p. 75

 

  1. A 55-year-old male has swelling of the feet. Which of the following aided in development of swelling?
a. Increased ATP
b. Chloride movement out of the cell
c. Na+ movement into the cell
d. Decreased oncotic pressure

 

 

ANS:   C

When sodium and water enter the cell freely, cellular swelling, as well as early dilation of the endoplasmic reticulum, results.

Decreased ATP would lead to swelling, not increased ATP.

Chloride movement out of the cell would affect muscle contraction and does not lead to swelling.

Increased oncotic pressure would not affect swelling.

 

REF:    p. 75

 

  1. A 35-year-old female is diagnosed with multiple myeloma. Biopsy of the tumor reveals Russell bodies, and laboratory testing reveals kidney dysfunction. Which substance should the nurse monitor as it is accumulating in the patient’s body?
a. Glycogen
b. Protein
c. Pigment
d. Melanin

 

 

ANS:   B

Russell bodies occur due to excess aggregates of protein.

Excess glycogen would affect blood glucose and this is not related to Russell bodies.

Increased pigment would not lead to kidney dysfunction.

Melanin accumulates in epithelial cells (keratinocytes) of the skin and retina. It is an extremely important pigment because it protects the skin against long exposure to sunlight.

 

REF:    p. 83

 

  1. A newborn male is diagnosed with albinism based on skin, eye, and hair appearance. Which finding will support this diagnosis?
a. Increased melanin
b. Increased hemoproteins
c. Inability to convert tyrosine to DOPA (3,4 dihydroxyphenylalanine)
d. Inability to convert bile to bilirubin

 

 

ANS:   C

The person with albinism is unable to convert tyrosine to DOPA, an intermediate in melanin biosynthesis.

An increase in melanin would cause skin to be darker.

Hemoprotein accumulations in cells are caused by excessive storage of iron, which is transferred to the cells from the bloodstream.

An inability to convert bile to bilirubin would not lead to albinism.

 

REF:    p. 83

 

  1. A 23-year-old male develops a black eye following a fight. When the aide asks the nurse why this occurred, the nurse’s best response is that the bruising is due to an accumulation of:
a. Transferrin
b. Bilirubin
c. Albumin
d. Hemosiderin

 

 

ANS:   D

Hemosiderin is responsible for the color changes in a black eye.

Transferrin is a transport protein responsible for iron transport.

Bilirubin is the normal, yellow-to-green pigment of bile derived from the porphyrin structure of hemoglobin.

Albumin is the protein in the serum, responsible for cellular integrity.

 

REF:    p. 83

 

  1. Liquefactive necrosis occurs in the brain because:
a. Debris is not digested by hydrolases
b. Of protein denaturation
c. It is rich in hydrolytic enzymes and lipids
d. Ischemia results in chemical injury

 

 

ANS:   C

Liquefactive necrosis is due to enzymatic action and because cells of the brain are rich in enzymes.

Liquefactive necrosis is not due to hydrolases.

Protein denaturation occurs primarily in the kidneys.

Liquefactive necrosis is due to enzymatic reaction and not to hypoxia.

 

REF:    p. 87

 

  1. A 2-year-old swallowed watch batteries. Following ingestion, kidney function was impaired, and the heart began to fail. Which of the following was the most likely cause?
a. Karyorrhexis
b. Coagulative necrosis
c. Ammonia accumulation
d. Caseous necrosis

 

 

ANS:   B

Coagulative necrosis occurs primarily in the kidneys, heart, and adrenal glands and commonly results from hypoxia.

Karyorrhexis means fragmentation of the nucleus into smaller particles or “nuclear dust.”

Ammonia accumulation is not associated with this toxicity.

Caseous necrosis results from tuberculosis pulmonary infection.

 

REF:    p. 87

 

  1. A group of prison inmates developed tuberculosis following exposure to an infected inmate. On examination, tissues were soft and granular (like clumped cheese). Which of the following is the most likely cause?
a. Coagulative necrosis
b. Liquefactive necrosis
c. Caseous necrosis
d. Autonecrosis

 

 

ANS:   C

Caseous necrosis results from tuberculosis pulmonary infection.

Coagulative necrosis occurs primarily in the kidneys, heart, and adrenal glands and commonly results from hypoxia.

Liquefactive necrosis results from ischemic injury to neurons and glial cells in the brain.

Autonecrosis is a process of cellular self-digestion and is not due to infection such as tuberculosis.

 

REF:    p. 87

 

  1. A 50-year-old female became infected with Clostridium bacteria and died a week later. Examination of her red blood cells revealed lysis of membranes. Which of the following was the most likely cause of her death?
a. Fat necrosis
b. Wet gangrene
c. Gangrenous necrosis
d. Gas gangrene

 

 

ANS:   D

Gas gangrene is a special type of gangrene caused by infection of injured tissue by one of many species of Clostridium.

Fat necrosis is cellular dissolution caused by powerful enzymes, called lipases, that occur in the breast, pancreas, and other abdominal structures. It is not due to infection.

Wet gangrene develops when neutrophils invade the site, causing liquefactive necrosis. It is not due to infection.

Gangrenous necrosis is due to death of tissue and results from severe hypoxic injury, not infection.

 

REF:    p. 88

 

  1. While reading a textbook, the student reads the term, “apoptosis.” The student recalls that apoptosis is a condition in which cells program themselves to:
a. Atrophy
b. Die
c. Regenerate
d. Age

 

 

ANS:   B

In apoptosis, cells are programmed to die.

In apoptosis, cells do not atrophy; they die.

In apoptosis, cells do not regenerate; they die.

In apoptosis, cells do not age; they die.

 

REF:    p. 88

 

  1. A 50-year-old male intravenous drug user is diagnosed with hepatitis C. Examination of the liver reveals cell death secondary to:
a. Fat necrosis
b. Physiologic apoptosis
c. Pathologic apoptosis
d. Pyknosis

 

 

ANS:   C

With hepatitis C, the liver will demonstrate apoptosis that is pathologic.

Fat necrosis occurs with enzymatic action due to lipases.

Apoptosis is not a normal physiological process.

Pyknosis occurs when the nucleus shrinks and becomes a small, dense mass of genetic material.

 

REF:    p. 88

 

  1. What principle should the nurse remember when trying to distinguish aging from diseases?
a. It is difficult to tell the difference because both processes are believed to result from cell injury.
b. It is easy to tell normal processes from abnormal processes.
c. Disease, unlike aging, has a genetic component.
d. Aging is defined as exceeding life expectancy, but not maximal life span.

 

 

ANS:   A

It is difficult to differentiate between aging and disease because both occur secondary to cellular aging.

It is not easy to differentiate normal processes from abnormal because aging appears as a normal process.

Disease and aging have a possible genetic component.

Aging is a time-dependent loss of structure and function that proceeds slowly and in such small increments that it appears to be the result of the accumulation of small, imperceptible injuries. It is not a time period outside of life expectancy.

 

REF:    p. 91

 

  1. When a nurse observes muscle stiffening occurring within 6 to 14 hours after death, the nurse should document this finding as _____ present.
a. Livor mortis
b. Gangrene
c. Algor mortis
d. Rigor mortis

 

 

ANS:   D

Rigor mortis occurs within 6 hours after death and is evidence by muscle stiffening.

Livor mortis is a purple discoloration.

Gangrene refers to death of tissue and results from severe hypoxic injury and does not lead to stiffening.

Algor mortis is postmortem reduction of body temperature.

 

REF:    p. 95

 

  1. When the nurse is checking the urinalysis, the finding that would alert the nurse to cellular injury is the presence of:
a. Slight glucose
b. Excessive protein
c. Blood
d. Urea

 

 

ANS:   B

The presence of protein in the urine in significant amounts indicates cellular injury and altered cellular function.

Glucose should not normally be present in the urine, but its presence is not indicative of altered cellular function, but of excess glucose in the blood.

Blood should not normally be present in the urine, but its presence indicates kidney alteration and not cellular injury.

Urea is an expected substance in the kidney.

 

REF:    p. 83

 

  1. An 86-year-old female patient has the wasting syndrome of aging, making her vulnerable to falls, functional decline, disease, and death. The nurse knows this patient is experiencing:
a. Frailty
b. Sarcopenia
c. Somatic death
d. Cellular aging

 

 

ANS:   A

Frailty leaves the individual vulnerable to falls, disease, and death.

Sarcopenia is loss of muscle mass. It is associated with aging, but is not as severe as frailty.

Somatic death is death of the whole person.

Cellular aging occurs at the cellular level and is characteristic of aging, including cell atrophy, decreased function, and loss of cells.

 

REF:    p. 94

 

  1. Confirmation of somatic death is based on:
a. Presence of algor mortis
b. Presence of livor mortis
c. Complete cessation of respiration and circulation
d. Change in skin color to pale yellow

 

 

ANS:   C

The most notable manifestations are complete cessation of respiration and circulation.

Algor mortis is postmortem reduction of body temperature and is not confirmation of somatic death.

Rigor mortis is muscles stiffening and is not confirmation of somatic death.

Change in skin color to pale yellow does occur, but complete cessation of respiration and circulation confirms somatic death.

 

REF:    p. 94

 

MULTIPLE RESPONSE

 

  1. A patient has been reading on the Internet that light to moderate intake of alcohol is cardioprotective. When the patient asks the nurse what this means, the nurse should respond that the heart is protected by which of the following mechanisms? (Select all that apply.)
a. Increased levels of high-density lipoprotein cholesterol
b. Prevention of clot formation
c. Reduction in platelet aggregation
d. Increasing fibrinolysis
e. Increased collateral circulation
f. Vasodilation

 

 

ANS:   A, B, C, D

The suggested mechanisms for cardioprotection by low to moderate alcohol intake include increased levels of high-density lipoprotein cholesterol (HDL-c), prevention of clot formation, reduction in platelet aggregation, and increasing clot degradation (fibrinolysis). Increased collateral circulation is not a benefit of alcohol, nor is vasodilation.

 

REF:    p. 73

 

  1. After ingestion of lead, what organ systems should the nurse monitor because they are the most sensitive to the effects of lead? (Select all that apply.)
a. Heart
b. Lungs
c. Liver
d. Kidneys
e. Brain
f. Hematopoietic

 

 

ANS:   D, E, F

The organ systems primarily affected by lead ingestion include the nervous system (brain), the hematopoietic system (tissues that produce blood cells), and the kidneys. The heart, liver, and lungs are not affected.

 

REF:    p. 71

 

Huether and McCance: Understanding Pathophysiology, 5th Edition

 

Chapter 13: Pain, Temperature, Sleep, and Sensory Function

 

Test Bank

 

MULTIPLE CHOICE

 

  1. A patient asks the nurse where nociceptors can be found. How should the nurse respond? One location in which nociceptors can be found is the:
a. Skin
b. Spinal cord
c. Efferent pathways
d. Hypothalamus

 

 

ANS:   A

Nociceptors are pain receptors and can be found in the skin.

Nociceptors are not located in the spinal cord.

Nociceptors are not located in efferent, but afferent pathways.

Nociceptors are not located in the hypothalamus, but can be found in the meninges.

 

REF:    p. 326

 

  1. A nurse is discussing an individual’s conditioned or learned approach or avoidance behavior in response to pain. Which system is the nurse describing?
a. Sensory-discriminative system
b. Affective-motivational system
c. Sensory-motivational system
d. Cognitive-evaluative system

 

 

ANS:   B

The affective-motivational system determines an individual’s conditioned avoidance behaviors and emotional responses to pain.

The sensory-discriminative system is mediated by the somatosensory cortex and is responsible for identifying the presence, character, location, and intensity of pain.

The sensory-motivational system is not a system in the response to pain.

The cognitive-evaluative system overlies the individual’s learned behavior concerning the experience of pain and can modulate perception of pain.

 

REF:    p. 326

 

  1. When a neurologist explains how pricking a finger with a needle provides minimal pain while cutting the finger with a knife provides more severe pain, what theory is being described?
a. Gate control theory
b. Neuromatrix theory
c. Specificity theory
d. Neuromodulation

 

 

ANS:   C

The specificity theory of pain proposes that the intensity of pain is directly related to the degree of associated tissue injury.

The gate control theory of pain suggests pain transmission is modulated by a balance of impulses conducted to the spinal cord, where cells in the substantia gelatinosa function as a “gate” that regulates the nociceptive (pain) transmission to higher centers in the central nervous system (CNS).

The neuromatrix theory proposes that the brain produces patterns of nerve impulses drawn from various inputs, including genetic, psychological, and cognitive experiences.

 

Neuromodulators of pain are found in the pathways that mediate information about painful stimuli throughout the nervous system.

 

REF:    p. 324

 

  1. A 5-year-old female breaks her leg after falling from a merry-go-round. Which of the following would be released from the midbrain to modulate her pain?
a. â-Endorphin
b. Enkephalin
c. Endomorphin
d. Dynorphin

 

 

ANS:   D

Dynorphins are the most potent of the endogenous opioids, binding strongly to ê receptors to impede pain signals.

â-endorphins produce the greatest sense of exhilaration, as well as substantial natural pain relief.

Enkephalins are natural opioids.

Endomorphins have analgesic effects.

 

REF:    p. 327

 

  1. A 15-year-old female scrapes her knee while playing soccer and complains of sharp and well-localized pain. Which of the following should the nurse document to most accurately characterize her pain?
a. Chronic pain
b. Referred pain
c. Somatic pain
d. Visceral pain

 

 

ANS:   C

Somatic pain is superficial, arising from the skin. It is typically well localized and described as sharp, dull, aching, or throbbing.

Chronic pain has been defined as lasting for more than 3 to 6 months.

Referred pain is felt in an area removed or distant from its point of origin; the area of referred pain is supplied by the same spinal segment as the actual site of pain.

Visceral pain is pain in internal organs and lining of body cavities and tends to be poorly localized with an aching, gnawing, throbbing, or intermittent cramping quality.

 

REF:    p. 327

 

  1. A nurse should document on the chart that chronic pain is occurring when the patient reports the pain has lasted longer than:
a. 1 month
b. 3 to 6 months
c. 1 year
d. 2 to 3 years

 

 

ANS:   B

Chronic or persistent pain has been defined as lasting for more than 3 to 6 months.

One month is too short a time period to be classified as chronic pain.

Chronic or persistent pain has been defined as lasting for more than 3 to 6 months; 1 year is too long.

Chronic or persistent pain has been defined as lasting for more than 3 to 6 months; 2 to 3 years is too long.

 

REF:    p. 328

 

  1. A 50-year-old male cut his hand off while working in a sawmill. Several years later he still sporadically feels pain in the absent hand. What type of pain should the nurse document in the chart?
a. Neuropathic pain
b. Visceral pain
c. Phantom limb pain
d. Chronic pain

 

 

ANS:   C

The qualities we normally feel from the body, including pain, also can be felt in the absence of inputs from the body, such as is noted with phantom limb pain.

Neuropathic pain is initiated or caused by a primary lesion or dysfunction in the nervous system.

Visceral pain refers to pain in internal organs and lining of body cavities.

Chronic pain lasts more the 3 to 6 months and is not associated with loss of a limb.

 

REF:    p. 329

 

  1. When planning care for a child in pain, which principle should the nurse remember? The pain threshold in children is _____ that of adults.
a. Higher than
b. Lower than
c. The same as
d. Not related to

 

 

ANS:   B

The pain threshold in children is lower than that of adults.

The pain threshold in children is lower, not higher, than that of adults.

The pain threshold in children is lower, not the same, as that of adults.

The pain threshold in children is lower than that of adults.

 

REF:    p. 330

 

  1. When the nurse is taking a patient’s temperature, which principle should the nurse remember? Regulation of body temperature primarily occurs in the:
a. Cerebrum
b. Brainstem
c. Hypothalamus
d. Pituitary gland

 

 

ANS:   C

Temperature regulation (thermoregulation) is mediated primarily by the hypothalamus.

Temperature regulation (thermoregulation) is mediated primarily by the hypothalamus, not the cerebrum.

Temperature regulation (thermoregulation) is mediated primarily by the hypothalamus, not the brainstem.

Temperature regulation (thermoregulation) is mediated primarily by the hypothalamus, not the pituitary gland.

 

REF:    p. 330

 

  1. When the nurse is discussing the patient’s cyclical temperature fluctuation occurring on a daily basis, what term should the nurse use?
a. Thermogenesis cycle
b. Thermoconductive phases
c. Adaptive pattern
d. Circadian rhythm

 

 

ANS:   D

Internal temperature varies in response to activity, environmental temperature, and daily fluctuation (circadian rhythm).

Temperature fluctuation is related to circadian rhythm, not thermogenesis cycle.

Temperature fluctuation is related to circadian rhythm, not thermoconductive phases.

Temperature fluctuation is related to circadian rhythm, not adaptive pattern.

 

REF:    p. 330

 

  1. A nurse wants to teach about one of the primary organs responsible for heat production. Which organ should the nurse include?
a. Pancreas
b. Liver
c. Adrenal gland
d. Heart

 

 

ANS:   C

The adrenal gland is one of the organs responsible for heat production because thyroxine acts on the adrenal medulla causing the release of epinephrine into the bloodstream. Epinephrine causes vasoconstriction that increases metabolic rates, thus increasing heat production.

The pancreas does not play a role in heat production; the adrenal gland does as it releases epinephrine. which increases metabolic rates and increases heat production.

The liver does not play a role in heat production; the adrenal gland does as it releases epinephrine, which increases metabolic rates and increases heat production.

The heart does not play a role in heat production; the adrenal gland does as it releases epinephrine, which increases metabolic rates and increases heat production.

 

REF:    p. 330

 

  1. Which statement by a patient indicates teaching was successful for heat loss? Heat loss from the body via convection occurs by:
a. Evaporation of electromagnetic waves
b. Transfer of heat through currents of liquids or gas
c. Dilation of blood vessels bringing blood to skin surfaces
d. Direct heat loss from molecule-to-molecule transfer

 

 

ANS:   B

Convection occurs by transfer of heat through currents of gases or liquids, exchanging warmer air at the body’s surface with cooler air in surrounding space.

Convection occurs by transfer of heat through gases or liquids, not electromagnetic waves.

Convection occurs by transfer of heat through gases or liquids, not dilation of blood vessels bringing blood to skin surfaces.

Convection occurs by transfer of heat through gases or liquids, not direct heat loss from molecule-to-molecule transfer.

 

REF:    p. 331

 

  1. For evaporation to function effectively as a means of dissipating excess body heat, which one of the following conditions must be present?
a. Moisture
b. Fever
c. Pyrogens
d. Trauma

 

 

ANS:   A

Moisture must be present because heat is lost through evaporation from the surface of skin and lining of mucous membranes, a major source of heat reduction connected with increased sweating in warmer surroundings.

Fever is not required for evaporation to occur, but moisture is.

Pyrogens are heat producers and do not assist with evaporation, but moisture is required.

Trauma is not a portion of the evaporative process of heat loss.

 

REF:    p. 331

 

  1. A 25-year-old female received a prescription for a weight loss pill. One effect of the pills is to increase the release of epinephrine. Which of the following would be expected to also occur?
a. Decreased vascular tone
b. Increased skeletal muscle tone
c. Increased heat production
d. Decreased basal metabolic rate

 

 

ANS:   C

Epinephrine causes vasoconstriction, stimulates glycolysis, and increases metabolic rates, thus increasing heat production.

Epinephrine increases vascular tone, but this does not lead to heat production.

Epinephrine does not increase skeletal muscle tone.

Epinephrine increases metabolic rate.

 

REF:    p. 330

 

  1. When a patient has a fever, which of the following thermoregulatory mechanisms is activated?
a. The body’s thermostat is adjusted to a lower temperature.
b. Temperature is raised above the set point.
c. Bacteria directly stimulate peripheral thermogenesis.
d. The body’s thermostat is reset to a higher level.

 

 

ANS:   D

Fever (febrile response) is a temporary “resetting of the hypothalamic thermostat” to a higher level in response to endogenous or exogenous pyrogens.

Fever is the result of the body’s attempt to raise temperature, not adjust it to a lower level.

When fever occurs, the temperature is raised, but the rise is due to a reset of the thermostat.

Bacteria do not stimulate peripheral thermogenesis, but their endotoxins do.

 

REF:    p. 331

 

  1. A patient has researched exogenous pyrogens on the Internet. Which information indicates the patient has a good understanding? Exogenous pyrogens are:
a. Interleukins
b. Endotoxins
c. Prostaglandins
d. Corticotropin-releasing factors

 

 

ANS:   B

Exogenous pyrogens are endotoxins.

Exogenous pyrogens are endotoxins, not interleukins.

Exogenous pyrogens are endotoxins, not prostaglandins.

Exogenous pyrogens are endotoxins, not corticotropin-releasing factors.

 

REF:    p. 331

 

  1. Hikers are attempting to cross the Arizona desert with a small supply of water. The temperatures cause them to sweat profusely and become dehydrated. The hikers are experiencing:
a. Heat cramping
b. Heat exhaustion
c. Heat stroke
d. Malignant hyperthermia

 

 

ANS:   B

Heat exhaustion results from prolonged high core or environmental temperatures, which cause profound vasodilation and profuse sweating, leading to dehydration, decreased plasma volumes, hypotension, decreased cardiac output, and tachycardia. Symptoms include weakness, dizziness, confusion, nausea, and fainting.

Heat cramping is severe, spasmodic cramps in the abdomen and extremities that follow prolonged sweating and associated sodium loss. Heat cramping usually occurs in those not accustomed to heat or those performing strenuous work in very warm climates.

Heat stroke is a potentially lethal result of an overstressed thermoregulatory center. With very high core temperatures (>40° C; 104° F), the regulatory center ceases to function, and the body’s heat loss mechanisms fail.

Malignant hyperthermia is a potentially lethal complication of a rare inherited muscle disorder that may be triggered by inhaled anesthetics and depolarizing muscle relaxants.

 

REF:    p. 332

 

  1. A 10-year-old male sneaks into a meat freezer at the local supermarket. Fearing he will get caught if he comes out, he decides to stay in there for several hours until the store closes. While in the cooler his body is most likely experiencing:
a. Increased respirations
b. Ischemic tissue damage
c. CNS excitation
d. Increased cellular metabolism

 

 

ANS:   B

Hypothermia (marked cooling of core temperature) produces depression of the central nervous and respiratory systems, vasoconstriction, alterations in microcirculation, coagulation, and ischemic tissue damage.

Hypothermia does not lead to increased respirations; it leads to ischemia.

Hypothermia does not lead to CNS excitation; it leads to ischemia.

Hypothermia does not lead to increased cellular metabolism; it leads to ischemia.

 

REF:    p. 333

 

  1. Which finding indicates the patient is having complications from heat stroke?
a. Mild elevation of core body temperatures
b. Cerebral edema and degeneration of the CNS
c. Spasmodic cramping in the abdomen and extremities
d. Alterations in calcium uptake

 

 

ANS:   B

Symptoms of heat stroke include high core temperature, absence of sweating, rapid pulse, confusion, agitation, coma, and complications include cerebral edema and degeneration of the CNS.

Characteristics of heat stroke include cerebral edema and degeneration of CNS, not mild elevation of core body temperature.

Characteristics of heat stroke include cerebral edema and degeneration of the CNS, not cramping.

Characteristics of heat stroke include cerebral edema and degeneration of the CNS, not alterations in calcium uptake.

 

REF:    p. 332

 

  1. For which patient would the primary care provider order therapeutic hypothermia? A patient with:
a. Malnutrition
b. Hypothyroidism
c. Reimplantation surgery
d. Parkinson disease

 

 

ANS:   C

Therapeutic hypothermia is seen with reimplantation surgery.

Therapeutic hypothermia is seen with reimplantation surgery, not malnutrition.

Therapeutic hypothermia is seen with reimplantation surgery, not hypothyroidism.

Therapeutic hypothermia is seen with reimplantation surgery, not Parkinson disease.

 

REF:    p. 333

 

  1. A patient is undergoing a sleep lab test. When the sleep lab worker notices EEG patterns with brain activity similar to the normal awake pattern, which phase of sleep is occurring?
a. Non-rapid eye movement (REM)
b. Fast wave
c. REM
d. Delta wave

 

 

ANS:   C

REM sleep is called paradoxical sleep because the EEG pattern is similar to the normal awake pattern and the brain is very active with dreaming.

Non-REM sleep does not produce EEG patterns similar to the normal awake pattern.

Fast wave sleep does not produce EEG patterns similar to the normal awake pattern.

Delta wave sleep does not produce EEG patterns similar to the normal awake pattern.

 

REF:    p. 333

 

  1. A patient asks when most dreams occur. What is the nurse’s best response? Most dreams occur during _____ sleep.
a. Non-REM
b. Alpha wave
c. REM
d. Delta wave

 

 

ANS:   C

Dreams occur during REM sleep.

Dreams occur during REM sleep, not non-REM sleep.

Dreams occur during REM sleep, not alpha wave sleep.

Dreams occur during REM sleep, not delta wave sleep.

 

REF:    p. 13 | p. 19 | p. 33

 

  1. During the sleep cycle, when does loss of temperature control occur?
a. Non-REM sleep
b. Light sleep
c. REM sleep
d. Delta wave sleep

 

 

ANS:   C

Loss of temperature control occurs during REM sleep.

Loss of temperature control occurs during REM sleep, not non-REM sleep.

Loss of temperature control occurs during REM sleep, not light sleep.

Loss of temperature control occurs during REM sleep, not delta wave sleep.

 

REF:    p. 333

 

  1. A patient asks the nurse how often REM sleep occurs. How should the nurse respond? About every _____ minutes.
a. 15
b. 30
c. 60
d. 90

 

 

ANS:   D

REM sleep occurs every 90 minutes.

REM sleep occurs every 90 minutes, not every 15.

REM sleep occurs every 90 minutes, not every 30.

REM sleep occurs every 90 minutes, not every 60.

 

REF:    p. 333

 

  1. A 52-year-old male enters a sleep study to gather information about his sleep disturbances. He reports that his wife will not let him sleep in the bed with her until he stops snoring so loudly. He also reports feeling tired a lot through the day. When the nurse checks the chart, what is the most likely diagnosis?
a. Insomnia
b. Obstructive sleep apnea syndrome (OSAS)
c. Somnambulism
d. Jet-lag syndrome

 

 

ANS:   B

OSAS generally results from upper airway obstruction recurring during sleep with excessive snoring and multiple apneic episodes that last 10 seconds or longer.

Insomnia is the inability to fall or stay asleep and may be mild, moderate, or severe. It does not involve snoring.

Somnambulism is sleep-walking.

Jet-lag syndrome is a disorder of waking and sleeping and does not involve snoring.

 

REF:    p. 334

 

  1. A 14-month-old child suffers from sudden apparent arousals in which she expresses intense fear or other emotion. Her mother reports that she seems to wake screaming, but that she is difficult to waken completely. The child most likely suffers from:
a. Night terrors
b. Parasomnia
c. Somnambulism
d. Enuresis episodes

 

 

ANS:   A

Night terrors are characterized by sudden apparent arousals in which the child expresses intense fear or emotion.

Parasomnia is unusual behaviors during sleep.

Somnambulism is sleep-walking.

Enuresis episodes are bed wetting.

 

REF:    p. 334

 

  1. The ophthalmologist is teaching about the structure of the eye that prevents light from scattering in the eye. What structure is the ophthalmologist describing?
a. Iris
b. Pupil
c. Choroid
d. Retina

 

 

ANS:   C

The choroid is the deeply pigmented middle layer that prevents light from scattering inside the eye.

The iris is a part of the choroid and contains the pupil, which lets light into the eye.

The pupil allows light to enter the eye.

The retina is the innermost layer of the eye.

 

REF:    p. 335

 

  1. A 50-year-old diabetic patient experiences visual disturbances and decides to visit his primary care provider. After examination, the primary care provider tells the patient that the cells that allow him to see are degenerated. Which of the following structures is most likely damaged?
a. Lens
b. Pupil
c. Cornea
d. Retina

 

 

ANS:   D

The retina is the innermost layer of the eye, converting light energy into nerve impulses.

Light entering the eye is focused on the retina by the lens.

The pupil allows light to enter the eye.

The cornea is the portion of the sclera in the central anterior region that allows light to enter

the eye.

 

REF:    p. 335

 

  1. A young child presents to the ophthalmologist for visual difficulties secondary to eye deviation. One of the child’s eyes deviates outward, thereby decreasing the visual field. Which of the following diagnoses is most likely?
a. Entropia
b. Extropia
c. Diplopia
d. Nystagmus

 

 

ANS:   B

The deviation of the eye outward is extropia.

The deviation of the eye inward is entropia.

Diplopia is double vision.

Nystagmus is an involuntary unilateral or bilateral rhythmic movement of the eyes.

 

REF:    p. 336

 

  1. A patient has increased intraocular pressure. Which diagnosis will the nurse observe on the chart?
a. Glaucoma
b. Ocular degeneration
c. Diplopia
d. Nystagmus

 

 

ANS:   A

Glaucoma is the result of increased intraocular pressure.

Ocular degeneration results in changes in vision, but not intraocular pressure.

Diplopia is double vision.

Nystagmus is an involuntary unilateral or bilateral rhythmic movement of the eyes.

 

REF:    p. 336

 

  1. A 70-year-old male presents to his primary care provider reporting loss of vision. He reports that he has hypertension and smokes cigarettes. Which of the following disorders is most likely causing his visual loss?
a. Presbyopia
b. Macular degeneration
c. Strabismus
d. Amblyopia

 

 

ANS:   B

Age-related macular degeneration (AMD) is a severe and irreversible loss of vision and a major cause of blindness in older individuals. Hypertension and cigarette smoking are risk factors.

Presbyopia is a condition associated with aging in which the patient experiences reduced near vision.

In strabismus, one eye deviates from the other when the person is looking at an object.

In amblyopia, vision is reduced in the affected eye caused by cerebral blockage of the visual stimuli.

 

REF:    p. 336

 

  1. Which group of people is most prone to red-green color blindness?
a. Males
b. Females
c. Elderly persons
d. Children

 

 

ANS:   A

Color blindness affects 8% of the male population and 0.5% of the female population.

Color blindness occurs most often in males, not females.

Color blindness occurs most often in males, not the elderly.

Color blindness occurs most often in males, not children.

 

REF:    p. 337

 

  1. A 35-year-old female presents with watering and severely reddened eyes. She reports being very sensitive to light. Her primary care provider determined it was viral conjunctivitis caused by:
a. Secondary bacterial infections
b. Cytomegalovirus
c. Herpes virus
d. Adenovirus

 

 

ANS:   D

Viral conjunctivitis is caused by an adenovirus and is manifested by symptoms of watering, redness, and photophobia.

Bacterial infections are not manifested by photophobia.

Cytomegalovirus infections are not manifested by photophobia.

Adenovirus infections are not manifested by photophobia.

 

REF:    p. 338

 

  1. A nurse is teaching about the structure that connects the middle ear with the pharynx. Which structure is the nurse describing?
a. Organ of Corti
b. Eustachian tube
c. Semicircular canal
d. Auditory canal

 

 

ANS:   B

The Eustachian tube connects the middle ear to the pharynx.

The organ of Corti contains the hair cells.

The semicircular canal is one of the three bones of the labyrinth.

The auditory canal leads to the middle ear.

 

REF:    p. 338

 

  1. The most common form of sensorineural hearing loss in the elderly is:
a. Conductive hearing loss
b. Acute otitis media
c. Presbycusis
d. Ménière disease

 

 

ANS:   C

Presbycusis is the most common form of sensorineural hearing loss in elderly people.

Conductive hearing loss does not occur as frequently as presbycusis.

Otitis media is an infection in the middle ear and is not defined as a hearing loss.

Ménière disease leads to vertigo, not hearing loss.

 

REF:    p. 340

 

  1. A 15-year-old female is diagnosed with an outer ear infection. Which of the following is most likely to cause this infection?
a. Haemophilus
b. Streptococcus pneumonia
c. Moraxella catarrhalis
d. Escherichia coli

 

 

ANS:   D

The most common causes of acute infections are bacterial microorganisms including Pseudomonas, Escherichia coli, and Staphylococcus aureus.

The most common causes of acute infections are bacterial microorganisms including Pseudomonas, Escherichia coli, and Staphylococcus aureus, not Haemophilus.

The most common causes of acute infections are bacterial microorganisms including Pseudomonas, Escherichia coli, and Staphylococcus aureus, not Streptococcus.

The most common causes of acute infections are bacterial microorganisms including Pseudomonas, Escherichia coli, and Staphylococcus aureus, not Moraxella catarrhalis.

 

REF:    p. 340

 

  1. The nurse would expect the patient with an alteration in proprioception to experience vertigo which is manifested by:
a. Headache
b. Light sensitivity
c. A sensation that the room is spinning
d. Loss of feeling in the lips

 

 

ANS:   C

Alterations in proprioception are manifested by a sensation that the room is spinning.

Alterations in proprioception are manifested by a sensation of spinning, not headache.

Alterations in proprioception are manifested by a sensation that the room is spinning. Light sensitivity does not occur.

Alterations in proprioception are manifested by a sensation that the room is spinning. Loss of feeling in the lips does not occur.

 

REF:    p. 341

 

  1. Which system modulates a patient’s perception of pain?
a. Sensory-discriminative system
b. Affective-motivational system
c. Cognitive-evaluative system
d. Reticular-activating system

 

 

ANS:   C

The cognitive-evaluative system overlies the individual’s learned behavior concerning the experience of pain and can modulate perception of pain.

The sensory-discriminative system is mediated by the somatosensory cortex and is responsible for identifying the presence, character, location, and intensity of pain.

The affective-motivational system determines an individual’s conditioned avoidance behaviors and emotional responses to pain.

The reticular-activating system does not play a role in the perception of pain.

 

REF:    p. 326

 

MULTIPLE RESPONSE

 

  1. While planning care for infants, which principles should the nurse remember? (Select all that apply.) Infants have problems with thermoregulation because they:
a. Cannot conserve heat
b. Do not shiver
c. Rarely sweat
d. Have decreased metabolic rates
e. Have excess subcutaneous fat

 

 

ANS:   A, B

Infants cannot conserve heat; thus, they have a problem with thermoregulation because of their small size. Infants are unable to shiver, do have the ability to sweat, have an increased metabolic rate, and have little subcutaneous fat.

 

REF:    p. 330

 

COMPLETION

 

  1. Fever of unknown origin (FUO) is characterized by a fever of ____° F or greater

 

ANS:

101

FUO is a fever of greater than 38.3° C (101° F) that remains undiagnosed after three days of hospital investigation or two or more outpatient visits.

 

REF:    p. 331

 

Huether and McCance: Understanding Pathophysiology, 5th Edition

 

Chapter 27: Alterations of Pulmonary Function in Children

 

Test Bank

 

MULTIPLE CHOICE

 

  1. A 1-year-old female is diagnosed with croup. When the parent asks what caused this, what is the nurse’s best response? The most likely cause of this disease is:
a. Bacteria
b. Acute hyperventilation
c. Allergy
d. Viral infection

 

 

ANS:   D

The cause of croup is a viral infection.

The cause of croup is viral, not bacterial.

Croup is due to a viral infection, not to acute hyperventilation.

Croup is due to a viral infection, not to allergy.

 

REF:    p. 707

 

  1. While planning care, a nurse recalls respiratory distress and hypoxemia in laryngotracheobronchitis are caused by:
a. Infectious pulmonary edema
b. Mucosal edema
c. Decreased surfactant
d. Nasopharyngeal obstruction

 

 

ANS:   B

Edema leads to obstruction of the airway and respiratory distress.

Pulmonary edema does not occur; it is due to edema of the mucosa.

Laryngotracheobronchitis is not a problem of surfactant.

The obstruction is in the airway, not the nasopharyngeal area.

 

REF:    p. 708

 

  1. A 5-year-old male presents with high fever, inspiratory stridor, severe respiratory distress, drooling, and dysphagia. Which of the following behaviors by the student nurse would be a cause for concern?
a. The student nurse tries to keep the child calm.
b. The student nurse examines the throat for redness.
c. The student nurse auscultates the child’s respiratory rate.
d. The student nurse counts the heart rate apically.

 

 

ANS:   B

Examination of the throat should not be attempted as it may trigger laryngospasm and cause respiratory collapse.

Keeping the child calm is appropriate.

Auscultating the respiratory rate is appropriate.

Assessing the heart rate apically is appropriate.

 

REF:    p. 709

 

  1. A 10-year-old male was diagnosed with obstructive sleep apnea. When the parents ask what treatment comes next, how should the nurse respond? The treatment that will most likely be tried first is:
a. Tonsillectomy and adenoidectomy (T&A)
b. Weight loss
c. Continuous positive airway pressure
d. Drug therapy

 

 

ANS:   A

Children with sleep apnea are most often referred for T&A.

Children with sleep apnea are most often referred for T&A. Weight loss is secondary.

Children with sleep apnea are most often referred for T&A. Continuous positive airway pressure is secondary.

Children with sleep apnea are most often referred for T&A. Drug therapy is secondary.

 

REF:    p. 710

 

  1. A newborn has respiratory distress syndrome. When obtaining the patient’s history, which of the following is the most important predisposing factor for this condition?
a. Low birth weight
b. Alcohol consumption by the mother during pregnancy
c. Premature birth
d. Smoking by the mother during pregnancy

 

 

ANS:   C

Respiratory distress syndrome in the newborn is more often due to premature birth.

Newborn respiratory distress occurs almost exclusively in premature infants, not low birth weight.

Newborn respiratory distress occurs almost exclusively in premature infants, not from alcohol use by the mother.

Newborn respiratory distress occurs almost exclusively in premature infants, not from smoking by the mother during pregnancy.

 

REF:    p. 710

 

  1. A newborn has respiratory distress syndrome. A nurse monitors the newborn for atelectasis because of:
a. A lack of surfactant
b. Pulmonary edema
c. Airway obstruction
d. Pulmonary fibrosis

 

 

ANS:   A

Atelectasis in newborn respiratory distress is due to lack of surfactant.

Atelectasis in newborn respiratory distress is due to lack of surfactant, not pulmonary edema.

Atelectasis in newborn respiratory distress is due to lack of surfactant, not airway obstruction.

Atelectasis in newborn respiratory distress is due to lack of surfactant, not pulmonary fibrosis.

 

REF:    p. 711

 

  1. A newborn has respiratory distress syndrome. A nurse recalls cardiovascular alterations seen in respiratory distress syndrome include:
a. Left-to-right shunt
b. Left ventricular dilation
c. Pulmonary hypotension
d. Opening of fetal shunt pathways

 

 

ANS:   D

Increased pulmonary vascular resistance may even cause a partial return to fetal circulation, with right-to-left shunting of blood through the ductus arteriosus and foramen ovale.

A left-to-right shunt does not occur but vice versa.

A return to fetal shunting occurs, not ventricular dilation.

A return to fetal shunting occurs, not pulmonary hypotension.

 

REF:    p. 711

 

  1. A newborn has respiratory distress syndrome (RDS). The nurse reports this condition appeared:
a. Within minutes of birth
b. 2 to 3 hours after birth
c. Within the first 12 to 24 hours after birth
d. 24 to 48 hours after exposure to an infectious organism

 

 

ANS:   A

Signs of RDS appear within minutes of birth.

Signs of RDS appear within minutes of birth, not 2 to 3 hours.

Signs of RDS appear within minutes of birth, not within the first 24 hours.

Signs of RDS appear within minutes of birth; it is not associated with an infectious organism.

 

REF:    p. 712

 

  1. During a respiratory assessment of an infant with respiratory distress syndrome, a sinking in the supraclavicular and intercostal areas of the thorax was noted with inspiration. This observation is documented as:
a. Grunting
b. Tachypnea
c. Retractions
d. Nasal flaring

 

 

ANS:   C

The sinking of supraclavicular and intercostal areas is termed retractions.

The symptoms describe retractions, not grunting.

The symptoms describe retractions, not tachypnea.

The symptoms describe retractions, not nasal flaring.

 

REF:    p. 712

 

  1. An infant was born 10 weeks premature and put on mechanical ventilation. Two months later he presents with hypoxemia and hypercapnia. Which of the following is the most likely diagnosis the nurse will observe documented on the chart?
a. Respiratory distress syndrome of the newborn
b. Bronchopulmonary dysplasia (BPD)
c. Bronchiolitis
d. Pneumonia

 

 

ANS:   B

Mechanical ventilation can result in a proinflammatory state that may contribute to the development of chronic lung disease, such as BPD.

Mechanical ventilation can result in a proinflammatory state that may contribute to the development of chronic lung disease, such as BPD. Respiratory distress might have led to the intubation, but BPD is the diagnosis.

Mechanical ventilation can result in a proinflammatory state that may contribute to the development of chronic lung disease, such as BPD, not bronchiolitis.

Mechanical ventilation can result in a proinflammatory state that may contribute to the development of chronic lung disease, such as BPD, not pneumonia.

 

REF:    p. 712

 

  1. A 6-month-old female presents with rhinorrhea, cough, poor feeding, lethargy, and fever. She is diagnosed with bronchiolitis. Which of the following will the nurse most likely observe on the culture report?
a. Parainfluenza virus
b. Haemophilus B influenzae
c. Respiratory syncytial virus
d. Group A beta-hemolytic streptococcus

 

 

ANS:   C

The most common cause of bronchiolitis is respiratory syncytial virus.

The most common cause of bronchiolitis is respiratory syncytial virus, not parainfluenza virus.

The most common cause of bronchiolitis is respiratory syncytial virus, not Haemophilus B influenzae.

The most common cause of bronchiolitis is respiratory syncytial virus, not strep.

 

REF:    p. 714

 

  1. A 2-year-old male presents with fever and cough. He is diagnosed with pneumonia. While planning treatment for this patient, the nurse recognizes that which of the following is the most likely cause?
a. Bacteria
b. Viruses
c. Mycoplasma species
d. Toxic inhalations

 

 

ANS:   B

Viral pneumonia is more common than bacterial pneumonia, and children are 2 to 3 times more likely than adults to acquire these viruses.

Viral pneumonia is more common than bacterial pneumonia, and children are 2 to 3 times more likely than adults to acquire these viruses.

Viral pneumonia is more common in children than Mycoplasma species.

Viral pneumonia is more common in children than toxic inhalations.

 

REF:    p. 714

 

  1. An 11-year-old female presents with a low-grade fever and cough. She is diagnosed with atypical pneumonia. What type of pneumonia does the nurse suspect the patient is experiencing?
a. Pneumococcal pneumonia
b. Viral pneumonia
c. Mycoplasma pneumonia
d. Streptococcal pneumonia

 

 

ANS:   C

Chlamydophila pneumonia is clinically indistinguishable from and is typically grouped with Mycoplasma as “atypical pneumonia.”

Bacterial pneumonia would not be atypical.

Viral pneumonia is not an atypical pneumonia.

Bacterial pneumonia is not part of atypical pneumonia.

 

REF:    p. 714

 

  1. A 2-week-old female presents with fever, cough, respiratory distress, and empyema. Which of the following is the most likely diagnosis the nurse will observe on the chart?
a. Viral pneumonia
b. Pneumococcal pneumonia
c. Staphylococcal pneumonia
d. Mycoplasma pneumonia

 

 

ANS:   C

Staphylococcal and group A streptococcal pneumonia can be particularly fulminant (sudden, severe) and necrotizing (causing cell death) with a high incidence of accompanying empyema, pneumatocele, and sepsis.

Staphylococcal pneumonia is the more likely diagnosis than viral.

Staphylococcal pneumonia is more likely to cause empyema than pneumococcal.

Staphylococcal pneumonia is more likely to cause empyema than Mycoplasma.

 

REF:    p. 714

 

  1. A 9-year-old male contracted influenza. Which of the following complications is of greatest concern to the nurse?
a. Chronic bronchitis
b. Bronchiolitis obliterans
c. Emphysema
d. Respiratory distress syndrome (RDS)

 

 

ANS:   B

Bronchiolitis obliterans most often occurs as a sequelae of a severe viral pulmonary infection (e.g., influenza, adenovirus, pertussis [whooping cough], or measles).

Bronchiolitis obliterans, not just chronic bronchitis, most often occurs as a sequelae of a severe viral pulmonary infection (e.g., influenza, adenovirus, pertussis [whooping cough], or measles).

Bronchiolitis obliterans, not emphysema, most often occurs as a sequelae of a severe viral pulmonary infection (e.g., influenza, adenovirus, pertussis [whooping cough], or measles).

Bronchiolitis obliterans, not RDS, most often occurs as a sequelae of a severe viral pulmonary infection (e.g., influenza, adenovirus, pertussis [whooping cough], or measles).

 

REF:    p. 715

 

  1. While planning care for a child with asthma, which of the following is characteristic of asthma?
a. Increased lung volumes
b. Prolonged expirations
c. Air trapping
d. Dead space

 

 

ANS:   B

On physical examination, there is expiratory wheezing that is often described as high pitched and musical, and there is prolongation of the expiratory phase of the respiratory cycle.

Lung volumes are decreased.

Air trapping occurs in emphysema, not asthma.

Dead space occurs in emphysema, not asthma.

 

REF:    p. 716

 

  1. A 14-year-old male is experiencing an asthma exacerbation. When reviewing the lab results, which of the following cells in the submucosa promote this inflammatory response and will be elevated?
a. Neutrophils
b. Eosinophils
c. Macrophages
d. Lymphocytes

 

 

ANS:   B

In the late asthmatic response, there are areas of epithelial damage and shedding caused at least in part by toxicity of eosinophil products.

Eosinophils, not neutrophils, promote the inflammatory response.

Eosinophils, not macrophages, promote the inflammatory response.

Eosinophils, not lymphocytes, promote the inflammatory response.

 

REF:    p. 716

 

  1. A 13-year-old female is diagnosed with asthma. Which of the following should the nurse teach the patient to recognize as part of an asthmatic attack?
a. Headache
b. Chest pain
c. Wheezing
d. Low heart rate

 

 

ANS:   C

Wheezing occurs in asthma, due to narrowing of airways.

Headache is not a part of an asthma attack.

Wheezing is part of an asthma attack, not chest pain.

The heart rate will be increased, not decreased.

 

REF:    p. 716

 

  1. A geneticist is discussing cystic fibrosis (CF). Which information should be included? CF is an _____ disease.
a. Autosomal recessive
b. Autosomal dominant
c. X-linked recessive
d. X-linked dominant

 

 

ANS:   A

CF is an autosomal recessive disease.

CF is an autosomal recessive disease, not dominant.

CF is not X-linked.

CF is not X-linked.

 

REF:    p. 718

 

  1. A 2-year-old female fell in a swimming pool and nearly drowned. She then developed acute respiratory distress syndrome (ARDS). Which of the following should the nurse assess the patient for?
a. Decreased heart rate
b. Increased lung compliance
c. Increased surfactant production
d. Hypoxemia

 

 

ANS:   D

The child with ARDS will experience severe hypoxemia.

The child with ARDS will have an elevated, not decreased, heart rate.

The child with ARDS has decreased, not increased, lung compliance.

Surfactant production is not affected in ARDS.

 

REF:    p. 718

 

  1. While reviewing lab results, to help confirm a diagnosis of cystic fibrosis in a 1-year-old child which substance will be present in the child’s sweat?
a. Potassium
b. Sodium chloride
c. Magnesium
d. Carbonic acid

 

 

ANS:   B

The standard method of diagnosis is the sweat test, which reveals sweat chloride concentration in excess of 60 mEq/L.

Sodium chloride, not potassium, is present in the sweat.

Sodium chloride, not magnesium, is present in the sweat.

Sodium chloride, not carbonic acid, is present in the sweat.

 

REF:    p. 719

 

  1. A 7-month-old male presents with cystic fibrosis (CF) accompanied by failure to thrive and frequent, loose, and oily stools. Sweat testing reveals increased chloride. Which of the following should the nurse observe for that would accompany this disease?
a. Autoantibodies that target the lungs and pancreas
b. A thick mucus
c. Enzymes that degrade surfactant in the alveoli
d. A toxic amount of electrolytes from secretory glands

 

 

ANS:   B

In CF, thick mucus is present.

Thick mucus is present, not autoantibodies.

Thick mucus is present; CF does not involve surfactant.

Thick mucus is present, not elevated electrolytes.

 

REF:    p. 719

 

Huether and McCance: Understanding Pathophysiology, 5th Edition

 

Chapter 37: Alterations of Musculoskeletal Function

 

Test Bank

 

MULTIPLE CHOICE

 

  1. The incidence of fractures of the pelvis is highest in:
a. Preadolescent boys
b. Adolescent boys
c. Adolescent girls
d. Older adults

 

 

ANS:   D

The incidence of fractures of the upper femur, upper humerus, vertebrae, and pelvis is highest in older adults and is often associated with osteoporosis.

Fractures of healthy bones, particularly the tibia, clavicle, and lower humerus, tend to occur in young persons. Fracture of the pelvis is highest in older adults.

Fractures of healthy bones, particularly the tibia, clavicle, and lower humerus, tend to occur in young persons. Fracture of the pelvis is highest in older adults.

Fractures of healthy bones, particularly the tibia, clavicle, and lower humerus, tend to occur in young persons. Fracture of the pelvis is highest in older adults.

 

REF:    p. 978

 

  1. A 65-year-old Hispanic female is admitted to the hospital with a pathologic, compound, transverse fracture of the femur. Which of the following statements best describes this type of fracture?
a. The fracture line is parallel to the bone.
b. The fracture line is straight across the bone.
c. The fracture line is perpendicular to the bone.
d. The fracture line is vertical to the shaft of the bone.

 

 

ANS:   B

A transverse fracture occurs straight across the bone.

A linear fracture runs parallel to the long axis of the bone.

A transverse fracture runs straight across the bone, not perpendicular.

A transverse fracture runs straight across the bone, not vertically.

 

REF:    p. 979

 

  1. A 70-year-old female with osteoporosis fractures her leg at a location of preexisting abnormality. She reports that the fracture occurred following a minor fall. Which of the following best describes the fracture?
a. Fatigue fracture
b. Stress fracture
c. Pathologic fracture
d. Greenstick fracture

 

 

ANS:   C

A pathologic fracture is a break at the site of a preexisting abnormality, usually by force that would not fracture a normal bone.

A fatigue fracture is caused by abnormal stress or torque applied to a bone with normal ability to deform and recover.

Stress fractures occur in normal or abnormal bone that is subjected to repeated stress, such as occurs during athletics.

A greenstick fracture perforates one cortex and splinters the spongy bone.

 

REF:    p. 979

 

  1. A 32-year-old obese male begins a jogging routine. A week after beginning, he fractures his leg. This is referred to as a what type of fracture?
a. Comminuted
b. Greenstick
c. Fatigue
d. Compound

 

 

ANS:   C

A fatigue fracture is caused by abnormal stress or torque applied to a bone that usually occurs in individuals who engage in a new activity that is both strenuous and repetitive.

A comminuted fracture is one in which a bone breaks into two or more fragments.

A greenstick fracture perforates one cortex and splinters the spongy bone.

An open fracture is a complete and incomplete fracture that breaks through the skin.

 

REF:    p. 980

 

  1. Transchondral fractures are most prevalent in:
a. Adolescents
b. Older adults
c. Infants
d. Premenopausal females

 

 

ANS:   A

Transchondral fractures are most prevalent in adolescents.

Transchondral fractures are most prevalent in adolescent, not older adults.

Transchondral fractures are most prevalent in adolescents, not infants.

Transchondral fractures are most prevalent in adolescents, not premenopausal females.

 

REF:    p. 980

 

  1. A 35-year-old female suffers a broken clavicle following a motor vehicle accident. X-ray reveals that the bone surfaces in the joint partially lost contact with each other. This condition is called:
a. Dislocation
b. Subluxation
c. Distortion
d. Nonunion

 

 

ANS:   B

Subluxation occurs when contact between the opposing joint surfaces of a fracture are partially lost.

Dislocation is the displacement of one or more bones in a joint in which the opposing joint surfaces lose contact entirely.

Distortion is not a term applicable to fracture healing.

Nonunion is failure of the bone ends to grow together.

 

REF:    p. 981

 

  1. A 12-year-old female hurts her ankle while playing basketball. Tests reveal that she tore a ligament. This condition is known as a:
a. Sprain
b. Strain
c. Disunion
d. Subluxation

 

 

ANS:   A

A torn ligament is also called a sprain.

Tearing or stretching of a muscle or tendon is commonly known as a strain.

Disunion occurs when fracture ends fail to heal.

Subluxation occurs when contact between the opposing joint surfaces of a fracture are partially lost.

 

REF:    p. 982

 

  1. A 36-year-old male complains of pain and weakness in the elbow. He reports that he is a warehouse worker and lifts boxes daily. MRI reveals inflammation of the tendon where it attaches to bone. This condition is called:
a. Periostitis
b. Muscle strain
c. Bursitis
d. Epicondylopathy

 

 

ANS:   D

When force is sufficient to cause microscopic tears (microtears) in tissue, the result is known epicondylopathy.

When force is sufficient to cause microscopic tears (microtears) in tissue, the result is known epicondylopathy, not periostitis.

Muscle strain is local muscle damage that occurs when the muscle is stretched beyond capacity.

Bursitis is inflammation of the bursae.

 

REF:    p. 982

 

  1. An important and useful clinical measure in the diagnosis of rhabdomyolysis is measurement of which laboratory value?
a. White blood cell count
b. Antinuclear antibodies
c. Aspartate aminotransferase
d. Creatine kinase (CK)

 

 

ANS:   D

The most important and clinically useful measurement in rhabdomyolysis is serum CK. A level five times the upper limit of normal (about 1000 units/liter) is used to identify rhabdomyolysis.

White blood cell count may be measured, but it is not more important than the CK.

Antinuclear antibodies may be measured, but it is not more important than the CK.

Aspartate aminotransferase may be measured, but it is not more important than the CK.

 

REF:    p. 985

 

  1. Which of the following clinical findings would be expected in the patient with rhabdomyolysis?
a. Sweating
b. Dark urine
c. Yellow color to the skin
d. Lower extremity swelling

 

 

ANS:   B

A classic triad of muscle pain, weakness, and dark urine is considered typical of rhabdomyolysis.

Dark urine, not sweating, is a classic sign of rhabdomyolysis.

Dark urine, not yellow skin, is a classic sign of rhabdomyolysis.

Dark urine, not lower extremity swelling, is a classic sign of rhabdomyolysis.

 

REF:    p. 984

 

  1. A 70-year-old female presents with a hip fracture secondary to osteoporosis. This condition is caused by an increase in bone:
a. Density
b. Formation
c. Resorption
d. Mineralization

 

 

ANS:   C

Osteoporosis is due to an increase in bone resorption.

Osteoporosis is due to an increase in bone resorption; density would be decreased, not increased.

Osteoporosis is due to an increase in bone resorption, not formation.

Osteoporosis is due to an increase in bone resorption, not mineralization.

 

REF:    p. 988

 

  1. A 70-year-old female presents with a hip fracture. She is diagnosed with osteoporosis. One factor that most likely contributed to her condition is:
a. Increased androgen levels
b. Decreased estrogen levels
c. Strenuous exercise
d. Excessive dietary calcium

 

 

ANS:   B

Osteoporosis can be attributed to decreased estrogen levels.

Osteoporosis can be attributed to decreased estrogen levels, not increased androgen levels.

Osteoporosis can be attributed to decreased estrogen levels, not strenuous exercise.

Osteoporosis can be attributed to decreased estrogen levels, not excessive dietary calcium.

 

REF:    p. 989

 

  1. A 76-year-old female was diagnosed with osteoporosis by radiologic exam. She is at high risk for:
a. Bone infections
b. Joint injuries
c. Pathologic bone fractures
d. Ssteomalacia

 

 

ANS:   C

The patient will be at risk for pathologic bone fractures due to bone fragility.

The patient will not be at increased risk for infection.

The patient could be at risk for joint injury, but will be at greatest risk for fracture.

The patient is not at risk for osteomalacia.

 

REF:    p. 989

 

  1. An 80-year-old male presents with skeletal pain and tenderness, especially in the hips. He is diagnosed with osteomalacia caused by:
a. Collagen breakdown in the bone matrix
b. Excessive bone resorption
c. Crowding of bone marrow by excessive bone growth
d. Inadequate bone mineralization

 

 

ANS:   D

Osteomalacia is a metabolic disease characterized by inadequate and delayed mineralization of osteoid in mature compact and spongy bone.

Idiopathic osteoarthritis leads to collagen breakdown.

Giant cell tumors promote excessive bone resorption.

Abnormal remodeling causes crowding of bone marrow.

 

REF:    p. 993

 

  1. A 56-year-old male was admitted to the hospital with a diagnosis of osteomalacia. History reveals that he takes anticonvulsants, underwent small bowel resection 3 years earlier, and suffers from chronic pancreatitis. What is the common link between these three factors and the development of osteomalacia?
a. Impaired phosphate absorption
b. Increased calcium excretion
c. Vitamin D deficiency
d. Impaired vitamin C metabolism

 

 

ANS:   C

Disorders of the small bowel, hepatobiliary system, and pancreas are causes of vitamin D deficiency in the United States. Vitamin D deficiency is the most important factor in osteomalacia.

Vitamin D deficiency, not impaired phosphate absorption, is the common cause of osteomalacia.

Vitamin D deficiency, not increased calcium excretion, is the common cause of osteomalacia.

Vitamin D deficiency, not impaired vitamin C metabolism, is the common cause of osteomalacia.

 

REF:    p. 993

 

  1. A disorder similar to osteomalacia that occurs in growing bones of children is termed:
a. Paget disease
b. Rickets
c. Osteomyelitis
d. Osteosarcoma

 

 

ANS:   B

Abnormal bone growth in children is termed rickets.

Paget disease is a state of increased metabolic activity in bone characterized by abnormal and excessive bone remodeling, both resorption and formation.

Osteomyelitis is a bone infection.

Osteosarcoma is a form of bone cancer.

 

REF:    p. 993

 

  1. The cause of Paget disease is:
a. Fluoride deficiency
b. Unknown at present
c. Excess vitamin A
d. Osteogenic sarcoma

 

 

ANS:   B

The cause of Paget disease is unknown.

The cause of Paget disease is unknown; it is not due to fluoride deficiency.

 

The cause of Paget disease is unknown; it is not due to excess vitamin A.

The cause of Paget disease is unknown; it is not due to osteosarcoma.

 

REF:    p. 994

 

  1. A 70-year-old male presents with back pain, fever, and weight loss. He reports that he had a recent respiratory infection from which he thought he recovered. Tests revealed increased white blood cell count, and a diagnosis of endogenous osteomyelitis was made. The primary organism causing this condition is:
a. Staphylococcus aureus
b. Salmonella
c. Mycobacterium
d. Haemophilus influenza

 

 

ANS:   A

Staphylococcus aureus remains the primary microorganism responsible for osteomyelitis.

Staphylococcus aureus, not Salmonella, remains the primary microorganism responsible for osteomyelitis.

Staphylococcus aureus, not Mycobacterium, remains the primary microorganism responsible for osteomyelitis.

Staphylococcus aureus, not Haemophilus influenza, remains the primary microorganism responsible for osteomyelitis.

 

REF:    p. 995

 

  1. A 54-year-old female was recently diagnosed with degenerative joint disease. This condition is characterized by loss of:
a. The epiphyses
b. Articular cartilage
c. Synovial fluid
d. The joint capsule

 

 

ANS:   B

Degenerative joint disease is caused by loss of the articular cartilage.

Degenerative joint disease is caused by loss of the articular cartilage, not the epiphyses.

Degenerative joint disease is caused by loss of the articular cartilage, not the synovial fluid.

Degenerative joint disease is caused by loss of the articular cartilage, not the joint capsule.

 

REF:    p. 996

 

  1. A 54-year-old male was recently diagnosed with rheumatoid arthritis (RA). Which of the following is the expected treatment of choice?
a. Nonsteroidal anti-inflammatory drugs (NSAIDs)
b. Gold salts
c. Methotrexate
d. Hydroxychloroquine

 

 

ANS:   C

Methotrexate remains the first line of treatment for RA.

Methotrexate, not NSAIDs, remains the first line of treatment for RA.

Methotrexate, not gold salts, remains the first line of treatment for RA.

Methotrexate, not hydroxychloroquine, remains the first line of treatment for RA.

 

REF:    p. 1002

 

  1. Researchers now believe that RA is:
a. Curable with antiviral agents
b. An autoimmune disease
c. A complication of rheumatic fever
d. Related superficial joint injury

 

 

ANS:   B

RA is now thought to be an autoimmune disease.

RA is an incurable disease.

RA is not a complication of rheumatic fever.

RA is not due to joint injury.

 

REF:    p. 999

 

  1. A 34-year-old female was recently diagnosed with RA. Physical examination revealed that inflammation started in the:
a. Synovial membrane
b. Articular cartilage
c. Subchondral bone
d. Surrounding ligaments

 

 

ANS:   A

Inflammation of RA starts in the synovial membrane.

Inflammation of RA starts in the synovial membrane, not the articular cartilage.

Inflammation of RA starts in the synovial membrane, not the subchondral bone.

Inflammation of RA starts in the synovial membrane, not the surrounding ligaments.

 

REF:    p. 999

 

  1. A 21-year-old female presents with low back pain and stiffness that is alleviated by physical activity. She was diagnosed with ankylosing spondylitis (AS). The first joint to be affected would be the:
a. Sacroiliac
b. Carpal
c. Shoulder
d. Knee

 

 

ANS:   A

The sacroiliac joint is affected first, usually before any damage can be radiographically detected.

The sacroiliac joint, not the carpal joint, is affected first, usually before any damage can be radiographically detected.

The sacroiliac joint, not the shoulder, is affected first, usually before any damage can be radiographically detected.

The sacroiliac joint, not the knee, is affected first, usually before any damage can be radiographically detected.

 

REF:    p. 1002

 

  1. Which of the following people is at highest risk for the development of gout?
a. Men aged 40 to 50 years
b. Premenopausal women
c. Male adolescents
d. Female children

 

 

ANS:   A

People at highest risk for gout are men aged 40 to 50 years of age.

People at highest risk for gout are men aged 40 to 50 years of age, not premenopausal women.

People at highest risk for gout are men aged 40 to 50 years of age, not male adolescents.

People at highest risk for gout are men aged 40 to 50 years of age, not female children.

 

REF:    p. 1005

 

  1. A 46-year-old male presents with severe pain, redness, and tenderness in the right big toe. He was diagnosed with gouty arthritis. The symptoms he experienced are caused by the crystallization of _____ within the synovial fluid.
a. Purines
b. Pyrimidines
c. Uric acid
d. Acetic acid

 

 

ANS:   C

Gout is caused by an increase in uric acid.

Gout is caused by an increase of uric acid. Uric acid is a result of purine metabolism, but purine is not present in the joint.

Gout is caused by an increase in uric acid, not pyrimidines.

Gout is caused by an increase in uric acid, not acetic acid.

 

REF:    p. 1005

 

  1. A 46-year-old male presents with severe pain, redness, and tenderness in the right big toe. He was diagnosed with gouty arthritis. He is at risk for developing:
a. Cholelithiasis
b. Myocarditis
c. Renal stones
d. Liver failure

 

 

ANS:   C

Renal stones are 1000 times more prevalent in individuals with primary gout than in the general population.

Renal stones, not cholelithiasis, are a risk factor in gout.

Renal stones, not myocarditis, are a risk factor in gout.

Renal stones, not liver failure, are a risk factor in gout.

 

REF:    p. 1005

 

  1. A 51-year-old male experienced severe acute gouty arthritis. Which of the following is the most common trigger for the symptoms?
a. Trauma
b. Anemia
c. High-fat foods
d. Lack of exercise

 

 

ANS:   A

Trauma is the most common trigger for gout symptoms.

Trauma is the most common trigger for gout symptoms. Gout is not manifested by anemia.

Trauma is the most common trigger for gout symptoms. Gout is not caused by high-fat foods, but high purine.

Trauma, not lack of exercise, is the most common trigger for gout symptoms.

 

REF:    p. 1005

 

  1. The final stage of gout, characterized by crystalline deposits in cartilage, synovial membranes, and soft tissue, is called:
a. Monarticular arthritis
b. Tophaceous gout
c. Asymptomatic hyperuricemia
d. Complicated gout

 

 

ANS:   B

Tophaceous gout is a progressive inability to excrete uric acid, which expands the urate pool. Until urate crystal deposits (tophi) appear in cartilage, synovial membranes, tendons, and soft tissue.

Tophaceous gout, not monarticular arthritis gout, is characterized by crystalline deposits.

Asymptomatic hyperuricemia would not lead to crystalline deposits.

Tophaceous gout, not complicated gout, is characterized by crystalline deposits.

 

REF:    p. 1007

 

  1. A 32-year-old male was injured in a motor vehicle accident and confined to bed for 3 weeks. During this time, the size and strength of muscle fibers decreased, a condition referred to as:
a. Myodysplasia
b. Ischemic atrophy
c. Disuse atrophy
d. Deconditioning hypoplasia

 

 

ANS:   C

The term disuse atrophy describes the pathologic reduction in normal size of muscle fibers after prolonged inactivity from bed rest.

The patient is experiencing disuse atrophy, not myodysplasia.

The patient is experiencing disuse atrophy, not ischemic, which would be due to decreased blood flow.

The patient is experiencing disuse atrophy, not hypoplasia.

 

REF:    p. 1008

 

  1. Fibromyalgia is a chronic musculoskeletal disorder characterized by:
a. Pain resulting from joint and muscle inflammation
b. Muscle pain in the back and gastrointestinal symptoms
c. Neurologic pain in the skeletal muscles
d. Diffuse pain, fatigue, and tender points

 

 

ANS:   D

Fibromyalgia is characterized by diffuse pain, fatigue, and point tenderness.

Fibromyalgia is not related to joint and muscle inflammation.

Fibromyalgia is not related to specific back pain and is not manifested by gastrointestinal upset.

Fibromyalgia is not related to neurologic pain in muscles.

 

REF:    p. 1008

 

  1. Myotonia is characterized by:
a. Prolonged depolarization of muscle cell membranes
b. Absence of adenosine triphosphate (ATP) for muscle contraction
c. Delayed muscle contraction
d. Hyperactive reflexes

 

 

ANS:   A

Myotonia is a delayed relaxation after voluntary muscle contraction caused by the prolonged depolarization of the muscle membrane.

Myotonia is a delayed relaxation after voluntary muscle contraction caused by the prolonged depolarization of the muscle membrane, not due to absence of ATP for muscle contraction.

Myotonia is a delayed relaxation after voluntary muscle contraction caused by the prolonged depolarization of the muscle membrane, not delayed muscle contraction.

Myotonia is a delayed relaxation after voluntary muscle contraction caused by the prolonged depolarization of the muscle membrane, not hyperactive reflexes.

 

REF:    p. 1010

 

  1. A 13-year-old female is admitted to the hospital for evaluation and treatment of an osteosarcoma in her left distal femur. Which statement best describes osteosarcoma?
a. Myelogenic, develops in red bone marrow only
b. Benign, develops in spongy bone tissue
c. Collagenic, originates in the periosteum
d. Osteogenic, most often develops in the bone marrow

 

 

ANS:   D

Osteosarcomas are osteogenic tumors.

Osteosarcomas are osteogenic tumors, not myelogenic.

Osteosarcomas are osteogenic tumors, not benign.

Osteosarcomas are osteogenic tumors, not collagenic.

 

REF:    p. 1015

 

  1. A 60-year-old male presents with swelling and pain in the knee. CT reveals a tumor of spongy bone. His diagnosis would be:
a. Chondrosarcoma
b. Rhabdomyoma
c. Rhabdomyosarcoma
d. Fibrosarcoma

 

 

ANS:   A

A chondrosarcoma is an ill-defined malignant tumor that infiltrates trabeculae in spongy bone.

Rhabdomyoma is an extremely rare benign tumor of muscle that generally occurs in the tongue.

The malignant tumor of striated muscle is called rhabdomyosarcoma.

A fibrosarcoma is a solitary tumor that most often affects the metaphyseal region of the femur or tibia.

 

REF:    p. 1016

 

  1. The most common cause of toxic myopathy is:
a. Infection
b. A tumor
c. Alcoholism
d. Osteoporosis

 

 

ANS:   C

Alcohol remains the most common cause of toxic myopathy.

Alcohol, not infection, remains the most common cause of toxic myopathy.

Alcohol, not a tumor, remains the most common cause of toxic myopathy.

Alcohol, not osteoporosis, remains the most common cause of myopathy.

 

REF:    p. 1012

 

  1. A malignant tumor of striated muscle tissue origin is called:
a. Myelogenic tumor
b. Giant cell tumor
c. Rhabdomyosarcoma
d. Rhabdomyoma

 

 

ANS:   C

The malignant tumor of striated muscle is called rhabdomyosarcoma.

Myelogenic tumors originate from various bone marrow cells.

Giant cell tumor is the sixth most common of the primary bone tumors.

A rhabdomyoma is an extremely rare benign tumor of muscle that generally occurs in the tongue.

 

REF:    p. 1013

 

MULTIPLE RESPONSE

 

  1. A 35-year-old female presents with impaired motor function and visual disturbances. The diagnosis is Paget disease. What additional symptoms would be expected? (Select all that apply.)
a. Skull thickness
b. Dementia
c. Deafness
d. Headache
e. Hypertension

 

 

ANS:   A, B, C, D

In Paget disease, the skull thickens and assumes an asymmetric shape. Thickened segments of the skull may compress areas of the brain, producing altered mentality and dementia. Impingement of new bone on cranial nerves causes deafness. Headache is commonly noted. Hypertension does not occur.

 

REF:    p. 994

 

  1. Signs and symptoms of subluxation include (select all that apply):
a. Pain
b. Swelling
c. Hemorrhage
d. Limitation of movement
e. Joint deformity

 

 

ANS:   A, B, D, E

Signs and symptoms of dislocations or subluxations include pain, swelling, limitation of motion, and joint deformity.

 

REF:    p. 982

 

  1. A 29-year-old male was recently diagnosed with AS. He is interested in obtaining more information about his disease. Patient teaching would include which of the following? (Select all that apply.)
a. A diagnosis is made from history, physical examination, x-rays, and genetic analysis.
b. Inflammation of the fibrocartilage in cartilaginous joints results in the erosion of bone structure, scar tissue formation, and joint fusion.
c. The more common signs and symptoms of early disease include restricted joint movement and increased pain after physical activity.
d. The usual treatment includes anti-inflammatory and analgesic medications, exercises, and physical therapy.
e. The spine becomes bent forward as the normal convex curve of the lower spine diminishes.

 

 

ANS:   A, B, D, E

The most common signs and symptoms of early AS are low back pain and stiffness. Typically, the individual with primary disease develops low back pain during the early 20s. The pain is at first insidious but progressively becomes persistent. It is often worse after prolonged rest and is alleviated by physical activity. The normal convex curve of the lower spine (lumbar lordosis) diminishes and concavity of the upper spine (kyphosis) increases. NSAIDs will often provide temporary symptom relief within 48 hours. Analgesic medications are prescribed to suppress some of the pain and stiffness and to facilitate exercise.

 

REF:    p. 1004

 

  1. The pattern of bone destruction indicative of an aggressive malignant tumor is known as J_____ pattern. (Select all that apply.)
a. Moth-eaten
b. Permeative
c. Geographic
d. Radial
e. Selective

 

 

ANS:   A, B, C

Three patterns of bone destruction by bone tumors have been identified: (1) the geographic pattern, (2) the moth-eaten pattern, and (3) the permeative pattern. Radial and selective are not considered patterns of malignancy.

 

REF:    p. 1014

 

COMPLETION

 

  1. To make a diagnosis of fibromyalgia, tenderness must be present in ____ of the 18 points necessary for diagnosis.

 

ANS:

11

eleven

Tenderness in 11 of these 18 points is necessary for diagnosis along with a history of diffuse pain.

 

REF:    p. 1008

 

  1. A young patient is admitted to the pediatric unit with cystic fibrosis (CF) exacerbation. The nurse monitors the patient closely because the main cause of death in a child with CF is:
a. Airway rigidity
b. Pulmonary edema
c. Respiratory failure
d. Asthma-like bronchospasms

 

 

ANS:   C

Although CF is a multi-organ disease, its most important effects are on the lungs, and respiratory failure is almost always the cause of death.

Although CF is a multi-organ disease, its most important effects are on the lungs, and respiratory failure is almost always the cause of death; airway rigidity does not occur.

Mucus plugging, not pulmonary edema, occurs.

Mucus plugging, not asthma-like symptoms, occurs.

 

REF:    p. 719

 

  1. A nurse is teaching about sudden infant death syndrome (SIDS). Which information should the nurse include? SIDS peaks between _____ and ____months of age.
a. 1, 2
b. 3, 4
c. 6, 8
d. 10, 12

 

 

ANS:   B

SIDS peaks in children 3 to 4 months of age.

SIDS peaks in children 3 to 4 months of age, not 1 and 2 months of age.

SIDS peaks in children 3 to 4 months of age, not 6 and 8 months of age.

SIDS peaks in children 3 to 4 months of age, not 10 and 12 months of age.

 

REF:    p. 720

 

  1. A 5-month-old female is found dead in her crib. The coroner ruled sudden infant death syndrome (SIDS) as the cause of death. Which of the following risk factors is most likely associated with SIDS?
a. Congenital heart disease
b. Female gender
c. Caucasian race
d. Frequent respiratory infections

 

 

ANS:   D

A higher rate of respiratory tract infection during those months will likely decreases sleep arousal, making it a risk factor for SIDS.

Congenital anomalies play a role, but respiratory infections play a greater role.

SIDS occurs in males more than females.

Genetic factors may play a role, but ethnicity does not.

 

REF:    p. 720

 

  1. To prevent sudden infant death syndrome, the nurse should instruct parents to:
a. Place infants on a soft mattress for sleeping.
b. Always lay infants down on their backs to sleep.
c. Breast-feed their infants.
d. Keep the infant’s room very warm.

 

 

ANS:   B

Infants should be laid on their backs to sleep.

A soft mattress is a possible contributing factor to SIDS.

Feeding method does not play as great a role as positioning during sleep.

Sleeping position is the most preventable risk factor.

 

REF:    p. 720

 

MULTIPLE RESPONSE

 

  1. A 1-year-old female is diagnosed with croup. Which of the following symptoms is most likely to be present when the nurse performs an assessment? (Select all that apply.)
a. Barking cough
b. Stridor
c. Hoarseness
d. Drooling
e. Truncal rash

 

 

ANS:   A, B, C

Typically, the child experiences rhinorrhea, sore throat, and low-grade fever for a few days, then develops a harsh (seal-like) barking cough, inspiratory stridor, and hoarse voice.

 

REF:    p. 709

 

COMPLETION

 

  1. A nurse remembers bronchiolitis mainly occurs in children under the age of _____.

 

ANS:

1

one

Bronchiolitis is a common, viral lower respiratory tract infection that occurs almost exclusively in infants and young toddlers.

 

REF:    p. 714

 

  1. Asthma affects ____% of children between 5 and 17 years of age.

 

ANS:

10

It is the most prevalent chronic disease in childhood, affecting 10% of U.S. children between 5 and 17 years of age.

 

REF:    p. 716