NSG 5003 Final (2018): Advanced pathophysiology: South University (Already graded A)
NSG 5003 Final: Advanced pathophysiology: South University
Question 1 (5 points)
Which component of the cell produces hydrogen peroxide (H2O2) by using oxygen to remove hydrogen atoms from specific substrates in an oxidative reaction?
Question 1 options:
Question 2 (5 points)
What is a consequence of plasma membrane damage to the mitochondria?
Question 2 options:
Enzymatic digestion halts deoxyribonucleic acid (DNA) synthesis.
Influx of calcium ions halts adenosine triphosphate (ATP) production.
Edema from an influx in sodium causes a reduction in ATP production.
Potassium shifts out of the mitochondria, which destroys the infrastructure.
Question 3 (5 points)
Which statement is a description of one of the characteristics of apoptosis?
Question 3 options:
Apoptosis involves programmed cell death of scattered single cells.
Apoptosis is characterized by the swelling of the nucleus and the cytoplasm.
Apoptosis involves unpredictable patterns of cell death.
Apoptosis results in benign malignancies.
Question 4 (5 points)
During cell injury caused by hypoxia, sodium and water move into the cell because:
Question 4 options:
During cell injury caused by hypoxia, sodium and water move into the cell because:
The pump that transports sodium out of the cell cannot function because of a decrease in adenosine triphosphate (ATP) levels.
The osmotic pressure is increased, which pulls additional sodium across the cell membrane
Oxygen is not available to bind with sodium to maintain it outside of the cell.
Question 5 (5 points)
What is an effect of ionizing radiation exposure?
Question 5 options:
Deoxyribonucleic acid (DNA) aberrations
Question 6 (5 points)
Obesity creates a greater risk for dehydration in people because:
Question 6 options: chapter 3 q.2
?Adipose cells contain little water because fat is water repelling.
The metabolic rates of obese adults are slower than those of lean adults.
The rates of urine output of obese adults are higher than those of lean adults.
The thirst receptors of the hypothalamus do not function effectively.
Question 7 (5 points)
In addition to osmosis, what force is involved in the movement of water between the plasma and interstitial fluid spaces?
Question 7 options:
a) Oncotic pressure
c) Net filtration
d) Hydrostatic pressure
Question 8 (5 points)
Venous obstruction is a cause of edema because of an increase in which pressure?
Question 8 options:
a) Capillary hydrostatic
b) Interstitial hydrostatic
c) Capillary oncotic
d) Interstitial oncotic
Question 9 (5 points)
At the arterial end of capillaries, fluid moves from the intravascular space into the interstitial space because:
Question 9 options:
a) The interstitial hydrostatic pressure is higher than the capillary hydrostatic pressure.
b) The capillary hydrostatic pressure is higher than the capillary oncotic pressure.
c) The interstitial oncotic pressure is higher than the interstitial hydrostatic pressure.
d) The capillary oncotic pressure is lower than the interstitial hydrostatic pressure.
Question 10 (5 points)
It is true that natriuretic peptides:
Question 10 options:
a) Decrease blood pressure and increase sodium and water excretion.
b) Increase blood pressure and decrease sodium and water excretion.
c) Increase the heart rate and decrease potassium excretion.
d) Decrease the heart rate and increase potassium excretion.
Question 11 (5 points)
What causes the clinical manifestations of confusion, convulsions, cerebral hemorrhage, and coma in hypernatremia?
Question 11 options:
a) High sodium in the blood vessels pulls water out of the brain cells into the blood vessels, causing brain cells to shrink.
b) High sodium in the brain cells pulls water out of the blood vessels into the brain cells, causing them to swell.
c) High sodium in the blood vessels pulls potassium out of the brain cells, which slows the synapses in the brain.
d) High sodium in the blood vessels draws chloride into the brain cells followed by water, causing the brain cells to swell.
Question 12 (5 points)
A major determinant of the resting membrane potential necessary for the transmission of nerve impulses is the ratio between:
Question 12 options:
a) Intracellular and extracellular Na
b) . Intracellular and extracellular K
c) Intracellular Na and extracellular K
d) Intracellular K and extracellular Na
Question 13 (5 points)
In hyperkalemia, what change occurs to the cells’ resting membrane potential?
Question 13 options:
Question 14 (5 points)
Physiologic pH is maintained at approximately 7.4 because bicarbonate (HCO3) and carbonic acid (H2CO3) exist in a ratio of:
Question 14 options:
Question 15 (5 points)
Increased capillary hydrostatic pressure results in edema because of:
Question 15 options:
a) Losses or diminished production of plasma albumin
b) Inflammation resulting from an immune response
c) Blockage within the lymphatic channel system
d) Sodium and water retention
Question 16 (5 points)
Hypomethylation and the resulting effect on oncogenes result in:
Question 16 options:
a) A decrease in the activity of the oncogene, thus suppressing cancer development
b) Deactivation of MLH1 to halt deoxyribonucleic acid (DNA) repair
c) An increase in tumor progression from benign to malignant
d) Overexpression of micro-ribonucleic acid (miRNA), resulting in tumorigenesis
Question 17 (5 points)
The functions of the major histocompatibility complex (MHC) and CD1 molecules are alike because both:
Question 17 options:
a) Are antigen-presenting molecules
b) Bind antigens to antibodies
c) Secrete interleukins (ILs) during the immune process
d) Are capable of activating cytotoxic T lymphocytes
Question 18 (5 points)
The B-cell receptor (BCR) complex functions uniquely by:
Question 18 options:
a) Communicating information about the antigen to the helper T (Th) cell
b) Secreting chemical signals to help cells communicate
c) Recognizing the antigen on the surface of the B lymphocyte
d) Communicating information about the antigen to the cell nucleus
Question 19 (5 points)
The generation of clonal diversity includes a process that:
Question 19 options:
a) Involves antigens that select lymphocytes with compatible receptors
b) Allows the differentiation of cells into antibody-secreting plasma cells or mature T cells
c) Takes place in the primary (central) lymphoid organs
d) Causes antigens to expand and diversify their populations
Question 20 (5 points)
Vaccinations are able to provide protection against certain microorganisms because of the:
Question 20 options:
a) Strong response from immunoglobulin M (IgM)
b) Level of protection provided by immunoglobulin G (IgG)
c) Memory cells for immunoglobulin E (IgE)
d) Rapid response from immunoglobulin A (IgA)
Question 21 (5 points)
What is the mechanism that results in type II hypersensitivity reactions?
Question 21 options:
a) Antibodies coat mast cells by binding to receptors that signal its degranulation, followed by a discharge of preformed mediators.
b) Antibodies bind to soluble antigens that were released into body fluids, and the immune complexes are then deposited in the tissues.
c) Cytotoxic T (Tc) lymphocytes or lymphokine-producing helper T 1 (Th1) cells directly attack and destroy cellular targets.
d) Antibodies bind to the antigens on the cell surface.
Question 22 (5 points)
When soluble antigens from infectious agents enter circulation, tissue damage is a result of:
Question 22 options:
a) Complement-mediated cell lysis
b) Phagocytosis by macrophages
c) Phagocytosis in the spleen
d) Neutrophil granules and toxic oxygen products
Question 23 (5 points)
? Considering the hypothalamus, a fever is produced by:
Question 23 options:
a) Endogenous pyrogens acting directly on the hypothalamus
b) Exogenous pyrogens acting directly on the hypothalamus
c) Immune complexes acting indirectly on the hypothalamus
d) Cytokines acting indirectly on the hypothalamus
Question 24 (5 points)
Vaccines against viruses are created from:
Question 24 options:
a) Killed organisms or extracts of antigens
b) Live organisms weakened to produce antigens
c) Purified toxins that have been chemically detoxified
d) Recombinant pathogenic protein
Question 25 (5 points)
Carcinoma in situ is characterized by which changes?
Question 25 options:
a) Cells have broken through the local basement membrane.
b) Cells have invaded immediate surrounding tissue.
c) Cells remain localized in the glandular or squamous cells
d) Cellular and tissue alterations indicate dysplasia.
Question 26 (5 points)
Two “hits” are required to inactivate tumor-suppressor genes because:
Question 26 options:
a) Each allele must be altered and each person has two copies, or alleles, of each gene, one from each parent.
b) The first hit stops tissue growth and the second hit is needed to cause abnormal tissue growth.
c) Tumor-suppressor genes are larger than proto-oncogenes, requiring two hits to effect carcinogenesis.
d) The first hit is insufficient to cause enough damage to cause a mutation.
Question 27 (5 points)
What is the skin-related health risk induced by some types of chemotherapy?
Question 27 options:
b) Ultraviolet damage
Question 28 (5 points)
When a child is diagnosed with cancer, which intervention has the greatest influence on the child’s mortality rate?
Question 28 options:
a) Age at the time of diagnosis
b) Participation in clinical trials
c) Proximity to a major cancer treatment center
d) Parental involvement in the treatment planning
Question 29 (5 points)
Reflex activities concerned with the heart rate, blood pressure, respirations, sneezing, swallowing, and coughing are controlled by which area of the brain?
Question 29 options:
d) Medulla oblongata
Question 30 (5 points)
The edema of the upper cervical cord after a spinal cord injury is considered life threatening because of which possible outcome?
Question 30 options:
a) Hypovolemic shock from blood lost during the injury
b) Breathing difficulties from an impairment to the diaphragm
c) Head injury that likely occurred during the injury
d) Spinal shock immediately after the injury
Question 31 (5 points)
What term is used to describe the complication that can result from a spinal cord injury above T6 that is producing paroxysmal hypertension, as well as piloerection and sweating above the spinal cord lesion?
Question 31 options:
a) Craniosacral dysreflexia
b) Parasympathetic dysreflexia
c) Autonomic hyperreflexia
d) Retrograde hyperreflexia
Question 32 (5 points)
Atheromatous plaques are most commonly found:
Question 32 options:
a) . In larger veins
b) Near capillary sphincters
c) At branches of arteries
d) On the venous sinuses
Question 33 (5 points)
Multiple sclerosis is best described as:
Question 33 options:
a) A CNS demyelination, possibly from an immunogenetic virus
b) Inadequate supply of acetylcholine at the neurotransmitter junction as a result of an autoimmune disorder
c) The depletion of dopamine in the CNS as a result of a virus
d) A degenerative disorder of lower and upper motor neurons caused by viral-immune factors
Question 34 (5 points)
Graves disease develops from:
Question 34 options:
a) A viral infection of the thyroid gland that causes overproduction of thyroid hormone
b) An autoimmune process during which lymphocytes and fibrous tissue replace thyroid tissue
c) Thyroid-stimulating immunoglobulin, which causes overproduction of thyroid hormones
d) Ingestion of goitrogens, which inhibits the synthesis of the thyroid hormones, causing goiter
Question 35 (5 points)
Pathologic changes associated with Graves disease include:
Question 35 options:
a) High levels of circulating thyroid-stimulating immunoglobulins
b) Diminished levels of TRH
c) High levels of TSH
d) Diminished levels of thyroid-binding globulin
Question 36 (5 points)
A patient diagnosed with diabetic ketoacidosis (DKA) has the following laboratory values: arterial pH 7.20, serum glucose 500 mg/dl, positive urine glucose and ketones, serum potassium (K ) 2 mEq/L, and serum sodium (Na ) 130 mEq/L. The patient
reports that he has been sick with the “flu” for a week. What relationship do these values have to his insulin deficiency?
Question 36 options:
a) Increased glucose use causes the shift of fluid from the intravascular to the intracellular space.
b) . Decreased glucose use causes fatty acid use, ketogenesis, metabolic acidosis, and osmotic diuresi
c) Increased glucose and fatty acids stimulate renal diuresis, electrolyte loss, and metabolic alkalosis.
d) Decreased glucose use results in protein catabolism, tissue wasting, respiratory acidosis, and electrolyte loss.
Question 37 (5 points)
Type 2 diabetes mellitus is best described as:
Question 37 options:
a) Resistance to insulin by insulin-sensitive tissues
b) The need for lispro instead of regular insulin
c) An increase in glucagon secretion from α cells of the pancreas
d) The presence of insulin autoantibodies that destroy β cells in the pancreas
Question 38 (5 points)
The common hay fever allergy is expressed through a reaction that is mediated by which class of immunoglobulins?
Question 38 options:
a) Immunoglobulin E (IgE)
b) Immunoglobulin G (IgG)
c) Immunoglobulin M (IgM)
d) T cells
Question 39 (5 points)
A person diagnosed with type 1 diabetes experiences hunger, lightheadedness, tachycardia, pallor, headache, and confusion. The most probable cause of these symptoms is:
Question 39 options:
a) Hyperglycemia caused by incorrect insulin administration
b) The dawn phenomenon from eating a snack before bedtime
c) Hypoglycemia caused by increased exercise
d) Somogyi effect from insulin sensitivity
Question 40 (5 points)
Hypoglycemia, followed by rebound hyperglycemia, is observed in those with:
Question 40 options:
a) The Somogyi effect
b) The dawn phenomenon
c) Diabetic ketoacidosis (DKA)
d) Hyperosmolar hyperglycemic nonketotic syndrome
Question 41 (5 points)
Which structure is lined with columnar epithelial cells
Question 41 options:
b) Endocervical canal
Question 42 (5 points)
Where is the usual site of cervical dysplasia or cancer in situ?
Question 42 options:
a) Where the squamous epithelium of the cervix meets the cuboidal epithelium of the vagina
b) Where the columnar epithelium of the cervix meets the squamous epithelium of the uterus
c) Where the squamous epithelium of the cervix meets the columnar epithelium of the uterus
d) Where the columnar epithelium of the cervix meets the squamous epithelium of the vagina
Question 43 (5 points)
Which statement best describes a Schilling test?
Question 43 options:
a) Administration of radioactive cobalamin and the measurement of its excretion in the urine to test for vitamin B12 deficiency
b) Measurement of antigen-antibody immune complexes in the blood to test for hemolytic anemia
c) Measurement of serum ferritin and total iron-binding capacity in the blood to test for iron deficiency anemia
d) Administration of folate and measurement in two hours of its level in a blood sample to test for folic acid deficiency anemia
Question 44 (5 points)
In aplastic anemia (AA), pancytopenia develops as a result of which of the following?
Question 44 options:
a) Suppression of erythropoietin to produce adequate amounts of erythrocytes
b) Suppression of the bone marrow to produce adequate amounts of erythrocytes, leukocytes, and thrombocytes
c) Lack of deoxyribonucleic acid (DNA) to form sufficient quantities of erythrocytes, leukocytes, and thrombocytes
d) Lack of stem cells to form sufficient quantities of leukocytes
Question 45 (5 points)
Which statement is true regarding warm autoimmune hemolytic anemia?
Question 45 options:
a) Warm autoimmune hemolytic anemia occurs primarily in men.
b) It is self-limiting and rarely produces hemolysis.
c) Erythrocytes are bound to macrophages and sequestered in the spleen.
d) Immunoglobulin M (IgM) coats erythrocytes and binds them to receptors on monocytes.
Question 46 (5 points)
Hemolytic disease of the newborn (HDN) can occur if the mother:
Question 46 options:
a) Is Rh-positive and the fetus is Rh-negative
b) Is Rh-negative and the fetus is Rh-positive
c) Has type A blood and the fetus has type O blood
d) Has type AB blood and the fetus has type B blood
Question 47 (5 points)
When diagnosed with hemolytic disease of the newborn (HDN), why does the newborn develop hyperbilirubinemia after birth but not in utero?
Question 47 options:
a) Excretion of unconjugated bilirubin through the placenta into the mother’s circulation is no longer possible.
b) Hemoglobin does not break down into bilirubin in the intrauterine environment.
c) The liver of the fetus is too immature to conjugate bilirubin from a lipid-soluble form to a water-soluble form.
d) The destruction of erythrocytes producing bilirubin is greater after birth.
Question 48 (5 points)
How does angiotensin II increase the workload of the heart after a myocardial infarction (MI)?
Question 48 options:
a) By increasing the peripheral vasoconstriction
b) By causing dysrhythmias as a result of hyperkalemia
c) By reducing the contractility of the myocardium
Question 49 (5 points)
What event is a characteristic of the function in Zone I of the lung?
Question 49 options:
a) Blood flow through the pulmonary capillary bed increases in regular increments.
b) Alveolar pressure is greater than venous pressure but not greater than arterial pressure.
c) The capillary bed collapses, and normal blood flow ceases.
d) Blood flows through Zone I, but it is impeded to a certain extent by alveolar pressure.
Question 50 (5 points)
What factor associated with gluten-sensitive enteropathy (celiac sprue) causes an infant to bruise and bleed easily?
Question 50 options:
a) Vitamin K deficiency from fat malabsorption
b) Bone marrow function depression
c) Iron, folate, and B12 deficiency anemias
Arteries and veins of upper limb
Describes entirely about the arteries and the venous drainage of the upper limb. Explains its supply and discusses about some clinical applications.
Anatomy of the pericardium, heart chambres, cardiac skeleton, coronary vasculature, Koch\'s Triangle, cardiac contraction, conduction system of the heart, innervation, ascending aorta, pulmonary trunk. Overview of the foetal circulation, and microanatomy of arteries and veins.
NURS 6512 exam 3CA. 100% Done and Correct
• The opening of the cervix is referred to as the
b. pouch of Douglas.
c. cervical isthmus.
d. cervical os.
e. anterior fornix.
The uterus opens into the vagina at the cervical os.
REF: p. 419
• The vaginal mucosa of a woman of childbearing years should appear
a. transversely rugated.
b. moist and excoriated.
c. dry and papular.
d. smooth and pink.
e. moist with vertical ridges.
Between puberty and menopause, the vagina is transversely rugated; after menopause, it loses its rugation.
REF: p. 418
• The adnexa of the uterus are composed of the
a. corpus and cervix.
b. fallopian tubes and ovaries.
c. uterosacral and broad ligaments.
d. round ligaments and ovaries.
e. vagina and fundus.
The fallopian tubes and the ovaries are collectively referred to as the adnexa of the uterus.
REF: p. 419
• During ovulation, the cervical mucus becomes more
During ovulation the cervical mucus is increased and is stringy and elastic (spinnbarkeit)
REF: p. 421
• The pelvic joint that separates most appreciably during late pregnancy is the
b. symphysis pubis
e. sacrosciatic notch.
Of the four pelvic joints, the one that appreciably moves later in pregnancy is the symphysis pubis. The sacrosciatic notch is not a joint, and no changes occur.
REF: p. 423
• Pregnancy-related cervical changes include
a. flattening and lengthening.
b. thinning and reddening.
c. hardening and pallor.
d. shortening and reddening.
e. softening and bluish coloring.
During pregnancy, the cervix softens (Goodell sign) and then appears bluish (Chadwick sign).
REF: p. 423
• The conventional definition of menopause is
a. 3 months with no menses.
b. 1 year with no menses.
c. 6 months of progressively shorter menses.
d. 3 consecutive anovulatory cycles.
e. the cessation of ovulation.
Menopause is defined as 1 year without menses.
REF: p. 423
• Which systemic feature is related to the effects of menopause?
a. Increased intraabdominal fat deposition
b. Decreased LDL levels
c. Cold intolerant
d. Decreased cholesterol levels
e. Decreased risk of cardiovascular disease
Systemic effects of menopause include increased intraabdominal body fat, increased LDL and cholesterol levels, and hot flashes.
REF: p. 423
• Which factor is associated with an increased risk of cervical cancer?
b. Low parity
c. HPV vaccination
d. High socioeconomic status
e. Early parity
Women who were younger than 17 years when they had their first full-term pregnancy are almost 2 times more likely to get cervical cancer later in life than women who were not pregnant until they were 25 years or older.
REF: p. 425
• The risk of ovarian cancer is increased by a history of
a. low-fat diet.
b. cigarette smoking.
c. age between 35 and 50 years.
d. thin body habitus.
There is a relationship between nulliparity and an increased risk of ovarian cancer. Although the risk increases with age, most ovarian cancers develop after menopause; half are found in women older than 63 years. The other choices have no relationship with ovarian cancer. REF: p. 425
• The form of gynecologic cancer that is increased in women who have taken tamoxifen is
e. perineal skin.
Tamoxifen is an antiestrogen drug that acts like an estrogen in the uterus.
REF: p. 426
• The mother of an 8-year-old child reports that she has recently noticed a discharge stain on her daughter’s underwear. Both the mother and daughter appear nervous and concerned. You would need to ask questions to assess the child’s
a. drug ingestion.
b. fluid intake.
c. risk for sexual abuse.
d. hormone responsiveness.
e. fat intake.
Vaginal discharge in a child could be related to a chemical irritation from soaps, lotions, or powders or to urinary tract infections. Concerned parents or children should be assessed for the risk of sexual abuse.
REF: p. 440
• When you enter the examination room of a patient who is scheduled for a pelvic examination, you note that she seems very anxious. You should
a. tell her that there is nothing to be afraid of.
b. try to determine the source of anxiety.
c. avoid eye contact.
d. proceed as though nothing is wrong.
e. reschedule for another time.
Most women do not have marked anxiety about a pelvic examination. If your patient does, you will need to find out why she is anxious before proceeding with the examination.
REF: p. 427
• The female patient should ideally be in which position for the pelvic examination?
Ideally, position the woman in a lithotomy position for a pelvic examination.
REF: p. 426
• During a pelvic examination, you ask the patient to perform the Valsalva maneuver while you observe for bulging and urinary incontinence, to test for the presence of
a. a cystocele.
b. a rectocele.
c. vaginal prolapse.
d. rectal prolapse.
e. hymenal remnants.
Asking the woman to bear down as you watch for anterior wall bulging and urinary incontinence is done to assess for the presence of a cystocele.
REF: p. 435
• When you plan to obtain cytologic studies, speculum introduction may be facilitated by
a. Valsalva maneuver.
b. lubrication with warm water.
c. use of plastic speculum.
d. opening the blades completely.
e. lubrication with gel.
It is generally thought that gel lubrication may interfere with cytologic studies; therefore, most clinicians lubricate the speculum with warm water.
REF: p. 431
• Which of the following findings indicates a possible gonococcal infection?
a. Vaginal prolapse
b. Discharge from urethra or Skene glands
c. Irregular urethral orifice in midline
d. Irregular vaginal edges at introitus
e. Bulging of anterior or posterior vaginal wall
When milking the Skene glands produces a discharge, it is most commonly a gonococcal infection.
REF: p. 441
• When performing a gynecologic exam, the examiner should change gloves after touching the patient’s
a. anal area.
b. Bartholin glands.
c. Skene glands.
Whenever the anal surface is touched, the examiner should change gloves to prevent bacterial cross-contamination to other genital areas.
REF: p. 430
• During digital examination of the vagina, the cervix is noted to be positioned posteriorly. Upon bimanual examination of this woman, you would expect to palpate a(n) _____ uterus.
d. laterally deviated
The position of the cervix correlates with the position of the uterus. A cervix that is pointing posteriorly indicates an anteverted uterus.
REF: p. 431
• The presence of cervical motion tenderness may indicate
c. pelvic inflammatory disease.
Painful cervical motion tenderness suggests a pelvic inflammatory disease or a ruptured tubal pregnancy. The cervix is expected to move 1 to 2 cm without discomfort under normal conditions.
REF: p. 436
• Which one of the following is a proper technique for use of a speculum during a vaginal examination?
a. Allow the labia to spread; insert the speculum slightly open.
b. Press the introitus upward; insert the closed speculum horizontally.
c. Press the introitus downward; insert the closed speculum obliquely.
d. Spread the labia; insert the closed speculum horizontally.
e. Insert one finger; insert the opened speculum.
Gently insert a finger of one hand to push the introitus down to relax the pubococcygeal muscle. Then hold the closed speculum with the other hand and insert the speculum past your finger obliquely.
REF: p. 430
• During a routine vaginal examination, you insert the speculum and visualize the cervix. The cervix projection into the vaginal vault is approximately 5 cm. Upon bimanual examination, you would expect to find the uterus
a. in the midline position.
b. in the retroverted position.
c. in the anteverted position.
d. deviated to the left or right.
e. in the retroflexed position.
Normally, the cervix protrudes into the vagina 1 to 3 cm. Longer projections suggest a pelvic or uterine mass. A pelvic mass would cause the uterus to be deviated to the right or left, but an anteverted, retroverted, or retroflexed uterus would still be in the midline regardless of its position. REF: p. 431
• Small, pale yellow, raised, and rounded areas are visualized on the surface of the cervix. You should
a. chart this as nabothian cysts.
b. chart this as a friable cervix.
c. obtain a viral culture.
d. test the pH of the cervical os.
e. chart this as an eroded cervix.
This describes nabothian cysts, which are retention cysts of the endocervical glands and are considered a normal variant. No further testing is warranted.
REF: p. 431
• An examiner rotated a brush several times into the cervical os. The brush was withdrawn and stroked lightly on a glass slide. The slide was sprayed with fixative. Which type of specimen requires this technique for collection?
a. Gonococcal culture
b. Cytology smear
c. Haemophilus smear
d. Trichomonas smear
e. Fungal cultures
This describes the technique for obtaining a cytology Pap smear.
REF: p. 433
• When collecting specimens, which sample should be obtained first?
a. Chlamydia swab
b. Gonococcal culture
c. Pap smear
d. Wet mount
e. Potassium hydroxide prep
A Pap smear is performed first; then other tests for gonorrhea, Chlamydia, Trichomonas, bacterial vaginosis, or candidiasis are done. Pap smear results are affected by the presence of blood, and vaginal infections result in more friable tissues; therefore, the Pap smear should be done first.
REF: p. 433
• Dacron swabs are necessary when testing for which condition?
d. Bacterial vaginosis
DNA probe for gonorrhea and Chlamydia uses a Dacron swab because a wooden cotton-tipped applicator may interfere with the test results.
REF: p. 435
• The visualization of a large proportion of “clue cells” on your wet mount slide examination suggests
a. trichomonal infection.
b. bacterial vaginosis.
e. cervical cancer.
Clue cells are present in bacterial vaginosis. Hyphae are present in candidiasis, and flagella are present in trichomonal infection. Gonorrhea and cervical cancer cannot be identified on a wet mount.
REF: p. 435
• The presence of a fishy odor after dropping potassium hydroxide on a wet mount slide containing vaginal mucus suggests
a. bacterial vaginosis.
b. yeast infection.
c. chlamydial infection.
A positive “whiff test” suggests bacterial vaginosis.
REF: p. 435
• A fixed uterus may indicate
e. a normal finding.
The uterus should be mobile in the anteroposterior plane. A fixed uterus indicates adhesions.
REF: p. 437
• The assessment of which structure is not part of the bimanual examination?
The bimanual examination consists of assessing the cervix, uterus, adnexa, and ovaries.
REF: p. 435
• The rectovaginal examination is an important component of the total pelvic examination because it
a. is the most direct cervical examination route.
b. is a more comfortable examination for the posthysterectomy patient.
c. is an alternate source for cytology specimens.
d. allows the examiner to reach almost 2.5 cm higher into the pelvis.
e. provides better evaluation of the bladder.
The rectovaginal examination allows you to reach almost 2.5 cm higher into the pelvis to examine structures not reached with the bimanual examination. It is more uncomfortable for the patient and is not the source for cytology specimens or more complete evaluation of the bladder. REF: p. 438
• Prominent labia minora are a normal finding in
b. menopausal women.
d. pregnant women.
e. postmenopausal women.
Newborn genitalia findings are the result of maternal hormones. Both the labia majora and minora are swollen, with the minora often being more prominent.
REF: p. 439
• Swollen and bruised genitalia in a newborn are most likely related to
a. a breech delivery.
b. a congenital defect.
c. an infection.
d. maternal hormones.
e. an enlarged clitoris.
Although the genitalia of a newborn girl can be swollen because of maternal hormones, swelling and bruising are more likely from a breech delivery.
REF: p. 439
• The most common cause of a foul vaginal discharge in children is a(n)
b. foreign body.
d. ruptured hymen.
Foul vaginal discharge in a preschool child is most likely indicative of the presence of a foreign body.
REF: p. 441
• A 3-year-old girl is being seen because of a foul vaginal odor. To inspect the vagina vault, you should first
a. insert a pediatric vaginal speculum.
b. place your hand firmly against the labia and spread your fingers.
c. insert a cotton-tipped applicator and press down.
d. pull the labia anteriorly and slightly to the side.
e. place the child prone and in the fetal position.
Applying anterior labial traction allows the hymenal opening to become visible as well as the interior of the vagina, almost to the cervix. The presence of a foreign body will be visible with this maneuver.
REF: p. 440
• A mother brings her 8-year-old daughter to the clinic because the child says it hurts to urinate after she fell while riding her bicycle. Upon inspection, you find posterior vulvar and gross perineum bruising. These findings are consistent with
a. chronic masturbation.
b. congenital defects.
c. acute urinary tract infection.
d. sexual abuse.
A straddle injury from a bicycle seat is usually evident over the symphysis pubis; injuries resulting from sexual molestation are generally more posterior and may involve the perineum grossly.
REF: p. 441
• When a woman is not sexually active, cervical cancer screening should begin
a. at menarche.
b. by age 15 years.
c. by age 18 years.
d. by age 21 years.
e. by age 30 years.
Women who are not sexually active should have their first examination by the age of 21 years. Women under age 21 should not be tested.
REF: p. 437
• Softening of the uterine isthmus occurring between 6 and 8 weeks of pregnancy is the _____ sign.
Between the sixth and eighth weeks of pregnancy, the uterine isthmus softens, which is known as the Hegar sign.
REF: p. 443
• Fundal height to the level of the umbilicus normally occurs around week _____ of pregnancy.
At 20 weeks of gestation, the fundal height reaches the level of the umbilicus.
REF: p. 443
• During a pelvic examination for a postmenopausal woman, you would expect to assess
a. a wider and longer vaginal vault.
b. absence of vaginal wall rugation.
c. a nonpalpable cervical os.
d. a more mobile cervix.
e. palpable ovaries.
Expected findings in the pelvic examination for an older woman include a narrower and shorter vagina, absence of rugation, a less mobile cervix, and a palpable cervical os. The ovaries are rarely palpable because of atrophy.
REF: p. 423
• What accommodations should be used in the position of a hearing-impaired woman for a pelvic examination?
a. The patient should assume the “M” or “V” position.
b. The patient should be in the diamond-shaped position.
c. The head of the table should be elevated.
d. The lithotomy position with obstetric stirrups should be used.
e. The patient should be in the knee–chest position.
The woman with a hearing impairment will need to see the clinician or an interpreter during the examination; therefore, her head should be elevated.
REF: p. 449
• Asking the woman to close the introitus during a pelvic examination is a test for
c. cervical polyps.
d. muscle tone.
Test for muscle tone is to have the woman squeeze the vaginal opening around your finger. A rectocele can be seen as a bulge on the posterior wall. A cystocele will be seen as bulge on the anterior wall. Endometriosis is suggested with tender nodules along the uterosacral ligaments. Cervical polyps can be inspected without squeezing.
REF: p. 430
• Which of the following is a normal component of physiologic vaginitis seen on a wet mount?
a. Three to five white blood cells (WBCs)
b. Clue cells
c. Branching hyphae
e. Motile flagellates
Up to three to five WBCs on a wet mount are within normal limits.
REF: p. 457
• The vaginal discharge of a woman with a typical Trichomonas vaginalis infection is
a. homogeneous and gray with a low pH.
b. scant and curdy with a low pH.
c. profuse and frothy with a high pH.
d. profuse and curdy with a low pH.
e. bloody and thin with a high pH.
Trichomonal infection produces a profuse, frothy discharge with a pH of 5 to 6.6 (normal is less than 4.5).
REF: p. 457
• A young, sexually active woman comes to the urgent care clinic complaining of suprapubic abdominal pain. She is afebrile with rebound tenderness to the right side. There is no dysuria or vaginal discharge or odor. A pelvic examination is done. She has pain with cervical motion, and you palpate a painful mass over the left adnexal area. Your prioritized action is to
a. swab for gonococcal infection and then dip her urine.
b. obtain a surgical consult immediately.
c. remove the foreign body.
d. dip her urine and then swab for Chlamydia.
e. diagnose ovarian cyst and schedule follow-up.
The presenting symptoms of a tubal pregnancy are a surgical emergency. The only diagnostic test should be a pregnancy test.
REF: p. 461
• A cervical polyp usually appears as a
a. grainy appearance at the ectocervical junction.
b. bright-red soft protrusion from the endocervical canal.
c. transverse or stellate scar.
d. hard granular surface at or near the os.
e. flesh-colored, firm protrusion at the cervical os.
Cervical polyps are bright red, soft, and fragile. They usually protrude from the endocervical canal.
REF: p. 431
• Mittelschmerz may occur in which phase of the menstrual cycle?
Mittelschmerz, lower abdominal pain associated with ovulation, may also be accompanied by tenderness on the side where ovulation took place that month REF: p. 437
• What breast structure drains milk from each lobe onto the surface of the nipple?
b. Lactiferous duct
c. Montgomery follicle
d. Tail of Spence
e. Coopers ligament
The lactiferous duct is the structure that drains milk from each lobe onto the surface of the nipple.
REF: p. 351
• The largest amount of glandular breast tissue lies in the
a. upper inner quadrant.
b. lower inner
c. tail of Spence.
d. upper outer quadrant.
e. lower outer.
The greatest amount of glandular tissue in the breast lies in the upper outer quadrant.
REF: p. 351
• For purposes of examination and communication of physical findings, the breast is divided into
a. halves (upper and lower).
b. thirds (left, middle, and right).
c. four quadrants plus a tail.
d. circles (six consecutive rings, each 1 inch farther away from nipple).
e. radial portions 1 through 6.
The breast is referenced according to five segments: four quadrants and a tail.
REF: p. 351
• Contraction of breast smooth muscle results in
a. benign breast lumps.
b. emptying of milk ducts.
c. nipple inversion.
d. nipple tenderness.
e. tension on the suspensory ligaments of Cooper.
Contraction of the breast smooth muscle, as a result of tactile, sensory, or autonomic stimuli, produces erection of the nipple and causes the milk ducts to empty.
REF: p. 351
• Montgomery tubercles are most prominent in the breasts of
b. patients with lung disease.
c. adolescent girls.
d. prepubertal girls.
e. pregnant women.
Montgomery tubercles undergo hypertrophy and become more prominent in the breast of pregnant and lactating women.
REF: p. 353
• Approximately 75% of women are menstruating by which Tanner stage of breast development?
a. Stage 1
b. Stage 2
c. Stage 3
d. Stage 4
e. Stage 5
About one fourth of women begin menstruation at stage 4. Approximately 75% are menstruating at stage 4, the stage at which the areola forms a second mound. Some 10% of young women do not begin to menstruate until stage 5.
REF: p. 352
• During pregnancy, which of the following changes normally occurs in the breasts because of the effects of luteal and placental hormones?
a. The amount of connective tissue increases.
b. Epithelial secretory activity decreases.
c. Alveoli increase in size and number.
d. Vascularization decreases.
e. Lactiferous ducts diminish.
Breast changes during pregnancy include lactiferous duct proliferation, an increase in alveoli and glandular tissue that displaces connective tissue, and an increase in mammary vascularization. As a result, the breasts are larger, softer, and looser with a blue venous network visible through the skin.
REF: p. 353
• Milk production usually begins during which period?
a. At conception
b. During the first trimester of pregnancy
c. During the second trimester of pregnancy
d. At delivery
e. 2 to 4 days after delivery
Colostrum secretion begins after delivery and then is replaced with milk production within 2 to 4 days.
REF: p. 353
• Which breast change is typical after menopause?
a. Thickening of the inframammary ridge
b. Hypertrophy of glandular tissue
c. Increase in number of lactiferous ducts
d. Reduction of fat deposits
e. Shortening of Cooper’s ligaments
After menopause, the breast tissue atrophies and is replaced by fat deposit, the inframammary ridge at the lower edge of the breast thickens, and the breast hangs more loosely as Cooper’s ligaments relax.
REF: p. 353
• In a woman complaining of a breast lump, it is most important to ask about
a. its relationship to menses.
b. weight gain.
c. sleep patterns.
d. immunization status.
e. alcohol consumption.
Hormonal changes of menstruation can result in breast tenderness, swelling, and enlarged nodes that can be felt on palpation.
REF: p. 363
• When conducting a clinical breast examination, the examiner should
a. forgo the examination if the patient has had a recent mammogram.
b. keep the patient covered to respect modesty.
c. dim the lights to minimize anxiety.
d. inspect both breasts simultaneously.
e. begin with palpation of the breasts.
Inspection with simultaneous observation of both breasts is essential in order to detect differences between the breast size, symmetry, contour, and skin color.
REF: p. 357
• A 50-year-old woman presents as a new patient. Which finding in her personal and social history would increase her risk profile for developing breast cancer?
a. Drinking three glasses of wine per week
b. Early menopause
d. Late menarche
e. Young age at birth of first child.
Nulliparity or late age at birth of first child (after 30 years old) is a risk factor for breast cancer. Other risk factors include late menopause, early menarche, and drinking more than one alcoholic drink daily.
REF: p. 354
• If your patient has nipple discharge, you will most likely need a
a. Vacutainer tube.
b. glass slide and fixative.
c. specimen jar with formaldehyde.
d. tape strip to test pH.
e. needle and syringe.
A glass slide and fixative is used for microscopic examination of the discharge to identify the cellular makeup of the discharge. The other options are not used for this purpose.
REF: p. 355
• To begin the clinical breast examination (CBE) for a man, ask him to
a. recline on the table with his arms overhead.
b. sit with his arms hanging at his sides.
c. sit with his hands on his hips.
d. stand with his arms clasped behind his back.
e. stand leaning forward.
Inspection begins the CBE. Ask the patient to sit with his arms hanging loosely at his sides. The technique is the same for both men and women.
REF: p. 355
• Inspection of the breasts usually begins with the patient in which position?
Inspection begins with the patient in a sitting position with arms hanging loosely at the sides.
REF: p. 355
• While examining a 30-year-old woman, you note that one breast is slightly larger than the other. In response to this finding, you should
a. note the finding in the patient’s record.
b. ask the patient if she has ever had breast cancer.
c. tell the patient to get a mammogram as soon as possible.
d. tell the patient to get a mammary sonogram as soon as possible.
e. tell the patient to stop caffeine intake.
Often one breast is slightly larger than the other. This is a normal variation, and no further intervention is required.
REF: p. 365
• Which finding, found on inspection, is related to fibrotic tissue changes that occur with breast carcinoma?
a. Convex or conical shape
b. Skin dimpling or retraction
c. Pendulous and loose breasts
d. Unequal shape or contour
e. Lifelong inverted nipple
Skin dimpling or retraction signifies the contraction of fibrotic tissue that occurs with carcinoma. The other choices are normal variations without significance to cancer development. REF: p. 356
• Venous patterns on breasts are suggestive of pathology when they are
a. bilaterally visible.
b. seen in obese patients.
d. observed during pregnancy.
e. associated with a long-standing unchanging nevus.
Malignant tumors require more blood flow. Superficial veins dilate to provide more flow and can be assessed as unilateral venous patterns. Bilateral findings are of no concern and are more commonly seen in pregnant or obese women. Nevi that are long-standing, unchanging, or nontender are of little concern.
REF: p. 356
• Which of the following is a common benign variation in the breasts of a pregnant woman?
a. Unilateral leakage of bloody fluid
b. Bilateral leakage of bloody fluid
c. Bilateral pronounced venous patterns
d. Reddened areas in the tail of Spence
e. Peau d’orange appearance
Bilateral venous patterns on the breast are commonly found in pregnant and obese women and are of no clinical concern. The other choices indicate either mastitis or breast cancer, which are not common findings.
REF: p. 364
• A 23-year-old white woman has come to the clinic because she has missed two menstrual periods. She states that her breasts have enlarged and that her nipples have turned a darker color. Your further response to this finding is to
a. instruct her that this is a side effect of birth control injection therapy.
b. suggest pregnancy testing.
c. question her use of tanning beds.
d. schedule an appointment with a surgeon.
e. recommend she remove caffeine from her diet.
In light-skinned women, pregnancy produces enlarged breasts with darker areolae. Hormonal injections, caffeine, and the use of tanning beds will not change the color of the areolae as pregnancy does. Surgical consultation is not necessary.
REF: p. 364
• In patients with breast cancer, peau d’orange skin is often first evident
a. in the axilla.
b. in the upper inner quadrant.
c. on or around the nipple.
d. at the inframammary ridge.
e. in the tail of Spence.
The areola is the most common initial site to visualize peau d’orange skin.
REF: p. 356
• A peppering of nontender, nonsuppurative Montgomery tubercles is considered to be a
a. normal finding.
b. sign of carcinoma.
c. skin disease.
d. symptom of malnutrition.
e. sign of late menarche.
Montgomery tubercles are the tiny bumps scattered around the areola and are regarded as an expected finding when they are nontender and have no purulent drainage.
REF: p. 356
• Which of the following is most likely to be a variation of minor consequence?
a. Bilateral nipple inversion
b. Fixed stonelike nodule
c. Serous nipple drainage
d. Unequal nipple axis
e. Paget disease of the breast
Bilateral nipple inversion to the same extent on both breasts in not a concern. The other choices are a result of cancer growth, affecting the surrounding tissue.
REF: p. 356
• Recent unilateral inversion of a previously everted nipple suggests
c. benign breast disease.
Recent unilateral inversion or retraction of a previously everted nipple suggests malignancy rather than a benign condition.
REF: p. 357
• Which condition is more common in African American women than in white women?
a. Light areolae
b. Nipple inversion
c. Retracted areolae
d. Supernumerary nipples
e. Nipple and areolar colors do not match.
The incidence of supernumerary nipples is higher in African American women than in white women.
REF: p. 357
• When palpating breast tissue, the examiner should use the _____ at each site.
b. finger pads
c. palms of the hands
d. ulnar surface of the hands
The finger pads are used for breast palpation because they are more sensitive than the fingertips.
REF: p. 361
• Documentation of a breast mass location is
a. according to illustration, without a narrative.
b. according to clock positions from the nipple.
c. measured with calipers from the nipple.
d. measured in centimeters from the sternal notch.
e. measured in centimeters from the axilla.
Documenting a breast mass is described according to clock positions and distance from the nipple, or according to quadrants of the breast. An illustration should appear in the medical record as well.
REF: p. 361
• If a firm, transverse ridge of compressed tissue is felt bilaterally along the lower edge of a 40-year-old patient’s breast, you should
a. ask the patient if she has a history of breast cancer.
b. refer the patient for biopsy.
c. ask the patient to have a mammogram as soon as possible.
d. record the finding in the patient’s record.
e. tell the patient to stop drinking alcohol.
The inframammary ridge thickens and can be felt more easily with age. It is an expected, normal finding without indications for further action.
REF: p. 363
• During palpation of a 30-year-old woman’s breast, she complains that the procedure is painful. You suspect that this may be because she is
b. a heavy smoker.
e. an alcoholic.
Women’s breasts are more tender during the premenstrual and menstrual periods than during any other time of the menstrual cycle because hormone changes cause the breasts to swell and increase nodularity. Clinical breast examinations should be scheduled for 1 week after the start of the menstrual flow. REF: p. 363
• A 12-year-old boy is being seen because of right-sided breast tenderness. Your examination technique includes inspection and palpation with a finding of swelling and a palpable firm, mobile, pealike mass under the areola. Recommendations to the child and parent are to
a. apply an Ace wrap compression bandage for 6 hours a day.
b. return for evaluation in 6 months if the problem persists.
c. obtain a surgical referral for needle biopsy.
d. discontinue all contact sports.
e. administer urine screen for illicit drugs.
Many boys at puberty have unilateral or bilateral subareolar masses, resulting from hormonal changes. Most of these disappear in 6 to 12 months without further intervention. Reassurance to the young man that this is a common occurrence is essential.
REF: p. 363
• The tail of Spence extends
a. into the midclavicular region.
b. toward the supraclavicular area.
c. down into the inframammary ridge.
d. into the axillae.
e. along the sternal border.
The tail of Spence extends from the upper outer breast quadrant into the axillae.
REF: p. 351
• To spread the breast tissue evenly over the chest wall, you should ask the woman to lie supine with
a. her arms straight alongside her body.
b. both arms overhead with her palms upward.
c. her hands clasped just above her umbilicus.
d. one arm overhead and a pillow under her shoulder.
e. both hands pressed against her hips.
Breast tissue is spread more evenly across the chest wall when the patient raises one arm overhead with a small pillow or rolled towel under that shoulder.
REF: p. 360
• Palpation of the nipple is done by
a. depressing it behind the areola.
b. pressing it against the rib cage.
c. pulling it outward and releasing it.
d. rolling it in a clockwise motion.
e. inverting the nipple.
At the completion of the examination, return to the nipple and with two fingers gently depress the tissue inward into the well behind the areola. Your fingers and tissue should move easily inward, nipple compression to evoke discharge is no longer part of the clinical breast examination.
REF: p. 361
• When examining axillary lymph nodes, the patient’s arm is
a. raised full above the head.
b. extended at the side.
c. pressed against the hip.
d. crossed over the chest.
e. flexed at the elbow.
To examine the axilla, support the patient’s lower arm with the elbow flexed with one of your hands and use your other hand to palpate the axilla.
REF: p. 360
• Lymphatic flow of the breast primarily drains
a. inferiorly toward the abdomen.
b. laterally toward the corresponding arm.
d. medially toward the sternum.
e. inferomedially toward the xiphoid.
Each breast contains a lymphatic network that drains the breast radially and deeply to underlying lymphatics.
REF: p. 352
• The greatest concern for breast cancer is when you palpate _____ nodes.
a. anterior cervical
e. internal mammary
The supraclavicular and infraclavicular nodal areas are sentinel nodes; any enlargement in these areas is especially significant.
REF: p. 360
• You are performing a clinical breast examination for a 55-year-old woman. While palpating the supraclavicular area, you suspect that you felt a node. To improve your hooked technique, you should
a. apply lotion to your hands.
b. use both hands simultaneously.
c. ask the patient to press both palms together.
d. ask the patient to lower her shoulder on that side.
e. ask the patient to turn her head toward that side.
Having the patient turn her head toward the examination side, as well as raising the shoulder on that same side, gives your fingers more room to palpate deeper into the fossa.
REF: p. 360
• The mother of a newborn boy tells you that her baby’s breasts are swollen and sometimes look as if they are leaking milk. It is most appropriate to tell her that the
a. enlargement and leaking are caused by maternal hormones and will likely resolve without treatment.
b. infant may have a congenital heart defect.
c. infant may need genetic testing.
d. infant needs ultrasonography of the breasts to exclude a pathologic cause.
e. infant may have mastitis.
Maternal passive transfer of estrogen to the infant can result in enlarged breasts of the newborn. Squeezed gently, the breast can excrete a small amount of clear or milky white fluid. This condition resolves spontaneously within 2 weeks and rarely lasts beyond 3 months.
REF: p. 363
• Male gynecomastia associated with illicit or prescription drug use can be expected to
a. lessen when the body becomes accustomed to the drug.
b. resolve after the drug is discontinued.
c. leave permanent breast enlargement when the drug is discontinued.
d. cause purulent drainage if left untreated.
e. lead to an increased risk of breast cancer.
Gynecomastia associated with illicit or prescription drug use (antihypertensive, estrogens, or steroids) usually resolves after the offending drug is discontinued and does not require further intervention.
REF: p. 364
• A nursing mother complains that her breasts are tender. You assess hard, shiny, and erythremic breasts bilaterally. You should advise the patient to
a. massage gently and continue nursing.
b. apply warm compresses and stop nursing.
c. monitor her temperature and restrict fluids.
d. sleep with a bra and wash her breasts with antibacterial soap.
e. stop nursing and restrict fluids.
This patient has engorged breasts. The aim of treatment is to promote breast drainage. Stopping nursing will increase the risk that a breast infection will turn into a breast abscess. The other choices do not encourage breast milk flow. Only mild soaps are advised; harsh soaps can dry and crack the nipple and compound infection.
REF: p. 365
• You are conducting a clinical breast examination for a 30-year-old patient. Her breasts are symmetrical with bilateral, multiple tender masses that are freely moveable with well-defined borders. You recognize that these symptoms and assessment findings are consistent with
b. Paget disease.
d. mammary duct ectasia.
e. fibrocystic changes.
Fibrocystic changes are tender masses, usually bilateral, with multiple round, mobile, well-delineated borders. Fibroadenoma and cancer are usually nontender; Paget disease is an eczema-like condition of the nipple that signals an underlying cancer. Mammary duct ectasia most commonly occurs in menopausal women.
REF: p. 365
• Your patient is a nursing mother who asks you to look at a mole she has under her left breast at the inframammary fold. The mole is nontender and soft and has grown in size since she started nursing. There are no other changes to the mole. This mole probably represents an undiagnosed
a. retention cyst.
b. case of Paget disease.
c. supernumerary nipple.
d. fat necrosis.
e. Montgomery tubercle.
Supernumerary nipples appear as one or more extra nipples located along the embryonic mammary ridge (the “milk line”). These nipples and areolae may be pink or brown, are usually small, and are commonly mistaken for moles. Infrequently, some glandular tissue may accompany these nipples.
REF: p. 357
• The sensitivity of clinical breast exam (CBE) in detecting breast cancer ranges from
a. 10% to 20%.
b. 20% to 39%.
c. 40% to 69%.
d. 70% to 89%.
e. 88% to 99%.
The sensitivity of CBE in detecting breast cancer ranges from 40% to 69%, and the specificity ranges from 88% to 99%. The sensitivity of the CBE combined with mammography is greater than that of mammography alone because CBE can detect cancer missed by mammography.
REF: p. 358
• The structure that carries oxygenated blood to the body from the left ventricle is the
b. pulmonary artery.
c. pulmonary vein.
d. superior vena cava.
e. inferior vena cava.
The aorta carries oxygenated blood from the left ventricle to the body. The pulmonary artery carries deoxygenated blood from the right side of the heart to the lungs. The pulmonary vein carries oxygenated blood from the lungs to the left side of the heart. The superior and inferior venae cavae carry blood from the upper and lower body to the right atrium.
REF: p. 332
• The arterial pulse is produced by
a. atrial contraction.
b. ventricular systole.
c. peripheral vascular resistance.
d. diastolic pressure.
e. atrial relaxation.
Arterial pulses are palpable and at times visible during ventricular systole. During this time, the left ventricle contracts, pushing blood from the heart to the body. Atrial contraction pushes blood into the ventricles. Diastolic pressure is the force exerted against the wall of the artery when the heart is in the filling or relaxed state. Diastolic pressure is the function of peripheral vascular resistance.
REF: p. 336
• The characteristics of arterial pulses are directly affected by all of the following except
a. the volume of blood ejected.
b. peripheral arterial resistance.
c. venous valvular competence.
d. blood viscosity.
e. distensibility of aorta.
Arterial pulses are affected by stroke volume (volume of blood ejected), distensibility of the aorta and large arteries, viscosity of the blood, and peripheral arteriolar resistance. Venous valvular competence contributes to the venous blood flow back to the heart.
REF: p. 336
• The level at which the jugular venous pulse is visible gives an indication of
a. mitral valve efficiency.
b. aortic valve efficiency.
c. stroke volume.
d. left ventricular pressure.
e. right atrial pressure.
The level at which the jugular venous pulse is visible indicates right atrial pressure. The jugular veins empty into the superior vena cava, which empties into the right atria. The jugular venous system reflects the competency of the right side of the heart. The other four possible answers reflect the competency of the left side of the heart.
REF: p. 336
• The most prominent component of the jugular venous pulse is the
a. a wave.
b. c wave.
c. v wave.
d. x slope.
e. y slope.
The a wave is the first and most prominent component of the jugular venous pulse. The a wave represents a brief backflow of blood into the vena cava during right atrial contraction.
REF: p. 336
• In newborn infants, closure of the ductus arteriosus usually occurs
a. before the initiation of labor.
b. 12 to 14 hours after birth.
c. after 7 days of life.
d. between the second and third month.
e. during the toddler period.
The ductus arteriosus closes usually within the first 12 to 14 hours of life.
REF: p. 337
• Blood pressure normally decreases during what period?
b. First trimester of pregnancy
c. Second trimester of pregnancy
d. Third trimester of pregnancy
e. During labor and delivery
Blood pressure reaches its lowest during the second trimester. During the third trimester, hypotension most often occurs when the patient is lying in the supine position.
REF: p. 337
• During a routine prenatal visit, Ms. T. was noted as having dependent edema, varicosities of the legs, and hemorrhoids. She expressed concern about these symptoms. You explain to Ms. T. that her enlarged uterus is compressing her pelvic veins and her inferior vena cava. You would further explain that these findings
a. are usual conditions during pregnancy.
b. indicate a need for hospitalization.
c. indicate the need for amniocentesis.
d. suggest that she is having twins.
e. suggest that she never lie on her side.
Explain to the patient that these are usual conditions during pregnancy. Blood in the lower extremities tends to pool in later pregnancy because of the occlusion of the pelvic veins and inferior vena cava from pressure created by the enlarged uterus. The occlusion results in an increase in dependent edema, varicosities of the legs and vulva, and hemorrhoids. Lying in the lateral recumbent position may help relieve some her symptoms. REF: p. 337
• Vascular changes expected in older adults include
a. loss of vessel elasticity.
b. decreased peripheral resistance.
c. decreased pulse pressure.
d. constriction of the aorta and major bronchi.
e. increased vasomotor tone.
With age, the walls of the arteries become calcified, and they lose their elasticity and vasomotor tone; therefore, they lose their ability to respond appropriately to changing body needs. Increased peripheral vascular resistance occurs, causing an increase in blood pressure.
REF: p. 337
• The amplitude of pulses is recorded on a(n)
a. Likert scale of absent to bounding.
b. numerical scale of 0 to 4.
c. alphabetic scale of A to E.
d. descriptive scale of mild, moderate, and severe.
e. graded scale of I to VI.
The amplitude of pulses is recorded on a numeric scale of 0 to 4: 0 is absent, not palpable; 1 is diminished, barely palpable; 2 is expected finding; 3 is full, increased; and 4 is bounding.
REF: p. 340
• Which of the following statements is true regarding the examination of peripheral arteries?
a. The thumb should never be used to assess pulses.
b. Palpate at least one pulse in each extremity, usually the most proximal one.
c. The pulses are most readily felt over arteries that lie over bones.
d. Extremity pulses do not normally generate waveforms.
e. The pads of the fourth and fifth digits of the examiner’s hands are the most sensitive.
The pulses are best palpated over arteries that are close to the surface of the body and lie over bones. The arterial pulses with the digital pads of the second and third fingers. The thumb may also be used if vessels have a tendency to move or roll when palpated by the fingers. Palpate at least one pulse, the most distal pulse, in each extremity to determine the sufficiency of the arterial circulation. Arterial pulses have contour (waveform).
REF: p. 338
• Which arterial pulse is most useful in evaluating heart activity?
Carotid arteries provide the most easily accessible arterial pulse and are closest to the heart and therefore are most useful in evaluating heart activity.
REF: p. 338
• A pulsation that is diminished to the point of being barely palpable would be graded as
A pulse that is diminished and barely palpable would be graded as a 1 on a scale of 0 to 4.
REF: p. 340
• The term claudication refers to
a. pain from muscle ischemia.
b. lack of palpable pulsations.
c. visible extremity changes of arterial occlusion.
d. numbness and tingling in toes and fingers.
e. constriction or narrowing of a vessel.
Claudication is known as pain that results from muscle ischemia. This pain is described as a dull ache with muscle fatigue and can often be accompanied by cramping. It is brought on by sustained exercise and relieved by rest. Individuals with peripheral artery disease experience claudication because of a decrease in the amount of blood passing through the artery as a result of atherosclerosis, which cause the arteries to become narrow. Risk factors for claudication are hypertension, smoking, hyperlipidemia, diabetes, and old age. REF: p. 340
• Conduction system impairment should be suspected if an irregular heartbeat is
A patternless, unpredictable, irregular rate may indicate heart disease or conduction system impairment. A gallop is an abnormal regular heart rhythm with three sounds in each cycle resembling the gallop of a horse. Amplitude of the paradoxical pulse decreases on inspiration.
REF: p. 340
• In which location would carotid bruits best be heard?
a. Posterior cervical triangle
b. Anterior margin of the sternocleidomastoid muscle
c. Over the aortic valve
d. At the angle of the mandible
e. Just anterior to the ear
Carotid artery bruits are best heard at the anterior margin of the sternocleidomastoid muscle.
REF: p. 342
• You are examining Mr. S., a 79-year-old man with diabetes who is complaining of claudication. Which of the following physical findings is consistent with the diagnosis of arterial insufficiency?
a. Thick, calloused skin
b. Ruddy, thin skin
c. Warmer temperature of extremity in contrast to other body parts
d. Thin atrophied skin
e. Full superficial veins with rapid filling
An individual with peripheral artery disease or claudication will have thin skin with localized pallor and cyanosis, a loss of body warmth in the affected area. There may be collapsed superficial veins with delayed filling.
REF: p. 340
• A sound similar to a murmur that is heard over arteries is a
c. friction rub.
A bruit is the sound of turbulent blood flow auscultated over arteries and heard best with the bell of the stethoscope. Thrills, as well as a heave, are palpated findings. A friction rub is a distinct sound heard when two surfaces are rubbed together as occurs with pericardial or pleural inflammation. Hums are low-pitched sounds associated with the venous system.
REF: p. 340
• In differentiating between an occluded artery or vein, a differentiating sign (present in venous but not arterial occlusion) is
a. color change.
c. pain with walking.
d. pain with palpation.
Deep vein thrombosis is suspected if swelling, pain, and tenderness occur over a vein. An occluded artery does not cause any swelling (edema). A positive Homan sign indicates venous thrombosis. Paralysis is a rare complication of arterial occlusion.
REF: p. 344
• To assess a patient’s jugular veins, he or she should first be placed in which position?
d. Left lateral recumbent
e. Leaning forward
To assess jugular veins, place the patient in supine position. This causes engorgement of the jugular veins. Then gradually raise the head of the bed until the jugular vein pulsating becomes visible between the angle of the jaw and the clavicle. Jugular veins cannot be palpated.
REF: p. 342
• Observation of hand veins can facilitate assessment of
a. mitral valve competency.
b. stoke volume.
c. right heart pressure.
d. pulse pressure.
e. left heart pressure.
Hand veins can be used as an auxiliary manometer of right heart pressure. Assess the hand veins while the hand is at the patient’s side. Then raise the hand until the veins collapse, and then use a ruler to measure the vertical distance between the mid-axillary line (level of the heart) and the level of the collapsed hand veins. REF: p. 343
• You are assessing Mr. Z.’s fluid volume status as a result of heart failure. If your finger depresses a patient’s edematous ankle to a depth of 6 mm, you should record this pitting as
a. 1 .
b. 2 .
c. 3 .
d. 4 .
e. 5 .
Pitting edema to 6 mm represents a 3 rating. This edema is noticeably deep and may last more than 1 minute; the dependent extremity looks fuller and swollen. Edema is graded on a scale of mild (1 ) through worse (4 ).
REF: . p344
• If pitting edema is unilateral, you would suspect occlusion of a
a. lymphatic duct.
b. major vein.
c. surface capillary.
d. superficial artery.
e. deep artery.
If edema is unilateral, you should suspect the occlusion of a major vein. If edema is bilateral, consider congestive heart failure. If edema occurs without pitting, suspect arterial disease and occlusion or lymphedema.
REF: p. 344
• Thrombosis of a leg vein should be suspected if the patient feels calf pain
a. after running a short distance.
b. on dorsiflexion of the foot.
c. on extending a flexed thigh.
d. while wearing high-heeled shoes.
e. flexing the knee.
Suspect deep vein thrombosis if calf pain occurs with dorsiflexion of the foot. The maneuver is referred to as a positive Homan sign.
REF: p. 344
• Which of the following statements is most accurate in describing hepatic jugular reflux?
a. It is an accurate indicator of heart failure.
b. It is exaggerated in patients with right heart failure.
c. It is normal when patients are sitting up straight.
d. It should be absent in older patients with heart failure.
e. It never elevates the jugular venous pressure (JVP) in patients without heart failure.
Hepatojugular reflux is used to evaluate right heart failure and is exaggerated when right heart failure is present. All patients will have elevation of the JVP with this maneuver, depending on the elevation of their head and their underlying venous pressure. Use your hand and apply firm pressure to the abdomen in the mid-epigastric region while the patient breathes regularly. Observe the neck for increased JVP followed by an abrupt fall in JVP when the hand pressure is released. The JVP quickly returns to its true level between the abdominal hand pressure and the release of the abdominal hand pressure. REF: p. 343
• You are performing jugular venous pressure measurement for your patient in heart failure. You see a pulse wave with the patient’s head elevated at a 45-degree angle. Your action as a result of this assessment is to
a. record this measurement as less than 9 cm H2O pressure.
b. record this measurement as more than 9 cm H2O pressure.
c. confirm that the pulsations decrease with inspirations.
d. confirm that the pulsations increase with inspirations.
e. place the patient in the supine position and recheck.
Confirmation of assessing venous pressure rather than a carotid wave pulse is necessary. Jugular venous pulse will decrease on inspiration and increases on expiration, but the carotid pulse will not be affected.
REF: p. 343
• A bounding pulse in an infant may be associated with
a. patent ductus arteriosus.
b. coarctation of the aorta.
c. decreased cardiac output.
d. peripheral vaso-occlusion.
e. painful, swollen extremities.
A bounding pulse is associated with a large left-to-right shunt produced by a patent ductus arteriosus. A weaker or thinner pulse represents diminished cardiac output or peripheral vasoconstriction. A difference in pulse amplitude between upper extremities or between femoral and radial pulses and absence of the femoral pulse suggests a coarctation of the aorta. Painful, swollen extremities are usually a sign of venous occlusion. REF: p. 345
• In infants or small children, a capillary refill time of 4 seconds
a. is normal.
b. indicates hypervolemia.
c. indicates dehydration or hypovolemic shock.
d. indicates renal artery stenosis.
e. indicates venous occlusion.
Capillary refill time represents the time it takes the capillary bed to refill after being occluded by pressure to the nail bed for several seconds. Observe the time it takes for the nail to regain its full color, which should be less than 2 seconds for an intact system. The capillary refill will be greater than 2 seconds during arterial occlusion, hypovolemic shock, hypothermia, and dehydration.
REF: p. 345
• A venous hum heard over the internal jugular vein of a child
a. usually signifies untreatable illness.
b. usually has no pathologic significance.
c. usually requires surgical intervention.
d. must be monitored until the child is grown.
e. usually indicates dehydration.
A venous hum is caused by the turbulence of blood flow in the internal jugular veins. A venous hum is common in children and usually has no pathologic significance. To detect a venous hum, auscultate over the right supraclavicular space at the medial end of the clavicle and along the anterior border of the sternocleidomastoid muscle. It is louder during diastole. REF: p. 345
• In pregnancy, blood pressure is lowest
a. at conception.
b. during the first trimester.
c. during the second trimester.
d. during the third trimester.
e. at the time of delivery.
The lowest levels occur in the second trimester and then rise but still remain below prepregnancy levels.
REF: p. 337
• An idiopathic spasm of arterioles in the digits is called
a. arteriosclerosis obliterans.
b. giant cell arteritis.
c. arteriovenous fistula.
d. peripheral arterial aneurysm.
e. Raynaud disease.
Raynaud phenomenon is an idiopathic, intermittent spasm of the arterioles in the digits, which causes skin pallor. Arteriosclerosis obliterans is the occlusion of the blood supply to the extremities by atherosclerotic plaques. Giant cell arteritis is a generalized inflammatory disease that affects arteries of the carotid, temporal, and occipital arteries. Arteriovenous fistula is a pathologic communication between an artery and a vein. An aneurysm is dilation of an artery caused by a weakness in the arterial wall. They occur in the aorta, renal, femoral, and popliteal arteries. REF: p. 347
• A major risk factor for arterial embolic disease is
a. venous thrombosis.
b. atrial fibrillation.
d. diuretic therapy.
e. constrictive pericarditis.
Atrial fibrillation results in a disturbance of blood flow through the atrium. Blood is not pumped out completely, so it may pool and clot. An embolus can travel throughout the arterial system, causing an occlusion of small arteries and leading to necrosis of the tissue. REF: p. 347
• In children, coarctation of the aorta should be suspected if you detect
a. a delay between the radial and femoral pulses.
b. a simultaneous radial and femoral pulse.
c. an absent femoral pulse on the left.
d. bilateral absence of femoral pulses.
e. equal blood pressures in the arms and legs.
Coarctation of the aorta is a congenital stenosis or narrowing seen most commonly in the descending aortic arch near the origin of the left subclavian artery and ligamentum arteriosum. Ordinarily, the radial and femoral pulses are palpated simultaneously. When there is a delay or a palpable diminution of amplitude of the femoral pulse, coarctation must be suspected. Differences in blood pressure taken in the arms and legs should confirm the suspicion. REF: p. 348
• Kawasaki disease is suspected when assessments of a child reveal
a. conjunctival injection, strawberry tongue, and edema of the hands and feet.
b. conjunctival infection, lymphadenopathy, and a vesicular rash.
c. low-grade fever, strawberry tongue, and edema of the hands and feet.
d. dermatomal bullae rash, high fever, and cyanotic hands and feet.
e. recent streptococcal pharyngitis, vesicular rash, and geographic tongue.
Kawasaki disease is an acute small vessel vasculitic illness of uncertain cause affecting young males more often than females. Findings may include fever, conjunctival injection, strawberry tongue, and edema of the hands and feet. Findings may also include lymphadenopathy and polymorphous nonvesicular rashes.
REF: p. 349
• Cranial Nerves (1-6)
• Cranial Nerves (7-12)
8. Vestbulocochlear (Auditory)
• CN I - Olfactory Assessment
Test patient's ability to smell (coffee, vanilla, peppermint).
• CN II - Optic Assessment
o Snellen eye Chart
o Examine visual fields
• CN III, IV, VI Oculomotor, Trochlear, Abducens
o pupil size, shape, ptosis
o Shine light from side to gauge pupils reaction to light.
o EOM exam
o Convergence and accomodation
• CN V - Trigeminal
o Corneal reflex
o look for blink in both eyes
o facial sensation
o Motor - pt opens mouth, clenches teeth
• CN VII - Facial
o Facial droop
o pt looks up and wrinkles forehead
o pt shuts eyes tightly, compare each side
o frown, show teeth, puff out cheeks
• CN VIII - Vestibulocochlear (hearing)
o ask patient if they can hear you rubbing your fingers together
o Weber's Test
o Rinne's Test
• CN IX, X: Glossopharyngeal, Vagus
o Voice: hoarse or nasal.
o Pt. swallows, coughs (bovine cough: recurrent laryngeal).
o Examine palate for uvular displacement. (unilateral lesion: uvula drawn to normal side).
o Pt says "Ah": symmetrical soft palate movement.
o Gag reflex [sensory IX, motor X]:
o • Stimulate back of throat each side.
o • Normal to gag each time.
• CN XI: Accessory
o From behind, examine for trapezius atrophy, asymmetry.
o Pt. shrugs shoulders (trapezius).
o Pt. turns head against resistance: watch, palpate SCM on opposite side.
• CN XII: Hypoglossal
o Listen to articulation.
o Inspect tongue in mouth for wasting, fasciculations.
o Protrude tongue: unilateral deviates to affected side.
• The autonomic nervous system coordinates which of the following?
a. High-level cognitive function
b. Balance and affect
c. Internal organs of the body
d. Balance and equilibrium
e. Emotions and behavior
The autonomic nervous system coordinates the internal organs of the body by the sympathetic and parasympathetic nervous systems. The other options are associated with the cerebral cortex, whose function consists of determining intelligence, personality, and motor function. REF: p. 544
• A serous membrane that lines the abdominal cavity and forms a protective cover for many abdominal structures is the
c. linea alba.
The peritoneum is a serous membrane that lines the abdominal cavity and serves as a protective cover.
REF: p. 370
• What part of the small intestine forms a C-shaped curve around the head of the pancreas?
d. Falciform ligament
The C-shaped curve around the head of the pancreas is the duodenum, the first 12 inches of the small intestine.
REF: p. 372
• Peristalsis of intestinal contents is under the control of
a. cognitive processes.
c. the autonomic nervous system.
d. the fluid content of the stomach.
The movement of food and digestive products is regulated by the autonomic nervous system.
REF: p. 372
• The esophagus travels a route from
a. anterior to the trachea through the mediastinal cavity.
b. lateral to the trachea through the diaphragm.
c. left of the trachea through the peritoneum.
d. the anterior trachea through the cardiac orifice.
e. behind the trachea through the mediastinal cavity.
The esophagus lies posteriorly to the trachea, descends through the mediastinal cavity and through the diaphragm, and enters into the stomach. The esophagus connects the pharynx to the stomach.
REF: p. 372
• Which organ is part of the alimentary tract?
The term alimentary tract refers to the continuous tract from the mouth, esophagus, stomach, small intestine, large intestine, and anus.
REF: p. 372
NURS6501 Week 4 Assignment - Walden University - Advanced Pathophysiology
NURS6501 Week 4 Assignment - Walden University - Advanced Pathophysiology
Week 4 assignment
Assignment: Disorders of the Veins and Arteries
Advanced practice nurses often treat patients with vein and artery disorders such as chronic venous insufficiency (CVI) and deep venous thrombosis (DVT). While the symptoms of both disorders are noticeable, these symptoms are sometimes mistaken for signs of other conditions, making the disorders difficult to diagnose. Nurses must examine all symptoms and rule out other potential disorders before diagnosing and prescribing treatment for patients. In this Assignment, you explore the epidemiology, pathophysiology, and clinical presentation of CVI and DVT.
Review the section “Diseases of the Veins” (pp. 598-599) in Chapter 23 of the Huether and McCance text. Identify the pathophysiology of chronic venous insufficiency and deep venous thrombosis. Consider the similarities and differences between these disorders.
Select a patient factor different from the one you selected in this week’s Discussion: genetics, gender, ethnicity, age, or behavior. Think about how the factor you selected might impact the pathophysiology of CVI and DVT. Reflect on how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected.
Review the “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2 Learning Resources. Use the examples in the media as a guide to construct two mind maps—one for chronic venous insufficiency and one for venous thrombosis. Consider the epidemiology and clinical presentation of both chronic venous insufficiency and deep venous thrombosis.
Write a 2- to 3-page paper that addresses the following:
Compare the pathophysiology of chronic venous insufficiency and deep venous thrombosis. Describe how venous thrombosis is different from arterial thrombosis.
Explain how the patient factor you selected might impact the pathophysiology of CVI and DVT. Describe how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected.
Construct two mind maps—one for chronic venous insufficiency and one for deep venous thrombosis. Include the epidemiology, pathophysiology, and clinical presentation, as well as the diagnosis and treatment you explained in your paper.
By Day 7
The Assignment is due.
Note: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at
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NURS6501 Week 4 Assignment - Walden University - Advanced Pathophysiology Week 4 assignment Assignment: Disorders of the Veins and Arteries Advanced practice nurses often treat patients with vein and artery disorders such as chronic venous insufficiency (CVI) and deep venous thrombosis (DVT). While the symptoms of both disorders are noticeable, these symptoms are sometimes mistaken for signs of other conditions, making the disorders difficult to diagnose. Nurses must examine all symptoms and rule out other potential disorders before diagnosing and prescribing treatment for patients. In this Assignment, you explore the epidemiology, pathophysiology, and clinical presentation of CVI and DVT. To Prepare Review the section “Diseases of the Veins” (pp. 598-599) in Chapter 23 of the Huether and McCance text. Identify the pathophysiology of chronic venous insufficiency and deep venous thrombosis. Consider the similarities and differences between these disorders. Select a patient factor different from the one you selected in this week’s Discussion: genetics, gender, ethnicity, age, or behavior. Think about how the factor you selected might impact the pathophysiology of CVI and DVT. Reflect on how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected. Review the “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2 Learning Resources. Use the examples in the media as a guide to construct two mind maps—one for chronic venous insufficiency and one for venous thrombosis. Consider the epidemiology and clinical presentation of both chronic venous insufficiency and deep venous thrombosis. To Complete Write a 2- to 3-page paper that addresses the following: Compare the pathophysiology of chronic venous insufficiency and deep venous thrombosis. Describe how venous thrombosis is different from arterial thrombosis. Explain how the patient factor you selected might impact the pathophysiology of CVI and DVT. Describe how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected. Construct two mind maps—one for chronic venous insufficiency and one for deep venous thrombosis. Include the epidemiology, pathophysiology, and clinical presentation, as well as the diagnosis and treatment you explained in your paper. By Day 7 The Assignment is due. Note: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at
NSG 6020 Midterm Exam Latest Already Graded A Health Assessment South University
NSG 6020 Midterm Exam Latest Already Graded A Health Assessment South University
are no mentioned structural or biochemical abnormalities, irritable bowel syndrome seems most likely. This is a very common condition which can be triggered by certain foods and stress.14.Jim is a 60-year-old man who presents with vomiting. He denies seeing any blood with emesis, which has been occurring for 2 days. He does note a dark, granular substance resembling the coffee left in the filter after brewing. What do you suspect?A)Bleeding from a diverticulumB)Bleeding from a peptic ulcerC)Bleeding from a colon cancerD)Bleeding from cholecystitisAns:BFeedback:When blood is exposed to the environment of the stomach, it often resembles “coffee grounds.” This is not always recognized by patients as blood, so it is important to inquire about this. This symptom is not common in cholecystitis, and the other possibilities occur lower in the intestine. It should be noted that conversely, rapid bleeding from the stomach or other upper gastrointestinal source can produce bright red blood in the stool. Do not rule out proximal bleeding on the basis of the absence of “coffee grounds.” Likewise, bright red blood seen with emesis may originate from the stomach. Black, sticky stools also can accompany upper GI bleeding.15.A daycare worker presents to your office with jaundice. She denies IV drug use, blood transfusion, and travel and has not been sexually active for the past 10 months. Which type of hepatitis is most likely?A)Hepatitis AB)Hepatitis BC)Hepatitis CD)Hepatitis DAns:AFeedback:The lack of contact with blood and body fluids makes hepatitis B, C, and D unlikely. She regularly changes the diapers of her clients and is at risk for hepatitis A. Vaccine against hepatitis A is recommended for daycare workers.16.Linda is a 29-year-old who had excruciating pain which started under her lower ribs on the right side. The pain eventually moved to her lateral abdomen and then into her right lower quadrant. Which is most likely, given this presentation?A)AppendicitisB)DysmenorrheaC)Ureteral stoneD)Ovarian cystAns:CFeedback:The presentation of right flank pain spiraling down to the groin is typical of a ureteral stone. There would most likely be microscopic hematuria as well. The migration pattern of this condition makes the others less likely.17.Mrs. LaFarge is a 60-year-old who presents with urinary incontinence. She is unable to get to the bathroom quickly enough when she senses the need to urinate. She has normal mobility. Which of the following is most likely?A)Stress incontinenceB)Urge incontinenceC)Overflow incontinenceD)Functional incontinenceAns:BFeedback:Stress incontinence occurs with increased intra-abdominal pressure such as with coughing, sneezing, or laughing. This history is most consistent with urge incontinence secondary to detrusor overactivity. Overflow incontinence occurs with anatomic obstruction such as prostatic hypertrophy (obviously not in this case, as the patient is a woman), urethral stricture, or neurogenic bladder. Functional incontinence results from lack of mobility severe enough to impair getting to the bathroom quickly enough.18.Which is the proper sequence of examination for the abdomen?A)Auscultation, inspection, palpation, percussionB)Inspection, percussion, palpation, auscultationC)Inspection, auscultation, percussion, palpationD)Auscultation, percussion, inspection, palpationAns:CFeedback:The abdominal examination is conducted in a sequence different from other systems, for which the usual order is inspection, percussion, palpation, and auscultation. Because palpation may actually cause some bowel noise when the bowels are not moving, auscultation is performed before percussion and palpation in an abdominal examination.19.A 62-year-old woman has been followed by you for 3 years and has had recent onset of hypertension. She is still not at goal despite three antihypertensive medicines, and you strongly doubt nonadherence. Her father died of a heart attack at age 58. Today her pressure is 168/94 and pressure on the other arm is similar. What would you do next?A)Add a fourth medicineB)Refer to nephrologyC)Get a CT scanD)Listen closely to her abdomenAns:DFeedback:At this point, it is important to consider secondary causes for this woman's hypertension because of its severity, rapidity of progression, and lack of response to therapy. While you will most likely add a fourth medicine, it is important to carefully examine the abdomen for the presence of renal artery bruits. These are usually heard best in the upper quadrants. It may be necessary to have the patient hold her breath, to have a very quiet room, and to listen with the diaphragm for a very soft, high- pitched sound with systole. It may also help to simultaneously feel the patient's pulse (a bruit with both a systolic and diastolic component is very specific for a significant blockage, while a lone systolic bruit may not be abnormal). Obtaining a CT scan is not likely to be useful, and you may save the delay, expense, and inconvenience of a nephrology referral if you can hear a bruit.20.Mr. Patel is a 64-year-old man who was told by another care provider that his liver is enlarged. Although he is a life-long smoker, he has never used drugs or alcohol and has no knowledge of liver disease. Indeed, on examination, a liver edge is palpable 4 centimeters below the costal arch. Which of the following would you do next?A)Check an ultrasound of the liverB)Obtain a hepatitis panelC)Determine liver span by percussionD)Adopt a “watchful waiting” approachAns:CFeedback:A liver edge palpable this far below the costal arch should not be ignored. Ultrasound and laboratory investigation are reasonable if the liver is actually enlarged. Mr. Patel has developed emphysema with flattening of the diaphragms. This pushes a normal- sized liver below the costal arch so that it appears to be enlarged. A liver span should be determined by percussing down the chest wall until dullness is heard. A measurement is then made between this point and the lower border of the liver to determine its span; 6–12 centimeters in the mid-clavicular line is normal. Percussion is the only way to assess liver size on examination, and in this case it saved the patient much inconvenience and expense.21.Cody is a teenager with a history of leukemia and an enlarged spleen. Today he presents with fairly significant left upper quadrant pain. On examination of this area a rough grating noise is heard. What is this sound?A)It is a splenic rub.B)It is a variant of bowel noise.C)It represents borborygmi.D)It is a vascular noise.Ans:AFeedback:A rough, grating noise over this area represents a splenic rub, which can accompany splenic infarction. Rubs also occur over the liver and pleura and pericardium.22.You are palpating the abdomen and feel a small mass. Which of the following would you do next?A)UltrasoundB)Examination with the abdominal muscles tensedC)Surgery referralD)Determine size by percussionAns:BFeedback:It is easy to determine whether the mass is actually in the abdominal wall versus in the abdomen by palpating with the abdominal wall tensed. This can be accomplished by having the patient lift her head off the bed while supine. Usually, abdominal wall masses can be observed, whereas intra-abdominal masses are more concerning.23.Josh is a 14-year-old boy who presents with a sore throat. On examination, you notice dullness in the last intercostal space in the anterior axillary line on his left side with a deep breath. What does this indicate?A)His spleen is definitely enlarged and further workup is warranted.B)His spleen is possibly enlarged and close attention should be paid to further examination.C)His spleen is possibly enlarged and further workup is warranted.D)His spleen is definitely normal.Ans:BFeedback:This scenario is not uncommon in infectious mononucleosis. The presence of dullness with inspiration should definitely increase your attention to further examination of the spleen, although dullness can occur in normal patients too.24.A young patient presents with a left-sided mass in her abdomen. You confirm that it is present in the left upper quadrant. Which of the following would support that this represents an enlarged kidney rather than her spleen?A)A palpable “notch” along its edgeB)The inability to push your fingers between the mass and the costal marginC)The presence of normal tympany over this areaD)The ability to push your fingers medial and deep to the massAns:CFeedback:A left upper quadrant mass is more likely to be a kidney if there is no palpable “notch,” you can push your fingers between the mass and the costal margin, there is normal tympany over this area, and you cannot push your fingers medial and deep to the mass. These findings are very difficult to appreciate in an obese patient.25.Mr. Kruger is an 84-year-old who presents with a smooth lower abdominal mass in the midline which is minimally tender. There is dullness to percussion up to 6 centimeters above the symphysis pubis. What does this most likely represent?A)Sigmoid massB)Tumor in the abdominal wallC)HerniaD)Enlarged bladderAns:DFeedback:It is possible that this represents a sigmoid colon mass, but this is less likely than an enlarged bladder. Prostatic hypertrophy is very common in this age group and can frequently cause partial urinary obstruction with bladder enlargement. If the mass resolves with catheterization, this is a likely cause. Other forms of urinary obstruction such as neurogenic bladder, urethral stricture, and side effects of drugs can also be contributing to the problem. A hernia would most likely not be dull to percussion. Midline abdominal wall tumors of this size would be unusual but could be discerned by having the patient tense his abdominal muscles.26.Mr. Martin is a 72-year-old smoker who comes to you for his hypertension visit. You note that with deep palpation you feel a pulsatile mass which is about 4 centimeters in diameter. What should you do next?A)Obtain abdominal ultrasoundB)Reassess by examination in 6 monthsC)Reassess by examination in 3 monthsD)Refer to a vascular surgeonAns:AFeedback:A pulsatile mass in this man should be followed up with ultrasound as soon as possible. His risk of aortic rupture is at least 15 times greater if his aorta measures more than 4 centimeters. It would be inappropriate to recheck him at a later time without taking action. Likewise, referral to a vascular surgeon before ultrasound may be premature.27.Mr. Maxwell has noticed that he is gaining weight and has increasing girth. Which of the following would argue for the presence of ascites?A)Bilateral flank tympanyB)Dullness which remains despite change in positionC)Dullness centrally when the patient is supineD)Tympany which changes location with patient positionAns:DFeedback:A diagnosis of ascites is supported by findings that are consistent with movement of fluid and gas with changes in position. Gas-filled loops of bowel tend to float so that dullness when supine would argue against this. Likewise, because fluid gathers in dependent areas, the flanks should ordinarily be dull with ascites. Tympany which changes location with patient position (“shifting dullness”) would support the presence of ascites. A fluid wave and edema would support this diagnosis as well.28.Which of the following is consistent with obturator sign?A)Pain distant from the site used to check rebound tendernessB)Right hypogastric pain with the right hip and knee flexed and the hip internally rotatedC)Pain with extension of the right thigh while the patient is on her left side or while pressing her knee against your hand with thigh flexionD)Pain that stops inhalation in the right upper quadrantAns:BFeedback:Obturator sign is seen in appendicitis. It is pain with the stretching of the internal obturator muscle because of inflammation. Pain distant from the site used to check rebound tenderness is Rovsing's sign and is a reliable sign of peritonitis. Answer “C” describes psoas sign, which is also seen in appendicitis. Palpation in the right upper quadrant that causes pain severe enough to stop inhalation is consistent with inflammation of the gallbladder and is called Murphy's sign.29.An elderly woman with a history of coronary bypass comes in with severe, diffuse, abdominal pain. Strangely, during your examination, the pain is not made worse by pressing on the abdomen. What do you suspect?A)MalingeringB)NeuropathyC)IschemiaD)Physical abuseAns:CFeedback:Ischemic pain can be severe but is not made worse with palpation. The history of bypass could be a clue that there is vascular narrowing elsewhere. Malingering is less likely, and neuropathic pain, as seen in herpes zoster, would worsen with touch. You are to be commended if you considered elder abuse, because this is frequently missed. Ordinarily, this pain would be worse with examination because of the preceding trauma.1.A 57-year-old maintenance worker comes to your office for evaluation of pain in his legs. He has smoked two packs per day since the age of 16, but he is otherwise healthy. You are concerned that he may have peripheral vascular disease. Which of the following is part of common or concerning symptoms for the peripheral vascular system?A)Intermittent claudicationB)Chest pressure with exertionC)Shortness of breathD)Knee painAns:AFeedback:Intermittent claudication is leg pain that occurs with walking and is relieved by rest. It is a key symptom of peripheral vascular disease. This symptom is present in only about one third of patients with significant arterial disease and, if found, calls for more aggressive management of cardiovascular risk factors. Screening with ankle brachial index can help detect this problem.2.A 72-year-old teacher comes to your clinic for an annual examination. She is concerned about her risk for peripheral vascular disease and states that there is a place in town that does tests to let her know her if she has this or not. Which of the following disease processes is a risk factor for peripheral vascular disease?A)Gastroesophageal reflux diseaseB)Coronary artery diseaseC)Migraine headachesD)OsteoarthritisAns:BFeedback:Evidence of coronary artery disease implies that there is most likely disease in other vessels; therefore, this is a risk factor for peripheral vascular disease. Conversely, the presence of peripheral vascular disease is also a risk factor for coronary artery disease, and if present, it should be considered in reduction of cardiac risk factors.3.A 68-year-old retired truck driver comes to your office for evaluation of swelling in his legs. He is a smoker and has been taking medications to control his hypertension for the past 25 years. You are concerned about his risk for peripheral vascular disease. Which of the following tests are appropriate to order to initially evaluate for this condition?A)VenogramB)CT scan of the lower legsC)Ankle–brachial index (ABI)D)PET scanAns:CFeedback:The ankle–brachial index is a good test for obtaining information about significant stenosis in the vessels of the lower extremities. Sixteen percent of patients with known peripheral vascular disease also have coronary artery disease.4.A 55-year-old secretary with a recent history of breast cancer, for which she underwent surgery and radiation therapy, and a history of hypertension comes to your office for a routine checkup. Which of the following aspects of the physical are important to note when assessing the patient for peripheral vascular disease in the arms?A)Femoral pulse, popliteal pulseB)Dorsalis pedis pulse, posterior tibial pulseC)Carotid pulseD)Radial pulse, brachial pulseAns:DFeedback:This is an important aspect of physical examination to assess for peripheral vascular disease. This patient is at risk for disease in this distribution because of her recent radiation therapy.5.You are a student in the vascular surgery clinic. You are asked to perform a physical examination on a patient with known peripheral vascular disease in the legs. Which of the following aspects is important to note when you perform your examination?A)Size, symmetry, and skin colorB)Muscle bulk and toneC)Nodules in jointsD)Lower extremity strengthAns:AFeedback:This is an important aspect to note in physical examination. Swelling in the legs, cyanosis, and lack of appropriate hair growth are all signs of peripheral vascular disease.6.You are assessing a patient for peripheral vascular disease in the arms, secondary to a complaint of increased weakness and a history of coronary artery disease and diabetes. You assess the brachial and radial pulses and note that they are bounding. What does that translate to on a scale of 0 to 3?A)0B)3 C)2 D)1 Ans:BFeedback:A pulse of 3 is considered to be bounding.7.You are obtaining an arterial blood gas in the radial artery on a retired cab driver who has been hospitalized in the intensive care unit for a stroke. You are concerned about the possibility of arterial insufficiency. You perform the Allen test. This means that you:A)Checked for patency of the radial arteryB)Checked for patency of the brachial arteryC)Checked for patency of the ulnar arteryD)Checked for patency of the femoral arteryAns:CFeedback:The Allen test is for determining patency of the ulnar artery before puncturing the radial artery. In the event of an occlusion in the radial artery system, the ulnar artery can provide adequate blood flow.8.You are assessing a 59-year-old gas station owner for atherosclerosis in the lower extremities. In which of the following locations would the patient's pain make you concerned for this disease process?A)ThighB)KneeC)CalfD)AnkleAns:CFeedback:Pain in the calf is the most common site for claudication; however, there could be pain in the buttock, hip, thigh, or foot, depending on the level of the obstruction. The absence of this pain does not rule out significant vascular disease, and actually the minority of these patients are symptomatic.9.You are performing a routine check-up on an 81-year-old retired cotton farmer in the vascular surgery clinic. You note that he has a history of chronic arterial insufficiency. Which of the following physical examination findings in the lower extremities would be expected with this disease?A)Normal pulsationB)Normal temperatureC)Marked edemaD)Thin, shiny, atrophic skinAns:DFeedback:Thin, shiny, atrophic skin is more commonly seen in chronic arterial insufficiency; in chronic venous insufficiency the skin often has a brown pigmentation and may be thickened.10.A 77-year-old retired nurse has an ulcer on a lower extremity that you are asked to evaluate when you do your weekly rounds at a local long-term care facility. All of the following are responsible for causing ulcers in the lower extremities except for which condition?A)Arterial insufficiencyB)Venous insufficiencyC)Diminished sensation in pressure pointsD)HypertensionAns:DFeedback:Hypertension is not directly associated with the formation of ulcers. It is an indirect risk factor if it is uncontrolled for a long time and associated with atherosclerosis, because it can lead to arterial insufficiency or neuropathy.11.As the internal diameter of a blood vessel changes, the resistance changes as well. Which of the following descriptions depicts this relationship?A)Resistance varies linearly with the diameter.B)Resistance varies proportionally to the second power of the diameter.C)Resistance varies proportionally to the third power of the diameter.D)Resistance varies proportionally to the fourth power of the diameter.Ans:DFeedback:The body is able to make significant changes in blood vessel resistance with very small changes to diameter. LaPlace's law tells us that the resistance varies proportionally to the fourth power of the diameter.12.Which area of the arm drains to the epitrochlear nodes?A)Ulnar surface of the forearm and hand, little and ring fingers, and ulnar middle fingerB)Radial surface of the forearm and hand, thumb and index fingers, and radial middle fingerC)Ulnar surface of the forearm and hand; second, third, and fourth fingersD)Radial surface of the forearm and hand; second, third, and fourth fingersAns:AFeedback:The epitrochlear node receives lymphatic drainage from the ulnar surface of the forearm and hand, little and ring fingers, and ulnar middle finger. More importantly, it is generally a sign of generalized lymphadenopathy as seen in syphilis and HIV infection.13.Mr. Edwards complains of cramps and difficulties with walking. The cramps occur in his calves consistently after walking about 100 yards. After a period of rest, he can start to walk again, but after 100 yards these same symptoms recur. Which of the following would suggest spinal stenosis as a cause of this pain?A)Coldness and pallor of the legsB)Relief of the pain with bending at the waistC)Color changes of the skinD)Swelling with tenderness of the skinAns:BFeedback:While these symptoms are classic for claudication, they may also be accounted for by spinal stenosis. Relief with bending at the waist would be consistent with this etiology. Some will state that they must lean over the shopping cart while shopping to avoid these symptoms. Bending stretches the spinal cord and presumably decreases compression. The other symptoms would lead one to suspect a vascular etiology.14.Which of the following pairs of ischemic symptoms versus vascular supply is correct?A)Lower calf/superficial femoralB)Erectile dysfunction/iliac or pudendalC)Buttock/common femoralD)Upper calf/tibial or peronealAns:BFeedback:The ischemia from the iliac or pudendal arteries results in erectile dysfunction. The lower calf is supplied by the popliteal artery, the buttock is supplied by the common femoral artery, and the upper calf is supplied by the superficial femoral artery.15.The ankle–brachial index (ABI) is calculated by dividing the systolic BP at the dorsalis pedis by the systolic BP at the brachial artery. Which of the following values would be consistent with mild peripheral arterial disease?A)1.1B)0.85C)0.65D)0.35Ans:BFeedback:The mild disease is represented by an ABI of 0.71 to 0.9. Any value above 0.9 is normal. Moderate disease is defined as between 0.7 and 0.41, and severe disease is defined as 0.4 or less. Patients in the “severe” category have a 20% to 25% annual risk of death.16.Asymmetric BPs are seen in which of the following conditions?A)Coronary artery diseaseB)Congenital narrowing of the aortaC)Diffuse atherosclerosisD)Vasculitis, as seen in systemic lupus erythematosusAns:BFeedback:A difference of as little as 10 mm Hg in the systolic blood pressure may be significant. Coarctation and dissecting aortic aneurysm are causes of asymmetric blood pressures. Coarctation represents a congenital narrowing of the aorta. While some forms of vasculitis can affect large vessels where we measure the blood pressure, lupus is generally a small-vessel vasculitis. Usually, neither diffuse atherosclerosis nor coronary artery disease is responsible for a focal difference in blood pressure.17.Diminished radial pulses may be seen in patients with which of the following?A)Aortic insufficiencyB)HyperthyroidismC)Arterial emboliD)Early “warm” septic shockAns:CFeedback:Arterial emboli would decrease flow to a region, and therefore pulses would decrease as well. The other conditions actually cause bounding pulses. Aortic insufficiency can cause significant leakage of blood back to the heart, so the heart compensates by increasing forward flow. Stroke volume can increase dramatically with hyperthyroidism, especially in “thyroid storm.” This also results in bounding pulses. Although shock generally causes decreased blood pressure and pulses, early septic shock can produce increased peripheral circulation and increase pulses.18.When assessing temperature of the skin, which portion of your hand should be used?A)FingertipsB)PalmsC)Backs of fingersD)Ulnar aspect of the handAns:CFeedback:The backs of the fingers are thought to be the most temperature sensitive, perhaps because the skin is thinnest there. You may have difficulty detecting subtle differences if you do not use the backs of the fingers.19.A patient presents with claudication symptoms and diminished pulses. Which of the following is consistent with chronic arterial insufficiency?A)Pallor of the foot when raised to 60 degrees for one minuteB)Return of color to the skin within 5 seconds of allowing legs to dangleC)Filling of the veins of the ankles within 10 seconds of allowing the legs to dangleD)Hyperpigmentation of the skinAns:AFeedback:Pallor of the soles after one minute of elevation is a reliable sign of arterial insufficiency. Return of the color to the skin should occur within 10 seconds of dangling, and the filling of veins should occur within 15 seconds. Hyperpigmentation of the skin is usually seen in venous insufficiency.20.You note a painful ulcerative lesion near the medial malleolus, with accompanying hyperpigmentation. Which of the following etiologies is most likely?A)Arterial insufficiencyB)Neuropathic ulcerC)Venous insufficiencyD)TraumaAns:CFeedback:These features are most consistent with venous insufficiency. You may also see scaling, redness, varicosities, and other findings. Arterial insufficiency usually affects distal or traumatized areas. Other clues of arterial insufficiency would most likely be present. Neuropathic ulcers occur because of decreased sensation and are common in patients with neuropathy. They are often over bony prominences with surrounding calluses.1.A 28-year-old musician comes to your clinic, complaining of a “spot” on his penis. He states his partner noticed it 2 days ago and it hasn't gone away. He says it doesn't hurt. He has had no burning with urination and no pain during intercourse. He has had several partners in the last year and uses condoms occasionally. His past medical history consists of nongonococcal urethritis from Chlamydia and prostatitis. He denies any surgeries. He smokes two packs of cigarettes a day, drinks a case of beer a week, and smokes marijuana and occasionally crack. He has injected IV drugs before but not in the last few years. He is single and currently unemployed. His mother has rheumatoid arthritis and he doesn't know anything about his father. On examination you see a young man appearing deconditioned but pleasant. His vital signs are unremarkable. On visualization of his penis there is a 6-mm red, oval ulcer with an indurated base just proximal to the corona. There is no prepuce because of neonatal circumcision. On palpation the ulcer is nontender. In the inguinal region there is nontender lymphadenopathy.What disorder of the penis is most likely the diagnosis?A)Condylomata acuminataB)Genital herpesC)Syphilitic chancreD)Penile carcinomaAns:CFeedback:Primary syphilis causes a larger ulcer that is firm and painless. Syphilis is fairly uncommon but does occur in the highly promiscuous population, especially when coupled with illegal drug use. You should consider further questions and workup regarding HIV status.2.A 20-year-old part-time college student comes to your clinic, complaining of growths on his penile shaft. They have been there for about 6 weeks and haven't gone away. In fact, he thinks there may be more now. He denies any pain with intercourse or urination. He has had three former partners and has been with his current girlfriend for 6 months. He says that because she is on the pill they don't use condoms. He denies any fever, weight loss, or night sweats. His past medical history is unremarkable. In addition to college, he works part-time for his father in construction. He is engaged to be married and has no children. His father is healthy and his mother has hypothyroidism. On examination the young man appears healthy. His vital signs are unremarkable. On visualization of his penis you see several moist papules along all sides of his penile shaft and even two on the corona. He has been circumcised. On palpation of his inguinal region there is no inguinal lymphadenopathy.Which abnormality of the penis does this patient most likely have?A)Condylomata acuminataB)Genital herpesC)Syphilitic chancreD)Penile
Blood Vessels Study Guide PDF
PDF study guide on blood vessels. (Check out my free notes on blood vessels and blood, too!) Includes vocabulary, labeled diagrams, and if appropriate, microscope slides. Can be used for lecture exams and laboratory practicals. Based off of McKinley, O\'Laughlin, and Bidle\'s 3e text for A&P I-II.
MN551 Unit 5 Midterm Exam/ MN 551 Unit 5 Midterm Exam / MN551 Week 5 Midterm Exam/ MN 551 Week 5 Midterm Exam (5 Latest Versions): Kaplan University (Already graded A)
MN551 Unit 5 Midterm Exam/ MN 551 Unit 5 Midterm Exam / MN551 Week 5 Midterm Exam/ MN 551 Week 5 Midterm Exam (Latest): Kaplan University
Question 1.1. A student nurse practitioner asks her preceptor about the origins of different tissues, and their cellular origins during the process of development. Which of the following statements by the preceptor best describes the process of cell differentiation? (Points : 3)
“Cells of the hematopoietic system produce the appropriate body cells that are required at each stage of development.”
“A single stem cell differentiates into approximately 200 different types of cells.”
“A fertilized ovum undergoes a series of divisions, yielding many different cell types.”
“Cells differentiate into necessary body cells, peaking after conception, and ceasing near the time of birth.”
Question 2.2. A 77-year-old male patient with a diagnosis of stomach cancer has been found to have metastases in his liver. The patient and his family are surprised at this turn of events, stating that they don\'t see how he could have developed cancer in his liver. Which of the following facts would underlie the reply that the care team provides? (Points : 3)
The parenchymal tissue of the liver is particularly susceptible to secondary malignancies.
The portal circulatory system brings venous blood from the gastrointestinal tract into the liver.
Hepatic stromal tissue shares characteristics with cancerous cells, including lack of anchorage dependence.
The proximity of the liver to the stomach allows for direct spread of cancerous cells due to a lack of contact inhibition.
Question 3.3. The NP is teaching a group of older adults about the value of including foods containing antioxidants in their diet. Which of the following statements best captures the rationale underlying the NPs advice?(Points : 3)
Antioxidants inhibit the actions of reactive oxygen species (ROS).
Antioxidants prevent the formation of superoxide dismutase.
Antioxidants react nonspecifically with molecules.
Antioxidants prevent the occurrence of cell dysplasia.
Question 4.4. The nurse practitioner is providing care for a patient with a diagnosis of cirrhosis, and he notes that the patient\'s sclerae are jaundiced. The nurse practitioner recalls that jaundice is caused by excess accumulation of bilirubin, a pigment that can accumulate in which part of the cell? (Points : 3)
Rough endoplasmic reticulum (ER)
Question 5.5. Which of the following patients of a primary care nurse practitioner would not require extra screening for cancer? (Points : 3)
A 51-year-old woman whose grandmother died of breast cancer
A 48-year-old man who takes immunosuppressant drugs following a kidney transplant
A 50-year-old male who is obese and has a low-fiber, high-fat diet
A 38-year-old female with Down syndrome and congenital scoliosis
Question 6.6. A new older female patient at a long-term care facility has a diagnosis of type 1 neurofibromatosis (NF-1). As part of the intake assessment protocol for the facility, the clinical educator is teaching the care staff about the diagnosis. Which of the following statements most accurately conveys an aspect of neurofibromatosis? (Points : 3)
“The neurofibroma lesions are unsightly for the patient, but they are not painful.
“Her diagnosis puts her at higher risk of developing a malignant neoplasm.”
“She is living with an example of an autosomal recessive disorder.”
“The patient is likely to be photosensitive as a result of the disease.”
Question 7.7. A child possesses a trait that is the result of the interaction of two different genes, neither of which could have produced the trait independently. Which of the following explanations best captures the genetic explanation for this? (Points : 3)
The trait is an expression of multiple alleles.
Epistasis has dictated the phenotypic outcome.
The phenomenon is an example of polygenic inheritance.
The outcome is the result of the interaction between collaborative genes.
Question 8.8. Which of the following statements most accurately conveys an aspect of cell injury due to impaired calcium homeostasis? (Points : 3)
Normal intracellular calcium ion levels are higher than extracellular levels.
Ischemia and certain toxins cause a decrease in cytosolic calcium.
Injured cells tend to accumulate calcium.
Low calcium levels cause an activation of damaging enzymes.
Question 9.9. A group of researchers has identified that the prevalence of two particular genetic disorders share a statistical correlation. Which of the following statements best conveys the genetic rationale for this situation? (Points : 3)
There is likely a cause-and-effect relationship between the two genes responsible.
The chromosomes containing each gene are likely closely situated.
The genes causing each disorder are likely in the same section of the same chromosome.
The disorders likely share the same locus.
Question 10.10. A male patient of a nurse practitioner has an autosomal dominant disorder. The patient and his partner are considering starting a family. Which of the patient\'s following statements indicates the patient has an adequate understanding of the genetic basis of this health problem? (Points : 3)
“I know there\'s no way of accurately determining the chance that my child will inherit the disease.”
“My children who don\'t have the disease still run the risk of passing it on to their children.”
“I know that new genetic mutations won\'t occur between generations.”
“I know that a single mutant allele is to blame for the health problem.”
Question 11.11. As part of an orientation to a genetic counseling practice, a group of medical students is differentiating between autosomal recessive disorders and autosomal dominant disorders. Which of the following statements is true of autosomal recessive disorders? (Points : 3)
They can manifest when present in one or both gene pairs.
There is a one in two chance of an affected child in each pregnancy with an affected mother.
They tend to have a more uniform symptomatology than autosomal dominant disorders.
The associated disorders are usually attributable to abnormalities in structural proteins.
Question 12.12. The nurse practitioner working in occupational health has been asked to speak to a group of factory workers about the importance of wearing gloves when working with strong chemicals such as turpentine and paint thinner. Which of the following characteristics of cell membranes underlies the nurse\'s teaching? (Points : 3)
Cell membranes are impermeable to all but lipid-soluble substances.
Cell membranes have lipids that have a hydrophilic head and a hydrophobic tail.
Cell membranes contain receptors for hormones and biologically active substances.
Transmembrane proteins can pass through the cell membrane into the intracellular environment.
Question 13.13. The NP is providing care for a 21-year-old female patient with gas gangrene of a compound fracture in her arm. Which of the following assessment findings would the nurse most reasonably expect to find when caring for a patient with a diagnosis of gas gangrene? (Points : 3)
Inflammation of the affected tissue
A positive culture for Staphylococcus
Impaired alveolar gas exchange
Question 14.14. A community health nurse practitioner is teaching a group of female high school students about the importance of regular Papanicolaou (Pap) smears. The nurse recognizes that which of the following items underlies the rationale for this teaching? (Points : 3)
The active substitution of normal cells in the cervix correlates to cancer risk.
Undifferentiated stem cells are an early indicator of cervical cancer.
Cancer of the uterine cervix develops incrementally at a cellular level.
Dysplasia in the connective tissue of the cervix is a strong precursor to cancer.
Question 15.15. Which target of both chemotherapy and radiation treatment accounts for adverse as well as therapeutic effects? (Points : 3)
Circulating hormone levels
Rapidly proliferating cells
Question 16.16. A patient who has a diagnosis of lung cancer is scheduled to begin radiation treatment. The NP providing pretreatment education is explaining some of the potential unwanted effects of the treatment. Which of the following statements by the nurse is most accurate? (Points : 3)
“Some patients experience longer-term irritation of skin adjacent to the treatment site.”
“Sometimes you might find that your blood takes longer to clot than normal.”
“The changes that you might see are normally irreversible.”
“The unwanted effects will be limited to the exposed portions of your skin.”
Question 17.17. The family of a 68-year-old man who is in the end stages of small cell lung cancer is distraught at his visible body wasting that has worsened in recent weeks. Which of the following phenomena best accounts for the patient\'s anorexia and cachexia? (Points : 3)
Inadequate cellular metabolism of glucose results from tumor factors
High fat losses coupled with preservation of muscle mass exaggerate the appearance of wasting
Products of the tumor itself as well as a hypermetabolic state cause cachexia
Inadequate food intake due to symptoms and treatment results in loss of both muscle and fat
Question 18.18. The nurse practitioner is seeing a client who has an acute exacerbation of Crohn’s disease. The NP recognizes the fact that the disease involves the inflammation and irritation of the intestinal lining. Which of the following types of tissue is most likely involved in the patient\'s pathology? (Points : 3)
Simple columnar epithelium
Simple cuboidal epthelium
Question 19.19. Which of the following pregnant women has most likely encountered the greatest increase in the risk that her child will have a fetal anomaly? (Points : 3)
A woman with diagnoses of syphilis and cirrhosis of the liver
A woman who has herpes simplex and recently recovered from endocarditis
A woman with chronic obstructive pulmonary syndrome and tuberculosis
A woman with diagnoses of insulin-dependent diabetes mellitus and peripheral neuropathy
Question 20.20. A nurse practitioner employed in the emergency department admits a patient who has experienced severe frostbite to his hands and toes after becoming lost on a ski trail. The NP recognizes that which of the following phenomena has caused the tissue damage? (Points : 3)
Decreased blood viscosity has resulted in interstitial bleeding.
Reactive vasodilation has compromised perfusion.
Autonomic nervous stimulation has resulted in injury.
Decreased blood flow has induced hypoxia.
Question 21.21. A nurse practitioner employed in a hospitalist notices that a patient is experiencing muscle atrophy following 2 weeks in traction after a motor vehicle accident. Which of the following factors has most likely contributed to the atrophy of the patient\'s muscle cells? (Points : 3)
High levels of insulin and IGF-1 in the patient\'s blood during immobilization
Denervation of the affected muscles during the time of traction
A reduction of skeletal muscle use secondary to the traction treatment
Reduced oxygen consumption and cellular function that ensures muscle cell survival
Question 22.22. An infant who is four days postpartum has been diagnosed with a single-gene disorder. The parents of the child have a number of questions about the etiology of the health problem, which the physician is attempting to address in detail. Which of the following teaching points most accurately captures an aspect of single-gene congenital disorders? (Points : 3)
Affected genes are present on autosomal chromosomes rather than sex chromosomes.
The majority of single-gene disorders manifest near the time of puberty.
A particular defect can be caused by mutations at one of several different loci.
Single-gene disorders are associated with existing rather than new mutations.
Question 23.23. A researcher is involved in the production of insulin through recombinant DNA technology. Which of the following statements could the researcher best provide as a rationale for her work? (Points : 3)
The gene fragment responsible for insulin production can be isolated and reproduced.
Particular bacteria are capable of insulin production.
It is possible to reproduce the chromosome responsible for insulin production.
Recombination of DNA base pairs can result in a gene that will produce insulin.
Question 24.24. A 6-year-old girl with a diagnosis of Marfan syndrome is being assessed at a community health clinic. Which of the following assessments would be the health care professional\'s lowest priority? (Points : 3)
A test of the child\'s visual acuity
A musculoskeletal assessment
Tests of kidney function
Question 25.25. Following a biopsy, a 54-year-old man has been diagnosed as having a benign neoplastic tumor. Which of the following characteristics most likely applies to his tumor? (Points : 3)
The tumor is poorly approximated and has the potential to break loose.
The tumor may secrete hormones or cytokines.
The well-differentiated neoplastic cells are clustered together in a single mass.
It has a rapid rate of growth and can induce ischemia.
1. A 40-year-old woman who experiences severe seasonal allergies has been referred by her family physician to an allergist for weekly allergy injections. The woman is confused as to why repeated exposure to substances that set off her allergies would ultimately benefit her. Which of the following phenomena best captures the rationale for allergy desensitization therapy? (Points : 3)
Repeated exposure to offending allergens binds the basophils and mast cells that mediate the allergic response.
Exposure to allergens in large, regular quantities overwhelms the IgE antibodies that mediate the allergic response.
Repeated exposure stimulates adrenal production of epinephrine, mitigating the allergic response.
Injections of allergens simulate production of IgG, which blocks antigens from combining with IgE.
Question 2.2. A 14-year-old boy has been diagnosed with infectious mononucleosis. Which of the following pathophysiological phenomena is most responsible for his symptoms? (Points : 3)
The Epstein-Barr virus (EBV) is lysing many of the boy\'s neutrophils.
Viruses are killing some of his B cells and becoming incorporated into the genomes of others.
The EBV inhibits the maturation of white cells within his peripheral lymph nodes.
The virus responsible for mononucleosis inhibits the maturation of myeloblasts into promyelocytes.
Question 3.3. A 66-year-old female patient has presented to the emergency department because of several months of intermittently bloody stools that has recently become worse. The woman has since been diagnosed with a gastrointestinal bleed secondary to overuse of nonsteroidal anti-inflammatory drugs that she takes for her arthritis. The health care team would realize that which of the following situations is most likely?(Points : 3)
The woman has depleted blood volume due to her ongoing blood loss.
She will have iron-deficiency anemia due to depletion of iron stores.
The patient will be at risk for cardiovascular collapse or shock.
She will have delayed reticulocyte release.
Question 4.4. Which of the following patients is most likely to benefit from transplantation of thymic tissue or major histocompatibility complex (MHC)-compatible bone marrow? (Points : 3)
A 12-year-old girl with a history of epilepsy and low IgG levels secondary to phenytoin use
A 7-year-old boy whose blood work indicates decreased IgA and IgG with increased IgM
A 6-year-old boy whose pre-B cells are incapable of translation to normal B cells
A 9-year-old girl who has a diagnosis of IgA deficiency
Question 5.5. A 29-year-old construction worker got a sliver under his fingernail four days ago. The affected finger is now reddened, painful, swollen, and warm to the touch. Which of the following hematological processes is most likely occurring in response to the infection? (Points : 3)
Proliferation of immature neutrophils
High circulatory levels of myeloblasts
Increased segmented neutrophil production
Phagocytosis by myelocytes
Question 6.6. Sputum samples from a patient with pneumonia contain an infective agent that has a peptidoglycan cell wall, expresses endotoxins, replicates readily in broth and on agar, grows in clusters, has pili, and does not stain when exposed to crystal violet. This pneumonia is most likely: (Points : 3)
Question 7.7. A child has been diagnosed with thalassemia. Which of the following other health problems is the child at risk for? (Points : 3)
Iron and ferritin deficiencies
Splenomegaly and hepatomegaly
Question 8.8. A nurse practitioner is providing prenatal care and education for a first-time expectant mother, 22 weeks\' gestation, who has a diagnosis of a sexually transmitted infection. Which of the following statements by the expectant mother demonstrates an adequate understanding of vertical disease transmission and congenital infections? (Points : 3)
“Gonorrhea and chlamydia pose the greatest risks of transmission from mother to child.”
“I know that my baby will need observation for HIV signs and symptoms in the weeks following my delivery.”
“My baby could become infected either across the placenta or during the birth itself.”
“Prophylactic immunization will reduce my baby\'s chance of being born with an illness.”
Question 9.9. As part of his diagnostic workup, a 77-year-old man\'s nurse practitioner has ordered blood work that includes ferritin levels. The man is very interested in the details of his health care and is unfamiliar with ferritin and its role. He asks his nurse practitioner to explain the significance of it and the rationale for testing it. Which of the following explanations by the nurse practitioner is most accurate?(Points : 3)
“Ferritin is the activated and usable form of iron that your red blood cells can use to transport oxygen.”
“Ferritin is a stored form of iron that indirectly shows me whether you would benefit from iron pills.”
“Ferritin is a protein-iron complex that allows your red blood cells to make use of the iron that you consume in your diet.”
“Ferritin is the form of iron that is transported in your blood plasma to the red blood cells that need it.”
Question 10.10. A 16-year-old female has been brought to her primary care nurse practitioner by her mother due to the girl\'s persistent sore throat and malaise. Which of the following facts revealed in the girl\'s history and examination would lead the nurse practitioner to rule out infectious mononucleosis? (Points : 3)
The girl has a temperature of 38.1°C (100.6°F) and has enlarged lymph nodes.
Her liver and spleen are both enlarged.
Blood work reveals an increased white blood cell count.
Chest auscultation reveals crackles in her lower lung fields bilaterally.
Question 11.11. A 30-year-old man has spent 5 hours on a cross-country flight seated next to a passenger who has been sneezing and coughing, and the man has been inhaling viral particles periodically. Which of the following situations would most likely result in the stimulation of the man\'s T lymphocytes and adaptive immune system? (Points : 3)
Presentation of a foreign antigen by a familiar immunoglobulin
Recognition of a foreign MHC molecule
Recognition of a foreign peptide bound to a self MHC molecule
Cytokine stimulation of a T lymphocyte with macrophage or dendritic cell mediation
Question 12.12. A 22-year-old female who adheres to a vegan diet has been diagnosed with iron-deficiency anemia. Which of the following components of her diagnostic blood work would be most likely to necessitate further investigation? (Points : 3)
Decreased mean corpuscular volume (MCV)
Decreased hemoglobin and hematocrit
Microcytic, hypochromic red cells
Decreased erythropoietin levels
Question 13.13. A couple who are expecting their first child have been advised by friends to consider harvesting umbilical cord blood in order to have a future source of stem cells. The couple have approached their nurse practitioner with this request and are seeking clarification of exactly why stem cells are valuable and what they might expect to gain from harvesting them. How can the nurse practitioner best respond to the couple\'s inquiry? (Points : 3)
“Stem cells can help correct autoimmune diseases and some congenital defects.”
“Stem cells can be used to regenerate damaged organs should the need ever arise.”
“Stem cells can be used as a source of reserve cells for the entire blood production system.”
“Stem cells can help treat some cancers and anemias, but they must come from your child himself or herself.”
Question 14.14. A 23-year-old man has received a recent diagnosis of appendicitis following 24 hours of acute abdominal pain. The nurse practitioner providing care for the man is explaining that while it is unpleasant, the inflammation of his appendix is playing a role in his body\'s fight against the underlying infectious process. Which of the following teaching points should the nurse practitioner eliminate from his teaching for the patient? (Points : 3)
“Inflammation can help to remove the body tissue cells that have been damaged by infection.”
“Inflammation will start your body on the path to growing new, healthy tissue at the site of infection.
“Inflammation helps your body to produce the right antibodies to fight the infection.”
“Inflammation ultimately aids in eliminating the initial cause of the cell injury in your appendix.”
Question 15.15. A 60-year-old woman is suspected of having non-Hodgkin lymphoma (NHL). Which of the following aspects of her condition would help to rule out Hodgkin lymphoma? (Points : 3)
Her neoplasm originates in secondary lymphoid structures.
The lymph nodes involved are located in a large number of locations in the lymphatic system.
The presence of Reed-Sternberg cells has been confirmed.
The woman complains of recent debilitating fatigue.
Question 16.16. Which of the following statements most accurately conveys an aspect of lymphatic system activity? (Points : 3)
B and T lymphocyte development begins in the bone marrow and ends in the peripheral lymphoid structures.
B cells and macrophages are released from the bone marrow in their completed state.
Stem cells in the lymph nodes initiate and regulate the process of white cell synthesis.
Leukocytes bypass vascular circulation and are distributed instead by the lymphatic system.
Question 17.17. A nurse practitioner is explaining to a 40-year-old male patient the damage that Mycobacterium tuberculosis could do to lung tissue. Which of the following phenomena would underlie the nurse practitioner\'s explanation? (Points : 3)
Tissue destruction results from neutrophil deactivation.
Nonspecific macrophage activity leads to pulmonary tissue destruction and resulting hemoptysis.
Macrophages are unable to digest the bacteria, resulting in immune granulomas.
Neutrophils are ineffective against the Mycobacterium tuberculosis antigens.
Question 18.18. A 2-year-old girl has had repeated ear and upper respiratory tract infections since she was born. A pediatrician has determined a diagnosis of transient hypogammaglobulinemia of infancy. What is the physiological origin of the child\'s recurrent infections? (Points : 3)
Antibody production by plasma cells is compromised because of impaired communication between B and T cells.
The child had a congenital absence of immunoglobulin G (IgG) antibodies and her body is only slowly beginning to produce them independently.
The child was born with immunoglobulin A (IgA) and immunoglobulin (IgM) antibodies, suggesting intrauterine infection.
The child lacks the antigen presenting cells integral to normal B-cell antibody production.
Question 19.19. Following a course of measles, a 5-year-old girl developed scattered bruising over numerous body surfaces and was diagnosed with immune thrombocytopenic purpura (ITP). As part of her diagnostic workup, blood work was performed. Which of the following results is most likely to be considered unexpected by the health care team? (Points : 3)
Increased thrombopoietin levels
Decreased platelet count
Normal vitamin K levels
Normal leukocyte levels
Question 20.20. A 60-year-old male patient with an acute viral infection is receiving interferon therapy. The nurse practitioner is teaching the family of the patient about the diverse actions of the treatment and the ways that it differs from other anti-infective therapies. Which of the following teaching points should the nurse practitioner exclude? (Points : 3)
“Interferon can help your father\'s unaffected cells adjacent to his infected cells produce antiviral proteins that limit the spread of the infection.”
“Interferon can help limit the replication of the virus that\'s affecting your father.”
“Interferon helps your father\'s body recognize infected cells more effectively.”
“Interferon can bolster your father\'s immune system by stimulating natural killer cells that attack viruses.”
Question 21.21. A 24-year-old woman presents with fever and painful, swollen cervical lymph nodes. Her blood work indicates neutrophilia with a shift to the left. She most likely has: (Points : 3)
A mild parasitic infection
A severe bacterial infection
A mild viral infection
A severe fungal infection
Question 22.22. A nurse practitioner student is familiarizing herself with the overnight admissions to an acute medical unit of a university hospital. Which of the following patients would the student recognize as being least likely to have a diagnosis of antiphospholipid syndrome in his or her medical history? (Points : 3)
A 66-year-old obese male with left-sided hemiplegia secondary to a cerebrovascular accident
A 90-year-old female resident of a long-term care facility who has been experiencing transient ischemic attacks
A 30-year-old female with a diagnosis of left leg DVT and a pulmonary embolism
A 21-year-old male with a diagnosis of cellulitis and suspected endocarditis secondary to intravenous drug use
Question 23.23. The blood work of a 44-year-old male patient with a diagnosis of liver disease secondary to alcohol abuse indicates low levels of albumin. Which of the following phenomena would a clinician be most justified in anticipating? (Points : 3)
Impaired immune function
Question 24.24. A nurse practitioner is teaching her colleagues about the role of cytokines in a variety of pathologies. Which of the following teaching points best captures an aspect of the functions and nature of cytokines? (Points : 3)
“A particular cytokine can have varied effects on different systems, a fact that limits their therapeutic use.”
“Cytokine production is constant over time, but effects are noted when serum levels cross a particular threshold.”
“Most cytokines are produced by granular leukocytes, and different cells are capable of producing the same cytokine.”
“Cytokine actions are self-limiting in that activation of one precludes activation of other cytokines with similar actions.”
Question 25.25. Which of the following phenomena would be least likely to result in activation of the complement system? (Points : 3)
Recognition of an antibody bound to the surface of a microbe
The binding of mannose residues on microbial glycoproteins
Activation of Toll-like receptors (TLRs) on complement proteins
Direct recognition of microbial proteins
1. The nurse practitioner for a cardiology practice is responsible for providing presurgical teaching for patients who are about to undergo a coronary artery bypass graft. Which of the following teaching points best conveys an aspect of the human circulatory system? (Points : 3)
“Your blood pressure varies widely between arteries and veins, and between pulmonary and systemic circulation.”
“Only around one quarter of your blood is in your heart at any given time.”
“Blood pressure and blood volume roughly mimic one another at any given location in the circulatory system.”
“Left-sided and right-sided pumping action at each beat of the heart must equal each other to ensure adequate blood distribution.”
Question 2.2. A physical assessment of a 28-year-old female patient indicates that her blood pressure in her legs is lower than that in her arms and that her brachial pulse is weaker in her left arm than in her right. In addition, her femoral pulses are weak bilaterally. Which of the following possibilities would her care provider be most likely to suspect? (Points : 3)
Coarctation of the aorta
An adrenocortical disorder
Question 3.3. As part of the diagnostic workup for a male patient with a complex history of cardiovascular disease, the care team has identified the need for a record of the electrical activity of his heart, insight into the metabolism of his myocardium, and physical measurements, and imaging of his heart. Which of the following series of tests is most likely to provide the needed data for his diagnosis and care? (Points : 3)
Echocardiogram, PET scan, ECG
Ambulatory ECG, cardiac MRI, echocardiogram
Serum creatinine levels, chest auscultation, myocardial perfusion scintigraphy
Cardiac catheterization, cardiac CT, exercise stress testing
Question 4.4. An older adult female patient has presented with a new onset of shortness of breath, and the patient\'s nurse practitioner has ordered measurement of her BNP levels along with other diagnostic tests. What is the most accurate rationale for the nurse practitioner\'s choice of blood work? (Points : 3)
BNP is released as a compensatory mechanism during heart failure and measuring it can help differentiate the patient\'s dyspnea from a respiratory pathology.
BNP is an indirect indicator of the effectiveness of the RAA system in compensating for heart failure.
BNP levels correlate with the patient\'s risk of developing cognitive deficits secondary to heart failure and consequent brain hypoxia.
BNP becomes elevated in cases of cardiac asthma, Cheyne-Stokes respirations, and acute pulmonary edema, and measurement can gauge the severity of pulmonary effects.
Question 5.5. A patient in the intensive care unit has a blood pressure of 87/39 and has warm, flushed skin accompanying his sudden decline in level of consciousness. The patient also has arterial and venous dilation and a decrease in systemic vascular resistance. What is this patient\'s most likely diagnosis? (Points : 3)
Question 6.6. A number of patients have presented to the emergency department in the last 24 hours with complaints that are preliminarily indicative of myocardial infarction. Which of the following patients is least likely to have an ST-segment myocardial infarction (STEMI)? (Points : 3)
A 70-year-old woman who is complaining of shortness of breath and vague chest discomfort
A 66-year-old man who has presented with fatigue, nausea and vomiting, and cool, moist skin
A 43-year-old man who woke up with substernal pain that is radiating to his neck and jaw
A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest
Question 7.7. A 54-year-old man with a long-standing diagnosis of essential hypertension is meeting with his nurse practitioner. The patient\'s nurse practitioner would anticipate that which of the following phenomena is most likely occurring? (Points : 3)
The patient\'s juxtaglomerular cells are releasing aldosterone as a result of sympathetic stimulation.
Epinephrine from his adrenal gland is initiating the renin-angiotensin-aldosterone system.
Vasopressin is exerting an effect on his chemoreceptors and baroreceptors, resulting in vasoconstriction.
The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption.
Question 8.8. A 66-year-old obese man with a diagnosis of ischemic heart disease has been diagnosed with heart failure that his care team has characterized as attributable to systolic dysfunction. Which of the following assessment findings is inconsistent with his diagnosis? (Points : 3)
His resting blood pressure is normally in the range of 150/90 and an echocardiogram indicates his ejection fraction is 30%.
His end-diastolic volume is higher than normal and his resting heart rate is regular and 82 beats per minute.
He is presently volume overloaded following several days of intravenous fluid replacement.
Ventricular dilation and wall tension are significantly lower than normal.
Question 9.9. Which of the following assessment findings in a newly admitted 30-year-old male patient would be most likely to cause his nurse practitioner to suspect polyarteritis nodosa? (Points : 3)
The man\'s blood work indicates polycythemia (elevated red cells levels) and leukocytosis (elevated white cells).
The man\'s blood pressure is 178/102 and he has abnormal liver function tests.
The man is acutely short of breath and his oxygen saturation is 87%.
The man\'s temperature is 101.9°F and he is diaphoretic (heavily sweating).
Question 10.10. A 6-year-old boy has been brought to the emergency department by ambulance after his mother discovered that his heart rate was “so fast I couldn\'t even count it.” The child was determined to be in atrial flutter and his mother is seeking an explanation from the health care team. Which of the following points should underlie an explanation to the mother? (Points : 3)
The child is experiencing a reentry rhythm in his right atrium.
The resolution of the problem is dependent on spontaneous recovery and is resistant to pacing interventions.
The child is likely to have a normal ECG apart from the rapid heart rate.
The boy\'s atria are experiencing abnormal sympathetic stimulation.
Question 11.11. A patient has suffered damage to his pericardium following a motor vehicle accident. Which of the following consequences should the nurse practitioner be most likely to rule out? (Points : 3)
Impaired physical restraint of the left ventricule
Increased friction during the contraction/relaxation cycle
Reduced protection from infectious organisms
Impaired regulation of myocardial contraction
Question 12.12. Which of the following situations related to the transition from fetal to perinatal circulation would be most likely to necessitate medical intervention? (Points : 3)
Pressure in the pulmonary circulation and the right side of the infant\'s heart fall markedly.
Alveolar oxygen tension increases, causing reversal of pulmonary vasoconstriction of the fetal arteries.
Systemic vascular resistance and left ventricular pressure are both increasing.
Pulmonary vascular resistance, related to muscle regression in the pulmonary arteries, rises over the course of the infant\'s first week.
Question 13.13. A 70-year-old male patient presents to the emergency department complaining of pain in his calf that is exacerbated when he walks. His pedal and popliteal pulses are faintly palpable and his leg distal to the pain is noticeably reddened. What would his care provider\'s preliminary diagnosis and anticipated treatment most likely be? (Points : 3)
Acute arterial occlusion that will be treated with angioplasty
Raynaud disease that will require antiplatelet medications
Atherosclerotic occlusive disease necessitating thrombolytic therapy
Giant cell temporal arteritis that will be treated with corticosteroids
Question 14.14. A patient is experiencing impaired circulation secondary to increased systemic arterial pressure. Which of the following statements is the most relevant phenomenon? (Points : 3)
Increased preload due to vascular resistance
High afterload because of backpressure against the left ventricle
Impaired contractility due to aortic resistance
Systolic impairment because of arterial stenosis
Question 15.15. A nurse practitioner is providing care for several patients on a medical unit of a hospital. In which of the following patient situations would the nurse practitioner be most likely to rule out hypertension as a contributing factor? (Points : 3)
A 61-year-old man who has a heart valve infection and recurrent fever
An 81-year-old woman who has had an ischemic stroke and has consequent one-sided weakness
A 44-year-old man awaiting a kidney transplant who requires hemodialysis three times per week
A 66-year-old woman with poorly controlled angina and consequent limited activity tolerance
Question 16.16. A formerly normotensive woman, pregnant for the first time, develops hypertension and headaches at 26 weeks\' gestation. Her blood pressure is 154/110 mm Hg and she has proteinuria. What other labs should be ordered for her? (Points : 3)
Plasma angiotensin I and II and renin
Urinary sodium and potassium
Platelet count, serum creatinine, and liver enzymes
Urinary catecholamines and metabolites
Question 17.17. A nurse practitioner is instructing a group of older adults about the risks associated with high cholesterol. Which of the following teaching points should the participants try to integrate into their lifestyle after the teaching session? (Points : 3)
“Remember, the \'H\' in HDL and the \'L\' in LDL correspond to high danger and low danger to your health.”
“Having high cholesterol increases your risk of developing diabetes and irregular heart rate.”
“Smoking and being overweight increases your risk of primary hypercholesterolemia.”
“Your family history of hypercholesterolemia is important, but there are things you can do to compensate for a high inherited risk.”
Question 18.18. An autopsy is being performed on a 44-year-old female who died unexpectedly of heart failure. Which of the following components of the pathologist\'s report is most suggestive of a possible history of poorly controlled blood pressure? (Points : 3)
“Scarring of urethra suggestive of recurrent urinary tract infections is evident.”
“Bilateral renal hypertrophy noted.”
“Vessel wall changes suggestive of venous stasis are evident.”
“Arterial sclerosis of subcortical brain regions noted.”
Question 19.19. A nurse practitioner has ordered the measurement of a cardiac patient\'s electrolyte levels as part of the patient\'s morning blood work. Which of the following statements best captures the importance of potassium in the normal electrical function of the patient\'s heart? (Points : 3)
Potassium catalyzes the metabolism of ATP, producing the gradient that results in electrical stimulation.
Potassium is central to establishing and maintaining the resting membrane potential of cardiac muscle cells.
The impermeability of cardiac cell membranes to potassium allows for action potentials achieved by the flow of sodium ions.
The reciprocal movement of one potassium ion for one sodium ion across the cell membrane results in the production of an action potential.
Question 20.20. In which of the following patient situations would a nurse practitioner be most justified in preliminarily ruling out pericarditis as a contributing pathology to the patient\'s health problems? (Points : 3)
A 61-year-old man whose ECG was characterized by widespread T wave inversions on admission but whose T waves have recently normalized
A 77-year-old with diminished S3 and S4 sounds, an irregular heart rate, and a history of atrial fibrillation
A 56-year-old obese man who is complaining of chest pain that is exacerbated by deep inspiration and is radiating to his neck and scapular ridge
A 60-year-old woman whose admission blood work indicates elevated white cells, erythrocyte sedimentation rate, and C-reactive protein levels
Question 21.21. During a routine physical examination of a 66-year-old woman, her nurse practitioner notes a pulsating abdominal mass and refers the woman for further treatment. The nurse practitioner is explaining the diagnosis to the patient, who is unfamiliar with aneurysms. Which of the following aspects of the pathophysiology of aneurysms would underlie the explanation the nurse provides? (Points : 3)
Aneurysms are commonly a result of poorly controlled diabetes mellitus.
Hypertension is a frequent modifiable contributor to aneurysms.
Individuals with an aneurysm are normally asymptomatic until the aneurysm ruptures.
Aneurysms can normally be resolved with lifestyle and diet modifications.
Question 22.22. A 66-year-old patient\'s echocardiogram reveals a hypertrophied left ventricle, normal chamber volume, and a normal ejection fraction from the heart. What is this patient\'s most likely diagnosis? (Points : 3)
Mitral valve regurgitation
Aortic valve stenosis
Mitral valve stenosis
Aortic valve regurgitation
Question 23.23. A nurse practitioner is teaching a student NP about the physiologic basis for damage to the circulatory and neurological systems that can accompany hypotension. Which of the following responses by the student would warrant correction by the nurse practitioner? (Points : 3)
“As vessel wall thickness increases, tension decreases.”
“Smaller blood vessels require more pressure to overcome wall tension.”
“The smaller the vessel radius, the greater the pressure needed to keep it open.”
“Tension and vessel thickness increase proportionately.”
Question 24.24. An 81-year-old female patient of a long-term care facility has a history of congestive heart failure. The nurse practitioner caring for the patient has positioned her sitting up at an angle in bed and is observing her jugular venous distention. Why is jugular venous distention a useful indicator for the assessment of the patient\'s condition? (Points : 3)
Increased cardiac demand causes engorgement of systemic blood vessels, of which the jugular vein is one of the largest.
Blood backs up into the jugular vein because there are no valves at the point of entry into the heart.
Peripheral dilation is associated with decreased stroke volume and ejection fraction.
Heart valves are not capable of preventing backflow in cases of atrial congestion.
Question 25.25. A 22-year-old male is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. What immediate treatments are likely to most benefit the man? (Points : 3)
Resolution of compensatory pulmonary edema and heart arrhythmias
Infusion of vasodilators to foster perfusion and inotropes to improve heart contractility
Infusion of normal saline of Ringer lactate to maintain the vascular space
Administration of oxygen and epinephrine to promote perfusion
1. Which of the following patients who presented to a walk-in medical clinic is most likely to be diagnosed with a rhinosinusitis rather than a common cold? (Points : 3)
A man complaining of general fatigue, a headache, and facial pain with a temperature of 100.9°F
A woman presenting with malaise, lethargy, and copious nasal secretions
A man with a dry, stuffy nasopharynx, a sore throat, and temperature of 98.9°F
A woman complaining of generalized aches who has a hoarse voice and reddened, painful upper airways
Question 2.2. A 44-year-old woman developed calf pain during a transatlantic flight followed by acute shortness of breath upon arrival at her destination. She was subsequently diagnosed with a pulmonary embolism (PE), which resolved with anticoagulant therapy. Which of these statements best characterizes the underlying problem of her PE? (Points : 3)
She was short of breath because ventilation was occurring but perfusion was inadequate.
The combination of normal perfusion but compromised ventilation caused hypoxia.
She developed a transient anatomic shunt resulting in impaired oxygenation.
Impaired gas diffusion across alveolar membranes resulted in dyspnea and hypoxia.
Question 3.3. A premature infant on mechanical ventilation has developed bronchopulmonary dysplasia (BPD) and is showing signs and symptoms of hypoxemia, low lung compliance, and respiratory distress syndrome (RDS). Which of the following is the most likely contributor to the infant\'s present health problem? (Points : 3)
High inspired oxygen concentration and injury from positive-pressure ventilation
Failure to administer corticosteroids to the infant in utero
Insufficient surfactant production and insufficient surfactant therapy
Insufficient supplemental oxygen therapy
Question 4.4. Which of the following residents of a long-term care facility is most likely to be exhibiting the signs and symptoms of chronic obstructive pulmonary disease (COPD)? (Points : 3)
A 79-year-old lifetime smoker who is complaining of shortness of breath and pain on deep inspiration
An 81-year-old smoker who has increased exercise intolerance, a fever, and increased white blood cells
An 81-year-old male who has a productive cough and recurrent respiratory infections
An 88-year-old female who experiences acute shortness of breath and airway constriction when exposed to tobacco smoke
Question 5.5. A 66-year-old male presents to the emergency department accompanied by his wife who claims that he has been acting confused. The man is complaining of a sudden onset of severe weakness and malaise and has a dry cough and diarrhea. His temperature is 102.8°F and his blood work indicates his sodium level is 126 mEq/L (normal is 135 to 145 mEq/L). What will be the assessing nurse practitioner\'s most likely suspicion? (Points : 3)
Question 6.6. A 51-year-old female patient who is 2 days postoperative on a surgical unit of a hospital is at risk for developing atelectasis as a result of being largely immobile. Which of the following teaching points by her nurse practitioner is most appropriate? (Points : 3)
“Being in bed increases the risk of fluid accumulating between your lungs and their lining, so it\'s important for you to change positions often.”
“You should breathe deeply and cough to help your lungs expand as much as possible while you\'re in bed.”
“Make sure that you stay hydrated and walk as soon as possible to avoid our having to insert a chest tube.”
“I\'ll prescribe bronchodilator medications that will help open up your airways and allow more oxygen in.”
Question 7.7. Due to complications, a male postoperative patient has been unable to mobilize for several days following surgery and has developed atelectasis. Which of the following processes would his care team anticipate with relation to his health problem? (Points : 3)
Vasodilation in the alveolar vessels in the affected region of his lung
Increased workload for the left side of the patient\'s heart
Increased blood flow to the area of atelectasis
Redirection of blood flow away from the lung regions that are hypoxic
Question 8.8. Which of the following clinical findings would be most closely associated with a patient who has interstitial lung disease rather than COPD? (Points : 3)
Audible wheezing on expiration
Diminished expiratory flow rates
Increased respiratory rate with decreased tidal volume
Normal compliance of alveolar tissue
Question 9.9. A male lifetime smoker has died as a result of chronic obstructive pulmonary disease. Which of the following phenomena regarding his alveoli would his care team have most reasonably expected in the weeks prior to his death? (Points : 3)
Proliferation of natural killer (NK) cells in the alveolar lumen
Large numbers of alveolar macrophages in septal connective tissue
The presence of tubercles in the intra-alveolar spaces
Compensatory regeneration of type I alveolar cells
Question 10.10. A 21-year-old male patient has suffered a head injury during a crash on his motorcycle, and a deficit that assessments have revealed is an impaired swallowing mechanism. He has also developed aspiration pneumonia. Which of the following statements most accurately capture an aspect of his condition? (Points : 3)
His oropharynx is obstructed.
His epiglottis is covering his larynx
His vocal folds have been compromised.
His tracheobronchial tree is intermittently obstructed.
Question 11.11. A short, nonsmoking middle-aged man presents to the emergency department with left-sided chest pain and a cough. He says that the pain started abruptly, just after lunch, and that breathing and coughing make it worse. He denies recent injury. He is breathing shallowly and rapidly and expresses fear that he may be having a heart attack. Breath sounds are normal, and he is not cyanotic. Which condition is most likely causing his symptoms? (Points : 3)
Pleuritis related to infection
Question 12.12. Which of the following statements best conveys an aspect of the respiratory pressures that govern ventilation? (Points : 3)
Intrapleural pressure slightly exceeds that of the inflated lung
The chest wall exerts positive pressure on the lungs that contributes to expiration
The lungs are prevented from collapsing by constant positive intrapulmonary pressure
Negative intrapleural pressure holds the lungs against the chest wall
Question 13.13. The mother of a 7-year-old boy who has recently been diagnosed with childhood asthma has come to the education center to learn more about her son\'s condition. Which of the following teaching points is most justifiable? (Points : 3)
“Research has shown that viruses may actually be a factor in many children\'s asthma.”
“The most reliable indicator that your child is having an asthma attack is audible wheezing.”
“Steroids that your child can inhale will likely be the first line of defense.
“Your son will likely need to limit or avoid exercise and sports.”
Question 14.14. Which of the following phenomena is most likely occurring during a child\'s alveolar stage of lung development? (Points : 3)
Terminal alveolar sacs are developing and surfactant production is beginning.
A single-capillary network exists and the lungs are capable of respiration.
The conducting airways are formed, but respiration is not yet possible.
Primitive alveoli are formed and the bronchi and bronchioles become much larger.
Question 15.15. A 71-year-old woman is dependent on oxygen therapy and bronchodilators due to her diagnosis of emphysema. Which of the following processes would her care team be most justified in ruling out? (Points : 3)
Decreased elastic recoil due to alveolar damage
Decreased residual lung volume due to impaired alveolar ventilation
Increased anatomic dead space due to reduced tidal volume
Increased alveolar dead space due to incorrect intrapleural pressure
Question 16.16. A definitive test for cystic fibrosis is (Points : 3)
The sweat test
A sputum culture
A fecal fat test
A Chymex test for pancreatic insufficiency
Question 17.17. A patient who presented with shortness of breath and difficulty climbing stairs has been diagnosed with pulmonary fibrosis, a disease characterized by scarring of the alveoli. What would her care team anticipate when observing her breathing? (Points : 3)
Rapid, deep breaths
Short, shallow breaths
Question 18.18. Which of the following patients are NOT displaying known risk factors for the development of pulmonary emboli? (Points : 3)
A patient who is immobilized following orthopedic surgery
A patient who has impaired Cl– and Na regulation
A patient who is taking amiodarone for the treatment of a cardiac arrhythmia
A patient who is a smoker and takes oral contraceptives
A patient who is undergoing radiation therapy for the treatment of breast cancer
Question 19.19. Following a winter power outage, a patient who had been using a home gasoline generator began to experience dizziness and headaches and was diagnosed with carbon monoxide poisoning. What is the goal of hyperbaric oxygen treatment for carbon monoxide poisoning? (Points : 3)
To increase the amount of oxygen dissolved in plasma
To increase the production of unbound hemoglobin
To stimulate the release of oxygen at the capillaries
To remove bound CO from hemoglobin
Question 20.20. A nurse practitioner is performing patient teaching about the influenza virus with each patient who has come to the clinic to receive that year\'s vaccine. Which of the following statements by patients best reflects an accurate understanding of the flu virus? (Points : 3)
“I could come down with viral or bacterial pneumonia as a result of a bad flu bug.”
“I know my vaccination is especially important since there aren\'t any drugs that can treat the flu once I get sick with it.”
“The emphasis on bundling up, staying warm, and drinking lots of fluids is outdated and actually ineffective.”
“Like all vaccines, it is ideal if everyone in a population gets immunized against the flu.”
Question 21.21. A 77-year-old lifetime smoker has been diagnosed with a tumor in his lung at the site of an old tubercle scarring site, located in a peripheral area of his bronchiolar tissue. What is this patient\'s most likely diagnosis? (Points : 3)
Squamous cell carcinoma
Small cell lung cancer
Large cell carcinoma
Question 22.22. As a result of dehydration, a patient\'s epithelial cells are producing insufficient amounts of mucus. Consequently, the patient\'s mucociliary blanket is compromised. Which of the following changes would a care provider most reasonably anticipate as a direct result of this change? (Points : 3)
Impaired function of the patient\'s cilia
Decreased levels of oxygen saturation
Increased amounts of bacteria in the lungs
Increased carbon dioxide levels
Question 23.23. Which of the following statements best captures the etiology of the acute response phase of extrinsic (atopic) asthma? (Points : 3)
IgG production is heightened as a consequence of exposure to an allergen.
Airway remodeling results in airflow limitations.
Epithelial injury and edema occur along with changes in mucociliary function.
Chemical mediators are released from presensitized mast cells.
Question 24.24. A 62-year-old female smoker is distraught at her recent diagnosis of small cell lung cancer (SCLC). How can her nurse practitioner most appropriately respond to her? (Points : 3)
“I\'m sure this is very hard news to hear, but be aware that with aggressive treatment your chances of beating this are quite good.”
“This is very difficult to hear, I\'m sure, and we have to observe to see if it spreads because that often happens.”
“I\'m very sorry to have to give you this news; I\'d like to talk to you about surgical options, however.”
“This is a difficult diagnosis to receive, but there is a chance that the cancer may go into remission.”
Question 25.25. About 3 weeks after razing an old chicken house, a 71-year-old retired farmer has developed a fever, nausea, and vomiting. After ruling out more common health problems, his care provider eventually makes a diagnosis of histoplasmosis. Which of the following processes is most likely taking place? (Points : 3)
Toxin production by Histoplasma capsulatum is triggering an immune response.
Antibody production against the offending fungi is delayed by the patient\'s age and the virulence of the organism.
Spore inhalation initiates an autoimmune response that produces the associated symptoms.
Macrophages are able to remove the offending fungi from the bloodstream but can\'t destroy them.
1. A 60-year-old man has been diagnosed with renal calculi after repeated episodes of excruciating flank pain in recent weeks. The man states, “I don\'t know how this could happen to me, since I\'m so careful about eating a healthy diet.” What is the most appropriate response to the man\'s statement? (Points : 3)
“Your diet may have played a part in this, but in fact genetics is likely primarily to blame.”
“What you eat can influence your risk of stone formation, but many other factors like hormones and your metabolism are involved.”
“You likely don\'t need to change your diet, but now that you have stones in one kidney, you\'re at very high risk of growing them in the other kidney.”
“Your diet might be normally healthy, but high intake of normally beneficial minerals like calcium and magnesium can lead to stones.”
Question 2.2. An 87-year-old male resident of an assisted living facility has been consistently continent of urine until the last several weeks. Which of the following actions by the care providers at the facility is the most likely priority? (Points : 3)
Performing a physical examination and history to determine the exact cause and character of the incontinence
Providing patient education focusing on the fact that occasional incontinence is a normal, age-related change
Teaching the resident about protective pads, collection devices, and medications that may be effective
Showing the resident the correct technique for exercises to improve bladder, sphincter, and pelvic floor tone
Question 3.3. A 34-year-old male patient has diagnoses of liver failure, ascites, and hepatic encephalopathy secondary to alcohol abuse. The patient\'s family is questioning the care team about why his abdomen is so large even though he is undernourished and emaciated. Which of the following statements most accurately underlies the explanation that a member of the care team would provide to the family? (Points : 3)
An inordinate amount of interstitial fluid is accumulating in the patient\'s abdomen.
The transcellular component of the intracellular fluid compartment contains far more fluid than normal.
The normally small transcellular fluid compartment, or third space, is becoming enlarged.
Gravity-dependent plasma is accumulating in the patient\'s peritoneal cavity.
Question 4.4. A patient is brought to the emergency department with complaints of shortness of breath. Assessment reveals a full, bounding pulse, severe edema, and audible crackles in the lower lung fields bilaterally. What is the patient\'s most likely diagnosis? (Points : 3)
Fluid volume excess
Question 5.5. Following several days in an acidotic state, a hospital patient has returned to the desired pH. Which of the following processes could have contributed to the resolution of the patient\'s health problem?(Points : 3)
Exchange of Na and H ions
Selective renal secretion and reabsorption of CO2
Phosphate and ammonia buffer systems in the renal tubules
Excretion of HCO3– by the kidneys
Question 6.6. Which of the following patients would be considered to have a significant risk of developing the prerenal form of acute renal failure? (Points : 3)
A 22-year-old male who has lost a large amount of blood following a workplace injury
A 41-year-old female who is admitted for intravenous antibiotic treatment of pyelonephritis
A 79-year-old male with diagnoses of poorly controlled diabetes mellitus and congestive heart failure
A 20-year-old male who is admitted for treatment of an overdose of a nephrotoxic drug
A 68-year-old male with a diagnosis of benign prostatic hyperplasia (BPH)
An 80-year-old female who has been admitted for treatment of dehydration, hyponatremia, and malnutrition
Question 7.7. An 81-year-old female has long-standing hypocalcemia secondary to kidney disease and will shortly be moving into an assisted living facility from her own apartment. Which of the following findings should staff at the facility be instructed to observe for? (Points : 3)
Loss of appetite and complaints of nausea
Muscular spasms and complaints of cramps
High fluid intake and urine output
Lethargy and stupor
Question 8.8. A 55-year-old man has made an appointment to see his nurse practitioner because he has been awakening three to four times nightly to void and often has a sudden need to void with little warning during the day. What is the man\'s most likely diagnosis and possible underlying pathophysiologic problem? (Points : 3)
Stress incontinence due to damage to CNS inhibitory pathways
Overactive bladder that may result from both neurogenic and myogenic sources
Overactive bladder due to intravesical pressure exceeding urethral pressure
Overflow incontinence that can result from displacement of the angle between the bladder and the posterior proximal urethra
Question 9.9. A 68-year-old woman with a new onset of vascular dementia has recently begun retaining urine. Which of the following physiological phenomena would her care providers most realistically expect to be currently occurring as a result of her urinary retention? (Points : 3)
Hypertrophy of the bladder muscle and increased bladder wall thickness
Decreased urine production and nitrogenous wasted excretion by the kidneys
Decompensation, bladder stretching, and high residual urine volume
Overflow incontinence and loss of contraction power
Question 10.10. Which of the following individuals is at the highest risk for developing a urinary tract infection (UTI)? (Points : 3)
A 60-year-old man with a history of cardiovascular disease who is recovering in the hospital from a coronary artery bypass graft
A 66-year-old man undergoing dialysis for the treatment of chronic renal failure secondary to hypertension
A 38-year-old man with high urine output due to antidiuretic hormone insufficiency
A 30-year-old obese woman with poorly controlled diabetes mellitus
Question 11.11. A nurse educator is orientating new nurses to a renal unit of a hospital. Which of the following teaching points should the nurse include as part of a review of normal glomerular function? (Points : 3)
“Nephrons are delicate structures that cannot endure the high pressure that exists in capillary beds elsewhere in the body.”
“Glomerular filtrate is very similar in composition to blood plasma found elsewhere in circulation.”
“Dilation of the afferent arteriole allows more blood into the nephron and increases the glomerular filtration rate.”
“The glomerulus is located between an arteriole and a venule that work together to regulate blood flow.”
Question 12.12. A 51-year-old woman diagnosed with multiple sclerosis (MS) five months prior is distressed that she has had several recent episodes of urinary incontinence. She has asked her nurse practitioner why this is the case. Which of the following statements best captures the facts that would underlie the nurse\'s response to the patient? (Points : 3)
Neurologic diseases like MS often result in flaccid bladder dysfunction.
She may be unable to sense her bladder filling as a result of her MS.
Lesions of the basal ganglia or extrapyramidal tract associated with MS inhibit detrusor contraction.
Pathologic reductions in bladder volume brought on by MS necessitate frequent micturition.
Question 13.13. A patient with poorly controlled diabetes mellitus presents to the emergency department with suspected ketoacidosis. Which of the following diagnostic results would be most likely to confirm this diagnosis? (Points : 3)
Low O2 levels, increased anion gap, base excess
High ammonia levels, decreased anion gap, high potassium
Increased CO2, increased anion gap, base deficit
Decreased CO2, decreased anion gap
Question 14.14. A pediatric unit will be receiving from a rural medical outpost a patient transfer of an 8-day-old infant with a suspected congenital renal disorder. Which of the following possibilities is the care team most likely to be able to rule out early? (Points : 3)
One of the infant\'s kidneys may have failed to develop to a normal size.
The kidneys may be misshapen and have cysts.
The upper or lower poles of the two kidneys may be fused.
Renal cell carcinoma may be present.
Question 15.15. A 4-year-old boy who has been deaf since birth and has bilateral cataracts has been brought to the emergency department by his mother because she noticed blood in the toilet after he last voided. Urinalysis confirms heavy microscopic hematuria as well as proteinuria. What will the care team\'s initial differential diagnosis most likely be? (Points : 3)
Systemic lupus erythematosus glomerulonephritis
Henoch-Schonlein purpura nephritis
Immunoglobulin A nephropathy
Question 16.16. Which of the following individuals would be considered to be at risk for the development of edema?
(Points : 3)
An 81-year-old man with right-sided heart failure and hypothyroidism
A 60-year-old obese female with a diagnosis of poorly controlled diabetes mellitus
A 34-year-old industrial worker who has suffered extensive burns in a job-related accident
A 77-year-old woman who has an active gastrointestinal bleed and consequent anemia
A 22-year-old female with hypoalbuminemia secondary to malnutrition and anorexia nervosa
Question 17.17. A 22-year-old female with a history of intermittent flank pain, repeated UTIs, and hematuria has been diagnosed with autosomal dominant polycystic kidney disease (ADPKD). Which of the following phenomena has most likely contributed to the development of her health problem? (Points : 3)
UTIs coupled with an impaired immune response have caused her ADPKD.
She has inherited a tendency for epithelial cell in her tubules to proliferate inappropriately.