Final Review

A 28-year-old male who is 6 feet 11 inches tall has a diagnosis of acromegaly. The man is explaining to a curious but sympathetic coworker exactly what accounts for his extraordinary height. Which of the following explanations demonstrates a sound understanding of his health problem? Question 10 options: "A tumor in my brain threw off my hormone levels after I was finished with adolescence." "My pituitary gland produced a much higher than normal amount of growth hormone when I was a child." T"The high sugar levels that go along with my diabetes made my pituitary gland overproduce the hormones that cause you to grow." "My liver is malfunctioning and produces too many of the hormones that ultimately cause growth."

"A tumor in my brain threw off my hormone levels after I was finished with adolescence."

A nurse practitioner is assessing a 7-year-old boy who has been brought to the clinic by his mother, who is concerned about her son's increasingly frequent, severe headaches. Which of the nurse's following questions is least likely to yield data that will allow for a confirmation or ruling out of migraines as the cause of his problem? Question 7 options: "Is your son generally pain free during the intervals between headaches?" "Does your son have any food allergies that have been identified?" "When your son has a headache, does he ever have nausea and vomiting as well?" "Does your son have a family history of migraines?"

"Does your son have any food allergies that have been identified?"

A 79-year-old male resident of a long-term care facility has contracted Clostridium difficile and is experiencing consequent diarrhea. Auscultation of the man's abdomen indicates hyperactive bowel sounds. What processes in the man's small intestine are most likely accompanying his current status?

Inflammation is accompanied by an increase in peristaltic movements of his small intestine.

A 20-year-old male has been diagnosed with a chlamydial infection, and his primary care provider is performing teaching in an effort to prevent the patient from infecting others in the future. Which of the following statements by the patient demonstrates the best understanding of his health problem? Question options: "Even if I spread it to someone else, there's a good chance she won't have any symptoms or know she has it." "Each of the three stages of the disease seems to be worse than the previous one." "Even though I couldn't end up sterile, a woman that I give it to certainly could." "Either me or a partner could end up with an eye infection from chlamydia that could make us blind."

"Even if I spread it to someone else, there's a good chance she won't have any symptoms or know she has it."

A patient with a diagnosis of insomnia is surprised when his physician explains to him that his brain is still highly active during normal sleep. Which of the following statements best captures the character of brain activity during sleep? Question 9 options: "Your brain alternates between periods of activity and periods of inactivity when you're asleep, and these correspond to your eye movement." "There are four types of brain activity, and actually all of them occur at different stages of sleep." "While you're obviously less aware of stimuli when you're asleep, your brain is actually more active when you're asleep than when you're awake." "Fewer neurons in your brain are firing when you're asleep, but they're more synchronized than when you're awake."

"Fewer neurons in your brain are firing when you're asleep, but they're more synchronized than when you're awake."

A 51-year-old woman who has been receiving estrogen and progesterone therapy (EPT) for the last 5 years has visited her care provider because her peers have told her about the risks of heart disease, stroke, and breast cancer that could accompany hormone therapy (HT). How should her care provider respond to her concerns? Question options: "There's in fact a slight protective effect against stroke associated with HT, but this is partially offset by increased rates of heart disease and breast cancer." "HT is actually associated with a decrease in heart disease risk, but there is an increase in stroke risk; the breast cancer connection is still unclear." "All things considered, the benefits of HT outweigh the slightly increased risks of heart disease, stroke, or breast cancer." "There is a demonstrable increase in breast cancer risk with HT, but the risk of stroke or heart disease actually goes down slightly."

"HT is actually associated with a decrease in heart disease risk, but there is an increase in stroke risk; the breast cancer connection is still unclear."

The unique clinical presentation of a three-month-old infant in the emergency department leads the care team to suspect botulism. Which of the following assessment questions posed to the parents is likely to be most useful in the differential diagnosis? Question options: "Is there any mold in your home that you know of?" "Has your baby ever been directly exposed to any chemical cleaning products?" "Is there any family history of neuromuscular diseases?" "Have you ever given your child any honey or honey-containing products?"

"Have you ever given your child any honey or honey-containing products?"

Following a visit to her campus medical clinic motivated by persistent abdominal pain and dyspareunia, a 20-year-old female college student has been referred for a diagnostic workup to rule out pelvic inflammatory disease. Her elevated white cell and C-reactive protein levels lead her care provider to suspect pelvic inflammatory disease (PID). What follow-up question is most likely to help with the differential diagnosis? Question options: "Have you ever had a therapeutic abortion in the past?" "How many sexual partners have you had?" "What does your daily hygiene routine usually consist of?" "Are you using tampons during your period, or do you normally use pads?"

"How many sexual partners have you had?"

A 60-year-old man has presented to his nurse practitioner because of an earache that has become progressively more painful in recent days. After giving his history and having an examination with an otoscope, the man has been diagnosed with otitis externa. Which of the nurse practitioner's following statements to the man is most accurate? Question 4 options: a. "This likely happened because your ears aren't draining like they should, but antibiotics that you'll put in your ears will resolve this." b. "I'll prescribe some ear drops for you, and in the meantime it's important not to use ear swabs." c. "I'm going to instill some warm water into your ear to flush out debris and bacteria." d. "You'll need to avoid getting any water in your ear until you finish your course of antibiotic pills."

"I'll prescribe some ear drops for you, and in the meantime it's important not to use ear swabs."

A pregnant 23-year-old with a diagnosis of herpes simplex virus (HSV) is receiving prenatal care from her nurse practitioner. What is the nurse practitioner most likely to tell the patient about the precautions that will be taken to prevent transmission of the virus to her baby? Question options: "We'll have to book you for a caesarean delivery in order to ensure that your baby isn't exposed to the virus." "A vaginal delivery will be safe as long as you are consistent about taking your vancyclovir." "If there aren't any visible lesions when you enter labor, a vaginal delivery will be safe to go ahead with." "After your caesarean section, it will be safest if you don't breast-feed your child."

"If there aren't any visible lesions when you enter labor, a vaginal delivery will be safe to go ahead with."

A 20-year-old male has been diagnosed with testicular cancer and is seeking information about his diagnosis from a number of websites. Which of the following statements that he has read is most plausible? Question options: "Recent developments in the treatment of testicular cancer mean that few men now need to have a testicle removed." "For most men with testicular cancer, bloody urine is their first sign that something is wrong." "Men with cryptorchidism—the term for an undescended testicle—are known to have a higher risk of developing testicular cancer." "Testicular cancer is a leading cause of death among males who should be in the prime of their lives."

"Men with cryptorchidism—the term for an undescended testicle—are known to have a higher risk of developing testicular cancer."

During a group prenatal class, the nurse teaching the course is explaining the thinning of the cervix that accompanies the stages of labor leading up to delivery. A participant admits that she is not familiar with either the location or normal role of the cervix. Which of the following responses, by the nurse, would be most appropriate? Question options: "The cervix is the soft lining of your uterus that has to expand greatly to accommodate your baby during delivery." "Your cervix is the part of your uterus where the fallopian tubes join it and the baby has to pass through it to the vagina." "The cervix is the opening between the uterus and the vagina and so it opens wide during the lead-up to birth." "Your cervix is just the term for the lowest part of your uterus and it is tightly shut at all times except in women who are giving birth."

"The cervix is the opening between the uterus and the vagina and so it opens wide during the lead-up to birth."

A gastroenterologist is teaching a group of nurse practitioner students about the enteric nervous system in preparation for a consultation on a patient who has suffered a spinal cord injury. Which of the physician's teaching points is most accurate?

"The enteric nervous system is made up of the myenteric and submucosal plexuses; these are located in the wall of the GI tract."

A 57-year-old woman who has been diagnosed with atrophic vaginitis has expressed her surprise to her care provider, citing a lifetime largely free of gynecological health problems. She has asked what may have contributed to her problem. How can the care provider best respond? Question options: "The exact cause of this problem isn't known, but it can usually be resolved with a diet high in probiotic bacteria." "This type of vaginitis is most commonly a symptom of a latent sexually transmitted infection that you may have contracted in the distant past." "Vaginitis is not usually the direct result of any single problem, but rather an inevitability of the vaginal dryness that accompanies menopause." "The lower levels of estrogen since you've begun menopause make your vagina prone to infection."

"The lower levels of estrogen since you've begun menopause make your vagina prone to infection."

A three-year-old girl has just been diagnosed with type 1A diabetes and her parents are currently receiving education from the diabetes education nurse at the hospital where their daughter is receiving treatment. How can the nurse best explain the etiology of their daughter's health problem to her parents?

"The problem that underlies her diabetes is that her own body has destroyed the cells in her pancreas that produce insulin."

A 60-year-old male patient with a long history of back pain has had little success with a variety of analgesic regimens that his nurse practitioner has prescribed. He has recently been diagnosed formally with a chronic pain disorder. Which of the following teaching points about chronic pain would his nurse practitioner most likely emphasize to the patient? Question 6 options: "You need to remind yourself that this is a purely physical phenomenon that requires physical treatment." "If your pain comes and goes, then we won't characterize it as chronic, and it will require different treatment." "These pain signals your body is sending likely serve no real, useful, or protective function." "Our challenge is to bring you relief but still treat the underlying back problem that your body is telling you about."

"These pain signals your body is sending likely serve no real, useful, or protective function."

Following a motor vehicle accident three months prior, a 20-year-old female who has been in a coma since her accident has now had her condition declared a persistent vegetative state. How can her care providers most accurately explain an aspect of her situation to her parents? Question 3 options: "Your daughter's condition is an unfortunate combination of total loss of consciousness with continuation of all other normal brain functions." "If you or the care team notice any spontaneous eye opening, then we will change our treatment plan." "Though she still goes through a cycle of sleeping and waking, her condition is unlikely to change." "Your daughter has lost all her cognitive functions as well as all her basic reflexes."

"Though she still goes through a cycle of sleeping and waking, her condition is unlikely to change."

A female neonate has been in respiratory distress since delivery and is unresponsive to oxygen therapy. Endoscopy has confirmed a diagnosis of esophageal atresia and tracheoesophageal fistula (EA/TEF). Which of the following explanations should the care team provide to the infant's parents?

"We will have to perform surgery to correct the hole in her throat to make sure that she is able to swallow and breathe normally."

Which of the following questions is most likely to be clinically useful in the differential diagnosis of sensorineural versus conductive hearing loss? Question options: "Do you ever hear a persistent ringing in your ears?" "Has your hearing loss developed quickly or more slowly?" "What effect is this hearing loss having on your quality of life?" "What medications do you currently take?"

"What medications do you currently take?"

A 51-year-old male professional is in the habit of consuming six to eight rum and cokes each evening after work. He assures the nurse practitioner, who is performing his regular physical exam, that his drinking is under control and does not have negative implications for his work or family life. How could the nurse best respond to the patient's statement?

"When your body has to regularly break down that much alcohol, your blood and the functional cells in your liver accumulate a lot of potentially damaging toxic byproducts."

An endocrinologist is providing care for a 30-year-old male who has lived with the effects of increased levels of GH. Which of the following teaching points about the patient's future health risks is most accurate?

"When your pituitary gland is enlarged, there's a real risk that you'll develop some sight deficiencies.

A 71-year-old male has been recently diagnosed with a stage III tumor of colorectal cancer and is attempting to increase his knowledge about his diagnosis. Which of the following statements about colorectal cancer demonstrates a sound understanding of the disease?

"While diet is thought to play a role in the development of colorectal cancer, the ultimate causes are largely unknown."

A 42-year-old female patient with a long-standing history of chronic nausea and vomiting but a near-insatiable appetite has had her symptoms attributed to an enzyme deficiency. Further diagnostic testing indicates that she has inadequate pancreatic enzyme levels and that her large appetite is due to a lack of enzyme control of food intake inhibition. In which of the following enzymes is the woman most likely deficient?

Cholecystokinin

Which of the following individuals would be most likely to experience global ischemia to his or her brain? Question 4 options: A woman who is being brought to the hospital by ambulance following suspected carbon monoxide poisoning related to a faulty portable heater A man who has entered cardiogenic shock following a severe myocardial infarction A woman who has been admitted to the emergency department with a suspected intracranial bleed A male patient who has just had an ischemic stroke confirmed by CT of his head

A man who has entered cardiogenic shock following a severe myocardial infarction

A 20-year-old male college student has recently finished a Thanksgiving dinner of heroic proportions while home for the holiday weekend. Which of the following phenomena would most likely have produced his sensation of satiety?

Cholecystokinin and glucagon-like peptide-1 suppress the hunger impulse.

Which of the following women is most likely to have a sexually transmitted infection as a contributing factor to her health problem? Question options: A 41-year-old with a diagnosis of mucopurulent cervicitis A 32-year-old who is undergoing diagnostics to rule out endometriosis A 40-year-old who is being treated for vaginal cancer A 29-year-old woman with a diagnosis of localized vulvodynia

A 41-year-old with a diagnosis of mucopurulent cervicitis

Which of the following sexually active women most likely faces the highest risk of developing an ectopic pregnancy? Question options: A 22-year-old who has a history of anorexia nervosa and who has a body mass index (BMI) of 12.0 (normal is 18.5 to 24.9). A 27-year-old who stopped using medroxyprogesterone contraceptive injection (Depo-Provera) several months ago A 42-year-old who has decided to try to have one more child and has had her tubal ligation reversed A 14-year-old who experienced menarche 2 years prior

A 42-year-old who has decided to try to have one more child and has had her tubal ligation reversed

Which of the following patients on a hospital medical unit is most clearly demonstrating the signs and symptoms of liver failure?

A 44-year-old man with low hemoglobin levels, low platelet levels, and spider angiomas

Large amounts of glucagon were recently released into an individual's circulation, but glucagon circulation has now ceased. Which of the following situations could have led to this inhibition of glucagon release?

A decrease in cellular metabolic needs and an increase in glucose levels

A nurse practitioner is providing care for a 68-year-old female whose anxiety disorder is significantly decreasing her quality of life. Which of the following pharmacologic therapies is most likely to benefit the woman? Question options: An epinephrine and norepinephrine supplement An antipsychotic medication that blocks dopamine receptors A selective serotonin reuptake inhibitor (SSRI) A drug that influences gamma-aminobutyric acid (GABA) levels

A drug that influences gamma-aminobutyric acid (GABA) levels

A 22-year-old female college student is shocked to receive a diagnosis of myasthenia gravis. What are the etiology and most likely treatment for her health problem? Question options: Excess acetylcholinesterase production; treatment with thymectomy Cerebellar lesions; surgical and immunosuppressive treatment A shortage of acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins Autoimmune destruction of skeletal muscle cells; treatment with intensive physical therapy and anabolic steroids

A shortage of acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins

A newborn male has been diagnosed with hypospadias following his postpartum assessment by a nurse practitioner. Which of the following diagnostics and treatment options is the nurse practitioner most likely to rule out first? Question options: Testosterone supplementation Surgical repair Circumcision Chromosomal studies

Circumcision

A 24-year-old woman undergoing a premarital screening test is found to have elevated levels of AST, ALT, and IgG, but no antibody-specific markers for viral hepatitis. A liver biopsy reveals inflammation and cellular damage. Which of the following treatments is most likely to be effective for her?

Corticosteroids and immunosuppressant drugs

While on tour, a 32-year-old male musician has presented to the emergency department of a hospital after a concert complaining of severe and sudden abdominal pain. He admits to a history of copious alcohol use in recent years, and his vital signs include a temperature of 38.8°C (101.8°F), blood pressure of 89/48 mm Hg, and heart rate of 116 beats per minute. Blood work indicates that his serum levels of C-reactive protein, amylase, and lipase are all elevated. Which of the following diagnoses would the care team first suspect?

Acute pancreatitis

A 60-year-old man has long managed his type 1 diabetes effectively with a combination of vigilant blood sugar monitoring, subcutaneous insulin administration, and conscientious eating habits. This morning, however, his wife has noted that he appears pale and clammy and to be in a stupor, though he is responsive. She suspects that he has made an error in his insulin administration and that he is experiencing a hypoglycemic episode. Which of the following actions should be the wife's first choice?

Administration of 15 to 20 g of glucose in a concentrated carbohydrate source

During descent, an airplane passenger is complaining that his "ears are plugged." What aspect of the structure and function of the ear best accounts for the passenger's complaint? Question 6 options: Air must be able to flow between the middle ear and the nasopharynx in order to accommodate pressure changes. The tympanic membrane is selectively permeable in order to accommodate pressure changes and this capacity is often impaired during upper respiratory infections. The eustachian tubes must remain patent to equalize pressure between the middle ear and inner ear. The inner ear adjusts its volume in response to atmospheric pressure, increasing during low pressure and decreasing in high pressure.

Air must be able to flow between the middle ear and the nasopharynx in order to accommodate pressure changes.

Which of the following hormones are derivatives of cholesterol? Question options: Eicosanoids and retinoids Aldosterone and testosterone Insulin and glucagon Epinephrine and norepine

Aldosterone and testosterone

A 46-year-old male has presented to the emergency department because of the eye pain, severe headache, and blurred vision that have followed an eye exam at an optometrist's office earlier in the day. The patient tells the triage nurse that he received eyedrops during the exam "to keep my pupils wide open." What differential diagnosis will the care team first suspect? Question options: Angle-closure glaucoma Corneal trauma Keratitis Infectious conjunctivitis

Angle-closure glaucoma

After a long and frustrating course of constant vaginal pain, a 38-year-old woman has been diagnosed with generalized vulvodynia by her nurse practitioner. What treatment plan is her nurse practitioner most likely to propose? Question options: Narcotic analgesia and nonsteroidal anti-inflammatory medications Lifestyle modifications aimed at accommodating and managing neuropathic pain Antidepressant and antiepileptic medications Alternative herbal therapies coupled with antifungal medications

Antidepressant and antiepileptic medications

A 51-year-old has been admitted to a rehabilitation center after hospital treatment for an ischemic stroke. Which of the following aspects of the patient's history would not be considered to have contributed to his stroke? Question options: History of sickle cell anemia The patient is an African American Male Blood pressure that is normally 120/80 Elevated cholesterol He was diagnosed with type 2 diabetes eight years ago

Blood pressure that is normally 120/80

A nurse practitioner is providing care for a 40-year-old male who is experiencing chronic insomnia in recent months while going through a divorce and child custody proceedings. The man is requesting a prescription for "sleeping pills" to help him through this time. Which of the following statements forms a valid basis for the nurse practitioner's plan for treatment? Question options: Behavioral therapies, counseling, and education may be of some use to the patient. Melatonin supplements will be the safest and most effective long-term pharmacological treatment. The man is suffering from primary insomnia. Sedative and hypnotic drugs will not provide safe relief of the man's health problem.

Behavioral therapies, counseling, and education may be of some use to the patient.

A 71-year-old man has visited his nurse practitioner for a check-up, during which the nurse practitioner has initiated a discussion about the patient's sexual function. Which of the following phenomena would the nurse practitioner most likely consider a pathological rather than an age-related change? Question options: A decrease in the force of the man's ejaculation Cessation of FSH production A decrease in the size and firmness of the patient's testes The presence of relative or absolute hypogonadism

Cessation of FSH production

Which of the following factors are NOT known to contribute to vaginal yeast infections? Question options: High hormone levels during pregnancy Use of oral contraceptives Recent antibiotic therapy Poorly controlled diabetes' Inflammation of the Skene and Bartholin glands

Inflammation of the Skene and Bartholin glands

The parents of a 15-year-old boy are frustrated by his persistent inability to fall asleep at a reasonable hour at night, as well as the extreme difficulty that they have in rousing him in the morning. While sleepy after waking, the son claims not to feel drowsy after lunch or in the evening. What is the most likely classification of the boy's sleep disorder? Question options: Chronic insomnia Advanced sleep phase syndrome (ASPS) Non-24-hour sleep-wake syndrome Delayed sleep phase syndrome (DSPS)

Delayed sleep phase syndrome (DSPS)

Which of the following statements best captures an aspect of normal spermatogenesis? Question options: Each primary spermatocyte undergoes two nuclear divisions, yielding four cells with 23 chromosomes each. Spermatogonia adjacent to the tubular wall undergo meiotic division and provide a continuous source of new germinal cells. Sertoli cells differentiate into spermatids, each of which can contribute half of the chromosomes necessary for reproduction. Testosterone chemically lyses each primary spermatocyte into two secondary spermatocytes with 23 chromosomes each.

Each primary spermatocyte undergoes two nuclear divisions, yielding four cells with 23 chromosomes each.

As part of the diagnostic workup for a patient's long-standing vertigo, a clinician wants to gauge the patient's eye movements. Which of the following tests is the clinician most likely to utilize? Question options: Caloric stimulation Electronystagmography (ENG) Rotational tests Romberg test

Electronystagmography (ENG)

John presents to the clinic with complaints of scrotal heaviness. Your assessment reveals swelling of the testicle and warm scrotal skin. What would your diagnosis be? Question options: Epididymitis Testicular torsion Orchitis Cryptorchidism

Epididymitis

A 30 year old man with a diagnosis of type 1 diabetes is aware of the multiple effects that insulin has on his metabolism. Which of the following physiological processes are actions of insulin?

Facilitating triglycerides from glucose in fat cells

Having heard positive reports of the benefits of HT from her sister-in-law and friends, a 49-year-old woman has presented to her nurse practitioner asking to start HT. Her uterus is intact and previous bone scans have indicated low bone density. The patient also has a family history of heart disease. She characterizes her symptoms of menopause as "noticeable, but not debilitating by any means." Based on the most current research, what is her nurse practitioner's best course of action? Question options: Begin low-dose HT but perform regular breast cancer screening and heart health checks Forgo HT but consider alternative therapies and reevaluate if her symptoms significantly affect her quality of life Forgo HT in light of her preexisting low bone density and consequent risk of osteoporosis Begin estrogen-progesterone HT (EPT) to prevent future menopausal symptoms and coronary heart disease (CHD)

Forgo HT but consider alternative therapies and reevaluate if her symptoms significantly affect her quality of life

During a late-night study session, a pathophysiology student reaches out to turn the page of her textbook. Which of the following components of her nervous system has the highest level of control over her arm and hand action? Question 10 options: Frontal lobe Basal ganglia Thalamus Cerebelum

Frontal lobe

As a result of oral ingestion of the microorganisms, an individual has contracted H. pylori. Which of the following health problems is the individual now at increased risk for?

Gastric adenocarcinoma

Which of the following measures would likely be rejected as part of a first-line weight loss plan for a patient with a BMI of 30.2, type 2 diabetes, and hypertension?

Gastric bypass

Which of the following statements best describes an aspect of the normal process of glucose metabolism? Question 3 options: a. Glucose that exceeds metabolic needs is converted and stored by the liver. b. Blood glucose levels are kept in a steady state by selective excretion and reuptake by the kidneys. c. Ingested glucose that is not needed for cellular metabolism circulates in the blood until it is taken up to meet cellular needs. d. Blood glucose levels are primarily a result of the timing, quantity, and character of food intake.

Glucose that exceeds metabolic needs is converted and stored by the liver.

A 30-year-old woman has sought care because of her recurrent photophobia, tearing, and eye irritation. During assessment, her care provider asks about any history of cold sores or genital herpes. What is the rationale for the care provider's line of questioning? Question options: A history of HSV with eye irritation is suggestive of glaucoma. Chronic viral infection of the eyes can result in HSV autoinoculation of the mouth and labia. HSV infection of the cornea is a common cause of corneal ulceration and blindness. Herpes simplex virus (HSV) conjunctivitis indicates a need for antiviral rather than antibacterial treatment.

HSV infection of the cornea is a common cause of corneal ulceration and blindness.

Long, stretchy cervical mucus that exhibits ferning on a microscope slide is characteristic of which of the following? Question options: Low human chorionic gonadotropin levels High progesterone levels Low estrogen levels High LH levels

High LH levels

A 66-year-old man has presented to a nurse practitioner to get a refill for his antiplatelet medication. The patient has a history of ischemic heart disease and suffered a myocardial infarction 5 years ago and has unstable angina; he uses a transdermal nitroglycerin patch to control his angina. The patient has a 40-pack-year smoking history and uses nebulized bronchodilators at home for the treatment of transient shortness of breath. He has long-standing hypertension that is treated with a potassium-sparing diuretic and a ß-adrenergic blocking medication. During the nurse's assessment, the man notes that he has been unable to maintain his erection in recent months. Which of the following aspects of the man's health problems and treatments would the nurse identify as NOT being contributing to his erectile dysfunction (ED)? Question options: His age His smoking history His ischemic heart disease His hypertension His use of bronchodilators His antihypertensive medications

His use of bronchodilators

A 29-year-old woman has been trying for many months to become pregnant, and fertilization has just occurred following her most recent ovulation. What process will now occur that will differentiate this ovulatory cycle from those prior? Question options: The basal layer of the endometrium will be sloughed in preparation for implantation. The corpus luteum will atrophy and be replaced by corpus albicans. The remaining primary follicles will provide hormonal support for the first 3 months of pregnancy. Human chorionic gonadotropin will be produced, preventing luteal regression.

Human chorionic gonadotropin will be produced, preventing luteal regression.

What does a high level of thyroid-stimulating hormone indicate?

Hypothyroidism

A nurse practitioner is providing care for a male patient with a long-standing hiatal hernia. Which of the following statements most accurately captures an aspect of the pathophysiology of hiatal hernias?

If esophageal acid clearance is impaired, esophagitis can result.

Following the identification of low levels of T3 and T4 coupled with the presence of a goiter, a 28-year-old female has been diagnosed with Hashimoto thyroiditis. In light of this diagnosis, which of the following assessment results would constitute an unexpected finding? Question 7 options: Increased white cell count and audible crackles on chest auscultation Coarse, dry skin and hair with decreased sweat production Recent weight gain despite a loss of appetite and chronic fatigue The presence of myxedema in the woman's face and extremities

Increased white cell count and audible crackles on chest auscultation

A 20-year-old male who is addicted to crystal methamphetamine has been admitted to the hospital with a diagnosis of protein-calorie malnutrition after many months of inadequate food intake. Which of the following treatment plans would the care team most likely favor?

Incremental feeding combined with vitamin and mineral supplementation

A 51-year-old woman has been experiencing signs and symptoms of perimenopause and has sought help from her nurse practitioner. Doctors have confirmed a deficiency in estrogen levels as a contributing factor. Which of the following phenomena could potentially underlie the woman's health problem? Question options: A lack of prohormone precursors needed for estrogen synthesis and release Insufficient estrogen production within the smooth endoplasmic reticulum of the relevant cells Inadequate synthesis in the rough endoplasmic reticulum of her ovarian cells Sufficient synthesis of estrogen but inadequate vesicle-mediated release

Insufficient estrogen production within the smooth endoplasmic reticulum of the relevant cells

Which of the following conditions usually improves when a woman is taking oral contraceptives? Question options: Herpes simplex virus Iron deficiency anemia Migraine headaches Human Papillomavirus infection

Iron deficiency anemia

A 39-year-old male patient has been recently diagnosed with primary hypogonadism. Which of the following lab results would be most indicative of this diagnosis? Question options: Low testosterone levels; normal levels of LH and FSH Low levels of GnRH Low free testosterone, LH, and FSH levels Normal levels of free testosterone; low levels of total testosterone

Low testosterone levels; normal levels of LH and FSH

Which of the following phenomena constitutes a component of axonal transport? Question options: Anterograde and retrograde axonal transport allow for the communication of nerve impulses between a neuron and the central nervous system (CNS). Materials can be transported to the nerve terminal by either fast or slow components. The unidirectional nature of the axonal transport system protects the CNS against potential pathogens. Axonal transport facilitates the movement of electrical impulses but precludes the transport of molecular materials.

Materials can be transported to the nerve terminal by either fast or slow components.

Which of the following diagnostic findings is likely to result in the most serious brain insult? Question options: High intracellular concentration of glutamate Increased ICP accompanied by hyperventilation Moderate increase in brain tissue volume secondary to a brain tumor Mean arterial blood pressure (MABP) that equals intracranial pressure (ICP)

Mean arterial blood pressure (MABP) that equals intracranial pressure (ICP)

A woman with severe visual and auditory deficits is able to identify individuals by running her fingers lightly over their face. Which of the following sources is most likely to provide the input that allows for the woman's ability? Question options: Free nerve endings Meissner corpuscles Ruffini end organs Pacinian corpuscles

Meissner corpuscles

All of the following are schedule II medications

Mereridine, Cocaine, Pentobarbital

A 13-year-old patient undergoing puberty is alarmed to find small, white bumps surrounding the areolae on her nipples. You reassure her that these are a normal sign of her sexual maturation and tell her that they are which of the following: Question options: Cooper ligaments Montgomery tubercles Bartholin glands Skene glands

Montgomery tubercles

A patient with a diagnosis of depression has been prescribed a medication that ultimately increases the levels of the neurotransmitter serotonin between neurons. Which of the following processes will accompany the actions of the neurotransmitter in her chemical synapses? Question 5 options: More serotonin molecules will cross the synaptic cleft and bond with postsynaptic receptors. The neurotransmitter will cross gap junctions more readily. Communication between a neuron and the single neuron it is connected with will be facilitated. Two-way communication between neurons is permitted, in contrast to the one-way communication in electrical synapses.

More serotonin molecules will cross the synaptic cleft and bond with postsynaptic receptors.

A 48-year-old male has a new diagnosis of Guillain-Barré syndrome. Which of the following processes underlies the deficits that accompany the degeneration of myelin in his peripheral nervous system (PNS)? Question options: A deficit of myelin predisposes the patient to infection by potential pathogens. Nerve cells lack insulation and impulse conduction is compromised by the destruction of myelin. The axonal transport system is compromised by the lack of myelin surrounding nerve cells. The destruction of myelin causes fewer Schwann cells to be produced in the patient's PNS.

Nerve cells lack insulation and impulse conduction is compromised by the destruction of myelin.

A 29-year-old woman has been diagnosed with otosclerosis after several years of progressive hearing loss. What pathophysiologic process has characterized her diagnosis?

New, sclerotic bone has been formed around her stapes and oval window.

A patient on an acute medicine unit of a hospital, with a diagnosis of small bowel obstruction, is complaining of intense, diffuse pain in her abdomen. Which of the following physiologic phenomena is most likely contributing to her complaint? Question options: The patient's C fibers are conducting pain in the absence of damaged Ad fibers. The patient is experiencing neuropathic pain. First-order neurons are inappropriately signaling pain to the dorsal root ganglion. Nociceptive afferents are conducting the sensation of pain along the cranial and spinal nerve pathways of the ANS.

Nociceptive afferents are conducting the sensation of pain along the cranial and spinal nerve pathways of the ANS.

A 24-year-old woman has presented to an inner-city free clinic because of the copious, foul vaginal discharge that she has had in recent days. Microscopy has confirmed the presence of Trichomonas vaginalis. What is the woman's most likely treatment and prognosis? Question options: Vaginal suppositories and topical ointments can provide symptom relief but cannot eradicate the microorganism. Antifungal medications are effective against the anovulation and risk of HIV that accompany the infection. Oral antibiotics can prevent complications such as infertility and pelvic inflammatory disease. Abstinence will be required until the infection resolves, since treatments do not yet have proven efficacy.

Oral antibiotics can prevent complications such as infertility and pelvic inflammatory disease.

A 40-year-old female has been categorized as being obese, with a BMI of 33.2. Which of the following health problems is the patient at a significantly increased risk for compared with individuals with a BMI below 25?

Osteoarthritis

A 13-year-old female is undergoing rapid development of her breasts after experiencing menarche several months ago. Which of the following hormones are NOT active in the development of her breasts? Question options: Prolactin Oxytocin Estrogen Follicle-stimulating hormone Progesterone

Oxytocin

After several months of persistent heartburn, a 57-year-old female patient has been diagnosed with gastroesophageal reflux disease (GERD). Which of the following treatment regimens is likely to best address the woman's health problem?

Proton pump inhibitors, avoiding large meals, and remaining upright after meals

A 55-year-old man has been diagnosed with a hiatal hernia, in which the function of the lower esophageal sphincter is compromised. Which of the following consequences of this condition is most likely?

Protrusion of the stomach or regurgitation of stomach contents into the esophagus

A 48-year-old woman has been diagnosed with extrahepatic cholestasis following a thorough history, ultrasound, and blood work. Which of the following symptoms most likely caused her to seek medical treatment, and what consequences of her health problem would the medical team anticipate?

Pruritus with consequences of deficient levels of fat-soluble vitamins

A 44-year-old female has been diagnosed with major depression. Which of the following neuroimaging findings is most congruent with the woman's diagnosis? Question 1 options: Enlargement of the lateral and third ventricles and reduction in frontal and temporal volumes Atrophy and decreased blood flow in the amygdala Reduced activity and gray matter volume in the prefrontal cortex Decreased brain activity in the pons and brain stem

Reduced activity and gray matter volume in the prefrontal cortex

A 4-year-old boy has had otitis media with effusion (OME) for several weeks and his condition has recently progressed to acute otitis media (AOM). Which of the following factors could have contributed to his AOM? Question 5 options: Exposure to respiratory syncytial virus (RSV) Sensorineural deficits in the auditory control apparatus Accumulation of cerumen in the external acoustic meatus A deficiency in immunoglobulin G Reflux of fluid from the boy's nose into his middle ear

Reflux of fluid from the boy's nose into his middle ear

A male patient complaining of chronic cramping, bloating, and diarrhea has been determined to have a deficiency in brush border enzymes within his small intestine. Which of the following meals or snacks is most likely to exacerbate the patient's signs and symptoms?

Roast beef and a baked potato

A 32-year-old man is complaining of burning, itching, photophobia, and severe pain in his right eye after swimming in the ocean. To determine that the eye condition is corneal rather than a conjunctival disease, which of the following would be the distinguishing symptom?

Severe pain

Which of the following factors is most responsible for the fact that prefrontal lobotomy is no longer a common treatment for mental illness? Question options: Loss of communication to and from the prefrontal cortex changes, but ultimately exacerbates, symptoms of mental illness. Severing connections between the brain and its prefrontal areas inhibits problem solving and results in a loss of ambition. Lobotomy inhibits the individual's ability to add perception and meaning to sensory information. Individuals treated by lobotomy have difficulty interpreting somatic, visual, and auditory information.

Severing connections between the brain and its prefrontal areas inhibits problem solving and results in a loss of ambition.

A 17-year-old female is suspected of having narcolepsy. Which of the following aspects of her medical history and sleep analysis would contribute to a confirmation of the diagnosis? Question options: She repeatedly moves her large toe, ankle, and knee during sleep. She complains of a powerful urge to move her legs when in bed at night. She has frequently awakened unable to move or speak. She believes that she experiences auditory hallucinations when she awakens. Her sleep latency is normally around 1 hour.

She has frequently awakened unable to move or speak.

A three-year-old girl has been diagnosed with amblyopia. Which of the following pathophysiologic processes is most likely to underlie her health problem? Question 2 options: a. The child may have a neural pathway disorder b. She may have been born with infantile cataracts c. The girl may have chronic bacterial conjunctivitis d. The child may have a congenital deficit of rods and/or cones

She may have been born with infantile cataracts

Which of the following statements best captures an aspect of the role of hormones in the body?

Some chemical substances can function as either hormones or neurotransmitters.

A 21-year-old female is suspected of having inadequate function of her hypothalamic-pituitary-thyroid system. Her care provider is planning to inject thyrotropin-releasing hormone (TRH) and then measure her levels of TSH. Which of the following diagnostic tests is being performed? Question options: Metabolite excretion test Stimulation test Radioimmunoassay (RIA) test Suppression test

Stimulation test

A couple that has three daughters would like to add a son to their family, and they have recently learned that the woman is pregnant. Which of the following phenomena would most likely be associated with the woman's eventual delivery of a healthy son? Question options: The production of dihydrotestosterone (DHT) by the embryo and DHT's differentiation into testosterone Development of testes under the influence of the X chromosome Suppression of female reproductive structures by antimüllerian hormone (AMH) Atrophy of the wolffian ducts during embryonic development

Suppression of female reproductive structures by antimüllerian hormone (AMH)

A 14-year-old boy has been brought to the emergency department by his mother in excruciating pain that is radiating from his scrotum to his inguinal area. The boy's heart rate is 122 beats per minute and he vomited twice before arrival at the hospital. Examination reveals that his scrotum is reddened and slightly swollen and the testes are firm to the touch and tender, with extensive cremaster muscle contraction noted. What is the boy's most likely diagnosis? Question options: Varicocele Testicular torsion Hydrocele Epididymitis

Testicular torsion

Which of the following statements best captures the role of the adrenal cortex in maintaining homeostasis? Question 1 options: A. Normal sexual function is dependent on adequate adrenal cortical function. B. Redundant, secondary production of adrenal cortical hormones can compensate for the loss of the adrenal glands. C. The adrenal cortical hormones are primarily steroids and sex hormones. D. The adrenal cortex is responsible for the production of epinephrine and norepinephrine, which are part of the sympathetic nervous system.

The adrenal cortical hormones are primarily steroids and sex hormones.

A woman with a diagnosis of type 2 diabetes has been ordered by her primary care provider to have a hemoglobin A1C test for the first time. The woman states, "I don't see why you want to test my blood cells when it's sugar that's the problem." What aspect of physiology will underlie the care provider's response to the patient?

The amount of glucose attached to A1C cells reflects the average blood glucose levels over the life of the cell.

After surviving an ischemic stroke, a 79-year-old male has demonstrated significant changes in his emotional behavior, with his family noting that he now experiences wide mood swings and exaggerated responses of empathy, anger, and sadness to situations. His care team would most likely attribute these responses to ischemic changes in which of the following brain structures? Question 8 options: The components of the patient's limbic system The man's parietal lobe The patient's temporal lobe in general and Wernicke area in particular The man's occipital lobe

The components of the patient's limbic system

A stroke affecting which of the following areas of the brain would be most likely to leave an individual's vestibular system intact and posture and balance maintained? Question options: The limbic system of the cerebrum The temporal and parietal cortex The thalamus The brain stem

The limbic system of the cerebrum

Following a long history of fatigue, weakness, and poor appetite, a 39-year-old male has been diagnosed with hypopituitarism. Which of the following clinical findings would most likely cause his care team to suspect that the man has an additional endocrine disorder from a different source? Question options: The man displays the signs and symptoms of hypothyroidism. The patient is 5 feet 2 inches tall and was consistently short for his age as a child. The man has a chronic platelet deficiency and is occasionally anemic. The man has a low sperm count and has been unable to have children.

The man has a chronic platelet deficiency and is occasionally anemic.

Following a spinal cord injury suffered in a motor vehicle accident, a 22-year-old male has lost fine motor function of his finger and thumb, but is still able to perform gross motor movements of his hand and arm. Which of the following components of his white matter has most likely been damaged? Question options: The reticular formation The outer layer (neolayer) The middle layer (paleolayer) The inner layer (archilayer)

The outer layer (neolayer)

A clinician is conducting an assessment of a male patient suspected of having a disorder of motor function. Which of the following assessment findings would suggest a possible upper motor neuron (UMN) lesion? Question options: The patient displays weakness in the distal portions of his limbs. The patient's muscles appear atrophied. The patient displays increased muscle tone. The patient has decreased deep tendon reflexes.

The patient displays increased muscle tone.

A 40-year-old male patient with multiple health problems has been diagnosed with a testosterone deficiency. Which of the following assessment findings would his care provider attribute to an etiology other than this deficiency? Question options: The patient has a low muscle mass as a proportion of total body weight. The patient has a history of susceptibility to upper respiratory infections. The patient has long-standing anemia and low red cell counts. The patient has a voice that is unusually high in pitch.

The patient has a history of susceptibility to upper respiratory infections.

A 43-year-old male who is 5 feet 10 inches tall and weighs 216 pounds has been informed by his nurse practitioner that his body mass index (BMI) is 31. Which of the following clinical conclusions based on these data would his nurse be most justified in rejecting?

The patient is borderline obese but is not yet at the point of significantly increased risks to health.

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?

The portal circulatory system brings venous blood from the gastrointestinal tract into the liver.

A student is feeling inside her backpack to find her mobile phone, which has fallen to the bottom, and there are a number of items in the bag in addition to the phone. Which of the following components of somatosensory conduction is most likely to provide the detailed sensory information that will help her distinguish her phone from other items? Question options: A bilateral, multisynaptic, slow-conducting tract The opposite anterolateral pathway that travels to the reticular activating system A slow-conducting pathway that projects into the intralaminar nuclei of the thalamus The primary dorsal root ganglion neuron, the dorsal column neuron, and the thalamic neuron

The primary dorsal root ganglion neuron, the dorsal column neuron, and the thalamic neuron

Which of the following statements most accurately characterizes an aspect of the neurobiology of sleep? Question 2 options: Input from the retinas is interpreted by the cerebellum and contributes to maintenance of the circadian rhythm. The reticular formation, thalamus, and cerebral cortex interact to integrate the sleep-wake cycle. The pituitary releases melatonin at predictable points in the circadian rhythm in order to facilitate sleep. The hypothalamus stimulates the anterior and posterior pituitary to modulate sleeping-waking cycles.

The reticular formation, thalamus, and cerebral cortex interact to integrate the sleep-wake cycle.

A 40-year-old woman has been found to have a deficiency in estrogen. Which of the following physiological phenomena is most likely to remain unaffected? Question options: The synthesis and release of adrenal glucocorticoids The maintenance of normal skin and blood vessel structure The regulation of uterine endothelial development Parathyroid hormone antagonism and the rate of bone resorption

The synthesis and release of adrenal glucocorticoids

A nurse practitioner and social worker are facilitating a family meeting for the children and wife of a 79-year-old man who has been diagnosed with Alzheimer disease. What goal of treatment will the clinicians most likely prioritize in their interactions with the family? Question options: Cognitive and behavioral therapy to counteract the agitation, depression, and suspiciousness associated with Alzheimer disease. The use of medications such as donepezil and rivastigmine to slow the progression of the disease Surgical treatment of the ischemic changes that underlie the manifestations of the man's disease Modest reversal of brain plaque formation and improved symptomatology through cholinesterase inhibitors

The use of medications such as donepezil and rivastigmine to slow the progression of the disease

A male newborn infant has been diagnosed with spina bifida occulta. Which of the following pathophysiologic processes has most likely contributed to the infant's health problem? Question options: The infant's soma and viscera are underdeveloped. The child's central and peripheral nervous systems have insufficiently differentiated during embryonic development. The infant's spinal cord and meninges protrude through his skin. The vertebral arches around his neural tube have failed to completely close.

The vertebral arches around his neural tube have failed to completely close.

Which of the following situations would be considered pathologic in an otherwise healthy 30-year-old female? Question options: The woman's ovaries are not producing progesterone. The epithelium covering the woman's ovaries is broken during the time of ovulation. The woman's ovaries do not synthesize or secrete luteinizing hormone (LH). The woman's ovaries are not producing new ova.

The woman's ovaries are not producing progesterone.

A 70-year-old male has been diagnosed with a stroke that resulted in an infarct to his cerebellum. Which of the following clinical findings would be most closely associated with cerebellar insult? Question options: Unsteady gait and difficulty speaking and swallowing Tremor, rigidity, and bradykinesia Difficulty starting movement, stopping movement, and maintaining rhythmic movement Flaccid loss of muscle tone

Unsteady gait and difficulty speaking and swallowing

A patient with a history of an endocrine disorder exhibits signs and symptoms of hormone deficiency. Which of the following processes would the patient's care team most likely rule out first as a contributing factor? Question options: Up-regulation has increased the sensitivity of the body to particular hormone levels. The process of down-regulation has resulted in decreased hormone sensitivity. Hormone production is sufficient, but affinity on the part of the target cells is lacking. The patient's target cells lack sufficient receptors for the hormone in question.

Up-regulation has increased the sensitivity of the body to particular hormone levels.

A patient in the intensive care unit who has a brain tumor has experienced a sharp decline. The care team suspects that water and protein have crossed the blood-brain barrier and been transferred from the vascular space into the patient's interstitial space. Which of the following diagnoses best captures this pathophysiology? Question options: Vasogenic edema Hydrocephalus Cytotoxic edema Focal hypoxia

Vasogenic edema

David has an acute exacerbation of Crohn's disease. Which of the following lab tests would you expect to be decreased?

Vitamins A, B complex and C levels

A care aide at a long-term care facility has informed a resident's nurse practitioner that the 80-year-old woman's eyes appear to be inflamed and her eyelids are caked with sticky secretions. The woman subsequently has been diagnosed with posterior blepharitis. Which of the following treatments is the nurse practitioner likely to initiate? Question 9 options: Intravenous steroids coupled with topical antibiotic ointment Regularly scheduled cleansing of the woman's eyes with normal saline Warm compresses to be applied regularly to her eyes in addition to oral antibiotics Surgical repair of the woman's blocked meibomian glands

Warm compresses to be applied regularly to her eyes in addition to oral antibiotics

A 60-year-old woman who is 11 years menopausal has presented to the emergency department stating, "I haven't had my period in years, but lately I've been bleeding again, and quite heavily in the last few days." The care team needs to rule out endometrial cancer. How should they best explain the most accurate plan for confirming or ruling out the diagnosis? Question options: "We can do a Pap smear right now and we will get the results as soon as we can." "We are going to order blood work that will measure your hormone levels." "We're going to have to open your cervix with a speculum and take scrapings from the wall of your uterus." "We're going to book a CT scan for you as soon as possible so that we can see what is inside your uterus."

We're going to have to open your cervix with a speculum and take scrapings from the wall of your uterus."

A patient with a new diagnosis of an endocrine disorder is unclear about how the body can control the levels of different hormones over time. Which of the following statements most accurately underlies the dominant regulation process of hormone levels in the body? Question 8 options: The pituitary gland is genetically programmed to stimulate and inhibit hormone production and/or release based on needs at different points in the life cycle. The hypothalamus ensures that hormone levels correspond accurately to the diurnal cycle. With input from various sensors, hormone production and release are adjusted based on existing hormone levels. A positive feedback cycle ensures that stable levels of hormones exist in the body over time.

With input from various sensors, hormone production and release are adjusted based on existing hormone levels.