FNP exam 3

18. A child has sickle cell disease (SCD). What treatment or therapy does the healthcare professional discuss with the parents and child?

A A common therapy for sickle cell disease is hydroxyurea which is an inhibitor of DNA synthesis. It increases HbF synthesis, which decreases the proportion of HbS. Aspirin is not used as the potential blood loss could worsen SCD. The same is true of heparin, plus blood clotting is not the major issue in the disorder. Genetic testing would not be used as a treatment or therapy. PTS: 1 DIF: Cognitive Level: Understanding

22. A patient has thalassemia major. After receiving multiple blood transfusions over the last several months, what complication does the healthcare professional assess the patient for?

A A complication of multiple blood transfusions is hemochromatosis (iron overload) which is a major cause of death in these patients. Iron deficiency anemia does not occur. Vitamin C depletion does not occur with transfusions. Rh autoimmunity is related to pregnant women and not blood transfusions. PTS: 1 DIF: Cognitive Level: Understanding

21. Soon after birth, a newborn has cord blood drawn which shows hemoglobin of 28.2 mg/dL. What does the healthcare professional understand about this finding?

A A normal cord blood hemoglobin mean is 16.8 mg/dL, so this is a high value. A hypoxic intrauterine environment stimulates erythropoietin production in the fetus and accelerates fetal erythropoiesis, producing polycythemia. This value does not indicate a need for transfusion nor does it demonstrate immature bone marrow. PTS: 1 DIF: Cognitive Level: Understanding

9. What is the life span of platelets (in days)?

A A platelet circulates for approximately 8 to 11 days and ages. Macrophages of the mononuclear phagocyte system, mostly in the spleen, remove platelets. PTS: 1 DIF: Cognitive Level: Remembering

14. If a patient develops acidosis, the nurse would expect the oxyhemoglobin dissociation curve to react in which manner?

A A shift to the right depicts hemoglobin's decreased affinity for O2 or an increase in the ease with which oxyhemoglobin dissociates and O2 moves into the cells. The oxyhemoglobin dissociation curve is shifted to the right by acidosis (low pH), hyperthermia, increased 2,3-BPG, and hypercapnia (increased partial pressure of arterial carbon dioxide [PaCO2]). A shift to the left would occur with alkalosis, hypocapnia, hypothermia, and decreased 2,3-BPG. PTS: 1 DIF: Cognitive Level: Remembering

9. An infant has a crescendo-decrescendo systolic ejection murmur located between the second and third intercostal spaces along the left sternal border. The healthcare professional suspects an atrial septal defect (ASD). For what other manifestation does the healthcare professional assess to confirm the suspicion?

A A wide fixed splitting of the second heart sound is also characteristic of ASD, reflecting volume overload to the RV, causing prolonged ejection time and delay of pulmonic valve closure. A loud, harsh holosystolic murmur is consistent with a ventricular septal defect. Cyanosis with crying and feeding (exertion) are classic "tet spells" associated with Tetralogy of Fallot. Rapid deterioration with acidosis, hypotension, and shock can accompany coarctation of the aorta. PTS: 1 DIF: Cognitive Level: Understanding

2. A patient has been diagnosed with acute lymphocytic leukemia (ALL) and asks the healthcare professional to describe it. What description by the professional is most accurate?

A ALL is a progressive neoplasm defined by the presence of greater than 30% lymphoblasts in the bone marrow or blood. Leukemia is a malignant disorder of leukocytes and does not involve immunoglobulins. The BCR-ABL gene has been identified in chronic myelogenous leukemia, not ALL. PTS: 1 DIF: Cognitive Level: Understanding

4. Respirations that are characterized by alternating periods of deep and shallow breathing are a result of which respiratory mechanism?

A Alternating periods of deep and shallow breathing are characteristic of Cheyne-Stokes respirations and are the result of any condition that slows the blood flow to the brainstem, which in turn slows impulses that send information to the respiratory centers of the brainstem. The medulla oblongata contains the respiratory center and is where the autonomic functions of respiration originate. An increased PaCO2 would lead to Kussmaul respirations. The intercostal muscles help move the chest wall during breathing and if fatigued, might lead to hypoventilation. PTS: 1 DIF: Cognitive Level: Remembering

30. A patient has been diagnosed with primary emphysema but claims there is no history of smoking. What action by the healthcare professional is most appropriate?

A Although emphysema is usually caused by smoking, a mutation in the α1-antitrypsin gene results in the development of the disease in younger, nonsmokers. The healthcare professional would facilitate this test. There is no reason to ask the family of a patient about the patient's smoking history unless the patient was unable to answer questions on his or her own. Pulmonary function studies will be done at some time, but does not help determine the etiology of the disease. Baseline arterial blood gasses would not be needed. PTS: 1 DIF: Cognitive Level: Analyzing

8. Which factor can trigger an immune response in the bloodstream that may result in an embolus?

A Amniotic fluid displaces blood, thereby reducing oxygen, nutrients, and waste exchange; however, it also introduces antigens, cells, and protein aggregates that trigger inflammation, coagulation, and the immune response in the bloodstream. Fat, bacteria, and air emboli do not trigger an immune response. PTS: 1 DIF: Cognitive Level: Remembering

23. How does angiotensin II increase the workload of the heart after a myocardial infarction (MI)?

A Angiotensin II is released during myocardial ischemia and contributes to the pathogenesis of a myocardial infarction (MI) in several ways, including causing peripheral vasoconstriction and fluid retention. These homeostatic responses increase myocardial work and thus exacerbate the effects of the loss of myocyte contractility. Angiotensin II does not cause hyperkalemia and dysrhythmias; it does not reduce cardiac contractility, and it does not stimulate the SNS. PTS: 1 DIF: Cognitive Level: Remembering

34. What is an expected change in the cardiovascular system that occurs with aging?

A Arterial stiffening occurs with aging even in the absence of clinical hypertension. Aging is not responsible for the other conditions. PTS: 1 DIF: Cognitive Level: Remembering

31. Which of these is the most common route of lower respiratory tract infection?

A Aspiration of oropharyngeal secretions is the most common route of lower respiratory tract infection; thus the nasopharynx and oropharynx constitute the first line of defense for most infectious agents. Inhalation of microorganisms and spread of organisms via the blood do occur but much less frequently. Poor mucus membrane protection would increase a person's risk of infection but is not a common direct route of infection. PTS: 1 DIF: Cognitive Level: Remembering

10. Which statement by the healthcare professional accurately describes childhood asthma?

A Asthma is an obstructive airway disease characterized by reversible airflow obstruction, bronchial hyperreactivity, and inflammation. A disease with severe hypoxemia, decreased compliance, and diffuse densities on chest x-ray is ARDS. The viscous mucus lining the airways and other organs and tissues is seen in cystic fibrosis. Surfactant deficiency is found in RDS of the newborn. PTS: 1 DIF: Cognitive Level: Understanding

6. Regarding the endothelium, what is the difference between healthy vessel walls and those that promote clot formation?

A Atherosclerosis causes roughening of the intima of blood vessels, which subsequently leads to activation of the coagulation cascade. Clot promotion is not caused by vasoconstriction of the endothelium, or age-related changes that weaken the endothelium. This process occurs in the intima of the artery. PTS: 1 DIF: Cognitive Level: Remembering

14. In what form of bronchiectasis do both constrictions and dilations deform the bronchi?

A Bronchiectasis is persistent abnormal dilation of the bronchi. Bronchial dilation may be cylindrical (cylindrical bronchiectasis), with symmetrically dilated airways, as can be seen after pneumonia and is reversible; saccular (saccular bronchiectasis), in which the bronchi become large and balloon-like; or varicose (varicose bronchiectasis), in which constrictions and dilations deform the bronchi, creating a bulbous appearance PTS: 1 DIF: Cognitive Level: Remembering

9. Which statement best describes thromboangiitis obliterans (Buerger disease)?

A Buerger disease is an inflammatory disease of the peripheral arteries. Inflammation, thrombus formation, and vasospasm can eventually occlude and obliterate portions of small- and medium-size arteries. The digital, tibial, and plantar arteries of the feet and the digital, palmar, and ulnar arteries of the hands are typically affected. Vasospasm in the small arteries and arterioles of the fingers and occasionally the toes describes Raynaud disease. It does not involve larger arteries and veins and it is not a neoplastic disease. PTS: 1 DIF: Cognitive Level: Remembering

1. Most cardiovascular developments occur between which weeks of gestation?

A Cardiogenesis begins at approximately 3 weeks' gestation; however, most cardiovascular development occurs between 4 and 7 weeks' gestation. PTS: 1 DIF: Cognitive Level: Remembering

27. A healthcare professional is educating a patient on asthma. The professional tells the patient that the most successful treatment for chronic asthma begins with which action?

A Chronic management of asthma begins with the avoidance of allergens and other triggers. The need for other treatments is reliant on the avoidance of triggers. PTS: 1 DIF: Cognitive Level: Understanding

34. What is the cause of the dyspnea resulting from a thoracic aneurysm?

A Clinical manifestations of an aneurysm depend on the location of the aneurysm. Pressure of a thoracic aneurysm on surrounding organs directly causes symptoms of dysphagia (difficulty in swallowing) and dyspnea (breathlessness). A thoracic aneurysm does not cause dyspnea through poor oxygenation, atherosclerotic lesions, or impaired blood flow. PTS: 1 DIF: Cognitive Level: Remembering

19. The drug heparin acts in hemostasis by which processes?

A Clinically administered heparin binds to AT-III and induces a conformational change that greatly enhances its activity. Under normal conditions, the presence of endothelial cell heparin sulfate and available AT-III in the circulation cooperate to protect the vessels from the effects of spontaneously activated thrombin. Heparin does not prevent the conversion of prothrombin to thrombin, shorten fibrin strands, or degrade the fibrin in blood clots. PTS: 1 DIF: Cognitive Level: Remembering

16. Parents of a child with cystic fibrosis want to know the chance of their next baby having this disease. What response by the healthcare professional is most accurate?

A Cystic fibrosis is an autosomal recessive inherited disorder. When two parents each have the trait (are carriers), each child will have a 25% chance of having normal genes and being unaffected, a 50% chance of inheriting one of the mutated genes and being a carrier, and a 25% chance of inheriting the mutated gene from both parents and having the disease. PTS: 1 DIF: Cognitive Level: Remembering

16. What period follows depolarization of the myocardium and represents a period during which no new cardiac potential can be propagated?

A During the absolute refractory period, no new cardiac action potential can be initiated by a stimulus. The other options do not reflect the time period in which no stimulation will produce a new cardiac potential. PTS: 1 DIF: Cognitive Level: Remembering

37. A patient has been diagnosed with an empyema. What does the healthcare professional tell the patient about this condition?

A Empyema is the presence of pus in the pleural space. The usual treatment is drainage of the pleural space with a chest tube and administration of antibiotics (not antivirals). Blebs are the cause of some cases of spontaneous pneumothorax and they can rupture with exercise. Respiratory muscle fatigue may develop with empyema, but this is a vague finding not directly related to empyema. PTS: 1 DIF: Cognitive Level: Understanding

27. What is the function of erythrocytes?

A Erythrocytes are solely responsible for tissue oxygenation. Hemostasis occurs due to the actions of multiple substances such as fibrin, collagen, and clotting factors. Infection control and allergic responses are mediated by white blood cells. PTS: 1 DIF: Cognitive Level: Remembering MULTIPLE RESPONSE

18. The lung is innervated by the parasympathetic nervous system via which nerve?

A Fibers of the parasympathetic division of the autonomic nervous system (ANS) travel in the vagus nerve to the lung. PTS: 1 DIF: Cognitive Level: Remembering

11. A healthcare professional has educated a student on folic acid. Which statement by the student indicates that more teaching is needed?

A Folic acid absorption is not dependent on the enzyme folacin. The professional would need to provide more teaching if the student made this statement. The other options are true statements regarding folic acid. PTS: 1 DIF: Cognitive Level: Evaluating

11. When diagnosed with hemolytic disease of the fetus and newborn (HDFN), why does the newborn develop hyperbilirubinemia after birth but not in utero?

A Hyperbilirubinemia occurs in the neonate after birth because excretion of lipid-soluble unconjugated bilirubin through the placenta is no longer possible. HDFN is not related to hemoglobin failing to breakdown, an immature liver, or destruction of erythrocytes being greater after birth. PTS: 1 DIF: Cognitive Level: Remembering

30. A patient has leukemia. The healthcare professional explains to a patient about the significance of hyperdiploidy. What statement by the professional is most accurate?

A Hyperdiploidy (increased number of chromosome copies) is associated with a good prognosis. The other options are incorrect regarding the significance of hyperdiploidy. PTS: 1 DIF: Cognitive Level: Understanding MULTIPLE RESPONSE

25. What does treatment for polycythemia vera involve?

A In low-risk individuals, the recommended therapy is phlebotomy and low-dose aspirin, whereas radioactive phosphorus has been used to suppress erythropoiesis. Plasma expanders, cyanocobalamin, and blood transfusions are not treatments for this disease. PTS: 1 DIF: Cognitive Level: Remembering

1. Why is nasal congestion a serious threat to young infants?

A Infants up to 2 to 3 months of age are obligatory nose breathers and are unable to breathe in through their mouths. Nasal congestion is therefore a serious threat to a young infant. This selection is the only option that accurately describes why nasal congestion is a serious threat to young infants. Although infants' nares are smaller than older children, this is not the main reason why congestion poses such a threat. Becoming dehydrated also is not a factor. The size of their epiglottis is also not as big a factor in young infants. PTS: 1 DIF: Cognitive Level: Remembering

13. What is the initial manifestation of aortic coarctation observed in a neonate?

A Initially, the newborn usually exhibits symptoms of HF. Cor pulmonale, pulmonary hypertension, and cerebral hypertension are not associated with coarctation of the aorta. PTS: 1 DIF: Cognitive Level: Remembering

21. A patient has microcytic, hypochromic anemia. Which type of treatment or procedure does the healthcare professional discuss as a potential cure with the patient?

A Microcytic, hypochromic anemia is one manifestation of thalassemia. The only definitive cures for this disorder are allogeneic hematopoietic stem cell transplantation (HSCT) from a matched family or unrelated donor or cord blood transplantation from a related donor. Gamma globulins protect the body against infectious diseases. Blood transfusions can be used to correct low hemoglobin. Rho-GAM is used in postpartum women who are Rh-negative after delivering an Rh-positive baby to prevent development of maternal antibodies against the baby's blood. PTS: 1 DIF: Cognitive Level: Applying

7. What are blood cells that differentiate into macrophages known as?

A Monocytes migrate into a variety of tissues and fully mature into tissue macrophages and myeloid dendritic cells. Neutrophils, eosinophils, and basophils do not undergo this transformation. PTS: 1 DIF: Cognitive Level: Remembering

19. A student asks the professor what the most common pathophysiologic process is that triggers aplastic anemia (AA). What response by the professor is most accurate?

A Most cases of AA result from an autoimmune disease directed against hematopoietic stem cells. Tc cells appear to be the main culprits in this process. AA does not include proliferation of erythrocytes. The autoimmune process seems to be mediated by alterations in CD4+, CD8+, and Th-17 T-cell responses and reduced numbers of regulatory T cells. Only a small percentage of patients have an inherited or familial form. PTS: 1 DIF: Cognitive Level: Understanding

39. A patient has silicosis. Which medication classification does the healthcare professional educate the patient about?

A No specific treatment exists for silicosis, although corticosteroids may produce some improvement in the early, more acute stages. Patients with silicosis are not usually treated with antibiotics, bronchodilators, or expectorants unless individual circumstances warrant these drugs. PTS: 1 DIF: Cognitive Level: Understanding

6. Older children with an unrepaired cardiac septal defect experience cyanosis because of which factor?

A Older children who have an unrepaired septal defect with a left-to-right shunt may become cyanotic because of pulmonary vascular changes secondary to increased pulmonary blood flow. Left-to-right shunts are usually acyanotic. Obstructive and mixed lesions vary in their presentation but obstructive lesions do not include shunting. PTS: 1 DIF: Cognitive Level: Remembering

3. Which blood cell type is elevated at birth and through the preschool years, but decreases to adult levels afterward?

A Only monocyte counts are high in the newborn and through the preschool years. After this time period, they decrease to adult levels. PTS: 1 DIF: Cognitive Level: Remembering

34. Pulmonary artery hypertension (PAH) results from which alteration?

A PAH is characterized by endothelial dysfunction with an overproduction of vasoconstrictors (e.g., thromboxane, endothelin) and decreased production of vasodilators (e.g., nitric oxide, prostacyclin), resulting in narrowed pulmonary capillaries. This process does not occur in bronchi and bronchioles and does not include destruction of the alveoli or ischemia of the myocardium. PTS: 1 DIF: Cognitive Level: Remembering

38. Fluid in the pleural space characterizes which condition?

A Pleural effusion is the presence of fluid in the pleural space. Atelectasis is the collapse of small airways. Bronchiectasis is persistent and abnormal dilation of bronchi. Ischemia is inadequate blood supply to the tissues. PTS: 1 DIF: Cognitive Level: Remembering

7. A healthcare professional is caring for four patients. Which patient does the professional assess for pulmonary emboli (PE) as the priority?

A Pulmonary emboli originate in the venous circulation (mostly from the deep veins of the legs) or in the right heart. While any patient can develop a PE, the patients with endocarditis, valvular disease, and left heart failure do not have as big a risk as the patient with the deep vein thrombosis. PTS: 1 DIF: Cognitive Level: Understanding

31. A patient is diagnosed with chronic obstructive pulmonary disease (COPD) and has elevated pulmonary vascular resistance. Which complication would the health care professional assess the patient for?

A Right heart failure is most often caused by left heart failure, but if it occurs in isolation it is usually due to pulmonary conditions such as pulmonary hypertension, COPD, or cystic fibrosis. The professional would assess the patient for this condition at healthcare visits. Eventually the left side of the heart will fail if right-sided failure is left untreated. Restrictive cardiomyopathy is caused by infiltrative diseases. Hypertrophic cardiomyopathy is caused by hypertension. PTS: 1 DIF: Cognitive Level: Applying

8. A hospitalized patient's lab work is as follows: WBC 2000, bands 14.8%, and segmented neutrophils 5. The healthcare professional calculates the patient's absolute neutrophil count (ANC). What action does the professional take next?

A The ANC is calculated by multiplying the white blood cell count by the sum of the bands and segmented neutrophils. This patient's ANC is 396, placing him or her at extremely high risk of developing a life-threatening infection. Visitors may need to be limited but that will not protect the patient from all sources of infection. The patient's medications would not all be held because of this finding. PTS: 1 DIF: Cognitive Level: Analyzing

12. A professor explains to a class that the reason lymph nodes enlarge and become tender during infection is because of what reason?

A The B lymphocyte proliferation in response to significant antigen (e.g., during infection) may result in lymph node enlargement and tenderness (reactive lymph node). The nodes are not specifically inflamed or filled with purulent exudate. PTS: 1 DIF: Cognitive Level: Understanding

28. The Bainbridge reflex is thought to be initiated by sensory neurons in which cardiac location?

A The Bainbridge reflex causes changes in the heart rate after intravenous infusions of blood or other fluid. The changes in heart rate are thought to be caused by a reflex mediated by volume receptors found only in the atria that are innervated by the vagus nerve. PTS: 1 DIF: Cognitive Level: Remembering

23. The alpha- and beta-thalassemias are considered what types of inherited disorder?

A The alpha- and beta-thalassemias are inherited autosomal recessive disorders. PTS: 1 DIF: Cognitive Level: Remembering

29. A healthcare professional cares for older adults in a skilled nursing facility. What should the professional assess for in these individuals related to cardiovascular functioning?

A The baroreceptor reflex is important in blood pressure control. Baroreceptor activity can decrease with age, slowing response to changes in blood pressure and posture. An older adult may not adjust rapidly to position changes, leading to falls and dizzy spells. PTS: 1 DIF: Cognitive Level: Remembering

11. The coronary sinus empties into which cardiac structure?

A The cardiac veins empty only into the right atrium through another ostium, the opening of a large vein called the coronary sinus. PTS: 1 DIF: Cognitive Level: Remembering

29. A patient with emphysema comes to the clinic and reports increased, productive cough. What diagnostic test should the healthcare professional facilitate as the priority?

A The cough in emphysema is generally not productive, unless the patient has an acute exacerbation, which can be caused by a pulmonary infection. The best way to diagnose an infection such as pneumonia is with a chest x-ray. A sputum culture would be helpful to specify the organism for tailored treatment, but is not required for the diagnosis. Pulmonary function studies might be ordered later to see if the patient's disease has progressed, but would not be ordered during an acute illness. Peak expiratory flow is usually used to monitor asthma. The professional should expedite a chest x-ray. PTS: 1 DIF: Cognitive Level: Analyzing

10. How is the effectiveness of vitamin B12 therapy measured?

A The effectiveness of cobalamin replacement therapy is determined by a rising reticulocyte count. The other options are not used as indicators of the effectiveness of vitamin B12 therapy PTS: 1 DIF: Cognitive Level: Remembering

9. Occlusion of the left anterior descending artery during a myocardial infarction would interrupt blood supply to which structures?

A The left anterior descending artery (LAD), also called the anterior interventricular artery, delivers blood to portions of the left and right ventricles and much of the interventricular septum. The circumflex artery supplies the left atrium and lateral wall of the left ventricle. The right coronary artery supplies the right ventricle and one of its branches is the right marginal branch. The interventricular sulcus and smaller branches of both ventricles are also supplied by the right coronary artery. PTS: 1 DIF: Cognitive Level: Remembering

6. Bronchiolitis tends to occur during the first years of life and is most often caused by what type of infection?

A The most common associated pathogen is RSV, but bronchiolitis may also be associated with adenovirus, rhinovirus, influenza, parainfluenza virus (PIV), and Mycoplasma pneumoniae. PTS: 1 DIF: Cognitive Level: Remembering

21. What is the most important cause of pulmonary artery constriction?

A The most important cause of pulmonary artery constriction is a low alveolar PaO2. PTS: 1 DIF: Cognitive Level: Remembering

2. The presence of the foramen ovale in a fetus allows what to occur?

A The nonfused septum secundum and ostium secundum result in the formation of a flapped orifice known as the foramen ovale, which allows the right-to-left shunting necessary for fetal circulation. The foramen ovale is not involved in left-to-right shunting, blood flow from the umbilical cord, or blood flow to the lungs. PTS: 1 DIF: Cognitive Level: Remembering

23. The student learns that Langerhans cells are only found in which organ?

A The skin is the only location for Langerhans cells. PTS: 1 DIF: Cognitive Level: Remembering

2. Which cardiac chambers have the thinnest wall and why?

A The two atria have the thinnest walls because they are low-pressure chambers that serve as storage units and conduits for blood that is emptied into the ventricles. The ventricles have thicker walls in order to pump blood against resistance. PTS: 1 DIF: Cognitive Level: Remembering

17. A healthcare professional is reviewing a patient's laboratory results and sees that the patient has a low reticulocyte count and a high iron level. Which type of anemia does the professional associate these findings with?

A These results are characteristic of folate deficiency. Iron deficiency would manifest with normal reticulocyte count and high iron. Hemolytic anemia would show high reticulocyte count and normal or high iron levels. Anemia of chronic disease would have a normal reticulocyte count but low iron levels. PTS: 1 DIF: Cognitive Level: Remembering

23. Within a physiologic range, what does an increase in left ventricular end-diastolic volume (preload) result in?

A This concept is expressed in the Frank-Starling law; the cardiac muscle, like other muscles, increases its strength of contraction when it is stretched. An inotropic substance would increase the force of contraction and consist of hormones, neurotransmitters, or medications, and do not include volume. Afterload is the force against which the heart must pump. A decrease in repolarization would affect electrical activity. PTS: 1 DIF: Cognitive Level: Remembering

10. A person comes to the healthcare clinic and reports night sweats and fever. The healthcare professional obtains a chest x-ray which shows a mediastinal mass. What other assessment or diagnostic test does the professional provide as a priority?

A This patient has signs of Hodgkin lymphoma (HL). Pericardial involvement can lead to pericardial friction rub and pericardial effusion. The professional should listen to the patient's heart for the sounds that characterize these conditions. The patient may demonstrate itchy skin lesions, but this would not take priority over heart sounds. Familial DNA testing would not be a priority. Anemia accompanies many healthcare conditions and so would be nonspecific for HL. PTS: 1 DIF: Cognitive Level: Applying MULTIPLE RESPONSE

26. An adult patient has been hospitalized with thrombocytopenia with a platelet count of 8000/mm3. What action by the healthcare professional is most appropriate?

A Thrombocytopenia is a platelet count of less than 150,000/mm3. A platelet count of 8,000/mm3 is low enough to produce spontaneous bleeding, which would be devastating if it occurred in the brain. The healthcare professional should advise the patient not to get out of bed without assistance to help prevent falls. Whole blood is not needed since only platelets are deficient. The patient would not receive heparin as this would increase the chance of bleeding. A normal platelet count in an adult is 150,000 to 350,000/mm3. PTS: 1 DIF: Cognitive Level: Applying

28. A patient is 8 hours postoperative after a long orthopedic procedure. The student asks why this patient is at particular risk of developing a thromboembolism. What response by the healthcare professional is best?

A Thromboembolic events are caused by some component of Virchow triad: endothelial injury, abnormal blood flow, and hypercoagulability of the blood. Long operative procedures such as orthopedic cases promote venous stasis. Anesthetic agents are not implicated. Endothelial repair is not appreciably hindered by postoperative pain. Atherosclerotic buildup can lead to endothelial injury but that is not specific to this patient. PTS: 1 DIF: Cognitive Level: Understanding

4. Which of these describes how the body compensates for anemia?

A Tissue hypoxia from anemia creates additional demands and compensatory actions on the pulmonary and hematologic systems. The rate and depth of breathing increase in an attempt to increase the availability of oxygen. The body does not compensate by decreasing vasoconstriction, tightening the hemoglobin bonds with oxygen, or releasing more erythropoietin. PTS: 1 DIF: Cognitive Level: Remembering

17. Which condition is consistent with the cardiac defect of transposition of the great vessels?

A Transposition of the great arteries refers to a condition in which the aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle. A transposition of the great vessels is not associated with the pulmonary trunk arising from the RV, the RV pumping blood into the lungs, or an intermittent murmur. PTS: 1 DIF: Cognitive Level: Remembering

13. What is the name of the disorder in which levels of bilirubin remain excessively high in the newborn and are deposited in the brain?

A Without replacement transfusions, during which the child receives Rh-negative erythrocytes, the bilirubin is deposited in the brain, a condition called kernicterus. This is the only condition where bilirubin is deposited in the brain. PTS: 1 DIF: Cognitive Level: Remembering

4. The two major forms of leukemia, acute and chronic, are classified by which criteria? (Select all that apply.)

A, B The current classification of leukemia is based on (1) the predominant cell of origin (either myeloid or lymphoid) and (2) the rate of progression. A person's age, stage of cell development at the onset of malignancy, and serum blood levels of leukocytes are not part of the classification of leukemias. PTS: 1 DIF: Cognitive Level: Remembering

5. What are the clinical manifestations of advanced non-African Burkitt lymphoma? (Select all that apply.)

A, B, C In non-African Burkitt lymphoma, the most common presentation is abdominal swelling. More advanced disease may exhibit night sweats, fever, and weight loss. Dementia is not associated with this disease. PTS: 1 DIF: Cognitive Level: Remembering

1. A healthcare professional is evaluating laboratory results for a patient who has disseminated intravascular coagulation (DIC). What results would the professional consider consistent with this condition? (Select all that apply.)

A, B, C Lab results consistent with DIC include elevated d-dimer and creatinine (showing kidney damage), and decreased protein C. The lactate dehydrogenase would be elevated and the pH would be decreased. PTS: 1 DIF: Cognitive Level: Remembering

4. What does the student learn regarding the role of the endothelium in clot formation? (Select all that apply.)

A, B, C The surface of the endothelium produces plasma protease inhibitors to resist clot formation. Thrombomodulin is a membrane thrombin-binding protein matter and is converted to activated protein C on the surface of endothelial cells. Protein C in the circulation binds to thrombomodulin. Activated protein C inhibits the adhesion of neutrophils to the endothelium. PTS: 1 DIF: Cognitive Level: Remembering

2. The student learns that which inflammatory mediators are produced in asthma? (Select all that apply.)

A, B, C, D A large number of inflammatory mediators, such as histamine, bradykinins, prostaglandins, and leukotrienes, are produced by asthma. Neutrophil proteases are not produced in relationship to asthma. PTS: 1 DIF: Cognitive Level: Remembering

3. A healthcare professional who works in a senior center knows about the effects of aging on the pulmonary system, which include which of these? (Select all that apply.)

A, B, C, D Aging affects the mechanical aspects of ventilation by decreasing chest wall compliance and elastic recoil of the lungs. Changes in these elastic properties reduce ventilatory reserve. Aging causes the PaO2 to decrease but does not affect the partial pressure of arterial carbon dioxide (PaCO2) or respiratory rate. PTS: 1 DIF: Cognitive Level: Remembering

2. What factors contribute to the development of orthostatic hypotension? (Select all that apply.)

A, B, C, D Orthostatic hypotension may be acute or chronic. Acute orthostatic hypotension (temporary type) may result from (1) altered body chemistry, (2) drug action (e.g., antihypertensives, antidepressants), (3) prolonged immobility caused by illness, (4) starvation, (5) physical exhaustion, (6) any condition that produces volume depletion (e.g., massive diuresis, potassium or sodium depletion), and (7) venous pooling (e.g., pregnancy, extensive varicosities of the lower extremities). Older adults are susceptible to this type of orthostatic hypotension, in which postural reflexes are slowed as part of the aging process. Volume overload would not produce orthostatic hypotension. PTS: 1 DIF: Cognitive Level: Remembering

7. A patient has pneumonia. For which clinical manifestations should the healthcare professional assess for? (Select all that apply.)

A, B, C, D Pneumonia is characterized by inspiratory crackles, increased tactile fremitus (palpable chest vibrations), egophony (a voice sound heard on auscultation as a prolonged "a" over consolidated lung tissue when a person says "e"), and whispered pectoriloquy (the sound of whispering heard on auscultation over consolidated lung tissue which are normally not heard). An absence of breath sounds would not be consistent with this disease process. PTS: 1 DIF: Cognitive Level: Remembering Chapter 33: Alterations of Cardiovascular Function McCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th Edition MULTIPLE CHOICE

1. Which information regarding fatty streaks does the pathophysiology student learn? (Select all that apply.)

A, B, C, D The oxidized LDLs penetrate the intima of the arterial wall and are engulfed by macrophages. Macrophages filled with oxidized LDLs are called foam. Once these lipid-laden foam cells accumulate in significant amounts, they form a lesion called a fatty streak. Once formed, fatty streaks produce more toxic oxygen radicals and cause immunologic and inflammatory changes, resulting in progressive damage to the vessel wall. They are not formed by killer T cells. PTS: 1 DIF: Cognitive Level: Remembering

2. A pediatric patient presents with pallor, fatigue, fever, petechiae, and purpura. What diagnostic testing does the healthcare professional help prepare the patient for? (Select all that apply.)

A, B, C, D This child has manifestations of a leukemia. Since hemoglobin and platelets may be low and white cells may be very high, a complete blood count will be done. Renal failure occurs frequently in ALL so renal function studies will be ordered. A bone marrow biopsy will be done in order to differentiate the type of leukemia the child has. A chest x-ray will be helpful to evaluate the cause of the fever which could be from an infection. Joint aspiration is not needed. PTS: 1 DIF: Cognitive Level: Remembering Chapter 36: Alterations of Pulmonary Function McCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th Edition MULTIPLE CHOICE

5. A patient is diagnosed in the Emergency Department with a flail chest. Which assessment findings would the healthcare professional expect to find in this patient? (Select all that apply.)

A, B, C, E A flail chest results from the fracture of several consecutive ribs in more than one place or the fracture of the sternum and several consecutive ribs. The loss of bony integrity of the chest wall leads to paradoxical chest wall movement during respiration. PTS: 1 DIF: Cognitive Level: Remembering

1. What are the common triggers for sickle cell crisis? (Select all that apply.)

A, B, C, E Crises can be prevented by avoiding fever, infection, acidosis, dehydration, constricting clothes, and exposure to cold. PTS: 1 DIF: Cognitive Level: Remembering

4. Which of these cause the airway epithelium to constrict? (Select all that apply.)

A, B, C, E Epithelial constriction can be caused by histamines, prostaglandins, alveolar acidosis, and serotonins. PTS: 1 DIF: Cognitive Level: Remembering Chapter 32: Structure and Function of the Cardiovascular and Lymphatic Systems McCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th Edition MULTIPLE CHOICE

3. The student studying pathophysiology learns which facts about leukemias? (Select all that apply.)

A, B, C, E In the leukemias, a single progenitor cell undergoes malignant transformation. The common feature of all forms of leukemia is an uncontrolled proliferation of malignant leukocytes, causing an overcrowding of bone marrow and decreased production and function of normal hematopoietic cells. PTS: 1 DIF: Cognitive Level: Remembering

2. Which statements about plasma proteins are correct? (Select all that apply.)

A, B, C, E Plasma proteins do not create hydrostatic pressure. The other options are all accurate statements regarding plasma proteins. PTS: 1 DIF: Cognitive Level: Remembering

2. What does the pathophysiology student learn about the respiratory process referred to as remodeling? (Select all that apply.)

A, B, C, E Remodeling is a process by which the vascular wall becomes scarred and thickened, thus resulting in permanent decreases in luminal diameter, increased resistance to blood flow, and permanent pulmonary artery hypertension. PTS: 1 DIF: Cognitive Level: Remembering

1. Which statements are true concerning the method in which substances pass between capillaries and the interstitial fluid? (Select all that apply.)

A, B, C, E Substances pass between the capillary lumen and the interstitial fluid in several ways: (1) through junctions between endothelial cells, (2) through fenestrations in endothelial cells, (3) in vesicles moved by active transport across the endothelial cell membrane, or (4) by diffusion through the endothelial cell membrane. PTS: 1 DIF: Cognitive Level: Remembering Chapter 34: Alterations of Cardiovascular Function in Children McCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th Edition MULTIPLE CHOICE

2. Which symptoms meet the diagnostic criteria for Kawasaki disease in a child? (Select all that apply.)

A, B, C, E The child must exhibit five of these six criteria: (1) fever for 5 days or longer, (2) bilateral conjunctival infection without exudation, (3) changes in oral mucus such as strawberry tongue, (4) a polymorphous rash, (5) cervical lymphadenopathy, and (6) changes in the extremities such as peripheral edema. PTS: 1 DIF: Cognitive Level: Remembering 3. Which statements related to the ambulatory blood pressure monitoring (ABPM) system with children are true? (Select all that apply.) ANS: A, B, C, D ABPM records blood pressure over a 24-hour period to help identify those children with white coat hypertension and masked hypertension. ABPM is useful in documenting the blood pressure load, which is the total amount of time the blood pressure is elevated above normal limits during a 24-hour period. By measuring blood pressure load, the ABPM may be able to identify those children who are at greatest risk for target organ damage. PTS: 1 DIF: Cognitive Level: Remembering Chapter 31: Alterations of Hematologic Function in Children McCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th Edition MULTIPLE CHOICE

4. What are the clinical manifestations of bacterial pneumonia in children? (Select all that apply.)

A, B, C, E The clinical presentation of bacterial pneumonia, particularly pneumococcal, may include a preceding viral illness, followed by fever with chills and rigors, shortness of breath, and an increasingly productive cough. Auscultation usually reveals such abnormalities as crackles or decreased breath sounds. Other less specific findings may include malaise, emesis, abdominal pain, and chest pain. Respiratory alkalosis is not usually associated with bacterial pneumonia in children. PTS: 1 DIF: Cognitive Level: Remembering

3. What are the primary anticoagulant mechanisms? (Select all that apply.)

A, B, D The major regulatory factors that control hemostasis reside where the greatest probability of clotting would occur—on the endothelial cell surface. The primary anticoagulant mechanisms include thrombin inhibitors (e.g., antithrombin III), tissue factor inhibitors (e.g., tissue factor pathway inhibitor), and mechanisms for degrading activated clotting factors (e.g., protein C). Hematopoiesis and phagocytosis are processes that are not related to anticoagulation. PTS: 1 DIF: Cognitive Level: Remembering

5. A person wishes to reduce the risk of developing varicose veins. What does the health care professional advise this person? (Select all that apply.)

A, B, D Varicose veins result from incompetent valves, venous obstruction, muscle pump dysfunction, or a combination of these. Standing for prolonged periods of time and being overweight increase the hydrostatic pressure and lead to the characteristic remodeling of the vein. Wearing compression stockings can help by maintaining venous return from the legs. Drinking inadequate fluids is not a risk factor. Sitting for prolonged periods of time is a risk factor. PTS: 1 DIF: Cognitive Level: Understanding

2. A healthcare professional is caring for five patients. Which one would the professional assess for disseminated intravascular coagulation (DIC) as the priority? (Select all that apply.)

A, B, D, E Common causes of DIC include heat stroke, severe pancreatitis, HELLP syndrome (and other OB complications), and snake bite. A normal term delivery would not put a patient at high risk for developing DIC. PTS: 1 DIF: Cognitive Level: Remembering Chapter 28: Structure and Function of the Hematologic System McCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th Edition MULTIPLE CHOICE

1. A patient has dyspnea. Which of these should the healthcare professional assess the patient for? (Select all that apply.)

A, B, D, E Dyspnea is a subjective feeling of difficulty in breathing. Triggers include decreased PaO2, heart disease, anxiety, and pain among others. Nasal surgery or trauma might impair nose breathing, but should not cause dyspnea as the person should be able to breathe through the mouth. PTS: 1 DIF: Cognitive Level: Understanding

2. Children diagnosed with acute asthma are likely to exhibit which symptoms? (Select all that apply.)

A, B, D, E On physical examination, expiratory wheezing that is often described as high pitched and musical is exhibited, along with prolongation of the expiratory phase of the respiratory cycle. Hyperinflation is sometimes visible. The respiratory rate is elevated, as is the heart rate. Nasal flaring and accessory muscle use are evident, with retractions in the substernal, subcostal, intercostal, suprasternal, or sternocleidomastoid areas. Infants may appear to be "head bobbing" because of sternocleidomastoid muscle use. Pulsus paradoxus may also be present. The child may appear anxious or diaphoretic, which are important signs of respiratory compromise. Clubbing of fingers and toes is not typically associated with asthma as it is caused by chronic hypoxemia. PTS: 1 DIF: Cognitive Level: Remembering

7. A student is learning about the functions of leukocytes. What statements about these cells are correct? (Select all that apply.)

A, B, E Eosinophilia can occur from parasitic infections or ingestion/inhalation of toxic particles. Basophilia occurs in hypersensitivity reactions because of the release of histamine. Monocytosis occurs in chronic infections or in the later stage of other infections. Lymphocytosis occurs in chronic infections, leukemia, lymphoma, and viral infections. Granulocytosis can be life-threatening if the person's defenses are so inadequate that sepsis results. PTS: 1 DIF: Cognitive Level: Applying

6. A patient has been diagnosed with tuberculosis (TB). What does the student know about this condition? (Select all that apply.)

A, B, E TB is a common worldwide health problem, but in the United States, most cases of TB are seen in foreign-born individuals. TB is rapidly developing multi-drug resistance. It is transmitted through inhaling infectious droplets. A positive skin test demonstrates exposure to TB, not specifically active disease; a chest x-ray is needed for confirmation. Treatment does consist of a multiple antibiotic regime. PTS: 1 DIF: Cognitive Level: Remembering

1. Which structures belong to the upper conduction airway? (Select all that apply.)

A, C The conducting airways are the portion of the pulmonary system that provides a passage for the movement of air into and out of the gas-exchange portions of the lung. The nasopharynx, oropharynx, and related structures are often called the upper airway. The larynx connects the upper and lower airways. The trachea connects the larynx to the bronchi, which are the conducting airways for the lungs. PTS: 1 DIF: Cognitive Level: Remembering

6. A person has lab drawn and the white blood cell count is much higher than normal. The healthcare professional understands which facts about this finding? (Select all that apply.)

A, C, D Leukocytosis is a higher than normal white blood cell count and can indicate physiological stress, an infection, or a malignancy such as a myeloproliferative disorder. Leukopenia is a lower than normal white cell count. Depending on the rest of the person's history and physical examination, a bone marrow biopsy may or may not be needed. PTS: 1 DIF: Cognitive Level: Applying

1. What congenital heart defects are associated with intrauterine exposure to rubella? (Select all that apply.)

A, C, D PS, PDA, and COA are congenital heart defects associated with intrauterine exposure to rubella. Cardiomegaly and VSD are associated with maternal diabetes. PTS: 1 DIF: Cognitive Level: Remembering

4. What does the student learn about exudative pleural effusion? (Select all that apply.)

A, C, D, E Exudative effusion is less watery and contains high concentrations of white blood cells and plasma proteins. Exudative effusion occurs in response to inflammation, infection, or malignancy and involves inflammatory processes that increase capillary permeability. The exudate is thin or watery. PTS: 1 DIF: Cognitive Level: Remembering

1. Which classic clinical manifestations are symptoms of infectious mononucleosis (IM)? (Select all that apply.)

A, C, E At the time of diagnosis, the individual usually has the classic triad of symptoms: fever, pharyngitis, and lymphadenopathy of the cervical lymph nodes. The triad does not include hepatitis or orbital edema. PTS: 1 DIF: Cognitive Level: Remembering

8. A student studying microbiology learns which facts about the Epstein-Barr virus (EBV)? (Select all that apply.)

A, C, E EBV has been implicated as a causative organism for infectious mononucleosis, Burkitt lymphoma, some rare non-Burkitt lymphomas, and nasopharyngeal cancer. PTS: 1 DIF: Cognitive Level: Remembering

5. A health professions student learns which facts about the pediatric differences in the respiratory system? (Select all that apply.)

A, C, E There are several age-related differences to consider when working with children. Chest wall compliance is higher in infants than it is in adults, particularly in premature infants. Immunological immaturity makes infants and small children more susceptible to infection. Until 2 to 3 months of age, infants are obligatory nose breathers which increases their risk for obstruction and poor gas exchange. A child grows and develops more alveoli until between 5 to 8 years of age. Airway obstruction does occur sooner in infants because an infant's airway is smaller in general and in any airway; resistance is proportional to the inverse of the fourth power of the radius; thus a decrease to half the original diameter increases resistance by 16-fold. PTS: 1 DIF: Cognitive Level: Remembering Chapter 35: Structure and Function of the Pulmonary System McCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th Edition MULTIPLE CHOICE

3. Which symptoms are least likely to be assessed in a child with croup? (Select all that apply.)

A, E Typically, a prodrome of rhinorrhea (not congestion), sore throat, and low-grade fever is exhibited for a few days with croup. The child then develops the characteristic harsh (seal-like) barking cough, hoarse voice, and inspiratory stridor. Rhonchi are associated with lower respiratory diseases. PTS: 1 DIF: Cognitive Level: Remembering

20. A couple who both carry the sickle cell trait wish to have children. What does the healthcare professional tell them is the chance that each pregnancy will result in a child who has sickle cell disease (SCD)?

B A 25% chance exists with each pregnancy that a child born to two parents with sickle cell trait will have SCD. Genetic counseling enables people with SCD or with the sickle cell trait to make informed decisions about transmitting this genetic disorder to their offspring. PTS: 1 DIF: Cognitive Level: Understanding

10. Which condition is capable of producing alveolar dead space?

B A pulmonary embolus that impairs blood flow to a segment of the lung results in an area where alveoli are ventilated but not perfused, which causes alveolar dead space. Alveolar dead space is not the result of pulmonary edema, atelectasis, or pneumonia. PTS: 1 DIF: Cognitive Level: Remembering

18. In aplastic anemia (AA), pancytopenia develops as a result of what?

B AA is a critical condition characterized by pancytopenia, which is a reduction or absence of all three blood cell types, resulting from the failure or suppression of bone marrow to produce adequate amounts of blood cells. It is not related to lack of DNA. PTS: 1 DIF: Cognitive Level: Remembering

12. Which statement by the professor best describes acute respiratory distress syndrome (ARDS)?

B ARDS is a condition that can result from either a direct or indirect pulmonary insult. It is defined as respiratory failure of acute onset characterized by severe hypoxemia that is refractory to treatment with supplemental oxygen, bilateral infiltrates on chest x-ray imaging, and no evidence of heart failure, as well as decreased pulmonary compliance. The disorder with reversible airflow limitation is asthma. The disease with viscous mucus that lines the airways and other organs and tissues is cystic fibrosis. A surfactant deficiency occurs in RDS of the newborn. PTS: 1 DIF: Cognitive Level: Remembering

19. A patient has been diagnosed with acute respiratory distress syndrome (ARDS). For what other health condition should the healthcare professional assess this patient for as the priority?

B ARDS is a fulminant form of respiratory failure characterized by acute lung inflammation and diffuse alveolocapillary injury not attributed to heart failure or fluid overload. All disorders causing ARDS cause acute immune cell-mediated injury to the alveolocapillary membrane producing massive inflammation, increased capillary permeability, and alveolar flooding with protein-rich fluid that overwhelms ion channels and lymphatic removal of fluid. The most common predisposing factors for ARDS are genetic factors, sepsis, and multiple trauma (especially when multiple transfusions are received). However, there are many other causes, including pneumonia, burns, aspiration, cardiopulmonary bypass surgery, pancreatitis, drug overdose, smoke or noxious gas inhalation, oxygen toxicity, radiation therapy, and disseminated intravascular coagulation. Alcohol abuse and smoking are preventable environmental risk factors. PTS: 1 DIF: Cognitive Level: Applying

33. In systolic heart failure, what effect does the renin-angiotensin-aldosterone system (RAAS) have on stroke volume?

B Activation of the RAAS increases preload through the effects of aldosterone secretion, a sequela of the RAAS activity. RAAS also increases afterload through vasoconstriction mediated by angiotensin II. PTS: 1 DIF: Cognitive Level: Remembering

20. A patient who had a myocardial infarction is going to cardiac rehabilitation where progressive exercise is monitored by health care professionals. When would this patient be most vulnerable to injury and complications?

B After a myocardial infarction, healing takes place in a graduated fashion. Within 10 to 14 days, a collagen matrix is deposited as the beginning of a scar that is initially weak, mushy, and vulnerable to reinjury. It is during this time period, as the patient feels better and increases activity, that the scar is most susceptible to injury from increasing stress. PTS: 1 DIF: Cognitive Level: Remembering

1. What is the most abundant class of plasma protein?

B Albumin (approximately 60% of total plasma protein at a concentration of about 4 g/dL) is the most abundant plasma protein. PTS: 1 DIF: Cognitive Level: Remembering

24. The healthcare professional explains to a student that the amount of volume of blood in the heart is directly related to the _____ of contraction.

B As stated in the Frank-Starling law, the volume of blood in the heart at the end of diastole (the length of its muscle fibers) is directly related to the force (strength) of contraction during the next systole. This selection is the only option that accurately describes the relationship associated with the Frank-Starling law. PTS: 1 DIF: Cognitive Level: Understanding

24. Which immunoglobulin (Ig) may contribute to the pathophysiologic characteristics of asthma?

B Asthma is a familial disorder, and more than 100 genes have been identified that may play a role in the susceptibility of and the pathogenetic mechanisms that cause asthma, including those that influence the production of interleukin (IL)-4, IL-5, and IL-13; IgE; eosinophils; mast cells; adrenergic receptors; and leukotrienes. The pathophysiologic characteristics of asthma are not associated with other immunoglobulins. PTS: 1 DIF: Cognitive Level: Remembering

3. The student studying pathophysiology learns which fact about circulation at birth?

B At birth, gas exchange shifts from the placenta to the lungs. Systemic vascular resistance increases after birth and pulmonary resistance decreases. PTS: 1 DIF: Cognitive Level: Remembering

26. What change to the hematologic system is related to age?

B Blood composition changes little with age. A delay in erythrocyte replenishment may occur after bleeding, presumably because of iron deficiency. Lymphocyte function appears to decrease with age. Particularly affected is a decrease in cellular immunity. Platelet adhesiveness probably increases with age. PTS: 1 DIF: Cognitive Level: Remembering

20. An allogenic bone marrow transplantation remains the preferred method for treating which anemia?

B Bone marrow and, most recently, peripheral blood stem cell transplantation from a histocompatible sibling are the preferred treatments for the underlying bone marrow failure observed in aplastic anemias. This is not a treatment for polycythemia vera, sideroblastic anemia, or anemia of chronic disease. PTS: 1 DIF: Cognitive Level: Remembering

28. When does fetal erythrocyte production shift from the liver to the bone marrow?

B By the fifth month of gestation, hematopoiesis begins to occur in the bone marrow and increases rapidly until hematopoietic (red) marrow fills the entire bone marrow space. By the time of delivery, the bone marrow is the only significant site of hematopoiesis. PTS: 1 DIF: Cognitive Level: Remembering

18. What can shorten the conduction time of action potential through the atrioventricular (AV) node?

B Catecholamines speed the heart rate, shorten the conduction time through the AV node, and increase the rhythmicity of the AV pacemaker fibers. The vagal nerve is part of the sympathetic nervous system and stimulation will decrease heart rate. The SA node is responsible for generating the electrical activity of the heart, but is not responsible for the time it takes for it to travel through the AV node. PTS: 1 DIF: Cognitive Level: Remembering

20. Hypoventilation that results in the retention of carbon dioxide will stimulate which receptors in an attempt to maintain a normal homeostatic state?

B Central chemoreceptors indirectly monitor arterial blood by sensing changes in the pH of cerebrospinal fluid (CSF). The central chemoreceptors are sensitive to very small changes in the pH of CSF (equivalent to a 1 to 2 mmHg change in partial pressure of carbon dioxide [PCO2]) and are able to maintain a normal partial pressure of arterial carbon dioxide (PaCO2) under many different conditions, including strenuous exercise. The retention of carbon dioxide will not stimulate irritant receptors, peripheral chemoreceptors, or stretch receptors. PTS: 1 DIF: Cognitive Level: Remembering

15. A healthcare professional works with recent refugees. A mother brings in her children who have been diagnosed with iron deficiency anemia. What action by the professional is most appropriate?

B Children in developing countries often are affected by chronic parasite infestations that result in intestinal blood and iron loss that outpaces dietary intake. The professional should arrange testing for parasites in the newly arrived children. An iron-rich diet and iron supplements may be appropriate, but unless the cause is addressed, the problem will not be solved by those two actions. Weekly iron infusions are not needed. PTS: 1 DIF: Cognitive Level: Applying

7. A patient has long-standing pulmonary disease and chronic hypoxia. The student assesses the patient's fingertips and notices bulbous enlargement of the distal segment of the digits. How does the student document this finding?

B Clubbing is the selective bulbous enlargement of the end (distal segment) of a digit (finger or toe) and is commonly associated with diseases that interfere with oxygenation, such as bronchiectasis, cystic fibrosis, pulmonary fibrosis, lung abscess, and congenital heart disease. Edema is swelling caused by fluid retention. The normal angle of the fingernail at the nail plate/proximal end of the nail is 160 degrees or less. Angling would describe an angle of >180 degrees indicates clubbing. Osteoarthropathy is a generic term for any disease of bone or joint. PTS: 1 DIF: Cognitive Level: Remembering

24. What does the student learn about the role of collagen in the clotting process?

B Collagen and thrombin are particularly strong stimuli for platelet aggregation. Collagen does not initiate the clotting cascade, stimulate fibrin, or deactivate fibrinogen. PTS: 1 DIF: Cognitive Level: Remembering

5. Which event triggers congenital heart defects that cause acyanotic congestive heart failure?

B Congenital heart defects that cause acyanotic congestive heart failure usually involve left-to-right shunts. Right-to-left shunting causes hypoxemia and cyanosis. Obstructive and mixed lesions vary in their presentation, but obstructive lesions do not have shunting. PTS: 1 DIF: Cognitive Level: Remembering

5. A hospitalized patient is complaining of shortness of breath, but the student does not notice cyanosis. The patient's hemoglobin is 9 g/dL, so the student asks the healthcare professional to explain. The professional tells the student that what amount of hemoglobin must be desaturated before cyanosis occurs?

B Cyanosis generally develops when 5 g/dL of hemoglobin is desaturated, regardless of hemoglobin concentration. So even though the patient is anemic and has less oxygen-carrying capacity, if less than 5 g/dL of hemoglobin is desaturated, the patient will not show cyanosis. PTS: 1 DIF: Cognitive Level: Remembering

14. A patient has pernicious anemia and asks the healthcare professional to explain the disease. Which statement by the professional is most accurate?

B Dietary vitamin B12 is a large molecule that requires a protein secreted by parietal cells in the stomach (intrinsic factor [IF]) to transport across the ileum. Defects in IF production lead to decreased B12 absorption and pernicious anemia. A lack of certain foods (i.e., meat) might lead to iron-deficiency anemia. Vitamin C lack would not lead to anemia, but in a severe state could lead to scurvy. If the bone marrow had totally failed, that would be termed aplastic anemia. PTS: 1 DIF: Cognitive Level: Understanding

4. What is the process that ensures mitral and tricuspid valve closure after the ventricles are filled with blood?

B During ventricular relaxation, the two atrioventricular valves open and blood flows from the higher pressure atria to the relaxed ventricles. With increasing ventricular pressure, these valves close and prevent backflow into the atria as the ventricles contract. The chordae tendineae attach the bottom end of the AV valves to the papillary muscles. The endocardium covers beamlike projections of muscle tissue, called trabeculae carneae. The valves are not pulled closed by reduced atrial pressure. PTS: 1 DIF: Cognitive Level: Remembering

8. Which T-lymphocyte phenotype is the key determinant of childhood allergic asthma?

B Early onset allergic asthma is initiated by a type I hypersensitivity reaction primarily mediated by Th2 lymphocytes whose cytokines activate mast cells, eosinophilia, leukocytosis, and enhance B-cell IgE production. PTS: 1 DIF: Cognitive Level: Remembering

13. A patient in the healthcare clinic reports fatigue, weakness, and dyspnea, as well as pale conjunctiva of the eyes and brittle, concave nails. What assessment by the healthcare professional is most appropriate for the suspected anemia?

B Early symptoms of iron deficiency anemia (IDA) include fatigue, weakness, and shortness of breath. Pale earlobes, palms, and conjunctivae are also common signs. Progressive IDA causes more severe alterations, with structural and functional changes apparent in epithelial tissue. The nails become brittle, thin, coarsely ridged, and spoon-shaped or concave (koilonychia) as a result of impaired capillary circulation. The tongue becomes red, sore, and painful. The healthcare professional should assess the patient's mouth and tongue. Blood pressure and pulse readings would not be specific for any one type of anemia. Dysphagia (difficulty swallowing) could indicate pernicious anemia. Jaundice (most often seen in the sclera and on the skin) would be a characteristic of hemolytic anemia, although it is not always noticed. PTS: 1 DIF: Cognitive Level: Applying

3. The paresthesia that occurs in vitamin B12 deficiency anemia is a result of which of these?

B Effects on the nervous system can occur if a vitamin B12 deficiency causes anemia. Myelin degeneration may occur with the resultant loss of fibers in the spinal cord, producing paresthesia (numbness), gait disturbances, extreme weakness, spasticity, and reflex abnormalities. The paresthesia is not caused by reduction in acetylcholine receptors, destruction of myelin in peripheral nerves, or altered neuronal function in the parietal lobe. PTS: 1 DIF: Cognitive Level: Remembering

17. Which condition involves an abnormally enlarged gas-exchange system and the destruction of the lung's alveolar walls?

B Emphysema is abnormal permanent enlargement of gas-exchange airways (acini) accompanied by the destruction of alveolar walls without obvious fibrosis. An effusion is the presence of fluid in the pleural space that can be caused by hypoproteinemia (transudative) or malignancy, infection, or inflammation (exudative). An abscess is a collection of pus. PTS: 1 DIF: Cognitive Level: Remembering

7. How is erythroblastosis fetalis defined?

B Erythroblastosis fetalis, also known as hemolytic disease of the fetus and newborn (HDFN), is an alloimmune disease in which maternal blood and fetal blood are antigenically incompatible, causing the mother's immune system to produce antibodies against fetal erythrocytes. This selection is the only option that accurately defines erythroblastosis fetalis. PTS: 1 DIF: Cognitive Level: Remembering

29. A patient has been hospitalized for a large deep vein thrombosis and states he is the third person in his family to have this condition in the last 2 years. What response by the healthcare professional is most appropriate?

B Factor V Leiden results from a single nucleotide mutation of guanine to adenine at nucleotide 1691 (G1691A) and is the most common hereditary thrombophilia. It is autosomal dominant so would not be confined to one sex. Most people with this disorder do not have clinically significant events. PTS: 1 DIF: Cognitive Level: Applying MULTIPLE RESPONSE

15. The healthcare professional explains to a student that glucose 6-phosphate dehydrogenase (G6PD) deficiency is what type of inherited disorder?

B G6PD deficiency is an inherited, X-linked recessive disorder. PTS: 1 DIF: Cognitive Level: Understanding

6. How does hemolytic disease of the fetus and newborn (HDFN) cause acquired congenital hemolytic anemia?

B HDFN is an alloimmune disease in which maternal blood and fetal blood are antigenically incompatible, causing the mother's immune system to produce antibodies against fetal erythrocytes. Fetal erythrocytes that have been attacked by (or bound to) maternal antibodies are recognized as foreign or defective by the fetal mononuclear phagocyte system and are removed from the circulation by phagocytosis, usually in the fetal spleen. The other statements do not correctly explain this pathology. PTS: 1 DIF: Cognitive Level: Remembering

10. Which mother does the healthcare professional prepare to administer Rh immune globulin (Rho-GAM) to?

B Hemolytic disease of the fetus and newborn (HDFN) can occur only if antigens on fetal erythrocytes differ from antigens on maternal erythrocytes. Maternal-fetal incompatibility exists only if the mother and fetus differ in ABO blood type or if the fetus is Rh-positive and the mother is Rh-negative. The healthcare professional would plan to administer Rho-GAM to the mother who is Rh-negative whose baby is Rh positive. PTS: 1 DIF: Cognitive Level: Applying

13. A person wishes to reduce the risk of developing coronary artery disease. This person has a normal lipid panel. What risk factor reduction would the healthcare professional advise for this person?

B Hypertension is responsible for a twofold-to-threefold increased risk of atherosclerotic cardiovascular disease. Of the listed options, controlling blood pressure would have the greatest effect in reducing the risk of developing coronary artery disease. The person's lipid panel is already normal, so eating a low-fat diet is not the priority. Air pollution and ionizing radiation are considered novel risk factors. Although people should be advised to drink in moderation, alcohol is not a significant risk factor for coronary artery disease. PTS: 1 DIF: Cognitive Level: Understanding

27. A patient has primary immune thrombocytopenic purpura (ITP) and is hospitalized after a bleeding episode. What treatment does the healthcare provider anticipate being ordered for this patient?

B ITP is an autoimmune disorder of platelet consumption. In cases of bleeding, infusions of IV immune globulin are preferred with short bursts of steroids in severe disease. Blood transfusions will not be helpful; however platelet transfusions may be used. Anticoagulants would make the bleeding more dangerous for the patient. Folic acid does not help treat the underlying pathophysiology or relieve symptoms. PTS: 1 DIF: Cognitive Level: Understanding

14. An infant was born with hemolytic disease of the fetus and newborn (HDFN). What treatment does the healthcare professional anticipate for this baby?

B If antigenic incompatibility of the mother's erythrocytes is not discovered in time to administer Rh immunoglobulin and the child is born with HDFN, then the treatment consists of exchange transfusions in which the neonate's blood is replaced with new Rh-positive blood that is not contaminated with anti-Rh antibodies. This treatment is administered during the first 24 hours of extrauterine life to prevent kernicterus. Kernicterus is not prevented by diluting the blood with IV fluids, splenectomy, or by giving Rh-negative blood. PTS: 1 DIF: Cognitive Level: Remembering

19. A patient had a myocardial infarction that damaged the SA node, which is no longer functioning as the pacemaker of the heart. What heart rate would the healthcare provider expect the patient to have?

B If the SA node is damaged, then the AV node will become the heart's pacemaker at a rate of approximately 40 to 60 spontaneous depolarizations per minute. The SA node normally fires at a rate of 60 to 100 beats/min. The Purkinje fibers can function as the heart's pacemaker and will fire at a rate of around 40 beats/min. PTS: 1 DIF: Cognitive Level: Remembering

3. A healthcare professional is educating a community parent group and informs them that which type of croup is most common?

B In 85% of children with croup, a virus is the cause, most commonly parainfluenza. The healthcare professional would inform the parent group of this fact. PTS: 1 DIF: Cognitive Level: Remembering

15. A patient is brought to the Emergency Department with a gunshot wound to the chest. The healthcare professional assesses an abnormality involving a pleural rupture that acts as a one-way valve, permitting air to enter on inspiration but preventing its escape by closing during expiration. What action by the healthcare professional is the priority?

B In a tension pneumothorax, the site of pleural rupture acts as a one-way valve, permitting air to enter on inspiration but preventing its escape by closing up during expiration. As more and more air enters the pleural space, air pressure in the pneumothorax begins to exceed barometric pressure. Air pressure in the pleural space pushes against the already recoiled lung, causing compression atelectasis, and against the mediastinum, compressing and displacing the heart, great vessels, and trachea. This is an emergency condition requiring chest tube insertion or immediate needle decompression. Arterial blood gas results will not change the treatment plan. This patient may need oxygen if definitive treatment is delayed, but it would need to be high-flow oxygen. Clubbing of fingernails occurs in chronic hypoxemic conditions. The professional should assist with immediate needle decompression or chest tube insertion. PTS: 1 DIF: Cognitive Level: Applying

4. In a full-term infant, the normal erythrocyte life span is _____ days.

B In full-term infants, normal erythrocyte life span is 60 to 80 days. PTS: 1 DIF: Cognitive Level: Remembering

19. What is the most common predisposing factor to obstructive sleep apnea in children?

B In otherwise healthy children, the most common predisposing factor is adenotonsillar hypertrophy, which causes physical impingement on the nasopharyngeal airway. The other options are not associated with obstructive sleep apnea in children. PTS: 1 DIF: Cognitive Level: Remembering MULTIPLE RESPONSE

4. What pathologic change occurs to the kidney's glomeruli as a result of hypertension?

B In the kidney, ischemia causes inflammation and dysfunction of the glomeruli and tubules. This leads to increased sodium retention. Neither the renal tubules are compressed nor do they generate increased pressure. There is no obstruction. PTS: 1 DIF: Cognitive Level: Remembering

21. Pulmonary edema in acute respiratory distress syndrome (ARDS) is the result of an increase in what?

B Increased capillary permeability, a hallmark of ARDS, allows fluids, proteins, and blood cells to leak from the capillary bed into the pulmonary interstitium and alveoli. The resulting pulmonary edema and hemorrhage severely reduce lung compliance and impair alveolar ventilation. The pulmonary edema seen in ARDS is not the result of sodium and water concentrations, capillary hydrostatic pressure, or oncotic pressure. PTS: 1 DIF: Cognitive Level: Remembering

22. What electrocardiogram (ECG) change would the healthcare professional assess for when a patient's myocardial infarction extends through the myocardium from the endocardium to the epicardium?

B Individuals with this pattern on an ECG usually have significant elevations in the ST segments and are categorized as having STEMI (ST segment elevation myocardial infarction). A prolonged QT interval can lead to dysrhythmias. A prolonged PR interval is a benign first degree AV block. PTS: 1 DIF: Cognitive Level: Remembering

15. An infant diagnosed with a small patent ductus arteriosus (PDA) would likely exhibit which symptom?

B Infants with a small PDA usually remain asymptomatic. The infant may only have a murmur, but should be watched carefully in the future for worsening of the condition. PTS: 1 DIF: Cognitive Level: Remembering

2. When endothelial cells are injured, what alteration contributes to atherosclerosis?

B Injured endothelial cells become inflamed and cannot make normal amounts of antithrombotic and vasodilating cytokines. They do not release toxic oxygen radicals or develop hypersensitivity to homocysteine and lipids. PTS: 1 DIF: Cognitive Level: Remembering

7. A patient has defective secretion of the intrinsic factor leading to anemia. What treatment option does the healthcare professional discuss with the patient?

B Intrinsic factor (IF) is responsible for B12 uptake from the gut. A lack of IF leads to pernicious anemia, which is treated with vitamin B12 injections for the rest of the person's life. The injections are weekly at first the monthly. Increasing dietary iron would help with iron-deficiency anemia. A bone marrow transplant might be used to treat aplastic anemia. Better control of an underlying medical condition would be important in anemia of chronic disease. PTS: 1 DIF: Cognitive Level: Applying

29. A healthcare professional educates parents to monitor their child's dietary intake for sufficient iron during which period of time as the priority?

B Iron deficiency anemia is the most common blood disorder of infancy and childhood, with the highest incidence occurring between 6 months and 2 years of age. PTS: 1 DIF: Cognitive Level: Understanding

12. What term is used to identify when a cell is temporarily deprived of blood supply?

B Ischemia is a local state in which cells are temporarily deprived of blood supply. Infarction is cell death due to lack of blood flow caused by an obstruction in a vessel. Necrosis is death of cells or tissue from any cause. Inflammation is a local response that leads to redness, warmth, swelling, pain, and possibly loss of function. PTS: 1 DIF: Cognitive Level: Remembering

25. Which form of iron (Fe) can be used in the formation of normal hemoglobin?

B It is crucial that the iron be correctly charged; only reduced ferrous iron (Fe2+) can bind oxygen in the lungs and release it in the tissues. Fe+ is simple iron. Fe3+ is bound with oxygen. Fe4+ is ferryl iron. PTS: 1 DIF: Cognitive Level: Remembering

22. A student asks the professor to explain the jaundice that accompanies hemolytic anemia. Which statement is by the professor is most accurate?

B Jaundice (icterus) is present when heme destruction exceeds the liver's ability to conjugate and excrete bilirubin. Jaundice is not as directly related to the destruction of the erythrocytes. It is also not related to liver enzyme elevation or being coated with an immunoglobulin. PTS: 1 DIF: Cognitive Level: Understanding

15. Which substance primarily contains cholesterol and protein?

B LDLs contain primarily cholesterol and protein. VLDLs are primarily triglycerides and protein and HDLs are mainly phospholipids and proteins. Triglycerides are the major form of fat stored in the body. PTS: 1 DIF: Cognitive Level: Remembering

6. Local signs and symptoms of Hodgkin disease-related lymphadenopathy are a result of what?

B Local symptoms caused by pressure and obstruction of the lymph nodes are the result of lymphadenopathy. The other options do not contribute to the lymphadenopathy associated with Hodgkin disease. PTS: 1 DIF: Cognitive Level: Remembering

4. A patient is admitted to the hospital with multiple myeloma (MM). Which diagnostic test should the healthcare professional assess as the priority?

B Many clinical manifestations of MM are due to hypercalcemia. Since calcium can affect cardiac conduction, the priority diagnostic test is serum calcium levels. Bone destruction does occur in MM, but obtaining images of bones is not a higher priority than the calcium. The patient already has been diagnosed with MM, so a bone marrow biopsy may not be needed at this time. Potassium and other electrolytes will be assessed but not as the priority. PTS: 1 DIF: Cognitive Level: Applying

5. Which of these classified as a megaloblastic anemia?

B Megaloblastic anemia is characterized by a low red blood cell count and larger-than-normal red blood cells. Pernicious anemia is the most common type of megaloblastic anemia. Iron deficiency is a hypochromic, microcytic anemia meaning the red blood cells are pale and small. The red blood cells in sideroblastic anemia are not abnormally large; they have an abnormal ring of iron around the nucleus of the RBC. Hemolytic anemia is normochromic, normocytic anemia caused by blood loss. PTS: 1 DIF: Cognitive Level: Remembering

33. The student asks a professor to explain how tuberculosis (TB) can remain dormant in some people. What explanation by the professor is best?

B Neutrophils, lymphocytes, and macrophages seal off colonies of the TB bacilli, forming granulomatous tubercles of scar tissue that isolates them. In this manner, and with developing immunity, TB can remain dormant sometimes for years or for life. Some bacilli are killed by host defenses but not enough to rid to body of the disease. Macrophages do phagocytize some of the bacilli. Virulence factors do not weaken over time. PTS: 1 DIF: Cognitive Level: Understanding

23. Which type of pulmonary disease requires more force to expire a volume of air?

B Obstructive pulmonary disease is characterized by airway obstruction that is worse with expiration. Either more force (i.e., the use of accessory muscles of expiration) or more time is required to expire a given volume of air. Restrictive disorders are characterized by decreased lung tissue compliance. Acute means sudden onset, or severe. Communicable means transmittable. PTS: 1 DIF: Cognitive Level: Remembering

24. Which receptors are located in the smooth muscles of airways?

B Of the options available, only the stretch receptors are located in the smooth muscles of airways. PTS: 1 DIF: Cognitive Level: Remembering

10. An infant has a loud, harsh, holosystolic murmur and systolic thrill that can be detected at the left lower sternal border that radiates to the neck. These clinical findings are consistent with which congenital heart defect?

B On physical examination of a child with a VSD, a loud, harsh, holosystolic murmur and systolic thrill can be detected at the left lower sternal border. An ASD is accompanied by a crescendo-decrescendo systolic ejection murmur located between the second and third intercostal spaces along the left sternal border. The PDA would present with a machine-like murmur. Physical findings in an AVC defect are similar to those found in individuals with VSDs with the addition of a holosystolic murmur radiating to the back and apex, reflecting mitral regurgitation. PTS: 1 DIF: Cognitive Level: Remembering

16. A patient has chronic anemia associated with chronic renal failure. What substance does the healthcare professional tell the patient is needed to treat this anemia?

B One of the most significant advances in the study of hematopoietic growth factors has been the development of erythropoietin for individuals with chronic renal failure. The other options are not associated with the treatment of chronic anemia. PTS: 1 DIF: Cognitive Level: Understanding

26. A disproportionate thickening of the interventricular septum is the hallmark of which form of cardiomyopathy?

B Only hypertrophic obstructive cardiomyopathy is characterized by a thickening of the septal wall, which may cause outflow obstruction to the left ventricle outflow tract. PTS: 1 DIF: Cognitive Level: Remembering

2. A patient reports needing to sit up at night in order to breathe. What term does the healthcare professional document about this condition?

B Orthopnea is seen in patients with heart failure. When they lie down, abdominal pressure on the lungs causes dyspnea and the person needs to sit up in order to breathe. Hyperpnea is an increased rate and depth of breathing. Apnea is the absence of breathing. Atelectasis is the collapse of lung tissue. PTS: 1 DIF: Cognitive Level: Remembering

12. How is most of the oxygen in the blood transported?

B Oxygen is transported in the blood in two forms. A small amount dissolves in plasma (3%), and the remainder (97%) binds to hemoglobin molecules. Oxygen is not transformed into carbon dioxide and it is not bound to protein. PTS: 1 DIF: Cognitive Level: Remembering

13. A patient has a problem with Phase 0 of the cardiac cycle. What electrolyte imbalance would the healthcare professional associate most directly with this problem?

B Phase 0 consists of depolarization and represents rapid sodium entry into the cell. A deficit of sodium could be a possible contributor. The other electrolyte disturbances would not be directly correlated to this problem. PTS: 1 DIF: Cognitive Level: Understanding

6. Which of these are formed elements of the blood that are not cells but are disk-shaped cytoplasmic fragments essential for blood clotting?

B Platelets (thrombocytes) are not true cells but are disk-shaped cytoplasmic fragments that are essential for blood coagulation and control of bleeding. Monocytes, macrophages, and erythrocytes are cells. PTS: 1 DIF: Cognitive Level: Remembering

18. A patient has been diagnosed with pneumoconiosis and asks the healthcare professional to explain this disease. What description by the professional is best?

B Pneumoconiosis represents any change in the lung caused by the inhalation of inorganic dust particles, which usually occurs in the workplace. The dusts of silica, asbestos, and coal are the most common causes of pneumoconiosis. Others include talc, fiberglass, clays, mica, slate, cement, and metals. Pneumococci bacteria would cause pneumococcal pneumonia. Asbestos exposure can cause mesothelioma. Cigarette smoke is the leading cause of lung cancer. PTS: 1 DIF: Cognitive Level: Remembering

36. A patient is diagnosed with a pneumothorax and asks the healthcare professional to explain this condition. What statement by the professional is most accurate?

B Pneumothorax is the presence of air or gas in the pleural space caused by a rupture in the visceral pleura (which surrounds the lungs) or the parietal pleura and chest wall. Blood in the pleural space describes a hemothorax. Pus in the pleural space is an empyema. Collapse of small airways describes atelectasis. PTS: 1 DIF: Cognitive Level: Understanding

9. Which describes the pressure in the pleural space?

B Pressure in the pleural space is usually negative or subatmospheric (-4 to -10 mmHg). PTS: 1 DIF: Cognitive Level: Remembering

25. Pressure in the left ventricle must exceed pressure in which structure before the left ventricle can eject blood?

B Pressure in the ventricle must exceed aortic pressure before blood can be pumped out during systole. The aorta is the only structure in which pressure must be less than the amount of blood in the left ventricle for ejection to occur. PTS: 1 DIF: Cognitive Level: Remembering

12. A patient has a pulmonary capillary wedge pressure of 30mmHg. What assessment finding by the healthcare professional would be most consistent with this reading?

B Pulmonary edema usually begins to develop at a pulmonary capillary wedge pressure or left atrial pressure of 20 mmHg. Signs of pulmonary edema include dyspnea, hypoxemia, and increased work of breathing. Physical examination may reveal inspiratory crackles (rales), dullness to percussion over the lung bases, and evidence of ventricular dilation (S3 gallop and cardiomegaly). In severe edema, pink, frothy sputum is expectorated, hypoxemia worsens, and hypoventilation with hypercapnia may develop. Eupnea is normal work of breathing. Rhonchi are low-pitched rumbling lung sounds due to turbulent airflow due to obstruction or secretions in the large airways. PTS: 1 DIF: Cognitive Level: Applying

20. A healthcare professional is assessing a baby in the neonatal intensive care unit who is very unstable. The professional hears a systolic ejection click at the upper left sternal border with a thrill palpated at the upper left sternal border. What procedure does the professional prepare the parents for the baby to have?

B Pulmonary stenosis results in a systolic ejection murmur at the left upper sternal border, reflecting an obstruction to flow through the narrowed pulmonary valve. A variable systolic ejection click is present in some children, as well as valvular stenosis at the upper left sternal border. PS also produces a thrill that may be palpated at the upper left sternal border. Although mild cases may not need treatment, this critically ill infant needs immediate intervention with balloon angioplasty. A heart transplant might be used to treat hypoplastic left heart syndrome. Prostaglandin infusion is used to keep a patent ductus arteriosus open until surgical correction can be accomplished. Aspirin is used to treat Kawasaki disease. PTS: 1 DIF: Cognitive Level: Applying

30. Reflex control of total cardiac output and total peripheral resistance is controlled by what mechanism?

B Reflex control of total cardiac output and peripheral resistance includes (1) sympathetic stimulation of the heart, arterioles, and veins; and (2) parasympathetic stimulation of the heart only. Neither autonomic nor somatic controls are involved in this process. PTS: 1 DIF: Cognitive Level: Remembering

27. Amyloidosis, hemochromatosis, or glycogen storage disease usually causes which form of cardiomyopathy?

B Restrictive cardiomyopathy may occur idiopathically or as a cardiac manifestation of systemic diseases, such as scleroderma, amyloidosis, sarcoidosis, lymphoma, and hemochromatosis, or a number of inherited storage diseases. This characterization is not true of the other forms of cardiomyopathy. PTS: 1 DIF: Cognitive Level: Remembering

16. A healthcare professional is teaching a community group about inherited disorders. What pattern of inheritance does the professional describe for sickle cell disease?

B Sickle cell disease is an inherited autosomal recessive disorder. Sickling is an occasional, intermittent phenomenon that can be triggered or sustained by one or more of these stressors: decreased oxygen tension (PO2) of the blood (hypoxemia), increased hydrogen ion concentration in the blood (decreased pH), increased plasma osmolality, decreased plasma volume, and low temperature. However, this does not describe the inheritance pattern. PTS: 1 DIF: Cognitive Level: Understanding

5. What is the most common cause of insufficient erythropoiesis in children?

B Similar to the anemias of adulthood, ineffective erythropoiesis or premature destruction of erythrocytes causes the anemias of childhood. The most common cause of insufficient erythropoiesis is iron deficiency. The other options may be causes but are not common ones. PTS: 1 DIF: Cognitive Level: Remembering

27. A patient is having a spirometry measurement done and asks the healthcare professional to explain this test. What response by the professional is best?

B Spirometry measures volume and flow rate during forced expiration. The alveolar-arterial oxygen gradient is used to evaluate the cause of hypoxia. Diffusing capacity is a measure of the gas diffusion rate at the alveolocapillary membrane. Arterial blood gas analysis can be used to determine pH and oxygen and carbon dioxide concentrations. PTS: 1 DIF: Cognitive Level: Understanding MULTIPLE RESPONSE

19. Which manifestations of vasoocclusive crisis are associated with sickle cell disease (SCD) in children?

B Symmetric, painful swelling of the hands and feet (hand-foot syndrome) caused by infarction in the small vessels of the extremities is often the initial manifestation of SCD in children. Acute chest syndrome manifests with cough, fever, and lung infiltrates and has a high mortality rate. Splenomegaly occurs in sequestration crises. Stasis ulcers are not a typical finding. PTS: 1 DIF: Cognitive Level: Remembering

37. What is the major effect of a calcium channel blocker such as verapamil on cardiac contractions?

B The L-type, or long-lasting, channels are the predominant type of calcium channels and are the channels blocked by calcium channel-blocking drugs (verapamil, nifedipine, diltiazem). The major effect of these medications is to decrease the strength of cardiac contraction. These medications do not increase the rate of contractions or stabilize either rhythm of contractions or vessel response during contractions. PTS: 1 DIF: Cognitive Level: Remembering

1. In infectious mononucleosis (IM), what does the Monospot test detect?

B The Monospot test is used to diagnose infectious mononucleosis by detecting heterophile antibodies. These are a heterogeneous group of immunoglobulin M (IgM) antibodies that are agglutinins against nonhuman red blood cells and are present in IM. PTS: 1 DIF: Cognitive Level: Remembering

17. A patient has a disorder affecting ventricular depolarization. What ECG finding would the healthcare professional associate with this condition?

B The QRS complex represents the sum of all ventricular muscle cell depolarizations. If a patient had ECG findings suggestive of problems with this activity, there would be prolongation of the QRS interval. The PR interval reflects the amount of time needed for the action potential to travel from the atrium to the ventricle. QT interval variability is normal. An absence of P waves would indicate a problem with the SA node. PTS: 1 DIF: Cognitive Level: Understanding

38. An early diastole peak caused by filling of the atrium from peripheral veins is identified by which intracardiac pressure?

B The V wave is an early diastolic peak caused by the filling of the atrium from the peripheral veins. The A wave is generated by atrial contraction. The C wave is a small pressure increase seen after the A wave in early systole. The X descent follows the A wave and is produced by the descent of the tricuspid valve ring and by the ejection of blood from both ventricles. PTS: 1 DIF: Cognitive Level: Remembering MULTIPLE RESPONSE

7. Which part of the brainstem provides basic automatic rhythm of respiration by sending efferent impulses to the diaphragm and intercostal muscles?

B The basic automatic rhythm of respiration is set by the VRG, a cluster of inspiratory nerve cells located in the medulla that sends efferent impulses to the diaphragm and inspiratory intercostal muscles. The DRG, also located in the medulla, receives afferent impulses from peripheral chemoreceptors in the carotid and aortic bodies; from mechanical, neural, and chemical stimuli; and from receptors in the lungs, and it alters breathing patterns to restore normal blood gases.The pneumotaxic center and apneustic center, situated in the pons, do not generate primary rhythm, but rather act as modifiers of the rhythm established by the medullary centers. PTS: 1 DIF: Cognitive Level: Remembering

26. Which disease is an autosomal dominant inherited hemorrhagic disease?

B The bleeding disorder, von Willebrand disease, usually results from an inherited autosomal dominant trait; however, some cases demonstrate an autosomal recessive or compound heterozygous pattern. The pattern of inheritance depends on the type of mutation that is present. PTS: 1 DIF: Cognitive Level: Remembering

7. Oxygenated blood flows through which vessel?

B The four pulmonary veins, two from the right lung and two from the left lung, carry oxygenated blood from the lungs to the left side of the heart. All other veins carry deoxygenated blood. The superior vena cava returns deoxygenated blood from systemic circulation to the right atrium. The pulmonary arteries carry deoxygenated blood from the right side of the heart into the lungs. PTS: 1 DIF: Cognitive Level: Remembering

18. Between which months of age does sudden infant death syndrome (SIDS) most often occur?

B The incidence of SIDS is low during the first month of life but sharply increases in the second month of life, peaking at 2 to 4 months and is unusual after 6 months of age. PTS: 1 DIF: Cognitive Level: Remembering

22. What enables electrical impulses to travel in a continuous cell-to-cell fashion in myocardial cells?

B The intercalated disks are thickened portions of the sarcolemma and enable electrical impulses to spread quickly in a continuous cell-to-cell (syncytial) fashion. A sarcolemma is a transparent sheath that surrounds nerve fibers. They are not subject to plaque buildup. The trabeculae carneae are beam-like projections of myocardial tissue. Bachmann bundles are part of the conduction system. PTS: 1 DIF: Cognitive Level: Remembering

25. A healthcare professional is educating a patient about asthma. The professional states that good control is necessary due to which pathophysiologic process?

B The late asthmatic response begins 4 to 8 hours after the early response when the release of toxic neuropeptides contributes to increased bronchial hyperresponsiveness. Untreated inflammation leads to increased scarring and remodeling of pulmonary tissue, so good control of asthma is necessary to prevent that complication. Poor asthma control does not specifically lead to hypertension or dysrhythmias, nor will it permanently weaken respiratory muscles. PTS: 1 DIF: Cognitive Level: Understanding

22. Where are Kupffer cells located?

B The liver macrophages are the only location for Kupffer cells. PTS: 1 DIF: Cognitive Level: Remembering

11. A patient has pulmonary edema. For what condition should the healthcare professional assess the patient as the priority?

B The most common cause of pulmonary edema is left-sided heart failure. When the left ventricle fails, filling pressures on the left side of the heart increase and cause a concomitant increase in pulmonary capillary hydrostatic pressure, leading to pulmonary edema. PTS: 1 DIF: Cognitive Level: Understanding

14. A healthcare professional in an urban clinic is seeing a patient who has iron deficiency anemia (IDA). What question by the professional is most appropriate to assess for the cause of IDA?

B The most common causes of IDA in well-developed countries are pregnancy and chronic blood loss. The healthcare professional would assess for any sources of blood loss. A dietary deficiency of iron may be the cause, but is not common in developed countries. A mechanical heart valve can lead to hemolytic anemia. Recent infections are not associated with iron deficiency anemia. PTS: 1 DIF: Cognitive Level: Applying

5. A student asks the healthcare professional to explain the function of the papillary muscles. What response by the professional is best?

B The papillary muscles are extensions of the myocardium that pull the cusps of the AV valves together and downward at the onset of ventricular contraction, thus preventing their backward expulsion into the atria. They do not close the semilunar valves or open the AV valves or semilunar valves. PTS: 1 DIF: Cognitive Level: Understanding

1. Which statement made by a student indicates the healthcare professional needs to describe the pericardium again?

B The pericardium is made up of a surface layer of mesothelium over a thin layer of connective tissue. The healthcare professional would need to re-explain if the student stated the pericardium is made up of connective tissue and a layer of squamous cells. The other statements are accurate. PTS: 1 DIF: Cognitive Level: Evaluating

27. The resting heart rate in a healthy person is primarily under the control of which nervous system?

B The resting heart rate in healthy individuals is primarily under the control of parasympathetic stimulation. PTS: 1 DIF: Cognitive Level: Remembering

3. When an individual aspirates food particles, where would the healthcare professional expect to hear decreased or absent breath sounds?

B The right mainstem bronchus extends from the trachea more vertically than the left main bronchus; therefore aspirated fluids or foreign particles tend to enter the right lung rather than into the left lung, trachea, or carina. PTS: 1 DIF: Cognitive Level: Remembering

10. Fetal hematopoiesis occurs primarily in which structure?

B The spleen is the largest of the secondary lymphoid organs and the primary site of fetal hematopoiesis. The bone marrow and thymus are other primary lymphoid organs. Peyer patches in the small intestine are considered secondary lymphoid organs. PTS: 1 DIF: Cognitive Level: Remembering

22. A 9-year-old child has a blood pressure of 112/72 mmHg in the school nurse's office. What action by the school nurse is most appropriate?

B The suggested mean blood pressure for an 8- to 9-year-old child is 106/58 mmHg. The 95th percentile mean reading is 120/82 mmHg. Hypertension in children is defined as three readings above the 95th percentile, so this child's blood pressure is well within the normal range. The school nurse would document this reading in the child's records. There is no need for the nurse to worry about dehydration, the child's body mass index, or to refer the child for medication. PTS: 1 DIF: Cognitive Level: Applying MULTIPLE RESPONSE

29. A patient in the clinic reports fever, arthralgia, a rash, and nosebleeds. What other information should the healthcare professional elicit from this patient?

B These manifestations are characteristic of rheumatic fever and usually occur 1 to 5 weeks after a streptococcal infection of the nasopharynx. The professional should inquire about recent illnesses and infections. Other family members may or may not have been sick too, so this is not the best question. These symptoms are not seen after chest trauma or with Marfan syndrome. PTS: 1 DIF: Cognitive Level: Applying

14. Parents bring a 5-year-old to the Emergency Department and report sudden onset of high fever, drooling, and they describe a "hot potato voice." What action by the healthcare professional takes priority?

B This child has manifestations of epiglottitis. Inflammation can lead to airway obstruction rapidly so the main focus of immediate care is securing the airway and keeping the child calm because agitation can worsen the airway problems. Allow the child to remain on the parent's lap for all examinations and tests. Examination of the throat in this condition may trigger laryngospasm and cause respiratory collapse so this is not done. The child should not be sent out of the department for x-rays as death can occur quickly. After the child has been stabilized, family members can begin post-exposure prophylaxis with rifampin. PTS: 1 DIF: Cognitive Level: Applying

4. Air passage among alveoli is collateral and evenly distributed because of the function of which structures?

B Tiny passages called pores of Kohn permit some air to pass through the septa from alveolus to alveolus, promoting collateral ventilation and even distribution of air among the alveoli. Type I alveolar cells provide structure to the alveoli. The acinus is the conducting airways that terminate in the respiratory bronchioles, alveolar ducts, and alveoli. Alveolar pores would be the same as the pores of Kohn. PTS: 1 DIF: Cognitive Level: Remembering

18. Which scenario describes total anomalous pulmonary venous return?

B Total anomalous pulmonary venous return occurs when the pulmonary veins abnormally connect to the right side of the heart either directly or through one or more systemic veins that drain into the right atrium. None of the other options accurately describe the presentation of a total anomalous pulmonary venous return. PTS: 1 DIF: Cognitive Level: Remembering

8. Which structures secrete surfactant?

B Two major types of epithelial cells appear in the alveolus. Type I alveolar cells provide structure, and type II alveolar cells secrete surfactant, a lipoprotein that coats the inner surface of the alveolus and facilitates its expansion during inspiration, lowers alveolar surface tension at end expiration, and thereby prevents lung collapse. Neither alveolar macrophages nor stretch receptors secrete surfactant. PTS: 1 DIF: Cognitive Level: Remembering

35. Squamous cell carcinoma of the lung is best described as a tumor that causes which alterations?

B Typically, the tumors are centrally located near the hila and project into bronchi. Because of this central location, nonproductive cough or hemoptysis is common. Pneumonia and atelectasis are often associated with squamous cell carcinoma. Chest pain is a late symptom associated with large tumors. Ectopic hormone secretion can occur with small cell carcinoma of the lung. Adenocarcinoma, large cell carcinoma, and mesothelioma can produce pleural effusions. Early metastasis and chest wall pain occur with large cell carcinoma although many types do have early metastases. Chest pain is also a common finding, although chest wall pain is specific to large cell carcinoma. PTS: 1 DIF: Cognitive Level: Remembering

2. Which term is used to identify the movement of gas and air into and out of the lungs?

B Ventilation is the term used to identify the mechanical movement of gas or air into and out of the lungs. Perfusion is the term used to describe blood that reaches the alveoli. Respiration is the exchange of gasses. Diffusion is the movement of particles through a semipermeable membrane from an area of higher concentration to an area of lower concentration. PTS: 1 DIF: Cognitive Level: Remembering

7. Which nutrients are necessary for hemoglobin synthesis? (Select all that apply.)

B, C Iron and B6 (pyridoxine) are necessary for hemoglobin synthesis. The remaining options are not necessary for hemoglobin synthesis. PTS: 1 DIF: Cognitive Level: Remembering

5. Which statements characterize albumin? (Select all that apply.)

B, C, D Albumin is a plasma protein produced by the liver. It serves as a carrier molecule for the normal components of blood, as well as for drugs that have low solubility in water (e.g., free fatty acids, lipid-soluble hormones, thyroid hormones, bile salts). Albumin molecules are large and do not diffuse freely through the vascular endothelium; thus they maintain the critical colloidal osmotic pressure (or oncotic pressure) that regulates the passage of water and solutes into the surrounding tissues. PTS: 1 DIF: Cognitive Level: Remembering

6. A person with diabetes mellitus does not realize that this disease contributes to coronary artery disease and asks the healthcare professional to explain. What information does the professional provide? (Select all that apply.)

B, C, D, E Diabetes leads to endothelial damage, thickening of vessel walls, increased inflammation and leukocyte adhesion, increased thrombosis, glycation of vascular proteins, and decreased production of endothelial-derived vasodilators such as nitric oxide. Diabetes is also associated with dyslipidemia. High blood glucose does not directly attack the myocytes. PTS: 1 DIF: Cognitive Level: Understanding

7. A healthcare professions student learns which facts about mitral valve stenosis? (Select all that apply.)

B, C, D, E Mitral valve stenosis is the most common valve disorder in the United States and affects predominantly women. It may be related to genetic or environmental disruption in valvular development in early pregnancy. Most cases are asymptomatic and require no treatment. Symptoms, when they occur, tend to be vague and puzzling. PTS: 1 DIF: Cognitive Level: Understanding Chapter 30: Alterations of Leukocyte and Lymphoid Function McCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th Edition MULTIPLE CHOICE

4. A patient has infective endocarditis. Which risk factors should the healthcare professional assess this patient for? (Select all that apply.)

B, C, D, E Risk factors for infective endocarditis include acquired valvular heart disease and valve replacements, intravenous drug abuse, long-term indwelling catheterization (e.g., for pressure monitoring, hyperalimentation, or hemodialysis), and recent cardiac surgery. Rheumatic fever is not considered a direct risk factor for infective endocarditis. PTS: 1 DIF: Cognitive Level: Remembering

9. A patient has splenomegaly on physical examination. What does the healthcare professional understand about this condition? (Select all that apply.)

B, D, E While splenomegaly may be normal in some persons, it should never be ignored and requires further investigation. Splenomegaly can be caused by acute inflammatory disorders, acute infection, congestive disorders (heart failure), infiltrative processes, and tumors or cysts. It does not specifically lead to hepatic failure. PTS: 1 DIF: Cognitive Level: Remembering Chapter 29: Alterations of Erythrocytes, Platelets, and Hemostatic Function McCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th Edition MULTIPLE CHOICE

17. The student asks the professor to explain what characteristic is demonstrated by lungs with decreased compliance?

C A decrease in compliance indicates that the lungs or chest wall is abnormally stiff or difficult to inflate. Lung compliance is not related specifically to deflation or inability to diffuse oxygen. PTS: 1 DIF: Cognitive Level: Understanding

8. An infant has a continuous machine-type murmur best heard at the left upper sternal border throughout systole and diastole. The healthcare professional suspects a congenital heart disorder. What other assessment finding is inconsistent with the professional's knowledge about this disorder?

C A machine-type murmur is a classic sign of a PDA. Other manifestations include bounding pulses, an active precordium, a thrill on chest palpation, and signs of pulmonary overcirculation. PTS: 1 DIF: Cognitive Level: Understanding

27. A patient in the hospital has been receiving heparin injections. The platelet count on admission was 222,000/mm3 and four days later is 113,000/mm3. What action by the healthcare professional is best?

C After initiating heparin in the hospital this patient's platelet count dropped by 51%. A drop in more than 50% of the platelet count is seen in more than 95% of patients with heparin-induced thrombocytopenia. The treatment is to withdraw the heparin and use alternatives such as lepirudin. If the platelet count were severely low, transfusion would be indicated. There is no need to stop all the patient's medications. PTS: 1 DIF: Cognitive Level: Applying

11. Which normal physiologic change occurs in the aging pulmonary system?

C Aging decreases chest wall compliance and elastic recoil of the lungs. There is loss of alveolar wall tissue and alveolar enlargement, thus diminishing surface area available for gas diffusion with aging. Aging can also cause the PaO2 to decrease. Vital capacity decreases and residual volume increases; however, total lung capacity remains unchanged. PTS: 1 DIF: Cognitive Level: Remembering

35. Which statement is true concerning the cells' ability to synthesize cholesterol?

C Although cholesterol can easily be obtained from dietary fat intake, most body cells can also manufacture cholesterol. It is not affected by aging nor do cells only produce cholesterol when dietary fat is low. Most is not converted to the low-density form. PTS: 1 DIF: Cognitive Level: Remembering

19. What event is characteristic of the function in Zone 1 of the lung?

C Alveolar pressure exceeds pulmonary arterial and venous pressures in Zone 1. The capillary bed collapses, and normal blood flow ceases. Zone II is the portion where alveolar pressure is greater than venous pressure but not greater than arterial pressure. Blood flows through zone II, but it is impeded by alveolar pressure. Zone II is normally above the level of the left atrium. In zone III, arterial and venous pressures are greater than alveolar pressure and blood flow is not affected by alveolar pressure. Zone III is in the base of the lung. Blood flow through the pulmonary capillary bed increases in regular increments from the apex to the base. PTS: 1 DIF: Cognitive Level: Remembering

23. Shortened erythrocyte life span, ineffective bone marrow response to erythropoietin, and altered iron metabolism describe the pathophysiologic characteristics of which type of anemia?

C Anemia of chronic disease specifically results from a combination of (1) decreased erythrocyte life span, (2) suppressed production of erythropoietin, (3) ineffective bone marrow erythroid progenitor response to erythropoietin, and (4) altered iron metabolism and iron sequestration in macrophages. PTS: 1 DIF: Cognitive Level: Remembering

3. Which factor is responsible for the hypertrophy of the myocardium associated with hypertension?

C Angiotensin II is responsible for the hypertrophy of the myocardium and much of the renal damage associated with hypertension. Increased SNS activity with norepinephrine leads to increases in heart rate and systemic vasoconstriction. Diabetes and glucose intolerance are risk factors for developing hypertension. Polymorphisms in some adducin proteins have been linked to hypertension but more study is needed. PTS: 1 DIF: Cognitive Level: Remembering

1. What term is used to describe the capacity of some erythrocytes to vary in size, especially in relationship to some anemias?

C Anisocytosis means assuming various sizes and is a term used to describe erythrocytes in some anemias. Poikilocytosis is used to describe erythrocytes that can assume various shapes. Isocytosis and microcytosis are not terms that are associated with this condition. PTS: 1 DIF: Cognitive Level: Remembering

24. A patient has polycythemia vera and presents to the Emergency Department with plethora and neurological changes. The student asks the healthcare professional to explain the primary cause of these symptoms. What response by the professional is best?

C As polycythemia vera progresses, many of the symptoms are related to the increased blood cellularity and viscosity. These include plethora, engorgement of the retinal and cerebral veins. Individuals also may experience headache, drowsiness, delirium, mania, psychotic depression, chorea, and visual disturbances. The symptoms of polycythemia vera are not related to decreased erythrocyte counts, destruction of erythrocytes, or tissue destruction by macrophages. PTS: 1 DIF: Cognitive Level: Understanding

1. What is the initiating event that leads to the development of atherosclerosis?

C Atherosclerosis begins with an injury to the endothelial cells that line the arterial walls. Possible causes of endothelial injury include the common risk factors for atherosclerosis, such as smoking, hypertension, diabetes, increased levels of low-density lipoprotein (LDL), decreased levels of high-density lipoprotein (HDL), and autoimmunity. The remaining options occur only after the endothelial cells are injured. PTS: 1 DIF: Cognitive Level: Remembering

5. What effect does atherosclerosis have on the development of an aneurysm?

C Atherosclerosis is a common cause of aneurysms because plaque formation erodes the vessel wall. Atherosclerosis does not lead to ischemia of the intima, increase nitric oxide, or obstruct the vessel. PTS: 1 DIF: Cognitive Level: Remembering

10. A patient has been diagnosed with Raynaud disease and asks for an explanation. What statement by the healthcare professional is best?

C Attacks of vasospasm in the small arteries and arterioles of the fingers and, less commonly, of the toes characterize Raynaud phenomenon and Raynaud disease. The inflammatory disorder of small- and medium-size arteries in the feet and sometimes in the hands is Buerger disease. Reynaud disease is not neoplastic and does not involve large arteries and veins. PTS: 1 DIF: Cognitive Level: Understanding

3. What is the life span of an erythrocyte (in days)?

C Because it cannot undergo mitotic division, the erythrocyte has a limited life span of up to approximately 120 days. PTS: 1 DIF: Cognitive Level: Remembering

19. A healthcare professional assesses a systolic ejection murmur at the right upper sternal border that transmits to the neck and left lower sternal border. What condition does the professional prepare to educate the parents on?

C Blood flow through the stenotic area of the aorta produces a systolic ejection murmur at the right upper sternal border that transmits to the neck and left lower sternal border. None of the other options produce the described assessment findings. PTS: 1 DIF: Cognitive Level: Remembering

11. Where can coarctation of the aorta (COA) be located?

C COA can occur anywhere between the origin of the aortic arch and the bifurcation of the aorta in the lower abdomen. PTS: 1 DIF: Cognitive Level: Remembering

18. Cardiac cells can withstand ischemic conditions and still return to a viable state for how many minutes?

C Cardiac cells remain viable for approximately 20 min under ischemic conditions. If blood flow is restored, then aerobic metabolism resumes, contractility is restored, and cellular repair begins. If the coronary artery occlusion persists beyond 20 min, then myocardial infarction (MI) occurs. PTS: 1 DIF: Cognitive Level: Remembering

31. What is the most important negative inotropic agent?

C Chemicals affecting contractility are called inotropic agents. The most important negative inotropic agent is acetylcholine released from the vagus nerve. The most important positive inotropic agents produced by the body are norepinephrine released from the sympathetic nerves that supply the heart and epinephrine released by the adrenal cortex. Other positive inotropes include thyroid hormone and dopamine. PTS: 1 DIF: Cognitive Level: Remembering

32. A patient has recently been diagnosed with emphysema. What initial step in management of this disease does the healthcare professional discuss with the patient?

C Chronic management of emphysema begins with smoking cessation. As long as the patient continues to smoke, the disease will worsen. Pharmacologic management includes inhaled anticholinergic agents and beta agonists. Pulmonary rehabilitation, improved nutrition, and breathing techniques all can improve symptoms. Oxygen therapy is indicated in chronic hypoxemia but must be administered with care. In selected patients, lung volume reduction surgery or transplantation can be considered. PTS: 1 DIF: Cognitive Level: Remembering

11. A 7 year-old-child presents to the clinic where parents report signs and symptoms consistent with asthma. What does the healthcare professional do in order to confirm this diagnosis?

C Confirmation of the diagnosis of asthma relies on pulmonary function testing using spirometry, which can be accomplished after the child is 5 to 6 years of age. Reduced expiratory flow rates that are reversible in response to an inhaled bronchodilator would be characteristic abnormalities. For younger children, an empiric trial of asthma medications is commonly initiated. A positive parental history of asthma and elevated levels of IgE and eosinophils are major historical and physical factors that contribute but do not confirm the diagnosis of asthma in children. PTS: 1 DIF: Cognitive Level: Applying

28. Which factor contributes to the production of mucus associated with chronic bronchitis?

C Continual bronchial inflammation causes bronchial edema and increases the size and number of mucous glands and goblet cells in the airway epithelium. Thick, tenacious mucus is produced and cannot be cleared because of impaired ciliary function. The lung's defense mechanisms are therefore compromised, increasing a susceptibility to pulmonary infection, which contributes to airway injury. Frequent infectious exacerbations are complicated by bronchospasm with dyspnea and productive cough. PTS: 1 DIF: Cognitive Level: Remembering

15. Which statement best describes cystic fibrosis?

C Cystic fibrosis is best described as a pulmonary disorder involving an abnormal expression of a protein-producing viscous mucus that obstructs the airways, pancreas, sweat ducts, and vas deferens. Reversible airflow limitations are seen in asthma. Severe hypoxemia and diffuse densities seen on x-ray are characteristic of ARDS. Surfactant deficiency leads to RDS of the newborn. PTS: 1 DIF: Cognitive Level: Remembering

6. The students learn that deficiencies in folate and vitamin B12 alter the synthesis of which of these?

C Deficiencies in folate and vitamin B12 result in defective erythrocyte precursor DNA synthesis. These deficiencies are not associated with alterations of RNA, cell membranes, or mitochondria. PTS: 1 DIF: Cognitive Level: Remembering

12. During the cardiac cycle, which structure directly delivers action potential to the ventricular myocardium?

C Each cardiac action potential travels from the SA node to the AV node to the bundle of His (AV bundle), through the bundle branches, and finally to the Purkinje fibers and the ventricular myocardium, where the impulse is stopped. PTS: 1 DIF: Cognitive Level: Remembering

2. Why does fetal hemoglobin have a greater affinity for oxygen than adult hemoglobin?

C Fetal hemoglobin has greater affinity for oxygen than adult hemoglobin does because it interacts less readily with the enzyme, DPG, which inhibits hemoglobin-oxygen binding. The lack of independent oxygen supply, the type of chains on the hemoglobin, and the location of hemoglobin production do not impact fetal hemoglobin's ability to bind more readily to oxygen than do adult hemoglobin. PTS: 1 DIF: Cognitive Level: Remembering

5. Where in the lung does gas exchange occur?

C Gas exchange occurs only across the alveolocapillary membrane. PTS: 1 DIF: Cognitive Level: Remembering

17. Hemoglobin S (HbS) is formed in sickle cell disease as a result of which process?

C HbS is formed by a genetic mutation in which one amino acid (valine) replaces another (glutamic acid). G6PD deficiency is the most common RBC disorder in which RBCs are not protected against oxidative stress. HbS is not formed as the result of an autoimmune process. PTS: 1 DIF: Cognitive Level: Remembering

25. A student asks the professor why hemophilia A is seen mostly in men. The professor explains that hemophilia A is considered to be what type of inherited disorder?

C Hemophilia A (classic hemophilia) is inherited as an X-linked recessive disorder. That means that the genes for this disorder are carried on the X chromosome. In men, a single copy of the altered gene causes the condition. Females are carriers. PTS: 1 DIF: Cognitive Level: Remembering

16. A patient has hepatomegaly, bronze-colored skin, and cardiac dysrhythmias. What condition does the healthcare professional prepare to teach the patient about?

C Hereditary hemochromatosis presents with hepatomegaly, bronze-colored skin, and cardiac dysrhythmias. Aplastic anemia specifically presents with total bone marrow failure. Pernicious anemia can be characterized with neurocognitive dysfunction in addition to the classic signs of all anemias. ITP presents with minor signs of bleeding such as petechiae but soon show major bleeding. PTS: 1 DIF: Cognitive Level: Understanding

6. What does the student learn about ventilation?

C Hyperventilation is alveolar ventilation that exceeds metabolic demands. The lungs remove carbon dioxide at a faster rate than produced by cellular metabolism, resulting in decreased PaCO2 or hypocapnia. A decreased PaCO2 would lead to alkalosis. Hypoventilation would lead to hypercapnia and acidosis. PTS: 1 DIF: Cognitive Level: Remembering

16. A patient has a transudative pleural effusion but has minimal symptoms. What action by the healthcare professional is best?

C In transudative pleural effusion, the fluid, or transudate, is watery and diffuses out of the capillaries as a result of disorders that increase intravascular hydrostatic pressure or decrease capillary oncotic pressure. Examples are congestive heart failure, in which venous and left atrial pressures are increased, and liver or kidney disorders that cause hypoproteinemia. Hypoproteinemia decreases capillary oncotic pressure, which promotes diffusion of water out of the capillaries. The best action for the professional is to assess the patient's protein stores through blood analysis. The patient does not need a chest tube since the symptoms are minimal. An incentive spirometer will not provide definitive information to treat the problem. Exudative effusions are caused by inflammation, infection, or malignancy, so this patient does not need an oncology consult. PTS: 1 DIF: Cognitive Level: Applying

7. Which immunoglobulin (Ig) is present in childhood asthma?

C Included in the long list of asthma-associated genes are those that code for increased levels of immune and inflammatory mediators (e.g., interleukin [IL]-4, IgE, leukotrienes), nitric oxide, and transmembrane proteins in the endoplasmic reticulum. IgM, IgG, and IgA are not associated with childhood asthma. PTS: 1 DIF: Cognitive Level: Remembering

30. What is the most common cause of infective endocarditis?

C Infective endocarditis is a general term used to describe infection and inflammation of the endocardium—especially the cardiac valves. Bacteria are the most common cause of infective endocarditis, especially streptococci, staphylococci, or enterococci. PTS: 1 DIF: Cognitive Level: Remembering

8. A healthcare professional tells a student that a patient has lost atrial kick. What would the student expect to see when examining this patient?

C Left atrial contraction, the atrial kick, provides a significant increase of blood to the left ventricle. This would help to increase cardiac output. With the loss of this atrial kick, the student would expect to find signs of decreased cardiac output such as decreased blood pressure or tachycardia. Loss of atrial kick would not improve dysrhythmias or increase serum troponin levels which usually indicate myocardial damage. PTS: 1 DIF: Cognitive Level: Applying

9. A student asks the healthcare professional why researchers are trying to link specific genes to specific asthma phenotypes. What response by the professional is best?

C Linking specific genes to specific asthma phenotypes is leading to targeted therapies and personalized approaches to asthma treatment. It may be true that some types are easier to treat or that some people could use different, less expensive medications, but those responses are too narrow in focus to be the best answer. Several phenotypes of asthma have already been recognized. PTS: 1 DIF: Cognitive Level: Understanding

16. Which elevated value may be protective of the development of atherosclerosis?

C Low levels of HDL cholesterol are also a strong indicator of coronary risk, whereas high levels of HDLs may be more protective for the development of atherosclerosis than low levels of LDLs. Neither VLDLs nor elevated triglycerides are associated with a protective mechanism. PTS: 1 DIF: Cognitive Level: Remembering

22. In acute respiratory distress syndrome (ARDS), alveoli and respiratory bronchioles fill with fluid as a result of which mechanism?

C Lung inflammation and injury damage the alveolar epithelium and the vascular endothelium in ARDS. Surfactant is inactivated, and its production by type II alveolar cells is impaired as alveoli and respiratory bronchioles fill with fluid or collapse. The other processes would not trigger the described response. PTS: 1 DIF: Cognitive Level: Remembering

32. What cardiac pathologic condition contributes to ventricular remodeling?

C Myocardial ischemia contributes to inflammatory, immune, and neurohumoral changes that mediate a process called ventricular remodeling. PTS: 1 DIF: Cognitive Level: Remembering

25. Which receptors are located near the respiratory center?

C Of the options available, only the central chemoreceptors are located near the respiratory center. PTS: 1 DIF: Cognitive Level: Remembering

24. Hemophilia B is caused by a deficiency of which clotting factor?

C Only factor IX deficiency causes hemophilia B (Christmas disease). Factor VIII causes hemophilia A or classic hemophilia. Elimination of coagulation factor IX leads to a very severe form of hemophilia A. Deficiency of factor V can lead to a tendency for hemorrhage but can also contain mutations that lead to thrombosis. PTS: 1 DIF: Cognitive Level: Remembering

11. A patient who has lung cancer calls the clinic reports facial and neck swelling severe enough so that shirts no longer fit. What question by the healthcare professional there would be most appropriate?

C Patients with certain kinds of cancer (small cell and nonsmall cell cancers of the lung, and lymphoma) can develop superior vena cava syndrome (SVCS) which is a progressive occlusion of the superior vena cava. This leads to venous distention in the upper extremities and head. Other symptoms include hoarse voice, dyspnea, dysphagia, stridor, cough, and chest pain. The professional should ask about the other symptoms. A large weight gain would occur slowly. Asking about edema elsewhere would be a question if the patient denied any other symptoms of SVCS. The date of the last chemotherapy is not relevant. PTS: 1 DIF: Cognitive Level: Applying

17. What is the role of thromboxane A (TXA2) in the secretion stage of hemostasis?

C Platelet aggregation is primarily stimulated by TXA2 and adenosine diphosphate (ADP), which induce functional fibrinogen receptors on the platelet. Thromboxane A is not involved with serotonin synthesis, vasodilation, or production of cyclooxygenase. PTS: 1 DIF: Cognitive Level: Remembering

26. A healthcare professional is caring for a patient who has continuous increases in left ventricular filing pressures. What disorder would the professional assess the patient for?

C Pressure changes are important because increased left ventricular filling pressures back up into the pulmonary circulation, where they force plasma out through vessel walls, causing fluid to accumulate in lung tissues (pulmonary edema). Problems such as mitral regurgitation and mitral stenosis are valve problems, not directly related to this patient's situation. Jugular vein distention can be a sign of fluid overload. PTS: 1 DIF: Cognitive Level: Applying

3. Which chamber of the heart endures the highest pressures?

C Pressure is greatest in the left ventricle with a systolic range of 90 to 140 mmHg. The right ventricle is next with a systolic range of 15 to 28 mmHg, followed by the left and right atria, respectively. PTS: 1 DIF: Cognitive Level: Remembering

1. Besides dyspnea, what is the most common characteristic associated with pulmonary disease?

C Pulmonary disease is associated with many signs and symptoms, and their specific characteristics often help in identifying the underlying disorder. The most common characteristics are dyspnea and cough. Others include abnormal sputum, hemoptysis, altered breathing patterns, hypoventilation and hyperventilation, cyanosis, clubbing of the digits, and chest pain. PTS: 1 DIF: Cognitive Level: Remembering

4. What is the primary cause of respiratory distress syndrome (RDS) of the newborn?

C RDS is primarily caused by surfactant deficiency and secondarily by a deficiency in alveolar surface area for gas exchange. RDS is not caused by having an immature immune system, small alveoli, or anemia. PTS: 1 DIF: Cognitive Level: Remembering

5. Reed-Sternberg (RS) cells represent malignant transformation and proliferation of which of these?

C Reed-Sternberg cells are associated with Hodgkin lymphoma and represent a malignant transformation of B cells. They are not related to interleukins, tumor necrosis factor-beta, or T cells. PTS: 1 DIF: Cognitive Level: Remembering

17. What abnormalities lead to the mucus plugging seen in children with cystic fibrosis (CF)?

C Respiratory mucus in CF is dehydrated and viscous because of impaired chloride secretion and excess sodium absorption. The gut's ability to absorb water is not affected. The inflammatory response is active in this disease process. Pulmonary remodeling does lead to chronic hypoxia, but this is not related to mucus plugging. PTS: 1 DIF: Cognitive Level: Remembering

4. What does the student learn about erythrocytes?

C Reversible deformity enables the erythrocyte to assume a more compact torpedo-like shape, squeeze through the microcirculation, and return to normal. The mature erythrocyte lacks a nucleus and cytoplasmic organelles so it cannot synthesize protein or carry out oxidative reactions. Men have more erythrocytes than women (48% to 42% respectively). PTS: 1 DIF: Cognitive Level: Remembering

28. Which condition is a cause of acquired aortic regurgitation?

C Rheumatic heart disease, bacterial endocarditis, syphilis, hypertension, connective tissue disorders (e.g., Marfan syndrome, ankylosing spondylitis), appetite suppressing medications, trauma, or atherosclerosis can cause acquired aortic regurgitation. PTS: 1 DIF: Cognitive Level: Remembering

21. A patient in the Emergency department is suspected of having a myocardial infarction (MI). The initial cardiac troponin 1 level was negative. What action by the healthcare professional is best?

C Several cardiac biomarkers exist including the most specific, cardiac troponin 1 (cTnI), cTnI begins to rise within 2 to 4 hours after cardiac injury, so if the initial result is normal, the test should be repeated within 6 to 9 hours and again at 12 to 24 hours. It is not known yet if the patient has had an MI so treatment with thrombolytic therapy would be premature. The patient should not be dismissed since the professional suspected an MI. The patient does need oxygen and pain medication (if pain is present) but that option is not directly related to the question. PTS: 1 DIF: Cognitive Level: Applying

11. What is the consequence of a splenectomy?

C Splenic absence from any cause (e.g., atrophy, traumatic injury, removal because of disease) has several secondary effects on the body, among them an increase in morphologically defective blood cells in the circulation, confirming the spleen's role in removing old or damaged cells. Loss of the spleen does not increase iron blood levels, increase antibody production, or increase the number of clotting factors. PTS: 1 DIF: Cognitive Level: Remembering

14. A parent asks the healthcare professional to explain why a child diagnosed with Tetralogy of Fallot squats frequently. What explanation by the professional is best?

C Squatting is a spontaneous compensatory mechanism used by older children with Tetralogy of Fallot to alleviate hypoxic spells. Squatting and its variants increase systemic resistance while decreasing venous return to the heart from the inferior vena cava. Squatting does not reduce chest pain, control dizziness, or improve headaches. PTS: 1 DIF: Cognitive Level: Understanding

6. Surfactant produced by type II alveolar cells facilitates alveolar distention and ventilation by which mechanism?

C Surfactant, a lipoprotein produced by type II alveolar cells, has a detergent-like effect that separates the liquid molecules, thereby decreasing alveolar surface tension. Surfactant does not decrease thoracic compliance, attract water to the alveolar surface, or increase surface tension in the alveoli. PTS: 1 DIF: Cognitive Level: Remembering

21. Where in the heart are the receptors for neurotransmitters located?

C Sympathetic neural stimulation of the myocardium and coronary vessels depends on the presence of adrenergic receptors, which specifically bind with neurotransmitters of the sympathetic nervous system. The β1 receptors are found mostly in the heart, specifically the conduction system (AV and SA nodes, Purkinje fibers) and the atrial and ventricular myocardium, whereas the β2 receptors are found in the heart and also on vascular smooth muscle. β3 receptors are also found in the myocardium and coronary vessels. This selection is the only option that accurately identifies the location of the receptors for neurotransmitters. PTS: 1 DIF: Cognitive Level: Remembering

14. A healthcare professional is caring for a patient who has a delay in electrical activity reaching the ventricle as seen on ECG. What ECG finding would the healthcare professional associate with this problem?

C The PR interval is a measure of time from the onset of atrial activation to the onset of ventricular activation; it normally ranges from 0.12 to 0.20 sec. The PR interval represents the time necessary to travel from the sinus node through the atrium, the atrioventricular (AV) node, and the His-Purkinje system to activate ventricular myocardial cells. The measured PR of 0.28 sec is too long, signifying a delay in the conduction process from atrium to ventricle. The ST interval represents the time needed for ventricular depolarization. The QT interval is normally around 0.4 sec, but varies inversely with heart rate. The QRS measurement is within the normal range of less than or equal to 0.12 sec. PTS: 1 DIF: Cognitive Level: Applying

23. How low must the partial pressure of arterial oxygen (PaO2) drop before the peripheral chemoreceptors influence ventilation?

C The PaO2 must drop well below normal (to approximately 60 mmHg) before the peripheral chemoreceptors have much influence on ventilation. PTS: 1 DIF: Cognitive Level: Remembering

9. A person has been diagnosed with acute lymphocytic leukemia (ALL) that is positive for the Philadelphia chromosome. What statement by the healthcare professional is most appropriate?

C The Philadelphia chromosome is seen in about 30% of adults with ALL and is a poor prognostic indicator. The healthcare professional should recognize this and reassure the patient that they will be doing everything they can to get the disease in remission. Colony-stimulating factor is given when the white blood cell count is too low, which can occur in nearly all neoplasms due to treatment. PTS: 1 DIF: Cognitive Level: Understanding

2. What is the fundamental physiologic manifestation of anemia?

C The fundamental physiologic manifestation of anemia is a reduced oxygen-carrying capacity of the blood, resulting in tissue hypoxia. Hypotension may result when the initial compensatory mechanism, vasoconstriction, fails to provide adequate perfusion to tissues. Ischemia may result if the oxygen deficit in tissues and organs is severe or prolonged. Hyperesthesia is not a finding. PTS: 1 DIF: Cognitive Level: Remembering

1. What is the cause of polycythemia in the fetus?

C The hypoxic intrauterine environment stimulates erythropoietin production in the fetus. Fetal polycythemia is not the result of hemoglobin having greater affinity for oxygen, different hemoglobin structure, or undeveloped lungs. PTS: 1 DIF: Cognitive Level: Remembering

21. What does the student learn about warm autoimmune hemolytic anemia?

C The immunoglobulin G-coated red blood cells bind to the Fc receptors on monocytes and splenic macrophages and are removed by phagocytosis. This disease occurs mainly in people older than 40 years of age. It is one of the hemolytic anemias and destruction of red blood cells occurs by extravascular processes. The erythrocytes are bound to macrophages, not monocytes. PTS: 1 DIF: Cognitive Level: Remembering

33. A patient had a motor vehicle crash and suffered critical injuries to the brainstem. What physiological responses would the healthcare professional expect to see?

C The major cardiovascular control center is in the brainstem in the medulla with secondary areas in the hypothalamus, the cerebral cortex, the thalamus, and the complex networks of exciting or inhibiting interneurons (connecting neurons) throughout the brain. The brainstem specifically controls blood pressure and pulse, so a severe injury to this area would manifest with changes in blood pressure and pulse. Changes on the ECG and fluid overload would not occur due to this injury. PTS: 1 DIF: Cognitive Level: Applying

12. Which anemia produces small, pale erythrocytes?

C The microcytic-hypochromic anemias, which include iron deficiency anemia (IDA), are characterized by erythrocytes that are abnormally small (microcytic) and contain abnormally reduced amounts of hemoglobin (hypochromic). Folic acid and pernicious anemias are megaloblastic. Hemolytic anemia consists of normal red blood cells that are destroyed more frequently than normal. PTS: 1 DIF: Cognitive Level: Remembering

35. What is the major determinant of the resistance that blood encounters as it flows through the systemic circulation?

C The muscle layer of the arterioles constricts or dilates depending on the stimulation it receives. The change in the diameter of the vessels determines the resistance to blood flow. Blood viscosity usually stays the same; however severe fluid loss can increase it, leading to an increase in resistance. This is not the major determinant however. The force of contraction does not determine resistance to flow. PTS: 1 DIF: Cognitive Level: Remembering

13. A patient has a lung problem caused by dysfunction in the pores of Kohn. What action by the healthcare professional is best?

C The pores of Kohn, which open only during deep breathing, allow air to pass from well-ventilated alveoli to obstructed alveoli. A dysfunction in this system would lead to absorption atelectasis, which is the result of gradual absorption of air from obstructed or hypoventilated alveoli. The professional should have the patient do breathing exercises, including using an incentive spirometer. Water will thin any secretions the patient has but will not directly improve ventilation. The patient may need oxygen if the oxygen saturations are low, but this does not address the cause. Withholding pain medication will lead to a patient being unwilling to move about or do breathing exercises. PTS: 1 DIF: Cognitive Level: Applying

9. High altitudes may produce hypoxemia through which mechanism?

C The presence of adequate oxygen content of the inspired air is the first factor to consider regarding hypoxia. Oxygen content is lessened at high altitudes which can produce hypoxemia. High altitudes do not produce shunting, hypoventilation, or diffusion abnormalities. PTS: 1 DIF: Cognitive Level: Remembering

5. What is the primary problem resulting from respiratory distress syndrome (RDS) of the newborn?

C The primary problem is atelectasis, which causes significant hypoxemia and is difficult for the neonate to overcome because a significant negative inspiratory pressure is required to open the alveoli with each breath. Consolidation, pulmonary edema, and bronchiolar plugging are not the primary problems in RDS. PTS: 1 DIF: Cognitive Level: Remembering

13. Stretch receptors and peripheral chemoreceptors send afferent impulses regarding ventilation to which location in the brain?

C The respiratory center is made up of several groups of neurons located bilaterally in the brainstem: the DRG, the VRG, the pneumotaxic center, and the apneustic center. The basic automatic rhythm of respiration is set by the VRG, a cluster of inspiratory nerve cells located in the medulla that sends efferent impulses to the diaphragm and inspiratory intercostal muscles. The DRG, also located in the medulla, receives afferent impulses from peripheral chemoreceptors in the carotid and aortic bodies; from mechanical, neural, and chemical stimuli; and from receptors in the lungs, and it alters breathing patterns to restore normal blood gases. The pneumotaxic center and apneustic center, situated in the pons, do not generate primary rhythm, but rather act as modifiers of the rhythm established by the medullary centers. PTS: 1 DIF: Cognitive Level: Remembering

32. The right lymphatic duct drains into which structure?

C The right lymphatic duct drains lymph into the right subclavian vein only. PTS: 1 DIF: Cognitive Level: Remembering

1. What pulmonary defense mechanism propels a mucous blanket that entraps particles moving toward the oropharynx?

C The submucosal glands of the bronchial lining produce mucus, contributing to the mucous blanket that covers the bronchial epithelium. The ciliated epithelial cells rhythmically beat this mucous blanket toward the trachea and pharynx, where it can be swallowed or expectorated by coughing. Mucous is not propelled by nasal turbinates, alveolar macrophages, or irritant receptors. PTS: 1 DIF: Cognitive Level: Remembering

22. A healthcare professional tells the student that a properly placed endotracheal tube for mechanical ventilation is 5 to 7 cm above the tracheal bifurcation. Where does this bifurcation occur?

C The trachea, which is supported by U-shaped cartilage, connects the larynx to the bronchi, the conducting airways of the lungs. The trachea divides into the two main airways, or bronchi, at the carina. The healthcare professional would describe placement as being above the carina. PTS: 1 DIF: Cognitive Level: Understanding

9. Which condition resulting from untreated pernicious anemia (PA) is fatal?

C Untreated PA is fatal, usually because of heart failure. PTS: 1 DIF: Cognitive Level: Remembering

9. A child has iron deficiency anemia. In addition to iron supplements, what else does the healthcare professional educate the parents on giving the child?

C Vitamin C helps with absorption of iron, so the healthcare professional instructs the parents about giving it to the child with iron deficiency anemia. Vitamin A, magnesium, and zinc do not help promote the absorption of iron. PTS: 1 DIF: Cognitive Level: Understanding

13. Which hemoglobin is made from oxidized ferric iron (Fe3+) and lacks the ability to bind oxygen?

C Without reactivation by methemoglobin reductase, the Fe3+-containing hemoglobin (methemoglobin) cannot bind oxygen. Deoxyhemoglobin is hemoglobin available for oxygen binding. Oxyhemoglobin is bound with oxygen. Glycosylated hemoglobin is hemoglobin with which glucose is bound. PTS: 1 DIF: Cognitive Level: Remembering

6. Which nutrients are necessary for the synthesis of DNA and the maturation of erythrocytes? (Select all that apply.)

C, D Cobalamin and folate are necessary for the synthesis of DNA and for the maturation of erythrocytes. The remaining options are not necessary for these processes to occur. PTS: 1 DIF: Cognitive Level: Remembering

2. Early detection of acute leukemia would include which symptoms? (Select all that apply.)

C, D, E Signs and symptoms related to bone marrow depression include fatigue caused by anemia, bleeding resulting from thrombocytopenia (reduced numbers of circulating platelets), and fever caused by infection. Anorexia can occur in all varieties of acute leukemia and is associated with weight loss. Pain in the bones and joints is thought to result from leukemia infiltration with secondary stretching of the periosteum. The other options are not generally associated with acute leukemia. PTS: 1 DIF: Cognitive Level: Remembering

3. Which clinical manifestations would the healthcare professional assess for in a painter with pulmonary hypertension? (Select all that apply.)

C, D, E Symptoms of fatigue, chest discomfort, tachypnea, and dyspnea on exertion, palpitations, and cough are common in pulmonary hypertension. Examination may reveal peripheral edema, jugular venous distention, a precordial heave, and accentuation of the pulmonary compartment of the second heart sound. Neither rhonchi nor a systemic blood pressure of 130/90 mmHg is associated with pulmonary hypertension. PTS: 1 DIF: Cognitive Level: Remembering

1. Which characteristics allow erythrocytes to function as gas carriers? (Select all that apply.)

C, E A red blood cell (RBC) is a small disk with two unique properties: (1) a biconcave shape and (2) the capacity to be reversibly deformed. Compactness is not a feature that promotes gas exchange. Erythrocytes do not contain mitochondria. PTS: 1 DIF: Cognitive Level: Remembering

1. What information does the student learn about alveoli? (Select all that apply.)

C, E Capillaries grow into the distal respiratory units that keep subdividing (alveolarization) to maximize the surface area for gas exchange. The number of alveoli continues to increase during the first 5 to 8 years of life, after which the alveoli increase in size and complexity. Surfactant is a lipid-protein mix that is produced by type II alveolar cells. PTS: 1 DIF: Cognitive Level: Remembering

8. After a person has a subtotal gastrectomy for chronic gastritis, which type of anemia will result?

D A gastrectomy will lead to deficient intrinsic factor which is related to pernicious anemia. The gastrectomy would not lead to iron deficiency, aplastic, or folic acid anemia. PTS: 1 DIF: Cognitive Level: Remembering

2. The risk for respiratory distress syndrome (RDS) decreases for premature infants when they are born between how many weeks of gestation?

D A lack of surfactant leads to RDS. Surfactant is secreted into fetal airways between 30 and 36 weeks, so a baby born between these weeks would have less of developing RDS. PTS: 1 DIF: Cognitive Level: Remembering

13. When assessing for the signs and symptoms of acute respiratory distress syndrome (ARDS), the absence of which condition is considered characteristic?

D ARDS is characterized by progressive respiratory distress, severe hypoxemia refractory to treatment with supplemental oxygen, decreased pulmonary compliance, bilateral infiltrates on chest x-ray imaging, and no evidence of heart failure. PTS: 1 DIF: Cognitive Level: Remembering

36. What is the trigger for angina pectoris?

D Angina pectoris is chest pain caused by myocardial ischemia. Atherosclerotic lesions make angina more likely as vessel lumens narrow in coronary artery disease. High lipid levels are a risk factor for CAD. Myocardial necrosis is death of heart tissue and would be the consequence of ischemia that was not relieved. PTS: 1 DIF: Cognitive Level: Remembering MULTIPLE RESPONSE

26. A patient comes to the Emergency Department with inspiratory and expiratory wheezing, dyspnea, nonproductive cough, and tachypnea. What treatment does the healthcare professional anticipate for this patient as the priority?

D Asthma is characterized by expiratory wheezing, dyspnea, nonproductive coughing, prolonged expiration, tachycardia, and tachypnea. Severe attacks involve the use of accessory muscles of respiration, and wheezing is heard during both inspiration and expiration. The treatment consists of inhaled β-agonist bronchodilators, oxygen if needed, and corticosteroids. After the patient has been stabilized, the healthcare professional attempts to determine the cause of the attack, which would include a possible sputum culture and getting a history of any recent exposures to illness. Antibiotics will be given for a bacterial infection, such as pneumonia or pharyngitis, that led to the attack. PTS: 1 DIF: Cognitive Level: Understanding

15. By which structure are mature erythrocytes removed from the bloodstream?

D At the end of their life spans, old erythrocytes are removed by tissue macrophages, primarily in the spleen. PTS: 1 DIF: Cognitive Level: Remembering

5. What are granulocytes that contain granules of vasoactive amines, such as histamine, called?

D Basophils contain cytoplasmic granules that hold an abundant mixture of biochemical mediators, including histamine, chemotactic factors, proteolytic enzymes, and an anticoagulant (heparin). These substances are not found in neutrophils, monocytes, or eosinophils. PTS: 1 DIF: Cognitive Level: Remembering

12. A parent brings a 10-year-old child to the clinic and reports a mottled appearance to the skin and legs cramps when the child is in physical education class. What diagnostic testing or treatment does the healthcare professional prepare the family for?

D Clinical manifestations of coarctation of the aorta include hypertension noted in the upper extremities with decreased or absent pulses in the lower extremities. Children may also have cool mottled skin and occasionally experience leg cramps during exercise. An echocardiogram would be used to diagnose the condition. In an older child, percutaneous balloon dilation angioplasty with or without stent implantation may be a good treatment option, however; an immediate cardiac catheterization is not needed at this time. Prostaglandin is used to stabilize a newborn prior to surgical correction is typically straightforward unless the COA is part of another condition. The healthcare professional would educate the family on the echocardiogram. PTS: 1 DIF: Cognitive Level: Applying

7. A baby has been born with Down syndrome. What congenital heart defect does the healthcare professional assess this baby for?

D Congenital heart defects that are related to Down syndrome include VSD and ASVD. COA is associated with Turner syndrome. Tetralogy of Fallot does not have a strong association with chromosomal defects. An ASD is often seen in Cri du Chat syndrome, Turner syndrome, or Klinefelter variant syndrome. PTS: 1 DIF: Cognitive Level: Understanding

40. What medical term is used for a condition that results from pulmonary hypertension, creating chronic pressure overload in the right ventricle?

D Cor pulmonale develops as pulmonary hypertension and creates chronic pressure overload in the right ventricle similar to that created in the left ventricle by systemic hypertension. Hypoxemia is low oxygen in the blood. Hypoxia is low oxygen in tissues. Bronchiectasis is persistent abnormal dilation of bronchi. PTS: 1 DIF: Cognitive Level: Remembering MULTIPLE RESPONSE

10. Where are the coronary ostia located?

D Coronary arteries receive blood through openings in the aorta, called the coronary ostia. PTS: 1 DIF: Cognitive Level: Remembering

8. The student asks the healthcare professional to explain how pulmonary edema and pulmonary fibrosis cause hypoxemia. What description by the professional is best?

D Diffusion of oxygen through the alveolocapillary membrane is impaired if the alveolocapillary membrane is thickened or if the surface area available for diffusion is decreased. Abnormal thickness, as occurs with edema (tissue swelling) and fibrosis (formation of fibrous lesions), increases the time required for diffusion across the alveolocapillary membrane. These diseases do not create dead space, decrease the FIo2 of inspired air, or create a shunt. PTS: 1 DIF: Cognitive Level: Understanding

18. Which of these is the role of nitric oxide (NO) in hemostasis?

D Endothelial cell NO synthase produces NO, which controls platelet activation in concert with prostacyclin. The other options do not present an accurate description of the role of NO in hemostasis. PTS: 1 DIF: Cognitive Level: Remembering

7. Which virus is associated with Burkitt lymphoma in African children?

D Epstein-Barr virus, found in nasopharyngeal secretions, is associated with Burkitt lymphoma in African children. The other viruses are not associated with this malignancy. PTS: 1 DIF: Cognitive Level: Remembering

12. The healthcare professional is caring for a woman whose baby died of hydrops fetalis. How does the professional explain this condition to a student?

D Fetuses with hydrops fetalis who do not survive anemia in utero are usually stillborn with gross edema in the entire body. The inherited abnormal RBC skeletal membrane is called spherocytosis. The hyperbilirubinemia is known as icterus gravis neonatorum. Erythroblastosis fetalis is another name for hemolytic disease of the fetus and newborn. PTS: 1 DIF: Cognitive Level: Understanding

17. Which laboratory test is an indirect measure of atherosclerotic plaque?

D Highly sensitive CRP (hs-CRP) is an acute phase reactant or protein mostly synthesized in the liver and is an indirect measure of atherosclerotic plaque-related inflammation and plaque progression. High levels of homocysteine are considered a cardiac risk factor but not a measurement of atherosclerotic plaque. LDL is a type of lipid that confers risk with higher levels. The ESR is a nonspecific measure of inflammation. PTS: 1 DIF: Cognitive Level: Remembering

2. What is the effect of low plasma albumin?

D In the case of decreased production (e.g., cirrhosis, other diffuse liver diseases, protein malnutrition) or excessive loss of albumin (e.g., certain kidney diseases, extensive burns), the reduced oncotic pressure leads to excessive movement of fluid and solutes into the tissues and decreased blood volume. Low plasma albumin does not affect clotting factors, immunoglobulins, or iron. PTS: 1 DIF: Cognitive Level: Remembering

16. A newborn has chronic sustained hypertension but otherwise appears healthy. What diagnostic testing does the healthcare professional facilitate as the priority?

D Infants and newborns usually have secondary hypertension, which can be caused by many disease processes. Renal disorders are very common causes so the healthcare professional would facilitate getting blood work for renal function studies. Electrolytes would be obtained as well, but are not specific for a cause like renal studies are. Without any other manifestations, the professional would not facilitate cardiac catheterization or echocardiogram. PTS: 1 DIF: Cognitive Level: Remembering

3. Kussmaul respirations as a respiratory pattern may be associated with which characteristic(s)?

D Kussmaul respirations are characterized by a slightly increased ventilatory rate, very large tidal volume, and no expiratory pause. Alternating periods of deep and shallow breathing characterize Cheyne-Stokes breathing. Increased work of breathing is seen in labored breathing. Inadequate alveolar ventilation describes hypoventilation. PTS: 1 DIF: Cognitive Level: Remembering

8. Without prior exposure to an antigen, which cells are able to destroy some types of tumor cells and some virus-infected cells?

D NK cells, which resemble large granular lymphocytes, kill some types of tumor cells (in vitro) and some virus-infected cells without being induced by previous exposure to these antigens. This capability is not true of lymphocytes, plasma cells, or megakaryocytes. PTS: 1 DIF: Cognitive Level: Remembering

14. Nicotine increases atherosclerosis by the release of which neurotransmitter?

D Nicotine stimulates the release of catecholamines (e.g., epinephrine, norepinephrine), which increases the heart rate and causes peripheral vascular constriction. As a result, blood pressure increases, as do both cardiac workload and oxygen demand. Nicotine does not stimulate the release of histamine, nitric oxide or angiotensin II. PTS: 1 DIF: Cognitive Level: Remembering

10. A healthcare professional wants to determine the adequacy of a person's alveolar ventilation. What assessment finding is most important for the professional to consider?

D Observation of the ventilatory rate, pattern, or effort cannot determine the adequacy of alveolar ventilation. If a healthcare professional needs to determine the adequacy of ventilation, then an arterial blood gas analysis must be performed to measure partial pressure of arterial carbon dioxide (PaCO2). The professional would analyze the PaCO2 for this determination. PTS: 1 DIF: Cognitive Level: Applying

26. Which receptors are located in the aortic bodies, aortic arch, and carotid bodies?

D Of the options available, only the peripheral chemoreceptors are located in the aortic bodies, aortic arch, and carotid bodies at the bifurcation of the carotids, near the baroreceptors. PTS: 1 DIF: Cognitive Level: Remembering

20. What is plasmin's role in the clotting process?

D Plasmin (also called fibrinase or fibrinolysin) is a serine protease that degrades fibrin polymers in clots. It is not capable of stimulating platelet aggregation, inhibiting platelet adhesion, or preventing conversion of prothrombin. PTS: 1 DIF: Cognitive Level: Remembering

19. A patient reports chest pain that occurs most often during sleep. What treatment does the healthcare professional discuss with the patient?

D Prinzmetal angina (also called variant angina) is chest pain attributable to transient ischemia of the myocardium that occurs unpredictably and almost exclusively at rest. The typical treatment for this condition is long-acting nitrites or calcium channel blockers. Treating sleep apnea, taking short-acting nitroglycerin, or taking low dose aspirin will not benefit the patient. PTS: 1 DIF: Cognitive Level: Applying

24. A healthcare provider is assessing a patient who has a pericardial effusion and notes a pulsus paradoxus. A student asks for an explanation of how this occurs. What description by the professional is best?

D Pulsus paradoxus means that the arterial blood pressure during expiration exceeds arterial pressure during inspiration by more than 10 mmHg. This clinical finding reflects impairment of diastolic filling of the left ventricle plus a reduction of blood volume within all four cardiac chambers. PTS: 1 DIF: Cognitive Level: Understanding

15. The sternocleidomastoid and scalene muscles are referred to as which group?

D The accessory muscles of inspiration are the sternocleidomastoid and scalene muscles. The diaphragm is the major muscle of inspiration. Expiration is mainly passive and has no muscles associated with it. The intercostal muscles protect the lungs from injury and assist the diaphragm with inspiration. PTS: 1 DIF: Cognitive Level: Remembering

16. A newborn has alveolar collapse, decreased lung expansion, increased work of breathing, and severe gas-exchange abnormalities and the student asks the healthcare professional for an explanation of what is happening. What response by the professional is best?

D The decrease in surface tension caused by surfactant is also responsible for keeping the alveoli free of fluid. In the absence of surfactant, the surface tension tends to attract fluid into the alveoli. If surfactant production is disrupted or surfactant is not produced in adequate quantities, then the alveolar surface tension increases, causing alveolar collapse, decreased lung expansion, increased work of breathing, and severe gas-exchange abnormalities. The decrease in surface tension caused by surfactant is also responsible for keeping the alveoli free of fluid. The newborn is most likely to be experiencing this condition. There is no information about the labor and delivery being long or traumatic or causing decreased compliance or a pneumothorax. There is also no information on the newborn receiving supplemental oxygen although for a short period of time, this would do no damage. PTS: 1 DIF: Cognitive Level: Understanding

15. The cardiac electrical impulse normally begins spontaneously in the sinoatrial (SA) node because of what reason?

D The electrical impulse normally begins in the SA node because its cells depolarize more rapidly than other automatic cells at a rate of 60 to 100 beats/min. The SA node's location does not influence this activity. Other areas of the heart include the AV node and the Purkinje fibers. The vagus nerve causes the heart rate to slow as part of the parasympathetic nervous system. PTS: 1 DIF: Cognitive Level: Remembering

4. When does systemic vascular resistance in infants begin to increase?

D The low-resistance placenta is removed from circulation, which causes an immediate increase in systemic vascular resistance to approximately twice of that before birth. PTS: 1 DIF: Cognitive Level: Remembering

3. Which description is consistent with chronic myelogenous leukemia (CML)?

D The presence of the BCR-ABLI fusion gene distinguishes CML from other myeloproliferative disorders. PTS: 1 DIF: Cognitive Level: Remembering

20. Which structure(s) in acute respiratory distress syndrome (ARDS) release inflammatory mediators such as proteolytic enzymes, oxygen-free radicals, prostaglandins, leukotrienes, and platelet-activating factor?

D The role of neutrophils is central to the development of ARDS. Activated neutrophils release a battery of inflammatory mediators, among them proteolytic enzymes, oxygen-free radicals (superoxide radicals, hydrogen peroxide, hydroxyl radicals), arachidonic acid metabolites (prostaglandins, thromboxanes, leukotrienes), and platelet-activating factor. These mediators cause extensive damage to the alveolocapillary membrane and greatly increase capillary membrane permeability. The described responses are not associated with the other options. PTS: 1 DIF: Cognitive Level: Remembering

25. A patient reports sudden onset of severe chest pain that radiates to the back and worsens with breathing and when lying down. What action by the healthcare professional is most appropriate?

D This patient has manifestations of acute pericarditis, which also include dysphagia, restlessness, irritability, anxiety, malaise, and weakness. The treatment is generally a course of nonsteroidal antiinflammatory medication. A pericardiocentesis would be used for a cardiac tamponade. The patient does not need an ECG or diuretics. PTS: 1 DIF: Cognitive Level: Applying

21. Which heart defect results in a single vessel arising from both ventricles, providing blood to both the pulmonary and systemic circulations?

D Truncus arteriosus is the failure of the large embryonic artery, the truncus arteriosus, to divide into the pulmonary artery and the aorta, which results in a single vessel arising from both ventricles, providing blood flow to the pulmonary and systemic circulations. None of the other options produce the described structural malformation. PTS: 1 DIF: Cognitive Level: Remembering

8. A newborn displays pallor, tachycardia, and has a systolic murmur. What hemoglobin value does the healthcare professional correlate with these manifestations?

D When the hemoglobin falls below 5 g/dL, pallor, tachycardia, and systolic murmurs may occur. PTS: 1 DIF: Cognitive Level: Understanding

6. During the cardiac cycle, why do the aortic and pulmonic valves close after the ventricles relax?

D When the ventricles relax, blood fills the cusps and causes their free edges to meet in the middle of the vessel, closing the valve and preventing any backflow. The papillary muscles function in the tricuspid and mitral valves as do the chordae tendineae. Reduced pressure does not pull the valves closed. PTS: 1 DIF: Cognitive Level: Remembering

36. What physical sign does the healthcare professional relate to the result of turbulent blood flow through a vessel?

D Where flow is obstructed, the vessel turns or blood flows over rough surfaces. The flow becomes turbulent with whorls or eddy currents that produce noise, causing a murmur to be heard on auscultation. Increased blood pressure during stress is the result of sympathetic nervous system stimulation. A bounding pulse usually indicates fluid overload. Cyanosis would relate to a decrease in gas exchange and oxygenation. PTS: 1 DIF: Cognitive Level: Understanding

20. What is the effect of epinephrine on β3 receptors on the heart?

D β3 receptors are found in the myocardium and coronary vessels. In the heart, stimulation of these receptors opposes the effects of β1- and β2-receptor stimulation and negative inotropic effect. Thus β3 receptors may provide a safety mechanism that decreases myocardial contractility to prevent overstimulation of the heart by the sympathetic nervous system. PTS: 1 DIF: Cognitive Level: Remembering

3. Which assessment findings would the health care professional correlate with aortic stenosis? (Select all that apply.)

D, E The classic manifestations of aortic stenosis are angina, syncope, and heart failure. None of the other options are associated with aortic stenosis. PTS: 1 DIF: Cognitive Level: Remembering