patho Chapter 14 QUESTIONS- your body hurts you because it loves you

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

ANS: A Color blindness, present most often in males, affects 8% of the male population and 0.5% of the female population. Neither the elderly nor children are most prone to color blindness. REF: p. 349

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

ANS: A Glaucoma is the result of increased intraocular pressure. Ocular degeneration results in changes in vision, but not intraocular pressure. Diplopia is double vision. Nystagmus is an involuntary unilateral or bilateral rhythmic movement of the eyes. REF: p. 349

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

ANS: A Moisture must be present because heat is lost through evaporation from the surface of skin and lining of mucous membranes, a major source of heat reduction connected with increased sweating in warmer surroundings. Fever is not required for evaporation to occur, but moisture is. Pyrogens are heat producers and do not assist with evaporation, but moisture is required. Trauma is not a portion of the evaporative process of heat loss. REF: p. 343, Table 14-5

A child suffers from sudden apparent arousals in which she expresses intense fear or other emotion. Her mother reports that she seems to wake screaming, but that she is difficult to waken completely. The child most likely suffers from: a. night terrors. b. parasomnia. c. somnambulism. d. enuresis episodes.

ANS: A Night terrors are characterized by sudden apparent arousals in which the child expresses intense fear or emotion. Parasomnia is unusual behaviors during sleep. Somnambulism is sleep-walking. Enuresis episodes are bed-wetting. REF: p. 346

A patient asks the nurse where nociceptors can be found. How should the nurse respond? One location in which nociceptors can be found is the: a. skin. b. spinal cord. c. efferent pathways. d. hypothalamus.

ANS: A Nociceptors are pain receptors and can be found in the skin. Nociceptors are not located in the spinal cord. Nociceptors are not located in efferent, but afferent, pathways. Nociceptors are not located in the hypothalamus but can be found in the meninges. REF: p. 337, Table 14-1

MS While planning care for infants, which principles should the nurse remember? (select all that apply) Infants have problems with thermoregulation because they: a. cannot conserve heat. b. do not shiver. c. rarely sweat. d. have decreased metabolic rates. e. have excess subcutaneous fat.

ANS: A, B Infants cannot conserve heat; thus, they have a problem with thermoregulation because of their small size. Infants are unable to shiver, do have the ability to sweat, have an increased metabolic rate, and have little subcutaneous fat. REF: p. 342

A 70-year-old patient presents to the primary care provider reporting loss of vision. A history that includes hypertension and cigarette smoking supports which visual diagnosis? a. Presbyopia b. Macular degeneration c. Strabismus d. Amblyopia

ANS: B Age-related macular degeneration (AMD) is a severe and irreversible loss of vision and a major cause of blindness in older individuals. Hypertension and cigarette smoking are risk factors. Presbyopia is a condition associated with aging in which the patient experiences reduced near vision. In strabismus, one eye deviates from the other when the person is looking at an object. In amblyopia, vision is reduced in the affected eye caused by cerebral blockage of the visual stimuli. REF: p. 349

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

ANS: B Chronic or persistent pain has been defined as lasting for more than 3-6 months.

Heat loss from the body via convection occurs by: a. evaporation of electromagnetic waves. b. transfer of heat through currents of liquids or gas. c. dilation of blood vessels bringing blood to skin surfaces. d. direct heat loss from molecule-to-molecule transfer.

ANS: B Convection occurs by transfer of heat through currents of gases or liquids, exchanging warmer air at the body's surface with cooler air in surrounding spaces. Convection does not involve electromagnetic waves, bringing blood to skin surfaces, or molecule-to-molecule transfer. REF: p. 343, Table 14-5

Exogenous pyrogens are: a. interleukins. b. endotoxins. c. prostaglandins. d. corticotropin-releasing factors.

ANS: B Exogenous pyrogens are endotoxins produced by pathogens. They are not interleukins, prostaglandins, or corticotropin-releasing factors. REF: p. 343

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

ANS: B Heat exhaustion results from prolonged high core or environmental temperatures, which cause profound vasodilation and profuse sweating, leading to dehydration, decreased plasma volumes, hypotension, decreased cardiac output, and tachycardia. Symptoms include weakness, dizziness, confusion, nausea, and fainting. Heat cramping is severe, spasmodic cramps in the abdomen and extremities that follow prolonged sweating and associated sodium loss. Heat cramping usually occurs in those not accustomed to heat or those performing strenuous work in very warm climates. Heat stroke is a potentially lethal result of an overstressed thermoregulatory center. With very high core temperatures (>40° C; 104° F), the regulatory center ceases to function, and the body's heat loss mechanisms fail. Malignant hyperthermia is a potentially lethal complication of a rare inherited muscle disorder that may be triggered by inhaled anesthetics and depolarizing muscle relaxants. REF: p. 344

What is the physiological response when the body's core temperature is altered due to prolonged exposure to a cold environment? a. Increased respirations b. Ischemic tissue damage c. CNS excitation d. Increased cellular metabolism

ANS: B Hypothermia (marked cooling of core temperature) produces depression of the central nervous and respiratory systems, vasoconstriction, alterations in microcirculation, coagulation, and ischemic tissue damage. Hypothermia does not lead to increased respirations, CNS excitation, or increased cellular metabolism. REF: p. 344

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

ANS: B OSAS generally results from upper airway obstruction recurring during sleep with excessive snoring and multiple apneic episodes that last 10 seconds or longer. Insomnia is the inability to fall or stay asleep and may be mild, moderate, or severe. It does not involve snoring. Somnambulism is sleep-walking. Jet-lag syndrome is a disorder of waking and sleeping and does not involve snoring. REF: p. 346

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

ANS: B Symptoms of heat stroke include high core temperature, absence of sweating, rapid pulse, confusion, agitation, and coma, and complications include cerebral edema and degeneration of the CNS. Neither cramping nor alterations in calcium uptake are considered complications of a heat stroke. REF: p. 344

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

ANS: B The Eustachian tube connects the middle ear to the pharynx. The organ of Corti contains the hair cells. The semicircular canal is one of the three bones of the labyrinth. The auditory canal leads to the middle ear. REF: p. 351

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

ANS: B The affective-motivational system determines an individual's conditioned avoidance behaviors and emotional responses to pain. The sensory-discriminative system is mediated by the somatosensory cortex and is responsible for identifying the presence, character, location, and intensity of pain. The sensory-motivational system is not a system in the response to pain. The cognitive-evaluative system overlies the individual's learned behavior concerning the experience of pain and can modulate perception of pain. REF: p. 338

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

ANS: B The pain threshold in children is lower than or the same as that of adults. REF: p. 338, Table 14-2

The nurse would expect the patient with an alteration in proprioception to experience vertigo, which is manifested by: a. headache. b. light sensitivity. c. a sensation that the room is spinning. d. loss of feeling in the lips.

ANS: C Alterations in proprioception are manifested by a sensation that the room is spinning, not headache, light sensitivity, or loss of feeling in the lips. REF: p. 353

Most memorable dreams occur during which sleep phase? a. Non-REM b. Alpha wave c. REM d. Delta wave

ANS: C Dreams occur during REM sleep. Dreams are not associated with non-REM, alpha wave, or delta wave sleep.

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

ANS: C Epinephrine causes vasoconstriction, stimulates glycolysis, and increases metabolic rate, thus increasing secondary heat production. Epinephrine does not lead to decreased vascular tone or increased skeletal muscle tone but does increase metabolic rate. REF: p. 342

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

ANS: C Loss of temperature control occurs during REM sleep. Loss of temperature control is not associated with non-REM sleep, light sleep, or delta wave sleep. REF: p. 345

The most common form of sensorineural hearing loss in the elderly is: a. conductive hearing loss. b. acute otitis media. c. presbycusis. d. Ménière disease.

ANS: C Presbycusis is the most common form of sensorineural hearing loss in elderly people. Conductive hearing loss does not occur as frequently as presbycusis. Otitis media is an infection in the middle ear and is not defined as a hearing loss. Ménière disease leads to vertigo, not hearing loss. REF: p. 352

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

ANS: C REM sleep is called paradoxical sleep because the EEG pattern is similar to the normal awake pattern and the brain is very active with dreaming. Neither non-REM, fast wave sleep, nor delta wave sleep produces EEG patterns similar to the normal awake pattern. REF: p. 345

A patient scrapes both knees while playing soccer and reports sharp and well-localized pain. Which of the following should the nurse document to most accurately characterize the pain? a. Chronic pain b. Referred pain c. Somatic pain d. Visceral pain

ANS: C Somatic pain is superficial, arising from the skin. It is typically well localized and described as sharp, dull, aching, or throbbing. Chronic pain has been defined as lasting for more than 3-6 months. Referred pain is felt in an area removed or distant from its point of origin; the area of referred pain is supplied by the same spinal segment as the actual site of pain. Visceral pain is pain in internal organs and lining of body cavities and tends to be poorly localized, with an aching, gnawing, throbbing, or intermittent cramping quality. REF: p. 340

When the nurse is taking a patient's temperature, which principle should the nurse remember? Regulation of body temperature primarily occurs in the: a. cerebrum. b. brainstem. c. hypothalamus. d. pituitary gland.

ANS: C Temperature regulation (thermoregulation) is mediated primarily by the hypothalamus, not the cerebrum, the brainstem, or the pituitary gland. REF: p. 342

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

ANS: C The choroid is the deeply pigmented middle layer that prevents light from scattering inside the eye. The iris is a part of the choroid and contains the pupil, which lets light into the eye. The retina is the innermost layer of the eye. REF: p. 347

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

ANS: C The cognitive-evaluative system overlies the individual's learned behavior concerning the experience of pain and can modulate perception of pain. The sensory-discriminative system is mediated by the somatosensory cortex and is responsible for identifying the presence, character, location, and intensity of pain. The affective-motivational system determines an individual's conditioned avoidance behaviors and emotional responses to pain. The reticular-activating system does not play a role in the perception of pain. REF: p. 338

Several years after an amputation the patient continues to sporadically feel pain in the absent hand. What type of pain should the nurse document in the chart? a. Neuropathic pain b. Visceral pain c. Phantom limb pain d. Chronic pain

ANS: C The qualities we normally feel from the body, including pain, also can be felt in the absence of inputs from the body, such as is noted with phantom limb pain. Neuropathic pain is initiated or caused by a primary lesion or dysfunction in the nervous system. Visceral pain refers to pain in internal organs and the lining of body cavities. Chronic pain lasts more than 3-6 months and is not associated with loss of a limb. REF: p. 341, Table 14-3

Which condition would be treated with therapeutic hypothermia? a. Malnutrition b. Hypothyroidism c. Reimplantation surgery d. Parkinson disease

ANS: C Therapeutic hypothermia is seen with reimplantation surgery, not malnutrition, hypothyroidism, or Parkinson disease. REF: p. 345, Box 14-3

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

ANS: C Thyroxine acts on the adrenal medulla, causing the release of epinephrine into the bloodstream. Epinephrine causes vasoconstriction that increases metabolic rates, thus increasing heat production. Heat production does not involve the pancreas, the liver, or the heart.

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

ANS: D Fever (febrile response) is a temporary "resetting of the hypothalamic thermostat" to a higher level in response to endogenous or exogenous pyrogens. Fever is the result of the body's attempt to raise temperature, not adjust it to a lower level. When fever occurs, the temperature is raised, but the rise is due to a reset of the thermostat. Bacteria do not stimulate peripheral thermogenesis, but their endotoxins do. REF: pp. 342-343

A patient asks the nurse how often REM sleep occurs. The nurse responds, "About every _____ minutes." a. 15 b. 30 c. 60 d. 90

ANS: D REM sleep occurs every 90 minutes. REF: p. 345

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

ANS: D Temperature fluctuation is related to circadian rhythm, not the thermogenesis cycle, thermoconductive phases, or adaptive patterns. REF: p. 342

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

ANS: D The most common causes of acute infections are bacterial microorganisms including Pseudomonas, Escherichia coli, and Staphylococcus aureus. REF: p. 352

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

ANS: D The retina is the innermost layer of the eye, converting light energy into nerve impulses. Light entering the eye is focused on the retina by the lens. The pupil allows light to enter the eye. The cornea is the portion of the sclera in the central anterior region that allows light to enter the eye. REF: p. 347