Pathophysiology Exam 1 Practice Problems
A 20-year-old college student has presented to her campus medical clinic for a scheduled Pap smear. The clinician who will interpret the smear will examine cell samples for evidence of: A. Changes in cell shape, size, and organization B. Presence of unexpected cell types C. Ischemic changes in cell sample D. Abnormally high numbers of cells
A
A 22-year-old was recently diagnosed with acquired immunodeficiency syndrome (AIDS). Which decreased lab finding would be expected to accompany this virus? A. CD4 helper T cells B. CD8 helper T cells C. CDC cells D. CDC10 cells
A
A 50-year-old female was diagnosed with sideroblastic anemia. Which of the following assessment findings would most likely occur? A. Bronze colored skin B. Decreased iron C. Normochromic erythrocytes D. Aplastic bone marrow
A
A patient arrives at her follow-up appointment 1 month post-hysterectomy and complains to the nurse that her scars do not seem to be healing properly. Upon inspection, the nurse notices that the scars are raised but still within the boundaries of the original incisions. The nurse tells the patient this kind of dysfunction wound healing is called: A. Hypertrophic scarring B. Dehiscence C. Contracture D. A keloid
A
A person is given an attenuated antigen as a vaccine. When the person asks what was given in the vaccine, how should the nurse respond? The antigen is: A. Alive, but less infectious B. Mutated, but highly infectious C. Normal, but not infectious D. Inactive ,but infectious
A
A secondary immune response differs from the primary immune response in that: A. It is more rapid than the primary response and results in higher antibody levels B. It is slower than the primary response and doesn't chance the antibody levels C. It occurs at the same time as the primary response but results in a decrease in antibodies D. It only occurs in hyperallergic reactions and results in a decrease in antibodies
A
After teaching the students about B cells, which statement indicates teaching was successful? B cells are originally derived from cells of the: A. Bone marrow B. Lymph nodes C. Gut-associated lymphoid tissue D. Thymus
A
An older adult patient has just sheared the skin on her elbow while attempting to boost herself up in bed, an event that has precipitated acute inflammation in the region surrounding the wound. Which of the following events will occur during the vascular stage of the patient's inflammation? A. Outpouring of exudate into interstitial spaces B. Chemotaxis C. Accumulation of leukocytes along epithelium D. Phagocytosis of cellular debris
A
Antibodies are produced by: A. B cells B. T cells C. helper cells E. memory cells
A
How should the nurse prepare a patient who is to receive a Schilling test for pernicious anemia? A. Administer radioactive cobalamin and measure its excretion time B. Measure antigen-antibody immune complexes C. Measure serum ferritin and total iron-binding capacity D.Administer folate and evaluate folate content in a blood serum sample
A
When a nurse cares for a patient with systemic lupus erythematosus (SLE), the nurse remembers this disease is an example of: A. Autoimmunity B. Alloimmunity C. Homoimmunity D. Alleimmunity
A
When planning care for a cardiac patient, the nurse knows that in response to an increased workload, cardiac myocardial cells will: A. Increase in size B. Decrease in length C. Increase in excitability D. Increase in number
A
Two people experience the same stressor yet only one is able to cope and adapt adequately. An example of the person with an increased capacity to adapt is the one with: A. A sense of purpose in life B. Circadian rhythm disruption C. Age-related renal dysfunction D. Excessive weight gain or loss
A Back to mediating factors. Which of these things do you think would help a person deal with stress? Disruption in sleep cycle (B) will definitely not help, age-related renal dysfunction (C) is an indicator of poor health status which also would not help, and excessive weight changes (D) are also likely to cause more stress than alleviate it.
An immunology nurse is caring for a patient. While planning care, which principle will the nurse remember? The primary role of IgA1 is to prevent infections in the: A. Blood B. Kidneys C. Lungs D. Mucous membranes
A IgA1 found in blood, IgA2 found in secretions
Direct effects of antibodies include (Select all that apply): A. Neutralization B. Agglutination C. Precipitation D. Phagocytosis E. Division
A, B, C Directly, antibodies can affect infectious agents or their toxic products by ... Neutralization (inactivating or blocking the binding of antigen to receptors) Agglutination (clumping insoluble particles that are in suspension) Precipitation (making a soluble antigen into an insoluble precipitate)
The characteristic, localized cardinal signs of acute inflammation include: (Select all that apply.) A. Redness B. Fatigue C. Swelling D. Warmth E. Fever
A, C, D
A nurse is explaining to a pt the difference between primary and secondary immunodeficiency disorders and explains that secondary immunodeficiencies (select all that apply): A. May develop after viral infections B. Develop before birth C. May develop following immunosuppressive therapies D. Are caused by superimposed conditions E. Are not always readily evident
A, C, D, E
A 10-year-old male presents to his primary care provider reporting wheezing and difficulty breathing. History reveals that both of the child's parents suffer from allergies. Which of the following terms would be used to classify the child? A. desensitized B. atopic C. hyperactive D. autoimmune
B
A 21-year-old female was recently diagnosed with iron deficiency anemia. In addition to fatigue and weakness, which of the following clinical signs and symptoms would she most likely exhibit? A. Hyperactivity B. Spoon-shaped nails C. Gait problems D. Petechiae
B
A 5-year-old male presents with low-set ears, a fish-shaped mouth, and involuntary rapid muscular contraction. Laboratory testing reveals decreased calcium levels. Which of the following diagnosis is most likely: A. B cell deficiency B. T cell deficiency C. Combined immunologic deficiency D. Complement deficiency
B
A 5-year-old male was diagnosed with normocytic-normochromic anemia. Which of the following anemias does the nurse suspect the patient has? A. Sideroblastic anemia B. Hemolytic anemia C. Pernicious anemia D. Iron deficiency anemia
B
A patient with an 18 pack per year history presents to a family practice clinic complaining of painless hoarseness and inability to clear mucus. A biopsy of respiratory tract cells is taken and shows that these cells have been replaced by less mature squamous epithelium cells. The nurse knows this type of change is referred to as: A. Dysplasia B. Metaplasia C. Hyperplasia D. Coagulation
B
A patient with an 18 pack per year history presents to a family practice clinic complaining of painless hoarseness and inability to clear mucus. A biopsy of respiratory tract cells is taken and shows that these cells have been replaced by less mature squamous epithelium cells. The nurse knows this type of change is referred to as: A. dysplasia B. metaplasia C. hyperplasia D. coagulation
B
A patient's anemia is described as having erythrocytes that demonstrate anisocytosis. The nurse would recognize the erythrocytes would be: A. Pale in color B. Present in various sizes C. Able to assume various shapes D. Live only a few days
B
A report comes back indicating that muscular atrophy has occurred. A nurse recalls that muscular atrophy involves a decrease in muscle cell: A. Number B. Size C. Vacuoles D. Lipofuscin
B
A staff member asks what leukocytosis means. How should the nurse respond? Leukocytosis can be defined as: A. A normal leukocyte count B. A high leukocyte count C. A low leukocyte count D. Another term for leukopenia
B
After a patient is exposed to a specific antigen, B cells will differentiate into: A. B cytotoxic cells B. Plasma cells C. Bursal cells D. Clonal equivalents
B
An experiment is designed to determine specific cell types involved in cell-mediated immune response. The experimenter is interested in finding cells that attack cells that have specific antigens. Which cells should be isolated? A. Lymphokine-producing cells B. Cytotoxic T cells C. Helper T cells D. Macrophages
B
Cellular swelling is: A. irreversible B. evident early in all types of cellular injury C. manifested by decreased intracellular sodium D. none of the above is correct E. both b and c are correct
B
DiGeorge syndrome is a primary immune deficiency caused by: A. Failure of B cells to mature B. Congenital lack of thymic tissue C. Failure of formed elements of blood to develop D. Selective IgG deficiency
B
DiGeorge syndrome is a primary immune deficiency caused by: A. failure of B cells to mature B. congenital lack of thymic tissue C. Failure of formed elements of blood to develop D. Selective IgG deficiency E. Selective IgA deficiency
B
During childhood, the thymus decreases in size, and this is referred to as _____ atrophy. A. Physiologic B. Pathologic C. Disuse D. Neurogenic
B
In addition to matching ABO antigens, a blood transfusion must also be matched for: A. HLA type B. Rh antigen C. immunoglobulins D. platelet compatibility
B
Inflammatory exudates are a combination of several types. Which of the following exudates is composed of a large accumulation of leukocytes? A. Serous B. Purulent C. Fibrinous D. Hemorrhagic
B
Swelling during acute inflammation is caused by: A. collagenase B. fluid exudate C. lymphocytic margination E. anaerobic glycolysis
B
What common symptom should be assessed in individuals with immunodeficiency? A. Anemia B. Recurrent infections C. Hypersensitivity D. Autoantibody production
B
When a nurse is reviewing lab results and notices that the erythrocytes contain an abnormally low concentration of hemoglobin, the nurse calls these erythrocytes: A. Hyperchromic B. Hypochromic C. Macrocytic D. Microcytic
B
Which of the following is a characteristic of the human immunodeficiency virus (HIV), which causes AIDS? A. HIV only infects B cells B. HIV is a retrovirus C. Infection does not require a host cell receptor D. After infection, cell death is immediate
B
Which of the following wounds is most likely to heal by secondary intention? A. A finger laceration received while cutting onions B. A stage IV pressure ulcer that developed in a nursing home C. A needlestick injury received while administering parenteral medication D. An incision from an open appendectomy
B
Stress-induced cortisol hormone secretion is associated with: A. Increased growth hormone level B. Regulation of the stress response C. Increased thyroid-stimulating hormone D. Depressed adrenal gland function
B You know it's not A because I mentioned in an earlier slide that growth hormone levels decrease with stress. We didn't mention thyroid-stimulating hormone as one of the ones associated with the stress repsonse so you can pretty much assume that's not right. And we know adrenal function is not depressed because ACTH from the anterior pituitary stimulates the adrenal glands to release cortisol.
A patient with severe peripheral vascular disease has developed signs of dry gangrene on the great toe of one foot. Which of the following pathophysiologic processes most likely contributed to this diagnosis? A. Inappropriate activation of apoptosis B. Bacterial invasion C. Impaired arterial blood supply D. Metaplastic cellular changes
B Remember that it's not C because to have gangrene, you must have infection
The parents of a 4-year-old girl have sought care because their daughter has admitted to chewing and swallowing imported toy figurines that have been determined to be made of lead. Which of the following blood tests should the care team prioritize? A. White blood cell levels with differential B. Red blood cell levels and morphology C. Urea and creatinine levels D. Liver function panel
B Lead -> anemia, RBC lysis You know it's not A because there is no infection involved. C is focused on kidney function while D is focused on liver function. Both of these would be important in the case of lead poisoning BUT the priority answer is B, because you need first to address the most life-threatening patient needs. The little girl in this question can go into shock or suffer permanent organ damage if her RBCs are low.
Which of the following factors are known to contribute to an individual's ability to adapt to stress? (Select all that apply.) A. Ethnicity B. Age C. Socioeconomic status D. Gender E. Health status
B, C, D, E "Ability to adapt to stress" = mediating factors! Slide 28 of this powerpoint
An older adult patient comes to the clinic complaining of not being able to do what he used to be able to. You know that normal changes associated with aging include: (Select all that apply.) A. Improved blood flow B. Slowed metabolic rate C. Decreased brain weight D. Improved nerve fiber conduction E. Less respiratory capacity
B, C, E
While planning care for an elderly patient, the nurse remembers that increased age is associated with (Select all that apply): A. Increased T cell function B. Decreased immune function C. Increased production of antibodies D. Increased levels of circulating autoantibodies E. Decreased ability to fight infection
B, D, E Decreased T cell function and antibody response
A 10-year-old male is stung by a bee while playing in the yard. He begins itching and develops pain, swelling, redness, and respiratory difficulties. He is suffering from: A. Immunodeficiency B. Autoimmunity C. Anaphylaxis D. Tissue-specific hypersensitivity
C
A 23-year-old pregnant female visits her primary care provider for her final prenatal checkup. The primary care provider determines that the fetus has developed an infection in utero. Which of the following would be increased in the fetus at birth? A. IgG B. IgA C. IgM D. IgD
C
A 35-year-old female is diagnosed with vitamin B12 deficiency anemia (pernicious anemia). How should the nurse respond when the patient asks what causes pernicious anemia? A decrease in ______ is the most likely cause. A. Ferritin B. Gastric enzymes C. Intrinsic factor D. Erythropoietin
C
A 35-year-old male has enlarged lymph nodes in the neck and a mediastinal mass. He was diagnosed with Hodgkin lymphoma. Which of the following abnormal cells would the nurse expect to find with this disease? A. Merkel cell B. Schwann cell C. Reed-Sternberg cell D. Kupffer cell
C
A 75-year-old male presents with chest pain on exertion. The chest pain is most likely due to hypoxic injury secondary to: A. Malnutrition B. Free radicals C. Ischemia D. Chemical toxicity
C
A group of prison inmates developed tuberculosis following exposure to an infected inmate. On examination, tissues were soft and granular (like clumped cheese). Which of the following is the most likely cause? A. Coagulative necrosis B. Liquefactive necrosis C. Caseous necrosis D. Autonecrosis
C
A newborn is diagnosed with congenital intrinsic factor deficiency. Which of the following types of anemia will the nurse see documented on the chart? A. Iron deficiency anemia B. Sideroblastic anemia C. Pernicious anemia D. Hemolytic anemia
C
A nurse recalls an example of an immune-complex-mediated disease is: A. Bronchial asthma B. Contact dermatitis C. Serum sickness D. Rheumatoid arthritis
C
A patient is found to have liver disease, resulting in the removal of a lobe of his liver. Adaptation to the reduced size of the liver leads to ___________ of the remaining liver cells. A. Metaplasia B. Organ atrophy C. Compensatory hyperplasia D. Physiologic hyperplasia
C
A patient underwent an open cholecystectomy 4 days ago and her incision is now in the proliferative phase of healing. The nurse knows that the next step in the process of wound healing is: A. Inflammation B. Maturation C. Remodeling D. Coagulation
C
After studying about viruses, which information indicates the student has a good understanding of viruses? Viruses: A. Contain no RNA or DNA B. Are capable of independent reproduction C. Replicate their genetic material inside host cells D. Are killed easily by antimicrobials
C
Although stress exposure initiates integrated responses by multiple systems, the most important changes are first activated by which system? A. Pulmonary B. Gastrointestinal C. Neuroendocrine D. Cardiovascular
C
Humoral immunity is mediated by: A. Natural killer cells B. T cells C. B cells D. neutrophils
C
The cellular stage of acute inflammation is marked by the movement of leukocytes into the area. Which of the following cells arrives first and in great numbers? A. Basophils B. Lymphocytes C. Neutrophils D. Platelets
C
Type of lymphocyte that recognizes and eliminates virus-infected cells and cancerous cells: A. neutrophils B. macrophages C. Natural killer cells D. Langerhans cells
C
When a nurse notices that a patient has type O blood, she realizes that anti-_____ antibodies are present in the patient's body. A. A only B. B only C. A and B D. O
C
When a patient asks the nurse what hypersensitivity is, how should the nurse respond? Hypersensitivity is best defined as: A. A reduced immune response found in most pathologic states B. A normal immune response to an infectious agent C. An excessive or inappropriate response of immune system to sensitizing antigen D. Antigenic desensitization
C
When a patient asks the nurse what hypersensitivity is, how should the nurse respond? Hypersensitivity is best defined as: A. a reduced immune response found in most pathologic states B. a normal immune response to an infectious agent C. an excessive or inappropriate response of immune system to sensitizing antigen D. antigenic desensitization
C
When the body produces antibodies against its own tissue, the condition is called A. alloimmunity B. opsonization C. autoimmunity D. hypersensitivity
C
When the maternal immune system becomes sensitized against antigens expressed by the fetus, what type of immune reaction occurs? A. autoimmune B. anaphylaxis C. alloimmune D. allergic
C
Which immunoglobulin presents the first challenge to the antigen? A. IgA B. IgG C. IgM D. IgE
C
Which of the following is responsible for initiating clonal selection? A. B cells B. T cells C. Antigens D. Lymphocytes
C
Which of the following mediators of inflammation causes increased capillary permeability and pain? A. Serotonin B. Histamine C. Bradykinin D. Nitric oxide
C
A 10-year-old male is stung by a bee while playing in the yard. He experiences a severe allergic reaction and has to go to the ER. The nurse providing care realizes this reaction is the result of: A. Toxoids B. IgA C. IgE D. IgM
C IgE is a mediator of many common allergic responses
A 5-month-old child is admitted to the hospital with recurring respiratory infections. A possible cause of this condition is: A. Hypergammaglobulinemia B. Increased maternal IgG C. Immune insufficiency D. Decreased maternal antibody breakdown, resulting in hyposensitivity
C Remember, we are immunologically immature when born
A child's thymus gland is fully formed and proportionately larger than an adult's. Which of the following processes that contribute to immunity takes place in the thymus gland? A. Differentiation of B cells B. Production of natural killer (NK) cells C. Proliferation of T cells D. Filtration of antigens from the blood
C T cell production and proliferation occurs in the thymus
A 30-year-old male was diagnosed with HIV. Which of the following treatments would be most effective? A. Reverse transcriptase inhibitors B. Protease inhibitors C. Entrance inhibitors D. Highly active antiretroviral therapy
D
A 57-year-old male presents to his primary care provider for red face, hands, feet, ears, and headache and drowsiness. A blood smear reveals an increased number of erythrocytes, indicating: A. Leukemia B. Sideroblastic anemia C. Hemosiderosis D. Polycythemia vera
D
A nurse is teaching a class about immune deficiencies, and a person from the audience asks which cells are affected by severe combined immune deficiency (SCID) syndrome, and the nurse answers: A. B cell deficits B. T cell deficits C. complement deficits D. B and T cell deficits
D
A patient has a heart attack that leads to progressive cell injury that causes cell death with severe cell swelling and breakdown of organelles. What term would the nurse use to define this process? A. Adaptation B. Pathologic calcification C. Apoptosis D. Necrosis
D
A pt presents with a rash from poison ivy. The nurse knows that this is which type of hypersensitivity? A. Type I B. Type II C. Type III D. Type IV
D
After studying about fungi, which information indicates a correct understanding of fungi? Fungi causing deep or systemic infections: A. Are easily treated with penicillin B. Are extremely rare C. Never occur with other infections D. Are commonly opportunistic
D
Innate resistance or immunity: A. involves "memory" B. is a development of an individual's later years C. is a relatively slow and specific process D. depends on physical, mechanical, and biochemical barriers
D
The inflammatory response: A. prevents blood from entering the injured tissue B. elevates body temp to prevent spread of infxn C. prevents formation of abscess D. minimizes injury and promotes healing
D
The registered nurse is teaching a class on inflammation and explains that which cell is the predominant phagocyte arriving early at inflammatory and infection sites? A. macrophages B. mast cells C. monocytes D. neutrophils
D
When a nurse observes muscle stiffening occurring within 6 to 14 hours after death, the nurse should document this finding as _____ present. A. Livor mortis B. Gangrene C. Algor mortis D. Rigor mortis
D
Which information would indicate more teaching is needed regarding hypersensitivity reactions? Type _______ hypersensitivity reactions involve an antibody response. A. I B. II C. III D. IV
D
Which is not an autoimmune disease? A. Multiple sclerosis B. Pernicious anemia C. Goodpasture syndrome D. Transfusion reaction
D
Which is not an autoimmune disease? A. multiple sclerosis B. pernicious anemia C. ulcerative colitis D. transfusion reaction E. goodpasture disease
D
Which of the following statements indicates more teaching is needed regarding secondary lymph organs? ________is/are a secondary lymph organ. A. The spleen B. Peyer patches C. Adenoids D. The liver
D
The first circulating immunoglobulin to appear in response to a new antigen is: A. IgA B. IgG C. IgE D. IgM
D IgM dominates primary immune response
Which manifestation of stress reflects the non-specific fight or flight response? A. Decreased pupillary light response B. Increased GI motility C. Decreased short-term memory D. Increased cardiopulmonary rates
D This would fall under physiologic responses to stress!! Slide 25 in your lecture powerpoint
Prior to leaving on a backpacking trip to Southeast Asia, a college student has received a tetanus booster shot. This immunization confers protection by way of what immune process? A. Passive natural immunity B. Active natural immunity C. Passive artificial immunity D. Active artificial immunity
D Active artificial immunity includes immunizations An example of passive natural immunity would be maternal IgG in baby An example of active natural immunity would be developing immunity in response to infection (e.g., chickenpox) An example of passive artificial immunity would be giving an antitoxin for a snake bite
A 5-year-old female takes a hike through the woods during a school field trip. Upon returning home, she hugs her father, and he later develops poison ivy. Which of the following immune reactions is he experiencing? A. IgE-mediated B. Tissue-specific C. Immune complex D. Cell-mediated
D - type IV hypersensitivity
