EXAM 1 Fall

The phase of the cell cycle during which the centromeres split and the sister chromatids are pulled apart is referred to as: a. Anaphase b. Telophase c. Prophase d. Metaphase

ANS: A Anaphase begins when the centromeres split and the sister chromatids are pulled apart. During telophase, the final stage, a new nuclear membrane is formed around each group of 46 chromosomes, the spindle fibers disappear, and the chromosomes begin to uncoil. During prophase, the first appearance of chromosomes occurs. Metaphase occurs when two centrioles located at opposite poles of the cell pull the chromosomes to opposite sides of the cell. REF: p. 23

An 8-year-old female presents with edema of the cutaneous and mucosal tissue layers. Her mother reports that the condition is recurrent and seems to occur more often during stressful situations. The child is diagnosed with hereditary angioedema. Which of the following is deficient in this child? a. C1 esterase inhibitor b. Carboxypeptidase c. Neutrophils d. Plasmin

ANS: A A genetic defect in C1 esterase inhibitor (C1 INH deficiency) results in hereditary angioedema. Hereditary angioedema is due to C1 esterase inhibitor. Carboxypeptidase degrades kinins. Hereditary angioedema is due to C1 esterase inhibitor, not a disorder of neutrophils. Plasmin is not associated with hereditary angioedema, but is associated with clots. REF: p. 124

A patient has a tissue growth that was diagnosed as cancer. Which of the following terms best describes this growth? a. Neoplasm b. Lipoma c. Meningioma d. Hypertrophy

ANS: A A neoplasm is a cancerous growth. Lipomas are benign growths. A meningioma is a benign tumor. Hypertrophy refers to tissue overgrowth, but not cancer. REF: p. 222

During childhood, the thymus decreases in size, and this is referred to as _____ atrophy. a. Physiologic b. Pathologic c. Disuse d. Neurogenic

ANS: A A normal decrease in cell size is physiologic atrophy. When cell size decrease due to disease, it is termed pathologic atrophy. When cells undergo disuse, the cells shrink in size, and this is disuse atrophy. Neurogenic atrophy is injury or disease affecting the nerves that connect to the muscle. REF: p. 61

Sodium and water accumulation in an injured cell are a direct result of: a. Decreased ATP production b. Karyorrhexis c. Ribosome detachment d. Dehydration

ANS: A A reduction in ATP levels causes the plasma membrane's sodium-potassium (Na+-K+) pump and sodium-calcium exchange to fail. Sodium and water can then enter the cell freely. Karyorrhexis means fragmentation of the nucleus into smaller particles or "nuclear dust." Ribosome detachment reduces protein synthesis. Dehydration leads to loss of sodium and water. REF: p. 66

Self-antigens do not meet the requirements for immunogenicity because they lack which of the following? a. Foreignness b. Size c. Quantity d. Virulence

ANS: A A self-antigen that fulfills all the criteria listed above except foreignness does not normally elicit an immune response. A self-antigen fulfills all the criteria listed above except foreignness. They possess size. A self-antigen fulfills all the criteria listed above except foreignness. They possess quantity. Virulence is not a factor. REF: p. 145

A 50-year-old male sustained a closed head injury as a result of a motor vehicle accident. CT scan revealed a collection of blood between the inner surface of the dura mater and the surface of the brain. Which type of injury will the nurse be caring for? a. Subdural hematoma b. Epidural hematoma c. Contusion d. Abrasion

ANS: A A subdural hematoma occurs when blood is between the inner surface of the dura mater and the surface of the brain; it can result from blows, falls, or sudden acceleration/deceleration of the head. An epidural hematoma is a collection of blood between the inner surface of the skull and the dura; it is most often associated with a skull fracture. A contusion is bleeding into the skin or underlying tissues. An abrasion (scrape) results from removal of the superficial layers of the skin caused by friction between the skin and injuring object. REF: p. 78

Which patient will develop active immunity? A patient who: a. Has natural exposure to an antigen or receives an immunization b. Receives preformed antibodies or T cells from a donor c. Has T cells that become B cells d. Receives immunoglobulin

ANS: A Active immunity occurs after either natural exposure to an antigen or after immunization. Active immunity occurs after either natural exposure to an antigen or after immunization, not with preformed antibodies. Active immunity occurs after either natural exposure to an antigen or after immunization, not when T cells become B cells. Active immunity occurs after either natural exposure to an antigen or after immunization, not when the patient receives immunoglobulins. REF: p. 144

Which statement indicates a correct understanding of antibodies? The most abundant class of antibody in the serum is: a. IgG b. IgM c. IgA d. IgE

ANS: A IgG is the most abundant class of immunoglobulins, constituting 80% to 85% of the immunoglobulins in the blood. IgG is the most abundant class of immunoglobulins, not IgM. IgG is the most abundant class of immunoglobulins, not IgA. IgG is the most abundant class of immunoglobulins, not IgE. REF: p. 147

A 6-year-old female is diagnosed with a bacterial infection of the respiratory system. Which of the following will most likely try to fight the antigen? a. Antibodies b. Cytotoxic T cells c. Self-antigens d. Helper T cells

ANS: A Antibodies are produced by plasma cells that mature from lymphocytes, called B lymphocytes (B cells), in response to an antigen. Antibodies are produced by plasma cells that mature from lymphocytes, called B lymphocytes (B cells), in response to an antigen. Cytotoxic T cells do not respond to antigens. Antibodies are produced by plasma cells that mature from lymphocytes, called B lymphocytes (B cells), in response to an antigen. Self-antigens do not respond to antigens. Antibodies are produced by plasma cells that mature from lymphocytes, called B lymphocytes (B cells), in response to an antigen. Helper T cells do not respond to antigens. REF: p. 147 | p. 149

An immunologist has isolated a molecule from the human body to study. It is found to react with antibodies on B cells. Further testing reveals that the molecule is large and chemically diverse. What type of molecule is the immunologist studying? a. Antigen b. Immunogen c. Epitope d. Paratope

ANS: A Antibodies react with antigens. Antibodies react with antigens, not immunogen. Antibodies react with antigens, not epitopes. Antibodies react with antigens, not paratopes. REF: p. 147

A 10-year-old female is arriving at a national spelling bee contest. Her heart starts beating faster and harder, and she begins to sweat. Which of the following is she experiencing? a. Anticipatory response b. Homeostasis c. Reactive response d. Exhaustion stage

ANS: A Anticipation of experiencing these events produces a physiologic stress response. Homeostasis is a steady state. Reactive response occurs following a stressful event; the student is anticipating a stressful event. Exhaustion stage is the final stage of the stressful response. REF: p. 207

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

ANS: A Attenuated vaccines are alive, but less infectious. Attenuated vaccines are alive, not mutated or highly infectious. Attenuated vaccines are normal, but mutated doesn't relate to the answer. Attenuated vaccines are alive, but less infectious; they are not inactive. REF: p. 177

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

ANS: A B cells are derived from the bone marrow. B cells are derived from the bone marrow, not the lymph nodes. B cells are derived from the bone marrow, not the gut-associated lymphoid tissue. B cells are derived from the bone marrow, not the thymus. REF: p. 147

When bacterial pathogens enter a patient's body, they can defend themselves from an immune response by: a. Producing capsules b. Phagocytosis c. Retreating d. Developing antibodies

ANS: A Bacterial survival and growth depend on the effectiveness of the body's defense mechanisms and on the bacterium's ability to resist these defenses. Many pathogens devise ways of preventing destruction by the inflammatory and immune systems by producing thick capsules of carbohydrate or protein. Bacteria do not produce phagocytosis. Bacteria do not retreat. Bacteria do not develop antibodies. REF: p. 168

A nurse is discussing the movement of fluid across the arterial end of capillary membranes into the interstitial fluid surrounding the capillary. Which process of fluid movement is the nurse describing? a. Hydrostatic pressure b. Osmosis c. Diffusion d. Active transport

ANS: A Blood reaching the capillary bed has a hydrostatic pressure of 25 to 30 mm Hg, which is sufficient force to push water across the thin capillary membranes into the interstitial space. Osmosis involves the movement of fluid from an area of higher concentration to an area of lower concentration. It does not involve pressure or force. It is related to hydrostatic pressure. Diffusion is the passive movement of a solute from an area of higher solute concentration to an area of lower solute concentration. Active transport involves movement up a concentration gradient. REF: p. 16

When phagocytes begin to stick avidly to capillary walls, which process is occurring? a. Margination b. Exudation c. Integration d. Emigration

ANS: A Both leukocytes and endothelial cells secrete substances that increase adhesion, or stickiness, causing the leukocytes to adhere more avidly to the endothelial cells in the walls of the capillaries and venules in a process called margination. Exudation is the process of pus formation and does not result in stickiness. Integration occurs in cells but is not a major function and does not lead to stickiness. Emigration is similar to diapedesis and is not associated with increased stickiness. REF: p. 131

A patient has researched bradykinin on the Internet. Which information indicates the patient understands the functions of bradykinin? Bradykinin is involved in: a. Increasing vascular permeability b. Vasoconstricting blood vessels c. Stimulating the clotting system d. Increasing degradation of prostaglandins

ANS: A Bradykinin increases vascular permeability. Bradykinin increases vascular permeability; it does not promote vasoconstriction. Bradykinin increases vascular permeability; it does not stimulate clotting. Bradykinin promotes pain; thus, it does not degrade prostaglandins but supports them. REF: p. 124

A cell that is produced in the thymus and interacts with MHC class II molecules would have which of the following surface proteins? a. CD4 b. CD8 c. Th1 d. Superantigen

ANS: A CD4-positive Th cells are restricted to interactions with cells presenting antigen by MHC class II molecules. CD4-positive Th, not CD8, cells are restricted to interactions with cells presenting antigen by MHC class II molecules. CD4-positive Th, not Th1, cells are restricted to interactions with cells presenting antigen by MHC class II molecules. CD4-positive Th, not superantigen, cells are restricted to interactions with cells presenting antigen by MHC class II molecules. REF: p. 158

Which form of cell communication is used to relate to other cells in direct physical contact? a. Cell junction b. Gap junction c. Desmosomes d. Tight junctions

ANS: A Cell junctions hold cells together and permit molecules to pass from cell to cell. Gap junctions allow communication from the inside of one cell to the inside of another. Desmosomes are not involved in communication, but allow cells to hold together. Tight junctions are barriers that prevent movement of some substances and leakages of others. REF: p. 9

A 10-year-old male is brought to the emergency room (ER) because he is incoherent and semiconscious. CT scan reveals that he is suffering from cerebral edema. This type of edema is referred to as: a. Localized edema b. Generalized edema c. Pitting edema d. Lymphedema

ANS: A Cerebral edema is a form of localized edema. Generalized edema is manifested by a more uniform distribution of fluid in interstitial spaces. Pitting edema is due to a pit left in the skin. Lymphedema is due to swelling in interstitial spaces, primarily in the extremities. REF: p. 102

The directional migration of leukocytes along a chemical gradient is termed: a. Chemotaxis b. Endocytosis c. Margination d. Diapedesis

ANS: A Chemotaxis is the process by which leukocytes undergo directed migration. Endocytosis is a form of engulfment and a part of phagocytosis. Margination occurs when leukocytes adhere to endothelial cells in the walls of vessels. Diapedesis is the emigration of the cells through cell junctions that have loosened in response to inflammatory mediators. REF: p. 131

A 30-year-old male develops poison ivy after mowing the lawn near the woods. His primary care provider prescribes a synthetic cortisol. How will the cortisol relieve his symptoms? a. Suppressing Th1 cell activity b. Increasing cytokine secretion c. Suppressing natural killer cell activity d. Increasing Th2 activity

ANS: A Cortisol suppresses Th1 responses. Cortisol does not increase cytokine secretion. Cortisol does not suppress natural killer cell activity. Cortisol suppresses Th2 activity. REF: p. 213

What is the role of cytokines in cell reproduction? a. Provide growth factor for tissue growth and development b. Block progress of cell reproduction through the cell cycle c. Restrain cell growth and development d. Provide nutrients for cell growth and development

ANS: A Cytokines play a major role in the regulation of tissue growth and development. Cytokines help overcome intracellular braking mechanisms that restrain cell growth. Cytokines promote cell growth, not restrain it. Cytokines regulate growth; they do not provide nutrients. REF: p. 23

A nurse is teaching the staff about the three phases of cellular catabolism. Which of the following should the nurse include? a. Digestion, glycolysis and oxidation, and the citric acid cycle b. Diffusion, osmosis, and mediated transport c. S phase, G phase, and M phase d. Metabolic absorption, respiration, and excretion

ANS: A Digestion, glycolysis and oxidation, and the citric acid cycle are the three phases of cellular catabolism. Diffusion, osmosis, and mediated transport are parts of the movement of fluids in and out of cells. The S, G, and M phases are phases of cellular division, not catabolism. Metabolic absorption, respiration, and excretion are functions of the cell. REF: p. 13

An immunologist is discussing endotoxin production. Which information should the immunologist include? Endotoxins are produced by: a. Gram-negative bacteria b. Gram-positive bacteria c. Gram-negative fungi d. Gram-positive fungi

ANS: A Endotoxins are produces by gram-negative bacteria. Endotoxins are produced primarily by gram-negative bacteria, not gram-positive. Endotoxins are produced primarily by gram-negative bacteria, not gram-negative fungi. Endotoxins are produced primarily by gram-negative bacteria, not gram-positive fungi. REF: p. 171

A 30-year-old male with HIV is diagnosed with Epstein-Barr virus. After 2 months, the virus is still active. Based upon the Epstein-Barr virus, which of the following cancers is most likely to develop in this patient? a. B cell lymphoma b. Kaposi sarcoma c. T cell leukemia d. T cell lipoma

ANS: A Epstein-Barr virus is associated with B cell lymphoma. Kaposi sarcoma is associated with HIV. Retroviruses are associated with leukemia. Lipomas are not associated with HIV. REF: p. 241

A couple has three offspring: one child with an autosomal dominant disease trait and two who are normal. The father is affected by the autosomal dominant disease, but the mother does not have the disease gene. What is the recurrence risk of this autosomal dominant disease for their next child? a. 50% b. 33% c. 25% d. Impossible to determine

ANS: A For each child with an autosomal dominant disease parent there is a 1 in 2, or 50%, risk. The risk is 50%. The risk is 50%. The risk can be determined and the risk is 50%. REF: p. 46

An 86-year-old female patient has the wasting syndrome of aging, making her vulnerable to falls, functional decline, disease, and death. The nurse knows this patient is experiencing: a. Frailty b. Sarcopenia c. Somatic death d. Cellular aging

ANS: A Frailty leaves the individual vulnerable to falls, disease, and death. Sarcopenia is loss of muscle mass. It is associated with aging, but is not as severe as frailty. Somatic death is death of the whole person. Cellular aging occurs at the cellular level and is characteristic of aging, including cell atrophy, decreased function, and loss of cells. REF: p. 94

A 25-year-old female was diagnosed with cervical cancer. History reveals she had many sexual partners, which she indicates is "too many to count." Which of the following is most likely to have caused her cancer? a. HPV-16 b. HPV-18 c. HPV-31 d. HPV-45

ANS: A HPV-16, in most countries, accounts for 50% to 60% of cervical cancer cases. HPV-18 accounts for 10% to12% of cervical cancer cases. HPV-31 accounts for 4% to 5% of cervical cancer cases. HPV-45 accounts for 4% to 5% of cervical cancer cases. REF: p. 282

When taking care of a patient with hyperkalemia, which principle is priority? Hyperkalemia causes a(n) _____ in resting membrane potential with _____ excitability of cardiac muscle. a. Increase; increased b. Decrease; increased c. Increase; decreased d. Decrease; decreased

ANS: A Hyperkalemia causes an increase in resting membrane potential and increased excitability of cardiac muscle. Hyperkalemia does cause an increased excitability of cardiac muscle, but the result is an increase in resting membrane potential. Hyperkalemia does cause an increase in resting membrane potential, but the result is an increase in excitability of cardiac muscle. Hyperkalemia causes an increase in resting membrane potential and increased excitability of cardiac muscle. REF: p. 110

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

ANS: A IgA1 is found predominantly in the blood. IgA1 is found predominantly in the blood, not the kidneys. IgA1 is found predominantly in the blood, not the lungs. IgA1 is found predominantly in the blood, not the mucous membranes. REF: p. 147

In teaching a patient with cirrhosis, which information should the nurse include regarding cholesterol? a. Cholesterol decreases the membrane fluidity of the erythrocyte, which reduces its ability to carry oxygen. b. Cholesterol decreases the membrane fluidity of erythrocytes, which reduces its ability to carry hemoglobin. c. Cholesterol increases the membrane fluidity of erythrocytes, which allows binding of excess glucose. d. Cholesterol increases the membrane fluidity of erythrocytes, which prolongs its life span beyond 120 days.

ANS: A In cirrhosis, the cholesterol content of the red blood cell's plasma membrane increases, causing a decrease in membrane fluidity that seriously affects the cell's ability to transport oxygen. In cirrhosis, for example, the cholesterol content of the red blood cell's plasma membrane increases, causing a decrease in membrane fluidity that seriously affects the cell's ability to transport oxygen, not hemoglobin; the hemoglobin carries the oxygen. In cirrhosis, for example, the cholesterol content of the red blood cell's plasma membrane increases, causing a decrease in membrane fluidity that seriously affects the cell's ability to transport oxygen; it does not bind excess glucose. In cirrhosis, for example, the cholesterol content of the red blood cell's plasma membrane increases, causing a decrease in membrane fluidity that seriously affects the cell's ability to transport oxygen. It does not prolong the life of the RBC and could decrease it. REF: p. 7

Which of the following indicates a nurse understands a proto-oncogene? A proto-oncogene is best defined as a(n) _____ gene. a. Normal b. Altered c. Inactive d. Tumor-suppressor

ANS: A In its normal, nonmutant state, an oncogene is referred to as a proto-oncogene. A proto-oncogene is a normal gene, not an altered gene. A proto-oncogene is a normal gene, not an inactive gene. A proto-oncogene is a normal gene, not a tumor-suppressor gene. REF: p. 229

A 3-year-old is making play cakes in a sandbox and is eating the play cakes. The sand was also being used by cats as a litter box and was contaminated with toxoplasmosis. Which of the following would most likely also be present? a. Granuloma formation b. Degranulation c. Blood clots d. Exudate production

ANS: A Infections caused by bacteria such as toxoplasmosis can result in granuloma formation. Degranulation is a part of mast cell destruction. Blood clots are not expected with chronic inflammation. Exudate production is pus formation. REF: p. 134

An infant develops a fever secondary to a bacterial infection. Which of the following most likely triggered the fever? a. Interleukin-1 b. Interleukin-6 c. Interleukin-10 d. Interferons (INFs)

ANS: A Interleukin-1 is responsible for fever production. Interleukin-6 stimulates growth and differentiation of blood cells. Interleukin-10 helps decrease the immune response. INFs are members of a family of cytokines that protect against viral infections. REF: p. 126

What principle should the nurse remember when trying to distinguish aging from diseases? a. It is difficult to tell the difference because both processes are believed to result from cell injury. b. It is easy to tell normal processes from abnormal processes. c. Disease, unlike aging, has a genetic component. d. Aging is defined as exceeding life expectancy, but not maximal life span.

ANS: A It is difficult to differentiate between aging and disease because both occur secondary to cellular aging. It is not easy to differentiate normal processes from abnormal because aging appears as a normal process. Disease and aging have a possible genetic component. Aging is a time-dependent loss of structure and function that proceeds slowly and in such small increments that it appears to be the result of the accumulation of small, imperceptible injuries. It is not a time period outside of life expectancy. REF: p. 91

A 52-year-old male with hepatitis C recently developed hepatic cancer. Which of the following markers should be increased? a. Alpha-fetoprotein (AFP) b. Catecholamines c. Prostate-specific antigen d. Homovanillic acid

ANS: A Liver and germ cell tumors secrete a protein known as AFP. Liver and germ cell tumors secrete a protein known as AFP, not catecholamines. Prostate tumors secrete prostate-specific antigen. Homovanillic acid is a catecholamine marker. REF: p. 225

Physiologic pH is maintained around 7.4 because carbonic acid and bicarbonate exist in a ratio of: a. 20:1 b. 1:20 c. 10:2 d. 2:10

ANS: A Normal carbonic acid to bicarbonate ratio is 20:1. Normal carbonic acid to bicarbonate ratio is 20:1. Normal carbonic acid to bicarbonate ratio is 20:1. Normal carbonic acid to bicarbonate ratio is 20:1. REF: p. 110

A 65-year-old male was recently diagnosed with cancer. He is retired from construction work. Which of the following cancers is he likely to develop secondary to occupational hazards? a. Mesothelioma b. Bladder cancer c. Prostate cancer d. Bone cancer

ANS: A One notable occupational factor is asbestos, which increases the risk of mesothelioma, lung cancer, and possibly others. The cancer secondary to occupational hazards is mesothelioma, not bladder cancer. The cancer secondary to occupational hazards is mesothelioma, not prostate cancer. The cancer secondary to occupational hazards is mesothelioma, not bone cancer. REF: p. 278

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

ANS: A Organ cells respond to increased workload by increasing in size, much as a muscle when it is exercised. Organ cells increase in size with increased workload; they do not decrease in length. A deficiency of electrolytes or minerals could lead to an increase in excitability; it is not due to increased workload. Increase in cell numbers is referred to as hyperplasia and is not related to increased workload. REF: p. 62

A newborn male is born with heart failure. Three weeks later he receives a heart transplant. Which of the following is he at the highest risk for developing? a. Leukemia b. Liver cancer c. Pancreatic cancer d. Burkitt lymphoma

ANS: A Organ transplant places the child at risk for leukemia. Organ transplant places the child at risk for leukemia, not liver cancer. Organ transplant places the child at risk for leukemia, not pancreatic cancer. Organ transplant places the child at risk for leukemia, not Burkitt lymphoma. REF: p. 290

A patient has a body fluid of 300 mOsm/kg. This lab result is measuring: a. Osmolality b. Osmolarity c. Osmotic pressure d. Oncotic pressure

ANS: A Osmolality measures the number of milliosmoles per kilogram of water, or the concentration of molecules per weight of water. Osmolarity measures the number of milliosmoles per liter of solution, or the concentration of molecules per volume of solution. Osmotic pressure is the amount of hydrostatic pressure required to oppose the osmotic movement of water. Oncotic pressure is from plasma proteins, not body fluids. REF: p. 16

Water movement between the ICF and ECF compartments is determined by: a. Osmotic forces b. Plasma oncotic pressure c. Antidiuretic hormone d. Buffer systems

ANS: A Osmotic forces determine water movement between the ECF and ICF compartments. Oncotic pressure pulls water at the end of the capillary, which makes it move between intra and extra as interstitial is considered extra. The antidiuretic hormone regulates water balance which would make water move between the intra and extra. Buffer systems help regulate acid balance. REF: p. 101

Pancreatic beta cells secrete insulin, which inhibits secretion of glucagon from neighboring alpha cells. This action is an example of which of the following signaling types? a. Paracrine b. Autocrine c. Neurohormonal d. Hormonal

ANS: A Paracrine signaling involves the release of local chemical mediators that are quickly taken up, destroyed, or immobilized, as in the case of insulin and the inhibition of the secretion of glucagon. When cells produce signals that they themselves respond to, autocrine signaling is used. Neurohormonal signaling involves secretion of hormones into the bloodstream by neurosecretory hormones. Hormonal signaling involves specialized endocrine cells that secrete hormone chemicals released by one set of cells that travel through the tissue through the bloodstream to produce a response in other sets of cells. REF: p. 11

A 15-year-old female is diagnosed with Prader-Willi syndrome. This condition is an example of: a. Gene imprinting b. An autosomal recessive trait c. An autosomal dominant trait d. A sex-linked trait

ANS: A Prader-Willi is an example of gene imprinting. Prader-Willi is not an autosomal recessive trait, but due to gene imprinting. Prader-Willi is not an autosomal dominant train, but due to gene imprinting. Prader-Willi is not a sex-linked trait, but due to gene imprinting. REF: p. 49

A nurse is reviewing a report from a patient with metastatic cancer. What finding would support the diagnosis of metastatic cancer? Alterations in extracellular matrix that include: a. Decreased fibronectin b. Increased collagen c. Decreased elastin d. Increased glycoproteins

ANS: A Reduced amounts of fibronectin are found in some types of cancerous cells, allowing cancer cells to travel, or metastasize. Collagen provides strength, and its breakdown is associated with osteoarthritis, not cancer. Elastin is found in the lungs and allows tissues to stretch; it is not associated with cancerous cells. Decreased, not increased, glycoproteins are associated with cancerous cells. REF: p. 8

A 52-year-old male suffered a myocardial infarction secondary to atherosclerosis and ischemia. Once oxygen returned to the damaged heart, reperfusion injury occurred as a result of: a. Free radical formation b. Vacuolation c. Increased metabolic state d. Lipid acceptor proteins

ANS: A Reperfusion injury results from radicals that cause further membrane damage and mitochondrial calcium overload. Vacuolation leads to cellular swelling and is not associated with reperfusion. Lactic acid increases as a result of damage due to necrosis, and necrosis would interfere with reperfusion, not initiate it. Lipid acceptor proteins bind with triglycerides to create fatty liver, and they do not affect the myocardium. REF: p. 67

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

ANS: A SLE is the most common, complex, and serious of the autoimmune disorders. SLE is an autoimmune disorder, not alloimmune. SLE is an autoimmune disorder not homoimmune. SLE is an autoimmune disorder not alleimmune. REF: p. 197

While planning care, a nurse recalls seasonal allergic rhinitis is expressed through: a. IgE-mediated reactions b. Tissue-specific reactions c. Antigen-antibody complexes d. Type II hypersensitivity reactions

ANS: A Seasonal allergic rhinitis is expressed through IgE-mediated reactions. Tissue-specific reaction is an autoimmune reaction. Antigen-antibody reactions are type III and are organ specific. Type II hypersensitivity reactions are tissue specific. REF: p. 190

A 25-year-old female has sexual relations with her boyfriend. Later she is told that the boyfriend is infected with Neisseria gonorrhoeae. Testing reveals that she does not have the disease. How is it possible that she did not contract the disease? a. Antibodies covered sites of attachment. b. She was vaccinated against it. c. Platelets provided protection. d. IgE was released.

ANS: A Some bacteria, such as Neisseria gonorrhoeae that causes gonorrhea, must attach to specific sites on urogenital epithelial cells. Antibodies may protect the host by covering sites on the microorganism that are needed for attachment, thereby preventing infection. The patient did not contract the disease because antibodies covered sites of attachment, not because of vaccination. The patient did not contract the disease because antibodies covered sites of attachment, not because of platelets. The patient did not contract the disease because antibodies covered sites of attachment, not because of IgE release. REF: p. 150

A female student is driving to school when another driver nearly hits her. Her heart begins beating harder and faster as she becomes aroused and scared. Which of the following stages of the general adaptation syndrome is she experiencing? a. Alarm stage b. Stage of resistance c. Adaptation d. Exhaustion

ANS: A The alarm stage is manifested by arousal of the body's defenses. The stage of resistance is the second step. Adaptation is a part of resistance. Exhaustion marks the breakdown of compensatory mechanisms. REF: p. 204

The complement, clotting, and kinin systems share which of the following characteristics? a. Activation of a series of proenzymes b. Phagocytosis initiation c. Granulocyte production d. Activated by interferon

ANS: A The complement system, the clotting system, and the kinin system are normally in inactive forms, but can activate in a series as proenzymes and are involved in the inflammatory process. The complement system, the clotting system, and the kinin system do not play a role in phagocytosis, but do play a role in the inflammatory response as proenzymes. The complement system, the clotting system, and tje kinin system do not play a role in granulocyte production, but they function as proenzymes in the inflammatory response. The complement system, the clotting system, and the kinin system are not activated by interferon, but are activated by enzymatic action. REF: p. 122

The nurse would anticipate the patient with syndrome of inappropriate ADH (SIADH) to demonstrate which of the following symptoms? (Select all that apply.) a. Weakness b. Nausea c. Headache d. Weight loss e. Muscle twitching

ANS: A, B, C, E Weakness, nausea, muscle twitching, headache, and weight gain, not loss, are common symptoms of chronic water accumulation. REF: p. 107

Chromosome aberrations and mutations in cells that were not directly irradiated are referred to as: a. Bystander effects b. Lethal mutation c. Delayed reproductive death d. Genetic instability

ANS: A The directly irradiated cells also can lead to genetic effects in so-called bystander cells or innocent cells. This is termed bystander effects. Lethal mutations occur when cells cannot reproduce, and this is not related to bystander effects. Lethal mutation and delayed reproductive death are similar phenomenon and are not related to bystander effects. Genetic instability is related to chromosomal instability. REF: p. 274

A 20-year-old male received a knife wound to the arm during an altercation. Which of the following types of immunity was compromised? a. Innate immunity b. Inflammatory response c. Adaptive immunity d. Specific immunity

ANS: A The epithelial cells of the skin are a part of innate immunity. The inflammatory response is not a type of immunity. Adaptive immunity is represented by the normal flora of the bowel. Specific immunity is a type of adaptive immunity and is not associated with a break in skin integrity. REF: p. 120

When trying to distinguish between an infectious disease and noninfectious disease, what is the hallmark symptom for most infectious diseases? a. Fever b. Jaundice c. Vomiting d. Pain

ANS: A The hallmark of most infectious diseases is fever. The hallmark of most infectious diseases is fever, not jaundice. The hallmark of most infectious diseases is fever, not vomiting. The hallmark of most infectious diseases is fever, not pain. REF: p. 175

For a patient with respiratory acidosis, chronic compensation by the body will include: a. Kidney excretion of H+ b. Kidney excretion of HCO3 c. Prolonged exhalations to blow off CO2 d. Protein buffering

ANS: A The kidneys excrete H+ to compensate for respiratory acidosis. The kidneys do not excrete HCO3 to compensate; this would increase acidosis. Prolonged exhalations would not be effective for compensation, especially in a chronic state. Protein buffering is intracellular and will not be effective enough to compensate for respiratory acidosis. REF: p. 114

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 T-helper b. CD8 T-helper c. CDC cells d. CDC10 cells

ANS: A The major immunologic finding in AIDS is the striking decrease in the number of CD4-positive (CD4+) T cells. The change occurs in CD4 cells, not CD8. CDC is not a type of cell. CDC10 cells are not a type of cell. REF: p. 186

The most common cause of pure water deficit is: a. Renal water loss b. Hyperventilation c. Sodium loss d. Insufficient water intake

ANS: A The most common cause of water loss is increased renal clearance of free water as a result of impaired tubular function. Hyperventilation can cause water loss, but it is not the most common cause. Sodium loss leads to hyponatremia, not pure water deficit. Insufficient water intake causes hypernatremia, not water deficit. REF: p. 106

A nurse is preparing to teach the most common malignancy in children. Which malignancy should the nurse discuss? a. Leukemia b. Neuroblastoma c. Wilms tumor d. Retinoblastoma

ANS: A The most common malignancy in children is leukemia, accounting for one third. Tumors of the nervous system are the second most common. Wilms tumor is less frequently occurring. Retinoblastoma is less frequently occurring. REF: p. 288

A 25-year-old male nursing student recently learned how diet can alter the chances of developing cancer. He tries to minimize his risks of developing the disease by ordering his steak: a. Rare b. Medium c. Medium-well d. Well done

ANS: A The nursing student should order the steak rare, as the most relevant carcinogens produced by cooking are found in well-done charbroiled beef. The nursing student should order the steak rare, not medium, as the most relevant carcinogens produced by cooking are found in well-done charbroiled beef. The nursing student should order the steak rare, not medium-well, as the most relevant carcinogens produced by cooking are found in well-done charbroiled beef. The nursing student should order the steak rare, not well-done, as the most relevant carcinogens produced by cooking are found in well-done charbroiled beef. REF: p. 262

A nurse is reviewing the pedigree chart. When checking for a proband, what is the nurse looking for? a. The person who is first diagnosed with a genetic disease b. The individual who has a disease gene but is phenotypically normal c. The phenotype of genetic material d. The codominance

ANS: A The pedigree chart summarizes family relationships and shows which members of a family are affected by a genetic disease. The pedigree begins with the proband. The person who has a disease gene but is phenotypically normal is a carrier. The phenotype is the result of both genotype and environment; it is not a proband. Codominance is not represented by proband, but it occurs when the heterozygote is distinguishable from both homozygotes. REF: p. 46

The nurse would be correct in identifying the predominant extracellular cation as: a. Sodium b. Potassium c. Chloride d. Glucose

ANS: A The predominant extracellular cation is sodium. Potassium is the predominant intracellular cation. Chloride is an anion. Urea is a nonelectrolyte. Glucose is a nonelectrolyte. REF: p. 20

A 45-year-old male presents with persistent, severe stomach pain. Testing reveals a peptic ulcer. Further laboratory tests reveal the presence of Helicobacter pylori. Which of the following is of concern for this patient? a. Gastric cancer b. Leukemia c. Lung cancer d. Adenocarcinoma of the colon

ANS: A The presence of Helicobacter pylori is associated with gastric cancer. The presence of Helicobacter pylori is associated with gastric cancer, not leukemia. The presence of Helicobacter pylori is associated with gastric cancer, not lung cancer. The presence of Helicobacter pylori is associated with gastric cancer, not colon cancer. REF: p. 241

A patient has been researching telomere caps on the Internet. Which statement indicates the patient has a good understanding? Presence of telomere caps gives cancer cells: a. The ability to divide over and over again b. Clonal distinction c. Limited mitosis d. Mutation abilities

ANS: A The presence of telomere caps gives cancer cells the ability to divide over and over. The presence of telomere caps does not give cells clonal distinction. Telomeres allow division over and over; thus, cancer cells have unlimited mitosis. Mutation capability is a characteristic of cancer cells, but this property is not related to telomeres. REF: pp. 235-236

Which of the following compounds has been shown to increase the risk of cancer when used in combination with smoking? a. Alcohol b. Steroids c. Antihistamines d. Hypnotics

ANS: A Tobacco use and alcohol use are known etiologic factors in head and neck cancers. It is alcohol, not steroids, and tobacco that have been identified as etiologic factors in cancer. It is alcohol, not antihistamines, and tobacco that have been identified as etiologic factors in cancer. It is alcohol, not hypnotics, and tobacco that have been identified as etiologic factors in cancer. REF: p. 261

When a patient asks what types of cancers are associated with tobacco use, how should the nurse respond? a. Squamous and small cell adenocarcinomas b. Sarcoma and adenoma c. Melanoma and lymphoma d. Basal cell and lipoma

ANS: A Tobacco use is associated with squamous and small cell adenocarcinomas. Tobacco use is associated with squamous and small cell adenocarcinomas, not sarcoma and adenoma. Tobacco use is associated with squamous and small cell adenocarcinomas, not melanoma and lymphoma. Tobacco use is associated with squamous and small cell adenocarcinomas, not basal cell and lipoma. REF: p. 261

A 3-year-old female was diagnosed with Wilms tumor. This disease is a tumor of the: a. Kidney b. Brain c. Bone marrow d. Liver

ANS: A Wilms tumor is a tumor found in the kidney. Wilms tumor is a tumor found in the kidney, not the brain. Wilms tumor is a tumor found in the kidney, not the bone marrow. Wilms tumor is a tumor found in the kidney, not the liver. REF: p. 288

A 55-year-old female presents to her primary care provider and reports dizziness, confusion, and tingling in the extremities. Blood tests reveal an elevated pH, decreased PCO2, and slightly decreased HCO3. Which of the following is the most likely diagnosis? a. Respiratory alkalosis with renal compensation b. Respiratory acidosis with renal compensation c. Metabolic alkalosis with respiratory compensation d. Metabolic acidosis with respiratory compensation

ANS: A With an elevated pH, the diagnosis must be alkalosis. Since the PCO2 is low, it is likely respiratory with a slight decrease in HCO3 indicating renal compensation. With an elevated pH, the diagnosis must be alkalosis, not acidosis. With an elevated pH, the diagnosis must be alkalosis. Since the PCO2 is low, it is likely respiratory since the HCO3 is decreased. With an elevated pH, the diagnosis must be alkalosis. REF: p. 115

A cell is isolated, and electrophysiology studies reveal that the resting membrane potential is -70 millivolts. The predominant intracellular ion is Na+, and the predominant extracellular ion is K+. With voltage change, which of the following would result in an action potential? a. K+ rushing into the cell b. Na+ rushing into the cell c. Na+ rushing out of the cell d. K+ rushing out of the cell

ANS: A With voltage change, potassium rushes into the cell. Potassium, not sodium, rushes into the cell. Potassium, not sodium, is involved in the process, and potassium moves into the cells, not out. Potassium rushes into the cell, not out. REF: p. 22

Characteristics of prokaryotes include which of the following? (Select all that apply.) a. They contain no organelles. b. Their nuclear material is not encased by a nuclear membrane. c. They contain a distinct nucleus. d. They contain histones. e. They contain a cellular membrane.

ANS: A, B The prokaryotes contain no organelles. The prokaryotic cells do not have their nuclear materials encased by a nuclear membrane. Prokaryotic cells are characterized by lack of a distinct nucleus. Prokaryotes lack a class of proteins called histones, which in eukaryotic cells bind with DNA and are involved in the supercoiling of DNA. Prokaryotic cells do not have a cellular membrane. REF: p. 2

Direct effects of antibodies include (select all that apply): a. Neutralization b. Agglutination c. Precipitation d. Phagocytosis e. Division

ANS: 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), or precipitation (making a soluble antigen into an insoluble precipitate). Indirectly, antibodies activate components of innate resistance, including complement and phagocytes. Antibodies are generally a mixed population of classes, specificities, and capacity to provide the functions listed above. REF: p. 150

Physical barriers that offer the body protection from damage and infection are located in the (select all that apply): a. Gastrointestinal tract b. Genitourinary tract c. Respiratory tract d. Lymph system e. Hematopoietic system

ANS: A, B, C The physical barriers that cover the external parts of the human body offer considerable protection from damage and infection. These barriers are composed of tightly associated epithelial cells of the skin and of the linings of the gastrointestinal, genitourinary, and respiratory tracts. REF: p. 119

A 60-year-old male with a 30-year history of smoking is diagnosed with a hormone-secreting lung tumor. Further testing indicates that the tumor secretes ADH. Which of the following assessment findings should the nurse expect? (Select all that apply.) a. Confusion b. Weakness c. Nausea d. Muscle twitching e. Weight loss

ANS: A, B, C, D Secretion of ADH leads to water intoxication with symptoms of cerebral edema, with confusion and convulsions; weakness; nausea; muscle twitching; headache; and weight gain, not loss. REF: p. 107

A patient has been reading on the Internet that light to moderate intake of alcohol is cardioprotective. When the patient asks the nurse what this means, the nurse should respond that the heart is protected by which of the following mechanisms? (Select all that apply.) a. Increased levels of high-density lipoprotein cholesterol b. Prevention of clot formation c. Reduction in platelet aggregation d. Increasing fibrinolysis e. Increased collateral circulation f. Vasodilation

ANS: A, B, C, D The suggested mechanisms for cardioprotection by low to moderate alcohol intake include increased levels of high-density lipoprotein cholesterol (HDL-c), prevention of clot formation, reduction in platelet aggregation, and increasing clot degradation (fibrinolysis). Increased collateral circulation is not a benefit of alcohol, nor is vasodilation. REF: p. 73

The nurse is assessing a patient with a diagnosis of inflammation. The nurse would expect to find which of the following signs and symptoms consistent with acute inflammation? (Select all that apply.) a. Heat b. Erythema c. Pain d. Swelling e. Exudates f. Loss of function

ANS: A, B, C, D, F The classic symptoms of acute inflammation include redness (erythema), heat, swelling, pain, and loss of function. Exudates would indicate infection, not inflammation. REF: p. 121

A 50-year-old female confirms chronic alcohol intake. This practice places the patient at risk for cancer in which organs? (Select all that apply.) a. Larynx b. Esophagus c. Liver d. Lung e. Brain f. Breast

ANS: A, B, C, F Chronic alcohol consumption is a strong risk factor for colorectal cancer and cancer of the oral cavity, pharynx, hypopharynx, larynx, esophagus, liver, and breast. It is not associated with lung or brain cancer. REF: p. 263

When a patient asks about secondary lymph organs, how should the nurse respond? Secondary lymph organs include (select all that apply): a. Spleen b. Peyer patches c. Adenoids d. Liver e. Bone marrow f. Appendix

ANS: A, B, C, F The secondary lymphoid organs include the spleen, lymph nodes, adenoids, tonsils, Peyer patches (intestines), and the appendix. The liver and bone marrow are not secondary lymph organs. REF: p. 155

A nurse recalls that the four basic types of tissues are (select all that apply): a. Nerve b. Epithelial c. Mucosal d. Connective e. Skeletal f. Muscle

ANS: A, B, D, F Nerve is one of the four basic tissue types. Epithelial is one of the four basic tissue types Connective is one of the four basic tissue types. Muscle is one of the basic tissue types. Mucosal is a type of epithelial cell and is not a basic tissue type. Skeletal is a type of connective tissue and is not a basic tissue type. REF: p. 24

When dealing with repression in patients, which of the following assessment findings are associated with repression? (Select all that apply.) a. Decreased monocyte counts b. Increased eosinophil counts c. Decreased serum glucose d. Increased pulse rates e. Increased medication reactions

ANS: A, B, E Repression was associated with lower monocyte counts, higher eosinophil counts, higher serum glucose, and more self-reported medication reactions in medical outpatients. It is not associated with increased pulse rates and glucose increases, rather than decreases. REF: p. 217

A nurse remembers the primary actions of the complement cascade include (select all that apply): a. Increased vascular permeability b. Vasoconstriction c. Chemotaxis d. Opsonization e. Cell killing f. Increased clotting

ANS: A, C, D, E The actions of the complement cascade include increased vascular permeability and vasodilation, chemotaxis, opsonization, and cell killing. It does not involve vasoconstriction or increased clotting. REF: p. 122

After a geneticist talks to the patient about being a chromosomal mosaic, the patient asks the nurse what that means. How should the nurse respond? You may _____ genetic disease(s). a. Only be a carrier of the b. Have a mild form of the c. Have two d. Be sterile as a result of the

ANS: B A chromosomal mosaic means the body has two or more different cell lines, each of which has a different karyotype; thus, the person has a mild form of the disease. Mosaics are not only carriers; they have the disease. Mosaics have two different lines but not two different diseases. Mosaics are not sterile. REF: p. 42

Healing by secondary intention would occur in which of the following patients? A patient with a: a. Sutured surgical wound b. Stage IV pressure ulcer c. Paper cut d. Sunbur

ANS: B A patient with a stage IV pressure ulcer would heal by secondary intention. A patient with a surgical wound would heal by primary intention. A patient with a paper cut would heal by primary intention. A patient with a sunburn would heal without needing either primary or secondary intention. REF: p. 135

A nurse is teaching the staff about antidiuretic hormone (ADH). Which information should the nurse include? Secretion of ADH is stimulated by: a. Increased serum potassium b. Increased plasma osmolality c. Decreased renal blood flow d. Generalized edema

ANS: B ADH is secreted when plasma osmolality increases or circulating blood volume decreases and blood pressure drops. ADH is secreted when plasma osmolality increases, not by an increase in potassium. ADH is secreted when plasma osmolality increases; it is not affected by decreased renal blood flow. Edema does not affect the secretion of ADH. REF: p. 104

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.

ANS: B AIDS is an acquired dysfunction of the immune system caused by a retrovirus (HIV) that infects and destroys CD4+ lymphocytes (T-helper cells). HIV infection begins when a virion binds to CD4, not a B cell. Infection requires a host cell receptor. The cell remains dormant, but does not die. REF: p. 186

A 25-year-old male is diagnosed with a hormone-secreting tumor of the adrenal cortex. Which finding would the nurse expect to see in the lab results? a. Decreased blood volume b. Decreased blood K+ levels c. Increased urine Na+ levels d. Increased white blood cells

ANS: B Aldosterone is secreted from the adrenal cortex. It promotes renal sodium and water reabsorption and excretion of potassium, leading to decreased potassium levels. Blood volume actually increases with aldosterone secretion. Aldosterone promotes sodium reabsorption, leading to normal or decreased Na+ levels. Aldosterone is not associated with white blood cells. REF: p. 103

A 20-year-old male presents to the emergency department with a jagged sharp-force injury that is longer than it is deep. Which type of wound will the nurse be caring for? a. Stab wound b. Incised wound c. Puncture wound d. Chopping wound

ANS: B An incised wound is a cut that is longer than it is deep. A stab wound is a penetrating sharp-force injury that is deeper than it is long. A puncture wound is without sharp edges and is made with an instrument like a nail. Heavy, edged instruments (axes, hatchets, propeller blades) produce wounds with a combination of sharp and blunt force characteristics. REF: p. 78

When planning care for the pregnant patient, the nurse will recall that the mammary glands enlarge as a consequence of: a. Compensatory hyperplasia b. Hormonal hyperplasia c. Hormonal anaplasia d. Compensatory anaplasia

ANS: B An increase in the mammary glands during pregnancy is a result of hormonal changes. The number of mammary cells increases in response to increased hormone levels. Hyperplasia is correct, but it is not a compensatory response, but a hormonal response. Hormonal is correct, but the growth is due to an increased number of cells, not enlargement. Compensatory is not correct, nor is anaplasia, a reversal to more immature cells. Mammary enlargement is a normal response. REF: p. 62

An oncologist is discussing when a cancer cell loses differentiation. Which of the following is the oncologist describing? a. Autonomy b. Anaplasia c. Pleomorphic d. Metastasis

ANS: B Anaplasia is the loss of differentiation. The loss of differentiation is anaplasia, not autonomy. Malignant cells are pleomorphic. A malignant tumor's ability to spread far beyond the tissue of origin is metastasis. REF: p. 223

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

ANS: B Atopic individuals are genetically predisposed to the development of allergies. Desensitization is a term used to describe the process of reducing the severity to allergies. Hypersensitivity is an altered immunologic response to an antigen that results in disease or damage to the individual. Autoimmunity is a disturbance in the immunologic tolerance of self-antigens. REF: p. 201

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

ANS: B Atrophy is a decrease or shrinkage in cellular size. Hyperplasia is an increase in the number of cells. Vacuoles are membrane-bound vesicles within the cell that contain cellular debris and hydrolytic enzymes. Lipofuscin is the yellow-brown age pigment. REF: p. 61

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

ANS: B Blood transfusions must also be matched for the Rh antigen. Blood transfusions do not need to be matched to HLA. Blood transfusions do not need to be matched to immunoglobulins. Blood transfusions do not need to be matched to platelet compatibility. REF: p. 198

Stress-induced catecholamine release from the adrenal medulla may result in: a. Decreased blood flow to the brain b. Elevated blood pressure c. Increased glycogen synthesis in the liver d. Decreased muscle contraction resulting from energy depletio

ANS: B Catecholamine release results in elevated blood pressure. Catecholamine release results in increased blood flow to the brain. Catecholamine release results in increased glucose production, not glycogen synthesis. Catecholamine release results in increased muscle contraction. REF: p. 209

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

ANS: B Cell-mediated immunity is driven by T-cytotoxic (Tc) cells that attack antigens directly and destroy cells that bear foreign antigens. Cell-mediated immunity is driven by T-cytotoxic (Tc) cells, not lymphokine-producing cells, that attack antigens directly and destroy cells that bear foreign antigens. Cell-mediated immunity is driven by T-cytotoxic (Tc) cells, not helper T cells, that attack antigens directly and destroy cells that bear foreign antigens. Cell-mediated immunity is driven by T-cytotoxic (Tc) cells, not macrophages, that attack antigens directly and destroy cells that bear foreign antigens. REF: p. 144

A biopsy of the lung bronchi revealed ciliated epithelial cells that are capable of secretion and absorption. These cells are called _____ columnar epithelium. a. Simple b. Ciliated simple c. Stratified d. Pseudostratified ciliated

ANS: B Ciliated simple columnar epithelium are found in the lungs. Simple columnar epithelium are found from the stomach to the anus. Stratified columnar epithelium are found in the linings of epiglottis, part of pharynx, anus, and male urethra. Pseudostratified ciliate columnar epithelium is found in the linings of large ducts of some glands (parotid, salivary), male urethra, respiratory passages, and eustachian tubes of ears. REF: p. 26

A 2-year-old swallowed watch batteries. Following ingestion, kidney function was impaired, and the heart began to fail. Which of the following was the most likely cause? a. Karyorrhexis b. Coagulative necrosis c. Ammonia accumulation d. Caseous necrosis

ANS: B Coagulative necrosis occurs primarily in the kidneys, heart, and adrenal glands and commonly results from hypoxia. Karyorrhexis means fragmentation of the nucleus into smaller particles or "nuclear dust." Ammonia accumulation is not associated with this toxicity. Caseous necrosis results from tuberculosis pulmonary infection. REF: p. 87

The student is reviewing functions of the cell. The student would be correct in identifying the primary function of the nerve cell as: a. Sensory interpretation b. Conductivity c. Maintenance of homeostasis d. Communication

ANS: B Conduction as a response to a stimulus is manifested by a wave of excitation; an electrical potential that passes along the surface of the cell to reach its other parts. Conductivity is the chief function of nerve cells. Nerve cells assist with sensory interpretation, but their primary function is conductivity. Nerve cells assist with maintenance of homeostasis, but their primary function is conductivity. Nerve cells assist with communication, but their primary function is conductivity. REF: p. 2

A nurse recalls the basic components of DNA are: a. Pentose sugars and four phosphate bases b. A phosphate molecule, deoxyribose, and four nitrogenous bases c. Adenine, guanine, and purine d. Codons, oxygen, and cytosine

ANS: B DNA has three basic components: the pentose sugar molecule, deoxyribose; a phosphate molecule; and four types of nitrogenous bases. DNA contains four nitrogenous bases, not phosphate bases. Adenine and quinine are purines and are only a portion of the components of DNA. DNA synthesizes body protein, of which a codon is a component. REF: p. 35

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 lymphocyte deficiency b. T lymphocyte deficiency c. Combined immunologic deficiency d. Complement deficiency

ANS: B DiGeorge syndrome results in greatly decreased T cell numbers and function and is evidenced by abnormal development of facial features that are controlled by the same embryonic pouches; these include low-set ears, fish-shaped mouth, and other altered features. B lymphocyte deficiency is not manifested by these symptoms. Combined immunologic deficiency is not manifested by these symptoms. Complement deficiency is not manifested by these symptoms. REF: p. 201

The faculty member asked the student to identify the appropriate term for the movement of small, electrically uncharged molecules through a semipermeable barrier. Which answer indicates the nursing student understood the teaching? a. Osmosis b. Diffusion c. Hydrostatic pressure d. Active transport

ANS: B Diffusion is the movement of a solute molecule from an area of greater solute concentration to an area of lesser solute concentration. Osmosis is the movement of water across a semipermeable membrane from a region of higher water concentration to one of lower concentration. Hydrostatic pressure is the force of fluid against a cell membrane. Within the vascular system, this pressure is the blood pressure. In active transport, molecules move up a concentration gradient. This process requires energy. REF: p. 15

Hyperlipidemia and hyperglycemia are associated with: a. Hypernatremia b. Hypertonic hyponatremia c. Hypokalemia d. Acidosis

ANS: B Hypertonic hyponatremia develops with hyperlipidemia, hyperproteinemia, and hyperglycemia. Increases in plasma lipids displace water volume and decrease sodium concentration. Hyperlipidemia and hyperglycemia are associated with hyponatremia, not hypernatremia. Hyperlipidemia and hyperglycemia are associated with hyponatremia, not hypokalemia. Hyperlipidemia and hyperglycemia are associated with hyponatremia, not acidosis. REF: p. 107

A 25-year-old female presents to her primary care provider reporting vaginal discharge of a white, viscous, and foul-smelling substance. She reports that she has been taking antibiotics for the past 6 months. Which finding will the nurse most likely see on the microorganism report? a. Clostridium difficile overgrowth b. Decreased Lactobacillus c. Streptococcus overgrowth d. Decreased Candida albicans

ANS: B Diminished colonization with Lactobacillus that occurs as a result of prolonged antibiotic treatment increases the risk for vaginal infections, such as vaginosis. Clostridium difficile occurs in the colon, not the vagina. Streptococcus overgrowth will occur in the mouth. Candida albicans occurs in the colon, not the vagina. REF: p. 120

Which of the following characteristics is shared by both the secretory and systemic immune systems? a. Lymphocytic paths of migration b. Neutralization following antigen-antibody binding c. Timing of response d. Location of response

ANS: B Direct effects result from the binding of antibody directly to a harmful antigen or infectious agent. These include inhibition of processes that are necessary for infection, such as the reaction of an infectious agent with a particular cell in the body or neutralization of harmful bacterial toxins. The effect of the immune system is neutralization, not lymphocytic paths of migration. The effect of the immune system is neutralization, not timing of response. The effect of the immune system is neutralization, not location of response. REF: p. 150

A 19-year-old male presents to his primary care provider reporting restlessness, muscle cramping, and diarrhea. Lab tests reveal that he is hyperkalemic. Which of the following could have caused his condition? a. Primary hyperaldosteronism b. Acidosis c. Insulin secretion d. Diuretic use

ANS: B During acute acidosis, hydrogen ions accumulate in the ICF and potassium shifts out of the cell to the ECF, causing hyperkalemia. Primary hyperaldosteronism is associated with hypokalemia, not hyperkalemia. Insulin secretion helps reduce potassium levels in the cell, not cause it. Diuretics would cause hypokalemia, not hyperkalemia. REF: p. 110

In cellular metabolism, each enzyme has a high affinity for a: a. Solute b. Substrate c. Receptor d. Ribosome

ANS: B Each enzyme has a high affinity for a substrate, a specific substance converted to a product of the reaction. Solutes are small particles that pass through the cell membrane. A receptor is a site on the cell wall that allows transport into the cell. Ribosomes are located inside the cell and are not related to the work of enzymes. REF: p. 13

Outcomes of laboratory tests include an elevated level of natriuretic peptides. Which organ is the priority assessment? a. Lungs b. Heart c. Liver d. Brain

ANS: B Elevated natriuretic peptides indicate problems with the heart or the vasculature. Elevated natriuretic peptides indicate problems with the heart or the vasculature, not the lungs. Elevated natriuretic peptides indicate problems with the heart or the vasculature, not the liver. Elevated natriuretic peptides indicate problems with the heart or the vasculature, not the brain. REF: p. 103

A 10-year-old male is diagnosed with a parasite. Which lab result should the nurse check for a response to the parasite? a. Monocytes b. Eosinophils c. Neutrophils d. Macrophages

ANS: B Eosinophils serve as the body's primary defense against parasites. Monocytes are not the body's primary defense against parasite; eosinophils are. Monocytes are phagocytic. Neutrophils are phagocytic; they are not the body's defense against parasites. Macrophages are not active against parasites; they act as long-term defense against infections. REF: p. 131

A water test recently revealed arsenic levels above 200 ìg/L. Which of the following cancers would be most likely to develop in those who consistently drank the water? a. Liver b. Skin c. Colon d. Kidney

ANS: B Evidence indicates an increased risk of bladder, skin, and lung cancers following consumption of water with high levels of arsenic. Evidence indicates an increased risk of bladder, skin, and lung cancers, not liver, following consumption of water with high levels of arsenic. Evidence indicates an increased risk of bladder, skin, and lung cancers, not colon, following consumption of water with high levels of arsenic. Evidence indicates an increased risk of bladder, skin, and lung cancers, not kidneys, following consumption of water with high levels of arsenic. REF: p. 278

A 5-year-old male becomes ill with a severe cough. Histologic examination reveals a bacterial infection, and further laboratory testing reveals cell membrane damage and decreased protein synthesis. Which of the following is the most likely cause of this illness? a. Endotoxin b. Exotoxin c. Hemolysis d. Septicemia

ANS: B Exotoxins are enzymes that can damage the plasma membranes of host cells or can inactivate enzymes critical to protein synthesis, and endotoxins activate the inflammatory response and produce fever. Endotoxins released by blood-borne bacteria cause the release of vasoactive enzymes that increase the permeability of blood vessels. Hemolysis is the breakdown of red cells. Septicemia is the growth of bacteria in the blood. REF: p. 171

An aide asks the nurse why people who have neurofibromatosis will show varying degrees of the disease. Which genetic principle should the nurse explain to the aide? a. Penetrance b. Expressivity c. Dominance d. Recessiveness

ANS: B Expressivity is the extent of variation in phenotype associated with a particular genotype. For neurofibromatosis, a variety of manifestations occur among individuals. The penetrance of a trait is the percentage of individuals with a specific genotype who also exhibit the expected phenotype. Dominance refers to observable traits and risk of transmission. Recessiveness refers to silent strains with reduced risk of occurrence. REF: p. 48

A 52-year-old diabetic male presents to the ER with lethargy, confusion, and depressed reflexes. His wife indicates that he does not follow the prescribed diet and takes his medication sporadically. Lab results indicate hyperglycemia. Which assessment finding is most likely to occur? a. Clammy skin b. Decreased sodium c. Decreased urine formation d. Metabolic alkalosis

ANS: B Hypertonic hyponatremia develops with hyperglycemia. Increases in plasma lipids displace water volume and decrease sodium concentration, leading to the symptoms described. The patient is experiencing symptoms of hyponatremia and hyperglycemia, not hypernatremia and hypoglycemia. The patient will have increased ECF and would have increased urine formation. Metabolic acidosis would occur, not alkalosis. REF: p. 107

When a nurse notices that a patient has type O blood, the nurse realizes that anti-_____ antibodies are present in the patient's body. a. A only b. B only c. A and B d. O

ANS: C Type O individuals have both anti-A and anti-B antibodies. Type O individuals have both A and B antibodies. Type O individuals have both A and B antibodies. Type O individuals will have A and B antibodies, but not O. REF: p. 198

The predominant antibody of a typical primary immune response is: a. IgG b. IgM c. IgA d. IgE

ANS: B IgM is the largest immunoglobulin and is the first antibody produced during the initial, or primary, response to antigen. IgM, not IgG, is the largest immunoglobulin and is the first antibody produced during the initial, or primary, response to antigen. IgM, not IgA, is the largest immunoglobulin and is the first antibody produced during the initial, or primary, response to antigen. IgM, not IgE, is the largest immunoglobulin and is the first antibody produced during the initial, or primary, response to antigen. REF: p. 147

A 30-year-old male was involved in a motor vehicle accident. The glass from the shattered window cut his face and neck. The scar, however, was raised and extended beyond the original boundaries of the wound. This pattern of scarring is caused by impaired: a. Nutritional status b. Collagen synthesis c. Epithelialization d. Contraction

ANS: B Impaired production of collagen can cause surface overhealing, leading to a keloid or a hypertrophic scar. Nutritional deficiencies would lead to healing problems, but not extended scarring. Necrosis or steroid use leads to impaired epithelialization. Impaired contraction would lead to drawing of tissues, not raised. REF: p. 137

Which of the following conditions would cause the nurse to monitor for hyperkalemia? a. Excess aldosterone b. Acute acidosis c. Insulin usage d. Metabolic alkalosis

ANS: B In acidosis, ECF hydrogen ions shift into the cells in exchange for ICF potassium and sodium; hyperkalemia and acidosis therefore often occur together. Acidosis causes hyperkalemia, not excess aldosterone. Insulin would help treat hyperkalemia, not cause it. It is acidosis, not alkalosis, that leads to hyperkalemia. REF: p. 110

For a patient experiencing metabolic acidosis, the body will compensate by: a. Excreting H+ through the kidneys b. Hyperventilating c. Retaining CO2 in the lungs d. Secreting aldosterone

ANS: B In an attempt to compensate for metabolic acidosis, the lungs hyperventilate to blow off CO2. It is the lungs hyperventilating that would compensate for metabolic acidosis, not the kidneys. CO2 retention would increase the acidotic state. Aldosterone would conserve water, but does not help compensate for acidosis. REF: pp. 112-113

While reading a textbook, the student reads the term, "apoptosis." The student recalls that apoptosis is a condition in which cells program themselves to: a. Atrophy b. Die c. Regenerate d. Age

ANS: B In apoptosis, cells are programmed to die. In apoptosis, cells do not atrophy; they die. In apoptosis, cells do not regenerate; they die. In apoptosis, cells do not age; they die. REF: p. 88

A 10-year-old male was physically abused for the previous 4 years. He reports feeling stressed all the time and frequently gets ill. Which of the following hormones is most likely suppressed in this child? a. Endorphins b. Growth hormone c. Prolactin d. Cortisol

ANS: B Increased levels of growth hormone are associated with psychological stimuli associated with stress and, thus, increase the chance of becoming ill. Increased levels of growth hormone are associated with psychological stimuli associated with stress; endorphins do not affect this. Increased levels of growth hormone are associated with psychological stimuli associated with stress; prolactin does not affect this. Increased levels of growth hormone are associated with psychological stimuli associated with stress; cortisol does not affect this. REF: p. 219

A 50-year-old female is diagnosed with a hormone-secreting tumor of the adrenal cortex. Which of the following would be expected? a. Decreased blood pressure b. Increased lipogenesis of face and trunk c. Increased lipogenesis of extremities d. Decreased gastric secretion

ANS: B Increased release of cortisol leads to increased lipogenesis of face and trunk. Increased release of cortisol leads to increased blood pressure. Increased release of cortisol leads to lipolysis, not lipogenesis, of the extremities. Increased release of cortisol leads to increased gastric secretion. REF: p. 206 | p. 211

When histamine is released in the body, which of the following responses would the nurse expect? a. Bronchial dilation b. Edema c. Vasoconstriction d. Constipation

ANS: B Increased vascular permeability leads to edema and is a direct response to histamine. Histamine produces bronchoconstriction. Histamine produces vasodilation. Histamine does not produce constipation; it increases gastric acidity. REF: p. 190

A nurse is giving an example of inflammation as an etiology for cancer development. What is the best example the nurse should give? a. Pneumonia and lung cancer b. Ulcerative colitis and colon cancer c. Prostatic hypertrophy and prostate cancer d. Hypercholesteremia and leukemia

ANS: B Individuals with a 10+ year history of ulcerative colitis have a 30-fold increase in developing colon cancer. There is no relationship between pneumonia and lung cancer, but there is a relationship between ulcerative colitis and colon cancer. There is no relationship between prostatic hypertrophy and cancer of the prostate, but there is a relationship between ulcerative colitis and colon cancer. There is no relationship between hypercholesteremia and leukemia, but there is a relationship between ulcerative colitis and colon cancer. REF: p. 240

An XXY person asks the nurse what this genetic disorder is called. What is the nurse's best response? This disorder is _____ syndrome. a. Turner b. Klinefelter c. Down d. Fragile X

ANS: B Individuals with at least two X chromosomes and one Y chromosome in each cell (47 XXY karyotype) have a disorder known as Klinefelter syndrome. A condition with the presence of a single X chromosome and no homologous X or Y chromosome, so the individual has a total of 45 chromosomes, is known as Turner syndrome. Down syndrome is a trisomy. Fragile X syndrome is due to a break or a gap in a chromosome, not an extra chromosome. REF: p. 43

A patient asks why indoor pollution is worse than outdoor pollution. How should the nurse respond? Indoor pollution is considered worse than outdoor pollution because of cigarette smoke and: a. Fireplace wood smoke b. Radon c. Benzene d. Chlorine

ANS: B Indoor pollution is related to cigarette smoke and radon. Indoor pollution is related to cigarette smoke and radon, not fireplace smoke. Indoor pollution is related to cigarette smoke and radon, not benzene. Indoor pollution is related to cigarette smoke and radon, not chlorine. REF: p. 268

A public health nurse is teaching the community about health promotion. Which information should the nurse include for innate immunity? Innate immunity is gained: a. Following an illness b. At birth c. Via injection of specific antibodies d. In adulthood

ANS: B Innate immunity is present at birth. Innate immunity is present at birth and does not require an illness. Innate immunity is present at birth and does not require injection. Innate immunity is present at birth. REF: p. 119

The fluid mosaic model for biologic membranes describes membrane behavior. According to this model, which of the following float singly or as aggregates in the fluid lipid bilayer? a. Peripheral membrane proteins b. Integral membrane proteins c. Glycoproteins d. Cell adhesion molecules

ANS: B Integral membrane proteins float freely in the fluid lipid bilayer. Peripheral membrane proteins are not embedded in the layer, but reside at the surface. Glycoproteins act as cell surface markers. Cell adhesion molecules are on the outside of the membrane and allow cells to hook together. REF: p. 6

The regions of the heterogeneous nuclear RNA that must be spliced out to form functional RNA are called: a. Promoter sites b. Introns c. Exons d. Anticodon

ANS: B Introns are spliced from the mRNA before the mRNA leaves the nucleus. A promoter site is a sequence of DNA that specifies the beginning of a gene. In eukaryotes, many RNA sequences are removed by nuclear enzymes; the sequences that are left to code for proteins are called exons. In translation, RNA directs the synthesis of a polypeptide, a cloverleaf-shaped strand of about 80 nucleotides. The tRNA molecule has a site where an amino acid attaches. The three-nucleotide sequence at the opposite side of the cloverleaf is called the anticodon. REF: p. 39

Which of the following patients should the nurse assess for a decreased oncotic pressure in the capillaries? A patient with: a. A high-protein diet b. Liver failure c. Low blood pressure d. Low blood glucose

ANS: B Liver failure leads to lost or diminished plasma albumin production, and this contributes to decreased plasma oncotic pressure. A high-protein diet would provide albumin for the maintenance of oncotic pressure. Low blood pressure would lead to decreased hydrostatic pressure. Decreased glucose does not affect oncotic pressure. REF: p. 101

When the immunoglobulin crosses the placenta, what type of immunity does the fetus receive? a. Active b. Passive c. Innate d. Cell-mediated

ANS: B Maternal antibodies that pass across the placenta into the fetus before birth provide passive systemic immunity. Maternal antibodies that pass across the placenta into the fetus before birth provide passive systemic immunity, not active immunity. Maternal antibodies that pass across the placenta into the fetus before birth provide passive systemic immunity, not innate immunity. Maternal antibodies that pass across the placenta into the fetus before birth provide passive systemic immunity, not cell-mediated immunity. REF: p. 145

The post-surgical patient is experiencing delayed wound healing. The dietician believes the delay is related to nutritional intake. A deficiency in which of the following substances could directly affect healing? a. Vitamin D b. Ascorbic acid c. Melanin d. Cholesterol

ANS: B Most of the factors that interfere with the production of collagen in healing tissues are nutritional. Scurvy, for example, is caused by lack of ascorbic acid—one of the cofactors required for collagen formation by fibroblasts. The results of scurvy are poorly formed connective tissue and greatly impaired healing. Vitamin D deficiency will not directly affect healing; ascorbic acid does. Melanin deficiency will not directly affect healing; ascorbic acid does. Cholesterol deficiency will not directly affect healing; ascorbic acid does. REF: p. 136

A patient has been searching on the Internet about natriuretic hormones. When the patient asks the nurse what do these hormones do, how should the nurse respond? Natriuretic hormones affect the balance of: a. Calcium b. Sodium c. Magnesium d. Potassium

ANS: B Natriuretic hormones are sometimes called a "third factor" in sodium regulation. Natriuretic hormones are a factor in sodium balance, not calcium. Natriuretic hormones are a factor in sodium balance, not magnesium. Natriuretic hormones are a factor in sodium balance, not potassium. REF: p. 103

The predominant phagocyte of early inflammation is the: a. Eosinophil b. Neutrophil c. Lymphocyte d. Macrophage

ANS: B Neutrophils are the predominant phagocytes in the early inflammatory site, arriving within 6 to 12 hours after the initial injury. Eosinophils help limit and control inflammation, but they are not the prominent phagocyte. Lymphocytes are part of the innate immune response. Macrophages kill microorganisms. REF: p. 129

A 20-year-old male shoots his hand with a nail gun while replacing roofing shingles. Which of the following cell types would be the first to aid in killing bacteria to prevent infection in his hand? a. Eosinophils b. Neutrophils c. Leukotrienes d. Monocytes

ANS: B Neutrophils are the predominant phagocytes in the early inflammatory site, arriving within 6 to 12 hours after the initial injury. Eosinophils help limit and control inflammation. Leukotrienes are activators of the inflammatory response. Monocytes enter much later and replace leukocytes. REF: p. 129

When homologous chromosomes fail to separate during meiosis, which of the following occurs? a. Neurofibromatosis b. Nondisjunction c. Polyploidy d. Conjoined twins

ANS: B Nondisjunction is an error in which homologous chromosomes or sister chromatids fail to separate normally during meiosis or mitosis. Neurofibromatosis is a dominant disorder. It is not due to chromosome failure during meiosis. Polyploidy occurs when a euploid cell has more than the diploid number of chromosomes. Conjoined twins are not due to chromosome failure during meiosis. REF: p. 42

A nurse is reading a chart and sees the term oncotic pressure. The nurse recalls that oncotic pressure (colloid osmotic pressure) is determined by: a. Concentration of sodium b. Plasma proteins c. Hydrostatic pressure d. Availability of membrane transporter proteins

ANS: B Oncotic pressure is determined by the effect of colloids or plasma proteins. The concentration of sodium plays a role in tonicity. Hydrostatic pressure is the force within a vessel. Membrane transporter proteins are involved in active transport within a concentration gradient. REF: p. 16

The condition in which an extra portion of a chromosome is present in each cell is called: a. Reciprocal translocation b. Partial trisomy c. Inversion d. Down syndrome

ANS: B Partial trisomy is a condition in which only an extra portion of a chromosome is present in each cell. A reciprocal translocation occurs when breaks take place in two different chromosomes and the material is exchanged. An inversion occurs when two breaks take place on a chromosome, followed by the reinsertion of the missing fragment at its original site, but in inverted order. Down syndrome is an aneuploidy of the twenty-first chromosome. REF: p. 40

To express a polygenic trait: a. Genes must interact with the environment. b. Several genes must act together. c. Multiple mutations must occur in the same family. d. Penetrance must occur.

ANS: B Polygenic traits are those that result from several genes acting together. When environmental factors influence the expression of the trait, the term multifactorial inheritance is used. When multiple mutations occur in the same family, the mechanism most likely responsible is termed germline mosaicism. Penetrance of a trait is the percentage of individuals with a specific genotype who also exhibit the expected phenotype. REF: p. 54

A 25-year-old male is in a car accident and sustains a fracture to his left femur with extensive soft tissue injury. The pain associated with the injury is related to: a. Histamine and serotonin b. Kinins and prostaglandins c. Vasoconstriction d. Immune complex formation

ANS: B Prostaglandins cause increased vascular permeability, neutrophil chemotaxis, and pain by direct effects on nerves. Kinins also promote pain. Prostaglandins produce pain; histamine promotes vasodilation. Prostaglandins produce pain, not vasoconstriction. Prostaglandins produce pain, not the immune complex. REF: p. 129

When an oncologist is teaching about how radiation induces genomic instability, which of the following should the oncologist discuss? a. Increasing hypersensitivity b. Facilitating new mutations c. Promoting cell death d. Enhancing mitosis

ANS: B Radiation induces genomic instability because it facilitates new mutations. Radiation does not promote hypersensitivity. Radiation may promote cell death, but this is not its role in inducing genomic instability. Radiation does not enhance mitosis but halts it. REF: p. 274

A 35-year-old female is diagnosed with multiple myeloma. Biopsy of the tumor reveals Russell bodies, and laboratory testing reveals kidney dysfunction. Which substance should the nurse monitor as it is accumulating in the patient's body? a. Glycogen b. Protein c. Pigment d. Melanin

ANS: B Russell bodies occur due to excess aggregates of protein. Excess glycogen would affect blood glucose and this is not related to Russell bodies. Increased pigment would not lead to kidney dysfunction. Melanin accumulates in epithelial cells (keratinocytes) of the skin and retina. It is an extremely important pigment because it protects the skin against long exposure to sunlight. REF: p. 83

Selye reported several structural changes in rats exposed to repeated stressors. These included: a. Hypertrophy of the thymus gland b. Ulceration in the gastrointestinal system c. Atrophy of the cortex in the adrenal gland d. Fight or flight response

ANS: B Selye found the development of bleeding ulcers in response to stress. Selye found atrophy, not hypertrophy, of the thymus gland. Selye found enlargement of the cortex, rather than atrophy. The flight or fight response was part of the general adaptation syndrome, not a structural change. REF: p. 204

A patient has a disease state that results from the secretion of toxins by bacteria. Which medical diagnosis will the nurse see documented on the chart? a. Malaria b. Tetanus c. Smallpox d. Hepatitis

ANS: B Some bacteria secrete toxins that harm individuals. For instance, specific bacterial toxins cause the symptoms of tetanus or diphtheria. Tetanus, not malaria, is due to toxin secretion. Tetanus, not smallpox, is due to toxin secretion. Tetanus, not hepatitis, is due to toxin secretion. REF: p. 150

After teaching about stress, which information indicates a correct understanding of stress? a. It worsens but does not cause disease. b. It can be viewed as transactional. c. It is a psychologic, rather than biologic, event. d. It is a passive event.

ANS: B Stress has come to be defined by most as a transactional concept. There is a relationship between stress and disease. Stress is both a psychologic and a biologic event. Stress is an active, rather than a passive, event. REF: p. 208

A family presents to their primary care provider reporting headache, nausea, weakness, and vomiting. Which of the following would be the most likely explanation for these symptoms? a. Lead exposure b. Carbon monoxide poisoning c. Ethanol exposure d. Mercury poisoning

ANS: B Symptoms related to carbon monoxide poisoning include headache, giddiness, tinnitus (ringing in the ears), nausea, weakness, and vomiting. Although nausea and vomiting can occur with lead exposure, lead toxicity is primarily manifested by convulsions and delirium and, with peripheral nerve involvement, wrist, finger, and sometimes foot paralysis. Ethanol exposure has CNS effects and would not affect the whole family. Mercury poisoning is manifested by CNS effects and would not lead to nausea and vomiting. REF: p. 72

A nurse recalls stress-induced stimulation of the adrenal cortex causes it to secrete: a. Estrogen b. Cortisol c. Parathyroid hormone d. Adrenocorticotropin hormone (ACTH)

ANS: B The adrenal cortex secretes cortisol. The adrenal cortex secretes cortisol, not estrogen. The adrenal cortex secretes cortisol, not parathyroid hormone. The adrenal cortex secretes cortisol, not ACTH. REF: p. 210

Which of the following buffer pairs is considered the major plasma buffering system? a. Protein/fat b. Carbonic acid/bicarbonate c. Sodium/potassium d. Amylase/albumin

ANS: B The carbonic acid/bicarbonate buffer pair operates in both the lung and the kidney and is a major extracellular buffer. Protein and fat are nutrients not related to the buffering system. Sodium and potassium are electrolytes for fluid and electrolyte balance, not the major plasma buffering system for acid-base balance. Amylase is a carbohydrate enzyme, and albumin is a protein; neither is a buffering system. REF: pp. 111-112

A student is observing a cell under the microscope. It is observed to have supercoiled DNA with histones. Which of the following would also be observed by the student? a. A single circular chromosome b. A nucleus c. Free-floating nuclear material d. No organelles

ANS: B The cell described is a eukaryotic cell, so it has histones and a supercoiled DNA within its nucleus; thus, the nucleus should be observed. A single circular chromosome is characteristic of prokaryotic cells, which do not have histones. Free-floating nuclear material describes a prokaryotic cell, which would not have a distinct nucleus. Eukaryotic cells have membrane bounded cellular components called organelles. No organelles describes a prokaryotic cell. REF: p. 2

A 25-year-old male develops a tumor of the breast glandular tissue. What type of tumor will be documented on the chart? a. Carcinoma b. Adenocarcinoma c. Sarcoma d. Lymphoma

ANS: B Tumors that arise from or form ductal or glandular structures are named adenocarcinomas. Cancers arising in epithelial tissue are called carcinomas. Cancers arising from mesenchymal tissue (including connective tissue, muscle, and bone) usually have the suffix sarcoma. Cancers of lymphatic tissue are called lymphomas. REF: p. 223

Which statement indicates teaching was successful regarding the classic pathway of the complement system? The classic pathway of the complement system is activated by: a. Histamine b. Antigen-antibody complexes c. Leukotrienes d. Prostaglandins

ANS: B The classic pathway of the complement system is activated by antibodies of the immune system. The classic pathway of the complement system is activated by antibodies, not by histamine. The classic pathway of the complement system is activated by antibodies, not by leukotrienes. The classic pathway of the complement system is activated by antibodies, not by prostaglandins. REF: p. 123

What common symptom should be assessed in individuals with immunodeficiency? a. Anemia b. Recurrent infections c. Hypersensitivity d. Autoantibody production

ANS: B The clinical hallmark of immunodeficiency is a propensity to unusual or recurrent severe infections. The type of infection usually reflects the immune system defect. Anemia is not a manifestation of immunodeficiency. Hypersensitivity is not a symptom of immunodeficiency. Autoantibody production is not a symptom of immunodeficiency. REF: p. 201

A DNA strand has a region with the sequence ATCGGAT. Which of the following would be a complementary strand? a. CGATACGT b. TAGCCTAG c. TUGCCTUG d. UAGCCUAG

ANS: B The consistent pairing of adenine with thymine and of guanine with cytosine is known as complementary base pairing; thus, A complements to T and C to G and vice versa throughout the strand. A complements to T; thus, the first letter must be a T. U does not represent a complement in the sequence. U does not represent a complement in the sequence. REF: p. 35

While planning care for elderly individuals, the nurse remembers the elderly are at a higher risk for developing dehydration because they have a(n): a. Higher total body water volume b. Decreased muscle mass c. Increase in thirst d. Increased tendency towards developing edema

ANS: B The elderly are at higher risk for dehydration due to a decrease in muscle mass. The elderly have a decrease in total body water, not an increase. The elderly have a decrease in thirst. The elderly may develop edema, but this does not lead to dehydration. REF: p. 100

After teaching the staff about the clotting system, which statement indicates teaching was successful? The end product of the clotting system is: a. Plasmin b. Fibrin c. Collagen d. Factor X

ANS: B The end product of the clotting system is fibrin. Plasmin activates the complement cascade. Collagen plays a factor in wound healing. Factor X is a first step in the clotting system. REF: p. 124

A child is born with blue eyes (bb). The child's mother has blue eyes and the father has brown eyes. Which of the following represents the father? a. Bb b. Bb c. BB d. Bbb

ANS: B The father would need to have one b and one B because blue eyes are recessive and the father has a dominant eye color. bb is incorrect because, with this description, the father could not have brown eyes. BB would describe the father's brown eyes, but without a b he could not father a blue-eyed child. The father would have only two, not three. REF: p. 52

The gradual increase in height among the human population over the past 100 years is an example of: a. A polygenic trait b. A multifactorial trait c. Crossing over d. Recombination

ANS: B The gradual increase in height is an example of multifactorial traits influenced by genes and also by environment. Polygenic traits result from several genes acting together. Crossing over is an abnormal chromosome structure. Recombination results from new arrangements of alleles. REF: p. 54

A 30-year-old female presents to her primary care provider reporting fatigue, excessive sweating, and increased appetite. Physical examination reveals protruding eyes, and laboratory testing reveals hyperthyroidism secondary to autoantibody production. This disorder falls into the category of type _____ hypersensitivity. a. I b. II c. III d. IV

ANS: B The patient is experiencing type II hypersensitivity. In hyperthyroidism, autoantibody binds to and activates receptors for thyroid-stimulating hormone (TSH) (a pituitary hormone that controls the production of the hormone thyroxine by the thyroid). The patient is experiencing a type II reaction, not type I, which is the most common type of allergic reaction. The patient is experiencing a type II reaction, not type III, which is not organ specific. The patient is experiencing a type II reaction; type IV is a delayed reaction. REF: p. 193

A 40-year-old female developed adenocarcinoma of the vagina. Which of the following is the most likely cause of her cancer? a. Rb gene mutation b. Prenatal exposure to diethylstilbestrol (DES) c. Prenatal exposure to solvents d. Prenatal exposure to radiation

ANS: B The patient with adenocarcinoma of the vagina experienced prenatal exposure to DES. The patient with adenocarcinoma of the vagina experienced prenatal exposure to DES, not Rb gene mutation. The patient with adenocarcinoma of the vagina experienced prenatal exposure to DES, not solvents. The patient with adenocarcinoma of the vagina experienced prenatal exposure to DES, not radiation. REF: p. 291

A 30-year-old female complains of fatigue, arthritis, rash, and changes in urine color. Laboratory testing reveals anemia, lymphopenia, and kidney inflammation. Assuming a diagnosis of SLE, which of the following is also likely to be present? a. Anti-LE antibodies b. Antinuclear antibodies c. Antiherpes antibodies d. Anti-CMV antibodies

ANS: B The presence of antinuclear antibodies is a diagnostic criterion for SLE. The presence of antinuclear antibodies is a diagnostic criterion for SLE. It would be positive LE. The presence of antinuclear antibodies is a diagnostic criterion for SLE, not antiherpes. The presence of antinuclear antibodies is a diagnostic criterion for SLE, not anti-CMV. REF: p. 198

When the nurse is checking the urinalysis, the finding that would alert the nurse to cellular injury is the presence of: a. Slight glucose b. Excessive protein c. Blood d. Urea

ANS: B The presence of protein in the urine in significant amounts indicates cellular injury and altered cellular function. Glucose should not normally be present in the urine, but its presence is not indicative of altered cellular function, but of excess glucose in the blood. Blood should not normally be present in the urine, but its presence indicates kidney alteration and not cellular injury. Urea is an expected substance in the kidney. REF: p. 83

During inflammation, the liver is stimulated to release plasma proteins, collectively known as: a. Opsonins b. Acute phase reactants c. Antibodies d. Phagolysosome

ANS: B The synthesis of many plasma proteins by the liver is increased during inflammation. These proteins, which can be either proinflammatory or antiinflammatory in nature, are referred to as acute phase reactants. Opsonins coat the surface of bacteria and increase their susceptibility to being phagocytized. Antibodies are proteins of the immune system. Phagolysosome destroys bacterium. REF: p. 133

Which information indicates a correct understanding of viral vaccines? Most viral vaccines contain: a. Active viruses b. Attenuated viruses c. Killed viruses d. Viral toxins

ANS: B Viral vaccines contain live viruses that are weakened (attenuated). Viral vaccines contain live viruses that are weakened (attenuated), not active. Viral vaccines contain live viruses that are weakened (attenuated), not killed. Viral vaccines contain live viruses that are weakened (attenuated), not toxins. REF: p. 187

What causes the rapid change in the resting membrane potential that initiates an action potential? a. Potassium gates open, and potassium rushes into the cell, changing the membrane potential from negative to positive. b. Sodium gates open, and sodium rushes into the cell, changing the membrane potential from negative to positive. c. Sodium gates close, allowing potassium into the cell to change the membrane potential from positive to negative. d. Potassium gates close, allowing sodium into the cell to change the membrane potential from positive to negative.

ANS: B When the threshold is reached, the cell will continue to depolarize with no further stimulation. The sodium gates open, and sodium rushes into the cell, causing the membrane potential to reduce to zero and then become positive (depolarization). Sodium is involved in creating the action potential, not potassium. The sodium gate must be open, not closed. The sodium channel must be open; this is not affected by a change in the potassium gate. REF: p. 21

When an aide asks why carcinomas rarely occur in childhood, how should the nurse respond? (Select all that apply.) a. Carcinomas cannot develop in an immunosuppressed environment. b. Carcinomas need a long time from exposure to occurrence. c. Carcinomas are due to environmental exposures. d. Carcinomas occur primarily in secondary sexual organs. e. Carcinomas are mesodermal.

ANS: B, C Carcinomas rarely occur in children because these cancers most commonly result from environmental carcinogens and require a long period from exposure to the appearance of the carcinoma. REF: p. 288

Brachytherapy is being used to treat cancer in a patient. What type of cancers responds well to brachytherapy? (Select all that apply.) a. Heart b. Cervix c. Head d. Neck e. Lung

ANS: B, C, D Radiation sources can be temporarily placed into body cavities through a delivery method termed brachytherapy. Brachytherapy is useful in the treatment of cervical, prostate, and head and neck cancers. REF: p. 249

When the nurse is teaching the staff about X-linked recessive disorders, which information should the nurse include? (Select all that apply.) a. The trait is seen much more often in females than in males. b. The trait is never transmitted from father to son. c. The gene can be transmitted through a series of carrier females. d. The gene is passed from an affected father to all his daughters. e. The trait never skips generations.

ANS: B, C, D The principles of X-linked recessive inheritance include: the trait is seen much more often in males than in females; the trait is never transmitted from father to son; the gene can be transmitted through a series of carrier females; the gene is passed from an affected father to all his daughters, who, as phenotypically normal carriers, transmit it to approximately half their sons, who are affected. X-linked recessive disorders can skip generations since it is a 1 in 4 chance. REF: p. 52

The nurse identified each of the following clinical manifestations of inflammation. Which would the nurse classify as a local response? (Select all that apply.) a. Fever b. Redness c. Swelling d. Heat e. Pain

ANS: B, C, D, E Local manifestations of inflammation are the result of the vascular changes associated with the inflammatory process, including vasodilation and increased capillary permeability. The symptoms include redness, heat, swelling, and pain. REF: p. 138

When teaching about the stress-age syndrome, what information should the nurse include? (Select all that apply.) a. Decreased cortisol secretion b. Increased thyroxine c. Immunodepression d. Increased catecholamine secretion e. Hypercoagulation of the blood f. Free radical damage

ANS: B, C, D, E, F The stress-age syndrome includes alterations in the excitability of structures of the limbic system and hypothalamus; rise of the blood concentration of catecholamines, ADH, ACTH, and cortisol; decrease in testosterone, thyroxine, and others; alterations of opioid peptides; immunodepression and pattern of chronic inflammation; alterations in lipoproteins; hypercoagulation of the blood; and free radical damage of cells. REF: p. 218

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. Decreased numbers of circulating immune complexes e. Decreased ability to fight infection

ANS: B, D, E Increased age is associated with diminished T cell function, decreased immune function, diminished production of antibody responses, decreased circulating immune complexes, and decreased ability to fight infection. REF: p. 164

Some cancer drugs work during the cell cycle phase where nuclear and cytoplasmic division occurs. What is this cell cycle phase called? a. G1 b. S c. M d. G2

ANS: C The M phase includes both nuclear and cytoplasmic division. The G1 phase includes the period between the M phase and the start of DNA synthesis. The S phase include synthesis of DNA in the cell nucleus. The G2 phase includes RNA and protein synthesis. REF: p. 23

How are potassium and sodium transported across plasma membranes? a. By passive electrolyte channels b. By coupled channels c. By adenosine triphosphate enzyme (ATPase) d. By diffusion

ANS: C A "carrier" mechanism in the plasma membrane mediates the transport of ions and nutrients. The best-known pump is the Na+-K+-dependent ATPase pump. Electrolyte movements require energy and do not move passively. Enzymes, not electrolytes, are passed via coupled channels. Electrolytes are not transported by diffusion. REF: p. 17

A 13-year-old girl has a karyotype that reveals an absent homologous X chromosome with only a single X chromosome present. What medical diagnosis will the nurse observe on the chart? a. Down syndrome b. Cri du chat syndrome c. Turner syndrome d. Fragile X syndrome

ANS: C A condition with the presence of a single X chromosome and no homologous X or Y chromosome, so the individual has a total of 45 chromosomes, is known as Turner syndrome. Down syndrome is a change in one arm of a chromosome. Cri du chat syndrome is due to a chromosome deletion. Fragile X syndrome is due to a break or a gap in a chromosome. REF: p. 43

A 54-year-old male with a long history of smoking complains of excessive tiredness, shortness of breath, and overall ill feelings. Lab results reveal decreased pH, increased CO2, and normal bicarbonate ion. These findings help to confirm the diagnosis of: a. Respiratory alkalosis b. Metabolic acidosis c. Respiratory acidosis d. Metabolic alkalosis

ANS: C A decreased pH indicates acidosis. With increased CO2, it is respiratory acidosis. The decreased pH indicates acidosis, not alkalosis. It is acidosis, but the bicarbonate is normal, so it cannot be metabolic. The decreased pH indicates acidosis, not alkalosis. REF: p. 114

A 16-year-old male with aspirations of becoming a bodybuilder spends 3 hours a day in the gym. Five years later he develops hepatocellular carcinoma. Which of the following is the most likely cause of the cancer? a. Immunosuppressive agents b. Cytotoxic agents c. Anabolic steroids d. A viral infection

ANS: C A history of anabolic steroids places the patient at risk for hepatocellular carcinoma. A history of anabolic steroids, not immunosuppressive agents, places the patient at risk for hepatocellular carcinoma. A history of anabolic steroids, not cytotoxic agents, places the patient at risk for hepatocellular carcinoma. A history of anabolic steroids, not a viral infection, places the patient at risk for hepatocellular carcinoma. REF: p. 291

A cell that does not contain a multiple of 23 chromosomes is called a _____ cell. a. diploid b. euploid c. polyploid d. haploid

ANS: C A polyploid cell is one in which a euploid cell has more than the diploid number of chromosomes. A diploid cell is when the somatic cell nucleus has 46 chromosomes in 23 pairs. A euploid cell is a cell with multiples of the normal number of chromosomes. A haploid cell has only one member of each chromosome pair, for a total of 23 chromosomes. REF: p. 39

A patient asks when adjuvant chemotherapy is used. How should the nurse respond? Adjuvant chemotherapy treatment is used: a. As the primary treatment b. Before radiation therapy c. After surgical removal of a tumor d. In cancer with little risk of metastasis

ANS: C Adjuvant chemotherapy is given after surgical excision of a cancer with the goal of eliminating micrometastases. Adjuvant chemotherapy is given after surgery, not as the primary treatment. Adjuvant chemotherapy is given after surgery, not before radiation therapy. Adjuvant chemotherapy is given after surgery and is indicated in the treatment of individuals with metastasis. REF: pp. 248-249

Which statement by the staff indicates teaching was successful concerning aldosterone? Secretion of aldosterone results in: a. Decreased plasma osmolality b. Increased serum potassium levels c. Increased blood volume d. Localized edema

ANS: C Aldosterone promotes renal sodium and water reabsorption and excretion of potassium, thus, increasing blood volume. Aldosterone secretion would cause increased plasma osmolality. Secretion of aldosterone decreases potassium levels because it causes potassium excretion. Secretion of aldosterone does not promote the development of localized edema; it affects blood volume. REF: p. 104

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

ANS: C Alloimmunity can be observed during immunologic reactions against transfusions, transplanted tissue, or the fetus during pregnancy. Autoimmunity is a disturbance in the immunologic tolerance of self-antigens. The most rapid and severe immediate hypersensitivity reaction is anaphylaxis. An allergic response occurs related to exposure to an allergen. REF: p. 190

The student is studying for a pathophysiology exam and is trying to remember the definition of amphipathic. The student should choose which of the following to be correct? a. All cells have a membrane that is composed of lipids. b. Cells have organelles that have specialized function. c. Molecules are polar with one part loving water and one part hating water. d. Cells have receptor sites that other substances attach to and create additional functions.

ANS: C Amphipathic means that one part is hydrophobic (uncharged, or "water hating") and another part is hydrophilic (charged, or "water loving"). Cells have a membrane, but this is not the definition of amphipathic. Cells have organelles, but this is not the definition of amphipathic. Cells have receptor sites, but this is not the definition of amphipathic. REF: p. 3

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

ANS: C Anaphylaxis occurs within minutes of reexposure to the antigen and can be either systemic (generalized) or cutaneous (localized). Immunodeficiency is a decrease in the immune response. Autoimmunity is a disturbance in the immunologic tolerance of self-antigens. Tissue-specific reaction is an autoimmune reaction. REF: p. 190

A 25-year-old female experiences a headache and takes aspirin for relief. A nurse recalls aspirin relieves the headache by: a. Decreasing leukotriene production b. Increasing histamine release c. Decreasing prostaglandin production d. Increasing platelet-activating factor

ANS: C Aspirin is a prostaglandin inhibitor. Aspirin inhibits prostaglandins; it does not affect leukotriene production. Aspirin inhibits prostaglandins; it does not affect histamine release. Aspirin does not play a role in the platelet activating factor; this is a leukotriene response. REF: p. 129

A 50-year-old female develops skin cancer on her head and neck following years of sunbathing. Which of the following cancers is the most likely? a. Lymphoma b. Adenoma c. Basal cell carcinoma d. Leukemia

ANS: C Basal cell is related to UV radiation primarily from the sun. Lymphoma is not related to sunbathing. Adenoma is not related to sunbathing. Leukemia is not related to sunbathing. REF: p. 274

A 30-year-old female is diagnosed with cancer. Testing reveals that the cancer cells have spread to local lymph nodes. A nurse realizes this cancer would be documented as stage: a. 1 b. 2 c. 3 d. 4

ANS: C Cancer that has spread to regional structures, such as lymph nodes, is stage 3. Cancer confined to the organ of origin is stage 1. Cancer that is locally invasive is stage 2. Cancer that has spread to distant sites, such as a liver cancer spreading to lung or a prostate cancer spreading to bone, is stage 4. REF: p. 244

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

ANS: C Caseous necrosis results from tuberculosis pulmonary infection. Coagulative necrosis occurs primarily in the kidneys, heart, and adrenal glands and commonly results from hypoxia. Liquefactive necrosis results from ischemic injury to neurons and glial cells in the brain. Autonecrosis is a process of cellular self-digestion and is not due to infection such as tuberculosis. REF: p. 87

Which statement indicates teaching was successful regarding collectins? Collectins are produced by the: a. Kidneys b. Bowel c. Lungs d. Integument

ANS: C Collectins are produced by the lungs. Collectins are produced by the lungs, not the kidneys. Collectins are produced by the lungs, not the bowel. Collectins are produced by the lungs, not the integument. REF: p. 119

When an immunologist teaches about the relationship that benefits the organism but causes no harm to the host, the immunologist is describing which of the following? a. Symbiosis b. Mutualism c. Commensalism d. Pathogenicity

ANS: C Commensalism benefits only the microorganism; there is no harm to the human. Parasitic microorganisms establish symbiosis with another species in which the parasite benefits at the expense of the other species. Mutualism benefits the human and the microorganism. Pathogenicity benefits the microorganism, but harms the human. (Opportunism is the situation that occurs when benign microorganisms become pathogenic because of decreased human-host resistance.) REF: p. 166

The nurse is reviewing the lab data of a newly admitted patient. The nurse notes the patient had an erythrocyte sedimentation done, and the results are quite elevated. The nurse would focus the care plan on which of the following conditions? a. Anemia b. Infection c. Inflammation d. Electrolyte imbalance

ANS: C Common laboratory tests for inflammation measure levels of acute phase reactants. An increase in fibrinogen is associated with an increased erythrocyte sedimentation rate, which is considered a good indicator of an acute inflammatory response. Anemia would not result in an increased erythrocyte sedimentation rate. An infection would result in an increase in white blood cell count, but not the erythrocyte sedimentation rate. An electrolyte imbalance would not cause a rise in the sedimentation rate. REF: p. 133

A 55-year-old male is diagnosed with hepatocellular cancer secondary to hepatitis C. If the cancerous region of the liver were removed, the remaining cells would undergo: a. Pathologic hyperplasia b. Pathologic metaplasia c. Compensatory hyperplasia d. Compensatory aplasia

ANS: C Compensatory hyperplasia is an adaptive mechanism that enables certain organs to regenerate. The cells become compensatory and would not be pathologic. Metaplasia is the reversible replacement of one mature cell type by another, sometimes less differentiated, cell type. Aplasia is not a compensatory mechanism. REF: p. 62

A child is diagnosed with cystic fibrosis. History reveals that the child's parents are siblings. Cystic fibrosis was most likely the result of: a. X inactivation b. Genomic imprinting c. Consanguinity d. Obligate carriers

ANS: C Consanguinity refers to the mating of two related individuals, and the offspring of such matings are said to be inbred. Consanguineous matings produce a significant increase in recessive disorders and are seen most often in pedigrees for rare recessive disorders. X inactivation occurs when one X chromosome in the somatic cells of females is permanently inactivated. Genomic imprinting is related to methylation and other changes. Obligate carriers are those who have an affected parent and affected children and, therefore, must themselves carry the mutation. REF: p. 50

A 30-year-old female presents with a gunshot wound to the head. The wound has seared edges and a deep penetration of smoke and gunpowder fragments. This wound would be documented as a(n) _____ wound. a. Exit b. Intermediate range entrance c. Contact range entrance d. Indeterminate range entrance

ANS: C Contact range entrance wound is a distinctive type of wound when the gun is held so the muzzle rests on or presses into the skin surface; in addition to the hole, there is searing of the edges of the wound from flame and soot or smoke on the edges of the wound. It is unlikely it is an exit wound since there is only one wound and it has seared edges and gunpowder fragments. Intermediate range entrance wound is surrounded by gunpowder tattooing or stippling. Indeterminate range entrance wound occurs when flame, soot, or gunpowder does not reach the skin surface, but the bullet does. REF: p. 79

A patient has severe mental retardation caused by a deletion of part of chromosome 5. What genetic disorder will the nurse see documented in the chart? a. Prader-Willi syndrome b. Down syndrome c. Cri du chat syndrome d. Trisomy X

ANS: C Cri du chat syndrome means "cry of the cat" and describes the characteristic cry of the affected child. Another symptom of the disorder is mental retardation. Prader-Willi syndrome is characterized by short stature, obesity, and hypogonadism. Down syndrome does cause mental retardation, but is due to chromosome 21, not chromosome 5. Trisomy X can result in mental retardation, but is due to an extra X chromosome. REF: p. 43

A nurse recalls the mast cell, a major activator of inflammation, initiates the inflammatory response through the process of: a. Chemotaxis b. Endocytosis c. Degranulation d. Opsonization

ANS: C Degranulation of mast cells is a major cellular component of inflammation. Chemotaxis is the process of white cell migration. Endocytosis is a part of phagocytosis and is not a factor in mast cell response. Opsonization is part of phagocytosis and is not a factor in mast cell response. REF: p. 127

Which of the following patients is the most at risk for developing hypernatremia? A patient with: a. Vomiting b. Diuretic use c. Dehydration d. Hypoaldosteronism

ANS: C Dehydration leads to hypernatremia because an increase in sodium occurs with a net loss in water. Vomiting leads to hyponatremia. Diuretic use would lead to sodium loss. Hypoaldosteronism leads to hyponatremia. REF: p. 106

A nurse is teaching the staff about platelet-derived growth factor. Which information should the nurse include? Platelet-derived growth factor (PDGF) stimulates the production of: a. Platelets b. Epidermal cells c. Connective tissue cells d. Fibroblast cells

ANS: C Different types of cells require different growth factors; for example, PDGF stimulates the production of connective tissue cells. The factor stimulates the production of connective tissue, not platelets. The factor stimulates the production of connective tissue, not epidermal cells. The factor stimulates the production of connective tissue, not fibroblast cells. REF: p. 24

The early dilation (swelling) of the cell's endoplasmic reticulum results in: a. Increased aerobic metabolism b. Failure of DNA c. Reduced protein synthesis d. Decreased Na+-K+ pump function

ANS: C Early dilation of the endoplasmic reticulum causes the ribosomes to detach from the rough endoplasmic reticulum, reducing protein synthesis. Aerobic metabolism is a normal process and would not lead to swelling. Cellular swelling will not alter cellular DNA. A reduction, not an increase, in the Na+-K+ pump leads to an intracellular accumulation of sodium and calcium and diffusion of potassium out of the cell. Sodium and water can then enter the cell freely, and cellular swelling results. REF: p. 66

A nurse is discussing preinvasive epithelial tumors of glandular or squamous cell origin. What is the nurse describing? a. Tumor in differentiation b. Dysplastic c. Cancer in situ d. Cancer beyond (meta) situ

ANS: C Early stage growths that are localized to the epithelium and have not invaded are called cancer in situ. Cancer in situ is early stage growth and not a tumor in differentiation. Cancer in situ is early stage growth and may contain dysplastic cells, but dysplastic cells do not define cancer in situ. Cancer in situ is early stage growth, and cancer beyond situ is more mature growth. REF: p. 223

The most common tissue type of cancer occurring after adolescence is: a. Sarcoma b. Squamous cell c. Carcinoma d. Neuromas

ANS: C The most common tissue type after adolescence is carcinoma. The most common tissue type after adolescence is carcinoma, not sarcoma. The most common tissue type after adolescence is carcinoma, not squamous cell. The most common tissue type after adolescence is carcinoma, not neuromas. REF: p. 288

When assessing the effects of elevated â-endorphins in a patient, which of the following should the nurse monitor? a. Peripheral vasoconstriction b. Hyperglycemia c. Pain inhibition d. Decreased immune cell activity

ANS: C Elevated â-endorphins activate endorphin (opiate) receptors on peripheral sensory nerves leading to pain relief or analgesia. Elevated â-endorphins activate endorphin (opiate) receptors on peripheral sensory nerves leading to pain relief or analgesia, not vasoconstriction. Elevated â-endorphins activate endorphin (opiate) receptors on peripheral sensory nerves leading to pain relief or analgesia, not hyperglycemia. Elevated â-endorphins activate endorphin (opiate) receptors on peripheral sensory nerves leading to pain relief or analgesia, not decreased immune cell activity. REF: p. 214

During which process can lysosomal enzymes be released to degrade engulfed particles? a. Endocytosis b. Pinocytosis c. Phagocytosis d. Exocytosis

ANS: C Engulfment of particles occurs by phagocytosis. Endocytosis involves the formation of vesicles to facilitate movement into the cell. Pinocytosis is a type of endocytosis in which fluids and solute molecules are ingested through formation of small vesicles. Exocytosis occurs when coated pits invaginate and internalize ligand-receptor complexes in coated vesicles. REF: p. 20

Which of the following hormones activates adrenergic receptors? a. Oxytocin b. Prolactin c. Epinephrine d. Somatotropin

ANS: C Epinephrine activates adrenergic receptors. Oxytocin activates receptors in the uterus. Prolactin does not activate adrenergic receptors. Somatotropin activates protein and carbohydrate metabolism. REF: p. 209

Biochemical secretions that trap and kill microorganisms include: a. Hormones b. Neurotransmitters c. Earwax d. Gastric acid

ANS: C Epithelial cells secrete several substances that protect against infection, including earwax. Hormones do not contain biochemical secretions that trap and kill microorganisms. Neurotransmitters carry important messages, but they do not contain biochemical secretions. Gastric acid helps break down food into its component parts, but does not contain biochemical secretions. REF: p. 120

Exhaustion occurs if stress continues and _____ is not successful. a. Fight or flight b. Alarm c. Adaptation d. Arousal

ANS: C Exhaustion occurs if adaptation is not successful. Exhaustion occurs if adaptation is not successful, not fight or flight. Alarm is part of the adaptation process, but it is adaptation that prevents exhaustion. Arousal is the recognition of stress. REF: p. 205

An infant is experiencing hemolytic disease of the newborn. Which of the following would the nurse expect to find in the infant's history and physical? a. The mother was exposed to measles. b. The father was exposed to Agent Orange. c. The baby is Rh positive. d. The baby was born 6 weeks prematurely.

ANS: C Hemolytic disease of the newborn was most commonly caused by IgG anti-D alloantibody produced by Rh-negative mothers against erythrocytes of their Rh-positive fetuses. This disorder is due to Rh incompatibility, not the mother's exposure to measles. This disorder is due to Rh incompatibility, not the father's exposure to Agent Orange. This disorder is due to Rh incompatibility, not the baby's prematurity. REF: p. 189

A 60-year-old female is diagnosed with hyperkalemia. Which assessment finding should the nurse expect to observe? a. Weak pulse b. Excessive thirst c. Oliguria d. Constipation

ANS: C Hyperkalemia is manifested by oliguria. Hypokalemia is manifested by a weak pulse; it is not caused by hyperkalemia. Hypokalemia is manifested by excessive thirst. Diarrhea, not constipation, is a manifestation of hyperkalemia. REF: p. 110

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 the immune system to a sensitizing antigen d. Antigenic desensitization

ANS: C Hypersensitivity is an altered immunologic response to an antigen that results in disease or damage to the individual. Hypersensitivity is not a reduced immune response. Hypersensitivity is not a normal response to an infectious agent. Antigenic desensitization is performed to decrease hypersensitivity. REF: p. 165

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

ANS: C IgE is normally at low concentrations in the circulation. It has very specialized functions as a mediator of many common allergic responses. IgE, not toxoids, is the mediator of common allergic response. IgE, not IgA, is the mediator of common allergic response. IgE, not IgM, is the mediator of common allergic response. REF: p. 151

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

ANS: C IgM is synthesized early in neonatal life, and its synthesis may be increased as a response to infection in utero. IgM, not IgG, is synthesized early in neonatal life, and its synthesis may be increased as a response to infection in utero. IgM, not IgA, is synthesized early in neonatal life, and its synthesis may be increased as a response to infection in utero. IgM, not IgD, is synthesized early in neonatal life, and its synthesis may be increased as a response to infection in utero. REF: p. 149

A nurse recalls an example of an immune-complex-mediated disease is: a. Bronchial asthma b. Contact dermatitis c. Serum sickness d. Rheumatoid arthritis

ANS: C Immune-complex disease can be a systemic reaction, such as serum sickness and related to type III reactions. Bronchial asthma is not an immune-complex mediated disease and related to type I reactions. Contact dermatitis is related to type IV reactions. Rheumatoid arthritis is related to type IV reactions. REF: p. 193

A 70-year-old male with chronic renal failure presents with edema. Which of the following is the most likely cause of this condition? a. Increased capillary oncotic pressure b. Decreased interstitial oncotic pressure c. Increased capillary hydrostatic pressure d. Increased interstitial hydrostatic pressure

ANS: C Increased capillary hydrostatic pressure would facilitate increased movement from the capillary to the interstitial space, leading to edema. Increased capillary (plasma) oncotic pressure attracts water from the interstitial space back into the capillary. Decreased interstitial oncotic pressure would keep water in the capillary. Increased interstitial hydrostatic pressure would facilitate increased water movement from the interstitial space into the capillary. REF: p. 100

When the immunologist says that pathogens possess infectivity, what is the immunologist explaining? Infectivity allows pathogens to: a. Spread from one individual to others and cause disease b. Induce an immune response c. Invade and multiply in the host d. Damage tissue

ANS: C Infectivity is the ability of the pathogen to invade and multiply in the host. Communication is the ability to spread from one individual to others and cause disease. Immunogenicity is the ability of pathogens to induce an immune response. Damaging tissues is the pathogen's mechanism of action. REF: p. 167

Liquefactive necrosis occurs in the brain because: a. Debris is not digested by hydrolases b. Of protein denaturation c. It is rich in hydrolytic enzymes and lipids d. Ischemia results in chemical injury

ANS: C Liquefactive necrosis is due to enzymatic action and because cells of the brain are rich in enzymes. Liquefactive necrosis is not due to hydrolases. Protein denaturation occurs primarily in the kidneys. Liquefactive necrosis is due to enzymatic reaction and not to hypoxia. REF: p. 87

Which organ system should the nurse monitor when the patient has long-term potassium deficits? a. Central nervous system (CNS) b. Lungs c. Kidneys d. Gastrointestinal tract

ANS: C Long-term potassium deficits lasting more than 1 month may damage renal tissue, with interstitial fibrosis and tubular atrophy. Long-term potassium deficits damage the kidneys, not the CNS. Long-term potassium deficits damage the kidneys, not the lungs. Long-term potassium deficits damage the kidneys, not the gastrointestinal tract. REF: p. 108

A macrophage was isolated and analyzed for major histocompatibility complex. Which of the following would be expected? a. MHC I only b. MHC II only c. MHC I and II d. Neither MHC I or MHC II

ANS: C MCH I and II would be expected. MCH I and II would be expected. MCH I and II would be expected. Both MCH I and II would be expected. REF: p. 157

Which information indicates a nurse understands characteristics of malignant tumors? a. Grows slowly b. Has a well-defined capsule c. Has a high mitotic index d. Is well-differentiated

ANS: C Malignant tumors have a high mitotic index. Malignant tumors grow rapidly. Malignant tumors are not encapsulated. Malignant tumors are poorly-differentiated. REF: p. 223

A 55-year-old male with a 30-year history of smoking is examined for respiratory disturbance. Examination of his airway (bronchial) reveals that stratified squamous epithelial cells have replaced the normal columnar ciliated cells. This type of cellular adaptation is called: a. Anaplasia b. Hyperplasia c. Metaplasia d. Dysplasia

ANS: C Metaplasia is the reversible replacement of one mature cell type by another, sometimes a less differentiated cell type. Anaplasia is loss of cellular differentiation. Hyperplasia is an increase in the number of cells resulting from an increased rate of cellular division. Dysplasia refers to abnormal changes in the size, shape, and organization of mature cells. REF: p. 63

A patient has done research on monoclonal antibodies on the Internet. Which statement indicates a correct understanding? Pure monoclonal antibodies are produced by: a. T lymphocytes b. Bone marrow c. Laboratories d. Fetuses

ANS: C Monoclonal antibodies are produced in the laboratory from one B cell that has been cloned; thus, the entire antibody is of the same class, specificity, and function. Monoclonal antibodies are produced in the laboratory, not by T lymphocytes. Monoclonal antibodies are produced in the laboratory, not by the bone marrow. Monoclonal antibodies are produced in the laboratory, not by the fetus. REF: p. 155

While planning care for children with cancer, which information should the nurse remember? Most childhood cancers originate from the: a. Placenta b. Environment c. Mesodermal germ layer d. Neural tube

ANS: C Most childhood cancers originate from the mesodermal germ layer that gives rise to connective tissue, bone, cartilage, muscle, blood, blood vessels, gonads, kidney, and the lymphatic system. Most childhood cancers originate from the mesodermal germ layer, not the placenta. Most childhood cancers originate from the mesodermal germ layer, not the environment. Neural tubes are generally not associated with cancer. REF: p. 288

Which of the following disorders is manifested primarily in males? a. Cystic fibrosis b. Neurofibromatosis c. Muscular dystrophy d. Klinefelter syndrome

ANS: C Muscular dystrophy is manifested primarily in males. Cystic fibrosis is manifested in males and females. Neurofibromatosis is manifested in males and females. Klinefelter syndrome is manifested in males and females. REF: p. 52

A 35-year-old male is diagnosed with a hormone-secreting tumor of the adrenal medulla. He experiences elevated blood pressure, pupil dilation, "goose bumps," and increased anxiety. Which of the following hormones is the predominant one released by the tumor? a. Antidiuretic hormone b. Acetylcholine c. Norepinephrine d. Cortisol

ANS: C Norepinephrine regulates blood pressure and promotes arousal, increased vigilance, increased anxiety, and other protective emotional responses. Antidiuretic hormone regulates urine output. Acetylcholine will not result in an increase in blood pressure. Cortisol regulates glucocorticoids. REF: p. 209

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

ANS: C Normal human infants are immunologically immature when born, with deficiencies in antibody production, phagocytic activity, and complement activity, especially components of alternative pathways. Normal human infants are immunologically immature when born. They do not posses hypergammaglobulinemia. Possessing increased maternal IgG would not lead to recurring infections. The recurrent infections are due to decreased immunity, not maternal antibody breakdown. REF: p. 164

A couple brings their child to his primary care provider for a checkup. The child has Down syndrome, and the couple is concerned about other diseases that could afflict the child. The primary care provider explains that young children with Down syndrome are at higher risk for developing: a. Nephroblastoma b. Rhabdomyosarcoma c. Leukemia d. Retinoblastoma

ANS: C One of the more recognized syndromes is the association of trisomy 21, Down syndrome, and with an increased susceptibility to acute leukemia. One of the more recognized syndromes is the association of trisomy 21, Down syndrome, and with an increased susceptibility to acute leukemia, not nephroblastoma. One of the more recognized syndromes is the association of trisomy 21, Down syndrome, and with an increased susceptibility to acute leukemia, not rhabdomyosarcoma. One of the more recognized syndromes is the association of trisomy 21, Down syndrome, and with an increased susceptibility to acute leukemia, not retinoblastoma. REF: p. 290

When an aide asks the nurse what is a purpose of the inflammatory process, how should the nurse respond? a. To provide specific responses toward antigens b. To lyse cell membranes of microorganisms c. To prevent infection of the injured tissue d. To create immunity against subsequent tissue injury

ANS: C One purpose of the inflammatory process is to prevent infection and further damage by contaminating microorganisms. Specific response toward antigens is a part of the complement system that assists in the inflammatory response, but not its purpose. Lysis of cell membranes is part of the process of phagocytosis, which removes foreign material, but this is not the purpose of the inflammatory response. Immunity cannot be achieved against future tissue injury. REF: p. 121

Which of the following individuals would be at greatest risk for an opportunistic infection? a. 18-year-old with diabetes b. 70-year-old with congestive heart failure c. 24-year-old who is immunocompromised d. 30-year-old with pneumonia

ANS: C Opportunistic microorganisms can cause disease if the individual's defenses are compromised. An 18-year-old with diabetes would not be immunocompromised and would not be at risk. A 70-year-old with congestive heart failure would not be immunocompromised and would not be at risk. A 30-year-old with pneumonia would not be immunocompromised and would not be at risk. REF: p. 120

The role of physical activity in the prevention of colon cancer is identified by which of the following? a. It increases fluid loss leading to thirst and increased fluid intake, hydrating the colon. b. It increases blood supply thereby increasing oxygen to the colon. c. It increases gut motility thereby decreasing the time the bowel is exposed to mutagens. d. It increases the secretion of hydrochloric acid thereby killing mutants.

ANS: C Physical activity increases gut motility thereby decreasing exposure to mutagens. Physical activity increases fluid loss, but this does not prevent mutagens. Physical activity increases blood supply to the colon, but this does not prevent mutagens. Physical activity does not increase hydrochloric acid. REF: p. 278

A 12-year-old male is fighting with another child when he receives a puncture wound from a pencil. The school nurse cleans and bandages the wound. After about 1 week, the wound would be in which phase of healing? a. Debridement b. Primary intention c. Resolution d. Maturation

ANS: C Resolution occurs when repaired tissue is approaching close to normal. Debridement is the scraping away of dead tissue and is not a phase of wound healing. Primary intention is the stage of healing of wounds that are closely proximated. Maturation is the result of severe wounds which would begin several weeks after injury and may take 2 years. REF: p. 134

Which finding would support the diagnosis of respiratory acidosis? a. Vomiting b. Hyperventilation c. Pneumonia d. An increase in noncarbonic acids

ANS: C Respiratory acidosis occurs with hypoventilation, and pneumonia leads to hypoventilation. Vomiting leads to loss of acids and then to alkalosis. Hyperventilation leads to respiratory alkalosis, not acidosis. Metabolic acidosis is caused by an increase in noncarbonic acids. REF: p. 114

Of the following genetic lesions that cause cancer, which is the most common? a. Insertions b. Deletions c. Point mutations d. Amplification

ANS: C Several types of genetic events can activate oncogenes. The most common are small scale changes in DNA called point mutations. Several types of genetic events can activate oncogenes. The most common are small scale changes in DNA called point mutations, not insertions. Several types of genetic events can activate oncogenes. The most common are small scale changes in DNA called point mutations, not deletions. Several types of genetic events can activate oncogenes. The most common are small scale changes in DNA called point mutations, not amplification. REF: p. 229

Mutations that do not change the amino acid sequence and thus have no consequence are termed _____ mutations. a. Frameshift b. Spontaneous c. Silent d. Missense

ANS: C Silent mutations do not change the amino acid sequence and have no consequences. Frameshift mutation involves the insertion or deletion of one or more base pairs of the DNA molecule. They alter the amino acid sequence. Spontaneous mutations occur in the absence of exposure to a mutagen and produce changes in amino acid sequence. Missense mutations, a form of base pair substitution, alter amino acids, which produce a change (i.e., the "sense") in a single amino acid. REF: p. 37

A 50-year-old female experiences decreased blood pressure, decreased oxygen delivery, cardiovascular shock, and subsequent death. A complication of endotoxic shock is suspected. Which of the following is the most likely cause? a. Gram-positive bacteria b. Fungi c. Gram-negative bacteria d. Virus

ANS: C Symptoms of gram-negative septic shock are produced by endotoxins. Once in the blood, endotoxins cause the release of vasoactive peptides and cytokines that affect blood vessels, producing vasodilation, which reduces blood pressure, causes decreased oxygen delivery, and produces subsequent cardiovascular shock. Gram-positive bacteria typically do not produce endotoxins and thus do not manifest in shock. Fungi do not produce the endotoxic shock symptoms described. Viruses do not produce symptoms of shock. REF: p. 171

A 20-year-old pregnant female gives birth to a stillborn child. Autopsy reveals that the fetus has 92 chromosomes. What term may be on the autopsy report to describe this condition? a. Biploidy b. Triploidy c. Tetraploidy d. Aneuploidy

ANS: C Tetraploidy is a condition in which euploid cells have 92 chromosomes. Biploidy is a euploid cell with 2 times more chromosomes, or 46. Triploidy is a zygote that has three copies of each chromosome, rather than the usual two. Aneuploidy is when an aneuploid cell does not contain a multiple of 23 chromosomes. REF: p. 40

After a patient is exposed to a specific antigen, B cells will differentiate into: a. B cytotoxic cells b. Clonal equivalents c. Plasma cells d. Bursal cells

ANS: C The B cell differentiates into plasma cells. The B cell differentiates into plasma cells, not B cytotoxic cells. The B cell differentiates into plasma cells, not clonal equivalents. The B cell differentiates into plasma cells, not bursal cells. REF: p. 158

Which portion of the antibody is responsible for the biologic functions of antibodies? a. Heavy chain b. Variable region c. Fc portion d. Epitope

ANS: C The Fc portion is responsible for most of the functions of antibodies. The Fc portion is responsible for most of the functions of antibodies, not the heavy chain. The Fc portion is responsible for most of the functions of antibodies, not the variable region. The Fc portion is responsible for most of the functions of antibodies, not the epitope. REF: p. 149

A 5-year-old male is diagnosed with a bacterial infection. Cultures of the bacteria revealed lipopolysaccharides on the bacterial cell surface. Which of the complement pathways would be activated in this case? a. Classical pathway b. Lectin pathway c. Alternative pathway d. Kinin pathway

ANS: C The alternative pathway is activated by several substances found on the surface of infectious organisms, such as those containing lipopolysaccharides. The classical pathway is primarily activated by antibodies that are proteins of the acquired immune system. The lectin pathway is similar to the classic pathway but is independent of antibody. It is activated by several plasma proteins. The kinin pathway is involved in coagulation. REF: p. 124

An experiment is carried out to characterize newly discovered immunoglobulins. Specificity of the amino acids within the immunoglobulin could be determined by studying the: a. C region of the light chain b. C region of the H chain c. Complementary-determining region (CDR) d. Framework regions

ANS: C The amino acid differences are clustered into three areas in the variable region. These three areas are called CDRs. The amino acid differences are clustered into three areas in the variable region. These three areas are called CDRs, not the C region of the light chain. The amino acid differences are clustered into three areas in the variable region. These three areas are called CDRs, not the C region of the H chain. The amino acid differences are clustered into three areas in the variable region. These three areas are called CDRs, not the framework regions. REF: p. 149

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

ANS: C The cardiac cells are deprived of oxygen leading to ischemia, a reduction in blood supply to tissues. The cells are deprived of oxygen; they are not malnourished. Free radicals are electrically uncharged atoms or groups of atoms that have an unpaired electron. Chemical toxicity is not a factor in the chest pain; the pain is related to a lack of oxygen. REF: p. 65

Stress induces sympathetic stimulation of the adrenal medulla. This causes the secretion of catecholamines, which include: a. Epinephrine and aldosterone b. Norepinephrine and cortisol c. Epinephrine and norepinephrine d. Cortisol and aldosterone

ANS: C The catecholamines are epinephrine and norepinephrine. The catecholamines are epinephrine and norepinephrine, not aldosterone. The catecholamines are epinephrine and norepinephrine, not cortisol. The catecholamines are epinephrine and norepinephrine, not cortisol and aldosterone. REF: p. 209

An athlete runs a marathon, after which his muscles feel fatigued and unable to contract. The athlete asks the nurse why this happened. How should the nurse respond? A deficiency in ________ can cause impaired muscle contraction. a. GTP b. AMP c. ATP d. GMP

ANS: C The cell uses ATP for muscle contraction. when it is deficient, impaired muscle contraction results. GTP is involved in cell signaling, not muscle contraction. AMP is not involved in muscle contraction. GMP is not involved in muscle contraction. REF: p. 13

A nurse is teaching the staff about cholesterol. Which information should be taught? The cellular uptake of cholesterol depends on: a. Active-mediated transport b. The antiport system c. Receptor-mediated endocytosis d. Passive transport

ANS: C The cellular uptake of cholesterol depends on receptor-mediated endocytosis. The cellular uptake of cholesterol depends on receptor-mediated endocytosis; it is not dependent on active-mediated transport. The cellular uptake of cholesterol depends on receptor-mediated endocytosis; it is not a part of the antiport system. The cellular uptake of cholesterol depends on receptor-mediated endocytosis; it requires energy and is not passive in transport. REF: p. 20

The base components of DNA are: a. A, G, C, and U b. P, G, C, and T c. A, G, C, and T d. X, XX, XY, and YY

ANS: C The four base components of DNA are cytosine, thymine, adenine, and guanine and are commonly represented by their first letters: A, C, T, and G. The four base components of DNA are cytosine, thymine, adenine, and guanine and are commonly represented by their first letters: A, C, T, and G. U is not included. The four base components of DNA are cytosine, thymine, adenine, and guanine and are commonly represented by their first letters: A, C, T, and G. P is not included. X, XX, XY and YY are components of human chromosomes. REF: p. 35

A patient who has diarrhea receives a hypertonic saline solution intravenously to replace the sodium and chloride lost in the stool. What effect will this fluid replacement have on cells? a. Cells will become hydrated. b. Cells will swell or burst. c. Cells will shrink. d. Cells will divide.

ANS: C The hypertonic saline will cause fluid to leave the intracellular space and enter the vascular space, causing cells to shrink. Intravenous hypertonic solutions lead to cell dehydration. Intravenous hypertonic solutions cause fluid to leave cells; thus, they would shrink, not swell. Intravenous hypertonic solutions do not affect cellular division. REF: p. 17

Which of the following is responsible for initiating clonal selection? a. T cells b. B cells c. Antigens d. Lymphocytes

ANS: C The lymphocytes remain dormant until an antigen initiates clonal selection. T cells are part of the immune response, but do not initiate clonal selection. B cells are antibodies. Lymphocytes are released into the circulation as immature cells that react with antigens. REF: p. 14

The nurse is teaching staff about the most common cause of Down syndrome. What is the nurse describing? a. Paternal nondisjunction b. Maternal translocations c. Maternal nondisjunction d. Paternal translocations

ANS: C The most common cause of Down syndrome is maternal nondisjunction. Down syndrome is not related to paternal nondisjunction. Down syndrome is related to the maternal side, but not due to translocation. Down syndrome is not related to paternal abnormalities. REF: p. 42

Which statement indicates the patient has a correct understanding of metastasis? The most common route of metastasis is through the blood vessels and: a. Lung tissue b. Body cavities c. Lymphatics d. Connective tissues

ANS: C The most common route of metastasis is through the lymphatics. The most common route of metastasis is through the lymphatics, not lung tissue. The most common route of metastasis is through the lymphatics, not the body cavity. The most common route of metastasis if through the lymphatics, not connective tissues. REF: p. 242

Confirmation of somatic death is based on: a. Presence of algor mortis b. Presence of livor mortis c. Complete cessation of respiration and circulation d. Change in skin color to pale yellow

ANS: C The most notable manifestations are complete cessation of respiration and circulation. Algor mortis is postmortem reduction of body temperature and is not confirmation of somatic death. Rigor mortis is muscles stiffening and is not confirmation of somatic death. Change in skin color to pale yellow does occur, but complete cessation of respiration and circulation confirms somatic death. REF: p. 94

When a patient presents at the emergency department for an allergic reaction, the nurse recognizes the most severe consequence of a type I hypersensitivity reaction is: a. Urticaria b. Hives c. Anaphylaxis d. Antibody-dependent cell-mediated cytotoxicity (ADCC)

ANS: C The most rapid and severe immediate hypersensitivity type I reaction is anaphylaxis. Urticaria, or hives, is a dermal (skin) manifestation of allergic reactions. Hives and urticaria are similar responses. ADCC is a mechanism that involves natural killer (NK) cells. Antibodies on the target cell are recognized by Fc receptors on the NK cells, which release toxic substances that destroy the target cell. REF: p. 190

A newborn male is diagnosed with albinism based on skin, eye, and hair appearance. Which finding will support this diagnosis? a. Increased melanin b. Increased hemoproteins c. Inability to convert tyrosine to DOPA (3,4 dihydroxyphenylalanine) d. Inability to convert bile to bilirubin

ANS: C The person with albinism is unable to convert tyrosine to DOPA, an intermediate in melanin biosynthesis. An increase in melanin would cause skin to be darker. Hemoprotein accumulations in cells are caused by excessive storage of iron, which is transferred to the cells from the bloodstream. An inability to convert bile to bilirubin would not lead to albinism. REF: p. 83

A 45-year-old female was recently diagnosed with cervical cancer. She reports a sexual history that includes 43 partners. Which of the following is the most likely cause of her cancer? a. Herpes virus b. Rubella virus c. Human papillomavirus (HPV) d. Hepatitis B virus

ANS: C The presence of HPV is a factor in cervical cancer. The presence of HPV is a factor in cervical cancer, not herpes. The presence of HPV is a factor in cervical cancer, not rubella. The presence of HPV is a factor in cervical cancer, not hepatitis B. REF: p. 241

A eukaryotic cell is undergoing DNA replication. In which region of the cell would most of the genetic information be contained? a. Mitochondria b. Ribosome c. Nucleolus d. Nucleus

ANS: C The region of the cell that contains genetic material, including a large amount of ribonucleic acid, most of the DNA, and DNA-binding proteins, is the nucleolus. The mitochondria is the site of cellular respiration. The ribosomes are involved in manufacturing of proteins within the cell. The nucleus contains the nucleolus, and it is the nucleolus that contains genetic material. REF: p. 5

A patient presents with poison ivy on the extremities, face, and buttocks. This condition is an example of: a. Anaphylaxis b. Serum sickness c. Delayed hypersensitivity d. Viral disease

ANS: C The response to poison ivy is a delayed hypersensitivity because it takes up 72 hours to develop. Anaphylaxis is immediate. Serum sickness-type reactions are caused by the formation of immune complexes in the blood and their subsequent generalized deposition in target tissues. Poison ivy is not a viral disease. REF: p. 190

Why is potassium able to diffuse easily in and out of cells? a. Because potassium has a greater concentration in the intracellular fluid (ICF) b. Because sodium has a greater concentration in the extracellular fluid (ECF) c. Because the resting plasma membrane is more permeable to potassium d. Because there is an excess of anions inside the cell

ANS: C The resting membrane is more permeable to potassium because potassium is more easily transported inward. Potassium is greater in concentration in the ICF, but this is not why it is transported more easily. Sodium does have a greater concentration, but this is not why potassium moves easily when the membrane potential is at rest. It is cations, not anions, that are involved in membrane potential activity. REF: p. 18

A nurse recalls regulation of acid-base balance through removal or retention of volatile acids is accomplished by the: a. Buffer systems b. Kidneys c. Lungs d. Liver

ANS: C The volatile acid is carbonic acid (H2CO3), which readily dissociates into carbon dioxide (CO2) and water (H2O). The CO2 is then eliminated by the lungs. Buffer systems are throughout the body and operate in the extracellular and intracellular systems. The kidneys release hydrogen ions, not volatile acids. The liver does not regulate acid-base balance. REF: p. 111

A primary care provider is attempting to diagnose cancer and is looking for a tumor marker. Which of the following could be a possible marker? a. Red blood cells b. Apoptotic cells c. Enzymes d. Neurotransmitters

ANS: C Tumor markers include hormones, enzymes, genes, antigens, and antibodies. Tumor markers include hormones, enzymes, genes, antigens, and antibodies, but not red blood cells. Tumor markers include hormones, enzymes, genes, antigens, and antibodies, but not apoptotic cells. Tumor markers include hormones, enzymes, genes, antigens, and antibodies, but not neurotransmitters. REF: p. 225

A 65-year-old female is diagnosed with metastatic breast cancer. She has developed muscle wasting. Which of the following substances would be produced in large quantities to eliminate the tumor cells and cause muscle wasting? a. Interleukin-6 b. Eosinophils c. Tumor necrosis factor d. Platelets

ANS: C Tumor necrosis factor causes muscle wasting. Interleukin-6 stimulates growth and differentiation of blood cells. Eosinophils are stimulated for parasites. Platelets stimulate clotting. REF: p. 127

What is the diagnosis of a 13-year-old female who has a karyotype that reveals an absent homologous X chromosome with only a single X chromosome present? Her features include a short stature, widely spaced nipples, reduced carrying angle at the elbow, and sparse body hair. a. Down syndrome b. Cri du chat syndrome c. Turner syndrome d. Klinefelter syndrome

ANS: C Turner syndrome is characterized by short stature, female genitalia, webbed neck, shieldlike chest with underdeveloped breasts and widely spaced nipples, and imperfectly developed ovaries. Down syndrome is characterized by distinctive characteristics: low nasal bridge, epicanthal folds, protruding tongue, and low-set ears. Cri du chat syndrome is characterized by low birth weight, severe mental retardation, microcephaly (smaller than normal head size), and heart defects. Klinefelter syndrome is characterized by small testes, some development of the breasts, sparse body hair, and long limbs. REF: p. 43

Which information indicates a good understanding of bacterial vaccines? Most bacterial vaccines contain: a. Active bacteria b. Synthetic bacteria c. Dead bacteria d. Bacterial toxins

ANS: C Vaccines are biological preparations of weakened or dead pathogens that when administered stimulate production of antibodies or cellular immunity against the pathogen without causing disease. Vaccines are biological preparations of weakened or dead pathogens, not active bacteria. Vaccines are biological preparations of weakened or dead pathogens, not synthetic bacteria. D Vaccines are biological preparations of weakened or dead pathogens, not bacterial toxins. REF: p. 178

When the immunologist says that pathogens possess virulence, what does virulence mean? a. Spreads from one individual to others and causes disease b. Induces an immune response c. Causes disease d. Damages tissue

ANS: C Virulence is the capacity of a pathogen to cause severe disease—for example, measles virus is of low virulence; rabies virus is highly virulent. Communication is the ability to spread from one individual to others and cause disease. Immunogenicity is the ability of pathogens to induce an immune response. Damaging tissues is the pathogen's mechanism of action. REF: p. 167

After studying about viruses, which information indicates the student has a good understanding of viruses? Viruses: a. Contain no DNA or RNA b. Are capable of independent reproduction c. Replicate their genetic material inside host cells d. Are easily killed by antimicrobials

ANS: C Virus replication depends totally on their ability to infect a permissive host cell, a cell that cannot resist viral invasion and replication. Viruses contain both DNA and RNA. Viruses are incapable of independent reproduction. Viruses cannot be killed by antimicrobials. REF: p. 171

Which patient is most prone to metabolic alkalosis? A patient with: a. Retention of metabolic acids b. Hypoaldosteronism c. Excessive loss of chloride (Cl) d. Hyperventilation

ANS: C When acid loss is caused by vomiting, renal compensation is not very effective because loss of Cl stimulates renal retention of bicarbonate, leading to alkalosis. Retention of metabolic acids would lead to acidosis, not alkalosis. Hypoaldosteronism leads to hyponatremia and does not cause alkalosis. Hyperventilation leads to respiratory alkalosis, not metabolic alkalosis. REF: p. 113

A runner has depleted all the oxygen available for muscle energy. Which of the following will facilitate his continued muscle performance? a. Electron-transport chain b. Aerobic glycolysis c. Anaerobic glycolysis d. Oxidative phosphorylation

ANS: C When no oxygen is available, anaerobic glycolysis occurs. The electron-transport chain is part of the citric acid cycle. Aerobic glycolysis involves the presence of oxygen. Oxidative phosphorylation is the mechanism by which the energy produced from carbohydrates, fats, and proteins is transferred to ATP. It is not part of muscle performance. REF: p. 14

A 55-year-old male has swelling of the feet. Which of the following aided in development of swelling? a. Increased ATP b. Chloride movement out of the cell c. Na+ movement into the cell d. Decreased oncotic pressure

ANS: C When sodium and water enter the cell freely, cellular swelling, as well as early dilation of the endoplasmic reticulum, results. Decreased ATP would lead to swelling, not increased ATP. Chloride movement out of the cell would affect muscle contraction and does not lead to swelling. Increased oncotic pressure would not affect swelling. REF: p. 75

A 50-year-old male intravenous drug user is diagnosed with hepatitis C. Examination of the liver reveals cell death secondary to: a. Fat necrosis b. Physiologic apoptosis c. Pathologic apoptosis d. Pyknosis

ANS: C With hepatitis C, the liver will demonstrate apoptosis that is pathologic. Fat necrosis occurs with enzymatic action due to lipases. Apoptosis is not a normal physiological process. Pyknosis occurs when the nucleus shrinks and becomes a small, dense mass of genetic material. REF: p. 88

A 5-year-old male presents to the ER with delirium and sunken eyes. After diagnosing him with severe dehydration, the primary care provider orders fluid replacement. The nurse administers a hypertonic intravenous solution. Which of the following would be expected? a. Symptoms subside quickly b. Increased ICF volume c. Decreased ECF volume d. Intracellular dehydration

ANS: D A hypertonic solution would cause fluid to move into the extracellular space, leading to intracellular dehydration. With this solution, his symptoms will not subside quickly because his cells will lose fluid. His intracellular volume will decrease, not increase. His extracellular volume will increase, not decrease. REF: p. 106

A 50-year-old male was recently diagnosed with Huntington disease. Transmission of this disease is associated with: a. Penetrance b. Recurrence risk c. Expressivity d. Delayed age of onset

ANS: D A key feature of Huntington disease is its delayed age of onset such that symptoms are not seen until 40 years of age or later. The penetrance of a trait is the percentage of individuals with a specific genotype who also exhibit the expected phenotype. Recurrence risk is the percentage of family members that will inherit the disease. Expressivity is the extent of variation in phenotype associated with a particular genotype. REF: p. 48

A 12-year-old male is diagnosed with Klinefelter syndrome. His karyotype would reveal which of the following? a. XY b. XX c. XYY d. XXY

ANS: D A person with Klinefelter syndrome has an XXY karyotype. An XY is a normal male. An XX is a normal female. An XYY is an aneuploid karyotype. REF: p. 51

A 15-year-old male suffers from severe hemorrhage following a motor vehicle accident. He is given a blood transfusion, but shortly afterward the red blood cells are destroyed by agglutination and lysis. Which of the following blood type-transfusion type matches would cause this? a. A-A b. B-O c. AB-O d. A-AB

ANS: D A person with type A blood also has circulating antibodies to the B carbohydrate antigen. If this person receives blood from a type AB or B individual, a severe transfusion reaction occurs, and the transfused erythrocytes are destroyed by agglutination or complement-mediated lysis. Type A can receive type A blood. Type B can receive type O. Type AB can accept type O. REF: p. 198

The nurse would correctly respond that the etiology of a congenital immune deficiency is due to a(n): a. Negative response to an immunization b. Adverse response to a medication c. Renal failure d. Genetic defect

ANS: D A primary (congenital) immune deficiency is caused by a genetic defect. A primary (congenital) immune deficiency is caused by a genetic defect, not a response to an immunization; if such could occur, the etiology would be secondary. A primary (congenital) immune deficiency is caused by a genetic defect, not an adverse response to a medication; if such could occur, the etiology would be secondary. A primary (congenital) immune deficiency is caused by a genetic defect, not renal failure; if such could occur, the etiology would be secondary. REF: p. 178

A nurse is teaching a patient with diabetes how glucose is transported from the blood to the cell. What type of transport system should the nurse discuss with the patient? a. Active-mediated transport (active transport) b. Active diffusion c. Passive osmosis d. Passive-mediated transport (facilitated diffusion)

ANS: D A well-known passive-mediated transport system is that for glucose in erythrocytes (red blood cells). The transport of glucose does not require energy, so active-mediated transport is not correct. The transport of glucose does not require energy, so active diffusion is not correct. Osmosis involves the movement of water. REF: p. 17

A nurse recalls bacteria become resistant to antimicrobials by: a. Proliferation b. Attenuation c. Specialization d. Mutation

ANS: D Antibiotic resistance is usually a result of genetic mutations that can be transmitted directly to neighboring microorganisms by plasmid exchange. Antibiotic resistance is a result of mutations, not proliferation, which is increased growth. Antibiotic resistance is a result of genetic mutations, not attenuation. Antibiotic resistance is a result of genetic mutations, not specialization. REF: p. 176

A normal male and a female carrier for red-green color blindness mate. Given that red-green color blindness is an X-linked recessive trait, what is the likelihood of their children being affected? a. 25% b. 50% c. Females most affected; no males affected d. Males most affected; no females affected

ANS: D Because a single copy of an X-linked recessive gene will cause disease in a male, whereas two copies are required for disease expression in females, more males are affected by X-linked recessive diseases than are females. Males are more often affected at a greater than 25% rate. Males are more often affected at a greater than 50% rate. Males are most often affected. REF: p. 27

A 24-year-old female presents with excessive menstrual bleeding. The physician identified endometrial changes that are due to hormonal imbalances. These cellular changes would be referred to as: a. Dysplasia b. Pathologic dysplasia c. Hyperplasia d. Pathologic hyperplasia

ANS: D Because the changes are due to an imbalance, they would be considered pathologic hyperplasia. The endometrial changes were not abnormal in size and shape; thus, it is not dysplasia. The description of alteration in hormone levels is pathologic. Hyperplasia is not as accurate as pathologic because there is an imbalance of hormone levels. REF: p. 63

A 35-year-old male is diagnosed with lobar pneumonia (lung infection). Which of the following exudates would be present in highest concentration at the site of this advanced inflammatory response? a. Serous b. Purulent c. Hemorrhagic d. Fibrinous

ANS: D Fibrinous exudates occur in the lungs of individuals with pneumonia. Serous fluid is watery fluid, as in a blister. Purulent is characterized by an abscess, such as pus. Hemorrhagic occurs when the exudates are filled with erythrocytes. REF: p. 132

When planning care for a dehydrated patient, the nurse remembers the principle of water balance is closely related to _____ balance. a. Potassium b. Chloride c. Bicarbonate d. Sodium

ANS: D Because water follows the osmotic gradients established by changes in salt concentration, water balance is tied to sodium balance. Because water follows the osmotic gradients established by changes in salt concentration, water balance is tied to sodium balance, not potassium. Because water follows the osmotic gradients established by changes in salt concentration, water balance is tied to sodium balance, not chloride. Because water follows the osmotic gradients established by changes in salt concentration, water balance is tied to sodium balance, not bicarbonate. REF: p. 103

A nurse is reviewing lab reports. The nurse recalls blood plasma is located in which of the following fluid compartments? a. Intracellular fluid (ICF) b. Extracellular fluid (ECF) c. Interstitial fluid d. Intravascular fluid

ANS: D Blood plasma is the intravascular fluid. ICF is fluid in the cells. ECF is all the fluid outside the cells. Interstitial fluid is fluid between the cells and outside the blood vessels. REF: p. 100

Which information should the nurse include when teaching about angiogenic factors? In cancer, angiogenic factors stimulate: a. Release of growth factors b. Tumor regression c. Apoptosis d. New blood vessel growth

ANS: D Cancers can secrete multiple factors that stimulate new blood vessel growth, which is called angiogenesis. Cancers can secrete multiple factors that stimulate new blood vessel growth called angiogenesis, not release of growth factors. Cancers can secrete multiple factors that stimulate new blood vessel growth called angiogenesis, not tumor regression. Apoptosis is cell death. REF: p. 235

Which statement indicates the patient has a good understanding of cancer risk factors? The most important environmental risk factor for cancer is exposure to: a. Ultraviolet (UV) radiation b. Radon c. Estrogen d. Cigarette smoke

ANS: D Cigarette smoking is carcinogenic and remains the most important cause of cancer. UV radiation is an important risk factor, but cigarette smoking remains the most important cause of cancer. Radon plays a role as a risk factor for cancer, but cigarette smoking remains the most important cause of cancer. Estrogen plays a role in the risk factors of cancer, but cigarette smoking remains the most important cause of cancer. REF: p. 261

After teaching about coping, which information indicates a correct understanding? Coping is best defined as the process of: a. Adjusting to disease b. Preventing psychological distress c. Mediating anger d. Managing stressful challenges

ANS: D Coping is the process of managing stressful challenges that tax the individual's resources. Coping is the process of managing stressful challenges that tax the individual's resources; it is not adjusting to disease. Coping is the process of managing stressful challenges that tax the individual's resources; it is not preventing psychological distress. Coping is the process of managing stressful challenges that tax the individual's resources; it is not mediating anger. REF: p. 217

When a patient asks what causes cystic fibrosis, how should the nurse respond? Cystic fibrosis is caused by an _____ gene. a. X-linked dominant b. X-linked recessive c. Autosomal dominant d. Autosomal recessive

ANS: D Cystic fibrosis is an autosomal recessive disorder. Cystic fibrosis is not X linked, but autosomal. Cystic fibrosis is not X linked, but recessive. Cystic fibrosis is not dominant. REF: p. 50

When discussing DNA replication, which enzyme is most important? a. RNA polymerase b. Transfer RNA c. Messenger RNA d. DNA polymerase

ANS: D DNA polymerase is the primary enzyme involved in replication. It adds bases to the new DNA strand and performs "proofreading" functions. It is DNA polymerase, not RNA polymerase, that is most important for DNA replication. It is DNA polymerase, not transfer RNA, that is most important for DNA replication. It is DNA polymerase, not messenger RNA, that is most important for DNA replication. REF: p. 36

When an oncologist is discussing the degree to which an organism's development is contingent on its environment, which of the following is the oncologist explaining? a. Transgenerational inheritance b. Epigenetics c. Histone modification d. Developmental plasticity

ANS: D Developmental plasticity is the degree to which an organism's development is contingent on its environment. Transgenerational inheritance is the heritable transmission to future generations of environmentally caused phenotypes. Epigenetics is the role of genes in development and disease. Histone modifications are changes in genetic acetylation. REF: p. 260

A 25-year-old female reports having unprotected sexual intercourse with several men. Blood tests reveal that she is positive for human papillomavirus. What else should the nurse assess for? a. Vaginal discharge b. Liver failure c. Breast cancer d. Warts

ANS: D Direct contact with papillomavirus can lead to warts. Direct contact with papillomavirus can lead to warts, not vaginal discharge. Direct contact with papillomavirus can lead to warts, not liver failure. Direct contact with papillomavirus can lead to warts, not breast cancer. REF: p. 172

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

ANS: D Diseases caused by fungi are called mycoses. Mycoses can be opportunistic. Diseases caused by fungi are called mycoses. Mycoses can be opportunistic and are not treatable with penicillin. Diseases caused by fungi are called mycoses. Mycoses can be opportunistic and are common. Diseases caused by fungi are called mycoses. Mycoses can be opportunistic and occur with other infections. REF: p. 174

A patient, age 9, is admitted to a pediatric unit with Duchenne muscular dystrophy. When planning care the nurse recalls the patient inherited this condition through a _____ trait. a. Sex-linked dominant b. Sex-influenced c. Sex-limited d. Sex-linked recessive

ANS: D Duchenne muscular dystrophy is a relatively common X-linked recessive disorder. Duchenne is a recessive trait, not dominant. Duchenne is a sex-linked, not sex-influenced, trait. Duchenne is a sex-linked, not sex-limited, trait. REF: p. 52

A nurse is teaching a patient about fluid and electrolytes. Which of the following indicates the teaching was successful regarding electrolytes? Electrolytes are: a. Small lipid-soluble molecules b. Large protein molecules c. Micronutrients used to produce ATP d. Electrically charged molecules

ANS: D Electrolytes are electrically charged molecules. Electrolytes are not lipid soluble. Electrolytes are not made up of protein. Electrolytes do not have a role in the production of ATP. REF: p. 15

A 50-year-old female became infected with Clostridium bacteria and died a week later. Examination of her red blood cells revealed lysis of membranes. Which of the following was the most likely cause of her death? a. Fat necrosis b. Wet gangrene c. Gangrenous necrosis d. Gas gangrene

ANS: D Gas gangrene is a special type of gangrene caused by infection of injured tissue by one of many species of Clostridium. Fat necrosis is cellular dissolution caused by powerful enzymes, called lipases, that occur in the breast, pancreas, and other abdominal structures. It is not due to infection. Wet gangrene develops when neutrophils invade the site, causing liquefactive necrosis. It is not due to infection. Gangrenous necrosis is due to death of tissue and results from severe hypoxic injury, not infection. REF: p. 88

A patient has chicken pox. How does the varicella replicate? a. With the host cell DNA b. Using host cell DNA polymerase c. Using reverse transcriptase d. In the cytoplasm

ANS: D Generally, all RNA viruses replicate their genetic material in the cytoplasm of the infected cell. Generally, all RNA viruses replicate their genetic material in the cytoplasm of the infected cell, not the host cell DNA. Generally, all RNA viruses replicate their genetic material in the cytoplasm of the infected cell, not the polymerase. Generally, all RNA viruses replicate their genetic material in the cytoplasm of the infected cell, not using reverse transcriptase. REF: p. 171

A 23-year-old male develops a black eye following a fight. When the aide asks the nurse why this occurred, the nurse's best response is that the bruising is due to an accumulation of: a. Transferrin b. Bilirubin c. Albumin d. Hemosiderin

ANS: D Hemosiderin is responsible for the color changes in a black eye. Transferrin is a transport protein responsible for iron transport. Bilirubin is the normal, yellow-to-green pigment of bile derived from the porphyrin structure of hemoglobin. Albumin is the protein in the serum, responsible for cellular integrity. REF: p. 83

Which of the following patients is most prone to hypochloremia? A patient with: a. Hypernatremia b. Hypokalemia c. Hypercalcemia d. Increased bicarbonate intake

ANS: D Hypochloremia is the result of elevated bicarbonate concentration, as occurs in metabolic alkalosis. Hypochloremia is the result of hyponatremia, not hypernatremia. Hypochloremia is the result of hyponatremia, not hypokalemia. Hypochloremia is the result of hyponatremia, not hypercalcemia. REF: p. 106

A 54-year-old male intravenous (IV) drug user is diagnosed with chronic hepatitis C. Testing revealed that he is a candidate for treatment. Which of the following could be used to treat his condition? a. Interleukin-1 b. Interleukin-6 c. Interleukin-10 d. INFs

ANS: D INFs are members of a family of cytokines that protect against viral infections. Interleukin-1 is responsible for fever production. Interleukin-6 stimulates growth and differentiation of blood cells. Interleukin-10 helps decrease the immune response. REF: p. 127

A biologist is explaining how RNA directs the synthesis of protein. Which process is the biologist describing? a. Termination b. Transcription c. Translocation d. Translation

ANS: D In translation, RNA directs the synthesis of a polypeptide, interacting with transfer RNA (tRNA), a cloverleaf-shaped strand of about 80 nucleotides. At a termination signal, translation and polypeptide formation cease. This does not involve synthesis of protein. Transcription is the process by which DNA specifies a sequence of messenger RNA (mRNA). Translocation is the interchange of genetic material between nonhomologous chromosomes. REF: p. 39

An experiment was designed to test the effects of the Starling forces on fluid movement. Which of the following alterations would result in fluid moving into the interstitial space? a. Increased capillary oncotic pressure b. Increased interstitial hydrostatic pressure c. Decreased capillary hydrostatic pressure d. Increased interstitial oncotic pressure

ANS: D Increased interstitial oncotic pressure would attract water from the capillary into the interstitial space. Increased capillary oncotic pressure would attract water from the interstitial space back into the capillary. Increased interstitial hydrostatic pressure would attract movement of water from the interstitial spaces into the capillary. Decreased capillary hydrostatic pressure would move water into the capillaries. REF: p. 101

A child fell off the swing and scraped the right knee. The injured area becomes painful. What else will the nurse observe upon assessment? a. Vasoconstriction at injured site b. Decreased RBC concentration at injured site c. Pale skin at injured site d. Edema at injured site

ANS: D Increased vascular permeability and leakage of fluid out of the vessel cause edema at the site of injury. Vasodilation occurs, not vasoconstriction. Increased RBCs come to the site, not fewer. Redness occurs, not paleness, during inflammation. REF: p. 121

A common pathway of irreversible cell injury involves increased intracellular: a. Sodium b. Potassium c. Magnesium d. Calcium

ANS: D Irreversible cellular injury is due to increased intracellular calcium and loss of calcium steady state. It is calcium, not sodium, that is involved in cellular injury. It is calcium, not potassium, that is involved in cellular injury. It is calcium, not magnesium, that is involved in cellular injury. REF: p. 71

Which factor will help the nurse differentiate leukotrienes from histamine? a. Site of production b. Vascular effect c. Chemotactic ability d. Time of release

ANS: D Leukotrienes are released slower and longer than histamine. Leukotrienes and histamine are produced from mast cells. Leukotrienes and histamine have similar vascular effects. Leukotrienes and histamine have similar chemotactic ability. REF: p. 129

Which of the following can bind to plasma membrane receptors? a. Oxygen b. Ribosomes c. Amphipathic lipids d. Ligands

ANS: D Ligands are specific molecules that can bind with receptors on the cell membrane. Oxygen moves by diffusion; it does not bind to receptors. Ribosomes make proteins and are not involved in binding. Amphipathic lipids are a portion of the cell membrane. REF: p. 11

The macrophage secretion that stimulates procollagen synthesis and secretion is: a. Angiogenesis factor b. Matrix metalloproteinase c. Vascular endothelial growth factor d. Transforming growth factor-beta

ANS: D Macrophages secrete transforming growth factor-beta to stimulate fibroblasts to secrete the collagen precursor procollagen. Angiogenesis factor supports the growth of new vessels. Matrix metalloproteinase remodels proteins at the site of injury. Vascular endothelial growth factors are also involved in vessel growth. REF: p. 135

Which phase of catabolism produces the most ATP? a. Digestion b. Glycolysis c. Oxidation d. Citric acid cycle

ANS: D Most of the ATP is generated during the citric acid cycle. Larger molecules are broken down into smaller units during digestion; no ATP is produced during this cycle. During glycolysis, two molecules of ATP are produced from each glucose molecule, but the most ATP is produced during the citric acid cycle. Oxidation is part of the glycolysis process and ATP is produced, but more ATP is produced during the citric acid cycle. REF: p. 13

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

ANS: D Necrosis is the sum of cellular changes after local cell death. Cellular adaptation is a reversible, structural, or functional response to both normal or physiologic conditions and adverse or pathologic conditions. Calcification is an accumulation of calcium salts. Apoptosis is an active process of cellular self-destruction. REF: p. 67

The microorganisms that make up the normal human flora are important for: a. Regulating inflammation b. Secreting bacteriostatic substances c. Activating white blood cells d. Preventing the colonization and multiplication of pathogens

ANS: D Normal flora are provided with nutrients from ingested food, and in exchange they produce enzymes that produce antibacterial factors that prevent colonization by pathogenic microorganisms. Normal flora prevent colonization of pathogens; they do not regulate inflammation. Normal flora prevent colonization of pathogens; they do not secrete bacteriostatic substances. Normal flora prevent colonization of pathogens; they do not activate white blood cells. REF: p. 166

What is the chance that two siblings share both HLA haplotypes, making them a good match for an organ transplant from one to the other? a. 100% b. 75% c. 50% d. 25%

ANS: D Odds dictate that children will share one haplotype with half their siblings and either no haplotypes or both haplotypes with a quarter of their siblings. Thus, the chance of finding a match among siblings is much higher (25%) than the general population. 100% is too high; the chance is 25%. 75% is too high; the chance is 25%. 50% is too high; the chance is 25%. REF: p. 199

A nurse is preparing to teach on the subject of opsonins. Which information should the nurse include? Opsonins are molecules that: a. Are composed of fatty acids b. Regulate inflammation c. Degranulate mast cells d. Enhance phagocytosis

ANS: D Opsonins coat the surface of bacteria and increase their susceptibility to being phagocytized. Opsonins are not composed of fatty acids; they are antibodies. Opsonins coat the surface of bacteria and increase their susceptibility to being phagocytized. They do not regulate inflammation; mast cells do. Opsonins coat the surface of bacteria and increase their susceptibility to being phagocytized; they do not react with mast cells. REF: p. 122

A 40-year-old female is diagnosed with SLE. Which of the following findings would be considered a symptom of this disease? a. Gastrointestinal ulcers b. Decreased glomerular filtration rate c. Rash on trunk and extremities d. Photosensitivity

ANS: D Photosensitivity is one of the 11 common clinical findings in SLE. Gastrointestinal ulcers are not a finding in SLE. Proteinuria is a symptom of SLE. A rash on the face is a symptom, but not a rash on the body. REF: p. 198

A nurse recalls physical activity was shown to reduce the risk of which of the following types of cancer? a. Prostate b. Lung c. Bone d. Colon

ANS: D Physical activity reduces the risk for breast and colon cancers. Physical activity reduces the risk for breast and colon cancers, but not prostate. Physical activity reduces the risk for breast and colon cancers, but not lung. Physical activity reduces the risk for breast and colon cancers, but not bone. REF: p. 278

A 42-year-old female presents to her primary care provider reporting muscle weakness and cardiac abnormalities. Laboratory tests indicate that she is hypokalemic. Which of the following could be the cause of her condition? a. Respiratory acidosis b. Constipation c. Hypoglycemia d. Primary hyperaldosteronism

ANS: D Primary hyperaldosteronism, with excessive secretion of aldosterone from an adrenal adenoma (tumor) also causes potassium wasting. Acidosis is related to hyperkalemia, not hypokalemia. Constipation can occur with hypokalemia but does not cause it. Hypoglycemia is not related to muscle weakness. REF: p. 108

Which patient should the nurse assess for both hyperkalemia and metabolic acidosis? A patient diagnosed with: a. Diabetes insipidus b. Pulmonary disorders c. Cushing syndrome d. Renal failure

ANS: D Renal failure is associated with hyperkalemia and metabolic acidosis. Diabetes insipidus results in hypernatremia. Pulmonary disorders are a cause of respiratory acidosis or alkalosis but do not affect hyperkalemia. Cushing syndrome results in hypernatremia. REF: p. 113

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

ANS: D Rigor mortis occurs within 6 hours after death and is evidence by muscle stiffening. Livor mortis is a purple discoloration. Gangrene refers to death of tissue and results from severe hypoxic injury and does not lead to stiffening. Algor mortis is postmortem reduction of body temperature. REF: p. 95

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

ANS: D Secondary contact activates a type IV cell-mediated reaction that causes dermatitis. The father's response is a secondary, cell mediated, not a primary type IgE mediated. The father's response is secondary, not tissue specific. The father's response is a type IV, not an immune complex response. REF: p. 189

A 15-year-old female presents to the ER following a physical assault. She has internal damage to the neck with deep bruising. X-ray reveals fractures of the hyoid bone and tracheal and cricoid cartilage. Which of the following most likely caused her injuries? a. Chemical asphyxiation b. Choking asphyxiation c. Ligature strangulation d. Manual strangulation

ANS: D Squeezing of the neck as with strangulation would fraction the hyoid bone. Chemical asphyxiation would lead to breathing problems but would not result in fracture. Choking asphyxiation would lead to swelling of tissues but would not result in fracture. In ligature strangulation, the mark on the neck is horizontal without the inverted V pattern seen in hangings. It would not lead to fracture. REF: p. 75

A 30-year-old male is having difficulty breathing and has been spitting blood. He reports that he began experiencing this reaction after cleaning his pigeons' cages. Testing reveals he is suffering from allergic alveolitis. Which of the following is he experiencing? a. Serum sickness b. Raynaud phenomenon c. Antibody-dependent cytotoxicity d. Arthus reaction

ANS: D The Arthus reaction is a model of localized or cutaneous reactions. Serum sickness-type reactions are caused by the formation of immune complexes in the blood and their subsequent generalized deposition in target tissues. Typically affected tissues are the blood vessels, joints, and kidneys. Raynaud phenomenon is a condition caused by the temperature-dependent deposition of immune complexes in the capillary beds of the peripheral circulation. Antibody-dependent cytotoxicity is a type II form. REF: p. 193

A nurse is instructing the staff about cellular functions. Which cellular function is the nurse describing when an isolated cell absorbs oxygen and uses it to transform nutrients to energy? a. Metabolic absorption b. Communication c. Secretion d. Respiration

ANS: D The ability of the cell to absorb oxygen refers to the cell's function of respiration. The ability of the cell to function within a society of cells refers to its function of communication. The ability of the cell to take in nutrients refers to the cell's function of metabolic absorption. The ability of the cell to synthesize new substances and secrete these elsewhere refers to the cell's function of secretion. REF: p. 3

A 20-year-old female is applying for nursing school and is required to be tested for immunity against several illnesses. Testing that looks at which of the following would be the best to determine immunity? a. Culture and sensitivity b. Agglutination c. Precipitation d. Titer

ANS: D The amount of antibody in a serum sample is referred to as the titer; a higher titer indicates more antibodies. Culture and sensitivity determine the type of organism that causes an infection, and sensitivity identifies the antibody it is sensitive to. The amount of antibody in a serum sample is referred to as the titer, not agglutination. The amount of antibody in a serum sample is referred to as the titer, not precipitation. REF: p. 155

A 6-month-old infant is brought to the pediatrician for recurrent colds. The child is fed formula, and the other family members have not been ill. The primary care provider tells the mother that the child's immune system is not yet competent, but will be about 60% of an adult system around age _____ months. a. 3 b. 6 c. 9 d. 12

ANS: D The child has an immune system of about 60% of the adult by age 12 months. The child has an immune system of about 60% of the adult by age 12 months, not 3 months. The child has an immune system of about 60% of the adult by age 12 months, not 6 months. The child has an immune system of about 60% of the adult by age 12 months, not 9 months. REF: p. 164

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 (HAART)

ANS: D The current regimen for treatment of HIV infection is a combination of drugs, termed highly active antiretroviral therapy (HAART). Approved AIDS medications are classified by mechanism of action; nucleoside and nonnucleoside inhibitors of reverse transcriptase (reverse transcriptase inhibitors). Inhibitors of the viral protease (protease inhibitors) are also part of therapy for AIDS. Inhibitors of viral entrance into the target cell (entrance inhibitors) are also part of the treatment of AIDS. REF: p. 186

Which of the following mutations have the most significant effect on protein synthesis? a. Base pair substitutions b. Silent mutations c. Intron mutations d. Frameshift mutations

ANS: D The frameshift mutation involves the insertion or deletion of one or more base pairs of the DNA molecule. They alter the amino acid sequence. The base pair substitution is a type of mutation in which one base pair replaces another. Silent mutations do not change amino acids or protein synthesis. Intron mutations are part of RNA sequencing. REF: p. 37

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

ANS: D The liver is not a secondary lymph organ. The spleen is a secondary lymphoid organ. Peyer patches are a secondary lymph organ. The adenoids are a secondary lymph organ. REF: p. 155

A patient wants to know the risk factors for Down syndrome. What is the nurse's best response? a. Fetal exposure to mutagens in the uterus b. Increased paternal age c. Family history of Down syndrome d. Pregnancy in women over age 35

ANS: D The primary risk for Down syndrome is pregnancy in women over 35. Down syndrome is a trisomy and not due to fetal exposure. Paternal age is not a risk factor in Down syndrome. Down syndrome is a chromosomal abnormality and is not related to family history. REF: p. 42

A male student arrives at school to find that he has an exam for which he is unprepared. Which of the following would be expected? a. Decreased lipolysis b. Bronchoconstriction c. Decreased cortisol release d. Increased glucagon release

ANS: D The student would experience increased glucagon release to supply glucose. Increased lipolysis would occur, not decreased. Bronchodilation would occur, not constriction. The student would experience increased cortisol release. REF: p. 206 | p. 211

A 35-year-old male weighs 70 kg. Approximately how much of this weight is ICF? a. 5 L b. 10 L c. 28 L d. 42 L

ANS: D The total volume of body water for a 70-kg person is about 42 L. 5 L is incorrect because a 70-kg person has about 42 L of body water. 10 L is incorrect because a 70-kg person has about 42 L of body water. 28 L is incorrect because a 70-kg person has about 42 L of body water. REF: p. 99

A child was recently diagnosed with cancer. The diagnosis suggests it is an embryonic tumor. Which of the following characterizes this type of cancer? a. Commonly occurring b. Often seen in adults c. Composed of mature, differentiated cells d. Usually manifested around age 5

ANS: D These types of cancers usually manifest around age 5. These types of cancers are not commonly occurring. These types of cancers are not commonly seen in adults. These types of cancers are composed of undifferentiated cells. REF: p. 288

Several prisoners are experiencing symptoms of tuberculosis. A tuberculin reaction test was ordered. This test is an example of type _____ hypersensitivity. a. I b. II c. III d. IV

ANS: D Tuberculosis testing is an example of type IV hypersensitivity. Tuberculosis testing is an example of type IV hypersensitivity, not type I. Tuberculosis testing is an example of type IV hypersensitivity, not type II. Tuberculosis testing is an example of type IV hypersensitivity, not type III. REF: p. 196

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

ANS: D Type IV reactions are mediated by T lymphocytes and do not involve antibodies. Type I reactions involve antibody responses. Type II reactions involve antibody responses. Type III reactions involve antibody responses. REF: p. 195

A 5-year-old male presents with mental retardation and is diagnosed with fragile X syndrome. When the parents ask what caused this, how should the geneticist respond? This was most probably caused from: a. Translocation b. Inversion c. Nondisjunction d. Duplication at fragile sites

ANS: D Unaffected transmitting males have been shown to have more than about 50 repeated DNA sequences near the beginning of the fragile X gene. Translocation effects do not result in mental retardation. Inversions have no physical effects. Fragile X is not related to nondisjunction. REF: p. 45

A 16-year-old is bitten by a rabid dog while jogging in the park. Upon admission to the emergency department, the nurse will administer which of the following to help prevent infection? a. Cytotoxic T cells b. Helper T cells c. Macrophages d. Immune globulin

ANS: D Unvaccinated individuals who are exposed to particular infectious agents often will be given immune globulins, which are prepared from individuals who already have antibodies against that particular pathogen. The patient would be given immune globulin, not cytotoxic T cells. The patient would be given immune globulin, not helper T cells. The patient would be given immune globulin, not macrophages. REF: p. 145

A 40-year-old female is diagnosed with cervical cancer after a Pap smear. Which of the following cellular changes would the nurse most likely see on the report? a. Metaplasia b. Atrophy c. Hypertrophy d. Dysplasia

ANS: D When cervical cells become cancerous, they have undergone dysplasia, a change in the size and shape of cells. The cells have changed; they have not been replaced, so metaplasia is not the correct choice. The cells have not decreased in size; therefore, atrophy is incorrect. The cells have not increased in size; therefore, they have not hypertrophied. REF: p. 63

The ion transporter that moves Na+ and Ca2+ simultaneously in the same direction is an example of which of the following types of transport? a. Biport b. Uniport c. Antiport d. Symport

ANS: D When ions are transported in one direction, it is termed symport. There is no such term as biport. Uniport refers to the movement of a single molecule. Antiport refers to movement of molecules in the opposite direction. REF: p. 17

After ingestion of lead, what organ systems should the nurse monitor because they are the most sensitive to the effects of lead? (Select all that apply.) a. Heart b. Lungs c. Liver d. Kidneys e. Brain f. Hematopoietic

ANS: D, E, F The organ systems primarily affected by lead ingestion include the nervous system (brain), the hematopoietic system (tissues that produce blood cells), and the kidneys. The heart, liver, and lungs are not affected. REF: p. 71

Which of the following patients would be at greatest risk for basal cell carcinoma? a. Dark complexion, light eyes, underweight b. Light complexion, dark eyes, overweight c. Medium complexion, light eyes, smoker d. Light complexion, light eyes, fair hair

NS: D Individuals at risk for basal cell carcinoma are light complected and have light eyes and fair hair. Individuals at risk for basal cell carcinoma are light complected and have light eyes and fair hair. Individuals at risk for basal cell carcinoma are light complected and have light eyes and fair hair. Individuals at risk for basal cell carcinoma are light complected and have light eyes and fair hair. REF: p. 274