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Exam 3

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Match the phrases with the corresponding terms: 43. Hypersecretion of thyroid hormone (TH) 44. Hypersecretion of adrenocorticotropic hormone (ACTH) 45. Hypersecretion of adrenal medulla hormones 46. Hyposecretion of thyroid hormone (TH) 47. Hyposecretion of adrenal cortex hormones 48. Hypersecretion of growth hormone (GH) ______ A. Acromegaly ______ B. Cushing disease ______ C. Addison disease ______ D. Graves disease ______ E. Myxedema ______ F. Pheochromocytoma

43. ANS: D Graves disease is caused by the hypersecretion of TH. 44. ANS: B Cushing disease is caused by the hypersecretion of ACTH. 45. ANS: F Pheochromocytoma is a tumor that causes hypersecretion of adrenal medulla hormones. 46. ANS: E Myxedema is the long-standing hyposecretion of TH. 47. ANS: C Addison disease is a result of hyposecretion of adrenal cortex hormones. 48. ANS: A Acromegaly is the condition associated with the exposure of adults to high levels of GH.

Chamber volume increase is observed in what type of cardiomyopathy? a. dilated b. hypertrophic c. restrictive d. Both a and b are correct. e. a, b, and c are correct.

Primary hypertension: a. is essentially idiopathic. b. can be caused by renal disease. c. can be caused by hormone imbalance. d. results from arterial coarctation. e. b, c, and d are correct.

Sideroblastic anemia can occasionally result from an autosomal recessive transmission inherited from which relative? A. Mother B. Father C. Grandfather D. Grandmother

A An occasional autosomal recessive transmission occurs only with mitochondrial mutations from the mother.

Which statement about folic acid is false? A. Folic acid absorption is dependent on the enzyme folacin. B. Folic acid is stored in the liver. C. Folic acid is essential for RNA and DNA synthesis within erythrocytes. D. Folic acid is absorbed in the upper small intestine.

A Folic acid absorption is not dependent on the enzyme folacin. The other options are true statements regarding folic acid

Treatment for polycythemia vera involves which of the following? A. Therapeutic phlebotomy and radioactive phosphorus B. Restoration of blood volume by plasma expanders C. Administration of cyanocobalamin D. Blood transfusions

A In low-risk individuals, the recommended therapy is phlebotomy and low-dose aspirin, whereas radioactive phosphorus has been used to suppress erythropoiesis.

Considering iron replacement therapy prescribed for iron deficiency anemia, who is likely to require long-term daily maintenance dosage? A. A woman who has not yet experienced menopause B. A teenager who is involved in strenuous athletics C. A middle-aged man who smokes two packs of cigarettes a day D. An older person demonstrating signs of dementia

A Menstruating women may need daily oral iron replacement therapy (325 mg/day) until menopause as a result of their menstrual blood loss.

What is the most common pathophysiologic process that triggers aplastic anemia (AA)? A. Autoimmune disease against hematopoiesis by activated cytotoxic T (Tc) cells B. Malignancy of the bone marrow in which unregulated proliferation of erythrocytes crowd out other blood cells C. Autoimmune disease against hematopoiesis by activated immunoglobulins D. Inherited genetic disorder with recessive X-linked transmission

A Most cases of AA result from an autoimmune disease directed against hematopoietic stem cells. Tc cells appear to be the main culprits.

Considering sideroblastic anemia, what would be the expected effect on the plasma iron levels? A. Plasma iron levels would be high. B. Levels would be low. C. Levels would be normal. D. Levels would be only minimally affected.

A Plasma iron levels would be high (see Table 28-3).

Which statement best describes a Schilling test? A. Administration of radioactive cobalamin and the measurement of its excretion in the urine to test for vitamin B12 deficiency B. Measurement of antigen-antibody immune complexes in the blood to test for hemolytic anemia C. Measurement of serum ferritin and total iron-binding capacity in the blood to test for iron deficiency anemia D. Administration of folate and measurement in 2 hours of its level in a blood sample to test for folic acid deficiency anemia.

A The Schilling test indirectly evaluates vitamin B12 absorption by administering radioactive B12 and measuring excretion in the urine.

How is the effectiveness of vitamin B12 therapy measured? A. Reticulocyte count B. Serum transferring C. Hemoglobin D. Serum vitamin B12

A The effectiveness of cobalamin replacement therapy is determined by a rising reticulocyte count.

Which of the following describes how the body compensates for anemia? A. Increasing rate and depth of breathing B. Decreasing capillary vasoconstriction C. Hemoglobin holding more firmly onto oxygen D. Kidneys releasing more erythropoietin

A Tissue hypoxia creates additional demands and compensatory actions on the pulmonary and hematologic systems. The rate and depth of breathing increase in an attempt to increase the availability of oxygen.

A 2000 ml blood loss will produce which assessment finding? (Select all that apply.) A. Air hunger B. Normal blood pressure in the supine position C. Rapid thready pulse D. Cold clammy skin E. lactic acidosis

A, C, D With a 2000 ml loss of blood, central venous pressure, cardiac output, and arterial blood pressure are below normal, even when at rest and in the supine position. The person commonly has air hunger; a rapid, thready pulse; and cold, clammy skin. With a 1500 ml loss of blood, supine blood pressure and pulse can still be normal. Lactic acidosis is observed with a blood loss of 2500 ml or more.

Which conditions are generally included in the symptoms of pernicious anemia (PA)? (Select all that apply.) A. Weakness B. Weight gain C. Low hemoglobin D. Paresthesias E. Low hematocrit

A, C, D, E When the hemoglobin and hematocrit levels in the blood have significantly decreased, the individual experiences the classic symptoms of PA—weakness, fatigue, paresthesias of the feet and fingers, difficulty in walking, loss of appetite, abdominal pains, and weight loss.

In congestive heart failure, the pump or myocardium itself fails because of which of the following? (More than one answer may be correct.) a. loss of contractile force of the heart b. hypertension c. cardiac dysrhythmias d. intermittent claudication from occlusive vascular disease

ABC

Bacterial infective endocarditis differs from rheumatic heart disease because of which of the following? (More than one answer may be correct.) a. Bacterial endocarditis is an infection of the heart, endocardium, and valves. b. It always follows rheumatic fever. c. It may occur following dental or bladder catheterization procedures. d. It commonly involves the vena cava valve. e. It is caused by a type III hypersensitivity.

Which factor can trigger an immune response in the bloodstream that may result in an embolus? a. Amniotic fluid b. Fat c. Bacteria d. Air

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

How does angiotensin II increase the workload of the heart after a myocardial infarction (MI)? a. By increasing the peripheral vasoconstriction b. By causing dysrhythmias as a result of hyperkalemia c. By reducing the contractility of the myocardium d. By stimulating the sympathetic nervous system

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

ANS: A Angiotensin II is released during myocardial ischemia and contributes to the pathogenesis of a myocardial infarction (MI) in several ways. First, it results in the systemic effects of peripheral vasoconstriction and fluid retention. These homeostatic responses are counterproductive in that they increase myocardial work and thus exacerbate the effects of the loss of myocyte contractility. Angiotensin II is also locally released, where it is a growth factor for vascular smooth muscle cells, myocytes, and cardiac fibroblasts; promotes catecholamine release; and causes coronary artery spasm.

Regarding the endothelium, what is the difference between healthy vessel walls and those that promote clot formation? a. Inflammation and roughening of the endothelium of the artery are present. b. Hypertrophy and vasoconstriction of the endothelium of the artery are present. c. Excessive clot formation and lipid accumulation in the endothelium of the artery are present. d. Evidence of age-related changes that weaken the endothelium of the artery is present.

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

Which statement best describes thromboangiitis obliterans (Buerger disease)? a. Inflammatory disorder of small and medium-size arteries in the feet and sometimes in the hands b. Vasospastic disorder of the small arteries and arterioles of the fingers and, less commonly, of the toes c. Autoimmune disorder of the large arteries and veins of the upper and lower extremities d. Neoplastic disorder of the lining of the arteries and veins of the upper extremities

ANS: A Buerger disease is an inflammatory disease of the peripheral arteries. Inflammation' thrombus formation, and vasospasm can eventually occlude and obliterate portions of small and medium-size arteries. The digital, tibial, and plantar arteries of the feet and the digital, palmar, and ulnar arteries of the hands are typically affected. This selection is the only option that accurately describes Buerger disease.

What is the cause of the dyspnea resulting from a thoracic aneurysm? a. Pressure on surrounding organs b. Poor oxygenation c. Formation of atherosclerotic lesions d. Impaired blood flow

ANS: A Clinical manifestations depend on the location of the aneurysm. Pressure of a thoracic aneurysm on surrounding organs cause symptoms of dysphagia (difficulty in swallowing) and dyspnea (breathlessness).

Regarding the endothelium, what is the difference between healthy vessel walls and those that promote clot formation? a. Inflammation and roughening of the endothelium of the artery are present. b. Hypertrophy and vasoconstriction of the endothelium of the artery are present c. Excessive clot formation and lipid accumulation in the endothelium of the artery are present. d. Evidence of age-related changes that weaken the endothelium of the artery are present.

ANS: A Invasion of the tunica intima by an infectious agent also roughens the normally smooth lining of the artery, causing platelets to adhere readily. This selection is the only option that accurately describes the mechanism that supports abnormal clot formation.

What is the effect of oxidized low-density lipoproteins (LDLs) in atherosclerosis? a. LDLs cause smooth muscle proliferation. b. LDLs cause regression of atherosclerotic plaques. c. LDLs increase levels of inflammatory cytokines. d. LDLs direct macrophages to the site in the endothelium

ANS: A LDLs are toxic to endothelial cells' cause smooth muscle proliferation' and activate further immune and inflammatory responses. This selection is the only option that accurately identifies the effects of LDLs.

Which predominantly female valvular disorder is thought to have an autosomal dominant inheritance pattern, as well as being associated with connective tissue disease? a. Mitral valve prolapse b. Tricuspid stenosis c. Tricuspid valve prolapse d. Aortic insufficiency

ANS: A Mitral valve prolapse tends to be most prevalent in young women. Studies suggest an autosomal dominant and X-linked inheritance pattern. Because mitral valve prolapse often is associated with other inherited connective tissue disorders (e.g., Marfan syndrome, Ehlers-Danlos syndrome, osteogenesis imperfecta), it is thought to result from a genetic or environmental disruption of valvular development during the fifth or sixth week of gestation.

Which risk factor is associated with coronary artery disease (CAD) because of its relationship with the alteration of hepatic lipoprotein? a. Diabetes mellitus b. Hypertension c. Obesity d. High alcohol consumption

ANS: A Of the available options, only diabetes mellitus is associated with CAD because of the resulting alteration of hepatic lipoprotein synthesis; it increases triglyceride levels and is involved in low-density lipoprotein oxidation

Ventricular dilation and grossly impaired systolic function, leading to dilated heart failure, characterize which form of cardiomyopathy? a. Congestive b. Hypertrophic c. Septal d. Dystrophic

ANS: A Only dilated cardiomyopathy (congestive cardiomyopathy) is characterized by ventricular dilation and grossly impaired systolic function, leading to dilated heart failure.

What is the usual source of pulmonary emboli? a. Deep venous thrombosis b. Endocarditis c. Valvular disease d. Left heart failure

ANS: A Pulmonary emboli originate in the venous circulation (mostly from the deep veins of the legs) or in the right heart. This selection is the only option that accurately identifies the usual source of pulmonary emboli.

A healthcare professional is caring for four patients. Which patient does the professional assess for pulmonary emboli (PE) as the priority? a. Deep venous thrombosis b. Endocarditis c. Valvular disease d. Left heart failure

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

A patient is diagnosed with pulmonary disease and elevated pulmonary vascular resistance. Which form of heart failure may result from pulmonary disease and elevated pulmonary vascular resistance? a. Right heart failure b. Left heart failure c. Low-output failure d. High-output failure

ANS: A Right heart failure is defined as the inability of the right ventricle to provide adequate blood flow into the pulmonary circulation at a normal central venous pressure. This condition is often a result of pulmonary disease and the resulting elevated pulmonary vascular resistance.

A patient is diagnosed with chronic obstructive pulmonary disease (COPD) and has elevated pulmonary vascular resistance. Which complication would the health care professional assess the patient for? a. Right heart failure b. Left heart failure c. Restrictive cardiomyopathy d. Hypertrophic cardiomyopathy

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

What factors contribute to the development of orthostatic hypotension? (Select all that apply.) a. Altered body chemistry b. Drug action of certain antihypertensive agents c. Prolonged immobility d. Effects of aging on postural reflexes e. Any condition that produces volume overload

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

Which information regarding fatty streaks does the pathophysiology student learn? (Select all that apply.) a. Fatty streaks progressively damage vessel walls. b. Fatty streaks are capable of producing toxic oxygen radials. c. When present, inflammatory changes occur to the vessel walls. d. Oxidized low-density lipoproteins (LDLs) are involved in their formation. e. Fatty streaks are formed by killer T cells filled with oxidized LDLs.

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

Which statements are true regarding fatty streaks? (Select all that apply.) a. Fatty streaks progressively damage vessel walls. b. Fatty streaks are capable of producing toxic oxygen radials. c. When present, inflammatory changes occur to the vessel walls. d. Oxidized low-density lipoproteins (LDLs) are involved in their formation. e. Fatty streaks are formed by killer T cells filled with oxidized LDLs

ANS: A, B, C, D The oxidized LDLs penetrate the intima of the arterial wall and are engulfed by macrophages. Macrophages filled with oxidized LDLs are called foam cells. Once these lipid-laden foam cells accumulate in significant amounts, they form a lesion called a fatty streak. Once formed, fatty streaks produce more toxic oxygen radicals and cause immunologic and inflammatory changes, resulting in progressive damage to the vessel wall.

A person wishes to reduce the risk of developing varicose veins. What does the health care professional advise this person? (Select all that apply.) a. Avoid standing for long periods of time. b. Maintain a healthy weight. c. Drink plenty of fluids. d. Wear compression stockings. e. Choose a job that involves sitting.

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

Which substance is manufactured by the liver and primarily contains cholesterol and protein? a. Very low:density lipoproteins (VLDLs) b. Low-density lipoproteins (LDLs) c. High-density lipoproteins (HDLs) d. Triglycerides

ANS: B A series of chemical reactions in the liver results in the production of several lipoproteins that vary in density and function. These include VLDLs, primarily triglycerides and protein; LDLs, mostly cholesterol and protein; and HDLs, mainly phospholipids and protein. LDLs are the only lipoproteins that are manufactured by the liver and primarily contain cholesterol and protein.

In systolic heart failure, what effect does the renin-angiotensin-aldosterone system (RAAS) have on stroke volume? a. Increases preload and decreases afterload b. Increases preload and increases afterload c. Decreases preload and increases afterload d. Decreases preload and decreases afterload

ANS: B Activation of the RAAS increases preload through the effects of aldosterone secretion, a sequela of the RAAS activity. RAAS also increases afterload through vasoconstriction mediated by angiotensin II.

In systolic heart failure, what effect does the renin-angiotensin-aldosterone system (RAAS) have on stroke volume? a. Increases preload and decreases afterload. b. Increases preload and increases afterload. c. Decreases preload and increases afterload. d. Decreases preload and decreases afterload.

ANS: B Activation of the RAAS not only causes an increase in preload and afterload, but it also causes direct toxicity to the myocardium. This selection is the only option that accurately identifies the effect that the RAAS has on stroke volume in this situation.

A patient who had a myocardial infarction is going to cardiac rehabilitation where progressive exercise is monitored by health care professionals. When would this patient be most vulnerable to injury and complications? a. Between 5 and 9 days b. Between 10 and 14 days c. Between 15 and 20 days d. Between 20 and 30 days

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

What term is used to identify when a cell is temporarily deprived of blood supply? a. Infarction b. Ischemia c. Necrosis d. Inflammation

ANS: B Coronary artery disease (CAD) can diminish the myocardial blood supply until deprivation impairs myocardial metabolism enough to cause ischemia, a local state in which the cells are temporarily deprived of blood supply. This term is the only option that is used to identify a temporarily deprived blood supply.

When is the scar tissue that is formed after a myocardial infarction (MI+ most vulnerable to injury? a. Between 5 and 9 days b. Between 10 and 14 days c. Between 15 and 20 days d. Between 20 and 30 days

ANS: B During the recovery period (10 to 14 days after infarction), individuals feel more capable of increasing activities and thus may stress the newly formed scar tissue. After 6 weeks, the necrotic area is completely replaced by scar tissue, which is strong but unable to contract and relax like healthy myocardial tissue.

Which disorder causes a transitory truncal rash that is nonpruritic and pink with erythematous macules that may fade in the center' making them appear as a ringworm? a. Fat emboli b. Rheumatic fever c. Bacterial endocarditis d. Myocarditis of acquired immunodeficiency syndrome

ANS: B Erythema marginatum is a distinctive truncal rash that often accompanies acute rheumatic fever. It consists of nonpruritic, pink erythematous macules that never occur on the face or hands.

A person wishes to reduce the risk of developing coronary artery disease. This person has a normal lipid panel. What risk factor reduction would the healthcare professional advise for this person? a. Eating a low-fat diet b. Controlling the blood pressure c. Avoiding air pollution d. Moderate alcohol use

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

The risk of developing coronary artery disease is increased up to threefold by which factor? a. Diabetes mellitus b. Hypertension c. Obesity d. High alcohol consumption

ANS: B Hypertension is the only factor responsible for a twofold-to-threefold increased risk of atherosclerotic cardiovascular disease.

What change in a vein supports the development of varicose veins? a. Increase in osmotic pressure b. Damage to the valves in veins c. Damage to the venous endothelium d. Increase in hydrostatic pressure

ANS: B If a valve is damaged, permitting backflow, then a section of the vein is subjected to the pressure exerted by a larger volume of blood under the influence of gravity. The vein swells as it becomes engorged, and the surrounding tissue becomes edematous because increased hydrostatic pressure pushes plasma through the stretched vessel wall.

What pathologic change occurs to the kidney's glomeruli as a result of hypertension? a. Compression of the renal tubules b. Ischemia of the tubule c. Increased pressure from within the tubule d. Obstruction of the renal tubule

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

ANS: B In the kidney, vasoconstriction and resultant decreased renal perfusion cause tubular ischemia and preglomerular arteriopathy. This selection is the only option that accurately identifies the pathologic change to the kidney that occurs as a result of hypertension.

What electrocardiogram (ECG) change would the healthcare professional assess for when a patient's myocardial infarction extends through the myocardium from the endocardium to the epicardium? a. Prolonged QT interval b. ST elevation c. ST depression d. Prolonged PR interval

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

What is the expected electrocardiogram (ECG) pattern when a thrombus in a coronary artery permanently lodges in the vessel and the infarction extends through the myocardium from the endocardium to the epicardium? a. Prolonged QT interval b. ST elevation myocardial infarction (STEMI) c. ST depression myocardial infarction (STDMI) d. Non-ST elevation myocardial infarction (non-STEMI)

ANS: B Individuals with this pattern on an ECG usually have significant elevations in the ST segments and are categorized as having STEMI.

When endothelial cells are injured, what alteration contributes to atherosclerosis? a. The release of toxic oxygen radicals that oxidize low-density lipoproteins (LDLs) b. Cells are unable to make the normal amount of vasodilating cytokines. c. Cells produce an increased amount of antithrombotic cytokines. d. Cells develop a hypersensitivity to homocysteine and lipids.

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

When endothelial cells are injured, what alteration contributes to atherosclerosis? a. The release of toxic oxygen radicals that oxidize low-density lipoproteins (LDLs). b. Cells are unable to make the normal amount of vasodilating cytokines. c. Cells produce an increased amount of antithrombotic cytokines. d. Cells develop a hypersensitivity to homocysteine and lipids.

ANS: B Injured endothelial cells become inflamed and cannot make normal amounts of antithromboticand vasodilating cytokines. This selection is the only option that accurately identifies the factor that contributes to atherosclerosis.

What term is used to identify when a cell is temporarily deprived of blood supply? a. Infarction b. Ischemia c. Necrosis d. Inflammation

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

Which substance primarily contains cholesterol and protein? a. Very low-density lipoproteins (VLDLs) b. Low-density lipoproteins (LDLs) c. High-density lipoproteins (HDLs) d. Triglycerides

ANS: B LDLs contain primarily cholesterol and protein. VLDLs are primarily triglycerides and protein and HDLs are mainly phospholipids and proteins. Triglycerides are the major form of fat stored in the body.

A disproportionate thickening of the interventricular septum is the hallmark of which form of cardiomyopathy? a. Dystrophic b. Hypertrophic c. Restrictive d. Dilated

ANS: B Only hypertrophic cardiomyopathy is characterized by a thickening of the septal wall, which may cause outflow obstruction to the left ventricle outflow tract.

A disproportionate thickening of the interventricular septum is the hallmark of which form of cardiomyopathy? a. Dystrophic b. Hypertrophic c. Restrictive d. Dilated

ANS: B Only hypertrophic obstructive cardiomyopathy is characterized by a thickening of the septal wall, which may cause outflow obstruction to the left ventricle outflow tract.

Amyloidosis, hemochromatosis, or glycogen storage disease usually causes which form of cardiomyopathy? a. Infiltrative b. Restrictive c. Septal d. Hypertrophic

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

Amyloidosis, hemochromatosis, or glycogen storage disease usually causes which form of cardiomyopathy? a. Infiltrative b. Restrictive c. Septal d. Hypertrophic

Superior vena cava syndrome is a result of a progressive increase of which process? a. Inflammation b. Occlusion c. Distention d. Sclerosis

ANS: B Superior vena cava syndrome (SVCS) is a progressive occlusion of the superior vena cava that leads to venous distention in the upper extremities and head. The remaining options are not associated with this disorder.

A person with diabetes mellitus does not realize that this disease contributes to coronary artery disease and asks the healthcare professional to explain. What information does the professional provide? (Select all that apply.) a. "High blood glucose directly attacks the heart cells." b. "Diabetes is associated with impaired lipid metabolism." c. "It can lead to more vasoconstriction in the blood vessels." d. "Diabetes can damage the inside of your blood vessel." e. "It causes inflammation and cells to clump together in the vessels."

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

A healthcare professions student learns which facts about mitral valve stenosis? (Select all that apply.) a. It is an uncommon valvular disorder. b. It mostly affects women. c. May result from genetic factors d. Most cases are asymptomatic. e. Symptoms tend to be vague.

ANS: B, C, D, E Mitral valve stenosis is the most common valve disorder in the United States and affects predominantly women. It may be related to genetic or environmental disruption in valvular development in early pregnancy. Most cases are asymptomatic and require no treatment. Symptoms, when they occur, tend to be vague and puzzling.

A patient has infective endocarditis. Which risk factors should the healthcare professional assess this patient for? (Select all that apply.) a. Rheumatic fever b. Intravenous drug use c. Prosthetic heart valve d. Aortic regurgitation e. Heart valve disease

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

Which risk factors are associated with infective endocarditis? (Select all that apply.) a. Rheumatic fever b. Intravenous drug use c. Long-term indwelling catheterization d. Aortic regurgitation e. Heart valve disease

ANS: B, C, E Risk factors for infective endocarditis include acquired valvular heart disease, intravenous drug abuse, long-term indwelling catheterization (e.g., for pressure monitoring, hyperalimentation, or hemodialysis), and recent cardiac surgery. Neither rheumatic fever nor aortic regurgitation is considered a risk factor for infective endocarditis.

Which statement is true concerning the cells' ability to synthesize cholesterol? a. Cell production of cholesterol is affected by the aging process. b. Cells produce cholesterol only when dietary fat intake is low. c. Most body cells are capable of producing cholesterol. d. Most cholesterol produced by the cells is converted to the low-density form.

ANS: C Although cholesterol can easily be obtained from dietary fat intake, most body cells can also manufacture cholesterol.

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

Which factor is responsible for the hypertrophy of the myocardium associated with hypertension? a. Increased norepinephrine b. Adducin c. Angiotensin II d. Insulin resistance

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

What is the initiating event that leads to the development of atherosclerosis? a. Release of the inflammatory cytokines b. Macrophages adhere to vessel walls. c. Injury to the endothelial cells that line the artery walls d. Release of the platelet-deprived growth factor

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

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

What effect does atherosclerosis have on the development of an aneurysm? a. Atherosclerosis causes ischemia of the intima. b. It increases nitric oxide. c. Atherosclerosis erodes the vessel wall. d. It obstructs the vessel.

ANS: C Atherosclerosis is a common cause of aneurysms because pla5ue formation erodes the vessel wall. This selection is the only option that accurately identifies the effect that atherosclerosis has on aneurysm development.

Which statement best describes Raynaud disease? a. Inflammatory disorder of small and medium-size arteries in the feet and sometimes in the hands b. Neoplastic disorder of the lining of the arteries and veins of the upper extremities c. Vasospastic disorder of the small arteries and arterioles of the fingers and, less commonly, of the toes d. Autoimmune disorder of the large arteries and veins of the upper and lower extremities

ANS: C Attacks of vasospasm in the small arteries and arterioles of the fingers and, less commonly, of the toes characterize Raynaud phenomenon and Raynaud disease and is the only option that accurately describes this disease.

Cardiac cells can withstand ischemic conditions and still return to a viable state for how many minutes? a. 10 b. 15 c. 20 d. 25

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

Cardiac cells can withstand ischemic conditions and still return to a viable state for how many minutes? a. 10 b. 15 c. 20 d. 25

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

An individual who is demonstrating elevated levels of troponin, creatine kinase-isoenzyme MB (CK-MB) and lactic dehydrogenase (LDH) is exhibiting indicators associated with which condition? a. Myocardial ischemia b. Hypertension c. Myocardial infarction (MI) d. Coronary artery disease (CAD)

ANS: C Cardiac troponins (troponin I and troponin T) are the most specific indicators of MI. Other biomarkers released by myocardial cells include CK-MB and LDH but they are not associated with the other options.

What is the most common cause of infective endocarditis? a. Virus b. Fungus c. Bacterium d. Rickettsiae

ANS: C Infective endocarditis is a general term used to describe infection and inflammation of the endocardiumGespecially the cardiac valves. Bacteria are the most common cause of infective endocarditis, especially streptococci, staphylococci, or enterococci.

What is the most common cause of infective endocarditis? a. Virus b. Fungus c. Bacterium d. Rickettsiae

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

Which elevated value may be protective of the development of atherosclerosis? a. Very low-density lipoproteins (VLDLs) b. Low-density lipoproteins (LDLs) c. High-density lipoproteins (HDLs d. Triglycerides

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

Which elevated value may be protective of the development of atherosclerosis? a. Very low:density lipoproteins (VLDLs) b. Low-density lipoproteins (LDLs) c. High-density lipoproteins (HDLs) d. Triglycerides

Individuals being effectively managed for type 2 diabetes mellitus often experience a healthy decline in blood pressure as a result of what intervention? a. Managed carbohydrate intake b. Appropriate exercise c. Insulin-sensitivity medication therapy d. Introduction of minimal doses of insulin

ANS: C Many people with type 2 diabetes mellitus, who are treated with drugs that increase insulin sensitivity, experience a decline in their blood pressure without taking antihypertensive drugs. Although the other medications may be included in the management plan, the other options are not associated with a decrease in hypertension.

What cardiac pathologic condition contributes to ventricular remodeling? a. Left ventricular hypertrophy b. Right ventricular failure c. Myocardial ischemia d. Contractile dysfunction

ANS: C Myocardial ischemia contributes to inflammatory, immune, and neurohumoral changes that mediate a process called ventricular remodeling.

Which inflammatory cytokines are released when endothelial cells are injured? a. Granulocyte-macrophage colony-stimulating factor (GM-CFS) b. Interferon-beta (IFN-β), interleukin 6 (IL-6) and granulocyte colony-stimulating factor (G-CFS) c. Tumor necrosis factor-alpha (TNF-α), interferon-gamma (IFN-γ), and interleukin 1 (IL-1) d. Interferon-alpha (IFN-α), interleukin-12 (IL-12), and macrophage colony-stimulating factor (M-CSF)

ANS: C Numerous inflammatory cytokines are released, including TNF-α, IFN-γ, IL-1, toxic oxygen radicals, and heat shock proteins. This selection is the only option that accurately identifies which inflammatory cytokines are associated with endothelial cell injury.

Which factor is responsible for the hypertrophy of the myocardium associated with hypertension? a. Increased norepinephrine b. Adducin c. Angiotensin II d. Insulin resistance

ANS: C Of the available options' only angiotensin II is responsible for the hypertrophy of the myocardium and much of the renal damage associated with hypertension.

What cardiac pathologic condition contributes to ventricular remodeling? a. Left ventricular hypertrophy b. Right ventricular failure c. Myocardial ischemia d. Contractile dysfunction

ANS: C Of the options available, myocardial ischemia contributes to inflammatory, immune, and neurohumoral changes that mediate a process called ventricular remodeling.

A patient who has lung cancer calls the clinic reports facial and neck swelling severe enough so that shirts no longer fit. What question by the healthcare professional there would be most appropriate? a. "Have you gained weight recently?" b. "Are your feet and ankles swollen?" c. "Does your voice sound hoarse?" d. "When was your last chemotherapy?"

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

What is the most common cardiac disorder associated with acquired immunodeficiency syndrome (AIDS)? a. Cardiomyopathy b. Myocarditis c. Left heart failure d. Heart block

ANS: C Pericardial effusion and left heart failure are the most common complications of human immunodeficiency virus (HIV) infection. Other conditions include cardiomyopathy, myocarditis, tuberculous pericarditis, infective and nonbacterial endocarditis, heart block, pulmonary hypertension, and nonantiretroviral drug-related cardiotoxicity.

Which condition is a cause of acquired aortic regurgitation? a. Congenital malformation b. Cardiac failure c. Rheumatic fever d. Coronary artery disease (CAD)

ANS: C Rheumatic heart disease, bacterial endocarditis, syphilis, hypertension, connective tissue disorders (e.g., Marfan syndrome, ankylosing spondylitis), appetite suppressing medications, trauma, or atherosclerosis can cause acquired aortic regurgitation. This selection is the only available option that is known to cause acquired aortic regurgitation.

A patient in the Emergency department is suspected of having a myocardial infarction (MI). The initial cardiac troponin 1 level was negative. What action by the healthcare professional is best? a. Prepare the patient for thrombolytic therapy. b. Dismiss the patient because the lab was negative. c. Schedule repeat lab within a few hours. d. Give the patient oxygen and pain medication.

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

What is the trigger for angina pectoris? a. Atherosclerotic lesions b. Hyperlipidemia c. Myocardial necrosis d. Myocardial ischemia

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

What is the trigger for angina pectoris? a. Atherosclerotic lesions b. Hyperlipidemia c. Myocardial necrosis d. Myocardial ischemia

ANS: D Angina pectoris is chest pain caused by myocardial ischemia. None of the other options are considered triggers for angina pectoris

Which laboratory test is an indirect measure of atherosclerotic plaque? a. Homocysteine b. Low-density lipoprotein (LDL) c. Erythrocyte sedimentation rate (ESR) d. C-reactive protein (CRP)

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

Which laboratory test is an indirect measure of atherosclerotic plaque? a. Homocysteine b. Low-density lipoprotein c. Erythrocyte sedimentation rate (ESR) d. C-reactive protein (CRP)

ANS: D Highly sensitive CRP (hs-CRP) is an acute phase reactant or protein mostly synthesized in the liver and, of the available options, is an indirect measure of atherosclerotic plaque-related inflammation.

A patient reports sudden onset of severe chest pain that radiates to the back and worsens with respiratory movement and when lying down. These clinical manifestations describe: a. Myocardial infarction (MI) b. Pericardial effusion c. Restrictive pericarditis d. Acute pericarditis

ANS: D Most individuals with acute pericarditis describe several days of fever, myalgias, and malaise, followed by the sudden onset of severe chest pain that worsens with respiratory movements and with lying down. Although the pain may radiate to the back, it is generally felt in the anterior chest and may be initially confused with the pain of an acute MI. Individuals with acute pericarditis also may report dysphagia, restlessness, irritability, anxiety, and weakness.

Nicotine increases atherosclerosis by the release of which neurotransmitter? a. Histamine b. Nitric oxide c. Angiotensin II d. Epinephrine

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

Nicotine increases atherosclerosis by the release of which neurotransmitter? a. Histamine b. Nitric oxide c. Angiotensin II d. Epinephrine

ANS: D Nicotine stimulates the release of catecholamines (e.g., epinephrine, norepinephrine), which increases the heart rate and causes peripheral vascular constriction. As a result, blood pressure increases, as do both cardiac workload and oxygen demand. None of the other options are associated with this mechanism.

Which form of angina occurs most often during sleep as a result of vasospasms of one or more coronary arteries? a. Unstable b. Stable c. Silent d. Prinzmetal

ANS: D Of the options available, only Prinzmetal angina (also called variant angina) is chest pain attributable to transient ischemia of the myocardium that occurs unpredictably and almost exclusively at rest.

A patient reports chest pain that occurs most often during sleep. What treatment does the healthcare professional discuss with the patient? a. Treatment of obstructive sleep apnea b. Short-acting nitroglycerin tablets c. A low-dose aspirin regimen d. Oral calcium channel blockers

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

The pulsus paradoxus that occurs as a result of pericardial effusion is caused by a dysfunction in which mechanism? a. Diastolic filling pressures of the right ventricle and reduction of blood volume in both ventricles b. Blood ejected from the right atrium and reduction of blood volume in the right ventricle c. Blood ejected from the left atrium and reduction of blood volume in the left ventricle d. Diastolic filling pressures of the left ventricle and reduction of blood volume in all four heart chambers.

ANS: D Pulsus paradoxus means that the arterial blood pressure during expiration exceeds arterial pressure during inspiration by more than 10 mm Hg. This clinical finding reflects impairment of diastolic filling of the left ventricle plus a reduction of blood volume within all four cardiac chambers.

A patient reports sudden onset of severe chest pain that radiates to the back and worsens with breathing and when lying down. What action by the healthcare professional is most appropriate? a. Prepare to assist with an immediate pericardiocentesis. b. Inform the patient about the side effects of diuretics. c. Facilitate the patient getting an immediate ECG. d. Teach the patient about a course of antiinflammatory medications.

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

Which assessment findings would the health care professional correlate with aortic stenosis? (Select all that apply.) a. Jugular vein distention b. Bounding pulses c. Hypotension d. Angina e. Syncope

ANS: D, E The classic manifestations of aortic stenosis are angina, syncope, and heart failure. None of the other options are associated with aortic stenosis.

Which assessment findings are clinical manifestations of aortic stenosis? (Select all that apply.) a. Jugular vein distention b. Bounding pulses c. Hypotension d. Angina e. Syncope

ANS: D, E The classic manifestations of aortic stenosis are angina, syncope, and heart failure. None of the other options are associated with aortic stenosis.

Which factor can trigger an immune response in the bloodstream that may result in an embolus? a. Amniotic fluid b. Fat c. Bacteria d. Air

Ans: A Of the options available, only amniotic fluid displaces blood, thereby reducing oxygen, nutrients, and waste exchange; however, it also introduces antigens, cells, and protein aggregates that trigger inflammation, coagulation, and the immune response in the bloodstream.

Normocytic-normochromic anemia

Aplastic anemia

A 53-year-old man was admitted to the emergency room after experiencing shortness of breath, weakness, cardiac dysrhythmias, and chest pain that did not subside after nitroglycerin therapy. Laboratory tests showed that the patient had an elevations of serum CPK, troponin, and SCOT or AST. ECG tracings revealed a prominent Q wave and an elevated ST segment. The most probable diagnosis is: a. a transient ischemic attack. b. an acute myocardial infarct. c. an attack of unstable angina pectoris. d. Prinzmetal angina. e. coronary artery vasospasm.

Orthostatic hypotension is caused by all of the following except: a. increased age. b. increased blood volume. c. autonomic nervous system dysfunction. d. bed rest. e. severe varicose veins.

The complications of uncontrolled hypertension include all of the following except: a. cerebrovascular accidents. b. anemia. c. renal injury. d. cardiac hypertrophy. e. All of the above are complications.

In aplastic anemia (AA), pancytopenia develops as a result of which of the following? A. Suppression of erythropoietin to produce adequate amounts of erythrocytes B. Suppression of the bone marrow to produce adequate amounts of erythrocytes, leukocytes, and thrombocytes C. Lack of DNA to form sufficient quantities of erythrocytes, leukocytes, and thrombocytes D. Lack of stem cells to form sufficient quantities of leukocytes

B AA is a critical condition characterized by pancytopenia, which is a reduction or absence of all three blood cell types, resulting from the failure or suppression of bone marrow to produce adequate amounts of blood cells.

Which type of anemia is characterized by fatigue, weakness, and dyspnea, as well as conjunctiva of the eyes and brittle, concave nails? A. Pernicious B. Iron deficiency C. Aplastic D. Hemolytic

B Early symptoms of iron deficiency anemia (IDA) include fatigue, weakness, and shortness of breath. Pale earlobes, palms, and conjunctivae (see Figure 28-4) are also common signs. Progressive IDA causes more severe alterations, with structural and functional changes apparent in epithelial tissue (see Figure 28-4). The nails become brittle, thin, coarsely ridged, and spoon-shaped or concave (koilonychia) as a result of impaired capillary circulation. The tongue becomes red, sore, and painful. These symptoms are not associated with the other options.

The paresthesia that occurs in vitamin B12 deficiency anemia is a result of which of the following? A. Reduction in acetylcholine receptors in the postsynaptic nerves B. Myelin degeneration in the spinal cord C. Destruction of myelin in peripheral nerves D. Altered function of neurons in the parietal lobe

B Effects on the nervous system can occur if a vitamin B12 deficiency causes the anemia. Myelin degeneration may occur with the resultant loss of fibers in the spinal cord, producing paresthesia (numbness), gait disturbances, extreme weakness, spasticity, and reflex abnormalities.

When considering hemolytic anemia, which statement is true regarding the occurrence of jaundice? A. Erythrocytes are destroyed in the spleen. B. Heme destruction exceeds the liver's ability to conjugate and excrete bilirubin. C. The patient has elevations in aspartate transaminase (AST) and alanine transaminase (ALT). D. The erythrocytes are coated with an immunoglobulin.

B Jaundice (icterus) is present when heme destruction exceeds the liver's ability to conjugate and excrete bilirubin.

An allogenic bone marrow transplantation remains the preferred method for treating which anemia? A. Polycythemia vera B. Aplastic C. Sideroblastic D. Anemia of chronic disease (ACD)

B Of the options available, bone marrow and, most recently, peripheral blood stem cell transplantation from a histocompatible sibling are the preferred treatments for the underlying bone marrow failure observed in aplastic anemias.

Which of the following is classified as a megaloblastic anemia? A. Iron deficiency B. Pernicious C. Sideroblastic D. Hemolytic

B Pernicious anemia is the most common type of megaloblastic anemia.

What is the treatment of choice for pernicious anemia (PA)? A. Cyanocobalamin by oral intake B. Vitamin B12 by injection C. Ferrous fumarate by Z-track injection D. Folate by oral intake

B Replacement of vitamin B12 (cobalamin) is the treatment of choice for PA. Initial injections of vitamin B12 are administered weekly until the deficiency is corrected, followed by monthly injections for the remainder of the individual's life

What is the most common cause of iron deficiency anemia (IDA)? A. Decreased dietary intake B. Chronic blood loss C. Vitamin deficiency D. Autoimmune disease

B The most common cause of IDA in well-developed countries is pregnancy and chronic blood loss.

The underlying disorder of which anemia is a result of the defective secretion of the intrinsic factor, which is essential for the absorption of vitamin B12? A. Microcytic B. Pernicious C. Hypochromic D. Hemolytic

B Vitamin B12 deficiency causes pernicious anemia, the most common type of megaloblastic anemia

Microcytic-hypochromic anemia

B Sideroblastic anemia

Which medications are associated with an intermediate increase in a person's risk for developing aplastic anemia? (Select all that apply.) A. Penicillin B. Chloramphenicol (Chloromycetin) C. Phenytoin (Dilantin) D. Trimethoprim-sulfamethoxazole (Bactrim) E. Thiazides

B, C, D Chloramphenicol (Chloromycetin), phenytoin (Dilantin), and trimethoprim-sulfamethoxazole (Bactrim) are associated with an intermediate increase in the risk of developing aplastic anemia.

What are the clinical manifestations of folate deficiency anemia? (Select all that apply.) A. Constipation B. Flatulence C. Dysphagia D. Stomatitis E. Cheilosis

B, C, D, E Specific symptoms of folate deficiency anemia include severe cheilosis (scales and fissures of the lips and corners of the mouth), stomatitis (inflammation of the mouth), and painful ulcerations of the buccal mucosa and tongue. Gastrointestinal symptoms may be present and include dysphagia (difficulty swallowing), flatulence, and watery diarrhea.

Individuals with only left heart failure would exhibit which of the following? (More than one answer may be correct.) a. hepatomegaly b. dyspnea c. ankle swelling d. pulmonary edema e. peripheral edema

Which statement is true regarding rheumatic heart disease? (More than one answer may be correct.) a. It is caused by staphylococcal infections. b. It is caused by hypersensitivity/immunity to streptococci. c. It damages the tricuspid valve most often. d. It usually damages the mitral valve.

Complications of an infarcted myocardium likely could include: (More than one answer may be correct.) a. emphysema. b. heart failure. c. endocarditis. d. death. e. systemic thromboembolism.

BDE

A 76-year-old man came to the emergency room after experiencing chest pain while shoveling snow. Laboratory tests revealed essentially normal blood levels of SGOT, CPK, and LDH enzymes. The chest pain was relieved following rest and nitroglycerin therapy. The most probable diagnosis is: a. myocardial infarct. b. emphysema. c. angina pectoris. d. hepatic cirrhosis. e. acute pancreatitis.

G.P., a 50-year-old man, was referred for evaluation of blood pressure. If he has a high diastolic blood pressure, which of the following is G.P.'s reading? a. 140/82 mm Hg b. 160/72 mm Hg c. 130/95 mm Hg d. 95/68 mm Hg e. 140/72 mm Hg

Transmural myocardial infarction: a. displays non-STEMI. b. occurs when infarction is limited to part of the heart wall. c. is categorized as STEMI. d. displays I-wave inversion.

Which statement is incorrect concerning hypertension? a. Malignant hypertension is characterized by a diastolic pressure higher than140 mm Hg. b. More than 90% of cases are of the essential or primary type. c. Headache is the most reliable symptom. d. When it is left untreated, the major risks include CVAs and cardiac hypertrophy.

What term is used to describe the capacity of some erythrocytes to vary in size, especially in relationship to some anemias? A. Poikilocytosis B. Isocytosis C. Anisocytosis D. Microcytosis

C Additional descriptors of erythrocytes associated with some anemias include anisocytosis (assuming various sizes) or poikilocytosis (assuming various shapes) (see Figure 28-1).

Erythrocyte life span of less than 120 days, ineffective bone marrow response to erythropoietin, and altered iron metabolism describe the pathophysiologic characteristics of which type of anemia? A. Aplastic B. Sideroblastic C. Anemia of chronic disease D. Iron deficiency

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

What is the primary cause of the symptoms of polycythemia vera? A. Decreased erythrocyte count B. Destruction of erythrocytes C. Increased blood viscosity D. Neurologic involvement

C As polycythemia vera progresses, many of the symptoms are related to the increased blood cellularity and viscosit

Deficiencies in folate and vitamin B12 alter the synthesis of which of the following? A. RNA B. Cell membrane C. DNA D. Mitochondria

C Deficiencies in folate and vitamin B12 result in defective erythrocyte precursor DNA synthesis.

Clinical manifestations of mild-to-moderate splenomegaly and hepatomegaly, bronze-colored skin, and cardiac dysrhythmias are indicative of which anemia? A. Iron deficiency B. Pernicious C. Sideroblastic D. Aplastic

C Of the options available, only sideroblastic anemia exhibits mild-to-moderate enlargement of the spleen (splenomegaly) and liver (hepatomegaly), as well as abnormal skin pigmentation (bronze colored). Heart rhythm disturbances, along with congestive heart failure, are major life-threatening complications related to cardiac iron overload.

Which condition resulting from untreated pernicious anemia (PA) is fatal? A. Brain hypoxia B. Liver hypoxia C. Heart failure D. Renal failure

C Of the options available, untreated PA is fatal, usually because of heart failure.

What is the fundamental physiologic manifestation of anemia? A. Hypotension B. Hyperesthesia C. Hypoxia D. Ischemia

C The fundamental physiologic manifestation of anemia is a reduced oxygen-carrying capacity of the blood, resulting in tissue hypoxia.

Which statement is true regarding warm autoimmune hemolytic anemia? A. Warm autoimmune hemolytic anemia occurs primarily in men. B. It is self-limiting and rarely produces hemolysis. C. Erythrocytes are bound to macrophages and sequestered in the spleen. D. Immunoglobulin M coats erythrocytes and binds them to receptors on monocytes.

C The immunoglobulin G-coated red blood cells bind to the Fc receptors on monocytes and splenic macrophages and are removed by phagocytosis.

Which anemia produces small, pale erythrocytes? A. Folic acid B. Hemolytic C. Iron deficiency D. Pernicious

C The microcytic-hypochromic anemias, which include iron deficiency anemia (IDA), are characterized by erythrocytes that are abnormally small and contain abnormally reduced amounts of hemoglobin.

What causes the atrophy of gastric mucosal cells that result in pernicious anemia? A. Erythrocyte destruction B. Folic acid malabsorption C. Vitamin B12 malabsorption D. Poor nutritional intake

C Deficiency in intrinsic factor (IF) secretion may be congenital or may result from adult onset gastric mucosal atrophy and the destruction of parietal cells. In older adults, virtually all vitamin B12-deficiency anemia is caused by a failure of IF-related absorption.

Localized outpouching of a vessel wall or heart chamber is: a. a thrombus. b. an embolus. c. a thromboembolus. d. an aneurysm. e. a vegetation.

Continued therapy of pernicious anemia (PA) generally lasts how long? A. 6 to 8 weeks B. 8 to 12 months C. Until the iron level is normal D. The rest of one's life

D Because PA cannot be cured, maintenance therapy is a life-long endeavor.

After a person has a subtotal gastrectomy for chronic gastritis, which type of anemia will result? A. Iron deficiency B. Aplastic C. Folic acid D. Pernicious

D From the options available, only pernicious anemia is caused by vitamin B12 deficiency, which is often associated with the end-stage type A chronic atrophic gastritis.

Which statement is true regarding the physical manifestations of vitamin B12 deficiency anemia? A. Vitamin B12 deficiency anemia seldom results in neurologic symptoms. B. The chances of a cure are good with appropriate treatment. C. The condition is reversible in 75% of the cases. D. Symptoms are a result of demyelination.

D The neurologic manifestations characteristic of vitamin B12 deficiency anemia result from nerve demyelination that may produce neuronal death. These complications pose a serious threat because they are not reversible, even with appropriate treatment.

Events in the development of atherosclerotic plaque include all of the following except: a. accumulation of LDL (low-density lipoprotein) cholesterol. b. smooth muscle proliferation. c. calcification. d. decreased elasticity. e. complement activation.

Which is a possible cause of varicose veins? a. gravitational forces on blood b. long periods of standing c. trauma to the saphenous veins d. Both b and c are correct. e. a, b, and c are correct.

What Is Polycythemia Vera?

It's a blood cancer that begins in the marrow of your bones, the soft center where new blood cells grow. If you have polycythemia vera, your marrow makes TO MANY red blood cells, which causes your blood to get too thick. That can make you more likely to have blood clots, a stroke, or a heart attack. Caused by a gene called JAK2 that doesn't work right. This gene is supposed to make sure your bone marrow doesn't make too many blood cells. Most likely, the problem in your JAK2 gene happened over the course of your life.

Macrocytic-normochromic anemia

Pernicious anemia

A patient in the clinic reports fever, arthralgia, a rash, and nosebleeds. What other information should the healthcare professional elicit from this patient? a. Family history of Marfan's disease b. History of a recent bacterial infection c. History of any recent chest trauma d. Any illnesses in family members

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

Which description is consistent with acute lymphocytic leukemia (ALL)? a.ALL is a progressive neoplasm defined by the presence of greater than 30% lymphoblasts in the bone marrow or blood. b.Leukocytosis and a predominance of blast cells characterize the bone marrow and peripheral blood. As the immature blasts increase, they replace normal myelocytic cells, megakaryocytes, and erythrocytes. c.B cells fail to mature into plasma cells that synthesize immunoglobulins. d.The translocation of genetic material from genes 9 and 22 create an abnormal, fused gene identified as BCR-ABL.

a. ALL is a progressive neoplasm defined by the presence of greater than 30% lymphoblasts in the bone marrow or blood.

33. Which serum glucose level would indicate hypoglycemia in a newborn? a. 28 mg/dl b. 40 mg/dl c. 60 mg/dl. d. 80 mg/dl

a. 28 mg/dl ANS: A Serum glucose <30 mg/dl in newborn (first 2 to 3 days) and <55 to 60 mg/dl in adults is associated with hypoglycemia.

4. Diabetes insipidus is a result of: a. Antidiuretic hormone hyposecretion b. Antidiuretic hormone hypersecretion c. Insulin hyposecretion d. Insulin hypersecretion

a. Antidiuretic hormone hyposecretion ANS: A Of the available options, diabetes insipidus is a result of insufficient antidiuretic hormone.

37. Which classification of oral hypoglycemic drugs decreases hepatic glucose production and increases insulin sensitivity and peripheral glucose uptake? a. Biguanide (metformin) b. Sulfonylureas (glyburide) c. Meglitinides (glinides) d. α-Glycosidase inhibitor (miglitol)

a. Biguanide (metformin) ANS: A Only biguanides decrease hepatic glucose production and increase insulin sensitivity and peripheral glucose uptake.

The common cause of elevated levels of antidiuretic hormone (ADH) secretion is: a. Ectopically produced ADH b. Inflammation of the hypothalamus c. Posterior pituitary tumor. d. Inflammation of the nephrons

a. Ectopically produced ADH ANS: A A common cause of elevated levels of ADH secretion is ectopically produced ADH, which makes the other options incorrect.

20. Pathologic changes associated with Graves disease include: a. High levels of circulating thyroid-stimulating immunoglobulins b. Diminished levels of thyrotropin-releasing hormone c. High levels of thyroid-stimulating hormone d. Diminished levels of thyroid-binding globulin

a. High levels of circulating thyroid-stimulating immunoglobulins ANS: A The only option that correctly describes the changes associated with Graves disease identifies high levels of circulating thyroid-stimulating immunoglobulins that are found in more than 95% of individuals diagnosed with the disease.

11. Which condition may result from pressure exerted by a pituitary tumor? a. Hypothyroidism b. Hypercortisolism c. Diabetes insipidus d. Insulin hyposecretion

a. Hypothyroidism ANS: A If the tumor exerts sufficient pressure, then thyroid and adrenal hypofunction may occur because of a lack of thyroid-stimulating hormone (TSH) and adrenocorticotropic hormone (ACTH). These result in the symptoms of hypothyroidism and hypocortisolism. The remaining options are not associated with the pressure exerted by a pituitary tumor.

10. Which form of diabetes insipidus (DI) is treatable with exogenous antidiuretic hormone (ADH)? a. Neurogenic b. Psychogenic c. Nephrogenic d. schemic

a. Neurogenic

5. A patient who is diagnosed with a closed head injury has a urine output of 6 to 8 L/day. Electrolytes are within normal limits, but his antidiuretic hormone (ADH) level is low. Although he has had no intake for 4 hours, no change in his polyuria level has occurred. These symptoms support a diagnosis of: a. Neurogenic diabetes insipidus b. Syndrome of inappropriate antidiuretic hormone c. Psychogenic polydipsia d. Osmotically induced diuresis

a. Neurogenic diabetes insipidus ANS: A The stated symptoms are reflective of neurogenic diabetes insipidus and not of the remaining options.

12. The term used to describe a person who experiences a lack of all hormones associated with the anterior pituitary is: a. Panhypopituitarism b. Adrenocorticotropic hormone c. Hypopituitarism. d. Anterior pituitary failure deficiency

a. Panhypopituitarism ANS: A Panhypopituitarism is the only available term that is correctly associated with the lack of all anterior pituitary hormones.

31. Type 2 diabetes mellitus is best described as a(an): a. Resistance to insulin by insulin-sensitive tissues b. Need for lispro instead of regular insulin c. Increase of glucagon secretion from α cells of the pancreas d. Presence of insulin autoantibodies that destroy β cells in the pancreas

a. Resistance to insulin by insulin-sensitive tissues ANS: A One of the basic pathophysiologic characteristics of type 2 diabetes is the development of insulin-resistant tissue cells. None of the remaining options appropriately describes type 2 diabetes.

35. Hypoglycemia, followed by rebound hyperglycemia, is observed in those with: a. The Somogyi effect b. The dawn phenomenon c. Diabetic ketoacidosis d. Hyperosmolar hyperglycemic nonketotic syndrome

a. The Somogyi effect ANS: A Hypoglycemia, followed by rebound hyperglycemia, is observed only in the Somogyi effect.

9. Which laboratory value is consistently low in a patient with diabetes insipidus (DI)? a. Urine-specific gravity b. Serum sodium c. Urine protein. d. Serum total protein

a. Urine-specific gravity ANS: A The basic criteria for diagnosing DI include a low urine-specific gravity while sodium levels are high. Protein levels are not considered.

Which statements are true regarding leukemias? (Select all that apply.) a.A single progenitor cell undergoes a malignant change. b.Leukemia is a result of uncontrolled cellular proliferation. c.Bone marrow becomes overcrowded. d.Leukocytes are under produced. e.Hematopoietic cell production is decreased.

a.A single progenitor cell undergoes a malignant change. b.Leukemia is a result of uncontrolled cellular proliferation. c.Bone marrow becomes overcrowded. e.Hematopoietic cell production is decreased.

The two major forms of leukemia, acute and chronic, are classified by which criteria? (Select all that apply.) a.Predominant cell type b.Rate of progression c.Age of individual when cells differentiation occurs d.Stage of cell development when malignancy first occurs e.Serum level of leukocytes

a.Predominant cell type b.Rate of progression

What does poikilocytosis refer to?

assuming various shapes

Local signs and symptoms of Hodgkin disease-related lymphadenopathy are a result of which of the following? a.Pressure and ischemia b.Pressure and obstruction c.Inflammation and ischemia d.Inflammation and pressure

b. Pressure and obstruction

15. Which disorder is caused by hypersecretion of the growth hormone (GH) in adults? a. Cushing syndrome b. Acromegaly c. Giantism d. Myxedema

b. Acromegaly ANS: B Acromegaly is a term for adults who have been exposed to continuously high levels of GH, whereas the term giantism is reserved for children and adolescents. The other options do not apply to hypersecretion of GH.

Multiple myeloma a. Epstein-Barr virus b. Bence Jones protein c. Diagnosed by the Reed-Sternberg cell d. Diagnosed by the Philadelphia chromosome

b. Bence Jones protein

29. A patient diagnosed with diabetic ketoacidosis (DKA) has the following laboratory values: arterial pH 7.20; serum glucose 500 mg/dl; positive urine glucose and ketones; serum potassium (K+) 2 mEq/L; serum sodium (Na+) 130 mEq/L. The patient reports that he has been sick with the "flu" for 1 week. What relationship do these values have to his insulin deficiency? a. Increased glucose use causes the shift of fluid from the intravascular to the intracellular space. b. Decreased glucose use causes fatty acid use, ketogenesis, metabolic acidosis, and osmotic diuresis. c. Increased glucose and fatty acids stimulate renal diuresis, electrolyte loss, and metabolic alkalosis. d. Decreased glucose use results in protein catabolism, tissue wasting, respiratory acidosis, and electrolyte loss.

b. Decreased glucose use causes fatty acid use, ketogenesis, metabolic acidosis, and osmotic diuresis. ANS: B Decreased glucose causes fatty acid use, ketogenesis, metabolic acidosis, and osmotic diuresis, which have resulted in the symptoms listed in the question. The relationship between the stated assessment values and insulin deficiency is not effectively described by any of the other options.

14. Which disorder is considered a co-morbid condition of acromegaly? a. Hypotension b. Diabetes c. Brain cancer d. Thyroid cancer

b. Diabetes ANS: B Symptoms of type 2 diabetes mellitus, such as polyuria and polydipsia, may occur. Acromegaly-associated hypertension is usually asymptomatic until symptoms of heart failure develop. Neither thyroid nor brain cancer has been associated with acromegaly.

16. Giantism occurs only in children and adolescents because their: a. Growth hormones are still diminished. b. Epiphyseal plates have not yet closed. c. Skeletal muscles are not yet fully developed. d. Metabolic rates are higher than in adulthood.

b. Epiphyseal plates have not yet closed. ANS: B Giantism is related to the effects of growth hormones on the growth of long bones at their epiphyseal plates. This information makes the other options incorrect.

23. A deficiency of which chemical may result in hypothyroidism? a. Iron c. Zinc b. Iodine c. zinc d. Magnesium

b. Iodine ANS: B The only cause of hypothyroidism from among the provided options is a deficiency of endemic iodine.

21. The level of thyroid-stimulating hormone (TSH) in individuals with Graves disease is usually: a. High b. Low c. Normal D. In constant flux

b. Low ANS: B The hyperfunction of the thyroid gland leads to suppression of TSH because of the normal negative feedback mechanism, thus eliminating the other options as being correct.

8. Which form of diabetic insipidus (DI) will result if the target cells for antidiuretic hormone (ADH) in the renal collecting tubules demonstrate insensitivity? a. Neurogenic b. Nephrogenic c. Psychogenic d. Ischemic

b. Nephrogenic ANS: B Only nephrogenic DI is associated with an insensitivity of the renal collecting tubules to ADH.

26. Renal failure is the most common cause of which type of hyperparathyroidism? a. Primary b. Secondary c. Exogenous d. Inflammatory

b. Secondary ANS: B Chronic renal failure is the most common cause of secondary hyperparathyroidism because of the resulting hyperphosphatemia that stimulates parathyroid hormone secretion. Although the other options may occur, they are not the most common types of the disorder.

Clinical manifestations of multiple myelomainclude all of the following except: a. bone pain. b. decreased serum calcium. c. M-protein. d. renal damage. e. pathologic fractures.

b. decreased serum calcium.

When the demand for mature neutrophils exceeds the supply, immature neutrophils are released indicating: a.A shift to the right b.A shift to the left c.Leukocytosis d.Leukemia

b.A shift to the left

Which electrolyte imbalance accompanies multiple myeloma (MM)? a.Hyperkalemia b.Hypercalcemia c.Hyperphosphatemia d.Hypernatremia

b.Hypercalcemia c.Hyperphosphatemia I don't know

Which description is consistent with chronic lymphocytic leukemia (CLL)? a.Defects exist in the ras oncogene, TP53 tumor-suppressor gene, and INK4A, the gene encoding a cell-cycle regulatory protein. b.Leukocytosis and a predominance of blast cells characterize the bone marrow and peripheral blood. As the immature blasts increase, they replace normal myelocytic cells, megakaryocytes, and erythrocytes. c.B cells fail to mature into plasma cells that synthesize immunoglobulins. d.The translocation of genetic material from genes 9 and 22 creates an abnormal, fused protein identified as BCR-ABL.

c. B cells fail to mature into plasma cells that synthesize immunoglobulins.

Reed-Sternberg (RS) cells represent malignant transformation and proliferation of which of the following? a.Interleukin (IL)-1, IL-2, IL-5, and IL-6 b.Tumor necrosis factor-beta c.B cells d.T cells

c. B cells

Hodgkin lymphoma a. Epstein-Barr virus b. Bence Jones protein c. Diagnosed by the Reed-Sternberg cell d. Diagnosed by the Philadelphia chromosome

c. Diagnosed by the Reed-Sternberg cell

The effects of the syndrome of inappropriate antidiuretic hormone (SIADH) secretion include solute: a. Retention and water retention b. Retention and water loss c. Dilution and water retention d. Dilution and water loss

c. Dilution and water retention ANS: C The symptoms of SIADH secretion are a result of dilutional hyponatremia and water retention. This information supports the elimination of the other options.

30. Polyuria occurs with diabetes mellitus because of the: a. Formation of ketones b. Chronic insulin resistance c. Elevation in serum glucose d. Increase in antidiuretic hormone

c. Elevation in serum glucose ANS: C Glucose accumulates in the blood and appears in the urine as the renal threshold for glucose is exceeded, producing an osmotic diuresis and the symptoms of polyuria and thirst. None of the other options appropriately describes the pathologic features of diabetes mellitus-induced polyuria.

19. The signs of thyrotoxic crisis include: a. Constipation with gastric distention b. Bradycardia and bradypnea c. Hyperthermia and tachycardia d. Constipation and lethargy

c. Hyperthermia and tachycardia ANS: C The systemic symptoms of thyrotoxic crisis include hyperthermia and tachycardia. The remaining options are not associated with this disorder.

32. A person diagnosed with type 1 diabetes experiences hunger, lightheadedness, tachycardia, pallor, headache, and confusion. The most probable cause of these symptoms is: a. Hyperglycemia caused by incorrect insulin administration b. Dawn phenomenon from eating a snack before bedtime c. Hypoglycemia caused by increased exercise d. Somogyi effect from insulin sensitivity

c. Hypoglycemia caused by increased exercise ANS: C The most likely cause of these symptoms is hypoglycemia, which is often caused by a lack of systemic glucose as a result of muscular activity. None of the remaining options appropriately describes why a person diagnosed with type 1 diabetes experiences the described symptoms.

28. The most probable cause of low serum calcium after a thyroidectomy is: a. Hyperparathyroidism, secondary to Graves disease b. Myxedema, secondary to surgery c. Hypoparathyroidism caused by surgical injury d. Hypothyroidism caused by the lack of thyroid replacement

c. Hypoparathyroidism caused by surgical injury ANS: C The most common cause of hypoparathyroidism is damage caused during thyroid surgery, resulting in a lack of circulating PTH and causing a depressed level of serum calcium. This information supports the elimination of the other options.

27. The most common cause of hypoparathyroidism is: a. Pituitary hyposecretion b. Parathyroid adenoma c. Parathyroid gland damage d.Autoimmune parathyroid disease

c. Parathyroid gland damage ANS: C The most common cause of hypoparathyroidism is damage caused during thyroid surgery, thus eliminating the other options as being correct.

7. The cause of neurogenic diabetes insipidus (DI) is related to an organic lesion of the: a. Anterior pituitary b. Thalamus c. Posterior pituitary. d. Renal tubules

c. Posterior pituitary. ANS: C Neurogenic DI is a result of dysfunctional antidiuretic hormone synthesis, caused by a lesion of the posterior pituitary, hypothalamus, or pituitary stalk.

13. Visual disturbances are a result of a pituitary adenoma because of the: a. Liberation of anterior pituitary hormones into the optic chiasm b. Pituitary hormones clouding the lens of the eyes c. Pressure of the tumor on the optic chiasm d. Pressure of the tumor on the optic and oculomotor cranial nerves

c. Pressure of the tumor on the optic chiasm ANS: C Of the available options, pressure on the optic chiasm is the only cause for visual disturbances resulting from a pituitary adenoma.

17. Amenorrhea, galactorrhea, hirsutism, and osteoporosis are each caused by a: a. Posterior pituitary adenoma b. Thymoma c. Prolactinoma d. Growth hormone adenoma

c. Prolactinoma ANS: C Of the options available, the hallmark of a prolactinoma is the sustained elevation of serum prolactin that is responsible for the symptoms listed in the question.

36. The first laboratory test that indicates type 1 diabetes is causing the development of diabetic nephropathy is: a. Dipstick test for urine ketones b. Increase in serum creatinine and blood urea nitrogen c. Protein on urinalysis. d. Cloudy urine on the urinalysis

c. Protein on urinalysis. ANS: C Microalbuminuria is the first manifestation of this form of renal failure. Although the other options may develop, they occur after protein is found in the urine.

Which laboratory value would the nurse expect to find if a person is experiencing syndrome of inappropriate antidiuretic hormone (SIADH)? a. Hypernatremia and urine hypoosmolality b. Serum potassium (K+) level of 5 mEq/L and urine hyperosmolality c. Serum sodium (Na+) level of 120 mEq/L and serum hypoosmolality d. Hypokalemia and serum hyperosmolality

c. Serum sodium (Na+) level of 120 mEq/L and serum hypoosmolality ANS: C A diagnosis of SIADH requires a serum sodium level of less than 135 mEq/L, serum hypoosmolality less than 280 mOsm/kg, and urine hyperosmolarity. Potassium levels are not considered a factor.

38. What causes the microvascular complications in patients with diabetes mellitus? a. The capillaries contain plaques of lipids that obstruct blood flow. b. Pressure in capillaries increase as a result of the elevated glucose attracting water. c. The capillary basement membranes thicken, and cell hyperplasia develops. d. Fibrous plaques form from the proliferation of subendothelial smooth muscle of arteries.

c. The capillary basement membranes thicken, and cell hyperplasia develops. ANS: C Microvascular complications are a result of capillary basement membranes thickening and endothelial cell hyperplasia. None of the remaining options appropriately describes the cause of microvascular complications in patients with diabetes mellitus.

Graves disease develops from a(n): a. Viral infection of the thyroid gland that causes overproduction of thyroid hormone b. Autoimmune process during which lymphocytes and fibrous tissue replace thyroid tissue c. Thyroid-stimulating immunoglobulin that causes overproduction of thyroid hormones d. Ingestion of goitrogens that inhibits the synthesis of the thyroid hormones, causing a goiter

c. Thyroid-stimulating immunoglobulin that causes overproduction of thyroid hormones ANS: C The pathologic features of Graves disease indicates that normal regulatory mechanisms are overridden by abnormal immunologic mechanisms that result in the stimulation of excessive TH. The remaining options are incorrect statements.

Early detection of acute leukemia would include which of the following symptoms? (Select all that apply.) a.Dizziness b.Paresthesia c.Anorexia d.Bruising e.Bone pain

c.Anorexia d.Bruising e.Bone pain

Hodgkin disease is characterized by the presence of which of the following? a.Philadelphia chromosome b.Virchow triad c.Microvascular thrombi d.Reed-Sternberg (RS) cells

d. Reed-Sternberg (RS) cells

Which description is consistent with chronic myelogenous leukemia (CML)? a.Defects exist in the ras oncogene, TP53 tumor-suppressor gene, and INK4A, the gene encoding a cell-cycle regulatory protein. b.Leukocytosis and a predominance of blast cells characterize the bone marrow and peripheral blood. As the immature blasts increase, they replace normal myelocytic cells, megakaryocytes, and erythrocytes. c.B cells fail to mature into plasma cells that synthesize immunoglobulins. d.The translocation of genetic material from genes 9 and 22 creates an abnormal, fused protein identified as BCR-ABL1.

d. The translocation of genetic material from genes 9 and 22 creates an abnormal, fused protein identified as BCR-ABL1.

Chronic myelogenous leukemia a. Epstein-Barr virus b. Bence Jones protein c. Diagnosed by the Reed-Sternberg cell d. Diagnosed by the Philadelphia chromosome

d. Diagnosed by the Philadelphia chromosome

24. What are clinical manifestations of hypothyroidism? a. Intolerance to heat, tachycardia, and weight loss b. Oligomenorrhea, fatigue, and warm skin c. Restlessness, increased appetite, and metrorrhagia d. Constipation, decreased heart rate, and lethargy

d. Constipation, decreased heart rate, and lethargy ANS: D The lower levels of thyroid hormone result in decreased energy metabolism, resulting in constipation, bradycardia, and lethargy, thus eliminating the remaining options.

40. A person has acne, easy bruising, thin extremities, and truncal obesity. These clinical manifestations are indicative of which endocrine disorder? a. Hyperthyroidism b. Hypoaldosteronism c. Diabetes insipidus. d. Cushing disease

d. Cushing disease ANS: D These symptoms are characteristic of Cushing disease and are caused by excessive ACTH secretion. The symptoms described are not characteristic of any of the other options.

22. Palpation of the neck of a person diagnosed with Graves disease would detect a thyroid that is: a. Left of midline b. Small with discrete nodules c. Normal in size d. Diffusely enlarged

d. Diffusely enlarged ANS: D The only option that characterizes Graves disease is a diffused enlargement of the thyroid gland.

25. Diagnosing a thyroid carcinoma is best performed with: a. Measurement of serum thyroid levels b. Radioisotope scanning c. Ultrasonography. d. Fine-needle aspiration biopsy

d. Fine-needle aspiration biopsy ANS: D Fine-needle aspiration of a thyroid nodule is generally performed to diagnose this condition; this method is best for early detection, thus eliminating the other options.

34. When comparing the clinical manifestations of both diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNKS), which condition is associated with only DKA? a. Fluid loss b. Weight loss c. Increased serum glucose. d. Kussmaul respirations

d. Kussmaul respirations ANS: D Kussmaul respirations are only observed in those with DKA.

39. Retinopathy develops in patients with diabetes mellitus because: a. Plaques of lipids develop in the retinal vessels. b. Pressure in the retinal vessels increase as a result of increased osmotic pressure. c. Ketones cause microaneurysms in the retinal vessels. d. Retinal ischemia and red blood cell aggregation occur.

d. Retinal ischemia and red blood cell aggregation occur. ANS: D Retinopathy appears to be a response to retinal ischemia and red blood cell aggregation. None of the remaining options appropriately describes the relationship between retinopathy and diabetes mellitus.

6. Diabetes insipidus, diabetes mellitus, and syndrome of inappropriate antidiuretic hormone all exhibit which symptom? a. Polyuria b. Edema c. Vomiting d. Thirst

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