Unit 2 Quiz (Ch 13 - 16, 18-23)

Which left atrial pressure readings indicate a risk of increased capillary filtration that results in the clinical manifestations of pulmonary edema? A. 25 mm Hg B. 10 mm Hg C. 6 mm Hg D. 4 mm Hg

A. 25 mm Hg Readings at or above 25 mm Hg are associated with increased capillary filtration and pulmonary edema. The normal left atrial pressure is 4 to 12 mm Hg. *CH 19*

Tetralogy of Fallot is characterized by which of the following? (Select all that apply.) A. A ventricular septal defect B. Right ventricular hypertrophy C. Transposition of the great arteries D. Obstructed right ventricular outflow E. An aorta positioned above the ventricular septal opening

A. A ventricular septal defect B. Right ventricular hypertrophy D. Obstructed right ventricular outflow E. An aorta positioned above the ventricular septal opening Defining features of tetralogy of Fallot are ventricular septal defect, right ventricular hypertrophy, pulmonary stenosis that obstructs right ventricular outflow, andan aorta positioned above the ventricular septal opening (overriding aorta). Transposition of the great arteries is not a defining feature of tetralogy of Fallot. *CH 18*

Risk factors for the development of high blood pressure are which of the following? (Select all that apply.) A. Age B. Race C. Diet D. Weight E. Chronic illness

A. Age B. Race C. Diet D. Weight The older a person is, the less elastic the blood vessels are, which results in higher systemic vascular resistance. High blood pressure occurs two to three times more frequently in the African American population than in the Caucasian population. Diets high in fat and sodium have been associated with hypertension. An association with elevated body mass index and high blood pressure has been noted; however, the exact mechanism is unclear. Chronic illness will not necessarily result in hypertension. *CH 16*

Which is a risk factor associated with hypertension? (Select all that apply.) A. Age B. Caucasian race C. African American race D. High potassium intake E. History of tobacco smoking

A. Age C. African American race E. History of tobacco smoking Normal aging produces a rising systolic pressure over the course of a lifetime, whereas diastolic pressure increases for approximately 50 years, levels off during the sixth decade, and remains stable or declines later on. African Americans are predisposed to hypertension. Also, tobacco use has been shown to increase the risk of hypertension. Being Caucasian is not a known risk factor for hypertension. Diets high in fat and sodium, and low in potassium have been found to increase the risk of developing hypertension. *CH 16*

The nurse includes what information when educating a client concerning a first-degree heart block? (Select all that apply.) A. An electrocardiogram is used to identify this conduction disorder. B. Congenital heart defects are often the cause of the disorder. C. The condition is monitored, but not actively managed. D. Bradycardia is a common characteristic. E. First-degree blocks are rare.

A. An electrocardiogram is used to identify this conduction disorder. B. Congenital heart defects are often the cause of the disorder. C. The condition is monitored, but not actively managed. First-degree block is generally identified by a prolonged PR interval (more than 0.20 second) on the ECG. Drugs and organic heart disorders, such as myocardial ischemia and congenital heart defects, may cause first-degree block. First-degree block is generally monitored, but not actively managed except to alleviate the underlying cause, if possible. A second-degree type II block may also result in severe bradycardia due to the number of dropped beats. First-degree block is a common finding and may occur in the absence of organic heart disease. *CH 19*

Dead space includes which of the following dimensions? (Select all that apply.) A. Anatomic B. Alveolar C. Physiologic D. Cartilaginous E. Airway resistance

A. Anatomic B. Alveolar C. Physiologic Dead space includes three dimensions: Anatomic dead space includes the volume of nonusable gas (not used in gas exchange) in the conducting airways from the nose down to the respiratory bronchioles. Alveolar dead space is composed of ventilated, but unperfused or underperfused, areas of the lung and is often referred to as wasted ventilation. Alveolar dead space increases with the development of pulmonary emboli owing to decreased perfusion. Physiologic dead space (functional dead space) is the sum of the anatomic dead space and alveolar dead space. Approximately one third of each breath occupies dead space. Cartilaginous is not a type of dead space. Airway resistance is not a type of dead space but is primarily determined by the diameter of the airways. *CH 21*

Which statement(s) are true regarding circulatory hemodynamics? (Select all that apply.) A. As blood flow increases, resistance decreases. B. Resistance decreases as the radius of a vessel increases. C. Decreased viscosity of the blood increases resistance. D. Decreased systemic peripheral vascular resistance causes distributive shock. E. As the pressure difference in the vessels increases, the blood flow increases

A. As blood flow increases, resistance decreases. B. Resistance decreases as the radius of a vessel increases. E. As the pressure difference in the vessels increases, the blood flow increases The relationship between blood flow and resistance is an inverse one: as resistance increases, blood flow decreases. Resistance decreases as the radius of a vessel increases. The greater the pressure difference, the greater the blood flow. The more viscous the blood is, the more resistance to flow exists because of the friction between the cells. Decreased systemic vascular resistance (SVR) is the main cause of distributive shock states. *CH 15*

Which clinical manifestation suggests epiglottitis? (Select all that apply.) A. Assumes "sniffing dog" position B. White patches on tonsils C. Throat is "cherry red" D. Reports dysphagia E. Sounds hoarse

A. Assumes "sniffing dog" position C. Throat is "cherry red" D. Reports dysphagia E. Sounds hoarse Common signs and symptoms of epiglottitis include "sniffing dog" position, which provides the best airway patency; oropharynx that is edematous and cherry red; refusal of food because of difficulty swallowing; and dysphonia (hoarseness). White patches would be seen in strep throat. *CH 22*

Which are major obstructive airway diseases? (Select all that apply.) A. Asthma B. Bronchitis C. Pneumonia D. Emphysema E. Bronchiectasis

A. Asthma B. Bronchitis D. Emphysema E. Bronchiectasis Asthma is an inflammatory lung disease characterized by (a) airway obstruction that is reversible (but not completely in some patients). The swelling of bronchial mucosa is associated with obstruction, respiratory distress, and wheezing is known as asthmatic bronchitis. Acute bronchitis differs from bronchiolitis in the size of the airways affected (i.e., trachea and bronchi as opposed to the small bronchiole). Emphysema is a form of chronic obstructive pulmonary disease (COPD) that results from destruction of alveoli and small airways. Bronchiectasis is characterized by recurrent infection and inflammation of bronchial walls, which leads to persistent dilation of the medium-sized bronchi and bronchioles, the three main pathogenic mechanisms are bronchial wall thickening from airway inflammation, bronchial lumen obstruction, and traction on the airways from thick secretions. Pneumonia is not a major obstructive airway disease, but rather results in a decrease in lung compliance. *CH 22*

Which diagnostic analysis is used to identify patients with heart failure? (Select all that apply.) A. BNP (B-type natriuretic peptide) B. ANP (atrial natriuretic peptide) C. Complete blood count (CBC) D. Echocardiogram E. Chest x-ray film

A. BNP (B-type natriuretic peptide) D. Echocardiogram E. Chest x-ray film BNP is a blood test that assists in identifying patients with heart failure. An echocardiogram uses sound waves to create a moving picture of the heart and is used in the diagnosis of heart failure. A chest x-ray is a physical diagnostic test that shows heart structures and is used in the diagnosis of heart failure. Complete blood count (CBC) is a blood analysis used to determine the composition of blood related to amounts of specific cells in a serum sample. The overall effect of ANP on the body is to counter increases in blood pressure and volume caused by the renin-angiotensin system. *CH 19*

Which statement is true regarding the composition of human blood? A. Blood volume averages 5 to 6 L. B. Plasma makes up 10% of blood volume. C. Blood plasma is composed of 7% water. D. Blood cells make up 95% of blood volume.

A. Blood volume averages 5 to 6 L. Blood volume averages 5 to 6 L, or 7% to 8% of total body weight. Blood plasma makes up 44% of blood volume. Blood plasma is composed of 92% water and 7% plasma proteins. Blood cells make up approximately 45% of blood volume. *CH 13*

The pathogenesis of tuberculosis includes the entrance of mycobacteria into the lungs and the resulting of which of the following? (Select all that apply.) A. Calcification B. Ghon tubercles C. Formation of granulomas D. Activation of macrophages E. Antigen-antibody complexes

A. Calcification B. Ghon tubercles C. Formation of granulomas D. Activation of macrophages Calcification of walled off fibrotic areas occurs. Ghon tubercles are characteristic of tuberculosis. Granulomas refers to inflammatory proteins that wall off the mycobacteria. Mycobacteria enter into the lung tissue, where the bacteria are ingested by macrophages. Tuberculosis does not involve antigen-antibody complexes. *CH 23*

Which is a classification of emphysema? (Select all that apply.) A. Centriacinar B. Parenchyma C. Panacinar D. Paraseptal E. Bullae

A. Centriacinar C. Panacinar D. Paraseptal Three major classifications of emphysema exist including centriacinar (also called centrilobular), which is associated with both smoking and chronic bronchitis and destroys the respiratory bronchioles; panacinar (also called panlobular), which destroys the alveoli; and paraseptal, which affects the peripheral lobules. Parenchyma is a type of lung tissue. Emphysema can result in the presence of blebs or bullae in the lungs. *CH 22*

A common cause of heart failure is which of the following? (Select all that apply.) A. Coronary artery disease B. Valvular heart disease C. Cardiomyopathy D. Hypertension E. Anemia

A. Coronary artery disease C. Cardiomyopathy D. Hypertension The most common cause of HF is myocardial ischemia from coronary artery disease, followed by hypertension and dilated cardiomyopathy. Valvular heart disease and anemia are not common causes of heart failure. *CH 19*

A patient is admitted to the hospital with left-sided heart failure. Which clinical manifestation would the nurse expect the client to exhibit? (Select all that apply.) A. Cough B. Dyspnea C. Bradypnea D. Crackles in lungs E. Peripheral edema

A. Cough B. Dyspnea D. Crackles in lungs Common clinical manifestations of left-sided heart failure include cough, dyspnea, and crackles in lungs upon auscultation. Bradypnea describes abnormal slowness of breathing not seen in left-sided heart failure. Peripheral edema is associated with right-sided heart failure. *CH 19*

A general mechanism noted in thrombocytopenia is which of the following? (Select all that apply.) A. Decreased platelet production B. Decreased platelet survival C. Splenic sequestration D. Intravascular dilution E. Hemorrhage

A. Decreased platelet production B. Decreased platelet survival C. Splenic sequestration D. Intravascular dilution Hemorrhage is not one of the mechanisms involved in thrombocytopenia. *Ch 14*

High blood pressure can be treated with lifestyle modification related to which of the following? (Select all that apply.) A. Decreased sodium intake B. Relaxation techniques C. Weight management D. Medication therapy E. Exercise

A. Decreased sodium intake B. Relaxation techniques C. Weight management E. Exercise A low-sodium diet decreases sodium retention and blood volume, altering stroke volume and cardiac output, which results in a lower blood pressure. Relaxation techniques help manage stress which helps lower blood pressure. Obesity is a major risk factor for hypertension. Exercise increases vascular tone, thus decreasing systemic vascular resistance and blood pressure. Medication therapy is not considered a lifestyle modification. *CH 16*

Which is a transport form for CO2 in the blood? (Select all that apply.) A. Dissolved gas B. As a bicarbonate ion C. Between bivalent molecules D. Attached to erythropoietin E. Association with hemoglobin (Hgb)

A. Dissolved gas B. As a bicarbonate ion E. Association with hemoglobin (Hgb) Carbon dioxide, a byproduct of cellular metabolism, is transported in the blood as a dissolved gas, as a bicarbonate ion (HCO3-), and in association with hemoglobin (Hgb). Bivalent molecules are molecules formed from two or more atoms bound together as a single unit molecule. They are not a mechanism for transport of CO2 in the blood. Bone marrow is stimulated by a hormone growth factor called erythropoietin. It is not a mechanism for transport of CO2 in the blood. *CH 13*

Abnormal fluid accumulations in the pleural space affect the lung function by causing which of the following? (Select all that apply.) A. Dyspnea B. Dry cough C. Pleuritic pain D. Expiratory grunting E. Localized diminished breath sounds

A. Dyspnea B. Dry cough C. Pleuritic pain E. Localized diminished breath sounds Pleural effusion causes dyspnea, dry cough, pleuritic pain, and diminished breath sounds over effusion. Grunting on expiration is not associated with pleural effusion. *CH 23*

Von Willebrand disease may present itself by which of the following? (Select all that apply.) A. Epistaxis B. Ecchymoses C. Prolonged PT D. A shortened aPTT E. Decreased von Willebrand factor

A. Epistaxis B. Ecchymoses E. Decreased von Willebrand factor Epistaxis and ecchymoses are common clinical manifestations of von Willebrand disease, and the level of von Willebrand factor is decreased or absent. In von Willebrand disease, the platelet count and PT are normal, but aPTT is prolonged. *Ch 14*

Signs and symptoms of aplastic anemia include which of the following? (Select all that apply.) A. Fever B. Pallor C. Dyspnea D. Petechiae E. Bradycardia

A. Fever B. Pallor C. Dyspnea D. Petechiae TACHYCARDIA, NOT BRADYCARDIA *CH 13*

Characteristics of allergic purpura lesions include which of the following? (Select all that apply.) A. Fever and itching B. Easily palpated lesions C. Bleeding from the lesions D. Lesions located on the face E. Lesions located on the trunk

A. Fever and itching B. Easily palpated lesions Purpura lesions are itchy and a fever is likely. They are raised and are usually easily felt. Bleeding from the lesions themselves and generalized bleeding are uncommon. The lesions tend to be found on the proximal extremities, especially on the legs and buttocks. *Ch 14*

The purpose of the upper respiratory system is which of the following? (Select all that apply.) A. Filtering of inspired gas B. Warming of inspired gas C. Exchange of inspired gas D. Humidification of inspired gas E. Conduction of air toward the alveoli

A. Filtering of inspired gas B. Warming of inspired gas D. Humidification of inspired gas E. Conduction of air toward the alveoli The nose filters air as it enters into the upper airway. The nose and upper airways warm the air as it passes across the membranes. As the air is taken through the upper airways, it picks up moisture from the mucous membranes of the nose and sinuses. The airways are designed to conduct the air to the lower airways. Gas exchange occurs in the alveoli, not in the upper respiratory system. *CH 21*

Petechiae that are a result of vascular and platelet disorders are noted to be which of the following? (Select all that apply.) A. Flat B. Scaly C. Pinpoint D. Vesicular E. Nonblanching

A. Flat C. Pinpoint E. Nonblanching Petechiae are caused by capillary hemorrhages in the skin and mucous membranes, so they are small, flat, and nonblanching. Petechiae are caused by capillary hemorrhages in the skin and mucous membranes, so they are not scaly or fluid-filled. *Ch 14*

Systemic blood pressure is determined by which factor(s)? (Select all that apply.) A. Heart rate (HR) B. Stroke volume (SV) C. Cardiac output (CO) D. Systemic vascular resistance (SVR) E. Pulmonary vascular resistance (PVR)

A. Heart rate (HR) B. Stroke volume (SV) C. Cardiac output (CO) D. Systemic vascular resistance (SVR) The systemic arterial blood pressure is the physiologic result of the cardiac output (CO) and the resistance to the ejection (SVR) of blood from the heart. Cardiac output is the product of two variables: stroke volume (SV) and heart rate (HR) (CO = SV × HR). SV is the specific volume of blood leaving the heart with each contraction. Pulmonary vascular resistance (PVR) is not a factor in determining systemic blood pressure. *CH 16*

Vitamin K Deficiency induced bleeding in infancy is characterized by which of the following? (Select all that apply.) A. Hematuria B. Tarry stools C. History of breast feeding D. Commonly diagnosed in the United States E. Symptoms onset occurs between 48 and 72 hours

A. Hematuria B. Tarry stools C. History of breast feeding E. Symptoms onset occurs between 48 and 72 hours Symptoms include bleeding, such as hematuria and melena (tarry, black feces composed of partially digested blood). Hemorrhagic disease of the newborn is more common in breast-fed babies (who do not receive vitamin K supplement) than in formula-fed babies. As the name implies, this coagulation disorder is seen in the newborn, typically 48 to 72 hours after birth, through 6 months of age. It is rare in Western countries because of routine administration of vitamin K to newborns. *Ch 14*

Hemoglobin desaturates in which states? (Select all that apply.) A. High PCO2 (hypercapnia) B. Low PCO2 (hypocapnia) C. High pH (alkalosis) D. Low pH (acidosis) E. Dehydration

A. High PCO2 (hypercapnia) D. Low pH (acidosis) Oxygen saturation refers to the extent to which hemoglobin is saturated with oxygen. In the presence of low pH (acidosis) and high PCO2 concentrations (hypercapnia), the hemoglobin molecule releases the O2 molecule more readily resulting in a lack of attached oxygen molecules. In the presence of either low pH (acidosis) and/or high PCO2 concentrations (hypercapnia), the hemoglobin molecule releases the O2 molecule more readily resulting on oxygenation. Dehydration is not a factor in hemoglobin desaturation. *CH 13*

Which cellular change is seen with chronic bronchitis? A. Increased eosinophils B. Decreased CD8 T lymphocytes C. Decreased interleukin-8 levels D. Atrophy of bronchial glands

A. Increased eosinophils There is a thirtyfold increase in eosinophils. Chronic bronchitis is characterized by increased interleukin-8 and CD8 T lymphocytes. There is hypertrophy of bronchial glands and goblet cells. *CH 22*

What causes a shift of the oxyhemoglobin curve to the left? (Select all that apply.) A. Increased pH B. Chronic disease C. Decreased H+ ions D. Decreased temperature E. Increased in 2,3-DPG

A. Increased pH C. Decreased H+ ions D. Decreased temperature The shift of the curve to the left occurs with an increase in pH, a decrease in H+ concentration, and with a decrease in temperature. The shift of the oxyhemoglobin curve to the right enhances oxygen release to the cell. The shift provides the increase in oxygen delivery that is needed during stress, chronic disease, and exercise. The shift of the curve to the left occurs with a decrease in 2,3-DPG, in some congenital hemoglobinopathies, and with carboxyhemoglobin. *CH 13*

What effect does stimulation of the sympathetic nervous system have on the arterioles and resulting systemic reaction? (Select all that apply.) A. Increased vascular resistance B. Increased blood pressure C. Increased afterload D. Constriction E. Dilation

A. Increased vascular resistance B. Increased blood pressure C. Increased afterload D. Constriction Stimulation of the sympathetic nervous system results in increased vascular resistance, increased blood pressure, increased afterload, and constriction of the arterioles. Stimulation of the sympathetic nervous system results in constriction, not dilation, of the arterioles. *CH 19*

The pathogenesis of pneumonia includes the inhalation of microbial agents and the resulting of which of the following? (Select all that apply.) A. Inflammation B. Lung consolidation C. Formation of exudates D. Alveolar wall thickening E. Decreased lung compliance

A. Inflammation B. Lung consolidation C. Formation of exudates Pneumonia presents with pulmonary inflammation. Alveolar air spaces fill with exudative fluid, and inflammatory cells invade alveolar septa. With pneumonia lung consolidation occurs. Alveolar exudates are characteristic of pneumonia. Alveolar wall thickness is not affected by pneumonia. Lung compliance is not affected by pneumonia. *CH 23*

Acute bronchitis can be caused by which of the following? (Select all that apply.) A. Influenza A B. Adenovirus C. Coxsackie virus D. Pseudomonas aeruginosa E. Streptococcus pneumoniae

A. Influenza A B. Adenovirus C. Coxsackie virus E. Streptococcus pneumoniae Influenza A, adenovirus, Coxsackie virus, and Streptococcus pneumoniae can cause acute bronchitis. Pseudomonas aeruginosa does not cause acute bronchitis. *CH 22*

The pathogenesis of adult respiratory distress syndrome (ARDS) involves which of the following? (Select all that apply.) A. Injury to the alveolar-capillary membrane B. Increased alveolar-capillary permeability C. Decreased lung compliance D. Alveolar wall thickening E. Collapse of the lung

A. Injury to the alveolar-capillary membrane B. Increased alveolar-capillary permeability C. Decreased lung compliance Injury to the alveolar-capillary membrane, increased alveolar-capillary permeability, and alveolar edema and the resulting decreased lung compliance are characteristic of adult respiratory distress syndrome. Alveolar wall thickening is not characteristic of adult respiratory distress syndrome. A collapsing of a lung is characteristic of atelectasis. *CH 23*

Which is a required for red blood cell production? (Select all that apply.) A. Iron B. Folate C. Vitamin B12 D. Vitamin K E. Vitamin C

A. Iron B. Folate C. Vitamin B12 Iron, folate, and vitamin B12 are required for red blood cell production. Vitamins K and C are not required for red blood cell production. *CH 13*

Which statement is true about disseminated intravascular coagulation (DIC)? A. It is both a bleeding and clotting disorder. B. The acute form has more thrombotic episodes. C. Fibrin split products are decreased. D. Fibrinogen level is increased.

A. It is both a bleeding and clotting disorder. DIC is both a bleeding and clotting disorder. There are two types, with the chronic type being more prone to thrombotic episodes because the liver and bone marrow are functioning at a higher level and are able to produce more clotting factors and platelets. There is a rise in fibrin split products secondary to the destruction of clots. The fibrinogen level decreases as the body uses it up. *Ch 14*

Which statement(s) are true regarding aplastic anemia? (Select all that apply.) A. It is caused by viral infections. B. It is characterized by pancytopenia. C. It can be either acquired or familiar in nature. D. It is a result of radiant damage to bone marrow stem cells. E. It is characterized by overproduction of hematopoietic tissue.

A. It is caused by viral infections. B. It is characterized by pancytopenia. C. It can be either acquired or familiar in nature. D. It is a result of radiant damage to bone marrow stem cells. Causes include certain viral infections (e.g., hepatitis, Epstein-Barr virus, human immunodeficiency virus [HIV]). It is usually caused by toxic, radiant, or immunologic injury to the bone marrow stem cells. Pancytopenia can be a symptom. It can be classified as acquired or familial. Aplastic anemia is a stem cell disorder with reduction of hematopoietic tissue in the bone marrow. *CH 13*

Which statement regarding bronchiectasis is true? A. It is common in cystic fibrosis. B. It often leads to lung carcinoma. C. It is classified according to stage of spread. D. The most common bacterial pathogen is Streptococcus pneumoniae.

A. It is common in cystic fibrosis. Cystic fibrosis is associated with 50% of the cases of bronchiectasis. There is no current research to support a connection between these conditions. Bronchiectasis can be classified according to bronchial shape: saccular (with cavitylike dilatations) or cylindrical, and with widening of the bronchial walls. A fusiform shape is a combination of saccular and cylindrical changes. H. influenzae is the most common cause of bacterial infections (29% to 70%), followed by pseudomonas aeruginosa (12% to 31%). *CH 22*

The portion of the brain that is responsible for neural control of the respiratory system is which of the following? (Select all that apply.) A. Medulla oblongata B. Cerebellum C. Frontal lobe D. Thalamus E. Pons

A. Medulla oblongata E. Pons The medullary respiratory center within the brainstem consists of two groups of widely dispersed neurons that function as a unit to regulate breathing. The pneumotaxic center of the upper pons appears to influence the rate of respiration and ends inspiration by inhibition of the inspiratory ramp, with increasing action potentials in a crescendo fashion. The cerebellum is associated with receiving auditory and visual information. The frontal lobes are involved in motor function, problem-solving, spontaneity, memory, language, initiation, judgment, impulse control, and social and sexual responses. The thalamus controls your sensory integration and motor integration. *CH 21*

Which statement(s) are true regarding hemoglobin? (Select all that apply.) A. Oxyhemoglobin is hemoglobin-carrying oxygen. B. There are 100 hemoglobin molecules per red blood cell. C. Hemoglobin makes up 90% of dry weight of the red cell. D. Hemoglobin is composed of two pairs of polypeptide chains. E. Polypeptide chains contain iron that makes up a heme molecule.

A. Oxyhemoglobin is hemoglobin-carrying oxygen. C. Hemoglobin makes up 90% of dry weight of the red cell. D. Hemoglobin is composed of two pairs of polypeptide chains. E. Polypeptide chains contain iron that makes up a heme molecule. Oxyhemoglobin is hemoglobin that is carrying oxygen molecules. Hemoglobin makes up about 90% of the dry weight of the red blood cell, and is composed of two pairs of polypeptide chains: the globins. Each globin has an attached heme molecule that is composed of iron plus a protoporphyrin molecule. There are 300, not 100, hemoglobin molecules per cell. *CH 13*

Which clinical manifestation is characteristic of arterial thrombosis? (Select all that apply.) A. Pain is increased with activity in the affected limb. B. A positive Homans' sign is seen in 10% of patients. C. The limb is usually cool to the touch and cyanotic. D. A late sign is an ulcer around the toe. E. Intermittent claudication and pain.

A. Pain is increased with activity in the affected limb. C. The limb is usually cool to the touch and cyanotic. D. A late sign is an ulcer around the toe. E. Intermittent claudication and pain. Clinical manifestations of an arterial thrombosis include pain with activity in the affected limb that improves with rest, the limb being cool to touch and cyanotic, a painful arterial ulcer found usually around one toe, and intermittent claudication. A positive Homans' sign is seen in a venous thrombosis. *CH 15*

Which condition presents a problem with lung diffusion? (Select all that apply.) A. Pneumonia B. Pulmonary edema C. Interstitial lung disease D. Small cell (oat cell) carcinoma E. Squamous cell epidermoid carcinoma

A. Pneumonia B. Pulmonary edema C. Interstitial lung disease Patients with problems with diffusion include those with pneumonia, pulmonary edema, and interstitial lung disease. Small cell (oat cell) carcinoma and squamous cell epidermoid carcinoma present obstruction problems. *CH 21*

Which clinical manifestation differentiates myocardial infarction (MI) from angina pectoris? (Select all that apply.) A. Radiating chest pain B. Chest pain initiated by exercise C. ST-segment changes on the ECG D. Elevated serum levels of troponin E. Chest pain aggravated by coughing

A. Radiating chest pain C. ST-segment changes on the ECG D. Elevated serum levels of troponin Radiating chest pain is a clinical finding for individuals experiencing myocardial infarction. Myocardial ischemia and infarction are indicated on the ECG by ST-segment changes. Serum protein marker elevations such as troponin and CK-MB are clinical findings for individuals experiencing myocardial infarction. Exercise-induced chest pain is a classic symptom of angina pectoris. Chest pain that is aggravated by coughing is more likely observed with angina pectoris than myocardial infarction. *CH 18*

A skin assessment of the legs of a client diagnosed with chronic venous insufficiency would show which of the following? (Select all that apply.) A. Reddish pigmented areas B. Reports of legs "cramping" C. Edema increasing as the day progresses D. An ulcer on the ankle of the affected leg E. Pain that decreases when legs are in the dependent position

A. Reddish pigmented areas B. Reports of legs "cramping" C. Edema increasing as the day progresses D. An ulcer on the ankle of the affected leg Pigmented areas of reddish brown are commonly noted. Clients describe the leg(s) as aching or cramping, and edema, especially at end of day, is common. An ulcer on the bony prominences at the ankle (medial malleolus) is characteristic. Pain is relieved by elevating the legs. *CH 15*

Which type of shock is characterized by generalized vasodilation and peripheral pooling of blood? (Select all that apply.) A. Septic B. Neurogenic C. Cardiogenic D. Anaphylactic E. Hypovolemic

A. Septic B. Neurogenic D. Anaphylactic Septic shock, neurogenic shock, and anaphylactic shock are characterized by excessive vasodilation and peripheral pooling of blood. Cardiac output is inadequate because of reduced preload. Cardiogenic shock occurs primarily as a result of severe dysfunction of the left or right ventricles, or both, that results in inadequate cardiac pumping. Hypovolemic shock is a result of excessive blood loss; vasoconstriction is initially seen in this form of shock. *CH 20*

Which is a modifiable risk factor for prevention of atherosclerosis? A. Smoking B. Genetics C. Gender D. Age

A. Smoking *CH 15*

What occurs during an acute asthma attack? (Select all that apply.) A. Sputum is often thick, tenacious, scant, and viscid. B. Bronchoconstriction occurs. C. Residual lung volume increases. D. Tidal volume remains unchanged. E. Forced expiratory volumes decrease.

A. Sputum is often thick, tenacious, scant, and viscid. B. Bronchoconstriction occurs. C. Residual lung volume increases. E. Forced expiratory volumes decrease. Sputum is often thick, tenacious, scant, and viscid. Bronchospasm are experienced during asthma attacks. Air becomes trapped because of the inflammatory changes that occur so increasing residual lung volume. Forced expiratory volumes decrease during asthma attacks. Tidal does not remain constant during an asthma attack. *CH 22*

Which statement(s) are true regarding plasma proteins? (Select all that apply.) A. There are three types of plasma proteins. B. Plasma protein β fraction transports iron. C. These proteins are formed in the kidneys. D. Plasma proteins function as regulatory factors. E. Plasma proteins are responsible regulating blood pressure.

A. There are three types of plasma proteins. B. Plasma protein β fraction transports iron. D. Plasma proteins function as regulatory factors. E. Plasma proteins are responsible regulating blood pressure. There are three general types of plasma proteins; albumin, globulin, and fibrinogen. The β fraction protein is associated with the transport of iron and copper in plasma. Regulatory proteins, such as hormones and enzymes, are also present in the plasma. Plasma proteins contribute to colloid osmotic pressure, which is important in maintaining blood pressure. Plasma proteins are formed mainly in the liver, not in the kidneys. *CH 13*

The characteristics of bronchiolitis include which of the following? (Select all that apply.) A. Thick, tenacious mucus B. Wheezing C. Crackles D. Bradypnea E. Ear pain

A. Thick, tenacious mucus B. Wheezing C. Crackles E. Ear pain Common clinical features include tenacious sputum, wheezing resulting from bronchospasm, crackles, and otitis media associated with S. pneumoniae. Increased rather than decreased respirations are noted. *CH 22*

Which statement is true regarding the process of autoregulation? (Select all that apply.) A. This process is responsible for maintaining a relatively constant flow of blood in the body. B. As vascular smooth muscle is stretched, it contracts, which produces vasoconstriction. C. The process takes blood flow within a range that is unique to a specific organ's needs. D. When an organ experiences high demand for blood the appropriate vessels constrict. E. In instances of decreased metabolic demand, blood flow to the tissue is reduced.

A. This process is responsible for maintaining a relatively constant flow of blood in the body. B. As vascular smooth muscle is stretched, it contracts, which produces vasoconstriction. C. The process takes blood flow within a range that is unique to a specific organ's needs. E. In instances of decreased metabolic demand, blood flow to the tissue is reduced. Autoregulation refers to the ability of blood vessels within organs to maintain a relatively constant blood flow, regardless of changes in arterial pressure. It is known that as vascular smooth muscle is stretched, it contracts. Therefore, as arterial pressure rises and arterial walls stretch, contraction is stimulated, producing vasoconstriction. This flow is relatively constant because it does have limits; there is a range within which it is maintained, and the range varies slightly from organ to organ. In instances of high blood pressure or decreased metabolic demand, the arterioles and precapillary sphincters that control flow to the tissue constrict, reducing flow. In instances of low blood pressure or high demand, vessels dilate (not constrict), increasing flow. *CH 15*

The role of the circulatory system is to do which of the following? (Select all that apply.) A. Transport O2 and nutrients throughout the body B. Remove waste products found within the body C. Move blood to the lungs from the left side of the heart D. Move blood systemically from the right side of the heart E. Release of oxygen through the gastrointestinal tract via the splanchnic circulation

A. Transport O2 and nutrients throughout the body B. Remove waste products found within the body The primary functions of the circulatory system include the transportation of O2 and nutrients within the body and the removal of metabolic waste products within the body. Movement of blood through the lungs is via the right side of the heart. Systemic blood flow is supplied by the left side of the heart. Nutrients are absorbed into the blood as it moves through the gastrointestinal tract via splanchnic circulation, and O2 uptake and the release of CO2 occur in the specialized vascular bed of the pulmonary circulation. *CH 15*

What type of cells make up the alveoli and are involved in gas exchange? A. Type I pneumocytes B. Type II pneumocytes C. Alveolar macrophages D. Goblet cells

A. Type I pneumocytes Type I cells (pneumocytes) make up the alveoli. Type II cells make surfactant. Alveolar macrophages act as a defense mechanism by phagocytizing particles in the alveoli. Goblet cells are involved in mucus production. *CH 21*

Which is a major determinant of diastolic blood pressure? A. Vascular resistance B. Stroke volume C. Preload D. Heart rate

A. Vascular resistance Systemic vascular resistance is the major determinant of diastolic blood pressure. It reflects the arteriolar radius and the degree of constriction, and it is the main variable in determining afterload. Stroke volume is the primary factor impacting systolic pressure. The end-diastolic volume is determined by the amount of blood returned to the heart between contractions, and is typically called the heart's preload. Heart rate is the number of times the heart contracts within a 60-second timeframe. *CH 16*

An accurate comparison of arterial and venal vessels would include which of the following? (Select all that apply.) A. Vein walls are thinner than those of arteries. B. Veins have two distinct layers, while arteries have three. C. Venules are composed primarily of connective tissue. D. The principle tissue found in arterioles is smooth muscle. E. With increasing age, the intimal arterial wall loses elasticity.

A. Vein walls are thinner than those of arteries. C. Venules are composed primarily of connective tissue. D. The principle tissue found in arterioles is smooth muscle. E. With increasing age, the intimal arterial wall loses elasticity. Generally, the walls of veins are not as thick as the walls of arteries, but the lumina are larger. In venules, connective tissue dominates. In arterioles, the principal tissue is smooth muscle. Aging causes this inner layer to become thinner and less elastic. The walls of both arteries and veins are composed of three (not two) microscopically distinct layers, or tunicae: the intima, the media, and the adventitia. *CH 15*

Pulmonary function testing for restrictive diseases reveals which of the following to be decreased? (Select all that apply.) A. Vital capacity B. Respiratory rates C. Total lung capacity D. Residual volume E. Forced expiratory flow

A. Vital capacity C. Total lung capacity D. Residual volume In restrictive diseases there is limitation of chest expansion, resulting in decreased vital, total lung, and diffusing capacities. Respiratory rates and forced expiratory flow are not characteristically decreased with restrictive respiratory diseases. *CH 23*

What are the main causes of edema? A. When the adjacent lymphatic system develops an impaired lymphatic flow or when the capillaries themselves become more permeable and "leak" fluid into the cell B. When the capillaries develop an impaired flow or when the lymphatic system becomes more permeable and "leaks" fluid into the cell C. When the capillary beds develop a decreased pressure, thereby promoting fluid "leaks" into the interstitial fluid D. When the lymphatic system fails to pick up excess fluid from the interstitial space

A. When the adjacent lymphatic system develops an impaired lymphatic flow or when the capillaries themselves become more permeable and "leak" fluid into the cell The main mechanisms that result in edema are usually the development of impaired lymphatic flow in an adjacent lymphatic system or "leaking" of fluid into the cell as a result of capillaries themselves becoming more permeable. The mechanisms that result in edema are not related to impaired flow in the capillaries or the lymphatic system's becoming permeable and leaking. Increased rather than decreased pressure would be a factor in edema. The lymphatic system's failing to pick up excess fluid does not address the major pathology that results in edema. *CH 15*

Circulatory shock is best defined as A. inadequate tissue perfusion. B. cardiovascular collapse. C. acute pump failure. D. vasodilation.

A. inadequate tissue perfusion. Circulatory shock is characterized by an imbalance between oxygen supply and oxygen requirements at the cellular level, wherein oxygen supply is decreased. Circulatory shock and acute pump failure are not the only causes of cardiovascular collapse. Vasodilation is not a cause of cardiovascular collapse, but is seen in anaphylactic, neurogenic, and septic shocks. *CH 20*

Compliance of the lung is the measure of A. the lungs ability to be inflated. B. gas exchange at the alveoli. C. the lungs dead space. D. shunting.

A. the lungs ability to be inflated. Compliance is the measure of resistance of the lung to being inflated. If the lung is stiff, it is said to have too little compliance and the lung is difficult to inflate. Gas exchange at the alveoli level involves perfusion. Dead space is not defined in terms of compliance. Pulmonary shunting is a physiologic condition which results when the alveoli of the lung are perfused with blood as normal, but ventilation (the supply of air) fails to supply the perfused region. *CH 21*

Areas of the lung that have little ventilation and thus little oxygen will cause the blood vessels of that area to A. vasoconstrict. B. vasodilate. C. stabilize. D. clot off.

A. vasoconstrict. The lungs match the blood flow with ventilation and oxygen delivery to the alveoli to optimize oxygen delivery to the bloodstream. The area of lung tissue with little ventilation will constrict. Areas of lung tissue with more ventilation will experience vasodilation. Ventilation and resulting oxygenation will normally result in a change in order to allow for adaptation. Clotting is not a result of ventilation or oxygenation. *CH 21*

Which statement is true regarding the streamlined nature of laminar blood flow? A. Turbulent blood flow is a result of a vessel branching at a wide angle. B. A thrill can be palpated when blood flows over a roughened intimal surface. C. Blood contacting the intima moves more quickly than that in the center of the vessel. D. A thrombus results when the blood in the middle of the vessel flows more quickly than that in the outer layer.

B. A thrill can be palpated when blood flows over a roughened intimal surface. Blood flowing over a roughened intimal surface which can be auscultated is called a bruit; if it can be palpated it is called a thrill. Turbulent blood flow can be caused by a branching vessel at a sharp angle. Under normal circumstances, blood flows more quickly in the middle of the vessel than the blood touching the intima of the vessel wall. Slowed or obstructed blood flow promotes the development of a thrombus (blood clot). *CH 15*

What is an appropriate treatment for sickle cell disease? A. Early spleen removal B. Acetaminophen for fever control C. Hydroxyurea for Streptococcus pneumoniae D. Dehydration to prevent vaso-occlusive crisis

B. Acetaminophen for fever control Acetaminophen is preferred for fever control, because aspirin causes an acid load. Splenectomy is done when sequestration syndrome occurs. Hydroxyurea increases fetal hemoglobin. Vaccination is for encapsulated organisms such as Streptococcus pneumoniae and Haemophilus influenzae. Streptococcus pneumoniae is treated with penicillin. Hydration is important to prevent dehydration, which is one of the causes of vaso-occlusive crisis. *CH 13*

Which condition can produce signs and symptoms of a stroke? (Select all that apply.) A. Varicose veins B. Atherosclerosis C. Cerebral aneurysm D. Cerebral AV fistula E. Chronic venous insufficiency

B. Atherosclerosis C. Cerebral aneurysm D. Cerebral AV fistula Atherosclerosis produces an increase of smooth muscle cells and increased lipids within the intima of the arteries, which narrows the blood flow. This eventually affects the entire body and can produce many diseases, such as hypertension, renal failure, coronary artery disease, and cerebrovascular accident. An aneurysm is a weakened area in an artery that may eventually rupture resulting is strokelike symptoms. AV fistulas are a collection of weakened vessels that are congenital and can cause swelling on the vein therefore increasing pressure. Structural alterations can form in the veins (in the leaflets), resulting in diminished blood flow that may affect superficial veins (varicose veins) or deep veins (chronic venous insufficiency), causing severe tissue hypoxia and venous stasis ulcers. *CH 15*

A true statement regarding atherosclerosis is which of the following? (Select all that apply.) A. Atherosclerosis obliterans occurs when the peripheral system of upper extremities are affected. B. Atherosclerosis usually affects the coronary, cerebral, carotid, femoral arteries and the aorta. C. Atherosclerosis obliterans is used to describe atherosclerosis; the terms are interchangeable. D. Atherosclerosis is a result of medium and large arteries being occluded. E. Atherosclerosis is the dominant type of arteriosclerosis.

B. Atherosclerosis usually affects the coronary, cerebral, carotid, femoral arteries and the aorta. D. Atherosclerosis is a result of medium and large arteries being occluded. E. Atherosclerosis is the dominant type of arteriosclerosis. Atherosclerosis most frequently affects the coronary, cerebral, carotid, and femoral arteries and the aorta. Atherosclerosis is caused by occlusion of large and medium-sized arteries and is the dominant type of arteriosclerosis. When atherosclerosis involves the peripheral vascular system, it is most often the lower extremities, and the disease process may be called atherosclerosis obliterans. Atherosclerosis obliterans is a form of atherosclerosis; the terms are not interchangeable, since atherosclerosis obliterans refers to a specific location of the disease. *CH 15*

What is the difference between capillary fluid pressure and plasma colloid osmotic pressure? A. Capillary fluid pressure is the fluid pressure outside the capillary and is the force pushing fluid from the interstitium from the capillary; plasma colloid osmotic pressure is the primary force because of the presence of anions, which result in fluid remaining in the capillary. B. Capillary fluid pressure is the fluid pressure inside the capillary and is the force pushing fluid from the capillary into the interstitium; plasma colloid osmotic pressure is the primary force because of the presence of plasma proteins, which results in fluid remaining in the capillary. C. Capillary fluid pressure is the fluid pressure inside the capillary and is the force pulling fluid from the interstitium into the capillary; plasma colloid osmotic pressure is the primary force because of the presence of plasma proteins, which result in fluid remaining in the capillary. D. Capillary fluid pressure is the fluid pressure inside the capillary and is the force pushing fluid from the capillary into the interstitium; plasma colloid osmotic pressure is the primary force because of the presence of cations, which result in fluid remaining in the interstitial space.

B. Capillary fluid pressure is the fluid pressure inside the capillary and is the force pushing fluid from the capillary into the interstitium; plasma colloid osmotic pressure is the primary force because of the presence of plasma proteins, which results in fluid remaining in the capillary. Capillary fluid pressure is the fluid pressure inside the capillary and is the force pushing fluid from the capillary into the interstitium (called hydrostatic pressure). Plasma colloid osmotic pressure is the primary force because of the presence of plasma proteins, which result in fluid remaining in the capillary. Most plasma proteins remain in the capillaries because they are such large molecules that they are unable to move easily through the capillary walls. The other options do not correctly define the terms or the processes. *CH 15*

Which structures are located within the larynx? (Select all that apply.) A. Acinus B. Cartilage C. Epiglottis D. Vocal cords E. Estachian tube

B. Cartilage C. Epiglottis D. Vocal cords The larynx contains cartilages, the epiglottis, and the vocal cords. Acinus is the terminal portion of the tracheobronchial tree. The eustachian tube is between the middle ear and the posterior nasopharynx. *CH 21*

When emphysema is a result of a α1-antitrypsin disorder, assessment data is likely to include which of the following? (Select all that apply.) A. Caucasian B. Client age younger than 50 C. Elevated levels of α1-antitrypsin D. History of cigarette smoking E. Enzyme levels that are below normal

B. Client age younger than 50 D. History of cigarette smoking E. Enzyme levels that are below normal When emphysema occurs in young- to middle-aged adults or before the age of 50 in a smoker, it may be associated with a deficiency of α1-antitrypsin activity in the lung. Cigarette smoking is not always a risk factor when this hereditary disorder is present. α1-Antitrypsin deficiency is a hereditary disorder characterized by low serum levels (25 to 50 mg/dL). Research does not currently support race as being a risk factor. α1-Antitrypsin deficiency is a hereditary disorder characterized by low serum levels (25 to 50 mg/dL). *CH 22*

What is the pathophysiologic phenomenon underlying disseminated intravascular coagulation (DIC)? A. Elevated platelet and fibrinogen levels B. Clotting that leads to bleeding C. Inadequate cardiac output D. Mast cell degranulation

B. Clotting that leads to bleeding DIC is a result of widespread clot formation that consumes platelets and clotting factors, which leaves the patient at risk for serious bleeding. As the result of extensive clotting, platelet and fibrinogen levels are decreased not increased. Inadequate cardiac outcome is the fatal outcome of DIC. Mast cell degranulation is not relevant to DIC. *CH 20*

Which is a true statement regarding the airways? A. There are three main bronchi. B. Cough receptors lie at the carina. C. The carina is in the right mainstem bronchus. D. There are six secondary or lobar branches from the bronchi.

B. Cough receptors lie at the carina. The majority of cough receptors lie at the carina. The trachea divides into two main bronchi. The carina is located at the point where the trachea divides. The two main bronchi branch into five secondary or lobar branches. *CH 21*

Systemic vascular resistance (SVR) can be indirectly estimated with the use of which blood pressure measurement? A. Systolic pressure B. Diastolic pressure C. Pulmonary arterial pressure D. Left ventricular end-diastolic pressure

B. Diastolic pressure The systemic diastolic pressure is determined by the narrowing of blood vessel diameter and therefore the resistance to blood flow, whether from peripheral vascular constriction or atherosclerosis. Systolic pressure is not as influenced by the narrowing of blood vessel diameter. Pulmonary arterial pressure is generated by the right ventricle ejecting blood into the pulmonary artery. By definition, the volume of blood within a ventricle immediately before a contraction is known as the end-diastolic volume. *CH 16*

A contributing factor to the formation of an embolus includes which of the following? (Select all that apply.) A. A chronic blood disorder like anemia B. Dislodged fat after long-bone surgery C. Air bolus introduced by IV therapy D. Foreign object in the blood stream E. An infected blood vessel

B. Dislodged fat after long-bone surgery C. Air bolus introduced by IV therapy D. Foreign object in the blood stream E. An infected blood vessel Fat emboli can occur after long-bone surgery or trauma. Air introduced into the circulatory system can result in an air embolus. Any foreign body in the circulating in the system can be the cause of an embolus. An infection present in a vessel can trigger an embolus. Chronic blood disorders like anemia are not generally triggers for emboli. *CH 15*

Which results in an increase in lung compliance? A. Pneumonia B. Emphysema C. Pulmonary fibrosis D. Pulmonary edema

B. Emphysema Emphysema makes the lung compliance increase because of a loss of alveoli. Pneumonia, pulmonary fibrosis, and pulmonary edema make the lung stiffer and decrease respiratory function. *CH 21*

Which medication may be required for status asthmaticus? (Select all that apply.) A. β-Blockers B. Epinephrine C. Oral corticosteroids D. Terbutaline (Brethine) E. Aminophylline (Phyllocontin)

B. Epinephrine D. Terbutaline (Brethine) E. Aminophylline (Phyllocontin) Epinephrine, terbutaline (Brethine), or aminophylline (Phyllocontin) may be required. β-Blockers are contraindicated in asthma, because they worsen bronchospasm. Intravenous corticosteroids are most appropriate (versus oral corticosteroids). *CH 22*

What describes an asthma that is common in children and adolescents, with bronchospasm occurring within 3 minutes of physical exertion? A. Occupational-induced B. Exercise-induced C. Cardiac-induced D. Drug-induced

B. Exercise-induced Exercise-induced asthma (bronchospasm that occurs after activity or exercise) is common in children and adolescents. Occupational-induced asthma results from exposure to allergens and mimics extrinsic asthma. Cardiac-induced asthma results from bronchospasm precipitated by congestive heart failure. Drug-induced asthma occurs after reaction to medication. *CH 22*

Which form(s) of anemia will present with macrocytes? (Select all that apply.) A. Chronic renal failure B. Folate deficiency C. Iron-deficiency D. Thalassemia E. B12

B. Folate deficiency E. B12 Folate and B12 deficiency causes the production of macrocytes in the peripheral blood. In renal failure, the red blood cells are decreased and may have spicules. Iron-deficiency anemia is described by the presence of hypochromic and microcytic cells. Thalassemia is caused by destruction or hemolysis of red blood cells. *CH 13*

Which statement is true regarding hypertension? A. Hypertension is defined as pressure greater than 160 mm Hg systolic. B. High blood pressure can be associated with headache and seizures. C. Diagnosis can be made with one elevated reading. D. Low weight contributes to high blood pressure.

B. High blood pressure can be associated with headache and seizures. Headache and seizures are associated with high blood pressure. The actual definition of high blood pressure is a systolic pressure greater than 140 mm Hg or a diastolic pressure greater than 90 mm Hg, or both. The diagnosis of hypertension requires the recording on two separate occasions of these elevations. Obesity, elevated sodium intake, age, ethnicity, and family history are all causes of high blood pressure. *CH 16*

Uncontrolled massive bleeding causes what type of shock? A. Cardiogenic B. Hypovolemic C. Neurogenic D. Septic

B. Hypovolemic Hypovolemic (low-volume) shock occurs in the presence of massive blood loss when the amount of blood available for circulation decreases. Cardiogenic shock is usually a result of severe ventricular dysfunction associated with myocardial infarction. Other causes include cardiomyopathy, ventricular rupture, and congenital heart defects. Neurogenic shock results from depression of the vasomotor center in the medulla or from interruption of sympathetic nerve fibers in the spinal cord. Causes of neurogenic shock include brain trauma that results in depression of the vasomotor center, spinal cord injury, high spinal anesthesia, and drug overdose. Septic shock commonly is associated with Gram-negative infections. *CH 20*

Which statement is true regarding asthma? A. There is decreased responsiveness to environmental stimuli. B. It is characterized by airway inflammation. C. It involves irreversible airway obstruction. D. Extrinsic asthma has adult onset.

B. It is characterized by airway inflammation. Asthma is characterized by airway inflammation. There is increased airway responsiveness to stimuli. The resulting airway obstruction is usually reversible. Extrinsic asthma is child-onset asthma. *CH 22*

Which component of the blood is responsible for protecting the body by phagocytosis of micro-organisms and other debris? A. Platelets B. Leukocytes C. Erythrocytes D. Plasma proteins

B. Leukocytes Leukocytes protect the body by phagocytosis of micro-organisms and other debris. They also participate in antibody formation. Platelets are essential in clot formation. Erythrocytes are responsible for transporting oxygen. Plasma proteins contribute to blood viscosity and blood pressure. *CH 13*

Which describes a pathologic manifestation of neurogenic shock? A. Release of vasodilatory mediators such as histamine into the circulation B. Loss of sympathetic activation of arteriolar smooth muscle C. Increased sympathetic nervous stimulation D. Massive immune system activation

B. Loss of sympathetic activation of arteriolar smooth muscle Neurogenic shock results from loss of sympathetic activation of arteriolar smooth muscle. Medullary depression (brain injury, drug overdose) or lesions of sympathetic nerve fibers (spinal cord injury) are the usual causes. Release of vasodilatory mediators such as histamine into the circulation and massive immune system activation are seen in anaphylactic shock. Increased sympathetic nervous stimulation is not a characteristic of neurogenic shock. *CH 20*

Hematopoiesis is a process that includes which of the following? (Select all that apply.) A. Oxyhemoglobin dissociation B. Mitotic division C. Reticulocytosis D. Chloride shift E. Maturation

B. Mitotic division E. Maturation The two-stage process of hematopoiesis involves mitotic division and maturation. A shift of the oxyhemoglobin dissociation curve is caused by changes in the blood levels of PCO2 and the H+ concentration. Reticulocytosis is an increased number of circulating reticulocytes. A chloride shift causes an increase in intracellular cation concentration that results in the anion chloride to diffuse from the plasma into the red cell to maintain electrical neutrality. *CH 13*

Which condition may result in chronic pulmonary hypertension, right ventricular hypertrophy, and right-sided heart failure? A. Aortic valve stenosis B. Mitral valve stenosis C. Acute myocarditis D. Aortic insufficiency

B. Mitral valve stenosis Pulmonary hypertension, right ventricular hypertrophy, and right-sided heart failure result from untreated mitral valve stenosis. Syncope, fatigue, low systolic blood pressure, and faint pulses are common signs and symptoms of aortic valve stenosis. Aortic insufficiency is characterized by a high-pitched blowing murmur during ventricular diastole. Patients may complain of palpitations and a throbbing or pounding heart because of the large ventricular stroke volume. Common presenting symptoms of acute myocarditis include fatigue, dyspnea on exertion, and dysrhythmia with associated palpitations. *CH 18*

Which term is used to describe an excess of red blood cells? A. Anemia B. Polycythemia C. Pancytopenia D. Granulocytopenia

B. Polycythemia Polycythemia is an excess of red blood cells. Anemia is a deficiency of red blood cells. Pancytopenia is a decrease in red blood cells, white blood cells, and platelets. Granulocytopenia is a decrease in platelets. *CH 13*

What stimulates the release of renin? (Select all that apply.) A. Increased heart rate B. Renal hypoperfusion C. Sympathetic activation D. Parasympathetic activation E. Decreased sodium delivery

B. Renal hypoperfusion C. Sympathetic activation E. Decreased sodium delivery Increased heart rate and parasympathetic activation do not stimulate the release of renin. *CH 16*

What factor causes a congenital heart disease to produce cyanosis? A. Left-to-right shunting of blood B. Right-to-left shunting of blood C. Ventricular septal obstruction D. Atrial septal defect

B. Right-to-left shunting of blood Disorders that result in right-to-left shunting cause cyanosis. A left-to-right shunt occurs when oxygenated blood from the left side of the heart or aorta flows back into the right side to be recirculated through the lungs. The blood reaching the systemic circulation is oxygenated and the infant is not cyanotic (acyanotic defect). However, the right side of the heart has an increased workload because of the extra shunt blood. In time, the overload of the right side of the heart can result in right ventricular hypertrophy and high right-sided heart pressures. Large ventricular septal defects may be apparent at birth because of rapidly developing right-sided heart failure and a loud systolic murmur. The majority of atrial septal defects occur at the location of the foramen ovale. The abnormal septal opening may be of variable size. Small defects (1 cm) are well tolerated. Even larger atrial septal defects may be asymptomatic for many years as long as the shunt flow is left to right and therefore acyanotic. *CH 18*

Which pathogenetic change is associated with acute bronchitis? (Select all that apply.) A. Mast cell-induced inflammation B. Swelling from exudation of fluid C. Decreased mucous production D. Loss of ciliary function E. Inflamed airways

B. Swelling from exudation of fluid D. Loss of ciliary function E. Inflamed airways Swelling from exudation of fluid, loss of ciliary function, and inflamed airways are observed in acute bronchitis. Asthma is associated with release of inflammatory chemicals from mast cells in the airways. There is increased mucous production with acute bronchitis. *CH 22*

Which major cartilage structure is often referred to as the Adam's apple? A. Cricoid cartilage B. Thyroid cartilage C. Arytenoid cartilage D. Tracheal cartilage

B. Thyroid cartilage The thyroid cartilage is shield shaped and often referred to as the Adam's apple. The cricoid cartilage lies below the thyroid cartilage and is the narrowest point in the airway of a child. Each vocal cord is attached anteriorly to the thyroid cartilage and posteriorly to the arytenoid cartilage. Tracheal cartilages are C-shaped rings surrounding the trachea acting as a support system. *CH 21*

What physiologic abnormality is characteristic of emphysema? A. Collapse of the proximal airways B. Trapping of air in the distal air sacs C. Widespread occurrence of bronchial plugs D. Extensive inflammation of the lower airways

B. Trapping of air in the distal air sacs Emphysema leads to a loss of elastic tissue in the lung, which leads to a decrease in the size of the smaller bronchioles. The loss of lung tissue leads to a loss of radial traction, which normally holds the airway open, and to increasing pressure around the outside of the airway lumen, which in turn increases airway resistance and decreases air flow. Emphysema would affect distal airways. Asthma, not emphysema, results in mucous plug formation. Emphysema is not characterized by inflammation. *CH 22*

What is the name of the structure of long hairs that filter air? A. Cilia B. Vibrissae C. Columnar epithelium D. Convoluted turbinates

B. Vibrissae Vibrissae filter the air and are large hairlike projections. Cilia beat in a sweeping motion like oars rowing a boat and move mucus upward. Columnar epithelium lines the trachea and bronchi. The convoluted turbinates are cone-shaped bones located in the nasal cavity that are highly vascular. Their blood flow forms an efficient heat exchanger. *CH 21*

A common radiologic diagnostic manifestation of fibrotic restrictive disease is the appearance of A. distended alveoli. B. a honeycomb lung. C. destruction of acini. D. constrictive bronchi.

B. a honeycomb lung. Lung destructive pattern manifested by loss of alveolar walls appears as a honeycomb lung radiographically. Distended alveoli, destruction of acini, and constrictive bronchi are not generally associated with fibrotic restrictive long disease. *CH 23*

In extrinsic asthma the immune system responds to the presence of allergens by causing A. bronchodilation. B. bronchoconstriction. C. decreased cough reflex. D. decreased sputum production.

B. bronchoconstriction. Vagal stimulation leads to edema, mucous hypersecretion, and bronchoconstriction. Asthma results in bronchconstriction. Some patients have only a chronic dry cough, and others have a productive cough. Especially in children, cough is often the earliest sign of exacerbation of asthma. Hypertrophy of mucosal glands and goblet cells leads to increased mucous production; the mucus then combines with purulent exudate to form bronchial plugs. *CH 22*

Atrial fibrillation is best described as when A. the P wave precedes, follows, or is buried in the QRS complex. B. disorganized and irregular atrial waves are accompanied by an irregular ventricular rate. C. an atrial rate of 240 to 350 beats/minute in a sawtooth pattern of atrial depolarization is seen. D. P waves occur earlier than normal, preceded by a P wave with a normal QRS configuration.

B. disorganized and irregular atrial waves are accompanied by an irregular ventricular rate. Atrial fibrillation is described as disorganized and irregular atrial waves accompanied by an irregular ventricular rate. Escape rhythms can present with a P wave that precedes, follows, or is buried in the QRS complex. Atrial flutter is typically manifested by a rapid atrial rate of 240 to 350 beats/minute and a characteristic saw-tooth pattern of atrial depolarizations. Premature atrial complexes (PAC) are characterized by P waves that occur earlier than normal, preceded by a P wave with a normal QRS configuration. *CH 19*

Anemia of chronic renal failure is caused by the lack of A. adrenaline. B. erythropoietin. C. thyroid hormone. D. parathyroid hormone.

B. erythropoietin. Erythropoietin is secreted by the kidney in response to hypoxia caused by a low hemoglobin concentration. Erythropoietin stimulates the bone marrow to produce mature red blood cells. The tissue of the diseased kidney has difficulty producing this hormone. A lack of adrenaline, thyroid hormone, and parathyroid hormone are not factors in anemia of chronic renal failure. *CH 13*

Activation of the renin-angiotensin system in shock causes A. vasodilation. B. fluid retention. C. sodium shifts. D. glucogenesis.

B. fluid retention. Renin triggers and stimulates kidney nephrons to conserve sodium and water. Renin triggers the formation of angiotensin II, which is a potent vasoconstrictor. Renin triggers and stimulates kidney nephrons to conserve not shift sodium. Activation of the renin-angiotensin system does not cause glucogenesis. *CH 20*

Tachycardia, decreased or absent breath sounds on the affected side, hyperresonance, and sudden chest pain on the affected side are clinical manifestations of A. sarcoidosis. B. pneumothorax. C. hypersensitivity pneumonitis. D. adult respiratory distress syndrome.

B. pneumothorax. Clinical features of a pneumothorax include tachycardia, decreased or absent breath sounds on the affected side, hyperresonance, and sudden chest pain on the affected side. General symptoms of hypersensitivity pneumonitis may include chills, sweating, shivering, myalgias, nausea, lethargy, headache, and malaise. The patient may or may not have a fever. Respiratory symptoms may include dyspnea at rest, dry cough, tachypnea, and chest discomfort. Physical findings may include cyanosis (a late sign) and crackles (rales) in the lung bases. Sarcoidosis is characterized by malaise, fatigue, weight loss, fever chest discomfort, dyspnea of insidious onset, and a dry, nonproductive cough. The clinical features of ARDS usually include a history of a precipitating event that has led to a low blood volume state ("shock" state) 1 or 2 days prior to the onset of respiratory failure. The patient may complain of sudden marked respiratory distress. Early signs and symptoms include a slight increase in pulse rate, dyspnea, and a low PaO2. The initial presenting sign may be shallow, rapid breathing. *CH 23*

How many liters of blood are circulating in the human body at any one time? A. 1 to 2 B. 2 to 3 C. 4 to 6 D. 10 to 20

C. 4 to 6 There are 4 to 6 L of blood circulating in the body at any one time. Forty-five percent of the volume is blood cells (red blood cells and white blood cells), and 55% is plasma volume (which contains nutrients and plasma proteins). 1 to 2 and 2 to 3 L are too low a blood volume. 10 to 20 L is an exaggerated amount of blood volume. *CH 13*

The lungs are normally fully developed by what year of age? A. 15 B. 10 C. 8 D. 5

C. 8 The lungs are normally fully developed by the eighth year of life. The other ages are too old or too young. *CH 21*

Gas exchange occurs in which of the respiratory system's structures? A. Sinuses B. Trachea C. Alveoli D. Bronchi

C. Alveoli The alveoli allow air to come in indirect contact with the bloodstream through the pulmonary capillary system. This alveolar membrane, which is one cell thick, allows carbon dioxide to diffuse into the alveoli from the bloodstream and oxygen to diffuse to the bloodstream from the alveoli. Sinuses are hollow spaces found in the skull. The trachea is a structure that allows passage of gases to and from the gas exchange units (alveoli). Bronchi are branches of the conducting airways that allow passage of gases to and from the gas exchange units (alveoli). *CH 21*

Which statement is true about baroreceptors? A. They are sensitive to changes in cardiac output (CO) and systemic vascular resistance (SVR). B. They alter the mean arterial pressure (MAP) to regulate blood pressure. C. An increase in pressure causes an increase in impulse discharge. D. They are located in the left ventricle.

C. An increase in pressure causes an increase in impulse discharge. An increase in pressure (MAP) causes an increase in discharge of the baroreceptors. An increase in firing of the baroreceptors causes a decrease in sympathetic outflow. Baroreceptors alter CO and SVR. Changes in MAP affect the baroreceptors. Baroreceptors are located in the carotid sinus and arch of the aorta. *CH 16*

Which is a characteristic of intrinsic (non-allergic) asthma? A. The prognosis is better than that of extrinsic (allergic) asthma. B. The onset is usually in adolescence. C. Attacks are often severe. D. It is IgE-mediated.

C. Attacks are often severe. Intrinsic asthma attacks may be often and are often severe. Intrinsic asthma has a less favorable prognosis, is adult onset and develops in middle age, and is not IgE-mediated. *CH 22*

Which statement regarding oxygen and carbon dioxide is true? A. Carbon dioxide is less soluble than oxygen. B. Oxygen diffuses more quickly than carbon dioxide. C. Carbon dioxide is carried in three forms in the blood. D. The capillary beds do not allow for the exchange of carbon dioxide

C. Carbon dioxide is carried in three forms in the blood. Carbon dioxide is carried in four forms in the blood. Carbon dioxide is more soluble and is diffused more quickly than oxygen. The capillary beds surround the alveoli and allow for easy exchange of O2 and CO2. *CH 21*

Which is responsible for stimulating primitive stem cells in the bone marrow to differentiate into proerythroblasts or pronormoblasts? A. Erythron B. Bilirubin C. Erythropoietin D. Methemoglobin

C. Erythropoietin Erythropoietin stimulates primitive stem cells in the bone marrow to differentiate into proerythroblasts or pronormoblasts, thereby increasing the erythron. When blood is described as a single body system, it is called the erythron. Bilirubin is the product of reduction of porphyrin. Methemoglobin is formed when the iron of the hemoglobin molecule is oxidized. *CH 13*

.Which restrictive disease is associated with the formation of an antigen-antibody complex, causing fibrosis of the lung? A. Sarcoidosis B. Pneumoconiosis C. Hypersensitivity pneumonitis D. Diffuse interstitial lung disease

C. Hypersensitivity pneumonitis Causative dust acts as an antigen, which combines with serum antibodies in the alveolar walls, leading to type III hypersensitivity reaction. Sarcoidosis is associated with the development of multiple, uniform, noncaseating epithelioid granulomas that affect multiple organ systems, most commonly the lymph nodes and lung tissue. Pneumoconiosis is defined as parenchymal lung disease caused by the inhalation of inorganic dust particles. Diffuse interstitial lung disease is associated with thickening of the alveolar interstitium. *CH 23*

What is the underlying problem common among all types of shock? A. Cardiac failure B. Generalized vasodilation C. Inadequate cellular oxygenation D. Faulty compensatory mechanisms

C. Inadequate cellular oxygenation Although each type of shock has specific characteristics, all are associated with a deficiency of cellular oxygen consumption. Inadequate cellular oxygenation may result from decreased cardiac output, maldistribution of blood flow, or reduced blood oxygen content. The impaired oxygen utilization by cells may lead to cell death, organ dysfunction, and stimulation of inflammatory reactions. Cardiac failure can be an outcome, but is not a common cause in all types of shock. Vasodilation occurs in only selective forms of shock. Faulty compensatory mechanisms may contribute to the seriousness of all shocks but that is not the cause of all forms of shock. *CH 20*

Which statement regarding the lymphatic system is true? A. The arrangement of the lymphatic system is very similar to that of the circulatory system. B. Lymphatic vessels are more like arteries in that they are thick-walled and do not have valves. C. It allows for leakage from the vascular system to be reabsorbed into the body's circulation system. D. Lymphatic tissue and lymph nodes are found deep within muscles, but not within connective tissue.

C. It allows for leakage from the vascular system to be reabsorbed into the body's circulation system. One of the functions of the lymphatic system is to reabsorb fluid that leaks out of the vascular network into the interstitium and to return it to the general circulation. The lymphatic system is markedly different from the circulatory system in both function and structure. Lymphatic vessels are thin-walled with valves, and most resemble veins; when stretched, the vessels contract and propel lymph along the vessel. The lymphatic vessels begin blindly, deep in the body's connective tissue. *CH 15*

Which statement is true regarding thalassemia? A. α-Thalassemia is found primarily in individuals of Mediterranean descent. B. β-Thalassemia is found primarily in individuals of Asian descent. C. It is a deficiency of one or more polypeptide chains. D. It is caused by toxins.

C. It is a deficiency of one or more polypeptide chains. Thalassemia is caused by destruction or hemolysis of red blood cells. These diseases are caused by mutant genes that suppress the rate of synthesis of globin chains, which are composed of two pairs of polypeptide chains. α-Thalassemia is common in Asians. β-thalassemia is common in individuals of Mediterranean descent. The cause of this disorder does not relate to toxins. *CH 13*

Which is true regarding hemophilia A? A. It is carried by a symptomatic female carrier. B. It is also known as Christmas disease. C. It is caused by factor VIII deficiency. D. It is an X-linked dominant disorder.

C. It is caused by factor VIII deficiency. Hemophilia A is caused by a deficiency in factor VIII. Hemophilia A is transmitted by an asymptomatic carrier female to an affected son. Hemophilia B is also called Christmas disease. The majority of patients inherit this X-linked recessive disorder. *Ch 14*

What is the primary cause of airway obstruction in patients with chronic bronchitis? A. Thinning bronchial smooth muscle B. Hyperventilation C. Mucous plugs D. Infection

C. Mucous plugs Hypertrophy of mucosal glands and goblet cells leads to increased mucous production; the mucus then combines with purulent exudate to form bronchial plugs. Thickening of bronchial smooth muscle occurs. Hyperventilation is not related to airway obstruction. While infection may be evident, it is not the cause of airway obstruction. *CH 22*

Which best defines systolic blood pressure? A. Occurs during passive elastic recoil of the aorta B. Is the sole function of aortic compliance C. Occurs during ventricular contraction D. Averages 70 mm Hg

C. Occurs during ventricular contraction Systolic blood pressure occurs during ventricular contraction and is a function of volume ejected and the compliance of the aorta. The diastolic blood pressure occurs during passive elastic recoil of the aorta and is an average of 70 mm Hg. The diastolic blood pressure occurs during passive elastic recoil of the aorta. Systolic blood pressure is a function of volume ejected and the compliance of the aorta, and averages 120 mm Hg. *CH 16*

What situation occurs with hypoventilation? A. The amount of air entering the alveoli increases. B. It is a normal response to high altitude. C. The PaCO2 exceeds 45 mm Hg. D. Hypocapnia occurs.

C. The PaCO2 exceeds 45 mm Hg. Hypoventilation results in a PaCO2 exceeding 45 mm Hg. Hypoventilation occurs when delivery of air into the alveoli is insufficient to meet the need to provide oxygen and remove carbon dioxide. A normal response to high altitude is hyperventilation. Hypoventilation results in hypercapnia. *CH 21*

The pathologic changes that occur in the development of coronary atherosclerotic lesions include cell damage resulting from which of the following? (Select all that apply.) A. A decrease in smooth muscle cells B. A chronic calcium buildup C. The effects of oxidized lipids D. An inflammatory response E. The formation of plaques

C. The effects of oxidized lipids D. An inflammatory response E. The formation of plaques Damage to endothelial cells by oxidized lipids releases inflammatory mediators that form atherosclerotic plaques. A decrease in smooth muscle and a chronic buildup of calcium cells do not contribute to the development of coronary atherosclerotic lesions. *CH 18*

For the patient in hypovolemic shock, what compensatory mechanism will help preserve adequate circulation? A. Increased activity of the parasympathetic nervous system B. Decreased secretion of antidiuretic hormone (ADH) C. The renin-angiotensin-aldosterone cascade D. Vasodilation

C. The renin-angiotensin-aldosterone cascade The sympathetic nervous system stimulates cells in the kidney to release renin, which triggers the renin-angiotensin-aldosterone cascade. The sympathetic and not the parasympathetic nervous system is involved in the compensatory mechanisms of hypovolemic shock. Antidiuretic hormone (ADH, vasopressin) is secreted from the posterior pituitary gland in response to reduced blood volume. ADH stimulates the kidney tubules to reabsorb water and improves the vascular response to catecholamines. Renin triggers the formation of angiotensin II, which is a potent vasoconstrictor, and also stimulates the kidney nephrons to conserve sodium and water. *CH 20*

A patient experiencing an acute myocardial infarction (MI) is given a drug to lyse the clot in the coronary artery. What is the best explanation for the sudden development of a serious arrhythmia once circulation is restored? A. The patient has developed cardiogenic shock. B. An increase in oxygen demand once circulation is restored C. The return of oxygen perfusion resulted in reperfusion injury. D. Resuscitation drugs did not circulate to the heart until the clot was lysed.

C. The return of oxygen perfusion resulted in reperfusion injury. Ischemic cells may produce oxygen-free radicals when oxygen supplies are restored. This process has been called reperfusion injury. Reactive oxygen molecules are unstable and will attack membrane structures, denature proteins, and break apart cell DNA. Cardiogenic shock, increased oxygen, and the effects of resuscitation drugs would not account for the arrhythmia. *CH 20*

Which lung zone has continuous perfusion throughout the cardiac cycle? A. Zone 1 B. Zone 2 C. Zone 3 D. Zone 4

C. Zone 3 Zone 3 has continuous perfusion through the entire cardiac cycle. Pulmonary arterial pressure is greater than pulmonary venous pressure. Zone 1 reflects blood flow through the apices and is minimal. The alveolar pressure is higher than capillary pressure. Zone 2 has pulmonary arterial pressure greater than the pressure inside the alveoli during ventricular systole. Zone 2 has intermittent perfusion. There is no recognized Zone 4. *CH 21*

A patient has a regular heart rate of 54 beats/minute. The nurse would document this rhythm as A. normal. B. arrhythmia. C. bradycardia. D. tachycardia.

C. bradycardia. Sinus bradycardia is defined as a heart rate of less than 60 beats/minute. Normal sinus rhythm is defined as an impulse rate between 60 and 100 per minute. Sinus arrhythmia is a normal finding associated with fluctuations in autonomic influences and respiratory dynamics. Sinus tachycardia is an abnormally fast heart rate of greater than 100 beats/minute. *CH 19*

Destruction of bronchial walls from dilation of airway sacs is a result of A. Aspergillus fumigatus. B. cor pulmonale. C. bronchiectasis. D. cyanosis.

C. bronchiectasis. Bronchiectasis is the destruction of bronchial walls from dilation of airway sacs. Aspergillus fumigatus is a mold that can cause infection. Cor pulmonale is congestive heart failure. Cyanosis is a symptom of decreased oxygenation and is manifested by bluish or pallor of the skin. *CH 22*

The major risk factor for the development of lung cancer is A. age. B. heredity. C. cigarette smoking. D. asbestos exposure.

C. cigarette smoking. Tobacco smoking is the major cause (85%) of lung cancer, with approximately 160,000 deaths reported per year. While individuals older than 50 years of age have an increased risk for developing lung cancer; it is not comparable to that of a history of tobacco smoking. A family history that includes non-tobacco use related lung cancer does have an impact on the risk for developing lung cancer; it is not comparable to that of a history of tobacco smoking. Working under conditions of asbestos exposure increases the risk for developing lung cancer; it is not comparable to that of a history of tobacco smoking. *CH 21*

Aortic and carotid baroreceptors are activated by ___________, resulting in ___________. A. increased blood pressure; a decrease in blood pressure B. decreased blood pressure; normalization of blood pressure C. decreased blood pressure; an increase in cardiac output (CO), systemic vascular resistance (SVR), heart rate (HR), and blood pressure D. decreased blood pressure; a decrease in cardiac output (CO), systemic vascular resistance (SVR), heart rate (HR), and blood pressure

C. decreased blood pressure; an increase in cardiac output (CO), systemic vascular resistance (SVR), heart rate (HR), and blood pressure The aortic and carotid baroreceptors respond to a decrease in blood pressure by stimulating the sympathetic nervous system of the heart and vascular bed, increasing heart rate, cardiac output, and systemic vascular resistance. They also inhibit the parasympathetic nervous system's influence on the heart, which results in an increased heart rate. Aortic and carotid baroreceptors are activated by a decrease in blood pressure, but the results are not the normalization of blood pressure, but rather an increase in cardiac output (CO), systemic vascular resistance (SVR), heart rate (HR), and blood pressure. *CH 16*

COPD type A is referred to as A. chronic bronchitis. B. bronchiectasis. C. emphysema. D. asthma.

C. emphysema. Emphysema is also referred to as COPD type A, or the pink puffer. Chronic bronchitis is referred to as type B COPD. Bronchiectasis is associated with recurrent inflammation of the bronchial walls; it is not commonly associated with COPD. Asthma is an inflammatory lung disease. *CH 22*

The shift to anaerobic metabolism in shock results in A. metabolic alkalosis. B. decreased oxygen utilization. C. increased lactate production. D. decreased hydrogen ion production.

C. increased lactate production. When the citric acid cycle is inhibited, pyruvate accumulates in the cytoplasm. Pyruvate accumulation would quickly inhibit further glycolysis and shut down ATP production entirely except that it can be converted to a substance called lactate, which diffuses from the cell and into the extracellular fluid. A shift to anaerobic metabolism in shock does not result in metabolic alkalosis, decreased oxygen utilization, or decreased hydrogen ion production. *CH 20*

What value is consistent with acute respiratory failure? A. PaO2 of 100 mm Hg B. PaCO2 of 40 mm Hg C. pH less than 7.3 D. PaCO2 of 30 mm Hg

C. pH less than 7.3 A pH less than 7.3 is consistent with acute respiratory failure. A value consistent with acute respiratory failure includes a PaO2 less than 60 mm Hg and a PaCO2 greater than 50 mm Hg. Hypercapnia rather than hypocapnia is consistent with acute respiratory failure. *CH 21*

Factors released by platelets contribute to hemostasis by enhancing A. vasodilation. B. intrinsic pathway. C. platelet aggregation. D. fibrinolysis.

C. platelet aggregation. Platelets, when activated, release factors that lead to vasoconstriction, platelet clumping, and vessel repair. Vasodilation is not caused by platelet factors. The intrinsic pathway and fibrinolysis are steps in clot formation. *Ch 14*

A current diagnosis of tuberculosis requires a A. chest x-ray. B. positive Mantoux test. C. positive sputum culture for acid-fast bacillus. D. presentation of typical symptoms including night sweats.

C. positive sputum culture for acid-fast bacillus. Three consecutive morning sputum specimens are obtained to identify the slow-growing acid-fast bacillus and confirm a current diagnosis of tuberculosis. A chest ray is used to confirm nodules with infiltrates in the lung apex and posterior segments of the upper lobes; not the definitive diagnostic result. The Mantoux test does not distinguish between current disease and past infection. Presentation of symptoms is not considered a definitive indication of the disease. *CH 23*

Early compensation for hypovolemic shock includes A. decreased heart rate. B. decreased systemic vascular resistance. C. release of epinephrine from adrenal glands. D. shunting of blood from the brain to the extremities.

C. release of epinephrine from adrenal glands. In the early stage of shock, the adrenal medulla is stimulated to release increased amounts of the catecholamines epinephrine and norepinephrine (NE), which circulate to the heart and stimulate β-1 receptors, thus increasing cardiac output. Heart rate initially increases. Systemic vascular resistance is not decreased in early hypovolemic shock. Blood is shunted to the brain in cases of shock. *CH 20*

The condition associated with hypoxemia as a result of lung disease or living at high altitudes is called A. polycythemia vera. B. relative polycythemia. C. secondary polycythemia. D. anemia of chronic illness.

C. secondary polycythemia. Secondary polycythemia is the body's response to hypoxemia from causes such as lung disease or living at high altitudes. Polycythemia vera is a high red blood cell count without associated lung disease or dehydration. It is usually associated with neoplastic disease. Relative polycythemia is associated with poor intake and dehydration. Anemia of any type is associated with a low red blood cell count. *CH 13*

Atherosclerosis predisposes to a number of processes that are factors in myocardial ischemia. These processes include A. hemorrhage. B. coronary dilation. C. thrombus formation. D. ventricular dysrhythmia.

C. thrombus formation. Atherosclerotic plaques with large lipid cores are fragile and prone to rupture. Rupture of a plaque exposes subendothelial proteins and initiates platelet aggregation and thrombus formation. Hemorrhage can lead to hemorrhagic shock, but death is not directly related to either atherosclerosis or myocardial ischemia, but rather hypovolemia. Coronary dilation would not hinder blood flow which is a cause of myocardial ischemia. Ventricular dysrhythmia affects cardiac conduction and function, but these dysfunctions are not related to atherosclerosis or myocardial ischemia. *CH 18*

Which receptor is responsible for innervation of the arterioles? A. β-1 B. β-2 C. α-1 D. α-2

C. α-1 α-1 receptors are responsive to stimulation by the autonomic nervous system. Stimulation of the α-1 receptor causes vasoconstriction and increased systemic vascular resistance. Renin release is increased when neurotransmitters released by the sympathetic nervous system bind to β1 receptors in the kidney. β-adrenergic agonists, also known as β2-adrenergic receptor agonists, are a class of drugs used to treat asthma and other pulmonary disease states. α2-adrenergic receptors mediate part of the diverse biological effects of the endogenous catecholamines epinephrine and norepinephrine *CH 16*

The normal life span of a red blood cell is A. 20 to 40 days. B. 40 to 60 days. C. 60 to 80 days. D. 80 to 120 days.

D. 80 to 120 days. *CH 13*

Which is an approved treatment for children with thalassemia? A. Vitamin B for iron overload B. Exchange transfusion C. Iron supplements D. Blood transfusion

D. Blood transfusion Blood transfusion is used to keep hemoglobin to a level of 11 to 13 g/dL to ensure normal growth and development and to avoid skeletal deformities. Vitamin C, not vitamin B, is used for iron overload as well as for chelation therapy. Exchange transfusions are not recognized as treatment, since this would not increase or help maintain a therapeutic hemoglobin level. Iron supplements are avoided, since a concern is iron overload. *CH 13*

Which condition is an endocrine disorder that causes elevated blood pressure? (Select all that apply.) A. Guillain-Barré syndrome B. Coarctation of the aorta C. Pheochromocytoma D. Cushing disease E. Hyperthyroidism

D. Cushing disease E. Hyperthyroidism Endocrine disorders that result in hypertension include Cushing disease and hyperthyroidism. While Guillain-Barré syndrome results in hypertension, it is neurologic disorder. While coarctation of the aorta causes high blood pressure, it is a cardiac disorder. While pheochromocytoma causes high blood pressure, it is a tumor of adrenal gland tissue. *CH 16*

Which medication classification is used to decrease preload in patients with heart failure? A. Calcium channel blockers B. Corticosteroids C. β-Blockers D. Diuretics

D. Diuretics The right ventricle is particularly sensitive to reductions in preload, and care must be taken to avoid a significant drop in right ventricular output when intravascular volume is decreased. Drugs, such as diuretics, may be administered to reduce intravascular volume. Diuretics promote the excretion of fluid by increasing renal blood flow and blocking sodium and chloride reabsorption, or both. Calcium channel blockers are not commonly used to decrease cardiac preload. Corticosteroids are not used for affecting cardiac preload. β-Blockers slow the heart rate and reduce the force with which the heart muscle contracts, thereby lowering blood pressure. *CH 19*

What is the marker of choice for detecting a myocardial infarction? A. Elevated T waves on an ECG B. Elevated serum levels of C-MB C. Elevated serum levels of cardiac myoglobin D. Elevated serum levels of cardiac troponin

D. Elevated serum levels of cardiac troponin Two proteins that make up part of the cardiac cell contractile apparatus, troponins I and T, have become the markers of choice for detecting MI. Cardiac troponin levels become elevated in serum at about the same time as CK-MB, but they remain elevated for a longer period. ST-segment elevation is thought to represent acute cell injury and ischemia. An elevated level of serum CK-MB is a highly specific indicator of MI and considered to be diagnostic. However, CK-MB remains elevated for only 48 to 72 hours after MI. Cardiac myoglobin levels are elevated in serum very quickly after MI and may be helpful in early detection; however, cardiac myoglobin is less specific than the other markers. *CH 18*

Which is a true statement regarding the mechanics of breathing? A. During inspiration the muscles relax. B. During exhalation the muscles contract. C. Atelectasis occurs when bronchi collapse. D. Functional residual capacity is the air remaining in alveoli.

D. Functional residual capacity is the air remaining in alveoli. Functional residual capacity is the air that remains in the alveoli at the end of expiration. During exhalation there is elastic recoil of the lungs and the muscles relax. Muscles contract during inspiration. Collapse of alveoli occurs when there is a lack of surfactant and is called atelectasis. *CH 21*

Which situation causes an increase in blood pressure? A. Blood loss B. Dehydration C. Prolonged bed rest D. Intracerebral hemorrhage

D. Intracerebral hemorrhage Intracerebral hemorrhage and intracranial hematomas are two of the neurologic causes for increased blood pressure through increased secretion of catecholamines. Blood loss, dehydration, and prolonged bed rest can result in hypotension. *CH 16*

Which statement is true regarding cystic fibrosis? A. It is autosomal-dominant. B. It affects endocrine glands. C. It is common in African Americans. D. It is the most common genetic disease in the United States.

D. It is the most common genetic disease in the United States. Cystic fibrosis is the most common genetic disease in the United States. It is autosomal recessive, not dominant. It affects exocrine, not endocrine, glands. Cystic fibrosis affects primarily Caucasians. *CH 22*

Which is an upper airway structure? A. Trachea B. Larynx C. Bronchi D. Oropharynx

D. Oropharynx *CH 21*

A patient with heart failure reports awakening intermittently with shortness of breath. Which terms appropriately describe this clinical manifestation? A. Dyspnea B. Cyanosis C. Bradypnea D. Paroxysmal nocturnal

D. Paroxysmal nocturnal Paroxysmal nocturnal dyspnea refers to intermittent attacks of severe dyspnea that occur during the night. Dyspnea is a general term referring to difficulty breathing. Cyanosis is the appearance of a blue or purple coloration of the skin or mucous membranes due to the tissues near the skin surface being low on oxygen. Bradypnea describes abnormal slowness of breathing. *CH 19*

Which term is determined by stroke volume, speed of ejection, and arterial distensibility? A. Arterial pulse pressure B. Mean arterial pressure C. Diastolic pressure D. Pulse pressure

D. Pulse pressure Pulse pressure is determined by stroke volume, speed of ejection of the stroke volume, and arterial distensibility. Arterial pulse pressure is the difference between the systolic and diastolic blood pressure. Mean arterial pressure is the average pressure in the circulating system throughout the cardiac cycle. Diastolic pressure is the pressure excreted during the rest phase of the cardiac cycle. *CH 16*

Which term is used to identify hypertension that has a specific disease as its cause? A. Primary B. Essential C. Idiopathic D. Secondary

D. Secondary Secondary is the term given to hypertension that is secondary to a specific disease. Idiopathic, primary, and essential hypertensions are interchangeable terms for hypertension that cannot be related to a specific disease/cause. *CH 16*

What is the specific terminology to describe the formation of a blood clot in a vein? A. Ischemia B. Phlebitis C. Thrombus D. Thrombophlebitis

D. Thrombophlebitis When phlebitis is present in a vein and is accompanied by a thrombus, it is called a thrombophlebitis. Ischemia is lack of oxygen to an area within the body. If a thrombus forms in an arterial system, decreased distal flow can result in ischemia, injury, and necrosis. A blood clot formed, which activates the clotting mechanism, is generally referred to as a thrombus. In the venous system, an inflamed vein is called a phlebitis. *CH 15*

What are the upper acceptable values for cholesterol within the blood? A. Total cholesterol level of 40 mg/dL, HDL of 200 mg/dL, and LDL of 160 mg/dL B. Total cholesterol level of 40 mg/dL, HDL of 160 mg/dL, and LDL of 200 mg/dL C. Total cholesterol level of 200 mg/dL, HDL of 160 mg/dL, and LDL of 40 mg/dL D. Total cholesterol level of 200 mg/dL, HDL of 40 mg/dL, and LDL of 160 mg/dL

D. Total cholesterol level of 200 mg/dL, HDL of 40 mg/dL, and LDL of 160 mg/dL An acceptable total cholesterol level for an adult who has no coronary disease is less than 200 mg/dL. Levels of LDL-C are felt to be detrimental if greater than 160 mg/dL. In those with known coronary disease, an LDL-C of less than 100 mg/dL is thought to be beneficial. Protective levels of HDL are those greater than 45 mg/dL for men and 55 mg/dL for women. The other answer options are not currently viewed as acceptable values. *CH 15*

Tubercular bacilli are transmitted by contract with infected A. blood. B. sputum. C. body fluids. D. airborne droplets.

D. airborne droplets. Tuberculosis is an airborne disease spread by droplets. Tubercular bacilli are not transmitted via infected blood, sputum, or body fluids. *CH 23*

The movement of nutrients and O2 as well as the removal of metabolic wastes occurs in A. veins. B. arteries. C. arterioles. D. capillaries.

D. capillaries. The aorta propels blood into the arteries, arterioles, and finally the capillary beds. Here the proximity of the capillary endothelium to the other cells of the body facilitates movement of nutrients and O2into the cells and removal of cellular metabolic wastes. Capillary blood is then collected by venules in order to be returned to the right side of the heart. Arteries deliver blood to the arterioles. Arterioles deliver blood to the capillary bed. *CH 15*

The renin-angiotensin system (RAS) alters blood pressure in response to A. decreased flow to the brain. B. decreased perfusion to the liver. C. decreased perfusion to the lungs. D. decreased perfusion to the kidney.

D. decreased perfusion to the kidney. When blood flow is restricted to the kidney by low blood volume, low cardiac output, or stricture of the renal artery, the kidney secretes more renin into the bloodstream, which in turn changes angiotensinogen to angiotensin I. Angiotensin-converting enzyme (ACE) then changes angiotensin I to a potent vasoconstrictor, angiotensin II. Angiotensin II then increases vascular constriction, systemic vascular resistance, and blood pressure. The renin-angiotensin system (RAS) is not associated with the brain, liver, or lungs. *CH 16*

Thrombosis in the microcirculation throughout the body is called A. stroke. B. atherosclerosis. C. myocardial infarction (MI). D. disseminated intravascular coagulation (DIC).

D. disseminated intravascular coagulation (DIC). Thrombosis may also be initiated by a generalized reduction in flow and release of vasoactive substances that occur in shock states. Systemic derangement in coagulation takes place in disseminated intravascular coagulation (DIC), resulting in thrombosis in the microcirculation throughout the body. A stroke results from the obstruction of blood flow in or to the brain by a clot. Atherosclerosis is a circulatory condition that results in the inability of vessels to regulate blood flow as a result of the stiffening of their walls. An MI is a result of obstructed blood flow in a vessel supplying the heart muscle itself. *CH 15*

Abnormal vascular regulation by endothelial cells in small vessels of the heart contributes to A. hypertension. B. dysrhythmias. C. truncus arteriosus. D. ischemic heart disease.

D. ischemic heart disease. Endothelial cells are important regulators of vascular tone. They secrete variable amounts of constricting and relaxing factors to control tissue perfusion. Hypertension is a result of a variety of factors not all related to vascular tone. Dysrhythmias would affect conduction and the function of the heart chambers but not vascular tone. Truncus arteriosus results in only one large artery leaving the heart. *CH 18*

In a patient with mitral stenosis, cardiac catheterization findings would indicate increased pressure in the A. right ventricle B. left ventricle C. right atria D. left atria

D. left atria In mitral valve stenosis, left atrial pressure remains higher than ventricular pressure throughout diastole. Mitral valve stenosis is not characterized by increased pressure in the right ventricle, left ventricle, or right atria. *CH 18*

The most common cause of chronic bronchitis is A. bacterial infection. B. chemical irritants. C. viral infection. D. smoking.

D. smoking. Smoking causes 90% of chronic bronchitis cases. Chronic bronchitis may be caused by bacterial infection, chemical irritants, or viral infection, but these are not the leading causes. *CH 22*

Cardiac output is the product of both A. mean arterial pressure (MAP) and systemic vascular resistance (SVR). B. systemic vascular resistance (SVR) and pulse pressure. C. pulse pressure and mean arterial pressure (MAP). D. stroke volume and heart rate.

D. stroke volume and heart rate. The product of stroke volume and heart rate provides the amount of cardiac output. None of the other options (MAP, SVR, or pulse pressure) are factors in cardiac output. *CH 16*

The vasoactive mediators released in septic shock contribute to increase A. systemic vascular resistance. B. destruction of microemboli. C. systemic vasoconstriction. D. vascular permeability.

D. vascular permeability. The kinin system is activated and bradykinin is released, which results in vasodilation and increased capillary permeability. Histamine also increases capillary permeability, which enhances edema formation. Systemic vascular resistance is decreased in septic shock. The complement system is activated with release of C5a and C3a, which can produce microemboli and endothelial cell destruction. The coagulation system is activated and may enhance the development of microemboli. Histamine, a potent vasodilator, is released by mast cells. *CH 20*

The primary cause of sudden cardiac death is usually because of A. heart failure. B. cardiomyopathy. C. atherosclerotic plaques. D. ventricular dysrhythmia.

D. ventricular dysrhythmia. Lethal dysrhythmia as ventricular fibrillation is usually the primary cause of sudden cardiac death. While heart failure, cardiomyopathy, and atherosclerosis are serious cardiac conditions they are not the primary causes of sudden cardiac death. *CH 18*

Contraction of vascular smooth muscle (referred to as vasomotor tone) is mostly accomplished via the extrinsic mechanism of the autonomic nervous system, resulting in which receptor response? A. β-2 B. β-1 C. α-2 D. α-1

D. α-1 Because arteries have the most smooth muscle, they are most affected by central nervous system stimulation. The release of norepinephrine (the postganglionic neurotransmitter) results in arterial vasoconstriction via the α-1 receptors located on the vascular smooth muscle walls Although β-2 receptors on smooth muscles are affected, they only increase nutrient and oxygen supplies to skeletal muscles via vasodilation, not vasoconstriction, during times of stress. β-1 and α-2 receptor responses are not involved in this scenario. *CH 15*