Final 1

What causes the chronic microvascular and macrovascular complications of DM? a. Pancreatic changes b. Hyperglycemia c. Ketone toxicity d. Hyperinsulinemia

ANS: B The underlying cause of the microvascular and macrovascular diseases is related to hyperglycemia, not pancreatic changes, ketone toxicity, or hyperinsulinemia.

The shapes that represent bone classifications include: (select all that apply) a. long. b. flat. c. short. d. irregular. e. round.

ANS: A, B, C, D Bones can be classified by shape as long, flat, short (cuboidal), or irregular.

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

ANS: C Long-term potassium deficits lasting more than 1 month may damage renal tissue, with interstitial fibrosis and tubular atrophy. Long-term potassium deficits are not associated with damage to the CNS, GI tract, or lungs.

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

ANS: A A normal decrease in cell size is physiologic atrophy. Atrophy can result from disease (pathologic), disuse, or nerve injury (neurogenic).

Sodium and water accumulation in an injured cell are a direct result of: a. decreased ATP production. b. karyorrhexis. c. ribosome detachment. d. dehydration.

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

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

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

What term is used to describe a torn ligament? a. Sprain b. Strain c. Disunion d. Subluxation

ANS: A A torn ligament is also called a sprain. Tearing or stretching of a muscle or tendon is commonly known as a strain. Disunion occurs when fracture ends fail to heal. Subluxation occurs when contact between the opposing joint surfaces of a fracture are partially lost.

What is the most common cause of Addison disease? a. An autoimmune reaction b. Dietary deficiency of sodium and potassium c. Cancer d. Viral infection of the pituitary gland

ANS: A Addison disease is caused by autoimmune mechanisms that destroy adrenal cortical cells and is more common in women. Addison disease is not due to dietary deficiency, to cancer, or to a viral infection.

A 60-year-old male is diagnosed with adenocarcinoma of the esophagus. Which of the following factors most likely contributed to his disease? a. Reflux esophagitis b. Intestinal parasites c. Ingestion of salty foods d. Frequent use of antacids

ANS: A Adenocarcinomas are more prevalent in males and are associated with cigarette smoking, obesity, and gastroesophageal reflux disease (GERD). Intestinal parasites, ingestion of salty foods, or the use of antacids does not lead to adenocarcinoma of the esophagus.

In alcoholic cirrhosis, hepatocellular damage is caused by: a. acetaldehyde accumulation. b. bile toxicity. c. acidosis. d. fatty infiltrations.

ANS: A Alcoholic cirrhosis is caused by the toxic effects of alcohol metabolism on the liver. Alcohol is transformed to acetaldehyde, and excessive amounts significantly alter hepatocyte function and activate hepatic stellate cells, a primary cell involved in liver fibrosis. Bile toxicity does not cause alcoholic cirrhosis. Acidosis does not cause alcoholic cirrhosis. Fatty infiltrations do not cause alcoholic cirrhosis.

What is the main source of bleeding in extradural (epidural) hematomas? a. Arterial b. Venous c. Capillary d. Sinus

ANS: A An artery is the source of bleeding in 85% of extradural hematomas. The bleeding associated with an extradural hematoma is not a result of damage to a vein, a capillary, or a sinus.

Which of the following lab results would indicate a slowdown in the rate of parathyroid hormone secretion? a. Increased serum calcium levels b. Decreased serum calcium levels c. Decreased levels of TSH d. Increased levels of TSH

ANS: A An increase, not a decrease, in serum calcium inhibits parathyroid hormone (PTH) secretion. Thyroid-stimulating hormone would not affect PTH secretion.

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

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

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

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

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

ANS: A Cerebral edema is a form of localized edema. Generalized edema is manifested by a more uniform distribution of fluid in interstitial spaces. When pressure is applied, pitting edema results in an indention in the skin. Lymphedema is due to swelling in interstitial spaces, primarily in the extremities.

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

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

During an infection, lymph nodes enlarge and become tender because: a. lymphocytes are rapidly dividing. b. edema accumulates within the fibrous capsule. c. microorganisms are accumulating. d. the nodes are not functioning properly.

ANS: A During an infection, the rate of proliferation of lymphocytes within the nodes is so great that the nodes enlarge and become tender. Edema may be present, but the tenderness is due to proliferation of lymphocytes and is a normal function of the nodes. The tenderness is not due to the microorganisms.

Endometrial thickening during the proliferative phase is stimulated by increased levels of: a. estrogen. b. progesterone. c. FSH. d. inhibin.

ANS: A Estrogen, not progesterone, promotes endometrial thickening. Endometrial thickening is not associated with FSH or with inhibin

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

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

Which assessment result would the nurse expect to find associated with a patient diagnosed with Graves disease? a. High levels of circulating thyroid-stimulating autoantibodies b. Ectopic secretion of thyroid-stimulating hormone (TSH) c. Low circulating levels of thyroid hormones d. Increased circulation of iodine

ANS: A Graves disease results from a form of type II hypersensitivity in which there is stimulation of the thyroid by autoantibodies directed against the TSH receptor. The thyroid-stimulating antibodies stimulate TSH receptors; it is not an ectopic secretion. Graves disease is manifested by elevated levels of thyroid hormones. Iodine deficiency leads to goiter but not Graves disease.

When planning care for a cardiac patient, the nurse knows that in response to an increased workload, cardiac myocardial cells will experience hypertrophy which is an: a. increase in size. b. decrease in length. c. increase in excitability. d. decrease in number.

ANS: A Hypertrophy is a compensatory increase in the size of cells in response to mechanical stimuli (also called mechanical load or stress, such as from stretching, repetitive, chronic, pressure, or volume overload) and consequently increases the size of the affected organ. The cells of the heart and kidneys are particularly prone to enlargement. A decrease in length is not associated with hypertrophy. A deficiency of electrolytes or minerals could lead to an increase in excitability; it is not due to increased workload or related to hypertrophy. A decrease in cell numbers is referred to as hypoplasia.

A 21-year-old woman was recently diagnosed with iron deficiency anemia. Her hematocrit is 32%. Which of the following treatments would the nurse expect to be prescribed for her? a. Iron replacement b. Splenectomy c. A bone marrow transplant d. No treatment is necessary

ANS: A Iron replacement therapy is required and very effective. Initial doses are 150-200 milligrams per day and are continued until the serum ferritin level reaches 50 milligrams per liter. Neither a splenectomy nor a bone marrow transplant is indicated.

The symptoms and signs of large bowel obstruction are: a. abdominal distention and hypogastric pain. b. diarrhea and excessive thirst. c. dehydration and epigastric pain. d. abdominal pain and rectal bleeding.

ANS: A Large intestine obstruction usually presents with hypogastric pain and abdominal distention. Neither diarrhea, epigastric pain, nor rectal bleeding occurs.

A patient is admitted to the medical unit for complications of long-term, poorly controlled type 2 DM. Which of the following would the nurse expect to find in addition to elevated glucose? a. Atherosclerosis b. Metabolic alkalosis c. Elevated liver enzymes d. Anemia

ANS: A Macrovascular disease (lesions in large and medium-sized arteries) increases morbidity and mortality and increases risk for accelerated atherosclerosis. Acidosis, rather than alkalosis, would occur in this patient. Neither elevated liver enzymes nor anemia would be expected.

Monocytes are blood cells that mature (differentiate) into: a. macrophages. b. neutrophils. c. eosinophils. d. mast cells.

ANS: A Monocytes mature into macrophages, not neutrophils, eosinophils, or mast cells.

A 35-year-old presents with symptomology that is associated with syphilis. What organism is responsible for the development of syphilis? a. Treponema pallidum b. Chlamydia trachomatis c. Neisseria gonorrhoeae d. Haemophilus ducreyi

ANS: A Neurosyphilis and life-threatening hypersensitivities can develop without treatment. Syphilis is caused by Treponema pallidum. Chlamydia is caused by Chlamydia trachomatis. Gonorrhea is caused by Neisseria gonorrhoeae. Chancroid is caused by Haemophilus ducreyi.

Neurotransmitters interact with the postsynaptic membrane by binding to which structure? a. Receptor b. Nissl body c. Glial cell d. Neurofibril

ANS: A Neurotransmitters bind to a receptor. The Nissl body is involved in protein synthesis. Neurotransmitters do not bind to glial cells. Neurofibrils provide support for the neuron.

An adult patient's blood sample is analyzed in a laboratory. Assuming a normal sample, which type of white blood cell accounts for the highest percentage? a. Neutrophil b. Eosinophil c. Basophil d. Lymphocyte

ANS: A Neutrophils constitute about 40-60% of the total leukocyte count in adults. The eosinophils, which have large, coarse granules, constitute only 1-4% of the normal leukocyte count in adults. Basophils make up less than 1% of the leukocytes. Lymphocytes constitute approximately 36% of the total leukocyte count.

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

ANS: A Nociceptors are pain receptors and can be found in the skin. Nociceptors are not located in the spinal cord. Nociceptors are not located in efferent, but afferent, pathways. Nociceptors are not located in the hypothalamus but can be found in the meninges.

Water movement between the ICF and ECF compartments is determined by: a. osmotic forces. b. plasma oncotic pressure. c. antidiuretic hormone. d. buffer systems.

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

Which of the following people is at highest risk for the development of gout? a. Men aged 40-50 years b. Premenopausal women c. Male adolescents d. Female children

ANS: A People at highest risk for gout are men aged 40-50 years of age. Gout is rare in children, adolescent males, and premenopausal women.

Which cytokines participate in hematopoiesis? a. Stimulating factors (CSFs) b. Eosinophils c. Basophils d. Neutrophils

ANS: A Several cytokines participate in hematopoiesis, particularly CSFs (or hematopoietic growth factors). Neither eosinophils, basophils, nor neutrophils play a role in hematopoiesis.

What is the primary organism responsible for osteomyelitis? a. Staphylococcus aureus b. Salmonella c. Mycobacterium d. Haemophilus influenza

ANS: A Staphylococcus aureus remains the primary microorganism responsible for osteomyelitis. While the other options are possible causes, they are not as predominant as is Staphylococcus aureus.

When a patient's vagus nerve is stimulated, what does the nurse expect to observe? a. Increased gastrointestinal activity b. Increased heart rate c. Pupil constriction d. Vasoconstriction

ANS: A Stimulation of the vagus nerve increases gastrointestinal activity. Stimulation of the vagus decreases heart rate, causes pupil dilation, and leads to vasodilation.

What term should the nurse use when talking about the outermost membrane surrounding the brain? a. Dura mater b. Arachnoid mater c. Pia mater d. Falx cerebri

ANS: A The dura mater is the outer layer of the brain. The arachnoid is a spongy, web-like structure that loosely follows the contours of the cerebral structures. The pia mater adheres to the contours of the brain. The falx cerebri dips between the two cerebral hemispheres along the longitudinal fissure.

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

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

A 2-year-old malnourished child is diagnosed with vitamin B12 and folate deficiencies. A blood smear suggests the deficiency is macrocytic and normochromic. The nurse would expect the hemoglobin to be: a. normal. b. sporadic. c. low. d. high.

ANS: A The macrocytic (megaloblastic) anemias are characterized by unusually large stem cells (megaloblasts) in the marrow that mature into erythrocytes that are unusually large in size (macrocytic), thickness, and volume. The hemoglobin content is normal, thus allowing them to be classified as normochromic.

A common complaint from men with mild to moderate benign prostatic hypertrophy (BPH) is: a. decreased urinary stream. b. infertility. c. sexual dysfunction. d. prostatodynia.

ANS: A The most common complaint of men with BPH is decreased urine stream. Infertility is not associated with benign prostatic hypertrophy. Sexual dysfunction could be associated with BPH, but it is not as common a complaint as decreased stream. A painful prostate is not a frequent complaint of men with BPH.

While planning care for a patient with renal calculi, the nurse remembers the most important factor in renal calculus formation is: a. urine pH. b. body temperature. c. gender. d. serum mineral concentrations.

ANS: A The most important factor in renal calculus formation is urine pH, not gender, although calculi form more often in men. Neither body temperature nor serum mineral concentrations are as important as urine pH.

What is the most common aggravating trigger of gouty arthritis attacks? a. Trauma b. Anemia c. High-fat foods d. Lack of exercise

ANS: A Trauma is the most common aggravating factor of an acute gouty exacerbation. Gout is not triggered by anemia or lack of exercise. Gout is not caused by high-fat foods, but rather high-purine foods.

Which of the following nutritional components will the nurse encourage a patient to consume as it is needed for erythropoiesis? a. Vitamin B12 b. Vitamin B1 c. Vitamin D d. Zinc

ANS: A Vitamin B12 is necessary for erythropoiesis, not vitamin B1. Erythropoiesis is not dependent on vitamin D or zinc.

A coup injury resulting from a blow to the frontal portion of the skull would occur in which region of the brain? a. Frontal b. Temporal c. Parietal d. Occipital

ANS: A When there is force applied to the skull, an injury may occur to the corresponding location on the brain. The injury may be coup (injury at site of impact) or contrecoup (injury from brain rebounding and hitting opposite side of skull).

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

ANS: A With an elevated pH, the diagnosis must be alkalosis. Since the PCO2 is low, it is likely respiratory, with a slight decrease in HCO3 indicating renal compensation.

When a staff member asks how erythrocytes can carry oxygen, the nurse should describe which of the following properties that allow erythrocytes to function as gas carriers? (select all that apply) a. Biconcavity b. Reversible deformability c. Undergoes mitotic division d. Presence of many mitochondria e. Presence of a nucleus

ANS: A, B Erythrocytes are small disks that are biconcave in shape and have the capacity to be reversibly deformed. They cannot undergo mitotic division and do not have many mitochondria. Erythrocytes do not have a nucleus.

Physical barriers that offer the body protection from damage and infection are located in the: (select all that apply) a. gastrointestinal tract. b. genitourinary tract. c. respiratory tract. d. lymph system. e. hematopoietic system.

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

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

ANS: A, B, C, D Secretion of ADH leads to water intoxication with symptoms of cerebral edema, including confusion, convulsions, weakness, nausea, and muscle twitching. Depressed reflexes are associated with water intoxication.

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

ANS: A, B, C, D, F The classic symptoms of acute inflammation include redness (erythema), heat, swelling, pain, and loss of function. Paleness would indicate poor circulation, not inflammation.

A nurse is assessing a patient with hypoparathyroidism. Clinical manifestations of hypoparathyroidism include: (select all that apply) a. tetany. b. Chvostek sign. c. Trousseau sign. d. oily skin. e. hair loss.

ANS: A, B, C, E Symptoms of hypoparathyroidism include tetany, Chvostek and Trousseau signs, dry (not oily) skin, and loss of body and scalp hair.

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

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

The nurse is discussing information about menopause with an older woman. Which characteristics are associated with declining ovarian function with age? (select all that apply) a. Vasomotor flush b. Decline in bone mass c. Decreased risk of coronary disease d. Atrophy of the uterus e. Dysfunctional uterine bleeding

ANS: A, B, D, E Aging women can expect to experience vasomotor flashing, decline in bone mass, atrophy of the uterus, and dysfunctional uterine bleeding. Cardiovascular risk increases but does not decrease.

A nurse recalls that the basic types of tissues are: (select all that apply) a. nerve. b. epithelial. c. mucosal. d. connective. e. skeletal. f. muscle.

ANS: A, B, D, F The basic tissue types include nerve, epithelial, connective, and muscle. Mucosal is a type of epithelial cell, while skeletal is a type of connective tissue.

A nurse remembers that the primary actions of the complement cascade include: (select all that apply) a. increased vascular permeability. b. vasoconstriction. c. chemotaxis. d. opsonization. e. cell killing. f. increased clotting.

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

While checking lab results, the nurse remembers that the normal leukocyte count is: a. 1000-2000 per cubic millimeter. b. 5000-10,000 per cubic millimeter. c. 4.2-6.2 million per cubic millimeter. d. 1.2-2.2 million per cubic millimeter.

ANS: B 5000-10,000 per cubic millimeter is the normal leukocyte count. 1000-2000 per cubic millimeter is an abnormally low leukocyte count. 4.2-6.2 million per cubic millimeter is the normal erythrocyte count. 1.2-2.2 million per cubic millimeter would indicate anemia.

Healing by secondary intention would occur in which of the following patients? A patient with a: a. sutured surgical wound. b. stage IV pressure ulcer. c. paper cut. d. sunburn.

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

A client is admitted to the hospital with a transverse fracture of the femur. Which statement best describes this type of fracture? a. The fracture line is parallel to the bone. b. The fracture line is straight across the bone. c. The fracture line is perpendicular to the bone. d. The fracture line is vertical to the shaft of the bone.

ANS: B A transverse fracture occurs straight across the bone. Such a fracture would not occur either perpendicularly or vertically in relationship to the bone. A linear fracture runs parallel to the long axis of the bone.

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

ANS: B ADH is secreted when plasma osmolality increases or circulating blood volume decreases and blood pressure drops. ADH is not secreted by an increase in potassium, a decrease in renal blood flow, or the presence of generalized edema.

A disorder similar to osteomalacia that occurs in growing bones of children is termed: a. Paget disease. b. rickets. c. osteomyelitis. d. osteosarcoma.

ANS: B Abnormal bone growth in children is termed rickets. Paget disease is a state of increased metabolic activity in bone characterized by abnormal and excessive bone remodeling, both resorption and formation. Osteomyelitis is a bone infection while osteosarcoma is a form of bone cancer.

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

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

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

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

Which information is basic to the assessment findings associated with a patient diagnosed with an aneurysm? a. A headache is the most common symptom. b. The majority are asymptomatic. c. Nosebleeds are an early symptom. d. Epidural hemorrhage occurs in over 80% of patients.

ANS: B Aneurysms often are asymptomatic. A headache can occur but is not the most common symptom. Nosebleeds do not occur. Subarachnoid hemorrhage is the first indication.

ADH release from the posterior pituitary is stimulated by which process? a. Low blood pressure sensed by baroreceptors in the kidneys. b. High plasma osmolarity sensed by osmoreceptors in the hypothalamus. c. Low osmolality sensed by osmoreceptors in the kidneys. d. High concentration of potassium sensed by chemoreceptors in the carotid body.

ANS: B As plasma osmolality increases, osmoreceptors are stimulated, the rate of ADH secretion increases, more water is reabsorbed from the kidney, and the plasma is diluted back to its set point osmolality. ADH release is stimulated by high serum osmolality, not lowered blood pressure, low osmolality, or high concentrations of potassium.

A report comes back indicating that muscular atrophy has occurred. A nurse recalls that muscular atrophy involves a decrease in muscle cell: a. number. b. size. c. vacuoles. d. lipofuscin.

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

Which of the following types of diarrhea would most likely occur with a bacterial GI infection? a. Osmotic b. Secretory c. Hypotonic d. Motility

ANS: B Bacterial infections lead to secretory diarrhea. A nonabsorbable substance in the intestine leads to osmotic diarrhea. Hypotonic diarrhea is not a form of diarrhea. Food is not mixed properly, digestion and absorption are impaired, and motility is increased, leading to motility diarrhea.

Cholecystitis is inflammation of the gallbladder wall usually caused by: a. accumulation of bile in the hepatic duct. b. obstruction of the cystic duct by a gallstone. c. accumulation of fat in the wall of the gallbladder. d. viral infection of the gallbladder.

ANS: B Cholecystitis can be acute or chronic, but both forms are almost always caused by a gallstone lodged in the cystic duct. Accumulation of bile in the hepatic duct would not lead to cholecystitis. Neither the accumulation of fat nor a viral infection leads to cholecystitis.

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

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

A 69-year-old patient with a history of alcohol abuse presents to the emergency room (ER) after a month-long episode of headaches and confusion. The patient's history and symptomology support which medical diagnosis? a. Concussion b. Chronic subdural hematoma c. Epidural hematoma d. Subacute subdural hematoma

ANS: B Chronic subdural hematomas are commonly found in persons who abuse alcohol and develop over weeks to months. A concussion is more acute in nature. Epidural hematomas are not associated with the patient's history or symptoms. Subacute subdural hematomas present with confusion but are more acute in nature.

An 11-year-old is newly diagnosed with type 1 DM. Which classic symptoms should the nurse assess the patient for? a. Recurrent infections, visual changes, fatigue, and paresthesia b. Polydipsia, polyuria, polyphagia, and weight loss c. Vomiting, abdominal pain, sweet, fruity breath, dehydration, and Kussmaul breathing d. Weakness, vomiting, hypotension, and mental confusion

ANS: B Classic symptoms of type 1 DM include polydipsia, polyuria, polyphagia, and weight loss. Recurrent infections and visual changes are complications of diabetes. Vomiting, abdominal pain, and sweet breath are signs of diabetic ketoacidosis. Weakness, hypotension, and mental confusion are signs of hypoglycemia.

A nurse checks individuals with liver disease for clotting problems because: a. the liver is often the site of platelet pooling. b. clotting factors are produced in the liver. c. high levels of bilirubin interfere with the clotting system. d. treatment medications for liver failure cause fibrinolysis.

ANS: B Clotting factors are produced by the liver; the liver is not the site of platelet pooling. Bilirubin does not interfere with clotting. The treatment of liver failure does not affect clotting.

A student is reviewing functions of the cell. The student would be correct in identifying a chief function of the nerve cell as: a. sensory interpretation. b. conductivity. c. maintenance of homeostasis. d. communication.

ANS: B Conductivity, not sensory interpretation, homeostasis, or communication, is one of the eight chief functions of nerve cells.

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

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

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

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

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

ANS: B Eosinophils serve as the body's primary defense against parasites. Monocytes and neutrophils are phagocytic. Macrophages are not active against parasites; they act as long-term defense against infections.

An increase in the rate of red blood cell breakdown causes which form of jaundice? a. Obstructive b. Hemolytic c. Hepatocellular d. Metabolic

ANS: B Excessive hemolysis (breakdown) of red blood cells can cause hemolytic jaundice (prehepatic jaundice). Red blood cell breakdown is not associated with the other forms of jaundice.

What is the purpose of the glycosylated hemoglobin (hemoglobin A1c) test? a. Measuring fasting glucose levels. b. Monitoring long-term serum glucose control. c. Detecting acute complications of diabetes. d. Checking for hyperlipidemia.

ANS: B Glycosylated hemoglobin refers to the permanent attachment of glucose to hemoglobin molecules and reflects the average plasma glucose exposure over the life of a red blood cell (approximately 120 days). Glycosylated hemoglobin does not measure fasting, but rather glucose control over time. Glycosylated hemoglobin does not identify complications but could provide data if the patient is at risk. Glycosylated hemoglobin does not check for hyperlipidemia.

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

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

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

ANS: B In acidosis, ECF hydrogen ions shift into the cells in exchange for ICF potassium and sodium; hyperkalemia and acidosis therefore often occur together. Acidosis does not cause excess aldosterone. Insulin would help treat hyperkalemia, not cause it. Alkalosis does not lead to hyperkalemia.

While reading a textbook, a student reads the term apoptosis. The student recalls that apoptosis is a condition in which cells program themselves to: a. atrophy. b. die. c. regenerate. d. age.

ANS: B In apoptosis, cells are programmed to die. Apoptosis is not associated with cell atrophy, regeneration, or aging.

After falling, a patient's Glasgow Coma Scale (GCS) was 5 initially and 7 after 1 day. The patient remained unconscious for 2 weeks but is now awake, confused, and experiencing anterograde amnesia. This history supports which medical diagnosis? a. Mild diffuse brain injury b. Moderate diffuse brain injury c. Severe diffuse brain injury d. Postconcussive syndrome

ANS: B In moderate diffuse axonal injury, the score on the GCS is 4-8 initially and 6-8 by 24 hours, and the person is confused and suffers a long period of posttraumatic anterograde and retrograde amnesia. In mild diffuse axonal injury, coma lasts 6-24 hours, with 30% of persons displaying decerebrate or decorticate posturing. They may experience prolonged periods of stupor or restlessness. In severe diffuse axonal injury, the person experiences immediate autonomic dysfunction that disappears in a few weeks. Increased ICP appears 4-6 days after the injury. In postconcussive syndrome, the individual experiences headache, nervousness or anxiety, irritability, insomnia, depression, inability to concentrate, forgetfulness, and fatigability.

In disseminated intravascular coagulation (DIC), the nurse assesses for active bleeding after intravascular clotting because: a. prothrombin is activated. b. clotting factors are depleted. c. inflammatory mediators are released. d. tissue factor (TF) is inactivated.

ANS: B Intravascular clotting leads to depletion of clotting factors. DIC is due to depletion of clotting factors, not activation of prothrombin. Activation of clotting associated with DIC leads to inflammation, but inflammation does not cause DIC. TF is activated during DIC.

For a patient experiencing metabolic acidosis, the body will compensate by: a. excreting H+ through the kidneys. b. hyperventilating. c. retaining CO2 in the lungs. d. secreting aldosterone.

ANS: B It is the lungs hyperventilating that would compensate for metabolic acidosis by blowing off CO2, not any function associated with the kidneys. CO2 retention would increase the acidotic state. Aldosterone would conserve water but does not help compensate for acidosis.

Leukocytosis can be defined as: a. a normal leukocyte count. b. a high leukocyte count. c. a low leukocyte count. d. another term for leukopenia.

ANS: B Leukocytosis is present when the count is higher than normal. It is not another term for leukopenia.

The predominant phagocyte of early inflammation is the: a. eosinophil. b. neutrophil. c. lymphocyte. d. macrophage.

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

A nurse is reading a chart and sees the term oncotic pressure. The nurse recalls that oncotic pressure (colloid osmotic pressure) is determined by: a. the concentration of sodium. b. plasma proteins. c. hydrostatic pressure. d. the availability of membrane transporter proteins.

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

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

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

Osteoarthritis, a degenerative joint disease, is characterized by loss of: a. the epiphyses. b. articular cartilage. c. synovial fluid. d. the joint capsule.

ANS: B Osteoarthritis is caused by loss of the articular cartilage. It is not associated with the epiphyses of bones, synovial fluid, or the joint capsule.

Once their initial function is complete, what do osteoblasts become? a. Osteoclasts b. Osteocytes c. Chondroblasts d. Osteoids

ANS: B Osteoblasts are the bone-forming cells. Their primary function is to lay down new bone. Once this function is complete, osteoblasts become osteocytes. Osteoclasts reabsorb bone. Chondroblasts are a part of mature bone. Osteoids are part of nonmineralized bone matrix that the osteoblasts work on

When a 70-year-old female presents with a hip fracture she is diagnosed with osteoporosis. One factor that most likely contributed to her condition is: a. increased androgen levels. b. decreased estrogen levels. c. strenuous exercise. d. excessive dietary calcium.

ANS: B Osteoporosis can be attributed to decreased estrogen levels. Osteoporosis is not attributed to increased androgen levels, excessive exercise, or excessive dietary calcium.

In addition to playing a role in hemostasis, platelets have the ability to: a. stimulate bone marrow production of erythrocytes. b. release biochemical mediators of inflammation. c. undergo cell division in response to bleeding. d. activate a humoral response.

ANS: B Platelets contain cytoplasmic granules capable of releasing proinflammatory biochemical mediators when stimulated by injury to a blood vessel. Platelets assist with inflammation; they do not produce erythrocytes, undergo cell division in response to bleeding, or activate the humoral response.

A 54-year-old reports vomiting blood. Tests reveal portal hypertension. Which of the following is the most likely cause of this condition? a. Thrombosis in the spleen b. Cirrhosis of the liver c. Left ventricular failure d. Renal stenosis

ANS: B Portal hypertension occurs secondarily to cirrhosis of the liver. Portal hypertension is not associated with thrombosis of the spleen, left ventricular failure, or renal stenosis.

Which organ contains prolactin-inhibiting factor's target tissue? a. Hypothalamus b. Anterior pituitary c. Mammary glands d. Posterior pituitary

ANS: B Prolactin-inhibiting factor (PIF) inhibits prolactin secretion by the anterior pituitary, not the hypothalamus, mammary glands, or posterior pituitary.

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

ANS: B Prostaglandins cause increased vascular permeability, neutrophil chemotaxis, and pain by direct effects on nerves. Histamine promotes vasodilation. Prostaglandins are not associated with vasoconstriction or the immune complex formation.

A 35-year-old suffers a broken clavicle following a motor vehicle accident. X-ray reveals that the bone surfaces in the joint partially lost contact with each other. This condition is called: a. dislocation. b. subluxation. c. distortion. d. nonunion.

ANS: B Subluxation occurs when contact between the opposing joint surfaces of a fracture are partially lost. Dislocation is the displacement of one or more bones in a joint in which the opposing joint surfaces lose contact entirely. Distortion is not a term applicable to fracture healing. Nonunion is failure of the bone ends to grow together.

While checking the lab results for a patient diagnosed with Graves disease, the nurse would expect the T3 level to be abnormally: a. low. b. high. c. variable. d. absent.

ANS: B T3 levels are elevated in Graves disease.

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

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

The patient reports generalized muscle weakness. The health care provider orders administration of the medication edrophonium chloride (Tensilon). This medication is used in the diagnosis of: a. amyotrophic lateral sclerosis (ALS). b. myasthenia gravis. c. multiple sclerosis (MS). d. autonomic hyperreflexia.

ANS: B The diagnosis of myasthenia gravis is made on the basis of a response to edrophonium chloride (Tensilon). This medication is not associated with the diagnosis of ALS, MS, or autonomic hyperreflexia

While planning care for elderly individuals, the nurse remembers the elderly are at a higher risk for developing dehydration because they have: a. a higher total body water volume. b. decreased muscle mass. c. increased thirst. d. an increased tendency toward developing edema.

ANS: B The elderly are at higher risk for dehydration due to a decrease in muscle mass. The elderly have a decrease in total body water and thirst. The increased tendency to develop edema is not related to dehydration.

If a patient's posterior pituitary is removed, which hormone would the nurse expect to decrease? a. PRF b. ADH c. ACTH d. Growth hormone (GH)

ANS: B The hormones ADH and oxytocin are released from the posterior pituitary gland. PRF is released by the hypothalamus. ACTH is released by the anterior pituitary. GH is released by the hypothalamus.

If a patient has a problem with the adrenal medulla, which of the following hormones should the nurse monitor? a. Cortisol b. Epinephrine c. Androgens d. Estrogens

ANS: B The major products stored and secreted by the adrenal medulla are the catecholamines epinephrine (adrenaline) and norepinephrine. The adrenal cortex secretes cortisol and androgens. The pituitary secretes estrogens.

When considering hypothyroidism, the basal metabolic rate is unusually: a. high. b. low. c. steady. d. variable.

ANS: B The metabolic rate with hypothyroidism is low

What is the most common cause of elevated levels of antidiuretic hormone (ADH) secretion? a. Autoimmune disease b. Cancer c. Pregnancy d. Heart failure

ANS: B The most common cause of elevated levels of ADH is cancer, not autoimmune disorders, pregnancy, or heart failure.

A patient is newly diagnosed with multiple sclerosis (MS). What physiological change is causing the patient's symptoms? a. Depletion of dopamine in the central nervous system (CNS) b. Demyelination of nerve fibers in the CNS c. The development of neurofibril webs in the CNS d. Reduced amounts of acetylcholine at the neuromuscular junction

ANS: B The pathophysiology of MS includes demyelination of nerve fibers. Depletion of dopamine is related to Parkinson disease. The development of neurofibrils is related to Alzheimer disease. Myasthenia gravis is due to decreased amounts of acetylcholine at the junction.

A patient is brought to the ER for treatment of injuries received in a motor vehicle accident. An MRI reveals spinal cord injury, and his body temperature fluctuates markedly. The most accurate explanation of this phenomenon is that: a. he developed pneumonia. b. his sympathetic nervous system has been damaged. c. he has a brain injury. d. he has septicemia from an unknown source.

ANS: B The patient experiences disturbed thermal control because the sympathetic nervous system is damaged. The hypothalamus cannot regulate body heat through vasoconstriction and increased metabolism; therefore, the individual assumes the temperature of the air. In this situation there is no evidence to support the presence of pneumonia, brain injury, or septicemia.

When a staff member asks the nurse which gland secretes ADH and oxytocin, how should the nurse respond? a. Anterior pituitary b. Posterior pituitary c. Hypothalamus d. Pineal

ANS: B The posterior pituitary secretes ADH, which is also called vasopressin, and oxytocin. The anterior pituitary secretes ACTH, melanocyte-stimulating hormone (MSH), somatotropic hormones (GH, prolactin), and glycoprotein hormones—follicle-stimulating hormone (FSH), LH, and TSH. The hypothalamus secretes PRF, which stimulates secretion of prolactin; PIF (dopamine), which inhibits prolactin secretion; TRH, which affects release of thyroid hormones; GH-releasing hormone (GHRH), which stimulates the release of GH; somatostatin, which inhibits the release of GH; gonadotropin-releasing hormone (GnRH), which facilitates the release of FSH and LH; corticotropin-releasing hormone (CRH), which facilitates the release of ACTH and endorphins; and substance P, which inhibits ACTH release and stimulates release of a variety of other hormones. The pineal gland secretes melatonin.

When a nurse is checking a urinalysis, the finding that would alert the nurse to cellular injury is the presence of: a. slight glucose. b. excessive protein. c. blood. d. urea.

ANS: B The presence of protein in the urine in significant amounts indicates cellular injury and altered cellular function. Neither glucose nor blood is normally present in the urine, but its presence is not indicative of altered cellular function. Urea is an expected substance in the kidney.

A 60-year-old patient diagnosed with emphysema experiences a rapid and pounding heart, dizziness, and fatigue with exertion. Which respiratory assessment findings indicate the respiratory system is compensating for the increased oxygen demand? a. Bronchoconstriction b. Increased rate and depth of breathing c. Dyspnea d. Activation of the renin-angiotensin response

ANS: B The rate and depth of breathing increase in an effort to increase oxygen availability accompanied by an increase in the release of oxygen from hemoglobin. Bronchodilation occurs, not constriction. Dyspnea is not a compensatory mechanism but a side effect of the body's attempt to increase oxygen. The respiratory system does not activate the renin-angiotensin response; the kidneys are involved.

A patient has a severe kidney obstruction leading to removal of the affected kidney. Which of the following would the nurse expect to occur? a. Atrophy of the remaining kidney b. Compensatory hypertrophy of the remaining kidney c. Dysplasia in the remaining kidney d. Renal failure

ANS: B The remaining kidney would hypertrophy to compensate for the increased workload of the loss of the affected kidney. Compensation for such a situation would not include atrophy or a change in cell structure of the remaining kidney. Renal failure would be avoided.

A 19-year-old college student reports to his primary care provider that he cannot stay awake in class regardless of how much sleep he gets. Under-stimulation of which area of the brain is likely the site of the problem? a. Corpora quadrigemina b. Reticular activating system c. Cerebellum d. Hypothalamus

ANS: B The reticular activating system is responsible for wakefulness, not the corpora quadrigemina, the cerebellum, or the hypothalamus.

The chronic stage of gout, characterized by crystalline deposits in cartilage, synovial membranes, and soft tissue, is called: a. monoarticular arthritis. b. tophaceous gout. c. asymptomatic hyperuricemia. d. complicated gout.

ANS: B Tophaceous gout is the third and chronic stage of the disease. It is characterized by a progressive inability to excrete uric acid, which expands the urate pool. This causes urate crystal deposits (tophi) to appear in cartilage, synovial membranes, tendons, and soft tissue. The characteristic crystalline deposits are not associated with monarticular or complicated gout. Asymptomatic hyperuricemia would not lead to crystalline deposits.

Visual disturbances are a common occurrence in patients with untreated Graves disease. The endocrinologist explains to the patient that the main cause of these complications is: a. decreased blood flow to the eye. b. orbital edema and protrusion of the eyeball. c. TSH neurotoxicity to retinal cells. d. local lactic acidosis.

ANS: B Visual disturbances with Graves disease include orbital fat accumulation, inflammation, and edema of the orbital contents resulting in exophthalmos (protrusion of the eyeball), periorbital edema, and extraocular muscle weakness leading to diplopia (double vision). Blood flow to the eye is not an effect, but visual changes occur. Functional abilities of the eye result from hyperactivity of the sympathetic system. Lactic acid is not involved with visual changes in the eye.

Which physical feature supports the diagnosis of Cushing syndrome? a. Weight loss and muscle wasting b. Truncal obesity and moon face c. Pallor and swollen tongue d. Depigmented skin and eyelid lag

ANS: B Weight gain is the most common feature and results from the accumulation of adipose tissue in the trunk, facial, and cervical areas. These characteristic patterns of fat deposition have been described as "truncal obesity," "moon face," and "buffalo hump." Weight gain, not loss, is the most common feature of Cushing syndrome. Pallor is not associated with Cushing syndrome. The skin of the patient with Cushing syndrome is bronze in color.

A 48-year-old patient presents at the ER reporting an acute severe headache, nausea, photophobia, and nuchal rigidity. Which medical diagnosis is supported by these signs and symptoms? a. Diffuse brain injury b. Subarachnoid hemorrhage c. Epidural hematoma d. Classic concussion

ANS: B With subarachnoid hemorrhage, meningeal irritation occurs, leading to nuchal rigidity. Nuchal rigidity is not associated with a diffuse brain injury, an epidural hematoma, or a classic concussion.

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

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

A patient presents to the physician with reports infrequent bowel movements and is diagnosed with functional constipation. What can be a contributing factor to this condition? (select all that apply) a. Neurogenic disorder b. Sedentary lifestyle c. Low residue diet d. Colon cancer e. Low fluid intake

ANS: B, C, E Functional constipation is a type of or primary constipation that is triggered by a low residue diet and low fluid intake. A sedentary lifestyle and lack of regular exercise are other common causes of this type of constipation. Secondary constipation is a result of a pre-existing condition that may be a neurogenic disorder or colon cancer.

A 46-year-old male diagnosed with gouty arthritis is at high risk for developing: a. cholelithiasis. b. myocarditis. c. renal stones. d. liver failure.

ANS: C Renal stones are 1000 times more prevalent in individuals with primary gout than in the general population. Gouty arthritis does not appear to increase the risk for the development of cholelithiasis, myocarditis, or liver failure.

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

ANS: C A decreased pH indicates acidosis. With increased CO2, it is respiratory acidosis. The bicarbonate is normal, so it cannot be metabolic acidosis.

A 70-year-old diagnosed with osteoporosis fell and fractures the left leg at a location of pre-existing abnormality. Which term describes the fracture? a. Fatigue b. Stress c. Pathologic d. Greenstick

ANS: C A pathologic fracture is a break at the site of a pre-existing abnormality, usually by force such as a fall that would not fracture a normal bone. A fatigue fracture is caused by abnormal stress or torque applied to a bone with normal ability to deform and recover. Stress fractures occur in normal or abnormal bone that is subjected to repeated stress, such as occurs during athletics. A greenstick fracture perforates one cortex and splinters the spongy bone.

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

ANS: C Aldosterone promotes renal sodium and water reabsorption and excretion of potassium, thus increasing blood volume. Aldosterone secretion would cause increased plasma osmolality but it does not promote the development of localized edema; it affects blood volume.

What regulates aldosterone secretion? a. The sympathetic nervous system b. ACTH feedback c. The renin-angiotensin system d. Positive feedback

ANS: C Aldosterone synthesis and secretion are regulated primarily by the renin-angiotensin system. Aldosterone synthesis and secretion are not regulated by the sympathetic nervous system, adrenocorticotropic hormone feedback, or positive feedback.

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

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

A 19-year-old presents with abdominal pain in the right lower quadrant. Physical examination reveals rebound tenderness and a low-grade fever. A possible diagnosis would be: a. colon cancer. b. pancreatitis. c. appendicitis. d. hepatitis.

ANS: C Appendicitis is manifested originally with periumbilical pain that then migrates to the right lower quadrant pain with rebound tenderness. A low-grade fever is common. Colon cancer may be asymptomatic, followed by bleeding. Pancreatitis is manifested by vomiting. Hepatitis would be manifested by upper abdominal pain, not lower.

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

ANS: C Aspirin is a prostaglandin inhibitor. Aspirin is not associated with leukotriene production, histamine release, or platelet-activating factor.

Bright red bleeding from the rectum is referred to as: a. melena. b. occult bleeding. c. hematochezia. d. hematemesis.

ANS: C Bleeding from the upper GI tract can also be rapid enough to produce hematochezia (bright red stools). Melena is a black or tarry stool. Occult bleeding is hidden bleeding. Hematemesis is vomiting blood.

What is the cause of the hyperpigmentation seen in people with Cushing syndrome? a. Abnormal levels of cortisol b. Permissive effects of aldosterone when cortisol levels are altered c. Elevated levels of ACTH d. Hypersensitivity of melanocytes with sun exposure

ANS: C Bronze or brownish hyperpigmentation of the skin, mucous membranes, and hair occurs when there are very high levels of ACTH. The pigmentation changes associated with Cushing syndrome and Addison disease are not due to increased levels of cortisol or hypersensitivity of melanocytes. Aldosterone affects fluid balance.

Which condition is considered the ultimate cause of death in the patient with diabetes? a. Renal disease b. Stroke c. Cardiovascular disease d. Cancer

ANS: C Cardiovascular disease, not renal disease, stroke, or cancer, is the ultimate cause of death in up to 68% of people with diabetes.

Symptoms of acute bacterial prostatitis are similar to symptoms of: a. prostate cancer. b. benign prostatic hypertrophy (BPH). c. urinary tract infection (UTI). d. epididymitis.

ANS: C Clinical manifestations of acute bacterial prostatitis are those of UTI or pyelonephritis. Cancer often has no symptoms. Symptoms could include difficulty with urinary stream, but more commonly it is of UTI. The main symptom of epididymitis is scrotal or inguinal pain caused by inflammation of the epididymis and surrounding tissues.

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

ANS: C Common laboratory tests for inflammation measure levels of acute phase reactants. An increase in fibrinogen is associated with an increased erythrocyte sedimentation rate, which is considered a good indicator of an acute inflammatory response. An elevated sedimentation rate is not associated with anemia, infection, or an electrolyte imbalance.

A nurse checks lab results as both Cushing disease and Addison disease can manifest with elevated levels of: a. ADH. b. estrogen. c. adrenocorticotropic hormone (ACTH). d. aldosterone.

ANS: C Cushing disease and Addison disease are related to elevated levels of ACTH, not ADH, estrogen, or aldosterone.

A patient diagnosed with a diffuse brain injury (DBI) is at increased risk for which complication? a. Complete loss of vision b. Arrhythmia c. Acute brain swelling d. Meningitis infection

ANS: C DBI is not associated with intracranial hypertension immediately after injury; however, acute brain swelling caused by increased intravascular blood flow within the brain, vasodilation, and increased cerebral blood volume is seen often and can result in death. Individuals who experience diffuse brain injury may experience visual impairments but do not experience loss of vision. A diffuse brain injury is not associated with arrhythmias. Individuals experiencing basilar skull fractures are at increased risk for the development of meningitis.

A nurse recalls the mast cell, a major activator of inflammation, initiates the inflammatory response through the process of: a. chemotaxis. b. endocytosis. c. degranulation. d. opsonization.

ANS: C Degranulation of mast cells is a major cellular component of inflammation. Chemotaxis is the process of white cell migration. Endocytosis and opsonization are parts of phagocytosis but are not factors in mast cell response.

Which of the following patients is the most at risk for developing hypernatremia? A patient with: a. vomiting. b. diuretic use. c. dehydration. d. hypoaldosteronism.

ANS: C Dehydration leads to hypernatremia because an increase in sodium occurs with a net loss in water. Vomiting and diuretic use leads to hyponatremia. Hypoaldosteronism leads to hyponatremia.

Acute pancreatitis often manifests with pain to which of the following regions? a. Right lower quadrant b. Right upper quadrant c. Epigastric d. Suprapubic

ANS: C Epigastric or midabdominal pain ranging from mild abdominal discomfort to severe, incapacitating pain is one of the manifestations of pancreatitis. Right lower pain would be a symptom of appendicitis. Right upper quadrant pain would be manifestation of liver inflammation. Suprapubic pain would be related to full bladder or colon problems.

Erythropoietin is produced in the: a. liver. b. bone marrow. c. kidneys. d. spleen.

ANS: C Erythropoietin is produced in the kidneys, not the liver, bone marrow, or spleen.

The most common disorder associated with upper GI bleeding is: a. diverticulosis. b. hemorrhoids. c. esophageal varices. d. cancer.

ANS: C Esophageal varices is the most common disorder associated with upper GI bleeding. Diverticulosis could lead to bleeding, but it would be lower GI rather than upper. Hemorrhoids can lead to bleeding, but they would be lower GI. Cancer could lead to upper GI bleeding, but peptic ulcers and varices are identified as more common.

A 50-year-old is diagnosed with gastroesophageal reflux. This condition is caused by: a. fibrosis of the lower third of the esophagus. b. sympathetic nerve stimulation. c. loss of muscle tone at the lower esophageal sphincter. d. reverse peristalsis of the stomach.

ANS: C Gastroesophageal reflux is due to loss of muscle tone at the lower esophageal sphincter. The resting tone of the lower esophageal sphincter (LES) tends to be lower than normal from either transient relaxation or weakness of the sphincter. Gastroesophageal reflux is not due to fibrosis, stimulation of sympathetic nerves, or reverse peristalsis.

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

ANS: C Respiratory acidosis occurs with hypoventilation, and pneumonia leads to hypoventilation. Vomiting leads to loss of acids and then to alkalosis. Hyperventilation leads to respiratory alkalosis. Metabolic acidosis is caused by an increase in noncarbonic acids.

Manifestations associated with hepatic encephalopathy from chronic liver disease are the result of: a. hyperbilirubinemia and jaundice. b. fluid and electrolyte imbalances. c. impaired ammonia metabolism. d. decreased cerebral blood flow.

ANS: C Hepatic encephalopathy effect on the liver prevents end products of intestinal protein digestion, particularly ammonia, from being converted to urea by the diseased liver. Impaired ammonia metabolism leads to the symptoms of hepatic encephalopathy. Symptoms are primarily neurologic, not jaundice oriented. Manifestations associated with hepatic encephalopathy are not associated with hyperbilirubinemia and jaundice, fluid, and electrolyte imbalances or decreased cerebral blood flow.

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

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

Which symptom would the nurse expect in a patient diagnosed with hyperaldosteronism? a. Hypovolemia b. Hypotension c. Hypokalemia d. Hyponatremia

ANS: C Hypertension, hypokalemia, and neuromuscular manifestations are the hallmarks of primary hyperaldosteronism. Neither hypovolemia nor hyponatremia is associated with hyperaldosteronism.

What is the most common cause of hypoparathyroidism? a. Pituitary hyposecretion b. Parathyroid adenoma c. Parathyroid gland injury d. Hypothalamic inactivity

ANS: C Hypoparathyroidism is most commonly caused by damage to the parathyroid glands, not pituitary hyposecretion, parathyroid adenoma, or inactivity of the hypothalamus.

A 56-year-old male was admitted to the hospital with a diagnosis of osteomalacia. History reveals that he underwent bariatric surgery 3 years earlier. What is the common link between the surgery and the development of osteomalacia? a. Impaired phosphate absorption b. Increased calcium excretion c. Vitamin D deficiency d. Impaired vitamin C metabolism

ANS: C Impaired nutrient absorption from bariatric surgery can result in vitamin D deficiency. Vitamin D deficiency is the most important factor in the development of osteomalacia. Neither impaired phosphate absorption, increased calcium excretion, nor impaired vitamin C metabolism is a cause of osteomalacia.

The inflammatory symptoms of classic gouty arthritis are caused by the crystallization of _____ within the synovial fluid. a. purines b. pyrimidines c. monosodium urate d. acetic acid

ANS: C In classic gouty arthritis, monosodium urate crystals form and are deposited in joints and their surrounding tissues, initiating a powerful inflammatory response. Uric acid is a result of purine metabolism, but purine is not present in the joint. Gout is not caused by an increase in pyrimidines or acetic acid.

The nurse is assessing the patient with a pen light. The integrity of which cranial nerve is being evaluated? a. Olfactory b. Vagus c. Oculomotor d. Trigeminal

ANS: C In evaluating the oculomotor nerve, the pupils are examined for size, shape, and equality; pupillary reflex tested with a pen light (pupils should constrict when illuminated); and ability to follow moving objects. The olfactory nerve is assessed using smells. The vagus nerve is assessed using the ophthalmoscope. The trigeminal nerve is assessed with a safety pin and hot and cold objects for sensations of pain, touch, and temperature.

A 70-year-old female presents with a hip fracture secondary to osteoporosis. This condition is caused by an increase in bone: a. density. b. formation. c. resorption. d. mineralization.

ANS: C In osteoporosis, old bone is being resorbed faster than new bone is being made, causing the bones to lose density, becoming thinner, and more porous. Mineralization is not increased by osteoporosis.

Tissue damage in pancreatitis is initially triggered by: a. insulin toxicity. b. autoimmune destruction of the pancreas. c. backup of pancreatic enzymes. d. hydrochloric acid reflux into the pancreatic duct.

ANS: C In pancreatitis there is backup of pancreatic secretions and activation and release of enzymes (activated trypsin activates chymotrypsin, lipase, and elastase) within the pancreatic acinar cells. The enzymes become activated, triggering the resulting autodigestion, inflammation, and oxidative stress. The tissue damage associated with pancreatitis is not due to insulin toxicity or to hydrochloric acid reflux.

Immediately after being struck by a motor vehicle, a patient is unconscious, but the patient regains consciousness before arriving at the hospital and appears alert and oriented. The next morning the patient is confused and demonstrates impaired responsiveness. The patient's history and symptoms support which medical diagnosis? a. Mild concussion b. Subdural hematoma c. Extradural (epidural) hematoma d. Mild diffuse axonal injury

ANS: C Individuals with extradural hematomas lose consciousness at injury; one third then become lucid for a few minutes to a few days. Mild concussion is characterized by immediate but transitory confusion that lasts for one to several minutes, possibly with amnesia for events preceding the trauma. Subdural hematomas begin with headache, drowsiness, restlessness or agitation, slowed cognition, and confusion. These symptoms worsen over time and progress to loss of consciousness, respiratory pattern changes, and pupillary dilation. Individuals with mild diffuse axonal injury display decerebrate or decorticate posturing and may experience prolonged periods of stupor or restlessness.

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

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

A patient diagnosed with thyroid carcinoma would be expected to have T3 and T4 levels that are: a. high. b. low. c. normal. d. variable.

ANS: C Most individuals with thyroid carcinoma have normal T3 and T4 levels and are therefore euthyroid.

When a patient asks, "What is the cause of multiple sclerosis?" the nurse bases the answer on the interaction between: a. vascular and metabolic factors. b. bacterial infection and the inflammatory response. c. autoimmunity and genetic susceptibility. d. neurotransmitters and inherited genes.

ANS: C Multiple sclerosis is due to an interaction between the autoimmune response and genetics. Multiple sclerosis is an autoimmune disorder that is thought to have developed secondary to a viral infection. It is not bacterial, nor is it related to a neurotransmitter dysfunction or vascular or metabolic factors.

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

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

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

ANS: C Opportunistic microorganisms can cause disease if the individual's defenses are compromised. Diabetes, congestive heart failure, and pneumonia are not associated with immunocompromised disorders.

A major contributing process in CVAs is the development of atheromatous plaques in cerebral circulation. Where do these plaques most commonly form? a. In the larger veins b. Near capillary sphincters c. In cerebral arteries d. In the venous sinuses

ANS: C Over 20-30 years, atheromatous plaques (stenotic lesions) form at branchings and curves in the cerebral circulation, primarily the arteries, not in veins, near the sphincters, or in the venous sinuses.

Pancreatic insufficiency is manifested by deficient production of: a. insulin. b. amylase. c. lipase. d. bile.

ANS: C Pancreatic insufficiency is the deficient production of lipase by the pancreas. Pancreatic insufficiency is not associated with the deficient production of insulin, amylase, or bile.

Which neurotransmitter is released when a patient's parasympathetic motor neurons are stimulated? a. Epinephrine b. Serotonin c. Acetylcholine d. Substance P

ANS: C Parasympathetic motor neurons release acetylcholine. Adrenergic motor neurons release epinephrine. Serotonin is associated with the brain. Substance P is a neurotransmitter in pain transmission pathways. Blocking the release of substance P by morphine reduces pain.

Patients diagnosed with myasthenia gravis often have tumors or pathologic changes in the: a. brain. b. pancreas. c. thymus. d. lungs.

ANS: C Patients diagnosed with myasthenia gravis experience tumors in the thymus, not the brain, the pancreas, or the lungs.

During which process are bacteria engulfed for ingestion? a. Endocytosis b. Pinocytosis c. Phagocytosis d. Exocytosis

ANS: C Phagocytosis (cell eating) involves the ingestion of large particles, such as bacteria, through the formation of large vesicles. Endocytosis involves the formation of vesicles to facilitate movement into the cell. Pinocytosis is a type of endocytosis in which fluids and solute molecules are ingested through the formation of small vesicles. Exocytosis occurs when coated pits invaginate and internalize ligand-receptor complexes in coated vesicles.

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

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

After birth, red blood cells are normally made only in the: a. liver. b. spleen. c. bone marrow. d. kidney.

ANS: C Red blood cells are produced in the bone marrow, not the liver, spleen, or kidney.

Which neurons have the capacity for regeneration? a. Unmyelinated neurons in the brain b. Myelinated neurons in the spinal cord c. Myelinated peripheral neurons d. Postganglionic motor neurons

ANS: C Regeneration is limited to myelinated fibers and generally occurs only in the PNS. Regeneration does not occur in unmyelinated neurons, myelinated neurons in the spinal cord, or postganglionic motor neurons.

A 40-year-old develops disseminated intravascular coagulation (DIC). Upon obtaining the history, which finding is the most likely cause of this condition? a. Snakebite b. Blood transfusion c. Sepsis d. Immune thrombocytopenic purpura (ITP)

ANS: C Sepsis is one of the most common conditions associated with DIC. While snake venom, blood transfusions, and ITP may cause DIC, sepsis is the most likely cause.

What is the main energy source or fuel for skeletal muscle contraction? a. Potassium b. Lactic acid c. Adenosine triphosphate (ATP) d. Actin

ANS: C Skeletal muscle requires a constant supply of ATP and phosphocreatine. These substances are necessary to fuel the complex processes of muscle contraction. Neither potassium, lactic acid, nor actin is the main energy source for muscle contraction.

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

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

A patient diagnosed with Graves disease is admitted to a medical-surgical unit. Which of the following symptoms would the nurse expect to find before treatment? a. Weight gain, cold intolerance b. Slow heart rate, rash c. Skin hot and moist, rapid heart rate d. Constipation, confusion

ANS: C Symptoms of Graves disease include heat intolerance and increased tissue sensitivity to stimulation by the sympathetic division of the autonomic nervous system. Weight loss, rather than weight gain, and heat intolerance would result. Tachycardia, not slow heart rate, would occur. Diarrhea would occur as opposed to constipation.

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

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

A 75-year-old male presents with chest pain on exertion. The chest pain is most likely due to hypoxic injury secondary to: a. malnutrition. b. free radicals. c. ischemia. d. chemical toxicity.

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

Thrombocytopenia may be: a. transient or consistent. b. normal or abnormal. c. congenital or acquired. d. active or inactive.

ANS: C The condition may also be either congenital or acquired and may be either primary or secondary to other conditions. It is not referred to as transient or consistent, normal or abnormal, or active or inactive.

A patient diagnosed with a spinal cord injury experienced spinal shock lasting 15 days. The patient is now experiencing an uncompensated cardiovascular response to sympathetic stimulation. What does the nurse suspect caused this condition? a. Toxic accumulation of free radicals below the level of the injury b. Pain stimulation above the level of the spinal cord lesion c. A distended bladder or rectum d. An abnormal vagal response

ANS: C The described symptoms indicate autonomic hyperreflexia and are due to a distended bladder or rectum. The described symptoms are not due to the accumulation of free radicals, pain stimulation, or an abnormal vagal response.

What is the cause of type 1 diabetes mellitus (DM)? a. A familial, autosomal dominant gene defect b. Obesity and lack of exercise c. Immune destruction of the pancreas d. Hyperglycemia from eating too many sweets

ANS: C The most common cause of type 1 DM is a slowly progressive autoimmune T-cell-mediated disease that destroys the beta cells of the pancreas; it is not due to a gene defect. Although obesity can contribute to diabetes, it doesn't cause type 1 DM. Eating too many sweets may contribute to the development of obesity.

What is the most common type of renal stone composed of? a. Struvite b. Cystine c. Calcium d. Uric acid

ANS: C The most common stone types are calcium oxalate or phosphate (70-80%). Struvite (magnesium-ammonium-phosphate) occurs 15% of the time. Cystine stoes are rare (less than 1%). Uric acid stones occur 7% of the time.

An athlete runs a marathon, after which his muscles feel fatigued and unable to contract. The athlete asks the nurse why this happened. The nurse's response is based on the knowledge that the problem is result of a deficiency of: a. GTP b. AMP c. ATP d. GMP

ANS: C When ATP is deficient, impaired muscle contraction results. None of the other options are involved in muscle contraction.

A 30-year-old white male recently suffered a cerebrovascular accident. Which of the following is the most likely factor that contributed to his stroke? a. Age b. Gender c. Diabetes d. Race

ANS: C The most likely contributing factor to the patient's stroke is that he has diabetes with a fourfold increase in stroke incidence and an eightfold increase in stroke mortality. Age greater than 65 years is contributing factor. Men are affected, but for the 30-year-old, his type 2 diabetes mellitus contributes to a fourfold increase in stroke incidence and an eightfold increase in stroke mortality. Blacks are affected more than whites, and it is this patient's diabetes that places him at risk.

Which is the most potent naturally occurring glucocorticoid? a. Aldosterone b. Testosterone c. Cortisol d. Prolactin

ANS: C The most potent naturally occurring glucocorticoid is cortisol, not aldosterone, testosterone, or prolactin.

Six weeks ago a patient suffered a T6 spinal cord injury. What complication does the nurse suspect when the patient develops a blood pressure of 200/120, a severe headache, blurred vision, and bradycardia? a. Extreme spinal shock b. Acute anxiety c. Autonomic hyperreflexia d. Parasympathetic areflexia

ANS: C The patient is experiencing autonomic hyperreflexia, which is manifested by paroxysmal hypertension (up to 300 mm Hg, systolic), a pounding headache, blurred vision, sweating above the level of the lesion with flushing of the skin, nasal congestion, nausea, piloerection caused by pilomotor spasm, and bradycardia (30-40 beats/min). The patient in extreme spinal shock experiences paralysis and flaccidity in muscles, absence of sensation, loss of bladder and rectal control, transient drop in blood pressure, and poor venous circulation. The patient may experience acute anxiety, but the symptoms of elevated blood pressure with severe headache are due to autonomic hyperreflexia. It is autonomic hyperreflexia, not parasympathetic areflexia, that produces paroxysmal hypertension (up to 300 mm Hg, systolic), a pounding headache, blurred vision, sweating above the level of the lesion with flushing of the skin, nasal congestion, nausea, piloerection caused by pilomotor spasm, and bradycardia (30-40 beats/min).

After rehabilitation for severe brain damage following a motor vehicle accident, a patient reports that her thought processes and ability to concentrate are impaired. Which area does the nurse suspect is damaged? a. Thalamus b. Limbic c. Prefrontal d. Occipital

ANS: C The prefrontal area is responsible for goal-oriented behavior (e.g., ability to concentrate), short-term or recall memory, the elaboration of thought, and inhibition of the limbic areas of the CNS. Goal-oriented behavior is not the function of the thalamus, limbic system, or occipital area.

A 60-year-old patient with a recent history of head trauma and a long-term history of hypertension presents to the ER for changes in mental status. MRI reveals that the patient has experienced a subarachnoid hemorrhage. What does the nurse suspect caused this type of stroke? a. Rheumatic heart disease b. Thrombi c. Aneurysm d. Hypotension

ANS: C The primary causative factor of subarachnoid hemorrhagic bleeding is an aneurysm, not thrombi, which would lead to thrombotic stroke. A thrombi would lead to a CVA from blockage, but not to hemorrhagic bleeding. Hypertension, not hypotension, would lead to a hemorrhagic stroke. Rheumatic heart disease is not associated with subarachnoid hemorrhages.

Tests reveal narrowing of the opening between the stomach and the duodenum. This condition is referred to as: a. ileocecal obstruction. b. hiatal hernia. c. pyloric obstruction. d. hiatal obstruction.

ANS: C The pylorus is the opening between the esophagus and the duodenum; the obstruction is pyloric. Ileocecal obstruction is in the small intestine. Hiatal hernia is related to the esophagus. Hiatal obstruction is related to the esophagus.

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

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

When a patient asks what the somatic nervous system controls, how should the nurse respond? It controls: a. the heart. b. the spinal cord. c. skeletal muscle. d. smooth muscle organs.

ANS: C The somatic nervous system consists of pathways that regulate voluntary motor control, the skeletal muscle system. The somatic nervous system does not control the heart; the autonomic nervous system controls the heart, the spinal cord, and the smooth muscle organs.

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

ANS: C The transporter protein ATPase is directly related to sodium and potassium transport via active transport. Electrolyte movements require energy and do not move passively, nor are they transported by diffusion. Enzymes, not electrolytes, are passed via coupled channels.

A 35-year-old female is diagnosed with vitamin B12 deficiency anemia (pernicious anemia). The most likely cause is a decrease in: a. ferritin. b. gastric enzymes. c. intrinsic factor. d. erythropoietin.

ANS: C The underlying alteration in pernicious anemia (PA) is the absence of intrinsic factor (IF), an enzyme required for gastric absorption of dietary vitamin B12, a vitamin essential for nuclear maturation, and DNA synthesis in red blood cells. PA is not due to a decrease in ferritin, gastric enzymes, or erythropoietin but to a lack of intrinsic factor.

Where is the primary visual cortex of the brain located? a. Frontal lobe b. Temporal lobe c. Occipital lobe d. Parietal lobe

ANS: C The visual cortex is located in the occipital lobe

A 30-year-old male is demonstrating hematuria with red blood cell casts and proteinuria exceeding 3-5 grams per day, with albumin being the major protein. The most probable diagnosis the nurse will see documented on the chart is: a. cystitis. b. chronic pyelonephritis. c. acute glomerulonephritis. d. renal calculi.

ANS: C Two major symptoms distinctive of more severe glomerulonephritis are: (i) hematuria with red blood cell casts and (ii) proteinuria exceeding 3-5 grams per day with albumin (macroalbuminuria) as the major protein. Cystitis is not associated with proteinuria and so is not relevant to the diagnosis of glomerulonephritis. Chronic pyelonephritis is manifested by dysuria, not proteinuria. Proteinuria is not seen with renal calculi.

The most common condition associated with the development of acute pyelonephritis is: a. cystitis. b. renal cancer. c. urinary tract obstruction. d. nephrotic syndrome.

ANS: C Urinary obstruction and reflux of urine from the bladder are the most common underlying risk factors. Risk factors do not include cystitis, renal cancer, or nephrotic syndrome.

The most common clinical manifestation of portal hypertension is _____ bleeding. a. rectal b. duodenal c. esophageal d. intestinal

ANS: C Vomiting of blood from bleeding esophageal varices is the most common clinical manifestation of portal hypertension. Neither rectal, duodenal, nor intestinal bleeding is a common clinical manifestation of portal hypertension.

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

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

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

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

A 72-year-old patient demonstrates left-sided weakness of upper and lower extremities. The symptoms lasted less than an hour and resolved with no evidence of infarction. The patient most likely experienced a(n): a. stroke in evolution. b. arteriovenous malformation. c. transient ischemic attack. d. cerebral hemorrhage.

ANS: C When symptoms resolve with complete recovery, it is a transient ischemic attack. A stroke in evolution is an impending stroke, and symptoms would not resolve. An arteriovenous malformation is an abnormal arrangement of blood vessels that could lead to stroke but is not a disorder in itself. Cerebral hemorrhage would not resolve.

A nurse is caring for a patient diagnosed with SIADH. What severe complication should the nurse assess for? a. Stroke b. Diabetes insipidus c. Neurologic damage d. Renal failure

ANS: C When the hyponatremia of SIADH becomes severe, 110-115 milliequivalents per liter, confusion, lethargy, muscle twitching, convulsions, and severe and sometimes irreversible neurologic damage may occur. Neither stroke, diabetes insipidus, nor renal failure is associated with SIADH.

Which component of the bone matrix gives bone its tensile strength? a. Calcium b. Phosphate c. Collagen d. Magnesium

ANS: C While calcium, phosphate, and magnesium all play a role in bone formation, collagen is the component of bone matrix that gives bone tensile strength.

Which assessment finding would the nurse expect to be increased in a patient with deficient ADH production? a. Blood volume b. Urine osmolality c. Urine volume d. Arterial vasoconstriction

ANS: C With deficient ADH, the kidneys would not concentrate urine, leading to increased urine output. Blood volume would decrease with increased renal excretion of fluid. Urine osmolality would decrease. Arteries would dilate with deficient ADH production.

A 50-year-old male intravenous drug user is diagnosed with hepatitis C. Examination of the liver reveals cell death secondary to: a. fat necrosis. b. physiologic apoptosis. c. infection-induced apoptosis. d. pyknosis.

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

A patient diagnosed with Addison disease reports weakness and is easily fatigued. What is the root of these symptoms? a. Hyperkalemia b. Hypoglycemia c. Hypocortisolism d. Metabolic acidosis

ANS: C With mild-to-moderate hypocortisolism, symptoms usually begin with weakness and easy fatigability. The weakness is not due to hyperkalemia, hypoglycemia, or metabolic

A patient wants to know about risk factors for acute leukemia. Which of the following should the nurse include? (select all that apply) a. Cytomegalovirus (CMV) infection b. Eating genetically modified food c. Chemotherapy treatment for other cancers d. Excessive ultraviolet radiation exposure e. Ovarian cancer

ANS: C, D, E Hepatitis C or HIV can predispose the patient to leukemia, not CMV. Drugs that cause bone marrow depression, such as chemotherapeutic agents, predispose an individual to leukemia; eating genetically modified food is not a predisposing factor. Excessive ultraviolet radiation exposure can predispose an individual to myelogenous leukemia. Acute leukemia may also develop secondary to certain acquired disorders, including ovarian cancer.

Which of the following are true regarding prostate cancer? (select all that apply) a. It is responsible for the majority of cancer-related deaths in males. b. It usually occurs before age 50. c. It is the leading type of nonskin cancer in men in the United States. d. It is more common in White men in the United States. e. Prostate cancer death rates have been declining in the United States.

ANS: C, E Prostate cancer is the most commonly diagnosed nonskin cancer in men in the United States with a lifetime risk for diagnosis currently estimated at 15.9%. The incidence varies greatly worldwide, but it is still considered to be the second most frequently diagnosed cancer in men and the sixth leading cause of death worldwide. Black men are more greatly affected. Rates have been declining.

A nurse is preparing to teach staff about the most common type of traumatic brain injury. Which type of traumatic brain injury should the nurse discuss? a. Penetrating trauma b. Diffuse axonal injury c. Focal brain injury d. Concussion

ANS: D A concussion is the most common type of traumatic brain injury. A concussion is a much more common brain injury than penetrating trauma, diffuse axonal injury, or focal injury.

Which of the following alterations would the nurse expect to find in a patient with untreated Cushing disease or syndrome? a. Bradycardia b. Tachypnea c. Hyperkalemia d. Hypertension

ANS: D With elevated cortisol levels, vascular sensitivity to catecholamines increases significantly, leading to vasoconstriction and hypertension. Tachycardia is more likely than bradycardia due to increased sensitivity to catecholamines. Tachypnea does not occur; the patient experiences hypertension. Hyokalemia, not hyperkalemia, occurs.

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

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

Palpation of the neck of a patient diagnosed with Graves disease would most likely reveal: a. a normal-sized thyroid. b. a small discrete thyroid nodule. c. multiple discrete thyroid nodules. d. diffuse thyroid enlargement.

ANS: D A patient with Graves disease would reveal stimulation of the gland causing diffuse thyroid enlargement. In Graves disease, the thyroid will not have nodules present.

Diabetes insipidus, diabetes mellitus (DM), and SIADH share which of the following assessment manifestations? a. Polyuria b. Edema c. Vomiting d. Thirst

ANS: D All three share thirst as a common clinical manifestation. SIADH does not have polyuria as a clinical manifestation. Diabetes insipidus does not have edema as a clinical manifestation. SIADH is manifested by gastrointestinal symptoms; the other two are not.

When planning care for a dehydrated patient, the nurse remembers that the principle of water balance is closely related to the balance of: a. potassium. b. chloride. c. bicarbonate. d. sodium.

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

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

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

Which electrolyte will the nurse check to ensure normal platelet functioning? a. Sodium b. Potassium c. Magnesium d. Calcium

ANS: D Calcium is necessary for many of the intracellular signaling mechanisms that control platelet activation. Control of platelet activation is not associated with sodium, potassium, or magnesium.

Which of the following would increase a patient's risk for thrombotic stroke? a. Hyperthyroidism b. Hypertension c. Anemia d. Dehydration

ANS: D Dehydration is a risk factor because it increases blood viscosity and decreases cerebral perfusion. Hyperthyroidism would lead to increased blood pressure but does not place the patient at risk for thrombotic stroke. Hypotension, not hypertension, is a risk factor for thrombotic stroke. Anemia would decrease a person's risk for thrombotic stroke.

Who is most at risk of spinal cord injury because of preexisting degenerative disorders? a. Infants b. Men c. Women d. The elderly

ANS: D Elderly people are particularly at risk from minor trauma that results in serious spinal cord injury because of preexisting degenerative vertebral disorders. Neither females nor infants are at any particular risk for spinal cord injuries. Males are at great risk for spinal cord injury but not as a result of preexisting disorders.

Which description accurately describes electrolytes? a. Small lipid-soluble molecules b. Large protein molecules c. Micronutrients used to produce ATP d. Electrically charged molecules

ANS: D Electrolytes are electrically charged molecules. They are not lipid soluble, they are not made up of protein, and they do not play a role in ATP production.

A nurse is caring for a patient who cannot clot. Which end product of the clotting cascade is this patient unable to make? a. Collagen b. Fibrinogen c. Thrombin d. Fibrin

ANS: D Fibrin is the end product of the coagulation cascade. While involved in the coagulation cascade, neither collagen, fibrinogen, nor thrombin is considered the end product of the coagulation cascade.

Which condition will cause a patient to secrete erythropoietin? a. Low blood pressure b. Hypercarbia c. Inflammation d. Hypoxia

ANS: D Hypoxia stimulates production of erythropoietin. Erythropoietin is not secreted in response to low blood pressure, hypercarbia, or inflammation.

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

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

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

ANS: D Increased vascular permeability and leakage of fluid out of the vessel cause edema at the site of injury. Vasodilation occurs, bringing increased RBCs to the site and causing redness.

A 55-year-old is diagnosed with extrahepatic obstructive jaundice that is a result of the obstruction of the: a. intrahepatic bile canaliculi. b. gallbladder. c. cystic duct. d. common bile duct.

ANS: D Jaundice is due to obstruction of the common bile duct. This form of jaundice is not due to obstruction of the intrahepatic canaliculi, gallbladder, or the cystic duct.

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

ANS: D Losses of potassium from body stores are usually caused by gastrointestinal and renal disorders. Diarrhea, intestinal drainage tubes or fistulae, and laxative abuse also result in hypokalemia. Acidosis is related to hyperkalemia, not hypokalemia. Constipation can occur with hypokalemia but does not cause it. Hypoglycemia is not related to muscle weakness.

Patient teaching is considered successful regarding myasthenia gravis when the patient identifies its cause as being: a. viral infection of skeletal muscle. b. atrophy of motor neurons in the spinal cord. c. demyelination of skeletal motor neurons. d. autoimmune injury at the neuromuscular junction.

ANS: D Myasthenia gravis is a disorder resulting from autoimmune injury at the neuromuscular junction, not from a viral infection. It is not due to motor neuron atrophy, but a lack of acetylcholine. Multiple sclerosis (MS) is due to demyelination of skeletal motor neurons.

The predominant phagocyte of early inflammation is the: a. eosinophil. b. lymphocyte. c. macrophage. d. neutrophil.

ANS: D Neutrophils are the chief phagocytes of early inflammation. Eosinophils ingest antigen-antibody complexes and are induced by IgE-mediated hypersensitivity reactions to attack parasites. Most lymphocytes transiently circulate in the blood and eventually reside in lymphoid tissues as mature T cells, B cells, or plasma cells. Macrophages migrate out of the vessels in response to infection or inflammation but are not the early responders.

Osteomalacia is a result of: a. collagen breakdown in the bone matrix. b. excessive bone resorption. c. crowding of bone marrow by excessive bone growth. d. inadequate bone mineralization.

ANS: D Osteomalacia is a metabolic disease characterized by inadequate and delayed mineralization of osteoid in mature compact and spongy bone. Idiopathic osteoarthritis leads to collagen breakdown. Giant cell tumors promote excessive bone resorption. Abnormal remodeling causes crowding of bone marrow.

A 35-year-old female took corticosteroid therapy for several months. Which of the following would the nurse expect to find? a. Renal toxicity b. Episodes of hypoglycemia c. Hypotension d. Type 2 DM

ANS: D Overt DM develops in approximately 20% of individuals with hypercortisolism. Diabetes develops not renal toxicity, but hyperglycemia and hypertension may occur.

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

ANS: D Physical activity has been proven to reduce the risk for breast and colon cancers, but its effect in reducing prostate, lung, or bone cancer is not as strong.

An important risk factor in the development of benign prostatic hypertrophy (BPH) among Americans is: a. recurrent prostatitis. b. a diet high in fat. c. cigarette smoking. d. increased age.

ANS: D Prevalence in the United States is about 50% in men 60 years and older and 90% among men 70 years or older. BPH is common and involves a complex pathophysiology with several endocrine and local factors and remodeled microenvironment, but its relationship to aging is well documented. Risk factors for BPH do not include prostatitis, a diet high in fat, or cigarette smoking.

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

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

A patient who has elevated thyroxine production should be assessed for which accompanying condition? a. Increased thyroid-releasing hormone (TRH) b. Increased anterior pituitary stimulation c. Decreased T4 d. Decreased thyroid-stimulating hormone (TSH)

ANS: D Secretion of TSH stimulates the synthesis and secretion of thyroid hormones. Increasing levels of T4 and T3 then feedback negatively on the pituitary and hypothalamus to inhibit TRH and TSH synthesis. With increased thyroxine production, TRH will be decreased. Increased thyroxine would lead to decreased anterior pituitary stimulation. Thyroxine is T4; its level will be elevated.

A patient is diagnosed with renal calculus that is causing a urinary obstruction. Which symptoms would be most likely experienced? a. Anuria b. Hematuria c. Pyuria d. Flank pain

ANS: D Significant flank pain is the most common manifestation. Neither anuria nor pyuria is a common manifestation. Hematuria does occur, but it is not the most common manifestation.

What can trigger ACTH to be released? a. High serum levels of cortisol b. Hypotension c. Hypoglycemia d. Stress

ANS: D Stress increases ACTH secretion. ACTH regulates the release of cortisol from the adrenal cortex. It is not stimulated by high serum cortisol levels. Neither hypotension nor hypoglycemia stimulates ACTH secretion.

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

ANS: D The cell's ability to absorb oxygen is referred to as respiration while its communication ability involves maintenance of a steady dynamic state, metabolic absorption provides nutrition, and secretion allows for the synthesizing of new substances.

A common cause of chronic mesenteric ischemia among the elderly is: a. anemia. b. aneurysm. c. lack of nutrition in gut lumen. d. atherosclerosis.

ANS: D The most common cause of chronic mesenteric ischemia is atherosclerosis. Neither poor nutrition nor anemia leads to vascular insufficiency. An aneurysm would lead to acute vascular insufficiency.

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

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

The majority of intervertebral disk herniations occur between which vertebral levels (cervical, C; thoracic, T; lumbar, L; sacral, S)? a. C1-C3 b. T1-T4 c. T12-L3 d. L4-S1

ANS: D The most common disks affected by herniation are the lumbosacral disks—that is, L5-S1 and L4-L5.

The body's inability to conserve water and sodium when affected by Addison disease is explained by which of the following conditions? a. Elevated levels of cortisol b. Decreased levels of ACTH c. Hypersecretion of ADH d. Aldosterone deficiency

ANS: D The symptoms of Addison disease are primarily a result of hypocortisolism, elevated serum ACTH, and hypoaldosteronism. ADH does not play a role in Addison disease.

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

ANS: D While some ATP is produced during the oxidation and glycolysis phases, most of the ATP is generated during the citric acid cycle. Digestion does not produce any ATP.

A 19-year-old female with type 1 DM was admitted to the hospital with the following lab values: serum glucose 500 milligrams per deciliter (high), urine glucose and ketones 4+ (high), and arterial pH 7.20 (low). Her parents state that she has been sick with the "flu" for a week. Which of the following statements best explains her acidotic state? a. Increased insulin levels promote protein breakdown and ketone formation. b. Her uncontrolled diabetes has led to renal failure. c. Low serum insulin promotes lipid storage and a corresponding release of ketones. d. Insulin deficiency promotes lipid metabolism and ketone formation.

ANS: D With insulin deficiency, lipolysis is enhanced, and there is an increase in the amount of nonesterified fatty acids delivered to the liver. The consequence is increased glyconeogenesis contributing to hyperglycemia and production of ketone bodies (acetoacetate, hydroxybutyrate, and acetone) by the mitochondria of the liver at a rate that exceeds peripheral use. Insulin levels are decreased. There is no evidence that the patient is in renal failure. Insulin is low, but the ketones are the result of fatty acid breakdown due to lack of insulin, not because of lipid storage.