Huether Combined patho/pharm 4 week 2

Which type of scoliosis accounts for the majority of the cases of scoliosis? a. Idiopathic b. Infectious c. Iatrogenic d. Secondary

ANS: A Eighty percent of all scoliosis is idiopathic. REF: p. 1046

When should the nurse assess for the vomiting and headache that are the classic symptoms of childhood brain tumors? a. Morning b. Early afternoon c. As the sun goes down and darkness begins d. During the middle of the night

ANS: A Headache and vomiting occur more commonly in the morning. REF: p. 434

What is the term used to identify a pattern of bone destruction indicative of an aggressive malignant tumor? (select all that apply) a. Moth-eaten b. Permeative c. Geographic d. Radial e. Selective

ANS: A, B, C Three patterns of bone destruction by bone tumors have been identified: (1) the geographic pattern, (2) the moth-eaten pattern, and (3) the permeative pattern. Radial and selective are not considered patterns of malignancy

Assessment signs of neuroblastoma include: (select all that apply) a. weight loss. b. irritability. c. fatigue. d. fever. e. constipation.

ANS: A, B, C, D Systemic signs of neuroblastoma include weight loss, irritability, fatigue, fever, and intractable diarrhea, not constipation. REF: p. 435

A 6-year-old male presents with fever, pain, swelling, and warmth and is diagnosed with osteomyelitis. In addition to the clinical symptoms, the nurse would expect elevations in which lab tests? (select all that apply) a. C-reactive protein b. White blood cell count c. Red cell count d. Erythrocyte sedimentation rate (ESR) e. Liver enzymes

ANS: A, B, D Children often will present with fever, elevated white blood cell count (50-70%), elevated C-reactive protein (98%), and elevated ESR (90%). REF: p. 1042

A 32-year-old obese male begins a jogging routine. A week after beginning, he fractures his leg. This is referred to as a what type of fracture? a. Comminuted b. Greenstick c. Fatigue d. Compound

ANS: C A fatigue fracture is caused by abnormal stress or torque applied to a bone that usually occurs in individuals who engage in a new activity that is both strenuous and repetitive. A comminuted fracture is one in which a bone breaks into two or more fragments. A greenstick fracture perforates one cortex and splinters the spongy bone. A compound fracture is a complete and incomplete fracture that breaks through the skin.

A 54-year-old male was recently diagnosed with rheumatoid arthritis (RA). Which of the following is the expected treatment of choice? a. Nonsteroidal anti-inflammatory drugs (NSAIDs) b. Gold salts c. Methotrexate d. Colchicine

ANS: C Methotrexate remains the first line of treatment for RA. Neither NSAIDs, gold salts, nor colchicine is a treatment of choice for RA.

A 9-month-old male was diagnosed with osteogenesis imperfecta (OI). This disease is caused by errors in the synthesis of: a. elastin. b. glycoproteins. c. collagen. d. calcium salts.

ANS: C OI (brittle bone disease) is a spectrum of disease caused by genetic mutation in the gene that encodes for type I collagen. OI (brittle bone disease) is not caused by faulty synthesis of elastin, glycoproteins, or calcium salts. REF: p. 1039

Parents of a 3-month-old bring the infant to the emergency room (ER) after a seizure has caused muscle rigidity. Both parents are of Jewish ancestry. For what genetic disease should this infant be screened? a. Juvenile myoclonic epilepsy b. Congenital encephalopathy c. Tay-Sachs disease d. PKU

ANS: C Perhaps the best known of the lysosomal storage disorders is Tay-Sachs disease, an autosomal recessive disorder related to a deficiency of the enzyme hexosaminidase A (HEX A). Approximately 80% of individuals diagnosed are of Jewish ancestry. Jewish ancestry is not necessarily associated with epilepsy, encephalopathy, or PKU. REF: p. 430

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.

What is the most common type of cerebral palsy? a. Ataxic b. Dystonic c. Spastic d. Mixed

ANS: C Spastic cerebral palsy accounts for approximately 70-80% of cerebral palsy cases. Ataxic cerebral palsy accounts for 5-10% of cerebral palsy cases. Dystonic cerebral palsy accounts for 10-20% of cerebral palsy cases. Mixed cases account for 13% of cerebral palsy cases. REF: p. 429

A baby is stillborn after 6 hours of labor. Autopsy reveals hydrocephalus caused by cystic dilation of the fourth ventricle and aqueductal compression. Which of the following is the most likely diagnosis? a. Congenital hydrocephalus b. Microcephaly c. Dandy-Walker deformity d. Macewen sign

ANS: C The Dandy-Walker malformation is a congenital defect of the cerebellum characterized by a large posterior fossa cyst, which communicates with the fourth ventricle, and an atrophic upwardly rotated cerebellar vermis. Congenital hydrocephalus is characterized by enlargement of the cerebral ventricles. Microcephaly is lack of brain growth with retarded mental and motor development. Macewen sign is characterized by separation of the cranial sutures with a resonant sound when the skull is tapped. REF: p. 428

A 10-month-old infant presents for a well-baby visit. Which of the following reflexes should be present at this age? a. Stepping b. Sucking c. Landau d. Palmar grasp

ANS: C The Laundau reflex would be present up until 24 months. The stepping reflex should no longer be obtainable at 6 weeks. The sucking reflex should have disappeared by 10 months. The palmar grasp should no longer be obtainable at 6 months. REF: p. 423, Table 17-1

During infancy, what is the fastest growing part of the human body? a. Spinal cord b. Limb bones c. Head d. Vertebral column

ANS: C The head, not the spinal cord, limb bones, or vertebral column, is the fastest growing part of the body during infancy. REF: p. 422

A malignant tumor of striated muscle tissue origin commonly found on the neck is called a: a. myelogenic tumor. b. giant cell tumor. c. rhabdomyosarcoma. d. rhabdomyoma.

ANS: C The malignant tumor of striated muscle is called rhabdomyosarcoma. They are located in the muscle tissue of the head, neck, and genitourinary tract in 75% of cases. Myelogenic tumors originate from various bone marrow cells. Giant cell tumor is the sixth most common of the primary bone tumors. A rhabdomyoma is an extremely rare benign tumor of muscle that generally occurs in the tongue.

A 32-year-old male was injured in a motor vehicle accident and confined to bed for 3 weeks. During this time, the size and strength of muscle fibers decreased, a condition referred to as: a. myelodysplasia. b. ischemic atrophy. c. disuse atrophy. d. fibromyalgia.

ANS: C The term disuse atrophy describes the pathologic reduction in normal size of muscle fibers after prolonged inactivity from bed rest, trauma (casting), or local nerve damage as can be seen with spinal cord trauma or polio. Ischemic atrophy is due to decreased blood flow. Such an experience would not result in either myelodysplasia or fibromyalgia.

A 3-year-old male is diagnosed with Duchenne muscular dystrophy. Treatment will include: a. aspirin. b. antivirals. c. steroids. d. chemotherapy.

ANS: C Treatment with steroids can prolong the ability to walk by several years and improves life expectancy. Treatment does not include aspirin, antivirals, or chemotherapy. REF: p. 1046

The percent of retinoblastomas that are inherited as an autosomal dominant trait is ____%.

ANS: 40 REF: p. 436

A nurse recalls that the most frequent location of a neuroblastoma is the: a. retroperitoneal region. b. mediastinum. c. cervical ganglion. d. lung.

ANS: A 65% of neuroblastomas occur in the retroperitoneal region. 15% of neuroblastomas occur in the mediastinum. 4% of neuroblastomas occur in the cervical ganglion. Neuroblastomas do not occur in the lung. REF: p. 435

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.

A 21-year-old is diagnosed with ankylosing spondylitis (AS). The most likely joint to be affected would be the: a. sacroiliac. b. carpal. c. shoulder. d. knee.

ANS: A AS is a chronic, inflammatory joint disease characterized by stiffening and fusion (ankylosis) of the spine and sacroiliac joints. AS is not associated initially with the carpal joints, the shoulder, or the knees.

What term is used to document a herniation of brain and meninges through a defect in the occipital area of the skull? a. Encephalocele b. Meningocele c. Myelomeningocele d. Craniosynostosis

ANS: A An encephalocele refers to a herniation or protrusion of brain and meninges through a defect in the occipital region of the skull, resulting in a saclike structure. A meningocele is a saclike cyst of meninges filled with spinal fluid, a mild form of posterior neural tube closure defect. These can occur throughout the cervical, thoracic, and lumbar spine areas. A myelomeningocele is a hernial protrusion of a saclike cyst (containing meninges, spinal fluid, and a portion of the spinal cord with its nerves) through a defect in the posterior arch of a vertebra in the lower spine. Craniosynostosis is the premature closure of one or more of the cranial sutures (saggital, coronal, lambdoid, and metopic) during the first 18-20 months of the infant's life. REF: p. 425

Children with osteogenesis imperfecta (OI) are at high risk for frequent: a. bone fractures. b. shoulder dislocations. c. bone infections. d. joint injuries.

ANS: A Children with OI experience frequent bone fractures. They are not as susceptible for shoulder dislocations, bone infections, or other joint injuries. REF: p. 1039

A 60-year-old male presents with swelling and pain in the knee. CT reveals a tumor has developed from a pre-existing benign bone lesion. This supports which diagnosis? a. Secondary chondrosarcoma b. Rhabdomyoma c. Rhabdomyosarcoma d. Fibrosarcoma

ANS: A Chondrosarcoma is the second most common primary malignant bone tumor and is a tumor of middle-aged and older adults. Chondrosarcomas that develop from a pre-existing benign bone lesion are known as secondary chondrosarcomas. Rhabdomyoma is an extremely rare benign tumor of muscle that generally occurs in the tongue. The malignant tumor of striated muscle is called rhabdomyosarcoma. A fibrosarcoma is a solitary tumor that most often affects the metaphyseal region of the femur or tibia.

An infant is diagnosed with congenital hydrocephalus. Which of the following characteristics would the nurse expect to find? a. Enlarged ventricles b. Decreased cerebrospinal fluid (CSF) production c. Increased resorption of CSF d. Smaller than average head circumference

ANS: A Congenital hydrocephalus is characterized by enlargement of the cerebral ventricles. Increased, not decreased, CSF production would lead to hydrocephalus. Decreased resorption of CSF would lead to hydrocephalus, not increased CSF. An infant with congenital hydrocephalus would have increased head circumference. REF: p. 428

What term is used to describe a premature closure of one or more of the cranial sutures during the first 18 months of life? a. Craniosynostosis b. Congential hydrocephalus c. Microcephaly d. Acrania

ANS: A Craniosynostosis is the premature closure of one or more of the cranial sutures. Congenital hydrocephalus is characterized by enlargement of the cerebral ventricles. Microcephaly is lack of brain growth with retarded mental and motor development. In acrania, the cranial vault is almost completely absent; an extensive defect of the vertebral column is often present. REF: p. 426

A 34-year-old female was recently diagnosed with rheumatoid arthritis (RA). Physical examination revealed that inflammation is noted in various: a. synovial membranes. b. short bones. c. subchondral bones. d. bursae sacs.

ANS: A Inflammation of RA starts in the synovial membrane. The inflammation is not associated with short bones, subchondral bones, or bursae sacs.

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.

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.

Which reflex of infancy will disappear first? a. Stepping b. Rooting c. Palmar grasp d. Moro reflex

ANS: A The stepping reflex should no longer be obtainable at 6 weeks. The rooting reflex should no longer be obtainable at 4 months. The palmar grasp should no longer be obtainable at 6 months. The Moro reflex should no longer be obtainable at 3 months. REF: p. 423, Table 17-1

Transchondral fractures are most prevalent in: a. adolescents. b. older adults. c. infants. d. premenopausal females.

ANS: A Transchondral fractures are most prevalent in adolescents. Such fractures are not associated with older adults, infants, or premenopausal females.

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.

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.

Osteosarcoma is most likely present in the _____ of long bones. a. epiphyses b. metaphyses c. marrow d. osteocytes

ANS: B Osteosarcoma occurs mainly in the metaphyses of long bones near sites of active physical growth, not in the epiphyses. Osteosarcoma is not associated with the marrow or osteocytes. REF: p. 1049

A nurse is preparing to teach about the most common defects of neural tube closure. Which one should the nurse discuss? a. Anterior b. Posterior c. Lateral d. Superior

ANS: B Posterior neural tube defects are the most common. Neural tube defects associated with the other options are not as common. REF: p. 424

Researchers now believe that rheumatoid arthritis (RA) is a result of: a. an ineffective antiviral agent. b. an autoimmune disease. c. a complication of rheumatic fever. d. a superficial joint injury.

ANS: B RA is now thought to be an autoimmune disease. There is no proof that RA is associated with ineffective antiviral therapy, rheumatic fever, or joint injuries.

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.

The cause of Paget disease is: a. fluoride deficiency. b. unknown at present. c. excess vitamin A. d. osteogenic sarcoma.

ANS: B The cause of Paget disease is unknown, but studies have implicated both genetic and environmental factors. There is no known association between Paget disease and fluoride deficiency, excess vitamin A, or osteosarcoma.

A 3-year-old has been diagnosed with bacterial meningitis. What should the nurse expect to find on the lab report for the most common cause of this bacterial meningitis? a. Haemophilus influenzae b. Neisseria meningitidis c. Streptococcus pneumonia d. Escherichia coli

ANS: B The most common cause of bacterial meningitis in children under 4 is Neisseria meningitidis. Haemophilus influenzae formerly was the most common cause of bacterial meningitis, but vaccines have decreased this. Streptococcus pneumonia can cause meningitis and is the most common cause of bacterial meningitis in children under 23 months, while Escherichia coli is the most common cause of meningitis in the newborn. REF: p. 431

The treatment of Osgood-Schlatter disease includes: a. steroids. b. restriction from physical activity. c. intense physical therapy. d. knee replacement surgery.

ANS: B The primary treatment of Osgood-Schlatter disease includes restriction from physical activity. The primary treatment does not include steroids, intense physical therapy, or knee replacement. REF: p. 1045

Which term is used to document a hernial protrusion of a saclike cyst through a defect in the posterior arch of a vertebra? a. Craniosynostosis b. Meningocele c. Encephalocele d. Myelomeningocele

ANS: D A myelomeningocele is a hernial protrusion of a saclike cyst (containing meninges, spinal fluid, and a portion of the spinal cord with its nerves) through a defect in the posterior arch of a vertebra in the lower spine. Craniosynostosis is the premature closure of one or more of the cranial sutures (saggital, coronal, lambdoid, metopic) during the first 18-20 months of the infant's life. A meningocele, a saclike cyst of meninges filled with spinal fluid, is a mild form of posterior neural tube closure defect. These can occur throughout the cervical, thoracic, and lumbar spine areas. An encephalocele refers to a herniation or protrusion of brain and meninges through a defect in the occipital region of the skull, resulting in a saclike structure. REF: p. 425

Which of the following diseases does the nurse screen for in all newborns? a. Epilepsy b. Tay-Sachs disease c. Pica d. Phenylketonuria (PKU)

ANS: D All newborns are screened for PKU. Not all newborns are screened for epilepsy, Tay-Sachs, or pica. REF: p. 430

Ewing sarcoma originates from: a. osteoblasts. b. epithelial cells. c. the spleen. d. the bone marrow.

ANS: D Ewing sarcoma originates from the bone marrow. This tumor does not originate from osteoblasts, epithelial cells, or the spleen. REF: p. 1049

Fibromyalgia is a chronic musculoskeletal disorder characterized by: a. pain resulting from joint and muscle inflammation. b. muscle pain in the back and gastrointestinal symptoms. c. neurologic pain in the skeletal muscles. d. diffuse pain, fatigue, and tender points.

ANS: D Fibromyalgia is characterized by diffuse pain, fatigue, and point tenderness and the absence of systemic or localized inflammation. Fibromyalgia is not related to specific back pain and is not manifested by gastrointestinal upset. Nor is it related to neurologic pain in muscles.

What nutrient should the nurse encourage a woman in the early stages of pregnancy to consume to prevent neural tube defects? a. Protein b. Iron c. Vitamin D d. Folic acid

ANS: D Folic acid deficiency during early stages of pregnancy increases the risk for neural tube defects. Neural tube defects are not associated with deficiencies of protein, iron, or vitamin D. REF: pp. 424-425

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.

The incidence of fractures of the pelvis is highest in: a. preadolescent boys. b. adolescent boys. c. adolescent girls. d. older adults.

ANS: D The incidence of fractures of the upper femur, upper humerus, vertebrae, and pelvis is highest in older adults and is often associated with osteoporosis. Fractures of healthy bones, particularly the tibia, clavicle, and lower humerus, tend to occur in young persons and without gender preference.

The diagnosis of rhabdomyolysis is based on the measurement of which laboratory value? a. White blood cell count (WBC) b. Antinuclear antibodies c. Aspartate aminotransferase d. Creatine kinase (CK)

ANS: D The most important and clinically useful measurement in rhabdomyolysis is serum CK. A level five times the upper limit of normal (about 1000 units per liter) is used to identify rhabdomyolysis. While the other options may be measured, they are not used as diagnostic criteria.

A 36-year-old reports pain and weakness in the elbow. MRI reveals inflammation of the tendon and the presence of microtears where it attaches to bone. This condition is called: a. periostitis. b. muscle strain. c. bursitis. d. epicondylopathy.

ANS: D When force is sufficient to cause microscopic tears (microtears) in tissue, the result is known as epicondylopathy. Such an injury is not referred to as periostitis which involves the presence of inflammation. Muscle strain is local muscle damage that occurs when the muscle is stretched beyond capacity. Bursitis is inflammation of the bursae.

A 13-year-old presents with pain at night, cough, and dyspnea and is diagnosed with a metastasizing malignant bone tumor. The most likely type of tumor is: a. nonossifying fibroma. b. chondrosarcoma. c. Ewing sarcoma. d. osteosarcoma.

ANS: D With osteosarcoma, the most common presenting complaint is pain. Night pain, awakening a child from sleep, is a particularly foreboding sign. There may be swelling, warmth, and redness caused by the vascularity of the tumor. Symptoms may also include cough, dyspnea, and chest pain if lung metastasis is present. This symptomatology is not associated with the other options. REF: p. 1049

A 70-year-old male presents to his primary care provider reporting loss of vision. He reports that he has hypertension and smokes cigarettes. Which of the following disorders is most likely causing his visual loss? a. Presbyopia b. Macular degeneration c. Strabismus d. Amblyopia

b. macular degeneration

A 35-year-old female presents with watering and severely reddened eyes. She reports being very sensitive to light. Her primary care provider determined it was viral conjunctivitis caused by: a. Secondary bacterial infections b. Cytomegalovirus c. Herpes virus d. Adenovirus

d. adenovirus

A 15-year-old female 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

d. escherichia coli

A 50-year-old diabetic patient experiences visual disturbances and decides to visit his primary care provider. After examination, the primary care provider tells the patient that the cells that allow him to see are degenerated. Which of the following structures is most likely damaged? a. Lens b. Pupil c. Cornea d. Retina

d. retina

To make a diagnosis of fibromyalgia, tenderness must be present in ____ of the 18 points necessary for diagnosis.

ANS: 11

Polyarthritis is a type of juvenile arthritis in which more than _____ joints are affected.

ANS: 3 REF: p. 1043

Incidence of Legg-Calvé-Perthes (LCP) disease peaks at age______.

ANS: 6 LCP disease is a common osteochondrosis usually occurring in children between the ages of 3 and 10 years, with a peak incidence at 6 years. REF: p. 1044

Signs and symptoms of subluxation include: (select all that apply) a. Pain b. Swelling c. Hemorrhage d. Limitation of movement e. Joint deformity

ANS: A, B, D, E Signs and symptoms of dislocations or subluxations include pain, swelling, limitation of motion, and joint deformity.

Which clinical finding would be expected in the patient with rhabdomyolysis? a. Sweating b. Dark urine c. Yellow color to the skin d. Lower extremity swelling

ANS: B A classic triad of muscle pain, weakness, and dark urine is considered typical of rhabdomyolysis. Neither sweating, yellow skin, nor lower extremity swelling is associated with rhabdomyolysis.

Legg-Calvé-Perthes (LCP) disease affects which of the following joints? a. Vertebral b. Shoulder c. Hip d. Knee

ANS: C LCP affects the hip. This condition is not associated with the vertebrae, the shoulder, or the knee. REF: p. 1044

A 10-year-old presents with headache and seizures. CT scan reveals a tumor that is located near the pituitary gland. Which of the following is the most likely tumor type? a. Astrocytoma b. Craniopharyngioma c. Ependymoma d. Medulloblastoma

ANS: B A craniopharyngioma originates from the pituitary gland or hypothalamus. Symptoms include headache, seizures, diabetes insipidus, early onset of puberty, and growth delay. Astrocytomas are located on the surface of the right or left cerebellar hemisphere and cause unilateral symptoms (occurring on the same side as the tumor), such as head tilt, limb ataxia, and nystagmus. Ependymoma develops in the fourth ventricle and arises from the ependymal cells that line the ventricular system. Medulloblastoma occurs as an invasive malignant tumor that develops in the vermis of the cerebellum and may extend into the fourth ventricle. Because both tumors are located in the posterior fossa region along the midline, presenting signs and symptoms are similar and are usually related to hydrocephalus and increased intracranial pressure. REF: p. 434

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 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 nurse is preparing to teach about brain tumors. Which information should the nurse include? The most common type of brain tumor in children is: a. Neuroblastoma b. Astrocytoma c. Meningioma d. Germ cell

ANS: B Astrocytoma is the most common type of brain tumor in children. REF: p. 432

The onset of Duchenne muscular dystrophy (DMD) most often occurs at: a. 3-6 months of age. b. preschool years. c. school age. d. the onset of puberty.

ANS: B Boys with DMD will present in the preschool years with muscle weakness, difficulty walking, and large calves. REF: p. 1046

Duchenne muscular dystrophy (DMD) has a(n) _____ inheritance pattern. a. autosomal recessive b. X-linked recessive c. Y-linked dominant d. autosomal dominant

ANS: B DMD is X-linked, occurring only in boys. REF: p. 1046

A child is diagnosed with cerebral palsy, characterized by extreme difficulty in fine motor coordination and purposeful movement. Which of the following types of cerebral palsy is the child experiencing? a. Ataxic b. Dystonic c. Spastic d. Mixed

ANS: B Dystonic cerebral palsy is associated with extreme difficulty in fine motor coordination and purposeful movements. Ataxic cerebral palsy manifests with gait disturbances and instability. The infant with this form of cerebral palsy may have hypotonia at birth, but stiffness of the trunk muscles develops by late infancy. Spastic cerebral palsy is associated with increased muscle tone, persistent primitive reflexes, hyperactive deep tendon reflexes, clonus, rigidity of the extremities, scoliosis, and contractures. Mixed cerebral palsy may have symptoms of each of the disorders. REF: p. 429

A 9-month-old was diagnosed with osteogenesis imperfecta (OI). This disease is caused by: a. uterine teratogens. b. a genetic defect. c. malnutrition. d. trauma.

ANS: B OI (brittle bone disease) is a spectrum of disease caused by genetic mutation in the gene that encodes for type I collagen, the main component of bone and blood vessels. OI (brittle bone disease) is not due to teratogens, malnutrition, or a fracture. REF: p. 1039

While performing an assessment of a 2-month-old, the nurse notes a positive Ortolani click. The nurse would suspect the child has: a. a hip fracture. b. hip dysplasia. c. osteogenesis imperfecta. d. osteomyelitis.

ANS: B Ortolani click is symptomatic of developmental dysplasia of the hip. A hip fracture would be evident by shortening of the leg and external rotation. Osteogenesis imperfecta is diagnosed by fractures. Osteomyelitis is diagnosed by fever and infection. REF: p. 1039

Osgood-Schlatter disease causes inflammation of the: a. shoulder joint. b. patellar tendon. c. elbow ligaments. d. hip cartilage.

ANS: B Osgood-Schlatter affects the patella, not the shoulder, elbow, or hip. REF: pp. 1044-1045

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.

A major predictor of poor prognosis for Ewing sarcoma is: a. age of onset. b. size of tumor. c. presence of metastasis. d. gender of child.

ANS: C Metastasis at diagnosis is another poor prognostic indicator, with 5-year survival rate dropping to under 40%. REF: p. 1050

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.

What is the cause of true (primary) microcephaly? a. Viral infection b. An autosomal recessive gene c. Fetal trauma d. Hydrocephalus

ANS: B True (primary) microcephaly is usually caused by an autosomal recessive genetic or chromosomal defect. Viral infections and fetal trauma can lead to microcephaly but are not the true cause. Hydrocephalus does not lead to microcephaly. REF: p. 427

What is the most common location of brain tumors in children? a. Above the cerebellum b. In the posterior fossa c. In the anterior cerebrum d. In the ventricular lining

ANS: B Two thirds of all pediatric brain tumors are found in the posterior fossa, not above the cerebellum, in the cerebrum, or in the ventricular lining. REF: p. 432

It is true that viral meningitis: a. is always sudden in onset. b. often occurs with measles, mumps, or herpes. c. is effectively treated with antibiotics. d. causes increased sugar in the cerebral spinal fluid (CSF).

ANS: B Viral meningitis may result from a direct infection of a virus, or it may be secondary to disease, such as measles, mumps, or herpes. Onset may be sudden or gradual. Treatment is symptomatic; antibiotics are not used. Glucose in the CSF is normal. REF: p. 431

A newborn child is diagnosed with a vertebral arch defect, spina bifida. This condition would lead the nurse to suspect the child may have which of the following as well? (select all that apply) a. Type II Chiari malformation b. Myelomeningocele c. Meningocele d. Acrania e. Craniosynostosis

ANS: B, C When meningocele and myelomeningocele occur, they are related to an accompanying vertebral defect that allows the protrusion of the neural tube contents. Type II Chiari malformation is a complex malformation of the brainstem and cerebellum in which the cerebellar tonsils are displaced downward into the cervical spinal canal. This does not occur through a spina bifida. In acrania, the cranial vault is almost completely absent; an extensive defect of the vertebral column is often present. Craniosynostosis is the premature closure of one or more of the cranial sutures. REF: pp. 424-425

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.

The most common cause of toxic myopathy is: a. infection. b. a tumor. c. alcoholism. d. osteoporosis.

ANS: C Alcohol remains the most common cause of toxic myopathy.

A 1-year-old female was diagnosed with osteogenesis imperfecta (OI). Which complication must be monitored for? a. Congestive heart failure b. Liver failure c. Aortic aneurysm d. Pulmonary emboli

ANS: C Because type I collagen is also the main component of blood vessels, vascular deformity, such as aortic aneurysm, can occur. Neither congestive heart failure, liver failure, nor pulmonary emboli are associated with osteogenesis imperfecta (OI). REF: p. 1039

A 3-year-old Black child with a history of sickle cell disease and is now diagnosed with meningitis. Which is the most likely microorganism the nurse will find on the lab report? a. Virus b. Haemophilus influenzae type B c. Streptococcus pneumonia d. Neisseria meningitidis

ANS: C Children with sickle cell disease are at risk for developing bacterial meningitis. These children do not experience an increased risk for the development of a viral infection, Haemophilus influenzae, or Neisseria meningitidis. REF: p. 431

An infant has an anterior midline defect of neural tube closure. What term will the nurse observe written on the chart? a. Anencephaly b. Myelodysplasia c. Cyclopia d. Hydrocephalus

ANS: C Cyclopia is an example of an anterior midline defect that may cause brain and face abnormalities. In anencephaly, the soft, bony component of the skull and part of the brain are missing. Myelodysplasia is a posterior neural tube disorder. Hydrocephalus is associated with accelerated head growth. REF: p. 424

A 22-year-old female whose brother is diagnosed with Duchenne muscular dystrophy (DMD) wants to know if her children will inherit it. A fairly accurate test to identify female carriers of the disease is measurement of serum levels of: a. dystrophin. b. myoglobin. c. creatine kinase (CK). d. troponin 1.

ANS: C Diagnosis is confirmed by measuring the blood CK level, which is sometimes 100 times the normal level, with confirmation by genetic testing for mutations in the dystrophin gene. None of the other options is relevant to this screening. REF: p. 1046

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.

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.

A young child presents to the ophthalmologist for visual difficulties secondary to eye deviation. One of the child's eyes deviates outward, thereby decreasing the visual field. Which of the following diagnoses is most likely? a. Entropia b. Extropia c. Diplopia d. Nystagmus

a. extropia

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

a. glaucoma

Which group of people is most prone to red-green color blindness? a. Males b. Females c. Elderly persons d. Children

a. males

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

b. eustachian tube

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

c. a sensation that the room is spinning

The ophthalmologist is teaching about the structure of the eye that prevents light from scattering in the eye. What structure is the ophthalmologist describing? a. Iris b. Pupil c. Choroid d. Retina

c. choroid

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

c. presbycusis