Patho exam 1 Practice Qs

27. Which manifestation of inflammation is systemic? a. Formation of exudates b. Fever and leukocytosis c. Redness and heat d. Pain and edema

ANS: B The only three primary systemic changes associated with the acute inflammatory response are fever, leukocytosis (a transient increase in circulating leukocytes), and increased levels in circulating plasma proteins. Exudate, redness, heat, pain, and edema are local signs.

What is the term for cancers originating in connective tissue? A. Sarcoma B. Leukemia C. Lymphoma D. Carcinoma

A. Sarcoma Cancers arising from connective tissue usually have the suffix sarcoma. Cancers of lymphatic tissue are called lymphomas, whereas cancers of blood-forming cells are called leukemias. Carcinoma is a cancer of epithelial tissue. Ch12.3

10. What is the vascular effect of histamine released from mast cells? a. Platelet adhesion b. Initiation of the clotting cascade c. Vasodilation d. Increased endothelial adhesiveness

ANS: C Histamine, when released from mast cells, causes vasodilation. It does not cause platelet adhesion, initiation of the clotting cascade, or increased endothelial adhesiveness.

1. How is hypersensitivity best defined? a. A disturbance in the immunologic tolerance of self-antigens b. An immunologic reaction of one person to the tissue of another person c. An altered immunologic response to an antigen that results in disease d. An undetectable immune response in the presence of antigens

ANS: C Hypersensitivity is an altered immunologic response to an antigen that results in disease or damage to the host. Autoimmunity is a disturbance in the immunologic tolerance of self-antigens. Alloimmunity is the immunologic reaction of one person to the tissue of another person. An immune deficiency of some type would cause undetectable immune response in the presence of antigens.

Which statement indicates the nurse has an accurate understanding of mast cells? Mast cells A. "can be activated through an intrinsic or extrinsic pathway." B. "degranulate in response to chemical agents." C. "reduce blood flow after activation." D. "can be blocked by the therapeutic use of aspirin."

B. "degranulate in response to chemical agents." Ch7.2PPT Innate Immunity: Inflammation and Wound Healing - Mast Cells

A person has a type I allergic reaction. Which pathophysiologic response is occurring? A. Antibody binds to tissue-specific antigen. B. Immune complexes are deposited in vessel walls. C. T lymphocytes, not antibodies, mediate the process. D. IgE and products of tissue mast cells are released.

4. IgE and products of tissue mast cells are released. Ch09.2PPT Aaptations in Immunity and Inflammation - Antigenic Targets of Hypersensitivity Reactions

Which definition is true? A. Allergy means the deleterious effects of hypersensitivity. B. Immunity means an altered immunologic response. C. Hypersensitivity means the protective response to an antigen. D. Autoimmunity means the normal response to foreign antigens.

A. Allergy means the deleterious effects of hypersensitivity. Allergy means the deleterious effects of hypersensitivity to environmental antigens. Immunity is an organism's ability to resist disease. Hypersensitivity is an altered immunologic response to an antigen that results in disease or damage to the host. Autoimmunity is a disturbance in the immunologic tolerance of self-antigens. Ch09.1

Which statements are true regarding apoptosis? (Select all that apply.) A. An active process of cellular self-destruction B. A process that deletes cells during embryonic development C. Local cell death after severe and sudden injury D. Causes cell loss in proliferating cell populations

A. An active process of cellular self-destruction B. A process that deletes cells during embryonic development D. Causes cell loss in proliferating cell populations Apoptosis is programmed cell death. It is an active process of cellular self-destruction that is implicated in normal embryonic development, as well as in rapidly proliferating cancer cells. Necrosis is accidental cell death that occurs to local cells after a severe and sudden injury. Ch02.10

Which complement factor is considered an anaphylatoxin? A. C3a B. C1 C. C7 D. C9

A. C3a C3a, C5a, and C4a are anaphylatoxins. They can induce the rapid degranulation of mast cells and the release of histamine. Ch07.3

What biochemical messenger is produced by macrophages and lymphocytes in response to a bacterial pathogen? A. Interleukins B. Interferons C. Chemokines D. Tumor necrosis factor

A. Interleukins Interleukins are biochemical messengers produced by macrophages and lymphocytes in response to a bacterial pathogen. Interferons primarily protect against viral infections. Chemokines induce leukocyte chemotaxis. Tumor necrosis factor, produced by macrophages and lymphocytes, induces a multitude of proinflammatory effects including the enhancement of endothelial cell adhesion. Ch07.8

Which statement regarding coronary heart disease is true? A. It is the leading killer of Americans. B. Atherosclerosis causes widening of the blood vessels. C. CHD is more common in women. D. The relative risk for CHD does not increase with relatives affected.

A. It is the leading killer of Americans. Coronary heart disease is the leading killer of Americans. Narrowing of blood vessels occurs as a result of atherosclerosis. Men are more commonly affected. Relative risk increases when two or more relatives are affected before the age 55 years. Ch05.4

Which term describes an acidic sulfur-containing lipid that produces effects similar to histamine? A. Leukotriene B. Prostaglandin C. Adhesion molecule D. Phagocyte

A. Leukotriene Leukotrienes act similar to histamine and cause smooth muscle contraction, increased vascular permeability, and chemotaxis. Prostaglandins cause increased vascular permeability, chemotaxis, and pain. Adhesion molecules increase the stickiness between cells. Phagocyte cells ingest and dispose of foreign material. Ch07.6

Which statements are true regarding melanoma? (Select all that apply.) A. Melanoma is the most lethal form of skin cancer. B. Individuals with fair skin and hair color are at risk for melanoma. C. Individuals with a history of sunburns are at risk for melanoma. D. Melanoma is typically underdiagnosed.

A. Melanoma is the most lethal form of skin cancer. B. Individuals with fair skin and hair color are at risk for melanoma. C. Individuals with a history of sunburns are at risk for melanoma. Melanoma is the most lethal form of skin cancer and can occur on any skin surface. Risk factors vary for different types of skin cancer but, in general, the risk factors include a lighter natural skin color; a family history of skin cancer; a personal history of skin cancer; exposure to the sun through work and play; a history of sunburns, especially early in life; a history of indoor tanning; skin that burns, freckles, reddens easily, or becomes painful in the sun; blue or green eyes; blonde or red hair; and certain types of moles and a large number of moles. Healthcare clinicians have been found to over-diagnose and over-treat melanoma. Ch13.9

A person drinks alcohol in excessive quantities. Which areas are likely to develop cancer related to alcohol consumption? (Select all that apply.) A. Oral cavity B. Larynx C. Pharynx D. Spleen E. Liver

A. Oral cavity B. Larynx C. Pharynx E. Liver Cancers of the gastrointestinal system are linked to alcohol and include cancer of the oral cavity, larynx, pharynx, hypopharynx, esophagus, and liver. Ch13.7

Which characteristics are observable of vascular injury and inflammation? (Select all that apply.) A. Redness B. Coolness to the touch C. Warmth to the touch D. Increased swelling E. Pain

A. Redness C. Warmth to the touch D. Increased swelling E. Pain The four characteristics that are observable for inflammation in vascular tissue are redness, heat, swelling, and pain. Ch07.11

A person with a history of chronic lung disease arrives in the clinic with a 1-week history of a productive cough, hypoventilation, and headache. The nurse suspects the person is experiencing A. Respiratory acidosis. B. Respiratory alkalosis. C. Metabolic acidosis. D. Metabolic alkalosis

A. Respiratory acidosis. Ch2.8PPT Summary Question 4

Which statement is true regarding hypersensitivity reactions? A. They require sensitization against a particular antigen. B. They occur after the primary immune response. C. Reactions are always delayed. D. The most delayed reaction is anaphylaxis.

A. They require sensitization against a particular antigen. A hypersensitivity reaction requires sensitivity to an antigen and occurs after an adequate secondary immune response. These reactions may then be immediate or delayed. The most immediate reaction is anaphylaxis. Ch09.2

Which statement is true regarding ultraviolet (UV) light? A. UV light causes basal cell carcinoma and squamous cell carcinoma. B. The degree of damage is not affected by wavelength. C. UV light can cause the formation of sarcomas. D. The principal source of ultraviolet radiation (UVR) is tanning beds.

A. UV light causes basal cell carcinoma and squamous cell carcinoma. Skin exposure to UVR and to ionizing radiation (IR) produces reactive oxygen species (ROS) in large quantities, which can lead to oxidative stress, tissue injury, and direct deoxyribonucleic acid (DNA) damage. The duration, intensity, and wavelength content affect exposure. UV light can cause the formation of basal cell and squamous cell carcinomas. The principal source of UVR is sunlight. Ch13.4

Which information is correct regarding phagocytosis? Phagocytosis involves A. opsonization, engulfment, and formation of a phagosome. B. a reduction in nitric oxide production. C. formation of a phagosome by mast cells. D. a respiratory burst produced by the release of the primary lysosomal granules.

A. opsonization, engulfment, and formation of a phagosome. Ch7.3PPT Innate Immunity: Inflammation and Wound Healing - Phagocytosis

34. During phagocytosis, what is occurring during the step referred to as opsonization? a. Phagocytes recognize and adhere to the bacteria. b. Microorganisms are ingested. c. Microorganisms are killed and digested. d. An intracellular phagocytic vacuole is formed.

ANS: A During phagocytosis, opsonization involves only the recognition and adherence of phagocytes to bacteria.

9. Which component of the plasma protein system tags pathogenic microorganisms for destruction by neutrophils and macrophages? a. Complement cascade b. Coagulation system c. Kinin system d. Immune system

ANS: A C3b (a component of the complement cascade) adheres to the surface of a pathogenic microorganism and serves as an efficient opsonin. Opsonins are molecules that tag microorganisms for destruction by cells of the inflammatory system, primarily neutrophils and macrophages. The other options do not accurately identify a component capable of tagging pathogenic microorganisms.

10. When mismatched blood is administered causing an ABO incompatibility, how are the erythrocytes destroyed? a. Complement-mediated cell lysis b. Phagocytosis by macrophages c. Phagocytosis in the spleen d. Natural killer cells

ANS: A Erythrocytes are destroyed by complement-mediated lysis in individuals with autoimmune hemolytic anemia or as a result of an alloimmune reaction to ABO-mismatched transfused blood cells. Erythrocytes are not destroyed by phagocytosis or natural killer cells.

15. What causes the clinical manifestations of confusion, convulsions, cerebral hemorrhage, and coma in hypernatremia? a. High sodium in the blood vessels pulls water out of the brain cells into the blood vessels, causing brain cells to shrink. b. High sodium in the brain cells pulls water out of the blood vessels into the brain cells, causing them to swell. c. High sodium in the blood vessels pulls potassium out of the brain cells, which slows the synapses in the brain. d. High sodium in the blood vessels draws chloride into the brain cells followed by water, causing the brain cells to swell.

ANS: A Hypertonic (hyperosmolar) imbalances result in an extracellular fluid concentration greater than 0.9% salt solution (e.g., water loss or solute gain); cells shrink in a hypertonic fluid (see Table 3-7). This shrinking of cells results in the symptoms described in the question. The other options do not accurately describe the cause of these symptoms as they relate to hypernatremia.

12. When changes in total body water are accompanied by proportional changes in electrolytes, what type of alteration occurs? a. Isotonic b. Hypertonic c. Hypotonic d. Normotonic

ANS: A Only isotonic alterations occur when proportional changes in electrolytes and water accompany changes in total body water .

12. What is the function of opsonization related to the complement cascade? a. To tag pathogenic microorganisms for destruction by neutrophils and macrophages b. To process pathogenic microorganisms so that activated lymphocytes can be created for acquired immunity c. To destroy glycoprotein cell membranes of pathogenic microorganisms d. To promote anaphylatoxic activity, resulting in mast cell degranulation

ANS: A Opsonins are molecules that tag microorganisms for destruction by cells of the inflammatory system (opsonization), primarily neutrophils and macrophages. Opsonization does not process pathogenic microorganisms, destroy glycoprotein cell membranes, or promote anaphylactoxic activity.

29. What occurs during the process of repair after tissue damage? a. Nonfunctioning scar tissue replaces destroyed tissue. b. Regeneration occurs; the original tissue is replaced. c. Resolution occurs; tissue is regenerated. d. Epithelialization replaces destroyed tissue.

ANS: A Repair is the replacement of destroyed tissue with scar tissue. Regeneration is the replacement of damaged tissue with healthy tissue with complete return to normal structure and function. Resolution is synonymous with regeneration. Epithelialization is the process by which epithelial cells grow into the wound from surrounding healthy tissue.

6. What process causes heat and redness to occur during the inflammatory process? a. Vasodilation of blood vessels b. Platelet aggregation c. Decreased capillary permeability d. Endothelial cell contraction

ANS: A The increased blood flow as a result of vasodilation and increasing concentration of red cells at the site of inflammation cause locally increased warmth and redness. Platelet aggregation is important in the clotting cascade. Decreased capillary permeability would affect local edema. Endothelial cell contraction leads to increased capillary permeability and the formation of edema.

4. Water movement between the intracellular fluid (ICF) compartment and the extracellular fluid (ECF) compartment is primarily a function of: a. Osmotic forces b. Plasma oncotic pressure c. Antidiuretic hormone d. Hydrostatic forces

ANS: A The movement of water between the ICF and ECF compartments is primarily a function of osmotic forces. (Osmosis and other mechanisms of passive transport are discussed in Chapter 1.)

28. Physiologic pH is maintained at approximately 7.4 because bicarbonate (HCO3) and carbonic acid (H2CO3) exist in a ratio of: a. 20:1 c. 10:2 b. 1:20 d. 10:5

ANS: A The relationship between HCO3 and H2CO3 is usually expressed as a ratio. When the pH is 7.4, this ratio is 20:1 (HCO3:H2CO3). The other options do not accurately identify physiologic pH by the correct ratio of HCO3 and H2CO3.

3. The common hay fever allergy is expressed through a reaction that is mediated by which class of immunoglobulins? a. IgE b. IgG c. IgM d. T cells

ANS: A Type I reactions are mediated by antigen-specific IgE and the products of tissue mast cells. The most common allergies (e.g., pollen allergies) are type I reactions. In addition, most type I reactions occur against environmental antigens and are therefore allergic. Hay fever allergy is not mediated by IgG, IgM, or T cells.

6. Venous obstruction is a cause of edema because of an increase in which pressure? a. Capillary hydrostatic b. Interstitial hydrostatic c. Capillary oncotic d. Interstitial oncotic

ANS: A Venous obstruction can increase the hydrostatic pressure of fluid in the capillaries enough to cause fluid to escape into the interstitial spaces. The remaining options are not causes of edema resulting from venous obstruction.

42. Which statements regarding total body water (TBW) are true? (Select all that apply.) a. During childhood, TBW slowly decreases in relationship to body weight. b. Gender has no influence on TBW until old age. c. Men tend to have greater TBW as a result of their muscle mass. d. Estrogen plays a role in female TBW. e. Older adults experience a decrease in TBW as a result of decreased muscle mass.

ANS: A, C, D, E During childhood, TBW slowly decreases to 60% to 65% of body weight. At adolescence, the percentage of TBW approaches adult proportions, and gender differences begin to appear. Men eventually have a greater percentage of body water as a function of increasing muscle mass. Women have more body fat and less muscle as a function of estrogens and therefore have less body water. With increasing age, the percentage of TBW declines further still. The decrease is caused, in part, by an increased amount of fat and a decreased amount of muscle, as well as by a reduced ability to regulate sodium and water balance.

40. Which chemical mediators induce pain during an inflammatory response? (Select all that apply.) a. Prostaglandins b. Leukotrienes c. Tryptase d. Phospholipase e. Bradykinin

ANS: A,E The only chemical mediators that induce pain during an inflammatory response are the prostaglandins and bradykinin. Leukotrienes produce smooth muscle contraction, increased vascular permeability, and perhaps neutrophil and eosinophil chemotaxis. Tryptase is a proteinase released from mast cells during an inflammatory response. Phospholipase cleaves phospholipids.

7. At the arterial end of capillaries, fluid moves from the intravascular space into the interstitial space because the: a. Interstitial hydrostatic pressure is higher than the capillary hydrostatic pressure. b. Capillary hydrostatic pressure is higher than the capillary oncotic pressure. c. Interstitial oncotic pressure is higher than the interstitial hydrostatic pressure. d. Capillary oncotic pressure is lower than the interstitial hydrostatic pressure.

ANS: B At the arterial end of capillaries, fluid moves from the intravascular space into the interstitial because capillary hydrostatic pressure is higher than the capillary oncotic pressure.

24. It is true that Kussmaul respirations indicate: a. Anxiety is a cause of respiratory acidosis. b. A compensatory measure is needed to correct metabolic acidosis. c. Diabetic ketoacidosis is the cause of the metabolic acidosis. d. More oxygen is necessary to compensate for respiratory acidosis.

ANS: B Deep, rapid respirations (Kussmaul respirations) are indicative of respiratory compensation for metabolic acidosis. The other options are not true.

2. What is a hypersensitivity reaction that produces an allergic response called? a. Hemolytic shock b. Anaphylaxis c. Necrotizing vasculitis d. Systemic erythematosus

ANS: B Examples of systemic anaphylaxis are allergic reactions to beestings, peanuts, and fish. Hemolytic shock would be a state in which erythrocytes are destroyed by complement-mediated lysis to the point of causing a state of shock. Necrotizing vasculitis is inflammation of blood vessel walls that limits perfusion. Systemic lupus erythematosus (SLE) is a chronic, multisystem, inflammatory disease and is one of the most common, complex, and serious of the autoimmune disorders.

14. What mechanism can cause hypernatremia? a. Syndrome of inappropriate antidiuretic hormone b. Hypersecretion of aldosterone c. Brief bouts of vomiting or diarrhea d. Excessive diuretic therapy

ANS: B Hypernatremia occurs because of (1) inadequate free water intake, (2) inappropriate administration of hypertonic saline solution (e.g., sodium bicarbonate for treatment of acidosis during cardiac arrest), (3) high sodium levels as a result of oversecretion of aldosterone (as in primary hyperaldosteronism), or (4) Cushing syndrome (caused by the excess secretion of adrenocorticotropic hormone [ACTH], which also causes increased secretion of aldosterone). The other options do not result in hypernatremia.

23. In the later stages of an inflammatory response, which phagocytic cell is predominant? a. Neutrophils b. Monocytes c. Chemokines d. Eosinophils

ANS: B Only monocytes and macrophages perform many of the same functions as neutrophils but for a longer time and in a later stage of the inflammatory response.

9. Secretion of antidiuretic hormone (ADH) and the perception of thirst are stimulated by a(n): a. Decrease in serum sodium b. Increase in plasma osmolality c. Increase in glomerular filtration rate d. Decrease in osmoreceptor stimulation

ANS: B Secretion of ADH and the perception of thirst are primary factors in the regulation of water balance. Thirst is a sensation that stimulates water-drinking behavior. Thirst is experienced when water loss equals 2% of an individual's body weight or when osmotic pressure increases. The other options do not accurately describe how ADH and the perception of thirst are related.

5. What causes the edema that occurs during the inflammatory process? a. Vasodilation of blood vessels b. Increased capillary permeability c. Endothelial cell expansion d. Emigration of neutrophils

ANS: B The increased flow and capillary permeability result in a leakage of plasma from the vessels, causing swelling (edema) in the surrounding tissue and is solely responsible for inflammation-induced edema. Vasodilation (increased size of the blood vessels) causes slower blood velocity and increases blood flow to the injured site. Endothelial cell contraction (not expansion) leads to increased capillary permeability. Emigration of neutrophils to the area of infection/injury leads to increased destruction of the offending agent.

34. Which groups are at risk for fluid imbalance? (Select all that apply.) a. Women b. Infants c. Men d. Obese persons e. Older adults

ANS: B, D, E Kidney function, surface area, total body water, and the hydrophobic nature of fat cells all contribute to the increased risk for fluid imbalance among obese individuals, infants, and older adults. Gender alone is not a risk factor for fluid imbalance.

1. Which action is a purpose of the inflammatory process? 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 If the epithelial barrier is damaged, then a highly efficient local and systemic response (inflammation) is mobilized to limit the extent of damage, to protect against infection, and to initiate the repair of damaged tissue. The response to a specific offending agent is the function of the adaptive immune response. Lysosomes lyse cell membranes. Immunity against a subsequent tissue injury occurs through the action of B cells and T cells.

20. During acidosis, the body compensates for the increase in serum hydrogen ions by shifting hydrogen ions into the cell in exchange for which electrolyte? a. Oxygen c. Potassium b. Sodium d. Magnesium

ANS: C In states of acidosis, hydrogen ions shift into the cells in exchange for intracellular fluid potassium; hyperkalemia and acidosis therefore often occur together. This is not true of the other options.

18. Insulin is used to treat hyperkalemia because it: a. Stimulates sodium to be removed from the cell in exchange for potassium. b. Binds to potassium to remove it through the kidneys. c. Transports potassium from the blood to the cell along with glucose. d. Breaks down the chemical components of potassium, causing it to be no longer effective.

ANS: C Insulin contributes to the regulation of plasma potassium levels by stimulating the Na+, potassium-adenosine triphosphatase (K+-ATPase) pump, thereby promoting the movement of potassium simultaneously into the liver and muscle cells with glucose transport after eating. The intracellular movement of potassium prevents an acute hyperkalemia related to food intake. The other options do not accurately describe how insulin is used to treat hyperkalemia.

8. Low plasma albumin causes edema as a result of a reduction in which pressure? a. Capillary hydrostatic b. Interstitial hydrostatic c. Plasma oncotic d. Interstitial oncotic

ANS: C Losses or diminished production of plasma albumin is the only option that contributes to a decrease in plasma oncotic pressure.

5. During an IgE-mediated hypersensitivity reaction, which leukocyte is activated? a. Neutrophils b. Monocytes c. Eosinophils d. T lymphocytes

ANS: C Of the options provided, only eosinophils are activated during IgE-mediated hypersensitivity reactions.

22. When considering white blood cell differentials, acute inflammatory reactions are related to elevations of which leukocyte? a. Monocytes b. Eosinophils c. Neutrophils d. Basophils

ANS: C Only neutrophils are the predominant phagocytes in the early inflammatory site, arriving within 6 to 12 hours after the initial injury, they ingest (phagocytose) bacteria, dead cells, and cellular debris at the inflammatory site.

1. Infants are most susceptible to significant losses in total body water because of an infant's: a. High body surface-to-body size ratio b. Slow metabolic rate c. Kidneys are not mature enough to counter fluid losses d. Inability to communicate adequately when he or she is thirsty

ANS: C Renal mechanisms that regulate fluid and electrolyte conservation are often not mature enough to counter the losses; consequently, dehydration may rapidly develop. Infants can be susceptible to changes in total body water because of their high metabolic rate and the turnover of body fluids caused by their greater body surface area in proportion to their total body size. The inability to communicate their thirst is a problem only when they are poorly cared for.

3. A patient's blood gases reveal the following findings: pH, 7.3; bicarbonate (HCO3) 27 mEq/L; carbon dioxide (CO2), 58 mm Hg. What is the interpretation of these gases? a. Respiratory alkalosis b. Metabolic acidosis c. Respiratory acidosis d. Metabolic alkalosis

ANS: C The values provided in this question characterize only acute uncompensated respiratory acidosis.

15. How does the chemotactic factor affect the inflammatory process? a. By causing vasodilation around the inflamed area b. By stimulating smooth muscle contraction in the inflamed area c. By directing leukocytes to the inflamed area d. By producing edema around the inflamed area

ANS: C Two chemotactic factors, neutrophil chemotactic factor (NCF) and eosinophil chemotactic factor of anaphylaxis (ECF-A), are released during mast cell degranulation. NCF attracts neutrophils (a type of leukocytes), and ECF-A attracts eosinophils to the site of inflammation. The other options do not accurately describe the affect chemotactic factors have on the inflammatory process.

30. Two thirds of the body's water is found in its: a. Interstitial fluid spaces c. Intracellular fluid compartments b. Vascular system d. Intraocular fluids

ANS: C Two thirds of the body's water is in the intracellular fluid (ICF) compartment, and one third is in the extracellular fluid (ECF) compartment. The two main ECF compartments are the interstitial fluid and the intravascular fluid, which is the blood plasma. Other ECF compartments include the lymph and the transcellular fluids, such as the synovial, intestinal, biliary, hepatic, pancreatic, and cerebrospinal fluids; sweat; urine; and pleural, synovial, peritoneal, pericardial, and intraocular fluids.

16. Vomiting-induced metabolic alkalosis, resulting in the loss of chloride, causes: a. Retained sodium to bind with the chloride b. Hydrogen to move into the cell and exchange with potassium to maintain cation balance c. Retention of bicarbonate to maintain the anion balance d. Hypoventilation to compensate for the metabolic alkalosis

ANS: C When vomiting with the depletion of ECF and chloride (hypochloremic metabolic alkalosis) causes acid loss, renal compensation is not effective; the volume depletion and loss of electrolytes (sodium [Na+], potassium [K+], hydrogen [H+], chlorine [Cl-]) stimulate a paradoxic response by the kidneys. The kidneys increase sodium and bicarbonate reabsorption with the excretion of hydrogen. Bicarbonate is reabsorbed to maintain an anionic balance because the ECF chloride concentration is decreased. The other options do not accurately describe the mechanism that results from vomiting-induced metabolic alkalosis.

32. Increased capillary hydrostatic pressure results in edema because of: a. Losses or diminished production of plasma albumin b. Inflammation resulting from an immune response c. Blockage within the lymphatic channel system d. Sodium and water retention

ANS: D Increased capillary hydrostatic pressure can result from venous obstruction or sodium and water retention. The other options do not accurately describe the cause of edema related to increased capillary hydrostatic pressure.

12. When soluble antigens from infectious agents enter circulation, what is tissue damage a result of? a. Complement-mediated cell lysis b. Phagocytosis by macrophages c. Phagocytosis in the spleen d. Neutrophil granules and toxic oxygen products

ANS: D Of the options available, only the components of neutrophil granules as well as the several toxic oxygen products produced by these cells, damage the tissue.

What is the mechanism that results in type II hypersensitivity reactions? a. Antibodies coat mast cells by binding to receptors that signal its degranulation, followed by a discharge of preformed mediators. b. Antibodies bind to soluble antigens that were released into body fluids, and the immune complexes are then deposited in the tissues. c. Cytotoxic T lymphocytes or lymphokine-producing helper T 1 cells directly attack and destroy cellular targets. d. Antibodies bind to the antigens on the cell surface.

ANS: D The mechanism that results in a type II hypersensitivity reaction begins with antibody binding to tissue-specific antigens or antigens that have attached to particular tissues. The cell can be destroyed by antibody IgG or IgM and activation of the complement cascade through the classical pathway.

17. The pathophysiologic process of edema is related to which mechanism? a. Sodium depletion b. Decreased capillary hydrostatic pressure c. Increased plasma oncotic pressure d. Lymphatic obstruction

ANS: D The pathophysiologic process of edema is related to an increase in the forces favoring fluid filtration from the capillaries or lymphatic channels into the tissues. The most common mechanisms are increased capillary hydrostatic pressure, decreased plasma oncotic pressure, increased capillary membrane permeability and lymphatic obstruction, and sodium retention.

5. In addition to osmosis, what force is involved in the movement of water between the plasma and interstitial fluid spaces? a. Oncotic pressure b. Buffering c. Net filtration d. Hydrostatic pressure

ANS: D Water moves between the plasma and interstitial fluid through the forces of only osmosis and hydrostatic pressure, which occur across the capillary membrane. Buffers are substances that can absorb excessive acid or base to minimize pH fluctuations. Net filtration is a term used to identify fluid movement in relationship to the Starling hypothesis. Oncotic pressure encourages water to cross the barrier of capillaries to enter the circulatory system.

**not in our edition Which statement is true regarding neutrophils? a. Neutrophils are agranular. b. Neutrophils are the predominant phagocytes of early inflammation. c. Neutrophils are the largest blood cells. d. Neutrophils enter the site of injury after lymphocytes and macrophages.

B Neutrophils are the predominant phagocytes of early inflammation. They arrive before lymphocytes and macrophages. Monocytes are the largest blood cells and are granular.

**not in our edition Which are systemic effects of inflammation? (Select all that apply.) a. Abscess formation b. Fever c. Leukocytosis d. Increased levels of plasma proteins e. Decreased levels of plasma proteins

B, C, D The three primary systemic changes associated with an acute inflammatory response are fever, leukocytosis, and increased levels in circulating plasma proteins. Abscesses are a local manifestation of inflammation and are walled-off lesions filled with purulent exudates.

Which statement regarding tumors is true? A. All neoplasms are cancerous. B. Cancer refers to a malignant tumor. C. Benign growths are cancerous. D. Malignant tumors have slow growth.

B. Cancer refers to a malignant tumor. The term cancer refers to a malignant tumor with rapid growth, a loss of differentiation, and the absence of normal tissue organization. Neoplasm generally refers to new growth and retain some normal tissue structure and do not invade the capsules surrounding them or spread to regional lymph nodes or distant locations. Ch12.1

Which are causes of cellular injury? (Select all that apply.) A. Antioxidants B. Chemical agents C. Hypoxia D. Mechanical factors

B. Chemical agents C. Hypoxia D. Mechanical factors Injury to cells may be caused by chemical agents, hypoxia, free radicals, infectious agents, physical and mechanical factors, immunologic reactions, genetic factors, and nutritional imbalances. Antioxidants block the synthesis of free radicals. Ch02.8

Common causes of edema formation (increased filtration of fluid from capillaries and lymph into surrounding tissues) include which of the following? (Select all that apply.) A. Decreased capillary hydrostatic pressure B. Decreased capillary oncotic pressure C. Increased capillary membrane permeability D. Lymphatic obstruction E. Sodium retention

B. Decreased capillary oncotic pressure C. Increased capillary membrane permeability D. Lymphatic obstruction E. Sodium retention The five common causes of increased edema are: (1) increased capillary hydrostatic pressure, (2) decreased capillary oncotic pressure, (3) increased capillary membrane permeability, (4) lymphatic obstruction, and (5) sodium retention. Ch03.9

Which are systemic effects of inflammation? (Select all that apply.) A. Abscess formation B. Fever C. Leukocytosis D. Increased levels of plasma proteins E. Decreased levels of plasma proteins

B. Fever C. Leukocytosis D. Increased levels of plasma proteins The three primary systemic changes associated with an acute inflammatory response are fever, leukocytosis, and increased levels in circulating plasma proteins. Abscesses are a local manifestation of inflammation and are walled-off lesions filled with purulent exudates. Ch07.14

Which virus is linked to the development of cancer? (Select all that apply.) A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Epstein-Barr virus E. Human papillomavirus

B. Hepatitis B C. Hepatitis C D. Epstein-Barr virus E. Human papillomavirus Hepatitis B and C have been linked to the development of liver cancer, which is usually caused by chronic inflammation. Epstein-Barr virus can lead to B-cell lymphomas in those individuals who are immunosuppressed. Human papillomavirus has been linked to cervical, anogenital, oral-pharyngeal, and penile cancers. Hepatitis A has not been linked to the development of cancer. Ch12.9

Which are molecular classes of immunoglobulins? (Select all that apply.) A. IgC B. IgD C. IgE D. IgM E. IgN

B. IgD C. IgE D. IgM The five classes of immunoglobulin are IgG, IgA, IgM, IgD, and IgE. Ch08.11

Which factor indicates a recurrence of prostate cancer? A. Decrease in PSA B. Increase in PSA C. False negative D. False positive

B. Increase in PSA Ch12.5PPT Cancer - Tumor Markers

When in its normal state, which gene negatively regulates proliferation? A. Oncogenes B. Tumor-suppressor genes C. Proto-oncogenes D. Telomeres

B. Tumor-suppressor genes Tumor-suppressor genes encode proteins that, when in their normal state, negatively regulate proliferation. Oncogenes are mutant genes that, when in their normal nonmutant state, direct the synthesis of protein that positively accelerate proliferation. A proto-oncogene is an oncogene in its nonmutant state. Telemeres are protective ends or caps on each chromosome. Ch12.5

A nurse learns that an individual has benign tumors. What does this mean? The tumors A. are poorly differentiated. B. are encapsulated. C. may develop anaplasia. D. may spread to a distant location.

B. are encapsulated. Ch12.1PPT Cancer - Classification and Nomenclature

Which statement is true regarding metastasis? A. Metastasis is a highly efficient process. B. Metastasis occurs through the vascular and lymphatic systems. C. Metastatic cancer cells suppress proteases. D. Most cancer cells are able to metastasize to new areas.

B. Metastasis occurs through the vascular and lymphatic systems. Two distinct mechanisms give rise to patterns of distant spread. First, cancer cells spread through vascular and lymphatic pathways, as well as natural tissue planes. Metastatic cells are very heterogeneous, and some of these cells have new abilities that can facilitate metastasis. Metastasis is highly inefficient; to metastasize, a cancer cell must surmount multiple physical and physiologic barriers. Many metastatic cells secrete proteases and protease activators to digest the extracellular matrix and basement membrane, enabling cells to move. Only rare cells in a cancer are able to metastasize. Ch12.7

Which statement best describes a type I reaction? A. Most type I reactions are mediated by IgA. B. Most type I reactions are allergic. C. Most occur against medications. D. Rarely does this type of reaction contribute to autoimmune diseases.

B. Most type I reactions are allergic. Most type I reactions are allergic. They are mediated by IgE. Most type I reactions occur against environmental antigens and can contribute to some autoimmune diseases. Ch09.3

Which statement is true regarding neutrophils? A. Neutrophils are agranular. B. Neutrophils are the predominant phagocytes of early inflammation. C. Neutrophils are the largest blood cells. D. Neutrophils enter the site of injury after lymphocytes and macrophages.

B. Neutrophils are the predominant phagocytes of early inflammation. Neutrophils are the predominant phagocytes of early inflammation. They arrive before lymphocytes and macrophages. Monocytes are the largest blood cells and are granular. Ch07.7

Which statement is true regarding hypokalemia? A. Hypokalemia occurs when the serum level is below 45 mEq/L. B. One cause of hypokalemia is diabetic ketoacidosis. C. Dietary causes of hypokalemia are common. D. Diuretics do not cause hypokalemia.

B. One cause of hypokalemia is diabetic ketoacidosis. Hypokalemia is low potassium. Therefore hypokalemia is defined as a serum level less than 3.5 mEq/L. It is often caused by diuretics. Diabetic ketoacidosis does cause hypokalemia. Potassium is shifted out of the cell in exchange for hydrogen and then excreted. The serum level may remain within a normal range, but then when insulin is administered, potassium is shifted back into the cells and a deficit occurs. Potassium balance is especially significant in the treatment of conditions requiring insulin administration, such as insulin-dependent diabetes mellitus (type 1). Dietary causes are uncommon. Ch03.5

Which gene is often seen in retinoblastoma? A. MLH1 B. RB1 C. BRCA1 D. BRCA2

B. RB1 Hypermethylation of the promoter region on the RB1 gene is often seen in retinoblastoma. An inherited form of colon cancer is related to methylation of the promoter region of the MLH1 gene. The BRCA1 and BRCA2 genes are observed in some cases of inherited breast cancer. Ch06.1

Which information is correct regarding ultraviolet light? Ultraviolet light causes A. multiple myeloma. B. basal cell carcinoma. C. cervical cancer. D. glioma.

B. basal cell carcinoma Ch13.3PPT Cancer Epidemiology - Environmental/Lifestyle Factors

The characteristic vascular changes at the site of an injury produce A. blood vessel constriction after dilation . B. increased permeability and leakage. C. tightening of the capillary endothelial cell junctions. D. pallor and swelling where the injury occurred.

B. increased permeability and leakage. Ch7.1PPT Innate Immunity: Inflammation and Wound Healing - Second Line of Defense

A nurse knows that free radicals may be produced by A. protein peroxidation. B. metabolism of exogenous chemicals or drugs. C. spontaneous decay of superoxide. D. vitamins E and C supplements.

B. metabolism of exogenous chemicals or drugs. Ch2.2 Cellular Injury

A 17-year-old boy is admitted to the pediatric intensive care unit after surgery. The teen requires debridement of a wound on his sacrum (triangular bone at the base of the spine). His mother attributes this to difficulty in repositioning him because of his size. He has been in a persistent vegetative state for almost 4 years after suffering a traumatic brain injury as a result of a self-inflicted gunshot to his head 2. A large portion of the area is removed because of ischemia and cell death. The teen suffers from tissue. A. apoptosis. B. necrosis. C. catabolism. D. metabolism

B. necrosis Ch2.10PPT Unit 1 The Cell - Case Study 1b

It is true that immunoglobulin E (IgE) is A. designed to protect the host from large viruses. B. the primary cause of common allergies. C. the only inflammatory cell that can damage a virus. D. normally found at high concentrations in the circulation.

B. the primary cause of common allergies. IgE, a mediator of common allergic responses, is an antibody that is designed to protect the host from parasites and is the only inflammatory cell that can damage a parasite. IgE is normally found in low concentrations in the circulation. Ch08.8

**not in our edition Chronic inflammation is characterized by a(an) a. lack of giant cells. b. absence of exudate. c. dense infiltrate of lymphocytes and macrophages. d. inflammation that lasts less than 2 weeks.

C Chronic inflammation is characterized by a dense infiltrate of lymphocytes and macrophages. Giant cells are multinucleated cells that are formed by fused macrophages during granuloma formation. Chronic inflammation often results in pus formation, purulent discharge, and incomplete wound healing. Chronic inflammation of any cause lasts longer than 2 weeks.

**not in out edition Which statement is true regarding the inflammatory response? a. Inflammatory response is the third line of defense. b. Inflammatory response relies on cellular components only. c. Inflammatory response generates a nonspecific response. d. Inflammatory response occurs in nonvascular tissue.

C The inflammatory response is the second line of defense. It occurs at the site of tissue injury and generates a nonspecific response that involves cellular and chemical components. The inflammatory response occurs in tissues with a blood supply (vascularized).

Which statement is true regarding aging and the immune system function? A. Older adults have decreased circulating antibodies. B. T-cell function is increased. C. Antibody production to specific antigens is inferior. D. Response to infection is rapid.

C. Antibody production to specific antigens is inferior. T-cell function is decreased, and immune responses are delayed. B-cell production is inferior; however, the cells have increased circulating antibody levels. Ch08.9

Which statement is true regarding atopic individuals? A. If one parent has allergies, then a 4% chance exists that the offspring will have similar allergies. B. If two parents have allergies, then a 50% chance exists that their offspring will have similar allergies. C. Atopic individuals tend to produce higher quantities of IgE. D. No genes are associated with an atopic state.

C. Atopic individuals tend to produce higher quantities of IgE. Higher quantities of IgE are present in atopic individuals. If one parent has an allergy, then the individual has a 40% of having allergies; with two parents, the individual has an 80% of having allergies. Multiple genes have been associated with the atopic state. Ch09.5

Which statement is true regarding the staging of cancer? A. Localized cancer is considered a high stage. B. Benign tumors are stage 4. C. Cancers that have spread regionally are stage 3. D. Stage 1 has the poorest prognosis.

C. Cancers that have spread regionally are stage 3. Cancer confined to the organ of origin is stage 1; cancer that is locally invasive is stage 2; cancer that has spread to regional structures, such as lymph nodes, is stage 3; and cancer that has spread to distant sites, such as a liver cancer spreading to the lung or prostate cancer spreading to bone, is stage 4. The prognosis generally worsens with increasing tumor size, lymph node involvement, and metastasis. Benign tumors do not spread to distant regions. Ch12.6

A 17-year-old boy is admitted to the pediatric intensive care unit after surgery. The teen requires debridement of a wound on his sacrum (triangular bone at the base of the spine). His mother attributes this to difficulty in repositioning him because of his size. He has been in a persistent vegetative state for almost 4 years after suffering a traumatic brain injury as a result of a self-inflicted gunshot to his head. 1. The sacral area is covered with which type of tissue? A. Muscle B. Neural C. Epithelial D. Connective

C. Epithelial Ch2.9PPT Unit 1 The Cell - Case Study 1a

When considering water balance, which statement demonstrates the correct balance? A. Isotonic fluids cause increased cellular swelling. B. Hypertonic fluid causes increased cellular swelling. C. Hypotonic fluid causes cellular swelling. D. Hypernatremia causes cellular swelling.

C. Hypotonic fluid causes cellular swelling. Hypotonic extracellular fluid (ECF) causes intracellular water gain and swelling. When the ECF is hypotonic, water moves from the intravascular space to the interstitial space, across the cell membrane, and into the cell. This action causes the cell to swell. An isotonic solution is equal to the plasma in concentration of solute molecules. Therefore no net water will move because equilibrium exists. The cell size is unchanged. A hypertonic fluid has excessive solute; therefore water will leave the cell and move into the vascular space to help balance this excess. Water leaving the cell results in cell shrinkage. Hypernatremia can occur with an acute gain in sodium or a loss of water, but generally it does not cause cellular swelling. Ch03.1

Which statement is true regarding the inflammatory response? A. Inflammatory response is the third line of defense. B. Inflammatory response relies on cellular components only. C. Inflammatory response generates a nonspecific response D. Inflammatory response occurs in nonvascular tissue.

C. Inflammatory response generates a nonspecific response. The inflammatory response is the second line of defense. It occurs at the site of tissue injury and generates a nonspecific response that involves cellular and chemical components. The inflammatory response occurs in tissues with a blood supply (vascularized). Ch07.2

Which statement regarding hypertension is true? A. Systemic hypertension is observed in less than 5% of populations. B. Environmental factors do not cause hypertension. C. One of the most important factors affecting blood pressure is sodium intake. D. A 100% correlation exists among family members and blood pressure.

C. One of the most important factors affecting blood pressure is sodium intake. Sodium intake, obesity, decreased physical activity, and psychosocial stress are important environmental risk factors for obesity. Systemic hypertension affects approximately 25% to 30% of the population. Only a 20% to 40% correlation exists among family members. Ch05.5

Chronic inflammation is characterized by a(an) A. lack of giant cells. B. absence of exudate. C. dense infiltrate of lymphocytes and macrophages. D. inflammation that lasts less than 2 weeks.

C. dense infiltrate of lymphocytes and macrophages. Chronic inflammation is characterized by a dense infiltrate of lymphocytes and macrophages. Giant cells are multinucleated cells that are formed by fused macrophages during granuloma formation. Chronic inflammation often results in pus formation, purulent discharge, and incomplete wound healing. Chronic inflammation of any cause lasts longer than 2 weeks. Ch07.9

Which statement indicates the nurse has an accurate understanding about the association between tobacco and cancers? "Tobacco use is associated with cancer of the A. prostate. B. endometrium. C. esophagus. D. breast.

C. esophagus. Ch13.1PPT Cancer Epidemiology - Environmental/Lifestyle Factors

A nurse is asked about NK cells. How should the nurse respond? NK cells A. only work alone to cause apoptosis. B. destroy abnormal cells with MHC class I markers. C. lack antigen-specific receptors. D. mature in the thymus.

C. lack antigen-specific receptors. Ch8.4PPT Adaptive Immunity - Active vs. Passive Immunity - Other Cells that Kill Abnormal Cells

Chromosome instability may result in the overexpression of A. tumor-suppressor genes. B. heterozygosity. C. oncogenes. D. point mutations.

C. oncogenes. Ch12.2PPT Cancer - Genomic Instability

Which statement is true regarding a type IV allergic reaction? A. Is immediate in its action B. Is infiltrated with B cells C. Is mediated by antibody production D. Can be transferred by cells

D. Can be transferred by cells Type IV hypersensitivity reactions can be transferred by cells but not by serum. Their actions are delayed because their onset takes from 24 to 72 hours. The site is infiltrated with T lymphocytes and macrophages. A clear hard center surrounds the erythema (redness). Ch09.8

Which statement is true regarding the immune response in humans? A. Before birth, lymphocytes are not produced. B. B lymphocytes come from the thymus. C. The thymus releases mature lymphocytes. D. Generation of clonal diversity occurs in primary lymphoid organs.

D. Generation of clonal diversity occurs in primary lymphoid organs. Generation of clonal diversity occurs in the primary lymphoid organs, which includes the thymus (T lymphocytes) and bone marrow (B lymphocytes). In the fetus, lymphocytes undergo extensive differentiation and proliferation that recognize almost any foreign antigen predominate. The thymus releases immature T cells that have the ability to recognize foreign antigens. Ch08.2

Which statement is true regarding potassium balance? A. Potassium is the major extracellular electrolyte. B. During acidosis, potassium shifts into the cell. C. Aldosterone is secreted when potassium is decreased. D. Insulin causes the movement of potassium into the cell.

D. Insulin causes the movement of potassium into the cell. Insulin causes movement of potassium into the cell and is one of the treatments for hyperkalemia. Potassium balance is especially significant in the treatment of conditions requiring insulin administration, such as insulin-dependent diabetes mellitus (type 1). Potassium is the major intracellular electrolyte and maintains the osmotic balance of the intracellular fluid (ICF) space. During acidosis, potassium is shifted out of the cell in exchange for hydrogen ions. Aldosterone is secreted when potassium is elevated, resulting in the excretion of potassium by the kidneys. Ch03.4

Which is a characteristic of a malignant tumor? A. It is encapsulated. B. It does not invade local tissues. C. It is well differentiated. D. It is able to spread far from the tissue of origin.

D. It is able to spread far from the tissue of origin. Malignant tumors have no capsule, which allows them to spread readily. They have rapid growth rates and specific microscopic alterations. They are poorly differentiated and spread to distant tissues. Ch12.2

Which of the following statements is correct regarding pathologic hyperplasia? A. Produces abnormal proliferation of abnormal cells. B. Is an adaptive mechanism that enables organ regeneration. C. Increases cell size. D. May occur in response to growth factors

D. May occur in response to growth factors Ch2.1PPT Cellular Adaptation

A person arrives in the emergency department after a loss of consciousness and the development of Kussmaul respirations. The individual has a history of diabetes and 2 days of vomiting and diarrhea. The nurse suspects the person has which of the following primary disorders? A. Respiratory alkalosis B. Respiratory acidosis C. Metabolic alkalosis D. Metabolic acidosis

D. Metabolic acidosis Ch2.7PPT Summary Question 3

Which statement is true regarding hyponatremia? A. Is commonly caused by inadequate sodium intake B. Can occur with a decrease in total body water (TBW) C. Never occurs with burns, vomiting, or diarrhea D. Occurs when sodium drops below 135 mEq/L

D. Occurs when sodium drops below 135 mEq/L Hyponatremia occurs when the serum sodium drops below 135 mEq/L. It is the most common electrolyte disorder in individuals who are hospitalized. Although inadequate sodium intake can cause hyponatremia, it is uncommon. It can also occur with an increase in TBW or as a result of burns, vomiting, diarrhea, or gastrointestinal suctioning. Ch03.3

A substance that is recognized as foreign or nonself is A. immunoglobulins. B. lymphocytes. C. antibodies. D. antigens.

D. antigens. Antigens are recognized as foreign and initiate the immune response. Immunoglobulins and antibodies are part of the adaptive immune response; they attack the antigen. Lymphocytes are a type of blood cell that is part of the adaptive response. Ch08.1

A person with hypertension and heart failure has edema in the lower legs and sacral area. The nurse suspects this condition is due to a(n) A. increase in plasma oncotic pressure. B. decrease in capillary hydrostatic pressure. C. decrease in lymph obstruction pressure. D. increase in capillary hydrostatic pressure

D. increase in capillary hydrostatic pressure Ch2.5 Alterations in Water Movement