PATHOPHYSIOLOGY EXAM 1

type 1 diabetes mellitus

- Diagnosed in young children/adolescents -Autoimmune disorder, beta cells in pancreas destroyed -Unable to produce insulin

Type IV hypersensitivity

-Involves tissue damage

Type II Diabetes Mellitus

-Most common type - Cells become resistant to insulin, decrease insulin receptors on target cells -Overtime insulin production by pancreas, decreases.

1. The nurse is planning care for a 6-hour-old neonate who has been born with cleft palate. What aspect of care should the nurse prioritize? A. Adequate nutrition B. Positive body image C. Managed parental anxiety D. Infection control

A. Adequate nutrition Rationale: The immediate problem in an infant with cleft palate is feeding; the nurse should therefore focus on ensuring the neonate achieves adequate nutrition, which may require adaptive feeding equipment and approaches. A neonate does not have a body image. Though the parents may experience anxiety, the nurse will manage this while ensuring adequate nutrition. Though infants with cleft palate are at greater risk for ear infections (otitis media), this will not develop as a concern as readily as malnutrition or dehydration in these first few days of life. Proper feeding techniques can also reduce this risk for otitis media.

A 13 year old girl has a karyotype that reveals an absent homologus X chromosome with only single X chromosome present. What medical diagnosis will the nurse observe on the chart? A. Down Syndrome B. Cri du chat syndrome C. Turner syndrome D. Fragile X syndrome

C. Turner syndrome Rationale: A condition with the presence of a single X chromosome and no homologus X or Y chromosome, so the individual has a total of 45 chromosomes is known as Turner Syndrome. Down syndrome is change in one arm of a chromosome. Cri du chat syndrome due to chromosomal deletion. Fragile X is due to a break or gap in a chromosome.

What is a diagnosis of a 13 year old female who has a karyotype that reveals an absent homologus X chromosome with only a single X chromosome present? Features: a short stature, widely spaced nipples, and a reduced carrying angle at the elbow. A.Cri du chat syndrome B. Down syndrome C. Klinefelter syndrome D. Turner Syndrome

D. Turner syndrome Cri du chat: low birth weight, severe mental retardation, microcephaly, heart defects. Down syndrome: low nasal bridge, epicanthal folds, protruding tongue, low set ears. Klinefelter syndrome: small testes, some development of breasts, sparse body hair, long limbs.

4. The nurse knows which statement listed below is accurate regarding the functions and nature of cytokines relative to a variety of pathologies? A. "A particular cytokine can have varied effects on different systems, a fact which limits their therapeutic use." B. "Cytokine production is constant over time, but effects are noted when serum levels cross a particular threshold." C. "Most cytokines are produced by granular leukocytes, and different cells are capable of producing the same cytokine." D. "Cytokine actions are self-limiting, in that activation of one precludes activation of other cytokines with similar actions."

A. "A particular cytokine can have varied effects on different systems, a fact which limits their therapeutic use." Rationale: Because cytokines can mediate diverse effects due to their pleotropic properties, they can have significant side effects. Cytokine production is brief, not constant, and production does not normally take place in granulocytes. Activation of a cytokine does not necessarily limit other similar cytokines, and additive effects are not uncommon.

5. Which student statement demonstrates a sound understanding of the cellular processes of hypertrophy and hyperplasia? A. "I know that cells like neurons have little capacity for hyperplastic growth." B. "A remaining kidney can sometimes undergo hyperplasia in response to one that has been removed." C. "When male clients experience 'an enlarged prostate,' they are describing a form of hypertrophy." D. "Clients with cardiomyopathy undergo myocardial hypertrophy with proportional increases in cell length and width."

A. "I know that cells like neurons have little capacity for hyperplastic growth." Rationale: Because they do not normally divide, neurons do not undergo hyperplasia. Remaining organs can display hypertrophy, not hyperplasia, and prostate enlargement is a form of hyperplasia. Cardiomyopathic hyperplasia involves greater increases in cell length than width.

8. A 3-year-old girl has just been diagnosed with type 1 diabetes. Her parents are currently receiving education from the diabetes education nurse. How can the nurse best explain to the parents the etiology (cause) of their daughter's diabetes? A. "The problem that underlies her diabetes is that her own body has destroyed the cells in her pancreas that produce insulin." B. "It's not known exactly why your daughter has completely stopped making insulin, and treatment will consist of your rigidly controlling her diet." C. "This tendency to produce insufficient amounts of insulin is likely something that she inherited." D. "Environmental and lifestyle factors are known to play a part in the fact that her pancreas secretes and withholds insulin at the wrong times."

A. "The problem that underlies her diabetes is that her own body has destroyed the cells in her pancreas that produce insulin." Rationale: Type 1A, or immune-mediated, diabetes involves the autoimmune destruction of pancreatic beta cells and a consequent absolute lack of insulin. Exogenous insulin is required as dietary control alone is insufficient. The central problem is an absolute lack of insulin production rather than deranged release.

5. Which individual situation listed below best exemplifies the processes of innate immunity? A. A child who has experienced heat and swelling of his skinned knuckle B. An adult who complains of itching and is sneezing because he is allergic to pollen C. A client whose blood work indicates increased antibody titers during an acute illness D. A client who has experienced rejection of a donor liver after transplantation

A. A child who has experienced heat and swelling of his skinned knuckle Rationale: In a skinned knuckle, one of the body's main innate defenses—the skin—is breached. The heat and swelling that accompany a breach in the skin are inflammatory responses, part of the body's innate immune defenses. Allergies are an inappropriate adaptive response mediated by immunoglobulin E; antibody titers increase during illness in response to the infection; and transplanted organs are rejected because the organ is recognized as foreign. These are all aspects of specific, acquired immunity.

8. Which statement most accurately conveys an aspect of lymphatic system activity? A. B and T lymphocyte development begins in the bone marrow and ends in the peripheral lymphoid structures. B. B cells and macrophages are released from the bone marrow in their completed state. C. Stem cells in the lymph nodes initiate and regulate the process of white cell synthesis. D. Leukocytes bypass vascular circulation and are distributed instead by the lymphatic system.

A. B and T lymphocyte development begins in the bone marrow and ends in the peripheral lymphoid structures. Rationale: While both precursor B and T lymphocytes begin their development in the bone marrow, they migrate to peripheral lymphoid structures to complete the differentiation process. Stem cells are not located in the lymph nodes and circulation of white cells is not exclusive to the lymphatic circulatory system.

7. Which glycoprotein is responsible for treating such diseases as bone marrow failure following chemotherapy and hematopoietic neoplasms such as leukemia? A. Growth factors and cytokines. B. Neutrophils and eosinophils. C. T lymphocytes and natural killer cells. D. Natural killer cells and granulocytes.

A. Growth factors and cytokines. Rationale: The identification and characterization of the various growth factors and cytokines has led to their use in treating a wide range of diseases like bone marrow failure, hematopoietic neoplasms, infectious diseases, and congenital and myeloproliferative disorders. Neutrophils are primarily responsible for maintaining normal host defenses against invading bacteria, cell debris, or foreign substances. Eosinophils increase in number during allergic reactions and parasitic infections. T lymphocytes are involved in cell-mediated immunity. Natural killer cells participate in innate or natural immunity and their function is to destroy foreign cells. Granulocytes are phagocytic cells.

3. A 71-year-old male client with a history of myocardial infarction (MI) and peripheral vascular disease (PVD) has been advised by his family physician to begin taking 81 mg aspirin once daily. Which statement best captures an aspect of the underlying rationale for the physician's suggestion? A. Platelet aggregation can be precluded through inhibition of prostaglandin production by aspirin. B. Aspirin helps to inhibit ADP action and minimizes platelet plug formation. C. Aspirin can reduce unwanted platelet adhesion by inhibiting TXA2 synthesis. D. Aspirin inhibits the conversion of fibrinogen into fibrin and consequent platelet plug formation.

A. Platelet aggregation can be precluded through inhibition of prostaglandin production by aspirin. Rationale: Aspirin prevents platelet plug formation by inhibiting synthesis of prostaglandins that mediate clot formation. Aspirin does not influence ADP, TXA2 synthesis, or fibrinogen conversion.

5. A nurse is providing care for a client with a diagnosis of Crohn's disease. The nurse recognizes the fact that the disease involves the inflammation and irritation of the intestinal lining. Which type of tissue is most likely involved in the client's pathology? A. Simple columnar epithelium B. Glandular epithelium C. Simple cuboidal epithelium D. Stratified epithelium

A. Simple columnar epithelium Rationale: Simple columnar epithelium lines the intestine and its cilia and mucus-secreting goblet cells. The intestinal tract does not consist of glandular epithelium, simple cuboidal epithelium, or stratified epithelium.

5. Which statement best captures an aspect of the role of hormones in the body? A. Some chemical substances can function as hormones or be integrated with central/peripheral nervous systems. B. Hormones directly initiate many of the processes that contribute to homeostasis. C. Control of body processes is ensured by the fact that a single hormone can only exert one effect on one specific system or tissue. D. Each hormone that exists in the body is produced by only one specific endocrine gland.

A. Some chemical substances can function as hormones or be integrated with central/peripheral nervous systems. Rationale: Some chemicals, such as epinephrine, can function as both a hormone and be closely integrated with the central and peripheral nervous systems as well as the immune systems, leading to current terminology such as "neuroendocrine." Hormones modulate, but do not initiate, changes in the body. One hormone may exert multiple effects on multiple body systems. Hormones are produced by a variety of body tissues, not solely by endocrine glands.

A 50 y/o male sustained close head injury as a result of a vehicular accident. CT revealed build up of blood between the inner surface of dura matter and surface of brain. Which type of injury will the nurse be caring for? A. Subdural hematoma B. Epidural hematoma C. Contusion D. Abrasion

A. Subdural hematoma

1. A professor is teaching a group of students about the role of mitochondria within the cell. Which statement is true of mitochondria? A. They are the site of adenosine triphosphate (ATP) production. B. The number of mitochondria in a cell is equal to the number of nuclei. C. They are replicated within the smooth endoplasmic reticulum (ER). D. Mitochondrial DNA is inherited patrilineally.

A. They are the site of adenosine triphosphate (ATP) production. Rationale: Consistent with their characterization as the "power plants" of the cell, mitochondria are the site of ATP synthesis for the cell. There are a varying number in each cell, according to the energy demands of the particular cell. They are self-replicating rather than being produced in the smooth ER and they are inherited matrilineally.

A 65 y/o recently diagnosed wth cancer retired from construction work. Which cancer is likely to develop secondarily to occupational hazards? A. mesothelioma B. Bladder cancer C. Prostate cancer D. Cancer cancer

A. mesothelioma Rationale: One notable occupational factor is asbestos which increases one's risk of mesothelioma, lung cancer and others.

2. The nurse is explaining the workings of selective serotonin reuptake inhibitors (SSRIs) to a client with a diagnosis of depression. Within the teaching, the nurse mentions that in the nervous system, the transmission of information by neurotransmitters is: A. synaptic signaling. B. endocrine signaling. C. autocrine signaling. D. paracrine signaling.

A. synaptic signaling. Rationale: Synaptic signaling occurs in the nervous system, where neurotransmitters act only on adjacent nerve cells through special contact areas called synapses. Endocrine signaling relies on hormones carried in the bloodstream to cells throughout the body. Autocrine signaling occurs when a cell releases a chemical into the extracellular fluid that affects its own activity. With paracrine signaling, enzymes rapidly metabolize the chemical mediators and therefore act mainly on nearby cells.

6. The nurse knows which component is needed for long-lasting immunity in a client with a diagnosis of sepsis without the causative agent identified? A. Neutrophils B. Lymphocytes C. Colony-stimulating factors D. Natural killer cells

B Rationale: Lymphocytes provide lifelong immunity and an antigen-specific response to harmful microorganisms. Neutrophils, macrophages, and natural killer cells do not provide this.

1. A student makes the statement to a colleague, "Blood plasma is essentially just a carrier for the formed cells like red blood cells and white blood cells." What would be the most accurate response to this statement? A. "That's not really true. Plasma is crucial in the immune and inflammatory responses." B. "Actually, plasma plays a significant role in nutrient and waste transport." C. "Not really. Plasma also contributes to the processes of protein synthesis and hematopoiesis." D. "Actually, plasma is integral to the proper function of the liver and maintenance of acid-base balance."

B. "Actually, plasma plays a significant role in nutrient and waste transport." Rationale: Plasma proteins are integral to transport. They are not noted to contribute to the inflammatory response, hematopoiesis, protein synthesis, or liver function.

8. As part of her prenatal education, a 29-year-old woman who is pregnant with her first child is receiving teaching from her primary care provider. Which statement by the woman reflects an accurate understanding of HIV transmission? A. "I know my baby is safe from HIV while in the womb, but the delivery will place him or her at real risk." B. "It's discouraging to know that my breast milk can pass on HIV to my baby." C. "I know it's possible, but it's comforting that the chances of my child contracting my HIV are actually very low." D. "I'm relieved to learn that a caesarean delivery will protect my baby from being born HIV positive."

B. "It's discouraging to know that my breast milk can pass on HIV to my baby." Rationale: Transmission from mother to infant is the most common way that children become infected with HIV. HIV may be transmitted from infected women to their offspring in utero, during labor and delivery, or through breast-feeding. Ninety percent of infected children acquired the virus from their mother. The risk of transmission of HIV from mother to infant is approximately 25%, with estimates ranging from 15% to 45% depending on what country they live in.

4. A nurse is teaching a client with a recent diagnosis of diabetes about the roles that glucose and insulin play in the disease pathology and the fact that glucose must enter the body cell in order to provide energy for the client. The nurse knows that which process allows glucose to enter body cells? A. Osmosis B. Facilitated diffusion C. Active transport D. Diffusion

B. Facilitated diffusion Rationale: Facilitated diffusion involves the movement of a substance like glucose from an area of high concentration, such as the bloodstream, to an area of low concentration, such as the intracellular space through the use of a transport protein. Osmosis, active transport, and diffusion do bring about the movement of glucose into body cells.

7. While teaching about HIV/AIDS to a group of high school seniors, the school health nurse will begin by explaining the basic facts. Which information will this likely include? A. Like all viruses, HIV is a genetic material made from DNA with long molecules that carry genetic information. B. HIV is different from other viruses since it is a retrovirus that selectively attacks the body's immune cells. C. There are two types of HIV, but the one that is endemic to the U.S. is HIV type 2 D. HIV type 1 for some reason rarely develops into full-blown AIDS.

B. HIV is different from other viruses since it is a retrovirus that selectively attacks the body's immune cells. Rationale: HIV is a retrovirus that selectively attacks the CD4+ T lymphocytes, the immune cells responsible for orchestrating and coordinating the immune response to infection. It must change from RNA to DNA through a series of stages in order to get in a cell and begin replication. HIV type 2 is endemic in West Africa but is rarely seen in other parts of the world. People with HIV-2 tend not to develop AIDS.

2. The nurse is caring for an 8-month-old male client who has just been diagnosed with hemophilia A. The parents ask about the likelihood that any future children would be born with the condition. What is the nurse's best response? A. I cannot offer an opinion as the pattern of inheritance is unknown and you need to seek genetic counseling. B. If you have another son there is a 50% chance that he will also have hemophilia. C. There is a 50% chance that your next child will have hemophilia, but the severity varies and it could be a mild form. D. Since you have already had a son with hemophilia, the chance that you will have another child with the condition is unlikely.

B. If you have another son there is a 50% chance that he will also have hemophilia. Rationale: Hemophilia A is an x-linked recessive condition; thus, the defective gene is only expressed in males who inherit the affected X chromosome from the mother. Females will only be carriers of the condition if they receive the affected X chromosome from the mother. Therefore, only if the couple have a second son will there be a 50% chance the child will have hemophilia; this chance does not change because the first son has the condition. Though it is true the severity can vary, the nurse should be clear that only male children will develop the condition. The nurse should not dismiss the question outright since the inheritance pattern of this condition is well known.

What genetic disorder is the result if an individual possesses an XYY chromosome configuration? A. Turner B. Klinefelter C. Down D. Fragile X

B. Klinefelter

4. A hospital client is receiving intravenous infusion of heparin for treatment of a pulmonary embolus. Which phenomenon is most likely occurring, resulting in the drug's therapeutic effect? A. Inhibition of vitamin K synthesis in the liver B. Suppression of fibrin formation C. Deactivation of the intrinsic clotting pathway D. Inhibition of ADP-induced platelet aggregation

B. Suppression of fibrin formation Rationale: Ultimately, heparin inhibits the clotting factors that mediate the formation of fibrin. It does not inhibit vitamin K synthesis, nor does it deactivate the intrinsic clotting pathway in particular. Heparin does not act on platelet plug formation.

3. The nurse is teaching new nursing assistants on the unit about the phenomenon of muscle hypertrophy. Which client on the unit is most likely to experience muscle hypertrophy? A client with: A. urinary incontinence following a cerebrovascular accident (CVA). B. hypertension, obesity, and decreased activity tolerance. C. peripheral edema secondary to heart failure (HF). D. possible rejection symptoms following a liver transplant.

B. hypertension, obesity, and decreased activity tolerance. Rationale: Hypertension is a common cause of adaptive hypertrophy, in which cardiac muscle cells increase in size in response to the increased work of circulation over time. The other diagnoses are not associated with muscle hypertrophy.

2. The spirochete Leptospira is primarily transmitted to farmers by: A. an airborne mechanism. B. exposure to spores in the environment. C. direct contact with infected animals. D. a mosquito bite.

C

4. Which client is at high risk for developing dilated cardiomyopathy? A. 17-year-old with a diving injury resulting in paraplegia B. 4-year-old child born with cerebral palsy and confined to a wheelchair C. 44-year-old noncompliant female who forgets to take her hypertensive medications D. 78-year-old Alzheimer client who received a third-degree burn following an oven fire

C. 44-year-old noncompliant female who forgets to take her hypertensive medications Rationale: In hypertension, the increased workload required to pump blood against an elevated arterial pressure in the aorta results in a progressive increase in LV muscle mass and need for coronary blood flow. The pressure overload causes hypertrophied cells to have greater width and length. Paraplegia, cerebral palsy, and Alzheimer disease do not increase the workload of the cardiac muscle per se.

2. A client is experiencing muscle atrophy following 2 weeks in traction after a motor vehicle accident. Which factor has most likely contributed to the atrophy of the client's muscle cells? A. High levels of insulin and IGF-1 in the client's blood during immobilization B. Denervation of the affected muscles during the time of traction C. A reduction of skeletal muscle use secondary to the traction treatment D. Reduced oxygen consumption and cellular function that ensures muscle cell survival

C. A reduction of skeletal muscle use secondary to the traction treatment Rationale: Disuse atrophy results from the reduction in skeletal muscle use such as that following encasement in plaster casts or traction. Low levels of insulin and IGF-1 contribute to atrophy, and denervation only occurs in paralyzed limbs. Reduced oxygen consumption and cellular function are the mechanisms of cell atrophy but not the causes of the process

6. Which hormones are derivatives of cholesterol? A. Epinephrine and norepinephrine B. Insulin and glucagon C. Aldosterone and testosterone D. Eicosanoids and retinoids

C. Aldosterone and testosterone Rationale: Steroids such as aldosterone and testosterone are a classification of hormones that are derived from cholesterol. Epinephrine and norepinephrine are both amino acids. Insulin and glucagon and classified among peptides, polypeptides, proteins, and glycoproteins. Eicosanoids and retinoids consist of fatty acid compounds.

3. An 81-year-old female client in a subacute medical unit of a hospital has developed an oral Candida albicans infection. Which phenomena would the client's nurse suspect as a key contributing factor to her infection? A. The moist and temperature-suited oral environment of the client's mouth B. The ability of fungi to remain latent until the host reaches an immunocompromised state C. Antibiotic therapy that eliminated normal bacterial flora D. The airborne communicability of yeast and molds and subsequent inhalation

C. Antibiotic therapy that eliminated normal bacterial flora

5. A 62-year-old female with a diagnosis of acute and chronic renal failure secondary to diabetes mellitus is receiving her weekly injection of epoetin, a supplementary form of erythropoietin. Which statement best captures the necessity of this medication? A. Erythropoietin is needed in order for stem cells to proliferate into committed erythroid precursors. B. Erythropoietin is necessary for the accurate sensation of hypoxia that stimulates erythropoiesis. C. Erythropoietin causes the erythrocyte colony-forming units to proliferate and mature. D. Erythropoietin facilitates the extrusion of the reticulocyte nucleus and the formation of true erythrocytes.

C. Erythropoietin causes the erythrocyte colony-forming units to proliferate and mature. Rationale: Erythropoietin acts primarily in later stages of erythropoiesis to induce the erythrocyte colony-forming units to proliferate and mature through the normoblast into reticulocytes and mature erythrocytes. It does not act directly on stem cells, nor does it play a role in the sensation of hypoxia. Reticulocytes already lack a cell nucleus.

What is the most common cause of Down Syndrome? A. Paternal nondisjunction B. Maternal translocation C. Maternal nondisjunction D. Paternal translocations

C. Maternal nondisjunction

What is the origin of most childhood cancers ? A. neural tube B. Placenta C. Mesodermal germ layer D. Environment

C. Mesodermal germ layer

4. An oncology nurse who has worked for many years providing care for children with cancer has taken a job on an adult oncology unit of a hospital. What differences might the nurse anticipate in this new job? A. There will be a greater number of cancers that are epithelial in origin. B. A greater proportion of the clients will have cancer that involves the hematopoietic system. C. The nurse will be working with more clients who have blastomas. D. More clients will be receiving treatment for leukemia.

C. The nurse will be working with more clients who have blastomas. Rationale: Benign tumors are composed of well-differentiated cells that resemble the cells of the tissues of origin and are characterized by a slow, progressive rate of growth that may come to a standstill or regress. They tend to exist in a single mass. Malignant tumors tend to be poorly differentiated, grow rapidly, secrete hormones or cytokines, and have the potential to break loose.

3. Following a biopsy, a 54-year-old man has been diagnosed as having a benign neoplastic tumor. Which characteristic most likely applies to his tumor? A. The tumor is poorly approximated and has the potential to break loose. B. The tumor may secrete hormones, cytokines. C. The well-differentiated, neoplastic cells are clustered together in a single mass. D. It has a rapid rate of growth and can induce ischemia.3. Following a biopsy, a 54-year-old man has been diagnosed as having a benign neoplastic tumor. Which characteristic most likely applies to his tumor? A. The tumor is poorly approximated and has the potential to break loose. B. The tumor may secrete hormones, cytokines. C. The well-differentiated, neoplastic cells are clustered together in a single mass. D. It has a rapid rate of growth and can induce ischemia.

C. The well-differentiated, neoplastic cells are clustered together in a single mass.

1. Which type of pneumonia is best characterized by an infective agent that produces sputum samples with a peptidoglycan cell wall, expresses endotoxins, replicates readily in broth and on agar, grows in clusters, has pili, and does not stain when exposed to crystal violet? A. Chlamydial B. Viral C. Mycoplasmal D. Bacterial

D

9. A 19 year-old intravenous drug user was exposed to the HIV virus 3 weeks ago and is experiencing a rapid proliferation in viral load. Which statement best captures an aspect of the process of HIV replication that underlies this proliferation? A. Free HIV RNA is able to attach to the cell coat of CD4+ cells. B. The cytoplasm of CD4+ cells provides a protected environment for the replication of RNA by HIV. C. Expression of reverse transcriptase by CD4+ cells allows replication of HIV cells rather than new lymphocytes. D. HIV is able to change its RNA into DNA to allow for replication by CD4+ cells.

D Rationale: In order for the HIV to reproduce, it must change its RNA into DNA. It does this by using the reverse transcriptase enzyme. Reverse transcriptase makes a copy of the viral RNA, and then in reverse makes another mirror-image copy. The result is double-stranded DNA that carries instructions for viral replication. HIV RNA does not directly attach to CD4+ cells and RNA is not replicated by HIV itself in the CD4+ cytoplasm. Reverse transcriptase is not produced by CD4+ cells, and CD4+ cells do not directly produce new lymphocytes.

6. A client with a diagnosis of hemolytic anemia has gone to a community-based laboratory for follow-up blood work. The lab technician confirms with the client that hematocrit is one of the components of the blood work. The client replies, "I thought the point of the blood work was to see how many red blood cells I have today." How could the technician best respond to the client's statement? A. "This result will tell your care provider about the number of red blood cells in a given quantity of your blood plasma." B. "Your hematocrit measures the average size of your red blood cells, and indirectly measures your oxygen-carrying capacity." C. "The result will indicate how many of your red blood cells are new and young, and will indicate your body's production rate of red cells." D. "The hematocrit measures the mass that your red blood cells account for in a quantity of your blood."

D. "The hematocrit measures the mass that your red blood cells account for in a quantity of your blood." Rationale: Hematocrit measures the mass of erythrocytes in a given quantity of blood plasma. It does not measure the number of red cells, their size, or their production rate and age.

1. Of the following situations, which one would be an example of a maladaptive cellular change? A. 18-year-old body builder who has developed extremely large pectoral muscles following years of weight lifting. B. 31-year-old marathon runner who has developed hypertrophied myocardial cells C. 54-year-old female who has developed ovarian atrophy following loss of estrogen stimulation during menopause D. 44-year-old male with a 60 pack/year smoking history who was diagnosed with a histological grade-3 lung cancer

D. 44-year-old male with a 60 pack/year smoking history who was diagnosed with a histological grade-3 lung cancer Rationale: In many adaptive cellular responses, the expression of the differentiation genes is altered. When working with cancer clients, histological grade or differentiation refers to how much the tumor cells resemble normal cells of the same tissue type. In body builders and athletes, cells hypertrophy based on the increase in workload placed on the muscle. Reproductive atrophy is expected due to the loss of estrogen stimulation during menopause.

Which substance directly controls the reabsorption of water from the collecting ducts? A. aldosterone B. Renin C. Angiotensin D. Antidiuretic hormone

D. Antidiuretic hormone

2. The blood work of a 44-year-old male client with a diagnosis of liver disease secondary to alcohol abuse indicates low levels of albumin. Which phenomenon would a clinician be most justified in anticipating? A. Impaired immune function B. Acid-base imbalances C. Impaired thermoregulation D. Fluid imbalances

D. Fluid imbalances Rationale: Albumin plays a central role in the maintenance of osmotic pressure and fluid balance. Immune function, acid-base balance, and thermoregulation are not functions of albumin.

7. Which statement best describes an aspect of the normal process of glucose metabolism? A. Blood glucose levels are primarily a result of the timing, quantity, and character of food intake. B. Ingested glucose that is not needed for cellular metabolism circulates in the blood until it is taken up to meet cellular needs. C. Blood glucose levels are kept in a steady state by selective excretion and reuptake by the kidneys. D. Glucose that exceeds metabolic needs is converted and stored by the liver.

D. Glucose that exceeds metabolic needs is converted and stored by the liver. Rationale: Approximately two-thirds of the glucose that is ingested with a meal is removed from the blood and stored in the liver as glycogen. Between meals, the liver releases glucose as a means of maintaining blood glucose within its normal range. Normal glucose metabolism does not involve large variations in blood glucose levels in response to food intake, and excess glucose does not normally remain in circulation. Glucose levels are not primarily maintained by the kidneys.

The most common malignancy in children: A. Neuroblastoma B. Wilms tumor C. Retinoblastoma D. Leukemia

D. Leukemia

3. The health caregiver is explaining the rationale for administering a hypotonic intravenous solution (lower concentration of solutes in its surroundings) to a client. Which mechanism of membrane transport most likely underlies this action? A. Facilitated diffusion B. Active transport C. Diffusion D. Osmosis

D. Osmosis Rationale: The fact that body cells are permeable to water but not all solute particles, and the amount of solute relative to water content, underlies the choice of intravenous fluid in health care. Water moves through water channels in a semipermeable membrane along a concentration gradient, moving from an area of higher to one of lower concentration. This is the essence of osmosis, and the other mechanisms of membrane transport do not have as significant a bearing on the nurse's action.

A patient wants to know the risk factors for Down Syndrome. What is the nurse's best response? A. Fetal response to mutagens in the uterus B. Increased paternal age C. Family Hx of Down Syndrome D. Pregnancy in women over age 35

D. Pregnancy in women over age 35 Down Syndrome is a trisomy, unrelated to paternal age or fetal exposure. Down syndrome is a chromosomal abnormality, unrelated to family history.

What affects neuromuscular fxn. of voluntary muscles?

Myasthenia Gravis (Chronic autoimmune disorder)