AP test 2

19. What is the ability of the pathogen to invade and multiply in the host referred to as? a. Infectivity b. Toxigenicity c. Pathogenicity d. Virulence

ANS: A Infectivity is the ability of the pathogen to invade and multiply in the host. The other options do not accurately denote the pathogen's ability to invade and multiply in the host.

4. Phagocytosis involves neutrophils actively attacking, engulfing, and destroying which microorganisms? a. Bacteria b. Fungi c. Viruses d. Yeasts

ANS: A Invasion is the direct confrontation with an individual's primary defense mechanisms against only bacteria, which include the complement system, antibodies, and phagocytes, such as neutrophils and macrophages. Fungi, viruses, and yeasts are not phagocytosed.

Which statement is true regarding how cortisol reacts when activated by ACTH? a. Cortisol is plasma bound to corticotropin. b. Gluconeogenesis is halted. c. Cortisol increases blood glucose. d. Cortisol decreases protein synthesis.

C Cortisol has many actions. It is bound to a protein called transcortin. It stimulates gluconeogenesis, increases glucose production, and increases protein synthesis.

Which of the following is an example of a physical barrier? a. Antibacterial fatty acids b. Lysozymes in tears c. Epithelial cells d. Earwax

C Epithelial cells form tight junctions that are a physical barrier to entry for organisms. Sebaceous glands in the skin secrete antibacterial and antifungal fatty acids. Earwax and lysozymes in tears are examples of biochemical secretions that trap potential disease-causing microorganisms.

The Arthus reaction is an example of which type of sensitivity reaction? a. I b. II c. III d. IV

C The Arthus reaction is a type III hypersensitivity reaction.

2. What is the first stage in the infectious process? a. Invasion b. Colonization c. Spread d. Multiplication

ANS: B From the perspective of the microorganisms that cause disease, the infectious process undergoes four separate stages of progression: (1) colonization, (2) invasion, (3) multiplication, and (4) spread.

8. What characteristic do atopic individuals have that make them genetically predisposed to develop allergies? a. Greater quantities of histamine b. More histamine receptors c. Greater quantities of IgE d. A deficiency in epinephrine

ANS: C Atopic individuals tend to produce higher quantities of IgE and to have more crystalline fragment (Fc) receptors for IgE on their mast cells. Greater quantities of histamine, more histamine receptors, and a deficiency in epinephrine do not lead to a genetic predisposition to allergies.

2. In which structure does B lymphocytes mature and undergo changes that commit them to becoming B cells? a. Thymus gland b. Regional lymph nodes c. Bone marrow d. Spleen

ANS: C B lymphocytes mature and become B cells in specialized (primary) lymphoid organs—the thymus gland for T cells and the bone marrow for B cells. Neither regional lymph nodes nor the spleen are involved in changing B lymphocytes into B cells.

6. During an IgE-mediated hypersensitivity reaction, what causes bronchospasm? a. Bronchial edema caused by the chemotactic factor of anaphylaxis b. Bronchial edema caused by binding of the cytotropic antibody c. Smooth muscle contraction caused by histamine bound to H1 receptors d. Smooth muscle contraction caused by histamine bound to H2 receptors

ANS: C During an IgE-mediated hypersensitivity reaction, smooth muscle contraction caused by histamine bound to H1 receptors results in bronchospasms. The bronchospasm is not caused by edema or by histamine binding to H2 receptors.

During the cardiac cycle, which structure directly delivers action potential to the ventricular myocardium? a. Sinoatrial (SA) node b. Atrioventricular (AV) node c. Purkinje fibers d. Bundle branches

ANS: C Each cardiac action potential travels from the SA node to the AV node to the bundle of His (AV bundle), through the bundle branches, and finally to the Purkinje fibers and the ventricular myocardium, where the impulse is stopped.

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.

12. What does the student learn about HIV? a. HIV only infects T-helper (Th) cells. b. HIV is a retrovirus. c. HIV carries genetic information in its DNA. d. HIV has five identified strains.

ANS: B HIV is a member of the retrovirus family, which carries genetic information in the form of two copies of RNA. The major immunologic finding in AIDS is the striking decrease in the number of CD4+ Th cells. The major surface receptor on the HIV virus binds to the CD4 molecule found mostly on the surface of T-helper cells. There appear to be two strains of HIV: HIV-1 and HIV-2.

37. When cellular damage occurs and regeneration is minor with no significant complications, what is the process of returning the cells to preinjury function referred to as? a. Restoration b. Resolution c. Regrowth d. Replacement

ANS: B If damage is minor with no complications and destroyed tissues are capable of regeneration, then returning the injured tissues to an approximation of their original structure and physiologic function is possible. This restoration is called resolution. Resolution is the restoration of the original tissue structure and function. Regrowth and replacement are not part of resolution.

A patient had a myocardial infarction that damaged the SA node, which is no longer functioning as the pacemaker of the heart. What heart rate would the healthcare provider expect the patient to have? a. 60 to 70 beats/min b. 40 to 60 beats/min c. 30 to 40 beats/min d. 10 to 20 beats/min

ANS: B If the SA node is damaged, then the AV node will become the heart's pacemaker at a rate of approximately 40 to 60 spontaneous depolarizations per minute. The SA node normally fires at a rate of 60 to 100 beats/min. The Purkinje fibers can function as the heart's pacemaker and will fire at a rate of around 40 beats/min.

17. In a type III hypersensitivity reaction, the harmful effects after the immune complexes that are deposited in tissues are a result of what? a. Cytotoxic T cells b. Natural killer cells c. Complement activation d. Degranulation of mast cells

ANS: C Complement activation, particularly through the generation of chemotactic factors for neutrophils, causes the harmful effects of immune complex deposition. The neutrophils bind to antibody and C3b contained in the complexes and attempt to ingest the immune complexes. Type III hypersensitivity reactions as described are not the result of cytotoxic T cells, natural killer cells, or degranulation of mast cells.

The student studying pathophysiology learns which fact about circulation at birth? a. Systemic resistance and pulmonary resistance fall. b. Gas exchange shifts from the placenta to the lung. c. Systemic resistance falls and pulmonary resistance rises. d. Systemic resistance and pulmonary resistance rise.

ANS: B At birth, gas exchange shifts from the placenta to the lungs. Systemic vascular resistance increases after birth and pulmonary resistance decreases.

What pathologic change occurs to the kidney's glomeruli as a result of hypertension? a. Compression of the renal tubules b. Ischemia of the tubule c. Increased pressure from within the tubule d. Obstruction of the renal tubule

ANS: B In the kidney, ischemia causes inflammation and dysfunction of the glomeruli and tubules. This leads to increased sodium retention. Neither the renal tubules are compressed nor do they generate increased pressure. There is no obstruction.

8. Cytokines are thought to cause fevers by stimulating the synthesis of which chemical mediator? a. Leukotriene b. Histamine c. Prostaglandin d. Bradykinin

ANS: C Cytokines seem to raise the thermoregulatory set point through stimulation of prostaglandin synthesis and turnover in thermoregulatory (brain) and nonthermoregulatory (peripheral) tissues. Leukotrienes, histamine, and bradykinin are not directly related to fever production.

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.

What electrocardiogram (ECG) change would the healthcare professional assess for when a patient's myocardial infarction extends through the myocardium from the endocardium to the epicardium? a. Prolonged QT interval b. ST elevation c. ST depression d. Prolonged PR interval

ANS: B Individuals with this pattern on an ECG usually have significant elevations in the ST segments and are categorized as having STEMI (ST segment elevation myocardial infarction). A prolonged QT interval can lead to dysrhythmias. A prolonged PR interval is a benign first degree AV block.

When endothelial cells are injured, what alteration contributes to atherosclerosis? a. The release of toxic oxygen radicals that oxidize low-density lipoproteins (LDLs) b. Cells are unable to make the normal amount of vasodilating cytokines. c. Cells produce an increased amount of antithrombotic cytokines. d. Cells develop a hypersensitivity to homocysteine and lipids.

ANS: B Injured endothelial cells become inflamed and cannot make normal amounts of antithrombotic and vasodilating cytokines. They do not release toxic oxygen radicals or develop hypersensitivity to homocysteine and lipids.

What term is used to identify when a cell is temporarily deprived of blood supply? a. Infarction b. Ischemia c. Necrosis d. Inflammation

ANS: B Ischemia is a local state in which cells are temporarily deprived of blood supply. Infarction is cell death due to lack of blood flow caused by an obstruction in a vessel. Necrosis is death of cells or tissue from any cause. Inflammation is a local response that leads to redness, warmth, swelling, pain, and possibly loss of function.

Which substance primarily contains cholesterol and protein? a. Very low-density lipoproteins (VLDLs) b. Low-density lipoproteins (LDLs) c. High-density lipoproteins (HDLs) d. Triglycerides

ANS: B LDLs contain primarily cholesterol and protein. VLDLs are primarily triglycerides and protein and HDLs are mainly phospholipids and proteins. Triglycerides are the major form of fat stored in the body.

A healthcare professions student learns which facts about mitral valve stenosis? (Select all that apply.) a. It is an uncommon valvular disorder. b. It mostly affects women. c. May result from genetic factors d. Most cases are asymptomatic. e. Symptoms tend to be vague.

ANS: B, C, D, E Mitral valve stenosis is the most common valve disorder in the United States and affects predominantly women. It may be related to genetic or environmental disruption in valvular development in early pregnancy. Most cases are asymptomatic and require no treatment. Symptoms, when they occur, tend to be vague and puzzling.

A patient has infective endocarditis. Which risk factors should the healthcare professional assess this patient for? (Select all that apply.) a. Rheumatic fever b. Intravenous drug use c. Prosthetic heart valve d. Aortic regurgitation e. Heart valve disease

ANS: B, C, D, E Risk factors for infective endocarditis include acquired valvular heart disease and valve replacements, intravenous drug abuse, long-term indwelling catheterization (e.g., for pressure monitoring, hyperalimentation, or hemodialysis), and recent cardiac surgery. Rheumatic fever is not considered a direct risk factor for infective endocarditis.

20. The increased production of proinflammatory cytokines is associated with which considerations? (Select all that apply.) a. Chronic respiratory dysfunction b. Elevated anxiety levels c. Immune disorders d. Age and gender e. Dementia

ANS: B,C Increased levels of proinflammatory cytokines have been shown to have a possible link between stress and immune function. Chronic respiratory dysfunction, age, gender, and dementia are not directly linked to cytokine levels.

10. Where are antibodies produced? a. Helper T lymphocytes b. Thymus gland c. Plasma cells d. Bone marrow

ANS: C An antibody or immunoglobulin is a serum glycoprotein produced only by plasma cells in response to a challenge by an immunogen. Antibodies are not produced by the thymus gland, bone marrow, or by helper T lymphocytes.

31. A keloid is the result of which dysfunctional wound healing response? a. Epithelialization b. Contraction c. Collagen matrix assembly d. Maturation

ANS: C An imbalance between collagen synthesis and collagen degradation, during which synthesis is increased relative to degradation, causes both keloids and hypertrophic scars. Epithelialization, contraction, and maturation are not involved in keloids production.

12. What effect do androgens have on lymphocytes? a. Suppression of B-cell responses and enhancement of T-cell responses b. Suppression of T-cell responses and enhancement of B-cell responses c. Suppression of B- and T-cell responses d. Enhancement of B- and T-cell responses

ANS: C Androgens suppress T- and B-cell responses. Androgens do not enhance either B- or T-cell responses.

11. When antibodies are formed against red blood cell antigens of the Rh system, how are the blood cells destroyed? a. Complement-mediated cell lysis b. Phagocytosis by macrophages c. Phagocytosis in the spleen d. Neutrophil granules and toxic oxygen products

ANS: C Antibodies against platelet-specific antigens or against red blood cell antigens of the Rh system coat those cells at low density, resulting in their preferential removal by phagocytosis in the spleen, rather than by complement-mediated lysis. These blood cells are not destroyed by complement-mediated cell lysis, phagocytosis by macrophages, neutrophil granules, or toxic oxygen products.

17. Frequently when H1 and H2 receptors are located on the same cells, they act in what fashion? a. Synergistically b. Additively c. Antagonistically d. Agonistically

ANS: C Both types of receptors are distributed among many different cells and are often present on the same cells and may act in an antagonistic fashion. For instance, neutrophils express both types of receptors, with stimulation of H1 receptors resulting in the augmentation of neutrophil chemotaxis and H2 stimulation resulting in its inhibition. The two receptors do not act synergistically, additively, or agonistically.

29. Which cell has the ability to recognize antigens presented by the MHC class I molecules? a. T cytotoxic b. CD 4 c. CD 8 d. T helper

ANS: C CD8 cells recognize antigens presented by the major histocompatibility complex (MHC) class I molecules and become mediators of cell-mediated immunity and directly kill other cells (T-cytotoxic cells). CD4 cells tend to recognize antigen presented by MHC class II molecules and develop into helpers in the later clonal selection process (T-helper cells).

What is the most important negative inotropic agent? a. Norepinephrine b. Epinephrine c. Acetylcholine d. Dopamine

ANS: C Chemicals affecting contractility are called inotropic agents. The most important negative inotropic agent is acetylcholine released from the vagus nerve. The most important positive inotropic agents produced by the body are norepinephrine released from the sympathetic nerves that supply the heart and epinephrine released by the adrenal cortex. Other positive inotropes include thyroid hormone and dopamine.

11. Which immunoglobulin is present in blood, saliva, breast milk, and respiratory secretions? a. IgA b. IgE c. IgG d. IgM

ANS: A IgA can be divided into two subclasses, IgA1 and IgA2. IgA1 molecules are predominantly found in the blood, whereas IgA2 is the predominant class of antibody found in normal body secretions.

9. The functions of the major histocompatibility complex (MHC) and CD1 molecules are alike because both do what? a. Are antigen-presenting molecules b. Bind antigens to antibodies c. Secrete interleukins during the immune process d. Are capable of activating cytotoxic T lymphocytes

ANS: A MHC and CD1 molecules are both antigen presenting molecules (APCs). Antigen binding fragments bind antigens to antibodies. Interleukins have many sources, but they are not secreted by MHCs and CD1 molecules. Activating cytotoxic T lymphocytes requires the presence of antigen presentation and effector Th cells.

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.

5. What type of immunity is produced when an immunoglobulin crosses the placenta? a. Passive-acquired immunity b. Active-acquired immunity c. Passive-innate immunity d. Active-innate immunity

ANS: A Passive-acquired immunity (passive immunity) does not involve the host's immune response at all. Rather, passive immunity occurs when preformed antibodies or T lymphocytes are transferred from a donor to the recipient. This transfer can occur naturally, as in the passage of maternal antibodies across the placenta to the fetus, or artificially, as in a clinic using immunotherapy for a specific disease. The remaining options do not produce immunity via immunoglobulin transfer across the placenta.

18. A healthcare professional is teaching a patient about Raynaud phenomenon and instructs the patient to avoid cold. What is the best explanation of how cold impacts the manifestations of this disease? a. Immune complexes that are deposited in capillary beds, blocking circulation b. Mast cells that are bound to specific endothelial receptors, causing them to degranulate and creating a localized inflammatory reaction that occludes capillary circulation c. Cytotoxic T cells that attack and destroy the capillaries so that they are unable to perfuse local tissues d. Antibodies that detect the capillaries as foreign protein and destroy them using lysosomal enzymes and toxic oxygen species

ANS: A Raynaud phenomenon is a condition (type III hypersensitivity reaction) caused by the temperature-dependent deposition of immune complexes in the capillary beds of the peripheral circulation. The healthcare professional should teach the patient to avoid cold or to wear gloves to mitigate the cold. None of the other options are involved in causing this condition.

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.

The Bainbridge reflex is thought to be initiated by sensory neurons in which cardiac location? a. Atria b. Aorta c. Sinoatrial (SA) node d. Ventricles

ANS: A The Bainbridge reflex causes changes in the heart rate after intravenous infusions of blood or other fluid. The changes in heart rate are thought to be caused by a reflex mediated by volume receptors found only in the atria that are innervated by the vagus nerve.

14. Graves disease (hyperthyroidism) is an example of which type II hypersensitivity reaction? a. Modulation b. Antibody-dependent cell-mediated cytotoxicity c. Neutrophil-mediated damage d. Complement-mediated lysis

ANS: A The antibody reacts with the receptors on the target cell surface and modulates the function of the receptor by preventing interactions with their normal ligands, replacing the ligand and inappropriately stimulating the receptor or destroying the receptor. For example, in the hyperthyroidism (excessive thyroid activity) of Graves disease, autoantibody binds to and activates receptors for thyroid-stimulating hormone (TSH) (a pituitary hormone that controls the production of the hormone thyroxine by the thyroid). Graves disease is not a result of cell-mediated cytotoxicity, neutrophil-mediated damage, or complement-mediated lysis.

A healthcare professional cares for older adults in a skilled nursing facility. What should the professional assess for in these individuals related to cardiovascular functioning? a. Increased rate of falling and dizzy spells b. Improved exercise tolerance c. A gradual slowing of the heart rate d. Progressive ECG changes

ANS: A The baroreceptor reflex is important in blood pressure control. Baroreceptor activity can decrease with age, slowing response to changes in blood pressure and posture. An older adult may not adjust rapidly to position changes, leading to falls and dizzy spells.

The coronary sinus empties into which cardiac structure? a. Right atrium b. Left atrium c. Superior vena cava d. Aorta

ANS: A The cardiac veins empty only into the right atrium through another ostium, the opening of a large vein called the coronary sinus.

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.

7. Which characteristic is the most important determinant of immunogenicity when considering the antigen? a. Size b. Foreignness c. Complexity d. Quantity

ANS: B Foremost among the criteria for immunogenicity is the antigen's foreignness. A self-antigen that fulfills all of these criteria except foreignness does not normally elicit an immune response. Thus most individuals are tolerant of their own antigens. The immune system has an exquisite ability to distinguish self (self-antigens) from nonself (foreign antigens). Size, complexity, and quantity are considered when determining immunogenicity but not to the extent that foreignness is.

37. A pregnant woman has Graves disease. What test/s does the healthcare professional advise the woman about? a. Frequent tests of the newborn's muscular strength and movement. b. Blood test for hyperthyroidism c. Monthly OB checkups for fetal anomalies or pregnancy loss d. Serum complete blood count including platelet count

ANS: B Graves disease is an autoimmune disease in which maternal antibody against the receptor for TSH causes neonatal hyperthyroidism. The healthcare professional should advise the woman that her newborn will need to be tested for hyperthyroidism.

14. After sexual transmission of HIV, how soon can lab results detect the infection? a. 1 to 2 days b. 4 to 10 days c. 4 to 8 weeks d. 2 to 4 months

ANS: B HIV RNA may be detected in the plasma by about 4 to 10 days after an acute infection and HIV.

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.

15. A patient perceives living in a state of chronic stress. What will diagnostic blood work ordered by the healthcare professional likely demonstrate? a. Decreased Th lymphocytes b. Increased erythrocytes c. Decreased Tc cells d. Increased platelets

ANS: C Illustrating the influence of chronic stress appraisal on the physiologic processes, a meta-analysis of the relationships between stressors and immunity found that a higher perception of stress was associated with reduced T cytotoxic (Tc)-cell cytotoxicity, although not with levels of circulating Th or Tc lymphocytes. Research has not shown this relationship with changes in Th lymphocytes, erythrocytes, or platelets.

10. A healthcare professional is conducting community education on vaccinations. Which statement about vaccines does the professional include in the presentation? a. Most bacterial vaccines contain attenuated organisms. b. Most viral vaccines are made by using dead organisms. c. Vaccines require booster injections to maintain life-long protection. d. Vaccines provide effective protection against most infections.

ANS: C In general, vaccine-induced protection does not persist as long as infection-induced immunity, thus booster injections may be necessary to maintain protection throughout the life. Some common bacterial vaccines are killed microorganisms, extracts of bacterial antigens, or toxoids.

Which statement is true regarding stress and the immune system? a. Seasonal allergies are related to stress. b. Cardiovascular disease is one condition that is related to stress. c. The level of proinflammatory cytokines is decreased. d. Negative emotions cause few alterations in cytokine production.

B Cardiovascular disease, aging, cancer, osteoporosis, arthritis, type II diabetes mellitus, and chronic obstructive pulmonary disease (COPD) are associated with the prolonged presence of proinflammatory cytokines. These proinflammatory cytokines increase during stress. Negative emotions are directly associated with the increased level of these proinflammatory cytokines.

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

Which term describes an agent's ability to produce disease? a. Virulence b. Pathogenicity c. Infectivity d. Immunogenicity

B Pathogenicity is the ability of an agent to produce disease and depends on the speed of reproduction, the extent of tissue damage, and the production of toxins. Virulence is the capacity of a pathogen to cause severe disease. Infectivity is the ability of the pathogen to invade and multiply in the host. Immunogenicity is the ability of pathogens to induce an immune response.

Which are not natural barriers? a. Physical b. Resistance c. Biochemical d. Mechanical

B Resistance is a means by which the body may avoid being infected, but it is not a natural barrier. The natural barriers include physical, biochemical, and mechanical, as well as inflammation at the body's surfaces.

Which receptor is expressed on macrophages and facilitates recognition and phagocytosis of bacterial pathogens? a. Complement receptors b. Scavenger receptors c. Toll-like receptors d. Pattern recognition receptors

B The scavenger receptors are primarily expressed on macrophages and facilitate recognition and phagocytosis of bacterial pathogens. Complement receptors recognize a variety of fragments produced through activation of the complement system. Toll-like receptors are expressed on the surface of cells, including epithelial, mast, neutrophils, macrophages, dendritic cells, and lymphocytes. They recognize pathogen-associated molecular patterns or stressed host cells. Pattern recognition receptors recognize patterns of infectious molecules. These receptors are found on cells involved in innate resistance.

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 pathways activate the complement system? (Select all that apply.) a. Antigen antibody b. Classical c. Lectin d. Alternative

B,C,D The complement system may be activated by the classical, lectin, and alternative pathways.

Which are molecular classes of immunoglobulins? (Select all that apply.) a. IgC b. IgD c. IgE d. IgM e. IgN

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

Which statement regarding mast cells is true? a.Histamine causes vasoconstriction. b. Mast cells are found only in blood vessels. c. Snake bites, bee venoms, and toxins may cause activation. d. Mast cells are not involved in allergic reactions.

C A number of things cause the activation of mast cells, including physical injury, chemical agents (including toxins, bee venom, and snake bites), immunologic means, and activation of an inflammatory response. Histamine is released from mast cells and causes vasodilation. Mast cells are found in loose connective tissue close to blood vessels. Mast cells are involved in initiating many allergic reactions.

Which statement best describes the cells and their functions in the humoral arm of the immune system? a. Cells undergo differentiation and develop into subpopulations. b. Cells attack cancerous cells. c. Antibodies are primarily responsible for protection. d. Cells in the humoral arm are also called cellular immunity.

C Antibodies are primarily responsible for protection against viruses and bacteria and are part of the humoral arm of the immune system. The antibody can directly invade a microorganism or activate the immune response. T cells undergo differentiation, attack cancerous cells, and are part of cellular immunity.

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.

18. Some older adults have impaired inflammation and wound healing because of which problem? a. Circulatory system cannot adequately perfuse tissues. b. Complement and chemotaxis are deficient. c. Underlying chronic illness(es) exists. d. Number of mast cells is insufficient.

ANS: C In some cases, impaired healing is not directly associated with aging, in general, but can instead be linked to a chronic illness such as cardiovascular disease or diabetes mellitus. Older adults may have circulatory problems, but that would not lead directly to impaired inflammation and wound healing. Older people do not have deficient complement and chemotaxis, nor do they have insufficient mast cell numbers.

13. An individual is more susceptible to infections of mucous membranes when he or she has a seriously low level of which immunoglobulin antibody? a. IgG b. IgM c. IgA d. IgE

ANS: C The IgA molecules found in bodily secretions are dimers anchored together through a J-chain and secretory piece. This secretory piece is attached to the IgA antibodies inside the mucosal epithelial cells and may function to protect these immunoglobulin antibodies against degradation by enzymes also found in the secretions, thus decreasing the risk of infections in the mucous membrane. The other options do not accurately identify the immunoglobulin antibody involved in mucous membrane infections.

Which factor is responsible for the hypertrophy of the myocardium associated with hypertension? a. Increased norepinephrine b. Adducin c. Angiotensin II d. Insulin resistance

ANS: C Angiotensin II is responsible for the hypertrophy of the myocardium and much of the renal damage associated with hypertension. Increased SNS activity with norepinephrine leads to increases in heart rate and systemic vasoconstriction. Diabetes and glucose intolerance are risk factors for developing hypertension. Polymorphisms in some adducin proteins have been linked to hypertension but more study is needed.

What effect does atherosclerosis have on the development of an aneurysm? a. Atherosclerosis causes ischemia of the intima. b. It increases nitric oxide. c. Atherosclerosis erodes the vessel wall. d. It obstructs the vessel.

ANS: C Atherosclerosis is a common cause of aneurysms because plaque formation erodes the vessel wall. Atherosclerosis does not lead to ischemia of the intima, increase nitric oxide, or obstruct the vessel.

20. Some bacterial surface proteins bind with the crystalline fragment (Fc) portion of an antibody to do what? a. Hide in cells to avoid triggering an immune response b. Form self-protecting toxins c. Make staining possible for microscopic observation d. Produce a protective "self" protein

ANS: D Some bacterial surface proteins (protein A of Staphylococcus aureus, protein G of Streptococcus pyogenes) bind the Fc portion of the individual's antibody, thus forming a protective coat of "self" protein. The other options do not accurately define the role of bacterial surface proteins as they bind with the Fc portion on an antibody.

11. What is an outcome of the complement cascade? a. Activation of the clotting cascade b. Prevention of the spread of infection to adjacent tissues c. Inactivation of chemical mediators such as histamine d. Lysis of bacterial cell membranes

ANS: D The complement cascade can be activated by at least three different means, and its products have four functions: (1) anaphylatoxic activity, resulting in mast cell degranulation, (2) leukocyte chemotaxis, (3) opsonization, and (4) cell lysis. The complement cascade does not activate the clotting cascade, prevent spread of infection, or inactivate chemical mediators.

The cardiac electrical impulse normally begins spontaneously in the sinoatrial (SA) node because of what reason? a. It has a superior location in the right atrium. b. It is the only area of the heart capable of spontaneous depolarization. c. It has rich sympathetic innervation via the vagus nerve. d. It depolarizes more rapidly than other automatic cells of the heart.

ANS: D The electrical impulse normally begins in the SA node because its cells depolarize more rapidly than other automatic cells at a rate of 60 to 100 beats/min. The SA node's location does not influence this activity. Other areas of the heart include the AV node and the Purkinje fibers. The vagus nerve causes the heart rate to slow as part of the parasympathetic nervous system.

9. A student asks about the mechanism that results in type II hypersensitivity reactions. What description by the professor is best? 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.

13. How are target cells destroyed in a type II hypersensitivity reaction? a. Tissue damage from mast cell degranulation b. Antigen-antibody complexes deposited in vessel walls c. Cytotoxic T lymphocytes attack the cell directly. d. Natural killer cells

ANS: D The mechanism that results in a type II hypersensitivity reaction involves a subpopulation of cytotoxic cells that are not antigen specific (natural killer [NK] cells). Antibody on the target cell is recognized by Fc receptors on the NK cells, which releases toxic substances that destroy the target cell. Tissue damage from mast cell degranulation occurs in type I hypersensitivity reactions. Antigen-antibody complexes are active in type III hypersensitivity responses. Cytotoxic lymphocytes are involved in type IV hypersensitivity responses.

23. Which blood cell carries the carbohydrate antigens for blood type? a. Platelets b. Neutrophils c. Lymphocytes d. Erythrocytes

ANS: D The reaction that causes a blood transfusion recipient's red blood cells to clump together is related to the ABO antigens located on the surface of only erythrocytes.

26. Which T cell controls or limits the immune response to protect the host's own tissues against an autoimmune response? a. Cytotoxic T cells b. Th1 cells c. Th2 cells d. Regulatory T (Treg) cells

ANS: D The regulatory T (Treg) cell's role is to control or limit the immune response to protect the host's own tissues against autoimmune reactions. Cytotoxic T cells attack and kill cellular targets directly. Th2 cells provide help for developing B cells and produce IL-4, IL-5, IL-6, and IL-13. Th1 cells are induced by antigens derived from cancer cells.

14. How does the B-cell receptor (BCR) complex function? a. Communicating information about the antigen to the helper T cell b. Secreting chemical signals to communicate between cells c. Releasing histamine and other vasoactive substances d. Communicating information about the antigen to the cell nucleus

ANS: D The role of the BCR is to recognize the antigen; however, unlike circulating antibodies, the receptor must communicate that information to the cell's nucleus. The BCR does not communicate information about the antigen to the helper T cell or secrete chemical signals to communicate between cells. The release of histamine and other vasoactive substances is part of inflammation, not adaptive immunity.

21. Which organism is a common sexually transmitted bacterial infection? a. Staphylococcus aureus b. Clostridium perfringens c. Helicobacter pylori d. Treponema pallidum

ANS: D Treponema pallidum (spirochete, syphilis) is a sexually transmitted disease. Staphylococcus aureus is commonly ingested, causing food poisoning; Clostridium perfringens (gas gangrene) is a skin or wound infection; and Helicobacter pylori (gastritis, peptic ulcers) is found in the gastrointestinal tract.

24. A person with type O blood needs a blood transfusion. What blood type does the healthcare professional prepare to administer to the patient? a. A b. B c. AB d. O

ANS: D Type O individuals have neither A or B antigen but have both anti-A and anti-B antibodies and therefore cannot accept blood from any of the other three types. The healthcare professional would prepare to administer a transfusion of type O blood.

30. Urticaria is a manifestation of a which type of hypersensitivity reaction? a. IV b. III c. II d. I

ANS: D Urticaria, or hives, is a dermal (skin) manifestation of only type I allergic reactions.

During the cardiac cycle, why do the aortic and pulmonic valves close after the ventricles relax? a. Papillary muscles relax, which allows the valves to close. b. Chordae tendineae contract, which pulls the valves closed. c. Reduced pressure in the ventricles creates a negative pressure, which pulls the valves closed. d. Blood fills the cusps of the valves and causes the edges to merge, closing the valves.

ANS: D When the ventricles relax, blood fills the cusps and causes their free edges to meet in the middle of the vessel, closing the valve and preventing any backflow. The papillary muscles function in the tricuspid and mitral valves as do the chordae tendineae. Reduced pressure does not pull the valves closed.

What physical sign does the healthcare professional relate to the result of turbulent blood flow through a vessel? a. Increased blood pressure during periods of stress b. Bounding pulse felt on palpation c. Cyanosis observed on exertion d. Murmur heard on auscultation

ANS: D Where flow is obstructed, the vessel turns or blood flows over rough surfaces. The flow becomes turbulent with whorls or eddy currents that produce noise, causing a murmur to be heard on auscultation. Increased blood pressure during stress is the result of sympathetic nervous system stimulation. A bounding pulse usually indicates fluid overload. Cyanosis would relate to a decrease in gas exchange and oxygenation.

What is the effect of epinephrine on β3 receptors on the heart? a. Decreases coronary blood flow b. Supplements the effects of both β1 and β2 receptors c. Increases the strength of myocardial contraction d. Prevents overstimulation of the heart by the sympathetic nervous system

ANS: D β3 receptors are found in the myocardium and coronary vessels. In the heart, stimulation of these receptors opposes the effects of β1- and β2-receptor stimulation and negative inotropic effect. Thus β3 receptors may provide a safety mechanism that decreases myocardial contractility to prevent overstimulation of the heart by the sympathetic nervous system.

A parent brings a 10-year-old child to the clinic and reports a mottled appearance to the skin and legs cramps when the child is in physical education class. What diagnostic testing or treatment does the healthcare professional prepare the family for? a. Immediate cardiac catheterization b. Administration of prostaglandin c. Multiple-stage surgical correction d. An echocardiogram

ANS: D Clinical manifestations of coarctation of the aorta include hypertension noted in the upper extremities with decreased or absent pulses in the lower extremities. Children may also have cool mottled skin and occasionally experience leg cramps during exercise. An echocardiogram would be used to diagnose the condition. In an older child, percutaneous balloon dilation angioplasty with or without stent implantation may be a good treatment option, however; an immediate cardiac catheterization is not needed at this time. Prostaglandin is used to stabilize a newborn prior to surgical correction is typically straightforward unless the COA is part of another condition. The healthcare professional would educate the family on the echocardiogram.

A baby has been born with Down syndrome. What congenital heart defect does the healthcare professional assess this baby for? a. Coarctation of the aorta (COA) b. Tetralogy of Fallot c. Atrial septal defect (ASD) d. Ventricular septal defect (VSD)

ANS: D Congenital heart defects that are related to Down syndrome include VSD and ASVD. COA is associated with Turner syndrome. Tetralogy of Fallot does not have a strong association with chromosomal defects. An ASD is often seen in Cri du Chat syndrome, Turner syndrome, or Klinefelter variant syndrome.

Which laboratory test is an indirect measure of atherosclerotic plaque? a. Homocysteine b. Low-density lipoprotein (LDL) c. Erythrocyte sedimentation rate (ESR) d. C-reactive protein (CRP)

ANS: D Highly sensitive CRP (hs-CRP) is an acute phase reactant or protein mostly synthesized in the liver and is an indirect measure of atherosclerotic plaque-related inflammation and plaque progression. High levels of homocysteine are considered a cardiac risk factor but not a measurement of atherosclerotic plaque. LDL is a type of lipid that confers risk with higher levels. The ESR is a nonspecific measure of inflammation.

A newborn has chronic sustained hypertension but otherwise appears healthy. What diagnostic testing does the healthcare professional facilitate as the priority? a. Cardiac catheterization b. Echocardiogram c. Serum electrolytes d. Renal function studies

ANS: D Infants and newborns usually have secondary hypertension, which can be caused by many disease processes. Renal disorders are very common causes so the healthcare professional would facilitate getting blood work for renal function studies. Electrolytes would be obtained as well, but are not specific for a cause like renal studies are. Without any other manifestations, the professional would not facilitate cardiac catheterization or echocardiogram.

Nicotine increases atherosclerosis by the release of which neurotransmitter? a. Histamine b. Nitric oxide c. Angiotensin II d. Epinephrine

ANS: D Nicotine stimulates the release of catecholamines (e.g., epinephrine, norepinephrine), which increases the heart rate and causes peripheral vascular constriction. As a result, blood pressure increases, as do both cardiac workload and oxygen demand. Nicotine does not stimulate the release of histamine, nitric oxide or angiotensin II.

A patient reports chest pain that occurs most often during sleep. What treatment does the healthcare professional discuss with the patient? a. Treatment of obstructive sleep apnea b. Short-acting nitroglycerin tablets c. A low-dose aspirin regimen d. Oral calcium channel blockers

ANS: D Prinzmetal angina (also called variant angina) is chest pain attributable to transient ischemia of the myocardium that occurs unpredictably and almost exclusively at rest. The typical treatment for this condition is long-acting nitrites or calcium channel blockers. Treating sleep apnea, taking short-acting nitroglycerin, or taking low dose aspirin will not benefit the patient.

Which is a function of norepinephrine? a. Increases contraction of the heart b. Constricts smooth muscle in all blood vessels c. Secretes steroid hormones d. Stimulates adrenal medulla

B Norepinephrine is released from the adrenal medulla and regulates blood pressure by constricting smooth muscle in all blood vessels. Epinephrine increases myocardial contractility and heart rate. The steroid hormones are stimulated by the hypothalamus, which sets off a chain of events during which steroid hormones are secreted from the adrenal cortex. Cortisol is one of the primary steroid hormones.

What is the precise portion of the antigen that is configured for recognition and binding of an antibody? a. Paratope b. Epitope c. Self-antigen d. Immunogen

B The antigenic determinant or epitope is the precise portion of the antigen that is configured for recognition and binding of an antibody. A paratope is the matching portion on the antibody or lymphocyte receptor. A self-antigen is one that is not foreign to the host. An immunogen is an antigen that induces an immune response.

Which statement regarding fever is true? a. Fever is a failure of the body to regulate temperature. b. An endogenous pyrogen may produce fever. c. The body's central thermostat is the pituitary gland. d. Fever is a failure of the body's defense system.

B A pyrogen is a substance that causes fever. Exogenous and endogenous pyrogens exist and affect the regulatory set point in the hypothalamus, which is the body's thermostat. Fever is not a failure of the body's defense system but may actually be beneficial. The body does not fail to regulate temperature; rather, the temperature is regulated at a higher level than normal with a fever.

What is the definition of the reactive response? a. Mounting a response in anticipation of a stressor b. Mounting a response in reaction to a psychologic stressor c. Mounting a response to a learned stressor d. Mounting a response to a physical stressor

B A reactive response is a psychologic response to a stressor. An anticipatory response is a psychologic response to an anticipated response. A conditioned response is an anticipated psychologic (learned) response to stimuli that have been associated with danger.

Which term is used to identify elevated systolic pressure accompanied by normal diastolic pressure (less than 90 mmHg)? a. Primary hypertension Incorrect b. Secondary hypertension c. Stage 2 hypertension d. Isolated systolic hypertension

d. Isolated systolic hypertension is an elevated systolic pressure with a normal diastolic pressure. Primary hypertension is the result of extremely complicated interactions of genetics and the environment, mediated by a host of neurohumoral effects. Altered hemodynamics, associated with a primary disease, cause secondary hypertension. Stage 2 hypertension is systolic pressure equal to or greater than 160 mmHg and diastolic pressure equal to or greater than 100 mmHg.

What enables electrical impulses to travel in a continuous cell-to-cell fashion in myocardial cells? a. Sarcolemma sclerotic plaques b. Intercalated disks c. Trabeculae carneae d. Bachmann bundles

ANS: B The intercalated disks are thickened portions of the sarcolemma and enable electrical impulses to spread quickly in a continuous cell-to-cell (syncytial) fashion. A sarcolemma is a transparent sheath that surrounds nerve fibers. They are not subject to plaque buildup. The trabeculae carneae are beam-like projections of myocardial tissue. Bachmann bundles are part of the conduction system.

2. How do surfactant proteins A through D provide innate resistance? a. Initiate the complement cascade. b. Promote phagocytosis. c. Secrete mucus. d. Synthesize lysosomes.

ANS: B The lung produces and secretes a family of glycoproteins, collectins, which includes surfactant proteins A through D and mannose-binding lectin. Collectin binding facilitates macrophages to recognize the microorganism, enhancing macrophage attachment, phagocytosis, and killing. The complement cascade occurs during the inflammatory phase. These proteins do not secrete mucus of synthesize lysosomes.

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.

15. Which cells are primary targets for HIV? a. CD4+ Th cells only b. CD4+ Th cells, macrophages, and dendritic cells c. CD8-positive cytotoxic T (Tc) cells and plasma cells d. CD8-positive Tc cells only

ANS: B The primary cellular targets for HIV include CD4+ Th cells, macrophages, and dendritic cells. The other cell types are not the primary target cells of HIV.

In systolic heart failure, what effect does the renin-angiotensin-aldosterone system (RAAS) have on stroke volume? a. Increases preload and decreases afterload b. Increases preload and increases afterload c. Decreases preload and increases afterload d. Decreases preload and decreases afterload

ANS: B Activation of the RAAS increases preload through the effects of aldosterone secretion, a sequela of the RAAS activity. RAAS also increases afterload through vasoconstriction mediated by angiotensin II.

A patient who had a myocardial infarction is going to cardiac rehabilitation where progressive exercise is monitored by health care professionals. When would this patient be most vulnerable to injury and complications? a. Between 5 and 9 days b. Between 10 and 14 days c. Between 15 and 20 days d. Between 20 and 30 days

ANS: B After a myocardial infarction, healing takes place in a graduated fashion. Within 10 to 14 days, a collagen matrix is deposited as the beginning of a scar that is initially weak, mushy, and vulnerable to reinjury. It is during this time period, as the patient feels better and increases activity, that the scar is most susceptible to injury from increasing stress.

Which event triggers congenital heart defects that cause acyanotic congestive heart failure? a. Right-to-left shunts b. Left-to-right shunts c. Obstructive lesions d. Mixed lesions

ANS: B Congenital heart defects that cause acyanotic congestive heart failure usually involve left-to-right shunts. Right-to-left shunting causes hypoxemia and cyanosis. Obstructive and mixed lesions vary in their presentation, but obstructive lesions do not have shunting.

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 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.

Which statement regarding corticotropin-releasing hormone (CRH) and its influence on the immune system is true? a. CRH is also released from peripheral inflammatory sites. b. CRH causes vasoconstriction. c. CRH causes decreased vascular permeability. d. Red blood cells are the peripheral targets.

A CRH is released from the hypothalamus and from peripheral inflammatory sites. Because this hormone is proinflammatory, it causes vasodilation and increased vascular permeability. The primary target of peripheral CRH is the mast cell.

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 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.

A stress response results in the stimulation of which sympathetic nervous system receptors? a. α-Adrenergic receptors b. Anterior pituitary receptors c. Adrenocorticotropic hormone (ACTH) d. Growth hormone (GH)

A The alpha receptors of the sympathetic nervous system are stimulated during the stress response and promote the release of catecholamines. The anterior pituitary receptors when stimulated result in ACTH and growth hormone production.

Which criteria influence the degree of immunogenicity? (Select all that apply.) a. Foreignness to the host b. Appropriate size c. Appropriate quantity d Chemical simplicity e. Chemical complexity

A, B, C, E The four criteria that influence the degree of immunogenicity are foreignness to the host, appropriate size, appropriate quantity, and chemical complexity.

Which demonstrates how antibiotic resistance may occur? (Select all that apply.) a. Thickened bacterial cell walls trap the antibiotic. b. Modification of the bacterial cell wall prevents antibiotic access. c. Bacterial enzymes destroy the antibiotic. d. Nucleus of the virus is destroyed.

A,B,C Resistance may result from sequestration or decreased uptake of the antibiotic. Thickened cell walls or biofilms trap antibiotics in the extracellular matrix to prevent access to bacteria. Decreased uptake of the antibiotic results from modification of the cell wall. Bacterial enzymes can destroy the antibiotic. Antibiotics are given for bacterial infections, not viral.

Which are stages in the development of the general adaptation syndrome? (Select all that apply.) a. Alarm b. Exposure c. Resistance d. Exhaustion

A,C,D The three successive stages in the development of the general adaptation syndrome are alarm, resistance, and exhaustion.

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,C,D,E The four characteristics that are observable for inflammation in vascular tissue are redness, heat, swelling, and pain.

Which are the stages of pathologic infection? (Select all that apply.) a. Invasion b. Death c. Colonization d. Metastasis e. Multiplication

A,C,E The stages of pathologic infection include colonization, invasion, spread, and multiplication. Death and metastasis are not stages of pathologic infection.

Where does the perception of stress initiate? (Select all that apply.) a. Peripheral nervous system b. Exocrine system c. Parasympathetic nervous system d. Central nervous system

A,D The perception of stress is initiated in the central nervous and peripheral nervous systems.

18. A reduction in an individual's number of natural killer (NK) cells appears to correlate with an increased risk for the development of what? a. Depression b. Type 1 diabetes c. Obsessive compulsive disorder (OCD) d. Gastroesophageal reflux disorder (GERD)

ANS: A A meta-analysis of studies shows a relationship between depression and the reduction in lymphocyte proliferation and natural killer cell activity. Currently, no research supports correlations between the number of NK cells and type 1 diabetes, OCD, or GERD.

16. What effect does the process of histamine binding to the histamine-2 (H2) receptor have on inflammation? a. Inhibition b. Activation c. Acceleration d. Termination

ANS: A Binding histamine to the H2 receptor is generally antiinflammatory because it results in the suppression of leukocyte function. Binding to H2 receptors does not cause activation, acceleration, or termination of the inflammatory process.

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. What effect of increased secretions of epinephrine, glucagon, and growth hormone would the healthcare professional assess for? a. Hyperglycemia b. Hypertension c. Bronchodilation d. Pupil dilation

ANS: A Cortisol enhances the elevation of blood glucose promoted by other hormones, such as epinephrine, glucagon, and growth hormone. Increases in glucagon and growth hormone do not lead to increases in blood pressure, bronchodilation, or pupil dilation although epinephrine does.

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.

What period follows depolarization of the myocardium and represents a period during which no new cardiac potential can be propagated? a. Refractory b. Hyperpolarization c. Threshold d. Sinoatrial (SA)

ANS: A During the absolute refractory period, no new cardiac action potential can be initiated by a stimulus. The other options do not reflect the time period in which no stimulation will produce a new cardiac potential.

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.

30. Which cell has a role in developing cell-mediated immunity? a. Th1 b. CD4 c. CD8 d. Th2

ANS: A Only Th1 cells help develop cellular immunity.

Which cardiac chambers have the thinnest wall and why? a. The right and left atria; they are low-pressure chambers that serve as storage units and conduits for blood. b. The right and left atria; they are not directly involved in the preload, contractility, or afterload of the heart. c. The left ventricle; the mean pressure of blood coming into this ventricle is from the lung, which has a low pressure. d. The right ventricle; it pumps blood into the pulmonary capillaries, which have a lower pressure compared with the systemic circulation.

ANS: A The two atria have the thinnest walls because they are low-pressure chambers that serve as storage units and conduits for blood that is emptied into the ventricles. The ventricles have thicker walls in order to pump blood against resistance.

Within a physiologic range, what does an increase in left ventricular end-diastolic volume (preload) result in? a. Increase in force of contraction b. Decrease in refractory time c. Increase in afterload d. Decrease in repolarization

ANS: A This concept is expressed in the Frank-Starling law; the cardiac muscle, like other muscles, increases its strength of contraction when it is stretched. An inotropic substance would increase the force of contraction and consist of hormones, neurotransmitters, or medications, and do not include volume. Afterload is the force against which the heart must pump. A decrease in repolarization would affect electrical activity.

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.

Regarding the endothelium, what is the difference between healthy vessel walls and those that promote clot formation? a. Inflammation and roughening of the endothelium of the artery are present. b. Hypertrophy and vasoconstriction of the endothelium of the artery are present. c. Excessive clot formation and lipid accumulation in the endothelium of the artery are present. d. Evidence of age-related changes that weaken the endothelium of the artery is present.

ANS: A Atherosclerosis causes roughening of the intima of blood vessels, which subsequently leads to activation of the coagulation cascade. Clot promotion is not caused by vasoconstriction of the endothelium, or age-related changes that weaken the endothelium. This process occurs in the intima of the artery.

Which statement best describes thromboangiitis obliterans (Buerger disease)? a. Inflammatory disorder of small- and medium-size arteries in the feet and sometimes in the hands b. Vasospastic disorder of the small arteries and arterioles of the fingers and, less commonly, of the toes c. Autoimmune disorder of the large arteries and veins of the upper and lower extremities d. Neoplastic disorder of the lining of the arteries and veins of the upper extremities

ANS: A Buerger disease is an inflammatory disease of the peripheral arteries. Inflammation, thrombus formation, and vasospasm can eventually occlude and obliterate portions of small- and medium-size arteries. The digital, tibial, and plantar arteries of the feet and the digital, palmar, and ulnar arteries of the hands are typically affected. Vasospasm in the small arteries and arterioles of the fingers and occasionally the toes describes Raynaud disease. It does not involve larger arteries and veins and it is not a neoplastic disease.

Most cardiovascular developments occur between which weeks of gestation? a. Fourth and seventh weeks b. Eighth and tenth weeks c. Twelfth and fourteenth weeks d. Fifteenth and seventeenth weeks

ANS: A Cardiogenesis begins at approximately 3 weeks' gestation; however, most cardiovascular development occurs between 4 and 7 weeks' gestation

What is the cause of the dyspnea resulting from a thoracic aneurysm? a. Pressure on surrounding organs b. Poor oxygenation c. Formation of atherosclerotic lesions d. Impaired blood flow

ANS: A Clinical manifestations of an aneurysm depend on the location of the aneurysm. Pressure of a thoracic aneurysm on surrounding organs directly causes symptoms of dysphagia (difficulty in swallowing) and dyspnea (breathlessness). A thoracic aneurysm does not cause dyspnea through poor oxygenation, atherosclerotic lesions, or impaired blood flow.

What is the initial manifestation of aortic coarctation observed in a neonate? a. Heart failure (HF) b. Cor pulmonale c. Pulmonary hypertension d. Cerebral hypertension

ANS: A Initially, the newborn usually exhibits symptoms of HF. Cor pulmonale, pulmonary hypertension, and cerebral hypertension are not associated with coarctation of the aorta.

Older children with an unrepaired cardiac septal defect experience cyanosis because of which factor? a. Right-to-left shunts b. Left-to-right shunts c. Obstructive lesions d. Mixed lesions

ANS: A Older children who have an unrepaired septal defect with a left-to-right shunt may become cyanotic because of pulmonary vascular changes secondary to increased pulmonary blood flow. Left-to-right shunts are usually acyanotic. Obstructive and mixed lesions vary in their presentation but obstructive lesions do not include shunting.

The presence of the foramen ovale in a fetus allows what to occur? a. Right-to-left blood shunting b. Left-to-right blood shunting c. Blood flow from the umbilical cord d. Blood flow to the lungs

ANS: A The nonfused septum secundum and ostium secundum result in the formation of a flapped orifice known as the foramen ovale, which allows the right-to-left shunting necessary for fetal circulation. The foramen ovale is not involved in left-to-right shunting, blood flow from the umbilical cord, or blood flow to the lungs.

Which condition is consistent with the cardiac defect of transposition of the great vessels? a. The aorta arises from the right ventricle. b. The pulmonary trunk arises from the right ventricle. c. The right ventricle pumps blood to the lungs. d. An intermittent murmur is present.

ANS: A Transposition of the great arteries refers to a condition in which the aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle. A transposition of the great vessels is not associated with the pulmonary trunk arising from the RV, the RV pumping blood into the lungs, or an intermittent murmur.

44. An individual's acquired immunity is dependent on the function of which cells? (Select all that apply.) a. T lymphocytes b. B lymphocytes c. Macrophages d. Opsonins e. Neutrophils

ANS: A, B, C T lymphocytes, B lymphocytes, macrophages, and dendritic cells are involved in acquired immunity. Opsonins are molecules that tag microorganisms for destruction by cells of the inflammatory system; these cells are primarily neutrophils. Neutrophils are white blood cells.

4. What are blood transfusion reactions an example of? a. Autoimmunity b. Alloimmunity c. Homoimmunity d. Hypersensitivity

ANS: B Alloimmunity (also termed isoimmunity) occurs when the immune system of one individual produces an immunologic reaction against tissues of another individual. Autoimmunity is a disturbance in the immunologic tolerance of self-antigens. Homoimmunity refers to the resistance of a lysogenic bacterium that is carrying a phage to an infection by the same type of phage. Hypersensitivity is an altered immunologic response to an antigen that results in disease or damage to the host.

3. Which type of microorganism reproduces on the skin? a. Viruses b. Bacteria and fungi c. Protozoa and Rickettsiae d. Mycoplasma

ANS: B Only bacteria and fungi have the capacity to reproduce on the skin.

29. Considering the effects of nutritional deficiencies on the immune system, severe deficits in calories and protein lead to deficiencies in the formation of which immune cells? a. B cells b. T cells c. Natural killer cells d. Neutrophils

ANS: B Severe deficits in calorie or protein intake lead to deficiencies in T-cell function and numbers. B cells, natural killer cells, and neutrophils are not necessarily affected by nutritional deficits.

A patient has a disorder affecting ventricular depolarization. What ECG finding would the healthcare professional associate with this condition? a. Shortened PR interval b. Prolonged QRS interval c. QT interval variability d. Absence of P waves

ANS: B The QRS complex represents the sum of all ventricular muscle cell depolarizations. If a patient had ECG findings suggestive of problems with this activity, there would be prolongation of the QRS interval. The PR interval reflects the amount of time needed for the action potential to travel from the atrium to the ventricle. QT interval variability is normal. An absence of P waves would indicate a problem with the SA node.

38. An early diastole peak caused by filling of the atrium from peripheral veins is identified by which intracardiac pressure? a. A wave b. V wave c. C wave d. X descent

ANS: B The V wave is an early diastolic peak caused by the filling of the atrium from the peripheral veins. The A wave is generated by atrial contraction. The C wave is a small pressure increase seen after the A wave in early systole. The X descent follows the A wave and is produced by the descent of the tricuspid valve ring and by the ejection of blood from both ventricles.

2. Which organ is stimulated during the alarm phase of the general adaptation syndrome (GAS)? a. Adrenal cortex b. Hypothalamus c. Anterior pituitary d. Limbic system

ANS: B The alarm phase of the GAS begins when a stressor triggers the actions of the hypothalamus and the sympathetic nervous system (SNS). The other organs are not stimulated by the alarm phase of GAS.

32. Raynaud phenomenon is an example of which type of hypersensitivity? a. IV b. III c. II d. I

ANS: B The characteristics of serum sickness are observed in only systemic type III autoimmune diseases such as Raynaud phenomenon.

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.

Which chamber of the heart endures the highest pressures? a. Right atrium b. Left atrium c. Left ventricle d. Right ventricle

ANS: C Pressure is greatest in the left ventricle with a systolic range of 90 to 140 mmHg. The right ventricle is next with a systolic range of 15 to 28 mmHg, followed by the left and right atria, respectively.

31. A student asks the healthcare professional how the aging process of the T-cell activity affects older adults. What response by the professional is best? a. Poor heat regulation abilities b. Increased risk for bone fractures c. Tendency to develop various infections d. Likelihood of experiencing benign skin lesions

ANS: C T-cell activity is deficient in older adults, and a shift in the balance of T-cell subsets is observed. These changes may result in increased susceptibility to infection. The other issues are not related to T-cell activity.

19. Th2 cells produce IL-4 and suppress which cells? a. B lymphocytes b. Cytotoxic T lymphocytes c. Th1 cells d. Memory T lymphocytes

ANS: C Th2 cells produce IL-4, which suppresses only Th1 and Th17 cells through their IL-4 receptors.

3. During an anticipatory response to stress, what is the reaction from the limbic system stimulated by? a. The retronucleus of the anterior pituitary b. The anterior nucleus of the hippocampus c. The paraventricular nucleus of the hypothalamus d. The prefrontal nucleus of the amygdala

ANS: C The paraventricular nucleus (PVN) of the hypothalamus must be stimulated to cause the limbic system to be stimulated. The other areas are not involved in the stimulation of the limbic system.

5. Perceived stress elicits an emotional, anticipatory response that begins where? a. Prefrontal cortex b. Anterior pituitary c. Limbic system d. Hypothalamus

ANS: C The perception of stress initiates a series of events in the central and peripheral nervous systems. In the brain, stress elicits an anticipatory response that activates the limbic system; the brain area is responsible for motivation, emotions, and cognition.

6. The portion of the antigen that is configured for recognition and binding is referred to as what type of determinant? a. Immunotope b. Paratope c. Epitope d. Antigenitope

ANS: C The precise portion of the antigen that is configured for recognition and binding is called its antigenic determinant or epitope. The other terms are not discussed in the text.

The right lymphatic duct drains into which structure? a. Right subclavian artery b. Right atrium c. Right subclavian vein d. Superior vena cava

ANS: C The right lymphatic duct drains lymph into the right subclavian vein only.

7. Stress-induced sympathetic stimulation of the adrenal medulla causes the secretion of what? a. Epinephrine and aldosterone b. Norepinephrine and cortisol c. Epinephrine and norepinephrine d. Acetylcholine and cortisol

ANS: C The sympathetic nervous system is aroused during the stress response and causes the medulla of the adrenal gland to release catecholamines (80% epinephrine and 20% norepinephrine) into the bloodstream. Sympathetic stimulation of the adrenal medulla does not cause the secretion of aldosterone, cortisol, or acetylcholine.

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.

34. Cytokines are vital to a cell's ability to do which function? a. Excrete b. Reproduce c. Metabolize d. Communicate

ANS: D During their interactions, cells must communicate with each other through soluble cytokines. The other options are not so rigidly related to cytokines.

8. A student asks why some vaccinations are given orally and some are given by injection. What response by the professor is best? a. Different routes allow the speed of onset of the antigen to be varied, with the intravenous route being the fastest. b. Some individuals appear to be unable to respond to an antigen by a specific route, thus requiring the availability of different routes for the same antigen. c. Antigen-presenting cells are highly specialized and thus require stimulation by different routes. d. Each route stimulates a different lymphocyte-containing tissue, resulting in different types of cellular and humoral immunity.

ANS: D Each route preferentially stimulates a different set of lymphocyte-containing (lymphoid) tissues and therefore results in the induction of different types of cell-mediated or humoral immune responses. The speed of onset of the antigen, individual differences in response, and the requirement for different routes to stimulate different antigen-presenting cells are not accurate descriptions of why different routes of immunization are used.

20. What is the inflammatory effect of nitric oxide (NO)? a. Increases capillary permeability, and causes pain b. Increases neutrophil chemotaxis and platelet aggregation c. Causes smooth muscle contraction and fever d. Decreases mast cell function, and decreases platelet aggregation

ANS: D Effects of NO on inflammation include vasodilation by inducing relaxation of vascular smooth muscle, a response that is local and short-lived, and by suppressing mast cell function, as well as platelet adhesion and aggregation. NO does not increase capillary permeability and cause pain, increase neutrophil chemotaxis and platelet aggregation, or cause smooth muscle contraction and fever.

17. What is the final stage of the infectious process? a. Colonization b. Invasion c. Multiplication d. Spread

ANS: D From the perspective of the microorganisms that cause disease, the infectious process undergoes four separate stages of progression: (1) colonization, (2) invasion, (3) multiplication, and (4) spread.

13. What is the role of reverse transcriptase in HIV infection? a. Reverse transcriptase converts single-stranded DNA into double-stranded DNA. b. It is needed to produce integrase. c. It transports the RNA into the cell nucleus. d. It converts RNA into double-stranded DNA.

ANS: D HIV is a retrovirus and carries an enzyme, reverse transcriptase, which creates a double-stranded DNA version of the virus. HIV virus does not contain DNA. Reverse transcriptase does not transport the RNA into the cell nucleus.

25. Which class of immunoglobulins forms isohemagglutinins? a. IgA b. IgE c. IgG d. IgM

ANS: D Naturally occurring antibodies, called isohemagglutinins, are immunoglobulins of only the IgM class.

26. Which component of the immune system is deficient in individuals with infections caused by viruses, fungi, or yeast? a. Natural killer cells b. Macrophages c. B cells d. T cells

ANS: D Of the available options, deficiencies in T-cell immune responses are suggested when certain viruses (e.g., varicella, vaccinia, herpes, cytomegalovirus), fungi, and yeasts (e.g., Candida, Histoplasma) or certain atypical microorganisms (e.g., Pneumocystis jiroveci) cause recurrent infections.

3. Which secretion is a first line of defense against pathogen invasion that involves antibacterial and antifungal fatty acids, as well as lactic acid? a. Optic tears b. Oral saliva c. Sweat gland perspiration d. Sebaceous gland sebum

ANS: D Sebaceous glands in the skin secrete sebum that is made up of antibacterial and antifungal fatty acids and lactic acid that provide the first-line barrier against pathogen invasion. Perspiration, tears, and saliva contain an enzyme (lysozyme) that attacks the cell walls of gram-positive bacteria.

Which are mechanisms of antigenic variation? (Select all that apply.) a. Siderophoric switching b. Mutation c. Recombination d. Gene switching

B,C,D Mutation, recombination, and gene switching all are forms of antigenic variation. Siderophores are iron receptors on bacteria that assist in replication, and they have nothing to do with antigenic variation.

Which antigen is too small to initiate an immune response? a. Carrier b. Allergen c. Hapten d. Self-antigen

C A hapten is a molecule that is foreign but too small to induce an immune response alone. However, when it binds to a larger carrier molecule, it is able to induce an immune response. An allergen is an antigen that can induce an allergic response. A self-antigen is not foreign but has the three other criteria to be an immunogen.

36. What does the phagosome step result in during the process of endocytosis? a. Microorganisms are ingested. b. Microorganisms are killed and digested. c. Phagocytes recognize and adhere to bacteria. d. An intracellular phagocytic vacuole is formed.

ANS: D Small pseudopods that extend from the plasma membrane and surround the adherent microorganism, forming an intracellular phagocytic vacuole or phagosome, carry out engulfment (endocytosis). The membrane that surrounds the phagosome consists of inverted plasma membrane. After the formation of the phagosome, lysosomes converge, fuse with the phagosome, and discharge their contents, creating a phagolysosome.

Which statement is true regarding immunoglobulin A (IgA) antibodies? a. IgA-2 is predominantly found in blood. b. IgA-1 is predominantly found in the body's secretions. c. The J chain anchors together the IgA molecules. d. IgA is the most predominant immunoglobulin.

C The J chain anchors together the IgA molecules to form dimers and helps them resist degradation from enzymes. IgA-1 is found in the blood, and IgA-2 is found in the secretions of the body. IgG, not IgA, is the most predominant immunoglobulin.

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).

What is the trigger for angina pectoris? a. Atherosclerotic lesions b. Hyperlipidemia c. Myocardial necrosis d. Myocardial ischemia

ANS: D Angina pectoris is chest pain caused by myocardial ischemia. Atherosclerotic lesions make angina more likely as vessel lumens narrow in coronary artery disease. High lipid levels are a risk factor for CAD. Myocardial necrosis is death of heart tissue and would be the consequence of ischemia that was not relieved.

Which is an example of an alloimmune disease? a. Tuberculin reaction b. Graves disease c. Contact dermatitis d. Penicillin allergy

B Graves disease is a classic autoimmune, or alloimmune, disease. Tuberculin reaction is a type IV reaction. Contact dermatitis is a type I reaction. Penicillin is an allergen that induces type I hypersensitivity.

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 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.

Damaged myocardial muscle will release which enzymes? (Select all that apply.) a. Creatine phosphokinase-myocardial band (CPK-MB) b. Lactic acid dehydrogenase (LDH) c. Aspartate aminotransferase (AST) d. Cardiac troponin I (cTnI) e. Low-density lipoprotein (LDL)

a, b, d cTnI is the most specific indicator of MI. Other biomarkers released by myocardial cells include CPK-MB and LDH. AST is a liver enzyme that indicates damage to the liver cells. An increased level of LDL is a risk factor for atherosclerosis. Awarded 0.0 points out of 3.0 possible points.

Which assessment findings are a sign of atherosclerosis? (Select all that apply.) a. Xanthelasmas b. Arcus senilis c. Cardiac murmurs d Extra-rapid heart sounds e. Carotid arterial bruits

a, b, e Xanthelasmas are small fat deposits around the eyes. Arcus senilis is a yellow lipid ring around the cornea. Both of these findings suggest dyslipidemia, which is associated with atherosclerosis. Carotid arterial bruit also suggests probable atherosclerotic disease. Cardiac murmurs may indicate acute valvular insufficiency. Extra-rapid heart sounds, such as a left ventricular gallop, indicate impaired left ventricular function during an ischemic attack.

Which of the following are risk factors for hypertension? (Select all that apply.) a. Positive family history for hypertension Correct b. Asian race c. High dietary sodium intake Correct d. Glucose intolerance Correct e. Female gender

a, c, d, The risk factors for hypertension include a positive family history for hypertension, male gender, advanced age, black race, obesity, and high sodium intake. Factors also include low potassium, calcium, and magnesium intake, diabetes mellitus, labile blood pressure, cigarette smoking, and heavy alcohol consumption.

Which part of the heart is responsible for electrical impulse stimulation? a. Atrioventricular node b. Sinus node c. Bundle of His d. Right bundle branch

b. The sinus node, the pacemaker of the heart, is the site of impulse formation. The atrioventricular node is the junction of the electrical transmission between the atria and the ventricles. The impulse then travels to the bundle of His and, finally, to the right and left bundle branches. The terminal branches are the Purkinje fibers.

A person wishes to reduce the risk of developing coronary artery disease. This person has a normal lipid panel. What risk factor reduction would the healthcare professional advise for this person? a. Eating a low-fat diet b. Controlling the blood pressure c. Avoiding air pollution d. Moderate alcohol use

ANS: B Hypertension is responsible for a twofold-to-threefold increased risk of atherosclerotic cardiovascular disease. Of the listed options, controlling blood pressure would have the greatest effect in reducing the risk of developing coronary artery disease. The person's lipid panel is already normal, so eating a low-fat diet is not the priority. Air pollution and ionizing radiation are considered novel risk factors. Although people should be advised to drink in moderation, alcohol is not a significant risk factor for coronary artery disease.

An infant diagnosed with a small patent ductus arteriosus (PDA) would likely exhibit which symptom? a. Intermittent murmur b. Lack of symptoms c. Rapid decompensation d. Triad of congenital defects

ANS: B Infants with a small PDA usually remain asymptomatic. The infant may only have a murmur, but should be watched carefully in the future for worsening of the condition.

38. When a tuberculin skin test is positive, the hard center and erythema surrounding the induration are a result of which of these? (Select all that apply.) a. Histamine b. T lymphocytes c. Immune complexes d. Products of complement e. Macrophages

ANS: B,E The reaction site is infiltrated with T lymphocytes and macrophages, resulting in a clear hard center (induration) and a reddish surrounding area (erythema).

28. How many months does it take for the newborn to be sufficiently protected by antibodies produced by its own B cells? a. 1 to 2 b. 4 to 5 c. 6 to 8 d. 10 to 12

ANS: C By 6 to 8 months, the newborn should be efficiently protected by antibodies produced by its own B cells.

1. Exhaustion occurs if stress continues when which stage of the general adaptation syndrome is not successful? a. Flight or fight b. Alarm c. Adaptation d. Arousal

ANS: C Exhaustion occurs if stress continues and adaptation is not successful, ultimately causing impairment of the immune response, heart failure, and kidney failure, leading to death. The other stages occur before the adaptation stage.

30. What is the role of fibroblasts during the reconstructive phase of wound healing? a. Generate new capillaries from vascular endothelial cells around the wound. b. Establish connections between neighboring cells and contract their fibers. c. Synthesize and secrete collagen and the connective tissue proteins. d. Provide enzymes that débride the wound bed of dead cells.

ANS: C Fibroblasts are the most important cells during the reconstructive phase of wound healing because they synthesize and secrete collagen and other connective tissue proteins. Macrophage-derived transforming growth factor-beta (TGF-ß) stimulates fibroblasts. Fibroblasts do not generate new capillaries, establish connections between neighboring cells, or provide enzymes to debride the wound bed.

16. What are the signs that a patient is in the adaptive stage of the general adaptation syndrome? a. He or she begins to experience elevated heart and respiratory rates. b. He or she finds it difficult to concentrate on a solution for the stress. c. The patient perceives his or her only options are to run away or fight back. d. The patient has exceeded his or her ability to cope with the current situation.

ANS: C Fight-or-flight behaviors are characteristic of the more advanced adaptive stage, whereas the remaining options are noted in the initial alarm stage and are mediated by the sympathetic nervous system.

35. Fusion is the step of phagocytosis during which what happens? a. Microorganisms are killed and digested. b. An intracellular phagocytic vacuole is formed. c. Lysosomal granules enter the phagocyte. d. Microorganisms are ingested.

ANS: C Fusion occurs with lysosomal granules entering the phagocyte (phagolysosome). Fusion does not include killing and digesting microorganisms, forming vacuoles, or ingesting microorganisms.

31. What is Graves disease a result of? a. Increased levels of circulating immunoglobulins b. The infiltration of the thyroid with T lymphocytes c. Autoantibodies binding to thyroid-stimulating hormone (TSH)-receptor sites d. Exposure to acetylates in substances such as rubber

ANS: C In the hyperthyroidism (excessive thyroid activity) of Graves disease, autoantibody binds to and activates receptors for TSH (a pituitary hormone that controls the production of the hormone thyroxine by the thyroid). Graves disease is not caused by increased levels of circulating immunoglobulins, infiltration of the thyroid by T lymphocytes, or by exposure to acetylates.

5. Once they have penetrated the first line of defense, which microorganisms do natural killer (NK) cells actively attack? a. Bacteria b. Fungi c. Viruses d. Mycoplasma

ANS: C NK cells are the principal defenders against only tumor cells or virally infected cells.

Which condition is a complication of hypertension? a. Cardiovascular muscle atrophy b. Hypoglycemia c. Congestive heart failure d. Neuropathy

c. Cardiovascular complications include left ventricular hypertrophy, angina pectoris, congestive heart failure (left heart failure), coronary artery disease, myocardial infarction (MI), and sudden death.

A child has been noted to have hypertension with decreased pulses in the lower extremities. What is the most likely congenital cause for this finding? a. Tricuspid atresia b. Atrial septal defect c. Pulmonary stenosis d. Coarctation of the aorta

d. Coarctation of the aorta is a narrowing of the lumen of the aorta that impedes blood flow. Children may have cool, mottled skin and occasionally leg cramps during exercise. A systolic ejection murmur, heard best at the left interscapular area, is caused by rapid blood flow through the narrowed area, which is often found with hypertension. Children with pulmonary stenosis may have a systolic ejection murmur and possibly exertional dyspnea and fatigability. Atrial septal defects have a murmur. Cyanosis, growth failure, and dyspnea may occur with tricuspid atresia.

Which term describes an acidic sulfur-containing lipid that produces effects similar to histamine? a. Leukotriene b. Prostaglandin c. Adhesion molecule d. Phagocyte

A 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.

What antibody binds to a mast cell? a. Cytotropic b. Allergen c. Antigen d. Fc

A A cytotropic antibody (also called a reagin) is the antibody that binds to the mast cell. An allergen is an environmental antigen that induces an allergic response. An antigen stimulates the immune response and antibody to bind to the mast cell. The Fc is the portion of the mast cell where IgE binds.

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 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.

Which complement factor is considered an anaphylatoxin? a.C3a b. C1 c.C7 d.C9

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

Which statement is true of serum sickness? a. Immune complexes are formed and deposited in target issues. b. Immune complexes are formed and deposited in the blood vessels. c. It is considered a Type II hypersensivity response. d. Cytotoxic T lymphocytes are responsible for the condition.

A Serum sickness reactions are caused by the formation of immune complexes in the blood and their deposition in target tissues. An Arthus reaction deposits complexes into the walls of blood vessels. Serum sickness is a Type III hypersensitivity reaction. Type IV mechanisms occur through either cytotoxic T lymphocytes or lymphokine-producing T-helper (Th) 1 cells.

Which term describes the type of immunity that occurs when preformed antibodies are transferred from a donor to a recipient? a. Passive b. Active c. Memory d. Cellular

A The two types of adaptive immunity are active and passive. Passive immunity occurs when preformed antibodies are transferred from a donor to a recipient. An example of passive immunity is the passage of maternal antibodies across the placenta to the fetus. Active immunity is produced by an individual after either a natural exposure or an immunization. Memory cells are formed through cellular and humoral immunity; they remember the antigen.

Which mechanisms are used by viruses to evade the immune response? (Select all that apply.) a. Rapid division b. Antigenic specificity c. Self-protein coat d. Immune suppression e. Lipopolysaccharide

A, D Viruses have developed a number of ways to evade the immune system, including rapid division, the ability to survive inside a host cell, coating the viral capsid with self-antigens from the host cell, antigenic variation, neutralization of immune complexes, complement evasion, immune suppression, and tissue damage.

Which functions of the clotting system are exhibited at the site of injury or inflammation? (Select all that apply.) a. Prevents the spread of infection to adjacent tissues b. Traps microorganisms at the site of inflammation for removal c. Prevents clot formation at the site of injury d. Provides a framework for future repair and healing

A,B,D The clotting system exhibits the following functions: (1) prevents the spread of infection to adjacent tissues; (2) traps microorganisms and foreign bodies at the site of inflammation for removal by infiltrating cells such as neutrophils and macrophages; (3) forms a clot that stops bleeding; and (4) provides a framework for future repair and healing.

Histamine release leads to which of the following? (Select all that apply.) a. Bronchial smooth muscle contraction b. Bronchoconstriction c. Decreased vascular permeability d. Vasoconstriction e. Edema

A,B,E Histamine contracts bronchial smooth muscle, which causes bronchoconstriction. Vascular permeability, edema, and vasodilation also increase.

21. Which statement is believed to be true concerning Th2 cells? a. Th2 cells are induced by antigens derived from allergens. b. They are induced by antigens derived from cancer cells. c. Th2 cells produce IL-2, TNF-ß, and IFN-γ. d. They assist in the development of cell-mediated immunity.

ANS: A Antigens derived from multicellular parasites and allergens are hypothesized to be involved in the production of more Th2 cells. Th1 cells are induced by antigens derived from cancer cells. Th2 cells produce IL-4, IL-5, IL-6, and IL-13.

What is an expected change in the cardiovascular system that occurs with aging? a. Arterial stiffening b. Decreased left ventricular wall tension c. Decreased aortic wall thickness d. Arteriosclerosis

ANS: A Arterial stiffening occurs with aging even in the absence of clinical hypertension. Aging is not responsible for the other conditions.

24. The healthcare professional working with older adults teaches general infection-prevention measures as a priority for this age group due to which change in lymphocyte function? a. Increased production of antibodies against self-antigens b. Decreased number of circulating T cells c. Decreased production of autoantibodies d. Increased production of helper T cells

ANS: A B-cell function is altered with age as shown by decreases in specific antibody production in response to antigenic challenge, with concomitant increases in circulating immune complexes and in circulating autoantibodies (antibodies against self-antigens). Aging does not play a role in either decreasing T cells circulation or increasing helper T cells production.

35. A person with type O blood is considered to be the universal blood donor because type O blood contains which of these? a. No antigens b. No antibodies c. Both A and B antigens d. Both A and B antibodies

ANS: A Because individuals with type O blood lack both types of antigens, they are considered universal donors, meaning that anyone can accept their red blood cells. Type O individuals, who have neither A or B antigen but have both anti-A and anti-B antibodies, cannot accept blood from any of the other three types.

39. Which cell is the body's primary defense against parasite invasion? a. Eosinophil b. Neutrophils c. T lymphocytes d. B lymphocytes

ANS: A Eosinophils serve as the body's primary defense against parasites. T lymphocytes and B lymphocytes are involved in acquired immunity. Neutrophils are the predominant phagocytes in the early inflammatory site.

9. Considering the hypothalamus, what is a fever produced by? a. Endogenous pyrogens acting directly on the hypothalamus b. Exogenous pyrogens acting directly on the hypothalamus c. Immune complexes acting indirectly on the hypothalamus d. Cytokines acting indirectly on the hypothalamus

ANS: A Exogenous pyrogens indirectly affect the hypothalamus through the release of endogenous pyrogens by cells of the host, however; a number of cytokines have been identified as endogenous pyrogens and these act directly on the hypothalamus. Neither immune complexes nor cytokines are involved in the process.

28. The acute inflammatory response is characterized by fever that is produced by the hypothalamus being affected by what? a. Endogenous pyrogens b. Bacterial endotoxin c. Antigen-antibody complexes d. Exogenous pyrogens

ANS: A Fever-causing cytokines are known as endogenous pyrogens. These pyrogens act directly on the hypothalamus, which is the portion of the brain that controls the body's thermostat. The hypothalamus is not directly affected by bacterial endotoxins, antigen-antibody complexes, or exogenous pyrogens.

34. Which statement is true regarding immunodeficiency? a. Immunodeficiency is generally not present in other family members. b. Immunodeficiency is never acquired; rather, it is congenital. c. Immunodeficiency is almost immediately symptomatic. d. Immunodeficiency is a result of a postnatal mutation.

ANS: A Generally, the genetic mutations that cause immunodeficiency are sporadic and not inherited; a family history exists in only approximately 25% of individuals. The sporadic mutations occur before birth, but the onset of symptoms may be early or later, depending on the particular syndrome. The immunodeficiency can be either congenital or acquired.

15. The generation of clonal diversity occurs primarily during which phase of life? a. Fetal b. Neonatal c. Infancy d. Puberty

ANS: A Generation of clonal diversity primarily occurs in the fetus and probably continues to a low degree throughout most of adult life

16. What area in the body may act as a reservoir in which HIV can be relatively protected from antiviral drugs? a. Central nervous system b. Bone marrow c. Thymus gland d. Lungs

ANS: A HIV may persist in regions where the antiviral drugs are not as effective, such as the central nervous system (CNS). The bone marrow, thymus gland, and lungs are not as protected from antiviral drugs.

7. A patient is having an IgE-mediated hypersensitivity reaction. What action by the healthcare professional is best? a. Give the patient an antihistamine. b. Prepare to give the patient a blood transfusion. c. Ask the patient is he/she is having pain at the site. d. Apply warm, moist heat to the affected area.

ANS: A Histamine is the most potent mediator in an IgE-mediated hypersensitivity reaction (Type 1). Histamine bound to H2 results in the degranulation of mast cells with the release of histamine. Blocking histamine receptors with antihistamines can control some type I responses. The healthcare professional would not need to give the patient blood; warm; moist heat; or ask about pain.

36. Immunoglobulin E (IgE) is associated with which type of hypersensitivity reaction? a. I b. II c. III d. IV

ANS: A Hypersensitivity reactions have been divided into four distinct types: type I (IgE-mediated) hypersensitivity reactions, type II (tissue-specific) hypersensitivity reactions, type III (immune complex-mediated) hypersensitivity reactions, and type IV (cell-mediated) hypersensitivity reactions.

Occlusion of the left anterior descending artery during a myocardial infarction would interrupt blood supply to which structures? a. Left and right ventricles and much of the interventricular septum b. Left atrium and the lateral wall of the left ventricle c. Upper right ventricle, right marginal branch, and right ventricle to the apex d. Posterior interventricular sulcus and the smaller branches of both ventricles

ANS: A The left anterior descending artery (LAD), also called the anterior interventricular artery, delivers blood to portions of the left and right ventricles and much of the interventricular septum. The circumflex artery supplies the left atrium and lateral wall of the left ventricle. The right coronary artery supplies the right ventricle and one of its branches is the right marginal branch. The interventricular sulcus and smaller branches of both ventricles are also supplied by the right coronary artery.

3. What is the term for the process during which lymphoid stem cells migrate and change into either immunocompetent T cells or immunocompetent B cells? a. Clonal diversity b. Clonal differentiation c. Clonal selection d. Clonal competence

ANS: A The process is called the generation of clonal diversity and occurs in specialized (primary) lymphoid organs—the thymus gland for T cells and the bone marrow for B cells. Clonal differentiation, selection, and competence do not describe this process.

22. A patient asks the healthcare professional why tissue damage occurs in acute rejection after organ transplantation. What response by the professional is best? a. Th1 cells release cytokines that activate infiltrating macrophages, and cytotoxic T cells directly attack the endothelial cells of the transplanted tissue. b. Circulating immune complexes are deposited in the endothelial cells of transplanted tissue, where the complement cascade lyses tissue. c. Receptors on natural killer cells recognize antigens on the cell surface of transplanted tissue, which releases lysosomal enzymes that destroy tissue. d. Antibodies coat the surface of transplanted tissue to which mast cells bind and liberate preformed chemical mediators that destroy tissue.

ANS: A The recipient's lymphocytes interacting with the donor's dendritic cells within the transplanted tissue usually initiate sensitization, resulting in the induction of recipient Th1 and Tc cells against the donor's antigens. The Th1 cells release cytokines that activate infiltrating macrophages, and the Tc cells directly attack the endothelial cells in the transplanted tissue. The other options do not accurately describe how acute rejection after organ transplantation results in tissue damage.

4. Which hormone prompts increased anxiety, vigilance, and arousal during a stress response? a. Norepinephrine b. Epinephrine c. Cortisol d. Adrenocorticotropic hormone (ACTH)

ANS: A The release of norepinephrine promotes arousal, increased vigilance, increased anxiety, and other protective emotional responses. Epinephrine's effects are primarily on the cardiovascular system. Cortisol's chief effects involve metabolic processes. By inhibiting the use of metabolic substances while promoting their formation, cortisol mobilizes glucose, amino acids, lipids, and fatty acids and delivers them to the bloodstream. ACTH binds with specific receptors on the adrenal glands which causes the release of the glucocorticoids.

27. A child in the clinic has an absence of a parathyroid gland, structural heart defects, and a shortened structure of the upper lip. What immune dysfunction does the healthcare professional suspect? a. Partial-to-complete absence of T-cell immunity b. X-linked recessive microcephaly c. An autoimmune disease like systemic lupus erythematosus d. Adenosine deaminase deficiency

ANS: A This child has the clinical features of DiGeorge disease, which is caused by a partial-to-complete absence of T-cell immunity.

32. Which statement is true regarding maternal antibodies provided to the neonate? a. The antibodies enter into the fetal circulation by means of active transport. b. The antibodies are transferred to the fetus via the lymphatic system. c. The antibodies are directly related to the mother's nutritional intake. d. The antibodies reach protective levels after approximately 6 months of age.

ANS: A To protect the child against infectious agents both in utero and during the first few postnatal months, a system of active transport facilitates the passage of maternal antibodies into the fetal circulation. The antibodies are transmitted via the placenta and are related to the mother's immune system. The infant's own IgG-related antibodies reach protective levels by 6 months of age. The antibodies are not transferred via the lymphatic system, are not directly related to maternal nutrition, or reach protective levels after 6 months of age.

28. Which statement is true concerning IgM? a. IgM is the first antibody produced during the initial response to an antigen. b. IgM mediates many common allergic responses. c. IgM is the most abundant class of immunoglobulins. d. IgM is capable of crossing the human placenta.

ANS: A Typically, IgM is produced first (primary immune response), followed by IgG against the same antigen. IgE mediates allergic responses and is active in the defense against parasitic infections. IgG is the most abundant immunoglobulin class and can cross the human placenta to enter into fetal circulation.

An infant has a crescendo-decrescendo systolic ejection murmur located between the second and third intercostal spaces along the left sternal border. The healthcare professional suspects an atrial septal defect (ASD). For what other manifestation does the healthcare professional assess to confirm the suspicion? a. Wide, fixed splitting of the second heart sound b. Loud, harsh holosystolic murmur c. Cyanosis with crying and feeding d. Rapid deterioration with acidosis ANS: A A wide fixed splitting of the second heart sound is also characteristic of ASD, reflecting volume overload to the RV, causing prolonged ejection time and delay of pulmonic valve closure. A loud, harsh holosystolic murmur is consistent with a ventricular septal defect. Cyanosis with crying and feeding (exertion) are classic "tet spells" associated with Tetralogy of Fallot. Rapid deterioration with acidosis, hypotension, and shock can accompany coarctation of the aorta.

ANS: A A wide fixed splitting of the second heart sound is also characteristic of ASD, reflecting volume overload to the RV, causing prolonged ejection time and delay of pulmonic valve closure. A loud, harsh holosystolic murmur is consistent with a ventricular septal defect. Cyanosis with crying and feeding (exertion) are classic "tet spells" associated with Tetralogy of Fallot. Rapid deterioration with acidosis, hypotension, and shock can accompany coarctation of the aorta.

Which factor can trigger an immune response in the bloodstream that may result in an embolus? a. Amniotic fluid b. Fat c. Bacteria d. Air

ANS: A Amniotic fluid displaces blood, thereby reducing oxygen, nutrients, and waste exchange; however, it also introduces antigens, cells, and protein aggregates that trigger inflammation, coagulation, and the immune response in the bloodstream. Fat, bacteria, and air emboli do not trigger an immune response.

How does angiotensin II increase the workload of the heart after a myocardial infarction (MI)? a. By increasing the peripheral vasoconstriction b. By causing dysrhythmias as a result of hyperkalemia c. By reducing the contractility of the myocardium d. By stimulating the sympathetic nervous system

ANS: A Angiotensin II is released during myocardial ischemia and contributes to the pathogenesis of a myocardial infarction (MI) in several ways, including causing peripheral vasoconstriction and fluid retention. These homeostatic responses increase myocardial work and thus exacerbate the effects of the loss of myocyte contractility. Angiotensin II does not cause hyperkalemia and dysrhythmias; it does not reduce cardiac contractility, and it does not stimulate the SNS.

A healthcare professional is caring for four patients. Which patient does the professional assess for pulmonary emboli (PE) as the priority? a. Deep venous thrombosis b. Endocarditis c. Valvular disease d. Left heart failure

ANS: A Pulmonary emboli originate in the venous circulation (mostly from the deep veins of the legs) or in the right heart. While any patient can develop a PE, the patients with endocarditis, valvular disease, and left heart failure do not have as big a risk as the patient with the deep vein thrombosis.

A patient is diagnosed with chronic obstructive pulmonary disease (COPD) and has elevated pulmonary vascular resistance. Which complication would the health care professional assess the patient for? a. Right heart failure b. Left heart failure c. Restrictive cardiomyopathy d. Hypertrophic cardiomyopathy

ANS: A Right heart failure is most often caused by left heart failure, but if it occurs in isolation it is usually due to pulmonary conditions such as pulmonary hypertension, COPD, or cystic fibrosis. The professional would assess the patient for this condition at healthcare visits. Eventually the left side of the heart will fail if right-sided failure is left untre

40. Which disorders are considered autoimmune? (Select all that apply.) a. Crohn disease b. Addison disease c. Rheumatoid arthritis d. Systemic lupus erythematosus e. Type 2 diabetes

ANS: A, B, C, D Crohn disease, Addison disease, rheumatoid arthritis, and systemic lupus erythematosus are all diseases that result from autoimmune pathologic conditions. Insulin-dependent diabetes is also an autoimmune disorder, but type 2 diabetes is not.

CD4 is a characteristic surface marker and a result of which of these? (Select all that apply.) a. Activity in the primary lymphoid organs b. Process of cellular differentiation c. Alterations to T cells d. Changes to B cells e. Clonal selection

ANS: A, B, C, D Differentiation of B cells and T cells in the primary lymphoid organs results in the expression of several characteristic surface markers, such as CD4 on helper T cells, CD8 on cytotoxic T cells, and CD21 and CD40 on B cells. Clonal selection is the process during which antigens select those lymphocytes with complementary T-cell receptors (TCRs) or BCRs.

Which statements related to the ambulatory blood pressure monitoring (ABPM) system with children are true? (Select all that apply.) a. ABPM monitors blood pressure for a 24-hour period. b. ABPM assists in identifying children with white coat hypertension. c. ABPM is effective in identifying children at risk for target organ damage. d. ABPM assists in identifying children who demonstrate masked hypertension. e. ABPM is effective in determining blood pressure load for 48 hours.

ANS: A, B, C, D ABPM records blood pressure over a 24-hour period to help identify those children with white coat hypertension and masked hypertension. ABPM is useful in documenting the blood pressure load, which is the total amount of time the blood pressure is elevated above normal limits during a 24-hour period. By measuring blood pressure load, the ABPM may be able to identify those children who are at greatest risk for target organ damage.

What factors contribute to the development of orthostatic hypotension? (Select all that apply.) a. Altered body chemistry b. Drug action of certain antihypertensive agents c. Prolonged immobility d. Effects of aging on postural reflexes e. Any condition that produces volume overload

ANS: A, B, C, D Orthostatic hypotension may be acute or chronic. Acute orthostatic hypotension (temporary type) may result from (1) altered body chemistry, (2) drug action (e.g., antihypertensives, antidepressants), (3) prolonged immobility caused by illness, (4) starvation, (5) physical exhaustion, (6) any condition that produces volume depletion (e.g., massive diuresis, potassium or sodium depletion), and (7) venous pooling (e.g., pregnancy, extensive varicosities of the lower extremities). Older adults are susceptible to this type of orthostatic hypotension, in which postural reflexes are slowed as part of the aging process. Volume overload would not produce orthostatic hypotension.

Which information regarding fatty streaks does the pathophysiology student learn? (Select all that apply.) a. Fatty streaks progressively damage vessel walls. b. Fatty streaks are capable of producing toxic oxygen radials. c. When present, inflammatory changes occur to the vessel walls. d. Oxidized low-density lipoproteins (LDLs) are involved in their formation. e. Fatty streaks are formed by killer T cells filled with oxidized LDLs.

ANS: A, B, C, D The oxidized LDLs penetrate the intima of the arterial wall and are engulfed by macrophages. Macrophages filled with oxidized LDLs are called foam. Once these lipid-laden foam cells accumulate in significant amounts, they form a lesion called a fatty streak. Once formed, fatty streaks produce more toxic oxygen radicals and cause immunologic and inflammatory changes, resulting in progressive damage to the vessel wall. They are not formed by killer T cells

45. Examples of pathogens capable of surviving and even multiplying inside a macrophage include what? (Select all that apply.) a. Mycobacterium tuberculosis (tuberculosis) b. Mycobacterium leprae (leprosy) c. Salmonella typhi (typhoid fever) d. Clostridium difficile e. Brucella abortus (brucellosis)

ANS: A, B, C, E Several bacteria are resistant to killing by granulocytes and can even survive inside macrophages. Microorganisms such as M. tuberculosis (tuberculosis), M. leprae (leprosy), S. typhi (typhoid fever), B. abortus (brucellosis), and Listeria monocytogenes (listeriosis) can remain dormant or even multiply inside the phagolysosomes of macrophages. C. difficile is said to be resistant to antibiotics, making it difficult to control.

What congenital heart defects are associated with intrauterine exposure to rubella? (Select all that apply.) a. Pulmonary stenosis (PS) b. Cardiomegaly c. Patent ductus arteriosus (PDA) d. Coarctation of aorta (COA) e. Ventricular septal defect (VSD)

ANS: A, C, D PS, PDA, and COA are congenital heart defects associated with intrauterine exposure to rubella. Cardiomegaly and VSD are associated with maternal diabetes.

Which statements are true concerning the method in which substances pass between capillaries and the interstitial fluid? (Select all that apply.) a. Substances pass through junctions between endothelial cells. b. Substances pass through pores or oval windows (fenestrations). c. Substances pass between vesicles by active transport across the endothelial cell membrane. d. Substances pass across the endothelial cell membrane by osmosis. e. Substances pass through endothelial cell membranes by diffusion.

ANS: A, B, C, E Substances pass between the capillary lumen and the interstitial fluid in several ways: (1) through junctions between endothelial cells, (2) through fenestrations in endothelial cells, (3) in vesicles moved by active transport across the endothelial cell membrane, or (4) by diffusion through the endothelial cell membrane.

Which symptoms meet the diagnostic criteria for Kawasaki disease in a child? (Select all that apply.) a. Fever for 5 days or longer b. "Strawberry tongue" c. Peripheral edema d. Inguinal lymphadenopathy e. Bilateral conjunctival infection

ANS: A, B, C, E The child must exhibit five of these six criteria: (1) fever for 5 days or longer, (2) bilateral conjunctival infection without exudation, (3) changes in oral mucus such as strawberry tongue, (4) a polymorphous rash, (5) cervical lymphadenopathy, and (6) changes in the extremities such as peripheral edema.

21. Which statements are true regarding lymphocytes? (Select all that apply.) a. Lymphocytes are involved in the production of the human growth hormone. b. Elevated catecholamine levels influence lymphocytes. c. Lymphocytes are synthesized in the anterior pituitary gland. d. Lymphocytes have receptors for the hormone prolactin. e. Lymphocytes produce endorphins in large amounts.

ANS: A, B, D GH is synthesized from the anterior pituitary gland and is produced by lymphocytes and mononuclear phagocytic cells. Several classes of lymphocytes have receptors for prolactin, suggesting a direct effect of prolactin on immune function. Although the effects of acute elevation of catecholamines on the alteration of lymphocyte function are real, they are short-lived, lasting only approximately 2 hours. Lymphocytes are not synthesized in the anterior pituitary gland or produce endorphins in large amounts.

41. What do sebaceous glands secrete in order to protect the body from infection? (Select all that apply.) a. Antibacterial fatty acids b. Antifungal fatty acids c. Ascorbic acid d. Lactic acid e. Hydrochloric acid

ANS: A, B, D Sebaceous glands secrete only antibacterial and antifungal fatty acids and lactic acid. They do not secrete ascorbic acid (which is vitamin C) or hydrochloric acid.

A person wishes to reduce the risk of developing varicose veins. What does the health care professional advise this person? (Select all that apply.) a. Avoid standing for long periods of time. b. Maintain a healthy weight. c. Drink plenty of fluids. d. Wear compression stockings. e. Choose a job that involves sitting.

ANS: A, B, D Varicose veins result from incompetent valves, venous obstruction, muscle pump dysfunction, or a combination of these. Standing for prolonged periods of time and being overweight increase the hydrostatic pressure and lead to the characteristic remodeling of the vein. Wearing compression stockings can help by maintaining venous return from the legs. Drinking inadequate fluids is not a risk factor. Sitting for prolonged periods of time is a risk factor.

39. Exposure to which of these could result in a type IV hypersensitivity reaction? (Select all that apply.) a. Poison ivy b. Neomycin c. Dairy products d. Nickel e. Detergents

ANS: A, B, D, E Allergens that primarily elicit type IV allergic hypersensitivities include plant resins (e.g., poison ivy, poison oak); metals (e.g., nickel, chromium); acetylates and chemicals in rubber, cosmetics, detergents; and topical antibiotics (e.g., neomycin). Food products typically result in type I hypersensitivity reactions.

Which statements are true regarding endotoxins? (Select all that apply.) a. Endotoxins are lipopolysaccharides. b. Endotoxins are located in the walls of bacteria. c. Endotoxins are created during the process of lysis. d. Endotoxins are found in gram-negative microorganisms. e. Endotoxins are released during the destruction of its host.

ANS: A, B, D, E Endotoxins are lipopolysaccharides (LPSs) contained in the cell walls of gram-negative bacteria and released during lysis (or destruction) of the bacteria.

24. Which infections are fungal? (Select all that apply.) a. Ringworm b. Candida c. Cholera d. Athlete's foot e. Aspergillus

ANS: A, B, D, E Infection with a fungus is called mycosis and includes dermatophytes (e.g., tineas, which refers to several skin mycoses including ringworm, athlete's foot, and others) or yeasts (e.g., Candida, Aspergillus, Cryptococcus). Cholera is a bacterial infection.

28. Which of these play a role in the control of fungal infections? (Select all that apply.) a. Cytokines b. Macrophages c. Natural killer cells d. Neutrophils e. T lymphocytes

ANS: A, B, D, E The host defense against fungal infection includes the fungistatic properties of neutrophils and macrophages. T lymphocytes are crucial in limiting the extent of infection and producing cytokines to further activate macrophages. Natural killer cells are a component of innate immune system.

46. An older adult is particularly susceptible to infections of which body parts? (Select all that apply.) a. Lungs b. Skin c. Liver d. Eyes e. Bladder

ANS: A, B, E Older adults have increased susceptibility to bacterial infections of the lungs, urinary tract, and skin. Other infections may occur but on an individualized basis.

43. What do the main functions of NK cells include? (Select all that apply.) a. Recognizing virus-infected cells b. Eliminating virus-infected cells c. Recognizing bacteria-infected cells d. Eliminating bacteria-infected cells e. Eliminating previously identified cancer cells

ANS: A, B, E The main functions of NK cells are recognizing and eliminating cells infected with viruses, not bacteria. They are also somewhat effective at eliminating other abnormal host cells, specifically cancer cells.

29. Which are complications of AIDS? (Select all that apply.) a. Kaposi sarcoma b. Helicobacter pylori c. Cytomegalovirus retinitis d. Herpes simplex infection e. Legionella pneumophila

ANS: A, C, D Kaposi sarcoma, cytomegalovirus retinitis, and herpes simplex infection are clinical complications characteristically observed in patients with AIDS. Neither Helicobacter pylori nor Legionella pneumophila are considered classic AIDS opportunistic diseases.

42. Which body fluids have the ability to attack the cell walls of gram-positive bacteria? (Select all that apply.) a. Perspiration b. Semen c. Tears d. Saliva e. Urine

ANS: A, C, D Only perspiration, tears, and saliva contain an enzyme (lysozyme) that attacks the cell walls of gram-positive bacteria.

41. Which statements best define acute rejection? (Select all that apply.) a. Acute rejection is a cell-mediated immune response. b. Acute rejection is usually a type III rejection. c. Immunosuppressive drugs delay or lessen the intensity of an acute rejection. d. Acute rejection is associated with the body's response to an organ transplant. e. Acute rejection is a response against unmatched human leukocyte antigens (HLAs).

ANS: A, C, D, E Acute rejection is primarily a cell-mediated immune response that occurs within days to months after transplantation. This type of rejection occurs when the recipient develops an immune response against unmatched HLAs after transplantation. A biopsy of the rejected organ usually shows an infiltration of lymphocytes and macrophages characteristic of a type IV reaction. Immunosuppressive drugs may delay or lessen the intensity of an acute rejection.

What are the necessary components of an adaptive immune response? (Select all that apply.) a. Antigen b. Gamma IgG c. Lymphocyte surface receptors d. Crystalline fragment e. Antibody

ANS: A, C, E Antigens are the molecules that can react with components of the adaptive immune system, including antibodies and lymphocyte surface receptors. Gamma IgG and crystalline fragment are not necessary components of an adaptive immune response.

22. Which cytokines initiate the production of corticotropin-releasing hormone (CRH)? (Select all that apply.) a. IL-1 b. IL-6 c. TNF-ß d. IFN e. IL-12

ANS: A,B Although a number of stress factors initiate the production of CRH, of the options available, only high levels of IL-1 and IL-6 initiate such a response.

23. Which secretions transmit HIV? (Select all that apply.) a. Semen b. Urine c. Saliva d. Breast milk e. Sweat

ANS: A,D HIV is a blood-borne pathogen present in specific body fluids (e.g., blood, vaginal fluid, semen, breast milk).

19. The effect epinephrine has on the immune system during the stress response is to increase which cells? (Select all that apply.) a. NK cells b. Immunoglobulins c. Cytokines d. T cells e. Th cells

ANS: A,D The injection of epinephrine into healthy human beings is associated with a transient increase of the number of lymphocytes (e.g., T cells, natural killer (NK) cells) in the peripheral blood. This association is not true of the other options.

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.

What is the initiating event that leads to the development of atherosclerosis? a. Release of the inflammatory cytokines b. Macrophages adhere to vessel walls. c. Injury to the endothelial cells that line the artery walls d. Release of the platelet-deprived growth factor

ANS: Atherosclerosis begins with an injury to the endothelial cells that line the arterial walls. Possible causes of endothelial injury include the common risk factors for atherosclerosis, such as smoking, hypertension, diabetes, increased levels of low-density lipoprotein (LDL), decreased levels of high-density lipoprotein (HDL), and autoimmunity. The remaining options occur only after the endothelial cells are injured.

7. What does activation of the classical pathway begin with? a. Viruses b. Antigen-antibody complexes c. Mast cells d. Macrophages

ANS: B Activation of the classical pathway begins only with the activation of protein C1 and is preceded by the formation of a complex between an antigen and an antibody to form an antigen-antibody complex (immune complex). Infection with a virus can lead to the start of the inflammatory process, but is not the specific activation factor. Mast cells release the contents of their granules to initiate synthesis of other mediators of inflammation among other actions. Macrophages are one cell type involved in phagocytosis.

20. An Rh-negative woman gave birth to an Rh-positive baby. When discussing Rho[D] immunoglobulin with her, what information should the healthcare professional provide? a. It provides protection against infection from poor immunity in the baby. b. It prevents alloimmunity and hemolytic anemia of the newborn. c. It provides necessary antibodies in case the mother doesn't breastfeed. d. It causes the intestinal tract of the newborn to produce antibodies.

ANS: B Alloimmunity occurs when an individual's immune system reacts against antigens on the tissues of other members of the same species. This can occur when a woman is Rh-negative and gives birth to an Rh-positive baby, leading to hemolytic anemia of the newborn. Rho[D] immunoglobulin does not provide protection against infection, provide antibodies to a bottle-fed baby, or cause the intestine to produce antibodies.

4. Which type of immunity is produced by an individual after either natural exposure to the antigen or after immunization against the antigen? a. Passive-acquired immunity b. Active-acquired immunity c. Passive-innate immunity d. Active-innate immunity

ANS: B An individual produces active-acquired immunity (active immunity) after natural exposure to an antigen or after immunization, whereas passive-acquired immunity (passive immunity) does not involve the host's immune response at all. The innate immune system, also known as nonspecific immune system and the first line of defense, is composed of the cells and mechanisms that defend the host from infection by other organisms in a nonspecific manner, which means that the cells of the innate system recognize and respond to pathogens in a generic way.

14. Which statement is true concerning the differences between stress-induced hormonal alterations of men and women? a. After injury, women produce more proinflammatory cytokines than men, a profile that is associated with poor outcomes. b. Androgens appear to induce a greater degree of immune cell apoptosis after injury, creating greater immunosuppression in injured men than in injured women. c. Psychologic stress associated with some types of competition decreases both testosterone and cortisol, especially in athletes older than 45 years of age. d. After stressful stimuli, estrogen is increased in women, but testosterone is decreased in men.

ANS: B Androgens appear to induce a greater degree of immune cell apoptosis after injury, a mechanism that may elicit a greater immunosuppression in injured men vs. injured women. Men produce more proinflammatory cytokines. Competitive stress increases testosterone and cortisol. Estrogen is not increased in women after stressful stimuli.

15. Type III hypersensitivity reactions are a result of which of these? a. Antibodies coating mast cells by binding to receptors that signal its degranulation, followed by the discharge of preformed mediators b. Antibodies binding to soluble antigens that were released into body fluids and the immune complexes being deposited in the tissues c. Tc cells or lymphokine-producing Th1 cells directly attacking and destroying cellular targets d. Antibodies binding to the antigen on the cell surface

ANS: B Antigen-antibody (immune) complexes that are formed in the circulation and then deposited later in vessel walls or extravascular tissues cause most type III hypersensitivity diseases. Type III hypersensitivity reactions are not the result of antibodies coating mast cells to signal their degranulation, immune cells directly attacking and destroying targets, or antibodies binding to the antigen on the cell surface.

20. Which statement is believed to be true concerning Th1 cells? a. Th1 cells are induced by antigens derived from allergens. b. They are induced by antigens derived from cancer cells. c. Th1 cells produce IL-4, IL-5, IL-6, and IL-13. d. They assist in the development of humoral immunity.

ANS: B Antigens derived from viral or bacterial pathogens and those derived from cancer cells are hypothesized to induce a greater number of Th1 cells relative to Th2 cells. The other statements are not true regarding Th1 cells.

The healthcare professional explains to a student that the amount of volume of blood in the heart is directly related to the _____ of contraction. a. Pressure b. Strength c. Viscosity d. Speed

ANS: B As stated in the Frank-Starling law, the volume of blood in the heart at the end of diastole (the length of its muscle fibers) is directly related to the force (strength) of contraction during the next systole. This selection is the only option that accurately describes the relationship associated with the Frank-Starling law.

27. Evaluation of umbilical cord blood can confirm that which immunoglobulin level is near adult levels? a. IgA b. IgG c. IgM d. IgE

ANS: B At birth, the total IgG level in the umbilical cord is the only immunoglobulin that is near adult levels. This is due to a system of active transport that facilitates the passage of maternal antibodies into the fetal circulation. The other antibodies are not present at this level in the newborn.

33. Which statement is true concerning an atopic individual? a. They tend to produce less IgE. b. They tend to produce more Fc receptors. c. They tend to attract very few mast cells. d. They tend to produce very high levels of IgM.

ANS: B Atopic individuals tend to produce higher quantities of IgE and have more Fc receptors for IgE on their mast cells. Atopic individuals tend to produce more, not less, IgE. Manifestations these individuals display are influenced greatly by the release of histamine from mast cells, which are found in large numbers in the affected tissue. An IgM response is a mainstay of type II responses.

What can shorten the conduction time of action potential through the atrioventricular (AV) node? a. Parasympathetic nervous system b. Catecholamines c. Vagal stimulation d. Sinoatrial node (SA)

ANS: B Catecholamines speed the heart rate, shorten the conduction time through the AV node, and increase the rhythmicity of the AV pacemaker fibers. The vagal nerve is part of the sympathetic nervous system and stimulation will decrease heart rate. The SA node is responsible for generating the electrical activity of the heart, but is not responsible for the time it takes for it to travel through the AV node.

6. A student asks the healthcare professional how immunity is decreased by stress. The professional responds that during a stress response, the helper T (Th) 1 response is suppressed by which hormone? a. ACTH b. Cortisol c. Prolactin d. Growth hormone

ANS: B Cortisol acts to suppress the activity of Th1 cells, which leads to a decrease in innate immunity and the proinflammatory response. Cortisol also stimulates the activity of Th2 cells, which increases adaptive immunity and the antiinflammatory response. ACTH binds with specific receptors on the adrenal glands which causes the release of the glucocorticoids. Prolactin is secreted in response to a variety of stressful stimuli and acts as a second messenger for IL-2 and has a positive influence on B-cell activation and differentiation. Growth hormone affects protein, lipid, and carbohydrate metabolism; counters effects of insulin; and is involved in tissue repair.

What is the process that ensures mitral and tricuspid valve closure after the ventricles are filled with blood? a. Chordae tendineae relax, which allows the valves to close. b. Increased pressure in the ventricles pushes the valves to close. c. Trabeculae carneae contract, which pulls the valves closed. d. Reduced pressure in the atria creates a negative pressure that pulls the valves closed.

ANS: B During ventricular relaxation, the two atrioventricular valves open and blood flows from the higher pressure atria to the relaxed ventricles. With increasing ventricular pressure, these valves close and prevent backflow into the atria as the ventricles contract. The chordae tendineae attach the bottom end of the AV valves to the papillary muscles. The endocardium covers beamlike projections of muscle tissue, called trabeculae carneae. The valves are not pulled closed by reduced atrial pressure.

24. In regulating vascular mediators released from mast cells, the role of eosinophils is to release what? a. Arylsulfatase B, which stimulates the formation of B lymphocytes b. Histaminase, which limits the effects of histamine during acute inflammation c. Lysosomal enzymes, which activate mast cell degranulation during acute inflammation d. Immunoglobulin E, which defends the body against parasites

ANS: B Eosinophil lysosomes contain several enzymes that degrade vasoactive molecules, thereby controlling the vascular effects of inflammation. These enzymes include histaminase, which mediates the degradation of histamine, and arylsulfatase B, which mediates the degradation of some of the lipid-derived mediators produced by mast cells. The other options do not accurately describe the role of eosinophils.

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.

8. A severely stressed patient has cold, clammy skin. The healthcare professional quizzes the student about this effect. The student correctly answers that this effect is directly from which action? a. Epinephrine dilating blood vessels leading to the vital organs b. Norepinephrine constricting blood vessels in the skin c. Dilating the airways to increased oxygenation of the tissues d. Dysfunctional temperature regulation from cortisol secretion

ANS: B In a stress response, the actions of norepinephrine and epinephrine are complementary. While epinephrine dilates blood vessels to the vital organs (among other things), norepinephrine constricts blood vessels in the viscera and skin, providing more blood supply for those vital organs. The clinical result is cold, clammy skin. Epinephrine can also dilate airways, but this does not produce the skin changes as described. Temperature dysregulation is not the cause of the cold, clammy skin.

11. What are vaccines against viruses created from? a. Killed organisms or extracts of antigens b. Live organisms weakened to produce antigens c. Purified toxins that have been chemically detoxified d. Recombinant pathogenic protein

ANS: B Most vaccines against viral infections (e.g., measles, mumps, rubella, varicella [chickenpox], rotavirus) contain live viruses that are weakened (attenuated) to continue expressing the appropriate antigens but are unable to establish more than a limited and easily controlled infection. Vaccines against viruses do not contain extracts of antigens, purified toxins, or recombinant pathogenic proteins.

33. Many neonates have a transient depressed inflammatory response as a result of which condition? a. The circulatory system is too immature to perfuse tissues adequately. b. Complement and chemotaxis are deficient. c. Mast cells are lacking. d. The respiratory system is too immature to deliver oxygen to tissues.

ANS: B Neonates commonly have transiently depressed inflammatory and immune function partially as a result of a deficiency in components of the alternative pathway. For example, neutrophils and perhaps monocytes may not be capable of efficient chemotaxis. The circulatory system should be adequate to perfuse tissues in a normal neonate and would not contribute to decreased immunity if not. Mast cells are not lacking. The respiratory system should be adequate to oxygenate tissues, and if not, would not contribute to decreased immunity.

19. Deficiencies in which element can produce depression of both B- and T-cell function? a. Iron b. Zinc c. Iodine d. Magnesium

ANS: B Of the options available, only deficient zinc intake can profoundly depress T- and B-cell function.

18. Which cytokine is needed for the maturation of a functional helper T cell? a. IL-1 b. IL-2 c. IL-4 d. IL-12

ANS: B Of the options provided, IL-2 production is critical for the Th cell to mature efficiently into a functional helper cell.

Which is an example of an endogenous antigen? a. Yeast b. Cancer cells c. Bacteria d. Fungus

ANS: B Of the options provided, endogenous antigens include only those uniquely produced by cancerous cells.

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.

A patient has a problem with Phase 0 of the cardiac cycle. What electrolyte imbalance would the healthcare professional associate most directly with this problem? a. Hyperkalemia b. Hyponatremia c. Hypercalcemia d. Hypomagnesemia

ANS: B Phase 0 consists of depolarization and represents rapid sodium entry into the cell. A deficit of sodium could be a possible contributor. The other electrolyte disturbances would not be directly correlated to this problem.

Pressure in the left ventricle must exceed pressure in which structure before the left ventricle can eject blood? a. Superior vena cava b. Aorta c. Inferior vena cava d. Pulmonary veins

ANS: B Pressure in the ventricle must exceed aortic pressure before blood can be pumped out during systole. The aorta is the only structure in which pressure must be less than the amount of blood in the left ventricle for ejection to occur.

Reflex control of total cardiac output and total peripheral resistance is controlled by what mechanism? a. Parasympathetic stimulation of the heart, arterioles, and veins b. Sympathetic stimulation of the heart, arterioles, and veins c. Autonomic control of the heart only d. Somatic control of the heart, arterioles, and veins

ANS: B Reflex control of total cardiac output and peripheral resistance includes (1) sympathetic stimulation of the heart, arterioles, and veins; and (2) parasympathetic stimulation of the heart only. Neither autonomic nor somatic controls are involved in this process.

37. What is the major effect of a calcium channel blocker such as verapamil on cardiac contractions? a. Increases the rate of cardiac contractions b. Decreases the strength of cardiac contractions c. Stabilizes the rhythm of cardiac contractions d. Stabilizes the vasodilation during cardiac contractions

ANS: B The L-type, or long-lasting, channels are the predominant type of calcium channels and are the channels blocked by calcium channel-blocking drugs (verapamil, nifedipine, diltiazem). The major effect of these medications is to decrease the strength of cardiac contraction. These medications do not increase the rate of contractions or stabilize either rhythm of contractions or vessel response during contractions.

8. What plasma protein system forms a fibrinous meshwork at an inflamed site? a. Complement b. Coagulation c. Kinin d. Fibrinolysis

ANS: B The coagulation (clotting) system is a group of plasma proteins that form a fibrinous meshwork at an injured or inflamed site. This protein system (1) prevents the spread of infection to adjacent tissues, (2) traps microorganisms and foreign bodies at the site of inflammation for removal by infiltrating cells (e.g., neutrophils and macrophages), (3) forms a clot that stops the bleeding, and (4) provides a framework for future repair and healing. The complement system, kinins, and fibrinolysis do not form a fibrinous meshwork at an inflamed site.

Oxygenated blood flows through which vessel? a. Superior vena cava b. Pulmonary veins c. Pulmonary artery d. Coronary veins

ANS: B The four pulmonary veins, two from the right lung and two from the left lung, carry oxygenated blood from the lungs to the left side of the heart. All other veins carry deoxygenated blood. The superior vena cava returns deoxygenated blood from systemic circulation to the right atrium. The pulmonary arteries carry deoxygenated blood from the right side of the heart into the lungs.

7. A healthcare professional student is learning about fungal infections. What information should the student use to help another student understand? a. Fungal infections occur only on skin, hair, and nails. b. Phagocytes and T lymphocytes control fungal infections. c. Fungal infections release endotoxins. d. Vaccines prevent fungal infections.

ANS: B The host defense against fungal infection includes the fungistatic properties of neutrophils and macrophages. T lymphocytes are crucial in limiting the extent of infection and producing cytokines to further activate macrophages. Fungi infect other tissue types such as vaginal or gastrointestinal. Fungi do not release endotoxins; they reside in the cell walls of gram-negative bacteria. Fungal infections are not prevented by current vaccines.

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.

25. What is a role of a natural killer (NK) cells? a. Initiation of the complement cascade b. Elimination of malignant cells c. Binding tightly to antigens d. Proliferation after immunization with antigen

ANS: B The main function of NK cells is to recognize and eliminate cells infected with viruses, although they are also somewhat effective at eliminating other abnormal host cells, specifically cancer cells. The complement system is activated in one of three ways (classical, lectin, and alternative), none of which involve NK cells. Antibodies bind tightly to antigens. Immunization leads to the proliferation of antibodies.

A student asks the healthcare professional to explain the function of the papillary muscles. What response by the professional is best? a. The papillary muscles close the semilunar valves. b. These muscles prevent backward expulsion of the atrioventricular valves. c. They open the atrioventricular valves. d. The papillary muscles open the semilunar valves.

ANS: B The papillary muscles are extensions of the myocardium that pull the cusps of the AV valves together and downward at the onset of ventricular contraction, thus preventing their backward expulsion into the atria. They do not close the semilunar valves or open the AV valves or semilunar valves.

Which statement made by a student indicates the healthcare professional needs to describe the pericardium again? a. The pericardium is a double-walled membranous sac that encloses the heart. b. It is made up of connective tissue and a surface layer of squamous cells. c. The pericardium protects the heart against infection and inflammation from the lungs and pleural space. d. It contains pain and mechanoreceptors that can elicit reflex changes in blood pressure and heart rate.

ANS: B The pericardium is made up of a surface layer of mesothelium over a thin layer of connective tissue. The healthcare professional would need to re-explain if the student stated the pericardium is made up of connective tissue and a layer of squamous cells. The other statements are accurate.

27. The resting heart rate in a healthy person is primarily under the control of which nervous system? a. Sympathetic b. Parasympathetic c. Somatic d. Spinal

ANS: B The resting heart rate in healthy individuals is primarily under the control of parasympathetic stimulation.

25. How do antibodies protect the host from bacterial toxins? a. Lysing the cell membrane of the toxins b. Binding to the toxins to neutralize their biologic effects c. Inhibiting the synthesis of DNA proteins needed for growth d. Interfering with the DNA enzyme needed for replication

ANS: B To cause disease, most toxins must bind to surface molecules on the individual's cells. Protective antibodies can bind to the toxins, prevent their interaction with cells, and neutralize their biologic effects. Antibodies do not lyse the toxin cell membrane, inhibit the synthesis of DNA, or interfere with DNA replication.

18. How is toxigenicity defined? a. The ability of the pathogen to invade and multiply in the host b. The pathogen's ability to produce disease by the production of a soluble toxin c. The ability of an agent to produce disease d. The potency of a pathogen measured in terms of the number of microorganisms required to kill the host

ANS: B Toxigenicity is the ability of a pathogen to produce soluble toxins or endotoxins, which are factors that greatly influence the pathogen's degree of virulence. The other options do not accurately define toxigenicity.

12. Which antibody initially indicates a typical primary immune response? a. IgG b. IgM c. IgA d. IgE

ANS: B Typically, IgM is produced first (primary immune response), followed by IgG against the same antigen. IgA and IgE are not involved in the typical primary immune response.

1. Which primary characteristic is unique for the immune response? a. The immune response is similar each time it is activated. b. The immune response is specific to the antigen that initiates it. c. The response to a specific pathogen is short term. d. The response is innate, rather than acquired.

ANS: B Unlike inflammation, which is nonspecifically activated by cellular damage and pathogenic microorganisms, the immune response is primarily designed to afford long-term specific protection (i.e., immunity) against particular invading microorganisms; that is, it has a memory function. The inflammatory response is similar each time it is activate. Passive immunity is short term or temporary. The inflammatory process is innate.

23. Vaccinations are able to provide protection against certain microorganisms because of what? a. Strong response from IgM b. Level of protection provided by IgG c. Memory cells for IgE d. Rapid response from IgA

ANS: B Vaccinations provide protection by a secondary response when the individual is exposed to the microorganism to which he or she was vaccinated. At that time, IgG production is considerably increased, making it the predominant antibody class of the secondary response. IgM is more active against the primary exposure. IgE is usually seen in allergies. IgA is the predominant secretory antibody and prevents the attachment and invasion of pathogens through mucosal membranes.

An infant has a loud, harsh, holosystolic murmur and systolic thrill that can be detected at the left lower sternal border that radiates to the neck. These clinical findings are consistent with which congenital heart defect? a. Atrial septal defect (ASD) b. Ventricular septal defect (VSD) c. Patent ductus arteriosus (PDA) d. Atrioventricular canal (AVC) defect

ANS: B On physical examination of a child with a VSD, a loud, harsh, holosystolic murmur and systolic thrill can be detected at the left lower sternal border. An ASD is accompanied by a crescendo-decrescendo systolic ejection murmur located between the second and third intercostal spaces along the left sternal border. The PDA would present with a machine-like murmur. Physical findings in an AVC defect are similar to those found in individuals with VSDs with the addition of a holosystolic murmur radiating to the back and apex, reflecting mitral regurgitation.

A disproportionate thickening of the interventricular septum is the hallmark of which form of cardiomyopathy? a. Dystrophic b. Hypertrophic c. Restrictive d. Dilated

ANS: B Only hypertrophic obstructive cardiomyopathy is characterized by a thickening of the septal wall, which may cause outflow obstruction to the left ventricle outflow tract.

A healthcare professional is assessing a baby in the neonatal intensive care unit who is very unstable. The professional hears a systolic ejection click at the upper left sternal border with a thrill palpated at the upper left sternal border. What procedure does the professional prepare the parents for the baby to have? a. Heart transplant b. Balloon angioplasty c. Prostaglandin infusion d. High dose aspirin

ANS: B Pulmonary stenosis results in a systolic ejection murmur at the left upper sternal border, reflecting an obstruction to flow through the narrowed pulmonary valve. A variable systolic ejection click is present in some children, as well as valvular stenosis at the upper left sternal border. PS also produces a thrill that may be palpated at the upper left sternal border. Although mild cases may not need treatment, this critically ill infant needs immediate intervention with balloon angioplasty. A heart transplant might be used to treat hypoplastic left heart syndrome. Prostaglandin infusion is used to keep a patent ductus arteriosus open until surgical correction can be accomplished. Aspirin is used to treat Kawasaki disease.

Amyloidosis, hemochromatosis, or glycogen storage disease usually causes which form of cardiomyopathy? a. Infiltrative b. Restrictive c. Septal d. Hypertrophic

ANS: B Restrictive cardiomyopathy may occur idiopathically or as a cardiac manifestation of systemic diseases, such as scleroderma, amyloidosis, sarcoidosis, lymphoma, and hemochromatosis, or a number of inherited storage diseases. This characterization is not true of the other forms of cardiomyopathy.

A 9-year-old child has a blood pressure of 112/72 mmHg in the school nurse's office. What action by the school nurse is most appropriate? a. Inform the parents the child might be dehydrated. b. Note the normal finding in the child's records. c. Calculate the child's Body Mass Index. d. Refer the child for medication.

ANS: B The suggested mean blood pressure for an 8- to 9-year-old child is 106/58 mmHg. The 95th percentile mean reading is 120/82 mmHg. Hypertension in children is defined as three readings above the 95th percentile, so this child's blood pressure is well within the normal range. The school nurse would document this reading in the child's records. There is no need for the nurse to worry about dehydration, the child's body mass index, or to refer the child for medication.

A patient in the clinic reports fever, arthralgia, a rash, and nosebleeds. What other information should the healthcare professional elicit from this patient? a. Family history of Marfan's disease b. History of a recent bacterial infection c. History of any recent chest trauma d. Any illnesses in family members

ANS: B These manifestations are characteristic of rheumatic fever and usually occur 1 to 5 weeks after a streptococcal infection of the nasopharynx. The professional should inquire about recent illnesses and infections. Other family members may or may not have been sick too, so this is not the best question. These symptoms are not seen after chest trauma or with Marfan syndrome.

Which scenario describes total anomalous pulmonary venous return? a. The foramen ovale closes after birth. b. Pulmonary venous return is to the right atrium. c. Pulmonary venous return is to the left atrium. d. The left atrium receives oxygenated blood.

ANS: B Total anomalous pulmonary venous return occurs when the pulmonary veins abnormally connect to the right side of the heart either directly or through one or more systemic veins that drain into the right atrium. None of the other options accurately describe the presentation of a total anomalous pulmonary venous return.

36. Which statements are true concerning the humoral immune response? (Select all that apply.) a. The humoral immune response is divided into major and minor phases. b. The response has IgG and IgM produced during each of its phrases. c. It has a greater presence of IgG than IgM in one of its phases. d. The humoral immune response is produced in reaction to the presence of an antigen. e. Phases differ in their response time as a result of the effect of memory cells.

ANS: B, C, D, E The humoral immune response is divided into two phases, primary and secondary. These phases differ in the relative amounts of IgG produced—the secondary response having a significantly higher proportion of IgG relative to IgM. The two phases also differ in the speed with which each occurs after the antigen challenge—the secondary phases is significantly more rapid than the primary phase because of the presence of memory cells in the secondary phase.

A person with diabetes mellitus does not realize that this disease contributes to coronary artery disease and asks the healthcare professional to explain. What information does the professional provide? (Select all that apply.) a. "High blood glucose directly attacks the heart cells." b. "Diabetes is associated with impaired lipid metabolism." c. "It can lead to more vasoconstriction in the blood vessels." d. "Diabetes can damage the inside of your blood vessel." e. "It causes inflammation and cells to clump together in the vessels."

ANS: B, C, D, E Diabetes leads to endothelial damage, thickening of vessel walls, increased inflammation and leukocyte adhesion, increased thrombosis, glycation of vascular proteins, and decreased production of endothelial-derived vasodilators such as nitric oxide. Diabetes is also associated with dyslipidemia. High blood glucose does not directly attack the myocytes.

A healthcare professional tells a student that a patient has lost atrial kick. What would the student expect to see when examining this patient? a. Improvement in atrial dysrhythmias b. Increased blood pressure c. Signs of decreased cardiac output d. Elevations in serum troponin levels

ANS: C Left atrial contraction, the atrial kick, provides a significant increase of blood to the left ventricle. This would help to increase cardiac output. With the loss of this atrial kick, the student would expect to find signs of decreased cardiac output such as decreased blood pressure or tachycardia. Loss of atrial kick would not improve dysrhythmias or increase serum troponin levels which usually indicate myocardial damage.

38. Newborns often have deficiencies in collectin-like proteins, making them more susceptible to what type of infection? a. Cardiac b. Urinary c. Respiratory d. Gastrointestinal

ANS: C Neonates may also be deficient in some of the collectins and collectin-like proteins. This deficiency is especially true of preterm neonates. Some preterm infants with respiratory distress syndrome are deficient in at least one collectin, which negatively affects its innate defense against respiratory infections. The other options are not necessarily related to collectin deficiencies.

32. A student is preparing to irrigate a patient's wound and gathers supplies, including hydrogen peroxide. What response by the health care professional is best? a. Help the student gather the rest of the supplies. b. Instruct the student to dilute the hydrogen peroxide. c. Tell the student to get some normal saline instead. d. Ask the patient if pain medication is needed first.

ANS: C Normal saline is the most innocuous solution that can be used to cleanse or irrigate a wound that is primarily healing by epithelialization. The professional should instruct the student to use it instead of the peroxide to avoid tissue damage. Helping to gather supplies, diluting the solution, or medicating the patient for pain will not avoid the tissue damage that will be caused by the hydrogen peroxide.

13. The action of which hormone helps explain increases in affective anxiety and eating disorders, mood cycles, and vulnerability to autoimmune and inflammatory diseases in women as a result of stimulation of the CRH gene promoter and central norepinephrine system? a. Progesterone b. Cortisol c. Estrogen d. Prolactin

ANS: C Of the options provided, only estrogen directly stimulates the CRH gene promoter and the central noradrenergic (norepinephrine) system, which may help explain adult women's slight hypercortisolism, increases in affective anxiety and eating disorders, mood cycles, and vulnerability to autoimmune and inflammatory disease, all of which follow estradiol fluctuations.

21. What is the correct sequence in phagocytosis? a. Engulfment, recognition, fusion, destruction b. Fusion, engulfment, recognition, destruction c. Recognition, engulfment, fusion, destruction d. Engulfment, fusion, recognition, destruction

ANS: C Once the phagocytic cell enters the inflammatory site, the only correct sequence of phagocytosis involves the following steps: (1) opsonization, or recognition, of the target and adherence of the phagocyte to it; (2) engulfment, or ingestion or endocytosis, and the formation of phagosome; (3) fusion with lysosomal granules within the phagocyte (phagolysosome); and (4) destruction of the target.

11. A severely stressed patient has hypoglycemia each time the patient's blood glucose is checked. The healthcare professional should order laboratory tests to measure which hormone in the patient's blood? a. Epinephrine b. Norepinephrine c. Cortisol d. Growth hormone

ANS: C One of the primary effects of cortisol is the stimulation of gluconeogenesis or the formation of glucose from noncarbohydrate sources, such as amino or free fatty acids in the liver. Neither reaction is a result of the effects of any of the other hormones.

9. Released stress-induced cortisol results in the stimulation of gluconeogenesis by affecting which structure? a. Adrenal cortex b. Pancreas c. Liver d. Anterior pituitary

ANS: C One of the primary effects of cortisol is the stimulation of gluconeogenesis through stimulation of the liver. The adrenal cortex, pancreas, and anterior pituitary do not produce stimulation of gluconeogenesis when exposed to cortisol.

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.

A healthcare professional is caring for a patient who has continuous increases in left ventricular filing pressures. What disorder would the professional assess the patient for? a. Mitral regurgitation b. Mitral stenosis c. Pulmonary edema d. Jugular vein distention

ANS: C Pressure changes are important because increased left ventricular filling pressures back up into the pulmonary circulation, where they force plasma out through vessel walls, causing fluid to accumulate in lung tissues (pulmonary edema). Problems such as mitral regurgitation and mitral stenosis are valve problems, not directly related to this patient's situation. Jugular vein distention can be a sign of fluid overload.

4. Which bacterium grows in the intestines after prolonged antibiotic therapy? a. Lactobacillus b. Candida albicans c. Clostridium difficile d. Helicobacter pylori

ANS: C Prolonged antibiotic treatment can alter the normal intestinal flora, decreasing its protective activity and leading to the overgrowth of other microorganisms, such as the bacterium C. difficile in the colon. C. albicans can overgrow in the vagina but does not usually cause intestinal issues. Lactobacillus and Helicobacter also do not produce intestinal overgrowth problems with antibiotic use.

Where in the heart are the receptors for neurotransmitters located? a. Semilunar and atrioventricular (AV) valves b. Endocardium and sinoatrial (SA) node c. Myocardium and coronary vessels d. Epicardium and AV node

ANS: C Sympathetic neural stimulation of the myocardium and coronary vessels depends on the presence of adrenergic receptors, which specifically bind with neurotransmitters of the sympathetic nervous system. The β1 receptors are found mostly in the heart, specifically the conduction system (AV and SA nodes, Purkinje fibers) and the atrial and ventricular myocardium, whereas the β2 receptors are found in the heart and also on vascular smooth muscle. β3 receptors are also found in the myocardium and coronary vessels. This selection is the only option that accurately identifies the location of the receptors for neurotransmitters.

A healthcare professional is caring for a patient who has a delay in electrical activity reaching the ventricle as seen on ECG. What ECG finding would the healthcare professional associate with this problem? a. A prolonged ST interval b. Variability in measurement with heart rate c. PR interval measuring 0.28 sec d. A QRS complex measuring 0.08 sec

ANS: C The PR interval is a measure of time from the onset of atrial activation to the onset of ventricular activation; it normally ranges from 0.12 to 0.20 sec. The PR interval represents the time necessary to travel from the sinus node through the atrium, the atrioventricular (AV) node, and the His-Purkinje system to activate ventricular myocardial cells. The measured PR of 0.28 sec is too long, signifying a delay in the conduction process from atrium to ventricle. The ST interval represents the time needed for ventricular depolarization. The QT interval is normally around 0.4 sec, but varies inversely with heart rate. The QRS measurement is within the normal range of less than or equal to 0.12 sec.

19. Which chemical mediator derived from mast cells retracts endothelial cells to increase vascular permeability and to cause leukocyte adhesion to endothelial cells? a. Chemokines b. Prostaglandin E c. Platelet-activating factor d. Bradykinin

ANS: C The biologic activity of platelet-activating factor is virtually identical to that of leukotrienes; namely, it causes endothelial cell retraction to increase vascular permeability, leukocyte adhesion to endothelial cells, and platelet activation. The othe r options do not accurately identify the chemical mediator derived from the process described in the question. Chemokines function primarily to induce leukocyte chemotaxis. Prostaglandins interact with the kinin system to stimulate nerve endings and cause pain, among other actions. Bradykinin is the most important product of the kinin system and causes vascular permeability, smooth muscle contraction, and pain.

13. In the coagulation (clotting) cascade, the intrinsic and the extrinsic pathways converge at which factor? a. XII b. VII c. X d. V

ANS: C The coagulation cascade consists of the extrinsic and intrinsic pathways that converge only at factor X.

21. Tissue damage caused by the deposition of circulating immune complexes containing an antibody against the host DNA is the cause of which disease? a. Hemolytic anemia b. Pernicious anemia c. Systemic lupus erythematosus d. Myasthenia gravis

ANS: C The deposition of circulating immune complexes containing an antibody against the host DNA produces tissue damage in individuals with systemic lupus erythematosus (SLE). That is not a process in hemolytic anemia, pernicious anemia, or myasthenia gravis.

A patient had a motor vehicle crash and suffered critical injuries to the brainstem. What physiological responses would the healthcare professional expect to see? a. Prolonged QRS segment b. Shortened PR interval c. Pulse and blood pressure changes d. Fluid overload

ANS: C The major cardiovascular control center is in the brainstem in the medulla with secondary areas in the hypothalamus, the cerebral cortex, the thalamus, and the complex networks of exciting or inhibiting interneurons (connecting neurons) throughout the brain. The brainstem specifically controls blood pressure and pulse, so a severe injury to this area would manifest with changes in blood pressure and pulse. Changes on the ECG and fluid overload would not occur due to this injury.

35. What is the major determinant of the resistance that blood encounters as it flows through the systemic circulation? a. Volume of blood in the systemic circulation b. Muscle layer of the metarterioles c. Muscle layer of the arterioles d. Force of ventricular contraction

ANS: C The muscle layer of the arterioles constricts or dilates depending on the stimulation it receives. The change in the diameter of the vessels determines the resistance to blood flow. Blood viscosity usually stays the same; however severe fluid loss can increase it, leading to an increase in resistance. This is not the major determinant however. The force of contraction does not determine resistance to flow.

16. A student is confused about the process of the generation of clonal diversity. What description by the professor is best? a. It involves antigens that select those lymphocytes with compatible receptors. b. It allows the differentiation of cells into antibody-secreting plasma cells or mature Peyer patches. c. It takes place in the primary (central) lymphoid organs. d. It causes antigens to expand and diversify their populations.

ANS: C This process occurs in central lymphoid organs—the thymus gland for T cells and bone marrow for B cells. It does not involve antigens selecting lymphocytes or expanding and diversifying. It does allow the differentiation of lymphoid stem cells into B and T lymphocytes. Payer patches are lymphoid organs found in the intestines.

16. A type IV hypersensitivity reaction causes which result? a. Antibodies coating mast cells by binding to receptors that signal its degranulation, followed by the discharge of preformed mediators b. Antibodies binding to soluble antigens that were released into body fluids and the immune complexes being deposited in the tissues c. Lymphokine-producing Th1 cells directly attacking and destroying cellular targets d. Antibodies binding to the antigen on the cell surface

ANS: C Type I, II, and III hypersensitivity reactions are mediated by antibody, type IV reactions are mediated by T lymphocytes and do not involve antibody. Type IV mechanisms occur through either Tc cells or lymphokine-producing Th1 cells. Tc cells directly attack and destroy cellular targets.

An infant has a continuous machine-type murmur best heard at the left upper sternal border throughout systole and diastole. The healthcare professional suspects a congenital heart disorder. What other assessment finding is inconsistent with the professional's knowledge about this disorder? a. Bounding pulses b. Active precordium c. Thrill on palpation d. Signs of heart failure

ANS: C A machine-type murmur is a classic sign of a PDA. Other manifestations include bounding pulses, an active precordium, a thrill on chest palpation, and signs of pulmonary overcirculation.

Which statement is true concerning the cells' ability to synthesize cholesterol? a. Cell production of cholesterol is affected by the aging process. b. Cells produce cholesterol only when dietary fat intake is low. c. Most body cells are capable of producing cholesterol. d. Most cholesterol produced by the cells is converted to the low-density form.

ANS: C Although cholesterol can easily be obtained from dietary fat intake, most body cells can also manufacture cholesterol. It is not affected by aging nor do cells only produce cholesterol when dietary fat is low. Most is not converted to the low-density form.

A patient has been diagnosed with Raynaud disease and asks for an explanation. What statement by the healthcare professional is best? a. Inflammatory disorder of small- and medium-size arteries in the feet and sometimes in the hands b. Neoplastic disorder of the lining of the arteries and veins of the upper extremities c. Vasospastic disorder of the small arteries and arterioles of the fingers and, less commonly, of the toes d. Autoimmune disorder of the large arteries and veins of the upper and lower extremities

ANS: C Attacks of vasospasm in the small arteries and arterioles of the fingers and, less commonly, of the toes characterize Raynaud phenomenon and Raynaud disease. The inflammatory disorder of small- and medium-size arteries in the feet and sometimes in the hands is Buerger disease. Reynaud disease is not neoplastic and does not involve large arteries and veins.

A healthcare professional assesses a systolic ejection murmur at the right upper sternal border that transmits to the neck and left lower sternal border. What condition does the professional prepare to educate the parents on? a. Coarctation of the aorta b. Pulmonic stenosis c. Aortic stenosis d. Hypoplastic left heart syndrome

ANS: C Blood flow through the stenotic area of the aorta produces a systolic ejection murmur at the right upper sternal border that transmits to the neck and left lower sternal border. None of the other options produce the described assessment findings.

Where can coarctation of the aorta (COA) be located? a. Exclusively on the aortic arch b. Proximal to the brachiocephalic artery c. Between the origin of the aortic arch and the bifurcation of the aorta in the lower abdomen d. Between the origin of the aortic arch and the origin of the first intercostal artery

ANS: C COA can occur anywhere between the origin of the aortic arch and the bifurcation of the aorta in the lower abdomen.

Cardiac cells can withstand ischemic conditions and still return to a viable state for how many minutes? a. 10 b. 15 c. 20 d. 25

ANS: C Cardiac cells remain viable for approximately 20 min under ischemic conditions. If blood flow is restored, then aerobic metabolism resumes, contractility is restored, and cellular repair begins. If the coronary artery occlusion persists beyond 20 min, then myocardial infarction (MI) occurs.

What is the most common cause of infective endocarditis? a. Virus b. Fungus c. Bacterium d. Rickettsiae

ANS: C Infective endocarditis is a general term used to describe infection and inflammation of the endocardium—especially the cardiac valves. Bacteria are the most common cause of infective endocarditis, especially streptococci, staphylococci, or enterococci.

Which elevated value may be protective of the development of atherosclerosis? a. Very low-density lipoproteins (VLDLs) b. Low-density lipoproteins (LDLs) c. High-density lipoproteins (HDLs d. Triglycerides

ANS: C Low levels of HDL cholesterol are also a strong indicator of coronary risk, whereas high levels of HDLs may be more protective for the development of atherosclerosis than low levels of LDLs. Neither VLDLs nor elevated triglycerides are associated with a protective mechanism.

What cardiac pathologic condition contributes to ventricular remodeling? a. Left ventricular hypertrophy b. Right ventricular failure c. Myocardial ischemia d. Contractile dysfunction

ANS: C Myocardial ischemia contributes to inflammatory, immune, and neurohumoral changes that mediate a process called ventricular remodeling

A patient who has lung cancer calls the clinic reports facial and neck swelling severe enough so that shirts no longer fit. What question by the healthcare professional there would be most appropriate? a. "Have you gained weight recently?" b. "Are your feet and ankles swollen?" c. "Does your voice sound hoarse?" d. "When was your last chemotherapy?"

ANS: C Patients with certain kinds of cancer (small cell and nonsmall cell cancers of the lung, and lymphoma) can develop superior vena cava syndrome (SVCS) which is a progressive occlusion of the superior vena cava. This leads to venous distention in the upper extremities and head. Other symptoms include hoarse voice, dyspnea, dysphagia, stridor, cough, and chest pain. The professional should ask about the other symptoms. A large weight gain would occur slowly. Asking about edema elsewhere would be a question if the patient denied any other symptoms of SVCS. The date of the last chemotherapy is not relevant.

Which condition is a cause of acquired aortic regurgitation? a. Congenital malformation b. Cardiac failure c. Rheumatic fever d. Coronary artery disease (CAD)

ANS: C Rheumatic heart disease, bacterial endocarditis, syphilis, hypertension, connective tissue disorders (e.g., Marfan syndrome, ankylosing spondylitis), appetite suppressing medications, trauma, or atherosclerosis can cause acquired aortic regurgitation.

A patient in the Emergency department is suspected of having a myocardial infarction (MI). The initial cardiac troponin 1 level was negative. What action by the healthcare professional is best? a. Prepare the patient for thrombolytic therapy. b. Dismiss the patient because the lab was negative. c. Schedule repeat lab within a few hours. d. Give the patient oxygen and pain medication.

ANS: C Several cardiac biomarkers exist including the most specific, cardiac troponin 1 (cTnI), cTnI begins to rise within 2 to 4 hours after cardiac injury, so if the initial result is normal, the test should be repeated within 6 to 9 hours and again at 12 to 24 hours. It is not known yet if the patient has had an MI so treatment with thrombolytic therapy would be premature. The patient should not be dismissed since the professional suspected an MI. The patient does need oxygen and pain medication (if pain is present) but that option is not directly related to the question.

A parent asks the healthcare professional to explain why a child diagnosed with Tetralogy of Fallot squats frequently. What explanation by the professional is best? a. Reduces the chest pain b. Controls dizziness c. Relieves hypoxia d. Improves headache

ANS: C Squatting is a spontaneous compensatory mechanism used by older children with Tetralogy of Fallot to alleviate hypoxic spells. Squatting and its variants increase systemic resistance while decreasing venous return to the heart from the inferior vena cava. Squatting does not reduce chest pain, control dizziness, or improve headaches.

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.

25. Which statements are true regarding the development of HIV symptoms? (Select all that apply.) a. Symptoms generally appear in the clinical latency stage. b. Symptoms are generally observable within 5 years of the initial infection. c. T cells levels, particularly those of memory T cells, progressively decrease. d. Untreated infected individuals may remain asymptomatic for up to10 years. e. Secondary lymphoid organs experience damage and resulting malfunction.

ANS: C, D, E Individuals during the early stages of HIV (early stage disease or clinical latency) are usually asymptomatic. The early stage may last as long as 10 years in untreated people, during which the viral load increases and the numbers of CD4+ cells progressively decrease. As a result of these processes, the level of T cells decreases (particularly memory T cells, which seem more susceptible to HIV infection); thymic production of new T cells is decreased; and the secondary lymphoid organs (particularly the lymph nodes) are damaged.

27. Which statements are true regarding viruses? (Select all that apply.) a. Viruses are very complex microorganisms. b. Viruses are referred to as eukaryotes. c. Viruses are capable of producing messenger RNA (mRNA). d. Viruses penetrate plasma membranes via endocytosis. e. Viruses are capable of uncoating cytoplasmic nucleocapsid.

ANS: C, D, E Viruses are extremely simple microorganisms and do not possess any of the metabolic organelles found in prokaryotes (e.g., bacteria) or eukaryotes (e.g., human cells). Once bound, the virus can penetrate the plasma membrane by receptor-mediated endocytosis. Within the cytoplasm, the virus uncoats the protective nucleocapsid and releases viral genetic information. Most RNA viruses directly produce mRNA, which is translated into viral proteins, and genomic RNA, which is eventually packaged into new viruses.

35. Which is an example of a bacterial toxin that has been inactivated but still retains its immunogenicity to protect the person? (Select all that apply.) a. Poliomyelitis b. Measles c. Tetanus d. Gonorrhea e. Diphtheria

ANS: C,E The symptoms of tetanus or diphtheria are mediated by specific toxins. To prevent harming the recipient of the immunization, bacterial toxins are chemically inactivated so that they have lost most of their harmful properties but still retain their immunogenicity. These agents are referred to as toxoids. Poliomyelitis, measles, and gonorrhea are not examples.

17. What is the most influential factor in whether a person will experience a stress reaction? a. General state of physical health b. Spiritual belief system c. Intellectual abilities d. Ability to cope

ANS: D A person does not have a stress reaction unless the stress exceeds his or her coping abilities. General health, spiritual belief systems, and intellectual abilities do not have the same degree of influence on stress reactions.

22. When a person is exposed to most antigens, antibodies can be usually detected in their circulation within what timeframe? a. 12 hours b. 24 hours c. 3 days d. 6 days

ANS: D After approximately 5 to 7 days is an IgM antibody specific for that antigen detected in the circulation.

33. Antibodies that are associated with mucosal immune system, such as immunoglobulins, function to prevent which type of infections? a. Infections that attack the respiratory system b. Infections that tend to be chronic in nature c. Infections likely to be resistant to antibiotics d. Infections that focus on epithelial surfaces of the body

ANS: D Antibodies of the systemic immune system function throughout the body, whereas antibodies of the secretory (mucosal) immune system—primarily immunoglobulins of the IgA class—are associated with bodily secretions and function to prevent pathogenic infection on epithelial surfaces. The other options are not necessarily true when considering the immunoglobulins.

10. Where are the coronary ostia located? a. Left ventricle b. Aortic valve c. Coronary sinus d. Aorta

ANS: D Coronary arteries receive blood through openings in the aorta, called the coronary ostia.

1. What is a significant cause of morbidity and mortality worldwide? a. Starvation b. Traumatic injury c. Cardiovascular disease d. Infectious disease

ANS: D Despite the wide-scale implementation of progressive public health and immunization policies, infectious disease remains a significant cause of morbidity and mortality. The other options are not as significant.

6. A student asks the healthcare professional to describe exotoxins. Which statement by the professional is best? a. Exotoxins are contained in cell walls of gram-negative bacteria. b. Exotoxins are released during the lysis of bacteria. c. Exotoxins are able to initiate the complement and coagulation cascades. d. Exotoxins are released during bacterial growth.

ANS: D Exotoxins are proteins released during bacterial growth. Exotoxins are not contained in cell walls of gram-negative bacteria, released during lysis of bacterial, or able to initiate the complement and coagulation cascades.

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.

26. Which cytokine is produced and released from virally infected host cells? a. IL-1 b. IL-10 c. TNF-α d. IFN-α

ANS: D Only interferons (IFNs) are produced and released by virally infected cells in response to viral double-stranded ribonucleic acid (RNA). IFN-α and IFN-β induce the production of antiviral proteins, thereby conferring protection on uninfected cells. IFN-α or IFN-β is released from virally infected cells and attaches to a receptor on a neighboring cell. IFNs also enhance the efficiency of developing an acquired immune response. IL-1 is a proinflammatory interleukin. IL-10 plays a critical role in wound healing. TNF has several systemic effects but is not released from virally infected host cells.

14. Which chemical interacts among all plasma protein systems by degrading blood clots, activating complement, and activating the Hageman factor? a. Kallikrein b. Histamine c. Bradykinin d. Plasmin

ANS: D Only plasmin regulates clot formation by degrading fibrin and fibrinogen, and it can activate the complement cascade through components C1, C3, and C5. Plasmin can activate the plasma kinin cascade by activating the Hageman factor (factor XII) and producing prekallikrein activator.

22. Which disease is an example of a rickettsial infection? a. Cholera b. Candida c. Sleeping sickness d. Rocky Mountain spotted fever

ANS: D Rocky Mountain spotted fever is a result of rickettsiae. Cholera is a bacterial infection, candida is a fungal infection, and sleeping sickness is a protozoal infection.

A healthcare provider is assessing a patient who has a pericardial effusion and notes a pulsus paradoxus. A student asks for an explanation of how this occurs. What description by the professional is best? a. Diastolic filling pressures of the right ventricle and reduction of blood volume in both ventricles b. Blood ejected from the right atrium and reduction of blood volume in the right ventricle c. Blood ejected from the left atrium and reduction of blood volume in the left ventricle d. Diastolic filling pressures of the left ventricle and reduction of blood volume in all four heart chambers

ANS: D Pulsus paradoxus means that the arterial blood pressure during expiration exceeds arterial pressure during inspiration by more than 10 mmHg. This clinical finding reflects impairment of diastolic filling of the left ventricle plus a reduction of blood volume within all four cardiac chambers.

When does systemic vascular resistance in infants begin to increase? a. One month before birth b. During the beginning stage of labor c. One hour after birth d. Once the placenta is removed from circulation

ANS: D The low-resistance placenta is removed from circulation, which causes an immediate increase in systemic vascular resistance to approximately twice of that before birth.

A patient reports sudden onset of severe chest pain that radiates to the back and worsens with breathing and when lying down. What action by the healthcare professional is most appropriate? a. Prepare to assist with an immediate pericardiocentesis. b. Inform the patient about the side effects of diuretics. c. Facilitate the patient getting an immediate ECG. d. Teach the patient about a course of antiinflammatory medications.

ANS: D This patient has manifestations of acute pericarditis, which also include dysphagia, restlessness, irritability, anxiety, malaise, and weakness. The treatment is generally a course of nonsteroidal antiinflammatory medication. A pericardiocentesis would be used for a cardiac tamponade. The patient does not need an ECG or diuretics.

Which heart defect results in a single vessel arising from both ventricles, providing blood to both the pulmonary and systemic circulations? a. Coarctation of the aorta b. Tetralogy of Fallot c. Total anomalous pulmonary connection d. Truncus arteriosus

ANS: D Truncus arteriosus is the failure of the large embryonic artery, the truncus arteriosus, to divide into the pulmonary artery and the aorta, which results in a single vessel arising from both ventricles, providing blood flow to the pulmonary and systemic circulations. None of the other options produce the described structural malformation.

Which assessment findings would the health care professional correlate with aortic stenosis? (Select all that apply.) a. Jugular vein distention b. Bounding pulses c. Hypotension d. Angina e. Syncope

ANS: D, E The classic manifestations of aortic stenosis are angina, syncope, and heart failure. None of the other options are associated with aortic stenosis.

What contributes to antibiotic-resistant pathogens? a. Inadequate sanitation b. Genetic mutation c. Loss of multidrug transporters d. Limited use of antibiotics

B Antibiotic resistance usually results from genetic mutations in the microorganism that can be directly transmitted to neighboring microorganisms. Sanitation and clean drinking water can help control infection. Multidrug transporters on the microorganism's membrane affect the rate of intracellular accumulation of antibiotics by preventing entrance or increasing the efflux of the antibiotic into the cell. Overuse of antibiotics can lead to the destruction of the normal flora and selective overgrowth of antibiotic-resistant strains.

Which statement is true regarding bacteremia? a. It occurs with a normal defense system of the body. b. Gram-positive organisms typically cause bacteremia. c. Endotoxins often cause symptoms such as vasodilation. d. Symptoms include increased blood pressure.

C Endotoxins are often produced by bacteria that grow in the blood. Common symptoms include vasodilation, hypotension (reduced blood pressure), and decreased oxygen delivery and can produce cardiovascular shock. Bacteremia is often caused by gram-negative bacteria and usually occurs with a failure of the body's defense mechanisms.

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 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.

Which statement regarding viruses is true? a. Viruses are less common than bacterial infections. b. Viruses actively produce exotoxins. c. Viruses bypass many defense mechanisms by developing intracellularly. d. Viruses contain all their genetic information in ribonucleic acid (RNA).

C Viruses enter the cell and may bypass many defense mechanisms. Viruses are the most common form of infection. They contain deoxyribonucleic acid (DNA) and RNA for their genetic information. They do not produce exotoxins or endotoxins

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 T-cell function is decreased, and immune responses are delayed. B-cell production is inferior; however, the cells have increased circulating antibody levels.

Which statement is true regarding unmatched packed red blood cell (RBC) transfusions? a. Only three different RBC antigens have been identified. b. Approximately 80 major carbohydrate antigens exist. c. People with O type blood have neither A or B antigens. d. A person with type A blood contains anti-O antibodies.

C Type O blood does not contain type A or B antigens. However, 80 major different RBC antigens are present. A person with type A blood carries anti-B antibodies and a person with type B blood carries anti-A antibodies. Those with type O blood have anti-A and anti-B antibodies.

Which statement accurately describes blood flow through the heart? a. Blood flows from the left atrium through the tricuspid valve to the left ventricle. b. Blood flows from the right atrium through the aortic valve to the right ventricle. c. Blood flows from the right ventricle through the pulmonic semilunar valve. d. Blood flows from the left ventricle through the bicuspid valve.

C. Blood flows from the right atrium through the tricuspid valve to the right ventricle. Blood then travels from the right ventricle through the pulmonic semilunar valve to the pulmonary circulation. Once in the pulmonary circulation, it is oxygenated and travels to the left atrium through the bicuspid valve to the left ventricle. Blood leaves the left ventricle through the aortic valve and enters the systemic circulation.

A substance that is recognized as foreign or nonself is a. immunoglobulins. b. lymphocytes. c. antibodies. d. antigens.

D 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.

When does secondary vaccine failure occur? a. When toxoids are not administered b. When bacteriophages are administered c. When routine vaccinations are not administered d. When booster immunizations are not administered

D Secondary vaccine failure results if appropriate booster immunizations are not administered. Many adults vaccinated against diseases that are more severe in childhood will not get routine boosters. Although not developing debilitating illness, they may become asymptomatic carriers and infect unvaccinated children. Toxoids are purified toxins that have been chemically detoxified without loss of immunogenicity. Bacteriophages are viruses that specifically infect bacteria; these are used to treat antibiotic resistance.

Which statement is true regarding the immune system in response to stress? a. T-helper 1 (Th1) cells increase. b. A shift in Th1 cells occurs. c. The immune system is not affected. d. Cortisol is released.

D Stress can activate an excessive immune response through cortisol. It can cause the suppression of Th1 cells and a shift in Th2 cells.

Which statement is true regarding the effects of circulating epinephrine in the body? a. The heart rate will slow down. b. The heart's contractility will decrease. c. Blood vessels to skeletal muscle will constrict. d. Transient hyperglycemia will result.

D Epinephrine dilates blood vessels of the muscles and causes transient hyperglycemia. The epinephrine will increase heart rate and contractility. The venous return to the heart will increase, thus increasing cardiac output and blood pressure.

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 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.

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 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).

Which options characterize tricuspid atresia? (Select all that apply.) a. No pathway between the right heart chambers b. A decrease in pulmonary blood flow Incorrect c. The mixing of unoxygenated and oxygenated bloods d. Cyanosis in the newborn experiencing this disorder e. Children at a risk for endocarditis

a, c, d, e Tricuspid atresia is failure of the tricuspid valve to develop; consequently, there is no communication from right atrium to right ventricle. Blood flows through an atrial septal defect or a patent foramen ovale to the left atrium and through a VSD to the right ventricle, resulting in the complete mixing of unoxygenated and oxygenated blood. A murmur is noted, and cyanosis is usually seen in the newborn period. Children are at risk for bacterial endocarditis, brain abscess, and stroke. Tachycardia, dyspnea, fatigue, and poor feeding may be noted as a result of the excessive pulmonary blood flow.

Which are the functions of the pericardial sac? (Select all that apply.) a. Prevents displacement of the heart during gravitational acceleration or deceleration Correct b. Physical barrier that protects the heart against infection and inflammation Correct c. Forms a lining that is continuous with the arteries, veins, and capillaries of the body d. Contains pain receptors and mechanoreceptors that affect blood pressure Correct e. Creates a continuous closed circulatory system

a,b, d Functions of the pericardial sac are: (1) to prevent the displacement of the heart during gravitational acceleration or deceleration, (2) to provide a physical barrier that protects the heart against infection and inflammation from the lungs and pleural space, and (3) to provide pain receptors and mechanoreceptors that can elicit reflex changes in blood pressure and heart rate. The endocardium is the lining that is continuous with the arteries, veins, and capillaries of the body and creates a continuous closed circulatory system.

Which factors promote deep venous thrombosis? (Select all that apply.) a. Venous stasis Correct b. Venous endothelial damage Correct c. Polycythemia d. Hypercoagulable states Correct e. Female gender

a,b,d Three factors (triad of Virchow) promote venous thrombosis: (1) venous stasis, caused by immobility, obesity, prolonged leg dependency (e.g., air travel), age, heart failure (HF), (2) venous endothelial damage, caused by trauma or medications, and (3) hypercoagulable states, as a result of inherited disorders, malignancy, pregnancy, oral contraceptives, hormone replacement, hyperhomocysteinemia, or antiphospholipid syndrome. Neither polycythemia nor gender is known to be a factor that promotes venous thrombosis.

Which statements are true regarding congenital heart defects? (Select all that apply.) a. Congenital heart disease is the second leading cause of death in infants during the first year of life. b. Incidence of heart defects is high in stillbirths, low-birth-weight babies, and spontaneous abortions. c. Maternal use of drugs during pregnancy has not been shown to increase congenital heart disease. d. The underlying cause of congenital heart disease is known in 30% of cases. e. Infants with trisomy 21 have a high incidence of congenital heart disease.

a,b,e Congenital heart disease is the leading cause of death, excluding prematurity, in infants during the first year of life. The incidence of heart defects also has been found to be high in stillbirths, low-birth-weight or small-for-gestational-age infants, and spontaneous abortions. The use of some drugs during pregnancy is associated with an above-average incidence of congenital heart disease. Examples of these drugs include thalidomide, lithium, phenytoin (Dilantin), and warfarin. The underlying cause of congenital heart disease is known in only 10% of cases. As many as 50% of infants with trisomy 21 have a congenital heart defect, either an atrioventricular (AV) canal defect or a VSD.

Which statements are true regarding hypertension? (Select all that apply.) a. Approximately two thirds of Americans older than 60 years of age have hypertension. b. More than two thirds of those with hypertension have it controlled. c. Hypertension is defined as a diastolic pressure higher than 90 mmHg. d. Hypertension is a systolic pressure of 140 mmHg or higher. e. Approximately 15% of US adults are in the prehypertension category and are at risk for developing hypertension.

a,c,d Approximately two thirds of Americans older than 60 years of age have hypertension, and approximately 48% of those have adequately controlled hypertension. Hypertension is defined as a diastolic pressure of 90 mmHg or higher or a systolic pressure of 140 mmHg or higher. Between 25% and 37% of adults in the United States are prehypertensive.

Cyanosis, followed by rubor and paraesthesias in the digits, are associated with which condition? a. Raynaud phenomenon or disease b. Thromboangiitis obliterans c. Atherosclerosis Incorrect d. Varicose veins

a. Attacks of vasospasm in the small arteries and arterioles of the fingers and, less commonly, of the toes, characterize Raynaud phenomenon and Raynaud disease. Symptoms include cold and numb digits. Thromboangiitis obliterans, an inflammatory disease of the peripheral arteries, tends to occur in young men who are heavy smokers. Arteries occlude in the feet and hands. The chief symptoms of thromboangiitis obliterans are pain and tenderness of the affected part. Atherosclerosis is an inflammatory disease and is the major cause of coronary artery disease and stroke. A varicose vein is a superficial vein in which blood has pooled.

Which cardiac event represents the measure of time from the onset of atrial activation to the onset of ventricular activation? a. PR interval b. QRS complex c. ST interval d. QT interval

a. The PR interval measures the time of onset of atrial activation to the onset of ventricular activation. The QRS complex represents the sum of all ventricular muscle cell depolarization. The ST interval is the time when the entire ventricular myocardium is depolarized. The QT interval is often called electrical systole.

What is the appropriate name for the connection between the aorta and the pulmonary artery? a. Ductus arteriosus b. Ligamentum venosum c. Foramen ovale Incorrect d. Bulbus cordis

a. The ductus arteriosus is the communication link between the aorta and the pulmonary artery. Once the ductus venosus closes, its remnants form the ligamentum venosum. The foramen ovale is the flapped orifice that allows right-to-left shunting, which is necessary for fetal circulation. The bulbus cordis is the conal portion of the ventricular septum that separates the aorta artery from the pulmonary artery.

Which two items are related in the Frank-Starling law of the heart? a. Resting sarcomere length to tension generation b. Resting sarcomere length to end-diastolic volume c. Tension generation and left ventricular pressure d. Tension generation and diastolic filling pressures

a. Resting sarcomere length to tension generation The Frank-Starling law of the heart relates resting sarcomere length (expressed as the volume of blood in the heart at the end of diastole or end-diastolic volume) to tension generation (development of left ventricular pressure). In summary, this means the volume of blood in the heart at the end of diastole is directly related to the force of contraction of the next systole.

Which statement correctly describes the A wave? a. The A wave is generated by atrial contraction. b. The filling of the atrium causes early diastolic peak of the A wave. c. The A wave is produced as a result of the descent of the tricuspid valve ring. d. The A wave reflects the rapid flow of blood from the great veins and right atrium into right ventricle.

a. The A wave is generated by atrial contraction. The A wave is generated by atrial contraction. The V wave is the early diastolic peak caused by the filling of the atrium. The X descent follows the A wave and is produced because of the descent of the tricuspid valve ring. The Y descent follows the V wave and reflects the rapid flow of blood from the great veins and right atrium into the right ventricle.

Which cardiac anomalies are associated with tetralogy of Fallot? (Select all that apply.) a. Atrial septal defect b. Ventricular septal defect Correct c. Pulmonary stenosis Correct d. Right ventricular hypertrophy Correct e. Tricuspid atresia

b,c,d Tetralogy of Fallot consists of four defects: (1) a ventricular septal defect (VSD) that is high in the septum and usually large; (2) an aorta that is overriding and straddles the VSD; (3) pulmonary stenosis; and (4) right ventricular hypertrophy. Atrial septal defect may occur as a congenital heart anomaly but is not included in the tetralogy of Fallot. Tricuspid atresia consists of an imperforate tricuspid valve, resulting in no communication between the right atrium and the right ventricle and is not included in the tetralogy of Fallot.

Which statements are true regarding atherosclerosis? (Select all that apply.) a. Atherosclerosis is an acute process of heart muscle degeneration. b. Atherosclerosis is the thickening and hardening of the vessel wall. c. Atherosclerosis is a plaque caused by neutrophils. Incorrect d. Endothelial cell injury begins the process of atherosclerosis. e. Atherosclerosis can affect all vascular systems in the body.

b,d, e Atherosclerosis is a form of arteriosclerosis in which thickening and hardening of the vessels (not heart muscle) occurs. Collagen deposits over a fatty streak causes plaque. Atherosclerosis begins with injury to the endothelial cells that line artery walls and is not a single disease; rather, it is a pathologic process that can affect vascular systems throughout the body.

A child who is about to begin school is found to have a crescendo-decrescendo systolic ejection murmur. This finding supports the presence of which cardiac anomaly? a. Mitral valve prolapse b Atrial septal defect c. Ventricular septal defect Incorrect d. Congestive heart failure

b. An atrial septal defect may exhibit a crescendo-decrescendo systolic ejection murmur. Mitral valve prolapse is not usually diagnosed in childhood and is identified by an opening click. A ventricular septal defect has a harsh, loud, holosystolic murmur and systolic thrill. A child with congestive heart failure may show changes in feeding, respirations, or lung sounds.

Which term describes an occlusion in a blood vessel caused by a bolus of circulating matter in the bloodstream? a. Thrombus b. Embolus c. Thrombophlebitis d. Foam cell

b. An embolus is a bolus of matter that is circulating in the blood. A thrombus is a blood clot that remains attached to the vessel wall. Thrombophlebitis is the inflammation caused by a thrombus. Foam cells are lipid-laden cells that contribute to fatty streaks.

Which is likely to occur in infants with left ventricular heart failure? a. Nasal flaring b. Failure to thrive Correct c. Coughing d. Mottled skin

b. Poor feeding or poor sucking is often found in left ventricular failure and leads to failure to thrive. Right ventricular failure is representative of the remaining options.

What is the most common complication of acute myocardium infarction (AMI)? a. Dressler postinfarction syndrome b. Dysrhythmia c. Pericarditis d. Congestive heart failure

b. Dysrhythmias (arrhythmias), which are disturbances of the cardiac rhythm, are the most common complication of AMI. Although all of these choices are true complications of AMI, dysrhythmias are the most common. Dressler postinfarction syndrome, which is a delayed form of acute pericarditis, can occur from 1 week to several months after AMI. Congestive heart failure can occur with a weakened cardiac muscle.

Which artery travels in the coronary sulcus between the left atrium and the left ventricle? a. Left anterior descending b. Circumflex c. Right coronary d. Left coronary

b. The circumflex artery travels in the coronary sulcus. The left anterior descending artery travels down the anterior surface of the interventricular septum. The right coronary artery originates from an ostium behind the right aortic cusp and travels behind the pulmonary artery. The left coronary artery passes between the left atrial appendage and the pulmonary artery and generally divides into two branches.

Which process is responsible for slowing the heart rate? a. Sympathetic excitation b. Parasympathetic excitation c. Bainbridge reflex Incorrect d. Baroreceptor reflex

b. Parasympathetic excitation The parasympathetic excitation slows the heart rate and is often referred to as the cardioinhibitory center. The sympathetic stimulation is often called the cardioexcitation center because the heart rate increases. The Bainbridge reflex causes the heart rate to increase after intravenous infusions of blood or fluid. The baroreceptor reflex facilitates blood pressure changes and heart rate changes.

A woman with chest pain that occurs at rest is diagnosed as having abnormal vasospasm of her coronary arteries. These symptoms support which medical diagnosis? a. Stable angina b. Prinzmetal angina c. Silent ischemia d. Angina pectoris

b. Prinzmetal angina is an abnormal vasospasm of the coronary vessels that causes transient ischemia, unpredictably and usually at rest, and is more common in women. Stable angina occurs with activity, is often limited, and resolves with rest. Silent ischemia is poor myocardial perfusion that does not cause angina and may be associated only with nonspecific symptoms such as fatigue, dyspnea, or a feeling of unease. Angina pectoris is typically experienced as transient substernal chest discomfort, ranging from a sensation of heaviness or pressure to moderately severe pain.

Which statement is true regarding the thoracic duct? a. The thoracic duct is the major source of venous return to the heart. b. The thoracic duct receives lymph from most of the body. c. The thoracic duct receives lymph from the right arm, head, and thorax. d. Blood is dumped into the right atrium through the thoracic duct

b. The thoracic duct receives lymph from most of the body. Lymph is primarily water and small amounts of protein. It is reabsorbed through the lymph nodes and delivered to either the right lymphatic duct (lymph from right arm, head, and thorax) or the thoracic duct (rest of the body). These structures, in turn, dump the lymph into the inferior vena cava and superior vena cava (major sources of venous return to the heart), which conduct blood to the right atrium.

Regarding normal features of cardiac function in the newborn, which statements are true? (Select all that apply.) a. Heart rate is 220-280 beats per minute (bpm). b. Cardiac output is low. c. Oxygen consumption doubles. d. The newborn heart initially has left ventricle dominance. e. By 1 month of age, the newborn's ventricles are approximately equal in weight.

c, e Oxygen consumption doubles at birth, and the newborn's ventricles are approximately equal in weight by 1 month of age. The newborn heart rate is 100-180 bpm, and cardiac output is high. Unlike the adult heart, the newborn heart has right ventricular (RV) dominance with a thickened RV wall.

Which statement is true regarding cellular injury of the myocardium? a. Cardiac cells can withstand ischemic conditions for approximately 60 minutes. b. Electrocardiographic (ECG) changes are visible after approximately 120 seconds. c. Myocardial cells remain viable if blood flow returns within 20 minutes. d. After 20 seconds of decreased blood flow, myocardial cells become cooler.

c. Cardiac cells can withstand ischemic conditions for approximately 20 minutes. ECG changes are visible after 30-60 seconds of hypoxia. After 8-10 seconds of decreased blood flow, the myocardial cells are already cyanotic and cooler. Even if cardiac cells are metabolically altered and are nonfunctional, they can remain viable if blood flow returns within 20 minutes.

What is the correct definition of Eisenmenger syndrome? a. Left-to-right shunt b. Oxygenated blood flows into pulmonary circulation c. Deoxygenated blood flows into systemic circulation Correct d. Correction of the ventricular septal defect

c. Eisenmenger syndrome occurs when pulmonary vascular resistance rises and becomes greater than systemic vascular resistance, causing blood flow to reverse direction. In this syndrome, deoxygenated blood now flows into the systemic circulation and cyanosis occurs.

Which structure allows right-to-left shunting, which is necessary for fetal circulation? a. Ostium primum b. Ostium secundum c. Foramen ovale d. Bulbus cordis

c. The foramen ovale is the flapped orifice that allows right-to-left shunting, which is necessary for fetal circulation. Altered development can lead to atrial septal defect. Failure of the septum primum to fuse with the endocardial cushions results in an ostium primum defect. Fenestrations (or openings), which develop in the superior portion of the septum primum, create the ostium secundum. The bulbus cordis is the conal portion of the ventricular septum that separates the aorta from the pulmonary artery.

Which factors determine cardiac output? a. Parasympathetic and sympathetic activity b. Preload and afterload c. Heart rate and stroke volume d. Right and left atrial pressure

c. Heart rate and stroke volume Cardiac output is directly related to the heart rate and stroke volume. Changes in either variable affect the cardiac output. Preload is the pressure generated in the left ventricle at the end of diastole (end-diastolic volume). Afterload is the resistance or impedance to the ejection of blood from the left ventricle. Although the parasympathetic stimulation has a bradycardic effect and sympathetic nervous system increases the frequency of the cardiac pacemaker and may influence cardiac output, these factors are not used in the cardiac output formula; neither are atrial pressures.

Which cardiac chamber has the thickest wall? a. Left atrium b. Right atrium c. Left ventricle d. Right ventricle

c. Left ventricle The atria are approximately 1-2 mm thick. The right ventricle is 4-5 mm thick, and the left ventricle, the most muscular chamber, is approximately 12-15 mm thick.

Which statement correctly defines preload? a. Resistance to the ejection of blood from the left ventricle b. Wall tension that is related to internal blood vessel radius c. Pressure generated by atrial contraction d. Pressure generated by the end-diastolic volume Preload is the pressure generated in the left ventricle at the end of diastole (end-diastolic volume). Afterload is the resistance or impedance to the ejection of blood from the left ventricle. Wall tension is directly related to the product of the intraventricular pressure and internal radius, and inversely related to the wall thickness (Laplace's law). A tension curve lower than normal is characteristic of congestive heart failure.

d. Pressure generated by the end-diastolic volume Preload is the pressure generated in the left ventricle at the end of diastole (end-diastolic volume). Afterload is the resistance or impedance to the ejection of blood from the left ventricle. Wall tension is directly related to the product of the intraventricular pressure and internal radius, and inversely related to the wall thickness (Laplace's law). A tension curve lower than normal is characteristic of congestive heart failure.