nu 545 unit 7 Test study questions

Which type of cancer is said to aggregate among families? a. Breast b. Lung c. Skin d. Brain

ANS: A Breast cancer appears to aggregate strongly in families. The other cancers are not believed to be familial in nature.

The disruption in cellular adhesion observed in bullous impetigo is caused by an exfoliative toxin related to which organism? a. Staphylococcus aureus b. Streptococcus pyogenes c. Escherichia coli d. Candida albicans

ANS: A Bullous impetigo is a rare variant of impetigo caused by S. aureus. The staphylococci produce a bacterial toxin called exfoliative toxin (ET), which causes a disruption in desmosomal adhesion molecules with blister formation characteristic of bullous impetigo. The other organisms are not involved in this disorder.

Which cancer originates from connective tissue? a. Osteogenic sarcoma b. Basal cell carcinoma c. Multiple myeloma d. Adenocarcinoma

ANS: A Cancers arising from connective tissue usually have the suffix -sarcoma. Carcinomas arise in epithelial tissue. Myeloma arises in the bone marrow.

What is the role of caretaker genes? a. Maintenance of genomic integrity b. Proliferation of cancer cells c. Secretion of growth factors d. Restoration of normal tissue structure

ANS: A Caretaker genes are responsible for the maintenance of genomic integrity. The other options are not roles assumed by caretaker genes.

What does a child diagnosed with acquired immunodeficiency syndrome (AIDS) have an increased risk of developing? a. Non-Hodgkin lymphoma b. Retinoblastoma c. Epstein-Barr d. Leukemia

ANS: A Children with AIDS have an increased risk of developing non-Hodgkin lymphoma and Kaposi sarcoma. Leukemia is linked to retinoblastoma. Epstein-Barr has been linked to the development of some cancers, whereas no known link has been found between AIDS and the development of leukemia.

Studies have identified several genes that play a role in the prevention of obesity by affecting what? a. Regulation of appetite b. Metabolizing of fat c. Absorption of fat d. Altering the sense of satiety

ANS: A Clinical trials using recombinant leptin have demonstrated moderate weight loss in a subset of obese individuals. In addition, leptin participates in important interactions with other components of appetite control, such as neuropeptide Y and a-melanocyte-stimulating hormone and its receptor, the melanocortin-4 receptor (MC4R). Currently, no research supports the other options as being genetically regulated.

A student cannot remember the differences between rubeola and rubella. Which clinical manifestation does the healthcare professional tell the student is present in rubeola but not in rubella? a. Conjunctivitis b. Enlarged lymph nodes c. Presence of a cough d. Runny nose

ANS: A Conjunctivitis is present in rubeola, but not in rubella.

Which is an important criterion for discerning autosomal recessive inheritance? a. Consanguinity is sometimes present. b. Females are affected more than males. c. The disease is observed in both the parents, as well as in the siblings. d. On average, one half of the offspring of the carrier will be affected.

ANS: A Consanguinity ("inbreeding") is often an important characteristic of pedigrees for recessive diseases; relatives share a certain proportion of genes received from a common ancestor. The other statements do no describe a criterion important in autosomal recessive inheritance.

Cutaneous vasculitis develops from the deposit of which substance? a. Immune complexes b. Immunoglobulin E (IgE) c. Complement proteins d. T lymphocytes

ANS: A Cutaneous vasculitis involves the deposit of immune complexes, initiating an uncontrolled inflammatory response and causing the lesions that are often polymorphic.

DNA formation occurs in which of the cell's structures? a. Nucleus b. Cytoplasm c. Organelle d. Membrane

ANS: A DNA is formed and replicated only in the cell nucleus.

A healthcare professional is caring for a patient undergoing chemotherapy. What is the skin-related health risk the professional should assess the patient for and be prepared to treat? a. Infection b. Ultraviolet damage c. Pain d. Erythema

ANS: A Decreased renewal rates of the epidermal layers in the skin may lead to skin breakdown and dryness, altering the normal barrier protection against infection. The healthcare professional should assess the patient for infection regularly and be prepared to treat any infection noted. Radiation therapy may cause skin erythema (redness). Pain and ultraviolet damage is not related to chemotherapies.

What genetic process is likely responsible for the occurrence of asthma in only one of a pair of identical twins? a. Epigenetic modifications b. Genomic imprinting c. Transgenerational inheritance d. Methylation

ANS: A Epigenetic modifications can cause individuals with the same deoxyribonucleic acid (DNA) sequences (such as identical twins) to have different disease profiles. Imprinting means that either the copy of a gene inherited through the sperm or the copy inherited through the egg is inactivated and remains in this inactive state in all of the somatic cells of the individual. The heritable transmission to future generations of epigenetic modifications is called transgenerational inheritance. DNA methylation occurs through the attachment of a methyl group to the carbon-5 position of a cytosine.

What is the most common type of shock in children? a. Hypovolemic b. Cardiogenic c. Neurogenic d. Septic

ANS: A Hypovolemic shock, the most common type of shock in children, is associated with a reduction in the intravascular volume relative to the vascular space. It is most frequently caused by dehydration and trauma.

When a woman has one first-degree relative with breast cancer, her risk of developing breast cancer is how many times greater? a. 2 b. 3 c. 6 d. 10

ANS: A If a woman has one affected first-degree relative, her risk of developing breast cancer doubles.

Approximately 80% of all hospital-acquired infections in children are a result of which type of organism? a. Bacteria b. Viruses c. Fungi d. Rickettsia

ANS: A In adults and children, approximately 40% of all hospital-acquired infections are linked to gram-negative infections, 40% to gram-positive infections, and 21% each to viruses and fungi.

In allergic contact dermatitis, which cells possess the antigens and present them to T cells? a. Langerhans cells b. Merkel cells c. Keratinocytes d. Macrophages

ANS: A In allergic contact dermatitis, Langerhans cells process the antigen and carry it to T cells that then become sensitized to the antigen-releasing cytokines and chemokines, leading to leukocyte infiltration and inflammation. Merkel cells are associated with touch receptors and function as slowly adapting mechanoreceptors when stimulated by deformation of the epidermis. Keratinocytes produce keratin, a scleroprotein that provides protection from mechanical stress. Keratin is the main constituent of skin, hair, and nail cells.

In somatic cell gene therapy, what type of vector is most commonly used to alter a specific set of an individual's somatic cells? a. Virus b. Bacteria c. RNA polymerase d. Recombinant DNA

ANS: A In somatic cell gene therapy, a vector is used to carry a normal copy of the mutated gene into the individual's cells. These vectors are usually viruses, such as retroviruses, lentiviruses, or adenoviruses, which have been genetically modified so that they contain the normal human gene and cannot make copies of themselves (otherwise they could cause a viral infection). Bacteria, RNA polymerase, and recombinant DNA are not used as vectors in somatic cell gene therapy.

Which leukocytes are elevated in atopic dermatitis? a. Eosinophils b. Neutrophils c. Basophils d. Monocytes

ANS: A In the acute phase of atopic dermatitis, inflammation is associated with the activation of T helper 1 (Th-1) cells with an overexpression of cytokines (interleukin [IL]-4, IL-5, and IL13) and chemokine ligand 1 (CCL1) and 18 (CCL 18) with increases in IgE, eosinophils, and macrophages. Neutrophil refers to white blood cells and eosinophils are one component. Basophils and monocytes are not elevated in atopic dermatitis.

A student has studied secondary multiple organ dysfunction syndrome (MODS). What substance does the student learn is least likely to stimulate the normal endothelial cells to change to a proinflammatory state? a. Interleukin (IL)-1 b. IL-4 c. IL 6 d. Tumor necrosis factor

A student has studied secondary multiple organ dysfunction syndrome (MODS). What substance does the student learn is least likely to stimulate the normal endothelial cells to change to a proinflammatory state? a. Interleukin (IL)-1 b. IL-4 c. IL 6 d. Tumor necrosis factor

A student is perplexed that in a patient with multiple organ dysfunction syndrome (MODS), no infectious source has been found. What statement by the healthcare professional best describes this phenomenon? a. Death of organs b. Translocation of bacteria c. Maldistribution of blood flow d. Massive inflammatory response

A student is perplexed that in a patient with multiple organ dysfunction syndrome (MODS), no infectious source has been found. What statement by the healthcare professional best describes this phenomenon? a. Death of organs b. Translocation of bacteria c. Maldistribution of blood flow d. Massive inflammatory response

A student learns that a fatal burn injury has what effect on interleukins (ILs)? a. Decreases levels of IL-2 b. Decreases levels of IL-4 lymphocytes c. Increases levels of IL-6 d. Increases levels of IL-12

ANS: A A fatal burn injury has often shown decreased levels of IL-2, which may result in decreased Th1 lymphocytes. This results in a major disruption in cellular immunity and IgG production.

Why are two "hits" required to inactivate tumor-suppressor genes? a. Each allele must be altered, and each person has two copies, or alleles, of each gene, one from each parent. b. The first hit stops tissue growth, and the second hit is needed to cause abnormal tissue growth. c. Tumor-suppressor genes are larger than proto-oncogenes, requiring two hits to affect carcinogenesis. d. The first hit is insufficient to cause enough damage to cause a mutation.

ANS: A A single genetic event can activate an oncogene, acting in a dominant manner in the cell. However, each person has two copies, or alleles, of each gene, one from each parent. Therefore two hits are required to inactivate the two alleles of a tumor-suppressor gene, allowing the process to become active. The remaining options do not describe the reason two hits are required.

A patient has an acute burn injury. What type of treatment for shock will the healthcare professional anticipate for this patient? a. Intravenous fluids b. Antibiotics c. Intra-aortic balloon pump d. Antihistamines and steroids

ANS: A Acute burn injuries can lead to hypovolemic shock from massive fluid losses from the circulating blood volume. The professional anticipates treating hypovolemic shock with fluid resuscitation. Antibiotics would be used in septic shock. A balloon pump would be used in cardiogenic shock. Antihistamines and steroids are used in anaphylactic shock.

Which substance has been shown to increase the risk of cancer when used in combination with tobacco smoking? a. Alcohol b. Steroids c. Antihistamines d. Antidepressants

ANS: A Alcohol interacts with smoke, increasing the risk of malignant tumors, possibly by acting as a solvent for the carcinogenic chemicals in smoke products. No current research supports steroids, antihistamines, or antidepressants as having an increased effect on the incidence of cancer when used in combination with tobacco smoking.

The BRCA1 and BRCA2 mutations increase the risk of which cancer in women? a. Ovarian b. Lung c. Uterine d. Pancreatic

ANS: A BRCA1 mutations increase the risk of ovarian cancer among women (20% to 50% lifetime risk), and BRCA2 mutations also confer an increased risk of ovarian cancer (10% to 20% lifetime prevalence). BRCA1 and BRCA2 mutations are not currently believed to be linked with risks of lung, uterine, or pancreatic cancers.

What does the student learn about pleomorphic cells? a. Pleomorphic cells are similar in size. b. They have different sizes and shapes. c. They are a result of anaplasia. d. Pleomorphic cells differentiate uniformly.

ANS: B In contrast to normal cells, which are uniform in size and shape, cancer cells are of variable size and shape, known as "pleomorphic."

Which component of the epidermis initiates immune responses and provides a defense against environmental antigens? a. Langerhans cells b. Merkel cells c. Keratinocytes d. Melanocytes

ANS: A Langerhans cells (a type of dendritic cell) and dermal dendritic cells initiate an immune response by presenting processed antigen to T cells, thus providing a defense against environmental antigens. This function is not carried out by Merkel cells, keratinocytes, or melanocytes.

A healthcare professional assesses that a child's capillary refill time is 4 sec. What does the healthcare professional evaluate that finding to mean? a. The child is in shock. b. The child must have septic shock. c. The child has compensated shock. d. This finding is normal.

ANS: A Normal capillary refill time is <2 sec (brisk). A refill time of 4 sec in prolonged and indicates a perfusion deficit possibly from shock. In septic shock, the capillary refill time may be normal or faster than normal due to vasodilation.

What is apoptosis? a. Normal mechanism for cells to self-destruct when growth is excessive b. Antigrowth signal activated by the tumor-suppressor gene Rb c. Mutation of cell growth stimulated by the TP53 gene d. Transformation of cells from dysplasia to anaplasia

ANS: A Normal cells have a mechanism that causes them to self-destruct when growth is excessive and cell cycle checkpoints have been ignored. Unchecked proliferation could lead to malignancy.

Which contagious disease creates a primary skin lesion that is a pinpointed macule, papule, or wheal with hemorrhagic puncture site? a. Pediculosis b. Tinea capitis c. Scabies d. Rubeola

ANS: A Of the options available, only the primary lesion of the body louse (pediculosis) exhibits a pinpoint red macule, papule, or wheal with a hemorrhagic puncture site.

The professor explains to students that oncogenes are genes that are capable of what? a. Undergoing mutation that directs the synthesis of proteins to accelerate the rate of tissue proliferation b. Directing synthesis of proteins to regulate growth and to provide necessary replacement of tissue c. Encoding proteins that negatively regulate the synthesis of proteins to slow or halt the replacement of tissue d. Undergoing mutation that directs malignant tissue toward blood vessels and lymph nodes for metastasis

ANS: A Oncogenes are independent of normal regulatory mechanisms; thus the cell is driven into a state of unregulated constitutive expression of proliferation signals and uncontrolled cell growth.

. Which cell is thought to be the progenitor cell of Kaposi sarcoma? a. Endothelial b. Keratinocyte c. Melanocyte d. Exothelial

ANS: A Only the endothelial cell is thought to be the progenitor of Kaposi sarcoma, but the specific origin is elusive.

Rubella (German or 3-day measles) is caused by what type of organism? a. Virus b. Bacterium c. Fungus d. Yeast

ANS: A Rubella is a common communicable disease in children and young adults and is caused only by a ribonucleic acid (RNA) virus that enters the bloodstream through the respiratory route.

A patient is diagnosed with septic shock. What action by the healthcare professional will address the main underlying pathophysiologic mechanism of this disorder? a. Administer antibiotics as soon as possible. b. Provide high volumes of isotonic fluid. c. Place patient on an intra-aortic balloon pump. d. Give the patient antihistamines and steroids.

ANS: A Septic shock begins when bacteria enter the bloodstream, so the effective treatment for this specific problem is antibiotics. High volumes of fluid may been needed in all types of shock other than cardiogenic. A balloon pump would be beneficial in cardiogenic shock. Antihistamines and steroids would be used in anaphylactic shock.

In DNA replication, what does the enzyme DNA polymerase do? a. Travel along the single DNA strand, adding the correct nucleotide to the new strand b. Move along the double strand of DNA to unwind the nucleotides of the double helix c. Hold the double strand apart while the correct nucleotides are added to the strand d. Transport the double strand of DNA from the nucleus to the cytoplasm for protein formation

ANS: A The DNA polymerase enzyme travels along the single DNA strand, adding the correct nucleotides to the free end of the new strand (see Figure 4-3, B). The correct option is the only one that accurately describes the process involved in DNA replication using DNA polymerase.

What stimulates the respiratory burst and production of highly toxic free radicals in the multiple organ dysfunction syndrome (MODS)? a. Neutrophils adhering to the endothelium b. Activation of the complement cascade c. Release of prostaglandins, thromboxanes, and leukotrienes d. Activation of the fibrinolytic system

ANS: A The accumulation of activated neutrophils in organs is thought to play a key role in the pathogenetic development of MODS. When neutrophils adhere to the endothelium, they undergo a respiratory burst (oxidative burst) and release oxygen radicals. The respiratory burst occurs as the activated neutrophil experiences a sudden increase in oxidative metabolism, producing large quantities of highly toxic oxygen free radicals. Activation of the complement cascade; release of prostaglandins, thromboxanes, and leukotrienes; and activation of the fibrinolytic system do not provide this stimulus.

Lesions on the elbows and knees that are well demarcated, thick, silvery, scaly, and erythematous characterize which type of psoriasis? a. Plaque b. Inverse c. Guttate d. Erythrodermic

ANS: A The description provided is characteristic of only lesions observed in plaque psoriasis. These lesions are well-demarcated, thick, silvery, scaly, erythematous plaque surrounded by normal skin. Inverse psoriasis is rare and is seen in skinfolds. Guttate psoriasis small papules appear after a streptococcal infection. Erythrodermic psoriasis covers a large portion of the body with red, scaling lesions.

In latex allergies, which immunoglobulin (Ig) is associated with an immediate reaction? a. IgA b. IgE c. IgG d. IgM

ANS: B Latex allergy can be either a type IV hypersensitivity to chemicals used in latex rubber processing or a type I immediate hypersensitivity, with IgE antibodies formed in response to latex rubber protein.

To determine a child's response to fluid therapy for shock, the healthcare professional should monitor which measurements as the priority? a. Hematocrit and hemoglobin levels b. Urine output and specific gravity c. Blood pressure and pulse d. Arterial blood gases and heart rate

ANS: B Monitoring of the volume of urine output and specific gravity is most useful in determining the child's response to fluid therapy.

A patient in the clinic is diagnosed with dermatitis. The patient states that a previous healthcare professional diagnosed eczema. What response by the healthcare professional is best? a. "Both are general terms for a specific inflammatory response in the skin." b. "Eczema is an older, outdated term. The preferred term is dermatitis." c. "No, it's not eczema. Eczema has yellowish scaly plaques." d. "If it were eczema, it would have blisters that go away on their own."

ANS: A The most common inflammatory disorder of the skin is eczema, or dermatitis. Eczema and dermatitis are general terms that describe a particular type of inflammatory response in the skin—these terms can be used interchangeably. Yellowish scaly plaques are seen in seborrheic dermatitis. Self-limiting blisters can be seen in bullous pemphigoid.

. The healthcare professional plans care for a child in shock. What are the primary goals for the treatment of shock? a. Maximizing oxygen delivery and minimizing oxygen demand b. Maintaining hydration and adequate urinary output c. Supporting all facets of the cardiovascular system d. Maintaining all vital signs within normal functioning ranges

ANS: A The primary goals of the treatment of shock are maximizing oxygen delivery and minimizing oxygen demand. The other goals are desirable, but do not take priority over maximizing oxygen delivery and minimizing demand. If those goals are met, the others will be as a result.

The presence of a zygote having one chromosome with the normal complement of genes and one with a missing gene is characteristic of which genetic disorder? a. Cri du chat b. Down syndrome c. Klinefelter syndrome d. Turner syndrome

ANS: A This description is only accurate for Cri du chat syndrome.

A child has white plaque in the mouth with a few shallow ulcers. What treatment does the healthcare professional educate the parent about? a. Nystatin oral suspension b. Warm saline rinses c. Topical antivirals d. No specific treatment

ANS: A This infant has thrush, caused by Candida albicans. The treatment is an antifungal mouth rinse such as nystatin. Warm saline rinses and antiviral medications will not treat this fungal infection.

Traits caused by the combined effects of multiple genes are referred to by which term? a. Polygenic b. Multifocal c. Modifiable d. Involuntary

ANS: A Traits in which variation is thought to be caused by the combined effects of multiple genes are polygenic, meaning many genes. Multifocal means relating to or arising from many points. Modifiable refers to the changeability of something. Involuntary suggests being out of the control of someone or something.

What congenital malformation is commonly linked to acute leukemia in children? a. Down syndrome b. Wilms tumor c. Retinoblastoma d. Neuroblastoma

ANS: A Trisomy 21 (Down syndrome) is the most common genetic defect linked to the development of acute leukemia. Children with Down syndrome have a 10- to 20-fold increased risk of developing acute lymphoblastic and myelogenous leukemia and a higher risk for developing acute megakaryocytic leukemia. No current research supports a link between Wilms tumor, retinoblastoma, or neuroblastoma and acute leukemia.

What are tumor cell markers? a. Hormones, enzymes, antigens, and antibodies that are produced by cancer cells b. Receptor sites on tumor cells that can be identified and marked c. Cytokines that are produced against cancer cells d. Identification marks that are used in administering radiation therapy

ANS: A Tumor (biologic) markers are substances produced by both benign and malignant cells that are found either in or on the tumor cells or in the blood, spinal fluid, or urine. Tumor markers may include hormones, enzymes, genes, antigens, and antibodies. Tumor markers are not receptor sites, cytokines, or identification marks for radiation.

What is the belief regarding twins who adopt dramatically different lifestyles? a. They may experience very different aging processes. b. They will retain very similar methylation patterns. c. They will experience identical phenotypes throughout their lifespans. d. They may never demonstrate similar DNA sequences of their somatic cells.

ANS: A Twins with significant lifestyle differences (e.g., smoking versus nonsmoking) accumulate large numbers of differences in their methylation patterns. The twins, despite having identical DNA sequences, become more and more different as a result of epigenetic changes, which in turn affect the expression of genes. These results, along with findings generated in animal studies, suggest that changes in epigenetic patterns may be an important part of the aging process. They will not experience identical phenotypes throughout their life spans.

Which form of cancer is linked to congenital malformation syndromes? a. Wilms tumor b. Retinoblastoma c. Osteosarcoma d. Rhabdomyosarcoma

ANS: A Wilms tumors are linked with other genetically linked childhood cancers. It is the only form among the available options that is associated with congenital malformation syndromes.

Which intervention has the greatest effect on a child's mortality rate when diagnosed with cancer? a. Age at the time of diagnosis b. Participation in clinical trials c. Proximity to a major cancer treatment center d. Parental involvement in the treatment planning

ANS: B Mortality rates have significantly declined in the past 40 years largely as a result of advances in treatment and participation in clinical trials. Although important, age, proximity to treatment centers, and parental involvement are not believed to have an effect on the decline of the mortality rate of childhood cancer.

What do most childhood cancers arise from? a. Epithelium b. Mesodermal germ layer c. Embryologic ectodermal layer d. Viscera

ANS: B Most childhood cancers originate from the mesodermal germ layer that gives rise to connective tissue, bone, cartilage, muscle, blood, blood vessels, gonads, kidney, and the lymphatic system. The epithelium, embryologic ectodermal layer, and the viscera are not common sites from which cancers originate.

Which statement supports the hypothesis that intestinal polyps are benign neoplasms and the first stage in the development of colon cancer? a. Cancer cells accumulate slower than noncancer cells. b. An accumulation of mutations in specific genes is required to develop cancer. c. Tumor invasion and metastasis progress more slowly in the gastrointestinal tract. d. Apoptosis is triggered by diverse stimuli, including excessive growth.

ANS: B Multiple genetic mutations are required for the evolution of full-blown cancer. This sequential development of cancer has been well documented in the transformation of benign colon polyps to colon cancer.

What is the clinical hallmark of neurogenic shock as a result of the overstimulation of the parasympathetic nervous system? a. Vasoconstriction b. Vasodilation c. Increased metabolism d. Respiratory distress

ANS: B Neurogenic shock refers to a widespread and massive vasodilation that results from an imbalance between parasympathetic and sympathetic stimulation of vascular smooth muscle. Increased metabolism is seen in all forms of shock. Respiratory distress may occur in any form of shock.

The healthcare professional is assessing four patients for pressure ulcer formation. What is the first change in the skin that the professional would note if a patient were developing a pressure ulcer? a. Blanchable erythema of intact skin b. Nonblanchable erythema of intact skin c. Blister at the site of pressure d. Reddish-purple discoloration

ANS: B Nonblanchable erythema of intact skin, usually over bony prominences, characterizes stage 1 pressure ulcers. A blister would indicate a deep tissue pressure injury as would a reddish-purple discoloration. Blanchable erythema of intact skin would not indicate any pressure damage.

Which condition is best defined as a clinical syndrome involving a systemic response to infection, which is manifested by two or more of the systemic inflammatory response syndrome criteria? a. Bacteremia b. Sepsis c. Septicemia d. Septic shock

ANS: B Of the options available, only sepsis is best defined as a systemic response to infection that is manifested by two or more criteria of the systemic inflammatory response syndrome.

What aberrant change causes the abnormal growth in retinoblastoma? a. Proto-oncogenes are changed to oncogenes. b. The tumor-suppressor gene is turned off. c. Genetic amplification causes the growth. d. Chromosomes 9 and 21 are fused.

ANS: B One of the first discovered tumor-suppressor genes, the retinoblastoma (Rb) gene, normally strongly inhibits the cell division cycle. When it is inactivated, the cell division cycle can proceed unchecked. The Rb gene is mutated in childhood retinoblastoma. The remaining options do not describe the abnormal growth in retinoblastoma.

. The World Health Organization (WHO) defines grade 1 (overweight) as which BMI range? a. 18.5 to 24.9 b. 25 to 29.9 c. 30 to 39.9 d. 40 to 50.9

ANS: B A BMI of 25 to 29.9 kg/m2 is considered a grade 1 (overweight) classification. A BMI of 18.5 to 24.9 kg/m2 is considered normal range, whereas 30 to 39.9 kg/m2 is a grade 2 overweight (obese) classification, and a BMI higher than 40 kg/m2 is considered grade 3 overweight (morbidly overweight).

Which condition does a burn injury create for an extended period? a. Hypervolemia b. Hypermetabolism c. Hyponatremia d. Hypotension

ANS: B A burn injury induces a hypermetabolic state that persists until wound closure. Fluid and electrolyte imbalances and hypotension can be resolved with rapid treatment, but the hypermetabolic state lasts for an extended period of time.

A person with 47, XXY karyotype has the genetic disorder resulting in which syndrome? a. Turner b. Klinefelter c. Down d. Fragile X

ANS: B A disorder in the chromosome (47, XXY karyotype) results in a disorder known as Klinefelter syndrome. Turner syndrome has a karyotype of 45, X. Down syndrome is caused by Trisomy 21. Fragile X syndrome is caused by microscopically observable breaks and gaps in the X chromosome.

A parent wants to know how to prevent type 1 diabetes in the newborn. The healthcare professional explains that prevention is not possible, because which of these is a major characteristic of type 1 diabetes mellitus? a. Partial insulin secretion b. An autoimmune cause factor c. Insulin resistance d. Obesity as a common risk factor

ANS: B A strong association between type 1 diabetes and the presence of several human leukocyte antigen (HLA) class II alleles indicate that type 1 diabetes mellitus is an autoimmune disease. The remaining options are associated with type 2 diabetes.

Keloids are caused by excessive amounts of which substance in the corneum during connective tissue repair? a. Elastin b. Collagen c. Stroma d. Reticular fibers

ANS: B Abnormal wound healing with excessive fibroblast activity and collagen formation during dermal connective tissue repair cause keloids. The other substances are not associated with keloid formation.

A 4-year-old child with a burn injury has entered the catabolic flow phase. What assessment would the healthcare provider correlate with this situation? a. Oxygen saturation normal on room air b. 7 pound weight loss in 1 week c. Capillary refill <2 sec d. Blood pressure 89/56 mmHg

ANS: B After the resolution of the shock and the restoration of circulating volume, the metabolic response shifts to a catabolic (flow) phase. A state of hypermetabolism ensues characterized by elevation of catecholamines which are insulin antagonists. Glycogen stores in the child are limited leading to a state of prolonged metabolic dysfunction, the end result of which is loss of lean body mass. The professional would assess the child as being in this phase with a documented weight loss. Oxygen saturation would not give information about oxygen consumption which is elevated in the phase. A capillary refill of <2 sec is normal as is the blood pressure for a 4-year-old.

Amniocentesis is recommended for pregnant with what history? a. Have a history of chronic illness b. Have a family history of genetic disorders c. Have experienced in vitro fertilization d. Had a late menarche

ANS: B Amniocentesis is recommended only for pregnancies known to have an elevated risk for a genetic disease or in women older than 30 to 35 years of age because of the slightly higher risk of fetal loss as compared to the general population. Having a chronic illness, previous in vitro fertilization, or late menarche are not reasons to have an amniocentesis.

A student asks, "What is the percentage of all cases of breast cancer that are identified as an autosomal dominant form?" What response by the professor is best? a. <1 b. 5 to 10 c. 15 to 20 d. 20 to 30

ANS: B An autosomal dominant form of breast cancer accounts for approximately 5% to 10% of breast cancer cases in the United States.

What is an individual's genetic makeup called? a. Phenotype b. Genotype c. Heterozygous locus d. Homozygous locus

ANS: B An individual's genotype is his or her genetic makeup. The outward appearance of an individual is the phenotype. A locus refers to the position a gene occupies on a chromosome.

What is the term for an error in which homologous chromosomes fail to separate during meiosis or mitosis? a. Aneuploidy b. Nondisjunction c. Polyploidy d. Translocation

ANS: B Aneuploidy is usually the result of nondisjunction, an error in which homologous chromosomes or sister chromatids fail to separate normally during meiosis or mitosis. Aneuploidy refers to cells that do not contain a multiple of 23 chromosomes. Polyploidy is when a cell has more than the diploid number of chromosomes, it is said to be a polyploid cell. Translocation refers the interchanging of genetic material between nonhomologous chromosomes.

The student learns that alteration of which gene is associated with basal cell carcinoma? a. myc b. TP53 c. src d. Ras

ANS: B Basal cell carcinoma arises as a consequence of ultraviolet-associated mutation in only the TP53 tumor-suppressor gene leading to the loss of keratinocyte repair functions and apoptosis resistance of DNA-damaged cells. The Ras gene is involved in melanoma. The myc gene codes for a transcription factor and is involved in several cancers. The src gene is a proto-oncogene.

What is the role of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) in cell metastasis? a. To stimulate growth of nearby tumor cells b. To develop new blood vessels to feed cancer cells c. To prevent cancer cells from escaping apoptosis d. To act as a chemical gradient to guide cells to blood vessels

ANS: B By recruiting new vascular endothelial cells and initiating the proliferation of existing blood vessel cells, the angiogenic factors, such as VEGF and growth factor bFGF, allow small cancers to become large cancers.

. By what process do cancer cells multiply in the absence of external growth signals? a. Proto-oncogene b. Autocrine stimulation c. Reliance on caretaker genes d. Pleomorphology

ANS: B Cancer cells must have mutations that enable them to proliferate in the absence of external growth signals. To achieve this, some cancers acquire the ability to secrete growth factors that stimulate their own growth, a process known as autocrine stimulation. A proto-oncogene is a gene that could become an oncogene. Caretaker genes are responsible for genomic integrity. Pleomorphology is the ability of cells to alter their shape or size depending on environmental conditions.

A child is in cardiogenic shock and the parents ask why the child has hepatomegaly and periorbital edema. What explanation by the healthcare professional is best? a. Mass vasodilation as a result of chemical mediators released from the myocardium b. Low cardiac output and systemic venous congestion c. Tissue damage to the myocardium, causing increased capillary permeability d. Reduced renal perfusion, stimulating the RAAS system

ANS: B Cardiogenic shock is generally associated with low cardiac output and systemic venous congestion, leading to signs of fluid backup into organs and tissues. The professional would explain that this is the cause of the hepatomegaly and edema. It is not the result of mass vasodilation, tissue damage, or the RAAS system activation.

What is the purpose of using a Giemsa staining technique on chromosomes? a. Permit the mitotic process to be followed and monitored for variations. b. Allow for the numbering of chromosomes and the identification of variations. c. Identify new somatic cells formed through mitosis and cytokinesis. d. Distinguish the sex chromosomes from the homologous chromosomes.

ANS: B One of the most commonly used stains is Giemsa stain. By using banding techniques, chromosomes can be unambiguously numbered, and individual variation in chromosome composition can be studied. Missing or duplicated portions of chromosomes, which often result in serious diseases, also can be readily identified. The correct option is the only one that accurately describes the purpose of the Giemsa staining technique.

Parents want their child vaccinated against chickenpox. The healthcare professional prepares to administer the vaccine against which organism? a. Poxvirus b. Varicella-zoster virus c. Adenovirus d. Human papillomavirus

ANS: B Only a varicella-zoster viral infection produces chickenpox (varicella) and herpes zoster (shingles).

For which type of shock would antihistamines and corticosteroids be prescribed? a. Septic b. Anaphylactic c. Hypovolemic d. Cardiogenic

ANS: B Only anaphylactic shock responds to the administration of epinephrine to decrease mast cell and basophil degranulation. Antihistamines and steroids are administered to stop the inflammatory reaction. Septic shock specifically requires antibiotics. Hypovolemic shock is treated with large amounts of fluid. Cardiogenic shock requires the use of drugs or devices to improve the pumping ability of the heart.

Carcinoma refers to abnormal cell proliferation originating from which tissue origin? a. Blood vessels b. Epithelial cells c. Connective tissue d. Glandular tissue

ANS: B Only cancers arising from epithelial cells are called carcinomas. Connective tissue cancers are called sarcomas. Glandular tissue cancers are named adenocarcinomas. Malignant cancers can invade blood vessels.

. A patient has an onychomycosis. Where would the healthcare professional assess this disorder? a. Scalp b. Fingernail c. Lower legs d. Mucus membranes

ANS: B Onychomycosis is the term used to identify a fungal or dermatophyte infection of the nail plate. The professional would assess the patient's fingernails (or toenails).

An amniocentesis indicates a neural tube defect when an increase in which protein is evident? a. Cytochrome P-450 b. Alpha fetoprotein c. DNA polymerase d. Embryonic proteins

ANS: B Other disorders can be detected with this procedure. These include most neural tube defects, which cause an elevation of alpha fetoprotein in the amniotic fluid, and hundreds of diseases caused by mutations of single genes. Cytochrome P-450 is useful in helping to formulate drug doses more precisely. DNA polymerase travels along the single DNA strand, adding the correct nucleotides to the free end of the new strand during DNA replication. Embryonic proteins are not involved in neural tube defects.

A patient with several risk factors is concerned about developing type 2 diabetes. The healthcare professional advises the patient to lose weight, explaining that obesity is an important risk factor for type 2 diabetes mellitus because it causes what? a. Reduced insulin production by the pancreas b. Increased resistance to insulin in the cells c. Obstructed outflow of insulin from the pancreas d. Stimulation of glucose production by the liver

ANS: B People with type 2 diabetes mellitus suffer from insulin resistance. Obesity causes this resistance so their cells have difficulty using insulin. Obesity does not lead to reduced insulin production, obstructed insulin outflow, or stimulation of glucose production.

Prader-Willi syndrome causes a chromosomal defect that is what? a. Initiated by postnatal exposure to a virus b. Inherited from the father c. Related to maternal alcohol abuse d. Transferred from mother to child

ANS: B Prader-Willi syndrome can be caused by a 4 Mb deletion of chromosome 15q when inherited from the father. This disorder is not caused by a virus, or related to maternal alcohol abuse. The same gene deletion causes Angelman syndrome when inherited from the mother.

The data reporting that sickle cell disease affects approximately 1 in 600 American blacks is an example of which concept? a. Incidence b. Prevalence c. Ratio d. Risk

ANS: B Prevalence rate is the proportion of the population affected by a disease at a specific point in time. Thus both the incidence rate and the length of the survival period in affected individuals determine prevalence. The incidence rate is the number of new cases of a disease reported during a specific period (typically 1 year), divided by the number of individuals in the population. A numerical expression representing a part of a larger whole or proportion is considered a ratio. Any factor that increases the chance of disease or injury is considered a

. The healthcare professional is teaching a group of new parents about childhood diseases. What does the professional tell them the incubation period for rubella is? a. 3 to 5 days b. 14 to 21 days c. 7 to 10 days d. 5 to 15 days

ANS: B Rubella has an incubation period that ranges from 14 to 21 days.

When are childhood cancers most often diagnosed? a. During infancy b. At peak times of physical growth c. After diagnosis of a chronic illness d. After an acute illness

ANS: B Childhood cancers are most often diagnosed during peak times of physical growth. No current research supports the association between frequency of diagnosis and infancy, chronic illness, or acute illness.

Burkitt lymphomas designate a chromosome that has a piece of chromosome 8 fused to a piece of chromosome 14. This is an example of which mutation of normal genes to oncogenes? a. Point mutation b. Chromosome translocation c. Gene amplification d. Chromosome fusion

ANS: B Chromosome translocations, in which a piece of one chromosome is translocated to another chromosome, can activate oncogenes. One of the best examples is the t(8;14) translocation found in many Burkitt lymphomas; t(8;14) designates a chromosome that has a piece of chromosome 8 fused to a piece of chromosome 14. A point mutation is the alteration of one or a few nucleotide base pairs. Gene amplification is the result of repeated duplication of a region of a chromosome, so that instead of the normal two copies of a gene, tens or even hundreds of copies are present. Chromosome fusion occurs during translocation.

Parents do not want the child to contract tinea corporis. Which animal would they limit the child's exposure to? a. Mites b. Kittens c. Ponies d. Ticks

ANS: B Contact with kittens and puppies is considered a common source of tinea corporis.

People diagnosed with neurofibromatosis have varying degrees of the condition because of which genetic principle? a. Penetrance b. Expressivity c. Dominance d. Recessiveness

ANS: B Expressivity is the extent of variation in phenotype associated with a particular genotype. If expressivity of a disease is variable, then the penetrance may be complete but the severity of the disease can vary greatly. A well-known example of variable expressivity in an autosomal dominant disease is type 1 neurofibromatosis. The penetrance of a trait is the percentage of individuals with a specific genotype who also exhibit the expected phenotype. An allele whose effects are observable is said to be dominant, while one whose effects are hidden is said to be recessive.

What is the most commonly reported symptom of cancer treatment? a. Nausea b. Fatigue c. Hair loss d. Weight loss

ANS: B Fatigue is the most frequently reported symptom of cancer and cancer treatment. Although patients report the other options, they are not as frequently experienced as fatigue.

What are empirical risks for most multifactorial diseases based on? a. Chromosomal testing b. Direct observation c. Liability thresholds d. Relative risks

ANS: B For most multifactorial diseases, empirical risks (i.e., risks based on direct observation of data) have been derived. Chromosomal testing, liability thresholds, and relative risks are not the basis for determining the empirical risk of most multifactorial diseases.

Which disease form is associated with identified empirical risks? a. Polygenic b. Multifactorial c. Monozygotic d. Genetic

ANS: B For most multifactorial diseases, empirical risks (i.e., risks based on direct observation of data) have been derived. Traits in which variation is thought to be caused by the combined effects of multiple genes are polygenic. Monozygotic is a term that refers to identical twins. Genetic refers to issues related to genes and their influence on the body.

A baby has diaper dermatitis. What secondary infection does the healthcare professional assess for? a. Escherichia coli b. Candida albicans c. Proteus spp. d. Staphylococcus aureus

ANS: B Frequently the infant with diaper dermatitis has a secondary infection with C. albicans.

The healthcare professional explains to a student that the most serious outcome resulting from limited glycogen stores in children who have been seriously burned is which of these? a. Poor wound healing b. Increased morbidity c. Decreased immunity d. Loss of adipose tissue stores

ANS: B Glycogen stores are limited in children, making it hard for them to meet the increased energy demands of the burn. This prolonged metabolic dysfunction may lead to the loss of lean body mass. The most serious effect of weight loss is increased morbidity. Limited glycogen stores do not directly affect wound healing, immunity, or adipose tissue stores.

. A healthcare professional assesses a patient who has elevated lesions on the face that are waxy and yellowish. What condition does the professional discuss with the patient? a. Basal keratosis b. Seborrheic keratosis c. Keratoacanthoma d. Actinic keratosis

ANS: B Seborrheic keratosis is a benign proliferation of cutaneous basal cells that produces smooth or warty elevated lesions. The pathogenetic origin is unknown. Seborrheic keratosis usually occurs in older people as multiple lesions on the chest, back, and face. The color varies from tan to waxy, yellow, flesh-colored, or dark brown to black. Keratoacanthoma usually arise from hair follicles. Actinic keratosis is a common premalignant condition with lesions that are rough, poorly defined, and pink or reddish.

Why an X-linked recessive disease can skip generations? a. Females are hemizygous for the X chromosome. b. The disease can be transmitted through female carriers. c. Mothers cannot pass X-linked genes to their sons. d. These diseases need only one copy of the gene in females.

ANS: B Skipped generations are often observed in X-linked recessive disease pedigrees because the gene can be transmitted through female carriers. Males are hemizygous for genes on the X chromosome. Fathers cannot pass X-linked genes to their sons. X-linked recessive diseases are observed significantly more often in males than in females, because males need only one copy of the gene to express the disease.

Which type of dressings should the healthcare professional apply to pressure ulcers? a. Flat and dry b. Flat, moisture-retaining c. Bulky and dry d. Bulky, moisture-retaining

ANS: B Superficial pressure ulcers should be covered with flat, nonbulky dressings that cannot wrinkle or cause increased pressure or friction. The dressing should be moisture-retaining such as Hydrogel.

A child has been diagnosed with acute lymphoblastic leukemia (ALL). What does the healthcare professional tell the parents about the survival rate at 5 years for this disease? a. 90% b. 70% c. 40% d. 20%

ANS: B The 5-year survival rate for ALL is about 90%.

What is the final outcome of impaired cellular metabolism? a. Cellular alterations in the heart and brain b. Buildup of cellular waste products c. Cellular alterations in the vasculature structures and kidneys d. Impairment of urine excretion

ANS: B The common pathway in all types of shock is impairment of cellular metabolism as a result of decreased delivery of oxygen and nutrients, which are frequently coupled with an increased demand, the consumption of oxygen and nutrients, and a decreased removal of cellular waste products. Eventually organ dysfunction and failure do occur. Urine excretion diminishes as the kidneys fail from lack of perfusion or due to hypovolemic shock and volume loss.

What is the second most commonly recognized genetic cause of intellectual disability? a. Down syndrome b. Fragile X syndrome c. Klinefelter syndrome d. Turner syndrome

ANS: B The fragile X syndrome is the second most common genetic cause of intellectual disability (after Down syndrome). Fragile X, Klinefelter, and Turner syndromes not observed with enough frequency are to be recognized as the second most common cause of intellectual disability.

Which genetic disease has been linked to a mutation of the tumor-suppressor gene? a. Hemochromatosis b. Retinoblastoma c. Familial breast cancer d. Hemophilia A

ANS: B The gene responsible for retinoblastoma has been mapped to the long arm of chromosome 13, and its DNA sequence has been extensively studied. This gene is known as a tumor-suppressor gene; the normal function of its protein product is to regulate the cell cycle so that cells do not grow uncontrollably. Hemochromatosis, familial breast cancer, and hemophilia A are not caused by a mutation of the tumor-suppressor gene.

Blistering of the skin within minutes occurs in which type of burn injury? a. First degree b. Superficial partial thickness c. Deep partial thickness d. Full thickness

ANS: B The hallmark of superficial partial-thickness injury is the appearance of thin-walled, fluid-filled blisters that develop within only a few minutes after injury. First degree burns only involve the epidermis and can be compared to a sunburn. A deep partial thickness burn looks waxy white and may initially be indistinguishable from a full thickness burn until new skin buds and hair appear within 7 to 10 days.

The number of new cases of a disease reported during a specific period divided by the number of individuals in the population is defined as which characteristic of a disease? a. Prevalence rate b. Incidence rate c. Relative risk d. Frequency

ANS: B The incidence rate is the number of new cases of a disease reported during a specific period (typically 1 year) divided by the number of individuals in the population. The prevalence rate is the proportion of the population affected by a disease at a specific point in time. The relative risk is a ratio of the increased rate of disease among a population exposed to a risk factor compared with the increased rate of the disease in an unexposed population. Frequency is a simple measure of how often something occurs.

Which clinical manifestation of septic shock confirms an elevation in immune system response? a. Tachycardia b. Increased white blood cell count c. Low respiratory rate d. Hypothermia

ANS: B The increased WBCs indicate the immune response. Tachycardia occurs as a compensatory mechanism. The respiratory rate will be increased. Temperature will most likely be increased in most patients.

What is the consequence for cells when the functioning TP53 gene is lost as a result of mutation? a. Cells undergo apoptosis. b. Cells escape apoptosis. c. Cells receive less oxygen. d. Cells adhere more readily.

ANS: B The most common mutations conferring resistance to apoptosis occur in the TP53 gene. The remaining options do not accurately describe the effect when the functioning TP53 gene is lost as a result of mutation.

The student learns that the cause of molluscum contagiosum is which of these? a. Bacteria b. Virus c. Fungi d. Rickettsia

ANS: B The poxvirus is the only organism that induces epidermal cell proliferation and blocks immune responses that would control the virus as noted with molluscum contagiosum.

When a chromosome lacking 4 million base pairs is inherited from the mother, the child is at risk for developing which syndrome? a. Prader-Willi b. Angelman c. Beckwith-Wiedemann d. Russell-Silver

ANS: B This anomaly illustrates the inheritance pattern of Angelman syndrome, which can be caused by a deletion of 4 million base pairs from chromosome 15q when inherited from the mother. The anomaly is not the cause of any of the other syndromes, although the same gene deletion when inherited from the father does lead to Prader-Willi syndrome.

A healthcare professional is assessing a child who has complete trisomy of the twenty-first chromosome. What findings does the professional relate to this condition? a. Widely spaced nipples, reduced carrying angle at the elbow, and sparse body hair b. An IQ of 25 to 70, low nasal bridge, protruding tongue, and flat, low-set ears c. High-pitched voice, tall stature, gynecomastia, and an IQ of 60 to 90 d. Circumoral cyanosis, edema of the feet, short stature, and mental slowness

ANS: B This child has Trisomy 21, also known as Down syndrome. These children typically present with IQs ranging from 25 to 70. The facial appearance is distinctive and exhibits a low nasal bridge, epicanthal folds, protruding tongue, and flat, low-set ears. Widely spaced nipples and edema of the newborn's feet are characteristic of Turner syndrome. The high-pitched voice and gynecomastia are characteristic of Klinefelter syndrome.

A healthcare professional assesses a patient who presents with a single lesion on the trunk that is circular, demarcated, and salmon pink. The lesion measures approximately 3 to 4 cm in diameter. What treatment option does the professional educate the patient about? a. Narrow-band ultraviolet light therapy b. Oral erythromycin regime c. Keratolytic agent application d. Consistent photoprotection

ANS: B This patient has a herald patch, seen in pityriasis rosea. Treatments include medication for itching and erythromycin and acyclovir. UV light therapy is a treatment for lichen planus. Keratolytic agents are used in psoriasis. Photoprotection is vital in acne rosacea.

A person has a vascular anomaly associated with a congenital malformation of dermal capillaries and has been told this lesion does not fade with age. What treatment options can the healthcare professional discuss with this person? a. Surgical excision b. Pulsed dye laser c. Cool temperatures d. Cosmetic tattooing

ANS: B This person has a port-wine stain. The pulsed dye laser is the treatment of choice to fade the color and flatten its contour. Surgical excision is not required. Cool temperatures will not help. This lesion may be very large and is on the face so tattooing would not be a viable option for most people.

A child has been diagnosed with ringworm and the parent asks how to get rid of this parasite. What response by the healthcare professional is most appropriate? a. "We have several antibiotics that can be used." b. "Ringworm is actually a fungal infection of the skin." c. "Actually, ringworm is an old name for pemphigus." d. "Inexpensive topical antifungals often work well."

ANS: B Tinea corporis (ringworm) is a fungal infection of the skin and is not actually an infestation of worms. The healthcare professional should educate the parent to this fact.

When microRNA (miRNA) are methylated their messenger RNA (mRNA) targets are over-expressed. What would be the resulting effect on existing cancer? a. Cell death b. Metastasis c. Remission d. Relapse

ANS: B When miRNA genes are methylated, their mRNA targets are over-expressed, and this over-expression has been associated with aberrant function of tumor-suppression genes. This process does not cause cell death, remission, or relapse.

Which statement is true regarding X-linked recessive conditions? a. Such diseases use males as phenotypical carriers. b. These conditions are passed from affected father to all of his female children. c. 25% of an affected individual's grandsons will be affected. d. Cystic fibrosis is an example of such a condition.

ANS: B X-linked recessive conditions are passed from an affected father to all of his daughters, who, as phenotypically normal carriers, transmit it to approximately one half of their sons, who are affected. Cystic fibrosis is an autosomal dominant disease.

. A patient has a furuncle. Where would the healthcare professional assess the patient for this condition? a. Feet b. Palms c. Hair follicles d. Fingernails

ANS: C A furuncle, or "boil," is used to identify an inflammation of the hair follicles (root) that may develop from a preceding folliculitis and spread through the follicular wall into the surrounding dermis.

Which dietary lifestyle choice has been associated with a decreased risk for developing colon cancer? a. Increased consumption of dairy products b. Increased consumption of foods containing vitamin C c. Decreased consumption of foods high in fat d. Decreased consumption of artificial food coloring

ANS: C A low-fat, high-fiber diet is thought to decrease the risk of colon cancer. Consumption of dairy products, vitamin C, and artificial food coloring are not thought to be related to colon cancer.

How does the ras gene convert from a proto-oncogene to an oncogene? a. Designating a chromosome that has a piece of one chromosome fused to a piece of another chromosome b. Duplicating a small piece of a chromosome, repeatedly making numerous copies c. Altering one or more nucleotide base pairs d. Promoting proliferation of growth signals by impairing tumor-suppressor genes

ANS: C A point mutation is the alteration of one or a few nucleotide base pairs. This type of mutation can have profound effects on the activity of proteins. A point mutation in the ras gene converts it from a regulated proto-oncogene to an unregulated oncogene, an accelerator of cellular proliferation. Fusion, duplications, and proliferation of growth signals are not the cause of a ras gene converting to an oncogene.

In teaching a women's community group, which risk factor does the healthcare professional teach is related to high morbidity of cancer of the colon, uterus, and kidney? a. Women older than 45 years of age b. Women who have never had children c. Women who have a high body mass index d. Woman who have smoked for more than 10 years

ANS: C A recent hypothesis states that the observed increased incidence of such cancers as breast, endometrium, colon, liver, kidney, and adenomas of the esophagus may be associated with obesity. No current research supports the remaining options.

What is the cause of familial hypercholesterolemia (FH)? a. Diet high in saturated fats b. Increased production of cholesterol by the liver c. Reduction in the number of low-density lipoprotein (LDL) receptors on cell surfaces d. Abnormal function of lipoprotein receptors circulating in the blood

ANS: C A reduction in the number of functional LDL receptors on cell surfaces causes FH. Lacking the normal number of LDL receptors, cellular cholesterol uptake is reduced and circulating cholesterol levels increase. High dietary fat intake, increased cholesterol production, and abnormal circulating lipoprotein receptors are not the basis for developing familial FH.

What are genes responsible for the maintenance of all cells referred to as? a. Universal b. Managerial c. Housekeeping d. Executive

ANS: C A small percentage of genes, termed housekeeping genes, are necessary for the function and maintenance of all cells. The remaining options do not accurately refer to these cells.

What can a malfunction in DNA methylation lead to? a. Hypothyroidism b. Blindness c. Cancer d. Diabetes mellitus

ANS: C Aberrant methylation can lead to silencing of tumor-suppressor genes in the development of cancer. No research supports a connection between hypothyroidism, blindness, or diabetes mellitus to a malfunctioning of DNA methylation

Adoption studies have shown that the offspring of an alcoholic parent have what amount of an increased risk of developing alcoholism when raised by a nonalcoholic parent? a. Twofold b. Threefold c. Fourfold d. Tenfold

ANS: C Adoption studies have shown that the offspring of an alcoholic parent, even when raised by nonalcoholic parents, have a fourfold increased risk of developing the disorder.

In childhood neuroblastoma, the N-myc oncogene undergoes which type of mutation of normal gene to oncogene? a. Point mutation b. Chromosome fusion c. Gene amplification d. Chromosome translocation

ANS: C Amplifications are the result of the duplication of a small piece of a chromosome over and over again; consequently, instead of the normal two copies of a gene, tens or even hundreds of copies are present. The N-myc oncogene is amplified in 25% of childhood neuroblastoma.

Four patients are in the intensive care unit with different types of shock. Which patient would the healthcare professional assess as the priority? a. Septic b. Hypovolemic c. Anaphylactic d. Neurogenic

ANS: C Anaphylactic shock is characterized by massive vasodilation and widespread inflammation that can lead to death in minutes if treatment is not instituted immediately. If all else is equal, the healthcare professional should assess the patient with anaphylactic shock first.

Autocrine stimulation is the ability of cancer cells to do what? a. Stimulate angiogenesis to create their own blood supply b. Encourage secretions that turn off normal growth inhibitors c. Secrete growth factors that stimulate their own growth d. Divert nutrients away from normal tissue for their own use

ANS: C Cancer cells must have mutations that enable them to proliferate in the absence of external growth signals. To achieve this, some cancers acquire the ability to secrete growth factors that stimulate their own growth, a process known as autocrine stimulation. The other options describe other activities of cancer cells, but not autocrine stimulation.

It has been determined that a patient's tumor is in stage 2. How does the healthcare professional describe this finding to the patient? a. Cancer is confined to the organ of origin. b. Cancer has spread to regional structures. c. Cancer is locally invasive. d. Cancer has spread to distant sites.

ANS: C Cancer confined to the organ of origin is stage 1; cancer that is locally invasive is stage 2; cancer that has spread to regional structures, such as the lymph nodes, is stage 3; and cancer that has spread to distant sites, such as a liver cancer spreading to the lung or a prostate cancer spreading to bone, is stage 4.

Carcinoma in situ is characterized by which changes? a. Cells have broken through the local basement membrane. b. Cells have invaded immediate surrounding tissue. c. Cells remain localized in the glandular or squamous cells. d. Cellular and tissue alterations indicate dysplasia.

ANS: C Carcinoma in situ (CIS) refers to preinvasive epithelial malignant tumors of glandular or squamous cell origin. These early stage cancers are localized to the epithelium and have not broken through the local basement membrane or invaded the surrounding tissue. Dysplasia refers to changes in mature cell structure.

Which gastrointestinal tract condition can be an outcome of both chemotherapy and radiation therapy? a. Increased cell turnover b. Constipation c. Stomatitis d. Bloody stool

ANS: C Chemotherapy and radiation therapy may cause a decreased cell turnover, thereby leading to oral ulcers (stomatitis), malabsorption, and diarrhea.

Consanguinity refers to the mating of people in what situation? a. Who are unrelated b. When one has an autosomal dominant disorder c. Having common family relations d. When one has a chromosomal abnormality

ANS: C Consanguinity refers to the mating of two related individuals, and the offspring of such matings are said to be "inbred."

Prenatal exposure to diethylstilbestrol (DES) can result in which type of cancer? a. Breast cancer b. Leukemia c. Vaginal cancer d. Lymphoma

ANS: C DES has been identified as a transplacental chemical carcinogen; a small percentage of the daughters of women who took DES during pregnancy developed adenocarcinomas of the vagina. No current research supports a link between the drug and other cancers.

What is most likely the shape of the face of a child diagnosed with Russell-Silver syndrome? a. Round b. Square c. Triangular d. Elongated

ANS: C Growth retardation, proportionate short stature, leg-length discrepancy, and a small, triangular-shaped face characterizes Russell-Silver syndrome. The other face shapes are not characteristic of Russell-Silver syndrome.

Which receptors of the sympathetic nervous system regulate heat loss through the skin? a. Cholinergic b. b-Adrenergic c. a-Adrenergic d. Anticholinergic

ANS: C Heat loss can be regulated by varying blood flow through the skin by opening and closing the arteriovenous anastomoses in conjunction with evaporative heat loss of sweat. The sympathetic nervous system regulates vasoconstriction and vasodilation through a-adrenergic receptors only.

Research has shown a link between cancer and which sexually transmitted disease? a. Syphilis b. Gonorrhea c. Human papillomavirus d. Pelvic inflammatory disease

ANS: C Human papillomavirus (HPV) is the most common sexually transmitted virus in the United States. High-risk, or oncogenic, HPVs can cause cancer. A persistence of infection with high-risk HPV is a prerequisite for the development of cervical intraepithelial neoplasia (CIN) lesions and invasive cervical cancers. No research supports such a link between syphilis, gonorrhea, or pelvic inflammatory disease and cancer.

Hypovolemic shock begins to develop when intravascular volume has decreased by what percentage? a. 5 b. 10 c. 15 d. 20

ANS: C Hypovolemic shock begins to develop when intravascular volume has decreased by approximately 15%.

A parent of a child in a crowded daycare is worried about the staff passing on a bacterial infection to the child. Which infection would be most likely? a. Atopic dermatitis b. Staphylococcal scalded-skin syndrome c. Impetigo d. Tinea capitis

ANS: C Impetigo is a common bacterial skin infection in infants and children and is particularly infectious among people living in crowded conditions with poor sanitary facilities or in settings such as daycare facilities. The other options are not as infectious as impetigo.

What syndrome, characterized by an absent homologous X chromosome with only a single X chromosome, exhibits features that include a short stature, widely spaced nipples, and webbed neck? a. Down b. Cri du chat c. Turner d. Klinefelter

ANS: C In Turner syndrome, a sex chromosome is missing, and the person's total chromosome count is 45. Characteristic signs include short stature, female genitalia, webbed neck, shieldlike chest with underdeveloped breasts and widely spaced nipples, and imperfectly developed ovaries. Children with Down syndrome have an IQ of 25 to 70, low nasal bridge, protruding tongue, and flat, low-set ears. Children with Cri du chat have a characteristic cry and other symptoms include low birth weight, severe intellectual disability, microcephaly (smaller than normal head size), heart defects, and a typical facial appearance. A high-pitched voice and gynecomastia are characteristic of Klinefelter syndrome.

When a child inherits a disease that is autosomal recessive, it is inherited from whom? a. Father b. Mother c. Both parents d. Grandparent

ANS: C In most cases of recessive disease, both parents of affected individuals are heterozygous carriers.

The student learns that which mechanism causes organ injury in primary multiple organ dysfunction syndrome (MODS)? a. Impaired immune response b. Impaired glucose use c. Impaired perfusion d. Impaired ventilation

ANS: C In primary MODS, the organ injury is directly associated with a specific insult, most often ischemia or impaired perfusion from an episode of shock or trauma, thermal injury, soft tissue necrosis, or invasive infection. Although MODS can be associated with impaired immune response, glucose use, and ventilation, the commonality in all cases of primary MODS is impaired perfusion.

Which immunoglobulin (Ig) is elevated in atopic dermatitis? a. IgA b. IgM c. IgE d. IgG

ANS: C In the acute phase of atopic dermatitis, inflammation is associated with the activation of T helper 1 (Th-1) cells with an overexpression of cytokines (interleukin [IL]-4, IL-5, and IL-13) and chemokine ligand 1 (CCL1) and 18 (CCL18) with increases in IgE, eosinophils, and macrophages. IgA, IgM, and IgG are not involved in atopic dermatitis.

What is the major virus involved in the development of cervical cancer? a. Herpes simplex virus type 6 b. Herpes simplex virus type 2 c. Human papillomavirus d. Human immunodeficiency virus

ANS: C Infection with specific subtypes of human papillomavirus (HPV) causes virtually all cervical cancers. The remaining options are not known to be associated with cervical cancer.

Inherited mutations that predispose to cancer are almost invariably what kind of gene? a. Proto-oncogenes b. Oncogenes c. Tumor-suppressor genes d. Growth-promoting genes

ANS: C Inherited mutations that predispose to cancer are almost invariably in tumor-suppressor genes. At present, no research supports the other options as factors related to how inherited mutations cause cancer.

Which cancers pose the highest risk for radiologists? a. Thyroid b. Breast c. Leukemia d. Brain

ANS: C Ionizing radiation exposure places radiologists at risk for the development of leukemia, lymphoma, and skin cancers.

A child has been diagnosed with tinea corporis. Which lesion would the healthcare professional assess for in this condition? a. Pink-to-red coalescing maculopapular rash on the face or trunk b. Vesicles that rupture, creating a thin, flat, honey-colored crust c. Circular (round or oval) lesions with erythema and scaling patches d. Red papules, vesicles, and pustules in clusters

ANS: C Lesions caused by tinea corporis are often erythematous, round, or oval-scaling patches that peripherally spread with clearing in the center, creating the ring appearance, which is why this disease is commonly referred to as ringworm. A pink-to-red rash is characteristic of rubella. The honey-colored crusts cover the lesions of bullous impetigo. Clusters of papules, vesicles, and pustules characterize varicella.

Males, having only one X chromosome, are said to be what? a. Homozygous b. Heterozygous c. Hemizygous d. Ambizygous

ANS: C Males, having only one X chromosome, are said to be hemizygous for genes on this chromosome. Homozygous refers to two alleles being identical at a specific locus. When the alleles are not identical at that locus, the individual is said to be heterozygous. Ambizygous is not a term in the text.

What is the most common cause of Down syndrome? a. Paternal nondisjunction b. Maternal translocations c. Maternal nondisjunction d. Paternal translocation

ANS: C Nondisjunction during the formation of one of the parent's gametes or during early embryonic development occurs in approximately 97% of infants born with Down syndrome. In approximately 90% to 95% of infants, the nondisjunction occurs in the formation of the mother's egg cell. Down syndrome is rarely caused by paternal nondisjunction. Robertsonian translocations are responsible for 3% to 5% of cases of Down syndrome. A high-pitched voice and gynecomastia are characteristic of Klinefelter syndrome.

The number of persons living with a specific disease at a specific point in time is referred to by which term? a. Relativity b. Survivability c. Prevalence d. Incidence

ANS: C The prevalence rate is the proportion of the population affected by a disease at a specific point in time. Thus both the incidence rate and the length of the survival period in affected individuals determine prevalence. The term "relativity" is not related to disease statistics. Survivability would refer to the chances of a person being able to survive a specific disease and is also not related to the question. The incidence rate is the number of new cases of a disease reported during a specific period (typically 1 year) divided by the number of individuals in the population.

What is the risk for the recurrence of autosomal dominant diseases? a. 10% b. 30% c. 50% d. 70%

ANS: C The recurrence risk for autosomal dominant diseases is usually 50%.

A patient shows the healthcare professional a collection of infected hair follicles on the back of the neck is red, painful, and draining. What condition does the professional educate the patient on? a. Erysipelas b. Furuncles c. Carbuncles d. Boils

ANS: C The term carbuncle is used to identify a collection of infected hair follicles occurring most often on the back of the neck, the upper back, and the lateral thighs. The lesion begins in the subcutaneous tissue and lower dermis as a firm mass that evolves into an erythematous, painful, and swollen mass and drains through many openings. Erysipelas is a bacterial infection with firm red spots that coalesce together. A furuncle, or boil, is a deep, firm, red, painful nodule that changes into a fluctuant cyst.

What are the two most important risk factors for type 2 diabetes? a. Autoantibodies and human leukocyte antigen associations b. Autoantibodies and obesity c. Obesity and positive family history d. HLA associations and positive family history

ANS: C The two most important risk factors for type 2 diabetes are positive family history and obesity. Autoantibodies and human leukocyte antigen associations are not believed to be important risk factors for this form of diabetes.

A patient is brought to the Emergency Department with cold, white, waxy fingers and toes. The patient denies pain. Which intervention does the healthcare professional provide as the priority? a. Applying local, dry heat b. Rubbing or massaging the area c. Immersing in warm water d. Leaving the area uncovered

ANS: C This patient has signs of frostbite. Immersion in a warm-water bath (40°C to 42°C [104°F to 107.6°F]) until frozen tissue is thawed is the best treatment for frostbite. Rubbing or massaging the area would damage the traumatized cells. Dry heat is not used. Leaving the area uncovered would occur in order to immerse it.

How is transcription best defined? a. DNA polymerase binds to the promoter site on ribonucleic acid (RNA). b. RNA directs the synthesis of polypeptides for protein synthesis. c. RNA is synthesized from a DNA template. d. A base pair substitution results in a mutation of the amino acid sequence.

ANS: C Transcription is the process by which RNA is synthesized from a DNA template. The correct option is the only one that accurately defines the term transcription.

What do hypomethylation and the resulting effect on oncogenes result in? a. A decrease in the activity of the oncogene, thus suppressing cancer development. b. A deactivation of MLH1 to halt DNA repair. c. An increase in tumor progression from benign to malignant. d. An over-expression of microRNA, resulting in tumorigenesis.

ANS: C Tumor cells typically exhibit hypomethylation (decreased methylation), which can increase the activity of oncogenes. Hypomethylation increases as tumors progress from benign neoplasms to malignancy. Hypomethylation does not result in suppressed cancer development, deactivation of MLH1, or over-expression of micro-RNA.

What is the difference between DNA sequence mutations and epigenetic modifications? a. DNA sequence mutations can be directly altered. b. Leukemia is a result of only DNA sequence mutation. c. Epigenetic modifications potentially can be reversed. d. No known drug therapies are available for epigenetic modifications.

ANS: C Unlike DNA sequence mutations, which cannot be directly altered, epigenetic modifications can be reversed. The remaining options are not true statements regarding the difference between DNA sequence mutations and epigenetic modifications.

A student studying biology asks the professor to describe how the ras gene is involved in cancer proliferation. What explanation by the professor is best? a. It suppresses the action of the tumor-suppressor genes. b. It changes the way the growth promotion genes work. c. A mutation in this gene allows continuous cell growth. d. It activates a cell surface receptor that allows signaling to the nucleus.

ANS: C Up to one-third of all cancers have an activating mutation in the gene for an intracellular signaling protein called ras. This mutant ras stimulates cell growth even when growth factors are missing. The remaining options do not describe how ras contributes to cancer formation and growth

What does the health professions student learn about benign tumors? a. The resulting pain is severe. b. Benign tumors are not encapsulated. c. Benign tumors are fast growing. d. The cells are well-differentiated.

ANS: D A benign tumor is well-differentiated with its tissue appearing similar to the tissue from which it arose. The other options are characteristic of a malignant tumor.

The ratio of the disease among the exposed population to the disease rate in an unexposed population is referred to as what type of risk? a. Attributable b. Contingency c. Causal d. Relative

ANS: D A common measure of the effect of a specific risk factor is the relative risk. Assuming a factor is the cause of a disease, attributable risk is the amount of risk that is due to that factor. A future event or circumstance that is possible but cannot be predicted with certainty is a contingency risk. The probability of the outcome is termed a causal risk factor.

Regarding type 2 diabetes, obesity is considered to be what type of risk? a. Genetic b. Empirical c. Relative d. Modifiable

ANS: D A modifiable risk is one a person can change in order to reduce risk. Obesity is a modifiable risk factor for many diseases including heart disease, stroke, hypertension, and type 2 diabetes. Genetic, empirical, and relative risks are not changeable by individuals in order to reduce their chance of developing diseases.

A couple has two children diagnosed with an autosomal dominant genetic disease and asks the healthcare professional what the probability is that their next child will have the same genetic disease. What response by the professional is best? a. One sixth b. One fourth c. One third d. One half

ANS: D Affected heterozygous individuals transmit the trait to approximately one half of their children; however, because gamete transmission is subject to chance fluctuations, it is possible that all or none of the children of an affected parent may have the trait. Nevertheless, when large numbers of matings of this type are studied, the proportion of affected children closely approaches one half.

Which statement is likely true regarding children being treated for cancer with radiation therapy? a. They will most likely have a successful remission of tumor growth. b. They seldom require follow-up maintenance treatments. c. They are prone to experience severe developmental delays. d. They are at increased risk for developing childhood cancers.

ANS: D Although the need exists for long-term studies, research has shown a correlation between radiation-induced malignancies from radiotherapy (as in cancer treatment) or radiation exposure from diagnostic imaging; both have shown to increase the risk of developing cancer during childhood. The other options are not necessarily true regarding the outcomes of radiation therapy for childhood cancers.

Which term is used to describe a cell showing a loss of cellular differentiation? a. Dysplasia b. Hyperplasia c. Metaplasia d. Anaplasia

ANS: D Anaplasia is defined as the loss of cellular differentiation, irregularities of the size and shape of the nucleus, and the loss of normal tissue structure. In clinical specimens, anaplasia is recognized by a loss of organization and a significant increase in nuclear size with evidence of ongoing proliferation. Dysplasia is the presence of an abnormal cell type within a tissue and often is called "precancerous." Hyperplasia is an enlargement of an organ or tissue due to increased production of its cells, also often considered precancerous. Metaplasia is an abnormal change in the characteristics of a tissue.

What is the treatment plan the healthcare professional discusses with a patient for a strawberry hemangioma? a. Cosmetic surgical removal b. Topical steroid therapy c. Oral antibiotics d. Support of its involution

ANS: D Approximately 90% of strawberry hemangiomas involute by 5 to 6 years of age, usually without scarring; therefore, self-resolution is the usual treatment plan.

Lesions that usually have depressed centers with rolled borders and are frequently located on the face and neck characterize which malignancy? a. Squamous cell carcinoma b. Kaposi sarcoma c. Malignant melanoma d. Basal cell carcinoma

ANS: D Basal cell carcinoma lesions have depressed centers with rolled borders. Lesions are most often observed on people who live in regions with intense sunlight and on those areas of the skin most exposed—namely, the face and neck. Squamous cell lesions are firm with a granular surface that bleeds easily. Kaposi sarcoma lesions are purplish brown macules and develop into plaques and nodules and are seen most often in people with AIDS. The ABCDE rule is used as a guide for assessing malignant melanoma: Asymmetry, Border irregularity, Color variation, Diameter larger than 6 mm, and Elevation which includes raised appearance or rapid enlargement.

What are characteristics of benign tumors? a. Benign tumors invade local tissues. b. Benign tumors spread through the lymph nodes. c. Benign tumors cause systemic symptoms. d. Benign tumors include the suffix -oma.

ANS: D Benign tumors are usually encapsulated and well-differentiated. They retain some normal tissue structure and do not invade the capsules surrounding them or spread to regional lymph nodes or distant locations. Benign tumors are generally named according to the tissues from which they arise and include the suffix -oma. Benign tumors do not cause systemic symptoms.

A 2-year-old is in shock. The healthcare professional assesses the child's heart rate as 52 beats/min. What action by the healthcare professional is most appropriate? a. Get an ECG. b. Increase the intravenous rate. c. Sedate the child. d. Begin CPR.

ANS: D Bradycardia often indicates impending cardiovascular collapse or cardiac arrest and is the most common terminal cardiac rhythm observed in children. The normal resting heart rate in a toddler is 80 to 120 beats/min, so a heart rate of 52 beats/min is too slow. The provider would assess perfusion and if the heart rate does not rise, begin CPR. The provider would not take the time to order an ECG. There is no reason to increase the fluid rate, or sedate the child at this moment.

The healthcare professional teaches a parent group that which organism causes thrush? a. Staphylococcus b. Streptococcus c. Herpesvirus d. Candida albicans

ANS: D C. albicans infection is a superficial fungal infection that commonly occurs in children. C. albicans is part of the normal skin flora in certain individuals and invades susceptible tissue sites if the predisposing factors are not eliminated.

How do cancer cells use the enzyme telomerase? a. To repair the telomeres to restore somatic cell growth b. As an intracellular signaling chemical to stimulate cell division c. To switch off the telomerase to enable cells to divide indefinitely d. To switch on the telomerase to enable cells to divide indefinitely

ANS: D Cancer cells, when they reach a critical age, somehow activate telomerase to restore and maintain their telomeres and thereby make it possible for cells to divide over and over again.

What is the technique for prenatal diagnosis of chromosomal abnormalities at 10 to 12 weeks' gestation? a. Gene mapping b. Linkage analysis c. Amniocentesis d. Chorionic villus sampling

ANS: D Chorionic villus sampling consists of extracting a small amount of villous tissue directly from the chorion. This procedure can be performed at 10 weeks' gestation and does not require in vitro culturing of cells; sufficient numbers are directly available in the extracted tissue. Thus the procedure allows prenatal diagnosis at approximately 3 months' gestation rather than at nearly 4 months' gestation which is generally when amniocentesis is performed. Gene mapping and linkage analysis are not performed exclusively on women who are 10 weeks' pregnant.

A child with which genetic disorder has a characteristic cry? a. Down syndrome b. Klinefelter syndrome c. Turner syndrome d. Cri du chat

ANS: D Cri du chat, which literally means "cry of the cat," describes the characteristic cry of the affected child. The correct option is the only one with the characteristic cry.

Currently, what percentage of children with cancer can be cured? a. 40% b. 50% c. 60% d. 85%

ANS: D Currently, more than 85% of children diagnosed with cancer are cured.

Cystic fibrosis is caused by what type of gene? a. X-linked dominant b. X-linked recessive c. Autosomal dominant d. Autosomal recessive

ANS: D Cystic fibrosis is the most common lethal autosomal recessive disease in white children. It is not X linked or dominant.

Which statement is true regarding the embryonic development of stem cells? a. They are already differentiated. b. They are referred to as housekeeping genes. c. They already demonstrate DNA sequencing. d. They are said to be totipotent.

ANS: D Early in embryonic development, all cells of the embryo have the potential to become any type of cell in the fetus or adult. These embryonic stem cells are said to be totipotent. They are not yet differentiated. Housekeeping genes are necessary for the function and maintenance of all cells. DNA sequencing is not limited to embryonic stem cells.

How should the healthcare professional reply when parents question why a computed tomographic (CT) scan of the head was not ordered for their 5-year-old child after a minor fall? a. Physicians are cautious about ordering CT scan on children younger than 10 years of age. b. CT scans are seldom conclusive when used to diagnosis head injuries in young children. c. The child's symptoms will determine whether a CT scan is necessary and worth the expense. d. Research suggests that repeated CT scans can increase the risk of developing brain cancer.

ANS: D Findings from a recent study of 176,587 children suggest that those who have two or three CT scans of the head before the age of 22 years are three times more likely to develop brain cancer as those in the general population, and the risk of developing leukemia is three times as great in those who received 5 to 10 CT scans. The other options do not represent the logic behind not ordering a CT scan in relationship to minor head trauma.

Which term refers to the silenced gene of a gene pair? a. Activated b. Altered c. Mutated d. Imprinted

ANS: D Gene silencing, a process during which genes are predictably silenced, depending on which parent transmits them, is known as imprinting; the transcriptionally silenced genes are then said to be imprinted. The remaining options do not accurately identify this process

Hypotension is likely to occur when an infant or child is greater than _____ % dehydrated. a. 2 b. 5 c. 7 d. 10

ANS: D Hypotension typically develops when dehydration is greater than 10% in the infant or child or greater than 6% in the adolescent.

A patient was hospitalized with frostbite and is receiving ibuprofen. The patient asks the healthcare professional to explain the rationale for the drug. What is the best response? a. Treating fever b. Preventing plate aggregation c. Reducing pain d. Inhibiting prostaglandins

ANS: D Ibuprofen is used to inhibit prostaglandins. Although ibuprofen may be administered for the other reasons stated, those applications are not related to the treatment of frostbite.

A 33-pound child is in shock. Which fluid bolus should the healthcare professional prepare to administer to this child? a. Hypotonic fluid, 150 mL b. Hypotonic fluid, 300 mL c. Isotonic fluid, 150 mL d. Isotonic fluid, 300 mL

ANS: D In general, isotonic crystalloids (salt-containing solutions, such as normal saline or lactated Ringer solution) or colloids (protein-containing fluids, such as albumin or blood) are administered in boluses of 20 mL/kg. This child weighs 33 pounds, or 15 kg. 15 ´ 20 = 300. Hypotonic fluids are not used.

In a normal, nonmutant state, what is an oncogene referred to as? a. Basal cell b. Target cell c. Caretaker gene d. Proto-oncogene

ANS: D In its normal nonmutant state, an oncogene is referred to as a proto-oncogene. A basal cell is in the innermost surface of epithelial tissue. Target cells are the recipients of mutations or substances. A caretaker gene is responsible for the maintenance of genomic integrity.

A child has atopic dermatitis. What assessment finding does the healthcare professional associate with this condition? a. Papular rash b. High fever c. Vesicles that burst and form crusts d. Itching

ANS: D Itching is considered a hallmark of atopic dermatitis, and rubbing and scratching to relieve the itch are responsible for many of the clinical changes of atopic dermatitis. Atopic dermatitis is not characterized by high fever, vesicles, or papular rash.

What term is used to identify skin lesions that are elevated, rounded, and firm with irregular clawlike margins that extend beyond the original site of injury? a. Psoriasis b. Dermatitis c. Acne d. Keloid

ANS: D Keloids typically send out clawlike projections from the margins.

Males are more often affected by which type of genetic disease? a. Sex-linked dominant b. Sex-influenced c. Sex-linked d. Sex-linked recessive

ANS: D Males are more frequently affected by X-linked recessive diseases, with the difference becoming more pronounced as the disease becomes rarer. The correct option is the only one that is a characteristic of a male-dominate disease.

Daily evaporative water loss after a burn injury is approximately how many times the normal? a. 5 b. 10 c. 15 d. 20

ANS: D Moncrief and Mason determined that daily evaporative water loss after burn injury was in the range of 20 times normal in the early phase, with gradual decreases as wound closure is achieved.

What clinical manifestations do allergic contact and stasis dermatitis have in common? a. Petechiae and hyperpigmentation b. Edema and vesicular lesions c. Scaling and crusting of lesions d. Erythema and pruritus

ANS: D Only erythema and pruritus are exhibited with both conditions.

A cancer patient has pain at the tumor site and is worried the tumor has metastasized. What does the healthcare provider understand about this patient's complaint? a. Pain is primarily a result of pressure caused by the tumor. b. Pain indicates the metastasis of a cancer. c. Pain is usually the initial symptom of cancer. d. Pain is generally associated with late-stage cancer.

ANS: D Pain is generally associated with the late stages of cancer. Pressure, obstruction, invasion of a structure sensitive to pain, stretching, tissue destruction, and inflammation can cause pain. Pain is not the initial symptom of cancer nor does it indicate that the cancer has metastasized.

Rubeola is a highly contagious acute disease in children caused by which type of infection? a. Bacterial b. Fungal c. Yeast d. Viral

ANS: D Rubeola, a highly contagious acute disease in children, is a result of only a viral infection.

Which contagious disease is caused by the itch mite? a. Miliaria b. Tinea corporis c. Pediculosis d. Scabies

ANS: D Scabies is the only contagious disease caused by the itch mite, Sarcoptes scabiei.

A patient with scleroderma asks the healthcare professional how this condition was acquired. What response is best? a. X-linked recessive gene b. X-linked dominant gene c. Virus d. Autoantibodies

ANS: D Scleroderma means sclerosis of the skin and is associated with immune dysregulation and several autoantibodies.

What is one function of the tumor cell marker? a. To provide a definitive diagnosis of cancer b. To treat certain types of cancer c. To predict where cancers will develop d. To screen individuals at high risk for cancer

ANS: D Screening and identifying individuals at high risk for cancer are ways tumor markers can be used. The two other uses for these markers are to help diagnosis a specific type of cancer (not give a definitive diagnosis) and to follow the clinical course of a tumor.

Bowen disease is a form of which type of cancer? a. Kaposi sarcoma b. Malignant melanoma c. Basal cell carcinoma d. Squamous cell carcinoma

ANS: D Squamous cell carcinoma (SCC) is a tumor of the epidermis and the second most common human cancer. Two types are characterized: (1) in situ (Bowen disease) and (2) invasive. Bowen disease is not a form of any of the other cancers.

A healthcare professional advises patients to exercise because it has a probable impact on reducing which cancer? a. Liver b. Endometrial c. Stomach d. Colon

ANS: D The expert panel report on exercise of the World Cancer Research Fund/American Institute for Cancer Research found a convincing impact of exercise on risk of colon cancer.

What is the significance of a high level of interleukin 1 (IL-1) in a patient who has experienced severe burns? a. Prognosis is poor. b. Antibiotic therapy is required. c. Urinary function is improved. d. They are less at risk for death.

ANS: D The level of IL-1 inversely correlates with burn survival; low levels may be associated with a higher mortality. This selection is the only option that accurately identifies the significance of a high level of IL-1.

Which risk factor for hypertension is influenced by genetic factors and lifestyle? a. Sodium intake b. Physical inactivity c. Psychosocial stress d. Obesity

ANS: D The most important environmental risk factors for hypertension are increased sodium intake, decreased physical activity, psychosocial stress, and obesity. However, obesity is, itself, influenced by genes and the environment.

A healthcare professional gets an update on four children. Which one should the professional assess as the priority? a. 6-month old, respiratory rate of 42 breaths/min b. 2-year-old, respiratory rate of 39 breaths/min c. Preschooler, respiratory rate of 26 breaths/min d. School-aged child, respiratory rate of 38 breaths/min

ANS: D The normal respiratory rate for a school-aged child is 18 to 25 breaths/min, so a respiratory rate of 38 is excessive. The professional should assess this child first. The 6-month-old and the preschooler have normal respiratory rates. The 2-year-old's respiratory rate is slightly above the normal of 27-37 breaths/min, but this is not as large a deviation from normal as seen in the school-aged child.

What causes renal failure after electrical burns in children? a. Cytokines are released after the damaged tissue. b. Immature kidneys are unable to compensate for the electrical burn. c. Cardiac output is reduced. d. Myoglobin is released from damaged muscles.

ANS: D The release of myoglobin may occlude the kidney tubules and result in renal failure. Renal failure after electrical burns is not related to cytokine release or immature kidneys. While severely decreased cardiac output as in cardiogenic shock can affect the kidneys due to poor perfusion, this is not related directly to electrical burns.

What is currently believed about the risk for developing Alzheimer disease? a. It is not directly related to genetic predisposition. b. It is higher among men than it is among women. c. It occurs less among Hispanics than in Asians. d. It doubles among those with an affected first-degree relative.

ANS: D The risk of developing Alzheimer disease doubles in individuals who have an affected first-degree relative. There is a genetic link to the disease. It is not true that the risk is higher among men than it is among women. Hispanics have relatively low risk of developing this disease.

The healthcare professional educates a community group that chickenpox (varicella) may be followed years later by which disorder? a. Erysipelas b. Cytomegalovirus c. Warts d. Herpes zoster

ANS: D The same herpesvirus—varicella-zoster virus (VZV)—causes both herpes zoster (shingles) and varicella (chickenpox). Varicella is the primary infection, followed years later by herpes zoster, particularly among those who are immunosuppressed. Varicella-zoster virus does not produce erysipelas, cytomegalovirus, or warts.

Research data support a carcinogenic relationship in children resulting from exposure to which virus? a. Herpes simplex virus b. Influenza c. Varicella-zoster virus d. Epstein-Barr virus

ANS: D The strongest association between viruses and the development of cancer in children has been the Epstein-Barr virus (EBV), Burkitt lymphoma, nasopharyngeal carcinoma, and Hodgkin disease. No current research supports a link between the other viruses and childhood cancer.

A parent reports a child has skin lesions that rupture, creating a thin, flat, honey-colored crust. What treatment does the healthcare professional educate the parent about? a. Supportive care only b. Oral griseofulvin c. Topical corticosteroids d. Topical mupirocin

ANS: D This child has bullous impetigo, which is treated with topical mupirocin. Supportive care is used in rubella, which has a faint-pink to red, coalescing maculopapular rash develops on the face, with spread to the trunk and extremities, Oral griseofulvin would be appropriate for tinea capitis, which is found on the scalp. Corticosteroids would be useful for itchy rashes such as atopic dermatitis

An infant has a skin disorder that is characterized by a vesicular eruption after prolonged exposure to perspiration, with subsequent obstruction of the eccrine ducts. What care measures does the healthcare provider educate the parents about? a. Topical antifungals b. Corticosteroids c. Oral ivermectin d. Keeping skin cool and dry

ANS: D This infant has miliaria which is characterized by a vesicular eruption after prolonged exposure to perspiration, with subsequent obstruction of the eccrine ducts. The key to management is avoidance of excessive heat and humidity, which cause sweating. Light clothing, cool baths, and air conditioning assist in keeping the skin surface dry and cool. The infant does not need antifungals, corticosteroids, or ivermectin.

A student asks the professor to explain the basics of vasogenic shock. What statement by the professor is best? a. The outcome of widespread hypersensitivity to an allergen b. Bacteremia combined with systemic inflammatory response c. Inability to get adequate blood to tissues and end organs d. Vasodilation from an imbalance between the two nervous systems

ANS: D Vasogenic shock refers to a widespread and massive vasodilation resulting from an imbalance between parasympathetic and sympathetic stimulation of vascular smooth muscle. Widespread hypersensitivity is characteristic of anaphylactic shock. Bacteremia and systemic inflammation are seen in septic shock. The inability to pump adequate blood to tissues and end organs describes cardiogenic shock.

What is the blood type of a person who is heterozygous, having A and B alleles as codominant? a. A b. B c. O d. AB

ANS: D When the heterozygote is distinguishable from both homozygotes, the locus is said to exhibit codominance. An example is the ABO blood group, in which heterozygotes having the A and B alleles express both of them as A and B antigens on their red cells (forming blood group AB). Blood types A, B, and O do not demonstrate codominance.

Which cells of the dermis secrete connective tissue matrix? a. Macrophages b. Mast cells c. Fibroblasts d. Histiocytes

ANS: C Only fibroblasts secrete the connective tissue matrix and collagen. Macrophages are phagocytic cells. Mast cells release histamine and play a role in hypersensitivity reactions in the skin. Histiocytes are a type of macrophage found in loose connective tissue.

. A patient has an intradermal nevus. What assessment does the healthcare professional know is consistent with this lesion? a. Flat, dark, may be up to 2 cm in size b. Elevated and smooth surface c. Regular edges with bristle-like hairs d. Heaped-up, keratinized cells

ANS: C Only intradermal nevus is characterized by a small (less than 1 cm) lesion with regular edges and bristlelike hairs with a color change that can range from skin tones to light brown. A junctional nevus is flat, dark, and up to 2 cm in size. A compound nevus is elevated and smooth. Heaped up keratinized cells describe a scale.

Which cells of the dermis release histamine and play a role in the hypersensitivity reactions of the skin? a. Histiocytes b. Fibroblasts c. Mast cells d. Macrophages

ANS: C Only mast cells release histamine and play a role in hypersensitivity reactions in the skin. Histiocytes are macrophages that reside in loose connective tissue and phagocytize pigments and the debris of inflammation. Fibroblast cells secrete collagen and connective tissue matrix. Macrophages are phagocytic.

The student learns that which skin lesion is mediated by the immunoglobulin E (IgE)-stimulated release of histamine, bradykinin, or kallikrein from mast cells? a. Dermatitis b. Scleroderma c. Urticaria d. Cutaneous vasculitis

ANS: C Only urticaria is mediated by the IgE-stimulated release of histamine, bradykinin, or kallikrein from mast cells or basophils, or both, which causes the endothelial cells of skin blood vessels to contract. Dermatitis is a general term for a particular type of skin inflammation. Scleroderma can be local or systemic and involves connective tissue. Cutaneous vasculitis involves the deposit of immune complexes.

A healthcare professional is caring for four patients with cancer. Which patient does the professional educate about brachytherapy? a. Lung b. Colon c. Cervical d. Brain

ANS: C Radiation sources, such as small 125I-labeled capsules (also called seeds), can also be temporarily placed into body cavities, a delivery method termed brachytherapy. Brachytherapy is useful in the treatment of cervical, prostate, and head and neck cancers. Brachytherapy is not used in the treatment of the other cancers.

A student asks the healthcare professional to explain reperfusion injuries. What explanation by the professional is best? a. Tissue damage that can occur with blood transfusions b. Tissue destruction during rewarming in frostbite c. Damage from restored blood flow and exposure to oxygen d. Fluid overload from intravenous therapy that is too rapid

ANS: C Reperfusion (reoxygenation) injury is associated with cell damage caused by the restoration of blood flow and physiologic concentrations of oxygen to cells that have been exposed to injurious but nonlethal hypoxic conditions. It is not related to blood transfusions, rewarming specifically, or fluid overload.

Research has supported that alcohol consumption has a convincing impact on increasing the risk of which cancer? a. Lung b. Breast c. Pharynx d. Pancreas

ANS: C Research had shown that alcohol consumption has a convincing positive impact on the risk of developing pharynx cancer. No research supports such a connection with the remaining options.

A preschool teacher notices a child who has burrows on the hands that are several millimeters to 1 cm long, papules, and vesicular lesions. What other assessment finding would help the teacher determine the type of infestation the child has? a. Ask the child if he or she has been around puppies or kittens. b. Check the child's hair for the presence of small mites. c. Ask the child if itching occurs especially at night. d. Assess the child's trunk and abdomen for petechiae.

ANS: C Scabies symptoms include burrows that are seen on the hands and are up to 1 cm long. Scabies also causes itching which is worse at night. The teacher would ask the child about itching. The other assessments would not be related to scabies.

What are blood pressure variations associated with? a. b1-Adrenergic receptors to increase heart rate b. The release of an antidiuretic hormone (ADH) c. The renin-angiotensin system's effect on vasoconstriction d. Serum bradykinin, causing vasodilation

ANS: C Studies of blood pressure correlations within families indicate that about 20% to 40% of the variation in both systolic and diastolic blood pressure is caused by genetic factors. Significant research is now focused on specific components that may influence blood pressure variation, such as the renin-angiotensin system (involved in sodium reabsorption and vasoconstriction). b1-Adrenergic receptors, ADH, and bradykinin are not the subjects of such research.

The Papanicolaou (Pap) test is used to screen for which cancer? a. Ovarian b. Uterine c. Cervical d. Vaginal

ANS: C The Pap test, an examination of cervical epithelial scrapings, readily detects early oncogenic human papillomavirus (HPV) infection. The Pap test is not used for screening the other cancer sites listed.

Which gland releases secretions that are important in thermoregulation and cooling of the body through evaporation? a. Sebaceous b. Apocrine c. Eccrine d. Exocrine

ANS: C The eccrine sweat glands are distributed over the body, with the greatest numbers in the palms of the hands, soles of the feet, and forehead. These secretions are important in thermoregulation and cooling of the body through evaporation. Sebaceous glands secrete sebum which is a lipid substance that protects from drying. Apocrine glands are found in the axillae, scalp, face, abdomen, and genital area and have very limited proven function. Exocrine glands secrete substances onto the epithelial surface; an example is a sweat gland.

The release of catecholamine by the adrenal glands provides which compensatory mechanism in hypovolemic shock? a. Interstitial fluid moves out of the vascular compartment. b. Systemic vascular resistance is decreased. c. Heart rate is increased. d. Water excretion is increased.

ANS: C The heart rate will increase in shock due to the effects of circulating catecholamines. Fluid moving out of the vascular compartment is deleterious, leading to a relative hypovolemia. Systemic vascular resistance is increased to improve blood pressure. Water excretion is not increased as a result of catecholamine release.

A child has a burn injury. What does the healthcare provider assess for when determining the child's chance of surviving? a. Immunosuppression b. Hypermetabolism c. Inhalation injury d. Hypertrophic scarring

ANS: C The leading cause of death in children after burn injury, as in adults, is an inhalation injury. Inhalation injuries cause approximately 50% of all deaths in children with burns. Burn victims do have immune dysfunction, hypermetabolism, and scarring, but those do not contribute to the majority of pediatric burn deaths.

What assessment finding would indicate to the healthcare professional that the patient is no longer in burn shock? a. Blood pressure 100/58 mmHg b. Pulse rate 98 beats/min c. Respiratory rate 24 breaths/min d. Urine output 35 mL/hour for 4 hours

The most reliable criterion for adequate resuscitation of burn shock is urine output. Normal urine output is minimally 30 mL/hour. The patient having a normal urine output for 4 hours has shown recovery from burn shock. None of the remaining options are considered as reliable as urine output.