Patho E2

A condition caused by a virus is a. athlete's foot. b. boils. c. warts. d. impetigo.

ANS: C A virus causes warts. A fungus causes athlete's foot. Bacteria cause boils and impetigo.

Individuals who have chronic bronchitis most often have a. a productive cough. b. normal lung sounds. c. a barrel chest. d. substantial weight loss.

ANS: A A productive cough for at least 3 months is the classic sign of chronic bronchitis. People who have chronic bronchitis commonly have abnormal lung sounds resulting from mucus in their airways. Barrel chest is a classic sign of emphysema. Substantial weight loss is characteristic of emphysema, but not of chronic bronchitis

A major difference between a vesicle and a wheal is that vesicles a. contain fluid, but wheals are edematous tissue. b. are palpable, but a wheal is not. c. are larger than wheals. d. are smaller than wheals.

ANS: A A vesicle is filled with fluid, whereas a wheal is edematous tissue. Both vesicles and wheals are palpable. The major difference between a vesicle and a wheal is not their size.

Widespread atelectasis, noncardiogenic pulmonary edema, and diffuse, fluffy alveolar infiltrates on chest radiograph are characteristic of a. acute respiratory distress syndrome. b. chronic obstructive pulmonary disease. c. asthma. d. cor pulmonale.

ANS: A Acute respiratory distress syndrome is characterized by widespread atelectasis, noncardiogenic pulmonary edema, and diffuse, fluffy alveolar infiltrates. These findings are not characteristics of chronic obstructive pulmonary disease, asthma, or cor pulmonale.

Air that enters the pleural space during inspiration but is unable to exit during expiration creates a condition called a. tension pneumothorax. b. open pneumothorax. c. pleural effusion. d. empyema.

ANS: A Air that enters the pleural space during inspiration but is unable to exit during expiration causes a tension pneumothorax. The question does not describe open pneumothorax, pleural effusion, or empyema.

Airway obstruction in chronic bronchitis is because of a. thick mucus, fibrosis, and smooth muscle hypertrophy. b. loss of alveolar elastin. c. pulmonary edema. d. hyperplasia and deformation of bronchial cartilage

ANS: A Airway obstruction in chronic bronchitis is as a result of thick mucus, fibrosis, and smooth muscle hypertrophy. Loss of alveolar elastin, pulmonary edema, and hyperplasia and deformation of bronchial cartilage are not part of the pathophysiology of chronic bronchitis.

An infectious disease that is common in a community is termed a. endemic. b. epidemic. c. pandemic. d. partdemic.

ANS: A An infectious disease that has a fairly constant presence in a community and changes little from year to year is classified as endemic. An epidemic is a significant increase in new infections in a certain population. A pandemic is an epidemic that has spread to a large geographic area, even worldwide. Partdemic is not a term that pertains to infectious diseases.

A patient with a productive cough and parenchymal infiltrates on x-ray is demonstrating symptomology of a. bacterial pneumonia. b. viral pneumonia. c. tuberculosis. d. acute respiratory distress syndrome.

ANS: A Bacterial pneumonia produces a productive cough and parenchymal infiltrates (white shadows) on x-ray. Viral pneumonia does not produce a productive cough. Tuberculosis may produce a productive cough but does not show parenchymal infiltrates (white shadows) on x-ray. Acute respiratory distress syndrome produces a nonproductive cough.

What is the most common, benign form of skin cancer? a. Basal b. Squamous c. Melanoma d. Actinic keratosis

ANS: A Basal cell cancer is the most common and benign skin cancer. Neither squamous cell cancer nor melanoma is the most common and benign skin cancer. Actinic keratosis is a precancerous condition.

To best prevent emphysema, a patient is instructed to stop smoking since cigarette smoke a. impairs a1 antitrypsin, allowing elastase to predominate. b. paralyzes the cilia, causing impaired mucociliary clearance. c. predisposes to respiratory infections. d. introduces carcinogens into the lungs.

ANS: A Cigarette smoking impairs a1 antitrypsin, allowing elastase to predominate and destroy lung tissue, causing emphysema. Although cigarette smoking does paralyze cilia, this action predisposes to respiratory infections rather than to emphysema. Although cigarette smoking does predispose to respiratory infections, that is not the mechanism that causes emphysema. Carcinogens introduced by cigarette smoking increase the risk of developing lung cancer, but they are not responsible for emphysema

Which pulmonary function test result is consistent with a diagnosis of asthma? a. Reduced forced expiratory volume in 1 second (FEV1) b. Decreased functional residual capacity c. Increased FEV1 d. Reduced total lung volume

ANS: A Forced expiratory volumes (FEV1) decrease during asthma attacks. Functional residual capacity is not used to diagnose asthma. Reduced (not increased) FEV1 is found in asthma. Total lung volume is not used to diagnose asthma

Acute, painful inflammation with vesicles along the distribution of a spinal nerve (dermatome) is characteristic of a. herpes zoster. b. herpes simplex. c. human papillomavirus. d. tinea

ANS: A Herpes zoster results in painful inflammation with vesicles along the distribution of a spinal nerve (dermatome). Herpes simplex produces painful inflammation with vesicles, but it does not follow the distribution of a spinal nerve. This skin reaction is not characteristic of human papillomavirus or tinea.

Legionnaires disease is characterized by a. presence of systemic illness. b. airborne mechanism of communicability. c. mild symptomatology. d. resolution with or without antimicrobial therapy

ANS: A Legionnaires disease produces system manifestations such as fever, diarrhea, abdominal pain, and pneumonia. The organism that causes Legionnaires disease is transmitted by means of contaminated water. Symptoms are severe, and the disease requires antimicrobial therapy.

When a client diagnosed with COPD type A asks, Why is my chest so big and round?, the nurse responds that a. Loss of elastic tissue in your lungs allows your airways to close and trap air, which makes your chest round. b. Swelling and mucus in your airways cause air to be trapped in your lungs, which makes your chest round. c. Coughing caused by your condition has changed the structure of your airways, which makes your chest round. d. Scar tissue in your lungs makes them stiff and more full of air than usual, which makes your chest round.

ANS: A Loss of elastic tissue in the lungs allows premature airway closure, which traps air, creating a barrel chest. The other answer choices do not describe the pathophysiology that causes barrel chest in persons with COPD type A

The hypersecretion of mucus resulting from chronic bronchitis is the result of a. recurrent infection. b. destruction of alveolar septa. c. reduced inflammation. d. barrel chest

ANS: A Mucus provides a hospitable environment for bacterial colonization and recurrent infection. Destruction of alveolar septa and reduced inflammation are not complications of chronic bronchitis. Hypersecretion of mucus does not contribute to barrel chest

The organism that causes pulmonary tuberculosis is a. Mycobacterium tuberculosis. b. Haemophilus tuberculosis. c. Tuberculosis tuberculoci. d. Mycococcidio tuberculosis.

ANS: A Mycobacterium tuberculosis causes pulmonary tuberculosis. Haemophilus tuberculosis, Tuberculosis tuberculoci, and Mycococcidio tuberculosis do not cause pulmonary tuberculosis.

All obstructive pulmonary disorders are characterized by a. resistance to airflow. b. hyperresponsiveness. c. decreased residual volumes. d. decreased lung compliance.

ANS: A Obstructive lung diseases are characterized by increased resistance to airflow. Only asthma is characterized by hyperresponsiveness. Increased residual volume is common in obstructive pulmonary disorders. Emphysema is characterized by increased lung compliance caused by a loss of alveoli and elastic tissue

Which skin disorder is thought to be caused by an autoimmune reaction and is characterized by bullous eruptions? a. Pemphigus b. Psoriasis c. Pityriasis rosea d. Lichen planus

ANS: A Pemphigus is a skin disorder thought to be caused by an autoimmune reaction and is characterized by bullous eruptions. Psoriasis, pityriasis, and lichen planus are not characterized by bullous eruptions

When preparing for the admission of a patient diagnosed with bronchiectasis, the nurse will a. put a sputum cup and a box of tissues on the bedside table. b. prepare an airborne isolation room for the patient. c. add a box of surgical masks to the nursing supplies near the door. d. remove the water pitcher to comply with anticipated fluid restrictions.

ANS: A People who have bronchiectasis have a productive cough, usually with foul-smelling sputum. Bronchiectasis is not contagious nor does it need transmission-based precautions. Fluid restriction is not part of the treatment for bronchiectasis

Pneumocystis is a term that refers to a a. fungal pneumonia secondary to HIV. b. viral pneumonia found in transplant recipients. c. noninfectious inflammation in the lung. d. pneumonia secondary to bladder infection.

ANS: A Pneumocystis is a fungal pneumonia secondary to HIV. Pneumocystis is not a viral pneumonia found in transplant recipients, a noninfectious inflammation of the lung, or a pneumonia secondary to bladder infection.

Psoriasis is characterized by a. silvery scale on the skin. b. itching, oozing rash. c. thickened, discolored nails. d. whitish coating on the tongue.

ANS: A Psoriasis is characterized by silvery scale on the skin. Psoriasis does not involve an itching, oozing rash or a whitish coating on the tongue. Psoriasis may cause pitting of nails, but it is not characterized by thickened, discolored nails.

A post infective painful neuralgia can occur as a complication of a. shingles. b. herpes simplex. c. impetigo. d. verrucae.

ANS: A Shingles can lead to a painful postherpetic neuralgia. Herpes simplex, impetigo, and verrucae do not lead to a painful postherpetic neuralgia.

The most definitive diagnostic method for active tuberculosis is acquired via a. sputum culture. b. Mantoux skin test. c. chest x-ray. d. blood culture.

ANS: A The most definitive diagnostic method for active tuberculosis is via sputum culture to identify the acid-fast bacillus. The Mantoux skin test does not distinguish between active infection and past infection. Although a chest x-ray will show characteristic nodules, a sputum culture is the most definitive diagnostic method for active tuberculosis. Unless a patient is septic (infection in the blood), the tuberculosis organism will not be found in the blood

Emphysema results from destruction of alveolar walls and capillaries, which is because of a. release of proteolytic enzymes from immune cells. b. air trapping with resultant excessive alveolar pressure. c. excessive a1 antitrypsin. d. autoantibodies against pulmonary basement membrane

ANS: A The pathologic changes leading to alveolar destruction are associated with the release of proteolytic enzymes from inflammatory cells such as neutrophils and macrophages. While air trapping occurs in emphysema, the destruction of alveolar walls and capillaries is because of release of proteolytic enzymes. Lack of 1 antitrypsin can result in emphysema. Autoantibodies are not involved in destruction of alveolar walls and capillaries in emphysema.

Which is true about epiglottitis? (Select all that apply.) a. Is usually caused by H. influenzae type B b. Can be caused by bacterial infection c. Usually occurs in children d. Is characterized by pain with swallowing e. Generally resolves without intervention

ANS: A, B, C, D Epiglottitis is usually caused by H. influenzae type B, but can be caused by bacteria. It usually occurs in children and is characterized by pain with swallowing. This condition is a medical emergency and requires immediate intervention.

An acute asthma attack is associated with which signs and symptoms? (Select all that apply.) a. Bronchoconstriction b. Bronchial mucosal edema c. Hypersecretion of mucus d. Alveolar collapse e. Hypoxemia

ANS: A, B, C, E An acute asthma attack is associated with bronchoconstriction, bronchial mucosal edema, hypersecretion of mucus, and possible hypoxemia. Alveolar collapse does not occur in asthma.

Risk of infection is increased in (Select all that apply.) a. use of corticosteroids. b. diabetes mellitus. c. spleen removal. d. appendix removal. e. stress.

ANS: A, B, C, E Use of corticosteroids depresses immune function and increases risk of infection. Diabetes mellitus increases risk of infection resulting from high blood sugar, decreased resistance to infection, and inability to sense pain secondary to neuropathies. Spleen removal increases susceptibility to infection as one of its functions was phagocytosis of encapsulated bacteria. Stress increases hormones that affect immune responsiveness. The stomach is not an organ that affects immune function; therefore, removal of the stomach does not increase the risk for infection.

A major cause of treatment failure in tuberculosis is a. resistant organism. b. allergy to drugs used. c. nonadherence. d. immunosuppression.

ANS: C The major cause of treatment failure in tuberculosis is nonadherence to drug therapy. The major cause of treatment failure in tuberculosis is not a resistant organism, drug allergy, or immunosuppression.

Dietary zinc is an important defense against infection because it maintains (Select all that apply.) a. natural killer cell function. b. lymphocyte activity. c. antioxidant activity. d. neutrophil activity. e. complement activity

ANS: A, B, D, E Decreased availability of zinc results in a reduction in natural killer cell function, lymphocyte activity, neutrophil function, and complement activity. Zinc does not maintain antioxidant activity.

Which of the following are characteristics of asthma? (Select all that apply.) a. Chronic inflammatory disorder b. Airway hyperresponsiveness c. Alveolar collapse d. Genetic susceptibility e. Airway remodeling

ANS: A, B, D, E Asthma is a chronic inflammatory disorder that involves interaction of genetic susceptibility with environmental factors. Inflammation in asthma causes hyperresponsive airways and eventual airway remodeling. The pathophysiology of asthma does not involve alveolar collapse. Asthma is a chronic inflammatory disorder that involves interaction of genetic susceptibility with environmental factors. Inflammation in asthma causes hyperresponsive airways and eventual airway remodeling

Chronic occupational lung disease is characterized by which of the following? (Select all that apply.) a. Causation from long-term inhalation of inorganic material b. A latent period before symptoms occur c. Hyperactive respiratory macrophages d. A progressive cough and dyspnea with exercise e. Possible negative chest x-ray when symptom-free

ANS: A, B, D, E Chronic occupational lung disease is caused by long-term inhalation of inorganic material. A latent period of 10 to 20 years may ensue before symptoms occur. One of the earliest manifestations is a progressive cough and dyspnea on exertion. The disease cannot be ruled out by a negative chest x-ray. Impairment of macrophage function is the primary mechanism through which inorganic particles initiate lung disease.

Common characteristics of sarcoidosis include which of the following? (Select all that apply.) a. Presence of CD4+ T cells b. A non-productive cough c. Leukocytosis d. Granulomas in multiple body systems e. Fatigue, weight loss, and fever

ANS: A, B, D, E Common characteristics of sarcoidosis include the presence of CD4+ T cells; a nonproductive cough; granulomas in lungs and other body systems; and fatigue, weight loss, and fever. Leukopenia is characteristic of this disorder.

When assessing an individual during an acute asthma episode, you should expect to find which manifestations? (Select all that apply.) a. Use of accessory breathing muscles b. Expiratory wheezing c. Foul-smelling sputum d. Coughing e. Feeling of chest tightness

ANS: A, B, D, E Manifestations of an acute asthma episode include use of accessory breathing muscles, wheezing, coughing, and a feeling of tightness in the chest. Foul-smelling sputum is not characteristic of acute asthma

Which statements are true about diffuse interstitial lung disease? (Select all that apply.) a. Leads to loss of alveolar walls. b. May be immunologic in nature. c. Produces a productive cough. d. Is always reversible. e. Shows on x-ray as a ―honeycomb lung.

ANS: A, B, E Diffuse interstitial lung disease results in loss of alveolar walls, may be immunologic in nature, and shows a ―honeycomb‖ appearance on x-ray. A nonproductive cough is characteristic of this disorder. The disorder is not always reversible.

Clinical manifestations of pleural effusion include which of the following? (Select all that apply.) a. Dyspnea b. Sharp pain on expiration c. Productive cough d. Diminished breath sounds e. A tracheal shift, if large

ANS: A, D, E Clinical manifestations of pleural effusion include dyspnea, diminished breath sounds, and tracheal shift if a large amount of fluid is present. With pleural effusion, pain is worse on inspiration and the cough is nonproductive. If productive, an infectious process within the lung is suspected.

Characteristics of immunization include which of the following? (Select all that apply.) a. Giving injections of preformed antibodies provides immediate immunity. b. Immunization provides life-long immunity. c. Immunization with killed vaccines may lead to infection from the agent. d. Herd immunity controls disease without immunizing everyone in the population. e. Lack of immunization may lead to an epidemic.

ANS: A, D, E Injections of preformed antibodies to an organism provide immediate immunity to disease caused by that organism. Herd immunity controls disease because a certain percentage of the population is no longer susceptible to the disease. Lack of immunization may lead to an epidemic. Immunization does not provide lifelong immunity. For example, immunization with preformed antibodies is temporary. The CDC monitors disease outbreaks and recommends additional boosters for some infectious diseases. Immunization with killed vaccines does not lead to infection from the agent, as the organism is no longer living.

5. Which are restrictive respiratory disorders? (Select all that apply.) a. Pneumothorax b. Emphysema c. Chronic asthma d. Type B COPD e. ARDS

ANS: A, E Pneumothorax is a restrictive respiratory disorder that involves the pleural space and ARDS is a restrictive respiratory disorder that involves lung parenchyma. Emphysema, chronic asthma, and type B COPD are obstructive respiratory diseases.

Which finding indicates a need for further evaluation of a nevus mole? a. The presence of light pigmentation b. Variations in color within the nevus c. Very dark coloration of the mole d. Diameter less than 2 mm

ANS: B A mole that has variations in color needs further evaluation. A skin-colored nevus lacking dark pigmentation does not indicate melanoma. Very dark coloration of a nevus does not indicate melanoma. A very small nevus does not indicate melanoma.

The nurse is learning about COVID-19. What statement indicates a need to review the material? a. This has become a worldwide pandemic. b. COVID-19 causes a bacterial pneumonia. c. There are three consecutive stages of severity. d. COVID-19 leads to diffuse alveolar damage.

ANS: B COVID-19 is a viral illness caused by a coronavirus. The disease has become a worldwide pandemic, demonstrates three stages of increasing severity, and leads to significant diffuse alveolar damage.

The hallmark manifestation of acute respiratory distress syndrome is a. tachycardia. b. hypotension. c. frothy secretions. d. refractory hypoxemia.

ANS: D The hallmark of acute respiratory distress syndrome is refractory hypoxemia caused by intrapulmonary shunting of blood. Tachycardia, hypotension, and frothy secretion occur in this disorder but are not hallmark.

Chronic bronchitis often leads to cor pulmonale because of a. ventricular hypoxia. b. increased pulmonary vascular resistance. c. left ventricular strain. d. hypervolemia.

ANS: B Chronic bronchitis often leads to cor pulmonale as a result of increased pulmonary vascular resistance when right ventricular end-diastolic pressure increases. Ventricular hypoxia, left ventricular strain, and hypervolemia do not lead to cor pulmonale.

Croup is characterized by a. a productive cough. b. a barking cough. c. an inability to cough. d. drooling, sore throat, and difficulty swallowing

ANS: B Croup is characterized by a barking cough with stridor. A productive cough is not characteristic of croup. Croup is associated with coughing. Drooling, sore throat, and difficulty swallowing are not characteristics of croup.

The presence of a widely distributed pruritic maculopapular rash and erythema is commonly associated with a. psoriasis. b. drug reaction. c. scleroderma. d. bedbug bites

ANS: B Drug reaction results in a widely distributed pruritic maculopapular rash and erythema. Psoriatic rash, scleroderma rash, and bedbug bites rash are not widely distributed or pruritic maculopapular in nature

Drug resistance of microbes occurs secondary to a. patient allergy to a drug. b. mutation of the microbe. c. enhanced pathogenicity of the microbe. d. using high doses of drugs.

ANS: B Drug resistance develops secondary to chance mutations of microbes in response to a change in the host's environment. Patient allergy to a drug does not cause drug resistance. Although drug resistance may lead to enhanced pathogenicity of a microbe, pathogenicity does not lead to drug resistance. Using low doses of a drug to treat infection leads to drug resistance.

When exposed to inhaled allergens, a patient with asthma produces large quantities of a. IgG. b. IgE. c. IgA. d. IgM.

ANS: B During an allergic response, plasma cells produce large quantities of IgE. IgG, IgA, and IgM are not part of the pathophysiology of asthma

Empyema is defined as an a. exudative bronchitis. b. infection in the pleural space. c. infection localized in the lung. d. infection in the blood.

ANS: B Empyema is infection in the pleural space. Empyema is not exudative bronchitis, localized infection in the lung, or an infection in the blood.

After evaluation, a child's asthma is characterized as ―extrinsic. This means that the asthma is a. of unknown pathogenesis. b. associated with specific allergic triggers. c. associated with respiratory infections. d. induced by psychological factors (stress).

ANS: B Extrinsic asthma is also referred to as allergic asthma, which is triggered by antigens. The underlying pathogenesis of extrinsic asthma is an allergic in nature. Intrinsic asthma is associated with respiratory infections. Intrinsic asthma is associated with psychological factors.

A topical therapy that would tend to dry the skin because it is an astringent is a. lotion. b. gel. c. cream. d. ointments.

ANS: B Gels tend to dry the skin because they are astringent. Lotions, creams, and ointments do not tend to dry the skin

Which disorder is caused by inhalation of organic substances? a. Diffuse interstitial lung disease b. Hypersensitivity pneumonitis c. Sarcoidosis d. Acute respiratory distress syndrome

ANS: B Hypersensitivity pneumonitis is caused by inhalation of organic substances that produces an inflammatory immunologic reaction. Diffuse interstitial lung disease is probably related to an immune reaction but not from inhalation of organic substances. Sarcoidosis likely has an immunologic basis, but not from inhalation of organic substances. Acute respiratory distress syndrome is associated with severe trauma, sepsis, and shock.

A major risk factor for the development of active pulmonary tuberculosis (TB) disease is a. contaminated water. b. immunosuppression. c. being a male. d. overuse of antibiotics.

ANS: B Immunosuppressed individuals, such as those with HIV, are at high risk for active TB disease. Contaminated water and gender are not major risk factors for pulmonary tuberculosis. Excessive use of antibiotics can lead to opportunistic yeast and fungal infections or cause bacterial resistance to available antibiotics, but it is not a major risk factor for TB

When a parent of a toddler recently diagnosed with pneumococcal pneumonia asks why their child is so much sicker than a classmate was when they were diagnosed with pneumonia, the nurse replies. a. It sounds as if the classmate was just lucky and less exposed at daycare. b. It sounds like your child has a case of bacterial pneumonia, while the classmate had viral pneumonia. c. It sounds as if your child is having a severe reaction to bacterial pneumonia. It hits some children harder than others. d. It sounds as if your child has a case of viral pneumonia, while the classmate had bacterial pneumonia.

ANS: B In general, symptoms of viral pneumonia are less severe than those of bacterial pneumonia. The classmate would have had a milder illness if it had been viral pneumonia. Pneumococcal pneumonia is not necessarily more severe in children. The children most likely have bacterial pneumonia, which is why their symptoms are more acute than the classmate's case of viral pneumonia.

The term used to describe fungal infections is a. sepsis. b. mycoses. c. amebiasis. d. Chlamydia.

ANS: B Infections caused by fungi are called mycoses. Sepsis means an overwhelming infection that may lead to shock, multiple organ failure, and death. Sepsis can be caused by any organism. Amebiasis is an infection caused by a protozoan parasite. Chlamydia is a bacterial infection

Lack of a antitrypsin in emphysema causes a. chronic mucous secretion and airway fibrosis. b. destruction of alveolar tissue. c. pulmonary edema and increased alveolar compliance. d. bronchoconstriction and airway edema.

ANS: B Lack of a1 antitrypsin in emphysema causes destruction of alveolar tissue, as it is a protective enzyme that prohibits proteolytic breakdown of alveolar tissue. Lack of a1-antitrypsin does not cause chronic mucous secretion and airway fibrosis, pulmonary edema and increased alveolar compliance, or bronchoconstriction and airway edema

Obstructive disorders are associated with a. low residual volumes. b. low expiratory flow rates. c. increased expiratory reserve volume. d. decreased total lung capacity

ANS: B Obstructive disorders are associated with low expiratory flow rates. Obstructive disorders are associated with high residual volume. Increased expiratory reserve volume and decreased total lung capacity are not characteristic of obstructive disorders.

A restrictive respiratory disorder is characterized by a. increased total lung capacity. b. decreased residual volume. c. inspiratory wheezing. d. expiratory wheezing.

ANS: B Restrictive respiratory disorders are characterized by decreased residual volume. Restrictive respiratory disorders are not characterized by increased residual volume. Inspiratory and expiratory wheezing are not characteristics of restrictive respiratory disorder

Scleroderma is characterized by a. large, weeping, open sores. b. thickening and decreased elasticity of the skin. c. butterfly rash on the face. d. hair loss and ulcer formation on the extremities

ANS: B Scleroderma is characterized by thickening and decreased elasticity of the skin. Scleroderma is not characterized by large, weeping, open sores or by hair loss and ulcer formation on the extremities. Lupus is characterized by a butterfly rash of the face

Which type of dermatitis is associated with cradle cap in newborns? a. Irritant b. Seborrheic c. Atopic d. Stasis

ANS: B Seborrheic dermatitis is associated with cradle cap in newborns and dandruff in adolescents and adults. Irritant, atopic, and stasis dermatitis are not associated with cradle cap

The most common method of direct disease transmission is a. airborne. b. droplet. c. vector. d. inoculant.

ANS: B The most common direct transmission of disease occurs through the exchange of body fluids (droplet) from kissing or sexual intercourse. Airborne transmission is not the most common method of direct disease transmission. Vector is not the most common method of direct disease transmission. Inoculant transmission is not the most common method of direct disease transmission.

A 4-year-old is brought to the clinic for evaluation of dry, scaly, itchy patches on the face, antecubital areas, and behind the ears and knees. The skin is dry overall, and there is evidence of scratching. This is likely a case of a. impetigo. b. atopic dermatitis. c. psoriasis. d. scabies.

ANS: B The most likely cause of dry, scaly, itchy patches on the face, antecubital areas, and behind the ears and knees is atopic dermatitis (eczema). Impetigo, psoriasis, and scabies do not produce dry, scaly, itchy patches on the face and antecubital areas and behind the ears and knees.

The primary cause of infant respiratory distress syndrome is a. prematurity. b. lack of surfactant. c. maternal illegal drug use during pregnancy. d. umbilical cord compression.

ANS: B The primary cause of this disorder is lack of surfactant. While premature infants may demonstrate this disorder, the actual cause is lack of surfactant. It is a syndrome seen in premature infants. Maternal illegal drug use during pregnancy and umbilical cord compression are not the primary causes of infant respiratory distress syndrome.

The characteristic x-ray findings in tuberculosis include a. diffuse white-out. b. Ghon tubercles. c. bibasilar infiltrates. d. tracheal deviation.

ANS: B Tuberculosis results in Ghon tubercles that show up as nodules with infiltrates. Diffuse white-out, basilar infiltrates, and tracheal deviation are not characteristic x-ray findings in tuberculosis

Viral pneumonia is characterized by a. a productive cough. b. a dry cough. c. exudative consolidation. d. significant ventilation-perfusion imbalance.

ANS: B Viral pneumonia does not produce exudates, so the typical cough is nonproductive. Ventilation-perfusion imbalance and exudative consolidation do not usually occur in viral pneumonia

It is true that vitiligo a. occurs as a result of a. genetic lack of melanin production. b. is a depigmented patch of skin. c. occurs most commonly in light-skinned individuals. d. is a warning sign for malignant melanoma.

ANS: B Vitiligo is a depigmented patch of skin. Vitiligo is not a genetic disorder. It occurs less often in light-skinned people and is associated with diabetes mellitus, hyperthyroidism, and pernicious anemia.

Which statements are true of herpes simplex I infection? (Select all that apply.) a. Causes both oral and genital infections b. Begins with a burning or tingling sensation c. Reactivates with stress, sun exposure, menses d. Is usually painless e. Remains latent in spinal ganglia between outbreaks

ANS: B, C, E Herpes simplex I outbreak begins with a burning or tingling sensation in the area of later eruption. The virus reactivates with stress, sun exposure, and sometimes menses, but between outbreaks remains latent in spinal cord ganglia. Herpes simplex II causes most genital infections. Herpes simplex outbreaks are very painful.

Which is a characteristic of some bacteria? a. Intracellular parasite b. Composed of RNA or DNA c. Contains cell wall endotoxin d. Cannot replicate extracellularly

ANS: C Some bacteria contain endotoxin in the cell wall. Viruses are intracellular parasites using host cell components to replicate; bacteria do not use host cell components to replicate. Viruses are composed of RNA or DNA, as opposed to bacteria. Bacteria can replicate extracellularly.

Which is indicative of a left tension pneumothorax? a. Course crackles throughout the left chest b. Tracheal deviation to the left c. Absent breath sounds on the left d. Respiratory acidosis

ANS: C A left pneumothorax results in absent breath sounds on the affected side. Crackles will not be heard because breath sounds are not present. Tracheal deviation occurs on the contralateral side, in this case, the right side. Pneumothorax results in acute respiratory alkalosis.

Asthma is categorized as a(n) a. restrictive pulmonary disorder. b. infective pulmonary disorder. c. obstructive pulmonary disorder. d. type of acute tracheobronchial obstruction.

ANS: C Asthma is an obstructive pulmonary disorder. Asthma is not a restrictive pulmonary disorder or a type of tracheobronchial obstruction. Although asthma can be associated with infection, it is not an infective pulmonary disorder.

At puberty when sebaceous gland secretion increases, follicle obstruction and infection may occur, resulting in a. psoriasis. b. eczema. c. acne vulgaris. d. pemphigus.

ANS: C At puberty when sebaceous gland secretion increases, follicle obstruction and infection may occur, resulting in acne vulgaris. Psoriasis, eczema, and pemphigus do not result from sebaceous gland secretion increases, follicle obstruction, and infection.

Which assessment would support a diagnosis of type A COPD rather than type B COPD a. Copious sputum, dyspnea, cor pulmonale b. Noisy breath sounds, fatigue, high PaCO2, overweight c. Normal PaCO2, scant sputum, accessory muscle use, barrel chest d. Barrel chest, productive cough, cyanosis, very decreased PaO2

ANS: C Barrel chest and obvious respiratory effort that maintains near normal blood gases are consistent with type A COPD (emphysema) in the early stages. Copious sputum, dyspnea, and cor pulmonale are consistent with type B COPD. Noisy breath sounds, fatigue, high PaCO2, and overweight are consistent with type B COPD. Barrel chest, productive cough, cyanosis, and very decreased PaO2 are not consistent with type A COPD

Deep pressure ulcers usually a. appear first as reddened areas that do not blanch. b. begin in the dermal and epidermal skin layers. c. result from thrombosis of deep vessels. d. are an unavoidable consequence of immobility.

ANS: C Deep pressure ulcers result from thrombosis of deep vessels. Superficial, not deep, pressure ulcers appear first as reddened areas that do not blanch. Deep pressure ulcers begin in the deep vessels of the tissue and are not always an unavoidable consequence of immobility.

Allergic (extrinsic) asthma is associated with a. hyporesponsiveness of airways. b. unknown precipitating factors. c. IgE-mediated airway inflammation. d. irreversible airway obstruction.

ANS: C Extrinsic (allergic) asthma is mediated by IgE triggers. Allergic (extrinsic) asthma involves hyperresponsiveness of the airways. Antigens are the precipitating factors. Airway obstruction is reversible

Cystic fibrosis is associated with a. asthma. b. chronic bronchitis. c. bronchiectasis. d. emphysema.

ANS: C Fifty percent of cases of bronchiectasis are associated with cystic fibrosis. Cystic fibrosis is not associated with asthma, chronic bronchitis, or emphysema

Immune function is likely to be most effective in a a. newborn. b. 7-month-old infant. c. 30-year-old. d. 70-year-old.

ANS: C Immune function is most effective in middle life. Newborns have an immature immune system. In older infants, maternal IgG that crossed the placenta at birth begins to fade over the first 6 months of life, and these babies are at greater risk for serious infection. Immunity tends to decline in the older population resulting in reduced antibody responses to new antigens. The very young and the very old are more susceptible to infection because of immature or degenerating immune functions.

Impetigo is a skin infection caused by a. fungus. b. yeast. c. bacteria. d. parasite.

ANS: C Impetigo is a skin infection caused by bacteria. Impetigo is a skin infection caused by bacteria, not fungus. Yeast and parasites do not cause impetigo.

The increased anterior-posterior chest diameter associated with obstructive lung disease is caused by a. increased pulmonary blood flow. b. increased expiratory flow rates. c. increased residual lung volumes. d. decreased chest wall compliance

ANS: C Increased residual lung volumes are because of air trapping in obstructive lung disease and cause a barrel chest. Increased pulmonary blood flow does not affect chest diameter. Increased expiratory flow rates would decrease air trapping rather than increase chest diameter. Obstructive lung disease does not involve decreased chest wall compliance. It is increased as a result of loss of alveoli and elastic tissue.

Itchy linear burrows on the hands and wrists are associated with a. tick bites. b. Rocky Mountain spotted fever. c. scabies. d. contact dermatitis.

ANS: C Itchy linear burrows on the hands and wrists are associated with scabies. Itchy linear burrows on the hands and wrists are not associated with tick bites, Rocky Mountain spotted fever, or contact dermatitis.

What is the deadliest form of skin cancer? a. Basal b. Squamous c. Melanoma d. Actinic keratosis

ANS: C Melanoma is the deadliest skin cancer. Neither basal cell cancer nor squamous cell cancer is the deadliest skin cancer. Actinic keratosis is a precancerous condition.

Neuromuscular disorders impair lung function primarily because of a. inflammatory events in the lung. b. secondary pneumonia. c. weak muscles of respiration. d. inactivity secondary to the disorder.

ANS: C Neuromuscular disorders weaken respiratory muscle function resulting in poor ventilation. Inflammatory events in the lung, secondary pneumonia, and inactivity secondary to the disorder are not the primary reasons neuromuscular disorders impair lung function.

Onycholysis is characterized by a. silvery plaques on the skin. b. itching, oozing rash. c. destruction of the nails. d. whitish coating on the tongue.

ANS: C Onycholysis is characterized by destruction of the nails. Onycholysis does not involve silvery plaques on the skin, itching, oozing rash, or a whitish coating on the tongue.

Obstructive sleep apnea would most likely be found in a patient diagnosed with a. myasthenia gravis. b. poliomyelitis. c. Pickwickian syndrome. d. pneumonia.

ANS: C Pickwickian syndrome is hypoventilation caused by obesity. Sleep apnea is often a problem in obese individuals. Obstructive sleep apnea is not likely to be found in a patient with myasthenia gravis, poliomyelitis, or pneumonia

Shingles is caused by the same virus that causes a. measles. b. mumps. c. chickenpox. d. rubella.

ANS: C Shingles is caused by the chickenpox virus. Shingles is not caused by the virus that causes measles, mumps, or rubella

Which complication of asthma is life threatening? a. Exercise-induced asthma b. Late phase response c. Status asthmaticus d. Mast cell degranulation

ANS: C Status asthmaticus is a severe attack unresponsive to routine therapy and can be life threatening if not reversed. Exercise-induced asthma is a form of asthma, rather than a complication of it. The late phase response is part of the pathophysiology of asthma and is not always life threatening. Mast cell degranulation is part of the pathophysiology of asthma and in itself is not life threatening

Bacterial pneumonia leads to hypoxemia caused by a. cardiogenic pulmonary edema. b. upper airway obstruction. c. accumulation of alveolar exudates. d. interstitial edema.

ANS: C The inflammatory response to bacterial pneumonia causes accumulation of exudates in the alveoli and impairs oxygenation. Bacterial pneumonia does not cause cardiogenic pulmonary edema. Pneumonia involves lower airway obstruction. Bacterial pneumonia does not lead to interstitial edema.

Atopic dermatitis (eczema) is caused by a. parasitic infestation of the skin. b. superficial staphylococcal infection. c. superficial fungal infection. d. contact with skin allergens.

ANS: D Atopic dermatitis (eczema) is caused by contact with skin allergens (atopic = allergy). Atopic dermatitis is not a parasitic infestation of the skin, a superficial staphylococcal infection, or a superficial fungal infection.

The difference between chickenpox and measles is that chickenpox a. is caused by a virus, whereas measles is caused by a bacterium. b. causes a widespread rash, whereas measles causes a macular rash. c. is a childhood infection, but measles can evolve into shingles in adults. d. causes vesicles that scab, whereas measles remains a macular rash.

ANS: D Chickenpox causes vesicles that scab, whereas measles remains a macular rash. Both chickenpox and measles are caused by viruses. The rash is widespread in both chickenpox and measles. Measles does not evolve into shingles.

Copious amounts of foul-smelling sputum are generally associated with a. emphysema. b. epiglottitis. c. pulmonary edema. d. bronchiectasis.

ANS: D Copious, foul-smelling respiratory secretions are associated with bronchiectasis. Copious, foul-smelling respiratory secretions are not associated with emphysema, epiglottitis, or pulmonary edema.

Corticosteroids are commonly administered for the management of skin disorders because they a. are analgesics. b. prevent infection. c. enhance collagen production. d. reduce inflammation

ANS: D Corticosteroids are commonly administered for the management of skin disorders because they reduce inflammation. Corticosteroids are steroids, not analgesics. Corticosteroids do not prevent infection or enhance collagen production.

Which clinical manifestation is not likely the result of a tuberculosis infection? a. Productive cough b. Low-grade fever c. Night sweats d. Cyanosis

ANS: D Cyanosis is not a typical manifestation of tuberculosis infection. A productive cough, low-grade fever, and night sweats are the typical manifestations of tuberculosis infection.

COPD leads to a barrel chest, because it causes a. pulmonary edema. b. muscle atrophy. c. prolonged inspiration. d. air trapping

ANS: D Destruction of alveolar walls reduces lung elastic recoil, which allows airway collapse during exhalation. Air enters the alveoli during inhalation, but has difficulty escaping during exhalation. When air is trapped in the alveoli, residual volume increases, causing a barrel chest. Destruction of alveolar walls does not cause pulmonary edema, muscle atrophy, or prolonged inspiration

A patient with flail chest will demonstrate a. absence of chest movement with breaths. b. no inspiratory breath sounds. c. fluttering chest movements on expirations. d. outward chest movement on expiration.

ANS: D Flail chest is demonstrated by paradoxical inward movement on inspiration and outward movement on expiration. Flail chest is not demonstrated by absence of chest movement with breaths, no inspiratory breath sounds, or fluttering chest movements on expiration.

Impetigo is usually caused by a a. virus. b. fungus. c. protozoan. d. bacteria.

ANS: D Impetigo is caused by bacteria, usually strep or staph. Impetigo is not caused by a virus, a fungus, or a protozoan

In individuals who have asthma, exposure to an allergen to which they are sensitized leads to which pathophysiologic event? a. Loss of alveolar elastin and premature closure of airways b. Pulmonary edema and decreased alveolar compliance c. Mast cell degranulation that causes decreased surfactant d. Inflammation, mucosal edema, and bronchoconstriction

ANS: D In asthma, exposure to an allergen causes mast cell degranulation and release of inflammatory mediators that trigger airway inflammation, mucosal edema, and bronchoconstriction. In asthma, exposure to an allergen does not cause loss of alveolar elastin, pulmonary edema and decreased alveolar compliance, or decreased surfactant

Manifestations of herpes zoster include a. multiple fluid-filled vesicles on the lips, tongue, and hands. b. generalized, painful maculopapular rash. c. red, itchy palms and soles of feet. d. a dermatomal distribution of lesions and pain.

ANS: D Manifestations of herpes zoster include a dermatomal distribution of lesions and pain. Herpes zoster manifestation includes fluid-filled vesicles along dermal planes. Herpes zoster is not a generalized, painful maculopapular rash and does not manifest as a red, itchy rash of the palms and soles of the feet.

The cancer considered to be the most malignant is a. hyperkeratosis. b. basal cell carcinoma. c. squamous cell carcinoma. d. melanoma.

ANS: D Melanoma is the cancer considered to be most malignant. Hyperkeratosis is not a cancer. Basal cell carcinoma and squamous cell carcinoma are not the most malignant skin cancers.

Which finding is characteristic of oral candidiasis? a. Silvery plaques on the skin b. Itching, oozing rash c. Thickened, discolored nails d. Whitish coating on the tongue

ANS: D Oral candidiasis is characterized by whitish coating on the tongue. Oral candidiasis does not involve silvery plaques on the skin; itching, oozing rash; or thickened, discolored nails.

Accumulation of fluid in the pleural space is called a. an abscess. b. pleurisy. c. flail chest. d. pleural effusion.

ANS: D Pleural effusion is accumulation of fluid in the pleural space. A lung abscess is a circumscribed area of suppuration and lung tissue destruction. Pleurisy is inflammation of the pleura that often manifests with pain on inspiration, fever, and chills. Flail chest is the fracture of several consecutive ribs

The assessment findings of a 5-year-old with a history of asthma include extreme shortness of breath, nasal flaring, coughing, pulsus paradoxus, and use of accessory respiratory muscles. There is no wheezing and the chest is silent in many areas. How should you interpret your assessment? a. The child probably has consolidated pneumonia; oxygen should be started immediately. b. Since there is no wheezing, asthma is not the problem, but oxygen should be started immediately anyway. c. The signs and symptoms are consistent with asthma; start oxygen and then check back on the child 30 minutes later. d. The child may be having such a severe asthma episode that the airways are closed, so start oxygen and get the provider immediately.

ANS: D The airway inflammation, edema, and bronchoconstriction of acute asthma may occlude small airways completely, so that no air is moving, which requires emergency intervention. Alicia has a history of asthma rather than pneumonia. Asthma can occur without wheezing. This is an emergency situation that requires you to start oxygen and notify the physician

A common characteristic of viral pneumonia is a. high fever. b. alveolar infiltrates on a chest x-ray. c. increased white blood cell count. d. dry cough.

ANS: D Viral pneumonia typically manifests with a dry cough. Viral infections usually do not cause high fever. Viral pneumonia typically does not produce alveolar infiltrates or leukocytosis