NURS-6501C-13/NURS-6501N-13-Advanced Pathophysiology Midterm Exam

NURS-6501C-13/NURS-6501N-13-Advanced Pathophysiology Midterm Exam

NURS-6501C-13/NURS-6501N-13-Advanced Pathophysiology Midterm Exam

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?

		Widely spaced nipples, reduced carrying angle at the elbow, and sparse body hair
		An IQ of 25 to 70, low nasal bridge, protruding tongue, and flat, low-set ears
		High-pitched voice, tall stature, gynecomastia, and an IQ of 60 to 90
		Circumoral cyanosis, edema of the feet, short stature, and mental slowness

B

Free radicals play a major role in the initiation and progression of which diseases?

		Cardiovascular diseases such as hypertension and ischemic heart disease
		Renal diseases such as acute tubular necrosis and glomerulonephritis
		Gastrointestinal diseases such as peptic ulcer disease and Crohn disease
		Muscular disease such as muscular dystrophy and fibromyalgia

A

Which of following is true about normal changes to the GI system that occur as individuals age?

		decreased motility and increased liver blood flow and liver enzyme activity
		decreased motility and  decreased liver blood flow and liver enzyme activity
		increased motility and decreased liver blood flow
		increased motility and increased liver enzyme activity

B

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?

		It suppresses the action of the tumor-suppressor genes.
		It changes the way the growth promotion genes work.
		A mutation in this gene allows continuous cell growth.
		It activates a cell surface receptor that allows signaling to the nucleus.

C

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?

		Partial insulin secretion
		An autoimmune cause factor
		Insulin resistance
		Obesity as a common risk factor

B

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?

		Infection
		Ultraviolet damage
		Pain
		Erythema

A

A patient’s chart indicates Kussmaul respirations. The student asks the healthcare professional what this is caused by. What response by the professional is most accurate?

		Anxiety leads to Kussmaul respirations and is a cause of respiratory acidosis.
		A compensatory measure is needed to correct metabolic acidosis.
		Diabetic ketoacidosis is leading to metabolic acidosis.
		More oxygen is necessary to compensate for respiratory acidosis.

B

Which of the following laws is defined as “Within limits, a greater end-diastolic volume will produce a greater contractile force during systole”?

		Laplace’s law
		Frank-Starling law
		Autonomic law
		Laplace’s law

B

The student asks the healthcare professional to explain how pulmonary edema and pulmonary fibrosis cause hypoxemia. What description by the professional is best?

		Creates alveolar dead space
		Decreases the oxygen in inspired gas
		Creates a right-to-left shunt
		Impairs alveolocapillary membrane diffusion

D

The healthcare professional explains to a student that the amount of volume of blood in the heart is directly related to the _____ of contraction.

		Pressure
		Strength
		Viscosity
		Speed

B

Surfactant produced by type II alveolar cells facilitates alveolar distention and ventilation by which mechanism?

		Decreasing thoracic compliance
		Attracting water to the alveolar surface
		Decreasing surface tension in the alveoli
		Increasing surface tension in the alveoli

C

The student wants information about a patient’s renal function. What test does the healthcare professional tell the student to evaluate?

		Glomerular filtration rate
		Hourly urine output
		Serum blood urea nitrogen and creatinine
		The specific gravity of the solute concentration of the urine

A

The tunica media is the middle layer of blood vessels and is composed of what type of tissue?

 

		endothelium and elastic fibers
		endothelium and connective tissue
		smooth muscle and elastic fibers
		smooth muscle and connective tissue

C

Which hormone is required for water to be reabsorbed in the distal tubule and collecting duct?

		Antidiuretic hormone
		Aldosterone
		Cortisol
		Adrenocorticotropic hormone

A

Which type of immunity is produced by an individual after either natural exposure to the antigen or after immunization against the antigen?

		Passive-acquired immunity
		Active-acquired immunity
		Passive-innate immunity
		Active-innate immunity

B

The glomerular filtration rate is directly related to which factor?

		Perfusion pressure in the glomerular capillaries
		Diffusion rate in the renal cortex
		Diffusion rate in the renal medulla
		Glomerular active transport

A

A patient has portal hypertension-induced splenomegaly. Which lab value would the healthcare professional associate with this condition?

		Low white blood cell count
		Low platelet count
		High red cell count
		High hemoglobin and hematocrit

B

When renin is released, it is capable of which action?

		Inactivation of autoregulation
		Direct activation of angiotensin II
		Direct release of antidiuretic hormone (ADH)
		Formation of angiotensin I

D

A student asks why some vaccinations are given orally and some are given by injection. What response by the professor is best?

		Different routes allow the speed of onset of the antigen to be varied, with the intravenous route being the fastest.
		Some individuals appear to be unable to respond to an antigen by a specific route, thus requiring the availability of different routes for the same antigen.
		Antigen-presenting cells are highly specialized and thus require stimulation by different routes.
		Each route stimulates a different lymphocyte-containing tissue, resulting in different types of cellular and humoral immunity.

D

The cardiac electrical impulse normally begins spontaneously in the sinoatrial (SA) node because of what reason?

		It has a superior location in the right atrium.
		It is the only area of the heart capable of spontaneous depolarization.
		It has rich sympathetic innervation via the vagus nerve.
		It depolarizes more rapidly than other automatic cells of the heart.

D

A pancreatic enzyme that digests carbohydrates is called __________________

		Trypsin
		Amylase
		Pepsin
		Ptyalin

B

A patient is having an IgE-mediated hypersensitivity reaction. What action by the healthcare professional is best?

		Give the patient an antihistamine.
		Prepare to give the patient a blood transfusion.
		Ask the patient is he/she is having pain at the site.
		Apply warm, moist heat to the affected area.

A

 

A healthcare professional is assessing a child whose parents report poor grades in school, trouble paying attention, and naughty behaviors that have become so frequent the child is always in trouble. For which health condition should the professional facilitate testing?

		Hypoxic injury
		Lead poisoning
		Mercury exposure
		Cadmium injection

B

The increased renal excretion of sodium and water  is caused by what substance?

		Anti diuretic hormone
		Angiotenson
		Amino acids
		Natriuretic peptides

D

Acute rheumatic fever is a complication of  a:

		streptococcal infection of the pharynx
		staphylococcal infection of pharynx
		E. Coli infection of the kidney
		Pseudomonas infection of the lung

A

What hormone stimulate  gastric emptying?

		gastrin and motilin
		gastrin and cholecystokinin
		secretin and cholecystokinin
		secretin and motilin

C

A patient with massive proteinuria, hypoproteinemia, hyperlipidemia,  and edema is experiencing classic symptoms of:

		Renal cancer
		Nephrotic syndrome
		Calculus lodged in ureter
		Acute kidney injury

B

The Bainbridge reflex is thought to be initiated by sensory neurons in which cardiac location?

		Atria
		Aorta
		Sinoatrial (SA) node
		Ventricles

A

The external urethral sphincter is under the voluntary control of what somatic motor nerve?

		pudendal
		phrenic
		sacral
		femoral

A

How do free radicals cause cell damage?

		Stealing the cell’s oxygen to stabilize the electron, thus causing hypoxia
		Stimulating the release of lysosomal enzymes that digest the cell membranes
		Transferring one of its charged, stabilized atoms to the cell membrane, which causes lysis
		Giving up an electron, which causes injury to the chemical bonds of the cell membrane

D

Rapidly progressive glomerulonephritis can cause what type of acute kidney injury?

		pre-renal
		intra-renal
		post-renal

A

Rapidly progressive glomerulonephritis can cause what type of acute kidney injury?

		pre-renal
		intra-renal
		post-renal

A

Inflammatory disease of peripheral arteries that usually is associated with smoking is a description of which condition?

		Pericarditis
		Varicose veins
		Intermittent claudication
		Thromboangiitis obliterans

D

A professor has taught the students about the pathogenesis of abdominal pain. Which statement by a student indicates the professor needs to review the material?

		Chemical mediators, such as histamine, bradykinin, and serotonin, produce abdominal pain.
		Edema and vascular congestion produce abdominal pain by stretching.
		Ischemia, caused by distention of bowel obstruction or mesenteric vessel thrombosis, produces abdominal pain.
		Low concentrations of anaerobes, such as Streptococci, Lactobacilli, Staphylococci, Enterobacteria, and Bacteroides, produce abdominal pain.

D

The acute inflammatory response is characterized by fever that is produced by the hypothalamus being affected by what?

		Endogenous pyrogens
		Bacterial endotoxin
		Antigen-antibody complexes
		Exogenous pyrogens

A

What mechanisms occur in the liver cells as a result of lipid accumulation?

		Accumulation of lipids that obstruct the common bile duct, preventing flow of bile from the liver to the gallbladder
		Increased synthesis of triglycerides from fatty acids and decreased synthesis of apoproteins
		Increased binding of lipids with apoproteins to form lipoproteins
		Increased conversion of fatty acids to phospholipids

B

What effect is a result of inhibiting the parasympathetic nervous system with a drug such as atropine?

		Salivation becomes thinner.
		Salivation decreases.
		The pH of saliva changes.
		Digestive enzymes are inhibited.

B

It has been determined that a patient’s tumor is in stage 2. How does the healthcare professional describe this finding to the patient?

		Cancer is confined to the organ of origin.
		Cancer has spread to regional structures.
		Cancer is locally invasive.
		Cancer has spread to distant sites.

C

A healthcare professional is educating a patient about asthma. The professional states that good control is necessary due to which pathophysiologic process?

		Norepinephrine causes bronchial smooth muscle contraction and mucus secretion but it also causes high blood pressure.
		Uncontrolled inflammation leads to increased bronchial hyperresponsiveness and eventual scarring.
		The release of epinephrine leads to development of cardiac dysrhythmias.
		Immunoglobulin G causes smooth muscle contraction which will eventually weaken the respiratory muscles.

B

Cells that  metabolize nutrients, detoxify chemicals, secrete bile, synthesize albumin and clotting factors, and other functions are called?

		Kupffer cells
		Pancreatic acinar cells
		Hepatocytes
		Parietal cells

C

The renal medulla recycles urea causing urine to become more:

		contaminated
		filtered
		concentrated
		diluted

C

A patient has a peptic ulcer related to h. pylori bacteria. What treatment does the healthcare professional educate the patient on?

		Antibiotic therapy
		Corticosteroids
		Vitamin B 12 injections
		Pancreatic enzyme replacement

A

A patient suffered multiple traumatic injuries and received many blood transfusions within a few days of the injuries. For which medical condition should the healthcare professional monitor the patient for?

		High blood pressure
		HIV infection
		Hemosiderosis
		Kidney damage

C

Acute mesenteric ischemia damages the intestinal mucosa and can eventually cause:

 

		peritonitis
		malabsorption
		rupture
		appendicitis

B

Secretion of potassium, ammonia, and H1; site of action of aldosterone and ADH occurs in what portion of the kidney?

		Proximal tubule
		Distal tubule and collecting duct
		Descending limb of loop of Henle
		Glomerulus

B

A person who has pulmonary edema will exhibit which symptoms?

		resonance to percussion over the lung bases, inspiratory wheezing, foul smelling sputum
		dullness to percussion over the lung bases, inspiratory crackles, and pink frothy sputum
		resonance to percussion over the lung bases, inspiratory wheezing, and pink frothy sputum
		dullness to percussion over the lung bases,  inspiratory wheezing, foul smelling sputum

B

A person who has pulmonary edema will exhibit which symptoms?

		resonance to percussion over the lung bases, inspiratory wheezing, foul smelling sputum
		dullness to percussion over the lung bases, inspiratory crackles, and pink frothy sputum
		resonance to percussion over the lung bases, inspiratory wheezing, and pink frothy sputum
		dullness to percussion over the lung bases,  inspiratory wheezing, foul smelling sputum

B

Cirrhosis and hepatitis can cause:

		intrahepatic portal hypertension
		posthepatic portal hypertension
		prehepatic portal hypertension
		aortic portal hypertension

A

Cells that remove bacteria and foreign particles from blood in the hepatic sinusoids are called?

		Kupffer cells
		Pancreatic acinar cells
		Hepatocytes
		Parietal cells

A

When plasma creatinine concentration increases what effect does it have on the GFR?

		GFR increases
		GFT decreases
		GFR remains the same
		GFR moves in the same direction as the plasma creatinine concentration

B

Reabsorption of large amounts of sodium, water, glucose, amino acids; net reabsorption of bicarbonate; secretion of H1, organic acids, and many medications occurs in what portion of the kidney?

		Proximal tubule
		Distal tubule and collecting duct
		Descending limb of loop of Henle
		Glomerulus

A

When endothelial cells are injured, what alteration contributes to atherosclerosis?

		The release of toxic oxygen radicals that oxidize low-density lipoproteins (LDLs)
		Cells are unable to make the normal amount of vasodilating cytokines.
		Cells produce an increased amount of antithrombotic cytokines.
		Cells develop a hypersensitivity to homocysteine and lipids.

B

Which renal change is found in older adults?

		Sharp decline in glomerular filtration rate
		Sharp decline in renal blood flow
		Decrease in the number of nephrons
		Decrease in urine output

C

Which patient would the healthcare professional assess for other signs of thyrotoxic crisis?

		Constipation with gastric distention
		Bradycardia and bradypnea
		Hyperthermia and tachycardia
		Constipation and lethargy

C

Nephrotoxic antibiotics can cause what type of acute kidney injury?

		pre-renal
		intra-renal
		post-renal

B

A patient that is hyperventilating will have a decreased:

		saturation
		Pa02
		PaCO2
		minute volume

C

Massive hemorrhage can cause what type of acute kidney injury?

		pre-renal
		intra-renal
		post-renal

A

A student asks the professor to explain what effect natriuretic peptides have during heart failure when the heart dilates. Which response by the professor is best?

		Stimulates antidiuretic hormones
		Inhibits antidiuretic hormones
		Stimulates renin and aldosterone
		Inhibits renin and aldosterone

D

Passage of fluid and/or solid particles into the lungs is a(n):

		Empyema
		Aspiration
		Atelectasis
		Hemoptysis

B

Neurotransmitters affect the postsynaptic membrane by binding to which structure?

		Lipids
		Ribosomes
		Amphipathic lipids
		Receptors

D

What does vomiting-induced metabolic alkalosis cause?

		Retained sodium to bind with the chloride
		Hydrogen to move into the cell and exchange with potassium
		Retention of bicarbonate to maintain the anion balance
		Hypoventilation to compensate for the metabolic alkalosis

C

A patient has diabetes mellitus. A recent urinalysis showed increased amounts of protein. What therapy does the healthcare provider educate the patient that is specific to this disorder?

		More frequent blood glucose monitoring
		Moderate dietary sodium restriction
		Treatment with an ACE inhibitor
		Home blood pressure monitoring

C

A patient has a history of excessive use of magnesium-containing antacids and aluminum-containing antacids. What lab value does the healthcare professional correlate to this behavior?

		Magnesium 1.8 mg/dL
		Phosphate 1.9 mg/dL
		Sodium 149 mEq/L
		Potassium 2.5 mEq/L

B

An alkaline urinary pH significantly increases the risk for what type of urinary stone formation?

		magnesium phosphate
		uric acid
		calcium phosphate
		potassium phosphate

C

 

What is the cause of familial hypercholesterolemia (FH)?

		Diet high in saturated fats
		Increased production of cholesterol by the liver
		Reduction in the number of low-density lipoprotein (LDL) receptors on cell surfaces
		Abnormal function of lipoprotein receptors circulating in the blood

C

What is the blood type of a person who is heterozygous, having A and B alleles as codominant?

		A
		B
		O
		AB

D

Bile acid are recycled by the body and absorbed via:

 

		portal circulation
		enterohepatic circulation
		biliary circulation
		splenic circulation

B

A patient has a pulmonary capillary wedge pressure of 30mmHg. What assessment finding by the healthcare professional would be most consistent with this reading?

		Normal lung sounds
		Pink, frothy sputum
		Eupnea
		Rhonchi

 

B

Renal failure is the most common cause of which type of hyperparathyroidism?

		Primary
		Secondary
		Exogenous
		Inflammatory

B

A patient is brought to the Emergency Department with a gunshot wound to the chest. The healthcare professional assesses an abnormality involving a pleural rupture that acts as a one-way valve, permitting air to enter on inspiration but preventing its escape by closing during expiration. What action by the healthcare professional is the priority?

		Draw arterial blood gasses.
		Assist with a chest tube insertion.
		Give the patient low-flow oxygen.
		Assess for clubbing of fingernails.

B

The V/Q ratio of a normal upright lunch is 0.8, this indicates that ventilation is _______________ than perfusion.

		compensated
		more
		less
		equal

B

The student asks the professor to explain what characteristic is demonstrated by lungs with decreased compliance?

		Difficult deflation
		Easy inflation
		Stiffness
		Inability to diffuse oxygen

C

Which primary characteristic is unique for the immune response?

		The immune response is similar each time it is activated.
		The immune response is specific to the antigen that initiates it.
		The response to a specific pathogen is short term.
		The response is innate, rather than acquired.

B

What are tumor cell markers?

		Hormones, enzymes, antigens, and antibodies that are produced by cancer cells
		Receptor sites on tumor cells that can be identified and marked
		Cytokines that are produced against cancer cells
		Identification marks that are used in administering radiation therapy

A

A student asks the professor how a faulty negative-feedback mechanism results in a hormonal imbalance. What response by the professor is best?

		Hormones are not synthesized in response to cellular and tissue activities.
		Decreased hormonal secretion is a response to rising hormone levels.
		Too little hormone production is initiated.
		Excessive hormone production results from a failure to turn off the system.

D

What pathologic change occurs to the kidney’s glomeruli as a result of hypertension?

		Compression of the renal tubules
		Ischemia of the tubule
		Increased pressure from within the tubule
		Obstruction of the renal tubule

B

Women who have symptoms of cystitis for more than 6 weeks with negative urine cultures may have:

		aseptic  cystitis
		interstitial  cystitis
		septic  cystitis
		pyelonephritis

B

A healthcare professional is educating a patient on asthma. The professional tells the patient that the most successful treatment for chronic asthma begins with which action?

		Avoidance of the causative agent
		Administration of broad-spectrum antibiotics
		Administration of drugs that reduce bronchospasm
		Administration of drugs that decrease airway inflammation

A

A healthcare professional is conducting community education on vaccinations. Which statement about vaccines does the professional include in the presentation?

		Most bacterial vaccines contain attenuated organisms.
		Most viral vaccines are made by using dead organisms.
		Vaccines require booster injections to maintain life-long protection.
		Vaccines provide effective protection against most infections.

C

What is an expected change in the cardiovascular system that occurs with aging?

		Arterial stiffening
		Decreased left ventricular wall tension
		Decreased aortic wall thickness
		Arteriosclerosis

A

Once they have penetrated the first line of defense, which microorganisms do natural killer (NK) cells actively attack?

		Bacteria
		Fungi
		Viruses
		Mycoplasma

C

A patient had a motor vehicle crash and suffered critical injuries to the brainstem. What physiological responses would the healthcare professional expect to see?

		Prolonged QRS segment
		Shortened PR interval
		Pulse and blood pressure changes
		Fluid overload

C

A healthcare professional is caring for four patients. Which patient should the professional assess for hyperkalemia?

		Hyperparathyroidism
		Vomiting
		Renal failure
		Hyperaldosteronism

C

A patient has been diagnosed with primary emphysema but claims there is no history of smoking. What action by the healthcare professional is most appropriate?

		Facilitate genetic testing on the patient.
		Ask the family if the patient smokes.
		Schedule pulmonary function studies.
		Get baseline arterial blood gasses.

A

A patient in the hospital has hypernatremia. What condition should the healthcare professional assess for?

		Syndrome of inappropriate antidiuretic hormone
		Hypersecretion of aldosterone
		Brief bouts of vomiting or diarrhea
		Excessive diuretic therapy

B

A patient has been diagnosed with an empyema. What does the healthcare professional tell the patient about this condition?

		We will have to drain the pus out of your pleural space.
		You will be given a long course of antiviral medication.
		These blebs in your lungs can rupture with exercise.
		We will watch you for respiratory muscle fatigue.

A

Sympathetic stimulation causes airways to:

		dilate
		constrict
		collapse
		trap air

A

A healthcare professional cares for older adults in a skilled nursing facility. What should the professional assess for in these individuals related to cardiovascular functioning?

		Increased rate of falling and dizzy spells
		Improved exercise tolerance
		A gradual slowing of the heart rate
		Progressive ECG changes

A

A person with a respiratory rate of 12 breaths per minute and a minute volume of 6.0 L/minute has a tidal volume of :

		720 ml
		600 ml
		1000 ml
		500 ml

D

The presence of pus in the pleural cavity is a(n):

		Empyema
		Atelectasis
		Aspiration
		Hemoptysis

A

A student asks the professor to differentiate Type 2 diabetes mellitus from Type 1. The professors’ response would be that Type 2 is best described as what?

		Resistance to insulin by insulin-sensitive tissues
		Need for lifelong insulin injections
		Increase of glucagon secretion from beta cells of the pancreas
		Presence of insulin autoantibodies that destroy beta cells in the pancreas

A

Clinical manifestations of bronchiolitis include:

		hypoxia,  use of accessory muscles,  and high grade fever
		tachypnea,  use of accessory muscles,  and high grade fever
		tachypnea, productive cough, and high grade fever
		tachypnea, non-productive cough, and low grade fever

D

Under anaerobic conditions, what process provides energy for the cell?

		Oxidative phosphorylation
		Glycolysis
		Lactolysis
		Passive transport

B

Which chamber of the heart endures the highest pressures?

		Right atrium
		Left atrium
		Left ventricle
		Right ventricle

C

Which of these structures are located in the renal medulla?

		Glomeruli, proximal tubules, and renal corpuscles
		Glomeruli,  distal tubules, and pyramids
		Collecting ducts, distal tubules, and pyramids
		Collecting ducts,  proximal tubules, and renal corpuscles

A

 

Within a physiologic range, what does an increase in left ventricular end-diastolic volume (preload) result in?

		Increase in force of contraction
		Decrease in refractory time
		Increase in afterload
		Decrease in repolarization

A

A student asks the healthcare professional to describe exotoxins. Which statement by the professional is best?

		Exotoxins are contained in cell walls of gram-negative bacteria.
		Exotoxins are released during the lysis of bacteria.
		Exotoxins are able to initiate the complement and coagulation cascades.
		Exotoxins are released during bacterial growth.

D

Para-aminohippuric acid is  used to estimate what?

		effective renal blood flow
		glomerular filtration rate
		protein metabolism
		renal artery pressure

A

What is one function of the tumor cell marker?

		To provide a definitive diagnosis of cancer
		To treat certain types of cancer
		To predict where cancers will develop
		To screen individuals at high risk for cancer

D

Severe right-sided heart failure can cause:

		intrahepatic portal hypertension
		posthepatic portal hypertension
		prehepatic portal hypertension
		aortic portal hypertension

B

Which gastric hormone inhibits acid and pepsinogen secretion, as well as decreases the release of gastrin?

		Motalin
		Histamine
		Somatostatin
		Acetylcholine

C

What are blood pressure variations associated with?

		b 1-Adrenergic receptors to increase heart rate
		The release of an antidiuretic hormone (ADH)
		The renin-angiotensin system’s effect on vasoconstriction
		Serum bradykinin, causing vasodilation

C