Pathophysiology Exam 2 Practice Test

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Practice questions from the CD that came with the book.

Which of the following valves directs blood flow from the left atrium to the left ventricle?
A. Mitral
B. Tricuspid
C. Aortic
D. Pulmonic

A. Mitral

The layer of squamous cells that lines the cardiac chambers and valves is called the:
A. myocardium
B. endocardium
C. epicardium
D. Pericardium

B. endocardium

How much does the atrial kick increase the blood volume?
A. 5%-10%
B. 10%-15%
C. 15%-20%
D. 20%-25%

C. 15%-20%

Which of the following waves corresponds with the AV valve bulging during ventricular contraction?
A. A wave
B. C wave
C. D wave
D. V wave

B. C wave (The A wave corresponds with atrial contraction, the C wave corresponds with the AV valve bulging during ventricular contraction, and the V wave corresponds to atrial filling. There is no D wave.

What portions of the heart does the left anterior descending branch supply?
A. Septal, anterior and apical
B. Lateral and Posterior
C. Lateral and septal
D. Posterior and apical

A. Septal, anterior, and apical

What is the name for the arrangement in which separate cells of the myocardium can function together?
A. Autoregulation
B. Syncytium
C. Ischemia
D. Myocyte

B. Syncytium

The structure that is composed of six polypeptide chains, two heavy chains, and four light chains is called:
A. actin
B. tropomyosin
C. troponin
D. myosin

D. myosin

Which electrolyte is necessary for muscle contraction?
A. Na+
B. K+
C. Ca++
D. Mg++

C. Ca++

Which of the following statments is true regarding muscle contraction?
A. Calcium removal from the cytoplasm causes contraction.
B. Calcium entry into the cytoplasm causes relaxation.
C. Cardiac myocytes are terminally differentiated.
D. Contraction of cardiac muscle results from lengthening of sarcomeres.

C. Cardiac myocytes are terminally differentiated.

Which of the following phases of cardiac action potentials is causes by closure of the fast sodium channels?
A. Phase 0
B. Phase1
C. Phase 2
D. Phase 3

B. Phase 1

Which of the following refers to intermittent, spontaneous generation of action potentials?
A. Rhythmicity
B. Relative refractory
C. Antiarrhythmics
D. Repolarization

A. Rhythmicity

Which of the following is not a normal excitation pathway?
A. AV node
B. SA node
C. Bundle of His
D. VA node

D. VA node

Which of the following statements is true regarding the vagus nerves?
A. The left vagus nerve supplies the SA node.
B. The right vagus nerve supplies both the SA and AV nodes.
C. Parasympathetic nerves innervate all of the ventricles.
D. Parasympathetic nerve stimulation reduces the heart rate.

D. Parasympathetic nerve stimulation reduces the heart rate.

Which of the following terms refers to increased speed of conduction?
A. Dromotropic
B. Chronotropic
C. Inotropic
D. Acetylcholine

A. Dromotropic (Chronotropic refers to increased heart rate, inotropic refers to increased contractile force)

Which of the following waves on the ECG is representative of depolarization of the lateral walls?
A. Q wave
B. R wave
C. S wave
D. T wave

C. S wave

The part of the cardiac cycle in which the cardiac muscle obtains its oxygen and gets rid of waste products is the:
A. Systole
B. Diastole
C. Isovolumic Contraction
D. Ventricular ejection

B. Diastole (the heart muscle relaxes and allows blood to flow through it as it relaxes and fills passively during diastole)

Myocytes leak the enzyme creatine kinase (CK) into the blood stream in response to :
A. cell growth
B. cell maturation
C. cell ischemia and death
D. all of the above

C. cell ischemia and death

The echocardiogram is especially useful in the measurement of the:
A. coronary blood flow and location of obstructions.
B. Structures and motion of the heart within the chest.
C. Structures and function of the lungs.
D. All of the above.

B. Structures and motion of the heart within the chest.

Atherosclerosis predisposes to a number of processes, precipitating myocardial ischemia. These processes include:
A. coronary dilation
B. thrombus formation
C. hemorrhage
D. ventricular dysrhythmia

B. thrombus formation

Abnormal vascular regulation by endothelial cells in small vessels of the heart contributes to:
A. truncus arteriosus
B. hypertension
C. dysrhythmias
D. ischemic heart disease.

D. ischemic heart disease.

Which of the following clinical manifestations differentiate myocardial infarction from angina pectoris?
A. chest pain affected by breathing and relieved by nitroglycerin administration
B. Chest pain initiated by exercise or stress and diaphoresis
C. Radiating chest pain, ST-segment changes on the ECG, and elevated serum levels of troponin
D. Chest pain aggravated by coughing and deep breathing

C. Radiating chest pain, ST-segment changes on the ECG, and elevated serum levels of troponin

Which of the following is the marker of choice for detecting a myocardial infarction?
A. Elevated T waves on an ECG
B. Elevated serum levels of cardiac troponin
C. Elevated serum levels of C-MB
D. Elevated serum levels of creatine

B. Elevated serum levels of cardiac troponin

In a patient with mitral stenosis, cardiac catheterization findings would indicate:
A. increased pressure in the right ventricle.
B. increased pressure in the left atria
C. increased pressure in the left ventricle
D. increased pressure in the right atria.

B. increased pressure in the left atria

Which of the following conditions may result in chronic pulmonary hypertension, right ventricular hypertrophy, and right-sided heart failure?
A. aortic valve stenosis
B. tricuspid valve stenosis
C. pulmonary artery valve stenosis
D. mitral valve stenosis

D. mitral valve stenosis

The primary cause of sudden cardiac death is usually due to:
A. cardiomyopathy
B. heart failure
C. ventricular dysrhythmia
D. myocardial infarction

C. ventricular dysrhythmia

The pathologic changes that occur in the development of coronary atherosclerotic lesions include:
A. a decrease in the number of smooth muscle cells.
B. chronic vasoconstriction, leading to calcium buildup
C. damage to endothelial cells by oxidized lipids, inflammatory response, and formation of plaques.
D. obstruction of a coronary vessel with death o tissue distal to the blockage

C. damage to endothelial cells by oxidized lipids, inflammatory response, and formation of plaques

What factor causes a congenital heart disease to produce cyanosis?
A. Left-to-right shunting of blood
B. right-to-left shunting of blood
C. Ventricular septal obstruction
D. none of the above

B. Right-to-left shunting of blood

Two main causes of diastolic and systolic heart failure are:
A. ischemic heart disease and hypertension
B. cardiomyopathy and anemia
C. hyperthyroidism and coronary artery disease
D. hypertension and valvular heart disease.

A. ischemic heart disease and hypertension.

Which of the following medications is used to decrease preload in patients with heart failure?
A. corticosteroids
B. Beta-blockers
C. Calcium channel blockers
D. Diuretics

D. Diuretics

A patient with heart failure complains of awakening intermittently during the night with shortness of breath. Which of the following terms is appropriate for this clinical manifestation?
A. Dyspnea
B. Orthopnea
C. Paroxysmal nocturnal dyspnea
D. Cyanosis

C. Paroxysmal nocturnal dyspnea

A patient is admitted to the hospital with left-sided heart failure. Which of the following clinical manifestations would the nurse not expect the client to exhibit?
A. Crackles in lungs
B. Cough
C. Peripheral edema
D. Dyspnea

C. Peripheral edema

Which of the following left atrial pressure readings indicates a risk of increased capillary filtration that results in the clinical manifestations of pulmonary edema?
A. 25 mmHg
B. 12 mmHg
C. 6 mm Hg
D. 2 mmHg

A. 25 mmHg

A blood test is used to identify patients with heart failure includes which of the following?
A. Echocardiogram
B. BNP
C. Chest x-ray film
D. ANP

B. BNP

What effect does stimulation of the sympathetic nervous system have on the arterioles?
A. Dilation, which results in increased vascular resistance, increased blood pressure, and decreased afterload.
B. Constriction, which results in increased vascular resistance, decreased blood pressure, and decreased afterload.
C. Constriction, which results in increased vascular resistance, increased blood pressure, and increased afterload
D. Dilation, which results in decreased vascular resistance, decreased blood pressure, and decreased afterload.

C. Constriction, which results in increased vascular resistance, increased blood pressure, and increased afterload

The patient has a regular heart rate of 54 bets/min. The nurse would document this rhythm as:
A. sinus arrhythmia
B. sinus bradycardia
C. sinus rhythm
D. sinus tachycardia

B. sinus bradycardia

Which of the following statements best describes atrial fibrillation?
A. The P wave precedes, follows, or is buried in the QRS complex
B. Disorganized and irregular atrial waves are accompanied by an irregular ventricular rate.
C. it causes an atrial rate of 240 to 350 beats/min in a sawtooth pattern of atrial depolarization.
D. It occurs earlier than normal, preceded by a P wave with a normal QRS configuration

B. Disorganized and irregular atrial waves are accompanied by an irregular ventricular rate.

A patient with an acute MI who is given a drug to lyse the clot in the coronary artery suddenly develops serious arrhythmias once circulation is restored. What is the best explanation for this phenomenon?
A. The patient has developed cardiogenic shock.
B. There is an increase in oxygen demand once circulation is restored.
C. The return of perfusion resulted in reperfusion injury
D. Emergency drugs given during resuscitation did not circulate to the heart until the clot was lysed

C. The return of perfusion resulted in reperfusion injury

For the patient in hypovolemic shock, what compensatory mechanism will help preserve adequate circulation?
A. The renin-angiotensin-aldosterone cascade
B. increased activity of the parasympathetic nervous system
C. Decreased secretion of antidiuretic hormone (ADH)
D. Vasodilation

A. The renin-angiotensin-aldosterone cascade

Which of the following types of shock is not characterized by generalized vasodilation and peripheral pooling of blood?
A. Anaphylactic shock
B. Neurogenic shock
C. Septic shock
D. Cardiogenic shock

D. Cardiogenic shock

Which is the underlying problem common among all types of shock?
A. Generalized vasodilation
B. Cardiac failure
C. Inadequate cellular oxygenation
D. Faulty compensatory mechanisms

C. Inadequate cellular oxygenation

What is the pathophysiologic phenomeon underlying disseminated intravascular coagulation (DIC)?
A. Clotting that leads to bleeding
B. Elevated platelet and fibrinogen levels
C. Inadequate cardiac output
D. Mast cell degranulation

A. Clotting that leads to bleeding.

Which of the following describes a pathologic manifestation of neurogenic shock?
A. release of vasodilatory mediators such as histimine into the circulation
B. Loss of sympathetic activation of arteriolar smooth muscle
C. Massive immune system activation
D. Increased sympathetic nervous stimulation

B. Loss of sympathetic activation of arteriolar smooth muscle

Early compensation for hypovolemic shock includes:
A. release of epinephrine from adrenal glands.
B. decreased heart rate
C. shunting of blood from the brain to the extremities
D.decreased systemic vascular resistance

A. release of epinephrine from adrenal glands

Uncontrolled massive bleeding causes which of the following types of shock?
A. Cardiogenic
B. Neurogenic
C. Hypovolemic
D. Septic

C. Hypovolemic

Activation of the renin-angiotensin system in shock causes:
A. vasodilation
B. Fluid retention
C. Sodium shifts
D. Glucogenesis

B. Fluid retention

The vasoactive mediators released in septic shock contribute to increased:
A. sodium and water retention
B. vascular permeability
C. systemic vascular resistance
D. production of mast cells

B. vascular permeability

Which of the following is an upper airway structure?
A. Trachea
B. Larynx
C. Bronchi
D. Oropharynx

D. Oropharynx

What is the name of the structure of long hairs that filter air?
A. Vibrissae
B. Cilia
C. Columnar epithelium
D. Mucus

A. Vibrissae

Which of the following structures is not located within the larynx?
A. Epiglottis
B. Acinus
C. Vocal cords
D. Cartilage

B. Acinus

Which of the following major cartilage structures is referred to as the Adam's apple?
A. Cricoid cartilage
B. Thyroid cartilage
C. Arytenoid cartilage
D. Tracheal cartilage

B. Thyroid cartilage

Which of the following is a true statement regarding the airways?
A. Cough receptors lie at the carina
B. The carina is in the right main stem bronchus
C. There are three main bronchi
D. There are six secondary or lobar branches from the bronchi

A. Cough receptors lie at the carina

At what age is the lung fully developed?
A. 15
B. 10
C. 8
D. 5

C. 8

What type of cells makes up the alveoli where gas exchange occurs?
A. Type I pneumocytes
B. Type II pneumocytes
C. Cartilage
D. Cilia

A. Type I pneumocytes

Which of the following is not one of the types of dead space?
A. anatomic
B. Cartilaginous
C. Alveolar
D. Physiologic

B. Cartilaginous

Which of the following is a true statement regarding the mechanics of breathing?
A. During inspiration the muscles relax
B. During exhalation the muscles contract
C. Functional residual capacity is the air remaining in the alveoli
D. Atelectasis is when bronchi collapse

C. Functional residual capacity is the air remaining in alveoli

Which of the following causes an increase in lung compliance?
A. Pneumonia
B. Pulmonary edema
C. ARDS
D. Emphysema

D. Emphysema

The portion of the brain that is responsible for neural control of the respiratory system is the:
A. cerebellum
B. medulla oblongata
C. frontal lobe
D. thalamus

B. medulla oblongata

Which of the following statements regarding oxygen and carbon dioxide is true?
A. carbon dioxide is less soluble than oxygen
B. oxygen diffuses more quickly than carbon dioxide
C. oxygen is carried in four forms in blood
D. carbon dioxide is carried in four forms in the blood

D. carbon dioxide is carried in four forms in the blood

What occurs with hypoventilation?
A. The amount of air entering the alveoli increases.
B. The PaCO2 exceeds 45 mmHg
C. It is a normal response to high altitude
D. Hypocapnia occurs

B. The PaCO2 exceeds 45 mmHg

Which of the following values is consistent with acute respiratory failure?
A. PaO2 of 100 mmHg
B. PaCO2 of 40 mmHg
C. pH less than 7.3
D. Hypocapnia

C. pH less than 7.3

Compliance of the lung is the measure of:
A. how easily the lung can be inflated
B. how easily gas exchange occurs at the alveoli
C. how much dead space the lung has
D. shunting

A. how easily the lung can be inflated

Areas of the lung that have little ventilation and thus little oxygen will cause the blood vessels of that area to
A. vasoconstrict
B. vasodilate
C. remain the same
D. clot off

A. vasoconstrict

Carbon dioxide diffuses faster than oxygen; therefore problems with diffusion often affect the levels of ____ first.
A. oxygen
B. carbon dioxide
C. nitrogen
D. none of these

A. oxygen

Which of the following is not a major obstructive airway disease?
A. Bronchitis
B. Pneumonia
C. Emphysema
D. Asthma

B. Pneumonia

Which of the following describes an asthma that is common in children and adolescents, with bronchospasm occurring within 3 minutes of activity?
A. Occupational-induced
B. Drug-induced
C. Exercise-induced
D. Cardiac-induced

C. Exercise-induced

Which of the following is a characteristic of intrinsic asthma?
A. The onset is usually in adolescence
B. The prognosis is more favorable than that for extrinsic asthma
C. It is IgE mediated
D. Attacks are often severe

D. Attacks are often severe

Which of the following is an additional medication that may be required for status asthmaticus?
A. Epinephrine
B. -blockers
C. Calcium channel blockers
D. Oral corticosteroids

A. Epinephrine

Which of the following is not a viral cause of acute bronchitis?
A. Influenza A
B. Staphylococcus pneumoniae
C. Coxsackie virus
D. Adenovirus

B. Staphylococcus pneumoniae

Which of the following is not a pathogenic change associated with acute bronchitis?
A. Inflamed airways
B. Swelling from exudation of fluid
C. Decreased mucous production
D. Loss of ciliary function

C. Decreased mucous production

Which cellular changes are seen with chronic bronchitis?
A. Decreased CD8 T lymphocytes
B. Increased eosinophils
C. Decreased interleukin-8 levels
D. Atrophy of bronchial glands

B. Increased eosinophils

Which of the following terms describes destruction of bronchial walls from dilation of airway sacs?
A. Aspergillus fumigatus
B. Cor pulmonale
C. Bronchiectasis
D. Cyanosis

C. Bronchiectasis

What is the name for COPD type A?
A. Emphysema
B. Bronchitis
C. "Blue bloater"
D. Asthma

A. Emphysema

Which of the following is not a major classification of emphysema?
A. Centriacinar
B. Panacinar
C. Paraseptal
D. Apex

D. Apex

A 24-year-old male presents with emphysema. He has never smoked and does not get much exposure to secondhand smoke. What is the name of the hereditary disease that may be responsible for his emphysema?
A. Intrinsic asthma
B. 1-Antitrypsin deficiency
C. Duchenne muscular dystrophy
D. Pulmonary fibrosis

B. 1-Antitrypsin deficiency

Which of the following statements regarding bronchiectasis is true?
A. it is common in cystic fibrosis
B. The most common bacterial pathogen is Streptococcus pneumoniae
C. It can lead to carcinoma
D. It is classified according to stage of spread.

A. It is common in cystic fibrosis

Which of the following statements is true regarding cystic fibrosis?
A. It is autosomal dominant
B. it is the mo st common genetic disease in the United States
C. It affects endocrine glands
D. It is common in African Americans

B. It is the most common genetic disease in the United States.

What is the primary cause of airway obstruction in patients with chronic bronchitis?
A. Thinning bronchial smooth muscle
B. Infection
C. Hyperventilation
D. Mucous plugs

D. Mucous plugs

In extrinsic asthma the immune system responds to the presence of allergens by causing:
A. bronchoconstriction
B. bronchodilation
C. decreased sputum production
D. decreased cough reflex

A. bronchoconstriction

Which of the following physiologic abnormalities is characteristic of emphysema?
A. Extensive inflammation of the lower airways
B. Trapping of air in distal air sacs
C. Widespread occurrence of bronchial plugs
D. Collapse of proximal airways

B. Trapping of air in distal air sacs

The major characteristic of bronchiolitis is:
A. destruction of lung parenchyma and collapse of distal airways
B. obstruction by eosinophilic mucous plugs in the upper airway.
C. widespread inflammation of the bronchioles.
D. extensive constriction of the bronchioles.

C. widespread inflammation of the bronchioles.

Which of the following triad of clinical manifestations suggests epiglottitis?
A. Sore throat, difficulty swallowing, and drooling
B. Hoarseness, sore throat, and productive cough
C. Persistent productive cough, vomiting and fever
D. Fever, sore throat, and increased thirst.

A. Sore throat, difficulty swallowing, and drooling

Which of the following occurs during an acute asthma attack?
A. vital capacity increases
B. residual lung volume increases
C. inspiratory reserve volume increases
D. tidal volume remains unchanged

B. residual lung volume increases

Which of the following restrictive diseases is associated with the formation of an antigen-antibody complex, causing fibrosis of the lung?
A. Sarcoidosis
B. Hypersensitivity pneumonitis
C. Diffuse interstitial lung disease
D. Pneumoconiosis

B. Hypersensitivity pneumonitis

Pulmonary function testing for restrictive diseases reveals which of the following?
A. Increased lung volumes and decreased respiratory rates
B. Increased vital capacity, total lung capacity, and diffusing capacity
C. Decreased vital capacity, total lung capacity, and diffusing capacity
D. Decreased vital capacity, increased diffusing capacity, and increased forced expiratory flow

C. Decreased vital capacity, total lung capacity, and diffusing capacity

A common radiologic diagnostic manifestation of fibrotic restrictive disease is the appearance of:
A. distended fibrotic alveoli
B. a honeycomb lung
C. enlargement and destruction of acini
D. constrictive bronchi

B. a honeycomb lung.

The pathogenesis of adult respiratory distress syndrome is:
A. injury to the alveolar-capillary membrane, impaired diffusion, and decreased lung compliance.
B. air trapping and difficulty in expiratory ventilation
C. airway obstruction with collapse of the lung
D. alveolar wall thickening, inflammation, and a stiff noncompliant lung

A. injury to the alveolar-capillary membrane, impaired diffusion, and decreased lung compliance

Abnnormal fluid accumulations in the pleural space affect the lung function by causing:
A. hyperresonance, severe tachycardia, and hypotension.
B. dyspnea, pleuritic pain, dry cough, and decreased tactile fremitus.
C. nasal flaring, expiratory grunting, and rapid shallow breathing
D. dyspnea, inflammation, fever, and enlarged lymph nodes.

B. dyspnea, pleuritic pain, dry cough, and decreased tactile fremitus

The pathogenesis of pneumonia is:
A. interstitial and alveolar wall thickening, inflammation, and lung destruction.
B. inhalation of dust, formation of antigen-antibody complexes, inflammation, and granulomas production.
C. inhalation of microbial agents, inflammation, formation of exudates, and fibrosis resulting in lung consolidation.
D. injury/damage to the alveolar-capillary membrane and disruption in oxygen transport and utilization resulting in decreased lung compliance.

C. inhalation of microbial agents, inflammation, formation of exudates, and fibrosis resulting in lung consolidation.

Tachycardia, decreased or absent breath sounds on the affected side, hyperresonance, and sudden chest pain on the affected side are clinical manifestations of:
A. myocardial infarction
B. adult respiratory distress syndrome
C. sarcoidosis
D. pneumothorax

D. pneumothorax

Tubercular bacilli are transmitted by:
A. blood and body fluids
B. contaminated food
C. contaminated blood
D. airborne droplet nuclei

D. airborne droplet nuclei

The pathogenesis of tuberculosis is:
A. inflammation, damage to the alveolar-capillary membrane, and formation of exudates.
B. entrance of mycobacteria into the lungs, activation of macrophages, formation of granulomas, fibrosis, and calcification.
C. interstitial and alveolar wall thickening, inflammtion, and noncompliant lungs
D. formation of antigen-antibody complexes, granuloma production, and fibrosis of the lung.

B. entrance of mycobacteria into the lungs, activation of macrophages, formation of granulomas, fibrosis, and calcification.

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