Gary was injured in an automobile accident that severed the motor neurons innervating his quadriceps. Even though he has had extensive physical therapy, he is still suffering muscle atrophy. Why is the therapy not working?
In denervation (disuse) atrophy, fibrous connective tissue replaces the muscle tissue that was lost. When atrophy is complete, fibrous tissue cannot be reversed to muscle tissue.
Aaron arrived at the hospital with the following symptoms: drooping eyelids; fatigue and weakness of his muscles; and difficulty talking, breathing, and swallowing. What was his diagnosis?
Lynn has been waking up each night with intense pain in her calves. She has been playing tennis all summer for several hours each day. She does not feel that her problem is serious enough to seek medical attention. What is the diagnosis, and why?
Cramp in the gastrocnemius muscle; the fact that Lynn has been playing tennis for several hours each day may have caused an electrolyte depletion.
After removal of an elbow cast, Lauren noticed her arm was immovable. What happened to her arm?
The immobilization of the arm caused some muscle mass to atrophy, and the loss of muscle was replaced with tough connective tissue that locked her arm in place.
A patient is admitted for electroconvulsive treatment (ECT). The physician orders the neuromuscular blocking agent metocurine iodide (metubine) to reduce trauma by relaxing skeletal muscles. How does a neuromuscular blocking agent such as metubine interfere with muscle contraction?
It acts at the postsynaptic membrane by competing with the ACh for the receptor sites, or by blocking depolarization.
A patient has no peristalsis in the gastrointestinal tract. Why would this be problematic?
The patient would be unable to expel his or her stool, leading to intestinal obstruction.
When a geriatric patient is admitted to the rehabilitation unit, an important nursing measure is to prevent the loss of muscle mass. What is the term used for loss of muscle mass, and how can the patient prevent it?
Disuse atrophy, where fibrous connective tissue replaces the muscle tissue that was lost. This can be prevented by regular weight-bearing exercise, unless atrophy is complete
The nurse encourages the patient to do his own activities of daily living such as bathing, eating, dressing, and toileting activities. How do these activities promote physical conditioning?
The contraction of the muscles in these activities helps maintain the shape, size, and strength of muscles, as well as joint mobility.
That part of the nervous system that is voluntary and conducts impulses from the CNS to the skeletal muscles is the ________ nervous system.
When a sensory neuron is excited by some form of energy, the resulting graded potential is called a(n) ________.
________ potentials are short-lived, local changes in membrane potential that can be either depolarized or hyperpolarized.
________ is a disease that gradually destroys the myelin sheaths of neurons in the CNS, particularly in young adults.
Multiple sclerosis (MS) is a disease in which the myelin sheaths are destroyed. What process does this interfere with, and what would be the consequence?
Demyelination interferes with saltatory conduction, which would result in a slowing down of nerve impulse propagation.
A patient is admitted to the hospital with exacerbation of multiple sclerosis (MS). She asks the nurse "Why did this have to happen to me again? I was doing so well." Why are some forms of MS characterized by periods of remission and exacerbation?
The axons are not damaged; growing numbers of sodium channels appear spontaneously in the demyelinated fibers, allowing conduction to resume.
What symptoms would a nurse focus on in his or her care of a patient with multiple sclerosis?
Visual disturbances, paralysis, and weakness
The synapse more common in embryonic nervous tissue than in adults is the ________.
When one or more presynaptic neurons fire in rapid order it produces a much greater depolarization of the postsynaptic membrane than would result from a single EPSP; this event is called ________ summation.
A patient was admitted for depression. What class of neurotransmitter is serotonin, and what should the nurse explain to the patient regarding the role of serotonin in depression?
Serotonin is a biogenic amine neurotransmitter widely distributed in the brain; it plays a role in emotional behavior and mood, and helps to regulate the "biological clock."
When information is delivered within the CNS simultaneously by different parts of the neural pathway, the process is called ________ processing.
Which pattern of neural processing is important for higher level mental processing such as problem solving?
The layer of the epidermis immediately under the stratum lucidum in thick skin is the stratum ________.
A summertime golden bronze tan may not be a tan at all; especially if the skin appears almost metallic bronze, it may be the result of ________ disease.
The only place you will find stratum ________ is in the skin that covers the palms, fingertips, and soles of the feet.
Albinos commonly contract skin cancer. What seems to be the reason, and what can be done to reduce the risk of skin cancer?
Albinos lack melanin and have thus lost their main defense against the damaging UV light that can cause skin cancer. They can cover all body areas and avoid bright sunlight.
The 68-year-old patient was admitted to the hospital medical floor with a diagnosis of chronic bronchitis. His wife asks the nurse why his skin looks blue. How would you explain cyanosis to this patient and his wife?
Cyanosis is a dusky bluish or grayish discoloration of the skin and mucous membranes that occurs with reduced oxygen levels
The major regions of a hair shaft include all of the following except ________.
external root sheath
John, a younger teenager, notices that he is experiencing a lot of pimples and blackheads, which frequently become infected. What is causing this problem?
The hormonal changes are causing the sebaceous glands to become overactive, resulting in them becoming clogged and infected.
We are told that every surface we touch is teeming with bacterial cells, and bacteria are found in the pools we swim in, the water we wash with, and on the hands of friends. Why are we not inundated with bacterial infections on our skin?
Not all bacteria are harmful or thrive on the skin.
Many bacteria are killed by bactericidal substances in the sebum and sweat.
The low pH of the skin secretions retards the multiplication of bacteria on the skin.
The temperature yesterday was an uncomfortable 98Â° F. You unwisely chose to play tennis at noon, counting on your body's internal defenses to protect you against heat exhaustion. How did your body respond to this distress?
Blood vessels in the skin dilated; sweat was secreted onto the skin's surface and evaporated, cooling the body.
Why might soap that has an alkaline base not be healthy for some patients to use daily?
The base will neutralize the acid on the skin that retards the growth of bacteria, and the removal of the normal microbiota of skin will leave the person exposed to opportunistic pathogens.
Mary noticed a large, brown spot on her skin. She has been playing tennis in the sun for several years without sun protection. She reported the discovery to a friend, who told her to apply the ABCD rule to determine whether or not she had malignant melanoma. Her friend told her that if her answer was "no" to the questions that were asked by the ABCD rule, she had nothing to worry about. What is the ABCD rule, and should she ignore the spot if her answers are negative?
A = asymmetry, B = border, C = color, D = diameter. It is imperative that Mary have a physician examine the spot immediately. Any unusual lesion on the skin of a sun worshipper should be examined.
The Waldorf family was caught in a fire but escaped. Unfortunately, the father and daughter suffered burns. The father had second-degree burns on his chest, abdomen, and both arms, and third-degree burns on his entire left lower extremity. The daughter suffered first-degree burns on her head and neck and second-degree burns on both lower extremities. What percentage of the father's body was covered by burns? The father experiences a good deal of pain in the area of the chest and abdomen, but little pain in the leg. Why?
54%. The nerve endings were damaged or destroyed in third degree burns, but in second degree burns the nerve endings are only irritated.
The Waldorf family was caught in a fire but escaped. Unfortunately, the father and daughter suffered burns. The father had second-degree burns on his chest, abdomen, and both arms, and third-degree burns on his entire left lower extremity. The daughter suffered first-degree burns on her head and neck and second-degree burns on both lower extremities. What percentage of the daughter's body received first-degree burns? What part of the daughter's body has burns to both the dermis and epidermis?
9%; the legs
Melanoma is a form of skin cancer that arises from melanocytes. Melanoma is most common in Caucasians between 40 and 70 years of age. Why do Caucasians have a greater incidence of melanoma?
Caucasians produce less melanin, resulting in less protection from the damaging effects of UV light. Dark brown or black skin does not guarantee against melanoma.
Robert, a surfer, has a mole that has changed its shape and size. His doctor, applying the ABCD(E) rule, diagnosed a melanoma. What do the letters ABCD(E) represent?
A = asymmetry, B = border, C = color, D = diameter, E = elevation
A central (Haversian) canal may contain arteries, veins, capillaries, lymph vessels, and ________ fibers.
A round or oval hole through a bone that contains blood vessels and/or nerves is called a(n) ________.
Johnny fractured the lower third of his right tibia in a skiing accident. The soft tissues in the area were severely damaged and their surgical removal was necessary. After prolonged immobilization, it was found that Johnny was healing very poorly. Why did Johnny have poor healing?
Removal of the soft tissue reduced blood flow to the affected area, resulting in a decreased supply of nutrients required for repair.
Wolff's law is concerned with ________.
the thickness and shape of a bone being dependent on stresses placed upon it
Which of the following glands or organs produces hormones that tend to decrease blood calcium levels?
Mrs. Brown was outside on her patio cleaning windows when she fell off her step ladder and fractured her right hip. She had emergency surgery for an open reduction and internal fixation of the right hip. After surgery, she asks you if she will have trouble going through airport security. What has prompted her concern?
Surgical repair of this fracture may involve use metal items (such as rods, wire, screws, pins, or nails) that could trigger security alarms.
How can a tooth be moved in a bony socket during orthodontic treatment?
By applying slight pressure to a tooth, the bone on the forward side will reabsorb, while the bone on the reverse side will be reformed.
________ is a disease of the bone in which bone reabsorption outpaces bone deposit, leaving the person with thin and often very fragile bones
Alice and James adopted a 3-year-old child from a developing country. They noticed that her legs were bowed and there were some deformities in her cranial and pelvic bones. They brought her to a physician for a diagnosis. What was the diagnosis, and what was the treatment for the disorder?
The child most likely has rickets. Treatment is to increase the intake of calcium and vitamin D in the diet, and to get some sunshine every day.
Emily, a 64-year-old obese woman, was brought to the hospital suffering pain in her legs, and an x-ray revealed that she had a simple fracture in her right femur and a crack in her left tibia. Other tests revealed that her bones were brittle and porous. What might have happened to Emily, and what advice would she have been given by the physician?
Emily has osteoporosis. She should lose weight because her bones may not be able to support her body mass.
A 75-year-old woman and her 9-year-old granddaughter were victims of a train crash. In both cases, trauma to the chest was sustained. X-rays of the grandmother revealed several fractured ribs, but her granddaughter had no fractured ribs. Why are the injuries different for the granddaughter and grandmother?
The child has more organic material in her bones, which allows them to bend; her grandmother's bones are extensively calcified, and are less flexible.
Why should people who live in the north take supplemental calcium with vitamin D?
People who live in the north have a decreased amount of sunlight exposure. Vitamin D is manufactured by skin cells when exposed to sunlight, and is needed for absorption of dietary calcium.
When should prevention of osteoporosis start?
The prevention of osteoporosis should begin with children while bones are still growing. Children should increase their bone mass to provide additional protection from osteoporosis in the future.
If your elderly patient's blood calcium level is normal, does that tell you anything about the likelihood that your patient has osteoporosis? Why or why not?
With normal levels of calcium in the blood, she may still have osteoporosis. In osteoporosis the level of calcium in the blood is expected to be normal, but the calcium level in the bones will be low.
Why, or why not, is swimming recommended as an exercise to prevent osteoporosis?
Swimming is not recommended to prevent osteoporosis, as it is not considered a weight-bearing exercise.
Using the functional classification, a freely movable joint would be called a ________ joint.
Articular cartilage found at the ends of the long bones serves to ________.
provide a smooth surface at the ends of synovial joints
A joint united by dense fibrocartilaginous tissue that usually permits a slight degree of movement is a ________.
In symphysis joints the articular surfaces of the bones are covered with ________.
Connective tissue sacs lined with synovial membranes that act as cushions in places where friction develops are called ________.
The ligaments that protect the alignment of the femoral and tibial condyles and limit the movement of the femur anteriorly and posteriorly are called ________.
Mary has been suffering from a "bad knee" for several months. She is a tennis player who often slides in to attack a ball; she is an aerobic devotee and a jogger. She visited an orthopedic surgeon last week who told her that he would "like to have a look at her knee joint." He also told her that her symptoms indicated damage to the meniscus, which might have to be removed. What will the doctor do to see the joint and, if the meniscus is removed, will Mary's knee be healthy enough to enable her to play tennis again?
The doctor will perform arthroscopic surgery. If Mary has severely damaged the meniscus, it can be removed with little impairment to the knee except some loss in stability.
A nurse is instructing the patient care assistants (PCAs) on transfer techniques. For patients requiring more assistance, the nurse tells the PCAs to reach through the patient's axillae and place their hands on the patient's scapulae during the transfer. She tells them to avoid placing hands or pressure in the axillae area. Based on your knowledge of the shoulder joint, why should this area be avoided?
Shoulder dislocations are fairly common, as stability was sacrificed for range of movement; therefore, pressure in this area should be avoided.
After reading a medical report, you learn that a 45-year-old female has the following symptoms: inflammation of synovial membranes, accumulation of synovial fluid, pain and tenderness about the joints, pannus formation, and some immobility at certain joints. On the basis of these symptoms, what would the patient probably have?
Akira, a 2.5-ranked tennis player (who thought he was a 4.5 player!), experienced severe pain in his elbow joint after playing for five straight hours, well beyond his limit. He told everyone it was due to a fall while diving to retrieve a difficult shot. What do you think?
It was probably inflammation of the bursa close to the olecranon process, because he overextended his abilities.
Farhad begins typing his term paper on his new computer early one morning. After 8 hours of typing, he notices that his wrists are stiff and very sore. The next morning, Farhad begins to finish his paper, but soon finds his wrists hurt worse than last night. What is Farhad suffering from?
How might probenecid be useful in treating gout?
It would lower the uric acid concentrations in the blood by stopping absorption of uric acid in the kidneys
Maggie is a 28-year-old Caucasian woman who has newly diagnosed rheumatoid arthritis (RA). She complains of painful, stiff hands and feet, feeling tired all the time, and reports an intermittent low-grade fever. She asks the nurse if she is going to be "crippled." How should the nurse respond?
RA is a chronic, systemic, inflammatory disorder. Inflammation occurs in the joint, and the fluid that accumulates causes swelling, stiffness, impairment of joint movement, and extreme pain.
Multiple rows of cells covering a tissue in which the cells are the same shape from the basement membrane to the surfaces would be ________ epithelia.
John, a 72-year-old grandfather, had been smoking heavily for 24 years and had a persistent cough. A biopsy of his lung tissue revealed considerable amounts of carbon particles. How could this happen considering the natural cleaning mechanism of the respiratory system?
Chemicals from the cigarettes inhibited the cilia in the respiratory tract from propelling the mucous and particles up and out the lungs, resulting in an accumulation of particles in the lungs.
________ tissue forms the framework for the lamina propria of mucous membranes.
Areolar or loose connective
Macrophage-like cells are found in many different tissues, and may have specific names that reflect their location or specializations. What is the one functional characteristic common to all macrophage-like cells?
Without macrophages, wound healing is delayed. Why?
Macrophages phagocytose many foreign materials, as well as cell debris and dead cells. This cleans the wound, allowing granulation tissue to form.
Aunt Jessie woke up one morning with excruciating pain in her chest. She had trouble breathing for several weeks. Following a visit to the doctor, she was told she had pleurisy. What is this condition and what did it affect?
Pleurisy is inflammation of the serous membranes covering the lungs. Inflamed pleural serous membranes create friction, resulting in pain as the lungs move during breathing.
A 45-year-old woman is admitted to the hospital for surgical removal of a tumor on her thyroid gland. The surgeon informs her that she will have only a very small scar. How could this be possible?
A thin incision will leave a small amount of scar tissue. The surface epithelium regenerates, and as scar tissue matures, it contracts, leaving only a fine white line.
Why does an open wound need a bed of granulation tissue for wound healing to occur?
Granulation tissue forms new capillary beds that provide oxygen-rich blood for the healing process
A 6-year-old child fell off his bike and scraped his knee. What is the first stage of wound healing, and what occurs during this stage?
Inflammatory stage, characterized by dilation and increased permeability of capillaries, movement of white blood cells and plasma into the area, clot formation, and removal of foreign material and cell debris.
An infection may occur in a tissue injury. Why?
The increased availability of nutrients allows microorganisms to replicate. The skin and mucous membranes are body's first line of defense and are mostly impenetrable to microorganisms, unless broken or damaged by tissue injury.
What are the local clinical signs and symptoms of the inflammatory stage of wound healing?
Pain, swelling, redness, and heat
A 19-year-old model for Glamour magazine tripped over an extension cord, causing injury to her epidermis. She is afraid the injury will leave a scar. What would be the best thing to say to the patient in response?
Regeneration is the replacement of destroyed epithelial tissue cells by cells that are identical or similar in structure and function. Scaring would be minimal, if there are no complications such as infection.
All of the following statements refer to events of tissue repair. Put the events in proper numbered order according to the sequence of occurrence. The initial event, the injury, is already indicated as number one.
1. The skin receives a cut that penetrates into the dermis and bleeding begins.
2. Epithelial regeneration is nearly complete.
3. Granulation tissue is formed.
4. Blood clotting occurs and stops the blood flow.
5. The scar retracts.
6. Macrophages engulf and clean away cellular debris.
7. Fibroblasts elaborate connective tissue fibers to span the break.
Water may move through membrane pores constructed by transmembrane proteins called ________.
The process of discharging particles from inside a cell to the outside is called ________.
The patient was admitted to the hospital on a hot day (100oF) for severe dehydration. What changes occur in extracellular and intracellular fluid compartments during dehydration, and what specific processes are involved at each step?
Fluid is initially lost from the intravascular compartment due to sweating, which is replaced by fluid from the interstitial compartment by osmosis, which then pulls fluid from the intracellular compartment by osmosis.
Your patient has the flu and reports 5 to 6 loose stools a day. He has experienced an isotonic fluid volume loss. What does "isotonic fluid loss" mean?
Water and electrolytes are lost in equal proportions.
You are giving a tap water enema to a patient. An adverse effect of the tap water enema is water intoxication. Why does tap water cause water intoxication?
Tap water is a hypotonic solution, and thus more water moves into the body and the cells, causing water intoxication.
Your patient has a respiratory disease that has literally paralyzed the cilia. Why would this patient be at an increased risk for a respiratory infection?
If cilia are paralyzed then mucus-containing particles, including bacteria, will remain in the lungs and may cause a respiratory infection.
Research shows that neurofibrillary tangles are the primary cause of Alzheimer's disease. Neurofibrillary tangles are associated with microtubules. What may happen if microtubules collapse to cause Alzheimer's disease?
Loss of cell shape and movement of cellular organelles
In order for the DNA molecule to get "short and fat" to become a chromosome, it must first wrap around small molecules called ________.
What type of chemical bond can form between an element with 11 protons and an element with 17 protons?
Amino acids joining together to make a peptide is a good example of a(n) ________ reaction.
Mrs. Mulligan goes to her dentist and, after having a couple of cavities filled, her dentist strongly suggests that she reduce her intake of sodas and increase her intake of calcium phosphates in the foods she eats. Why?
Sodas are strong acids that can dissolve the calcium phosphate in bone and teeth
Why is it possible to safely drink a solution that contains a 50:50 mixture of equal concentrations of a strong acid and a strong base, either of which, if ingested separately, would be very caustic and damaging?
Salt and water are formed when a strong acid and base are mixed.
A 65-year-old patient came to the emergency room with complaints of severe heartburn unrelieved by taking a "large handful" of antacids. Would you expect the pH to be relatively high, low, or normal for the patient's stomach contents, and why?
The pH would be high. Antacids are basic, and too many antacids would result in a relatively alkaline state.
Although his cholesterol levels were not high, Mr. Martinez read that cholesterol was bad for his health, so he eliminated all foods and food products containing this molecule. He later found that his cholesterol level dropped only 20%. Why did it not drop more?
Cholesterol is produced naturally by the liver, in addition to being ingested in foods.
Why can DNA be used to "fingerprint" a suspect in a crime?
The sequence and fragmentation pattern of a person's DNA is unique to that individual.
Starch is the stored carbohydrate in plants, while ________ is the stored carbohydrate in animals.
The study of the heart may incorporate many aspects of anatomy but as a whole you would say it is __________ anatomy.
________ is explained by chemical and physical principles and is concerned with the function of specific organs or organic systems.
The single most abundant chemical substance of the body, accounting for 60% to 80% of body weight, is ________.
The ability to sense changes in the environment and respond to them is called ________.
responsiveness or irritability
Which body system would be most affected by a lower than normal atmospheric pressure?
If you consider your home air conditioner in terms of homeostasis, then the wall thermostat would be the ________.
What is the pathway between the receptor and the control center in the reflex pathway called?
Which feedback mechanism causes the variable to deviate further and further from its original value or range?
Why does an 80-year-old woman require a much longer time to recover from the flu than a woman who is age 30?
As we age, our body's control systems become less efficient. As a result, our internal environment becomes less and less stable.
The patient was admitted to the hospital with hypertension. The development of arteriosclerosis has increased peripheral resistance to blood flow, worsening his hypertension. This is an example of what type of feedback loop and why?
This is an example of a positive feedback loop because the hypertension continued to get worse.
The ________ cavity contains tiny bones that transmit sound vibrations to the organ of hearing in the inner ear.
A small family was traveling in its van and had a minor accident. The children in the back seats were wearing lap belts, but still sustained numerous bruises about the abdomen, and had some internal organ injuries. Why is this area more vulnerable to damage than others?
The abdominal organs are not protected by a bony covering.
A surgeon removed a section of tissue along a transverse plane for microscopic examination. What are two names that correctly identify this section?
Cross section or transverse section
Judy is 16 years old and collapses on the gym floor with severe pain in her chest wall. She is rushed by ambulance to the emergency room. Judy is diagnosed with pleurisy and is given an anti-inflammatory through the intravenous route. Why is an anti-inflammatory prescribed for someone with pleurisy and what caused the pain?
Anti-inflammatories reduce the inflammation in the pleural serous membranes. The pain is caused by friction between the pleural serous membranes.