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Complete Patho 1 Final Set
Terms in this set (480)
At an international nursing conference, many discussions and breakout sessions focused
on the World Health Organization (WHO) views on health. Of the following comments
made by nurses during a discussion session, which statements would be considered a
good representation of the WHO definition? Select all that apply.
A) Interests in keeping the elderly population engaged in such activities as book
reviews and word games during social time
B) Increase in the number of chair aerobics classes provided in the skilled care
C) Interventions geared toward keeping the elderly population diagnosed with
diabetes mellitus under tight blood glucose control by providing in-home cooking
D) Providing transportation for renal dialysis patients to and from their hemodialysis
E) Providing handwashing teaching sessions to a group of young children
A B C E
A community health nurse is teaching a group of recent graduates about the large
variety of factors that influence an individual's health or lack thereof. The nurse is
referring to the Healthy People 2020 report from the U.S. Department of Health and
Human Services as a teaching example. Of the following aspects discussed, which
would be considered a determinant of health that is outside the focus of this report?
A) The client has a diverse background by being of Asian and Native American
descent and practices various alternative therapies to minimize effects of stress.
B) The client has a family history of cardiovascular disease related to
hypercholesterolemia and remains noncompliant with the treatment regime.
C) The client has a good career with exceptional preventative health care benefits.
D) The client lives in an affluent, clean, suburban community with access to many
health care facilities.
A physician is providing care for a number of patients on a medical unit of a large,
university hospital. The physician is discussing with a colleague the differentiation
between diseases that are caused by abnormal molecules and diseases that cause disease.
Which of the following patients most clearly demonstrates the consequences of
molecules that cause disease?
A) A 31-year-old woman with sickle cell anemia who is receiving a transfusion of
packed red blood cells
B) A 91-year-old woman who has experienced an ischemic stroke resulting from
C) A 19-year-old man with exacerbation of his cystic fibrosis requiring oxygen
therapy and chest physiotherapy
D) A 30-year-old homeless man who has Pneumocystis carinii pneumonia (PCP) and
is HIV positive.
A member of the health care team is researching the etiology and pathogenesis of a
number of clients who are under his care in a hospital context. Which of the following
aspects of clients' situations best characterizes pathogenesis rather than etiology?
A) A client who has been exposed to the Mycobacterium tuberculosis bacterium
B) A client who has increasing serum ammonia levels due to liver cirrhosis
C) A client who was admitted with the effects of methyl alcohol poisoning
D) A client with multiple skeletal injuries secondary to a motor vehicle accident
A new myocardial infarction patient requiring angioplasty and stent placement has
arrived to his first cardiac rehabilitation appointment. In this first session, a review of
the pathogenesis of coronary artery disease is addressed. Which statement by the patient
verifies to the nurse that he has understood the nurse's teachings about coronary artery
A) "All I have to do is stop smoking, and then I won't have any more heart attacks."
B) "My artery was clogged by fat, so I will need to stop eating fatty foods like
French fries every day."
C) "Sounds like this began because of inflammation inside my artery that made it
easy to form fatty streaks, which lead to my clogged artery."
D) "If I do not exercise regularly to get my heart rate up, blood pools in the veins
causing a clot that stops blood flow to the muscle, and I will have a heart attack."
A 77-year-old man is a hospital inpatient admitted for exacerbation of his chronic
obstructive pulmonary disease (COPD), and a respiratory therapist (RT) is assessing the
client for the first time. Which of the following aspects of the patient's current state of
health would be best characterized as a symptom rather than a sign?
A) The patient's oxygen saturation is 83% by pulse oxymetry.
B) The patient notes that he has increased work of breathing when lying supine.
C) The RT hears diminished breath sounds to the patient's lower lung fields
D) The patient's respiratory rate is 31 breaths/minute.
Which of the following situations would be classified as a complication of a disease or
outcome from the treatment regimen? Select all that apply.
A) Massive pulmonary emboli following diagnosis of new-onset atrial fibrillation
B) Burning, intense incision pain following surgery to remove a portion of colon due
to intestinal aganglionosis
C) Development of pulmonary fibrosis following treatment with bleomycin, an
antibiotic chemotherapy agent used in treatment of lymphoma
D) Gradual deterioration in ability to walk unassisted for a patient diagnosed with
E) Loss of short-term memory in a patient diagnosed with Alzheimer disease
Laboratory testing is ordered for a male patient during a clinic visit for a routine
follow-up assessment of hypertension. When interpreting lab values, the nurse knows
A) a normal value represents the test results that fall within the bell curve.
B) if the lab result is above the 50% distribution, the result is considered elevated.
C) all lab values are adjusted for gender and weight.
D) if the result of a very sensitive test is negative, that does not mean the person is
The laboratory technologists are discussing a new blood test that helps establish a
differential diagnosis between shortness of breath with a cardiac etiology and shortness
of breath with a respiratory/pulmonary etiology. A positive result is purported to
indicate a cardiac etiology. The marketers of the test report that 99.8% of patients who
have confirmed cardiac etiologies test positive in the test. However, 1.3% of patients
who do not have cardiac etiologies for their shortness of breath also test positive. Which
of the following statements best characterizes this blood test?
A) Low validity; high reliability
B) High sensitivity; low specificity
C) High specificity; low reliability
D) High sensitivity; low reliability
As part of a screening program for prostate cancer, men at a senior citizens' center are
having their blood levels of prostate-specific antigen (PSA) measured. Which of the
following statements would best characterize a high positive predictive value but a low
negative predictive value for this screening test?
A) All of the men who had high PSA levels developed prostate cancer; several men
who had low PSA levels also developed prostate cancer.
B) All of the men who had low PSA levels were cancer-free; several men who had
high levels also remained free of prostate cancer.
C) Men who had low PSA levels also displayed false-positive results for prostate
cancer; men with high levels were often falsely diagnosed with prostate cancer.
D) The test displayed low sensitivity but high specificity.
A male international business traveler has returned from a trip to Indonesia. While there,
he hired a prostitute for companionship and engaged in unprotected sex on more than
one occasion. Unbeknownst to him, this prostitute harbored the hepatitis C virus. Upon
return to the United States, he exhibited no symptoms and returned to his usual
activities. During this period of no outward symptoms, the man would be classified as
A) the preclinical stage of disease.
B) remission and unlikely to develop hepatitis C.
C) the clinical disease stage of hepatitis C.
D) the chronic phase of hepatitis C.
As of November 1, 2012, there were a total of 10 confirmed cases of Hantavirus
infection in people who were recent visitors (mid-June to end of August, 2012) to
Yosemite National Park. Three visitors with confirmed cases died. Health officials
believe that 9 out of the 10 people with Hantavirus were exposed while staying in Curry
Village in the Signature Tent Cabins. This is an example of
A) what the anticipated mortality rate would be if a family of five were planning to
vacation in Yosemite National Park.
B) the prevalence of Hantavirus one can anticipate if he or she is going to vacation in
Yosemite National Park.
C) the low rate of morbidity one can expect while traveling to Yosemite National
D) the incidence of people who are at risk for developing Hantavirus while staying in
Yosemite National Park.
A particular disease has a debilitating effect on the ability of sufferers to perform their
activities of daily living and is a significant cause of decreased quality of life. However,
few people die as a result of the disease's direct effects. There are hundreds of thousands
of Americans living with the disease but relatively few new cases in recent years. Which
of the following statements best conveys an accurate epidemiological characterization of
A) Low mortality; high morbidity; low prevalence; high incidence
B) Low mortality; high morbidity; high incidence; low prevalence
C) High mortality; low morbidity; high incidence; low prevalence
D) High morbidity; low mortality; high prevalence, low incidence
An epidemiologist is conducting a program of research aimed at identifying factors
associated with incidence and prevalence of congenital cardiac defects in infants. The
researcher has recruited a large number of mothers whose infants were born with
cardiac defects as well as mothers whose infants were born with healthy hearts. The
researcher is comparing the nutritional habits of all the mothers while their babies were
in utero. Which of the following types of study is the epidemiologist most likely
A) Cohort study
B) Cross-sectional study
C) Case-control study
D) Risk factor study
A nurse practitioner is working in a crowded neighborhood where the population is
primarily immigrants from China. The nurse has designed a research study to follow
children from kindergarten to the age of 25. She is going to be looking at their diet,
successful progression in school, health practices, and development of disease, to name
a few items. This type of research is known as
A) cohort study.
B) cross-sectional study.
C) case-control study.
D) epidemiological study.
As part of a community class, student nurses are developing a class to teach expectant
parents the importance of having their child properly secured in a child safety seat.
During the class, the students are going to have a safety officer examine the car seats
that the parents have installed in their vehicles. This is an example of which type of
A) Primary prevention
B) Secondary prevention
C) Tertiary prevention
D) Prognosis enhancement
A multidisciplinary health care team operates a program aimed at the prevention,
identification, and treatment of diabetes on a large Indian reservation. Which of the
following aspects of the program would be most likely to be classified as secondary
A) Regularly scheduled wound dressing changes for clients who have foot ulcers
secondary to peripheral neuropathy and impaired wound healing
B) Teaching school children how a nutritious, traditional diet can lessen their chances
of developing adult-onset diabetes
C) Staffing a booth where community residents who are attending a baseball
tournament can have their blood glucose levels checked
D) Administering oral antihyperglycemic medications to clients who have a
diagnosis of diabetes
An occupational therapist conducts a group therapy program called MindWorks with
older adults who have diagnoses of dementia and Alzheimer disease. The goal of the
group is to slow the cognitive decline of clients by engaging them in regular, organized
mental activity such as reading maps and solving puzzles. How would the program most
likely be characterized?
A) Primary prevention
B) Secondary prevention
C) Tertiary prevention
D) Prognosis enhancement
The clinical educator of a hospital medical unit has the mandate of establishing
evidence-based practice guidelines for the nursing care on the unit. Which of the
following statements most accurately captures a guiding principle of the nurse's task?
A) Evidence-based practice guidelines will be rooted in research rather than nurses'
subjective practice preferences and experiences.
B) Guidelines are synonymous with systematic research reviews.
C) The need for continuity and standardization of guidelines will mean that they will
be fixed rather than changeable.
D) The guidelines will combine individual expertise with external systematic
The neuroscience nursing unit has developed a set of step-by-step directions of what
should occur if a nursing assessment reveals that the patient may be exhibiting clinical
manifestations of a cerebrovascular accident (CVA). Which of the following statements
about clinical practice guidelines are accurate? Select all that apply.
A) Step-by-step guidelines are usually developed and based primarily on "how it has
always been done before."
B) The development of evidence-based practice guidelines requires a research review
from different studies to develop the most accurate diagnostic method to
C) Once developed, practice guidelines only need to be reviewed if a national
committee sends out an update on new research.
D) When developing a CVA set of step-by-step directions, the nursing unit should
ask for assistance from experts in the neuroscience field. The potential users of the
guidelines should pilot test it for further feedback.
E) A meta-analysis could be utilized to combine evidence from different studies to
produce a more accurate diagnostic method.
B D E
Of the following situations, which one would be an example of a maladaptive cellular
A) An 18-year-old body builder who has developed extremely large pectoral muscles
following years of weight lifting
B) A 31-year-old marathon runner who has developed hypertrophied myocardial
C) A 54-year-old female who has developed ovarian atrophy following loss of
estrogen stimulation during menopause
D) A 44-year-old male with a 60-pack-per year smoking history who was diagnosed
with a histological grade 3 lung cancer
A client is experiencing muscle atrophy following 2 weeks in traction after a motor
vehicle accident. Which of the following factors has most likely contributed to the
atrophy of the client's muscle cells?
A) High levels of insulin and IGF-1 in the client's blood during immobilization
B) Denervation of the affected muscles during the time of traction
C) A reduction of skeletal muscle use secondary to the traction treatment
D) Reduced oxygen consumption and cellular function that ensures muscle cell
The nurse is teaching new nursing assistants on the unit about the phenomenon of
muscle hypertrophy. Which of the following clients on the unit is most likely to
experience muscle hypertrophy? A client with
A) urinary incontinence following a cerebral vascular accident (CVA).
B) hypertension, obesity, and decreased activity tolerance.
C) peripheral edema secondary to heart failure (HF).
D) possible rejection symptoms following a liver transplant.
Which of the following clients is at a high risk for developing dilated cardiomyopathy?
A) A 17-year-old with a diving injury resulting in paraplegia
B) A 4-year-old child born with cerebral palsy and confined to a wheelchair
C) A 44-year-old noncompliant female who forgets to take her hypertensive
D) A 78-year-old patient with Alzheimer disease who received a third-degree burn
following an oven fire
Which of the following statements by a student demonstrates a sound understanding of
the cellular processes of hypertrophy and hyperplasia?
A) "I know that cells like neurons have little capacity for hyperplastic growth."
B) "A remaining kidney can sometimes undergo hyperplasia in response to one that
has been removed."
C) "When male patients experience 'an enlarged prostate,' they are describing a form
D) "Clients with cardiomyopathy undergo myocardial hypertrophy with proportional
increases in cell length and width."
A community health care nurse is teaching a group of female high school students about
the importance of regular Papanicolaou (Pap) smears. The nurse recognizes that what
fact underlies the rationale for this teaching?
A) The active substitution of normal cells in the cervix correlates to cancer risk.
B) Undifferentiated stem cells are an early indicator of cervical cancer.
C) Cancer of the uterine cervix develops incrementally at a cellular level.
D) Dysplasia in the connective tissue of the cervix is a strong precursor to cancer.
A home health nurse is making a visit to a family with an 8-month-old infant with
severe motor deterioration. The physician has diagnosed the infant with Tay-Sachs
disease. The parents are asking the nurse why this happened. The nurse will base her
answer knowing the root cause of Tay-Sachs is
A) high exposure to lead in the home environment.
B) an enzyme defect causing abnormal lipid accumulation in the brain.
C) hypoxia caused by placing the infant on their abdomen during sleep.
D) an increase in bilirubin retention leading to destruction of RBCs.
A 68-year-old male client with aortic stenosis secondary to calcification of the aortic
valve is receiving care. Which of the following statements best captures an aspect of this
A) Paget disease, cancer with metastases, or excess vitamin D may have contributed
to the problem.
B) Increased calcium intake over time may have contributed to the problem.
C) The client has possibly undergone damage as a result of calcification following
D) The client has possibly exhibited phosphate retention leading to calcium deposits.
A nurse in the emergency department admits a male client who has experienced severe
frostbite to his hands and toes after becoming lost on a ski hill. The nurse recognizes
that which of the following phenomena has contributed to his tissue damage?
A) Decreased blood viscosity has resulted in interstitial bleeding.
B) Reactive vasodilation has compromised perfusion.
C) Autonomic nervous stimulation has resulted in injury.
D) Decreased blood flow has induced hypoxia
As part of a first aid class, a health care instructor is teaching a group of industrial
workers about how electrical injuries can cause cell damage. Which of the statements
made by one of the workers indicates that further teaching is necessary?
A) "The greater the skin resistance, the greater the amount of deep and systemic
damage a victim is likely to incur."
B) "The particular pathway that a current takes through the body is very significant."
C) "Resistance to flow is the phenomenon that transforms electrical energy into
D) "The most severe damage is likely to occur where the current enters and leaves
A client who has had a diagnosis of lung cancer is scheduled to begin radiation
treatment. The nurse knows that which of the following statements listed below about
potential risks of radiation is most accurate?
A) "Some clients experience longer-term irritation of skin adjacent to the treatment
B) "Sometimes you might find that your blood takes longer to clot than normal."
C) "The changes that you might see are normally irreversible."
D) "The unwanted effects will be limited to the exposed portions of your skin."
A young patient has just been diagnosed with xeroderma pigmentosum. When teaching
the family about this disease, the nurse should emphasize which of the following points?
Select all that apply.
A) "Wash hands thoroughly when working in the garden to prevent infection."
B) "Wear long sleeves, long pants, gloves, a hat, sunglasses with side shields, and
sunscreen while outdoors."
C) "Apply antibacterial ointment to any break in the skin, and cover wounds with
D) "The best time to allow the child to play outside is in the evening hours after the
sun goes down."
E) "The best time for the family to go to the beach is in the fall/winter months."
A 7-year-old boy is admitted to the hospital with a suspected diagnosis of lead toxicity.
Which of the following assessment findings is most congruent with the client's
A) Decreased deep tendon reflexes
B) Hemoglobin 9.9 g/dL
C) Diffuse muscle pain
D) White blood cells (WBC) 11,000/mm3
The nurse is teaching a group of new mothers about postpartum nutrition, when one of
the clients states that she was told to avoid eating fish too often due to the risk of
mercury poisoning. Which of the nurse's following responses most accurately addresses
the clients concerns?
A) "You're right. It's best to avoid eating fish, especially while you are
B) "There are some modest risks, but they are only associated with some long-living
C) "Provided you avoid salmon, you likely won't be putting yourself or your child at
D) "The risk of mercury toxicity from eating fish has been shown to be
A nurse is teaching a group of older adults about the value of including foods containing
antioxidants in their diet. Which of the following statements best captures the rationale
underlying the nurse's advice?
A) Antioxidants inhibit the actions of reactive oxygen species.
B) Antioxidants prevent the formation of superoxide dismutase.
C) Antioxidants react nonspecifically with molecules.
D) Antioxidants prevent the occurrence of cell dysplasia.
During a myocardial infarction (MI), a patient with a 97% occlusion of his left
descending artery develops ventricular arrhythmias due to the amount of ischemia
occurring in the myocardium. While educating the patient about MIs, the nurse will base
her teaching on the fact that
A) permanent damage will occur in the myocardium if the vessel is not opened
within a 1- to 2-minute window following the occlusion.
B) treatment needs to be sought immediately so that the buildup of lactic acid is
limited and cellular changes can be reversed.
C) once the oxygen supply has been occluded, cellular changes are irreversible even
if oxygenation is restored.
D) the body will grow new genes through the process of angiogenesis, thereby
avoiding any permanent damage to the myocardium.
Which of the following statements most accurately conveys an aspect of cell injury due
to impaired calcium homeostasis?
A) Normal intracellular calcium ion levels are higher than extracellular levels.
B) Ischemia and certain toxins cause a decrease in cytosolic calcium.
C) Injured cells tend to accumulate calcium.
D) Low calcium levels cause an activation of damaging enzymes.
The nurse is providing care for a client with a diagnosis of amyotrophic lateral sclerosis
(ALS). The nurse recognizes which of the following mechanisms is suspected to play a
role in the cellular death associated with ALS?
B) Liquefaction necrosis
C) Hypoxic cell injury
D) Caseous necrosis
The nurse is providing care for a 21-year-old female client with gas gangrene secondary
to her compound fracture in her arm. Which of the following assessment findings would
the nurse most reasonably expect to find when caring for a client with a diagnosis of gas
A) Inflammation of the affected tissue
B) A positive culture for Staphylococcus
C) Spreading edema
D) Impaired alveolar gas exchange
Which of the following enzymes listed below is responsible for cancer cells' ability to
prevent aging of the cells and contributes to cellular immortality that is so characteristic
of this disease process?
How could a health care professional most accurately explain an aspect of the
underlying structure of DNA to a colleague who is unfamiliar with genetics?
A) "DNA consists of nucleotides plus one of the four nitrogenous bases."
B) "In the base pairs, adenine combines with thymine and guanine with cytosine."
C) "Thymine and cytosine are considered the purine bases."
D) "The backbone of a DNA molecule consists of either deoxyribose or phosphoric
A student is trying to understand the possible reasons that a genetic abnormality might
exist in an individual. Which of the following reasons is most plausible?
A) DNA has combined with several types of protein and a small amount of RNA.
B) Histones have exerted control on the folding of DNA strands.
C) DNA has blocked genetic transcription by preventing access of nucleotides to the
D) Chromatin has maintained its stable structure during the DNA replication process.
A 45-year-old client who experienced exposure to radiation during an industrial
accident several years prior is being assessed. Which of the following phenomena may
underlie the genetic changes that have been noted in the client?
A) Base pairs may have been rearranged by the radiation in the accident.
B) Endonucleases may have influenced the DNA structure following exposure.
C) Two paired bases may have exchanged helical position after the accident.
D) The radiation may have produced a redundant or degenerate genetic code.
A researcher is involved in the investigation of an individual's genetic abnormality.
Which of the following situations could the researcher most likely rule out as the genetic
cause of a mutation?
A) Loss of a cytosine-guanine base pair
B) Formation of an adenine-uracil base pair
C) Substitution of an adenine-thymine base pair for a cytosine-guanine base pair
D) Insertion of an extra adenine-thymine base pair
In the context of an explanation of how human growth occurs, a student is explaining to
a colleague the necessity and roles of different types of RNA in protein synthesis.
Which of the following types of RNA is a result of the process of transcription?
A) Ribosomal RNA
B) Messenger RNA
C) Translation RNA
D) Transfer RNA
A 31-year-old male has been newly diagnosed with early-onset Parkinson disease. As
the nurse is educating the patient and family, they ask how this happened so early in his
life. The nurse will base the response on which of the following statements listed
A) "No one really knows why some patients get this diagnosis in their 30s, while
others are in their 50s before they begin to have symptoms."
B) "Sometimes exposure to too much ultraviolet radiation causes changes in your
gene sequencing and therefore mutations occur."
C) "Disruption in some proteins called molecular chaperones causes intracellular
molecules to become denatured and insoluble leading to clumping and the
development of inclusion bodies."
D) "Gene repression is a process by which a regulatory gene acts to reduce or prevent
gene expression, thereby confusing the negative feedback mechanisms that could
prevent disease formation."
While discussing embryogenesis to a group of students moving through the maternity
ward, the nurse quizzes them to see if they know what is happening during sonic
hedgehog signaling. Which of the following answers would be considered accurate?
Select all that apply.
A) Development of the eyes
B) Separation of the brain into two cerebral hemispheres
C) A carrier system for delivering the appropriate amino acids to the ribosomes
D) Development of the correct number of fingers and toes
E) Bone formation leading to macrocephaly
A physician is working with a family whose daughter has been recently diagnosed with
the chromosomal disorder Turner syndrome. The physician would recognize that which
of the following statements about the characteristics of human chromosomes is
A) Individual variations are attributable to differences in appearance in autosomes.
B) Chromosomes undergo variations during each episode of cell division.
C) Autosomes contain the determination of an individual's sex.
D) Each of the 22 pairs of autosomes has a homolog
A man and woman are eager to determine the sex of their unborn child and have asked
the nurse at the fertility clinic how this is possible at an early stage of in vitro
development. Which of the nurse's responses best captures the genetic rationale for
early sex identification through tissue samples?
A) "The inactive X chromosome can be visible in a female."
B) "The cells of a male contain a Barr body that can be visualized."
C) "A normal female lacks Barr bodies."
D) "The number of visible Y chromosomes indicates the sex."
A health care researcher has identified the gene of interest in a particular genetic
disorder as well as the gene's location Xq97. Where would one find a gene named
A) Band q, region 97 of the Y chromosome
B) Band 7, region 9 of the short arm of the X chromosome
C) Band 9, region 7 of the long arm of the X chromosome
D) Band 9, region 7 of the short arm of the Y chromosome
A child possesses a trait that is the result of the interaction of two different genes,
neither of which could have produced the trait independently. Which of the following
explanations best captures the genetic explanation for this?
A) The trait is an expression of multiple alleles.
B) Epistasis has dictated the phenotypic outcome.
C) The phenomenon is an example of polygenic inheritance.
D) The outcome is the result of the interaction between collaborative genes.
A health care professional works in a context where there are a large number of clients
who live with genetic disorders. Which of the following circumstances would most
likely involve an individual who has a genetic disorder?
A) The primordial germ cells of both of the individual's parents have undergone
B) Two chromosomes of the same number have been inherited from one parent.
C) The individual possesses 22 pairs of autosomes.
D) The individual's karyotype indicates separate X and Y chromosomes at
Mary is heterozygous for blue eyes, a recessive trait. John is homozygous for brown
eyes, a dominant trait. What color eyes will their four children have?
C) Some will have blue, and some will have brown
D) Impossible to tell
Knowing that persons with blonde hair exhibit the phenotype of a recessive gene, which
of the following genetic scenarios would most likely underlie such a trait?
B) A heterozygous pairing
C) Either AA or Aa
D) Different alleles at a gene locus
A group of researchers have identified that the prevalence of two particular genetic
disorders shares a statistical correlation. Which of the following statements best conveys
the genetic rationale for this situation?
A) There is likely a cause-and-effect relationship between the two genes responsible.
B) The chromosomes containing each gene are likely closely situated.
C) The genes causing each disorder are likely in the same section of the same
D) The disorders likely share the same locus.
When educating the parents of an infant diagnosed with hemochromatosis, the nurse
should consider which of the following topics a priority for the parents to know?
A) Provide a restricted iron diet to prevent organ damage
B) How to check their infants' stools for blood
C) Where to look for lesion development on the skin
D) How to assess an infant for blood loss and anemia
A student is explaining to her colleague the different methods that are available for
genetic mapping. Which one of the colleague's following statements indicates a need for
A) "I know that linkage studies are rooted in the exchange of genes that occurs
B) "Gene dosage studies involve the measurement of enzyme activity as a reflection
of genetic activity."
C) "If hybrid cells were stable, somatic cell hybridization would not be viable."
D) "In situ hybridization focuses on genes that can express themselves in cell
A researcher is involved in the production of insulin through recombinant DNA
technology. Which of the following statements could the researcher best provide as a
rationale for her work?
A) The gene fragment responsible for insulin production can be isolated and
B) Particular bacteria are capable of insulin production.
C) It is possible to reproduce the chromosome responsible for insulin production.
D) Recombination of DNA base pairs can result in a gene that will produce insulin.
Which of the following patients are receiving treatment that has been developed
utilizing recombinant DNA techniques? Select all that apply.
A) Patient undergoing detection of gene location by chemically tagging DNA or
B) Mother undergoing amniocentesis to diagnose a congenital adrenal hyperplasia
C) End-stage renal disease patient receiving erythropoietin to stimulate RBC
D) Stroke victim receiving tissue plasminogen activator (tPA) to dissolve the thrombi
E) Couple going to an infertility clinic for diagnostic testing
While the nurse is educating a fellow nurse about some new research being developed to
treat hepatitis C, specifically to identify disease-related drug targets on the cells, the
nurse will be basing these data on which new technology finding?
A) Recombinant DNA technology
B) Haplotype mapping
C) The human genome project
D) Interference RNA (RNAi)
An infant who is 4 days postpartum has been diagnosed with a single-gene disorder. The
parents of the child have a number of questions about the etiology of the health problem,
which the physician is attempting to address in detail. Which of the following teaching
points most accurately captures an aspect of single-gene congenital disorders?
A) Affected genes are present on autosomal chromosomes rather than sex
B) The majority of single-gene disorders manifest near the time of puberty.
C) A particular defect can be caused by mutations at several different loci.
D) Single-gene disorders are associated with existing rather than new mutations.
A male client of a nurse practitioner has an autosomal dominant disorder. The client and
his partner are considering starting a family. Which of the following statements
indicates the client has an adequate understanding of the genetic basis of this health
A) "I know there's no way of accurately determining the chance that my child will
inherit the disease."
B) "My children who don't have the disease still run the risk of passing it on to their
C) "I know that new genetic mutations won't occur between generations."
D) "I know that a single mutant allele is to blame for the health problem."
A 6-year-old girl with a diagnosis of Marfan syndrome is being assessed at a community
health clinic. Which of the following assessments would be the health care
professional's lowest priority?
A) A test of the child's visual acuity
B) A musculoskeletal assessment
C) Tests of kidney function
D) Cardiovascular assessment
A clinician who works on a cardiac care unit of a hospital is providing care for a number
of clients. Which client most likely has a genetic disorder arising from inheritance of a
A) A short, thin, 56-year-old woman with hypertension
B) A tall, thin, myopic, 28-year-old woman with mitral valve prolapse
C) An overweight, middle-aged male smoker with coronary artery disease
D) A thin, middle-aged nonsmoking man with a repaired atrial septal defect
The nurse working in a pediatric office is scheduled to assess a female adolescent
diagnosed with neurofibromatosis (NF) type 1. During this assessment, the nurse should
be assessing the teenager for which of the following clinical manifestations of NF-1?
Select all that apply.
A) Irregular menstrual periods
B) Severe scoliosis
C) Hearing loss
D) Complaints of having a hard time concentrating in school
E) Speech impediments
B D E
A new older female client at a long-term care facility has a diagnosis of type 1
neurofibromatosis. As part of the intake assessment protocol for the facility, the clinical
educator is teaching the care staff about the diagnosis. Which of the following
statements most accurately conveys an aspect of neurofibromatosis?
A) "The neurofibroma lesions are unsightly for the client, but they are not painful."
B) "Her diagnosis puts her at higher risk of developing a malignant neoplasm."
C) "She is living with an example of an autosomal recessive disorder."
D) "The client is likely to be photosensitive as a result of the disease."
As part of an orientation to a genetic counseling practice, a group of medical students
are differentiating between autosomal recessive disorders and autosomal dominant
disorders. Which of the following statements is true of autosomal recessive disorders?
A) They can manifest when present in one or both gene pairs.
B) There is a one in two chance of an affected child in each pregnancy with an
C) They tend to have a more uniform symptomatology than autosomal dominant
D) The associated disorders are usually attributable to abnormalities in structural
A 6-year-old boy who has mental retardation secondary to fragile X syndrome has been
admitted to hospital with a mitral valve prolapse. A health care worker who is providing
care for the family should have which of the following statements as part of her
knowledge base around the disease?
A) The common pattern of inheritance is an affected mother who carries one normal
and one mutant allele.
B) The boy's mother had a 100% chance of transmitting the defective gene to her
C) Genes of the boy's Y chromosome can be affected in addition to the X
D) The boy will pass the gene to all his future daughters who will become carriers.
Two health care workers are comparing the etiology and incidence of multifactorial
inheritance disorders and single-gene disorders. Which of the following statements best
captures the relationship between the two types of genetic disorders?
A) "Multifactorial disorders and single-gene disorders can both be predicted quite
B) "Multifactorial disorders are more likely to involve multiple organs."
C) "Multifactorial disorders manifest themselves at birth."
D) "A couple with a child with a multifactorial disorder has a higher risk of having
another with the same disorder."
While taking their daily walk, the nurse is asked by a neighbor what centric fusion
(robertsonian) translocation means. She tells you that a family member has been
diagnosed with this and is now afraid to have children. Given this diagnosis, what may
be potential risks for her offspring?
A) If chromosome 21 is involved, there is a high risk for producing a child with
B) Since the extremely short fragment only contains a small amount of genetic
material, there should be no additional risk than the normal population.
C) This translocation of genetic material places the child at high risk for having
multiple limb abnormalities.
D) Cleft lip with cleft palate is frequently associated with this translocation of genetic
A physician is working with a 30-year-old male client with Down syndrome who has
been admitted to hospital with a diagnosis of acute leukemia. Which of the following
physical assessment findings would the physician be more likely to find in an
examination of this client than in other clients without Down syndrome?
B) Decreased visual acuity
C) Congenital heart defects
D) Diabetes mellitus
An 11-year-old girl is suspected of having Turner syndrome. Which of the following
diagnostic tests would be the most useful component of screening to confirm or rule out
A) Computed tomography of the head
C) Bone scan
D) Liver biopsy
If a male child was born with Klinefelter syndrome, as the child matures and becomes
an adolescent, the nurse will assess the child for which of the following clinical
manifestations listed below? Select all that apply.
A) Enlarged breast tissue
B) Sparse facial and pubic hair
C) Tall stature out of proportion
D) Severe mental retardation
E) Higher than average linguistic skills
A B C
As part of her prenatal care, a pregnant woman and her partner are being taught by a
community health nurse. Which of the following points about the teratogenic effects of
different substances should the nurse include in his teaching?
A) "Your developing baby is most vulnerable during the first 2 months of your
B) "You need to be very careful with vitamin D and its derivatives."
C) "Keep in mind that a high percentage of genetic abnormalities are attributable to
D) "Your best option is to avoid using any drugs during your pregnancy."
While taking a prenatal history, the nurse would be most concerned about severe
teratogenic effects on the fetus if the mother admits to taking which medications prior to
finding out that she was pregnant. Select all that apply.
A) Warfarin (Coumadin) for chronic atrial fibrillation
B) Ethyl alcohol ingestion regularly every weekend and some nights throughout the
C) Isotretinoin (Accutane) for acne
D) Over-the-counter cetirizine (Zyrtec) for seasonal allergies
E) Tetracycline for acne
A B C D
A woman gives birth to a small infant with a malformed skull. The infant grows
abnormally slowly and shows signs of substantial cognitive and intellectual deficits. The
child also has facial abnormalities that become more striking as it develops. What might
you expect to find in the mother's pregnancy history?
A) Folic acid deficiency
B) Chronic alcohol use
C) Chronic cocaine use
D) Active herpes simplex infection
Which of the following pregnant women has most likely encountered the greatest
increase in the risk that her child will have a fetal anomaly?
A) A woman with diagnoses of syphilis and cirrhosis of the liver
B) A woman who has herpes simplex and who has recently recovered from
C) A woman with chronic obstructive pulmonary syndrome and tuberculosis
D) A woman with diagnoses of insulin-dependent diabetes mellitus and peripheral
While traveling throughout Asia, a young couple was exposed to many cultural
experiences. One day, they were standing in line, and the person in front of them was
clearly displaying signs of illness and had a pink or light red rash on his face with
itching. Their guide commented on a recent outbreak of rubella. Upon return to the
United States, the couple found out they were pregnant. Upon arrival at the clinic, they
are very concerned about their possible exposure to rubella. From this history, the nurse
knows that this infant is at high risk for which of the following complications? Select all
A) Blindness or cataracts
C) Facial deformities like small palpebral fissures or thin vermillion border
D) Short, flipper-like appendages
E) Small outbreak of blisters around its eyes and mouth 2 weeks after delivery
A couple who are pregnant with their first child have made an appointment with a
clinical geneticist to discuss prenatal screening. The man states that they, "just want to
make sure that there is nothing wrong with our baby." How could the clinician best
respond to this statement?
A) "We can't rule out all abnormalities, but a routine fetal tissue biopsy can yield
B) "Testing the umbilical blood and performing amniocentesis can give us some
information, but not a guarantee."
C) "Prenatal screening is not usually necessary unless you are among a high-risk
D) "You need to be aware that if abnormalities are detected, termination is normally
While preparing a patient about to undergo percutaneous umbilical cord blood sampling,
which of the following information should the nurse provide as preprocedure teaching?
Select all that apply.
A) Once the procedure is begun, you must lie very still since they will be inserting a
needle through the uterine wall.
B) We will put you into the stirrups and dilate your cervix with a small catheter so
that we can obtain a cord sample.
C) During the procedure, an ultrasound will be utilized to guide the catheter into the
D) We will send a sample of amniotic fluid to a regional medical center to have DNA
tests performed for any genetic abnormality.
A male patient with a history of heavy alcohol use has been admitted to hospital for
malnutrition and suspected pancreatitis. The patient's diagnostic workup suggests
alcoholic ketoacidosis as a component of his current health problems. He is somewhat
familiar with the effect that drinking has had on his nutrition and pancreas but is wholly
unfamiliar with the significance of acid-base balance. How best could his care provider
explain the concept to him?
A) "The chemical processes that take place throughout your body are thrown off very
easily when your body is too acidic or not acidic enough.
B) "The multitude of chemical reactions that take place in your body depend on your
body fluids being slightly acidic."
C) "The healthy function of your kidneys and your lungs requires a specific level of
pH in your body."
D) "Your body is highly dependent on what food and fluid you consume to keep
itself at a functioning level of slight nonacidity."
When explaining how carbon dioxide combines with water to form carbonic acid as part
of acid-base lecture, the faculty instructor emphasized that which enzyme is needed as a
catalyst for this reaction?
A) Carbonic anhydrase
B) Phenylalanie hdroxylase
A 31-year-old client with a diagnosis of end-stage liver failure has been admitted to the
intensive care unit of a hospital. Arterial blood sampling indicates that the man has an
acid-base imbalance. Which of the following situations is most likely to result in an
A) Conservation or formation of new HCO3
- by the kidneys
B) Low albumin and plasma globulin levels
C) Transcompartmental exchange of H+ and potassium ions
D) Renal excretion of HCO3
- in the presence of excess base
A patient with ESRD comes into the emergency department in severe acidosis. The
nurse notes that the respiratory rate is 36 breaths/minute. The nurse understands the
pathophysiology of this response and explains to the student nurse that the patient's
A) anxiety level is high, and the body is trying to release endorphins.
B) chemoreceptors in the carotid and aortic bodies have noticed the pH change and
altered the ventilator rate.
C) kidneys are not able to buffer the acid and require the help from the lungs.
D) lungs are trying to excrete excess hydrogen.
Place the following stages of the hydrogen ion elimination and bicarbonate conservation
in the proximal tubules of the nephrons in the ascending chronological order. Use all the
A) CO2 and H2O are produced.
B) H+ is secreting into the tubular fluid.
C) Carbonic acid is produced.
D) H+ combines with filtered HCO3
B D C A
Following several days in an acidotic state, a hospital patient has returned to desired pH.
Which of the following processes could have contributed to the resolution of the
patient's health problem?
A) Exchange of Na+ and H+ ions
B) Selective renal secretion and reabsorption of CO2
C) The phosphate and ammonia buffer systems in the renal tubules
D) Excretion of HCO3
- by the kidneys
When trying to explain the role of potassium and hydrogen related to acid-base balance,
which of the following statements is accurate?
A) Hypokalemia stimulates H+ secretion.
B) Hyperkalemia will cause the reabsorption of HCO3.
C) Acidosis causes an increase in K+ elimination.
D) Alkalosis tends to increase H+ elimination.
A client with poorly controlled diabetes mellitus presents to the emergency department
with suspected ketoacidosis. Which of the following diagnostic results would most
likely confirm this diagnosis?
A) Low O2 levels, increased anion gap, base excess
B) High ammonia levels, decreased anion gap, high potassium
C) Increased anion gap, base deficit
D) Decreased anion gap, decreased urine ammonium level
A patient who has just had her first postoperative dinner out to celebrate her recovery
from an intestinal bypass is brought to the emergency room by her spouse. He reports
that the patient seems disoriented and is slurring her words. The patient did not have any
alcohol with her pasta dinner. Which of the following might be the cause of her
B) Lactic acidosis
The nurse is caring for a patient with ketoacidosis, who is complaining of increasing
lethargy and occasional confusion following several weeks of rigid adherence to a
carbohydrate-free diet. The nurse understands which of the following phenomena is
most likely occurring?
A) High-fat, low-carbohydrate dietary intake is associated with respiratory acidosis.
B) In the absence of carbohydrate energy sources, her body is metabolizing fat and
C) Metabolism of dietary fats without the buffer action of carbohydrates results in the
catabolism of ketoacids.
D) Decreased carbohydrate intake induces insulin deficiency and consequent
A 14-year-old boy, appearing to be intoxicated, is brought to the emergency room by
ambulance. The EMTs report that the boy has denied consuming anything out of the
ordinary, but an open antifreeze container was found in the boy's room. Which of the
following is likely to be used to treat the patient's symptoms?
A) Gastric lavage
B) Syrup of ipecac
D) Sodium bicarbonate
A patient who overdosed on aspirin is brought to the emergency department. The nurse
caring for this patient should anticipate which of the following clinical manifestations?
Select all that apply.
A) Respiratory rate of 40
B) BP 100/72
C) ABG report: pH 7.50, PCO2 31 mm Hg, and HCO3 level 19 mmol/L.
D) Urine output approximately 100 mL/hour
E) Bilateral crackles (fluid) in the lungs
Which of the following individuals are at risk of developing metabolic alkalosis? Select
all that apply.
A) A 70-year-old woman who has taken two tablespoons of baking soda to settle her
B) A hospital patient who is on nasogastric suction following gastric surgery
C) A 20-year-old male who has been regularly inducing himself to vomit following
D) A 33-year-old male patient who is on mechanical ventilation in the intensive care
unit following a head injury
E) A 58-year-old alcoholic male who has been foregoing food for several weeks
while drinking heavily
F) A 60-year-old female who has chronic renal failure secondary to hypertension
A B C
A 55-year-old male client with a history of cardiovascular disease has been admitted to
the intensive care unit after recovering from cardiogenic shock. In the hours since
admission, the client's arterial blood gases indicate acidosis, most likely acute lactic
acidosis. Which of the following signs, symptoms, and diagnostic findings might his
care team anticipate before the acid-base balance is restored? Select all that apply.
A) Decreased pH
B) Cardiac dysrhythmias
C) Decreased alertness and cognition
E) Nausea and vomiting
A B C E
A nurse is providing care for a client who has been diagnosed with metabolic alkalosis
after several days of antacid use. Which of the following treatments should the nurse
prepare to give?
A) Intravenous or oral administration of free hydrogen ions
B) Intravenous administration of KCl solution
C) Administration of oxygen and NaHCO3 solution
D) Supplementary oxygen and possible mechanical ventilation
A hospital patient's arterial blood gases indicate normal levels of oxygen and increased
carbon dioxide. The patient's respiratory rate is 12 breaths/minute (normal 14 to 20
breaths/minute) with all other vital signs within normal range. While not evident from
assessment and diagnostics, the patient's kidneys are minimizing both H+ excretion and
- reabsorption. What is this client's most likely diagnosis?
A) Respiratory alkalosis
B) Metabolic acidosis
C) Respiratory acidosis
D) Metabolic alkalosis
A 77-year-old female diagnosed with chronic obstructive pulmonary disease (COPD) is
experiencing impaired gas exchange and CO2 retention, despite a rapid respiratory rate.
Which of the following pathophysiological principles would her health care team expect
if her compensatory mechanisms are working?
A) Arterial blood gas sampling indicates a pH in the range of 7.45 to 7.55.
B) Her kidneys are likely to reabsorb H+ and secrete HCO3
C) Her body will produce excess metabolic CO2.
D) Her kidneys will adapt with an increase in plasma HCO3
- and her pH will
The ICU nurse is concerned with her patient's arterial blood gas (ABG)
results—especially the pH 7.30; and PCO2 49 mm Hg. The nurse interprets these ABG
results to mean respiratory acidosis. The nurse knows which of the following are clinical
manifestations of respiratory acidosis? Select all that apply.
A) Headache with complaints of blurred vision
B) Muscle twitching
C) Hyperactive deep tendon reflexes
D) Complaints of paresthesia sensations around the lips/mouth
E) Numbness in the fingers and toes
A 55-year-old woman has presented to the emergency department following a panic
attack. Her blood pressure, respiratory rate, and heart rate are all highly elevated, while
her temperature and oxygen saturation are within normal ranges. What is the woman's
body most likely doing to address the changes in pH associated with her situation?
A) Her kidneys will limit the amount of bicarbonate that they reabsorb.
B) She will be retaining Cl- ions in an effort to lower pH.
C) Her respiratory center will attempt to lower her CO2 levels.
D) The patient's kidneys will excrete more hydrogen ions than they normally do.
In the neurotrauma unit, a teenager with a closed head injury related to an automobile
accident is experiencing high intracranial pressure (ICP). He is intubated and is on a
ventilator. One treatment for this is to allow him to progress into which acid-base
imbalance in an attempt to lower ICP?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
During a period of extreme excess fluid volume, a renal dialysis patient may be
administered which type of IV solution to shrink the swollen cells by pulling water out
of the cell?
A) 0.9% sodium chloride
B) 5% dextrose and water
C) 3% sodium chloride
D) Lactated Ringer solution
A 34-year-old male client has diagnoses of liver failure, ascites, and hepatic
encephalopathy secondary to alcohol abuse. The client's family is questioning the care
team as to why his abdomen is so large even though he is undernourished and
emaciated. Which of the following statements most accurately underlies the explanation
that a member of the care team would provide the family?
A) An inordinate amount of interstitial fluid is accumulating his abdomen.
B) The transcellular component of the intracellular fluid compartment contains far
more fluid than normal.
C) Normally small transcellular fluid compartment, or third space, is becoming
D) Gravity-dependent plasma is accumulating in his peritoneal cavity.
Which of the following individuals would be considered to be at risk for the
development of edema? Select all that apply.
A) An 81-year-old man with right-sided heart failure and hypothyroidism
B) A 60-year-old obese female with a diagnosis of poorly controlled diabetes
C) A 34-year-old industrial worker who has suffered extensive burns in a job-related
D) A 77-year-old woman who has an active gastrointestinal bleed and consequent
E) A 22-year-old female with hypoalbuminemia secondary to malnutrition and
A C E
Recognizing the prevalence and incidence of dehydration among older adults, a care
aide at a long-term care facility is in the habit of encouraging residents to drink even
though they may not feel thirsty at the time. Which of the following facts underlies the
care aide's advice?
A) Older adults often experience a decrease in the sensation of thirst, even when
serum sodium levels are high.
B) The metabolic needs for both fluid and sodium in older adults differ from those of
C) Regulation and maintenance of effective circulating volume by the kidneys is less
effective in the elderly.
D) The renin-angiotensin-aldosterone system (RAAS) is less able to facilitate
sodium clearance in older adults.
The nurse is providing teaching to a student nurse about how antidiuretic hormone
(ADH) plays a central role in the reabsorption of water by the kidneys. The nursing
student is correct to place the following components of the homeostatic action of ADH
in the correct sequence. Use all the options.
A) Stored ADH is released into circulation.
B) ADH is transported along a neural pathway to the posterior pituitary gland.
C) Aquaporins are inserted into tubular cell membranes.
D) ADH is synthesized by cells in the supraoptic and paraventricular nuclei of the
E) Serum osmolality increases.
D B E A C
A patient arrives in the ED very hypovolemic related to excretion of "at least 3 gallon
jugs of urine in the past 24 hours." He describes the urine as being clear-like water. The
physician suspects diabetes insipidus. The nurse should be prepared to administer which
of the following medications?
A) Desmopressin acetate (DDAVP)
B) Benadryl, an anticholinergic
C) Calcium gluconate
A patient has been diagnosed with a brain tumor that cannot be removed surgically.
During each office visit, the nurse will be assessing the patient for syndrome of
inappropriate antidiuretic hormone (SIADH). Which of the following assessments
would alert the clinic nurse that the patient may be developing this complication?
A) Complaints that his urine output is decreased, no edema noted in ankles, and
B) Elevated blood glucose levels, dry mucous membranes, and severe projectile
C) Fever, diarrhea, and nausea
D) Muscle cramps, pins and needle sensation around the mouth/lips, and unexplained
A 77-year-old female hospital patient has contracted Clostridium difficile during her
stay and is experiencing severe diarrhea. Which of the following statements best
conveys a risk that this woman faces?
A) She is susceptible to isotonic fluid volume deficit.
B) She is prone to isotonic fluid volume excess.
C) She could develop third-spacing edema as a result of plasma protein losses.
D) She is at risk of compensatory fluid volume overload secondary to gastrointestinal
water and electrolyte losses.
You are volunteering in the medical tent of a road race on a hot, humid day. A runner
who has collapsed on the road is brought in with the following symptoms: sunken eyes,
a body temperature of 100°F, and a complaint of dizziness while sitting to have his
blood pressure taken (which subsides upon his lying down). These are signs of a fluid
volume deficit. Which of the following treatments should be carried out first?
A) Offer water by mouth.
B) Begin cooling of his body by ice packs.
C) Give him a transfusion of FFP.
D) Give him an electrolyte solution by mouth.
A client is brought to the emergency department with complaints of shortness of breath.
Assessment reveals a full, bounding pulse, severe edema, and audible crackles in lower
lung fields bilaterally. What is the client's most likely diagnosis?
B) Fluid volume excess
C) Electrolyte imbalance: hypocalcemia
A 26-year-old male patient with a diagnosis of schizophrenia has been admitted with
suspected hyponatremia after consuming copious quantities of tap water. Given this
diagnosis, what clinical manifestations and lab results should the nurse anticipate the
patient will exhibit?
A) High urine specific gravity, tachycardia, and a weak, thready pulse
B) Low blood pressure, dry mouth, and increased urine osmolality
C) Increased hematocrit and blood urea nitrogen and seizures
D) Muscle weakness, lethargy, and headaches.
An ECG technician is performing an ECG on a hospital patient who has developed
hypokalemia secondary to diuretic use. Which of the following manifestations of the
client's health problem will the technician anticipate on the ECG?
A) Irregular heart rate and a peaked T wave
B) A low T wave and an absent P wave
C) A prominent U wave and a flattened T wave
D) A narrow QRS complex and an absent U wave
A nurse in a medical unit has noted that a client's potassium level is elevated at 6.1
mEq/L. The nurse has notified the physician, removed the banana from the client's
lunch tray, and is performing a focused assessment. When questioned by the client for
the rationale for these actions, which of the following explanations is most appropriate?
A) "Your potassium level is high, and so I need you let me know if you feel
numbness, tingling, or weakness."
B) "Your potassium levels in the blood are higher than they should be, which brings
a risk of changes in the brain function."
C) "I'll need to monitor you today for signs of high potassium; tell me if you feel as if
your heart is beating quickly or irregularly."
D) "The amount of potassium in your blood is too high, but this can be resolved by
changing the intravenous fluid you are receiving."
A renal failure patient with severe hyperkalemia (K+ level 7.2 mEq/L) has just been
admitted to the nursing unit. Given the severity of this situation, the nurse should be
prepared to administer which intravenous infusion stat?
A) Lactated Ringer solution at 150 mL/hour to maintain blood glucose levels
B) Regular insulin infusion, rate dependent on lab values
C) Infusion of Solu-Medrol to decrease irritation to the intravascular system
D) Dilaudid via patient-controlled device (PCA) to control pain
Vitamin D is integral to the regulation of calcium and phosphate levels. Put the
following steps in the action of vitamin D into the correct sequence. Use all the options.
A) Vitamin D is present in the skin or intestine.
B) Vitamin D is concentrated in the liver.
C) Absorption of calcium from the intestine increases.
D) Vitamin D is transported to the kidneys.
E) Calcitriol is produced.
A B D E C
A 52-year-old patient has just passed a kidney stone and has high levels of calcium in
her urine. Blood tests show high levels of calcium in her blood as well. What
subsequent lab results would be most likely to distinguish between primary
hyperparathyroidism and hypercalcemia of malignancy?
A) Parathyroid hormone level
B) Bone scan
C) Plasma phosphate levels
D) Serum magnesium level
An 81-year-old female has a long-standing diagnosis of hypocalcemia secondary to
kidney disease. She will be moving into an assisted living facility shortly. Which of the
following clinical manifestations would the nursing staff at the facility likely observe in
A) Loss of appetite and complaints of nausea
B) Muscular spasms and complaints of tingling in the hands/feet
C) High fluid intake and copious amounts of dilute urine output
D) Lethargy and change in level of consciousness
A terminally ill cancer patient with metastasis to the bone has been admitted with
elevated calcium levels (hypercalcemic crisis). The patient is very lethargic and
exhibiting muscle flaccidity. The nurse should be prepared to administer (Select all that
A) pamidronate, a bisphosphonate.
B) intravenous drip of insulin.
C) furosemide, a loop diuretic.
D) gallium nitrate, a gallium salt of nitric acid.
E) prednisone, a corticosteroid.
A D E
A 56-year-old female hospital patient with a history of alcohol abuse is receiving
intravenous (IV) phosphate replacement. Which of the following health problems will
this IV therapy most likely resolve?
A) The client has an accumulation of fluid in her peritoneal cavity.
B) The client is acidotic and has impaired platelet function.
C) The client has an irregular heart rate and a thread pulse.
D) The client has abdominal spasms and hyperactive reflexes.
A patient who has had a prolonged period of nasogastric (NG) suctioning following
colon surgery is experiencing electrolyte imbalances. The magnesium level is low (1.2
mg/dL). Knowing that magnesium deficiency occurs in conjunction with low calcium
levels, the nurse should assess the patient for which of the following clinical
manifestations of hypocalcaemia? Select all that apply.
A) Personality changes
B) Hyperactive reflexes
C) Increase in ventricular arrhythmias
D) Increase in bouts of atrial fibrillation
E) Symptomatic hypotension
A B C
A 23-year-old man has received a recent diagnosis of appendicitis following 24 hours of acute abdominal pain. The nurse providing care for the man is explaining that while unpleasant, the inflammation of his appendix is playing a role in his body's fight against the underlying infectious process. Which of the following teaching points should the
nurse eliminate from his teaching to the patient?
A) "Inflammation can help to remove the body tissue cells that have been damaged
B) "Inflammation will start your body on the path to growing new, healthy tissue at
the site of infection."
C) "Inflammation helps your body to produce the right antibodies to fight the
D) "Inflammation ultimately aids in eliminating the initial cause of the cell injury in
A patient presented to the emergency department of the hospital with a swollen, reddened, painful leg wound and has been diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) cellulitis. The patient's physician has ordered a complete blood count and white cell differential. Which of the following blood components would the physician most likely anticipate to be elevated?
A 16-year-old girl has broken her arm while snowboarding. When she arrives at
hospital, she is shocked at the amount of swelling at the injury site. Which of the
following statements best explains the physiological rationale for her swelling?
A) Migration and proliferation of mast cells, neutrophils, and platelets to the injury
site occupy an increased volume of tissue.
B) Potent vasodilation increases the total volume of vascular space at the site of
C) Osmotic flow of plasma into the intravascular space causes increased blood
volume and interstitial fluid.
D) Loss of plasma proteins causes an increase in interstitial osmotic pressure.
Which of the following phenomena best accounts for the increased presence of
leukocytes at the site of inflammation?
A) Existing leukocytes stick to the epithelial cells and move along blood vessel walls.
B) Increased numbers of leukocytes are released into circulation via cytokine
C) Leukocytes are osmotically drawn from circulation into the interstitial space as a
result of swelling.
D) Epithelium expresses leukocyte stimulation factors in response to cell injury.
When explaining the final stages of the inflammatory response to pathogens, the nurse
will educate the patient about
A) how the body can kill the pathogen by generating toxic oxygen and nitrogen
products producing such things as nitric oxide and hydrogen peroxide.
B) margination, which is a process whereby white cells (leukocytes) stick to the
endothelium and accumulate along the blood vessel.
C) the increase in vascular permeability, which lets fluids leak into the extravascular
D) the promotion of tissue regeneration whereby monocytes and macrophages
produce potent prostaglandins and leukotrienes.
A deficiency in which of the following would result in an inhibition of the inflammatory
B) Helper T cells
C) B cells
D) Vitamin K
When educating a patient with a wound that is not healing, the nurse should stress which
of the following dietary modifications to ward off some of the negative manifestations
that can occur with inflammation?
A) Increase the amount of calcium in the diet, especially drinking milk and eating
B) This is the one time whereby you should eat more fat (both polyunsaturated and
saturated), so you can absorb more fat soluble vitamins.
C) Since there is a loss of plasma proteins, you should increase your intake of organ
meats like liver.
D) Increase your intake of oily fish and fish oil so that you will increase absorption of
omega-3 polyunsaturated fatty acids.
Tumor necrosis factor-a and IL-1 are major cytokines that mediate inflammation. If the
patient is developing a systemic response to an infection, the nurse will likely assess
which of the following clinical manifestations? Select all that apply.
A) Elevated temperature
D) Decrease in urine output
A C E
A 63-year-old woman has begun a diet that purports to minimize the quantity and effects of free radicals in her body. What physiological processes could best underlie her care provider's teaching about her new diet?
A) Free radicals act as direct mediators in the inflammatory process.
B) Free radicals inhibit the inflammatory response, limiting preadaptive response to infection.
C) Free radicals increase cytokine expression and adhesion molecule levels, resulting in increased inflammation.
D) Free radicals contribute to atherosclerosis and decreased immune response.
A nurse is changing the wound dressing on the coccyx-region pressure ulcer of an immobilized patient. The existing dressing is saturated with both watery, clear discharge and foul, gray-colored liquid. Which of the following entries in the patient's chart best captures this?
A) "Large amounts of suppurative and serous exudates noted"
B) "Purulent discharge and fibrinous exudates noted on existing dressing"
C) "Abscess activity noted to coccyx wound"
D) "Plasma proteins and membranous exudates present on existing dressing"
Which of the following aspects of a patient's site of inflammation would help the care provider rule out chronic inflammation?
A) High levels of macrophages
B) Increased neutrophils
C) Proliferation of fibroblasts
D) Infiltration of lymphocytes
In the ICU, a patient has been diagnosed with sepsis due to a bacterial invasion. The human body usually responds to infections by developing an uncontrolled inflammatory
response with large production and release of inflammatory cytokines such as IL-1 and TNF-a. The nurse will note which of the following clinical manifestations in this septic patient as a result of the activation of these cytokines? Select all that apply.
A) Excessive interstitial edema related to increased vascular permeability
B) Decreased cardiac output resulting from myocardial depression
C) Increased respiratory rate with crackles heard throughout all lung fields
D) Excessive bleeding from bowels and bladder
E) Lower blood pressure due to intravascular fluid loss
A B E
A 24-year-old woman presents with fever and painful, swollen cervical lymph nodes.
Her blood work indicates neutrophilia with a shift to the left. She most likely has
A) a mild parasitic infection.
B) a severe bacterial infection.
C) a mild viral infection.
D) a severe fungal infection.
Which of the following patients would have a very poor response related to tissue
regeneration of his or her injured area?
A) A 21-day-old infant undergoing a diaphragmatic hernia repair
B) A 54-year-old male who had a massive MI 4 days ago and came to the ED today
C) A 73-year-old female who is undergoing lithotripsy for kidney stones
D) A 33-year-old athlete undergoing surgery to repair a torn MCL in his right knee
A hospital patient has a large, superficial wound on her elbow that was the result of shearing action when she was moved up in her bed. The patient's husband mentions that the wound looks infected and irritated because the wound bed is completely red. Which of the following responses would be inappropriate?
A) "Even though it is red, it doesn't mean that the wound is infected."
B) "The red areas show that there is enough circulation to facilitate healing."
C) "Those are fresh blood vessels that are a sign of healthy healing."
D) "A thin sheet of blood clotting is actually desirable and not a sign that your wife's wound is infected."
Which of the following processes would most likely be considered an anomaly during the cellular phase of inflammation?
A) Platelet aggregation
C) Migration of phagocytic white cells
D) Macrophage activity
A patient who is recovering from burn injuries is discussing his prognosis with a
physician. Which of the following teaching points about expectations for healing should
the physician include?
A) "Once your healing is complete, your skin will be just as strong as before your
B) "You may find that the scar is a bit smaller than the area of the wound."
C) "You'll find that your new tissue is more elastic and fragile than the rest of your
D) "The final remodeling phase of healing may last up to 3 months in your case."
Of the following list of patients, who would likely benefit the most from hyperbaric
A) A trauma patient who developed Clostridium spp., an anaerobic bacterial infection
in his femur
B) A patient who developed a fistula between her bowel and vagina following
cervical cancer surgery
C) A school-aged child who fell on gravel and has terrible road rash
D) A football player who has torn a meniscus in his knee for the third time this year
Which of the following patients is most likely to have impairments to the
wound-healing process? A patient with
A) chronic obstructive pulmonary disease.
B) a diagnosis of multiple sclerosis and consequent impaired mobility.
C) poorly controlled blood sugars with small blood vessel disease.
D) congenital heart defects and anemia.
A 79-year-old female resident of an assisted living facility receives care from a
community nurse on a regular basis for treatment of a chronic venous leg ulcer. Which
of the following factors would the nurse be most justified in ruling out as a contributing
factor to the client's impaired wound healing?
A) A lower skin collagen content than in younger adults
B) Decreased fibroblast synthesis
C) Slow reepithelialization
D) Decreased antibody levels
The nurse knows which of the following statements listed below relative to a client with
malignant melanoma treated with alpha interferon (IFN-a) is accurate? Alpha interferon
A) will kill certain microorganisms that may help spread the cancer.
B) plays an important role in the modulation of the inflammatory response.
C) helps keep all the blood levels at a higher level.
D) controls the migration of leukocytes to their primary site.
The nurse knows which of the following statements listed below is accurate regarding
the functions and nature of cytokines relative to a variety of pathologies?
A) "A particular cytokine can have varied effects on different systems, a fact that
limits their therapeutic use."
B) "Cytokine production is constant over time, but effects are noted when serum
levels cross a particular threshold."
C) "Most cytokines are produced by granular leukocytes, and different cells are
capable of producing the same cytokine."
D) "Cytokine actions are self-limiting, in that activation of one precludes activation
of other cytokines with similar actions."
The nurse knows that a drug in a category identified as a colony-stimulating factor
A) cells engulf and digest microbes that want to attach to cell membranes and destroy
normal cell function.
B) produce cells that will be the first responder cells to protect against cancer
C) stimulate the person's immune system so that he or she can kill his or her own
D) stimulate bone marrow to produce large numbers of mature cells such as platelets
Which of the following individual situations listed below best exemplifies the processes
of innate immunity?
A) A child who has experienced heat and swelling of his skinned knuckle
B) An adult who complains of itching and is sneezing because he is allergic to pollen
C) A client whose blood work indicates increased antibody titers during an acute
D) A client who has experienced rejection of a donor liver after transplantation
The nurse knows which of the following components listed below is needed for
long-lasting immunity in a client with a diagnosis of sepsis without the causative agent
C) Colony-stimulating factors
D) Natural killer cells
A client has been identified as having an excess of macrophage inhibitory factor,
causing the client to have inhibited movement and activity of macrophages. Which of
the following processes listed below would the health care team member expect to
A) Amplification of the immune response
B) Destruction of virus-infected or tumor cells
C) Initiation of adaptive immunity
D) Specificity and memory of the immune response
A client who has a diagnosis of an autoimmune disease asks his nurse why it is that his
immune system does not attack all of the cells that make up his body. Which of the
following aspects of pathogen recognition in the innate immune system listed below
would underlie the nurse's response?
A) Normal host cells excrete inhibitory proteins that are detected by natural killer
B) Intraepithelial lymphocytes and natural killer cells possess specific, highly diverse
C) Pattern recognition receptors (PRRs) ensure that cells are correctly identified.
D) Leukocytes possess pathogen-associated molecular patterns (PAMPs)
A 60-year-old male client with an acute viral infection is receiving interferon therapy.
The physician is teaching the family of the client about the diverse actions of the
treatment and the ways that it differs from other anti-infective therapies. Which of the
following teaching points listed below should the physician least likely include?
A) "Interferon can help your father's unaffected cells adjacent to his infected cells
produce antiviral proteins that can stop the spread of the infection."
B) "Interferon can help limit the replication of the virus that's affecting your father."
C) "Interferon helps your father's body recognize infected cells more quickly."
D) "Interferon can bolster your father's immune system through the stimulation of
natural killer cells that attack viruses."
Which of the following phenomena would be least likely to result in activation of the
A) Recognition of an antibody bound to the surface of a microbe
B) Increase in tissue blood flow and capillary permeability, so fluids/proteins can
leak into the area
C) Activation of toll-like receptors (TLRs) on complement proteins
D) Direct recognition of microbial proteins
A nurse is providing care for a client who is immunocompromised following
chemotherapy. The nurse knows which of the following characterizations of the
adaptive immune system listed below is responsible for the client's disruption in his
normal immune function?
A) Epitopes on antigens are recognized by immunoglobulin receptors following
presentation by accessory cells.
B) Haptens combine to form epitopes that stimulate the response of regulatory and
C) Effector cells orchestrate the immune response of regulatory cells toward an
D) Accessory cells such as macrophages are engulfed by regulatory cells, stimulating
The nurse knows the cells primarily programmed to remove the invading organisms and
remember the antigen to respond rapidly during the next exposure are
A) CD4 and CD8 cells.
B) natural killer (NK) cells and macrophages.
C) T and B lymphocytes.
D) white blood cells and platelets.
A 53-year-old female hospital patient has received a kidney transplant following renal
failure secondary to hypertension. As part of the teaching while she was on the organ
wait list, she was made aware that she would need to take antirejection drugs for the rest
of her life. Which aspect of the immune system underlies this necessity?
A) The lack of identifiable major histocompatibility complex (MHC) molecules will
stimulate the innate immune response.
B) Donor organ antibodies will be identified as foreign and stimulate an immune
C) Antirejection drugs will stimulate the production of familiar MHC molecules.
D) MHC molecules will never develop in the cells of the donor organ, and effector
cells will be continually stimulated.
A client has been inhaling viruses periodically while on a cross-country flight. Which of
the following situations listed below would most likely result in the stimulation of the
client's T lymphocytes and adaptive immune system?
A) Presentation of a foreign antigen by a familiar immunoglobulin
B) Recognition of a foreign major histocompatibility complex (MHC) molecule
C) Recognition of a foreign peptide bound to a self-major histocompatibility complex
D) Cytokine stimulation of a T lymphocyte with macrophage or dendritic cell
Three days ago, a mother delivered her full-term infant who had been identified as
having an in utero infection. The infant is receiving antibiotic and phototherapy, and the
mother is breast-feeding. Which of the following types of immunoglobulins could most
reasonably be expected to predominate in the infant's immune system?
A) IgA, IgM, IgD
B) IgG, IgA, IgM
C) IgE, IgG, IgD
D) IgM, IgD, Igm
A middle school student is scheduled to receive booster immunizations, and the father
asks the nurse why the booster is necessary. What characteristic of the adaptive immune
system listed below would provide the rationale for the nurse's response?
A) Some antibodies require a repeat of the primary immune response.
B) Some antibodies have a duration measured in months rather than years.
C) A secondary response causes a sharp rise in antibody levels.
D) Antigen receptors on CD4+ cells require multiple exposures separated by time.
A student states, "It seems like helper T cells do a lot more than just 'help' the cellular
immunity process." Which of the following responses listed below best conveys an
aspect of the role of CD4+ helper T cells in immunity?
A) "Without helper T cells, no antigens would be presented."
B) "Helper T cells play a major role in stimulating and regulating the whole process."
C) "Without helper T cells, the wrong antibodies would end up being produced."
D) "Helper T cells are key to the hematopoiesis that produces all the components of
the immune system."
A newly diagnosed HIV-positive adolescent has blood work drawn, which includes a
CD8 T-cell count. The nurse knows which of the following functions of CD8 T cells
listed below will assist the adolescent's immune system in fighting off the viral attack?
Select all that apply.
A) Release destructive enzymes
B) Trigger intracellular programmed death
C) Cause allergens to surround the virus
D) Boost antigen-antibody response
E) Remove foreign material from lymph before it enters the blood
A 10-year-old child with strep throat asks the nurse, "why there are large bumps [lymph
nodes] on my neck when my throat gets sore?" The nurse replies lymph nodes
A) help your body fight off infections by allowing special cells (lymphocytes and
macrophages) move through the lymph chain and engulf and destroy germs.
B) bring in cells into the lymph node (your bump) to stop the germs from going
anywhere else in the body.
C) bring all kind of good cells to your throat so that they can wall the strep off and
keep the germs from getting any food or water."
D) help your tonsils get bigger with cells that will bring immune cells into your throat
to prevent any other infections.
Which of the following situations can best be characterized as an example of passive
A) A 6-month-old infant receives his scheduled immunization against measles,
mumps, and rubella.
B) A 9-year-old boy is immune to chicken pox after enduring the infection before 1
C) An 8-year-old girl recovers from a respiratory infection after intravenous
D) A 6-week-old infant receives antibodies from his mother's breast milk.
The nurse knows high incidences of infectious illnesses among the older adults who
reside in a long-term care facility are most likely to have diminished immune capacity
A) decreased numbers and responsiveness of T lymphocytes.
B) decreased antigen recognition by B lymphocytes.
C) overexpression of cytokines and receptors.
D) altered function in peripheral lymphocytes.
After years of going to different physicians with vague symptoms, a 55-year-old client
with a history of Hodgkin disease has been diagnosed with a secondary
immunodeficiency syndrome. The client asks the nurse what this means. The nurse
knows from the following list of characteristics that secondary immunodeficiency
disorders: Select all that apply.
A) may be inherited as a sex-linked trait.
B) usually develop later in life.
C) may be a result of chemotherapy being used to treat a cancer.
D) can result from frequent recurring Staphylococcus aureus infections.
E) can occur in a chronic obstructive pulmonary disease patient taking
B C E
A 2-year-old girl has had repeated ear and upper respiratory infections since she was
born. A pediatrician has determined a diagnosis of transient hypogammaglobulinemia of
infancy. What is the physiological origin of the child's recurrent infections?
A) The child's immune system is unable to synthesize adequate immunoglobulin on
B) The child had a congenital absence of IgG antibodies that her body is only slowly
beginning to produce independently.
C) The child was born with IgA and IgM antibodies, suggesting intrauterine
D) The child lacks the antigen-presenting cells integral to normal B-cell antibody
A nurse is providing care for a 17-year-old boy who has experienced recurrent sinus and
chest infections throughout his life and presently has enlarged tonsils and lymph nodes.
Blood work indicated normal levels of B cells and free immunoglobulins but a lack of
differentiation into normal plasma cells. The boy is currently receiving intravenous
immunoglobulin (IVIG) therapy. What is the boy's most likely diagnosis?
A) X-linked hypogammaglobulinemia
B) Transient hypoglobulinemia
C) Common variable immunodeficiency
D) IgG subclass deficiency
Which of the following patients is most likely to benefit from transplantation of thymic
tissue or major histocompatibility complex (MHC)-compatible bone marrow?
A) A 12-year-old girl with a history of epilepsy and low IgG levels secondary to
B) A 7-year-old boy whose blood work indicates decreased IgA and IgG with
C) A 6-year-old boy whose pre-B cells are incapable of translation to normal B cells
D) A 9-year-old girl who has a diagnosis of IgA deficiency
An 8-week-old boy has been recently diagnosed with a severe combined
immunodeficiency (SCID). His parents have performed a significant amount of research
on the Internet and have brought a large amount of material to discuss with their care
provider. Which of the following statements best reflects an accurate understanding of
their son's health situation?
A) "We read that gene therapy could cure our son; we'd like you to look into that
B) "Our son likely has a deficiency of B lymphocytes and can't produce antibodies."
C) "We feel guilty, because dietary and environmental factors have been shown to
contribute to SCID"
D) "The antibodies that our son produces are mismatched to the infections that he
was born with and encounters."
A 1-year-old child who has experienced low platelet counts and bacterial susceptibility
has been admitted to a pediatric medical unit of a hospital for treatment of
Wiskott-Aldrich syndrome. The nurse who has admitted the child to the unit would
anticipate which of the following short-term and longer-term treatment plans?
A) Transfusion of clotting factors XII and XIII and serum albumin; splenectomy
B) Neutropenic precautions; fresh frozen plasma transfusions; treatment of
C) Intravenous immunoglobulin (IVIG) treatment; thyroidectomy
D) Treatment of eczema; management of bleeding; bone marrow transplant
A nurse has just learned that her child has a life-threatening complement disorder
known as hereditary angioneurotic edema (HAE). Due to deficiency in C1-INH, the
nurse needs to be prepared for which possible life-threatening clinical manifestation?
A) Bulging eyeballs
B) Swelling of the airway
C) Compressed carotid arteries
D) Compression of brachial nerves
A 4-year-old boy presents with a chronic cough and swollen lymph nodes. His records
show that he has been given antibiotics several times in the past year with limited
success, most recently for a liver abscess, and that he also has a recurring fungal skin
condition. Which of the following is his most likely diagnosis?
A) Selective IgA deficiency
B) A deficiency in IgG2 subclass antibodies
C) Chronic granulomatous disease
A patient diagnosed with a primary immunodeficiency disorder has asked his siblings to
be tested as possible stem cell donors. When discussing this procedure with his family,
the nurse emphasizes that stem cells can be harvested from: Select all that apply.
A) bone marrow.
B) peripheral blood.
C) skin tissue harvesting.
D) mouth swabs.
When explaining what is occurring when their child has an acute bronchial asthma
attack, the nurse will emphasize that which mediator is primarily responsible for the
A) Tree pollen
B) Mold dust
D) T-lymphocyte proliferation
A male elementary school student has a severe allergy to peanuts and is displaying the
signs of anaphylactic shock after inadvertently eating a peanut-containing candy bar.
Which of the following statements best captures the boy's current status and preferred
A) He is experiencing shortness of breath caused by potent vasoconstriction that can
be relieved by epinephrine injection.
B) He is approaching vascular shock and developing edema due to actions of IgE
antibodies, situations that can be reversed by administration of epinephrine.
C) His mast cells and basophils have been sensitized, but systemic effects can be
mitigated by administration of bronchodilators.
D) He is likely in a primary- or initial-stage allergic response that can be relieved by
A 40-year-old woman who experiences severe seasonal allergies has been referred by
her family physician to an allergist for weekly allergy injections. The woman is
confused as to why repeated exposure to substances that set off her allergies would
ultimately benefit her. Which of the following phenomena best captures the rationale for
allergy desensitization therapy?
A) Repeated exposure to offending allergens binds the basophils and mast cells that
mediate the allergic response.
B) Allergens in large, regular quantities overwhelm the IgE antibodies that mediate
the allergic response.
C) Repeated exposure stimulates adrenal production of epinephrine, mitigating the
D) Injections of allergens simulate production of IgG, combining with the antigens to
prevent activation of IgE antibodies.
A 24-year-old woman has gone to the OB-GYN clinic for her first visit since she found
out she was pregnant. The clinician tested her blood type along with the usual prenatal
testing. On a follow-up visit, the woman was told that she is Rh negative. When asked
what that means for her baby, the nurse explains that Rh-negative women lack RhD
antigens on their erythrocytes but produce anti-D antibodies. As a result of this blood
A) "If you and your baby have mismatched blood, it can invoke anaphylaxis in the
B) "If the types are incompatible, severe antibody-mediated inflammation occurs."
C) "If blood types do not match, the baby's liver will produce extra cells to replace
RBCs needed to oxygenate organs."
D) "If the fetus is Rh positive, maternal anti-D antibodies can coat fetal RBCs
resulting in severe anemia."
A 67-year-old patient diagnosed with myasthenia gravis will likely display which
clinical manifestations as a result of autoantibodies ultimately blocking the action of
acetylcholine, resulting in destruction of the receptors?
A) Weakness of the eye muscles; difficulty in swallowing and slurred speech;
B) Tremor of hands/arms; rigidity of the arms; shuffling gait
C) Short-term memory lapses; problems with orientation; a lack of drive or initiative
D) Facial droop; slurred speech; weakness on one side of the body
Following a spider bite she received while camping, a 20-year-old female presented to
the emergency department with rash, edema, and fever and was subsequently diagnosed
with serum sickness. Which of the following statements best conveys the physiological
rationale for the broad systemic effects of this event?
A) The woman is experiencing diffuse tissue necrosis as a consequence of an Arthus
B) Antigen-antibody complexes have been deposited in a variety of locations
throughout the body.
C) Antibody binding to specific target cell receptors is bringing about a change in
D) Deposited antibodies are activating her complement system.
A new nursing student is taking a tuberculin (TB) skin test as part of her preparation for
beginning clinical placement in the hospital. The student is unclear of the rationale or
physiology involved in this test. Which of the following is the correct explanation?
A) The cell-mediated hypersensitivity associated with Mycobacterium tuberculosis
remains detectable for several years.
B) Formation of contact dermatitis lesions confirms prior TB contact.
C) Previous TB exposure forms sensitized Th1 cells that are long-lived.
D) This type of delayed-type hypersensitivity (DTH) is a response to latent
Mycobacterium tuberculosis bacteria.
A female dental assistant has developed signs and symptoms of a latex sensitivity and is
undergoing allergy testing as well as blood work. Which of the following components of
the assistant's blood work would most likely be the focus of her health care provider's
A) Analysis of class II MHC antigens
B) Serum IgE immunoassays
C) Serum B-lymphocyte levels
D) Serum CD8+ levels
While undergoing a kidney transplant from a nonfamily member, the patient's
transplanted kidney has just had the arterial clamps removed. The OR staff notice that
the organ is turning purple with no urine output. When explaining to the family why
they had to remove the donor kidney, the nurse will anticipate that the surgeon would
likely include which statement?
A) Obviously, there has been a mismatch during the human leukocyte antigen (HLA)
B) The circulating B and T lymphocytes are just doing their job.
C) Hyperacute rejection occurs because antibodies against HLA antigens are
deposited in vessels causing necrosis.
D) Previous exposure to the HLA antigens is responsible for the high titers of
complement fixing antibodies that cause the rejection.
After several months on a waiting list, a 44-year-old male received a liver transplant 5
days ago. In the last 36 hours, he has developed a rash beginning on his palms and soles,
along with abdominal pain and nausea. It has been determined by his care team that the
immune response that is causing his symptoms originates not with his own
compromised immune components but with those introduced with his new organ. This
man's most likely medical diagnosis is
A) graft versus host disease (GVHD).
B) acute transplant rejection.
C) hyperacute organ rejection.
D) T-cell-mediated graft rejection
group of nurses about autoimmune diseases. Which of the following statements by an
attendee would the educator most likely want to follow up with further teaching?
A) "Introduction of a foreign antigen can sometimes induce a cascade of immune
response that is not self-limiting"
B) "Often the problem can be traced to antigens that sensitize T cells without the
need for presentation."
C) "In some cases, the body attacks its own cells that are chemically similar to those
of infectious organisms."
D) "Sometimes when the body's own cells are released after a long time, they are
interpreted as being foreign."
While teaching about HIV/AIDS to a group of high school seniors, the school health
nurse will begin by explaining the basic facts that will likely include which of the
A) Like all viruses, HIV is a genetic material made from DNA with long molecules
that carry genetic information.
B) HIV is different from other viruses since it is a retrovirus that selectively attacks
the body's immune cells.
C) There are two types of HIV, but the one that is endemic to the United States is
HIV type 2.
D) HIV type 1 for some reason rarely develops into full-blown AIDS.
As part of her prenatal education, a 29-year-old woman who is pregnant with her first
child is receiving teaching from her primary care provider. Which of the following
statements by the woman reflects an accurate understanding of HIV transmission?
A) "I know my baby is safe from HIV while in the womb, but the delivery will place
him or her at real risk."
B) "It's discouraging to know that my breast milk can pass on HIV to my baby."
C) "I know it's possible, but it's comforting that the chances of my child contracting
my HIV are actually very low."
D) "I'm relieved to learn that a caesarean delivery will protect my baby from being
born HIV positive."
A potential donor is angry at the personal nature of the questions about HIV risk factors
that he is required to answer at a blood collection center and states that simple blood
testing should suffice. How can the nurse at the center best respond?
A) "There are some very uncommon subtypes of the HIV virus that are not detectable
by current testing methods."
B) "There's a chance that persons who are asymptomatic, but HIV positive can have
their antibodies missed by serum testing."
C) "There's a period shortly after someone is infected with HIV when blood tests
might still be negative."
D) "Even though blood tests are completely accurate, the high stakes of blood
donation and transfusion mean that double measures are appropriate."
A 40-year-old male who has been HIV positive for 6 years is experiencing a new
increase in his viral load along with a corresponding decrease in his CD4+ count. Which
of the following aspects of his immune system is likely to remain most intact?
A) Presentation of major histocompatibility molecules on body cells
B) Orchestration of natural killer cells as part of cell-mediated immunity
C) Activation of B lymphocytes
D) Phagocytic function of monocytes and macrophages
A 19-year-old intravenous drug user was exposed to the HIV 3 weeks ago and is
experiencing a rapid proliferation in viral load. Which of the following statements best
captures an aspect of the process of HIV replication that underlies this proliferation?
A) Free HIV RNA is able to attach to the cell coat of CD4+ cells.
B) The cytoplasm of CD4+ cells provides a protected environment for the replication
of RNA by HIV.
C) Expression of reverse transcriptase by CD4+ cells allows replication of HIV cells
rather than new lymphocytes.
D) HIV is able to change its RNA into DNA to allow for replication by CD4+ cells.
Utilizing the World Health Organization (WHO) framework of clinical categories for
persons with acquired immunodeficiency syndrome (AIDS) over 15 years of age, a
visitor to the United States goes to a city clinic complaining of diarrhea, weight loss of
20 lb, and feeling like he is running a temperature. These manifestations have been
occurring for the past 5 weeks. The nurse would identify this patient to be in which
A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4
Which of the following patients would be considered to be in the latent period of HIV
A) A 16-year-old prostitute who has open sores on her labia that drain purulent
B) A 33-year-old heroin drug abuser who has numerous enlarged lymph nodes in his
axilla and cervical neck region for the past 4 months
C) A 45-year-old alcohol abuser who is complaining of excessive vomiting of blood
that started 2 weeks ago
D) A 24-year-old college student who has developed a chronic cough that will not go
away, even after taking two courses of antibiotics.
A person who has been diagnosed with HIV infection 12 years ago and still has a CD4+
cell count of 800 cells/μL and a low viral load is considered clinical to be a
A) rapid progressor.
B) typical progressor.
C) slow progressor.
D) long-term nonprogressor
A 39-year-old female with HIV infection has been characterized as a typical progressor
by her care team and is experiencing an increase in her manifestations and health
complaints as her CD4+ count declines. Which of the following health problems would
her care team most likely attribute to a cause other than her HIV?
A) Her recent diagnosis of bacterial pneumonia
B) Her esophagitis that has been linked to herpes simplex infection
C) Her decreased bone density and recent fractures
D) Her increasing confusion and disorientation
A patient comes into a clinic complaining of cough, fever, and shortness of breath. The
patient informs the health care provider that he is HIV positive. Upon physical exam,
the family nurse practitioner (FNP) may note which of the following clinical
manifestations of suspected Pneumocystis jiroveci pneumonia (PCP)? Select all that
A) Interstitial infiltrates on chest x-ray
B) Respiratory rate of 32 with normal breath sounds
C) Stridor when taking a deep breath
D) Use of abdominal muscles to breathe while sitting on the exam table
E) Night sweats that require clothing changes frequently throughout the night
Members of an AIDS support group who have more advanced cases are sharing some of
their recent health problems with a member who has just been diagnosed. Which of the
member's statements is most accurate?
A) "One of the scariest things out there now is the huge increase in drug-resistant
B) "The eradication of Pneumocystis jiroveci pneumonia (PCP) has helped extend
the life expectancy of a lot of persons living with AIDS."
C) "Those of us with HIV are so much more prone to loss of vision and hearing."
D) "As people with HIV live longer, most of us are eventually succumbing to the
cancers that are associated with HIV."
A 48-year-old man who has been HIV positive for 6 years has just learned that he has
been diagnosed with Kaposi sarcoma (KS). Which of the following facts most
accurately conveys an aspect of his diagnosis?
A) An opportunistic Epstein-Barr virus underlies the man's KS.
B) He is likely to have lesions on his skin, mouth, or GI tract.
C) Intense pain was probably his first manifestation of KS.
D) Heterosexual contact most likely underlies his HIV and subsequent KS.
Which of the following signs and diagnostic findings are recognized components of the
metabolic and morphologic changes that occur with HIV infection accompanied with
lipodystrophy? Select all that apply.
B) Insulin resistance
C) Deficiencies of anterior pituitary hormones
D) Increased abdominal girth
E) Breast enlargement
A B D E
When counseling a male patient with suspected HIV, the nurse informs him that if the
enzyme-linked immunosorbent assay (ELISA) comes back positive, then
A) no further testing is required since this confirms HIV infection.
B) a second test known as the Western blot assay will be ordered to confirm positive
C) he will be sent to an infectious disease physician for a tissue biopsy to confirm
D) if the second test, the Western blot, returns negative, he has not developed a case
of full-blown AIDS.
A school nurse is teaching high school students about HIV and AIDS in the context of
the school's sexual health curriculum. Which of the students' following statements
would the nurse most likely want to correct or clarify?
A) "They have to take a blood sample from you in order to test you for AIDS."
B) "Drugs for AIDS reduce the virus in your body, but they don't get rid of it."
C) "Lots more heterosexual people get HIV these days than they used to."
D) "Condoms provide really good protection from AIDS."
Which of the following individuals would most likely be placed on highly active
antiretroviral therapy (HAART) if he or she were not yet receiving the treatment? Select
all that apply.
A) A 35-year-old female sex trade worker who is HIV negative but who has a
documented history of sharing needles for heroin use
B) A 46-year-old male with long-standing HIV and a CD4+ count of 125 cells/mL
C) A 16-year-old female who was diagnosed with HIV 2 days prior and is
asymptomatic with normal CD4+ levels
D) A 38-year-old woman who has a CD4+ count of 250 cells/mL and is keen to begin
E) Prophylactically to a health care worker who incurred a laceration from a scalpel
used in surgery but has no abnormal lab results
A 37-year-old male with HIV who has recently become symptomatic has begun highly
active antiretroviral therapy (HAART). Among the numerous medications that the man
now regularly takes are several that inhibit the change of HIV RNA to DNA in a CD4+
cell. Which of the following classes of medications addresses this component of
the HIV replication cycle?
A) Entry inhibitors
B) Protease inhibitors
C) Integrase inhibitors
D) Non-nucleoside reverse transcriptase inhibitors
All antiretroviral medications interfere with some stage of the HIV life cycle. What
stage do protease inhibitors prevent?
A) Cleavage of the polyprotein chain into the individual proteins that will be used to
make new virus
B) Addition of more nucleosides to the DNA chain
C) Killing of the CD4+ T cell to release virions into the bloodstream
D) Attachment of the virus to CD4+ cell receptors
A 23-year-old HIV-positive woman in the United States with routinely low viral loads
and robust CD4+ cell counts is planning to get pregnant. Which precaution would
her care giver eliminate from her care?
A) Offer her HAART that includes zidovudine
B) Counsel her not to breast-feed
C) Give her single-dose perinatal nevirapine
D) Give the infant trimethoprim-sulfamethoxazole, starting at 4 to 6 weeks of age
While volunteering in an HIV clinic in a big city, the nurse notices a new mom and her
baby (a 6-month-old male) in the waiting room. Upon assessing the infant for possible
HIV infection, the nurse will be assessing for which of the following clinical
manifestations of HIV infection? Select all that apply.
A) Weighing him to determine if he is gaining 1.5 to 2 lb/month
B) Observing to see if he can roll over from back to stomach
C) Lack of coordination to play with toys/stuffed animals
D) History of repeated episodes of bacterial pneumonia and ear infections
E) Listlessness and poor eye contact
C D E
The nurse knows which of the following phenomena listed below is an accurate
statement about axonal transport?
A) Anterograde and retrograde axonal transport allow for the communication of
nerve impulses between the neuron and the central nervous system (CNS).
B) Materials can be transported to the nerve terminal by either a fast or slow
C) The unidirectional nature of the axonal transport system protects the CNS against
D) Axonal transport facilitates the movement of electrical impulses but precludes the
transport of molecular materials.
An adult male has a new diagnosis of Guillain-Barré syndrome. The nurse knows which
of the following pathophysiological processes underlie the deficits that accompany the
degeneration of myelin in his peripheral nervous system (PNS)?
A) The destruction of myelin causes fewer Schwann cells to be produced in the
B) The axonal transport system is compromised by the lack of myelin surrounding
C) Unless remyelination occurs, the axon will eventually die.
D) A deficit of myelin predisposes the client to infection by potential pathogens.
While assessing a critically ill patient in the emergency department, the nurse notes on
the cardiac monitor an R-on-T premature ventricular beat that develops into ventricular
tachycardia (VT). Immediately, the patient became unresponsive. The nurse knows that
based on pathophysiologic principles, the most likely cause of the unresponsiveness is
A) metabolic acidosis that occurs spontaneously following any dysrhythmias.
B) interruption of the blood/oxygen supply to the brain.
C) massive cerebrovascular accident (CVA) resulting from increased perfusion.
D) a blood clot coming from the heart and occluding the carotid arteries.
When educating a patient about to undergo a pacemaker insertion, the nurse explains the
normal phases of cardiac muscle tissue. During the repolarization phase, the nurse will
stress that membranes must be repolarized before they can be reexcited. Within the cell,
the nurse understands that
A) potassium channels open while sodium channels close, causing repolarization to
the resting state.
B) the influx of calcium is the primary stimulus for the repolarization of cardiac
C) only the electrical activity within the heart will determine when repolarization
D) the cell membranes need to stay calm resulting in muscle tissue becoming
A client with a diagnosis of depression has been prescribed a medication that ultimately
increases the levels of the neurotransmitter serotonin between neurons. Which of the
following processes will accompany the actions of the neurotransmitter in a chemical
A) Two-way communication between neurons is permitted in contrast to the one-way
communication in electrical synapses.
B) Communication between a neuron and the single neuron it is connected with will
C) The neurotransmitter will cross gap junctions more readily.
D) More neurotransmitters will cross the synaptic cleft and bond with postsynaptic
The neurotransmitter GABA mainly functions to trigger inhibitory postsynaptic
potentials (IPSPs). Therefore, when explaining this to a group of nursing students, the
nurse will state that
A) it takes at least three chemical substances (amino acids, neuropeptides, and
monoamines) to stimulate any activity between the cells.
B) there is a symbiotic relationship; therefore, the end result will be depolarization of
the postsynaptic membrane.
C) the combination of GABA with a receptor site is inhibitory since it causes the
local nerve membrane to become hyperpolarized and less excitable.
D) the neurotransmitters will interact with cholinergic receptors to bind to
acetylcholine in order to produce hypopolarization within the cell.
When reviewing the purpose/action of neurotransmitters as they interact with different
receptors, the nursing instructor gives an example using acetylcholine. When
acetylcholine is released at the sinoatrial node in the right atrium of the heart, it is
A) positively charged.
A male newborn infant has been diagnosed with spina bifida occulta. Which of the
following pathophysiological processes has most likely contributed to the infant's health
A) The neural groove failed to fuse and completely close across the top of the neural
B) The infant's spinal cord and meninges protrude through his skin.
C) The child's central and peripheral nervous systems have insufficiently
differentiated during embryonic development.
D) The infant's soma and viscera are underdeveloped.
A child is experiencing difficulty with chewing and swallowing. The nurse knows that
which of the following cells may be innervating specialized gut-related receptors that
provide taste and smell?
A) Special somatic afferent fibers
B) General somatic afferents
C) Special visceral afferent cells
D) General visceral afferent neurons
A nursing student having trouble moving his head from side to side is likely
experiencing a problem with which type of neurons?
A) General visceral efferent neurons
B) Preganglionic neurons
C) Parasympathetic postganglionic neurons
D) Pharyngeal efferent neurons
Following a spinal cord injury suffered in a motor vehicle accident, a 22-year-old male
has lost fine motor function of his fingers and thumb but is still able to perform gross
motor movements of his hand and arm. Which of the following components of his white
matter has most likely been damaged?
A) The inner layer (archilayer)
B) The middle layer (paleolayer)
C) The outer layer (neolayer)
D) The reticular formation
Not realizing that its surface was hot, a woman has quickly withdrawn her hand from
the surface of a bowl that she was removing from a microwave. Which of the following
phenomena has facilitated the rapid movement of her hand in response to the painful
A) Her midbrain has rapidly responded to the nociceptive stimuli and induced arm
B) The withdrawal reflex of her peripheral nervous system has quickly mediated
between afferent and effector neurons.
C) The forebrain has mediated a protective spinal cord reflex.
D) Her CNS has enacted a protective response received by neurons that innervate her
A Tae Kwon Do (TKD) master is applying downward pressure just above the elbow
joint on an attacker who immediately collapses to the ground. The TKD master knows
the elbow joint can bend inward toward the body but not in the opposite direction.
Which of the following reflexes is applicable to this example?
D) Inverse myotatic
During a clinical assessment of a 68-year-old client who has suffered a head injury, a
neurologist suspects that a client has a sustained damage to her vagus (CN X) nerve.
Which of the following assessment findings is most likely to lead the physician to this
A) The client has difficulty swallowing and has had recent constipation and
hypoactive bowel sounds.
B) The client is unable to turn her head from side to side, and her tongue is flaccid.
C) The client has a unilateral facial droop, dry eyes, and decreased salivary
D) The client is unable to perform any fine motor movements of her tongue.
A 9-year-old girl has a diffuse collection of symptoms that are indicative of deficits in
endocrine and autonomic nervous system control. She also suffers from persistent fluid
and electrolyte imbalances. The nurse knows which of the following aspects of the
nervous system listed below would her health care providers focus their diagnostic
A) Her afferent and efferent cranial nerve function
B) Possible damage to her pons and medulla
C) Impaired function of her hypothalamus
D) Potential damage to the girl's cerebellum
A badly burned firefighter has been in an induced coma for 3 weeks. When he awakens,
he thanks his son for singing Happy Birthday to him a week earlier. Which part of the
brain is responsible for allowing him to hear and comprehend while comatose?
C) Corpus callosum
D) Basal ganglia
Which of the following statements best conveys an aspect of the role of cerebrospinal
A) It provides physical protection for the brain and ensures that leukocytes and
erythrocytes are evenly distributed in the CNS.
B) CSF cushions the brain and provides a near-water medium for diffusion of
C) CSF distributes plasma proteins throughout the superficial gray matter of the
D) It ensures that the high metabolic and oxygenation needs of the brain are met, as
well as absorbing physical shocks.
A 21-year-old male is brought to the ED following a night of partying in his fraternity.
His friends found him "asleep" and could not get him to respond. They cannot recall
how many alcoholic beverages he drank the night before. While educating a student
nurse and the roommates in the fraternity, the nurse begins by explaining that alcohol is
A) water-soluble compound that is easily absorbed by the gastric lining of the
B) very lipid soluble and rapidly crosses the blood-brain barrier.
C) able to reverse the transport of some substances to remove them from the brain.
D) very likely to cause sedation, and therefore the patient just needs to sleep it off.
A 45-year-old diabetic male is experiencing erectile dysfunction. If his erectile
dysfunction is caused by the nervous system, then the nurse can educate the patient that
the venous blood supply to the penis is controlled by
A) sacral parasympathetic fibers.
B) the hypothalamus.
C) the vagus nerve.
D) postganglionic sympathetic neurons
As you are walking in the park, a huge black Labrador (dog) runs up to you and places
his paws on your shoulders. Immediately your heart starts racing, you feel palpations
and anxiety, and your hands become a little shaky. The nurse knows that this response is
primarily caused by
A) fear of dogs that make you feel like your chest is being tightened and that you
have lost control of the situation.
B) increased levels of glucocorticoids by the adrenal glands that result in an increase
in epinephrine level.
C) response of the cholinergic muscarinic receptors on innervational targets of
D) stimulation of the release of β2-adrenergic receptors, which will open the airway
and increase oxygenation
While batting, a baseball player is struck in the ribs by a pitch. Place the following
components of the player's pain pathway in the chronological order as they contribute to
the player's sensation of pain. Use all the options.
B) Dorsal root ganglion body
C) Dorsal root ganglion periphery
E) Cerebral cortex
C B D A E
A student is feeling inside her backpack to find her mobile phone. There are a number
of other items in the bag other than the phone. The nurse knows that which of the
following terms best describes one's ability to sense of shape and size of an object in the
absence of visualization?
A woman with severe visual and auditory deficits is able to identify individuals by
running her fingers lightly over their face. Which of the following sources is most likely
to provide the input that allows for the woman's unique ability?
A) Pacinian corpuscles
B) Ruffini end organs
C) Meissner corpuscles
D) Free nerve endings
A mother is placing her child into the bathtub. The child immediately jumps out of the
tub and begins to cry, stating his feet are "burning." The nurse in the emergency
department knows that the child's response is based on which of the following
pathophysiological principles listed below?
A) Children react much quicker to contact with hot water than adults.
B) The tactile sensation occurs well in advance of the burning sensation. The local
withdrawal reflex reacts first.
C) It takes a long time for thermal signals to be processed before the brain can send a
signal through the spinal cord and tell the foot to withdraw.
D) The thermal processing center is located on the rapid conducting anterolateral
system on the same side of the brain as the injury.
If the patient's dorsal columns are not functioning, the nurse will observe which of the
following responses during neurotesting, where the nurse asks the patient to close his
eyes and then proceeds to touch corresponding parts of the body on each side
simultaneously with two sharp points?
A) Grimacing when body touched with sharp points
B) No response to two-point discrimination
C) Heightened proprioceptive response
D) Inability to identify which way his finger was moved during the test
Match the pain theory to the correct physiologic basis for the pain.
A. Specificity theory
B. Pattern theory
C. Gate control theory
D. Neuromatrix theory
1. Light touch applied to the skin would produce the sensation of touch through low-frequency firing of the receptor.
2. Repeated sweeping of a soft-bristled brush on the skin over or near a
painful area may result in pain reduction for several minutes.
3. Proposes that the brain contains a widely distributed neural network
that contains somatosensory, limbic, and thalamocortical components.
4. Describes how an acute injury is predicted to be but does not take into
account the person's feelings of how the pain feels to him or her.
A - 4
C - 2
D - 3
Following a knee injury, a football player is taking ibuprofen, a nonsteroidal
anti-inflammatory drug, for the control of pain. Which of the following drug actions is
most likely to result in diminished sensation of pain for the player?
A) The drug inhibits communication by third-order neurons between the thalamus
and cerebral cortex.
B) The drug inhibits the enzyme needed for prostaglandin synthesis.
C) The drug changes the postexcitatory potential in C fibers, leading to pain
D) The drug slows the conduction velocity of myelinated Aδ fibers in the pain
A 60-year-old male client with a long history of back pain has had little success with a
variety of analgesic regimens that his family physician has prescribed. He has recently
been diagnosed with a chronic pain disorder. Which of the following teaching points
about chronic pain would his physician most likely emphasize to the client?
A) "If your pain comes and goes, then we won't characterize it as chronic, and it will
require different treatment."
B) "You need to remind yourself that this is a purely physical phenomenon that
requires physical treatment."
C) "Our challenge is to bring you relief but still treat the underlying back problem
that your body is telling you about."
D) "These pain signals your body is sending likely serve no real, useful, or protective
A client in an acute medicine unit of a hospital with a diagnosis of small bowel
obstruction is complaining of intense, diffuse pain in her abdomen. Which of the
following physiological phenomena is most likely contributing to her complaint?
A) Nociceptive afferents are conducting the sensation of pain along the cranial and
spinal nerve pathways of the ANS.
B) First-order neurons are inappropriately signaling pain to the dorsal root ganglion.
C) The client is experiencing neuropathic pain.
D) The client's C fibers are conducting pain in the absence of damaged Aδ fibers.
A nurse on a postsurgical unit is providing care for a 76-year-old female client who is 2
days posthemiarthroplasty (hip replacement) and who states that her pain has been out
of control for the last several hours, though she is not exhibiting signs of pain. Which of
the following guidelines should the nurse use for short-term and long-term treatment of
the client's pain?
A) Reconciling the client's need for opioid analgesics with the risk of addiction to
B) Recognizing the client's pain is not likely self-limiting
C) Knowing that the client's self-report of pain is the most reliable indicator of pain
D) Realizing that chronic pain is likely to require innovative and complex treatment
A female client with bone metastases secondary to lung cancer is admitted for palliative
radiation treatment and pain control. The client is presently experiencing pain that she
rates at 9 out of 10. Which of the following nonpharmacological treatments is most
likely to be a useful and appropriate supplement to pharmacological analgesia at this
A) Teaching the client guided imagery and meditation
B) Initiating neurostimulation
C) Heat therapy
D) Relaxation and distraction
A 30-year-old female has suffered a third-degree burn to her hand after spilling hot oil
on it in a kitchen accident. Which of the following teaching points by a member of her
care team is most appropriate?
A) "Tell us as soon as you sense the beginnings of a round of pain, and we will start
B) "Opioids like morphine often cause constipation, but if this happens to you, we
will discontinue opioids and change to another family of medications."
C) "Opioids aren't without side effects, but we will take action to manage these side
effects, so you can continue getting these drugs."
D) "It's imperative that we prevent you from developing a tolerance for opioids while
you're getting treatment for your burn."
Which of the following would be an example of a child born with congenital
insensitivity to pain? A child who
A) develops pins-and-needles sensation after jumping out of a tree.
B) fell off a skate board and fractured ankle but did not feel any pain and just noted
swelling in foot.
C) skinned knee from a bike accident but only told parents when it started burning.
D) cries every time the wind blows because it hurts his face and ears.
Which of the following hospital patients is most likely to be diagnosed with complex
regional pain syndrome II (CRPS II)?
A) A man who has been admitted for treatment of continuing hyperalgesia after
sustaining a nerve injury in a motor vehicle accident
B) A woman who requires analgesia more than 3 months after an episode of shingles
C) A male client with diabetes mellitus who requires analgesia prior to each dressing
change on his chronic foot wound
D) A female who has seemingly unprovoked attacks of pain that are accompanied by
facial tics and spasms
A 58-year-old woman comes to the clinic for evaluation of a sharp, intermittent, severe,
stabbing facial pain that she describes as, "like an electric shock." The pain occurs only
on one side of her face; it seems to be triggered when she chews, brushes her teeth, or
sometimes when she merely touches her face. There is no numbness associated with the
pain. What is most likely causing her pain?
A) Postherpetic neuralgia
B) Migraine headache
C) Complex regional pain syndrome
D) Trigeminal neuralgia
A patient with diabetes mellitus has just undergone a right, below-the-knee amputation
following gangrene infection. A few days post-op, the patient confides in the nurse that
he still feels his right foot. Knowing the pathophysiologic principles behind this, the
A) administer a psychotropic medication to help the patient cope with the loss of his
B) explain that many amputees have this sensation and that one theory surmises that
the end of a regenerating nerve becomes trapped in the scar tissue of the
C) call the physician and ask him for an order for a psychological consult.
D) educate the patient that this area has an usually abnormal increase in sensitivity to
sensation but that it will go away with time.
A nurse practitioner is assessing a 7-year-old boy who has been brought to the clinic by
his mother, who is concerned about her son's increasingly frequent, severe headaches.
Which of the nurse's following questions is least likely to yield data that will allow for a
confirmation or ruling out of migraines as the cause of his problem?
A) "Does your son have a family history of migraines?"
B) "When your son has a headache, does he ever have nausea and vomiting as well?"
C) "Does your son have any food allergies that have been identified?"
D) "Is your son generally pain free during the intervals between headaches?"
A 25-year-old woman who works as an air-traffic controller presents with facial pain
and severe headache. She reports that she sometimes feels the pain in her neck or ear
and that it is particularly bad during very busy times at the airport. What is the most
A) Migraine headache
B) Cluster headache
C) Temporomandibular joint syndrome
D) Sinus headache
A 7-year-old child had an emergency appendectomy during the night. When trying to
assess his pain, the nurse should
A) ask him to rate his pain on a scale of 0 to 10, with 0 = no pain and 10 = worse pain
B) show him a scale with faces of actual children and have him point to the picture
that best describes how he is feeling.
C) consider his pulse and BP readings to be the most specific indicators of the
amount of pain he is experiencing.
D) try to distract him by blowing bubbles to minimize the use of opioids so that he
does not become addicted to the narcotic.
Staff at the care facility note that a woman has started complaining of back pain in
recent weeks and occasionally groans in pain. She has many comorbids that require
several prescription medications. The nurse knows that which of the following factors is
likely to complicate the clinician's assessment and treatment of the client's pain?
A) Neural pain pathways in the elderly differ from those in younger adults and are
less responsive to treatment.
B) Assessment and treatment are possibly complicated by the large number of drugs
that the client receives.
C) Accurate pain assessment is not possible in clients with significant cognitive
D) Frequent complaints of pain in older adults with dementia normally indicate
hyperalgesia rather than an underlying physical problem.
During a late night study session, a pathophysiology student reaches out to turn the page
of her textbook. Which of the following components of her nervous system contains the
highest level of control of her arm and hand action?
C) Basal ganglia
D) Frontal lobe
A patient is asked to stand with feet together, eyes open, and hands by the sides. Then
the patient is asked to close his eyes while the nurse observes for a full minute. What
assessment is the nurse performing?
A) Segmental reflex
D) Crossed-extensor reflex
A clinician is conducting an assessment of a male client suspected of having a disorder
of motor function. Which of the following assessment findings would suggest a possible
upper motor neuron (UMN) lesion?
A) The client has decreased deep tendon reflexes.
B) The client displays increased muscle tone.
C) The client's muscles appear atrophied.
D) The client displays weakness in the distal portions of his limbs.
The parents of a 3-year-old boy have brought him to a pediatrician for assessment of the
boy's late ambulation and frequent falls. Subsequent muscle biopsy has confirmed a
diagnosis of Duchenne muscular dystrophy. Which of the following teaching points
should the physician include when explaining the child's diagnosis to his parents?
A) "Your son's muscular dystrophy is a result of faulty connections between muscles
and the nerves that normally control them."
B) "He'll require intensive physical therapy as he grows up, and there's a good
chance that he will outgrow this problem as he develops."
C) "Your son will be prone to heart problems and decreased lung function because of
D) "His muscles will weaken and will visibly decrease in size relative to his body
size throughout his childhood."
The unique clinical presentation of a 3-month-old infant in the emergency department
leads the care team to suspect botulism. Which of the following assessment questions
posed to the parents is likely to be most useful in the differential diagnosis?
A) "Have you ever given your child any honey or honey-containing products?"
B) "Is there any family history of neuromuscular diseases?"
C) "Has your baby ever been directly exposed to any chemical cleaning products?"
D) "Is there any mold in your home that you know of?"
A 22-year-old female college student is shocked to receive a diagnosis of myasthenia
gravis. What are the etiology and most likely treatment for her health problem?
A) Autoimmune destruction of skeletal muscle cells; treatment with intensive
physical therapy and anabolic steroids
B) A decline in functioning acetylcholine receptors; treatment with corticosteroids
and intravenous immunoglobulins
C) Cerebellar lesions; surgical and immunosuppressive treatment
D) Excess acetylcholinesterase production; treatment with thymectomy
A toddler is displaying signs and symptoms of weakness and muscle atrophy. The
pediatric neurologist suspects it may be a lower motor neuron disease called spinal
muscular atrophy (SMA). The patient's family asks how he got this. The nurse will
A) "This could result from playing in soil and then ingesting bacteria that are now
attacking his motor neurons."
B) "No one really knows how this disease is formed. We just know that in time, he
may grow out of it."
C) "This is a degenerative disorder that tends to be inherited as an autosomal
D) "This is a segmental demyelination disorder that affects all nerve roots and
eventually all muscle groups as well."
Which of the following individuals is likely to have the best prognosis for recovery from
his or her insult to the peripheral nervous system? An adult
A) who developed rhabdomyolysis and ischemic injury after a tourniquet application.
B) who suffered a bone-depth laceration to the shoulder during a knife attack.
C) who had his forearm partially crushed by gears during an industrial accident.
D) who had nerves transected during surgery to remove a tumor from the mandible
A nurse working in a busy orthopedic clinic is asked to perform the Tinel sign on a
patient having problems in his hand/wrist. In order to test Tinel sign, the nurse should
give the patient which of the following directions?
A) "Stand tall, arms at your side, shut your eyes; place the tip of your index finger to
B) "Hold your wrist in complete flexion; keep it in this position for 60 seconds; how
does your hand feel after placing it in a neutral position?"
C) "I'm going to tap (percuss) over the median nerve in your wrist; tell me what
sensation you feel while I am doing this. Does the sensation stay in the wrist or go
D) "I'm going to tap this tuning fork and place it on the side of your thumb; then tell
me what you are feeling in your hand and wrist."
During a flu shot clinic, one of the questions the student nurse asks relates to whether
the patient has had Guillain-Barré syndrome in his medical history. The patient asks,
"What is that?" How should the nursing student reply?
A) "A type of paralysis that affects movement on both sides of the body that may
even involve the respiratory muscles"
B) "Swelling of your arm where you got your flu shot, and maybe your eyes and lips
had some swelling as well"
C) "A degenerative disease where you have trouble walking without the help of a
cane or walker"
D) "Influenza-like illness where you had fever and chills for 2 to 3 days after your
last flu shot"
A 60-year-old male office worker presents to a clinic complaining of new onset of lower
back pain that has been worsening over the last 6 weeks. The nurse knows which of the
following components of his physical assessment and history is most indicative of a
serious pathological process (like aortic aneurysm or cancer)?
A) His pain is relieved by extended bed rest.
B) When supine, passive rising of his leg to 90 degrees results in hamstring pain.
C) He has needed regular nonsteroidal anti-inflammatory drugs to control the pain in
D) His onset of pain has been gradual, and he has no prior history of lower back
A middle-aged woman is brought to the emergency room after a minor auto accident.
Her gait is staggering and unsteady; her speech is slurred; and she displays slight
nystagmus. The police officer who brought her in says she has not been drinking. Her
blood pressure is very high. Which of the following health problems most likely
underlies her present state?
A) Multiple sclerosis
B) Guillain-Barré syndrome
C) Myasthenia crisis
D) Cerebellar damage caused by a cerebrovascular accident
A 70-year-old male has been diagnosed with a stroke that resulted in an infarct to his
cerebellum. Which of the following clinical findings would be most closely associated
with cerebellar insult?
A) Flaccid loss of muscle tone
B) Difficulty in starting movement, stopping movement, and maintaining rhythmic
C) Tremor, rigidity, and bradykinesia
D) Unsteady gait and difficulty in speaking and swallowing
The geriatrician providing care for a 74-year-old man with diagnosis of Parkinson
disease has recently changed the client's medication regimen. What is the most likely
focus of the pharmacologic treatment of the man's health problem?
A) Maximizing acetylcholine release from synaptic vesicles at neuromuscular
B) Preventing demyelination of the efferent cerebellar pathways
C) Increasing the functional ability of the underactive dopaminergic system
D) Preventing axonal degradation of motor neurons
A 47-year-old woman was diagnosed with amyotrophic lateral sclerosis 3 years ago and
has experienced a progressive onset and severity of complications. She has been
admitted to a palliative care unit due to her poor prognosis? What assessments and
interventions should the nursing staff of the unit prioritize in their care?
A) Assessment and documentation of cognitive changes, including confusion and
B) Regular pain assessment and administration of opioid analgesics as needed
C) Assessment of swallowing ability and respiratory status
D) Cardiac monitoring and administration of inotropic medications
A 41-year-old woman was diagnosed with multiple sclerosis (MS) 7 years ago and is
sharing her story with members of an MS support group, many of whom have been
diagnosed recently. Which of the following aspects of her health problem should the
woman warn others to expect at some point in the progression of the disease? Select all
A) Debilitating fatigue
B) Progressive loss of visual acuity
C) Gradual development of a resting tremor
D) Loss of mental acuity
E) Shuffling gait
A B C
The nurse should anticipate she will need to teach the newly diagnosed multiple
sclerosis patient how to give injections if he is prescribed which medication to modify
the course of the disease by reducing exacerbations?
C) Interferon beta
After being thrown off the back of a bull, the bull rider can move his arms but has loss
of motor function in the lumbar and sacral segments of the spinal cord. This is usually
referred to as
D) anterior cord syndrome.
Several months ago, a 20-year-old male suffered a spinal cord injury brought about by a
snowboard trick gone wrong. The lasting effects of his injury include a flaccid bowel
and bladder and the inability to obtain an erection. While sensation has been completely
preserved in his legs and feet, his motor function is significantly impaired. What type of
incomplete spinal cord injury has the man most likely experienced?
A) Anterior cord syndrome
B) Brown-Séquard syndrome
C) Central cord syndrome
D) Conus medullaris syndrome
If the nurse suspects a spinal cord injury, the patient has developed autonomic
dysreflexia. Which of the following assessments would confirm this complication?
Select all that apply.
A) BP 180/98
B) Skin covered with macular rash
C) Pulse rate 49
D) Complains of a pounding headache
E) Cold, cyanotic lower legs
A C D
A nurse on a neurology unit is assessing a female brain-injured client. The client is
unresponsive to speech, and her pupils are dilated and do not react to light. She is
breathing regularly, but her respiratory rate is 45 breaths/minute. In response to a
noxious stimulus, her arms and legs extend rigidly. What is her level of impairment?
C) Brain death
D) Vegetative state
Following a motor vehicle accident 3 months prior, a 20-year-old female who has been
in a coma since her accident has now had her condition declared a persistent vegetative
state. How can her care providers most accurately explain an aspect of her situation to
A) "Your daughter has lost all her cognitive functions as well as all her basic
B) "Though she still goes through a cycle of sleeping and waking, her condition is
unlikely to change."
C) "If you or the care team notices any spontaneous eye opening, then we will
change our treatment plan."
D) "Your daughter's condition is an unfortunate combination with total loss of
consciousness but continuation of all other normal brain functions."
Which of the following individuals would most likely experience global ischemia to his
or her brain?
A) A male client who has just had an ischemic stroke confirmed by CT of his head
B) A woman who has been admitted to the emergency department with a suspected
C) A man who has entered cardiogenic shock following a severe myocardial
D) A woman who is being brought to hospital by ambulance following suspected
carbon monoxide poisoning related to a faulty portable heater
Which of the following diagnostic findings is likely to result in the most serious brain
A) Mean arterial pressure (MAP) that equals intracranial pressure (ICP)
B) Moderate decrease in brain tissue volume secondary to a brain tumor removal
C) Increased ICP accompanied by hyperventilation
D) High intracellular concentration of glutamate
Following a car accident of a male teenager who did not have his seatbelt on, he arrived
in the emergency department with a traumatic brain injury. He has severe cerebral
edema following emergent craniotomy. Throughout the night, the nurse has been
monitoring and reporting changes in his assessment. Which of the following
assessments correspond to a supratentorial herniation that has progressed to include
midbrain involvement? Select all that apply.
A) Clouding of consciousness
B) Decorticate posturing with painful stimulation
C) Pupils fixed at approximately 5 mm in diameter
D) Respiration rate of 40 breaths/minute
E) Decerebrate posturing following painful stimulation of the sternum
C D E
A patient in the intensive care unit who has a brain tumor has experienced a sharp
decline. The care team suspects that water and protein have crossed the blood-brain
barrier and been transferred from the vascular space into the client's interstitial space.
Which of the following diagnoses best captures this pathophysiology?
A) Focal hypoxia
B) Cytotoxic edema
D) Vasogenic edema
A baseball player was hit in the head with a bat during practice. In the emergency
department, the physician tells the family that he has a "coup" injury. How will the
nurse explain this to the family so they can understand?
A) "It's like squeezing an orange so tight that the juice runs out of the top."
B) "Your son has a huge laceration inside his brain where the bat hit his skull."
C) "Your son has a contusion of the brain at the site where the bat hit his head."
D) "When the bat hit his head, his neck jerked backward causing injury to the spine."
Following an injury where a child hit his head from a fall, the CT scan reveals a
contusion that the doctor classifies as a moderate brain injury. Which of the following
manifestations will the nurse more than likely assess on this child that support this
diagnosis? Select all that apply.
A) Coma with total paralysis
B) Periods of unconsciousness
C) Aphasia at times
D) Nuchal rigidity
E) Weakness or slight paralysis affecting one side of the body
B C E
Following a collision while mountain biking, the diagnostic workup of a 22-year-old
male has indicated the presence of an acute subdural hematoma. Which of the following
pathophysiological processes most likely underlies his diagnosis?
A) Blood has accumulated between the man's dura and subarachnoid space.
B) Vessels have burst between the client's skull and his dura.
C) A traumatic lesion in the frontal or temporal lobe has resulted in increased ICP.
D) Blood has displaced CSF in the ventricles as a consequence of his
A 20-year-old has been admitted to a rehabilitation center after hospital treatment for an
ischemic stroke. Which of the following aspects of the client's history would be
considered to have contributed to his stroke? Select all that apply. The client
A) is an African American male.
B) takes iron supplements for the treatment of chronic anemia.
C) blood pressure has historically been in the range of 150s/90s.
D) was diagnosed with type 2 diabetes 8 years ago.
E) takes corticosteroids for the treatment of rheumatoid arthritis.
A C D
A nurse at a long-term care facility provides care for an 85-year-old man who has had
recent transient ischemic attacks (TIAs). Which of the following statements best
identifies future complications associated with TIAs? TIAs
A) are an accumulation of small deficits that may eventually equal the effects of a
B) are a relatively benign sign that necessitates monitoring but not treatment.
C) resolve rapidly but may place the client at an increased risk for stroke.
D) are caused by small bleeds that can be a warning sign of an impending stroke.
Which of the following clients' signs and symptoms would allow a clinician to be most
justified in ruling out stroke as a cause? An adult
A) has had a gradual onset of weakness, headache, and visual disturbances over the
last 2 days.
B) has experienced a sudden loss of balance and slurred speech.
C) has vomited and complained of a severe headache.
D) states that his left arm and leg are numb, and gait is consequently unsteady.
The nurse knows that which of the following treatment plans listed below is most likely
to be prescribed after a computed tomography (CT) scan of the head reveals a new-onset
aneurysmal subarachnoid hemorrhage?
A) Stat administration of tissue plasminogen activator (tPA)
B) Administration of a diuretic such as mannitol to reduce cerebral edema and ICP
C) Monitoring in the ICU for signs and symptoms of cerebral insult
D) Craniotomy and clipping of the affected vessel
A college student has been experiencing frequent headaches that he describes as
throbbing and complaining of difficulty concentrating while studying. Upon cerebral
angiography, he is found to have an arteriovenous malformation. Which of the
following pathophysiological concepts is likely responsible for his symptoms?
A) Increased tissue perfusion at the site of the malformation
B) Hydrocephalus and protein in the cerebral spinal fluid
C) High pressure and local hemorrhage of the venous system
D) Localized ischemia with areas of necrosis noted on CT angiography
A 9-year-old boy has been brought to the emergency department by his father who is
concerned by his son's recent fever, stiff neck, pain, and nausea. Examination reveals a
petechial rash. Which of the following assessment questions by the emergency room
physician is most appropriate?
A) "Is your son currently taking any medications?"
B) "Has your son had any sinus or ear infections in the last little while?"
C) "Does your son have a history of cancer?"
D) "Was your son born with any problems that affect his bone marrow or blood?"
A teenager, exposed to West Nile virus a few weeks ago while camping with friends, is
admitted with headache, fever, and nuchal rigidity. The teenager is also displaying some
lethargy and disorientation. The nurse knows which of the following medical diagnoses
listed below may be associated with these clinical manifestations?
A) Rocky Mountain spotted fever
B) Lyme disease
D) Spinal infection
A 20-year-old has been diagnosed with an astrocytic brain tumor located in the brain
stem. Which of the following statements by the oncologist treating the client is most
A) "Your prognosis will depend on whether we can surgically resect your tumor."
B) "Our treatment plan will depend on whether your tumor is malignant or benign."
C) "This is likely a result of a combination of heredity and lifestyle."
D) "The major risk that you face is metastases to your lungs, liver, or bones."
A brain tumor causing clinical manifestations of headache, nausea, projectile vomiting,
and mental changes is likely located in which parts of the brain? Select all that apply.
C) Brain stem
D) Temporal lobe
E) Frontal lobe
A B E
Which of the following clients may be experiencing a sensory focal seizure that has sent
an abnormal cortical discharge to the autonomic nervous system (ANS)?
A) A 44-year old patient complaining of constant movement and pain in the legs that
gets worse when he tries to sleep
B) An 85-year-old patient experiencing drooping of the right side of the face and
numbness in the right arm and leg
C) A 56-year-old complaining of tingling sensations and has both an elevated pulse
D) A 22-year-old complaining of a stiff neck and achiness, along with some nausea
A 26-year-old female is resting after a one-minute episode during which she lost
consciousness while her muscles contracted and extremities extended. This was
followed by rhythmic contraction and relaxation of her extremities. On regaining
consciousness, she found herself to have been incontinent of urine. What has the woman
most likely experienced?
A) A myoclonic seizure
B) A tonic-clonic seizure
C) An absence seizure
D) A complex partial seizure
Which of the following statements most accurately characterizes an aspect of the
neurobiology of sleep?
A) The hypothalamus stimulates the anterior and posterior pituitary to modulate
B) The pituitary releases melatonin at predictable points in the circadian rhythm in
order to facilitate sleep.
C) The reticular formation, thalamus, and cerebral cortex interact to integrate the
D) Input from the retinas is interpreted by the cerebellum and contributes to
maintenance of the circadian rhythm.
A client with a diagnosis of insomnia is surprised when his physician explains to him
that his brain is still highly active during normal sleep. Which of the following
statements best captures the character of brain activity during sleep?
A) "Fewer neurons in your brain are firing when you're asleep, but they're more
synchronized than when you're awake."
B) "While you're obviously less aware of stimuli when you're asleep, your brain is
actually more active when you're asleep than when you're awake."
C) "There are four types of brain activity, and actually all of them occur at different
stages of sleep."
D) "Your brain alternates between periods of activity and periods of inactivity when
you're asleep, and these correspond to your eye movement."
Which of the following characteristics describe stage 2 non-REM sleep? Select all that
A) It occurs at the onset of sleep and lasts approximately 7 minutes.
B) During this stage, theta waves are primarily seen on EEG.
C) This stage is known as deep sleep where heart rate and BP are decreased.
D) This stage has interruptions of spindle activity that helps with integration of new
E) Muscles of the body are relaxed
Which of the following observations of a female client in a sleep lab would indicate the
clinicians that she is in REM sleep?
A) Rolling eye movements are observed, and she has moderate muscle activity.
B) Her motor movements are suppressed, and muscle tone is flaccid.
C) Delta waves are evident on her EEG, and the heart and respiration rates are
D) She has a low level of cerebral activity, and her EEG indicates low voltage and
The nurse knows that which of the following observations of a client during a sleep
study would be most likely considered a pathological finding?
A) The client experiences periods of apnea of 5 to 15 seconds in duration.
B) The client's intrinsic clock involves a sleep-wake cycle that is consistently 2 hours
longer than the actual length of a day.
C) The client's PCO2 level is increased, and his PO2 level decreased during deep
D) The client spends the majority of his sleeping hours in deep REM sleep.
Which of the following statements about over-the-counter (OTC) melatonin is accurate?
A) It has received the FDA approval for effectiveness as a sleep aid.
B) Long-term studies of melatonin conclude that it is nonaddicting.
C) It produces phase-shifting changes in the circadian rhythm.
D) Under strict clinical testing, potency and purity of melatonin have been shown to
When explaining an upcoming test, a polysomnography, the nurse should include which
of the following education related to equipment placements the patient will have placed
on his or her person during the sleep study? Select all that apply.
A) An ECG with lots of chest leads will monitor heart rate and rhythm.
B) A pulse oximeter placed on a finger is used to determine arterial oxygen
C) An EOG will be placed on the skin near the eye to record eye movements.
D) An EMG patch will be placed under the chin to record muscle movement.
E) An actigraph device will be placed on the wrists and ankles to measure body
A B C D
The parents of a 15-year-old boy are frustrated at his persistent inability to fall asleep at
a reasonable hour at night, as well as the extreme difficulty that they have rousing him
in the morning. While sleepy after waking, the son claims not to feel drowsy after lunch
or in the evening. What is the most likely classification of the boy's sleep disorder?
A) Delayed sleep phase syndrome (DSPS)
B) Non-24-hour sleep-wake syndrome
C) Advanced sleep phase syndrome (ASPS)
D) Chronic insomnia
A business traveler has just arrived in Japan from the United States. During a meeting
with his customer, he begins to experience yawning and stretching with an inability to
stay focused on the meeting. He also has some eye irritation and has developed a
headache. Based on these clinical manifestations, what diagnosis would most likely be
causing these symptoms?
A) Advanced sleep phase syndrome
B) Delayed sleep phase syndrome
C) Free-running sleep disorder
D) Time zone change syndrome
Nurses regularly rotate between day shift hours and overnight work hours. Following an
overnight shift, nurses frequently exhibit which of the following manifestations? Select
all that apply.
A) Unable to sleep for a long period of time during the day
B) Falling asleep while sitting in front of a computer charting during the night
C) Finding it difficult to sleep when they have a night off
D) Heightened alertness and reflexes on their drive home after work
E) Increased hunger and thirst in the middle of the night
A B C
An adult client is experiencing chronic insomnia related to a recent divorce and child
custody proceedings. The client is requesting a renewable prescription for "sleeping
pills." The nurse knows that which of the following interventions listed below will
provide the most beneficial treatment for this client?
A) Sedatives and hypnotic drugs will not provide safe relief of the client's health
B) The client is suffering from primary insomnia.
C) Melatonin supplements will be the safest and most effective long-term
D) Behavioral therapies and education regarding sleep hygiene will provide
assistance for the client.
A 17-year-old female is suspected of having narcolepsy. Which of the following aspects
of her medical history and sleep analysis would contribute to a confirmation of the
diagnosis? Select all that apply.
A) She repeatedly moves her large toe, ankle, and knee during sleep.
B) She complains of a powerful urge to move her legs when in bed at night.
C) She has frequently awakened unable to move or speak.
D) She believes that she experiences auditory hallucinations when she awakens.
E) Her sleep latency is normally around 1 hour.
While working for a neurologist who is assessing a patient experiencing restless legs
syndrome (RLS), the nurse should be prepared to answer the question about why the
patient needs to have his iron level drawn? The nurse response should include,
A) "Many of the drugs we give for RLS can cause drastic decreases in your iron
B) "Many patients with RLS also have an iron deficiency anemia as well."
C) "You just look a little pale, and so we want to make sure you have normal blood
D) "People with low iron levels do not have enough oxygen circulating to their legs."
A 57-year-old female has presented to a clinic exasperated by the effect that restless legs
syndrome is having on her sleep. The clinician has performed client teaching prior to
choosing a treatment plan. Which of the following responses by the client demonstrates
a sound understanding of her condition?
A) "Increasing my calcium intake is something simple that might help."
B) "Transcutaneous electrical nerve stimulation might be a treatment that can help
me avoid needing drugs for this."
C) "This could be something that I'm simply prone to genetically."
D) "I'll try to get more exercise, since there aren't really any effective medications for
restless legs syndrome."
Which of the following individuals would be expected to have the highest risk of
developing sleep apnea?
A) A woman with restless legs syndrome and chronic obstructive pulmonary disease
B) A male client with a diagnosis of unstable angina and peripheral arterial disease
C) A man with poorly controlled diabetes and hypertension
D) A female with chronic insomnia and atrial fibrillation that is treated with warfarin
Which of the following motor disorders of sleep can be life threatening?
B) Periodic limb movement disorder
C) Obstructive apnea
D) Restless legs syndrome
A 77-year-old woman is concerned because she has occasionally found her husband
sleepwalking in the last several weeks. What is her care provider's most appropriate
response to her concerns?
A) "This is not an uncommon event that often accompanies older age."
B) "I'll likely prescribe a benzodiazepine for this when I next see your husband."
C) "This is understandably upsetting for you, but as long as the environment is safe,
it's likely not significant."
D) "There may be something else going on with your husband such as delirium or a
problem with his medications.
The nurse is educating the new mother about the sleep patterns of a newborn. Which of
the following statements should she include in her education?
A) "Newborns usually sleep approximately 16 to 20 hours/day."
B) "Newborns generally sleep 6 to 8 hours/day and then are awake for 2 to 4 hours."
C) "Don't worry about them sleeping too long; they will wake up when they are
D) "Most newborns will have their days and nights mixed up."
A 5-year-old boy has starting sitting up in bed displaying signs of extreme anxiety. In
the morning, when the parents ask the boy about this, he has no recollection. What
should the nurse convey to the parents if this happens again?
A) Assist the boy in settling down without awakening him after an episode.
B) Watch him closely to see if he has any twitching or thrashing about.
C) Bring him back to the clinic if this keeps happening, so we can prescribe some
D) Shake him to wake him up, and then comfort him and put him back in bed.
A geriatrician is assessing an 84-year-old male recently admitted to a subacute medical
unit of a hospital for rehabilitation following a recent fall resulting in a hip contusion.
Which of the following aspects of the client's sleep history would the physician want to
follow up with education? Select all that apply.
A) "I make sure that I take a long nap each afternoon to compensate for my frequent
waking at night."
B) "I've got a bottle of diazepam at home, but I only take them once or twice a
C) "I try my best to get out for a walk after breakfast or after supper."
D) "I make it a rule not to drink any alcohol in the evening."
E) "Once my head hits the pillow, I am fast asleep."
Which of the following statements best captures the current understanding of the
etiology of mental illness?
A) The role of "nurture," experiences, and relationships has been largely disproven.
B) Mental illness can be attributed to organic brain changes and pathophysiological
C) Mental illness exists from the interplay of biologic factors and psychosocial
D) Current understanding of mental illness has shown that both biologic psychiatry
and psychosocial psychiatry are incorrect.
As part of a diagnostic workup of a 22-year-old male with recently diagnosed
schizophrenia, a neurologist wants to examine the levels of metabolic activity in
particular areas of the client's brain. Which of the following diagnostic procedures is the
physician most likely to order?
A) Computed tomography (CT)
B) Electroencephalography (EEG)
C) Magnetic resonance imaging (MRI)
D) Positron emission tomography (PET)
An adult, who was sexually abused as a child, has been displaying some stress. She
seems to complain of increasing medical problems when she is under more stress. The
nurse would classify this as an example of
A) vitamin deficiency.
B) the stress-diathesis theory.
C) mendelian research.
D) parental disassociation.
A toddler brought up in a chaotic, nonnurturing environment may suffer neurological
consequences if the parent does not achieve attachment with the child. The nurse knows
that which of the following nervous systems listed below is the first to respond to the
safety needs of the child?
A) Parasympathetic nervous system
B) Autonomic nervous system
C) Sympathetic nervous system
D) Limbic system
A student notices that at certain times during his studying for final exams, he is more
awake and his ability to think at a higher level is happening easier. The nurse knows that
this experience may be attributed to which of the following neurological functions?
A) Release of excitatory neurotransmitters such as glutamate
B) Release of GABA, an inhibitory neurotransmitter
C) Release of corticotrophin-releasing hormone
D) Heightened precortex processes
Parents of a 16-year-old male who has been behaving in increasingly bizarre ways in
recent months are distraught that he has been diagnosed with schizophrenia. Which of
the mother's following statements about her son's diagnosis demonstrates an accurate
understanding of the disease?
A) "It's disturbing to know that what I did when I was pregnant and the way we
raised him contributed to this."
B) "We are somewhat relieved that psychotherapy and a supportive environment will
resolve most of the positive and negative symptoms."
C) "This makes us even more worried about his younger brother and whether he
might develop schizophrenia."
D) "We're committed to lovingly but firmly convincing him that his delusions aren't
based in reality"
Which of the following is a negative symptom of schizophrenia?
C) Word salad
D) Affective flattening
During an acute phase of schizophrenia when the patient is experiencing hallucinations
and delusions, the nurse should anticipate that the physician will prescribe which of the
following medication categories listed below?
A) An antipsychotic like risperidone
B) A benzodiazepine like lorazepam
C) A cholinesterase inhibitor like donepezil
D) An opioid receptor antagonist like naltrexone
Which of the following clinical manifestations would the nurse assess in the patient with
bipolar disorder who is experiencing mania? Select all that apply.
A) Labile mood
B) Highly distractible
C) Inflated self-esteem
D) Despondent when asked questions
E) Excessive sleepiness
A B C
A 44-year-old female has been diagnosed with major depression. Which of the
following neuroimaging findings is most congruent with the woman's diagnosis?
A) Decreased brain activity in the pons and brain stem
B) Reduced activity and gray matter volume in the prefrontal cortex
C) Atrophy and decreased blood flow in the amygdala
D) Enlargement of the lateral and third ventricles and reduction in frontal and
After surviving an ischemic stroke, a 79-year-old male has demonstrated significant
changes in his emotional behavior, with his family noting that he now experiences wide
mood swings with exaggerated responses of empathy, anger, and sadness to situations.
His care team would most likely attribute these responses to ischemic changes in which
of the following brain structures?
A) The man's occipital lobe
B) The client's temporal lobe in general and Wernicke area in particular
C) The man's parietal lobe
D) The components of the client's limbic system
A 20-year-old college student has presented to his campus medical clinic because of his
unshakable despondency in recent months. He has been diagnosed with depression
based on his signs, symptoms, and history. The nurse knows that which of the following
treatments will likely be prescribed for this student?
A) Medication that inhibits the reuptake of serotonin in his presynaptic space
B) Drugs that inhibit the accumulation of cyclic adenosine monophosphate (cAMP)
C) Benzodiazepines such as clonazepam that modulate his GABA receptors.
D) Cholinesterase inhibitors that potentiate the action of available acetylcholine
E) Antipsychotics such as olanzapine
A psychiatrist is providing care for a 68-year-old female whose anxiety disorder is
significantly decreasing her quality of life. The nurse knows that the client will likely
benefit from which of the following pharmacologic therapies listed below?
A) A drug that influences gamma-aminobutyric acid (GABA) levels
B) An MAO inhibitor to increase the concentration of serotonin and norepinephrine
C) An antipsychotic medication that blocks dopamine receptors
D) A calcium channel-blocking agent
A woman has a long-running compulsion to repeatedly check if the doors of her home
are locked and has received a diagnosis of obsessive-compulsive disorder (OCD). Her
husband is at a loss to understand her irrational behavior and has sought help from a
therapist himself to deal with the effect that his wife's OCD is having on their daily
lives. Which of the husband's following statements would require correction?
A) "It's a relief to know that this can be changed if she continues with therapy and the
medications she's been prescribed."
B) "It's odd that someone like her and someone who's depressed might both respond
positively to the same drugs."
C) "I thought that this was something exceedingly rare, but I'm actually a bit relieved
to learn that others have this disorder as well."
D) "I'm glad that this is something that's a result of life stressors and is not associated
with any dysfunction in her brain."
A 50-year-old woman has experienced devastating consequences in her family and work
life as a result of her long-standing alcohol addiction. The levels and pathways of which
of the following neurotransmitters in her body are likely to differ from an individual
The nurse knows that the patient admitted for opioid addiction may benefit from which
of the following treatment modalities? Select all that apply.
A) Prescription for dolophine (Methadone)
B) Administration of a long-term pain reliever like duragesic (Fentanyl)
C) Involvement in a self-help group like Opioid Anonymous (an offshoot of
D) Intense exercise therapy under supervision of a body builder
E) Administering beta-blocking medications to minimize agoraphobia symptoms
Which of the following statements on the final diagnostic report regarding a
computerized tomography (CT) of the head with contrast would lead health care
providers to diagnose a patient with Alzheimer disease?
A) Large area of ischemia noted in the temporal lobe
B) Too numerous to count beta-amyloid (βA) deposits noted
C) Ninety percent obstruction in the posterior cerebral artery
D) Mural thrombus of vertebrobasilar arteries
A geriatrician and social worker are facilitating a family meeting for the children and
wife of a 79-year-old man who has been diagnosed with Alzheimer disease. What goal
of treatment will the clinicians most likely prioritize in their interactions with the
A) Modest reversal of brain plaque formation and improved symptomatology through
B) Surgical treatment of the underlying ischemic changes that underlie the
manifestations of the man's disease
C) The use of medications such as donepezil and rivastigmine to slow the
progression of the disease
D) Cognitive and behavioral therapy to counteract the agitation, depression, and
suspiciousness associated with Alzheimer disease
A 70-year-old woman has been brought to the emergency department by her daughter
who noticed the woman is weak, confused, and forgetful in recent months, along with
uncoordinated movements and visual disturbances at times. Which of the following
questions by the physician are most likely to address her probable diagnosis? Select all
A) "What medications is your mother currently taking?"
B) "Does your mother drink alcohol?"
C) "Does your mother have a history of stroke?"
D) "Is your mother facing significant stressors right now?"
E) "Is your mother lonely?"
Which of the following is the most likely course of Wernicke syndrome?
A) If the symptoms are correctly diagnosed, most of the effects of the disease can be
reversed through better nutrition and supplemental thiamine.
B) Wernicke syndrome is uniformly fatal, with death most often occurring within a
few months of onset.
C) Wernicke syndrome has no treatment, but drugs may be used to treat its associated
dyskinesias and behavioral disturbances.
D) The course of the disease is relentless, and most affected persons will die of
infection within 2 to 10 years.
During a procedure to remove impacted cerumen, the nurse should be assessing the
patient for which of the following most critical complications?
A) Excessive bleeding from the ear
B) Pain related to instillation of warm fluids to soften the cerumen
C) Symptomatic bradycardia from vagal nerve innervation
D) Respiratory distress related to fluid entering bronchiole tubes
A 60-year-old man has presented to his family physician following an earache that has
become progressively more painful in recent days. Following a history and examination
with an otoscope, the man has been diagnosed with otitis externa. Which of the
physician's following statements to the man is most accurate?
A) "You'll need to avoid getting any water in your ear until you finish your course of
B) "I'm going to instill some warm water into your ear to flush out debris and
C) "I'll prescribe some ear drops for you, and in the mean time, it's important not to
use ear swabs."
D) "This likely happened because your ears aren't draining like they should, but
antibiotics that you'll put in your ears will resolve this."
During descent, an airplane passenger is complaining that his "ears are plugged." What
aspect of the structure and function of the ear best accounts for the passenger's
A) The inner ear adjusts its volume in response to atmospheric pressure, increasing
during low pressure and decreasing in high pressure.
B) The eustachian tubes must remain patent to equalize pressure between the middle
ear and inner ear.
C) The tympanic membrane is selectively permeable in order to accommodate
pressure changes, and this capacity is often impaired during upper respiratory
D) Air must be able to flow between the middle ear and nasopharynx in order to
accommodate pressure changes
A 4-year-old boy has had otitis media with effusion (OME) for several weeks, and his
condition has recently progressed to acute otitis media (AOM). Which of the following
factors could have contributed to his AOM? Select all that apply.
A) Reflux of fluid from the boy's nose into his middle ear
B) A deficiency in immunoglobulin M
C) Accumulation of cerumen in the external acoustic meatus
D) Sensorineural deficits in the auditory control apparatus
E) Exposure to respiratory virus
Which of the following would be considered an abnormal finding when the nurse
practitioner uses an otoscope to look at a toddler's ear? The tympanic membrane is
B) "a shallow, oval cone pointing inward toward apex."
C) "small, whitish cord seen traversing the middle ear from back to front."
D) "yellow, amber discoloration noted."
When educating the parents of a child who has just had tympanostomy tube insertion,
the nurse should provide further teaching if the parents say which of the following
A) "I will call the physician if I see that the tube has come out."
B) "I will be looking for any drainage coming from the ears."
C) "I'm so glad that we can take the child swimming next week when we go on
D) "I'm so glad we had the child tested for allergies prior to having these tubes
A 29-year-old woman has been diagnosed with otosclerosis after several years of
progressive hearing loss. What pathophysiological process has characterized her
A) New spongy bone has been formed around her stapes and oval window.
B) Her incus, malleus, and stapes have become disconnected from her normal neural
C) Her temporal bone is experiencing unusually rapid resorption.
D) Her tympanic cavity is becoming filled with bone due to inappropriate
Distraught at the persistent ringing in his ears and his inability to alleviate it, a
50-year-old man has visited his health care provider. After diagnostic testing, no
objective cause (like impacted cerumen or vascular abnormality) was found. Given
these testing results, which of the following teaching points by the care provider is most
A) "This is most often the result of a psychological disturbance, and therapy is often
useful in relieving tinnitus."
B) "There are many drugs such as blood pressure pills, relaxants, heart medications,
and antihistamines that can cause tinnitus."
C) "A specialist can listen with a sensitive microphone to determine whether you are
actually hearing these sounds."
D) "There are some treatments like tinnitus retraining therapy, which includes the
extended use of low-noise generators, which has shown good success."
Following focal seizures that have damaged the dominant hemisphere of a patient's
auditory association cortex, the nurse may observe the patient displaying
A) receptive aphasia.
B) facial drooping.
C) auditory hallucinations.
D) delusions of grandeur.
Following a serious bout of bacterial meningitis, the parents of a 14-month-old has
noted the child is not responding to verbal commands. The nurse will explain the
pathophysiologic principle behind this by educating the patients by which of the
A) "This could be caused by the same organism that caused the meningitis, infecting
the child's tympanic membrane."
B) "This may be due to a loss of hair cells and damage to the auditory nerve."
C) "The ear and the lining of the brain that was infected are all connected together."
D) "It is common for meningitis to use up all the natural killer cells and therefore
increase the risk of having brain tumors develop."
Which of the following questions is most likely to be clinically useful in the differential
diagnosis of sensorineural versus conductive hearing loss?
A) "What medications do you currently take?"
B) "What effect is this hearing loss having on your quality of life?"
C) "Has your hearing loss developed quickly or more slowly?"
D) "Do you ever hear a persistent ringing in your ears?"
Otitis media (OM), which can occur in any age group, is the most common diagnosis
made by health care providers who care for children. Which bacterial pathogen causes
the largest proportion of cases that result in sensorineural hearing loss?
A) Streptococcus pneumoniae
B) Acoustic neuromas
C) Haemophilus influenzae
As part of a health promotion initiative, a public health nurse is meeting with a group of
older adult residents of an assisted living facility. Which of the following teaching
points about hearing loss in the elderly should the nurse include in the teaching session?
A) "It is actually a myth that seniors have worse and worse hearing as they age."
B) "Most hearing loss in older adults is the result of easily fixed problems, such as
impacted ear wax."
C) "Experts don't quite know what causes seniors to lose their hearing with age, but
drugs like aspirin can contribute to the problem."
D) "With older adults, the goal is to adjust lifestyle to accommodate diminished
hearing rather than trying to treat the hearing loss itself."
A stroke affecting which of the following areas of the brain would be most likely to
leave an individual's vestibular system intact and posture and balance maintained?
A) The brain stem
B) The thalamus
C) The temporal and parietal cortex
D) The limbic system of the cerebrum