Porth’s Pathophysiology Concepts of Altered Health States 9th Edition by Sheila Grossman-Carol Mattson Porth -Test Bank A+

Porth’s Pathophysiology  Concepts of Altered Health States 9th Edition by Sheila Grossman-Carol Mattson Porth -Test Bank A+

Porth’s Pathophysiology Concepts of Altered Health States 9th Edition by Sheila Grossman-Carol Mattson Porth -Test Bank A+

Porth’s Pathophysiology Concepts of Altered Health States 9th Edition by Sheila Grossman-Carol Mattson Porth -Test Bank A+

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 acid.”
The base pairings of DNA are such that adenine combines with thymine and guanine with cytosine. DNA also includes the sugar deoxyribose, while thymine and cytosine are considered the pyrimidine bases. The backbone of DNA includes both deoxyribose and phosphoric acid.

2.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 DNA surface.
D)Chromatin has maintained its stable structure during the DNA replication process.
To facilitate DNA replication and gene expression, chromatin must change its structure through the process of chromatin remodeling. Answers A, B, and C all denote normal genetic processes.

3.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.
Radiation exposure can cause the rearrangement of base pairs and resultant mutation. Endonucleases facilitate gene repair, and base pairs are not noted to swap positions from their respective sides of the helical strand. Redundant or degenerate genetic code is a normal trait.

4.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
RNA contains uracil instead of thymine. Formation of an adenine–uracil base pair is a normal event during assembly of messenger RNA.

5.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
Messenger RNA results from the process of breakage and recombination of DNA strands, which is known as transcription. Ribosomal RNA and transfer RNA are not involved in the process of transcription, and translation RNA is not a type of RNA.

6.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 below?
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.”
An international project was charged with developing genetic and physical maps that allowed the precise location of genes and with exploring technologies that would enable the sequencing of large amounts of DNA with high accuracy and low cost. It is still undergoing experimental testing. The function of a chaperone is to assist a newly synthesized polypeptide chain to attain a functional conformation as a new protein and then assist the protein’s arrival at the site in the cell where the protein carries out its function. Disruption of chaperoning mechanisms causes intracellular molecules to become denatured and insoluble. These denatured proteins tend to stick to one another, precipitate, and form inclusion bodies. The development of inclusion bodies is a common pathologic process in Parkinson’s. Gene repression is a process by which a regulatory gene acts to reduce or prevent gene expression.

7.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
Ans:B, D
Sonic hedgehog signaling is involved in many key developmental events at multiple times during embryogenesis. It participates in such diverse developmental steps as establishment of the left-to-right axis responsible for the rostral–caudal orientation of the nervous system, the separation of the brain into two cerebral hemispheres, right and left eye orientation, and the separation and development of the correct number of fingers and toes. The PAX family of transcription factors is responsible for the development of the eye. Transfer RNA acts as a carrier system for delivering the appropriate amino acids to the ribosomes. Bone formation leading to macrocephaly is caused by fibroblast growth factors.

8.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 accurate?
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.
Each of the 22 autosomes contains a homolog in the diploid cell. Autosomes are consistent from individual to individual with regard to appearance. Chromosomes retain their integrity in cell divisions, and sex determination is found in the 23rd chromosome.

9.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.”
The fact that the inactive X chromosome can be visible as a Barr body in a female allows for the extrapolation of the number of X chromosomes and thus the sex associated with the cells. Normal male cells lack Barr bodies, but they are present in females. The number of X chromosomes ultimately determines the sex of an individual.

10.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 Xq97?
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
In gene names, the first letter stands for the chromosome. The second indicates the arm of the chromosome, p (short) or q (long). The first numeral indicates the band, and the second one indicates the region within that band.

11.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.
The expression of two genes influencing the same phenotype, neither of which could have produced it alone, is an example of collaborative genes. Multiple alleles involve more than one gene at a particular locus affecting the same trait, and in epistasis, a gene masks the phenotypic effects of another nonallelic gene. Polygenic inheritance involves multiple genes each affecting a small influence on a genetic outcome.

12.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 meiosis.
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 chromosome 23.
When two chromosomes of the same number are inherited from one parent, the result can be the disorder of uniparental disomy. Answers A, C, and D all relate normal genetic processes.

13.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
A heterozygote with a dominant and a recessive allele will have the dominant phenotype. In Mary’s case, this will manifest itself in her brown eyes. A homozygote with two dominant alleles will have the dominant phenotype, so John also has brown eyes. To have blue eyes, the children would have to inherit two alleles for blue eyes. Because they will inherit, at most, one recessive allele for blue eyes, the children’s eyes will be brown.

14.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 recessive trait is expressed solely in a homozygous pairing, such as aa. A heterozygous pairing, in which there are two different alleles at a gene locus, will not express a recessive trait. Aa is an example of a heterozygous pairing.

15.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 chromosome.
D)The disorders likely share the same locus.
The genes causing these problems are likely proximate in the same chromosome. They would not likely be correlated if they were in different chromosomes, and the situation is not indicative of a cause-and-effect relationship. The genes are likely closely situated, but they could not share the same locus.

16.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
Postnatal linkage studies have been used in the diagnosis of hemochromatosis, which is closely linked to another HLA type. People with this disorder are unable to metabolize iron, and it accumulates in the liver and other organs. It cannot be diagnosed by conventional means until irreversible damage has been done. Dietary restriction of iron intake may be used to prevent organ damage.

17.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 further teaching?
A)“I know that linkage studies are rooted in the exchange of genes that occurs during meiosis.”
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 culture.”
In situ hybridization examines genes that do not express themselves in cell culture. The rationale for linkage studies exists in the genetic exchange of genes that occurs during meiosis, and gene dosage is a reflection of gene activity. Somatic cell hybridization necessitates the fact that hybrid cells degrade during division.

18.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 reproduced.
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.
The gene fragment that initiates and controls the production of several human proteins, including insulin, can be identified, separated, and reproduced by recombinant technology. Bacteria are used as a medium of reproduction, but they are not inherently capable of insulin production. Recombinant technology does not take place at the macrochromosomal level or at the micro- base pair level.

19.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 RNA sequences
B)Mother undergoing amniocentesis to diagnose a congenital adrenal hyperplasia
C)End-stage renal disease patient receiving erythropoietin to stimulate RBC production
D)Stroke victim receiving tissue plasminogen activator (tPA) to dissolve the thrombi
E)Couple going to an infertility clinic for diagnostic testing
Ans:C, D
Recombinant DNA technology has made it possible to produce proteins that have therapeutic properties. These include erythropoietin, which is used to stimulate RBC production, and tissue plasminogen activator (tPA), which is frequently administered to dissolve thrombi. In situ hybridization involves the use of specific sequences of DNA/RNA to locate genes. Prenatally, the autosomal recessive disorder congenital adrenal hyperplasia is diagnosed through amniocentesis.

20.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)
Pharmaceutical companies are using RNAi to identify disease-related drug targets. There is considerable interest in harnessing RNAi for therapeutic purposes, linking the treatment of HIV infection and hepatitis C.

1.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 chromosomes.
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 particular defect is not limited to any one specific locus. Single-gene disorders can be present on either autosomal or sex chromosomes, and they are primarily pediatric disorders. They can result from either existing or new mutations.

2.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 problem?
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 children.”
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.”
Autosomal dominant disorders are the result of a single mutant allele from an affected parent. There is a 50% risk of transmission, and unaffected people do not pass on the disorder. New genetic mutations may occur between generations.

3.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
The autosomal dominant disorder of Marfan syndrome is primarily manifested in the ocular, cardiovascular, and skeletal systems. These assessments would take priority over renal assessment.

4.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 single gene?
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
This patient exhibits several classic signs of Marfan syndrome, an autosomal dominant genetic disorder of the connective tissue. The other patients show signs of heart disease most likely caused by multiple factors.

5.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
Ans:B, D, E
NF-1 children have many problems, often not apparent until puberty. They tend to have large tumors that cause facial disfigurement, skeletal deformities such as scoliosis, and neurologic complications like learning disabilities, attention deficit disorders, and speech abnormalities.

6.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.”
NF-1 is associated with increased risk of malignant neoplasm. The lesions may be painful to the client, and the disease is an autosomal dominant disorder. Photosensitivity is not noted as a complication of type 1 neurofibromatosis.

7.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 affected mother.
C)They tend to have a more uniform symptomatology than autosomal dominant disorders.
D)The associated disorders are usually attributable to abnormalities in structural proteins.
Autosomal recessive disorders tend to have a more uniform symptomology than autosomal dominant disorders. Their incidence is dependent on both members of the gene pair being affected, and there is a one in four risk of an affected child with each pregnancy. The associated disorders are usually attributable to enzyme deficiencies.

8.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 son.
C)Genes of the boy’s Y chromosome can be affected in addition to the X chromosome.
D)The boy will pass the gene to all his future daughters who will become carriers.
When the affected son procreates, he transmits the defective gene to all of his daughters, who become carriers of the mutant gene. The most common pattern of inheritance for fragile X syndrome is an unaffected mother carrying one normal and one mutant allele. The Y chromosome is not affected.

9.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 accurately.”
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.”
Parents of a child with a multifactorial disorder have a higher chance of having the disorder recur with another child. Multifactorial disorders are less predictable than single-gene disorders and usually involve single organs. They can manifest themselves at any point in the life span.

10.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 Down syndrome.
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 material.
In centric fusion or robertsonian translocation, the break occurs near the centromere affecting the short arm in one chromosome (13 and 14 or 14 and 21 most commonly). The short fragment is usually lost during subsequent divisions. In this case, the person has only 45 chromosomes, but the amount of genetic material lost is small. Difficulty arises during meiosis. The chief clinical significance arises when the translocation carriers involve chromosome 21, which may produce a child with Down syndrome.

11.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
Congenital heart defects are associated with Down syndrome. Hepatomegaly, visual disturbances, and diabetes are not associated with Down syndrome.

12.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 the diagnosis?
A)Computed tomography of the head
C)Bone scan
D)Liver biopsy
Because of the association between congenital heart defects and Turner syndrome, an echocardiogram would most likely yield useful results. Turner syndrome is not associated with brain, skeletal, or liver involvement, and these tests would be less likely to provide useful insight.

13.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
Ans:A, B, C
Klinefelter syndrome is characterized by breast enlargement, sparse facial and body hair, small testes, and inability to produce sperm. At puberty, testes do not respond to stimulation from gonadotropins and undergo degeneration. This leads to a tall stature with abnormal body proportions. Although the intellect usually is normal, most 47, XXY males have some language impairment.

14.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 pregnancy.”
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 drug origins.”
D)“Your best option is to avoid using any drugs during your pregnancy.”
The period between days 15 and 60 is the most susceptible time during development. Vitamin A, not D, poses a particular risk, and only 2% to 3% of anomalies are attributable to drug and environmental factors. It is not necessary to categorically avoid medication but rather to use caution and heed FDA guidelines.

15.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 week
C)Isotretinoin (Accutane) for acne
D)Over-the-counter cetirizine (Zyrtec) for seasonal allergies
E)Tetracycline for acne
Ans:A, B, C, D
Several medications have been considered teratogenic. They include thalidomide, antimetabolites, warfarin, anticonvulsants, ethyl alcohol, cocaine, propyulthiouracil, tetracycline, and Accutane.

16.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
The infant’s signs and symptoms are characteristic of fetal alcohol syndrome. Folic acid deficiency is associated with neural tube defects, such as anencephaly and spina bifida. Cocaine use is associated with some of the same signs and symptoms as alcohol use but does not produce the characteristic facial abnormalities of fetal alcohol syndrome. Herpes simplex infection, although it is associated with microcephaly, hydrocephalus, defects of the eye, and hearing problems, also does not produce characteristic facial abnormalities.

17.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 endocarditis
C)A woman with chronic obstructive pulmonary syndrome and tuberculosis
D)A woman with diagnoses of insulin-dependent diabetes mellitus and peripheral neuropathy
Herpes is among the microorganisms most commonly responsible for fetal anomalies. Syphilis and tuberculosis infections are also implicated but to a lesser degree. The other listed diagnoses are not noted to be associated with fetal anomalies.

18.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 that apply.
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
Ans:A, B
Rubella remains endemic in many developing countries, however, where it is the major preventable cause of hearing impairment, blindness, and adverse neurodevelopmental outcomes. Facial deformities are common with fetal alcohol exposure. Short, flipper-like appendages are usually a result of thalidomide. Small outbreak of blisters around the infant’s eyes and mouth may be related to early development of herpes simplex.

19.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 useful information.”
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 group.”
D)“You need to be aware that if abnormalities are detected, termination is normally required.”
Prenatal screening provides a useful, but incomplete, picture of fetal health; umbilical sampling and amniocentesis are common methods of screening. Fetal tissue biopsy is a rarely used screening method, and a couple need not belong to a high-risk group to benefit from prenatal screening. Abnormalities do not usually necessitate termination.

20.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 correct position.
D)We will send a sample of amniotic fluid to a regional medical center to have DNA tests performed for any genetic abnormality.
Ans:A, C
PUBS is an invasive diagnostic procedure that involves the transcutaneous insertion of a needle through the uterine wall and into the umbilical artery. It is performed under ultrasound guidance and can be done any time after 16 weeks of gestation. Amniocentesis is the withdrawal of a sample of amniotic fluid for abnormal fetal screening as well as for chromosomal analysis. In chorionic villus sampling, the transcervical approach may be used (answer B).

1.An 81-year-old male patient who has a diagnosis of orthostatic hypotension is experiencing an episode of particularly low blood pressure. The man’s body has responded by increasing levels of angiotensin II in the bloodstream, a hormone that decreases the glomerular filtration rate in the kidneys and contributes to an increase in blood pressure. Which of the following phenomena best describes what has occurred?
A)Positive feedback
C)Negative feedback
his regulation and attempt to normalize blood pressure are an example of a negative feedback mechanism, in which physiological processes result in the maintenance of homeostasis. This process of normalization is not an example of positive feedback, and homeostasis is the goal rather than the process. This process involves adaptation, but negative feedback is a more precise characterization of the process.

2.A 61-year-old woman with a 40-pack-a year history of cigarette smoking and a diagnosis of chronic obstructive pulmonary disease (COPD) is experiencing an increase in arterial levels of CO2. This change has been detected in the client’s medulla, aortic bodies, and carotid bodies, stimulating the inspiratory center in the medulla oblongata, which has in turn caused the diaphragm to contract more forcefully and increase the respiratory rate. Which of the following terms best describes the role of the inspiratory center?
D)Feedback system
An integrator/comparator sums and compares incoming data with a set point. In this case, the inspiratory center has determined the need for increased respiration and stimulated the effector (diaphragm) to respond. The sensor role is in the client’s medulla, aortic bodies, and carotid bodies. This overall process is an example of a feedback system, but this does not characterize the particular role of the inspiratory center.

3.Which of the following physiological processes would be considered a positive feedback mechanism?
A)The release of antidiuretic hormone (ADH) from the posterior pituitary gland
B)Shivering in response to low environmental temperature
C)The platelet aggregation mechanism for closing minute ruptures in very small blood vessels during accidental injury
D)Increased production of white blood cells (WBCs) in response to a microorganism
The release of hormones during labor increases rather than mitigates a physiological system. Specifically, uterine contraction stimulates the production of other relevant hormones that cause temporary instability that culminates in childbirth. ADH counters the potential instability of insufficient hydration and/or blood pressure, much as shivering is an attempt to counter low temperature. Increased production of WBCs is a response to the potential homeostatic instability of an infectious process.

4.An occupational health officer who works in the context of a large police force is attempting to understand the role that stress may play in the health of his clients. According to Selye, which of the following statements best captures an aspect of the phenomenon of stress?
A)The alarm stage involves the release of cortisol and catecholamines.
B)The nature of a stress response is determined by the objective severity of the stressor.
C)Systemic illnesses can sometimes result from the resistance stage of stress response.
D)Periods of stress can be developmentally positive or negative.
Selye noted that stress can result in positive growth and development, and that stress is not unanimously detrimental to health and development. The alarm stage is associated with the release of cortisol and catecholamines, and a stress response is dependent on properties of the stressor and the individual’s conditioning; the severity is not objectively determined. Illness is often a consequence of the exhaustion stage.

5.An 80-year-old woman is slated for total hip replacement the following day and is experiencing a large amount of stress around her potential surgical outcomes. Which of the following is most likely to be uninvolved in the physiological response to her stress?
C)Adrenal cortex
D)Pituitary gland
The physiology of stress is associated with the hypothalamic–pituitary–adrenal axis. The parathyroid is not noted to be centrally involved in stress response.

6.A 45-year-old woman with a diagnosis of shingles is experiencing an acute onset of severe neuropathic pain. Which stage of Selye’s characterization of stress response is the woman most likely experiencing at the moment?
A)General adaptation syndrome (GAS)
The stimulation of the sympathetic nervous system, such as that during an episode of pain, characterizes the alarm stage. Resistance and exhaustion would likely follow, and GAS encompasses the whole continuum, not just this particular stage.

7.When explaining to a patient admitted for stress-induced supraventricular tachycardia, the nurse will incorporate which of the following statements about what happens in the body as a result of excess stress?
A)The primary role of the parasympathetic nervous system is to stimulate the vagus nerve.
B)The corticotropin-releasing factor stimulates the release of norepinephrine, which is responsible for “fight-or-flight” reaction to stress.
C)Endorphins are released from the brain every time we experience stress.
D)The pituitary gland is ultimately responsible for growth, metabolism, and maturation, all of which are important when the body is stressed.
Norepinephrine stimulates the secretion of CRF, and CRF stimulates the release of norepinephrine.

8.A student is attempting to trace the feedback cycle involved in the stress response. Which of the following neural structures is thought to be the central integrating site for the stress response?
B)Cerebral cortex
C)Locus ceruleus
D)Reticular formation
The locus ceruleus (LC) produces norepinephrine (NE), which initiates the autonomic syndrome known as “fight-or-flight.” The LC–NE system is connected to the hypothalamus, the limbic system, the hippocampus, and the cerebral cortex, which carry out the specific functions of the stress response.

9.A medical student is scheduled to undergo a clinical exam of his assessment skills under the supervision of the attending physician. As a result of this stressor, the student has high serum levels of glucocorticoid hormones such as cortisol. Which of the following statements best captures an aspect of the role of glucocorticoid hormones such as cortisol in the physiological response to stress?
A)Blood glucose levels are increased in anticipation of energy expenditure.
B)The immune system is bolstered in response to an impending threat.
C)Osteoblast activity and protein synthesis are suppressed in order to refocus energy.
D)Attention, arousal, and respiratory rate are increased in order to prepare for a response.
Cortisol suppresses osteoblast activity, hematopoiesis, protein and collagen synthesis, and immune responses with the goal of preserving energy for a fight-or-flight response. Blood glucose levels are stabilized, not increased, and the immune system is not prioritized in the stress response. Increased attention, arousal, and respiratory rate are the domain of the locus ceruleus–norepinephrine system.

10.The physician suspects that a patient under a lot of stress (stimulation of the sympathetic nervous system) is experiencing stress-induced release of vasopressin. Knowing the effects of an activated renin–angiotensin–aldosterone system (RAAS), the nurse should be assessing the patient for which primary nursing diagnosis?
A)Fluid volume excess related to retention of water in the body
B)Decreased cardiac output related to positional low blood pressure
C)Electrolyte imbalance related to retention of potassium
D)Nutritional imbalance related to vomiting and diarrhea
Activation of the RAAS results in an increase in vascular tone (elevation of BP) and renal retention of sodium and water. These changes contribute to the physiologic changes that occur with the stress response.

11.A patient who has been awaiting the results of a bone marrow biopsy for several days is experiencing stress as a result of uncertainty and the possibility that abnormal cell growth may be detected. A physical examination and blood work would most likely yield which of the following results?
A)Increased respiratory rate; increased levels of testosterone
B)Increased blood pressure and heart rate; increased antidiuretic hormone (ADH)
C)Pupil dilation; increased somatomedin C
D)Increased gastrointestinal motility; decreased thyroid-stimulating hormone
Increases in ADH, blood pressure, and heart rate are all associated with the stress response. Testosterone and somatomedin C are decreased in prolonged stress exposure. Gastrointestinal motility is decreased, not increased, during stress.

12.A female patient with a recent diagnosis of systemic lupus erythematosus (SLE) has been told that this is an autoimmune disease whereby the immune system is attacking the body’s cells and tissues. She knows that she has inflammation and tissue damage. She asks her nurse to explain “What cells in the body are triggering this inflammation?” The nurse responds that
A)mainly the adrenocorticoids like cortisone are responsible for all your inflammation.
B)mineralocorticoids like aldosterone usually begin the process of inflammation.
C)the lymphocytes that migrate to the brain, where they secrete cytokines, which trigger inflammation.
D)primarily, this acute stress reaction is associated with stimulation of the autonomic nervous system that causes stiffness in the joints.
Immune cells such as monocytes and lymphocytes can penetrate the blood–brain barrier and take up residence in the brain, where they secrete chemical messengers called cytokines that influence the stress response. This triggers inflammation.

13.An electrician who has been working 14 to 16 hour/day for several weeks in order to ensure the financial survival of his business presents to his family physician with complaints of persistent headaches and insomnia. His family physician attributes the physical complaints to the ongoing stress that the man has been undergoing. Which of the following factors has most likely contributed the most to the man’s response to this stressful period of his life?
A)The fact that he has previously had difficulty coping with stress
B)The fact that he is not physically active on a regular basis
C)The fact that his company is heavily in debt
D)The fact that he takes diuretic medication for his hypertension
An individual’s subjective response to stress is closely linked to previous experiences in dealing with stress and the presence or absence of coping mechanisms. Physical activity, subjective financial status, and diuretic medications would be less likely to have as great an effect.

14.A widow, who lost her husband a few weeks ago, is having trouble with insomnia and maintaining her normal sleep pattern. When visiting with her health care provider, he suggests a prescription to help regain her normal circadian pattern. This is based on the fact that interruption of sleep–wake cycles can cause which of the following problems? Select all that apply.
A)Hallucinations that may result in harm to the individual
B)Alterations in the immune function that can result in an infection
C)Excess of non–rapid eye movement (NREM) sleep that affects the creativity process
D)An increased risk in accidents when sleep deprived similar to those under the influence of alcohol
E)Restless leg syndrome due to inability to find a comfortable sleeping position
Ans:B, D
Sleep disorders and alterations in the sleep–wake cycle have been shown to alter immune function, normal hormone secretion, and physical and psychological functioning. However, hallucinations are not associated with sleep deprivations. With sleep disorders, the REM sleep cycle decreases, affecting creativity and forming associations. Restless leg syndrome is not associated with insomnia.

15.A patient with Parkinson disease has challenged himself to maintain mobility for longer than the physician predicts. He strives every day to walk 5 to 10 steps further than the day before. This phenomenon, being researched by social psychologists, is known as
Hardiness describes a personality characteristic that includes a sense of having control over the environment, a sense of having a purpose in life, and an ability to conceptualize stressors as a challenge rather than a threat.

16.Which of the following patients, when faced with acute stressful situations, would be considered at highest risk for becoming noncompliant with their medication regimen?
A)End-stage renal failure patient experiencing electrolyte imbalances related to having trouble sticking to his prescribed diet
B)Teenager whose period is late by 2 weeks and afraid to tell her parents
C)Paraplegic patient who forgot his pressure control device and has a small decubitus on his coccyx
D)New mother who is breast-feeding every 2 to 3 hours throughout the day and night.
For people with health problems (like ESRD patients), acute stress can interrupt compliance with medication regimens and exercise programs.

17.Based on the assessment results, which of the following hospital patients is most likely to be experiencing the effects of chronic stress?
A)A 32-year-old intravenous drug user with a diagnosis of endocarditis
B)A 45-year-old paraplegic who is experiencing delayed wound healing of an ischial ulcer
C)A 79-year-old woman who has a diagnosis of acute and chronic renal failure
D)A 63-year-old man with a diagnosis of chronic obstructive pulmonary disease (COPD) and heart failure (HF)
Delayed wound healing has been associated with chronic stress. Endocarditis, renal failure, COPD, and CHF are not noted as common effects of chronic stress.

18.A counseling psychologist is working with a 30-year-old female client who is experiencing the symptoms of posttraumatic stress disorder (PTSD) following a house fire several months prior. Which of the client’s following diagnostic results could most likely be interpreted as a manifestation of PTSD?
A)The client has decreased levels of cortisol.
B)The client has decreased levels of norepinephrine.
C)The client has decreased levels of angiotensin II.
D)The client has increased levels of growth hormones.
Decreased cortisol levels are a marker of PTSD and a differentiation from other subtypes of stress. Low levels of norepinephrine and angiotensin II would not accompany any common variant of stress response, and growth hormones are suppressed in response to stress.

19.During a period of stress, the nurse asks the patient to close his eyes and think of a calm, relaxing place where he can feel the wind blowing on his cheek and smell the salty air from the ocean. This is an example of utilizing which type of treatment for stress reduction?
B)Guided imagery
Guided imagery is another technique that is used to achieve relaxation. One method is scene visualization, in which the person is asked to sit back, close the eyes, and concentrate on a scene narrated by the therapist. Whenever possible, all five senses are involved.

20.A health care professional has recommended biofeedback to a client as a method of dealing with the high levels of stress in her life. Which of the following explanations best characterizes an aspect of biofeedback treatment?
A)“You might be asked to use an electrocardiogram as part of the therapy.”
B)“The goal is to make you aware of your physiological processes.”
C)“You’ll hopefully be able to gain control over skeletal muscle contractions.”
D)“You’ll become aware of the increased skin temperature that accompanies anxiety.”
The goal of biofeedback is to gain control over muscle contractions that accompany anxiety and tension. Electrocardiograms are not used in biofeedback, and control, rather than simply awareness, is the ultimate goal. Skin temperature decreases, not increases, with anxiety.
1.A 40-year-old patient had an annual physical exam with routine lab tests. The patient’s lab values include the following:

Hgb13.8 g/dL
BG fasting146 mg/dL
Triglycerides200 mg/dL
Total cholesterol231 mg/dL
LDL175 mg/dL
HDL30 mg/dL

The client was counseled to begin an exercise and diet regime for his health. After implementing healthy lifestyle changes 6 months ago, follow-up lab tests were drawn. Which of the following lab values indicate that the changes have been effective?

A)Triglycerides elevated to 210 mg/dL
B)LDL level decreased to 120 mg/dL
C)Hgb decreased to 12.3 g/dL
D)HDL increased to 35 mg/dL
Physical activity and exercise can help maintain weight control and CV fitness. Physical activity and exercise can lower LDL and increase HDL in persons with hyperlipidemia and have better regulation of blood glucose.

2.The primary care provider knows which of the following statements below will also benefit an adult client with a diagnosis of diabetes mellitus performing isometric exercise to help control his blood glucose levels?
A)A reduction in the amount of adipose tissue
B)An increase in his basal metabolic level
C)Increased efficiency in the use of oxygen by his muscles
D)Improved range of motion in his joints
Increased basal metabolic level is associated with isometric exercise; thus, better blood glucose control should improve. Loss of fat and increased oxygen use efficiency are associated with aerobic exercise. Range of motion of the joints results from stretching exercises.

3.The nurse knows a client who is a long-distance runner is able to respond effectively to the increased oxygen demands while running is due to which of the following statements listed below?
A)Sympathetic and parasympathetic stimulation associated with muscle metabolism mediate hypothalamic control of cardiovascular activity.
B)End products of muscle metabolism cause vagal stimulation of the medullary cardiovascular centers.
C)The insular and anterior cingulated cortex interacts with the hypothalamic centers, resulting in stimulation of the medullary cardiovascular centers.
D)Vasodilation results from increased oxygen demand of renal and gastrointestinal blood vessels.
The cardiovascular response to exercise is accomplished through the insular and anterior cingulated cortex interacting with the hypothalamic centers. This causes stimulation of the medullary cardiovascular centers and, ultimately, increased cardiac output. Answers A, B, and D do not represent physiological processes associated with exercise and increased oxygen demand.

4.The nurse knows the differences between slow-twitch fibers and fast-twitch muscle fibers. Slow-twitch fibers can be described by which of the following statements listed below? Select all that apply.
A)Perform lower-intensity work for prolonged periods.
B)Run long distances such as a marathon.
C)Have more efficient high-intensity workouts at the gym.
D)Utilize anaerobic metabolism as a source of energy.
E)Participate in a long-distance bike marathon.
Ans:A, B, E
Slow-twitch fibers, which are smaller than fast-twitch fibers, tend to produce less overall force but are more energy efficient and better suited biochemically to perform lower-intensity work for prolonged periods. Examples of exercises that use slow-twitch fibers are long-distance running, swimming, and cycling, where endurance is desired. Fast-twitch fibers are suited for high-intensity workouts and utilize anaerobic metabolism.

5.The nurse knows that an older adult client with a diagnosis of heart failure (HF) will most likely have compromised ability to perform activities of daily living upon discharge due to which of the following statements listed below?
A)The client’s musculature will be dependent on aerobic metabolism.
B)The client’s diagnosis will have contributed to cardiac muscle atrophy.
C)Intramuscular acidification will cause the client to be more easily fatigued.
D)The client will have experienced a shift toward the use of slow-twitch muscle fibers.
HF patients experience increased fatigability due to intramuscular acidification. He will be more dependent on anaerobic metabolism and has likely experienced skeletal muscle atrophy and a shift toward increased fast-twitch muscle fibers.

6.A young healthy adult helps lift a sofa to move it 25 feet. The nurse knows which of the following sources of energy listed below will the client most likely use in this process?
A)Amino acids
B)Stored ATP
C)Fatty acids
Stored ATP, creatine phosphate, and muscle glycogen are among the first energy sources utilized during aerobic exercise. Amino acids, fatty acids, and glucose are utilized after prolonged periods of exercise.

7.A nurse holds an exercise class for older adults and knows which of the following statements listed below by a class member requires clarification?
A)“Regular exercise can prevent the blood clots that cause many strokes.”
B)“Exercise can help you digest your food more quickly and efficiently.”
C)“Physical activity can help diabetics stabilize their blood sugars.”
D)“Exercise can help to keep down the salt levels that cause high blood pressure.”
Prolonged exercise contributes to dehydration and electrolyte imbalances. Low sodium levels should be maintained and replaced. High sodium intake is causative of hypertension. Answers A, B, and C all convey demonstrated benefits of physical exercise.

8.The nurse knows prior to an elderly adult starting a cardiac rehabilitation exercise program, he or she should review which of the following objective data noted below to ensure client safety?
A)Echocardiogram with measure of ejection fraction
B)Transesophageal echocardiogram to assess for aortic aneurysm
C)Treadmill ergometry to measure maximal oxygen consumption and heart rate
D)Blood gas analysis looking for any metabolic acidosis
Bicycle or treadmill ergometry measures heart rate, and other responses during exercise. Echocardiograms for EF, TE echocardiograms, and blood gas analysis are not performed in the rehab setting.

9.The nurse knows which of the following clients might experience fatigue relative to physiologic, psychological, and/or pathologic aspects? Select all that apply.
A)An elderly client on tranquilizers for sleep in the noisy nursing home environment
B)An adult who performs manual outdoor labor as a roofer
C)An adolescent client with a diagnosis of leukemia on a chemotherapy regimen
D)An adult client who teaches art to a small group of children in kindergarten
E)An adult technician working in a sleep lab where lights are dimmed and noise is kept at a minimum
Ans:A, B, C
The origin or cause of fatigue can be physiologic, psychological, pathologic, or unknown. It can be caused by environmental factors (excess noise, temperature extremes, and changes in weather); drug-related incidents (use of tranquilizers); treatment-related causes (chemotherapy); physical exertion (exercise); and psychological (monotony).

10.The nurse knows which of the following clients listed below is most likely to exhibit signs and symptoms of fatigue?
A)An obese client with a recurring flulike illness, muscle and joint pain, headaches, and sleep problems
B)A sleep-deprived new mother with headache, sore throat, and anemia
C)A woman with breast cancer, joint pain, lack of motivation, and inability to concentrate
D)A client with major depression, allergies, and history of type 1 diabetes
This client fulfills the diagnostic criteria for chronic fatigue syndrome (CFS). The other three clients fulfill some of these criteria but not enough to qualify for a diagnosis of CFS; they also have other conditions that may be causing their fatigue.

11.The nurse knows which of the following clients listed below is most likely to exhibit clinical manifestations of chronic fatigue?
A)A client with a diagnosis of multiple sclerosis who has been admitted to the hospital for exacerbation of the disease process
B)A hospitalized client with cellulitis to the lower leg
C)A hospitalized client with a history of paraplegia with a necrotic ischial wound
D)A hospitalized client admitted for a surgical repair of a rectovaginal fistula
Clients with neurological conditions such as multiple sclerosis are particularly likely to experience signs and symptoms associated with chronic fatigue. Infections, wounds, and surgery will cause fatigue but are less likely to contribute to the long-term presentation associated with chronic fatigue.

12.The nurse knows which of the following teaching statements listed below best captures an aspect of chronic fatigue syndrome (CFS)? There are no
A)treatments for CFS.
B)biological markers for the diagnosis of CFS.
C)established diagnostic criteria for CFS diagnosis.
D)objective assessment findings that appear with CFS.
There is a lack of recognized biological markers for CFS. While there are no cures presently, there are treatments that are aimed at alleviating symptoms. Diagnostic criteria have been established, and CFS can manifest with such objective findings as fever and lymph node and thyroid enlargement.

13.The nurse knows that an individual diagnosed with chronic fatigue syndrome (CFS) may complain of which of the following clinical manifestations listed below?
A)Achy joints and muscles and low-grade temperature over the past few weeks
B)Intense ringing in the ears when listening to music or watching TV
C)Excessive thirst and hunger, especially late at night
D)Excessive sleepiness and difficulty getting out of bed in the morning
Often CFS is preceded by a cold or flulike illness. Frequently, the person describes the illness as recurring, with periods of exacerbations and remissions. Ringing of the ears, excess thirst/hunger, and too much sleep are not usually associated with CFS.

14.The nurse is providing an education session regarding mobility for a client who has experienced a myocardial infarction 10 days ago. While reviewing for this educational session, the nurse should recognize that one of the following teaching points listed below would not be appropriate to discuss with this client?
A)The reduced circulation of an individual who has been on bed rest can cause blood clots to form in the legs.
B)The individual’s heart, which has been consistently lying down, actually has to work harder than when standing up.
C)An individual who has been on bed rest has a faster heart beat, and as a result, there can be an increase in his blood pressure.
D)An individual staying in bed can experience excess fluid volume that may result in pitting edema of the lower extremities.
Inactivity in a supine position is not associated with hypertension. Immobility, however, can be associated with clot formation, increased cardiac workload, and inappropriate fluid collection in the inferior vena cava.

15.The nurse knows which of the following client events listed below would most likely precede the development of a deep vein thrombosis and a pulmonary embolism following a period of bed rest?
A)Increased heart rate
B)Impaired venous return
C)Decreased intravascular volume
D)Compression of blood vessels
Venous stasis, decreased intravascular volume contributing to a hypercoagulable state, and pressure from the mattress that compresses the veins are elements of Virchow risk triad for thromboembolic disease. Increased heart rate is less likely to contribute to DVT.

16.A nurse is providing a client with preoperative education. The nurse knows which of the following teaching points should be included in the instruction regarding deep breathing and coughing exercises?
A)“When you are lying down, your body ends up needing more oxygen.”
B)“One needs to breathe deeper while lying flat in bed since this increases the work load on the diaphragm.”
C)“The resistance of your bed limits your lung expansion.”
D)“We want you to be able to use your abdominal muscles more, rather than depending on movement of your chest cage for breathing.”
The resistance of the bed in a supine position limits lung expansion and, ultimately, oxygenation. Inactivity does not increase oxygen demand, and patients tend to breathe more shallowly. The goal is to use abdominal muscles less and the chest cage more.

17.The nurse knows which of the following trends is associated with some of the common changes in lab values relative to prolonged bed rest?
A)Fluctuations in the level of parathyroid hormone (PTH)
B)Hypercalcemia due to calcium coalescence in renal calculi
C)Hypophosphatemia due to bone decalcification
D)Increased insulin levels due to reduced energy demand
Muscle atrophy, protein breakdown, and decalcification of bone produce hypercalcemia and hyperphosphatemia in clients on bed rest. PTH tends to increase and insulin tends to decrease.

18.The nurse knows when caring for an elderly client who has a fractured right hip and is unable to undergo surgery due to his COPD, all joints with the exception of the right hip joint will need full range of motion exercises to prevent
A)decubitus ulcer formation.
B)tears in the tendons.
C)contracture formation.
D)muscle cellulitis.
Muscle atrophy and disuse contribute to wasting and weakening of the muscle tissue along with the development of joint contractures. Decubitus is usually caused by staying in one position for a long time, which results in compression of tissues and loss of circulation to the area. Tears in tendons usually result from intense physical exercise. Cellulitis is an infection usually as a result in a break in the skin (e.g., injury, surgery, or insect bites).

19.The nurse is caring for a client who has been diagnosed with a cerebrovascular accident and as a result has been immobilized for 4 weeks. The nurse knows which of the following statements listed below is associated with the client’s immobilized state?
A)The client’s last bowel movement was 3 days prior.
B)The client’s blood glucose levels have been below normal.
C)The client is producing copious quantities of dilute urine.
D)The client is complaining of joint and muscle pain.
Immobilization is associated with reduced bowel motility and constipation. Other common findings include hyperglycemia and reduced urine output. Joint and muscle pain are not noted to be common findings related to immobility.

20.The nurse knows which of the following interventions listed below would be inappropriate for a client unable to bear weight following bilateral hip surgery?
A)Administer heparin as ordered to prevent deep vein thrombosis.
B)Ensure a minimum of sensory distractions.
C)Assess the safety of the client’s environment regularly.
D)Reposition the client every 2 hours.
Immobilized clients need sensory stimulation and diversion, not sensory deprivation. DVT prophylaxis, safety assessments, and repositioning would all be components of sound care for an immobilized client.

1.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 (IFN-a)
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.
IFNs are cytokines that primarily protect the host against viral infections and play a role in the modulation of the inflammatory response.

2.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.”
Because cytokines can mediate diverse effects due to their pleiotropic properties, they can have significant side effects. Cytokine production is brief, not constant, and production does not normally take place in granulocytes. Activation of a cytokine does not necessarily limit other similar cytokines, and additive effects are not uncommon.

3.The nurse knows that a drug in a category identified as a colony-stimulating factor (CSF) helps
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 formation.
C)stimulate the person’s immune system so that he or she can kill his or her own cancer cells.
D)stimulate bone marrow to produce large numbers of mature cells such as platelets and erythrocytes.
CSFs participate in hematopoiesis by stimulating bone marrow pluripotent stem and progenitor or precursor cells to produce large numbers of mature platelets, erythrocytes, lymphocytes, neutrophils, and monocytes.

4.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 illness
D)A client who has experienced rejection of a donor liver after transplantation
In a skinned knuckle, one of the body’s main innate defenses, the skin, is breached. The heat and swelling that accompany a breach in the skin are inflammatory responses, part of the body’s innate immune defenses. Allergies are an inappropriate adaptive response mediated by immunoglobulin E; antibody titers increase during illness in response to the infection; and transplanted organs are rejected because the organ is recognized as foreign. These are all aspects of specific, acquired immunity.

5.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 identified?
C)Colony-stimulating factors
D)Natural killer cells
Lymphocytes provide lifelong immunity and an antigen-specific response to harmful microorganisms. Neutrophils, macrophages, and natural killer cells do not provide this.

6.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 remain unaffected?
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
Specificity and memory are the defining characteristics of the adaptive immune system, and macrophages do not perform this particular role. Amplification of the immune response, destruction of virus-infected or tumor cells, and initiation of adaptive immunity are all components of macrophage activity.

7.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 cells.
B)Intraepithelial lymphocytes and natural killer cells possess specific, highly diverse receptors.
C)Pattern recognition receptors (PRRs) ensure that cells are correctly identified.
D)Leukocytes possess pathogen-associated molecular patterns (PAMPs)
PRRs recognize the structure of invaders and thus prevent activation by healthy somatic cells, though neither intraepithelial lymphocytes nor natural killer cells possess the high level of specification and diversity of receptors associated with the adaptive immune system. Host cells do not excrete inhibitory proteins, and PAMPs exist on pathogens, not on leukocytes.

8.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.”
Interferons can activate macrophages in the fight against viral invaders, but they are not noted to stimulate the action of natural killer cells. Answers A, B, and C all capture elements of the action of interferons.

9.Which of the following phenomena would be least likely to result in activation of the complement system?
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
Toll-like receptors are not associated with the complement system. The complement system may be activated by antibody recognition, mannose binding, or microbial protein recognition.

10.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 effector cells.
C)Effector cells orchestrate the immune response of regulatory cells toward an antigen.
D)Accessory cells such as macrophages are engulfed by regulatory cells, stimulating effector cells.
In the adaptive immune response, accessory cells present antigen epitopes to receptors, initiating the immune response of lymphocytes. Epitopes may combine to form haptens, and regulatory cells orchestrate effector cells. Regulatory cells do not engulf accessory cells.

11.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.
T and B lymphocytes are unique in that they are the only cells in the body capable of recognizing specific antigens present on the surfaces of microbial agents and other pathogens.

12.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 response.
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.
The lack of familiar MHC molecules will stimulate an immune response by effector cells in the absence of antirejection drugs. An innate immune response is not central to the response, but rather the adaptive immune system. Lack of known MHC molecules, not foreign antibodies, accounts for the immune response, and familiar MHC molecules will not be produced by the donor kidney cells.

13.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 (MHC) molecule
D)Cytokine stimulation of a T lymphocyte with macrophage or dendritic cell mediation
The stimulation of T cells requires the recognition of a foreign peptide bound to a self-major histocompatibility complex (MHC) molecule. Immunoglobulins do not play an antigen-presenting role, and foreign MHC molecules and cytokines do not stimulate the adaptive immune system.

14.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
Infants are born with IgG from transfer across the placenta, while IgA is found in colostrum. IgM is indicative of an in utero infection.

15.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.
Booster immunizations take advantage of the increase in antibodies that accompanies a repeat exposure. The primary immune response cannot be repeated, and antibodies survive beyond several months. Antigen receptors on CD4+ cells do not require multiple exposures.

16.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.”
Helper T cells are central to the regulation, proliferation, and stimulation of the immune system. They do not play a central role in antigen presentation or early hematopoiesis, however. Their absence would not result in incorrect antibody production, but rather insufficient or absent immune response.

17.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
Ans:A, B
The primary function of cytotoxic T (CD8) cells is to monitor the activity of all cells in the body and destroy any that threaten the integrity of the body. The CD8 cells destroy target cells by releasing cytolytic enzymes, toxic cytokines, and pore-forming molecules or by triggering membrane molecules and intercellular apoptosis. Removal of foreign material from lymph before it enters the blood is the function of lymph nodes.

18.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.
Lymphocytes and macrophages move slowly through the lymph nodes so that they can have adequate time to engulf microorganisms and interact with circulating antigens. The lymph nodes do not bring cells into the node to stop germs; do not bring cells to the throat to wall off strep; and do not enlarge the tonsil with immune cells.

19.Which of the following situations can best be characterized as an example of passive immunity?
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 year.
C)An 8-year-old girl recovers from a respiratory infection after intravenous antibiotic treatment.
D)A 6-week-old infant receives antibodies from his mother’s breast milk.
Passive immunity involves the transfer of antibodies from an outside source, such as those from breast milk. Immunization and recovery from illness involve active immunity.

20.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 because of
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.
Although this phenomenon is not well understood, increasing proportions of lymphocytes become unresponsive with age, and CD4+ T lymphocytes are the most severely affected. B lymphocytes recognize more antigens, not fewer, and expression of cytokines and their cellular receptors decreases.

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