Pathophysiology, 5e 5th Edition By Lee-Ellen C. Copstead-Test Bank

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Pathophysiology, 5e 5th Edition By Lee-Ellen C. Copstead-Test Bank

Chapter 2: Homeostasis and Adaptive Responses to Stressors

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MULTIPLE CHOICE

 

  1. Indicators that an individual is experiencing high stress include all the following except
a. tachycardia.
b. diaphoresis.
c. increased peripheral resistance.
d. pupil constriction.

 

 

ANS:  D

Pupils dilate during stress from the effects of catecholamines. Tachycardia, diaphoresis, and increased peripheral resistance are indicators of stress and also occur due to catecholamine release.

 

REF:   Pg. 18 | Pg. 21

 

  1. Which is not normally secreted in response to stress?
a. Norepinephrine
b. Cortisol
c. Epinephrine
d. Insulin

 

 

ANS:  D

Insulin secretion is impaired during stress to promote energy from increased blood glucose. Norepinephrine is secreted during stress as a mediator of stress and adaptation. Cortisol is secreted during stress as a mediator of stress and adaptation and stimulates gluconeogenesis in the liver to supply the body with glucose. Epinephrine is secreted during stress as a mediator of stress and adaptation and increases glycogenolysis and the release of glucose from the liver.

 

REF:   Pg. 17

 

  1. Selye’s three phases of the stress response include all the following except
a. allostasis.
b. resistance.
c. alarm.
d. exhaustion.

 

 

ANS:  A

Allostasis is defined as the ability to successfully adapt to challenges. Allostasis may/may not occur in response to stress. Alarm, resistance, and exhaustion are the three phases of the stress response as described by Selye in the general adaptation syndrome.

 

REF:   Pgs. 13-14

 

  1. Many of the responses to stress are attributed to activation of the sympathetic nervous system and are mediated by
a. norepinephrine.
b. cortisol.
c. glucagon.
d. ACTH.

 

 

ANS:  A

Norepinephrine is secreted in response to activation of the sympathetic nervous system during stress by the adrenal medulla. Cortisol is secreted by the adrenal cortex. Glucagon is secreted by the pancreas. ACTH is secreted by the pituitary gland.

 

REF:   Pg. 17

 

  1. The effects of excessive cortisol production include
a. immune suppression.
b. hypoglycemia.
c. anorexia.
d. inflammatory reactions.

 

 

ANS:  A

Cortisol suppresses immune function and inflammation and stimulates appetite. Cortisol leads to hyperglycemia by stimulating gluconeogenesis in the liver.

 

REF:   Pgs. 21-22

 

  1. All the following stress-induced hormones increase blood glucose except
a. aldosterone.
b. cortisol.
c. norepinephrine.
d. epinephrine.

 

 

ANS:  A

Aldosterone results in water and sodium retention and potassium loss in the urine. It does not affect blood glucose. Cortisol is a glucocorticoid secreted by the adrenal cortex. Cortisol stimulates gluconeogenesis in the liver, thus increasing blood glucose. Norepinephrine inhibits insulin secretion, thus increasing blood sugar. Epinephrine increases glucose release from the liver and inhibits insulin secretion, thus increasing blood glucose.

 

REF:   Pgs. 17-19

 

  1. Allostasis is best defined as
a. steady state.
b. a state of equilibrium, of balance within the organism.
c. the process by which the body heals following disease.
d. the overall process of adaptive change necessary to maintain survival and well-being.

 

 

ANS:  D

Allostasis refers to the overall process of adaptive change necessary to maintain survival and well-being.

 

REF:   Pg. 13

 

  1. The primary adaptive purpose of the substances produced in the alarm stage is
a. energy and repair.
b. invoke resting state.
c. produce exhaustion.
d. set a new baseline steady state.

 

 

ANS:  A

These resources are used for energy and as building blocks, especially the amino acids, for the later growth and repair of the organism. The substances do not produce a resting state. The substances can produce exhaustion if they continue, but that is not the adaptive purpose of these. Although a new baseline steady state may result from the stress response that is not the adaptive purpose of the substances produced during the alarm stage.

 

REF:   Pgs. 15-16

 

  1. Persistence of the alarm stage will ultimately result in
a. stress reduction.
b. permanent damage and death.
c. movement into the resistance stage.
d. exhaustion of the sympathetic nervous system.

 

 

ANS:  B

If the alarm stage were to persist, the body would soon suffer undue wear and tear and become subject to permanent damage and even death. Actions taken by the individual during the resistance stage lead to stress reduction. The resistance stage may or may not occur following the alarm stage, based on resource availability. The sympathetic nervous system will continue to function, resulting in continued release of stress hormones.

 

REF:   Pg. 16

 

  1. The effect of stress on the immune system
a. is unknown.
b. has been demonstrated to be non-existent in studies.
c. most often involves enhancement of the immune system.
d. may involve enhancement or impairment the immune system.

 

 

ANS:  D

Many studies demonstrate that long-term stress impairs the immune system, but many researchers identify that short-term stress may enhance the immune system.

 

REF:   Pg. 19

 

MULTIPLE RESPONSE

 

  1. Aldosterone may increase during stress, leading to (Select all that apply.)
a. decreased urinary output.
b. increased blood potassium.
c. increased sodium retention.
d. increased blood volume.
e. decreased blood pressure.

 

 

ANS:  A, C, D

Aldosterone increases water and sodium reabsorption and potassium excretion by the renal distal tubules and collecting ducts, thus leading to decreased urinary output, sodium retention in the body, and increased extracellular fluid volume. Because it leads to potassium excretion, aldosterone leads to decreased blood potassium.

 

REF:   Pg. 18

 

  1. Chronic activation of stress hormones can lead to (Select all that apply.)
a. cardiovascular disease.
b. depression.
c. impaired cognitive function.
d. autoimmune disease.
e. overactive immune function.

 

 

ANS:  A, B, C, D

Excessive cortisol levels promote hypertension, atherosclerosis, and the development of cardiovascular disease. Chronic overactive stress hormones may result in atrophy and death of brain cells. Elevated levels of stress hormones are found in individuals with depressive disorders. Chronic stress leads to immune function impairment, rather than overactive immune function, and has been implicated in autoimmune disorders.

 

REF:   Pgs. 21-22

 

  1. Events which occur during the alarm stage of the stress response include secretion of (Select all that apply.)
a. catecholamines.
b. ACTH.
c. glucocorticoids.
d. immune cytokines.
e. TSH.

 

 

ANS:  A, B, C, D

During the alarm stage, catecholamines (epinephrine, norepinephrine), ACTH, glucocorticoids, and immune cytokines are secreted. TSH is not secreted during the stress response.

 

REF:   Pgs. 14-15

Chapter 12: HIV Disease and AIDS

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MULTIPLE CHOICE

 

  1. An effective HIV vaccine is difficult to produce, primarily because
a. HIV is not immunogenic.
b. B cells are unable to produce antibodies against HIV.
c. HIV mutates frequently.
d. reverse transcriptase cleaves to the vaccine.

 

 

ANS:  C

The variability between strains of HIV and the frequency of mutations makes it difficult to produce a vaccine. HIV infection does not overwhelm the immune system, because it is an immune deficiency. Research is still being conducted to develop a vaccine. Researchers are testing cloned T-cells for response to new therapies. Reverse transcriptase is not proven to adhere to the vaccine.

 

REF:   Pg. 254

 

  1. An HIV-positive patient is hospitalized for evaluation of symptoms of progressive weakness, dyspnea, weight loss, and low-grade fever. A biopsy of lung tissue reveals Pneumocystis carinii pneumonia. This diagnosis means that the patient
a. has AIDS.
b. has less than 2 years to live.
c. cannot be treated.
d. was an intravenous drug abuser.

 

 

ANS:  A

Pneumocystis carinii pneumonia (PCP) is a common initial opportunistic infection in HIV and is an AIDS-defining diagnosis. A diagnosis of PCP is not associated with a life-expectancy of 2 years or less. PCP is treated with antibiotic therapy. PCP is a pulmonary manifestation of AIDS, which is not associated with intravenous drug abuse.

 

REF:   Pg. 247

 

  1. The immune system disorder associated with HIV is
a. an overactive B-cell system.
b. proliferation of immature WBCs (blasts).
c. deficiency of T-helper lymphocytes.
d. cancerous growth of lymph tissue.

 

 

ANS:  C

HIV has been identified as a type of retrovirus associated with a disorder of the T-helper lymphocytes. T-cells have an interaction with B-cells, but this relationship is not associated with HIV. Immature blast cells are not the deficiency that contributes to HIV. Cancerous growths of lymphatic tissue have not been found to be the source of HIV.

 

REF:   Pg. 233

 

  1. Which statement best describes the etiologic development and transmission of AIDS?
a. AIDS is caused by a retrovirus and transmitted through body fluids.
b. The mechanism of AIDS transmission is unknown; therefore, AIDS is considered to be highly contagious.
c. AIDS is an autoimmune disease triggered by a homosexual lifestyle.
d. AIDS is caused by a virus that can be transmitted only by sexual contact.

 

 

ANS:  A

AIDS is caused by an infection of HIV, which is proven to be transmitted through blood and body fluids. The mechanism of HIV transmission is known to be through blood and body fluid exposure, newborn infection from the mother, and unprotected sex with an infected partner. AIDS is not an autoimmune disease of the homosexual. HIV can be transmitted through unprotected intercourse. HIV is a virus that is transmitted through various routes, not sexual contact only.

 

REF:   Pgs. 236-237

 

  1. HIV infection of T-helper cells is facilitated by attachment of the viral envelope protein gp120 to
a. CD8 proteins on suppressor cells.
b. reverse transcriptase.
c. CD4 proteins on helper cells.
d. the macrophage lipid bilayer.

 

 

ANS:  C

The HIV envelope protein gp120 specifically binds to the CD4 receptor. The receptor cells of the CD4 cells are attracted to virus changes. Reverse transcriptase is not found to be attracted to the gp120 protein at this time. The macrophage lipid bilayer is not associated with the CD4 receptor.

 

REF:   Pg. 238

 

  1. Which HIV-positive patient should be given a diagnosis of AIDS?
a. One who has a CD4 count of 300/µl
b. One who has neuropathy
c. One who has Mycobacterium tuberculosis
d. One who has genital herpes

 

 

ANS:  C

AIDS is a syndrome that is expressed in many ways. If a person has a CD4 count less than 200/ml along with an opportunistic infection such as Mycobacterium tuberculosis, then the person is diagnosed with AIDS. A patient is not diagnosed with AIDS until the CD4 count is less than 200/ml. Neuropathy would possibly be a sign or symptom associated with an opportunistic infection, but is not used to diagnose AIDS. Genital herpes is not used to diagnose AIDS.

 

REF:   Pg. 243

 

  1. A patient receiving zidovudine and a protease inhibitor to manage HIV infection is found to have an undetectable viral load. This means that the
a. dosage of both agents should be reduced.
b. zidovudine can be discontinued.
c. therapy is effective.
d. HIV virus has been eliminated.

 

 

ANS:  C

Protease inhibitors attack at a phase of the viral cycle and are used in conjunction with zidovudine. The goal of treatment is to suppress the viral load. Dosage of both agents would not be reduced, because the undetectable viral load means that the therapy is effective. Zidovudine would not be discontinued, because it is deemed effective in creating an undetectable viral load in this case. The HIV virus has not been eliminated in the event of an undetectable viral load. Rather, HIV plasma is suppressed and disease progression delayed.

 

REF:   Pgs. 251-252

 

  1. Which statement about HIV testing is correct?
a. Any patient can be tested for HIV with or without their informed consent.
b. A negative HIV test ensures absence of infection.
c. The false-positive rate for HIV testing is zero.
d. Significant exposure to infected blood or body fluids requires HIV testing.

 

 

ANS:  D

After a significant exposure to HIV-infected blood or body fluids, health care workers should be treated according to post-exposure protocols. These include testing and possible prophylactic medications. Patients that need to be tested for HIV should always be given the opportunity to provide verbal or written consent according to state consent guidelines. Negative HIV tests are not always indicative of negative status. False negative tests can occur during the period before seroconversion. Initial HIV tests are highly sensitive but should always be confirmed with a Western blot test.

 

REF:   Pg. 237

 

  1. As of 2010, _____ individuals worldwide have been infected with HIV infection.
a. 100,000
b. 1 million
c. slightly less than 16 million
d. nearly 35 million

 

 

ANS:  D

An estimated 33.3 million people were living with HIV worldwide as of 2010. Infection rates are calculated per 100,000 population. In the United States, more than 1 million people have been diagnosed with HIV and AIDS. Of the total number of people infected, women comprise 15.9 million.

 

REF:   Pg. 233

 

  1. Which type of HIV virus causes most infections in the United States and Europe?
a. HIV type 1
b. HIV type 2
c. HIV type A
d. HIV type B

 

 

ANS:  A

HIV-1 is the organism of most cases in Central Africa, the United States, Europe, and Australia. HIV-2 is found in West Africa or in countries with socioeconomic ties to West Africa. HIV type A is a subtype currently in research. HIV type B is a strain in research phases.

 

REF:   Pg. 233

 

  1. HIV infection causes immunodeficiency because it
a. directly inhibits antibody production by B cells.
b. causes the destruction of T-helper cells.
c. causes excessive production of cytotoxic T cells.
d. blocks the ability of macrophages to present antigens.

 

 

ANS:  B

The hallmark of HIV infection is defective cell-mediated immunity, with a decrease in CD4 or T-helper lymphocytes. HIV infection does not directly inhibit the production of antibodies by B cells. There is not an excessive production of cytotoxic T cells with HIV infection. HIV infection does not block the ability of macrophages to produce antigens.

 

REF:   Pg. 233

 

  1. The clinical latency period after HIV infection is a time when no
a. viral replication occurs.
b. decline in CD4 lymphocytes occurs.
c. virus is detectable in the blood.
d. significant symptoms of immunodeficiency occur.

 

 

ANS:  D

This latency period is the time when no significant symptoms occur, although mild symptoms of lymphadenopathy, lack of energy, weight loss, frequent fevers, and sweats may occur. Viral reproduction occurs immediately after the latency period, and can last up to 18 months. A decline in the CD4 T-cell count is taking place during the time of rapid virus production. Seroconversion usually occurs between 3 weeks and 6 months after exposure.

 

REF:   Pgs. 242-243

 

  1. HIV replicates very quickly from the onset of infection. What is the major site of HIV replication?
a. Vaginal mucosa
b. Anal mucosa
c. GI tract
d. Respiratory tract

 

 

ANS:  C

HIV is primarily a mucosal disease that replicates very quickly from the onset of infection. The GI tract is the major site of HIV replication because the infection replicates quickly in the GI tract and overwhelms the body’s defenses. The vaginal mucosa, anal mucosa, and respiratory tract may be involved in HIV replication, but these are not the initial sites of infection.

 

REF:   Pg. 240

 

MULTIPLE RESPONSE

 

  1. Which drugs are used for the management of HIV? (Select all that apply.)
a. Nucleoside reverse transcriptase inhibitors
b. DNA polymerase inhibitors
c. Protease inhibitors
d. Nonnucleoside reverse transcriptase inhibitors
e. CD4 analogs

 

 

ANS:  A, C, D

Nucleoside reverse transcriptase inhibitors are used to prevent replication by preventing HIV DNA synthesis. Protease inhibitors attack a phase in the viral life cycle by inhibiting the enzyme protease. Nonnucleoside reverse transcriptase inhibitors are potent antiretrovirals. DNA polymerase inhibitors are not used in the management of HIV. CD4 analogs are nonexistent as a pharmacological agent.

 

REF:   Pg. 252

 

  1. Which modes of transmission occur with HIV infection? (Select all that apply.)
a. Sexual transmission
b. Parenteral transmission
c. Fomite transmission to intact skin
d. Perinatal transmission to fetus
e. Inhalant transmission

 

 

ANS:  A, B, D

Unprotected sex with infected partners is a proven method of HIV transmission. Needle and syringe sharing between intravenous drug users is a proven HIV transmission method. Transmission from an infected mother to her infant may occur in the intrauterine period or at the time of delivery. The risk of contracting HIV through the skin has only been found with a direct puncture. HIV is not known to be transmitted via aerosol routes.

 

REF:   Pg. 234

 

  1. Opportunistic infections are a hallmark of HIV and AIDS. Which infections are considered opportunistic? (Select all that apply.)
a. Acinetobacter
b. Cytomegalovirus
c. Candida albicans
d. Pneumocystis carinii
e. Clostridium difficile

 

 

ANS:  B, C, D, E

Cytomegalovirus is an opportunistic infection seen in AIDS. Candida albicans is an oropharyngeal manifestation seen in most patients with HIV. Pneumocystis carinii is a respiratory manifestation and a major source of morbidity and mortality in the AIDS patient. Clostridium difficile is a gastrointestinal manifestation of HIV. The GI tract is the major target organ in HIV infection, and malnutrition is the leading cause of death among AIDS patients worldwide. Acinetobacter is not typically associated with HIV and AIDS.

 

REF:   Pg. 244 | Pgs. 246-247

 

  1. A patient is infected with the retrovirus HIV. The patient may have contracted HIV as it was transmitted via (Select all that apply.)
a. saliva.
b. tears.
c. semen.
d. cervical secretions.
e. cerebrospinal fluid.

 

 

ANS:  C, D

HIV is transmitted three ways: sexual transmission via semen or vaginal and cervical secretions through homosexual or heterosexual intercourse; parenteral transmission via blood, blood products, or blood-contaminated needles or syringes; and perinatal transmission in utero, during delivery, or in breast milk. HIV is known to be present in but has not been shown to be transmitted via urine, saliva, tears, cerebrospinal fluid, amniotic fluid, and feces. HIV is not known to be transmitted via aerosol routes.

 

REF:   Pg. 234

 

  1. The HIV nurse educator teaches a newly diagnosed patient about HIV. The nurse educator tells the patient that in the United States, those at greatest risk of HIV infection include (Select all that apply.)
a. infants born to infected fathers.
b. heterosexual women.
c. homosexual men.
d. restaurant workers.
e. men over age 50.

 

 

ANS:  B, C

In the United States, those at greatest risk of HIV infection include: men who have sex with other men (MSM), also called homosexual men; intravenous drug users who share needles or syringes; sexual partners of those in high risk groups, particularly heterosexual women; and infants born to infected mothers. Infants born to infected mothers, not infected fathers, are at greatest risk of HIV infection. Restaurant workers are not at greater risk of HIV infection solely due to their working in the restaurant industry. Using public restrooms, swimming in public swimming pools, touching or hugging someone who is HIV-positive, and eating with community utensils or in restaurants are safe practices. Approximately 10% to 11% of all HIV cases involve people over age 50, but this does not comprise the highest-risk group.

 

REF:   Pg. 234

 

  1. A nurse who works in an assisted living facility is preparing to teach the residents about safe sex practices. What resident criteria should the nurse take into consideration when creating a teaching plan? (Select all that apply.)
a. Age
b. Ethnicity
c. Culture
d. Sexual preference
e. Mobility status

 

 

ANS:  A, B, C, D

It is important that education regarding safe sex practices be tailored to appropriate age groups, ethnicity, culture, and sexual preference. Mobility status is not a consideration when teaching about safe sex practices.

 

REF:   Pg. 236

 

  1. In which type of cells is the CD4 found? (Select all that apply.)
a. T cells
b. Microglial cells
c. Retinal cells
d. Cervical cells
e. Pacemaker cells

 

 

ANS:  A, B, C, D

The CD4 receptor is found on many types of cells, including T cells, microglial cells, monocyte-macrophages, follicular dendritic cells, immortalized B cells, retinal cells, Langerhans cells in the skin, bone marrow stem cells, cervical cells, bone marrow–derived circulating dendritic cells, and enterochromaffin cells in the colon, duodenum, and rectum.

 

REF:   Pgs. 238-239

 

  1. A patient presents to the clinic with flu-like symptoms and a rash. The nurse knows that the type of rash associated with HIV may include (Select all that apply.)
a. maculopapular.
b. vesicular.
c. impetigo.
d. urticarial.
e. psoriasis.

 

 

ANS:  A, B, D

The rash in HIV is not the same in every patient and may be maculopapular, vesicular, or urticarial. Impetigo and psoriasis are not rashes linked to HIV.

 

REF:   Pg. 242

 

  1. The CDC defines three CD4+ T cell categories of T cell ranges. Which values are correct? (Select all that apply.)
a. In category 1, the CD4+ T cell count is greater than or equal to 500/ml.
b. In category 1, the CD4+ T cell counts range from 200 to 499/ml.
c. In category 2, the CD4+ T cell counts range from 200 to 499/ml.
d. In category 3, the CD4+ T cell count is less than 200/ml.
e. In category 3, the CD4+ T cell count is less than 300/ml.

 

 

ANS:  A, C, D

In category 1, the CD4+ T cell count is greater than or equal to 500/ml. In category 2, the CD4+ T cell counts range from 200 to 499/ml. In category 3, the CD4+ T cell count is less than 200/ml.

 

REF:   Pg. 243

 

COMPLETION

 

  1. Cleaning dirty needles prior to use helps prevent the spread of HIV. When using bleach, the user must rinse out all the blood first and then fill the needle and syringe with full-strength bleach three times for ____ to ____ seconds.

 

ANS:

30; 60

After rinsing all the blood first, the user fills the needle and syringe with full-strength bleach at least three times for 30 to 60 seconds.

 

REF:   Pg. 236

Chapter 24: Fluid and Electrolyte Homeostasis and Imbalances

Test Bank

 

MULTIPLE CHOICE

 

  1. Osmoreceptors located in the hypothalamus control the release of
a. angiotensin.
b. atrial natriuretic peptide.
c. aldosterone.
d. vasopressin (antidiuretic hormone, ADH).

 

 

ANS:  D

Factors that increase secretion of ADH into the blood include increased osmolality of the blood, which is sensed by osmoreceptors in the hypothalamus. Release of angiotensin, atrial natriuretic peptide, and aldosterone is not controlled by osmoreceptors in the hypothalamus.

 

REF:   Pg. 522

 

  1. Decreased neuromuscular excitability is often the result of
a. hypercalcemia and hypermagnesemia.
b. hypomagnesemia and hyperkalemia.
c. hypocalcemia and hypokalemia.
d. hypernatremia and hypomagnesemia.

 

 

ANS:  A

Hypercalcemia and hypermagnesemia result in decreased neuromuscular excitability. Hypomagnesemia, hypocalcemia, and hypomagnesemia result in increased neuromuscular excitability.

 

REF:   Pgs. 531-533

 

  1. What is likely to lead to hyponatremia?
a. Insufficient ADH secretion
b. Excess aldosterone secretion
c. Administration of intravenous normal saline
d. Frequent nasogastric tube irrigation with water

 

 

ANS:  D

Sodium is lost from gastric secretions when nasogastric tubes are irrigated with water. The sodium diffuses into the irrigating water and is then lost when the aspirate is withdrawn. Excessive ADH would lead to hyponatremia by retention of water in the body, thus diluting the sodium. Excess aldosterone would increase serum sodium. Normal saline is an isotonic solution and will not alter the serum sodium.

 

REF:   Pgs. 524-525

 

  1. An increase in the resting membrane potential (hyperpolarized) is associated with
a. hypokalemia.
b. hyperkalemia.
c. hypocalcemia.
d. hypercalcemia.

 

 

ANS:  A

Hypokalemia increases the resting membrane potential. Hyperkalemia results in hypopolarization. Hypocalcemia and hypercalcemia do not affect the resting membrane potential.

 

REF:   Pg. 530

 

  1. Abnormalities in intracellular regulation of enzyme activity and cellular production of ATP are associated with
a. hyponatremia.
b. hypocalcemia.
c. hypophosphatemia.
d. hypokalemia.

 

 

ANS:  C

Phosphate is an important component of ATP. Hypophosphatemia results in decreased ATP to cells. Hyponatremia, hypocalcemia, and hypokalemia do not affect ATP production.

 

REF:   Pgs. 533-534

 

  1. The fraction of total body water (TBW) volume contained in the intracellular space in adults is
a. three-fourths.
b. two-thirds.
c. one-half.
d. one-third.

 

 

ANS:  B

Approximately two-thirds of TBW is contained inside the cells. Two-thirds, not three-fourths, of TBW is contained inside the cells. Two-thirds, not one-half, of TBW is contained inside the cells. One-third of the TBW is extracellular in adults.

 

REF:   Pg. 520

 

  1. What age group has a larger volume of extracellular fluid than intracellular fluid?
a. Infants
b. Adolescents
c. Young adults
d. Older adults

 

 

ANS:  A

Infants have a larger volume of extracellular fluid than intracellular fluid. Adolescents, young adults, and older adults have a larger volume of intracellular fluid than extracellular fluid.

 

REF:   Pg. 520

 

  1. Clinical manifestations of severe symptomatic hypophosphatemia are caused by
a. excess proteins.
b. renal damage.
c. deficiency of ATP.
d. hypocalcemia.

 

 

ANS:  C

Clinical manifestations of severe symptomatic hypophosphatemia are caused by a deficiency of ATP. Phosphate is an important component of ATP, which is the major source of energy for many cellular substances. Severe symptomatic hypophosphatemia does not cause excess protein accumulation, damage the kidneys, or cause hypocalcemia.

 

REF:   Pgs. 533-534

 

  1. A person who overuses magnesium-aluminum antacids for a long period of time is likely to develop
a. hypokalemia.
b. hyperkalemia.
c. hypophosphatemia.
d. hyperphosphatemia.

 

 

ANS:  C

Antacid overuse for a long time can cause hypophosphatemia by binding phosphate in the gastrointestinal tract and preventing its absorption. Magnesium-aluminum antacids do not cause hypokalemia, hyperkalemia, or hyperphosphatemia.

 

REF:   Pgs. 533-534

 

  1. The electrolyte that has a higher concentration in the extracellular fluid than in the intracellular fluid is _____ ions.
a. sodium
b. phosphate
c. magnesium
d. potassium

 

 

ANS:  A

Extracellular fluid has a higher sodium ion concentration than does intracellular fluid. Intracellular fluid has a higher phosphate, magnesium, and potassium ion concentration than does extracellular fluid.

 

REF:   Pg. 520

 

  1. A person who has hyperparathyroidism is likely to develop
a. hypokalemia.
b. hyperkalemia.
c. hypocalcemia.
d. hypercalcemia.

 

 

ANS:  D

A person who has hyperparathyroidism is likely to develop hypercalcemia, because parathyroid hormone causes calcium to come out of the bones and go to the ECF. Hypokalemia, hyperkalemia, and hypocalcemia are not the result of hyperparathyroidism.

 

REF:   Pg. 532

 

  1. The inward-pulling force of particles in the vascular fluid is called _____ pressure.
a. capillary hydrostatic
b. interstitial osmotic
c. capillary osmotic
d. interstitial hydrostatic

 

 

ANS:  C

Capillary osmotic pressure is the inward-pulling force of particles in the vascular fluid. Capillary hydrostatic pressure is an outward-pulling. The question pertains to vascular fluid rather than interstitial fluid. Interstitial hydrostatic pressure is an outward-pulling force.

 

REF:   Pg. 521

 

  1. How do clinical conditions that increase vascular permeability cause edema?
a. Through altering the negative charge on the capillary basement membrane, which enables excessive fluid to accumulate in the interstitial compartment
b. By causing movement of fluid from the vascular compartment into the intracellular compartment, which leads to cell swelling
c. Through leakage of vascular fluid into the interstitial fluid, which increases interstitial fluid hydrostatic pressure
d. By allowing plasma proteins to leak into the interstitial fluid, which draws in excess fluid by increasing the interstitial fluid osmotic pressure

 

 

ANS:  D

Clinical conditions that increase vascular permeability cause edema by allowing plasma proteins to leak into the interstitial fluid, which draws in excess fluid by increasing the interstitial fluid osmotic pressure. The capillary basement membrane does not change its charge with increased vascular permeability. Increased vascular permeability does not move water into the cells. Increasing the interstitial fluid osmotic pressure would not cause edema.

 

REF:   Pg. 527

 

  1. Which alterations can lead to edema?
a. Decreased capillary hydrostatic pressure
b. Increased capillary colloid osmotic pressure
c. Decreased lymphatic flow
d. Decreased capillary membrane permeability

 

 

ANS:  C

Lymphatic obstruction prevents the drainage of accumulated interstitial fluid and proteins, which can lead to severe edema. Decreased capillary hydrostatic pressure would push less fluid into the interstitial space. Increased capillary colloid osmotic pressure would remove fluid from the interstitial space. Decreased capillary membrane permeability would allow less fluid movement into the interstitial space.

 

REF:   Pg. 527

 

  1. The process responsible for distribution of fluid between the interstitial and intracellular compartments is
a. filtration.
b. osmosis.
c. active transport.
d. diffusion.

 

 

ANS:  B

Distribution of fluid between the interstitial and intracellular compartments occurs by the process of osmosis. Filtration is responsible for the distribution of fluid between the vascular and interstitial compartments. Active transport moves ions across membranes, but does not move water. Diffusion involves movement of particles, not movement of water.

 

REF:   Pg. 522

 

  1. Which electrolyte imbalances cause increased neuromuscular excitability?
a. Hypokalemia and hyperphosphatemia
b. Hyperkalemia and hypophosphatemia
c. Hypocalcemia and hypomagnesemia
d. Hypercalcemia and hypermagnesemia

 

 

ANS:  C

Hypocalcemia and hypomagnesemia both cause increased neuromuscular excitability.

Hypokalemia, hyperkalemia, hypophosphatemia, hypercalcemia, and hypermagnesemia do not cause increased neuromuscular excitability.

 

REF:   Pg. 532

 

  1. Excessive antidiuretic hormone (ADH) secretion can cause _____ concentration.
a. increased serum sodium
b. decreased serum sodium
c. increased serum potassium
d. decreased serum potassium

 

 

ANS:  B

Excessive ADH stimulates excessive water reabsorption by the kidneys, which dilutes the blood, thus decreasing the serum sodium concentration. Excessive ADH secretion does not cause increased serum sodium or potassium concentrations, or decreased serum potassium concentration.

 

REF:   Pg. 525 | Pg. 528

 

  1. Causes of hypomagnesemia include
a. hyperphosphatemia.
b. chronic alcoholism.
c. oliguric renal failure.
d. clinical dehydration.

 

 

ANS:  B

Hypomagnesemia is common with chronic alcoholism. Hyperphosphatemia causes hypocalcemia. Oliguric renal failure and clinical dehydration reduce magnesium excretion.

 

REF:   Pg. 532

 

  1. Signs and symptoms of clinical dehydration include
a. decreased urine output.
b. increased skin turgor.
c. increased blood pressure.
d. decreased heart rate.

 

 

ANS:  A

One clinical manifestation of dehydration is decreased urine output. Skin turgor and blood pressure decrease in clinical dehydration. Heart rate increases in clinical dehydration.

 

REF:   Pg. 526

 

  1. Hypernatremia may be caused by
a. decreased aldosterone secretion.
b. decreased antidiuretic hormone secretion.
c. compulsive water drinking.
d. excessive dietary potassium.

 

 

ANS:  B

Decreased antidiuretic hormone secretion (diabetes insipidus) prevents water reabsorption in the kidneys, which creates large volumes of dilute urine and causes hypernatremia. Aldosterone causes sodium and water retention. Compulsive water drinking that overwhelms the kidneys would dilute the blood, causing hyponatremia. Excessive dietary potassium would not affect the serum sodium concentration.

 

REF:   Pgs. 525-526

 

  1. Clinical manifestations of hyponatremia include
a. weak pulse, low blood pressure, and increased heart rate.
b. thirst, dry mucous membranes, and diarrhea.
c. confusion, lethargy, coma, and perhaps seizures.
d. cardiac dysrhythmias, paresthesias, and muscle weakness.

 

 

ANS:  C

Clinical manifestations of hyponatremia include confusion, lethargy, coma, and perhaps seizures, as they are manifestations of CNS dysfunction. Weak pulse, low blood pressure, and increased heart rate are characteristic of clinical dehydration. Hyponatremia does not cause thirst, dry mucous membranes, and diarrhea. Cardiac dysrhythmias, paresthesias, and muscle weakness are manifestations of electrolyte imbalances.

 

REF:   Pg. 525

 

  1. Clinical manifestations of extracellular fluid volume deficit include
a. weak pulse, low blood pressure, and increased heart rate.
b. thirst, dry mucous membranes, and diarrhea.
c. confusion, lethargy, coma, and perhaps seizures.
d. cardiac dysrhythmias, paresthesias, and muscle weakness.

 

 

ANS:  A

Clinical manifestations of extracellular fluid volume deficit include weak pulse, low blood pressure, and increased heart rate. Extracellular fluid volume deficit does not cause diarrhea. Confusion, lethargy, coma, and perhaps seizures are associated with osmolality imbalances such as hyponatremia. Cardiac dysrhythmias, paresthesias, and muscle weakness are manifestations of electrolyte imbalances.

 

REF:   Pg. 523

 

  1. The imbalance that occurs with oliguric renal failure is
a. metabolic alkalosis.
b. hyperkalemia.
c. hypokalemia.
d. hypophosphatemia.

 

 

ANS:  B

Oliguric renal failure decreases potassium excretion, which causes hyperkalemia. Oliguric renal failure decreases acid excretion and causes metabolic acidosis (not alkalosis). Oliguric renal failure does not cause hypokalemia or hypophosphatemia.

 

REF:   Pgs. 530-531

 

  1. A known cause of hypokalemia is
a. oliguric renal failure.
b. pancreatitis.
c. insulin overdose.
d. hyperparathyroidism.

 

 

ANS:  C

Insulin overdose causes hypokalemia by shifting potassium into cells. Oliguric renal failure decreases electrolyte excretion. Pancreatitis causes fat malabsorption, which binds calcium and magnesium, but not potassium, in the gastrointestinal tract. Hyperparathyroidism regulates calcium, not potassium.

 

REF:   Pg. 530

 

  1. Effects of hypernatremia on the central nervous system typically include
a. confusion.
b. excitation.
c. insomnia.
d. hallucinations.

 

 

ANS:  A

Hypernatremia causes osmotic shrinking of brain cells, which manifests as confusion or coma. Hypernatremia does not usually cause central nervous system excitation, insomnia, or hallucinations.

 

REF:   Pg. 525

 

  1. Total body water in older adults is
a. increased due to decreased adipose tissue and decreased bone mass.
b. increased due to decreased renal function and hormonal fluctuations.
c. decreased due to increased adipose tissue and decreased muscle mass.
d. decreased due to renal changes that cause diuresis with sodium excretion.

 

 

ANS:  C

Older adults have decreased total body water due to increased adipose tissue and decreased muscle mass. Older adults have increased adipose tissue. Hormonal fluctuations and diuresis with sodium excretion are not characteristic of older adults.

 

REF:   Pgs. 520-521

 

  1. Clinical manifestations of moderate to severe hypokalemia include
a. muscle spasms and rapid respirations.
b. muscle weakness and cardiac dysrhythmias.
c. confusion and irritability.
d. vomiting and diarrhea.

 

 

ANS:  B

Hypokalemia causes muscle weakness (or paralysis) and cardiac dysrhythmias. Hypokalemia does not cause muscle spasms and rapid respirations or confusion and irritability. Vomiting and diarrhea can cause hypokalemia, but they are not signs and symptoms of it.

 

REF:   Pg. 530

 

  1. Signs and symptoms of extracellular fluid volume excess include
a. tachycardia.
b. increased serum sodium concentration.
c. bounding pulse.
d. increased hematocrit.

 

 

ANS:  C

Bounding pulse is one of the signs of extracellular fluid volume excess. Tachycardia is one of the signs of extracellular fluid volume deficit. Increased serum sodium concentration is found in hypernatremia. Hematocrit can be decreased with extracellular fluid volume excess.

 

REF:   Pg. 524

 

  1. Hyperaldosteronism causes
a. ECV deficit and hyperkalemia.
b. ECV excess and hypokalemia.
c. hyponatremia and hyperkalemia.
d. excessive water reabsorption without affecting sodium concentration.

 

 

ANS:  B

Hyperaldosteronism causes excessive renal retention of sodium and water and excessive potassium excretion, which lead to ECV excess and hypokalemia. Hyperaldosteronism does not cause ECV deficit, hyperkalemia, hyponatremia, or excessive water reabsorption without affecting sodium concentration.

 

REF:   Pg. 530

 

  1. The person at highest risk for developing hypernatremia is a person who
a. self-administers a daily tap water enema to manage a partial bowel obstruction.
b. receives tube feedings because he or she is comatose after a stroke.
c. has ectopic production of ADH from small cell carcinoma of the lung.
d. is receiving IV 0.9% NaCl at a fast rate.

 

 

ANS:  B

Tube feedings are associated with hypernatremia due to intake of highly concentrated solution that causes the kidneys to excrete extra water to remove the solute load. Absorption of excessive water from daily tap water enemas would cause hyponatremia. Uncontrolled secretion of ADH causes renal retention of water that leads to hyponatremia. An IV solution of 0.9% NaCl (normal saline) is isotonic.

 

REF:   Pg. 525

 

  1. When a parent asks how they will know if their 2-month-old baby, who is throwing up and has frequent diarrhea, is dehydrated, the nurse’s best response is
a. “Clinical dehydration is the combination of extracellular fluid volume deficit and hypernatremia, so those are the diagnostic criteria.”
b. “If he doesn’t wet his diaper all afternoon and his neck veins look flat when he is lying down, then he is probably dehydrated.”
c. “If he sleeps more than usual and acts tired when he is awake, then he is probably dehydrated.”
d. “If the soft spot on the top of his head feels sunken in and his mouth is dry between his cheek and his gums, then he is probably dehydrated.”

 

 

ANS:  D

Checking whether the head feels sunken and the mouth is dry between check and gums are useful assessments of ECV deficit in an infant, which is an important part of clinical dehydration. It is true that clinical dehydration is the combination of extracellular fluid volume deficit and hypernatremia, but it does not address the question Mr. Worry is asking. Although the diaper information provides a useful assessment, neck veins are not a reliable assessment in an infant. Drowsiness and fatigue are not reliable assessments for dehydration.

 

REF:   Pg. 526

 

  1. A patient who reports an intestinal fistula also reports feeling “weak and dizzy” when she stands. While taking her blood pressure she becomes temporarily unresponsive but quickly regains consciousness when put into a supine position. What nursing interventions will the nurse implement before calling the physician?
a. Sit her up again, with proper support, so you can have an accurate upright blood pressure and heart rate to report.
b. Give her a drink of water or juice, talk with her to calm her down, and ask if she slept well last night.
c. Give her water or juice and some salty crackers and ask if she has had any diarrhea or vomiting.
d. Assess small vein filling time, look for ankle edema, and ask if she had any fluid to drink yet today.

 

 

ANS:  C

Her substantial systolic postural blood pressure decrease with tachycardia and syncope when upright are indicators of ECV deficit and she needs salt and water. Your questions will provide information for her physician regarding the origin of the ECV deficit. She fainted the first time when she sat upright and is likely to faint again, given her upright systolic pressure of 77 mm Hg. She needs salt and water to increase her ECV and sleep quality is not directly related to ECV deficit. Ankle edema is a sign of ECV excess.

 

REF:   Pgs. 523-524

 

  1. What form of oral rehydration, bottled water or salty broth, is best suited for a patient who is demonstrating signs of clinical dehydration?
a. Bottled water, because he is so weak that he might choke on the fluid when he swallows, and water would be less damaging to the lungs than salty soup
b. Bottled water, because it will rehydrate his cells
c. Salty soup, because he needs nutrition as well as fluid
d. Salty soup, because it will provide some sodium to help hold the fluid in his blood vessels and interstitial fluid

 

 

ANS:  D

This man has indicators of clinical dehydration and he needs salt to hold the water in his extracellular compartment. Replacing fluids and electrolytes is more important than meeting his nutritional needs now.

 

REF:   Pg. 526

 

  1. A patient diagnosed with chronic compensated heart failure reports that, “My feet swell if I eat salt but I don’t understand why” The nurse’s best response is
a. “Salt holds water in your blood and makes more pressure against your blood vessels, so fluid leaks out into your tissues and makes them swell.”
b. “Gravity makes more pressure down by your feet than up at the top of your body, so more fluid leaks into your tissues at your feet and they swell.”
c. “Salt makes your blood vessels relax and the blood does not flow as fast, so some of it leaks into your tissues and makes swelling.”
d. “Salt binds to the proteins in your blood and changes the osmotic pressure so more fluid can leak out and stay in the tissues, causing swelling.”

 

 

ANS:  A

Salt holds water in the ECV, thus increasing capillary hydrostatic pressure. Gravity leads to feet swelling, but it does not explain what the patient is asking. Salt does not cause vasodilation, nor does it bind to blood proteins and change osmotic pressure.

 

REF:   Pgs. 527-528

 

  1. A patient, who is 8 months pregnant, has developed eclampsia and is receiving intravenous magnesium sulfate to prevent seizures. To determine if her infusion rate is too high, you should regularly
a. check the patellar reflex; if it becomes more and more hyperactive, her infusion rate probably is too high and she is at risk for respiratory depression or cardiac arrest.
b. check the patellar reflex; if it becomes weak or absent, her infusion rate probably is too high and she is at risk for respiratory depression or cardiac arrest.
c. check the patellar reflex; if it stays the same, her infusion rate probably is too high and she is at risk for respiratory depression or cardiac arrest.
d. check for seizure activity; if no seizures occur, her infusion rate is correct.

 

 

ANS:  B

Hypermagnesemia causes decreased neuromuscular excitability and testing the patellar reflex can detect that. Hypermagnesemia causes decreased, not increased, neuromuscular excitability. If the patellar reflex stays the same, the infusion rate is therapeutic. Watching for seizure activity is a dangerous course of action. Hypermagnesemia can cause respiratory depression and cardiac arrest, so you need to assess for its development.

 

REF:   Pgs. 532-533

 

  1. A patient has a positive Chvostek sign. The nurse interprets this as a sign of
a. hypercalcemia.
b. hypermagnesemia.
c. decreased neuromuscular excitability.
d. increased neuromuscular excitability.

 

 

ANS:  D

Positive Chvostek sign indicates increased neuromuscular excitability, which can be caused by hypocalcemia, hypomagnesemia, or other factors. Hypercalcemia and hypermagnesemia cause decreased neuromuscular excitability and do not cause positive Chvostek sign. Hypokalemia and hyperkalemia cause skeletal muscle weakness and do not cause positive Chvostek sign.

 

REF:   Pg. 532

 

  1. Which change in a patient’s assessment has the greatest urgency?
a. Serum potassium concentration is decreasing; abdominal distention, but denies any difficulty breathing
b. Serum calcium concentration is decreasing; reports constipation; is alert and denies any discomfort
c. Serum calcium concentration is increasing; reports constipation; is alert and denies any discomfort
d. Serum potassium concentration is increasing; has developed cardiac dysrhythmias, but denies any difficulty breathing

 

 

ANS:  D

Cardiac dysrhythmias from hyperkalemia need rapid attention to prevent potentially life-threatening consequences and are therefore the highest priority for reporting. Certainly you will want to report this symptomatic hypokalemia, but it is not your most urgent priority, because abdominal distention is not rapidly life threatening and you have another patient with cardiac dysrhythmias, which can be life threatening. Certainly you will want to report this hypocalcemia, but it is not your most urgent priority, because there are no signs and symptoms of hypocalcemia and you have another patient with cardiac dysrhythmias, which can be life threatening. Certainly you will want to report this symptomatic hypercalcemia, but it is not your most urgent priority, because constipation is not rapidly life threatening and you have another patient with cardiac dysrhythmias, which can be life threatening.

 

REF:   Pgs. 530-531

 

  1. How is a patient hospitalized with a malignant tumor that secretes parathyroid hormone–related peptide monitored for the resulting electrolyte imbalance?
a. Serum calcium, Chvostek and Trousseau signs
b. Serum calcium, bowel function, level of consciousness
c. Serum potassium, Chvostek and Trousseau signs
d. Serum potassium, bowel function, level of consciousness

 

 

ANS:  B

Parathyroid hormone increases the plasma calcium concentration, and constipation and lethargy are manifestations of hypercalcemia. Parathyroid hormone increases the plasma calcium concentration, but these are signs of increased neuromuscular excitability, which occurs with hypocalcemia. Parathyroid hormone affects plasma concentration of calcium, not potassium.

 

REF:   Pg. 532

 

  1. The nurse provides teaching regarding dietary intake of potassium to avoid an electrolyte imbalance when a patient
a. takes very large doses of vitamin D to supplement during chemotherapy for breast cancer.
b. has fatty stools from taking an OTC weight loss product that decreases absorption of fat.
c. has chronic heart failure that is treated with diuretics.
d. experiences anorexia and chronic oliguric renal failure.

 

 

ANS:  C

Chronic heart failure causes increased secretion of aldosterone, which often causes hypokalemia by increasing renal excretion of potassium; most diuretics used to treat heart failure also increase renal excretion of potassium. Vitamin D and malabsorption of fat decreases absorption of calcium, not potassium. Chronic oliguric renal failure causes decreased excretion of potassium. An anorexic patient with chronic oliguric renal failure should not increase dietary potassium.

 

REF:   Pg. 530

 

  1. What is the most likely explanation for a diagnosis of hypernatremia in an elderly patient receiving tube feeding?
a. Too much sodium in the feedings
b. Excess of feedings
c. Inadequate water intake
d. Kidney failure

 

 

ANS:  C

Failure to provide adequate water when a patient is receiving tube feedings could result in hypernatremia. The feedings may have too much sodium, or the patient may be receiving too much feeding solution, but most likely the patient is not receiving enough water. Kidney failure is most likely not the cause of hypernatremia in this patient.

 

REF:   Pg. 525

 

  1. Manifestations from sodium imbalances occur primarily due to
a. cellular fluid shifts.
b. vascular collapse.
c. hyperosmolarity.
d. hypervolemia.

 

 

ANS:  A

Sodium imbalances alter osmolality of fluid compartment leading to osmosis of water from the hypo-osmolar compartment to the hyperosmolar compartment. In brain cells, this leads to swelling or shrinkage of cells, and associated manifestations.

 

REF:   Pg. 522

Chapter 36: Gastrointestinal Disorders

Test Bank

 

MULTIPLE CHOICE

 

  1. Which symptom suggests the presence of a hiatal hernia?
a. Nausea
b. Heartburn
c. Diarrhea
d. Abdominal cramps

 

 

ANS:  B

Individuals with hiatal hernia are predisposed to GERD and may experience symptoms such as heartburn, chest pain, and dysphagia. Nausea and abdominal cramps are not symptoms that suggest hiatal hernia. Hiatal hernia is not manifested by diarrhea.

 

REF:   Pg. 725

 

  1. Proton pump inhibitors may be used in the management of peptic ulcer disease to
a. increase gastric motility.
b. inhibit secretion of pepsinogen.
c. neutralize gastric acid.
d. decrease hydrochloric acid (HCl) secretion.

 

 

ANS:  D

Proton pump inhibitors are generally given to block acid secretion in individuals with peptic ulcer disease. The major treatment objectives for PUD are to encourage healing of the injured mucosa by reducing gastric acidity and to prevent recurrence. Proton pump inhibitors are not used to inhibit secretion of pepsinogen. Gastric acid is not neutralized by the use of proton pump inhibitors.

 

REF:   Pg. 728

 

  1. Epigastric pain that is relieved by food is suggestive of
a. pancreatitis.
b. cardiac angina.
c. gastric ulcer.
d. dysphagia.

 

 

ANS:  C

Manifestations of peptic ulcer disease include epigastric burning pain that is usually relieved by the intake of food (especially dairy products) or antacids. Pancreatitis is not manifested by epigastric pain. Epigastric pain is not a symptom of cardiac angina. Dysphagia is not associated with epigastric pain relieved by food.

 

REF:   Pg. 728

 

  1. The most common cause of mechanical bowel obstruction is
a. volvulus.
b. intussusception.
c. adhesions.
d. fecal impaction.

 

 

ANS:  C

The most frequent contributing factors for bowel obstructions are previous abdominal surgery with adhesions and congenital abnormalities of the bowel. Intestinal obstruction can be caused by volvulus. Intussusception can be related to bowel obstruction, but the most common cause is surgical adhesions. Mechanical bowel obstructions can be related to fecal impaction, but this is not the most common cause.

 

REF:   Pg. 732

 

  1. Acute right lower quadrant pain associated with rebound tenderness and systemic signs of inflammation are indicative of
a. appendicitis.
b. peritonitis.
c. cholecystitis.
d. gastritis.

 

 

ANS:  A

The earliest manifestation of appendicitis is generalized periumbilical pain accompanied by nausea and, occasionally, diarrhea. The pain is often described as “migrating” or localizing to the lower right abdomen (McBurney’s point) due to distention of the serosa from inflammatory edema, at which time fever usually manifests. Acute localized pain with rebound tenderness is not associated with peritonitis. Cholecystitis is not manifested by lower quadrant pain. Gastritis is not associated with symptoms of right lower quadrant pain and systemic inflammation.

 

REF:   Pg. 730

 

  1. A silent abdomen 3 hours after bowel surgery most likely indicates
a. peritonitis.
b. mechanical bowel obstruction.
c. perforated bowel.
d. functional bowel obstruction.

 

 

ANS:  D

Functional obstruction or ileus refers to the loss of propulsive ability by the bowel and may occur after abdominal surgery or in association with hypokalemia, peritonitis, severe trauma, spinal fractures, ureteral distention, and the administration of medications such as narcotics. Peritonitis may be associated with functional obstruction. Mechanical obstructions are due to adhesions, hernia, tumors, impacted feces, volvulus (twisting), or intussusception (telescoping). Perforated bowel is a rare condition sometimes associated with Crohn disease.

 

REF:   Pg. 732

 

  1. Ulcerative colitis is commonly associated with
a. bloody diarrhea.
b. malabsorption of nutrients.
c. fistula formation between loops of bowel.
d. inflammation and scarring of the submucosal layer of the bowel.

 

 

ANS:  A

Ulcerative colitis (inflammation and ulceration of the colon and rectal mucosa) is manifested as bloody diarrhea and abdominal pain. Ulcerative colitis is not associated with malabsorption of nutrients. Fistula formation in the bowel is related to Crohn disease. Acute inflammation of the intestinal wall may manifest as pseudomembranous enterocolitis or necrotizing enterocolitis.

 

REF:   Pg. 729

 

  1. An early indicator of colon cancer is
a. rectal pain.
b. bloody diarrhea.
c. a change in bowel habits.
d. jaundice.

 

 

ANS:  C

The manifestations of colon cancer depend on the anatomic location and function of the bowel segment containing the tumor. Early manifestations may include a change in bowel habits. Later in the progression of tumor growth, a sensation of rectal fullness and a dull ache may be felt in the rectum or sacral region. Although no signs of obstruction are present, black, tarry stools, which signify bleeding into the intestinal lumen, are a significant finding. Jaundice is not an early indicator of colon cancer.

 

REF:   Pg. 738

 

  1. A patient who should be routinely evaluated for peptic ulcer disease is one who is
a. taking 6 to 8 tablets of acetaminophen per day.
b. being treated with high-dose oral glucocorticoids.
c. experiencing chronic diarrhea.
d. routinely drinking alcoholic beverages.

 

 

ANS:  B

Glucocorticoids released in response to stress may have a role in the promotion of excess acid production or the destruction of gastric mucosal defenses. Therefore, a patient taking high-dose glucocorticoids would be at higher risk of developing peptic ulcer disease. Acetaminophen is not a risk factor for development of peptic ulcer disease. Chronic diarrhea is not a symptom of peptic ulcer disease. There is little evidence of a pathogenic role for alcohol, spicy foods, and caffeine in the development of peptic ulcer disease.

 

REF:   Pg. 728

 

  1. Celiac sprue is a malabsorptive disorder associated with
a. inflammatory reaction to gluten-containing foods.
b. megacolon at regions of autonomic denervation.
c. ulceration of the distal colon and rectum.
d. deficient production of pancreatic enzymes.

 

 

ANS:  A

Celiac disease (also called celiac sprue) is characterized by intolerance of gluten, a protein in wheat and wheat products. Current research suggests that celiac sprue is an immune disorder. The main pathologic finding is villus atrophy, with a decrease in the activity and amount of surface epithelial enzymes. Celiac sprue is not associated with ulceration of the distal colon and rectum. Celiac disease is an intolerance of gluten.

 

REF:   Pg. 734

 

  1. What clinical finding would suggest an esophageal cause of a client’s report of dysphagia?
a. Nasal regurgitation
b. Airway obstruction with swallowing
c. Chest pain during meals
d. Coughing when swallowing

 

 

ANS:  C

Two types of pain occur in the esophagus: (1) heartburn (also called pyrosis) and (2) pain located in the middle of the chest, which may mimic the pain of angina pectoris. Heartburn is caused by the reflux of gastric contents into the esophagus and is a substernal burning sensation that may radiate to the neck or throat. A person experiencing pharyngeal contractions may cough and expel the ingested food or fluids through their mouth and nose or aspirate when they attempt to swallow. Airway obstruction with swallowing would be an oropharyngeal cause of dysphagia. A person experiencing pharyngeal contractions may cough and expel the ingested food or fluids through his or her mouth and nose or aspirate when he or she attempts to swallow.

 

REF:   Pg. 721

 

  1. Barrett esophagus is a
a. gastrin secreting lesion.
b. preneoplastic lesion.
c. benign condition.
d. gastrin-secreting tumor.

 

 

ANS:  B

Barrett esophagus is a complication of chronic GERD and represents columnar tissue replacing the normal squamous epithelium of the distal esophagus. It carries a significant risk for esophageal cancer. Patients with Barrett esophagus should undergo regular endoscopic screening for cancer, along with pharmacologic control of their reflux. Barrett esophagus carries a significant risk for esophageal cancer and does not secrete gastrin.

 

REF:   Pg. 725

 

  1. What finding should prompt further diagnostic testing in a child presenting with diarrhea?
a. Periumbilical discomfort
b. Greenish, watery diarrhea
c. Frequent, large-volume diarrhea
d. Blood and mucus in the stools

 

 

ANS:  D

Both ulcerative colitis and Crohn disease have their onset most commonly in childhood and young adulthood, with obviously profound implications. Stools may contain blood or mucus. Periumbilical discomfort, watery diarrhea, and frequent, large volume diarrhea are not causes for further diagnostic testing.

 

REF:   Pg. 724 | Pg. 729

 

  1. Fecal leukocyte screening would be indicated in a patient with suspected
a. lactose intolerance.
b. enterocolitis.
c. laxative abuse.
d. giardiasis.

 

 

ANS:  B

Enterocolitis is manifested by diarrhea (often bloody), abdominal pain, fever, leukocytosis, and rarely, colonic perforation. Lactose intolerance would not be a cause of leukocytosis. Leukocyte screening would not be a factor in laxative use or abuse. Suspected giardiasis would not be a reason to screen fecal leukocytes.

 

REF:   Pg. 730

 

  1. What finding would rule out a diagnosis of irritable bowel syndrome in a patient with chronic diarrhea?
a. Negative stool leukocytes
b. Intermittent constipation
c. Abdominal pain and distention
d. Bloody stools

 

 

ANS:  D

Bloody stools are not a symptom of irritable bowel syndrome. A person with irritable bowel syndrome would have negative stool leukocytes. The manifestations of IBS may vary greatly, with some persons experiencing only diarrhea or constipation and others experiencing an alternating pattern of both. In addition to cramping abdominal pain, manifestations such as nausea and mucus in the stool may also be present.

 

REF:   Pg. 732

 

  1. An urgent surgical consult is indicated for the patient with acute abdominal pain and
a. vomiting.
b. CVA tenderness.
c. absent bowel sounds.
d. borborygmi.

 

 

ANS:  C

Functional bowel obstructions are characterized by the absence of bowel sounds. Uncorrected obstruction may lead to intestinal wall edema, ischemia, and necrosis. Vomiting with abdominal pain is not a cause for urgent surgical consult. CVA tenderness in the presence of abdominal pain is not an indicator for urgent surgical consult. Acute abdominal pain with hyperactive bowel sounds does not indicate the need for an urgent surgical consultation.

 

REF:   Pg. 732

 

  1. Constipation in an elderly patient can be best treated by
a. maintaining a low-fiber diet.
b. maintaining the current level of activity.
c. fecal disimpaction.
d. increasing fiber in the diet.

 

 

ANS:  D

The presence of cellulose, the carbohydrate component of dietary fiber that is indigestible in the human intestine, may be effective in promoting regular peristaltic movement in the GI tract by forming bulk within the intestinal lumen to stimulate propulsion. Dietary factors, particularly a diet low in fiber, have been shown to contribute to constipation. In elderly persons the slowed rate of peristalsis that occurs with the aging process, coupled with a decreased level of physical activity, may promote chronic constipation. These factors may eventually contribute to the development of fecal impaction, a condition in which a firm, immovable mass of stool becomes stationary in the lower GI tract.

 

REF:   Pg. 723

 

  1. A patient receiving chemotherapy may be at greater risk for development of
a. gastroesophageal reflux.
b. stomatitis.
c. esophageal varices.
d. Mallory-Weiss syndrome.

 

 

ANS:  B

Stomatitis is defined as an ulcerative inflammation of the oral mucosa that may extend to the buccal mucosa, lips, and palate. Among its many causes are pathogenic organisms, including bacteria and viruses; mechanical trauma; exposure to such irritants as alcohol, tobacco, and other chemical substances; certain medications, particularly chemotherapeutic agents. Gastroesophageal reflux disease is not related to chemotherapy. Patients taking chemotherapy are not at greater risk for developing esophageal varices. Chemotherapy is not a risk factor for Mallory-Weiss syndrome.

 

REF:   Pg. 724

 

  1. Esophageal varices represent a complication of ________ hypertension.
a. primary
b. pregnancy-induced
c. portal
d. secondary

 

 

ANS:  C

Esophageal varices represent a complication of portal hypertension, which in Western society is generally the result of cirrhosis due to alcoholism or viral hepatitis. Primary hypertension is not manifested by esophageal varices. Pregnancy-induced hypertension is unrelated to esophageal varices. Esophageal varices is not a complication of secondary hypertension.

 

REF:   Pg. 726

 

  1. A patient with chronic gastritis would likely be tested for
a. Helicobacter pylori.
b. occult blood.
c. lymphocytes.
d. herpes simplex.

 

 

ANS:  A

It is now known that H. pylori causes chronic, superficial gastritis in virtually all infected persons. Once established in the gastric mucosa, H. pylori sets up a destructive pattern of persistent inflammation. The presence of bloody stools is not generally seen in chronic gastritis. Lymphocytes are not tested in the presence of chronic gastritis. Herpes simplex is not a manifestation of chronic gastritis.

 

REF:   Pg. 726

 

  1. Rupture of esophageal varices is a complication of cirrhosis with portal hypertension and carries a high ________ rate.
a. cure
b. morbidity
c. insurance
d. mortality

 

 

ANS:  D

Rupture of esophageal varices is a dreaded complication of cirrhosis with portal hypertension and carries a high mortality rate. Rupture of esophageal varices does not carry a high cure rate. Varices will affect more than half of cirrhotic patients, and approximately 30% of them experience an episode of variceal hemorrhage within 2 years of the diagnosis of varices. Insurance is not a factor in the rupture of esophageal varices.

 

REF:   Pg. 726

 

  1. Premature infants are at greater risk for developing
a. necrotizing enterocolitis.
b. pseudomembranous colitis.
c. appendicitis.
d. diverticular disease.

 

 

ANS:  A

Necrotizing enterocolitis (NEC) is a disorder occurring most often in premature infants (less than 34 weeks’ gestation) and infants with low birth weight (less than 5 lbs. or 2.25 kg). This disorder is characterized by diffuse or patchy intestinal necrosis accompanied by sepsis. Pseudomembranous colitis is an acute inflammation and necrosis of the large intestine caused by Clostridium difficile, usually affecting the mucosa but sometimes extending to other layers. The most common cause of emergency surgery on the abdomen, appendicitis is an inflammation of the vermiform appendix. The prevalence of diverticular disease increases with age.

 

REF:   Pg. 730

 

  1. Dumping syndrome is commonly seen after __________ procedures.
a. appendectomy
b. intestinal biopsy
c. colonoscopy
d. gastric bypass

 

 

ANS:  D

Dumping syndrome is a term used to describe the literal dumping of stomach contents into the proximal portion of the small intestine because of impaired gastric emptying. Interestingly, dumping seems to occur only with Roux-en-Y gastric bypass procedures. Dumping syndrome is not related to procedures involving appendectomy. Intestinal biopsies do not produce a dumping effect. Colonoscopies are not related to dumping syndrome.

 

REF:   Pgs. 734-735

 

MULTIPLE RESPONSE

 

  1. A disorder of the esophageal smooth muscle function where dysphagia is a symptom is (Select all that apply.)
a. esophageal stricture.
b. achalasia.
c. esophageal tumors.
d. Mallory-Weiss syndrome.
e. hiatal hernia.

 

 

ANS:  A, B, C

Esophageal stricture, achalasia, and esophageal tumors are all disorders of the esophageal smooth muscle function that cause dysphagia. Manifestations of Mallory-Weiss syndrome include vomiting of blood and passing of large amounts of blood rectally after an episode of forceful vomiting. Hiatal hernia is a defect of the diaphragm, not the esophagus, even though hiatal hernia is associated with dysphagia.

 

REF:   Pg. 721

 

  1. Crohn disease is associated with what complications? (Select all that apply.)
a. Perianal fissures
b. Fistulae
c. Green stool
d. Abscesses
e. Rectal pain

 

 

ANS:  A, B, D

Complications such as perianal fissures, fistulae, and abscesses are common in Crohn disease and may be the symptoms that lead individuals to seek health care. The stool may be bloody, and thus would be red or black, not green. In Crohn disease, abdominal pain is often constant and in the right lower quadrant of the abdomen.

 

REF:   Pg. 730

 

  1. What is a pathophysiologic mechanism involved in the development of diarrhea? (Select all that apply.)
a. Osmotic diarrhea
b. Excessive flatus
c. Secretory diarrhea
d. Exudative diarrhea
e. Motility disturbances

 

 

ANS:  A, C, D, E

Osmotic diarrhea is due to increased amounts of poorly absorbed solutes in the intestine. Secretory diarrhea is usually due to toxins that stimulate intestinal fluid secretion and impair absorption. Exudative diarrhea (mucus, blood, protein) results from inflammatory processes. A decreased transit time in the small intestine results in diarrhea because the absorptive capacity of the large intestine is exceeded. Excessive gas in the intestine is not a mechanism for developing diarrhea.

 

REF:   Pgs. 723-724

Chapter 48: Neurobiology of Psychotic Illnesses

Test Bank

 

MULTIPLE CHOICE

 

  1. Schizophrenia is characterized by
a. generalized anxiety.
b. depression.
c. disorganized thinking.
d. eating disorders.

 

 

ANS:  C

Schizophrenia is now correctly understood as a split or separation among normally well-synchronized brain functions. This loss of synchronized brain functioning leads to thoughts, behaviors, and feelings that are disordered, disorganized, and disconnected from reality. Generalized anxiety and eating disorders are not associated with schizophrenia. Schizophrenia is not characterized by depression.

 

REF:   Pg. 975

 

  1. The usual age of onset for schizophrenia in men is
a. before puberty.
b. 15 to 25 years.
c. 40 to 65 years.
d. after 65 years.

 

 

ANS:  B

The most common age of onset and diagnosis is between 15 and 25 years for men. Women are typically diagnosed between 25 and 35 years. Most persons first diagnosed with schizophrenia are between the ages of 15 and 54 years. The usual age of onset of schizophrenia occurs before the age of 25.

 

REF:   Pg. 975

 

  1. Which manifestation is characteristic of the “positive” symptoms of schizophrenia?
a. Social withdrawal
b. Flat affect
c. Lack of speech
d. Hallucinations

 

 

ANS:  D

Positive symptoms include the psychotic dimension, or distortions in thought content (delusions) and perception (hallucinations), as well as the disorganization dimension, or disorganization in speech and behavior. Asociality is considered a negative symptom. Flat affect is considered to be a cognitive symptom. Lack of speech is not considered to be a positive symptom of schizophrenia.

 

REF:   Pg. 978

 

  1. It is true that the “negative” symptoms of schizophrenia
a. are more easily managed than the positive symptoms.
b. are thought to be mediated by D1 receptors in the brain.
c. include rambling speech and delusional thoughts.
d. are due to a deficiency of brain dopamine.

 

 

ANS:  B

Negative symptoms of schizophrenia are thought to be associated with dopamine D1 receptor activity in the brain. Negative symptoms can be more difficult to recognize than positive symptoms. Rambling speech and delusional thoughts are positive symptoms. The positive symptoms of schizophrenia are thought to result from excessive dopamine D2 receptor activity in the brain.

 

REF:   Pg. 978

 

  1. Depression is thought to be associated with
a. abnormal personality development.
b. early childhood emotional trauma.
c. deficient brain norepinephrine and serotonin.
d. excessive stimulation of D1 and D2 receptors in the brain.

 

 

ANS:  C

Depression is thought to occur when serotonin and norepinephrine activity in the brain is low. Depression is not associated with abnormal personality development. Early childhood emotional trauma is not necessarily associated with depression. Symptoms associated with schizophrenia are thought to be related to dopamine receptors.

 

REF:   Pg. 981 | Pg. 983

 

  1. Mania and depression are both characterized by
a. high energy and hyperactivity.
b. poor appetite.
c. hopelessness.
d. altered decision-making ability.

 

 

ANS:  D

Depression is manifested by reduced decision-making capacity and mania is manifested by an inability to concentrate. High energy and hyperactivity is seen in mania only. Depression is manifested by poor appetite, whereas mania is associated with an increased appetite. Hopelessness is associated with depression.

 

REF:   Pg. 987

 

  1. Lithium is used to manage mania because it
a. inhibits norepinephrine and serotonin activity in the brain.
b. is a CNS sedative.
c. is converted to catecholamines within the brain.
d. blocks D2 receptors in the brain.

 

 

ANS:  A

The management of mania is accomplished with the use of lithium because it inhibits the action of norepinephrine and serotonin in the brain. Mania is not managed with the use of a CNS sedative. The mechanism of lithium is not related to a conversion of catecholamine in the brain. Lithium does not have a mechanism of action where D2 receptors in the brain are blocked.

 

REF:   Pg. 987

 

  1. Drugs that inhibit reuptake of norepinephrine or serotonin may be helpful in the management of
a. schizophrenia.
b. panic attacks.
c. depression.
d. delusional disorder.

 

 

ANS:  C

The management of major depressive disorder is aimed at increasing norepinephrine and serotonin activity in the brain. The goal of therapy in the management of schizophrenia is to alleviate some of the negative symptoms by blocking D1 receptors. Drugs that inhibit the reuptake of norepinephrine or serotonin are not useful in managing panic attacks. Delusional disorder is not managed with drugs that inhibit the reuptake of norepinephrine or serotonin.

 

REF:   Pg. 983

 

  1. A client who reported hearing voices, some of them saying bad and hurtful things, will now eat only food from unopened sealed packages. The behaviors described indicate that the patient may be experiencing a(n) _____ disorder.
a. bipolar
b. obsessive-compulsive
c. personality
d. psychotic

 

 

ANS:  D

Psychosis associated with MDD is thought to result from extreme symptoms of a prolonged duration. Auditory hallucinations, delusions and disorganization may become prominent symptoms. Bipolar disorder is characterized by recurring symptoms of depression and elation. Obsessive-compulsive disorder is not typically evidenced by withdrawn behavior or auditory hallucinations. Withdrawn behavior and auditory hallucinations are symptoms of psychosis.

 

REF:   Pg. 983

 

  1. The symptoms of hallucinations and paranoia that accompany schizophrenia are thought to be due to altered neurotransmitter activity in the brain, which results in excessive ________ receptor activation.
a. D2
b. serotonin
c. a-adrenergic
d. acetylcholine

 

 

ANS:  A

The positive symptoms of schizophrenia are thought to result from excessive dopamine D2 receptor activity in the brain. Depression is thought to be related to decreases in serotonin. Hallucinations and paranoia that accompany schizophrenia are not the result on excessive a-adrenergic receptor activation. Excessive acetylcholine receptor activation is not the cause of hallucinations or paranoia.

 

REF:   Pg. 978

 

  1. The assessment of a client recently diagnosed with schizophrenia confirms good cognitive function and reveals affect that is animated. The client is open about describing the voices and the content of their comments, but demonstrates a disorganized thought process. These findings suggest that
a. “negative” psychotic symptoms predominate.
b. there is a high risk for suicidal behaviors.
c. drug therapy is likely to be ineffective.
d. “positive” psychotic symptoms predominate.

 

 

ANS:  D

Positive symptoms of schizophrenia include the psychotic dimension and distortions of thought and perception, as well as the disorganization dimension. Auditory hallucinations are commonly experienced as voices. Negative symptoms are considered to be restricted affect, or asociality. The patient in this scenario does not appear to be at high risk for suicidal behaviors. The findings suggested do not indicate that the patient has ineffective drug therapy.

 

REF:   Pg. 978

 

  1. Drug therapy with a dopamine receptor antagonist is initiated to manage a patient’s symptoms of schizophrenia. The goal of treatment is to
a. increase dopamine activity.
b. reduce serotonin activity.
c. stabilize dopamine activity.
d. effect serotonin and norepinephrine neurotransmitters.

 

 

ANS:  C

The aim for effective antipsychotic medication is to stabilize, rather than reduce, dopamine activity. The newest medications show greater affinity for serotonin receptors (negative symptoms) and moderate affinity for dopamine and norepinephrine receptors (positive symptoms).

 

REF:   Pg. 980

 

  1. A mild form of hyperactivity in which social functioning is not significantly impaired is called
a. anhedonia.
b. dysphoria.
c. dysthymia.
d. hypomania.

 

 

ANS:  D

The individual experiencing hypomania has a sudden onset of increased energy, expanded self-esteem, and decreased anxiety; these typically are reported to have improved his or her productivity and are experienced as an acceptable natural high. Anhedonia is a loss of pleasure. Dysphoria is not a condition in which social functioning is not impaired. Depression with one or two symptoms that last 2 years or more is commonly referred to as dysthymia.

 

REF:   Pg. 985

 

  1. In youth, it is estimated that ____ will be diagnosed with serious mental illness between the ages of 13 and 18 years.
a. 5%
b. 26.2%
c. 46.3%
d. 75%

 

 

ANS:  C

In youth, 46.3% will be diagnosed with serious mental illness between the ages of 13 and 18 years. In the United States today, approximately 5% of all adults meet criteria for serious mental illness. 26.2% of the U.S. adult population will have experienced an SMI in the previous year. 75% of youth are not diagnosed with serious mental illness.

 

REF:   Pg. 971

 

  1. ________ is a term used to describe a serious and debilitating mental state.
a. Psychosis
b. Schizophrenia
c. Major depressive disorder
d. Dysthymia

 

 

ANS:  A

Psychosis is a term used to describe a serious and debilitating mental state. The narrowest definition refers to delusions and prominent hallucinations. Schizophrenia refers to a chronic, remitting and relapsing psychotic disorder. Major depressive disorder involves a complex diagnosis which encompasses depression symptoms. Dysthymia is associated with long-term depression.

 

REF:   Pg. 975

 

  1. Childlike silliness in a patient with schizophrenia is known as
a. delusions.
b. disorganized thinking.
c. grossly disorganized behavior.
d. asociality.

 

 

ANS:  C

Grossly disorganized behavior can range from childlike silliness to unpredictable agitation, and impairs tasks of daily living. Delusions, or systematic, fixed, false beliefs, usually involve themes of persecution, REF, somatization, religiosity, or grandiosity. Disorganized thinking is usually evaluated by an individual’s speech, and is frequently characterized by frequent derailment or loose associations, invented words, tangential idea, and, when most severe, incomprehensible speech. Asociality is a negative symptom of schizophrenia.

 

REF:   Pg. 978

 

  1. The schizophrenia category which indicates that the disturbance has continued but the active-phase symptoms are no longer met is the _____ Type.
a. Residual
b. Undifferentiated
c. Paranoid
d. Disorganized

 

 

ANS:  A

The Residual Type indicates that the disturbance has continued but the active-phase symptoms are no longer met. The Undifferentiated Type is essentially a catch-all category where the individual does not meet criteria for any of the other subtypes. The Paranoid and Disorganized Types are the least severe (in that order). The Paranoid and Disorganized Types are the least severe (in that order).

 

REF:   Pg. 979

 

  1. Researchers suggest a mediating role between the later development of schizophrenia and
a. prenatal radiation exposure.
b. prenatal influenza exposure.
c. childhood vaccinations.
d. childhood chickenpox.

 

 

ANS:  B

Researchers have suggested that delivery complications could be a factor, playing a mediating role between prenatal influenza exposure and later development of schizophrenia. Prenatal radiation exposure is not a suggested mediator in the development of schizophrenia. The development of later schizophrenia is not suggested to be associated with childhood vaccinations. It is not suggested that childhood chickenpox is related to the development of schizophrenia.

 

REF:   Pg. 977

 

  1. The action of most antidepressants currently available is to
a. improve brain norepinephrine and serotonin activity.
b. inhibit norepinephrine and serotonin activity.
c. convert into catecholamines in the brain.
d. block D2 receptors in the brain.

 

 

ANS:  A

Most currently available antidepressants act by improving brain norepinephrine and serotonin activity. Earlier generations of antidepressants had less specific effects on these neurotransmitters and significantly more side effects. The action of antidepressants is unrelated to conversion of catecholamines in the brain. D2 receptors in the brain are not blocked by antidepressants.

 

REF:   Pg. 983

 

  1. Which statement is true about the incidence of mental illness?
a. There are minimal differences in how cultures view mental health.
b. Women have twice the risk of experiencing anxiety disorders than men.
c. Men are more likely to suffer from depression and anxiety than women are.
d. Mood disorders are not likely to occur after the age of 65.

 

 

ANS:  B

Women are more than twice as likely to suffer from depression (including unipolar depression, dysthymia) and anxiety disorders (including panic disorder, post-traumatic stress disorder, generalized anxiety disorder, social anxiety, and phobias), than men. There are known differences in how cultures and regions around the world view mental health, and thus in how they express concerns about the body, self, and emotions. Reproductive hormones may play a role in exacerbating anxiety and depression in women. Mood disorders in the elderly are likely to be associated with concomitant illnesses or treatment.

 

REF:   Pg. 986

 

  1. An elderly patient is taking antipsychotic drugs and begins to develop involuntary chewing motions. The patient is likely exhibiting signs of
a. dementia.
b. Parkinson disease.
c. tardive dyskinesia.
d. dysthymia.

 

 

ANS:  C

Older patients may suffer side effects such as tardive dyskinesia, a disorder related to antipsychotic drug dosage and duration and characterized by involuntary chewing motions and darting of the tongue. It is generally accepted practice that antidepressants should be prescribed at lower dosages and titrated upward more slowly in the elderly. Antipsychotic medication use is not related to the development of dementia. Parkinson disease is not diagnosed by involuntary chewing motions. Dysthymia is related to major depressive disorder.

 

REF:   Pg. 987

 

MULTIPLE RESPONSE

 

  1. When a client is diagnosed with schizophrenia and asks what could have caused the disorder, the statements that could serve as a basis for answering include which of the following? (Select all that apply.)
a. Schizophrenia may be related to abnormal cerebral structure.
b. Schizophrenia is inherited as an autosomal recessive gene defect.
c. Schizophrenia often develops in the absence of family psychopathology.
d. Chronic prolonged stress may contribute to development of schizophrenia.
e. Symptoms of schizophrenia may be associated with smoking.

 

 

ANS:  A, C, D

A groundbreaking study showed that the neurochemical basis of schizophrenia might involve two processes: dopamine neurotransmission dysregulation and abnormal cerebral structure. Schizophrenia can and does develop in persons with no family history. In MRI studies of persons with schizophrenia, a link was found when psychological stress was placed on an individual. Genetic studies have found that the percentage of offspring who do and do not develop schizophrenia is about equal. Tobacco dependence is a common secondary disorder with schizophrenia.

 

REF:   Pgs. 976-977

 

  1. Which symptoms would support a diagnosis of major depressive disorder? (Select all that apply.)
a. Diminished interest or pleasure
b. Incomprehensible speech
c. Altered reality
d. Psychomotor agitation or retardation
e. Appetite disturbance

 

 

ANS:  A, D, E

To be diagnosed with MDD, an individual must experience five (or more) specified symptoms during the same 2-week period; this must also represent a change from previous functioning. In addition, at least one of the symptoms must be either depressed mood or loss of interest or pleasure. Symptoms include depressed mood, diminished interest or pleasure, appetite disturbance, insomnia, hypersomnia, psychomotor agitation or retardation. Incomprehensible speech is associated with a positive symptom of schizophrenia. Altered reality is a symptom of psychosis.

 

REF:   Pgs. 982-983

Chapter 54: Burn Injuries

Test Bank

 

MULTIPLE CHOICE

 

  1. It is true that second-degree, superficial partial-thickness burns
a. are less painful than third-degree burns.
b. involve only the epidermis.
c. usually heal in 7 to 21 days.
d. are rarely associated with scar formation.

 

 

ANS:  C

Second-degree, superficial partial-thickness burns usually heal in 7 to 21 days. Second-degree burns are more painful than third-degree burns, involve damage to the dermis, and can be associated with scar formation.

 

REF:   Pg. 1093

 

  1. The first priority when rescuing a burned individual is
a. establishing a patent airway.
b. removing his or her clothing.
c. eliminating the source of the burn.
d. covering the wounds with wet sheets.

 

 

ANS:  C

The first priority in rescuing a burned individual is eliminating the source of the burn. The next priority is to establish a patent airway. Removing the clothing is not recommended; however, dry, clean sheets or dressings should be placed over the burns. Covering the wound is not advised, as this may cause hypothermia.

 

REF:   Pg. 1095

 

  1. Burn shock is the direct result of
a. hypovolemia.
b. cardiac depression.
c. infection.
d. increased capillary permeability.

 

 

ANS:  D

Burn shock results from systemic capillary permeability with leakage of fluids throughout all tissues; the result is massive edema. Hypovolemia is not the direct cause of burn shock. Burn shock does not result from cardiac depression or infection.

 

REF:   Pgs. 1096-1097

 

  1. Electrical injury may cause extensive damage to low-resistance tissues, particularly
a. bone and muscle.
b. nerves and blood vessels.
c. epidermis.
d. dermis and subcutaneous tissue.

 

 

ANS:  B

Electrical injury may cause extensive damage to low-resistance tissues, particularly nerves and blood vessels. Bone and muscle, and dermis and subcutaneous tissue, are not low-resistance tissues. Skin is a high-resistance tissue.

 

REF:   Pg. 1105

 

  1. The time between the end of burn shock and closure of the burn to less than 20% of total body surface area is called the ________ phase.
a. postshock
b. rehabilitation
c. critical
d. emergent

 

 

ANS:  D

The time between the end of burn shock and closure of the burn to less than 20% of total body surface area is called the emergent phase. Postshock is not a phase of burn wound healing. The rehabilitation phase begins when the burn size is reduced to less than 20% TBSA and the patient is able to assume self-care. There is not a critical phase of burn wound healing.

 

REF:   Pg. 1100

 

  1. The primary aim of burn wound management is to prevent
a. trauma to burned tissue.
b. microbial colonization of the wound.
c. the wound from drying out.
d. premature wound closure.

 

 

ANS:  B

The primary aim of burn wound management is to prevent microbial colonization of the wound. A goal of wound management is to minimize further destruction of viable tissue. It is not possible to prevent the trauma after injury, since it has already occurred. Keeping the wound dry is not a primary aim of burn wound management. Preventing premature wound closure is not a goal of burn wound management.

 

REF:   Pg. 1100

 

  1. The third element essential to survival after major burn injury is
a. excision of the burn followed by skin grafting.
b. frequent wound debridement to encourage wound healing.
c. hyperbaric oxygen therapy.
d. continuous topical antibiotic therapy.

 

 

ANS:  A

The third element essential to survival after major burn injury is excision of the burn followed by skin grafting. Frequent wound debridement, hyperbaric oxygen therapy, and continuous topical antibiotic therapy are not the third element essential to survival after major burn injury.

 

REF:   Pg. 1100

 

  1. The most common cause of burn injuries in children is
a. house fires.
b. cigarette burns.
c. scalding with hot water.
d. contact with chemical agents.

 

 

ANS:  C

The most common cause of burn injuries in children is scalding with hot water. House fires, cigarette burns, and contact with chemical agents are not the most common causes of burn injuries in children.

 

REF:   Pg. 1091

 

  1. The goal of nutritional support of the burned individual is to
a. limit the glucose available to infectious organisms.
b. create a positive nitrogen balance.
c. protect the kidney from excessive protein intake.
d. avoid hyperlipidemia.

 

 

ANS:  B

The goal of nutritional support of the burned individual is to create a positive nitrogen balance. Limiting the glucose available to infectious organisms, protecting the kidney from excessive protein intake, and avoiding hyperlipidemia are not the goals of nutritional support of the burn patient.

 

REF:   Pg. 1100

 

  1. A necessary intervention when managing burns associated with automobile airbag injury include
a. irrigation with water.
b. application of steroid cream.
c. IV infusion of antibiotics.
d. debridement of skin.

 

 

ANS:  A

Management of burns associated with automobile airbag injury is irrigation with copious amounts of water. Application of steroid cream, IV antibiotics, and debridement are not necessary for airbag burns.

 

REF:   Pg. 1107

 

  1. The majority of electrical burns in children are caused by
a. playing with electrical outlets.
b. playing with defective electrical cords.
c. biting on extension cords.
d. putting fingers in electrical sockets.

 

 

ANS:  C

The majority of electrical burns in children are caused by biting on extension cords. Playing with electrical outlets, playing with defective electrical cords, and putting fingers in electrical sockets are not the causes of the majority of electrical burns in children.

 

REF:   Pg. 1105

 

  1. It is true that covering a burn with cool wet sheets
a. promotes comfort.
b. facilitates healing.
c. prevents fluid loss.
d. promotes hypothermia.

 

 

ANS:  D

Cool wet sheets quickly become cold wet sheets that promote hypothermia as the skin’s ability to regulate body temperature is lost. Although cool wet sheets may initially promote comfort, they may be the cause of hypothermia the longer the sheets remain in contact with the burned skin. Cool wet sheets do not facilitate burn healing or prevent fluid loss.

 

REF:   Pg. 1096

 

  1. The immediate management of a thermal burn victim once the fire has been extinguished is to
a. cover with blankets to prevent shock.
b. monitor for signs of respiratory impairment.
c. apply lubricant to the burn area.
d. start an IV line.

 

 

ANS:  B

Excessive heat to the respiratory tract could result in obstruction; therefore, respiratory status is the main priority. Do not cover with blankets, as this will prevent underlying heat from escaping. Do not apply anything but water to a burn. An IV line may be started after management of respiratory status.

 

REF:   Pg. 1096

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