Pathophysiology The Biologic Basis for Disease in Adults and Children,7th Edition by Kathryn L. – Test Bank

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Pathophysiology The Biologic Basis for Disease in Adults and Children,7th Edition by Kathryn L. – Test Bank

Chapter 2: Altered Cellular and Tissue Biology

 

MULTIPLE CHOICE

 

  1. Which type of cell adaptation occurs when normal columnar ciliated epithelial cells of the bronchial lining have been replaced by stratified squamous epithelial cells?
a. Hyperplasia c. Dysplasia
b. Metaplasia d. Anaplasia

 

 

ANS:  B

Metaplasia is the reversible replacement of one mature cell by another, sometimes a less differentiated cell type. The best example of metaplasia is the replacement of normal columnar ciliated epithelial cells of the bronchial (airway) lining by stratified squamous epithelial cells. The other options do not accurately describe the event in the question.

 

PTS:   1                    REF:   Page 54

 

  1. The loss of the adenosine triphosphate (ATP) during ischemia causes cells to:
a. Shrink because of the influx of calcium (Ca).
b. Shrink because of the influx of potassium chloride (KCl).
c. Swell because of the influx of sodium chloride (NaCl).
d. Swell because of the influx of nitric oxide (NO).

 

 

ANS:  C

A reduction in ATP levels causes the plasma membrane’s sodium-potassium (Na+–K+) pump and sodium-calcium exchange to fail, which leads to an intracellular accumulation of sodium and calcium and diffusion of potassium out of the cell. (The Na+–K+ pump is discussed in Chapter 1.) Sodium and water can then freely enter the cell, and cellular swelling results. The other options do not accurately describe the result of ATP at the cellular level.

 

PTS:   1                    REF:   Page 57

 

  1. The mammary glands enlarge during pregnancy primarily as a consequence of hormonal:
a. Atrophy c. Anaplasia
b. Hyperplasia d. Dysplasia

 

 

ANS:  B

Hormonal hyperplasia occurs chiefly in estrogen-dependent organs, such as the uterus and breast. The remaining options do not adequately describe the consequence of hormones on breast tissue during pregnancy.

 

PTS:   1                    REF:   Page 53

 

  1. Free radicals play a major role in the initiation and progression of which diseases?
a. Cardiovascular diseases such as hypertension and ischemic heart disease
b. Renal diseases such as acute tubular necrosis and glomerulonephritis
c. Gastrointestinal diseases such as peptic ulcer disease and Crohn disease
d. Muscular disease such as muscular dystrophy and fibromyalgia

 

 

ANS:  A

Emerging data indicate that reactive oxygen species play major roles in the initiation and progression of cardiovascular alterations associated with hyperlipidemia, diabetes mellitus, hypertension, ischemic heart disease, and chronic heart failure. No current research connects the disorders mentioned in the other options to the effects of free radicals.

 

PTS:   1                    REF:   Pages 59-60

 

  1. Free radicals cause cell damage by:
a. Stealing the cell’s oxygen to stabilize the electron, thus causing hypoxia
b. Stimulating the release of lysosomal enzymes that digest the cell membranes
c. Transferring one of its charged, stabilized atoms to the cell membrane, which causes lysis
d. Giving up an electron, which causes injury to the chemical bonds of the cell membrane

 

 

ANS:  D

A free radical is an electrically uncharged atom or group of atoms having an unpaired electron. Having one unpaired electron makes the molecule unstable; thus to stabilize, the molecule gives up an electron to another molecule or steals one. Therefore it is capable of forming injurious chemical bonds with proteins, lipids, or carbohydrates—key molecules in membranes and nucleic acids. The remaining options do not accurately describe the role played by free radicals in cell damage.

 

PTS:   1                    REF:   Page 60

 

  1. What is a consequence of plasma membrane damage to the mitochondria?
a. Enzymatic digestion halts DNA synthesis.
b. Influx of calcium ions halts ATP production.
c. Edema from an influx in sodium causes a reduction in ATP production.
d. Potassium shifts out of the mitochondria, which destroys the infrastructure.

 

 

ANS:  B

The most serious consequence of plasma membrane damage is, as in hypoxic injury, to the mitochondria. An influx of calcium ions from the extracellular compartment activates multiple enzyme systems, resulting in cytoskeleton disruption, membrane damage, activation of inflammation, and eventually DNA degradation. Calcium ion accumulation in the mitochondria causes the mitochondria to swell, which is an occurrence that is associated with irreversible cellular injury. The injured mitochondria can no longer generate ATP, but they do continue to accumulate calcium ions. The remaining options do not accurately describe the consequence of plasma membrane damage to the mitochondria.

 

PTS:   1                    REF:   Page 63

 

  1. What is a consequence of leakage of lysosomal enzymes during chemical injury?
a. Enzymatic digestion of the nucleus and nucleolus occurs, halting DNA synthesis.
b. Influx of potassium ions into the mitochondria occurs, halting the ATP production.
c. Edema of the Golgi body occurs, preventing the transport of proteins out of the cell.
d. Shift of calcium out of the plasma membrane occurs, destroying the cytoskeleton.

 

 

ANS:  A

Enzymatic digestion of cellular organelles, including the nucleus and nucleolus, ensues, halting the synthesis of DNA and ribonucleic acid (RNA). The remaining options do not accurately describe the consequence of lysosomal enzyme leakage during chemical injury.

 

PTS:   1                    REF:   Page 63

 

  1. Lead causes damage within the cell by interfering with the action of:
a. Sodium and chloride c. Calcium
b. Potassium d. ATP

 

 

ANS:  C

Lead affects many different biologic activities at the cellular and molecular levels, many of which may be related to its ability to interfere with the functions of calcium. Lead does not appear to cause damage by interfering with the action of the other options.

 

PTS:   1                    REF:   Page 66

 

  1. Which statement is a description of the characteristics of apoptosis?
a. Programmed cell death of scattered, single cells
b. Characterized by swelling of the nucleus and cytoplasm
c. Unpredictable patterns of cell death
d. Results in benign malignancies

 

 

ANS:  A

Apoptosis is an active process of cellular self-destruction, also known as programmed cell death, which is implicated in normal and pathologic tissue changes. The remaining options do not accurately describe the characteristics of apoptosis.

 

PTS:   1                    REF:   Page 91

 

  1. Lead poisoning affects the nervous system by:
a. Interfering with the function of neurotransmitters
b. Inhibiting the production of myelin around nerves
c. Increasing the resting membrane potential
d. Altering the transport of potassium into the nerves

 

 

ANS:  A

Alterations in calcium may play a crucial role in the interference with neurotransmitters, which may cause hyperactive behavior and the proliferation of capillaries of the white matter and intercerebral arteries. The remaining options do not accurately describe the effects of lead poisoning of the nervous system.

 

PTS:   1                    REF:   Page 66

 

  1. Carbon monoxide causes tissue damage by:
a. Competing with carbon dioxide so that it cannot be excreted
b. Binding to hemoglobin so that it cannot carry oxygen
c. Destroying the chemical bonds of hemoglobin so it cannot carry oxygen
d. Removing iron from hemoglobin so it cannot carry oxygen

 

 

ANS:  B

Because carbon monoxide’s affinity for hemoglobin is 200 times greater than that of oxygen, it quickly binds with the hemoglobin, preventing oxygen molecules from doing so. The remaining options do not accurately describe the means by which carbon monoxide damages tissue.

 

PTS:   1                    REF:   Page 67

 

  1. Acute alcoholism mainly affects which body system?
a. Hepatic c. Renal
b. Gastrointestinal d. Central nervous

 

 

ANS:  D

Acute alcoholism mainly affects the central nervous system but may induce reversible hepatic and gastric changes. Other systems may evidentially be affected by chronic alcoholism.

 

PTS:   1                    REF:   Page 68

 

  1. During cell injury caused by hypoxia, an increase in the osmotic pressure occurs within the cell because:
a. Plasma proteins enter the cell.
b. The adenosine triphosphatase (ATPase)–driven pump is stronger during hypoxia.
c. Sodium chloride enters the cell.
d. An influx of glucose occurs through the injured cell membranes.

 

 

ANS:  C

In hypoxic injury, movement of fluid and ions into the cell is associated with acute failure of metabolism and a loss of ATP production. Normally, the pump that transports sodium ions out of the cell is maintained by the presence of ATP and ATPase, the active-transport enzyme. In metabolic failure caused by hypoxia, reduced ATP and ATPase levels permit sodium to accumulate in the cell, whereas potassium diffuses outward. The increase of intracellular sodium increases osmotic pressure, which draws more water into the cell. (Transport mechanisms are described in Chapter 1.) The remaining options do not accurately describe the cell injury that results in increased osmotic pressure caused by hypoxia.

 

PTS:   1                    REF:   Page 84

 

  1. Which statement is true regarding the difference between subdural hematoma and epidural hematoma?
a. No difference exists, and these terms may be correctly used interchangeably.
b. A subdural hematoma occurs above the dura, whereas an epidural hematoma occurs under the dura.
c. A subdural hematoma is often the result of shaken baby syndrome, whereas an epidural hematoma rapidly forms as a result of a skull fracture.
d. A subdural hematoma usually forms from bleeding within the skull, such as an aneurysm eruption, whereas an epidural hematoma occurs from trauma outside the skull, such as a blunt force trauma.

 

 

ANS:  C

A subdural hematoma is a collection of blood between the inner surface of the dura mater and the surface of the brain, resulting from the shearing of small veins that bridge the subdural space. Subdural hematomas can be the result of blows, falls, or sudden acceleration-deceleration of the head, which occurs in the shaken baby syndrome. An epidural hematoma is a collection of blood between the inner surface of the skull and the dura and is almost always associated with a skull fracture. The other options do not accurately describe the differences between the two hematomas.

 

PTS:   1                    REF:   Page 72 | Table 2-6

 

  1. What physiologic change occurs during heat exhaustion?
a. Hemoconcentration occurs because of the loss of salt and water.
b. Cramping of voluntary muscles occurs as a result of salt loss.
c. Thermoregulation fails because of high core temperatures.
d. Subcutaneous layers are damaged because of high core temperatures.

 

 

ANS:  A

Heat exhaustion occurs when sufficient salt and water loss results in hemoconcentration. The other options do not accurately describe the physiologic changes that occur during heat exhaustion.

 

PTS:   1                    REF:   Page 77

 

  1. In hypoxic injury, sodium enters the cell and causes swelling because:
a. The cell membrane permeability increases for sodium during periods of hypoxia.
b. ATP is insufficient to maintain the pump that keeps sodium out of the cell.
c. The lactic acid produced by the hypoxia binds with sodium in the cell.
d. Sodium cannot be transported to the cell membrane during hypoxia.

 

 

ANS:  B

In hypoxic injury, movement of fluid and ions into the cell is associated with acute failure of metabolism and a loss of ATP production. Normally, the presence of ATP and ATPase, the active-transport enzyme, maintains the pump that transports sodium ions out of the cell. In metabolic failure caused by hypoxia, reduced ATP and ATPase levels permit sodium to accumulate in the cell, whereas potassium diffuses outward. The other options do not accurately describe the cause of the swelling caused by hypoxia.

 

PTS:   1                    REF:   Page 84

 

  1. What is the most common site of lipid accumulation?
a. Coronary arteries c. Liver
b. Kidneys d. Subcutaneous tissue

 

 

ANS:  C

Although lipids sometimes accumulate in heart and kidney cells, the most common site of intracellular lipid accumulation, or fatty change, is liver cells. Subcutaneous tissue is not a common site of lipid accumulation.

 

PTS:   1                    REF:   Pages 84-85

 

  1. What mechanisms occur in the liver cells as a result of lipid accumulation?
a. Accumulation of lipids that obstruct the common bile duct, preventing flow of bile from the liver to the gallbladder
b. Increased synthesis of triglycerides from fatty acids and decreased synthesis of apoproteins
c. Increased binding of lipids with apoproteins to form lipoproteins
d. Increased conversion of fatty acids to phospholipids

 

 

ANS:  B

Lipid accumulation in liver cells occurs after cellular injury sets the following mechanisms in motion: increased synthesis of triglycerides from fatty acids (increases in the enzyme, a-glycerophosphatase, which can accelerate triglyceride synthesis) and decreased synthesis of apoproteins (lipid-acceptor proteins). The other options do not accurately describe this event.

 

PTS:   1                    REF:   Pages 84-85

 

  1. Hemoprotein accumulations are a result of the excessive storage of:
a. Iron, which is transferred from the cells to the bloodstream
b. Hemoglobin, which is transferred from the bloodstream to the cells
c. Albumin, which is transferred from the cells to the bloodstream
d. Amino acids, which are transferred from the cells to the bloodstream

 

 

ANS:  A

Excessive storage of iron, which is transferred to the cells from the bloodstream, causes hemoprotein accumulations in cells. Hemoglobin, albumin, or amino acids will not cause hemoprotein accumulations.

 

PTS:   1                    REF:   Page 86

 

  1. Hemosiderosis is a condition that results in the excess of what substance being stored as hemosiderin in cells of many organs and tissues?
a. Hemoglobin c. Iron
b. Ferritin d. Transferrin

 

 

ANS:  C

Hemosiderosis is a condition that occurs only when excess iron is stored as hemosiderin in the cells of many organs and tissues.

 

PTS:   1                    REF:   Page 86

 

  1. What is the cause of free calcium in the cytosol that damages cell membranes by uncontrolled enzyme activation?
a. Activation of endonuclease interferes with the binding of calcium to protein.
b. Activation of phospholipases, to which calcium normally binds, degrades the proteins.
c. An influx of phosphate ions competes with calcium for binding to proteins.
d. Depletion of ATP normally pumps calcium from the cell.

 

 

ANS:  D

If abnormal direct damage occurs to membranes or ATP is depleted, then calcium increases in the cytosol. The other options do not accurately describe the cause of free calcium in cytosol to damage cell membranes.

 

PTS:   1                    REF:   Pages 57-58 | Page 87 | Figure 2-24

 

  1. What two types of hearing loss are associated with noise?
a. Acoustic trauma and noise-induced c. High frequency and acoustic trauma
b. High frequency and low frequency d. Noise-induced and low frequency

 

 

ANS:  A

Two types of hearing loss are associated with noise: (1) acoustic trauma or instantaneous damage caused by a single sharply rising wave of sound (e.g., gunfire), and (2) noise-induced hearing loss, the more common type, which is the result of prolonged exposure to intense sound (e.g., noise associated with the workplace and leisure-time activities). The remaining options are not related to noise but rather to the amplitude of the sound.

 

PTS:   1                    REF:   Page 83

 

  1. What type of necrosis results from ischemia of neurons and glial cells?
a. Coagulative c. Caseous
b. Liquefactive d. Gangrene

 

 

ANS:  B

Liquefactive necrosis commonly results from ischemic injury to neurons and glial cells in the brain. The other types of necrosis are not related to ischemic injuries in the brain.

 

PTS:   1                    REF:   Page 90

 

  1. What type of necrosis is often associated with pulmonary tuberculosis?
a. Bacteriologic c. Liquefactive
b. Caseous d. Gangrenous

 

 

ANS:  B

Caseous necrosis, which commonly results from tuberculous pulmonary infection, particularly Mycobacterium tuberculosis, is a combination of coagulative and liquefactive necrosis. The other types of necrosis are not observed in pulmonary tuberculosis.

 

PTS:   1                    REF:   Page 90

 

  1. What type of necrosis is associated with wet gangrene?
a. Coagulative c. Caseous
b. Liquefactive d. Gangrene

 

 

ANS:  B

Wet gangrene develops only when neutrophils invade the site, causing liquefactive necrosis.

 

PTS:   1                    REF:   Page 91

 

  1. Current research supports the believe that, after heart muscle injury, the damage:
a. Remains indefinitely because cardiac cells do not reproduce.
b. Is repaired by newly matured cardiomyocytes.
c. Gradually decreases in size as mitotic cell division occurs.
d. Is replaced by hypertrophy of remaining cells.

 

 

ANS:  B

The recent discovery that cardiac stem cells exist in the heart and differentiate into various cardiac cell lineages has profoundly changed the understanding of myocardial biology; it is now believed that bone marrow–derived cardiac stem cells or progenitor cells that have the ability to mature into cardiomyocytes may populate the heart after injury. The other options do not accurately describe the process that is believed to occur to address cardiac muscle damage.

 

PTS:   1                    REF:   Page 52 | What’s New box

 

  1. After ovulation, the uterine endometrial cells divide under the influence of estrogen. This process is an example of hormonal:
a. Hyperplasia c. Hypertrophy
b. Dysplasia d. Anaplasia

 

 

ANS:  A

Hormonal hyperplasia chiefly occurs in estrogen-dependent organs, such as the uterus and breast. After ovulation, for example, estrogen stimulates the endometrium to grow and thicken for reception of the fertilized ovum. The other options do not accurately describe the process identified in the question.

 

PTS:   1                    REF:   Pages 51-53

 

  1. The abnormal proliferation of cells in response to excessive hormonal stimulation is called:
a. Dysplasia c. Hyperplasia
b. Pathologic dysplasia d. Pathologic hyperplasia

 

 

ANS:  D

Pathologic hyperplasia is the abnormal proliferation of normal cells and can occur as a response to excessive hormonal stimulation or the effects of growth factors on target cells (see Figure 2-4). The other options do not accurately identify the term for the results of excessive hormonal stimulation on cells.

 

PTS:   1                    REF:   Page 53

 

  1. Removal of part of the liver leads to the remaining liver cells undergoing compensatory:
a. Atrophy c. Hyperplasia
b. Metaplasia d. Dysplasia

 

 

ANS:  C

Compensatory hyperplasia is an adaptive mechanism that enables certain organs to regenerate. For example, the removal of part of the liver leads to hyperplasia of the remaining liver cells (hepatocytes) to compensate for the loss. The other options do not accurately identify the compensatory process described in the question.

 

PTS:   1                    REF:   Pages 52-53

 

  1. What is the single most common cause of cellular injury?
a. Hypoxic injury c. Infectious injury
b. Chemical injury d. Genetic injury

 

 

ANS:  A

Hypoxia, or lack of sufficient oxygen, is the single most common cause of cellular injury (see Figure 2-8). The other options are not a commonly observed as is the correct option.

 

PTS:   1                    REF:   Page 56

 

  1. During cell injury caused by hypoxia, sodium and water move into the cell because:
a. Potassium moves out of the cell, and potassium and sodium are inversely related.
b. The pump that transports sodium out of the cell cannot function because of a decrease in ATP levels.
c. The osmotic pressure is increased, which pulls additional sodium across the cell membrane.
d. Oxygen is not available to bind with sodium to maintain it outside of the cell.

 

 

ANS:  B

A reduction in ATP levels causes the plasma membrane’s sodium-potassium (Na+–K+) pump and sodium-calcium exchange to fail, which leads to an intracellular accumulation of sodium and calcium and diffusion of potassium out of the cell. (The Na+–K+ pump is discussed in Chapter 1.)

 

PTS:   1                    REF:   Page 57

 

  1. In decompression sickness, emboli are formed by bubbles of:
a. Oxygen c. Carbon monoxide
b. Nitrogen d. Hydrogen

 

 

ANS:  B

If water pressure is too rapidly reduced, the gases dissolved in blood bubble out of the solution, forming emboli. Oxygen is quickly redissolved, but nitrogen bubbles may persist and obstruct blood vessels. Ischemia, resulting from gas emboli, causes cellular hypoxia, particularly in the muscles, joints, and tendons, which are especially susceptible to changes in oxygen supply. The remaining options are not involved in the formation of decompression sickness emboli.

 

PTS:   1                    REF:   Page 77

 

  1. Which is an effect of ionizing radiation exposure?
a. Respiratory distress c. DNA aberrations
b. Sun intolerance d. Death

 

 

ANS:  C

The effects of ionizing radiation may be acute or delayed. Acute effects of high doses, such as skin redness, skin damage, or chromosomal aberrations, occur within hours, days, or months. The delayed effects of low doses may not be evident for years. The other options are not commonly considered effects of radiation exposure.

 

PTS:   1                    REF:   Pages 78-79

 

  1. What is an example of compensatory hyperplasia?
a. Hepatic cells increase cell division after part of the liver is excised.
b. Skeletal muscle cells atrophy as a result of paralysis.
c. The heart muscle enlarges as a result of hypertension.
d. The size of the uterus increases during pregnancy.

 

 

ANS:  A

Compensatory hyperplasia is an adaptive mechanism that enables certain organs to regenerate. For example, the removal of part of the liver leads to hyperplasia of the remaining liver cells (hepatocytes) to compensate for the loss. The other options do not accurately describe the term compensatory hyperplasia.

 

PTS:   1                    REF:   Pages 52-53

 

  1. It is true that nondividing cells are:
a. Found in gastrointestinal lining c. Incapable of synthesizing DNA
b. Affected by hyperplasia d. Affected by only hypertrophy

 

 

ANS:  A

Gastrointestinal lining is made up of rapidly dividing cells. Hyperplasia and hypertrophy take place if the cells are capable of synthesizing DNA; however, only hypertrophy occurs in nondividing cells.

 

PTS:   1                    REF:   Pages 51-53

 

  1. Dysplasia refers to a(n):
a. Abnormal increase in the number of a specific cell type
b. True adaptive process at the cellular level
c. Modification in the shape of a specific cell type
d. Lack of oxygen at the cellular level

 

 

ANS:  C

Dysplasia refers only to abnormal changes in the size, shape, and organization of mature cells.

 

PTS:   1                    REF:   Pages 53-54

 

  1. Current research has determined that chemical-induced cellular injury:
a. Affects the permeability of the plasma membrane.
b. Is often the result of the damage caused by reactive free radicals.
c. Is rarely influenced by lipid peroxidation.
d. Seldom involves the cell’s organelles.

 

 

ANS:  B

Not all the mechanisms causing chemical-induced membrane destruction are known; however, the only two general mechanisms currently accepted include: (1) direct toxicity by combining with a molecular component of the cell membrane or organelles, and (2) reactive free radicals and lipid peroxidation.

 

PTS:   1                    REF:   Pages 62-63

 

MULTIPLE RESPONSE

 

  1. Which organs are affected by lead consumption? (Select all that apply.)
a. Bones
b. Muscles
c. Pancreas
d. Nerves
e. Eyes

 

 

ANS:  A, D

The only organ systems provided as options that are primarily affected by lead include the nervous system, bones, kidneys, teeth, cardiovascular, and reproductive and immune systems.

 

PTS:   1                    REF:   Page 66

 

  1. What effect does fetal alcohol syndrome have on newborns? (Select all that apply.)
a. Failure of alveoli to open
b. Cognitive impairment
c. Incompetent semilunar values
d. Esophageal stricture
e. Facial anomalies

 

 

ANS:  B, E

Fetal alcohol syndrome (FAS) can lead to growth restriction, cognitive impairment, facial anomalies, and ocular disturbances. The other options do not accurately describe the effects of FAS.

 

PTS:   1                    REF:   Page 69

 

  1. What organs are affected by the type of necrosis that results from either severe ischemia or chemical injury? (Select all that apply.)
a. Lungs
b. Brain
c. Kidneys
d. Muscles
e. Heart

 

 

ANS:  C, E

Coagulative necrosis, which occurs primarily in the kidneys, heart, and adrenal glands, is a common result of hypoxia from severe ischemia or hypoxia caused by chemical injury, especially the ingestion of mercuric chloride. The other options do not accurately identify organs affected by necrosis resulting from ischemia or chemical injury.

 

PTS:   1                    REF:   Page 90

 

  1. It is true that melanin is: (Select all that apply.)
a. Rarely found in epithelial cells
b. Found in cells called keratinocytes, which are present in the retina
c. A factor in the prevention of certain types of cancer
d. Most influential in managing the effects of short-term sunlight exposure
e. Accumulated in specific cells found in the skin

 

 

ANS:  B, C, E

Melanin accumulates in epithelial cells (keratinocytes) of the skin and retina and is an extremely important pigment because it protects the skin against long exposure to sunlight and is considered an essential factor in the prevention of skin cancer.

 

PTS:   1                    REF:   Pages 85-86

 

  1. Examples of adaptive cellular responses include: (Select all that apply.)
a. Atrophy
b. Dysplasia
c. Hypertrophy
d. Hyperplasia
e. Metaplasia

 

 

ANS:  A, C, D, E

Atrophy, hypertrophy, hyperplasia, and metaplasia are considered to be adaptive cellular responses.

 

PTS:   1                    REF:   Page 50

 

  1. Blunt force injuries would include a: (Select all that apply.)
a. Bruise to the upper arm, resulting from a fall
b. Simple tibia fracture sustained in a skiing accident
c. Cut on the finger while slicing vegetables for a salad
d. Spleen laceration caused by a punch during a physical fight
e. Small caliber gunshot wound to the foot while target shooting

 

 

ANS:  A, B, D

Blunt force injuries are the result of tearing, shearing, or crushing types of injuries, resulting in bruises, fractures, and lacerations caused by blows or impacts. Sharp force injuries include cuts. Gunshot wounds require the penetration of the skin and muscle by a bullet.

 

PTS:   1                    REF:   Page 72 | Table 2-6

 

  1. Which statements are true regarding the effects of marijuana use? (Select all that apply.)
a. Smoking the drug results in greater absorption that eating it.
b. Heavy use can result in psychomotor impairments.
c. Smoking four “joints” a day equals smoking approximately 20 cigarettes.
d. Research does not support marijuana use as a factor in developing lung cancer.
e. Fetal development appears to be unharmed by marijuana use.

 

 

ANS:  A, B, C

With marijuana smoking, approximately 50% of the potent agents are absorbed through the lungs; when marijuana is ingested, however, only 10% is absorbed. With heavy marijuana use, the following adverse effects have been reported: (1) alterations of sensory perceptions, cognitive and psychomotor impairment (e.g., inability to judge time, speed, distance); (2) smoking three or four joints per day is similar to smoking 20 cigarettes per day, in relation to the frequency of chronic bronchitis and may contribute to lung cancer; (3) data from animal studies only, indicate reproductive changes that include reduced fertility, decreased sperm motility, and decreased circulatory testosterone; (4) fetal abnormalities including low birth weight and increased frequency of childhood leukemia; (5) increased frequency of infectious illness, which is thought to be the result of depressed cell-mediated and humoral immunity.

 

PTS:   1                    REF:   Page 70 | Table 2-5

 

 

Chapter 16: Pain, Temperature Regulation, Sleep, and Sensory Function

 

MULTIPLE CHOICE

 

  1. Pricking one’s finger with a needle would cause minimal pain, whereas experiencing abdominal surgery would produce more pain. This distinction is an example of which pain theory?
a. Gate control theory c. Specificity theory
b. Intensity theory d. Pattern theory

 

 

ANS:  C

According to the specificity theory, a direct relationship exists between the intensity of pain and the extent of tissue injury. The remaining options are not related to the intensity of perceived pain.

 

PTS:   1                    REF:   Page 485

 

  1. Which pain theory proposes that a balance of impulses conducted from the spinal cord to the higher centers in the central nervous system (CNS) modulates the transmission of pain?
a. GCT c. Specificity theory
b. Pattern theory d. Neuromatrix theory

 

 

ANS:  A

Only the gate control theory (GCT) explains that a balance of impulses conducted to the spinal cord, where cells in the substantia gelatinosa function as a spinal gate, regulates pain transmission to higher centers in the CNS.

 

PTS:   1                    REF:   Page 485

 

  1. Which type of nerve fibers transmits pain impulses?
a. A-alpha (Aa) fibers c. A-delta (Ad) fibers
b. A-beta (Ab) fibers d. B fibers

 

 

ANS:  C

Of the available options, only medium-sized Ad fibers transmit pain impulses.

 

PTS:   1                    REF:   Page 486

 

  1. Where are the primary-order pain transmitting neurons located within the spinal cord?
a. Lateral root ganglia c. Anterior root ganglia
b. Dorsal root ganglia d. Medial root ganglia

 

 

ANS:  B

The cell bodies of the primary-order neurons, or pain-transmitting neurons, reside only in the dorsal root ganglia just lateral to the spine along the sensory pathways that penetrate the posterior part of the cord.

 

PTS:   1                    REF:   Page 487

 

  1. The gate in the GCT of pain is located in the:
a. Substantia gelatinosa c. Nucleus proprius
b. Marginal layer d. Dorsolateral tract of Lissauer

 

 

ANS:  A

The synaptic connections between the cells of the primary- and secondary-order neurons located in the substantia gelatinosa and other Rexed laminae function as a pain gate. The remaining options do not act in this function.

 

PTS:   1                    REF:   Page 487

 

  1. Which spinal tract carries the most nociceptive information?
a. Archeospinothalamic c. Dorsal spinothalamic
b. Paleospinothalamic d. Lateral spinothalamic

 

 

ANS:  D

Most nociceptive information travels by means of ascending columns in the lateral spinothalamic tract (also called the anterolateral funiculus). The other tract options do not carry the most nociceptive information.

 

PTS:   1                    REF:   Page 487

 

  1. The major relay station of sensory information is located in the:
a. Basal ganglia c. Thalamus
b. Midbrain d. Hypothalamus

 

 

ANS:  C

Although the organization of all of the ascending tracts is complex, the principal target for nociceptive afferents is the thalamus, which, in general, is the major relay station of sensory information. The remaining options do not fulfill this objective.

 

PTS:   1                    REF:   Page 487

 

  1. Where in the CNS does a person’s learned pain response occur?
a. Cerebral cortex c. Thalamus
b. Frontal lobe d. Limbic system

 

 

ANS:  A

The cognitive-evaluative system overlies the individual’s learned behavior concerning the experience of pain and can modulate the perception of pain and is mediated only through the cerebral cortex.

 

PTS:   1                    REF:   Page 487

 

  1. Massage therapy relieves pain by closing the pain gate with the stimulation which fibers?
a. Ab c. B
b. Ad d. C

 

 

ANS:  A

Massaging stimulates different Ab fibers to close the pain gate. The remaining options do not fulfill this objective.

 

PTS:   1                    REF:   Page 485

 

  1. What part of the brain provides the emotional response to pain?
a. Limbic system c. Thalamus
b. Parietal lobe d. Hypothalamus

 

 

ANS:  A

The limbic and reticular tracts are involved in alerting the body to danger, initiating arousal of the organism, and emotionally processing the perceived afferent signals, not just as stimuli, but also as pain. The remaining options do not fulfill this objective.

 

PTS:   1                    REF:   Page 487

 

  1. Which neurotransmitters inhibit pain in the medulla and pons?
a. Norepinephrine and serotonin
b. Gamma-aminobutyric acid (GABA) and aspartate
c. Glutamate and tumor necrosis factor–alpha
d. Neurokinin A and nitric oxide

 

 

ANS:  A

Norepinephrine and serotonin (5-hydroxytryptamine) contribute to pain modulation (inhibition) in the medulla and pons. The remaining options do not fulfill this objective.

 

PTS:   1                    REF:   Page 490

 

  1. Which endogenous opioid is located in the hypothalamus and pituitary and is a strong m-receptor agonist?
a. Enkephalins c. Dynorphins
b. Endorphins d. Endomorphins

 

 

ANS:  B

The synthesis and activity of b-endorphin is concentrated in the hypothalamus and the pituitary gland and act as strong µ-receptor agonist. The remaining options do not fulfill this objective.

 

PTS:   1                    REF:   Page 491

 

  1. What is the term that denotes the duration of time or the intensity of pain that a person will endure before outwardly responding?
a. Tolerance c. Threshold
b. Perception d. Dominance

 

 

ANS:  A

Pain tolerance is the duration of time or the intensity of pain that an individual will endure before initiating overt pain responses. The other options are not related to the duration or intensity of pain endured before the pain is recognized.

 

PTS:   1                    REF:   Page 491

 

  1. Pain that warns of actual or impending tissue injury is referred to as what?
a. Chronic c. Acute
b. Psychogenic d. Phantom

 

 

ANS:  C

Acute pain is a protective mechanism that alerts the individual to a condition or experience that is immediately harmful to the body. The remaining options do not fulfill this objective.

 

PTS:   1                    REF:   Pages 491-492

 

  1. Which description characterizes visceral pain?
a. Is sharp and well-defined when transmitted by A-delta (Ad)  fibers.
b. Is perceived as poorly localized and is transmitted by the sympathetic nervous system.
c. Arises from connective tissue, muscle, bone, or skin.
d. Is perceived as dull, aching, and poorly localized when transmitted by C fibers.

 

 

ANS:  B

Of the options provided, only visceral pain refers to pain in internal organs and the abdomen and is transmitted by sympathetic afferents. Visceral pain is poorly localized because of fewer nociceptors in the visceral structures.

 

PTS:   1                    REF:   Page 492

 

  1. When caring for a person who has experienced pain for 3 days, anxiety is likely to produce which physical signs that a nurse would expect to find?
a. Fever and muscle weakness or reports of fatigue
b. Irritability and depression or reports of constipation
c. Decreased blood pressure or reports of fatigue
d. Increased heart rate and respiratory rate with diaphoresis

 

 

ANS:  D

Anxiety is common in acute pain states and is usually apparent in the alterations of vital signs and can include elevation of blood sugar levels, decreases in gastric acid secretion and intestinal motility, and a general decrease in blood flow to the viscera and skin. Nausea occasionally occurs. The other symptoms are not generally associated with an anxiety response to acute pain.

 

PTS:   1                    REF:   Pages 491-492

 

  1. Enkephalins and endorphins act to relieve pain by which process?
a. Inhibiting cells in the substantia gelatinosa
b. Stimulating the descending efferent nerve fibers
c. Attaching to opiate receptor sites
d. Blocking transduction of nociceptors

 

 

ANS:  C

Enkephalins and endorphins are neurohormones that act as neurotransmitters by binding to one or more G protein–coupled opioid receptors and thus relieving pain. The other options are not accurate descriptions of how enkephalins and endorphins relieve pain.

 

PTS:   1                    REF:   Pages 490-491

 

  1. What is a long-term complication of rewarming as a treatment for hypothermia?
a. Acidosis c. Shock
b. Dysrhythmias d. Renal failure

 

 

ANS:  D

Rewarming can result in long-term complications that include congestive heart failure, hepatic and renal failure, abnormal erythropoiesis, myocardial infarction, pancreatitis, and neurologic dysfunctions. Short-term complications of rewarming include acidosis, rewarming shock, and dysrhythmias.

 

PTS:   1                    REF:   Page 501

 

  1. How does the release (increase) of epinephrine raise body temperature?
a. The release of epinephrine causes shivering.
b. It affects muscle tone.
c. It raises the metabolic rate.
d. It increases and strengthens the heart rate.

 

 

ANS:  C

Epinephrine and norepinephrine produce a rapid transient increase in heat production by raising the body’s basal metabolic rate. The other options are not correct descriptions of the effects of epinephrine on body heat.

 

PTS:   1                    REF:   Page 496

 

  1. Using a fan to reduce body temperature is an example of which mechanism of heat loss?
a. Evaporation c. Convection
b. Radiation d. Conduction

 

 

ANS:  C

Only convection causes the transfer of heat through currents of gases or liquids.

 

PTS:   1                    REF:   Page 497

 

  1. Up to how many liters of fluid per hour may be lost by sweating?
a. 2 c. 6
b. 4 d. 8

 

 

ANS:  A

Sweating may cause as much as 2.2 L of fluid per hour to be lost.

 

PTS:   1                    REF:   Page 497

 

  1. Heat loss from the body via radiation occurs by:
a. Emanations of electromagnetic waves
b. Transfer of heat through currents of liquids or gas
c. Dilation of blood vessels bringing blood to skin surfaces
d. Direct heat loss from molecule-to-molecule transfer

 

 

ANS:  A

Radiation refers to heat loss through electromagnetic waves. None of the other options accurately describes heat loss via radiation.

 

PTS:   1                    REF:   Page 497

 

  1. Which cytokines are endogenous pyrogens?
a. IL-3, IL-10, and IL-18
b. IL-2, IL-8, and IFN-b
c. IL-4, IL-12, colony-stimulating factor, and IFN-a
d. IL-1, IL-6, TNF-a, and IFN-g

 

 

ANS:  D

Endogenous pyrogens include prostaglandin E2 (PGE2), interleukin-1 (IL-1), IL-6, tumor necrosis factor–alpha (TNF-a), and interferon-gamma (IFN-g). The other options are not endogenous pyrogens.

 

PTS:   1                    REF:   Page 498

 

  1. Which hormones help diminish the febrile response?
a. Arginine vasopressin (AVP), melanocyte-stimulating hormone-alpha (a-MSH), and corticotropin-releasing factor
b. Adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone, and thyroxine (T4)
c. Antidiuretic hormone, growth hormone, and aldosterone
d. None; hormones only facilitate the increase of core body temperature.

 

 

ANS:  A

During fever, AVP, a-MSH, and corticotropin-releasing factors are released from the brain, and antiinflammatory cytokines (e.g., IL-1, IL-10) can act as endogenous cryogens or antipyretics to help diminish the febrile response. The other options are not hormones that diminish the febrile response.

 

PTS:   1                    REF:   Page 498

 

  1. Prolonged high environmental temperatures that produce dehydration, decreased plasma volumes, hypotension, decreased cardiac output, and tachycardia cause which disorder of temperature regulation?
a. Heat cramps c. Malignant hyperthermia
b. Heat stroke d. Heat exhaustion

 

 

ANS:  D

Of the options presented, only heat exhaustion, or collapse, is a result of prolonged high core or environmental temperatures resulting in dehydration, decreased plasma volumes, hypotension, decreased cardiac output, and tachycardia.

 

PTS:   1                    REF:   Page 500

 

  1. In acute hypothermia, what physiologic change shunts blood away from the colder skin to the body core in an effort to decrease heat loss?
a. Hypotension c. Voluntary muscle movements
b. Peripheral vasoconstriction d. Shivering

 

 

ANS:  B

Tissue hypothermia slows the rate of chemical reactions (tissue metabolism), increases the viscosity of the blood, slows blood flow through microcirculation, facilitates blood coagulation, and stimulates profound vasoconstriction. The remaining options do not fulfill this objective.

 

PTS:   1                    REF:   Page 501

 

  1. A heat stroke is characterized by:
a. Core temperatures usually reaching approximately 39.9° C (103.9° F)
b. Sweat production on the face occurring even during dehydration
c. A rapidly decreasing core temperature as heat loss from the evaporation of sweat ceases
d. Symptoms caused by the loss of sodium and prolonged sweating

 

 

ANS:  B

When the core temperature reaches or exceeds 40.5° C (104.9° F), the brain may be preferentially cooled by maximal blood flow through the veins of the head and face, specifically the forehead. Sweat production on the face is maintained even during dehydration. The remaining options do not occur during heat stroke.

 

PTS:   1                    REF:   Page 500

 

  1. Which medication is used to reverse the effects of malignant hyperthermia?
a. Propranolol c. Dantrolene sodium
b. Diazepam d. Sodium carbonate

 

 

ANS:  C

Treatment includes the withdrawal of the provoking agents and the administration of dantrolene sodium (a skeletal relaxant that inhibits calcium release during muscle contraction). The other options are not effective in the treatment of malignant hyperthermia.

 

PTS:   1                    REF:   Pages 500-501

 

  1. The major sleep center is located in which section of the brain?
a. Thalamus c. Frontal lobe
b. Brainstem d. Hypothalamus

 

 

ANS:  D

A small group of hypothalamic nerve cells, the suprachiasmatic nucleus (SCN), controls the timing of the sleep-wake cycle and coordinates this cycle with circadian rhythms (24-hour rhythm cycles) in areas of the brain and other tissues. The remaining options do not fulfill this objective.

 

PTS:   1                    REF:   Pages 502-503

 

  1. Which neuropeptide promotes wakefulness?
a. Prostaglandin D2 c. Hypocretins
b. L-tryptophan d. Growth factors

 

 

ANS:  C

The hypothalamus, as a major sleep center, secretes hypocretins (orexins), which are neuropeptides that promote wakefulness and rapid eye movement (REM) sleep, as well as appetite, energy consumption, and pleasure or reward. The remaining options do not fulfill this objective.

 

PTS:   1                    REF:   Page 503

 

  1. Which term is also used to refer to paradoxic sleep?
a. Non-REM c. REM
b. Light d. Delta wave

 

 

ANS:  C

REM sleep is also known as paradoxic sleep because the electroencephalographic (EEG) pattern is similar to the normal awake pattern. None of the other terms are used to identify paradoxic sleep.

 

PTS:   1                    REF:   Page 503

 

  1. The sudden apparent arousal in which a child expresses intense fear or another strong emotion while still in a sleep state characterizes which sleep disorder?
a. Night terrors c. Somnambulism
b. Insomnia d. Enuresis

 

 

ANS:  A

Three types of parasomnias include arousal disorders such as confusional arousals, sleepwalking (somnambulism), and night terrors (dream anxiety attacks). The remaining options do not involve a sense or expression of fear or any other strong emotion.

 

PTS:   1                    REF:   Page 505

 

  1. Coronary artery disease is most affected by which component of sleep?
a. Non-REM c. REM
b. Light d. Delta wave

 

 

ANS:  C

Coronary artery disease is most affected during rapid eye movement (REM) sleep. During this component of sleep, dreams may provoke nocturnal angina, increased heart rate, and electrocardiographic (ECG) changes. The other options are not associated with coronary artery disease.

 

PTS:   1                    REF:   Page 506

 

  1. Rapid eye movement (REM) sleep occurs in cycles approximately every:
a. 45 minutes c. 120 minutes
b. 90 minutes d. 150 minutes

 

 

ANS:  B

REM sleep accounts for 20% to 25% of sleep time and is characterized by desynchronized, low-voltage, fast activity that occurs for 5 to 60 minutes approximately every 90 minutes, beginning after 1 to 2 hours of non-REM sleep.

 

PTS:   1                    REF:   Page 503

 

  1. Loud snoring, a decrease in oxygen saturation, fragmented sleep, chronic daytime sleepiness, and fatigue are clinical manifestations of which sleep disorder?
a. Obstructive sleep apnea c. Somnambulism
b. Upper airway resistance syndrome d. Narcolepsy

 

 

ANS:  A

Obstructive sleep apnea is characterized by repetitive increases in resistance to airflow within the upper airway with loud snoring, gasping, intervals of apnea lasting from 10 to 30 seconds, fragmented sleep, and chronic daytime sleepiness and fatigue, as well as a decrease in oxygen saturation. The remaining options do not exhibit the signs and symptoms listed in the stem.

 

PTS:   1                    REF:   Page 504

 

  1. What are the expected changes in sleep patterns of older adults?
a. Older adults experience difficulty falling asleep with less time spent in REM sleep.
b. They experience sound sleep during the night with approximately 50% of the time spent in REM sleep and dreaming.
c. Older men commonly experience interrupted sleep patterns later in life than do older women.
d. Older adults awaken often but with a rapid return to sleep; they awaken refreshed but often later in the morning.

 

 

ANS:  A

The sleep pattern of the older adult differs from the younger adult in that total sleep time is decreased, and the older individual takes longer to initiate and maintain sleep. Older adults tend to go to sleep earlier in the evening and awaken more frequently during the night and earlier in the morning. Rapid eye movement (REM) and slow-wave sleep decreases. The alteration in sleep pattern typically appears approximately 10 years later in women than it does in men.

 

PTS:   1                    REF:   Page 504

 

  1. Pinkeye is characterized by inflammation of which structure?
a. Eyelids c. Meibomian glands
b. Sebaceous glands d. Conjunctiva

 

 

ANS:  D

Acute bacterial conjunctivitis (pinkeye) is an inflammation of the conjunctiva (mucous membrane covering the front part of the eyeball). The other structures are not affected by this inflammation.

 

PTS:   1                    REF:   Page 507

 

  1. Open-angle glaucoma occurs because of:
a. Decreased production of aqueous humor
b. Increased production of vitreous humor
c. Obstructed outflow of aqueous humor
d. Excessive destruction of vitreous humor

 

 

ANS:  C

Open-angle glaucoma occurs because of an obstruction of the outflow of aqueous humor at trabecular meshwork or Schlemm canal. The remaining options fail to accurately describe the cause of open-angle glaucoma.

 

PTS:   1                    REF:   Page 511 | Table 16-5

 

  1. How can glaucoma cause blindness?
a. Infection of the cornea
b. Pressure on the optic nerve
c. Opacity of the lens
d. Obstruction of the venous return from the retina

 

 

ANS:  B

Loss of visual acuity as a result of pressure on the optic nerve is the only reason glaucoma can result in blindness.

 

PTS:   1                    REF:   Pages 510-511

 

  1. When comparing the effects of acute and chronic pain on an individual, chronic pain is more often:
a. The external event that results in a sense of fear
b. Viewed as being meaningful but undesirable
c. A factor that contributes to depression
d. A sense of internal unease

 

 

ANS:  C

Chronic pain is often associated with a sense of hopelessness and helplessness as relief becomes more elusive and the timeframe more protracted. The pain is perceived as meaningless, and depression is often a concomitant finding, as either a result of the chronic pain state or as a contributor to its development. Individuals often psychologically respond to acute pain with fear (e.g., fear of diagnosis, fear of continued pain), anxiety, and a general sense of unpleasantness or unease.

 

PTS:   1                    REF:   Page 492

 

  1. When considering the risk factors for the development of phantom limb pain, the nurse recognizes which as a primary contributing factor?
a. Age, with adolescent patients being at a higher risk than adults
b. Presence of pain in the limb before amputation
c. Patient’s previous experience with managing pain
d. Cultural views regarding the acceptance of pain

 

 

ANS:  B

Phantom limb pain is pain that an individual feels in an amputated limb after the stump has completely healed. It is more likely to appear in individuals who experienced pain in the limb before amputation. The other options would not be considered a primary contributing factors.

 

PTS:   1                    REF:   Page 494

 

  1. Based on an understanding of the physiologic process of nociceptors, the nurse expects which surgical procedure to create more pain?
a. Repair of several crushed fingers
b. External fixation of a dislocated shoulder
c. Cyst removal on the internal surface of an ovary
d. Repair of a ruptured spleen

 

 

ANS:  A

The variable nature and distribution of nociceptors affect the relative sensitivity to pain in different areas of the body; the tips of the fingers have more nociceptors than the skin on the back, and all skin has many more nociceptors than the internal organs including bone.

 

PTS:   1                    REF:   Pages 485-486

 

  1. The basis of the specificity theory of pain is that:
a. Injury to specific organs results in specific types of pain.
b. Chronic pain is generally less intense than acute pain.
c. The greater the tissue injury, the greater the pain.
d. Acute pain is specific only to certain injuries.

 

 

ANS:  C

According to the specificity theory, a direct relationship exists between the intensity of pain and the extent of tissue injury. The remaining options are not accurate statements regarding this pain theory.

 

PTS:   1                    REF:   Page 485

 

  1. Which statement is true regarding the gate control theory (GCT) of pain?
a. The pain gate is located in the brain.
b. A closed gate increases pain perception.
c. The brain primarily controls the pain gate.
d. An open gate facilitates the brain in processing the pain.

 

 

ANS:  D

The open gate in the spinal cord regulates the transmission of pain impulses that ascend to the brain for further processing and interpretation, thus leading to the management of pain. The remaining statements are not true when discussing the GCT of pain.

 

PTS:   1                    REF:   Page 485

 

MULTIPLE RESPONSE

 

  1. Which factors contribute to sensorineural hearing loss? (Select all that apply.)
a. Ménière disease
b. Aging
c. Diabetes mellitus
d. Noise exposure
e. Outer ear trauma

 

 

ANS:  A, B, C, D

Impairment of the organ of Corti or its central connections causes a sensorineural hearing loss. The hearing loss may be gradual or sudden. Conditions that commonly cause sensorineural hearing loss include congenital and hereditary factors, noise exposure, aging, Ménière disease, ototoxicity, and systemic disease (e.g., syphilis, Paget disease, collagen diseases, diabetes mellitus). Outer ear trauma is not a typical cause of sensorineural hearing loss.

 

PTS:   1                    REF:   Page 517

 

  1. Why are children more susceptible to heat stroke than are adults? (Select all that apply.)
a. Children produce more metabolic heat when exercising.
b. They have more surface area–to-mass ratio.
c. Children have less sweating capacity.
d. They an underdeveloped hypothalamus.
e. Children have an overdeveloped ability to perceive heat.

 

 

ANS:  A, B, C

Children are more susceptible to heat stroke than are adults because (1) they produce more metabolic heat when exercising, (2) they have a greater surface area–to-mass ratio, and (3) their sweating capacity is less than that of adults. The remaining options are not true of a child.

 

PTS:   1                    REF:   Page 500

 

  1. Heat exhaustion results in: (Select all that apply.)
a. Profuse sweating
b. Profound vasodilation
c. A need to ingest warm liquids
d. Permanent damage to the hypothalamus
e. An increased risk for future heat exhaustion

 

 

ANS:  A, B, C

Internally high temperatures cause the appropriate hypothalamic response of profound vasodilation and profuse sweating. The individual should be encouraged to drink warm fluids to replace fluid lost through sweating. Heat exhaustion is a result of prolonged high core or environmental temperatures that are unique to each incidence.

 

PTS:   1                    REF:   Page 500

 

  1. It is true that a fever: (Select all that apply.)
a. Is a complex cascade involving several different systems.
b. Can be a result of a dysfunctional hypothalamus.
c. Should be eliminated as quickly as possible.
d. Triggers endocrine responses.
e. Is in response to a pyrogen.

 

 

ANS:  A, B, D, E

Fever is a complex, integrated cascade of behavioral, neurologic, and endocrine responses to an immune challenge initiated by endogenous pyrogens or disorders of the hypothalamus. Fever production aids responses to infectious processes through several mechanisms and should be interrupted only when it might present an additional risk to the individual.

 

PTS:   1                    REF:   Pages 498-500

 

MATCHING

 

Match the types of chronic pain with its description. Types of pain may be used more than once.

______ A. Myofascial pain syndrome

______ B. Neuropathic pain

______ C. Deafferentation pain

______ D. Sympathetically maintained pain

 

  1. Pain that results from tumor infiltration of nerve tissue, from trauma or chemical injury to the nerve, or from damage from radiation, chemotherapy, or surgical sectioning of the nerve

 

  1. Pain that is thought to be caused by trauma or disease of nerves and leads to abnormal processing of sensory information by the peripheral and central nervous systems

 

  1. Pain that occurs after peripheral nerve injury and is described as continuous with severe sensations and a burning quality

 

  1. Pain that is the result of muscle spasms, tenderness, and stiffness and leads to muscle guarding that limits muscle motion

 

  1. ANS:  C                    PTS:   1                    REF:   Page 494

MSC:  Deafferentation pain results from trauma or chemical injury to the peripheral nervous system, from tumor infiltration of nerve tissue, or from damage from radiation, chemotherapy, or surgical sectioning of a nerve with the loss of sensory input to the central nervous system.

 

  1. ANS:  B                    PTS:   1                    REF:   Page 494

MSC:  Neuropathic pain is the result of trauma or disease of nerves and leads to abnormal processing of sensory information by the peripheral and central nervous systems.

 

  1. ANS:  D                    PTS:   1                    REF:   Pages 494-495

MSC:  Sympathetically maintained pain (SMP) is another type of neuropathic pain that occurs after peripheral nerve or extremity injury and is characterized as continuous and severe with a burning quality.

 

  1. ANS:  A                    PTS:   1                    REF:   Pages 492-493

MSC:  Myofascial pain syndrome (MPS) is associated with injury to muscle, fascia, and tendons.

 

 

Chapter 32: Alterations of Cardiovascular Function

 

MULTIPLE CHOICE

 

  1. What is the initiating event that leads to the development of atherosclerosis?
a. Release of the inflammatory cytokines
b. Macrophages adhere to vessel walls.
c. Injury to the endothelial cells that line the artery walls
d. Release of the platelet-deprived growth factor

 

 

ANS:  C

Atherosclerosis begins with an injury to the endothelial cells that line the arterial walls. Possible causes of endothelial injury include the common risk factors for atherosclerosis, such as smoking, hypertension, diabetes, increased levels of low-density lipoprotein (LDL), decreased levels of high-density lipoprotein (HDL), and autoimmunity. The remaining options occur only after the endothelial cells are injured.

 

PTS:   1                    REF:   Page 1145

 

  1. What is the effect of oxidized low-density lipoproteins (LDLs) in atherosclerosis?
a. LDLs cause smooth muscle proliferation.
b. LDLs cause regression of atherosclerotic plaques.
c. LDLs increase levels of inflammatory cytokines.
d. LDLs direct macrophages to the site in the endothelium.

 

 

ANS:  A

Oxidized LDLs are toxic to endothelial cells, cause smooth muscle proliferation, and activate further immune and inflammatory responses. This selection is the only option that accurately identifies the effects of LDLs.

 

PTS:   1                    REF:   Page 1145

 

  1. Which inflammatory cytokines are released when endothelial cells are injured?
a. Granulocyte-macrophage colony-stimulating factor (GM-CSF)
b. Interferon-beta (IFN-b), interleukin 6 (IL-6), and granulocyte colony-stimulating factor (G-CSF)
c. Tumor necrosis factor–alpha (TNF-a), interferon-gamma (IFN-g), and interleukin 1 (IL-1)
d. Interferon-alpha (IFN-a), interleukin-12 (IL-12), and macrophage colony-stimulating factor (M-CSF)

 

 

ANS:  C

Numerous inflammatory cytokines are released, including TNF-a, IFN-g, IL-1, toxic oxygen radicals, and heat shock proteins. This selection is the only option that accurately identifies which inflammatory cytokines are associated with endothelial cell injury.

 

PTS:   1                    REF:   Page 1145

 

  1. When endothelia cells are injured, what alteration contributes to atherosclerosis?
a. The release of toxic oxygen radicals that oxidize low-density lipoproteins (LDLs).
b. Cells are unable to make the normal amount of vasodilating cytokines.
c. Cells produce an increased amount of antithrombotic cytokines.
d. Cells develop a hypersensitivity to homocysteine and lipids.

 

 

ANS:  B

Injured endothelial cells become inflamed and cannot make normal amounts of antithrombotic and vasodilating cytokines. This selection is the only option that accurately identifies the factor that contributes to atherosclerosis.

 

PTS:   1                    REF:   Page 1145

 

  1. Which factor is responsible for the hypertrophy of the myocardium associated with hypertension?
a. Increased norepinephrine c. Angiotensin II
b. Adducin d. Insulin resistance

 

 

ANS:  C

Of the available options, only angiotensin II is responsible for the hypertrophy of the myocardium and much of the renal damage associated with hypertension.

 

PTS:   1                    REF:   Pages 1132-1138

 

  1. What pathologic change occurs to the kidney’s glomeruli as a result of hypertension?
a. Compression of the renal tubules
b. Ischemia of the tubule
c. Increased pressure from within the tubule
d. Obstruction of the renal tubule

 

 

ANS:  B

In the kidney, vasoconstriction and resultant decreased renal perfusion cause tubular ischemia and preglomerular arteriopathy. This selection is the only option that accurately identifies the pathologic change to the kidney that occurs as a result of hypertension.

 

PTS:   1                    REF:   Pages 1134-1136

 

  1. What effect does atherosclerosis have on the development of an aneurysm?
a. Atherosclerosis causes ischemia of the intima.
b. It increases nitric oxide.
c. Atherosclerosis erodes the vessel wall.
d. It obstructs the vessel.

 

 

ANS:  C

Atherosclerosis is a common cause of aneurysms because plaque formation erodes the vessel wall. This selection is the only option that accurately identifies the effect that atherosclerosis has on aneurysm development.

 

PTS:   1                    REF:   Pages 1141-1142

 

  1. Regarding the endothelium, what is the difference between healthy vessel walls and those that promote clot formation?
a. Inflammation and roughening of the endothelium of the artery are present.
b. Hypertrophy and vasoconstriction of the endothelium of the artery are present.
c. Excessive clot formation and lipid accumulation in the endothelium of the artery are present.
d. Evidence of age-related changes that weaken the endothelium of the artery are present.

 

 

ANS:  A

Invasion of the tunica intima by an infectious agent also roughens the normally smooth lining of the artery, causing platelets to adhere readily. This selection is the only option that accurately describes the mechanism that supports abnormal clot formation.

 

PTS:   1                    REF:   Pages 1142-1143

 

  1. What is the usual source of pulmonary emboli?
a. Deep venous thrombosis c. Valvular disease
b. Endocarditis d. Left heart failure

 

 

ANS:  A

Pulmonary emboli originate in the venous circulation (mostly from the deep veins of the legs) or in the right heart. This selection is the only option that accurately identifies the usual source of pulmonary emboli.

 

PTS:   1                    REF:   Page 1143

 

  1. Which factor can trigger an immune response in the bloodstream that may result in an embolus?
a. Amniotic fluid c. Bacteria
b. Fat d. Air

 

 

ANS:  A

Of the options available, only amniotic fluid displaces blood, thereby reducing oxygen, nutrients, and waste exchange; however, it also introduces antigens, cells, and protein aggregates that trigger inflammation, coagulation, and the immune response in the bloodstream.

 

PTS:   1                    REF:   Pages 1143-1144

 

  1. Which statement best describes thromboangiitis obliterans (Buerger disease)?
a. Inflammatory disorder of small- and medium-size arteries in the feet and sometimes in the hands
b. Vasospastic disorder of the small arteries and arterioles of the fingers and, less commonly, of the toes
c. Autoimmune disorder of the large arteries and veins of the upper and lower extremities
d. Neoplastic disorder of the lining of the arteries and veins of the upper extremities

 

 

ANS:  A

Buerger disease is an inflammatory disease of the peripheral arteries. Inflammation, thrombus formation, and vasospasm can eventually occlude and obliterate portions of small- and medium-size arteries. The digital, tibial, and plantar arteries of the feet and the digital, palmar, and ulnar arteries of the hands are typically affected. This selection is the only option that accurately describes Buerger disease.

 

PTS:   1                    REF:   Page 1144

 

  1. Which statement best describes Raynaud disease?
a. Inflammatory disorder of small- and medium-size arteries in the feet and sometimes in the hands
b. Neoplastic disorder of the lining of the arteries and veins of the upper extremities
c. Vasospastic disorder of the small arteries and arterioles of the fingers and, less commonly, of the toes
d. Autoimmune disorder of the large arteries and veins of the upper and lower extremities

 

 

ANS:  C

Attacks of vasospasm in the small arteries and arterioles of the fingers and, less commonly, of the toes characterize Raynaud phenomenon and Raynaud disease and is the only option that accurately describes this disease.

 

PTS:   1                    REF:   Page 1144

 

  1. What change in a vein supports the development of varicose veins?
a. Increase in osmotic pressure c. Damage to the venous endothelium
b. Damage to the valves in veins d. Increase in hydrostatic pressure

 

 

ANS:  B

If a valve is damaged, permitting backflow, then a section of the vein is subjected to the pressure exerted by a larger volume of blood under the influence of gravity. The vein swells as it becomes engorged, and the surrounding tissue becomes edematous because increased hydrostatic pressure pushes plasma through the stretched vessel wall. This selection is the only option that accurately describes the development of varicose veins.

 

PTS:   1                    REF:   Pages 1129-1130

 

  1. Superior vena cava syndrome is a result of a progressive increase of which process?
a. Inflammation c. Distention
b. Occlusion d. Sclerosis

 

 

ANS:  B

Superior vena cava syndrome (SVCS) is a progressive occlusion of the superior vena cava (SVC) that leads to venous distention in the upper extremities and head. The remaining options are not associated with this disorder.

 

PTS:   1                    REF:   Page 1131

 

  1. What term is used to identify when a cell is temporarily deprived of blood supply?
a. Infarction c. Necrosis
b. Ischemia d. Inflammation

 

 

ANS:  B

Coronary artery disease (CAD) can diminish the myocardial blood supply until deprivation impairs myocardial metabolism enough to cause ischemia, a local state in which the cells are temporarily deprived of blood supply. This term is the only option that is used to identify a temporarily deprived blood supply.

 

PTS:   1                    REF:   Page 1148

 

  1. The risk of developing coronary artery disease is increased up to threefold by which factor?
a. Diabetes mellitus c. Obesity
b. Hypertension d. High alcohol consumption

 

 

ANS:  B

Hypertension is the only factor responsible for a twofold-to-threefold increased risk of atherosclerotic cardiovascular disease.

 

PTS:   1                    REF:   Page 1151

 

  1. Which risk factor is associated with coronary artery disease (CAD) because of its relationship with the alteration of hepatic lipoprotein?
a. Diabetes mellitus c. Obesity
b. Hypertension d. High alcohol consumption

 

 

ANS:  A

Of the available options, only diabetes mellitus is associated with CAD because of the resulting alteration of hepatic lipoprotein synthesis; it increases triglyceride levels and is involved in low-density lipoprotein oxidation.

 

PTS:   1                    REF:   Pages 1148-1151

 

  1. Nicotine increases atherosclerosis by the release of which neurotransmitter?
a. Histamine c. Angiotensin II
b. Nitric oxide d. Epinephrine

 

 

ANS:  D

Nicotine stimulates the release of catecholamines (e.g., epinephrine, norepinephrine), which increases the heart rate and causes peripheral vascular constriction. As a result, blood pressure increases, as do both cardiac workload and oxygen demand. None of the other options are associated with this mechanism.

 

PTS:   1                    REF:   Page 1151

 

  1. Which substance is manufactured by the liver and primarily contains cholesterol and protein?
a. Very low–density lipoproteins (VLDLs)
b. Low-density lipoproteins (LDLs)
c. High-density lipoproteins (HDLs)
d. Triglycerides

 

 

ANS:  B

A series of chemical reactions in the liver results in the production of several lipoproteins that vary in density and function. These include VLDLs, primarily triglycerides and protein; LDLs, mostly cholesterol and protein; and HDLs, mainly phospholipids and protein. LDLs are the only lipoproteins that are manufactured by the liver and primarily contain cholesterol and protein.

 

PTS:   1                    REF:   Page 1149

 

  1. Which elevated value may be protective of the development of atherosclerosis?
a. Very low–density lipoproteins (VLDLs)
b. Low-density lipoproteins (LDLs)
c. High-density lipoproteins (HDLs
d. Triglycerides

 

 

ANS:  C

Low levels of HDL cholesterol are also a strong indicator of coronary risk, whereas high levels of HDLs may be more protective for the development of atherosclerosis than low levels of LDLs. Neither VLDLs nor elevated triglycerides are associated with a protective mechanism.

 

PTS:   1                    REF:   Pages 1149-1151

 

  1. Which laboratory test is an indirect measure of atherosclerotic plaque?
a. Homocysteine
b. Low-density lipoprotein (LDL)
c. Erythrocyte sedimentation rate (ESR)
d. C-reactive protein (CRP)

 

 

ANS:  D

Highly sensitive CRP (hs-CRP) is an acute phase reactant or protein mostly synthesized in the liver and, of the available options, is an indirect measure of atherosclerotic plaque-related inflammation.

 

PTS:   1                    REF:   Page 1152

 

  1. Cardiac cells can withstand ischemic conditions and still return to a viable state for how many minutes?
a. 10 c. 20
b. 15 d. 25

 

 

ANS:  C

Cardiac cells remain viable for approximately 20 minutes under ischemic conditions. If blood flow is restored, then aerobic metabolism resumes, contractility is restored, and cellular repair begins. If the coronary artery occlusion persists beyond 20 minutes, then myocardial infarction (MI) occurs.

 

PTS:   1                    REF:   Page 1153

 

  1. Which form of angina occurs most often during sleep as a result of vasospasms of one or more coronary arteries?
a. Unstable c. Silent
b. Stable d. Prinzmetal

 

 

ANS:  D

Of the options available, only Prinzmetal angina (also called variant angina) is chest pain attributable to transient ischemia of the myocardium that occurs unpredictably and almost exclusively at rest.

 

PTS:   1                    REF:   Page 1154

 

  1. When is the scar tissue that is formed after a myocardial infarction (MI) most vulnerable to injury?
a. Between 5 and 9 days c. Between 15 and 20 days
b. Between 10 and 14 days d. Between 20 and 30 days

 

 

ANS:  B

During the recovery period (10 to 14 days after infarction), individuals feel more capable of increasing activities and thus may stress the newly formed scar tissue. After 6 weeks, the necrotic area is completely replaced by scar tissue, which is strong but unable to contract and relax like healthy myocardial tissue.

 

PTS:   1                    REF:   Page 1160

 

  1. An individual who is demonstrating elevated levels of troponin, creatine kinase–isoenzyme MB (CK-MB), and lactic dehydrogenase (LDH) is exhibiting indicators associated with which condition?
a. Myocardial ischemia c. Myocardial infarction (MI)
b. Hypertension d. Coronary artery disease (CAD)

 

 

ANS:  C

Cardiac troponins (troponin I and troponin T) are the most specific indicators of MI. Other biomarkers released by myocardial cells include CK-MB and LDH, but they are not associated with the other options.

 

PTS:   1                    REF:   Pages 1160-1161

 

  1. What is the expected electrocardiogram (ECG) pattern when a thrombus in a coronary artery permanently lodges in the vessel and the infarction extends through the myocardium from the endocardium to the epicardium?
a. Prolonged QT interval
b. ST elevation myocardial infarction (STEMI)
c. ST depression myocardial infarction (STDMI)
d. Non-ST elevation myocardial infarction (non-STEMI)

 

 

ANS:  B

Individuals with this pattern on an ECG usually have significant elevations in the ST segments and are categorized as having STEMI. The other options are not associated with the described pathologic condition.

 

PTS:   1                    REF:   Pages 1157-1158

 

  1. How does angiotensin II increase the workload of the heart after a myocardial infarction (MI)?
a. By increasing the peripheral vasoconstriction
b. By causing dysrhythmias as a result of hyperkalemia
c. By reducing the contractility of the myocardium
d. By stimulating the sympathetic nervous system

 

 

ANS:  A

Angiotensin II is released during myocardial ischemia and contributes to the pathogenesis of a myocardial infarction (MI) in several ways. First, it results in the systemic effects of peripheral vasoconstriction and fluid retention. These homeostatic responses are counterproductive in that they increase myocardial work and thus exacerbate the effects of the loss of myocyte contractility. Angiotensin II is also locally released, where it is a growth factor for vascular smooth muscle cells, myocytes, and cardiac fibroblasts; promotes catecholamine release; and causes coronary artery spasm. This selection is the only option that accurately describes how angiotensin II increases workload after a MI.

 

PTS:   1                    REF:   Page 1159

 

  1. The pulsus paradoxus that occurs as a result of pericardial effusion is caused by a dysfunction in which mechanism?
a. Diastolic filling pressures of the right ventricle and reduction of blood volume in both ventricles
b. Blood ejected from the right atrium and reduction of blood volume in the right ventricle
c. Blood ejected from the left atrium and reduction of blood volume in the left ventricle
d. Diastolic filling pressures of the left ventricle and reduction of blood volume in all four heart chambers.

 

 

ANS:  D

Pulsus paradoxus means that the arterial blood pressure during expiration exceeds arterial pressure during inspiration by more than 10 mm Hg. This clinical finding reflects impairment of diastolic filling of the left ventricle plus a reduction of blood volume within all four cardiac chambers. This selection is the only option that accurately describes the mechanism.

 

PTS:   1                    REF:   Page 1164

 

  1. A patient reports sudden onset of severe chest pain that radiates to the back and worsens with respiratory movement and when lying down. These clinical manifestations describe:
a. Myocardial infarction (MI) c. Restrictive pericarditis
b. Pericardial effusion d. Acute pericarditis

 

 

ANS:  D

Most individuals with acute pericarditis describe several days of fever, myalgias, and malaise, followed by the sudden onset of severe chest pain that worsens with respiratory movements and with lying down. Although the pain may radiate to the back, it is generally felt in the anterior chest and may be initially confused with the pain of an acute MI. Individuals with acute pericarditis also may report dysphagia, restlessness, irritability, anxiety, and weakness. This selection is the only option with these symptoms.

 

PTS:   1                    REF:   Page 1163

 

  1. Ventricular dilation and grossly impaired systolic function, leading to dilated heart failure, characterize which form of cardiomyopathy?
a. Congestive c. Septal
b. Hypertrophic d. Dystrophic

 

 

ANS:  A

Only dilated cardiomyopathy (congestive cardiomyopathy) is characterized by ventricular dilation and grossly impaired systolic function, leading to dilated heart failure.

 

PTS:   1                    REF:   Page 1165

 

  1. A disproportionate thickening of the interventricular septum is the hallmark of which form of cardiomyopathy?
a. Dystrophic c. Restrictive
b. Hypertrophic d. Dilated

 

 

ANS:  B

Only hypertrophic cardiomyopathy is characterized by a thickening of the septal wall, which may cause outflow obstruction to the left ventricle outflow tract.

 

PTS:   1                    REF:   Page 1166

 

  1. Amyloidosis, hemochromatosis, or glycogen storage disease usually causes which form of cardiomyopathy?
a. Infiltrative c. Septal
b. Restrictive d. Hypertrophic

 

 

ANS:  B

Restrictive cardiomyopathy may occur idiopathically or as a cardiac manifestation of systemic diseases, such as scleroderma, amyloidosis, sarcoidosis, lymphoma, and hemochromatosis, or a number of inherited storage diseases. This characterization is not true of the other forms of cardiomyopathy.

 

PTS:   1                    REF:   Page 1167

 

  1. Which condition is a cause of acquired aortic regurgitation?
a. Congenital malformation c. Rheumatic fever
b. Cardiac failure d. Coronary artery disease (CAD)

 

 

ANS:  C

Rheumatic heart disease, bacterial endocarditis, syphilis, hypertension, connective tissue disorders (e.g., Marfan syndrome, ankylosing spondylitis), appetite suppressing medications, trauma, or atherosclerosis can cause acquired aortic regurgitation. This selection is the only available option that is known to cause acquired aortic regurgitation.

 

PTS:   1                    REF:   Page 1169

 

  1. Which predominantly female valvular disorder is thought to have an autosomal dominant inheritance pattern, as well as being associated with connective tissue disease?
a. Mitral valve prolapse c. Tricuspid valve prolapse
b. Tricuspid stenosis d. Aortic insufficiency

 

 

ANS:  A

Mitral valve prolapse tends to be most prevalent in young women. Studies suggest an autosomal dominant and X-linked inheritance pattern. Because mitral valve prolapse often is associated with other inherited connective tissue disorders (e.g., Marfan syndrome, Ehlers-Danlos syndrome, osteogenesis imperfecta), it is thought to result from a genetic or environmental disruption of valvular development during the fifth or sixth week of gestation. This provided history is not associated with any of the other options.

 

PTS:   1                    REF:   Page 1170

 

  1. Which disorder causes a transitory truncal rash that is nonpruritic and pink with erythematous macules that may fade in the center, making them appear as a ringworm?
a. Fat emboli
b. Rheumatic fever
c. Bacterial endocarditis
d. Myocarditis of acquired immunodeficiency syndrome

 

 

ANS:  B

Erythema marginatum is a distinctive truncal rash that often accompanies acute rheumatic fever. It consists of nonpruritic, pink erythematous macules that never occur on the face or hands. This presentation is not associated with any of the other options.

 

PTS:   1                    REF:   Page 1172

 

  1. What is the most common cause of infective endocarditis?
a. Virus c. Bacterium
b. Fungus d. Rickettsiae

 

 

ANS:  C

Infective endocarditis is a general term used to describe infection and inflammation of the endocardium—especially the cardiac valves. Bacteria are the most common cause of infective endocarditis, especially streptococci, staphylococci, or enterococci.

 

PTS:   1                    REF:   Page 1173

 

  1. What is the most common cardiac disorder associated with acquired immunodeficiency syndrome (AIDS)
a. Cardiomyopathy c. Left heart failure
b. Myocarditis d. Heart block

 

 

ANS:  C

Pericardial effusion and left heart failure are the most common complications of human immunodeficiency virus (HIV) infection. Other conditions include cardiomyopathy, myocarditis, tuberculous pericarditis, infective and nonbacterial endocarditis, heart block, pulmonary hypertension, and nonantiretroviral drug-related cardiotoxicity.

 

PTS:   1                    REF:   Page 1175

 

  1. A patient is diagnosed with pulmonary disease and elevated pulmonary vascular resistance. Which form of heart failure may result from pulmonary disease and elevated pulmonary vascular resistance?
a. Right heart failure c. Low-output failure
b. Left heart failure d. High-output failure

 

 

ANS:  A

Right heart failure is defined as the inability of the right ventricle to provide adequate blood flow into the pulmonary circulation at a normal central venous pressure. This condition is often a result of pulmonary disease and the resulting elevated pulmonary vascular resistance.

 

PTS:   1                    REF:   Page 1181

 

  1. What cardiac pathologic condition contributes to ventricular remodeling?
a. Left ventricular hypertrophy c. Myocardial ischemia
b. Right ventricular failure d. Contractile dysfunction

 

 

ANS:  C

Of the options available, myocardial ischemia contributes to inflammatory, immune, and neurohumoral changes that mediate a process called ventricular remodeling.

 

PTS:   1                    REF:   Page 1175

 

  1. In systolic heart failure, what effect does the renin-angiotensin-aldosterone system (RAAS) have on stroke volume?
a. Increases preload and decreases afterload.
b. Increases preload and increases afterload.
c. Decreases preload and increases afterload.
d. Decreases preload and decreases afterload.

 

 

ANS:  B

Activation of the RAAS not only causes an increase in preload and afterload, but it also causes direct toxicity to the myocardium. This selection is the only option that accurately identifies the effect that the RAAS has on stroke volume in this situation.

 

PTS:   1                    REF:   Page 1175 | Page 1177

 

  1. What is the cause of the dyspnea resulting from a thoracic aneurysm?
a. Pressure on surrounding organs c. Formation of atherosclerotic lesions
b. Poor oxygenation d. Impaired blood flow

 

 

ANS:  A

Clinical manifestations depend on the location of the aneurysm. Pressure of a thoracic aneurysm on surrounding organs cause symptoms of dysphagia (difficulty in swallowing) and dyspnea (breathlessness). This selection is the only option that accurately describes the cause of dyspnea resulting from a thoracic aneurysm.

 

PTS:   1                    REF:   Page 1142

 

  1. Which statement is true concerning the cells’ ability to synthesize cholesterol?
a. Cell production of cholesterol is affected by the aging process.
b. Cells produce cholesterol only when dietary fat intake is low.
c. Most body cells are capable of producing cholesterol.
d. Most cholesterol produced by the cells is converted to the low-density form.

 

 

ANS:  C

Although cholesterol can easily be obtained from dietary fat intake, most body cells can also manufacture cholesterol. This selection is the only option that accurately describes the cellular role in cholesterol synthesis.

 

PTS:   1                    REF:   Page 1149

 

  1. What is the trigger for angina pectoris?
a. Atherosclerotic lesions c. Myocardial necrosis
b. Hyperlipidemia d. Myocardial ischemia

 

 

ANS:  D

Angina pectoris is chest pain caused by myocardial ischemia. None of the other options are considered triggers for angina pectoris.

 

PTS:   1                    REF:   Page 1154

 

  1. Individuals being effectively managed for type 2 diabetes mellitus often experience a healthy decline in blood pressure as a result of what intervention?
a. Managed carbohydrate intake
b. Appropriate exercise
c. Insulin-sensitivity medication therapy
d. Introduction of minimal doses of insulin

 

 

ANS:  C

Many people with type 2 diabetes mellitus, who are treated with drugs that increase insulin sensitivity, experience a decline in their blood pressure without taking antihypertensive drugs. Although the other medications may be included in the management plan, the other options are not associated with a decrease in hypertension.

 

PTS:   1                    REF:   Page 1136

 

MULTIPLE RESPONSE

 

  1. Which statements are true regarding fatty streaks? (Select all that apply.)
a. Fatty streaks progressively damage vessel walls.
b. Fatty streaks are capable of producing toxic oxygen radials.
c. When present, inflammatory changes occur to the vessel walls.
d. Oxidized low-density lipoproteins (LDLs) are involved in their formation.
e. Fatty streaks are formed by killer T cells filled with oxidized LDLs.

 

 

ANS:  A, B, C, D

The oxidized LDLs penetrate the intima of the arterial wall and are engulfed by macrophages. Macrophages filled with oxidized LDLs are called foam. Once these lipid-laden foam cells accumulate in significant amounts, they form a lesion called a fatty streak. Once formed, fatty streaks produce more toxic oxygen radicals and cause immunologic and inflammatory changes, resulting in progressive damage to the vessel wall.

 

PTS:   1                    REF:   Page 1145 | Page 1147

 

  1. What factors contribute to the development of orthostatic hypotension? (Select all that apply.)
a. Altered body chemistry
b. Drug action of certain antihypertensive agents
c. Prolonged immobility
d. Effects of aging on postural reflexes
e. Any condition that produces volume overload

 

 

ANS:  A, B, C, D

Orthostatic hypotension may be acute or chronic. Acute orthostatic hypotension (temporary type) may result from (1) altered body chemistry, (2) drug action (e.g., antihypertensives, antidepressants), (3) prolonged immobility caused by illness, (4) starvation, (5) physical exhaustion, (6) any condition that produces volume depletion (e.g., massive diuresis, potassium or sodium depletion), and (7) venous pooling (e.g., pregnancy, extensive varicosities of the lower extremities). Older adults are susceptible to this type of orthostatic hypotension, in which postural reflexes are slowed as part of the aging process.

 

PTS:   1                    REF:   Page 1140

 

  1. Which assessment findings are clinical manifestations of aortic stenosis? (Select all that apply.)
a. Jugular vein distention
b. Bounding pulses
c. Hypotension
d. Angina
e. Syncope

 

 

ANS:  D, E

The classic manifestations of aortic stenosis are angina, syncope, and heart failure. None of the other options are associated with aortic stenosis.

 

PTS:   1                    REF:   Pages 1168-1169

 

  1. Which risk factors are associated with infective endocarditis? (Select all that apply.)
a. Rheumatic fever
b. Intravenous drug use
c. Long-term indwelling catheterization
d. Aortic regurgitation
e. Heart valve disease

 

 

ANS:  B, C, E

Risk factors for infective endocarditis include acquired valvular heart disease, intravenous drug abuse, long-term indwelling catheterization (e.g., for pressure monitoring, hyperalimentation, or hemodialysis), and recent cardiac surgery. Neither rheumatic fever nor aortic regurgitation is considered a risk factor for infective endocarditis.

 

PTS:   1                    REF:   Page 1173 | Box 32-3

 

MATCHING

 

Match the descriptions with the corresponding terms.

______ A. Impairs flow from left atrium to left ventricle

______ B. Impairs flow from the left ventricle

______ C. Backflow into left atrium

______ D. Backflow into right atrium

______ E. Backflow into left ventricle

 

  1. Aortic stenosis

 

  1. Aortic regurgitation

 

  1. Mitral stenosis

 

  1. Tricuspid regurgitation

 

  1. Mitral regurgitation

 

  1. ANS:  B                    PTS:   1                    REF:   Page 1168

MSC:  Outflow obstruction increases pressure within the left ventricle as it tries to eject blood through the narrowed opening. Left ventricular hypertrophy develops to compensate for the increased workload.

 

  1. ANS:  E                    PTS:   1                    REF:   Pages 1169-1170

MSC:  During systole, blood is ejected from the left ventricle into the aorta. If the aortic semilunar valve fails to close completely, then some of the ejected blood flows back into the left ventricle during diastole.

 

  1. ANS:  A                    PTS:   1                    REF:   Page 1169

MSC:  Mitral stenosis impairs the flow of blood from the left atrium to the left ventricle.

 

  1. ANS:  D                    PTS:   1                    REF:   Page 1170

MSC:  Tricuspid regurgitation is more common than tricuspid stenosis and is usually associated with cardiac failure and dilation of the right ventricle, secondary to pulmonary hypertension.

 

  1. ANS:  C                    PTS:   1                    REF:   Page 1170

MSC:  Mitral regurgitation permits the backflow of blood from the left ventricle into the left atrium during ventricular systole, giving rise to a loud pansystolic (throughout systole) murmur heard best at the apex that radiates into the back and axillae.

 

 

Chapter 48: Shock, Multiple Organ Dysfunction Syndrome, and Burns in Adults

 

MULTIPLE CHOICE

 

  1. What is the final outcome of impaired cellular metabolism?
a. Cellular alterations in the heart and brain
b. Buildup of cellular waste products
c. Cellular alterations in the vasculature structures and kidneys
d. Impairment of urine excretion

 

 

ANS:  B

The common pathway in all types of shock is impairment of cellular metabolism as a result of decreased delivery of oxygen and nutrients, which are frequently coupled with an increased demand, the consumption of oxygen and nutrients, and a decreased removal of cellular waste products. Of the options available, this selection is the only accurate outcome.

 

PTS:   1                    REF:   Page 1669

 

  1. Which clinical manifestation of septic shock confirms an elevation in immune system response?
a. Tachycardia c. Low respiratory rate
b. Increased white blood cell count d. Hypothermia

 

 

ANS:  B

Clinical manifestations common in septic shock are fever, high heart rate, high respiratory rate, or elevations in immune responses, such as increased white blood cells and circulating blood glucose.

 

PTS:   1                    REF:   Page 1671

 

  1. The release of catecholamine by the adrenal glands compensate for which initial effects of hypovolemic shock?
a. Interstitial fluid moves out of the vascular compartment.
b. Systemic vascular resistance is decreased.
c. Heart rate is increased.
d. Water excretion is increased.

 

 

ANS:  C

Compensatory mechanisms (see Figure 48-3) initially offset hypovolemia. Heart rate and systemic vascular resistance increase as a result of catecholamine release by the adrenal glands, which boosts cardiac output and tissue perfusion pressures. Compelled by a decrease in capillary hydrostatic pressures, interstitial fluid moves into the vascular compartment. The liver and spleen add to blood volume by disgorging stored red blood cells and plasma. In the kidneys, renin (through several intermediaries) stimulates aldosterone release and the retention of sodium and therefore water, whereas antidiuretic hormone (ADH), or vasopressin, from the posterior pituitary gland increases water retention. Data on the compensation of ADH, however, show that as shock worsens, ADH in plasma decreases.

 

PTS:   1                    REF:   Page 1672

 

  1. Hypovolemic shock begins to develop when intravascular volume has decreased by what percentage?
a. 5 c. 15
b. 10 d. 20

 

 

ANS:  C

Hypovolemic shock begins to develop when intravascular volume has decreased by approximately 15%.

 

PTS:   1                    REF:   Page 1672

 

  1. What type of shock develops as a result of the overstimulation of the parasympathetic nervous system or the understimulation of the sympathetic nervous system?
a. Septic c. Anaphylactic
b. Cardiogenic d. Vasogenic

 

 

ANS:  D

Only vasogenic shock refers to a widespread and massive vasodilation resulting from an imbalance between parasympathetic and sympathetic stimulation of vascular smooth muscle.

 

PTS:   1                    REF:   Pages 1673-1674

 

  1. What is the clinical hallmark of neurogenic shock as a result of the overstimulation of the parasympathetic nervous system?
a. Vasoconstriction c. Increased metabolism
b. Vasodilation d. Respiratory distress

 

 

ANS:  B

Neurogenic shock refers to a widespread and massive vasodilation that results from an imbalance between parasympathetic and sympathetic stimulation of vascular smooth muscle. None of the other options are related to this condition.

 

PTS:   1                    REF:   Page 1673

 

  1. Which form of shock is often more severe than other forms because of its sudden, rapid systemic vasodilation?
a. Septic c. Anaphylactic
b. Hypovolemic d. Neurogenic

 

 

ANS:  C

Anaphylactic shock is often more severe than other types of shock because the hypersensitivity reaction, which triggers vasodilation, has other pathophysiologic effects that rapidly involve the entire body. This action is not associated with the other options.

 

PTS:   1                    REF:   Pages 1674-1675

 

  1. What type of shock is related to a decrease in systemic vascular resistance?
a. Septic c. Hypovolemic
b. Cardiogenic d. Heart failure

 

 

ANS:  A

Clinical manifestations of only septic shock are persistent low arterial pressure, low systemic vascular resistance from vasodilation, and an alteration in oxygen extraction by all cells.

 

PTS:   1                    REF:   Page 1675

 

  1. For which type of shock would antihistamines and corticosteroids be prescribed?
a. Septic c. Hypovolemic
b. Anaphylactic d. Cardiogenic

 

 

ANS:  B

Only anaphylactic shock responds to the administration of epinephrine to decrease mast cell and basophil degranulation. Antihistamines and steroids are administered to stop the inflammatory reaction.

 

PTS:   1                    REF:   Page 1675

 

  1. Which condition is best defined as a clinical syndrome involving a systemic response to infection, which is manifested by two or more of the systemic inflammatory response syndrome criteria?
a. Bacteremia c. Septicemia
b. Sepsis d. Septic shock

 

 

ANS:  B

Of the options available, only sepsis is best defined as a systemic response to infection that is manifested by two or more criteria of the systemic inflammatory response syndrome.

 

PTS:   1                    REF:   Page 1676 | Table 48-1

 

  1. In septic shock, which mediators are antiinflammatory?
a. Interleukin (IL)–4 (IL-4), IL-10, and IL-13
b. Tumor necrosis factor–alpha (TNF-a) and granulocyte cell-stimulating factor
c. IL-1, IL-2, and IL-6
d. Prostaglandin, leukotrienes, and bradykinin

 

 

ANS:  A

In septic shock, the only antiinflammatory mediators released include lipopolysaccharide-binding protein; IL-1 receptor antagonist; soluble cluster of differentiation 14 (CD-14); type 2 IL-1 receptor; leukotriene b4-receptor antagonist; IL-4, IL-10, and IL-13; and soluble TNF.

 

PTS:   1                    REF:   Page 1675

 

  1. What mechanism causes organ injury in primary multiple organ dysfunction syndrome (MODS)?
a. Impaired immune response c. Impaired perfusion
b. Impaired glucose use d. Impaired ventilation

 

 

ANS:  C

In primary MODS, the organ injury is directly associated with a specific insult, most often ischemia or impaired perfusion from an episode of shock or trauma, thermal injury, soft-tissue necrosis, or invasive infection. None of the other options accurately identifies the cause of MODS.

 

PTS:   1                    REF:   Page 1680

 

  1. In secondary multiple organ dysfunction syndrome (MODS), what stimulates the normal endothelial cells to change to a proinflammatory state?
a. Interleukin (IL)–4 (IL-4) and IL-13
b. IL-1, IL-6, and tumor necrosis factor (TNF)
c. Interferon gamma (IFN-g) and granulocyte cell-stimulating factor
d. Prostaglandin, leukotrienes, histamine, and bradykinin

 

 

ANS:  B

Normal endothelial cells have little interaction with leukocytes except when stimulated by TNF, IL-1, and IL-6. This selection is the only option that accurately describes what stimulates the normal endothelial cells to change to a proinflammatory state.

 

PTS:   1                    REF:   Page 1680

 

  1. What stimulates the respiratory burst and production of highly toxic free radicals in the multiple organ dysfunction syndrome (MODS)?
a. Neutrophils adhering to the endothelium
b. Activation of the complement cascade
c. Release of prostaglandins, thromboxanes, and leukotrienes
d. Activation of the fibrinolytic system

 

 

ANS:  A

The accumulation of activated neutrophils in organs is thought to play a key role in the pathogenetic development of MODS. When neutrophils adhere to the endothelium, they undergo a respiratory burst (oxidative burst) and release oxygen radicals. The respiratory burst occurs as the activated neutrophil experiences a sudden increase in oxidative metabolism, producing large quantities of highly toxic oxygen free radicals. This selection is the only option that accurately identifies the stimulant of the respiratory burst that results in the production of toxic free radicals.

 

PTS:   1                    REF:   Page 1682

 

  1. In multiple organ dysfunction syndrome (MODS), the gut hypothesis attempts to explain which phenomena?
a. Paralytic ileus
b. Translocation of bacteria
c. Maldistribution of blood flow
d. Massive diarrhea accompanying septic shock

 

 

ANS:  B

The loss of intestinal barrier function leads to the systemic spread of bacteria and/or endotoxin from the gut (systemic endotoxemia). This phenomenon is called translocation of bacteria. The gut hypothesis provides a possible explanation for the fact that an infectious focus is not always found in individuals with MODS. The gut hypothesis is not related to any other option.

 

PTS:   1                    REF:   Page 1682

 

  1. Blistering of the skin within minutes occurs in which type of burn injury?
a. First degree c. Deep second degree
b. Superficial second degree d. Third degree

 

 

ANS:  B

The hallmark of superficial partial-thickness injury is the appearance of thin-walled, fluid-filled blisters that develop within only a few minutes after injury. Blistering that occurs within minutes of the burn injury is not a defining characteristic of the other options.

 

PTS:   1                    REF:   Page 1686

 

  1. Which form of shock occurs from an acute burn injury?
a. Hypovolemic c. Cardiogenic
b. Septic d. Vasogenic

 

 

ANS:  A

Burn shock consists of a hypovolemic cardiovascular component and a cellular component. Hypovolemia associated with burn shock results from massive fluid losses from the circulating blood volume. The other forms of shock are not directly related to an acute burn injury.

 

PTS:   1                    REF:   Page 1689

 

  1. Which fluid is most often used in fluid resuscitation after a major burn injury?
a. Saline c. Lactated Ringer solution
b. Albumin d. Dextrose in water

 

 

ANS:  C

Lactated Ringer solution is used most often because it closely approximates extracellular fluid, the repository of fluid leaving the circulatory system during this phase of extensive edema formation (see Table 48-4). The other options are not most often used in fluid resuscitation after major burns.

 

PTS:   1                    REF:   Page 1689

 

  1. What is the most reliable criterion of adequate fluid resuscitation after a major burn injury?
a. Blood pressure c. Respiratory rate
b. Pulse rate d. Urine output

 

 

ANS:  D

The most reliable criterion for adequate resuscitation of burn shock is urine output. None of the remaining options are considered reliable.

 

PTS:   1                    REF:   Page 1690

 

  1. The endpoint of burn shock is defined as the time when the individual is able to do which of the following?
a. Maintain adequate blood pressure for 4 hours.
b. Maintain adequate urine output for 2 hours.
c. Manage pain without narcotics.
d. Manage pain during dressing changes.

 

 

ANS:  B

The endpoint of burn shock is defined as the state in which the individual is able to maintain adequate urine output for 2 hours with the intravenous fluid administration rate equal to the individual’s calculated maintenance rate (see Box 48-4). None of the remaining options are defined as the endpoint of burn shock.

 

PTS:   1                    REF:   Page 1690

 

  1. Which condition does a burn injury create for an extended period?
a. Hypervolemia c. Hyponatremia
b. Hypermetabolism d. Hypotension

 

 

ANS:  B

Of the options available, a burn injury induces a hypermetabolic state that persists until wound closure.

 

PTS:   1                    REF:   Page 1691

 

  1. What effect does a fatal burn injury have on interleukins (ILs)?
a. Decreases levels of IL-2, which may decrease T helper 1 (Th1) lymphocytes.
b. Decreases levels of IL-4, which causes a shift in production from Th1 to Th2 lymphocytes.
c. Decreases levels of IL-6, which produces cytokines.
d. Decreases levels of IL-12, which stimulates the production of immunoglobulins.

 

 

ANS:  A

A fatal burn injury has often shown decreased levels of IL-2, which may result in decreased Th1 lymphocytes. This option is the only accurate description of the effect a fatal burn injury has on ILs.

 

PTS:   1                    REF:   Page 1692

 

  1. Daily evaporative water loss after a burn injury is approximately how many times the normal?
a. 5 c. 15
b. 10 d. 20

 

 

ANS:  D

Moncrief and Mason attempted to determine the magnitude of such a loss and determined that daily evaporative water loss was in the range of 20 times normal in the early phase of injury, with gradual decreases as wound closure is achieved.

 

PTS:   1                    REF:   Page 1693

 

  1. What is the significance of a high level of interleukin 1 (IL-1) in a patient who has experienced severe burns?
a. Prognosis is poor. c. Urinary function is improved.
b. Antibiotic therapy is required. d. They are less at risk for death.

 

 

ANS:  D

The level of IL-1 inversely correlates with burn survival; low levels may be associated with a higher mortality. This selection is the only option that accurately identifies the significance of a high level of IL-1.

 

PTS:   1                    REF:   Page 1692

 

  1. What is the purpose of monitoring procalcitonin (PCT) levels in a patient after a burn?
a. To help evaluate the potential risk for respiratory complications
b. To justify the initiation of antibiotic therapy
c. To determine when discontinuing antibiotic use is feasible
d. To help in the selection of appropriate antibiotic therapy agents

 

 

ANS:  C

Seeking to decrease the use of antibiotics in the patient who is critically ill and thus prevent resistance to antibiotics is an important strategy in treating infection. Recent research suggests that monitoring serial PCT levels, a precursor hormone to calcitonin, may be used to shorten antibiotic use in the treatment of respiratory infections. PCT, normally not discernible on assay, when elevated may indicate specific proinflammatory response during a bacterial infection. PCT levels should not be used as an indicator to start antibiotics; however, if monitored sequentially at the start of empiric antibiotics and then dropped to low levels, then discontinuation may be clinically indicated.

 

PTS:   1                    REF:   Page 1679 | What’s New box

 

  1. How many milliliters of fluid replacement per hour does a 70-kg adult with a 50% total body surface area burn and a body surface area of 2 m require?
a. 150 c. 350
b. 275 d. 500

 

 

ANS:  B

A 70-kg adult with a 50% total body surface area burn and a body surface area of 2 m requires the following:

Basal = (1500 ml/day) (2 m2 body surface area) = 3000 ml/24 hr or 125 ml/hr

Evaporative = (25 + 50% total body surface burn)

(2m2 total body surface area) = (75) (2) = 150 ml/hr

Total maintenance fluids = 125 ml + 150 ml = 275 ml/hr

 

PTS:   1                    REF:   Page 1690 | Box 48-4

 

MULTIPLE RESPONSE

 

  1. A patient will be referred to the burn unit when which criteria are met? (Select all that apply.)
a. Patient is older than 5 years of age.
b. The burn involves the face or a major joint.
c. The source of the burn is electrical.
d. Partial thickness burns are on more than 10% of the total body surface area (TBSA).
e. Patient has a life-threatening trauma injury.

 

 

ANS:  B, C, D

A burn unit may treat adults or children or both. Burn injuries that should be referred to a burn unit include the following: partial-thickness burns on more than 10% TBSA, burns that involve the face, hands, feet, genitalia, perineum, or major joints, and electrical burns, including lightning injury. If the trauma poses the greater immediate risk, then the patient’s condition may be initially stabilized in a trauma center before being transferred to a burn center.

 

PTS:   1                    REF:   Page 1689 | Box 48-3

 

  1. Which feedback loop will further impair oxygen in all types of shock? (Select all that apply.)
a. Activation of the fibrinolytic cascade
b. Increased circulating volume
c. Hypermetabolic state
d. Lysosomal enzyme release
e. Activation of the clotting cascade

 

 

ANS:  D, E

Both positive and negative compensatory mechanisms, such as anaerobic metabolism, lysosomal enzyme release, decreased intravascular volume, and activation of the clotting cascade, may further impair oxygen delivery and use. The remaining options are not related to impaired oxygen delivery.

 

PTS:   1                    REF:   Page 1669

 

MATCHING

 

Match the types of shock with the corresponding descriptions. Terms can be used more than once.

______ A. Cardiogenic

______ B. Hypovolemic

______ C. Neurogenic

______ D. Anaphylactic

______ E. Septic

 

  1. Follows a systemic inflammatory response.

 

  1. Follows widespread hypersensitivity reaction.

 

  1. Follows myocardial infarction.

 

  1. Follows major burns.

 

  1. Follows parasympathetic stimulation.

 

  1. ANS:  E                    PTS:   1                    REF:   Page 1675

MSC:  Septic shock begins with systemic inflammatory response syndrome. It then evolves into sepsis, into severe sepsis, and finally into septic shock.

 

  1. ANS:  D                    PTS:   1                    REF:   Page 1674

MSC:  Anaphylactic shock is the outcome of a widespread hypersensitivity reaction known as anaphylaxis.

 

  1. ANS:  A                    PTS:   1                    REF:   Page 1671

MSC:  Cardiogenic shock results from the inability of the heart to pump adequate blood to tissues and end organs. This type of shock occurs from any cause, the most common being within hours of an acute myocardial infarction or severe episode of myocardial ischemia.

 

  1. ANS:  B                    PTS:   1                    REF:   Page 1689

MSC:  Hypovolemia associated with burn shock results from massive fluid losses from the circulating blood volume.

 

  1. ANS:  C                    PTS:   1                    REF:   Pages 1673-1674

MSC:  Any factor that stimulates parasympathetic activity or inhibits sympathetic activity of vascular smooth muscle can cause neurogenic shock.

 

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