MN 551 Midterm<\/p>\n
Pin It
\nAdvanced Physiology and Pathophysiology Across the Life Span
\nmidterm <\/p>\n
1. A student nurse practitioner asks her preceptor about the
\norigins of different tissues, and their cellular origins during the process of
\ndevelopment. Which of the following statements by the preceptor best describes
\nthe process of cell differentiation? (Points : 3)
\n \u00e2\u0080\u009cCells of the
\nhematopoietic system produce the appropriate body cells that are required at
\neach stage of development.\u00e2\u0080\u009d<\/p>\n
\u00e2\u0080\u009cA single stem
\ncell differentiates into approximately 200 different types of cells.\u00e2\u0080\u009d<\/p>\n
\u00e2\u0080\u009cA fertilized
\novum undergoes a series of divisions, yielding many different cell types.\u00e2\u0080\u009d<\/p>\n
\u00e2\u0080\u009cCells
\ndifferentiate into necessary body cells, peaking after conception, and ceasing
\nnear the time of birth.\u00e2\u0080\u009d<\/p>\n
Question 2.2. A 77-year-old male patient with a diagnosis of
\nstomach cancer has been found to have metastases in his liver. The patient and
\nhis family are surprised at this turn of events, stating that they don’t see
\nhow he could have developed cancer in his liver. Which of the following facts
\nwould underlie the reply that the care team provides? (Points : 3)
\n The parenchymal
\ntissue of the liver is particularly susceptible to secondary malignancies.<\/p>\n
The portal
\ncirculatory system brings venous blood from the gastrointestinal tract into the
\nliver.<\/p>\n
Hepatic stromal tissue shares characteristics
\nwith cancerous cells, including lack of anchorage dependence.<\/p>\n
The proximity
\nof the liver to the stomach allows for direct spread of cancerous cells due to
\na lack of contact inhibition.<\/p>\n
Question 3.3. The NP is teaching a group of older adults
\nabout the value of including foods containing antioxidants in their diet. Which
\nof the following statements best captures the rationale underlying the NPs
\nadvice?(Points : 3)
\n Antioxidants
\ninhibit the actions of reactive oxygen species (ROS).<\/p>\n
Antioxidants
\nprevent the formation of superoxide dismutase.<\/p>\n
Antioxidants
\nreact nonspecifically with molecules.<\/p>\n
Antioxidants
\nprevent the occurrence of cell dysplasia.<\/p>\n
Question 4.4. The nurse practitioner is providing care for a
\npatient with a diagnosis of cirrhosis, and he notes that the patient’s sclerae
\nare jaundiced. The nurse practitioner recalls that jaundice is caused by excess
\naccumulation of bilirubin, a pigment that can accumulate in which part of the
\ncell? (Points : 3)
\n Nucleus<\/p>\n
Cytoplasm<\/p>\n
Golgi apparatus<\/p>\n
Rough
\nendoplasmic reticulum (ER)<\/p>\n
Question 5.5. Which of the following patients of a primary
\ncare nurse practitioner would not require extra screening for cancer? (Points :
\n3)
\n A 51-year-old
\nwoman whose grandmother died of breast cancer<\/p>\n
A 48-year-old
\nman who takes immunosuppressant drugs following a kidney transplant<\/p>\n
A 50-year-old
\nmale who is obese and has a low-fiber, high-fat diet<\/p>\n
A 38-year-old
\nfemale with Down syndrome and congenital scoliosis<\/p>\n
Question 6.6. A new older female patient at a long-term care
\nfacility has a diagnosis of type 1 neurofibromatosis (NF-1). As part of the
\nintake assessment protocol for the facility, the clinical educator is teaching
\nthe care staff about the diagnosis. Which of the following statements most
\naccurately conveys an aspect of neurofibromatosis? (Points : 3)
\n \u00e2\u0080\u009cThe
\nneurofibroma lesions are unsightly for the patient, but they are not painful.<\/p>\n
\u00e2\u0080\u009cHer diagnosis
\nputs her at higher risk of developing a malignant neoplasm.\u00e2\u0080\u009d<\/p>\n
\u00e2\u0080\u009cShe is living
\nwith an example of an autosomal recessive disorder.\u00e2\u0080\u009d<\/p>\n
\u00e2\u0080\u009cThe patient is
\nlikely to be photosensitive as a result of the disease.\u00e2\u0080\u009d<\/p>\n
Question 7.7. A child possesses a trait that is the result
\nof the interaction of two different genes, neither of which could have produced
\nthe trait independently. Which of the following explanations best captures the
\ngenetic explanation for this?<\/p>\n
(Points : 3)
\n The trait is an
\nexpression of multiple alleles.<\/p>\n
Epistasis has
\ndictated the phenotypic outcome.<\/p>\n
The phenomenon
\nis an example of polygenic inheritance.<\/p>\n
The outcome is
\nthe result of the interaction between collaborative genes.<\/p>\n
Question 8.8. Which of the following statements most
\naccurately conveys an aspect of cell injury due to impaired calcium
\nhomeostasis? (Points : 3)
\n Normal
\nintracellular calcium ion levels are higher than extracellular levels.<\/p>\n
Ischemia and
\ncertain toxins cause a decrease in cytosolic calcium.<\/p>\n
Injured cells
\ntend to accumulate calcium.<\/p>\n
Low calcium
\nlevels cause an activation of damaging enzymes.<\/p>\n
Question 9.9. A group of researchers has identified that the
\nprevalence of two particular genetic disorders share a statistical correlation.
\nWhich of the following statements best conveys the genetic rationale for this
\nsituation? (Points : 3)
\n There is likely
\na cause-and-effect relationship between the two genes responsible.<\/p>\n
The chromosomes
\ncontaining each gene are likely closely situated.<\/p>\n
The genes
\ncausing each disorder are likely in the same section of the same chromosome.<\/p>\n
The disorders
\nlikely share the same locus.<\/p>\n
Question 10.10. A male patient of a nurse practitioner has
\nan autosomal dominant disorder. The patient and his partner are considering
\nstarting a family. Which of the patient’s following statements indicates the
\npatient has an adequate understanding of the genetic basis of this health
\nproblem? (Points : 3)
\n \u00e2\u0080\u009cI know there’s
\nno way of accurately determining the chance that my child will inherit the
\ndisease.\u00e2\u0080\u009d<\/p>\n
\u00e2\u0080\u009cMy children
\nwho don’t have the disease still run the risk of passing it on to their
\nchildren.\u00e2\u0080\u009d<\/p>\n
\u00e2\u0080\u009cI know that
\nnew genetic mutations won’t occur between generations.\u00e2\u0080\u009d<\/p>\n
\u00e2\u0080\u009cI know that a single mutant allele is to
\nblame for the health problem.\u00e2\u0080\u009d<\/p>\n
Question 11.11. As part of an orientation to a genetic
\ncounseling practice, a group of medical students is differentiating between
\nautosomal recessive disorders and autosomal dominant disorders. Which of the
\nfollowing statements is true of autosomal recessive disorders? (Points : 3)
\n They can
\nmanifest when present in one or both gene pairs.<\/p>\n
There is a one
\nin two chance of an affected child in each pregnancy with an affected mother.<\/p>\n
They tend to
\nhave a more uniform symptomatology than autosomal dominant disorders.<\/p>\n
The associated
\ndisorders are usually attributable to abnormalities in structural proteins.<\/p>\n
Question 12.12. The nurse practitioner working in
\noccupational health has been asked to speak to a group of factory workers about
\nthe importance of wearing gloves when working with strong chemicals such as
\nturpentine and paint thinner. Which of the following characteristics of cell
\nmembranes underlies the nurse’s teaching?<\/p>\n
(Points : 3)
\n Cell membranes
\nare impermeable to all but lipid-soluble substances.<\/p>\n
Cell membranes
\nhave lipids that have a hydrophilic head and a hydrophobic tail.<\/p>\n
Cell membranes
\ncontain receptors for hormones and biologically active substances.<\/p>\n
Transmembrane
\nproteins can pass through the cell membrane into the intracellular environment.<\/p>\n
Question 13.13. The NP is providing care for a 21-year-old
\nfemale patient with gas gangrene of a compound fracture in her arm. Which of
\nthe following assessment findings would the nurse most reasonably expect to
\nfind when caring for a patient with a diagnosis of gas gangrene? (Points : 3)
\n Inflammation of
\nthe affected tissue<\/p>\n
A positive
\nculture for Staphylococcus<\/p>\n
Spreading edema<\/p>\n
Impaired
\nalveolar gas exchange<\/p>\n
Question 14.14. A community health nurse practitioner is
\nteaching a group of female high school students about the importance of regular
\nPapanicolaou (Pap) smears. The nurse recognizes that which of the following
\nitems underlies the rationale for this teaching? (Points : 3)
\n The active
\nsubstitution of normal cells in the cervix correlates to cancer risk.<\/p>\n
Undifferentiated stem cells are an early indicator of cervical cancer.<\/p>\n
Cancer of the
\nuterine cervix develops incrementally at a cellular level.<\/p>\n
Dysplasia in
\nthe connective tissue of the cervix is a strong precursor to cancer.<\/p>\n
Question 15.15. Which target of both chemotherapy and
\nradiation treatment accounts for adverse as well as therapeutic effects?
\n(Points : 3)
\n Cell-surface
\nreceptors<\/p>\n
Circulating
\nhormone levels<\/p>\n
Blood vessels<\/p>\n
Rapidly
\nproliferating cells<\/p>\n
Question 16.16. A patient who has a diagnosis of lung cancer
\nis scheduled to begin radiation treatment. The NP providing pretreatment
\neducation is explaining some of the potential unwanted effects of the
\ntreatment. Which of the following statements by the nurse is most accurate?
\n(Points : 3)
\n \u00e2\u0080\u009cSome patients
\nexperience longer-term irritation of skin adjacent to the treatment site.\u00e2\u0080\u009d<\/p>\n
\u00e2\u0080\u009cSometimes you
\nmight find that your blood takes longer to clot than normal.\u00e2\u0080\u009d<\/p>\n
\u00e2\u0080\u009cThe changes
\nthat you might see are normally irreversible.\u00e2\u0080\u009d<\/p>\n
\u00e2\u0080\u009cThe unwanted
\neffects will be limited to the exposed portions of your skin.\u00e2\u0080\u009d<\/p>\n
Question 17.17. The family of a 68-year-old man who is in
\nthe end stages of small cell lung cancer is distraught at his visible body
\nwasting that has worsened in recent weeks. Which of the following phenomena
\nbest accounts for the patient’s anorexia and cachexia? (Points : 3)
\n Inadequate
\ncellular metabolism of glucose results from tumor factors<\/p>\n
High fat losses
\ncoupled with preservation of muscle mass exaggerate the appearance of wasting<\/p>\n
Products of the
\ntumor itself as well as a hypermetabolic state cause cachexia<\/p>\n
Inadequate food
\nintake due to symptoms and treatment results in loss of both muscle and fat<\/p>\n
Question 18.18. The nurse practitioner is seeing a client
\nwho has an acute exacerbation of Crohn\u00e2\u0080\u0099s disease. The NP recognizes the fact
\nthat the disease involves the inflammation and irritation of the intestinal
\nlining. Which of the following types of tissue is most likely involved in the
\npatient’s pathology? (Points : 3)
\n Simple columnar
\nepithelium<\/p>\n
Glandular epithelium<\/p>\n
Simple cuboidal
\nepthelium<\/p>\n
Stratified
\nepithelium<\/p>\n
Question 19.19. Which of the following pregnant women has
\nmost likely encountered the greatest increase in the risk that her child will
\nhave a fetal anomaly? (Points : 3)
\n A woman with
\ndiagnoses of syphilis and cirrhosis of the liver<\/p>\n
A woman who has
\nherpes simplex and recently recovered from endocarditis<\/p>\n
A woman with
\nchronic obstructive pulmonary syndrome and tuberculosis<\/p>\n
A woman with
\ndiagnoses of insulin-dependent diabetes mellitus and peripheral neuropathy<\/p>\n
Question 20.20. A nurse practitioner employed in the
\nemergency department admits a patient who has experienced severe frostbite to
\nhis hands and toes after becoming lost on a ski trail. The NP recognizes that
\nwhich of the following phenomena has caused the tissue damage? (Points : 3)
\n Decreased blood
\nviscosity has resulted in interstitial bleeding.<\/p>\n
Reactive
\nvasodilation has compromised perfusion.<\/p>\n
Autonomic
\nnervous stimulation has resulted in injury.<\/p>\n
Decreased blood
\nflow has induced hypoxia.<\/p>\n
Question 21.21. A nurse practitioner employed in a
\nhospitalist notices that a patient is experiencing muscle atrophy following 2
\nweeks in traction after a motor vehicle accident. Which of the following
\nfactors has most likely contributed to the atrophy of the patient’s muscle
\ncells? (Points : 3)
\n High levels of
\ninsulin and IGF-1 in the patient’s blood during immobilization<\/p>\n
Denervation of
\nthe affected muscles during the time of traction<\/p>\n
A reduction of
\nskeletal muscle use secondary to the traction treatment<\/p>\n
Reduced oxygen
\nconsumption and cellular function that ensures muscle cell survival<\/p>\n
Question 22.22. An infant who is four days postpartum has
\nbeen diagnosed with a single-gene disorder. The parents of the child have a
\nnumber of questions about the etiology of the health problem, which the
\nphysician is attempting to address in detail. Which of the following teaching
\npoints most accurately captures an aspect of single-gene congenital disorders?
\n(Points : 3)
\n Affected genes are present on autosomal
\nchromosomes rather than sex chromosomes.<\/p>\n
The majority of
\nsingle-gene disorders manifest near the time of puberty.<\/p>\n
A particular
\ndefect can be caused by mutations at one of several different loci.<\/p>\n
Single-gene
\ndisorders are associated with existing rather than new mutations.<\/p>\n
Question 23.23. A researcher is involved in the production
\nof insulin through recombinant DNA technology. Which of the following
\nstatements could the researcher best provide as a rationale for her work?
\n(Points : 3)
\n The gene
\nfragment responsible for insulin production can be isolated and reproduced.<\/p>\n
Particular
\nbacteria are capable of insulin production.<\/p>\n
It is possible
\nto reproduce the chromosome responsible for insulin production.<\/p>\n
Recombination
\nof DNA base pairs can result in a gene that will produce insulin.<\/p>\n
Question 24.24. A 6-year-old girl with a diagnosis of Marfan
\nsyndrome is being assessed at a community health clinic. Which of the following
\nassessments would be the health care professional’s lowest priority? (Points :
\n3)
\n A test of the
\nchild’s visual acuity<\/p>\n
A
\nmusculoskeletal assessment<\/p>\n
Tests of kidney
\nfunction<\/p>\n
Cardiovascular
\nassessment<\/p>\n
Question 25.25. Following a biopsy, a 54-year-old man has
\nbeen diagnosed as having a benign neoplastic tumor. Which of the following
\ncharacteristics most likely applies to his tumor? (Points : 3)
\n The tumor is
\npoorly approximated and has the potential to break loose.<\/p>\n
The tumor may
\nsecrete hormones or cytokines.<\/p>\n
The
\nwell-differentiated neoplastic cells are clustered together in a single mass.<\/p>\n
It has a rapid
\nrate of growth and can induce ischemia.<\/p>\n
1. A 40-year-old woman who experiences severe seasonal
\nallergies has been referred by her family physician to an allergist for weekly
\nallergy injections. The woman is confused as to why repeated exposure to
\nsubstances that set off her allergies would ultimately benefit her. Which of
\nthe following phenomena best captures the rationale for allergy desensitization
\ntherapy? (Points : 3)
\n Repeated
\nexposure to offending allergens binds the basophils and mast cells that mediate
\nthe allergic response.<\/p>\n
Exposure to allergens in large, regular
\nquantities overwhelms the IgE antibodies that mediate the allergic response.<\/p>\n
Repeated
\nexposure stimulates adrenal production of epinephrine, mitigating the allergic
\nresponse.<\/p>\n
Injections of
\nallergens simulate production of IgG, which blocks antigens from combining with
\nIgE.<\/p>\n
Question 2.2. A 14-year-old boy has been diagnosed with
\ninfectious mononucleosis. Which of the following pathophysiological phenomena
\nis most responsible for his symptoms? (Points : 3)
\n The
\nEpstein-Barr virus (EBV) is lysing many of the boy’s neutrophils.<\/p>\n
Viruses are
\nkilling some of his B cells and becoming incorporated into the genomes of
\nothers.<\/p>\n
The EBV
\ninhibits the maturation of white cells within his peripheral lymph nodes.<\/p>\n
The virus
\nresponsible for mononucleosis inhibits the maturation of myeloblasts into
\npromyelocytes.<\/p>\n
Question 3.3. A 66-year-old female patient has presented to
\nthe emergency department because of several months of intermittently bloody
\nstools that has recently become worse. The woman has since been diagnosed with
\na gastrointestinal bleed secondary to overuse of nonsteroidal anti-inflammatory
\ndrugs that she takes for her arthritis. The health care team would realize that
\nwhich of the following situations is most likely?(Points : 3)
\n The woman has
\ndepleted blood volume due to her ongoing blood loss.<\/p>\n
She will have
\niron-deficiency anemia due to depletion of iron stores.<\/p>\n
The patient
\nwill be at risk for cardiovascular collapse or shock.<\/p>\n
She will have
\ndelayed reticulocyte release.<\/p>\n
Question 4.4. Which of the following patients is most likely
\nto benefit from transplantation of thymic tissue or major histocompatibility
\ncomplex (MHC)-compatible bone marrow? (Points : 3)
\n A 12-year-old
\ngirl with a history of epilepsy and low IgG levels secondary to phenytoin use<\/p>\n
A 7-year-old
\nboy whose blood work indicates decreased IgA and IgG with increased IgM<\/p>\n
A 6-year-old boy whose pre-B cells are
\nincapable of translation to normal B cells<\/p>\n
A 9-year-old
\ngirl who has a diagnosis of IgA deficiency<\/p>\n
Question 5.5. A 29-year-old construction worker got a sliver
\nunder his fingernail four days ago. The affected finger is now reddened,
\npainful, swollen, and warm to the touch. Which of the following hematological
\nprocesses is most likely occurring in response to the infection? (Points : 3)
\n Proliferation
\nof immature neutrophils<\/p>\n
High circulatory
\nlevels of myeloblasts<\/p>\n
Increased
\nsegmented neutrophil production<\/p>\n
Phagocytosis by
\nmyelocytes<\/p>\n
Question 6.6. Sputum samples from a patient with pneumonia
\ncontain an infective agent that has a peptidoglycan cell wall, expresses
\nendotoxins, replicates readily in broth and on agar, grows in clusters, has
\npili, and does not stain when exposed to crystal violet. This pneumonia is most
\nlikely: (Points : 3)
\n Chlamydial<\/p>\n
Viral<\/p>\n
Mycoplasmal<\/p>\n
Bacterial<\/p>\n
Question 7.7. A child has been diagnosed with thalassemia.
\nWhich of the following other health problems is the child at risk for? (Points
\n: 3)
\n Hypocoagulation<\/p>\n
Iron and
\nferritin deficiencies<\/p>\n
Splenomegaly
\nand hepatomegaly<\/p>\n
Neutropenia<\/p>\n
Question 8.8. A nurse practitioner is providing prenatal
\ncare and education for a first-time expectant mother, 22 weeks’ gestation, who
\nhas a diagnosis of a sexually transmitted infection. Which of the following
\nstatements by the expectant mother demonstrates an adequate understanding of
\nvertical disease transmission and congenital infections? (Points : 3)
\n \u00e2\u0080\u009cGonorrhea and
\nchlamydia pose the greatest risks of transmission from mother to child.\u00e2\u0080\u009d<\/p>\n
\u00e2\u0080\u009cI know that my
\nbaby will need observation for HIV signs and symptoms in the weeks following my
\ndelivery.\u00e2\u0080\u009d<\/p>\n
\u00e2\u0080\u009cMy baby could
\nbecome infected either across the placenta or during the birth itself.\u00e2\u0080\u009d<\/p>\n
\u00e2\u0080\u009cProphylactic
\nimmunization will reduce my baby’s chance of being born with an illness.\u00e2\u0080\u009d<\/p>\n
Question 9.9. As part of his diagnostic workup, a
\n77-year-old man’s nurse practitioner has ordered blood work that includes
\nferritin levels. The man is very interested in the details of his health care
\nand is unfamiliar with ferritin and its role. He asks his nurse practitioner to
\nexplain the significance of it and the rationale for testing it. Which of the
\nfollowing explanations by the nurse practitioner is most accurate?(Points : 3)
\n \u00e2\u0080\u009cFerritin is
\nthe activated and usable form of iron that your red blood cells can use to
\ntransport oxygen.\u00e2\u0080\u009d<\/p>\n
\u00e2\u0080\u009cFerritin is a
\nstored form of iron that indirectly shows me whether you would benefit from
\niron pills.\u00e2\u0080\u009d<\/p>\n
\u00e2\u0080\u009cFerritin is a
\nprotein-iron complex that allows your red blood cells to make use of the iron
\nthat you consume in your diet.\u00e2\u0080\u009d<\/p>\n
\u00e2\u0080\u009cFerritin is
\nthe form of iron that is transported in your blood plasma to the red blood
\ncells that need it.\u00e2\u0080\u009d<\/p>\n
Question 10.10. A 16-year-old female has been brought to her
\nprimary care nurse practitioner by her mother due to the girl’s persistent sore
\nthroat and malaise. Which of the following facts revealed in the girl’s history
\nand examination would lead the nurse practitioner to rule out infectious
\nmononucleosis? (Points : 3)
\n The girl has a
\ntemperature of 38.1\u00c2\u00b0C (100.6\u00c2\u00b0F) and has enlarged lymph nodes.<\/p>\n
Her liver and
\nspleen are both enlarged.<\/p>\n
Blood work
\nreveals an increased white blood cell count.<\/p>\n
Chest
\nauscultation reveals crackles in her lower lung fields bilaterally.<\/p>\n
Question 11.11. A 30-year-old man has spent 5 hours on a
\ncross-country flight seated next to a passenger who has been sneezing and
\ncoughing, and the man has been inhaling viral particles periodically. Which of
\nthe following situations would most likely result in the stimulation of the
\nman’s T lymphocytes and adaptive immune system? (Points : 3)
\n Presentation of
\na foreign antigen by a familiar immunoglobulin<\/p>\n
Recognition of
\na foreign MHC molecule<\/p>\n
Recognition of
\na foreign peptide bound to a self MHC molecule<\/p>\n
Cytokine
\nstimulation of a T lymphocyte with macrophage or dendritic cell mediation<\/p>\n
Question 12.12. A 22-year-old female who adheres to a vegan
\ndiet has been diagnosed with iron-deficiency anemia. Which of the following
\ncomponents of her diagnostic blood work would be most likely to necessitate
\nfurther investigation? (Points : 3)
\n Decreased mean
\ncorpuscular volume (MCV)<\/p>\n
Decreased
\nhemoglobin and hematocrit<\/p>\n
Microcytic,
\nhypochromic red cells<\/p>\n
Decreased
\nerythropoietin levels<\/p>\n
Question 13.13. A couple who are expecting their first child
\nhave been advised by friends to consider harvesting umbilical cord blood in
\norder to have a future source of stem cells. The couple have approached their
\nnurse practitioner with this request and are seeking clarification of exactly
\nwhy stem cells are valuable and what they might expect to gain from harvesting
\nthem. How can the nurse practitioner best respond to the couple’s inquiry?
\n(Points : 3)
\n \u00e2\u0080\u009cStem cells can
\nhelp correct autoimmune diseases and some congenital defects.\u00e2\u0080\u009d<\/p>\n
\u00e2\u0080\u009cStem cells can
\nbe used to regenerate damaged organs should the need ever arise.\u00e2\u0080\u009d<\/p>\n
\u00e2\u0080\u009cStem cells can
\nbe used as a source of reserve cells for the entire blood production system.\u00e2\u0080\u009d<\/p>\n
\u00e2\u0080\u009cStem cells can
\nhelp treat some cancers and anemias, but they must come from your child himself
\nor herself.\u00e2\u0080\u009d<\/p>\n
Question 14.14. A 23-year-old man has received a recent
\ndiagnosis of appendicitis following 24 hours of acute abdominal pain. The nurse
\npractitioner providing care for the man is explaining that while it is
\nunpleasant, the inflammation of his appendix is playing a role in his body’s
\nfight against the underlying infectious process. Which of the following
\nteaching points should the nurse practitioner eliminate from his teaching for
\nthe patient? (Points : 3)
\n \u00e2\u0080\u009cInflammation
\ncan help to remove the body tissue cells that have been damaged by infection.\u00e2\u0080\u009d<\/p>\n
\u00e2\u0080\u009cInflammation
\nwill start your body on the path to growing new, healthy tissue at the site of
\ninfection.<\/p>\n
\u00e2\u0080\u009cInflammation
\nhelps your body to produce the right antibodies to fight the infection.\u00e2\u0080\u009d<\/p>\n
\u00e2\u0080\u009cInflammation
\nultimately aids in eliminating the initial cause of the cell injury in your
\nappendix.\u00e2\u0080\u009d<\/p>\n
Question 15.15. A 60-year-old woman is suspected of having
\nnon-Hodgkin lymphoma (NHL). Which of the following aspects of her condition
\nwould help to rule out Hodgkin lymphoma? (Points : 3)
\n Her neoplasm
\noriginates in secondary lymphoid structures.<\/p>\n
The lymph nodes
\ninvolved are located in a large number of locations in the lymphatic system.<\/p>\n
The presence of
\nReed-Sternberg cells has been confirmed.<\/p>\n
The woman
\ncomplains of recent debilitating fatigue.<\/p>\n
Question 16.16. Which of the following statements most
\naccurately conveys an aspect of lymphatic system activity? (Points : 3)
\n B and T
\nlymphocyte development begins in the bone marrow and ends in the peripheral
\nlymphoid structures.<\/p>\n
B cells and
\nmacrophages are released from the bone marrow in their completed state.<\/p>\n
Stem cells in
\nthe lymph nodes initiate and regulate the process of white cell synthesis.<\/p>\n
Leukocytes
\nbypass vascular circulation and are distributed instead by the lymphatic
\nsystem.<\/p>\n
Question 17.17. A nurse practitioner is explaining to a
\n40-year-old male patient the damage that Mycobacterium tuberculosis could do to
\nlung tissue. Which of the following phenomena would underlie the nurse
\npractitioner’s explanation? (Points : 3)
\n Tissue
\ndestruction results from neutrophil deactivation.<\/p>\n
Nonspecific
\nmacrophage activity leads to pulmonary tissue destruction and resulting
\nhemoptysis.<\/p>\n
Macrophages are
\nunable to digest the bacteria, resulting in immune granulomas.<\/p>\n
Neutrophils are
\nineffective against the Mycobacterium tuberculosis antigens.<\/p>\n
Question 18.18. A 2-year-old girl has had repeated ear and
\nupper respiratory tract infections since she was born. A pediatrician has
\ndetermined a diagnosis of transient hypogammaglobulinemia of infancy. What is
\nthe physiological origin of the child’s recurrent infections? (Points : 3)
\n Antibody
\nproduction by plasma cells is compromised because of impaired communication
\nbetween B and T cells.<\/p>\n
The child had a
\ncongenital absence of immunoglobulin G (IgG) antibodies and her body is only
\nslowly beginning to produce them independently.<\/p>\n
The child was
\nborn with immunoglobulin A (IgA) and immunoglobulin (IgM) antibodies,
\nsuggesting intrauterine infection.<\/p>\n
The child lacks
\nthe antigen presenting cells integral to normal B-cell antibody production.<\/p>\n
Question 19.19. Following a course of measles, a 5-year-old
\ngirl developed scattered bruising over numerous body surfaces and was diagnosed
\nwith immune thrombocytopenic purpura (ITP). As part of her diagnostic workup,
\nblood work was performed. Which of the following results is most likely to be
\nconsidered unexpected by the health care team? (Points : 3)
\n Increased
\nthrombopoietin levels<\/p>\n
Decreased
\nplatelet count<\/p>\n
Normal vitamin
\nK levels<\/p>\n
Normal
\nleukocyte levels<\/p>\n
Question 20.20. A 60-year-old male patient with an acute
\nviral infection is receiving interferon therapy. The nurse practitioner is
\nteaching the family of the patient about the diverse actions of the treatment
\nand the ways that it differs from other anti-infective therapies. Which of the
\nfollowing teaching points should the nurse practitioner exclude? (Points : 3)
\n \u00e2\u0080\u009cInterferon can
\nhelp your father’s unaffected cells adjacent to his infected cells produce
\nantiviral proteins that limit the spread of the infection.\u00e2\u0080\u009d<\/p>\n
\u00e2\u0080\u009cInterferon can help limit the replication
\nof the virus that’s affecting your father.\u00e2\u0080\u009d<\/p>\n
\u00e2\u0080\u009cInterferon
\nhelps your father’s body recognize infected cells more effectively.\u00e2\u0080\u009d<\/p>\n
\u00e2\u0080\u009cInterferon can
\nbolster your father’s immune system by stimulating natural killer cells that
\nattack viruses.\u00e2\u0080\u009d<\/p>\n
Question 21.21. A 24-year-old woman presents with fever and
\npainful, swollen cervical lymph nodes. Her blood work indicates neutrophilia
\nwith a shift to the left. She most likely has: (Points : 3)
\n A mild parasitic
\ninfection<\/p>\n
A severe
\nbacterial infection<\/p>\n
A mild viral
\ninfection<\/p>\n
A severe fungal
\ninfection<\/p>\n
Question 22.22. A nurse practitioner student is
\nfamiliarizing herself with the overnight admissions to an acute medical unit of
\na university hospital. Which of the following patients would the student
\nrecognize as being least likely to have a diagnosis of antiphospholipid
\nsyndrome in his or her medical history? (Points : 3)
\n A 66-year-old
\nobese male with left-sided hemiplegia secondary to a cerebrovascular accident<\/p>\n
A 90-year-old
\nfemale resident of a long-term care facility who has been experiencing
\ntransient ischemic attacks<\/p>\n
A 30-year-old
\nfemale with a diagnosis of left leg DVT and a pulmonary embolism<\/p>\n
A 21-year-old
\nmale with a diagnosis of cellulitis and suspected endocarditis secondary to
\nintravenous drug use<\/p>\n
Question 23.23. The blood work of a 44-year-old male patient
\nwith a diagnosis of liver disease secondary to alcohol abuse indicates low
\nlevels of albumin. Which of the following phenomena would a clinician be most
\njustified in anticipating? (Points : 3)
\n Impaired immune
\nfunction<\/p>\n
Acid-base
\nimbalances<\/p>\n
Impaired
\nthermoregulation<\/p>\n
Fluid
\nimbalances<\/p>\n
Question 24.24. A nurse practitioner is teaching her
\ncolleagues about the role of cytokines in a variety of pathologies. Which of
\nthe following teaching points best captures an aspect of the functions and
\nnature of cytokines? (Points : 3)
\n \u00e2\u0080\u009cA particular
\ncytokine can have varied effects on different systems, a fact that limits their
\ntherapeutic use.\u00e2\u0080\u009d<\/p>\n
\u00e2\u0080\u009cCytokine
\nproduction is constant over time, but effects are noted when serum levels cross
\na particular threshold.\u00e2\u0080\u009d<\/p>\n
\u00e2\u0080\u009cMost cytokines
\nare produced by granular leukocytes, and different cells are capable of
\nproducing the same cytokine.\u00e2\u0080\u009d<\/p>\n
\u00e2\u0080\u009cCytokine
\nactions are self-limiting in that activation of one precludes activation of
\nother cytokines with similar actions.\u00e2\u0080\u009d<\/p>\n
Question 25.25. Which of the following phenomena would be
\nleast likely to result in activation of the complement system? (Points : 3)
\n Recognition of
\nan antibody bound to the surface of a microbe<\/p>\n
The binding of
\nmannose residues on microbial glycoproteins<\/p>\n
Activation of
\nToll-like receptors (TLRs) on complement proteins<\/p>\n
Direct
\nrecognition of microbial proteins<\/p>\n
1. The nurse practitioner for a cardiology practice is
\nresponsible for providing presurgical teaching for patients who are about to
\nundergo a coronary artery bypass graft. Which of the following teaching points
\nbest conveys an aspect of the human circulatory system? (Points : 3)
\n \u00e2\u0080\u009cYour blood
\npressure varies widely between arteries and veins, and between pulmonary and
\nsystemic circulation.\u00e2\u0080\u009d<\/p>\n
\u00e2\u0080\u009cOnly around one quarter of your blood is
\nin your heart at any given time.\u00e2\u0080\u009d<\/p>\n
\u00e2\u0080\u009cBlood pressure
\nand blood volume roughly mimic one another at any given location in the
\ncirculatory system.\u00e2\u0080\u009d<\/p>\n
\u00e2\u0080\u009cLeft-sided and
\nright-sided pumping action at each beat of the heart must equal each other to
\nensure adequate blood distribution.\u00e2\u0080\u009d<\/p>\n
Question 2.2. A physical assessment of a 28-year-old female
\npatient indicates that her blood pressure in her legs is lower than that in her
\narms and that her brachial pulse is weaker in her left arm than in her right.
\nIn addition, her femoral pulses are weak bilaterally. Which of the following
\npossibilities would her care provider be most likely to suspect? (Points : 3)<\/p>\n
Pheochromocytoma<\/p>\n
Essential
\nhypertension<\/p>\n
Coarctation of
\nthe aorta<\/p>\n
An
\nadrenocortical disorder<\/p>\n
Question 3.3. As part of the diagnostic workup for a male
\npatient with a complex history of cardiovascular disease, the care team has
\nidentified the need for a record of the electrical activity of his heart,
\ninsight into the metabolism of his myocardium, and physical measurements, and
\nimaging of his heart. Which of the following series of tests is most likely to
\nprovide the needed data for his diagnosis and care? (Points : 3)
\n Echocardiogram,
\nPET scan, ECG<\/p>\n
Ambulatory ECG,
\ncardiac MRI, echocardiogram<\/p>\n
Serum
\ncreatinine levels, chest auscultation, myocardial perfusion scintigraphy<\/p>\n
Cardiac
\ncatheterization, cardiac CT, exercise stress testing<\/p>\n
Question 4.4. An older adult female patient has presented
\nwith a new onset of shortness of breath, and the patient’s nurse practitioner
\nhas ordered measurement of her BNP levels along with other diagnostic tests.
\nWhat is the most accurate rationale for the nurse practitioner’s choice of
\nblood work? (Points : 3)
\n BNP is released
\nas a compensatory mechanism during heart failure and measuring it can help
\ndifferentiate the patient’s dyspnea from a respiratory pathology.<\/p>\n
BNP is an
\nindirect indicator of the effectiveness of the RAA system in compensating for
\nheart failure.<\/p>\n
BNP levels
\ncorrelate with the patient’s risk of developing cognitive deficits secondary to
\nheart failure and consequent brain hypoxia.<\/p>\n
BNP becomes
\nelevated in cases of cardiac asthma, Cheyne-Stokes respirations, and acute
\npulmonary edema, and measurement can gauge the severity of pulmonary effects.<\/p>\n
Question 5.5. A patient in the intensive care unit has a
\nblood pressure of 87\/39 and has warm, flushed skin accompanying his sudden
\ndecline in level of consciousness. The patient also has arterial and venous
\ndilation and a decrease in systemic vascular resistance. What is this patient’s
\nmost likely diagnosis? (Points : 3)
\n Hypovolemic
\nshock<\/p>\n
Septic shock<\/p>\n
Neurogenic
\nshock<\/p>\n
Obstructive
\nshock<\/p>\n
Question 6.6. A number of patients have presented to the
\nemergency department in the last 24 hours with complaints that are
\npreliminarily indicative of myocardial infarction. Which of the following
\npatients is least likely to have an ST-segment myocardial infarction (STEMI)?
\n(Points : 3)
\n A 70-year-old
\nwoman who is complaining of shortness of breath and vague chest discomfort<\/p>\n
A 66-year-old
\nman who has presented with fatigue, nausea and vomiting, and cool, moist skin<\/p>\n
A 43-year-old
\nman who woke up with substernal pain that is radiating to his neck and jaw<\/p>\n
A 71-year-old
\nman who has moist skin, fever, and chest pain that is excruciating when he
\nmoves but relieved when at rest<\/p>\n
Question 7.7. A 54-year-old man with a long-standing
\ndiagnosis of essential hypertension is meeting with his nurse practitioner. The
\npatient’s nurse practitioner would anticipate that which of the following
\nphenomena is most likely occurring? (Points : 3)
\n The patient’s
\njuxtaglomerular cells are releasing aldosterone as a result of sympathetic
\nstimulation.<\/p>\n
Epinephrine
\nfrom his adrenal gland is initiating the renin-angiotensin-aldosterone system.<\/p>\n
Vasopressin is
\nexerting<\/p>\n","protected":false},"excerpt":{"rendered":"
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