NAT 503 - Integrative Pathiophisiology
When the cause is unknown, a condition is said to be idiopathic
true
Your patient’s red blood cell is slightly elevated today. This might be explained by (Select all that apply.)
gender difference. situational factors. normal variation. illness
The nurse is swabbing a patient’s throat to test for streptococcal pharyngitis. The nurse must understand that tests such as this differ in the probability that they will be positive for a condition when applied to a person with the condition; this probability is termed sensitivity.
true
After suffering a heart attack, a middle-aged man is counseled to take a cholesterol-lowering medication. This is an example of
tertiary prevention
In general, with aging, organ size and function
decrease
C.Q. was recently exposed to group A hemolytic Streptococcus and subsequently developed a pharyngeal infection. His clinic examination reveals an oral temperature of 102.3°F, skin rash, dysphagia, and reddened throat mucosa with multiple pustules. He complains of sore throat, malaise, and joint stiffness. A throat culture is positive for Streptococcus, and antibiotics have been prescribed. The etiology of C.Q.’s disease is
streptococcal infection.
A 17-year-old college-bound student receives a vaccine against an organism that causes meningitis. This is an example of
primary prevention
An obese but otherwise healthy teen is given a prescription for a low-calorie diet and exercise program. This is an example of
secondary prevention
A disease that is native to a particular region is called
endemic
A patient with high blood pressure who is otherwise healthy is counseled to restrict sodium intake. This is an example of
secondary prevention
Indicators that an individual is experiencing high stress include all the following except
pupil constriction
Persistence of the alarm stage will ultimately result in
permanent damage and death.
Many of the responses to stress are attributed to activation of the sympathetic nervous system and are mediated by
norepinephrine
Which is not normally secreted in response to stress?
Insulin
Chronic activation of stress hormones can lead to (Select all that apply
cardiovascular disease. depression. impaired cognitive function. autoimmune disease.
Aldosterone may increase during stress, leading to (Select all that apply.)
increased blood volume, increased sodium retention. decreased urinary output.
Events which occur during the alarm stage of the stress response include secretion of (Select all that apply.)
catecholamines. Correct! ACTH. Correct Answer glucocorticoids. Correct! immune cytokines.
All the following stress-induced hormones increase blood glucose except
aldosterone
Allostasis is best defined as
the overall process of adaptive change necessary to maintain survival and well-being.
Selye’s three phases of the stress response include all the following except
allostasis
The cardiac drug digitalis enhances myocardial contraction, because it
increases intracellular calcium level in cardiac cells.
The resting membrane potential in nerve and skeletal muscle is determined primarily by
the ratio of intracellular to extracellular potassium ions.
An increase in extracellular potassium ion from 4.0 to 6.0 mEq/L would
hypopolarize the resting membrane potential
Some individuals inherit a gene that results in dangerously high blood cholesterol caused by impaired endocytosis of low-density lipoproteins (LDLs).
true
Phospholipids spontaneously form lipid bilayers, because they are
amphipathic
During conditions of prolonged insufficient oxygen availability (e.g., respiratory or cardiovascular disease) anaerobic glycolysis accumulated pyruvate can lead to lactic acidosis.
true
The benefit of glycolysis is that this second stage of catabolism supplies
pyruvate to the citric acid cycle.
Cell-to-cell communication through secretion of chemical signals into the bloodstream to target cells throughout the body is called _____ signaling.
endocrine
Metaplasia is
the replacement of one differentiated cell type with another.
Reperfusion injury to cells
involves formation of free radicals.
The primary effect of aging on all body systems is
decreased functional reserve
Coagulative necrosis is caused by
interrupted blood supply.
The cellular response indicative of injury because of faulty metabolism is
intracellular accumulations.
Viruses differ from most bacteria in that they (Select all that apply.)
enter the host cell. use the host’s metabolic processes to survive and replicate.do not produce toxins
Somatic death refers to death
of the entire organism
The main principle of the fluid mosaic model is that:
proteins float in a fluid lipid bilayer.
The chief function of the Golgi apparatus is:
packaging proteins into secretory vesicles.
Signaling molecules such as hormones and growth factors influence their target cells by binding to their:
receptors.
Why is ongoing synthesis of ATP necessary for cell survival?
ATP provides energy for ion pumping and other cellular processes.
A white blood cell can ingest bacteria or cellular debris through the process of:
phagocytosis
Approximately what percentage of the human DNA chromosomes code for proteins?
1%
Characteristics of cellular differentiation include which of the following? (Select all that apply.)
Specialization for different functions, influenced by memory of developmental events, dependent on cell-to-cell coordination, Generally not reversibl
Protein synthesis involves (Select all that apply.)
direction from mRNA, nucleotide triplets, RNA polymerase, removal of introns from the DNA template
Calcium channel blocker drugs are often used to treat conditions associated with (Select all that apply.)
cardiac muscle, smooth muscle
In DNA replication DNA polymerase functions to (Select all that apply.)
match appropriate bases to the template base.Correct! proofread the newly developed DNA for errors in base pairing.
Characteristics of stem cells include that they (Select all that apply.)
may differentiate into any type of cell, have greater capacity to proliferate than more differentiated cells, are dependent upon environmental cues for proliferation., can die in the absence of an appropriate environment.
The primary role of genes is to
direct the synthesis of proteins.
Males are more likely than females to be affected by ________ disorders.
X-linked
Results of biochemical tests indicate an infant has phenylketonuria (PKU). The parents ask what PKU means. Correct responses would include all the following except PKU
results from a chromosome abnormality called nondisjunction.
The parents of a child with PKU are concerned about the risk of transmitting the disorder in future pregnancies. The correct assessment of the risk is
each child has a 25% chance of being affected.
Information parents should be given about the consequences of PKU includes
failure to avoid phenylalanine results in progressive mental retardation.
The risk period for maternal rubella infection leading to congenital problems begins
prior to conception.
Characteristics of Marfan syndrome include that it (Select all that apply.)
is a single-gene disorder, involves alterations in connective tissue, leads to skeletal and joint deformities, results in dangerous cardiovascular disorders.
Huntington disease is often transferred to offspring before a parent knows of the genetic possibility of this disease, because
symptoms often do not occur until approximately 40 years of age.
Huntington disease primarily affects the _____ system.
neurologic
The chief function of ribosomes is:
protein synthesis
The two primary locations of active ribosomes in a cell are:
attached to endoplasmic reticulum and free in cytoplasm
Growth factors influence a cell by:
binding to receptors
The primary function of the Golgi apparatus is:
processing and packaging of proteins into vesicles.
Since the nucleus is surrounded by a nuclear membrane, how do most molecules leave the nucleus?
Through nuclear pores
Malignant neoplasms of epithelial origin are known as
carcinomas
The most common tumor-suppressor gene defect identified in cancer cells is
p53
Side effects of chemotherapy include (Select all that apply.)
anemia, nausea, bleeding, infections
Cancer grading is based on
cell differentiation.
Your patient is scheduled for a staging procedure. She wants to know what that means. The correct response is which of the following?
It is a procedure for determining the extent of tumor spread.
Deficits in immune system function occur in cancer as a result of (Select all that apply.)
Characteristics of telomerase include (Select all that apply.)
Paraneoplastic syndromes in cancer involve excessive production of substances by multiple means. A common substance found in excessive amounts resulting from cancer paraneoplastic syndromes is
calcium
Your patient eats “lots of fat,” leads a “stressful” life, and has smoked “about two packs a day for the last 40 years.” Her chronic morning cough recently worsened, and she was diagnosed with a lung mass. The most likely contributing factor for development of lung cancer in this patient is
cigarette smoking
After surgery to remove a lung tumor, your patient is scheduled for chemotherapy, which will
kill rapidly dividing cells.
Proto-oncogenes
are normal cellular genes that promote growth.
A patient with metastatic lung cancer wants to know her chances for survival. Which response is correct?
“Lung cancer has about a 15% survival rate.”
The hypermetabolic state leading to cachexia in terminal cancer is thought to be because of
tumor necrosis factor
Retroviruses are associated with human cancers, including
Burkitt lymphoma.
Tumor markers (Select all that apply.)
Apoptosis is the process by which damaged cells:
die by orderly disassembly.
What cells are made from precursor cells in bone marrow?
Free radical injury can be caused by:
ionizing radiation.
What is the importance of a sequence of three base pairs (a codon) in DNA?
It ultimately determines which amino acid will be placed in a protein.
Plasma membrane receptors are available to bind to:
extracellular chemicals.
The primary function of kinins is
vasodilation to enhance inflammation.
Antigen-presenting cells function to
display foreign antigen on their cell surfaces bound to MHC.
Activation of the complement cascade results in (Select all that apply.)
A. inflammation
C. chemotaxis
Interleukin-1, interleukin-6, and tumor necrosis factor-α are inflammatory cytokines secreted by
macrophages
Functions of antibodies include (Select all that apply.)
a. antigen agglutination.
b. antigen precipitation. c. opsonization. d. complement activation.
The spleen is an important defense against infection, because it
filters the blood.
Functions of B cells include
synthesizing antibodies
The membrane attack complex formed by complement is similar in function to
perforin
Which clinical finding is most indicative of an acute bacterial infection?
Increased (band) neutrophils
Passive immunity is provided by (Select all that apply.)
The primary function of eosinophils is to
kill parasitic helminths (worms).
Leukocytosis with a “shift to the left” refers to
elevated immature neutrophils.
Functions of T cells include (Select all that apply.)
all apply
Proteins that are increased in the bloodstream during acute inflammation are called
acute phase proteins
Characteristics of complement include (Select all that apply.)
What is a lysosome?
A membrane-bound bag of degradative enzymes within a cell
The cell structure that contains DNA is called the:
nucleus
What is a gene?
A section of DNA that has the code for making a protein
Proteins are made of:
amino acids.
Most receptors in cell membranes are made of:
protein.
Immune function is likely to be most effective in a
30-year-old.
An infectious disease that is common in a community is termed
endemic
Drug resistance of microbes occurs secondary to
mutation of the microb
A characteristic of some bacteria
contains cell wall endotoxin.
Dietary zinc is an important defense against infection, because it maintains (Select all that apply.)
The most common method of disease transmission is
droplet
Risk of infection is increased in (Select all that apply.)
The term used to describe fungal infections is
mycoses
Rickets is characterized by soft, weak bones resulting from a deficiency of
vitamin d
Bone healing may be impaired by
nicotine use
The disorders characterized by softening and then enlargement of bones is referred to as
Paget disease.
Compartment syndrome occurs secondary to
soft-tissue damage.
Pain with passive stretching of a muscle is indicative of
noncontractile tissue injury
The pathophysiology of osteomalacia involves
inadequate mineralization in the osteoid
Characteristics of scoliosis include (Select all that apply.)
When mast cells degranulate, they release:
histamine and other inflammatory mediators.
Which of the following cells are strong phagocytes?
Macrophages
What is a lysosome?
A membrane-bound bag of degradative enzymes within a cell
Which of the following terms indicates cell death that occurs by severe cell swelling and the breakdown of organelles?
necrosis
The process of programmed cellular self-destruction is called:
apoptosis
Which disorder is associated with a type III hypersensitivity mechanism of injury?
Systemic lupus erythematosus
Transfusion reactions involve RBC destruction caused by
recipient bodies
Secondary immune deficiency problems may be caused by (Select all that apply.)
Myasthenia gravis is a type II hypersensitivity disorder that involves
impaired muscle function.
Severe combined immunodeficiency (SCID) syndrome is an example of a(n)
deficient immune response
The effects of histamine release include
increased vascular permeability.
Autoimmune diseases result from (Select all that apply.)
Anaphylaxis may occur in certain hypersensitivity reactions, including type (Select all that apply.)
RhoGAM (an Rh antibody) would be appropriate in an Rh-_____ woman with an _____ Rh-_____ antibody titer carrying an Rh-_____ fetus.
negative; negative; positive
which disorder is considered a primary immunodeficiency disease?
HIV/AIDS
Dramatic hypotension sometimes accompanies type I hypersensitivity reactions, because
massive histamine release from mast cells leads to vasodilation.
The principle Ig mediator of type I hypersensitivity reactions i
IgE
A child with a history of recent strep throat infection develops glomerulonephritis. This is most likely a type _____ hypersensitivity reaction.
III
A primary effector cell of the type I hypersensitivity response is
mast cells
An important mediator of a type I hypersensitivity reaction is
histamine
The predominant antibody of a typical allergic response is:
IgE
What is the major function of T helper cells?
Secreting cytokines that regulate immune response
Which of the following cells produce antibodies?
Plasma cells
When antigen-antibody complexes are formed in the blood, which of the following processes can occur?
All of the above
Which of the following cells are strong phagocytes?
Macrophages
Which statement about HIV testing is correct?
Significant exposure to infected blood or body fluids requires HIV testing.
As of 2014, _____ individuals worldwide have been infected with HIV infection.
nearly 35 million
The CDC defines three CD4+ T-cell categories of T cell ranges. Which values are correct? (Select all that apply.)
The HIV nurse educator teaches a newly diagnosed patient about HIV. The nurse educator tells the patient that in the United States, those at greatest risk of HIV infection include (Select all that apply.)
heterosexual women.
homosexual men.
A nurse who works in an assisted living facility is preparing to teach the residents about safe sex practices. What resident criteria should the nurse take into consideration when creating a teaching plan? (Select all that apply.)
Age! Ethnicity! Culture! Sexual preference
Cleaning dirty needles prior to use helps prevent the spread of HIV. When using bleach, the user must rinse out all the blood first and then fill the needle and syringe with full-strength bleach three times for 10 to 20 seconds.
false
Which HIV-positive patient should be given a diagnosis of AIDS?
One who has Mycobacterium tuberculosis
A patient presents to the clinic with flulike symptoms and a rash. The nurse knows that the type of rash associated with HIV may include (Select all that apply.)
HIV replicates very quickly from the onset of infection. What is the major site of HIV replication?
GI trac
Opportunistic infections are a hallmark of HIV and AIDS. Which infections are considered opportunistic? (Select all that apply.)
Which modes of transmission occur with HIV infection? (Select all that apply.)
HIV infection causes immunodeficiency because it
causes the destruction of T-helper cells
A patient is infected with the retrovirus HIV. The patient may have contracted HIV as it was transmitted via (Select all that apply.)
semen
cervical secretions
Which statement best describes the etiologic development and transmission of AIDS?
AIDS is caused by a retrovirus and transmitted through body fluids.
Which drugs are used for the management of HIV? (Select all that apply.)
What is the major function of TH1 cells?
Secrete cytokines that stimulate cytotoxic T cells, NK cells, and macrophages
What is the major function of T helper cells?
Secreting cytokines that regulate immune response
The process of programmed cell self-destruction is called:
apoptosis.
What is the major function of TH2 cells?
The major function of TH2 cells is to secrete cytokines that stimulate antibody production and activate eosinophils.
What are CD4+ T cells?
What are CD4+ T cells?
A diagnostic laboratory finding in myeloma is
Bence Jones proteins in the urine.
The only known curative treatment for CML is allogeneic bone marrow transplantation from a suitable donor.
true
A patient is diagnosed with hairy cell leukemia. The patient’s laboratory results would most likely indicate a decrease in (Select all that apply.)
A patient is diagnosed with stage IIA Hodgkin disease. This patient’s clinical stage was most likely determined by (Select all that apply.)
Autologous stem cell transplantation is a procedure in which
stem cells are harvested from the patient and then returned to the same patient.
A 58-year-old woman is seen in the clinic for reports of severe back pain. Her chest x-ray demonstrates generalized bone demineralization and compression fracture. Blood studies demonstrate elevated calcium levels. The most likely diagnosis is
myeloma
Burkitt lymphoma is most closely associated with
Epstein–Barr virus
A patient is diagnosed with CML (chronic myeloid leukemia). The patient may experience which of these symptoms? (Select all that apply.)
A 5-year-old patient’s parents report loss of appetite and fatigue in their child. The parents also state that the child refuses to walk as a result of pain. The child’s most likely diagnosis is
ALL (acute lymphoid leukemia)
Which viruses have been implicated as cancer-causing agents? (Select all that apply.)
Which type of leukemia primarily affects children?
ALL (acute lymphoid leukemia
While in the hospital for management of acute lymphoid leukemia (ALL), a patient develops severe thrombocytopenia. The most appropriate action for this condition is
activity restriction
A patient is diagnosed with myeloma. The nurse teaches the patient about the multiple tumor sites that can develop with this cancer. The possible tumor sites in myeloma include the (Select all that apply.)
The patient is a 12-year-old boy with acute lymphoblastic leukemia (ALL). Manifestations of the patient’s leukemia prior to treatment may include (Select all that apply.)
A patient is diagnosed with stage III non-Hodgkin lymphoma and is preparing to undergo treatment. Which treatments may be used to treat this patient’s cancer? (Select all that apply.)
Macrophages interact with T helper cells by:
presenting antigens and secreting cytokines.
Which of the following cells are strong phagocytes?
Macrophages
Which of the following cells produce antibodies?
Plasma cells
Which answer describes adaptive immunity?
Each immune cell can respond to only one antigen.
What type of a cell is a B cell?
Lymphocyte
The anemia resulting from a deficiency of either vitamin B12 (cobalamin) or folate is caused by a disruption in DNA synthesis of the blast cells in the bone marrow that produces very large abnormal bone marrow cells called megaloblasts.
True
Thalassemia may be confused with iron-deficiency anemia, because they are both
microcytic
Which condition is associated with an elevated reticulocyte count?
Hemolytic anemia
Red blood cells obtain nearly all their energy from metabolism of
glucose
Vaccination for pneumococcal pneumonia should be performed before 1 year of age in patients with sickle cell anemia
false
Regarding iron-deficiency anemia, what laboratory features are typically decreased? (Select all that apply.)
What is necessary for red blood cell production?
iron
The most effective therapy for anemia associated with kidney failure is
erythropoietin administration.
The activated partial thromboplastin time (aPTT) is a measure of the integrity of
the intrinsic pathway
Treatment for hemophilia A includes
factor VIII replacement.
Activation of the extrinsic pathway of coagulation is initiated by
tissue thromboplastin.
A cause of thrombocytopenia includes
chemotherapy
A patient presents to the physician’s office with pinpoint hemorrhages on the skin. The patient is most likely between the ages of _____ years.
4 and 7
Disseminated intravascular coagulation may be treated with heparin therapy to
inhibit clotting factor consumption.
A 3-year-old boy who exhibits prolonged bleeding after minor trauma and a prolonged aPTT, but a normal platelet count, is likely to be diagnosed with
hemophilia
What is a megakaryocyte?
A large bone marrow cell that breaks apart into platelets
Which of the following proteins is not a normal component of plasma?
Collagen
What is a thrombocyte?
A platelet
In adults, hematopoiesis occurs in the bone marrow of all of the following bones except the:
shaft of the femur.
Where in the body are clotting factors synthesized?
liver