Which of the following statements describes phase 4 of the action potential of cells in the sinoatrial (SA) node?
A. Potassium permeability is allowing the cell membrane to remain depolarized, and Ca2+ channel opens moving Ca2+ back into the cell.
B. The cells are capable of responding to a greater than normal stimulus before the resting membrane potential is reached.
C. A slow depolarization occurs when Na+ is transported out of the cell and K+ moves back in, resulting in resting membrane potential.
D. The fast sodium channels in the cellular membranes close, causing an abrupt decrease in intracellular positivity.
A 31-year-old woman with a congenital heart defect reports episodes of light-headedness and syncope, with occasional palpitations. A resting electrocardiogram reveals sinus bradycardia, and she is suspected to have sick sinus syndrome. Which of the following diagnostic methods is the best choice to investigate the suspicion?
A. Signal-averaged ECG
B. Holter monitoring
C. Electrophysiologic study
D. Exercise stress testing
A patient has been diagnosed with anemia. The physician suspects an immune hemolytic anemia and orders a Coombs test. The patient asks the nurse what this test will tell the doctor. The nurse replies,
A. “They are looking for the presence of antibody or complement on the surface of the RBC.”
B. “They will wash your RBCs and then mix the cells with a reagent to see if they clump together.”
C. “They will look at your RBCs under a microscope to see if they have an irregular shape (poikilocytosis).”
D. “They will be looking to see if you have enough ferritin in your blood.”
Of the following list of patients, who would likely benefit the most from hyperbaric oxygen therapy?
A. A football player who has torn a meniscus in his knee for the third time this year
B. A patient who developed a fistula between her bowel and vagina following cervical cancer surgery
C. A school-aged child who fell on gravel and has terrible road rash
D. A trauma patient who developed Clostridium spp., an anaerobic bacterial infection in his femur
A 71-year-old male patient with a history of myocardial infarction (MI) and peripheral vascular disease (PVD) has been advised by his family physician to begin taking 81 mg aspirin once daily. Which of the following statements best captures an aspect of the underlying rationale for the physician’s suggestion?
A. Aspirin inhibits the conversion of fibrinogen into fibrin and consequent platelet plug formation.
B. Platelet aggregation can be precluded through inhibition of prostaglandin production by aspirin.
C. Aspirin can reduce unwanted platelet adhesion by inhibiting TXA2 synthesis.
D. Aspirin helps to inhibit ADP action and minimizes platelet plug formation.
Which of the following assessments and laboratory findings would be most closely associated with acute leukemia?
A. Increased serum potassium and sodium levels
B. Increased blood urea nitrogen and bone pain
C. High blast cell counts and fever
D. Decreased oxygen partial pressure and weight loss
A 55-year-old male who is beginning to take a statin drug for his hypercholesterolemia is discussing cholesterol and its role in health and illness with his physician. Which of the following aspects of hyperlipidemia would the physician most likely take into account when teaching the patient?
A. Hyperlipidemia is a consequence of diet and lifestyle rather than genetics.
B. The goal of medical treatment is to eliminate cholesterol from the vascular system.
C. Cholesterol is a metabolic waste product that the liver is responsible for clearing.
D. HDL cholesterol is often characterized as being beneficial to health.
A 6-year-old girl with a diagnosis of Marfan syndrome is being assessed at a community health clinic. Which of the following assessments would be the health care professional’s lowest priority?
A. A musculoskeletal assessment
B. A test of the child’s visual acuity
C. Tests of kidney function
D. Cardiovascular assessment
In the ICU setting, a patient transported from surgery following open heart bypass grafting will likely have his core temperature measured by a/an
A. esophageal flexible thermometer monitoring aorta distention.
B. rectal tube inserted to prevent evacuation from bowels while recovering from anesthesia.
C. pulmonary artery catheter being used to measure cardiac output.
D. temperature probe taped behind his ear.
The son of an 80-year-old man has noticed that in recent weeks his father has become incontinent of urine for the first time in his life. The man is later diagnosed with transient urinary incontinence, a condition that is most often attributable to
B. detrusor instability.
C. decrease in bladder and sphincter tone.
D. bladder outlet obstruction.
A health educator is teaching a group of colleagues about the physiology of thermoregulation. Which of the following statements is most accurate?
A. “Prostaglandin E2 (PGE2) exerts a direct fever-producing effect on the hypothalamus.”
B. “Endogenous pyrogens induce host cells to produce exogenous pyrogens.”
C. “PGE2 induces Kupffer cells to initiate a fever response via hepatic sinusoids.”
D. “Arachidonic acid induces cytokines to act on the temperature regulation center.”
A patient experiencing immotile cilia syndrome should be frequently assessed by the nurse for which priority complication?
A. Epistaxis resulting from loss of cilia in the nasal passageway
B. Sterility caused by inability of the sperm to swim downstream
C. Bronchiectasis due to interferences with clearance of inhaled bacteria along the respiratory tract
D. Inability to hear soft sounds related to kinocilium on the hair cells in the inner ear
The unique clinical presentation of a 3-month-old infant in the emergency department leads the care team to suspect botulism. Which of the following assessment questions posed to the parents is likely to be most useful in the differential diagnosis?
A. “Is there any mold in your home that you know of?”
B. “Is there any family history of neuromuscular diseases?”
C. “Has your baby ever been directly exposed to any chemical cleaning products?”
D. “Have you ever given your child any honey or honey-containing products?”
In the context of a workshop on rheumatoid arthritis, a clinical educator is teaching a group of nurses about autoimmune diseases. Which of the following statements by an attendee would the educator most likely want to follow up with further teaching?
A. “Often the problem can be traced to antigens that sensitize T cells without the need for presentation.”
B. “In some cases, the body attacks its own cells that are chemically similar to those of infectious organisms.”
C. “Introduction of a foreign antigen can sometimes induce a cascade of immune response that is not self-limiting”
D. “Sometimes when the body’s own cells are released after a long time, they are interpreted as being foreign.”
Which of the following pregnant women has most likely encountered the greatest increase in the risk that her child will have a fetal anomaly?
A. A woman with diagnoses of syphilis and cirrhosis of the liver
B. A woman who has herpes simplex and who has recently recovered from endocarditis
C. A woman with chronic obstructive pulmonary syndrome and tuberculosis
D. A woman with diagnoses of insulin-dependent diabetes mellitus and peripheral neuropathy
In which of the following individuals would a clinician most suspect multiple myeloma as a diagnosis?
A. A 70-year-old woman whose blood work reveals large numbers of immature granulocytes
B. A 68-year-old former coal miner who has white cell levels exponentially higher than normal ranges
C. A 40-year-old man who has had three broken bones over the past 6 months and whose serum calcium and creatinine levels are elevated
D. An 81-year-old male resident of a long-term care home who has an uncommon bacterial pneumonia and who is unable to produce a fever
A group of novice nursing students are learning how to manually measure a client’s blood pressure using a stethoscope and sphygmomanometer. Which of the following statements by students would the instructor most likely need to correct?
A. “If my client’s arm is too big for the cuff, I’m going to get a BP reading that’s artificially low.”
B. “I’ll inflate the cuff around 30 mm Hg above the point at which I can’t palpate the client’s pulse.”
C. “The accuracy of the whole process depends on my ability to clearly hear the Korotkoff sounds with the bell of my stethoscope.”
D. “With practice, my measurement of clients’ blood pressures with this method will be more accurate than with automated machines.”
A physician is explaining to a 40-year-old male patient the importance of completing his course of antibiotics for the treatment of tuberculosis. The physician explains the damage that could occur to lung tissue by Mycobacterium tuberculosis. Which of the following phenomena would underlie the physician’s explanation?
A. Tissue destruction results from neutrophil deactivation.
B. Macrophages form a capsule around the Mycobacterium tuberculosis bacteria, resulting in immune granulomas.
C. Neutrophils are ineffective against the Mycobacterium tuberculosis antigens.
D. Nonspecific macrophage activity leads to pulmonary tissue destruction and resulting hemoptysis.
0 out of 1 points
A student makes the statement to a colleague, “Blood plasma is essentially just a carrier for the formed elements like red blood cells and white blood cells.”What would be the most accurate response to this statement?
A. “Not really. Plasma also contributes to the processes of protein synthesis and hematopoiesis.”
B. “Actually, plasma is integral to the proper function of the liver and maintenance of acid–base balance.”
C. “Actually, plasma plays a significant role in nutrient and waste transport.”
D. “That’s not really true. Plasma is crucial in the immune and inflammatory responses.”
A number of clients have presented to the emergency department in the last 32 hours with complaints that are preliminarily indicative of myocardial infarction. Which of the following clients is least likely to have an ST-segment myocardial infarction (STEMI)?
A. A 70-year-old woman who is complaining of shortness of breath and vague chest discomfort
B. A 66-year-old man who has presented with fatigue, nausea and vomiting, and cool, moist skin
C. A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest
D. A 43-year-old man who woke up with substernal pain that is radiating to his neck and jaw
In which of the following situations would blood most likely rapidly relocate from central circulation to the lower extremities?
A. A client does isotonic exercises in a wheelchair.
B. A client reclines from a sitting to supine position.
C. A client is helped out of bed and stands up.
D. A client undergoes a stress test on a treadmill.
When talking about the various types of granulocytes, which granule contains heparin, an anticoagulant?
A nurse is providing care for a 44-year-old male client who is admitted with a diagnosis of fever of unknown origin (FUO). Which of the following characteristics of the client’s history is most likely to have a bearing on his current diagnosis?
A. The client is cachexic and an African American.
B. The client is malnourished, hypomagnesemic, and hypocalcemic.
C. The client is HIV positive and homeless.
D. The client is receiving intravenous normal saline with 20 mEq KCl.
As part of a screening program for prostate cancer, men at a senior citizens’ center are having their blood levels of prostate-specific antigen (PSA) measured.Which of the following statements would best characterize a high positive predictive value but a low negative predictive value for this screening test?
A. All of the men who had low PSA levels were cancer-free; several men who had high levels also remained free of prostate cancer.
B.Men who had low PSA levels also displayed false-positive results for prostate cancer; men with high levels were often falsely diagnosed with prostate cancer.
C. The test displayed low sensitivity but high specificity.
D. All of the men who had high PSA levels developed prostate cancer; several men who had low PSA levels also developed prostate cancer.
When looking at a granulocyte under a microscope, the anatomy student would describe it as a cell
A. having a kidney-shaped nucleus.
B. having no nuclei.
C. lacking granules.
D. shaped like a sphere with multilobar nuclei.
The cardiologist just informed a patient that he has a reentry circuit in the electrical conduction system in his heart. This arrhythmia is called Wolff-Parkinson-White (WPW) syndrome. After the physician has left the room, the patient asks the nurse to explain this to him. Which of the following statements most accurately describes what is happening?
A. “You must have a large clot in one of your arteries that supply oxygenated blood to the special conduction cells in your heart.”
B.“There is an extra, abnormal electrical pathway in the heart that leads to impulses traveling around the heart very quickly, in a circular pattern, causing the heart to beat too fast.”
C. “This means that the SA node (which is the beginning of your heart’s electrical system) has been damaged and is no longer functioning normal.”
D. “For some reason, your electrical system is not on full charge, so they will have to put in new leads and a pacemaker to make it work better.”
In the ED, a homeless patient is brought in with severe hypothermia. The police officers also state that they found a “bottle of booze” on the sidewalk next to him. This puts the nurse on high alert since alcohol contributes to hypothermia by
A. causing the person to have less fat on his body.
B. interfering with the appetite center in the brain causing the person to not respond to hunger pains.
C. increasing his basal metabolic rate, so he will run out of ATP faster than expected.
D. dulling the mental awareness that impairs judgment to seek shelter.
Which of the following glycoproteins is responsible for treating such diseases as bone marrow failure following chemotherapy and hematopoietic neoplasms such as leukemia?
A. Growth factors and cytokines
B. Natural killer cells and granulocytes
C. Neutrophils and eosinophils
D. T lymphocytes and natural killer cells
A professor is teaching a group of students about the role of mitochondria within the cell. Which of the following statements is true of mitochondria?
A. They are the site of adenosine triphosphate (ATP) production.
B. Mitochondrial DNA is inherited patrilineally.
C. The number of mitochondria in a cell is equal to the number of nuclei.
D. They are replicated within the smooth endoplasmic reticulum (ER).
A nurse practitioner is providing care for a client with low levels of the plasma protein gamma globulin. The nurse would recognize that the client is at risk of developing which of the following health problems?
C. Blood clots
A 63-year-old woman has begun a diet that purports to minimize the quantity and effects of free radicals in her body. What physiological processes could best underlie her care provider’s teaching about her new diet?
A. Free radicals increase cytokine expression and adhesion molecule levels, resulting in increased inflammation.
B. Free radicals contribute to atherosclerosis and decreased immune response.
C. Free radicals act as direct mediators in the inflammatory process.
D. Free radicals inhibit the inflammatory response, limiting preadaptive response to infection.
A male client of a nurse practitioner has an autosomal dominant disorder. The client and his partner are considering starting a family. Which of the following statements indicates the client has an adequate understanding of the genetic basis of this health problem?
A. “I know that a single mutant allele is to blame for the health problem.”
B. “I know that new genetic mutations won’t occur between generations.”
C. “I know there’s no way of accurately determining the chance that my child will inherit the disease.”
D. “My children who don’t have the disease still run the risk of passing it on to their children.”
In which of the following hospital patients would the care team most realistically anticipate finding normal cholesterol levels?
A. A 44-year-old male admitted for hyperglycemia and with a history of diabetic neuropathy
B. A 51-year-old male with a diagnosis of hemorrhagic stroke and consequent unilateral weakness
C. A 77-year-old female admitted for rheumatoid arthritis exacerbation who is receiving hormone replacement therapy and with a history of hypothyroidism
D. A morbidly obese 50-year-old female who is taking diuretics and a beta-blocker to treat her hypertension
As of November 1, 2012, there were a total of 10 confirmed cases of Hantavirus infection in people who were recent visitors (mid-June to end of August, 2012) to Yosemite National Park. Three visitors with confirmed cases died. Health officials believe that 9 out of the 10 people with Hantavirus were exposed while staying in Curry Village in the Signature Tent Cabins. This is an example of
A. the low rate of morbidity one can expect while traveling to Yosemite National Park.
B. the prevalence of Hantavirus one can anticipate if he or she is going to vacation in Yosemite National Park.
C. what the anticipated mortality rate would be if a family of five were planning to vacation in Yosemite National Park.
D. the incidence of people who are at risk for developing Hantavirus while staying in Yosemite National Park.
A 1-year-old child who has experienced low platelet counts and bacterial susceptibility has been admitted to a pediatric medical unit of a hospital for treatment of Wiskott-Aldrich syndrome. The nurse who has admitted the child to the unit would anticipate which of the following short-term and longer-term treatment plans?
A. Neutropenic precautions; fresh frozen plasma transfusions; treatment of gastrointestinal symptoms
B. Transfusion of clotting factors XII and XIII and serum albumin; splenectomy
C. Intravenous immunoglobulin (IVIG) treatment; thyroidectomy
D. Treatment of eczema; management of bleeding; bone marrow transplant
A 60-year-old woman is suspected of having non-Hodgkin lymphoma (NHL). Which of the following aspects of her condition would help to rule out Hodgkin lymphoma?
A. The lymph nodes involved are located in a large number of locations in the lymphatic system.
B. The woman complains of recent debilitating fatigue.
C. Her neoplasm originates in secondary lymphoid structures.
D. The presence of Reed-Sternberg cells has been confirmed.
An 81-year-old female client of a long-term care facility has a history of congestive heart failure. The nurse practitioner caring for the client has positioned her sitting up at an angle in bed and is observing her jugular venous distention. Why is jugular venous distention a useful indicator for the assessment of the client’s condition?
A. Peripheral dilation is associated with decreased stroke volume and ejection fraction.
B. Increased cardiac demand causes engorgement of systemic blood vessels, of which the jugular vein is one of the largest.
C. Blood backs up into the jugular vein because there are no valves at the point of entry into the heart.
D. Heart valves are not capable of preventing backflow in cases of atrial congestion.
A nurse who works on a pediatric cardiology unit of a hospital is providing care for an infant with a diagnosis of tetralogy of Fallot. Which of the following pathophysiologic results should the nurse anticipate?
A. Blood outflow into the pulmonary circulation is restricted by pulmonic valve stenosis.
B. There is a break in the normal wall between the right and left atria that results in compromised oxygenation.
C. The aortic valve is stenotic, resulting in increased afterload.
D. The right ventricle is atrophic as a consequence of impaired myocardial blood supply.
Which of the following hypertensive individuals is most likely to have his or her high blood pressure diagnosed as secondary rather than essential?
A. A 40-year-old smoker who eats excessive amounts of salt and saturated fats
B. A 69-year-old woman with a diagnosis of cardiometabolic syndrome
C. An African American man who leads a sedentary lifestyle
D. A 51-year-old male who has been diagnosed with glomerulonephritis
A 72-year-old female has been told by her physician that she has a new heart murmur that requires her to go visit a cardiologist. Upon examination, the cardiologist informs the patient that she has aortic stenosis. After the cardiologist has left the room, the patient asks, “What caused this [aortic stenosis] to happen now?” The clinic nurse responds,
A.“Aortic stenosis is commonly seen in elderly patients.Basically, there is a blockage in the valve that is causing blood to pool, causing decreased velocity of flow.”
B.“Because of the high amount of energy it takes to push blood through the aortic valve to the body, your valve is just had to work too hard and it is weakening.”
C.“This is caused by a tear in one of the papillary muscles attached to the valve. They can do a procedure where they thread a catheter into the heart and reattach the muscle ends.”
D. “Heart murmurs result from tumultuous flow through a diseased heart valve that is too narrow and stiff. This flow causes a vibration called a murmur.”
Which of the following patients is most likely to have impairments to the wound-healing process? A patient with
A. chronic obstructive pulmonary disease.
B. congenital heart defects and anemia.
C. poorly controlled blood sugars with small blood vessel disease.
D. a diagnosis of multiple sclerosis and consequent impaired mobility.
The geriatrician providing care for a 74-year-old man with diagnosis of Parkinson disease has recently changed the client’s medication regimen. What is the most likely focus of the pharmacologic treatment of the man’s health problem?
A. Increasing the functional ability of the underactive dopaminergic system
B. Maximizing acetylcholine release from synaptic vesicles at neuromuscular junctions
C. Preventing axonal degradation of motor neurons
D. Preventing demyelination of the efferent cerebellar pathways
A 4-year-old boy presents with a chronic cough and swollen lymph nodes. His records show that he has been given antibiotics several times in the past year with limited success, most recently for a liver abscess, and that he also has a recurring fungal skin condition. Which of the following is his most likely diagnosis?
A. Selective IgA deficiency
C. A deficiency in IgG2 subclass antibodies
D. Chronic granulomatous disease
A nurse is teaching a client with a recent diagnosis of diabetes about the roles that glucose and insulin play in the disease pathology and the fact that glucose must enter the body cell in order to provide energy for the client. The nurse knows that which of the following processes allows glucose to enter body cells?
A. Active transport
D. Facilitated diffusion
Two health care workers are comparing the etiology and incidence of multifactorial inheritance disorders and single-gene disorders. Which of the following statements best captures the relationship between the two types of genetic disorders?
A. “A couple with a child with a multifactorial disorder has a higher risk of having another with the same disorder.”
B. “Multifactorial disorders are more likely to involve multiple organs.”
C. “Multifactorial disorders and single-gene disorders can both be predicted quite accurately.”
D. “Multifactorial disorders manifest themselves at birth.”
A 44-year-old female who is on her feet for the duration of her entire work week has developed varicose veins in her legs. What teaching point would her care provider be most justified in emphasizing to the woman?
A. “Your varicose veins are likely a consequence of an existing cardiac problem.”
B. “Once you have varicose veins, there’s little that can be done to reverse them.”
C. “The use of blood thinner medications will likely relieve the backflow that is causing your varicose veins.”
D. “If you’re able to stay off your feet and wear tight stockings, normal vein tone can be reestablished.”
At 4 AM, the hemodynamic monitor for a critically ill client in the intensive care unit indicates that the client’s mean arterial pressure is at the low end of the normal range; at 6 AM, the client’s MAP has fallen definitively below normal. The client is at risk for
A. left ventricular hypertrophy.
B. pulmonary hypertension.
C. organ damage and hypovolemic shock.
D. orthostatic hypotension.
A baseball player was hit in the head with a bat during practice. In the emergency department, the physician tells the family that he has a “coup”injury. How will the nurse explain this to the family so they can understand?
A. “It’s like squeezing an orange so tight that the juice runs out of the top.”
B. “Your son has a huge laceration inside his brain where the bat hit his skull.”
C. “Your son has a contusion of the brain at the site where the bat hit his head.”
D. “When the bat hit his head, his neck jerked backward causing injury to the spine.”
Which of the following individuals is likely to have the best prognosis for recovery from his or her insult to the peripheral nervous system? An adult
A. who had nerves transected during surgery to remove a tumor from the mandible.
B. who developed rhabdomyolysis and ischemic injury after a tourniquet application.
C. who suffered a bone-depth laceration to the shoulder during a knife attack.
D. who had his forearm partially crushed by gears during an industrial accident.
A woman gives birth to a small infant with a malformed skull. The infant grows abnormally slowly and shows signs of substantial cognitive and intellectual deficits. The child also has facial abnormalities that become more striking as it develops. What might you expect to find in the mother’s pregnancy history?
A. Active herpes simplex infection
B. Chronic alcohol use
C. Chronic cocaine use
D. Folic acid deficiency
A teenager, exposed to West Nile virus a few weeks ago while camping with friends, is admitted with headache, fever, and nuchal rigidity. The teenager is also displaying some lethargy and disorientation. The nurse knows which of the following medical diagnoses listed below may be associated with these clinical manifestations?
A. Spinal infection
C. Lyme disease
D. Rocky Mountain spotted fever
The homecare nurse is making a home visit to a 51-year-old female client with a long-standing diagnosis of multiple sclerosis. The nurse knows that the muscle wasting and weakness associated with the disease process are ultimately manifested as a failure of what normal process in muscle tissue?
A. The contraction of fascicles within myofibrils
B. The contraction of the epimysium
C. The surrounding of fascicles by perimysium
D. Thick myosin and thin actin filaments sliding over each other
A 24-year-old woman presents with fever and painful, swollen cervical lymph nodes. Her blood work indicates neutrophilia with a shift to the left. She most likely has
A. a mild viral infection.
B. a severe fungal infection.
C. a mild parasitic infection.
D. a severe bacterial infection.
The nurse knows that which of the following treatment plans listed below is most likely to be prescribed after a computed tomography (CT) scan of the head reveals a new-onset aneurysmal subarachnoid hemorrhage?
A. Monitoring in the ICU for signs and symptoms of cerebral insult
B. Stat administration of tissue plasminogen activator (tPA)
C. Administration of a diuretic such as mannitol to reduce cerebral edema and ICP
D. Craniotomy and clipping of the affected vessel
A 40-year-old woman who experiences severe seasonal allergies has been referred by her family physician to an allergist for weekly allergy injections. The woman is confused as to why repeated exposure to substances that set off her allergies would ultimately benefit her. Which of the following phenomena best captures the rationale for allergy desensitization therapy?
A. Injections of allergens simulate production of IgG, combining with the antigens to prevent activation of IgE antibodies.
B. Repeated exposure stimulates adrenal production of epinephrine, mitigating the allergic response.
C. Allergens in large, regular quantities overwhelm the IgE antibodies that mediate the allergic response.
D. Repeated exposure to offending allergens binds the basophils and mast cells that mediate the allergic response.
Two nursing students are attempting to differentiate between the presentations of immune thrombocytopenic purpura (ITP) and thrombotic thrombocytopenic purpura (TTP). Which of the students’ following statements best captures an aspect of the two health problems?
A. “Both diseases can result from inadequate production of thrombopoietin by megakaryocytes.”
B. “Both of them involve low platelet counts, but in TTP, there can be more, not less, hemostasis.
C. “TTP can be treated with plasmapheresis, but ITP is best addressed with transfusion of fresh frozen plasma.”
D. “ITP can be either inherited or acquired, and if it’s acquired, it involves an enzyme deficiency.”
A 37-year-old male with HIV who has recently become symptomatic has begun highly active antiretroviral therapy (HAART). Among the numerous medications that the man now regularly takes are several that inhibit the change of HIV RNA to DNA in a CD4+ cell. Which of the following classes of medications addresses this component of the HIV replication cycle?
A. Protease inhibitors
B. Entry inhibitors
C. Non-nucleoside reverse transcriptase inhibitors
D. Integrase inhibitors
A male international business traveler has returned from a trip to Indonesia. While there, he hired a prostitute for companionship and engaged in unprotected sex on more than one occasion. Unbeknownst to him, this prostitute harbored the hepatitis C virus. Upon return to the United States, he exhibited no symptoms and returned to his usual activities. During this period of no outward symptoms, the man would be classified as being in
A. the clinical disease stage of hepatitis C.
B. the preclinical stage of disease.
C. the chronic phase of hepatitis C.
D. remission and unlikely to develop hepatitis C.
A group of nursing students were studying for their pathophysiology exam by quizzing each other about disorders of WBCs and lymphoid tissue. When asked what the first chromosomal abnormality that identified cancer was, one student correctly answered
B. interleukin cells.
A school nurse is teaching high school students about HIV and AIDS in the context of the school’s sexual health curriculum. Which of the students’ following statements would the nurse most likely want to correct or clarify?
A. “Lots more heterosexual people get HIV these days than they used to.”
B. “Drugs for AIDS reduce the virus in your body, but they don’t get rid of it.”
C. “They have to take a blood sample from you in order to test you for AIDS.”
D. “Condoms provide really good protection from AIDS.”
A nurse on a neurology unit is assessing a female brain-injured client. The client is unresponsive to speech, and her pupils are dilated and do not react to light.She is breathing regularly, but her respiratory rate is 45 breaths/minute. In response to a noxious stimulus, her arms and legs extend rigidly. What is her level of impairment?
C. Vegetative state
D. Brain death
Following a motor vehicle accident 3 months prior, a 20-year-old female who has been in a coma since her accident has now had her condition declared a persistent vegetative state. How can her care providers most accurately explain an aspect of her situation to her parents?
A. “Your daughter has lost all her cognitive functions as well as all her basic reflexes.”
B. “Your daughter’s condition is an unfortunate combination with total loss of consciousness but continuation of all other normal brain functions.”
C. “Though she still goes through a cycle of sleeping and waking, her condition is unlikely to change.”
D. “If you or the care team notices any spontaneous eye opening, then we will change our treatment plan.”
Which of the following patients would be considered to be in the latent period of HIV infection?
A. A 33-year-old heroin drug abuser who has numerous enlarged lymph nodes in his axilla and cervical neck region for the past 4 months
B. A 24-year-old college student who has developed a chronic cough that will not go away, even after taking two courses of antibiotics.
C. A 45-year-old alcohol abuser who is complaining of excessive vomiting of blood that started 2 weeks ago
D. A 16-year-old prostitute who has open sores on her labia that drain purulent secretions
When discussing the sequence of clot dissolution, the science instructor will talk about which item that begins the process?
B. α-plasmin inhibitor
A 30-year-old male’s blood work and biopsies indicate that he has proliferating osteoclasts that are producing large amounts of IgG. What is the man’s most likely diagnosis?
A. Multiple myeloma
B. Acute lymphocytic leukemia
C. Hodgkin lymphoma
D. Acute myelogenous leukemia
A client with a gastrointestinal bleed secondary to alcohol abuse and a hemoglobin level of 5.8 g/dL has been ordered a transfusion of packed red blood cells. The client possesses type B antibodies but lacks type D antigens on his red cells. Transfusion of which of the following blood types would be least likely to produce a transfusion reaction?
A nurse is providing care for a 17-year-old boy who has experienced recurrent sinus and chest infections throughout his life and presently has enlarged tonsils and lymph nodes. Blood work indicated normal levels of B cells and free immunoglobulins but a lack of differentiation into normal plasma cells. The boy is currently receiving intravenous immunoglobulin (IVIG) therapy. What is the boy’s most likely diagnosis?
A. X-linked hypogammaglobulinemia
B. Transient hypoglobulinemia
C. Common variable immunodeficiency
D. IgG subclass deficiency
A patient diagnosed with H pylori asks the nurse, “How an infection can occur in the stomach since it is an acid environment?” The nurse responds,
A. “This parasite secretes an enzyme called coagulase, which protects the pathogen from the antibodies.”
B. “H. pylori produces an enzyme called urease that converts gastric juices into ammonia, which neutralizes the acidic stomach environment.”
C. “H. pylori is a virus and is still being researched as to how it is able to survive in the stomach acids.”
D. “We have many infectious agents that can live in an acidic environment with a pH more than 8.0.”
The family members of an elderly patient are wondering why his “blood counts” are not rising after his last GI bleed. They state, “He has always bounced back after one of these episodes, but this time it isn’t happening. Do you know why?”The nurse will respond based on which of the following pathophysiological principles?
A. “Everything slows down when you get older. You just have to wait and see what happens.”
B. “Due to stress, the red blood cells of older adults are not replaced as promptly as younger people.”
C. “Don’t worry about it. We can always give him more blood.”
D. “The doctor may start looking for another cause of his anemia, maybe cancer of the bone.”
A 14-year-old boy is participating in his school’s track meet; the outdoor temperature is 99°F, and a teacher has found the boy sitting restless in the shade and disoriented to time. The teacher notes that the student has dry skin in spite of the high temperature and the fact that he has recently completed a running event. The teacher calls for the school nurse, who will recognize which of the following potential diagnoses and anticipated hospital treatments?
A. Heat exhaustion, likely treated with oral rehydration with cool water
B. Heat stroke, likely treated with rehydration by intravenous hypotonic solution
C. Heat stroke, likely treated with submersion in cold water
D. Heat exhaustion, likely treated with rest, shelter from the sun, and salt tablets
A 40-year-old male who has been HIV positive for 6 years is experiencing a new increase in his viral load along with a corresponding decrease in his CD4+ count. Which of the following aspects of his immune system is likely to remain most intact?
A. Activation of B lymphocytes
B. Phagocytic function of monocytes and macrophages
C. Orchestration of natural killer cells as part of cell-mediated immunity
D. Presentation of major histocompatibility molecules on body cells
The nurse practitioner working in an overnight sleep lab is assessing and diagnosing patients with sleep apnea. During this diagnostic procedure, the nurse notes that a patient’s blood pressure is 162/97. The nurse explains this connection to the patient based on which of the following pathophysiological principles?
A. When airways are obstructed, the body will retain extracellular fluid so that this fluid can be shifted to intravascular space to increase volume.
B. During apneic periods, the patient experiences hypoxemia that stimulates chemoreceptors to induce vasoconstriction.
C. When the patient starts to snore, his epiglottis is closed over the trachea.
D. When the airway is obstructed, specialized cells located in the back of the throat send signals to the kidney to increase pulse rate.
A female dental assistant has developed signs and symptoms of a latex sensitivity and is undergoing allergy testing as well as blood work. Which of the following components of the assistant’s blood work would most likely be the focus of her health care provider’s analysis?
A. Analysis of class II MHC antigens
B. Serum IgE immunoassays
C. Serum CD8+ levels
D. Serum B-lymphocyte levels
Which of the following clients’ signs and symptoms would allow a clinician to be most justified in ruling out stroke as a cause? An adult
A. has vomited and complained of a severe headache.
B. states that his left arm and leg are numb, and gait is consequently unsteady.
C. has had a gradual onset of weakness, headache, and visual disturbances over the last 2 days.
D. has experienced a sudden loss of balance and slurred speech.
As part of the diagnostic workup for a male client with a complex history of cardiovascular disease, the care team has identified the need for a record of the electrical activity of his heart, insight into the metabolism of his myocardium, and physical measurements and imaging of his heart. Which of the following series of tests is most likely to provide the needed data for his diagnosis and care?
A. Cardiac catheterization, cardiac CT, exercise stress testing
B. Ambulatory ECG, cardiac MRI, echocardiogram
C. Serum creatinine levels, chest auscultation, myocardial perfusion scintigraphy
D. Echocardiogram, PET scan, ECG
Which of the following statements best captures an aspect of the process of hematopoiesis?
A. Colony-stimulating factors (CSFs) produce cytokines that activate progenitor cells.
B. Various subtypes of pluripotent stem cells eventually differentiate into the cellular components of blood.
C. Progenitor cells differentiate into precursor cells.
D. Self-replicating precursor cells differentiate into specific CSFs.
A 54-year-old man with a long-standing diagnosis of essential hypertension is meeting with his physician. The patient’s physician would anticipate that which of the following phenomena is most likely occurring?
A. Epinephrine from his adrenal gland is initiating the renin–angiotensin–aldosterone system.
B. Vasopressin is exerting an effect on his chemoreceptors and baroreceptors resulting in vasoconstriction.
C. The patient’s juxtaglomerular cells are releasing aldosterone as a result of sympathetic stimulation.
D. The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption.
A 44-year-old female patient presents to the emergency department with abnormal bleeding and abdominal pain that is later attributed to gallbladder disease.Which of the following diagnoses would the medical team be most justified in suspecting as a cause of the patient’s bleeding?
A. Hemophilia B
B. Vitamin K deficiency
C. Idiopathic immune thrombocytopenic purpura (ITP)
D. Excess calcium
Members of an AIDS support group who have more advanced cases are sharing some of their recent health problems with a member who has just been diagnosed. Which of the member’s statements is most accurate?
A. “The eradication of Pneumocystis jiroveci pneumonia (PCP) has helped extend the life expectancy of a lot of persons living with AIDS.”
B. “As people with HIV live longer, most of us are eventually succumbing to the cancers that are associated with HIV.”
C. “One of the scariest things out there now is the huge increase in drug-resistant tuberculosis.”
D. “Those of us with HIV are so much more prone to loss of vision and hearing.”
A hospital laboratory technologist is analyzing the complete blood count (CBC) of a patient. Which of the following statements best reflects an aspect of the platelets that would constitute part of the CBC?
A. The α-granules of platelets contribute primarily to vasoconstriction.
B. New platelets are released from the bone marrow into circulation.
C. Platelets originate with granulocyte colony–forming units (CFU).
D. The half-life of a platelet is typically around 8 to 12 days.
Which of the following patients has an absolute neutrophil count that is critically low and that the standard of care would recommend they be placed on neutropenic precautions?
A. A 75-year-old renal failure patient receiving Epogen for anemia with hemoglobin level of 9.7.
B. A 37-year-old patient with leukemia being treated with chemotherapy with ANC of 400
C. A patient on long-term steroids for rheumatoid arthritis with WBC of 7000
D. A 65-year-old prostate cancer patient receiving radiation therapy with neutrophil count of 2000
A medical student is working with a 61-year-old male client in the hospital who has presented with a new onset of atrial fibrillation. Which of the following courses of treatment will the student most likely expect the attending physician to initiate?
A. Diuretics, total bed rest, and cardioversion if necessary
B. Anticoagulants and beta-blockers to control rate
C. Immediate cardioversion followed by surgery to correct the atrial defect
D. Antihypertensives and constant cardiac monitoring in a high acuity unit
A physiotherapist is measuring the lying, sitting, and standing blood pressure of a patient who has been admitted to hospital following a syncopal episode and recent falls. Which of the following facts about the patient best relates to these health problems?
A. The patient has a history of acute and chronic renal failure.
B. The patient’s cardiac ejection fraction was 40% during his last echocardiogram.
C. The patient is male and has a history of hypertension.
D. The client is 89 years old and takes a diuretic medication for his congestive heart failure.
Which of the following procedures reduces the potential for infection primarily by addressing the portal of entry?
A. Wearing gloves when contact with blood or body fluids is anticipated
B. Wiping down common areas with buffered bleach on a regular basis
C. Isolating patients who have antibiotic-resistant infections
D. Disposing of soiled clothing and bed linens in a dedicated receptacle
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A 70-year-old woman with ongoing severe atrial fibrillation is scheduled for defibrillation. What is an aspect of the rationale and physiology of defibrillation treatment?
A. Defibrillation can be achieved using either a transcutaneous or transvenous pacemaker.
B. Interruption of disorganized impulses by the current allows the AV node to readopt its normal pacemaker role.
C. Defibrillation must be coincided with the R wave of the ECG in order to be successful.
D. The goal is to depolarize the entire heart during the passage of current.
In the ICU, the nurse hears an emergency cardiac monitor go off. The nurse looks at the telemetry and notices the patient has gone into ventricular tachycardia.The nurse will likely assess for signs/symptoms of
A. increasing cardiac index by correlating the volume of blood pumped by the heart with an individual’s body surface area.
B. decreasing cardiac output due to less ventricular filling time.
C. development of hypertension with BP 190/98.
D. oxygen deprivation with O2 saturation decreasing to approximately 90%.
An agricultural worker is picking fruit on a day when the air temperature is 106°F. Which of the following processes will most likely be occurring while he works?
A. Conduction of heat from the air will be heating his skin surface and raising his core temperature.
B. His autonomic nervous system will be stimulating him to sweat.
C. Blood volume at his skin surface will be increasing to dissipate heat.
D. Radiation from his skin surfaces will be dissipating heat into the environment.
A 22-year-old female college student is shocked to receive a diagnosis of myasthenia gravis. What are the etiology and most likely treatment for her health problem?
A. A decline in functioning acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins
B. Cerebellar lesions; surgical and immunosuppressive treatment
C. Excess acetylcholinesterase production; treatment with thymectomy
D. Autoimmune destruction of skeletal muscle cells; treatment with intensive physical therapy and anabolic steroids
A student asks the instructor about the origins of different tissues and their cellular origins during the process of development. Which of the instructor’s following statements best describes the process of cell differentiation?
A. “A fertilized ovum undergoes a series of divisions, yielding many different cell types.”
B. “A single stem cell differentiates into approximately 200 different types of cells.”
C. “Cells differentiate into necessary body cells peaking after conception and ceasing near the time of birth.”
D. “Cells of the hematopoietic system produce the appropriate body cells that are required at each stage of development.”
A physician is providing care for several patients on a medical unit of a hospital. In which of the following patient situations would the physician most likelyrule out hypertension as a contributing factor?
A. A 66-year-old woman with poorly controlled angina and consequent limited activity tolerance
B. A 61-year-old man who has a heart valve infection and recurrent fever
C. An 81-year-old woman who has had an ischemic stroke and has consequent one-sided weakness
D. A 44-year-old man awaiting a kidney transplant who requires hemodialysis three times per week
A geriatric clinical nurse educator is teaching the other members of the health care team about the incidence, prevalence, and course of depression among older adults. Which of the following statements is most likely to appear in the physician’s teaching?
A. “Bronchodilators and antiplatelet medications have been correlated with depression in the elderly.”
B. “Many older adults lack the symptoms of sleep disturbances and lack of concentration that suggest depression in younger adults.”
C. “Even though suicide rates are lower among older adults than younger adults, depression needs to be diagnosed and treated early.”
D. “Though they are certainly not synonymous, depression can be an indicator of dementia.”
The nurse working in the ICU knows that chronic elevation of left ventricular end-diastolic pressure will result in the patient displaying which of the following clinical manifestations?
A. Petechia and spontaneous bleeding
B. Dyspnea and crackles in bilateral lung bases
C. Muscle cramping and cyanosis in the feet
D. Chest pain and intermittent ventricular tachycardia
A 51-year-old patient with a history of alcohol abuse and liver disease has low serum levels of albumin and presents with ascites (excess fluid in his peritoneal space) and jaundice. A health care professional would recognize that which of the following processes is most likely underlying his health problems?
A. Insufficient albumin is causing insufficient absorption of fluid into the capillaries.
B. Low albumin contributing to an inability to counter gravitational effects.
C. Low albumin is contributing to excess hydrostatic pressure and inappropriate fluid distribution.
D. Low albumin is inducing hypertension and increased filtration of fluid into interstitial spaces.
A community health nurse is teaching a group of recent graduates about the large variety of factors that influence an individual’s health or lack thereof. The nurse is referring to the Healthy People 2020 report from the U.S. Department of Health and Human Services as a teaching example. Of the following aspects discussed, which would be considered a determinant of health that is outside the focus of this report?
A.The client has a diverse background by being of Asian and Native American descent and practices various alternative therapies to minimize effects of stress.
B. The client has a family history of cardiovascular disease related to hypercholesterolemia and remains noncompliant with the treatment regime.
C. The client lives in an affluent, clean, suburban community with access to many health care facilities.
D. The client has a good career with exceptional preventative health care benefits.
The clinical educator of a hospital medical unit has the mandate of establishing evidence-based practice guidelines for the nursing care on the unit. Which of the following statements most accurately captures a guiding principle of the nurse’s task?
A. Evidence-based practice guidelines will be rooted in research rather than nurses’ subjective practice preferences and experiences.
B. Guidelines are synonymous with systematic research reviews.
C. The need for continuity and standardization of guidelines will mean that they will be fixed rather than changeable.
D. The guidelines will combine individual expertise with external systematic evidence.
A nurse who provides care in a geriatric subacute medicine unit of a hospital has noted that a large number of patients receive ?-adrenergic blocking medications such as metoprolol. Which of the following statements best conveys an aspect of the use of beta-blockers?
A. They counteract arrhythmias and tachycardias by increasing vagal stimulation.
B. They can be used to treat supraventricular arrhythmias and decrease automaticity by depressing phase 4 of the action potential.
C. They decrease myocardial oxygen demand by blocking the release of intracellular calcium ions.
D. They inhibit the potassium current and repolarization, extending the action potential and refractoriness.
Which of the following teaching points would be most appropriate for a group of older adults who are concerned about their cardiac health?
A. “The plaque that builds up in your heart vessels obstructs the normal flow of blood and can even break loose and lodge itself in a vessel.”
B. “Infections of any sort are often a signal that plaque disruption is in danger of occurring.”
C. “The impaired function of the lungs that accompanies pneumonia or chronic obstructive pulmonary disease is a precursor to plaque disruption.”
D. “People with plaque in their arteries experience attacks of blood flow disruption at seemingly random times.”
A 40-year-old male client is shocked to receive a diagnosis of mature B-cell lymphoma and is doing research on his diagnosis on the Internet. Which of the following statements that he reads on various Web sites is most reliable?
A. “Like most forms of Hodgkin lymphoma, mature B-cell lymphoma often requires radiation treatment.”
B. “Doctors are able to diagnose mature B-cell lymphoma by the presence of Reed-Sternberg cells.”
C. “The lymph nodes are usually affected, and often the spleen and bone marrow.”
D. “Unlike many other lymphomas, mature B-cell lymphoma is often self-limiting, and treatment is focused on symptoms.”
Which of the following processes would most likely be considered an anomaly during the cellular phase of inflammation?
A. Platelet aggregation
C. Migration of phagocytic white cells
D. Macrophage activity
A geriatrician has ordered an echocardiogram and stress test for an 80-year-old male client in an effort to gauge the client’s cardiovascular health status.Which of the following changes would the physician most likely identify as an anomaly that is not an expected age-related change?
A. Increased resting, supine heart rate
B. Low maximal heart rate and cardiac output
C. Increased left ventricular wall thickness
D. Delayed left ventricular filling
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