Essentials of Pathophysiology 3rd Edition, Porth Test Bank

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Essentials of Pathophysiology 3rd Edition, Porth Test Bank


Test Bank Essentials Pathophysiology 3rd Edition, Porth

Chapter 01: Cell Structure and Function

1. The nucleus _________, which is essential for function and survival of the cell.
A) is the site of protein synthesis
B) contains the genetic code
C) transforms cellular energy
D) initiates aerobic metabolism
2. Although energy is not made in mitochondria, they are known as the power plants of the cell because they:
A) contain RNA for protein synthesis.
B) utilize glycolysis for oxidative energy.
C) extract energy from organic compounds.
D) store calcium bonds for muscle contractions.
3. Although the basic structure of the cell plasma membrane is formed by a lipid bilayer, most of the specific membrane functions are carried out by:
A) bound and transmembrane proteins.
B) complex, long carbohydrate chains.
C) surface antigens and hormone receptors.
D) a gating system of selective ion channels.
4. To effectively relay signals, cell-to-cell communication utilizes chemical messenger systems that:
A) displace surface receptor proteins.
B) accumulate within cell gap junctions.
C) bind to contractile microfilaments.
D) release secretions into extracellular fluid.
5. Aerobic metabolism, also known as oxidative metabolism, provides energy by:
A) removing the phosphate bonds from ATP.
B) combining hydrogen and oxygen to form water.
C) activating pyruvate stored in the cytoplasm.
D) breaking down glucose to form lactic acid.
6. Exocytosis, the reverse of endocytosis, is important in _______ into the extracellular fluid.
A) Engulfing and ingesting fluid and proteins for transport
B) Killing, degrading, and dissolving harmful microorganisms
C) Removing cellular debris and releasing synthesized substances
D) Destruction of particles by lysosomal enzymes for secretion
7. The process responsible for generating and conducting membrane potentials is:
A) diffusion of current-carrying ions.
B) millivoltage of electrical potential.
C) polarization of charged particles.
D) ion channel neurotransmission.
8. Epithelial tissues are classified according to the shape of the cells and the number of layers. Which of the following is a correctly matched description and type of epithelial tissue?
A) Simple epithelium: cells in contact with intercellular matrix; some do not extend to surface
B) Stratified epithelium: single layer of cells; all cells rest on basement membrane
C) Glandular epithelium: arise from surface epithelia and underlying connective tissue
D) Pseudostratified epithelium: multiple layers of cells; deepest layer rests on basement membrane
9. Connective tissue contains fibroblasts that are responsible for:
A) providing a fibrous framework for capillaries.
B) synthesis of collagen, elastin, and reticular fibers.
C) forming tendons and the fascia that covers muscles.
D) filling spaces between tissues to keep organs in place.
10. Although all muscle tissue cells have some similarities, smooth muscle (also known as involuntary muscle) differs by:
A) having dense bodies attached to actin filaments.
B) containing sarcomeres between Z lines and M bands.
C) having rapid contractions and abundant cross-striations.
D) contracting in response to increased intracellular calcium.

Chapter 02: Cellular Responses to Stress Injury and Aging

1. Ischemia and other toxic injuries increase the accumulation of intracellular calcium as a result of:
A) release of stored calcium from the mitochondria.
B) improved intracellular volume regulation.
C) decreased influx across the cell membrane.
D) attraction of calcium to fatty infiltrates.
2. The patient is found to have liver disease, resulting in the removal of a lobe of his liver. Adaptation to the reduced size of the liver leads to ___________ of the remaining liver cells.
A) metaplasia
B) organ atrophy
C) compensatory hyperplasia
D) physiologic hypertrophy
3. A person eating peanuts starts choking and collapses. His airway obstruction is partially cleared, but he remains hypoxic until he reaches the hospital. The prolonged cell hypoxia caused a cerebral infarction and resulting __________ in the brain.
A) caspase activation
B) coagulation necrosis
C) rapid phagocytosis
D) protein p53 deficiency
4. Bacteria and viruses cause cell damage by _______, which is unique from the intracellular damage caused by other injurious agents.
A) disrupting the sodium/potassium ATPase pump
B) interrupting oxidative metabolism processes
C) replicating and producing continued injury
D) decreasing protein synthesis and function
5. The patient has a prolonged interruption in arterial blood flow to his left kidney, causing hypoxic cell injury and the release of free radicals. Free radicals damage cells by:
A) destroying phospholipids in the cell membrane.
B) altering the immune response of the cell.
C) disrupting calcium storage in the cell.
D) inactivation of enzymes and mitochondria.
6. Injured cells have impaired flow of substances through the cell membrane as a result of:
A) increased fat load.
B) altered permeability.
C) altered glucose utilization.
D) increased surface receptors.
7. Reversible adaptive intracellular responses are initiated by:
A) stimulus overload.
B) genetic mutations.
C) chemical messengers.
D) mitochondrial DNA.
8. Injured cells become very swollen as a result of:
A) increased cell protein synthesis.
B) altered cell volume regulation.
C) passive entry of potassium into the cell.
D) bleb formation in the plasma membrane.
9. A diabetic patient has impaired sensation, circulation, and oxygenation of his feet. He steps on a piece of glass, the wound does not heal, and the area tissue becomes necrotic. The necrotic cell death is characterized by:
A) rapid apoptosis.
B) cellular rupture.
C) shrinkage and collapse.
D) chronic inflammation.
10. A 99-year-old woman has experienced the decline of cell function associated with age. A group of theories of cellular aging focus on programmed:
A) changes with genetic influences.
B) elimination of cell receptor sites.
C) insufficient telomerase enzyme.
D) DNA mutation or faulty repair.

Chapter 03: Inflammation the Inflammatory Response and Fever

1. The characteristic, localized cardinal signs of acute inflammation include:
A) fever.
B) fatigue.
C) redness.
D) granuloma.
2. The vascular, hemodynamic stage of acute inflammation is initiated by momentary vasoconstriction followed by vasodilation that causes localized:
A) bleeding.
B) congestion.
C) pale skin.
D) coolness.
3. The cellular stage of acute inflammation is marked by the movement of leukocytes into the area. Which of the following cells arrives early in great numbers?
A) Basophils
B) Lymphocytes
C) Neutrophils
D) Platelets
4. The phagocytosis process involves three distinct steps. What is the initial step in the process?
A) Engulfment
B) Intracellular killing
C) Antigen margination
D) Recognition and adherence
5. Which of the following mediators of inflammation causes increased capillary permeability and pain?
A) Serotonin
B) Histamine
C) Bradykinin
D) Nitric oxide
6. Inflammatory exudates are a combination of several types. Which of the following exudates is composed of enmeshed necrotic cells?
A) Serous
B) Fibrinous
C) Suppurative
D) Membranous
7. The acute-phase systemic response usually begins within hours of the onset of inflammation and includes:
A) fever and lethargy.
B) decreased C-reactive protein.
C) positive nitrogen balance.
D) low erythrocyte sedimentation rate.
8. In contrast to acute inflammation, chronic inflammation is characterized by which of the following phenomena?
A) Profuse fibrinous exudation
B) A shift to the left of granulocytes
C) Metabolic and respiratory alkalosis
D) Lymphocytosis and activated macrophages
9. Exogenous pyrogens (interleukin-1) and the presence of bacteria in the blood lead to the release of endogenous pyrogens that:
A) stabilize thermal control in the brain.
B) produce leukocytosis and anorexia.
C) block viral replication in cells.
D) inhibit prostaglandin release.
10. An older adult patient has just sheared the skin on her elbow while attempted to boost herself up in bed, an event that has precipitated acute inflammation in the region surrounding the wound. Which of the following events will occur during the vascular stage of the patients inflammation?
A) Outpouring of exudate into interstitial spaces
B) Chemotaxis
C) Accumulation of leukocytes along the epithelium
D) Phagocytosis of cellular debris

Chapter 04: Cell Proliferation Tissue Regeneration and Repair

1. Epithelialization, the first component of the proliferative phase of wound healing, is delayed in open wounds until after ________ has formed.
A) granulation tissue
B) fibrinous meshwork
C) capillary circulation
D) collagenous layers
2. A mutation has occurred during mitosis of an individuals bone marrow cell. This event may be the result of the failure of which of the following?
A) Progenitor cells
B) Fibroblasts
C) Stem cells
D) Cyclins
3. A patient has experienced a myocardial infarction with accompanying necrosis of cardiac muscle, a permanent tissue. What are the ramifications of the fact that cardiac muscle is a permanent tissue?
A) The cardiac muscle cells will remain perpetually in the G1 stage of mitosis.
B) Regeneration of the patients cardiac muscle will be exceptionally slow.
C) The necrotic cells will be replaced with muscle cells that have limited metabolism.
D) The cells will not proliferate and will be replaced with scar tissue.
4. A couple have chosen to pay for the harvesting and storage of umbilical cord blood after the delivery of their child to secure a future source of embryonic stem cells. What is the most likely rationale for the couples decision?
A) The stem cells may be able to produce a wide range of body cells.
B) The embryonic stem cells allow stable and permanent tissues to enter mitosis.
C) The stem cells can change the proliferative capacity of other cells.
D) The embryonic stem cells remove cyclin-dependent kinase inhibitors from the body.
5. The basement membrane surrounding a patients foot wound remains intact, a fact that bodes well for the wound-healing process. Which of the following components constitute this form of the extracellular matrix? Select all that apply.
A) Prostaglandins
B) Fibrous structural proteins
C) Lymphocytes
D) Water-hydrated gels
E) Glycoproteins
6. A nursing student is cleaning and changing the dressing on a patients sacral ulcer. The student has vigorously cleansed the wound bed to remove all traces of the beefy, red tissue that existed in the wound bed. The student has most likely removed:
A) Necrotic tissue
B) Granulation tissue
C) Stem cells
D) The extracellular matrix
7. A 12-year-old boys severe wound that he received from a dog bite has begun to heal and currently shows no signs of infection. Which of the following processes occurred first during this process of repair by connective tissue deposition?
A) Reorganization of fibrous tissue
B) Angiogenesis
C) Emigration of fibroblasts to the wound site
D) Deposition of the extracellular matrix
8. Which of the following wounds is most likely to heal by secondary intention?
A) A finger laceration that a cook received while cutting up onions
B) A boys road rash that he got by falling off his bicycle
C) A needlestick injury that a nurse received when injecting a patients medication
D) The incision from a teenagers open appendectomy
9. A patient underwent an open cholecystectomy 4 days ago and her incision is now in the proliferative phase of healing. What is the dominant cellular process that characterizes this phase of the patients healing?
A) Hemostasis and vasoconstriction
B) Keloid formation
C) Collagen secretion by fibroblasts
D) Phagocytosis by neutrophils
10. Which of the following surgical patients is most likely to experience enhanced wound healing as a result of his or her diet?
A) A patient who eats a high-calorie diet and large amounts of red meat
B) A patient who is a vegetarian and who eats organic foods whenever possible
C) A patient who practices carefully calorie control and who avoids animal fats
D) A patient who is receiving total parenteral nutrition due to recurrent nausea

Chapter 05: Genetic Control of Cell Function and Inheritance

1. Triplet codes of three bases are the genetic codes used in transmitting genetic information necessary for:
A) chromatin formation.
B) protein synthesis.
C) enzyme activation.
D) nucleotide bonding.
2. Unlike messenger RNA (mRNA) and transfer RNA (tRNA), ribosomal RNA (rRNA):
A) is produced in the nucleolus.
B) delivers activated amino acids.
C) is formed by transcription.
D) coordinates RNA translation.
3. Splicing of mRNA during processing permits a cell to:
A) form different proteins.
B) increase DNA content.
C) stop copying DNA onto RNA.
D) add nucleic acid end pieces.
4. When an infant is born with gene mutations in his/her cells, the errors may be a result of all of the following except _____________ of base pairs.
A) deletion
B) substitution
C) differentiation
D) rearrangement
5. Identifying the genetic sex of a child is based on finding intracellular Barr bodies that consist of:
A) inactive chromatin material.
B) male-specific chromosomes.
C) homologous chromosomes.
D) excess autosomal material.
6. Multifactorial inheritance is similar to polygenic inheritance because both involve:
A) environmental effects on alleles.
B) multiple alleles at different loci.
C) predictable somatic allele effects.
D) homozygous pairing of two alleles.
7. Crossing over of chromatid segments during meiosis division 1 results in:
A) spontaneous gene mutations.
B) initial DNA synthesis.
C) bivalent X and Y genes.
D) new gene combinations.
8. During the transcription process, RNA:
A) polymerase attaches to DNA.
B) exon sequences are reversed.
C) delivers activated amino acids.
D) reverses redundant base pairs.
9. The process of gene expression is increased by:
A) mutation of normal suppressor genes.
B) induction by an external influence.
C) repression of internal penetrance.
D) activation of growth control genes.
10. Gene therapy, insertion of genes into the genome of multicellular organisms, is accomplished by:
A) restriction enzymes.
B) transferring genes.
C) DNA fragment separation.
D) cross-over gene exchange.

Chapter 06: Genetic and Congenital Disorders

1. Genetic disorders that involve a single gene trait are characterized by:
A) multifactorial gene mutations.
B) chromosome rearrangements.
C) Mendelian patterns of transmission.
D) abnormal numbers of chromosomes.
2. In addition to having a 50% chance of inheriting an autosomal dominant disorder from an affected parent, such a disorder is characterized by:
A) aneuploidy of genes in all cells.
B) deficiencies in enzyme synthesis.
C) affected X transmission to daughters.
D) varied gene penetration and expression.
3. Autosomal recessive disorders are characterized by:
A) age of onset later in life.
B) abnormal protein structure.
C) inborn errors of metabolism.
D) one in two risk of a carrier child.
4. When a male child inherits an X-linked disorder from his heterozygous carrier mother,
A) his sons will be carriers.
B) his father has the disorder.
C) some of his sisters will be carriers.
D) his daughters will have the disorder.
5. Multifactorial inheritance disorders, such as cleft palate, are often caused by____________ during fetal development.
A) multiple gene mutations
B) dominant gene expression
C) X-linked crossover problem
D) polyploidy of chromosomes
6. The newborn has the distinctive physical features of trisomy 21, Down syndrome, which includes:
A) upward slanting of eyes.
B) large, protruding ears.
C) thin lips and small tongue.
D) long fingers with extra creases.
7. Aneuploidy of the X chromosome can result in a monosomy or polysomy disorder. The manifestations of monosomy X, Turner syndrome, differ from polysomy X disorders in numerous ways that include:
A) short-stature female individual..
B) mental retardation.
C) enlarged breasts.
D) early onset puberty.
8. A teratogenic environmental agent can cause birth defects when:
A) inherited as a recessive trait.
B) intense exposure occurs at birth.
C) disjunction occurs during meiosis.
D) retained during early pregnancy.
9. Fetal alcohol syndrome (FAS) is unlike other teratogens in that the harmful effects on the fetus:
A) directly result in liver damage.
B) extend throughout the pregnancy.
C) is most noticeable in adulthood.
D) cause death in early childhood.
10. Prenatal diagnosis methods include the use of ultrasonography for identifying ________ abnormalities.
A) cytogenic
B) skeletal
C) chromosomal
D) a-fetoprotein

Chapter 07: Neoplasia

1. Unlike the tissue growth that occurs with hypertrophy and hyperplasia, the growth of a malignancy is:
A) adaptive.
B) specialized.
C) predictable.
D) autonomous.
2. In contrast to malignancies, benign tumors are characterized by:
A) a fibrous capsule.
B) distant infiltration.
C) rapid replication.
D) undifferentiated cells.
3. Because of their rapid growth, malignant tumors affect area tissues by:
A) increasing tissue blood flow.
B) providing essential nutrients.
C) liberating enzymes and toxins.
D) forming fibrous membranes.
4. The metastatic spread of tumor cells is facilitated by _______ that enables invasion and movement to distant tissues.
A) cell cohesiveness
B) enzyme secretion
C) contact inhibition
D) cell-to-cell signaling
5. The angiogenesis process, which allows tumors to develop new blood vessels, is triggered and regulated by tumor-secreted:
A) procoagulants.
B) growth factors.
C) attachment factors.
D) proteolytic enzymes.
6. Cancerous transformation of a cell requires the activation of:
A) cell cycle apoptosis.
B) multiple mutations.
C) a single gene mutation.
D) tumor suppressor genes.
7. Although clinical manifestations vary with the type of cancer and organs involved, abnormal tumor growth causes general manifestations that include:
A) copious lymph flow.
B) sleep disturbances.
C) involuntary weight gain.
D) visceral organ expansion.
8. Paraneoplastic syndromes are manifestations of cancer that often result from:
A) radiation and chemotherapy.
B) compression of area vessels.
C) tumor-related tissue necrosis.
D) inappropriate hormone release.
9. Although both grading and staging are methods for classifying cancer and selecting a treatment plan, staging is used to determine the:
A) number of mitoses.
B) tissue characteristics.
C) level of differentiation.
D) extent of disease spread.
10. Early diagnosis of childhood cancers is often difficult because the signs and symptoms are:
A) already present at birth.
B) absent until the late stage.
C) similar to those of other childhood diseases.
D) seen as developmental delays.

Chapter 08: Disorders of Fluid Electrolyte and Acid-Base Balance

1. An injured patient develops interstitial edema as a result of decreased:
A) vascular volume.
B) hydrostatic pressure.
C) capillary permeability.
D) colloidal osmotic pressure.
2. The most reliable method for measuring body water or fluid volume increase is by assessing:
A) tissue turgor.
B) intake and output.
C) body weight change.
D) serum sodium levels.
3. The syndrome of inappropriate ADH is characterized by:
A) increased osmolality.
B) excessive water thirst.
C) copious dilute urination.
D) dilutional hyponatremia.
4. In isotonic fluid volume deficit, changes in total body water are accompanied by:
A) intravascular hypotonicity.
B) increased intravascular water.
C) increases in intracellular sodium.
D) proportionate losses of sodium.
5. Hyponatremia can be caused by ______and manifested by _______.
A) hypovolemia; dehydration
B) third spacing; hypertonicity
C) water retention; hypotonicity
D) aldosterone excess; low ADH
6. One of the major causes of hyperkalemia is ____________, which alters potassium elimination.
A) renal dysfunction
B) aldosterone excess
C) metabolic alkalosis
D) plasma albumin deficit
7. Hypoparathyroidism causes hypocalcemia by:
A) increasing serum magnesium.
B) increasing phosphate excretion.
C) blocking bone release of calcium.
D) blocking action of intestinal vitamin D.
8. Magnesium is important for the overall function of the body because of its direct role in:
A) cell membrane permeability.
B) somatic cell growth control.
C) sodium and tonicity regulation.
D) DNA replication and transcription.
9. A patient has acidosis that is suspected to be respiratory in etiology. Which of the following is the major cause of acute primary respiratory acidosis?
A) Decreased CO2 retention
B) Increased metabolic acids
C) Renal bicarbonate retention
D) Impaired alveolar ventilation
10. As other mechanisms prepare to respond to a pH imbalance, immediate buffering is a result of increased:
A) intracellular albumin.
B) hydrogen/potassium binding.
C) sodium/phosphate anion absorption.
D) bicarbonate/carbonic acid regulation.

Chapter 09: Stress and Adaptation

1. According to Walter B. Cannon, homeostasis is a stable internal environment achieved through a system of:
A) interdependent system-wide adaptive responses.
B) variable internal and external conditioning factors.
C) coordinated physiologic processes that oppose change.
D) compatibility between cells and the internal environment.
2. Allostasis is characterized by:
A) organ-specific physiologic responses.
B) interactive physiologic changes in numerous systems.
C) systems that detect psychologic function.
D) future expectations as a catalyst for change.
3. According to Hans Selye, the first stage of the general adaptation syndrome (GAS) is:
A) alarm.
B) exhaustion.
C) resistance.
D) anticipation.
4. Although stress exposure initiates integrated responses by multiple systems, the functional changes are first manifested by which system?
A) Pulmonary
B) Gastrointestinal
C) Cardiovascular
D) Neuroendocrine
5. Which manifestation of stress reflects the nonspecific fight-or-flight response?
A) Decreased pupillary light response
B) Increased gastrointestinal motility
C) Decreased short-term memory
D) Increased cardiopulmonary rates
6. Stress-induced cortisol hormone secretion is associated with:
A) increased growth hormone level.
B) regulation of the stress response.
C) increased thyroid-stimulating hormone.
D) depressed adrenal gland function.
7. Two people experience the same stressor yet only one is able to cope and adapt adequately. An example of the person with an increased capacity to adapt is the one with:
A) a sense of purpose in life.
B) circadian rhythm disruption.
C) age-related renal dysfunction.
D) excessive weight gain or loss.
8. Acute stress is characterized by:
A) a time-limited fight or flight response.
B) recurrent exposure to a stressor.
C) negative feedback overactivity.
D) system impairment and fatigue.
9. The patient recently returned from a year of military battle duty and has posttraumatic stress disorder (PTSD). This disorder includes an intrusion state that is experienced as:
A) excessive anxiety and safety concerns.
B) repeated relived memories as nightmares.
C) loss of concentration and increased vigilance.
D) emotional numbing and feelings of depression.
10. A patient is extremely anxious about his impending surgery. Which of the following measures should the nurse implement to create an atmosphere for effective use of relaxation techniques?
A) A quiet, dim environment
B) A soothing, warm foot soak
C) Gentle muscle stroking
D) Repetitive questioning

Chapter 10: Disorders of Nutritional Status

1. The adipocytes in adipose tissue not only serve as a storage sites, they also:
A) produce linoleic fatty acid.
B) synthesize triglycerides.
C) increase glucagon release.
D) degrade fat-soluble vitamins.
2. Protein contains nitrogen. A negative nitrogen balance represents:
A) more protein consumed than excreted.
B) a reduced need for nitrogen as protein.
C) more nitrogen excreted than consumed.
D) less use of nitrogen for protein synthesis.
3. Natural appetite suppression mechanisms, necessary for food intake control, include :
A) ketoacid deficiency.
B) cholecystokinin storage.
C) decreased blood glucose.
D) leptin receptor stimulation.
4. Body weight should be used in combination with other measurements to establish if a person is underweight or overweight. Obesity is indicated by:
A) female body fat of 20% and 30%.
B) body mass index (BMI) of 30 to 40.
C) relative body weight of 70% to 100%.
D) abdominal fat/ hip ratio of 0.8 to 1.0.
5. A patient with upper body obesity also has central fat distribution. This body fat configuration places the patient at greater risk for _____________ than a patient with lower body obesity.
A) osteoporosis
B) renal disease
C) cardiometabolic disorders
D) chronic anemia
6. As the problem of childhood and adolescent obesity increases, an increase in the incidence of ____________ is occurring in this obese population.
A) type 2 diabetes mellitus
B) attention deficit disorder
C) juvenile rheumatoid arthritis
D) antibiotic-resistant bacterial infections
7. A diet deficient in calories and protein causes marasmus, which is characterized by:
A) discolored hair.
B) bradycardia.
C) enlarged liver.
D) pitting edema.
8. Protein-calorie malnutrition with loss of lean tissues and muscle mass results in:
A) respiratory muscle stimulation.
B) excessive blood cell production.
C) diarrhea.
D) increased cardiac contractility.
9. Similarities between girls or women with anorexia nervosa and bulimia nervosa include:
A) periodontal disease.
B) low estrogen level.
C) electrolyte imbalances.
D) enlarged parotid gland.
10. Both binge-eating and bulimia nervosa patients consume excessive amounts of foods secretively. A major difference is that binge-eaters:
A) remain overweight.
B) eat when not hungry.
C) are substance abusers.
D) experience depression.

Chapter 11: Disorders of White Blood Cells and Lymphoid Tissues

1. Cytokines that affect hematopoiesis in bone marrow are called colony-stimulating factors (CSFs) based on their ability to:
A) support lymphocytes.
B) differentiate red cells.
C) regulate blood cells.
D) stimulate lymphocytes.
2. Leukocytes consist of three categories of cells that have different roles in the inflammatory and immune responses. Which of the following leukocytes is correctly matched with its function?
A) Lymphocyte; phagocytosis
B) Eosinophils; allergic reactions
C) Basophils; engulf antigens
D) Monocytes; release heparin
3. The patient has an abnormally low neutrophil count. Neutropenia is most commonly caused by:
A) Epstein-Barr virus.
B) Kostmann syndrome.
C) drug reactions.
D) skin infections.
4. The 16-year-old boy has enlarged lymph nodes and a sore throat. His girlfriend was recently diagnosed with infectious mononucleosis, which is caused by ________ and commonly transmitted in ________.
A) heterophil antibodies; blood
B) Epstein Barr virus; saliva
C) T-cell infection; plasma
D) bacterial infection; monocytes
5. The patient is diagnosed with Hodgkin type of lymphoma based on the results of laboratory tests and study of the tumor cells. A distinct characteristic of Hodgkin lymphoma is the presence of:
A) Reed-Sternberg cells.
B) Bence Jones proteins.
C) M-type protein antibodies.
D) Philadelphia chromosome.
6. Manifestations of Hodgkin lymphoma that distinguish it from non-Hodgkin lymphoma include:
A) noncontiguous nodal spread.
B) superficial lymphadenopathy.
C) pruritus and night fevers.
D) poor humoral antibody response.
7. Leukemias are classified according to the predominant cell type. The myelogenous cell type of leukemia can:
A) interfere with thrombocyte cell maturation.
B) originate in marrow and infiltrate nodes.
C) affect B and T stem cells in bone marrow.
D) transform mature cells into immature ones.
8. A child has Down syndrome and has recently experienced unexplained nose bleeds. His blood tests identify blast cells in the peripheral smear. In addition to nose bleeds, his acute leukemia will typically manifest all of the following EXCEPT:
A) infections due to neutropenia.
B) fatigue due to RBC deficiency.
C) hypogammaglobulinemia.
D) bleeding due to thrombocytopenia.
9. In contrast to acute leukemias, chronic leukemias are malignancies involving abnormal _________________ blood cells in the marrow.
A) production of undifferentiated
B) proliferation of well-differentiated
C) uncontrolled growth of immature
D) replication of pluripotent precursor
10. Multiple myeloma is a malignancy of:
A) plasma cells.
B) bone osteoblasts.
C) T-cell lymphocytes.
D) immunoglobulin A.

Chapter 12: Disorders of Hemostasis

1. With the exception of the first two steps, what is required in all steps of the clotting process?
A) Calcium
B) Prothrombin
C) Tissue factor
D) Plasminogen
2. The first step of hemostasis occurs as a:
A) fibrin clot.
B) platelet plug.
C) clot retraction.
D) vessel spasm.
3. To form a platelet plug, platelets are attracted to the damaged vessel, and then platelet ___________ occurs.
A) adhesion
B) fibrinolysis
C) thrombosis
D) thromboxane A2
4. Blood coagulation is initiated by either of two pathways. The intrinsic pathway requires circulating ________ to begin the step-wise coagulation cascade.
A) protein C
B) thrombin
C) factor XII
D) tissue factor
5. Increased platelet function, and consequent hypercoagulability, can be caused by:
A) factor V mutation.
B) platelet insensitivity.
C) vascular wall damage.
D) decreased platelet numbers.
6. Immune thrombocytopenia purpura (ITP) is a/an ________ disorder that destroys ________.
A) allergic; fibrinogen
B) alloimmune; factor VIII
C) autoimmune; platelets
D) immunoglobulin; B cells
7. Thrombotic thrombocytopenic purpura (TTP) causes which of the following manifestations? Select all that apply.
A) Purpura
B) Jaundice
C) Petechiae
D) Erythema
E) Confusion
8. Hemophilia A is a hereditary blood disorder caused by inadequate activity or absent:
A) factor VIII.
B) prothrombin.
C) vWF complex.
D) intrinsic factor.
9. Disseminated intravascular coagulation (DIC) is characterized by:
A) headaches.
B) platelet loss.
C) hypertension.
D) hemorrhage.
10. In persons with a bleeding disorder caused by vascular defects, laboratory tests will most often reveal:
A) normal values.
B) hypocalcemia.
C) polycythemia.
D) thrombocytopenia.

Chapter 13: Disorders of Red Blood Cells

1. Sue is fatigued and some blood tests are done. Her results include Hct 40%; Hgb 8g/dL; WBC 8,000; platelets 175,000. The nurse should interpret Sues blood work as indicative of:
A) high platelets/thrombocytosis.
B) low WBC count/granulocytopenia.
C) low hemoglobin/anemia.
D) high hematocrit/polycythemia.
2. Manifestations of anemia that are directly due to the diminished oxygen-carrying capacity of hemoglobin include:
A) fatigue.
B) bleeding.
C) bone pain.
D) pale skin.
3. When an Rh-negative mother has been sensitized and is pregnant with an Rh-positive fetus, what happens to the fetus?
A) Bilirubin deficiency
B) Nothing, this is normal
C) Plasma volume depletion
D) Profound red cell hemolysis
4. The patient is an average-sized adult and has abnormal microcytic hypochromic red blood cells due to a long-term, chronic disease. Which of the following CBC results is characteristic of her type of anemia?
A) Hematocrit 44%
B) Reticulocytes 1.5%
C) Band cells 3,000/mL
D) Hemoglobin 8 g/dL
5. Megaloblastic anemias caused by folic acid or vitamin B12 deficiencies can seriously affect RBC production. This is because both are necessary for _______ synthesis and _______.
A) iron; hemoglobin adhesion
B) DNA; red blood cell maturation
C) thrombin; platelet aggregation
D) protein; reticulocyte maturation
6. Polycythemia develops in patients with lung disease as a result of:
A) hyperventilation.
B) chronic hypoxia.
C) decreased blood viscosity.
D) excessive respiratory fluid loss.
7. Which of the following types and characteristics of anemia are correctly matched?
A) Hemolytic; abnormal iron uptake
B) Iron deficiency; early RBC death
C) Folate; decreased erythropoiesis
D) Blood loss; bone marrow expansion
8. Conditions that predispose to sickling of hemoglobin in persons with sickle cell anemia include:
A) impaired red blood cell maturation.
B) increased iron content of blood.
C) decreased oxygen saturation.
D) increased intravascular volume.
9. An elevated level of unconjugated bilirubin, due to hemolysis of RBCs, results in a high level of iron released and:
A) diarrhea.
B) cyanosis.
C) numbness.
D) jaundice.
10. Hemolytic anemia is characterized by excessive red blood cell destruction and compensatory:
A) hypoactive bone marrow.
B) increased erythropoiesis.
C) iron retention in the body.
D) shrinkage of the spleen.

Chapter 14: Mechanisms of Infectious Disease

1. Although growth rate is variable among types of bacteria, the growth of bacteria is dependent on:
A) biofilm communication.
B) availability of nutrients.
C) an intact protein capsid.
D) individual cell motility.
2. Treponema pallidum, the cause of syphilis, is a spirochete bacterium that is spread from human to human by:
A) tick or lice vector bites.
B) direct physical contact.
C) exposure to infected urine.
D) inhaling airborne particles.
3. Chlamydiaceae, a rather common sexually transmitted infectious organism, has characteristics of both viruses and bacteria. The infectious form of this organisms life cycle is _______ until it enters the host cell.
A) an elementary body
B) adhered to cholesterol
C) propelled by filaments
D) encapsulated hyphae
4. Because dermatophytes are capable of growing _________, the infection is mainly found on cutaneous surfaces of the body.
A) a powdery colony
B) in moist skin folds
C) on cooler tissue
D) branching filaments
5. Although both eukaryotes and prokaryotes are capable of causing infectious diseases in humans, eukaryotes are unique because they have a distinct:
A) organized nucleus.
B) circular plasmid DNA.
C) cytoplasmic membrane.
D) variation of shape and size.
6. Whatever the mechanism of entry, the human-to-human transmission of infectious agents is directly related to the:
A) source of contact.
B) site of infection.
C) number of pathogens absorbed.
D) virulence factors.
7. The course of any infectious disease progresses through several distinct stages after the pathogen enters the host. Although the duration may vary, the hallmark of the prodromal stage is:
A) tissue inflammation and damage.
B) initial appearance of symptoms.
C) progressive pathogen elimination.
D) containment of infectious pathogens.
8. Although bacterial toxins vary in their activity and effects on host cells, a small amount of gram-negative bacteria endotoxin:
A) is released during cell growth.
B) inactivates key cellular functions.
C) uses protein to activate enzymes.
D) in the cell wall activates inflammation.
9. Serology testing includes the measurement of which of the following?
A) Antibody titers
B) Culture growth
C) Direct antigens
D) DNA sequencing
10. Prions cause transmissible neurodegenerative diseases and are characterized by:
A) a lack of reproductive capacity.
B) hypermetabolism.
C) enzyme production.
D) chronic inflammation.

Chapter 15: Innate and Adaptive Immunity

1. Innate immunity, also called natural or native immunity, consists of mechanisms that respond specifically to:
A) self-cells.
B) microbes.
C) antibodies.
D) inflammation.
2. Adaptive immune responses, also called acquired or specific immunity, are composed of _____________ and their products.
A) granulocytes
B) lymphocytes
C) epithelial cells
D) Toll-like receptors
3. The effector cells of the immune system have the primary function of:
A) activating phagocytic cells.
B) eliminating the antigens.
C) processing antigen into epitopes.
D) controlling the immune response.
4. Activation of lymphocytes is dependent upon the ________ and ________ of the antigens by macrophages.
A) memory; clustering
B) capture; destruction
C) recognition; grouping
D) processing; presentation
5. Major histocompatibility complex (MHC) molecules, with human leukocyte antigens (HLAs), are markers on all nucleated cells and have an important role in:
A) identifying blood types.
B) cell membrane transport.
C) suppressing viral replication.
D) avoiding transplant rejections.
6. Dendritic cells, found in skin tissues and lymphoid tissues, are important for:
A) initiation of adaptive immunity.
B) deep-tissue phagocytosis.
C) disposal of dead cells.
D) delaying inflammation.
7. Once T helper cells are activated, they secrete ____________ that activate and regulate nearly all of the other cells of the immune system.
A) complement proteins
B) cytokines
C) leukotrienes
D) bradykinins
8. The first circulating immunoglobulin to appear in response to a new antigen is:
A) IgG.
B) IgM.
C) IgA.
D) IgD.
9. The effector function of activated members of the complement system includes all of the following EXCEPT:
A) chemotaxis.
B) opsonization.
C) pathogen lysis.
D) phagocytosis.
10. During the latent period before antibodies are detected in the humoral immune response, B cells differentiate into ________ cells.
A) plasma
B) cytotoxic
C) stem
D) helper

Chapter 16: Disorders of the Immune Response

1. The mediators involved in type I hypersensitivity allergic responses are released from:
A) mast cells.
B) plasma cells.
C) monocytes.
D) arachidonic acid.
2. A genetically determined hypersensitivity to common environmental allergens causes ___________ reactions, such as:
A) atopic; urticaria.
B) autoimmune; diarrhea.
C) IgM-mediated; infections.
D) delayed; poison ivy rash:
3. Mismatched blood transfusion reaction with hemolysis of blood cells is an example of type II, _____ mediated hypersensitivity reaction.
A) T-cell
B) antibody
C) leukotriene
D) complement
4. Type III hypersensitivity immune responses can be harmful when immune complex deposits in tissue activate ___________ that can directly damage area tissues.
A) inflammation
B) autoantibodies
C) cytotoxic cells
D) immunoglobulins
5. The mechanism by which humans recognize self-cells from non-self (antigens)-cells is _________.
A) autoimmunity
B) self-tolerance
C) non-self anergy
D) immunocompatibility
6. Organ rejection is a complication of organ transplantation caused by recipient immune cells:
A) destroying the host T cells.
B) attack on the donor cells.
C) combining with grafts HLA.
D) being recognized as foreign.
7. The leading cause of death for people with HIV is opportunistic ____________.
A) leukemia
B) tuberculosis
C) pneumonia
D) toxoplasmosis
8. Wasting syndrome, an AIDS-defining illness, is characterized by involuntary weight loss of at least 10% of baseline body weight in the presence of:
A) diarrhea.
B) hypermetabolism.
C) weakness and fever.
D) glucose intolerance.
9. The window period of HIV infection refers to the period of time between infection and:
A) transmission.
B) seroconversion.
C) initial symptoms.
D) antibody screening.
10. HIV-positive persons that display manifestations of laboratory category 3 or clinical category C are considered to have:
A) zero viral load.
B) seroconversion.
C) complete remission.
D) AIDS-defining illnesses.

Chapter 17: Control of Cardiovascular Function

1. In the arterial-venous circulatory system, pressure is inversely related to:
A) velocity.
B) volume.
C) tension.
D) viscosity.
2. Turbulent blood flow can be caused by a number of factors, including:
A) increased velocity.
B) short vessel length.
C) high blood viscosity.
D) layering of blood cells.
3. Heart muscle differs from skeletal muscle tissue by being able to generate:
A) contractions.
B) calcium influx.
C) action potentials.
D) sarcomere binding.
4. During ventricular systole, closure of the atrioventricular (AV) valves coincides with:
A) atrial chamber filling.
B) aortic valve opening.
C) isovolumetric contraction.
D) semilunar valves opening.
5. The difference between the end-diastolic and end-systolic volumes is the:
A) stroke volume.
B) cardiac output.
C) ejection fraction.
D) cardiac reserve.
6. Preload represents the volume work of the heart and is largely determined by:
A) venous blood return.
B) vascular resistance.
C) force of contraction.
D) ventricular emptying.
7. A large increase in heart rate can cause:
A) increased blood viscosity.
B) loss of action potential.
C) decreased stroke volume.
D) reduced cardiac contractility.
8. Long-term autoregulation of local blood flow in the microcirculation is mediated by:
A) collateral circulation.
B) arteriovenous shunting.
C) autonomic nervous system.
D) metabolic needs of the tissues.
9. The tissue factor that contributes to humoral control of blood flow by causing vasoconstriction is:
A) histamine.
B) bradykinin.
C) serotonin.
D) nitric oxide.
10. The parasympathetic nervous system causes a slowing of the heart rate by increasing:
A) norepinephrine.
B) vessel constriction.
C) vagus nerve activity.
D) smooth muscle tone.

Chapter 18: Disorders of Blood Flow and Blood Pressure

1. Because cholesterol is insoluble in plasma, it is mainly carried by the lipoprotein:
2. A major cause of secondary hyperlipoproteinemia is _______, which increases the production of VLDL and conversion to LDL.
A) high-calorie diet
B) diabetes mellitus
C) bile-binding resin
D) cholesterol ingestion
3. The most important complication of atherosclerosis is _________, which may cause occlusion of small heart vessels.
A) ulceration
B) thrombosis
C) fatty streaks
D) fibrous plaque
4. A serum marker for systemic inflammation, _______, is now considered a major risk factor marker for atherosclerosis, and vascular disease.
A) leukocytosis
B) homocysteine
C) serum lipoprotein
D) C-reactive protein
5. Small-vessel vasculitides, a group of vascular disorders that cause vasculitis, are mainly mediated by:
A) infectious agents.
B) tissue necrosis.
C) mononuclear cells.
D) hypersensitivity reactions.
6. Atherosclerotic peripheral vascular disease is symptomatic with at least 50% occlusion. The primary peripheral symptom, due to ischemia, is:
A) edema.
B) calf pain.
C) varicosities.
D) strong pulse.
7. Although both are characterized by ischemia, Raynaud phenomenon is caused by _________, and thromboangiitis obliterans is caused by:
A) occlusion; compression.
B) thrombi; vasoconstriction.
C) vasculitides; hypertension.
D) vasospasm; inflammation.
8. Because of its location, the presence of an abdominal aortic aneurysm may first be noticed as:
A) constipation.
B) indigestion.
C) a pulsating mass.
D) mid-abdominal pain.
9. By definition, hypertension is systolic blood pressure of ____ mm Hg or higher or diastolic blood pressure of ____ mm Hg or higher.
A) 129; 85
B) 138; 89
C) 140; 90
D) 155; 95
10. The patient is immobilized following a hip injury and has begun demonstrating lower leg discoloration with edema, pain, tenderness, and increased warmth in the mid-calf area. He has many of the manifestations of:
A) stasis ulcerations.
B) arterial insufficiency.
C) primary varicose veins.
D) deep vein thrombosis.

Chapter 19: Disorders of Cardiac Function

1. Chronic stable angina, associated with inadequate blood flow to meet the metabolic demands of the myocardium, is caused by:
A) fixed coronary obstruction.
B) increased collateral circulation.
C) intermittent vessel vasospasms.
D) excessive endothelial relaxing factors.
2. Atherosclerotic plaque is most likely to be unstable and vulnerable to rupture when the plaque has a thin fibrous cap over a:
A) red thrombus.
B) large lipid core.
C) calcified lesion.
D) vessel wall injury.
3. Cardiac tamponade and pericardial effusion can be life-threatening when the pericardial sac _______ and ______ the heart.
A) ruptures; releases
B) thickens; stretches
C) contracts; friction rubs
D) fills rapidly; compresses
4. In adults, sudden death from an acute myocardial infarction is usually caused by:
A) acute myocarditis.
B) high troponin levels.
C) acute ventricular arrhythmia.
D) hypertrophic cardiomyopathy.
5. On the second or third day after an acute myocardial infarction, the area of necrosis is:
A) soft and yellow.
B) acutely inflamed.
C) granulation tissue.
D) fibrous scar tissue.
6. In aortic regurgitation, failure of aortic valve closure during diastole causes an abnormal drop in diastolic pressure. This change in pressure causes decreased:
A) stroke volume.
B) left ventricular size.
C) coronary perfusion.
D) arterial pulse pressure.
7. Patients with ischemic coronary vessel disease and acute coronary syndrome (ACS) are classified as low or high risk for acute myocardial infarction based on characteristics that include significant:
A) heart murmurs.
B) ECG changes.
C) pulmonary disease.
D) pericardial effusion.
8. Dilated cardiomyopathy with left ventricular dysfunction is characterized by increased wall:
A) rigidity.
B) thinning.
C) thickness.
D) contractility.
9. Endocarditis and rheumatic heart disease are both cardiac complications of systemic infections. Characteristics include a new or changed heart murmur caused by:
A) chronic atrial fibrillation.
B) myocardial inflammation.
C) left ventricle hypertrophy.
D) vegetative valve destruction.
10. Congenital heart defects can cause a right heart to left heart shunting of blood that results in increased:
A) pulmonary blood volume.
B) right ventricle workload.
C) unoxygenated blood flow.
D) right atrial blood volume.

Chapter 20: Heart Failure and Circulatory Shock

1. The pathophysiology of heart failure involves an interaction between decreased pumping ability and the ________ to maintain cardiac output.
A) aortic hypertrophy
B) compensatory mechanisms
C) electrical conductivity
D) parasympathetic system
2. Cardiac output is the ________ each minute.
A) volume load
B) blood pumped
C) stroke volume
D) force generated
3. One of the principal mechanisms by which the heart compensates for increased workload is:
A) myocardial hypertrophy.
B) sodium and water retention.
C) endothelin vasoconstrictors.
D) ventricular wall tension increase.
4. In right-sided heart failure, peripheral edema is evidenced by:
A) weight gain.
B) copious urination.
C) shortness of breath.
D) decreased blood pressure.
5. The most common causes of left-sided heart failure include:
A) acute myocardial infarction.
B) chronic pulmonary disease.
C) impaired renal blood flow.
D) tricuspid valve regurgitation.
6. Hypovolemic shock occurs as a result of:
A) myocardial infarction.
B) excessive vasoconstriction.
C) chronic intracellular fluid shift.
D) acute intravascular volume loss.
7. In shock, one of the best indicators of blood flow to vital organs is:
A) warm legs.
B) urine output.
C) blood pressure.
D) consciousness.
8. Anaphylactic shock is directly associated with:
A) loss of blood volume.
B) bacterial blood infection.
C) failure of the heart as a pump.
D) type I hypersensitivity response.
9. Severe shock can be followed by acute lung injury/acute respiratory distress syndrome (ALI/ARDS) characterized by:
A) hyperventilation.
B) excessive surfactant.
C) hyperinflated alveolar sacs.
D) ventilation-perfusion mismatch.
10. A common symptom of the ischemia associated with gastrointestinal redistribution of blood flow is:
A) gastric bleeding.
B) nausea and vomiting.
C) irritable bowel syndrome.
D) copious high volume diarrhea.


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