Essentials of Pathophysiology Concepts of Altered States 4th Edition Porth Test bank

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Essentials of Pathophysiology Concepts of Altered States 4th Edition Porth Test bank

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1.
A large, high-calorie meal has resulted in the intake of far more energy than a person requires. What will the individuals body do with the excess carbohydrates provided by this meal?
A)
Convert them into glucose and store them in the liver and muscles
B)
Excrete most of the excess polysaccharides through the kidneys
C)
Convert the carbohydrates into amino acids in preparation for long-term storage
D)
Create structural proteins from some of the carbohydrates and store the remainder as triglycerides
Ans:
A

Feedback:

Dietary carbohydrates are largely converted to glucose, which is stored as glycogen in the liver and skeletal muscle cells. They are not excreted by the kidneys, and carbohydrates cannot be directly converted into amino acids or structural proteins.

2.
While educating a class about adipocytes in adipose tissue, the faculty will emphasize these cells not only serve as storage sites but also are able to:
A)
Produce linoleic fatty acid
B)
Synthesize triglycerides
C)
Increase glucagon release
D)
Degrade fat-soluble vitamins
Ans:
B

Feedback:

Adipocytes synthesize and store lipids as triglycerides. Polyunsaturated linoleic fatty acid is obtained from dietary fats. Fat-soluble vitamins are components of the enzyme system required for energy to be released from fat. Adipocytes store glycerol and release it as an energy source when needed.

3.
When educating students about the differences between brown fat versus white fat, the instructor will share that brown fat has iron in its mitochondria that will facilitate:
A)
Production of a protein that releases the energy generated from metabolism as heat
B)
The primary function of storing fat energy
C)
Insulation and cushioning of the bodys vital organs
D)
Concentration of the fat tissue in the greater omentum and around the kidneys
Ans:
A

Feedback:

Brown fat differs from white fat in terms of its thermogenic capacity (its ability to produce heat). The color of brown fat reflects the presence of iron in its abundant mitochondria. Brown fat mitochondria produce a specific protein called uncoupling protein-1 (UCP-1) that releases the energy generated from metabolism as heat. The functions of white fat include energy storage, endocrine and adipocytokine secretion, insulation, and cushioning of vital organs. Internally, white adipose tissue is preferentially located in the greater omentum, mesentery, and retroperitoneal space and is usually abundant around the kidney.

4.
Which of the following clients is most likely to be in positive nitrogen balance? A client:
A)
Who is receiving treatment for sepsis
B)
Whose diagnosis of pneumonia is causing a fever
C)
Who has been admitted to the hospital in early labor
D)
Who sustained extensive burns in a recent industrial accident
Ans:
C

Feedback:

Pregnancy is associated with a positive nitrogen balance, whereas illness, fever, infection, and burns typically result in a negative nitrogen balance.

5.
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
Ans:
C

Feedback:

Negative nitrogen balance represents more excretion of nitrogen than consumed as protein. It represents a state of tissue breakdown. Positive nitrogen balance is when more protein (nitrogen) is consumed than is needed or excreted. A normal nitrogen balance is when protein intake is equivalent to nitrogen output.

6.
In addition to facilitating bowel movements, a diet that is high in fiber confers which of the following benefits?
A)
Lowering cholesterol and blood glucose
B)
Removing toxins and metabolic by-products
C)
Lowering blood pressure and resting heart rate
D)
Increasing intestinal absorption of vitamins and minerals
Ans:
A

Feedback:

Fiber binds with cholesterol and prevents it from being absorbed by the body as well as lowers blood glucose. It does not directly detoxify the body or increase intestinal absorption of vitamins and minerals. Fiber alone does not cause a reduction in blood pressure or heart rate.

7.
Which of the following body mechanisms is necessary for food intake control?
A)
Ketoacid deficiency
B)
Cholecystokinin storage
C)
Decreased blood glucose
D)
Leptin receptor stimulation
Ans:
D

Feedback:

Leptin receptor stimulation of the hypothalamus causes decreased appetite and increased metabolic rate/energy consumption. Natural appetite suppression is a response to cholecystokinin release and increased ketoacids. Decreased blood glucose causes a hunger response.

8.
From the following list of physical assessment results, which would be interpreted as the client has developed obesity?
A)
Female body fat of 20%
B)
Body mass index (BMI) of 40
C)
Relative body weight of 70%
D)
Abdominal fat/hip ratio of 0.8
Ans:
B

Feedback:

A person with a BMI of 30 or greater is classified as obese. Relative body weight greater than 120% indicates obesity. Body fat percentage over 30% indicates obesity in females. Waisthip ratio that calculates abdominal fat in proportion to total body fat is greater than 1.0 when upper body obesity is present.

9.
A client is undergoing a bioelectrical impedance test to estimate body fat. The nurse will explain to the client that this test involves:
A)
Not eating anything after midnight and walking/running on a treadmill
B)
Measuring skin fold thicknesses in a number of different sites on the body
C)
Taking quantitative pictures to determine the thickness of the body fat
D)
Using electrodes to send harmless current through the body to measure resistance to estimate body fat
Ans:
D

Feedback:

Bioelectrical impedance involves the use of electrodes attached to the wrists and ankles to send a harmless current through the body. The flow of the current is affected by the amount of water in the body. Because fat-free tissue contains virtually all the water and current-conducting electrolytes, measurements of the resistance (i.e., impedance) can be used to estimate the percentage of body fat present. Computed tomography and MRI can be used to provide quantitative pictures from which the thickness of fat can be determined. Measurements of skinfold thickness can provide a reasonable assessment of body fat, particularly if taken at multiple sites.

10.
Which of the following statements best conveys the endocrine function of adipose tissue? Adipose tissue:
A)
Antagonizes the effects of insulin on cell membranes
B)
Produces ghrelin, which stimulates both appetite and eating
C)
Produces and secretes cholecystokinin (CCK), which stimulates the hypothalamic feeding center
D)
Produces leptin, which mediates body weight
Ans:
D

Feedback:

Adipose tissue is now recognized as an endocrine organ that produces several hormones, including leptin, an important mediator of body weight. It does not produce CCK or ghrelin, however, and adipose tissue does not directly antagonize the effects of insulin.

11.
Knowing that excess adipose tissue can result in chronic inflammation, the high school nurse should be assessing obese students for which of the following health problems?
A)
Osteoporosis
B)
Type 2 diabetes
C)
Rheumatoid arthritis
D)
Systemic lupus erythematosus (SLE)
Ans:
B

Feedback:

The inflammatory response that is initiated by adipose tissue is implicated in the pathogenesis of insulin resistance and type 2 diabetes. This inflammatory process is not known to contribute directly to osteoporosis, rheumatoid arthritis, or SLE.

12.
Following yearly routine physical examination by the health care provider, a client has been diagnosed with upper body obesity along with central fat distribution. The client is at greater risk for developing which of the following disease processes?
A)
Osteoporosis
B)
Renal disease
C)
Cardiometabolic disorders
D)
Chronic anemia
Ans:
C

Feedback:

Upper body obesity, more than other types of obesity, carries a high cardiometabolic risk. Obese people tend to develop joint problems and arthritis, but there is no direct association with osteoporosis. Chronic anemia is associated with malnutrition and starvation. Primary renal disease is unrelated to excessive weight.

13.
When discussing adolescent health with a group of high school teachers, the school nurse shares that each year their student population is becoming increasingly obese. Therefore, the school nurse took the opportunity to educate the teachers about signs and symptoms of which of the following high-risk disease processes?
A)
Type 2 diabetes mellitus
B)
Attention deficit disorder
C)
Juvenile rheumatoid arthritis
D)
Antibiotic-resistant bacterial infections
Ans:
A

Feedback:

Childhood obesity is directly related to the increased incidence of type 2 diabetes. Until recently, type 2 diabetes rarely developed in children. Rheumatoid arthritis, attention deficit disorder, and resistant bacterial infections are unrelated to excessive fat storage (obesity).

14.
In collecting assessment data on the school-aged population, which of the following factors could be the most significant predictor of childhood obesity?
A)
Low socioeconomic status
B)
Low self-esteem
C)
Having parents who are obese
D)
Living in a rural neighborhood
Ans:
C

Feedback:

The most significant risk for childhood obesity is having parents who are obese. This variable is more important than socioeconomic status, low self-esteem, or a rural or inner-city residence.

15.
Which of the following measures should a school nurse prioritize in the treatment and prevention of childhood obesity?
A)
Group cognitive therapy
B)
Use of selective serotonin reuptake inhibitors (SSRIs)
C)
Education on exercise and nutrition
D)
High-protein, low-carbohydrate diet
Ans:
C

Feedback:

Teaching children about the pivotal roles of regular exercise and a healthy diet should be the primary focus of treatment for the majority of obese children. Pharmacologic treatments and cognitive therapy are measures that are likely to be appropriate for only a small minority of obese children. A high-protein, low-carbohydrate diet is a short-term weight loss strategy that is not synonymous with creating lifelong healthy eating habits.

16.
Which of the following clients coming to a small free clinic are at high risk for malnutrition? Select all that apply.
A)
An 88-year-old senior citizen on a fixed budget
B)
A 60-year-old homeless Vietnam veteran complaining of pain
C)
A 4-year-old child who lives with a single mom in a rooming house
D)
A 17-year-old female who thinks she might have been exposed to syphilis
E)
A 32-year-old construction working having muscle spasms in his back
Ans:
A, B, C

Feedback:

Among the many causes of malnutrition are poverty and lack of knowledge, acute and chronic illness, and self-imposed dietary restrictions. Homeless people, the elderly, and the children of the poor often demonstrate the effects of protein and energy malnutrition, as well as vitamin and mineral deficiencies. Sexually active teenagers and working young adults are not usually at high risk for malnutrition.

17.
Which of the following characteristics distinguishes kwashiorkor from marasmus?
A)
Impairment of immune function
B)
Lack of dietary fat intake
C)
High intake of carbohydrates
D)
Impaired pigment synthesis
Ans:
C

Feedback:

Kwashiorkor is a protein deficiency coupled with a high-carbohydrate diet; marasmus is a deficiency in both calories and protein. Both forms of malnutrition impair immune function and pigment synthesis, and each is normally accompanied by inadequate intake of dietary fats.

18.
A child has been diagnosed with marasmus due to the fact that the parents have both lost their jobs and have very limited funds for food. Which of the following clinical manifestations would the school nurse assess that would confirm this diagnosis? Select all that apply.
A)
Discolored hair
B)
Bradycardia
C)
Enlarged liver
D)
Pitting edema
E)
Stunted growth pattern
Ans:
B, E

Feedback:

Inadequate food intake, with equal deficiencies of calories and protein, is the cause of marasmus, which is characterized by low heart rate, blood pressure, and body temperature; dull hair; and an emaciated appearance. Hair discoloration, enlarged liver, and pitting edema are manifestations of kwashiorkor, which is a severe protein deficiency.

19.
A school nurse has identified a student with noticeable loss of lean tissues and muscle mass. More than likely, this is caused by proteincalorie malnutrition. The nurse should ask the student if he is experiencing which of the following clinical manifestations that helps confirm this diagnosis?
A)
Respiratory muscle stimulation
B)
Excessive blood cell production
C)
Diarrhea
D)
Increased cardiac contractility
Ans:
C

Feedback:

Proteincalorie malnutrition results in skeletal muscle loss and diarrhea. This type of malnutrition is also characterized by respiratory muscle weakness and blood cell loss that impairs the immune response.

20.
A homeless client asks, Why cant I get this wound on my foot to heal? Knowing that the client is not receiving good nutrition on a regular basis, the nurse will reply:
A)
Maybe if you could come to the clinic every day, we can help you change your dressing.
B)
Right now your immune system is decreased because you are not eating a balanced diet.
C)
Maybe if you could find a place to sleep that is cleaner than where you usually sleep that will help.
D)
We just need to make sure you are getting the right antibiotics.
Ans:
B

Feedback:

As protein is lost from the liver, hepatic synthesis of proteins declines, and plasma protein levels decrease. There also is a decrease in immune cells. Wound healing is poor, and the body is unable to fight off infection because of multiple immunologic malfunctions throughout the body.

21.
A frail, 87-year-old female client has been admitted to a hospital after a fall and has been diagnosed with failure to thrive. Which of the following laboratory values would suggest that the client may be experiencing malnutrition?
A)
Low prealbumin
B)
High C-reactive protein
C)
High bilirubin
D)
Low fasting blood sugar
Ans:
A

Feedback:

Prealbumin levels are a reliable indicator of calorieprotein malnutrition. Low blood sugar does not necessarily indicate malnutrition, and neither C-reactive protein nor bilirubin levels are sensitive or specific indicators of nutritional status.

22.
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
Ans:
C

Feedback:

Diagnostic criteria for anorexia nervosa and bulimia nervosa are distinctly different. Anorexia nervosa is a form of starvation that causes complications that include low estrogen levels with osteoporosis and life-threatening electrolyte imbalances. Bulimia nervosa, unbalanced binge eating, also causes life-threatening electrolyte imbalances. The self-induced vomiting of bulimia causes acid-related periodontal disease and enlarged parotid glands.

23.
Which of the following assessments should be the priority when caring for a client with anorexia nervosa?
A)
Serum electrolyte levels
B)
Chest auscultation
C)
White blood cell count with differential
D)
Blood pressure monitoring
Ans:
A

Feedback:

Electrolyte disturbances are common and potentially severe in clients with anorexia nervosa. The importance of close monitoring supersedes the need to auscultate the clients chest or monitor white blood cells (WBCs) and blood pressure, although all of these may be relevant and appropriate parameters for assessment.

24.
While assessing a teenage girl suspected of having bulimia nervosa, the health care provider may find which of the following clinical manifestations that would confirm the diagnosis? Select all that apply.
A)
Large number of teeth with dental caries
B)
Eroded tooth enamel leading to sensitive teeth
C)
Kyphosis
D)
Painless parotid gland enlargement
E)
Skin with lanugo
Ans:
A, B, D

Feedback:

The complications of bulimia nervosa include those resulting from overeating, self-induced vomiting, and cathartic and diuretic abuse. Dental abnormalities, such as sensitive teeth, increased dental caries, and periodontal disease, occur with frequent vomiting because the high acid content of the vomitus causes tooth enamel to dissolve. An unexplained physical response to vomiting is the development of benign, painless parotid gland enlargement. The most frequent complication of anorexia nervosa is amenorrhea and loss of secondary sex characteristics with decreased levels of estrogen, which can eventually lead to osteoporosis. Bone loss can occur in young women after as short a period of illness as 6 months. Symptomatic compression fractures and kyphosis have been reported. Skin with lanugo (i.e., increased amounts of fine hair) is also commonly seen in clients with anorexia nervosa.

25.
Knowing that both binge-eating and bulimia nervosa clients consume excessive amounts of foods secretively, which assessment data lead the high school nurse to suspect the student is a binge eater?
A)
Remain overweight
B)
Eat when not hungry
C)
Are alcohol and substance abusers
D)
Being treated for depression
Ans:
A

Feedback:

Binge eaters are overweight or obese because they do not use excessive exercise or self-induced vomiting to control their weight after an eating episode. Bulimic and binge eaters eat when not hungry and experience depression related to their eating disorder. Bulimics often abuse laxatives or diuretics.

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