Pathophysiology, 5e 5th Edition By Lee-Ellen C. Copstead-Test Bank

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Pathophysiology, 5e 5th Edition By Lee-Ellen C. Copstead-Test Bank

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WITH ANSWERS
Pathophysiology, 5e 5th Edition By Lee-Ellen C. Copstead-Test Bank

Chapter 2: Homeostasis and Adaptive Responses to Stressors

Test Bank

 

MULTIPLE CHOICE

 

  1. Indicators that an individual is experiencing high stress include all the following except
a. tachycardia.
b. diaphoresis.
c. increased peripheral resistance.
d. pupil constriction.

 

 

ANS:  D

Pupils dilate during stress from the effects of catecholamines. Tachycardia, diaphoresis, and increased peripheral resistance are indicators of stress and also occur due to catecholamine release.

 

REF:   Pg. 18 | Pg. 21

 

  1. Which is not normally secreted in response to stress?
a. Norepinephrine
b. Cortisol
c. Epinephrine
d. Insulin

 

 

ANS:  D

Insulin secretion is impaired during stress to promote energy from increased blood glucose. Norepinephrine is secreted during stress as a mediator of stress and adaptation. Cortisol is secreted during stress as a mediator of stress and adaptation and stimulates gluconeogenesis in the liver to supply the body with glucose. Epinephrine is secreted during stress as a mediator of stress and adaptation and increases glycogenolysis and the release of glucose from the liver.

 

REF:   Pg. 17

 

  1. Selyes three phases of the stress response include all the following except
a. allostasis.
b. resistance.
c. alarm.
d. exhaustion.

 

 

ANS:  A

Allostasis is defined as the ability to successfully adapt to challenges. Allostasis may/may not occur in response to stress. Alarm, resistance, and exhaustion are the three phases of the stress response as described by Selye in the general adaptation syndrome.

 

REF:   Pgs. 13-14

 

  1. Many of the responses to stress are attributed to activation of the sympathetic nervous system and are mediated by
a. norepinephrine.
b. cortisol.
c. glucagon.
d. ACTH.

 

 

ANS:  A

Norepinephrine is secreted in response to activation of the sympathetic nervous system during stress by the adrenal medulla. Cortisol is secreted by the adrenal cortex. Glucagon is secreted by the pancreas. ACTH is secreted by the pituitary gland.

 

REF:   Pg. 17

 

  1. The effects of excessive cortisol production include
a. immune suppression.
b. hypoglycemia.
c. anorexia.
d. inflammatory reactions.

 

 

ANS:  A

Cortisol suppresses immune function and inflammation and stimulates appetite. Cortisol leads to hyperglycemia by stimulating gluconeogenesis in the liver.

 

REF:   Pgs. 21-22

 

  1. All the following stress-induced hormones increase blood glucose except
a. aldosterone.
b. cortisol.
c. norepinephrine.
d. epinephrine.

 

 

ANS:  A

Aldosterone results in water and sodium retention and potassium loss in the urine. It does not affect blood glucose. Cortisol is a glucocorticoid secreted by the adrenal cortex. Cortisol stimulates gluconeogenesis in the liver, thus increasing blood glucose. Norepinephrine inhibits insulin secretion, thus increasing blood sugar. Epinephrine increases glucose release from the liver and inhibits insulin secretion, thus increasing blood glucose.

 

REF:   Pgs. 17-19

 

  1. Allostasis is best defined as
a. steady state.
b. a state of equilibrium, of balance within the organism.
c. the process by which the body heals following disease.
d. the overall process of adaptive change necessary to maintain survival and well-being.

 

 

ANS:  D

Allostasis refers to the overall process of adaptive change necessary to maintain survival and well-being.

 

REF:   Pg. 13

 

  1. The primary adaptive purpose of the substances produced in the alarm stage is
a. energy and repair.
b. invoke resting state.
c. produce exhaustion.
d. set a new baseline steady state.

 

 

ANS:  A

These resources are used for energy and as building blocks, especially the amino acids, for the later growth and repair of the organism. The substances do not produce a resting state. The substances can produce exhaustion if they continue, but that is not the adaptive purpose of these. Although a new baseline steady state may result from the stress response that is not the adaptive purpose of the substances produced during the alarm stage.

 

REF:   Pgs. 15-16

 

  1. Persistence of the alarm stage will ultimately result in
a. stress reduction.
b. permanent damage and death.
c. movement into the resistance stage.
d. exhaustion of the sympathetic nervous system.

 

 

ANS:  B

If the alarm stage were to persist, the body would soon suffer undue wear and tear and become subject to permanent damage and even death. Actions taken by the individual during the resistance stage lead to stress reduction. The resistance stage may or may not occur following the alarm stage, based on resource availability. The sympathetic nervous system will continue to function, resulting in continued release of stress hormones.

 

REF:   Pg. 16

 

  1. The effect of stress on the immune system
a. is unknown.
b. has been demonstrated to be non-existent in studies.
c. most often involves enhancement of the immune system.
d. may involve enhancement or impairment the immune system.

 

 

ANS:  D

Many studies demonstrate that long-term stress impairs the immune system, but many researchers identify that short-term stress may enhance the immune system.

 

REF:   Pg. 19

 

MULTIPLE RESPONSE

 

  1. Aldosterone may increase during stress, leading to (Select all that apply.)
a. decreased urinary output.
b. increased blood potassium.
c. increased sodium retention.
d. increased blood volume.
e. decreased blood pressure.

 

 

ANS:  A, C, D

Aldosterone increases water and sodium reabsorption and potassium excretion by the renal distal tubules and collecting ducts, thus leading to decreased urinary output, sodium retention in the body, and increased extracellular fluid volume. Because it leads to potassium excretion, aldosterone leads to decreased blood potassium.

 

REF:   Pg. 18

 

  1. Chronic activation of stress hormones can lead to (Select all that apply.)
a. cardiovascular disease.
b. depression.
c. impaired cognitive function.
d. autoimmune disease.
e. overactive immune function.

 

 

ANS:  A, B, C, D

Excessive cortisol levels promote hypertension, atherosclerosis, and the development of cardiovascular disease. Chronic overactive stress hormones may result in atrophy and death of brain cells. Elevated levels of stress hormones are found in individuals with depressive disorders. Chronic stress leads to immune function impairment, rather than overactive immune function, and has been implicated in autoimmune disorders.

 

REF:   Pgs. 21-22

 

  1. Events which occur during the alarm stage of the stress response include secretion of (Select all that apply.)
a. catecholamines.
b. ACTH.
c. glucocorticoids.
d. immune cytokines.
e. TSH.

 

 

ANS:  A, B, C, D

During the alarm stage, catecholamines (epinephrine, norepinephrine), ACTH, glucocorticoids, and immune cytokines are secreted. TSH is not secreted during the stress response.

 

REF:   Pgs. 14-15

Chapter 12: HIV Disease and AIDS

Test Bank

 

MULTIPLE CHOICE

 

  1. An effective HIV vaccine is difficult to produce, primarily because
a. HIV is not immunogenic.
b. B cells are unable to produce antibodies against HIV.
c. HIV mutates frequently.
d. reverse transcriptase cleaves to the vaccine.

 

 

ANS:  C

The variability between strains of HIV and the frequency of mutations makes it difficult to produce a vaccine. HIV infection does not overwhelm the immune system, because it is an immune deficiency. Research is still being conducted to develop a vaccine. Researchers are testing cloned T-cells for response to new therapies. Reverse transcriptase is not proven to adhere to the vaccine.

 

REF:   Pg. 254

 

  1. An HIV-positive patient is hospitalized for evaluation of symptoms of progressive weakness, dyspnea, weight loss, and low-grade fever. A biopsy of lung tissue reveals Pneumocystis carinii pneumonia. This diagnosis means that the patient
a. has AIDS.
b. has less than 2 years to live.
c. cannot be treated.
d. was an intravenous drug abuser.

 

 

ANS:  A

Pneumocystis carinii pneumonia (PCP) is a common initial opportunistic infection in HIV and is an AIDS-defining diagnosis. A diagnosis of PCP is not associated with a life-expectancy of 2 years or less. PCP is treated with antibiotic therapy. PCP is a pulmonary manifestation of AIDS, which is not associated with intravenous drug abuse.

 

REF:   Pg. 247

 

  1. The immune system disorder associated with HIV is
a. an overactive B-cell system.
b. proliferation of immature WBCs (blasts).
c. deficiency of T-helper lymphocytes.
d. cancerous growth of lymph tissue.

 

 

ANS:  C

HIV has been identified as a type of retrovirus associated with a disorder of the T-helper lymphocytes. T-cells have an interaction with B-cells, but this relationship is not associated with HIV. Immature blast cells are not the deficiency that contributes to HIV. Cancerous growths of lymphatic tissue have not been found to be the source of HIV.

 

REF:   Pg. 233

 

  1. Which statement best describes the etiologic development and transmission of AIDS?
a. AIDS is caused by a retrovirus and transmitted through body fluids.
b. The mechanism of AIDS transmission is unknown; therefore, AIDS is considered to be highly contagious.
c. AIDS is an autoimmune disease triggered by a homosexual lifestyle.
d. AIDS is caused by a virus that can be transmitted only by sexual contact.

 

 

ANS:  A

AIDS is caused by an infection of HIV, which is proven to be transmitted through blood and body fluids. The mechanism of HIV transmission is known to be through blood and body fluid exposure, newborn infection from the mother, and unprotected sex with an infected partner. AIDS is not an autoimmune disease of the homosexual. HIV can be transmitted through unprotected intercourse. HIV is a virus that is transmitted through various routes, not sexual contact only.

 

REF:   Pgs. 236-237

 

  1. HIV infection of T-helper cells is facilitated by attachment of the viral envelope protein gp120 to
a. CD8 proteins on suppressor cells.
b. reverse transcriptase.
c. CD4 proteins on helper cells.
d. the macrophage lipid bilayer.

 

 

ANS:  C

The HIV envelope protein gp120 specifically binds to the CD4 receptor. The receptor cells of the CD4 cells are attracted to virus changes. Reverse transcriptase is not found to be attracted to the gp120 protein at this time. The macrophage lipid bilayer is not associated with the CD4 receptor.

 

REF:   Pg. 238

 

  1. Which HIV-positive patient should be given a diagnosis of AIDS?
a. One who has a CD4 count of 300/l
b. One who has neuropathy
c. One who has Mycobacterium tuberculosis
d. One who has genital herpes

 

 

ANS:  C

AIDS is a syndrome that is expressed in many ways. If a person has a CD4 count less than 200/ml along with an opportunistic infection such as Mycobacterium tuberculosis, then the person is diagnosed with AIDS. A patient is not diagnosed with AIDS until the CD4 count is less than 200/ml. Neuropathy would possibly be a sign or symptom associated with an opportunistic infection, but is not used to diagnose AIDS. Genital herpes is not used to diagnose AIDS.

 

REF:   Pg. 243

 

  1. A patient receiving zidovudine and a protease inhibitor to manage HIV infection is found to have an undetectable viral load. This means that the
a. dosage of both agents should be reduced.
b. zidovudine can be discontinued.
c. therapy is effective.
d. HIV virus has been eliminated.

 

 

ANS:  C

Protease inhibitors attack at a phase of the viral cycle and are used in conjunction with zidovudine. The goal of treatment is to suppress the viral load. Dosage of both agents would not be reduced, because the undetectable viral load means that the therapy is effective. Zidovudine would not be discontinued, because it is deemed effective in creating an undetectable viral load in this case. The HIV virus has not been eliminated in the event of an undetectable viral load. Rather, HIV plasma is suppressed and disease progression delayed.

 

REF:   Pgs. 251-252

 

  1. Which statement about HIV testing is correct?
a. Any patient can be tested for HIV with or without their informed consent.
b. A negative HIV test ensures absence of infection.
c. The false-positive rate for HIV testing is zero.
d. Significant exposure to infected blood or body fluids requires HIV testing.

 

 

ANS:  D

After a significant exposure to HIV-infected blood or body fluids, health care workers should be treated according to post-exposure protocols. These include testing and possible prophylactic medications. Patients that need to be tested for HIV should always be given the opportunity to provide verbal or written consent according to state consent guidelines. Negative HIV tests are not always indicative of negative status. False negative tests can occur during the period before seroconversion. Initial HIV tests are highly sensitive but should always be confirmed with a Western blot test.

 

REF:   Pg. 237

 

  1. As of 2010, _____ individuals worldwide have been infected with HIV infection.
a. 100,000
b. 1 million
c. slightly less than 16 million
d. nearly 35 million

 

 

ANS:  D

An estimated 33.3 million people were living with HIV worldwide as of 2010. Infection rates are calculated per 100,000 population. In the United States, more than 1 million people have been diagnosed with HIV and AIDS. Of the total number of people infected, women comprise 15.9 million.

 

REF:   Pg. 233

 

  1. Which type of HIV virus causes most infections in the United States and Europe?
a. HIV type 1
b. HIV type 2
c. HIV type A
d. HIV type B

 

 

ANS:  A

HIV-1 is the organism of most cases in Central Africa, the United States, Europe, and Australia. HIV-2 is found in West Africa or in countries with socioeconomic ties to West Africa. HIV type A is a subtype currently in research. HIV type B is a strain in research phases.

 

REF:   Pg. 233

 

  1. HIV infection causes immunodeficiency because it
a. directly inhibits antibody production by B cells.
b. causes the destruction of T-helper cells.
c. causes excessive production of cytotoxic T cells.
d. blocks the ability of macrophages to present antigens.

 

 

ANS:  B

The hallmark of HIV infection is defective cell-mediated immunity, with a decrease in CD4 or T-helper lymphocytes. HIV infection does not directly inhibit the production of antibodies by B cells. There is not an excessive production of cytotoxic T cells with HIV infection. HIV infection does not block the ability of macrophages to produce antigens.

 

REF:   Pg. 233

 

  1. The clinical latency period after HIV infection is a time when no
a. viral replication occurs.
b. decline in CD4 lymphocytes occurs.
c. virus is detectable in the blood.
d. significant symptoms of immunodeficiency occur.

 

 

ANS:  D

This latency period is the time when no significant symptoms occur, although mild symptoms of lymphadenopathy, lack of energy, weight loss, frequent fevers, and sweats may occur. Viral reproduction occurs immediately after the latency period, and can last up to 18 months. A decline in the CD4 T-cell count is taking place during the time of rapid virus production. Seroconversion usually occurs between 3 weeks and 6 months after exposure.

 

REF:   Pgs. 242-243

 

  1. HIV replicates very quickly from the onset of infection. What is the major site of HIV replication?
a. Vaginal mucosa
b. Anal mucosa
c. GI tract
d. Respiratory tract

 

 

ANS:  C

HIV is primarily a mucosal disease that replicates very quickly from the onset of infection. The GI tract is the major site of HIV replication because the infection replicates quickly in the GI tract and overwhelms the bodys defenses. The vaginal mucosa, anal mucosa, and respiratory tract may be involved in HIV replication, but these are not the initial sites of infection.

 

REF:   Pg. 240

 

MULTIPLE RESPONSE

 

  1. Which drugs are used for the management of HIV? (Select all that apply.)
a. Nucleoside reverse transcriptase inhibitors
b. DNA polymerase inhibitors
c. Protease inhibitors
d. Nonnucleoside reverse transcriptase inhibitors
e. CD4 analogs

 

 

ANS:  A, C, D

Nucleoside reverse transcriptase inhibitors are used to prevent replication by preventing HIV DNA synthesis. Protease inhibitors attack a phase in the viral life cycle by inhibiting the enzyme protease. Nonnucleoside reverse transcriptase inhibitors are potent antiretrovirals. DNA polymerase inhibitors are not used in the management of HIV. CD4 analogs are nonexistent as a pharmacological agent.

 

REF:   Pg. 252

 

  1. Which modes of transmission occur with HIV infection? (Select all that apply.)
a. Sexual transmission
b. Parenteral transmission
c. Fomite transmission to intact skin
d. Perinatal transmission to fetus
e. Inhalant transmission

 

 

ANS:  A, B, D

Unprotected sex with infected partners is a proven method of HIV transmission. Needle and syringe sharing between intravenous drug users is a proven HIV transmission method. Transmission from an infected mother to her infant may occur in the intrauterine period or at the time of delivery. The risk of contracting HIV through the skin has only been found with a direct puncture. HIV is not known to be transmitted via aerosol routes.

 

REF:   Pg. 234

 

  1. Opportunistic infections are a hallmark of HIV and AIDS. Which infections are considered opportunistic? (Select all that apply.)
a. Acinetobacter
b. Cytomegalovirus
c. Candida albicans
d. Pneumocystis carinii
e. Clostridium difficile

 

 

ANS:  B, C, D, E

Cytomegalovirus is an opportunistic infection seen in AIDS. Candida albicans is an oropharyngeal manifestation seen in most patients with HIV. Pneumocystis carinii is a respiratory manifestation and a major source of morbidity and mortality in the AIDS patient. Clostridium difficile is a gastrointestinal manifestation of HIV. The GI tract is the major target organ in HIV infection, and malnutrition is the leading cause of death among AIDS patients worldwide. Acinetobacter is not typically associated with HIV and AIDS.

 

REF:   Pg. 244 | Pgs. 246-247

 

  1. A patient is infected with the retrovirus HIV. The patient may have contracted HIV as it was transmitted via (Select all that apply.)
a. saliva.
b. tears.
c. semen.
d. cervical secretions.
e. cerebrospinal fluid.

 

 

ANS:  C, D

HIV is transmitted three ways: sexual transmission via semen or vaginal and cervical secretions through homosexual or heterosexual intercourse; parenteral transmission via blood, blood products, or blood-contaminated needles or syringes; and perinatal transmission in utero, during delivery, or in breast milk. HIV is known to be present in but has not been shown to be transmitted via urine, saliva, tears, cerebrospinal fluid, amniotic fluid, and feces. HIV is not known to be transmitted via aerosol routes.

 

REF:   Pg. 234

 

  1. The HIV nurse educator teaches a newly diagnosed patient about HIV. The nurse educator tells the patient that in the United States, those at greatest risk of HIV infection include (Select all that apply.)
a. infants born to infected fathers.
b. heterosexual women.
c. homosexual men.
d. restaurant workers.
e. men over age 50.

 

 

ANS:  B, C

In the United States, those at greatest risk of HIV infection include: men who have sex with other men (MSM), also called homosexual men; intravenous drug users who share needles or syringes; sexual partners of those in high risk groups, particularly heterosexual women; and infants born to infected mothers. Infants born to infected mothers, not infected fathers, are at greatest risk of HIV infection. Restaurant workers are not at greater risk of HIV infection solely due to their working in the restaurant industry. Using public restrooms, swimming in public swimming pools, touching or hugging someone who is HIV-positive, and eating with community utensils or in restaurants are safe practices. Approximately 10% to 11% of all HIV cases involve people over age 50, but this does not comprise the highest-risk group.

 

REF:   Pg. 234

 

  1. A nurse who works in an assisted living facility is preparing to teach the residents about safe sex practices. What resident criteria should the nurse take into consideration when creating a teaching plan? (Select all that apply.)
a. Age
b. Ethnicity
c. Culture
d. Sexual preference
e. Mobility status

 

 

ANS:  A, B, C, D

It is important that education regarding safe sex practices be tailored to appropriate age groups, ethnicity, culture, and sexual preference. Mobility status is not a consideration when teaching about safe sex practices.

 

REF:   Pg. 236

 

  1. In which type of cells is the CD4 found? (Select all that apply.)
a. T cells
b. Microglial cells
c. Retinal cells
d. Cervical cells
e. Pacemaker cells

 

 

ANS:  A, B, C, D

The CD4 receptor is found on many types of cells, including T cells, microglial cells, monocyte-macrophages, follicular dendritic cells, immortalized B cells, retinal cells, Langerhans cells in the skin, bone marrow stem cells, cervical cells, bone marrowderived circulating dendritic cells, and enterochromaffin cells in the colon, duodenum, and rectum.

 

REF:   Pgs. 238-239

 

  1. A patient presents to the clinic with flu-like symptoms and a rash. The nurse knows that the type of rash associated with HIV may include (Select all that apply.)
a. maculopapular.
b. vesicular.
c. impetigo.
d. urticarial.
e. psoriasis.

 

 

ANS:  A, B, D

The rash in HIV is not the same in every patient and may be maculopapular, vesicular, or urticarial. Impetigo and psoriasis are not rashes linked to HIV.

 

REF:   Pg. 242

 

  1. The CDC defines three CD4+ T cell categories of T cell ranges. Which values are correct? (Select all that apply.)
a. In category 1, the CD4+ T cell count is greater than or equal to 500/ml.
b. In category 1, the CD4+ T cell counts range from 200 to 499/ml.
c. In category 2, the CD4+ T cell counts range from 200 to 499/ml.
d. In category 3, the CD4+ T cell count is less than 200/ml.
e. In category 3, the CD4+ T cell count is less than 300/ml.

 

 

ANS:  A, C, D

In category 1, the CD4+ T cell count is greater than or equal to 500/ml. In category 2, the CD4+ T cell counts range from 200 to 499/ml. In category 3, the CD4+ T cell count is less than 200/ml.

 

REF:   Pg. 243

 

COMPLETION

 

  1. Cleaning dirty needles prior to use helps prevent the spread of HIV. When using bleach, the user must rinse out all the blood first and then fill the needle and syringe with full-strength bleach three times for ____ to ____ seconds.

 

ANS:

30; 60

After rinsing all the blood first, the user fills the needle and syringe with full-strength bleach at least three times for 30 to 60 seconds.

 

REF:   Pg. 236

Chapter 24: Fluid and Electrolyte Homeostasis and Imbalances

Test Bank

 

MULTIPLE CHOICE

 

  1. Osmoreceptors located in the hypothalamus control the release of
a. angiotensin.
b. atrial natriuretic peptide.
c. aldosterone.
d. vasopressin (antidiuretic hormone, ADH).

 

 

ANS:  D

Factors that increase secretion of ADH into the blood include increased osmolality of the blood, which is sensed by osmoreceptors in the hypothalamus. Release of angiotensin, atrial natriuretic peptide, and aldosterone is not controlled by osmoreceptors in the hypothalamus.

 

REF:   Pg. 522

 

  1. Decreased neuromuscular excitability is often the result of
a. hypercalcemia and hypermagnesemia.
b. hypomagnesemia and hyperkalemia.
c. hypocalcemia and hypokalemia.
d. hypernatremia and hypomagnesemia.

 

 

ANS:  A

Hypercalcemia and hypermagnesemia result in decreased neuromuscular excitability. Hypomagnesemia, hypocalcemia, and hypomagnesemia result in increased neuromuscular excitability.

 

REF:   Pgs. 531-533

 

  1. What is likely to lead to hyponatremia?
a. Insufficient ADH secretion
b. Excess aldosterone secretion
c. Administration of intravenous normal saline
d. Frequent nasogastric tube irrigation with water

 

 

ANS:  D

Sodium is lost from gastric secretions when nasogastric tubes are irrigated with water. The sodium diffuses into the irrigating water and is then lost when the aspirate is withdrawn. Excessive ADH would lead to hyponatremia by retention of water in the body, thus diluting the sodium. Excess aldosterone would increase serum sodium. Normal saline is an isotonic solution and will not alter the serum sodium.

 

REF:   Pgs. 524-525

 

  1. An increase in the resting membrane potential (hyperpolarized) is associated with
a. hypokalemia.
b. hyperkalemia.
c. hypocalcemia.
d. hypercalcemia.

 

 

ANS:  A

Hypokalemia increases the resting membrane potential. Hyperkalemia results in hypopolarization. Hypocalcemia and hypercalcemia do not affect the resting membrane potential.

 

REF:   Pg. 530

 

  1. Abnormalities in intracellular regulation of enzyme activity and cellular production of ATP are associated with
a. hyponatremia.
b. hypocalcemia.
c. hypophosphatemia.
d. hypokalemia.

 

 

ANS:  C

Phosphate is an important component of ATP. Hypophosphatemia results in decreased ATP to cells. Hyponatremia, hypocalcemia, and hypokalemia do not affect ATP production.

 

REF:   Pgs. 533-534

 

  1. The fraction of total body water (TBW) volume contained in the intracellular space in adults is
a. three-fourths.
b. two-thirds.
c. one-half.
d. one-third.

 

 

ANS:  B

Approximately two-thirds of TBW is contained inside the cells. Two-thirds, not three-fourths, of TBW is contained inside the cells. Two-thirds, not one-half, of TBW is contained inside the cells. One-third of the TBW is extracellular in adults.

 

REF:   Pg. 520

 

  1. What age group has a larger volume of extracellular fluid than intracellular fluid?
a. Infants
b. Adolescents
c. Young adults
d. Older adults

 

 

ANS:  A

Infants have a larger volume of extracellular fluid than intracellular fluid. Adolescents, young adults, and older adults have a larger volume of intracellular fluid than extracellular fluid.

 

REF:   Pg. 520

 

  1. Clinical manifestations of severe symptomatic hypophosphatemia are caused by
a. excess proteins.
b. renal damage.
c. deficiency of ATP.
d. hypocalcemia.

 

 

ANS:  C

Clinical manifestations of severe symptomatic hypophosphatemia are caused by a deficiency of ATP. Phosphate is an important component of ATP, which is the major source of energy for many cellular substances. Severe symptomatic hypophosphatemia does not cause excess protein accumulation, damage the kidneys, or cause hypocalcemia.

 

REF:   Pgs. 533-534

 

  1. A person who overuses magnesium-aluminum antacids for a long period of time is likely to develop
a. hypokalemia.
b. hyperkalemia.
c. hypophosphatemia.
d. hyperphosphatemia.

 

 

ANS:  C

Antacid overuse for a long time can cause hypophosphatemia by binding phosphate in the gastrointestinal tract and preventing its absorption. Magnesium-aluminum antacids do not cause hypokalemia, hyperkalemia, or hyperphosphatemia.

 

REF:   Pgs. 533-534

 

  1. The electrolyte that has a higher concentration in the extracellular fluid than in the intracellular fluid is _____ ions.
a. sodium
b. phosphate
c. magnesium
d. potassium

 

 

ANS:  A

Extracellular fluid has a higher sodium ion concentration than does intracellular fluid. Intracellular fluid has a higher phosphate, magnesium, and potassium ion concentration than does extracellular fluid.

 

REF:   Pg. 520

 

  1. A person who has hyperparathyroidism is likely to develop
a. hypokalemia.
b. hyperkalemia.
c. hypocalcemia.
d. hypercalcemia.

 

 

ANS:  D

A person who has hyperparathyroidism is likely to develop hypercalcemia, because parathyroid hormone causes calcium to come out of the bones and go to the ECF. Hypokalemia, hyperkalemia, and hypocalcemia are not the result of hyperparathyroidism.

 

REF:   Pg. 532

 

  1. The inward-pulling force of particles in the vascular fluid is called _____ pressure.
a. capillary hydrostatic
b. interstitial osmotic
c. capillary osmotic
d. interstitial hydrostatic

 

 

ANS:  C

Capillary osmotic pressure is the inward-pulling force of particles in the vascular fluid. Capillary hydrostatic pressure is an outward-pulling. The question pertains to vascular fluid rather than interstitial fluid. Interstitial hydrostatic pressure is an outward-pulling force.

 

REF:   Pg. 521

 

  1. How do clinical conditions that increase vascular permeability cause edema?
a. Through altering the negative charge on the capillary basement membrane, which enables excessive fluid to accumulate in the interstitial compartment
b. By causing movement of fluid from the vascular compartment into the intracellular compartment, which leads to cell swelling
c. Through leakage of vascular fluid into the interstitial fluid, which increases interstitial fluid hydrostatic pressure
d. By allowing plasma proteins to leak into the interstitial fluid, which draws in excess fluid by increasing the interstitial fluid osmotic pressure

 

 

ANS:  D

Clinical conditions that increase vascular permeability cause edema by allowing plasma proteins to leak into the interstitial fluid, which draws in excess fluid by increasing the interstitial fluid osmotic pressure. The capillary basement membrane does not change its charge with increased vascular permeability. Increased vascular permeability does not move water into the cells. Increasing the interstitial fluid osmotic pressure would not cause edema.

 

REF:   Pg. 527

 

  1. Which alterations can lead to edema?
a. Decreased capillary hydrostatic pressure
b. Increased capillary colloid osmotic pressure
c. Decreased lymphatic flow
d. Decreased capillary membrane permeability

 

 

ANS:  C

Lymphatic obstruction prevents the drainage of accumulated interstitial fluid and proteins, which can lead to severe edema. Decreased capillary hydrostatic pressure would push less fluid into the interstitial space. Increased capillary colloid osmotic pressure would remove fluid from the interstitial space. Decreased capillary membrane permeability would allow less fluid movement into the interstitial space.

 

REF:   Pg. 527

 

  1. The process responsible for distribution of fluid between the interstitial and intracellular compartments is
a. filtration.
b. osmosis.
c. active transport.
d. diffusion.

 

 

ANS:  B

Distribution of fluid between the interstitial and intracellular compartments occurs by the process of osmosis. Filtration is responsible for the distribution of fluid between the vascular and interstitial compartments. Active transport moves ions across membranes, but does not move water. Diffusion involves movement of particles, not movement of water.

 

REF:   Pg. 522

 

  1. Which electrolyte imbalances cause increased neuromuscular excitability?
a. Hypokalemia and hyperphosphatemia
b. Hyperkalemia and hypophosphatemia
c. Hypocalcemia and hypomagnesemia
d. Hypercalcemia and hypermagnesemia

 

 

ANS:  C

Hypocalcemia and hypomagnesemia both cause increased neuromuscular excitability.

Hypokalemia, hyperkalemia, hypophosphatemia, hypercalcemia, and hypermagnesemia do not cause increased neuromuscular excitability.

 

REF:   Pg. 532

 

  1. Excessive antidiuretic hormone (ADH) secretion can cause _____ concentration.
a. increased serum sodium
b. decreased serum sodium
c. increased serum potassium
d. decreased serum potassium

 

 

ANS:  B

Excessive ADH stimulates excessive water reabsorption by the kidneys, which dilutes the blood, thus decreasing the serum sodium concentration. Excessive ADH secretion does not cause increased serum sodium or potassium concentrations, or decreased serum potassium concentration.

 

REF:   Pg. 525 | Pg. 528

 

  1. Causes of hypomagnesemia include
a. hyperphosphatemia.
b. chronic alcoholism.
c. oliguric renal failure.
d. clinical dehydration.

 

 

ANS:  B

Hypomagnesemia is common with chronic alcoholism. Hyperphosphatemia causes hypocalcemia. Oliguric renal failure and clinical dehydration reduce magnesium excretion.

 

REF:   Pg. 532

 

  1. Signs and symptoms of clinical dehydration include
a. decreased urine output.
b. increased skin turgor.
c. increased blood pressure.
d. decreased heart rate.

 

 

ANS:  A

One clinical manifestation of dehydration is decreased urine output. Skin turgor and blood pressure decrease in clinical dehydration. Heart rate increases in clinical dehydration.

 

REF:   Pg. 526

 

  1. Hypernatremia may be caused by
a. decreased aldosterone secretion.
b. decreased antidiuretic hormone secretion.
c. compulsive water drinking.
d. excessive dietary potassium.

 

 

ANS:  B

Decreased antidiuretic hormone secretion (diabetes insipidus) prevents water reabsorption in the kidneys, which creates large volumes of dilute urine and causes hypernatremia. Aldosterone causes sodium and water retention. Compulsive water drinking that overwhelms the kidneys would dilute the blood, causing hyponatremia. Excessive dietary potassium would not affect the serum sodium concentration.

 

REF:   Pgs. 525-526

 

  1. Clinical manifestations of hyponatremia include
a. weak pulse, low blood pressure, and increased heart rate.
b. thirst, dry mucous membranes, and diarrhea.
c. confusion, lethargy, coma, and perhaps seizures.
d. cardiac dysrhythmias, paresthesias, and muscle weakness.

 

 

ANS:  C

Clinical manifestations of hyponatremia include confusion, lethargy, coma, and perhaps seizures, as they are manifestations of CNS dysfunction. Weak pulse, low blood pressure, and increased heart rate are characteristic of clinical dehydration. Hyponatremia does not cause thirst, dry mucous membranes, and diarrhea. Cardiac dysrhythmias, paresthesias, and muscle weakness are manifestations of electrolyte imbalances.

 

REF:   Pg. 525

 

  1. Clinical manifestations of extracellular fluid volume deficit include
a. weak pulse, low blood pressure, and increased heart rate.
b. thirst, dry mucous membranes, and diarrhea.
c. confusion, lethargy, coma, and perhaps seizures.
d. cardiac dysrhythmias, paresthesias, and muscle weakness.

 

 

ANS:  A

Clinical manifestations of extracellular fluid volume deficit include weak pulse, low blood pressure, and increased heart rate. Extracellular fluid volume deficit does not cause diarrhea. Confusion, lethargy, coma, and perhaps seizures are associated with osmolality imbalances such as hyponatremia. Cardiac dysrhythmias, paresthesias, and muscle weakness are manifestations of electrolyte imbalances.

 

REF:   Pg. 523

 

  1. The imbalance that occurs with oliguric renal failure is
a. metabolic alkalosis.
b. hyperkalemia.
c. hypokalemia.
d. hypophosphatemia.

 

 

ANS:  B

Oliguric renal failure decreases potassium excretion, which causes hyperkalemia. Oliguric renal failure decreases acid excretion and causes metabolic acidosis (not alkalosis). Oliguric renal failure does not cause hypokalemia or hypophosphatemia.

 

REF:   Pgs. 530-531

 

  1. A known cause of hypokalemia is
a. oliguric renal failure.
b. pancreatitis.
c. insulin overdose.
d. hyperparathyroidism.

 

 

ANS:  C

Insulin overdose causes hypokalemia by shifting potassium into cells. Oliguric renal failure decreases electrolyte excretion. Pancreatitis causes fat malabsorption, which binds calcium and magnesium, but not potassium, in the gastrointestinal tract. Hyperparathyroidism regulates calcium, not potassium.

 

REF:   Pg. 530

 

  1. Effects of hypernatremia on the central nervous system typically include
a. confusion.
b. excitation.
c. insomnia.
d. hallucinations.

 

 

ANS:  A

Hypernatremia causes osmotic shrinking of brain cells, which manifests as confusion or coma. Hypernatremia does not usually cause central nervous system excitation, insomnia, or hallucinations.

 

REF:   Pg. 525

 

  1. Total body water in older adults is
a. increased due to decreased adipose tissue and decreased bone mass.
b. increased due to decreased renal function and hormonal fluctuations.
c. decreased due to increased adipose tissue and decreased muscle mass.
d. decreased due to renal changes that cause diuresis with sodium excretion.

 

 

ANS:  C

Older adults have decreased total body water due to increased adipose tissue and decreased muscle mass. Older adults have increased adipose tissue. Hormonal fluctuations and diuresis with sodium excretion are not characteristic of older adults.

 

REF:   Pgs. 520-521

 

  1. Clinical manifestations of moderate to severe hypokalemia include
a. muscle spasms and rapid respirations.
b. muscle weakness and cardiac dysrhythmias.
c. confusion and irritability.
d. vomiting and diarrhea.

 

 

ANS:  B

Hypokalemia causes muscle weakness (or paralysis) and cardiac dysrhythmias. Hypokalemia does not cause muscle spasms and rapid respirations or confusion and irritability. Vomiting and diarrhea can cause hypokalemia, but they are not signs and symptoms of it.

 

REF:   Pg. 530

 

  1. Signs and symptoms of extracellular fluid volume excess include
a. tachycardia.
b. increased serum sodium concentration.
c. bounding pulse.
d. increased hematocrit.

 

 

ANS:  C

Bounding pulse is one of the signs of extracellular fluid volume excess. Tachycardia is one of the signs of extracellular fluid volume deficit. Increased serum sodium concentration is found in hypernatremia. Hematocrit can be decreased with extracellular fluid volume excess.

 

REF:   Pg. 524

 

  1. Hyperaldosteronism causes
a. ECV deficit and hyperkalemia.
b. ECV excess and hypokalemia.
c. hyponatremia and hyperkalemia.
d. excessive water reabsorption without affecting sodium concentration.

 

 

ANS:  B

Hyperaldosteronism causes excessive renal retention of sodium and water and excessive potassium excretion, which lead to ECV excess and hypokalemia. Hyperaldosteronism does not cause ECV deficit, hyperkalemia, hyponatremia, or excessive water reabsorption without affecting sodium concentration.

 

REF:   Pg. 530

 

  1. The person at highest risk for developing hypernatremia is a person who
a. self-administers a daily tap water enema to manage a partial bowel obstruction.
b. receives tube feedings because he or she is comatose after a stroke.
c. has ectopic production of ADH from small cell carcinoma of the lung.
d. is receiving IV 0.9% NaCl at a fast rate.

 

 

ANS:  B

Tube feedings are associated with hypernatremia due to intake of highly concentrated solution that causes the kidneys to excrete extra water to remove the solute load. Absorption of excessive water from daily tap water enemas would cause hyponatremia. Uncontrolled secretion of ADH causes renal retention of water that leads to hyponatremia. An IV solution of 0.9% NaCl (normal saline) is isotonic.

 

REF:   Pg. 525

 

  1. When a parent asks how they will know if their 2-month-old baby, who is throwing up and has frequent diarrhea, is dehydrated, the nurses best response is
a. Clinical dehydration is the combination of extracellular fluid volume deficit and hypernatremia, so those are the diagnostic criteria.
b. If he doesnt wet his diaper all afternoon and his neck veins look flat when he is lying down, then he is probably dehydrated.
c. If he sleeps more than usual and acts tired when he is awake, then he is probably dehydrated.
d. If the soft spot on the top of his head feels sunken in and his mouth is dry between his cheek and his gums, then he is probably dehydrated.

 

 

ANS:  D

Checking whether the head feels sunken and the mouth is dry between check and gums are useful assessments of ECV deficit in an infant, which is an important part of clinical dehydration. It is true that clinical dehydration is the combination of extracellular fluid volume deficit and hypernatremia, but it does not address the question Mr. Worry is asking. Although the diaper information provides a useful assessment, neck veins are not a reliable assessment in an infant. Drowsiness and fatigue are not reliable assessments for dehydration.

 

REF:   Pg. 526

 

  1. A patient who reports an intestinal fistula also reports feeling weak and dizzy when she stands. While taking her blood pressure she becomes temporarily unresponsive but quickly regains consciousness when put into a supine position. What nursing interventions will the nurse implement before calling the physician?
a. Sit her up again, with proper support, so you can have an accurate upright blood pressure and heart rate to report.
b. Give her a drink of water or juice, talk with her to calm her down, and ask if she slept well last night.
c. Give her water or juice and some salty crackers and ask if she has had any diarrhea or vomiting.
d. Assess small vein filling time, look for ankle edema, and ask if she had any fluid to drink yet today.

 

 

ANS:  C

Her substantial systolic postural blood pressure decrease with tachycardia and syncope when upright are indicators of ECV deficit and she needs salt and water. Your qu

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