Pathophysiology 2nd Half of Term Practice Test Questions and Answers

"Why is chronic irritation a risk factor for cancer?" asks Mr. Murtha, who is reluctant to give up his cigarettes. "I switched to a filter to reduce the cancer-causing chemicals, but the doctor says that the inflammation still makes a risk." Choose the information that you should include in your answer. This question may have more than one correct answer. Choose all that apply. Correct answer- b) Inflammatory chemicals can damage DNA in cells, causing mutations that lead to cancer. c) During inflammation, cells divide more frequently to replace damaged tissue, which can lead to mutations that lead to cancer. e) Growth factors released during inflammation can cause excessive cell division, increasing the risk of mutations that lead to cancer. "Tomorrow they are planning to grade my tumor," says Mr. Donner. "What information will that provide? I do not want any unnecessary procedures!" Choose the words that best complete this response: "Tumor grading is important because it gives information about the: Correct answer- degree of deviation from normal in the tumor cells. "I thought cancer was carcinoma, because that is what my cousin has," says Mrs. Rouch. "But my doctor says I have cancer and he calls it sarcoma. Do both of these words mean cancer?" Choose the best words to complete this response: "Yes, both carcinoma and sarcoma mean cancer, but they refer to different types of cancer. Sarcomas are cancers that arise from: Correct answer- connective tissue such as bone or cartilage Mr. Nakata has leukopenia from his cancer chemotherapy treatment. You should teach him how to protect himself from which of the following? Correct answer- Infection You are working in a hospital oncology unit with patients who have advanced cancer. In addition to assessing for the general signs and symptoms that are caused by most advanced cancers and for the effects of metastases, what specific assessment should you perform that pertains to the primary cancer site for each of these individuals? Each question has one correct answer. Correct answer- Cough, dyspnea, decreased PaO2, activity intolerance Correct answer- Mrs. Wu, who has bronchogenic carcinoma Urinary urgency, hesitancy, retention Correct answer- Mr. Jamal, who has prostatic adenocarcinoma Peripheral edema, ascites, increased bilirubin Correct answer- Mr. Warger, who has hepatocellular carcinoma Hypercalcemia, localized pain Correct answer- Mr. Nguyen, who has an osteosarcoma In morning report you learn that Mrs. Kant has developed alopecia from her chemotherapy treatment. What should you expect to find in your assessment? Correct answer- Hair loss Mrs. Graber is newly diagnosed with cervical carcinoma in situ. "Tell me again what that means," she says. "I was so upset at first that I did not hear anything except cervical cancer. Now I want to know what in situ means." Choose the best words to complete this response: "Carcinoma in situ means that the cancer cells: Correct answer- have not invaded the surrounding tissue." Mrs. Pierce has a strong family history of breast cancer. She is thinking about undergoing genetic testing. "Let me see if I have this right," she says. "If I have the family mutation that causes the proto-oncogenes to get abnormal and turn on too much, then I am at very high risk for developing cancer. Is that right?" Choose the best response. Correct answer- Yes, you are correct. Mr. Tabor has the wasting syndrome associated with cancer and cancer treatment. What term should you use to describe his condition at change-of-shift report? Correct answer- Cachexia Miss Murcheson has a malignant tumor. She says, "The doctor said my tumor is growing really quickly. Why does it grow so fast?" Which of the following principles is the basis for the response that you should provide her in layperson terms? Correct answer- Malignant cells lack contact inhibition. A woman who is infected with which of the following viruses should undergo periodic screening for cervical cancer? Correct answer- Human papillomavirus Mr. Jenner has stage IV colon cancer and he is receiving chemotherapy today. "Please tell me again what stage IV means," he says. Choose the best response. Correct answer- Your cancer has spread to distant lymph nodes and is growing in other locations that are far from where it began. Which of the following risk factors should you teach people to avoid in order to reduce their risk of lung, bladder, pancreatic, renal, laryngeal, pharyngeal, and esophageal cancer? Correct answer- Tobacco use Mr. Houden had surgery for tumor removal this morning. The pathology report provided a diagnosis of adenoma. In your postoperative care, you should expect him to be dealing with the emotional impact of having: Correct answer- a benign tumor of epithelium in a gland. Mr. Parker was diagnosed with Parkinson disease. His daughter asks you to explain what causes this disorder. Which of the following pathophysiology descriptions should you translate into layperson's terms in order to explain it to her? Correct answer- Degeneration of dopaminergic neurons causes a dopamine deficiency in the basal ganglia. Dopamine is important for opposing the action of the neurotransmitter acetylcholine; the relative lack of dopamine causes an imbalance between the two. Tommy Waters was injured 6 weeks ago in a diving accident and has been diagnosed with a spinal cord injury at the level of the fourth cervical vertebra. His spine has been stabilized surgically and he is being transferred to your unit to begin rehabilitation. You are aware that Tommy is at risk for autonomic dysreflexia. Which of the following correctly describes the clinical manifestations of autonomic dysreflexia for which you should be alert? Correct answer- Hypertension and bradycardia. The skin is flushed above the level of injury and clammy below the level of injury. Mr. Kanodi is upset. His son Calvin developed a subdural hematoma after being hit in the head by a golf ball during a tournament. "Why do they want to cut open his skull?" he says. "They could damage his brain!" Your explanation begins: "I know you are worried about Calvin's safety. See how Calvin is responding less and less to you when you try to talk with him?" Choose the best sentence to complete this explanation. Correct answer- The bleeding above the surface of his brain is squeezing his brain and causing it to function poorly. It can damage his brain unless surgery is done to relieve the pressure. Mrs. Virginia has been admitted with a diagnosis of bacterial meningitis. Her level of consciousness is severely depressed. Her husband wants to know why her illness makes her "so sleepy and difficult to awaken". Your explanation begins: "The brain normally is surrounded by fluid." Choose the best sentence to complete this explanation. Correct answer- The infection blocks the passages by which this fluid is removed, thereby causing it to accumulate. This accumulation of fluid puts pressure on brain cells and prevents them from functioning normally. Mrs. Gehirn is 64 years old and has experienced a hemorrhagic cerebrovascular accident (CVA). Based upon the pathophysiology of cerebrovascular disease, you should anticipate finding that Mrs. Gehirn had which of the following risk factors? Correct answer- Hypertension and cerebral aneurysm In the change of shift report, you hear that Mr. Danies had a CVA in the left side of his brain and has hemiplegia. How should you interpret this information? Correct answer- His right arm and leg are paralyzed Mrs. Kelso, who has MS, wants to know why it took her doctors 7 years to diagnose her condition. Which of the following pathophysiology statements should you translate into layperson's terms in order to explain it to her? Correct answer- The signs and symptoms of MS vary widely because the demyelination can occur in many different places in the CNS. Mr. Wonder says, "I think somebody is confused here. They said my wife has aphasia because her speech is so garbled after that stroke last week. But her mother had aphasia after a stroke and she kept talking until she died. We just couldn't get her to understand us. I can tell that my wife understands me! So what's going on here?" Choose the best response. Correct answer- There are two kinds of aphasia and you have described both of them. Your wife has expressive aphasia, difficulty with speaking. Her mother had receptive aphasia, which means difficulty understanding. There are two kinds of aphasia and you have described both of them. Your wife has expressive aphasia, difficulty with speaking. Her mother had receptive aphasia, which means difficulty understanding. Correct answer- Delirium Mr. Manolo, age 86, who has diabetes and arterial insufficiency in his lower extremities, had a sudden loss of ability to speak and was unable to move his left arm and leg. This condition lasted for 9 minutes and then resolved, with no apparent lasting effects. What terms should you use with another health professional to describe this situation? Correct answer- Aphasia, hemiplegia, transient ischemic attack Mr. Landau has been sitting with one arm pointed skyward for 30 minutes without moving. What technical term should you use to describe this behavior to another health professional? Correct answer- Posturing Mr. Jackson says, "I used to have a lot of fun activities, but they don't make me happy any more." What technical term should you use to describe his comment to another health professional? Correct answer- Anhedonia "That doctor may know his stuff, but I think he is rude!" says Mrs. Kim, whose son David has been diagnosed with schizophrenia. "The doctor kept talking about negative symptoms. David is really sweet and sits quietly in his room most of the time. I have never heard him say a negative word to anyone. I think the doctor is the one who is negative!" Choose the best response. Correct answer- Negative symptoms are things that we normally expect to see that are not happening. An example is David not coming out of his room to talk with other people Mr. Tennyson, who lives in his own apartment, has schizophrenia, which is managed with medications. You see him about every 2 months in the diabetes clinic. Which of the following assessments should indicate to you that Mr. Tennyson may have stopped taking his schizophrenia medications? Correct answer- No eye contact, use of words you have never heard before Mr. Santee is talking to his mother whom he insists is sitting in the corner of the room, although you are the only other person present. What technical term should you use to describe this behavior to another health professional? Correct answer- Hallucination You are preparing a teaching poster about transmission of HIV to place in the waiting room of a clinic. From the following, choose routes of transmission of HIV that you should list on the poster. This question has more than one correct answer. Choose all that apply. Correct answer- sexual intercourse with an infected partner Contact with infected blood Breastfeeding by an infected mother The lab report from a person with AIDS tells you that his CD4+ count is falling. You should interpret this lab report to mean that his body is not making enough: Correct answer- helper T cells to make up for the ones that are dying. "Why do people who have AIDS get Kaposi sarcoma but not people who have healthy immune systems?" says Mrs. Jeptoo. Choose the best response. Correct answer- A healthy immune system can destroy abnormal cells that can develop into cancers, but the suppressed immune system in a person who has AIDS is not able to do so as effectively. The night nurse said I have an opportunistic infection," says Mr. Smeltzer, who has AIDS. "However, my physician says I have Pneumocystis pneumonia. I do not want that nurse to take care of me again tonight; she must have me mixed up with someone else!" Choose the best way to complete this response: "Pneumocystis pneumonia is a type of opportunistic infection, so the night nurse and your physician were talking about the same thing. An opportunistic infection is an infection that people who are immunosuppressed get: Correct answer- from microorganisms that usually are harmless." You are working in a pediatric AIDS clinic. What should you watch for in children who have AIDS that is less common with adults who have AIDS? Correct answer- Repeated episodes of chickenpox You are working in a clinic where people come for HIV testing. A man whose test result is HIV negative says, "I have been learning about HIV replication. I know that integrase puts the HIV DNA into the host cell DNA, but I do not understand where integrase comes from in the first place." Choose the best response. Correct answer- When HIV enters a host cell, it brings integrase with it. Mr. Jacobs has AIDS. You should teach him ways to protect himself from infection because: Correct answer- the decrease in his T helper cells suppresses his adaptive and innate immune functions. You are a hospice intake nurse who is seeing a new client today. Mr. Kenworth has AIDS that has not responded well to antiviral therapy. What should you expect to find in your assessment? This question has more than one correct answer. Choose all that apply. Correct answer- History of night sweats Thrush Weight loss Swollen lymph nodes Fatigue You have been assigned to write clinical protocols to guide assessment and treatment for several sexually transmitted infections (STIs). Your plan is to work first on protocols for the disorders that are localized in their pathophysiology, since they will be quicker, and then focus on the disorders that have more systemic involvement. From the following list, choose the STIs that are localized so you will know how to proceed. Choose all that apply. Correct answer- HPV infection Trichomoniasis STIs with systemic involvement are Correct answer- PID, syphilis, and genital herpes. You are a telephone advice nurse. Mr. Wu calls to say he has a sore on his penis and is afraid that he has syphilis. You have asked him about possible exposure to syphilis and to describe the sore. Choose the next assessment question that you should ask. Correct answer- Is the sore painful? Which of the following assessment findings should cause you to suggest that a woman should be evaluated for breast cancer? Choose all that apply. Correct answer- Abnormal discharge from the nipple Dimpling of the skin on the breast Enlarged axillary lymph nodes "I have a Pap smear every year to check for cervical cancer," says Ms. Zephyr. "But I do not know how to monitor for ovarian cancer. I hear that there is no screening test. What are the early symptoms?" Choose the best response. Correct answer- Early ovarian cancer does not have any signs and symptoms. "Why does my endometriosis hurt more at some times in my menstrual cycle than at others?" says Ms. Lortzing. Choose the best response. Correct answer- The endometriosis tissue responds to the hormones that cause your menstrual cycle and it builds up and then bleeds inside your body with each cycle. Carter Mulion, age 14, heard his grandfather complaining about benign prostatic hyperplasia (BPH), but was too shy to ask for details. He asks you to tell him what the signs and symptoms are, so he will know if he gets BPH. After you assure him that BPH occurs primarily in older men, you need to tell him the signs and symptoms. From the following list, choose all that apply. Correct answer- Urinary hesitation Weak urine stream "Our AIDS patients get infections when their CD4 cell count gets too low," says another nurse. "I can understand why their killer cell immunity decreases, but their antibodies still should protect them. Why do they get so many infections?" a) Immune cells need amino acids to make antibodies and CD4 cells secrete cytokines that help antibody-producing cells take up amino acids. With fewer CD4 cells, antibody function decreases also. b) Antibodies attach to microorganisms and make them easier to phagocytize. CD4 cells normally phagocytize organisms that macrophages cannot. With fewer CD4 cells, this function is lost. c) CD4 cells normally secrete cytokines that stimulate antibody-producing cells as well as cells that kill other cells directly. With fewer CD4 cells, antibody function decreases also. d) CD4 cells are antigen-presenting cells that are necessary to introduce antibody- producing cells, as well as killer cells, to microorganisms. With fewer CD4 cells, antibody function decreases also. Correct answer- "I heard the doctor say my wife has a compliment disorder," says Mr. Teagle. "She is a little crabby because she has had so many infections recently, but that is no reason for him to insult her!" Choose the best words to complete this reply to him. "Mr. Teagle, a complement disorder is an problem in the immune system that contributes to the infections your wife has been having. Complement is: Correct answer- a set of proteins that normally circulate in the blood. When they become activated, they help to protect us from infection by several important mechanisms." Which of the following should you teach a pregnant woman in order to preserve the first line of defense against microorganisms? Correct answer- Avoid picking off scabs and let them fall off naturally. You are a nurse in an immunization clinic. Which of the following individuals should you expect to have difficulty developing immunity from an immunization? Correct answer- Adult taking immunosuppressive drugs after a kidney transplant "Our AIDS patients get infections when their CD4 cell count gets too low," says another nurse. "I can understand why their killer cell immunity decreases, but their antibodies still should protect them. Why do they get so many infections?" Correct answer- CD4 cells normally secrete cytokines that stimulate antibody-producing cells as well as cells that kill other cells directly. With fewer CD4 cells, antibody function decreases also. Mr. Jacobs, who has cancer, has been reading a lot about it. He found a journal article indicating that some cancer cells evade lysis by cytotoxic T cells by producing fewer MHC proteins. "Explain this to me," he says. "I learned that cytotoxic T cells can kill a bad cell when they find its bad antigens, but why does producing fewer MHC proteins enable cancer cells to avoid death from cytotoxic T cells?" Choose the best explanation. Correct answer- Cytotoxic T cells can recognize bad antigens on cancer cells only if those antigens are associated with MHC proteins. Mrs. Levine has an autoimmune skin disorder that involves excessively active dendritic cells and cytotoxic T cells. "What are dendritic cells?" she asks. "They have made a terrible mess of my skin!" Choose the best words to complete this explanation: "Dendritic cells are normal immune cells that: Correct answer- gobble up substances, chop them up, and show them to other immune cells to excite them to attack." You are talking with another health professional about immunity. What term should you use to describe a person who has resistance to a disease after having the disease? Correct answer- Active acquired immunity "That nurse said we need to give little Mikey this polio vaccine because he will develop a secondary immune response if he meets the polio germ in real life." says Mrs. Janos. "That sounds stupid to me. I want him to have a first-rate response, not a secondary one!" Choose the best words to complete this explanation: "The word 'secondary' is a bit misleading. A secondary immune response occurs: Correct answer- when a person meets the polio germ the second time. It is faster and more powerful than the initial response." "I am worried about having my baby in the hospital because of all the germs!" says Mrs. Auber. "I know babies have immature immune systems and are really vulnerable to infection." Choose the best words to complete this response: "Your newborn baby will have some protection from antibodies called: Correct answer- IgG that cross from your blood into baby's blood before birth. Those antibody levels will be about the same as yours." "The doctor said Graves disease is an autoimmune disease," says Mrs. Contras. "That does not make sense to me. In an autoimmune disease, the immune system attacks parts of the body with antibodies and destroys them. However, I have too much thyroid hormone, not too little of it." Choose the best response. Correct answer- In Graves disease, the immune system does make antibodies against part of the thyroid gland but they are stimulating antibodies, not destructive antibodies. The antibodies actually cause your thyroid gland to make too much thyroid hormone. "I am going out of town this evening, to be gone for a week," says Mr. Deusan. "Can you give me the TB skin test this morning and then read it late this afternoon? I really need to be certified TB-free so I can take my new job." Choose the best words to complete this response: "A negative reading this afternoon will not certify you as TB-free because it takes several days: Correct answer- for the immune T cells to react to the TB skin test." You are a camp nurse. "I am not afraid of poison ivy!" says Max Grewe, age 13. "I touched it once accidentally last summer for the first time and did not have a problem, so I stuck my hand in some this morning. See, my hand is perfectly fine. I am immune to it!" Choose the best response. Correct answer- Last summer, your immune cells met poison ivy for the first time and some of them may have become sensitized to it. Now they are meeting poison ivy again and they may cause some damage that you will see as an itchy blistering rash in the next few days. Let me check your hand every day this week. Mr. Buscaglia developed contact dermatitis on his arms from a new brand of laundry detergent. "Now that I am allergic to laundry soap, I am afraid to wear any of my old shirts because my throat might swell up fast and stop my breathing like I saw on TV," he says. "What should I do?" Choose the best words to complete this response: "What you have is contact dermatitis, a fancy term for the itchy rash that happened when: Correct answer- special immune cells called T cells became activated and started damaging your skin. That is very different from an allergic response that causes a throat to swell up. Your activated T cells will not cause your throat to swell like that." Mr. Thrall has colon cancer and is receiving cytotoxic cancer chemotherapy. His leukocyte count is low, due to the chemotherapy, and you are reviewing the precautions he should take to protect himself from infection. "That other nurse said I had secondary immunosuppression," he says. "She would not belittle it if she had to stay away from people and cook all her vegetables instead of eating them raw! I think my immunosuppression is a primary influence!" Choose the best words to complete this response: "The term secondary immunosuppression has a technical meaning that focuses on the cause of immunosuppression rather than on its importance. Correct answer- Secondary immunosuppression means that it is caused by something outside the immune system. Primary immunosuppression is a defect within the immune system. As you know, the cancer drugs are causing your immunosuppression." "One time my doctor said I have an autoimmune disease and the next time he called it a hypersensitive reaction," says Mr. Treloni. "Are they the same thing?" Choose the best response. Correct answer- No. There are several types of hypersensitivity reactions, which means the immune system damages the body. Sometimes what triggers a hypersensitivity reaction is not autoimmune, meaning that it is a trigger from the environment, like pollen. But, in your case, what triggers the hypersensitivity reaction is autoimmune, meaning that it is one of your body's own chemicals that makes the immune system attack. "I was so upset when the doctor told me I have this autoimmune lupus that he said I have an immune complex," says Mrs. Lenley. "Now I am afraid to go back to see him because he thinks I am neurotic. My friends say that is what having a complex means: neurotic!" Choose the best words to complete this response: "The word 'complex' means something else when we talk about lupus. Tell your friends that an immune complex is: Correct answer- what forms when the lupus autoantibodies attach to your own body parts. Then your immune cells attack the area and cause your lupus symptoms. An immune complex is a physical part of your disease, not a mental disorder." Kellie Frond was stung by a bee. "Help!" her mother shouts. "She is allergic to bees!" She administered the emergency epinephrine (EpiPen) that she carries in case of bee sting. Someone has called 911 for emergency assistance. What signs and symptoms would tell you that Kellie is having a life-threatening type I hypersensitivity reaction and needs a second dose of epinephrine before the paramedics arrive? Correct answer- Wheezing, difficulty breathing, weak pulse