NURS 611- Advanced Pathophysiology PATHO EXAM Question & Answer (GRADED A+)

NURS 611-PATHO EXAM Question & Answer (GRADED A+) 1 1. What are clinical manifestations of hypothyroidism? Constipation, decreased heat rate, and lethargy 2. Thyroid-stimulating hormone (TSH) is released to stimulate thyroid hormone (TH) and is inhibited when plasma levels of TH are adequate. This is an example of: Negative feedback Negative feedback. Negative feedback occurs because the changing chemical, neural, or endocrine response to a stimulus negates the initiating change that triggered the release of the hormone. 3. Lipid-soluble hormone receptors are located: Inside the plasma membrane in the cytoplasm Inside the plasma membrane in the cytoplasm. Lipid-soluble hormone receptors are located inside the plasma membrane and easily diffuse across the plasma membrane to bind to either cytosolic or nuclear receptors. 4. The releasing hormones that are made in the hypothalamus travel to the anterior pituitary via the: Portal hypophyseal blood vessels Portal hypophyseal blood vessels. Releasing and inhibitory hormones are synthesized in the hypothalamus and are secreted into the portal blood vessels through which they travel to the anterior pituitary hormones. 5. Which mineral is needed for thyroid-stimulating hormone (TSH) to stimulate the secretion of thyroid hormone (TH)? Iodide Iodide. TSH, which is synthesized and stored in the anterior pituitary, stimulates secretion of TH by activating intracellular processes, including the uptake of iodine necessary for the synthesis of TH. 6. What effect does hyperphosphatemia have on other electrolytes? Decreases serum calcium Decreases serum calcium. Hyperphosphatemia leads to hypocalcemia. Remember that phos and calcium are inversely related. 7. Insulin transports which electrolyte in the cell? a. Potassium Potassium. Insulin facilitates the intracellular transport of potassium, phosphate, and magnesium. 8. Which second messenger is stimulated by epinephrine binding to a β-adrenergic receptor? Cyclic adenosine monophosphate (cAMP) Cyclic adenosine monophosphate (cAMP). Second-messenger molecules are the initial link between the first signal (hormone) and the inside of the cell. 9. Regulation of the release of catecholamines from the adrenal medulla is an example of which type of regulation? Neural Neural. The release of hormones occurs either in response to an alteration in the cellular environment or in the process of maintaining a regulated level of certain hormones or certainNURS 611-PATHO EXAM Question & Answer (GRADED A+) 2 substances. Several different mechanisms, one of which is neural control (e.g., stress-induced release of catecholamines from the adrenal medulla), regulate the release of hormones. 10. Which hormone does the second messenger calcium (Ca++) bind to activate phospholipase C through a G protein? Angiotensin II 11. The control of calcium in cells is important because it: Acts as a second messenger. Acts as a second messenger. In addition to being an important ion that participates in a multitude of cellular actions, Ca++ is considered an important second messenger. 12. Where is antidiuretic hormone (ADH) synthesized, and where does it act? Hypothalamus; renal tubular cells Hypothalamus; renal tubular cells. Once synthesized in the hypothalamus, ADH acts on the vasopressin 2 (V2) receptors of the renal duct cells to increase their permeability. 13. How does a faulty negative-feedback mechanism result in a hormonal imbalance? Excessive hormone production results from a failure to turn off the system. Excessive hormone production results from a failure to turn off the system. Negativefeedback systems are important in maintaining hormones within physiologic ranges. The lack of negative-feedback inhibition on hormonal release often results in pathologic conditions. Excessive hormone production, which is the result of the failure to turn off the system, can cause various hormonal imbalances and related conditions. 14. A deficiency of which chemical may result in hypothyroidism? Iodine Iodine. The only cause of hypothyroidism from among the provided options is a deficiency of endemic iodine. 15. What imbalance lessens the rate of secretion of parathyroid hormone Increased serum calcium levels The overall effect of parathyroid hormone (PTH)is to increase serum calcium and to decrease serum phosphate concentration. 16. Which condition may result from pressure exerted by a pituitary tumor? Hypothyroidism Hypothyroidism. If the tumor exerts sufficient pressure, then thyroid and adrenal hypofunction may occur because of lack of thyroid-stimulating hormone (TSH) and adrenocorticotropic hormone (ACTH). These result in the symptoms of hypothyroidism and hypocortisolism. 17. Which substance is a water-soluble protein hormone? Insulin Insulin. Peptide or protein hormones, such as insulin, pituitary, hypothalamic, and parathyroid, are water soluble and circulate in free (unbound) forms. 18. Which of the following is a lipid-soluble hormone? Cortisol Cortisol. Cortisol and adrenal androgens are lipid-soluble hormones and are primarily bound to a carrier or transport protein in circulation. 19. Most protein hormones are transported in the bloodstream and are:NURS 611-PATHO EXAM Question & Answer (GRADED A+) 3 Free in an unbound, water-soluble form Free in an unbound, water-soluble form. Peptide or protein hormones, such as insulin, pituitary, hypothalamic, and parathyroid, are water soluble and circulate in free (unbound) forms. 20. When insulin binds its receptors on muscle cells, an increase in glucose uptake by the muscle cells is the result. This is an example of what type of effect by a hormone? Direct Direct. Direct effects are the obvious changes in cell function that specifically result from the stimulation by a particular hormone. 21. Graves disease develops from a(n): Thyroid-stimulating immunoglobulin that causes overproduction of thyroid hormones. Thyroid-stimulating immunoglobulin that causes the overproduction of thyroid hormones. 22. Pathologic changes associated with Graves disease include: High levels of circulating thyroid-stimulating immunoglobulins High levels of circulating thyroid-stimulating immunoglobulins. The only option that correctly describes the changes associated with Graves disease identifies high levels of circulating thyroid-stimulating immunoglobulins that are found in more than 95% of individuals diagnosed with the disease. 23. The signs of thyrotoxic crisis include: Hyperthermia and tachycardia Hyperthermia and tachycardia 24. The level of thyroid-stimulating hormone (TSH) in individuals with Graves disease is usually: Low Low. The hyperfunction of the thyroid gland leads to suppression of TSH because of the normal negative feedback mechanism. 25. Palpation of the neck of a person diagnosed with Graves disease would detect a thyroid that is: Diffusely enlarged 26. The effects of the syndrome of inappropriate antidiuretic hormone (SIADH) secretion include solute: Dilution and water loss 27. The common cause of elevated levels of antidiuretic hormone (ADH) secretion is: Ectopically produced ADH Ectopically produced ADH 28. Which laboratory value would the nurse expect to find if a person is experiencing syndrome of inappropriate antidiuretic hormone (SIADH)? Serum sodium (Na+) level of 120 mEq/L and serum hypo-osmolality A diagnosis of SIADH requires a serum sodium level of less than 135 mEq/L, serum hypoosmolality less than 280 mOsm/kg, and urine hyper-osmolarity. 29. A patient who is diagnosed with a closed head injury has a urine output of 6 to 8 L/day. Electrolytes are within normal limits, but his antidiuretic hormone (ADH) level is low.NURS 611-PATHO EXAM Question & Answer (GRADED A+) 4 Although he has had no intake for 4 hours, no change in his polyuria level has occurred. These symptoms support a diagnosis of: Neurogenic diabetes insipidus Neurogenic diabetes insipidus. Remember, sodium has to be below 135 to meet the requirement for SIADH. 30. Diabetes insipidus, diabetes mellitus, and syndrome of inappropriate antidiuretic hormone all exhibit which symptom? Thirst 31. The cause of neurogenic diabetes insipidus (DI) is related to an organic Posterior pituitary Posterior pituitary. Neurogenic DI is a result of dysfunctional antidiuretic hormone synthesis, caused by a lesion of the posterior pituitary, hypothalamus, or pituitary stalk. 32. Which form of diabetic insipidus (DI) will result if the target cells for antidiuretic hormone (ADH) in the renal collecting tubules demonstrate insensitivity? Nephrogenic Nephrogenic. Only nephrogenic DI is associated with an insensitivity of the renal collecting tubules to ADH. 33. Which laboratory value is consistently low in a patient with diabetes insipidus (DI)? Urine-specific gravity Urine-specific gravity. The basic criteria for diagnosing DI include a low urine-specific gravity while sodium levels are high. Protein levels are not considered. 34. Which form of diabetes insipidus (DI) is treatable with exogenous antidiuretic hormone (ADH)? Neurogenic Neurogenic DI is treated with ADH replacement therapy. 35. The term used to describe a person who experiences a lack of all hormones associated with the anterior pituitary is: Panhypopituitarism Panhypopituitarism is the only available term that is correctly associated with the lack of all anterior pituitary hormones. 36. Diabetes insipidus is a result of: Antidiuretic hormone hyposecretion 37. Visual disturbances are a result of a pituitary adenoma because of the: Pressure of the tumor on the optic chiasm 38. Which hormone is involved in the regulation of serum calcium levels? Parathyroid hormone (PTH) The parathyroid glands produce PTH, a regulator of serum calcium. 39. Target cells for parathyroid hormone are located in the: Tubules of nephrons Parathyroid hormone acts on its plasma membrane receptor only in the distal and proximal tubules of the kidney’s nephron. 40. Renal failure is the most common cause of which type of hyperparathyroidism? SecondaryNURS 611-PATHO EXAM Question & Answer (GRADED A+) 5 Chronic renal failure is the most common cause of secondary hyperparathyroidism because of the resulting hyperphosphatemia that stimulates parathyroid hormone secretion. 41. The most common cause of hypoparathyroidism is: Parathyroid gland damage Parathyroid gland damage. The most common cause of hypoparathyroidism is damage caused during thyroid surgery. 42. The most probable cause of low serum calcium after a thyroidectomy is: Hypoparathyroidism caused by surgical injury The most common cause of hypoparathyroidism is damage caused during thyroid surgery, resulting in a lack of circulating PTH and causing a depressed level of serum calcium. 43. A patient diagnosed with diabetic ketoacidosis (DKA) has the following laboratory values: arterial pH 7.20; serum glucose 500 mg/dl; positive urine glucose and ketones; serum potassium (K+) 2 mEq/L; serum sodium (Na+) 130 mEq/L. The patient reports that he has been sick with the “flu” for 1 week. What relationship do these values have to his insulin deficiency? Decreased glucose use causes fatty acid use, ketogenesis, metabolic acidosis, and osmotic diuresis. 44. Polyuria occurs with diabetes mellitus because of the: Elevation in serum glucose Elevation of serum glucose. Glucose accumulates in the blood and appears in the urine as the renal threshold for glucose is exceeded, producing an osmotic diuresis and the symptoms of polyuria and thirst. 45. Type 2 diabetes mellitus is best described as a(an): Resistance to insulin by insulin-sensitive tissues Resistance to insulin by insulin-sensitive tissues. One of the basic pathophysiologic characteristics of type 2 diabetes is the development of insulin-resistant tissue cells. 46. A person diagnosed with type 1 diabetes experiences hunger, lightheadedness, tachycardia, pallor, headache, and confusion. The most probable cause of these symptoms is: Hypoglycemia caused by increased exercise Hypoglycemia caused by increased exercise. The most likely cause of these symptoms is hypoglycemia, which is often caused by a lack of systemic glucose as a result of muscular activity. 47. When comparing the clinical manifestations of both diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNKS), which condition is associated with only DKA? Kussmaul respirations Kussmaul respirations are only observed in those with DKA and is that “air hunger” or rapid deep labored breathing. 48. Hypoglycemia, followed by rebound hyperglycemia, is observed in those with: The Somogyi effect 49. The first laboratory test that indicates type 1 diabetes is causing the development of diabetic nephropathy is:NURS 611-PATHO EXAM Question & Answer (GRADED A+) 6 Protein on urinalysis Microalbuminuria is the first manifestation of this form of renal failure. Although the other options may develop, they occur after protein is found in the urine. 50. Which classification of oral hypoglycemic drugs decreases hepatic glucose production and increases insulin sensitivity and peripheral glucose uptake? Biguanide (metformin) Only biguanides decrease hepatic glucose production and increase insulin sensitivity and peripheral glucose uptake. 51. What causes the microvascular complications in patients with diabetes mellitus? The capillary basement membranes thicken, and cell hyperplasia develops. Microvascular complications are a result of capillary basement membranes thickening and endothelial cell hyperplasia. 52. Retinopathy develops in patients with diabetes mellitus because: Retinal ischemia and red blood cell aggregation occur. Retinal ischemia and RBC aggregation occur. Retinopathy appears to be a response to retinal ischemia and red blood cell aggregation. 53. Which disorder is caused by hypersecretion of the growth hormone (GH) Acromegaly Acromegaly is a term for adults who have been exposed to continuously high levels of GH, whereas the term giantism is reserved for children and adolescents. 54. Which disorder is considered a co-morbid condition of acromegaly? Diabetes Diabetes. Symptoms of type 2 diabetes mellitus, such as polyuria and polydipsia, may occur. Acromegaly-associated hypertension is usually asymptomatic until symptoms of heart failure develop. Neither thyroid nor brain cancer has been associated with acromegaly. 55. Giantism occurs only in children and adolescents because their: Epiphyseal plates have not yet closed. Giantism is related to the effects of growth hormones on the growth of long bones at their epiphyseal plates. 56. Amenorrhea, galactorrhea, hirsutism, and osteoporosis are each caused by: Prolactinoma Of the options available, the hallmark of a prolactinoma is the sustained elevation of serum prolactin that is responsible for the symptoms listed. 57. The signs of thyrotoxic crisis include: Hyperthermia and tachycardia 58. A person has acne, easy bruising, thin extremities, and truncal obesity. These clinical manifestations are indicative of which endocrine disorder? Cushing disease These symptoms are characteristic of Cushing disease and are caused by excessive cortisol secretion. 59. A person may experience which complications as a result of a reduction in parathyroid hormone (PTH)? (Select all that apply.) a. Muscle spasms xNURS 611-PATHO EXAM Question & Answer (GRADED A+) 7 b. Tonic-clonic seizures x c. Laryngeal spasms x d. Hyporeflexia e. Asphyxiation x Symptoms associated with hypoparathyroidism are related to hypocalcemia. Hypocalcemia causes a lowering of the threshold for nerve and muscle excitation so that a slight stimulus anywhere along the length of a nerve or muscle fiber may initiate a nerve impulse. This creates tetany manifested as muscle spasms, hyperreflexia, tonicclonic convulsions, laryngeal spasms, and, in severe cases, death from asphyxiation. 60. A chronic complication of diabetes mellitus is likely to result in microvascular complications in which areas? (Select all that apply.) a. Eyes x b. Coronary arteries c. Renal system x d. Peripheral vascular system e. Nerves x The areas most often affected are the retina, kidneys, and nerves. 61. Which compound or hormone is secreted by the adrenal medulla? Epinephrine 62. The secretion of adrenocorticotropic-stimulating hormone (ACTH) will result in the increased level of which hormone? Cortisol Cortisol. Psychologic and physiologic stress (e.g., hypoxia, hypoglycemia, hyperthermia, exercise) increases ACTH secretion, leading to increased cortisol levels. Only cortisol describes the appropriate feedback loop. 63. Aldosterone directly increases the reabsorption of: Sodium Sodium. In the kidney, aldosterone primarily acts on the epithelial cells of the nephroncollecting duct to increase sodium ion reabsorption. 64. Which is an expected hormonal change in an older patient? Thyroid-stimulating hormone secretion below normal Aging causes overall thyroid- stimulating hormone secretion to diminish but does not bring about the other changes. 65. What are actions of glucocorticoids? (Select all that apply.) a. Decreasing muscle cell reuptake of glucose X b. Fat storage c. Decreased blood glucose d. Carbohydrate metabolism X e. Liver gluconeogenesis X 66. What is the most abundant class of plasma protein? Albumin 67. What is the effect of low plasma albumin? Osmotic pressure decreases, thus water moves from the capillaries to the interstitium.NURS 611-PATHO EXAM Question & Answer (GRADED A+) 8 In the case of decreased production (e.g., cirrhosis, other diffuse liver diseases, protein malnutrition) or excessive loss of albumin (e.g., certain kidney diseases, extensive burns), the reduced oncotic pressure leads to excessive movement of fluid and solutes into the tissues and decreased blood volume. 68. The absence of parietal cells would prevent the absorption of an essential nutrient necessary to prevent which type of anemia? Pernicious anemia Dietary vitamin B12 is a large molecule that requires a protein secreted by parietal cells into the stomach (intrinsic factor [IF]) to transport across the ileum. Defects in IF production lead to decreased B12 absorption and pernicious anemia. 69. Which nutrients are necessary for the synthesis of DNA and the maturation of erythrocytes? Cobalamin (vitamin B12) and folate Cobalamin and folate are necessary for the synthesis of DNA and for the maturation of erythrocytes. 70. Which substance is used to correct the chronic anemia associated with chronic renal failure? Erythropoietin One of the most significant advances in the study of hematopoietic growth factors has been the development of erythropoietin for individuals with chronic renal failure. 71. What is plasmin’s role in the clotting process? Degrades the fibrin within blood clots. Degrades the fibrin within blood clots. Plasmin (also called fibrinase or fibrinolysin) is a serine protease that degrades fibrin polymers in clots. 72. What changes to the hematologic system is related to age? Lymphocyte function decreases. Blood composition changes little with age. A delay in erythrocyte replenishment may occur after bleeding, presumably because of iron deficiency. Lymphocyte function appears to decrease with age. Particularly affected is a decrease in cellular immunity. Platelet adhesiveness probably increases with age. 73. Which statements characterize albumin? (Select all that apply.) a. Retains sodium to maintain water balance. b. Provides colloid osmotic pressure. X c. Is synthesized in the liver. X d. Is a carrier for drugs that have low water solubility. X e. Is a small molecule It serves as a carrier molecule for the normal components of blood, as well as for drugs that have low solubility in water (e.g., free fatty acids, lipid-soluble hormones, thyroid hormones, bile salts). Albumin molecules are large and do not diffuse freely through the vascular endothelium, thus they maintain the critical colloidal osmotic pressure (or oncotic pressure) that regulates the passage of water and solutes into the surrounding tissues. 74. The paresthesia that occurs in vitamin B12 deficiency anemia is a result of which of the following? Myelin degeneration in the spinal cordNURS 611-PATHO EXAM Question & Answer (GRADED A+) 9 Effects on the nervous system can occur if a vitamin B12 deficiency causes the anemia. Myelin degeneration may occur with the resultant loss of fibers in the spinal cord, producing paresthesia, gait disturbances, extreme weakness, spasticity, and reflex abnormalities. 75. Which of the following is classified as a megaloblastic anemia? Pernicious Pernicious anemia is the most common type of megaloblastic anemia. 76. Deficiencies in folate and vitamin B12 alter the synthesis of which of the following? DNA 77. Which condition resulting from untreated pernicious anemia (PA) is fatal? Heart failure 78. Considering sideroblastic anemia, what would be the expected effect on the plasma iron levels? Plasma iron levels would be high. 79. In aplastic anemia (AA), pancytopenia develops as a result of which of the following? Suppression of the bone marrow to produce adequate amounts of erythrocytes, leukocytes, and thrombocytes AA is a critical condition characterized by pancytopenia, which is a reduction or absence of all three blood cell types, resulting from the failure or suppression of bone marrow to produce adequate amounts of blood cells. 80. What is the most common pathophysiologic process that triggers aplastic anemia (AA)? a. Autoimmune disease against hematopoiesis by activated cytotoxic T (Tc) cells. Most cases of AA result from an autoimmune disease directed against hematopoietic stem cells. Tc cells appear to be the main culprits. 81. When considering hemolytic anemia, which statement is true regarding the occurrence of jaundice? Heme destruction exceeds the liver’s ability to conjugate and excrete bilirubin. Jaundice (icterus) is present when heme destruction exceeds the liver’s ability to conjugate and excrete bilirubin. This selection is the only option that accurately describes the process that affects the occurrence of hemolytic anemia–related jaundice. 82. Which statement is true regarding the physical manifestations of vitamin B12 deficiency anemia? Symptoms are a result of demyelination. The neurologic manifestations characteristic of vitamin B12 deficiency anemia result from nerve demyelination that may produce neuronal death. These complications pose a serious threat because they are not reversible, even with appropriate treatment. 83. A 2000 ml blood loss will produce which assessment finding? (Select all that apply.) a. Air hunger X b. Normal blood pressure in the supine position c. Rapid thready pulse X d. Cold clammy skin X e. lactic acidosis With a 2000 ml loss of blood, central venous pressure, cardiac output, and arterial blood pressure are below normal, even when at rest and in the supine position. The person commonly has air hunger; a rapid, thready pulse; and cold, clammy skin.NURS 611-PATHO EXAM Question & Answer (GRADED A+) 10 84. Which conditions are generally included in the symptoms of pernicious anemia (PA)? (Select all that apply.) a. Weakness X b. Weight gain c. Low hemoglobin X d. Paresthesias X e. Low hematocrit X When the hemoglobin and hematocrit levels in the blood have significantly decreased, the individual experiences the classic symptoms of PA—weakness, fatigue, paresthesias of the feet and fingers, difficulty in walking, loss of appetite, abdominal pains, and weight loss. 85. What are the clinical manifestations of folate deficiency anemia? (Select all that apply.) a. Constipation b. Flatulence X c. Dysphagia X d. Stomatitis X e. Cheilosis X Specific symptoms of folate deficiency anemia include severe cheilosis (scales and fissures of the lips and corners of the mouth), stomatitis (inflammation of the mouth), and painful ulcerations of the buccal mucosa and tongue. Gastrointestinal symptoms may be present and include dysphagia (difficulty swallowing), flatulence, and watery diarrhea. 86. Which diseases are commonly associated with anemia of chronic disease? (Select all that apply.) a. Rheumatoid arthritis X b. Acquired immunodeficiency syndrome (AIDS) X c. Polycythemia vera d. Systemic lupus erythematosus X e. Chronic hepatitis X 87. Which type of anemia is characterized by fatigue, weakness, and dyspnea, as well as conjunctiva of the eyes and brittle, concave nails? Iron deficiency Iron deficiency. Early symptoms of iron deficiency anemia (IDA) include fatigue, weakness, and shortness of breath. Pale earlobes, palms, and conjunctivae are also common signs. Progressive IDA causes more severe alterations, with structural and functional changes apparent in epithelial tissue. The nails become brittle, thin, coarsely ridged, and spoonshaped or concave (koilonychia) as a result of impaired capillary circulation. The tongue becomes red, sore, and painful. 88. Which statement concerning erythrocytes is true? Erythrocytes have the ability to change shape to squeeze through microcirculation. Reversible deformity enables the erythrocyte to assume a more compact torpedo-like shape, squeeze through the microcirculation, and return to normal. 89. Which of the following are formed elements of the blood that are not cells but are diskshaped cytoplasmic fragments essential for blood clotting?NURS 611-PATHO EXAM Question & Answer (GRADED A+) 11 Platelets Platelets (thrombocytes) are not true cells but are disk-shaped cytoplasmic fragments that are essential for blood coagulation and control of bleeding. 90. What is the life span of platelets (in days)? 10 A platelet circulates for approximately 10 days and ages. Macrophages of the mononuclear phagocyte system, mostly in the spleen, remove platelets. 91. Which blood cells are the chief phagocytes involved in the early inflammation process? Neutrophils Which blood cells are biconcave in shape and have the capacity to be reversibly deformed? Erythrocytes The erythrocyte’s size and shape are ideally suited to its function as a gas carrier. A red blood cell (RBC) is a small disk with two unique properties: (1) a biconcave shape and (2) the capacity to be reversibly deformed. 92. What is the life span of an erythrocyte (in days)? 100 to 120 Because it cannot undergo mitotic division, the erythrocyte has a limited life span of approximately 120 days. 93. Local signs and symptoms of Hodgkin disease–related lymphadenopathy are a result of which of the following? Pressure and obstruction Pressure and obstruction. Local symptoms caused by pressure and obstruction of the lymph nodes are the result of lymphadenopathy. 94. Which statement best describes heparin-induced thrombocytopenia (HIT)? Immunoglobulin G immune–mediated adverse drug reaction that reduces circulating platelets Heparin is a common cause of drug-induced thrombocytopenia. HIT is an immune-mediated, adverse drug reaction caused by immunoglobulin G antibodies that leads to increased platelet consumption and a decrease in platelet counts. 95. Vitamin is required for normal clotting factor synthesis by the ? K; liver Vitamin K, a fat-soluble vitamin, is necessary for the synthesis and regulation of prothrombin, procoagulant factors (VII, IX, X), and anticoagulant regulators (proteins C and S) in the liver. 96. Which disorder is described as an unregulated release of thrombin with subsequent fibrin formation and accelerated fibrinolysis? Disseminated intravascular coagulation (DIC) DIC is an acquired clinical syndrome characterized by widespread activation of coagulation resulting in the formation of fibrin clots in medium and small vessels throughout the body. 97. In disseminated intravascular coagulation (DIC), what activates the coagulation cascade? Tissue factor (TF) located in the endothelial layer of blood vessels and subcutaneous tissue.NURS 611-PATHO EXAM Question & Answer (GRADED A+) 12 Direct tissue damage (ischemia and necrosis, surgical manipulation, crushing injury) causes the endothelium to release TF. The common pathway for DIC appears to be excessive and widespread exposure of TF. 98. Which proinflammatory cytokines are responsible for the development and maintenance of disseminated intravascular coagulation (DIC)? Tumor necrosis factor-alpha (TNF-α); IL-1, IL-6, and IL-8; and platelet-activating factor (PAF). Endotoxin, in particular, triggers the release of multiple cytokines that play a significant role in the development and maintenance of DIC. Proinflammatory cytokines—TNF-α; IL-1, IL-6, IL-8; PAF—are responsible for the clinical signs and symptoms associated with the sepsis associated with DIC. 99. In disseminated intravascular coagulation (DIC), what are the indications of microvascular thrombosis? Symmetric cyanosis of fingers and toes Several organ systems are susceptible to microvascular thrombosis that affects their function. Indicators of multisystem failure include changes in the level of consciousness, behavior, and mentation; confusion; seizure activity; oliguria; hematuria; hypoxia; hypotension; hemoptysis; chest pain; and tachycardia. Symmetric cyanosis of the fingers and toes (i.e., “blue finger/toe syndrome”) and, in some instances, of the nose and breasts may be present. 100. What is the most reliable and specific test for diagnosing disseminated intravascular coagulation (DIC)? D-dimer D-dimer testing measures a specific DIC-related product. 101. When the demand for mature neutrophils exceeds the supply, immature neutrophils are released indicating: A shift to the left When the demand for circulating mature neutrophils exceeds the supply, the marrow begins to release immature neutrophils (and other leukocytes) into the blood. Premature release of the immature white cells is responsible for the phenomenon known as a shik to the lek or leukemoid reaction. 102. Hodgkin disease is characterized by the presence of which of the following? Reed-Sternberg (RS) cells Reed-Sternberg cells. Hodgkin disease is characterized by its progression from one group of lymph nodes to another, the development of systemic symptoms, and the presence of RS cells, but not the involvement of the Philadelphia chromosome. Virchow triad is a symptom related to thrombus formation. Disseminated intravascular coagulation is associated with microvascular thrombi. 103. Reed-Sternberg (RS) cells represent malignant transformation and proliferation of which of the following? B cells B cells. Although the molecular events that cause malignant transformation remain controversial, RS cells are apparently from B-cell lineage. 104. Which description is consistent with acute lymphocytic leukemia (ALL)?NURS 611-PATHO EXAM Question & Answer (GRADED A+) 13 ALL is a progressive neoplasm defined by the presence of greater than 30% lymphoblasts in the bone marrow or blood. The answer is A. ALL is a progressive neoplasm defined by the presence of greater than 30% lymphoblasts in the bone marrow or blood. 105. Which description is consistent with chronic myelogenous leukemia (CML)? The translocation of genetic material from genes 9 and 22 creates an abnormal, fused protein identified as BCR-ABL1. The answer is D. The Philadelphia chromosome is present in more than 95% of those with CML, and the presence of the BCR-ABL1 protein is responsible for the initiation of CML. 106. Which description is consistent with chronic lymphocytic leukemia (CLL)? B cells fail to mature into plasma cells that synthesize immunoglobulins. Answer is C. CLL is derived from transformation of a partially mature B cell that has not yet encountered antigen. 107. Which electrolyte imbalance accompanies multiple myeloma (MM)? Hypercalcemia Hypercalcemia. Elevated levels of calcium in the blood (hypercalcemia) characterize the common presentation of MM. 108. Which statements are true regarding leukemias? (Select all that apply.) a. A single progenitor cell undergoes a malignant change. X b. Leukemia is a result of uncontrolled cellular proliferation. X c. Bone marrow becomes overcrowded. X d. Leukocytes are under produced. X e. Hematopoietic cell production is decreased. A, B, C, D. In the leukemias, a single progenitor cell undergoes malignant transformation. The common feature of all forms of leukemia is an uncontrolled proliferation of malignant leukocytes, causing an overcrowding of bone marrow and decreased production and function of normal hematopoietic cells. 109. The two major forms of leukemia, acute and chronic, are classified by which criteria? (Select all that apply.) a. Predominant cell type X b. Rate of progression X c. Age of individual when cells differentiation occurs d. Stage of cell development when malignancy first occurs e. Serum level of leukocytes A & B. The current classification of leukemia is based on (1) the predominant cell of origin (either myeloid or lymphoid) and (2) the rate of progression, which usually reflects the degree at which cell differentiation was arrested when the cell became malignant (acute or chronic). 110. Which chamber of the heart endures the highest pressures? Left ventricle 111. Oxygenated blood flows through which vessel? Pulmonary veinsNURS 611-PATHO EXAM Question & Answer (GRADED A+) 14 Pulmonary veins. Only the four pulmonary veins, two from the right lung and two from the left lung, carry oxygenated blood from the lungs to the left side of the heart. 112. The significance of the atrial kick is that it affects the contraction of the: Left atria, which increases the blood volume into the ventricle. atrial contraction, the atrial kick, provides a significant increase of blood to the left ventricle. 113. The coronary sinus empties into which cardiac structure? Right atrium Right atrium. The cardiac veins empty only into the right atrium through another ostium, the opening of a large vein called the coronary sinus. 114. During the cardiac cycle, which structure directly delivers action potential to the ventricular myocardium? Purkinje fibers Purkinje fibers. Each cardiac action potential travels from the SA node to the AV node to the bundle of His (AV bundle), through the bundle branches, and finally to the Purkinje fibers and the ventricular myocardium, where the impulse is stopped. The refractory period of cells that have just been polarized prevents the impulse from reversing its path. The refractory period ensures that diastole (relaxation) will occur, thereby completing the cardiac cycle. This selection is the only option that accurately describes the structure that delivers the action potential directly to the myocardium. 115. Where in the heart are the receptors for neurotransmitters located? Myocardium and coronary vessels Sympathetic neural stimulation of the myocardium and coronary vessels depends on the presence of adrenergic receptors, which specifically bind with neurotransmitters of the sympathetic nervous system. The β1 receptors are found mostly in the heart, specifically the conduction system (AV and SA nodes, Purkinje fibers) and the atrial and ventricular myocardium, whereas the β2 receptors are found in the heart and also on vascular smooth muscle. β3 receptors are also found in the myocardium and coronary vessels. 116. Within a physiologic range, what does an increase in left ventricular end-diastolic volume (preload) result in? Increase in force of contraction Increase in force of contraction. This concept is expressed in the Frank-Starling law; the cardiac muscle, like other muscles, increases its strength of contraction when it is stretched. 117. As stated in the Frank-Starling law, a direct relationship exists between the of the blood in the heart at the end of diastole and the of contraction during the next systole. Volume; strength Volume; strength. As stated in the Frank-Starling law, the volume of blood in the heart at the end of diastole (the length of its muscle fibers) is directly related to the force (strength) of contraction during the next systole. 118. Pressure in the left ventricle must exceed pressure in which structure before the left ventricle can eject blood? AortaNURS 611-PATHO EXAM Question & Answer (GRADED A+) 15 Aorta. Pressure in the ventricle must exceed aortic pressure before blood can be pumped out during systole. The aorta is the only structure in which pressure must be less than the amount of blood in the left ventricle for ejection to occur. 119. When the volume of blood in the ventricle at the end of diastole increases, the force of the myocardial contraction during the next systole will also increase, which is an example of which law or theory about the heart? Frank-Starling law Frank-Starling law. his concept is expressed only in the Frank-Starling law; the cardiac muscle, like other muscles, increases its strength of contraction when it is stretched. 120. Reflex control of total cardiac output and total peripheral resistance is controlled by what mechanism? a. Sympathetic stimulation of the heart, arterioles, and veins Reflex control of total cardiac output and peripheral resistance includes (1) sympathetic stimulation of the heart, arterioles, and veins; and (2) parasympathetic stimulation of the heart only. Neither autonomic nor somatic controls are involved in this process. 121. What is the major effect of a calcium channel blocker such as verapamil on cardiac contractions? Decreases the strength of cardiac contractions. The L-type, or long-lasting, channels are the predominant type of calcium channels and are the channels blocked by calcium channel–blocking drugs (verapamil, nifedipine, diltiazem). The major effect of these medications is to decrease the strength of cardiac contraction. This selection is the only option that accurately identifies the effect of a calcium channel blocker on the cardiac contractions. 122. What is the initiating event that leads to the development of atherosclerosis? Injury to the endothelial cells that line the artery walls Atherosclerosis begins with an injury to the endothelial cells that line the arterial walls. Possible causes of endothelial injury include the common risk factors for atherosclerosis, such as smoking, hypertension, diabetes, increased levels of low-density lipoprotein (LDL), decreased levels of high-density lipoprotein (HDL), and autoimmunity. 123. What is the effect of oxidized low-density lipoproteins (LDLs) in atherosclerosis? LDLs cause smooth muscle proliferation. Oxidized LDLs are toxic to endothelial cells, cause smooth muscle proliferation, and activate further immune and inflammatory responses. 124. When endothelia cells are injured, what alteration contributes to atherosclerosis? Cells are unable to make the normal amount of vasodilating cytokines. Injured endothelial cells become inflamed and cannot make normal amounts of antithrombotic and vasodilating cytokines. 125. Which factor is responsible for the hypertrophy of the myocardium associated with hypertension? Angiotensin II Angiotensin II. Of the available options, only angiotensin II is responsible for the hypertrophy of the myocardium and much of the renal damage associated with hypertension.NURS 611-PATHO EXAM Question & Answer (GRADED A+) 16 126. What pathologic change occurs to the kidney’s glomeruli as a result of hypertension? Ischemia of the tubule Ischemia of the tubule. n the kidney, vasoconstriction and resultant decreased renal perfusion cause tubular ischemia and pre-glomerular arteriopathy. This selection is the only option that accurately identifies the pathologic change to the kidney that occurs as a result of hypertension. 127. What effect does atherosclerosis have on the development of an aneurysm? Atherosclerosis erodes the vessel wall. Atherosclerosis erodes the vessel wall. Atherosclerosis is a common cause of aneurysms because plaque formation erodes the vessel wall. 128. What change in a vein supports the development of varicose veins? Damage to the valves in veins Damage to the valves in veins. If a valve is damaged, permitting backflow, then a section of the vein is subjected to the pressure exerted by a larger volume of blood under the influence of gravity. The vein swells as it becomes engorged, and the surrounding tissue becomes edematous because increased hydrostatic pressure pushes plasma through the stretched vessel wall. 129. What term is used to identify when a cell is temporarily deprived of blood supply? Ischemia Ischemia. Coronary artery disease (CAD) can diminish the myocardial blood supply until deprivation impairs myocardial metabolism enough to cause ischemia, a local state in which the cells are temporarily deprived of blood supply. 130. The risk of developing coronary artery disease is increased up to threefold by which factor? Hypertension Hypertension. Hypertension is the only factor responsible for a twofold-to-threefold increased risk of atherosclerotic cardiovascular disease. 131. Which risk factor is associated with coronary artery disease (CAD) because of its relationship with the alteration of hepatic lipoprotein? Diabetes mellitus Diabetes mellitus. Of the available options, only diabetes mellitus is associated with CAD because of the resulting alteration of hepatic lipoprotein synthesis; it increases triglyceride levels and is involved in low-density lipoprotein oxidation. 132. Nicotine increases atherosclerosis by the release of which neurotransmitter? Epinephrine Nicotine stimulates the release of catecholamines (e.g., epinephrine, norepinephrine), which increases the heart rate and causes peripheral vascular constriction. As a result, blood pressure increases, as do both cardiac workload and oxygen demand. 133. Which substance is manufactured by the liver and primarily contains cholesterol and protein? Low-density lipoproteins (LDLs)NURS 611-PATHO EXAM Question & Answer (GRADED A+) 17 Low-density lipoproteins. A series of chemical reactions in the liver results in the production of several lipoproteins that vary in density and function. These include VLDLs, primarily triglycerides and protein; LDLs, mostly cholesterol and protein; and HDLs, mainly phospholipids and protein. LDLs are the only lipoproteins that are manufactured by the liver and primarily contain cholesterol and protein. 134. Which elevated value may be protective of the development of atherosclerosis? High-density lipoproteins (HDL) High-density lipoproteins. Low levels of HDL cholesterol are also a strong indicator of coronary risk, whereas high levels of HDLs may be more protective for the development of atherosclerosis than low levels of LDLs. 135. Which laboratory test is an indirect measure of atherosclerotic plaque? C-reactive protein (CRP) C-reactive protein. Highly sensitive CRP (hs-CRP) is an acute phase reactant or protein mostly synthesized in the liver and, of the available options, is an indirect measure of atherosclerotic plaque-related inflammation. 136. An individual who is demonstrating elevated levels of troponin, creatine kinase– isoenzyme MB (CK-MB), and lactic dehydrogenase (LDH) is exhibiting indicators associated with which condition? Myocardial infarction (MI) MI. Cardiac troponins (troponin I and troponin T) are the most specific indicators of MI. Other biomarkers released by myocardial cells include CK-MB and LDH. 137. How does angiotensin II increase the workload of the heart after a myocardial infarction (MI)? By increasing the peripheral vasoconstriction Angiotensin II is released during myocardial ischemia and contributes to the pathogenesis of a myocardial infarction (MI) in several ways. First, it results in the systemic effects of peripheral vasoconstriction and fluid retention. These homeostatic responses are counterproductive in that they increase myocardial work and thus exacerbate the effects of the loss of myocyte contractility. Angiotensin II is also locally released, where it is a growth factor for vascular smooth muscle cells, myocytes, and cardiac fibroblasts; promotes catecholamine release; and causes coronary artery spasm. 138. The pulsus paradoxus that occurs as a result of pericardial effusion is caused by a dysfunction in which mechanism? Diastolic filling pressures of the left ventricle and reduction of blood volume in all four heart chambers. Pulsus paradoxus means that the arterial blood pressure during expiration exceeds arterial pressure during inspiration by more than 10 mm Hg. This clinical finding reflects impairment of diastolic filling of the left ventricle plus a reduction of blood volume within all four cardiac chambers. 139. A patient reports sudden onset of severe chest pain that radiates to the back and worsens with respiratory movement and when lying down. These clinical manifestations describe: Acute pericarditisNURS 611-PATHO EXAM Question & Answer (GRADED A+) 18 Most individuals with acute pericarditis describe several days of fever, myalgias, and malaise, followed by the sudden onset of severe chest pain that worsens with respiratory movements and with lying down. Although the pain may radiate to the back, it is generally felt in the anterior chest and may be initially confused with the pain of an acute MI. Individuals with acute pericarditis also may report dysphagia, restlessness, irritability, anxiety, and weakness. 140. Ventricular dilation and grossly impaired systolic function, leading to dilated heart failure, characterize which form of cardiomyopathy? Congestive Only dilated cardiomyopathy (congestive cardiomyopathy) is characterized by ventricular dilation and grossly impaired systolic function, leading to dilated heart failure. 141. A disproportionate thickening of the interventricular septum is the hallmark of which form of cardiomyopathy? Hypertrophic Hypertrophic. Only hypertrophic cardiomyopathy is characterized by a thickening of the septal wall, which may cause outflow obstruction to the left ventricle outflow tract. 142. Amyloidosis, hemochromatosis, or glycogen storage disease usually causes which form of cardiomyopathy? Restrictive Restrictive. Restrictive cardiomyopathy may occur idiopathically or as a cardiac manifestation of systemic diseases, such as scleroderma, amyloidosis, sarcoidosis, lymphoma, and hemochromatosis, or a number of inherited storage diseases. 143. Which condition is a cause of acquired aortic regurgitation? Rheumatic fever Rheumatic heart disease, bacterial endocarditis, syphilis, hypertension, connective tissue disorders (e.g., Marfan syndrome, ankylosing spondylitis), appetite suppressing medications, trauma, or atherosclerosis can cause acquired aortic regurgitation. 144. Which predominantly female valvular disorder is thought to have an autosomal dominant inheritance pattern, as well as being associated with connective tissue disease? Mitral valve prolapse Mitral valve prolapse. Mitral valve prolapse tends to be most prevalent in young women. Studies suggest an autosomal dominant and X-linked inheritance pattern. Because mitral valve prolapse often is associated with other inherited connective tissue disorders (e.g., Marfan syndrome, Ehlers-Danlos syndrome, osteogenesis imperfecta), it is thought to result from a genetic or environmental disruption of valvular development during the fifth or sixth week of gestation. 145. A patient is diagnosed with pulmonary disease and elevated pulmonary vascular resistance. Which form of heart failure may result from pulmonary disease and elevated pulmonary vascular resistance? Right heart failure Right heart failure. Right heart failure is defined as the inability of the right ventricle to provide adequate blood flow into the pulmonary circulation at a normal central venous pressure. This condition is often a result of pulmonary disease and the resulting elevated pulmonary vascular resistance.NURS 611-PATHO EXAM Question & Answer (GRADED A+) 19 146. In systolic heart failure, what effect does the renin-angiotensin-aldosterone system (RAAS) have on stroke volume? Increases preload and increases afterload. Increases preload and increases afterload. Activation of the RAAS not only causes an increase in preload and afterload, but it also causes direct toxicity to the myocardium. 147. What is the cause of the dyspnea resulting from a thoracic aneurysm? Pressure on surrounding organs Pressure on surrounding organs. Clinical manifestations depend on the location of the aneurysm. Pressure of a thoracic aneurysm on surrounding organs cause symptoms of dysphagia (difficulty in swallowing) and dyspnea (breathlessness). 148. Which statement is true concerning the cells’ ability to synthesize cholesterol? Most body cells are capable of producing cholesterol. Although cholesterol can easily be obtained from dietary fat intake, most body cells can also manufacture cholesterol. 149. What is the trigger for angina pectoris? Myocardial ischemia Myocardial ischemia. Angina pectoris is chest pain caused by myocardial ischemia. 150. Individuals being effectively managed for type 2 diabetes mellitus often experience a healthy decline in blood pressure as a result of what intervention? Insulin-sensitivity medication therapy Many people with type 2 diabetes mellitus, who are treated with drugs that increase insulin sensitivity, experience a decline in their blood pressure without taking antihypertensive drugs. 151. Which statements are true regarding fatty streaks? (Select all that apply.) a. Fatty streaks progressively damage vessel walls X b. Fatty streaks are capable of producing toxic oxygen radials. X c. When present, inflammatory changes occur to the vessel walls. X d. Oxidized low-density lipoproteins (LDLs) are involved in their formation. X e. Fatty streaks are formed by killer T cells filled with oxidized LDLs. A, B, C, D. The oxidized LDLs penetrate the intima of the arterial wall and are engulfed by macrophages. Macrophages filled with oxidized LDLs are called foam. Once these lipid-laden foam cells accumulate in significant amounts, they form a lesion called a fatty streak. Once formed, fatty streaks produce more toxic oxygen radicals and cause immunologic and inflammatory changes, resulting in progressive damage to the vessel wall.