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NR 507 Week 8 Final Exam Study Guide
NR 507 Week 8 Final Exam Study Guide Reproductive: endometrial cycle and the occurrence of ovulation; During the midfollicular phase, increasing levels ... [Show More] of estrogen contribute to endometrial repair and proliferation, thus increasing endometrial thickness (luteal phase). Once ovulation occurs and serum progesterone levels increase, the endometrial tissue develops secretory characteristics (secretory phase). If implantation of a fertilized ovum does not take place, endometrial tissue begins to break down approximately 11 days after ovulation (ischemic phase of menstruation) (see Fig. 24.9). Sloughing of tissue (menstrual bleeding) begins about 14 days after ovulation. uterine prolapse; A uterine prolapse is when the uterus descends toward or into the vagina. Prevention of constipation and treatment of chronic cough may help prevent uterine prolapse, the uterus slips down into or protrudes out of the vagina. 1. Cause = pelvic floor muscles and ligaments stretch and weaken, providing inadequate support 2. Risks - aging/gravity, pregnancy/birthing, straining 3. Treatment - nothing to pessary to hysterectomy polycystic ovarian syndrome excessive androgens that affect follicular decline by suppressing apoptosis, enabling follicles, which normally disintegrate to survive, infertility testicular cancer and conditions that increase risk; Firm, nontender testicular mass cancer is a germ cell tumor arising from the male gamete Most common cancer in men ages 15-34 Incidence higher in Caucasians 5:1 (Caucasian:African American) - undescended testes - first-born - pre/perinatal estrogen exposure - polyvinyl cholirde exposure - advanced maternal age - Down's syndrome - Klinefelter's syndrome (XXY) - CIS - HIV/AIDS symptoms that require evaluation for breast cancer; painless lump signs of premenstrual dysphoric disorder; Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are the cyclic recurrence (in the luteal phase of the menstrual cycle) of distressing physical, psychologic, or behavioral changes that impair interpersonal relationships or interfere with usual activities and resolve after menstruation. Emotional symptoms, particularly depression, anger, irritability, and fatigue, have been reported as the most prominent and the most distressing, whereas physical symptoms seem to be the least prevalent and problematic. Physical symptoms include breast tenderness, abdominal bloating, headache, and swelling of extremities. In addition, underlying physical or psychologic disease may be aggravated premenstrually and must be diagnosed and treated independently from PMS/PMDD. dysfunctional uterine bleeding; The clinical manifestations of a woman include the following: irregular or heavy bleeding, passage of large clots, and depletion of iron stores. This person is experiencing: pathophysiology of prostate cancer; normal prostate epithelium --> proliferative inflammatory atrophy --> prostatic intraepithelial neoplasia --> localized prostate cancer --> metastatic prostate cancer --> androgen-independent cancer, More than 95% of prostatic neoplasms are histologically similar to adenocarcinomas and rely on androgen-dependent signaling for their development and progression.108-110 Most of these neoplasms occur in the periphery of the prostate. Prostatic adenocarcinoma is a heterogeneous group of tumors with a diverse spectrum of molecular and pathologic characteristics, and therefore clinical behaviors and challenges.111 The biologic aggressiveness of the neoplasm appears to be related to the degree of differentiation rather than the size of the tumo HPV and the development of cervical cancer Endocrine: body’s process for adapting to high hormone levels; D) down-regulation. To adapt to high levels of hormones, some cells have the capacity to decrease the number of receptors for that hormone through the process of down-regulation. Cushing’s Syndrome; B) ectopic production of ACTH from a lung tumor. Cushing disease is excessive ACTH production most commonly caused by an adrenal adenoma or a non-pituitary adenoma as is often seen with lung cancer. Autoimmune destruction of the adrenal cortex results in hypocortisolism or Addison disease. Cushing syndrome occurs whenever there is an excessive level of cortisol regardless of cause. Excessive production of aldosterone from a tumor in the adrenal cortex causes hyperaldosteronism. Cushing disease is excessive cortisol secondary to increased ACTH. causes of hypoparathyroidism; Parathyroid gland injury or removal Parathyroid gland injury or surgical removal of the gland is the most common cause of hypoparathyroidism. lab results that point to primary hypothyroidism; Primary hypothyroidism Low levels of T3 and T4 production caused by the destruction or removal of the thyroid gland (primary hypothyroidism) stimulate the anterior pituitary to increase the production of TSH. An endocrinologist orders a series of lab tests to assess thyroid function. Low levels of thyroid hormone (T3 and T4) and high levels of thyroid-stimulating hormone (TSH) are indicative of: pathophysiology of thyroid storm; Fever and tachycardia leading to high-output heart failure High levels of thyroid hormone in conjunction with high levels of stress hormones lead to fever, tachycardia, and eventually high-ouput heart failure if the condition is not treated. signs of thyrotoxicosis; Weight loss and enlarged thyroid gland Weight loss and enlarged thyroid gland are common signs of hyperthyroidism in thyrotoxicosis Neurological: dermatomes; Sensory innervation by a single spinal nerve in the skin is ___ A dermatome is the area of the skin of the human anatomy that is mainly supplied by branches of a single spinal sensory nerve root. These spinal sensory nerves enter the nerve root at the spinal cord, and their branches reach to the periphery of the body. The sensory nerves in the periphery of the body are a type of nerve that transmits signals from sensations (for example, pain symptoms, touch, temperature) to the spinal cord from specific areas of our anatomy. substance release at the synapse; Chemicals, called neurotransmitters, are released from one neuron at the presynaptic nerve terminal. Spondylolysis; structural defect either degenerative or developmental of the vertebra. heredity and associated with other malformations of the spine location of the motor and sensory areas of the brain; motor: Location: Precentral gyrus of frontal lobe of each hemisphere sensory: Location: Postcentral gyrus of the parietal lobe pathophysiology of cerebral infarction and excitotoxins; In the pathophysiology of cerebral infarction, the release of which substance is associated with neuron hyperpolarization and seizure activity? excitotoxins c. release of excitotoxins especially aspartate and glutamate - these are normal neurotransmitters that are released in toxic amounts during brain injury of any kind agnosia; Agnosia is the inability to process sensory information. Often there is a loss of ability to recognize objects, persons, sounds, shapes, or smells while the specific sense is not defective nor is there any significant memory loss. accumulation of blood in a subarachnoid hemorrhage; A) in the cerebrospinal fluid (CSF) between the brain and skull. most common cause of meningitis; Viral infections are the most common cause of meningitis Neisseria Meningitides (meningococcus) and Streptococcus pneumoniae (pnemococcus) Genitourinary: diet and the prevention of prostate cancer; Epidemiologic studies have found total fat intake, animal and saturated fat, red meat, and dairy products are associated with an increase in prostate cancer risk. Healthy lifestyles Diet low in red meats and high in vegetable and fruits Exercise Impact of Benign Prostatic Hypertrophy (BPH) on the urinary system -kidney disorders caused by pressure and back flow of urine - post renal -recurrent UTI's -pyelonephritis -sepsis-infection gets in blood -secondary renal insufficiency Genetics: the role of DNA in genetics; DNA stores, copies and transmits the genetic information in a cell. transcription; RNA is formed from DNA in a process that is called transcription and requires the enzyme RNA polymerase. RNA serves as the bridge between DNA and protein synthesis. effects of genetic mutations; -Any type of mutation in DNA or RNA can result in a nonfunctional protein or one with reduced function -A silent point mutation does not change protein function, a missense point mutation usually reduces protein function, and a nonsense mutation often eliminates protein function Trisomy; [BLANK_AUDIO] -Trisomy 21 -A person has 47 chromosomes with an extra chromosome in the 21 position -Due to nondisjunction, or the failure of chromosome pairs to separate properly during meiosis -This leads to a sperm or egg cell to have 24 chromosomes (instead of 23) -After conception, the extra chromosome is replicated in each cell in the embryo When we fertilize these abnormal gametes with normal gametes, what we will end up with is then a mixture of chromosomes. Extra amounts trisomy, cuz our gamete had two chromosomes instead of the one it should have. So we bring in the gamete with the matching chromosome. And now we have two plus one is a trisomy. In this case, the gamete didn't get the chromosome it needed. And so, the normal gamete that fertilizes it will not have a mate. So, we have monosomy. And when we have nondisjunction, the overall effect in meiosis will always be significant. Because this results in aneuploidy. Gamete cells that do not contain 23 chromosomes, the resulting embryo will have fewer or extra chromosomes. And not all of the abnormal embryos may even survive. [BLANK_AUDIO] When we have aneuploidy of the sex chromosome, during meiosis. This results in conditions such as Klinefelter syndrome, or Turner syndrome. Where we have an abnormal amount of the sex chromosomes, either too few or too many. Abnormalities are aneuploidy of sex chromosomes are always gender specific. So an individual with Klinefelter syndrome, even though they have two X chromosomes, the normal genotype for a female, that Y chromosome will still cause development of male characteristics. So Klinefelter syndrome that individual is genetically male. In the case of Turner syndrome that individual is missing one of the sex chromosomes. And so they have still one X chromosome. They will be typically female. But with a genetic abnormalities present. An employee of autosomal chromosomes results, it conditions such as Down syndrome trisomy 21 or Edwards syndrome Trisomy 18. Since these don't involve the sex chromosomes. These are not gender specific meaning that they can occur in either male or female. Down Syndrome; Down syndrome, a trisomy of chromosome 21, is the most well-known disease caused by a chromosome aberration. It affects 1 in 800 live births and is much more likely to occur in the offspring of women older than 35 years of age. Klinefelter syndrome; Klinefelter syndrome smallness of testes with fibrosis and hyalinization of seminiferous tubules, variable degrees of masculinization, azoospermia, infertility, and increased levels of urinary gonadotropins; associated typically with an XXY chromosome complement although variants include XXYY, XXXY, and XXXXY. also known as 47,XXY or XXY, is the set of symptoms that result from two or more X chromosomes in males. The primary features are infertility and small testicles. Often, symptoms may be subtle and many people do not realize they are affected. ... Klinefelter syndrome usually occurs randomly. diseases that have multifactorial traits; They include isolated cleft lip and/or cleft palate (CL/P), neural tube defects (anencephaly, spina bifida), clubfoot (talipes), and some forms of congenital heart disease. multifactorial inheritance; When environmental factors are also believed to cause variation in the trait, which is usually the case, the term multifactorial trait is used When the trait/disease is the consequence of the combined effect of mutations in multiple genes +/- environmental effects. Usually do not show a clear pattern of mendelian inheritance. The more genes that combine to produce the trait the more possible phenotypes there are resulting in a normal distribution within the population. low heritability (most affected progeny have unaffected parents), relationship by blood slightly increases the risk for an affected offspring, risk of affected relatives falls off very quickly with the degree of relationship, risk increases with the number of affected offspring in a family (indicated parents more likely to be closer to the threshold), a more severely affected parent is more likely to produce an affected offspring. Duchenne muscular dystrophy; Duchenne muscular dystrophy (DMD) is a genetic disorder characterized by progressive muscle degeneration and weakness. It is one of nine types of muscular dystrophy. DMD is caused by an absence of dystrophin, a protein that helps keep muscle cells intact. first affecting the muscles of the hips, pelvic area, thighs and shoulders, and later the skeletal (voluntary) muscles in the arms, legs and trunk. The calves often are enlarged. Neurofibromatosis Neurofibromatosis is a genetic disorder that causes tumors to form on nerve tissue. These tumors can develop anywhere in your nervous system, including your brain, spinal cord and nerves. Neurofibromatosis is usually diagnosed in childhood or early adulthood Musculoskeletal: ions that initiate muscle contraction; Calcium growth of long bones in children; takes place in the epiphyseal plate. bones belonging to the appendicular skeleton; Ilium Immunity/Inflammation: how vaccines are formed; B) an attenuated antigen, a dead antigen, a detoxified toxin. populations at risk for getting systemic fungal infections and parasitic infections; immunocompromised systemic manifestations of infection; interleukin 1? Fever (pyrexia), Leukocytosis, & increase plasma protein synthesis wich are called acute phase reactants. mechanisms responsible for the increase in antimicrobial resistance worldwide; the misuse and overuse of antimicrobials is accelerating this process functions of normal flora in the body; The functions of the normal flora include digestion of substrates, production of vitamins, stimulation of cell maturation, stimulation of the immune system, aid in intestinal transit and colonization resistance desensitization therapy; improves allergies by which of the following mechanisms? Producing antibodies that prevent the allergen from binding to IgE cells involved in “left shift” in the WBC count differential; Bands and PMN's forms of immunity; If a person has innate resistance to a disease, the person has _____ immunity. A) natural If a person has resistance to a disease from natural exposure to an antigen, the person has which form of immunity?D) Active naturally acquired Humoral immunity is generated through the process of:C) producing antibodies. What type of immunity is conferred when an individual is given a vaccine? C) Active acquired immunity major histocompatibility class I antigens; are found in All body cells except for red blood cells inflammatory chemicals blocked by anti-inflammatory drugs; prostaglandins characteristics of acute phase reactant C-reactive protein A) Produced by the liver, B) Plasma indicator of inflammation, C) Significant risk factor for heart disease Dermatology: process by which a deep pressure ulcer heals; Secondary intention Successful healing requires continued adequate relief of pressure; débridement of dead tissue; opening of deep pockets for drainage; and repair of damaged tissue by construction of skin flaps for large, deep ulcers. Negative-pressure wound healing is used in the treatment of advanced-stage pressure injuries, but clinical trials are lacking.13 Infection requires treatment with topical and/or systemic agents, but there are no clear guidelines.14 Pain must be controlled. Randomized controlled trials are needed to determine the best methods for treating pressure injuries. Deep injuries develop closer to the bone as a result of tissue distortion and vascular occlusion from pressure that is perpendicular to the tissue (over the heels, trochanter, and ischia). Bacteria colonize the dead tissue, and infection is usually localized and self-limiting. Proteolytic enzymes from bacteria and macrophages dissolve necrotic tissues and cause a foul-smelling discharge that resembles, but is not, pus. The necrotic tissue initiates an inflammatory response with potential pain, fever, and leukocytosis. If the ulceration is large, toxicity and pain lead to a host of possible complications, including loss of appetite, debility, local/systemic infections, and renal insufficiency complications of the development of contractures during wound healing Excessive wound contraction may result in a deformity or contracture. Burn wounds are especially susceptible to the development of contractures. Internal contractures may occur as well, and are common in cirrhosis of the liver. Internally, scar tissue that becomes contracted constricts blood flow that may contribute to the development of portal hypertension and esophageal varices. Other types of internal contraction deformity include duodenal strictures caused by dysfunctional healing of an ulcer and esophageal strictures caused by chemical burns. Proper positioning and range-of-motion exercises, as well as surgery, are among the physical means used to overcome the excessive myofibroblast-derived tension that results in contractures. Clinical use of pharmacologic methods for control of wound contracture is still largely experimental, but includes control of myofibroblast contraction by the administration of smooth muscle cell inhibitors such as colchicine and inhibition of proper collagen matrix assembly with drugs that prevent either collagen cross-linking or MMP activity. These latter treatments are based on the knowledge that myofibroblast binding to collagen can “lock” contracted cells into position. Acid/Base: • causes of respiratory alkalosis; hyperventilation (anxiety, aspirin overdose) • Respiratory alkalosis occurs when there is alveolar hyperventilation and decreased concentration of plasma carbon dioxide (termed hypocapnia), thus increasing the ratio of HcO3 to PCO2 (H2CO3). Stimulation of ventilation is precipitated by hypoxemia (i.e., high altitudes); hypermetabolic states such as fever, anemia, and thyrotoxicosis; early salicylate intoxication; or anxiety or panic disorder. Improper use of mechanical ventilators can cause iatrogenic respiratory alkalosis. Secondary respiratory alkalosis may develop from hyperventilation stimulated by metabolic acidosis, causing a mixed acid-base disorder. Stress[1] • Pulmonary disorder[2] • Thermal insult[5] • High altitude areas[6] • Salicylate poisoning (aspirin overdose)[6] • Fever[1] • Hyperventilation (due to heart disorder or other, including improper mechanical ventilation)[1][7] • Vocal cord paralysis (compensation for loss of vocal volume results in over-breathing/breathlessness).[8] • Liver disease[6] molecules that act as buffers in the blood; Buffering occurs in response to changes in acid-base status. Buffers can absorb excessive H+ (acid) or hydroxyl ion (OH−) (base) to minimize fluctuations in pH. The buffer systems are located in both the ICF and the ECF compartments, and they function at different rates. Buffer systems exist as buffer pairs, consisting of a weak acid and its conjugate base (Table 3.11). The most important plasma buffer systems are bicarbonate–carbonic acid and hemoglobin. Phosphate and protein are the most important intracellular buffers and provide a first line of defense. Ammonia and phosphate can attach hydrogen ion and are important renal buffers. The carbonic acid–bicarbonate buffer pair operates in both the lung and the kidney. The greater the carbon dioxide partial pressure (PCO2), the more carbonic acid is formed. The buffer systems of the body also act to stabilize the acid-base balance (pH). There are three major buffer systems, with the plasma buffer system being the quickest to act (within seconds), whereas the respiratory system responds in minutes. The renal system is more powerful but responds over a period of hours to days. Each buffer system has a differing ability to compensate or correct acid-base disturbances. For example, respiratory compensation for a primary metabolic acid-base disorder can be initiated within minutes. However, the respiratory system can compensate for a metabolic disorder but requires the kidneys to fully correct the imbalance. Chronic respiratory acid-base disturbances can be fully compensated by renal activity, but the ultimate correction occurs through the regulation of carbon dioxide. Cardiovascular: most common cardiac valve disease in women; Mitral valve prolapse when myocardial ischemia may be reversible; Anaerobic metabolism maintains basic cellular integrity for approximately 20 minutes, although cardiac output during this time can be dramatically reduced. Individuals with reversible myocardial ischemia present clinically in several ways. Chronic atherosclerotic coronary obstruction usually results in recurrent predictable chest pain called stable angina. Abnormal vasospasm of coronary vessels results in unpredictable chest pain called Prinzmetal angina. Myocardial ischemia that does not cause detectable symptoms is called silent ischemia. . Reversible myocardial ischemia presents clinically in several ways. Chronic coronary obstruction results in recurrent predictable chest pain called stable angina. Abnormal vasospasm of coronary vessels results in unpredictable chest pain called Prinzmetal angina. Myocardial ischemia that does not cause detectable symptoms is called silent ischemia. Unstable angina causes reversible myocardial ischemia and is a harbinger of impending infarction. MI results when prolonged ischemia causes irreversible damage to the heart muscle. Sudden cardiac death can occur in any of the acute coronary syndromes. Reversibility of damage to ischemic myocardium after reperfusion may mainly occur within 60-min ischemia symptoms of stable angina; Severe substernal pain that lasts more than a few hours Severe substernal pain lasting more than a few hours is a symptom of a myocardial infarctioin. Stable angina manifests with chest tightness or discomfort that goes away with rest. Angina pectoris is chest pain caused by myocardial ischemia. Stable angina is caused by gradual luminal narrowing and hardening of the arterial walls, so that affected vessels cannot dilate in response to increased myocardial demand associated with physical exertion or emotional stress. With rest, blood flow is restored and no necrosis of myocardial cells results. Angina pectoris is typically experienced as transient substernal chest discomfort, ranging from a sensation of heaviness or pressure to moderately severe pain. Individuals often describe the sensation by clenching a fist over the left sternal border. The discomfort may be mistaken for indigestion. The pain is caused by the buildup of lactic acid or abnormal stretching of the ischemic myocardium that irritates myocardial nerve fibers. These afferent sympathetic fibers enter the spinal cord from levels C3 to T4, accounting for the variety of locations and radiation patterns of anginal pain. Pain may radiate to the neck, lower jaw, left arm, and left shoulder or occasionally to the back or down the right arm. Pallor, diaphoresis, and dyspnea may be associated with the pain. The pain is usually relieved by rest and nitrates. Myocardial ischemia in women may not present with typical angina. Common symptoms in women include atypical chest pain, palpitations, sense of unease, and severe fatigue. In addition, it is estimated that half of women with stable angina do not have obstructive coronary artery disease, but rather have microvascular angina that results from vasoconstriction of small coronary arterioles deep in the myocardium116 (see What's New? Women and Microvascular Angina). Similarly, in individuals who have autonomic nervous system dysfunction, such as older adults or those with diabetes, angina may be mild, atypical, or even silent (see the following). orthostatic hypotension; Stands up Orthostatic hypotension refers to a decrease in blood pressure upon standing and is caused by the gravitational changes on the circulation that are inadequately compensated for. The term orthostatic (postural) hypotension (OH) refers to a decrease in systolic blood pressure of at least 20 mmHg or a decrease in diastolic blood pressure of at least 10 mmHg within 3 minutes of moving to a standing position.55 Primary OH is often called neurogenic and is usually the result of neurologic disorders that affect autonomic function. Compensatory changes during standing normally increase sympathetic activity mediated through stretch receptors (baroreceptors) in the carotid sinus and the aortic arch (see Chapter 32). This reflex response to shifts in volume caused by postural changes leads to a prompt increase in heart rate and constriction of the systemic arterioles, which maintains a stable blood pressure. These compensatory mechanisms are not effective in maintaining a stable blood pressure in individuals with orthostatic hypotension. Primary OH is often chronic. Older adults are susceptible to this type of OH because of slowing of postural reflexes as part of the aging process. It also occurs in neurologic diseases, such as Parkinson disease, multiple system atrophy, and inherited neurologic disorders. Multiple system atrophy is a severe form of chronic autonomic failure in which there are multiple central nervous system degenerative changes, and Parkinson disease. Individuals with this disorder also may exhibit supine hypertension, altered drug sensitivity, hyperresponsiveness of blood pressure to hypo/hyperventilation, sleep apnea, and other neurologic disturbances.56Primary OH is a significant risk factor for falls and associated injury. It also is associated with an increased risk of death, coronary artery disease, heart failure, and stroke.57 Secondary OH is often acute and associated with (1) altered body chemistry, (2) drug action (e.g., antihypertensives or antidepressants), (3) prolonged immobility caused by illness, (4) starvation, (5) physical exhaustion, (6) any condition that produces volume depletion (e.g., massive diuresis, potassium or sodium depletion), and (7) any condition that results in venous pooling (e.g., pregnancy, extensive varicosities of the lower extremities). Other more chronic forms of secondary OH are seen with adrenal insufficiency, diabetes mellitus, cardiovascular diseases, and paraneoplastic syndromes.57 Orthostatic hypotension often is accompanied by dizziness, blurring or loss of vision, and syncope or fainting. To assess hypotensive episode frequency, severity, and correlation with symptoms, 24-hour blood pressure monitoring is recommended. Basic diagnostic tests include ECG and blood electrolyte measurements. Other tests in selected individuals may include autonomic testing, serum catecholamine measurements, and heart rate variability testing. Treatment for secondary OH is focused on correcting the underlying disorder. No curative treatment is available for primary orthostatic hypertension. Management includes liberalizing salt intake; raising the head of the bed; wearing thigh-high stockings; and administering erythropoietin, somatostatin, volume expansion with mineralocorticoids, and vasoconstrictors, such as midodrine and pyridostigmine isolated systolic hypertension; Isolated systolic hypertension (ISH) is elevated systolic blood pressure accompanied by normal diastolic blood pressure (less than 90 mmHg). ISH is becoming more prevalent in all age groups and is strongly associated with cardiovascular and cerebrovascular events.5loss of elasticity of the arteries resulting in an increase in cardiac output or stroke volume, a systolic blood pressure consistently greater than 160 mmHg, and a diastolic pressure less than 90 mmHg. results of sustained controlled hypertension; Vascular remodeling Over time, prolonged vasoconstriction can result in permanent remodeling of blood vessel walls. Renal disease, stroke and retinal damage High pressures in the vasculature cause damage to many organs, including the eye (retinal injury), kidneys (nephrosclerosis), and brain (aneurysm resulting in stroke). In the healthy individual, the RAAS provides an important homeostatic mechanism for maintaining adequate blood pressure and therefore tissue perfusion (see Chapter 32). In hypertensive individuals, overactivity of the RAAS contributes to salt and water retention and increased vascular resistance. In the brain, angiotensin (ang) II enhances sympathetic neural outflow and alters the release of hormones that contribute to endothelial dysfunction, insulin resistance, dyslipidemia, and platelet aggregation.23 Further, ang II mediates arteriolar remodeling, which is a structural change in the vessel wall that results in permanent increases in peripheral resistance24 (see Figs. 33.5 and 32.28). Ang II is associated with end-organ effects of hypertension, including atherosclerosis, renal disease, and cardiac hypertrophy. Decreased renal salt excretion. (shift in pressure-natriuresis relationship) the relationship of insulin resistance on the development of primary hypertension; Insulin resistance activates the sympathetic nervous system, contributes to the development of diabetes, dyslipidemia, and eventually atherosclerosis, and promotes thrombus formation Insulin resistance contributes to increases in SNS activity, peripheral resistance, endothelial injury and thrombus formation. Finally, insulin resistance is common in hypertension, even in individuals without clinical diabetes. Insulin resistance is associated with endothelial injury and affects renal function, causing renal salt and water retention.37 Insulin resistance is associated with overactivity of the SNS and the RAAS. It is interesting to note that in many individuals with diabetes treated with drugs that increase insulin sensitivity, blood pressure often declines, even in the absence of antihypertensive drugs. The interactions between obesity, hypertension, insulin resistance, and lipid disorders in the metabolic syndrome result in a high risk of cardiovascular disease defects in the normal secretion of natriuretic hormones and the impact on renal system; Sodium Natriuretic hormones affect renal reabsorption of sodium. The natriuretic hormones modulate renal sodium (Na+) excretion and require adequate potassium, calcium, and magnesium to function properly. The natriuretic hormones include atrial natriuretic peptide (ANP), B-type natriuretic peptide (BNP), C-type natriuretic peptide (CNP), and urodilatin. These hormones induce diuresis; enhancement of renal blood flow and glomerular filtration rate, systemic vasodilatation, and suppression of aldosterone; and inhibition of the SNS. Dysfunction of these hormones, along with alterations in the RAAS and the SNS, cause an increase in vascular tone and a shift in the pressure-natriuresis relationship. When there is inadequate natriuretic function, serum levels of the natriuretic peptides rise in an attempt to compensate. In hypertension, increased ANP and BNP levels are linked to an increased risk for ventricular hypertrophy, atherosclerosis, and heart failure.28 Salt retention leads to water retention and increased blood volume, which contributes to an increase in blood pressure. Subtle renal injury results, with renal vasoconstriction and tissue ischemia. Tissue ischemia causes inflammation of the kidney and contributes to dysfunction of the glomeruli and tubules and promotes additional sodium retention. Increasing dietary intake of potassium, calcium, and magnesium can enhance natriuretic peptide function. New natriuretic peptide agonists are being studied. effects of increased sympathetic nervous system activity due to primary hypertension; Peripheral vasoconstriction A major factor in the development of primary hypertension is vasoconstriction and increased peripheral resistance caused by abnormal SNS activity. The SNS contributes to the pathogenesis of hypertension in many people. In the healthy individual, the SNS contributes to the maintenance of adequate blood pressure and tissue perfusion by promoting cardiac contractility and heart rate (maintenance of adequate cardiac output) and by inducing arteriolar vasoconstriction (maintenance of adequate peripheral resistance). In individuals with hypertension, overactivity of the SNS can result from increased production of catecholamines (epinephrine and norepinephrine) or from increased receptor reactivity involving these neurotransmitters.22 Increased SNS activity causes increased heart rate and systemic vasoconstriction, thus raising the blood pressure. Efferent sympathetic outflow stimulates renin release, increases tubular sodium reabsorption, and reduces renal blood flow. Additional mechanisms of SNS-induced hypertension include structural changes in blood vessels (vascular remodeling), insulin resistance, increased renin and angiotensin levels, and procoagulant effects.22 The SNS is implicated in the cardiovascular and renal complications of hypertension. Beta-blocking medications oppose the effects of the SNS and have been used for decades in the treatment of hypertension. However, because of their side effects, these medications are no longer considered first-line treatment. The role of the SNS in the pathogenesis of cardiovascular disease is summarized in complications of unstable plaque in the coronary arteries; Myocardial infarction An unstable plaque can rupture, and the resulting thrombus can obstruct the lumen, causing an abrupt halt to myocardial blood flow. This event is called a myocardial infarction Many plaques, however, are “unstable,” meaning they are prone to rupture even before they affect blood flow and are clinically silent until they rupture. Plaque rupture occurs because of the inflammatory activation of proteinases (matrix metalloproteinases and cathepsins), apoptosis of cells within the plaque, and bleeding within the lesion (plaque hemorrhage).76,77 Plaques that have ruptured are called complicated plaques (see Fig. 33.12). Once rupture occurs, exposure of underlying tissue results in platelet adhesion, initiation of the clotting cascade, and rapid thrombus formation that may suddenly occlude the affected vessel, resulting in ischemia and infarction. Aspirin or other antithrombotic agents are used to prevent this complication of atherosclerotic disease. forms of dyslipidemia associated with the development of the fatty streak in atherosclerosis; High LDL In atherosclerosis, LDL adheres to the injured endothelium and is oxidized by macrophages to form the fatty streak. High serum LDL is a risk factor for atherosclerosis. Injured endothelial cells become inflamed and cannot make normal amounts of antithrombotic and vasodilating cytokines. The adventitia also plays an important role through production of reactive oxygen species and activation of endothelial inflammation.72 Low-density lipoprotein (LDL) penetrates into the subintima of arterial walls, where it is trapped by proteoglycans (Fig. 33.13). Inflammation, oxidative stress, and activation of macrophages cause the aggregated LDL to become oxidized. Hypertension, increased levels of LDL, oxidative stress, and activation of the renin-angiotensin-aldosterone system all contribute to an acceleration of this step in atherogenesis.73 Inflammation and oxidized LDL cause endothelial cells to express adhesion molecules that bind monocytes and other inflammatory and immune cells. Monocytes penetrate the vessel wall becoming macrophages. Several types of receptors on these macrophages (toll-like receptors [TLRs] and LDL receptor-related protein [LRP]) enable detection and engulfment of the oxidized LDL.74 These lipid-laden macrophages are now called foam cells, and when they accumulate in significant amounts, they form a lesion called a fatty streak and numerous inflammatory cytokines are released (e.g., tumor necrosis factor-alpha [TNF-α], interferons, interleukins, and C-reactive protein), as well as enzymes that further injure the vessel wall.75 Growth factors also are released, including ang II, fibroblast growth factor, TGF-β, and platelet- [Show Less]
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NR 507 Advanced Patho Week 2 Quiz
NR 507 Advanced Patho Week 2 Quiz 1. All of the following are characteristics that occur with any type of acute inflammation except? p.214 a. Redness b.... [Show More] Pain c. Swelling d. Fever – mccance 2. The primary phagocytic cells in the immune systems are (p. 199) a. Macrophages b. Mast Cells c. Eosinophils d. Cytotoxic T-Cells 3. Which of the ff is NOT a function of T- Cells? a. Antibody synthesis * b. Interleukin production c. Cell lysis d. Stimulation of B-cells 4. Chronic inflammation is defined as a long- term inflammatory response that last? P.214 a. More than 1 week b. More than 2 months c. More than 2 weeks * d. One or more year 5. The immune components to appear first in ANY immune response are? a. IgM b. T-cells c. Neutrophils * d. Eosinophils 6. Biopsy results for tumor staging would indicate? P. 394 a. Stage 1 tumor cells are well differentiated, and the patient has a good prognosis * b. Stage 4 tumor cells are well differentiated and not likely to metastasize c. Stage 2 tumor cells are poorly differentiated with spread to regional structures d. Stage 3 is localized evasion of cancer cells 7. The process by which tumors develop new vascular networks is? a. Angiogenesis b. Differentiation c. Anaplasia d. Apoptosis 8. The TNM classification system for clinical staging of cancer indicates p. 1238 a. Tumor size, node, metastasis* b. Tissue type, necrosis, mitosis rate c. Tissue type, necrosis, myosis rate d. Tumor size. Nodule, morphology 9. All of the ff are characteristics of benign cells EXCEPT? P.364 a. Slow growth rate b. Low reoccurrence frequency c. Invasive d. Cell differentiated 10. All of the ff statements are true concerning the development of cancer EXCEPT? a. Tumor cells are descendants of multiple mutant cells b. Usually the result of 3 or more independent DNA mutation events c. Cancer cells have a higher than normal level of telomerase d. Can occur as the result of over activation of proto-oncogene 11. Which would not shift the blood pH towards alkalosis? Fig 3-15, p 128 a. Increased exhalation of carbon dioxide b. Excessive used of antacids c. Increased bicarbonate ion (HCO3-) excretion in urine d. Increased H+ secretion into urine 12. Hypoventilation can result in____________ leading to _____________ p. 130 a. HCO3- retention, respiratory acidosis b. Co2 retention, respiratory alkalosis c. H+ loss, metabolic alkalosis d. Co2 retention, respiratory acidosis 13. The body fluid compartment that includes cerebral spinal fluid, peritoneal, and synovial fluid is known as? a. Intracellular fluid (ICF) b. Extracellular fluid (ECF) c. Interstitial fluid (IF) d. Plasma (IV) 14. Most of our body water is located in? a. In the interstitium (IF) b. Inside the cell (ICF) c. In the blood vessels (IV) d. In the extracellular area (ECF) 15. Interstitial fluid (IF) is located? a. Outside the blood vessels b. Inside the cells c. Inside the blood vessels d. Inside lymph vessels 16. A deficiency in oxygen will cause all of the ff except? P. 29 fig 1-26 a. Shift from Krebs Cycle to glycolysis b. Decreased production of ATP c. Increased intracellular pH due to lactic accumulation 17. Which of the following organelle-function pairs is NOT correctly matched? P. 11 a. Mitochondria- sites of ATP synthesis b. Microfilaments-site of DNA synthesis c. Ribosomes- sites of protein synthesis d. Golgi apparatus-site of protein packaging 18. The endoplasmic reticulum (ER) provides a large surface area within the cells in which: p. 5 a. ATP is generated b. The chemical reactions of glycolysis occur c. DNA is replicated and transcribed d. Material is synthesized and transported within the cell. 19. Which cell structure is responsible for digestion of foreign debris and worn out part of the cells? P. 7 a. Lysosomes b. Ribosomes c. Endoplasmic reticulum (ER) d. Golgi apparatus 20. The fluid Mosaic model explains: p. 12 a. How cellular metabolism occurs b. How electrolyte levels are regulated c. Why our body is mainly composed of fluids d. How the cell membranes functions [Show Less]
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NR 507 Week 2 Assignment: Disease Process Presentation Part 1: Schizophrenia
NR 507 Week 2 Assignment: Disease Process Presentation Part 1: Schizophrenia PPT
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NR 507 Week 2 Assignment: Disease Process Assignment Part 1: Anemia Disease
NR 507 Week 2 Assignment: Disease Process Assignment Part 1: Anemia Disease Anemia Disease Process Chamberlain College of Nursing NR 507: Advanced Patho... [Show More] physiology Anemia Disease Process Anemia is a condition in which the body does not have the proper amount of red blood cells to carry hemoglobin throughout the body. There are many different reasons as to why one might have the diagnosis of Anemia. Etiology and Risk Factors Iron deficiency anemia (IDA) occurs when there is not enough iron absorbed from one’s diet. These individuals either do not consume enough iron or have an excessive iron loss. Iron deficiency can also occur from trauma resulting in excessive blood loss. Some causes included: o Decrease iron intake due to poor intake (19%) o Impaired absorption of iron (41%) o Gastric surgery (10%) o Celiac disease (6%) o Pica o Gastrointestinal Bleed (56%) o Hemorrhoids (16%) o Pregnancy/lactation (6%) o Unknown cause (17%) (Epocrates, 2019) Anyone can develop IDA at any time, but there are some who are more prone than others. Women are at a higher risk due to menstruation which is related to blood loss. Infants that are born with low birth weight or children going through a growth spurt are at risk for anemia. Individuals who do not eat meat, vegetarians, do not consume enough iron in their diet due to not eating meat or other iron-rich foods (Mayo Clinic, 2016. People who are frequent blood donors are also at risk because they are suffering a blood loss. Their bodies need time to recover from their loss to regenerate new red blood cells. They may need more time than required in between donations (Mayo Clinic, 2016). Pernicious anemia is caused by a lack of intrinsic factor which aids in the absorption of vitamin B12. There is an autoimmune response that causes the body to attack and destroy the parietal cells. These are the cells that are responsible for producing intrinsic factor (NHLBI, 2018). When the body is not able produce intrinsic factor there is then a high chance of developing pernicious anemia. Risk factors for having pernicious anemia are as followed: o Malabsorption in the small intestine Different diseases can interfere with vitamin B12 absorption Celiac Disease Crohn’s Disease HIV Medications prevent absorption of vitamin B 12 Antibiotics Anti-seizure medications Surgical removal of some or all of the stomach o Lack of vitamin B12 in one’s diet (NHLBI, 2018) The most common type of people at risk for developing pernicious anemia are those of Northern European and African descent. The elder generation carries a high risk due to lack of stomach acid and intrinsic factor. The younger generation is at risk if there is a family history, had part or all of their stomach or small intestines removed, has an autoimmune disorder affecting the endocrine glands, or are a vegetarian (NHLBI, 2018). Anemia and the Injury to the Body Iron deficiency anemia is the most common type of anemia. This type of anemia can occur for different reasons. For example, whenever one losses blood, whether it be a cut or a traumatic injury, they lose iron as well. There are certain conditions or medications that can cause blood loss that leads to iron deficiency anemia. Some of these include bleeding in the gastrointestinal tract, rare genetic conditions, frequent blood donations/blood test, heavy menstrual periods, injury or surgery, and urinary tract bleeding (NHLBI, 2018). Another reason for iron deficiency anemia is a lack of consumption of iron, based on daily requirements. On the other hand, some individuals consume the daily recommended amount of iron and remain anemic. This is due to their body not being able to absorb iron. Individuals who have this form of anemia could have an intestinal or digestive condition (celiac disease, inflammatory bowel disease, or Helicobacter pylori infection), a history of gastrointestinal surgery, or certain rare genetic conditions such as TMRPSS6 (NHLBI, 2018). This is a gene mutation that produces too much of a hormone called hepcidin that blocks the intestine from absorbing iron. Lastly, there are other medical conditions such as end-stage kidney failure or inflammation from congestive heart failure or obesity that can result in iron deficiency anemia. Individuals with end-stage kidney failure have blood loss due to dialysis. As previously mentioned, blood loss can relate to iron deficiency anemia. These individuals usually take medications such as proton pump inhibitors, anticoagulants, or blood thinners. These medications act as a catch twenty-two because they need them but proton pump inhibitors interfere with iron absorption while blood thinners increase the individual’s risk of gastrointestinal bleeding. Congestive heart failure or obesity can cause inflammation that can result in iron deficiency anemia (NHLBI, 2018). Iron deficiency anemia can be an easy fix such as consuming more iron daily or it can tend to be more difficult and need more in-depth solutions. As mentioned earlier, pernicious anemia is when the body is not able to make enough red blood cells because there are not enough vitamin B12 absorption occurring in the body (NHLBI, 2018). But how is there not enough B12 in one’s body? Individuals who are found to have pernicious anemia are unable to absorb vitamin B12 from food sources. This is due to the fact that these individuals lack intrinsic factor. Intrinsic factor is a protein that is made in the stomach. When the stomach is not able to produce this protein, the result is a vitamin B12 deficiency (Toh, 2016). This is an autoimmune response from the individual’s immune system to make antibodies that unadvisedly attacks and damages its own tissues and cells. Therefore, individuals with pernicious anemia tend to make antibodies that attack the parietal cells. These cells are what lines the stomach and are responsible for making intrinsic factor. Currently, there is no clear reason as to why this autoimmune response occurs. Due to the lack of intrinsic factor in the gastrointestinal system, the vitamin B12 that is present cannot be absorbed (NHLBI, 2018). When the body lacks significant amounts of vitamin B 12, the body is unable to properly synthesize DNA. This then affects the production of red blood cells. Red blood cells are able to divide but the nuclei will not mature. These types of red blood cells are called megaloblasts. These cells are destroyed when in the bone marrow and do not reach the circulatory system. However, some of the cells mature and become large red blood cells called macrocytes (The Editors of Encyclopaedia Britannica, 2019). When these cells reach the circulatory system, they function abnormally resulting in other blood conditions. Role of the Nurse Practitioner As a Family Nurse practitioner, my role would first determine the type of anemia prior to making a treatment plan. Some treatments would include seeing a dietician for diet modification, nutritional supplements, or medications. If there is a family history it is important to closely monitor a patient (The Nurse Practitioner, 2005). Whenever the patient starts to show changed in laboratory work or physically then intervention is needed. Some individuals may have anemia due to an underlying disease. It is important to address this underlying disease while maintaining one’s anemia. Conclusion Papers should end with a conclusion or summary. The assignment directions will specify which is required. It should be concise and contain little or no detail. No matter how much space is left on the page, the references always start on a separate page (insert a page break). References Epocrates. (2019). Iron Deficiency Anemia. Retrieved March 11, 2019, from https://online.epocrates.com/diseases/9424/Iron-deficiency-anemia/Etiology Mayo Clinic. (2016, November 11). Iron deficiency anemia. Retrieved March 11, 2019, from https://www.mayoclinic.org/diseases-conditions/iron-deficiency-anemia/symptoms-causes/syc-20355034 National Heart, Lung, and Blood Institute. (2018). Pernicious Anemia. Retrieved March 7, 2019, from https://www.nhlbi.nih.gov/health-topics/pernicious-anemia National Heart, Lung, and Blood Institute. (2018). Iron-Deficiency Anemia. Retrieved March 7, 2019, from https://www.nhlbi.nih.gov/health-topics/iron-deficiency-anemia The Editors of Encyclopaedia Britannica. (2019, January 11). Pernicious anemia. Retrieved March 7, 2019, from https://www.britannica.com/science/pernicious-anemia The Nurse Practitioner. (2005, December). Anemia. [Miscellaneous]. Retrieved March 11, 2019, from https://ovidsp.tx.ovid.com/sp-3.32.2a/ovidweb.cgi?&S=DGIDFPCFIIDDJHKENCDKADMCOHCFAA00&Link Set=S.sh.22|1|sl_10&Counter5=CRS_full_text|00006205-200512000-00010|ovft|ovftdb|ovfth Toh, B. (2016). Pathophysiology and laboratory diagnosis of pernicious anemia. Immunologic Research, 65(1), 326-330. Doi: 10.1007/s12026-016-8841-7 [Show Less]
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NR 507 Midterm Exam 2 – Questions and Answers (Graded A)
NR 507 Midterm Exam 2 – Questions and Answers (Graded A) Score 58/60 = 96.7% 1. The coronary ostia are located in the: (Points : 2) Left ... [Show More] ventricle Aortic valve Coronary sinus Aorta 2. Where in the respiratory tract do the majority of foreign objects aspirated by children finally lodge? (Points : 2) Trachea Left lung Bronchus Bronchioles 3. Which type of antibody is involved in type I hypersensitivity reaction? (Points : 2) IgA IgE IgG IgM 4. Hypersensitivity is best defined as a(an): (Points : 2) Disturbance in the immunologic tolerance of self-antigens Immunologic reaction of one person to the tissue of another person Altered immunologic response to an antigen that results in disease Undetectable immune response in the presence of antigens 5. What is the final stage of the infectious process? (Points : 2) Colonization Invasion Multiplication Spread 6. The function of the foramen ovale in a fetus allows what to occur? (Points : 2) Right-to-left blood shunting Left-to-right blood shunting Blood flow from the umbilical cord Blood flow to the lungs 7. What physical sign is the result of turbulent blood flow through a vessel? (Points : 2) Increased blood pressure during periods of stress Bounding pulse felt on palpation Cyanosis observed on excretion Murmur heard on auscultation 8. Which statement concerning benign tumors is true? (Points : 2) The resulting pain is severe. Benign tumors are not encapsulated. Benign tumors are fast growing. The cells are well-differentiated. 9. It has been determined that a tumor is in stage 2. What is the meaning of this finding? (Points : 2) Cancer is confined to the organ of origin. Cancer has spread to regional structures. Cancer is locally invasive. Cancer has spread to distant sites 10. What is the primary problem resulting from respiratory distress syndrome (RDS) of the newborn? (Points : 2) Consolidation Pulmonary edema Atelectasis Bronchiolar plugging 11. Which statement is true concerning the IgM? (Points : 2) IgM is the first antibody produced during the initial response to an antigen. IgM mediates many common allergic responses. IgM is the most abundant class of immunoglobulins. IgM is capable of crossing the human placenta. 12. Apoptosis is a(an): (Points : 2) Normal mechanism for cells to self-destruct when growth is excessive Antigrowth signal activated by the tumor-suppressor gene Rb Mutation of cell growth stimulated by the TP53 gene Transformation of cells from dysplasia to anaplasia 13. Which complex (wave) represents the sum of all ventricular muscle cell depolarizations? (Points : 2) PRS QRS QT interval P 14. Which organism is a common sexually transmitted bacterial infection? (Points : 2) Staphylococcus aureus Clostridium perfringens Helicobacter pylori Treponema pallidum 15. Which organ is stimulated during the alarm phase of the general adaptation syndrome (GAS)? (Points : 2) Adrenal cortex Hypothalamus Anterior pituitary Limbic system 16. What is the role of caretaker genes? (Points : 2) Maintenance of genomic integrity Proliferation of cancer cells Secretion of growth factors Restoration of normal tissue structure 17. Where are antibodies produced? (Points : 2) Helper T lymphocytes Thymus gland Plasma cells Bone marrow 18. The lung is innervated by the parasympathetic nervous system via which nerve? (Points : 2) Vagus Phrenic Brachial Pectoral 19. What is the primary cause of respiratory distress syndrome (RDS) of the newborn? (Points : 2) Immature immune system Small alveoli Surfactant deficiency Anemia 20. What is the fundamental physiologic manifestation of anemia? (Points : 2) Hypotension Hyperesthesia Hypoxia Ischemia 21. Which term is used to describe a muscle cell showing a reduced ability to form new muscle while appearing highly disorganized? (Points : 2) Dysplasia Hyperplasia Myoplasia Anaplasia 22. Which of the following is classified as a megaloblastic anemia? (Points : 2) Iron deficiency Pernicious Sideroblastic Hemolytic 23. How is most carbon dioxide (CO2) in the blood transported? (Points : 2) Attached to oxygen In the form of bicarbonate Combined with albumin Dissolved in the plasma 24. Which immunoglobulin (Ig) is present in childhood asthma? (Points : 2) IgM IgG IgE IgA 25. An individual is more susceptible to infections of mucous membranes when he or she has a seriously low level of which immunoglobulin antibody? (Points : 2) IgG IgM IgA IgE 26. Examination of the throat in a child demonstrating signs and symptoms of acute epiglottitis may contribute to which life-threatening complication? (Points : 2) Retropharyngeal abscess Laryngospasms Rupturing of the tonsils Gagging induced aspiration 27. Which laboratory test is considered adequate for an accurate and reliable diagnosis of gonococcal urethritis in a symptomatic man? (Points : 2) Ligase chain reaction (LCR) Gram-stain technique Polymerase chain reaction (PCR) DNA testing 28. Which primary characteristic is unique for the immune response? (Points : 2) The immune response is similar each time it is activated. The immune response is specific to the antigen that initiates it. The response to a specific pathogen is short term. The response is innate, rather than acquired. 29. When an individual aspirates food particles, where would the nurse expect to hear decreased or absent breath sounds? (Points : 2) Left lung Right lung Trachea Carina 30. What is the primary site for uncomplicated local gonococci infections in men? (Points : 2) Epididymis Lymph nodes Urethra Prostate 31. Deficiencies in which element can produce depression of both B- and T-cell function? (Points : 2) Iron Zinc Iodine Magnesium 32. An infant has a loud, harsh, holosystolic murmur and systolic thrill that can be detected at the left lower sternal border that radiates to the neck. These clinical findings are consistent with which congenital heart defect? (Points : 2) Atrial septal defect (ASD) Ventricular septal defect (VSD) Patent ductus arteriosus (PDA) Atrioventricular canal (AVC) defect 33. Which compensatory mechanism is spontaneously used by children diagnosed with tetralogy of Fallot to relieve hypoxic spells? (Points : 2) Lying on their left side Performing the Valsalva maneuver Squatting Hyperventilating 34. In a normal, nonmutant state, an oncogene is referred to as a: (Points : 2) Basal cell Target cell Caretaker gene Proto-oncogene 35. Infants are most susceptible to significant losses in total body water because of an infant’s: (Points : 2) High body surface–to–body size ratio Slow metabolic rate Kidneys are not mature enough to counter fluid losses Inability to communicate adequately when he or she is thirsty 36. A person with type O blood is considered to be the universal blood donor because type O blood contains which of the following? (Points : 2) No antigens No antibodies Both A and B antigens Both A and B antibodies 37. Which type of immunity is produced by an individual after either natural exposure to the antigen or after immunization against the antigen? (Points : 2) Passive-acquired immunity Active-acquired immunity Passive-innate immunity Active-innate immunity 38. Erythrocyte life span of less than 120 days, ineffective bone marrow response to erythropoietin, and altered iron metabolism describe the pathophysiologic characteristics of which type of anemia? (Points : 2) Aplastic Sideroblastic Anemia of chronic disease Iron deficiency 39. How is most of the oxygen in the blood transported? (Points : 2) Dissolved in plasma Bound to hemoglobin In the form of carbon dioxide (CO2) Bound to protein 40. What is the action of urodilatin? (Points : 2) Urodilatin causes vasoconstriction of afferent arterioles. It causes vasodilation of the efferent arterioles. Urodilatin inhibits antidiuretic hormone secretion. It inhibits salt and water reabsorption. 41. What is the chief predisposing factor for respiratory distress syndrome (RDS) of the newborn? (Points : 2) Low birth weight Alcohol consumption during pregnancy Premature birth Smoking during pregnancy 42. What is the most common cause of insufficient erythropoiesis in children? (Points : 2) Folic acid deficiency Iron deficiency Hemoglobin abnormality Erythrocyte abnormality 43. What are the abnormalities in cytokines found in children with cystic fibrosis (CF)? (Points : 2) Deficit of interleukin (IL)–1 and an excess of IL-4, IL-12, and interferon-alpha (IFN- Deficit of IL-6 and an excess of IL-2, IL-8, and granulocyte colony-stimulating factor (G-CSF) Deficit of IL-10 and an excess of IL-1, IL-8, and TNF- Deficit of IL-3 and an excess of IL-14, IL-24, and colony-stimulating factor (CSF) 44. Which manifestations of vasoocclusive crisis are associated with sickle cell disease (SCD) in infants? (Points : 2) Atelectasis and pneumonia Edema of the hands and feet Stasis ulcers of the hands, ankles, and feet Splenomegaly and hepatomegaly 45. What process allows the kidney to respond to an increase in workload? (Points : 2) Glomerular filtration Secretion of 1,25-dihydroxyvitamin D3 Increased heart rate Compensatory hypertrophy .46. What is the direct action of atrial natriuretic hormone? (Points : 2) Sodium retention Sodium excretion Water retention Water excretion 47. Which cells have phagocytic properties similar to monocytes and contract like smooth muscles cells, thereby influencing the glomerular filtration rate? (Points : 2) Principle cells Podocin cells Mesangial cells Intercalated cells 48. Research supports the premise that exercise has a probable impact on reducing the risk of which cancer? (Points : 2) Liver Endometrial Stomach Colon 49. What effect do natriuretic peptides have during heart failure when the heart dilates? (Points : 2) Stimulates antidiuretic hormones. Inhibits antidiuretic hormones. Stimulates renin and aldosterone. Inhibits renin and aldosterone. 50. Which T-lymphocyte phenotype is the key determinant of childhood asthma? (Points : 2) Cluster of differentiation (CD) 4 T-helper Th1 lymphocytes CD4 T-helper Th2 lymphocytes CD8 cytotoxic T lymphocytes Memory T lymphocytes 51. In which primary immune deficiency is there a partial-to-complete absence of T-cell immunity? (Points : 2) Bruton disease DiGeorge syndrome Reticular dysgenesis Adenosine deaminase deficiency 52. What is the ratio of coronary capillaries to cardiac muscle cells? (Points : 2) 1:1 (one capillary per one muscle cell) 1:2 (one capillary per two muscle cells) 1:4 (one capillary per four muscle cells) 1:10 (one capillary per ten muscle cells) 53. The most common site of metastasis for a patient diagnosed with prostate cancer is which location? (Points : 2) Bones Brain Bladder Kidney 54. Which cardiac chamber has the thinnest wall and why? (Points : 2) The right and left atria; they are low-pressure chambers that serve as storage units and conduits for blood. The right and left atria; they are not directly involved in the preload, contractility, or afterload of the heart. The left ventricle; the mean pressure of blood coming into this ventricle is from the lung, which has a low pressure. The right ventricle; it pumps blood into the pulmonary capillaries, which have a lower pressure compared with the systemic circulation. 55. The only surface inside the nephron where cells are covered with microvilli to increase the reabsorptive surface area is called the: (Points : 2) Proximal convoluted tubules Distal tubules Ascending loop of Henle Descending loop of Henle 56. How high does the plasma glucose have to be before the threshold for glucose is achieved? (Points : 2) 126 mg/dl 150 mg/dl 180 mg/dl 200 mg/dl 57. Which cytokines initiate the production of corticotropin-releasing hormone (CRH)? (Points : 2) IL–1 and IL-6 IL-2 and TNF- IFN and IL-12 TNF-ß and IL-4 58. Which hormone is synthesized and secreted by the kidneys? (Points : 2) Antidiuretic hormone Aldosterone Erythropoietin Angiotensinogen 59. What effects do exercise and body position have on renal blood flow? (Points : 2) Exercise and body position activate renal parasympathetic neurons and cause mild vasoconstriction. They activate renal sympathetic neurons and cause mild vasoconstriction. Both activate renal parasympathetic neurons and cause mild vasodilation. They activate renal sympathetic neurons and cause mild vasodilation. 60. The glomerular filtration rate is directly related to which factor? (Points : 2) Perfusion pressure in the glomerular capillaries Diffusion rate in the renal cortex Diffusion rate in the renal medulla Glomerular active transport [Show Less]
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NR 507 Midterm Exam 1 – Questions and Answers (Graded A)
NR 507 Midterm Exam 1 – Questions and Answers (Graded A) 1. A 10 year old male is stung by a bee while playing in the yard. He experiences a severe al... [Show More] lergic reaction and has to go to the ER. The nurse providing care realizes this reaction is the result of: IgE 2. Chronic bronchitis is characterized by: Right ventricular hypertrophy 3. A 6 year old female is diagnosed with a bacterial infection of the respiratory system. Which of the following will most likely try to fight the antigen? Antibodies 4. A 52 year old male is diagnosed with urinary tract obstruction. While designing the treatment plan, the nurse realizes that the patient is expected to have hydronephrosis and a decreased glomerular filtration rate caused by: Dilation of the renal pelvis and calyces proximal to a blockage 5. Which hormone is synthesized and secreted by the kidneys to stimulate bone marrow production of red blood cells? Erythropoietin 6. A 4 year old male is diagnosed with nephrotic syndrome. Which of the following assessment findings accompanies this condition? Proteinuria 7. During which stage of human development does the role of epigenetics have the greatest impact on the development of epigenetic abnormalities? In utero 8. Under most circumstances, increased work of breathing results in: Oxygenated blood is transported from the lungs to the heart via the pulmonary veins 9. The renin-angiotensin system will be activated by: Decreased blood pressure in the afferent arterioles 10. A nurse realizes glucose will be excreted in the urine when: The carrier molecules have reached their maximum 11. The FNP is giving an example of inflammation as an etiology for cancer development. What is the best example the FNP should give? Ulcerative colitis and colon cancer 12. Which type of nephron determines the concentration of the urine? Juxtamedullary 13. A 22 year old was recently diagnosed with acquired immunodeficiency syndrome (AIDS). Which decreased lab finding would be expected to accompany this virus? CD4 + T-helper 14. What type of phagocytic cell lies between the layers of the renal capillaries? Mesangial cells 15. A 35 year old hypertensive male begins taking a diuretic. Which of the following common side effects of this medication should the nurse monitor? Hypokalemia 16. The movement of blood info and out of the capillary beds of the lungs to the body tissues and cells describes the process of: Perfusion 17. Which of the following terms should the nurse use when there is a balance between outward recoil of the chest wall and inward recoil of lungs at rest? Functional residual capacity (FRC) is reached 18. Upon examination of the male infant, it is determined that the urethral meatus is located undersurface of the penis. The nurse will document this condition as: Hypospadias 19. If the FNP wants to obtain the best estimate of renal function, which test should the nurse monitor? Glomerular filtration rate (GFR) 20. A 54 year old male with a long history of smoking complains of excessive tiredness, shortness of breath, and overall ill feelings. Lab results reveal decreased pH, increased CO2, and normal bicarbonate ion. These findings help to confirm the diagnosis of: Respiratory acidosis 21. A 5 year old male presents with low-set ears, a fish-shaped mouth, and involuntary rapid muscular contraction. Laboratory testing reveals decreased calcium levels. Which of the following diagnosis is most likely? T-lymphocyte deficiency 22. When the FNP is checking the urinalysis, plasma proteins should be absent from the urine because: The negative charge of the glomerular filtration membrane repels the plasma proteins 23. A 55 year old female reports urinary retention. Tests reveal a lower urinary tract obstruction. Which of the following is of most concern to the nurse? Formation of renal calculi 24. The lamina propria area of the bronchioles plays a significant role in the pathogenesis of chronic bronchitis because this is where: Inflammatory cell activation occurs 25. Pulmonary function tests reveal that an 80 year old dyspneic patient has an increase in residual volume. The FNP suspects the most likely cause of the increased residual volume is ____ in lung compliance. A decrease 26. The nurse practitioner would correctly respond that the etiology of a congenital immune deficiency is due to a: Genetic defect 27. Carbon dioxide is mainly transported in the blood: In the form of bicarbonate 28. The glomerular filtration rate (GFR) is directly related to the : Perfusion pressure in the glomerular capillaries 29. When considering abnormal epigenetic modifications, what factor is currently being viewed as strongly associated with the development of some cancers? Environmental stressors 30. Which of the following clusters of symptoms would support a child’s diagnosis of glomerulonephritis? Gross hematuria, edema, and hypertension 31. When a staff member asks which of the following substances is actively secreted by the renal tubules, what is the FNP’s best response? Hydrogen and potassium 32. A client with chronic bronchitis is most likely to experience: Respiratory acidosis due to inability to exhale CO2 33. An infant is experiencing hemolytic disease of the newborn. Which of the following would the nurse expect to find in the infant’s history and physical? The baby is Rh positive 34. During inspiration, muscular contraction of the diaphragm causes air to move into the lung. The mechanism that drives air movement during inspiration results is a: Increase in the size of the thorax and decrease in intrapleural pressure 35. A 10 year old child is diagnosed with glomerulonephritis. Tests reveal the deposition of immunoglobulin IgA in the glomerular capillaries. The nurse will monitor for recurrent: Hematuria 36. When the FNP discusses the glomerulus and bowman’s capsule together, it is referred to as the renal: Corpuscle 37. Which of the following buffer pairs is considered the major plasma buffering system? Carbonic acid/ bicarbonate 38. The condition most associated with a history of seasonal and/or chronic allergies is: Extrinsic asthma 39. A 15 year old presents with flank pain, irritability, malaise, and fever and is diagnosed with glomerulonephritis. What is the most likely cause of this condition? Poststreptococcol infection 40. Treatment for asthma includes anticholinergic drugs. The mechanism of action for these medications is to: Block acetylcholine binding to promote bronchodilation 41. A 60 year old with a 25 year history of smoking is diagnosed with emphysema. Assessment shows an increased anterior-posterior chest diameter. The nurse attributes this finding to: Air trapping 42. In a patient with acidosis, the nurse would expect the oxyhemoglobin dissociation curve to shift: To the right, causing more 02 to be released from the cells 43. Reabsorption of water in the collecting ducts requires which hormone? Antidiuretic hormone (ADH) 44. The descending segment of the loop of Henle primarily allows for: Water reabsorption 45. A 30 year old male was diagnosed with HIV. Which of the following treatments would be most effective? Antiretroviral therapy (ART) 46. Where does the majority of sodium reabsorption take place? Proximal tubule 47. When discussing the functional unit of the kidney, what term should the FNP use? Nephron 48. What characteristic of Prader-Willi syndrome is not a characteristic of angelman syndrome? It is inherited from the father \ [Show Less]
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NR 507 Midterm Exam 2 – Questions and Answers
NR 507 Midterm Exam 2 – Questions and Answers NR 507 Midterm Exam 2 – Questions and Answers (Graded A) Score 58/60 = 96.7% 1. The coronary ostia... [Show More] are located in the: (Points : 2) Left ventricle Aortic valve Coronary sinus Aorta 2. Where in the respiratory tract do the majority of foreign objects aspirated by children finally lodge? (Points : 2) Trachea Left lung Bronchus Bronchioles 3. Which type of antibody is involved in type I hypersensitivity reaction? (Points : 2) IgA IgE IgG IgM 4. Hypersensitivity is best defined as a(an): (Points : 2) Disturbance in the immunologic tolerance of self-antigens Immunologic reaction of one person to the tissue of another person Altered immunologic response to an antigen that results in disease Undetectable immune response in the presence of antigens 5. What is the final stage of the infectious process? (Points : 2) Colonization Invasion Multiplication Spread 6. The function of the foramen ovale in a fetus allows what to occur? (Points : 2) Right-to-left blood shunting Left-to-right blood shunting Blood flow from the umbilical cord Blood flow to the lungs 7. What physical sign is the result of turbulent blood flow through a vessel? (Points : 2) Increased blood pressure during periods of stress Bounding pulse felt on palpation Cyanosis observed on excretion Murmur heard on auscultation 8. Which statement concerning benign tumors is true? (Points : 2) The resulting pain is severe. Benign tumors are not encapsulated. Benign tumors are fast growing. The cells are well-differentiated. 9. It has been determined that a tumor is in stage 2. What is the meaning of this finding? (Points : 2) Cancer is confined to the organ of origin. Cancer has spread to regional structures. Cancer is locally invasive. Cancer has spread to distant sites 10. What is the primary problem resulting from respiratory distress syndrome (RDS) of the newborn? (Points : 2) Consolidation Pulmonary edema Atelectasis Bronchiolar plugging 11. Which statement is true concerning the IgM? (Points : 2) IgM is the first antibody produced during the initial response to an antigen. IgM mediates many common allergic responses. IgM is the most abundant class of immunoglobulins. IgM is capable of crossing the human placenta. 12. Apoptosis is a(an): (Points : 2) Normal mechanism for cells to self-destruct when growth is excessive Antigrowth signal activated by the tumor-suppressor gene Rb Mutation of cell growth stimulated by the TP53 gene Transformation of cells from dysplasia to anaplasia 13. Which complex (wave) represents the sum of all ventricular muscle cell depolarizations? (Points : 2) PRS QRS QT interval P 14. Which organism is a common sexually transmitted bacterial infection? (Points : 2) Staphylococcus aureus Clostridium perfringens Helicobacter pylori Treponema pallidum 15. Which organ is stimulated during the alarm phase of the general adaptation syndrome (GAS)? (Points : 2) Adrenal cortex Hypothalamus Anterior pituitary Limbic system 16. What is the role of caretaker genes? (Points : 2) Maintenance of genomic integrity Proliferation of cancer cells Secretion of growth factors Restoration of normal tissue structure 17. Where are antibodies produced? (Points : 2) Helper T lymphocytes Thymus gland Plasma cells Bone marrow 18. The lung is innervated by the parasympathetic nervous system via which nerve? (Points : 2) Vagus Phrenic Brachial Pectoral 19. What is the primary cause of respiratory distress syndrome (RDS) of the newborn? (Points : 2) Immature immune system Small alveoli Surfactant deficiency Anemia 20. What is the fundamental physiologic manifestation of anemia? (Points : 2) Hypotension Hyperesthesia Hypoxia Ischemia 21. Which term is used to describe a muscle cell showing a reduced ability to form new muscle while appearing highly disorganized? (Points : 2) Dysplasia Hyperplasia Myoplasia Anaplasia 22. Which of the following is classified as a megaloblastic anemia? (Points : 2) Iron deficiency Pernicious Sideroblastic Hemolytic 23. How is most carbon dioxide (CO2) in the blood transported? (Points : 2) Attached to oxygen In the form of bicarbonate Combined with albumin Dissolved in the plasma 24. Which immunoglobulin (Ig) is present in childhood asthma? (Points : 2) IgM IgG IgE IgA 25. An individual is more susceptible to infections of mucous membranes when he or she has a seriously low level of which immunoglobulin antibody? (Points : 2) IgG IgM IgA IgE 26. Examination of the throat in a child demonstrating signs and symptoms of acute epiglottitis may contribute to which life-threatening complication? (Points : 2) Retropharyngeal abscess Laryngospasms Rupturing of the tonsils Gagging induced aspiration 27. Which laboratory test is considered adequate for an accurate and reliable diagnosis of gonococcal urethritis in a symptomatic man? (Points : 2) Ligase chain reaction (LCR) Gram-stain technique Polymerase chain reaction (PCR) DNA testing 28. Which primary characteristic is unique for the immune response? (Points : 2) The immune response is similar each time it is activated. The immune response is specific to the antigen that initiates it. The response to a specific pathogen is short term. The response is innate, rather than acquired. 29. When an individual aspirates food particles, where would the nurse expect to hear decreased or absent breath sounds? (Points : 2) Left lung Right lung Trachea Carina 30. What is the primary site for uncomplicated local gonococci infections in men? (Points : 2) Epididymis Lymph nodes Urethra Prostate 31. Deficiencies in which element can produce depression of both B- and T-cell function? (Points : 2) Iron Zinc Iodine Magnesium 32. An infant has a loud, harsh, holosystolic murmur and systolic thrill that can be detected at the left lower sternal border that radiates to the neck. These clinical findings are consistent with which congenital heart defect? (Points : 2) Atrial septal defect (ASD) Ventricular septal defect (VSD) Patent ductus arteriosus (PDA) Atrioventricular canal (AVC) defect 33. Which compensatory mechanism is spontaneously used by children diagnosed with tetralogy of Fallot to relieve hypoxic spells? (Points : 2) Lying on their left side Performing the Valsalva maneuver Squatting Hyperventilating 34. In a normal, nonmutant state, an oncogene is referred to as a: (Points : 2) Basal cell Target cell Caretaker gene Proto-oncogene 35. Infants are most susceptible to significant losses in total body water because of an infant’s: (Points : 2) High body surface–to–body size ratio Slow metabolic rate Kidneys are not mature enough to counter fluid losses Inability to communicate adequately when he or she is thirsty 36. A person with type O blood is considered to be the universal blood donor because type O blood contains which of the following? (Points : 2) No antigens No antibodies Both A and B antigens Both A and B antibodies 37. Which type of immunity is produced by an individual after either natural exposure to the antigen or after immunization against the antigen? (Points : 2) Passive-acquired immunity Active-acquired immunity Passive-innate immunity Active-innate immunity 38. Erythrocyte life span of less than 120 days, ineffective bone marrow response to erythropoietin, and altered iron metabolism describe the pathophysiologic characteristics of which type of anemia? (Points : 2) Aplastic Sideroblastic Anemia of chronic disease Iron deficiency 39. How is most of the oxygen in the blood transported? (Points : 2) Dissolved in plasma Bound to hemoglobin In the form of carbon dioxide (CO2) Bound to protein 40. What is the action of urodilatin? (Points : 2) Urodilatin causes vasoconstriction of afferent arterioles. It causes vasodilation of the efferent arterioles. Urodilatin inhibits antidiuretic hormone secretion. It inhibits salt and water reabsorption. 41. What is the chief predisposing factor for respiratory distress syndrome (RDS) of the newborn? (Points : 2) Low birth weight Alcohol consumption during pregnancy Premature birth Smoking during pregnancy 42. What is the most common cause of insufficient erythropoiesis in children? (Points : 2) Folic acid deficiency Iron deficiency Hemoglobin abnormality Erythrocyte abnormality 43. What are the abnormalities in cytokines found in children with cystic fibrosis (CF)? (Points : 2) Deficit of interleukin (IL)–1 and an excess of IL-4, IL-12, and interferon-alpha (IFN- Deficit of IL-6 and an excess of IL-2, IL-8, and granulocyte colony-stimulating factor (G-CSF) Deficit of IL-10 and an excess of IL-1, IL-8, and TNF- Deficit of IL-3 and an excess of IL-14, IL-24, and colony-stimulating factor (CSF) 44. Which manifestations of vasoocclusive crisis are associated with sickle cell disease (SCD) in infants? (Points : 2) Atelectasis and pneumonia Edema of the hands and feet Stasis ulcers of the hands, ankles, and feet Splenomegaly and hepatomegaly 45. What process allows the kidney to respond to an increase in workload? (Points : 2) Glomerular filtration Secretion of 1,25-dihydroxyvitamin D3 Increased heart rate Compensatory hypertrophy .46. What is the direct action of atrial natriuretic hormone? (Points : 2) Sodium retention Sodium excretion Water retention Water excretion 47. Which cells have phagocytic properties similar to monocytes and contract like smooth muscles cells, thereby influencing the glomerular filtration rate? (Points : 2) Principle cells Podocin cells Mesangial cells Intercalated cells 48. Research supports the premise that exercise has a probable impact on reducing the risk of which cancer? (Points : 2) Liver Endometrial Stomach Colon 49. What effect do natriuretic peptides have during heart failure when the heart dilates? (Points : 2) Stimulates antidiuretic hormones. Inhibits antidiuretic hormones. Stimulates renin and aldosterone. Inhibits renin and aldosterone. 50. Which T-lymphocyte phenotype is the key determinant of childhood asthma? (Points : 2) Cluster of differentiation (CD) 4 T-helper Th1 lymphocytes CD4 T-helper Th2 lymphocytes CD8 cytotoxic T lymphocytes Memory T lymphocytes 51. In which primary immune deficiency is there a partial-to-complete absence of T-cell immunity? (Points : 2) Bruton disease DiGeorge syndrome Reticular dysgenesis Adenosine deaminase deficiency 52. What is the ratio of coronary capillaries to cardiac muscle cells? (Points : 2) 1:1 (one capillary per one muscle cell) 1:2 (one capillary per two muscle cells) 1:4 (one capillary per four muscle cells) 1:10 (one capillary per ten muscle cells) 53. The most common site of metastasis for a patient diagnosed with prostate cancer is which location? (Points : 2) Bones Brain Bladder Kidney 54. Which cardiac chamber has the thinnest wall and why? (Points : 2) The right and left atria; they are low-pressure chambers that serve as storage units and conduits for blood. The right and left atria; they are not directly involved in the preload, contractility, or afterload of the heart. The left ventricle; the mean pressure of blood coming into this ventricle is from the lung, which has a low pressure. The right ventricle; it pumps blood into the pulmonary capillaries, which have a lower pressure compared with the systemic circulation. 55. The only surface inside the nephron where cells are covered with microvilli to increase the reabsorptive surface area is called the: (Points : 2) Proximal convoluted tubules Distal tubules Ascending loop of Henle Descending loop of Henle 56. How high does the plasma glucose have to be before the threshold for glucose is achieved? (Points : 2) 126 mg/dl 150 mg/dl 180 mg/dl 200 mg/dl 57. Which cytokines initiate the production of corticotropin-releasing hormone (CRH)? (Points : 2) IL–1 and IL-6 IL-2 and TNF- IFN and IL-12 TNF-ß and IL-4 58. Which hormone is synthesized and secreted by the kidneys? (Points : 2) Antidiuretic hormone Aldosterone Erythropoietin Angiotensinogen 59. What effects do exercise and body position have on renal blood flow? (Points : 2) Exercise and body position activate renal parasympathetic neurons and cause mild vasoconstriction. They activate renal sympathetic neurons and cause mild vasoconstriction. Both activate renal parasympathetic neurons and cause mild vasodilation. They activate renal sympathetic neurons and cause mild vasodilation. 60. The glomerular filtration rate is directly related to which factor? (Points : 2) Perfusion pressure in the glomerular capillaries Diffusion rate in the renal cortex Diffusion rate in the renal medulla Glomerular active transport [Show Less]
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NR 507 Week 4 Midterm
NR 507 Week 4 Midterm NR 507 Week 4 Midterm 58/60 = 96.7% The coronary ostia are located in the: (Points : 2) Left ventricle Aorti... [Show More] c valve Coronary sinus Aorta Where in the respiratory tract do the majority of foreign objects aspirated by children finally lodge? (Points : 2) Trachea Left lung Bronchus Bronchioles Which type of antibody is involved in type I hypersensitivity reaction? (Points : 2) IgA IgE IgG IgM Hypersensitivity is best defined as a(an): (Points : 2) Disturbance in the immunologic tolerance of self-antigens Immunologic reaction of one person to the tissue of another person Altered immunologic response to an antigen that results in disease Undetectable immune response in the presence of antigens What is the final stage of the infectious process? (Points : 2) Colonization Invasion Multiplication Spread 1. Colonization 2. Invasion 3. Multiply 4. spread The function of the foramen ovale in a fetus allows what to occur? (Points : 2) Right-to-left blood shunting Left-to-right blood shunting Blood flow from the umbilical cord Blood flow to the lungs It has been determined that a tumor is in stage 2. What is the meaning of this finding? (Points : 2) Cancer is confined to the organ of origin. Cancer has spread to regional structures. Cancer is locally invasive. Cancer has spread to distant sites What is the primary problem resulting from respiratory distress syndrome (RDS) of the newborn? (Points : 2) Consolidation Pulmonary edema Atelectasis Bronchiolar plugging Which statement is true concerning the IgM? (Points : 2) IgM is the first antibody produced during the initial response to an antigen. IgM mediates many common allergic responses. IgM is the most abundant class of immunoglobulins. IgM is capable of crossing the human placenta. Apoptosis is a(an): (Points : 2) Normal mechanism for cells to self-destruct when growth is excessive Antigrowth signal activated by the tumor-suppressor gene Rb Mutation of cell growth stimulated by the TP53 gene Transformation of cells from dysplasia to anaplasia Which statement concerning benign tumors is true? (Points : 2) The resulting pain is severe. Benign tumors are not encapsulated. Benign tumors are fast growing. The cells are well-differentiated. Which complex (wave) represents the sum of all ventricular muscle cell depolarizations? (Points : 2) PRS QRS QT interval P Which organism is a common sexually transmitted bacterial infection? (Points : 2) Staphylococcus aureus Clostridium perfringens Helicobacter pylori Treponema pallidum Which organ is stimulated during the alarm phase of the general adaptation syndrome (GAS)? (Points : 2) Adrenal cortex Hypothalamus Anterior pituitary Limbic system What is the role of caretaker genes? (Points : 2) Maintenance of genomic integrity Proliferation of cancer cells Secretion of growth factors Restoration of normal tissue structure Where are antibodies produced? (Points : 2) Helper T lymphocytes Thymus gland Plasma cells Bone marrow The lung is innervated by the parasympathetic nervous system via which nerve? (Points : 2) Vagus Phrenic Brachial Pectoral What physical sign is the result of turbulent blood flow through a vessel? (Points : 2) Increased blood pressure during periods of stress Bounding pulse felt on palpation Cyanosis observed on excretion Murmur heard on auscultation What is the primary cause of respiratory distress syndrome (RDS) of the newborn? (Points : 2) Immature immune system Small alveoli Surfactant deficiency Anemia What is the fundamental physiologic manifestation of anemia? (Points : 2) Hypotension Hyperesthesia Hypoxia Ischemia Which term is used to describe a muscle cell showing a reduced ability to form new muscle while appearing highly disorganized? (Points : 2) Dysplasia Hyperplasia Myoplasia Anaplasia Which of the following is classified as a megaloblastic anemia? (Points : 2) Iron deficiency Pernicious Sideroblastic Hemolytic How is most carbon dioxide (CO2) in the blood transported? (Points : 2) Attached to oxygen In the form of bicarbonate Combined with albumin Dissolved in the plasma Question 24.24. Which immunoglobulin (Ig) is present in childhood asthma? (Points : 2) IgM IgG IgE IgA Question 25.25. An individual is more susceptible to infections of mucous membranes when he or she has a seriously low level of which immunoglobulin antibody? (Points : 2) IgG IgM IgA IgE Question 26.26. Examination of the throat in a child demonstrating signs and symptoms of acute epiglottitis may contribute to which life-threatening complication? (Points : 2) Retropharyngeal abscess Laryngospasms Rupturing of the tonsils Gagging induced aspiration Question 27.27. Which laboratory test is considered adequate for an accurate and reliable diagnosis of gonococcal urethritis in a symptomatic man? (Points : 2) Ligase chain reaction (LCR) Gram-stain technique Polymerase chain reaction (PCR) DNA testing Question 28.28. Which primary characteristic is unique for the immune response? (Points : 2) The immune response is similar each time it is activated. The immune response is specific to the antigen that initiates it. The response to a specific pathogen is short term. The response is innate, rather than acquired. Question 29.29. When an individual aspirates food particles, where would the nurse expect to hear decreased or absent breath sounds? (Points : 2) Left lung Right lung Trachea Carina Question 30.30. What is the primary site for uncomplicated local gonococci infections in men? (Points : 2) Epididymis Lymph nodes Urethra Prostate Question 31.31. Deficiencies in which element can produce depression of both B- and T-cell function? (Points : 2) Iron Zinc Iodine Magnesium Question 32.32. An infant has a loud, harsh, holosystolic murmur and systolic thrill that can be detected at the left lower sternal border that radiates to the neck. These clinical findings are consistent with which congenital heart defect? (Points : 2) Atrial septal defect (ASD) Ventricular septal defect (VSD) Patent ductus arteriosus (PDA) Atrioventricular canal (AVC) defect Question 33.33. Which compensatory mechanism is spontaneously used by children diagnosed with tetralogy of Fallot to relieve hypoxic spells? (Points : 2) Lying on their left side Performing the Valsalva maneuver Squatting Hyperventilating Question 34.34. In a normal, nonmutant state, an oncogene is referred to as a: (Points : 2) Basal cell Target cell Caretaker gene Proto-oncogene Question 35.35. Infants are most susceptible to significant losses in total body water because of an infant’s: (Points : 2) High body surface–to–body size ratio Slow metabolic rate Kidneys are not mature enough to counter fluid losses Inability to communicate adequately when he or she is thirsty Question 36.36. A person with type O blood is considered to be the universal blood donor because type O blood contains which of the following? (Points : 2) No antigens No antibodies Both A and B antigens Both A and B antibodies Question 37.37. Which type of immunity is produced by an individual after either natural exposure to the antigen or after immunization against the antigen? (Points : 2) Passive-acquired immunity Active-acquired immunity Passive-innate immunity Active-innate immunity Question 38.38. Erythrocyte life span of less than 120 days, ineffective bone marrow response to erythropoietin, and altered iron metabolism describe the pathophysiologic characteristics of which type of anemia? (Points : 2) Aplastic Sideroblastic Anemia of chronic disease Iron deficiency Question 39.39. How is most of the oxygen in the blood transported? (Points : 2) Dissolved in plasma Bound to hemoglobin In the form of carbon dioxide (CO2) Bound to protein Question 40.40. What is the action of urodilatin? (Points : 2) Urodilatin causes vasoconstriction of afferent arterioles. It causes vasodilation of the efferent arterioles. Urodilatin inhibits antidiuretic hormone secretion. It inhibits salt and water reabsorption. Question 41.41. What is the chief predisposing factor for respiratory distress syndrome (RDS) of the newborn? (Points : 2) Low birth weight Alcohol consumption during pregnancy Premature birth Smoking during pregnancy Question 42.42. What is the most common cause of insufficient erythropoiesis in children? (Points : 2) Folic acid deficiency Iron deficiency Hemoglobin abnormality Erythrocyte abnormality Question 43.43. What are the abnormalities in cytokines found in children with cystic fibrosis (CF)? (Points : 2) Deficit of interleukin (IL)–1 and an excess of IL-4, IL-12, and interferon-alpha (IFN- Deficit of IL-6 and an excess of IL-2, IL-8, and granulocyte colony-stimulating factor (G-CSF) Deficit of IL-10 and an excess of IL-1, IL-8, and TNF- Deficit of IL-3 and an excess of IL-14, IL-24, and colony-stimulating factor (CSF) Question 44.44. Which manifestations of vasoocclusive crisis are associated with sickle cell disease (SCD) in infants? (Points : 2) Atelectasis and pneumonia Edema of the hands and feet Stasis ulcers of the hands, ankles, and feet Splenomegaly and hepatomegaly Question 45.45. What process allows the kidney to respond to an increase in workload? (Points : 2) Glomerular filtration Secretion of 1,25-dihydroxyvitamin D3 Increased heart rate Compensatory hypertrophy Question 46.46. What is the direct action of atrial natriuretic hormone? (Points : 2) Sodium retention Sodium excretion Water retention Water excretion Question 47.47. Which cells have phagocytic properties similar to monocytes and contract like smooth muscles cells, thereby influencing the glomerular filtration rate? (Points : 2) Principle cells Podocin cells Mesangial cells Intercalated cells Question 48.48. Research supports the premise that exercise has a probable impact on reducing the risk of which cancer? (Points : 2) Liver Endometrial Stomach Colon Question 49.49. What effect do natriuretic peptides have during heart failure when the heart dilates? (Points : 2) Stimulates antidiuretic hormones. Inhibits antidiuretic hormones. Stimulates renin and aldosterone. Inhibits renin and aldosterone. Question 50.50. Which T-lymphocyte phenotype is the key determinant of childhood asthma? (Points : 2) Cluster of differentiation (CD) 4 T-helper Th1 lymphocytes CD4 T-helper Th2 lymphocytes CD8 cytotoxic T lymphocytes Memory T lymphocytes Question 51.51. In which primary immune deficiency is there a partial-to-complete absence of T-cell immunity? (Points : 2) Bruton disease DiGeorge syndrome Reticular dysgenesis Adenosine deaminase deficiency What is the ratio of coronary capillaries to cardiac muscle cells? (Points : 2) 1:1 (one capillary per one muscle cell) 1:2 (one capillary per two muscle cells) 1:4 (one capillary per four muscle cells) 1:10 (one capillary per ten muscle cells) Question 53.53. The most common site of metastasis for a patient diagnosed with prostate cancer is which location? (Points : 2) Bones Brain Bladder Kidney Question 54.54. Which cardiac chamber has the thinnest wall and why? (Points : 2) The right and left atria; they are low-pressure chambers that serve as storage units and conduits for blood. The right and left atria; they are not directly involved in the preload, contractility, or afterload of the heart. The left ventricle; the mean pressure of blood coming into this ventricle is from the lung, which has a low pressure. The right ventricle; it pumps blood into the pulmonary capillaries, which have a lower pressure compared with the systemic circulation. Question 55.55. The only surface inside the nephron where cells are covered with microvilli to increase the reabsorptive surface area is called the: (Points : 2) Proximal convoluted tubules Distal tubules Ascending loop of Henle Descending loop of Henle Question 56.56. How high does the plasma glucose have to be before the threshold for glucose is achieved? (Points : 2) 126 mg/dl 150 mg/dl 180 mg/dl 200 mg/dl Question 57.57. Which cytokines initiate the production of corticotropin-releasing hormone (CRH)? (Points : 2) IL–1 and IL-6 IL-2 and TNF- IFN and IL-12 TNF-ß and IL-4 Question 58.58. Which hormone is synthesized and secreted by the kidneys? (Points : 2) Antidiuretic hormone Aldosterone Erythropoietin Angiotensinogen Question 59.59. What effects do exercise and body position have on renal blood flow? (Points : 2) Exercise and body position activate renal parasympathetic neurons and cause mild vasoconstriction. They activate renal sympathetic neurons and cause mild vasoconstriction. Both activate renal parasympathetic neurons and cause mild vasodilation. They activate renal sympathetic neurons and cause mild vasodilation. Question 60.60. The glomerular filtration rate is directly related to which factor? (Points : 2) Perfusion pressure in the glomerular capillaries Diffusion rate in the renal cortex Diffusion rate in the renal medulla Glomerular active transport [Show Less]
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