MULTIPLE RESPONSE
1. Estrogen has many biological effects on the female body including: (Select all that
apply.)
a. Maturation of reproductive
... [Show More] organs
b. Differentiating female physical characteristics
c. Postpuberty closure of short bones
d. Regulation of the menstrual cycle
e. Endometrial regeneration after menstruation
ANS: A, B, D, E
Estrogen has numerous biologic effects, many of which involve interactions with other
hormones. Estrogen is needed for the maturation of the reproductive organs, development of
secondary sex characteristics (differentiating male and female physical characteristics that are
not directly related to reproduction), closure of long bones after the pubertal growth spurt,
regulation of the menstrual cycle, and endometrial regeneration after menstruation.
2. Which statements about the human papillolmavirus (HPV) and vaccine are true?
(Select all that apply.)
a. Currently, two HPV vaccines have been approved for use in the United States.
b. HPV is believed to be responsible for the majority of the diagnosed cases of
cervical cancer.
c. A form of the vaccine has been approved for use in males to prevent genital warts.
d. The administration of the vaccine is a one-dose intramuscular injection.
e. The recommended age for vaccination of girls is between 11 and 12 years of age.
ANS: A, B, C, E
Two HPV vaccines are currently approved in the United States: (1) quadrivalent HPV
recombinant vaccine and (2) bivalent HPV recombinant vaccine. HPV is responsible for
99.7% of cervical cancer cases, 40% of penile cancers, and an estimated 5% of all cancers
worldwide. The vaccine is administered by intramuscular injection, and the recommended
schedule is a three-dose series with the second and third doses administered 2 and 6 months
after the first dose. The recommended age for vaccination of girls is 11 to 12 years. The
vaccine can be administered to girls as young as 9 years of age. The quadrivalent vaccine has
been approved for males 9 to 26 years of age to prevent genital warts.
3. Which statements are true regarding the female menstrual cycle? (Select all that
apply.)
a. Initial cycles may dramatically vary in length.
b. By adulthood, the commonly accepted cycle average is 28 (27 to 30) days.
c. The length of a cycle varies among women.
d. Up to 8 years before menopause, the intervals of the menstrual cycle begin to
lengthen.
e. Menopause is achieved when a woman is without a period for 2 years.
ANS: A, B, C, D
At first, cycles are anovulatory and may vary in length from 10 to 60 days or longer. As
adolescence proceeds into adulthood, regular patterns of menstruation and ovulation are
established at intervals ranging from 25 to 35 days. The length of the menstrual cycle varies
considerably among women. The commonly accepted cycle average is 28 (27 to 30) days,
with rhythmic intervals of 21 to 35 days considered normal. Approximately 2 to 8 years
before menopause, cycles begin to lengthen again. Menopause is defined as the cessation of
menstrual flow for 1 year.
4. Testosterone is believed to have a role in: (Select all that apply.)
a. Male-patterned baldness
b. Libido levels
c. Acne development
d. Altered cholesterol metabolism
e. Thinning of the larynx
ANS: A, B, C, D
Testosterone is associated with all the options except thinning of the larynx; it actually
stimulates the growth of the larynx’s cartilage.
5. What are normal characteristics of aging of the male reproductive system? (Select
all that apply.)
a. Reduced sperm count
b. Slower, less forceful ejaculations
c. Testicular atrophy and softening
d. Longer time to achieve full erection
e. Decreased levels of testosterone
ANS: B, C, D, E
The described effects on ejaculation, testes, erection, and testosterone are normal
characteristics of male aging. Sperm count remains normal with age, although the semen tends
to contain more defective and nonmotile sperm.
6. What is a recognized treatment for the symptoms often associated with pelvic organ
prolapse? (Select all that apply.)
a. Pessary
b. Kegel exercises
c. Estrogen therapy
d. Surgical repair
e. Bearing down exercises
ANS: A, B, C, D
A common first-line treatment is a pessary, which is a removable mechanical device that
holds the uterus in position. The pelvic fascia may be strengthened through Kegel exercises
(repetitive isometric tightening and relaxing of the pubococcygeal muscles) or by estrogen
therapy in menopausal women. Maintaining a healthy body mass index, preventing
constipation, and treating chronic cough may help as well. Surgical repair with or without a
hysterectomy is the treatment of last resort. Bearing down would likely exacerbate the
problem.
7. Dysfunctional uterine bleeding (DUB), secondary to ovarian dysfunction, is
abnormal uterine bleeding resulting from: (Select all that apply.)
a. Endometriosis
b. Progesterone deficiency
c. Sexually transmitted infections
d. Congenital abnormalities in the uterine structure
e. Estrogen excess
ANS: B, E
Of the options available, DUB, secondary to ovarian dysfunction, is a result of either
progesterone deficiency or unopposed estrogen excess.
8. The size of benign uterine tumors, such as leiomyomas, is thought to be caused by
the influence of which hormone? (Select all that apply.)
a. Progesterone
b. Estrogen
c. Luteinizing hormone
d. Gonadotropin-stimulating hormone
e. Growth factors
ANS: A, B, E
The cause of uterine leiomyomas is unknown, although their size appears to be related to only
estrogen, progesterone, growth factors, angiogenesis, and apoptosis.
9. What are the common clinical manifestations of endometriosis? (Select all that
apply.)
a. Back and flank pain
b. Infertility
c. Dysuria
d. Amenorrhea
e. Dysmenorrhea
ANS: B, E
Common clinical manifestations primarily include infertility, dysmenorrhea, dyschezia (pain
on defecation), and dyspareunia (pain on intercourse).
10. Which are clinical manifestations of male breast cancer? (Select all that apply.)
a. Ulceration present on the breast
b. Retraction of breast tissue
c. Nipple discharge
d. Palpable mass midline of the nipple
e. Unilateral solid mass
ANS: A, B, C, E
The malignant male breast lesion is usually a unilateral solid mass located near the nipple.
Because the nipple is commonly involved, crusting and nipple discharge are typical clinical
manifestations. Other findings include skin retraction, ulceration of the skin over the tumor,
and axillary node involvement.
11. Which statements are true regarding urethritis? (Select all that apply.)
a. A purulent drainage may be present.
b. A clear mucus-like discharge may be present.
c. Symptoms include urethral tingling and itching or burning on urination.
d. A 24-hour urine test is required to diagnose the disorder.
e. Treatment includes appropriate antibiotic therapy.
ANS: A, B, C, E
Symptoms of urethritis include urethral tingling and itching or a burning sensation on
urination (dysuria), frequency, and urgency. The individual may note a purulent or clear
mucus-like discharge from the urethra. Nucleic acid detection amplification tests allow easy
detection of Neisseria gonorrhoeae and Chlamydia trachomatis in first-void urine. Treatment
consists of appropriate antibiotic therapy for infectious urethritis and an avoidance of future
chemical or mechanical irritation.
12. Which statements are true regarding prostate cancer? (Select all that apply.)
a. It ranks second to lung cancer as being most common among American men.
b. A familial history of prostate cancer is a risk factor.
c. Dietary habits seem to play a role in its development.
d. African-American men have an increased risk for its development.
e. Being over 65 years of age increases the risk for developing prostate cancer.
ANS: B, C, D, E
Prostate cancer is the most commonly diagnosed non–skin cancer in American men, and the
incidence varies greatly worldwide. Possible causes include a genetic predisposition,
environmental and dietary factors, inflammation, and alterations in levels of hormones (e.g.,
testosterone, dihydrotestosterone, estradiol) and growth factors. Incidence is greatest among
northwestern European and North American men (particularly African Americans) older than
65 years of age.
13. Which statements are true regarding the hepatitis B infection? (Select all that
apply.)
a. Hepatitis B poses a significant risk for chronic liver disease.
b. Hepatocellular cancer is a common comorbid condition.
c. Universal vaccination of infants and children is recommended.
d. The preventive method of choice is immunization.
e. Universal vaccination of sexually active adults is recommended.
ANS: A, B, C, D
Hepatitis B infection poses significant health risks including chronic liver disease and
hepatocellular cancer. Immunization against hepatitis B is the most effective means of
preventing transmission. Universal vaccination of infants and children is recommended, as
well as vaccination of high-risk adults.
14. What are the common modes of transmission for the hepatitis B virus (HBV)? (Select all
that apply.)
a. Needle punctures
b. Blood transfusions
c. Contact with infected body fluids
d. Skin cuts
e. Ingestion of infected substances
ANS: A, B, C, D
Transmission of HBV can occur through needle puncture, blood transfusion, cuts in the skin,
and contact with infected body fluids. Ingestion is not a recognized transmission mode.
14. Which statements are true regarding the parasitic infection referred to as scabies?
(Select all that apply.)
a. Scabies is spread through skin-to-skin contact.
b. The crab lice, Phthirus pubis, cause scabies.
c. Severe pruritus is its major clinical manifestation.
d. Symptoms worsen at night.
e. Treatment is provided through oral medication therapy.
ANS: A, C, D
Scabies is a common parasitic infection that can be spread by skin-to-skin contact and sexual
contact. The scabies mite burrows through the skin, depositing two or three large eggs per day.
Intense pruritus, especially at night, is the most pronounced clinical manifestation. Treatment
consists of topical application of a pediculicide. Pediculosis pubis (crabs) is commonly
transmitted sexually and is caused by the crab louse, P. pubis.
15. Which statements are true concerning the sexually transmitted infection (STI)
lymphogranuloma venereum? (Select all that apply.)
a. Lymphogranuloma venereum is an STI commonly diagnosed in the United States.
b. It begins as a skin infection.
c. Lymphogranuloma venereum spreads to lymph tissues.
d. Primary and secondary lesions are apparent with this STI.
e. A 60-day course of oral erythromycin is the recommended treatment.
ANS: B, C, D
Lymphogranuloma venereum is a chronic STI uncommon in the United States. The lesion
begins as a skin infection and spreads to the lymph tissue, causing inflammation, necrosis,
buboes, and abscesses of the inguinal lymph nodes. Primary lesions appear on the penis and
scrotum in men and on the cervix, vaginal wall, and labia in women. Secondary lesions
involve inflammation and swelling of the lymph nodes with the formation of large blue
buboes that rupture and form draining ulcerative lesions. A 21-day or longer course of oral
doxycycline or erythromycin is needed for treatment. Treatment of sexual partners is
recommended.
16. Which statements are true concerning the method in which substances pass between
capillaries and the interstitial fluid? (Select all that apply.)
a. Substances pass through junctions between endothelial cells.
b. Substances pass through pores or oval windows (fenestrations).
c. Substances pass between vesicles by active transport across the endothelial cell
membrane.
d. Substances pass across the endothelial cell membrane by osmosis.
e. Substances pass through endothelial cell membranes by diffusion.
ANS: A, B, C, E
Substances pass between the capillary lumen and the interstitial fluid in several ways: (1)
through junctions between endothelial cells, (2) through fenestrations in endothelial cells, (3)
in vesicles moved by active transport across the endothelial cell membrane, or (4) by diffusion
through the endothelial cell membrane.
17. Which statements are true regarding fatty streaks? (Select all that apply.)
a. Fatty streaks progressively damage vessel walls.
b. Fatty streaks are capable of producing toxic oxygen radials.
c. When present, inflammatory changes occur to the vessel walls.
d. Oxidized low-density lipoproteins (LDLs) are involved in their formation.
e. Fatty streaks are formed by killer T cells filled with oxidized LDLs.
ANS: A, B, C, D
The oxidized LDLs penetrate the intima of the arterial wall and are engulfed by macrophages.
Macrophages filled with oxidized LDLs are called foam. Once these lipid-laden foam cells
accumulate in significant amounts, they form a lesion called a fatty streak. Once formed, fatty
streaks produce more toxic oxygen radicals and cause immunologic and inflammatory
changes, resulting in progressive damage to the vessel wall.
18. What factors contribute to the development of orthostatic hypotension? (Select all
that apply.)
a. Altered body chemistry
b. Drug action of certain antihypertensive agents
c. Prolonged immobility
d. Effects of aging on postural reflexes
e. Any condition that produces volume overload
ANS: A, B, C, D
Orthostatic hypotension may be acute or chronic. Acute orthostatic hypotension (temporary
type) may result from (1) altered body chemistry, (2) drug action (e.g., antihypertensives,
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) venous pooling (e.g., pregnancy, extensive
varicosities of the lower extremities). Older adults are susceptible to this type of orthostatic
hypotension, in which postural reflexes are slowed as part of the aging process.
19. Which assessment findings are clinical manifestations of aortic stenosis? (Select all
that apply.)
a. Jugular vein distention
b. Bounding pulses
c. Hypotension
d. Angina
e. Syncope
ANS: D, E
The classic manifestations of aortic stenosis are angina, syncope, and heart failure. None of
the other options are associated with aortic stenosis.
20. Which risk factors are associated with infective endocarditis? (Select all that apply.)
a. Rheumatic fever
b. Intravenous drug use
c. Long-term indwelling catheterization
d. Aortic regurgitation
e. Heart valve disease
ANS: B, C, E
Risk factors for infective endocarditis include acquired valvular heart disease, intravenous
drug abuse, long-term indwelling catheterization (e.g., for pressure monitoring,
hyperalimentation, or hemodialysis), and recent cardiac surgery. Neither rheumatic fever nor
aortic regurgitation is considered a risk factor for infective endocarditis.
21. What congenital heart defects are associated with intrauterine exposure to rubella?
(Select all that apply.)
a. Pulmonary stenosis (PS)
b. Cardiomegaly
c. Patent ductus arteriosus (PDA)
d. Coarctation of aorta (COA)
e. Ventricular septal defect (VSD)
ANS: A, C, D
PS, PDA, and COA are congenital heart defects associated with intrauterine exposure to
rubella. Cardiomegaly and VSD are associated with maternal diabetes.
22. Which symptoms meet the diagnostic criteria for Kawasaki disease in a child?
(Select all that apply.)
a. Fever for 5 days or longer
b. “Strawberry tongue”
c. Peripheral edema
d. Inguinal lymphadenopathy
e. Bilateral conjunctival infection
ANS: A, B, C, E
The child must exhibit five of the following six criteria: (1) fever for 5 days or longer, (2)
bilateral conjunctival infection without exudation, (3) changes in oral mucus such as
strawberry tongue, (4) a polymorphous rash, (5) cervical lymphadenopathy, and (6) changes in
the extremities such as peripheral edema
23. Which structures belong to the upper conduction airway? (Select all that apply.)
a. Oropharynx
b. Larynx
c. Nasopharynx
d. Trachea
e. Bronchi
ANS: A, C
The conducting airways are the portion of the pulmonary system that provides a passage for
the movement of air into and out of the gas-exchange portions of the lung. The nasopharynx,
oropharynx, and related structures are often called the upper airway. The remaining options
are not considered to be included in the upper conduction airway.
24. Regarding the respiratory process referred to as remodeling, which statements are
true? (Select all that apply.)
a. Remodeling involves the vascular walls.
b. Scarring and thickening occurs during this respiratory process.
c. Remodeling results in a permanent change.
d. Pulmonary artery hypotension results.
e. Remodeling increases blood flow resistance.
ANS: A, B, C, E
Remodeling is a process by which the vascular wall becomes scarred and thickened, thus
resulting in permanent decreases in luminal diameter, increased resistance to blood flow, and
permanent pulmonary artery hypertension.
25. What are the effects of aging on the pulmonary system?
a. Decreased chest wall compliance
b. Decreased lung recoil
c. Reduced ventilatory reserve
d. Decreased partial pressure of arterial oxygen (PaO2)
e. Reduced respiratory rate
ANS: A, B, C, D
Aging affects the mechanical aspects of ventilation by decreasing chest wall compliance and
elastic recoil of the lungs. Changes in these elastic properties reduce ventilatory reserve.
Aging causes the PaO2 to decrease but does not affect the partial pressure of arterial carbon
dioxide (PaCO2) or respiratory rate.
26. What are the causes of dyspnea? (Select all that apply.)
a. Decreased pH, increased partial pressure of arterial carbon dioxide (PaCO2) and
decreased partial pressure of arterial oxygen (PaO2)
b. Decreased blood flow to the medulla oblongata
c. Stimulation of stretch or J-receptors
d. Presence of anxiety
e. Presence of pain
ANS: A, C, D
Dyspnea can be triggered by decreased pH, increased PaCO2, and decreased PaO2. Stimulation
of either stretch or J-receptors is also known as a cause of dyspnea. Dyspnea may be the result
of pulmonary disease or many other conditions, such as pain, heart disease, trauma, and
anxiety. No data are available to support the role of decreased blood flow to the medulla
oblongata as being a cause of dyspnea.
27. Which inflammatory mediators are produced in asthma? (Select all that apply.)
a. Histamine
b. Bradykinin
c. Leukotrienes
d. Prostaglandins
e. Neutrophil proteases
ANS: A, B, C, D
A large number of inflammatory mediators, such as histamine, prostaglandins, and
leukotrienes, are produced by asthma. Neutrophil proteases are not produced in relationship to
asthma.
28. Which statement is true regarding alveoli? (Select all that apply.)
a. The number of functioning alveoli is determined by birth.
b. The alveoli begin to increase in size starting at 8 years of age.
c. The complexity of the alveoli increases into adulthood.
d. These structures produce surfactant.
e. Capillaries are the origin of alveoli.
ANS: B, C, E
Capillaries grow into the distal respiratory units that keep subdividing (alveolarization) to
maximize the surface area for gas exchange. The number of alveoli continues to increase
during the first 5 to 8 years of life, after which the alveoli increase in size and complexity.
Surfactant is a lipid-protein mix that is produced by type II alveolar cells.
29. Children diagnosed with chronic asthma are likely to exhibit which symptoms?
(Select all that apply.)
a. Nasal flaring
b. Musical expiratory wheezing
c. Clubbing of fingers and toes
d. Substernal retractions
e. Diaphoresis
ANS: A, B, D, E
On physical examination, expiratory wheezing that is often described as high pitched and
musical is exhibited, along with prolongation of the expiratory phase of the respiratory cycle.
Hyperinflation is sometimes visible. The respiratory rate is elevated, as is the heart rate. Nasal
flaring and accessory muscle use are evident, with retractions in the substernal, subcostal,
intercostal, suprasternal, or sternocleidomastoid areas. Infants may appear to be “head
bobbing” because of sternocleidomastoid muscle use. Pulsus paradoxus may also be present.
The child may appear anxious or diaphoretic, which are important signs of respiratory
compromise. Clubbing of fingers and toes is not typically associated with asthma.
30. Which symptom is not a clinical manifestation of croup?
a. Rhinorrhea
b. Sore throat
c. Low-grade fever
d. Barking cough
e. Coarse rhonchi
ANS: E
Typically, a prodrome of rhinorrhea, sore throat, and low-grade fever is exhibited for a few
days with croup. The child then develops the characteristic harsh (seal-like) barking cough,
hoarse voice, and inspiratory stridor. Rhonchi are associated with lower respiratory diseases.
31. What are the clinical manifestations of bacterial pneumonia in children? (Select all
that apply.)
a. Fever with chills
b. Productive cough
c. Dyspnea
d. Respiratory alkalosis
e. Malaise
ANS: A, B, C, E
The clinical presentation of bacterial pneumonia, particularly pneumococcal, may include a
preceding viral illness, followed by fever with chills and rigors, shortness of breath, and an
increasingly productive cough. Auscultation usually reveals such abnormalities as crackles or
decreased breath sounds. Other less specific findings may include malaise, emesis, abdominal
pain, and chest pain. Respir [Show Less]