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TEST BANK McCance Huether Pathophysiology The Biological basis in Disease in Adults and Children 8 Edition,1005 CORRECT

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Chapter 1: Cellular Biology MULTIPLE CHOICE 1. Which statement best describes the cellular function of metabolic absorption? a. Cells can produce proteins. c. Cells can take in and use nutri... ents. b. Cells can secrete digestive enzymes. d. Cells can synthesize fats. ANS: C In metabolic absorption, all cells take in and use nutrients and other substances from their surroundings. The remaining options are not inclusive in their descriptions of cellular metabolic absorption. PTS: 1 REF: Page 2 2. Most of a cell’s genetic information, including RNA and DNA, is contained in the: a. Mitochondria c. Nucleolus b. Ribosome d. Lysosome ANS: C The nucleus contains the nucleolus, a small dense structure composed largely of RNA, most of the cellular DNA, and the DNA-binding proteins, such as the histones, which regulate its activity. The other options do not contain most of a cell’s genetic information. PTS: 1 REF: Page 2 3. Which component of the cell prodNuUceRsSIhNyGdTroBg.CenOMperoxide (H2O2) by using oxygen to remove hydrogen atoms from specific substrates in an oxidative reaction? a. Lysosomes c. Ribosomes b. Peroxisomes d. Oxyhydrosomes ANS: B Peroxisomes are so named because they usually contain enzymes that use oxygen to remove hydrogen atoms from specific substrates in an oxidative reaction that produces H2O2, which is a powerful oxidant and potentially destructive if it accumulates or escapes from peroxisomes. Ribosomes are RNA-protein complexes (nucleoproteins) that are synthesized in the nucleolus and secreted into the cytoplasm through pores in the nuclear envelope called nuclear pore complexes. Lysosomes are saclike structures that originate from the Golgi complex and contain more than 40 digestive enzymes called hydrolases, which catalyze bonds in proteins, lipids, nucleic acids, and carbohydrates. Oxyhydrosomes are involved in enzyme production. PTS: 1 REF: Page 8 4. Which cell component is capable of cellular autodigestion when it is released during cell injury? a. Ribosome c. Smooth endoplasmic reticulum b. Golgi complex d. Lysosomes ANS: D The lysosomal membrane acts as a protective shield between the powerful digestive enzymes within the lysosome and the cytoplasm, preventing their leakage into the cytoplasmic matrix. Disruption of the membrane by various treatments or cellular injury leads to a release of the lysosomal enzymes, which can then react with their specific substrates, causing cellular self-digestion. The other options do not correctly describe this process. PTS: 1 REF: Pages 7-8 5. What is the sequence of steps in the development of a digestive enzyme by the pancreas cells from the initial transcription to the release from the cell? a. The enzyme is transcribed from DNA by RNA in the nucleus, proceeds to the ribosome for synthesis, and is transported in a secretory vesicle to the cell membrane. b. The enzyme is transcribed from RNA by DNA in the nucleus, proceeds to the lysosome for synthesis, and is transported in an encapsulated membrane to the cell membrane. c. The enzyme is transcribed by the mitochondria in the nucleus, proceeds to the ribosome for synthesis, and is transported in a cytoskeleton to the cell membrane. d. The enzyme is transcribed from DNA by RNA in the nucleus, proceeds to the Golgi complex for synthesis, and is transported in a cytosol to the cell membrane. ANS: A The enzyme is transcribed from DNA by RNA in the nucleus, proceeds to the ribosome for synthesis, and is transported in a secretory vesicle to the cell membrane. The other options do not correctly describe this process. NURSINGTB.COM PTS: 1 REF: Page 7 | Figure 1-5 6. During which phase of the cell cycle is DNA synthesized? a. G1 c. G2 b. S d. M ANS: B The four designated phases of the cell cycle are: (1) the G1 phase (G = gap), which is the period between the M phase (M = mitosis) and the start of DNA synthesis; (2) the S phase (S = synthesis), during which DNA is synthesized in the cell nucleus; (3) the G2 phase, during which RNA and protein synthesis occurs, the period between the completion of DNA synthesis and the next phase (M); and (4) the M phase, which includes nuclear and cytoplasmic division. PTS: 1 REF: Page 37 7. What organic compound facilitates transportation across cell membranes by acting as receptors, transport channels for electrolytes, and enzymes to drive active pumps? a. Lipids c. Proteins b. Proteases d. Carbohydrates ANS: C Proteins act as (1) recognition and binding units (receptors) for substances moving in and out of the cell; (2) pores or transport channels for various electrically charged particles called ions or electrolytes and specific carriers for amino acids and monosaccharides; and (3) specific enzymes that drive active pumps that promote the concentration of certain ions, particularly potassium (K+), within the cell while keeping concentrations of other ions, for example, sodium (Na+), below the concentrations found in the extracellular environment. The other options do not correctly describe this process. PTS: 1 REF: Page 13 | Page 15 8. Understanding the various steps of proteolytic cascades, such as caspase-mediated apoptosis and complement cascades, may be useful in designing drug therapy for which human diseases? a. Cardiac and vascular disorders b. Autoimmune and malignant disorders c. Gastrointestinal and renal disorders d. Endocrine and gastrointestinal disorders ANS: B Understanding the various steps involved in this process is crucial for designing drug interventions. Dysregulation of proteases features prominently in many human diseases, including cancer, autoimmunity, and neurodegenerative disorders. The other options do not correctly describe this process. PTS: 1 REF: Page 15 9. Which structure prevents water-soluble molecules from entering cells across the plasma membrane? NURSINGTB.COM a. Carbohydrate chains c. Membrane channel proteins b. Glycoprotein channels d. Lipid bilayer ANS: D The bilayer’s structure accounts for one of the essential functions of the plasma membrane. It is impermeable to most water-soluble molecules (molecules that dissolve in water) because the water-soluble molecules are insoluble in the oily core region. The bilayer serves as a barrier to the diffusion of water and hydrophilic substances while allowing lipid-soluble molecules, such as oxygen (O2) and carbon dioxide (CO2), to diffuse through it readily. The other options do not correctly describe this process. PTS: 1 REF: Pages 12-13 10. The fluid mosaic model explains: a. How a cell membrane functions b. Why our bodies appear to be solid c. How tissue is differentiated d. How fluid moves between the intracellular and extracellular compartments ANS: A The fluid mosaic model accounts for the flexibility of cellular membranes, their self-sealing properties, and their impermeability to many substances. The remaining options do not explain the mosaic model. PTS: 1 REF: Page 12 | What's New box 11. Which form of cell communication is used to communicate within the cell itself and with other cells in direct physical contact? a. Protein channel (gap junction) b. Plasma membrane–bound signaling molecules (involving receptors) c. Hormone secretion such as neurotransmitters d. Extracellular chemical messengers such as ligands ANS: A Cells communicate by using hundreds of kinds of signal molecules, for example, insulin. Cells communicate in three main ways; they display plasma membrane–bound signaling molecules (receptors) that affect the cell itself and other cells in direct physical contact. The other options do not correctly describe this process. PTS: 1 REF: Page 20 12. Which mode of chemical signaling uses blood to transport communication to cells some distance away? a. Paracrine c. Neurotransmitter b. Autocrine d. Hormonal ANS: D Chemical signaling can be classified into three categories: (1) local-chemical mediator, (2) hormone, and (3) neurotransmitter. In the local-chemical mediator model, the secreted chemical acts on the cells in the immediate environment. Hormones are used for communication with distant targetNcUeRllSsI.NFGoTrBe.xCaOmMple, cells can secrete a chemical and rely on the blood system to deliver the signal to a distant cell. Finally, neurotransmitters are secreted by neurons to stimulate an adjoining cell. For example, a neuron might secrete acetylcholine to stimulate the movement of a muscle cell. PTS: 1 REF: Page 20 13. Which mode of chemical signaling uses local chemical mediators that are quickly taken up, destroyed, or immobilized? a. Paracrine c. Neurotransmitter b. Autocrine d. Hormone ANS: A In paracrine signaling, cells secrete local chemical mediators that are quickly taken up, destroyed, or immobilized. The other options do not correctly describe this process. PTS: 1 REF: Page 20 14. Neurotransmitters affect the postsynaptic membrane by binding to: a. Lipids c. Amphipathic lipids b. Ribosomes d. Receptors ANS: D In each type of chemical signaling, the target cell receives the signal by first attaching to its receptors. The other options do not correctly describe this process. PTS: 1 REF: Page 17 15. How do cells receive communication from the extracellular fluid surrounding them? a. Protein channel (gap junction) b. Plasma membrane–bound signaling molecules (involving receptors) c. Hormone secretion such as neurotransmitters d. Chemical messengers such as ligands ANS: D Cellular communication can occur by the binding of a chemical massager (a ligand) to a specific membrane receptor that is closely associated with the channel (e.g., G proteins). The other options do not correctly describe how cells communicate. PTS: 1 REF: Pages 21-22 16. When a second message is necessary for extracellular communication to be activated, it is provided by which one? a. Guanosine triphosphate (GTP) c. Adenosine triphosphate (ATP) b. Adenosine monophosphate (AMP) d. Guanosine diphosphate (GDP) ANS: B The two major second messenger pathways are cyclic AMP (cAMP) and calcium (Ca++). PTS: 1 REF: Pages 22-23 17. Under anaerobic conditions, what process provides energy for the cell? a. Oxidative phosphorylation NURSINGTcB..COLMactolysis b. Glycolysis d. Passive transport ANS: B Glycolysis produces a net of two molecules of ATP per glucose molecule through the process of oxidation or the removal and transfer of a pair of electrons. The other options do not correctly identify an anaerobic process that provides energy to the cell. PTS: 1 REF: Page 28 18. What is the mechanism by which the energy produced from carbohydrates, proteins, and lipids is transferred to adenosine triphosphate (ATP)? a. Anaerobic glycolysis c. Oxidative phosphorylation b. Oxidative cellular metabolism d. Tricarboxylic acid phosphorylation ANS: C Oxidative phosphorylation occurs in the mitochondria and is the mechanism by which the energy produced from carbohydrates, fats, and proteins is transferred to ATP. The other options do not correctly identify the mechanism described in the question. PTS: 1 REF: Pages 27-28 19. Passive transport is best described with which statement? a. Being driven by osmosis, hydrostatic pressure, and diffusion b. Involving receptors that can bind with substances being transported c. Being capable of transporting macromolecules d. Requiring energy generated by the cell ANS: A Water and small electrically uncharged molecules move easily through pores in the plasma membrane’s lipid bilayer. This process, called passive transport, naturally occurs through any semipermeable barrier. It is driven by osmosis, hydrostatic pressure, and diffusion, all of which depend on the laws of physics and do not require life. The other options do not correctly describe passive transport. PTS: 1 REF: Page 28 20. Active transport occurs across which type of membranes? a. Membranes that have a higher concentration of the solute on the outside of the cell b. Membranes that are semipermeable to water and small electrically uncharged molecules c. Membranes that have receptors that are capable of binding with the substances to be transported d. Membranes that have a cell membrane that is hydrophobic rather than hydrophilic ANS: C Some molecules are moved into the cell by mechanisms of active transport, which require receptors that are capable of recognizing and binding with the substance to be transported. Diffusion is the movement of a solute molecule from an area of greater solute concentration to an area of lesser solute concentration. Hydrostatic pressure is the mechanical force of water pushing against cellular membranes. Osmosis is the movement of water down a concentration gradient; that is, across a semipermeable membrane from a region of higher water concentratiNoUnRtoSIaNGloTwBe.Cr OwMater concentration PTS: 1 REF: Page 28 21. Which method of transport uses transmembrane proteins with receptors with a high degree of specificity for the substance being transported? a. Active c. Transmembranous b. Mediated d. Passive ANS: B Mediated transport (passive and active) involves integral or transmembrane proteins with receptors having a high degree of specificity for the substance being transported. Inorganic anions and cations (e.g., Na+, K+, Ca++, chloride [Cl–], bicarbonate [HCO3–]) and charged and uncharged organic compounds (e.g., amino acids, sugars) require specific transport systems to facilitate movement through different cellular membranes. The remaining options do not correctly identify the process described. PTS: 1 REF: Page 31 22. The movement of fluid across the arterial end of capillary membranes into the interstitial fluid surrounding the capillary is an example of which fluid movement process? a. Hydrostatic pressure c. Diffusion b. Osmosis d. Active transport ANS: A Hydrostatic pressure is the mechanical force of water pushing against cellular membranes. In the vascular system, hydrostatic pressure is the blood pressure generated in vessels by the contraction of the heart. Blood reaching the capillary bed has a hydrostatic pressure of 25 to 30 mm Hg, which is sufficient force to push water across the thin capillary membranes into the interstitial space. The remaining options do not correctly identify the process described. PTS: 1 REF: Pages 29-30 23. Why is osmolality preferred over osmolarity as the measurement of osmotic activity in the clinical assessment of individuals? a. Plasma contains sodium and chloride, which influence the volume of solution. b. Volume affects perfusion more than the weight of solutes. c. More of the weight of plasma is influenced by solutes, such as protein and glucose, rather than by water. d. Osmotic activity depends on the concentration of solutes present in plasma, such as proteins and glucose. ANS: C In plasma, less of the plasma weight is water; therefore the overall concentration of particles is greater. The osmolality will be greater than the osmolarity because of the smaller proportion of water. Osmolality is thus the preferred measure of osmotic activity in clinical assessment of individuals. PTS: 1 REF: Page 30 24. A patient who has diarrhea receives a 3% saline solution intravenously to replace the sodium and chloride lost in the stoNoUl.RWSINhaGtTeBf.fCeOctMwill this fluid replacement have on cells? a. Become hydrated c. Shrink b. Swell or burst d. Divide ANS: C A hypertonic solution has a concentration of greater than 285 to 294 mOsm/kg. An example of a hypertonic solution is 3% saline solution. Water can be pulled out of the cells by a hypertonic solution; therefore the cells shrink. The remaining options do not correctly describe the effect identified in the stem. PTS: 1 REF: Page 31 25. The transport of glucose from the blood to the cell is accomplished by which process? a. Active-mediated transport (active transport) b. Active diffusion c. Passive osmosis d. Passive-mediated transport (facilitated diffusion) ANS: D Facilitated diffusion is the means by which glucose is transported from the blood to the cells. The remaining options do not correctly identify this process. PTS: 1 REF: Pages 31-32 26. Potassium and sodium are transported across plasma membranes by: a. Passive electrolyte channels b. Coupled channels c. Adenosine triphosphatase (ATPase) enzyme d. Diffusion ANS: C The exact mechanism for the transport of Na+ and K+ across the membrane is uncertain. One proposal is that ATPase enzyme induces the transporter protein to undergo several conformational changes, causing Na+ and K+ to move short distances (see Figure 1-29). The remaining options do not correctly describe the means by which K+ and Na+ are transported. PTS: 1 REF: Pages 32-33 27. What occurs during exocytosis? a. Macromolecules can be secreted across eukaryotic cell membranes. b. All substances are secreted into the cellular matrix. c. No repairs in the plasma membrane can take place. d. Solute molecules flow freely into and out of the cell. ANS: A In eukaryotic cells, secretion of macromolecules almost always occurs by exocytosis. The remaining options do not correctly describe exocytosis. PTS: 1 REF: Pages 35-36 28. Why is it possible for potassium to diffuse easily into and out of cells? a. Potassium has a greater conceNntUraRtSioINnGinTBth.CeOiMntracellular fluid (ICF). b. Sodium has a greater concentration in the extracellular fluid (ECF). c. The resting plasma membrane is more permeable to potassium. d. An excess of anions are inside the cell. ANS: C Because the resting plasma membrane is more permeable to K+ than to Na+, K+ can easily diffuse from its area of higher concentration in the ICF to its area of lower concentration in the ECF. Because Na+ and K+ are both cations, the net result is an excess of anions inside the cell, resulting in the resting membrane potential. The remaining options do not correctly identify the process that most easily diffuses K+. PTS: 1 REF: Page 36 29. The cellular uptake of the nutrient cholesterol depends on which process? a. Receptor-mediated exocytosis c. Receptor-mediated endocytosis b. Antiport system d. Passive transport ANS: C The cellular uptake of nutrients, such as cholesterol, for example, depends on receptor-mediated endocytosis. Nutrients are not transported via the other options. PTS: 1 REF: Page 33 30. What causes the rapid change in the resting membrane potential to initiate an action potential? a. Potassium gates open, and potassium rushes into the cell, changing the membrane potential from negative to positive. b. Sodium gates open, and sodium rushes into the cell, changing the membrane potential from negative to positive. c. Sodium gates close, allowing potassium into the cell to change the membrane potential from positive to negative. d. Potassium gates close, allowing sodium into the cell to change the membrane potential from positive to negative. ANS: B When a resting cell is stimulated through voltage-regulated channels, the cell membranes become more permeable to Na+. A net Na+ moves into the cell, and the membrane potential decreases, or moves forward, from a negative value (in millivolts) to zero. The Na+ gates open, and Na+ rushes into the cell, causing the membrane potential to reduce to zero and then become positive (depolarization). The remaining options do not correctly describe the change that initiates an action potential. PTS: 1 REF: Page 36 31. The action of platelet-derived growth factor is to stimulate the production of which cells? a. Platelets c. Connective tissue cells b. Epidermal cells d. Fibroblast cells ANS: C Different types of cells require different factors; for example, platelet-derived growth factor stimulates the production ofNcUoRnSnINecGtiTvBe.CtiOssMue cells. The remaining options do not correctly describe the action of platelet-derived growth factor. PTS: 1 REF: Page 39 32. The role of cytokines in cell reproduction is that they: a. Provide growth factor for tissue growth and development. b. Block progress of cell reproduction through the cell cycle. c. Restrain cell growth and development. d. Provide nutrients for cell growth and development. ANS: A Growth factors, also called cytokines, are peptides that transmit signals within and among cells. They have a major role in the regulation of tissue growth and development (see Table 1-6). The remaining options do not correctly describe the role of cytokines in cell reproduction. PTS: 1 REF: Pages 38-39 33. What is the process of cellular reproduction? a. The process often takes months or years to complete. b. Cellular reproduction typically has a short interphase. c. Two diploid cells, called daughter cells, have been formed. d. The process involves the interaction of male and female cells. ANS: C During telophase, the final stage, a new nuclear membrane is formed around each group of 46 chromosomes, the spindle fibers disappear, and the chromosomes begin to uncoil. Cytokinesis causes the cytoplasm to divide into roughly equal parts during this phase. At the end of telophase, two identical diploid cells, called daughter cells, have been formed from the original cell. PTS: 1 REF: Page 37 34. Which statement is true about eukaryotic cells? a. They lack distinct nucleus. b. They contain compartments called organelles. c. They lack an encasing nuclear membrane. d. They are smaller than the typical prokaryote cell. ANS: B Eukaryotic cells have a characteristic set of membrane-bound intracellular compartments called organelles that include a well-defined nucleus and are larger than prokaryotes. The remaining statements are not true regarding eukaryotic cells. PTS: 1 REF: Page 2 35. Which statement is true about phagocytosis? a. Phagocytosis is an example of exocytosis. b. Phagocytosis is dependent on small vesicles. c. Phagocytosis involves the ingestion of bacteria. d. Phagocytosis focuses on solute molecules. NURSINGTB.COM ANS: C In phagocytosis, the large molecular substances are engulfed by the plasma membrane and enter the cell so that they can be isolated and destroyed by lysosomal enzymes. Two types of endocytosis are designated, based on the size of the vesicle formed. Pinocytosis (cell drinking) involves the ingestion of fluids and solute molecules through the formation of small vesicles, and phagocytosis (cell eating) involves the ingestion of large particles, such as bacteria, through formation of large vesicles (also called vacuoles). Phagocytosis in an example of endocytosis, not exocytosis. PTS: 1 REF: Pages 33-34 36. A muscle cell possesses which specialized function? a. Movement c. Secretion b. Conductivity d. Respiration ANS: A A cell has the potential to differentiation and to gain the ability to perform one of eight specialized functions. Muscle cells can generate forces that produce motion. Nerves cells are capable of conductivity. Cells of the adrenal gland, testis, and ovary can secrete. Respiration is a function that all cells possess. PTS: 1 REF: Page 2 37. When a mucous gland cell creates a new substance from previously absorbed material, this process is known as which specialized cellular function? a. Excretion c. Reproduction b. Metabolic absorption d. Secretion ANS: D Certain cells, such as mucous gland cells, can synthesize new substances from substances they absorb and then secrete the new substances to serve elsewhere as needed. The other options are not used to describe the function described in the stem. PTS: 1 REF: Page 2 38. All cells are capable of what process? a. Excretion c. Metabolic absorption b. Movement d. Continuous division ANS: A All cells have the capacity to excrete, thus allowing them to rid themselves of waste products resulting from the metabolic breakdown of nutrients. The remaining options are not functions possessed by all cells. PTS: 1 REF: Page 2 MULTIPLE RESPONSE 39. What are the major chemical components of the cell membranes? (Select all that apply.) a. Lipids b. Sodium ions c. Carbohydrates d. DNA e. Proteins ANS: A, E NURSINGTB.COM The major chemical components of all cell membranes are lipids and proteins, but the percentage of each varies among different membranes. PTS: 1 REF: Page 12 40. Which cells lose their ability to replicate and divide? (Select all that apply.) a. Intestines b. Nerves c. Skin d. Lens of the eye e. Skeletal muscle ANS: B, D, E All types of cells undergo mitosis during the formation of the embryo, but many adult cells, such as nerve cells, lens cells of the eye, and muscle cells, lose their ability to replicate and divide. Intestines and skin cells retain their ability to replicate and divide. PTS: 1 REF: Page 37 41. Which statements are true concerning the process of facilitated diffusion? (Select all that apply). a. Facilitated diffusion is also referred to as passive mediated transport. b. This process expends no metabolic energy. c. Moving solute molecules through cellular membranes are involved in this process. d. Movement up a concentration gradient is necessary. e. Facilitated diffusion is the primary means for water transport. ANS: A, B, C In passive mediated transport, also called facilitated diffusion, the protein transporter moves solute molecules through cellular membranes without expending metabolic energy. Downward movement along a concentration gradient is necessary. Osmosis is the movement of water down a concentration gradient. PTS: 1 REF: Pages 31-32 42. Passive transport is dependent on: (Select all that apply.) a. Semipermeable barrier membrane b. The process of osmosis c. Diffusion as a driving force d. A living host e. Hydrostatic pressure ANS: A, B, C, E Passive transport naturally occurs through any semipermeable barrier. It is driven by osmosis, hydrostatic pressure, and diffusion, all of which depend on the laws of physics and do not require life. NURSINGTB.COM PTS: 1 REF: Page 28 43. What is the primary function of proteins? (Select all that apply.) a. Proteins are binding units. b. Proteins are transport channels. c. Proteins are ribonucleoproteins. d. Proteins provide cell surface markers. e. Proteins are chemical reaction catalysts. ANS: A, B, D, E Protein functions include (a) recognition and binding units (receptors) for substances moving in and out of the cell; (b) pores or transport channels; (c) enzymes that drive active pumps; (d) cell surface markers, such as glycoproteins; (e) cell adhesion molecules; and (f) catalysts of chemical reactions. PTS: 1 REF: Page 15 MATCHING Match the structure with its function. Answers may be used more than once. A. Endoplasmic reticulum B. Ribosome C. Secretory vesicle D. Lysosomes 44. Packages and transports proteins. 45. Fuses with the plasma membrane to release contents from the cell. 46. Synthesizes and transports lipids. 47. Provides energy to digest proteins into amino acids. 44. ANS: A PTS: 1 REF: Pages 5-6 MSC: The endoplasmic reticulum (endo = within; plasma = cytoplasm; reticulum = network) is a membrane factory that specializes in the synthesis and transport of the protein and lipid components of most of the cell's organelles. 45. ANS: C PTS: 1 REF: Pages 6-7 MSC: Proteins from the endoplasmic reticulum are processed and packaged into small membrane-bound sacs or vesicles called secretory vesicles that collect at the end of the membranous folds of the Golgi bodies. The secretory vesicles then break off from the Golgi complex and migrate to a variety of intracellular and extracellular destinations, including the plasma membrane. The vesicles fuse with the plasma membrane, and their contents are released from the cell. 46. ANS: A PTS: 1 REF: Pages 5-6 MSC: The endoplasmic reticulum (endo = within; plasma = cytoplasm; reticulum = network) is a membrane factory that specializes in the synthesis and transport of the protein and lipid components of most of the cell's organelles. 47. ANS: D PTS: 1 REF: Page 7 MSC: Lysosomes function as the intracellular digestive system (see Figure 1-6). Lysosomal enzymes are capable of digesting most cellular constituents down to their basic forms, such as amino acids, fatty acids, and sugars. Match the structure with its functiNoUn.RASInNsGwTeBrs.CmOaMy be used more than once. A. Passive-mediated transport B. Active-mediated transport C. Osmosis 48. Movement of water 49. Protein carrier 50. Facilitated diffusion 48. ANS: C PTS: 1 REF: Page 30 MSC: Osmosis is the movement of water down a concentration gradient; that is, across a semipermeable membrane from a region of higher water concentration to a lower water concentration. 49. ANS: B PTS: 1 REF: Page 32 MSC: In active-mediated transport, also called active transport, the protein transporter moves molecules against, or up, the concentration gradient. Unlike passive-mediated transport, active-mediated transport requires the expenditure of energy. 50. ANS: A PTS: 1 REF: Pages 31-32 MSC: In passive-mediated transport, also called facilitated diffusion, the protein transporter moves solute molecules through cellular membranes without expending metabolic energy. Chapter 2: Altered Cellular and Tissue Biology MULTIPLE CHOICE 1. Which type of cell adaptation occurs when normal columnar ciliated epithelial cells of the bronchial lining have been replaced by stratified squamous epithelial cells? a. Hyperplasia c. Dysplasia b. Metaplasia d. Anaplasia ANS: B Metaplasia is the reversible replacement of one mature cell by another, sometimes a less differentiated cell type. The best example of metaplasia is the replacement of normal columnar ciliated epithelial cells of the bronchial (airway) lining by stratified squamous epithelial cells. The other options do not accurately describe the event in the question. PTS: 1 REF: Page 54 2. The loss of the adenosine triphosphate (ATP) during ischemia causes cells to: a. Shrink because of the influx of calcium (Ca). b. Shrink because of the influx of potassium chloride (KCl). c. Swell because of the influx of sodium chloride (NaCl). d. Swell because of the influx of nitric oxide (NO). ANS: C A reduction in ATP levels causes the plasma membrane’s sodium-potassium (Na+–K+) pump and sodium-calcium exchange to fail, which leads to an intracellular accumulation of sodium and calcium and diffusiNoUnRoSfINpoGtTaBss.CiuOmMout of the cell. (The Na+–K+ pump is discussed in Chapter 1.) Sodium and water can then freely enter the cell, and cellular swelling results. The other options do not accurately describe the result of ATP at the cellular level. PTS: 1 REF: Page 57 3. The mammary glands enlarge during pregnancy primarily as a consequence of hormonal: a. Atrophy c. Anaplasia b. Hyperplasia d. Dysplasia ANS: B Hormonal hyperplasia occurs chiefly in estrogen-dependent organs, such as the uterus and breast. The remaining options do not adequately describe the consequence of hormones on breast tissue during pregnancy. PTS: 1 REF: Page 53 4. Free radicals play a major role in the initiation and progression of which diseases? a. Cardiovascular diseases such as hypertension and ischemic heart disease b. Renal diseases such as acute tubular necrosis and glomerulonephritis c. Gastrointestinal diseases such as peptic ulcer disease and Crohn disease d. Muscular disease such as muscular dystrophy and fibromyalgia ANS: A Emerging data indicate that reactive oxygen species play major roles in the initiation and progression of cardiovascular alterations associated with hyperlipidemia, diabetes mellitus, hypertension, ischemic heart disease, and chronic heart failure. No current research connects the disorders mentioned in the other options to the effects of free radicals. PTS: 1 REF: Pages 59-60 5. Free radicals cause cell damage by: a. Stealing the cell’s oxygen to stabilize the electron, thus causing hypoxia b. Stimulating the release of lysosomal enzymes that digest the cell membranes c. Transferring one of its charged, stabilized atoms to the cell membrane, which causes lysis d. Giving up an electron, which causes injury to the chemical bonds of the cell membrane ANS: D A free radical is an electrically uncharged atom or group of atoms having an unpaired electron. Having one unpaired electron makes the molecule unstable; thus to stabilize, the molecule gives up an electron to another molecule or steals one. Therefore it is capable of forming injurious chemical bonds with proteins, lipids, or carbohydrates—key molecules in membranes and nucleic acids. The remaining options do not accurately describe the role played by free radicals in cell damage. PTS: 1 REF: Page 60 6. What is a consequence of plasma membrane damage to the mitochondria? a. Enzymatic digestion halts DNA synthesis. b. Influx of calcium ions halts ANTUPRpSrIoNdGuTctBio.CnO. M c. Edema from an influx in sodium causes a reduction in ATP production. d. Potassium shifts out of the mitochondria, which destroys the infrastructure. ANS: B The most serious consequence of plasma membrane damage is, as in hypoxic injury, to the mitochondria. An influx of calcium ions from the extracellular compartment activates multiple enzyme systems, resulting in cytoskeleton disruption, membrane damage, activation of inflammation, and eventually DNA degradation. Calcium ion accumulation in the mitochondria causes the mitochondria to swell, which is an occurrence that is associated with irreversible cellular injury. The injured mitochondria can no longer generate ATP, but they do continue to accumulate calcium ions. The remaining options do not accurately describe the consequence of plasma membrane damage to the mitochondria. PTS: 1 REF: Page 63 7. What is a consequence of leakage of lysosomal enzymes during chemical injury? a. Enzymatic digestion of the nucleus and nucleolus occurs, halting DNA synthesis. b. Influx of potassium ions into the mitochondria occurs, halting the ATP production. c. Edema of the Golgi body occurs, preventing the transport of proteins out of the cell. d. Shift of calcium out of the plasma membrane occurs, destroying the cytoskeleton. ANS: A Enzymatic digestion of cellular organelles, including the nucleus and nucleolus, ensues, halting the synthesis of DNA and ribonucleic acid (RNA). The remaining options do not accurately describe the consequence of lysosomal enzyme leakage during chemical injury. PTS: 1 REF: Page 63 8. Lead causes damage within the cell by interfering with the action of: a. Sodium and chloride c. Calcium b. Potassium d. ATP ANS: C Lead affects many different biologic activities at the cellular and molecular levels, many of which may be related to its ability to interfere with the functions of calcium. Lead does not appear to cause damage by interfering with the action of the other options. PTS: 1 REF: Page 66 9. Which statement is a description of the characteristics of apoptosis? a. Programmed cell death of scattered, single cells b. Characterized by swelling of the nucleus and cytoplasm c. Unpredictable patterns of cell death d. Results in benign malignancies ANS: A Apoptosis is an active process of cellular self-destruction, also known as programmed cell death, which is implicated in normal and pathologic tissue changes. The remaining options do not accurately describe the characteristics of apoptosis. NURSINGTB.COM PTS: 1 REF: Page 91 10. Lead poisoning affects the nervous system by: a. Interfering with the function of neurotransmitters b. Inhibiting the production of myelin around nerves c. Increasing the resting membrane potential d. Altering the transport of potassium into the nerves ANS: A Alterations in calcium may play a crucial role in the interference with neurotransmitters, which may cause hyperactive behavior and the proliferation of capillaries of the white matter and intercerebral arteries. The remaining options do not accurately describe the effects of lead poisoning of the nervous system. PTS: 1 REF: Page 66 11. Carbon monoxide causes tissue damage by: a. Competing with carbon dioxide so that it cannot be excreted b. Binding to hemoglobin so that it cannot carry oxygen c. Destroying the chemical bonds of hemoglobin so it cannot carry oxygen d. Removing iron from hemoglobin so it cannot carry oxygen ANS: B Because carbon monoxide’s affinity for hemoglobin is 200 times greater than that of oxygen, it quickly binds with the hemoglobin, preventing oxygen molecules from doing so. The remaining options do not accurately describe the means by which carbon monoxide damages tissue. PTS: 1 REF: Page 67 12. Acute alcoholism mainly affects which body system? a. Hepatic c. Renal b. Gastrointestinal d. Central nervous ANS: D Acute alcoholism mainly affects the central nervous system but may induce reversible hepatic and gastric changes. Other systems may evidentially be affected by chronic alcoholism. PTS: 1 REF: Page 68 13. During cell injury caused by hypoxia, an increase in the osmotic pressure occurs within the cell because: a. Plasma proteins enter the cell. b. The adenosine triphosphatase (ATPase)–driven pump is stronger during hypoxia. c. Sodium chloride enters the cell. d. An influx of glucose occurs through the injured cell membranes. ANS: C In hypoxic injury, movement of fluid and ions into the cell is associated with acute failure of metabolism and a loss of ATP pNrUoRdSuIcNtiGoTnB. .NCoOrMmally, the pump that transports sodium ions out of the cell is maintained by the presence of ATP and ATPase, the active-transport enzyme. In metabolic failure caused by hypoxia, reduced ATP and ATPase levels permit sodium to accumulate in the cell, whereas potassium diffuses outward. The increase of intracellular sodium increases osmotic pressure, which draws more water into the cell. (Transport mechanisms are described in Chapter 1.) The remaining options do not accurately describe the cell injury that results in increased osmotic pressure caused by hypoxia. PTS: 1 REF: Page 84 14. Which statement is true regarding the difference between subdural hematoma and epidural hematoma? a. No difference exists, and these terms may be correctly used interchangeably. b. A subdural hematoma occurs above the dura, whereas an epidural hematoma occurs under the dura. c. A subdural hematoma is often the result of shaken baby syndrome, whereas an epidural hematoma rapidly forms as a result of a skull fracture. d. A subdural hematoma usually forms from bleeding within the skull, such as an aneurysm eruption, whereas an epidural hematoma occurs from trauma outside the skull, such as a blunt force trauma. ANS: C A subdural hematoma is a collection of blood between the inner surface of the dura mater and the surface of the brain, resulting from the shearing of small veins that bridge the subdural space. Subdural hematomas can be the result of blows, falls, or sudden acceleration-deceleration of the head, which occurs in the shaken baby syndrome. An epidural hematoma is a collection of blood between the inner surface of the skull and the dura and is almost always associated with a skull fracture. The other options do not accurately describe the differences between the two hematomas. PTS: 1 REF: Page 72 | Table 2-6 15. What physiologic change occurs during heat exhaustion? a. Hemoconcentration occurs because of the loss of salt and water. b. Cramping of voluntary muscles occurs as a result of salt loss. c. Thermoregulation fails because of high core temperatures. d. Subcutaneous layers are damaged because of high core temperatures. ANS: A Heat exhaustion occurs when sufficient salt and water loss results in hemoconcentration. The other options do not accurately describe the physiologic changes that occur during heat exhaustion. PTS: 1 REF: Page 77 16. In hypoxic injury, sodium enters the cell and causes swelling because: a. The cell membrane permeability increases for sodium during periods of hypoxia. b. ATP is insufficient to maintain the pump that keeps sodium out of the cell. c. The lactic acid produced by the hypoxia binds with sodium in the cell. d. Sodium cannot be transportedNtoURthSeINcGelTlBm.CeOmMbrane during hypoxia. ANS: B In hypoxic injury, movement of fluid and ions into the cell is associated with acute failure of metabolism and a loss of ATP production. Normally, the presence of ATP and ATPase, the active-transport enzyme, maintains the pump that transports sodium ions out of the cell. In metabolic failure caused by hypoxia, reduced ATP and ATPase levels permit sodium to accumulate in the cell, whereas potassium diffuses outward. The other options do not accurately describe the cause of the swelling caused by hypoxia. PTS: 1 REF: Page 84 17. What is the most common site of lipid accumulation? a. Coronary arteries c. Liver b. Kidneys d. Subcutaneous tissue ANS: C Although lipids sometimes accumulate in heart and kidney cells, the most common site of intracellular lipid accumulation, or fatty change, is liver cells. Subcutaneous tissue is not a common site of lipid accumulation. PTS: 1 REF: Pages 84-85 18. What mechanisms occur in the liver cells as a result of lipid accumulation? a. Accumulation of lipids that obstruct the common bile duct, preventing flow of bile from the liver to the gallbladder b. Increased synthesis of triglycerides from fatty acids and decreased synthesis of apoproteins c. Increased binding of lipids with apoproteins to form lipoproteins d. Increased conversion of fatty acids to phospholipids ANS: B Lipid accumulation in liver cells occurs after cellular injury sets the following mechanisms in motion: increased synthesis of triglycerides from fatty acids (increases in the enzyme, -glycerophosphatase, which can accelerate triglyceride synthesis) and decreased synthesis of apoproteins (lipid-acceptor proteins). The other options do not accurately describe this event. PTS: 1 REF: Pages 84-85 19. Hemoprotein accumulations are a result of the excessive storage of: a. Iron, which is transferred from the cells to the bloodstream b. Hemoglobin, which is transferred from the bloodstream to the cells c. Albumin, which is transferred from the cells to the bloodstream d. Amino acids, which are transferred from the cells to the bloodstream ANS: A Excessive storage of iron, which is transferred to the cells from the bloodstream, causes hemoprotein accumulations in cells. Hemoglobin, albumin, or amino acids will not cause hemoprotein accumulations. PTS: 1 REF: Page 86 NURSINGTB.COM 20. Hemosiderosis is a condition that results in the excess of what substance being stored as hemosiderin in cells of many organs and tissues? a. Hemoglobin c. Iron b. Ferritin d. Transferrin ANS: C Hemosiderosis is a condition that occurs only when excess iron is stored as hemosiderin in the cells of many organs and tissues. PTS: 1 REF: Page 86 21. What is the cause of free calcium in the cytosol that damages cell membranes by uncontrolled enzyme activation? a. Activation of endonuclease interferes with the binding of calcium to protein. b. Activation of phospholipases, to which calcium normally binds, degrades the proteins. c. An influx of phosphate ions competes with calcium for binding to proteins. d. Depletion of ATP normally pumps calcium from the cell. ANS: D If abnormal direct damage occurs to membranes or ATP is depleted, then calcium increases in the cytosol. The other options do not accurately describe the cause of free calcium in cytosol to damage cell membranes. PTS: 1 REF: Pages 57-58 | Page 87 | Figure 2-24 22. What two types of hearing loss are associated with noise? a. Acoustic trauma and noise-induced c. High frequency and acoustic trauma b. High frequency and low frequency d. Noise-induced and low frequency ANS: A Two types of hearing loss are associated with noise: (1) acoustic trauma or instantaneous damage caused by a single sharply rising wave of sound (e.g., gunfire), and (2) noise-induced hearing loss, the more common type, which is the result of prolonged exposure to intense sound (e.g., noise associated with the workplace and leisure-time activities). The remaining options are not related to noise but rather to the amplitude of the sound. PTS: 1 REF: Page 83 23. What type of necrosis results from ischemia of neurons and glial cells? a. Coagulative c. Caseous b. Liquefactive d. Gangrene ANS: B Liquefactive necrosis commonly results from ischemic injury to neurons and glial cells in the brain. The other types of necrosis are not related to ischemic injuries in the brain. PTS: 1 REF: Page 90 24. What type of necrosis is often associated with pulmonary tuberculosis? a. Bacteriologic NURSINGTcB..COLMiquefactive b. Caseous d. Gangrenous ANS: B Caseous necrosis, which commonly results from tuberculous pulmonary infection, particularly Mycobacterium tuberculosis, is a combination of coagulative and liquefactive necrosis. The other types of necrosis are not observed in pulmonary tuberculosis. PTS: 1 REF: Page 90 25. What type of necrosis is associated with wet gangrene? a. Coagulative c. Caseous b. Liquefactive d. Gangrene ANS: B Wet gangrene develops only when neutrophils invade the site, causing liquefactive necrosis. PTS: 1 REF: Page 91 26. Current research supports the believe that, after heart muscle injury, the damage: a. Remains indefinitely because cardiac cells do not reproduce. b. Is repaired by newly matured cardiomyocytes. c. Gradually decreases in size as mitotic cell division occurs. d. Is replaced by hypertrophy of remaining cells. ANS: B The recent discovery that cardiac stem cells exist in the heart and differentiate into various cardiac cell lineages has profoundly changed the understanding of myocardial biology; it is now believed that bone marrow–derived cardiac stem cells or progenitor cells that have the ability to mature into cardiomyocytes may populate the heart after injury. The other options do not accurately describe the process that is believed to occur to address cardiac muscle damage. PTS: 1 REF: Page 52 | What's New box 27. After ovulation, the uterine endometrial cells divide under the influence of estrogen. This process is an example of hormonal: a. Hyperplasia c. Hypertrophy b. Dysplasia d. Anaplasia ANS: A Hormonal hyperplasia chiefly occurs in estrogen-dependent organs, such as the uterus and breast. After ovulation, for example, estrogen stimulates the endometrium to grow and thicken for reception of the fertilized ovum. The other options do not accurately describe the process identified in the question. PTS: 1 REF: Pages 51-53 28. The abnormal proliferation of cells in response to excessive hormonal stimulation is called: a. Dysplasia c. Hyperplasia b. Pathologic dysplasia d. Pathologic hyperplasia NURSINGTB.COM ANS: D Pathologic hyperplasia is the abnormal proliferation of normal cells and can occur as a response to excessive hormonal stimulation or the effects of growth factors on target cells (see Figure 2-4). The other options do not accurately identify the term for the results of excessive hormonal stimulation on cells. PTS: 1 REF: Page 53 29. Removal of part of the liver leads to the remaining liver cells undergoing compensatory: a. Atrophy c. Hyperplasia b. Metaplasia d. Dysplasia ANS: C Compensatory hyperplasia is an adaptive mechanism that enables certain organs to regenerate. For example, the removal of part of the liver leads to hyperplasia of the remaining liver cells (hepatocytes) to compensate for the loss. The other options do not accurately identify the compensatory process described in the question. PTS: 1 REF: Pages 52-53 30. What is the single most common cause of cellular injury? a. Hypoxic injury c. Infectious injury b. Chemical injury d. Genetic injury ANS: A Hypoxia, or lack of sufficient oxygen, is the single most common cause of cellular injury (see Figure 2-8). The other options are not a commonly observed as is the correct option. PTS: 1 REF: Page 56 31. During cell injury caused by hypoxia, sodium and water move into the cell because: a. Potassium moves out of the cell, and potassium and sodium are inversely related. b. The pump that transports sodium out of the cell cannot function because of a decrease in ATP levels. c. The osmotic pressure is increased, which pulls additional sodium across the cell membrane. d. Oxygen is not available to bind with sodium to maintain it outside of the cell. ANS: B A reduction in ATP levels causes the plasma membrane’s sodium-potassium (Na+–K+) pump and sodium-calcium exchange to fail, which leads to an intracellular accumulation of sodium and calcium and diffusion of potassium out of the cell. (The Na+–K+ pump is discussed in Chapter 1.) PTS: 1 REF: Page 57 32. In decompression sickness, emboli are formed by bubbles of: a. Oxygen c. Carbon monoxide b. Nitrogen d. Hydrogen ANS: B If water pressure is too rapidly redNuUcRedS,INthGeTgBa.CseOsMdissolved in blood bubble out of the solution, forming emboli. Oxygen is quickly redissolved, but nitrogen bubbles may persist and obstruct blood vessels. Ischemia, resulting from gas emboli, causes cellular hypoxia, particularly in the muscles, joints, and tendons, which are especially susceptible to changes in oxygen supply. The remaining options are not involved in the formation of decompression sickness emboli. PTS: 1 REF: Page 77 33. Which is an effect of ionizing radiation exposure? a. Respiratory distress c. DNA aberrations b. Sun intolerance d. Death ANS: C The effects of ionizing radiation may be acute or delayed. Acute effects of high doses, such as skin redness, skin damage, or chromosomal aberrations, occur within hours, days, or months. The delayed effects of low doses may not be evident for years. The other options are not commonly considered effects of radiation exposure. PTS: 1 REF: Pages 78-79 34. What is an example of compensatory hyperplasia? a. Hepatic cells increase cell division after part of the liver is excised. b. Skeletal muscle cells atrophy as a result of paralysis. c. The heart muscle enlarges as a result of hypertension. d. The size of the uterus increases during pregnancy. ANS: A Compensatory hyperplasia is an adaptive mechanism that enables certain organs to regenerate. For example, the removal of part of the liver leads to hyperplasia of the remaining liver cells (hepatocytes) to compensate for the loss. The other options do not accurately describe the term compensatory hyperplasia. PTS: 1 REF: Pages 52-53 35. It is true that nondividing cells are: a. Found in gastrointestinal lining c. Incapable of synthesizing DNA b. Affected by hyperplasia d. Affected by only hypertrophy ANS: A Gastrointestinal lining is made up of rapidly dividing cells. Hyperplasia and hypertrophy take place if the cells are capable of synthesizing DNA; however, only hypertrophy occurs in nondividing cells. PTS: 1 REF: Pages 51-53 36. Dysplasia refers to a(n): a. Abnormal increase in the number of a specific cell type b. True adaptive process at the cellular level c. Modification in the shape of a specific cell type d. Lack of oxygen at the cellular level ANS: C NURSINGTB.COM Dysplasia refers only to abnormal changes in the size, shape, and organization of mature cells. PTS: 1 REF: Pages 53-54 37. Current research has determined that chemical-induced cellular injury: a. Affects the permeability of the plasma membrane. b. Is often the result of the damage caused by reactive free radicals. c. Is rarely influenced by lipid peroxidation. d. Seldom involves the cell’s organelles. ANS: B Not all the mechanisms causing chemical-induced membrane destruction are known; however, the only two general mechanisms currently accepted include: (1) direct toxicity by combining with a molecular component of the cell membrane or organelles, and (2) reactive free radicals and lipid peroxidation. PTS: 1 REF: Pages 62-63 If needing more Test Banks, just let me know: [email protected] MULTIPLE RESPONSE 38. Which organs are affected by lead consumption? (Select all that apply.) a. Bones b. Muscles c. Pancreas d. Nerves e. Eyes ANS: A, D The only organ systems provided as options that are primarily affected by lead include the nervous system, bones, kidneys, teeth, cardiovascular, and reproductive and immune systems. PTS: 1 REF: Page 66 39. What effect does fetal alcohol syndrome have on newborns? (Select all that apply.) a. Failure of alveoli to open b. Cognitive impairment c. Incompetent semilunar values d. Esophageal stricture e. Facial anomalies ANS: B, E Fetal alcohol syndrome (FAS) can lead to growth restriction, cognitive impairment, facial anomalies, and ocular disturbances. The other options do not accurately describe the effects of FAS. NURSINGTB.COM PTS: 1 REF: Page 69 40. What organs are affected by the type of necrosis that results from either severe ischemia or chemical injury? (Select all that apply.) a. Lungs b. Brain c. Kidneys d. Muscles e. Heart ANS: C, E Coagulative necrosis, which occurs primarily in the kidneys, heart, and adrenal glands, is a common result of hypoxia from severe ischemia or hypoxia caused by chemical injury, especially the ingestion of mercuric chloride. The other options do not accurately identify organs affected by necrosis resulting from ischemia or chemical injury. PTS: 1 REF: Page 90 41. It is true that melanin is: (Select all that apply.) a. Rarely found in epithelial cells b. Found in cells called keratinocytes, which are present in the retina c. A factor in the prevention of certain types of cancer d. Most influential in managing the effects of short-term sunlight exposure e. Accumulated in specific cells found in the skin ANS: B, C, E Melanin accumulates in epithelial cells (keratinocytes) of the skin and retina and is an extremely important pigment because it protects the skin against long exposure to sunlight and is considered an essential factor in the prevention of skin cancer. PTS: 1 REF: Pages 85-86 42. Examples of adaptive cellular responses include: (Select all that apply.) a. Atrophy b. Dysplasia c. Hypertrophy d. Hyperplasia e. Metaplasia ANS: A, C, D, E Atrophy, hypertrophy, hyperplasia, and metaplasia are considered to be adaptive cellular responses. PTS: 1 REF: Page 50 43. Blunt force injuries would include a: (Select all that apply.) a. Bruise to the upper arm, resulting from a fall b. Simple tibia fracture sustained in a skiing accident c. Cut on the finger while slicing vegetables for a salad d. Spleen laceration caused by a punch during a physical fight e. Small caliber gunshot wound tNoUtRhSeIfNoGoTt Bw.ChOileMtarget shooting ANS: A, B, D Blunt force injuries are the result of tearing, shearing, or crushing types of injuries, resulting in bruises, fractures, and lacerations caused by blows or impacts. Sharp force injuries include cuts. Gunshot wounds require the penetration of the skin and muscle by a bullet. PTS: 1 REF: Page 72 | Table 2-6 44. Which statements are true regarding the effects of marijuana use? (Select all that apply.) a. Smoking the drug results in greater absorption that eating it. b. Heavy use can result in psychomotor impairments. c. Smoking four “joints” a day equals smoking approximately 20 cigarettes. d. Research does not support marijuana use as a factor in developing lung cancer. e. Fetal development appears to be unharmed by marijuana use. ANS: A, B, C With marijuana smoking, approximately 50% of the potent agents are absorbed through the lungs; when marijuana is ingested, however, only 10% is absorbed. With heavy marijuana use, the following adverse effects have been reported: (1) alterations of sensory perceptions, cognitive and psychomotor impairment (e.g., inability to judge time, speed, distance); (2) smoking three or four joints per day is similar to smoking 20 cigarettes per day, in relation to the frequency of chronic bronchitis and may contribute to lung cancer; (3) data from animal studies only, indicate reproductive changes that include reduced fertility, decreased sperm motility, and decreased circulatory testosterone; (4) fetal abnormalities including low birth weight and increased frequency of childhood leukemia; (5) increased frequency of infectious illness, which is thought to be the result of depressed cell-mediated and humoral immunity. PTS: 1 REF: Page 70 | Table 2-5 NURSINGTB.COM Chapter 3: The Cellular Environment: Fluids and Electrolytes, Acids and Bases MULTIPLE CHOICE 1. Infants are most susceptible to significant losses in total body water because of an infant’s: a. High body surface–to–body size ratio b. Slow metabolic rate c. Kidneys are not mature enough to counter fluid losses d. Inability to communicate adequately when he or she is thirsty ANS: C Renal mechanisms that regulate fluid and electrolyte conservation are often not mature enough to counter the losses; consequently, dehydration may rapidly develop. Infants can be susceptible to changes in total body water because of their high metabolic rate and the turnover of body fluids caused by their greater body surface area in proportion to their total body size. The inability to communicate their thirst is a problem only when they are poorly cared for. PTS: 1 REF: Page 104 2. Obesity creates a greater risk for dehydration in people because: a. Adipose cells contain little water because fat is water repelling. b. The metabolic rate of obese adults is slower than the rate of lean adults. c. The rate of urine output of obese adults is higher than the rate of output of lean adults. d. The thirst receptors of the hypNoUthRaSlaINmGuTsBd.CoOnMot function effectively. ANS: A The percentage of total body water (TBW) varies with the amount of body fat and age. Because fat is water repelling (hydrophobic), very little water is contained in adipose cells. Individuals with more body fat have proportionately less TBW and tend to be more susceptible to fluid imbalances that cause dehydration. PTS: 1 REF: Page 104 3. A patient’s blood gases reveal the following findings: pH, 7.3; bicarbonate (HCO3) 27 mEq/L; carbon dioxide (CO2), 58 mm Hg. What is the interpretation of these gases? a. Respiratory alkalosis c. Respiratory acidosis b. Metabolic acidosis d. Metabolic alkalosis ANS: C The values provided in this question characterize only acute uncompensated respiratory acidosis. PTS: 1 REF: Pages 129-130 4. Water movement between the intracellular fluid (ICF) compartment and the extracellular fluid (ECF) compartment is primarily a function of: a. Osmotic forces c. Antidiuretic hormone b. Plasma oncotic pressure d. Hydrostatic forces ANS: A The movement of water between the ICF and ECF compartments is primarily a function of osmotic forces. (Osmosis and other mechanisms of passive transport are discussed in Chapter 1.) PTS: 1 REF: Page 105 5. In addition to osmosis, what force is involved in the movement of water between the plasma and interstitial fluid spaces? a. Oncotic pressure c. Net filtration b. Buffering d. Hydrostatic pressure ANS: D Water moves between the plasma and interstitial fluid through the forces of only osmosis and hydrostatic pressure, which occur across the capillary membrane. Buffers are substances that can absorb excessive acid or base to minimize pH fluctuations. Net filtration is a term used to identify fluid movement in relationship to the Starling hypothesis. Oncotic pressure encourages water to cross the barrier of capillaries to enter the circulatory system. PTS: 1 REF: Page 105 6. Venous obstruction is a cause of edema because of an increase in which pressure? a. Capillary hydrostatic c. Capillary oncotic b. Interstitial hydrostatic d. Interstitial oncotic ANS: A Venous obstruction can increase thNeUhRySdINroGsTtaBt.iCcOpMressure of fluid in the capillaries enough to cause fluid to escape into the interstitial spaces. The remaining options are not causes of edema resulting from venous obstruction. PTS: 1 REF: Page 106 7. At the arterial end of capillaries, fluid moves from the intravascular space into the interstitial space because the: a. Interstitial hydrostatic pressure is higher than the capillary hydrostatic pressure. b. Capillary hydrostatic pressure is higher than the capillary oncotic pressure. c. Interstitial oncotic pressure is higher than the interstitial hydrostatic pressure. d. Capillary oncotic pressure is lower than the interstitial hydrostatic pressure. ANS: B At the arterial end of capillaries, fluid moves from the intravascular space into the interstitial because capillary hydrostatic pressure is higher than the capillary oncotic pressure. PTS: 1 REF: Page 105 8. Low plasma albumin causes edema as a result of a reduction in which pressure? a. Capillary hydrostatic c. Plasma oncotic b. Interstitial hydrostatic d. Interstitial oncotic ANS: C Losses or diminished production of plasma albumin is the only option that contributes to a decrease in plasma oncotic pressure. PTS: 1 REF: Pages 106-107 9. Secretion of antidiuretic hormone (ADH) and the perception of thirst are stimulated by a(n): a. Decrease in serum sodium c. Increase in glomerular filtration rate b. Increase in plasma osmolality d. Decrease in osmoreceptor stimulation ANS: B Secretion of ADH and the perception of thirst are primary factors in the regulation of water balance. Thirst is a sensation that stimulates water-drinking behavior. Thirst is experienced when water loss equals 2% of an individual’s body weight or when osmotic pressure increases. The other options do not accurately describe how ADH and the perception of thirst are related. PTS: 1 REF: Page 109 10. Thirst activates osmoreceptors by an increase in which blood plasma? a. Antidiuretic hormone c. Hydrostatic pressure b. Aldosterone d. Osmotic pressure ANS: D Thirst is experienced when water loss equals 2% of an individual’s body weight or when osmotic pressure increases. Dry mouth, hyperosmolality, and plasma volume depletion activate osmoreceptors (neurons located in the hypothalamus that are stimulated by increased osmotic pressure). The oNtUhRerSIoNpGtiToBn.sCdOoMnot accurately identify what increases to activate osmoreceptors. PTS: 1 REF: Page 109 11. It is true that natriuretic peptides: a. Decrease blood pressure and increase sodium and water excretion. b. Increase blood pressure and decrease sodium and water excretion. c. Increase heart rate and decrease potassium excretion. d. Decrease heart rate and increase potassium excretion. ANS: A Natriuretic peptides are hormones that include atrial natriuretic peptide (ANP) produced by the myocardial atria, brain natriuretic peptide (BNP) produced by the myocardial ventricles, and urodilatin within the kidney. Natriuretic peptides decrease blood pressure and increase sodium and water excretion. PTS: 1 REF: Page 109 12. When changes in total body water are accompanied by proportional changes in electrolytes, what type of alteration occurs? a. Isotonic c. Hypotonic b. Hypertonic d. Normotonic ANS: A Only isotonic alterations occur when proportional changes in electrolytes and water accompany changes in total body water . PTS: 1 REF: Pages 109-110 13. Which enzyme is secreted by the juxtaglomerular cells of the kidney when circulating blood volume is reduced? a. Angiotensin I c. Aldosterone b. Angiotensin II d. Renin ANS: D When circulating blood volume or blood pressure is reduced, renin, an enzyme secreted by the juxtaglomerular cells of the kidney, is released in response to sympathetic nerve stimulation and decreased perfusion of the renal vasculature. The other options are not released by the situation described in the question. PTS: 1 REF: Pages 108-109 14. What mechanism can cause hypernatremia? a. Syndrome of inappropriate antidiuretic hormone b. Hypersecretion of aldosterone c. Brief bouts of vomiting or diarrhea d. Excessive diuretic therapy ANS: B Hypernatremia occurs because of (1) inadequate free water intake, (2) inappropriate administration of hypertonic saline solution (e.g., sodium bicarbonate for treatment of acidosis during cardiac arrest), (3)NhUiRghSINsoGdTiuBm.COleMvels as a result of oversecretion of aldosterone (as in primary hyperaldosteronism), or (4) Cushing syndrome (caused by the excess secretion of adrenocorticotropic hormone [ACTH], which also causes increased secretion of aldosterone). The other options do not result in hypernatremia. PTS: 1 REF: Page 111 15. What causes the clinical manifestations of confusion, convulsions, cerebral hemorrhage, and coma in hypernatremia? a. High sodium in the blood vessels pulls water out of the brain cells into the blood vessels, causing brain cells to shrink. b. High sodium in the brain cells pulls water out of the blood vessels into the brain cells, causing them to swell. c. High sodium in the blood vessels pulls potassium out of the brain cells, which slows the synapses in the brain. d. High sodium in the blood vessels draws chloride into the brain cells followed by water, causing the brain cells to swell. ANS: A Hypertonic (hyperosmolar) imbalances result in an extracellular fluid concentration greater than 0.9% salt solution (e.g., water loss or solute gain); cells shrink in a hypertonic fluid (see Table 3-7). This shrinking of cells results in the symptoms described in the question. The other options do not accurately describe the cause of these symptoms as they relate to hypernatremia. PTS: 1 REF: Page 111 16. Vomiting-induced metabolic alkalosis, resulting in the loss of chloride, causes: a. Retained sodium to bind with the chloride b. Hydrogen to move into the cell and exchange with potassium to maintain cation balance c. Retention of bicarbonate to maintain the anion balance d. Hypoventilation to compensate for the metabolic alkalosis ANS: C When vomiting with the depletion of ECF and chloride (hypochloremic metabolic alkalosis) causes acid loss, renal compensation is not effective; the volume depletion and loss of electrolytes (sodium [Na+], potassium [K+], hydrogen [H+], chlorine [Cl–]) stimulate a paradoxic response by the kidneys. The kidneys increase sodium and bicarbonate reabsorption with the excretion of hydrogen. Bicarbonate is reabsorbed to maintain an anionic balance because the ECF chloride concentration is decreased. The other options do not accurately describe the mechanism that results from vomiting-induced metabolic alkalosis. PTS: 1 REF: Page 128 17. The pathophysiologic process of edema is related to which mechanism? a. Sodium depletion b. Decreased capillary hydrostatic pressure c. Increased plasma oncotic pressure d. Lymphatic obstruction ANS: D NURSINGTB.COM The pathophysiologic process of edema is related to an increase in the forces favoring fluid filtration from the capillaries or lymphatic channels into the tissues. The most common mechanisms are increased capillary hydrostatic pressure, decreased plasma oncotic pressure, increased capillary membrane permeability and lymphatic obstruction, and sodium retention. PTS: 1 REF: Page 105 18. Insulin is used to treat hyperkalemia because it: a. Stimulates sodium to be removed from the cell in exchange for potassium. b. Binds to potassium to remove it through the kidneys. c. Transports potassium from the blood to the cell along with glucose. d. Breaks down the chemical components of potassium, causing it to be no longer effective. ANS: C Insulin contributes to the regulation of plasma potassium levels by stimulating the Na+, potassium–adenosine triphosphatase (K+–ATPase) pump, thereby promoting the movement of potassium simultaneously into the liver and muscle cells with glucose transport after eating. The intracellular movement of potassium prevents an acute hyperkalemia related to food intake. The other options do not accurately describe how insulin is used to treat hyperkalemia. PTS: 1 REF: Page 114 19. A major determinant of the resting membrane potential necessary for the transmission of nerve impulses is the ratio between: a. Intracellular and extracellular Na+ c. Intracellular Na+ and extracellular K+ b. Intracellular and extracellular K+ d. Intracellular K+ and extracellular Na+ ANS: B The ratio of K+ in the ICF to K+ in the ECF is the major determinant of the resting membrane potential, which is necessary for the transmission and conduction of nerve impulses, for the maintenance of normal cardiac rhythms, and for the skeletal and smooth muscle contraction. This is not true of the other options. PTS: 1 REF: Page 114 20. During acidosis, the body compensates for the increase in serum hydrogen ions by shifting hydrogen ions into the cell in exchange for which electrolyte? a. Oxygen c. Potassium b. Sodium d. Magnesium ANS: C In states of acidosis, hydrogen ions shift into the cells in exchange for intracellular fluid potassium; hyperkalemia and acidosis therefore often occur together. This is not true of the other options. PTS: 1 REF: Page 117 | Pages 126-127 NURSINGTB.COM 21. Causes of hyperkalemia include: a. Hyperparathyroidism and malnutrition b. Vomiting and diarrhea c. Renal failure and Addison disease d. Hyperaldosteronism and Cushing disease ANS: C Hyperkalemia should be investigated when a history of renal disease, massive trauma, insulin deficiency, Addison disease, use of potassium salt substitutes, or metabolic acidosis exists. The other options are not known to be causes of hyperkalemia. PTS: 1 REF: Page 119 22. In hyperkalemia, what change occurs to the cells’ resting membrane potential? a. Hypopolarization c. Depolarization b. Hyperexcitability d. Repolarization ANS: A If extracellular potassium concentration increases without a significant change in intracellular potassium, then the resting membrane potential becomes more positive (i.e., changes from –90 to –80 mV) and the cell membrane is hypopolarized (i.e., the inside of the cell becomes less negative or partially depolarized [increase excitability]). PTS: 1 REF: Pages 117-118 23. The calcium and phosphate balance is influenced by which three substances? a. Parathyroid hormone, vasopressin, and vitamin D b. Parathyroid hormone, calcitonin, and vitamin D c. Thyroid hormone, vasopressin, and vitamin A d. Thyroid hormone, calcitonin, and vitamin A ANS: B Three hormones regulate calcium and phosphate balance: parathyroid hormone (PTH), vitamin D, and calcitonin. Vasopressin, thyroid hormone, and vitamin A do not influence calcium and phosphate balance. PTS: 1 REF: Page 119 24. It is true that Kussmaul respirations indicate: a. Anxiety is a cause of respiratory acidosis. b. A compensatory measure is needed to correct metabolic acidosis. c. Diabetic ketoacidosis is the cause of the metabolic acidosis. d. More oxygen is necessary to compensate for respiratory acidosis. ANS: B Deep, rapid respirations (Kussmaul respirations) are indicative of respiratory compensation for metabolic acidosis. The other options are not true. PTS: 1 REF: Page 128 25. Chvostek and Trousseau signs indicate which electrolyte imbalance? a. Hypokalemia NURSINGTcB..COHMypocalcemia b. Hyperkalemia d. Hypercalcemia ANS: C Two clinical signs of hypocalcemia are the Chvostek sign and Trousseau sign. These clinical signs are not indicative of any of the other options. PTS: 1 REF: Page 120 26. An excessive use of magnesium-containing antacids and aluminum-containing antacids can result in: a. Hypomagnesemia c. Hyponatremia b. Hypophosphatemia d. Hypokalemia ANS: B The most common causes of hypophosphatemia are intestinal malabsorption and increased renal excretion of phosphate. Inadequate absorption is associated with vitamin D deficiency, the use of magnesium and aluminum-containing antacids (which bind with phosphorus), long-term alcohol abuse, and malabsorption syndromes. The excessive use of such antacids will not result in the other options. PTS: 1 REF: Page 121 27. The most common cause of hypermagnesemia is: a. Hepatitis c. Trauma to the hypothalamus b. Renal failure d. Pancreatitis ANS: B Renal failure usually causes hypermagnesemia, in which magnesium concentration is greater than 2.5 mEq/L. Hypermagnesemia is not a result of the other options. PTS: 1 REF: Page 122 28. Physiologic pH is maintained at approximately 7.4 because bicarbonate (HCO3) and carbonic acid (H2CO3) exist in a ratio of: a. 20:1 c. 10:2 b. 1:20 d. 10:5 ANS: A The relationship between HCO3 and H2CO3 is usually expressed as a ratio. When the pH is 7.4, this ratio is 20:1 (HCO3:H2CO3). The other options do not accurately identify physiologic pH by the correct ratio of HCO3 and H2CO3. PTS: 1 REF: Page 124 29. Which arterial pH will initiate the formation of ammonium (NH4) from ammonia (NH3), referred to as academia, in the tubular lumen of the kidney? a. 7.25 c. 7.55 b. 7.35 d. 7.65 ANS: A Pathophysiologic changes in the concentration of hydrogen ion or base in the blood lead to acid-base imbalances. Acidemia is a state in which the pH of arterial blood is less than 7.35. NH3 is produced from gl NURSINGTB.COM lial cell and diffuses to the tubular lumen, where it combines with H+ to form NH4. PTS: 1 REF: Page 126 30. Two thirds of the body’s water is found in its: a. Interstitial fluid spaces c. Intracellular fluid compartments b. Vascular system d. Intraocular fluids ANS: C Two thirds of the body’s water is in the intracellular fluid (ICF) compartment, and one third is in the extracellular fluid (ECF) compartment. The two main ECF compartments are the interstitial fluid and the intravascular fluid, which is the blood plasma. Other ECF compartments include the lymph and the transcellular fluids, such as the synovial, intestinal, biliary, hepatic, pancreatic, and cerebrospinal fluids; sweat; urine; and pleural, synovial, peritoneal, pericardial, and intraocular fluids. PTS: 1 REF: Pages 103-104 31. It is true that when insulin is administered: a. The Na+, K+–ATPase pump is turned off. b. Potassium is moved out of muscle cells. c. The liver increases its potassium levels. d. Glucose transport is impaired. ANS: C Insulin contributes to the regulation of plasma potassium levels by stimulating the Na+, K+–ATPase pump, thereby promoting the movement of potassium simultaneously into the liver and muscle cells with glucose transport after eating. The other options do not accurately describe the effect of insulin administration. PTS: 1 REF: Page 114 32. Increased capillary hydrostatic pressure results in edema because of: a. Losses or diminished production of plasma albumin b. Inflammation resulting from an immune response c. Blockage within the lymphatic channel system d. Sodium and water retention ANS: D Increased capillary hydrostatic pressure can result from venous obstruction or sodium and water retention. The other options do not accurately describe the cause of edema related to increased capillary hydrostatic pressure. PTS: 1 REF: Page 106 33. The existence of hyperkalemia is likely to result in which changes to a person’s electrocardiogram (ECG)? a. Flattened U waves c. Depressed ST segments b. Peaked T waves d. Peaked P waves ANS: B Observed ECG changes include pNeaUkReSdINTGwTaBv.CeOs,Mprolonged PR interval, and absent P wave with a widened QRS complex. The other options are not related to hyperkalemia. PTS: 1 REF: Page 118 MULTIPLE RESPONSE 34. Which groups are at risk for fluid imbalance? (Select all that apply.) a. Women b. Infants c. Men d. Obese persons e. Older adults ANS: B, D, E Kidney function, surface area, total body water, and the hydrophobic nature of fat cells all contribute to the increased risk for fluid imbalance among obese individuals, infants, and older adults. Gender alone is not a risk factor for fluid imbalance. PTS: 1 REF: Pages 104-105 35. Dehydration can cause which result? (Select all that apply.) a. Moist mucous membranes b. Weak pulses c. Tachycardia d. Polyuria e. Weight loss ANS: B, C, E Significant water deficit is demonstrated by symptoms of dehydration that include headache, thirst, dry skin and mucous membranes, elevated temperature, weight loss, and decreased or concentrated urine (with the exception of diabetes insipidus). Skin turgor may be normal or decreased. Symptoms of hypovolemia include tachycardia, weak pulses, and postural hypotension. PTS: 1 REF: Page 112 36. Causes of hypocalcemia include: (Select all that apply.) a. Repeated blood administration b. Pancreatitis c. Decreased reabsorption of calcium d. Hyperparathyroidism e. Kidney stones ANS: A, B Blood transfusions are a common cause of hypocalcemia because the citrate solution used in storing whole blood binds with calcium. Pancreatitis causes a release of lipases into soft-tissue spaces; consequently, the free fatty acids that are formed bind calcium, causing a decrease in ionized calcium. The other options are not recognized causes of hypocalcemia. PTS: 1 REF: Page 12N0URSINGTB.COM 37. The electrolyte imbalance called hyponatremia exhibits which clinical manifestations? (Select all that apply.) a. Headache b. Seizures c. Paranoia d. Confusion e. Lethargy ANS: A, B, D, E Behavioral and neurologic changes characteristic of hyponatremia include lethargy, headache, confusion, apprehension, seizures, and coma. Paranoia is not associated with hyponatremia. PTS: 1 REF: Page 113 38. The electrolyte imbalance hypercalcemia exhibits which clinical manifestations? (Select all that apply.) a. Diarrhea b. Calcium based kidney stones c. ECG showing narrow T waves d. Lethargy e. Bradycardia ANS: B, D, E Fatigue, weakness, lethargy, anorexia, nausea, and constipation are common. Behavioral changes may occur. Impaired renal function frequently develops, and kidney stones form as precipitates of calcium salts. A shortened QT segment and depressed widened T waves also may be observed on the ECG, with bradycardia and varying degrees of heart block. PTS: 1 REF: Pages 120-121 39. The electrolyte imbalance hypokalemia exhibits which clinical manifestations? (Select all that apply.) a. Paralytic ileus b. Sinus bradycardia c. Atrioventricular block d. Dry mucous membranes e. Tetany ANS: A, B, C A variety of dysrhythmias may occur, including sinus bradycardia, atrioventricular block, paroxysmal atrial tachycardia, and paralytic ileus. The other options are not related to hypokalemia. PTS: 1 REF: Pages 116-117 40. A third of the body’s fluid is contained in the extracellular interstitial fluid spaces that include: (Select all that apply.) a. Urine b. Intraocular fluids c. Lymph d. Blood plasma e. Sweat ANS: A, B, C, E NURSINGTB.COM Two thirds of the body’s water is in the intracelluarl fluid (ICF) compartment, and one third is in the extracellular fluid (ECF) compartments. The two main ECF compartments are the interstitial fluid and the intravascular fluid, such as the blood plasma. Interstitial ECF compartments include the lymph and the transcellular fluids, such as the synovial, intestinal, biliary, hepatic, pancreatic, and cerebrospinal fluids; sweat; urine; and pleural, synovial, peritoneal, pericardial, and intraocular fluids. PTS: 1 REF: Pages 103-104 41. An imbalance of potassium can produce which dysfunctions? (Select all that apply.) a. Weakness skeletal muscles b. Cardiac dysrhythmias c. Smooth muscle atony d. Visual impairment e. Hearing loss ANS: A, B, C Symptoms of hyperkalemia vary, but common characteristics are muscle weakness or paralysis and dysrhythmias with changes in the ECG. A wide range of metabolic dysfunctions may result from hypokalemia. Neuromuscular excitability is decreased, causing skeletal muscle weakness, smooth muscle atony, and cardiac dysrhythmias. PTS: 1 REF: Pages 116-118 42. Which statements regarding total body water (TBW) are true? (Select all that apply.) a. During childhood, TBW slowly decreases in relationship to body weight. b. Gender has no influence on TBW until old age. c. Men tend to have greater TBW as a result of their muscle mass. d. Estrogen plays a role in female TBW. e. Older adults experience a decrease in TBW as a result of decreased muscle mass. ANS: A, C, D, E During childhood, TBW slowly decreases to 60% to 65% of body weight. At adolescence, the percentage of TBW approaches adult proportions, and gender differences begin to appear. Men eventually have a greater percentage of body water as a function of increasing muscle mass. Women have more body fat and less muscle as a function of estrogens and therefore have less body water. With increasing age, the percentage of TBW declines further still. The decrease is caused, in part, by an increased amount of fat and a decreased amount of muscle, as well as by a reduced ability to regulate sodium and water balance. PTS: 1 REF: Pages 104-105 MATCHING NURSINGTB.COM Match the electrolytes with the corresponding descriptions. Terms may be used more than once. A. Sodium B. Chloride C. Potassium D. Magnesium E. Phosphate 43. Regulates osmolality in the extracellular fluid (ECF) space. 44. Is inversely related to HCO3 concentration. 45. Is a major determinant of resting membrane potential. 46. An intracellular metabolic form is adenosine triphosphate (ATP). 47. Changes in hydrogen ion concentration affect this electrolyte. 43. ANS: A PTS: 1 REF: Page 105 MSC: Sodium is the most abundant ECF ion and is responsible for the osmotic balance of the ECF space. Potassium maintains the osmotic balance of the ICF space. 44. ANS: B PTS: 1 REF: Page 109 MSC: Chloride levels are inversely related to HCO3 concentration. 45. ANS: C PTS: 1 REF: Page 114 MSC: The ratio of K+ in the ICF to K+ in the ECF is the major determinant of the resting membrane potential, which is necessary for the transmission and conduction of nerve impulses, for the maintenance of normal cardiac rhythms, and for skeletal and smooth muscle contraction. (Membrane transport and membrane potentials are discussed in Chapter 1.) 46. ANS: E PTS: 1 REF: Page 119 MSC: Phosphate acts as an intracellular and extracellular anion buffer in the regulation of acid-base balance; it provides energy for muscle contraction in the form of ATP. 47. ANS: C PTS: 1 REF: Page 117 MSC: In states of acidosis, hydrogen ions shift into the cells in exchange for ICF potassium; hyperkalemia and acidosis therefore often occur together. NURSINGTB.COM Chapter 4: Genes and Genetic Diseases MULTIPLE CHOICE 1. Inserting bone marrow cells into an individual who produces abnormal erythrocytes is an example of what type of therapy? a. Somatic cell c. Genetic engineering b. Germ cell d. Recombinant DNA ANS: A Gene therapy can be applied in two ways. The less controversial approach is somatic cell therapy, which consists of inserting normal genes into the cells of an individual who has a genetic disease. In this approach, a particular tissue, such as bone marrow cells that produce abnormal erythrocytes, is treated. The correct option is the only one that accurately identifies the therapy described in the question. PTS: 1 REF: Page 137 | Box 4-2 2. DNA replication requires the enzyme DNA polymerase to: a. Travel along the single DNA strand, adding the correct nucleotide to the new strand b. Move along the double strand of DNA to unwind the nucleotides of the double helix c. Hold the double strand apart while the correct nucleotides are added to the strand d. Transport the double strand of DNA from the nucleus to the cytoplasm for protein formation ANS: A NURSINGTB.COM The DNA polymerase enzyme travels along the single DNA strand, adding the correct nucleotides to the free end of the new strand (see Figure 4-2, B). The correct option is the only one that accurately describes the process involved in DNA replication using DNA polymerase. PTS: 1 REF: Page 137 3. Transcription is best defined as a process by which: a. DNA polymerase binds to the promoter site on ribonucleic acid (RNA). b. RNA directs the synthesis of polypeptides for protein synthesis. c. RNA is synthesized from a DNA template. d. A base pair substitution results in a mutation of the amino acid sequence. ANS: C Transcription is the process by which RNA is synthesized from a DNA template. The correct option is the only one that accurately defines the term transcription. PTS: 1 REF: Page 141 4. The purpose of a staining technique of chromosomes such as Giemsa is to: a. Permit the mitotic process to be followed and monitored for variations. b. Allow for the numbering of chromosomes and the identification of variations. c. Identify new somatic cells formed through mitosis and cytokinesis. d. Distinguish the sex chromosomes from the homologous chromosomes. ANS: B One of the most commonly used stains is Giemsa stain. By using banding techniques, chromosomes can be unambiguously numbered, and individual variation in chromosome composition can be studied. Missing or duplicated portions of chromosomes, which often result in serious diseases, also can be readily identified. The correct option is the only one that accurately describes the purpose of the Giemsa staining technique. PTS: 1 REF: Pages 142-143 5. An amniocentesis indicates a neural tube defect when an increase in which protein is evident? a. Chorionic c. Amniotic b. Alpha fetoprotein d. Embryonic ANS: B Other disorders can be detected with this procedure. These include most neural tube defects, which cause an elevation of alpha fetoprotein in the amniotic fluid, and hundreds of diseases caused by mutations of single genes. The correct option is the only one that accurately identifies the protein responsible for a neural tube defect. PTS: 1 REF: Page 136 | Box 4-1 6. An amniocentesis is recommended for pregnant women who: a. Have a history of chronic illness b. Have a family history of genetNicUdRiSsIoNrGdeTrBs.COM c. Have experienced in vitro fertilization d. Had a late menarche ANS: B Amniocentesis is recommended only for pregnancies known to have an elevated risk for a genetic disease or in women older than 30 to 35 years of age. The correct option is the only one that accurately describes a criterion for ordering an amniocentesis. PTS: 1 REF: Page 136 | Box 4-1 7. The most clinically useful technique for prenatal diagnosis of chromosomal abnormalities at 3 months’ (12 weeks’) gestation is: a. Gene mapping c. Amniocentesis b. Linkage analysis d. Chorionic villus sampling ANS: D Chorionic villus sampling consists of extracting a small amount of villous tissue directly from the chorion. This procedure can be performed at 10 weeks’ gestation and does not require in vitro culturing of cells; sufficient numbers are directly available in the extracted tissue. Thus the procedure allows prenatal diagnosis at approximately 3 months’ gestation rather than at nearly 5 months’ gestation. The correct option is the only one that accurately describes the most useful technique for prenatal diagnosis of chromosomal abnormalities. PTS: 1 REF: Page 136 | Box 4-1 8. The term for an error in which homologous chromosomes fail to separate during meiosis or mitosis is: a. Aneuploidy c. Polyploidy b. Nondisjunction d. Translocation ANS: B Aneuploidy is usually the result of nondisjunction, an error in which homologous chromosomes or sister chromatids fail to separate normally during meiosis or mitosis. The correct option is the only one that is used to describe an error in chromosomal separation during reproduction. PTS: 1 REF: Page 145 9. Which clinical manifestations would be expected for a child who has complete trisomy of the twenty-first chromosome? a. Widely spaced nipples, reduced carrying angle at the elbow, and sparse body hair b. An IQ of 25 to 70, low nasal bridge, protruding tongue, and flat, low-set ears c. High-pitched voice, tall stature, gynecomastia, and an IQ of 60 to 90 d. Circumoral cyanosis, edema of the feet, short stature, and mental slowness ANS: B Individuals with this disease are mentally retarded, with IQs usually ranging from 25 to 70. The facial appearance is distinctive and exhibits a low nasal bridge, epicanthal folds (which produce a superficially Asian appearance), protruding tongue, and flat, low-set ears. The correct option is the only one that accurately describes the clinical manifestations of the complete trisomy of the twenty-first chromosome. NURSINGTB.COM PTS: 1 REF: Pages 146-147 10. What is the most common cause of Down syndrome? a. Paternal nondisjunction c. Maternal nondisjunction b. Maternal translocations d. Paternal translocation ANS: C Nondisjunction during the formation of one of the parent’s gametes or during early embryonic development occurs in approximately 97% of infants born with Down syndrome. In approximately 90% to 95% of infants, the nondisjunction occurs in the formation of the mother’s egg cell. The correct option is the only one that accurately describes the most common cause of Down syndrome. PTS: 1 REF: Page 147 11. What syndrome, characterized by an absent homologous X chromosome with only a single X chromosome, exhibits features that include a short stature, widely spaced nipples, and webbed neck? a. Down c. Turner b. Cri du chat d. Klinefelter ANS: C In Turner syndrome, a sex chromosome is missing, and the person’s total chromosome count is 45. Characteristic signs include short stature, female genitalia, webbed neck, shieldlike chest with underdeveloped breasts and widely spaced nipples, and imperfectly developed ovaries. The correct option is the only one that accurately describes the clinical manifestations described in the question. PTS: 1 REF: Page 147 12. A person with 47, XXY karyotype has the genetic disorder resulting in which syndrome? a. Turner c. Down b. Klinefelter d. Fragile X ANS: B A disorder in the chromosome (47, XXY karyotype) results in a disorder known as Klinefelter syndrome. The correct option is the only one that accurately describes a genetic disorder that exhibits the described genetic configuration. PTS: 1 REF: Page 148 13. What is the chromosomal variation that causes Klinefelter syndrome? a. Nondisjunction of the X chromosome in the father b. Translocation of the X chromosome in the mother c. Nondisjunction of X chromosome in the mother d. Translocation of the Y chromosome in the father ANS: C Nondisjunction of the X chromosomes in the mother causes Klinefelter syndrome in the majority of infants, and the frequeNnUcyRSoIfNtGhTeBd.iCsOorMder rises with maternal age. The correct option is the only one that accurately describes the chromosomal variation characteristic of Klinefelter syndrome. PTS: 1 REF: Page 148 14. What is the second most commonly recognized genetic cause of mental retardation? a. Down syndrome c. Klinefelter syndrome b. Fragile X syndrome d. Turner syndrome ANS: B The fragile X syndrome is the second most common genetic cause of mental retardation (after Down syndrome). The correct option is not observed with enough frequency to be recognized as the second most common cause of mental retardation. PTS: 1 REF: Page 151 15. What is the blood type of a person who is heterozygous, having A and B alleles as codominant? a. A c. O b. B d. AB ANS: D When the heterozygote is distinguishable from both homozygotes, the locus is said to exhibit codominance. An example is the ABO blood group, in which heterozygotes having the A and B alleles express both of them as A and B antigens on their red cells (forming blood group AB). The correct option is the only one that accurately describes codominance. PTS: 1 REF: Page 151 16. A couple has two children diagnosed with an autosomal dominant genetic disease. What is the probability that the next child will have the same genetic disease? a. One sixth c. One third b. One fourth d. One half ANS: D Affected heterozygous individuals transmit the trait to approximately one half of their children; however, because gamete transmission is subject to chance fluctuations, it is possible that all or none of the children of an affected parent may have the trait. Nevertheless, when large numbers of matings of this type are studied, the proportion of affected children closely approach one half. PTS: 1 REF: Pages 152-153 17. When a child inherits a disease that is autosomal recessive, it is inherited from: a. Father c. Both parents b. Mother d. Grandparent ANS: C In most cases of recessive diseaseN, bUoRtShINpaGrTeBn.tCsOoMf affected individuals are heterozygous carriers. PTS: 1 REF: Pages 155-156 18. People diagnosed with neurofibromatosis have varying degrees of the condition because of the genetic principle of: a. Penetrance c. Dominance b. Expressivity d. Recessiveness ANS: B Expressivity is the extent of variation in phenotype associated with a particular genotype. If expressivity of a disease is variable, then the penetrance may be complete but the severity of the disease can vary greatly. A well-known example of variable expressivity in an autosomal dominant disease is type 1 neurofibromatosis. The correct option is the only one that accurately describes the presence of varying degrees of symptomatologic characteristics. PTS: 1 REF: Page 154 19. Which genetic disease has been linked to a mutation of the tumor-suppressor gene? a. Hemochromatosis c. Familial breast cancer b. Retinoblastoma d. Hemophilia A ANS: B The gene responsible for retinoblastoma has been mapped to the long arm of chromosome 13, and its DNA sequence has been extensively studied. This gene is known as a tumor-suppressor gene; the normal function of its protein product is to regulate the cell cycle so that cells do not grow uncontrollably. The correct option is the only one that accurately identifies a disease resulting from a mutation of the tumor-suppressor gene. PTS: 1 REF: Page 154 20. Cystic fibrosis is caused by what type of gene? a. X-linked dominant c. Autosomal dominant b. X-linked recessive d. Autosomal recessive ANS: D The most common lethal autosomal recessive disease in white children, cystic fibrosis, occurs in approximately 1 in 2500 births. The correct option is the only one that accurately identifies the gene type responsible for cystic fibrosis. PTS: 1 REF: Page 154 21. Which is an important criterion for discerning autosomal recessive inheritance? a. Consanguinity is sometimes present. b. Females are affected more than males. c. The disease is observed in both the parents, as well as in the siblings. d. On average, one half of the offspring of the carrier will be affected. ANS: A Consanguinity is often an important characteristic of pedigrees for recessive diseases; relatives share a certain proportionNUofRgSIeNnGesTBre.CceOiMved from a common ancestor. The correct option is the only one that accurately identifies a required factor in autosomal recessive genetic inheritance. PTS: 1 REF: Page 155 22. Consanguinity refers to the mating of persons: a. Who are unrelated b. When one has an autosomal dominant disorder c. Having common family relations d. When one has a chromosomal abnormality ANS: C Consanguinity refers to the mating of two related individuals, and the offspring of such matings are said to be inbred. The correct option is the only one that accurately identifies consanguinity as it relates to human mating. PTS: 1 REF: Page 155 23. Males, having only one X chromosome (as is expected), are said to be: a. Homozygous c. Hemizygous b. Heterozygous d. Ambizygous ANS: C Males, having only one X chromosome, are said to be hemizygous for genes on this chromosome. The correct option is the only one that accurately identifies the term for males having only one X chromosome. PTS: 1 REF: Page 156 24. Males are more often affected by which type of genetic disease? a. Sex-linked dominant c. Sex-linked b. Sex-influenced d. Sex-linked recessive ANS: D Males are more frequently affected by X-linked recessive diseases, with the difference becoming more pronounced as the disease becomes rarer. The correct option is the only one that is a characteristic of a male-dominate disease. PTS: 1 REF: Page 156 25. An X-linked recessive disease can skip generations because: a. Females are hemizygous for the X chromosome. b. The disease can be transmitted through female carriers. c. Mothers cannot pass X-linked genes to their sons. d. These diseases need only one copy of the gene in females. ANS: B Skipped generations are often observed in X-linked recessive disease pedigrees because the gene can be transmitted through female carriers. Males are hemizygous for genes on the X chromosome. Fathers cannot pass X-linked genes to their sons. X-linked recessive diseases are observed significantlyNUmRoSrIeNoGfTteBn.CinOMmales than in females, because males need only one copy of the gene to express the disease. PTS: 1 REF: Page 157 26. The presence of a zygote having one chromosome with the normal complement of genes and one with a missing gene is characteristic of which genetic disorder? a. Cri du chat c. Klinefelter syndrome b. Down syndrome d. Turner syndrome ANS: A This description is only accurate for Cri du chat syndrome. PTS: 1 REF: Pages 148-149 27. A child with which genetic disorder has a characteristic cry? a. Down syndrome c. Turner syndrome b. Klinefelter syndrome d. Cri du chat ANS: D Cri du chat, which literally means “cry of the cat,” describes the characteristic cry of the affected child. The correct option is the only one with the characteristic cry. PTS: 1 REF: Page 148 28. Which statement is true regarding X-linked recessive conditions? a. Such diseases use males as phenotypical carriers. b. These conditions are passed from affected father to all of his female children. c. 25% of an affected individual’s grandsons will be affected. d. Cystic fibrosis is an example of such a condition. ANS: B X-linked recessive conditions are passed from an affected father to all of his daughters, who, as phenotypically normal carriers, transmit it to approximately one half of their sons, who are affected. Cystic fibrosis is an autosomal dominant disease. PTS: 1 REF: Page 158 29. DNA formation occurs in which of the cell’s structures? a. Nucleus c. Organelle b. Cytoplasm d. Membrane ANS: A DNA is formed and replicated only in the cell nucleus. PTS: 1 REF: Pages 135-141 30. What is the risk for the recurrence of autosomal dominant diseases? a. 10% c. 50% b. 30% d. 70% ANS: C The recurrence risk for autosomal dominant diseases is usually 50%. NURSINGTB.COM PTS: 1 REF: Pages 152-153 31. An individual’s genetic makeup is referred to as his or her: a. Phenotype c. Heterozygous locus b. Genotype d. Homozygous locus ANS: B An individual’s genotype is his or her genetic makeup. The correct option is the only one that accurately defines a person’s genetic makeup. PTS: 1 REF: Page 151 MULTIPLE RESPONSE 32. Which disorders have similar modes of inheritance? (Select all that apply.) a. Cri du chat syndrome b. Duchenne muscular dystrophy c. Polycystic kidney disease d. Down syndrome e. Becker muscular dystrophy ANS: B, E Becker muscular dystrophy and Duchenne muscular dystrophy are the only options that are X-linked recessive disorders. PTS: 1 REF: Page 158 33. The key to accurate DNA replication depends on which complementary base pairs? (Select all that apply.) a. Adenine with thymine b. Adenine with guanine c. Guanine with cytosine d. Cytosine with thymine e. Guanine with thymine ANS: A, C The consistent pairing of adenine with thymine and of guanine with cytosine, known as complementary base pairing, is the key to accurate DNA replication. The correct options are the only ones that accurately identify complementary base pairs. PTS: 1 REF: Page 137 34. Chromosomal abnormalities are the leading known cause of: (Select all that apply.) a. Mental illness b. Mental retardation c. Fetal miscarriage d. Cardiovascular disease e. Respiratory disorders ANS: B, C NURSINGTB.COM Chromosome abnormalities are the leading known cause of mental retardation and miscarriage. The correct options are the only ones that accurately identify disorders that related to chromosomal abnormalities. PTS: 1 REF: Page 143 35. Examples of prenatal diagnostic studies include: (Select all that apply.) a. Chorionic villus sampling (CVS) b. Amniocentesis c. Carrier screening d. Preimplantation genetic diagnosis (PGD) e. Drug-sensitivity testing ANS: A, B, D Prenatal testing is conducted before or during the pregnancy but not once labor begins. Such diagnostic studies include amniocenteses, CVS, and PGD. The correct options are the only ones that are exclusively used during the prenatal period. PTS: 1 REF: Page 136 | Box 4-1 36. The advantage derived from human genome sequencing on genetic disorders focuses on: (Select all that apply.) a. Identification of the mutated gene b. Reversal of the mutation c. Diagnosis of the existing disorder d. Appropriate treatment e. Prevention of the disorder ANS: A, C, D The complete human genome sequence will facilitate gene identification, diagnosis, and disease treatment. The reversal of a mutation is not possible. The mapping has no effect on preventing a genetic disorder. PTS: 1 REF: Page 160 MATCHING Match the genetic terms with the corresponding diseases. Terms may be used more than once. A. Autosomal dominant B. Autosomal recessive C. X-linked dominant D. X-linked recessive 37. Cystic fibrosis 38. Duchenne muscular dystrophy 39. Sickle cell disease 40. Huntington disease 37. ANS: B PTS: 1 REF: Page 154 38. MSC: ANS: Is an important example of anNaUuRtoSsIoNmGaTlBre.CceOsMsive disease is cystic fibrosis. D PTS: 1 REF: Page 158 MSC: Is an important example of an X-linked recessive disease is Duchenne muscular dystrophy. 39. ANS: B PTS: 1 REF: Page 136 | Box 4-1 MSC: Is an important example of an autosomal recessive disease is sickle cell disease. 40. ANS: A PTS: 1 REF: Page 154 MSC: Another well-known autosomal dominant disease is Huntington disease. Chapter 5: Genes, Environment-Lifestyle, and Common Diseases MULTIPLE CHOICE 1. The data reporting that sickle cell disease affects approximately 1 in 600 American blacks is an example of which concept? a. Incidence c. Ratio b. Prevalence d. Risk ANS: B Prevalence rate is the proportion of the population affected by a disease at a specific point in time. Thus both the incidence rate and the length of the survival period in affected individuals determine prevalence. The incidence rate is the number of new cases of a disease reported during a specific period (typically 1 year), divided by the number of individuals in the population. A numerical expression representing a part of a larger whole or proportion is considered a ratio. Any factor that increases the chance of disease or injury is considered a risk. PTS: 1 REF: Page 165 2. The ratio of the disease among the exposed population to the disease rate in an unexposed population is referred to as what type of risk? a. Attributable c. Causal b. Contingency d. Relative ANS: D A common measure of the effect oNfUaRsSpINecGiTfiBc.CriOskMfactor is the relative risk. Assuming a factor is the cause of a disease, attributable risk is the amount of risk that is due to that factor. A future event or circumstance that is possible but cannot be predicted with certainty is a contingency risk. The probability of the outcome is termed a causal risk factor. PTS: 1 REF: Page 165 3. Empirical risks for most multifactorial diseases are based on: a. Chromosomal testing c. Liability thresholds b. Direct observation d. Relative risks ANS: B For most multifactorial diseases, empirical risks (i.e., risks based on direct observation of data) have been derived. The other options are not the basis for determining the empirical risk of most multifactorial diseases. PTS: 1 REF: Page 167 4. What is the cause of familial hypercholesterolemia (FH)? a. Diet high in saturated fats b. Increased production of cholesterol by the liver c. Reduction in the number of low-density lipoprotein (LDL) receptors on cell surfaces d. Abnormal function of lipoprotein receptors circulating in the blood ANS: C A reduction in the number of functional LDL receptors on cell surfaces causes FH. Lacking the normal number of LDL receptors, cellular cholesterol uptake is reduced and circulating cholesterol levels increase (see Box 5-3). The other options are not the basis for developing familial FH. PTS: 1 REF: Page 173 | Box 5-3 5. Which risk factor for hypertension is influenced by genetic factors and lifestyle? a. Sodium intake c. Psychosocial stress b. Physical inactivity d. Obesity ANS: D The most important environmental risk factors for hypertension are increased sodium intake, decreased physical activity, psychosocial stress, and obesity. However, obesity is, itself, influenced by genes and the environment. PTS: 1 REF: Page 172 6. What percentage of all cases of breast cancer are identified as an autosomal dominant form? a. 5 c. 15 b. 10 d. 20 ANS: A An autosomal dominant form of breast cancer accounts for approximately 5% of breast cancer cases in the United States. NURSINGTB.COM PTS: 1 REF: Page 172 | Page 174 7. When a woman has one first-degree relative with breast cancer, her risk of developing breast cancer is how many times greater? a. 2 c. 6 b. 3 d. 10 ANS: A If a woman has one affected first-degree relative, her risk of developing breast cancer doubles. PTS: 1 REF: Page 172 8. Adoption studies have shown that the offspring of an alcoholic parent when raised by nonalcoholic parents have what amount of an increased risk of developing alcoholism? a. Twofold c. Fourfold b. Threefold d. Tenfold ANS: C Adoption studies have shown that the offspring of an alcoholic parent, even when raised by nonalcoholic parents, have a fourfold increased risk of developing the disorder. PTS: 1 REF: Page 179 9. Studies have identified several genes that play a role in the prevention of obesity by affecting what? a. Regulation of appetite c. Absorption of fat b. Metabolizing of fat d. Altering the sense of satiety ANS: A Clinical trials using recombinant leptin have demonstrated moderate weight loss in a subset of obese individuals. In addition, leptin participates in important interactions with other components of appetite control, such as neuropeptide Y and –melanocyte-stimulating hormone and its receptor, the melanocortin-4 receptor (MC4R). Currently, no research supports the other options as being genetically regulated. PTS: 1 REF: Page 178 10. The BRCA1 and BRCA2 mutations increase the risk of which cancer in women? a. Ovarian c. Uterine b. Lung d. Pancreatic ANS: A BRCA1 mutations increase the risk of ovarian cancer among women (20% to 50% lifetime risk), and BRCA2 mutations also confer an increased risk of ovarian cancer (10% to 20% lifetime prevalence). BRCA1 and BRCA2 mutations are not currently believed to be linked with risks of lung, uterine, or pancreatic cancers. PTS: 1 REF: Page 174 11. Blood pressure variations are assoNcUiaRteSdINwGiTthB:.COM a. ß1-adrenergic receptors to increase heart rate b. The release of an antidiuretic hormone (ADH) that increases water reabsorption c. The renin-angiotensin system’s effect on vasoconstriction d. Serum bradykinin, causing vasodilation ANS: C Significant research is now focused on specific components that may influence blood pressure variation, such as the renin-angiotensin system (involved in sodium reabsorption and vasoconstriction). The other options are not related to hypertension. PTS: 1 REF: Page 172 12. The two most important risk factors for type 2 diabetes are: a. Autoantibodies and human leukocyte antigen associations b. Autoantibodies and obesity c. Obesity and positive family history d. HLA associations and positive family history ANS: C The two most important risk factors for type 2 diabetes are positive family history and obesity. The other options are not believed to be important risk factors for this form of diabetes. PTS: 1 REF: Pages 177-178 13. A major characteristic of type 1 diabetes mellitus is that there is: a. Partial insulin secretion c. Insulin resistance b. An autoimmune cause factor d. Obesity as a common risk factor ANS: B A strong association between type 1 diabetes and the presence of several human leukocyte antigen (HLA) class II alleles indicate that type 1 diabetes mellitus is an autoimmune disease. The remaining options are associated with type 2 diabetes. PTS: 1 REF: Page 174 14. Obesity acts as an important risk factor for type 2 diabetes mellitus by: a. Reducing the amount of insulin the pancreas produces b. Increasing the resistance to insulin by cells c. Obstructing the outflow of insulin from the pancreas d. Stimulating the liver to increase glucose production ANS: B People with type 2 diabetes mellitus suffer from insulin resistance (i.e., their cells have difficulty using insulin). The other options are not associated with the effect of obesity regarding insulin production. PTS: 1 REF: Pages 177-178 15. Traits caused by the combined effects of multiple genes are referred to by which term? a. Polygenic c. Modifiable b. Multifocal ANS: A NURSINGTdB..COInMvoluntary Traits in which variation is thought to be caused by the combined effects of multiple genes are polygenic, meaning many genes. Multifocal means relating to or arising from many points. Modifiable refers to the changeability of something. Involuntary suggests being out of the control of someone or something. PTS: 1 REF: Page 165 16. Regarding type 2 diabetes, obesity is considered to be what type of risk? a. Genetic c. Relative b. Empirical d. Modifiable ANS: D Obesity is a modifiable risk factor for many diseases including heart disease, stroke, hypertension, and type 2 diabetes. The other terms do not apply. PTS: 1 REF: Pages 177-178 17. Which disease form is identified on the basis of empirical risk observation? a. Polygenic c. Monozygotic b. Multifactorial d. Genetic ANS: B For most multifactorial diseases, empirical risks (i.e., risks based on direct observation of data) have been derived. Traits in which variation is thought to be caused by the combined effects of multiple genes are polygenic. Monozygotic is a term that refers to identical twins. Genetic refers to issues related to genes and their influence on the body. PTS: 1 REF: Page 167 18. The number of persons living with a specific disease at a specific point in time is referred to by which term? a. Relativity c. Prevalence b. Survivability d. Incidence ANS: C The prevalence rate is the proportion of the population affected by a disease at a specific point in time. Thus both the incidence rate and the length of the survival period in affected individuals determine prevalence. The description in the question does not relate to any of the other options. PTS: 1 REF: Page 164 19. Which type of cancer is said to aggregate among families? a. Breast c. Skin b. Lung d. Brain ANS: A Breast cancer appears to aggregate strongly in families. The other cancers are not believed to be familial in nature. NURSINGTB.COM PTS: 1 REF: Page 172 20. Which dietary lifestyle choice has been associated with a decreased risk for developing colon cancer? a. Increased consumption of dairy produces b. Increased consumption of foods containing vitamin C c. Decreased consumption of foods high in fat d. Decreased consumption of artificial food coloring ANS: C A low-fat, high-fiber diet is thought to decrease the risk of colon cancer. PTS: 1 REF: Page 165 21. It is currently believed that the risk for developing Alzheimer disease: a. Is not directly related to genetic predisposition. b. Is higher among men than it is among women. c. Occurs less among Hispanics than in Asians. d. Doubles among those with an affected first-degree relative. ANS: D The risk of developing Alzheimer disease doubles in individuals who have an affected first-degree relative. The other statements are not true. PTS: 1 REF: Page 178 22. The number of new cases of a disease reported during a specific period divided by the number of individuals in the population is defined as which characteristic of a disease? a. Prevalence rate c. Relative risk b. Incidence rate d. Frequency ANS: B The incidence rate is the number of new cases of a disease reported during a specific period (typically 1 year) divided by the number of individuals in the population. The description provided in the question does not describe any of the other options. PTS: 1 REF: Page 164 MULTIPLE RESPONSE 23. Cancers that cluster strongly in families include: (Select all that apply.) a. Breast b. Colon c. Ovarian d. Lung e. Brain ANS: A, B, C Although breast, ovarian, and colon cancers have shown a strong familial tendency, lung and brain cancers have not. PTS: 1 REF: Page 17N2URSINGTB.COM 24. Which genes are responsible for an autosomal dominant form of breast cancer? (Select all that apply.) a. LCAT b. CHK1 c. CHK2 d. BRCA1 e. BRCA2 ANS: D, E Women who inherit a mutation in BRCA1 or BRCA2 experience a 50% to 80% lifetime risk of developing breast cancer. The other options do not carry this risk. PTS: 1 REF: Page 174 25. Lifestyle modifications that affect health-related risk factors include: (Select all that apply.) a. Diet b. Exercise c. Education d. Finances e. Stress reduction ANS: A, B, E Lifestyle modification (e.g., diet, exercise, stress reduction) can often reduce health risks significantly. Education and finances have not been shown to have an effect on health in a way that involves lifestyle modifications. PTS: 1 REF: Page 180 26. What factors are typically considered when assessing an individual’s risk for developing such common diseases as hypertension? (Select all that apply.) a. Age b. Diet c. Exercise habits d. Family history e. Spiritual beliefs ANS: A, B, C, D Many factors influence the risk of acquiring a common disease, such as cancer, diabetes, or hypertension. These factors can include age, gender, diet, exercise, and family history of the disease. Current research does not support a connection between spiritual beliefs and the development of hypertension. PTS: 1 REF: Page 165 27. Examples of multifactorial diseases associated with adults include: (Select all that apply.) a. Breast cancer b. Coronary heart disease c. Emphysema d. Diabetes mellitus e. Schizophrenia ANS: A, B, D, E NURSINGTB.COM Multifactorial diseases in adults include coronary heart disease, hypertension, breast cancer, colon cancer, diabetes mellitus, obesity, Alzheimer disease, alcoholism, schizophrenia, and bipolar affective disorder. Emphysema is not considered multifactorial. PTS: 1 REF: Pages 171-180 MATCHING Match the terms with the corresponding descriptions. A. Incidence rate effect of multiple genes B. Gene-environment interaction C. Prevalence rate at which some diseases occur D. Obesity E. Polygenic F. Empirical risk G. Relative risk 28. Traits caused by the combined effects of multiple genes 29. Number of persons living with the disease 30. Yields an increased risk for some diseases 31. Modifiable risk factor for many diseases 32. Number of new cases (persons) detected with the disease 33. Measure of the effect of a specific risk factor 34. Risks based on direct observation of data 28. ANS: E PTS: 1 REF: Page 165 MSC: Traits in which variation is thought to be caused by the combined effects of multiple genes are polygenic (i.e., many genes). 29. ANS: C PTS: 1 REF: Page 164 MSC: The prevalence rate is the proportion of the population affected by a disease at a specific point in time. Thus both the incidence rate and the length of the survival period in affected individuals determine prevalence. 30. ANS: B PTS: 1 REF: Page 171 MSC: In some cases, a genetic predisposition may interact with an environmental factor to increase the risk of disease to a significantly higher level than would either factor acting alone. A good example of a gene-environment interaction is given by 1-antitrypsin deficiency, a genetic condition that causes pulmonary emphysema and is greatly exacerbated by cigarette smoking (see Box 5-2). 31. ANS: D PTS: 1 REF: Pages 177-178 MSC: Obesity is a modifiable risk factor for many diseases including heart disease, stroke, hypertension, and type 2 diabetes. 32. ANS: A PTS: 1 REF: Page 164 MSC: The incidence rate is the number of new cases of a disease reported during a specific period (typically 1 year), divided by the number of individuals in the population. 33. ANS: G PTS: 1 REF: Page 165 MSC: A common measure of the effect of a specific risk factor is the relative risk. 34. ANS: F PTS: 1 REF: Page 167 MSC: For most multifactorial diseases, empirical risks (i.e., risks based on direct observation of data) have been derived. NURSINGTB.COM Chapter 6: Epigenetics and Disease MULTIPLE CHOICE 1. What genetic process is likely responsible for the occurrence of asthma in only one of a pair of identical twins? a. Epigenetic modifications c. Transgenerational inheritance b. Genomic imprinting d. Methylation ANS: A Epigenetic modifications can cause individuals with the same deoxyribonucleic acid (DNA) sequences (such as identical twins) to have different disease profiles. The correct option is the only one that accurately identifies the genetic process likely responsible for the occurrence of asthma in only one of a pair of twins. PTS: 1 REF: Page 183 | Page 185 2. Prader-Willi syndrome causes a chromosomal defect that is: a. Initiated by postnatal exposure to a virus b. Inherited from the father c. Related to maternal alcohol abuse d. Transferred from mother to child ANS: B Prader-Willi syndrome can be caused by a 4 Mb deletion of chromosome 15q when inherited from the father. The other options do not accurately identify the reason for the chromosomal damage that causesNPUraRdSeIrN-GWTiBll.iCsOyMndrome. PTS: 1 REF: Pages 187-188 3. A malfunction in DNA methylation can lead to: a. Hypothyroidism c. Cancer b. Blindness d. Diabetes mellitus ANS: C Aberrant methylation can lead to silencing of tumor-suppressor genes in the development of cancer. No research supports a connection between hypothyroidism, blindness, or diabetes mellitus to a malfunctioning of DNA methylation. PTS: 1 REF: Page 183 | Page 186 4. Which statement is true regarding the embryonic development of stem cells? a. They are already differentiated. b. They are referred to as housekeeping genes. c. They already demonstrate DNA sequencing. d. They are said to be pluripotent. ANS: D Early in embryonic development, all cells of the embryo have the potential to become any type of cell in the fetus or adult. These embryonic stem cells are said to be pluripotent. The remaining options are not true statements regarding embryonic stem cell development. PTS: 1 REF: Page 184 5. When microRNA (miRNA) are methylated their messenger RNA (mRNA) targets are over-expressed, the resulting effect on existing cancer would be: a. Cell death c. Remission b. Metastasis d. Relapse ANS: B When miRNA genes are methylated, their mRNA targets are over-expressed, and this over-expression has been associated with metastasis. of the described effect on mRNA targets on existing cancer does not result in any of the other options. PTS: 1 REF: Page 186 6. The difference between DNA sequence mutations and epigenetic modifications is: a. DNA sequence mutations can be directly altered. b. Leukemia is a result of only DNA sequence mutation. c. Epigenetic modifications can be reversed. d. No known drug therapies are available for epigenetic modifications. ANS: C Unlike DNA sequence mutations, which cannot be directly altered, epigenetic modifications can be reversed. The remaining options are not true statements regarding the difference between DNA sequence mutations and epigenetic modifications. PTS: 1 REF: Page 186 NURSINGTB.COM 7. Which term refers to the silenced gene of a gene pair? a. Activated c. Mutated b. Altered d. Imprinted ANS: D Gene silencing, a process during which genes are predictably silenced, depending on which parent transmits them, is known as imprinting; the transcriptionally silenced genes are then said to be imprinted. The remaining options do not accurately identify this process. PTS: 1 REF: Page 187 8. The shape of the face of a child diagnosed with Russell-Silver syndrome is likely to be: a. Round c. Triangular b. Square d. Elongated ANS: C Growth retardation, proportionate short stature, leg-length discrepancy, and a small, triangular-shaped face characterizes Russell-Silver syndrome. The other face shapes are not characteristic of Russell- Silver syndrome. PTS: 1 REF: Page 188 9. Genes responsible for the maintenance of all cells are referred to as: a. Universal c. Housekeeping b. Managerial d. Executive ANS: C A small percentage of genes, termed housekeeping genes, are necessary for the function and maintenance of all cells. The remaining options do not accurately refer to these cells. PTS: 1 REF: Page 184 10. What is the belief regarding twins who adopt dramatically different lifestyles? a. They may experience very different aging processes. b. They will retain very similar methylation patterns. c. They will experience identical phenotypes throughout their lifespans. d. They may never demonstrate similar DNA sequences of their somatic cells. ANS: A Twins with significant lifestyle differences (e.g., smoking versus nonsmoking), accumulate large numbers of differences in their methylation patterns. The twins, despite having identical DNA sequences, become more and more different as a result of epigenetic changes, which in turn affect the expression of genes. These results, along with findings generated in animal studies, suggest that changes in epigenetic patterns may be an important part of the aging process. They will not experience identical phenotypes throughout their lifespans. PTS: 1 REF: Page 185 11. Hypomethylation and the resulting effect on oncogenes result in a(an): a. Decrease in the activity of theNoUnRcoSgINeGneT,Bt.hCuOsMsuppressing cancer development b. Deactivation of MLH1 to halt DNA repair c. Increase in tumor progression from benign to malignant d. Over-expression of microRNA, resulting in tumorigenesis ANS: C Tumor cells typically exhibit hypomethylation (decreased methylation), which can increase the activity of oncogenes. Hypomethylation increases as tumors progress from benign neoplasms to malignancy. Only the correct option accurately describes hypomethylation and its resulting effects. PTS: 1 REF: Page 186 12. When a chromosome lacking 4 Mb is inherited from the mother, the child is at risk for developing which syndrome? a. Prader-Willi c. Beckwith-Wiedemann b. Angelman d. Russell-Silver ANS: B This anomaly illustrates the inheritance pattern of Angelman syndrome, which can be caused by a 4 Mb deletion of chromosome 15q when inherited from the mother. The anomaly is not the cause of any of the other options. PTS: 1 REF: Page 187 MULTIPLE RESPONSE 13. A child’s diagnosis of Beckwith-Wiedemann syndrome is supported by the presence of: (Select all that apply.) a. An omphalocele b. Neonatal hypoglycemia c. Creased earlobes d. Low birth weight e. A large tongue ANS: A, B, C, E Beckwith-Wiedemann syndrome is usually identifiable at birth because the child exhibits a large size for gestational age, neonatal hypoglycemia, a large tongue, creases on the earlobe, and omphalocele. PTS: 1 REF: Page 188 14. A diagnosis of Angelman syndrome in a child is supported by which assessment findings? (Select all that apply.) a. Small feet and hands b. Profound cognitive dysfunction c. Obesity d. Ataxic gait e. History of seizures ANS: B, D, E NURSINGTB.COM A child diagnosed with Angelman syndrome demonstrates a characteristic posture, bouts of uncontrolled laughter, severe mental retardation, seizures, and an ataxic gait. PTS: 1 REF: Page 187 Chapter 7: Innate Immunity: Inflammation MULTIPLE CHOICE 1. Which action is a purpose of the inflammatory process? a. To provide specific responses toward antigens b. To lyse cell membranes of microorganisms c. To prevent infection of the injured tissue d. To create immunity against subsequent tissue injury ANS: C If the epithelial barrier is damaged, then a highly efficient local and systemic response (inflammation) is mobilized to limit the extent of damage, to protect against infection, and to initiate the repair of damaged tissue. The other options do not accurately identify a purpose of the inflammatory process. PTS: 1 REF: Page 191 2. How do surfactant proteins A through D provide innate resistance? a. Initiate the complement cascade. c. Secrete mucus. b. Promote phagocytosis. d. Synthesize lysosomes. ANS: B The lung produces and secretes a family of glycoproteins, collectins, which includes surfactant proteins A through D and mannose-binding lectin. Collectin binding facilitates macrophages to recognize the microorganism, enhancing macrophage attachment, phagocytosis, and killing. The othNerUoRpStIiNoGnTs Bd.oCOnoMt accurately identify how surfactant proteins provide innate resistance. PTS: 1 REF: Page 194 3. Which secretion is a first line of defense against pathogen invasion that involves antibacterial and antifungal fatty acids, as well as lactic acid? a. Optic tears c. Sweat gland perspiration b. Oral saliva d. Sebaceous gland sebum ANS: D Sebaceous glands in the skin secrete sebum that is made up of antibacterial and antifungal fatty acids and lactic acid that provide the first-line barrier against pathogen invasion. PTS: 1 REF: Pages 192-193 4. Which bacterium grows in the intestines after prolonged antibiotic therapy? a. Lactobacillus c. Clostridium difficile b. Candida albicans d. Helicobacter pylori ANS: C Prolonged antibiotic treatment can alter the normal intestinal flora, decreasing its protective activity and leading to the overgrowth of other microorganisms, such as the yeast C. albicans or the bacterium C. difficile. The other options do not accurately identify intestinal bacterium whose growth is a result of prolonged antibiotic therapy. PTS: 1 REF: Page 194 5. What causes the edema that occurs during the inflammatory process? a. Vasodilation of blood vessels c. Endothelial cell contraction b. Increased capillary permeability d. Emigration of neutrophils ANS: B The increased flow and capillary permeability result in a leakage of plasma from the vessels, causing swelling (edema) in the surrounding tissue and is solely responsible for inflammation-induced edema. PTS: 1 REF: Page 195 6. What process causes heat and redness to occur during the inflammatory process? a. Vasodilation of blood vessels c. Decreased capillary permeability b. Platelet aggregation d. Endothelial cell contraction ANS: A The increased blood flow as a result of vasodilation and increasing concentration of red cells at the site of inflammation cause locally increased warmth and redness. The other options do not accurately identify the process that results in inflammatory redness and heat. PTS: 1 REF: Page 195 7. Activation of the classical pathway begins with: a. Viruses NURSINGTcB..COMMast cells b. Antigen-antibody complexes d. Macrophages ANS: B Activation of the classical pathway begins only with the activation of protein C1 and is preceded by the formation of a complex between an antigen and an antibody to form an antigen-antibody complex (immune complex) (see Chapter 8). PTS: 1 REF: Page 197 8. What plasma protein system forms a fibrinous meshwork at an inflamed site? a. Complement c. Kinin b. Coagulation d. Fibrinolysis ANS: B The coagulation (clotting) system is a group of plasma proteins that form a fibrinous meshwork at an injured or inflamed site. This protein system (1) prevents the spread of infection to adjacent tissues, (2) traps microorganisms and foreign bodies at the site of inflammation for removal by infiltrating cells (e.g., neutrophils and macrophages), (3) forms a clot that stops the bleeding, and (4) provides a framework for future repair and healing. The other options do not accurately identify such a protein system. PTS: 1 REF: Page 199 | Page 201 9. Which component of the plasma protein system tags pathogenic microorganisms for destruction by neutrophils and macrophages? a. Complement cascade c. Kinin system b. Coagulation system d. Immune system ANS: A C3b (a component of the complement cascade) adheres to the surface of a pathogenic microorganism and serves as an efficient opsonin. Opsonins are molecules that tag microorganisms for destruction by cells of the inflammatory system, primarily neutrophils and macrophages. The other options do not accurately identify a component capable of tagging pathogenic microorganisms. PTS: 1 REF: Pages 197-199 10. What is the vascular effect of histamine released from mast cells? a. Platelet adhesion c. Vasodilation b. Initiation of the clotting cascade d. Increased endothelial adhesiveness ANS: C C2b affects smooth muscle, causing vasodilation and increased vascular permeability. C3a, C5a, and, to a limited extent, C4a are anaphylatoxins; that is, they induce rapid mast cell degranulation (i.e., release of granular contents) and the release of histamine, causing vasodilation and increased capillary permeability. The other options do not accurately describe the vascular effect of histamine released from mast cells? PTS: 1 REF: Pages 198-199 11. What is an outcome of the compleNmUeRnStINcaGsTcBad.CeO?M a. Activation of the clotting cascade b. Prevention of the spread of infection to adjacent tissues c. Inactivation of chemical mediators such as histamine d. Lysis of bacterial cell membranes ANS: D The complement cascade can be activated by at least three different means, and its products have four functions: (1) anaphylatoxic activity, resulting in mast cell degranulation, (2) leukocyte chemotaxis, (3) opsonization, and (4) cell lysis. The other options do not accurately describe an outcome of the complement cascade. PTS: 1 REF: Page 199 12. The function of opsonization related to the complement cascade is to: a. Tag of pathogenic microorganisms for destruction by neutrophils and macrophages. b. Process pathogenic microorganisms so that activated lymphocytes can be created for acquired immunity. c. Destroy glycoprotein cell membranes of pathogenic microorganisms. d. Promote anaphylatoxic activity, resulting in mast cell degranulation. ANS: A C3b adheres to the surface of a pathogenic microorganism and serves as an efficient opsonin. Opsonins are molecules that tag microorganisms for destruction by cells of the inflammatory system, primarily neutrophils and macrophages. The other options do not accurately describe the function of opsonization related to the complement cascade. PTS: 1 REF: Page 199 13. In the coagulation (clotting) cascade, the intrinsic and the extrinsic pathways converge at which factor? a. XII c. X b. VII d. V ANS: C The coagulation cascade consists of the extrinsic and intrinsic pathways that converge only at factor X. PTS: 1 REF: Page 201 14. Which chemical interacts among all plasma protein systems by degrading blood clots, activating complement, and activating the Hageman factor? a. Kallikrein c. Bradykinin b. Histamine d. Plasmin ANS: D Only plasmin regulates clot formation by degrading fibrin and fibrinogen, and it can activate the complement cascade through components C1, C3, and C5. Plasmin can activate the plasma kinin cascade by activating the Hageman factor (factor XII) and producing prekallikrein activator.NURSINGTB.COM PTS: 1 REF: Page 201 15. The chemotactic factor affects the inflammatory process by: a. Causing vasodilation around the inflamed area b. Stimulating smooth muscle contraction in the inflamed area c. Directing leukocytes to the inflamed area d. Producing edema around the inflamed area ANS: C Two chemotactic factors, neutrophil chemotactic factor (NCF) and eosinophil chemotactic factor of anaphylaxis (ECF-A), are released during mast cell degranulation. NCF attracts neutrophils (a type of leukocytes), and ECF-A attracts eosinophils to the site of inflammation. The other options do not accurately describe the affect chemotactic factors have on the inflammatory process. PTS: 1 REF: Page 207 16. What affect does the process of histamine binding to the histamine-2 (H2) receptor have on inflammation? a. Inhibition c. Acceleration b. Activation d. Termination ANS: A Binding of histamine to the H1 receptor is essentially proinflammatory; that is, it promotes inflammation. On the other hand, binding histamine to the H2 receptor is generally antiinflammatory because it results in the suppression of leukocyte function. The other options do not accurately describe the affect histamine binding to the H2 receptor has on inflammation. PTS: 1 REF: Page 206 17. Frequently when H1 and H2 receptors are located on the same cells, they act in what fashion? a. Synergistically c. Antagonistically b. Additively d. Agonistically ANS: C Both types of receptors are distributed among many different cells and are often present on the same cells and may act in an antagonistic fashion. For instance, neutrophils express both types of receptors, with stimulation of H1 receptors resulting in the augmentation of neutrophil chemotaxis and H2 stimulation resulting in its inhibition. The other options do not accurately describe the relationship between H1 and H2 receptors. PTS: 1 REF: Page 207 18. Some older adults have impaired inflammation and wound healing because of which problem? a. Circulatory system cannot adequately perfuse tissues. b. Complement and chemotaxis are deficient. c. Underlying chronic illness(es) exists. d. Number of mast cells is insuffNicUieRnStI.NGTB.COM ANS: C In some cases, impaired healing is not directly associated with aging, in general, but can instead be linked to a chronic illness such as cardiovascular disease or diabetes mellitus. The other problems are not related to the aging process. PTS: 1 REF: Page 220 19. Which chemical mediator derived from mast cells retracts endothelial cells to increase vascular permeability and to cause leukocyte adhesion to endothelial cells? a. Leukotrienes c. Platelet-activating factor b. Prostaglandin E d. Bradykinin ANS: C The biologic activity of platelet-activating factor is virtually identical to that of leukotrienes; namely, it causes endothelial cell retraction to increase vascular permeability, leukocyte adhesion to endothelial cells, and platelet activation. The other options do not accurately identify the chemical mediator derived from the process described in the question. PTS: 1 REF: Page 207 20. What is the inflammatory effect of nitric oxide (NO)? a. Increases capillary permeability, and causes pain. b. Increases neutrophil chemotaxis and platelet aggregation. c. Causes smooth muscle contraction and fever. d. Decreases mast cell function, and decreases platelet aggregation. ANS: D Effects of NO on inflammation include vasodilation by inducing relaxation of vascular smooth muscle, a response that is local and short lived, and by suppressing mast cell function, as well as platelet adhesion and aggregation. The other options do not accurately identify the effect of NO on the process of inflammation. PTS: 1 REF: Page 209 21. What is the correct sequence in phagocytosis? a. Engulfment, recognition, fusion, destruction b. Fusion, engulfment, recognition, destruction c. Recognition, engulfment, fusion, destruction d. Engulfment, fusion, recognition, destruction ANS: C Once the phagocytic cell enters the inflammatory site, the only correct sequence of phagocytosis involves the following steps: (1) opsonization, or recognition, of the target and adherence of the phagocyte to it; (2) engulfment, or ingestion or endocytosis, and the formation of phagosome; (3) fusion with lysosomal granules within the phagocyte (phagolysosome); and (4) destruction of the target. PTS: 1 REF: Pages 210-211 22. When considering white blood celNlUdRifSfIeNreGnTtBia.lCsO, aMcute inflammatory reactions are related to elevations of which leukocyte? a. Monocytes c. Neutrophils b. Eosinophils d. Basophils ANS: C Only neutrophils are the predominant phagocytes in the early inflammatory site, arriving within 6 to 12 hours after the initial injury, they ingest (phagocytose) bacteria, dead cells, and cellular debris at the inflammatory site. PTS: 1 REF: Pages 208-209 23. In the later stages of an inflammatory response, which phagocytic cell is predominant? a. Neutrophils c. Chemokines b. Monocytes d. Eosinophils ANS: B Only monocytes and macrophages perform many of the same functions as neutrophils but for a longer time and in a later stage of the inflammatory response. PTS: 1 REF: Page 209 | Page 212 24. In regulating vascular mediators released from mast cells, the role of eosinophils is to release: a. Arylsulfatase B, which stimulates the formation of B lymphocytes b. Histaminase, which limits the effects of histamine during acute inflammation c. Lysosomal enzymes, which activate mast cell degranulation during acute inflammation d. Immunoglobulin E, which defends the body against parasites ANS: B Eosinophil lysosomes contain several enzymes that degrade vasoactive molecules, thereby controlling the vascular effects of inflammation. These enzymes include histaminase, which mediates the degradation of histamine, and arylsulfatase B, which mediates the degradation of some of the lipid-derived mediators produced by mast cells. The other options do not accurately describe the role of eosinophils. PTS: 1 REF: Page 209 25. What is the role of a natural killer (NK) cells? a. Initiation of the complement cascade b. Elimination of malignant cells c. Binding tightly to antigens d. Proliferation after immunization with antigen ANS: B The main function of NK cells is to recognize and eliminate cells infected with viruses, although they are also somewhat effective at eliminating other abnormal host cells, specifically cancer cells. The other options do not accurately identify the role of a NK cell. PTS: 1 REF: Page 213 26. Which cytokine is produced and rNelUeRasSeINd GfrToBm.CvOiMrally infected host cells? a. IL-1 c. TNF- b. IL-10 d. IFN- ANS: D Only interferons (IFNs) are produced and released by virally infected cells in response to viral double-stranded ribonucleic acid (RNA). IFN- and IFN- induce the production of antiviral proteins, thereby conferring protection on uninfected cells. IFN- or IFN- is released from virally infected cells and attaches to a receptor on a neighboring cell. IFNs also enhance the efficiency of developing an acquired immune response. PTS: 1 REF: Pages 204-205 27. IFN- is secreted from which cells? a. Virally infected cells c. Macrophages b. Bacterial infected cells d. Mast cells ANS: C Different kinds of interferons (IFNs) are produced by different types of cells—macrophages are the primary producers of both IFN- and IFN-. The other options do not accurately identify cells secreted by IFN-. PTS: 1 REF: Pages 204-205 28. Which manifestation of inflammation is systemic? a. Formation of exudates c. Redness and heat b. Fever and leukocytosis d. Pain and edema ANS: B The only three primary systemic changes associated with the acute inflammatory response are fever, leukocytosis (a transient increase in circulating leukocytes), and increased levels in circulating plasma proteins. PTS: 1 REF: Page 213 29. The acute inflammatory response is characterized by fever that is produced by the hypothalamus being affected by: a. Endogenous pyrogens c. Antigen-antibody complexes b. Bacterial endotoxin d. Exogenous pyrogens ANS: A Fever-causing cytokines are known as endogenous pyrogens. These pyrogens act directly on the hypothalamus, which is the portion of the brain that controls the body’s thermostat. The other options do not accurately describe the cause of fever related to the effects on the hypothalamus. PTS: 1 REF: Page 213 30. What occurs during the process of repair after tissue damage? a. Nonfunctioning scar tissue replaces destroyed tissue. b. Regeneration occurs; the original tissue is replaced. c. Resolution occurs; tissue is regenerated. d. Epithelialization replaces destNroUyReSdINtiGssTuBe..COM ANS: A Repair is the replacement of destroyed tissue with scar tissue. Scar tissue is primarily made up of collagen, which fills in the lesion and restores tensile strength but cannot carry out the physiologic functions of the destroyed tissue. The other options do not accurately describe the process of repair after tissue damage. PTS: 1 REF: Pages 215-216 31. The role of fibroblasts during the reconstructive phase of wound healing is to: a. Generate new capillaries from vascular endothelial cells around the wound. b. Establish connections between neighboring cells and contract their fibers. c. Synthesize and secrete collagen and the connective tissue proteins. d. Provide enzymes that débride the wound bed of dead cells. ANS: C Fibroblasts are the most important cells during the reconstructive phase of wound healing because they synthesize and secrete collagen and other connective tissue proteins. Macrophage-derived transforming growth factor–beta (TGF-ß) stimulates fibroblasts. The other options do not accurately describe the role of fibroblasts in the reconstructive phase of wound healing. PTS: 1 REF: Pages 216-218 32. A keloid is the result of which dysfunctional wound healing response? a. Epithelialization c. Collagen matrix assembly b. Contraction d. Maturation ANS: C An imbalance between collagen synthesis and collagen degradation, during which synthesis is increased relative to degradation, causes both keloids and hypertrophic scars. The other options are not involved in keloids production. PTS: 1 REF: Page 219 33. Which solution is best to use when cleaning a wound that is healing by epithelialization? a. Normal saline c. Hydrogen peroxide b. Povidone-iodine d. Dakin solution ANS: A Normal saline is the most innocuous solution that can be used to cleanse or irrigate a wound that is primarily healing by epithelialization and is the only correct answer for this question. PTS: 1 REF: Page 220 34. Many neonates have a transient depressed inflammatory response as a result of which condition? a. The circulatory system is too immature to perfuse tissues adequately. b. Complement and chemotaxis are deficient. c. Mast cells are lacking. d. The respiratory system is too iNmUmRaStIuNrGeTtBo.CdeOlMiver oxygen to tissues. ANS: B Neonates commonly have transiently depressed inflammatory and immune function partially as a result of a deficiency in components of the alternative pathway. For example, neutrophils and perhaps monocytes may not be capable of efficient chemotaxis. The other options do not accurately explain the common cause of a transient depressed inflammatory response in neonates. PTS: 1 REF: Page 220 35. During phagocytosis, what is occurring during the step referred to as opsonization? a. Phagocytes recognize and adhere to the bacteria. b. Microorganisms are ingested. c. Microorganisms are killed and digested. d. An intracellular phagocytic vacuole is formed. ANS: A During phagocytosis, opsonization involves only the recognition and adherence of phagocytes to bacteria. PTS: 1 REF: Page 210 36. Fusion is the step in phagocytosis during which: a. Microorganisms are killed and digested. b. An intracellular phagocytic vacuole is formed. c. Lysosomal granules enter the phagocyte. d. Microorganisms are ingested. ANS: C Fusion occurs with lysosomal granules entering the phagocyte (phagolysosome). The remaining options do not accurately describe fusion as a step in phagocytosis. PTS: 1 REF: Page 210 37. During the process of endocytosis, the phagosome step results in: a. Microorganisms are ingested. b. Microorganisms are killed and digested. c. Phagocytes recognize and adhere to bacteria. d. An intracellular phagocytic vacuole is formed. ANS: D Small pseudopods that extend from the plasma membrane and surround the adherent microorganism, forming an intracellular phagocytic vacuole or phagosome, carry out engulfment (endocytosis). The membrane that surrounds the phagosome consists of inverted plasma membrane. After the formation of the phagosome, lysosomes converge, fuse with the phagosome, and discharge their contents, creating a phagolysosome. PTS: 1 REF: Pages 210-211 38. When cellular damage occurs and regeneration is minor with no significant complications, the process of returning the cells to preinjury function is referred to as: a. Restoration NURSINGTcB..CORMegrowth b. Resolution d. Replacement ANS: B If damage is minor with no complications and destroyed tissues are capable of regeneration, then returning the injured tissues to an approximation of their original structure and physiologic function is possible. This restoration is called resolution. The other terms are not used to describe this process. PTS: 1 REF: Page 215 39. Newborns often have deficiencies in collectin-like proteins, making them more susceptible to what type of infection? a. Cardiac c. Respiratory b. Urinary d. Gastrointestinal ANS: C Neonates may also be deficient in some of the collectins and collectin-like proteins. This deficiency is especially true of preterm neonates. Some preterm infants with respiratory distress syndrome are deficient in at least one collectin, which negatively affects its innate defense against respiratory infections. The other options are not necessarily related to collectin deficiencies. PTS: 1 REF: Page 220 40. Which cell is the body’s primary defense against parasite invasion? a. Eosinophil c. T lymphocytes b. Neutrophils d. B lymphocytes ANS: A Eosinophils serve as the body’s primary defense against parasites. T lymphocytes and B lymphocytes are involved in acquired immunity. Neutrophils are the predominant phagocytes in the early inflammatory site. PTS: 1 REF: Page 209 MULTIPLE RESPONSE 41. Which chemical mediators induce pain during an inflammatory response? (Select all that apply.) a. Prostaglandins b. Leukotrienes c. Tryptase d. Phospholipase e. Bradykinin ANS: A, E The only chemical mediators that induce pain during an inflammatory response are the prostaglandins and bradykinin. PTS: 1 REF: Page 201 42. Sebaceous glands protect the bodyNUfrRoSmINinGfTeBc.tCioOnMby secreting: (Select all that apply.) a. Antibacterial fatty acids b. Antifungal fatty acids c. Ascorbic acid d. Lactic acid e. Hydrochloric acid ANS: A, B, D Sebaceous glands secrete only antibacterial and antifungal fatty acids and lactic acid. PTS: 1 REF: Pages 192-193 43. Which body fluid has the ability to attack the cell walls of gram-positive bacteria? (Select all that apply.) a. Perspiration b. Semen c. Tears d. Saliva e. Urine ANS: A, C, D Only perspiration, tears, and saliva contain an enzyme (lysozyme) that attacks the cell walls of gram-positive bacteria. PTS: 1 REF: Page 193 44. The main function of NK cells includes: (Select all that apply.) a. Recognizing virus-infected cells b. Eliminating virus-infected cells c. Recognizing bacteria-infected cells d. Eliminating bacteria-infected cells e. Eliminating previously identified cancer cells ANS: A, B, E The main functions of NK cells are recognizing and eliminating cells infected with viruses, not bacteria. They are also somewhat effective at eliminating other abnormal host cells, specifically cancer cells. PTS: 1 REF: Page 213 45. Normal bacterial flora found in the intestines produce vitamin K to assist in the absorption of which of the following? (Select all that apply.) a. Calcium b. Fatty acids c. Large polysaccharides d. Iron e. Magnesium ANS: A, D, E The flora’s production of vitamin K is needed to absorb various ions, such as calcium, iron, and magnesium. Normal intestinal flora is responsible for digesting fatty acids, large polysaccharides, and other dietary substance, but such digestion is not reliant on vitamin K. NURSINGTB.COM PTS: 1 REF: Page 194 46. An individual’s acquired immunity is dependent on the function of which cells? (Select all that apply.) a. T lymphocytes b. B lymphocytes c. Macrophages d. Opsonins e. Neutrophils ANS: A, B, C T lymphocytes, B lymphocytes, macrophages, and dendritic cells are involved in acquired immunity. Opsonins are molecules that tag microorganisms for destruction by cells of the inflammatory system; these cells are primarily neutrophils. PTS: 1 REF: Page 192 | Table 7-1 47. An example of a pathogen capable of surviving and even multiplying inside a macrophage is known as: (Select all that apply.) a. Mycobacterium tuberculosis (tuberculosis) b. Mycobacterium leprae (leprosy) c. Salmonella typhi (typhoid fever) d. Clostridium difficile e. Brucella abortus (brucellosis) ANS: A, B, C, E Several bacteria are resistant to killing by granulocytes and can even survive inside macrophages. Microorganisms such as M. tuberculosis (tuberculosis), M. leprae (leprosy), S. typhi (typhoid fever), and B. abortus (brucellosis) can remain dormant or even multiply inside the phagolysosomes of macrophages. C. difficile is said to be resistant to antibiotics, making it difficult to control. PTS: 1 REF: Pages 212-213 48. An older adult is particularly susceptible to infections of which body parts? (Select all that apply.) a. Lungs b. Skin c. Liver d. Eyes e. Bladder ANS: A, B, E Older adults have increased susceptibility to bacterial infections of the lungs, urinary tract, and skin. Other infections may occur but on an individualized basis. PTS: 1 REF: Page 220 MATCHING NURSINGTB.COM Match each step of phagocytosis with its function. A. Opsonization B. Engulfment C. Phagosome D. Fusion E. Destruction 49. Microorganisms are ingested. 50. Microorganisms are killed and digested. 51. Phagocytes gain enhanced recognition and adherence of bacteria. 52. Lysosomal granules enter the phagocyte. 53. Intracellular phagocytic vacuole is formed. 49. ANS: MSC: B PTS: 1 REF: Pages 210-211 Engulfment is the ingestion of phagosomes. 50. ANS: MSC: E PTS: 1 REF: Pages 210-211 Destruction is the step during which microorganisms are killed and digested. 51. ANS: MSC: A PTS: 1 REF: Pages 210-211 Opsonization is the recognition and adherence of phagocytes to bacteria. 52. ANS: MSC: D PTS: 1 REF: Pages 210-211 Fusion occurs with lysosomal granules within the phagocyte (phagolysosome). 53. ANS: MSC: C PTS: 1 REF: Pages 210-211 Small pseudopods that extend from the plasma membrane and surround the adherent microorganism, forming an intracellular phagocytic vacuole or phagosome, carry out engulfment (endocytosis). NURSINGTB.COM Chapter 8: Adaptive Immunity MULTIPLE CHOICE 1. Which primary characteristic is unique for the immune response? a. The immune response is similar each time it is activated. b. The immune response is specific to the antigen that initiates it. c. The response to a specific pathogen is short term. d. The response is innate, rather than acquired. ANS: B Unlike inflammation, which is nonspecifically activated by cellular damage and pathogenic microorganisms, the immune response is primarily designed to afford long-term specific protection (i.e., immunity) against particular invading microorganisms; that is, it has a memory function. The other options are not unique characteristics of the immune response. PTS: 1 REF: Page 225 2. In which structure does B lymphocytes mature and undergo changes that commit them to becoming B cells? a. Thymus gland c. Bone marrow b. Regional lymph nodes d. Spleen ANS: C B lymphocytes mature and become B cells in specialized (primary) lymphoid organs—the thymus gland for T cells and the bNoUnReSmINaGrrToBw.CfOorMB cells. Neither regional lymph nodes nor the spleen are involved in changing B lymphocytes into B cells. PTS: 1 REF: Page 225 3. What is the term for the process during which lymphoid stem cells migrate and change into either immunocompetent T cells or immunocompetent B cells? a. Clonal diversity c. Clonal selection b. Clonal differentiation d. Clonal competence ANS: A The process is called the generation of clonal diversity and occurs in specialized (primary) lymphoid organs—the thymus gland for T cells and the bone marrow for B cells. The other options do not accurately identify the process described in the question. PTS: 1 REF: Page 225 4. Which type of immunity is produced by an individual after either natural exposure to the antigen or after immunization against the antigen? a. Passive-acquired immunity c. Passive-innate immunity b. Active-acquired immunity d. Active-innate immunity ANS: B An individual produces active-acquired immunity (active immunity) after natural exposure to an antigen or after immunization, whereas passive-acquired immunity (passive immunity) does not involve the host’s immune response at all. The innate immune system, also known as nonspecific immune system and the first line of defense, is composed of the cells and mechanisms that defend the host from infection by other organisms in a nonspecific manner, which means that the cells of the innate system recognize and respond to pathogens in a generic way. PTS: 1 REF: Page 227 5. What type of immunity is produced when an immunoglobulin crosses the placenta? a. Passive-acquired immunity c. Passive-innate immunity b. Active-acquired immunity d. Active-innate immunity ANS: A Passive-acquired immunity (passive immunity) does not involve the host’s immune response at all. Rather, passive immunity occurs when preformed antibodies or T lymphocytes are transferred from a donor to the recipient. This transfer can occur naturally, as in the passage of maternal antibodies across the placenta to the fetus, or artificially, as in a clinic using immunotherapy for a specific disease. The remaining options do not produce immunity via immunoglobulin transfer across the placenta. PTS: 1 REF: Page 227 6. The portion of the antigen that is configured for recognition and binding is referred to as what type of determinant? a. Immunotope c. Epitope b. Paratope ANS: C NURSINGTdB..COAMntigenitope The precise portion of the antigen that is configured for recognition and binding is called its antigenic determinant or epitope. The other options are not used to identify this portion of the antigen. PTS: 1 REF: Page 228 7. Which characteristic is the most important determinant of immunogenicity when considering the antigen? a. Size c. Complexity b. Foreignness d. Quantity ANS: B Foremost among the criteria for immunogenicity is the antigen’s foreignness. A self-antigen that fulfills all of these criteria except foreignness does not normally elicit an immune response. Thus most individuals are tolerant of their own antigens. The immune system has an exquisite ability to distinguish self (self-antigens) from nonself (foreign antigens). The other options are considered when determining immunogenicity. PTS: 1 REF: Page 229 8. When antigens are administered to produce immunity, why are different routes of administration considered? a. Different routes allow the speed of onset of the antigen to be varied, with the intravenous route being the fastest. b. Some individuals appear to be unable to respond to an antigen by a specific route, thus requiring the availability of different routes for the same antigen. c. Antigen-presenting cells are highly specialized and thus require stimulation by different routes. d. Each route stimulates a different lymphocyte-containing tissue, resulting in different types of cellular and humoral immunity. ANS: D Each route preferentially stimulates a different set of lymphocyte-containing (lymphoid) tissues and therefore results in the induction of different types of cell-mediated or humoral immune responses. The other options do not accurately explain the use of different routes when administering antigens to produce immunity. PTS: 1 REF: Page 229 9. The functions of the major histocompatibility complex (MHC) and CD1 molecules are alike because both: a. Are antigen-presenting molecules. b. Bind antigens to antibodies. c. Secrete interleukins during the immune process. d. Are capable of activating cytotoxic T lymphocytes. ANS: A MHC and CD1 molecules are both antigen presenting molecules (APCs). The other options do not accurately describe the common function of these cells. NURSINGTB.COM PTS: 1 REF: Page 233 | Page 235 10. Where are antibodies produced? a. Helper T lymphocytes c. Plasma cells b. Thymus gland d. Bone marrow ANS: C An antibody or immunoglobulin is a serum glycoprotein produced only by plasma cells in response to a challenge by an immunogen. PTS: 1 REF: Page 229 11. Which immunoglobulin is present in blood, saliva, breast milk, and respiratory secretions? a. IgA c. IgG b. IgE d. IgM ANS: A IgA can be divided into two subclasses, IgA1 and IgA2. IgA1 molecules are predominantly found in the blood, whereas IgA2 is the predominant class of antibody found in normal body secretions. The other options are not found in the substances identified in the question. PTS: 1 REF: Page 229 12. Which antibody initially indicates a typical primary immune response? a. IgG c. IgA b. IgM d. IgE ANS: B Typically, IgM is produced first (primary immune response), followed by IgG against the same antigen. The other options are not involved. PTS: 1 REF: Page 247 13. An individual is more susceptible to infections of mucous membranes when he or she has a seriously low level of which immunoglobulin antibody? a. IgG c. IgA b. IgM d. IgE ANS: C The IgA molecules found in bodily secretions are dimers anchored together through a J-chain and secretory piece. This secretory piece is attached to the IgA antibodies inside the mucosal epithelial cells and may function to protect these immunoglobulin antibodies against degradation by enzymes also found in the secretions, thus decreasing the risk of infections in the mucous membrane. The other options do not accurately identify the immunoglobulin antibody involved in mucous membrane infections. PTS: 1 REF: Page 229 14. The B-cell receptor (BCR) complex functions uniquely by: a. Communicating information about the antigen to the helper T cell b. Secreting chemical signals to cNoUmRmSIuNnGiTcBat.eCObeMtween cells c. Recognizing the antigen on the surface of the B lymphocyte d. Communicating information about the antigen to the cell nucleus ANS: D The role of the BCR is to recognize the antigen; however, unlike circulating antibodies, the receptor must communicate that information to the cell’s nucleus. The other options are not unique to the function of the BCR complex. PTS: 1 REF: Page 232 15. The generation of clonal diversity occurs primarily during which phase of life? a. Fetal c. Infancy b. Neonatal d. Puberty ANS: A Generation of clonal diversity primarily occurs in the fetus and probably continues to a low degree throughout most of adult life. PTS: 1 REF: Pages 236-237 16. The generation of clonal diversity includes a process that: a. Involves antigens that select those lymphocytes with compatible receptors. b. Allows the differentiation of cells into antibody-secreting plasma cells or mature T cells. c. Takes place in the primary (central) lymphoid organs. d. Causes antigens to expand and diversify their populations. ANS: C This process occurs in central lymphoid organs—the thymus gland for T cells and bone marrow for B cells. The other options do not accurately describe the processes included in clonal diversity. PTS: 1 REF: Pages 236-237 17. Which statement is true concerning clonal selection? a. Clonal selection is driven by hormones and does not require foreign antigens. b. This theory involves antigens that select those lymphocytes with compatible receptors. c. Clonal selection takes place in the primary (central) lymphoid organs. d. This process generates immature but immunocompetent T and B cells with receptors. ANS: B Clonal selection, a process during which antigens select those lymphocytes with compatible receptors, expands their population and causes differentiation into antibody-secreting plasma cells or mature T cells (see Table 8-6). The other statements are not true regarding clonal selection. PTS: 1 REF: Page 236 18. Which is an example of an endogenous antigen? a. Yeast NURSINGTcB..COBMacteria b. Cancer cells d. Fungus ANS: B Of the options provided, endogenous antigens include only those uniquely produced by cancerous cells. PTS: 1 REF: Page 244 19. Which cytokine is needed for the maturation of a functional helper T cell? a. IL-1 c. IL-4 b. IL-2 d. IL-12 ANS: B Of the options provided, IL-2 production is critical for the Th cell to mature efficiently into a functional helper cell. PTS: 1 REF: Page 245 20. Th2 cells produce IL-4 and suppress which cells? a. B lymphocytes c. Th1 cells b. Cytotoxic T lymphocytes d. Memory T lymphocytes ANS: C Th2 cells produce IL-4, which suppresses only Th1 and Th17 cells through their IL-4 receptors. PTS: 1 REF: Pages 246-247 21. Which statement is believed to be true concerning Th1 cells? a. Th1 cells are induced by antigens derived from allergens. b. They are induced by antigens derived from cancer cells. c. Th1 cells produce IL-4, IL-5, IL-6, and IL-13. d. They assist in the development of humoral immunity. ANS: B Antigens derived from viral or bacterial pathogens and those derived from cancer cells are hypothesized to induce a greater number of Th1 cells relative to Th2 cells. The other statements are not true regarding Th1 cells. PTS: 1 REF: Pages 246-247 22. Which statement is believed to be true concerning Th2 cells? a. Th2 cells are induced by antigens derived from allergens. b. They are induced by antigens derived from cancer cells. c. Th2 cells produce IL-2, TNF-ß, and IFN- . d. They assist in the development of cell-mediated immunity. ANS: A Antigens derived from multicellular parasites and allergens are hypothesized to be involved in the production of more Th2 cells. The other statements are not true regarding Th2 cells. PTS: 1 REF: Pages 2N4U6-R2S4I7NGTB.COM 23. When a person is exposed to most antigens, antibodies can be usually detected in his or her circulation within: a. 12 hours c. 3 days b. 24 hours d. 6 days ANS: D After only approximately 5 to 7 days is an IgM antibody specific for that antigen detected in the circulation. PTS: 1 REF: Page 247 24. Vaccinations are able to provide protection against certain microorganisms because of the: a. Strong response from IgM c. Memory cells for IgE b. Level of protection provided by IgG d. Rapid response from IgA ANS: B IgG production is considerably increased, making it the predominant antibody class of the secondary response. IgG is often present in concentrations several times larger than those of IgM, and levels of circulating IgG specific for that antigen may remain elevated for an extended period. The other options are not relevant to how vaccinations protect against certain microorganisms. PTS: 1 REF: Page 247 25. Why is the herpes virus inaccessible to antibodies after the initial infection? a. The virus does not circulate in the blood. b. It does not have antibody receptors. c. It resists agglutination. d. The virus is a soluble antigen. ANS: A Many viruses (e.g., measles, herpes) are inaccessible to antibodies after the initial infection only because these viruses do not circulate in the bloodstream; rather, they remain inside infected cells, spreading by direct cell-to-cell contact. PTS: 1 REF: Page 252 26. Increased age may cause which change in lymphocyte function? a. Increased production of antibodies against self-antigens b. Decreased number of circulating T cells c. Decreased production of autoantibodies d. Increased production of helper T cells ANS: A B-cell function is altered with age as shown by decreases in specific antibody production in response to antigenic challenge, with concomitant increases in circulating immune complexes and in circulating autoantibodies (antibodies against self-antigens). Aging does not play a role in either decreasing T cells circulation or increasing helper T cells production. PTS: 1 REF: Pages 2N5U7-R2S5I8NGTB.COM 27. How do antibodies protect the host from bacterial toxins? a. Lysing the cell membrane of the toxins b. Binding to the toxins to neutralize their biologic effects c. Inhibiting the synthesis of DNA proteins needed for growth d. Interfering with the DNA enzyme needed for replication ANS: B To cause disease, most toxins must bind to surface molecules on the individual’s cells. Protective antibodies can bind to the toxins, prevent their interaction with cells, and neutralize their biologic effects. The other options fail to explain how antibodies protect the host from bacterial toxins. PTS: 1 REF: Page 252 28. Which T cell controls or limits the immune response to protect the host’s own tissues against an autoimmune response? a. Cytotoxic T cells c. Th2 cells b. Th1 cells d. Regulatory T (Treg) cells ANS: D The regulatory T (Treg) cell is the only option whose role is to contr