Question 1 (1 point)

A patient has been admitted to an inpatient medical unit of a hospital with an acute viral infection. The health care team providing care for the patient would recognize which of the following statements as an accurate description of the role of viruses in human infections?

A. Viruses have limited or absent genetic material of their own.

B. Some viruses are capable of transforming normal host cells into malignant cells.

C. Viruses are often implicated in cases of transmissible neurodegenerative disease.

D. Viruses require stimulation after a latent period before they are able to produce symptoms.

Question 2 (1 point)

A tourist presented to a primary care health clinic complaining of malaise, fever, and headache. She has subsequently been diagnosed with Rocky Mountain spotted fever, a pathology caused by Rickettsiaceae. Which of the followed statements best captures a characteristic trait of Rickettsiaceae?

A. They are eukaryotic.

B. They have both RNA and DNA.

C. They have a distinct spiral-shaped morphology.

D. They are neither gram-negative nor gram-positive

Question 3 (1 point)

An 81-year-old female patient on a subacute medical unit of a hospital has developed an oral Candida albicans infection. Which of the following phenomena would the patient's nurse suspect as a key contributing factor to her infection?

A. The moist and temperature-suitable oral environment of the patient's mouth

B. The ability of fungi to remain latent until the host reaches an immunocompromised state

C. Antibiotic therapy that eliminated bacterial flora

D. The airborne communicability of yeast and molds and subsequent inhalation

Question 4 (1 point)

A 21-year-old male has returned from a backpacking trip early because of a diagnosis of malaria. Which of the following teaching points for the patient is most accurate?

A. “Your infection likely began with the introduction of fertilized protozoan ova from a mosquito.”

B. “The protozoa responsible have hijacked the genetic material of your own cells in order to reproduce.”

C. “You're exhausted because the pathogens are utilizing the adenosine triphosphate (ATP) that your own cells need.”

D. “The infectious organisms can be considered tiny, single-celled animals, given their complete eukaryotic machinery.”

Question 5 (1 point)

A family physician is providing prenatal care and education for a first-time expectant mother, 22 weeks' gestation, who has a diagnosis of a sexually transmitted infection. Which of the following statements by the expectant mother demonstrates an adequate understanding of vertical disease transmission and congenital infections?

A. “Gonorrhea and chlamydia pose the greatest risks of transmission from mother to child.”

B. “I know that my baby will need observation for HIV signs and symptoms in the weeks following my delivery.”

C. “My baby could become infected either across the placenta or during the birth itself.”

D. “Prophylactic immunization will reduce my baby's chance of being born with an illness.”

Question 6 (1 point)

The infection control officer of a hospital is conducting a refresher course for staff. Which of the following procedures reduces the potential for infection primarily by addressing the portal of entry?

A. Wiping down common areas with buffered bleach on a regular basis

B. Wearing gloves when contact with blood or body fluids is anticipated

C. Disposing of soiled clothing and bed linens in a dedicated receptacle

D. Isolating patients who have antibiotic-resistant infections

Question 7 (1 point)

Eight hours after a meal of chicken and potato salad on a hot day at the beach, a 30-year-old woman has awoken with sudden, violent diarrhea and vomiting. How is the current stage of her food poisoning best characterized?

A. Fulminant illness

B. Insidious prodromal phase

C. Sudden incubation

D. Acute prodromal phase

Question 8 (1 point)

A particular microorganism has been implicated in the illness of a group of individuals. Laboratory investigation notes that the gram-negative bacteria involved are problematic due to their toxic cell wall proteins and their ability to adapt to and survive phagocytosis within leukocytes. Which virulence factors are the bacteria employing?

A. Evasive factors; endotoxins

B. Exotoxins; endotoxins

C. Adhesion factors; evasive factors

D. Invasive factors; adhesion factors

Question 9 (1 point)

Infection of a patient by a particular microorganism is suspected by the health care team, but the microorganism in question cannot be cultured. Which of the following processes is most likely to result in an accurate diagnosis?

A. Direct observation of the presence or absence of specific antigens in the patient's blood serum sample.

B. Introduction of cultured, marked antibodies to a specimen from the patient and observation for a reaction with antigens.

C. Observation for a cytopathic effect on biopsy tissue samples from the patient's mucosa.

D. Release of purified antigens into the patient's circulation to observe whether the patient has produced the relevant antibodies.

Question 10 (1 point)

A 22-year-old female patient has been diagnosed with the herpes simplex virus, and the patient's physician is explaining the course of treatment that will most likely be undertaken. The patient is shocked by the limited treatment options that the physician explains and states that she thought modern medicine was producing more and more antibiotics every year. How could the physician best respond to the patient?

A. “The recent rise of drug resistance has significantly hampered the elimination of viruses.”

B. “The cell coat of viruses is particularly resilient to the available synthetic antivirals.”

C. “The use of antivirals is severely limited by the unwanted side effects that they cause.”

D. “Treatment options for viruses are often limited because what damages viruses often damages your own body cells.”

Question 11 (1 point)

A patient with a diagnosis of sepsis is receiving intravenous immune globulin (IVIG) as part of her hospital treatment. The patient's family has been curious about the treatment and the nurse providing care for the patient has taught the family some of the key aspects of IVIG. Which of the following responses by the family would best suggest an accurate understanding of IVIG treatment?

A. “These antibodies in the solution have been collected from specific people who have successfully fought off the same infection.”

B. “The IVIG should help stimulate fever, inflammation, and tissue repair in the fight against the infection.”

C. “So a big part of her IVIG treatment is actually stimulating and supplementing her immune system to do the work itself.”

D. “The main effect of IVIG is to cause her body to produce more white blood cells to fight infection.”

Question 12 (1 point)

Recent years have seen incidents of infection like West Nile virus and SARS that do not match previously established patterns. Which of the following phenomena constitutes the most significant contributor to the spread of new and previously eradicated diseases in the United States?

A. Drug resistance by bacterial and protozoan infections

B. Increased ease and speed of travel

C. Genetic variation and mutation by microorganisms

D. Decreased living standards and public health standards in urban areas

Question 13 (1 point)

Which of the following scenarios best describes an example of infection originating with a fomite?

A. A 32-year-old man who contracts hepatitis C by sharing a syringe

B. A 44-year-old nurse who tests positive for tuberculosis (TB) after admitting a TB-positive patient

C. A 22-year-old woman who contracts Lyme disease after a tick bite

D. A 44-year-old man who has trichinosis after eating undercooked pork

Question 14 (1 point)

Swabs and culture samples of patients admitted to hospitals show that Staphylococcus aureus is commonly found in the skin, nares, and other body sites of people who show no signs or symptoms of infection. This condition is an example of:

A. Opportunistic infection

B. Parasitism

C. Colonization

D. Saprophytic infection

Question 15 (1 point)

Sputum samples from a patient with pneumonia contain an infective agent that has a peptidoglycan cell wall, expresses endotoxins, replicates readily in broth and on agar, grows in clusters, has pili, and does not stain when exposed to crystal violet. This pneumonia is most likely:

A. Chlamydial

B. Viral

C. Mycoplasmal

D. Bacterial

Question 16 (1 point)

A 34-year-old male patient has diagnoses of liver failure, ascites, and hepatic encephalopathy secondary to alcohol abuse. The patient's family is questioning the care team about why his abdomen is so large even though he is undernourished and emaciated. Which of the following statements most accurately underlies the explanation that a member of the care team would provide to the family?

A. An inordinate amount of interstitial fluid is accumulating in the patient's abdomen.

B. The transcellular component of the intracellular fluid compartment contains far more fluid than normal.

C. The normally small transcellular fluid compartment, or third space, is becoming enlarged.

D. Gravity-dependent plasma is accumulating in the patient's peritoneal cavity.

Question 17 (1 point)

Recognizing the prevalence and incidence of dehydration among older adults, a care aide at a long-term care facility is in the habit of encouraging residents to drink even though they may not feel thirsty at the time. Which of the following facts underlies the care aide's advice?

A. Older adults often experience a decrease in the sensation of thirst, even when serum sodium levels are high.

B. The metabolic needs for both fluid and sodium in older adults differ from those of younger individuals.

C. Regulation and maintenance of effective circulating volume by the kidneys is less effective in the elderly.

D. The renin-angiotensin-aldosterone (RAA) system is less able to facilitate sodium clearance in older adults.

Question 18 (1 point)

A 77-year-old female hospital patient has contracted Clostridium difficile during her stay and is experiencing severe diarrhea. Which of the following statements best conveys a risk that this woman faces?

A. She is susceptible to isotonic fluid volume deficit and hypernatremia as a result of water losses.

B. She is prone to isotonic fluid volume excess due to impaired osmolality from sodium losses.

C. She could develop third-spacing edema as a result of plasma protein losses.

D. She is at risk of compensatory fluid volume overload secondary to gastrointestinal water and electrolyte losses.

Question 19 (1 point)

A 26-year-old male patient with a diagnosis of schizophrenia has been admitted with suspected hyponatremia after consuming copious quantities of tap water. Which of the following signs, symptoms, and lab results should the care team be assessing for?

A. High urine specific gravity, tachycardia, and a weak, thready pulse

B. Low blood pressure, fever, and increased urine osmolality

C. Increased hematocrit and blood urea nitrogen (BUN), and seizures

D. Weakness, lethargy, and nausea

Question 20 (1 point)

A nurse on a medical unit has noted that a patient's potassium level is elevated at 6.1 mEq/L. The nurse has notified the physician and removed the banana from the patient's lunch tray and is performing a focused assessment. When questioned by the patient about the rationale for these actions, which of the following explanations by the nurse would be the most appropriate?

A. “Your potassium level is high and so I need you to let me know if you feel numbness, tingling, or weakness.”

B. “Your potassium levels in your blood are higher than they should be, which brings a risk of changes in brain function.”

C. “I'll need to monitor you today for signs of high potassium; tell me if you feel as if your heart is beating quickly or irregularly.”

D. “The amount of potassium in your blood is too high, but this can be resolved by changing the intravenous fluid you are receiving.”

Question 21 (1 point)

An ECG technician is performing an ECG on a hospital patient who has developed hypokalemia secondary to diuretic use. Which of the following manifestations of the patient's health problem will the technician anticipate seeing on the ECG?

A. A slow heart rate and a peaked T wave

B. A low T wave and an absent P wave

C. A prominent U wave and a low T wave

D. A narrow QRS complex and an absent U wave

Question 22 (1 point)

A patient is brought to the emergency department with complaints of shortness of breath. Assessment reveals a full, bounding pulse, severe edema, and audible crackles in the lower lung fields bilaterally. What is the patient's most likely diagnosis?

A. Hyponatremia

B. Fluid volume excess

C. Hypocalcemia

D. Hyperkalemia

Question 23 (1 point)

An 81-year-old female has long-standing hypocalcemia secondary to kidney disease and will shortly be moving into an assisted living facility from her own apartment. Which of the following findings should staff at the facility be instructed to observe for?

A. Loss of appetite and complaints of nausea

B. Muscular spasms and complaints of cramps

C. High fluid intake and urine output

D. Lethargy and stupor

Question 24 (1 point)

A 56-year-old female hospital patient with a history of alcohol abuse is receiving intravenous (IV) phosphorus replacement. Which of the following health problems will this IV therapy most likely resolve?

A. The patient has an accumulation of fluid in her peritoneal cavity.

B. The patient is acidotic and has impaired platelet function.

C. The patient has an irregular heart rate and a thready pulse.

D. The patient has abdominal spasms and hyperactive reflexes.

Question 25 (1 point)

A 52-year-old patient has just passed a kidney stone and has high levels of calcium in her urine. Blood tests show high levels of calcium in her blood as well. What subsequent lab results would be most likely to distinguish between primary hyperparathyroidism and hypercalcemia of malignancy?

A. Levels of parathyroid hormone (PTH)

B. Bone scan

C. Plasma phosphate levels

D. Levels of magnesium

Question 26 (1 point)

You are volunteering in the medical tent at a road race on a hot, humid day. A runner who has collapsed on the road is brought in with the following symptoms: sunken eyes, a body temperature of 100ºF, and a complaint of dizziness when sitting to have his blood pressure taken (which subsides upon his lying down). These are signs of a fluid volume deficit. Which of the following treatments should be carried out first?

A. Give him water by mouth.

B. Bring down his body temperature with ice.

C. Give him a blood transfusion.

D. Give him an electrolyte solution by mouth.

Question 27 (1 point)

Which of the following individuals demonstrates a health problem with his or her axial skeleton?

A. A 21-year-old male who fractured his humerus while snowboarding

B. A 40-year-old man who has a contusion to the left temporal bone of his skull following a motor vehicle accident

C. A 79-year-old female who has undergone hemiarthroplasty (hip replacement surgery)

D. A 30-year-old pregnant woman who has a separated pubic symphysis

Question 28 (1 point)

Which of the following characteristics most accurately applies to compact (cortical) bone?

A. It is found along lines of stress in the body.

B. The bone is arranged in an interwoven, lattice-like pattern.

C. It is relatively light but still strong.

D. The surface of the bone is lined with osteogenic cells.

Question 29 (1 point)

A 30-year-old woman has just given birth to a boy. How will the mother's bone marrow differ from that of her son?

A. Her bone marrow performs additional functions for the maintenance of homeostasis that her son is not yet able to perform.

B. The son will have a greater proportion of adipose tissue in his bone marrow.

C. Proportionately, the infant will have more red marrow and less yellow marrow than his mother.

D. The amount of yellow marrow in the son's bones will decrease as he develops.

Question 30 (1 point)

Four weeks ago, an 83-year-old male fractured his femoral head in a fall that was caused by orthostatic hypotension. His care provider has stated that the healing process is occurring at a reasonable pace, and that the man will regain full function after healing and rehabilitation. Which of the following cells are most responsible for restoring the integrity of the man's broken bone?

A. Osteocytes

B. Osteoclasts

C. Osteoblasts

D. Osteomas

Question 31 (1 point)

Which of the following individuals who have recently presented to a hospital emergency department is displaying an injury that involves his or her fibrocartilage?

A. A 7-year-old girl whose ear has been lacerated during a dog attack

B. A 24-year-old male who has had his trachea crushed in a workplace accident

C. A 15-year-old boy who has suffered a knee injury during a football game

D. A 78-year-old man who has fallen and is suspected of having a “slipped disc” in his back

A 70-year-old woman's family physician has recommended she take a vitamin D supplement. The woman states that she tries hard to take as few pills as possible and questions her physician on the rationale and necessity for the supplementation. How can the physician most accurately reply to the patient's concerns?

A. “Vitamin D can prevent osteoporosis by increasing the density of your bones.”

B. “Vitamin D is important in order for your body to absorb the calcium that you consume in your diet.”

C. “When your liver is unable to produce enough on its own, it's important to take vitamin D supplements to promote bone strength.”

D. “Vitamin D slows down the rate that your body breaks down your bones.”

Question 33 (1 point)

In which of the following locations would a clinician expect to find a ligament?

A. At the attachment points between ribs and the sternum

B. Between the radius bone of the arm and the biceps brachii muscle

C. Around the capsule that forms the knee joint

D. Between the individual plates of the skull

Question 34 (1 point)

A 71-year-old male with a suspected diagnosis of osteoarthritis is being scheduled for a knee aspiration. The patient is surprised to learn that his knee joint contains fluid and asks the physician ordering the procedure what the main role of the fluid is. Which of the following statements best underlies the explanation that the physician will provide?

A. Synovial fluid allows for joint movement by minimizing friction.

B. Fluid in the synovial cavities is essential for its role in immunity, and deficits indicate autoimmune etiologies.

C. Synovial fluid allows for the diffusion of gases and nutrients to cartilage that lacks blood supply.

D. The fluid inhibits clot formation in bone surfaces that are in constant contact.

Question 35 (1 point)

Laparoscopic knee surgery on a 22-year-old basketball player has necessitated entry into the synovial cavity. The surgeon performing the procedure would be aware of which of the following relevant characteristics of synovial tissue?

A. Synovial tissue has a slow rate of healing compared to muscle tissue.

B. Damage to synovial tissue is known to be excruciatingly painful.

C. The synovial membrane lacks direct blood supply, precluding bleeding into the joint.

D. Few pain receptors are located in the synovial membrane.

Question 36 (1 point)

A female tennis player has suffered an injury to her shoulder that has affected her bursae in the joint. Which of the following consequences would be most expected from this aspect of her injury?

A. Increased friction on the tendons of the shoulder joint

B. Direct contact between the humerus and scapula bones

C. Loss of connection between the humerus bone and biceps muscle

D. Fusing of the head of the humerus with the glenoid capsule of the scapula

Question 37 (1 point)

Which of the following is the best example of a diarthrodial joint?

A. The interface between the body of the femur and the epiphyseal plates at the ends of the bone

B. The interphalangeal joint between the proximal and middle phalanges of the fingers

C. The suture between the frontal and parietal bones of the skull

D. The syndesmoses between the two sides of the pelvis

Question 38 (1 point)

Bone is connective tissue in which the intercellular matrix has been impregnated with inorganic calcium salts. It has great tensile and compressible strength but is light enough to be moved by coordinate muscle contractions. One third of the dry weight of bone is composed of the following:

A. Bone cells, inorganic salts, and blood vessels

B. Hydroxyapatite, calcium carbonate, and calcium fluoride

C. Bone cells, blood vessels, and nerves

D. Organic matter and inorganic salts

Question 39 (1 point)

While being tackled, a 20-year-old football player put out his hand to break his fall to the ground. Because the intense pain in his wrist did not subside by the end of the game, he was brought to an emergency department, where diagnostic imaging indicated an incomplete tear of the ligament surrounding his wrist joint. At the time of admission, his wrist was swollen and had a severely restricted range of motion. What will his care team most likely tell the player about his diagnosis and treatment?

A. “This strain will likely resolve itself with sufficient rest.”

B. “You've suffered a severe sprain and you might need a cast.”

C. “Your wrist contusion will have to be observed for bleeding under the skin surface.”

D. “It looks like a mild to moderate sprain and you'll need to keep it immobilized for a few weeks.”

Question 40 (1 point)

A 41-year-old woman has been diagnosed as having a loose body of cartilage in her left knee. What data would be most likely to lead clinicians to this conclusion?

A. A visible hematoma is present on the anterior portion of the knee.

B. The woman experiences intermittent, painful locking of her joint.

C. Computed tomography indicates a complete tear of her knee ligament.

D. An X-ray shows that her femoral head and tibia are no longer articulated.

Question 41 (1 point)

A public health nurse is conducting a health promotion teaching session at a seniors' drop-in center. Which of the following teaching points about hip fractures in older adults is most justified?

A. “Current treatment options for hip fractures in older adults mean that surgery is no longer a common necessity.”

B. “Because of their generally higher body mass, men are particularly susceptible to breaking a hip in a fall.”

C. “Most hip fractures are actually a break at the very top of the thigh bone.”

D. “Because bone density is largely determined by your genes, there's little you can do to prevent hip fractures other than avoiding falls.”

Question 42 (1 point)

Which of the following recent admissions to an emergency department is most likely to be diagnosed with a greenstick fracture?

A. A 20-year-old football player who had an opposing player fall laterally on his leg

B. An 8-year-old boy who fell out of a tree and on his arm

C. An 81-year-old woman with a history of osteoporosis who stumbled and fell on her hip

D. A 32-year-old woman who fell awkwardly on her arm while skiing

Question 43 (1 point)

A nurse is providing care for a patient who had a cast applied to her fractured arm 6 hours prior. The patient is now complaining of severe pain that she describes as “even worse than when I broke my arm.” What would be the nurse's best course of action?

A. Administration of analgesics and patient teaching about the normal course of pain after a fracture

B. Teaching the patient simple range of motion exercises to promote circulation and perfusion

C. Taking the patient's temperature due to the possibility of infection

D. Assessment of motor and sensory function with the goal of identifying compartment syndrome

Question 44 (1 point)

Following a motorcycle accident that resulted in bilateral femoral fractures, a 42-year-old male has been receiving skeletal traction for the past 8 days. His care providers would recognize that which of the following risks is paramount?

A. Risk of thromboemboli

B. Risk of compartment syndrome

C. Risk of permanent muscle atrophy

D. Risk of decreased bone density and increased future fracture risk

Question 45 (1 point)

A 56-year-old male is obese and has poorly controlled type 2 diabetes mellitus. The home care nurse who changes the dressing on his chronic foot ulcer 3 times weekly has noted that the patient's bone is now visible in the wound bed. The patient has a fever and has not complained of any notable increase in pain in his foot. Which of the following statements best captures what is likely occurring?

A. The patient is possibly experiencing direct penetration osteomyelitis, with microorganisms entering through his foot wound.

B. Infectious microorganisms in his blood have proliferated in the distal portions of his skeletal system.

C. Vascular insufficiency has contributed to infection in both soft tissue and now his bone.

D. His immunocompromised status associated with diabetes has allowed skin flora to penetrate his foot bone via the surface wound.

Question 46 (1 point)

Which of the following individuals is likely to have the highest risk of developing tuberculosis osteomyelitis?

A. A 55-year-old female who is in renal failure secondary to poorly controlled type 1 diabetes

B. A 79-year-old man who is immunocompromised following a bone marrow transplant

C. A 30-year-old man who has undergone open reduction and internal fixation of his fractured tibia

D. A 68-year-old woman who had a laminectomy 4 days prior for treatment of her chronic back pain

Question 47 (1 point)

A 51-year-old male with a history of hypertension has received a kidney transplant. The patient's physician is explaining some of the consequences of the procedure, including the fact that he will need to be on long-term steroid therapy. Which of the following teaching points should the physician emphasize?

A. “One of the risks that these steroids brings is the possibility that part of a bone might die.”

B. “Steroids will help your body to not reject your new kidney, but they bring a risk of bone infection.”

C. “You're going to have to avoid contact sports because the steroids will make your bones very susceptible to breakage.”

D. “If you notice sudden limb pain after taking your steroid pills, it could be an increase in pressure in the compartment around your muscles.”

Question 48 (1 point)

A 35-year-old woman who has been in recovery from alcoholism for 2 years presents at her primary care physician's office with chronic hip pain. She reports that as part of her commitment to her recovery, she began exercising regularly about a year earlier. After a month or two, her hip began to hurt when she ran on the treadmill. She stretches, has had a physical trainer check her form to ensure that it is correct, and rests adequately between each workout. Six months ago the pain began awakening her at night, and now it is constant. She is not aware of any injury to her hip and has no other outward symptoms. Which of the following is most likely to be the cause of her pain?

A. Hematogenous osteomyelitis

B. Osteomyelitis with vascular insufficiency

C. Tuberculosis of the bone

D. Osteonecrosis

Question 49 (1 point)

A 13-year-old girl and her father come to the local health clinic hoping to see an orthopedic physician about the girl's stiff and warm knee. The father reports that she hurt it sliding into a base during a softball game and the daughter concurs, but with further discussion it becomes clear that the slide made an existing pain worse. Her knee had been stiff, warm, and shiny and had been keeping her awake at night for a week or so before the game. Which of the following might be the cause of the girl's symptoms?

A. Osteosarcoma

B. Osteoma

C. Chondroma

D. Osteochondroma

Question 1 (1 point)

A 31-year-old patient with a diagnosis of end-stage liver failure has been admitted to the intensive care unit of a hospital. Arterial blood gas sampling indicates that the man has an acid-base imbalance. Which of the following situations is most likely to result in an inappropriate pH?

a. Conservation or formation of new HCO3– by the kidneys

b. Low albumin and plasma globulin levels

c.

d. Renal excretion of HCO3– in the presence of excess base

Question 2 (1 point)

A 77-year-old female with a diagnosis of chronic obstructive pulmonary disease is experiencing impaired gas exchange and CO2 retention, despite a rapid respiratory rate. Which of the following phenomena would her care team most realistically anticipate?

a. Arterial blood gas sampling is likely to indicate a pH in the range of 7.45 to 7.55.

b. Her kidneys are likely to reabsorb H+ and secrete HCO3–.

c. Her body may be producing excess metabolic CO2.

d. Her kidneys will adapt with an increase in plasma HCO3– and her pH will increase.

Question 3 (1 point)

Following several days in an acidotic state, a hospital patient has returned to the desired pH. Which of the following processes could have contributed to the resolution of the patient's health problem?

a. Exchange of Na+ and H+ ions

b. Selective renal secretion and reabsorption of CO2

c. Phosphate and ammonia buffer systems in the renal tubules

d. Excretion of HCO3– by the kidneys

Question 4 (1 point)

A male patient with a history of heavy alcohol use has been admitted to the hospital for malnutrition and suspected pancreatitis. The patient's diagnostic workup suggests alcoholic ketoacidosis is a component of his current health problems. He is somewhat familiar with the effect that drinking has had on his nutrition and pancreas, but is wholly unfamiliar with the significance of acid-base balance. How best could his care provider explain the concept to him?

a. “The chemical processes that take place throughout your body are thrown off very easily when your body is too acidic or not acidic enough.”

b. “The many chemical reactions that take place in your body depend on your body fluids being slightly acidic.”

c. “The healthy function of your kidneys and your lungs requires a specific level of pH in your body.”

d. “Your body is highly dependent on what food and fluid you consume to keep itself at a functioning level of slight nonacidity.”

Question 5 (1 point)

A patient with poorly controlled diabetes mellitus presents to the emergency department with suspected ketoacidosis. Which of the following diagnostic results would be most likely to confirm this diagnosis?

a. Low O2 levels, increased anion gap, base excess

b. High ammonia levels, decreased anion gap, high potassium

c. Increased CO2, increased anion gap, base deficit

d. Decreased CO2, decreased anion gap

Question 6 (1 point)

A hospital patient's arterial blood gases indicate normal levels of oxygen and increased carbon dioxide. The patient's respiratory rate is 12 breaths per minute (normal is 14 to 20 breaths per minute), with all other vital signs within normal range. While not evident from assessment and diagnostics, the patient's kidneys are minimizing both H+ excretion and HCO3– reabsorption. What is this patient's most likely diagnosis?

a. Respiratory alkalosis

b. Metabolic acidosis

c. Respiratory acidosis

d. Metabolic alkalosis

Question 7 (1 point)

Following several weeks of rigid adherence to a carbohydrate-free diet, a 22-year-old female college student has presented to her campus medical center complaining of increasing lethargy and occasional confusion. A subsequent diagnostic workup has identified that she is in a state of ketoacidosis. The staff of the medical center would think which of the following phenomena is most likely occurring?

a. High fat, low carbohydrate dietary intake is associated with respiratory acidosis.

b. In the absence of carbohydrate energy sources, her body is metabolizing fat and releasing ketoacids.

c. Metabolism of dietary fats without the buffer action of carbohydrates results in the catabolism of ketoacids.

d. Decreased carbohydrate intake induces insulin deficiency and consequent ketoacidosis.

Question 8 (1 point)

A 55-year-old woman has presented to the emergency department following a panic attack. Her blood pressure, respiratory rate, and heart rate are all highly elevated, while her temperature and oxygen saturation are within normal ranges. What is the woman's body most likely doing to address the changes in pH associated with her situation?

a. Her kidneys will limit the amount of bicarbonate that they reabsorb.

b. She will be retaining Cl– ions in an effort to lower pH.

c. Her respiratory center will attempt to lower her CO2 levels.

Question 9 (1 point)

A nurse is providing care for a patient who has been diagnosed with metabolic alkalosis after several days of antacid use. Which of the following treatments should the nurse prepare to give?

a. Intravenous or oral administration of free hydrogen ions

b. Intravenous administration of a KCl solution

c. Administration of oxygen and NaHCO3 solution

d. Supplementary oxygen and possible mechanical ventilation

Question 10 (1 point)

A patient who has just had her first postoperative dinner out to celebrate her recovery from an intestinal bypass is brought to the emergency department by her spouse. He reports that the patient seems disoriented and is slurring her words. The patient did not have any alcohol with her pasta dinner. Which of the following might be the cause of her symptoms?

a. Ketoacidosis

b. Lactic acidosis

c. Hypercapnia

d. Hypothalemia

Question 11 (1 point)

A 14-year-old boy who appears to be intoxicated is brought to the emergency department by ambulance. The EMTs report that the boy has denied consuming anything out of the ordinary, but an open antifreeze container was found in the boy's room. Which of the following is likely to be used to treat the patient's symptoms?

a. Gastric lavage

b. Syrup of ipecac

c. Fomepizole

d. Sodium bicarbonate

Question 12 (1 point)

A hospital laboratory technician performing routine blood analysis as part of an inpatient's assessment is examining the sample in a test tube following processing in a centrifuge and the addition of an anticoagulant. Which of the following observations would the technician most likely interpret as an anomaly?

a. The bottom layer of blood in the tube accounts for about one third of the total volume.

b. The middle layer of cells appears white to gray in color.

c. The top layer of cells is too thin to visualize without microscopy.

d. The yellowish fluid on the top of the sample appears to constitute around one half of the total volume.

Question 13 (1 point)

A student makes the statement to a colleague, “Blood plasma is essentially just a carrier for the formed cells, like red blood cells and white blood cells.” What would be the most accurate response to this statement?

a. “That's not really true. Plasma is crucial in the immune and inflammatory responses.”

b. “Actually, plasma plays significant roles in nutrient and waste transport and immunity.”

c. “Not really. Plasma also contributes to the processes of protein synthesis and hematopoiesis.”

d. “Actually, plasma is integral to the proper function of the liver and the maintenance of acid-base balance.”

Question 14 (1 point)

The blood work of a 44-year-old male patient with a diagnosis of liver disease secondary to alcohol abuse indicates low levels of albumin. Which of the following phenomena would a clinician be most justified in anticipating?

a. Impaired immune function

b. Acid-base imbalances

c. Impaired thermoregulation

d. Fluid imbalances

Question 15 (1 point)

Which of the following statements best conveys a characteristic of red blood cells?

a. They lack organelles and soluble enzymes.

b. They contribute to the maintenance of blood pH.

c. They help maintain the body's fluid balance.

d. They are self-replicating.

Question 16 (1 point)

A 29-year-old construction worker got a sliver under his fingernail 4 days ago. The affected finger is now reddened, painful, swollen, and warm to the touch. Which of the following hematological processes is most likely occurring in response to the infection?

a. Proliferation of immature neutrophils

b. High circulatory levels of myeloblasts

c. Increased segmented neutrophil production

d. Phagocytosis by myelocytes

Question 17 (1 point)

A physician is explaining to a 40-year-old male patient the damage that Mycobacterium tuberculosis could do to lung tissue. Which of the following phenomena would underlie the physician's explanation?

a. Tissue destruction results from neutrophil deactivation.

b. Nonspecific macrophage activity leads to pulmonary tissue destruction and resulting hemoptysis.

c. Macrophages are unable to digest the bacteria, resulting in immune granulomas.

d. Neutrophils are ineffective against the Mycobacterium tuberculosis antigens.

Question 18 (1 point)

A couple who are expecting their first child have been advised by friends to consider harvesting umbilical cord blood in order to have a future source of stem cells. The couple have approached their caregiver with this request and are seeking clarification of exactly why stem cells are valuable and what they might expect to gain from harvesting them. How can their caregiver best respond to the couple's inquiry?

a. “Stem cells can help correct autoimmune diseases and some congenital defects.”

b. “Stem cells can be used to regenerate damaged organs should the need ever arise.”

c. “Stem cells can be used as a source of reserve cells for the entire blood production system.”

d. “Stem cells can help treat some cancers and anemias, but they must come from your child himself or herself.”

Question 19 (1 point)

A nurse is providing care for several patients on an acute medical unit of a hospital. Which of the following patients would be most likely to benefit from hematopoietic growth factors?

a. A 51-year-old female patient with liver failure secondary to hepatitis

b. A 61-year-old female patient with end-stage renal cancer

c. A 55-year-old obese male patient with peripheral neuropathy secondary to diabetes

d. A 44-year-old man with a newly diagnosed brain tumor

Question 20 (1 point)

A geriatrician is following a number of patients on a subacute geriatric medical unit, some of whom require diagnostic blood work. For which of the following patients would he be most likely to order an erythrocyte sedimentation rate (ESR) screening test?

a. A man with a diagnosis of Alzheimer disease and depression

b. A man with orthostatic hypotension and syncopal episodes

c. A woman with irritable bowel syndrome and congestive heart failure

d. A man with rheumatoid arthritis and pneumonia

Question 21 (1 point)

Which of the following statements best captures an aspect of the process of hematopoiesis?

a. Colony-stimulating factors (CSFs) produce cytokines that activate progenitor cells.

b. Progenitor cells differentiate into precursor cells.

c. Various subtypes of pluripotent stem cells eventually differentiate into the cellular components of blood.

d. Self-replicating precursor cells differentiate into specific CSFs.

Question 22 (1 point)pg261

An oncologist has ordered a bone marrow biopsy for a patient and is explaining the reasons for the test and what the patient might expect during the test. Which of the following explanations best reflects an aspect of a bone marrow biopsy?

a. “I'll take a sample of your bone marrow from your breastbone or your spine.”

b. “I will be harvesting a sample of your stem cells for examination.”

c. “I need a more accurate count of your blood components than normal blood work is able to provide.”

d. “I need to get samples of the types of blood cells that your body is producing.”

Question 23 (1 point)

A nurse practitioner is providing care for a patient with low levels of the plasma protein gamma globulin. The nurse would recognize that the patient is at risk for developing which of the following health problems?

a. Jaundice

b. Anemia

c. Infections

d. Blood clots

Question 24 (1 point)

A hospital laboratory technologist is analyzing the complete blood count (CBC) of a hospital patient. Which of the following statements best reflects an aspect of the platelets that would constitute part of the CBC?

a. Platelets originate with granulocyte colony-forming units.

b. The lifespan of a platelet is typically around 1 week.

c. The -granules of platelets contribute primarily to vasoconstriction.

d. New platelets are released from the bone marrow into circulation. Spleen

Question 25 (1 point)

A 71-year-old male patient with a history of myocardial infarction and peripheral vascular disease has been advised by his family physician to begin taking 81 mg aspirin once daily. Which of the following statements best captures an aspect of the underlying rationale for the physician's suggestion?

a. Platelet aggregation can be precluded through inhibition of prostaglandin production by aspirin.

b. Aspirin helps to inhibit adenosine disphosphate (ADP) action and minimizes platelet plug formation.

c. Aspirin can reduce unwanted platelet adhesion by inhibiting thromboxane A2 (TXA2) synthesis.

d. Aspirin inhibits the conversion of fibrinogen into fibrin and consequent platelet plug formation.

Question 26 (1 point)

A hospital patient is receiving an intravenous infusion of heparin for treatment of a pulmonary embolus. Which of the following phenomena is most likely occurring, resulting in the drug's therapeutic effect?

a. Inhibition of vitamin K synthesis in the liver

b. Suppression of fibrin formation

c. Deactivation of the intrinsic clotting pathway

d. Inhibition of ADP-induced platelet aggregation

Question 27 (1 point)

In which of the following patients would diagnostic investigations be least likely to reveal increased thrombopoietin production?

a. An 81-year-old woman with diagnoses of rheumatoid arthritis and failure to thrive

b. A 55-year-old man with dehydration secondary to Crohn disease

c. A 66-year-old woman with a diagnosis of lung cancer with bone metastases

d. A 21-year-old woman awaiting bone marrow transplant for myelogenous leukemia

Question 28 (1 point)

A 44-year-old white woman is being treated in an airport infirmary after she developed a painful, swollen leg during a transatlantic flight in economy class. The woman is suspected of having deep vein thrombosis (DVT) and is questioning the paramedics about why this might be the case, given that she has twice previously had similar experiences. Which of the following teaching points would be most appropriate?

a. “A lot of white people have a genetic mutation that causes platelets to stick to their blood vessel walls.”

b. “There is a genetic disorder that causes many whites to form more clots in their blood vessels.”

c. “A lot of whites have an inherited inability to dissolve clots that form in their bodies.”

d. “Your doctor might be able to tell you if you've inherited a predisposition to bleeding in your veins.”

Question 29 (1 point)

A medical student is familiarizing herself with the overnight admissions to an acute medical unit of a university hospital. Which of the following patients would the student recognize as being least likely to have a diagnosis of antiphospholipid syndrome in his or her medical history?

a. A 66-year-old obese male with left-sided hemiplegia secondary to a cerebrovascular accident

b. A 90-year-old female resident of a long-term care facility who has been experiencing transient ischemic attacks

c. A 30-year-old female with a diagnosis of left leg DVT and a pulmonary embolism

d. A 21-year-old male with a diagnosis of cellulitis and suspected endocarditis secondary to intravenous drug use

Question 30 (1 point)

A 36-year-old woman with a diagnosis of antiphospholipid syndrome is receiving a scheduled checkup from her nurse practitioner. Which of the following teaching points would the nurse most likely prioritize?

a. “It's important for you to do regular physical activity and maintain a healthy body weight.”

b. “Good nutrition and blood sugar control are important in your case.”

c. “You'll need to avoid taking nonsteroidal anti-inflammatory drugs when you have menstrual cramps.”

d. “We need to ensure your birth control pills don't contain estrogen.”

Question 31 (1 point)

A surgeon is explaining to the parents of a 6-year-old boy the rationale for the suggestion of removing the boy's spleen. Which of the following teaching points would be most accurate?

a. “We believe that your son's spleen is causing the destruction of many of his blood platelets, putting him at a bleeding risk.”

b. “Your son's spleen is inappropriately filtering out the platelets from his blood and keeping them from normal circulation.”

c. “Your son's spleen is holding on to too many of his platelets, so they're not available for clotting.”

d. “We think that his spleen is inhibiting the production of platelets by his bone marrow.”

Question 32 (1 point)

Following a course of measles, a 5-year-old girl developed scattered bruising over numerous body surfaces and was diagnosed with immune thrombocytopenic purpura (ITP). As part of her diagnostic workup, blood work was performed. Which of the following results is most likely to be considered unexpected by the health care team?

a. Increased thrombopoietin levels

b. Decreased platelet count

c. Normal vitamin K levels

d. Normal leukocyte levels

Question 33 (1 point)

Two nursing students are attempting to differentiate between the presentations of ITP and thrombotic thrombocytopenic purpura (TTP). Which of the students' following statements best captures an aspect of the two health problems?

a. “Both diseases can result from inadequate production of thrombopoietin by megakaryocytes.

b. “ITP can be either inherited or acquired, and if it's acquired, it involves an enzyme deficiency.”

c. “Both of them involve low platelet counts, but in TTP there can be more, not less, hemostasis.”

d. “TTP can be treated with plasmapheresis, but ITP is best addressed with transfusion of fresh frozen plasma.”

Question 34 (1 point)

Having misinterpreted her physician's instructions, a 69-year-old woman with a history of peripheral artery disease has been taking two 325 mg tablets of aspirin daily. How has this most likely affected her hemostatic status?

a. Irreversible acetylation of platelet cyclooxygenase activity has occurred.

b. The patient's prostaglandin TXA2 levels are abnormally high.

c. She is at risk of developing secondary ITP.

d. The binding of an antibody to platelet factor 4 produces immune complexes.

Question 35 (1 point)

Which of the following teaching points would be most appropriate with a patient who has a recent diagnosis of von Willebrand disease?

a. “It's important that you avoid trauma.”

b. “Your disease affects your platelet function rather than clot formation.”

c. “Make sure that you avoid taking aspirin.”

d. “Clotting factor VIII can help your body compensate for the difficulty in clotting.”

Question 36 (1 point)

A 30-year-old woman who has given birth 12 hours prior is displaying signs and symptoms of disseminated intravascular coagulation (DIC). The patient's husband is confused about why a disease of coagulation can result in bleeding. Which of the nurse's following statements best characterizes DIC?

a. “So much clotting takes place that there are no available clotting components left, and bleeding ensues.”

b. “Massive clotting causes irritation, friction, and bleeding in the small blood vessels.”

c. “Excessive activation of clotting causes an overload of vital organs, resulting in bleeding.”

d. “These same hormones and bacteria that cause clotting also cause bleeding.”

Question 37 (1 point)

A 44-year-old female patient presents to the emergency department with abnormal bleeding and abdominal pain that is later attributed to gallbladder disease. Which of the following diagnoses would the medical team be most justified in suspecting as a cause of the patient's bleeding?

a. Calcium deficiency

b. Vitamin K deficiency

c. Hemophilia B

d. Idiopathic ITP

Question 1 (1 point)
An infant who is 4 days postpartum has been diagnosed with a single-gene disorder. The parents of the child have a number of questions about the etiology of the health problem, which the physician is attempting to address in detail. Which of the following teaching points most accurately captures an aspect of single-gene congenital disorders?

a. Affected genes are present on autosomal chromosomes rather than sex chromosomes.

b. The majority of single-gene disorders manifest near the time of puberty.

c. A particular defect can be caused by mutations at one of several different loci.

d. Single-gene disorders are associated with existing rather than new mutations.

c. A particular defect can be caused by mutations at one of several different loci.

Question 2 (1 point)
A male patient of a nurse practitioner has an autosomal dominant disorder. The patient and his partner are considering starting a family. Which of the patient's following statements indicates the patient has an adequate understanding of the genetic basis of this health problem?

a. “I know there's no way of accurately determining the chance that my child will inherit the disease.”

b. “My children who don't have the disease still run the risk of passing it on to their children.”

c. “I know that new genetic mutations won't occur between generations.”

d. “I know that a single mutant allele is to blame for the health problem.”

Question 3 (1 point)
A 6-year-old girl with a diagnosis of Marfan syndrome is being assessed at a community health clinic. Which of the following assessments would be the health care professional's lowest priority?

a. A test of the child's visual acuity

b. A musculoskeletal assessment

c. Tests of kidney function

d. Cardiovascular assessment

Question 4 (1 point)
A new older female patient at a long-term care facility has a diagnosis of type 1 neurofibromatosis (NF-1). As part of the intake assessment protocol for the facility, the clinical educator is teaching the care staff about the diagnosis. Which of the following statements most accurately conveys an aspect of neurofibromatosis?

a. “The neurofibroma lesions are unsightly for the patient, but they are not painful.”

b. “Her diagnosis puts her at higher risk of developing a malignant neoplasm.”

c. “She is living with an example of an autosomal recessive disorder.”

d. “The patient is likely to be photosensitive as a result of the disease.”

Question 5 (1 point)
As part of an orientation to a genetic counseling practice, a group of medical students is differentiating between autosomal recessive disorders and autosomal dominant disorders. Which of the following statements is true of autosomal recessive disorders?

a. They can manifest when present in one or both gene pairs.

b. There is a one in two chance of an affected child in each pregnancy with an affected mother.

c. They tend to have a more uniform symptomatology than autosomal dominant disorders.

d. The associated disorders are usually attributable to abnormalities in structural proteins.

Question 6 (1 point)
A 6-year-old boy who has mental retardation secondary to fragile X syndrome has been admitted to a hospital with mitral valve prolapse. A health care worker who is providing care for the family should have which of the following statements as part of her knowledge base about the disease?

a. The common pattern of inheritance is an affected mother who carries one normal and one mutant allele.

b. The boy's mother had a 100% chance of transmitting the defective gene to her son.

c. Genes of the boy's Y chromosome, in addition to the X chromosome, can be affected.

d. The boy will pass the gene to all of his future daughters, who will become carriers.

Question 7 (1 point)
Two health care workers are comparing the etiology and incidence of multifactorial inheritance disorders and single-gene disorders. Which of the following statements best captures the relationship between the two types of genetic disorders?

a. “Multifactorial disorders and single-gene disorders can both be predicted quite accurately.”

b. “Multifactorial disorders are more likely to involve multiple organs.”

c. “Multifactorial disorders manifest themselves at birth.”

d. “A couple with a child with a multifactorial disorder has a higher risk of having another with the same disorder.”

Question 8 (1 point)
A physician is working with a 30-year-old male patient with Down syndrome who has been admitted to a hospital with a diagnosis of acute leukemia. Which of the following physical assessment findings would the physician be more likely to find in an examination of this patient than in patients without Down syndrome?

a. Hepatomegaly

b. Decreased visual acuity

c. Congenital heart defects

d. Diabetes mellitus

Question 9 (1 point)
An 11-year-old girl is suspected of having Turner syndrome. Which of the following diagnostic tests would be the most useful component of screening to confirm or rule out the diagnosis?

a. Computed tomography of the head

b. Echocardiogram

c. Bone scan

d. Liver biopsy

Question 10 (1 point)
As part of her prenatal care, a pregnant woman and her partner are being taught by a community health nurse. Which of the following points about the teratogenic effects of different substances should the nurse include in his teaching?

a. “Your developing baby was most vulnerable during the first 2 months of your pregnancy.”

b. “You need to be very careful with vitamin D and its derivatives.”

c. “Keep in mind that a high percentage of genetic abnormalities are attributable to drug origins.”

d. “Your best option is to avoid using any drugs during your pregnancy.”

Question 11 (1 point)
Which of the following pregnant women has most likely encountered the greatest increase in the risk that her child will have a fetal anomaly?

a. A woman with diagnoses of syphilis and cirrhosis of the liver

b. A woman who has herpes simplex and recently recovered from endocarditis

c. A woman with chronic obstructive pulmonary syndrome and tuberculosis

d. A woman with diagnoses of insulin-dependent diabetes mellitus and peripheral neuropathy

Question 12 (1 point)
A couple who are pregnant with their first child have made an appointment with a clinical geneticist to discuss prenatal screening. The man states that they “just want to make sure that there is nothing wrong with our baby.” How could the clinician best respond to this statement?

a. “We can't rule out all abnormalities, but a routine fetal tissue biopsy can yield useful information.”

b. “Testing the umbilical blood and performing amniocentesis can give us some information, but not a guarantee.”

c. “Prenatal screening is not usually necessary unless you are among a high-risk group.”

d. “You need to be aware that if abnormalities are detected, termination is normally required.”

Question 13 (1 point)
A clinician who works on a cardiac care unit of a hospital is providing care for a number of patients. Which patient most likely has a genetic disorder arising from inheritance of a single gene?

a. A short, thin, 56-year-old woman with hypertension

b. A tall, thin, myopic, 28-year-old woman with mitral valve prolapse

c. An overweight, middle-aged male smoker with coronary artery disease

d. A thin, middle-aged nonsmoking man with a repaired atrial septal defect

Question 14 (1 point)
A woman gives birth to a small infant with a malformed skull. The infant grows abnormally slowly and shows signs of substantial cognitive and intellectual deficits. The child also has facial abnormalities that become more striking as it develops. What might you expect to find in the mother's pregnancy history?

a. Folic acid deficiency

b. Chronic alcohol use

c. Chronic cocaine use

d. Active herpes simplex infection

Question 15 (1 point)
Which of the following situations related to the transition from fetal to perinatal circulation would be most likely to necessitate medical intervention?

a. Pressure in the pulmonary circulation and the right side of the infant's heart fall markedly.

b. Alveolar oxygen tension increases, causing reversal of pulmonary vasoconstriction of the fetal arteries.

c. Systemic vascular resistance and left ventricular pressure are both increasing.

d. Pulmonary vascular resistance, related to muscle regression in the pulmonary arteries, rises over the course of the infant's first week.

Question 16 (1 point)
A nurse who works on a pediatric cardiology unit of a hospital is caring for an infant with a diagnosis of tetralogy of Fallot. Which of the following problems would the nurse be most justified in anticipating?

a. There is a break in the normal wall between the right and left atria that results in compromised oxygenation.

b. The aortic valve is stenotic, resulting in increased afterload.

c. Blood outflow into the pulmonary circulation is restricted by pulmonic valve stenosis.

d. The right ventricle is atrophic as a consequence of impaired myocardial blood supply.

Question 17 (1 point)
A female neonate has been in respiratory distress since delivery and is unresponsive to oxygen therapy. Endoscopy has confirmed a diagnosis of esophageal atresia and tracheoesophageal fistula (EA/TEF). Which of the following explanations should the care team provide to the infant's parents?

a. “We will have to perform surgery to correct the hole in her throat to make sure that she is able to swallow and breathe normally.”

b. “This problem will require respiratory therapy and supplementary feeding, but it will likely resolve itself over time.”

c. “The biggest risk that will face your daughter until this is fixed is the danger of malnutrition and dehydration.”

d. “The priority in our immediate treatment prior to her surgery will be pain management, as the contents of her stomach can burn her lungs.”