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Test Bank for Pathophysiology: Concepts of Altered Health States, 8th Edition

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    Name: __________________________ Date: _____________ 1. A community health nurse is teaching a group of recent graduates about the large variety of factors that influence an individual's health or lack thereof. The nurse is referring to the framework of determinants of health in one client's situation as a teaching example. Which of the following aspects of this client's situation most likely exists outside the framework of determinants of health? A) The client has had difficulty finding a family doctor. B) The client has a family history of cardiovascular disease. C) The client has a graduate degree from a renowned university. D) The client lives in an affluent, clean, suburban community. 2. A physician is providing care for a number of patients on a medical unit of a large university hospital. The physician is discussing with a colleague the differentiation between diseases that are caused by abnormal molecules and molecules that cause disease. Which of the following patients most clearly demonstrates the consequences of molecules that cause disease? A) A 31-year-old woman with sickle cell disease who is receiving a transfusion of packed red blood cells B) A 91-year-old woman who has experienced an ischemic stroke resulting from familial hypercholesterolemia C) A 19-year-old man with exacerbation of his cystic fibrosis requiring oxygen therapy and chest physiotherapy D) A 30-year-old homeless man who has pneumocystis carinii pneumonia (PCP) and is HIV positive 3. A member of the health-care team is researching the etiology and pathogenesis of a number of clients who are under her care in a hospital context. Which of the following aspects of clients' situations best characterizes pathogenesis rather than etiology? A) A client who has been exposed to the mycobacterium tuberculosis bacterium B) A client who has increasing serum ammonia levels due to liver cirrhosis C) A client who was admitted with the effects of methyl alcohol poisoning D) A client with multiple skeletal injuries secondary to a motor vehicle accident 4. A 77-year-old man is a hospital inpatient admitted for exacerbation of his chronic obstructive pulmonary disease (COPD), and a respiratory therapist (RT) is assessing the client for the first time. Which of the following aspects of the patient's current state of health would be best characterized as a symptom rather than a sign? A) The patient's oxygen saturation is 83% by pulse oximetry. B) The patient notes that he has increased work of breathing when lying supine. C) The RT hears diminished breath sounds to the patient's lower lung fields bilaterally. D) The patient's respiratory rate is 31 breaths per minute. Page 1

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    5. The laboratory technologists are discussing a new blood test that helps establish a differential diagnosis between shortness of breath with a cardiac etiology and shortness of breath with a respiratory/pulmonary etiology. A positive result is purported to indicate a cardiac etiology. The marketers of the test report that 99.8% of patients who have confirmed cardiac etiologies test positive in the test. However, 1.3 percent of patients who do not have cardiac etiologies for their shortness of breath also test positive. Which of the following statements best characterizes this blood test? A) Low validity, high reliability B) High sensitivity, low specificity C) High specificity, low reliability D) High sensitivity, low reliability 6. As part of a screening program for prostate cancer, men at a senior citizens' centre are having their blood levels of prostate-specific antigen (PSA) measured. Which of the following statements would best characterize high positive predictive value but low negative predictive value for this screening test? A) All of the men who had high PSA levels developed prostate cancer; several men who had low PSA levels also developed prostate cancer. B) All of the men who had low PSA levels were cancer free; several men who had high levels also remained free of prostate cancer. C) Men who had low PSA levels also displayed false-positive results for prostate cancer; men with high levels were often falsely diagnosed with prostate cancer. D) The test displayed low sensitivity but high specificity. 7. A particular disease has a debilitating effect on the ability of sufferers to perform their activities of daily living and is a significant cause of decreased quality of life. However, few people die as a result of the disease's direct effects. There are hundreds of thousands of Canadians living with the disease but relatively few new cases in recent years. Which of the following statements best conveys an accurate epidemiological characterization of the disease? A) Low mortality, high morbidity, low prevalence, high incidence B) Low mortality, high morbidity, high incidence, low prevalence C) High mortality, low morbidity, high incidence, low prevalence D) High morbidity, low mortality, high prevalence, low incidence Page 2

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    8. An epidemiologist is conducting a program of research aimed at identifying factors associated with incidence and prevalence of congenital cardiac defects in infants. The researcher has recruited a large number of mothers whose infants were born with cardiac defects, as well as mothers whose infants were born with healthy hearts. The researcher is comparing the nutritional habits of all the mothers while their babies were in utero. Which of the following types of studies is the epidemiologist most likely conducting? A) Cohort study B) Cross-sectional study C) Case-control study D) Risk-factor study 9. A multidisciplinary health-care team operates a program aimed at the prevention, identification, and treatment of diabetes in a rural community. Which of the following aspects of the program would be most likely to be classified as secondary prevention? A) Regularly scheduled wound-dressing changes for clients who have foot ulcers secondary to peripheral neuropathy and impaired wound healing B) Teaching schoolchildren how a nutritious, traditional diet can lessen their chances of developing adult-onset diabetes C) Staffing a booth where community residents who are attending a baseball tournament can have their blood-glucose levels checked D) Administering oral antihyperglycemic medications to clients who have a diagnosis of diabetes 10. An occupational therapist conducts a group therapy program called MindWorks with older adults who have diagnoses of dementia and Alzheimer disease. The goal of the group is to slow the cognitive decline of clients by engaging them in regular, organized mental activity, such as reading maps and solving puzzles. How would the program most likely be characterized? A) Primary prevention B) Secondary prevention C) Tertiary prevention D) Prognosis enhancement 11. The clinical educator of a hospital medical unit has the mandate of establishing evidence-based practice guidelines for the nursing care on the unit. Which of the following statements most accurately captures a guiding principle of the nurse's task? A) Evidence-based practice guidelines will be rooted in research rather than nurses' subjective practice preferences and experiences. B) Guidelines are synonymous with systematic research reviews. C) The need for continuity and standardization of guidelines will mean that they will be fixed rather than changeable. D) The guidelines will combine individual expertise with external systematic evidence. Page 3

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    12. An understanding of pathophysiology is crucial for providing adequate care for your future patients. To best understand the study of pathophysiology, you must have a clear understanding of the term itself. Of the definitions below, which one best describes the term pathophysiology? A) The physiology of altered health B) Any deviation from or interruption of the normal structure or function of any part, organ, or system of the body C) Causes of disease D) Changes in structure or form that is characteristic of a disease 13. A physician's assistant (PA) is examining a 21-year-old college student that is exhibiting the classic symptoms of schizophrenia. In the course of her evaluation the PA begins developing a treatment strategy based on what she knows about the disease, available therapies, and medications. She also makes the patient aware of the consequences of not following the treatment regimen. To accomplish this, what aspect of the disease is the PA using? A) Etiology B) Causation C) Natural history D) Morbidity statistics 14. While you are working on a case, your patient dies, and you are charged with filling out the death certificate. In performing this task, you are required to record age, sex, cause of death, and socieoeconomic status, among other factors. What is the purpose of reporting these statistics? A) These statistics are recorded so pharmaceutical companies may compile the data to determine future need. B) These statistics are useful for the government to update tax records. C) These statistics are useful in terms of anticipating health-care needs, planning public-education programs, directing health research efforts, and allocating health-care dollars. D) These statistics are useful in ranking the efficiency of hospitals and clinics. 15. The Framingham Heart Study is one of the most well-known studies carried out to date. Clinicians use the information obtained from the study to predict outcomes of patients with coronary disease. What type of study was this? A) Repetition B) Double-blind placebo C) Case-control D) Cohort Page 4

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    16. Your patient has already suffered a heart attack and is placed on  -blockers to reduce the workload on the heart, as well as a statin drug and a low-fat diet to lower cholesterol. This treatment plan is based on multiple levels; one is diet and statin therapy, and the other is the use of  -blockers. Assign the level of prevention each of these therapies can be classified as. A) Primary, secondary B) Secondary, tertiary C) Primary, tertiary D) Secondary, primary Page 5

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    Answer Key 1. C 2. D 3. B 4. B 5. B 6. A 7. D 8. C 9. C 10. C 11. D 12. A 13. C 14. C 15. D 16. C Page 6

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    Name: __________________________ Date: _____________ 1. A woman has recently determined that she is pregnant, and her clinician believes that conception occurred around 8 weeks prior. Since the embryo is in the third stage of embryonic development, which of the following events and processes in growth and development would be expected to be taking place? A) Transition from a morula to a blastocyte B) Ossification of the skeleton and acceleration of body length C) Rapid eye movement and early support of respiration D) Formation of upper limbs and opening of the eyes 2. A midwife who is providing care for a woman during her first pregnancy is assessing for intrauterine growth retardation (IUGR) during an early prenatal checkup. Which of the following questions best addresses the risks for IUGR? A) “What does your typical diet look like over the course of a day?” B) “What is the highest level of education that you've finished?” C) “Are there many people in your life that you can count on for help and support?” D) “How would you describe your mood and your outlook on life since you've been pregnant?” 3. Which of the following assessment findings of a male infant 14 hours postpartum would be considered abnormal and would require further assessment and possible intervention? A) The baby's first stool appears to contain blood. B) The child is unable to breathe through his mouth. C) The baby's skin has a yellowish-orange hue. D) The child's suck is weak when placed at his mother's breast. 4. A nurse is performing a 5-minute Apgar score on a newborn female. Which of the following characteristics of the infant's current condition would not be reflected in the child's Apgar score? A) The baby's heart rate is 122 beats per minute. B) The infant is crying. C) The child's temperature is 35.0°C (95°F) by axilla. D) The infant's skin is pink in tone. Page 1

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    5. The first-time parents of an infant girl 2 days postpartum are distressed at the jaundiced appearance of her skin and are eager for both an explanation and a treatment for the problem. Which of the following responses by their physician is most accurate? A) “Your daughter's young liver is unable to get rid of the waste products from old red blood cells.” B) “Because your daughter's kidneys are so small, they have a hard time getting rid of the wastes that are always accumulating in her blood.” C) “Nearly half of all infants have this problem, and while it is distressing to look at, it is largely harmless and will resolve in time.” D) “This is a sign that your baby needs more milk than she is currently getting, and increased breastfeeding will act to flush these pigments out of her system.” 6. Which of the following infants most likely requires medical intervention? A) A 2-day-old baby boy who has caput succedaneum B) An infant 4 hours postpartum who has visible coning of his head following his vaginal delivery C) A girl 3 days postpartum with noticeable unilateral cephalhematoma D) A male infant whose vertex delivery resulted in a brachial plexus injury 7. A nurse who works in a neonatal intensive care unit is providing care for an infant who was born at 26 weeks' gestation. Which of the following assessments should be the nurse's highest priority? A) Regular measurement of the baby's blood pressure and temperature. B) Assessment of the infant's respiratory status and oxygen saturation levels. C) Assessment of the child's motor skills and limb mobility range of motion. D) Assessment of the child's neurological status. 8. A premature infant who is receiving care on a neonatal intensive care unit has just been identified as having necrotizing enterocolitis (NEC). During the differential diagnosis, which of the following possible contributing factors would his care providers be most likely to rule out first? A) Impaired immune function secondary to the child's premature status B) Bowel obstruction following the introduction of enteral feeding C) Infectious microorganisms D) Intestinal ischemia due to circulatory priority of the heart and brain Page 2

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    9. The exasperated parents of a 4-month-old infant with colic have asked their primary care physician what they can do to alleviate their child's persistent crying. What should the physician tell the parents? A) “The exact cause of colic hasn't really been identified, which makes it hard to treat.” B) “Reducing the amount of commercial formula and increasing breastfeeding is likely to help.” C) “Colic is a result of excess gas, and the antiflatulent medication I'll prescribe will probably help.” D) “Even though it's hard to live with, colic is a normal part of infancy and will resolve with time.” 10. During a prenatal education class, a participant has related a story about how her friend's infant died of sudden infant death syndrome (SIDS). What can the educator tell the group about how they can prevent SIDS when they have their babies? A) “The best sleeping position for your baby is on his or her abdomen.” B) “Children are at particular risk of SIDS when they have a cold or flu, so these times require extra vigilance.” C) “Using drugs during pregnancy has been shown to have no association with SIDS after birth, so mothers should not concern themselves with their medications.” D) “It's important if anyone in your home smokes to make sure he or she only does it outside.” E) “The exact cause of SIDS still isn't known, so there's little that you can do to prevent this tragic event.” 11. What topic should health-promotion initiatives emphasize if the target audience is parents of preschoolers and the goal is to minimize mortality? A) Handwashing as an infection-control measure B) Accident and injury prevention C) Identifying signs of child abuse and neglect D) The importance of good nutrition 12. A 13-year-old boy has a body mass index that places him in the ninety-sixth percentile for his age and gender. Which of the following health problems does his weight predispose him to? A) Scoliosis B) Respiratory infections C) Gastrointestinal disorders D) Type 2 diabetes Page 3

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    13. A 14-year-old boy has experienced a pronounced growth spurt over the last several months. Which of the following components of his endocrine system are most likely responsible for this phenomenon? A) Thyroid hormones and gonadotropic hormones B) Testosterone and adrenocorticotropic hormone C) Parathyroid hormone and somatostatin D) Oxytocin and growth hormone 14. Jane F., a 31-year-old white female, is pregnant. She has been smoking for 10 years and was unable to quit during her pregnancy. As a result, her infant is smaller than normal. What is the pathological process that results in the low birth weight? A) Small for gestational age B) Hypoplastic growth C) Intrauterine growth retardation D) Hyperplastic growth 15. Your patient is a 15-year-old African boy. His parents are concerned about recent changes in his behaviour and are asking you for help. Which of the following would be your best answer? A) Recommend a full neurological assessment because their son may have a tumour that is causing a change in brain function. B) Recommend a full psychological evaluation, as depression and schizophrenia often develop in mid- to late years of adolescence. C) Recommend a drug test, as young people are known to experiment with drugs. D) Recommend they remain calm. Slight changes in behaviour are normal, and incongruencies can result from discrepancies between physical and cognitive levels of development. 16. Mr. Jones brings his 13-year-old son, John, to your clinic for a regular checkup. Mr. Jones is unaware of the normal developmental level his son should be attaining, so he asks you for guidance. What guidelines can you provide for Mr. Jones to help him assess his son's development? A) John should experience a steady growth rate. B) John should begin to seek independence, adopt peer codes, and make personal- lifestyle choices. C) John should start to display secondary sexual characteristics by age 11, his voice will change at age 13, and he will begin to grow taller when he turns 16. D) John should begin his changes before any female friends that he may have. Page 4

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    17. A social worker arrives at your clinic with a 10-month-old infant that is 20% underweight for her age. Your initial workup shows no signs of hypoxia, her temperature is normal, and her blood glucose level is 2.2 mmol/L. In the infant's history you see that her mother recently died due to complications of severe alcoholism. The infant shows no signs of fetal alcohol syndrome, and she was born healthy. What could explain her low body weight? A) The infant is suffering from hypoglycemia. B) The infant is suffering from the complications of jaundice. C) The infant was misdiagnosed with caput succedaneum. D) The infant is suffering from nonorganic failure to thrive. 18. Michael C. is an 8-year-old boy that arrives at the emergency room after having a seizure during school. After extensive testing and follow-up visits with the family physician, it is determined that Michael C. has epilepsy. Is this uncommon? A) Yes, and a thorough investigation must be done to determine if his epilepsy is genetic or environmentally caused. B) No; patients with epilepsy may have their first seizures during middle childhood. C) Yes; this case is very rare, and you should order a full neurological evaluation to determine if there is a lesion in his brain. D) No; all patients with epilepsy begin to have seizures by 7 or 8 years of age. Page 5

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    Answer Key 1. D 2. A 3. C 4. C 5. A 6. D 7. B 8. B 9. A 10. D 11. B 12. D 13. A 14. C 15. D 16. B 17. D 18. B Page 6

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    Name: __________________________ Date: _____________ 1. A community health nurse is working with an 81-year-old female client who states that she has made a concerted effort throughout her life to protect her skin from the sun and regularly apply topical moisturizers. The client is lamenting the fact that her skin's appearance has nonetheless deteriorated in recent years. Which of the following statements best captures a fact that the nurse should take into consideration when crafting a response to the client? A) The epidermal layer of the skin inevitably thins as part of the normal aging process, lending a transparent appearance to the skin. B) Skin becomes weaker and less elastic in older adults because of the rearrangement of fibrin and keratin. C) Skin becomes more fragile and prone to hematomas because of impaired vascularity. D) Output of sebaceous glands declines, with accompanying reductions in sweat production. 2. A physiotherapist (PT) at an assisted-living facility for older adults is leading an exercise class for the residents. Part of the PT's introductory class is an explanation of the health problems that can be mitigated by physical activity and those which are considered inevitabilities of the aging process. Which of the following phenomena would the PT most justifiably characterize as modifiable? A) Reduction in density of the trabecular bone B) Gradual decline in physical reaction time C) Overall reduction in muscle strength D) Decline in height 3. A geriatrician has ordered an echocardiogram and stress test for a 77-year-old male client in an effort to gauge the client's cardiovascular health status. Which of the following changes would the physician most likely identify as an anomaly that is not an expected age-related change? A) Increased resting, supine heart rate B) Low maximal heart rate and cardiac output C) Increased left ventricular wall thickness. D) Delayed left ventricular filling 4. A nurse provides care for a number of older adult residents of a long-term-care facility. Which of the following events from the last shift is most deserving of further assessment and possible interventions? A) An 83-year-old female client complains of the glare of the fluorescent lights off the floor of the facility. B) A 79-year-old male client displays unprecedented forgetfulness. C) A 91-year-old male client who has been newly admitted displays balance problems when ambulating. D) A 90-year-old long-term resident is displaying decreased motor strength. Page 1

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    5. The educator of a geriatric, subacute medical unit in a hospital has oriented new staff and is teaching orientees strategies on communicating with older adults with impaired hearing. Which of the following teaching points is most justifiable? A) “Speak slowly and directly to these clients.” B) “Avoid complex or abstract ideas when you're talking.” C) “Increase the volume of your speech as much as possible.” D) “Choose simple, short words to minimize confusion.” 6. An 81-year-old woman is attending a scheduled visit to her family physician. The client asks her doctor why she and her peers seem to get sick frequently, in spite of their efforts to stay active and eat nutritiously. Which of the following responses best captures an aspect of the immune function of older adults? A) “It's normal that the function and resiliency of your immune system decreases with age.” B) “Normal, age-related changes combine with outside factors to make older adults more likely to get sick.” C) “Your body produces fewer antibodies as you age, making you more vulnerable to infections than younger people.” D) “With a healthy lifestyle and proper medical treatment, you can generally maintain the same immune function as younger people.” 7. As a follow-up to the introduction of a new medication regimen for an older adult client, the physician is interpreting the client's recent blood work, paying particular attention to the client's serum creatinine (Cr) levels (normal range 0.6-1.2 mg/100ml) and glomerular filtration rate or GFR (normal value >60 ml/minute). Which of the following lab results would be considered typical of an older adult with impaired renal function? A) Cr 1.8; GFR 66 B) Cr 2.3; GFR 30 C) Cr 0.5; GFR 58 D) Cr 1.1; GFR 22 8. A nurse who is visiting a seniors' wellness centre is teaching a group of older adult women about sexual activity among older adults. Which of the following teaching points best captures the reality of sexual activity among older adults? A) “Androgen replacement therapy for older men can help resolve erectile dysfunction and low libido.” B) “Cessation of estrogen production after menopause makes sexual activity rarely possible for older women.” C) “You can expect the duration and intensity of sexual response to decrease with age.” D) “With education, sexual pleasure and frequency can remain similar to that of younger adults.” Page 2

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    9. An occupational therapist (OT) is assessing an 80-year-old male client who is poised to return to his assisted-living residence following a 14-day hospital stay with a diagnosis of bilateral pneumonia. As part of the OT's functional assessment, the client's activities of daily living (ADL) and instrumental activities of daily living (IADL) are being assessed. Which of the following assessment findings is most indicative of a deficit in ADLs? A) The client is unable to clean the washroom in his residence adequately or safely. B) The client requires help with dressing himself in the morning. C) The client is unable to manage his medication regimen without his daughter's help. D) The client requires help climbing the stairs to his residence. 10. Recognizing that falls are a significant source of morbidity among older adults, the manager of a geriatric medical unit is conducting a workshop for the health-care team on fall prevention. Which of the following patients would the care providers be most likely to anticipate being at a potentially high risk for falls? A) A 76-year-old woman with diagnoses of Parkinson's disease and orthostatic hypotension B) A 78-year-old woman admitted for rheumatoid arthritis exacerbation and uncontrolled diabetes mellitus C) An 81-year-old woman with exacerbation of her chronic obstructive pulmonary disease (COPD) and increasing shortness of breath D) An 80-year-old man with benign prostatic hyperplasia and consequent urinary retention 11. A geriatric clinical nurse educator is teaching the other members of the health-care team about the incidence, prevalence, and course of depression among older adults. Which of the following statements is most likely to appear in the physician's teaching? A) “Even though suicide rates are lower among older adults than younger adults, depression needs to be diagnosed and treated early.” B) “Though they are certainly not synonymous, depression can be an indicator of dementia.” C) “Many older adults lack the symptoms of sleep disturbances and lack of concentration that suggest depression in younger adults.” D) “Bronchodilators and antiplatelet medications have been correlated with depression in the elderly.” Page 3

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