Cellular Biology and Cancer - Study Guide (PDF)

Week 1———————————————————— 1. The cellular component that is most susceptible to radiation injury is the - DNA. 2. The stage during which the patient functions normally, although the disease processes are well established, is referred to as - subclinical. 3. Selye’s three phases of the st...

Week 1———————————————————— 1. The cellular component that is most susceptible to radiation injury is the - DNA. 2. The stage during which the patient functions normally, although the disease processes are well established, is referred to as - subclinical. 3. Selye’s three phases of the stress response include all the following except - Allostasis. 4. Of the statements below, the accurate statement regarding nutrition and cellular health is - deficient cellular uptake by one cell type may contribute to excess nutrient delivery to other cell types. - Deficient cellular uptake by one cell type may contribute to excess nutrient delivery to other cell types such as in diabetes mellitus. Most of these essential nutrients must be obtained from external sources, because the cell is unable to manufacture them. Obesity involves an excess of caloric intake. The BMI is a measure for obesity, but does not indicate if a nutritional imbalance is present. 5. Proto-oncogenes - are normal cellular genes that promote growth. - Proto-oncogenes are normal cellular genes that promote growth. Proto-oncogenes are not the same as oncogenes, which are mutant proto-oncogenes. They are different from tumor-suppressor genes and do not alter tumor-suppressor genes. Mutational events lead to oncogenes, a mutated proto-oncogene. 6. The most common tumor-suppressor gene defect identified in cancer cells is - P53. - The most common tumor-suppressor gene defect identified in cancer cells involves P53. More than half of all types of human tumors lack functional P53, which inhibits cell cycling. Rb, DC, and APC are not the most common tumor-suppressor gene defects identified in cancer cells. 7. The hypermetabolic state leading to cachexia in terminal cancer is thought to be because of - tumor necrosis factor. - Production of tumor necrosis factor (TNF) and other immune cytokines is thought to be important in producing the hypermetabolic state leading to cachexia in cancer. Angiogenesis is the development of new blood vessels to feed the tumor; it is not a cause of the hypermetabolic state leading to cachexia in terminal cancer. Loss of ATP production and pain medications is not causes of the hypermetabolic state leading to cachexia in terminal cancer. 8. Paraneoplastic syndromes in cancer involve excessive production of substances by multiple means. A common substance found in excessive amounts resulting from cancer paraneoplastic syndromes is - Calcium. - Common paraneoplastic syndromes include hypercalcemia associated with abnormal production of parathyroid hormone-related protein by tumor cells. Insulin is a general growth factor for a number of tissues and may be implicated in development of some cancers, but it is not a cause of paraneoplastic syndromes. Tumor necrosis factor is associated with cachexia in cancer, but it is not associated with paraneoplastic disorders of cancer. Potassium is not found in excess amounts in cancer. 9. Familial retinoblastoma involves the transmission of what from parent to offspring? - Mutant tumor-suppressor gene - Familial retinoblastoma involves transmission of a mutant tumor-suppressor gene from parent to child. Familial retinoblastoma is not caused by a virus and does not involve an extra chromosome, but rather a single gene. Familial retinoblastoma is caused by a mutant tumor-suppressor gene, not an oncogene, which is a mutated proto-oncogene. 10. In general, a cancer cell that is more tissue-specific differentiated is more likely to be aggressive. - False - The degree of tissue-specific differentiation predicts malignant potential. A lack of differentiated features in a cancer cell is called anaplasia, and a greater degree of anaplasia is correlated with a more aggressively malignant tumor. 11. Necrotic death of brain tissue usually produces _____ necrosis - Liquefactive - Liquefactive necrosis is produced when brain tissue dies, as it is rich in enzymes and has little connective tissue. Coagulative necrosis occurs from ischemic injury in any tissue. Caseous necrosis occurs in lung tissue damaged by tuberculosis. Fat necrosis occurs in adipose (fat) tissue. 12. Breast cancer in women who have the breast cancer gene - occurs at an earlier age. - The age of onset of inherited breast cancer is earlier than the onset of non-inherited forms and the prevalence of bilateral breast cancer is higher. Breast cancer in women who have the breast cancer gene is less common (only 5% to 10% of all cases) than non-inherited breast cancer and is more likely to be bilateral. Response to treatment is not affected by whether the cancer gene is present. 13. After bronchoscopy and histologic examination of a suspected tumor, your patient is diagnosed with primary bronchial carcinoma. Thus, the tumor - is malignant. - Bronchial carcinoma is a malignant cancer of the epithelial lining of the bronchi. Carcinoma refers to a malignant tumor. Primary indicates that the cancer began in the lungs and did not metastasize from another site. A staging procedure must be done before knowing if the lung cancer has spread. 14. Cancer grading is based on - cell differentiation. - Grading refers to the histologic characterization of tumor cells and is basically a determination of the degree of anaplasia (lack of differentiation). The other answer options are associated with tumor staging. 15. Metaplasia is - the replacement of one differentiated cell type with another. - Metaplasia is the replacement of one differentiated cell type with another secondary to persistent damage. Dysplasia transforms cells to preneoplastic lesions, which may become malignant. Metaplasia is reversible when the damage is stopped. Disorganization of cells into various sizes, shapes, and arrangements occurs in dysplasia. 16. Malignant neoplasms of epithelial origin are known as - Carcinomas  - Carcinoma refers to malignant tumors of epithelial origin. Lymphoma refers to cancer of the lymphatic tissue. Sarcoma refers to malignant tumors of mesenchymal (nerve, bone, muscle) origin. Adenoma is a benign tumor of glandular tissue. 17. A patient with metastatic lung cancer wants to know her chances for survival. Which response is correct? - “Lung cancer has about a 15% survival rate.” - Lung cancer has a 15% survival rate. Lung cancer is not always fatal, but is not highly curable at any stage of diagnosis. The death rate from lung cancer has increased dramatically. 18. A 17-year-old college-bound student receives a vaccine against an organism that causes meningitis. This is an example of - primary prevention - Primary prevention is prevention of disease by altering susceptibility or reducing exposure for susceptible individuals by providing vaccination. Secondary prevention is the early detection, screening, and management of the disease. Tertiary prevention includes rehabilitative and supportive care and attempts to alleviate disability and restore effective functioning. Disease treatment involves management of the disease once it has developed. 19. Somatic death refers to death - of the entire organism - Somatic death refers to death of an entire organism. Somatic death is not simply death of one body organ. Somatic death involves death of all cells in the body. Brain death refers to death of the brain only, but organ systems can remain living with mechanical assistance. 20. The nurse is swabbing a patient’s throat to test for streptococcal pharyngitis. The nurse must understand that tests such as this differ in the probability that they will be positive for a condition when applied to a person with the condition; this probability is termed sensitivity - True - The sensitivity of any test refers to the probability that the test will be positive when applied to a person with the condition and will not provide a false negative result. In contrast, specificity is the probability that a test will be negative when applied to a person who does not have a given condition 21. Allostasis is best defined as - the overall process of adaptive change necessary to maintain survival and well-being - Allostasis refers to the overall process of adaptive change necessary to maintain survival and well-being. 22. Which is not normally secreted in response to stress? - Insulin - Insulin secretion is impaired during stress to promote energy from increased blood glucose. Norepinephrine is secreted during stress as a mediator of stress and adaptation. Cortisol is secreted during stress as a mediator of stress and adaptation and stimulates gluconeogenesis in the liver to supply the body with glucose. Epinephrine is secreted during stress as a mediator of stress and adaptation and increases glycogenolysis and the release of glucose from the liver. 23. The effect of stress on the immune system - may involve enhancement or impairment the immune system. - Many studies demonstrate that long-term stress impairs the immune system, but many researchers identify that short-term stress may enhance the immune system. 24. The effects of excessive cortisol production include - immune suppression. - Cortisol suppresses immune function and inflammation and stimulates appetite. Cortisol leads to hyperglycemia by stimulating gluconeogenesis in the liver. 25. An obese but otherwise healthy teen is given a prescription for a low-calorie diet and exercise program. This is an example of - secondary prevention - Secondary prevention is the early detection, screening, and management of the disease such as prescribing diet and exercise for an individual who has already developed obesity. Primary prevention is prevention of disease by altering susceptibility or reducing exposure for susceptible individuals. Tertiary prevention includes rehabilitative and supportive care and attempts to alleviate disability and restore effective functioning. Disease treatment involves management of the disease once it has developed. 26. Extreme cold injures cells by all the following except - Decrease blood viscosity. - It DOES - ischemic injury from vasoconstriction. - peripheral nerve damage from rebound vasodilation. - crystallization of cellular components. - Hypothermia causes increased blood viscosity, which can result in ischemic injury. Initial vasoconstriction causes ischemic injury. Rebound vasodilation leads to intense swelling which damages peripheral nerves. Crystallization of cellular components leads to rupture of these components. 27. After suffering a heart attack, a middle-aged man is counseled to take a cholesterol-lowering medication. This is an example of - tertiary prevention. - Tertiary prevention includes rehabilitative and supportive care and attempts to alleviate disability and restore effective functioning such as prescribing a cholesterol-lowering medication following a heart attack. Primary prevention is prevention of disease by altering susceptibility or reducing exposure for susceptible individuals. Secondary prevention is the early detection, screening, and management of the disease. Disease treatment involves management of the disease once it has developed. 28. Coagulative necrosis is caused by - interrupted blood supply. - Coagulative necrosis results from interrupted blood supply leading to ischemic cell injury. Liquefactive necrosis results from dissolving of dead cells and cyst formation. Fat necrosis is caused by trauma or pancreatitis. Caseous necrosis is caused by lung tissue damage such as that caused by tuberculosis. 29. A patient with high blood pressure who is otherwise healthy is counseled to restrict sodium intake. This is an example of - secondary prevention - Secondary prevention is the early detection, screening, and management of the disease, such as by prescribing sodium restriction for high blood pressure. Primary prevention is prevention of disease by altering susceptibility or reducing exposure for susceptible individuals. Tertiary prevention includes rehabilitative and supportive care and attempts to alleviate disability and restore effective functioning. Disease treatment involves management of the disease once it has developed. 30. Persistence of the alarm stage will ultimately result in - permanent damage and death. - If the alarm stage were to persist, the body would soon suffer undue wear and tear and become subject to permanent damage and even death. Actions taken by the individual during the resistance stage lead to stress reduction. The resistance stage may or may not occur following the alarm stage, based on resource availability. The sympathetic nervous system will continue to function, resulting in continued release of stress hormones. 31. Reperfusion injury to cells - involves formation of free radicals. - Free radicals are formed when high-energy electrons partially reduce oxygen in reperfusion injury. Reperfusion injury usually causes more cell damage than the original hypoxia. It results from calcium overload in the cells. Reperfusion injury results from hypoxic injury, rather than from nutritional injury. 32. An increase in organ size and function caused by increased workload is termed - hypertrophy. - Increased function of an organ such as the heart or skeletal muscle results in organ hypertrophy because of cellular enlargement. Atrophy refers to reduction in size of an organ because of cellular shrinkage. Metaplasia refers to replacement of one differentiated cell type with another. Inflammation results from immune response rather than workload. 33. C.Q. was recently exposed to group A hemolytic Streptococcus and subsequently developed a pharyngeal infection. His clinic examination reveals an oral temperature of 102.3°F, skin rash, dysphagia, and reddened throat mucosa with multiple pustules. He complains of sore throat, malaise, and joint stiffness. A throat culture is positive for Streptococcus, and antibiotics have been prescribed. The etiology of C.Q.’s disease is - streptococcal infection. - Etiology refers to the proposed cause or causes of a particular disease process. A sore throat is the manifestation of the disease process. Genetic susceptibility refers to inherited tendency to develop a disease. Pharyngitis refers to inflammation of the throat and is also a clinical manifestation of the disease process. 34. When the cause is unknown, a condition is said to be idiopathic - True - Many diseases are idiopathic in nature 35. All these cellular responses are potentially reversible except - necrosis. - Necrosis refers to death of cells/tissue and is not reversible. Metaplasia refers to the replacement of one differentiated cell type with another from persistent injury and is reversible when the injury stops. Atrophy occurs because of lack of use of an organ and is reversible. Hyperplasia is an increase in the number of cells from increased physiologic demands or hormonal stimulation and is reversible. 36. Many of the responses to stress are attributed to activation of the sympathetic nervous system and are mediated by - Norepinephrine  - Norepinephrine is secreted in response to activation of the sympathetic nervous system during stress by the adrenal medulla. Cortisol is secreted by the adrenal cortex. Glucagon is secreted by the pancreas. ACTH is secreted by the pituitary gland. 37. Indicators that an individual is experiencing high stress include all the following except - Pupil constriction - Pupils dilate during stress from the effects of catecholamines. Tachycardia, diaphoresis, and increased peripheral resistance are indicators of stress and also occur because of catecholamine release. 38. All the following stress-induced hormones increase blood glucose except - Aldosterone - Aldosterone results in water and sodium retention and potassium loss in the urine. It does not affect blood glucose. Cortisol is a glucocorticoid secreted by the adrenal cortex. Cortisol stimulates gluconeogenesis in the liver, thus increasing blood glucose. Norepinephrine inhibits insulin secretion, thus increasing blood sugar. Epinephrine increases glucose release from the liver and inhibits insulin secretion, thus increasing blood glucose. 39. The primary adaptive purpose of the substances produced in the alarm stage is - energy and repair. - These resources are used for energy and as building blocks, especially the amino acids, for the later growth and repair of the organism. The substances do not produce a resting state. The substances can produce exhaustion if they continue, but that is not the adaptive purpose of these. Although a new baseline steady-state may result from the stress response that is not the adaptive purpose of the substances produced during the alarm stage. 40. Side effects of chemotherapy include (select all that apply) - Anemia - Nausea - Bleeding - Infections 41. Deficits in immune system function occur in cancer due to (select all that apply) - Chemotherapy - cancer cells - cancer metastasis to bone marrow - Malnutrition 42. Prophylaxis – A measure designed to preserve health and prevent the spread of disease 43. Onset – Beginning of a disease 44. Acute onset – Begins sudden and obvious 45. Insidious onset – gradual progression with only vague or very mild signs 46. Precipitating factor – condition that triggers an acute episode 47. Anaerobic metabolism – The metabolism that takes place in the absence of oxygen; the principle product is lactic acid. Week 2———————————————————— Question 1 The effects of histamine release include a. Vasoconstriction. b. Bronchodilation. c. increased vascular permeability. d. decreased gut permeability. Question 2 A 58-year-old woman is seen in the clinic for reports of severe back pain. Her chest x-ray demonstrates generalized bone demineralization and compression fracture. Blood studies demonstrate elevated calcium levels. The most likely diagnosis is a. Leukemia. b. Myeloma. c. Hodgkin disease. d. back trauma. - A diagnosis of plasma cell myeloma is confirmed by the presence of hypercalcemia, which can contribute to the compression fracture. Patients with leukemia diagnoses do not exhibit bone demineralization or elevated calcium levels. Lymphadenopathy is a more common manifestation of Hodgkin disease. Compression fractures can be the result of back trauma, but not in the presence of the other radiographic and laboratory results. Question 3 Dramatic hypotension sometimes accompanies type I hypersensitivity reactions, because a. massive histamine release from mast cells leads to vasodilation. b. toxins released into the blood interfere with cardiac function. c. anaphylaxis results in large volume losses secondary to sweating. d. hypoxia resulting from bronchoconstriction impairs cardiac function. - Hypotension can occur in type I hypersensitivity resulting from massive histamine release leading to vasodilation. Toxins are not released during type I hypersensitivity reactions. Sweating occurs as a reaction to shock from severe hypotension; the hypotension occurs first and is because of histamine release. Hypoxia occurs in anaphylaxis as a result of shock from severe hypotension; the hypotension occurs first and is because of histamine release. Question 4 In general, the best prognosis for long-term disease-free survival occurs with A. ALL (acute lymphoid leukemia). B. CLL (chronic lymphoid leukemia). C. AML (acute myeloid leukemia). D. CML (chronic myeloid leukemia). - ALL is highly curable in the pediatric population with an 85% survival rate in children. The average age of patients with CLL is 65 to 70 years. Median survival rate is less than 8 years. Patients younger than age 60 have a 4-year survival rate of 30% to 40% in AML. CML does not respond well to chemotherapy and carries a long-term survival rate of 50% to 60%. Question 5. Which form of leukemia demonstrates the presence of the Philadelphia chromosome? a. ALL (acute lymphoid leukemia) b. CLL (chronic lymphoid leukemia)  c. AML (acute myeloid leukemia) d. CML (chronic myeloid leukemia) - The majority of CML cases are characterized by malignant granulocytes that carry the Philadelphia chromosome. ALL is manifested by the malignant transformation of B cells and some T cells. CLL is associated with T-cell transformation. The Philadelphia chromosome is not seen in CLL. AML is associated with a transformation of a myeloid stem cell. Question 6 A 5-year-old patient’s parents report loss of appetite and fatigue in their child. The parents also state that the child refuses to walk as a result of pain. The child’s most likely diagnosis is a. ALL (acute lymphoid leukemia) b. CLL (chronic lymphoid leukemia) c. AML (acute myeloid leukemia) d. CML (chronic myeloid leukemia) - ALL is primarily a disorder of children with an abrupt onset of bone pain, bruising, fever, and infection. Children may refuse to walk and experience fatigue, loss of appetite, and abdominal pain. In CML, AML, and CLL, children do not complain of pain with walking. Additionally, chronic leukemia is most commonly found in adults. Question 7 Severe combined immunodeficiency (SCID) syndrome is an example of a(n) a. deficient immune response. b. excessive immune response. c. primary acquired immunodeficiency. d. hypersensitivity reaction. - SCID syndrome is an example of a deficient immune response in which the immune response is ineffective because of disease-causing genotypes or secondary/acquired dysfunction. An excessive immune response includes disorders in which the immune system is overfunctioning or hyperfunctioning. HIV/AIDS is an example of a primary acquired immunodeficiency disorder. Hypersensitivity reactions are an excessive immune response. Question 8 Patients with immunodeficiency disorders are usually first identified because they a. run high fevers. b. have unusually high WBC counts. c. develop brain infections. d. develop recurrent infections. Question 9 Which disorder is considered a primary immunodeficiency disease? a. HIV/AIDS b. Malnutrition immunodeficiency c. Cancer immunodeficiency d. Radiation immunodeficiency - HIV/AIDS is a primary immunodeficiency disease involving destruction of T helper cells. Malnutrition immunodeficiency is a secondary immunodeficiency disorder and leads to T-cell destruction and dysfunction. Cancer immunodeficiency is a secondary immunodeficiency disorder caused by the destruction of rapidly proliferating cells from chemotherapeutic agents. Radiation immunodeficiency is a secondary immunodeficiency disorder caused by the destruction of rapidly proliferating cells from the effects of radiation. Question 10 The relationship of blood flow (Q), resistance (R), and pressure (P) in a vessel can be expressed by which equation? a. Q = P/R b. Q = R/P c. R = PQ d. P = Q/R - The relationship between the variables of pressure and resistance is expressed by Ohm’s law: Q = P/R. Q is the blood flow, P is the pressure difference, and R is the resistance. Ohm’s law is Q = P/R. R = PQ is not the expression for the relationship between blood flow, resistance, and pressure. P = Q/R is not the correct expression reflecting Ohm’s law. Question 11 The goal of long term heparin for the management of a deep vein thrombosis is to a. relieve edema. b. prevent clot dislodgement. c. dissolve the thrombus. d. prevent further clot formation - Anticoagulation is utilized in deep vein thrombosis to prevent further clot formation. Heparin does not play a role in edema. Prevention of clot dislodgement is not the goal of therapy with the use of heparin. Heparin is not utilized to dissolve a thrombus. Question 12 The Philadelphia chromosome is a balanced chromosome translocation that forms a new gene called a. Bcr-abl. b. Rb. c. P53. d. ARA-c. - bcr-abl is the translocation of chromosomes 9 and 22, which are known as the Philadelphia chromosome. Rb is a retinoblastoma protein, which is not associated with the Philadelphia chromosome. p53 is a tumor suppressor not associated with the Philadelphia chromosome. ARA-c is a chemotherapeutic agent used to treat leukemia. Question 13 Which disorder is associated with a type III hypersensitivity mechanism of injury? a. Systemic lupus erythematosus b. Graves disease c. Erythroblastosis fetalis d. Seasonal allergic rhinitis - Systemic lupus erythematosus is a type III hypersensitivity disorder. Type III hypersensitivity is characterized by antigen–antibody complex deposition into tissues, with consequent activation of complement and a subsequent self-sustaining inflammatory reaction. Graves disease and erythroblastosis fetalis are type II hypersensitivity reactions. Seasonal allergic rhinitis is a type I hypersensitivity reaction. Question14 Which is not considered to be a risk factor for thrombus formation? a. Thrombocytopenia b. Vascular trauma c. Stasis of blood flow d. Circulatory shock Question 15 Myasthenia gravis is a type II hypersensitivity disorder that involves a. impaired muscle function. b. symptoms of hyperthyroidism. c. symptoms of arthritis or polyarthralgia. d. symptoms of glomerular disease. - Myasthenia gravis involves muscle weakness caused by loss of acetylcholine stimulation at the motor end-plate. Symptoms of hyperthyroidism occur in Graves disease. Symptoms of arthritis or polyarthralgia occur in systemic lupus erythematosus, a type II hypersensitivity disorder. Glomerular disease can occur in type III hypersensitivity disorders. Question16 Venous obstruction leads to edema because it ________ pressure. a. increases capillary oncotic b. increases arterial blood c. decreases tissue d. increases capillary hydrostatic - Increased fluid accumulation in the interstitial space also occurs when the lymphatic flow is impaired or when capillaries become more permeable and “leak” fluid. These pressure gradients lead to edema. Interstitial fluid colloid osmotic pressure increases play a role in edema. Arterial blood pressure does not lead to edema. Decreased tissue pressure does not lead to edema in venous obstruction. Question 17 The principle Ig mediator of type I hypersensitivity reactions is a. IgA. b. IgG. c. IgM. d. IgE. - Immunoglobulin E (IgE) is the principal antibody mediating type I hypersensitivity reactions. IgA is not the primary Ig mediator of type I hypersensitivity reactions. IgG is involved in type II hypersensitivity reactions. IgM is involved in type II hypersensitivity reactions. Question 18 The liver is responsible for the synthesis of coagulation factors, with the exception of part of VIII. True False Question 19 Clinical manifestations of chronic arterial obstruction include a. Edema. b. intermittent claudication. c. decreased pressure proximal to the obstruction. d. distal hyperemia. Question 20 Which is not a manifestation of acute arterial obstruction? a. Pain b. Purpura c. Pallor d. Pulselessness - Purpura is purple-colored spots on the skin, which are not a manifestation of acute arterial obstruction. Pain is intense, continuous, and unrelated to activity in an acute arterial obstruction. In an acute arterial obstruction, pallor is seen in the involved extremity. Pulselessness may occur  in the affected extremity of an acute arterial occlusion, although often a weak pulse may be noted by Doppler. Question 21 A commonly ingested substance associated with prolongation of the bleeding time is a. Acetaminophen. b. Tobacco. c. Caffeine. d. aspirin. Question 22 The conversion of plasminogen to plasmin results in a. clot retraction. b. Fibrinolysis. c. platelet aggregation. d. activation of thrombin. - Fibrinolysis is the process of clot dissolution and occurs when plasminogen activators cleave plasminogen to plasmin. Clot retraction occurs when the components of the fibrin clot are compressed or contracted to form a clot. Factors released from platelets contribute to hemostasis by enhancing vasoconstriction, platelet aggregation, and vessel repair. Platelet aggregation is not the result of plasmin conversion. Thrombin cleaves fibrinogen to form a fibrin clot. Question23 The only known curative treatment for CML is allogeneic bone marrow transplantation from a suitable donor. True False Question 24 The movement of blood through the vascular system is opposed by the force of A. Viscosity. B. the vessel length. C. the vessel radius. D. resistance. - The movement of blood through the vascular system is opposed by the force of resistance. Three determinants of resistance are vessel length, vessel radius, and blood viscosity. Viscosity is the thickness of fluid and has an effect on resistance. The length of the vessel does have an effect on the resistance. Vessel radius has an effect on resistance. Question 25 The arterial oxygen content (CaO2) for a patient with PaO2 100 mm Hg, SaO2 95%, and hemoglobin 15 g/dL is _____ mL oxygen/dL. A. 19.4 B. 1909.8 C. 210 D. 21.05 - A hemoglobin level of 15 divided by 100 equals 0.15. Multiply by 1.34 mL and then multiply by saturation on 95%. The result is 19.1% oxyhemoglobin. Then add 0.3% volume dissolved in plasma to get the total content of oxygen/dL. The arterial blood oxygen content is the amount of oxygen carried in the arterial blood. 1909.8 is an incorrect answer if the formula is followed correctly. 210 is incorrect when the formula is applied correctly. 21.05 is an incorrect response if the formula is applied correctly. Question 26 The primary source of erythropoietin is provided by the A. bone marrow. B. kidney. C. lung. D. liver. - Erythropoietin is a hormone that is secreted into the bloodstream by the kidney. Bone marrow is not responsible for the production of erythropoietin. Hypoxia from low hemoglobin levels causes a decrease in tissue oxygen tension in the kidney, thereby releasing the hormone erythropoietin. The liver is not associated with erythropoietin production. Question 27 Hemophilia B is also known as Christmas disease. True False Question 28 Two of the most serious oncology emergencies associated with non-Hodgkin lymphoma are obstruction of the superior vena cava and compression of the spinal cord. True False - Compression of the spinal cord is one of the two most serious oncology emergencies associated with non-Hodgkin lymphoma. Question 29 Patients who experience anemic episodes when exposed to certain drugs most likely have A. thalassemia. B. spherocytosis. C. sickle cell anemia. D. glucose-6-phosphate dehydrogenase deficiency. Question 30 The cause of the most common form of anemia is A. acute bleeding. B. iron deficiency. C. protein malnutrition. D. chronic disease. Question 31 The final step in clot formation is A. conversion of prothrombin to thrombin. B. platelet degranulation and adhesion. C. conversion of fibrinogen to fibrin. D. clot retraction. - Clot retraction, the final stage of clot formation, occurs when the components of the fibrin clot are compressed or contracted to form a firm clot. Platelets serve as a catalyst in accelerating the conversion of prothrombin to thrombin. Platelet degranulation is not involved in clot formation. The formation of a fibrin clot occurs when fibrinogen is converted to fibrin, usually at the site of an injury. Question 32 The most effective therapy for anemia associated with kidney failure is A. iron administration. B. high-protein diet. C. erythropoietin administration. D. vitamin B12 and folate administration. Question 33 A normal bleeding time in association with normal platelet count, and increased prothrombin time (PT) and INR, is indicative of A. vitamin K deficiency. B. hemophilia B. C. hemophilia A. D. idiopathic thrombocytopenia. - Vitamin K deficiency should be considered as the cause for bleeding when the PT and INR are increased but other coagulation studies are normal. Hemophilia B results from factor deficiency or the abnormal function of factor IX. Hemophilia A results from factor deficiency or the abnormal function of factor VIII. In idiopathic thrombocytopenia, a decreased platelet count is seen in prolonged bleeding times. Question 34 Excessive red cell lysis can be detected by measuring the serum A. hemoglobin. B. methemoglobin. C. bilirubin. D. erythropoietin. - Any condition causing increased red cell destruction increases the total load of bilirubin to be cleared, which leads to increased serum bilirubin levels and possible jaundice. Red cell destruction does not lead to changes in the hemoglobin level. Methemoglobin is formed when iron of the hemoglobin molecule is oxidized to the ferric state. Erythropoietin is secreted in response to hypoxia. Question 35 The anemia resulting from a deficiency of either vitamin B12 (cobalamin) or folate is caused by a disruption in DNA synthesis of the blast cells in the bone marrow that produces very large abnormal bone marrow cells called megaloblasts. True False Question 36 What is necessary for red blood cell production? A. Phosphate B. Iron C. Magnesium D. Calcium Question 37 Red blood cells differ from other cell types in the body, because they A. contain cytoplasmic proteins. B. have no cytoplasmic organelles. C. have a longer life span. D. contain glycolytic enzymes. Question 38 The most appropriate treatment for secondary polycythemia is A. volume expansion with saline. B. measured to improve oxygenation. C. phlebotomy. D. chemotherapy. - Secondary polycythemia is because of chronic hypoxemia with a resultant increase in erythropoietin production. The goal of treatment is aimed at measures to reduce hypoxemia and improve oxygenation by implementing oxygen therapy. IV fluids may be used to treat relative polycythemia, because it is related to dehydration. Phlebotomy or increases in laboratory studies do not have an effect on secondary polycythemia. Polycythemia is not treated with chemotherapeutic agents. Question 39 Which causes vasoconstriction? A. Norepinephrine B. Calcium channel blocker C. α-Adrenergic antagonist D. Acetylcholine - The release of norepinephrine results in arterial vasoconstriction via receptors located on the vascular smooth muscle walls. Calcium channel blockers produce vasodilation by interfering with calcium intake into the vascular smooth muscle cells. α-Adrenergic antagonists do not cause vasoconstriction. Acetylcholine does not have an effect on vasoconstriction. Question 40 Activation of the extrinsic pathway of coagulation is initiated by A. platelet factors. B. collagen exposure. C. tissue thromboplastin. D. factor VII. - The extrinsic pathway of coagulation begins when the vascular wall is traumatized. Tissue factor from injured tissue activates factors which in turn activate and convert into thrombin for clotting. Platelets play a major role in primary hemostasis as well as secondary hemostasis and clot retraction. Platelets accelerate the conversion of prothrombin to thrombin. Platelets adhere to collagen exposed by trauma and initiate degranulation. Factor VII is involved in the extrinsic pathway of coagulation when it is activated by tissue factor following a traumatic injury. Question 41 Which condition enhances lymphatic flow? A. Increased tissue hydrostatic pressure B. Increased interstitial fluid colloid osmotic pressure C. Decreased capillary hydrostatic pressure D. Increased capillary oncotic pressure - Lymphatic flow is controlled by increasing interstitial fluid colloid osmotic pressure and by the stimulation of the contractile fibers (often called lymphatic pumps) as they are stretched. Increasing interstitial fluid colloid osmotic pressure enhances lymphatic flow. Lymphatic flow is not enhanced by decreased capillary hydrostatic pressure. Lymphatic flow is controlled by increases in osmotic pressure, not oncotic pressure. Question 42 A serious complication of deep vein thrombosis is A. stroke. B. hypertensive crisis.  C. extremity necrosis. D. pulmonary embolus. - Deep vein thrombosis is treated aggressively, as it is the most frequent source of pulmonary embolus. Deep vein thrombosis is not the cause of a stroke. Hypertensive crisis is unrelated to deep vein thrombosis. Extremity necrosis could result from prolonged arterial occlusion. Question 43 Tissues are able to autoregulate their rate of blood flow by controlling A. perfusion pressure. B. arterial blood pressure. C. vascular resistance. D. venous return to the heart. - Systemic vascular resistance is used to determine the resistance of vessels, diseases, or drug therapies that affect vessels. Any condition that increases vascular resistance requires more work for the heart to overcome the resistance and eject blood volume. Blood moves from an area of higher pressure to an area of lower pressure. The arterial and arteriolar walls with their muscular media coats provide the high-pressure end of the gradient. Seeking a lower pressure, blood moves toward the venous system. The thinner, more pliable walls of the venous bed furnish the low-pressure portion of the pressure gradient. Question 44 When a patient is struck in the eye by a baseball, the result is redness and swelling. This increase in blood flow to a localized area is called A. autoregulation. B. edema. C. hyperemia. D. Hypoxia. - Hyperemia is a local increase in blood flow. Autoregulation is the ability of blood vessels within organs to maintain a constant blood flow. Edema is the swelling that results from hyperemia. Hypoxia is an insufficient supply of oxygen. Question 45 An important mediator of a type I hypersensitivity reaction is A. complement. B. antigen–antibody immune complexes. C. T cells. D. Histamine. - Histamine mediates type I hypersensitivity reactions. Complement mediates type II hypersensitivity reactions. Antigen–antibody immune complexes mediate type III hypersensitivity reactions. T cells mediate type IV hypersensitivity reactions. Question 46 While in the hospital for management of acute lymphoid leukemia (ALL), a patient develops severe thrombocytopenia. The most appropriate action for this condition is A. anticoagulant therapy. B. chemotherapy. C. activity restriction. D. Isolation. - Thrombocytopenia can produce a life-threatening hemorrhage. Patients with this condition should be protected from trauma and placed on activity restriction to reduce the risk of bleeding. Anticoagulant therapy in a patient with thrombocytopenia could actually cause the patient more bleeding. Thrombocytopenia is a complication of leukemia and chemotherapy. Chemotherapy is  not an appropriate treatment option for thrombocytopenia. Isolation is not effective in managing the risk of hemorrhage. Question 47 Risk factors for atherosclerosis include A. female gender. B. hyperlipidemia. C. high-protein diet. D. low-fiber diet. - Hyperlipidemia is a modifiable risk factor associated with atherosclerosis. Men have a higher incidence of atherosclerosis earlier in life than women. A high-protein diet is not associated with atherosclerosis. Dietary fats do play a role as a modifiable risk factor. A low-fiber diet is not a risk factor for atherosclerosis Question 48 The most common primary immune deficiency that affects only B cells is A. DiGeorge. B. Bruton agammaglobulinemia. C. Wiskott–Aldrich. D. selective IgA. - The most common B-cell primary immunodeficiency disorder is selective IgA deficiency. This disorder affects 1:2000 persons. DiGeorge is a T-cell primary immune deficiency. Bruton agammaglobulinemia is not the most common primary immune deficiency affecting B cells; frequency of disease is 1:250,000 males. Females are carriers. Wiskott–Aldrich affects both T cells and B cells. Question 49 RhoGAM (an Rh antibody) would be appropriate in an Rh-_____ woman with an _____ Rh-_____ antibody titer carrying an Rh-_____ fetus. A. negative; positive; positive B. positive; negative; negative C. negative; negative; positive D. negative; negative; negative - If a woman is Rh-negative, RhoGAM is administered for prevention of Rh-positive antibodies. Erythroblastosis fetalis develops during pregnancy when an Rh-negative mother is sensitized to her fetus’s Rh-positive red cell group antigens because of exposure during her current or a previous pregnancy. RhoGAM contains antibodies against Rh antigens on fetal blood cells and is given to the mother to destroy fetal cells that may be present in her circulation before her immune system becomes activated and begins to produce anti-Rh antibodies. RhoGAM is not effective if the mother already has a positive antibody titer for fetal Rh antigens. An Rh-positive woman with negative Rh antibody titer carrying Rh-negative fetus does not require RhoGAM because the mother is Rh-positive and the fetus is Rh-negative. Question 50 The hypersensitivity reaction that does not involve antibody production is type A. I. B. II. C. III. D. IV. - Type IV hypersensitivity reactions do not involve antibody production. The principal mediators are lymphocytes, including T helper cells (Th) that mediate the reaction by releasing lymphokines (cytokines) and/or antigen-sensitized cytotoxic T cells (Tc) that can directly kill  cells. The other types involve antibody production. Type I involves IgE; type II involves IgM or IgG; type III involves IgG. Question 51 A primary effector cell of the type I hypersensitivity response is A. monocytes. B. mast cells. C. neutrophils. D. cytotoxic cells. - Mast cells are a primary effector cell of the type I hypersensitivity response. Monocytes, neutrophils, and cytotoxic cells are not primary effectors of the type I hypersensitivity response. Question 52 Velocity of blood flow is measured in A. centimeters per second. B. millimeters per minute. C. yards per hour. D. kilometers per minute. Question 53 Seasonal allergic rhinitis is most involved in type II hypersensitivity reactions. A. True B. False - Seasonal allergic rhinitis is most involved in type I hypersensitivity reactions. Question 54 Vaccination for pneumococcal pneumonia should be performed before 1 year of age in patients with sickle cell anemia. A. True B. False - Vaccination for pneumococcal pneumonia should be performed before 2 years of age in patients with sickle cell anemia and booster vaccinations given 3 to 5 years later. Question 55 Red blood cells obtain nearly all their energy from metabolism of A. glucose. B. fats. C. proteins. D. acetyl coenzyme A. - For RBCs to survive and perform efficiently, they must have a source of energy. Essential for red blood cell viability is the glucose that is used for metabolism. RBC membrane structures are formed from double layer of phospholipids. Fats do not provide energy to red blood cells. A protein network on the surface of the membrane is important for cell structure, but does not provide energy for red blood cell production and maintenance. Acetyl coenzyme A is not a factor in providing energy to the red blood cells. Question 56 When systemic vascular resistance is decreased, blood flow A. increases. B. decreases. C. stays the same. D. moves to the extremities.  - When SVR is pathologically decreased, the blood is spread over a larger area and blood flow slows dramatically. Individual organs, such as the kidney and brain, may not obtain sufficient blood flow to meet metabolic needs. Blood flow decreases in response to decreases in vascular resistance. When SVR is pathologically decreased, the blood is spread over a larger area and blood flow slows dramatically. Individual organs, such as the kidney and brain, may not obtain sufficient blood flow to meet metabolic needs. Blood flow is not diverted to the extremities when systemic vascular resistance is decreased. However, the vital organs may not have sufficient blood flow to maintain metabolic needs. Question 57 Disseminated intravascular coagulation may be treated with heparin therapy to A. enhance fibrinolysis. B. inhibit clotting factor consumption. C. activate platelets. D. enhance liver synthesis of clotting factors. - Although controversial, heparin may be used to minimize further consumption of clotting factors. Fibrinolysis is not enhanced by the use of heparin. The use of heparin does not activate platelets. Heparin is not known to enhance liver synthesis of clotting factors. Question 58 A low mean corpuscular hemoglobin concentration (MCHC) and mean corpuscular volume (MCV) are characteristic of which type of anemia? A. Vitamin B12 deficiency B. Folate deficiency C. Iron deficiency D. Erythropoietin deficiency - Iron-deficiency anemia is characterized by a low hemoglobin concentration and low mean corpuscular volume. Vitamin B12 deficiency anemia is characterized by a high concentration of MCV and a normal level of MCHC. Folate deficiency anemia is characterized by a normal mean corpuscular hemoglobin concentration and a high mean corpuscular volume. Erythropoietin deficiency creates hypoxia from a low hemoglobin level. Question 59 Which vessel normally demonstrates the most rapid blood flow? A. An arteriole B. A capillary C. A venule D. The vena cava - The vena cava has the most rapid rate of flow. Arterioles don’t offer the most rapid blood flow. Capillaries are composed of a single thickness of endothelial cells attached to a protein network called the basement membrane and don’t offer the most rapid blood flow. A venule begins where the arteriole ends and doesn’t offer the most rapid blood flow. Question 60 Which characteristic is indicative of hemolytic anemia? A. Increased total iron-binding capacity B. Increased heart rate C. Hypovolemia D. Jaundice - Jaundice is a classic clinical manifestation of hemolytic anemia. The total iron-binding capacity in hemolytic anemia is not increased. Hemolytic anemia is not generally associated with an  increased heart rate unless there is aplastic crisis associated with infection. Hypovolemia is not an indication of hemolytic anemia. Question 61 A patient presents to the physician’s office with pinpoint hemorrhages on the skin. The patient is most likely between the ages of _____ years. A. 6 months and 2 B. 4 and 7 C. 15 and 18 D. 25 and 45 - Allergic purpura is most often seen in children between the ages of 4 and 7 years. Allergic purpura is not often seen in infants, teenagers, or adults. Question 62 A newborn has melena, bleeding from the umbilicus, and hematuria. The newborn most likely experiencing A. vitamin K deficiency bleeding. B. acquired vitamin K deficiency. C. von Willebrand disease. D. disseminated intravascular coagulation. - Vitamin K deficiency bleeding is found in newborns and includes melena, bleeding from the umbilicus, and hematuria. Acquired vitamin K deficiency may include gastrointestinal bleeding, ecchymoses, menorrhagia, and hematuria. von Willebrand disease presents as epistaxis, mucosal bleeding, ecchymoses, gastrointestinal bleeding, and menorrhagia. Disseminated intravascular coagulation includes bleeding from orifices, petechiae, and ecchymoses on skin and mucous membranes. Question 63 Widespread activation of the clotting cascade secondary to massive trauma is called A. hemophilia B. B. disseminated intravascular coagulation (DIC). C. Hageman disease. D. idiopathic thrombocytopenia purpura. - Widespread clotting in small vessels leads to consumption of the clotting factors and platelets, which in turn leads to bleeding. DIC is either acute or chronic and occurs secondary to malignancy, sepsis, snake bites, trauma, shock, burns, and many other factors. Hemophilia B results from factor deficiency or the abnormal function of factor IX. Massive trauma is unrelated to the development of Hageman disease. Immune thrombocytopenia, formerly called idiopathic thrombocytopenia purpura, is an acquired immune-mediated disorder. Question 64 Treatment for hemophilia A includes A. heparin administration. B. factor IX replacement. C. factor VIII replacement. D. platelet transfusion. - Factor VIII administration is a common treatment choice for hemophilia A, particularly with dental procedures requiring local anesthesia. Heparin administration is typically highly contraindicated in an individual with a bleeding disorder although in some cases it is given to patients with DIC. Factor IX may be available as a treatment option for hemophilia B. A platelet transfusion is not of benefit in the hemophilia A patient. Question 65 A 3-year-old boy who exhibits prolonged bleeding after minor trauma and a prolonged aPTT, but a normal platelet count, is likely to be diagnosed with A. hemophilia. B. liver dysfunction. C. disseminated intravascular coagulation. D. Thrombocytopenia. - Hemophilia is rare, but it is the most common severe inherited coagulation disorder. Prolonged bleeding from a minor trauma is a characteristic manifestation. Liver disease is commonly manifested by a decreased platelet count and prolonged coagulation studies. DIC is more often seen in adults as the result of trauma or sepsis. A very low platelet count is often seen in thrombocytopenia. Question 66 A patient is diagnosed with a tortuous blood vessel of the right hand that bleeds spontaneously. This patient presents with A. petechiae. B. purpura. C. telangiectasia. D. Thrombocytosis. - A telangiectasia is a dilated or tortuous small blood vessel found in the skin or mucous membranes that have a tendency to bleed spontaneously or following minor trauma. Petechiae are pinpoint hemorrhages. Purpura is a collection of petechiae. Thrombocytosis is a platelet count above 400,000/mm3. Question 67 Blood flow throughout the periphery is regulated by A. cardiac output. B. the autonomic nervous system. C. velocity. D. Hemodynamics. - Blood flow throughout the periphery is controlled by central mechanisms that are mediated by the autonomic nervous system, the venous and thoracic pumps, and intrinsic autoregulatory mechanisms. Cardiac output does not control peripheral blood flow. Velocity is the measure of distance traveled in a given interval. Hemodynamics is the principle that governs the quantity of blood passing by a given point at a certain period. Question 68 Transfusion reactions involve RBC destruction caused by A. donor antigens. B. recipient antibodies. C. donor T cells. D. recipient T cells. - The recipient of the blood transfusion has antibodies to the donor’s red blood cell (RBC) antigens; the antibodies destroy large numbers of RBC. Donor antigens, donor T, and recipient T cells do not cause transfusion reactions. Question 69 Which type of leukemia primarily affects children? A. ALL (acute lymphoid leukemia) B. CLL (chronic lymphoid leukemia) C. AML (acute myeloid leukemia) D. CML (chronic myeloid leukemia)  - ALL is primarily a disorder of children. The peak incidence occurs between the ages of 3 and 7 years. The average age of patients with CLL is about 65 to 70 years. The median age of presentation of AML is 64 years. Average onset of CML is between 40 and 50 years. Question 70 Autologous stem cell transplantation is a procedure in which A. there is a high rejection rate. B. stem cells are transferred to the patient from an HLA-matched donor. C. stem cells are transferred to the patient from an identical twin. D. stem cells are harvested from the patient and then returned to the same patient. - In autologous transplantation, the stem cells are collected from the patient’s own blood and then stored and reinfused in the same patient after chemotherapy and radiation. The use of autologous transplants eliminates the problem of graft-versus-host disease. Transplant from a closely matched donor is known as allogeneic transplant. In autologous transplant, stem cells are used from the patient’s own blood. Question 71 A child with a history of recent strep throat infection develops glomerulonephritis. This is most likely a type _____ hypersensitivity reaction. A. I B. II C. III D. IV - Immune complex glomerulonephritis (an inflammatory renal disorder) is an example of a type III hypersensitivity reaction. The circulating immune complex is then deposited in the glomerular capillary wall and mesangium. Glomerulonephritis secondary to strep throat is not a type I, II, or IV sensitivity reaction. Question 72 What is the correct definition of complete remission (CR) of leukemia? A. CR is the absence of leukemic cells in the blood. B. CR is less than 5% blasts in marrow and normal CBC values. C. CR is absence of leukemic cells regardless of CBC values. D. CR is less than 5% leukemic cells in the blood. - Complete remission (CR) is a return to normal hematopoiesis. The bone marrow must have less than 5% blasts and must be maintained for at least 4 weeks in order to achieve CR. CR is an absence of leukemic cells, in addition to normal red cell, platelet, and neutrophil counts. CR must include normal hematopoiesis as well as an absence of leukemic cells. CR must include less than 5% blasts in marrow in addition to no detectible neoplastic cells. Question 73 A diagnostic laboratory finding in myeloma is A. Bence Jones proteins in the urine. B. decreased platelet count. C. increased IgM antibody titer. D. elevated blood glucose levels. - Bence Jones protein in the urine is a common clinical manifestation of plasma cell myeloma. It is also known to accumulate in the kidneys and cause kidney damage. Decreased platelet count is not usually a finding in plasma cell myeloma. IgM is not a factor in plasma cell myeloma. Glucose levels are not directly impacted in plasma cell myeloma. Question 74 Which clinical finding is indicative of compartment syndrome? A. Peripheral edema B. Absent peripheral pulses C. Redness and swelling D. Atrophy of distal tissues - Compartment syndrome creates an effective absence of arterial circulation to an extremity. Swelling within a cast or tight dressing may contribute to the development of compartment syndrome. Compartment syndrome creates pallor in the affected extremity. Acute arterial occlusion is an emergency, and could result in profound ischemia in the involved limb. Question 75 What laboratory finding is usually found in aplastic anemia? A. Leukocytosis B. Thrombocythemia C. Neutrophilia D. Pancytopenia - Aplastic anemia is a stem cell disorder affecting the bone marrow mass. It is usually caused by toxic, radiant, or immunologic injury to the bone marrow stem cells, which causes a decrease in red cells, white cells, and platelets, or pancytopenia. Thrombocythemia causes an increased number of platelets and is not found in aplastic anemia. Leukocytosis indicates a higher white blood count and is not found in aplastic anemia. The presence of neutrophils in laboratory findings does not indicate a diagnosis of aplastic anemia. Question 76 Thalassemia may be confused with iron-deficiency anemia, because they are both A. hyperchromic. B. microcytic. C. genetic. D. responsive to iron therapy. - Both thalassemia and iron-deficiency anemia reveal hypochromic, microcytic red cells. Thalassemia and iron-deficiency red cells are hypochromic. Genetics play a role in thalassemia, and are found primarily in Asian individuals. Iron-deficiency anemia is responsive to iron therapy, but thalassemia patients have increased iron absorption. Question 77 Dysfunction of which organ would lead to clotting factor deficiency? A. Liver B. Kidney C. Spleen D. Pancreas - The liver is responsible for the synthesis of coagulation factors. A clotting factor deficiency is the result of liver dysfunction. Coagulation does not occur in the kidneys. About 25% of the total number of platelets can be found in the spleen. The pancreas is not a location where coagulation occurs. Question 78 A cause of thrombocytopenia includes A. hypoxemia. B. reduced erythropoietin. C. chemotherapy. D. secondary polycythemia.  - Bone marrow suppression from chemotherapy, recent immunizations, and alcohol ingestion are common causes of platelet production. Underlying systemic diseases may be presently related to bleeding problems. Hypoxemia is not directly associated with thrombocytopenia. A reduction in erythropoietin is not associated with alterations in coagulation. Secondary polycythemia is not a cause of thrombocytopenia. Week 3———————————————————— Question 1 A patient has a history of falls, syncope, dizziness, and blurred vision. The patient’s symptomatology is most likely related to A. hypertension. B. hypotension. C. deep vein thrombosis. D. angina. - Hypotension is low blood pressure characterized by dizziness, blurred vision, syncope, and injury from falls. Hypertension is high blood pressure characterized by headache, confusion, chest pain, and difficulty breathing. Deep vein thrombosis is evidenced by calf pain or tenderness. Angina is characterized by chest, shoulder, or jaw pain Question 2 A patient with a history of myocardial infarction continues to complain of intermittent chest pain brought on by exertion and relieved by rest. The likely cause of this pain is A. stable angina. B. myocardial infarction. C. coronary vasospasm. D. unstable angina. - Stable angina is the most common form of chest pain and is characterized by pain that is caused under conditions of increased myocardial workload, such as physical exertion or emotional strain. Pain related to myocardial infarction is not relieved by rest. Coronary vasospasm is characterized by unpredictable attacks of angina pain. A patient with unstable angina presents with symptoms similar to myocardial infarction. Question 3 Rheumatic heart disease is most often a consequence of A. chronic intravenous drug abuse. B. viral infection with herpesvirus. C. β-hemolytic streptococcal infection. D. cardiomyopathy. - Rheumatic heart disease is an uncommon but serious consequence of rheumatic fever. Rheumatic fever is an acute inflammatory disease that follows infection with group A β-hemolytic streptococci. Rheumatic heart disease is not associated with chronic IV drug abuse. Rheumatic fever is an acute inflammatory infectious disease. Cardiomyopathy does not cause rheumatic heart disease. Question 4 The ingestion of certain drugs, foods, or chemicals can lead to secondary hypertension. True False - The ingestion of certain drugs, foods, or chemicals can lead to secondary hypertension Question 5 Patients presenting with symptoms of unstable angina and no ST segment elevation are treated with A. cardiac catheterization. B. antiplatelet drugs. C. acute reperfusion therapy. D. cardiac biomarkers only. - Patients presenting with symptoms of unstable angina and no ST elevation on the ECG would be treated with antiplatelet drugs as a cornerstone of therapy. Coronary angiography may be used as an additional method of diagnosis but would not be the primary option. The patient with symptoms of unstable angina would not benefit from reperfusion strategies. Cardiac biomarkers may be assessed in the unstable angina patient, but are not the primary indicator. Question 6 Hypertension is closely linked to A. obstructive sleep apnea. B. urinary tract infection. C. de Quervain syndrome. D. spinal stenosis. - Hypertension is present in 45% to 60% of those diagnosed with obstructive sleep apnea. Urinary tract infection is not directly linked to hypertension. de Quervain syndrome is a type of tendonitis and is not linked to hypertension. Spinal stenosis is not closely associated with hypertension. Question 7 Critically ill patients may have parenterally administered vasoactive drugs that are adjusted according to their _____ pressure. A. systolic B. mean arterial C. diastolic D. pulse - The mean arterial pressure is used to make incremental adjustments to vasoactive drugs. The MAP is the calculated average pressure within the circulatory system throughout the cardiac cycle. The systolic pressure is a part of the calculation but is not the data element used in adjustment of vasoactive medications. The diastolic reading is involved in calculating the MAP, but is not the number used in titration of vasoactive medications. The pulse pressure is the difference between the systolic and diastolic pressure. Question 8 An example of an acyanotic heart defect is A. tetralogy of Fallot. B. transposition of the great arteries. C. ventricular septal defect. D. all right-to-left shunt defects. - An example of an acyanotic heart defect is a ventricular septal defect. In this condition, blood from the left ventricle leaks into the right ventricle because of a defect in the ventricular wall. This leakage causes extra pressure in the right ventricle resulting in pulmonary hypertension. Tetralogy of Fallot is a cyanotic congenital defect. Transposition of the great vessels is a cyanotic congenital defect. The category of cyanotic congenital defects refers to those that are right-to-left shunts. Question 9 Aortic regurgitation is associated with A. diastolic murmur. B. elevated left ventricular/aortic systolic pressure gradient. C. elevated systemic diastolic blood pressure. D. shortened ventricular ejection phase. - Aortic regurgitation results from an incompetent aortic valve that allows blood to leak back from the aorta into the left ventricle during diastole. In aortic regurgitation, there is not an elevated left ventricular/aortic pressure gradient. Diastolic blood pressure is generally lower because of rapid runoff of blood into the ventricle. Aortic regurgitation is associated with a longer ventricular ejection phase. Question 10 While hospitalized, an elderly patient with a history of myocardial infarction was noted to have high levels of low-density lipoproteins (LDLs). What is the significance of this finding? A. Increased LDL levels are associated with increased risk of coronary artery disease. B. Measures to decrease LDL levels in the elderly would be unlikely to affect the progression of this disease. C. Increased LDL levels are indicative of moderate alcohol intake, and patients should be advised to abstain. D. Elevated LDL levels are an expected finding in the elderly and therefore are not particularly significant. - High levels of low-density lipoproteins (LDLs), which are high in cholesterol, have been associated with the highest risk of coronary atherosclerosis. Even when lipid metabolism is normal, a high-fat diet can overwhelm the liver’s ability to clear LDL cholesterol from the circulation and result in hyperlipidemia. Dietary fat restriction may be beneficial in reducing cholesterol in this case. Increased LDL levels are not indicative of alcohol intake. Elevated LDL levels are not an expected finding in the elderly and should be treated. Question 11 Which blood pressure reading is considered to be indicative of prehypertension according to the JNC-7 criteria? A. 118/78 B. 128/82 C. 140/88 D. 138/94 - In adults, a normal blood pressure is <120 mm Hg systolic and <80 mm Hg diastolic pressure. Stage 1 hypertension begins with a systolic pressure of 140 mm Hg or a diastolic pressure of 90 mm Hg. Between these values, the individual is said to have prehypertension, and interventions related to lifestyle changes should be initiated for primary hypertension. 118/78 is considered normal. An individual with a reading of 140/88 or 138/94 may be considered to have stage 1 hypertension. Question 12 An elderly patient’s blood pressure is measured at 160/98. How would the patient’s left ventricular function be affected by this level of blood pressure? A. This is an expected blood pressure in the elderly and has little effect on left ventricular function. B. Left ventricular workload is increased with high afterload. C. High blood pressure enhances left ventricular perfusion during systole. D. High-pressure workload leads to left ventricular atrophy. Question 13 A patient with significant aortic stenosis is likely to experience A. syncope. B. hypertension. C. increased pulse pressure. D. peripheral edema. Question 14 High blood pressure increases the workload of the left ventricle, because it increases A. stroke volume. B. blood volume. C. preload. D. afterload. - Hypertension reflects an elevation in SVR; rising afterload increases myocardial oxygen demand and overall cardiac workload. The workload of the left ventricle does not increase the stroke volume, blood volume, or preload. Question 15 A middle-aged patient has a follow up visit for a recorded blood pressure of 162/96 mm Hg taken 3 weeks ago. The patient has no significant past medical history and takes no medications, but smokes 1 1/2 packs of cigarettes per day, drinks alcohol regularly, and exercises infrequently. The patient is about 40 lbs. overweight and admits to a high-fat, high-calorie diet. At the office visit today, the patient’s blood pressure is 150/92 mm Hg. What is the least appropriate intervention for this patient at this time? A. Begin lifestyle modifications. B. Begin antihypertensive drug therapy. C. Recheck blood pressure in 4 to 6 weeks. D. Encourage smoking cessation. - Antihypertensive drug therapy is not the first intervention in a person with modifiable risk factors. Therefore, lifestyle alterations are attempted first. Lifestyle alterations include exercise, smoking cessation, and weight loss. Blood pressure should be rechecked in 4 to 6 weeks. Smoking cessation counseling is an appropriate lifestyle alteration. Question 16 Angiotensin-converting enzyme (ACE) inhibitors block the A. release of rennin. B. conversion of angiotensin I to angiotensin II. C. conversion of angiotensinogen to angiotensin I. D. effect of aldosterone on the kidney. - Angiotensin I is converted into angiotensin II while it is circulating through the pulmonary vessels, by the angiotensin-converting enzyme. ACE inhibitors block the conversion of angiotension I to angiotension II. Renin plays a role in the regulation of arterial blood pressure. ACE inhibitors do not block the conversion of angiotensinogen to angiotensin or the effect of aldosterone on the kidney. Question 17 After being diagnosed with hypertension, a patient returns to the clinic 6 weeks later. The patient reports “moderate” adherence to the recommended lifestyle changes and has experienced a decreased from 165/96 to 148/90 mm Hg in blood pressure. What is the most appropriate intervention for this patient at this time? A. Continue lifestyle modifications only. B. Continue lifestyle modifications plus diuretic therapy. C. Continue lifestyle modifications plus ACE inhibitor therapy. D. Continue lifestyle modifications plus b-blocker therapy. - The patient should be encouraged to continue compliance with lifestyle changes since the patient has exhibited some positive response to his changes. Diuretics are not needed at this time. ACE inhibitors should not be added to the therapy yet. β-blockers are not required at this time. Question 18 A patient presents to the emergency department with a diastolic blood pressure of 132 mm Hg, retinopathy, and symptoms of an ischemic stroke. This symptomology is likely the result of A. arthrosclerosis. B. angina. C. myocardial infarction. D. hypertensive crisis.  - Hypertensive crisis is characterized by a diastolic blood pressure of greater than 120 mm Hg, and symptoms of end-organ damage such as retinopathy and ischemic stroke. Blood pressure is not an indication of arthrosclerosis. Angina may accompany hypertensive crisis, but the question stem relates directly to hypertensive crisis. The patient may be having a myocardial infarction, but the addition of end-organ damage symptoms points to hypertensive crisis. Question 19 Angina caused by coronary artery spasm is called _____ angina. A. stable B. classic C. unstable D. Prinzmetal variant Question 20 Constrictive pericarditis is associated with A. impaired cardiac filling. B. cardiac hypertrophy. C. increased cardiac preload. D. elevated myocardial oxygen consumption. - Constrictive pericarditis results in a fibrous scarred pericardium that restricts cardiac filling. Chronic pericarditis may be the result of a previous cardiac surgery. Pericarditis is associated with increased workload of the heart because contraction is opposed by the surrounding structures. The constrictive process includes symptoms of exercise intolerance, weakness, and fatigue. Question 21 The therapy that most directly improves cardiac contractility in a patient with systolic heart failure is A. afterload reduction. B. β-antagonist agents. C. preload reduction. D. digitalis. - Digitalis may be used for symptom management of heart failure. Cardiac glycosides directly inhibit the sodium-potassium pump present in the cell membrane of all cells. The intracellular changes allow more calcium to remain in the cell, thus strengthening myocardial contraction. Contractility is not improved through afterload reduction. Beta-blockers inhibit the effects of sympathetic activation and have the potential to reduce cardiac output. Preload reduction is not the therapy of choice in improving cardiac contractility. Question 22 The common denominator in all forms of heart failure is A. poor diastolic filling. B. reduced cardiac output. C. pulmonary edema. D. tissue ischemia. Question 23 After sitting in a chair for an hour, an elderly patient develops moderate lower extremity edema. His edema is most likely a consequence of A. arterial obstruction. B. isolated left-sided heart failure. C. right-sided heart failure. D. peripheral vascular disease.  - The backward effects of right-sided heart failure are as a result of congestion in the systemic venous system and lead to lower extremity edema. Arterial obstruction is not associated with dependent edema of the lower extremities. Left-sided heart failure is associated with pulmonary symptoms. Edema may be associated with peripheral vascular disease, but dependent edema over a 1-hour period is related to right-sided heart failure. Question 24 A patient is exhibiting severe dyspnea and anxiety. The patient also has bubbly crackles in all lung fields with pink, frothy sputum. This patient is most likely experiencing A. right-sided heart failure. B. cardiomyopathy. C. a medication reaction. D. acute cardiogenic pulmonary edema. - Acute cardiogenic pulmonary edema is a life-threatening condition requiring immediate treatment. It is associated with left ventricular failure that severely impairs gas exchange, and produces dramatic signs and symptoms including anxiety, severe dyspnea, an upright posture to breathe effectively, and pink frothy sputum. Right-sided heart failure produces systemic venous congestion. Cardiomyopathy is not associated with bubbly crackles and pink frothy sputum. A medication reaction is not the reason for the patient to exhibit severe dyspnea, anxiety, bubbly crackles, and frothy sputum Question 25 The majority of cases of anaphylactic shock occur when a sensitized individual comes in contact with A. perfumes. B. incompatible blood products. C. animal proteins or dander. D. antibiotics. - Anaphylactic shock is most frequently associated with antibiotic therapy. Contact with perfumes is not the most frequent cause of anaphylactic shock. Incompatible blood products do not lead to anaphylactic shock. Animal dander may lead to an anaphylactic reaction, but does so less commonly than antibiotics. Question 26 Improvement in a patient with septic shock is indicated by an increase in A. cardiac output. B. SvO2. C. systemic vascular resistance. D. serum lactate level. - Systemic vascular resistance results in intravascular pooling in the venous system. Some portions of tissue are overperfused, and some are underperfused. Improvement in systemic vascular resistance is an indication of improvement in septic shock. In septic shock, the heart rate and stroke volume increase, and cardiac output is higher than normal. In septic shock, SvO2 levels may already be higher than normal. An increase in serum lactate levels may increase levels of acidosis and tissue hypoxia. Question 27 Which dysrhythmia is thought to be associated with reentrant mechanisms? A. Second-degree AV block B. Sinus bradycardia C. Junctional escape D. Preexcitation syndrome tachycardia (Wolf-Parkinson-White syndrome) - Reentry is a complex process in which a cardiac impulse continues to depolarize in a part of the heart after the main impulse has finished its path and the majority of the fibers have repolarized. Wolff–Parkinson–White syndrome is caused by accessory pathways that originate in the atria, bypass the AV node, and enter a site in the ventricular myocardium. This causes the ventricles to contract  prematurely, resulting in a reentrant tachycardia. Second-degree block is a conduction failure between the sinus impulse and its ventricular response. Sinus bradycardia is a slowed impulse generation by the sinus node. A junctional escape rhythm originates in the AV node. Question 28 Administration of which therapy is most appropriate for hypovolemic shock? A. Crystalloids B. Vasoconstrictor agents C. Inotropic agents D. 5% dextrose in water - Crystalloids are solutions that contain electrolytes. Isotonic solutions, such as lactated Ringers, are commonly used crystalloid solutions. These solutions are preferred for volume resuscitation, because they remain in the extracellular space and are more effective in increasing blood volume. Vasoconstrictor agents are contraindicated in hypovolemic shock. Isotonic crystalloids are the most appropriate fluid for volume resuscitation. Isotonic fluids are preferred over glucose or hypotonic electrolyte solutions. Question 29 The effect of nitric oxide on systemic arterioles is A. vasodilation. B. vasoconstriction. C. not significant. D. opposed by nitrate drugs. - Nitric oxide causes vasodilation in the systemic arterioles. Vasoconstriction is not associated with nitric oxide. There is a significant effect on the systemic arterioles related to nitric oxide. The effects of nitric oxide are not known to be opposed by nitrate drugs. Question 30 A patient with heart failure who reports intermittent shortness of breath during the night is experiencing A. orthopnea. B. paroxysmal atrial tachycardia. C. sleep apnea. D. paroxysmal nocturnal dyspnea. Question 31 Patients with structural evidence of heart failure who exhibit no signs or symptoms are classified into which New York Heart Association heart failure class? A. Class I B. Class II C. Class III D. Class IV - Patients who have structural heart disease but no signs or symptoms of heart failure are placed in Class I of the NYHA Classes. Class II patients have current or previous symptoms of heart failure. Class III patients have current or previous symptoms of heart failure, such as dyspnea or fatigue. Class IV patients have advanced structural heart disease and marked symptoms at rest. Question 32 Left-sided heart failure is characterized by A. pulmonary congestion. B. decreased systemic vascular resistance. C. jugular vein distention. D. peripheral edema.  - Left-sided heart failure is characterized by pulmonary congestion and edema. Right-sided heart failure is characterized by congestion in the systemic venous system that increases systemic vascular resistance. Jugular vein distention is a classic sign of right-sided heart failure. Peripheral edema is seen in right-sided failure. Question 33 Hypotension associated with neurogenic and anaphylactic shock is because of A. hypovolemia. B. peripheral pooling of blood. C. poor cardiac contractility. D. high afterload. - Profound peripheral vasodilation of both arterioles and veins leads to peripheral pooling of blood and hypotension. Decreased venous return to the heart results in decreased cardiac output and hypotension. Hypovolemia is not the source of the hypotension involved in neurogenic and anaphylactic shock. Cardiac output is generally adequate in neurogenic and anaphylactic shock. Hypotension in neurogenic and anaphylactic shock is not related to high afterload. Question 34 Increased preload of the cardiac chambers may lead to which patient symptom? A. Decreased heart rate B. Decreased respiratory rate C. Edema D. Excitability - Preload reduces glomerular filtration resulting in fluid conservation, or edema. Increased preload may lead to an increased, not decreased, heart rate. Increased preload may lead to shortness of breath and an increased respiratory rate. Increased preload may lead to fatigue, not excitability, as the heart works harder to circulate blood. Question 35 A patient with pure left-sided heart failure is likely to exhibit A. jugular vein distention. B. pulmonary congestion with dyspnea. C. peripheral edema. D. hepatomegaly. - Left-sided heart failure is most often associated with left ventricular infarction and systemic hypertension. The ineffective pumping of the left ventricle results in an accumulation of blood within the pulmonary circulation. As a result, pulmonary congestion with dyspnea is an expected finding. Jugular vein distention is more often associated with right-sided failure. Peripheral edema is associated with right-sided failure. Hepatomegaly is not seen in pure left-sided edema. Question 36 Low cardiac output in association with high preload is characteristic of ________ shock. A. hypovolemic B. cardiogenic C. anaphylactic D. septic - In cardiogenic shock, preload is high and cardiac output is low. In hypovolemic shock, preload and cardiac outputs are both low. In anaphylactic shock, blood volume may be normal. Septic shock is associated with infections. Question 37 Cor pulmonale refers to A. biventricular failure. B. left ventricular hypertrophy secondary to lung disease. C. right ventricular hypertrophy secondary to pulmonary hypertension. D. right ventricular failure secondary to right ventricular infarction. - Pulmonary disorders that result in increased pulmonary vascular resistance impose a high afterload on the right ventricle. The resultant right ventricular hypertrophy known as cor pulmonale may progress to right ventricular failure as the lung disease worsens. Biventricular failure is most often the result of primary left ventricular failure that progresses to the right. Cor pulmonale is not associated with left ventricular hypertrophy. Only 3% of MIs occur in the right ventricle. Question 38 Second-degree heart block type I (Wenckebach) is characterized by A. absent P waves. B. lengthening PR intervals and dropped P wave. C. constant PR interval and dropped QRS complexes. D. no correlation between P waves and QRS complexes. - Type I second-degree block is associated with progressively lengthening PR intervals until one P wave is not conducted and becomes a dropped beat. Second-degree block is not characterized by an absence of P waves. Type II second-degree block is associated with a consistent PR interval and dropped beats. The ECG of third-degree block shows regularly occurring P waves that are independent of the ventricular rhythm. Question 39 In which dysrhythmias should treatment be instituted immediately? A. Asymptomatic sinus bradycardia at a heart rate of 50 beats/minute B. Fever-induced tachycardia at 122 beats/minute C. Premature atrial complexes occurring every 20 seconds D. Atrial fibrillation with a ventricular rate of 220 beats/minute - Atrial fibrillation is a completely disorganized and irregular atrial rhythm accompanied by an irregular ventricular rhythm of variable rate. Atrial fibrillation causes the atria to quiver rather than to contract forcefully. This allows blood to become stagnant in the atria and may lead to formation of thrombi. This condition requires resuscitation because of the reduction in cardiac output. The cause of the bradycardia should be investigated, but is not treated emergently when an individual is not exhibiting any symptoms. Fever-induced tachycardia will correct itself once the fever is lowered. Dysrhythmias are treated if they produce significant symptoms or are expected to progress to a more serious level. Question 40 Sepsis has been recently redefined as A. a systemic infection with viable organisms in the bloodstream. B. a systemic inflammatory response to ischemia. C. a systemic inflammatory response to infection. D. severe hypotension in an infected patient. - Systemic inflammatory response syndrome is the body’s response to infection or other insults, which result in systemic signs and symptoms of widespread inflammation. Sepsis results from the presence of microorganisms in the bloodstream (bacteremia). Sepsis occurs as a result of bacteremia and is defined as a systemic inflammatory response to infection. Severe hypotension may be the result of sepsis, but it is not the definition. 1. Restriction of which electrolytes is recommended in the management of high blood pressure? A. Sodium - The balance of the intake of water and sodium with their excretion by the kidney remains the central feature of long-term blood pressure maintenance. Sodium is not rapidly eliminated by the  kidney like water and adds to the body’s fluid volume. It is not necessary to restrict the intake of calcium when managing high blood pressure. Potassium does not need to be restricted in the management of high blood pressure. Magnesium does not play a role in the management of high blood pressure. 2. Primary treatment for myocardial infarction (MI) is directed at A. decreasing myocardial oxygen demands. - Reducing oxygen demand may be effective in preserving myocardial muscle. Decreasing demand increases myocardial oxygen supply. Once the cardiac muscle has been damaged, it is more important to preserve remaining muscle and prevent further loss of the myocardium. Reduction in the heart rate and blood pressure is not the primary treatment goal in MI care. Parasympathetic activation is not the primary treatment for myocardial infarction. 3. What compensatory sign would be expected during periods of physical exertion in a patient with limited ventricular stroke volume? A. Tachycardia - An individual with reduced stroke volume would exhibit compensatory increases in heart rate. Hypertension is associated with decreased ventricular stroke volume. An individual with reduced stroke volume would exhibit compensatory increases in heart rate; therefore, bradycardia would not be expected. Aortic regurgitation would not be an expected compensatory sign of limited stroke volume. 4. What results when systemic blood pressure is increased? A. Vasoconstriction - At the smooth muscle of the arterial system, neurotransmitters bind to receptors to initiate vasoconstriction and increase systemic vascular resistance. An increase in vascular resistance causes the heart to work harder and thus increases blood pressure. Hypovolemia does not result in an increase in blood pressure. Cardiac output is not decreased when systemic blood pressure is increased. Vascular resistance is actually increased when the systemic blood pressure is increased. 5. Mitral stenosis is associated with A. a pressure gradient across the mitral valve. - Mitral stenosis is characterized by an abnormal left atrial–left ventricular pressure gradient during ventricular diastole. Mitral stenosis is not associated with an S4 heart sound. Mitral stenosis is associated with left atrial hypertrophy, not left ventricular hypertrophy. Mitral stenosis does not have a symptom of a muffled second heart sound. 6. Which finding is indicative of orthostatic hypotension in a person with a supine blood pressure (BP) of 110/70 and a heart rate (HR) of 100? A. Sitting BP 88/60, HR 118 - The definition of orthostatic hypotension is a decrease in systolic blood pressure greater than 20 mm Hg or a decrease in systolic pressure that is greater than 10 mm Hg within 3 minutes of moving to an upright position. The measurements of BP 108/68, HR 102 and BP 110/78, HR 98 are not indicative of orthostatic hypotension. An increase in blood pressure do not occur with orthostatic hypotension. 7. A patient is diagnosed with cardiogenic shock. The patient is hyperventilating and is therefore at risk for the respiratory complication of respiratory acidosis. A. False - A patient diagnosed with cardiogenic shock who is hyperventilating is at risk for respiratory alkalosis. 8. A loud pansystolic murmur that radiates to the axilla is most likely a result of  A. mitral regurgitation. - The murmur of mitral regurgitation usually occurs throughout ventricular systole (pansystolic), radiates toward the left axilla, and has a high-pitched blowing character. Aortic insufficiency is characterized by a high-pitched blowing murmur during ventricular diastole. A characteristic murmur of aortic stenosis occurs during ventricular systole and varies in intensity, progressively getting louder and then diminishing (crescendo-decrescendo). The murmur of aortic stenosis generally radiates to the neck. Blood rushing through the narrowed mitral valve during ventricular diastole can sometimes be heard as a low-pitched, rumbling diastolic murmur at the heart’s apex. 9. The prevalence of high blood pressure is higher in A. non-Hispanic black adults. - The prevalence of high blood pressure remains higher among non-Hispanic black adults. Non-Hispanic white adults have a lower prevalence of high blood pressure. Mexican-American adults have a lower prevalence than black adults. Asian children do not display a high prevalence for high blood pressure. 10. Patent ductus arteriosus is accurately described as a(n) A. communication between the aorta and the pulmonary artery. - A patent ductus arteriosus is a normal channel between the pulmonary artery and the aorta that remains open during intrauterine life. A patent ductus arteriosus is not an opening or a stricture in the atria. Patent ductus arteriosus is an acyanotic congenital defect 11. Which serum biomarker(s) are indicative of irreversible damage to myocardial cells? A. Elevated CK-MB, troponin I, and troponin T - Elevated cardiac biomarkers are one indication of myocardial necrosis. Cardiac biomarkers may not be utilized if a patient presents with chest pain and evidence of acute ischemia on the electrocardiogram. Cardiac biomarkers are elevated in the presence of MI. Elevated LDL is a risk factor for coronary atherosclerosis. Coagulation times are not used to assess myocardial damage. 12. Lactated Ringer solution and normal saline are commonly used crystalloid solutions that contain electrolytes. True - Lactated Ringer solution and normal saline are commonly used crystalloid solutions that contain electrolytes. 13. Cardiogenic shock is characterized by A. reduced cardiac output. - Cardiogenic shock occurs primarily as a result of severe dysfunction of the left or right ventricles, or both, that results in inadequate cardiac pumping. The low cardiac output state is associated with a high left ventricular diastolic filling pressure. Cardiogenic shock is not manifested by hypovolemia. Sympathetic activation leads to increases in heart rate, vasoconstriction, and a narrow pulse pressure. Low cardiac output leads to reduced SvO2. 14. A type of shock that includes brain trauma that results in depression of the vasomotor center is cardiogenic. False - A type of shock that includes brain trauma that results in depression of the vasomotor center is neurogenic shock. 15. Chronic elevation of myocardial wall tension results in atrophy. False - Chronic elevation of myocardial wall tension results in hypertrophy. 16. Administration of a vasodilator to a patient in shock would be expected to A. decrease left ventricular afterload. - Vasodilators are used to decrease the workload of the heart by decreasing left ventricular afterload. Nitroprusside and nitroglycerin are examples of vasodilators. Dobutamine is used to decrease vascular resistance. Positive inotropic drugs are used to increase contractility. Positive inotropes include β-adrenergic agonists, which have the ability to increase tissue perfusion. 17. Overproduction of nitric oxide is an important aspect of the pathophysiologic process of what type of shock? A. Septic - The overproduction of nitric oxide is seen in septic shock as a result of the release of immune cytokines. Nitric oxide is not seen in cardiogenic shock. Hypovolemic shock is not associated with the overproduction of nitric acid. The pathophysiologic process of anaphylactic shock is not associated with the overproduction of nitric oxide. 18. Lusitropic impairment refers to A. impaired diastolic relaxation. - Lusitropic impairment refers to an energy-requiring process that removes free calcium ions from the cytoplasm by pumping them back into the sarcoplasmic reticulum and across the cell membrane into the extracellular fluid. Ischemia interferes with this process in the active phase of diastolic relaxation. Poor contractile force is not associated with lusitropic impairment. The conduction rate is not associated with the energy-requiring process known as lusitropy. Automaticity is not a factor in lusitropy. 19. Tachycardia is an early sign of low cardiac output that occurs because of A. baroreceptor activity. - A number of compensatory responses are set in motion to restore tissue perfusion and oxygenation in the early stage of shock. Baroreceptors located in the aorta and carotid arteries quickly sense the decrease in pressure and transmit signals to the vasomotor center in the brainstem medulla. The sympathetic nervous system stimulates β1 receptors, which respond by increasing the heart rate in an attempt to increase cardiac output. Tachycardia is not caused initially by tissue hypoxia. An early sign of low cardiac output is not anxiety. Tachycardia does not occur because of acidosis. 20. A laboratory test that should be routinely monitored in patients receiving digitalis therapy is A. serum potassium. - Digitalis slows the heart rate through parasympathetic system activation and promotes sodium and water excretion through improved cardiac output to the kidney. Depletion of serum potassium (hypokalemia) may potentiate digitalis toxicity. Sodium and water excretion is activated through the parasympathetic system because of improved cardiac output to the kidneys. Albumin level is not affected by digitalis. Digitalis allows more calcium to remain in the cell through a slowing of the sodium-dependent calcium pump. 21. The progressive stage of hypovolemic shock is characterized by A. tachycardia. - In the progressive stage of hypovolemic shock, the patient is anxious and confused, with decreased blood pressure and heart rate greater than 120 beats/minute. In this stage of shock, the blood pressure is decreased. Lactic acidosis does not occur in the progressive stage of  hypovolemic shock. Cardiac failure is not likely to occur in the earlier stages of hemorrhagic shock. 22. First-degree heart block is characterized by A. prolonged PR interval. - First-degree block is generally identified by a prolonged PR interval (more than 0.20 second) on ECG. P waves are not absent in first-degree heart block. A widened QRS complex is associated with a particular dysrhythmia, but not first-degree heart block. A variable PR interval is found in type I second-degree block. 23. In which stage of shock is a patient who has lost 1200 mL of blood, who has normal blood pressure when supine, but who experiences orthostatic hypotension upon standing? A. Class II, Compensated Stage - In compensated stage hemorrhage (Class II), the blood loss is between 750 and 1500 mL. Blood pressure remains normal when the patient is supine but decreases upon standing. In initial stage hemorrhage (Class I) blood loss is up to 750 mL, and the patient’s vital signs remain normal. Class III hemorrhage (progressive stage) is blood loss of 1500 and 2000 mL. Vital signs are changing. Severe Class IV hemorrhage (refractory stage) occurs when more than 2000 mL is lost. The patient is lethargic, with severe hypotension. 24. The most reliable indicator that a person is experiencing an acute myocardial infarction (MI) is A. ST-segment elevation. - Injuries to cardiac tissue caused by myocardial ischemia and infarction are indicated on the ECG by ST-segment changes. ST-segment elevation on the ECG indicates that ischemic injury is ongoing and that efforts to improve perfusion or reduce oxygen demand may be effective in preserving myocardial muscle. In some instances, an MI is entirely asymptomatic. Dysrhythmias that accompany MI are attr