ADV AP Exam 1 Flashcards
This disease is caused by a deletion of part of the short
arm of chromosome 5.
Cri du chat
Broken chromosomes and lost DNA cause deletions. Usually, a gamete with a deletion unites
with a normal gamete to form a zygote. The zygote thus has one chromosome with the normal
complement of genes and one with some missing genes. Because many genes can be lost in a
deletion, serious consequences result, even though one normal chromosome is present. The most
often cited example of a disease caused by a chromosomal deletion is this syndrome:
Cri du chat
The term literally means “cry of the cat” and describes the characteristic cry of the affected child.
Other symptoms include low birth weight, severe intellectual disability, microcephaly (smaller
than normal head size), and heart defects.
Cri du chat
- Not considered to be intellectually
disabled, although some impairment of spatial and mathematical reasoning ability is found. - Male/ female
findings: found only in females. - Musculoskeletal system: Short stature common, characteristic webbing of
neck, widely spaced nipples, reduced carrying angle at elbow Systemic disorders Coarctation (narrowing)
of aorta, edema of feet in newborns, usually sterile and have gonadal streaks rather than ovaries; streaks
are sometimes susceptible to cancer Mortality About 15%-20% of spontaneous abortions with
chromosome abnormalities have this karyotype, most common single-chromosome aberration; highly
lethal during gestation, only about 0.5% of these conceptions survive to term
Turner’s
Causative factors 75%
inherit X chromosome from mother, thus caused by meiotic error in father.
Turner’s
The gene responsible for this disease encodes a chloride ion channel in some epithelial cells.
Cystic fibrosis
Defective
transport of chloride ions leads to a salt imbalance, which results in secretions of abnormally thick,
dehydrated mucus. Some digestive organs, particularly the pancreas, become obstructed, causing
malnutrition, and the lungs become clogged with mucus, making them highly susceptible to bacterial
infections.
Cystic fibrosis
Death from lung disease or heart failure occurs before age 40 years in about half the
individuals with this disease.
Cystic fibrosis
4-1. A report comes back indicating that muscular atrophy has occurred. A nurse recalls that
muscular atrophy involves a decrease in muscle cell:
a. number.
b. size.
c. vacuoles.
d. lipofuscin.
ANS: B
Atrophy is a decrease or shrinkage in cellular size. Hyperplasia is an increase in the number of
cells. Vacuoles are membrane-bound vesicles within the cell that contain cellular debris and
hydrolytic enzymes. Lipofuscin is the yellow-brown age pigment.
4-2. During childhood, the thymus decreases in size, and this is referred to as what type of
atrophy?
a. Physiologic
b. Pathologic
c. Disuse
d. Neurogenic
ANS: A
A normal decrease in cell size is physiologic atrophy. Atrophy can result from disease
(pathologic), disuse, or nerve injury (neurogenic).
4-3. When planning care for a cardiac patient, the nurse knows that in response to an increased
workload, cardiac myocardial cells will experience hypertrophy which is an:
a. increase in size.
b. decrease in length.
c. increase in excitability.
d. decrease in number.
ANS: A
Hypertrophy is a compensatory increase in the size of cells in response to mechanical stimuli
(also called mechanical load or stress, such as from stretching, repetitive, chronic, pressure, or
volume overload) and consequently increases the size of the affected organ. The cells of the
heart and kidneys are particularly prone to enlargement. A decrease in length is not associated
with hypertrophy. A deficiency of electrolytes or minerals could lead to an increase in
excitability; it is not due to increased workload or related to hypertrophy. A decrease in cell
numbers is referred to as hypoplasia.
4-4. A 55-year-old male with a 30-year history of smoking is examined for respiratory disturbance.
Examination of his airway (bronchial) reveals that stratified squamous epithelial cells have
replaced the normal columnar ciliated cells. This type of cellular adaptation is called:
a. anaplasia.
b. hyperplasia.
c. metaplasia.
d. dysplasia.
ANS: C
Metaplasia is the reversible replacement of one mature cell type by another, sometimes a less
differentiated cell type. Anaplasia is loss of cellular differentiation. Hyperplasia is an increase
in the number of cells resulting from an increased rate of cellular division. Dysplasia refers to
abnormal changes in the size, shape, and organization of mature cells.
4-5. When planning care for the pregnant patient, the nurse will recall that the mammary glands
enlarge as a consequence of:
a. compensatory hyperplasia.
b. hormonal hyperplasia.
c. hormonal anaplasia.
d. compensatory anaplasia.
ANS: B
An increase in the mammary glands during pregnancy is a result of hormonal changes. The
number of mammary cells increases in response to increased hormone levels, not as a
compensatory mechanism. Anaplasia is a reversal to less mature cells.
4-6. A 24-year-old female presents with excessive menstrual bleeding. The physician identified
endometrial changes that are due to hormonal imbalances. These cellular changes would be
referred to as:
a. dysplasia.
b. pathologic dysplasia.
c. hyperplasia.
d. pathologic hyperplasia
ANS: D
Because the changes are due to an imbalance, they would be considered pathologic
hyperplasia, a term more descriptive than simple hyperplasia. The endometrial changes were
not abnormal in size and shape; thus, it is not dysplasia regardless of cause.
4-7. A 55-year-old male is diagnosed with hepatocellular cancer secondary to hepatitis C. If the
cancerous region of the liver is removed, the remaining cells would undergo:
a. pathologic hyperplasia.
b. pathologic metaplasia.
c. compensatory hyperplasia.
d. compensatory aplasia.
ANS: C
Compensatory hyperplasia is an adaptive, not pathologic, mechanism that enables certain
organs to regenerate. Metaplasia is the reversible replacement of one mature cell type by
another, sometimes less differentiated, cell type. Aplasia is not a compensatory mechanism.
4-8. A 40-year-old female’s Pap smear indicates abnormal changes in the shape and organization
of cervical cells. Which term would be used to identify this type of change?
a. Metaplasia
b. Atrophy
c. Hypertrophy
d. Dysplasia
ANS: D
When cervical cells undergo dysplasia, there is a change in their size, shape, and organization.
Metaplasia is the reversible replacement of one mature cell type. The cells have not decreased
in size; therefore, atrophy is incorrect. The cells have not increased in size in response to
stimuli; therefore, they have not hypertrophied.
2-19. A patient, age 9, is admitted to a pediatric unit with Duchenne muscular dystrophy. When
planning care, the nurse recalls the patient inherited this condition through a trait that is:
a. X-linked dominant.
b. X-influenced.
c. X-limited.
d. X-linked recessive.
ANS: D
Duchenne muscular dystrophy is a relatively common X-linked recessive, not dominant,
disorder. While it is sex linked, it is not X-limited or X-influenced.
A relatively common X-linked recessive disorder is __________, which affects
approximately 1 in 3500 males.
Duchenne muscular dystrophy (DMD)
As its name suggests, this disorder is characterized by progressive muscle
degeneration.
Duchenne (DMD)
Affected individuals usually are unable to walk by age 10 or 12 years.
Duchenne DMD
The ________ gene is
the largest gene ever found in humans, spanning more than 2 million DNA bases. It encodes a previously
undiscovered muscle protein, termed dystrophin. Extensive study of dystrophin indicates that it plays an
essential role in maintaining the structural integrity of muscle cells: it may also help regulate the activity
of membrane proteins.
DMD Duchenne
Most cases of _____ are caused by frameshift deletions of portions of the _____ gene
and thus involve alterations of the amino acids encoded by the DNA following the deletion. The most
common mating type involving X-linked recessive genes is the combination of a carrier female and a
normal male.
DMD Duchenne
On average, the carrier mother will transmit the disease-causing allele to half
her sons (who are affected) and half her daughters (who are carriers).
Duchenne DMD
2-10. After a geneticist talks to a patient about being a chromosomal mosaic, the patient asks the
nurse what that means. How should the nurse respond? You may _____ genetic disease(s).
a. only be a carrier of the
b. have a mild form of the
c. have two
d. be sterile as a result of the
ANS: B
A chromosomal mosaic means the body has two or more different cell lines, each of which
has a different karyotype; thus, the person has a mild form of the disease. Mosaics are not
only carriers; they have the disease; they have two different lines but not two different
diseases; and they are not necessarily sterile.
2-14. What genetic disorder is the result if an individual possesses an XXY chromosome
configuration?
a. Turner
b. Klinefelter
c. Down
d. Fragile X
ANS: B
Individuals with at least two X chromosomes and one Y chromosome in each cell (47 XXY
karyotype) have a disorder known as Klinefelter syndrome. A condition with the presence of a
single X chromosome and no homologous X or Y chromosome, so the individual has a total
of 45 chromosomes, is known as Turner syndrome. Down syndrome is a trisomy. Fragile X
syndrome is due to a break or a gap in a chromosome, not an extra chromosome.
2-23. What is the diagnosis of a 13-year-old female who has a karyotype that reveals an absent
homologous X chromosome with only a single X chromosome present? Her features include a
short stature, widely spaced nipples, and a reduced carrying angle at the elbow.
a. Down syndrome
b. Cri du chat syndrome
c. Turner syndrome
d. Klinefelter syndrome
ANS: C
Turner syndrome is characterized by short stature, female genitalia, webbed neck, shield-like
chest with underdeveloped breasts and widely spaced nipples, and imperfectly developed
ovaries. Down syndrome is characterized by distinctive characteristics: low nasal bridge,
epicanthal folds, protruding tongue, and low-set ears. Cri du chat syndrome is characterized
by low birth weight, severe mental retardation, microcephaly (smaller than normal head size),
and heart defects. Klinefelter syndrome is characterized by small testes, some development of
the breasts, sparse body hair, and long limbs.
2-21. A 12-year-old male is diagnosed with Klinefelter syndrome. His karyotype would reveal
which of the following?
a. XY
b. XX
c. XYY
d. XXY
ANS: D
A person with Klinefelter syndrome has an XXY karyotype. An XY is a normal male. An XX
is a normal female. An XYY is an aneuploid karyotype.
XXY karyotype pertains to:
Klinefelter syndrome
2-13. A 13-year-old girl has a karyotype that reveals an absent homologous X chromosome with
only a single X chromosome present. What medical diagnosis will the nurse observe on the
chart?
a. Down syndrome
b. Cri du chat syndrome
c. Turner syndrome
d. Fragile X syndrome
ANS: C
A condition with the presence of a single X chromosome and no homologous X or Y
chromosome, so the individual has a total of 45 chromosomes, is known as Turner syndrome.
Down syndrome is a change in one arm of a chromosome. Cri du chat syndrome is due to a
chromosome deletion. Fragile X syndrome is due to a break or a gap in a chromosome.
Missing an X chromosome, so you only have 45 chromosomes.
(Person only has one ‘X’.)
Turner syndrome
Is due to a break or a gap in a chromosome, not an extra chromosome.
Fragile X
A condition with the presence of a
single X chromosome and no homologous X or Y chromosome, so the individual has a total
of 45 chromosomes, is known as _________
Turner syndrome
2-17. Cystic fibrosis is caused by what gene abnormality?
a. X-linked dominant
b. X-linked recessive
c. Autosomal dominant
d. Autosomal recessive
ANS: D
Cystic fibrosis is an autosomal recessive disorder. It is not a result of X links or dominant
pathology.
2-20. A child is diagnosed with cystic fibrosis. History reveals that the child’s parents are siblings.
Cystic fibrosis was most likely the result of:
a. X-inactivation.
b. genomic imprinting.
c. consanguinity.
d. obligate carriers.
ANS: C
Consanguinity refers to the mating of two related individuals, and the offspring of such
matings are said to be inbred. Consanguineous matings produce a significant increase in
recessive disorders and are seen most often in pedigrees for rare recessive disorders.
X-inactivation occurs when one X chromosome in the somatic cells of females is permanently
inactivated. Genomic imprinting is related to methylation and other changes. Obligate carriers
are those who have an affected parent and affected children and, therefore, must themselves
carry the mutation.
2-15. A patient demonstrates severe mental retardation caused by a deletion of part of chromosome
5. What genetic disorder will the nurse see documented in the chart?
a. Prader-Willi syndrome
b. Down syndrome
c. Cri du chat syndrome
d. Trisomy X
ANS: C
Cri du chat syndrome means “cry of the cat” and describes the characteristic cry of the
affected child. Another symptom of the disorder is mental retardation. The disease is caused
by a deletion of part of the short arm of chromosome 5. Prader-Willi syndrome is
characterized by short stature, obesity, and hypogonadism. Down syndrome does cause
mental retardation but is due to chromosome 21, not chromosome 5. Trisomy X can result in
mental retardation but is due to an extra X chromosome.
2-30. Which of the following disorders is manifested primarily in males?
a. Cystic fibrosis
b. Neurofibromatosis
c. Muscular dystrophy
d. Klinefelter syndrome
ANS: C
Muscular dystrophy is manifested primarily in males. Cystic fibrosis, neurofibromatosis, and
Klinefelter syndrome are manifested in both males and females.
4-14. A family presents to their primary care provider reporting headache, nausea, weakness,
tinnitus, and vomiting. Which of the following would be the most likely explanation for these
symptoms?
a. Lead exposure
b. Carbon monoxide poisoning
c. Ethanol exposure
d. Mercury poisoning
ANS: B
Symptoms related to carbon monoxide poisoning include headache, giddiness, tinnitus
(ringing in the ears), nausea, weakness, and vomiting. Although nausea and vomiting can
occur with lead exposure, lead toxicity is primarily manifested by convulsions and delirium
and, with peripheral nerve involvement, wrist, finger, and sometimes foot paralysis. Ethanol
exposure has CNS effects and would not affect the whole family. Mercury poisoning is
manifested by CNS effects and would not lead to nausea and vomiting.
4-19. A 15-year-old female presents to the ER following a physical assault. She has internal damage
to the neck with deep bruising. X-ray reveals fractures of the hyoid bone and tracheal and
cricoid cartilage. Which of the following most likely caused her injuries?
a. Chemical asphyxiation
b. Choking asphyxiation
c. Ligature strangulation
d. Manual strangulation
ANS: D
Squeezing of the neck as with strangulation would fracture the hyoid bone. Chemical
asphyxiation would lead to breathing problems but would not result in fracture. Choking
asphyxiation would lead to swelling of tissues but would not result in fracture. In ligature
strangulation, the mark on the neck is horizontal without the inverted V pattern seen in
hangings. It would not lead to fracture.
Leads to loss of sodium and
water.
Dehydration
7-2. Which patient will develop active immunity? A patient who:
a. has natural exposure to an antigen or receives an immunization.
b. receives preformed antibodies or T cells from a donor.
c. has T cells that become B cells.
d. receives immunoglobulin.
ANS: A
Active immunity occurs either after natural exposure to an antigen or after immunization, not
with preformed antibodies or the transformation of T cells into B cells or as a result of
receiving immunoglobulin.
7-3. An experiment is designed to determine specific cell types involved in cell-mediated immune
response. The experimenter is interested in finding cells that attack cells that have specific
antigens. Which cells should be isolated?
a. Lymphokine-producing cells
b. T-cytotoxic cells
c. Helper T cells
d. Macrophages
ANS: B
Cell-mediated immunity is driven by T-cytotoxic (Tc) cells that attack antigens directly and
destroy cells that bear foreign antigens. Lymphokine-producing cells, helper T cells, and
macrophages do not attack antigens directly and destroy cells that bear foreign antigens.
6-1. A public health nurse is teaching the community about health promotion. Which information
should the nurse include for innate immunity? Innate immunity is gained:
a. following an illness.
b. at birth.
c. via injection of specific antibodies.
d. in adulthood.
ANS: B
Innate immunity is present at birth, and is considered the body’s first line of defense. It is not
dependent on illness or injection.
6-3. A 20-year-old male received a knife wound to the arm during an altercation. Which of the
following types of immunity was compromised?
a. Innate immunity
b. Inflammatory response
c. Adaptive immunity
d. Specific immunity
ANS: A
The epithelial cells of the skin are a part of innate immunity. The inflammatory response is
not a type of immunity. Adaptive immunity is represented by the normal flora of the bowel.
Specific immunity is a type of adaptive immunity and is not associated with a break in skin
integrity.
6-12. The predominant phagocyte of early inflammation is the:
a. eosinophil.
b. neutrophil.
c. lymphocyte.
d. macrophage.
ANS: B
Neutrophils are the predominant phagocytes in the early inflammatory site, arriving within
6–12 hours after the initial injury. Eosinophils help limit and control inflammation, but they
are not the prominent phagocyte. Lymphocytes are part of the innate immune response.
Macrophages kill microorganisms.
This immunity is represented by the normal flora of the bowel.
Adaptive
This immunity is a type of adaptive immunity and is not associated with a break in skin
integrity.
Specific
The epithelial cells of the skin are a part of _____ immunity.
innate
6-8. A nurse recalls the mast cell, a major activator of inflammation, initiates the inflammatory
response through the process of:
a. chemotaxis.
b. endocytosis.
c. degranulation.
d. opsonization.
ANS: C
Degranulation of mast cells is a major cellular component of inflammation. Chemotaxis is the
process of white cell migration. Endocytosis and opsonization are parts of phagocytosis but
are not factors in mast cell response.
6-13. A 25-year-old female experiences a headache and takes aspirin for relief. A nurse recalls
aspirin relieves the headache by:
a. decreasing leukotriene production.
b. increasing histamine release.
c. decreasing prostaglandin production.
d. increasing platelet-activating factor.
ANS: C
Aspirin is a prostaglandin inhibitor. Aspirin is not associated with leukotriene production,
histamine release, or platelet-activating factor.
6-14. Which factor will help the nurse differentiate leukotrienes from histamine?
a. Site of production
b. Vascular effect
c. Chemotactic ability
d. Time of release
ANS: D
Leukotrienes are released slower and longer than histamine. Both leukotrienes and histamine
are produced by mast cells, and they have similar vascular effects and chemotactic abilities.
6-15. A 25-year-old male is in a car accident and sustains a fracture to his left femur with extensive
soft tissue injury. The pain associated with the injury is related to:
a. histamine.
b. prostaglandins.
c. vasoconstriction.
d. immune complex formation.
ANS: B
Prostaglandins cause increased vascular permeability, neutrophil chemotaxis, and pain by
direct effects on nerves. Histamine promotes vasodilation. Prostaglandins are not associated
with vasoconstriction or the immune complex formation.
6-16. The complement, clotting, and kinin systems share which of the following characteristics?
a. Activation of a series of proenzymes
b. Phagocytosis initiation
c. Granulocyte production
d. Activated by interferon
ANS: A
The complement system, the clotting system, and the kinin system are normally in inactive
forms but can activate in a series as proenzymes and are involved in the inflammatory
process. This system is not associated with phagocytosis, granulocyte production, or the
activation of interferon.
6-17. Which statement indicates teaching was successful regarding the classical pathway of the
complement system? The classical pathway of the complement system is activated by:
a. histamine.
b. antigen-antibody complexes.
c. leukotrienes.
d. prostaglandins.
ANS: B
The classical pathway of the complement system is activated by antibodies of the immune
system, not by histamine, leukotrienes, or prostaglandins.
6-23. A 10-year-old male is diagnosed with a parasite. Which lab result should the nurse check for a
response to the parasite?
a. Monocytes
b. Eosinophils
c. Neutrophils
d. Macrophages
ANS: B
Eosinophils serve as the body’s primary defense against parasites. Monocytes and neutrophils
are phagocytic. Macrophages are not active against parasites; they act as long-term defense
against infections.
7-4. A 6-year-old female is diagnosed with a bacterial infection of the respiratory system. Which
of the following will most likely try to fight the antigen?
a. Antibodies
b. Cytotoxic T cells
c. Self-antigens
d. Helper T cells
ANS: A
Antibodies are produced by plasma cells that mature from lymphocytes, called B lymphocytes
(B cells), in response to an antigen. Cytotoxic T cells do not respond to antigens. Self-antigens
do not respond to antigens. Helper T cells do not respond to antigens.
7-12. A 10-year-old male is stung by a bee while playing in the yard. He experiences a severe
allergic reaction and has to go to the ER. The nurse providing care realizes this reaction is the
result of:
a. toxoids.
b. IgA.
c. IgE.
d. IgM.
ANS: C
IgE is normally at low concentrations in the circulation. It has very specialized functions as a
mediator of many common allergic responses. Neither toxoids, IgA, nor IgM is the mediator
of common allergic response.
7-6. The predominant antibody of a typical primary immune response is:
a. IgG.
b. IgM.
c. IgA.
d. IgE.
ANS: B
IgM is the largest immunoglobulin and is the first antibody produced during the initial, or
primary, response to antigen.
7-8. A 23-year-old pregnant female visits her primary care provider for her final prenatal checkup.
The primary care provider determines that the fetus has developed an infection in utero.
Which of the following would be increased in the fetus at birth?
a. IgG
b. IgA
c. IgM
d. IgD
ANS: C
IgM is synthesized early in neonatal life, and its synthesis may be increased as a response to
infection in utero.
Occurs when an assailant’s hands compress the neck of the victim to the
point where death by asphyxiation occurs. There is evidence of variable amounts of external
trauma to the neck. Contusions and abrasions are either caused directly by the assailant or by the
victim clawing at their own neck in an attempt to remove the assailant’s hands. Internal damage
can be quite severe; bruising of deep structures, including fractures of the hyoid bone, the
tracheal cartilage, and the cricoid cartilages, are seen. Petechiae are common.
Manual strangulation
Refers to nonspecific defense mechanisms that come into play immediately or within
hours of an antigen’s appearance in the body. These mechanisms include physical barriers such as skin,
chemicals in the blood, and immune system cells that attack foreign cells in the body. The innate
immune response is activated by chemical properties of the antigen.
Innate Immunity
The third line of defense in the human body is _____, which is acquired or specific, often called
the immune response or immunity.
Adaptive Immunity
Consists of lymphocytes and serum
proteins called antibodies. Once external barriers have been compromised and inflammation (innate
immunity) has been activated, this response is mobilized.
Adaptive Immunity
Inflammation is the “first
responder” that contains the initial injury and slows the spread of infection, whereas ____________
slowly augments the initial defenses against infection and promotes processes against reinfection.
Adaptive Immunity
_____________ is long lived, whereas passive immunity is only temporary because the
donor’s antibodies or T cells are eventually destroyed.
Active Acquired Immunity
Release of the contents of mast cell granules. Substances within the granules
include histamine, chemotactic factors, and cytokines. Their effects occur immediately.
Histamine is a small-molecular-weight molecule with potent effects on many other cells,
particularly those that control the circulation
Degranulation
The new production and release of mediators in response to a stimulus. Activated
mast cells initiate synthesis of other mediators of inflammation. These mediators include
leukotrienes, prostaglandins, and platelet-activating factor.
Synthesis
_______ are significant and potent activators of the inflammatory response.
Mast cells
They have abundant
granules containing biochemical mediators, which are released in instances of tissue injury.
They also can be activated by components of the complement cascade and by immunoglobulin E (IgE)
antibodies produced in allergies.
Mast cells
A variety of stimuli associated with
tissue injury can induce inflammation by triggering the release of potent soluble substances from mast
cells.
Mast cells
Located in connective tissue and close to vessels, they can be found
near the body’s surfaces (skin, GI, and respiratory tract linings).
Mast cells
____________ leads to acute inflammation and may result in resolution and healing of the
injured site or may progress into chronic inflammation. Chronic inflammation in turn may result
in healing or progress to development of a granuloma. The final step of the inflammatory process
is usually healing and reconstruction of the damaged tissue.
Cellular injury
Normal cellular substances
• Water
• Proteins
• Lipids
• Carbohydrates
Abnormal substances
• Endogenous substances
• Exogenous substances
Accumulations result from four mechanisms.
Insufficient removal of normal substance because of _________
altered transport
Accumulations result from four mechanisms
Accumulation of abnormal substance because of ________
defects
Accumulations result from four mechanisms
Inadequate metabolism of endogenous substance because of ______________
lack of lysosomal enzyme
Accumulations result from four mechanisms
Harmful _________ materials
exogenous
____ is found in blood and in bodily secretions as secretory ___.
IgA
The primary
role of ____ is to prevent the attachment and invasion of pathogens through mucosal membranes,
such as those of the gastrointestinal, pulmonary, and genitourinary tracts.
IgA
___ is the dominant
secretory immunoglobulin, although IgM and IgG also are present in secretions.
IgA
___ is normally at low concentrations in the circulation.
IgE
___ has very specialized functions as a
mediator of many common allergic responses and as a defense against parasitic infections.
IgE
(1) Soluble antigens from a parasitic infection
cause production of IgE antibody by B cells.
(2) Secreted IgE binds to IgE-specific receptors on
the mast cell.
(3) Additional soluble parasite antigen cross-links the IgE on the mast cell surface,
(4) leading to mast cell degranulation and release of many proinflammatory products, including
eosinophil chemotactic factor of anaphylaxis (ECF-A).
(5) ECF-A attracts eosinophils from the
circulation.
(6) The eosinophil attaches to the surface of the parasite and releases potent
lysosomal enzymes that damage microorganisms.
Immunoglobulin E (IgE) Function.
___ is the largest antibody and usually exists as a pentamer (a molecule consisting of five
identical smaller molecules) that is stabilized by a J chain.
IgM
It is the first antibody produced during
the initial, or primary, response to antigens.
IgM
___ is usually synthesized early in neonatal life but
may be increased as a response to infection in utero.
IgM
___ is the best complement-activating antibody,
IgM
Ethanol, a toxoid, can cause:
Fetal alcohol syndrome
Fetal alcohol spectrum disorders
Heavy metals
Lead, Cadmium and arsenic, Mercury
Lead, Cadmium and arsenic, Mercury
Heavy metals
Air pollution
Environmental toxins
Chemical agents including drugs
Over-the-counter and prescribed drugs
Opioid abuse
Leading cause of child poisoning is medications
Xenobiotics—toxic, mutagenic, carcinogenic
Carbon tetrachloride, Lead, Carbon monoxide, Ethanol, Mercury,Social or street drugs
Cause chemical or toxic injury:
Toxoids
5-1. A nurse is reviewing lab reports. The nurse recalls blood plasma is located in which of the
following fluid compartments?
a. Intracellular fluid (ICF)
b. Extracellular fluid (ECF)
c. Interstitial fluid
d. Intravascular fluid
ANS: D
Blood plasma is the intravascular fluid. ICF is fluid in the cells. ECF is all the fluid outside
the cells. Interstitial fluid is fluid between the cells and outside the blood vessels.
5-2. A 35-year-old male weighs 70 kg. Approximately how much of this weight is considered the
total volume of body water?
a. 5 L
b. 10 L
c. 28 L
d. 42 L
ANS: D
The total volume of body water for a 70-kg person is about 42 L or two thirds of 70 kg.
5-3. While planning care for elderly individuals, the nurse remembers the elderly are at a higher
risk for developing dehydration because they have:
a. a higher total body water volume.
b. decreased muscle mass.
c. increased thirst.
d. an increased tendency toward developing edema.
ANS: B
The elderly are at higher risk for dehydration due to a decrease in muscle mass. The elderly
have a decrease in total body water and thirst. The increased tendency to develop edema is not
related to dehydration.
5-7. When planning care for a dehydrated patient, the nurse remembers that the principle of water
balance is closely related to the balance of:
a. potassium.
b. chloride.
c. bicarbonate.
d. sodium.
ANS: D
Because water follows the osmotic gradients established by changes in salt concentration,
water balance is tied to sodium balance, not that of potassium, chloride, or bicarbonate.
5-15. Which of the following patients is the most at risk for developing hypernatremia? A patient
with:
a. vomiting.
b. diuretic use.
c. dehydration.
d. hypoaldosteronism.
ANS: C
Dehydration leads to hypernatremia because an increase in sodium occurs with a net loss in
water. Vomiting and diuretic use leads to hyponatremia. Hypoaldosteronism leads to
hyponatremia.
5-16. Which of the following conditions would cause the nurse to monitor for hyperkalemia?
a. Excess aldosterone
b. Acute acidosis
c. Insulin usage
d. Metabolic alkalosis
ANS: B
In acidosis, ECF hydrogen ions shift into the cells in exchange for ICF potassium and sodium;
hyperkalemia and acidosis therefore often occur together. Acidosis does not cause excess
aldosterone. Insulin would help treat hyperkalemia, not cause it.
Alkalosis does not lead to hyperkalemia.
5-17. Which organ system should the nurse monitor when the patient has long-term potassium
deficits?
a. Central nervous system (CNS)
b. Lungs
c. Kidneys
d. Gastrointestinal tract
ANS: C
Long-term potassium deficits lasting more than 1 month may damage renal tissue, with
interstitial fibrosis and tubular atrophy. Long-term potassium deficits are not associated with
damage to the CNS, GI tract, or lungs.
5-18. A 42-year-old female presents to her primary care provider reporting muscle weakness and
cardiac abnormalities. Laboratory tests indicate that she is hypokalemic. Which of the
following could be the cause of her condition?
a. Respiratory acidosis
b. Constipation
c. Hypoglycemia
d. Laxative abuse
ANS: D
Losses of potassium from body stores are usually caused by gastrointestinal and renal
disorders. Diarrhea, intestinal drainage tubes or fistulae, and laxative abuse also result in
hypokalemia. Acidosis is related to hyperkalemia, not hypokalemia. Constipation can occur
with hypokalemia but does not cause it. Hypoglycemia is not related to muscle weakness.
5-19. A 19-year-old male presents to his primary care provider reporting restlessness, muscle
cramping, and diarrhea. Lab tests reveal that he is hyperkalemic. Which of the following
could have caused his condition?
a. Primary hyperaldosteronism
b. Acidosis
c. Insulin secretion
d. Diuretic use
ANS: B
During acute acidosis, hydrogen ions accumulate in the ICF and potassium shifts out of the
cell to the ECF, causing hyperkalemia. Primary hyperaldosteronism is associated with
hypokalemia, not hyperkalemia. Insulin secretion helps reduce potassium levels in the cell; it
does not cause hyperkalemia. Diuretics would cause hypokalemia, not hyperkalemia.
5-20. A 60-year-old female is diagnosed with hyperkalemia. Which assessment finding should the
nurse expect to observe?
a. Weak pulse
b. Excessive thirst
c. Oliguria
d. Constipation
ANS: C
Hyperkalemia is manifested by oliguria. Hypokalemia is manifested by a weak pulse; it is not
caused by hyperkalemia. Hypokalemia is manifested by excessive thirst. Diarrhea, not
constipation, is a manifestation of hyperkalemia.
5-21. Which of the following buffer pairs is considered the major plasma buffering system?
a. Protein/fat
b. Carbonic acid/bicarbonate
c. Sodium/potassium
d. Amylase/albumin
ANS: B
The carbonic acid/bicarbonate buffer pair operates in both the lung and the kidney and is a
major extracellular buffer. Protein and fat are nutrients, not related to the buffering system.
Sodium and potassium are electrolytes for fluid and electrolyte balance, not the major plasma
buffering system for acid-base balance. Amylase is a carbohydrate enzyme, and albumin is a
protein; neither is a buffering system.
5-22. A nurse recalls that regulation of acid-base balance through removal or retention of volatile
acids is accomplished by the:
a. buffer systems.
b. skin.
c. lungs.
d. liver.
ANS: C
The volatile acid is carbonic acid (H2CO3), which readily dissociates into carbon dioxide
(CO2) and water (H2O). The CO2 is then eliminated by the lungs. Buffer systems are
throughout the body and operate in the extracellular and intracellular systems. Neither the
liver nor the skin regulates acid-base balance.
5-23. Which patient is most prone to metabolic alkalosis? A patient with:
a. retention of metabolic acids.
b. hypoaldosteronism.
c. excessive loss of chloride (Cl).
d. hyperventilation.
ANS: C
When acid loss is caused by vomiting, renal compensation is not very effective because loss
of Cl stimulates renal retention of bicarbonate, leading to alkalosis. Retention of metabolic
acids would lead to acidosis, not alkalosis. Hypoaldosteronism leads to hyponatremia and
does not cause alkalosis. Hyperventilation leads to respiratory alkalosis, not metabolic
alkalosis.
5-25. For a patient experiencing metabolic acidosis, the body will compensate by:
a. excreting H+ through the kidneys.
b. hyperventilating.
c. retaining CO2 in the lungs.
d. secreting aldosterone.
ANS: B
It is the lungs hyperventilating that would compensate for metabolic acidosis by blowing off
CO2, not any function associated with the kidneys. CO2 retention would increase the acidotic
state. Aldosterone would conserve water but does not help compensate for acidosis.
5-26. Which finding would support the diagnosis of respiratory acidosis?
a. Vomiting
b. Hyperventilation
c. Pneumonia
d. An increase in noncarbonic acids
ANS: C
Respiratory acidosis occurs with hypoventilation, and pneumonia leads to hypoventilation.
Vomiting leads to loss of acids and then to alkalosis. Hyperventilation leads to respiratory
alkalosis. Metabolic acidosis is caused by an increase in noncarbonic acids.
5-27. A 54-year-old male with a long history of smoking complains of excessive tiredness,
shortness of breath, and overall ill feelings. Lab results reveal decreased pH, increased CO2,
and normal bicarbonate ion. These findings help to confirm the diagnosis of:
a. respiratory alkalosis.
b. metabolic acidosis.
c. respiratory acidosis.
d. metabolic alkalosis.
ANS: C
A decreased pH indicates acidosis. With increased CO2, it is respiratory acidosis. The
bicarbonate is normal, so it cannot be metabolic acidosis.
5-28. For a patient with respiratory acidosis, chronic compensation by the body will include:
a. kidney excretion of H+.
b. kidney excretion of HCO3.
c. prolonged exhalations to blow off CO2.
d. protein buffering.
ANS: A
The kidneys excrete H+ to compensate for respiratory acidosis. The kidneys do not excrete
HCO3 to compensate; this would increase acidosis. Prolonged exhalations would not be
effective for compensation, especially in a chronic state. Protein buffering is intracellular and
would not be effective enough to compensate for respiratory acidosis.
5-29. A 55-year-old female presents to her primary care provider and reports dizziness, confusion,
and tingling in the extremities. Blood tests reveal an elevated pH, decreased PCO2, and
slightly decreased HCO3. Which of the following is the most likely diagnosis?
a. Respiratory alkalosis with renal compensation
b. Respiratory acidosis with renal compensation
c. Metabolic alkalosis with respiratory compensation
d. Metabolic acidosis with respiratory compensation
ANS: A
With an elevated pH, the diagnosis must be alkalosis. Since the PCO2 is low, it is likely
respiratory, with a slight decrease in HCO3 indicating renal compensation.
During the first meiotic stage, the arms of homologous chromosome pairs intertwine and sometimes
exchange portions of their DNA in a process known as _______.
Crossover
Trisomies may occur in only some cells of the body. Individuals thus affected are said to be
______________, meaning that the body has two or more different cell lines, each of which has a
different karyotype.
chromosomal mosaics
_________ are often formed by early mitotic nondisjunction occurring in one
embryonic cell but not in others. An example of this is Downs Syndrome.
Mosaics
Loss of cellular differentiation.
Anaplasia
⦁ Genetic disorder where females are born with only ONE X chromosome (karyotype noted as 45,X)
⦁ Turner Syndrome
⦁ X chromosome is usually inherited from mother, thus caused by meiotic error in father
⦁ Turner Syndrome
Symptoms:
⦁ Not considered intellectually disabled—some impairment of spatial and mathematical reasoning ability is found
⦁ Short stature, wide spaced nipples, reduced carrying angle at elbow, webbing of neck
⦁ Cortication of aorta, edema in feet
⦁ Underdeveloped ovaries—sterile
⦁ Turner Syndrome
⦁ 15-20% of spontaneous abortions with chromosome abnormalities have this karyotype—only 0.5% survive to term
⦁ Turner Syndrome
⦁ Symptoms: low birth weight, severe intellectual disability, microcephaly (smaller than normal head size), and heart defects
⦁ Cri du chat
⦁ Term literally means “cry of the cat”—describes the characteristic cry of the affected child
⦁ Cri du chat
⦁ Genetic disorder caused by a chromosomal deletion of the short arm of chromosome 5
⦁ Cri du chat
⦁ Fragile site located on the long arm of the X chromosome—caused by duplication at fragile sites
⦁ Fragile X
⦁ Second most common genetic cause of intellectual disability (second to down syndrome)
⦁ Fragile X
⦁ Higher incidence in males because they only have one X chromosome
⦁ Fragile X
Symptoms:
⦁ Intellectual disability (mental retardation)
⦁ Fragile X
Symptoms:
⦁ Progressive muscle deterioration—unable to walk by 10-12 years old
⦁ Affects heart and respiratory muscles—death from resp. or cardiac failure usually occurs by 20 years old
⦁ Duchenne Muscular Dystrophy
⦁ Dystrophin plays essential role in maintain structural integrity of muscle cells and helps regulate the activity of membrane proteins
⦁ When dystrophin is absent, as in DMD, the cell cannot survive and muscle deterioration occurs
⦁ Duchenne Muscular Dystrophy
⦁ DMD gene is the largest gene found in humans—encodes a muscle protein termed dystrophin
⦁ Duchenne Muscular Dystrophy
⦁ Common x-linked recessive disorder (1 in 3500 males)
⦁ Duchenne Muscular Dystrophy
Symptoms:
⦁ Male appearance—but usually sterile
⦁ Moderate degree of mental impairment
⦁ Sparse body hair
⦁ Small testicles
⦁ Long limbs
⦁ Breast development
⦁ Klinefelter Syndrome
⦁ Individuals with at least two X chromosomes and one Y chromosome in each cell (XXY)
⦁ Klinefelter Syndrome
⦁ Males and females are affected equally
⦁ Cystic Fibrosis
⦁ Autosomal recessive disorder—most lethal recessive disease in white children
⦁ Cystic Fibrosis
_________ gene encodes a chloride ion that alters sodium balance
⦁ Defective transport of chloride ions leads to a salt imbalance, which results in secretions of abnormally thick, dehydrated mucus.
⦁ Digestive organs, particularly the pancreas, become obstructed, causing malnutrition, and the lungs become clogged with mucus, making them highly susceptible to bacterial infections
⦁ Cystic Fibrosis
⦁ Consanguinity (marriage between related individuals) can cause ____________.
⦁ Cystic Fibrosis
⦁ Seen in siblings of affected individuals but not usually their parents
⦁ Cystic Fibrosis
⦁ Main mechanism for ________ is the production of growth factors, which stimulate the remaining cells after injury or cell loss to synthesize new cell components and, ultimately, to divide
hyperplasia
⦁ As a response to injury _________ occurs when the damage is severe or prolonged or when it results in cell death
hyperplasia
⦁ Increase in the number of cells, resulting from an increased rate of cellular division
⦁ Hyperplasia
⦁ These changes are common in the epithelial tissue of the uterine cervix, the endometrium, and the gastrointestinal and respiratory tract mucosa
Dysplasia
⦁ Refers to abnormal changes in the size, shape, and organization of mature cells
Dysplasia
_____ can be grouped into four general categories: suffocation, strangulation, chemical asphyxiants, and drowning.
Asphyxiation
______ injuries are caused by the failure of cells to receive or use oxygen. Deprivation of oxygen may be partial (hypoxia) or total (anoxia).
Asphyxial
⦁ Normal HCO3 =
22-26
⦁ Normal Co2=
35-45
elevation of pco2 as a result of ventilation depression
⦁ Respiratory acidosis
depression of pco2 as a result of alveolar hyperventilation
⦁ Respiratory alkalosis
depression of HCO3– or an increase in noncarbonic acids
⦁ Metabolic acidosis
elevation of HCO3– usually caused by an excessive loss of metabolic acids
⦁ Metabolic alkalosis
first line of defense at the body’s surfaces
⦁ Innate
the second line of defense when the surface barriers are breached
⦁ Inflammatory Response
“Acquired or specific immunity.” The third line of defense.
⦁ Adaptive Immunity
