Exam 3 Flashcards
1
Q
What imbalance lessens the rate of secretion of parathyroid hormone (PTH)?
o Increased serum calcium levels
o Decreased levels of thyroid-stimulating hormone
o Increased levels of thyroid-stimulating hormone
o Decreased serum magnesium levels
A
Increased serum calcium levels
2
Q
Regulation of the release of insulin is an example of which type of regulation?
o Negative feedback
o Neural
o Positive feedback
o Physiologic
A
Neural
3
Q
A student asks the professor how a faulty negative-feedback mechanism results in a hormonal imbalance. What response by the professor is best?
o Decreased hormonal secretion is a response to rising hormone levels.
o Excessive hormone production results from a failure to turn off the system.
o Hormones are not synthesized in response to cellular and tissue activities.
o Too little hormone production is initiated.
A
Excessive hormone production results from a failure to turn off the system.
4
Q
Which substance is a water-soluble protein hormone?
o Insulin
o Thyroxine
o Follicle-stimulating hormone
o Aldosterone
A
Insulin
5
Q
Which of these is a lipid-soluble hormone?
o Epinephrine
o Growth hormone
o Oxytocin
o Cortisol
A
Cortisol
6
Q
Most protein hormones are transported in the bloodstream and are what?
o Bound to a water soluble-binding protein
o Bound to a lipid-soluble carrier
o Free in an unbound, water-soluble form
o Free because of their lipid-soluble chemistry
A
Free in an unbound, water-soluble form
7
Q
When insulin binds its receptors on muscle cells, an increase in glucose uptake by the muscle cells is the result. This is an example of what type of effect by a hormone?
o Pharmacologic
o Synergistic
o Permissive
o Direct
A
Direct
8
Q
Thyroid-stimulating hormone (TSH) is released to stimulate thyroid hormone (TH) and is inhibited when plasma levels of TH are adequate. What is this an example of?
o Neural regulation
o Positive feedback
o Negative feedback
o Physiologic regulation
A
Negative feedback
9
Q
A person wants to know if eating only plant-based foods is advisable as a way to cut cholesterol to near-zero levels. What response by the health care professional is best?
o “No, you will become extremely malnourished.”
o “No, many hormones are made from cholesterol.”
o “Yes, that will increase the action of insulin.”
o “Yes, that is an effective way to eliminate cholesterol.”
A
“No, many hormones are made from cholesterol.”
10
Q
Which second messenger is stimulated by epinephrine binding to a β-adrenergic receptor?
o Cyclic adenosine monophosphate (cAMP)
o Calcium
o Diacylglycerol (DAG)
o Inositol triphosphate (IP3)
A
Cyclic adenosine monophosphate (cAMP)
11
Q
Why is the control of calcium in cells important?
o It acts as a second messenger.
o It is controlled by the calcium negative-feedback loop.
o It is continuously synthesized.
o It carries lipid-soluble hormones in the bloodstream.
A
It acts as a second messenger.
12
Q
What is the portion of the pituitary that secretes oxytocin?
o Anterior
o Inferior
o Posterior
o Superior
A
Posterior
13
Q
A patient is in severe shock and is receiving vasopressin. A student asks the health care professional to explain the rationale for this treatment. What response by the professional is most accurate?
o “Antidiuretic hormone conserves fluid when urine output is less than 20 mL/hr.”
o “Antidiuretic hormone leads to better insulin utilization.”
o “Antidiuretic hormone causes serum osmolality to be increased.”
o “Antidiuretic hormone causes vasoconstriction to help increase blood pressure.”
A
“Antidiuretic hormone causes vasoconstriction to help increase blood pressure.”
14
Q
What is the target tissue for prolactin-releasing factor?
o Mammary glands
o Hypothalamus
o Posterior pituitary
o Anterior pituitary
A
Anterior pituitary
15
Q
Where is antidiuretic hormone (ADH) synthesized, and where does it act?
o Anterior pituitary; posterior pituitary
o Hypothalamus; renal tubular cells
o Renal tubules; renal collecting ducts
o Posterior pituitary; loop of Henle
A
Hypothalamus; renal tubular cells
16
Q
Where is oxytocin synthesized?
o Paraventricular nuclei
o Posterior pituitary
o Hypothalamus
o Anterior pituitary
A
Hypothalamus
17
Q
How do the releasing hormones that are made in the hypothalamus travel to the anterior pituitary?
o Infundibular process
o Pituitary stalk
o Vessels of the zona fasciculata
o Portal hypophyseal blood vessels
A
Portal hypophyseal blood vessels
18
Q
To ensure optimal thyroid health and function, which mineral does the health care professional advise a nutrition class to include in the daily diet?
o Iodide
o Iron
o Copper
o Zinc
A
Iodide
19
Q
Which hormone triggers uterine contractions?
o Oxytocin
o Growth hormone
o Thyroxine
o Insulin
A
Oxytocin
20
Q
What effect does hyperphosphatemia have on other electrolytes?
o Increases serum calcium
o Decreases serum calcium
o Increases serum magnesium
o Decreases serum magnesium
A
Decreases serum calcium
21
Q
A diabetic patient has not taken insulin in several days and has an extremely high blood sugar. What electrolyte would the health care professional assess as the priority?
o Chloride
o Calcium
o Sodium
o Potassium
A
Potassium
22
Q
A person who has experienced physiologic stresses will have increased levels of which hormone?
o Cortisol
o Thyroid hormone
o Somatostatin
o Alpha endorphin
A
Cortisol
23
Q
What is the action of calcitonin?
o Decreases serum calcium
o Decreases metabolism
o Increases metabolism
o Increases serum calcium
A
Decreases serum calcium
24
Q
Which hormone is involved in the regulation of serum calcium levels?
o Thyroxine (T4)
o Triiodothyronine (T3)
o Adrenocorticotropic hormone (ACTH)
o Parathyroid hormone (PTH)
A
Parathyroid hormone (PTH)
25
Which hormone inhibits the secretion of growth hormone (GH)?
o Somatostatin
o Thyroid-stimulating hormone
o Thyroxine
o Calcitonin
Somatostatin
26
Where are target cells for parathyroid hormone located?
o Smooth and skeletal muscles
o Thyroid gland
o Tubules of nephrons
o Glomeruli of nephrons
Tubules of nephrons
27
Which compound or hormone is secreted by the adrenal medulla?
o Aldosterone
o Cortisol
o Androgens
o Epinephrine
Epinephrine
28
What are the effects of aging on pancreatic cells?
o Pancreatic cells are replaced by fibrotic cells.
o No appreciable change occurs on pancreatic cells.
o Increased insulin production is typical.
o Beta cell function decreases.
Beta cell function decreases.
29
What does aldosterone directly increase the reabsorption of?
o Calcium
o Magnesium
o Water
o Sodium
Sodium
30
Which is an expected hormonal change in an older patient?
o Adrenocorticotropic hormone level above normal
o Cortisol level below normal
o Thyroid-stimulating hormone secretion below normal
o Triiodothyronine level below normal
Thyroid-stimulating hormone secretion below normal
31
What are actions of glucocorticoids? (Select all that apply.)
-Fat storage
-Liver gluconeogenesis
-Decreasing muscle cell reuptake of glucose
-Carbohydrate metabolism
-Decreased blood glucose
Liver gluconeogenesis
Decreasing muscle cell reuptake of glucose
Carbohydrate metabolism
32
The effects of the syndrome of inappropriate antidiuretic hormone (SIADH) secretion include which solute?
o Sodium retention and water loss
o Sodium dilution and water loss
o Sodium dilution and water retention
o Sodium and water retention
Sodium dilution and water retention
33
Which patient would the healthcare professional assess for elevated levels of antidiuretic hormone (ADH) secretion?
o Taking high dose acetaminophen (Tylenol) for arthritis
o Has long-standing kidney disease from diabetes
o Being treated for small cell carcinoma of the stomach
o Had a hip replacement operation 14 days ago
Being treated for small cell carcinoma of the stomach
34
Which laboratory value would the nurse expect to find if a person is experiencing syndrome of inappropriate antidiuretic hormone (SIADH)?
o Serum potassium (K+) level of 5 mEq/L and urine hyperosmolality compared to serum
o Serum sodium (Na+) level of 120 mEq/L and serum osmolality 260 mOsm/kg
o Serum potassium (K+) of 2.8 mEq/L and serum hyperosmolality
o Hypernatremia and urine hypoosmolality
Serum sodium (Na+) level of 120 mEq/L and serum osmolality 260 mOsm/kg
35
What is diabetes insipidus a result of?
o Antidiuretic hormone hyposecretion
o Insulin hypersecretion
o Antidiuretic hormone hypersecretion
o Insulin hyposecretion
Antidiuretic hormone hyposecretion
36
A patient who is diagnosed with a closed head injury has a urine output of 6 to 8 L/day. Electrolytes are within normal limits, but the antidiuretic hormone (ADH) level is low. Although the patient has had no intake for 4 hours, no change in the polyuria level has occurred. What treatment or diagnostic testing does the healthcare professional prepare the patient for?
o Serum copeptin testing
o Renal angiogram
o Administration of desmopressin
o Insulin administration
Administration of desmopressin
37
A patient is having a water deprivation test. The patient’s initial weight was 220 pounds (100 kg). The next weight is 209 pounds (95 kg). What action by the healthcare professional is most appropriate?
o Continue with the test as planned.
o Administer salt tablets.
o Stop the water deprivation test.
o Take the patient’s blood glucose.
Stop the water deprivation test.
38
A healthcare professional is caring for four patients. Which patient does the professional assess for neurogenic diabetes insipidus (DI)?
o Renal tubule disease
o Anterior pituitary tumor
o Posterior pituitary trauma
o Thalamus hypofunction
Posterior pituitary trauma
39
Which form of diabetic insipidus (DI) will result if the target cells for antidiuretic hormone (ADH) in the renal collecting tubules demonstrate insensitivity?
o Psychogenic
o Ischemic
o Nephrogenic
o Neurogenic
Nephrogenic
40
Which laboratory value is consistent with diabetes insipidus (DI)?
o High serum total protein
o Low urine-specific gravity
o Low serum sodium
o Low urine protein
Low urine-specific gravity
41
A patient has nephrogenic diabetes insipidus (DI). What treatment does the healthcare professional anticipate for this patient?
o Exogenous ADH replacement
o Intranasal desmopressin
o Loop diuretic administration
o Water and sodium restriction
Exogenous ADH replacement
42
Visual disturbances are a result of a pituitary adenoma because of what?
o Liberation of anterior pituitary hormones into the optic chiasm
o Pressure of the tumor on the optic chiasm
o Pressure of the tumor on the optic and oculomotor cranial nerves
o Pituitary hormones clouding the lens of the eyes
Pressure of the tumor on the optic chiasm
43
A patient has an enlarged tongue, body odor, rough skin, and coarse hair. Which laboratory result does the healthcare professional associate with this presentation?
o Decreased ACTH
o Increased TSH
o Increased growth hormone
o Decreased blood glucose
Increased growth hormone
44
A patient has acromegaly. What assessment by the healthcare professional would be most important?
o Skin condition
o Bowel function
o Range of motion
o Sleep patterns
Sleep patterns
45
Why does giantism occur only in children and adolescents?
o Their epiphyseal plates have not yet closed.
o Their metabolic rates are higher than in adulthood.
o Their growth hormones are still diminished.
o Their skeletal muscles are not yet fully developed.
Their epiphyseal plates have not yet closed.
46
A patient chart notes the patient has amenorrhea, galactorrhea, hirsutism, and osteoporosis. What diagnostic test would the healthcare professional prepare the patient for?
o Water deprivation test
o Ovarian biopsy
o CT scan of the head
o Hemoglobin A1C
CT scan of the head
47
What does Graves’ disease develop from?
o An autoimmune process during which lymphocytes and fibrous tissue replace thyroid tissue
o A viral infection of the thyroid gland that causes overproduction of thyroid hormone
o A thyroid-stimulating immunoglobulin that causes overproduction of thyroid hormones
o An ingestion of goitrogens that inhibits the synthesis of the thyroid hormones, causing a goiter
A thyroid-stimulating immunoglobulin that causes overproduction of thyroid hormones
48
What does Graves’ disease develop from?
o An autoimmune process during which lymphocytes and fibrous tissue replace thyroid tissue
o A viral infection of the thyroid gland that causes overproduction of thyroid hormone
o A thyroid-stimulating immunoglobulin that causes overproduction of thyroid hormones
o An ingestion of goitrogens that inhibits the synthesis of the thyroid hormones, causing a goiter
A thyroid-stimulating immunoglobulin that causes overproduction of thyroid hormones
49
Which patient would the healthcare professional assess for other signs of thyrotoxic crisis?
o Bradycardia and bradypnea
o Constipation and lethargy
o Hyperthermia and tachycardia
o Constipation with gastric distention
Hyperthermia and tachycardia
50
Which pathologic changes are associated with Graves’ disease?
o High levels of thyroid-stimulating hormone
o High levels of circulating thyroid-stimulating immunoglobulins
o Diminished levels of thyroid-binding globulin
o Diminished levels of thyrotropin-releasing hormone
High levels of circulating thyroid-stimulating immunoglobulins
51
A healthcare professional is palpating the neck of a person diagnosed with Graves’ disease. What finding would the professional associate with this disorder?
o Thyroid diffusely enlarged
o Thyroid small with discrete nodules
o Parathyroids normal in size
o Parathyroids left of midline
Thyroid diffusely enlarged
52
A person has hypothyroidism. What chemical does the healthcare professional advise the person to include in the diet?
o Iodine
o Zinc
o Iron
o Magnesium
Iodine
53
A patient has a suspected thyroid carcinoma. What diagnostic test does the healthcare professional prepare the patient for?
o Measurement of serum thyroid levels
o Radioisotope scanning
o Fine-needle aspiration biopsy
o Ultrasonography
Fine-needle aspiration biopsy
54
Renal failure is the most common cause of which type of hyperparathyroidism?
o Inflammatory
o Secondary
o Primary
o Exogenous
Secondary
55
A patient had a thyroidectomy and now reports tingling around the mouth and has a positive Chvostek sign. What laboratory finding would be most helpful to the healthcare professional?
o TSH and T4
o Serum calcium
o Urine osmolality
o Serum sodium
Serum calcium
56
A patient diagnosed with diabetic ketoacidosis (DKA) has the following laboratory values: arterial pH 7.20; serum glucose 500 mg/dL; positive urine glucose and ketones; serum potassium (K+) 2 mEq/L; serum sodium (Na+) 130 mEq/L. The patient reports that he has been sick with the “flu” for 1 week. What relationship do these values have to his insulin deficiency?
o Decreased glucose use causes fatty acid use, ketogenesis, metabolic acidosis, and osmotic diuresis.
o Increased glucose and fatty acids stimulate renal diuresis, electrolyte loss, and metabolic alkalosis.
o Increased glucose use causes the shift of fluid from the intravascular to the intracellular space.
o Decreased glucose use results in protein catabolism, tissue wasting, respiratory acidosis, and electrolyte loss.
Decreased glucose use causes fatty acid use, ketogenesis, metabolic acidosis, and osmotic diuresis.
57
Why does polyuria occur with diabetes mellitus?
o Increase in antidiuretic hormone
o Chronic insulin resistance
o Elevation in serum glucose
o Formation of ketones
Elevation in serum glucose
58
A student asks the professor to differentiate Type 2 diabetes mellitus from Type 1. The professors’ response would be that Type 2 is best described as what?
o Need for lifelong insulin injections
o Resistance to insulin by insulin-sensitive tissues
o Presence of insulin autoantibodies that destroy beta cells in the pancreas
o Increase of glucagon secretion from beta cells of the pancreas
Resistance to insulin by insulin-sensitive tissues
59
A person diagnosed with type 1 diabetes experienced an episode of hunger, lightheadedness, tachycardia, pallor, headache, and confusion. The healthcare professional teaches the person that what is the most probable cause of these symptoms?
o Somogyi effect from insulin sensitivity
o Hyperglycemia caused by incorrect insulin administration
o Hypoglycemia caused by increased exercise
o Dawn phenomenon from eating a snack before bedtime
Hypoglycemia caused by increased exercise
60
Which serum glucose level would indicate hypoglycemia in a newborn?
o 28 mg/dL
o 80 mg/dL
o 40 mg/dL
o 60 mg/dL
28 mg/dL
61
When comparing the clinical manifestations of both diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNKS), which condition is associated with only DKA?
o Weight loss
o Fluid loss
o Increased serum glucose
o Kussmaul respirations
Kussmaul respirations
62
Hypoglycemia, followed by rebound hyperglycemia, is observed in those with what?
o The Somogyi effect
o Hyperosmolar hyperglycemic nonketotic syndrome
o Diabetic ketoacidosis
o The dawn phenomenon
The Somogyi effect
63
A patient has diabetes mellitus. A recent urinalysis showed increased amounts of protein. What therapy does the healthcare provider educate the patient that is specific to this disorder?
o Treatment with an ACE inhibitor
o Moderate dietary sodium restriction
o Home blood pressure monitoring
o More frequent blood glucose monitoring
Treatment with an ACE inhibitor
64
Which classification of oral hypoglycemic drugs decreases hepatic glucose production and increases insulin sensitivity and peripheral glucose uptake?
o Sulfonylureas (glyburide)
o Meglitinides (glinides)
o Biguanide (metformin)
o α-Glycosidase inhibitor (miglitol)
Biguanide (metformin)
65
Which classification of oral hypoglycemic drugs decreases hepatic glucose production and increases insulin sensitivity and peripheral glucose uptake?
o Sulfonylureas (glyburide)
o Meglitinides (glinides)
o Biguanide (metformin)
o α-Glycosidase inhibitor (miglitol)
Biguanide (metformin)
66
What causes the microvascular complications in patients with diabetes mellitus?
o The capillary basement membranes thicken, and cell hyperplasia develops.
o The capillaries contain plaques of lipids that obstruct blood flow.
o Pressure in capillaries increases as a result of the elevated glucose attracting water.
o Fibrous plaques form from the proliferation of subendothelial smooth muscle of arteries.
The capillary basement membranes thicken, and cell hyperplasia develops.
67
A healthcare professional advises a person with diabetes mellitus to have an annual eye exam. When the person asks why this is necessary, the professional states that retinopathy develops in patients with diabetes mellitus because of what reason?
o Pressure in the retinal vessels increase as a result of increased osmotic pressure.
o Retinal ischemia and red blood cell aggregation occur.
o Ketones cause microaneurysms in the retinal vessels.
o Plaques of lipids develop in the retinal vessels.
Retinal ischemia and red blood cell aggregation occur.
68
A person has acne, easy bruising, thin extremities, and truncal obesity. The healthcare professional assesses the person for which of these?
o Serum electrolytes
o Urine osmolality
o Use of glucocorticoids
o Previous thyroid surgery
Use of glucocorticoids
69
A person may experience which complications as a result of a reduction in parathyroid hormone (PTH)? (Select all that apply.)
Asphyxiation
Laryngeal spasms
Muscle spasms
Hyporeflexia
Tonic-clonic seizures
Asphyxiation
Laryngeal spasms
Muscle spasms
Tonic-clonic seizures
70
A chronic complication of diabetes mellitus is likely to result in microvascular complications in which areas? (Select all that apply.)
Coronary arteries
Eyes
Peripheral vascular system
Nerves
Renal system
Eyes
Nerves
Renal system
71
What are clinical manifestations of hypothyroidism? (Select all that apply.)
Bradycardia
Constipation
Lethargy
Bradycardia
Constipation
Lethargy
72
Which type of adipose tissue contributes to obesity?
o MAT
o WAT
o bAT
o BAT
WAT
73
Where is the largest amount of bone marrow adipose tissue found?
o Flat bones
o Sesamoid bones
o Short bones
o Long bones
Long bones
74
Which area of the brain controls reward, pleasure, and addictive behavior?
o Hypothalamus
o Midbrain
o Cerebellum
o Medulla
Hypothalamus
75
Which BMI reflects obesity?
o Greater than 25 kg/m2
o Equal to 23 kg/m2
o Less than 20 kg/m2
o Greater than 30 kg/m2
Greater than 30 kg/m2
76
Which BMI reflects obesity?
o Greater than 25 kg/m2
o Equal to 23 kg/m2
o Less than 20 kg/m2
o Greater than 30 kg/m2
Greater than 30 kg/m2
77
Which is a risk factor for anorexia of aging?
o Overhydration
o Social isolation
o Increased activity
o Dislike of food
Social isolation
78
A researcher is moving to an area with a year-round cold climate. The researcher asks the health care professional how people in these areas are able to adjust to the temperature. What response by the professional is most accurate?
o They have less adipose tissue.
o They have more beige (bAT) adipose tissue.
o Their bone marrow produces more adipose tissue.
o They gain weight which insulates them.
They have more beige (bAT) adipose tissue.
79
The student asks the professor for a definition of “orexigenic neurons.” What description by the professor is most accurate?
o Increase overall metabolism
o Promote appetite and stimulate eating
o Promote satiety after eating
o Suppress appetite and inhibit eating
Promote appetite and stimulate eating
80
A student asks the health care professional why obese people are at higher risk for hypertension than non-obese individuals. What response by the professional is best?
o Their thyroid gland secretes less hormone.
o They produce more ghrelin in the stomach.
o They produce more angiotensinogen.
o They secrete fewer endocannabinoids
They produce more angiotensinogen.
81
Which individual does the health care professional determine is obese?
o Body mass index 32 kg/m2
o Body mass index 25 kg/m2
o Body mass index 29 kg/m2
o Body mass index 23 kg/m2
Body mass index 32 kg/m2
82
A person has abnormally severe tooth decay and erosion of the tooth enamel. What problem should the health care professional assess the person for?
o Bulimia
o Binge eating
o Anorexia nervosa
o Refeeding syndrome
Bulimia
83
A student asks the professor about the functions of adipose tissue. What responses by the professor are accurate? (Select all that apply.)
-Helps generate heat
-Helps with mechanical support
-Secretes adipokines
-Dysregulates thyroid function
-Provides insulation
-Helps generate heat
-Helps with mechanical support
-Secretes adipokines
-Provides insulation
84
A health care professional is speaking to a weight-loss support group and encourages the participants to have regular screening for medical conditions that are related to obesity. Which conditions does the professional include in this list? (Select all that apply.)
Dementias
Cirrhosis
Diabetes
Cancer
Cardiovascular disease
Diabetes
Cancer
Cardiovascular disease
85
What role does leptin resistance have in promoting obesity? (Select all that apply.)
-Promotes overeating
-Leads to hyperglycemia
-Promotes early satiety
-Increases oxidative stress
-Inhibits orexigenic outcomes
-Promotes overeating
-Leads to hyperglycemia
-Increases oxidative stress
86
What does the student learn about the effects of long-term starvation? (Select all that apply.)
-Gluconeogenesis begins for energy requirements.
-Use of ketone bodies for energy needs.
-Energy is supplied through glycogenolysis.
-Increase in inflammatory mediators.
-Proteolysis begins in adipose tissue.
-Use of ketone bodies for energy needs.
-Increase in inflammatory mediators.
87
A family is concerned that their most elderly member is not eating. What information about the anorexia of aging does the health care professional provide the family? (Select all that apply.)
-Age-related loss of appetite is common finding.
-Social stimulation at meals might promote better eating habits.
-Usually there is a direct cause that can be treated successfully.
-Is not related to age-related changes and signifies illness
-Decreases in saliva and the sense of taste are contributing factors.
-Age-related loss of appetite is common finding.
-Social stimulation at meals might promote better eating habits.
-Decreases in saliva and the sense of taste are contributing factors.
88
In the mouth and stomach, salivary α-amylase initiates the digestion of which nutrients?
o Fats
o Proteins
o Carbohydrates
o Fiber
Carbohydrates
89
Saliva contains which immunoglobulin (Ig)?
o IgE
o IgA
o IgG
o IgM
IgA
90
What effect is a result of inhibiting the parasympathetic nervous system with a drug such as atropine?
o Salivation decreases.
o Digestive enzymes are inhibited.
o Salivation becomes thinner.
o The pH of saliva changes.
Salivation decreases.
91
Food enters the stomach via which orifice or sphincter?
o Fundal
o Gastric
o Upper esophageal
o Cardiac
Cardiac
92
Food enters the stomach via which orifice or sphincter?
o Fundal
o Gastric
o Upper esophageal
o Cardiac
Cardiac
93
Which gastric cells secrete hydrochloric acid and intrinsic factor?
o Chief
o Parietal
o D
o G
Parietal
94
Which cells in the stomach secrete histamine?
o Enterochromaffin-like
o D
o Chief
o Oxyntic
Enterochromaffin-like
95
Which enzyme breaks down protein-forming polypeptides in the stomach?
o Pepsin
o Gastrin
o Secretin
o Acetylcholine
Pepsin
96
The ileum and jejunum are suspended by folds of the peritoneum that contain an extensive vascular and nervous network. What are these folds called?
o Ligament of Treitz
o Lamina propria
o Auerbach folds
o Mesentery
Mesentery
97
Where in the small intestines are lymphocytes, plasma cells, and macrophages produced?
o Crypts of Lieberkühn
o Lamina propria
o Microvilli
o Brush border
Lamina propria
98
The student asks the professor why water and electrolytes are transported in both directions through tight junctions and intercellular spaces rather than across cell membranes. What response by the professor is best?
o The epithelial cell membranes are formed of lipids that are hydrophobic and therefore repel water.
o Receptors on those cell membranes are occupied with a diffusion of amino acids and monosaccharides.
o A balance of cations and ions among the electrolytes on each side of the cell membranes cannot be maintained.
o The intercellular hydrostatic pressure is inadequate to push the water and electrolytes across the cell membranes.
The epithelial cell membranes are formed of lipids that are hydrophobic and therefore repel water.
99
Which statement best describes the gastrointestinal tract?
o The gastrointestinal tract is 5 m long and consists of three segments.
o The gastrointestinal tract is a hollow tube that extends from the mouth to the anus.
o The gastrointestinal tract is a muscular tube that transports food from the mouth to the stomach.
o The gastrointestinal tract is a baglike structure that propels partially digested food (chyme).
The gastrointestinal tract is a hollow tube that extends from the mouth to the anus.
100
Glucose transport enhances the absorption of which electrolyte?
o Chloride
o Sodium
o Potassium
o Phosphate
Sodium
101
What process is capable of increasing both intrathoracic and intraabdominal pressure, thereby facilitating defecation?
o Intestinal peristalsis
o Valsalva maneuver
o Ileogastric reflex
o Relaxation of the internal anal sphincter
Valsalva maneuver
102
What process is capable of increasing both intrathoracic and intraabdominal pressure, thereby facilitating defecation?
o Intestinal peristalsis
o Valsalva maneuver
o Ileogastric reflex
o Relaxation of the internal anal sphincter
Valsalva maneuver
103
Which pancreatic enzyme is responsible for the breakdown of carbohydrates?
o Lipase
o Chymotrypsin
o Trypsin
o Amylase
Amylase
104
Which pancreatic enzyme is responsible for the breakdown of carbohydrates?
o Lipase
o Chymotrypsin
o Trypsin
o Amylase
Amylase
105
What is the formation of water-soluble molecules to facilitate the absorption of the byproducts of lipid hydrolysis accomplished by?
o Micelles
o Chylomicrons
o Phospholipase
o Colipase
Micelles
106
What is the primary source of physiologic iron?
o Transferrin from plasma
o Bile from bilirubin
o Heme from animal protein
o Pepsin form pepsinogen
Heme from animal protein
107
What is the role of the normal intestinal bacterial flora?
o Metabolizing bile salts, estrogens, and lipids
o Breaking down proteins into amino acids
o Metabolizing aldosterone and insulin
o Facilitating the motility of the colon
Metabolizing bile salts, estrogens, and lipids
108
How are Kupffer cells best described?
o Able to metabolize estrogen, progesterone, and androgens
o Contractile and therefore capable of regulating the sinusoid blood flow
o Bactericidal and therefore central to innate immunity
o Natural killer cells that produce interferon-gamma (IFN-γ)
Bactericidal and therefore central to innate immunity
109
Bilirubin is a byproduct of the destruction of which aged cells?
o Leukocytes
o Erythrocytes
o Protein
o Platelets
Erythrocytes
110
The process of conjugation of bilirubin in the liver is best described as which transformation?
o Unconjugated (fat-soluble) bilirubin into conjugated (water-soluble) bilirubin
o Conjugated (water-soluble) bilirubin into urobilinogen
o Conjugated (water-soluble) bilirubin into unconjugated (fat-soluble) bilirubin
o Unconjugated (fat-soluble) bilirubin into urobilinogen
Unconjugated (fat-soluble) bilirubin into conjugated (water-soluble) bilirubin
111
A professor has been teaching a class on gastrointestinal function. Which statement by a student indicates the need for more education?
o Within 30 min of eating, the gallbladder forces bile into the stomach.
o Cholinergic branches of the vagus nerve mediate gallbladder contraction.
o Cholecystokinin provides hormonal regulation of gallbladder contraction.
o The sphincter of Oddi controls the flow of bile from the gallbladder.
Within 30 min of eating, the gallbladder forces bile into the stomach.
112
Which structure synthesizes clotting factors and the vitamin K necessary for hemostasis?
o Spleen
o Liver
o Colon
o Gallbladder
Liver
113
Which statement, made by a student, is correct regarding the state of the intestinal tract at birth?
o Streptococcus colonization in the intestinal tract has begun.
o The intestinal tract is colonized by Escherichia coli.
o The intestinal tract is sterile.
o Clostridium welchii is present in but in very small numbers.
The intestinal tract is sterile.
114
Which hormones are involved in the relaxation of the stomach’s fundus during swallowing? (Select all that apply.)
o Gastrin
o Progesterone
o Glucagon
o Cholecystokinin
o Motilin
Gastrin
Cholecystokinin
115
Which hormones are involved in regulating gastric motility by lowering the threshold potential of muscle fibers? (Select all that apply.)
o Secretin
o Estrogen
o Gastrin
o Motilin
o Somatostatin
Gastrin
Motilin
116
What requirements are necessary for calcium to be absorbed through the ileum at concentrations of less than 5 mmol/L? (Select all that apply.)
o Carboxypeptidase
o Vitamin D3
o A carrier protein
o Vitamin K
o Receptor site on the ileum
Vitamin D3
A carrier protein
117
What information does the student learn regarding the functions of the pancreas? (Select all that apply.)
o Acetylcholine (ACh) is liberated from the pancreatic branches of the vagus nerve.
o Pancreatic polypeptide is released after eating.
o Bilirubin and S cells inhibit the secretion of pancreatic enzymes.
o ACh stimulates the release of pancreatic enzymes.
o Cholecystokinin stimulates the release of pancreatic enzymes.
o Acetylcholine (ACh) is liberated from the pancreatic branches of the vagus nerve.
o Pancreatic polypeptide is released after eating.
o Cholecystokinin stimulates the release of pancreatic enzymes.
118
Which elements in saliva protect against tooth decay? (Select all that apply.)
o Mucin
o A pH of 7.4
o Salivary α-amylase
o Ptyalin
o Exogenous fluoride
A pH of 7.4
Exogenous fluoride
119
Where in the brain is the vomiting center located?
o Midbrain
o Pons
o Medulla oblongata
o Hypothalamus
Medulla oblongata
120
Antiemetic agents, such as domperidone and metoclopramide, are antagonists for which receptors?
o 5-Hydroxytryptamine (5-HT) serotonin
o Acetylcholine
o Dopamine
o Histamine-2
Dopamine
120
A patient in the clinic reports projectile vomiting without nausea or other gastrointestinal symptoms. What action by the healthcare professional is most appropriate?
o Provide antiemetic medications.
o Arrange a brain scan.
o Schedule a GI consultation.
o Administer intravenous hydration.
Arrange a brain scan.
121
A patient reports feeling constipated. When assessing this patient, how often should the patient report bowel movements to be considered within the normal range?
o Once a week
o Once every 2 days
o Once every 2 weeks
o Once a day
Once a week
122
How many stools per day are considered the upper limits of normal?
o Five
o Two
o Seven
o Three
3
123
The adult intestine processes approximately how many liters of luminal content per day?
o 9
o 3
o 6
o 12
9
124
A person who has cholera (Vibrio cholerae) would be expected to have which type of diarrhea?
o Secretory
o Osmotic
o Motility
o Small volume
Secretory
125
What type of diarrhea is a result of lactase deficiency?
o Motility
o Osmotic
o Secretory
o Small-volume
Osmotic
126
A professor has taught the students about the pathogenesis of abdominal pain. Which statement by a student indicates the professor needs to review the material?
o Low concentrations of anaerobes, such as Streptococci, Lactobacilli, Staphylococci, Enterobacteria, and Bacteroides, produce abdominal pain.
o Chemical mediators, such as histamine, bradykinin, and serotonin, produce abdominal pain.
o Ischemia, caused by distention of bowel obstruction or mesenteric vessel thrombosis, produces abdominal pain.
o Edema and vascular congestion produce abdominal pain by stretching.
Low concentrations of anaerobes, such as Streptococci, Lactobacilli, Staphylococci, Enterobacteria, and Bacteroides, produce abdominal pain.
127
How can abdominal pain that is visceral in nature best be described?
o It travels from a specific organ to the spinal cord.
o Associated with the peristalsis of the gastrointestinal tract
o Diffuse, vague, poorly localized, and dull
o The pain lateralizes from only one side of the nervous system.
Diffuse, vague, poorly localized, and dull
128
A patient asks the healthcare professional to describe the cause of gastroesophageal reflux disease (GERD). What response by the professional is best?
o Reverse muscular peristalsis of the esophagus
o Presence of Helicobacter pylori in the esophagus
o Excessive production of hydrochloric acid
o Zone of low pressure of the lower esophageal sphincter
Zone of low pressure of the lower esophageal sphincter
129
A patient has frank bleeding of the rectum. How does the healthcare professional document this finding?
o Hematochezia
o Hematemesis
o Occult bleeding
o Melena
Hematochezia
130
What is the cause of functional dysphagia?
o Tumor
o Extrinsic mechanical obstruction
o Intrinsic mechanical obstruction
o Neural or muscular disorders
Neural or muscular disorders
131
A patient has been diagnosed with reflux esophagitis (GERD). What instruction by the healthcare professional is most appropriate?
o Over-the-counter antiemetics work well for this condition.
o You need to schedule an upper GI endoscopy soon.
o Exercise soon after eating to increase gastric emptying.
o Try these proton-pump inhibitors for 2 weeks.
Try these proton-pump inhibitors for 2 weeks.
132
By what mechanism does intussusception cause an intestinal obstruction?
o Fibrin and scar tissue that attaches to the intestinal omentum
o Telescoping of part of the intestine into another section of intestine
o Loss of peristaltic motor activity in the intestine
o Twisting the intestine on its mesenteric pedicle
Telescoping of part of the intestine into another section of intestine
133
A patient has been admitted for a possible small intestinal obstruction. What is the first sign the healthcare professional assesses for that would indicate the presence of this condition?
o Distention
o Electrolyte imbalances
o Dehydration
o Vomiting
Distention
134
An intestinal obstruction at the pylorus or high in the small intestine causes metabolic alkalosis by causing which outcome?
o Excessive loss of potassium, promoting atony of the intestinal wall
o Excessive loss of hydrogen ions normally absorbed from gastric juices
o Loss of bile acid secretions that cannot be absorbed
o Gain of bicarbonate from pancreatic secretions that cannot be absorbed
Excessive loss of hydrogen ions normally absorbed from gastric juices
135
A patient has been admitted to the hospital with a possible bowel obstruction. Which assessment finding would alert the healthcare professional that the obstruction is in the small vs. large intestine?
o Colicky pain caused by distention, followed by vomiting
o Vague dull hypogastric pain without vomiting
o Profuse vomiting of clear gastric fluids
o Excruciating pain, vomiting, and fever
Colicky pain caused by distention, followed by vomiting
136
A patient has chronic gastritis. What treatment does the healthcare professional educate the patient on?
o Antibiotic therapy
o Vitamin B12 injections
o Corticosteroids
o Pancreatic enzyme replacement
Antibiotic therapy
137
A peptic ulcer may occur in all of these areas except which?
o Jejunum
o Esophagus
o Duodenum
o Stomach
Jejunum
138
A class of students has learned about contributing factors to duodenal ulcers. What statement indicates to the professor that the students need a review?
o Duodenal ulcers occur with greater frequency than other types of peptic ulcers.
o The characteristic pain begins 30 min to 2 hours after eating
o Gastric emptying is slowed, causing greater exposure of the mucosa to acid.
o Bleeding from duodenal ulcers causes hematemesis or melena.
Gastric emptying is slowed, causing greater exposure of the mucosa to acid.
139
After a partial gastrectomy or pyloroplasty, clinical manifestations that include increased pulse, hypotension, weakness, pallor, sweating, and dizziness are the results of which mechanism?
o Postoperative hemorrhage
o Excessive relaxation of gastric and vascular smooth muscles
o Concentrated food bolus, causing hyperglycemia
o Rapid gastric emptying
Rapid gastric emptying
140
A patient reports dumping syndrome after a partial gastrectomy. What does the healthcare professional teach this patient?
o This will need surgical correction.
o Eat small, frequent high-protein meals.
o Drink plenty of water with your meals.
o Take antacids 30 min before meals.
Eat small, frequent high-protein meals.
141
The most common clinical manifestation of portal hypertension is what type of bleeding?
o Esophageal
o Intestinal
o Duodenal
o Rectal
Esophageal
142
A patient has portal hypertension-induced splenomegaly. Which lab value would the healthcare professional associate with this condition?
o Low white blood cell count
o High hemoglobin and hematocrit
o Low platelet count
o High red cell count
Low platelet count
143
A professor has taught the students about the sources of increased ammonia in patients with hepatic encephalopathy. What statement by a student indicates the professor should review this material?
o Accumulation of short-chain fatty acids are a source of increased ammonia.
o Ammonia-forming bacteria in the colon are sources of increased ammonia.
o End products of intestinal protein digestion are sources of increased ammonia.
o Digested blood leaking from ruptured varices is a source of increased ammonia.
Accumulation of short-chain fatty acids are a source of increased ammonia.
144
Hepatic fat accumulation is observed in which form of cirrhosis?
o Metabolic
o Alcoholic
o Biliary
o Postnecrotic
Alcoholic
145
A student asks the healthcare professional to explain the pathophysiologic process of alcoholic cirrhosis. What statement by the professional would not be consistent with complete knowledge about this process?
o Inflammation and damage leading to cirrhosis begin in the bile canaliculi.
o Mitochondrial function is impaired, decreasing oxidation of fatty acids.
o Acetaldehyde inhibits export of proteins from the liver.
o Alcohol is transformed to acetaldehyde, which promotes liver fibrosis.
Inflammation and damage leading to cirrhosis begin in the bile canaliculi.
146
A student learns what information about acute pancreatitis?
o Pancreatic enzymes autodigest pancreatic cells and tissues.
o It is usually a severe disease with a high mortality rate.
o Oversecretion of pancreatic enzymes and malnutrition
o Autoimmune process with IgG attacking pancreatic acinar cells
ancreatic enzymes autodigest pancreatic cells and tissues.
147
The mutation of which gene is an early event associated with the pathogenetic origin of esophageal cancer?
o myc
o HER2
o TP53
o KRAS
TP53
148
What information does the student learn about parietal pain? (Select all that apply.)
o Nerve fibers that travel to the spinal cord are involved in parietal pain.
o Parietal pain is usually less intense than visceral pain.
o Parietal pain corresponds to dermatomes T6 and L1.
o It is generally more localized than visceral pain.
o Parietal pain arises from the parietal peritoneum.
o Nerve fibers that travel to the spinal cord are involved in parietal pain
o Parietal pain corresponds to dermatomes T6 and L1.
o It is generally more localized than visceral pain.
o Parietal pain arises from the parietal peritoneum.
149
Which information about chronic gastritis does the student learn? (Select all that apply.)
o Chronic gastritis results in chronic inflammation and mucosal atrophy.
o Mucosal atrophy is a common outcome of chronic gastritis.
o It causes thinning and degeneration of the stomach wall.
o Chronic gastritis tends to occur more in older adults.
o Epithelial metaplasia is often observed with chronic gastritis.
o Chronic gastritis results in chronic inflammation and mucosal atrophy.
o Mucosal atrophy is a common outcome of chronic gastritis.
o Epithelial metaplasia is often observed with chronic gastritis.
150
Which are the early (prodromal) clinical manifestations of hepatitis? (Select all that apply.)
o Fatigue
o Hyperalgia
o Itching
o Jaundice
o Vomiting
Fatigue
Hyperalgia
Vomiting
151
Which clinical manifestations are consistent with cancer of the cecum and ascending colon? (Select all that apply.)
o Mahogany-colored blood mixed with stool
o Constipation
o Anemia
o Palpable mass in the lower right quadrant
o Pain
o Mahogany-colored blood mixed with stool
o Palpable mass in the lower right quadrant
o Pain
152
Incomplete fusion of the nasomedial and intermaxillary process during the fourth week of embryonic development causes which condition in an infant?
o Esophageal malformation
o Cleft lip
o Sinus dysfunction
o Cleft palate
Cleft lip
153
Increased gastrin secretion by the mother in the last trimester of pregnancy may cause which condition in the infant?
o Meconium ileus
o Esophageal atresia
o Galactosemia
o Pyloric stenosis
Pyloric stenosis
154
Parents report their 3-week-old infant who eats well and has gained weight began to vomit forcefully for no apparent reason. What treatment option does the healthcare professional prepare to educate the parents on?
o Corrective surgery
o Wheat-free diet
o A gastric feeding tube
o Lactose-free diet
Corrective surgery
155
Which term is used to identify a condition in which the developing colon remains in the upper right quadrant instead of moving to its normal location?
o Ileocecal displacement
o Pyloric stenosis
o Duodenal obstruction
o Intestinal malrotation
Intestinal malrotation
156
Which term is used to identify an intestinal obstruction caused by meconium formed in utero that is abnormally sticky and adheres firmly to the mucosa of the small intestine?
o Meconium cecum
o Meconium obstruction
o Meconium ileus
o Meconium vivax
Meconium ileus
157
6. A newborn has meconium ileus. What diagnostic test does the healthcare professional advise the parents about?
o Pulmonary function studies
o A sweat test
o Nerve conduction studies
o Colonoscopy
A sweat test
158
Congenital aganglionic megacolon (Hirschsprung’s disease) involves inadequate motility of the colon caused by neural malformation of which nervous system?
o Sympathetic
o Central
o Somatic
o Parasympathetic
Parasympathetic
159
An infant has been diagnosed with intussusception and the student asks the healthcare professional to explain the condition. What explanation by the professional is most accurate?
o Fibrosis increases the resistance to blood flow within the portal system.
o Poor colonic motility due to a problem in the parasympathetic nervous system
o The colon stays in the upper right quadrant instead of moving to its normal location.
o One part of the intestine telescopes into another section of the intestine
One part of the intestine telescopes into another section of the intestine
160
An infant suddenly develops abdominal pain, becomes irritable, and draws up the knees. Vomiting occurs soon afterward. The mother reports that the infant passed a normal stool, followed by one that looked like currant jelly. What treatment does the healthcare professional prepare the infant for?
o Reduction enema
o Corrective surgery
o Gastric decompression
o Anal dilation
Reduction enema
161
Cystic fibrosis is characterized by which symptom?
o Abnormally thin exocrine secretions
o Excessive mucus production
o Elevated blood glucose levels
o Low sodium content in perspiration
Excessive mucus production
162
A child has cystic fibrosis (CF). Which medication does the healthcare professional teach the parents about?
o Pancreatic enzymes
o Salt tablets
o Antibiotics
o Antihypertensives
Pancreatic enzymes
163
What causes a person with cystic fibrosis to experience an exocrine pancreatic insufficiency?
o A genetically impaired pancreas is unable to produce digestive enzymes.
o Pancreatic ducts are obstructed with mucus.
o The pancreas has a volvulus at the ampulla of Vater.
o Impaired blood supply to the pancreas causes ischemia.
Pancreatic ducts are obstructed with mucus.
164
A student asks the professor to explain the characteristic appearance of stools in people with cystic fibrosis. What explanation by the professor is best?
o Deficiency of pancreatic enzymes leads to steatorrhea.
o Ischemia due to sodium blockages causes bloody stools.
o Bile ducts obstructed with mucus, leading to clay colored stools
o Mechanical obstruction causes narrow, ribbon-like stool
Deficiency of pancreatic enzymes leads to steatorrhea.
165
Which disorder is characterized by damage to the mucosa of the duodenum and jejunum and impaired secretion of secretin, cholecystokinin, and pancreatic enzymes?
o Galactosemia
o Wilson disease
o Gluten-sensitive enteropathy
o Cystic fibrosis
Gluten-sensitive enteropathy
166
An infant has gluten-sensitive enteropathy and the parents ask the healthcare professional to explain why the baby bruises so easily. The professional explains that the baby has which deficit?
o Vitamin K deficiency from fat malabsorption
o Iron, folate, and B12 deficiency anemias
o Prescribed daily warfarin
o Bone marrow function depression
Vitamin K deficiency from fat malabsorption
167
What does the student learn distinguishes kwashiorkor from marasmus?
o All nutrients, proteins, fats, and carbohydrates are reduced in kwashiorkor.
o Muscle wasting, diarrhea, low hemoglobin, and infection characterize kwashiorkor.
o Physical growth of children is stunted in kwashiorkor but not in marasmus.
o Subcutaneous fat, hepatomegaly, and fatty liver are present in kwashiorkor.
Subcutaneous fat, hepatomegaly, and fatty liver are present in kwashiorkor.
168
Why is prolonged diarrhea more severe in children than it is in adults?
o Fluid reserves are smaller in children.
o Less water is absorbed from the colon in children.
o Children have a higher fluid volume intake.
o Children have diarrhea more often than adults.
Fluid reserves are smaller in children.
169
A newborn baby displays jaundice 20 hours after birth. What action by the healthcare professional is most appropriate?
o Obtain consent for blood transfusions.
o Prepare to administer vitamin K.
o Draw blood to measure total bilirubin.
o Teach the patient about phototherapy.
Draw blood to measure total bilirubin.
170
What is physiologic jaundice in a newborn caused by?
o Mild conjugated (indirect-reacting) hyperbilirubinemia
o Impaired hepatic uptake and excretion of bilirubin
o Reabsorption of bilirubin in the small intestine
o Increased bilirubin production
Mild conjugated (indirect-reacting) hyperbilirubinemia
171
A woman who is positive for hepatitis B is in labor. What action by the healthcare professional is most appropriate?
o Discuss poor infant survival.
o Draw blood for a drug screen.
o Encourage the mother to bottle feed.
o Immunize the newborn within 12 hours.
Immunize the newborn within 12 hours.
172
Cirrhosis causes intrahepatic portal hypertension in children as a result of which mechanism?
o Increased pressure from the twisting of the common bile ducts
o Fibrosis that increases the resistance to blood flow within the portal system
o Shunting of fluid to the spleen or abdomen
o Development of collateral circulation within the portal system
Fibrosis that increases the resistance to blood flow within the portal system
173
A child has chronic hepatitis and the healthcare professional wants to assess the child for portal hypertension. What action by the professional is most appropriate?
o Listen to the child’s lung sounds
o Inspect the skin for jaundice
o Assess for pedal edema
o Palpate the child’s abdomen
Palpate the child’s abdomen
174
What factors can contribute to the development of a cleft lip and a cleft palate? (Select all that apply.)
o Exposure to heavy metals during pregnancy
o Maternal use of tobacco
o Maternal diabetes mellitus
o Trauma during pregnancy
o Maternal deficiency of B vitamins
o Maternal use of tobacco
o Maternal diabetes mellitus
o Maternal deficiency of B vitamins
175
Which situations are often associated with possible causes of failure to thrive (FTT) in infants? (Select all that apply.)
o Gastroesophageal reflux
o Living in poverty
o Incorrect formula preparation
o Feeding difficulties
o Child neglect
all
176
Which information does the student learn about Wilson disease in children? (Select all that apply.)
o Wilson disease is a rare autosomal recessive defect.
o The liver is often affected in Wilson disease.
o Corneal damage can be a result of Wilson disease.
o A lack of necessary copper is a result of Wilson disease.
o Wilson disease affects copper metabolism.
o Wilson disease is a rare autosomal recessive defect.
o The liver is often affected in Wilson disease.
o Corneal damage can be a result of Wilson disease.
o A lack of necessary copper is a result of Wilson disease.
177
A 3-year-old child has hepatitis A. What symptoms would the healthcare professional assess for? (Select all that apply.)
o Vomiting
o Nausea
o Muscle pain
o Diarrhea
o Jaundice
Vomiting
Nausea
Diarrhea
178
Cystic fibrosis is directly responsible for complications to which structures? (Select all that apply.)
o Kidneys
o Muscles
o Cervix
o Liver
o Lymph nodes
Cervix
Liver
179
A child has celiac disease. Which foods does the healthcare professional teach the parents to eliminate from their child’s diet? (Select all that apply.)
o Fat soluble vitamins
o Starchy vegetables
o Citrus fruits
o Wheat products
o Barley
Wheat products
Barley
180
A child has celiac disease. Which foods does the healthcare professional teach the parents to eliminate from their child’s diet? (Select all that apply.)
o Fat soluble vitamins
o Starchy vegetables
o Citrus fruits
o Wheat products
o Barley
Wheat products
Barley
