Pathopharm 2- Exam 1 Flashcards by Brad Koester

Which bone cells produce osteocalcin when stimulated by 1,25-dihydroxyvitamin D and synthesize osteoid?
a. Osteoclasts
b. Osteocytes
c. Fibrocytes
d. Osteoblasts

d. Osteoblasts

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What happens to the original bone during the second phase of bone remodeling?
a. The original bone is replaced.
b. It hardens.
c. The original bone is resorbed.
d. It is synthesized.

c. The original bone is resorbed.

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Which cells function to maintain bone matrix?
a. Osteoclasts
b. Osteocytes
c. Osteoblasts
d. Osteophytes

b. Osteocytes

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Which bone cells are large and multinucleated and contain lysosomes filled with hydrolytic enzymes?
a. Osteoblasts
b. Osteoclasts
c. Osteocytes
d. Fibrocytes

b. Osteoclasts

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Which bone cell secretes hydrochloric acid to help dissolve bone minerals and collagenase, thus aiding in the digestion of collagen?
a. Osteocytes
b. Osteoblasts
c. Osteoclasts
d. Osteophytes

c. Osteoclasts

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Which glucoprotein is believed to inhibit calcium phosphate precipitation and play a part in bone resorption by recruiting osteoclasts?
a. Osteocalcin
b. Osteonectin
c. Laminin
d. Osteopontin

a. Osteocalcin

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Which glucoprotein is thought to transport essential elements such as hormones, ions, and other metabolites to and from the bone cells?
a. Osteocalcin
b. Osteonectin
c. Laminin
d. Bone albumin

d. Bone albumin

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How is the work function of a muscle usually calculated?
a. Muscle type
b. Calculating force x distance
c. Foot pounds
d. Kilograms

b. Calculating force x distance

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What is the basic structural unit in compact bone?
a. Small channels called canaliculi
b. Osteocytes within the lacunae
c. Tiny spaces within the lacunae
d. Haversian system

d. Haversian system

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Which part of an injured joint becomes insensitive to pain and regenerates slowly and minimally?
a. Synovium
b. Articular cartilage
c. Bursa
d. Tendon

b. Articular cartilage

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The outer layer of the periosteum contains blood vessels and nerves that penetrate the inner structures of the bone by way of which structure?
a. Volkmann canals
b. Canaliculi
c. Sharpey canals
d. Trabeculae

a. Volkmann canals

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What is the function of Sharpey fibers?
a. To anchor the outer layer of the periosteum to the inner layer
b. To contain blood vessels and nerves on the outer layer of the periosteum
c. To help attach tendons and ligaments to the periosteum
d. To attach muscles to the periosteum

c. To help attach tendons and ligaments to the periosteum

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The student learns that after puberty, the epiphyseal plate calcifies and the epiphysis merges with which structure?
a. Epiphyseal line
b. Epiphyseal plate
c. Metaphysis
d. Articular cartilage

c. Metaphysis

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The stage of healing in the bone that involves procallus formation entails which process?
a. Formation of a hematoma that allows the development of a fibrin network
b. Production of granulation tissue by fibroblasts, capillary buds, and osteoblasts
c. Development of a primitive bone matrix termed woven bone
d. Remodeling of the periosteal and endosteal bone surfaces

b. Production of granulation tissue by fibroblasts, capillary buds, and osteoblasts

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The professor asks a student to describe the movement of a diarthrosis joint. What answer by the student is best?
a. Immovable joint
b. Slightly moveable
c. Variable movement
d. Freely moveable

d. Freely moveable

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Which type of joint holds teeth in the maxilla or mandible?
a. Amphiarthrosis
b. Diarthrosis
c. Synarthrosis
d. Gomphosis

d. Gomphosis

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The hyaline cartilage joints between the ribs and sternum are examples of which type of joint?
a. Synchondrosis
b. Symphysis
c. Gomphosis
d. Syndesmosis

a. Synchondrosis

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The joint that contains a synovial membrane that lines the inner joint capsule is an example of which type of joint?
a. Amphiarthrosis
b. Diarthrosis
c. Synarthrosis
d. Biarthrosis

b. Diarthrosis

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What is the function of the synovial membrane’s type A cells within the intima?
a. To release mast cells, initiating the inflammatory process after joint injury
b. To ingest and remove bacteria and debris by phagocytosis in the joint cavity
c. To secrete hyaluronate, a binding agent that gives synovial fluid its viscous quality
d. To store fat cells and glycogen, providing adenosine triphosphate for joint activity

b. To ingest and remove bacteria and debris by phagocytosis in the joint cavity

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What anchors articular cartilage to the underlying bone?
a. Sharpey fibers
b. Collagen fibers
c. Glycoproteins
d. Elastin fibers

b. Collagen fibers

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What controls the movement of synovial fluid through cartilage?
a. Cartiloregulins
b. Hyaluronate
c. Proteoglycans
d. Chondroitin

c. Proteoglycans

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Which statement indicates that a student needs more information about muscles?
a. Muscle comprises 50% of an adult’s body weight and 40% of a child’s body weight.
b. Muscle is 75% water, 20% protein, and 5% organic and inorganic compounds.
c. Muscle contains 32% of all protein stores for energy and metabolism.
d. Muscles are encased in fascia.

a. Muscle comprises 50% of an adult’s body weight and 40% of a child’s body weight.

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Which characteristic of type II (white fast-motor) muscle fibers does the student learn?
a. Slow contraction speed
b. Fast conduction velocities
c. Profuse capillary supply
d. Oxidative metabolism

b. Fast conduction velocities

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As the innervation ratio of a particular organ increases, what other property also increases?
a. Control
b. Movement
c. Coordination
d. Endurance

d. Endurance

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Which statement describes a neuroregulin? a. Chemical mediator that initiates signals from the anterior horn cell of the spinal card to the axon of motor nerve branches of groups of muscle fibers b. Neurotransmitter that provides a means of reporting changes in length, tension, velocity, and tone in muscles c. Proteoglycan secreted by neurons, which increases acetylcholine receptors d. Mechanoreceptor that lies parallel to muscle fibers and responds to muscle stretching

c. Proteoglycan secreted by neurons, which increases acetylcholine receptors

Which four-step process correctly describes muscle contraction? a. Coupling, contraction, relaxation, excitation b. Contraction, relaxation, excitation, coupling c. Relaxation, excitation, coupling, contraction d. Excitation, coupling, contraction, relaxation

d. Excitation, coupling, contraction, relaxation

Which type of ion directly controls the contraction of muscles? a. Sodium b. Potassium c. Calcium d. Magnesium

c. Calcium

In which type of contraction does the muscle maintain a constant tension as it moves? a. Isotonic b. Isometric c. Hypertonic d. Hypotonic

a. Isotonic

Which term is used to identify a functional muscle contraction in which the muscle contracts but the limb does not move? a. Isotonic b. Isometric c. Eccentric d. Concentric

b. Isometric

A student has learned about aging and the musculoskeletal system. What statement by the student indicates a need for more study on the topic? a. Haversian system erodes, the canals nearest the marrow cavity widen, and the endosteal cortex converts to spongy bone. b. The remodeling cycle increases because of a decreased ability of the basic multicellular units to resorb and deposit bone. c. Cartilaginous rigidity increases because of decreasing water content and decreasing concentrations of glycosaminoglycans. d. Muscle ribonucleic acid (RNA) synthesis declines, although the regenerative function of muscle tissue is reportedly normal in older adults.

a. Haversian system erodes, the canals nearest the marrow cavity widen, and the endosteal cortex converts to spongy bone.

Which component is found in synovial fluid? a. Protein polysaccharides b. Water c. Leukocytes d. Chondrocytes

c. Leukocytes

The health care professional is caring for a person who has a pathologic fracture. The patient asks the professional to explain the condition. What response by the professional is best? a. The outer surface of the bone is disrupted, but the inside is intact. b. A stable fracture where the cortex of the bone bends but doesn’t break. c. A fracture that happens at the site of an abnormality already in that bone. d. It was caused by the cumulative effects of stress on the bone over time.

c. A fracture that happens at the site of an abnormality already in that bone.

A health care professional is providing education to a group of seasonal athletes. What type of fracture does the professional warn them to avoid? a. Stress b. Greenstick c. Insufficiency d. Pathologic

a. Stress

A patient has a temporary displacement of two bones causing the bone surfaces to partially lose contact with each other. What treatment does the health care professional prepare the patient for? a. Internal fixation b. Reduction and immobilization c. Calcium phosphate cement d. Low-density ultrasound

b. Reduction and immobilization

Improper reduction or immobilization of a fractured femur can result in which outcome after cast removal? a. The muscles around the fracture site are weak. b. The fracture requires 6 to 8 weeks of physical therapy. c. The skin under the cast is dry and flaky. d. The bone is not straight.

d. The bone is not straight.

Which structure attaches skeletal muscle to bone? a. Tendon b. Ligament c. Bursa d. Mesentery

a. Tendon

What is the tear in a ligament referred to as? a. Fracture b. Strain c. Disunion d. Sprain

d. Sprain

A patient seen in the clinic has tissue degeneration or irritation of the extensor carpi radialis brevis tendon. What diagnosis does the health care professional document? a. Lateral epicondylopathy b. Medial epicondylopathy c. Bursitis d. Lateral tendinitis

a. Lateral epicondylopathy

A patient in the Emergency Department has either a tendon or ligament injury. What pain description from the patient would the health care professional associate with these injuries? a. Dull and diffuse, persisting over the distribution of the tendon or ligament b. Sharp and localized, persisting over the distribution of the tendon or ligament c. Pins-and-needle sensations that occur distal to the injury with movement d. Intermittent and aching, occurring over the distribution of the tendon or ligament

b. Sharp and localized, persisting over the distribution of the tendon or ligament

A student asks for an explanation of rhabdomyolysis. What response by the professor is best? a. Paralysis of skeletal muscles, resulting from an impaired nerve supply b. Smooth muscle degeneration, resulting from ischemia c. Lysis of skeletal muscle cells through the initiation of the complement cascade d. Release of myoglobin from damaged striated muscle cells

d. Release of myoglobin from damaged striated muscle cells

Which pathophysiologic alteration precedes crush syndrome after prolonged muscle compression? a. Muscle ischemia b. Myoglobinuria c. Volkmann contracture d. Neural injury

b. Myoglobinuria

By the time osteoporosis is visible on an x-ray examination, up to what percent of bone has been lost? a. 30% b. 40% c. 50% d. 60%

a. 30%

A patient has a bone density T score of -2.8. What diagnosis does the health care professional educate the patient on? a. Osteoplasia b. Osteoporosis c. Osteopenia d. Osteomalacia

b. Osteoporosis

Which type of osteoporosis would a person develop after having the left leg in a cast for 8 weeks to treat fracture of the tibia and fibula? a. Iatrogenic b. Regional c. Idiopathic d. Osteoblastic

b. Regional

In osteoporosis, the receptor activator of nuclear factor kB (RANK) activates what? a. Osteoclast apoptosis b. Osteoblast survival c. Osteoprotegerin d. Osteoclast survival

d. Osteoclast survival

A health care professional who works with older women understands that which changes are believed to play a significant role in the development of age-related bone loss? a. Increased oxidative stress and increased intracellular reactive oxygen species b. Hypoparathyroidism c. Increased body weight d. Decreased formation and short life span of osteoclasts

a. Increased oxidative stress and increased intracellular reactive oxygen species

Which hormone exerts antiapoptotic effects on osteoblasts but proapoptotic effects on osteoclasts? a. Parathyroid hormone b. Glucocorticoid c. Growth hormone d. Estrogen

d. Estrogen

A patient is brought to the Emergency Department after being found by neighbors. The patient says she has been lying on the floor in the house for 3 days. What action by the health care professional is best? a. Order a serum creatine kinase (CK) level b. Obtain an x-ray of the patient’s hips c. Arrange for the patient to have a DXA scan d. Perform the Fracture Risk Assessment

a. Order a serum creatine kinase (CK) level

The health care professional teaches a group of seniors that the most common clinical manifestation of osteoporosis is which of these? a. Bone deformity b. Bone pain c. Pathologic fracture d. Muscle strain

a. Bone deformity

A patient has been diagnosed with Paget disease. What explanation of the disease does the health care professional provide the patient? a. “It is a severe infection in your bones.” b. “It is a problem with bone resorption and formation.” c. “It is a condition in which your bones become soft.” d. “It’s a disorder of altered energy production in muscle.”

b. “It is a problem with bone resorption and formation.”

A health care professional determines that the student needs more education when the student makes which statement about treating bone infection? a. Bone contains multiple microscopic channels that are impermeable to the cells and biochemicals of the body’s natural defenses. b. Microcirculation of bone is highly vulnerable to damage and destruction by bacterial toxins, leading to ischemic necrosis of bone. c. Bone cells have a limited capacity to replace bone destroyed by infections. d. Bacteria are walled off by macrophages and T lymphocytes; consequently, the antibiotics cannot penetrate the infected area.

d. Bacteria are walled off by macrophages and T lymphocytes; consequently, the antibiotics cannot penetrate the infected area.

Bone death as a result of osteomyelitis is due to what? a. Formation of immune complexes at the site of infection b. Localized ischemia c. Tumor necrosis factor-alpha (TNF-) and interleukin 1 (IL-1) d. Impaired nerve innervation at the site of infection

b. Localized ischemia

A student studying osteomyelitis and asks for an explanation of the term “sequestrum.” What response by the professor is best? a. An area of devascularized and devitalized bone b. An enzyme that phagocytizes necrotic bone c. A subperiosteal abscess d. A layer of new bone surrounding the infected bone

a. An area of devascularized and devitalized bone

A patient in the clinic had a femur x-ray that was read as having a “moth-eaten” appearance. What treatment option does the health care professional discuss with the patient? a. Limb-salvaging surgery b. Amputation c. Oral bisphosphonates d. Calcium and vitamin D supplements

a. Limb-salvaging surgery

Which statement accurately describes a characteristic of osteosarcoma? a. Slow-growing tumor that begins in the bone marrow and infiltrates the trabeculae b. Solitary tumor that most often affects the metaphyseal region of the femur or tibia c. Aggressive tumor most often found in the bone marrow of long bones d. Tumor that infiltrates the trabeculae in spongy bone and implants in surrounding tissue by seeding

c. Aggressive tumor most often found in the bone marrow of long bones

A professor has taught the class about giant cell bone tumors. Which statement by a student would require the professor to review the material? a. Giant cell tumors are an overexpression of genes including osteoprotegerin ligand (OPGL). b. The tumors are malignant, solitary, and irregularly shaped. c. Giant cell tumors are typically located in the epiphysis in the femur, tibia, radius, and humerus. d. They are slow-growing tumors that extend over the articular cartilage

b. The tumors are malignant, solitary, and irregularly shaped.

Which patient finding would lead the health care professional to assess the patient for inflammatory joint disease? a. Unilateral joint involvement b. Normal joint synovial fluid c. Absence of synovial membrane inflammation d. Systemic symptoms of inflammation

d. Systemic symptoms of inflammation

What is a primary defect in osteoarthritis? a. Stromelysin and acid metalloproteinase breakdown articular cartilage. b. Immunoglobulin G (IgG) destroys the synovial membrane. c. Synovial membranes become inflamed. d. Cartilage-coated osteophytes create bone spurs.

a. Stromelysin and acid metalloproteinase breakdown articular cartilage.

A patient reports joint stiffness with movement and joint pain in weightbearing joints that is usually relieved by rest. What treatment option does the health care professional discuss with the patient? a. Ways to decrease serum uric acid b. Administration of oral methotrexate c. Exercise and weight reduction d. Rapid intravenous hydration

c. Exercise and weight reduction

A patient has ankylosing spondylitis. Which description of this condition by the health care professional is most accurate? a. Chronic inflammatory disease with stiffening and fusion of the spine and sacroiliac joints b. Chronic systemic inflammatory disease that affects many tissues and organs c. State of abnormal and excessive bone resorption and formation d. Wide-spread and deep chronic muscle pain, fatigue, and tender points

a. Chronic inflammatory disease with stiffening and fusion of the spine and sacroiliac joints

What is the primary pathologic alteration resulting from ankylosing spondylitis (AS)? a. Inflammation of the bursa b. Inflammation of the long bones c. Inflammation of fibrocartilaginous joints of the vertebrae d. Inflammation of the small hand and feet bones

c. Inflammation of fibrocartilaginous joints of the vertebrae

A person in the health care clinic has gout. In order to prevent a common complication, what self-care measure does the health care professional teach the person about? a. Drinking plenty of water b. Splinting affected joints c. Eating more protein d. Avoiding hot weather

a. Drinking plenty of water

What causes the crystallization within the synovial fluid of the joint affected by gouty arthritis? a. Reduced excretion of purines b. Overproduction of uric acid c. Increase in the glycosaminoglycan levels d. Overproduction of proteoglycans

b. Overproduction of uric acid

The pathophysiologic presentation of gout is closely linked to the metabolism of which chemical? a. Purine b. Pyrimidine c. Vitamin E d. Amino acid

a. Purine

A patient in the clinic is worried about having fibromyalgia. For which symptoms should the health care professional assess the patient for? a. Hot, tender, and edematous muscle groups bilaterally b. Fasciculations of the upper and lower extremity muscles c. Exercise intolerance and painful muscle cramps d. Sensitivity at tender points and profound fatigue

d. Sensitivity at tender points and profound fatigue

A health care professional is teaching a group of college women about increasing calcium in the diet to prevent osteoporosis. A participant asks at what age is peak bone mass is reached in women. What response is best? a. 15 years b. 20 years c. 30 years d. 35 years

c. 30 years

What event is associated with the beginning of bone loss in women? a. Puberty b. Sexual activity c. Childbirth d. Menopause

d. Menopause

A patient in the clinic has calcium crystals that are associated with chronic gout. How does the professional document this finding? a. Stones b. Spurs c. Tophi d. Nodes

c. Tophi

Until the skeleton matures and adult stature is reached, where does growth in the length of bone occur? a. Epiphyseal line b. Physeal plate c. Epiphyseal cartilage d. Metaphyseal plate

b. Physeal plate

A healthcare professional is educating an expectant parent class. Which skeletal deformity does the professional tell them is normal at birth but generally disappears by years of age? a. Genu varum (bowleg) b. Genu valgum (knock knee) c. Equinovarus (clubfoot) d. Pes planus (flat feet)

a. Genu varum (bowleg)

A healthcare professional wants to estimate the total mass of muscle in a patient’s body. What serum laboratory test should the professional evaluate? a. Albumin b. Blood urea nitrogen c. Creatinine d. Creatine

c. Creatinine

A healthcare professional working with children learns that which is the most common congenital skeletal defect of the upper extremity? a. Vestigial tabs b. Paget disease c. Rickets d. Syndactyly

d. Syndactyly

What diagnosis is given to parents when their infant’s hip maintains contact with the acetabulum but is not well seated within the hip joint? a. Dislocatable hip b. Subluxated hip c. Dislocated hip d. Subluxable hip

b. Subluxated hip

Which sign or symptom is a very late indication of developmental dysplasia of the hip? a. Asymmetry of the gluteal or thigh folds b. Leg-length discrepancy c. Waddling gait d. Pain

d. Pain

To assess for osteogenesis imperfecta, which laboratory result would the healthcare professional expect to find? a. Increased phosphorus b. Decreased calcium c. Increased alkaline phosphatase d. Decreased total protein

c. Increased alkaline phosphatase

A child has a disorder that resulted in the failure of bones to ossify, resulting in soft bones and skeletal deformity. What treatment plan does the healthcare professional discuss with the parents? a. Extremely careful handling b. Increasing vitamin D intake c. Revascularization d. Containment and motion therapy

b. Increasing vitamin D intake

An insufficient dietary intake of which vitamin can lead to rickets in children? a. C b. B12 c. B6 d. D

d. D

A child has scoliosis with a 40-degree curvature of the spine, and the parent is worried about pulmonary involvement. What statement by the healthcare professional is most appropriate? a. “Scoliosis is a bone disorder and does not affect the lungs.” b. “Yes, we should obtain pulmonary function studies soon.” c. “Scoliosis severe enough to involve the lungs would be fatal.” d. “The lungs aren’t affected until the curvature is over 80 degrees.”

d. “The lungs aren’t affected until the curvature is over 80 degrees.”

In osteomyelitis, bacteria gain access to the subperiosteal space in the metaphysis. What factor makes this route the easiest for bacteria to gain access to this area? a. Cortex of the bone in this area is porous or mazelike. b. Blood supply to the metaphysis is easily compromised. c. Macrophages and lymphocytes have limited access to the subperiosteal space. d. Bacteria usually spread down the medullary cavity of the bone.

a. Cortex of the bone in this area is porous or mazelike.

The student wants to know how the clinical manifestations and onset of juvenile idiopathic arthritis (JIA) differ from those of rheumatoid arthritis (RA) in adults. What answer by the healthcare professional is best? a. JIA begins insidiously with systemic signs of inflammation. b. JIA predominantly affects large joints. c. JIA has more severe joint pain than adult RA. d. JIA has a rapid onset of generalized aches as the first symptom.

b. JIA predominantly affects large joints.

An adolescent has been diagnosed with osteochondrosis. How does the healthcare professional describe the pathophysiology to the teen? a. Imbalance between calcitonin and parathyroid hormone b. Nutritional deficiency of calcium and phosphorus c. Bacterial infection of the bone d. Vascular impairment and trauma to bone

d. Vascular impairment and trauma to bone

Which bones are affected in Legg-Calvé-Perthes disease? a. Heads of the femur b. Distal femurs c. Heads of the humerus d. Distal tibias

a. Heads of the femur

What does the student learn about the pain experienced with Legg-Calvé-Perthes disease? a. Elbow and upper and lower arm pain is aggravated by activity and relieved by rest. b. Knee, inner thigh, and groin pain is described as a continuous ache and relieved by antiinflammatory drugs. c. Knee, inner thigh, and groin pain is aggravated by activity and relieved by rest. d. Elbow and upper and lower arm pain is described as a continuous ache and relieved by antiinflammatory drugs.

c. Knee, inner thigh, and groin pain is aggravated by activity and relieved by rest.

The healthcare professional directs a student to assess a teen who has Osgood-Schlatter disease. What assessment finding does the student anticipate for this disorder? a. Lateral epicondylitis of the elbow b. Inflammation of the anterior cruciate ligament c. Bursitis of the subscapular bursa in the glenohumeral joint d. Tendinitis of the anterior patellar tendon

d. Tendinitis of the anterior patellar tendon

At birth, the diagnosis of cerebral palsy (CP) may be made based on what factor? a. Brain trauma b. Prematurity c. Major brain malformation d. Genetic defect

c. Major brain malformation

A child has Duchenne muscular dystrophy and the parents want to know how this occurred. Which statement by the healthcare professional is most accurate? a. X-linked recessive inheritance b. Common SMN1 gene abnormality c. Autosomal dominant inheritance d. Inheritance is not well defined

a. X-linked recessive inheritance

Which protein, absent in muscle cells of Duchenne muscular dystrophy, mediates the anchoring of skeletal muscle fibers to the basement membrane? a. Syntrophin b. Laminin c. Dystrophin d. Troponin

c. Dystrophin

A child has Duchenne muscular dystrophy. What complication does the healthcare professional teach the parents is most important to control? a. Respiratory infection b. Joint contractures c. Urinary tract infection d. Fractures from falling

a. Respiratory infection

Generally, what is the first symptom of facioscapulohumeral muscular dystrophy? a. Inability to open the eyes completely b. Difficulty standing c. Drooping shoulders d. Facial pain

c. Drooping shoulders

What is the most common malignant bone tumor diagnosed during childhood? a. Chondrosarcoma b. Fibrosarcoma c. Ewing Sarcoma d. Osteosarcoma

d. Osteosarcoma

Molecular analysis has demonstrated that osteosarcoma is associated with which gene? a. TP53 b. src c. myc d. TSC2

b. src

A child has osteosarcoma and the healthcare team is assessing for metastases. What diagnostic study would be the priority? a. Pancreatic enzyme analysis b. Liver biopsy c. Chest x-ray or CT scan d. Brain MRI

c. Chest x-ray or CT scan

What does a Ewing sarcoma arise from? a. Bone marrow b. Bone-producing mesenchymal cells c. Metadiaphysis of long bones d. Embryonal osteocytes

a. Bone marrow

Rhabdomyosarcoma can develop in which type of muscle? a. Cardiac b. Smooth c. Involuntary d. Striated

d. Striated

A newborn is diagnosed with osteomyelitis. What organism does the healthcare professional prepare to treat? a. Staphylococcus aureus b. Escherichia coli c. Group B streptococcus d. Bacillus anthracis

a. Staphylococcus aureus

A student asks what the cause of structural scoliosis is. What explanation by the professor is accurate? a. Poor posture b. Vertebral rotation c. Poor calcium absorption d. Intrauterine trauma

b. Vertebral rotation

Which pathway carries sensory information toward the central nervous system (CNS)? a. Ascending b. Descending c. Somatic d. Efferent

a. Ascending

Which type of axon transmits a nerve impulse at the highest rate? a. Large nonmyelinated b. Large myelinated c. Small nonmyelinated d. Small myelinated

b. Large myelinated

Which nerves are capable of regeneration? a. Nerves within the brain and spinal cord b. Peripheral nerves that are cut or severed c. Myelinated nerves in the peripheral nervous system d. Unmyelinated nerves of the peripheral nervous system

c. Myelinated nerves in the peripheral nervous system

Where is the neurotransmitter, norepinephrine, secreted? a. Somatic nervous system b. Parasympathetic preganglion c. Sympathetic postganglion d. Parasympathetic postganglion

c. Sympathetic postganglion

Both oligodendroglia and Schwann cells share the ability to do what? a. Form a myelin sheath b. Remove cellular debris c. Transport nutrients d. Line the ventricles

a. Form a myelin sheath

During a synapse, what change occurs after the neurotransmitter binds to the receptor? a. The permeability of the presynaptic neuron changes; consequently, its membrane potential is changed as well. b. The permeability of the postsynaptic neuron changes; consequently, its membrane potential is changed as well. c. The postsynaptic cell prevents any change in permeability and destroys the action potential. d. The presynaptic cell synthesizes and secretes additional neurotransmitters.

b. The permeability of the postsynaptic neuron changes; consequently, its membrane potential is changed as well.

What name is given to a large network of neurons within the brainstem that is essential for maintaining wakefulness? a. Midbrain b. Reticular activating system c. Medulla oblongata d. Pons

b. Reticular activating system

Thought and goal-oriented behaviors are functions of which area of the brain? a. Cerebellum b. Limbic system c. Prefrontal lobe d. Occipital lobe

c. Prefrontal lobe

Where is the region responsible for the motor aspects of speech located? a. Wernicke area in the temporal lobe b. Broca speech area in the frontal lobe c. Wronka area in the parietal lobe d. Barlow area in the occipital lobe

b. Broca speech area in the frontal lobe

Parkinson disease is associated with defects in which area of the brain? a. Thalamus b. Medulla oblongata c. Cerebellum d. Substantia nigra

d. Substantia nigra

Maintenance of a constant internal environment and the implementation of behavioral patterns are main functions of which area of the brain? a. Thalamus b. Epithalamus c. Subthalamus d. Hypothalamus

d. Hypothalamus

The ability of the eyes to track moving objects through a visual field is primarily a function of which colliculi? a. Inferior b. Superior c. Mid d. Posterior

b. Superior

What part of the brain mediates the physical expression of emotions? a. Hypothalamus b. Basal ganglia c. Medulla oblongata d. Subthalamus

a. Hypothalamus

Reflex activities concerned with heart rate, blood pressure, respirations, sneezing, swallowing, and coughing are controlled by which area of the brain? a. Pons b. Midbrain c. Cerebellum d. Medulla oblongata

d. Medulla oblongata

A healthcare professional is assessing a patient who suffered a head trauma. The patient is not able to sense touch of a sharp pin and cannot distinguish a hot object from a cold one. What part of the patient’s brain does the professional suspect is damaged? a. Midbrain b. Pons c. Medulla oblongata d. Lateral colliculi

b. Pons

A healthcare professional is assessing a patient for dysfunction of cranial nerve VII. What assessment finding would confirm the professional’s suspicion? a. Patient is unable to open mouth against resistance. b. Patient does not display intact gag reflex. c. Patient is able to smile only on one side of the face. d. Patient’s tongue deviates to the right when sticking out.

c. Patient is able to smile only on one side of the face.

Which area of the brain assumes the responsibility for involuntary muscle control and for maintaining balance and posture? a. Cerebrum b. Cerebellum c. Diencephalon d. Brainstem

b. Cerebellum

A patient has a spinal cord injury that included damage to the upper motor neurons. What assessment finding would the healthcare provider associate with this injury? a. Permanent paralysis below the level of the injury b. Initial paralysis, but gradual partial recovery later c. Hemiplegia on the contralateral side of the body d. Notable increase in the amount of cerebral spinal fluid (CSF)

b. Initial paralysis, but gradual partial recovery later

What is the membrane that separates the brain’s cerebellum from its cerebrum? a. Tentorium cerebelli b. Falx cerebri c. Arachnoid membrane d. Falx cerebelli

a. Tentorium cerebelli

A patient has a defect in the arachnoid villi. What finding would the healthcare professional expect to note? a. Production of excess cerebrospinal fluid (CSF) b. Ischemia in the choroid plexuses c. Cloudy cerebral spinal fluid on analysis d. Absorption of too little cerebrospinal fluid

d. Absorption of too little cerebrospinal fluid

Where is the cerebrospinal fluid (CSF) produced? a. Arachnoid villi b. Choroid plexuses c. Ependymal cells d. Pia mater

b. Choroid plexuses

Which of the meninges closely adheres to the surface of the brain and spinal cord and follows the sulci and fissures? a. Dura mater b. Arachnoid c. Pia mater d. Inner dura

c. Pia mater

Norepinephrine produces what primary response? a. Increased contractility of the heart b. Release of renin from the kidney c. Vasoconstriction d. Sleep cycle disturbance

c. Vasoconstriction

The brain receives approximately what percentage of the cardiac output? a. 80% b. 40% c. 20% d. 10%

c. 20%

What is the collateral blood flow to the brain provided by? a. Carotid arteries b. Basilar artery c. Circle of Willis d. Vertebral arteries

c. Circle of Willis

The nurse recognizes that a patient’s diagnosis of a bacterial infection of the brain’s meningeal layer is supported by which diagnostic laboratory result? a. Chloride 125 mEq/L b. Leukocytes 110/mm3 c. Protein 32 mg/dL d. Glucose 63 mg/dL

b. Leukocytes 110/mm3

Cognitive operations cannot occur without the effective functioning of what part of the brain? a. Pons b. Medulla oblongata c. Reticular activating system d. Cingulate gyrus

c. Reticular activating system

Which intracerebral disease process is capable of producing diffuse dysfunction? a. Closed-head trauma with bleeding b. Subdural pus collections c. Neoplasm d. Embolic infarct

d. Embolic infarct

What is the most common infratentorial brain disease process that results in the direct destruction of the reticulating activation system (RAS)? a. Cerebrovascular disease b. Demyelinating disease c. Neoplasms d. Abscesses

a. Cerebrovascular disease

What stimulus causes posthyperventilation apnea (PHVA)? a. Changes in PaO2 levels b. Changes in PaCO2 levels c. Damage to the forebrain d. Any arrhythmic breathing pattern

b. Changes in PaCO2 levels

A healthcare professional reads in the patient’s chart and notes the patient has Cheyne-Stokes respirations. What clinical finding would the professional correlate with this condition? a. Sustained deep rapid but regular pattern of breathing b. Crescendo-decrescendo pattern of breathing, followed by a period of apnea c. Prolonged pause after the inspiratory period with occasional end-expiratory pause d. Completely random, irregular breathing pattern with pauses

b. Crescendo-decrescendo pattern of breathing, followed by a period of apnea

Vomiting is associated with central nervous system (CNS) injuries that compress which of the brain’s anatomic locations? a. Vestibular nuclei in the lower brainstem b. Floor of the third ventricle c. Any area in the midbrain d. Diencephalon

a. Vestibular nuclei in the lower brainstem

Which midbrain dysfunction causes pupils to be pinpoint size and fixed in position? a. Diencephalon dysfunction b. Oculomotor cranial nerve dysfunction c. Dysfunction of the tectum d. Pontine dysfunction

d. Pontine dysfunction

A healthcare professional suspects a patient is brain dead. How would the professional assess for brain death? a. Determine if the patient can make voluntary movements. b. Perform tests to assess if the patient is in a coma. c. Remove the patient’s ventilator to see if spontaneous breathing occurs. d. Monitor the patient for eye movements that seem purposeful.

c. Remove the patient’s ventilator to see if spontaneous breathing occurs

A patient has damage to the lower pons and medulla. What finding does the healthcare professional associate with this injury? a. Flexion with or without extensor response of the lower extremities b. Extension response of the upper and lower extremities c. Extension response of the upper extremities and flexion response of the lower extremities d. Flaccid response in the upper and lower extremities

d. Flaccid response in the upper and lower extremities

Which hospitalized patient does the healthcare professional assess as a priority for the development of delirium? a. An individual with diabetes celebrating a 70th birthday b. A depressed Hispanic woman c. An elderly male on the second day after hip replacement d. A man diagnosed with schizophrenia

c. An elderly male on the second day after hip replacement

A patient suffered a seizure for the first time. The spouse asks the healthcare professional to explain what a seizure is. What response by the professional is best? a. Actions that occur without conscious thought because of a stimulus b. A sudden, explosive, disorderly discharge of brain cells c. A disease where a person has frequent seizures like this one d. A series of excessive, purposeless movements.

b. A sudden, explosive, disorderly discharge of brain cells

A patient had a seizure that consisted of impaired consciousness and the appearance of a dreamlike state. How does the healthcare professional chart this episode? a. Focal seizure b. Complex focal seizure c. Tonic-clonic seizure d. Atonic seizure

b. Complex focal seizure

A patient is in status epilepticus. In addition to giving medication to stop the seizures, what would the healthcare professional place highest priority on? a. Facilitating a CT scan of the head b. Providing oxygen c. Assessing for brain death d. Assessing for drug overdose

b. Providing oxygen

What area of the brain mediates the executive attention functions? a. Limbic b. Prefrontal c. Parietal d. Occipital

b. Prefrontal

A healthcare professional is caring for a patient diagnosed with aphasia. What action by the professional would be best in working with this patient? a. Provide physical therapy. b. Provide speech therapy. c. Provide special thickened foods. d. Provide balance activities.

b. Provide speech therapy.

Cerebral edema is an increase in the fluid content of what part of the brain? a. Ventricles b. Tissue c. Neurons d. Meninges

b. Tissue

What type of cerebral edema occurs when permeability of the capillary endothelium increases after injury to the vascular structure? a. Cytotoxic b. Interstitial c. Vasogenic d. Ischemic

c. Vasogenic

What is a communicating hydrocephalus caused by an impairment of? a. Cerebrospinal fluid flow between the ventricles b. Cerebrospinal fluid flow into the subarachnoid space c. Blood flow to the arachnoid villi d. Absorption of cerebrospinal fluid

d. Absorption of cerebrospinal fluid

Which dyskinesia involves involuntary movements of the face, trunk, and extremities? a. Paroxysmal b. Tardive c. Hyperkinesia d. Cardive

b. Tardive

Antipsychotic drugs cause tardive dyskinesia by mimicking the effects of an increase of what? a. Dopamine b. Gamma-aminobutyric acid c. Norepinephrine d. Acetylcholine

a. Dopamine

The existence of regular, deep, and rapid respirations after a severe closed head injury is indicative of neurologic injury to what? a. Lower midbrain b. Pontine area c. Supratentorial d. Cerebral area

a. Lower midbrain

What type of posturing exists when a person with a severe closed head injury has all four extremities in rigid extension with the forearms in hyperpronation and the legs in plantar extension? a. Decorticate b. Decerebrate c. Spastic d. Cerebellar

b. Decerebrate

After a cerebrovascular accident, a patient has been diagnosed with anosognosia. What action by the healthcare professional would be most helpful? a. Provide a white board for the patient to write on. b. Ensure the patient has a safe environment. c. Provide physical therapy for strengthening exercises. d. Practice naming colors using flash cards.

b. Ensure the patient has a safe environment.

After a cerebrovascular accident, a man is unable to either feel or identify a comb with his eyes closed. What is this an example of? a. Agraphia b. Tactile agnosia c. Anosognosia d. Prosopagnosia

b. Tactile agnosia

Most aphasias are associated with cerebrovascular accidents involving which artery? a. Anterior communicating b. Posterior communicating c. Circle of Willis d. Middle cerebral

d. Middle cerebral

The body compensates for a rise in intracranial pressure by first displacing what? a. Cerebrospinal fluid b. Arterial blood c. Venous blood d. Cerebral cells

a. Cerebrospinal fluid

Dilation of the ipsilateral pupil following uncal herniation is the result of pressure on which cranial nerve (CN)? a. Optic (CN I) b. Abducens (CN VI) c. Oculomotor (CN III) d. Trochlear (CN IV)

c. Oculomotor (CN III)

When does uncal herniation occur? a. The hippocampal gyrus shifts from the middle fossa through the tentorial notch into the posterior fossa. b. The diencephalon shifts from the middle fossa straight downward through the tentorial notch into the posterior fossa. c. The cingulate gyrus shifts under the falx cerebri. d. A cerebellar tonsil shifts through the foramen magnum.

a. The hippocampal gyrus shifts from the middle fossa through the tentorial notch into the posterior fossa.

Which assessment finding marks the end of spinal shock? a. Return of blood pressure and heart rate to normal b. Gradual return of spinal reflexes c. Return of bowel and bladder function d. Evidence of diminished deep tendon reflexes and flaccid paralysis

b. Gradual return of spinal reflexes

Parkinson disease is a degenerative disorder of which part of the brain? a. Hypothalamus b. Anterior pituitary c. Frontal lobe d. Basal ganglia

d. Basal ganglia

Clinical manifestations of Parkinson disease are caused by a deficit in which of the brain’s neurotransmitters? a. Gamma-aminobutyric acid b. Dopamine c. Norepinephrine d. Acetylcholine

b. Dopamine

Tremors at rest, rigidity, akinesia, and postural abnormalities are a result of the atrophy of neurons in which part of the brain? a. Caudate that produces serotonin b. Putamen that produces gamma-aminobutyric acid c. Substantia nigra that produces dopamine d. Hypothalamus that produces acetylcholine

c. Substantia nigra that produces dopamine

What do diffuse axonal injuries (DAIs) of the brain often result in? a. Reduced levels of consciousness b. Mild but permanent dysfunction c. Fine motor tremors d. Visual disturbances

a. Reduced levels of consciousness

What event is most likely to occur when a person experiences a closed head injury? a. Brief period of vital sign instability b. Cerebral edema throughout the cerebral cortex c. Cerebral edema throughout the diencephalon d. Disruption of axons extending from the diencephalon and brainstem

a. Brief period of vital sign instability

A healthcare professional wants to volunteer for a community education project to help prevent spinal cord injury. What activity would the professional most likely volunteer for? a. Teaching school aged children bicycle safety b. Teaching stretching to high school athletes c. Teaching adults good body mechanics for lifting d. Teaching older adults how to prevent trip-and-fall events

d. Teaching older adults how to prevent trip-and-fall events

A patient has a spinal cord injury at C4. What should the healthcare professional assess as the priority in this patient? a. Blood pressure b. Respirations c. Pulse d. Temperature

b. Respirations

What indicates that spinal shock is terminating? a. Voluntary movement below the level of injury b. Reflex emptying of the bladder c. Paresthesia below the level of injury d. Decreased deep tendon reflexes and flaccid paralysis

b. Reflex emptying of the bladder

A healthcare professional is caring for a patient who has a spinal cord injury at T5. The patient exhibits severe hypertension, a heart rate of 32 beats/min, and sweating above the spinal cord lesion. How does the professional chart this event? a. Craniosacral dysreflexia b. Parasympathetic dysreflexia c. Autonomic hyperreflexia d. Retrograde hyperreflexia

c. Autonomic hyperreflexia

Autonomic hyperreflexia-induced bradycardia is a result of stimulation of what? a. Sympathetic nervous system to -adrenergic receptors to the sinoatrial node b. Carotid sinus to the vagus nerve to the sinoatrial node c. Parasympathetic nervous system to the glossopharyngeal nerve to the atrioventricular node d. Bundle branches to the -adrenergic receptors to the sinoatrial node

b. Carotid sinus to the vagus nerve to the sinoatrial node

A herniation of which disk will likely result in motor and sensory changes of the lateral lower legs and soles of the feet? a. L2 to L3 b. L3 to L5 c. L5 to S1 d. S2 to S3

c. L5 to S1

A healthcare professional is planning a community event to reduce risk of cerebrovascular accident (CVA) in high risk groups. Which group would the professional target as the priority? a. Insulin-resistant diabetes mellitus b. Hypertension c. Polycythemia d. Smoking

b. Hypertension

A right hemisphere embolic CVA has resulted in left-sided paralysis and reduced sensation of the left foot and leg. Which cerebral artery is most likely affected by the emboli? a. Middle cerebral b. Vertebral c. Posterior cerebral d. Anterior cerebral

d. Anterior cerebral

Atrial fibrillation, rheumatic heart disease, and valvular prosthetics are risk factors for which type of stroke? a. Hemorrhagic b. Thrombotic c. Embolic d. Lacunar

c. Embolic

Microinfarcts resulting in pure motor or pure sensory deficits are the result of which type of stroke? a. Embolic b. Hemorrhagic c. Lacunar d. Thrombotic

c. Lacunar

Which vascular malformation is characterized by arteries that feed directly into veins through vascular tangles of abnormal vessels? a. Cavernous angioma b. Capillary telangiectasia c. Arteriovenous angioma d. Arteriovenous malformation

d. Arteriovenous malformation

Which clinical finding is considered a diagnostic indicator for an arteriovenous malformation (AVM)? a. Systolic bruit over the carotid artery b. Decreased level of consciousness c. Hypertension with bradycardia d. Diastolic bruit over the temporal artery

a. Systolic bruit over the carotid artery

Which cerebral vascular hemorrhage causes meningeal irritation, photophobia, and positive Kernig and Brudzinski signs? a. Intracranial b. Subarachnoid c. Epidural d. Subdural

b. Subarachnoid

In adults, how are most intracranial tumors located? a. Infratentorially b. Supratentorially c. Laterally d. Posterolaterally

b. Supratentorially

In children, how are most intracranial tumors located? a. Infratentorially b. Supratentorially c. Laterally d. Posterolaterally

a. Infratentorially

What is the most common primary central nervous system (CNS) tumor? a. Microglioma b. Neuroblastoma c. Astrocytoma d. Neuroma

c. Astrocytoma

A person has been diagnosed with multiple sclerosis and asks the healthcare professional to explain the disease. What description by the professional is most accurate? a. Myelination of nerve fibers in the peripheral nervous system (PNS) b. Demyelination of nerve fibers in the CNS c. Development of neurofibrillary tangles in the CNS d. Inherited autosomal dominant trait with high penetrance

b. Demyelination of nerve fibers in the CNS

A blunt-force injury to the forehead would result in a coup injury to which region of the brain? a. Frontal b. Temporal c. Parietal d. Occipital

a. Frontal

A blunt-force injury to the forehead would result in a contrecoup injury to which region of the brain? a. Frontal b. Temporal c. Parietal d. Occipital

d. Occipital

Spinal cord injuries occur most frequently in which region? a. Cervical and thoracic b. Thoracic and lumbar c. Lumbar and sacral d. Cervical and thoracic lumbar

d. Cervical and thoracic lumbar

What is the type of vascular malformation that most often results in hemorrhage? a. Cavernous angioma b. Venous angioma c. Capillary telangiectasia d. Arteriovenous malformation

d. Arteriovenous malformation

Where are atheromatous plaques most commonly found? a. In larger veins b. Near capillary sphincters c. At branches of arteries d. On the venous sinuses

c. At branches of arteries

A patient has AIDS and reports fever, clumsiness, difficulty with balance and walking, and trouble speaking. What treatment does the healthcare professional educate the patient about? a. Radiation therapy b. Chemotherapy c. Oral pyrimethamine d. Surgery

c. Oral pyrimethamine

A patient has been hospitalized with Guillain-Barré syndrome (GBS). The patient asks how this could have occurred. What response by the healthcare professional is best? a. It is often preceded by a viral illness. b. It is due to a genetic defect in acetylcholine. c. It could be caused by a brain tumor. d. It is often transmitted by family pets.

a. It is often preceded by a viral illness.

In which disorder are acetylcholine receptor antibodies (IgG antibodies) produced against acetylcholine receptors? a. Guillain-Barré syndrome b. Multiple sclerosis c. Myasthenia gravis d. Parkinson disease

c. Myasthenia gravis

Multiple sclerosis and Guillain-Barré syndrome are similar in that they both do what? a. Result from demyelination by an immune reaction. b. Cause permanent destruction of peripheral nerves. c. Result from inadequate production of neurotransmitters. d. Block acetylcholine receptor sites at the myoneuronal junction.

a. Result from demyelination by an immune reaction.

What imbalance lessens the rate of secretion of parathyroid hormone (PTH)? a. Increased serum calcium levels b. Decreased serum magnesium levels c. Decreased levels of thyroid-stimulating hormone d. Increased levels of thyroid-stimulating hormone

a. Increased serum calcium levels

Regulation of the release of insulin is an example of which type of regulation? a. Negative feedback b. Positive feedback c. Neural d. Physiologic

c. Neural

A student asks the professor how a faulty negative-feedback mechanism results in a hormonal imbalance. What response by the professor is best? a. Hormones are not synthesized in response to cellular and tissue activities. b. Decreased hormonal secretion is a response to rising hormone levels. c. Too little hormone production is initiated. d. Excessive hormone production results from a failure to turn off the system.

d. Excessive hormone production results from a failure to turn off the system.

Which substance is a water-soluble protein hormone? a. Thyroxine b. Aldosterone c. Follicle-stimulating hormone d. Insulin

d. Insulin

Which of these is a lipid-soluble hormone? a. Cortisol b. Oxytocin c. Epinephrine d. Growth hormone

a. Cortisol

Most protein hormones are transported in the bloodstream and are what? a. Bound to a lipid-soluble carrier b. Free in an unbound, water-soluble form c. Bound to a water soluble-binding protein d. Free because of their lipid-soluble chemistry

b. Free in an unbound, water-soluble form

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? a. Pharmacologic b. Permissive c. Synergistic d. Direct

d. Direct

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? a. Positive feedback b. Negative feedback c. Neural regulation d. Physiologic regulation

b. Negative feedback

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? a. “No, you will become extremely malnourished.” b. “Yes, that is an effective way to eliminate cholesterol.” c. “No, many hormones are made from cholesterol.” d. “Yes, that will increase the action of insulin.”

c. “No, many hormones are made from cholesterol.”

Which second messenger is stimulated by epinephrine binding to a -adrenergic receptor? a. Calcium b. Inositol triphosphate (IP3) c. Diacylglycerol (DAG) d. Cyclic adenosine monophosphate (cAMP)

d. Cyclic adenosine monophosphate (cAMP)

Why is the control of calcium in cells important? a. It is controlled by the calcium negative-feedback loop. b. It is continuously synthesized. c. It acts as a second messenger. d. It carries lipid-soluble hormones in the bloodstream.

c. It acts as a second messenger.

What is the portion of the pituitary that secretes oxytocin? a. Posterior b. Inferior c. Anterior d. Superior

a. Posterior

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? a. “Antidiuretic hormone conserves fluid when urine output is less than 20 mL/hr.” b. “Antidiuretic hormone causes serum osmolality to be increased.” c. “Antidiuretic hormone leads to better insulin utilization.” d. “Antidiuretic hormone causes vasoconstriction to help increase blood pressure.”

d. “Antidiuretic hormone causes vasoconstriction to help increase blood pressure.”

What is the target tissue for prolactin-releasing factor? a. Hypothalamus b. Anterior pituitary c. Mammary glands d. Posterior pituitary

b. Anterior pituitary

Where is antidiuretic hormone (ADH) synthesized, and where does it act? a. Hypothalamus; renal tubular cells b. Renal tubules; renal collecting ducts c. Anterior pituitary; posterior pituitary d. Posterior pituitary; loop of Henle

a. Hypothalamus; renal tubular cells

Where is oxytocin synthesized? a. Hypothalamus b. Paraventricular nuclei c. Anterior pituitary d. Posterior pituitary

a. Hypothalamus

How do the releasing hormones that are made in the hypothalamus travel to the anterior pituitary? a. Vessels of the zona fasciculata b. Infundibular process c. Pituitary stalk d. Portal hypophyseal blood vessels

d. Portal hypophyseal blood vessels

To ensure optimal thyroid health and function, which mineral does the health care professional advise a nutrition class to include in the daily diet? a. Iron b. Zinc c. Iodide d. Copper

c. Iodide

Which hormone triggers uterine contractions? a. Thyroxine b. Oxytocin c. Growth hormone d. Insulin

b. Oxytocin

What effect does hyperphosphatemia have on other electrolytes? a. Increases serum calcium b. Decreases serum calcium c. Decreases serum magnesium d. Increases serum magnesium

b. Decreases serum calcium

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? a. Potassium b. Calcium c. Sodium d. Chloride

a. Potassium

A person who has experienced physiologic stresses will have increased levels of which hormone? a. Cortisol b. Thyroid hormone c. Somatostatin d. Alpha endorphin

a. Cortisol

What is the action of calcitonin? a. Increases metabolism b. Decreases metabolism c. Increases serum calcium d. Decreases serum calcium

d. Decreases serum calcium

Which hormone is involved in the regulation of serum calcium levels? a. Parathyroid hormone (PTH) b. Thyroxine (T4) c. Adrenocorticotropic hormone (ACTH) d. Triiodothyronine (T3)

a. Parathyroid hormone (PTH)

Which hormone inhibits the secretion of growth hormone (GH)? a. Somatostatin b. Thyroxine c. Thyroid-stimulating hormone d. Calcitonin

a. Somatostatin

Where are target cells for parathyroid hormone located? a. Tubules of nephrons b. Thyroid gland c. Glomeruli of nephrons d. Smooth and skeletal muscles

a. Tubules of nephrons

Which compound or hormone is secreted by the adrenal medulla? a. Cortisol b. Epinephrine c. Androgens d. Aldosterone

b. Epinephrine

What are the effects of aging on pancreatic cells? a. Pancreatic cells are replaced by fibrotic cells. b. Increased insulin production is typical. c. Beta cell function decreases. d. No appreciable change occurs on pancreatic cells.

c. Beta cell function decreases.

What does aldosterone directly increase the reabsorption of? a. Magnesium b. Calcium c. Sodium d. Water

c. Sodium

Which is an expected hormonal change in an older patient? a. Thyroid-stimulating hormone secretion below normal b. Triiodothyronine level below normal c. Cortisol level below normal d. Adrenocorticotropic hormone level above normal

a. Thyroid-stimulating hormone secretion below normal

The effects of the syndrome of inappropriate antidiuretic hormone (SIADH) secretion include which solute? a. Sodium and water retention b. Sodium retention and water loss c. Sodium dilution and water retention d. Sodium dilution and water loss

c. Sodium dilution and water retention

Which patient would the healthcare professional assess for elevated levels of antidiuretic hormone (ADH) secretion? a. Being treated for small cell carcinoma of the stomach b. Taking high dose acetaminophen (Tylenol) for arthritis c. Had a hip replacement operation 14 days ago d. Has long-standing kidney disease from diabetes

a. Being treated for small cell carcinoma of the stomach

Which laboratory value would the nurse expect to find if a person is experiencing syndrome of inappropriate antidiuretic hormone (SIADH)? a. Hypernatremia and urine hypoosmolality b. Serum potassium (K+) level of 5 mEq/L and urine hyperosmolality compared to serum c. Serum sodium (Na+) level of 120 mEq/L and serum osmolality 260 mOsm/kg d. Serum potassium (K+) of 2.8 mEq/L and serum hyperosmolality

c. Serum sodium (Na+) level of 120 mEq/L and serum osmolality 260 mOsm/kg

What is diabetes insipidus a result of? a. Antidiuretic hormone hyposecretion b. Antidiuretic hormone hypersecretion c. Insulin hyposecretion d. Insulin hypersecretion

a. Antidiuretic hormone hyposecretion

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? a. Administration of desmopressin b. Serum copeptin testing c. Insulin administration d. Renal angiogram

a. Administration of desmopressin

A patient is having a water deprivation test. The patient’s initial weight was 220 pounds (100kg). The next weight is 209 pounds (95 kg). What action by the healthcare professional is most appropriate? a. Stop the water deprivation test. b. Administer salt tablets. c. Continue with the test as planned. d. Take the patient’s blood glucose.

a. Stop the water deprivation test.

A healthcare professional is caring for four patients. Which patient does the professional assess for neurogenic diabetes insipidus (DI)? a. Anterior pituitary tumor b. Thalamus hypofunction c. Posterior pituitary trauma d. Renal tubule disease

c. Posterior pituitary trauma

Which form of diabetic insipidus (DI) will result if the target cells for antidiuretic hormone (ADH) in the renal collecting tubules demonstrate insensitivity? a. Neurogenic b. Nephrogenic c. Psychogenic d. Ischemic

b. Nephrogenic

Which laboratory value is consistent with diabetes insipidus (DI)? a. Low urine-specific gravity b. Low serum sodium c. Low urine protein d. High serum total protein

a. Low urine-specific gravity

A patient has nephrogenic diabetes insipidus (DI). What treatment does the healthcare professional anticipate for this patient? a. Exogenous ADH replacement b. Intranasal desmopressin c. Water and sodium restriction d. Loop diuretic administration

a. Exogenous ADH replacement

Which condition may result from pressure exerted by a pituitary tumor? a. Hypothyroidism b. Hypercortisolism c. Diabetes insipidus d. Insulin hyposecretion

a. Hypothyroidism

A healthcare professional reads a chart that notes the patient has panhypopituitarism. What does the professional understand that term to mean? a. The patient has a lack of all hormones associated with the anterior pituitary gland. b. The patient has a lack of all hormones associated with the lateral pituitary gland. c. The patient has total adrenocorticoptropic hormone deficiency. d. The patient has a dysfunction of the posterior pituitary gland due to a tumor.

a. The patient has a lack of all hormones associated with the anterior pituitary gland.

Visual disturbances are a result of a pituitary adenoma because of what? a. Liberation of anterior pituitary hormones into the optic chiasm b. Pituitary hormones clouding the lens of the eyes c. Pressure of the tumor on the optic chiasm d. Pressure of the tumor on the optic and oculomotor cranial nerves

c. Pressure of the tumor on the optic chiasm

A patient has an enlarged tongue, body odor, rough skin, and coarse hair. Which laboratory result does the healthcare professional associate with this presentation? a. Decreased blood glucose b. Increased growth hormone c. Decreased ACTH d. Increased TSH

b. Increased growth hormone

A patient has acromegaly. What assessment by the healthcare professional would be most important? a. Skin condition b. Sleep patterns c. Bowel function d. Range of motion

b. Sleep patterns

Why does giantism occur only in children and adolescents? a. Their growth hormones are still diminished. b. Their epiphyseal plates have not yet closed. c. Their skeletal muscles are not yet fully developed. d. Their metabolic rates are higher than in adulthood.

b. Their epiphyseal plates have not yet closed.

A patient chart notes the patient has amenorrhea, galactorrhea, hirsutism, and osteoporosis. What diagnostic test would the healthcare professional prepare the patient for? a. Water deprivation test b. Hemoglobin A1C c. CT scan of the head d. Ovarian biopsy

c. CT scan of the head

What does Graves’ disease develop from? a. A viral infection of the thyroid gland that causes overproduction of thyroid hormone b. An autoimmune process during which lymphocytes and fibrous tissue replace thyroid tissue c. A thyroid-stimulating immunoglobulin that causes overproduction of thyroid hormones d. An ingestion of goitrogens that inhibits the synthesis of the thyroid hormones, causing a goiter

c. A thyroid-stimulating immunoglobulin that causes overproduction of thyroid hormones

Which patient would the healthcare professional assess for other signs of thyrotoxic crisis? a. Constipation with gastric distention b. Bradycardia and bradypnea c. Hyperthermia and tachycardia d. Constipation and lethargy

c. Hyperthermia and tachycardia

Which pathologic changes are associated with Graves’ disease? a. High levels of circulating thyroid-stimulating immunoglobulins b. Diminished levels of thyrotropin-releasing hormone c. High levels of thyroid-stimulating hormone d. Diminished levels of thyroid-binding globulin

a. High levels of circulating thyroid-stimulating immunoglobulins

A healthcare professional is palpating the neck of a person diagnosed with Graves’ disease. What finding would the professional associate with this disorder? a. Parathyroids left of midline b. Thyroid small with discrete nodules c. Parathyroids normal in size d. Thyroid diffusely enlarged

d. Thyroid diffusely enlarged

A person has hypothyroidism. What chemical does the healthcare professional advise the person to include in the diet? a. Iron b. Iodine c. Zinc d. Magnesium

b. Iodine

A patient has a suspected thyroid carcinoma. What diagnostic test does the healthcare professional prepare the patient for? a. Measurement of serum thyroid levels b. Radioisotope scanning c. Ultrasonography d. Fine-needle aspiration biopsy

d. Fine-needle aspiration biopsy

Renal failure is the most common cause of which type of hyperparathyroidism? a. Primary b. Secondary c. Exogenous d. Inflammatory

b. Secondary

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? a. TSH and T4 b. Serum sodium c. Serum calcium d. Urine osmolality

c. Serum calcium

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? a. Increased glucose use causes the shift of fluid from the intravascular to the intracellular space. b. Decreased glucose use causes fatty acid use, ketogenesis, metabolic acidosis, and osmotic diuresis. c. Increased glucose and fatty acids stimulate renal diuresis, electrolyte loss, and metabolic alkalosis. d. Decreased glucose use results in protein catabolism, tissue wasting, respiratory acidosis, and electrolyte loss.

b. Decreased glucose use causes fatty acid use, ketogenesis, metabolic acidosis, and osmotic diuresis.

Why does polyuria occur with diabetes mellitus? a. Formation of ketones b. Chronic insulin resistance c. Elevation in serum glucose d. Increase in antidiuretic hormone

c. Elevation in serum glucose

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? a. Resistance to insulin by insulin-sensitive tissues b. Need for lifelong insulin injections c. Increase of glucagon secretion from beta cells of the pancreas d. Presence of insulin autoantibodies that destroy beta cells in the pancreas

a. Resistance to insulin by insulin-sensitive tissues

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? a. Hyperglycemia caused by incorrect insulin administration b. Dawn phenomenon from eating a snack before bedtime c. Hypoglycemia caused by increased exercise d. Somogyi effect from insulin sensitivity

c. Hypoglycemia caused by increased exercise

Which serum glucose level would indicate hypoglycemia in a newborn? a. 28 mg/dL b. 40 mg/dL c. 60 mg/dL d. 80 mg/dL

a. 28 mg/dL

When comparing the clinical manifestations of both diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNKS), which condition is associated with only DKA? a. Fluid loss b. Weight loss c. Increased serum glucose d. Kussmaul respirations

d. Kussmaul respirations

Hypoglycemia, followed by rebound hyperglycemia, is observed in those with what? a. The Somogyi effect b. The dawn phenomenon c. Diabetic ketoacidosis d. Hyperosmolar hyperglycemic nonketotic syndrome

a. The Somogyi effect

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? a. More frequent blood glucose monitoring b. Moderate dietary sodium restriction c. Treatment with an ACE inhibitor d. Home blood pressure monitoring

c. Treatment with an ACE inhibitor

Which classification of oral hypoglycemic drugs decreases hepatic glucose production and increases insulin sensitivity and peripheral glucose uptake? a. Biguanide (metformin) b. Sulfonylureas (glyburide) c. Meglitinides (glinides) d. -Glycosidase inhibitor (miglitol)

a. Biguanide (metformin)

What causes the microvascular complications in patients with diabetes mellitus? a. The capillaries contain plaques of lipids that obstruct blood flow. b. Pressure in capillaries increases as a result of the elevated glucose attracting water. c. The capillary basement membranes thicken, and cell hyperplasia develops. d. Fibrous plaques form from the proliferation of subendothelial smooth muscle of arteries.

c. The capillary basement membranes thicken, and cell hyperplasia develops.

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? a. Plaques of lipids develop in the retinal vessels. b. Pressure in the retinal vessels increase as a result of increased osmotic pressure. c. Ketones cause microaneurysms in the retinal vessels. d. Retinal ischemia and red blood cell aggregation occur.

d. Retinal ischemia and red blood cell aggregation occur.

A person has acne, easy bruising, thin extremities, and truncal obesity. The healthcare professional assesses the person for which of these? a. Previous thyroid surgery b. Urine osmolality c. Serum electrolytes d. Use of glucocorticoids

d. Use of glucocorticoids

Which drug is this? - Antimalarial agent - used to treat Rheumatoid Arthritis - Stabilizes lysosomal membranes - Can cause irreversible damage to retina - dermatitis, ototoxicity

Hydroxychloroquine (Plaquenil)

Which drug is this? - Chelator to treat Rheumatoid Arthritis - Chelator(remover) of copper and other metals - Increases pyridoxine requirement - Can cause loss of taste, nephrotoxicity, leukopenia

D-Penicillamine (Cuprimine)

Which drug is this? - Cytotoxic agent to treat Rheumatoid arthritis - Most affective and dangerous agent - Suppress and modifies immune response - Side effect bone marrow suppression, sterility, depression, carcinogenic and mutagenic. - Can cause irreversible damage - Mucosal ulcers are common

Azathioprine (Imuran) Methotrexate

Which drug is this? - TNF blockers - Used to treat Rheumatoid Arthritis - Proteins that block TNF at its receptor - Increased risk of infections due to inhibited immune function - Fatal blood dyscrasias side effect

Etanercept (Enbrel) 1st made Then all -Mab monoclonal antibodies

Which drug is this? - Janus Kinase Inhibitors - JAK1, JAK2, JAK3 - Used to treat Rheumatoid Arthritis - Inbhibition of JAK enzymes that block cytokine signaling - Decrease neutrophils - High instance of infection side effect

Ruxolitinib (Jakafi)- JAK1/JAK2 Baricitinib (Olumiant)- JAK1/JAK2 Tofacitinib (Xeljanz)- JAK3 for severe RA only

Which Gout drug therapy is used to increase Urate excretion?

Probenecid

Which Gout drug therapy is used for Acute Gout attacks?

Colchicine NSAIDS

Which Gout drug therapy is used to decrease Uric acid production?

Allopurinol (Zyloprim) Febuxostat (Uloric)

Which drug is this? - Alkaloid of Colchicum autumnale - used to treat Acute Gout attack - binds to tubulin and disrupts mitotic spindles to cause depolymerization - Effective at onset and relief in 12-72 hrs - Mitosis is arrested and common for N/V/D

Colchicine

Which drug is this? - used to treat Acute Gout attack - Inhibition of prostaglandin synthesis - less side effects

Indomethacin (NSAIDS)

Which drug is this? - used to treat Gout by increasing urate excretion - blocks reabsorption of urate in renal proximal tubule - uricosuric effect (paradoxical) initial increase in uric acid then increase in excretion - can also decrease excretion of penicillin/cephalosporins.

Probenecid

Which drug is this? - blocks uric acid transporter to increase urate excretion - only approved for use with allopurinol - decreases kidney function - Induces CYP3A4 and can affect warfarin effect

Lesinurad (Zurampic)

Which drug is this? - Decreases urate production in Gout treatment - inhibit xanthine oxidase to prevent uric acid production - suicide substrate inhibitor of XO - used to treat severe chronic Gout - skin rash is side effect - Inhibits metabolism of oral anticoagulants by inhibition of microsomal enzymes (warfarin)

Allopurinol (Zyloprim) Febuxostat (Uloric)

Which drug is this? - Modified porcine-type uricase - treatment of Refractory Chronic Gout - metabolizes uric acid to a more water soluble compound - IV infusion only - anaphalaxis possible - contraindicated in G6PD deficiency due to methemoglobinemia - many side effects - pretreat with steroids/antihistamines

Pegloticase (Krystexxa)

What is the most disabling disease manifestation of Parkinson's disease?

Bradykinesia - slow voluntary movement

Dopamine for parkinsons therapy does not cross the blood brain barrier and is ineffective if administered peripherally? T/F

True

Parkinsons treatment _____ crosses the blood brain barrier and _____ does not cross the blood brain barrier?

L-DOPA does cross Dopamine does not cross

Which dopamine receptor? - Adenyl cyclase stimulation - increases cAMP levels - located in substantia nigra zona

Which dopamine receptor? - Adenyl cyclase inhibition - decreases cAMP levels - located on striatal neurons

What percentage of administered Levodopa reaches the brain?

1-3% should be given with carbidopa to reach brain

In order to reach the brain Levodopa should be administered with what?

Carbidopa (dopa decarboxylase inhibitor)

Levodopa with ____ a COMT inhibitor works similar to carbidopa to decrease the metabolism of L-dopa. Allows 75% reduction in daily dose

Entacapone (Comtan)

What is the most common side effect of Levodopa monotherapy administration?

80% have Vomiting

Hyperfunction of the posterior pituitary leads to what? - caused by ectopic secretion of ADH

Too much ADH causing SIADH Water retention

Hypofunction of the posterior pituitary leads to what?

Too little ADH causing Diabetes insipidus polyuria and hypernatremia

What is the disease? -Hyponatremia Na<135 -Hyposomolality <280 mosm - urine hyperosmolality - hypervolemia - weight gain

SIADH too much ADH hyperfunction of Post pituitary

Which drug is an ADH receptor blocker used to treat SIADH?

Conivaptan (Vaprisol)

Which drug is used to treat resistant or chronic SIADH?

Demeclocyline can cause nephrogenic diabetes insipidus

Nephrogenic diabetes insipidus takes place where?

distal tubule and collecting duct

What is the disease? -Hypernatremia Na>145 -Hyposomolality <200 mosm - low urine specific gravity <1.010 - Polyuria - continued thirst

Diabetes inspidus hypofunction of post pituitary

What is the drug treatment for diabetes insipidus?

Desmopressin acetate (DDAVP) a synthetic analog of Arginine vasopressin - triggers release of prostaglandins and von willebrand factor increase water reabsorption in proximal tubule and affect ion conc

Which organ is responsible for growth hormone and Thyroid stimulating hormone?

Anterior pituitary

Graves disease is associated with ____ and Hashimoto disease is associated with____?

Graves- Hyperthyroidism Hashimotos- Hypothyroidism

Cretinism (dwarf stature, nondeveloped CNS) is associated with what disorder?

Hypothyroidism

What is the treatment for hyperparathyroidism?

Bisphosphonates such as Alendronate (Fosamax) to block osteoclast activity preserving bone density

Increased serum phosphate level is associated with what disorder?

Hypoparathyroidism Depressed calcium level= high phosphates

Chvostek (facial spasms) and Trouseau (wrist spasms) signs are associated with what disorder?

Hypoparathyroidism Low calcium levels

Type 1 DM? Destruction of pancreatic beta cells Type 1A

Autoimmune

Type 1 DM? Secondary to other diseases termed idiopathic diabetes Type 1B

Nonimmune

Amylin Ghrelin Which is decreased in Type 1 and/or Type 2?

Amylin- decreased in 1 and 2 Ghrelin- decreased in type 2

What is associated with hypoglycemia with rebound hyperglycemia due to counterregulatory hormones causing gluconeogenesis? - most common in Type 1 DM

Somogyi effect

What is associated with early morning glucose elevation without nocturnal hypoglycemia? - related to nocturnal growth hormone elevation

Dawn phenomenon

Match the following? - Addisons disease - Cushing disease - Hyperfunction of adrenal cortex - Hypofunction of adrenal cortex

Cushings disease- hyperfunction High cortisol Addisons disease- hypofunction low cortisol

Hyperpigmentation is a clinical manifestation of hyper or hypo cortisolism?

Hyperpigmentation is associated with Cushings disease and high cortisol levels

Pheochromocytomas are caused by tumors from chromaffin cells of the adrenal _____ that secrete catecholamines? - HTN, diaphoresis, tachycardia

Adrenal medulla

Which drug is this? inhalational powder form of recombinant human insulin? - Requires spirometer testing of patient lung strength

Afrezza

DM type 2 Which class? - inhibit ATP-sensitive potassium ion channels on beta cells in the pancreas resulting in increased calcium influx, increased exocytosis of insulin storage granules. - Cardioprotective, decrease ischemic preconditioning

Sulfonylureas Chlorpropamide- longest duration Tolbutamide- shortest duration Glyburide Glipizide Glimepiride

DM type 2 Which class? - similar mechanism of action to sulfonylureas but shorter duration of action and more rapid onset?

Meglitinides Repaglinide Nateglinide

DM type 2 Which class? Inhibits intestinal glucosidase to decrease disaccharide conversion to monosaccharides and decreasing GI absorption to lower blood sugar? - hypoglycemia not likely

Alpha Glucosidase inhibitors Acarbose Miglitol

DM type 2 Which class? Inhibit hepatic and renal gluconeogenesis. - Insulin sensitzer since insulin - Requires insulin presence - DC 48hrs prior to surgery due to metabolic shift and increase in lactic acid production

Biguanides Metformin

DM type 2 Which class? Decrease insulin resistance at skeletal muscle and adipose tissue. - Requires insulin presence - good for Obese patients - can cause weight gain due to extracellular fluid accumulation bad for CHF - MI incidents

Thiazolidinediones Rosiglitazone Pioglitazone

DM type 2 Which class? Inhibits metabolism of incretin which stimulates pancreatic beta cells to release insulin

Dipeptidyl Peptidase-4 inhibitors DDPP-4 Sitagliptin (Januvia) Saxagliptin

DM type 2 Which class? Inhibits the primary glucose transporter for glucose reabsorption in the kidney to increase urinary glucose elimination. - Risk for yeast infection and Fournier gangrene

SGLT-2 inhibitors Empagliflozin (Jardiance) has been shown to decrease heart attacks and strokes

DM type 2 Which class? Decrease glucose production in liver and make patient feel sated. lower mace risk in cardiac disease - hold last dose week before surgery due to increased risk of vomiting and aspiration.

GLP-1 agonists -tide endings Semaglutide (Ozempic) Tirzepatide (Mounjaro) Rybelsus- only oral form