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

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Name: __________________________ Date: _____________1. A community health nurse is teaching a group of recent graduates about the largevariety of factors that influence an individual's health or lack thereof. The nurse isreferring to the framework of determinants of health in one client's situation as ateaching example. Which of the following aspects of this client's situation most likelyexists outside the framework of determinants of health?A)The client has had difficulty finding a family doctor.B)The client has a family history of cardiovascular disease.C)The client has a graduate degree from a renowned university.D)The client lives in an affluent, clean, suburban community.2. A physician is providing care for a number of patients on a medical unit of a largeuniversity hospital. The physician is discussing with a colleague the differentiationbetween diseases that are caused by abnormal molecules and molecules that causedisease. Which of the following patients most clearly demonstrates the consequencesof molecules that cause disease?A)A 31-year-old woman with sickle cell disease who is receiving a transfusion ofpacked red blood cellsB)A 91-year-old woman who has experienced an ischemic stroke resulting fromfamilial hypercholesterolemiaC)A 19-year-old man with exacerbation of his cystic fibrosis requiring oxygentherapy and chest physiotherapyD)A 30-year-old homeless man who has pneumocystis carinii pneumonia (PCP)and is HIV positive3. A member of the health-care team is researching the etiology and pathogenesis of anumber of clients who are under her care in a hospital context. Which of thefollowing aspects of clients' situations best characterizes pathogenesis rather thanetiology?A)A client who has been exposed to themycobacterium tuberculosisbacteriumB)A client who has increasing serum ammonia levels due to liver cirrhosisC)A client who was admitted with the effects of methyl alcohol poisoningD)A client with multiple skeletal injuries secondary to a motor vehicle accident4. A 77-year-old man is a hospital inpatient admitted for exacerbation of his chronicobstructive pulmonary disease (COPD), and a respiratory therapist (RT) is assessingthe client for the first time. Which of the following aspects of the patient's currentstate of health would be best characterized as a symptom rather than a sign?A)The patient's oxygen saturation is 83% by pulse oximetry.B)The patient notes that he has increased work of breathing when lying supine.C)The RT hears diminished breath sounds to the patient's lower lung fieldsbilaterally.D)The patient's respiratory rate is 31 breaths per minute.Page 1

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5. The laboratory technologists are discussing a new blood test that helps establish adifferential diagnosis between shortness of breath with a cardiac etiology andshortness of breath with a respiratory/pulmonary etiology. A positive result ispurported to indicate a cardiac etiology. The marketers of the test report that 99.8%of patients who have confirmed cardiac etiologies test positive in the test. However,1.3 percent of patients who do not have cardiac etiologies for their shortness ofbreath also test positive. Which of the following statements best characterizes thisblood test?A)Low validity, high reliabilityB)High sensitivity, low specificityC)High specificity, low reliabilityD)High sensitivity, low reliability6. As part of a screening program for prostate cancer, men at a senior citizens' centreare having their blood levels of prostate-specific antigen (PSA) measured. Which ofthe following statements would best characterize high positive predictive value butlow negative predictive value for this screening test?A)All of the men who had high PSA levels developed prostate cancer; several menwho had low PSA levels also developed prostate cancer.B)All of the men who had low PSA levels were cancer free; several men who hadhigh levels also remained free of prostate cancer.C)Men who had low PSA levels also displayed false-positive results for prostatecancer; men with high levels were often falsely diagnosed with prostate cancer.D)The test displayed low sensitivity but high specificity.7. A particular disease has a debilitating effect on the ability of sufferers to perform theiractivities of daily living and is a significant cause of decreased quality of life.However, few people die as a result of the disease's direct effects. There are hundredsof thousands of Canadians living with the disease but relatively few new cases inrecent years. Which of the following statements best conveys an accurateepidemiological characterization of the disease?A)Low mortality, high morbidity, low prevalence, high incidenceB)Low mortality, high morbidity, high incidence, low prevalenceC)High mortality, low morbidity, high incidence, low prevalenceD)High morbidity, low mortality, high prevalence, low incidencePage 2

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8. An epidemiologist is conducting a program of research aimed at identifying factorsassociated with incidence and prevalence of congenital cardiac defects in infants. Theresearcher has recruited a large number of mothers whose infants were born withcardiac defects, as well as mothers whose infants were born with healthy hearts. Theresearcher is comparing the nutritional habits of all the mothers while their babieswere in utero. Which of the following types of studies is the epidemiologist mostlikely conducting?A)Cohort studyB)Cross-sectional studyC)Case-control studyD)Risk-factor study9. A multidisciplinary health-care team operates a program aimed at the prevention,identification, and treatment of diabetes in a rural community. Which of the followingaspects of the program would be most likely to be classified as secondary prevention?A)Regularly scheduled wound-dressing changes for clients who have foot ulcerssecondary to peripheral neuropathy and impaired wound healingB)Teaching schoolchildren how a nutritious, traditional diet can lessen theirchances of developing adult-onset diabetesC)Staffing a booth where community residents who are attending a baseballtournament can have their blood-glucose levels checkedD)Administering oral antihyperglycemic medications to clients who have adiagnosis of diabetes10. An occupational therapist conducts a group therapy program called MindWorks witholder adults who have diagnoses of dementia and Alzheimer disease. The goal of thegroup is to slow the cognitive decline of clients by engaging them in regular,organized mental activity, such as reading maps and solving puzzles. How would theprogram most likely be characterized?A)Primary preventionB)Secondary preventionC)Tertiary preventionD)Prognosis enhancement11. The clinical educator of a hospital medical unit has the mandate of establishingevidence-based practice guidelines for the nursing care on the unit. Which of thefollowing statements most accurately captures a guiding principle of the nurse's task?A)Evidence-based practice guidelines will be rooted in research rather than nurses'subjective practice preferences and experiences.B)Guidelines are synonymous with systematic research reviews.C)The need for continuity and standardization of guidelines will mean that they willbe fixed rather than changeable.D)The guidelines will combine individual expertise with external systematicevidence.Page 3

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12. An understanding of pathophysiology is crucial for providing adequate care for yourfuture patients. To best understand the study of pathophysiology, you must have aclear understanding of the term itself. Of the definitions below, which one bestdescribes the term pathophysiology?A)The physiology of altered healthB)Any deviation from or interruption of the normal structure or function of anypart, organ, or system of the bodyC)Causes of diseaseD)Changes in structure or form that is characteristic of a disease13. A physician's assistant (PA) is examining a 21-year-old college student that isexhibiting the classic symptoms of schizophrenia. In the course of her evaluation thePA begins developing a treatment strategy based on what she knows about thedisease, available therapies, and medications. She also makes the patient aware of theconsequences of not following the treatment regimen. To accomplish this, whataspect of the disease is the PA using?A)EtiologyB)CausationC)Natural historyD)Morbidity statistics14. While you are working on a case, your patient dies, and you are charged with fillingout the death certificate. In performing this task, you are required to record age, sex,cause of death, and socieoeconomic status, among other factors. What is the purposeof reporting these statistics?A)These statistics are recorded so pharmaceutical companies may compile the datato determine future need.B)These statistics are useful for the government to update tax records.C)These statistics are useful in terms of anticipating health-care needs, planningpublic-education programs, directing health research efforts, and allocatinghealth-care dollars.D)These statistics are useful in ranking the efficiency of hospitals and clinics.15. The Framingham Heart Study is one of the most well-known studies carried out todate. Clinicians use the information obtained from the study to predict outcomes ofpatients with coronary disease. What type of study was this?A)RepetitionB)Double-blind placeboC)Case-controlD)CohortPage 4

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16. Your patient has already suffered a heart attack and is placed on-blockers to reducethe workload on the heart, as well as a statin drug and a low-fat diet to lowercholesterol. This treatment plan is based on multiple levels; one is diet and statintherapy, and the other is the use of-blockers. Assign the level of prevention each ofthese therapies can be classified as.A)Primary, secondaryB)Secondary, tertiaryC)Primary, tertiaryD)Secondary, primaryPage 5

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Answer Key1. C2. D3. B4. B5. B6. A7. D8. C9. C10. C11. D12. A13. C14. C15. D16. CPage 6

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Name: __________________________ Date: _____________1. A woman has recently determined that she is pregnant, and her clinician believes thatconception occurred around 8 weeks prior. Since the embryo is in the third stage ofembryonic development, which of the following events and processes in growth anddevelopment would be expected to be taking place?A)Transition from a morula to a blastocyteB)Ossification of the skeleton and acceleration of body lengthC)Rapid eye movement and early support of respirationD)Formation of upper limbs and opening of the eyes2. A midwife who is providing care for a woman during her first pregnancy is assessingfor intrauterine growth retardation (IUGR) during an early prenatal checkup. Whichof the following questions best addresses the risks for IUGR?A)“What does your typical diet look like over the course of a day?”B)“What is the highest level of education that you've finished?”C)“Are there many people in your life that you can count on for help and support?”D)“How would you describe your mood and your outlook on life since you've beenpregnant?”3. Which of the following assessment findings of a male infant 14 hours postpartumwould be considered abnormal and would require further assessment and possibleintervention?A)The baby's first stool appears to contain blood.B)The child is unable to breathe through his mouth.C)The baby's skin has a yellowish-orange hue.D)The child's suck is weak when placed at his mother's breast.4. A nurse is performing a 5-minute Apgar score on a newborn female. Which of thefollowing characteristics of the infant's current condition would not be reflected in thechild's Apgar score?A)The baby's heart rate is 122 beats per minute.B)The infant is crying.C)The child's temperature is 35.0°C (95°F) by axilla.D)The infant's skin is pink in tone.Page 1

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5. The first-time parents of an infant girl 2 days postpartum are distressed at thejaundiced appearance of her skin and are eager for both an explanation and atreatment for the problem. Which of the following responses by their physician ismost accurate?A)“Your daughter's young liver is unable to get rid of the waste products from oldred blood cells.”B)“Because your daughter's kidneys are so small, they have a hard time getting ridof the wastes that are always accumulating in her blood.”C)“Nearly half of all infants have this problem, and while it is distressing to look at,it is largely harmless and will resolve in time.”D)“This is a sign that your baby needs more milk than she is currently getting, andincreased breastfeeding will act to flush these pigments out of her system.”6. Which of the following infants most likely requires medical intervention?A)A 2-day-old baby boy who has caput succedaneumB)An infant 4 hours postpartum who has visible coning of his head following hisvaginal deliveryC)A girl 3 days postpartum with noticeable unilateral cephalhematomaD)A male infant whose vertex delivery resulted in a brachial plexus injury7. A nurse who works in a neonatal intensive care unit is providing care for an infantwho was born at 26 weeks' gestation. Which of the following assessments should bethe nurse's highest priority?A)Regular measurement of the baby's blood pressure and temperature.B)Assessment of the infant's respiratory status and oxygen saturation levels.C)Assessment of the child's motor skills and limb mobility range of motion.D)Assessment of the child's neurological status.8. A premature infant who is receiving care on a neonatal intensive care unit has justbeen identified as having necrotizing enterocolitis (NEC). During the differentialdiagnosis, which of the following possible contributing factors would his careproviders be most likely to rule out first?A)Impaired immune function secondary to the child's premature statusB)Bowel obstruction following the introduction of enteral feedingC)Infectious microorganismsD)Intestinal ischemia due to circulatory priority of the heart and brainPage 2

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9. The exasperated parents of a 4-month-old infant with colic have asked their primarycare physician what they can do to alleviate their child's persistent crying. Whatshould the physician tell the parents?A)“The exact cause of colic hasn't really been identified, which makes it hard totreat.”B)“Reducing the amount of commercial formula and increasing breastfeeding islikely to help.”C)“Colic is a result of excess gas, and the antiflatulent medication I'll prescribe willprobably help.”D)“Even though it's hard to live with, colic is a normal part of infancy and willresolve with time.”10. During a prenatal education class, a participant has related a story about how herfriend's infant died of sudden infant death syndrome (SIDS). What can the educatortell the group about how they can prevent SIDS when they have their babies?A)“The best sleeping position for your baby is on his or her abdomen.”B)“Children are at particular risk of SIDS when they have a cold or flu, so thesetimes require extra vigilance.”C)“Using drugs during pregnancy has been shown to have no association withSIDS after birth, so mothers should not concern themselves with theirmedications.”D)“It's important if anyone in your home smokes to make sure he or she only doesit outside.”E)“The exact cause of SIDS still isn't known, so there's little that you can do toprevent this tragic event.”11. What topic should health-promotion initiatives emphasize if the target audience isparents of preschoolers and the goal is to minimize mortality?A)Handwashing as an infection-control measureB)Accident and injury preventionC)Identifying signs of child abuse and neglectD)The importance of good nutrition12. A 13-year-old boy has a body mass index that places him in the ninety-sixth percentilefor his age and gender. Which of the following health problems does his weightpredispose him to?A)ScoliosisB)Respiratory infectionsC)Gastrointestinal disordersD)Type 2 diabetesPage 3

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13. A 14-year-old boy has experienced a pronounced growth spurt over the last severalmonths. Which of the following components of his endocrine system are most likelyresponsible for this phenomenon?A)Thyroid hormones and gonadotropic hormonesB)Testosterone and adrenocorticotropic hormoneC)Parathyroid hormone and somatostatinD)Oxytocin and growth hormone14. Jane F., a 31-year-old white female, is pregnant. She has been smoking for 10 yearsand was unable to quit during her pregnancy. As a result, her infant is smaller thannormal. What is the pathological process that results in the low birth weight?A)Small for gestational ageB)Hypoplastic growthC)Intrauterine growth retardationD)Hyperplastic growth15. Your patient is a 15-year-old African boy. His parents are concerned about recentchanges in his behaviour and are asking you for help. Which of the following wouldbe your best answer?A)Recommend a full neurological assessment because their son may have a tumourthat is causing a change in brain function.B)Recommend a full psychological evaluation, as depression and schizophreniaoften develop in mid- to late years of adolescence.C)Recommend a drug test, as young people are known to experiment with drugs.D)Recommend they remain calm. Slight changes in behaviour are normal, andincongruencies can result from discrepancies between physical and cognitivelevels of development.16. Mr. Jones brings his 13-year-old son, John, to your clinic for a regular checkup. Mr.Jones is unaware of the normal developmental level his son should be attaining, so heasks you for guidance. What guidelines can you provide for Mr. Jones to help himassess his son's development?A)John should experience a steady growth rate.B)John should begin to seek independence, adopt peer codes, and make personal-lifestyle choices.C)John should start to display secondary sexual characteristics by age 11, his voicewill change at age 13, and he will begin to grow taller when he turns 16.D)John should begin his changes before any female friends that he may have.Page 4

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

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Answer Key1. D2. A3. C4. C5. A6. D7. B8. B9. A10. D11. B12. D13. A14. C15. D16. B17. D18. BPage 6

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Name: __________________________ Date: _____________1. A community health nurse is working with an 81-year-old female client who statesthat she has made a concerted effort throughout her life to protect her skin from thesun and regularly apply topical moisturizers. The client is lamenting the fact that herskin's appearance has nonetheless deteriorated in recent years. Which of the followingstatements best captures a fact that the nurse should take into consideration whencrafting a response to the client?A)The epidermal layer of the skin inevitably thins as part of the normal agingprocess, lending a transparent appearance to the skin.B)Skin becomes weaker and less elastic in older adults because of therearrangement of fibrin and keratin.C)Skin becomes more fragile and prone to hematomas because of impairedvascularity.D)Output of sebaceous glands declines, with accompanying reductions in sweatproduction.2. A physiotherapist (PT) at an assisted-living facility for older adults is leading anexercise class for the residents. Part of the PT's introductory class is an explanation ofthe health problems that can be mitigated by physical activity and those which areconsidered inevitabilities of the aging process. Which of the following phenomenawould the PT most justifiably characterize as modifiable?A)Reduction in density of the trabecular boneB)Gradual decline in physical reaction timeC)Overall reduction in muscle strengthD)Decline in height3. A geriatrician has ordered an echocardiogram and stress test for a 77-year-old maleclient in an effort to gauge the client's cardiovascular health status. Which of thefollowing changes would the physician most likely identify as an anomaly that is notan expected age-related change?A)Increased resting, supine heart rateB)Low maximal heart rate and cardiac outputC)Increased left ventricular wall thickness.D)Delayed left ventricular filling4. A nurse provides care for a number of older adult residents of a long-term-carefacility. Which of the following events from the last shift is most deserving of furtherassessment and possible interventions?A)An 83-year-old female client complains of the glare of the fluorescent lights offthe floor of the facility.B)A 79-year-old male client displays unprecedented forgetfulness.C)A 91-year-old male client who has been newly admitted displays balanceproblems when ambulating.D)A 90-year-old long-term resident is displaying decreased motor strength.Page 1

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5. The educator of a geriatric, subacute medical unit in a hospital has oriented new staffand is teaching orientees strategies on communicating with older adults with impairedhearing. Which of the following teaching points is most justifiable?A)“Speak slowly and directly to these clients.”B)“Avoid complex or abstract ideas when you're talking.”C)“Increase the volume of your speech as much as possible.”D)“Choose simple, short words to minimize confusion.”6. An 81-year-old woman is attending a scheduled visit to her family physician. Theclient asks her doctor why she and her peers seem to get sick frequently, in spite oftheir efforts to stay active and eat nutritiously. Which of the following responses bestcaptures an aspect of the immune function of older adults?A)“It's normal that the function and resiliency of your immune system decreaseswith age.”B)“Normal, age-related changes combine with outside factors to make older adultsmore likely to get sick.”C)“Your body produces fewer antibodies as you age, making you more vulnerableto infections than younger people.”D)“With a healthy lifestyle and proper medical treatment, you can generallymaintain the same immune function as younger people.”7. As a follow-up to the introduction of a new medication regimen for an older adultclient, the physician is interpreting the client's recent blood work, paying particularattention to the client's serum creatinine (Cr) levels (normal range 0.6-1.2 mg/100ml)and glomerular filtration rate or GFR (normal value >60 ml/minute). Which of thefollowing lab results would be considered typical of an older adult with impaired renalfunction?A)Cr 1.8; GFR 66B)Cr 2.3; GFR 30C)Cr 0.5; GFR 58D)Cr 1.1; GFR 228. A nurse who is visiting a seniors' wellness centre is teaching a group of older adultwomen about sexual activity among older adults. Which of the following teachingpoints best captures the reality of sexual activity among older adults?A)“Androgen replacement therapy for older men can help resolve erectiledysfunction and low libido.”B)“Cessation of estrogen production after menopause makes sexual activity rarelypossible for older women.”C)“You can expect the duration and intensity of sexual response to decrease withage.”D)“With education, sexual pleasure and frequency can remain similar to that ofyounger adults.”Page 2

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9. An occupational therapist (OT) is assessing an 80-year-old male client who is poisedto return to his assisted-living residence following a 14-day hospital stay with adiagnosis of bilateral pneumonia. As part of the OT's functional assessment, theclient's activities of daily living (ADL) and instrumental activities of daily living(IADL) are being assessed. Which of the following assessment findings is mostindicative of a deficit in ADLs?A)The client is unable to clean the washroom in his residence adequately or safely.B)The client requires help with dressing himself in the morning.C)The client is unable to manage his medication regimen without his daughter'shelp.D)The client requires help climbing the stairs to his residence.10. Recognizing that falls are a significant source of morbidity among older adults, themanager of a geriatric medical unit is conducting a workshop for the health-care teamon fall prevention. Which of the following patients would the care providers be mostlikely to anticipate being at a potentially high risk for falls?A)A 76-year-old woman with diagnoses of Parkinson's disease and orthostatichypotensionB)A 78-year-old woman admitted for rheumatoid arthritis exacerbation anduncontrolled diabetes mellitusC)An 81-year-old woman with exacerbation of her chronic obstructive pulmonarydisease (COPD) and increasing shortness of breathD)An 80-year-old man with benign prostatic hyperplasia and consequent urinaryretention11. A geriatric clinical nurse educator is teaching the other members of the health-careteam about the incidence, prevalence, and course of depression among older adults.Which of the following statements is most likely to appear in the physician's teaching?A)“Even though suicide rates are lower among older adults than younger adults,depression needs to be diagnosed and treated early.”B)“Though they are certainly not synonymous, depression can be an indicator ofdementia.”C)“Many older adults lack the symptoms of sleep disturbances and lack ofconcentration that suggest depression in younger adults.”D)“Bronchodilators and antiplatelet medications have been correlated withdepression in the elderly.”Page 3

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