MN551 Unit 5 Mid Term Latest 2017 (Already graded A+)

MN551 Unit 5 Mid Term Latest 2017

Question 1.1. A student nurse practitioner asks her preceptor about the origins of different tissues, and their cellular origins during the process of development. Which of the following statements by the preceptor best describes the process of cell differentiation? (Points : 3)

“Cells of the hematopoietic system produce the appropriate body cells that are required at each stage of development.”

“A single stem cell differentiates into approximately 200 different types of cells.”

“A fertilized ovum undergoes a series of divisions, yielding many different cell types.”

“Cells differentiate into necessary body cells, peaking after conception, and ceasing near the time of birth.”

Question 2.2. A 77-year-old male patient with a diagnosis of stomach cancer has been found to have metastases in his liver. The patient and his family are surprised at this turn of events, stating that they don't see how he could have developed cancer in his liver. Which of the following facts would underlie the reply that the care team provides? (Points : 3)

The parenchymal tissue of the liver is particularly susceptible to secondary malignancies.

The portal circulatory system brings venous blood from the gastrointestinal tract into the liver.

Hepatic stromal tissue shares characteristics with cancerous cells, including lack of anchorage dependence.

The proximity of the liver to the stomach allows for direct spread of cancerous cells due to a lack of contact inhibition.

Question 3.3. The NP is teaching a group of older adults about the value of including foods containing antioxidants in their diet. Which of the following statements best captures the rationale underlying the NPs advice?(Points : 3)

Antioxidants inhibit the actions of reactive oxygen species (ROS).

Antioxidants prevent the formation of superoxide dismutase.

Antioxidants react nonspecifically with molecules.

Antioxidants prevent the occurrence of cell dysplasia.

Question 4.4. The nurse practitioner is providing care for a patient with a diagnosis of cirrhosis, and he notes that the patient's sclerae are jaundiced. The nurse practitioner recalls that jaundice is caused by excess accumulation of bilirubin, a pigment that can accumulate in which part of the cell? (Points : 3)

Nucleus

Cytoplasm

Golgi apparatus

Rough endoplasmic reticulum (ER)

Question 5.5. Which of the following patients of a primary care nurse practitioner would not require extra screening for cancer? (Points : 3)

A 51-year-old woman whose grandmother died of breast cancer

A 48-year-old man who takes immunosuppressant drugs following a kidney transplant

A 50-year-old male who is obese and has a low-fiber, high-fat diet

A 38-year-old female with Down syndrome and congenital scoliosis

Question 6.6. A new older female patient at a long-term care facility has a diagnosis of type 1 neurofibromatosis (NF-1). As part of the intake assessment protocol for the facility, the clinical educator is teaching the care staff about the diagnosis. Which of the following statements most accurately conveys an aspect of neurofibromatosis? (Points : 3)

“The neurofibroma lesions are unsightly for the patient, but they are not painful.

“Her diagnosis puts her at higher risk of developing a malignant neoplasm.”

“She is living with an example of an autosomal recessive disorder.”

“The patient is likely to be photosensitive as a result of the disease.”

Question 7.7. A child possesses a trait that is the result of the interaction of two different genes, neither of which could have produced the trait independently. Which of the following explanations best captures the genetic explanation for this? (Points : 3)

The trait is an expression of multiple alleles.

Epistasis has dictated the phenotypic outcome.

The phenomenon is an example of polygenic inheritance.

The outcome is the result of the interaction between collaborative genes.

Question 8.8. Which of the following statements most accurately conveys an aspect of cell injury due to impaired calcium homeostasis? (Points : 3)

Normal intracellular calcium ion levels are higher than extracellular levels.

Ischemia and certain toxins cause a decrease in cytosolic calcium.

Injured cells tend to accumulate calcium.

Low calcium levels cause an activation of damaging enzymes.

Question 9.9. A group of researchers has identified that the prevalence of two particular genetic disorders share a statistical correlation. Which of the following statements best conveys the genetic rationale for this situation? (Points : 3)

There is likely a cause-and-effect relationship between the two genes responsible.

The chromosomes containing each gene are likely closely situated.

The genes causing each disorder are likely in the same section of the same chromosome.

The disorders likely share the same locus.

Question 10.10. A male patient of a nurse practitioner has an autosomal dominant disorder. The patient and his partner are considering starting a family. Which of the patient's following statements indicates the patient has an adequate understanding of the genetic basis of this health problem? (Points : 3)

“I know there's no way of accurately determining the chance that my child will inherit the disease.”

“My children who don't have the disease still run the risk of passing it on to their children.”

“I know that new genetic mutations won't occur between generations.”

“I know that a single mutant allele is to blame for the health problem.”

Question 11.11. As part of an orientation to a genetic counseling practice, a group of medical students is differentiating between autosomal recessive disorders and autosomal dominant disorders. Which of the following statements is true of autosomal recessive disorders? (Points : 3)

They can manifest when present in one or both gene pairs.

There is a one in two chance of an affected child in each pregnancy with an affected mother.

They tend to have a more uniform symptomatology than autosomal dominant disorders.

The associated disorders are usually attributable to abnormalities in structural proteins.

Question 12.12. The nurse practitioner working in occupational health has been asked to speak to a group of factory workers about the importance of wearing gloves when working with strong chemicals such as turpentine and paint thinner. Which of the following characteristics of cell membranes underlies the nurse's teaching? (Points : 3)

Cell membranes are impermeable to all but lipid-soluble substances.

Cell membranes have lipids that have a hydrophilic head and a hydrophobic tail.

Cell membranes contain receptors for hormones and biologically active substances.

Transmembrane proteins can pass through the cell membrane into the intracellular environment.

Question 13.13. The NP is providing care for a 21-year-old female patient with gas gangrene of a compound fracture in her arm. Which of the following assessment findings would the nurse most reasonably expect to find when caring for a patient with a diagnosis of gas gangrene? (Points : 3)

Inflammation of the affected tissue

A positive culture for Staphylococcus

Spreading edema

Impaired alveolar gas exchange

Question 14.14. A community health nurse practitioner is teaching a group of female high school students about the importance of regular Papanicolaou (Pap) smears. The nurse recognizes that which of the following items underlies the rationale for this teaching? (Points : 3)

The active substitution of normal cells in the cervix correlates to cancer risk.

Undifferentiated stem cells are an early indicator of cervical cancer.

Cancer of the uterine cervix develops incrementally at a cellular level.

Dysplasia in the connective tissue of the cervix is a strong precursor to cancer.

Question 15.15. Which target of both chemotherapy and radiation treatment accounts for adverse as well as therapeutic effects? (Points : 3)

Cell-surface receptors

Circulating hormone levels

Blood vessels

Rapidly proliferating cells

Question 16.16. A patient who has a diagnosis of lung cancer is scheduled to begin radiation treatment. The NP providing pretreatment education is explaining some of the potential unwanted effects of the treatment. Which of the following statements by the nurse is most accurate? (Points : 3)

“Some patients experience longer-term irritation of skin adjacent to the treatment site.”

“Sometimes you might find that your blood takes longer to clot than normal.”

“The changes that you might see are normally irreversible.”

“The unwanted effects will be limited to the exposed portions of your skin.”

Question 17.17. The family of a 68-year-old man who is in the end stages of small cell lung cancer is distraught at his visible body wasting that has worsened in recent weeks. Which of the following phenomena best accounts for the patient's anorexia and cachexia? (Points : 3)

Inadequate cellular metabolism of glucose results from tumor factors

High fat losses coupled with preservation of muscle mass exaggerate the appearance of wasting

Products of the tumor itself as well as a hypermetabolic state cause cachexia

Inadequate food intake due to symptoms and treatment results in loss of both muscle and fat

Question 18.18. The nurse practitioner is seeing a client who has an acute exacerbation of Crohn’s disease. The NP recognizes the fact that the disease involves the inflammation and irritation of the intestinal lining. Which of the following types of tissue is most likely involved in the patient's pathology? (Points : 3)

Simple columnar epithelium

Glandular epithelium

Simple cuboidal epthelium

Stratified epithelium

Question 19.19. Which of the following pregnant women has most likely encountered the greatest increase in the risk that her child will have a fetal anomaly? (Points : 3)

A woman with diagnoses of syphilis and cirrhosis of the liver

A woman who has herpes simplex and recently recovered from endocarditis

A woman with chronic obstructive pulmonary syndrome and tuberculosis

A woman with diagnoses of insulin-dependent diabetes mellitus and peripheral neuropathy

Question 20.20. A nurse practitioner employed in the emergency department admits a patient who has experienced severe frostbite to his hands and toes after becoming lost on a ski trail. The NP recognizes that which of the following phenomena has caused the tissue damage? (Points : 3)

Decreased blood viscosity has resulted in interstitial bleeding.

Reactive vasodilation has compromised perfusion.

Autonomic nervous stimulation has resulted in injury.

Decreased blood flow has induced hypoxia.

Question 21.21. A nurse practitioner employed in a hospitalist notices that a patient is experiencing muscle atrophy following 2 weeks in traction after a motor vehicle accident. Which of the following factors has most likely contributed to the atrophy of the patient's muscle cells? (Points : 3)

High levels of insulin and IGF-1 in the patient's blood during immobilization

Denervation of the affected muscles during the time of traction

A reduction of skeletal muscle use secondary to the traction treatment

Reduced oxygen consumption and cellular function that ensures muscle cell survival

Question 22.22. An infant who is four days postpartum has been diagnosed with a single-gene disorder. The parents of the child have a number of questions about the etiology of the health problem, which the physician is attempting to address in detail. Which of the following teaching points most accurately captures an aspect of single-gene congenital disorders? (Points : 3)

Affected genes are present on autosomal chromosomes rather than sex chromosomes.

The majority of single-gene disorders manifest near the time of puberty.

A particular defect can be caused by mutations at one of several different loci.

Single-gene disorders are associated with existing rather than new mutations.

Question 23.23. A researcher is involved in the production of insulin through recombinant DNA technology. Which of the following statements could the researcher best provide as a rationale for her work? (Points : 3)

The gene fragment responsible for insulin production can be isolated and reproduced.

Particular bacteria are capable of insulin production.

It is possible to reproduce the chromosome responsible for insulin production.

Recombination of DNA base pairs can result in a gene that will produce insulin.

Question 24.24. A 6-year-old girl with a diagnosis of Marfan syndrome is being assessed at a community health clinic. Which of the following assessments would be the health care professional's lowest priority? (Points : 3)

A test of the child's visual acuity

A musculoskeletal assessment

Tests of kidney function

Cardiovascular assessment

Question 25.25. Following a biopsy, a 54-year-old man has been diagnosed as having a benign neoplastic tumor. Which of the following characteristics most likely applies to his tumor? (Points : 3)

The tumor is poorly approximated and has the potential to break loose.

The tumor may secrete hormones or cytokines.

The well-differentiated neoplastic cells are clustered together in a single mass.

It has a rapid rate of growth and can induce ischemia.

1. A 40-year-old woman who experiences severe seasonal allergies has been referred by her family physician to an allergist for weekly allergy injections. The woman is confused as to why repeated exposure to substances that set off her allergies would ultimately benefit her. Which of the following phenomena best captures the rationale for allergy desensitization therapy? (Points : 3)

Repeated exposure to offending allergens binds the basophils and mast cells that mediate the allergic response.

Exposure to allergens in large, regular quantities overwhelms the IgE antibodies that mediate the allergic response.

Repeated exposure stimulates adrenal production of epinephrine, mitigating the allergic response.

Injections of allergens simulate production of IgG, which blocks antigens from combining with IgE.

Question 2.2. A 14-year-old boy has been diagnosed with infectious mononucleosis. Which of the following pathophysiological phenomena is most responsible for his symptoms? (Points : 3)

The Epstein-Barr virus (EBV) is lysing many of the boy's neutrophils.

Viruses are killing some of his B cells and becoming incorporated into the genomes of others.

The EBV inhibits the maturation of white cells within his peripheral lymph nodes.

The virus responsible for mononucleosis inhibits the maturation of myeloblasts into promyelocytes.

Question 3.3. A 66-year-old female patient has presented to the emergency department because of several months of intermittently bloody stools that has recently become worse. The woman has since been diagnosed with a gastrointestinal bleed secondary to overuse of nonsteroidal anti-inflammatory drugs that she takes for her arthritis. The health care team would realize that which of the following situations is most likely?(Points : 3)

The woman has depleted blood volume due to her ongoing blood loss.

She will have iron-deficiency anemia due to depletion of iron stores.

The patient will be at risk for cardiovascular collapse or shock.

She will have delayed reticulocyte release.

Question 4.4. Which of the following patients is most likely to benefit from transplantation of thymic tissue or major histocompatibility complex (MHC)-compatible bone marrow? (Points : 3)

A 12-year-old girl with a history of epilepsy and low IgG levels secondary to phenytoin use

A 7-year-old boy whose blood work indicates decreased IgA and IgG with increased IgM

A 6-year-old boy whose pre-B cells are incapable of translation to normal B cells

A 9-year-old girl who has a diagnosis of IgA deficiency

Question 5.5. A 29-year-old construction worker got a sliver under his fingernail four days ago. The affected finger is now reddened, painful, swollen, and warm to the touch. Which of the following hematological processes is most likely occurring in response to the infection? (Points : 3)

Proliferation of immature neutrophils

High circulatory levels of myeloblasts

Increased segmented neutrophil production

Phagocytosis by myelocytes

Question 6.6. Sputum samples from a patient with pneumonia contain an infective agent that has a peptidoglycan cell wall, expresses endotoxins, replicates readily in broth and on agar, grows in clusters, has pili, and does not stain when exposed to crystal violet. This pneumonia is most likely: (Points : 3)

Chlamydial

Viral

Mycoplasmal

Bacterial

Question 7.7. A child has been diagnosed with thalassemia. Which of the following other health problems is the child at risk for? (Points : 3)

Hypocoagulation

Iron and ferritin deficiencies

Splenomegaly and hepatomegaly

Neutropenia

Question 8.8. A nurse practitioner is providing prenatal care and education for a first-time expectant mother, 22 weeks' gestation, who has a diagnosis of a sexually transmitted infection. Which of the following statements by the expectant mother demonstrates an adequate understanding of vertical disease transmission and congenital infections? (Points : 3)

“Gonorrhea and chlamydia pose the greatest risks of transmission from mother to child.”

“I know that my baby will need observation for HIV signs and symptoms in the weeks following my delivery.”

“My baby could become infected either across the placenta or during the birth itself.”

“Prophylactic immunization will reduce my baby's chance of being born with an illness.”

Question 9.9. As part of his diagnostic workup, a 77-year-old man's nurse practitioner has ordered blood work that includes ferritin levels. The man is very interested in the details of his health care and is unfamiliar with ferritin and its role. He asks his nurse practitioner to explain the significance of it and the rationale for testing it. Which of the following explanations by the nurse practitioner is most accurate?(Points : 3)

“Ferritin is the activated and usable form of iron that your red blood cells can use to transport oxygen.”

“Ferritin is a stored form of iron that indirectly shows me whether you would benefit from iron pills.”

“Ferritin is a protein-iron complex that allows your red blood cells to make use of the iron that you consume in your diet.”

“Ferritin is the form of iron that is transported in your blood plasma to the red blood cells that need it.”

Question 10.10. A 16-year-old female has been brought to her primary care nurse practitioner by her mother due to the girl's persistent sore throat and malaise. Which of the following facts revealed in the girl's history and examination would lead the nurse practitioner to rule out infectious mononucleosis? (Points : 3)

The girl has a temperature of 38.1°C (100.6°F) and has enlarged lymph nodes.

Her liver and spleen are both enlarged.

Blood work reveals an increased white blood cell count.

Chest auscultation reveals crackles in her lower lung fields bilaterally.

Question 11.11. A 30-year-old man has spent 5 hours on a cross-country flight seated next to a passenger who has been sneezing and coughing, and the man has been inhaling viral particles periodically. Which of the following situations would most likely result in the stimulation of the man's T lymphocytes and adaptive immune system? (Points : 3)

Presentation of a foreign antigen by a familiar immunoglobulin

Recognition of a foreign MHC molecule

Recognition of a foreign peptide bound to a self MHC molecule

Cytokine stimulation of a T lymphocyte with macrophage or dendritic cell mediation

Question 12.12. A 22-year-old female who adheres to a vegan diet has been diagnosed with iron-deficiency anemia. Which of the following components of her diagnostic blood work would be most likely to necessitate further investigation? (Points : 3)

Decreased mean corpuscular volume (MCV)

Decreased hemoglobin and hematocrit

Microcytic, hypochromic red cells

Decreased erythropoietin levels

Question 13.13. A couple who are expecting their first child have been advised by friends to consider harvesting umbilical cord blood in order to have a future source of stem cells. The couple have approached their nurse practitioner with this request and are seeking clarification of exactly why stem cells are valuable and what they might expect to gain from harvesting them. How can the nurse practitioner best respond to the couple's inquiry? (Points : 3)

“Stem cells can help correct autoimmune diseases and some congenital defects.”

“Stem cells can be used to regenerate damaged organs should the need ever arise.”

“Stem cells can be used as a source of reserve cells for the entire blood production system.”

“Stem cells can help treat some cancers and anemias, but they must come from your child himself or herself.”

Question 14.14. A 23-year-old man has received a recent diagnosis of appendicitis following 24 hours of acute abdominal pain. The nurse practitioner providing care for the man is explaining that while it is unpleasant, the inflammation of his appendix is playing a role in his body's fight against the underlying infectious process. Which of the following teaching points should the nurse practitioner eliminate from his teaching for the patient? (Points : 3)

“Inflammation can help to remove the body tissue cells that have been damaged by infection.”

“Inflammation will start your body on the path to growing new, healthy tissue at the site of infection.

“Inflammation helps your body to produce the right antibodies to fight the infection.”

“Inflammation ultimately aids in eliminating the initial cause of the cell injury in your appendix.”

Question 15.15. A 60-year-old woman is suspected of having non-Hodgkin lymphoma (NHL). Which of the following aspects of her condition would help to rule out Hodgkin lymphoma? (Points : 3)

Her neoplasm originates in secondary lymphoid structures.

The lymph nodes involved are located in a large number of locations in the lymphatic system.

The presence of Reed-Sternberg cells has been confirmed.

The woman complains of recent debilitating fatigue.

Question 16.16. Which of the following statements most accurately conveys an aspect of lymphatic system activity? (Points : 3)

B and T lymphocyte development begins in the bone marrow and ends in the peripheral lymphoid structures.

B cells and macrophages are released from the bone marrow in their completed state.

Stem cells in the lymph nodes initiate and regulate the process of white cell synthesis.

Leukocytes bypass vascular circulation and are distributed instead by the lymphatic system.

Question 17.17. A nurse practitioner is explaining to a 40-year-old male patient the damage that Mycobacterium tuberculosis could do to lung tissue. Which of the following phenomena would underlie the nurse practitioner's explanation? (Points : 3)

Tissue destruction results from neutrophil deactivation.

Nonspecific macrophage activity leads to pulmonary tissue destruction and resulting hemoptysis.

Macrophages are unable to digest the bacteria, resulting in immune granulomas.

Neutrophils are ineffective against the Mycobacterium tuberculosis antigens.

Question 18.18. A 2-year-old girl has had repeated ear and upper respiratory tract infections since she was born. A pediatrician has determined a diagnosis of transient hypogammaglobulinemia of infancy. What is the physiological origin of the child's recurrent infections? (Points : 3)

Antibody production by plasma cells is compromised because of impaired communication between B and T cells.

The child had a congenital absence of immunoglobulin G (IgG) antibodies and her body is only slowly beginning to produce them independently.

The child was born with immunoglobulin A (IgA) and immunoglobulin (IgM) antibodies, suggesting intrauterine infection.

The child lacks the antigen presenting cells integral to normal B-cell antibody production.

Question 19.19. Following a course of measles, a 5-year-old girl developed scattered bruising over numerous body surfaces and was diagnosed with immune thrombocytopenic purpura (ITP). As part of her diagnostic workup, blood work was performed. Which of the following results is most likely to be considered unexpected by the health care team? (Points : 3)

Increased thrombopoietin levels

Decreased platelet count

 Normal vitamin K levels

Normal leukocyte levels

Question 20.20. A 60-year-old male patient with an acute viral infection is receiving interferon therapy. The nurse practitioner is teaching the family of the patient about the diverse actions of the treatment and the ways that it differs from other anti-infective therapies. Which of the following teaching points should the nurse practitioner exclude? (Points : 3)

“Interferon can help your father's unaffected cells adjacent to his infected cells produce antiviral proteins that limit the spread of the infection.”

“Interferon can help limit the replication of the virus that's affecting your father.”

“Interferon helps your father's body recognize infected cells more effectively.”

“Interferon can bolster your father's immune system by stimulating natural killer cells that attack viruses.”

Question 21.21. A 24-year-old woman presents with fever and painful, swollen cervical lymph nodes. Her blood work indicates neutrophilia with a shift to the left. She most likely has: (Points : 3)

A mild parasitic infection

A severe bacterial infection

A mild viral infection

A severe fungal infection

Question 22.22. A nurse practitioner student is familiarizing herself with the overnight admissions to an acute medical unit of a university hospital. Which of the following patients would the student recognize as being least likely to have a diagnosis of antiphospholipid syndrome in his or her medical history? (Points : 3)

A 66-year-old obese male with left-sided hemiplegia secondary to a cerebrovascular accident

A 90-year-old female resident of a long-term care facility who has been experiencing transient ischemic attacks

A 30-year-old female with a diagnosis of left leg DVT and a pulmonary embolism

A 21-year-old male with a diagnosis of cellulitis and suspected endocarditis secondary to intravenous drug use

Question 23.23. The blood work of a 44-year-old male patient with a diagnosis of liver disease secondary to alcohol abuse indicates low levels of albumin. Which of the following phenomena would a clinician be most justified in anticipating? (Points : 3)

Impaired immune function

Acid-base imbalances

Impaired thermoregulation

Fluid imbalances

Question 24.24. A nurse practitioner is teaching her colleagues about the role of cytokines in a variety of pathologies. Which of the following teaching points best captures an aspect of the functions and nature of cytokines? (Points : 3)

“A particular cytokine can have varied effects on different systems, a fact that limits their therapeutic use.”

“Cytokine production is constant over time, but effects are noted when serum levels cross a particular threshold.”

“Most cytokines are produced by granular leukocytes, and different cells are capable of producing the same cytokine.”

“Cytokine actions are self-limiting in that activation of one precludes activation of other cytokines with similar actions.”

Question 25.25. Which of the following phenomena would be least likely to result in activation of the complement system? (Points : 3)

Recognition of an antibody bound to the surface of a microbe

The binding of mannose residues on microbial glycoproteins

Activation of Toll-like receptors (TLRs) on complement proteins

Direct recognition of microbial proteins

1. The nurse practitioner for a cardiology practice is responsible for providing presurgical teaching for patients who are about to undergo a coronary artery bypass graft. Which of the following teaching points best conveys an aspect of the human circulatory system? (Points : 3)

“Your blood pressure varies widely between arteries and veins, and between pulmonary and systemic circulation.”

“Only around one quarter of your blood is in your heart at any given time.”

“Blood pressure and blood volume roughly mimic one another at any given location in the circulatory system.”

“Left-sided and right-sided pumping action at each beat of the heart must equal each other to ensure adequate blood distribution.”

Question 2.2. A physical assessment of a 28-year-old female patient indicates that her blood pressure in her legs is lower than that in her arms and that her brachial pulse is weaker in her left arm than in her right. In addition, her femoral pulses are weak bilaterally. Which of the following possibilities would her care provider be most likely to suspect? (Points : 3)

Pheochromocytoma

Essential hypertension

Coarctation of the aorta

An adrenocortical disorder

Question 3.3. As part of the diagnostic workup for a male patient with a complex history of cardiovascular disease, the care team has identified the need for a record of the electrical activity of his heart, insight into the metabolism of his myocardium, and physical measurements, and imaging of his heart. Which of the following series of tests is most likely to provide the needed data for his diagnosis and care? (Points : 3)

Echocardiogram, PET scan, ECG

Ambulatory ECG, cardiac MRI, echocardiogram

Serum creatinine levels, chest auscultation, myocardial perfusion scintigraphy

Cardiac catheterization, cardiac CT, exercise stress testing

Question 4.4. An older adult female patient has presented with a new onset of shortness of breath, and the patient's nurse practitioner has ordered measurement of her BNP levels along with other diagnostic tests. What is the most accurate rationale for the nurse practitioner's choice of blood work? (Points : 3)

BNP is released as a compensatory mechanism during heart failure and measuring it can help differentiate the patient's dyspnea from a respiratory pathology.

BNP is an indirect indicator of the effectiveness of the RAA system in compensating for heart failure.

BNP levels correlate with the patient's risk of developing cognitive deficits secondary to heart failure and consequent brain hypoxia.

BNP becomes elevated in cases of cardiac asthma, Cheyne-Stokes respirations, and acute pulmonary edema, and measurement can gauge the severity of pulmonary effects.

Question 5.5. A patient in the intensive care unit has a blood pressure of 87/39 and has warm, flushed skin accompanying his sudden decline in level of consciousness. The patient also has arterial and venous dilation and a decrease in systemic vascular resistance. What is this patient's most likely diagnosis? (Points : 3)

Hypovolemic shock

Septic shock

Neurogenic shock

Obstructive shock

Question 6.6. A number of patients have presented to the emergency department in the last 24 hours with complaints that are preliminarily indicative of myocardial infarction. Which of the following patients is least likely to have an ST-segment myocardial infarction (STEMI)? (Points : 3)

A 70-year-old woman who is complaining of shortness of breath and vague chest discomfort

A 66-year-old man who has presented with fatigue, nausea and vomiting, and cool, moist skin

A 43-year-old man who woke up with substernal pain that is radiating to his neck and jaw

A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest

Question 7.7. A 54-year-old man with a long-standing diagnosis of essential hypertension is meeting with his nurse practitioner. The patient's nurse practitioner would anticipate that which of the following phenomena is most likely occurring? (Points : 3)

The patient's juxtaglomerular cells are releasing aldosterone as a result of sympathetic stimulation.

Epinephrine from his adrenal gland is initiating the renin-angiotensin-aldosterone system.

Vasopressin is exerting an effect on his chemoreceptors and baroreceptors, resulting in vasoconstriction.

The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption.

 Question 8.8. A 66-year-old obese man with a diagnosis of ischemic heart disease has been diagnosed with heart failure that his care team has characterized as attributable to systolic dysfunction. Which of the following assessment findings is inconsistent with his diagnosis? (Points : 3)

His resting blood pressure is normally in the range of 150/90 and an echocardiogram indicates his ejection fraction is 30%.

His end-diastolic volume is higher than normal and his resting heart rate is regular and 82 beats per minute.

He is presently volume overloaded following several days of intravenous fluid replacement.

Ventricular dilation and wall tension are significantly lower than normal.

Question 9.9. Which of the following assessment findings in a newly admitted 30-year-old male patient would be most likely to cause his nurse practitioner to suspect polyarteritis nodosa? (Points : 3)

The man's blood work indicates polycythemia (elevated red cells levels) and leukocytosis (elevated white cells).

The man's blood pressure is 178/102 and he has abnormal liver function tests.

The man is acutely short of breath and his oxygen saturation is 87%.

The man's temperature is 101.9°F and he is diaphoretic (heavily sweating).

Question 10.10. A 6-year-old boy has been brought to the emergency department by ambulance after his mother discovered that his heart rate was “so fast I couldn't even count it.” The child was determined to be in atrial flutter and his mother is seeking an explanation from the health care team. Which of the following points should underlie an explanation to the mother? (Points : 3)

The child is experiencing a reentry rhythm in his right atrium.

The resolution of the problem is dependent on spontaneous recovery and is resistant to pacing interventions.

The child is likely to have a normal ECG apart from the rapid heart rate.

The boy's atria are experiencing abnormal sympathetic stimulation.

Question 11.11. A patient has suffered damage to his pericardium following a motor vehicle accident. Which of the following consequences should the nurse practitioner be most likely to rule out? (Points : 3)

Impaired physical restraint of the left ventricule

Increased friction during the contraction/relaxation cycle

Reduced protection from infectious organisms

Impaired regulation of myocardial contraction

Question 12.12. Which of the following situations related to the transition from fetal to perinatal circulation would be most likely to necessitate medical intervention? (Points : 3)

Pressure in the pulmonary circulation and the right side of the infant's heart fall markedly.

Alveolar oxygen tension increases, causing reversal of pulmonary vasoconstriction of the fetal arteries.

Systemic vascular resistance and left ventricular pressure are both increasing.

Pulmonary vascular resistance, related to muscle regression in the pulmonary arteries, rises over the course of the infant's first week.

Question 13.13. A 70-year-old male patient presents to the emergency department complaining of pain in his calf that is exacerbated when he walks. His pedal and popliteal pulses are faintly palpable and his leg distal to the pain is noticeably reddened. What would his care provider's preliminary diagnosis and anticipated treatment most likely be? (Points : 3)

Acute arterial occlusion that will be treated with angioplasty

Raynaud disease that will require antiplatelet medications

Atherosclerotic occlusive disease necessitating thrombolytic therapy

Giant cell temporal arteritis that will be treated with corticosteroids

Question 14.14. A patient is experiencing impaired circulation secondary to increased systemic arterial pressure. Which of the following statements is the most relevant phenomenon? (Points : 3)

Increased preload due to vascular resistance

High afterload because of backpressure against the left ventricle

Impaired contractility due to aortic resistance

Systolic impairment because of arterial stenosis

Question 15.15. A nurse practitioner is providing care for several patients on a medical unit of a hospital. In which of the following patient situations would the nurse practitioner be most likely to rule out hypertension as a contributing factor? (Points : 3)

A 61-year-old man who has a heart valve infection and recurrent fever

An 81-year-old woman who has had an ischemic stroke and has consequent one-sided weakness

A 44-year-old man awaiting a kidney transplant who requires hemodialysis three times per week

A 66-year-old woman with poorly controlled angina and consequent limited activity tolerance

Question 16.16. A formerly normotensive woman, pregnant for the first time, develops hypertension and headaches at 26 weeks' gestation. Her blood pressure is 154/110 mm Hg and she has proteinuria. What other labs should be ordered for her? (Points : 3)

Plasma angiotensin I and II and renin

Urinary sodium and potassium

Platelet count, serum creatinine, and liver enzymes

Urinary catecholamines and metabolites

Question 17.17. A nurse practitioner is instructing a group of older adults about the risks associated with high cholesterol. Which of the following teaching points should the participants try to integrate into their lifestyle after the teaching session? (Points : 3)

“Remember, the 'H' in HDL and the 'L' in LDL correspond to high danger and low danger to your health.”

“Having high cholesterol increases your risk of developing diabetes and irregular heart rate.”

“Smoking and being overweight increases your risk of primary hypercholesterolemia.”

“Your family history of hypercholesterolemia is important, but there are things you can do to compensate for a high inherited risk.”

Question 18.18. An autopsy is being performed on a 44-year-old female who died unexpectedly of heart failure. Which of the following components of the pathologist's report is most suggestive of a possible history of poorly controlled blood pressure? (Points : 3)

“Scarring of urethra suggestive of recurrent urinary tract infections is evident.”

“Bilateral renal hypertrophy noted.”

“Vessel wall changes suggestive of venous stasis are evident.”

“Arterial sclerosis of subcortical brain regions noted.”

Question 19.19. A nurse practitioner has ordered the measurement of a cardiac patient's electrolyte levels as part of the patient's morning blood work. Which of the following statements best captures the importance of potassium in the normal electrical function of the patient's heart? (Points : 3)

Potassium catalyzes the metabolism of ATP, producing the gradient that results in electrical stimulation.

Potassium is central to establishing and maintaining the resting membrane potential of cardiac muscle cells.

The impermeability of cardiac cell membranes to potassium allows for action potentials achieved by the flow of sodium ions.

The reciprocal movement of one potassium ion for one sodium ion across the cell membrane results in the production of an action potential.

Question 20.20. In which of the following patient situations would a nurse practitioner be most justified in preliminarily ruling out pericarditis as a contributing pathology to the patient's health problems? (Points : 3)

A 61-year-old man whose ECG was characterized by widespread T wave inversions on admission but whose T waves have recently normalized

A 77-year-old with diminished S3 and S4 sounds, an irregular heart rate, and a history of atrial fibrillation

A 56-year-old obese man who is complaining of chest pain that is exacerbated by deep inspiration and is radiating to his neck and scapular ridge

A 60-year-old woman whose admission blood work indicates elevated white cells, erythrocyte sedimentation rate, and C-reactive protein levels

Question 21.21. During a routine physical examination of a 66-year-old woman, her nurse practitioner notes a pulsating abdominal mass and refers the woman for further treatment. The nurse practitioner is explaining the diagnosis to the patient, who is unfamiliar with aneurysms. Which of the following aspects of the pathophysiology of aneurysms would underlie the explanation the nurse provides? (Points : 3)

Aneurysms are commonly a result of poorly controlled diabetes mell