Question

Question 1

Which of the following statements describes phase 4 of the action potential of cells in the sinoatrial (SA) node? 

Answers: 

A. Potassium permeability is allowing the cell membrane to remain depolarized, and Ca2+ channel opens moving Ca2+ back into the cell.

B. The cells are capable of responding to a greater than normal stimulus before the resting membrane potential is reached.

C. A slow depolarization occurs when Na+ is transported out of the cell and K+ moves back in, resulting in resting membrane potential.

D. The fast sodium channels in the cellular membranes close, causing an abrupt decrease in intracellular positivity.

Question 2

A 31-year-old woman with a congenital heart defect reports episodes of light-headedness and syncope, with occasional palpitations. A resting electrocardiogram reveals sinus bradycardia, and she is suspected to have sick sinus syndrome. Which of the following diagnostic methods is the best choice to investigate the suspicion? 

Answers: 

A. Signal-averaged ECG

B. Holter monitoring

C. Electrophysiologic study

D. Exercise stress testing

Question 3

A patient has been diagnosed with anemia. The physician suspects an immune hemolytic anemia and orders a Coombs test. The patient asks the nurse what this test will tell the doctor. The nurse replies, 

Answers: 

A. “They are looking for the presence of antibody or complement on the surface of the RBC.”

B. “They will wash your RBCs and then mix the cells with a reagent to see if they clump together.”

C. “They will look at your RBCs under a microscope to see if they have an irregular shape (poikilocytosis).”

D. “They will be looking to see if you have enough ferritin in your blood.”

Question 4

Of the following list of patients, who would likely benefit the most from hyperbaric oxygen therapy? 

Answers: 

A. A football player who has torn a meniscus in his knee for the third time this year

B. A patient who developed a fistula between her bowel and vagina following cervical cancer surgery

C. A school-aged child who fell on gravel and has terrible road rash

D. A trauma patient who developed Clostridium spp., an anaerobic bacterial infection in his femur

Question 5

A 71-year-old male patient with a history of myocardial infarction (MI) and peripheral vascular disease (PVD) has been advised by his family physician to begin taking 81 mg aspirin once daily. Which of the following statements best captures an aspect of the underlying rationale for the physician’s suggestion? 

Answers: 

A. Aspirin inhibits the conversion of fibrinogen into fibrin and consequent platelet plug formation.

B. Platelet aggregation can be precluded through inhibition of prostaglandin production by aspirin.

C. Aspirin can reduce unwanted platelet adhesion by inhibiting TXA2 synthesis.

D. Aspirin helps to inhibit ADP action and minimizes platelet plug formation.

Question 6

Which of the following assessments and laboratory findings would be most closely associated with acute leukemia? 

Answers: 

A. Increased serum potassium and sodium levels

B. Increased blood urea nitrogen and bone pain

C. High blast cell counts and fever

D. Decreased oxygen partial pressure and weight loss

Question 7

A 55-year-old male who is beginning to take a statin drug for his hypercholesterolemia is discussing cholesterol and its role in health and illness with his physician. Which of the following aspects of hyperlipidemia would the physician most likely take into account when teaching the patient? 

Answers: 

A. Hyperlipidemia is a consequence of diet and lifestyle rather than genetics.

B. The goal of medical treatment is to eliminate cholesterol from the vascular system.

C. Cholesterol is a metabolic waste product that the liver is responsible for clearing.

D. HDL cholesterol is often characterized as being beneficial to health.

Question 8

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? 

Answers: 

A. A musculoskeletal assessment

B. A test of the child’s visual acuity

C. Tests of kidney function

D. Cardiovascular assessment

Question 9

In the ICU setting, a patient transported from surgery following open heart bypass grafting will likely have his core temperature measured by a/an 

Answers: 

A. esophageal flexible thermometer monitoring aorta distention.

B. rectal tube inserted to prevent evacuation from bowels while recovering from anesthesia.

C. pulmonary artery catheter being used to measure cardiac output.

D. temperature probe taped behind his ear.

Question 10

The son of an 80-year-old man has noticed that in recent weeks his father has become incontinent of urine for the first time in his life. The man is later diagnosed with transient urinary incontinence, a condition that is most often attributable to 

Answers: 

A. medications.

B. detrusor instability.

C. decrease in bladder and sphincter tone.

D. bladder outlet obstruction.

Question 11

A health educator is teaching a group of colleagues about the physiology of thermoregulation. Which of the following statements is most accurate? 

Answers: 

A. “Prostaglandin E2 (PGE2) exerts a direct fever-producing effect on the hypothalamus.”

B. “Endogenous pyrogens induce host cells to produce exogenous pyrogens.”

C. “PGE2 induces Kupffer cells to initiate a fever response via hepatic sinusoids.”

D. “Arachidonic acid induces cytokines to act on the temperature regulation center.”

Question 12

A patient experiencing immotile cilia syndrome should be frequently assessed by the nurse for which priority complication? 

Answers: 

A. Epistaxis resulting from loss of cilia in the nasal passageway

B. Sterility caused by inability of the sperm to swim downstream

C. Bronchiectasis due to interferences with clearance of inhaled bacteria along the respiratory tract

D. Inability to hear soft sounds related to kinocilium on the hair cells in the inner ear

Question 13

The unique clinical presentation of a 3-month-old infant in the emergency department leads the care team to suspect botulism. Which of the following assessment questions posed to the parents is likely to be most useful in the differential diagnosis? 

Answers: 

A. “Is there any mold in your home that you know of?”

B. “Is there any family history of neuromuscular diseases?”

C. “Has your baby ever been directly exposed to any chemical cleaning products?”

D. “Have you ever given your child any honey or honey-containing products?”

Question 14

In the context of a workshop on rheumatoid arthritis, a clinical educator is teaching a group of nurses about autoimmune diseases. Which of the following statements by an attendee would the educator most likely want to follow up with further teaching? 

Answers: 

A. “Often the problem can be traced to antigens that sensitize T cells without the need for presentation.”

B. “In some cases, the body attacks its own cells that are chemically similar to those of infectious organisms.”

C. “Introduction of a foreign antigen can sometimes induce a cascade of immune response that is not self-limiting”

D. “Sometimes when the body’s own cells are released after a long time, they are interpreted as being foreign.”

Question 15

Which of the following pregnant women has most likely encountered the greatest increase in the risk that her child will have a fetal anomaly? 

Answers: 

A. A woman with diagnoses of syphilis and cirrhosis of the liver

B. A woman who has herpes simplex and who has recently recovered from endocarditis

C. A woman with chronic obstructive pulmonary syndrome and tuberculosis

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

Question 16

In which of the following individuals would a clinician most suspect multiple myeloma as a diagnosis? 

Answers: 

A. A 70-year-old woman whose blood work reveals large numbers of immature granulocytes

B. A 68-year-old former coal miner who has white cell levels exponentially higher than normal ranges

C. A 40-year-old man who has had three broken bones over the past 6 months and whose serum calcium and creatinine levels are elevated

D. An 81-year-old male resident of a long-term care home who has an uncommon bacterial pneumonia and who is unable to produce a fever

Question 17

A group of novice nursing students are learning how to manually measure a client’s blood pressure using a stethoscope and sphygmomanometer. Which of the following statements by students would the instructor most likely need to correct? 

Answers: 

A. “If my client’s arm is too big for the cuff, I’m going to get a BP reading that’s artificially low.”

B. “I’ll inflate the cuff around 30 mm Hg above the point at which I can’t palpate the client’s pulse.”

C. “The accuracy of the whole process depends on my ability to clearly hear the Korotkoff sounds with the bell of my stethoscope.”

D. “With practice, my measurement of clients’ blood pressures with this method will be more accurate than with automated machines.”

Question 18

A physician is explaining to a 40-year-old male patient the importance of completing his course of antibiotics for the treatment of tuberculosis. The physician explains the damage that could occur to lung tissue by Mycobacterium tuberculosis. Which of the following phenomena would underlie the physician’s explanation? 

Answers: 

A. Tissue destruction results from neutrophil deactivation.

B. Macrophages form a capsule around the Mycobacterium tuberculosis bacteria, resulting in immune granulomas.

C. Neutrophils are ineffective against the Mycobacterium tuberculosis antigens.

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

Question 19

0 out of 1 points

A student makes the statement to a colleague, “Blood plasma is essentially just a carrier for the formed elements like red blood cells and white blood cells.”What would be the most accurate response to this statement? 

Answers: 

A. “Not really. Plasma also contributes to the processes of protein synthesis and hematopoiesis.”

B. “Actually, plasma is integral to the proper function of the liver and maintenance of acid–base balance.”

C. “Actually, plasma plays a significant role in nutrient and waste transport.”

D. “That’s not really true. Plasma is crucial in the immune and inflammatory responses.”

Question 20

A number of clients have presented to the emergency department in the last 32 hours with complaints that are preliminarily indicative of myocardial infarction. Which of the following clients is least likely to have an ST-segment myocardial infarction (STEMI)? 

Answers: 

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

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

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

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

Question 21

In which of the following situations would blood most likely rapidly relocate from central circulation to the lower extremities? 

Answers: 

A. A client does isotonic exercises in a wheelchair.

B. A client reclines from a sitting to supine position.

C. A client is helped out of bed and stands up.

D. A client undergoes a stress test on a treadmill.

Question 22

When talking about the various types of granulocytes, which granule contains heparin, an anticoagulant? 

Answers: 

A. Lymphocytes

B. Neutrophils

C. Eosinophils

D. Basophils

Question 23

A nurse is providing care for a 44-year-old male client who is admitted with a diagnosis of fever of unknown origin (FUO). Which of the following characteristics of the client’s history is most likely to have a bearing on his current diagnosis? 

Answers: 

A. The client is cachexic and an African American.

B. The client is malnourished, hypomagnesemic, and hypocalcemic.

C. The client is HIV positive and homeless.

D. The client is receiving intravenous normal saline with 20 mEq KCl.

Question 24

As part of a screening program for prostate cancer, men at a senior citizens’ center are having their blood levels of prostate-specific antigen (PSA) measured.Which of the following statements would best characterize a high positive predictive value but a low negative predictive value for this screening test? 

Answers: 

A. All of the men who had low PSA levels were cancer-free; several men who had high levels also remained free of prostate cancer.

B.Men who had low PSA levels also displayed false-positive results for prostate cancer; men with high levels were often falsely diagnosed with prostate cancer.

C. The test displayed low sensitivity but high specificity.

D. All of the men who had high PSA levels developed prostate cancer; several men who had low PSA levels also developed prostate cancer.

Question 25

When looking at a granulocyte under a microscope, the anatomy student would describe it as a cell 

Answers: 

A. having a kidney-shaped nucleus.

B. having no nuclei.

C. lacking granules.

D. shaped like a sphere with multilobar nuclei.

Question 26

The cardiologist just informed a patient that he has a reentry circuit in the electrical conduction system in his heart. This arrhythmia is called Wolff-Parkinson-White (WPW) syndrome. After the physician has left the room, the patient asks the nurse to explain this to him. Which of the following statements most accurately describes what is happening? 

Answers: 

A. “You must have a large clot in one of your arteries that supply oxygenated blood to the special conduction cells in your heart.”

B.“There is an extra, abnormal electrical pathway in the heart that leads to impulses traveling around the heart very quickly, in a circular pattern, causing the heart to beat too fast.”

C. “This means that the SA node (which is the beginning of your heart’s electrical system) has been damaged and is no longer functioning normal.”

D. “For some reason, your electrical system is not on full charge, so they will have to put in new leads and a pacemaker to make it work better.”

Question 27

In the ED, a homeless patient is brought in with severe hypothermia. The police officers also state that they found a “bottle of booze” on the sidewalk next to him. This puts the nurse on high alert since alcohol contributes to hypothermia by 

Answers: 

A. causing the person to have less fat on his body.

B. interfering with the appetite center in the brain causing the person to not respond to hunger pains.

C. increasing his basal metabolic rate, so he will run out of ATP faster than expected.

D. dulling the mental awareness that impairs judgment to seek shelter.

Question 28

Which of the following glycoproteins is responsible for treating such diseases as bone marrow failure following chemotherapy and hematopoietic neoplasms such as leukemia? 

Answers: 

A. Growth factors and cytokines

B. Natural killer cells and granulocytes

C. Neutrophils and eosinophils

D. T lymphocytes and natural killer cells

Question 29

A professor is teaching a group of students about the role of mitochondria within the cell. Which of the following statements is true of mitochondria? 

Answers: 

A. They are the site of adenosine triphosphate (ATP) production.

B. Mitochondrial DNA is inherited patrilineally.

C. The number of mitochondria in a cell is equal to the number of nuclei.

D. They are replicated within the smooth endoplasmic reticulum (ER).

Question 30

A nurse practitioner is providing care for a client with low levels of the plasma protein gamma globulin. The nurse would recognize that the client is at risk of developing which of the following health problems? 

Answers: 

A. Infections

B. Jaundice

C. Blood clots

D. Anemia

Question 31

A 63-year-old woman has begun a diet that purports to minimize the quantity and effects of free radicals in her body. What physiological processes could best underlie her care provider’s teaching about her new diet? 

Answers: 

A. Free radicals increase cytokine expression and adhesion molecule levels, resulting in increased inflammation.

B. Free radicals contribute to atherosclerosis and decreased immune response.

C. Free radicals act as direct mediators in the inflammatory process.

D. Free radicals inhibit the inflammatory response, limiting preadaptive response to infection.

Question 32

A male client of a nurse practitioner has an autosomal dominant disorder. The client and his partner are considering starting a family. Which of the following statements indicates the client has an adequate understanding of the genetic basis of this health problem? 

Answers: 

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

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

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

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

Question 33

In which of the following hospital patients would the care team most realistically anticipate finding normal cholesterol levels? 

Answers: 

A. A 44-year-old male admitted for hyperglycemia and with a history of diabetic neuropathy

B. A 51-year-old male with a diagnosis of hemorrhagic stroke and consequent unilateral weakness

C. A 77-year-old female admitted for rheumatoid arthritis exacerbation who is receiving hormone replacement therapy and with a history of hypothyroidism

D. A morbidly obese 50-year-old female who is taking diuretics and a beta-blocker to treat her hypertension

Question 34

As of November 1, 2012, there were a total of 10 confirmed cases of Hantavirus infection in people who were recent visitors (mid-June to end of August, 2012) to Yosemite National Park. Three visitors with confirmed cases died. Health officials believe that 9 out of the 10 people with Hantavirus were exposed while staying in Curry Village in the Signature Tent Cabins. This is an example of 

Answers: 

A. the low rate of morbidity one can expect while traveling to Yosemite National Park.

B. the prevalence of Hantavirus one can anticipate if he or she is going to vacation in Yosemite National Park.

C. what the anticipated mortality rate would be if a family of five were planning to vacation in Yosemite National Park.

D. the incidence of people who are at risk for developing Hantavirus while staying in Yosemite National Park.

Question 35

A 1-year-old child who has experienced low platelet counts and bacterial susceptibility has been admitted to a pediatric medical unit of a hospital for treatment of Wiskott-Aldrich syndrome. The nurse who has admitted the child to the unit would anticipate which of the following short-term and longer-term treatment plans? 

Answers: 

A. Neutropenic precautions; fresh frozen plasma transfusions; treatment of gastrointestinal symptoms

B. Transfusion of clotting factors XII and XIII and serum albumin; splenectomy

C. Intravenous immunoglobulin (IVIG) treatment; thyroidectomy

D. Treatment of eczema; management of bleeding; bone marrow transplant

Question 36

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? 

Answers: 

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

B. The woman complains of recent debilitating fatigue.

C. Her neoplasm originates in secondary lymphoid structures.

D. The presence of Reed-Sternberg cells has been confirmed.

Question 37

An 81-year-old female client of a long-term care facility has a history of congestive heart failure. The nurse practitioner caring for the client has positioned her sitting up at an angle in bed and is observing her jugular venous distention. Why is jugular venous distention a useful indicator for the assessment of the client’s condition? 

Answers: 

A. Peripheral dilation is associated with decreased stroke volume and ejection fraction.

B. Increased cardiac demand causes engorgement of systemic blood vessels, of which the jugular vein is one of the largest.

C. Blood backs up into the jugular vein because there are no valves at the point of entry into the heart.

D. Heart valves are not capable of preventing backflow in cases of atrial congestion.

Question 38

A nurse who works on a pediatric cardiology unit of a hospital is providing care for an infant with a diagnosis of tetralogy of Fallot. Which of the following pathophysiologic results should the nurse anticipate? 

Answers: 

A. Blood outflow into the pulmonary circulation is restricted by pulmonic valve stenosis.

B. There is a break in the normal wall between the right and left atria that results in compromised oxygenation.

C. The aortic valve is stenotic, resulting in increased afterload.

D. The right ventricle is atrophic as a consequence of impaired myocardial blood supply.

Question 39

Which of the following hypertensive individuals is most likely to have his or her high blood pressure diagnosed as secondary rather than essential? 

Answers: 

A. A 40-year-old smoker who eats excessive amounts of salt and saturated fats

B. A 69-year-old woman with a diagnosis of cardiometabolic syndrome

C. An African American man who leads a sedentary lifestyle

D. A 51-year-old male who has been diagnosed with glomerulonephritis

Question 40

A 72-year-old female has been told by her physician that she has a new heart murmur that requires her to go visit a cardiologist. Upon examination, the cardiologist informs the patient that she has aortic stenosis. After the cardiologist has left the room, the patient asks, “What caused this [aortic stenosis] to happen now?” The clinic nurse responds, 

Answers: 

A.“Aortic stenosis is commonly seen in elderly patients.Basically, there is a blockage in the valve that is causing blood to pool, causing decreased velocity of flow.”

B.“Because of the high amount of energy it takes to push blood through the aortic valve to the body, your valve is just had to work too hard and it is weakening.”

C.“This is caused by a tear in one of the papillary muscles attached to the valve. They can do a procedure where they thread a catheter into the heart and reattach the muscle ends.”

D. “Heart murmurs result from tumultuous flow through a diseased heart valve that is too narrow and stiff. This flow causes a vibration called a murmur.”

Question 41

Which of the following patients is most likely to have impairments to the wound-healing process? A patient with 

Answers: 

A. chronic obstructive pulmonary disease.

B. congenital heart defects and anemia.

C. poorly controlled blood sugars with small blood vessel disease.

D. a diagnosis of multiple sclerosis and consequent impaired mobility.

Question 42

The geriatrician providing care for a 74-year-old man with diagnosis of Parkinson disease has recently changed the client’s medication regimen. What is the most likely focus of the pharmacologic treatment of the man’s health problem? 

Answers: 

A. Increasing the functional ability of the underactive dopaminergic system

B. Maximizing acetylcholine release from synaptic vesicles at neuromuscular junctions

C. Preventing axonal degradation of motor neurons

D. Preventing demyelination of the efferent cerebellar pathways

Question 43

A 4-year-old boy presents with a chronic cough and swollen lymph nodes. His records show that he has been given antibiotics several times in the past year with limited success, most recently for a liver abscess, and that he also has a recurring fungal skin condition. Which of the following is his most likely diagnosis? 

Answers: 

A. Selective IgA deficiency

B. Ataxia–telangiectasia

C. A deficiency in IgG2 subclass antibodies

D. Chronic granulomatous disease

Question 44

A nurse is teaching a client with a recent diagnosis of diabetes about the roles that glucose and insulin play in the disease pathology and the fact that glucose must enter the body cell in order to provide energy for the client. The nurse knows that which of the following processes allows glucose to enter body cells? 

Answers: 

A. Active transport

B. Diffusion

C. Osmosis

D. Facilitated diffusion

Question 45

Two health care workers are comparing the etiology and incidence of multifactorial inheritance disorders and single-gene disorders. Which of the following statements best captures the relationship between the two types of genetic disorders? 

Answers: 

A. “A couple with a child with a multifactorial disorder has a higher risk of having another with the same disorder.”

B. “Multifactorial disorders are more likely to involve multiple organs.”

C. “Multifactorial disorders and single-gene disorders can both be predicted quite accurately.”

D. “Multifactorial disorders manifest themselves at birth.”

Question 46

A 44-year-old female who is on her feet for the duration of her entire work week has developed varicose veins in her legs. What teaching point would her care provider be most justified in emphasizing to the woman? 

Answers: 

A. “Your varicose veins are likely a consequence of an existing cardiac problem.”

B. “Once you have varicose veins, there’s little that can be done to reverse them.”

C. “The use of blood thinner medications will likely relieve the backflow that is causing your varicose veins.”

D. “If you’re able to stay off your feet and wear tight stockings, normal vein tone can be reestablished.”

Question 47

At 4 AM, the hemodynamic monitor for a critically ill client in the intensive care unit indicates that the client’s mean arterial pressure is at the low end of the normal range; at 6 AM, the client’s MAP has fallen definitively below normal. The client is at risk for 

Answers: 

A. left ventricular hypertrophy.

B. pulmonary hypertension.

C. organ damage and hypovolemic shock.

D. orthostatic hypotension.

Question 48

A baseball player was hit in the head with a bat during practice. In the emergency department, the physician tells the family that he has a “coup”injury. How will the nurse explain this to the family so they can understand? 

Answers: 

A. “It’s like squeezing an orange so tight that the juice runs out of the top.”

B. “Your son has a huge laceration inside his br

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