Pathophysiology The Biologic Basis for Disease in Adults and Children 7th Edition by Kathryn L. McCance – Test Bank

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Pathophysiology The Biologic Basis for Disease in Adults and Children 7th Edition by Kathryn L. McCance – Test Bank

 

Sample  Questions

 

Chapter 6: Epigenetics and Disease

 

MULTIPLE CHOICE

 

  1. What genetic process is likely responsible for the occurrence of asthma in only one of a pair of identical twins?
a. Epigenetic modifications c. Transgenerational inheritance
b. Genomic imprinting d. Methylation

 

 

ANS:  A

Epigenetic modifications can cause individuals with the same deoxyribonucleic acid (DNA) sequences (such as identical twins) to have different disease profiles. The correct option is the only one that accurately identifies the genetic process likely responsible for the occurrence of asthma in only one of a pair of twins.

 

PTS:   1                    REF:   Page 183 | Page 185

 

  1. Prader-Willi syndrome causes a chromosomal defect that is:
a. Initiated by postnatal exposure to a virus
b. Inherited from the father
c. Related to maternal alcohol abuse
d. Transferred from mother to child

 

 

ANS:  B

Prader-Willi syndrome can be caused by a 4 Mb deletion of chromosome 15q when inherited from the father. The other options do not accurately identify the reason for the chromosomal damage that causes Prader-Willi syndrome.

 

PTS:   1                    REF:   Pages 187-188

 

  1. A malfunction in DNA methylation can lead to:
a. Hypothyroidism c. Cancer
b. Blindness d. Diabetes mellitus

 

 

ANS:  C

Aberrant methylation can lead to silencing of tumor-suppressor genes in the development of cancer. No research supports a connection between hypothyroidism, blindness, or diabetes mellitus to a malfunctioning of DNA methylation.

 

PTS:   1                    REF:   Page 183 | Page 186

 

  1. Which statement is true regarding the embryonic development of stem cells?
a. They are already differentiated.
b. They are referred to as housekeeping genes.
c. They already demonstrate DNA sequencing.
d. They are said to be pluripotent.

 

 

ANS:  D

Early in embryonic development, all cells of the embryo have the potential to become any type of cell in the fetus or adult. These embryonic stem cells are said to be pluripotent. The remaining options are not true statements regarding embryonic stem cell development.

 

PTS:   1                    REF:   Page 184

 

  1. When microRNA (miRNA) are methylated their messenger RNA (mRNA) targets are over-expressed, the resulting effect on existing cancer would be:
a. Cell death c. Remission
b. Metastasis d. Relapse

 

 

ANS:  B

When miRNA genes are methylated, their mRNA targets are over-expressed, and this over-expression has been associated with metastasis. of the described effect on mRNA targets on existing cancer does not result in any of the other options.

 

PTS:   1                    REF:   Page 186

 

  1. The difference between DNA sequence mutations and epigenetic modifications is:
a. DNA sequence mutations can be directly altered.
b. Leukemia is a result of only DNA sequence mutation.
c. Epigenetic modifications can be reversed.
d. No known drug therapies are available for epigenetic modifications.

 

 

ANS:  C

Unlike DNA sequence mutations, which cannot be directly altered, epigenetic modifications can be reversed. The remaining options are not true statements regarding the difference between DNA sequence mutations and epigenetic modifications.

 

PTS:   1                    REF:   Page 186

 

  1. Which term refers to the silenced gene of a gene pair?
a. Activated c. Mutated
b. Altered d. Imprinted

 

 

ANS:  D

Gene silencing, a process during which genes are predictably silenced, depending on which parent transmits them, is known as imprinting; the transcriptionally silenced genes are then said to be imprinted. The remaining options do not accurately identify this process.

 

PTS:   1                    REF:   Page 187

 

  1. The shape of the face of a child diagnosed with Russell-Silver syndrome is likely to be:
a. Round c. Triangular
b. Square d. Elongated

 

 

ANS:  C

Growth retardation, proportionate short stature, leg-length discrepancy, and a small, triangular-shaped face characterizes Russell-Silver syndrome. The other face shapes are not characteristic of Russell- Silver syndrome.

 

PTS:   1                    REF:   Page 188

 

  1. Genes responsible for the maintenance of all cells are referred to as:
a. Universal c. Housekeeping
b. Managerial d. Executive

 

 

ANS:  C

A small percentage of genes, termed housekeeping genes, are necessary for the function and maintenance of all cells. The remaining options do not accurately refer to these cells.

 

PTS:   1                    REF:   Page 184

 

  1. What is the belief regarding twins who adopt dramatically different lifestyles?
a. They may experience very different aging processes.
b. They will retain very similar methylation patterns.
c. They will experience identical phenotypes throughout their lifespans.
d. They may never demonstrate similar DNA sequences of their somatic cells.

 

 

ANS:  A

Twins with significant lifestyle differences (e.g., smoking versus nonsmoking), accumulate large numbers of differences in their methylation patterns. The twins, despite having identical DNA sequences, become more and more different as a result of epigenetic changes, which in turn affect the expression of genes. These results, along with findings generated in animal studies, suggest that changes in epigenetic patterns may be an important part of the aging process. They will not experience identical phenotypes throughout their lifespans.

 

PTS:   1                    REF:   Page 185

 

  1. Hypomethylation and the resulting effect on oncogenes result in a(an):
a. Decrease in the activity of the oncogene, thus suppressing cancer development
b. Deactivation of MLH1 to halt DNA repair
c. Increase in tumor progression from benign to malignant
d. Over-expression of microRNA, resulting in tumorigenesis

 

 

ANS:  C

Tumor cells typically exhibit hypomethylation (decreased methylation), which can increase the activity of oncogenes. Hypomethylation increases as tumors progress from benign neoplasms to malignancy. Only the correct option accurately describes hypomethylation and its resulting effects.

 

PTS:   1                    REF:   Page 186

 

  1. When a chromosome lacking 4 Mb is inherited from the mother, the child is at risk for developing which syndrome?
a. Prader-Willi c. Beckwith-Wiedemann
b. Angelman d. Russell-Silver

 

 

ANS:  B

This anomaly illustrates the inheritance pattern of Angelman syndrome, which can be caused by a 4 Mb deletion of chromosome 15q when inherited from the mother. The anomaly is not the cause of any of the other options.

 

PTS:   1                    REF:   Page 187

 

MULTIPLE RESPONSE

 

  1. A child’s diagnosis of Beckwith-Wiedemann syndrome is supported by the presence of: (Select all that apply.)
a. An omphalocele
b. Neonatal hypoglycemia
c. Creased earlobes
d. Low birth weight
e. A large tongue

 

 

ANS:  A, B, C, E

Beckwith-Wiedemann syndrome is usually identifiable at birth because the child exhibits a large size for gestational age, neonatal hypoglycemia, a large tongue, creases on the earlobe, and omphalocele.

 

PTS:   1                    REF:   Page 188

 

  1. A diagnosis of Angelman syndrome in a child is supported by which assessment findings? (Select all that apply.)
a. Small feet and hands
b. Profound cognitive dysfunction
c. Obesity
d. Ataxic gait
e. History of seizures

 

 

ANS:  B, D, E

A child diagnosed with Angelman syndrome demonstrates a characteristic posture, bouts of uncontrolled laughter, severe mental retardation, seizures, and an ataxic gait.

 

PTS:   1                    REF:   Page 187

Chapter 7: Innate Immunity: Inflammation

 

MULTIPLE CHOICE

 

  1. Which action is a purpose of the inflammatory process?
a. To provide specific responses toward antigens
b. To lyse cell membranes of microorganisms
c. To prevent infection of the injured tissue
d. To create immunity against subsequent tissue injury

 

 

ANS:  C

If the epithelial barrier is damaged, then a highly efficient local and systemic response (inflammation) is mobilized to limit the extent of damage, to protect against infection, and to initiate the repair of damaged tissue. The other options do not accurately identify a purpose of the inflammatory process.

 

PTS:   1                    REF:   Page 191

 

  1. How do surfactant proteins A through D provide innate resistance?
a. Initiate the complement cascade. c. Secrete mucus.
b. Promote phagocytosis. d. Synthesize lysosomes.

 

 

ANS:  B

The lung produces and secretes a family of glycoproteins, collectins, which includes surfactant proteins A through D and mannose-binding lectin. Collectin binding facilitates macrophages to recognize the microorganism, enhancing macrophage attachment, phagocytosis, and killing. The other options do not accurately identify how surfactant proteins provide innate resistance.

 

PTS:   1                    REF:   Page 194

 

  1. Which secretion is a first line of defense against pathogen invasion that involves antibacterial and antifungal fatty acids, as well as lactic acid?
a. Optic tears c. Sweat gland perspiration
b. Oral saliva d. Sebaceous gland sebum

 

 

ANS:  D

Sebaceous glands in the skin secrete sebum that is made up of antibacterial and antifungal fatty acids and lactic acid that provide the first-line barrier against pathogen invasion.

 

PTS:   1                    REF:   Pages 192-193

 

  1. Which bacterium grows in the intestines after prolonged antibiotic therapy?
a. Lactobacillus c. Clostridium difficile
b. Candida albicans d. Helicobacter pylori

 

 

ANS:  C

Prolonged antibiotic treatment can alter the normal intestinal flora, decreasing its protective activity and leading to the overgrowth of other microorganisms, such as the yeast C. albicans or the bacterium C. difficile. The other options do not accurately identify intestinal bacterium whose growth is a result of prolonged antibiotic therapy.

 

PTS:   1                    REF:   Page 194

 

  1. What causes the edema that occurs during the inflammatory process?
a. Vasodilation of blood vessels c. Endothelial cell contraction
b. Increased capillary permeability d. Emigration of neutrophils

 

 

ANS:  B

The increased flow and capillary permeability result in a leakage of plasma from the vessels, causing swelling (edema) in the surrounding tissue and is solely responsible for inflammation-induced edema.

 

PTS:   1                    REF:   Page 195

 

  1. What process causes heat and redness to occur during the inflammatory process?
a. Vasodilation of blood vessels c. Decreased capillary permeability
b. Platelet aggregation d. Endothelial cell contraction

 

 

ANS:  A

The increased blood flow as a result of vasodilation and increasing concentration of red cells at the site of inflammation cause locally increased warmth and redness. The other options do not accurately identify the process that results in inflammatory redness and heat.

 

PTS:   1                    REF:   Page 195

 

  1. Activation of the classical pathway begins with:
a. Viruses c. Mast cells
b. Antigen-antibody complexes d. Macrophages

 

 

ANS:  B

Activation of the classical pathway begins only with the activation of protein C1 and is preceded by the formation of a complex between an antigen and an antibody to form an antigen-antibody complex (immune complex) (see Chapter 8).

 

PTS:   1                    REF:   Page 197

 

  1. What plasma protein system forms a fibrinous meshwork at an inflamed site?
a. Complement c. Kinin
b. Coagulation d. Fibrinolysis

 

 

ANS:  B

The coagulation (clotting) system is a group of plasma proteins that form a fibrinous meshwork at an injured or inflamed site. This protein system (1) prevents the spread of infection to adjacent tissues, (2) traps microorganisms and foreign bodies at the site of inflammation for removal by infiltrating cells (e.g., neutrophils and macrophages), (3) forms a clot that stops the bleeding, and (4) provides a framework for future repair and healing. The other options do not accurately identify such a protein system.

 

PTS:   1                    REF:   Page 199 | Page 201

 

  1. Which component of the plasma protein system tags pathogenic microorganisms for destruction by neutrophils and macrophages?
a. Complement cascade c. Kinin system
b. Coagulation system d. Immune system

 

 

ANS:  A

C3b (a component of the complement cascade) adheres to the surface of a pathogenic microorganism and serves as an efficient opsonin. Opsonins are molecules that tag microorganisms for destruction by cells of the inflammatory system, primarily neutrophils and macrophages. The other options do not accurately identify a component capable of tagging pathogenic microorganisms.

 

PTS:   1                    REF:   Pages 197-199

 

  1. What is the vascular effect of histamine released from mast cells?
a. Platelet adhesion c. Vasodilation
b. Initiation of the clotting cascade d. Increased endothelial adhesiveness

 

 

ANS:  C

C2b affects smooth muscle, causing vasodilation and increased vascular permeability. C3a, C5a, and, to a limited extent, C4a are anaphylatoxins; that is, they induce rapid mast cell degranulation (i.e., release of granular contents) and the release of histamine, causing vasodilation and increased capillary permeability. The other options do not accurately describe the vascular effect of histamine released from mast cells?

 

PTS:   1                    REF:   Pages 198-199

 

  1. What is an outcome of the complement cascade?
a. Activation of the clotting cascade
b. Prevention of the spread of infection to adjacent tissues
c. Inactivation of chemical mediators such as histamine
d. Lysis of bacterial cell membranes

 

 

ANS:  D

The complement cascade can be activated by at least three different means, and its products have four functions: (1) anaphylatoxic activity, resulting in mast cell degranulation, (2) leukocyte chemotaxis, (3) opsonization, and (4) cell lysis. The other options do not accurately describe an outcome of the complement cascade.

 

PTS:   1                    REF:   Page 199

 

  1. The function of opsonization related to the complement cascade is to:
a. Tag of pathogenic microorganisms for destruction by neutrophils and macrophages.
b. Process pathogenic microorganisms so that activated lymphocytes can be created for acquired immunity.
c. Destroy glycoprotein cell membranes of pathogenic microorganisms.
d. Promote anaphylatoxic activity, resulting in mast cell degranulation.

 

 

ANS:  A

C3b adheres to the surface of a pathogenic microorganism and serves as an efficient opsonin. Opsonins are molecules that tag microorganisms for destruction by cells of the inflammatory system, primarily neutrophils and macrophages. The other options do not accurately describe the function of opsonization related to the complement cascade.

 

PTS:   1                    REF:   Page 199

 

  1. In the coagulation (clotting) cascade, the intrinsic and the extrinsic pathways converge at which factor?
a. XII c. X
b. VII d. V

 

 

ANS:  C

The coagulation cascade consists of the extrinsic and intrinsic pathways that converge only at factor X.

 

PTS:   1                    REF:   Page 201

 

  1. Which chemical interacts among all plasma protein systems by degrading blood clots, activating complement, and activating the Hageman factor?
a. Kallikrein c. Bradykinin
b. Histamine d. Plasmin

 

 

ANS:  D

Only plasmin regulates clot formation by degrading fibrin and fibrinogen, and it can activate the complement cascade through components C1, C3, and C5. Plasmin can activate the plasma kinin cascade by activating the Hageman factor (factor XII) and producing prekallikrein activator.

 

PTS:   1                    REF:   Page 201

 

  1. The chemotactic factor affects the inflammatory process by:
a. Causing vasodilation around the inflamed area
b. Stimulating smooth muscle contraction in the inflamed area
c. Directing leukocytes to the inflamed area
d. Producing edema around the inflamed area

 

 

ANS:  C

Two chemotactic factors, neutrophil chemotactic factor (NCF) and eosinophil chemotactic factor of anaphylaxis (ECF-A), are released during mast cell degranulation. NCF attracts neutrophils (a type of leukocytes), and ECF-A attracts eosinophils to the site of inflammation. The other options do not accurately describe the affect chemotactic factors have on the inflammatory process.

 

PTS:   1                    REF:   Page 207

 

  1. What affect does the process of histamine binding to the histamine-2 (H2) receptor have on inflammation?
a. Inhibition c. Acceleration
b. Activation d. Termination

 

 

ANS:  A

Binding of histamine to the H1 receptor is essentially proinflammatory; that is, it promotes inflammation. On the other hand, binding histamine to the H2 receptor is generally antiinflammatory because it results in the suppression of leukocyte function. The other options do not accurately describe the affect histamine binding to the H2 receptor has on inflammation.

 

PTS:   1                    REF:   Page 206

 

  1. Frequently when H1 and H2 receptors are located on the same cells, they act in what fashion?
a. Synergistically c. Antagonistically
b. Additively d. Agonistically

 

 

ANS:  C

Both types of receptors are distributed among many different cells and are often present on the same cells and may act in an antagonistic fashion. For instance, neutrophils express both types of receptors, with stimulation of H1 receptors resulting in the augmentation of neutrophil chemotaxis and H2 stimulation resulting in its inhibition. The other options do not accurately describe the relationship between H1 and H2 receptors.

 

PTS:   1                    REF:   Page 207

 

  1. Some older adults have impaired inflammation and wound healing because of which problem?
a. Circulatory system cannot adequately perfuse tissues.
b. Complement and chemotaxis are deficient.
c. Underlying chronic illness(es) exists.
d. Number of mast cells is insufficient.

 

 

ANS:  C

In some cases, impaired healing is not directly associated with aging, in general, but can instead be linked to a chronic illness such as cardiovascular disease or diabetes mellitus. The other problems are not related to the aging process.

 

PTS:   1                    REF:   Page 220

 

  1. Which chemical mediator derived from mast cells retracts endothelial cells to increase vascular permeability and to cause leukocyte adhesion to endothelial cells?
a. Leukotrienes c. Platelet-activating factor
b. Prostaglandin E d. Bradykinin

 

 

ANS:  C

The biologic activity of platelet-activating factor is virtually identical to that of leukotrienes; namely, it causes endothelial cell retraction to increase vascular permeability, leukocyte adhesion to endothelial cells, and platelet activation. The other options do not accurately identify the chemical mediator derived from the process described in the question.

 

PTS:   1                    REF:   Page 207

 

  1. What is the inflammatory effect of nitric oxide (NO)?
a. Increases capillary permeability, and causes pain.
b. Increases neutrophil chemotaxis and platelet aggregation.
c. Causes smooth muscle contraction and fever.
d. Decreases mast cell function, and decreases platelet aggregation.

 

 

ANS:  D

Effects of NO on inflammation include vasodilation by inducing relaxation of vascular smooth muscle, a response that is local and short lived, and by suppressing mast cell function, as well as platelet adhesion and aggregation. The other options do not accurately identify the effect of NO on the process of inflammation.

 

PTS:   1                    REF:   Page 209

 

  1. What is the correct sequence in phagocytosis?
a. Engulfment, recognition, fusion, destruction
b. Fusion, engulfment, recognition, destruction
c. Recognition, engulfment, fusion, destruction
d. Engulfment, fusion, recognition, destruction

 

 

ANS:  C

Once the phagocytic cell enters the inflammatory site, the only correct sequence of phagocytosis involves the following steps: (1) opsonization, or recognition, of the target and adherence of the phagocyte to it; (2) engulfment, or ingestion or endocytosis, and the formation of phagosome; (3) fusion with lysosomal granules within the phagocyte (phagolysosome); and (4) destruction of the target.

 

PTS:   1                    REF:   Pages 210-211

 

  1. When considering white blood cell differentials, acute inflammatory reactions are related to elevations of which leukocyte?
a. Monocytes c. Neutrophils
b. Eosinophils d. Basophils

 

 

ANS:  C

Only neutrophils are the predominant phagocytes in the early inflammatory site, arriving within 6 to 12 hours after the initial injury, they ingest (phagocytose) bacteria, dead cells, and cellular debris at the inflammatory site.

 

PTS:   1                    REF:   Pages 208-209

 

  1. In the later stages of an inflammatory response, which phagocytic cell is predominant?
a. Neutrophils c. Chemokines
b. Monocytes d. Eosinophils

 

 

ANS:  B

Only monocytes and macrophages perform many of the same functions as neutrophils but for a longer time and in a later stage of the inflammatory response.

 

PTS:   1                    REF:   Page 209 | Page 212

 

  1. In regulating vascular mediators released from mast cells, the role of eosinophils is to release:
a. Arylsulfatase B, which stimulates the formation of B lymphocytes
b. Histaminase, which limits the effects of histamine during acute inflammation
c. Lysosomal enzymes, which activate mast cell degranulation during acute inflammation
d. Immunoglobulin E, which defends the body against parasites

 

 

ANS:  B

Eosinophil lysosomes contain several enzymes that degrade vasoactive molecules, thereby controlling the vascular effects of inflammation. These enzymes include histaminase, which mediates the degradation of histamine, and arylsulfatase B, which mediates the degradation of some of the lipid-derived mediators produced by mast cells. The other options do not accurately describe the role of eosinophils.

 

PTS:   1                    REF:   Page 209

 

  1. What is the role of a natural killer (NK) cells?
a. Initiation of the complement cascade
b. Elimination of malignant cells
c. Binding tightly to antigens
d. Proliferation after immunization with antigen

 

 

ANS:  B

The main function of NK cells is to recognize and eliminate cells infected with viruses, although they are also somewhat effective at eliminating other abnormal host cells, specifically cancer cells. The other options do not accurately identify the role of a NK cell.

 

PTS:   1                    REF:   Page 213

 

  1. Which cytokine is produced and released from virally infected host cells?
a. IL-1 c. TNF-a
b. IL-10 d. IFN-a

 

 

ANS:  D

Only interferons (IFNs) are produced and released by virally infected cells in response to viral double-stranded ribonucleic acid (RNA). IFN-a and IFN-b induce the production of antiviral proteins, thereby conferring protection on uninfected cells. IFN-a or IFN-b is released from virally infected cells and attaches to a receptor on a neighboring cell. IFNs also enhance the efficiency of developing an acquired immune response.

 

PTS:   1                    REF:   Pages 204-205

 

  1. IFN-a is secreted from which cells?
a. Virally infected cells c. Macrophages
b. Bacterial infected cells d. Mast cells

 

 

ANS:  C

Different kinds of interferons (IFNs) are produced by different types of cells—macrophages are the primary producers of both IFN-a and IFN-b. The other options do not accurately identify cells secreted by IFN-a.

 

PTS:   1                    REF:   Pages 204-205

 

  1. Which manifestation of inflammation is systemic?
a. Formation of exudates c. Redness and heat
b. Fever and leukocytosis d. Pain and edema

 

 

ANS:  B

The only three primary systemic changes associated with the acute inflammatory response are fever, leukocytosis (a transient increase in circulating leukocytes), and increased levels in circulating plasma proteins.

 

PTS:   1                    REF:   Page 213

 

  1. The acute inflammatory response is characterized by fever that is produced by the hypothalamus being affected by:
a. Endogenous pyrogens c. Antigen-antibody complexes
b. Bacterial endotoxin d. Exogenous pyrogens

 

 

ANS:  A

Fever-causing cytokines are known as endogenous pyrogens. These pyrogens act directly on the hypothalamus, which is the portion of the brain that controls the body’s thermostat. The other options do not accurately describe the cause of fever related to the effects on the hypothalamus.

 

PTS:   1                    REF:   Page 213

 

  1. What occurs during the process of repair after tissue damage?
a. Nonfunctioning scar tissue replaces destroyed tissue.
b. Regeneration occurs; the original tissue is replaced.
c. Resolution occurs; tissue is regenerated.
d. Epithelialization replaces destroyed tissue.

 

 

ANS:  A

Repair is the replacement of destroyed tissue with scar tissue. Scar tissue is primarily made up of collagen, which fills in the lesion and restores tensile strength but cannot carry out the physiologic functions of the destroyed tissue. The other options do not accurately describe the process of repair after tissue damage.

 

PTS:   1                    REF:   Pages 215-216

 

  1. The role of fibroblasts during the reconstructive phase of wound healing is to:
a. Generate new capillaries from vascular endothelial cells around the wound.
b. Establish connections between neighboring cells and contract their fibers.
c. Synthesize and secrete collagen and the connective tissue proteins.
d. Provide enzymes that débride the wound bed of dead cells.

 

 

ANS:  C

Fibroblasts are the most important cells during the reconstructive phase of wound healing because they synthesize and secrete collagen and other connective tissue proteins. Macrophage-derived transforming growth factor–beta (TGF-ß) stimulates fibroblasts. The other options do not accurately describe the role of fibroblasts in the reconstructive phase of wound healing.

 

PTS:   1                    REF:   Pages 216-218

 

  1. A keloid is the result of which dysfunctional wound healing response?
a. Epithelialization c. Collagen matrix assembly
b. Contraction d. Maturation

 

 

ANS:  C

An imbalance between collagen synthesis and collagen degradation, during which synthesis is increased relative to degradation, causes both keloids and hypertrophic scars. The other options are not involved in keloids production.

 

PTS:   1                    REF:   Page 219

 

  1. Which solution is best to use when cleaning a wound that is healing by epithelialization?
a. Normal saline c. Hydrogen peroxide
b. Povidone-iodine d. Dakin solution

 

 

ANS:  A

Normal saline is the most innocuous solution that can be used to cleanse or irrigate a wound that is primarily healing by epithelialization and is the only correct answer for this question.

 

PTS:   1                    REF:   Page 220

 

  1. Many neonates have a transient depressed inflammatory response as a result of which condition?
a. The circulatory system is too immature to perfuse tissues adequately.
b. Complement and chemotaxis are deficient.
c. Mast cells are lacking.
d. The respiratory system is too immature to deliver oxygen to tissues.

 

 

ANS:  B

Neonates commonly have transiently depressed inflammatory and immune function partially as a result of a deficiency in components of the alternative pathway. For example, neutrophils and perhaps monocytes may not be capable of efficient chemotaxis. The other options do not accurately explain the common cause of a transient depressed inflammatory response in neonates.

 

PTS:   1                    REF:   Page 220

 

  1. During phagocytosis, what is occurring during the step referred to as opsonization?
a. Phagocytes recognize and adhere to the bacteria.
b. Microorganisms are ingested.
c. Microorganisms are killed and digested.
d. An intracellular phagocytic vacuole is formed.

 

 

ANS:  A

During phagocytosis, opsonization involves only the recognition and adherence of phagocytes to bacteria.

 

PTS:   1                    REF:   Page 210

 

  1. Fusion is the step in phagocytosis during which:
a. Microorganisms are killed and digested.
b. An intracellular phagocytic vacuole is formed.
c. Lysosomal granules enter the phagocyte.
d. Microorganisms are ingested.

 

 

ANS:  C

Fusion occurs with lysosomal granules entering the phagocyte (phagolysosome). The remaining options do not accurately describe fusion as a step in phagocytosis.

 

PTS:   1                    REF:   Page 210

 

  1. During the process of endocytosis, the phagosome step results in:
a. Microorganisms are ingested.
b. Microorganisms are killed and digested.
c. Phagocytes recognize and adhere to bacteria.
d. An intracellular phagocytic vacuole is formed.

 

 

ANS:  D

Small pseudopods that extend from the plasma membrane and surround the adherent microorganism, forming an intracellular phagocytic vacuole or phagosome, carry out engulfment (endocytosis). The membrane that surrounds the phagosome consists of inverted plasma membrane. After the formation of the phagosome, lysosomes converge, fuse with the phagosome, and discharge their contents, creating a phagolysosome.

 

PTS:   1                    REF:   Pages 210-211

 

  1. When cellular damage occurs and regeneration is minor with no significant complications, the process of returning the cells to preinjury function is referred to as:
a. Restoration c. Regrowth
b. Resolution d. Replacement

 

 

ANS:  B

If damage is minor with no complications and destroyed tissues are capable of regeneration, then returning the injured tissues to an approximation of their original structure and physiologic function is possible. This restoration is called resolution. The other terms are not used to describe this process.

 

PTS:   1                    REF:   Page 215

 

  1. Newborns often have deficiencies in collectin-like proteins, making them more susceptible to what type of infection?
a. Cardiac c. Respiratory
b. Urinary d. Gastrointestinal

 

 

ANS:  C

Neonates may also be deficient in some of the collectins and collectin-like proteins. This deficiency is especially true of preterm neonates. Some preterm infants with respiratory distress syndrome are deficient in at least one collectin, which negatively affects its innate defense against respiratory infections. The other options are not necessarily related to collectin deficiencies.

 

PTS:   1                    REF:   Page 220

 

  1. Which cell is the body’s primary defense against parasite invasion?
a. Eosinophil c. T lymphocytes
b. Neutrophils d. B lymphocytes

 

 

ANS:  A

Eosinophils serve as the body’s primary defense against parasites. T lymphocytes and B lymphocytes are involved in acquired immunity. Neutrophils are the predominant phagocytes in the early inflammatory site.

 

PTS:   1                    REF:   Page 209

 

MULTIPLE RESPONSE

 

  1. Which chemical mediators induce pain during an inflammatory response? (Select all that apply.)
a. Prostaglandins
b. Leukotrienes
c. Tryptase
d. Phospholipase
e. Bradykinin

 

 

ANS:  A, E

The only chemical mediators that induce pain during an inflammatory response are the prostaglandins and bradykinin.

 

PTS:   1                    REF:   Page 201

 

  1. Sebaceous glands protect the body from infection by secreting: (Select all that apply.)
a. Antibacterial fatty acids
b. Antifungal fatty acids
c. Ascorbic acid
d. Lactic acid
e. Hydrochloric acid

 

 

ANS:  A, B, D

Sebaceous glands secrete only antibacterial and antifungal fatty acids and lactic acid.

 

PTS:   1                    REF:   Pages 192-193

 

  1. Which body fluid has the ability to attack the cell walls of gram-positive bacteria? (Select all that apply.)
a. Perspiration
b. Semen
c. Tears
d. Saliva
e. Urine

 

 

ANS:  A, C, D

Only perspiration, tears, and saliva contain an enzyme (lysozyme) that attacks the cell walls of gram-positive bacteria.

 

PTS:   1                    REF:   Page 193

 

  1. The main function of NK cells includes: (Select all that apply.)
a. Recognizing virus-infected cells
b. Eliminating virus-infected cells
c. Recognizing bacteria-infected cells
d. Eliminating bacteria-infected cells
e. Eliminating previously identified cancer cells

 

 

ANS:  A, B, E

The main functions of NK cells are recognizing and eliminating cells infected with viruses, not bacteria. They are also somewhat effective at eliminating other abnormal host cells, specifically cancer cells.

 

PTS:   1                    REF:   Page 213

 

  1. Normal bacterial flora found in the intestines produce vitamin K to assist in the absorption of which of the following? (Select all that apply.)
a. Calcium
b. Fatty acids
c. Large polysaccharides
d. Iron
e. Magnesium

 

 

ANS:  A, D, E

The flora’s production of vitamin K is needed to absorb various ions, such as calcium, iron, and magnesium. Normal intestinal flora is responsible for digesting fatty acids, large polysaccharides, and other dietary substance, but such digestion is not reliant on vitamin K.

 

PTS:   1                    REF:   Page 194

 

  1. An individual’s acquired immunity is dependent on the function of which cells? (Select all that apply.)
a. T lymphocytes
b. B lymphocytes
c. Macrophages
d. Opsonins
e. Neutrophils

 

 

ANS:  A, B, C

T lymphocytes, B lymphocytes, macrophages, and dendritic cells are involved in acquired immunity. Opsonins are molecules that tag microorganisms for destruction by cells of the inflammatory system; these cells are primarily neutrophils.

 

PTS:   1                    REF:   Page 192 | Table 7-1

 

  1. An example of a pathogen capable of surviving and even multiplying inside a macrophage is known as: (Select all that apply.)
a. Mycobacterium tuberculosis (tuberculosis)
b. Mycobacterium leprae (leprosy)
c. Salmonella typhi (typhoid fever)
d. Clostridium difficile
e. Brucella abortus (brucellosis)

 

 

ANS:  A, B, C, E

Several bacteria are resistant to killing by granulocytes and can even survive inside macrophages. Microorganisms such as M. tuberculosis (tuberculosis), M. leprae (leprosy), S. typhi (typhoid fever), and B. abortus (brucellosis) can remain dormant or even multiply inside the phagolysosomes of macrophages. C. difficile is said to be resistant to antibiotics, making it difficult to control.

 

PTS:   1                    REF:   Pages 212-213

 

  1. An older adult is particularly susceptible to infections of which body parts? (Select all that apply.)
a. Lungs
b. Skin
c. Liver
d. Eyes
e. Bladder

 

 

ANS:  A, B, E

Older adults have increased susceptibility to bacterial infections of the lungs, urinary tract, and skin. Other infections may occur but on an individualized basis.

 

PTS:   1                    REF:   Page 220

 

MATCHING

 

Match each step of phagocytosis with its function.

______ A. Opsonization

______ B. Engulfment

______ C. Phagosome

______ D. Fusion

______ E. Destruction

 

  1. Microorganisms are ingested.

 

  1. Microorganisms are killed and digested.

 

  1. Phagocytes gain enhanced recognition and adherence of bacteria.

 

  1. Lysosomal granules enter the phagocyte.

 

  1. Intracellular phagocytic vacuole is formed.

 

  1. ANS:  B                    PTS:   1                    REF:   Pages 210-211

MSC:  Engulfment is the ingestion of phagosomes.

 

  1. ANS:  E                    PTS:   1                    REF:   Pages 210-211

MSC:  Destruction is the step during which microorganisms are killed and digested.

 

  1. ANS:  A                    PTS:   1                    REF:   Pages 210-211

MSC:  Opsonization is the recognition and adherence of phagocytes to bacteria.

 

  1. ANS:  D                    PTS:   1                    REF:   Pages 210-211

MSC:  Fusion occurs with lysosomal granules within the phagocyte (phagolysosome).

 

  1. ANS:  C                    PTS:   1                    REF:   Pages 210-211

MSC:  Small pseudopods that extend from the plasma membrane and surround the adherent microorganism, forming an intracellular phagocytic vacuole or phagosome, carry out engulfment (endocytosis).

Chapter 11: Stress and Disease

 

MULTIPLE CHOICE

 

  1. Exhaustion occurs if stress continues when which stage of the general adaptation syndrome is not successful?
a. Flight or fight c. Adaptation
b. Alarm d. Arousal

 

 

ANS:  C

Exhaustion occurs if stress continues and adaptation is not successful, ultimately causing impairment of the immune response, heart failure, and kidney failure, leading to death. The other stages occur before the adaptation stage.

 

PTS:   1                    REF:   Page 339

 

  1. Which organ is stimulated during the alarm phase of the general adaptation syndrome (GAS)?
a. Adrenal cortex c. Anterior pituitary
b. Hypothalamus d. Limbic system

 

 

ANS:  B

The alarm phase of the GAS begins when a stressor triggers the actions of the hypothalamus and the sympathetic nervous system (SNS) (see Figure 11-1). The other organs are not stimulated by the alarm phase of GAS.

 

PTS:   1                    REF:   Page 339

 

  1. During an anticipatory response to stress, the reaction from the limbic system is stimulated by the:
a. Retronucleus of the anterior pituitary
b. Anterior nucleus of the hippocampus
c. Paraventricular nucleus of the hypothalamus
d. Prefrontal nucleus of the amygdala

 

 

ANS:  C

The paraventricular nucleus (PVN) of the hypothalamus must be stimulated to cause the limbic system to be stimulated. The other options are not involved in the stimulation of the limbic system.

 

PTS:   1                    REF:   Page 341

 

  1. Which hormone prompts increased anxiety, vigilance, and arousal during a stress response?
a. Norepinephrine
b. Epinephrine
c. Cortisol
d. Adrenocorticotropic hormone (ACTH)

 

 

ANS:  A

Only the release of norepinephrine promotes arousal, increased vigilance, increased anxiety, and other protective emotional responses.

 

PTS:   1                    REF:   Page 343

 

  1. Perceived stress elicits an emotional, anticipatory response that begins where?
a. Prefrontal cortex c. Limbic system
b. Anterior pituitary d. Hypothalamus

 

 

ANS:  C

Perceived stressors elicit an anticipatory response that begins in the limbic system of the brain, the only option responsible for emotions and cognition.

 

PTS:   1                    REF:   Page 343

 

  1. During a stress response, the helper T (Th) 1 response is suppress by which hormone?
a. ACTH c. Prolactin
b. Cortisol d. Growth hormone

 

 

ANS:  B

Stress can activate an excessive immune response and, through cortisol and catecholamines, suppress the Th1 response, causing a Th2 shift. This response is not active by any of the other options.

 

PTS:   1                    REF:   Page 349

 

  1. What is the effect that low-serum albumin has on the central stress response?
a. Impaired circulation of epinephrine and norepinephrine
b. Impaired wound healing
c. Lessened circulation of cortisol
d. Diminished oncotic pressure

 

 

ANS:  A

Low-serum albumin impairs circulation of both epinephrine and norepinephrine since both bind to plasma protein albumin. The other options do not accurately describe the effect of low-serum albumin.

 

PTS:   1                    REF:   Page 345

 

  1. Stress-age syndrome directly results in depressed function of which system?
a. Respiratory c. Digestive
b. Endocrine d. Immune

 

 

ANS:  D

Of the available options, immunodepression is the only characteristic change observed in stress-age syndrome.

 

PTS:   1                    REF:   Page 358

 

  1. Stress-induced sympathetic stimulation of the adrenal medulla causes the secretion of:
a. Epinephrine and aldosterone c. Epinephrine and norepinephrine
b. Norepinephrine and cortisol d. Acetylcholine and cortisol

 

 

ANS:  C

The sympathetic nervous system is aroused during the stress response and causes the medulla of the adrenal gland to release catecholamines (80% epinephrine and 20% norepinephrine) into the bloodstream. The stress-induced efforts on the adrenal medulla do not include any of the other options.

 

PTS:   1                    REF:   Pages 344-345

 

  1. Stress-induced norepinephrine results in:
a. Pupil constriction c. Increased sweat gland secretions
b. Peripheral vasoconstriction d. Decreased blood pressure

 

 

ANS:  B

During stress, norepinephrine raises blood pressure by constricting peripheral vessels; it dilates the pupils of the eye, causes piloerection, and increases sweat gland action in the armpits and palms.

 

PTS:   1                    REF:   Page 345

 

  1. Released stress-induced cortisol results in the stimulation of gluconeogenesis by affecting which structure?
a. Adrenal cortex c. Liver
b. Pancreas d. Anterior pituitary

 

 

ANS:  A

One of the primary effects of cortisol is the stimulation of gluconeogenesis through stimulation of the adrenal cortex. The other options do not produce a stimulation of gluconeogenesis when exposed to cortisol.

 

PTS:   1                    REF:   Page 346

 

  1. What is the effect of increased secretions of epinephrine, glucagon, and growth hormone?
a. Hyperglycemia c. Bronchodilation
b. Hypertension d. Pupil dilation

 

 

ANS:  A

Cortisol enhances the elevation of blood glucose promoted by other hormones, such as epinephrine, glucagon, and growth hormone. This effect is not true of the other options.

 

PTS:   1                    REF:   Page 346

 

  1. Which hormone increases the formation of glucose from amino acids and free fatty acids?
a. Epinephrine c. Cortisol
b. Norepinephrine d. Growth hormone

 

 

ANS:  C

One of the primary effects of cortisol is the stimulation of gluconeogenesis or the formation of glucose from noncarbohydrate sources, such as amino or free fatty acids in the liver. Neither reaction is a result of the effects of any of the other options.

 

PTS:   1                    REF:   Page 346

 

  1. What effect do androgens have on lymphocytes?
a. Suppression of B-cell responses and enhancement of T-cell responses
b. Suppression of T-cell responses and enhancement of B-cell responses
c. Suppression of B- and T-cell responses
d. Enhancement of B- and T-cell responses

 

 

ANS:  C

Androgens suppress T- and B-cell responses. The other options do not occur in response to androgens.

 

PTS:   1                    REF:   Page 353

 

  1. Which gland regulates the immune response and mediates the apparent effects of circadian rhythms on immunity?
a. Anterior pituitary c. Basal ganglia
b. Adrenal d. Pineal

 

 

ANS:  D

Of the options available, only the pineal gland regulates the immune response and mediates the apparent effects of circadian rhythm on immunity.

 

PTS:   1                    REF:   Page 354

 

  1. Which cytokines initiate the production of corticotropin-releasing hormone (CRH)?
a. IL–1 and IL-6 c. IFN and IL-12
b. IL-2 and TNF-a d. TNF-ß and IL-4

 

 

ANS:  A

Although a number of stress factors initiate the production of CRH, of the options available, only high levels of IL-1 and IL-6 initiate such a response.

 

PTS:   1                    REF:   Pages 348-349

 

  1. The release of which cytokines is triggered by bacterial or viral infections, cancer, and tissue injury that, in turn, initiate a stress response?
a. IL-1 and IL-2
b. IL-12, TNF-a, and colony-stimulating factor
c. IFN, TNF-ß, and IL-6
d. IL-4 and IL-24

 

 

ANS:  C

Of the options offered, only the release of immune inflammatory mediators IL-6, TNF-ß, and IFN is triggered by bacterial or viral infections, cancer, and tissue injury that, in turn, initiates a stress response through the hypothalamic-pituitary-adrenal (HPA) pathway.

 

PTS:   1                    REF:   Page 349

 

  1. The action of which hormone helps explain increases in affective anxiety and eating disorders, mood cycles, and vulnerability to autoimmune and inflammatory diseases in women as a result of stimulation of the CRH gene promoter and central norepinephrine system?
a. Progesterone c. Estrogen
b. Cortisol d. Prolactin

 

 

ANS:  C

Of the options provided, only estrogen directly stimulates the CRH gene promoter and the central noradrenergic (norepinephrine) system, which may help explain adult women’s slight hypercortisolism, increases in affective anxiety and eating disorders, mood cycles, and vulnerability to autoimmune and inflammatory disease, all of which follow estradiol fluctuations.

 

PTS:   1                    REF:   Page 350

 

  1. What effect does estrogen have on lymphocytes?
a. Depression of B-cell functions and enhancement of T-cell functions
b. Depression of T-cell functions and enhancement of B-cell functions
c. Depression of B- and T-cell functions
d. Enhancement of B- and T-cell functions

 

 

ANS:  B

Estrogens generally are associated with only a depression of T-cell–dependent immune functions and an enhancement of B-cell functions.

 

PTS:   1                    REF:   Page 353

 

  1. Which statement is true concerning the differences between stress-induced hormonal alterations of men and women?
a. After injury, women produce more proinflammatory cytokines than men, a profile that is associated with poor outcomes.
b. Androgens appear to induce a greater degree of immune cell apoptosis after injury, creating greater immunosuppression in injured men than in injured women.
c. Psychologic stress associated with some types of competition decreases both testosterone and cortisol, especially in athletes older than 45 years of age.
d. After stressful stimuli, estrogen is increased in women, but testosterone is decreased in men.

 

 

ANS:  B

Androgens appear to induce a greater degree of immune cell apoptosis after injury, a mechanism that may elicit a greater immunosuppression in injured men versus injured women. The other options are not true statements concerning the differences between how the genders are affected by stress-induced hormones.

 

PTS:   1                    REF:   Page 353

 

  1. Diagnostic blood work on individuals who perceive themselves to be in a chronic stress state will likely demonstrate:
a. Decreased Th lymphocytes c. Decreased Tc cells
b. Increased erythrocytes d. Increased platelets

 

 

ANS:  C

Illustrating the influence of chronic stress appraisal on the physiologic processes, a meta-analysis of the relationships between stressors and immunity found that a higher perception of stress was associated with reduced T cytotoxic (Tc)-cell cytotoxicity, although not with levels of circulating Th or Tc lymphocytes. Research has substantiates the other options.

 

PTS:   1                    REF:   Page 355

 

  1. What are the signs that a patient is in the adaptive stage of the general adaptation syndrome?
a. He or she begins to experience elevated heart and respiratory rates.
b. He or she finds it difficult to concentrate on a solution for the stress.
c. The patient perceives his or her only options are to run away or fight back.
d. The patient has exceeded his or her ability to cope with the current situation.

 

 

ANS:  C

Fight-or-flight behaviors are characteristic of the more advanced adaptive stage, whereas the remaining options are noted in the initial alarm stage.

 

PTS:   1                    REF:   Page 339

 

  1. The most influential factor in whether a person will experience a stress reaction is his or her:
a. General state of physical health c. Intellectual abilities
b. Spiritual belief system d. Ability to cope

 

 

ANS:  D

A person does not have a stress reaction unless the stress exceeds his or her coping abilities. The other options do not have the same degree of influence, as does a person’s ability to cope.

 

PTS:   1                    REF:   Page 339

 

  1. A reduction is an individual’s number of natural killer (NK) cells appears to correlate with an increased risk for the development of:
a. Depression
b. Type 1 diabetes
c. Obsessive compulsive disorder (OCD)
d. Gastroesophageal reflux disorder (GERD)

 

 

ANS:  A

A meta-analysis of studies shows a relationship between depression and the reduction in lymphocyte proliferation and natural killer cell activity. Currently, no research supports the other options.

 

PTS:   1                    REF:   Page 355

 

  1. A nurse is providing care to a terminally ill adult who has been with his life partner for over 56 years. Research supports the nurse’s assessment of the life partner for signs of:
a. Suicidal ideations c. Severe stress reaction
b. Cardiac dysrhythmia d. Anorexia induced weight loss

 

 

ANS:  C

The results of a Harvard study showed evidence that a spouse’s illness or death can increase a partner’s mortality by causing severe stress and removing a primary source of emotional, psychologic, practical, and financial support. Although the other options may exist, research does not currently support them as having the stated correlation.

 

PTS:   1                    REF:   Page 357 | What’s New box

 

MULTIPLE RESPONSE

 

  1. The effect epinephrine has on the immune system during the stress response is to increase which cells? (Select all that apply.)
a. NK cells
b. Immunoglobulins
c. Cytokines
d. T cells
e. Th cells

 

 

ANS:  A, D

The injection of epinephrine into healthy human beings is associated with a transient increase of the number of lymphocytes (e.g., T cells, natural killer (NK) cells) in the peripheral blood. This association is not true of the other options.

 

PTS:   1                    REF:   Page 346

 

  1. Which immune cells are suppressed by the corticotropin-releasing hormone (CRH)? (Select all that apply.)
a. Monocyte-macrophage cells
b. Cytokines
c. Tc cells
d. Th cells
e. B cells

 

 

ANS:  A, D

Direct suppressive effects of CRH have been reported on two immune cell types possessing CRH receptors—the monocyte and macrophage and CD4 (T helper) lymphocytes. CRH does not suppress the remaining options.

 

PTS:   1                    REF:   Pages 353-354

 

  1. The increased production of proinflammatory cytokines is associated with which considerations? (Select all that apply.)
a. Chronic respiratory dysfunction
b. Elevated anxiety levels
c. Immune disorders
d. Age and gender
e. Dementia

 

 

ANS:  B, C

Increased levels of proinflammatory cytokines has been shown to have a possible link between stress and immune function. The other options are not as directly linked to cytokine levels.

 

PTS:   1                    REF:   Page 353

 

  1. Which statements are true regarding lymphocytes? (Select all that apply.)
a. Lymphocytes are involved in the production of the human growth hormone.
b. Elevated catecholamine levels influence lymphocytes.
c. Lymphocytes are synthesized in the anterior pituitary gland.
d. Lymphocytes have receptors for the hormone prolactin.
e. Lymphocytes produce endorphins in large amounts.

 

 

ANS:  A, B, D

GH is synthesized from the anterior pituitary gland and is produced by lymphocytes and mononuclear phagocytic cells. Several classes of lymphocytes have receptors for prolactin, suggesting a direct effect of prolactin on immune function. Although the effects of acute elevation of catecholamines on the alteration of lymphocyte function are real, they are short lived, lasting only approximately 2 hours. The other statements regarding lymphocytes are not true.

 

PTS:   1                    REF:   Page 350 | Page 352

 

MATCHING

 

Match the hormone with its effects during a stress response. Hormones may be used more than once.

______ A. Epinephrine

______ B. Norepinephrine

______ C. Cortisol

 

  1. Constricts peripheral vessels to increase blood pressure.

 

  1. Increases cardiac output by increasing heart rate and myocardial contractility.

 

  1. Increases gastric secretions.

 

  1. ANS:  B                    PTS:   1                    REF:   Page 345

MSC:  Norepinephrine regulates blood pressure by constricting smooth muscle in all blood vessels.

 

  1. ANS:  A                    PTS:   1                    REF:   Page 345

MSC:  Epinephrine enhances myocardial contractility (inotropic effect), increases the heart rate (chronotropic effect), and increases venous return to the heart, all of which increase cardiac output and blood pressure.

 

  1. ANS:  C                    PTS:   1                    REF:   Page 347

MSC:  Cortisol promotes gastric secretion in the gastrointestinal tract.

Chapter 15: Structure and Function of the Neurologic System

 

MULTIPLE CHOICE

 

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

 

 

ANS:  A

Peripheral nerve pathways can be afferent (ascending) pathways that carry sensory impulses toward the CNS. The remaining options do not carry sensory information to the CNS.

 

PTS:   1                    REF:   Page 448

 

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

 

 

ANS:  B

If the myelin layer is tightly wrapped many times around the axon and is forming the nodes of Ranvier, then conduction velocity increases and the neuron is referred to as myelinated. The increased diameter of the myelinated axons allows for the transmission of impulses at a faster rate. The other options do not affect nervous impulse transmission rates.

 

PTS:   1                    REF:   Pages 448-450

 

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

 

 

ANS:  C

Nerve regeneration is limited to only myelinated fibers and generally occurs only in the peripheral nervous system.

 

PTS:   1                    REF:   Pages 450-451

 

  1. The neurotransmitter, norepinephrine, is secreted in the:
a. Somatic nervous system c. Sympathetic postganglion
b. Parasympathetic preganglion d. Parasympathetic postganglion

 

 

ANS:  C

Most postganglionic sympathetic fibers release norepinephrine (adrenaline). The remaining options do not reflect the correct site of norepinephrine secretion.

 

PTS:   1                    REF:   Pages 473-474

 

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

 

 

ANS:  A

The function of oligodendroglia (oligodendrocytes) is to deposit myelin within the central nervous system (CNS). Oligodendroglia are the CNS counterpart of Schwann cells. The remaining options are not reflective of the common function of these structures.

 

PTS:   1                    REF:   Pages 449-450

 

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

 

 

ANS:  B

The binding of the neurotransmitter at the receptor site changes the permeability of the postsynaptic neuron and, consequently, its membrane potential. The remaining options do not accurately describe the occurrence.

 

PTS:   1                    REF:   Pages 452-453

 

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

 

 

ANS:  B

The reticular activating system is essential for maintaining wakefulness. The remaining options are not essential to this function.

 

PTS:   1                    REF:   Page 454

 

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

 

 

ANS:  C

The prefrontal area is responsible for goal-oriented behavior (i.e., ability to concentrate), short-term or recall memory, and the elaboration of thought and inhibition on the limbic (emotional) areas of the CNS. The remaining options are not involved in these functions.

 

PTS:   1                    REF:   Page 456

 

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

 

 

ANS:  B

Broca speech area is the only region responsible for the motor aspects of speech.

 

PTS:   1                    REF:   Page 457

 

  1. Parkinson and Huntington diseases are associated with defects in which area of the brain?
a. Thalamus c. Cerebellum
b. Medulla oblongata d. Basal ganglia

 

 

ANS:  D

Parkinson and Huntington diseases are conditions associated with defects of the basal ganglia. No current research supports the role of any of the other options in these diseases.

 

PTS:   1                    REF:   Page 457

 

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

 

 

ANS:  D

Hypothalamic function falls into two major areas: (1) maintenance of a constant internal environment, and (2) implementation of behavioral patterns. The remaining options do not address these functions.

 

PTS:   1                    REF:   Page 459

 

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

 

 

ANS:  B

The superior colliculi are involved with voluntary and involuntary visual motor movements (e.g., the ability of the eyes to track moving objects in the visual field). Tracking moving objects is not the primary function of the remaining options.

 

PTS:   1                    REF:   Page 459

 

  1. What parts of the brain mediate the expression of affect, both emotional and behavioral states?
a. Hypothalamus and subthalamus c. Limbic system and prefrontal cortex
b. Parietal and frontal lobes d. Basal ganglia and medulla oblongata

 

 

ANS:  C

Extensive connections with the limbic system and prefrontal cortex mediate the expression of affect, both emotional and behavioral states. The remaining options are not involved in these expressions.

 

PTS:   1                    REF:   Page 457

 

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

 

 

ANS:  D

The medulla oblongata makes up the myelencephalon and is the lowest portion of the brainstem. Reflex activities, such as heart rate, respiration, blood pressure, coughing, sneezing, swallowing, and vomiting, are controlled only in this area.

 

PTS:   1                    REF:   Page 460

 

  1. From which part of the midbrain do cranial nerves V to VIII emerge?
a. Midbrain c. Medulla oblongata
b. Pons d. Lateral colliculi

 

 

ANS:  B

The nuclei of cranial nerves V through VIII (see Table 15-6 for discussion) are located only in the pons.

 

PTS:   1                    REF:   Pages 459-460

 

  1. From which part of the midbrain do cranial nerves IX to XII emerge?
a. Midbrain c. Medulla oblongata
b. Pons d. Lateral colliculi

 

 

ANS:  C

The nuclei of cranial nerves IX through XII (see Table 15-6 for discussion) are located only in the medulla oblongata.

 

PTS:   1                    REF:   Page 460

 

  1. Which area of the brain assumes the responsibility for conscious and unconscious muscle synergy and for maintaining balance and posture?
a. Cerebrum c. Diencephalon
b. Cerebellum d. Brainstem

 

 

ANS:  B

The cerebellum is responsible for conscious and unconscious muscle synergy and for maintaining balance and posture. This role is not assumed by any of the remaining options.

 

PTS:   1                    REF:   Page 459

 

  1. Which statement is true regarding upper motor neurons?
a. Upper motor neurons directly influence muscles.
b. They modify spinal reflex arcs.
c. Upper motor neurons are located in the gray matter of the spinal cord.
d. They extend their dendritic processes out of the CNS.

 

 

ANS:  B

Upper motor neurons (i.e., corticospinal tract) are the classification of motor pathways completely contained within the CNS. Their primary roles include directing, influencing, and modifying reflex arcs, lower-level control centers, and motor and some sensory neurons. The remaining options do not accurately describe the characteristic functions of upper motor neurons.

 

PTS:   1                    REF:   Page 462

 

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

 

 

ANS:  A

The tentorium cerebelli is a membrane that separates the cerebellum below from the cerebral structures above. The remaining options do not perform the function described in the stem.

 

PTS:   1                    REF:   Page 464

 

  1. The function of arachnoid villi is to:
a. Produce cerebrospinal fluid
b. Provide nutrients to the choroid plexuses
c. Transmit impulses within the meninges
d. Absorb cerebrospinal fluid into the cerebral venous sinuses

 

 

ANS:  D

CSF is reabsorbed by means of a pressure gradient between the arachnoid villi and the cerebral venous sinuses. The remaining options do not accurately describe the function of arachnoid villi.

 

PTS:   1                    REF:   Page 466

 

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

 

 

ANS:  B

The choroid plexuses are the structures that produce CSF; they arise from the pia mater. The remaining options do not have a role in CSF production.

 

PTS:   1                    REF:   Pages 465-466

 

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

 

 

ANS:  C

The delicate pia mater closely adheres to the surface of the brain and spinal cord and even follows the sulci and fissures. The remaining options are not represented in the description provided in the stem.

 

PTS:   1                    REF:   Pages 464-465

 

  1. Norepinephrine produces what primary response?
a. Increased contractility of the heart c. Vasoconstriction
b. Release of renin from the kidney d. Pupillary dilation

 

 

ANS:  C

The primary response from norepinephrine is the stimulation of the a1-adrenergic receptors that cause vasoconstriction. The remaining options do not accurately reflect the primary response of norepinephrine.

 

PTS:   1                    REF:   Page 474

 

  1. What is an effect of the sympathetic nervous system?
a. Stimulation of peristalsis c. Reduction in heart rate
b. Increased blood sugar levels d. Pupillary constriction

 

 

ANS:  B

In general, sympathetic stimulation promotes responses that are concerned with the protection of the individual, which include increased blood sugar levels, temperature, and blood pressure. The responses noted in the remaining options are not a result of sympathetic stimulation.

 

PTS:   1                    REF:   Page 476

 

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

 

 

ANS:  C

The brain receives approximately 20% of the cardiac output, or 800 to 1000 ml of blood flow per minute.

 

PTS:   1                    REF:   Page 454

 

  1. The collateral blood flow to the brain is provided by the:
a. Carotid arteries c. Circle of Willis
b. Basal artery d. Vertebral arteries

 

 

ANS:  C

The arterial circle (circle of Willis) (see Figure 15-20) is a structure credited with the ability to compensate for reduced blood flow from any one of the major contributors (collateral blood flow). The remaining options are not considered sources of collateral blood flow.

 

PTS:   1                    REF:   Page 467

 

  1. The nurse recognizes that a patient’s diagnosis of a viral infection of the brain’s meningeal layer is supported by which diagnostic laboratory result?
a. Chloride <110 mEq/L c. Protein <10 mg/dl
b. Leukocytes >10/mm3 d. Glucose <40 mg/dl

 

 

ANS:  B

Viral infections causing meningitis will produce a white blood cell (leukocyte) count greater than 10/mm 3. The chloride level is observed in tuberculous meningitis, the protein level has little clinical significance, and the glucose level is observed in patients with acute bacterial meningitis.

 

PTS:   1                    REF:   Page 479 | Table 15-8

 

MULTIPLE RESPONSE

 

  1. Which cranial nerves contain parasympathetic nerves? (Select all that apply.)
a. I (olfactory) d. IX (glossopharyngeal)
b. III (oculomotor) e. X (vagus)
c. VII (facial)

 

 

ANS:  B, C, D, E

All but cranial nerve I (olfactory) contain parasympathetic nerves.

 

PTS:   1                    REF:   Page 473

 

  1. The sympathetic nervous system primarily serves to protect an individual by doing which of the following? (Select all that apply.)
a. Decreasing mucous production d. Decreasing sweat excretion
b. Increasing blood sugar levels e. Increasing blood pressure
c. Increasing body temperature

 

 

ANS:  B, C, E

In general, sympathetic stimulation promotes responses that are concerned with the protection of the individual, which include increasing blood sugar levels, temperature, and blood pressure. The remaining options are not protective measures resulting from initiatives made by the sympathetic nervous system.

 

PTS:   1                    REF:   Page 476

 

  1. The aging process brings about what changes to human cells? (Select all that apply.)
a. Increased neurofibrillary tangles d. Decreased myelin presence
b. Imbalance of neurotransmitters e. Altered dendrite structure
c. Increased neuron production

 

 

ANS:  A, B, D, E

Principal cellular changes associated with aging include a decrease in the number of neurons, decreased myelin, decreased number of dendritic processes and synaptic connections, intracellular neurofibrillary tangles, and an imbalance in the amount and distribution of neurotransmitters. The aging process does not bring about an increase in neuron production.

 

PTS:   1                    REF:   Page 478 | Box 15-5

 

  1. Which statement is true regarding the blood-brain barrier (BBB)? (Select all that apply.)
a. The BBB is dependent on astrocytes.
b. It uses the meningeal layers of the brain.
c. It restricts the flow of large molecules, such as potassium.
d. Naturally occurring inflammatory mediators affect the BBB.
e. The BBB appears to play a role in slowing down the onset of degenerative brain disease.

 

 

ANS:  A, C, D, E

The BBB is a term used to describe cellular structures that selectively inhibit certain substances in the blood from entering the interstitial spaces of the brain or CSF. This term emphasizes the impermeability of the nervous system to large and potentially harmful molecules. Astrocytes wrap their foot processes around the epithelial cells of brain capillaries, thereby contributing to the formation of the BBB. Tight junctions between capillary endothelial cells form a barrier that regulates the passage of ions (e.g., sodium, potassium) that could interfere with nerve transmission, prevent toxins from entering the brain, and promote transport of nutrients and the removal of metabolites. Hormones, neurotransmitters, and inflammatory mediators can affect BBB permeability. Inhibiting these endogenous chemicals with drug therapy may reduce brain edema and slow the onset of degenerative brain diseases. The statement regarding the meningeal layers of the brain is incorrect.

 

PTS:   1                    REF:   Page 469 | Box 15-4

 

  1. A nurse caring for an older adult patient would expect which functional changes to occur? (Select all that apply.)
a. Increased risk for falls
b. Increased risk for falls
c. Loss of muscle in the arms and legs
d. Decrease in the need for social interaction
e. Increased agitation and frustration levels

 

 

ANS:  A, B, C

Functional changes with aging include skeletal muscle atrophy, progressive deficits in taste and smell, and a decrease in neuromuscular control with changes in gait and posture. Neither increased agitation and frustration nor a decreased need for social interaction is considered an expected change resulting from the aging process.

 

PTS:   1                    REF:   Page 478 | Box 15-5

 

  1. What evidence does the nurse expect to see when a patient experiences trauma to the hypothalamus? (Select all that apply.)
a. Uneven expression of mood
b. Unstable blood glucose levels
c. Poor regulation of body temperature
d. Visual disturbances such as blurred vision
e. Nausea, vomiting, and symptoms of gastroesophageal reflux disease

 

 

ANS:  A, B, C

The hypothalamus forms the base of the diencephalon. Hypothalamic function controls autonomic nervous system (ANS) function, regulation of body temperature, endocrine function (e.g., unstable glucose levels), and regulation of emotional expression. Visual and gastrointestinal symptoms would not likely be related to hypothalamus function.

 

PTS:   1                    REF:   Page 459 | Box 15-3

 

  1. A Schwann cell: (Select all that apply.)
a. Can form the myelin sheath.
b. Is also referred to as a neurolemmocyte.
c. Affects the function of the nodes of Ranvier.
d. Is located in the peripheral nervous system.
e. Is responsible of decreasing conduction velocity.

 

 

ANS:  A, B, C, D

The Schwann cell, or neurolemmocyte, is a glial cell that wraps around and covers axons in the peripheral nervous system. Schwann cells form and maintain the myelin sheath, and the nodes of Ranvier form the spaces on either side of the Schwann cell. If the myelin layer is tightly wrapped many times around the axon, forming nodes of Ranvier, then it increases conduction velocity and the neuron is referred to as myelinated.

 

PTS:   1                    REF:   Page 450

 

MATCHING

 

Match the function with the appropriate cranial nerve.

______ A. Fibers emerge from the posterior midbrain and exit from the skull to run to the eye.

______ B. Provides motor and sensory functions to the face, mouth, nose, and eyes.

______ C. Fibers emerge from the midbrain, exit from the skull, and extend to the eye.

______ D. Controls motor functions to the pharynx and salivary glands and sensory functions from the pharynx and tongue.

______ E. Innervates muscles that move the eye laterally.

______ F. Affects control over the motor fibers to the muscles of tongue and sensory impulses from the tongue to the brain.

______ G. Is purely sensory and carries impulses for the sense of smell.

______ H. Is made up of parasympathetic motor fibers that supply the smooth muscles of the abdominal organs.

______ I. Transmits impulses for the sense of hearing.

______ J. Carries sensory and motor fibers to the pharynx and larynx.

 

  1. Glossopharyngeal nerve

 

  1. Oculomotor nerve

 

  1. Trochlear nerve

 

  1. Abducens nerve

 

  1. Trigeminal nerve

 

  1. Hypoglossal nerve

 

  1. Vagus nerve

 

  1. Spinal accessory nerve

 

  1. Olfactory nerve

 

  1. Vestibulocochlear nerve

 

  1. ANS:  D                    PTS:   1                    REF:   Page 472 | Table 15-6

MSC:  The glossopharyngeal nerve affects control over the motor fibers that serve the pharynx (throat) and salivary glands, as well as the sensory fibers that carry impulses from the pharynx, posterior tongue (taste buds), and pressure receptors of the carotid artery.

 

  1. ANS:  C                    PTS:   1                    REF:   Page 472 | Table 15-6

MSC:  The oculomotor nerve fibers emerge from the midbrain, exit from the skull, and extend to the eye. These fibers control: (1) the motor fibers to the inferior oblique, superior, inferior, and medial rectus extraocular muscles that direct the eyeball; (2) the levator muscles of the eyelid; (1) the smooth muscles of the iris and ciliary body; and (4) proprioception (sensory) to brain from the extraocular muscles.

 

  1. ANS:  A                    PTS:   1                    REF:   Page 472 | Table 15-6

MSC:  The trochlear nerve fibers emerge from posterior midbrain and exit from skull to affect control over the proprioceptor and motor fibers for the superior oblique muscle of eye (extraocular muscle).

 

  1. ANS:  E                    PTS:   1                    REF:   Page 472 | Table 15-6

MSC:  The abducens nerve affects control over the motor fibers to the lateral rectus muscle and the proprioceptor fibers from the same muscle to the brain, allowing the eyes to move laterally.

 

  1. ANS:  B                    PTS:   1                    REF:   Page 472 | Table 15-6

MSC:  The trigeminal nerve affects control over both the motor and sensory functions to the face; conducts sensory impulses from the mouth, nose, surface of eye, and dura mater; it also contains motor fibers that stimulate the chewing muscles.

 

  1. ANS:  F                    PTS:   1                    REF:   Page 472 | Table 15-6

MSC:  The hypoglossal nerve affects control over the motor fibers to the muscles of tongue and sensory impulses from the tongue to the brain.

 

  1. ANS:  H                    PTS:   1                    REF:   Page 472 | Table 15-6

MSC:  The vagus nerve affects control over the fibers that carry sensory and motor impulses for the pharynx. A large part of this nerve is parasympathetic motor fibers that supply smooth muscles of the abdominal organs and is capable of receiving sensory impulses from the viscera.

 

  1. ANS:  J                     PTS:   1                    REF:   Page 472 | Table 15-6

MSC:  The spinal accessory nerve affects control over the sensory and motor fibers for the sternocleidomastoid and trapezius muscles and the muscles of the soft palate, pharynx, and larynx.

 

  1. ANS:  G                    PTS:   0                    REF:   Page 472 | Table 15-6

MSC:  The olfactory nerve is purely sensory and carries impulses for the sense of smell.

 

  1. ANS:  I                     PTS:   0                    REF:   Page 472 | Table 15-6

MSC:  The vestibulocochlear nerve is purely sensory; the vestibular branch transmits impulses for the sense of equilibrium; the cochlear branch transmits impulses for the sense of hearing.

Chapter 27: Structure and Function of the Hematologic System

 

MULTIPLE CHOICE

 

  1. What is the most abundant class of plasma protein?
a. Globulin c. Clotting factors
b. Albumin d. Complement proteins

 

 

ANS:  B

Albumin (approximately 60% of total plasma protein at a concentration of about 4 g/dl) is the most abundant plasma protein.

 

PTS:   1                    REF:   Page 946

 

  1. What is the effect of low plasma albumin?
a. Clotting factors decrease, thus increasing the chance of prolonged bleeding.
b. Fewer immunoglobulins are synthesized, thus impairing the immune function.
c. Less iron is stored, thus increasing the incidence of iron deficiency anemia.
d. Osmotic pressure decreases, thus water moves from the capillaries to the interstitium.

 

 

ANS:  D

In the case of decreased production (e.g., cirrhosis, other diffuse liver diseases, protein malnutrition) or excessive loss of albumin (e.g., certain kidney diseases, extensive burns), the reduced oncotic pressure leads to excessive movement of fluid and solutes into the tissues and decreased blood volume. The other options are not accurate descriptions of the effect of low plasma albumin.

 

PTS:   1                    REF:   Page 946

 

  1. What is the life span of an erythrocyte (in days)?
a. 20 to 30 c. 100 to 120
b. 60 to 90 d. 200 to 240

 

 

ANS:  C

Because it cannot undergo mitotic division, the erythrocyte has a limited life span of approximately 120 days.

 

PTS:   1                    REF:   Pages 947-948

 

  1. Which statement concerning erythrocytes is true?
a. Erythrocytes contain a nucleus, mitochondria, and ribosomes.
b. Erythrocytes synthesize proteins.
c. Erythrocytes have the ability to change shape to squeeze through microcirculation.
d. Erythrocyte colony-stimulating factor (E-CSF) stimulates erythrocytes.

 

 

ANS:  C

Reversible deformity enables the erythrocyte to assume a more compact torpedo-like shape, squeeze through the microcirculation, and return to normal. The other options are not accurate statements about erythrocytes.

 

PTS:   1                    REF:   Page 948

 

  1. Granulocytes that contain granules of vasoactive amines, such as histamine, are called:
a. Neutrophils c. Monocytes
b. Eosinophils d. Basophils

 

 

ANS:  D

Basophils contain cytoplasmic granules that hold an abundant mixture of biochemical mediators, including histamine, chemotactic factors, proteolytic enzymes, and an anticoagulant (heparin) (see Figure 27-3, C). This is not an accurate description of any of the other options.

 

PTS:   1                    REF:   Page 949

 

  1. Which of the following are formed elements of the blood that are not cells but are disk-shaped cytoplasmic fragments essential for blood clotting?
a. Monocytes c. Macrophages
b. Platelets d. Erythrocytes

 

 

ANS:  B

Platelets (thrombocytes) are not true cells but are disk-shaped cytoplasmic fragments that are essential for blood coagulation and control of bleeding. This description is not accurate for any of the other options.

 

PTS:   1                    REF:   Pages 950-951

 

  1. Blood cells that differentiate into macrophages are known as:
a. Monocytes c. Eosinophils
b. Neutrophils d. Basophils

 

 

ANS:  A

Only monocytes migrate into a variety of tissues and fully mature into tissue macrophages and myeloid dendritic cells (see Table 27-3).

 

PTS:   1                    REF:   Page 950

 

  1. Without prior exposure to an antigen, which cells are able to destroy some types of tumor cells and some virus-infected cells?
a. Lymphocytes c. Megakaryocytes
b. Plasma cells d. Natural killer (NK) cells

 

 

ANS:  D

NK cells, which resemble large granular lymphocytes, kill some types of tumor cells (in vitro) and some virus-infected cells without being induced by previous exposure to these antigens. This capability is not true of the other options.

 

PTS:   1                    REF:   Page 950

 

  1. What is the life span of platelets (in days)?
a. 10 c. 90
b. 30 d. 120

 

 

ANS:  A

A platelet circulates for approximately 10 days and ages. Macrophages of the mononuclear phagocyte system, mostly in the spleen, remove platelets.

 

PTS:   1                    REF:   Page 951

 

  1. Fetal hematopoiesis occurs in which structure?
a. Gut c. Bone marrow
b. Spleen d. Thymus

 

 

ANS:  B

The spleen is the largest of the secondary lymphoid organs and the site of fetal hematopoiesis.

 

PTS:   1                    REF:   Page 951

 

  1. What is the consequence of a splenectomy?
a. The level of iron in circulation increases.
b. Antibody production increases to improve immune function.
c. The number of defective cells in circulation increases.
d. The number of clotting factors increases.

 

 

ANS:  C

Splenic absence from any cause (e.g., atrophy, traumatic injury, removal because of disease) has several secondary effects on the body, among them an increase in morphologically defective blood cells in the circulation, confirming the spleen’s role in removing old or damaged cells. This description of the consequence of a splenectomy is not accurate for the other options.

 

PTS:   1                    REF:   Pages 951-952

 

  1. During an infection, why do lymph nodes enlarge and become tender?
a. B lymphocytes proliferate.
b. The nodes are inflamed.
c. The nodes fill with purulent exudate.
d. The nodes are not properly functioning.

 

 

ANS:  A

The B lymphocyte proliferation in response to significant antigen (e.g., during infection) may result in lymph node enlargement and tenderness (reactive lymph node). This description is not accurate for the other options.

 

PTS:   1                    REF:   Page 954

 

  1. Which blood cells are the chief phagocytes involved in the early inflammation process?
a. Neutrophils c. Eosinophils
b. Monocytes d. Erythrocytes

 

 

ANS:  A

Neutrophils are the chief phagocytes of early inflammation.

 

PTS:   1                    REF:   Page 949

 

  1. Which blood cells are biconcave in shape and have the capacity to be reversibly deformed?
a. Neutrophils c. Eosinophils
b. Monocytes d. Erythrocytes

 

 

ANS:  D

The erythrocyte’s size and shape are ideally suited to its function as a gas carrier. A red blood cell (RBC) is a small disk with two unique properties: (1) a biconcave shape and (2) the capacity to be reversibly deformed. These are characteristics not observed in any of the other options.

 

PTS:   1                    REF:   Page 948

 

  1. Which hemoglobin is made from oxidized ferric iron (Fe3+) and lacks the ability to bind oxygen?
a. Deoxyhemoglobin c. Methemoglobin
b. Oxyhemoglobin d. Glycosylated hemoglobin

 

 

ANS:  C

Without reactivation by methemoglobin reductase, the Fe3+-containing hemoglobin (methemoglobin) cannot bind oxygen. This capability is not true of the other types of hemoglobin mentioned.

 

PTS:   1                    REF:   Page 961

 

  1. The absence of parietal cells would prevent the absorption of an essential nutrient necessary to prevent which type of anemia?
a. Iron deficiency c. Folic acid deficiency anemia
b. Pernicious anemia d. Aplastic anemia

 

 

ANS:  B

Dietary vitamin B12 is a large molecule that requires a protein secreted by parietal cells into the stomach (intrinsic factor [IF]) to transport across the ileum. Defects in IF production lead to decreased B12 absorption and pernicious anemia. The other options are not the result of this process.

 

PTS:   1                    REF:   Page 962

 

  1. Which nutrients are necessary for the synthesis of DNA and the maturation of erythrocytes?
a. Protein and niacin c. Cobalamin (vitamin B12) and folate
b. Iron and vitamin B6 (pyridoxine) d. Pantothenic acid and vitamin C

 

 

ANS:  C

Cobalamin and folate are necessary for the synthesis of DNA and for the maturation of erythrocytes. The remaining options are not necessary for these processes to occur.

 

PTS:   1                    REF:   Page 962 | Table 27-6

 

  1. Which nutrients are necessary for hemoglobin synthesis?
a. Protein and niacin c. Cobalamin (vitamin B12) and folate
b. Iron and vitamin B6 (pyridoxine) d. Pantothenic acid and vitamin C

 

 

ANS:  B

Iron and B6 (pyridoxine) are necessary for hemoglobin synthesis (see Table 27-6). The remaining options are not necessary for hemoglobin synthesis.

 

PTS:   1                    REF:   Page 962 | Table 27-6

 

  1. Recycling of iron from erythrocytes is made possible by which of the following?
a. Transferrin c. Apoferritin
b. Hemosiderin d. Erythropoietin

 

 

ANS:  A

Transferrin is recycled (transferrin cycle) in the following manner: (1) the transferrin-iron complex binds to a transferring receptor on the erythroblast’s plasma membrane; (2) the complex moves into the cell by receptor-mediated endocytosis; (3) iron is released (dissociated) from transferrin; and (4) the dissociated transferrin is returned to the bloodstream for reuse. The other options do not present an accurate description of the recycling of erythrocytic iron.

 

PTS:   1                    REF:   Pages 963-964

 

  1. By which structure are mature erythrocytes removed from the bloodstream?
a. Liver c. Thymus
b. Lymph nodes d. Spleen

 

 

ANS:  D

After approximately 100 to 120 days in the circulation, old erythrocytes are removed by tissue macrophages, primarily in the spleen.

 

PTS:   1                    REF:   Page 962

 

  1. Which substance is used to correct the chronic anemia associated with chronic renal failure?
a. Iron c. Cobalamin (vitamin B12)
b. Erythropoietin d. Folate

 

 

ANS:  B

One of the most significant advances in the study of hematopoietic growth factors has been the development of erythropoietin for individuals with chronic renal failure. The other options are not associated with the treatment of chronic anemia.

 

PTS:   1                    REF:   Pages 960-961

 

  1. What is the role of thromboxane A (TXA2) in the secretion stage of hemostasis?
a. Stimulates the synthesis of serotonin.
b. Promotes vasodilation.
c. Stimulates platelet aggregation.
d. Promotes formation of cyclooxygenase.

 

 

ANS:  C

Platelet aggregation is primarily stimulated by TXA2 and adenosine diphosphate (ADP), which induce functional fibrinogen receptors on the platelet. The other options do not present an accurate description of the role of thromboxane A.

 

PTS:   1                    REF:   Page 969

 

  1. Which of the following is the role of nitric oxide (NO) in hemostasis?
a. Stimulates the release of fibrinogen to maintain the platelet plug.
b. Stimulates the release of clotting factors V and VII.
c. Causes vasoconstriction and stimulates platelet aggregation.
d. Controls platelet activation through cyclic adenosine monophosphate (cAMP)–mediated signaling.

 

 

ANS:  D

Endothelial cell NO synthase produces NO, which controls platelet activation through cAMP-mediated signaling. The other options do not present an accurate description of the role of NO in hemostasis.

 

PTS:   1                    REF:   Page 966 | Figure 27-18

 

  1. The drug heparin acts in hemostasis by which processes?
a. Inhibiting thrombin and antithrombin III (AT-III)
b. Preventing the conversion of prothrombin to thrombin
c. Shortening the fibrin strands to retract the blood clot
d. Degrading the fibrin within blood clots

 

 

ANS:  A

Clinically administered heparin or heparin sulfate (on the surface of endothelial cells) binds to AT-III and induces a conformational change that greatly enhances its activity. Under normal conditions, the presence of endothelial cell heparin sulfate and available AT-III in the circulation cooperate to protect the vessels from the effects of spontaneously activated thrombin. The other options do not accurately describe the role heparin plays in hemostasis.

 

PTS:   1                    REF:   Page 970

 

  1. What is plasmin’s role in the clotting process?
a. Stimulates platelet aggregation.
b. Inhibits platelet adhesion and aggregation.
c. Prevents the conversion of prothrombin to degrade the fibrin within blood clots.
d. Degrades the fibrin within blood clots.

 

 

ANS:  D

Plasmin (also called fibrinase or fibrinolysin) is a serine protease that degrades fibrin polymers in clots. It is not capable of the functions described in the remaining options.

 

PTS:   1                    REF:   Pages 971-972

 

  1. What does polycythemia at birth indicate?
a. Hypoxia in utero c. Congenitally absent spleen
b. Dysfunctional bone marrow d. Dehydration in utero

 

 

ANS:  A

The hypoxic intrauterine environment stimulates erythropoietin production in the fetus and accelerates fetal erythropoiesis, producing polycythemia (excessive proliferation of erythrocyte precursors) of the newborn. The other options are not related to polycythemia.

 

PTS:   1                    REF:   Page 975

 

  1. Where are Kupffer cells located?
a. Kidneys c. Pancreas
b. Liver d. Spleen

 

 

ANS:  B

The liver macrophages are the only location for Kupffer cells.

 

PTS:   1                    REF:   Page 950 | Page 962 | Table 27-3

 

  1. Where are Langerhans cells found?
a. Skin c. Kidney
b. Intestinal lining d. Thyroid

 

 

ANS:  A

Of the available options, only the skin is the location for Langerhans cells.

 

PTS:   1                    REF:   Page 950 | Table 27-3

 

  1. What is the role of collagen in the clotting process?
a. Initiates the clotting cascade. c. Stimulates fibrin.
b. Activates platelets. d. Deactivates fibrinogen.

 

 

ANS:  B

In the clotting process, collagen provides a particularly strong stimulus to activate platelets. Collagen does not bring about any of the other options.

 

PTS:   1                    REF:   Page 969

 

  1. Which form of iron (Fe) can be used in the formation of normal hemoglobin?
a. Fe+ c. Fe3+
b. Fe2+ d. Fe4+

 

 

ANS:  B

It is crucial that the iron be correctly charged; only reduced ferrous iron (Fe2+) can bind oxygen in the lungs and release it in the tissues.

 

PTS:   1                    REF:   Page 961

 

  1. Where are alveolar macrophages found?
a. Skin c. Gastrointestinal tract
b. Breasts d. Lungs

 

 

ANS:  D

The lung is the only location for alveolar macrophages.

 

PTS:   1                    REF:   Page 950 | Table 27-3

 

  1. What changes to the hematologic system is related to age?
a. Platelet adhesiveness decreases.
b. Lymphocyte function decreases.
c. Cellular immunity increases.
d. Erythrocyte reproduction accelerates.

 

 

ANS:  B

Blood composition changes little with age. A delay in erythrocyte replenishment may occur after bleeding, presumably because of iron deficiency. Lymphocyte function appears to decrease with age. Particularly affected is a decrease in cellular immunity. Platelet adhesiveness probably increases with age.

 

PTS:   1                    REF:   Page 975

 

  1. What is the function of erythrocytes?
a. Tissue oxygenation c. Infection control
b. Hemostasis d. Allergy response

 

 

ANS:  A

Erythrocytes are solely responsible for tissue oxygenation.

 

PTS:   1                    REF:   Pages 947-948

 

MULTIPLE RESPONSE

 

  1. Which characteristics allow erythrocytes to function as gas carriers? (Select all that apply.)
a. Permanent shape
b. Compactness
c. Reversible deformability
d. Presence of hyperactive mitochondria
e. Biconcavity

 

 

ANS:  C, E

A red blood cell (RBC) is a small disk with two unique properties: (1) a biconcave shape and (2) the capacity to be reversibly deformed. The other options are not relevant to the function of gas transport.

 

PTS:   1                    REF:   Page 948

 

  1. Which statements about plasma proteins are correct? (Select all that apply.)
a. Provide clotting factors.
b. Transport triglycerides.
c. Synthesize complement proteins.
d. Create hydrostatic pressure.
e. Transport cholesterol.

 

 

ANS:  A, B, C, E

Plasma proteins do not create hydrostatic pressure. The other options are all accurate statements regarding plasma proteins.

 

PTS:   1                    REF:   Pages 945-947

 

  1. What are the primary anticoagulant mechanisms? (Select all that apply.)
a. Antithrombin III
b. Tissue factor pathway inhibitor
c. Hematopoiesis
d. Protein C
e. Phagocytosis

 

 

ANS:  A, B, D

The major regulatory factors that control hemostasis reside where the greatest probability of clotting would occur—on the endothelial cell surface. The primary anticoagulant mechanisms include thrombin inhibitors (e.g., antithrombin III), tissue factor inhibitors (e.g., tissue factor pathway inhibitor), and mechanisms for degrading activated clotting factors (e.g., protein C). Hematopoiesis and phagocytosis are processes that are not related to anticoagulation.

 

PTS:   1                    REF:   Page 970

 

  1. Which statements are true regarding the role of the endothelium in clot formation? (Select all that apply.)
a. The surface of the endothelium produces plasma protease inhibitors.
b. Plasma protease inhibitors assist in preventing clot formation.
c. Thrombomodulin is a protein that is converted on the surface of endothelial cells.
d. Protein A binds to thrombomodulin.
e. Activated protein C enhances the adhesion ability of neutrophils.

 

 

ANS:  A, B, C

The surface of the endothelium produces plasma protease inhibitors to resist clot formation. Thrombomodulin is a membrane thrombin-binding protein matter and is converted to activated protein C (see Figure 27-18) on the surface of endothelial cells. Protein C in the circulation binds to thrombomodulin. Activated protein C inhibits the adhesion of neutrophils to the endothelium.

 

PTS:   1                    REF:   Pages 970-971

 

  1. Which statements characterize albumin? (Select all that apply.)
a. Retains sodium to maintain water balance.
b. Provides colloid osmotic pressure.
c. Is synthesized in the liver.
d. Is a carrier for drugs that have low water solubility.
e. Is a small molecule

 

 

ANS:  B, C, D

Albumin is a plasma protein produced by the liver. It serves as a carrier molecule for the normal components of blood, as well as for drugs that have low solubility in water (e.g., free fatty acids, lipid-soluble hormones, thyroid hormones, bile salts). Albumin molecules are large and do not diffuse freely through the vascular endothelium, thus they maintain the critical colloidal osmotic pressure (or oncotic pressure) that regulates the passage of water and solutes into the surrounding tissues (see Chapters 1 and 3).

 

PTS:   1                    REF:   Page 946

 

MATCHING

 

Match the descriptions with the corresponding terms.

______ A. Clotting

______ B. Red blood cell development

______ C. Red blood cell destruction

______ D. Platelet formation

______ E. Blood cell production

 

  1. Endomitosis

 

  1. Hemostasis

 

  1. Hematopoiesis

 

  1. Erythropoiesis

 

  1. Phagocytosis

 

  1. ANS:  D                    PTS:   1                    REF:   Page 965

MSC:  During thrombopoiesis, the megakaryocyte progenitor is programmed to undergo an endomitotic cell cycle called endomitosis, during which DNA replication of platelets occurs.

 

  1. ANS:  A                    PTS:   1                    REF:   Page 965

MSC:  Hemostasis is defined as arrest of bleeding.

 

  1. ANS:  E                    PTS:   1                    REF:   Page 954

MSC:  Blood cell production (hematopoiesis) is ongoing, occurring in the liver and spleen of the fetus and only in bone marrow (medullary hematopoiesis) after birth.

 

  1. ANS:  B                    PTS:   1                    REF:   Page 959

MSC:  It was not until the 1850s that the bone marrow was identified as the site of erythropoiesis, or the development of red blood cells.

 

  1. ANS:  C                    PTS:   1                    REF:   Page 950

MSC:  Monocytes and macrophages are active phagocytes that participate in the immune and inflammatory responses. They also ingest dead or defective host cells, particularly blood cells.