Test bank for davis advantage for pathophysiology 2nd edition by caprio.pdf

Test Bank for Davis Advantage for Pathophysiology Introductory Concepts
and Clinical Perspectives,
3rd Edition, Theresa Capriotti
| Verified Chapter's 1 - 42 | Complete

TABLE OF CONTENTS
I. The Cell
1. The Cell in Health and Illness
2. Cellular Injury, Adaptations, and Maladaptive Changes
3. Genetic Basis of Disease
II. Integrated Body Processes
4. Stress, Exercise, and Immobility
5. Obesity and Nutritional Imbalances
6. Pain
III. Fluid, Electrolyte, and Acid-Base Homeostasis
7. Fluid and Electrolyte Imbalances
8. Acid-Base Imbalances
IV. Infection and Inflammation
9. Inflammation and Dysfunctional Wound Healing
10. Infectious Diseases
11. Disorders of the Immune System
V. Hematologic Disorders
12. Disorders of White Blood Cells
13. Disorders of Red Blood Cells
14. Disorders of Platelets, Hemostasis, and Coagulation
VI. Disorders of Cardiovascular Function
15. Arterial Disorders
16. Ischemic Heart Disease and Conduction Disorders
17. Heart Failure
18. Valvular Heart Disease
19. Disorders of the Venous System
VII. Pulmonary Disorders
20. Respiratory Inflammation and Infection
21. Restrictive and Obstructive Pulmonary Disorders
VIII. Renal and Urological Disorders
22. Renal Disorders
23. Urological Disorders
IX. Hormonal and Reproductive Disorders
24. Endocrine Disorders
25. Diabetes Mellitus and the Metabolic Syndrome
26. Disorders of the Female Reproductive System
27. Disorders of the Male Reproductive System
28. Sexually Transmitted Infections
X. Gastrointestinal Disorders
29. Disorders of the Esophagus, Stomach, and Small Intestine
30. Common Disorders of the Large Intestine

31. Infection, Inflammation, and Cirrhosis of the Liver

32. Gallbladder, Pancreatic, and Bile Duct Dysfunction
XI. Neurological Disorders
33. Cerebrovascular Disorders
34. Chronic and Degenerative Neurological Disorders
35. Brain and Spinal Cord Injury
36. Psychobiology of Behavioral Disorders
XII. Musculoskeletal Disorders
37. Musculoskeletal Trauma
38. Degenerative Disorders of the Musculoskeletal System
39. Infection and Inflammatory Disorders of the Musculoskeletal System
XIII. Cancer
40. Cancer
XIV. Integumentary Disorders
41. Skin Disorders
42. Burns
XV. Sensory Disorders
43. Eye Disorders
44. Ear Disorders
XVI. Aging and Multi-System Disorders
45. Pathophysiological Concepts of Aging
46. SIRS, Sepsis, Shock, MODS, and Death

Chapter 1, The Cell in Health and Illness
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. Which statement regarding the sodium–potassium pump is correct?
1. The cell’s plasma membrane is more soluble to sodium ions than potassium ions.
2. The concentration of sodium ions should be higher inside the cell compartment.
3. The concentration of potassium ions should be higher outside the cell
compartment.
4. The active transport involves pumping out three sodium ions and pumping in two
potassium ions.
2. In the absence of oxygen, which cellular function creates the same amount of energy as is created in the
presence of oxygen?
1. Dissipation of pyruvic acid
2. Initiation of the citric acid cycle
3. Activation of acetyl-coenzyme A
4. Creation of acidosis via lactic acid
3. How many adenosine triphosphates (ATPs) are produced in aerobic energy metabolism?
1. 2
2. 3
3. 34
4. 53
4. Which cell organelles differ in their number according to the cell’s energy needs?
1. Ribosomes
2. Mitochondria
3. Ribonucleic acids
4. Deoxyribonucleic acids
5. Which option best supports the reason more energy is produced when a person is exercising?
1. Exercise causes an increase in the synthesis of protein.
2. There is an increase in the production of pyruvic acid in the cells.
3. The conversion of pyruvic acid to lactic acid is increased by exercise.
4. Muscle cells have more mitochondria to meet energy demands.
6. When does ribosomal protein synthesis cease?
1. During endoplasmic reticulum stress
2. During the synthesis of adenosine triphosphate (ATP)
3. During a severe hypoxic state
4. During the processing of prohormone
7. Which cellular organelles are responsible for propelling mucus and inhaled debris out of the lungs?
1. Cilia
2. Microfilaments
.

.
3. Secretory vesicles
4. Endoplasmic reticula
8. Which are the key proteins in the contractile units of the muscle cells?
1. Actin and myosin
2. Prohormone and tubulin
3. Tubulin and actin
4. Myosin and prohormone
9. Which deficiency causes Tay–Sachs disease?
1. Proteasome
2. Peroxisome
3. Macrophage
4. Lysosomal enzymes
10. Which is a characteristic of adrenoleukodystrophy?
1. Accumulation of ganglioside
2. Cessation of ribosomal protein synthesis
3. Acceleration of cellular proteasome activity
4. Accumulation of long-chain fatty acids in the nervous system
11. Which statement regarding endoplasmic reticulum (ER) stress is correct?
1. During ER stress, proteins are rapidly degraded.
2. During ER stress, lipids cannot travel to their proper intracellular locations.
3. During ER stress, long-chain fatty acids accumulate in the nervous system.
4. During ER stress, nondegraded substances accumulate in the cells.
12. A client is diagnosed with type 1 diabetes mellitus. At a cellular level, which function is likely to be
involved?
1. Inability of ribosomes to produce a specific type of protein
2. Incorrect processing of a protein by the Golgi apparatus
3. Stagnation of a previously dynamic action in microtubules
4. Obstruction of the smooth endoplasmic reticulum
13. A newborn patient exhibits characteristics of severe physical deformities. Which cellular component is
examined to determine the cause and probability of the disease being genetically transferred?
1. Transfer RNA
2. Ribosomal RNA
3. Double helix of DNA
4. Mitochondrial DNA
14. A hiker experiences muscle pain and acidosis while ascending a mountain during a long, steep
climb. Which is the reason for these manifestations?
1. Cellular hypoxia
2. Autolysis
3. Heterolysis
4. Cellular edema

.
15. Which factor provides DNA the unique molecular ability to replicate?
1. The pairing of nitrogenous bases
2. The presence of pyrimidine bases
3. The presence of nucleotides
4. The nitrogenous base and phosphate bond
16. How many nitrogenous bases compose a single codon?
1. 2
2. 3
3. 4
4. 5
17. Which components form the structure of DNA?
1. Nucleotides
2. Amino acids
3. Fatty acids
4. Phosphates
18. Which factor is essential in order for protein synthesis to occur?
1. Free-standing ribosomes within the cell
2. Protein blueprint from the cell of the DNA
3. Specific information from the nucleus of the cell
4. Transfer RNA to move the protein out of the cell
19. Tetracycline antibiotic is prescribed for an adult client with chlamydia infection. Which is the
mechanism of action of the drug?
1. It prevents the replication of bacteria.
2. It alters the configuration of bacterial cytoplasm.
3. It interferes with the function of bacterial ribosomes.
4. It inhibits the functions of bacterial mitochondria.
20. Where does the conversion of a prohormone into a hormone take place?
1. In the ribosomes
2. In the Golgi apparatus
3. In the secretory granules
4. In the endoplasmic reticulum
21. Which is the cell’s “master mind”?
1. Nucleus
2. Ribosome
3. Golgi apparatus
4. Endoplasmic reticulum
Multiple Response
Identify one or more choices that best complete the statement or answer the question.
22. Which statements regarding the microtubules are true? Select all that apply.

.
1. Microtubules are solid.
2. Microtubules are flexible.
3. Microtubules are composed of tubulin.
4. Microtubules are called actin filaments.
5. Microtubules have structures involved in cell division.
23. Which cellular actions are carried out during the process of protein synthesis? Select all that apply.
1. DNA directs the cell to carry out the process.
2. Transcription occurs in the ribosome of the cell.
3. Protein translation takes place in the cell nucleus.
4. RNA is single-stranded and travels outside the nucleus.
5. In RNA, the pyrimidine base thymine is replaced with uracil.
24. Which characteristics are specific to RNA during protein synthesis? Select all that apply.
1. Presence of ribose pentose sugar
2. Presence of single-stranded helix
3. Presence of double-stranded helix
4. Presence of deoxyribose pentose sugar
5. Presence of uracil and cytosine as a pyrimidine base
25. Which are the purine bases found in DNA? Select all that apply.
1. Uracil
2. Adenine
3. Guanine
4. Thymine
5. Cytosine

.
Chapter 1, The Cell in Health and Illness
Answer Section
MULTIPLE CHOICE
1. ANS: 4
Chapter: Chapter 1, The Cell in Health and Illness
Objective: Recognize the major organelles and their function within the cell. Page: 1
Heading: Cell Structure and Function>The Sodium Potassium Pump (Na+/K+ Pump)
Integrated Process: Nursing Process
Client Need: Physiological Integrity: Physiological Adaptation
Cognitive Level: Comprehension [Understanding]
Concept: Cellular Regulation Difficulty:
Moderate
Feedback
1 This is incorrect. The plasma membrane of the cell is less soluble to sodium ions
and more soluble to potassium ions.
2 This is incorrect. The concentration of sodium ions should be higher outside the
cell compartment.
3 This is incorrect. The concentration of potassium ions should be higher inside
the cell compartment.
4 This is correct. In active transport, for every three sodium ions pumped out, two
potassium ions are pumped in.
PTS: 1 CON: Cellular Regulation
2. ANS: 2
Objective: Discuss the difference between aerobic and anaerobic metabolism. Page:
3
Heading: Cell Structure and Function>Energy Metabolism Integrated
Process: Nursing Process
Cognitive Level: Analysis [Analyzing]
Difficult
Feedback
1 This is incorrect. When oxygen is not available, anaerobic metabolism produces
significantly less cellular energy: a net yield of 2 ATP, as well as pyruvic acid.
2 This is correct. In the absence of oxygen, pyruvic acid is converted into acetyl-
coenzyme A, which triggers a series of reactions known as the Krebs cycle, also

.
called the citric acid cycle.
3 This is incorrect. Pyruvic acid is converted into acetyl-coenzyme A, not
activated.
4 This is incorrect. In cellular hypoxia, pyruvic acid is converted to lactic acid,
which is noxious to cells, causing muscle pain and biochemical alterations such as
acidosis.
3. ANS: 3
Objective: Discuss the difference between aerobic and anaerobic metabolism.
Page: 3
Heading: Cell Structure and Function>Energy Metabolism
Cognitive Level: Knowledge [Remembering]
Easy
Feedback
1 This is incorrect. In anaerobic energy metabolism, 2 ATPs and pyruvic acid are
produced.
2 This is incorrect. In active transport, 3 sodium ions are pumped out. This takes
place in the plasma membrane.
3 This is correct. The process of aerobic energy requires oxygen and provides the
maximum amount of energy for cellular function. The process yields 34 ATPs.
4 This is incorrect. Aerobic energy metabolism produces 34 ATPs, not 53.
4. ANS: 2
Objective: Recognize the major organelles and their function within the cell.
Page: 3
Heading: Cell Structure and Function>Mitochondria
Moderate
Feedback
1 This is incorrect. Ribosomes are small, spherical-shaped organelles of the
ribosomal ribonucleic acid.
2 This is correct. Cell types differ in their number of mitochondria according to

.
their energy needs. For example, muscle cells have abundant mitochondria
because they require a high amount of energy to function, whereas bone cells
have fewer mitochondria.
3 This is incorrect. Ribonucleic acid is not affected by the cell’s energy needs.
4 This is incorrect. Deoxyribonucleic acid contains double-stranded helical chains
containing various sequences of nucleotides. Its numbers are not affected by the
cell’s energy needs.
5. ANS: 4
Page: 3
Heading: Cell Structure and Function>Mitochondria
Moderate
Feedback
1 This is incorrect. Protein synthesis is the function of ribosomes. An increase in
the synthesis of proteins does not yield energy and is not directly related to
exercise.
2 This is incorrect. In aerobic energy metabolism created by exercise, anaerobic
metabolism, also referred to as glycolysis, occurs outside the mitochondria. In
anaerobic metabolism, glucose is used to create energy.
3 This is incorrect. Conversion of pyruvic acid to lactic acid in cellular hypoxia is
noxious to cells and does not create energy.
4 This is correct. Exercise stimulates mitochondria found in the muscle cells to
create energy. This process is supported by the increased number of
mitochondria found in muscle cells.
6. ANS: 3
Page: 4
Heading: Cell Structure and Function>Ribosomes>Endoplasmic Reticulum Integrated
Processes: Nursing Process
Moderate

.
Feedback
1 This is incorrect. Ribosomal protein synthesis does not cease during
endoplasmic reticulum stress.
2 This is incorrect. ATP is synthesized in the energy metabolism. It does not
interfere with protein synthesis.
3 This is correct. When the cells are deprived of adequate oxygen supply, the
ribosomal protein synthesis ceases.
4 This is incorrect. The processing of prohormones to hormones does not cease
the process of protein synthesis.
7. ANS: 1
Heading: Cell Structure and Function>Endoplasmic Reticulum>Microtubules and Microfilaments
Integrated Processes: Nursing Process
Client Need: Physiological Integrity: Physiological Adaptation Cognitive
Level: Knowledge [Remembering]
Easy
Feedback
1 This is correct. The cilia are responsible for propelling the mucus and inhaled
debris out of the lungs using a sweeping motion.
2 This is incorrect. Microfilaments help in changing the shape of certain cells,
such as macrophages, and help with contraction of muscle.
3 This is incorrect. Secretory vesicles store substances, such as hormones, that are
secreted by cells before they are released into the extracellular space.
4 This is incorrect. The endoplasmic reticulum aids in the transport of the
synthesized protein from the ribosomes to the Golgi apparatus.
8. ANS: 1
Easy

.
Feedback
1 This is correct. Actin and myosin are the key proteins in the contractile unit of
the muscle cells.
2 This is incorrect. Prohormone and tubulin are not the key elements in the
contractile units of the muscle cells. Prohormones are transferred to the Golgi
apparatus to be converted into complete hormones, and tubulin is associated
with microtubule formation.
3 This is incorrect. Tubulin and actin are not the key proteins in the contractile
units of the muscle cells. Microtubules are hollow filaments composed of
tubulin. So tubulin is associated with microtubule formation.
4 This is incorrect. Prohormones are not one of the key proteins in the contractile
units of the muscle cells. They are transferred to the Golgi apparatus to be
converted into complete hormones.
9. ANS: 4
Heading: Cell Structure and Function>Lysosomes>Lack of Lysosomal Enzymes and Disease
Level: Comprehension [Understanding]
Easy
Feedback
1 This is incorrect. A deficiency of proteasome in the cell does not cause Tay–
Sachs disease. Proteasome is an organelle that contains digestive enzymes
similar to lysosomes. Proteasomes degrade polypeptide chains and proteins.
2 This is incorrect. A deficiency of peroxisomes in the cell does not cause Tay–
Sachs disease. Peroxisomes contain digestive enzymes such as lysosomes.
Peroxisomes break down the long-chain fatty acids and free radicals.
3 This is incorrect. A deficiency of macrophages in the body does not cause Tay–
Sachs disease. Macrophages are the major defensive white blood cells of the
body. They contain a large number of lysosomes.
4 This is correct. Lysosomes contain digestive enzymes such as lysozyme,
proteases, and lipases to degrade the ingested foreign substances and cellular
debris. Tay–Sachs disease is a rare genetic disorder that is caused by the
deficiency of lysosomal enzymes. It results because of the buildup of lipids in
the brain and spinal cord.

.
10. ANS: 4
Page: 4
Heading: Cell Structure and Function>Proteasomes and Peroxisomes
Moderate
Feedback
1 This is incorrect. The deficiency of lysosomal enzymes, as in Tay–Sachs disease,
causes the accumulation of ganglioside in the central nervous system.
2 This is incorrect. Ribosomes are responsible for the synthesis of cellular proteins.
In severe hypoxic states, ribosomal protein synthesis ceases, resulting in
decreased synthesis of protein.
3 This is incorrect. Cachexia, or wasting of body mass, is associated with
accelerated proteasome activity. It is often seen in conditions such as cancer.
4 This is correct. Adrenoleukodystrophy is associated with dysfunction of the
peroxisomes. The disease is characterized by the accumulation of long-chain
fatty acids in the nervous system. The disease causes the deterioration of the
nervous system and eventually leads to death.
11. ANS: 1
Page: 4
Heading: Cell Structure and Function>Endoplasmic Reticulum
Moderate
Feedback
1 This is correct. Proteins are rapidly degraded during ER stress.
2 This is incorrect. Proteins cannot travel to their exact intracellular locations
during ER stress.
3 This is incorrect. Accumulation of long-chain fatty acids in the nervous system is
not associated with ER stress.
4 This is incorrect. Accumulation of nondegraded substances in the cells occurs
because of the lack of lysosomal enzymes, but not as a result of ER stress.

.
12. ANS: 1
Page: 5
Heading: Cell Structure and Function>Endoplasmic Reticulum>Ribosomes
Cognitive Level: Application [Applying]
Difficult
Feedback
1 This is correct. Ribosomes are known as the protein factories of the cell.
Different types of cells produce different types of proteins. For example,
ribosomes in pancreatic beta islet cells synthesize the proteins that make up
insulin. The inability results in type 1 diabetes mellitus, a condition where the
body is unable to produce insulin.
2 This is incorrect. Once ribosomes complete protein synthesis, the proteins are
transported via the endoplasmic reticulum to the Golgi apparatus to be processed,
packaged, and secreted. Impairment of this process does not result in type 1
diabetes mellitus.
3 This is incorrect. Microtubules are hollow filaments composed of protein subunits
called tubulin. They have a dynamic structure, meaning that they are constantly
being formed, broken down, and reformed. Stagnation of the process does not
occur.
4 This is incorrect. The endoplasmic reticulum is a network of tubules that act as a
transport system within the cell and help in the transport of proteins. Impairment
of this process does not result in type 1 diabetes mellitus.
13. ANS: 3
Objective: Distinguish between the components that make up DNA versus RNA. Page:
6
Heading: Cell Structure and Function>DNA Replication
Difficult
Feedback

.
1 This is incorrect. Transfer RNA (tRNA) plays an important role in the assembly
of proteins, but would not be examined as a source of severe deformities in a
newborn.
2 This is incorrect. Proteins manufactured by ribosomes are destined to become
parts of the cell, enzymes, or exported protein secretions. Different types of cells
manufacture different proteins. However, ribosomal RNA is not examined for a
cause of severe deformities in a newborn.
3 This is correct. In the event of severe physical deformities, the double helix of
DNA will be examined for identifiable defects. The findings will identify the
cause. The DNA of the parents will also be examined to aid in the identification
of the condition being genetically transferred.
4 This is incorrect. It is theorized that in aging and in disorders such as diabetes,
cancer, and heart failure, mitochondrial DNA undergoes mutations. Diseases that
target mitochondria specifically may be caused by injury of mitochondria
occurring in the cells of different organs. Mitochondrial disease causes a wide
array of problems, including energy depletion and severe muscle weakness, but
not severe deformities.
14. ANS: 1
Page: 3
Heading: Cell Structure and Function>Mitochondrial DNA Integrated
Difficult
Feedback
1 This is correct. Muscle cramping and acidosis occur when the cells are deprived of
adequate oxygen supply during energy metabolism. The oxygen level decreases
slightly as the hiker climbs up the mountain into higher altitudes.
2 This is incorrect. Autolysis is the process in which lysosomes release digestive
enzymes to destroy the parts of the dead cells. This process does not cause
muscle cramping and acidosis in a hiker.
3 This is incorrect. Heterolysis is the process in which the lysosomes are used to
digest the foreign bodies ingested by the macrophage. This process does not
cause muscle cramping and acidosis in a hiker.
4 This is incorrect. When the plasma membrane configuration is altered because
of diseases, excess fluids enter the cell’s internal environment and cause swelling,
resulting in cellular edema.

.
15. ANS: 1
Objective: Describe the functions of the nucleus and consequences of DNA damage.
Page: 5
Heading: Cell Structure and Function>The Nucleus
Moderate
Feedback
1 This is correct. The pairing of nitrogenous bases provides the DNA with the
unique molecular ability to replicate. For example, adenine always binds with
thymine.
2 This is incorrect. DNA nucleotides contain nitrogenous bases that are either
purines or pyrimidines.
3 This is incorrect. DNA consists of long, double-stranded helical chains
containing variable sequences of nucleotides. Nucleotides consist of a
nitrogenous base and a phosphate group attached to a sugar molecule. The
presence of nucleotides does not provide DNA molecules the unique ability to
replicate.
4 This is incorrect. Nitrogenous bases and phosphate groups are parts of the
nucleotide. The presence of nitrogenous bases and phosphate groups do not
provide DNA molecules with the unique ability to replicate.
16. ANS: 2
Objective: Describe the functions of the nucleus and consequences of DNA damage.
Page: 5
Easy
Feedback
1 This is incorrect. A codon contains three nitrogenous bases instead of just two.
2 This is correct. Three nitrogenous bases form a codon. Codons are interpreted
by the ribosomes during protein synthesis to form specific proteins to meet the
cell’s need.

.
3 This is incorrect. A codon is made up of three nitrogenous bases instead of four.
4 This is incorrect. A codon is made up of three nitrogenous bases instead of five.
17. ANS: 1
5
Easy
Feedback
1 This is correct. DNA is a polymer of nucleotides.
2 This is incorrect. DNA is not a polymer of amino acids.
3 This is incorrect. DNA is not a polymer of fatty acids.
4 This is incorrect. DNA is not a polymer of phosphate.
18. ANS: 3
5
Heading: Cell Structure and Function>Endoplasmic Reticulum>Ribosomes
Moderate
Feedback
1 This is incorrect. Some ribosomes are freestanding within the cytoplasm, and
some are attached to the rough endoplasmic reticulum; both are considered
protein factories.
2 This is incorrect. In all cells, protein synthesis by the ribosomes is directed by
specific information received from the nucleus but does not involve the cell’s
DNA.
3 This is correct. In all cells, protein synthesis by the ribosomes is directed by
specific information received from the nucleus regarding the needed protein.
4 This is incorrect. Transfer RNA (tRNA) plays a key role in the assembly of
proteins and does not move the proteins out of the cell.

.
19. ANS: 3
Heading: Cell Structure and Function>Endoplasmic Reticulum>Ribosomes>Clinical Concept
Level: Analysis [Analyzing]
Difficult
Feedback
1 This is incorrect. Tetracycline antibiotic does not prevent the replication of
bacteria.
2 This is incorrect. Tetracycline antibiotic does not alter the configuration of
bacterial cytoplasm.
3 This is correct. Tetracycline interferes with the functions of bacterial ribosomes. It
inhibits bacterial protein synthesis.
4 This is incorrect. Tetracycline antibiotic does not interfere with functions of
bacterial mitochondria.
20. ANS: 2
Heading: Cell Structure and Function>Endoplasmic Reticulum>Golgi Apparatus
Easy
Feedback
1 This is incorrect. The protein is initially manufactured in the ribosome. This
protein is referred to as preprohormone, which contains a single peptide.
2 This is correct. The conversion of prohormone into hormone takes place in the
Golgi apparatus. The prohormone is processed and then converted into the
actual hormone. The actual hormone is secreted by the endocrine gland’s cells.
3 This is incorrect. The secretory granule is present in the Golgi apparatus. The
completed hormone is stored in the secretory granule.
4 This is incorrect. The preprohormone contains a single peptide, which directs its

.
21. ANS: 1
Heading: Cell Structure and Function>The Nucleus Integrated
Easy
Feedback
1 This is correct. The nucleus is the master mind of a cell. It contains the body’s
genetic material, which regulates all cell structures and functions.
2 This is incorrect. Ribosomes are small, spherical organelles composed of
ribosomal ribonucleic acid. They are called the “protein factories” of the cell.
3 This is incorrect. The synthesized proteins from ribosomes are transported to the
Golgi apparatus through the endoplasmic reticulum. Proteins are processed,
packaged, and secreted by the Golgi apparatus.
4 This is incorrect. The endoplasmic reticulum is a network of tubules within the
cell that acts as a transport system. Lipid production takes place in the
endoplasmic reticulum.
MULTIPLE RESPONSE
22. ANS: 3, 5
Level: Comprehension [Understanding]
Moderate
Feedback
transfer to the endoplasmic reticulum. The single peptide of the pre-prohormone
is removed when it is transferred from ribosome to endoplasmic reticulum.

.
1. This is incorrect. Microtubules are tubular and hollow in composition, not solid.
2. This is incorrect. Microfilaments, not microtubules, are solid, flexible fibers,
sometimes referred to as actin filaments.
3. This is correct. Microtubules are composed of protein subunits called tubulin.
4. This is incorrect. Microfilaments are identified as actin filaments.
5. This is correct. Microtubules comprise cell structures involved in cell division such as
centrioles and mitotic spindles.
23. ANS: 1, 4, 5
Objective: Compare and contrast the processes of transcription and translation. Page:
6
Heading: Cell Structure and Function>Transcription and Translation
Difficult
Feedback
1. This is correct. Protein synthesis is a requirement for normal physiological function.
DNA directs the cell to carry out protein synthesis through a two-step process.
2. This is incorrect. DNA directs the cell to carry out protein synthesis through a two-step
process known as transcription, which occurs in the nucleus, and translation, which occurs in
the ribosome.
3. This is incorrect. DNA directs the cell to carry out protein synthesis through a two-step
process known as transcription, which occurs in the nucleus, and translation, which occurs in
the ribosome.
4. This is correct. RNA differs from DNA in some important ways; for example, it is
single-stranded and can travel to sites outside of the nucleus.
5. This is correct. The pentose sugar in RNA is ribose, and the pyrimidine base thymine is
replaced with uracil.
24. ANS: 1, 2, 5
5
Heading: Cell Structure and Function>Transcription and Translation
Concept: Cellular Regulation

.
Difficulty: Difficult
Feedback
1. This is correct. The pentose sugar present in RNA is ribose.
2. This is correct. RNA consists of a single-stranded helix and can travel to sites
outside the nucleus.
3. This is incorrect. Double-stranded helix is present in DNA.
4. This is incorrect. The pentose sugar present in DNA is deoxyribose.
5. This is correct. The pyrimidine base thymine in DNA is replaced with uracil in
RNA.
25. ANS: 2, 3, 4, 5
5
Heading: Cell Structure and Function>The Nucleus Integrated
Easy
Feedback
1. This is incorrect. Uracil is a pyrimidine base present in RNA.
2. This is correct. Adenine is a purine base present in DNA and always binds with
thymine.
3. This is correct. Guanine is a purine base present in DNA and always binds with
cytosine.
4. This is correct. Thymine is a pyrimidine base present in DNA.
5. This is correct. Cytosine is a pyrimidine base present in DNA and RNA.

Copyright ©2016 F. A. Davis Company
Chapter 2: Cellular Injury, Adaptations, and Maladaptive Changes
Multiple Choice
1. How does oxidative stress occur?
1. In cells that undergo transient ischemia and subsequent resumption of circulation
2. When estrogen stimulation results in mitotic division of breast gland cells
3. When a blood clot that obstructs a coronary artery causes cardiac muscle ischemia
4. When a cell’s environment cannot support its metabolic requirements
2. A client is diagnosed with a condition in which the brain cells cannot withstand low oxygen delivery long
enough for cell reversible changes to happen. Identify the condition.
1. Organelle disruption
2. Hypoxia
3. Xanthelasma
4. Ischemic-reperfusion injury
3. What is the process whereby newly growing cells acquire the specialized structure and function of the cells they
replace?
1. Apoptosis
2. Differentiation
3. Oxidative phosphorylation
4. Atherosclerosis
4. What is kwashiorkor?
1. A condition seen in individuals suffering from severe protein starvation
2. A condition where blood pressure within the aorta and systemic arterial circulation is
elevated
3. A condition where prostate gland cells increase in number because of testosterone
stimulation
4. A condition that causes defective cholesterol metabolism
5. What are the unique histological findings that represent distinct disease processes?
1. Histology
2. Biopsy
3. Autopsy
4. None of the above
6. A client is diagnosed with failure of the thyroid gland due to increase in apoptotic cell death. Which condition is
the client most likely to have?
1. Xanthomas
2. Hashimoto’s thyroiditis
3. Peptic ulcer
4. Anthracosis
7. Which field involves harvesting of embryonic stem cells and performing nuclear transfer on these cells?
1. Reproductive cloning
2. Restoration with stem cells
3. Transplantation

4. Therapeutic cloning
8. A nurse observes that a client has developed a foul odor in the spots where necrosis of tissue has developed.
What organism causes the emission of this foul odor?
1. Streptococcus
2. Helicobacter pylori
3. Clostridium perfringens
4. Human papilloma virus
9. A client is diagnosed with cellular apoptosis. Which disease can this condition lead to?
1. Cancer
2. Degenerative neurological diseases
3. Necrosis
4. Infarction
10. A client is suffering from prolonged ischemia and tissue death. Which term can be used to refer to such tissue
death?
1. Gangrene
2. Infarction
3. Necrosis
4. Apoptosis
11. A client comes in with persistently uncontrolled hypertension. The nurse informs the client’s spouse that one of
the consequences of prolonged raised blood pressure is a weakened area in the wall of the cerebral artery,
located on the Circle of Willis. What is this condition known as?
1. Xanthelasma
2. Infarction
3. Berry aneurysm
4. Ischemia
12. While conducting an endoscopic examination on a client, it is found that the client has acid reflex. Which
condition is associated with the gastroesophageal reflux disease (GERD) in which cell injury is reversible?
1. Parkinson’s disease
2. Myocardial infarction
3. Barrett’s esophagus
4. Hashimoto’s thyroiditis
13. Which body part contains pluripotent stem cells?
1. Umbilical cord
2. Skeletal muscle
3. Cardiac muscle
14. A client has an abnormal thickening of the lining of the uterus due to an increase in estrogen levels. How can
such a condition be reversed?
1. Restoration of blood circulation
2. Hormone therapy to counteract the effects of excessive estrogen
3. Surgical removal
4. Acid suppression treatment
15. Which organ is most susceptible to damage and death due to prolonged ischemia?
1. Brain

2. Skeletal muscles
3. Heart
16. A genetically programmed cell death is a process that can destroy cells that are no longer needed. What is the best
method to do this?
1. Necrosis
2. Apoptosis
3. Infarction
4. Gangrene
17. Which is the most prevalent method to replace permanently injured tissues and organs?
1. Stem cell restoration
2. Therapeutic cloning
3. Reproductive cloning
4. Transplantation
18. Arteriosclerosis is the thickening and hardening of arterial walls. Which condition acts as an initiator of
arteriosclerosis?
1. Apoptosis
2. Endothelial cell injury
3. Necrosis
4. Infarction
19. What is the weakened area in an arterial wall called?
1. Neoplasia
2. Aneurysm
3. Hypertrophy
4. Metaplasia
20. The increase in size of a weightlifter’s muscles is due to muscular
1. Hypertrophy
2. Metaplasia
3. Atrophy
4. Dysplasia
21. A client reports an itchy, bumpy scar around an old wound that is identified as a keloid. This occurs due to the
increase in the number of cells in a tissue or organ. Which term best describes this condition?
1. Neoplasia
2. Hyperplasia
3. Dysplasia
4. Metaplasia
Multiple Response
22. Which vitamins are fat-soluble? Select all that apply.
1. Vitamin A
2. Vitamin C
3. Vitamin D

4. Vitamin K
5. Vitamin B6
23. When does physiological apoptosis occur? Select all that apply.
1. During the embryonic development of the hand
2. During menopause in female adult ovaries
3. When cells die because of stressors
4. When cells have completed their function and need elimination
5. When the liver gets exposed to excessive amounts of alcohol
24. Which components of the serum level should be measured to confirm myocardial infarction? Select all that apply.
1. Epinephrine
2. Troponin
3. Lysosomal enzyme
4. Acetylcholine
5. CPKmb
25. A client is suffering from atherosclerosis. What are directly detrimental to the client’s condition? Select all that
apply.
1. Depletion of endothelial nitric oxide
2. Helicobacter pylori infection
3. Low-density lipoprotein (LDL) deposition
4. Inflammatory changes of the endothelium
5. Acid reflux

Chapter 2: Cellular Injury, Adaptations, and Maladaptive Changes
Answer Section
MULTIPLE CHOICE
1. ANS: 1
Chapter: Chapter 2, Cellular Injury, Adaptations, and Maladaptive Changes Page:
18
Objective: N/A
Difficulty: Moderate
Heading: Free Radical Injury Integrated
Client Need: Health Promotion and Maintenance
Cognitive Level: Application [Applying] Concept:
Cellular Regulation
Feedback
1 Oxidative stress is a form of cell injury that occurs when free radical generation exceeds the
mechanisms of removal. Oxidative stress commonly occurs in cells that undergo transient
ischemia and subsequent resumption of circulation.
2 Hormonal stimulation of hyperplasia occurs in pregnancy. It occurs when estrogen
stimulation results in mitotic division of breast gland cells.
3 Ischemic reperfusion injury occurs when a blood clot obstructs a coronary artery and
results in cardiac muscle ischemia.
4 Atrophy occurs when a cell’s environment cannot support its metabolic requirements.
The smaller size of the cells allows for less metabolic demand and more efficient
functioning that is compatible with survival.
2. ANS: 2
17
Objective: N/A
Heading: Hypertension Hypoxic Cell Injury Integrated
Cognitive Level: Applying [Application] Concept:
Oxygenation
Feedback
1 Organelles are a number of specialized structures within a living cell. Prolonged stress
can cause irreversible cell damage resulting in organelle disruption.
2 Hypoxia is a condition in which the body or a part of the body is deprived of adequate
oxygen. Brain cells cannot withstand hypoxia for more than 6 minutes, whereas skeletal
muscle can tolerate hypoxia for prolonged periods.

3 Xanthelasma are raised skin lesions that develop because of intracellular accretion of
excess cholesterol within epithelial cells.
4 Ischemic-reperfusion injury is tissue damage. It occurs when the blood supply returns to
the tissue after a period of ischemia or lack of oxygen.
3. ANS: 2
15
Objective: N/A
Difficulty: Easy Heading:
Neoplasia
Client Need: Health Promotion and Maintenance Cognitive
Level: Comprehension [Understanding] Concept: Cellular
Regulation
Feedback
1 Apoptosis is an organized process that eliminates unnecessary or damaged cells without
causing inflammation or any adverse effects on surrounding tissue.
2 Differentiation is the process whereby newly growing cells acquire the specialized
structure and function of the cells that are replaced.
3 Oxidative phosphorylation is a process through which cells generate energy in the
mitochondria.
4 Atherosclerosis is the change in metabolic processes associated with diabetes mellitus.
4. ANS: 1
19
Objective: N/A
Difficulty: Easy
Heading: Nutritional Imbalances
Concept: Nutrition
Feedback
1 Kwashiorkor is a form of malnutrition caused by protein deficiency in the diet.
2 Hypertension is a condition in which blood pressure within the aorta and systemic
arterial circulation is elevated.
3 Benign prostatic hyperplasia is a condition in which prostate gland cells increase in
number because of testosterone stimulation.
4 Hypercholesterolemia is a condition that is caused by an excess of cholesterol in the
bloodstream.

5. ANS: 4
11-12
Objective: N/A
Difficulty: Easy
Heading: Basic Concepts of Cellular Adaptations and Maladaptive Changes Integrated
Feedback
1 Histology is the microscopic study of tissues and cells, and it yields important diagnostic
information for the clinician.
2 Biopsy extracts a cell sample from an organ or mass of tissue to allow for histological
examination.
3 Autopsy is an examination of the tissues and organs of a deceased individual that allows for
a study of the cause of death.
4 The unique histological findings that represent distinct disease processes are referred to as
pathognomonic changes. For instance, an inflamed, craterlike breach in the
gastrointestinal mucosa is pathognomonic for peptic ulcer disease.
6. ANS: 2
22
Objective: N/A
Heading: Apoptosis
Cognitive Level: Applying [Application] Concept:
Cellular Regulation
Feedback
1 Xanthomas are yellow, raised skin lesions that develop due to intracellular accumulation of
excess cholesterol within epithelial cells.
2 Hashimoto’s thyroiditis is a common autoimmune disease that causes gradual failure of
the thyroid gland because of increased apoptotic cell death.
3 Peptic ulcers are caused by Helicobacter pylori, which is a bacterium that erodes the
gastric mucosa.
4 Anthracosis is a benign deposition of coal dust within the lungs from inhalation of sooty
air.
7. ANS: 4

24
Objective: N/A
Difficulty: Easy
Heading: Interventions to Treat Permanent Cell Injury Integrated
Client Need: Health Promotion and Maintenance Cognitive
Level: Comprehension [Understanding] Concept: Cellular
Regulation
Feedback
1 Reproductive cloning is the deliberate production of genetically identical individuals and it
involves the production of a genetic duplicate of an existing organism.
2 The regeneration of the cells that are incapable of regeneration, such as brain, neuron,
and heart muscle cells, are referred to as restoration with stem cells.
3 Transplantation is the most prevalent method to replace permanently injured tissues or
organs.
4 Therapeutic cloning is a field that involves harvesting of embryonic stem cells and
performing nuclear transfer on these cells.
8. ANS: 3
22-23
Objective: N/A
Difficulty: Medium
Heading: Gangrene
Feedback
1 Streptococcus bacteria distinctly alter cells. They cause inflammation and swelling. For
example, the etiology of sore throats is usually streptococcus bacteria.
2 Helicobacter pylori is a bacterium that erodes the mucosal lining of the gastrointestinal
tract. It causes gastric acids to damage the stomach lining and leads to peptic ulcers.
3 Clostridium perfringens is an anaerobic bacterium that multiplies in exposed necrotic tissue.
This bacterium produces gas that becomes trapped in the infected tissue and emits a distinct
foul odor related to gangrene.
4 Human papilloma virus (HPV) is a virus that is sexually transmitted. It can cause
cancerous cell changes within the cervix.
9. ANS: 1
22
Objective: N/A

Heading: Cell Degeneration and Death
Feedback
1 Certain cancers arise when cells lose the ability to program their own destruction, a process
known as apoptosis, and go on to have an abnormally prolonged life span. These cells begin
to divide uncontrollably and invade other tissues.
2 Degenerative neurological diseases are caused when the cells, due to dysfunctional
apoptosis, die excessively and prematurely. For example, spinal muscular atrophy
develops when nerve cells undergo increased apoptotic rates and die prematurely.
3 Necrosis is the death of cells in a tissue or organ through injury or disease. It is
irreversible.
4 Infarction is the death of tissue due to prolonged restriction of blood flow to it.
10. ANS: 2
22
Objective: N/A
Feedback
1 Gangrene is a condition that occurs when tissues endure prolonged ischemia, experience
infarction and necrosis, and then are exposed to bacteria such as Clostridium perfringens
that proliferate in the decaying tissue.
2 Infarction is the death of tissue due to prolonged insufficient blood supply (ischemia).
3 Necrosis is the death of cells in a tissue or organ through injury or disease. It is
irreversible.
4 Apoptosis is the cell’s genetically programmed degeneration.
11. ANS: 3
20
Objective: N/A
Heading: Significance of Endothelial Cell Injury Integrated

Feedback
1 Xanthelasma is a yellowish deposit of cholesterol underneath the skin cells, commonly on
or around the eyelids.
2 Infarction is tissue death due to prolonged obstruction of blood supply to the tissue.
3 Berry aneurysm is a small berry-like bulge that is caused by a weakened area in the wall of
the cerebral artery at or near the Circle of Willis in the brain.
4 Ischemia is the lack of sufficient blood flow to tissues that leads to cell injury. Prolonged
ischemia leads to infarction or death of tissue.
12. ANS: 3
14
Objective: N/A
Heading: Clinical Interventions to Reverse Cell Injury
Feedback
1 Parkinson’s disease causes gradual, progressive neurological deterioration where specific
brain cells undergo degeneration and die. It is irreversible.
2 Myocardial infarction is the irreversible damage caused by prolonged lack of blood
supply to the myocardial muscle.
3 Barrett's esophagus is a serious complication of gastroesophageal reflux disease. In GERD,
the lower esophageal squamous epithelial cells can undergo a metaplastic change into
columnar stomach-like cells. This condition develops into Barrett’s esophagus.
4 Hashimoto’s thyroiditis is an autoimmune disorder in which the body’s immune system
attacks the thyroid gland. This causes cell injury that is irreversible.
13. ANS: 1
24
Objective: N/A
Difficulty: Easy

Feedback
1 Stem cells obtained from the umbilical cord during the birthing process are capable of
developing into other cell types and are, therefore, referred to as pluripotent stem cells.
2 Skeletal muscle stem cells are adult stem cells that are capable of generating only new
skeletal muscle tissue.
3 Cardiac muscle stem cells are adult stem cells that are capable of regeneration of only the
host tissue or cardiac muscle tissue.
4 Umbilical cord stem cells are pluripotent, which means that they are capable of
developing into any tissue in the body.
14. ANS: 2
23
Objective: N/A
Heading: Clinical Interventions to Reverse Cell Injury
Feedback
1 Restoration of blood circulation has no bearing on hyperplasia of the uterine
endometrium. This is because hyperplasia of the uterine endometrium is caused by an
increase in the uterine endometrial cells brought on by excessive estrogen.
2 Hyperplasia of the uterine endometrium is caused by an overproduction of estrogen.
Hormone therapy to counter the effects of excessive estrogen helps reverse the condition.
3 Surgical removal of the hyperplastic uterine endometrium is an irreversible treatment
option.
4 Acid suppression treatment can resolve the metaplasia of Barrett’s esophagus.
15. ANS: 1
22
Objective: N/A
Feedback
1 The brain is the organ that is most sensitive to reduction in its blood supply. The brain

undergoes infarction and cell death within minutes.
2 Skeletal muscles can tolerate lack of blood circulation for a few hours.
3 Cardiac ischemia occurs when the heart muscle or myocardium receives insufficient
blood flow. In such condition, cell death can occur within minutes but generally not as
quickly as the brain.
4 The brain is the organ that is most susceptible to damage and death due to prolonged
ischemia.
16. ANS: 2
21
Objective: N/A
Feedback
1 Necrosis is the death of living tissue due to ischemia, physical injury, radiation, or
chemicals. It is not reversible.
2 In multicellular organisms, cells that are no longer needed or are a threat to the organism
are destroyed by a programmed cell death called apoptosis. An example of this process is
when an embryonic, paddle-shaped hand forms indentations to shape the individual fingers.
3 Infarction is the death of tissue as a result of continued disruption of blood supply. For
example, when there is a lack of adequate coronary artery blood supply to the myocardial
muscle, ischemic necrosis occurs.
4 Gangrene is a potentially life-threatening condition that can occur when tissues suffer
prolonged ischemia and undergo necrosis. Clostridium perfringens thrives on the decaying
necrotic tissue and causes gangrene.
17. ANS: 4
24
Objective: N/A
Difficulty: Easy
Feedback

1 Stem cells are capable of developing into any specialized tissue and organ and are,
therefore, used to treat and regenerate injured tissues and cells. However, it is not the
most prevalent method.
2 Therapeutic cloning involves harvesting of embryonic stem cells and performing nuclear
transfer on these cells. With this method, it could be theoretically possible for individuals in
need of organ transplant to obtain exact tissue matches of their organs. However, this is still
a nascent technology with extensive ongoing research.
3 Reproductive cloning is the creation of a genetic duplicate of an existing organism.
Currently, reproductive cloning is performed among livestock and other animals like
cats, mice, rabbits, and mules.
4 Transplantation is the most prevalent method to replace permanently injured tissues or
organs, such as kidneys. It is a complex process involving many stages that include
solicitation of donors, harvesting of organs, matching of donor organs and recipients,
surgical implantation, and interventions to avoid organ rejection.
18. ANS: 2
20
Objective: N/A
Heading: Significance of Endothelial Cell Injury Integrated
Feedback
1 Apoptosis is also known as programmed cell death. In multicellular organisms, cells that are
unwanted or a threat to the organism are eliminated through a programmed sequence of
events. Too little or too much apoptosis is dangerous.
2 Endothelial cell injury acts as an initiator of arteriosclerosis. The most significant
injurious agents of the endothelial cells are hypertension, diabetic hyperglycemia, free
radicals, persistent secretion of angiotensin II, and low-density lipoprotein cholesterol.
3 Necrosis is cell death caused by ischemia, physical injury, chemicals, or radiation, which is
irreversible and may adversely affect neighboring tissues or the organ as a whole.
4 Infarction is the death of tissue due to a lack of oxygen or absence of blood supply to
tissues.
19. ANS: 2
20
Objective: N/A
Difficulty: Easy Heading:
Hypertension

Feedback
1 Neoplasia means new growth and usually refers to disorganized, uncoordinated,
uncontrolled proliferative cell growth that can be cancerous or benign.
2 Aneurysm is referred to as a weakened area in an arterial wall.
3 Hypertrophy is an increase in individual cell size, resulting in an enlargement of
functioning tissue mass.
4 Metaplasia is the replacement of one cell type by another cell type.
20. ANS: 1
12
Objective: N/A
Feedback
1 Hypertrophy is the increase in size of an organ or tissue due to the enlargement of its
component cells. Muscle growth is due to physiological hypertrophy, which is caused by
angiogenesis.
2 Metaplasia is the replacement of one cell type by another cell type. It could be due to a
cell’s genetic programming because of a change in environment, or more commonly it
could be in response to chronic inflammation.
3 Atrophy is a wasting or decrease in size of a body organ, tissue, or part due to disease,
injury, or lack of use.
4 Dysplasia is abnormal cellular growth within a specific tissue, often as a result of chronic
inflammation or a precancerous condition.
21. ANS: 2
13
Objective: N/A
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Evaluation [Evaluating]
Concept: Critical Thinking

Feedback
1 Neoplasia means new growth and usually refers to disorganized, uncoordinated,
uncontrolled proliferative cell growth that can be cancerous or benign.
2 Hyperplasia is the increase in the number of cells in a tissue or organ, which only occurs in
tissues such as the epithelium and glandular tissue.
3 Dysplasia is abnormal cellular growth within a specific tissue, often as a result of chronic
inflammation or a precancerous condition.
4 Metaplasia is the replacement of one cell type by another cell type.
PTS: 1 CON: Critical Thinking
MULTIPLE RESPONSE
22. ANS: 1, 3, 4
19-20
Objective: N/A
Difficulty: Easy
Heading: Nutritional Imbalances Integrated
Cognitive Level: Knowledge [Remembering] Concept:
Cellular Regulation
Feedback
1. This is correct. Fat-soluble vitamins are vitamins A, D, E, and K. Fat is necessary for
storage of these vitamins in the body.
2. This is incorrect. Individuals can counteract free radical injury through consumption of
antioxidants such as vitamin C.
5. This is incorrect. Individuals can counteract free radical injury through consumption of
antioxidants such as vitamin E and beta-carotene.
23. ANS: 1, 2, 4
21
Objective: N/A
Heading: Apoptosis

Feedback
1. This is correct. Apoptosis of select cells occurs within the paddle-shaped hand plate to form
indentations to shape the individual fingers. The apoptotic cells disintegrate in a stepwise
manner without disrupting other cells.
2. This is correct. Physiological apoptosis also occurs in female adult ovaries during
menopause.
3. This is incorrect. Cell necrosis occurs when cells die because of stressors or insults that
overwhelm the cell’s ability to survive.
4. This is correct. Cells such as the white blood cells undergo apoptosis when they become
exhausted after participation in immune reactions.
5. This is incorrect. Intracellular accumulation can occur in the liver when exposed to
excessive amounts of alcohol.
24. ANS: 2, 3, 5
22
Objective: N/A
Heading: Cell Necrosis
Cognitive Level: Application [Applying] Concept:
Cellular Regulation
Feedback
1. This is incorrect. Blood constituents such as norepinephrine and epinephrine are produced by
the adrenal glands, and each constituent affects the vasculature’s function differently and may
have detrimental effects.
2. This is correct. Blood levels of CPKmb and troponin are measured to confirm myocardial
infarction.
3. This is correct. Blood level of the lysosomal enzyme is measured to confirm myocardial
infarction.
4. This is incorrect. Acetylcholineare is a vasodilating substance produced by the endothelial
cells and may have detrimental effects.
5. This is correct. Blood level of the lysosomal enzyme, CPKmb, is measured to confirm
myocardial infarction.
25. ANS: 1, 3, 4
21
Objective: N/A
Heading: Significance of Endothelial Cell Injury

Level: Application [Applying]
Feedback
1. This is correct. Depletion of endothelial nitric oxide can impede the dilatory capacity of
arteries, thus affecting blood flow. Restriction of coronary artery blood flow to the heart can
have a serious negative effect on cardiac health.
2. This is incorrect. Helicobacter pylori is a bacterium that causes peptic ulcers in the
gastrointestinal system.
3. This is correct. LDL cholesterol accumulates to form atherosclerotic plaque along the artery
walls and directly impacts cardiac health.
4. This is correct. Endothelial injury causes inflammation, which in turn causes diminished
vasodilatory capacity of the artery. This results in LDL cholesterol deposition and clot
formation in coronary arteries, resulting in a detrimental effect on cardiac health.
5. This is incorrect. Acid reflux irritates the lower esophageal cells, causing inflammation of the
esophagus. Prolonged irritation and lack of treatment could lead to a condition known as
Barrett’s esophagus.

Chapter 4: Stress, Exercise, and Immobility
Multiple Choice
1. Which is an example of eustress?
1. Job promotion
2. Death of a friend
3. Unemployment
4. Divorce
2. A client is scheduled for a heart valve replacement. Which strategic action of the primary healthcare provider
enhances the client’s adaptive ability and coping mechanism to reduce stress?
1. Encouraging a family member to stay with the client in the pre-operative setting
2. Permitting a family member to stay in the operation theater
3. Administering epinephrine to reduce stress
4. Restricting the family members from talking to the client in the pre-operative setting
3. In which stage of Hans Selye’s general adaptation syndrome is the sympathetic nervous system (SNS)
activated?
1. Alarm stage
2. Resistance stage
3. Exhaustion stage
4. Homeostasis
4. What is polysomnography?
1. A diagnostic test to examine sleep patterns
2. A diagnostic test to examine eye movement
3. A diagnostic test to examine respiratory functions
4. A diagnostic test to examine electrical activity of the brain
5. Which problem is a 55-year-old client most likely to exhibit as a result of prolonged benzodiazepine use?
1. Unstable gait
2. Bradycardia
3. Dyspnea
4. Anuria
6. A client who has been taking an antidepressant for 10 days complains of depression and does not find the
medication to be effective. Which is the best response by the nurse?
1. “I will increase the drug dosage after informing the physician”
2. “The medication will take at least 3 weeks to be effective.”
3. “I will change the medication after informing the physician.”
4. “Stop taking the medication.”
7. Which is the most commonly used over-the-counter sleep aid?
1. Diphenhydramine (Benadryl)
2. Phenylephrine (Neo-Synephrine)
3. Pseudoephedrine (Sudafed)
4. Acetylcholine (Miochol)

8. A registered nurse is explaining the effects of exercise on cardiovascular system to a student nurse. Which
statement by the student nurse indicates effective teaching?
1. “Exercise prevents thrombus formation.”
2. “Exercise increases fibrinogen levels.”
3. “Exercise prevents angiogenesis.”
4. “Exercise increases the heart’s efficiency by decreasing cardiac muscle mass.”
9. A client is on long-term bed rest. Which condition might the client develop due to immobility?
1. Orthostatic hypotension
2. Venous stasis
3. Hypertension
4. Dyspnea
10. A bedridden client has frequent gastrointestinal reflux. Which condition might the client develop due to
gastrointestinal reflux?
1. Aspiration pneumonia
2. Hypotension
3. Hyperthermia
4. Constipation
11. A nurse is providing care for a client, who is on bed rest due to immobility. Which measure does the nurse
adopt in order to counteract the ill effects of immobility?
1. Assess the client’s skin for erythema.
2. Place the client in prone position.
3. Avoid seating the client on a chair.
4. Change the position of the client every 4 hours.
12. A client was hospitalized due to immobility. The blood report after one month of hospitalization shows that
the client has developed septicemia. Which factor could have caused septicemia?
1. Erythema
2. Decubitus ulcer
3. Antibacterial drugs
4. Excessive exercise
13. A client, who is on prolonged bed rest, has developed kidney stones. Which factor could have caused kidney
stones?
1. Change in the levels of glucose
2. Change in the levels of growth hormone
3. Change in the levels of thyroid hormone
4. Change in the levels of parathyroid hormone
14. Which statement is correct regarding the effects of exercise?
1. Enlarges the muscle fibers
2. Decreases the rate of breathing
3. Increases the risk of colon cancer
4. Decreases the number of mitochondrial enzymes
15. What is the effect of physical activity on gastrointestinal system?
1. Increases constipation
2. Improves peristaltic movement
3. Increases the risk of diverticulosis

4. Increases the risk of inflammatory bowel diseases
16. Which condition commonly found in inactive clients results in edema?
1. Venous stasis
2. Pulmonary embolism
3. Hypertension
4. Orthostatic hypotension
17. What is the result of decreased cardiac output in a client, who is on a prolonged bed rest?
1. Increase in stroke volume
2. Increase in heart rate
3. Increase in venous returns
4. Increase in diastolic volume
18. What happens when nitric-oxide dependent vasodilation occurs in the coronary arteries?
1. Increase in platelet activation
2. Increase in thrombus formation
3. Increase in myocardial perfusion
4. Increase in endothelial inflammation
19. What is the physiological change that occurs in stage 5 of the sleep cycle?
1. Heart rate decreases
2. Breathing becomes rapid
3. Breathing becomes regular
20. Which stage of sleep makes it difficult to wake someone?
1. Stage 1
2. Stage 2
3. Stage 3
4. Stage 5
NARRBEGIN: Exhibit
Exhibit
NARREN
D
21. A nurse is assessing the sleep history of different clients for obstructive sleep apnea (OSA). Which signs
could indicate that the client has OSA?
Client 1 Client 2 Client 3 Client 4
Excessive daytime
sleepiness, snoring, and
repetitive pauses in
breathing during sleep
Drowsiness during
daytime, able to sleep
only 6 hours at night,
snoring, and leg cramps
at night
Difficulty getting back to
sleep after waking during
the night, hallucinations
when awake, and jerking
of the legs during sleep
Sleepwalking,
nightmares, and leg
cramps at night
1. Client 1
2. Client 2
3. Client 3
4. Client 4

Multiple Response
22. A client is on prolonged bed rest. What are the psychological changes the client would exhibit? Select all that apply.
1. Increased anxiety
2. Increased mood swings
3. Altered tactile responses
4. Increased levels of concentration
5. Increased problem solving ability
23. What gastrointestinal changes are seen in clients on bed rest? Select all that apply.
1. Slowed peristalsis
2. Diminished appetite
3. Increased diaphragm strength
4. Increased rate of intestinal absorption
5. Decreased abdominal and pelvic muscle strength
24. Which nutritional advice given by a nurse to a client under stress is appropriate? Select all that apply.
1. “Eat a heavy meal before bedtime.”
2. “Consume more soy products.”
3. “Drink a glass of milk before going to bed.”
4. “Add peanuts and brown rice to your diet.”
5. “Add spinach and green vegetables to your diet.”
Completion
Complete each statement.

25. A 50-year-old male client is scheduled for a cardiac exercise stress test. The predicted maximal heart rate in
beats/minute is
Chapter 4: Stress, Exercise, and Immobility
Answer Section
MULTIPLE CHOICE
1. ANS: 1
Chapter: Chapter 4, Stress, Exercise, and Immobility Page:
55
Objective: N/A
Difficulty: Easy
Heading: Stress, Exercise, and Immobility Integrated
Concept: Stress
Feedback
1 Eustress is the stress that motivates an individual positively. Ajob promotion is an
example of eustress as it gives positive feelings.
2 Distress is defined as the stress that induces negative sentiments and adverse reactions.
3 Unemployment does not motivate an individual and the situation evokes negative
feelings.
4 Divorce is generally stressful and individuals may suffer from depression during the
separation or divorce.
PTS: 1 CON: Stress
2. ANS: 1
56
Objective: N/A
Difficulty: Easy
Heading: The Effects of Stress Integrated
Concept: Stress
Feedback
1 The primary healthcare provider can improve the client’s adaptive ability and coping
mechanism by encouraging the client’s family members to stay with the client in the pre-
operative setting and also during the recovery phase.
2 The primary health care provider should not allow the family members to stay in the
operation theater.
3 Epinephrine is administered by the primary healthcare provider to the client during

emergency conditions such as severe allergic reactions.
4 The primary healthcare provider should encourage the family members to talk with the
client in the pre-operative setting to improve the adaptive ability of the client.
PTS: 1 CON: Stress
3. ANS: 1
56
Objective: N/A
Difficulty: Easy
Heading: The Effects of Stress
Concept: Stress
Feedback
1 In the alarm stage, the sympathetic nervous system (SNS) is activated. The SNS releases the
catecholamine norepinephrine which increases alertness and stimulates the vascular
responses and cardio-respiratory responses.
2 In the resistance stage, the body attempts to stave off the effects of stress through
continual hormone secretion.
3 In the exhaustion stage, the body’s resources are exhausted and signs of systemic
dysfunction occur. Stress overwhelms the body’s ability to defend itself in this stage.
4 Homeostasis is a condition of equilibrium when various physiological parameters such as
heart rate, blood pressure, respiration rate, blood glucose, and so on are within normal range.
PTS: 1 CON: Stress
4. ANS: 1
61
Objective: N/A
Difficulty: Easy
Heading: Treatment of Stress Integrated
Client Need: Physiological Integrity: Basic Care and Comfort Cognitive
Concept: Sleep, Rest, and Activity
Feedback
1 Polysomnography is a diagnostic test used to diagnose sleep patterns.
2 Eye movements are examined in a polysomnography; however, this is not the main
purpose of the test
3 Respiratory functions will be assessed in a polysomnography; however, this is not the
main purpose of the test.
4 Electrical activities of the brain will be analyzed in a polysomnography; however, this is

PTS: 1 CON: Sleep, Rest, and Activity
5. ANS: 1
64
Objective: N/A
Concept: Medication
Feedback
1 If a client takes sedatives on a long-term basis it might result in an unstable gait.
2 Bradycardia is abnormally slow heart rate. Long term use of sedatives does not result in
abnormally slow heart rate.
3 Dyspnea is difficulty breathing or labored breathing. Using sedatives for a long time
does not result in labored breathing.
4 Taking sedatives for a long period of time does not affect urine formation. It will not
cause anuria.
PTS: 1 CON: Medication
6. ANS: 2
64
Objective: N/A
Concept: Medication
Feedback
1 The nurse cannot increase the drug dosage. Only the physician can increase or decrease
the prescribed drug dosage.
2 Antidepressants generally require at least 3 weeks to reach the therapeutic level in the
blood. Once the therapeutic blood level is attained, the effects of the medications can be
seen. Ten days is too soon to assess the effectiveness of the medication.
3 The nurse cannot change the medication. Only the physician can change the medication.
4 The nurse cannot advise the client to stop the medication without notifying the physician
and getting information from the physician.
PTS: 1 CON: Medication
7. ANS: 1
not the main purpose of the test.

64
Objective: N/A
Difficulty: Easy
Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive
Concept: Medication: Sleep, Rest, and Activity
Feedback
1 The most commonly used over-the-counter-sleep aid is diphenhydramine (Benadryl).
2 Phenylephrine (Neo-Synephrine) is a decongestant. However, insomnia is a common
side effect of this medication.
3 Pseudoephedrine (Sudafed) is also used to relieve congestion caused by cold and
allergies, but this medication can interfere with sleep.
4 Acetylcholine (Miochol is a neurotransmitter released by nerves. It is not a sleep aid.
PTS: 1 CON: Medication: Sleep, Rest, and Activity
8. ANS: 1
65
Objective: N/A
Heading: The Beneficial Effects of Exercise
Integrated Processes: Teaching/Learning: Client Need: Safe and Effective Care Environment: Management of
Care
Cognitive Level: Evaluation [Evaluating] Concept:
Clotting
Feedback
1 Exercise prevents thrombus formation. Exercise improves vascular endothelial function.
The vascular endothelium responds to exercise by producing vasodilator compounds,
which widen the arterial blood vessels and prevents thrombus formation.
2 Exercise lowers fibrinogen levels. Fibrinogen is an indicator of active clot formation.
Therefore, exercise is believed to have anti-atherogenic effect on the endothelium, which
prevents clot formation.
3 Exercise stimulates angiogenesis. Angiogenesis is the growth of collateral blood vessels.
4 Exercise increases heart’s efficiency by promoting cardiac muscle mass and growth of
coronary vessel branches.
PTS: 1 CON: Clotting
9. ANS: 2
67
Objective: N/A

Heading: The Harmful Effects of Physical Inactivity and Immobility
Concept: Clotting: Sleep, Rest, and Activity
Feedback
1 Orthostatic hypotension might occur when a client tries to resume to upright position
after a prolonged period of bed rest. The symptoms of orthostatic hypotension are
dizziness and tachycardia, among others.
2 Clients on bed rest might develop venous stasis. Venous stasis is the risk of forming
blood clots in the veins of the legs.
3 Hypertension does not develop because of immobility.
4 Dyspnea or difficulty breathing does not develop because of immobility.
PTS: 1 CON: Clotting: Sleep, Rest, and Activity
10. ANS: 1
69
Objective: N/A
Concept: Bowel Elimination: Sleep, Rest, and Activity
Feedback
1 A bedridden client might be at a high risk of gastroesophageal reflux, which can cause
gastric contents to enter into the lungs and result in aspiration pneumonia.
2 Hypotension is reduced blood pressure. Gastroesophageal reflux does not reduce the
blood pressure of the client.
3 Hyperthermia is above normal body temperature. Gastroesophageal reflux does not alter
the body temperature of the client.
4 Gastroesophageal reflux does not cause constipation. However, the antacids that contain
aluminum light cause constipation.
PTS: 1 CON: Bowel Elimination: Sleep, Rest, and Activity
11. ANS: 1
72
Objective: N/A
Heading: Interventions to Counteract Effects of Immobility
Client Need: Physiological Integrity: Reduction of Risk Potential

Concept: Sleep, Rest, and Activity, Skin Integrity, Safety
Feedback
1 The nurse should assess the client’s skin for areas of erythema and irritation periodically.
This can help in preventing the development of decubitus ulcers.
2 The nurse should not place the client in prone position for a prolonged period, because it
hinders chest excursion. Clients should be turned sideways periodically.
3 The nurse should seat the client on a chair for a part of the day and ambulate small
distances.
4 The nurse should change the position of the client every 2 hours. This will help in
preventing skin breakdown and decubitus ulcers.
PTS: 1 CON: Sleep, Rest, and Activity, Skin Integrity, Safety
12. ANS: 2
72
Objective: N/A
Heading: Interventions to Counteract Effects of Immobility Integrated
Concept: Skin Integrity: Infection: Mobility: Sleep, Rest, and Activity
Feedback
1 Erythema is redness of the skin. It has to be assessed periodically to prevent decubitus
ulcer.
2 Decubitus ulcers are vulnerable to bacterial contamination and infection. These
infections can enter the blood stream and cause septicemia.
3 Antibacterial drugs do not cause septicemia. They are used to treat septicemia.
4 Excessive exercise does not cause septicemia. Exercise rebuilds muscles, improves
pulmonary function, and makes the bones strong.
PTS: 1 CON: Skin Integrity: Infection: Mobility: Sleep, Rest, and Activity
13. ANS: 4
71
Objective: N/A
Heading: Metabolic and Endocrine System Changes
Concept: Metabolism: Urinary Elimination: Mobility: Sleep, Rest, and Activity
Feedback
1 After 2 weeks of bed rest, peripheral cellular glucose uptake decreases by 50% and blood

glucose levels increase. This forces the increased production of insulin by the pancreas.
2 Immobility leads to changes in the levels of growth hormones. Cardiac rhythm and trough
levels of hormones change, which leads to changes in appetite, sleep, and mood.
3 Changes in thyroid hormone occur due to immobility. Cardiac rhythm and trough levels of
hormones change which leads to changes in appetite, sleep and mood.
4 Parathyroid hormone levels are increased due to immobility. This stimulates osteoclastic
activity and bone degeneration, which leads to increased amount of calcium in blood
stream. Excess calcium, which reaches kidney precipitates and forms kidney stones.
PTS: 1 CON: Mobility: Urinary Elimination: Sleep, Rest, and Activity
14. ANS: 1
66
Objective: N/A
Difficulty: Easy
Heading: The Beneficial Effects of Exercise Integrated
Concept: Sleep, Rest, and Activity
Feedback
1 Exercise enlarges the muscle fibers. With isometric exercise, muscles can hypertrophy,
which will result in increase in the size of the muscles.
2 Exercise increases the rate and depth of breathing. This in turn increases the blood’s
oxygenation.
3 Exercise decreases the risk of colon cancer by maintaining the energy balance, hormone
metabolism, and decreasing the time the colon is exposed to potential carcinogens.
4 Exercise increases the number of mitochondrial enzymes. This would help in improving
the body to generate more energy.
PTS: 1 CON: Sleep, Rest, and Activity
15. ANS: 2
67
Objective: N/A
Difficulty: Easy
Heading: The Beneficial Effects of Exercise Integrated
Concept: Bowel Elimination: Digestion
Feedback
1 Exercise counteracts constipation by stimulating natural contraction of intestinal
muscles.
2 Peristaltic movement is the involuntary contraction of smooth gastrointestinal muscles

that causes food to move through the digestive tract. Exercise improves the peristaltic
movement.
3 Diverticulosis is the condition where pouches are developed on the walls of the colon.
Exercise decreases the risk of developing diverticulosis.
4 Inflammatory bowel diseases are diseases of colon and small intestine. Exercise
decreases the risk of inflammatory bowel diseases.
PTS: 1 CON: Bowel Elimination: Digestion
16. ANS: 1
68
Objective: N/A
Difficulty: Easy
Concept: Clotting, Hematological Regulation, Mobility
Feedback
1 Venous stasis is a condition characterized by the stagnation of venous blood in the lower
extremities of the body. This is mainly due to immobility. It increases the hydrostatic
pressure of the legs which is then transmitted into the capillaries. Fluid is displaced from
the blood into the interstitial tissue forming edema due to the pressure.
2 Clients who are immobile and have venous insufficiency are at high risk of developing
pulmonary embolism. A venous clot formed due to venous blood stagnation, travels to
the right ventricle. From there it is pumped into the pulmonary artery, resulting in
pulmonary embolism.
3 Hypertension or increased blood pressure does not result in edema.
4 Orthostatic hypotension occurs as a client attempts to resume an upright position after a
prolonged period of bed rest. The client experiences a delay in arterial vasoconstriction
and a temporary drop in blood pressure.
PTS: 1 CON: Clotting, Hematological Regulation, Mobility
17. ANS: 2
68
Objective: N/A
Difficulty: Easy
Cardiovascular System Changes
Concept: Hematological Regulation: Mobility: Perfusion
Feedback

IF YOU WANT THIS TEST BANK OR
SOLUTION MANUAL EMAIL ME
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ALL CHAPTERS IN PDF FORMAT
IF YOU WANT THIS TEST BANK OR
SOLUTION MANUAL EMAIL ME
kevinkariuki227@gmail.com TO RECEIVE
ALL CHAPTERS IN PDF FORMAT

Test bank for davis advantage for pathophysiology 2nd edition by caprio.pdf

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Test bank for davis advantage for pathophysiology 2nd edition by caprio.pdf