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

Question 21

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


A. A client does isotonic exercises in a wheelchair.

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

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

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

Question 22

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


A. Lymphocytes

B. Neutrophils

C. Eosinophils

D. Basophils

Question 23

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


A. The client is cachexic and an African American.

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

C. The client is HIV positive and homeless.

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

Question 24

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


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

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

C. The test displayed low sensitivity but high specificity.

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

Question 25

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


A. having a kidney-shaped nucleus.

B. having no nuclei.

C. lacking granules.

D. shaped like a sphere with multilobar nuclei.

Question 26

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


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

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

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

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

Question 27

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


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

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

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

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

Question 28

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


A. Growth factors and cytokines

B. Natural killer cells and granulocytes

C. Neutrophils and eosinophils

D. T lymphocytes and natural killer cells

Question 29

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


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

B. Mitochondrial DNA is inherited patrilineally.

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

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

Question 30

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


A. Infections

B. Jaundice

C. Blood clots

D. Anemia

Question 31

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


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

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

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

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

Question 32

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


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

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

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

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

Question 33

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


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

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

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

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

Question 34

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


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

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

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

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

Question 35

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


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

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

C. Intravenous immunoglobulin (IVIG) treatment; thyroidectomy

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

Question 36

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


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

B. The woman complains of recent debilitating fatigue.

C. Her neoplasm originates in secondary lymphoid structures.

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

Question 37

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


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

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

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

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

Question 38

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


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

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

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

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

Question 39

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


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

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

C. An African American man who leads a sedentary lifestyle

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

Question 40

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


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

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

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

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

Question 41

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


A. chronic obstructive pulmonary disease.

B. congenital heart defects and anemia.

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

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

Question 42

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


A. Increasing the functional ability of the underactive dopaminergic system

B. Maximizing acetylcholine release from synaptic vesicles at neuromuscular junctions

C. Preventing axonal degradation of motor neurons

D. Preventing demyelination of the efferent cerebellar pathways

Question 43

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


A. Selective IgA deficiency

B. Ataxia–telangiectasia

C. A deficiency in IgG2 subclass antibodies

D. Chronic granulomatous disease

Question 44

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


A. Active transport

B. Diffusion

C. Osmosis

D. Facilitated diffusion

Question 45

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


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

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

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

D. “Multifactorial disorders manifest themselves at birth.”

Question 46

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


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

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

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

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

Question 47

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


A. left ventricular hypertrophy.

B. pulmonary hypertension.

C. organ damage and hypovolemic shock.

D. orthostatic hypotension.

Question 48

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


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

B. “Your son has a huge laceration inside his brain where the bat hit his skull.”

C. “Your son has a contusion of the brain at the site where the bat hit his head.”

D. “When the bat hit his head, his neck jerked backward causing injury to the spine.”

Question 49

Which of the following individuals is likely to have the best prognosis for recovery from his or her insult to the peripheral nervous system? An adult 


A. who had nerves transected during surgery to remove a tumor from the mandible.

B. who developed rhabdomyolysis and ischemic injury after a tourniquet application.

C. who suffered a bone-depth laceration to the shoulder during a knife attack.

D. who had his forearm partially crushed by gears during an industrial accident.

Question 50

A woman gives birth to a small infant with a malformed skull. The infant grows abnormally slowly and shows signs of substantial cognitive and intellectual deficits. The child also has facial abnormalities that become more striking as it develops. What might you expect to find in the mother’s pregnancy history? 


A. Active herpes simplex infection

B. Chronic alcohol use

C. Chronic cocaine use

D. Folic acid deficiency

Question 51

A teenager, exposed to West Nile virus a few weeks ago while camping with friends, is admitted with headache, fever, and nuchal rigidity. The teenager is also displaying some lethargy and disorientation. The nurse knows which of the following medical diagnoses listed below may be associated with these clinical manifestations? 


A. Spinal infection

B. Encephalitis

C. Lyme disease

D. Rocky Mountain spotted fever

Question 52

The homecare nurse is making a home visit to a 51-year-old female client with a long-standing diagnosis of multiple sclerosis. The nurse knows that the muscle wasting and weakness associated with the disease process are ultimately manifested as a failure of what normal process in muscle tissue? 


A. The contraction of fascicles within myofibrils

B. The contraction of the epimysium

C. The surrounding of fascicles by perimysium

D. Thick myosin and thin actin filaments sliding over each other

Question 53

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


A. a mild viral infection.

B. a severe fungal infection.

C. a mild parasitic infection.

D. a severe bacterial infection.

Question 54

The nurse knows that which of the following treatment plans listed below is most likely to be prescribed after a computed tomography (CT) scan of the head reveals a new-onset aneurysmal subarachnoid hemorrhage? 


A. Monitoring in the ICU for signs and symptoms of cerebral insult

B. Stat administration of tissue plasminogen activator (tPA)

C. Administration of a diuretic such as mannitol to reduce cerebral edema and ICP

D. Craniotomy and clipping of the affected vessel

Question 55

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


A. Injections of allergens simulate production of IgG, combining with the antigens to prevent activation of IgE antibodies.

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

C. Allergens in large, regular quantities overwhelm the IgE antibodies that mediate the allergic response.

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

Question 56

Two nursing students are attempting to differentiate between the presentations of immune thrombocytopenic purpura (ITP) and thrombotic thrombocytopenic purpura (TTP). Which of the students’ following statements best captures an aspect of the two health problems? 


A. “Both diseases can result from inadequate production of thrombopoietin by megakaryocytes.”

B. “Both of them involve low platelet counts, but in TTP, there can be more, not less, hemostasis.

C. “TTP can be treated with plasmapheresis, but ITP is best addressed with transfusion of fresh frozen plasma.”

D. “ITP can be either inherited or acquired, and if it’s acquired, it involves an enzyme deficiency.”

Question 57

A 37-year-old male with HIV who has recently become symptomatic has begun highly active antiretroviral therapy (HAART). Among the numerous medications that the man now regularly takes are several that inhibit the change of HIV RNA to DNA in a CD4+ cell. Which of the following classes of medications addresses this component of the HIV replication cycle? 


A. Protease inhibitors

B. Entry inhibitors

C. Non-nucleoside reverse transcriptase inhibitors

D. Integrase inhibitors

Question 58

A male international business traveler has returned from a trip to Indonesia. While there, he hired a prostitute for companionship and engaged in unprotected sex on more than one occasion. Unbeknownst to him, this prostitute harbored the hepatitis C virus. Upon return to the United States, he exhibited no symptoms and returned to his usual activities. During this period of no outward symptoms, the man would be classified as being in 


A. the clinical disease stage of hepatitis C.

B. the preclinical stage of disease.

C. the chronic phase of hepatitis C.

D. remission and unlikely to develop hepatitis C.

Question 59

A group of nursing students were studying for their pathophysiology exam by quizzing each other about disorders of WBCs and lymphoid tissue. When asked what the first chromosomal abnormality that identified cancer was, one student correctly answered 


A. Philadelphia.

B. interleukin cells.

C. BRCA-1.


Question 60

A school nurse is teaching high school students about HIV and AIDS in the context of the school’s sexual health curriculum. Which of the students’ following statements would the nurse most likely want to correct or clarify? 


A. “Lots more heterosexual people get HIV these days than they used to.”

B. “Drugs for AIDS reduce the virus in your body, but they don’t get rid of it.”

C. “They have to take a blood sample from you in order to test you for AIDS.”

D. “Condoms provide really good protection from AIDS.”

Question 61

A nurse on a neurology unit is assessing a female brain-injured client. The client is unresponsive to speech, and her pupils are dilated and do not react to light.She is breathing regularly, but her respiratory rate is 45 breaths/minute. In response to a noxious stimulus, her arms and legs extend rigidly. What is her level of impairment? 


A. Delirium

B. Coma

C. Vegetative state

D. Brain death

Question 62

Following a motor vehicle accident 3 months prior, a 20-year-old female who has been in a coma since her accident has now had her condition declared a persistent vegetative state. How can her care providers most accurately explain an aspect of her situation to her parents? 


A. “Your daughter has lost all her cognitive functions as well as all her basic reflexes.”

B. “Your daughter’s condition is an unfortunate combination with total loss of consciousness but continuation of all other normal brain functions.”

C. “Though she still goes through a cycle of sleeping and waking, her condition is unlikely to change.”

D. “If you or the care team notices any spontaneous eye opening, then we will change our treatment plan.”

Question 63

Which of the following patients would be considered to be in the latent period of HIV infection? 


A. A 33-year-old heroin drug abuser who has numerous enlarged lymph nodes in his axilla and cervical neck region for the past 4 months

B. A 24-year-old college student who has developed a chronic cough that will not go away, even after taking two courses of antibiotics.

C. A 45-year-old alcohol abuser who is complaining of excessive vomiting of blood that started 2 weeks ago

D. A 16-year-old prostitute who has open sores on her labia that drain purulent secretions

Question 64

When discussing the sequence of clot dissolution, the science instructor will talk about which item that begins the process? 


A. Plasminogen

B. α-plasmin inhibitor

C. Dabigatran

D. Platelets

Question 65

A 30-year-old male’s blood work and biopsies indicate that he has proliferating osteoclasts that are producing large amounts of IgG. What is the man’s most likely diagnosis? 


A. Multiple myeloma

B. Acute lymphocytic leukemia

C. Hodgkin lymphoma

D. Acute myelogenous leukemia

Question 66

A client with a gastrointestinal bleed secondary to alcohol abuse and a hemoglobin level of 5.8 g/dL has been ordered a transfusion of packed red blood cells. The client possesses type B antibodies but lacks type D antigens on his red cells. Transfusion of which of the following blood types would be least likely to produce a transfusion reaction? 


A. A+

B. B–

C. A–

D. B+

Question 67

A nurse is providing care for a 17-year-old boy who has experienced recurrent sinus and chest infections throughout his life and presently has enlarged tonsils and lymph nodes. Blood work indicated normal levels of B cells and free immunoglobulins but a lack of differentiation into normal plasma cells. The boy is currently receiving intravenous immunoglobulin (IVIG) therapy. What is the boy’s most likely diagnosis? 


A. X-linked hypogammaglobulinemia

B. Transient hypoglobulinemia

C. Common variable immunodeficiency

D. IgG subclass deficiency

Question 68

A patient diagnosed with H pylori asks the nurse, “How an infection can occur in the stomach since it is an acid environment?” The nurse responds, 


A. “This parasite secretes an enzyme called coagulase, which protects the pathogen from the antibodies.”

B. “H. pylori produces an enzyme called urease that converts gastric juices into ammonia, which neutralizes the acidic stomach environment.”

C. “H. pylori is a virus and is still being researched as to how it is able to survive in the stomach acids.”

D. “We have many infectious agents that can live in an acidic environment with a pH more than 8.0.”

Question 69

The family members of an elderly patient are wondering why his “blood counts” are not rising after his last GI bleed. They state, “He has always bounced back after one of these episodes, but this time it isn’t happening. Do you know why?”The nurse will respond based on which of the following pathophysiological principles? 


A. “Everything slows down when you get older. You just have to wait and see what happens.”

B. “Due to stress, the red blood cells of older adults are not replaced as promptly as younger people.”

C. “Don’t worry about it. We can always give him more blood.”

D. “The doctor may start looking for another cause of his anemia, maybe cancer of the bone.”

Question 70

A 14-year-old boy is participating in his school’s track meet; the outdoor temperature is 99°F, and a teacher has found the boy sitting restless in the shade and disoriented to time. The teacher notes that the student has dry skin in spite of the high temperature and the fact that he has recently completed a running event. The teacher calls for the school nurse, who will recognize which of the following potential diagnoses and anticipated hospital treatments? 


A. Heat exhaustion, likely treated with oral rehydration with cool water

B. Heat stroke, likely treated with rehydration by intravenous hypotonic solution

C. Heat stroke, likely treated with submersion in cold water

D. Heat exhaustion, likely treated with rest, shelter from the sun, and salt tablets