DEPARTMENT OF GENERAL NURSING

MODULE NAME: PATHOPHYSIOLOGY

SECTION A. MULTIPLE CHOICE QUESTIONS /107 Marks

1. Gas exchange between the lungs and blood and between the blood and tissues is called:
a. Active transport.
b. Respiration.
c. Ventilation.
d. Cellular respiration.

2. Nursing responsibilities before the thoracentesis should include:

a. Informing Mrs. Lomar about pressure sensations that will be experienced during
the procedure.
b. Making sure that chest imaging ordered in advance have been completed.
c. Seeing that the consent form has been explained and signed.
d. All of the above.

3. Streptococcus pneumoniae is the most common organism responsible for which of the
following types of pneumonia?
a. Hospital-acquired
b. Immunocompromised
c. Aspiration-specific
d. Community-acquired

4. A key characteristic feature of adult respiratory distress syndrome (ARDS) is:

a. Unresponsive arterial hypoxemia.
b. Diminished alveolar dilation.
c. Tachypnea.
d. Increased pao2.

5. Clinical manifestations directly related to cor pulmonale include all of the following
except:
a. Dyspnea and cough.
b. Diminished peripheral pulses.
c. Distended neck veins.
d. Edema of the feet and legs.

6. A patient is admitted with anemia. The nurse plans to assess circulation in the lower
extremities every two hours. Which of the following outcome criteria would the nurse
use?
 a. Body temperature of 99°F or less
b. Toes moved in active range of motion
c. Sensation reported when soles of feet are touched
d. Capillary refill of less than 2 to 3 seconds

7. The patient has got community acquired pneumonia and developed pleural effusion.
The physician has scheduled a thoracentesis on your duty. The patient asks why there is
so much fluid in the pleural space. The best response is:
a. An error occurred and you were administered too much IV medication.
b. Your body is unable to remove fluid, resulting in a build-up of fluid in the pleural
space around your lungs.
c. This is the result of oxygen therapy.
d. This is a normal side effect of antibiotics given to treat pneumonia.

8. Cardiac tamponade is a serious medical condition in which blood or fluids fill the space
between the sac that encases the heart and the heart muscle. Beck's triad among the
signs and symptoms of the cardiac tamponade include all the following except:
a. Hypotension,
b. Increased cardiac output due to tachycardia
c. Soft or absent heart sounds,
d. Jugular venous distention.

9. The patient with advanced cirrhosis develops the ascites and asks why his abdomen is
so swollen. The nurse’s response is based on the knowledge that
a. A lack of clotting factors promotes the collection of blood in the abdominal cavity.
b. Portal hypertension and hypoalbuminemia cause a fluid shift into the peritoneal
space.
c. Decreased peristalsis in the gi tract contributes to gas formation and distention of
the bowel.
d. Bile salts in the blood irritate the peritoneal membranes, causing edema and
pocketing of fluid.

10. Ascites refers to the condition in which there is accumulation of fluid in the peritoneal
cavity; the following conditions are contributing factors of ascites except:
a. Elevated levels of aldosterone
b. Hypertension
c. Low levels of albumin
d. Elevated levels of angiotensin I
11. The patient has a diagnosis of a biliary obstruction from gallstones. What type of
jaundice is the patient experiencing and what serum bilirubin results would be
expected?
a. Hemolytic jaundice with normal conjugated bilirubin
b. Posthepatic icteris with decreased unconjugated bilirubin
c. Obstructive jaundice with elevated unconjugated and conjugated bilirubin
d. Hepatocellular jaundice with altered conjugated bilirubin in severe disease

12. DIC (disseminated intravascular coagulopathy) is a disorder in which:

a. The coagulation pathway is genetically altered, leading to thrombus formation in all
major blood vessels.
b. An underlying disease depletes hemolytic factors in the blood, leading to diffuse
thrombotic episodes and infarcts.
c. A disease process stimulates coagulation processes with resultant thrombosis, as
well as depletion of clotting factors, leading to diffuse clotting and hemorrhage.
d. An inherited predisposition causes a deficiency of clotting factors that leads to
overstimulation

13. The type of shock that occurs as result from severe blood loss or loss of fluid from
circulation, either directly or indirectly resulting in poor perfusion and oxygenation is:
a. Distributive shock
b. Hypovolemic shock
c. Septic shock
d. Cardiogenic shock

14. The nurse is aware that a major difference between Hodgkin’s lymphoma and non-
Hodgkin’s lymphoma is that:
a. Hodgkin lymphoma occurs only in young adults.

b. Hodgkin’s lymphoma is considered potentially curable.

c. Non-Hodgkin lymphoma can manifest in multiple organs.

d. Non-Hodgkin lymphoma is treated only with radiation therapy.

15. The common feature of the leukemia is:

a. A compensatory polycythemia stimulated by thrombocytopenia.
b. An unregulated accumulation or proliferation of white cells in the bone marrow,
which replace normal marrow elements.
c. Increased blood viscosity, resulting from an overproduction of white cells.
d. Reduced plasma volume in response to a reduced production of cellular elements.
16. To treat a cirrhotic patient with hepatic encephalopathy, lactulose (duphalac)as laxative,
rifaximin (Xifaxan)as alpha- adrenergic blocker, and a proton pump inhibitor are
ordered. The patient’s family wants to know why the laxative is ordered. What is the
best explanation the nurse can give to the patient’s family?
a. It reduces portal venous pressure.
b. It eliminates blood from the GI tract.
c. It traps ammonia and eliminates it in the feces
d. It decreases bacteria to decrease ammonia formation.

17. All the following are the main characteristics of nephrotic syndrome, except:
a. Heavy proteinuria,
b. Pitting edema,
c. Hypoalbuminemia
d. Hematuria.

18. Two diseases common to the etiology of COPD are:

a. Asthma and atelectasis.
b. Chronic bronchitis and emphysema.
c. Pneumonia and pleurisy.
d. Tuberculosis and pleural effusions.

19. The underlying pathophysiology of COPD is:

a. Inflamed airways that obstruct airflow.
b. Mucus secretions that block airways.
c. Overinflated alveoli that impair gas exchange.
d. Characterized by variations of all of the above.

20. The pain of angina pectoris is produced primarily by:

a. Coronary vasoconstriction.
b. Movement of thromboemboli.
c. Myocardial ischemia.
d. The presence of atheromas.

21. The pathophysiology of emphysema is directly related to airway obstruction. The end
result of deterioration is:
a. Diminished alveolar surface area.
b. Hypercapnia resulting from decreased carbon dioxide elimination.
c. Hypoxemia secondary to impaired oxygen diffusion.
d. Respiratory acidosis due to airway obstruction.

22. Evelina, a 64-year-old female, is brought at Ruli Hospital in A&E Department for
management of chest pain caused by angina pectoris. As a caring nurse, you should know
that the basic cause of angina pectoris is believed to be:
 a. Dysrhythmias triggered by stress.
b. Insufficient coronary blood flow.
c. Minute emboli discharged through the narrowed lumens of the coronary vessels.
d. Spasms of the vessel walls owing to excessive secretion of epinephrine (adrenaline).

23. The nurse should be alert for a complication of bronchiectasis that results from a
combination of retained secretions and obstruction that leads to the collapse of alveoli.
This complication is known as:
a. Atelectasis.
b. Emphysema.
c. Pleurisy.
d. Pneumonia.

24. Stroke volume of the heart is determined by:

a. The degree of cardiac muscle strength (precontraction).
b. The intrinsic contractility of the cardiac muscle.
c. The pressure gradient against which the muscle ejects blood during contraction.
d. All of the above factors.

25. Incomplete closure of the tricuspid valve results in a backward flow of blood from the:
a. Aorta to the left ventricle.
b. Left atrium to the left ventricle.
c. Right atrium to the right ventricle.
d. Right ventricle to the right atrium.

26. Rheumatic endocarditis is an inflammatory reaction to mainly:

a. Group A, beta-hemolytic streptococcus.
b. Pseudomonas aeruginosa.
c. Serratia marcescens.
d. Staphylococcus aureus.

27. A client with angina pectoris (chest angina) complains that the anginal pain is
prolonged and severe and occurs at the same time each day, most often at rest in the
absence of precipitating factors. How would the nurse best describe this type of angina
pain?
a. Stable angina
b. Variant angina
c. Unstable angina
d. Nonanginal pain

28. The primary underlying disorder of pulmonary edema is:

a. Decreased left ventricular pumping.
b. Decreased right ventricular elasticity.
c. Increased left atrial contractility.
 d. Increased right atrial resistance.

29. The myocardial infarction pain is characterized as sudden severe chest pain. All these
are the descriptions of this pain except:
a. It is relieved by rest, inactivity and nitrates.
b. Is more severe and more persistent
c. It may be described as heavy and crushing
d. It radiates to the neck, jaw, back, shoulder or left arm.

30. The most characteristic symptom of pericarditis is:

a. Dyspnea and other signs and symptoms of heart failure.
b. Severe and retrosternal chest pain.
c. Fatigue and non-productive cough.
d. Uncontrolled restlessness and irritability.

31. The nurse knows that the anterior pituitary gland is responsible for secreting all of the
following except:
a. Adrenocorticotropic hormone (ACTH).
b. Antidiuretic hormone (ADH).
c. Follicle-stimulating hormone (FSH).
d. Thyroid-stimulating hormone (TSH).

32. Laboratory findings suggestive of Addison’s disease include all of the following except:
a. A relative lymphocytosis.
b. Hyperkalemia and hyponatremia.
c. Hypertension.
d. Hypoglycemia.

33. A positive diagnosis of Cushing’s syndrome is associated with:

a. The disappearance of lymphoid tissue.
b. A reduction in circulating eosinophils.
c. An elevated cortisol level.
d. All of the above.

34. A patient with aldosteronism would be expected to exhibit all of the following
symptoms except:
a. Alkalosis.
b. Hypokalemia.
c. Hyponatremia.
d. An increased PH.

35. A serious and most fatal consequence of pericarditis is:

a. Cardiac tamponade.
 b. Decreased venous return.
c. Decreased cardiac output.
d. Chronic constrictive pericarditis.

36. The type of shock that occurs when the heart’s ability to contract and to pump blood is
impaired and the supply of oxygen is inadequate for the heart and tissues resulting from to
myocardial infarction or other heart diseases is:
a. Hypovolemic shock
b. Septic shock
c. Distributive shock
d. Cardiogenic shock

37. The most common cause of the gastric and duodenal ulcers is:
a. Production of hydrochloric acid present into gastric juice
b. Abuse in the use of NSAID like Brufen and Aspirin
c. Cigarette smoking and drinking alcohol
d. Helicobacter pylori

38. What causes the anemia of sickle cell disease?

a. Intracellular hemolysis of sickled RBCs
b. Autoimmune antibody destruction of RBCs
c. Accelerated breakdown of abnormal RBCs
d. Isoimmune antibody-antigen reactions with RBCs

39. A patient with pneumonia has a nursing diagnosis of ineffective airway clearance
related fatigue, and thick secretions. What is the priority nursing intervention?
a. Monitoring of SPO2 using the pulse oximeter
b. Administration of antibiotics
c. Prepare for suctioning of the patient
d. To give the painkillers

Identify the acid-base imbalances represented by the following laboratory values:

A: /1mark
PH: 7.50
PaCO2: 30 mm Hg
HCO3−: 24 mEq/L

Answer:
1. pH >7.45 indicates alkalosis.
2. PaCO2 is low, indicating respiratory alkalosis.
3. HCO3− is normal.
4. Respiratory alkalosis matches the pH.
5. Although uncommon, if the HCO3− were decreased,compensation would be present.
Interpretation: Respiratory alkalosis

B: /1mark
PH: 7.62
PaCO2: 48 mm Hg
HCO3 −: 45 mEq/L

Answer:

1. pH >7.45 indicates alkalosis.

2. PaCO2 is high, indicating respiratory acidosis.
3. HCO3− is high, indicating metabolic alkalosis.
4. Metabolic alkalosis matches the pH.
5. The PaCO2 does not match the alkalotic pH but is inthe opposite direction, indicating that
the lungs are attempting to compensate for the alkalosis.
Interpretation: Metabolic alkalosis; partially compensated

40. The treatment of hyperkalemia includes administration of the drugs that will shift
potassium out of the vascular space and into the cells. This action is mainly assured by:
a. Calcium gluconate
b. Insulin therapy
c. Lasix
d. Sodium polystyrene sulfonate

41. The part of the long bone that actively produces bone to allow longitudinal growth in
children, and if injured can lead to a shorter extremity that can cause significant functional
problems is:
a. Epiphysis
b. Diaphysis
c. Epiphyseal plate
d. Metaphysis

42. The phase of fracture healing in which there is active phagocytosis, and granulation
tissues that produces new bone substance called osteoid is called:
a. Hematoma formation
b. Callus formation
c. Granulation tissue formation
d. Consolidation

43. The most common primary bone cancer, that occurs mostly in young between ages 10
and 25, and most often affect the bones of arms, legs, or pelvis is called:
 a. Ewing’s sarcoma
b. Osteosarcoma
c. Osteochondroma
d. Osteoclastoma

44. The burn that is characterized by severe pain due to nerve injury, mild to moderate
edema and the presence vesicles that are red and shiny and filled with fluid is classified as:
a. Third degree burn
b. First degree burn
c. Fourth degree burn
d. Second degree burn

45. What is the most common cause of acute pyelonephritis resulting from an ascending
infection from the lower urinary tract?
a. The kidney is scarred and fibrotic.
b. The organism is resistant to antibiotics.
c. There is a preexisting abnormality of the urinary tract.
d. The patient does not take all of the antibiotics for treatment of a UTI.

46. Glomerulonephritis is characterized by glomerular damage caused by

a. Growth of microorganisms in the glomeruli.
b. Release of bacterial substances toxic to the glomeruli.
c. Accumulation of immune complexes in the glomeruli.
d. Hemolysis of red blood cells circulating in the glomeruli.

47. What results in the edema associated with nephrotic syndrome?

a. Hypercoagulability
b. Hyperalbuminemia
c. Decreased plasma oncotic pressure
d. Decreased glomerular filtration rate

48. What indicates to the nurse that a patient with AKI is in the recovery phase?
a. A return to normal weight
b. A urine output of 3700 mL/day
c. Decreasing sodium and potassium levels
d. Decreasing blood urea nitrogen (BUN) and creatinine levels
49. In replying to a patient’s questions about the seriousness of her chronic kidney disease
(CKD), the nurse knows that the stage of CKD is based on what?
a. Total daily urine output
b. Glomerular filtration rate
c. Degree of altered mental status
d. Serum creatinine and urea levels
50. What causes the gastrointestinal (GI) manifestation of stomatitis in the patient with
CKD?
a. High serum sodium levels
b. Irritation of the GI tract from creatinine
c. Increased ammonia from bacterial breakdown of urea
d. Iron salts, calcium-containing phosphate binders, and limited fluid intake

51. What is the most serious electrolyte disorder associated with kidney disease?
a. Hypocalcemia
b. Hyperkalemia
c. Hyponatremia
d. Hypermagnesemia

52. Which complication of chronic kidney disease is treated with erythropoietin (EPO)?
a. Anemia
b. Hypertension
c. Hyperkalemia
d. Mineral and bone disorder
53. All the following are the characteristics of nephritic syndrome, except:
a. Decreased GFR
b. Hematuria
c. Oliguria
d. Hyperlipidemia

54. All the following are the main characteristics of nephrotic syndrome, except:
e. Heavy proteinuria,
f. Pitting edema,
g. Hypoalbuminemia
h. Hematuria.

55. After the surgeries that involve the head of femur replacement or hip replacement, the
nurse should include the following instructions when teaching a patient and caregiver,
except:
a. Use pillow between legs for first 6 weeks after surgery when lying on non-operative
side or when supine.
b. Place chair inside shower or tub and remain seated while washing.
c. Keep hip in neutral, straight position when sitting, walking, or lying.
d. Force hip into internal rotation and sometimes cross legs at knees or ankles.

56. What is the initial cause of hypovolemia during the emergent phase of burn injury?
a. Increased capillary permeability
b. Loss of sodium to the interstitium
c. Decreased vascular oncotic pressure
d. Fluid loss from denuded skin surfaces
57. The patient with osteoporosis had a spontaneous hip fracture. How should the nurse
document this before the x-ray results return?
a. Open fracture
b. Oblique fracture
c. Pathologic fracture
d. Greenstick fracture
58. A patient with a fractured femur experiences the complication of malunion. The nurse
recognizes that what happens with this complication?
a. The fracture heals in an unsatisfactory position.
b. The fracture fails to heal properly despite treatment.
c. Fracture healing progresses more slowly than expected.
d. Loss of bone substances occurs as a result of immobilization.

59. A patient complains of pain in the foot of a leg that was recently amputated. What
should the nurse recognize about this pain?
a. It is caused by swelling at the incision.
b. It should be treated with ordered analgesics.
c. It will become worse with the use of a prosthesis.
d. It can be managed with diversion because it is psychologic.
60. A patient with chronic osteomyelitis has been hospitalized for a surgical debridement
procedure. What does the nurse explain to the patient as the rationale for the surgical
treatment?
a. Removal of the infection prevents the need for bone and skin grafting.
b. Formation of scar tissue has led to a protected area of bacterial growth.
c. The process of depositing new bone blocks the vascular supply to the bone.
d. Antibiotics are not effective against microorganisms that cause chronic
osteomyelitis.
61. The patient had a fracture. At 3 weeks to 6 months there is clinical union, and this is the
first stage of healing that is sufficient to prevent movement of the fracture site when the
bones are gently stressed. How is this stage of fracture healing documented?
a. Ossification
b. Remodeling
c. Consolidation
d. Callus formation

62. A patient visits a minor surgery service at the hospital presenting open and clean
wound on the abdomen post-surgery secondary to peritonitis. A nurse assists the
medical doctor to do the wound cleaning and dressing and then suture. By informing
the patient the rationale of the procedure, the nurse will tell the patient that it is to help
the wound to heal by:
a. Primary intention
b. Secondary intention
 c. Tertiary intention
d. Normal wound healing process
63. What is an urgent action to be done after having a patient bleeding post traumatic
accident?
a. Compressive dressing.
b. Wet wound dressing.
c. Dry wound dressing.
d. Common wound dressing

64. The nurse is working in the emergency department when a child is brought in with
burns from the bath bassin where the child has got the burn at both legs and perineum. The
nurse knows that this constitutes burns to what percentage of the body using the rule of
nine formula?

a. 15%
b. 28%
c. 9.50%
d. 19%

65. During nursing round a nurse finds a client hospitalized for cirrhosis with ascites in
supine position. In the assessment the patient complaints were dyspnea, and fatigue. On
physical exam the patient was presenting 120 beats per min of pulse rate, 30 breaths per
minute of respiratory rate, the BP of 134/92 mmHg. What should nurse take as priority
problem for this client?
a. Ineffective airway clearance related to bronchospasm as evidenced by short of
breath.
b. Ineffective breathing pattern related to diminution of thoracic volume secondary
to the accumulation of fluid in peritoneal cavity as evidenced by short of breath,
and tachypnea.
c. Impaired gas exchange related to lung infection secondary to the accumulation of
fluid in peritoneal cavity as evidenced by short of breath, and tachypnea as
evidenced by short of breath.
d. A and c are correct

66. The nurse is caring for a client with skeletal traction. It is most important that the nurse
monitor which of the following?

a. The pin site for unusual redness, swelling, purulent drainage and foul odor
b. The distance between the client’s hip and the traction
c. The number of times the client exercises the affected limb
d. How the client is coping with immobilization
67. After the surgeries that involve the head of femur replacement or hip replacement, the
nurse should include the following instructions when teaching a patient and caregiver,
except:
a. Use pillow between legs for first 6 weeks after surgery when lying on non-operative
side or when supine.
b. Place chair inside shower or tub and remain seated while washing.
c. Keep hip in neutral, straight position when sitting, walking, or lying.
d. Force hip into internal rotation and sometimes cross legs at knees or ankles.

68. What does the mechanism of chemotaxis accomplish?

a. Causes the transformation of monocytes into macrophages

b. Involves a pathway of chemical processes resulting in cellular lysis
c. Attracts the accumulation of neutrophils and monocytes to an area of injury
d. Slows the blood flow in a damaged area, allowing migration of leukocytes into tissue
C
69. What effect does the action of the complement system have on inflammation?
a. Modifies the inflammatory response to prevent stimulation of pain
b. Increases body temperature, resulting in destruction of microorganisms
c. Produces prostaglandins and leukotrienes that increase blood flow, edema, and pain
d. Increases inflammatory responses of vascular permeability, chemotaxis, and
phagocytosis
70. Gaseous gangrene known as generalized extensive cellulitis due to Clostridium
Perfrigens is the results of muscular destruction secondary to exotoxin in the local
area. This is classified as one of the following type of necrosis:

a. Gangrenous necrosis

b. Caseous necrosis

c. Liquefactive necrosis

d. Coagulative necrosis

71. The most common cause of hypoxic cellular alterations/injury is:

a. Hypoxemic hypoxia
b. Chemical hypoxia
c. Ischemic hypoxia
d. Hypovolemic hypoxia
 72. The normal cell should be restricted by a narrow range of structure and function, it
can adapt to physiologic demands or stress to maintain a steady state. One of the
following assertions is not true about cell adaptation.
a. A process of an Irreversible, structural and functional response to both normal
or physiologic conditions and adverse or pathologic conditions.
b. Cellular adaptations are a common and central part of many disease states
including bacterial infections such malaria.
c. Compensatory hyperplasia seen in most patient undergone hepatomectomy
(removal of one part of liver) is an example of cell adaptive mechanism.
d. Apoptosis known as a regulated and programmed cell process characterized by
the “dropping off” of cellular fragments called apoptotic bodies can be
considered as normal cell adaptive mechanism.
73. Result from vascular changes as primary body response to cell injury and stress
include the following local and physiological manifestations. Which one of the
statement below is true about inflammation?
a. Pain resulting from pressure exerted by exudate accumulation, as well as the
presence of soluble biochemical mediators such as prostaglandins and bradykinin.
b. Swelling known as vasodilatation and increased blood flow through the injured site
c. Heat and redness known as exudate (fluid and cells) accumulation and usually
accompanied by pain.
d. Fever and plasma protein synthesis (increased levels of circulating plasma proteins)
is found in early stage of inflammation
74. The ability of an infectious agent to cause cell injury depends on the ability of the
organism to:
e. Invade and destroy cells
f. Produce toxins
g. Produce damaging hypersensitivity reactions
h. All of the above
75. Pituitary regulation of water balance is assured by the process of:
a. Releases ADH
b. Release of cortisol
c. Release of Natriuretic peptides
d. 0smoreceptors that sense fluid deficit or increase
76. As fluid circulates through the capillaries, there is movement of fluid between the
capillaries and the interstitium. What describes the fluid movement that would cause
edema?
a. Plasma hydrostatic pressure is less than plasma oncotic pressure.
b. Plasma oncotic pressure is higher than interstitial oncotic pressure.
c. Plasma hydrostatic pressure is higher than plasma oncotic pressure.
d. Plasma hydrostatic pressure is less than interstitial hydrostatic pressure.

77. What is a compensatory mechanism for metabolic alkalosis?

a. Shifting of bicarbonate into cells in exchange for chloride
b. Kidney conservation of bicarbonate and excretion of hydrogen ions
c. Deep, rapid respirations (Kussmaul respirations) to increase CO2 excretion
d. Decreased respiratory rate and depth to retain CO2 and kidney excretion of
bicarbonate

78. Which of the following are true of necrosis?

a. Can be caused by ischemia, toxin exposure, infection, or trauma
b. May be programmed or regulated
c. Leads to cellular self-digestion, or autolysis
d. All of the above
79. What clinical finding does a nurse anticipate when admitting a client with an
extracellular fluid volume excess?

a. Rapid, thready pulse

b. Distended jugular veins
c. Elevated hematocrit level
d. Increased serum sodium level

80. A client is admitted with metabolic acidosis. The nurse considers that two body systems
interact with the bicarbonate buffer system to preserve healthy body fluid PH. What two
body systems should the nurse assess for compensatory changes?

a. Skeletal and nervous

b. Circulatory and urinary
c. Respiratory and urinary
d. Muscular and endocrine
81. A nurse explains to an obese client that the rapid weight loss during the first week after
initiating a diet is because of fluid loss. The weight of extracellular body fluid is
approximately 20% of the total body weight of an average individual. Which component of
the extracellular fluid contributes the greatest proportion to this amount?

a. Plasma
b. Interstitial
c. Dense tissue
d. Body secretions
82. A nurse is reviewing the laboratory report of a client with a tentative diagnosis of
kidney failure. What mechanism does the nurse expect to be maintained when ammonia is
excreted by healthy kidneys?

a. Osmotic pressure of the blood

b. Acid-base balance of the body
c. Low bacterial levels in the urine
d. Normal red blood cell production
83. Key interventions for treating soft tissue injury and resulting inflammation are
remembered using the acronym RICE. What are the most important actions for the
emergency department nurse to do for the patient with an ankle injury?
a. Reduce swelling, shine light on wound, control mobility, and elicit the history of the
injury
b. Rub the wound clean, immobilize the area, cover the area protectively, and exercise
that leg
c. Rest with immobility, apply a cold compress, apply a compress bandage, and elevate
the ankle
d. Rinse the wounded ankle, image the ankle, carry the patient, and extend the ankle
with imaging
84. What is characteristic of chronic inflammation?
a. Lasts for weeks, months, or even years
b. The injurious agent persists or repeatedly injures tissue.
c. Infective endocarditis is an example of chronic inflammation.
d. Neutrophils are the predominant cell type at the site of inflammation.

85. A nurse is caring for a client with albuminuria resulting in edema. What pressure
change does the nurse determine as the cause of the edema?

a. Decrease in tissue hydrostatic pressure

b. Increase in plasma hydrostatic pressure
c. Increase in tissue colloid osmotic pressure
d. Decrease in plasma colloid oncotic pressure
[Link] most common cause of hypoxic cellular alterations/injury is
 a. Hypoxemic hypoxia
b. Chemical hypoxia
c. Ischemic hypoxia
d. Hypovolemic hypoxia
87. Homeostasis is defined as a series of automatic control systems ensures that the body
maintains a constant temperature, and steady levels of water, ions and blood sugar. The
following components explain homeostasis except:
a. Insulin therapy
b. Thermoregulation
c. Gluco-regulation
d. Osmoregulation
88. The period during which the host experiences the maximum impact of the infectious
process and in which there is toxic by-products of microbial metabolism, cell lysis, and
the immune response mounted by the host combine to produce tissue damage and
inflammation is called:
a. Prodromal period
b. Acute period
c. Resolution period
d. Incubation period

89. The normal cell should be restricted by a narrow range of structure and function, it can
adapt to physiologic demands or stress to maintain a steady state. One of the following
assertions is not true about cell adaptation:
a. A process of an Irreversible, structural and functional response to both normal or
physiologic conditions and adverse or pathologic conditions.
b. Cellular adaptations are a common and central part of many disease states including
bacterial infections such malaria.
c. Compensatory hyperplasia seen in most patient undergone hepatomectomy (removal of
one part of liver) is an example of cell adaptive mechanism.
d. Apoptosis known as a regulated and programmed cell process characterized by the
“dropping off” of cellular fragments called apoptotic bodies can be considered as
normal cell adaptive mechanism.

90. Result from vascular changes as primary body response to cell injury and stress include
the following local and physiological manifestations. Which one of the statement below is
true about inflammation?

a. Pain resulting from pressure exerted by exudate accumulation, as well as the

presence of soluble biochemical mediators such as prostaglandins and bradykinin.
b. Swelling known as vasodilatation and increased blood flow through the injured site
c. Heat and redness known as exudate (fluid and cells) accumulation and usually
accompanied by pain.
d. Fever and plasma protein synthesis (increased levels of circulating plasma proteins)
is found in early stage of inflammation

91. The following statement best describe pathophysiology except:

a. A study that emphasize on the biological and physical manifestations of disease

as they correlate with the underlying abnormalities and physiological
disturbances as results of homeostasis.
b. A purposeful maintenance of a stable internal environment maintained by
coordinated physiologic processes that oppose change.
c. Differences patterns of tissue changes necessary for the development of a disease
in living body cell.
d. An active process of cellular self-destruction aiming at cleaning and maintaining
of homeostasis.
92. Homeostasis known as set of process involving negative and positive feedback
response that counteract cellular change is best define by the following assertions except:

a. A maintenance or regulation of the stable condition of an organism by making

equilibrium of body fluids or simply as the balance of bodily functions.
b. A purposeful maintenance of a stability within internal environment maintained by
coordinated physiologic processes that oppose change.
c. An ongoing process that intermittently works to restore and maintain balance of
body equilibrium.
 d. Dynamic process that ensures ideal conditions are maintained within living cells, in
spite of constant internal and external changes

93. A nurse is caring for a client who is receiving serum albumin. What therapeutic effect
does the nurse anticipate?

a. Improved clotting of blood

b. Formation of red blood cells
c. Activation b of white blood cells
d. Maintenance of oncotic pressure

A patient is admitted to the A&E Department after sustaining the head injury post road
traffic accident with the blood pressure of 150/60 mmHg, pulse rate of 95 beats/min, SPo2
of 94% on room air and the temperature of 36.4 degree Celsius. The treating physician
measured his ICP and its reading was of 20 mm Hg. After calculating the MAP, the nurse
knows that the cerebral perfusion pressure (CPP) would be calculated at:
a. 50 mm Hg.
b. 60 mm Hg.
c. 70 mm Hg.
d. 80 mm Hg.

The majority of ischemic strokes have what type of origin?

a. Cardiogenic embolic
b. Cryptogenic
c. Large artery thrombotic
d. Small artery thrombotic

The degree of neurologic damage that occurs with an ischemic stroke depends on the:
A. Location of the lesion.
B. Size of the area of inadequate perfusion.
C. Amount of collateral blood flow.
D. Combination of the above factors.

The treatment of burns is related to the severity of the injury. While determining the
approach to use in managing the burn depending on its severity, the treating health care
professional will consider these determinants/factors of the severity of burns include:

A. Focus on depth of burn

B. Extent of burn calculated in percent of total body surface area (tbsa)

C. Location of burn and patient risk factors (e.g., age, past medical history)

D. All the above

CASE STUDIES

Charles is a 76-year-old retired professional footballer. He has recently been diagnosed as

having Parkinson’s disease.
94. The nurse knows that Parkinson’s disease, a progressive neurologic disorder, is
characterized by:
a. Bradykinesia.
b. Muscle rigidity.
c. Tremor.
d. All of the above.
95. The nurse assesses for the characteristic movement of Parkinson’s disease, which is:
a. Exaggerated muscle flaccidity that leads to frequent falls.
b. Hyperextension of the back and neck that alters normal movements.
c. Pronation–supination of the hand and forearm that interferes with normal hand
activities.
d. Combination of all of the above.

96. Charles is started on chemotherapy, which is aimed at restoring dopaminergic

activities. An example of such a drug is:
a. Artane.
b. Benadryl.
c. Elavil.
d. Levodopa.

A patient M.N. of 70 Kgs has the following mixed deep partial-thickness and full-thickness
burn injuries: anterior part of the head (face), only left side of the entire anterior
trunk/chest and the abdomen from the neck, only anterior surfaces of the entire left arm,
and only anterior surfaces of the whole left leg from the groin to the toes.
97. According to the rule of nines chart, what is the extent of the patient’s burns?
a. 32%
b. 27%
c. 22.5%
d. 45%

98. What will be the amount of fluids to be given within 24 hours using Parkland formula?

a. 6300ml
b. 8960ml
c. 7560ml
d. 4500ml
Theresa, a 20-year-old RHIH student, lives in a small house with 10 other students. Four
she was diagnosed as having bacterial pneumonia and was admitted to the hospital.

99. The nurse is informed that Theresa has the strain of bacteria most frequently found in
community-acquired pneumonia. The nurse suspects that the infecting agent is mostly:
a. Haemophilus influenza.
b. Klebsiella.
c. Pseudomonas aeruginosa.
d. Streptococcus pneumoniae.

100. All of the following are manifestations of bacterial pneumonia except:

a. Fever.
b. Bradycardia.
c. Stabbing or pleuritic chest pain.
d. Tachypnea.

101. The nurse expects that Theresa will be medicated with the usual antibiotic of choice
through IV line, which is:
a. Cephalosporin.
b. Clindamycin.
c. Erythromycin.
d. Penicillin G

102. The nurse is aware that Theresa may develop hypoxemia, because:
a. Bronchospasm causes alveolar collapse, which decreases the surface area
necessary for Perfusion.
b. Mucosal edema occludes the alveoli, thereby producing a drop in alveolar oxygen.
c. Venous blood is shunted from the right to the left side of the heart.
d. All of the above are true.

Patient called ME, a 30-year-old woman, is diagnosed as having secondary hypertension

from serial blood pressure recordings show her average reading to be 170/100 mm Hg.
From the history taking and physical exam, it was revealed that her hypertension is the
result of renal problems.

103. The kidneys help maintain the hypertensive state in essential hypertension by:
a. Increasing their elimination of sodium in response to aldosterone secretion.
b. Releasing renin in response to decreased renal perfusion.
c. Secreting acetylcholine, which stimulates the sympathetic nervous system to
constrict major vessels.
d. Doing all of the above.

104. ME is prescribed spironolactone (Aldactone), 50 mg once every day. The nurse knows
that
spironolactone:
 a. Blocks the reabsorption of sodium, thereby increasing urinary output.
b. Inhibits renal vasoconstriction, which prevents the release of renin.
c. Interferes with fluid retention by inhibiting aldosterone.
d. Prevents the secretion of epinephrine from the adrenal medulla.

Claude is to receive one unit of packed red cells because he has a hemoglobin level of 8
g/dL and a diagnosis of gastrointestinal bleeding.

105. Before initiating the transfusion, the nurse needs to check:

a. For the abnormal presence of gas bubbles and cloudiness in the blood bag.
b. That the blood has been typed and crossmatched.
c. That the recipient’s blood numbers match the donor’s blood numbers.
d. All of the above.

106. Administration technique of that packed red cells to Claude should include all of the
following except:

a. Verify the patency of IV line before administering the blood component using
seringues with NS 0.9%

b. Administering the unit in combination with dextrose or Ringers lactate if the patient
needs Additional carbohydrates

c. Don’t give additives (including IV drugs) via the same tubing as the blood unless if
the blood products administration is completed

d. Appropriate identification of the blood type, amount, rhesus factor and verify if its
match with the receiver’s information

107. If a transfusion reaction occurs, the nurse should primarily:

a. Call the physician and wait for directions based on the specific type of reaction.
b. Stop the transfusion immediately and keep the vein patent with a saline or dextrose
solution.
c. Slow the infusion rate and observe for an increase in the severity of the reaction.
d. Slow the infusion and request a venipuncture for retyping to start a second
transfusion.

SECTION B. MATCHING QUESTIONS /43 Marks

108. Match the term in column I with their meaning in column II (eg: 1-a)/7 marks

Column I:
1. Hernia
2. Hematochezia
3. Volvulus
4. Melena
5. Intussusception
6. Adhesions
7. Hematemesis

Column II:
a. Loops of intestines becomes adherent to the areas that heal slowly or scar after surgery
b. Protrusion of intestines into through a weakened area in the abdominal muscles or wall
c. One part of intestines slips into another part located below it.
d. Bowel twists and turns on itself
e. The vomiting of blood, which may be fresh blood or blood clots. Often it indicates upper
GI bleeding.

f. The passage of black tar-like stool due to mixing with altered blood.

g. The passage of liquid blood or blood clots of varied brightness in color per rectum. It
usually indicates lower GI bleeding, but it can be seen with massive upper GI bleeding.

109. Match the following lung conditions in column I with their definitions in column II (eg:
1-a)/7 marks
Column I:
1. Pleurisy
2. Transudate
3. Empyema
4. Cor pulmonale
5. Exudate
6. Atelectasis
7. Pleural effusion
Column II :
a. Presence of collapsed, airless alveoli
b. Lung expansion restricted by fluid in pleural space
c. Fluid buildup caused by tissue leakage due to inflammation or local cellular damage.
Fluid rich in proteins (leucocytes, plasma proteins of all kinds) that migrates out of the
capillaries
d. Lung expansion restricted by pus in intrapleural space
e. Fluid buildup caused by systemic conditions that alter the pressure in the blood vessels.
Water fluid that diffuses out of capillaries beneath the pleura
f. Inflammation of the pleura restricting lung movement
g. Happens when a respiratory disorder results in high blood pressure in the pulmonary
arteries (pulmonary hypertension). It is usually referred to pulmonary heart disease,
consists of right ventricular enlargement (hypertrophy, dilatation, or both)
110. Match the following conditions in column I with their causes in column II (eg: a-1)/7
marks
Column I:

a. Thalassemia
b. Aplastic anemia
c. Pernicious anemia
d. Sickle cell anemia
e. Folate deficiency anemia
f. Iron-deficiency anemia
g. Anemia from renal failure
Column II:

1. Microcytic- hypochromic anemia

2. Normocytic – normochromic anemia
3. Macrocytic- normochromic anemia

111. Match the following conditions in column II with their definitions, causes and
locations in column I (eg: a-1)/6 marks

Column I
1. Separates the right and left atria
2. Is located at the juncture of the superior vena cava and the right atrium
3. Supports the heart in the mediastinum
4. Sits between the right ventricle and the pulmonary artery
5. Distributes venous blood to the lungs
6. Is embedded in the right atrial wall near the tricuspid valve

Column II
a. Parietal pericardium
b. Pulmonary artery
c. Bicuspid valve
d. Pulmonic valve
e. Sinatrial node
f. Atrioventricular node

112. Match the type of heart failure listed in column II with its associated
pathophysiology and signs and symptoms in column I /9Marks

Column I
1. Fatigability
2. Dependent edema
3. Pulmonary congestion predominates
4. Distended neck veins
5. Ascites
6. Dyspnea from fluid in alveoli
7. Hepatomegaly
8. Cough that may be blood-tinged
9. Nocturia

Column II

a. Left-sided heart failure

b. Right-sided heart failure

113. Match the following descriptions from Column I with the mechanisms of fluid and
electrolyte movement in Column II (eg: 1 = a). / 7 Marks
Column I:
a. Adenosine triphosphate (ATP) required
b. Uses a carrier molecule
c. Force exerted by a fluid
d. Pressure exerted by proteins
e. Force determined by osmolality of a fluid
f. Flow of water from low-solute concentration to high-solute concentration
g. Passive movement of molecules from a high concentration to lower concentration

Column II:
1. Osmosis
2. Diffusion
3. Active transport
4. Oncotic pressure
5. Osmotic pressure
6. Facilitated diffusion
7. Hydrostatic pressure

THE END!!