Question 1. A community health nurse practitioner is teaching a group of female high school students about the importance of regular Papanicolaou (Pap) smears. The nurse recognizes that which of the following items underlies the rationale for this teaching?
The active substitution of normal cells in the cervix correlates to cancer risk.
Undifferentiated stem cells are an early indicator of cervical cancer.
Cancer of the uterine cervix develops incrementally at a cellular level.
Dysplasia in the connective tissue of the cervix is a strong precursor to cancer.
A patient who has a diagnosis of lung cancer is scheduled to begin radiation treatment. The NP providing pretreatment education is explaining some of the potential unwanted effects of the treatment. Which of the following statements by the nurse is most accurate?
“Some patients experience longer-term irritation of skin adjacent to the treatment site.”
“Sometimes you might find that your blood takes longer to clot than normal.”
“The changes that you might see are normally irreversible.”
“The unwanted effects will be limited to the exposed portions of your skin.”
Which of the following patients of a primary care nurse practitioner would not require extra screening for cancer?
A 51-year-old woman whose grandmother died of breast cancer
A 48-year-old man who takes immunosuppressant drugs following a kidney transplant
A 50-year-old male who is obese and has a low-fiber, high-fat diet
A 38-year-old female with Down syndrome and congenital scoliosis
A nurse practitioner is educating a patient 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 cell in order to provide energy for the patient. The nurse practitioner knows that which of the following processes allows glucose to enter body cells
A student nurse practitioner asks her preceptor about the origins of different tissues, and their cellular origins during the process of development. Which of the following statements by the preceptor best describes the process of cell differentiation?
“Cells of the hematopoietic system produce the appropriate body cells that are required at each stage of development.”
“A single stem cell differentiates into approximately 200 different types of cells.”
“A fertilized ovum undergoes a series of divisions, yielding many different cell types.”
“Cells differentiate into necessary body cells, peaking after conception, and ceasing near the time of birth.”
The nurse practitioner is seeing a client who has an acute exacerbation of Crohn’s disease. The NP recognizes the fact that the disease involves the inflammation and irritation of the intestinal lining. Which of the following types of tissue is most likely involved in the patient’s pathology?
Simple columnar epithelium
Simple cuboidal epthelium
A nurse practitioner employed in a hospitalist notices that a patient is experiencing muscle atrophy following 2 weeks in traction after a motor vehicle accident. Which of the following factors has most likely contributed to the atrophy of the patient’s muscle cells?
High levels of insulin and IGF-1 in the patient’s blood during immobilization
Denervation of the affected muscles during the time of traction
A reduction of skeletal muscle use secondary to the traction treatment
Reduced oxygen consumption and cellular function that ensures muscle cell survival
A 7-year-old boy is admitted to the hospital with a suspected diagnosis of lead toxicity. Which of the following assessment findings is most congruent with the patient’s diagnosis?
Decreased deep tendon reflexes
Hemoglobin 9.9 g/dL
Diffuse muscle pain
White blood cells (WBC) 11,000/mm3
The NP is teaching a group of older adults about the value of including foods containing antioxidants in their diet. Which of the following statements best captures the rationale underlying the NPs advice?
Antioxidants inhibit the actions of reactive oxygen species (ROS).
Antioxidants prevent the formation of superoxide dismutase.
Antioxidants react nonspecifically with molecules.
Antioxidants prevent the occurrence of cell dysplasia.
Which of the following statements most accurately conveys an aspect of cell injury due to impaired calcium homeostasis?
Normal intracellular calcium ion levels are higher than extracellular levels.
Ischemia and certain toxins cause a decrease in cytosolic calcium.
Injured cells tend to accumulate calcium.
Low calcium levels cause an activation of damaging enzymes.
The NP is providing care for a 21-year-old female patient with gas gangrene of a compound fracture in her arm. Which of the following assessment findings would the nurse most reasonably expect to find when caring for a patient with a diagnosis of gas gangrene?
Inflammation of the affected tissue
A positive culture for Staphylococcus
Impaired alveolar gas exchange
A 45-year-old patient who experienced exposure to radiation during an industrial accident several years prior is being assessed. Which of the following phenomena may underlie the genetic changes that have been noted in the patient?
Base pairs may have been rearranged by the radiation exposure.
Endonucleases may have influenced the DNA structure following exposure.
Two paired bases may have exchanged helical positions after the accident.
The radiation may have produced redundant or degenerate genetic code.
A child possesses a trait that is the result of the interaction of two different genes, neither of which could have produced the trait independently. Which of the following explanations best captures the genetic explanation for this?
The trait is an expression of multiple alleles.
Epistasis has dictated the phenotypic outcome.
The phenomenon is an example of polygenic inheritance.
The outcome is the result of the interaction between collaborative genes.
A group of researchers has identified that the prevalence of two particular genetic disorders share a statistical correlation. Which of the following statements best conveys the genetic rationale for this situation?
There is likely a cause-and-effect relationship between the two genes responsible.
The chromosomes containing each gene are likely closely situated.
The genes causing each disorder are likely in the same section of the same chromosome.
The disorders likely share the same locus.
A researcher is involved in the production of insulin through recombinant DNA technology. Which of the following statements could the researcher best provide as a rationale for her work?
The gene fragment responsible for insulin production can be isolated and reproduced.
Particular bacteria are capable of insulin production.
It is possible to reproduce the chromosome responsible for insulin production.
Recombination of DNA base pairs can result in a gene that will produce insulin.
An infant who is four days postpartum has been diagnosed with a single-gene disorder. The parents of the child have a number of questions about the etiology of the health problem, which the physician is attempting to address in detail. Which of the following teaching points most accurately captures an aspect of single-gene congenital disorders?
Affected genes are present on autosomal chromosomes rather than sex chromosomes.
The majority of single-gene disorders manifest near the time of puberty.
A particular defect can be caused by mutations at one of several different loci.
Single-gene disorders are associated with existing rather than new mutations.
A male patient of a nurse practitioner has an autosomal dominant disorder. The patient and his partner are considering starting a family. Which of the patient’s following statements indicates the patient has an adequate understanding of the genetic basis of this health problem?
“I know there’s no way of accurately determining the chance that my child will inherit the disease.”
“My children who don’t have the disease still run the risk of passing it on to their children.”
“I know that new genetic mutations won’t occur between generations.”
“I know that a single mutant allele is to blame for the health problem.”
A 6-year-old girl with a diagnosis of Marfan syndrome is being assessed at a community health clinic. Which of the following assessments would be the health care professional’s lowest priority?
A test of the child’s visual acuity
A musculoskeletal assessment
Tests of kidney function
A new older female patient at a long-term care facility has a diagnosis of type 1 neurofibromatosis (NF-1). As part of the intake assessment protocol for the facility, the clinical educator is teaching the care staff about the diagnosis. Which of the following statements most accurately conveys an aspect of neurofibromatosis?
“The neurofibroma lesions are unsightly for the patient, but they are not painful.
“Her diagnosis puts her at higher risk of developing a malignant neoplasm.”
“She is living with an example of an autosomal recessive disorder.”
“The patient is likely to be photosensitive as a result of the disease.”
As part of an orientation to a genetic counseling practice, a group of medical students is differentiating between autosomal recessive disorders and autosomal dominant disorders. Which of the following statements is true of autosomal recessive disorders?
They can manifest when present in one or both gene pairs.
There is a one in two chance of an affected child in each pregnancy with an affected mother.
They tend to have a more uniform symptomatology than autosomal dominant disorders.
The associated disorders are usually attributable to abnormalities in structural proteins.
Which of the following pregnant women has most likely encountered the greatest increase in the risk that her child will have a fetal anomaly?
A woman with diagnoses of syphilis and cirrhosis of the liver
A woman who has herpes simplex and recently recovered from endocarditis
A woman with chronic obstructive pulmonary syndrome and tuberculosis
A woman with diagnoses of insulin-dependent diabetes mellitus and peripheral neuropathy
A 77-year-old male patient with a diagnosis of stomach cancer has been found to have metastases in his liver. The patient and his family are surprised at this turn of events, stating that they don’t see how he could have developed cancer in his liver. Which of the following facts would underlie the reply that the care team provides?
The parenchymal tissue of the liver is particularly susceptible to secondary malignancies.
The portal circulatory system brings venous blood from the gastrointestinal tract into the liver.
Hepatic stromal tissue shares characteristics with cancerous cells, including lack of anchorage dependence.
The proximity of the liver to the stomach allows for direct spread of cancerous cells due to a lack of contact inhibition.
A woman is surprised to read on the Internet that certain infections can cause cancer and has sought clarification from her nurse practitioner during an office visit. How can the NP best respond to the woman’s query?
“Though it’s not particularly common, it’s true that certain bacteria and viruses can lead to cancer.”
“Most cancers that cannot be attributed to family history or lifestyle are in fact associated with viruses.”
“There are many viruses, but only a very few of them have been shown to cause cancer in humans.”
“This is true; for example, HIV has been shown to cause cancer in some patients.”
The family of a 68-year-old man who is in the end stages of small cell lung cancer is distraught at his visible body wasting that has worsened in recent weeks. Which of the following phenomena best accounts for the patient’s anorexia and cachexia?
Inadequate cellular metabolism of glucose results from tumor factors
High fat losses coupled with preservation of muscle mass exaggerate the appearance of wasting
Products of the tumor itself as well as a hypermetabolic state cause cachexia
Inadequate food intake due to symptoms and treatment results in loss of both muscle and fat
The nurse practitioner working in occupational health has been asked to speak to a group of factory workers about the importance of wearing gloves when working with strong chemicals such as turpentine and paint thinner. Which of the following characteristics of cell membranes underlies the nurse’s teaching?
Cell membranes are impermeable to all but lipid-soluble substances.
Cell membranes have lipids that have a hydrophilic head and a hydrophobic tail.
Cell membranes contain receptors for hormones and biologically active substances.
Transmembrane proteins can pass through the cell membrane into the intracellular environment.
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