Pathophysiology The Biologic Basis for Disease in Adults and Children,7th Edition by Kathryn L. – Test Bank
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Sample Test
Chapter 3: The Cellular Environment: Fluids and Electrolytes,
Acids and Bases
MULTIPLE CHOICE
1. Infants
are most susceptible to significant losses in total body water because of an
infant’s:
|
a. |
High body surface–to–body
size ratio |
|
b. |
Slow metabolic rate |
|
c. |
Kidneys are not mature
enough to counter fluid losses |
|
d. |
Inability to communicate adequately
when he or she is thirsty |
ANS: C
Renal mechanisms that regulate fluid and electrolyte
conservation are often not mature enough to counter the losses; consequently,
dehydration may rapidly develop. Infants can be susceptible to changes in total
body water because of their high metabolic rate and the turnover of body fluids
caused by their greater body surface area in proportion to their total body
size. The inability to communicate their thirst is a problem only when they are
poorly cared for.
PTS:
1
REF: Page 104
2. Obesity
creates a greater risk for dehydration in people because:
|
a. |
Adipose cells contain
little water because fat is water repelling. |
|
b. |
The metabolic rate of obese
adults is slower than the rate of lean adults. |
|
c. |
The rate of urine output of
obese adults is higher than the rate of output of lean adults. |
|
d. |
The thirst receptors of the
hypothalamus do not function effectively. |
ANS: A
The percentage of total body water (TBW) varies with the amount
of body fat and age. Because fat is water repelling (hydrophobic), very little
water is contained in adipose cells. Individuals with more body fat have
proportionately less TBW and tend to be more susceptible to fluid imbalances
that cause dehydration.
PTS:
1
REF: Page 104
3. A
patient’s blood gases reveal the following findings: pH, 7.3; bicarbonate (HCO3) 27
mEq/L; carbon dioxide (CO2), 58 mm Hg. What is
the interpretation of these gases?
|
a. |
Respiratory alkalosis |
c. |
Respiratory acidosis |
|
b. |
Metabolic acidosis |
d. |
Metabolic alkalosis |
ANS: C
The values provided in this question characterize only acute
uncompensated respiratory acidosis.
PTS:
1
REF: Pages 129-130
4. Water
movement between the intracellular fluid (ICF) compartment and the
extracellular fluid (ECF) compartment is primarily a function of:
|
a. |
Osmotic forces |
c. |
Antidiuretic hormone |
|
b. |
Plasma oncotic pressure |
d. |
Hydrostatic forces |
ANS: A
The movement of water between the ICF and ECF compartments is
primarily a function of osmotic forces. (Osmosis and other mechanisms of
passive transport are discussed in Chapter 1.)
PTS:
1
REF: Page 105
5. In
addition to osmosis, what force is involved in the movement of water between
the plasma and interstitial fluid spaces?
|
a. |
Oncotic pressure |
c. |
Net filtration |
|
b. |
Buffering |
d. |
Hydrostatic pressure |
ANS: D
Water moves between the plasma and interstitial fluid through
the forces of only osmosis and hydrostatic pressure, which occur across the
capillary membrane. Buffers are substances that can absorb excessive acid or
base to minimize pH fluctuations. Net filtration is a term used to identify
fluid movement in relationship to the Starling hypothesis. Oncotic pressure
encourages water to cross the barrier of capillaries to enter the circulatory
system.
PTS:
1
REF: Page 105
6. Venous
obstruction is a cause of edema because of an increase in which pressure?
|
a. |
Capillary hydrostatic |
c. |
Capillary oncotic |
|
b. |
Interstitial hydrostatic |
d. |
Interstitial oncotic |
ANS: A
Venous obstruction can increase the hydrostatic
pressure of fluid in the capillaries enough to cause fluid to escape into the
interstitial spaces. The remaining options are not causes of edema resulting
from venous obstruction.
PTS:
1
REF: Page 106
7. At
the arterial end of capillaries, fluid moves from the intravascular space into
the interstitial space because the:
|
a. |
Interstitial hydrostatic
pressure is higher than the capillary hydrostatic pressure. |
|
b. |
Capillary hydrostatic
pressure is higher than the capillary oncotic pressure. |
|
c. |
Interstitial oncotic
pressure is higher than the interstitial hydrostatic pressure. |
|
d. |
Capillary oncotic pressure
is lower than the interstitial hydrostatic pressure. |
ANS: B
At the arterial end of capillaries, fluid moves from the
intravascular space into the interstitial because capillary hydrostatic
pressure is higher than the capillary oncotic pressure.
PTS:
1
REF: Page 105
8. Low
plasma albumin causes edema as a result of a reduction in which pressure?
|
a. |
Capillary hydrostatic |
c. |
Plasma oncotic |
|
b. |
Interstitial hydrostatic |
d. |
Interstitial oncotic |
ANS: C
Losses or diminished production of plasma albumin is the only
option that contributes to a decrease in plasma oncotic pressure.
PTS:
1
REF: Pages 106-107
9. Secretion
of antidiuretic hormone (ADH) and the perception of thirst are stimulated by
a(n):
|
a. |
Decrease in serum sodium |
c. |
Increase in glomerular
filtration rate |
|
b. |
Increase in plasma
osmolality |
d. |
Decrease in osmoreceptor
stimulation |
ANS: B
Secretion of ADH and the perception of thirst are primary
factors in the regulation of water balance. Thirst is a sensation that
stimulates water-drinking behavior. Thirst is experienced when water loss
equals 2% of an individual’s body weight or when osmotic pressure increases.
The other options do not accurately describe how ADH and the perception of
thirst are related.
PTS:
1
REF: Page 109
10. Thirst
activates osmoreceptors by an increase in which blood plasma?
|
a. |
Antidiuretic hormone |
c. |
Hydrostatic pressure |
|
b. |
Aldosterone |
d. |
Osmotic pressure |
ANS: D
Thirst is experienced when water loss equals 2% of an
individual’s body weight or when osmotic pressure increases. Dry mouth,
hyperosmolality, and plasma volume depletion activate osmoreceptors (neurons
located in the hypothalamus that are stimulated by increased osmotic pressure).
The other options do not accurately identify what increases to activate
osmoreceptors.
PTS:
1
REF: Page 109
11. It
is true that
natriuretic peptides:
|
a. |
Decrease blood pressure and
increase sodium and water excretion. |
|
b. |
Increase blood pressure and
decrease sodium and water excretion. |
|
c. |
Increase heart rate and
decrease potassium excretion. |
|
d. |
Decrease heart rate and
increase potassium excretion. |
ANS: A
Natriuretic peptides are hormones that include atrial
natriuretic peptide (ANP) produced by the myocardial atria, brain natriuretic
peptide (BNP) produced by the myocardial ventricles, and urodilatin within the
kidney. Natriuretic peptides decrease blood pressure and increase sodium and
water excretion.
PTS:
1
REF: Page 109
12. When
changes in total body water are accompanied by proportional changes in
electrolytes, what type of alteration occurs?
|
a. |
Isotonic |
c. |
Hypotonic |
|
b. |
Hypertonic |
d. |
Normotonic |
ANS: A
Only isotonic alterations occur when proportional changes in
electrolytes and water accompany changes in total body water .
PTS:
1
REF: Pages 109-110
13. Which
enzyme is secreted by the juxtaglomerular cells of the kidney when circulating
blood volume is reduced?
|
a. |
Angiotensin I |
c. |
Aldosterone |
|
b. |
Angiotensin II |
d. |
Renin |
ANS: D
When circulating blood volume or blood pressure is
reduced, renin, an enzyme
secreted by the juxtaglomerular cells of the kidney, is released in response to
sympathetic nerve stimulation and decreased perfusion of the renal vasculature.
The other options are not released by the situation described in the question.
PTS:
1
REF: Pages 108-109
14. What
mechanism can cause hypernatremia?
|
a. |
Syndrome of inappropriate
antidiuretic hormone |
|
b. |
Hypersecretion of
aldosterone |
|
c. |
Brief bouts of vomiting or
diarrhea |
|
d. |
Excessive diuretic therapy |
ANS: B
Hypernatremia occurs because of (1) inadequate free water
intake, (2) inappropriate administration of hypertonic saline solution (e.g.,
sodium bicarbonate for treatment of acidosis during cardiac arrest), (3) high
sodium levels as a result of oversecretion of aldosterone (as in primary
hyperaldosteronism), or (4) Cushing syndrome (caused by the excess secretion of
adrenocorticotropic hormone [ACTH], which also causes increased secretion of
aldosterone). The other options do not result in hypernatremia.
PTS:
1
REF: Page 111
15. What
causes the clinical manifestations of confusion, convulsions, cerebral
hemorrhage, and coma in hypernatremia?
|
a. |
High sodium in the blood
vessels pulls water out of the brain cells into the blood vessels, causing
brain cells to shrink. |
|
b. |
High sodium in the brain
cells pulls water out of the blood vessels into the brain cells, causing them
to swell. |
|
c. |
High sodium in the blood
vessels pulls potassium out of the brain cells, which slows the synapses in
the brain. |
|
d. |
High sodium in the blood
vessels draws chloride into the brain cells followed by water, causing the
brain cells to swell. |
ANS: A
Hypertonic (hyperosmolar) imbalances result in an extracellular
fluid concentration greater than 0.9% salt solution (e.g., water loss or solute
gain); cells shrink in a hypertonic fluid (see Table 3-7). This shrinking of
cells results in the symptoms described in the question. The other options do
not accurately describe the cause of these symptoms as they relate to
hypernatremia.
PTS:
1
REF: Page 111
16. Vomiting-induced
metabolic alkalosis, resulting in the loss of chloride, causes:
|
a. |
Retained sodium to bind
with the chloride |
|
b. |
Hydrogen to move into the
cell and exchange with potassium to maintain cation balance |
|
c. |
Retention of bicarbonate to
maintain the anion balance |
|
d. |
Hypoventilation to
compensate for the metabolic alkalosis |
ANS: C
When vomiting with the depletion of ECF and chloride
(hypochloremic metabolic alkalosis) causes acid loss, renal compensation is not
effective; the volume depletion and loss of electrolytes (sodium [Na+],
potassium [K+], hydrogen [H+],
chlorine
[Cl–]) stimulate a paradoxic response by the kidneys. The kidneys
increase sodium and bicarbonate reabsorption with the excretion of hydrogen.
Bicarbonate is reabsorbed to maintain an anionic balance because the ECF
chloride concentration is decreased. The other options do not accurately
describe the mechanism that results from vomiting-induced metabolic alkalosis.
PTS:
1
REF: Page 128
17. The
pathophysiologic process of edema is related to which mechanism?
|
a. |
Sodium depletion |
|
b. |
Decreased capillary
hydrostatic pressure |
|
c. |
Increased plasma oncotic
pressure |
|
d. |
Lymphatic obstruction |
ANS: D
The pathophysiologic process of edema is related to an increase
in the forces favoring fluid filtration from the capillaries or lymphatic
channels into the tissues. The most common mechanisms are increased
capillary hydrostatic pressure, decreased plasma oncotic pressure, increased
capillary membrane permeability and lymphatic obstruction, and sodium
retention.
PTS:
1
REF: Page 105
18. Insulin
is used to treat hyperkalemia because it:
|
a. |
Stimulates sodium to be
removed from the cell in exchange for potassium. |
|
b. |
Binds to potassium to
remove it through the kidneys. |
|
c. |
Transports potassium from
the blood to the cell along with glucose. |
|
d. |
Breaks down the chemical
components of potassium, causing it to be no longer effective. |
ANS: C
Insulin contributes to the regulation of plasma potassium
levels by stimulating the Na+,
potassium–adenosine triphosphatase (K+–ATPase)
pump, thereby promoting the movement of potassium simultaneously into the liver
and muscle cells with glucose transport after eating. The intracellular
movement of potassium prevents an acute hyperkalemia related to food intake.
The other options do not accurately describe how insulin is used to treat hyperkalemia.
PTS:
1
REF: Page 114
19. A
major determinant of the resting membrane potential necessary for the
transmission of nerve impulses is the ratio between:
|
a. |
Intracellular and
extracellular Na+ |
c. |
Intracellular Na+ and extracellular K+ |
|
b. |
Intracellular and
extracellular K+ |
d. |
Intracellular K+ and extracellular Na+ |
ANS: B
The ratio of K+ in
the ICF to K+ in the ECF is the major determinant of the resting
membrane potential, which is necessary for the transmission and conduction of
nerve impulses, for the maintenance of normal cardiac rhythms, and for the
skeletal and smooth muscle contraction. This is not true of the other options.
PTS:
1
REF: Page 114
20. During
acidosis, the body compensates for the increase in serum hydrogen ions by
shifting hydrogen ions into the cell in exchange for which electrolyte?
|
a. |
Oxygen |
c. |
Potassium |
|
b. |
Sodium |
d. |
Magnesium |
ANS: C
In states of acidosis, hydrogen ions shift into the cells in
exchange for intracellular fluid potassium; hyperkalemia and acidosis therefore
often occur together. This is not true of the other options.
PTS:
1
REF: Page 117 | Pages 126-127
21. Causes
of hyperkalemia include:
|
a. |
Hyperparathyroidism and
malnutrition |
|
b. |
Vomiting and diarrhea |
|
c. |
Renal failure and Addison
disease |
|
d. |
Hyperaldosteronism and
Cushing disease |
ANS: C
Hyperkalemia should be investigated when a history of renal
disease, massive trauma, insulin deficiency, Addison disease, use of potassium
salt substitutes, or metabolic acidosis exists. The other options are not known
to be causes of hyperkalemia.
PTS:
1
REF: Page 119
22. In
hyperkalemia, what change occurs to the cells’ resting membrane potential?
|
a. |
Hypopolarization |
c. |
Depolarization |
|
b. |
Hyperexcitability |
d. |
Repolarization |
ANS: A
If extracellular potassium concentration increases without a
significant change in intracellular potassium, then the resting membrane
potential becomes more positive (i.e., changes from –90 to –80 mV) and the cell
membrane is hypopolarized (i.e., the
inside of the cell becomes less negative or partially depolarized [increase
excitability]).
PTS: 1
REF: Pages 117-118
23. The
calcium and phosphate balance is influenced by which three substances?
|
a. |
Parathyroid hormone,
vasopressin, and vitamin D |
|
b. |
Parathyroid hormone,
calcitonin, and vitamin D |
|
c. |
Thyroid hormone, vasopressin,
and vitamin A |
|
d. |
Thyroid hormone,
calcitonin, and vitamin A |
ANS: B
Three hormones regulate calcium and phosphate balance:
parathyroid hormone (PTH), vitamin D, and calcitonin. Vasopressin, thyroid
hormone, and vitamin A do not influence calcium and phosphate balance.
PTS:
1
REF: Page 119
24. It
is true that
Kussmaul respirations indicate:
|
a. |
Anxiety is a cause of
respiratory acidosis. |
|
b. |
A compensatory measure is
needed to correct metabolic acidosis. |
|
c. |
Diabetic ketoacidosis is
the cause of the metabolic acidosis. |
|
d. |
More oxygen is necessary to
compensate for respiratory acidosis. |
ANS: B
Deep, rapid respirations (Kussmaul respirations) are indicative
of respiratory compensation for metabolic acidosis. The other options are not
true.
PTS:
1
REF: Page 128
25. Chvostek
and Trousseau signs indicate which electrolyte imbalance?
|
a. |
Hypokalemia |
c. |
Hypocalcemia |
|
b. |
Hyperkalemia |
d. |
Hypercalcemia |
ANS: C
Two clinical signs of hypocalcemia are the Chvostek sign and
Trousseau sign. These clinical signs are not indicative of any of the other
options.
PTS:
1
REF: Page 120
26. An
excessive use of magnesium-containing antacids and aluminum-containing antacids
can result in:
|
a. |
Hypomagnesemia |
c. |
Hyponatremia |
|
b. |
Hypophosphatemia |
d. |
Hypokalemia |
ANS: B
The most common causes of hypophosphatemia are intestinal
malabsorption and increased renal excretion of phosphate. Inadequate absorption
is associated with vitamin D deficiency, the use of magnesium and
aluminum-containing antacids (which bind with phosphorus), long-term alcohol
abuse, and malabsorption syndromes. The excessive use of such antacids will not
result in the other options.
PTS:
1
REF: Page 121
27. The
most common cause of hypermagnesemia is:
|
a. |
Hepatitis |
c. |
Trauma to the hypothalamus |
|
b. |
Renal failure |
d. |
Pancreatitis |
ANS: B
Renal failure usually causes hypermagnesemia, in which magnesium
concentration is greater than 2.5 mEq/L. Hypermagnesemia is not a result of the
other options.
PTS:
1
REF: Page 122
28. Physiologic
pH is maintained at approximately 7.4 because bicarbonate (HCO3) and
carbonic acid (H2CO3) exist in a ratio of:
|
a. |
20:1 |
c. |
10:2 |
|
b. |
1:20 |
d. |
10:5 |
ANS: A
The relationship between HCO3 and
H2CO3 is usually expressed as a ratio. When the pH is 7.4, this
ratio is 20:1 (HCO3:H2CO3). The other options do not accurately identify physiologic pH
by the correct ratio of HCO3 and H2CO3.
PTS:
1
REF: Page 124
29. Which
arterial pH will initiate the formation of ammonium (NH4)
from ammonia (NH3), referred to as academia,
in the tubular lumen of the kidney?
|
a. |
7.25 |
c. |
7.55 |
|
b. |
7.35 |
d. |
7.65 |
ANS: A
Pathophysiologic changes in the concentration of hydrogen ion or
base in the blood lead to acid-base imbalances. Acidemia is a state in which
the pH of arterial blood is less than 7.35. NH3 is
produced from glutamine in the epithelial cell and diffuses to the tubular
lumen, where it combines with H+ to
form NH4.
PTS:
1
REF: Page 126
30. Two
thirds of the body’s water is found in its:
|
a. |
Interstitial fluid spaces |
c. |
Intracellular fluid
compartments |
|
b. |
Vascular system |
d. |
Intraocular fluids |
ANS: C
Two thirds of the body’s water is in the intracellular fluid
(ICF) compartment, and one third is in the extracellular fluid (ECF) compartment.
The two main ECF compartments are the interstitial fluid and the intravascular
fluid, which is the blood plasma. Other ECF compartments include the lymph and
the transcellular fluids, such as the synovial, intestinal, biliary, hepatic,
pancreatic, and cerebrospinal fluids; sweat; urine; and pleural, synovial,
peritoneal, pericardial, and intraocular fluids.
PTS:
1
REF: Pages 103-104
31. It
is true that
when insulin is administered:
|
a. |
The Na+, K+–ATPase pump is turned off. |
|
b. |
Potassium is moved out of
muscle cells. |
|
c. |
The liver increases its
potassium levels. |
|
d. |
Glucose transport is
impaired. |
ANS: C
Insulin contributes to the regulation of plasma potassium
levels by stimulating the Na+, K+–ATPase
pump, thereby promoting the movement of potassium simultaneously into the liver
and muscle cells with glucose transport after eating. The other options do not
accurately describe the effect of insulin administration.
PTS:
1
REF: Page 114
32. Increased
capillary hydrostatic pressure results in edema because of:
|
a. |
Losses or diminished
production of plasma albumin |
|
b. |
Inflammation resulting from
an immune response |
|
c. |
Blockage within the
lymphatic channel system |
|
d. |
Sodium and water retention |
ANS: D
Increased capillary hydrostatic pressure can
result from venous obstruction or sodium and water retention. The other options
do not accurately describe the cause of edema related to increased capillary
hydrostatic pressure.
PTS:
1
REF: Page 106
33. The
existence of hyperkalemia is likely to result in which changes to a person’s
electrocardiogram (ECG)?
|
a. |
Flattened U waves |
c. |
Depressed ST segments |
|
b. |
Peaked T waves |
d. |
Peaked P waves |
ANS: B
Observed ECG changes include peaked T waves, prolonged PR
interval, and absent P wave with a widened QRS complex. The other options are
not related to hyperkalemia.
PTS:
1
REF: Page 118
MULTIPLE RESPONSE
34. Which
groups are at risk for fluid imbalance? (Select
all that apply.)
|
a. |
Women |
|
b. |
Infants |
|
c. |
Men |
|
d. |
Obese persons |
|
e. |
Older adults |
ANS: B, D, E
Kidney function, surface area, total body water, and the
hydrophobic nature of fat cells all contribute to the increased risk for fluid
imbalance among obese individuals, infants, and older adults. Gender alone is
not a risk factor for fluid imbalance.
PTS:
1
REF: Pages 104-105
35. Dehydration
can cause which result? (Select
all that apply.)
|
a. |
Moist mucous membranes |
|
b. |
Weak pulses |
|
c. |
Tachycardia |
|
d. |
Polyuria |
|
e. |
Weight loss |
ANS: B, C, E
Significant water deficit is demonstrated by symptoms of
dehydration that include headache, thirst, dry skin and mucous membranes,
elevated temperature, weight loss, and decreased or concentrated urine (with
the exception of diabetes insipidus). Skin turgor may be normal or decreased.
Symptoms of hypovolemia include tachycardia, weak pulses, and postural
hypotension.
PTS:
1
REF: Page 112
36. Causes
of hypocalcemia include: (Select
all that apply.)
|
a. |
Repeated blood
administration |
|
b. |
Pancreatitis |
|
c. |
Decreased reabsorption of
calcium |
|
d. |
Hyperparathyroidism |
|
e. |
Kidney stones |
ANS: A, B
Blood transfusions are a common cause of hypocalcemia because
the citrate solution used in storing whole blood binds with calcium.
Pancreatitis causes a release of lipases into soft-tissue spaces; consequently,
the free fatty acids that are formed bind calcium, causing a decrease in
ionized calcium. The other options are not recognized causes of hypocalcemia.
PTS:
1
REF: Page 120
37. The
electrolyte imbalance called hyponatremia exhibits
which clinical manifestations? (Select
all that apply.)
|
a. |
Headache |
|
b. |
Seizures |
|
c. |
Paranoia |
|
d. |
Confusion |
|
e. |
Lethargy |
ANS: A, B, D, E
Behavioral and neurologic changes characteristic of hyponatremia
include lethargy, headache, confusion, apprehension, seizures, and coma.
Paranoia is not associated with hyponatremia.
PTS:
1
REF: Page 113
38. The
electrolyte imbalance hypercalcemia exhibits which clinical
manifestations? (Select
all that apply.)
|
a. |
Diarrhea |
|
b. |
Calcium based kidney stones |
|
c. |
ECG showing narrow T waves |
|
d. |
Lethargy |
|
e. |
Bradycardia |
ANS: B, D, E
Fatigue, weakness, lethargy, anorexia, nausea, and constipation
are common. Behavioral changes may occur. Impaired renal function frequently
develops, and kidney stones form as precipitates of calcium salts. A shortened
QT segment and depressed widened T waves also may be observed on the ECG, with
bradycardia and varying degrees of heart block.
PTS:
1
REF: Pages 120-121
39. The
electrolyte imbalance hypokalemia exhibits which clinical manifestations? (Select all that apply.)
|
a. |
Paralytic ileus |
|
b. |
Sinus bradycardia |
|
c. |
Atrioventricular block |
|
d. |
Dry mucous membranes |
|
e. |
Tetany |
ANS: A, B, C
A variety of dysrhythmias may occur, including sinus
bradycardia, atrioventricular block, paroxysmal atrial tachycardia, and
paralytic ileus. The other options are not related to hypokalemia.
PTS:
1
REF: Pages 116-117
40. A
third of the body’s fluid is contained in the extracellular interstitial fluid
spaces that include: (Select
all that apply.)
|
a. |
Urine |
|
b. |
Intraocular fluids |
|
c. |
Lymph |
|
d. |
Blood plasma |
|
e. |
Sweat |
ANS: A, B, C, E
Two thirds of the body’s water is in the intracelluarl fluid
(ICF) compartment, and one third is in the extracellular fluid (ECF)
compartments. The two main ECF compartments are the interstitial fluid and the
intravascular fluid, such as the blood plasma. Interstitial ECF compartments
include the lymph and the transcellular fluids, such as the synovial, intestinal,
biliary, hepatic, pancreatic, and cerebrospinal fluids; sweat; urine; and
pleural, synovial, peritoneal, pericardial, and intraocular fluids.
PTS:
1
REF: Pages 103-104
41. An
imbalance of potassium can produce which dysfunctions? (Select all that apply.)
|
a. |
Weakness skeletal muscles |
|
b. |
Cardiac dysrhythmias |
|
c. |
Smooth muscle atony |
|
d. |
Visual impairment |
|
e. |
Hearing loss |
ANS: A, B, C
Symptoms of hyperkalemia vary, but common characteristics are
muscle weakness or paralysis and dysrhythmias with changes in the ECG. A wide
range of metabolic dysfunctions may result from hypokalemia. Neuromuscular
excitability is decreased, causing skeletal muscle weakness, smooth muscle
atony, and cardiac dysrhythmias.
PTS: 1
REF: Pages 116-118
42. Which
statements regarding total body water (TBW) are true? (Select all that apply.)
|
a. |
During childhood, TBW
slowly decreases in relationship to body weight. |
|
b. |
Gender has no influence on
TBW until old age. |
|
c. |
Men tend to have greater
TBW as a result of their muscle mass. |
|
d. |
Estrogen plays a role in
female TBW. |
|
e. |
Older adults experience a
decrease in TBW as a result of decreased muscle mass. |
ANS: A, C, D, E
During childhood, TBW slowly decreases to 60% to 65% of body
weight. At adolescence, the percentage of TBW approaches adult proportions, and
gender differences begin to appear. Men eventually have a greater percentage of
body water as a function of increasing muscle mass. Women have more body fat
and less muscle as a function of estrogens and therefore have less body water.
With increasing age, the percentage of TBW declines further still. The decrease
is caused, in part, by an increased amount of fat and a decreased amount of
muscle, as well as by a reduced ability to regulate sodium and water balance.
PTS:
1
REF: Pages 104-105
MATCHING
Match the electrolytes with the corresponding descriptions.
Terms may be used more than once.
______ A. Sodium
______ B. Chloride
______ C. Potassium
______ D. Magnesium
______ E. Phosphate
43. Regulates
osmolality in the extracellular fluid (ECF) space.
44. Is
inversely related to HCO3 concentration.
45. Is a
major determinant of resting membrane potential.
46. An intracellular
metabolic form is adenosine triphosphate (ATP).
47. Changes
in hydrogen ion concentration affect this electrolyte.
43. ANS:
A
PTS:
1
REF: Page 105
MSC: Sodium is the most abundant ECF ion and is responsible
for the osmotic balance of the ECF space. Potassium maintains the osmotic
balance of the ICF space.
44. ANS:
B
PTS:
1
REF: Page 109
MSC: Chloride levels are inversely related to HCO3
concentration.
45. ANS:
C
PTS:
1
REF: Page 114
MSC: The ratio of K+ in the ICF to K+ in the ECF is the
major determinant of the resting membrane potential, which is necessary for the
transmission and conduction of nerve impulses, for the maintenance of normal
cardiac rhythms, and for skeletal and smooth muscle contraction. (Membrane
transport and membrane potentials are discussed in Chapter 1.)
46. ANS:
E
PTS:
1
REF: Page 119
MSC: Phosphate acts as an intracellular and extracellular
anion buffer in the regulation of acid-base balance; it provides energy for
muscle contraction in the form of ATP.
47. ANS:
C
PTS:
1
REF: Page 117
MSC: In states of acidosis, hydrogen ions shift into the
cells in exchange for ICF potassium; hyperkalemia and acidosis therefore often
occur together.
Chapter 4: Genes and Genetic Diseases
MULTIPLE CHOICE
1. Inserting
bone marrow cells into an individual who produces abnormal erythrocytes is an
example of what type of therapy?
|
a. |
Somatic cell |
c. |
Genetic engineering |
|
b. |
Germ cell |
d. |
Recombinant DNA |
ANS: A
Gene therapy can be applied in two ways. The less controversial
approach is somatic cell therapy, which consists of inserting normal genes into
the cells of an individual who has a genetic disease. In this approach, a
particular tissue, such as bone marrow cells that produce abnormal
erythrocytes, is treated. The correct option is the only one that accurately
identifies the therapy described in the question.
PTS:
1
REF: Page 137 | Box 4-2
2. DNA
replication requires the enzyme DNA polymerase to:
|
a. |
Travel along the single DNA
strand, adding the correct nucleotide to the new strand |
|
b. |
Move along the double
strand of DNA to unwind the nucleotides of the double helix |
|
c. |
Hold the double strand
apart while the correct nucleotides are added to the strand |
|
d. |
Transport the double strand
of DNA from the nucleus to the cytoplasm for protein formation |
ANS: A
The DNA polymerase enzyme travels along the single DNA strand,
adding the correct nucleotides to the free end of the new strand (see Figure
4-2, B).
The correct option is the only one that accurately describes the process involved
in DNA replication using DNA polymerase.
PTS:
1
REF: Page 137
3. Transcription
is best defined as a process by which:
|
a. |
DNA polymerase binds to the
promoter site on ribonucleic acid (RNA). |
|
b. |
RNA directs the synthesis
of polypeptides for protein synthesis. |
|
c. |
RNA is synthesized from a
DNA template. |
|
d. |
A base pair substitution
results in a mutation of the amino acid sequence. |
ANS: C
Transcription is the process by which RNA is synthesized from a
DNA template. The correct option is the only one that accurately defines the
term transcription.
PTS:
1
REF: Page 141
4. The
purpose of a staining technique of chromosomes such as Giemsa is to:
|
a. |
Permit the mitotic process
to be followed and monitored for variations. |
|
b. |
Allow for the numbering of
chromosomes and the identification of variations. |
|
c. |
Identify new somatic cells
formed through mitosis and cytokinesis. |
|
d. |
Distinguish the sex
chromosomes from the homologous chromosomes. |
ANS: B
One of the most commonly used stains is Giemsa stain. By using
banding techniques, chromosomes can be unambiguously numbered, and individual
variation in chromosome composition can be studied. Missing or duplicated
portions of chromosomes, which often result in serious diseases, also can be
readily identified. The correct option is the only one that accurately
describes the purpose of the Giemsa staining technique.
PTS:
1
REF: Pages 142-143
5. An
amniocentesis indicates a neural tube defect when an increase in which protein
is evident?
|
a. |
Chorionic |
c. |
Amniotic |
|
b. |
Alpha fetoprotein |
d. |
Embryonic |
ANS: B
Other disorders can be detected with this procedure. These
include most neural tube defects, which cause an elevation of alpha fetoprotein
in the amniotic fluid, and hundreds of diseases caused by mutations of single
genes. The correct option is the only one that accurately identifies the
protein responsible for a neural tube defect.
PTS:
1
REF: Page 136 | Box 4-1
6. An
amniocentesis is recommended for pregnant women who:
|
a. |
Have a history of chronic
illness |
|
b. |
Have a family history of
genetic disorders |
|
c. |
Have experienced in vitro
fertilization |
|
d. |
Had a late menarche |
ANS: B
Amniocentesis is recommended only for pregnancies known to have
an elevated risk for a genetic disease or in women older than 30 to 35 years of
age. The correct option is the only one that accurately describes a criterion
for ordering an amniocentesis.
PTS:
1
REF: Page 136 | Box 4-1
7. The
most clinically useful technique for prenatal diagnosis of chromosomal
abnormalities at 3 months’ (12 weeks’) gestation is:
|
a. |
Gene mapping |
c. |
Amniocentesis |
|
b. |
Linkage analysis |
d. |
Chorionic villus sampling |
ANS: D
Chorionic villus sampling consists
of extracting a small amount of villous tissue directly from the chorion. This
procedure can be performed at 10 weeks’ gestation and does not require in vitro
culturing of cells; sufficient numbers are directly available in the extracted
tissue. Thus the procedure allows prenatal diagnosis at approximately 3 months’
gestation rather than at nearly 5 months’ gestation. The correct option is the
only one that accurately describes the most useful technique for prenatal
diagnosis of chromosomal abnormalities.
PTS:
1
REF: Page 136 | Box 4-1
8. The
term for an error in which homologous chromosomes fail to separate during
meiosis or mitosis is:
|
a. |
Aneuploidy |
c. |
Polyploidy |
|
b. |
Nondisjunction |
d. |
Translocation |
ANS: B
Aneuploidy is usually the result of nondisjunction, an error in
which homologous chromosomes or sister chromatids fail to separate normally
during meiosis or mitosis. The correct option is the only one that is used to
describe an error in chromosomal separation during reproduction.
PTS:
1
REF: Page 145
9. Which
clinical manifestations would be expected for a child who has complete trisomy
of the twenty-first chromosome?
|
a. |
Widely spaced nipples,
reduced carrying angle at the elbow, and sparse body hair |
|
b. |
An IQ of 25 to 70, low
nasal bridge, protruding tongue, and flat, low-set ears |
|
c. |
High-pitched voice, tall
stature, gynecomastia, and an IQ of 60 to 90 |
|
d. |
Circumoral cyanosis, edema
of the feet, short stature, and mental slowness |
ANS: B
Individuals with this disease are mentally retarded, with IQs
usually ranging from 25 to 70. The facial appearance is distinctive and
exhibits a low nasal bridge, epicanthal folds (which produce a superficially
Asian appearance), protruding tongue, and flat, low-set ears. The correct
option is the only one that accurately describes the clinical manifestations of
the complete trisomy of the twenty-first chromosome.
PTS:
1
REF: Pages 146-147
10. What
is the most common cause of Down syndrome?
|
a. |
Paternal nondisjunction |
c. |
Maternal nondisjunction |
|
b. |
Maternal translocations |
d. |
Paternal translocation |
ANS: C
Nondisjunction during the formation of one of the parent’s
gametes or during early embryonic development occurs in approximately 97% of
infants born with Down syndrome. In approximately 90% to 95% of infants, the
nondisjunction occurs in the formation of the mother’s egg cell. The correct
option is the only one that accurately describes the most common cause of Down
syndrome.
PTS:
1
REF: Page 147
11. What
syndrome, characterized by an absent homologous X chromosome with only a single
X chromosome, exhibits features that include a short stature, widely spaced
nipples, and webbed neck?
|
a. |
Down |
c. |
Turner |
|
b. |
Cri du chat |
d. |
Klinefelter |
ANS: C
In Turner syndrome, a sex chromosome is missing, and the
person’s total chromosome count is 45. Characteristic signs include short
stature, female genitalia, webbed neck, shieldlike chest with underdeveloped
breasts and widely spaced nipples, and imperfectly developed ovaries. The
correct option is the only one that accurately describes the clinical manifestations
described in the question.
PTS:
1
REF: Page 147
12. A
person with 47, XXY karyotype has the genetic disorder resulting in which
syndrome?
|
a. |
Turner |
c. |
Down |
|
b. |
Klinefelter |
d. |
Fragile X |
ANS: B
A disorder in the chromosome (47, XXY karyotype) results in a
disorder known as Klinefelter
syndrome. The correct option is the only one that accurately
describes a genetic disorder that exhibits the described genetic configuration.
PTS:
1
REF: Page 148
13. What
is the chromosomal variation that causes Klinefelter syndrome?
|
a. |
Nondisjunction of the X
chromosome in the father |
|
b. |
Translocation of the X
chromosome in the mother |
|
c. |
Nondisjunction of X
chromosome in the mother |
|
d. |
Translocation of the Y
chromosome in the father |
ANS: C
Nondisjunction of the X chromosomes in the mother causes
Klinefelter syndrome in the majority of infants, and the frequency of the
disorder rises with maternal age. The correct option is the only one that
accurately describes the chromosomal variation characteristic of Klinefelter
syndrome.
PTS:
1
REF: Page 148
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