Pathophysiology A Practical Approach 1st Edition Story Test Bank

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Pathophysiology A Practical Approach 1st Edition Story Test Bank

ISBN-13: 978-1449624088

ISBN-10: 1449624081



Pathophysiology A Practical Approach 1st Edition Story Test Bank

ISBN-13: 978-1449624088

ISBN-10: 1449624081




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Chapter 12

___ 1. A sprain involves:
  A) Stretching injury to a muscle or musculotendinous unit.
  B) Injury to the ligamentous structures that support a joint.
  C) Displacement and loss of articulation of bone ends within the joint capsule.
  D) Partial dislocation in which bone ends within a joint are still in partial contact with each other.



___ 2. A life-threatening complication of a fracture is:
  A) compartment syndrome
  B) fat embolism
  C) nonunion
  D) infection



___ 3. A patient presents to the emergency room after a motor vehicle accident with obvious deformity and lack of function to the right lower leg. A x-ray of the extremity reveals that the tibia is broken into two pieces and the fibia is broken into three pieces. The patient has more than likely suffered a:
  A) Comminuted fracture.
  B) Greenstick fracture.
  C) Impacted fracture.
  D) Spiral fracture.



___ 4. After a period of prolonged bed rest, the healthcare provider tells the patient that she has developed brittle bones. The nurse should explain to the patient that the prolonged be rest has resulted in:
  A) Atrophy
  B) Fractures
  C) Contractures
  D) Osteoporosis



___ 5. Complete healing of a bone fracture occurs when:
  A) No movement of the break is detectable.
  B) The callus has been completely replaced with mature bone.
  C) The fracture site and surrounding soft tissue are pain free.
  D) A cast is no longer required to stabilize the break.



___ 6. J.R. is a 33-year-old lawyer who has sustained a leg fracture as a result of colliding with a tree while skiing. His fracture has been diagnosed as “compound, transverse fracture of the tibia and fibia.” The type of fracture J.R. sustained is best described as a bone
  A) Broken in two or more pieces.
  B) Cracked but not completely separated.
  C) Broken along the long axis.
  D) Broken and protruding through skin.



___ 7. Common early manifestations of fracture include which of the following:
  A) Muscle flaccidity.
  B) Swelling at fracture site.
  C) Elevated white blood cells.
  D) Loss of sensation in affected extremity.



___ 8. Which of the following would an appropriate treatment for mild scoliosis?
  A) Bracing.
  B) Routine exercise.
  C) Smoking cessation.
  D) Calcium supplement.



___ 9. Compartment syndrome involves:
  A) Nerve and blood vessel compression caused by swelling of tissues enclosed within muscle fascia.
  B) Large compartment or area of localized hemorrhage.
  C) Presence of a loose body with a joint space.
  D) Bleeding into a joint space.



___ 10. To determine if a patient is experiencing compartment syndrome, which of the following is a priority area for nursing assessment?
  A) Edema at the fracture site.
  B) Deformity at the fracture site.
  C) Presence of drainage on the cast.
  D) Pain at fracture site above what would be expected.



___ 11. A 12 year old patient comes into the emergency room with a strained wrist from a fall while skating. The appropriate intervention during the first 24 hours is to:
  A) Keep the wrist in a dependent position to decrease stress on the ligaments.
  B) Apply ice packs to promote vasoconstriction.
  C) Apply heat packs to promote vasodilatation.
  D) Apply traction to prevent muscle spasms.



___ 12. Which of the following persons is at highest risk for osteoporosis?
  A) 72 year old Caucasian female with a body mass index (BMI) of 19.
  B) 70 year old African American female with a BMI of 28.
  C) 40 year old Hispanic male that has been quadriplegic for 6 years.
  D) 68 year old Caucasian male that has been wheelchair bound for 5 years.



___ 13. Rickets is characterized by soft, weak bones resulting from:
  A) Hypercalcemia.
  B) Estrogen deficiency.
  C) Phosphate excess.
  D) Vitamin D deficiency.



___ 14. RICE would the appropriate treatment protocol for which of the following diseases?
  A) Paget’s disease
  B) Osteoarthritis
  C) Sprains
  D) Gout



___ 15. Prevention of osteoporosis focuses on:
  A) Increasing phosphorus intake.
  B) Increasing weight-bearing exercise.
  C) Limiting soy intake.
  D) Limiting vitamin D intake.



___ 16. Paget’s disease:
  A) Is a chronic, inflammatory, rheumatic, autoimmune disease.
  B) Is thought to be caused by a virus that induces osteoclast proliferation.
  C) Is a chronic, autoimmune, connective tissue disorder involving skin and other organs.
  D) Is an inadequate bone mineralization as a result of a deficiency of calcium and phosphorus.



___ 17. Which of the following lab data would be most significant in the patient with Paget’s disease?
  A) Elevated white blood cell count.
  B) Elevated erythrocyte sedimentation rate.
  C) Elevated serum alkaline phosphatase.
  D) Positive tissue biopsy for Staphylococcus.



___ 18. What is an excessive lateral curvature of the spine?
  A) Scoliosis
  B) Kyphosis
  C) Lordiosis
  D) Anklosing spondylitis



___ 19. A 40 year old women presents to the clinic complaining of morning stiffness, fatigue, and loss of energy. Physical exam reveals hard, swollen joints, limited range of motion, deformity of the interphalangeal joints, fever, and systemic inflammatory responses. Laboratory results indicate an elevated sedimentation rate. The healthcare provider should suspect which of the following diseases?
  A) Gout.
  B) Osteoarthritis.
  C) Rheumatoid arthritis.
  D) Systemic lupus erythematosus.



___ 20. Which of the following persons is at the highest risk for developing pathological fractures?
  A) A highly active 2 year old female
  B) 20 year old male that routinely participates in contact sports
  C) 40 year old female with moderate scoliosis
  D) 68 year old postmenopausal female with bone cancer



___ 21. A 58 year old, obese man presents to the clinic with joint pain that worsens with activity and relieved by rest. Physical exam reveals joint stiffness and crepitis. These findings are consistent with which of the following diseases?
  A) Osteoarthritis.
  B) Gouty arthritis.
  C) Reactive arthritis.
  D) Rheumatoid arthritis.



___ 22. The pathophysiology underlying gouty arthritis may be attributed to:
  A) Increased immune complexes within the joint cavity.
  B) The presence of fibrous adhesions within bony cartilage.
  C) An alteration in purine metabolism resulting in hyperuricemia.
  D) Excessive bone remodeling secondary to increased levels of phosphorus.



___ 23. Which of the following laboratory values would you expect for the patient with gout due to under excretion?
  A) Normal serum uric acid and elevated urine uric acid.
  B) Low serum uric acid and low urine uric acid.
  C) High serum uric acid and normal urine uric acid.
  D) High serum uric acid and low urine uric acid.



___ 24. Which of the following foods should you instruct the patient prone to gout to avoid?
  A) Spinach.
  B) Crawfish.
  C) Chocolate.
  D) Potato chips.



___ 25. The following are risk factors for arthritis except:
  A) overweight/obesity
  B) joint injuries
  C) infection in joints
  D) certain occupations
  E) All of the above are risk factors.


___ 26. __________ results in the failure of cartilage cells to maintain the balance between degradation and synthesis of the supporting matrix.
  A) Gout
  B) Rheumatoid Arthritis
  C) Osteoarthritis
  D) None of the above


___ 27. Tertiary activities for osteoporosis include which of the following:
  A) Education, diet
  B) Exercise, fall prevention
  C) Medication, education
  D) Bone density screening, medication


___ 28. The most serious consequence of osteoporosis is:
  A) Bad skin
  B) Falls
  C) Hip fracture
  D) Loss of height


___ 29. Osteoporosis is most likely to affect which group of people:
  A) Adolescents
  B) Young men and women
  C) Middle aged women
  D) Older women



___ 30. Which of the following statements related to herniated intervertebral disk is INCORRECT?
  A) Protrusion of the disk material may impinge on nerve roots that exit through intervertebral foramina.
  B) It usually results from chronic infection of the disk, which predisposes to the herniation.
  C) Protrusion of disk material may be detected by CT scan or myelogram.
  D) Part of the nucleus pulposus is extruded through a weak area or tear in the annulus fibrosus.


___ 31. Which of the following statements regarding gout is INCORRECT?
  A) It is a disturbance of purine metabolism.
  B) It is associated with an autoantibody directed against antigens in joint cartilage.
  C) Uric acid may precipitate in tissues, forming gouty tophi.
  D) The frequency of attacks can be reduced by drugs that lower blood uric acid.



___ 32. What is a pathologic fracture?
  A) A fracture in which the overlying skin is broken
  B) A fracture that occurs in a weakened area of bone secondary to a disease involving the bone
  C) A fracture in which the bone is shattered into multiple pieces
  D) A fracture associated with an autoantibody



___ 33. Which of the following conditions is NOT a characteristic manifestation of rheumatoid arthritis?
  A) Autoantibodies directed against gamma globulin
  B) High levels of uric acid in the blood
  C) Chronic inflammation of synovium
  D) Involvement of the small joints of the hands and feet



___ 34. Which of the following statements does NOT apply to myasthenia gravis?
  A) Abnormal fatigability of voluntary muscles
  B) Associated with degeneration of motor nerve cells supplying the affected muscles
  C) Associated with autoantibodies against acetylcholine receptors at the myoneural junction of the muscle fibers
  D) Symptoms of the disease are relieved by drugs that prolong the action of acetylcholine



___ 35. A deposit of uric acid in the soft tissues of a gouty subject is called:
  A) Calculus
  B) Synovium
  C) Tophus
  D) Arthritis



___ 36. All of the following conditions predispose to osteoporosis or increase the risk of osteoporosis EXCEPT:
  A) Overweight
  B) Low intake of calcium in the diet
  C) Vitamin D deficiency
  D) White race
  E) Female gender



___ 37. The active bone-forming cells that produce the collagenous bone matrix and secrete the enzyme alkaline phosphatase are called:
  A) Osteocytes
  B) Osteoblasts
  C) Trabeculae
  D) Osteoclasts



___ 38. Which of the following statements about scoliosis are CORRECT?
  A) Scoliosis can be identified by examination of the spine when the teen is either standing upright or while bending forward.
  B) Usually a curvature progresses after the teenager stops growing.
  C) Thoracic curvature reduces the size of the thorax, interfering with lung function.
  D) Scoliosis never requires surgical treatment.
  E) All of the above.




Answer Key


1. B
2. B
3. A
4. D
5. B
6. D
7. B
8. A
9. A
10. D
11. B
12. A
13. D
14. C
15. B
16. B
17. C
18. A
19. C
20. D
21. A
22. C
23. D
24. B
25. E
26. C
27. B
28. C
29. D
30. B
31. B
32. B
33. B
34. B
35. C
36. A
37. B
38. A and C



  1. Sprains refer to injury to a ligament that often involves stretching or tearing of the ligament. A describes a strain. C describes a dislocation. D describes a subluxation.
  2. While all are complications of a fracture, a fat embolism is the most likely to be life-threatening.
  3. Comminuted fractures refer to fractures that involve more than two pieces. Greenstick fractures involve an incomplete break. Impacted fractures refer to fractures in which the ends are forced into nearby bone. Spiral fractures involve twisting of the bone.
  4. Osteoporosis refers to decreased bone density, and it is common with prolonged bed rest because weight bearing is important with bone mineralization. Atrophy refers to decreasing in cell number; it is common in muscles resulting from disuse. Fractures refer to a break in a bone. Contractures refer to the shortening of a muscle.
  5. Complete wound healing has occurred when the callus has been completely replaced with mature bone. This process can take up to 8 weeks.
  6. A compound fracture refers to a fracture in which the bone is protruding through the skin. Transverse refers to the angle of the break. A describes a comminuted fracture. B describes a greenstick fracture. C describes a vertical fracture.
  7. Swelling at the fracture site occurs quickly following the injury because of the inflammatory process. Additionally, muscle spasms and loss of function may be seen. Leukocytosis may be present, but it not early. Loss of sensation may indicate nerve damage and should be further investigated.
  8. Bracing will correct most mild cases of scoliosis. Routine exercise, smoking cessation, and calcium supplements has not been shown to correct mild cases of scoliosis.
  9. Compartment syndrome refers to nerve and blood vessel compression in the muscle fascia caused by tissue swelling. It can be a complication of fractures. Compartment syndrome requires immediate treatment because it can result in the loss of the limb.
  10. Compartment syndrome refers to nerve and blood vessel compression in the muscle fascia caused by tissue swelling. It can be a complication of fractures. Compartment syndrome requires immediate treatment because it can result in the loss of the limb. It often presents first with excruciating pain, worse than what would be expected for the degree of injury. Additionally, the person may have indicators of neurovascular impairment (e.g., decreased pulse, pallor, paralysis, paresthsia) distal to the injury.
  11. Ice will promote vasoconstriction and limit swelling secondary to the inflammatory response. Maintaining a dependent position and applying heat will make the swelling worse. Muscle spasms are not expected with this type of injury; therefore, traction is not necessary.
  12. The 72 year old has four risk factors: advancing age, being Caucasian, being female, and having a low BMI. The 70 year old only has one risk factor: being female. The 40 year old only has one risk factor: long term immobility. The 68 year old only has one risk factor: long term decreased mobility.
  13. Rickets refers to weakened bones secondary to vitamin D deficit. Decreased estrogen levels and phosphate excess can lead to osteoporosis but not rickets.
  14. RICE refers to rest, ice, compression, and elevation; it is a treatment common for soft tissue injuries such as sprains. It would not be used to treat Paget’s disease, osteoarthritis, or gout.
  15. Weight-bearing exercises increase bone mineralization of calcium, which will prevent osteoporosis. Increasing phosphorus, limiting soy, and limiting vitamin D intake will increase the likelihood of developing osteoporosis.
  16. Paget’s disease is progressive metabolic condition characterized by excessive bone destruction. The exact cause is unclear, but it is thought to be caused a virus. A is describing rheumatoid arthritis. C is describing scleraderma. D is describing rickets.
  17. Of all the options, elevated serum alkaline phosphatase would be the most specific to Paget’s disease.
  18. Scoliosis refers to an excessive lateral curvature of the spine. Kyphosis is an increase in the thorasic spine curvature outward. Lordiosis is an exaggerated concave of the lumbar spine. Anklosing spondylitis refers to a progressive inflammatory condition that results in fusing of sacroiliac joints, intervertebral spaces, and costovertebral joints.
  19. Rheumatoid arthritis refers to a systemic, autoimmune, inflammatory condition involving multiple joints. It typically presents with morning stiffness, fatigue, joint changes, and systemic inflammatory indicators (e.g., elevated sedimentation rate). Gout and arthritis typically do not have morning stiffness. Systemic lupus erythematosus does not typically present with joint deformity.
  20. Pathological fractures are fractures that results from weakening of the bones because repetitive wear or disease. The 68 year old would be at most risk because of advancing age, being female, being postmenopausal, and having bone cancer.
  21. Osteoarthritis refers to a degenerative joint disease. Risk factors include being obese and highly active. The condition presents with pain that worsens with activity and relieved by, joint stiffness, and crepitis. These findings are not consistent with gouty arthritis, reactive arthritis, or rheumatoid arthritis.
  22. Gouty arthritis is caused by an error in purine metabolism, which results in hyperuricemia. The other options do not occur with gouty arthritis.
  23. Gout can result for two reasons: an under excretion of uric acid or an over production of uric acid. With under excretion the serum uric acid will be high while the urine levels will be low. With over production, the serum levels will be high while the urine uric acid levels will be either high or normal.
  24. Persons prone to gout should avoid foods high in purines such as protein, seafood, and alcohol.



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