Table of Contents
Chapter 01: Concepts of Health and Disease .............................................................................................................................. 2
Chapter 02: Cell and Tissue Characteristics ................................................................................................................................. 8
Chapter 03: Cellular Adaptation, Injury, and Death ................................................................................................................... 13
Chapter 04: Genetic Control of Cell Function andInheritance............................................................................................... 18
Chapter 05: Genetic and Congenital Disorders ......................................................................................................................... 24
Chapter 06: Neoplasia ................................................................................................................................................................ 29
Chapter 07: Stress and Adaptation ............................................................................................................................................ 34
Chapter 08: Disorders of Fluid and Electrolyte, and AcidBase Balance ................................................................................. 40
Chapter 09: Inflammation, Tissue Repair, and WoundHealing ................................................................................................ 51
Chapter 10: Mechanisms of Infectious Disease ......................................................................................................................... 61
Chapter 11: Innate and Adaptive Immunity ............................................................................................................................... 67
Chapter 12: Disorders of the Immune Response,Including HIV/AIDS ................................................................................... 72
Chapter 13: Organization and Control of Neural Function ....................................................................................................... 83
Chapter 14: Somatosensory Function, Pain, Headache,and Temperature Regulation ................................................................. 89
Chapter 15: Disorders of Motor Function ................................................................................................................................ 94
Chapter 16: Disorders of Brain Function ................................................................................................................................ 100
Chapter 17: Sleep and Sleep-Wake Disorders ......................................................................................................................... 105
Chapter 18: Disorders of Thought, Emotion, and Memory .................................................................................................... 111
Chapter 19: Disorders of Visual Function ............................................................................................................................... 117
Chapter 20: Disorders of Hearing and Vestibular Function.................................................................................................... 122
Chapter 21: Blood Cells and the Hematopoietic System ......................................................................................................... 128
Chapter 22: Disorders of Hemostasis ..................................................................................................................................... 133
Chapter 23: Disorders of Red Blood Cells .............................................................................................................................. 138
Chapter 24: Disorders of White Blood Cells andLymphoid Tissues ...................................................................................... 144
Chapter 25: Structure and Function of the CardiovascularSystem ........................................................................................ 149
Chapter 26: Disorders of Blood Flow and Blood PressureRegulation ...................................................................................... 155
Chapter 27: Disorders of Cardiac Function, and HeartFailure and Circulatory Shock.............................................................. 166
Chapter 28: Disorders of Cardiac Conduction andRhythm................................................................................................... 178
Chapter 29: Structure and Function of the RespiratorySystem............................................................................................. 184
Chapter 30: Respiratory Tract Infections, Neoplasms, andChildhood Disorders ......................................................................... 189
Chapter 31: Disorders of Ventilation and Gas Exchange........................................................................................................ 200
Chapter 32: Structure and Function of the Kidney ................................................................................................................. 205
Chapter 33: Disorders of Renal Function ............................................................................................................................... 210
Chapter 34: Acute Kidney Injury and Chronic KidneyDisease.............................................................................................. 216
Chapter 35: Disorders of the Bladder and Lower UrinaryTract ............................................................................................ 222
Chapter 36: Structure and Function of theGastrointestinal System ......................................................................................... 227
Chapter 37: Disorders of Gastrointestinal Function ............................................................................................................... 233
Chapter 38: Disorders of Hepatobiliary and ExocrinePancreas Function ............................................................................ 239
Chapter 39: Alterations in Nutritional Status ........................................................................................................................... 245
Chapter 40: Mechanisms of Endocrine Control ...................................................................................................................... 250
Chapter 41: Disorders of Endocrine Control of Growthand Metabolism .................................................................................... 256
Chapter 42: Structure and Function of the MaleGenitourinary System ................................................................................ 261
Chapter 43: Disorders of the Male Reproductive System ...................................................................................................... 267
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,Chapter 44: Structure and Function of the FemaleReproductive System ............................................................................. 273
Chapter 45: Disorders of the Female ReproductiveSystem .................................................................................................. 278
Chapter 46: Sexually Transmitted Infections ........................................................................................................................... 284
Chapter 47: Structure and Function of theMusculoskeletal System ......................................................................................... 289
Chapter 48: Disorders of Musculoskeletal Function:Trauma, Infection, Neoplasms ............................................................... 294
Chapter 49: Disorders of Musculoskeletal Function:Developmental and Metabolism Disorders ............................................. 300
Chapter 50: Disorders of Musculoskeletal Function:Rheumatic Disorders.......................................................................... 306
Chapter 51: Structure and Function of the Skin ..................................................................................................................... 311
Chapter 52: Disorders of Skin Integrity and Function ............................................................................................................ 317
Chapter 01: Concepts of Health and Disease
1. At an international nursing conference, many discussions and breakout sessionsfocused on the World Health
Organization (WHO) views on health. Of the following comments made by nurses during a discussion session, which
statements would beconsidered a good representation of the WHO definition? Select all that apply.
A) Interests in keeping the elderly population engaged in such activities as bookreviews and word games during
social time
B) Increase in the number of chair aerobics classes provided in the skilled carefacilities
C) Interventions geared toward keeping the elderly population diagnosed with diabetesmellitus under tight blood glucose control
by providing in-home cooking classes
D) Providing transportation for renal dialysis patients to and from their hemodialysissessions
E) Providing handwashing teaching sessions to a group of young children
Ans: A, B, C, E
Feedback:
The WHO definition of health is defined as “a state of complete physical, mental, andsocial well-being and not merely the
absence of disease and infirmity.” Engaging in book reviews facilitates mental and social well-being; chair aerobics helps
facilitate physical well-being; and assisting with tight control of diabetes helps with facilitating physical well-being even though
the person has a chronic disease. Handwashing is vital in the prevention of disease and spread of germs.
2. A community health nurse is teaching a group of recent graduates about the largevariety of factors that influence an
individual's health or lack thereof. The nurse is referring to the Healthy People 2020 report from the U.S. Department of
Health and Human Services as a teaching example. Of the following aspects discussed, which would be considered a
determinant of health that is outside the focus of this report?
A) The client has a diverse background by being of Asian and Native Americandescent and practices various
alternative therapies to minimize effects of stress.
B) The client has a family history of cardiovascular disease related to hypercholesterolemia and remains
noncompliant with the treatment regime.
C) The client has a good career with exceptional preventative health care benefits.
D) The client lives in an affluent, clean, suburban community with access to manyhealth care facilities.
Ans: B
Feedback:
In Healthy People 2020, the focus is to promote good health to all (such as usingalternative therapies to minimize
effects of stress); achieving health equity and promoting health for all (which includes having good health care
benefits); and
promoting good health (which includes living in a clean community with good accessto health care). A client's noncompliance
with treatments to control high cholesterol levels within the presence of a family history of CV disease does not meet the
“attaining lives free of preventable disease and premature death” determinant.
3. A physician is providing care for a number of patients on a medical unit of a large,university hospital. The physician is
discussing with a colleague the differentiation between diseases that are caused by abnormal molecules and diseases that
cause disease. Which of the following patients most clearly demonstrates the consequencesof molecules that cause disease?
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,A) A 31-year-old woman with sickle cell anemia who is receiving a transfusion ofpacked red blood cells
B) A 91-year-old woman who has experienced an ischemic stroke resulting fromfamilial hypercholesterolemia
C) A 19-year-old man with exacerbation of his cystic fibrosis requiring oxygentherapy and chest
physiotherapy
D) A 30-year-old homeless man who has Pneumocystis carinii pneumonia (PCP) andis HIV positive.
Ans: D
Feedback:
PCP is an example of the effect of a molecule that directly contributes to disease. Sickle cell anemia, familial
hypercholesterolemia, and cystic fibrosis are all examplesof the effects of abnormal molecules.
4. A member of the health care team is researching the etiology and pathogenesis ofa number of clients who are under his
care in a hospital context. Which of the following aspects of clients' situations best characterizes pathogenesis rather than
etiology?
A) A client who has been exposed to the Mycobacterium tuberculosis bacterium
B) A client who has increasing serum ammonia levels due to liver cirrhosis
C) A client who was admitted with the effects of methyl alcohol poisoning
D) A client with multiple skeletal injuries secondary to a motor vehicle accident
Ans: B
Feedback:
Pathogenesis refers to the progressive and evolutionary course of disease, such as the increasing ammonia levels that
accompany liver disease. Bacteria, poisons, andtraumatic injuries are examples of etiologic factors.
5. A new myocardial infarction patient requiring angioplasty and stent placement hasarrived to his first cardiac rehabilitation
appointment. In this first session, a review of the pathogenesis of coronary artery disease is addressed. Which statement
by the
patient verifies to the nurse that he has understood the nurse's teachings aboutcoronary artery disease?
A) “All I have to do is stop smoking, and then I won't have any more heart attacks.”
B) “My artery was clogged by fat, so I will need to stop eating fatty foods like Frenchfries every day.”
C) “Sounds like this began because of inflammation inside my artery that made iteasy to form fatty streaks, which
lead to my clogged artery.”
D) “If I do not exercise regularly to get my heart rate up, blood pools in the veinscausing a clot that stops blood flow
to the muscle, and I will have a heart attack.”
Ans: C
Feedback:
The true etiology/cause of coronary artery disease (CAD) is unknown; however, the pathogenesis of the disorder relates
to the progression of the inflammatory process from a fatty streak to the occlusive vessel lesion seen in people with
coronary artery disease. Risk factors for CAD revolve around cigarette smoking, diet high in fat, andlack of exercise.
6. A 77-year-old man is a hospital inpatient admitted for exacerbation of his chronic obstructive pulmonary disease
(COPD), and a respiratory therapist (RT) is assessing the client for the first time. Which of the following aspects of the
patient's current stateof health would be best characterized as a symptom rather than a sign?
A) The patient's oxygen saturation is 83% by pulse oxymetry.
B) The patient notes that he has increased work of breathing when lying supine.
C) The RT hears diminished breath sounds to the patient's lower lung fields bilaterally.
D) The patient's respiratory rate is 31 breaths/minute.
Ans: B
Feedback:
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, Symptoms are subjective complaints by the person experiencing the health problem, such as complaints of breathing
difficulty. Oxygen levels, listening to breath sounds,and respiratory rate are all objective, observable signs of disease.
7. Which of the following situations would be classified as a complication of a diseaseor outcome from the treatment
regimen? Select all that apply.
A) Massive pulmonary emboli following diagnosis of new-onset atrial fibrillation
B) Burning, intense incision pain following surgery to remove a portion of colon due tointestinal aganglionosis
C) Development of pulmonary fibrosis following treatment with bleomycin, an antibioticchemotherapy agent used in
treatment of lymphoma
D) Gradual deterioration in ability to walk unassisted for a patient diagnosed with
Parkinson disease
E) Loss of short-term memory in a patient diagnosed with Alzheimer disease
Ans: A, C
Feedback:
Development of pulmonary emboli and pulmonary fibrosis following chemotherapy areboth examples of a complication (adverse
extensions of a disease or outcome from treatment). It is normal to expect incisional pain following surgery. As Parkinson
disease progresses, the inability to walk independently is expected. This is a normal progression for people diagnosed with
Parkinson's. Loss of short-term memory in a patient diagnosed with Alzheimer disease is an expected finding.
8.Laboratory testing is ordered for a male patient during a clinic visit for a routine follow-up assessment of hypertension.
When interpreting lab values, the nurse knowsthat
A) a normal value represents the test results that fall within the bell curve.
B) if the lab result is above the 50% distribution, the result is considered elevated.
C) all lab values are adjusted for gender and weight.
D) if the result of a very sensitive test is negative, that does not mean the person isdisease free.
Ans: A
Feedback:
What is termed a normal value for a laboratory test is established statistically from results obtained from a selected sample of
people. A normal value represents the test results that fall within the bell curve or the 95% distribution. Some lab values (like
hemoglobin) are adjusted for gender, other comorbidities, or age. If the result of a very sensitive test is negative, it tells us the
person does not have the disease, and thedisease has been ruled out or excluded.
9. The laboratory technologists are discussing a new blood test that helps establish a differential diagnosis between shortness
of breath with a cardiac etiology and shortness of breath with a respiratory/pulmonary etiology. A positive result is purported
to indicate a cardiac etiology. The marketers of the test report that 99.8% ofpatients who have confirmed cardiac etiologies test
positive in the test. However, 1.3%of patients who do not have cardiac etiologies for their shortness of breath also test
positive. Which of the following statements best characterizes this blood test?
A) Low validity; high reliability
B) High sensitivity; low specificity
C) High specificity; low reliability
D) High sensitivity; low reliability
Ans: B
Feedback:
A large number of patients would receive the correct positive diagnosis (high sensitivity), while a significant number
would receive a false-positive diagnosis (lowspecificity). The information given does not indicate low reliability or low
validity.
10. As part of a screening program for prostate cancer, men at a senior citizens' center are having their blood levels of
prostate-specific antigen (PSA) measured. Which of the following statements would best characterize a high positive
predictivevalue but a low negative predictive value for this screening test?
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