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 b


Chapter 3: The Cellular Environment: Fluids and Electrolytes, Acids and Bases

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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 b
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                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

                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.

                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

                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

                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

                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

                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.

                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

                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

                10.          Thirst activates osmoreceptors by an increase in which blood plasma?

a.            Antidiuretic hormone    c.             Hydrostatic pressure

b.            Aldosterone       d.            Osmotic pressure

                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.

                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

                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

                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

                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.

                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

                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

                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.

                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+

                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

                21.          Causes of hyperkalemia include:

a.            Hyperparathyroidism and malnutrition

b.            Vomiting and diarrhea

c.             Renal failure and Addison disease

d.            Hyperaldosteronism and Cushing disease

                22.          In hyperkalemia, what change occurs to the cells’ resting membrane potential?

a.            Hypopolarization              c.             Depolarization

b.            Hyperexcitability              d.            Repolarization

                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

                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.

                25.          Chvostek and Trousseau signs indicate which electrolyte imbalance?

a.            Hypokalemia      c.             Hypocalcemia

b.            Hyperkalemia    d.            Hypercalcemia

                26.          An excessive use of magnesium-containing antacids and aluminum-containing antacids can result in:

a.            Hypomagnesemia           c.             Hyponatremia

b.            Hypophosphatemia        d.            Hypokalemia

                27.          The most common cause of hypermagnesemia is:

a.            Hepatitis              c.             Trauma to the hypothalamus

b.            Renal failure       d.            Pancreatitis

                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

                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

                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

                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.

                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

                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

Chapter 34: Structure and Function of the Pulmonary System


                1.            What pulmonary defense mechanism propels a mucous blanket that entraps particles moving toward the oropharynx?

a.            Nasal turbinates               c.             Cilia

b.            Alveolar macrophages   d.            Irritant receptors on the nares

                2.            Which term is used to identify the movement of gas and air into and out of the lungs?

a.            Perfusion            c.             Respiration

b.            Ventilation          d.            Diffusion

                3.            When an individual aspirates food particles, where would the nurse expect to hear decreased or absent breath sounds?

a.            Left lung              c.             Trachea

b.            Right lung            d.            Carina

                4.            Aspiration is most likely to occur in the right mainstem bronchus because it:

a.            Extends vertically from the trachea.

b.            Is narrower than the left mainstem bronchus.

c.             Comes into contact with food and drink first.

d.            Is located at the site where the bronchi bifurcate.

                5.            Air passage among alveoli is collateral and evenly distributed because of the function of which structures?

a.            Type I alveolar cells         c.             Acinus pores

b.            Pores of Kohn   d.            Alveolar pores

                6.            Where in the lung does gas exchange occur?

a.            Trachea                c.             Alveolocapillary membrane

b.            Segmental bronchi          d.            Main bronchus

                7.            Surfactant produced by type II alveolar cells facilitates alveolar distention and ventilation by which mechanism?

a.            Decreasing thoracic compliance

b.            Attracting water to the alveolar surface

c.             Decreasing surface tension in the alveoli

d.            Increasing surface tension in the alveoli

                8.            Which part of the brainstem provides basic automatic rhythm of respiration by sending efferent impulses to the diaphragm and intercostal muscles?

a.            Dorsal respiratory group (DRG)  c.             Pneumotaxic center

b.            Ventral respiratory group             d.            Apneustic center

                9.            Which structures secrete surfactant?

a.            Type I alveolar cells         c.             Alveolar macrophages

b.            Type II alveolar cells        d.            Stretch receptors

                10.          Which structure is not associated with any lymphatic vessels?

a.            Trachea                c.             Acinus

b.            Bronchi d.            Terminal bronchioles

                11.          Which describes the pressure in the pleural space?

a.            Atmospheric      c.             Above atmospheric

b.            Below atmospheric         d.            Variable

                12.          The adequacy of a person’s alveolar ventilation is assessed best by monitoring which mechanism?

a.            Ventilatory rate                c.             Respiratory effort

b.            Ventilatory pattern         d.            Arterial blood gas

                13.          Which normal physiologic change occurs in the aging pulmonary system?

a.            Decreased flow resistance           c.             Stiffening of the chest wall

b.            Fewer alveoli     d.            Improved elastic recoil

                14.          How is most of the oxygen in the blood transported?

a.            Dissolved in plasma         c.             In the form of carbon dioxide (CO2)

b.            Bound to hemoglobin    d.            Bound to protein

                15.          Stretch receptors and peripheral chemoreceptors send afferent impulses regarding ventilation to which location in the brain?

a.            Pneumotaxic center in the pons

b.            Apneustic center in the pons

c.             Dorsal respiratory group (DRG) in the medulla oblongata

d.            Ventral respiratory group (VRG) in the medulla oblongata

                16.          Which substances cause airway epithelium to constrict?

a.            Epinephrine and acetylcholine   c.             Bradykinin and thromboxane A

b.            Histamine and prostaglandin      d.            Leukotrienes and prostacyclin

                17.          If a patient develops acidosis, the nurse would expect the oxyhemoglobin dissociation curve to react in which manner?

a.            Shift to the right, causing more oxygen (O2) to be released to the cells

b.            Shift to the left, allowing less O2 to be released to the cells

c.             Show no change, allowing the O2 concentration to remain stable

d.            Show dramatic fluctuation, allowing the O2 concentration to increase

                18.          How is most carbon dioxide (CO2) in the blood transported?

a.            Attached to oxygen        c.             Combined with albumin

b.            In the form of bicarbonate          d.            Dissolved in the plasma

                19.          The sternocleidomastoid and scalene muscles are referred to as which group?

a.            Diaphragmatic muscles  c.             Intercostal muscles

b.            Muscles of expiration    d.            Muscles of inspiration

                20.          An increase in surface tension caused by decreased surfactant production results in which alteration?

a.            Decrease in alveolar macrophage production

b.            Increase in lung compliance

c.             Decrease in alveoli collapse

d.            Increase in alveoli fluid collection

                21.          Decreased lung compliance means that the lungs are demonstrating which characteristic?

a.            Difficult deflation             c.             Stiffness

b.            Easy inflation     d.            Inability to diffuse oxygen

                22.          The lung is innervated by the parasympathetic nervous system via which nerve?

a.            Vagus    c.             Brachial

b.            Phrenic d.            Pectoral

                23.          What event is characteristic of the function in Zone 1 of the lung?

a.            Blood flow through the pulmonary capillary bed increases in regular increments.

b.            Alveolar pressure is greater than venous pressure but not greater than arterial pressure.

c.             The capillary bed collapses, and normal blood flow ceases.

d.            Blood flows through Zone 1, but it is impeded to a certain extent by alveolar pressure.

ANS:      C

Alveolar pressure exceeds pulmonary arterial and venous pressures in Zone 1. The capillary bed collapses, and normal blood flow ceases. Zone II is the portion where alveolar pressure is greater than venous pressure but not greater than arterial pressure. Blood flows through zone II, but it is impeded to a certain extent by alveolar pressure. Zone II is normally above the level of the left atrium. In zone III, arterial and venous pressures are greater than alveolar pressure and blood flow is not affected by alveolar pressure. Zone III is in the base of the lung. Blood flow through the pulmonary capillary bed increases in regular increments from the apex to the base.

PTS:       1              REF:       Pages 1239-1240              

                24.          Hypoventilation that results in the retention of carbon dioxide will stimulate which receptors in an attempt to maintain a normal homeostatic state?

a.            Irritant receptors             c.             Peripheral chemoreceptors

b.            Central chemoreceptors               d.            Stretch receptors

                25.          What is the most important cause of pulmonary artery constriction?

a.            Low alveolar partial pressure of arterial oxygen (PaO2)

b.            Hyperventilation

c.             Respiratory alkalosis

d.            Epinephrine

                26.          Where does the tracheal bifurcation occur?

a.            Larynx   c.             Carina

b.            Bronchi d.            Nasopharynx

                27.          How low must the partial pressure of arterial oxygen (PaO2) drop before the peripheral chemoreceptors influence ventilation?

a.            Below 100 mm Hg            c.             Below 70 mm Hg

b.            Below 80 mm Hg              d.            Below 60 mm Hg

                28.          Which receptors are located in the smooth muscles of airways?

a.            Central chemoreceptors               c.             Peripheral chemoreceptors

b.            Stretch receptors             d.            J-receptors

                29.          Which receptors are located near the respiratory center?

a.            Peripheral chemoreceptors        c.             Central chemoreceptors

b.            Stretch receptors             d.            J-receptors

                30.          Which receptors are located in the aortic bodies, aortic arch, and carotid bodies?

a.            Central chemoreceptors               c.             J-receptors

b.            Stretch receptors             d.    &nbs


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