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(MARYVILLE UNIVERSITY EXAMS 2025/2026)
NURS 611/NURS611: ADVANCED PATHOPHYSIOLOGY
EXAM 2 ACTUAL 100 EXAM QUESTIONS & CORRECT
VERIFIED ANSWERS WITH RATIONALES|ALREADY
GRADED A+
- Review: the parasympathetic system is all about what? Conserving energy, digesting, metabolism, and rest
- The sympathetic nervous system primarily serves to protect an individual by doing which of
the following? ( select all that apply)
A. Decreasing mucous production B. Increasing blood sugar levels C. Increasing body temperature D. Decreasing sweat excretion E. Increasing blood pressure Increases blood sugar levels, increases body temperature, and increases blood pressure In general, sympathetic stimulation promotes responses that are concerned with the protection of the individual, which include increasing glucose, body temp, and BP.
- Review: the sympathetic system is all about what? It’s all about mobilizing energy stores, for instance glucose to muscles, decreased release of insulin, redirects blood supply from the gut to the muscles, heart, and lungs.
- Which characteristic is the most critical index of nervous system dysfunction? Level of consciousness LOC is the most critical clinical index of nervous system function or dysfunction. An alteration in consciousness indicates either improvement or deterioration of a person’s condition.
- Thought and goal-oriented behaviors are functions of which area of the brain? Prefrontal lobe The prefrontal area is responsible for goal-oriented behavior such as the ability to concentrate, short-term or recall memory, and the elaboration of thought and inhibition on the limbic (emotional) areas of the CNS.
- Where is the region responsible for the motor aspects? Broca area in the frontal lobe
Broca speech area is the only region responsible for the motor aspects of speech.
- Parkinson and Huntington diseases are associated with defects in which area of the brain? Basal ganglia
- Maintenance of a constant internal environment and the implementation of behavioral patterns are main functions of which area of the brain? Hypothalamus Hypothalamic function falls into 2 major areas: 1) maintenance of a constant internal environment, and 2) implementation of behavioral patterns.
- What parts of the brain mediate the expression of affect, both emotional and behavioral states? Limbic system and prefrontal cortex
- Reflex activities concerned with heart rate, blood pressure, respirations, sneezing, swallowing, and coughing are controlled by which area of the brain? Medulla oblongata The medulla oblongata makes up the myelencephalon and is the lowest portion of the brainstem.
- Which area of the brain assumes the responsibility for conscious and unconscious muscle synergy and for maintaining balance and posture? Cerebellum
- The brain receives approximately what percentage of the cardiac output? 20% or 800 to 1000 ml of blood flow per minute
- What evidence does the nurse expect to see when a patient experiences trauma to the
hypothalamus? ( select all that apply)
A. Uneven expression of mood B. Unstable blood glucose levels C. Poor regulation of body temperature D. Visual disturbances such as blurred vision E. N/V and symptoms of gastroesophageal reflux disease Uneven expression of mood, unstable blood glucose levels, and poor temp regulation The hypothalamus forms the base of the diencephalon. Hypothalamic function controls autonomic nervous system function, regulation of body temp, endocrine function (glucose
adheres to the surface of a pathogenic microorganism and serves as an efficient opsonin. Opsonins are molecules that tag microorganisms for destruction by cells of the inflammatory system, primarily neutrophils and macrophages.
- During phagocytosis what is occurring during the step referred to as opsonization? Phagocytes recognize and adhere to the bacteria During phagocytosis, opsonization involes only the recognition and adherence of phagocytes to bacteria.
- What is the correct sequence of phagocytosis? Recognition (opsonization), engulfment, fusion, and destruction Once the phagocytic cell enters the inflammatory site, the only correct sequence of
phagocytosis involves opsonization or recognition of the target and adherence of
the phagocyte to it, engulfment, or ingestion or endocytosis, and the formation of
phagosome, fusion with lysosomal granules within the phagocyte and destruction of the
target.
- Which manifestations of inflammation is systemic? Fever and leukocytosis
The only primary systemic changes associated with the acute inflammatory response are
fever, leukocytosis (a transient increase in circulating leukocytes), and increased levels in circulating plasma proteins.
- The acute inflammatory response is characterized by fever that is produced by the hypothalamus being affected by? Endogenous pyrogens
Fever-causing cytokines are known as endogenous pyrogens.
- When considering white blood cell differentials, acute inflammatory reactions are related to elevations of which leukocyte? A. Monocytes B. Eosinophils C. Neutrophils D. Basophils Neutrophils Only neutrophils are the predominant phagocytes in the early inflammatory site, arriving within 6 - 12 hours after the initial injury, they ingest (phagocytose) bacteria, dead cells, and cellular debris at the inflammatory site.
- What occurs during the process of repair after tissue damage? Nonfunctioning scar tissue replaces the destroyed tissue Repair is the replacement of destroyed tissue with scar tissue. Scar tissue is primarily made up of collagen, which fills in the lesion and restores tensile strength but cannot carry out the physiologic functions of the destroyed tissue.
- When cellular damage occurs and regeneration is minor with no significant complications, the process of returning the cells to pre-injury function is referred to as: Resolution If damage is minor with no complications and destroyed tissues are capable of regeneration, then returning the injured tissues to an approximation of their original
structure and physiologic function is possible. This restoration is called resolution.
- The role of fibroblasts during the reconstructive phase of wound healing is to? Synthesize and secrete collagen and the connective tissue proteins. Fibroblasts are the most important cells during the reconstructive phase of wound healing because they synthesize and secrete collagen and other connective tissue proteins. Macrophage-derived transforming growth factor-beta (TGF-Beta) stimulates fibroblasts.
- Some older adults have impaired inflammation and wound healing because of which problems? Underlying chronic illness(es) exists In some cases, impaired healing is not directly associated with aging, in general, but can instead be linked to a chronic illness such as cardiovascular disease or diabetes mellitus.
- Which cell is the body’s primary defense against parasite invasion? Eosinophils Eosinophils serve as the body’s primary defense against parasites.
- Normal bacterial flora found in the intestines produce vitamin K to assist in the
absorption of which of the following? ( select all that apply)
- Calcium
- Fatty acids
- Large polysaccharides
- Iron
- Magnesium Calcium, iron, and magnesium The flora’s production of vitamin K is needed to absorb various ions, such as calcium, iron, and magnesium.
Each route stimulates a different lymphocyte-containing tissue, resulting in differenttypes of cellular and humoral immunity. Each route preferentially stimulates a different set of lymphocyte-containing (lymphoid) tissues and therefore results in the induction of different types of cell-mediated or humoral immune responses.
- Which immunoglobulin is present in blood, saliva, breast milk, and respiratory secretions? IgA IgA can be divided into two subclasses, IgA1 and IgA2. IgA1 molecules are predominately found in the blood, whereas IgA2 is the predominant class of antibody found in normal body secretions.
- Which antibody initially indicates a typical primary immune response? IgM Typically, IgM is produced first (primary immune response), followed by IgG against the same antigen.
- An individual is more susceptible to infections of mucous membranes when he or she has a seriously low level of which immunoglobulin antibody? IgA The IgA molecules found in bodily secretions are dimers anchored together through a J- chain and secretory piece. This secretory piece is attached to the IgA antibodies inside the mucosal epithelial cells and may function to protect these immunoglobulin antibodies against degradation by enzymes also found in the secretions, thus decreasing the risk of infections in the mucous membrane.
- Which is an example of an endogenous antigen? Cancer cells
- When a person is exposed to most antigens, antibodies can be usually detected in his or her circulation within? 6 days After only approximately 5 - 7 days is an IgM antibody specific for that antigen detected in the circulation.
- Vaccinations are able to provide protection against certain microorganisms because of the? Level of protection provided by IgG
IgG production is considerably increased, making it the predominant antibody class of the secondary response. IgG is often present in concentrations several times larger than those of IgM, and levels of circulating IgG specific for that antigen may remain elevated for an extended period of time.
Erythrocytes are destroyed by complement-mediated lysis in individuals with automimmune hemolytic anemia or as a result of an alloimmune reaction to ABO mismatched transfused blood cells.
- When antibodies are formed against red blood cell antigens of the Rh system, the blood cells are destroyed by? Phagocytosis in the spleen Antibodies against platelet-specific antigens or against red blood cell antigens of the Rh system coat those cells at low density, resulting in their preferential removal by phagocytosis in the spleen, rather than by complement-mediated lysis.
- How are target cells destroyed in a type II hypersensitivity reaction? Natural killer cells The mechanism that results in a type II hypersensitivity reaction involves a subpopulation of cytotoxic cells that are not antigen specific (natural killer [NK] cells). Antibody on the target cell is recognized by Fc receptors on the NK cells, which releases toxic substances that destroy the target cell.
- Graves disease (hyperthyroidism) is an example of which type II hypersensitivity reaction? Modulation
- Graves disease is a result of? Autoantibodies binding to thyroid-stimulating hormone (TSH)-receptor sites
- Type III hypersensitivity reactions are a result of which action? Antibodies binding to soluble antigens that were released into body fluids and the immune complexes being deposited in the tissues. Antigen-antibody (immune) complexes that are formed in the circulation and then deposited later in vessel walls or extravascular tissues cause most type III hypersensitivity diseases.
- Reyaud phenomenon is an example of which type of hypersensitivity? Type III
Raynaud phenomenon is a condition caused by the temperature-dependent deposition of immune complexes in the capillary beds of the peripheral circulation.
- A person with type O blood is considered to be the universal blood donor because typeO blood contains which of the following?
- No antigens
- Both A and B antigens
- No antibodies
- Both A and B antibodies No Antigens Because individuals with type O blood lack both types of antigens, they are considered universal donors, meaning that anyone can accept their red blood cells. Type O individuals, who have neither A or B antigen but have both anti-A and anti-B antibodies cannot accept blood from any of the other three blood types.
- Immunoglobulin E (IgE) is associated with which type of hypersensitivity? Type I Hypersensitivity reactions have been divided into four distinct types: type I (IgE- mediated; beesting, peanuts, fish ) hypersensitivity reactions, type II (tissue-specific; mismatched blood transfusion, Graves disease) hypersensitivity reactions, type III (immune complex-mediated; Raynauld disease) hypersensitivity reactions, and type IV (cell-mediated; graft rejection) hypersensitivity reactions.
60. Some clinical examples of type IV hypersensitivity reactions include ( select all that
apply):
- Graft rejection
- Allergic reactions
- Autoimmune reactions
- Delayed Graft rejection, allergic reaction, and delayed
61. Which disorders are considered autoimmune? ( select all that apply):
- Vaccines require booster injections to maintain life-long protection
- Most viral vaccines are made by using dead organisms
- Vaccines provide effective protection against most infections Vaccines require booster injections to maintain life-long protection In general, vaccine-induced protection does not persist as long as infection-induced immunity, thus booster injections may be necessary to maintain protection throughout life.
68. Definition of toxigenicity
An important factor in determining a pathogen’s ability to produce disease Toxigenicity is the ability of a pathogen to produce soluble toxins or endotoxins, which are factors that greatly influence the pathogen’s degree of virulence.
- The infectious process is made up of invasion verses evasion. Evasion is when? The body’s defenses such as the inflammatory process is exhausted. Evasion is when those body defenses results in microorganisms being transported through the blood such as septicemia.
- Cytokines are thought to cause fevers by stimulating the synthesis of which chemical mediator? Prostaglandin Cytokines seem to raise the thermoregulatory set point through stimulation ofprostaglandin synthesis and turnover in thermoregulatory (brain) and non- thermoregulatory (peripheral) tissues.
- Exotoxins, those are actually released during bacterial growth, they are _immunogenic_so that’s good, so they are going to illicit this response.
72. Which statements are true regarding endotoxins? ( select all that apply):
- Endotoxins are lipopolysaccharides
- Endotoxins are located in the walls of bacteria
- Endotoxins are created during the process of lysis
- Endotoxins are found in gram-negative microorganisms
- Endotoxins are released during the destruction of its host
Endotoxins are lipopolysaccharides, located in walls of bacteria, gram-negative, and are released during the destruction of the host.
- Endotoxins if left unchecked can cause what? Disseminated intravascular coagulation (DIC)
- Endotoxins work by? Causing incredible vasodilation
- The CDC defines a diagnosis of AIDS is measured by a CD4 count less than _ 200 cells per microliter.
76. Which secretion transmits HIV? ( select all that apply):
- Semen
- Urine
- Saliva
- Breast milk
- Sweat HIV is a blood-borne pathogen present in body fluids such as blood, vaginal fluid, semen, and breast milk.
- Exhaustion occurs if stress continues when which stage of the general adaptation
syndrome is not successful?
Adaptation This lack of adaptation ultimately causes impairment of the immune response, heart failure, and kidney failure, leading to death.
- Which hormone prompts increased anxiety, vigilance, and arousal during a stress response? Norepinephrine Only the release of norepinephrine promotes arousal, increased vigilance, increased anxiety, and other protective emotional responses.
- What is the effect that low-serum albumin has on the central stress response? Impaired circulation of epinephrine and norepinephrine
A meta-analysis of studies shows a relationship between depression and the reduction in lymphocyte proliferation and natural killer cell activity.
- The increased production of proinflammatory cytokines is associated with which considerations? Elevated anxiety levels and age/gender Increased levels of proinflammatory cytokines has been shown to have a possible link between stress and immune function.
- Which organ is stimulated during the alarm phase of the general adaptation syndrome (GAS)? Hypothalamus The alarm phase of the GAS begins when a stressor triggers the actions of the hypothalamus and the sympathetic nervous system.
- What is the difference between benign and malignant? Benign=cell’s appearance is well differentiated and slow growing and typically avascular, growth is expansive (pushing on other structures and cells. Malignant=the cell is a mess because the cells have gone rogue! And they spread rapidly, invasive, vascular, and metastasizing.
- Which ctyokines initiate the production of corticotropin-releasing hormone (CRH)? IL- 1 and IL- 6 Although a number of stress factors initiate the production of CRH, only high levels of IL- 1 and IL- 6 initiate a response.
- What is the most common route for distant metastasis? Blood and lymphatic vessels-the Autobaun for cancer cells!
- Staging of cancer provides a framework to determine treatment.
- Staging system of cancer is as follows (example of breast cancer): refer to Workbook pg. 55 ➢ T1=within the breast tissue ➢ T2=still within the breast tissue but getting larger ➢ T3=start of invasion, either skin or chest wall
➢ T4=metastasis to other organs
- Node involvement means: ➢ N2=fixed nodes involved
- What are tumor cell markers? Hormones, enzymes, antigens, and antibodies that are produced by cancer cells Tumor (biologic) markers are substances produced by both benign and malignant cells that are found either in or on the tumor cells or in the blood, spinal fluid, or urine. Tumor markers may include hormones, enzymes, genes, antigens, and antibodies.
- The function of the tumor cell marker is to? Screen individuals at high risk for cancer Screening and identifying individuals at high risk for cancer are ways tumor markers can be used. Keep in mind these markers are not used to definitively diagnosis or treat cancer and are not useful in predicting specific sites of cancer development.
- Autocrine stimulation is the ability of cancer cells to? Secrete growth factors that stimulate their own growth Cancer cells must have mutations that enable them to proliferate in the absence of external growth signals. To achieve this, some cancers acquire the ability to secrete growth factors
that stimulate their own growth, a process known as autocrine stimulation. All I can say is
cancer cells are smart little shits!
- Which cancers are all associated with chronic inflammation? Colon, thyroid gland, and urinary bladder Some organs appear to be more susceptible to the oncogenic effects of chronic inflammation; for example, the GI tract, prostate, thyroid gland, pancreas, urinary bladder, pleura, and skin. One large study found a 66% increase in the risk of lung cancer among women with chronic asthma, an inflammatory disease of the airways.
- Chronic inflammation causes cancer by? Releasing compounds such as reactive oxygen species that promote mutations
By recruiting new vascular endothelial cells and initiating the proliferation of existing blood
vessel cells, the angiogenic factors, such as VEGF and growth factor bFGF, allowsmall
cancers to become large cancers.
106. What statement is true regarding pain and cancer?
Pain is generally associated with late-stage cancer Pain is generally associated with the late stages of cancer. Pressure, obstruction, invasion of a structure sensitive to pain, stretching, tissue destruction, and inflammation can cause pain. Pain is not the initial symptom of cancer nor does it indication that the cancer has metastasized.
107. What statement is true concerning aging and the occurrence of cancer?
Decline in immunologic functions, predisposition to nutritional inadequacies, and effects of immobility on the immune system Many common malignancies occur mostly in older age as a result of immunologic functions declining with age. Older persons are predisposed to nutritional inadequacies, and malnutrition impairs immunocompetence. Far-advanced cancer often results in immobility and general debility that worsens with age. No research supports a correlation between aging and a reluctance to seek health care, in general, or cancer screenings, in particular.
- Paraneoplastic syndromes may be the first or most prominent manifestation of a cancer. Examples include; Cushing Syndrome (endocrine) mediated by humoral factors such as hormones or cytokines excreted by tumor cells or by an immune response.
- What is the most commonly reported symptom of cancer treatment? Fatigue-duh!
110. The difference between focal and diffuse brain injury.
Focal=is typically in one area such as a stroke, epidural hemorrhage or subdural hemorrhage. Diffuse=affects the entire brain such as hypoxia, meningitis, and encephalitis. Remember the brain is a very small vault.
- In diabetes insipidus we watch for _increased intracranial pressure.
- Pressure on the pituitary gland from ICP prevents _anti-diuretic hormone from being excreted which leads to high output of urine. *Really got to watch that urine output because it will be really high!
- What term is used to describe the complication that can result from a spinal cord injury above T6 that is producing paroxysmal hypertension, as well as piloerection and sweating above the spinal cord lesion? Autonomic hyperreflexia Individuals most likely to be affected have lesions at the T6 level or above. Paroxysmal hypertension (up to 300 mm Hg systolic), a pounding headache, blurred vision, sweating above the level of the lesion with flushing of the skin, nasal congestion, nausea, piloerection caused by pilomotor spasm, and bradycardia (30-40 beats/minute) characterize autonomic hyperreflexia.
- Autonomic hyperreflexia can be triggered by? Full bladder, fecal impaction, or restrictive clothing
- Autonomic hyperreflexia-induced bradycardia is a result of stimulation of the what? Carotid sinus to the vagus nerve to the sinoatrial node The intact autonomic nervous system reflexively responds with an arteriolar spasm that increases blood pressure. Baroreceptors in the cerebral vessels, the carotid sinus, and the aorta sense the hypertension and stimulate the parasympathetic system. The heart rate decreases, but the visceral and peripheral vessels do not dilate because efferent impulses cannot pass through the cord.
- Bradycardia in autonomic hyperreflexia is due to? A reflexive mechanism due to stimulation of the carotid sinus to the vagus nerve to the SA node=causing the SA node to slow way down to that 30 - 40 beats per minute.
- You might see a question on the exam like this…A man who sustained a cervical spinal cord injury 2 days ago suddenly develops severe hypertension and bradycardia. He
