A 71-year-old male has been recently diagnosed with a stage III tumor of colorectal cancer and is attempting to increase his knowledge about his diagnosis. Which of the following statements about colorectal cancer demonstrates a sound understanding of the disease?

1. Following a long history of fatigue, weakness, and poor appetite, a 39-year-old male has been diagnosed with hypopituitarism. Which of the following clinical findings would most likely cause his care team to suspect that the man has an additional endocrine disorder from a different source? (Points : 2)
The man has a low sperm count and has been unable to have children.
The man has a chronic platelet deficiency and is occasionally anemic.
The patient is 5 feet 2 inches tall and was consistently short for his age as a child.
The man displays the signs and symptoms of hypothyroidism.
Question 2. 2. A 79-year-old male resident of a long-term care facility has contracted Clostridium difficile and is experiencing consequent diarrhea. Auscultation of the man’s abdomen indicates hyperactive bowel sounds. What processes in the man’s small intestine are most likely accompanying his current status? (Points : 2)
Pathogenic microorganisms are causing dilation of his small intestine, increasing motility.
Segmentation waves have become more frequent as a result of his infection.
Intestinal stasis brought on by infection is preventing his small intestine from sufficiently slowing the rate of motility.
Inflammation is accompanied by an increase in peristaltic movements of his small intestine.
Question 3. 3. A 51-year-old male professional is in the habit of consuming six to eight rum and cokes each evening after work. He assures the nurse practitioner, who is performing his regular physical exam, that his drinking is under control and does not have negative implications for his work or family life. How could the nurse best respond to the patient’s statement? (Points : 2)
“You are more than likely inflicting damage on your liver, but this damage would cease as soon as you quit drinking.
“That may be the case, but you are still creating a high risk of hepatitis A or B or liver cancer.”
“In spite of that, the amount of alcohol you are drinking is likely to result first in cirrhosis and, if you continue, in hepatitis or fatty liver changes.”
“When your body has to regularly break down that much alcohol, your blood and the functional cells in your liver accumulate a lot of potentially damaging toxic byproducts.”
Question 4. 4. A nurse practitioner is assessing a 7-year-old boy who has been brought to the clinic by his mother, who is concerned about her son’s increasingly frequent, severe headaches. Which of the nurse’s following questions is least likely to yield data that will allow for a confirmation or ruling out of migraines as the cause of his problem? (Points : 2)
“Does your son have a family history of migraines?”
“When your son has a headache, does he ever have nausea and vomiting as well?”
“Does your son have any food allergies that have been identified?”
“Is your son generally pain free during the intervals between headaches?”
Question 5. 5. A 51-year-old woman who has been receiving estrogen and progesterone therapy (EPT) for the last 5 years has visited her care provider because her peers have told her about the risks of heart disease, stroke, and breast cancer that could accompany hormone therapy (HT). How should her care provider respond to her concerns? (Points : 2)
“There is a demonstrable increase in breast cancer risk with HT, but the risk of stroke or heart disease actually goes down slightly.”
“All things considered, the benefits of HT outweigh the slightly increased risks of heart disease, stroke, or breast cancer.”
“HT is actually associated with a decrease in heart disease risk, but there is an increase in stroke risk; the breast cancer connection is still unclear.”
“There’s in fact a slight protective effect against stroke associated with HT, but this is partially offset by increased rates of heart disease and breast cancer.”
Question 6. 6. Chronic anxiety and stress contribute to ulcers. Which of the following effects of the sympathetic nervous system is most responsible for this effect?
(Points : 2)
Inhibition of the actions of Brunner glands
Overstimulation of the oxyntic glands
Suppression of cholecystokinin
Inflammation of the parotid glands
Question 7. 7. Following a motor vehicle accident three months prior, a 20-year-old female who has been in a coma since her accident has now had her condition declared a persistent vegetative state. How can her care providers most accurately explain an aspect of her situation to her parents? (Points : 2)
“Your daughter has lost all her cognitive functions as well as all her basic reflexes.”
“Though she still goes through a cycle of sleeping and waking, her condition is unlikely to change.”
“If you or the care team notice any spontaneous eye opening, then we will change our treatment plan.”
“Your daughter’s condition is an unfortunate combination of total loss of consciousness with continuation of all other normal brain functions.”
Question 8. 8. A 13-year-old female is undergoing rapid development of her breasts after experiencing menarche several months ago. Which of the following hormones are NOT active in the development of her breasts? (Points : 2)
Follicle-stimulating hormone
Question 9. 9. After surviving an ischemic stroke, a 79-year-old male has demonstrated significant changes in his emotional behavior, with his family noting that he now experiences wide mood swings and exaggerated responses of empathy, anger, and sadness to situations. His care team would most likely attribute these responses to ischemic changes in which of the following brain structures?
(Points : 2)
The man’s occipital lobe
The patient’s temporal lobe in general and Wernicke area in particular
The man’s parietal lobe
The components of the patient’s limbic system
Question 10. 10. A 29-year-old woman has been trying for many months to become pregnant, and fertilization has just occurred following her most recent ovulation. What process will now occur that will differentiate this ovulatory cycle from those prior? (Points : 2)
Human chorionic gonadotropin will be produced, preventing luteal regression.
The remaining primary follicles will provide hormonal support for the first 3 months of pregnancy.
The corpus luteum will atrophy and be replaced by corpus albicans.
The basal layer of the endometrium will be sloughed in preparation for implantation.
Question 11. 11. A patient with a history of an endocrine disorder exhibits signs and symptoms of hormone deficiency. Which of the following processes would the patient’s care team most likely rule out first as a contributing factor? (Points : 2)
The patient’s target cells lack sufficient receptors for the hormone in question.
Hormone production is sufficient, but affinity on the part of the target cells is lacking.
The process of down-regulation has resulted in decreased hormone sensitivity.
Up-regulation has increased the sensitivity of the body to particular hormone levels.
Question 12. 12. John presents to the clinic with complaints of scrotal heaviness. Your assessment reveals swelling of the testicle and warm scrotal skin. What would your diagnosis be? (Points : 2)
Testicular torsion
Question 13. 13. The parents of a 15-year-old boy are frustrated by his persistent inability to fall asleep at a reasonable hour at night, as well as the extreme difficulty that they have in rousing him in the morning. While sleepy after waking, the son claims not to feel drowsy after lunch or in the evening. What is the most likely classification of the boy’s sleep disorder? (Points : 2)
Delayed sleep phase syndrome (DSPS)
Non–24-hour sleep–wake syndrome
Advanced sleep phase syndrome (ASPS)
Chronic insomnia
Question 14. 14. Following the identification of low levels of T3 and T4 coupled with the presence of a goiter, a 28-year-old female has been diagnosed with Hashimoto thyroiditis. In light of this diagnosis, which of the following assessment results would constitute an unexpected finding? (Points : 2)
The presence of myxedema in the woman’s face and extremities
Recent weight gain despite a loss of appetite and chronic fatigue
Coarse, dry skin and hair with decreased sweat production
Increased white cell count and audible crackles on chest auscultation
Question 15. 15. Following a spinal cord injury suffered in a motor vehicle accident, a 22-year-old male has lost fine motor function of his finger and thumb, but is still able to perform gross motor movements of his hand and arm. Which of the following components of his white matter has most likely been damaged? (Points : 2)
The inner layer (archilayer)
The middle layer (paleolayer)
The outer layer (neolayer)
The reticular formation
Question 16. 16. An 11-year-old boy with skin lesions characteristic of ringworm on his trunk has been brought to the family’s primary care provider by his mother. Which of the following aspects of the clinician’s assessment relates most directly to the suspected diagnosis?
(Points : 2)
Previous infection with other parasitic worms
Potential contact with the fungus from pets or other children
Allergic reactions to drugs and environmental substances
The child’s infanthood immunization history
Question 17. 17. Which of the following women is most likely to have a sexually transmitted infection as a contributing factor to her health problem? (Points : 2)
A 29-year-old woman with a diagnosis of localized vulvodynia
A 40-year-old who is being treated for vaginal cancer
A 32-year-old who is undergoing diagnostics to rule out endometriosis
A 41-year-old with a diagnosis of mucopurulent cervicitis
Question 18. 18. Having heard positive reports of the benefits of HT from her sister-in-law and friends, a 49-year-old woman has presented to her nurse practitioner asking to start HT. Her uterus is intact and previous bone scans have indicated low bone density. The patient also has a family history of heart disease. She characterizes her symptoms of menopause as “noticeable, but not debilitating by any means.” Based on the most current research, what is her nurse practitioner’s best course of action?
(Points : 2)
Begin estrogen-progesterone HT (EPT) to prevent future menopausal symptoms and coronary heart disease (CHD)
Forgo HT in light of her preexisting low bone density and consequent risk of osteoporosis
Forgo HT but consider alternative therapies and reevaluate if her symptoms significantly affect her quality of life
Begin low-dose HT but perform regular breast cancer screening and heart health checks
Question 19. 19. A 41-year-old woman has been diagnosed as having a loose body of cartilage in her left knee. What data would be most likely to lead clinicians to this conclusion? (Points : 2)
A visible hematoma is present on the anterior portion of the knee.
The woman experiences intermittent, painful locking of her joint.
Computed tomography indicates a complete tear of her knee ligament.
An X-ray shows that her femoral head and tibia are no longer articulated.
Question 20. 20. Which of the following situations would be considered pathologic in an otherwise healthy 30-year-old female?
(Points : 2)
The woman’s ovaries are not producing new ova.
The woman’s ovaries do not synthesize or secrete luteinizing hormone (LH).
The epithelium covering the woman’s ovaries is broken during the time of ovulation.
The woman’s ovaries are not producing progesterone.
Question 21. 21. A nurse practitioner is providing care for a 68-year-old female whose anxiety disorder is significantly decreasing her quality of life. Which of the following pharmacologic therapies is most likely to benefit the woman? (Points : 2)
A drug that influences gamma-aminobutyric acid (GABA) levels
A selective serotonin reuptake inhibitor (SSRI)
An antipsychotic medication that blocks dopamine receptors
An epinephrine and norepinephrine supplement
Question 22. 22. Following exposure to poison oak while camping, a 20-year-old male is experiencing pruritus as a consequence of his immune response to irritants in the plant. What physiologic process best accounts for his complaint? (Points : 2)
His body is communicating a low-level pain response as a protective measure.
Free nerve endings are initiating an itch-specific signal to the somatosensory cortex.
Local irritation of Langerhans cells is sending signals by way of myelinated type C nerve fibers.
Ruffini corpuscles are transmitting the message of pruritis to the cerebral cortex.
Question 23. 23. A care aide at a long-term care facility has informed a resident’s nurse practitioner that the 80-year-old woman’s eyes appear to be inflamed and her eyelids are caked with sticky secretions. The woman subsequently has been diagnosed with posterior blepharitis. Which of the following treatments is the nurse practitioner likely to initiate? (Points : 2)
Surgical repair of the woman’s blocked meibomian glands
Warm compresses to be applied regularly to her eyes in addition to oral antibiotics
Regularly scheduled cleansing of the woman’s eyes with normal saline
Intravenous steroids coupled with topical antibiotic ointment
Question 24. 24. Which of the following conditions usually improves when a woman is taking oral contraceptives?
(Points : 2)
Human Papillomavirus infection
Migraine headaches
Iron deficiency anemia
Herpes simplex virus
Question 25. 25. Which of the following patients on a hospital medical unit is most clearly demonstrating the signs and symptoms of liver failure? (Points : 2)
A 44-year-old man with low hemoglobin levels, low platelet levels, and spider angiomas
A 50-year-old woman with blood pressure of 189/103, jaundice, and multiple thromboses
A 68-year-old female patient with sudden onset of confusion, a history of alcohol abuse, and low levels of serum AST and ALT
A 55-year-old man with ascites, fever, and recent onset of atrial fibrillation
Question 26. 26. A 29-year-old woman has been diagnosed with otosclerosis after several years of progressive hearing loss. What pathophysiologic process has characterized her diagnosis? (Points : 2)
New, sclerotic bone has been formed around her stapes and oval window.
Her incus, malleus, and stapes have become disconnected from her normal neural pathways.
Her temporal bone is experiencing unusually rapid resorption.
Her tympanic cavity is becoming filled with bone due to inappropriate osteogenesis.
Question 27. 27. What is stiffness or fixation of a joint called? (Points : 2)
Question 28. 28. The father of an 18-month-old girl noticed a small vesicle on her face several days ago. The lesion ruptured and left a straw-colored crust that remained on the girl’s face. The eruption of new vesicles has prompted him to bring the child to the emergency department. Which of the following treatments for the child’s skin problem is most likely?
(Points : 2)
A topical antifungal ointment
An oral corticosteroid
An antiviral ointment
A topical antibiotic
Question 29. 29. A stroke affecting which of the following areas of the brain would be most likely to leave an individual’s vestibular system intact and posture and balance maintained? (Points : 2)
The brain stem
The thalamus
The temporal and parietal cortex
The limbic system of the cerebrum
Question 30. 30. Long, stretchy cervical mucus that exhibits ferning on a microscope slide is characteristic of which of the following? (Points : 2)
High LH levels
Low estrogen levels
High progesterone levels
Low human chorionic gonadotropin levels
Question 31. 31. During a late-night study session, a pathophysiology student reaches out to turn the page of her textbook. Which of the following components of her nervous system has the highest level of control over her arm and hand action? (Points : 2)
Basal ganglia
Frontal lobe
Question 32. 32. A 40-year-old woman has been found to have a deficiency in estrogen. Which of the following physiological phenomena is most likely to remain unaffected? (Points : 2)
Parathyroid hormone antagonism and the rate of bone resorption
The regulation of uterine endothelial development
The maintenance of normal skin and blood vessel structure
The synthesis and release of adrenal glucocorticoids
Question 33. 33. A 24-year-old woman has presented to an inner-city free clinic because of the copious, foul vaginal discharge that she has had in recent days. Microscopy has confirmed the presence of Trichomonas vaginalis. What is the woman’s most likely treatment and prognosis?
(Points : 2)
Abstinence will be required until the infection resolves, since treatments do not yet have proven efficacy.
Oral antibiotics can prevent complications such as infertility and pelvic inflammatory disease.
Antifungal medications are effective against the anovulation and risk of HIV that accompany the infection.
Vaginal suppositories and topical ointments can provide symptom relief but cannot eradicate the microorganism.
Question 34. 34. As part of the diagnostic workup for a patient’s long-standing vertigo, a clinician wants to gauge the patient’s eye movements. Which of the following tests is the clinician most likely to utilize? (Points : 2)
Romberg test
Rotational tests
Electronystagmography (ENG)
Caloric stimulation
Question 35. 35. A nurse practitioner is providing care for a male patient with a long-standing hiatal hernia. Which of the following statements most accurately captures an aspect of the pathophysiology of hiatal hernias? (Points : 2)
Paraesophageal hiatal hernias are common and are normally not treated if the patient is asymptomatic.
The root causes of hiatal hernias are normally treatable with medication.
If esophageal acid clearance is impaired, esophagitis can result.
An incompetent pyloric sphincter and high fat diet are commonly implicated in the development of hiatal hernias.
Question 36. 36. A patient with a diagnosis of insomnia is surprised when his physician explains to him that his brain is still highly active during normal sleep. Which of the following statements best captures the character of brain activity during sleep? (Points : 2)
“Fewer neurons in your brain are firing when you’re asleep, but they’re more synchronized than when you’re awake.”
“While you’re obviously less aware of stimuli when you’re asleep, your brain is actually more active when you’re asleep than when you’re awake.”
“There are four types of brain activity, and actually all of them occur at different stages of sleep.”
“Your brain alternates between periods of activity and periods of inactivity when you’re asleep, and these correspond to your eye movement.”
Question 37. 37. While being tackled, a 20-year-old football player put out his hand to break his fall to the ground. Because the intense pain in his wrist did not subside by the end of the game, he was brought to an emergency department where diagnostic imaging indicated an incomplete tear of the ligament surrounding his wrist joint. At the time of admission, his wrist was swollen and had a severely restricted range of motion. What will his care team most likely tell the player about his diagnosis and treatment? (Points : 2)
“This strain will likely resolve itself with sufficient rest.”
“You’ve suffered a severe sprain and you might need a cast.”
“Your wrist contusion will have to be observed for bleeding under the skin surface.”
“It looks like a mild to moderate sprain and you’ll need to keep it immobilized for a few weeks.”
Question 38. 38. A 71-year-old male has been recently diagnosed with a stage III tumor of colorectal cancer and is attempting to increase his knowledge about his diagnosis. Which of the following statements about colorectal cancer demonstrates a sound understanding of the disease? (Points : 2)
“If accurate screening tests for this type of cancer existed, it could likely have been caught earlier.”
“The NSAIDs and aspirin that I’ve been taking for many years probably contributed to my getting cancer.”
“While diet is thought to play a role in the development of colorectal cancer, the ultimate causes are largely unknown.”
“A large majority of patients who have my type of colon cancer survive to live many more years.”
Question 39. 39. As a result of oral ingestion of the microorganisms, an individual has contracted H. pylori. Which of the following health problems is the individual now at increased risk for? (Points : 2)
Inflammatory bowel disease (IBD)
Gastric adenocarcinoma
Gastric atrophy
Peptic ulcer
Diverticular disease
Question 40. 40. Which of the following statements best captures an aspect of normal spermatogenesis? (Points : 2)
Testosterone chemically lyses each primary spermatocyte into two secondary spermatocytes with 23 chromosomes each.
Sertoli cells differentiate into spermatids, each of which can contribute half of the chromosomes necessary for reproduction.
Spermatogonia adjacent to the tubular wall undergo meiotic division and provide a continuous source of new germinal cells.
Each primary spermatocyte undergoes two nuclear divisions, yielding four cells with 23 chromosomes each.
Question 41. 41. David has an acute exacerbation of Crohn’s disease. Which of the following lab tests would you expect to be decreased? (Points : 2)
Sedimenatation rate
Liver enzyme levels
Vitamins A, B complex and C levels
Bilirubin level
Question 42. 42. Which of the following patients is most clearly displaying the signs and symptoms of IBD? (Points : 2)
A 32-year-old mother who complains of intermittent abdominal pain that persists even after defecation.
A 51-year-old male who states that his stomach pain is in his lower abdomen, “comes and goes,” and “feels more like a cramp than a dull ache.”
A 44-year-old man who is under great financial stress and who states that his lower abdominal pain is much worse at night than during the day.
A 24-year-old man who has a stressful job but whose diarrhea and cramping do not worsen during periods of high stress.
Question 43. 43. The mother of a 19-week-old infant has brought her baby to a nurse practitioner for assessment because of the baby’s persistent weight loss and diarrhea. An intestinal biopsy has confirmed a diagnosis of celiac disease, and the child’s mother is anxious to know what caused the disease. Which of the following aspects of the etiology of celiac disease would underlie the explanation that the nurse practitioner provides?
(Points : 2)
Bacterial or chemical invasion of the peritoneum leads to decreased nutrient absorption and transport.
An inappropriate T-cell mediated response results in increased levels of antibodies and an inflammatory response.
Neurogenic or muscular inhibition of peristalsis results in inappropriate motility of ingested food in the lower small intestine and the colon.
Inability to process or absorb the fat content of breast milk results in malnutrition and deficiency of fat-soluble vitamins.
Question 44. 44. Which of the following individuals is likely to have the highest risk of developing tuberculosis osteomyelitis?
(Points : 2)
A 55-year-old female who is in renal failure secondary to poorly controlled type 1 diabetes
A 79-year-old man who is immunocompromised following a bone marrow transplant
A 30-year-old man who has undergone open reduction and internal fixation of his fractured tibia
A 68-year-old woman who had a laminectomy 4 days prior for treatment of her chronic back pain
Question 45. 45. While on tour, a 32-year-old male musician has presented to the emergency department of a hospital after a concert complaining of severe and sudden abdominal pain. He admits to a history of copious alcohol use in recent years, and his vital signs include a temperature of 38.8°C (101.8°F), blood pressure of 89/48 mm Hg, and heart rate of 116 beats per minute. Blood work indicates that his serum levels of C-reactive protein, amylase, and lipase are all elevated. Which of the following diagnoses would the care team first suspect? (Points : 2)
Hepatitis C
Liver cirrhosis
Acute pancreatitis

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