Porths Pathophysiology Concepts of Altered Health States 9th Edition Grossman Test Bank

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Porths Pathophysiology Concepts of Altered Health States 9th Edition Grossman Test Bank

ISBN-13: 978-1451146004

ISBN-10: 1451146000



Porths Pathophysiology Concepts of Altered Health States 9th Edition Grossman Test Bank

ISBN-13: 978-1451146004

ISBN-10: 1451146000



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Chapter 53

1. Which of the following statements most accurately captures a characteristic of the external female genitalia?
  A) Skene and Bartholin glands perform endocrine and exocrine functions.
  B) Surgical repair is required in the case of a ruptured hymen in prepubescent females.
  C) The labia majora and clitoris are analogous to the male scrotum and penis, respectively.
  D) The external genitalia facilitate sexual function and hormonal regulation.
  Ans: C
  Embryonic differentiation results in an anatomical relationship between the labia majora and the scrotum and between the clitoris and the penis. There is no identified hormonal/endocrine role of the structures of the external genitalia, and a ruptured hymen does not necessitate medical intervention.



2. A woman has gone to her gynecologist complaining of pain during intercourse. The physician orders a maturation index on her vaginal scrapings. The results return an index of 75-25-0. The nurse can interpret this to mean
  A) she is in the beginning of cervical cancer.
  B) she is in the prime of her reproductive years.
  C) she is in a perimenopausal phase.
  D) she is experiencing postmenopausal vaginal dryness.
  Ans: D
  The vaginal scrapings are used for a test, the maturation index, that examines the cellular structure and configuration of the vaginal epithelial cells. Typically, this index is 0-40-60 during the reproductive years. With diminished estrogen levels, there is a shift to the left, producing an index of 30-40-30 during the perimenopausal period, and an index of 75-25-0 occurs during the postmenopausal period.



3. A 20-year-old female has come to the clinic complaining of severe menstrual cramps. The clinic nurse practitioner knows that dysmenorrhea occurs when which muscle group contracts?
  A) Perimetrium
  B) Myometrium
  C) Endometrium
  D) Fundus
  Ans: B
  The middle muscle layer, the myometrium, forms the major portion of the uterine wall. Contractions of these muscle fibers help to expel menstrual flow and the products of conception during miscarriage or childbirth. When pain accompanies the contractions associated with menses, it is called dysmenorrheal. The perimetrium is the outer layer of the uterus. Endometrium, the inner layer of the uterus, is made up of a basal and a superficial layer. The superficial layer is shed during menstruation and regenerated by cells of the basal layer. The fundus is the portion of the uterus that lies about the insertion of the fallopian tubes.



4. During a group prenatal class, the nurse teaching the course is explaining the thinning of the cervix that accompanies the stages of labor leading up to delivery. A participant admits that she is not familiar with either the location or normal role of the cervix. Which of the following responses by the nurse would be most appropriate?
  A) “Your cervix is just the term for the lowest part of your uterus, and it is tightly shut at all times except in woman who are giving birth.”
  B) “The cervix is the opening between the uterus and the vagina, and so it opens wide during the lead-up to birth.”
  C) “Your cervix is the part of your uterus where the fallopian tubes join in and the baby has to pass through it to the vagina.”
  D) “The cervix is the soft lining of your uterus that has to expand greatly to accommodate your baby during delivery.”
  Ans: B
  The cervix is best characterized as the neck of the uterus that projects into the vagina. It opens selectively to accommodate menses. The fallopian tubes enter the uterus far above the cervix, and the lining of the uterus is known as the endometrium.



5. Which of the following situations would be considered pathological in an otherwise healthy, 30-year-old female?
  A) The woman’s ovaries are not producing new ova.
  B) The woman’s ovaries do not synthesize or secrete luteinizing hormone (LH).
  C) The epithelium covering the woman’s ovaries is broken during the time of ovulation.
  D) The woman’s ovaries are not producing progesterone.
  Ans: D
  As the number of ova within an ovary is fixed at birth and decreases over time, a lack of production of ova is normal. The epithelial lining is normally broken during ovulation, and the LH is produced by the pituitary gland. A lack of progesterone would be considered pathological.



6. A pregnant client who is taking Risperidone (Risperdal), an antipsychotic prescribed for her bipolar disorder, is at high risk for developing which of the following hormonal adverse effects?
  A) Increased growth hormone production
  B) Decreased human chorionic gonadotropin levels
  C) Excess prolactin secretion
  D) Decreased follicle-stimulating hormone secretion
  Ans: C
  Although prolactin does not appear to play a physiologic role in ovarian function, hyperprolactinemia leads to hypogonadism. Hyperprolactinemia may occur as an adverse effect of drug treatment using phenothiazine derivatives (i.e., antipsychotic drugs that block dopamine receptors).



7. A 40-year-old woman has been identified to have a deficiency in estrogen. Which of the following physiological phenomena is most likely to remain unaffected?
  A) Parathyroid hormone antagonism and the rate of bone resorption
  B) The regulation of uterine endothelial development
  C) The maintenance of normal skin and blood vessel structure
  D) The synthesis and release of adrenal glucocorticoids
  Ans: D
  Synthesis and release of adrenal glucocorticoids are not directly influenced by estrogen, unlike the processes of bone resorption, endothelial regulation, and the maintenance of skin and blood vessel structure.



8. Which of the following statements best captures an aspect of the role of progesterone? Progesterone
  A) production begins shortly after conception and peaks prior to delivery.
  B) is responsible for the stimulation of lactation in the postpartum period.
  C) levels peak after ovulation and is present throughout the menstrual cycle.
  D) is the primary hormone responsible for the development of female secondary sex characteristics.
  Ans: C
  Progesterone is present in varying levels at all times in females, but peaks following ovulation. It is not responsible for lactation and does not have primary responsibility for the development of secondary sex characteristics.



9. Events in the ovulatory cycle progress in a similar manner each month. Place the following events in the ovulatory cycle in the correct chronological order. Use all the options.

A) Formation of the theca

B) Formation of the corpus luteum

C) Formation of the antral follicle

D) Development of the zona pellucida

E) Bursting of the mature follicle

  Ans: D, A, C, E, B
  The zona pellucida surrounds a primary oocyte as it transitions to a secondary follicle, after which the theca surrounds the follicle. The antrum is subsequently formed around the maturing follicle, and it eventually bursts. After ovulation, the corpus luteum is established marking the beginning of the luteal stage of the ovulatory cycle.



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?
  A) Human chorionic gonadotropin will be produced, preventing luteal regression.
  B) The remaining primary follicles will provide hormonal support for the first 3 months of pregnancy.
  C) The corpus luteum will atrophy and be replaced by corpus albicans.
  D) The basal layer of the endometrium will be sloughed in preparation for implantation.
  Ans: A
  Fertilization is followed by the release of human chorionic gonadotropin. The corpus luteum, not primary follicles, provides hormonal support for early pregnancy. The atrophy of corpus luteum and its replacement by corpus albicans only occur when fertilization does not take place. The endometrium will be preserved following fertilization.



11. Long, stretchy cervical mucus that exhibits ferning on a microscope slide is characteristic of which of the following?
  A) Crystallization of inorganic salts
  B) Low estrogen levels
  C) High progesterone levels
  D) Low human chorionic gonadotropin levels
  Ans: A
  Cervical mucus that exhibits ferning and so-called spinnbarkeit occurs right around the time of ovulation (midcycle) due to increased water content and alteration in the concentration of inorganic salts. This is influenced by high serum levels of estrogen, which lead to the LH spike that promotes ovulation (bursting of the oocyte from the mature follicle). Progesterone levels increase only after ovulation during the luteal phase, at which point the cervical mucus “dries up” (becomes more scant).



12. After hearing daunting reports from her slightly older coworkers and friends, a 44-year-old woman has a number of questions for her physician about what to expect during perimenopause and why. Which of the following teaching points is most accurate?
  A) “The decrease in estrogen and most other hormones in your body do cause a lot of instability for most women around menopause.”
  B) “Hot flashes are a reality for most women in menopause, and the exact cause of them isn’t known yet.”
  C) “The emotional swings that often accompany menopause result from changes to the limbic center in the brain, which governs emotion.”
  D) “There are a lot of changes to the gastrointestinal and respiratory systems that exist around menopause that ultimately result from estrogen deficiency.”
  Ans: B
  Hot flashes are a common accompaniment to menopause, and their exact etiology is not known. Menopause is caused by a gradual reduction in ovarian estrogen production, but decreases in other hormones do not commonly occur. Organic brain changes are not a noted component of menopause, and GI and respiratory symptoms are not prevalent.



13. The nurse knows that when combined continuous estrogen–progesterone therapy (CCEPT) is prescribed, the drug is considered effective if which of the following occurs?
  A) More regular periods for women with irregular menses
  B) Inhibited endometrial development resulting in no menses
  C) Relaxation of the myometrium, thereby limited painful cramps
  D) Shedding of the endometrial build-up on a more regular basis
  Ans: B
  Thus, continuous exposure to progesterone inhibits endometrial development. Eventually, the combined continuous estrogen–progesterone therapy (CCEPT) results in no bleeding. It can be associated with irregular bleeding and spotting until the lining becomes atrophic. It relieves cramps rather than generating them.



14. 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?
  A) “There is a demonstrable increase in breast cancer risk with HT, but the risk of stroke or heart disease actually go down slightly.”
  B) “All considered, the benefits of HT outweigh the slightly increased risks of heart disease, stroke, or breast cancer.”
  C) “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.”
  D) “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.”
  Ans: C
  Current evidence shows a decrease in coronary heart disease (CHD) risk with HT but an increase in CVA risk; the evidence regarding breast cancer is still indefinite.



15. A woman consults her physician about a study (Women’s Health Initiative) discussing an increased risk for breast cancer if taking hormones. The physician can allay her fears by sharing which of the following findings?
  A) Only women with a family history of breast cancer had an increased risk for developing breast cancer while on birth control pills.
  B) This 26% increased risk for developing invasive breast cancer occurred in women taking combined continuous estrogen–progesterone therapy.
  C) The increased risk for developing inflammatory breast cancer occurred in women taking hormone replacement therapy when they were over the age of 45.
  D) Follow-up studies demonstrated that there was only a 3% increase in risk for developing breast cancer if hormones were discontinued immediately.
  Ans: B
  The WHI added to the breast cancer concern by reporting a 26% increased risk of invasive breast cancer in the women using CCEPT. Results from a 3-year WHI follow-up study revealed that the breast cancer risk of women who stopped taking CCEPT continued at a rate similar to that observed during the intervention.



16. The Women’s Health Initiative results have led the Institute of Medicine (2010) to recommend which of the following guidelines related to hip fractures in women?
  A) All postmenopausal women should take 1200 mg of calcium per day to prevent osteoporosis.
  B) The standard daily recommended amount of vitamin D was increased to 400 IU/day.
  C) All adults should take 600 IU/day of vitamin D to maintain healthy bones.
  D) A combination of calcium and vitamin D does not appear to prevent hip fractures.
  Ans: C
  The release of data from two clinical trials within the WHI (low-fat dietary patterns, calcium and vitamin D supplementation) has challenged conventional wisdom in other areas. The use of calcium (1000 mg/day) plus vitamin D (200 IU/day) was shown to result in a small but significant improvement in hip bone density but failed to reduce the risk of hip fractures. The IOM recommends that all adults should take 600 IU/day of vitamin D to maintain healthy bones.



17. Having heard positive reports of the benefits of hormone therapy (HT) from her sister-in-law and friends, a 49-year-old woman has presented to her family physician asking to start HT. Her uterus is intact, and previous bone scans have indicated low bone density. The client 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 physician’s best course of action?
  A) Begin estrogen–progesterone HT (EPT) to prevent future menopausal symptoms and coronary heart disease (CHD).
  B) Forego HT in light of her preexisting low bone density and consequent risk of osteoporosis.
  C) Forego HT but consider alternative therapies and reevaluate if her symptoms significantly affect her quality of life.
  D) Begin low-dose HT but perform regular breast cancer screening and heart health checks.
  Ans: C
  Current recommendations for HT, in light of the findings of the WHI and other clinical trials, are to avoid HT for primary or secondary prevention of CHD; develop an individual risk profile for every woman contemplating HT and provide information regarding known risks; utilize HT only in those women who require relief from menopausal symptoms that affect quality of life; consider lower than standard doses and alternative routes of administration; limit the use of HT to the shortest duration consistent with goals, benefits, and risks of treatment for each woman; and because of the potential risks associated with HT products that are FDA approved for the prevention of postmenopausal osteoporosis, consider alternative therapies if the woman is not symptomatic.



18. A 13-year-old female is undergoing rapid development of her breasts after experiencing menarche several months ago. Which of the following hormones are active in the development of her breasts? Select all that apply.
  A) Prolactin
  B) Human growth hormone
  C) Luteinizing hormone
  D) Estrogen
  E) Follicle-stimulating hormone
  F) Progesterone
  Ans: A, C, D, E, F
  In women, the pituitary release of FSH, LH, and prolactin at puberty stimulates the ovary to produce and release estrogen. This estrogen stimulates the growth and proliferation of the ductile system. With the onset of ovulatory cycles, progesterone release stimulates the growth and development of ductile and alveolar secretory epithelium.



19. A 13-year-old patient undergoing puberty is alarmed to find small, white bumps surrounding the areolae on her nipples. You reassure her that these are a normal sign of her sexual maturation and tell her that they are which of the following?
  A) Skene glands
  B) Bartholin glands
  C) Montgomery tubercles
  D) Cooper ligaments
  Ans: C
  The small bumps or projections on the areolar surface known as Montgomery tubercles are sebaceous glands that keep the nipple area soft and elastic. At puberty and during pregnancy, increased levels of estrogen and progesterone cause the areola and nipple to become darker and more prominent and the Montgomery glands to become more active.



20. While explaining milk production and release to a group of expectant parents, the nurse educates the parents on the fact that suckling by the infant provides the stimulus for milk ejection. This suckling sends feedback to the hypothalamus, which stimulates the release of which hormone from the pituitary gland responsible for the ejection of milk into the ductal system?
  A) Oxytocin
  B) Prolactin
  C) Progesterone
  D) Follicle-stimulating hormone
  Ans: A
  During lactation, milk is secreted by alveolar cells, which are under the influence of the anterior pituitary hormone prolactin. Milk ejection from the ductile system occurs in response to the release of oxytocin from the posterior pituitary. The suckling of the infant provides the stimulus for milk ejection. Suckling produces feedback to the hypothalamus, stimulating the release of oxytocin from the posterior pituitary. Oxytocin causes contraction of the myoepithelial cells lining the alveoli and ejection of milk into the ductal system.