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Visual Anatomy and Physiology, 3e (Martini)

Chapter 5 The Integumentary System

Multiple Choice Questions

1) Each of the following is a function of the integumentary system except

A) protection of underlying tissue.
B) excretion of salts and wastes.
C) maintenance of body temperature.
D) synthesis of vitamin C.
E) provision of sensation.

Answer: D

Learning Outcome: 5.1

Bloom’s Taxonomy: Remembering

2) The two components of the integumentary system are the

A) epidermis and dermis.
B) cutaneous membrane and hypodermis.
C) cutaneous membrane and accessory structures.
D) integument and hypodermis.
E) epidermis and superficial fascia.

Answer: C

Learning Outcome: 5.1

Bloom’s Taxonomy: Remembering

3) Accessory structures of the skin include all of the following except

A) hair follicles.
B) sebaceous glands.
C) sweat glands.
D) the epidermis.
E) lamellar corpuscles.

Answer: D

Learning Outcome: 5.1

Bloom’s Taxonomy: Remembering

Figure 5-1

4) An intradermal injection is administered into which layer?

A) 1
B) 2
C) 3
D) below layer 5
E) 5

Answer: C

Learning Outcome: 5.1

Bloom’s Taxonomy: Understanding

5) Which layer is the primary barrier against environmental hazards?

A) 1
B) 2
C) 3
D) 4
E) 5

Answer: A

Learning Outcome: 5.1

Bloom’s Taxonomy: Understanding

6) Which tissue is located in the region labeled “2”?

A) stratified squamous epithelium
B) areolar connective tissue
C) adipose tissue
D) cartilage and blood
E) reticular connective tissues

Answer: B

Learning Outcome: 5.1

Bloom’s Taxonomy: Understanding

7) Which layer contains most of the accessory organs?

A) 1
B) 2
C) 3
D) below layer 5
E) 5

Answer: C

Learning Outcome: 5.1

Bloom’s Taxonomy: Understanding

8) While walking barefoot on the beach, Joe stepped on a thorn that penetrated through the sole of his foot to the dermis. How many layers of epidermis did the thorn penetrate?

A) 1
B) 2
C) 3
D) 4
E) 5

Answer: E

Learning Outcome: 5.2

Bloom’s Taxonomy: Understanding

9) The type of most cells that form the strata in the epidermis are

A) adipocytes.
B) keratinocytes.
C) fibroblasts.
D) melanocytes.
E) dendritic cells.

Answer: B

Learning Outcome: 5.2

Bloom’s Taxonomy: Remembering

10) The layer of dividing cells at the base of the epidermis is the

A) stratum corneum.
B) stratum lucidum.
C) stratum basale.
D) stratum granulosum.
E) stratum spinosum.

Answer: C

Learning Outcome: 5.2

Bloom’s Taxonomy: Remembering

11) The tough “horny” superficial layer of the epidermis is known as the

A) stratum corneum.
B) stratum lucidum.
C) stratum basale.
D) stratum granulosum.
E) stratum spinosum.

Answer: A

Learning Outcome: 5.2

Bloom’s Taxonomy: Remembering

12) Insensible perspiration takes place in the

A) stratum corneum.
B) stratum lucidum.
C) stratum basale.
D) stratum granulosum.
E) stratum spinosum.

Answer: A

Learning Outcome: 5.2

Bloom’s Taxonomy: Remembering

13) The keratinocytes are tightly connected with each other by

A) keratin.
B) prekeratin.
C) collagen fibers.
D) elastic fibers.
E) desmosomes.

Answer: E

Learning Outcome: 5.2

Bloom’s Taxonomy: Remembering

14) In which layer of skin are keratinocytes produced?

A) dermis
B) subcutaneous layer
C) stratum spinosum
D) stratum corneum
E) stratum basale

Answer: E

Learning Outcome: 5.2

Bloom’s Taxonomy: Remembering

15) The epidermis in the thin skin contains ________ layer(s) and in the thick skin contains ________ layers.

A) 1; 2
B) 2; 3
C) 3; 4
D) 4; 5
E) 5; 6

Answer: D

Learning Outcome: 5.2

Bloom’s Taxonomy: Remembering

16) All of the following are characteristics of the epidermis except that it

A) is multilayered.
B) is flexible.
C) is self-repairing.
D) serves as UV radiation protection.
E) is vascularized.

Answer: E

Learning Outcome: 5.2

Bloom’s Taxonomy: Remembering

17) All of the following are true of epidermal ridges except that they

A) extend into the dermis.
B) contain increased numbers of free nerve endings.
C) cause ridge patterns on the surface of the skin.
D) produce patterns that are determined genetically.
E) interconnect with the dermal papillae.

Answer: B

Learning Outcome: 5.2

Bloom’s Taxonomy: Remembering

18) ________ are cells in the epidermis that are part of the immune system.

A) Dendritic cells
B) Basal cells
C) Merkel cells
D) Squamous cells
E) Melanocytes

Answer: A

Learning Outcome: 5.2

Bloom’s Taxonomy: Remembering

19) An albino individual lacks the ability to produce

A) melanin.
B) keratin.
C) carotene.
D) perspiration.
E) hemoglobin.

Answer: A

Learning Outcome: 5.3

Bloom’s Taxonomy: Remembering

20) All of the following are true of the pigment melanin except that it

A) decreases in concentration within cells during exposure to the sun.
B) is usually some shade of brown or black.
C) protects DNA from the damaging effects of UV radiation.
D) is released through melanosomes.
E) is produced by cells called melanocytes.

Answer: A

Learning Outcome: 5.3

Bloom’s Taxonomy: Remembering

21) What is the survival rate of a localized malignant melanoma that is detected and removed in the early stages of the cancer?

A) Above 95%
B) 75%
C) 60%
D) 40%
E) less than 20%

Answer: A

Learning Outcome: 5.3

Bloom’s Taxonomy: Understanding

22) From what layer of skin are melanosomes released?

A) stratum coneum
B) stratum basale
C) papillary layer of dermis
D) reticular layer of dermis
E) hypodermis

Answer: B

Learning Outcome: 5.3

Bloom’s Taxonomy: Understanding

23) The ________ in keratinocytes protects the epidermis and dermis from the harmful effects of sunlight.

A) sebum
B) hemoglobin
C) melanin
D) carotene
E) keratin

Answer: C

Learning Outcome: 5.3

Bloom’s Taxonomy: Remembering

24) Cyanosis signifies that a patient has

A) had too much sun.
B) been kept out of the sun.
C) an allergic reaction.
D) oxygen-starved skin.
E) been exposed to cyanide.

Answer: D

Learning Outcome: 5.3

Bloom’s Taxonomy: Understanding

25) ________ is a pigment found in vegetables that can make the skin appear orange or yellow.

A) Melanin
B) Chlorophyll
C) Carotene
D) Hemoglobin
E) Bilirubin

Answer: C

Learning Outcome: 5.3

Bloom’s Taxonomy: Remembering

26) The most dangerous type of skin cancer is termed

A) cyanosis.
B) basal cell carcinoma.
C) malignant melanoma.
D) metastasis.
E) melanosome.

Answer: C

Learning Outcome: 5.3

Bloom’s Taxonomy: Remembering

27) Melanin is produced by melanocytes within the stratum

A) corneum.
B) lucidum.
C) granulosum.
D) spinosum.
E) basale.

Answer: E

Learning Outcome: 5.3

Bloom’s Taxonomy: Remembering

28) The layer of the skin that contains bundles of collagen and elastic fibers responsible for the strength of the skin is the ________ layer.

A) papillary
B) reticular
C) epidermal
D) subcutaneous
E) hypodermal

Answer: B

Learning Outcome: 5.4

Bloom’s Taxonomy: Understanding

29) All of the following are true of the hypodermis except it

A) contains many blood vessels.
B) permits independent movement of deeper structures.
C) contains large amounts of adipose tissue.
D) is attached to the dermis by a basement membrane.
E) stores energy reserves.

Answer: D

Learning Outcome: 5.4

Bloom’s Taxonomy: Remembering

30) What is the most common type of cells in the subcutaneous layer?

A) keratinocytes
B) adipocytes
C) melanocytes
D) fibroblasts
E) fibrocytes

Answer: B

Learning Outcome: 5.4

Bloom’s Taxonomy: Remembering

31) Central adiposity is strongly associated with

A) liver diseases.
B) lung diseases.
C) kidney disorders.
D) cardiovascular disorders.
E) reproductive illnesses.

Answer: D

Learning Outcome: 5.4

Bloom’s Taxonomy: Understanding

32) Skin wrinkle and sagging is caused by

A) UV radiation.
B) hormonal changes.
C) aging.
D) all of the choices.
E) none of the choices.

Answer: D

Learning Outcome: 5.4

Bloom’s Taxonomy: Understanding

33) If the epidermis, dermis, and part of hypodermis are burned, it is classified as

A) first degree.
B) second degree.
C) partial thickness.
D) full thickness.
E) none of the choices.

Answer: D

Learning Outcome: 5.5

Bloom’s Taxonomy: Remembering

34) All of the following can be used in the management of severe burn except

A) antibiotics.
B) fluid replacement.
C) corticosteroids.
D) skin graft.
E) cell culture.

Answer: C

Learning Outcome: 5.5

Bloom’s Taxonomy: Understanding

35) All of the following are derived from epithelial columns except

A) hair roots.
B) hair follicles.
C) nails.
D) sebaceous glands.
E) sweat glands.

Answer: C

Learning Outcome: 5.6

Bloom’s Taxonomy: Remembering

36) All of the following are functions of accessory structures of integument except

A) thermoregulation.
B) protection of skull.
C) sensation of touch.
D) production of skin pigments.
E) excretion of sweat.

Answer: D

Learning Outcome: 5.6

Bloom’s Taxonomy: Remembering

37) ________ is a small connective tissue peg that contains nerve endings and blood vessels.

A) Hair medulla
B) Hair bulb
C) Hair papilla
D) Hair matrix
E) Hair cuticle

Answer: C

Learning Outcome: 5.7

Bloom’s Taxonomy: Remembering

38) When the arrector pili muscles contract,

A) “goose bumps” are formed.
B) hairs are shed.
C) sweat is released from sweat glands.
D) shivering occurs.
E) the skin changes color.

Answer: A

Learning Outcome: 5.7

Bloom’s Taxonomy: Understanding

39) If the papilla of a hair follicle is destroyed,

A) the hair produced by the follicle will change from terminal to vellus.
B) the color of the hair will become lighter.
C) the texture of the hair will become coarser.
D) the follicle will lose its blood supply.
E) hair production will not be affected.

Answer: D

Learning Outcome: 5.7

Bloom’s Taxonomy: Understanding

40) Each of the following statements concerning hair is true except

A) the medulla is the soft core of the hair.
B) the cortex of the hair is composed of hard keratin.
C) terminal hairs are heavy and more darkly pigmented than other types of hair.
D) club hair is hair that has ceased growing.
E) scalp hairs grow constantly throughout life.

Answer: E

Learning Outcome: 5.7

Bloom’s Taxonomy: Understanding

41) All of the following are correct regarding hair growth cycle except that

A) a hair in the scalp grows for 2 — 5 years.
B) a healthy adult with full head of hair may lose up to 100 hairs each day.
C) during the active phase, the hair grows continuously.
D) club hair is shed during follicle reactivation.
E) the hair becomes club hair during regression phase.

Answer: E

Learning Outcome: 5.7

Bloom’s Taxonomy: Understanding

42) ________ are fine hairs that lack pigment and cover much of the body surface.

A) Vellus hairs
B) Velvet hairs
C) Follicular hairs
D) Terminal hairs

Answer: A

Learning Outcome: 5.7

Bloom’s Taxonomy: Remembering

43) ________ hairs are coarse pigmented hairs.

A) Vellus
B) Dense
C) Follicular
D) Terminal
E) Keratinous

Answer: D

Learning Outcome: 5.7

Bloom’s Taxonomy: Remembering

44) Dandruff is a disorder that results in dry skin flakes forming in the scalp. A common cause of dandruff could be

A) inflammation around sebaceous glands.
B) lack of lamellated corpuscles.
C) overactive arrector pili muscles.
D) inactive apocrine sweat glands.
E) inactive merocrine sweat glands.

Answer: A

Learning Outcome: 5.8

Bloom’s Taxonomy: Understanding

45) From what structure does merocrine secretion occur?

A) ceruminous gland
B) mammary gland
C) apocrine sweat gland
D) sebaceous gland
E) eccrine sweat gland

Answer: E

Learning Outcome: 5.8

Bloom’s Taxonomy: Understanding

46) The substance called sebum is commonly known as

A) regular sweat.
B) earwax.
C) milk.
D) skin oil.
E) odiferous sweat.

Answer: D

Learning Outcome: 5.8

Bloom’s Taxonomy: Remembering

47) The ________ glands in the axilla become active at the time of puberty.

A) ceruminous
B) apocrine sweat
C) merocrine sweat
D) sebaceous
E) axillary

Answer: B

Learning Outcome: 5.8

Bloom’s Taxonomy: Understanding

48) Perspiration is produced by ________ glands.

A) ceruminous
B) apocrine sweat
C) merocrine sweat
D) sebaceous
E) mammary

Answer: C

Learning Outcome: 5.8

Bloom’s Taxonomy: Remembering

49) Milk is produced by ________ glands.

A) sebaceous
B) mammary
C) merocrine sweat
D) ceruminous
E) eccrine sweat

Answer: D

Learning Outcome: 5.8

Bloom’s Taxonomy: Understanding

50) The highest concentration of merocrine sweat glands is found

A) in the axillae.
B) on the chest.
C) on the palms of the hands.
D) on the upper back.
E) surrounding the genitals.

Answer: C

Learning Outcome: 5.8

Bloom’s Taxonomy: Remembering

51) All of the following are true of perspiration produced by merocrine sweat glands except that it

A) is very watery.
B) contains electrolytes and waste products.
C) helps cool the body when it evaporates.
D) helps prevent bacteria from colonizing the skin.
E) produces the body odor characteristic of “sweating.”

Answer: E

Learning Outcome: 5.8

Bloom’s Taxonomy: Remembering

52) ________ sweat glands are widely distributed across the body surface, ________ glands are located wherever hair follicles exist, and ________ sweat glands are found only in a few areas.

A) Sebaceous; merocrine; apocrine
B) Apocrine; merocrine; sebaceous
C) Merocrine; sebaceous; apocrine
D) Merocrine; apocrine; sebaceous
E) Apocrine; sebaceous; merocrine

Answer: C

Learning Outcome: 5.8

Bloom’s Taxonomy: Remembering

53) Which of the following is a holocrine exocrine gland?

A) sebaceous
B) apocrine
C) merocrine
D) mammary
E) ceruminous

Answer: A

Learning Outcome: 5.8

Bloom’s Taxonomy: Remembering

54) Merocrine sweat glands

A) are compound alveolar glands.
B) produce organic secretions that are metabolized by bacteria to produce body odor.
C) secrete a watery fluid directly onto the surface of the skin.
D) increase in number and activity with aging.
E) primarily function in lubricating the hairs.

Answer: C

Learning Outcome: 5.8

Bloom’s Taxonomy: Understanding

55) The nail body covers the

A) nail root.
B) nail bed.
C) lunula.
D) free edge.
E) hyponychium.

Answer: B

Learning Outcome: 5.9

Bloom’s Taxonomy: Remembering

56) Nail production occurs at the nail

A) body.
B) bed.
C) root.
D) cuticle.
E) hyponychium.

Answer: C

Learning Outcome: 5.9

Bloom’s Taxonomy: Remembering

57) At the base of a nail, keratinized skin called the cuticle is also called the

A) eponychium.
B) lunula.
C) hyponychium.
D) cerumen.
E) phalanx.

Answer: A

Learning Outcome: 5.9

Bloom’s Taxonomy: Remembering

58) The effects of aging on the skin include

A) a decline in the activity of sebaceous glands.
B) increased production of vitamin D.
C) thickening of the epidermis.
D) an increased blood supply to the dermis.
E) an increased number of sweat glands.

Answer: A

Learning Outcome: 5.10

Bloom’s Taxonomy: Remembering

59) Wrinkles in elderly individuals are the result of

A) increased production of epidermis.
B) loss of elastic filaments in the reticular layer of the dermis.
C) increased keratinization of the epidermis.
D) the loss of glands and hair follicles from the skin.
E) decreased thickness of the dermis.

Answer: B

Learning Outcome: 5.10

Bloom’s Taxonomy: Understanding

60) Why would an elderly person be more prone to skin infections than a younger person?

A) Skin repairs take longer in the elderly.
B) The epidermis is thinner in the elderly.
C) There are fewer dendritic cells in the skin of the elderly.
D) All of the answers are correct.

Answer: D

Learning Outcome: 5.10

Bloom’s Taxonomy: Understanding

61) Which of the following is not an effect of ultraviolet radiation?

A) increased activity by melanocytes
B) production of cholecalciferol within epidermal cells
C) wrinkles
D) chromosomal damage in basal cells or melanocytes
E) hair growth

Answer: E

Learning Outcome: 5.11

Bloom’s Taxonomy: Remembering

62) Vitamin ________ is formed in the skin when it is exposed to sunlight.

A) A
B) B
C) C
D) D
E) E

Answer: D

Learning Outcome: 5.11

Bloom’s Taxonomy: Remembering

63) Epidermal growth factor exerts all of the following effects on the epidermis except

A) promoting cell division.
B) stimulating keratin synthesis.
C) accelerating tissue repair.
D) speeding up glandular function.
E) stimulating melanin production.

Answer: E

Learning Outcome: 5.11

Bloom’s Taxonomy: Remembering

64) Vitamin D3 formed within the skin has all of these effects on other organ systems except that it

A) is essential for absorption of calcium and phosphorus by the digestive system.
B) functions as a precursor for the hormone calcitriol in the endocrine system.
C) is essential for bone maintenance.
D) functions in the activation of plasma cells by the lymphatic system.
E) is essential for bone growth.

Answer: D

Learning Outcome: 5.11

Bloom’s Taxonomy: Understanding

65) Rickets can be prevented by

A) adequate sunlight.
B) dietary intake of cholecalciferol.
C) avoiding sunlight.
D) adequate sunlight and dietary intake of cholecalciferol.
E) dietary intake of cholecalciferol and avoiding sunlight.

Answer: D

Learning Outcome: 5.11

Bloom’s Taxonomy: Understanding

66) In a penetrating wound, ________ divide to produce mobile cells that repair the dermis.

A) granulation cells
B) dendritic cells
C) macrophages
D) fibroblasts
E) muscle cells

Answer: D

Learning Outcome: 5.12

Bloom’s Taxonomy: Remembering

67) The repair of the epidermis after a wound begins as basal cells produce new

A) elastic fibers.
B) collagen fibers.
C) reticular fibers.
D) dense connective tissue.
E) epidermal cells.

Answer: E

Learning Outcome: 5.12

Bloom’s Taxonomy: Remembering

68) Skin can regenerate effectively even after considerable damage has occurred because

A) the epidermis of the skin has a rich supply of small blood vessels.
B) stem cells persist in both epithelial and connective-tissue components of the skin even after injury.
C) fibroblasts in the dermis can give rise to new germinal cells in the epidermis.
D) contraction in the area of the injury brings cells of adjacent strata together.
E) cells of the stratum basale cannot migrate to other positions in the skin.

Answer: B

Learning Outcome: 5.12

Bloom’s Taxonomy: Understanding

69) The following are stages in the regeneration of skin following an injury.

blood clot/scab formation
cellular migration
epidermis covers granulation tissue
epidermis covers scar tissue

Which of the following places the steps in the correct order?

A) 1, 2, 3, 4
B) 4, 3, 2, 1
C) 4, 3, 1, 2
D) 3, 4, 1, 2
E) 2, 4, 1, 3

Answer: A

Learning Outcome: 5.12

Bloom’s Taxonomy: Understanding

70) Scar tissue is the result of

A) large numbers of collagen fibers and relatively few blood vessels in the injured area.
B) increased numbers of epidermal layers in the area of the injury.
C) a thickened stratum basale in the area of the injury.
D) increased numbers of fibroblasts in the injured area.
E) a lack of sebaceous glands in the injured area.

Answer: A

Learning Outcome: 5.12

Bloom’s Taxonomy: Understanding

71) Granulation tissue is composed of

A) clotted blood.
B) an extensive capillary network.
C) fibroblasts.
D) All of the answers are correct.

Answer: D

Learning Outcome: 5.12

Bloom’s Taxonomy: Remembering

72) A thickened area of scar tissue that is covered by a shiny, smooth epidermal surface is called

A) a scab.
B) a keloid.
C) granulation tissue.
D) a clot.
E) a lesion.

Answer: B

Learning Outcome: 5.12

Bloom’s Taxonomy: Remembering

73) A fibrin clot that is formed over a skin wound is called

A) a scab.
B) a keloid.
C) granulation tissue.
D) a clot.
E) a lesion.

Answer: A

Learning Outcome: 5.12

Bloom’s Taxonomy: Remembering

74) The combination of fibrin clot, fibroblasts, and extensive capillary network that is formed in injured skin is called

A) a scab.
B) a keloid.
C) granulation tissue.
D) a clot.
E) a lesion.

Answer: C

Learning Outcome: 5.12

Bloom’s Taxonomy: Remembering

75) Identify the two major components of the cutaneous membrane. (Module 5.1A)

A) dermis and epidermis
B) dermis and subcutaneous layer
C) epidermis and subcutaneous layer
D) dermis and the cutaneous plexus
E) epidermis and the cutaneous plexus

Answer: A

Learning Outcome: 5.1

Bloom’s Taxonomy: Remembering

76) Compare thin skin with thick skin. (Module 5.2A)

A) Thin skin has only 1 layer and is found on lips, eyelids, and other delicate structures. Thick skin has hundreds of layers and is found all over the body except where thin skin is found.
B) Thin skin has only 1 layer and contains only the epidermis. Thick skin has 2 layers made up of the epidermis and dermis.
C) Thin skin has 4 layers and covers most of the body surfaces. Thick skin has 5 layers and covers the palms of the hands and soles of the feet.
D) Thin skin has 4 layers and covers the palms of the hands and soles of the feet. Thick skin has 4 layers and covers most of the body surfaces.
E) Thin skin contains the epidermis and dermis but not the subcutaneous layer. Thick skin contains the epidermis, dermis and subcutaneous layer.

Answer: C

Learning Outcome: 5.2

Bloom’s Taxonomy: Understanding

77) Identify the five layers of the epidermis (from superficial to deep). (Module 5.2B)

A) stratum basale, stratum spinosum, stratum granulosum, stratum lucidum, and stratum corneum
B) stratum basale, stratum granulosum, stratum lucidum, stratum corneum, stratum spinosum
C) stratum basale, stratum granulosum, stratum lucideum, stratum spinosum, stratum corneum
D) stratum corneum, stratum lucidum, stratum granulosum, stratum basale, stratum spinosum
E) stratum corneum, stratum lucidum, stratum granulosum, stratum spinosum, stratum basale

Answer: E

Learning Outcome: 5.2

Bloom’s Taxonomy: Remembering

78) Dandruff is caused by excessive shedding of cells from the outer layer of skin on the scalp. So, dandruff is composed of cells from which epidermal layer? (Module 5.2C)

A) stratum basale
B) stratum granulosum
C) stratum lucidum
D) stratum corneum
E) stratum spinosum

Answer: D

Learning Outcome: 5.2

Bloom’s Taxonomy: Remembering

79) A splinter that penetrates to the third layer of epidermis of the palm is lodged in which layer? (Module 5.2D)

A) stratum basale
B) stratum granulosum
C) stratum lucidum
D) stratum corneum
E) stratum spinosum

Answer: B

Learning Outcome: 5.2

Bloom’s Taxonomy: Remembering

80) Name the two pigments contained in the epidermis. (Module 5.3A)

A) carotene and melatonin
B) creatinine and melatonin
C) carotene and melanin
D) keratin and melanin
E) carnitine and melanoma

Answer: C

Learning Outcome: 5.3

Bloom’s Taxonomy: Remembering

81) Why does exposure to sunlight or sunlamps darken skin? (Module 5.3B)

A) UV radiation stimulates melanocytes to produce more melanin.
B) UV radiation stimulates melanocytes to produce more melatonin.
C) UV radiation stimulates keratinocytes to produce more carotene.
D) UV radiation stimulates keratinocytes to produce more keratin.
E) UV radiation stimulates melanocytes to produce more melanin and keratinocytes to produce more keratin.

Answer: A

Learning Outcome: 5.3

Bloom’s Taxonomy: Understanding

82) Why is basal cell carcinoma considered less dangerous than malignant melanoma?

(Module 5.3D)

A) Basal cell carcinoma affects the stratum basale only and will not spread to any other layer, whereas malignant melanoma affects the melanocytes which can be found throughout the epidermis.
B) Basal cell carcinoma affect the cells of the stratum basale which cannot form tumors, whereas malignant melanoma affects the melanocytes which form cancerous tumors.
C) Basal cell carcinoma only occurs in the elderly, whereas malignant melanoma occurs in children and young adults.
D) Basal cell carcinoma only occurs on the face, whereas malignant melanoma can occur anywhere on the body.
E) Basal cell carcinomas rarely become malignant and metastasize, whereas malignant melanoma cells quickly spread throughout the lymphatic system to other organs.

Answer: E

Learning Outcome: 5.3

Bloom’s Taxonomy: Understanding

83) Explain why a healthy 6-month-old might have yellow-orange skin. (Module 5.3E)

A) The skin of infants is very thin making it appear yellow-orange.
B) Breastmilk causes the skin to look yellow-orange.
C) The child may have been outside when it was cold causing vasoconstriction which reduces the pink coloration and makes skin look more yellow-orange.
D) The child may have eaten foods with a high amount of carotene causing the pigment to accumulate in the skin making it look yellow-orange.
E) The child may be developing adipose tissue which has a yellowish tint.

Answer: D

Learning Outcome: 5.3

Bloom’s Taxonomy: Applying

84) Describe the layers of the dermis. (Module 5.4A)

A) The superficial papillary layer contains areolar tissue with capillaries, lymphatic vessels, and sensory neurons. The deep reticular layer contains dense irregular connective tissue with collagen and elastic fibers.
B) The superficial reticular layer contains areolar tissue with capillaries, lymphatic vessels, and sensory neurons. The deep papillary layer contains dense irregular connective tissue with collagen and elastic fibers.
C) The superficial papillary layer contains dense irregular connective tissue with collagen and elastic fibers. The deep reticular layer contains areolar tissue with capillaries, lymphatic vessels, and sensory neurons.
D) The superficial reticular layer contains dense irregular connective tissue with collagen and elastic fibers. The deep papillary layer contains areolar tissue with capillaries, lymphatic vessels, and sensory neurons.
E) The superficial papillary layer contains stratified squamous epithelial tissue. The deep reticular layer contains areolar tissue with capillaries, lymphatic vessels, and sensory neurons.

Answer: A

Learning Outcome: 5.4

Bloom’s Taxonomy: Remembering

85) Predict the degree of scarring after the healing of a horizontal cut on the forehead just above the eyebrow. (Module 5.4B)

A) The scarring will be minimal because the cut follows the same direction as the tension lines.
B) The scarring will be minimal because the cut is at a right angle to the direction of the tension lines.
C) The scarring will be significant because the cut follows the same direction as the tension lines.
D) The scarring will be significant because the cut is at a right angle to the direction of the tension lines.
E) The scarring will be minimal because no tension lines run through that area of the body.

Answer: D

Learning Outcome: 5.4

Bloom’s Taxonomy: Applying

86) Distinguish among a first-degree, second-degree, and third-degree burn. (Module 5.5A)

A) A first-degree burn affects only the surface of the skin. A second-degree burn affects the whole epidermis and some of the dermis. A third-degree burn destroys the epidermis, the dermis, and extends into the subcutaneous layer.
B) A first-degree burn affects the whole epidermis and some of the dermis. A second-degree burn affects only the surface of the skin. A third-degree burn destroys the epidermis, the dermis, and extends into the subcutaneous layer.
C) A first-degree burn destroys the epidermis, the dermis, and extends into the subcutaneous layer. A second-degree burn affects the whole epidermis and some of the dermis. A third-degree burn affects only the surface of the skin.
D) A first-degree burn destroys the epidermis, the dermis, and extends into the subcutaneous layer. A second-degree burn affects only the surface of the skin. A third-degree burn affects the whole epidermis and some of the dermis.
E) A first-degree burn affects only the surface of the skin. A second-degree burn destroys the epidermis, the dermis, and extends into the subcutaneous layer. A third-degree burn affects the whole epidermis and some of the dermis.

Answer: A

Learning Outcome: 5.5

Bloom’s Taxonomy: Remembering

87) Which type of burn usually requires skin grafting? Why? (Module 5.5B)

A) First-degree burns because the epidermis is damaged.
B) First-degree burns because the tissue damage is so great that the tissue cannot repair itself.
C) Second-degree burns because the tissue damage is so great that the tissue cannot repair itself.
D) Third-degree burns because the epidermis is damaged.
E) Third-degree burns because the tissue damage is so great that the tissue cannot repair itself.

Answer: E

Learning Outcome: 5.5

Bloom’s Taxonomy: Applying

88) A 32-year-old woman is admitted to the hospital with third-degree burns on her entire right leg, entire right arm, and the back of her trunk. Estimate the percentage of her body surface area affected by these burns. (Module 5.5D)

A) 9%
B) 18%
C) 36%
D) 45%
E) 91%

Answer: D

Learning Outcome: 5.5

Bloom’s Taxonomy: Applying

89) What are epidermal derivatives? (Module 5.6A)

A) Epidermal derivatives are pigment molecules produced by the epidermis, including carotene and melanin.
B) Epidermal derivatives are the different cell types found in the epidermis, including epithelial cells and melanocytes.
C) Epidermal derivatives are chemicals produced by the epidermis, such as heparin and prostaglandins.
D) Epidermal derivatives are secretions produced by the epidermis, including sweat and sebum.
E) Epidermal derivatives are accessory structures that originate from the epidermis during embryonic development, including hair follicles, sebaceous and sweat glands, and nails.

Answer: E

Learning Outcome: 5.6

Bloom’s Taxonomy: Remembering

90) Which exocrine glands are in the integument? (Module 5.6B)

A) Sweat glands and salivary glands
B) Mammary glands and salivary glands
C) Sweat glands and sebaceous glands
D) Mucous glands and sebaceous glands
E) Mucous glands and sweat glands

Answer: C

Learning Outcome: 5.6

Bloom’s Taxonomy: Remembering

91) Describe a typical strand of hair. (Module 5.7A)

A) A keratinous strand produced by basal cells within a hair follicle.
B) A small connective tissue peg filled with blood vessels and nerves.
C) A bundle of smooth muscles attached to a hair follicle.
D) A layer of epithelial cells surrounding a deep layer of connective tissue.
E) Many layers of dead, tightly compressed cells packed with keratin.

Answer: A

Learning Outcome: 5.7

Bloom’s Taxonomy: Remembering

92) What happens when an arrector pili muscle contracts? (Module 5.7B)

A) The hair falls out of the hair bulb.
B) The hair grows approximately 0.33mm.
C) The sebaceous gland secretes oil onto the surface of the hair.
D) The sweat gland secretes sweat out of the pores next to the hair.
E) The hair follicle becomes erect, producing “goose bumps.”

Answer: E

Learning Outcome: 5.7

Bloom’s Taxonomy: Understanding

93) Identify and describe the general functions of the exocrine glands found in the skin.

(Module 5.8A)

A) Sweat glands and salivary glands; the glands help with thermoregulation and dissolve particles on the skin.
B) Mammary glands and salivary glands; the glands help with reducing bacterial colonization and dissolve particles on the skin.
C) Sweat glands and sebaceous glands; the glands help with thermoregulation, excrete wastes, and lubricate hairs and the epidermis.
D) Mucous glands and sebaceous glands; the glands help lubricate hairs and epidermis and provide waterproofing.
E) Mucous glands and sweat glands; the glands excrete wastes and provide waterproofing.

Answer: C

Learning Outcome: 5.8

Bloom’s Taxonomy: Remembering

94) Describe the secretory method and functions of sebum. (Module 5.8B)

A) merocrine; sebum lubricates hair and skin, protects the keratin of the hair shaft, and inhibits bacterial growth
B) holocrine; sebum lubricates hair and skin, protects the keratin of the hair shaft, and inhibits bacterial growth
C) apocrine; sebum lubricates hair and skin, protects the keratin of the hair shaft, and inhibits bacterial growth
D) merocrine; sebum is important in thermoregulation and excretion of wastes
E) endocrine; sebum is important in thermoregulation and excretion of wastes

Answer: B

Learning Outcome: 5.8

Bloom’s Taxonomy: Remembering

95) Deodorants are used to mask the effects of secretions from which type of skin gland? (Module 5.8C)

A) apocrine sweat glands
B) eccrine sweat glands
C) merocrine sweat glands
D) sebaceous glands
E) mucous glands

Answer: A

Learning Outcome: 5.8

Bloom’s Taxonomy: Remembering

96) Name the type of cell that assists the discharge of merocrine secretions, and list the glands in which such cells are present. (Module 5.8D)

A) arrector pili cell; apocrine and eccrine sweat glands
B) arrector pili cell; apocrine and eccrine sweat glands, mammary glands, lacrimal glands, and salivary glands
C) myoepithelial cell; apocrine and eccrine sweat glands
D) myoepithelial cell; apocrine and eccrine sweat glands, mammary glands, lacrimal glands, and salivary glands
E) goblet cell; apocrine and eccrine sweat glands

Answer: D

Learning Outcome: 5.8

Bloom’s Taxonomy: Remembering

97) Where does nail production occur? (Module 5.9A)

A) At the lunula
B) At the cuticle
C) At the eponychium
D) At the hyponychium
E) At the nail root

Answer: E

Learning Outcome: 5.9

Bloom’s Taxonomy: Remembering

98) Define hyponychium. (Module 5.9B)

A) A portion of the stratum corneum of the nail root that extends over the exposed nail.
B) The thickened stratum corneum underlying the free edge of the nail.
C) An epidermal fold not visible from the surface where nail production occurs.
D) An area of epidermis that is covered by the nail.
E) The visible portion of the nail.

Answer: B

Learning Outcome: 5.9

Bloom’s Taxonomy: Remembering

99) Why does the free edge of a nail appear white? (Module 5.9C)

A) The melanocytes are no longer living in the nail.
B) The keratinocytes have been damaged as the nail grew out.
C) There are no underlying blood vessels.
D) The epidermis is dividing faster there than at the root.
E) The nail is dryer and more brittle there than at the root.

Answer: C

Learning Outcome: 5.9

Bloom’s Taxonomy: Understanding

100) Why does hair turn white or gray with age? (Module 5.10A)

A) The hair is no longer producing carotene.
B) The keratinocytes have been damaged.
C) Sebaceous gland activity increases, making the hair well lubricated during growth and turning it white or gray.
D) The epidermis is dividing faster, making the hair white or gray.
E) The melanocyte activity declines, making the hair white or gray.

Answer: E

Learning Outcome: 5.10

Bloom’s Taxonomy: Understanding

101) List some hormones that are necessary for maintaining a healthy integument.

(Module 5.11A)

A) growth hormone, mineralocorticoids, glucocorticoids, and melatonin
B) ADH, oxytocin, and prolactin
C) aldosterone, atrial natriuretic peptide, insulin, and glucagon
D) growth hormone, sex hormones, growth factors, glucocorticoids, and thyroid hormones
E) sex hormones, mineralocorticoids, gonadocorticoids, and calcitonin

Answer: D

Learning Outcome: 5.11

Bloom’s Taxonomy: Remembering

102) Identify the first stage in skin repair. (Module 5.12A)

A) inflammation
B) migration
C) proliferation
D) scarring
E) keloid formation

Answer: A

Learning Outcome: 5.12

Bloom’s Taxonomy: Remembering

103) Describe granulation tissue. (Module 5.12B)

A) Granulation tissue is newly formed epithelial tissue.
B) Granulation tissue is a combination of blood clots, fibroblasts, and capillaries in healing tissue.
C) Granulation tissue is all three layers of the integument forming, subcutaneous, dermis, and epidermis.
D) Granulation tissue is a raised, thickened mass of scar tissue.
E) Granulation tissue is thick, non-elastic tissue dominated by collagen fibers.

Answer: B

Learning Outcome: 5.12

Bloom’s Taxonomy: Remembering

Essay Questions

104) Why is a subcutaneous injection with a hypodermic needle a useful method of administering drugs?

Answer: The subcutaneous layer has a limited capillary supply and contains no vital organs; thus, the potential for tissue damage is reduced.

Learning Outcome: 5.1

Bloom’s Taxonomy: Understanding

105) Explain why the rate of dehydration is greater when a person is immersed in seawater than when in fresh water.

Answer: Salty ocean water is very hypertonic compared to bodily fluids, while fresh lake water is very hypotonic. Hence, in the sea, due to osmosis water will leave the body, accelerating the rate of dehydration. In fresh water, water will be gained.

Learning Outcome: 5.2

Bloom’s Taxonomy: Analyzing

106) A new mother notices that her 6-month-old infant has a yellow-orange complexion. Fearful that the child may have jaundice, she takes him to her pediatrician. After examining the child and learning about the infant’s diet, the pediatrician declares him perfectly healthy and advises the mother to watch the child’s diet. What is likely the cause for the change in skin color?

Answer: The infant probably has a fondness for vegetables that are high in carotene, such as sweet potatoes, squash, and carrots. It is not uncommon for parents to feed babies what they will eat best. If the child consumes large amounts of carotene, the yellow-orange pigment will be stored in the skin, producing a yellow-orange skin color.

Learning Outcome: 5.3

Bloom’s Taxonomy: Applying

107) Many medications can be administered transdermally by applying patches that contain the medication to the surface of the skin. These patches can be attached anywhere on the skin except the palms of the hands and the soles of the feet. Why?

Answer: Thick skin slows the rate of diffusion of the medication and thus decreases its effectiveness. In addition, excessive sweat formed on the palms of the hands and soles of the feet would make the patch fall off more readily.

Learning Outcome: 5.8

Bloom’s Taxonomy: Applying

108) In a condition known as sunstroke, the victim appears flushed, the skin is warm and dry, and the body temperature rises dramatically. Explain these observations based on what you know concerning the role of the skin in thermoregulation.

Answer: When the body temperature increases, more blood flow is directed to the vessels of the skin. The red cells in the blood give the skin a redder-than-usual color and account for the victim’s flushed appearance. The skin is dry because the sweat glands are not producing sweat (avoids further dehydration). Without evaporation cooling, not enough heat is dissipated from the skin, the skin is warm, and the body temperature rises. This situation represents positive feedback operating in a disease state.

Learning Outcome: 5.8

Bloom’s Taxonomy: Applying

109) Vanessa’s 80-year-old grandmother sets her thermostat at 26°C (80°F) and wears a sweater on balmy spring days. When asked why, the grandmother says she feels cold. What is a possible cause for her feeling cold?

Answer: Most elderly people have poor blood flow to the skin. Thus, their skin becomes cold. This triggers thermal receptors in the skin to signal cold skin. The brain interprets this as a cold body temperature.

Learning Outcome: 5.10

Bloom’s Taxonomy: Applying

110) Provide one beneficial effect of exposure to ultraviolet (UV) radiation.

Answer: It stimulates synthesis of vitamin D3.

Learning Outcome: 5.11

Bloom’s Taxonomy: Understanding

111) Why is scab formation important in wound healing?

Answer: Scabs temporarily restore epidermal integrity, restricting further entry of microorganisms. They also prevent the loss of fluids, maintaining internal fluid balance, and protect the delicate granulation tissue during tissue recovery.

Learning Outcome: 5.12

Bloom’s Taxonomy: Understanding

112) What are the stages of skin regeneration after injury?

Answer: Inflammation, migration, proliferation, and scarring

Learning Outcome: 5.12

Bloom’s Taxonomy: Understanding

113) Identify the major functions of the integumentary system. (Module 5.1B)

Answer: The major functions of the integumentary system are to protect underlying tissues and organs, excrete wastes by integumentary glands, maintain body temperature, produce melanin and keratin, synthesize vitamin D3, store lipids, and detect touch, pressure, pain, and temperature.

Learning Outcome: 5.1

Bloom’s Taxonomy: Remembering

114) Why does the skin of a light-skinned person appear red during exercise in hot weather? (Module 5.3C)

Answer: When the skin gets warm, arriving oxygenated blood is diverted to the superficial dermis (papillary layer) to eliminate heat. The oxygenated blood imparts a reddish coloration to the light skin.

Learning Outcome: 5.3

Bloom’s Taxonomy: Understanding

115) Describe the three types of skin grafts. Which one is best? Why? (Module 5.5C)

Answer: In an autograft, the patient’s undamaged skin is used as a graft source. An allograft uses skin from a donor, and a xenograft uses skin from an animal, such as a pig. Autografts are the best because they are not rejected by the patient’s immune system.

Learning Outcome: 5.5

Bloom’s Taxonomy: Understanding

116) Describe the four phases of the hair growth cycle. (Module 5.7C)

Answer: Hair follicles transition between (1) an active phase of continuous hair growth; (2) regression; (3) a resting phase, when the hair becomes a club hair; and (4) reactivation of hair growth and shedding of club hair.

Learning Outcome: 5.7

Bloom’s Taxonomy: Remembering

117) Why is pulling a hair painful, yet cutting a hair is not? (Module 5.7D)

Answer: Pulling a hair is painful because its root is attached deep within the hair follicle, the base of which is surrounded by a root hair plexus consisting of sensory nerves. Cutting a hair is painless because a hair shaft contains no sensory nerves.

Learning Outcome: 5.7

Bloom’s Taxonomy: Understanding

118) Why do people tolerate summer heat less well and become more susceptible to heat-related illness when they become older? (Module 5.10B)

Answer: As a person ages, the blood supply to the dermis decreases, and eccrine sweat glands become less active. Both changes make it more difficult for older people to cool themselves in hot weather.

Learning Outcome: 5.10

Bloom’s Taxonomy: Applying

119) Explain the relationship between sunlight exposure and vitamin D3. (Module 5.11B)

Answer: In the presence of UV radiation in sunlight, epidermal cells in the stratum spinosum and stratum basale convert a cholesterol-related steroid into cholecalciferol, also known as vitamin D3.

Learning Outcome: 5.11

Bloom’s Taxonomy: Understanding

120) In some cultures, females must be covered from head to toe when they go outdoors. Explain why these women are at increased risk of developing bone problems later in life. (Module 5.11C)

Answer: The hormone cholecalciferol (vitamin D3) is needed to form strong bones and teeth. When the body surface is covered, UV radiation cannot reach the skin to stimulate cholecalciferol (vitamin D3) production, so bones can become fragile.

Learning Outcome: 5.11

Bloom’s Taxonomy: Applying

121) Why can skin regenerate effectively even after considerable damage? (Module 5.12C)

Answer: Skin can regenerate effectively even after undergoing considerable damage because stem cells persist in both the epithelial and connective tissue components of skin. In response to injury, cells of the stratum basale replace epithelial cells, and mesenchymal cells replace lost dermal cells.

Learning Outcome: 5.12

Bloom’s Taxonomy: Applying

Visual Anatomy and Physiology, 3e (Martini)

Chapter 17 Blood

Multiple Choice Questions

1) Which of the following is not a function of blood?

A) transport of nutrients and wastes
B) transport of body heat
C) transport of gases
D) defense against toxins and pathogens
E) produce hormones

Answer: E

Learning Outcome: 17.1

Bloom’s Taxonomy: Remembering

2) All of the following are components of the cardiovascular system except

A) blood.
B) arteries.
C) heart.
D) lymph vessels.
E) capillaries.

Answer: D

Learning Outcome: 17.1

Bloom’s Taxonomy: Remembering

3) Each of the following is a characteristic of whole blood except

A) the ability to absorb heat from active skeletal muscles.
B) viscosity about the same as water.
C) the ability to neutralize acids.
D) a built-in system for clotting.
E) deep red color.

Answer: B

Learning Outcome: 17.1

Bloom’s Taxonomy: Remembering

4) Each of the following is a way that blood transports materials around the body except

A) nutrients from the digestive tract to the body.
B) hormones from endocrine glands to target cells.
C) carbon dioxide from the lungs to the tissues.
D) wastes from the cells to the kidneys.
E) stored nutrients from the liver to the tissues.

Answer: C

Learning Outcome: 17.1

Bloom’s Taxonomy: Remembering

5) Which of the following statements about blood is false?

A) It contains buffers that control pH.
B) Normal pH is 6.8 to 7.0.
C) It is more viscous than water.
D) It is about 55 percent plasma.
E) None of the statements are false; all are true.

Answer: B

Learning Outcome: 17.2

Bloom’s Taxonomy: Remembering

6) Formed elements make up about what percentage of blood?

A) 55 percent
B) 78 percent
C) 60 percent
D) 45 percent
E) 20 percent

Answer: D

Learning Outcome: 17.2

Bloom’s Taxonomy: Remembering

7) The combination of plasma and formed elements is called

A) serum.
B) lymph.
C) whole blood.
D) extracellular fluid.
E) packed blood.

Answer: C

Learning Outcome: 17.2

Bloom’s Taxonomy: Remembering

8) The percent fraction of formed elements relative to whole blood is the

A) viscosity.
B) specific gravity.
C) packed volume.
D) hematocrit.
E) differential cell count.

Answer: D

Learning Outcome: 17.2

Bloom’s Taxonomy: Remembering

9) A typical adult hematocrit is

A) higher in males than females.
B) higher in females than males.
C) the same in both men and women.

Answer: A

Learning Outcome: 17.2

Bloom’s Taxonomy: Applying

10) Platelets are

A) red cells that lack a nucleus.
B) blue cells that have a nucleus.
C) large cells with a prominent, concave nucleus.
D) tiny cells with a polynucleus.
E) cytoplasmic fragments of large cells.

Answer: E

Learning Outcome: 17.2

Bloom’s Taxonomy: Remembering

11) The total volume of blood in the body of an adult male is approximately ________ liters.

A) 10
B) 6 to 8
C) 5 to 6
D) 4
E) 3

Answer: C

Learning Outcome: 17.2

Bloom’s Taxonomy: Remembering

12) Which organ secretes most of the plasma proteins?

A) pancreas
B) heart
C) kidney
D) brain
E) liver

Answer: E

Learning Outcome: 17.2

Bloom’s Taxonomy: Remembering

13) The chief differences between plasma and interstitial fluid involves the concentration of

A) water.
B) electrolytes.
C) nitrogen wastes.
D) proteins.
E) glucose.

Answer: D

Learning Outcome: 17.2

Bloom’s Taxonomy: Remembering

14) The most abundant proteins in blood plasma are

A) globulins.
B) transport proteins.
C) albumins.
D) lipoproteins.
E) fibrinogens.

Answer: C

Learning Outcome: 17.2

Bloom’s Taxonomy: Remembering

15) Plasma proteins essential in body defense are the

A) albumins.
B) fibrinogens.
C) immunoglobulins.
D) platelets.
E) transport proteins.

Answer: C

Learning Outcome: 17.2

Bloom’s Taxonomy: Remembering

16) A plasma protein essential for blood coagulation is

A) albumin alpha.
B) fibrinogen.
C) immunoglobulin A.
D) platelets.
E) transport proteins.

Answer: B

Learning Outcome: 17.2

Bloom’s Taxonomy: Remembering

17) The most abundant component of plasma is

A) ions.
B) proteins.
C) water.
D) gases.
E) nutrients.

Answer: C

Learning Outcome: 17.2

Bloom’s Taxonomy: Remembering

18) A hematocrit provides information on

A) blood type.
B) clotting factors.
C) formed elements abundance.
D) plasma composition.
E) sedimentation rate.

Answer: C

Learning Outcome: 17.2

Bloom’s Taxonomy: Remembering

19) Which of the following is not a component of plasma?

A) electrolytes
B) platelets
C) fibrinogen
D) albumin
E) water

Answer: B

Learning Outcome: 17.2

Bloom’s Taxonomy: Remembering

20) Which of these is not one of the formed elements of blood?

A) RBCs
B) platelets
C) antibodies
D) lymphocytes
E) basophils

Answer: C

Learning Outcome: 17.2

Bloom’s Taxonomy: Remembering

21) Plasma composes about ________ percent of whole blood, and water composes ________ percent of the plasma volume.

A) 55; 92
B) 92; 7
C) 92; 55
D) 45; 55
E) 50; 50

Answer: A

Learning Outcome: 17.2

Bloom’s Taxonomy: Remembering

22) Which plasma protein is a major contributor to the osmotic pressure of plasma?

A) fibrinogen
B) steroid-binding protein
C) hormone-binding protein
D) albumin
E) gamma globulin

Answer: D

Learning Outcome: 17.2

Bloom’s Taxonomy: Remembering

23) Most of the protein factors that are required for clotting are synthesized by

A) platelets.
B) megakaryocytes.
C) the liver.
D) the kidneys.
E) the spleen.

Answer: C

Learning Outcome: 17.2

Bloom’s Taxonomy: Remembering

24) Plasma is closest in ionic composition to

A) urine.
B) isotonic saline solution.
C) sterile water.
D) CSF.
E) interstitial fluid.

Answer: E

Learning Outcome: 17.2

Bloom’s Taxonomy: Understanding

25) You are caring for a female adult patient who weighs 40 kg (90 lbs). Assuming no loss of blood, what would her approximate blood volume be?

A) 6.6 L
B) 6.0 L
C) 5.6 L
D) 1.8 L
E) 3.8 L

Answer: E

Learning Outcome: 17.2

Bloom’s Taxonomy: Applying

26) When blood is fractionated, its components are ________ for the purpose of analysis.

A) combined
B) lysed
C) separated
D) marked
E) returned to the body

Answer: C

Learning Outcome: 17.2

Bloom’s Taxonomy: Remembering

27) The normal pH of blood is

A) slightly alkaline.
B) neutral.
C) slightly acidic.
D) extremely alkaline.
E) extremely acidic.

Answer: A

Learning Outcome: 17.2

Bloom’s Taxonomy: Remembering

28) Red blood cell production is regulated by the hormone ________ which is mostly produced in the ________.

A) thymosin; thymus
B) angiotensin; lungs
C) erythropoietin; kidneys
D) erythropoietin; liver
E) renin; kidneys

Answer: C

Learning Outcome: 17.3

Bloom’s Taxonomy: Remembering

29) The level of erythropoietin in the blood would rise due to all of the following except

A) during anemia.
B) at high altitudes.
C) as a consequence of hemorrhage.
D) during periods of fasting.
E) when blood flow to the kidneys is disrupted.

Answer: D

Learning Outcome: 17.3

Bloom’s Taxonomy: Understanding

30) When a person who lives at sea level vacations in the Rocky Mountains, you would expect

A) a drop in oxygen levels.
B) the release of erythropoietin.
C) a rise in hematocrit.
D) All of the answers are correct.
E) None of the answers is correct.

Answer: D

Learning Outcome: 17.3

Bloom’s Taxonomy: Applying

31) Which of the following descriptions best matches the term colony stimulating factor?

A) releases histamine
B) antibodies are one type
C) hormone that regulates blood cell formation
D) kills bacteria using cytotoxic chemicals
E) often elevated in allergic individuals

Answer: C

Learning Outcome: 17.3

Bloom’s Taxonomy: Remembering

32) The process of white blood cell production and maturation goes on in all of the following except

A) the spleen.
B) the kidney.
C) the lymph nodes.
D) red bone marrow.
E) the thymus.

Answer: B

Learning Outcome: 17.3

Bloom’s Taxonomy: Remembering

33) Granulocytes form in

A) the intestines.
B) the spleen.
C) the thymus.
D) red bone marrow.
E) yellow bone marrow.

Answer: D

Learning Outcome: 17.3

Bloom’s Taxonomy: Remembering

34) In adults, the only site of red blood cell production and the primary site of white blood cell formation is

A) the liver.
B) the spleen.
C) the thymus.
D) red bone marrow.
E) yellow bone marrow.

Answer: D

Learning Outcome: 17.3

Bloom’s Taxonomy: Remembering

35) Erythropoiesis is stimulated when

A) oxygen levels in the blood increase.
B) oxygen levels in the blood decrease.
C) blood flow to the kidney declines.
D) both oxygen levels in the blood increase and blood flow to the kidney declines.
E) both oxygen levels in the blood decrease and blood flow to the kidney declines.

Answer: E

Learning Outcome: 17.3

Bloom’s Taxonomy: Remembering

36) Platelets are pinched off from giant multinucleated cells in the bone marrow called

A) erythroblasts.
B) normoblasts.
C) megakaryocytes.
D) myeloblasts.
E) lymphoblasts.

Answer: C

Learning Outcome: 17.3

Bloom’s Taxonomy: Remembering

37) Red cell production is stimulated by a kidney-derived hormone called

A) erythropoietin (EPO).
B) colony-stimulating factor.
C) renin
D) estrogen.
E) fibrin.

Answer: A

Learning Outcome: 17.3

Bloom’s Taxonomy: Remembering

38) Hormones called ________ are involved in regulation of white blood cell populations.

A) erythropoietin (EPO)
B) colony-stimulating factor
C) testosterone
D) estrogen
E) fibrin

Answer: B

Learning Outcome: 17.3

Bloom’s Taxonomy: Remembering

39) An obstruction in blood flow to the kidneys would ultimately result in

A) decreased iron absorption.
B) renal anemia.
C) increased erythropoiesis.
D) decreased erythropoiesis.
E) increased sensitivity to vitamin K.

Answer: C

Learning Outcome: 17.3

Bloom’s Taxonomy: Remembering

40) The ________ is a procedure that is used to determine the number of each of the various types of white blood cells.

A) hematocrit
B) complete blood count
C) reticulocyte count
D) differential count
E) mean corpuscular volume

Answer: D

Learning Outcome: 17.4

Bloom’s Taxonomy: Remembering

41) The ________ is a procedure that is used to determine the number of mature erythrocytes.

A) RBC count
B) complete blood count
C) reticulocyte count
D) differential count
E) platelet count

Answer: A

Learning Outcome: 17.4

Bloom’s Taxonomy: Remembering

42) Hematology can detect all of the following except

A) anemia.
B) clotting disorders.
C) diminished erythropoiesis.
D) infection.
E) body temperature.

Answer: E

Learning Outcome: 17.4

Bloom’s Taxonomy: Remembering

43) An increased mean corpuscular hemoglobin concentration is termed

A) anemia.
B) polycythemia.
C) hyperchromic.
D) macrocytic.
E) reticulocytosis.

Answer: C

Learning Outcome: 17.4

Bloom’s Taxonomy: Remembering

44) An elevated hematocrit value is termed

A) anemia.
B) polycythemia.
C) hyperchromic.
D) macrocytic.
E) reticulocytosis.

Answer: B

Learning Outcome: 17.4

Bloom’s Taxonomy: Remembering

45) ________ transport(s) oxygen and CO2 in the RBCs.

A) Ribosomes
B) Mitochondria
C) DNA
D) Hemoglobin molecules
E) Components of the cytoskeleton

Answer: D

Learning Outcome: 17.5

Bloom’s Taxonomy: Remembering

46) Which of the following statements concerning red blood cells is false?

A) Red cells are biconcave discs.
B) Red cells lack mitochondria.
C) Red cells are about 18 µm in diameter.
D) Red cells are specialized for carrying oxygen.
E) Red cells can form stacks called rouleaux.

Answer: C

Learning Outcome: 17.5

Bloom’s Taxonomy: Remembering

47) The function of red blood cells is to

A) carry carbon dioxide from the lungs to the body’s cells.
B) carry oxygen from the lungs to the body’s cells.
C) carry nutrients from the digestive system to the body’s cells.
D) defend the body against infectious organisms.
E) carry oxygen from the body’s cells to the lungs.

Answer: B

Learning Outcome: 17.5

Bloom’s Taxonomy: Remembering

48) More than 95 percent of the protein in a red blood cell is

A) albumin.
B) porphyrin.
C) hemoglobin.
D) immunoglobulin.
E) fibrinogen.

Answer: C

Learning Outcome: 17.5

Bloom’s Taxonomy: Remembering

49) The function of hemoglobin is to

A) carry oxygen.
B) defend against bacterial infection.
C) aid in the process of blood clotting.
D) distribute nutrients.
E) produce antibodies.

Answer: A

Learning Outcome: 17.5

Bloom’s Taxonomy: Remembering

50) Each hemoglobin molecule contains

A) four alpha chains.
B) one alpha and one beta chain.
C) four iron ions.
D) one heme group.
E) two heme groups.

Answer: C

Learning Outcome: 17.5

Bloom’s Taxonomy: Remembering

51) Each heme ring in hemoglobin encloses an atom of

A) magnesium.
B) calcium.
C) iron.
D) sodium.
E) copper.

Answer: C

Learning Outcome: 17.5

Bloom’s Taxonomy: Remembering

52) Mary is tested for the amount of hemoglobin in her blood. The test results indicate that her hemoglobin level is 16 g/dL of blood. This value indicates that

A) she is suffering from anemia.
B) she has fewer red blood cells than normal.
C) her hematocrit is probably lower than normal.
D) she may be suffering from a form of leukemia.
E) her hemoglobin level is normal.

Answer: E

Learning Outcome: 17.5

Bloom’s Taxonomy: Understanding

53) Rouleaux refers to the ability of RBCs to

A) carry hemoglobin.
B) form stacks.
C) squeeze through small capillaries smaller than their cell diameter.
D) establish a large surface area-to-volume ratio.
E) live without a nucleus.

Answer: B

Learning Outcome: 17.5

Bloom’s Taxonomy: Understanding

54) RBCs typically live about 120 days. The main reason for this short lifespan in RBCs is their

A) cell shape.
B) concentration of Hb.
C) flexibility.
D) lack of nucleus.
E) large surface area-to-volume ratio.

Answer: D

Learning Outcome: 17.5

Bloom’s Taxonomy: Understanding

55) All the circulating red blood cells originate in the

A) heart.
B) thymus.
C) spleen.
D) red bone marrow.
E) lymph tissue.

Answer: D

Learning Outcome: 17.6

Bloom’s Taxonomy: Remembering

56) The average lifespan of a red blood cell is

A) 24 hours.
B) 1 month.
C) 4 months.
D) about 1 year.
E) many years.

Answer: C

Learning Outcome: 17.6

Bloom’s Taxonomy: Remembering

57) Aged and damaged erythrocytes are broken down by macrophages in all of the following places except the

A) spleen.
B) liver.
C) bone marrow.
D) kidney.
E) None of the answers is correct.

Answer: D

Learning Outcome: 17.6

Bloom’s Taxonomy: Remembering

58) The waste product bilirubin is produced from

A) globin chains of hemoglobin.
B) heme molecules plus iron.
C) heme molecules lacking iron.
D) iron found in hemoglobin molecules.
E) abnormal proteins found in red blood cells.

Answer: C

Learning Outcome: 17.6

Bloom’s Taxonomy: Remembering

59) Most of the iron that is removed from degraded hemoglobin is

A) excreted by the kidneys.
B) excreted by the liver.
C) excreted by the intestines.
D) recycled to red bone marrow.
E) stored in yellow bone marrow.

Answer: D

Learning Outcome: 17.6

Bloom’s Taxonomy: Remembering

60) In adults, erythropoiesis exclusively takes place in

A) the liver.
B) yellow bone marrow.
C) red bone marrow.
D) the spleen.
E) lymphoid tissue.

Answer: C

Learning Outcome: 17.6

Bloom’s Taxonomy: Remembering

61) The process of red blood cell production is called

A) erythrocytosis.
B) erythropenia.
C) hemocytosis.
D) erythropoiesis.
E) hematopenia.

Answer: D

Learning Outcome: 17.6

Bloom’s Taxonomy: Remembering

62) The developmental stage at which erythrocytes enter the circulation is as

A) hemocytoblasts.
B) reticulocytes.
C) band forms.
D) myeloid cells.
E) proerythroblasts.

Answer: B

Learning Outcome: 17.6

Bloom’s Taxonomy: Remembering

63) ________ are immature erythrocytes that are present in the circulation.

A) Erythroblasts
B) Normoblasts
C) Myeloblasts
D) Band cells
E) Reticulocytes

Answer: E

Learning Outcome: 17.6

Bloom’s Taxonomy: Remembering

64) Which of the following proteins functions to store or transport oxygen?

A) hemoglobin
B) immunoglobulin
C) albumin
D) transferrin
E) All of the answers are correct.

Answer: A

Learning Outcome: 17.6

Bloom’s Taxonomy: Remembering

65) The yellow color that is visible in the eyes and skin in jaundice results from all of the following except

A) excessive amounts of bilirubin in the plasma.
B) extensive breakdown of RBCs.
C) destruction of hemoglobin.
D) blockage of bile ducts.
E) hematuria.

Answer: E

Learning Outcome: 17.6

Bloom’s Taxonomy: Understanding

66) After donating 0.5 liter of blood, one would expect

A) an increased reticulocyte count.
B) an increased platelet count.
C) an increased erythrocyte count.
D) an increased neutrophil count.
E) increased levels of clotting factors.

Answer: A

Learning Outcome: 17.6

Bloom’s Taxonomy: Understanding

67) If bile ducts are blocked, which of the following would not occur?

A) more bilirubin appears in the plasma
B) bilirubin appears in the skin
C) less hemolysis would occur
D) increased jaundice
E) yellow color of the sclera

Answer: C

Learning Outcome: 17.6

Bloom’s Taxonomy: Understanding

68) Which of the following would you expect to see in increased numbers in a peripheral blood sample after donating a unit of blood?

A) erythrocytes
B) platelets
C) reticulocytes
D) lymphocytes
E) neutrophils

Answer: C

Learning Outcome: 17.6

Bloom’s Taxonomy: Understanding

69) In which of the following would you expect the blood level of bilirubin to be elevated?

A) a person suffering from higher levels of hemolysis
B) an alcoholic with a damaged liver
C) a person with an iron-deficient diet
D) both a person suffering from hemolysis and an alcoholic with a damaged liver
E) a person with increased clotting times.

Answer: D

Learning Outcome: 17.6

Bloom’s Taxonomy: Analyzing

70) A person’s blood type is determined largely by the

A) size of the RBCs.
B) volume of the RBCs.
C) chemical character of the hemoglobin.
D) presence of specific glycoproteins on the cell membrane.
E) shape of the RBCs.

Answer: D

Learning Outcome: 17.7

Bloom’s Taxonomy: Remembering

71) A person with Type A blood has

A) antigen A on the RBCs.
B) anti-B antibodies in the plasma.
C) anti-A antibodies on the red blood cells.
D) antigen A on the RBCs and anti-B antibodies in the plasma.
E) anti-B antibodies in the plasma and anti-A antibodies on the red blood cells.

Answer: D

Learning Outcome: 17.7

Bloom’s Taxonomy: Remembering

72) If the blood types of a donor and recipient are compatible, then

A) the donor’s antibodies bind with the recipient’s antigens.
B) the donor’s antigens bind with the recipient’s antigens.
C) the donor’s antibodies bind with the recipient’s antibodies.
D) the donor’s antigens bind with the recipient’s antibodies.
E) there is no reaction between antibodies and antigens.

Answer: E

Learning Outcome: 17.7

Bloom’s Taxonomy: Understanding

73) Overall, the most common blood type is

A) A.
B) B.
C) AB.
D) O.
E) There is no common pattern of blood type distribution.

Answer: D

Learning Outcome: 17.7

Bloom’s Taxonomy: Remembering

74) People with type AB blood are considered the “universal recipient” for transfusions because

A) their blood cells lack A and B antigens.
B) their blood lacks A or B antibodies.
C) their blood is plentiful in A and B antibodies.
D) they usually have very strong immune systems.
E) they are usually Rh negative.

Answer: B

Learning Outcome: 17.7

Bloom’s Taxonomy: Understanding

75) Bill wants to determine his blood type, so he takes a few drops of blood from a puncture wound in his finger and mixes it with various antisera. His blood cells agglutinate when mixed with the anti-A sera but not with the anti-B or anti-D sera. Which of the following is not true?

A) Bill could receive type A-negative blood in a transfusion.
B) Bill could donate blood to an individual with type AB blood.
C) Bill is Rh negative.
D) Bill’s plasma contains B antibodies.
E) Bill’s plasma contains Rh antibodies.

Answer: E

Learning Outcome: 17.7

Bloom’s Taxonomy: Applying

76) Sensitization during hemolytic disease of the newborn refers to

A) the fetal immune system producing antibodies against the mother’s RBCs.
B) the fetal immune system producing antibodies against the fetus’ RBCs.
C) the mother’s immune system producing antibodies against the fetus’ RBCs.
D) the mother’s immune system producing antibodies against the mother’s RBCs.
E) spontaneous miscarriage of a woman’s first baby due to blood incompatibilities.

Answer: C

Learning Outcome: 17.8

Bloom’s Taxonomy: Remembering

77) Hemolytic disease of the newborn may result if

A) the mother is Rh positive and the father is Rh negative.
B) both the father and the mother are Rh negative.
C) both the father and the mother are Rh positive.
D) an Rh-negative mother carries an Rh-positive fetus.
E) an Rh-positive mother carries an Rh-negative fetus.

Answer: D

Learning Outcome: 17.8

Bloom’s Taxonomy: Understanding

78) How does a treatment with anti-Rh antibodies (RhoGAM) prevent hemolytic disease of the newborn (HDN)?

A) It prevents maternal anti-Rh antibodies from crossing the placenta.
B) It destroys maternal anti-Rh antibodies.
C) It destroys fetal anti-Rh antibodies.
D) It destroys fetal RBCs that enter the maternal circulation.
E) It destroys maternal RBCs that enter the fetal circulation.

Answer: D

Learning Outcome: 17.8

Bloom’s Taxonomy: Remembering

79) Which of the following is not true of basophils?

A) constitute about 1 percent of WBCs
B) promote inflammation
C) granules contain histamine
D) contain dense blue stained granules in the Wright stain
E) increased production during parasitic infections

Answer: E

Learning Outcome: 17.9

Bloom’s Taxonomy: Remembering

80) Which of the following descriptions best matches the term eosinophils?

A) release histamine
B) become macrophages
C) defend against specific pathogens or toxins and produce antibodies in response to antigens
D) kill bacteria using cytotoxic chemicals
E) often elevated in allergic individuals

Answer: E

Learning Outcome: 17.9

Bloom’s Taxonomy: Remembering

81) Which of the following is false concerning monocytes?

A) about same size as basophils
B) enter tissues and wander
C) become macrophages
D) are long-lived
E) can phagocytize bacteria

Answer: A

Learning Outcome: 17.9

Bloom’s Taxonomy: Remembering

82) All of the following are true of neutrophils except that they are

A) granular leukocytes.
B) phagocytic.
C) round cells with lobed nuclei.
D) important in coagulation.
E) active in fighting bacterial infections.

Answer: D

Learning Outcome: 17.9

Bloom’s Taxonomy: Remembering

83) The most numerous white blood cells in peripheral circulation are the

A) neutrophils.
B) eosinophils.
C) basophils.
D) lymphocytes.
E) monocytes.

Answer: A

Learning Outcome: 17.9

Bloom’s Taxonomy: Remembering

84) White blood cells that release histamine at the site of an injury are

A) neutrophils.
B) eosinophils.
C) basophils.
D) lymphocytes.
E) monocytes.

Answer: C

Learning Outcome: 17.9

Bloom’s Taxonomy: Remembering

85) ________ are large phagocytic white cells that spend most of their time outside the blood as fixed and free phagocytic cells.

A) Neutrophils
B) Eosinophils
C) Basophils
D) Lymphocytes
E) Monocytes

Answer: E

Learning Outcome: 17.9

Bloom’s Taxonomy: Remembering

86) White blood cells that are increased in individuals with allergic reactions are the

A) neutrophils.
B) eosinophils.
C) basophils.
D) lymphocytes.
E) monocytes.

Answer: B

Learning Outcome: 17.9

Bloom’s Taxonomy: Remembering

87) Which of these descriptions best matches the term lymphocytes?

A) release histamine
B) become macrophages
C) defend against specific pathogens or toxins
D) kill bacteria using cytotoxic chemicals
E) often elevated in allergic individuals

Answer: C

Learning Outcome: 17.9

Bloom’s Taxonomy: Remembering

88) Which of the following is false concerning neutrophils?

A) less abundant than lymphocytes
B) can make cytotoxic chemicals
C) can exit capillaries
D) can destroy bacteria
E) produced in the bone marrow

Answer: A

Learning Outcome: 17.9

Bloom’s Taxonomy: Remembering

89) During a bacterial infection you would expect to see increased numbers of

A) neutrophils.
B) eosinophils.
C) basophils.
D) reticulocytes.
E) thrombocytes.

Answer: A

Learning Outcome: 17.9

Bloom’s Taxonomy: Remembering

90) Below are some of the factors involved in the extrinsic clotting pathway.

calcium
tissue factor (III)
prothrombin
factor X
fibrin
clotting factor VII

What answer corresponds to the correct order in which they occur from the time of tissue damage to the formation of a blood clot?

A) 1, 2, 3, 4, 5, 6
B) 2, 6, 4, 5, 1, 3
C) 2, 1, 6, 4, 3, 5
D) 5, 3, 6, 4, 1, 2
E) 1, 5, 3, 2, 4, 6

Answer: C

Learning Outcome: 17.10

Bloom’s Taxonomy: Understanding

91) Platelets function in all of the following except

A) dissolving a formed clot.
B) forming temporary clump in injured areas.
C) contracting after clot formation.
D) initiating the clotting process.
E) releasing chemicals that stimulate clotting.

Answer: A

Learning Outcome: 17.10

Bloom’s Taxonomy: Remembering

92) ________ involves a cascade of reactions leading to the conversion of fibrinogen to fibrin.

A) Vascular spasm
B) The platelet phase
C) Retraction
D) Coagulation
E) Fibrinolysis

Answer: D

Learning Outcome: 17.10

Bloom’s Taxonomy: Remembering

93) The conversion of fibrinogen to fibrin is catalyzed by

A) fibrinogen-converting enzyme.
B) plasmin.
C) factor VIII.
D) thrombin.
E) prothrombin activator.

Answer: D

Learning Outcome: 17.10

Bloom’s Taxonomy: Remembering

94) The extrinsic pathway of coagulation is initiated by the

A) sticking of platelets to damaged tissue.
B) activation of Factor VII exposed to collagen.
C) release of tissue factor (Factor III) by damaged endothelium.
D) release of heparin from the liver.
E) conversion of prothrombin to thrombin.

Answer: C

Learning Outcome: 17.10

Bloom’s Taxonomy: Remembering

95) The intrinsic pathway of coagulation is activated by the

A) sticking of platelets to damaged tissue.
B) activation of proenzymes exposed to collagen.
C) release of tissue factor (Factor III) by damaged endothelium.
D) release of heparin from the liver.
E) conversion of prothrombin to thrombin.

Answer: B

Learning Outcome: 17.10

Bloom’s Taxonomy: Remembering

96) The common pathway of coagulation begins with the

A) sticking of platelets to damaged tissue.
B) activation of a proenzyme exposed to collagen.
C) release of tissue factor by damaged endothelium.
D) conversion of Factor X to prothrombin activator.
E) conversion of fibrinogen to fibrin.

Answer: D

Learning Outcome: 17.10

Bloom’s Taxonomy: Remembering

97) The process of fibrinolysis

A) activates fibrinogen.
B) draws torn edges of damaged tissue closer together.
C) dissolves clots.
D) forms emboli.
E) forms thrombi.

Answer: C

Learning Outcome: 17.10

Bloom’s Taxonomy: Remembering

98) The enzyme that can digest fibrin and dissolve a clot is

A) thrombin.
B) plasmin.
C) heparin.
D) fibrinase.
E) phosphokinase.

Answer: B

Learning Outcome: 17.10

Bloom’s Taxonomy: Remembering

99) Tissue factor (Factor III) is a factor in the ________ pathway.

A) extrinsic
B) intrinsic
C) common
D) retraction
E) fibrinolytic

Answer: A

Learning Outcome: 17.10

Bloom’s Taxonomy: Remembering

100) Platelet factor (PF-3) is a factor in the ________ pathway.

A) extrinsic
B) intrinsic
C) common
D) retraction
E) fibrinolytic

Answer: B

Learning Outcome: 17.10

Bloom’s Taxonomy: Remembering

101) Which of these descriptions best matches the term platelets?

A) adhere to collagen beneath endothelium
B) helper cells are one type
C) produce antibodies in response to antigens
D) kill bacteria using hydrogen peroxide
E) often elevated in allergic individuals

Answer: A

Learning Outcome: 17.10

Bloom’s Taxonomy: Remembering

102) A substance that activates plasminogen might be useful to

A) cause clots to form faster.
B) cause clot dissolution to proceed faster.
C) initiate clot formation.
D) mimic erythropoietin.
E) recruit neutrophils to an infection.

Answer: B

Learning Outcome: 17.10

Bloom’s Taxonomy: Understanding

103) Which of the following vitamins is needed for the formation of clotting factors?

A) A
B) B
C) K
D) D
E) E

Answer: C

Learning Outcome: 17.11

Bloom’s Taxonomy: Remembering

104) How would removal of calcium ions from a blood sample affect coagulation?

A) The coagulation pathway would be lacking a required cofactor at many steps.
B) Coagulation would be prevented.
C) There would be no effect because magnesium can substitute for calcium.
D) The coagulation pathway would be lacking a required cofactor at many steps and coagulation would be prevented.
E) There would be no effect because calcium is not a necessary cofactor in coagulation.

Answer: D

Learning Outcome: 17.11

Bloom’s Taxonomy: Understanding

105) Some rat poisons contain a toxin that blocks the liver’s ability to utilize vitamin K. Animals that consume this poison would die of

A) anemia.
B) acidosis.
C) hemorrhage.
D) thrombocytopenia.
E) starvation.

Answer: C

Learning Outcome: 17.11

Bloom’s Taxonomy: Understanding

106) ________ is a condition in which the oxygen-carrying capacity of the blood is reduced.

A) Polycythemia
B) Leukemia
C) Anemia
D) Leukopenia
E) Thrombocytopenia

Answer: C

Learning Outcome: 17.11

Bloom’s Taxonomy: Remembering

107) Whole blood for testing in a clinical laboratory is usually collected from

A) the heart.
B) a superficial artery.
C) a superficial vein.
D) a capillary.
E) an arteriole.

Answer: C

Learning Outcome: 17.11

Bloom’s Taxonomy: Remembering

108) Eileen is a strict vegan and therefore eats no animal products. She develops an anemia that her doctor thinks is caused by a nutritional deficiency. Which of the following is the likeliest candidate?

A) iron deficiency
B) vitamin B12deficiency
C) lack of intrinsic factor
D) vitamin K deficiency
E) vitamin B6deficiency

Answer: B

Learning Outcome: 17.11

Bloom’s Taxonomy: Understanding

109) The disease sickle cell anemia is an example of what can happen if

A) the diet is deficient in iron.
B) there is insufficient heme in the hemoglobin.
C) a gene for adult hemoglobin is abnormal.
D) red blood cells bind too much oxygen.
E) hemolysis is prevented by a bad gene.

Answer: C

Learning Outcome: 17.11

Bloom’s Taxonomy: Understanding

110) A cancer involving neutrophils, eosinophils, or basophils is called a

A) hemophilia.
B) pernicious anemia.
C) myeloid leukemia.
D) lymphoid leukemia.
E) jaundice.

Answer: C

Learning Outcome: 17.11

Bloom’s Taxonomy: Remembering

111) Pernicious anemia caused by a lack of intrinsic factor is specifically treated by

A) oral doses of iron.
B) injections of iron.
C) injections of Vitamin K.
D) injections of vitamin B12.
E) injections of clotting factors.

Answer: D

Learning Outcome: 17.11

Bloom’s Taxonomy: Applying

112) A condition where pathogens are present and multiplying in the blood is called

A) viremia.
B) bacteremia.
C) septicemia.
D) anemia.
E) hemophilia.

Answer: C

Learning Outcome: 17.11

Bloom’s Taxonomy: Remembering

113) All of the following blood diseases are caused by pathogens except

A) malaria.
B) bacteremia.
C) viremia.
D) hemophilia.
E) septicemia.

Answer: D

Learning Outcome: 17.11

Bloom’s Taxonomy: Understanding

114) All of the following are heritable blood disorders except

A) thalassemia.
B) sickle cell anemia.
C) hemophilia.
D) sickle cell disease.
E) malaria.

Answer: E

Learning Outcome: 17.11

Bloom’s Taxonomy: Remembering

115) All of the following blood disorders are due to specific issues with RBCs except

A) malaria.
B) pernicious anemia.
C) iron deficiency anemia.
D) thalassemia.
E) myeloid leukemia.

Answer: E

Learning Outcome: 17.11

Bloom’s Taxonomy: Understanding

116) Identify the components of the cardiovascular system. (Module 17.1A)

A) heart and blood vessels
B) heart and blood
C) blood and blood vessels
D) heart, blood, and blood vessels
E) blood vessels and lymphatic vessels

Answer: D

Learning Outcome: 17.1

Bloom’s Taxonomy: Remembering

117) Define hematocrit. (Module 17.2B)

A) Hematocrit is the percentage of whole blood volume contributed by platelets.
B) Hematocrit is the percentage of whole blood volume contributed by white blood cells.
C) Hematocrit is the percentage of whole blood volume contributed by formed elements.
D) Hematocrit is the percentage of whole blood volume contributed by plasma.
E) Hematocrit is the percentage of whole blood volume contributed by water.

Answer: C

Learning Outcome: 17.2

Bloom’s Taxonomy: Remembering

118) Which specific plasma proteins would you expect to be elevated during an infection? (Module 17.2C)

A) albumins
B) immunoglobulins
C) fibrinogen
D) transport globulins
E) thrombin

Answer: B

Learning Outcome: 17.2

Bloom’s Taxonomy: Applying

119) Define hemocytoblasts. (Module 17.3A)

A) Hemocytoblasts form from hematopoietic stem cells and divide into lymphoid stem cells and myeloid stem cells.
B) Hemocytoblasts form from megakaryocytes and produce platelets.
C) Hemocytoblasts form from myeloid stem cells and divide to become erythrocytes.
D) Hemocytoblasts form from lymphoid stem cells and divide to become lymphocytes and monocytes.
E) Hemocytoblasts shed their cytoplasm in membrane-enclosed packets called platelets.

Answer: A

Learning Outcome: 17.3

Bloom’s Taxonomy: Remembering

120) Describe platelets and their origin. (Module 17.3B)

A) Platelets are derived by lymphoid stem cells that divide into lymphocytes and in the process shed some cytoplasmic fragments.
B) Platelets are the remnants of the reticulocyte organelles during the maturation of a reticulocyte into a red blood cell.
C) Platelets are precursor cells to the myeloid and lymphoid stem cells.
D) Platelets are immature red blood cells.
E) Platelets are cell fragments that develop from megakaryocytes.

Answer: E

Learning Outcome: 17.3

Bloom’s Taxonomy: Remembering

121) Compare the types of cells that lymphoid stem cells and myeloid stem cells produce. (Module 17.3C)

A) Lymphoid stem cells give rise to lymphocytes. Myeloid stem cells give rise to all the formed elements except lymphocytes.
B) Lymphoid stem cells give rise to all the formed elements except lymphocytes. Myeloid stem cells give rise to lymphocytes.
C) Lymphoid stem cells give rise to all of the white blood cells. Myeloid stem cells give rise to the red blood cells and platelets.
D) Lymphoid stem cells give rise to all of the white blood cells and platelets. Myeloid stem cells give rise to the red blood cells.
E) Lymphoid stem cells give rise to the white blood cells and the red blood cells. Myeloid stem cells give rise to the platelets.

Answer: A

Learning Outcome: 17.3

Bloom’s Taxonomy: Understanding

122) What is hematology? (Module 17.4A)

A) Hematology is the study of the heart.
B) Hematology is the study of blood vessel structure and function.
C) Hematology is the study of blood, blood-producing organs, and blood disorders.
D) Hematology is the study of the immune system.
E) Hematology is the study of cancers of the blood.

Answer: C

Learning Outcome: 17.4

Bloom’s Taxonomy: Remembering

123) Which condition would a patient have if she had a depressed hematocrit level?

(Module 17.4C)

A) polycythemia
B) erythrocytosis
C) reticulocytosis
D) anemia
E) thrombocytopenia

Answer: D

Learning Outcome: 17.4

Bloom’s Taxonomy: Applying

124) Describe the functional aspects of RBCs. (Module 17.5A)

A) RBCs have a large surface area — to — volume ratio, exhibit the ability to form stacks, and they are flexible.
B) RBCs have a large surface area — to — volume ratio, have sticky plasma membranes, and are rigid discs.
C) RBCs have pseudopodia to allow motility, are spherical in shape, and roll easily across the endothelium of blood vessels.
D) RBCs have a small surface area — to — volume ratio, are spherical in shape, and stick easily to each other.
E) RBCs have a lot of mitochondria for ATP production, undergo rapid cell division, and are flexible.

Answer: A

Learning Outcome: 17.5

Bloom’s Taxonomy: Remembering

125) Describe hemoglobin. (Module 17.5B)

A) Hemoglobin is a protein inside platelets that when activated makes them sticky.
B) Hemoglobin is a lysosomal enzyme inside white blood cells that digests pathogens after phagocytosis.
C) Hemoglobin is a protein inside RBCs that helps maintain their flexibility.
D) Hemoglobin is a protein inside RBCs that binds oxygen.
E) Hemoglobin is an enzyme inside RBCs that converts carbon dioxide to carbonic acid.

Answer: D

Learning Outcome: 17.5

Bloom’s Taxonomy: Remembering

126) Compare oxyhemoglobin with deoxyhemoglobin. (Module 17.5C)

A) Oxyhemoglobin is hemoglobin whose iron has bound carbon dioxide. Deoxyhemoglobin is hemoglobin whose iron has bound oxygen.
B) Oxyhemoglobin is hemoglobin whose iron has bound oxygen. Deoxyhemoglobin is hemoglobin whose iron has not bound oxygen.
C) Oxyhemoglobin is hemoglobin whose iron has not bound oxygen. Deoxyhemoglobin is hemoglobin whose iron has bound oxygen.
D) Oxyhemoglobin is hemoglobin whose iron has bound both oxygen and carbon dioxide. Deoxyhemoglobin is hemoglobin whose iron has bound oxygen only.
E) Oxyhemoglobin is hemoglobin whose iron has bound oxygen only. Deoxyhemoglobin is hemoglobin whose iron has bound both oxygen and carbon dioxide.

Answer: B

Learning Outcome: 17.5

Bloom’s Taxonomy: Understanding

127) What is determined by the surface antigens on RBCs? (Module 17.7A)

A) hematocrit
B) the type of hemoglobin proteins inside
C) blood type
D) the developmental stage of the RBC
E) how much oxygen is bound to hemoglobin

Answer: C

Learning Outcome: 17.7

Bloom’s Taxonomy: Remembering

128) What is the most common blood type in the United States? (Module 17.7B)

A) A+
B) B+
C) AB+
D) O-
E) O+

Answer: E

Learning Outcome: 17.7

Bloom’s Taxonomy: Remembering

129) Which blood type(s) can be safely transfused into a person with type O- blood?

(Module 17.7C)

A) They can receive any type of blood.
B) They can receive any type of Rh negative blood.
C) AB+, AB-, O+, O-
D) O+and O-
E) They can receive only O-

Answer: E

Learning Outcome: 17.7

Bloom’s Taxonomy: Understanding

130) Why can’t a person with type A blood safely receive blood from a person with type B blood? (Module 17.7D)

A) A person with type A blood will have anti-A antibodies that will agglutinate with type B blood.
B) A person with type A blood will have anti-B antibodies that will agglutinate with type B blood.
C) A person with type A blood will have anti-B platelets that will cause abnormal clotting with type B blood.
D) A person with type A blood will have anti-A platelets that will cause abnormal clotting with type B blood.
E) A person with type A blood will have anti-AB antibodies that will agglutinate with type B blood.

Answer: B

Learning Outcome: 17.7

Bloom’s Taxonomy: Applying

131) Define hemolytic disease of the newborn (HDN). (Module 17.8A)

A) Hemolytic disease of the newborn is a congenital defect in the development of the heart.
B) Hemolytic disease of the newborn is a result of delayed bone marrow development.
C) Hemolytic disease of the newborn is a result of abnormally shaped hemoglobin molecules.
D) Hemolytic disease of the newborn is due to a deficiency in the numbers of red blood cells produced, resulting in anemia.
E) Hemolytic disease of the newborn is a condition in which maternal Rh antibodies attack and destroy fetal Rh-positive red blood cells, resulting in anemia.

Answer: E

Learning Outcome: 17.8

Bloom’s Taxonomy: Remembering

132) Why is RhoGAM administered to pregnant Rh‒ women ? (Module 17.8B)

A) RhoGAM will change the mother’s blood type to Rh+.
B) RhoGAM will change the fetus’s blood type to Rh‒.
C) RhoGAM contains Rh antigens so the mothers’ antibodies can attack the RhoGAM antigens, instead of the fetus’s blood cells.
D) RhoGAM contains anti-Rh antibodies, which circulate in the mothers’ bloodstream to destroy any fetal RBCs there, thereby preventing the mother from making antibodies against the developing fetus’s red blood cells.
E) RhoGAM contains proteins that surround the fetal RBCs and protect them from attack by maternal antibodies.

Answer: D

Learning Outcome: 17.8

Bloom’s Taxonomy: Understanding

133) Does an Rh+ mother carrying an Rh‒ fetus require a RhoGAM injection? Explain your answer. (Module 17.8C)

A) No, she will not require a RhoGAM injection because the fetus is not at risk for Rh incompatibility. The fetus is not at risk because its RBCs lack Rh surface antigens and the mother’s plasma lacks anti-Rh antibodies.
B) No, she will not require a RhoGAM injection because the fetus is not at risk for Rh incompatibility. The fetus is not at risk because its RBCs contain Rh surface antigens and the mother’s plasma has anti-Rh antibodies.
C) Yes, she will require a RhoGAM injection because the fetus is at risk for Rh incompatibility. The fetus is at risk because its RBCs contain Rh surface antigens and the mother’s plasma has anti-Rh antibodies.
D) Yes, she will require a RhoGAM injection because the fetus is at risk for Rh incompatibility. The fetus is at risk because its RBCs lack Rh surface antigens and the mother’s plasma has anti-Rh antibodies.
E) Yes, she will require a RhoGAM injection because the fetus is at risk for Rh incompatibility. The fetus is at risk because its RBCs lack Rh surface antigens and the mother’s plasma lacks anti-Rh antibodies.

Answer: A

Learning Outcome: 17.8

Bloom’s Taxonomy: Applying

134) Identify the five types of white blood cells. (Module 17.9A)

A) mast cells, dendritic cells, erythrocytes, platelets, and basophils
B) astrocytes, microglial cells, Kuppfer cells, lymphocytes, and ependymal cells
C) neutrophils, eosinophils, basophils, monocytes, and lymphocytes
D) monocytes, macrophages, dendritic cells, T lymphocytes, and B lymphocytes
E) plasma cells, memory B cells, memory T cells, cytotoxic T cells, helper T cells

Answer: C

Learning Outcome: 17.9

Bloom’s Taxonomy: Remembering

135) How do basophils respond to tissue damage? (Module 17.9B)

A) Basophils enter damaged tissue first and in high numbers to engulf the pathogens and debris and release cytotoxic enzymes and chemicals that attract other WBCs to the region.
B) Basophils enter damaged tissue and release a variety of chemicals, including histamine, which promotes inflammation.
C) Basophils enter damaged tissue and engulf antibody-labeled materials, release cytotoxic enzymes, and reduce inflammation.
D) Basophils enter damaged tissue and become macrophages which engulf pathogens or debris.
E) Basophils provide defense against specific pathogens or toxins by becoming B plasma cells, which produce antibodies.

Answer: B

Learning Outcome: 17.9

Bloom’s Taxonomy: Remembering

136) Which type of white blood cell would you find in the greatest numbers in an infected cut? (Module 17.9C)

A) neutrophil
B) eosinophil
C) basophil
D) monocyte
E) lymphocyte

Answer: A

Learning Outcome: 17.9

Bloom’s Taxonomy: Understanding

137) Define hemostasis. (Module 17.10A)

A) Hemostasis is an antigen-antibody binding response that alerts the immune system to a non-self antigen.
B) Hemostasis is the maintenance of relatively normal internal conditions in the face of a changing external environment.
C) Hemostasis is the process of stopping bleeding.
D) Hemostasis is the production of new blood components in the red bone marrow.
E) Hemostasis is the regulation of the hormones that control blood composition.

Answer: C

Learning Outcome: 17.10

Bloom’s Taxonomy: Remembering

138) Compare pernicious anemia with iron deficiency anemia. (Module 17.11A)

A) Pernicious anemia is insufficient red blood cell production caused by a deficiency in vitamin B12, whereas iron deficiency anemia is insufficient red blood cell production caused by a deficiency in vitamin K.
B) Pernicious anemia is insufficient red blood cell production caused by a deficiency in vitamin K, whereas iron deficiency anemia is insufficient red blood cell production caused by a deficiency in vitamin B12.
C) Pernicious anemia is insufficient red blood cell production caused by a deficiency in vitamin B12, whereas iron deficiency anemia is an inherited disorder of malformed hemoglobin due to an amino acid chain mutation.
D) Pernicious anemia is insufficient red blood cell production caused by a deficiency in vitamin B12, whereas iron deficiency anemia is impaired hemoglobin synthesis caused by a deficiency in dietary intake or absorption of iron.
E) Pernicious anemia is an inherited bleeding disorder caused by the reduced production of a single clotting factor, whereas iron deficiency anemia is impaired hemoglobin synthesis caused by a deficiency in dietary intake or absorption of iron.

Answer: D

Learning Outcome: 17.11

Bloom’s Taxonomy: Understanding

139) Identify the two types of leukemia. (Module 17.11B)

A) microcytic leukemia and macrocytic leukemia
B) bacterial leukemia and viral leukemia
C) spontaneous leukemia and inherited leukemia
D) hyperchromic leukemia and hypochromic leukemia
E) myeloid leukemia and lymphoid leukemia

Answer: E

Learning Outcome: 17.11

Bloom’s Taxonomy: Remembering

Essay Questions

140) Why do people with advanced kidney disease commonly become anemic?

Answer: For three reasons: (1) Damaged kidneys produce less erythropoietin and so there is less stimulation of the marrow to produce RBCs. (2) Erythropoietin is more easily lost into the urine by leaky kidneys. (3) During dialysis treatment, the patient’s erythropoietin is washed away. Treatment for kidney patients today includes injections of synthetic erythropoietin.

Learning Outcome: 17.3

Bloom’s Taxonomy: Analyzing

141) Which of the formed elements would increase after the donation of a pint of blood?

Answer: Reticulocytes would increase in number as additional numbers of immature RBCs move into the bloodstream to compensate for the reduction in blood volume.

Learning Outcome: 17.6

Bloom’s Taxonomy: Analyzing

142) How does RhoGAM prevent erythroblastosis fetalis (HDN, hemolytic disease of the newborn)?

Answer: If a mother who is Rh negative carries a fetus that is Rh positive, she will make antibodies against its Rh RBCs after being exposed to the infant’s blood during labor and delivery. By giving a dose of anti-Rh antibody (RhoGAM) just before or after delivery, the fetal red cells will be agglutinated and removed from the mother’s circulation before her immune system will have time to make anti-Rh antibodies that would endanger her next Rh-positive offspring.

Learning Outcome: 17.8

Bloom’s Taxonomy: Applying

143) What are the functions of blood? (Module 17.1B)

Answer: Blood functions to transport dissolved gases, nutrients, hormones, and metabolic wastes; regulate pH and ion composition of interstitial fluids; restrict fluid loss at injury sites; defend against toxins and pathogens; and stabilize body temperature.

Learning Outcome: 17.1

Bloom’s Taxonomy: Remembering

144) Identify the two components making up whole blood, and list the composition of each. (Module 17.2A)

Answer: Whole blood is composed of plasma (which contains albumins, globulins, fibrinogen, electrolytes, organic nutrients, and organic wastes) and formed elements (which are platelets, white blood cells, and red blood cells).

Learning Outcome: 17.2

Bloom’s Taxonomy: Remembering

145) Describe a complete blood count (CBC). (Module 17.4B)

Answer: A complete blood count (CBC) is a diagnostic blood test used to determine underlying medical conditions. A CBC includes the RBC count, WBC count, erythrocyte indices (such as hemoglobin concentration), hematocrit, platelet count, and WBC differential count.

Learning Outcome: 17.4

Bloom’s Taxonomy: Remembering

146) In what way would a liver disease affect the level of bilirubin in the blood? (Module 17.6A)

Answer: Bilirubin would accumulate in the blood, producing jaundice, because diseases that damage the liver impair the liver’s ability to excrete bilirubin in the bile.

Learning Outcome: 17.6

Bloom’s Taxonomy: Applying

147) Briefly describe the vascular, platelet, and coagulation phases of hemostasis.

(Module 17.10B)

Answer: During the vascular phase, local blood vessel constriction (vascular spasm) occurs at the injury site. In the platelet phase, platelets are activated, aggregate at the site, and adhere to damaged blood vessel surfaces. In the coagulation phase, factors released by platelets and endothelial cells interact with clotting factors (through either the extrinsic pathway, the intrinsic pathway, or the common pathway) to form a blood clot, a process involving the conversion of soluble fibrinogen to insoluble fibers of fibrin.

Learning Outcome: 17.10

Bloom’s Taxonomy: Remembering

148) Describe the events that follow the coagulation phase. (Module 17.10C)

Answer: Clot retraction and fibrinolysis follow the coagulation phase. The clot consists of fibrin, red blood cells, and platelets. The platelets contract, and the entire clot retracts, pulling the cut vessel edges together. As repairs continue, the clot dissolves through the process of fibrinolysis. Fibrinolysis is activated by plasminogen, which, in turn, activates plasmin, which erodes the foundation of the clot.

Learning Outcome: 17.10

Bloom’s Taxonomy: Understanding

149) Explain why venipuncture is a common clinical procedure for obtaining blood for examination. (Module 17.11C)

Answer: In venipuncture, blood is collected from a superficial vein. Venipuncture is a common clinical procedure because superficial veins are easy to locate, the walls of veins are thinner than comparable sized arteries, and blood pressure in the venous system is relatively low, so the puncture wound seals quickly.

Learning Outcome: 17.11

Bloom’s Taxonomy: Applying

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