Nursing Practice: Knowledge and Care Workbook for 6HSK1078

This individual workbook is part of the summative assessment for 6HSK1078. It consists of 30 multiple choice questions and 4 short answer questions on gastrointestinal, respiratory, and cardiac systems. Learn about the role of kidneys and associated hormones in fluid balance maintenance in healthy adults. Submit by 20th June 2022.

Nursing Practice: Knowledge and Care
6HSK1078
Individual Workbook (Resubmission)

Welcome
This is your individual workbook which is to be completed as part of the summative
assessment for 6HSK1078. The workbook is intended to be completed as an individual piece
of work and University rules on plagiarism and collusion must be adhered to.
Please do not put your name on the workbook or in the filename – this is an anonymous
submission (the marker will not know who submitted until after the marks are released.
The workbook must be completed using the template given and submitted (in Microsoft
Word format) to the module canvas site by 10:00 on the 20th June 2022. Make sure you
leave plenty of time for computer delays when you submit. It is your responsibility to make
sure you submit the correct file to the correct portal.
The workbook consists of 30 multiple choice questions (MCQs) and a section of four (4)
Short Answer Questions (SAQs). Ensure you read each question thoroughly, for the short
answer questions make sure you are aware of the word limit. Word limits carry an academic
bias of +/- 10%, for instance for a 500 word answer you are expected to write between 450
and 550 words. Any answers with a word count over the 10% limit: the marker will not mark
past the limit and any words over the limit will be ignored. As this is a workbook of anatomy
and physiology knowledge references are not required.

PART 1: MULTIPLE CHOICE QUESTIONS
Each question has only one correct answer. Each question is worth one mark.
Please indicate your choice of answer clearly by using the highlighter tool:
Select the text you wish to highlight:
and then click on the highlighter tool to highlight the required answer:
If your chosen answer is not clear the question will not be marked.

QUESTIONS:
Section one: gastrointestinal system
1. How does food move through the digestive system?
a. Gravity
b. Cilia
c. Wavelike muscle contractions
d. Suction of the lower gastro-intestinal system
2. Where does most of the process of digestion take place?
a. Small intestine
b. Large intestine
c. Stomach
d. All of the above
3. What is the role of the liver in digestion?
a. Makes important enzymes
b. Neutralises stomach acid
c. Produces bile
d. Regulated insulin
4. Which layer of the intestines is responsible for peristalsis?
a. Mucosa
b. Submucosa
c. Muscularis
d. Peritoneum

5. Which of the following enzymes breaks down proteins in the digestive system?
a. Bile
b. Amylase
c. Lipase
d. Chymotrypsin
6. Sympathetic nervous system outflow (stimulation):
a. Stimulates gastric secretions
b. Increases gastric activity
c. Reduces gastric activity
d. Opens the pyloric sphincter
7. Duodenal cells secrete two hormones they are:
a. Secretin and cholecystokinin
b. Bile and secretin
c. Bile and pancreatic amylase
d. Secretin and bile
8. The pH of the jejunum is usually:
a. 7-9
b. 8-9
c. 6-9
d. 5-6
9. Hepatic veins drain blood from the liver to the:
a. Inferior vena cava
b. Superior vena cava

c. Portal circulation
d. Mesenteric artery
10. What type of cells produce pancreatic juice?
a. Endocrine
b. Exocrine
c. Neuronal
d. Paracrine

Section2: Respiratory system
1. How many lobes does the right lung consist of?
a. 2
b. 3
c. 1
d. 4
2. The bronchi are lined with:
a. Ciliated epithelium
b. Striated epithelium
c. Smooth epithelium
d. Rough epithelium
3. The purpose of the turbinate (in the nose) is to:
a. Warm air
b. Humidify air
c. Filter dust and pollen
d. All of the above
4. The parietal pleura lines:
a. The lung wallsbn
b. The thoracic wall
c. The walls of the alveoli
d. The tracheal wall
5. During inspiration the thorax:
a. Expands and the intrapulmonary pressure falls below atmospheric pressure

b. Expands and the intrapulmonary pressure rises above atmospheric pressure
c. Contracts and the intrapulmonary pressure fall below atmospheric pressure
d. Contracts and the intrapulmonary pressure rise above atmospheric pressure
6. The major muscles of inspiration are:
a. The intercostal muscles and the sternocleidomastoid muscles
b. The intercostal muscles and the scalene muscles
c. The diaphragm and the intercostal muscles
d. The sternocleidomastoid muscles and the diaphragm
7. The respiratory centres in the medulla oblongata and the pons monitor:
a. Levels of O2 in the blood
b. Levels of O2 in the lungs
c. Levels of CO2 in the blood
d. Levels of CO2 in the lungs
8. Internal respiration is:
a. The exchange of O2 and CO2 across the alveoli wall
b. The exchange of O2 and CO2 between tissues and blood
c. The exchange of O2 and CO2 between cell and tissues
d. The exchange of O2 and CO2 between tissues and alveoli
9. How many haem units are there in a haemoglobin molecule?
a. 2
b. 3
c. 4
d. 6
10. The transport of gases across the alveolar wall is by:

a. Facilitated diffusion
b. Osmosis
c. Active transport
d. Simple diffusion

Section three: Cardiac system
1. The valve located between the right ventricle and the pulmonary arteries is the:
a. Aortic valve
b. Mitral valve
c. Pulmonary valve
d. Tricuspid valve
2. The layer of the pericardium next to the heart muscle is:
a. Parietal pericardium
b. Mitral valve
c. Pulmonary valve
d. Tricuspid valve
3. The conduction system of the electrical impulses from the AV node to the bundle
branches is via:
a. The bundle of His
b. The SA node
c. The purkinje system
d. Bacchman’s bundle
4. The normal range for a resting heart rate is:
a. 40-100bpm
b. 50-100bpm
c. 60-100bpm
d. 70-100bpm
5. Which artery predominantly supplies blood to the anterior of the left ventricle.
a. RCA
b. Circumflex
c. Diagonal
d. LAD
6. Which part of the ECG trace of a single cardiac cycle corresponds to atrial
depolarisation?
a. P wave
b. QRS complex
c. T wave

d. U wave
7. In the cardiac cycle the isovolumetric contraction phase refers to:
a. Atrial contraction with no change in blood volume
b. Ventricular contraction with no change in blood volume
c. Ventricular relaxation with no change in blood volume
d. Atrial relaxation with no change in blood volume
8. The majority of the cells in the heart are:
a. Cardiomyocytes
b. Cardiac pacemaker cells
c. Epithelial cells
d. Endocardial cells
9. The natural pacemaker of the heart is another name for:
a. AV Node
b. Bundle of His
c. SA Node
d. Purkinje system
10. Deoxygenated blood is pumped into the pulmonary arteries by:
a. Right atrium
b. Right ventricle
c. Left atrium
d. Left ventricle

PART 2: SHORT ANSWER QUESTIONS
Make sure you read the question and ensure you keep within the word count guidance.
Section 2a: Endocrine System
Question 1: Name 4 hormones that are produced by the pituitary gland or are stored or
released by the gland and describe their function. Word count 200 words. (10 marks)
The Adrenocorticotropic, thyroid-stimulating, follicle-stimulating/luteinizing and Oxytocin
hormones are four hormones that are secreted in pituitary-gland, which facilitates the
activities of other endocrine-glands, including body physiological regulations.
The adrenocorticotropic-hormone: stimulates the adrenal gland to release stress
hormones; adrenaline/ cortisol. The cortisol is released in the blood under-stress to
regulate the whole-body reactions under stressful conditions. Reduction of
inflammations, regulation of blood pressure and glucose metabolism are the primary
functions of cortisol, including the flight or fight responses. Cushing’s syndromes occur as
a result of the over-production of ACTH, while under production causes lack of adrenal.
Thyroid-Stimulating hormone is a glycol-protein that quickens the production and release
of the thyroid hormone. Metabolism regulations, growth, energy homeostasis, and
nervous system regulations are the main functions of the hormone. Over-production
causes hyperthyroidism and lack of it causes hypothyroidism. The Follicle-stimulating and
Luteinizing hormones – Both are called gonadotrophins: the stimulation of the ovary to
release oestrogen, progesterone and testes to discharge testosterone are their primary
functions. They help in growth regulations and maturations of the egg sperm cells.
Irregular production causes sexual malfunction, menstruation problems and infertility.
Finally, the Oxytocin: it stimulates the uterine contraction, during delivery and secretes
milk during breastfeeding of a baby.

Question 2b: Compare and contrast up regulation and down regulation as it pertains to the
endocrine system. Word count 200 words. (10 marks)
Receptors are produced and released from cellular DNA interactions and when the signal
is weak, its upregulated and when strong its downregulated. The system modulation
which reduces receptors as soon as they are no longer in use in a cell can make them to
be either up or down-regulated. The long exposure of receptors to large number of
ligands can lead to downregulation. Supersensitization of cellular structures when
exposed to adverse medications can lead to downregulation of receptors. Downregulation
of individual receptor can be caused by receptor booster while the temporary
upregulation of the individual receptors may be caused by receptor rivals. The reactions
caused by toxins can lead to Upregulation and downregulation.
In up-regulation, the receptor’s number increases in response with the increase in
hormone levels, it makes the cells to be very much sensitive to hormone and allowing
more cells activities. When the number of receptors decreases in response to rising
hormone levels, it is termed, down-regulation and whereas the cell activities are reduced.
When more receptors are present on the cells surface, it boosts its sensitivity of hormone.
E.g., of upregulation, there is a boost on the oxytocin during pregnancy, which enhances
the opening of the womb.

Section 2c. Renal system
1. Discuss the role of the kidneys and associated hormones in the maintenance of fluid
balance in the healthy adult. Word count 500 words (25 marks).
Kidneys are small bean shaped organ, that measures approximately 6cm wide and 12cm
long. It is made up of two main layers; an inner layer called medulla and an outer layer
called the cortex. Some people’s kidneys are located at the back of the abdomen, on
either side of the spine. The kidney plays some specific roles which includes but not
limited to the production of urine by removing toxic waste materials and too much fluids
from the body, maintaining constant volume and plasma osmolarity circulation within the
accepted limits, and maintenance of the body electrolyte homeostasis, ensuring that the
make-up and volume of the fluids in the body is correctly maintained, assists to ensure
total control of the chemical balancing of the blood and controls the sodium, potassium
and calcium levels in the body, removes waste products and too much liquid from the
human body, thereby regulating the blood pressure, activation of the vitamin D, which
helps to maintain strong bone structures and finally production of erythropoietin which is
a hormone that its primary function is to produce the red blood cells in the human body.
Kidney contains 1.0-1.5 million of minute tubules named Nephrons. It filters blood via the
network of smaller blood capillary vessels named glomerulus. This gives rise to a fluid that
moves via the nephrons, as soon as the fluid moves via the nephron, the useful nutrients
such as potassium, sodium, protein and water in which the body wants to keep are re-
absorbed into the blood stream immediately. The waste materials that are needed to be
removed from the human body such as urea and creatinine etc are passed out through
the urine. Up-to 200litres of blood are filtered via the kidney on daily basis and 1 to 2
litres of urine is produced daily.
Kidney secretes different types of hormones which are the dihydroxy vitamin D3, the
erythropoietin and prostaglandins. The Vitamin D is responsible for different kinds of
functions in the human body. The vitamins that are mostly found in the blood are inactive
and are modified by the kidney and other tissues to their activation. The stimulation of
the calcium uptake from the food is done by an active Vitamin D and maintains healthy
bones and also assists in the regulation of the responses of the immune system of the
body to various infections. Erythropoietin is produced when there is a decrease in the
level of the Oxygen in the blood stream. Its primary work is found inside the bone
marrow, to stimulate the formation of mature red blood cells, in order to maintain a
sufficient level of oxygen in the body tissues. The Prostaglandins are chemical substances
produced by the grouping of the lipids molecules. These chemical substances are
responsible for stimulating the production of renin. Renin (Enzyme) is produced by the
kidney and does its own role in renin. Finally, the Angiotensin aldosterone hormone,
assists to regulate the blood pressure. The kidney response to hormones like aldosterone,
prostaglandins, cortisol, parathyroid and calcitonin hormones.

Section 2d. Respiratory system
1. Discuss the structure of the respiratory system and the processes involved in the
defence against infection. Word count 500 words (25 marks).
Respiration can be referred to as the process of taking-in Oxygen and breathing-
out Carbon dioxide. The respiratory system can be referred to as the group of
tissues and organs that facilitates breathing in the human body. They are the
airways, blood vessels and lungs. The inter-coastal muscles and diaphragm are the
major muscles which assist in the process of respiration. The Lung is like a pair of
cone-shaped organ spongy in nature and pink in colour. They help to move Oxygen
inside the body and eliminate all the unwanted gasses such as C02. Upper
respiratory tract comprises of the: Nose, Nasa cavity, trachea sinuses and larynx.
The Lungs, Bronchi and bronchioles and air sacs(alveoli) makes up the lower part
of the respiratory tract. Oxygen is taken in by the lungs. Human system needs
oxygen for survival and perform daily activities. The waste products like Carbon
dioxide are completely eliminated by the lungs during the process. The space in
the chest-thorax is made up of the lungs and it is surrounded by a membrane-
pleura. The mediastinum separates the Lungs into areas that comprises of
Trachea, Oesophagus, heart, thymus gland. The lungs are divided into two lobes
right and left and further the right lobe is divided into 3 sections and the other
side has two divisions. The inhaled air enters the body via nose or mouth, it passes
through the throat via the larynx/ trachea and moves to the lungs via the tubes
termed bronchi-main-stem. Bronchi lead to the right lung and one to the left lung.
It’s sub- divided into smaller bronchi in the lung. The smaller ones are further
divided in a much smaller tubes referred to as the bronchioles. The bronchioles
are terminated in the small air bag referred to as the alveoli. Exchange of oxygen
and carbon dioxide occurs in the alveoli. Carbon dioxide will be exhaled as the bi-
product of respiration.
The respiratory organs are mostly exposed to infections and in order to keep fit
the respiratory system must always impose defence mechanism against infections.
The respiratory system has defence mechanism to prevent damages. The small
particles, viruses, bacteria, dust and dirt are trapped in the nasal cavity by hairs
and mucus, thereby preventing them from reaching the lungs. If the foreign
particles still reach the bronchi and bronchioles the neutrophils and macrophages
they contain critically protect them against the infection. The pathogens: ‘disease-
causing-organism’ are trapped by the mucus layer, thereby preventing them from
gaining access into the lungs. Mucus also avoids the micro-organism from entering
the epithelium, the trapped micro-organisms are exhaled out from the body
through the process of Ciliary-escalator.
The mucus that covers the airways is propelled by the cilia. Main process/way
respiratory system defends itself is called the mucociliary escalator. The
respiratory track is protected with epithelium which are covered with goblet-
mucus from the nose throughout the bronchi. Disease causing organism called
pathogens from the incoming air are trapped by the mucus. Protection
mechanisms involves mechanical filtration, electrostatic filtration, air-conditioning,
humidification, reflex apnoea, laryngeal-construction and broncho-construction,
charged particles dispersed in the air.