Path unit 5

A 77-year-old female hospital patient has contracted Clostridium difficile during her stay and is experiencing severe diarrhea. Which of the following statements best conveys a risk that this woman faces? Question options: She is susceptible to isotonic fluid volume deficit and hypernatremia as a result of water losses. She is prone to isotonic fluid volume excess due to impaired osmolality from sodium losses. She is at risk of compensatory fluid volume overload secondary to gastrointestinal water and electrolyte losses. She could develop third-spacing edema as a result of plasma protein losses.

a

A 77-year-old female with a diagnosis of chronic obstructive pulmonary disease is experiencing impaired gas exchange and CO2 retention, despite a rapid respiratory rate. Which of the following phenomena would her care team most realistically anticipate? Question options: Her kidneys will adapt with an increase in plasma HCO3- and her pH will decrease. Her body may be producing excess metabolic CO2. Her kidneys are likely to reabsorb H+ and secrete HCO3-. Arterial blood gas sampling is likely to indicate a pH in the range of 7.45 to 7.55.

a

Which diuretic acts by inhibiting sodium chloride reabsorption in the thick ascending limb of the loop of Henle? Question options: Bumetanide (Bumex) Mannitol (Osmitrol) Hydrochlorothiazide (Hydrodiuril) Acetazolamide (Diamox)

a

Which of the following individuals is at the highest risk for developing a urinary tract infection (UTI)? Question options: A 30-year-old obese woman with poorly controlled diabetes mellitus A 38-year-old man with high urine output due to antidiuretic hormone insufficiency A 66-year-old man undergoing dialysis for the treatment of chronic renal failure secondary to hypertension A 60-year-old man with a history of cardiovascular disease who is recovering in the hospital from a coronary artery bypass graft

a

Which of the following substances is most likely to be reabsorbed in the tubular segments of the nephron using passive transport mechanisms? Question options: Water Sodium Phosphate Calcium

a

A 14-year-old boy who appears to be intoxicated is brought to the emergency department by ambulance. The EMTs report that the boy has denied consuming anything out of the ordinary, but an open antifreeze container was found in the boy's room. Which of the following is likely to be used to treat the patient's symptoms? Question options: Sodium bicarbonate Fomepizole Syrup of ipecac Gastric lavage

b

A 25-year-old Asian American man arrives at the emergency department in a panic. Except for a bout with bronchitis a week earlier, he has been healthy his entire life; today he has blood in his urine. What is the most likely cause of his hematuria and how should it be treated? Question options: His Kimmelstiel-Wilson syndrome should be treated with control of high blood pressure and smoking cessation. His immunoglobulin A (IgA) nephropathy has no known effective treatments. His membranous glomerulonephritis should be treated with corticosteroids. His Goodpasture syndrome should be treated with plasmapheresis and immunosuppressive therapy.

b

A 61-year-old woman who has had an upper respiratory infection for several weeks has presented to her nurse practitioner with complaints of a recent onset of urinary retention. She reveals to her nurse practitioner that she has been taking over-the-counter cold medications at higher than the suggested dose for the past two weeks. Which of the following phenomena will her nurse practitioner most likely suspect is contributing to her urinary retention? Question options: Over-the-counter medications such as cold medicine stimulate the parasympathetic nervous system and inhibit bladder emptying. The anticholinergic effects of the medication are impairing normal bladder function. Antihistamine effects inhibit communication between the pons and the thoracolumbar cord. Cholinergic actions of the cold medicine are triggering internal and external sphincter contraction.

b

A nurse educator is orientating new nurses to a renal unit of a hospital. Which of the following teaching points should the nurse include as part of a review of normal glomerular function? Question options: "Nephrons are delicate structures that cannot endure the high pressure that exists in capillary beds elsewhere in the body." "Glomerular filtrate is very similar in composition to blood plasma found elsewhere in circulation." "Dilation of the afferent arteriole allows more blood into the nephron and increases the glomerular filtration rate." "The glomerulus is located between an arteriole and a venule that work together to regulate blood flow."

b

A nurse practitioner has ordered the measurement of a cardiac patient's electrolyte levels as part of the patient's morning blood work. Which of the following statements best captures the importance of potassium in the normal electrical function of the patient's heart? Question options: Potassium catalyzes the metabolism of ATP, producing the gradient that results in electrical stimulation. Potassium is central to establishing and maintaining the resting membrane potential of cardiac muscle cells. The impermeability of cardiac cell membranes to potassium allows for action potentials achieved by the flow of sodium ions. The reciprocal movement of one potassium ion for one sodium ion across the cell membrane results in the production of an action potential.

b

A patient with poorly controlled diabetes mellitus presents to the emergency department with suspected ketoacidosis. Which of the following diagnostic results would be most likely to confirm this diagnosis? Question options: Decreased CO2, decreased anion gap Increased CO2, increased anion gap, base deficit High ammonia levels, decreased anion gap, high potassium Low O2 levels, increased anion gap, base excess

b

Following several days in an acidotic state, a hospital patient has returned to the desired pH. Which of the following processes could have contributed to the resolution of the patient's health problem? Question options: Excretion of HCO3- by the kidneys Phosphate and ammonia buffer systems in the renal tubules Selective renal secretion and reabsorption of CO2 Exchange of Na+ and H+ ions

b

Which of the following individuals are displaying identified risk factors for the development of lower urinary tract obstruction? Question options: A 32-year-old woman who had a healthy delivery of her third child 4 months ago A 68-year-old man who has been diagnosed with benign prostatic hyperplasia (BPH) A 55-year-old man with diabetes who is receiving diuretic medications for the treatment of hypertension A 30-year-old woman who has been diagnosed with gonorrhea A 74-year-old woman who has developed a lower bowel obstruction following several weeks of chronic constipation A 20-year-old man who has spina bifida and consequent impaired mobility

b

Which of the following phenomena is most likely occurring during a child's alveolar stage of lung development? Question options: Terminal alveolar sacs are developing and surfactant production is beginning. A single-capillary network exists and the lungs are capable of respiration. The conducting airways are formed, but respiration is not yet possible. Primitive alveoli are formed and the bronchi and bronchioles become much larger.

b

A 22-year-old female with a history of intermittent flank pain, repeated UTIs, and hematuria has been diagnosed with autosomal dominant polycystic kidney disease (ADPKD). Which of the following phenomena has most likely contributed to the development of her health problem? Question options: She has inherited undersized kidneys that are prone to calculi formation. Severe hypertension and portal hypertension are likely precursors. She has inherited a tendency for epithelial cell in her tubules to proliferate inappropriately. UTIs coupled with an impaired immune response have caused her ADPKD.

c

A 23-year-old man has received a recent diagnosis of appendicitis following 24 hours of acute abdominal pain. The nurse practitioner providing care for the man is explaining that while it is unpleasant, the inflammation of his appendix is playing a role in his body's fight against the underlying infectious process. Which of the following teaching points should the nurse practitioner eliminate from his teaching for the patient? Question options: "Inflammation can help to remove the body tissue cells that have been damaged by infection." "Inflammation will start your body on the path to growing new, healthy tissue at the site of infection. "Inflammation helps your body to produce the right antibodies to fight the infection." "Inflammation ultimately aids in eliminating the initial cause of the cell injury in your appendix."

c

A 25-year-old Asian American man arrives at the emergency department in a panic. Except for a bout with bronchitis a week earlier, he has been healthy his entire life; today he has blood in his urine. What is the most likely cause of his hematuria and how should it be treated? Question options: His Goodpasture syndrome should be treated with plasmapheresis and immunosuppressive therapy. His membranous glomerulonephritis should be treated with corticosteroids. His immunoglobulin A (IgA) nephropathy has no known effective treatments. His Kimmelstiel-Wilson syndrome should be treated with control of high blood pressure and smoking cessation.

c

A 31-year-old patient with a diagnosis of end-stage liver failure has been admitted to the intensive care unit of a hospital. Arterial blood gas sampling indicates that the man has an acid-base imbalance. Which of the following situations is most likely to result in an inappropriate pH? Question options: Renal excretion of HCO3- in the presence of excess base Transcompartmental exchange of H+ and potassium ions Low albumin and plasma globulin levels Conservation or formation of new HCO3- by the kidneys

c

A 34-year-old male patient has diagnoses of liver failure, ascites, and hepatic encephalopathy secondary to alcohol abuse. The patient's family is questioning the care team about why his abdomen is so large even though he is undernourished and emaciated. Which of the following statements most accurately underlies the explanation that a member of the care team would provide to the family? Question options: An inordinate amount of interstitial fluid is accumulating in the patient's abdomen. The transcellular component of the intracellular fluid compartment contains far more fluid than normal. The normally small transcellular fluid compartment, or third space, is becoming enlarged. Gravity-dependent plasma is accumulating in the patient's peritoneal cavity.

c

A 60-year-old man has been diagnosed with renal calculi after repeated episodes of excruciating flank pain in recent weeks. The man states, "I don't know how this could happen to me, since I'm so careful about eating a healthy diet." What is the most appropriate response to the man's statement? Question options: "Your diet might be normally healthy, but high intake of normally beneficial minerals like calcium and magnesium can lead to stones." "You likely don't need to change your diet, but now that you have stones in one kidney, you're at very high risk of growing them in the other kidney." "What you eat can influence your risk of stone formation, but many other factors like hormones and your metabolism are involved." "Your diet may have played a part in this, but in fact genetics is likely primarily to blame."

c

A 72-year-old woman with a recent onset of syncopal episodes has been referred to a cardiology group by her family physician. As part of the patient's diagnostic workup, the nurse practitioner conducting the intake assessment has ordered a Holter monitor for 24 hours. Which of the following statements best captures an aspect of Holter monitoring? Question options: A Holter monitor is preferable to standard ECG due to its increased sensitivity to cardiac electrical activity. The primary goal is to allow the cardiologist to accurately diagnose cardiomyopathies. Accurate interpretation of the results requires correlating the findings with the activity that the woman was doing at the time of recording. Holter monitors are normally set to record electrical activity of the heart at least once per hour.

c

A patient is brought to the emergency department with complaints of shortness of breath. Assessment reveals a full, bounding pulse, severe edema, and audible crackles in the lower lung fields bilaterally. What is the patient's most likely diagnosis? Question options: Hyperkalemia Hypocalcemia Fluid volume excess Hyponatremia

c

An 81-year-old female has long-standing hypocalcemia secondary to kidney disease and will shortly be moving into an assisted living facility from her own apartment. Which of the following findings should staff at the facility be instructed to observe for? Question options: Lethargy and stupor High fluid intake and urine output Muscular spasms and complaints of cramps Loss of appetite and complaints of nausea

c

An 82-year-old resident of a long-term care facility with a recent history of repeated urinary tract infections and restlessness is suspected of having urinary retention. Which of the following actions by the care team is most appropriate? Question options: Urinalysis focusing on the presence or absence of microorganisms, blood, or white cells in the man's urine Renal ultrasound aimed at identifying acute or chronic kidney disease Ultrasound bladder scanning to determine the residual volume of urine after voiding Uroflowmetry to determine to rate of the patient's urine flow

c

An infant who is four days postpartum has been diagnosed with a single-gene disorder. The parents of the child have a number of questions about the etiology of the health problem, which the physician is attempting to address in detail. Which of the following teaching points most accurately captures an aspect of single-gene congenital disorders? Question options: Affected genes are present on autosomal chromosomes rather than sex chromosomes. The majority of single-gene disorders manifest near the time of puberty. A particular defect can be caused by mutations at one of several different loci. Single-gene disorders are associated with existing rather than new mutations.

c

At which of the following locations in the nephron would a nurse practitioner first expect blood to be largely free of plasma proteins? Question options: Proximal convoluted tubule Bowman space Loop of Henle Afferent arteriole

c

Which of the following data would a clinician consider to be most indicative of acute renal failure? Question options: Decreased urine output, hematuria, increased GFR Decreased serum creatinine and blood urea nitrogen (BUN), decreased potassium and calcium levels Increased nitrogenous waste levels, decreased glomerular filtration rate (GFR) Alterations in blood pH, peripheral edema

c

A 4-year-old boy who has been deaf since birth and has bilateral cataracts has been brought to the emergency department by his mother because she noticed blood in the toilet after he last voided. Urinalysis confirms heavy microscopic hematuria as well as proteinuria. What will the care team's initial differential diagnosis most likely be? Question options: Immunoglobulin A nephropathy Henoch-Schonlein purpura nephritis Systemic lupus erythematosus glomerulonephritis Alport syndrome

d

An 87-year-old male resident of an assisted living facility has been consistently continent of urine until the last several weeks. Which of the following actions by the care providers at the facility is the most likely priority? Question options: Showing the resident the correct technique for exercises to improve bladder, sphincter, and pelvic floor tone Teaching the resident about protective pads, collection devices, and medications that may be effective Providing patient education focusing on the fact that occasional incontinence is a normal, age-related change Performing a physical examination and history to determine the exact cause and character of the incontinence

d

Which of the following statements best conveys an aspect of the respiratory pressures that govern ventilation? Question options: Intrapleural pressure slightly exceeds that of the inflated lung The chest wall exerts positive pressure on the lungs that contributes to expiration The lungs are prevented from collapsing by constant positive intrapulmonary pressure Negative intrapleural pressure holds the lungs against the chest wall

d