Pathophysiology

Chronic activation of stress hormones can lead to all of the following, except a. cardiovascular disease. b. improved immune function. c.impaired cognitive function. d.depression.

b. improved immune function.

Jean's preoperative laboratory tests show a slightly elevated glucose level. This may be attributed to a.her normal saline infusion. b.increased cortisol release in response to stress. c.decreased physical activity while in the hospital. d.a side effect of her medication.

b. increased cortisol release in response to stress.

When administering heparin subcutaneously, the nurse will follow which procedure? a.Aspirating the syringe before injecting the medication. b.Massaging the site after injection. c.Applying heat to the injection site. d.Avoiding the umbilicus, incisions, wounds, and device insertion sites.

d.Avoiding the umbilicus, incisions, wounds, and device insertion sites.

The patient is a 12-year-old boy diagnosed with acute lymphoid leukemia (ALL). As part of treatment, the patient must undergo several weeks of chemotherapy. The most serious complication of chemotherapy is a.vomiting. b.anemia. c.alopecia. d.infection.

d.infection.

The cellular response indicative of injury because of faulty metabolism is a.hydropic swelling. b.lactate production. c.metaplasia. d.intracellular accumulations.

d.intracellular accumulations.

After surgery to remove a lung tumor, your patient is scheduled for chemotherapy, which will a.selectively kill tumor cells. b.stimulate immune cells to fight the cancer. c.have minimal side effects. d.kill rapidly dividing cells.

d.kill rapidly dividing cells.

A patient is diagnosed with stage III non-Hodgkin lymphoma and is preparing to undergo treatment. All of the following treatments may be used to treat this patient's cancer, except a.radiation. b.bone marrow transplant. c.chemotherapy. d.lymph node transplant. e.monoclonal antibody therapy.

d.lymph node transplant.

The primary factor associated with the risk of Down syndrome is a.family history of heritable diseases. b.exposure to TORCH syndrome organisms. c.maternal alcohol intake. d.maternal age.

d.maternal age.

The effect of stress on the immune system a.is unknown. b.has been demonstrated to be non-existent in studies. c.most often involves enhancement of the immune system. d.may involve enhancement or impairment the immune system.

d.may involve enhancement or impairment the immune system.

The cancer considered to be the most malignant is a.hyperkeratosis. b.basal cell carcinoma. c.squamous cell carcinoma. d.melanoma.

d.melanoma

The goal of heparin for the management of a deep vein thrombosis is to a.relieve edema. b.prevent clot dislodgement. c.dissolve the thrombus. d.prevent further clot formation.

d.prevent further clot formation.

The most common serious complication of deep vein thrombosis is a.stroke. b.hypertensive crisis. c.extremity necrosis. d.pulmonary embolus.

d.pulmonary embolus.

Indicators that an individual is experiencing high stress include all the following except a.tachycardia. b.diaphoresis. c.increased peripheral resistance. d.pupil constriction.

d.pupil constriction.

Corticosteroids are commonly administered for the management of skin disorders because they a.are analgesics b.prevent infection. c.enhance collagen production. d.reduce inflammation.

d.reduce inflammation.

Which anemia will cause the RBCs to be hypochromic and microcytic and can cause pica? a. Iron deficiency b. Pernicious c. Acute blood loss d. Polycythemia vera

a. Iron deficiency

Which of the folloing is not associated with socioeconomic factors that influence disease development? a.genetics. b.environmental toxins. c.overcrowding. d.nutrition. e.hygiene.

a. genetics

The nurse is caring for a patient receiving IV heparin therapy for treatment of a pulmonary embolus. The patient is being converted to warfarin (Coumadin) therapy. The following two questions relate to nursing considerations when caring for this patient: Which of the following should the nurse include when providing dietary teaching for the patient receiving warfarin (Coumadin) therapy? a.Avoid drinking large amounts of green tea. b.Cranberry juice will provide you with needed nutrients while taking Coumadin. c.You must never eat spinach. d.You can only eat broccoli once a month.

a.Avoid drinking large amounts of green tea.

A client has small waxy nodules on their face. The nurse knows this is a common presentation of what type of skin cancer? a.Basal Cell Carcinoma b.Squamous cell Carcinoma c.Malignant Melanoma d.Actinic Keratosis

a.Basal Cell Carcinoma

A diagnostic laboratory finding in myeloma is a.Bence Jones proteins in the urine. b.decreased platelet count. c.increased IgM antibody titer. d.elevated blood glucose levels.

a.Bence Jones proteins in the urine.

What type of fracture generally occurs in children? a.Greenstick b.Stress c.Nightstick d.Colles

a.Greenstick

A patient with chronic gastritis would likely be tested for a.Helicobacter pylori. b.occult blood. c.lymphocytes. d.herpes simplex.

a.Helicobacter pylori.

Your patient is scheduled for a staging procedure. She wants to know what that means. The correct response is which of the following? a.It is a procedure for determining the extent of tumor spread. b.It is a histologic examination of tissues to determine the degree of tumor differentiation. c.It is based on exploratory surgery. d.It is biochemical testing of tumor cells to determine the genetic basis of the tumor.

a.It is a procedure for determining the extent of tumor spread.

Dysfunction of which organ would lead to clotting factor deficiency? a.Liver b.Kidney c.Spleen d.Pancreas

a.Liver

Which disorder usually causes skeletal pain and involves significant bone demineralization from vitamin D deficiency? a.Osteomalacia b.Osteopenia c.Osteomyelitis d.Osteoporosis

a.Osteomalacia

A patient in the intensive care unit has a nasogastric tube and is also receiving a proton pump inhibitor (PPI). The nurse recognizes that the purpose of the PPI is which effect? a.Prevent stress ulcers b.Reduce bacteria levels in the stomach c.Reduce gastric gas formation (flatulence) d.Promote gastric motility

a.Prevent stress ulcers

During assessment of a patient with osteoarthritis pain, the nurse knows that which condition is a contraindication to the use of nonsteroidal anti-inflammatory drugs (NSAIDs)? a.Renal disease b.Diabetes mellitus c.Headaches d.Rheumatoid arthritis

a.Renal disease

A patient is asking advice about which over-the-counter antacid is considered the most safe to use for heartburn. The nurse explains that the reason that calcium antacids are not used as frequently as other antacids is for which of these reasons? a.Their use may result in kidney stones. b.They cause decreased gastric acid production. c.They cause severe diarrhea. d.Their use may result in fluid retention and edema.

a.Their use may result in kidney stones.

All the following stress-induced hormones increase blood glucose except a.aldosterone. b.cortisol. c.norepinephrine. d.epinephrine.

a.aldosterone.

Acute right lower quadrant pain associated with rebound tenderness and systemic signs of inflammation are indicative of a.appendicitis. b.peritonitis. c.cholecystitis. d.gastritis.

a.appendicitis.

Ulcerative colitis is commonly associated with a.bloody diarrhea. b.malabsorption of nutrients. c.fistula formation between loops of bowel. d.inflammation and scarring of the submucosal layer of the bowel.

a.bloody diarrhea.

A fracture in which bone breaks into two or more fragments is referred to as a.comminuted. b.open. c.greenstick. d.stress.

a.comminuted

A major difference between a vesicle and a wheal is that vesicles a.contain fluid, but wheals are edematous tissue. b.are palpable, but a wheal is not. c.are larger than wheals. d.are smaller than wheals.

a.contain fluid, but wheals are edematous tissue.

Aldosterone may increase during stress, leading to all of the following except a.decreased blood pressure. b.increased sodium retention. c.decreased urinary output. d.increased blood volume.

a.decreased blood pressure.

Following a bone fracture, the most likely event to occur is a.development of a blood clot beneath the periosteum. b.leukocyte infiltration into bone tissue. c.blood vessel growth at the fracture site. d.migration of osteoblasts to the fracture site.

a.development of a blood clot beneath the periosteum.

The primary adaptive purpose of the substances produced in the alarm stage is a.energy and repair. b.invoke resting state. c.produce exhaustion. d.set a new baseline steady-state.

a.energy and repair.

Acute, painful inflammation with vesicles along the distribution of a spinal nerve (dermatome) is characteristic of a.herpes zoster. b.herpes simplex. c.human papillomavirus. d.tinea.

a.herpes zoster.

The pathophysiology of rheumatoid arthritis involves a.immune cells accumulating in pannus and destroying articular cartilage. b.free radicals attaching to the synovial membrane and tunneling into articular cartilage. c.excessive wear and tear and microtrauma that damage articular cartilage. d.cysts developing in subchondral bone and creating fissures in articular cartilage.

a.immune cells accumulating in pannus and destroying articular cartilage.

The major cause of death from leukemic disease is a.infection. b.malnutrition. c.hypovolemic shock. d.kidney failure.

a.infection.

Ankylosing spondylitis is characterized by a.inflammation, stiffness, and fusion of spinal joints. b.loss of articular cartilage in weight-bearing joints. c.excessive bone remodeling leading to soft bone. d.immune mechanisms leading to widespread joint inflammation.

a.inflammation, stiffness, and fusion of spinal joints.

Celiac sprue is a malabsorptive disorder associated with a.inflammatory reaction to gluten-containing foods. b.megacolon at regions of autonomic denervation. c.ulceration of the distal colon and rectum. d.deficient production of pancreatic enzymes.

a.inflammatory reaction to gluten-containing foods.

Constipation in an elderly patient can be best treated by all of the following, except a.maintaining a low-fiber diet. b.increasing the level of activity as tolerated. c.minimizing opioid medications. d.increasing fiber in the diet.

a.maintaining a low-fiber diet.

The organelle that contains enzymes necessary for oxidative phosphorylation to produce ATP is the a.mitochondria. b.ribosome. c.lysosome. d.nucleus.

a.mitochondria

All these cellular responses are potentially reversible except a.necrosis. b.metaplasia. c.atrophy. d.hyperplasia.

a.necrosis

A 17-year-old college-bound student receives a vaccine against an organism that causes meningitis. This is an example of a.primary prevention. b.secondary prevention. c.tertiary prevention. d.disease treatment.

a.primary prevention.

Psoriasis is characterized by a.silvery scale on the skin. b.itching, oozing rash. c.thickened, discolored nails. d.whitish coating on the tongue.

a.silvery scale on the skin.

A clinical finding consistent with a diagnosis of rheumatoid arthritis would be a.systemic manifestations of inflammation. b.localized pain in weight-bearing joints. c.reduced excretion of uric acid by the kidney. d.firm, crystallized nodules or "tophi" at the affected joints.

a.systemic manifestations of inflammation.

A unique characteristic feature of fibromyalgia is the presence of a.tender point pain. b.head pain. c.contractures. d.muscle atrophy.

a.tender point pain.

Jean is a 28-year-old woman with chronic back pain subsequent to a motor vehicle collision she suffered at age 22. She is currently in the hospital in preparation for back surgery scheduled for the next day. Jean reports that she seems to have been experiencing colds more frequently since her back injury 6 years ago. Considering the physiologic effects of allostatic overload/chronic stress, you know that a.the immune system may be compromised. b.this is unrelated to her chronic stress. c.excessive secretion of endorphins increases sensitivity to viruses. d.the pain medication for her back probably has affected her coping skills.

a.the immune system may be compromised.

Metaplasia is a.the replacement of one differentiated cell type with another. b.the transformation of a cell type to malignancy. c.an irreversible cellular adaptation. d.the disorganization of cells into various sizes, shapes, and arrangements.

a.the replacement of one differentiated cell type with another.

The final stage of gout, characterized by crystalline deposits in cartilage, synovial membranes, and soft tissue, is called a.tophaceous gout. b.gouty arthritis. c.complicated gout. d.asymptomatic hyperuricemia.

a.tophaceous gout.

All of the following diseases may be associated with a bleeding problem except a.urinary retention. b.renal failure. c.cirrhosis. d.systemic lupus erythematosus. e.ovarian cancer.

a.urinary retention.

When caring for an indivudual diagnosed with Huntington disease, nurisng interventions include all of the following except a.use reverse isolation precautions during hospital stay. b.assess for suicidal ideations. c.monitor for signs and symptoms of self care deficits. d.minimize risk for falls.

a.use reverse isolation precautions during hospital stay.

A newborn has melena, bleeding from the umbilicus, and hematuria. The newborn is most likely experiencing a.vitamin K deficiency bleeding. b.acquired vitamin K deficiency. c.von Willebrand disease. d.disseminated intravascular coagulation.

a.vitamin K deficiency bleeding.

A sex-linked gene mutation on X chromosome that causes insufficient or defective dystrophin protein production that may result in progressive degeneration of muscle growth and development is known as a. Turner Syndrome. b. Muscular Dystrophy. c. Huntingtons Disease. d. Trisomy 21.

b. Muscular Dystrophy.

When caring for a person with Cystic Fibrosis, appropriate nursing considerations include a. encourage a low-fat, low-calorie diet. b. adhear to infection control practices including reverse isolation precautions. c. maintain strict bedrest. d. ensure patient recieves prescribed treatments exactly as scheduled per hospital policy.

b. adhear to infection control practices including reverse isolation precautions.

A patient is receiving heparin intravenous therapy as part of the treatment for a pulmonary embolism. The nurse monitors the results of which laboratory test to check the drug's effectiveness? a.Platelet count b.Activated partial thromboplastin time (PTT) c.Prothrombin time/international normalized ratio (PT/INR) d.Vitamin K levels

b.Activated partial thromboplastin time (PTT)

Which action is most important for the nurse to implement to prevent nausea and vomiting in a client who is prescribed to receive the first round of IV chemotherapy? a.Keep the client NPO during the time chemotherapy is infusing. b.Administer anti-nausea drugs before administering chemotherapy. c.Ensure that the chemotherapy is infused over a 4- to 6-hour period. d.Assess the client for manifestations of dehydration hourly during the infusion period.

b.Administer anti-nausea drugs before administering chemotherapy.

The nurse is caring for a client who is receiving monoclonal antibodies for treatment of lymphoma. It is essential for the nurse to observe for which potential complication? a.Alopecia b.Allergic reaction c.Fever d.Chills

b.Allergic reaction

The cellular component that is most susceptible to radiation injury is the a.membrane. b.DNA. c.RNA. d.ribosomes.

b.DNA

A patient who has AIDS has lost weight and is easily fatigued because of his malnourished state. The nurse anticipates an order for which antinausea drug to stimulate his appetite? a.Metoclopramide (Reglan), a prokinetic drug b.Dronabinol (Marinol), a tetrahydrocannabinoid c.Ondansetron (Zofran), a serotonin blocker d.Aprepitant (Emend), a substance P/NK1 receptor antagonist

b.Dronabinol (Marinol), a tetrahydrocannabinoid

A patient is being discharged on anticoagulant therapy. The nurse will include in the patient-education conversation that it is important to avoid herbal products that contain which substance? a.Valerian b.Ginkgo c.Soy d.Saw palmetto

b.Ginkgo

The nurse notes in a patient's medication history that the patient is taking allopurinol (Zyloprim). Based on this finding, the nurse interprets that the patient has which disorder? a.Rheumatoid arthritis b.Gout c.Osteoarthritis d.Systemic lupus erythematosus

b.Gout

Crohn's disease is associated with all of the following complications, except a.Fistulae b.Green stool c.Adhesions d.Abdomnial pain

b.Green stool

What is necessary for red blood cell production? a.Phosphate b.Iron c.Magnesium d.Calcium

b.Iron

A client has multiple moles with irregular edges that vary in color located on their legs, the nurse knows that this description is associated with what type of skin cancer? a.Actinic Keratosis b.Malignant Melanoma c.Squamous cell Carcinoma d.Basal Cell Carcinoma

b.Malignant Melanoma

Hydropic swelling is a sign of cellular injury associated with a.irreversible injury. b.Na+ K+ pump dysfunction. c.aging. d.excess fat intake.

b.Na+ K+ pump dysfunction.

Cystic fibrosis is a single-gene disorder that primarily affects a.brain and heart. b.kidney and adrenals. c.lungs and pancreas. d.liver and intestine.

c.lungs and pancreas.

A deficiency of von Willebrand factor impairs a.conversion of fibrinogen to fibrin. b.tissue factor release. c.platelet activation. d.platelet production.

c.platelet activation.

Esophageal varices represent a complication of ________ hypertension. a.primary b.pregnancy-induced c.portal d.secondary

c.portal

Children with PKU must avoid phenylalanine in the diet. Phenylalanine is most likely to be a component of a.fat. b.sugar. c.protein. d.carbohydrate.

c.protein

Deep pressure ulcers usually a.appear first as reddened areas that do not blanch. b.begin in the dermal and epidermal skin layers. c.result from lack of perfusion of deep vessels. d.are an unavoidable consequence of immobility.

c.result from lack of perfusion of deep vessels.

Itchy linear burrows on the hands and wrists are associated with a.tick bites. b.Rocky Mountain spotted fever. c.scabies. d.contact dermatitis.

c.scabies.

After suffering a heart attack, a middle-aged man is counseled to take a cholesterol-lowering medication. This is an example of a.primary prevention. b.secondary prevention. c.tertiary prevention. d.disease treatment.

c.tertiary prevention.

A fetus is most vulnerable to environmental teratogens during a.birth. b.conception. c.the first trimester. d.the last trimester.

c.the first trimester.

Activation of the extrinsic pathway of coagulation is initiated by a.platelet factors. b.collagen exposure. c.tissue factor. d.factor VII.

c.tissue factor.

The #1 cause of preventable cancer is a.HIV Infection. b.exposure to radiation. c.tobacco use. d.high protein diets.

c.tobacco use.

CASE STUDY:Mr. Alvarez, a 49y old diagnosed with lung cancer. Last year, he underwent surgical tumor resection and several rounds of radiation and chemotherapy. He is being seen in clinic today for follow-up and his evaluation indicates the cancer is in remission. Mr Alvarez askes the nurse if this means he is cured. The most appropriate response is: a. "There is no real cure for lung cancer." b. "Remission means there are no detectable cancer cells left in the body." c. "You are only considered cured if your symptoms don't come back for at least 5 years." d. "There are no longer signs and symptoms but, cancer cells may still be present in the body."

d. "There are no longer signs and symptoms but, cancer cells may still be present in the body."

When educating a client about CAR T-cell therapy, which of the following statements is true? a. "Using CAR T-cell therapy means you will not need chemo or radiation." b. "Similar to monoclonal antibody therapy, there is a high risk for allergic reaction." c. "Any type of cancer can be effectively treated with CAR T-cell therapy." d. "There is risk for developing stroke-like symtoms that are most often temporary but can be life-threatening."

d. "There is risk for developing stroke-like symtoms that are most often temporary but can be life-threatening."

A client, age 41, visits the gynecologist. After examining her, the physician suspects cervical cancer. The nurse reviews the client's history for risk factors for this disease. Which history finding is a risk factor for cervical cancer? a. Onset of sporadic sexual activity at age 17 b. Spontaneous abortion at age 19 c. Pregnancy complicated with eclampsia at age 27 d. Human papillomavirus (HPV) infection at age 32

d. Human papillomavirus (HPV) infection at age 32

When an individual is diagnosed with Turner Syndrome, which of the following is most likely true? a. Their life expectancy is less than 4 years. b. They will progressively lose the ability to walk and become wheelchair dependant. c. They are at high risk for respiratory infections due to poor muscle tone. d. They may have infertitlity issues and require hormone replacement therapy.

d. They may have infertitlity issues and require hormone replacement therapy.

When caring for a patient with Sickle-cell crisis, nursing considerations include all of the following except a. minimize physiologic stressors to decrease O2 demands. b. ensure adequate hydration. c. monitor closely for s/s of ischemic stroke or acute MI. d. administer minimum dose of analgesic medication, as patient may be drug seeking.

d. administer minimum dose of analgesic medication, as patient may be drug seeking.

Many of the responses to stress are attributed to activation of the adrenals and are mediated by a.norepinephrine and insuln. b.cortisol and epinephrine. c.glucagon and testosterone. d.ACTH nd ACH.

d.ACTH nd ACH.

Which of the following is not included in Primary disease prevention? a.the goal to prevent disease or injury before it occurs. b.altering unhealthy or unsafe behaviors through education. c.immunization against infectious diseases. d.rehabilitation programs.

d.rehabilitation programs.

Osteomalacia (Rickets in children) is characterized by soft, weak bones resulting from a deficiency of a.calcium. b.estrogen. c.phosphate. d.vitamin D.

d.vitamin D.

Mr. Nguyen, is an 89 y.o. male with a medical history of hypertension, diabetes mellitus, and coronary artery disease. He presents in the emergency department with acute onset of loss of balance and left sided weakness. A STAT CT scan confirms Mr. Nguyen has a thrombosis in his cerebral vasculature causing an ischemic stroke. As the nurse, you expect orders to administer a. intravenous alteplase (tPA). b. intravenous unfractionated heparin (UFH). c. subcutaneous low molecular weight heparin (LMWH). d. intravenous factor VII replacement.

a. intravenous alteplase (tPA).

What is the most common, benign form of skin cancer? a.Basal b.Squamous c.Melanoma d.Actinic keratosis

a.Basal

It is true that scleroderma involves a.inflammation and fibrosis of connective tissue. b.autoantibodies against acetylcholine receptors. c.infection by beta-hemolytic streptococcus. d.inflammation caused by antigenic fragments of dead organisms.

a.inflammation and fibrosis of connective tissue.

CASE STUDY: Mrs. Patel, a 68y old widow living at home alone, is being seen in clinic today with reports of a wound on her right foot she first noticed two weeks ago that is getting progressively larger. Her past medical history includes hypertension, diabetes, and renal insufficiency. She also suffered from a stroke last year that left her with right-sided weakness, now requiring the use of a wheelchair. Wound care options for Mrs. Patel may include all of the following, except a. non-adhesive dressing. b. antibotic therapy. c. compression therapy. d. debridement.

c. compression therapy.

Which of the following is an example of a clinical symptom of disease or illness? a.Runny nose b.Fever c.Headache d.Yellow sputum

c.Headache

CASE STUDY: Julio is 10 years old and came to the urgent care center after falling from his bicycle. An x-ray reveals an oblique fracture of the radius. Julio is otherwise healthy, normal in his growth and development, and has no known allergies. Juilo's fractured arm is immobilized with a full length cast. With a new cast and possible continued swelling from the injury, Julio will be monitored for development of compartment syndrome. Signs or sympotoms of compartment syndrome include all of the following except a. decreased movement of the hand and/or fingers. b. the hand and fingers are cool to touch. c. decreased sensation of the hand or fingers. d. a capillary refill time of less than 2 seconds.

d. a capillary refill time of less than 2 seconds.

Which is not normally secreted in response to stress? a.Norepinephrine b.Cortisol c.Epinephrine d.Insulin

d.Insulin

Marge is a 42-year-old woman who works full time as a legal secretary and has three children, ages 6, 9, and 11 years. She was divorced 6 months ago and relocated to a new school district. Her children are adjusting to school, but Marge has not established any friendships in the neighborhood. She presents in the clinic today with a severe migraine headache that has not responded to her usual dose of ibuprofen. Marge indicates that she does not think her migraines are a result of stress because her sister is in a much worse life situation than she is and does not get migraines. Which of the following statements is the best reply? a.Perhaps your sister's situation is not as bad as you think it is. b.People respond to stressful situations in different ways. c.Migraines are always stress related. d.Perhaps your sister has better coping skills.

b.People respond to stressful situations in different ways.

CASE STUDY:Mr. Alvarez, a 49y old diagnosed with lung cancer. Last year, he underwent surgical tumor resection and several rounds of radiation and chemotherapy. He is being seen in clinic today for follow-up and his evaluation indicates the cancer is in remission. Which of these does the nurse recognize as the goal of palliative surgery for the client with cancer? a.Cure of the cancer b.Relief of symptoms or improved quality of life c.Allowing other therapies to be more effective d.Prolonging the client's survival time

b.Relief of symptoms or improved quality of life

A patient is taking chemotherapy with a drug that has a high potential for causing nausea and vomiting. The nurse is preparing to administer an antiemetic drug. Which class of antiemetic drugs is most commonly used to prevent nausea and vomiting for patients receiving chemotherapy? a.Prokinetic drugs, such as metoclopramide (Reglan) b.Serotonin blockers, such as ondansetron (Zofran) c.Anticholinergic drugs, such as scopolamine d.Neuroleptic drugs, such as promethazine (Phenergan)

b.Serotonin blockers, such as ondansetron (Zofran)

The client is receiving external radiation to the neck for cancer of the larynx. The nurse monitors the client knowing that what is the most likely adverse affect of the external radiation? a.Chest pain b.Sore throat c.Diarrhea d.Swelling of hands and feet

b.Sore throat

A patient who has been anticoagulated with warfarin (Coumadin) has been admitted for gastrointestinal bleeding. The history and physical examination indicates that the patient may have taken too much warfarin. The nurse anticipates that the patient will receive which antidote? a.Vitamin E b.Vitamin K c.Protamine sulfate d.Potassium chloride

b.Vitamin K

Rheumatoid arthritis is commonly associated with the presence of rheumatoid factor autoantibodies in the bloodstream. This indicates that rheumatoid arthritis is likely to be a.caused by bacterial infection. b.an autoimmune process. c.an infective process. d.because of an enzymatic defect.

b.an autoimmune process.

The most appropriate treatment for secondary polycythemia is a.volume expansion with saline. b.an intervention to improve oxygenation. c.phlebotomy. d.chemotherapy.

b.an intervention to improve oxygenation.

Apoptosis is a process that results in cellular a.atrophy. b.death. c.proliferation. d.mutation.

b.death

Signs/symptoms of Lyme disease include all of the following, except a.fever and chills. b.diffuse rash. c.arthritic pain. d.headache. e.myalgia.

b.diffuse rash.

Widespread abnormal activation of the clotting cascade secondary to massive trauma is called a.hemophilia B. b.disseminated intravascular coagulation (DIC). c.liver disease. d.idiopathic thrombocytopenia purpura.

b.disseminated intravascular coagulation (DIC).

The cellular change that is considered preneoplastic (precancerous) is a.anaplasia. b.dysplasia. c.metaplasia. d.hyperplasia.

b.dysplasia

The prothrombin time (PT) and INR (international normalized ratio) measure the integrity of a.platelet function. b.extrinsic pathway. c.intrinsic pathway. d.fibrinolysis.

b.extrinsic pathway.

The conversion of plasminogen to plasmin results in a.clot formation. b.fibrinolysis. c.platelet aggregation. d.activation of thrombin.

b.fibrinolysis.

Risk factors for atherosclerosis include a.female gender. b.hyperlipidemia. c.high-protein diet. d.low-fiber diet.

b.hyperlipidemia.

An increase in organ size caused by increased workload is termed a.atrophy. b.hypertrophy. c.metaplasia d.inflammation

b.hypertrophy.

CASE STUDY: Julio is 10 years old and came to the urgent care center after falling from his bicycle. An x-ray reveals an oblique fracture of the radius. Julio is otherwise healthy, normal in his growth and development, and has no known allergies. Assessment of Julio's arm six hours after surgical alignment and casting demonstrates pulselessness and pallor. The priority action to take is to a.increase the administration his pain medication. b.initiate action to have the cast split or removed. c.note the increase in pain in his chart, and recheck the extremity in 30 minutes. d.elevate the extremity to relieve swelling.

b.initiate action to have the cast split or removed.

Pernicious anemia is caused by a lack of a.iron. b.intrinsic factor. c.folate. d.erythropoietin.

b.intrinsic factor.

The cause of the most common form of anemia is a.acute bleeding. b.iron deficiency. c.protein malnutrition. d.chronic disease.

b.iron deficiency.

It is true that vitiligo a.occurs as a result of a genetic lack of melanin production. b.is a depigmented patch of skin. c.occurs most commonly in light-skinned individuals. d.is a warning sign for malignant melanoma.

b.is a depigmented patch of skin.

The primary source of erythropoietin is provided by the a.bone marrow. b.kidney. c.lung. d.liver.

b.kidney.

A patient has been exposed to meningococcal meningitis, but is not yet demonstrating signs of this disease. This stage of illness is called the _____ stage. a.prodromal b.latent c.sequela d.convalescence

b.latent

A 58-year-old woman is seen in the clinic for reports of severe back pain. Her chest x-ray demonstrates generalized bone demineralization and compression fracture. Blood studies demonstrate elevated calcium levels. The most likely diagnosis is a.leukemia. b.myeloma. c.Hodgkin disease. d.back trauma.

b.myeloma

Two of the most serious oncology emergencies associated with non-Hodgkins lymphoma are a.obstruction of the superior vena cava and swollen lymph nodes. b.obstruction of the superior vena cava and compression of the spinal cord. c.compression of the spinal cord and malnutrition. d.obstruction of the inferior vena cava and malnutrition.

b.obstruction of the superior vena cava and compression of the spinal cord.

Somatic death refers to death a.of a body organ. b.of the entire organism. c.of nerve cells. d.secondary to brain damage.

b.of the entire organism.

Common causes of mechanical bowel obstruction include all of the following, except a.indigestable materials. b.opioids. c.adhesions. d.fecal impaction.

b.opioids.

The nurse is caring for a patient receiving IV heparin therapy for treatment of a pulmonary embolus. The patient is being converted to warfarin (Coumadin) therapy. The following two questions relate to nursing considerations when caring for this patient: Nursing considerations for conversion of IV heparin to oral warfarin (Coumadin) therapy will include: a.immediate discontinuation of IV heparin and administration of oral warfarin (Coumadin) therapy only. b.overlapping therapy of IV heparin and oral warfarin may take up to five days. c.monitoring the PT/INR and stopping the I.V. heparin when the INR is 1.0. d. dosage of warfarin is always 1 mg PO daily.

b.overlapping therapy of IV heparin and oral warfarin may take up to five days.

Barrett esophagus is a a.gastrin-secreting lesion. b.preneoplastic lesion. c.benign condition. d.gastrin-secreting tumor.

b.preneoplastic lesion.

Disseminated intravascular coagulation (DIC) may be treated with heparin therapy to a.enhance fibrinolysis. b.reduce clotting factor consumption. c.activate platelets. d.enhance liver synthesis of clotting factors.

b.reduce clotting factor consumption.

Osteoclast activity leads to a.hardening of the bones. b.resorption of bone. c.deposition of bone. d.arthritis.

b.resorption of bone.

Most nutrient digestion and absorption occurs in the a.stomach. b.small intestine. c.large intestine. d.cecum.

b.small intestine.

C.Q. was recently exposed to group A hemolytic Streptococcus and subsequently developed a pharyngeal infection. His clinic examination reveals an oral temperature of 102.3F, skin rash, dysphagia, and reddened throat mucosa with multiple pustules. He complains of sore throat, malaise, and joint stiffness. A throat culture is positive for Streptococcus, and antibiotics have been prescribed. The etiology of C.Q.'s disease is a.a sore throat. b.streptococcal infection. c.genetic susceptibility. d.pharyngitis.

b.streptococcal infection.

Huntington disease is often transferred to offspring before a parent knows of the genetic possibility of this disease, because a.symptoms are so mild that they are not recognized. b.symptoms often do not occur until approximately 40 years of age. c.genetic testing for the disease is not possible. d.the genetic alteration is rarely expressed.

b.symptoms often do not occur until approximately 40 years of age.

The structures that connect muscle to bone are referred to as a.ligaments. b.tendons. c.trabeculae. d.synovial sheaths.

b.tendons

Julio's father asks "how can you tell when the fracture has completely healed?" Complete healing of a bone fracture occurs when a.no movement of the break is detectable. b.the callus has been completely replaced with mature bone. c.the fracture site and surrounding soft tissue are pain free. d.a cast is no longer required to stabilize the break.

b.the callus has been completely replaced with mature bone.

The activated partial thromboplastin time (PTT) is a measure of the integrity of a.the extrinsic pathway. b.the intrinsic pathway. c.factor VIII synthesis. d.plasminogen.

b.the intrinsic pathway.

CASE STUDY: Ms. Green is a 44 year-old woman with no known allergies and a history of fibromyalgia, high cholesterol, PTSD, and smoking. No surgical history to report. She is seen in clinic for episodes of severe adbominal cramps and diarrhea that have become more frequent over the last few months. Ms. Green's vital signs are within normal limits and blood tests show no indication of deficiency or infection. A KUB appears normal and colonoscopy revealed "unremarkable mucosal wall with no abnormalities" of the large intestine. Her mucosal biopsy tested negative for antibodies. Based on these assessment findings, the most likely diagnosis for Ms. Green would be a. Short-gut syndrome. b. Celiac diesease. c. Irritable bowel syndrome. d. Diverticulosis.

c. Irritable bowel syndrome.

CASE STUDY: Ms. Green is a 44 year-old woman with no known allergies and a history of fibromyalgia, high cholesterol, PTSD, and smoking. No surgical history to report. She is seen in clinic for episodes of severe adbominal cramps and diarrhea that have become more frequent over the last few months. Nursing interventions for the care of Ms. Green include all of the following, except a. discuss keeping a food diary to help identify substances that may exacerbate the symptoms. b. explore alternative therapy options such as Cognative Behavioural Therapy (CBT). c. encourage eating a low-fiber diet. d. administer antidiarrheal agents as prescribed.

c. encourage eating a low-fiber diet.

CASE STUDY: Mrs. Patel, a 68y old widow living at home alone, is being seen in clinic today with reports of a wound on her right foot she first noticed two weeks ago that is getting progressively larger. Her past medical history includes hypertension, diabetes, and renal insufficiency. She also suffered from a stroke last year that left her with rigth-sided weakness, now requiring the use of a wheelchair. During assessment of Mrs. Patel, the nurse notes both lower extremities are cool to touch. On the right foot is an area with loss of epidermis, foul smelling, purulent drainage and erythematous borders. Possible contributing factors for this patient presentation include all of the following except a. diabetic neuropathy. b. arterial insufficiency. c. fungal infestation. d. bacterial infection.

c. fungal infestation.

The nurse recognizes all of the following as potential s/s of tumor lysis syndrome, except a. oliguria. b. dyspnea. c. hypokalemia. d. cardiac arrythmias.

c. hypokalemia.

CASE STUDY: Julio is 10 years old and came to the urgent care center after falling from his bicycle. An x-ray reveals an oblique fracture of the radius. Julio is otherwise healthy, normal in his growth and development, and has no known allergies. Julio's father asks the nurse if he should use aspirin to reduce the pain in Julio's arm. What is the best response by the nurse? a."It's best to wait to see if the pain gets worse." b."You can use the aspirin, but watch for worsening symptoms." c."Ibuprophen (Advil) should be used to reduce pain, not aspirin." d."You can use aspirin, but be sure to follow the instructions on the bottle."

c."Ibuprophen (Advil) should be used to reduce pain, not aspirin."

The nurse is reviewing the therapeutic effects of nonsteroidal anti-inflammatory drugs (NSAIDs), which include which effect? a.Anxiolytic b.Sedative c.Antipyretic d.Antimicrobial

c.Antipyretic

What clinical finding would suggest an esophageal cause of a client's report of dysphagia? a.Nasal regurgitation b.Airway obstruction with swallowing c.Chest pain during meals d.Coughing when swallowing

c.Chest pain during meals

A 75-year-old man fell at home and hit his head against a table. His wife reports to their daughter that he does not have cuts or scratches, but there is a small lump on his upper scalp. She does not see any blood. He is taking warfarin and an antidysrhythmic as part of his treatment for chronic atrial fibrillation. What is the main concern at this time? a.Pressure should be applied to the lump for 3 to 5 minutes b.He will need to take two doses of warfarin tonight to prevent blood clotting. c.He needs to be examined for possible internal bleeding from the fall. d.As long as there is no bleeding, there is no concern.

c.He needs to be examined for possible internal bleeding from the fall.

A patient has received an overdose of intravenous heparin, and is showing signs of excessive bleeding. Which substance is the antidote for heparin overdose? a.Vitamin E b.Vitamin K c.Protamine sulfate d.Potassium chloride

c.Protamine sulfate

The complication which is not likely to result from a compound, transverse fracture of the tibia and fibula is a.bone infection. b.fat emboli. c.air embolus. d.compartment syndrome.

c.air embolus.

Rheumatoid arthritis involves joint inflammation caused by a.bacterial infection. b.trauma. c.autoimmune injury. d.congenital hypermobility.

c.autoimmune injury.

Impetigo is a skin infection caused by a.fungus. b.yeast. c.bacteria. d.parasite.

c.bacteria

A cause of thrombocytopenia includes a.hypoxemia. b.non-alcoholic hepatitis. c.chemotherapy induced bone marrow suppression. d. warfarin overdose.

c.chemotherapy induced bone marrow suppression.

Shingles is caused by the same virus that causes a.measles. b.mumps. c.chickenpox. d.rubella.

c.chickenpox.

Mrs. Smith a 69 y.o. female has been admitted to the Rehab unit one week after R hip replacement. The patient has an order: Heparin 5000 units Subcut BID at 0900 and 2100. Today you heard in morning report that your patient is going to be scheduled for an endoscopy at 11am. Pt has been NPO since MN. As the nurse planning for Mrs.Smith's morning medicaion administraion, you would a.prepare to give the heparin as ordered. b.ask the patient if she would like juice with her medications. c.contact the ordering provider to hold the 0900 dose of heparin. d. cancel the endoscopy procedure.

c.contact the ordering provider to hold the 0900 dose of heparin.

The most effective therapy for anemia associated with kidney failure is a.iron administration. b.high-protein diet. c.erythropoietin administration. d.vitamin B12 and folate administration.

c.erythropoietin administration.

Treatment for hemophilia A includes a.heparin administration. b.vitamin K replacement. c.factor VIII replacement. d.platelet transfusion.

c.factor VIII replacement.

Information parents should be given about the consequences of PKU includes a.high dietary phenylalanine may help induce enzyme production. b.PKU is commonly associated with other congenital anomalies. c.failure to avoid phenylalanine results in progressive mental retardation. d.mental retardation is inevitable.

c.failure to avoid phenylalanine results in progressive mental retardation

Nurse David is teaching a client who suspects that she has a lump in her breast. The nurse instructs the client that a diagnosis of breast cancer is confirmed by a.breast self-examination. b.mammography. c.fine needle biopsy. d.chest X-ray.

c.fine needle biopsy.

Epigastric pain that is relieved by food is suggestive of a.pancreatitis. b.cardiac angina. c.gastric ulcer. d.hiatal hernia.

c.gastric ulcer.

Individuals diagnosed with systemic lupus erythematosus (SLE) are at risk for developing numerous complications of various organs because of a.excessive production of connective tissue. b.formation of osteophytes in tissues. c.immune injury to basement membranes. d.impaired tissue oxygen transport.

c.immune injury to basement membranes.

A physiologic response to the release of catecholamines during the alarm stage of stress response would be: a.increased gastrointestinal motility b.constriction of the pupils c.increased glycogenolysis d.decreased heart rate

c.increased glycogenolysis

Necrotic death of brain tissue usually produces _____ necrosis. a.coagulative b.caseous c.liquefactive d.fat

c.liquefactive

A patient has been prescribed warfarin (Coumadin) in addition to a heparin infusion. The patient asks the nurse why he has to be on two medications. The nurse's response is based on which rationale? a.The oral and injection forms work synergistically. b.The combination of heparin and an oral anticoagulant results in fewer adverse effects than heparin used alone. c.Oral anticoagulants are used to reach an adequate level of anticoagulation when heparin alone is unable to do so. d.Heparin is used to start anticoagulation so as to allow time for the blood levels of warfarin to reach adequate levels.

d.Heparin is used to start anticoagulation so as to allow time for the blood levels of warfarin to reach adequate levels.

Older individuals may experience which change in the mouth? a.Increase in salivation b.Increase in taste sensitivity. c.Increase in the number of papillae d.Increased exposure of dentin

d.Increased exposure of dentin

As a patient is receiving thrombolytic therapy, the nurse monitors the patient for adverse effects. What is the most common undesirable effect of thrombolytic therapy? a.Dysrhythmias b.Nausea and vomiting c.Anaphylactic reactions d.Internal and superficial bleeding

d.Internal and superficial bleeding

A student working on an oncology unit asks the healthcare provider how malignant cells are different from normal cells. Which of the following would not be included in the answer? a.Malignant cells have a potential for limitless replication. b.Normal cells are more specialized than malignant cells. c.As a malignant tumor grows, it can make its own blood supply. d.Malignant cells tend to stick together much more than normal cells.

d.Malignant cells tend to stick together much more than normal cells.

A male patient with thrombocytopenia is involved in a motor vehicle accident and is brought to the emergency department with acute flank pain. This patient could potentially exhibit any of the following signs of bleeding, except a.Hematuria b.Melena c.Hematemesis d.Menorrhagia e.Hemoptysis

d.Menorrhagia

A patient who has been on antibiotic therapy for 2 weeks has developed persistent diarrhea. The nurse expects which medication class to be ordered to treat this diarrhea? a.Lubricants b.Adsorbents c.Anticholinergics d.Probiotics

d.Probiotics

Although skin manifestations may occur in numerous locations, the classic presentation of systemic lupus erythematosus (SLE) includes a.lesions affecting the palms of hands and the soles of feet. b.dry, scaly patches in the antecubital area and behind the knees. c.cracked, scaly areas in the webs of fingers. d.a butterfly pattern rash on the face across the bridge of the nose.

d.a butterfly pattern rash on the face across the bridge of the nose.

Mr. Nguyen, is an 89 y.o. male with a medical history of hypertension, diabetes mellitus, and coronary artery disease. He presents in the emergency department with acute onset of loss of balance and left sided weakness. Additional s/s of acute ischemic stroke include all of the following, except a.acute onset facial droop or asymmetry. b.acute onset of loss of vision in one or both eyes. c.acute onset of difficulty speaking or understanding speech. d.acute onset chest pain or shortness of breath.

d.acute onset chest pain or shortness of breath.

A commonly ingested over-the-counter (OTC) substance associated with delayed hemostasis is a.acetaminophen. b.tobacco. c.caffeine. d.aspirin.

d.aspirin

People who have osteoporosis are at risk for a.rhabdomyolysis. b.osteomyelitis. c.osteomalacia. d.bone fractures.

d.bone fractures.

The electrolyte that must be present in cellular cytoplasm for muscle contraction to occur is a.potassium. b.sodium. c.magnesium. d.calcium.

d.calcium

Your patient eats "lots of fat," leads a "stressful" life, and has smoked "about two packs a day for the last 40 years." Her chronic morning cough recently worsened, and she was diagnosed with a lung mass. The most likely contributing factor for development of lung cancer in this patient is a.high-fat diet. b.urban pollutants. c.stressful lifestyle. d.cigarette smoking.

d.cigarette smoking.

Atopic dermatitis (eczema) is caused by a.parasitic infestation of the skin. b.superficial staphylococcal infection. c.superficial fungal infection. d.contact with skin irritants.

d.contact with skin irritants.

Proton pump inhibitors may be used in the management of peptic ulcer disease to a.increase gastric motility. b.inhibit secretion of pepsinogen. c.neutralize gastric acid. d.decrease hydrochloric acid (HCl) secretion.

d.decrease hydrochloric acid (HCl) secretion.

A silent abdomen 3 hours after bowel surgery most likely indicates a.peritonitis. b.mechanical bowel obstruction. c.perforated bowel. d.functional bowel obstruction.

d.functional bowel obstruction.

Dumping syndrome is commonly seen after __________ procedures. a.appendectomy b.intestinal biopsy c.colonoscopy d.gastric bypass

d.gastric bypass

The correct sequence of bone healing following fracture is a.hematoma formation, callous formation, fibrocartilage formation, ossification, remodeling. b.hematoma formation, callous formation, fibrocartilage formation, remodeling, ossification. c.callous formation, hematoma formation, fibrocartilage formation, ossification, remodeling. d.hematoma formation, fibrocartilage formation, callous formation, ossification, remodeling.

d.hematoma formation, fibrocartilage formation, callous formation, ossification, remodeling.

Marge is a 42-year-old woman who works full time as a legal secretary and has three children, ages 6, 9, and 11 years. She was divorced 6 months ago and relocated to a new school district. Her children are adjusting to school, but Marge has not established any friendships in the neighborhood. She presents in the clinic today with a severe migraine headache that has not responded to her usual dose of ibuprofen. Because stress or allostatic overload is believed to be a significant factor in the etiologic progression of a migraine headache, it may be helpful to suggest that Marge: a.avoid medicating her migraines. b.eliminate stressful situations. c.cope more effectively. d.identify precipitating stressors and initiate preventative measures.

d.identify precipitating stressors and initiate preventative measures.

Gouty arthritis is a complication of a.group A streptococcal infection. b.autoimmune destruction of joint collagen. c.excessive production of urea. d.inadequate renal excretion of uric acid.

d.inadequate renal excretion of uric acid.