Pathophysiology (PUC) Exam III
When an intestinal obstruction is suspected, a client has a nasogastric tube inserted and attached to suction. For what response should the nurse critically assess this client? 1. Edema 2. Belching 3. Dehydration 4. Excessive saliva
3. Dehydration
A client is admitted with dehydration as a result of prolonged watery diarrhea. Which intervention ordered by the physician should the nurse question? 1. Parental albumin 2. Psyllium (Metamucil) 3. Potassium supplements 4. Half normal saline solution
1. Parental albumin Albumin is hypertonic and will draw additional fluid from the tissues into the intravascular space.
The nurse is aware that fluid deficit can most accurately be assessed by: 1. A change in body weight 2. The presence of dry skin 3. A decrease in blood pressure 4. An altered general appearance
1. A change in body weight ** Remember 1 L fluid = 1 kg/2.2lbs
A client who is receiving furosemide (Lasix) and digoxin (Lanoxin) should be observed for symptoms of electrolyte depletion caused by: 1. Diuretic therapy 2. Sodium restriction 3. Continuous dyspnea 4. Inadequate oral intake
1. Diuretic therapy
An arterial blood gas report indicates the client's pH is 7.25, PCO2 is 35 mm Hg, and HCO3 is 20 mEq/L. Which disturbance should the nurse identify based on these results? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis
1. Metabolic acidosis
An IV solution containing potassium inadvertently infuses too rapidly. The physician prescribes insulin added to a 10% dextrose in water solution. The rationale for the order is: 1. Potassium moves into body cells with glucose and insulin 2. Increased insulin accelerates excretion of glucose and potassium 3. Glucose and insulin increase metabolism and accelerate potassium excretion 4. Increased potassium causes a temporary slowing of pancreatic production of insulin
1. Potassium moves into body cells with glucose and insulin
When intravenous fluid is allowed to flow into a person by gravity: 1. Potential energy is converted to kinetic energy 2. Kinetic energy is converted to potential energy 3. Chemical energy is converted to kinetic energy 4. Potential energy is converted to chemical energy
1. Potential energy is converted to kinetic energy The fluid in an IV bag hung over a person lying down possesses potential energy. When that fluid is allowed to drop into the person intravenously, its potential energy is then converted to kinetic energy (energy of motion).
What are the signs that the nurse should identify to conclude than an IC has infiltrated? (select all that apply) 1. Heat 2. Pallor 3. Edema 4. Decreased flow rate 5. Increased blood pressure
2, 3, & 4
The nurse must be alert for signs of respiratory acidosis in the client with emphysema, because with individual has a long-term problem with oxygen maintenance and: 1. The carbon dioxide is not excreted 2. Hyperventilation occurs, even if the cause is not physiologic 3. There is a loss of carbon dioxide from the body's buffer pool 4. Localized tissue necrosis occurs as a result of poor oxygen supply to the area
1. The carbon dioxide is not excreted
When preparing an IV piggyback medication for a client, the nurse is aware that it is essential to: 1. Use strict sterile technique 2. Rotate the bag after adding the medication 3. Use exactly 100 mL of fluid to mix the medication 4. Change the needle just before adding the medication
1. Use strict sterile technique
What adaptations should the nurse expect a client with hyperkalemia to exhibit? (select all that apply) 1. Tetany 2. Diarrhea 3. Weakness 4. Seizures 5. Dysrhythmias
2, 3, & 5 2. Because of potassium's role in the Na+/K+ pump, hyperkalemia will cause diarrhea. 3. Because of potassium's role in the Na+/K+ pump, hyperkalemia will cause weakness. 5. Because of potassium's role in the Na+/K+ pump, hyperkalemia will cause cardiac dysrhythmias.
After surgical clipping of a cerebral aneurysm, the client develops SIADH. The nurse should assess this client for which manifestations of excessive levels of ADH? (select all that apply) 1. Polyuria 2. Weight gain 3. Hypotension 4. Hyponatremia 5. Decreased specific gravity
2, 4, & 5
An intravenous piggyback (IVPB) of cefazolin (Kefzol) 500 mg in 50 mL of 5% dextrose in water is to be administered over a 20-minute period. The tubing has a drop factor of 15 drops/mL. At what rate per minute should the nurse regulate the infusion to run?
38 gtt/min
Ammonia is excreted by the kidney to help maintain: 1. Osmotic pressure of the blood 2. Acid-base balance of the body 3. Low bacterial levels in the urine 4. Normal red blood cell production
2. Acid-base balance of the body Ammonia combines with H+ ions in the glomerular filtrate for form ammonium ions, which are excreted from the body.
The nurse must assess the client with gastric lavage or prolonged vomiting for: 1. Acidosis 2. Alkalosis 3. Loss of oxygen from the blood 4. Loss of osmotic pressure of the blood
2. Alkalosis
Larger than normal amounts of acetoacetic acid have been entering the blood as one of the indirect results of a client's insulin deficiency. Like lactic acid and other nonvolatile acids, acetoacetic acid is buffered in the blood chiefly by: 1. Potassium 2. Bicarbonate 3. Carbon dioxide 4. Sodium chloride
2. Bicarbonate
The nurse observes an anxious client hyperventilating and intervenes to prevent: 1. Cardiac arrest 2. Carbonic acid deficit 3. Reduction in serum pH 4. Excess oxygen saturation
2. Carbonic acid deficit
Which finding suggests that interventions for a client with an excess fluid volume have been effective? 1. Normal potassium 2. Clear breath sounds 3. Positive pedal pulses 4. Increased urine specific gravity
2. Clear breath sounds
A client has an IV infusion. If the IC infusion infiltrates, the nurse should first: 1. Elevate the IV site 2. Discontinue the infusion 3. Attempt to flush the tube 4. Apply warm, moist soaks
2. Discontinue the infusion
The nurse is aware that the infiltration of a client's IV is most likely caused by: 1. Excessive height of the IV solution 2. Failure to adequately secure the catheter 3. Lack of asepsis during catheter insertion 4. Infusion of chemically irritating medication
2. Failure to adequately secure the catheter
The nurse is aware that negative nitrogen balance most directly occurs in a client receiving IV administration of 5% dextrose in water because of: 1. Excessive carbohydrate intake 2. Lack of protein supplementation 3. Insufficient intake of water-soluble vitamins 4. Increased concentration of electrolytes in cells
2. Lack of protein supplementation IV fluids don't provide proteins needed for tissue growth, repair, and maintenance, therefore tissue breakdown occurs to provide the essential amino acids.
A client is to receive 2000 mL of IV fluid in 12 hours. The drop factor is 10 gtt/mL. At how many drops per minute should the flow rate be set?
28 gtt/min
A hormone that stimulates the flow of pancreatic enzymes is: 1. Enterocrinin 2. Pancreozymin 3. Enterogastrone 4. Cholecystokinin
2. Pancreozymin This is the unique function of pancreozymin, which is excreted by the duodenal mucosa. It particularly affects the production of amylase.
In the emergent phase immediately after a severe burn injury, care is centered on replacement therapy by IV fluids. The nurse should question the physician's order if it is designed to provide: 1. Water 2. Potassium 3. Lactated Ringer's 4. Plasma expanders
2. Potassium Not generally indicated because hyperkalemia results from the liberation of K+ ions from the injured cells.
Before a cholecystectomy, vitamin K is prescribed, which element, should the nurse determine is the purpose of administering this medication? 1. Bilirubin 2. Prothrombin 3. Thromboplastin 4. Cholecystokinin
2. Prothrombin Vitamin K is necessary for the formation of prothrombin to prevent bleeding.
Prophylaxis for hepatitis B includes: 1. Preventing constipation 2. Screening of blood donors 3. Avoiding shellfish in the diet 4. Limiting hepatotoxic drug therapy
2. Screening of blood donors
The nurse notes that a client's serum potassium level is 5.8 mEq/L. The nurse should first: 1. Call the laboratory and repeat the test 2. Call the cardiac arrest team to alert them 3. Obtain an ECG strip and have lidocaine available 4. Take the client's vital signs and notify the physician
4. Take the client's vital signs and notify the physician Vital signs monitor cardiorespiratory status; hyperkalemia causes serious cardiac dysrhythmias.
While a client is receiving albumin, the planned therapeutic effect will be greater if the infusion is regulated to flow: 1. Rapidly, and fluids are encouraged 2. Slowly and fluid intake is restricted 3. Rapidly, and fluid intake is withheld 4. Slowly, and fluids are encouraged liberally
2. Slowly and fluid intake is restricted This will allow is to elevate BP to normal levels. It causes fluid to move from interstitial spaces into the circulatory system.
When caring for a client with ascites, the nurse should understand that the portal vein: 1. Brings blood away from the liver 2. Enters the superior vena cava from the cranium 3. Brings venous blood from the intestinal wall to the liver 4. Is located superficially on the anteromedial surface of the thigh
3. Brings venous blood from the intestinal wall to the liver
The nurse is aware that ascites can be related to: 1. Portal hypotension 2. Kidney malfunction 3. Diminished plasma protein 4. Decreased production of potassium
3. Diminished plasma protein
Which assessment data should the nurse anticipate when admitting a client with an extracellular fluid excess? 1. Elevated hematocrit 2. Rapid, thready pulse 3. Distended jugular veins 4. Increased serum sodium
3. Distended jugular veins
The nurse understands tha t client with albuminuria has edema caused by: 1. Fall in tissue hydrostatic pressure 2. Rise in plasma hydrostatic pressure 3. Fall in plasma colloid oncotic pressure 4. Rise in tissue colloid osmotic pressure
3. Fall in plasma colloid oncotic pressure
A client with cirrhosis of the liver has longstanding inadequate nutrition, including a protein deficiency. This deficiency leads to: 1. Tissue anabolism 2. Decreased bile in the blood 3. Fat accumulation in the liver tissue 4. Coagulation of blood in microcirculation
3. Fat accumulation in the liver tissue Lipoproteins, a combines of a fat and a simple protein, have not been formed because of limited protein intake. Therefore fat accumulates in the liver.
The nurse is aware that the symptoms of portal hypertension in clients with cirrhosis are chiefly the result of: 1. Infection of the liver parenchyma 2. Fatty degeneration of Kupffer cells 3. Obstruction of the portal circulation 4. Obstruction of the cystic and hepatic ducts
3. Obstruction of the portal circulation
The nurse, recognizing that digitalis preparations promote mild diuresis, should evaluate clients for a depletion of: 1. Sodium 2. Calcium 3. Potassium 4. Phosphate
3. Potassium Potassium is lost with urine during diuresis.
The nurse is aware that the body's attempts to compensate for excessive fluid losses associated with diarrhea are evident in an increased: 1. Hematocrit 2. Temperature 3. Specific gravity 4. Serum potassium
3. Specific gravity Specific gravity increased as urine becomes more concentrated but he body's attempt to conserve water.
When caring for a client with hepatitis A, the nurse should take special precautions to: 1. Prevent droplet spread of infection 2. Use caution when bringing food to the client 3. Use gloves when removing the client's bedpan 4. Wear mask and down before entering the room
3. Use gloves when removing the client's bedpan
After extensive, prolonged surgery it is most important that the nurse observe the client for the depletion of the electrolyte: 1. Sodium 2. Calcium 3. Chloride 4. Potassium
4. Potassium
The most important electrolyte of intracellular fluid is: 1. Sodium 2. Calcium 3. Chloride 4. Potassium
4. Potassium The concentration of potassium is greater inside the cells and is important in establishing a membrane potential, a critical factor in the cel's ability to function.
The nurse would expect to observe varicose veins when a client has cirrhosis because of: 1. Increased plasma hydrostatic pressure in veins of their extremities 2. Toxic irritating products released into the blood from the diseased organs 3. Ballooning of vein walls from decreased venous pressure and incompetent valves 4. Decreased plasma protein concentration resulting in the pooling of blood in the venous system
1. Increased plasma hydrostatic pressure in veins of their extremities
A client in a state of uncompensated acidosis. The nurse would expect the arterial blood pH to be approximately: 1. 7.20 2. 7.35 3. 7.45 4. 7.48
1. 7.20
Which statement correctly compares blood plasma and interstitial fluid? 1. Both contain the same kinds of ions 2. Plasma exerts lower osmotic pressure than does interstitial fluid 3. Plasma contains slightly more of each kind of ion than does interstitial fluid 4. The main cation in plasma is sodium, whereas the main cation in interstitial fluid is potassium
1. Both contain the same kinds of ions Blood plasma and interstitial fluid are both part of the extra cellar fluid and are of the same ionic composition.
When taking the blood pressure of a client who has had a thyroidectomy, the nurse notices the client is pale and has spasms of the hand and notifies the physician. While awaiting the physician's orders, the nurse should prepare for replacement of: 1. Calcium 2. Magnesium 3. Bicarbonate 4. Potassium chloride
1. Calcium These are S/S of calcium depletion.
A client with hypokalemia is placed on a cardiac monitor to evaluate cardiac activity during IC potassium replacement. Before starting the IV, the nurse observes the monitor, which shows: 1. Lowering of the T waves 2. Elevation of the ST segment 3. Shortening of the QRS complex 4. Increased deflection of the Q wave
1. Lowering of the T waves Hypokalemia causes a flattening of the T wave of the ECG because of its effect on muscle function.
The intake and output for a client over and 8-hour period (8 am to 4 pm) is as follows: 8 am: IV with D₅W infusing and 900 mL left in bag 8:30 am: 150 mL urine voided 9 am to 3 pm: 200 mL gastric tube formula and 50 mL water at q3h intervals 1 pm: 220 mL voided 3:15 pm: 235 mL voided 4 pm: IV with 550 mL left in bag What is the client's total intake and output for the 8-hour period?
1100 mL input & 605 mL output
A client with cholelithiasis experiences discomfort after ingesting fatty foods because: 1. Fatty foods are hard to digest 2. Bile flow into the intestine is obstructed 3. The liver is manufacturing inadequate bile 4. There is inadequate closure of the ampulla of Vater
2. Bile flow into the intestine is obstructed
The nurse suspects the development of compartment syndrome for a client who has sustained blunt trauma to the forearm. The early symptom most indicative of compartment syndrome would be: 1. Warm skin at the site of injury 2. Escalating pain in the fingers 3. Slow capillary refill in affected hand 4, Bounding radial pulse in the injured arm
2. Escalating pain in the fingers Restricted blood flow causes increased ischemia and increased pain.
A client is admitted with diarrhea, anorexia, weight loss, and abdominal cramps. A diagnosis of colitis is made. The symptoms of fluid and electrolyte imbalance caused by this condition that the nurse should report immediately are: 1. Skin rash, diarrhea, and diplopia 2. Extreme muscle weakness and tachycardia 3. Development of tetany with muscle spasms 4. Nausea, vomiting, and leg and stomach cramps
2. Extreme muscle weakness and tachycardia K+ is a major intracellular cation, and is required for neuromuscular activity and contraction of muscle fibers (especially in heart muscle).
The weight of extracellular body fluid is approximately 20% of the total body weight of an average individual. The component of the extracellular fluid that contributes the greatest portion to this amount is the: 1. Plasma fluid 2. Interstitial fluid 3. Fluid in dense tissue 4. Fluid in body secretions
2. Interstitial fluid ~ 16% of body weight
The type of hepatitis most frequently transmitted transmitted by transfusion is: 1. Hepatitis A 2. Hepatitis B 3. Hepatitis C 4. Hepatitis D
3. Hepatitis C It's caused by an RNA virus that is transmitted parentally. The incubation period is 5-10 weeks.
A nurse administers an intravenous solution of 0.45% sodium chloride. With respect to human blood cells, this solution is: 1. Isotonic 2. Isomeric 3. Hypotonic 4. Hypertonic
3. Hypotonic Hypotonic solutions are less concentrated than body fluids (< than 0.85g of NaCl/100 mL)
A client has been vomiting for 24 hours and is experiencing dizziness on arising. During an assessment in the emergency department, the client's skin is pale and moist and the blood pressure is 108/70 when the client is supine and 88/60 when the client is standing. The nurse suspects this client has: 1. Hyperkalemia 2. Hypoglycemia 3. Fluid overload 4. Orthostatic hypotension
4. Orthostatic hypotension
A client is admitted with a head injury. The nurse identifies that the client's urinary retention catheter is draining large amount of clear, colorless urine. What is the most likely cause? 1. Poor renal perfusion 2. Increased serum glucose 3. Inadequate ADH secretion 4. Excess amounts of IV fluid
3. Inadequate ADH secretion
The most therapeutic diet for a client with hepatic failure would be a: 1. High-fat diet 2. Low-calorie diet 3. Low-protein diet 4. High-sodium diet
3. Low-protein diet With liver failure, the protein intake is limited to 20 grams daily to decrease the possibility of hepatic encephalopathy.
Potassium chloride, 20 mEq is to be added to the IV solution of a client in diabetic ketoacidosis. The primary purpose for administering this drug is: 1. Treatment of hyperpnea 2. Prevention of flaccid paralysis 3. Replacement of excessive losses 4. Treatment of cardiac dysrhythmias
3. Replacement of excessive losses
Two body system that interact with the bicarbonate buffer system to preserve the normal body fluid pH of 7.4 are the: 1. Skeletal and nervous system 2. Circulatory and urinary system 3. Respiratory and urinary systems 4. Muscular and endocrine systems
3. Respiratory and urinary systems
An IV of 1000 mL 5% dextrose in water to be infused as 125 mL/hr is started on admission to correct a client's fluid imbalance. The infusion set delivers 15 drops per milliliter. To regulate the rate of flow so that the solution would be infused over an 8-hour period, the nurse should set the rate of flow at how many drops per minute?
31 gtt/min
The client is receiving 5% dextrose in water at a slow rate. The nurse should be aware that the longest period of time that one bottle can be infused without producing untoward effects is: 1. 6 hours 2. 12 hours 3. 18 hours 4. 24 hours
4. 24 hours
The nurse suspects hypokalemia is present when a client has: 1. Edema 2. Muscle spasms 3. Kussmaul breathing 4. Abdominal distention
4. Abdominal distention Hypokalemia diminishes the magnitude of the neuronal and muscle cell resting potentials. This results from flaccidity of intestinal and abdominal musculature.
A client has an interference in bile utilization causes by cholecystitis. The nurse understands that the ejection of bile into the alimentary tract is controlled by the hormone: 1. Gastrin 2. Secretin 3. Enterocrinin 4. Cholecystokinin
4. Cholecystokinin Cholecystokinin is a widely distributed hormone whose functions include stimulation of gallbladder contraction and the release of pancreatic enzymes.
The nurse understands that the ascites seen in cirrhosis results in part from: 1. The escape of lymph into the abdominal cavity directly from the inflamed liver sinusoid 2. Increased plasma colloid osmotic pressure due to excessive liver growth and metabolism 3. The decreased levels of ADH and aldosterone due to increasing metabolic activity in the liver 4. Compression of the portal veins, with resultant increased back pressure in the portal venous system
4. Compression of the portal veins, with resultant increased back pressure in the portal venous system
The nurse recognizes that the main role of the liver in relation to fat metabolism is: 1. Producing phospholipids 2. Storing fat for energy reserves 3. Oxidizing fatty acids to produce energy 4. Converting fat to lipoproteins for rapid transport out into the body
4. Converting fat to lipoproteins for rapid transport out into the body Simple protein combines with a lipid to form a lipoprotein. Lipoproteins circulate freely in the blood and can be utilized easily and quickly in various metabolic processes.
The client who has an increased risk for developing hyperkalemia would be a client with: 1. Crohn's disease 2. Cushing's syndrome 3. Chronic heart failure 4. End-stage renal disease
4. End-stage renal disease
A client's arterial blood gas report indicates the pH is 7.52, PaCO₂ is 32 mmHg, and HCO₃⁻ is 24 mEq/L. What is a possible cause of these results? 1. Airway obstruction 2. Inadequate nutrition 3. Prolonged gastric suction 4. Excessive mechanical ventilation
4. Excessive mechanical ventilation
When caring for a client with a portable wound drainage system, the nurse understand that the principle behind its functioning is: 1. Gravity causes liquids to flow down a pressure gradient 2. The lumen diameter will determine the rate of fluid flow 3. Siphonage causes fluids to flow from one level to a lower one 4. Fluids flow from an ear of higher pressure to one of lower pressure
4. Fluids flow from an ear of higher pressure to one of lower pressure
When teaching an athletic teenager about nutrition intake, the nurse should explain that the carbohydrate food that would provide the quickest source of energy is a: 1. Glass of milk 2. Slice of bread 3. Chocolate candy bar 4. Glass of orange juice
4. Glass of orange juice
When assessing a client with portal hypertension, the nurse should be alert for indications of: 1. Liver abscess 2. Intestinal obstruction 3. Perforation of the duodenum 4. Hemorrhage from esophageal varices
4. Hemorrhage from esophageal varices
The nurse administers serum albumin to a client to assist in: 1. Clotting of blood 2. Formation of RBCs 3. Activation of WBCs 4. Maintenance of oncotic pressure
4. Maintenance of oncotic pressure
The major digestive changes in fat are accomplished in the small intestine by lipase from the pancreas. The enzymatic activity of lipase: 1. Synthesizes new triglycerides from the dietary fat consumed 2. Emulsifies the fat globules and reduces surface tension 3. Easily breaks down all the dietary fat to fatty acids and glycerol 4. Splits off all the fatty acids in about 30% of the total dietary fat consumed
4. Splits off all the fatty acids in about 30% of the total dietary fat consumed Lipase aids in the digestion of fats, but does not break down all dietary fat.
The cooked food most likely to remain contaminated by the virus that causes hepatitis A is: 1. Canned tuna 2. Broiled shrimp 3. Baked haddock 4. Steamed lobster
4. Steamed lobster The temperature in steaming is never enough or sustained long enough to kill organisms.
The main function of adipose tissue in fat metabolism is synthesizing and: 1. Releasing glucose for energy 2. Regulating cholesterol production 3. Using lipoproteins for fat transport 4. Storing triglycerides for energy reserves
4. Storing triglycerides for energy reserves When energy is required, the fatty tissues are mobilized from adipose tissue for fuel.
A client with esophageal cancer is to receive total parenteral nutrition. A right subclavian catheter is inserted by the physician. The nurse knows that the primary reason for using a central line is that: 1. It prevents the development of phlebitis 2. There is less chance of this infusion infiltrating 3. It is more convenient so clients can use their hands 4. The large amount of blood helps to dilute the concentrated solution
4. The large amount of blood helps to dilute the concentrated solution