Study Review CH 44, 52

Rupture of a cerebral aneurysm should be suspected if the patient reports

sudden, severe headache. Response Feedback: Warning leaks may occur before an aneurysm ruptures and often produce severe headache, which is typically described by the patient as "the worst headache I have ever had." Ringing in the ears is not a symptom associated with rupture of a cerebral aneurysm. Transient episodes of numbness are not indicative of a cerebral aneurysm rupture. Transient episodes of vertigo are not indicative of a cerebral aneurysm rupture.

Risk factors for hemorrhagic stroke include

acute hypertension. Response Feedback: Intracerebral hemorrhage is a hemorrhage within the brain parenchyma and usually occurs in the context of severe and often long-standing hypertension. Risk factors for stroke are similar to those for other atherosclerotic vascular disease. Cardiac disease complicated by atrial fibrillation is an important risk factor for embolic stroke. Sedentary lifestyle is not a risk factor for hemorrhagic stroke.

Rheumatoid arthritis is commonly associated with the presence of rheumatoid factor autoantibodies in the bloodstream. This indicates that rheumatoid arthritis is likely to be

an autoimmune process. Response Feedback: The presence of rheumatoid factor autoantibodies indicates that RA is an autoimmune process. The presence of rheumatoid factor autoantibodies does not indicate infection, an infective process, or an enzymatic defect.

Rheumatoid arthritis involves joint inflammation caused by

autoimmune injury. Response Feedback: Rheumatoid arthritis is caused by autoimmune injury to synovial joints. Rheumatoid arthritis is not a joint infection, is not caused by trauma, and is not caused by congenital hypermobility.

Systemic lupus erythematosus (SLE) is a rheumatic disease attributed to

autoimmune mechanisms. Response Feedback: Systemic lupus erythematosus (SLE) is a rheumatic disease attributed to autoimmune mechanisms. Wear and tear on weight-bearing joints and septic joint inflammation and necrosis do not lead to SLE. SLE is known to be attributed to autoimmune mechanisms.

The most important preventative measure for hemorrhagic stroke is

blood pressure control. Response Feedback: Hemorrhagic stroke is a hemorrhage that is usually the result of longstanding hypertension. Blood pressure control is the most important preventative measure. Anticoagulation would be useful for preventing embolic stroke. Risk reduction strategies for thrombotic stroke are aimed at reducing atherosclerosis. Dysrhythmias are not related to a risk of hemorrhagic stroke.

The chief pathologic features of osteoarthritis are

degeneration of articular cartilage, destruction of the bone under the cartilage, and thickening of the synovium. Response Feedback: The chief pathologic features of osteoarthritis are degeneration of articular cartilage, destruction of the bone under the cartilage, and thickening of the synovium. Although osteoarthritis does involve formation of bone spurs, all the other answer choices listed do not occur with osteoarthritis.

Characteristics of gout include (Select all that apply.)

disturbed uric acid metabolism. crystalline deposits in bony and connective tissue. cardiac involvement. renal involvement. Response Feedback: Gout is caused by a disturbance in uric acid metabolism and leads to crystalline deposits in bony and connective tissue (tophi). Tophi can deposit in cardiac and renal tissue. In women the onset is post-menopause.

It is true that encephalitis is usually

due to a viral infection in brain cells. Response Feedback: Encephalitis is an inflammation of the brain which is caused by a variety of agents. Viral causes account for the majority of encephalitis cases. Bacteria can be responsible for the inflammation of the brain associated with encephalitis. Death occurs in 5% to 20% of encephalitis cases. Clinical manifestations of HSV encephalitis typically evolve over several days.

Signs/symptoms of Lyme disease include (Select all that apply.)

fever and chills. arthritic pain. headache. myalgia. Response Feedback: Manifestations of Lyme disease include fever and chills, arthritic pain, headache, and myalgia. A migratory rash does not occur in Lyme disease. A single characteristic lesion at the site of the tick bite is annular in nature.

Gouty arthritis is a complication of

inadequate renal excretion of uric acid. Response Feedback: Gouty arthritis is a complication of inadequate renal excretion of uric acid. Rheumatic fever-related arthritis is related to group A streptococcal infection. Gout is not an autoimmune disorder. Gout is due to inadequate renal excretion of uric acid, not excessive production of urea.

It is true that scleroderma involves

inflammation and fibrosis of connective tissue. Response Feedback: Scleroderma involves fibrosis of connective tissue. Myasthenia gravis involves autoantibodies against acetylcholine receptors. Rheumatic fever involves infection by beta-hemolytic streptococcus. Lyme disease is thought to involve inflammation due to antigenic fragments of dead organisms.

Ankylosing spondylitis is characterized by

inflammation, stiffness, and fusion of spinal joints. Response Feedback: Ankylosing spondylitis is characterized by inflammation, stiffness, and fusion of spinal joints. Osteoarthritis involves loss of articular cartilage in weight-bearing joints. Paget's disease involves excessive bone remodeling leading to soft bone. RA involves immune mechanisms leading to widespread joint inflammation.

Ankylosing spondylitis causes

intervertebral joint fusion. Response Feedback: Ankylosing spondylitis causes joint fibrosis, ossification, and fusion, most commonly of the intervertebral and sacroiliac joints. Ankylosing spondylitis does not cause instability of synovial joints, degeneration of cartilage, or temporomandibular joint degeneration.

A college student living in a dormitory, reports a stiff neck and headache and is found to have a fever of 102° F. This information is most consistent with

meningitis. Response Feedback: The combination of headache, fever, stiff neck, and signs of confusion are classic symptoms of meningitis. Clinical manifestations of encephalitis include fever, headache, and confusion that evolve over several days. Symptoms of a skull fracture are unrelated to fever and headache. Fever is not associated with cerebral ischemia.

The most important determinant for prescribing therapy for acute stroke is

ischemic versus hemorrhagic cause. Response Feedback: Treatment pathways differ between ischemic and hemorrhagic stroke. The goals of therapy for ischemic stroke are to minimize infarct size and preserve neurologic function. Secondary prevention for thrombotic stroke includes lifestyle modification to address risk factors. It is critical to prevent further hypoxia or ischemia after ischemic stroke regardless of the age of the patient.

A clinical finding consistent with a diagnosis of rheumatoid arthritis would be

systemic manifestations of inflammation. Response Feedback: Systemic manifestations of inflammation is a clinical finding consistent with rheumatoid arthritis. The pain of rheumatoid arthritis is not localized to weight-bearing joint. Uric acid is not a causative factor in this disorder. Gout causes firm, crystallized nodules, or "tophi," at the affected joints.

Cerebral aneurysm is most frequently the result of

subarachnoid hemorrhage. Response Feedback: Although trauma is an important cause of subarachnoid hemorrhage, it is more commonly associated with rupture of cerebral aneurysms. Embolic stroke is usually from a cardiac source. Subdural hematomas are related to trauma. Meningitis is caused by microbial invasion of the CNS.

In contrast to osteoarthritis, rheumatoid arthritis may be associated with

systemic aching in the musculoskeletal system. Response Feedback: Rheumatoid arthritis is associated with systemic aching in the musculoskeletal system, but osteoarthritis is not. Osteoarthritis also causes debilitating joint pain and stiffness. Aspirin therapy will improve symptoms in both disorders. Both disorders can lead to changes in activities of daily living.

"Tell me again the name of that chemical that makes crystals when my gout flares up," asks the client. The nurse's best response is

uric acid. Response Feedback: Gout occurs when uric acid crystals form in joints. Calcium phosphate and beta-hydroxybutyric acid do not lead to crystal formation in gout. Uric acid, not urea, leads to crystal formation in gout.