Mid term patho 3
A student makes the statement to a colleague, "Blood plasma is essentially just a carrier for the formed cells like red blood cells and white blood cells." What would be the most accurate response to this statement?
"Actually, plasma plays a significant role in nutrient and waste transport." Rationale: Plasma proteins are integral to transport. They are not noted to contribute to the inflammatory response, hematopoiesis, protein synthesis, or liver function. p 538
Two nursing students are attempting to differentiate between the presentations of immune thrombocytopenic purpura (ITP) and thrombotic thrombocytopenic purpura (TTP). Which of the students' statements best captures an aspect of the two health problems?
"Both of them involve low platelet counts, but in TTP there can be more, not less, hemostasis . Rationale: TTP is marked by sudden and severe thrombotic involvement. Neither disease has an etiology of low thrombopoietin production, and TTP, not ITP, is rooted in an enzyme deficiency. ITP is normally treated with corticosteroids and/or immunoglobulins. p 555
Amniocentesis has suggested that a couple's first child will be born with sickle cell disease. The parents are unfamiliar with the health problem and their caregiver is explaining the complexities. Which statement by the parents would suggest a need for further teaching or clarification?
"Our son or daughter likely won't show the effects of sickling until he or she is school-aged because of the different hemoglobin in babies." ~Rationale: Fetal hemoglobin in the infant is replaced by 8 or 10 weeks of age and manifestations of sickle cell disease can begin at this time. Early destruction, low oxygen levels, and sickled cells all convey aspects of sickle cell disease. p575
A client with a diagnosis of hemolytic anemia has gone to a community-based laboratory for follow-up blood work. The lab technician confirms with the client that hematocrit is one of the components of the blood work. The client replies, "I thought the point of the blood work was to see how many red blood cells I have today." How could the technician best respond to the client's statement?
"The hematocrit measures the mass that your red blood cells account for in a quantity of your blood."~ Rationale: Hematocrit measures the mass of erythrocytes in a given quantity of blood plasma. It does not measure the number of red cells, their size, or their production rate and age. p 566
The nurse is preparing to administer rasburicase to a client undergoing chemotherapy. How should the nurse explain the purpose of this medication to the client?
"This drug helps reduce uric acid levels and protect your kidneys." Rationale: Tumor lysis syndrome can lead to hyperuricemia due to necrosis of malignant cells during chemotherapy. Aggressive prophylactic hydration and administration of rasburicase reduces uric acid levels and help prevent uric acid-related acute kidney injury. It is not bladder-protective, does not alter phosphate levels, and is not an antiemetic. p 599
A child with leukemia hears the health care provider tell the parents that the child has "pancytopenia." This child asks the nurse, "What does 'pancy' mean? Am I going to die?" Which response by the nurse is most appropriate for this 10-year-old child?
"This means the chemotherapy has lowered your blood counts including red blood cells, white blood cells and platelets. You are very sick, but we are working hard to make you healthy again." ~Rationale: Telling a 10-year-old child the truth is usually the best strategy. Most children of this age understand the basic info about blood components so the nurse should explain that the chemotherapy has lowered the blood counts including red blood cells, white bloods cells and platelets. The chemotherapy is not attacking the bone marrow specifically but interfers with production of rapidly dividing cells. The statement about the possibility of death if the child starts bleeding badly might scare a child but definitely can be addressed with and when the child gets critical. The child might be tired with low counts; however, resting alone will not normalize their blood counts. p 543
A client with visual agnosia due to extensive damage to the visual association cortex is learning how to cope with this impairment. What should the nurse prioritize in teaching this client? A. Applying touch and sound when interacting in the environment will lessen the deficits of visual agnosia B. The ocular pain associated with the condition can be treated with topical anti-inflammatory medication. C. Because the condition will lead to blindness, programs which help the client adjust to vision loss are a priority. D. Visual agnosia is a benign condition similar to color blindness and will not greatly affect the client's quality of life.
. Applying touch and sound when interacting in the environment will lessen the deficits of visual agnosia Rationale: Extensive damage to the visual association cortex that surrounds an intact primary visual cortex results in a loss of the learned meaningfulness of visual images (i.e., visual agnosia). The person can see the patterns of color, shapes, and movement, but no longer can recognize formerly meaningful stimuli that affect the person's quality of life. However, if other sensory modalities, such as hearing and touch, can be applied, full recognition occurs. This is not a painful condition and does not lead to blindness. p. 507
When talking about the lifespan of various blood components, the students should know that once a neutrophil moves into tissue, it lives approximately how long?
4 days.~ Rationale: After release from the marrow, the neutrophils spend only approximately 4-8 hours in the circulation before moving into the tissues. They survive in the tissues for approximately 4-5 days. They die in the tissues by discharging their phagocytic function p 539
While working at the triage desk in the local emergency department, which client is likely having a medical emergency and needs to be seen first? A. 17-year-old high school student who has a red, itchy eye B. 55-year-old truck driver complaining of sudden onset of ocular pain and blurred vision C. 45-year-old schoolteacher complaining of a red eye that is draining yellow secretions D. Infant with red eyes who is irritable and refusing to eat
55-year-old truck driver complaining of sudden onset of ocular pain and blurred vision Rationale: Attacks of increased intraocular pressure are manifested by ocular pain and blurred vision caused by corneal edema. Acute angle-closure glaucoma is an ophthalmic emergency. Treatment is directed at reducing the intraocular pressure, usually with pharmacologic agents p 492
In which client would diagnostic investigations be least likely to reveal increased thrombopoietin production? A. An 81-year-old woman with diagnoses of rheumatoid arthritis and failure to thrive B. A 55-year-old man with dehydration secondary to Crohn disease C.A 66-year-old woman with a diagnosis of lung cancer with bone metastases D. A 21-year-old woman awaiting bone marrow transplant for myelogenous leukemia
A 21-year-old woman awaiting bone marrow transplant for myelogenous leukemia Rationale: Diseases such as myelogenous leukemia and other cases of primary thrombocytosis result in abnormalities in the thrombopoietin receptor and platelet binding. Cases of secondary thrombocytosis have an etiology rooted in increased thrombopoietin production. The common underlying causes of secondary thrombocytosis include tissue damage due to surgery, infection, cancer, and chronic inflammatory conditions such as rheumatoid arthritis and Crohn disease. p 551
The nurse is planning care for a group of clients. Which client should the nurse assess first? A. A 25-year-old client with an absolute neutrophil count of 300/mm3 (0.30 x 109/L) B. An 82-year-old client with a hemoglobin of 9.0 g/dL (90 g/L) C. A 65-year-old client with a white blood cell count of 15,200/μL (15.2 x 109/L) D. A 45-year-old client with a platelet count of 100,000/mm3 (100 x 109/L)
A 25-year-old client with an absolute neutrophil count of 300/mm3 (0.30 x 109/L) Rationale: All the clients have abnormal laboratory values, but the client with an absolute neutrophil count of 300/mm3(0.30 x 109/L) is at greatest risk for a life-threatening condition. Untreated infections can be rapidly fatal in clients with severe neutropenia. Additionally, the usual signs of infection may not be present, warranting a closer assessment. Finally, the client should be protected from exposure to any microorganisms, making the assessment of this client the correct choice. The other clients would be assessed in an order based on the degree of change these results represented compared to their baseline values p 591 p
Which individuals would most likely possess normal plasma cell synthesis and fully differentiated myeloid and lymphoid cells? A. A 7-year-old boy with a diagnosis of acute lymphocytic leukemia (ALL). B. A 70-year-old male who has acute myelogenous leukemia (AML) C. A 58-year-old female with HIV and multiple myeloma D. A 78-year-old male who has been diagnosed with chronic lymphocytic leukemia (CLL).
A 78-year-old male who has been diagnosed with chronic lymphocytic leukemia (CLL). ~Rationale: Chronic leukemia is associated with proliferation of myeloid and lymphoid cells that are better differentiated than in cases of acute leukemia. Multiple myeloma would denote abnormalities of the plasma cells. p 600
which individual is most likely to be diagnosed with a central vestibular disorder?
A women who has ongoing difficulty balancing herself when walking. Rational: Central vestibular disorders are marked by sensation of motion that interferes with balance, but that is mild and constant and chronic in duration. It should be differentiated from postural hypotension, loss of balance from a head injury, or motion sickness p 531
A client with a gastrointestinal bleed secondary to alcohol abuse and a hemoglobin level of 5.8 g/dL (58 g/L) has been prescribed a transfusion of packed red blood cells. The client possesses type B antibodies but lacks type D antigens on his red cells. Transfusion of which blood type would be least likely to produce a transfusion reaction? A. B- B. B+ C. A+ D. A-
A- Rationale: The client's blood type is A-, and would necessitate A- or O- donor blood. Other types would induce a transfusion reaction. p 569
A 32-year-old woman presents at her health clinic complaining of weakness, feeling of abdominal fullness, 6-month history of fatigue and night sweats. She added a multivitamin with iron and some extra meat and leafy greens to her diet but has not experienced an increase in energy. Upon assessment, her spleen was noted to be enlarged. Which diagnosis is most likely associated with her manifestations?
Accelerated chronic myelogenous leukemia Rationale: Typically, chronic myelogenous leukemia (CML) follows a triphasic course: (1) a chronic phase of variable length, (2) a short accelerated phase, and (3) a terminal blast crisis phase. The onset of the chronic phase is usually slow with nonspecific symptoms. Anemia causes weakness, easy fatigability, and exertional dyspnea. The accelerated phase is characterized by enlargement of the spleen and progressive symptoms. Persons with Hodgkin disease are commonly designated as stage A if they lack constitutional symptoms and stage B if significant weight loss, fevers, pruritus, or night sweats are present. In cases of infectious mononucleosis, most persons seek medical attention for severe pharyngitis, which usually is most severe on days 5 through 7 and persists for a total of 7 to 14 days. CLL is mainly a disorder of older persons; fewer than 10 percent of those who develop the disease are younger than 50 years of age. Men are affected twice as often as women. p 600-601
A 46 year-old male has presented to the emergency department because of the eye pain, severe headache and blurred vision that has followed an eye exam at an optometrist's office earlier in the day. The client tells the triage nurse that he received eye drops during the exam "to keep my pupils wide open." What differential diagnosis will the care team first suspect?
Angle-closure glaucoma~ Rationale: Symptoms of acute angle-closure glaucoma are related to sudden, intermittent increases in intraocular pressure. These occur after prolonged periods in the dark, emotional upset, and other conditions that cause extensive and prolonged dilation of the pupil. Administration of pharmacologic agents such as atropine that cause pupillary dilation (mydriasis) also can precipitate an acute episode of increased intraocular pressure in persons with the potential for angle-closure glaucoma. Attacks of increased intraocular pressure are manifested by ocular pain and blurred or iridescent vision. The man's symptomatology is not characteristic of conjunctivitis, corneal trauma, or keratitis. p 491-492
Following a bone marrow biopsy, which assessment would indicate the client is experiencing a complication as a result of this diagnostic procedure?
BP 90/60, heart rate 132, excess bleeding, and hematoma noted at insertion site. Rationale: The major hazard of a bone marrow biopsy is the risk of hemorrhage. This is usually seen by a decrease in BP, tachycardia, edema from blood pooling in the tissues, etc. All of the other answers contain signs/symptoms other than shock. Crackles in the lungs correlate with fluid/secretions in the lungs. A bone marrow aspiration is usually performed on the posterior iliac crest and should not cause an elevated respiratory rate. A low-grade fever is not considered a complication. p 543-544
A 16-year-old female has been brought to her primary care physician by her mother due to the girl's persistent sore throat and malaise. Which fact revealed in the girl's history and examination would lead the physician to rule out infectious mononucleosis?
Chest auscultation reveals crackles in her lower lung fields bilaterally.~ Rationale: While fever, enlarged lymph nodes, splenomegaly, hepatomegaly, and leukocytosis would suggest mononucleosis, adventitious lung sounds are not associated with the disease. p 596
From the assigned team of clients, which client is at highest risk for the development of endothelial damage that may lead to disseminated intravascular coagulation (DIC) A. Client who had an automobile accident client and sustained three broken ribs resulting in a small pneumothorax B .Adolescent clilent who developed blisters on the back from sunbathing requiring pain medication C. Client with chronic obstructive pulmonary disease (COPD) who is diagnosed with pneumonia, most likely from a virus D. Client on a monitor displaying frequent premature ventricular contractions (PCVs)
Client with chronic obstructive pulmonary disease (COPD) who is diagnosed with pneumonia, most likely from a virus Rationale: Endothelial damage may be caused by viruses, infections, immune mechanisms, stasis of blood, or temperature extremes. Therefore, the client with COPD and a viral pneumonia is at greatest risk for developing DIC. DIC is not associated with pneumothorax from a rib fracture, sunburn with blisters, or cardiac arrhythmias p 557
The nurse is caring for a client with jaundice. What evidence will the nurse use to determine if the cause of the jaundice is due to a hemolytic condition?
Elevated unconjugated bilirubin Rationale: If the jaundice is related to red cell destruction, unconjugated bilirubin accumulates in the blood; this represents products of red cell destruction that have not been converted to water soluble form by hepatocytes. Although hemoglobin may be low, this is not evidence of what is contributing to jaundice. Liver function tests will not be altered in jaundice that is related to hemolysis but would reflect hepatic causes. In this case, conjugated bilirubin levels may also be elevated, not decreased; decreased levels are not considered clinically significant. p 565
A 75-year-old client has been having chronic corneal irritation and is being scheduled for surgical correction of the eyelid. What condition should the nurse recognize the client is having corrected?
Entropion~ Rationale: Entropion is a turning in of the lid margin caused by scarring of the palpebral conjunctiva or degeneration of the fascial attachments to the lower lid that occurs with aging. Corneal irritation may occur as the eyelashes turn inward. Entropion and ectropion can be treated surgically. Blepharitis and conjunctivitis are treated with antibiotics; herpes simplex keratitis is treated with antiviral medications. p 483
Which glycoprotein is responsible for treating such diseases as bone marrow failure following chemotherapy and hematopoietic neoplasms such as leukemia?
Growth factors and cytokines. Rationale: The identification and characterization of the various growth factors and cytokines has led to their use in treating a wide range of diseases like bone marrow failure, hematopoietic neoplasms, infectious diseases, and congenital and myeloproliferative disorders. Neutrophils are primarily responsible for maintaining normal host defenses against invading bacteria, cell debris, or foreign substances. Eosinophils increase in number during allergic reactions and parasitic infections. T lymphocytes are involved in cell-mediated immunity. Natural killer cells participate in innate or natural immunity and their function is to destroy foreign cells. Granulocytes are phagocytic cells. p 602
Which assessment and laboratory findings would be most closely associated with acute leukemia?
High blast cell counts and fever Rationale: Acute leukemia is often marked by a fever as well as leukostasis. Changes in oxygen saturation, electrolytes and BUN would be less closely associated with ALL and AML. p 599
A 31-year-old female has been recently diagnosed with type 2 diabetes mellitus, and is attending a diabetes education class. Which statement by the woman demonstrates an accurate understanding of her health problem
I'll have to control my blood sugars, my blood pressure, and my cholesterol in order to make sure I don't develop sight problems." Rationale: The threat to vision that is posed by poorly controlled blood sugars is compounded by high blood pressure and/or cholesterol levels. Pregnant women with diabetes need additional care to monitor their sight, but they are not necessarily guaranteed to lose their sight. The damage caused by diabetes does not occur on the lens and restoration of lost visual acuity is not normally possible. p 500
While being on subcutaneous heparin injections for deep vein thrombosis during the third trimester of her pregnancy, a client begins to experience major side effects. Her OB physician has called in a specialist who thinks the client is experiencing heparin-induced thrombocytopenia. The nurse should anticipate which order?
Immediately discontinue the heparin therapy. Rationale: The treatment of HIT requires the immediate discontinuation of heparin therapy and the use of alternative anticoagulants to prevent thrombosis recurrence. Decreasing the dose will not stop the HIT. Warfarin is contraindicated in pregnancy. FFP is not called for in this situation. p 554
Following a course of measles, a 5-year-old girl developed scattered bruising over numerous body surfaces and was diagnosed with immune thrombocytopenic purpura (ITP). As part of her diagnostic workup, blood work was performed. Which result is mostlikely to be considered unexpected by the health care team?
Increased thrombopoietin levels Rationale: In ITP, thrombopoietin levels are not elevated. Platelet levels would be expected to be low, and vitamin K and leukocyte levels would be unlikely to be abnormal. p 551
Misinterpreting her physician's instructions, a 69-year-old woman with a history of peripheral artery disease has been taking two 325 mg tablets of aspirin daily. How has this most likely affected her hemostatic status?
Irreversible acetylation of platelet cyclooxygenase activity has occurred. Rationale: Aspirin can cause inhibition of platelet aggregation that last for the life of the platelet. High TXA2 levels would be associated with increased coagulability. ITP would not result from aspirin intake, and binding of an antibody to platelet factor 4 is associated with heparin-induced thrombocytopenia. p 546-547
A 30 year-old male's blood work and biopsies indicate that he has proliferating osteoclasts that are producing large amounts of IgG. What is the man's most likely diagnosis?
Multiple myeloma Rationale: One of the characteristics resulting from the proliferating osteoclasts in multiple myeloma is the unregulated production of a monoclonal antibody referred to as the M protein. In most cases the M protein is either IgG or IgA. This phenomenon is not present in cases of CML, ALL or Hodgkin lymphoma. p 602
A 30-year-old woman has presented to her family doctor reporting three distressing episodes over the last several months in which she got extremely dizzy, had loud ringing in her ears and felt like her ears were full of fluid. She states that her hearing diminishes and she feels nauseous during these episodes. What diagnosis is the physician most likely to first suspect?
Ménière disease~ Rationale: Ménière disease is characterized by fluctuating episodes of tinnitus, feelings of ear fullness, and violent rotary vertigo that often renders the person unable to sit or walk. There is a need to lie quietly with the head fixed in a comfortable position, avoiding all head movements that aggravate the vertigo. Symptoms referable to the autonomic nervous system, including pallor, sweating, nausea, and vomiting, usually are present. The more severe the attack, the more prominent the autonomic manifestations. A fluctuating hearing loss occurs with a return to normal after the episode subsides. Her symptomatology is not characteristic of AOM, acute vestibular neuronitis, or BPPV. p531
A 29-year-old woman has been diagnosed with otosclerosis after several years of progressive hearing loss. What pathophysiologic process has characterized her diagnosis?
New spongy bone has been formed around her stapes and oval window. Rationale: Otosclerosis begins with resorption of bone in one or more foci. During active bone resorption, the bone structure appears spongy and softer than normal (i.e., otospongiosis). The resorbed bone is replaced by an overgrowth of new, hard, sclerotic bone. Distortion of neural pathways, resorption of the temporal bone, and filling of the tympanic cavity do not occur with otosclerosis. p 521
When discussing the sequence of clot dissolution, the science instructor will talk about which item that begins the process?
Plasminogen Rationale: As with clot formation, clot dissolution requires a sequence of steps controlled by activators and inhibitors. Plasminogen, the proenzyme for the fibrinolytic process, normally is present in the blood in its inactive form. It is converted to its active form, plasmin, by plasminogen activators formed in the vascular endothelium, liver, and kidneys. Dabigatran is an anticoagulant. Platelets actually help cells stick together or adhere. p 548
A 29-year-old construction worker got a sliver under his fingernail 4 days ago. The affected finger is now reddened, painful, swollen, and warm to the touch. Which of the following hematologic processes is most likely occurring in the bone marrow in response to the infection?
Proliferation of immature neutrophils Rationale: A part of the immune response is the proliferation of neutrophils in response to i~nfectious organisms. Neutrophilia is an increase in immature neutrophils ("bands") most commonly seen in acute infections and tissue injuries that promote the accelerated release of neutrophils and their precursors into the circulation. Myeloblasts are not normally found in circulation, and segmented neutrophils would not yet have reached maturity (takes ~2 weeks to mature). Myelocytes do not perform phagocytosis. p 542
A pediatric health care worker is presenting education to a group of new parents on measures to prevent acute otitis media (AOM). Which topics will the provider include in this education? Select all that apply. A. Blow a warm breath into each ear upon the infant's awakening. B. Pull the outer ear gently straight back at least twice a day. C. Provide routine vaccinations against pneumococci and influenza. D. Avoid feeding infants while lying down and propping the bottle. E. Eliminate all household smoking. F. Provide chewing gum or candy after a bath to clear water from the ears
Provide routine vaccinations against pneumococci and influenza. Rationale: Measusres can be taken to reduce the risk of contracting or preventing the development of AOM. These include: providing routine vaccinations against pneumococci (specifically PCV 13) and annual influenza vaccine; eliminating all household smoking; if possible, exclusively breastfeeding until at least 6 months of age; avoiding feeding infants while lying down and propping bottles; and, selecting daycare facilities with a small staff-to-child ratio. Blowing a warm breath into each ear, pulling the outer ear gently straight back, and providing chewing gum or candy after a bath will not prevent AOM. p 518
A client has been suffering from fatigue and the health care provider suspects anemia. Which test results will the health care provider consult when investigating the cause of the anemia?
RBC indices Rationale: RBC indices reflect the size, shape, or color of the RBCs and are used to help indicate what type of anemia a person has. For example, a low mean corpuscular volume (MCV) indicates a small cell, and a low mean corpuscular hemoglobin concentration (MCHC) and mean corpuscular hemoglobin (MCH) indicate a pale cell that correlates with iron deficiency anemia. Hemoglobin, hematocrit, and RBC levels will all be lower in the client with anemia, but these levels cannot help determine the cause. p 543
Following focal seizures that have damaged the dominant hemisphere of a client's auditory association cortex, the nurse may observe the client displaying:
Receptive aphasia Rationale: Damage to the auditory association cortex, especially if bilateral, results in deficiencies of sound recognition and memory (auditory agnosia). If the damage is in the dominant hemisphere, speech recognition can be affected (sensory or receptive aphasia). The others are not caused by focal seizures. p 524
The nurse takes a client's blood pressure in the primary care provider's office. The last three times the client has been in the office it has been high. What structure in the eye is this adverse effect of hypertension most likely to affect?
Retina ~Rationale: The adverse effect of hypertension most likely will affect the retina of the eye. The lens is affected with a cataract. The iris and ciliary body are not impacted p 501
A college junior calls his mother, a nurse, reporting "not being able to see." When questioned further, he describes the following: "A gray curtain just went down my right visual field. I don't know what to do." The nurse should recognize this symptom as which condition and have the teenager go to the emergency department immediately?
Retinal detachment Rationale: The primary symptom of retinal detachment consists of painless changes in vision. Commonly, flashing lights or sparks followed by small floaters or spots in the field of vision occur as the vitreous pulls away from the posterior pole of the eye. As detachment progresses, the person perceives a shadow or dark curtain progressing across the visual field. p 501
If an Rh-negative mother is giving birth to an Rh-positive infant, the nurse should be prepared to administer:
Rh immune globulin. Rationale: The injection of Rh immune globulin prevents sensitization in Rh-negative mothers who have given birth to Rh-positive infants if administered at 28 weeks' gestation and within 72 hours of delivery, abortion, or genetic amniocentesis. Antihistamines, alpha interferon, or infliximab are not used in this situation. p 565
A child has been diagnosed with thalassemia. Which of the following comorbidities may occur as a result of having thalassemia? A.Hypocoagulation B. Iron deficiency C. Splenomegaly D. Neutropenia
Splenomegaly Rationale: Thalassemia can result in enlargement of the spleen and liver due to increased hematopoiesis and red cell destruction. It is associated with thrombotic events, not hypocoagulation, as well as iron excess. Neutropenia is not associated with thalassemia. p 576
A 4 month-old infant and his mother are at an appointment with a pediatrician to follow up his nonaccommodative strabismus and determine a treatment plan. Which treatment is most likely to prevent future loss of vision?
Surgical correction of the musculature. ~Rationale: Strabismus in infancy is ideally treated by surgery rather than with glasses. The condition will not resolve independently and medications are unlikely to help the condition. p.509
During descent, an airplane passenger is complaining that his "ears are plugged." What aspect of the structure and function of the ear best accounts for the passenger's complaint?
The Eustachian tubes must remain patent to equalize pressure between the middle ear and inner ear. ~Rationale: The Eustachian tubes between the middle ear and nasopharynx must be patent to allow for changes in atmospheric pressure. Pressure is not accommodated by changing the volume of the middle ear. The tympanic membrane is not selectively permeable to air. p 517
Distraught at the persistent ringing in his ears and his inability to alleviate it, a 50-year-old man has visited his health care provider. After diagnostic testing, no objective cause (like impacted cerumen or vascular abnormality) was found. Given these testing results, which teaching point by the care provider is most appropriate?
There are some treatments like tinnitus retraining therapy, which includes the extended use of low-noise generators, which has shown good success."~ Rationale: Current treatment modalities for tinnitus address the symptoms of the problem rather than curing the underlying etiology. While therapy can be of some use, it is inaccurate to characterize tinnitus as a psychological disturbance. Medications, including antihistamines, anticonvulsant drugs, calcium channel blockers, benzodiazepines, and antidepressants, have been used for tinnitus alleviation; they are not implicated as a cause. While listening to differentiate between objective and subjective tinnitus is possible, the absence of objective sounds does not mean that tinnitus does not exist, rather that it is subjective. The use of tinnitus retraining therapy, which includes directive counseling and extended use of low-noise generators to facilitate auditory adaptation to the tinnitus, has met with considerable success. p 524
Which statement best conveys a characteristic of red blood cells?
They contribute to the maintenance of blood pH. ~Rationale: Erythrocytes contribute to acid-base balance through the production of bicarbonate and hydrogen ions. They contain soluble enzymes but are neither self-replicating nor involved in fluid balance. p 538
Following a serious bout of bacterial meningitis, the parents of a 14-month old have noted the child is not responding to verbal commands. The nurse will explain the pathophysiologic principle behind this by making which statement?
This may be due to a loss of hair cells and damage to the auditory nerve ~Rationale: Deafness or some degree of hearing impairment is the most common serious complication of bacterial meningitis in infants and children. The mechanism causing hearing impairment seems to be suppurative labyrinthitis or neuritis resulting in the loss of hair cells and damage to the auditory nerve. There is no direct connection between the meninges of the brain and the tympanic membrane. Bacterial meningitis is not associated with an increased risk of developing a brain tumor p526
A client with leukemia begins hemorrhaging from every orifice. The physician is concerned that the client has developed disseminated intravascular coagulation (DIC). The nurse should anticipate which order to be prescribed for this client? Select all that apply. A. Transfuse 2 units of platelets. B. Transfuse fresh frozen plasma. C.Give aspirin twice/day. D. Administer IV ketorolac STAT. E. Place in reverse isolation.
Transfuse 2 units of platelets. Transfuse fresh frozen plasma Rationale: The treatment of DIC is directed toward managing the primary disease, replacing clotting components, and preventing further activation of clotting mechanisms. Transfusions of fresh frozen plasma, platelets, or fibrinogen-containing cryoprecipitate may correct the clotting factor deficiency. ASA would make the bleeding worse. Ketorolac is an NSAID and should be avoided in clients with a bleeding problem. Reverse isolation is implemented for clients with pancytopenia. p 559
Which preoperative teaching point related to corneal transplantation is most accurate? A. "You should know that there is a significant risk that your body will reject the transplant." B. The cornea is highly vascular and therefore you will be at risk for hemorrhage. C. Your new cornea would come from someone who has recently died." D. "You run a risk of developing a major inflammatory response post-op and will need frequent follow-up appointments."
Your new cornea would come from someone who has recently died." ~Rationale: Advances in ophthalmologic surgery permit corneal transplantation using a cadaver cornea. The low rejection rate is due to several factors: the cornea is avascular which limits perfusion by immune elements; major histocompatibility complexes are virtually absent in the cornea; antigen-presenting cells are not present in great numbers; the cornea secretes immunosuppressive factors; and corneal cells secrete substances that protect against apoptosis, thereby minimizing inflammation. p 489
A client diagnosed with low-risk chronic lymphocytic leukemia (CLL) has recently developed thrombocytopenia. One of the medications utilized to treat this would be:
dexamethasone, a corticosteroid. Rationale: Complications of CLL include thrombocytopenia and may require treatment with corticosteroids or splenectomy. None of the other medications are used for treatment of CLL. p600
When looking at a granulocyte under a microscope, the anatomy student would describe it as:
shaped like a sphere with multilobar nuclei. Rationale: Granulocytes are spherical and have distinctive multilobar nuclei. They are all phagocytic cells that are identifiable because of their cytoplasmic granules. Agranulocytes lack granular cytoplasm. Monocytes have a large amount of cytoplasm and a nucleus in the shape of a kidney. Erythrocytes lack a cell nucleus p 539
On the first obstetric clinic visit, which client is at risk for delivering a child with sensorineural hearing loss? Select all that apply. A. woman working in an industrial factory where exposed to toluene, a solvent in paints, and styrene in manufacturing plastics B. woman with a history of renal disease who regularly takes furosemide, a loop diuretic to control blood pressure C. woman who is a business executive and regularly works 10 to 12 hours/day D. woman who is an athlete and regularly receives traumatic kicks to the torso and abdomen during soccer matches E.woman who works as a nurse on a busy intensive care unit where exposed to numerous infections
woman working in an industrial factory where exposed to toluene, a solvent in paints, and styrene in manufacturing plastics Rationale: Early in pregnancy, the embryo is particularly sensitive to toxic substances, including ototoxic drugs such as the aminoglycosides and loop diuretics. Trauma, particularly head trauma, may also cause senorineural hearing loss. Toluene and styrene are the most widely and extensively used aromatic solvents in industry and can cause ototoxicity. Toluene is a major component of adhesives, paints, lacquers, varnishes, printing inks, degreasers, fuel additives, glues and thinners, whereas styrene is present when manufacturing plastics, rubber articles, and glass fibers. The businesswoman working long hours is at no greater risk than any pregnant female. Nurses are exposed to numerous infections, but standard precautions recommended by the CDC provides good protection. p 520