Midterm Check your Understanding

Which type of leukemia primarily affects children?

ALL (acute lymphoid leukemia)

In general, the best prognosis for long-term disease-free survival occurs with

ALL (acute lymphoid leukemia).

An elderly patient's blood pressure is measured at 160/98. How would the patient's left ventricular function be affected by this level of blood pressure?

Left ventricular workload is increased with high afterload.

Massive release of histamine with consequent vasodilation and hypotension occurs with what type of shock?

Anaphylactic

What results when systemic blood pressure is increased?

Vasoconstriction

A patient with a productive cough and parenchymal infiltrates on x-ray is demonstrating symptomology of

bacterial pneumonia.

Tachycardia is an early sign of low cardiac output that occurs because of

baroreceptor activity.

Excessive red cell lysis can be detected by measuring the serum

bilirubin.

Paraneoplastic syndromes in cancer involve excessive production of substances by multiple means. A common substance found in excessive amounts resulting from cancer paraneoplastic syndromes is

calcium.

Low cardiac output in association with high preload is characteristic of ________ shock.

cardiogenic

Velocity of blood flow is measured in

centimeters per second.

A cause of thrombocytopenia includes

chemotherapy

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

cigarette smoking.

The final step in clot formation is

clot retraction.

Patent ductus arteriosus is accurately described as a(n)

communication between the aorta and the pulmonary artery.

When a patient is struck in the eye by a baseball, the result is redness and swelling. This increase in blood flow to a localized area is called

hyperemia.

Risk factors for atherosclerosis include

hyperlipidemia

Venous obstruction leads to edema because it ________ pressure.

increases capillary hydrostatic

Empyema is defined as an

infection in the pleural space.

Disseminated intravascular coagulation may be treated with heparin therapy to

inhibit clotting factor consumption.

Clinical manifestations of chronic arterial obstruction include

intermittent claudication.

Coagulative necrosis is caused by

interrupted blood supply.

Pernicious anemia is caused by a lack of

intrinsic factor.

Reperfusion injury to cells

involves formation of free radicals.

The primary source of erythropoietin is provided by the

kidney.

Critically ill patients may have parenterally administered vasoactive drugs that are adjusted according to their _____ pressure.

mean arterial

A 17-year-old college-bound student receives a vaccine against an organism that causes meningitis. This is an example of

primary prevention.

A patient with metastatic lung cancer wants to know her chances for survival. Which response is correct?

"Lung cancer has about a 15% survival rate."

The arterial oxygen content (CaO2) for a patient with PaO2 100 mm Hg, SaO2 95%, and hemoglobin 15 g/dL is _____ mL oxygen/dL.

19.4

A patient presents to the physician's office with pinpoint hemorrhages on the skin. The patient is most likely between the ages of _____ years.

4 and 7

In which dysrhythmias should treatment be instituted immediately?

Atrial fibrillation with a ventricular rate of 220 beats/minute

The therapy that most directly improves cardiac contractility in a patient with systolic heart failure is

digitalis.

A middle-aged patient has a follow up visit for a recorded blood pressure of 162/96 mm Hg taken 3 weeks ago. The patient has no significant past medical history and takes no medications, but smokes 1 1/2 packs of cigarettes per day, drinks alcohol regularly, and exercises infrequently. The patient is about 40 lbs. overweight and admits to a high-fat, high-calorie diet. At the office visit today, the patient's blood pressure is 150/92 mm Hg. What is the least appropriate intervention for this patient at this time?

Begin antihypertensive drug therapy.

Retroviruses are associated with human cancers, including

Burkitt lymphoma.

How do clinical conditions that increase vascular permeability cause edema?

By allowing plasma proteins to leak into the interstitial fluid, which draws in excess fluid by increasing the interstitial fluid osmotic pressure

Increased preload of the cardiac chambers may lead to which patient symptom?

Edema

What is the correct definition of complete remission (CR) of leukemia?

CR is less than 5% blasts in marrow and normal CBC values.

Patients with structural evidence of heart failure who exhibit no signs or symptoms are classified into which New York Heart Association heart failure class?

Class I

In which stage of shock is a patient who has lost 1200 mL of blood, who has normal blood pressure when supine, but who experiences orthostatic hypotension upon standing?

Class II, Compensated Stage

Angina caused by coronary artery spasm is called _____ angina.

Prinzmetal variant

Administration of which therapy is most appropriate for hypovolemic shock?

Crystalloids

Which clinical manifestation is not likely the result of a tuberculosis infection?

Cyanosis

The cellular component that is most susceptible to radiation injury is the

DNA.

Which alterations can lead to edema?

Decreased lymphatic flow

Hyperaldosteronism causes

ECV excess and hypokalemia.

Burkitt lymphoma is most closely associated with

Epstein-Barr virus.

A patient is diagnosed with cardiogenic shock. The patient is hyperventilating and is therefore at risk for the respiratory complication of respiratory acidosis.

False

A type of shock that includes brain trauma that results in depression of the vasomotor center is cardiogenic.

False

In general, a cancer cell that is more tissue-specific differentiated is more likely to be aggressive.

False

Seasonal allergic rhinitis is most involved in type II hypersensitivity reactions.

False

Vaccination for pneumococcal pneumonia should be performed before 1 year of age in patients with sickle cell anemia.

False

What is likely to lead to hyponatremia?

Frequent nasogastric tube irrigation with water

The characteristic x-ray findings in tuberculosis include

Ghon tubercles.

The effects of histamine release include

increased vascular permeability.

A patient who reports an intestinal fistula also reports feeling "weak and dizzy" when she stands. While taking her blood pressure she becomes temporarily unresponsive but quickly regains consciousness when put into a supine position. What nursing interventions will the nurse implement before calling the physician?

Give her water or juice and some salty crackers and ask if she has had any diarrhea or vomiting.

Which disorder is considered a primary immunodeficiency disease?

HIV/AIDS

Which electrolyte imbalances cause increased neuromuscular excitability?

Hypocalcemia and hypomagnesemia

A child with a history of recent strep throat infection develops glomerulonephritis. This is most likely a type _____ hypersensitivity reaction.

III

The principle Ig mediator of type I hypersensitivity reactions is

IgE

When exposed to inhaled allergens, a patient with asthma produces large quantities of

IgE.

What is the most likely explanation for a diagnosis of hypernatremia in an elderly patient receiving tube feeding?

Inadequate water intake

While hospitalized, an elderly patient with a history of myocardial infarction was noted to have high levels of low-density lipoproteins (LDLs). What is the significance of this finding?

Increased LDL levels are associated with increased risk of coronary artery disease.

In individuals who have asthma, exposure to an allergen to which they are sensitized leads to which pathophysiologic event?

Inflammation, mucosal edema, and bronchoconstriction

Which is not normally secreted in response to stress?

Insulin

Your patient is scheduled for a staging procedure. She wants to know what that means. The correct response is which of the following?

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

Which characteristic is indicative of hemolytic anemia?

Jaundice

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.

Latent

Dysfunction of which organ would lead to clotting factor deficiency?

Liver

Diarrhea causes

Metabolic Acidosis because its from the (ass)

Familial retinoblastoma involves the transmission of what from parent to offspring?

Mutant tumor-suppressor gene

The organism that causes pulmonary tuberculosis is

Mycobacterium tuberculosis.

Renal insufficiency is a common complication of which disease?

Myeloma

Which assessment would support a diagnosis of type A COPD rather than type B COPD

Normal PaCO2, scant sputum, accessory muscle use, barrel chest

Which group of clinical findings describes the typical presentation of ALL (acute lymphoid leukemia)?

Pain in long bones, infection, fever, bruising

Which dysrhythmia is thought to be associated with reentrant mechanisms?

Preexcitation syndrome tachycardia (Wolf-Parkinson-White syndrome)

Which is not a manifestation of acute arterial obstruction?

Purpura

The most reliable indicator that a person is experiencing an acute myocardial infarction (MI) is

ST-segment elevation.

What form of oral rehydration, bottled water or salty broth, is best suited for a patient who is demonstrating signs of clinical dehydration?

Salty soup, because it will provide some sodium to help hold the fluid in his blood vessels and interstitial fluid

A patient presenting with fever, hypotension, and lactic acidosis is most likely to be experiencing what type of shock?

Septic

Overproduction of nitric oxide is an important aspect of the pathophysiologic process of what type of shock?

Septic

Which finding is indicative of orthostatic hypotension in a person with a supine blood pressure (BP) of 110/70 and a heart rate (HR) of 100?

Sitting BP 88/60, HR 118

The majority of tachydysrhythmias are believed to occur because of

reentry mechanisms.

Which complication of asthma is life threatening?

Status asthmaticus

Which disorder is associated with a type III hypersensitivity mechanism of injury?

Systemic lupus erythematosus

The assessment findings of a 5-year-old with a history of asthma include extreme shortness of breath, nasal flaring, coughing, pulsus paradoxus, and use of accessory respiratory muscles. There is no wheezing and the chest is silent in many areas. How should you interpret your assessment?

The child may be having such a severe asthma episode that the airways are closed, so start oxygen and get the doctor immediately.

Which vessel normally demonstrates the most rapid blood flow?

The vena cava

Disseminated intravascular coagulation is a serious complication of septic shock characterized by abnormal clot formation in the microvasculature throughout the body.

True

Hemophilia B is also known as Christmas disease.

True

Lactated Ringer solution and normal saline are commonly used crystalloid solutions that contain electrolytes.

True

The anemia resulting from a deficiency of either vitamin B12 (cobalamin) or folate is caused by a disruption in DNA synthesis of the blast cells in the bone marrow that produces very large abnormal bone marrow cells called megaloblasts.

True

The ingestion of certain drugs, foods, or chemicals can lead to secondary hypertension.

True

The liver is responsible for the synthesis of coagulation factors, with the exception of part of VIII.

True

Two of the most serious oncology emergencies associated with non-Hodgkin lymphoma are obstruction of the superior vena cava and compression of the spinal cord.

True

Croup is characterized by

a barking cough.

Viral pneumonia is characterized by

a dry cough.

Mitral stenosis is associated with

a pressure gradient across the mitral valve.

Which serum biomarker(s) are indicative of irreversible damage to myocardial cells?

a) Elevated CK-MB, troponin I, and troponin T

Bacterial pneumonia leads to hypoxemia caused by

accumulation of alveolar exudates.

While in the hospital for management of acute lymphoid leukemia (ALL), a patient develops severe thrombocytopenia. The most appropriate action for this condition is

activity restriction.

COPD leads to a barrel chest, because it causes

air trapping.

All the following stress-induced hormones increase blood glucose except

aldosterone.

Selye's three phases of the stress response include all the following except

allostasis

The majority of cases of anaphylactic shock occur when a sensitized individual comes in contact with

antibiotics

Proto-oncogenes

are normal cellular genes that promote growth.

A commonly ingested substance associated with prolongation of the bleeding time is

aspirin.

Effects of hypernatremia on the central nervous system typically include

confusion

Apoptosis is a process that results in cellular

death.

Hypernatremia may be caused by

decreased antidiuretic hormone secretion.

Total body water in older adults is

decreased because of increased adipose tissue and decreased muscle mass.

Extreme cold injures cells by all the following except

decreased blood viscosity.

The primary effect of aging on all body systems is

decreased functional reserve.

Excessive antidiuretic hormone (ADH) secretion can cause _____ concentration.

decreased serum sodium

When systemic vascular resistance is decreased, blood flow

decreases.

Primary treatment for myocardial infarction (MI) is directed at

decreasing myocardial oxygen demands.

Clinical manifestations of severe symptomatic hypophosphatemia are caused by

deficiency of ATP.

Of the statements below, the accurate statement regarding nutrition and cellular health is

deficient cellular uptake by one cell type may contribute to excess nutrient delivery to other cell types.

Aortic regurgitation is associated with

diastolic murmur.

Widespread activation of the clotting cascade secondary to massive trauma is called

disseminated intravascular coagulation (DIC).

A common characteristic of viral pneumonia is

dry cough.

Renal compensation for respiratory acidosis is evidenced by

elevated bicarbonate ion concentration.

A laboratory test finding helpful in confirming the diagnosis of iron-deficiency anemia is

elevated total iron-binding capacity.

A disease that is native to a particular region is called

endemic

Treatment for hemophilia A includes

factor VIII replacement.

The conversion of plasminogen to plasmin results in

fibrinolysis

Pneumocystitis is a term that refers to a

fungal pneumonia secondary to HIV.

Red blood cells obtain nearly all their energy from metabolism of

glucose.

The nurse provides teaching regarding dietary intake of potassium to avoid an electrolyte imbalance when a patient

has chronic heart failure that is treated with diuretics.

The patient who requires the most careful monitoring for development of metabolic acidosis is a patient who

has had diarrhea for over a week.

Early manifestations of a developing metabolic acidosis include

headache

A 3-year-old boy who exhibits prolonged bleeding after minor trauma and a prolonged aPTT, but a normal platelet count, is likely to be diagnosed with

hemophilia

Decreased neuromuscular excitability is often the result of

hypercalcemia and hypermagnesemia.

An increase in organ size and function caused by increased workload is termed

hypertrophy

Respiratory alkalosis is caused by

hyperventilation (early high altitude exposure), aspirin ingestion (early)

Metabolic alkalosis is often accompanied by

hypokalemia

A person who overuses magnesium-aluminum antacids for a long period of time is likely to develop

hypophosphatemia

Abnormalities in intracellular regulation of enzyme activity and cellular production of ATP are associated with

hypophosphatemia.

Respiratory acidosis may be caused by

hypoventilation.

The body compensates for metabolic alkalosis by

hypoventilation.

To best prevent emphysema, a patient is instructed to stop smoking since cigarette smoke

impairs α1-antitrypsin, allowing elastase to predominate.

A patient has a positive Chvostek sign. The nurse interprets this as a sign of

increased neuromuscular excitability.

Chronic bronchitis often leads to cor pulmonale because of

increased pulmonary vascular resistance.

The increased anterior-posterior chest diameter associated with obstructive lung disease is caused by

increased residual lung volumes.

Diarrhea and other lower intestinal fluid losses will contribute to

metabolic acidosis.

Thalassemia may be confused with iron-deficiency anemia, because they are both

microcytic

A loud pansystolic murmur that radiates to the axilla is most likely a result of

mitral regurgitation.

Two primary acid-base disorders that are present independently are referred to as

mixed acid-base imbalance.

Clinical manifestations of moderate to severe hypokalemia include

muscle weakness and cardiac dysrhythmias.

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

myeloma.

All these cellular responses are potentially reversible except

necrosis.

Tumor necrosis factor α and interleukin-1 contribute to shock states because they induce production of

nitric oxide.

A major cause of treatment failure in tuberculosis is

noncompliance.

A person who experiences a panic attack and develops hyperventilation symptoms may experience

numbness and tingling in the extremities.

Asthma is categorized as a(n)

obstructive pulmonary disorder.

Hypertension is closely linked to

obstructive sleep apnea.

Breast cancer in women who have the breast cancer gene

occurs at an earlier age.

A patient with flail chest will demonstrate

outward chest movement on expiration.

The strength of the bond between oxygen and hemoglobin is known as the

oxygen-hemoglobin affinity.

Fully compensated respiratory acidosis is demonstrated by

pH 7.36, PaCO2 55, HCO3- 36.

A patient has been hospitalized several times in 6 months with severe ECV depletion and hypokalemia resulting from chronic laxative abuse. Which blood gas results should be relayed to the physician?

pH in high part of normal range, PaO2 normal, PaCO2 high, bicarbonate high

Hypotension associated with neurogenic and anaphylactic shock is because of

peripheral pooling of blood.

A deficiency of von Willebrand factor impairs

platelet adhesion to injured tissue.

The megakaryocyte is a precursor to

platelets.

Accumulation of fluid in the pleural space is called

pleural effusion.

A patient exhibiting respiratory distress as well as a tracheal shift should be evaluated for

pneumothorax.

An abnormally wide (more than 0.10 second) QRS complex is characteristic of

premature ventricular complexes.

Legionnaires disease is characterized by

presence of systemic illness.

Left-sided heart failure is characterized by

pulmonary congestion.

A serious complication of deep vein thrombosis is

pulmonary embolus.

Indicators that an individual is experiencing high stress include all the following except

pupil constriction.

When preparing for the admission of a client diagnosed with bronchiectasis, the nurse will

put a sputum cup and a box of tissues on the bedside table.

The person at highest risk for developing hypernatremia is a person who

receives tube feedings because he or she is comatose after a stroke.

Transfusion reactions involve RBC destruction caused by

recipient antibodies.

The hypersecretion of mucus resulting for chronic bronchitis is the result of

recurrent infection.

The common denominator in all forms of heart failure is

reduced cardiac output.

Low cardiac output to the kidneys stimulates the release of _____ from juxtaglomerular cells.

renin

The ________ system compensates for metabolic acidosis and alkalosis.

respiratory

The arterial blood gas pH = 7.52, PaCO2 = 30 mm Hg, HCO3- = 24 mEq/L demonstrates

respiratory alkalosis.

Atherosclerotic plaques with large lipid cores are prone to

rupture.

Hypertension with a specific, identifiable cause is known as _____ hypertension.

secondary

The most common primary immune deficiency that affects only B cells is

selective IgA.

A patient with cold and edematous extremities, low cardiac output, and profound hypotension is likely to be experiencing a progressive stage of ________ shock.

septic

A laboratory test that should be routinely monitored in patients receiving digitalis therapy is

serum potassium.

An increase in hemoglobin affinity for oxygen occurs with

shift to the left.

The electrolyte that has a higher concentration in the extracellular fluid than in the intracellular fluid is _____ ions.

sodium

The most definitive diagnostic method for active tuberculosis is acquired via

sputum culture.

A patient with a history of myocardial infarction continues to complain of intermittent chest pain brought on by exertion and relieved by rest. The likely cause of this pain is

stable angina.

Autologous stem cell transplantation is a procedure in which

stem cells are harvested from the patient and then returned to the same patient.

C.Q. was recently exposed to group A hemolytic Streptococcus and subsequently developed a pharyngeal infection. His clinic examination reveals an oral temperature of 102.3°F, 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

streptococcal infection.

The stage during which the patient functions normally, although the disease processes are well established, is referred to as

subclinical.

A patient with significant aortic stenosis is likely to experience

syncope

Pulse pressure is defined as

systolic pressure - diastolic pressure.

The progressive stage of hypovolemic shock is characterized by

tachycardia.

A patient is diagnosed with a tortuous blood vessel of the right hand that bleeds spontaneously. This patient presents with

telangiectasia.

Air that enters the pleural space during inspiration but is unable to exit during expiration creates a condition called

tension pneumothorax.

After suffering a heart attack, a middle-aged man is counseled to take a cholesterol-lowering medication. This is an example of

tertiary prevention.

Blood flow throughout the periphery is regulated by

the autonomic nervous system.

The activated partial thromboplastin time (aPTT) is a measure of the integrity of

the intrinsic pathway.

Allostasis is best defined as

the overall process of adaptive change necessary to maintain survival and well-being.

Airway obstruction in chronic bronchitis is because of

thick mucus, fibrosis, and smooth muscle hypertrophy.

Causes of metabolic acidosis include

tissue anoxia.

Activation of the extrinsic pathway of coagulation is initiated by

tissue thromboplastin.

The hypermetabolic state leading to cachexia in terminal cancer is thought to be because of

tumor necrosis factor.

The effect of nitric oxide on systemic arterioles is

vasodilation.

Osmoreceptors located in the hypothalamus control the release of

vasopressin (antidiuretic hormone, ADH).

An example of an acyanotic heart defect is

ventricular septal defect.

A normal bleeding time in association with normal platelet count, and increased prothrombin time (PT) and INR, is indicative of

vitamin K deficiency.

Rheumatic heart disease is most often a consequence of

β-hemolytic streptococcal infection.

High blood pressure increases the workload of the left ventricle, because it increases

afterload.

The inward-pulling force of particles in the vascular fluid is called _____ pressure.

capillary osmotic

Cancer grading is based on

cell differentiation.

Manifestations from sodium imbalances occur primarily as a result of

cellular fluid shifts.

A patient, who is 8 months pregnant, has developed eclampsia and is receiving intravenous magnesium sulfate to prevent seizures. To determine if her infusion rate is too high, you should regularly

check the patellar reflex; if it becomes weak or absent, her infusion rate probably is too high and she is at risk for respiratory depression or cardiac arrest.

A known cause of hypokalemia is

insulin overdose.

The cellular response indicative of injury because of faulty metabolism is

intracellular accumulations.

The primary cause of infant respiratory distress syndrome is

lack of surfactant.

First-degree heart block is characterized by

prolonged PR interval.