NU271 Week 6 PrepU: Cellular Regulation

The nurse has administered a client's prescribed daily dose of filgrastim. When assessing for a therapeutic effect, what laboratory finding should the nurse prioritize? White cell differential CD4 count HIV viral load C-reactive protein level

White cell differential Filgrastim is given to treat neutropenia; the client's neutrophil level would be revealed in the white cell differential. CD4 and viral load levels are specific to HIV treatment. C-reactive protein levels rise with generalized inflammation, but do not reflect neutrophil levels.

A cytotechnologist is performing genetic testing on a series of tissues. One tissue comes back with the WT1 mutation, and it's mapped to chromosome 11. What disease will the client most likely develop? Wilms tumor Renal cell carcinoma Pyelonephritis Alport syndrome

Wilms tumor Wilms tumor gene, WT1, which is located on chromosome 11, encodes a transcription factor that is critical for normal kidney development. Roughly 20% of all Wilms tumors carry WT1 mutations. Renal cell carcinoma is a different mutation, as is Alport syndrome. Pyelonephritis is an infection.

Information has been received by a client's neuron and transmitted into the cell body. What component of the neurologic system performed this function? dendrite axon soma nucleus

dendrite Dendrites carry information to the nerve and axons; they also carry information from a nerve to be transmitted to effector cells, which are found in muscles, glands, or another nerve. Soma refers to the cell body. The nucleus is the central part of a cell, which is responsible for the cell's growth, reproduction, and metabolism.

A red blood cell placed in which solution would shrink as water moves out of the cell? isotonic hypertonic hypotonic plasma

hypertonic A red blood cell placed in hypertonic solution will shrink and shrivel up as water moves out of the cell. A red blood cell placed in isotonic solution is stable and will retain its shape. A red blood cell placed in hypotonic solution will swell and burst as water moves into the cell.

The nurse is planning care for a client postoperatively to prevent pressure ulcers. Which interventions should the nurse include in the plan of care? Select all that apply: placing sequential compression devices monitoring nutritional status elevating the head of the bed turning every 1-2 hours keeping linens dry

monitoring nutritional status, turning every 1-2 hours, keeping linens dry Nurses must be alert to the potential for pressure ulcers in clients postoperatively due to pain and sedation, which can both limit client movement. While sequential compression devices are preventative for deep vein thrombosis, this is not an intervention to prevent pressure ulcers. Elevating the head of the bed may increase the risk for friction and shear if the client slides in the bed. Turning every 2 hours and keeping linens dry will help with prevention of pressure ulcers. Nutritional status with protein and calories plays a factor in skin integrity and is important to monitor as an intervention for the prevention of pressure ulcers.

Cross-tolerance to a drug is defined as: one drug that can prevent withdrawal symptoms from another drug. an allergic reaction to a class of drugs. one drug reduces response to another drug. one drug increases another drug's potency.

one drug reduces response to another drug. Cross-tolerance occurs when a drug with a similar action causes a decreased response to another drug. A drug that can prevent withdrawal symptoms from another drug describes cross-dependence. Cross-tolerance isn't an allergic reaction to a class of drugs. A drug's ability to increase the potency of another drug describes potentiating effects.

A client with heart failure has been prescribed a calcium channel blocker. The nurse is aware that this medication primarily affects what aspect of cardiac cell function? permeability of the cell membrane functioning of the nucleus and nucleolus contents of the cytoplasm cell reproduction

permeability of the cell membrane Calcium channels are one of the many channels in the cell membrane that selectively allow substances to pass into and out of the cytoplasm. It does not involve the nucleus or reproduction.

A client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should the nurse assess first? blood pressure respirations temperature pulse

pulse An elevated serum potassium level may lead to a life-threatening cardiac arrhythmia, which the nurse can detect immediately by palpating the pulse. In addition to assessing the client's pulse, the nurse should place the client on a cardiac monitor because an arrythmia can occur suddenly. The client's blood pressure may change, but only as a result of the arrhythmia. Therefore, the nurse should assess blood pressure later. The nurse also may delay assessing respirations and temperature because these aren't affected by the serum potassium level.

Parents arrive to the clinic with their young child and inform the nurse the child has just been diagnosed with sickle cell disease. The parents ask the nurse how this could have happened and which one of them is the carrier. What is the best response by the nurse? "Most likely, the father is the carrier of the gene." "The trait is passed down through the mother." "The child must inherit two defective genes, one from each parent." "It is an acquired, not a hereditary disorder."

"The child must inherit two defective genes, one from each parent." Sickle cell disease is a hereditary disorder. To manifest this disorder, a person must inherit two defective genes, one from each parent, in which case all the hemoglobin is inherently abnormal. If the person inherits only one gene, he or she carries sickle cell trait. The hemoglobin of those who have sickle cell trait is about 40% affected. The other distractors are incorrect due to these factors.

The initial sign of skin pressure is erythema, which normally resolves in less than: 15 minutes. 30 minutes. 45 minutes. 1 hour.

1 hour. The initial sign of pressure is erythema caused by reactive hyperemia, which normally resolves in less than 1 hour. All of the other time frames are incorrect.

Which changes in an 86-year-old male's skin would necessitate further examination and possible medical treatment? A decrease in general sebaceous gland activity. Appearance of new skin tags on his chest. A new mole-like growth on his forearm. Appearance of a keratosis on the man's trunk.

A new mole-like growth on his forearm. Appearance of a new mole or a change in the size or shape of an existing mole can be indicative of malignant melanoma. Decreased sebaceous gland secretions, skin tags, and keratoses are normal age-related changes.

Cystic fibrosis is a condition passed on through which type of inheritance? Autosomal recessive Autosomal dominant X-linked recessive Multifactorial

Autosomal recessive Cystic fibrosis is an autosomal recessive inherited condition. Huntington disease is an example of an autosomal dominant inherited condition. Hemophilia is an X-linked recessive inherited condition. Cleft lip is a multifactorial inherited condition.

The nurse is providing care to a client who has had a kidney biopsy. The nurse would need to be alert for signs and symptoms of which of the following? Bleeding Infection Dehydration Allergic reaction

Bleeding Renal biopsy carries the risk of post procedure bleeding, because the kidneys receive up to 25% of the cardiac output each minute. Therefore, the nurse would need to be alert for signs and symptoms of bleeding. Although infection is also a risk, the risk for bleeding is greater. Dehydration and allergic reaction are not associated with a renal biopsy.

Surgical removal of the thyroid gland is the treatment of choice for thyroid cancer. During the immediate postoperative period, the nurse knows to evaluate serum levels of __________ to assess for a serious and primary postoperative complication of thyroidectomy. Sodium Calcium Potassium Magnesium

Calcium Efforts are made to spare parathyroid tissue to reduce the risk of postoperative hypocalcemia with resultant tetany.

A nurse is caring for a newborn that has developed a low platelet count. What could be the cause? Increased megakaryocytes Increased pluripotent stem cell division Decreased thrombopoietin (TPO) Decreased spleen function

Decreased thrombopoietin (TPO) TPO stimulates the differentiation of platelets.

A female patient receiving fluoxymesterone, an androgenic drug, for metastatic breast cancer is disturbed by the physical changes seen in her body. Which feature of virilization may be seen in the patient receiving this therapy? Deepening of the voice Hypopigmentation of the skin Decrease in clitoris size Increase in body weight

Deepening of the voice Deepening of the voice may be seen as a feature of virilization following male hormone therapy in a female patient. Virilization is the acquisition of male characteristics in the female. Other features of virilization include pigmentation, and not hypopigmentation, of the skin, and increase, not decrease, in the size of the clitoris. Increase in body weight is not a sign of virilization. It may occur due to impaired nutrition of the body.

An older adult client is being evaluated for suspected pyelonephritis and is ordered kidney, ureter, and bladder (KUB) x-ray. The nurse understands the significance of this order is related to which rationale? Shows damage to the kidneys If risk for chronic pyelonephritis is likely Reveals causative microorganisms Detects calculi, cysts, or tumors

Detects calculi, cysts, or tumors Urinary obstruction is the most common cause of pyelonephritis in the older adult. A KUB may reveal obstructions such as calculi, cysts, or tumors. KUB is not indicated for detection of impaired renal function or reveal increased risk for chronic form of the disorder. Urine cultures will reveal causative microorganisms present in the urine.

A client with chronic renal failure has begun treatment with a colony-stimulating factor. What medication does the nurse anticipate administering to the client that will promote the production of blood cells? Etanercept (Enbrel) infliximab (Remicade) Epoetin alfa (Epogen) Adalimumab (Humira)

Epoetin alfa (Epogen) Colony-stimulating factors are cytokines that prompt the bone marrow to produce, mature, and promote the functions of blood cells. CSFs enable stem cells in bone marrow to differentiate into specific types of cells such as leukocytes, erythrocytes, and platelets. Pharmacologic preparation of CSFs, such as epoetin alfa (Epogen), is used to promote the natural production of blood cells in people whose own hematopoietic functions have become compromised. The other medications in A, B, and D are tumor necrosis factor inhibitors.

A nursing student says the following to her instructor: "Malignant neoplasms are more well-differentiated than benign tumors." Which of the following is the answer? True False

False Malignant neoplasms are less well-differentiated tumors that have lost the ability to control both cell proliferation and differentiation.

The nurse is caring for the client with hepatocellular carcinoma. What does the nurse recognize is a cause of this disease? Exposure to nonsteroidal anti-inflammatory medications Illness with hepatitis B or C Gallbladder disease Diabetes

Illness with hepatitis B or C With hepatitis B virus and hepatitis C virus, both of which become integrated into the host DNA, repeated cycles of cell death and regeneration afford the potential for development of cancer-producing mutations.

A client is scheduled for a thyroid panel. The nurse understands that this test would involve which of the following? Radiograph of the neck Radioactive iodine uptake test Measurement of blood hormone levels Scan using an injected radioactive substance

Measurement of blood hormone levels A thyroid panel measures the blood hormone levels of TSH, T3, and T4. It is a blood test, not a radiograph (x-ray). A radioactive iodine uptake test is a radionuclide study that determines thyroid function. A thyroid scan would involve the use of a radioactive substance to visualize the thyroid gland or its activity.

Which term refers to an abnormal decrease in white blood cells, red blood cells, and platelets? Pancytopenia Anemia Leukopenia Thrombocytopenia

Pancytopenia Pancytopenia is defined as an abnormal decrease in WBCs, RBCs, and platelets. The condition may be congenital or acquired. Anemia refers to decreased red cell mass. Leukopenia refers to a less-than-normal amount of WBCs in circulation. Thrombocytopenia refers to a lower-than-normal platelet count.

A client comes to the ED with severe abdominal pain, nausea, and vomiting. The physician plans to rule out acute pancreatitis. The nurse would expect the diagnosis to be confirmed by an elevated result on which laboratory test? Serum calcium Serum bilirubin Serum amylase Serum potassium

Serum amylase Serum amylase and lipase concentrations are used to make the diagnosis of acute pancreatitis. Serum amylase and lipase concentrations are elevated within 24 hours of the onset of symptoms. Serum amylase usually returns to normal within 48 to 72 hours, but the serum lipase concentration may remain elevated for a longer period, often days longer than amylase. Urinary amylase concentrations also become elevated and remain elevated longer than serum amylase concentrations.

During a community education program on genetics and genomics, the nurse uses which of the following as an example of a small gene mutation that affects protein structure-producing hemoglobin S? Marfan syndrome Hemophilia Tay-Sachs disease Sickle cell anemia

Sickle cell anemia Sickle cell anemia is an example of a genetic condition caused by a small gene mutation that affects protein structure, producing hemoglobin S. Marfan syndrome is an autosomal dominant inherited condition. Hemophilia is an X-linked recessive inherited condition. Tay-Sachs disease is an autosomal recessive inherited condition.

A patient is having a fine-needle biopsy (FNB) for a mass in the left breast. When the needle is inserted and the mass is no longer palpable, what does the nurse know has most likely occurred? The mass has been absorbed into the tissues of the breast. The mass may be cystic and was ruptured when the needle was inserted. The mass may not have been located correctly. The mass is not palpable because it is an inflammatory lesion.

The mass may be cystic and was ruptured when the needle was inserted. A simple cyst often disappears on aspiration, and the fluid is usually discarded.

Which statement best describes the function of stem cells in the bone marrow? They are active against hypersensitivity reactions. They defend against bacterial infection. They produce all blood cells. They produce antibodies against foreign antigens.

They produce all blood cells. All blood cells are produced from undifferentiated precursors called pluripotent stem cells in the bone marrow. Other cells produced from the pluripotent stem cells help defend against bacterial infection, produce antibodies against foreign antigens, and are active against hypersensitivity reactions.

While examining a client, the practitioner notices large, flat, cutaneous pigmentations. They are a uniform light brown with sharply demarcated edges. He uses a Wood lamp to better detect the lighter spots. The practitioner knows that the pigmentations may be a component of which disorder? Von Recklinghausen disease Down syndrome Klinefelter syndrome Cystic fibrosis

Von Recklinghausen disease A second major component of type 1 neurofibromatosis, or von Recklinghausen disease, is the presence of large, flat cutaneous pigmentations known as café au lait spots. A Wood lamp, which uses ultraviolet light, can be used to detect lighter spots. The other options are chromosomal disorders and do not exhibit these pigmentations.

The nurse reviews the medical record of a woman diagnosed with ovarian cancer, stage II. The nurse interprets this information, understanding that the disease: is limited to the ovary. involves one or both ovaries and extends into the pelvis. has spread to the lymph nodes and other organs within the abdomen. has metastasized to distant sites.

involves one or both ovaries and extends into the pelvis. Stage II ovarian cancer involves one or both ovaries, with pelvic extension. Disease limited to the ovary characterizes stage I ovarian cancer. Stage III ovarian cancer has spread to the lymph nodes and other organs and structures inside the abdominal cavity. Stage IV disease typically involves metastasis to distant sites.

Which assessment is most likely to reveal a potential exacerbation in a 70-year-old client's diagnosis of benign prostatic hyperplasia (BPH)? Urine testing for microalbuminuria Blood test for white blood cells and differential Digital rectal examination Sperm morphology testing

Digital rectal examination The diagnosis of BPH is based on history, physical examination, digital rectal examination, urinalysis, blood tests for serum creatinine and prostate-specific antigen (PSA), and urine flow rate. The digital rectal examination is used to examine the external surface and size of the prostate. An enlarged prostate found during a digital rectal examination does not always correlate with the degree of urinary obstruction. Some men can have greatly enlarged prostate glands with no urinary obstruction, but others may have severe symptoms without a palpable enlargement of the prostate. Proteinuria, increased WBCs, and changes in sperm morphology are not associated with BPH.

A client has an autosomal-dominant disorder. His wife is unaffected. When explaining the risk for inheritance of the disorder in their offspring, which statement by the nurse would be most appropriate? "You have a 1 in 4 chance of a child being affected by the disorder." "Any child you have would most likely have the disorder." "There is a 50% chance that each of your children will have the condition." "The female determines whether your children will have the disorder."

"There is a 50% chance that each of your children will have the condition." When a client has an autosomal-dominant disorder and the spouse is unaffected, each of that person's offspring has a 50% chance of inheriting the gene mutation for the condition and a 50% chance of inheriting the normal version of the gene. Offspring who do not inherit the mutation do not develop the condition and do not have an increased chance for having children with the same condition. The affected individual, regardless of that person's gender, determines the inheritance pattern.

Renal function results may be within normal limits until the GFR is reduced to less than which percentage of normal? 20% 30% 40% 50%

50% Renal function test results may be within normal limits until the GFR is reduced to less than 50% of normal. Renal function can be assessed most accurately if several tests are performed and their results are analyzed together. Common tests of renal function include renal concentration tests, creatinine clearance, and serum creatinine and BUN (nitrogenous end product of protein metabolism) concentrations.

Which type of Mendelian inherited condition results in both genders being affected equally in a vertical pattern? Autosomal dominant inheritance Autosomal recessive inheritance X-linked inheritance Multifactorial genetic inheritance

Autosomal dominant inheritance An individual who has an autosomal dominant inherited condition carries a gene mutation for that condition on one chromosome of a pair. The pattern of inheritance in autosomal recessive inherited conditions is different from that of autosomal dominant inherited conditions in that it is more horizontal than vertical, with relatives within a single generation tending to have the condition. Chromosome X-linked conditions may be inherited in families in recessive or dominant patterns. In both patterns, the gene mutation is located on the X chromosome. All males inherit an X chromosome from their mother with no counterpart; hence, all males express the gene mutation. Neural tube defects such as spina bifida and anencephaly are examples of multifactorial genetic conditions. The majority of neural tube defects are caused by both genetic and environmental influences that combine during early embryonic development and lead to incomplete closure of the neural tube.

Which grade of tumor is also known as a well-differentiated tumor? Grade I Grade II Grade III Grade IV

Grade I Grade I tumors, also known as well-differentiated tumors, closely resemble the tissue of origin in structure and function. In grade II, the tumor is moderately differentiated. Tumors in grade III are poorly differentiated (little resemblance to tissue of origin). Grade IV tumors is undifferentiated (unable to tell tissue of origin).

A patient has been identified as a poor metabolizer for a drug that undergoes CYP 450 metabolism. The nurse interprets this information as indicating which of the following? The patient will need a higher dosage of medication. The patient is at increased risk for toxicity. The therapeutic response would be less. Drug absorption would be more rapid.

The patient is at increased risk for toxicity. Poor metabolizers have a specific single nucleotide polymorphism (SNP) variation in a CYP gene that causes little or no enzyme function, resulting in very little or no drug metabolism and higher levels of active drug because the drug cannot be absorbed or excreted. Poor metabolizers may have adverse effects or toxicities from high blood levels of drugs and need a lower dose. Ultrarapid metabolizers experience rapid absorption, distribution, and excretion; have inadequate treatment response because of lower drug blood levels; and may need a higher dose or more frequent dosing.

A 36-year-old man is receiving three different chemotherapeutic agents for Hodgkin's disease. The nurse explains to the client that the three drugs are given over an extended period because: The three drugs can be given at lower doses. The second and third drugs increase the effectiveness of the first drug. The first two drugs are toxic to cancer cells, and the third drug promotes cell growth. The three drugs have a synergistic effect and act on the cancer cells with different mechanisms.

The three drugs have a synergistic effect and act on the cancer cells with different mechanisms. Multiple drug regimens are used because the drugs have a synergistic effect. The drugs have different cell-cycle lysis effects, different mechanisms of action, and different toxic adverse effects. They are usually given in combination to enhance therapy. Dosage is not affected by giving the drugs in combination. The second and third drugs do not increase the effectiveness of the first. It is not true that the first two drugs are toxic to cancer cells while the third drug promotes cell growth.

Thalassemia can be classed as major or minor. If therapy for thalassemia major is not started in infants who present with this disease, severe growth retardation will occur. At 6 months of age, which therapy must be started? Transfusion Infusion Vitamin Water

Transfusion Persons who are homozygous for the trait (thalassemia major) have severe, transfusion-dependent anemia that is evident at 6 to 9 months of age when the hemoglobin switches from HbF to HbA. If transfusion therapy is not started early in life, severe growth retardation occurs in children with the disorder. Vitamin, water, and infusion will have no effect.

Select the statement that best describes stem cells. Undifferentiated cells of continuously dividing tissues that have the capacity to generate multiple cell types Epithelial cells of the skin and gastrointestinal tract are those that continue to regenerate throughout life. Cells that normally do not divide but are capable of regeneration when confronted with an appropriate stimulus Cells that are unable to regenerate

Undifferentiated cells of continuously dividing tissues that have the capacity to generate multiple cell types Stem cells are undifferentiated cells of continuously dividing tissues that have the capacity to generate multiple cell types. Labile cells, such as the epithelial cells of the skin and gastrointestinal tract, are those that continue to regenerate throughout life. Stable cells, such as those in the liver, are those that normally do not divide but are capable of regeneration when confronted with an appropriate stimulus. Permanent or fixed cells are those that are unable to regenerate.

A client is undergoing a diagnostic workup for suspected testicular cancer. When obtaining the client's history, the nurse checks for known risk factors for this type of cancer. Testicular cancer has been linked to:: testosterone therapy during childhood. sexually transmitted disease. early onset of puberty. cryptorchidism.

cryptorchidism Cryptorchidism (failure of one or both testes to descend into the scrotum) appears to play a role in testicular cancer, even when corrected surgically. Other significant history findings for testicular cancer include mumps orchitis, inguinal hernia during childhood, and maternal use of diethylstilbestrol or other estrogen-progestin combinations during pregnancy. Testosterone therapy during childhood, sexually transmitted disease, and early onset of puberty aren't risk factors for testicular cancer.

A breast cancer client has just learned that her tumor clinical stage is T3, N2, M0. After the physician leaves, the client asks the nurse to explain this to her again. The nurse will use which statement in his or her answer? Your: tumor is very small and has zero number of mitoses. tumor has metastasized to at least three distal sites and you have cancer in your lymph nodes. tumor is large and at least two lymph nodes are positive for cancer cells. extent of disease is unknown, but it looks like your cancer has stayed intact and not spread to the bloodstream.

tumor is large and at least two lymph nodes are positive for cancer cells. Tumor staging groups clients according to the extent and spread of the disease, using the TNM (tumor, node, and metastasis) system. In the TNM system, T1, T2, T3, and T4 describe tumorsize, N0, N1, N2, and N3, lymph node involvement; and M0 or M1, the absence or presence of metastasis.