PATHO EXAM 2 [M.4-6]

Upon admission assessment, the nurse hears a murmur located at the fifth intercostal space, midclavicular line. The client asks, "What does that mean?" The nurse will base her answer on which of the following physiologic principles?

"You have a heart valve that is diseased."

A client with persistent, primary hypertension remains apathetic about his high blood pressure, stating "I don't feel sick, and it doesn't seem to be causing me any problems that I can tell." How could the nurse best respond to this client's statement? Correct!

"You may not sense any problems, but it really increases your risk of heart disease and stroke."

When educating the parents of a cyanotic infant diagnosed with of tetralogy of Fallot, the nurse will include which of the following statements related to the physiological abnormalities? The infant has: Select all that apply ( 3 correct answers).

- A large, thick, right ventricular wall - A hole in the ventricular septal - A small, narrow pulmonary outflow channel

A nurse runs into an old high school friend after 20 years. She notes her friend continues to smoke after all these years. The friend asks, "Do you think I sound hoarse?" Upon further assessment, the nurse/friend notes her friend has several warning signs of cancer. Which manifestations would lead to this conclusion? Select all that apply ( 2 answers).

"Can you feel how large my lymph nodes are on my neck and armpits (axillae)?" -

A client with a history of heart failure and COPD (caused by 60 pack/year smoking) presents to the clinic with the following complaints: auscultation of breath sounds reveal absent/diminished breath sounds in the right lower lobe. Which other manifestations lead the health care provider to suspect the client may have developed atelectasis? Select all that apply ( 3 answers).

"Having a hard time catching my breath." , Respiratory rate—32; pulse rate—122 beats/minute. , Using accessory muscles to help him breathe.

A client with a history of chronic obstructive pulmonary disease (COPD) is undergoing pulmonary function testing. Which of the following instructions should the technician provide in order to determine the client's forced vital capacity (FVC)?

"I'll ask you to breathe in as deep as you can, and then blow out as much of that air as possible."

A 51-year-old man has been diagnosed with chronic bronchitis after a long history of recurrent coughing. Which of the man's following statements demonstrates a sound understanding of his new diagnosis?

"If I had quit smoking earlier than I did, I think I could have avoided getting bronchitis."

A client with heart failure asks, "Why am I taking a 'water pill' when it's my heart that is having a problem?" While educating the client about the Frank-Starling mechanism, which of the following explanations is most appropriate to share?

"Since your heart is not pumping efficiently, the kidneys are getting less blood flow; therefore, the kidneys are holding on to sodium and water."

A college student has been called into the student health office because she tested positive for HIV on the enzyme-linked immunosorbent assay (ELISA). The student asks, "What is this Western blot assay going to tell you?" The best response by the health care provider is:

"The Western blot is a more sensitive assay that looks for the presence of antibodies to specific viral antigens."

A sixth grade science teacher asks the students to explain the role of cilia in the lower respiratory tract. Which student response is the best?

"These little hairs move germs trapped in mucous toward the throat so the body can cough them out."

A 5-year-old child is experiencing itchy, watery eyes and an increased respiratory rate with some inspiratory wheezes. He has been outside playing in the yard and trees. The mother asks, "Why does he get like this?" The health care worker's best response is:

"This is what we call a type I hypersensitivity reaction and usually occurs a few minutes after exposure to his allergen. It is primarily caused by mast cells in his body."

A heart failure client has an echocardiogram performed revealing an ejection fraction (EF) of 40%. The nurse knows this EF is below normal and explains to the client:

"This means your heart is not pumping as much blood out of the heart with each beat."

Electrical burns over a large surface area of a client's body have resulted in hypovolemic shock after the loss of large amounts of blood and plasma. Following physical assessment, which findings lead the nurse to believe the client's body is compensating for this fluid loss? Select all that apply ( 3 answers).

- Increased heart rate - The client complaining of extreme thirst - Deep, rapid respirations

Which of the following clients at the clinic should be encouraged to receive the pneumococcal polysaccharide vaccine (PPSV23)? A client: Select all that apply ( 2).

- With a smoking history - Who is 65 years old with chronic asthma

Soon after delivery, the mother grabs the nurses arm and states, "Something's wrong...I can't get my breath." Which of the following assessments lead the nurse to suspect the client has had an amniotic emboli travel to the lungs? Select all that apply ( 2 answers).

-BP 90/65; pulse 130, irregular; respiratory rate 35, shallow. - Productive cough with blood-streaked sputum.

The nurse would anticipate that which of the following clients would be considered a good candidate for coronary artery bypass grafting (CABG)?

A 56-year-old with a history of MI experiencing new-onset chest pain and ST elevation

From the following clients, who are at high risk for developing heart failure as a result of diastolic dysfunction?

A 70-year-old with enlarged left ventricle due to myocardial hypertrophy

Which of the following clients would be considered at high risk for developing pneumonia (both community and hospital setting)? Select all that apply.

A HIV-positive client with a WBC count of 2000 who has been camping near a commercial farm raising chickens for food, A school-aged child with severe asthma controlled by steroids admitted for an exacerbation, A young adult in motorcycle accident with head injury requiring tracheostomy and mechanical ventilation

Which of the following individuals is suffering the effects of acute coronary syndrome (ACS)?

A client who occasionally experiences persistent and severe chest pain when at rest

Which of the following individuals is experiencing a health problem that is the result of a parasite?

A man who acquired malaria while on a tropical vacation

Which of the following clients is at risk for developing a preventable disorder related to prolonged immobility?

A postsurgical client who is refusing to get out of bed and walk and will not wear those "uncomfortable elastic stocking"

Diffusion of gases in the lung is decreased, as in pulmonary edema or pneumonia, by causing an increase in alveolar:

Capillary membrane thickness

A distinguishing feature of viral influenza is:

Abrupt-onset, profound malaise

A client with a diagnosis of secondary hypertension has begun to experience signs and symptoms that are consistent with decreased cardiac output. Which of the following determinants of cardiac output is hypertension most likely to affect directly?

Afterload

Which of the following individuals should be prioritized for receiving a seasonal influenza vaccination?

An 81-year-old resident of a long-term care facility

The cells that mediate humoral immunity do so because they are capable of producing:

Antibodies

A postsurgical client reports calf pain combined with the emergence of swelling and redness in the area, which have culminated in a diagnosis of deep vein thrombosis. What treatment options will be of greatest benefit to this client?

Anticoagulation therapy and elevation of the leg

A car accident client is admitted with a chest tube following pneumothorax. He also has an elevated blood alcohol level. When the nurse enters his room, she notes the client is dyspneic, short of breath, and holding his chest tube in his hand. When the nurse pulls the linens back, she finds a "sucking" chest wound. After calling a "code blue," the next priority intervention would be to:

Apply a Vaseline gauze (airtight) dressing over the insertion site

A client is diagnosed with an abdominal aortic aneurysm that the physician just wants to "watch" for now. When teaching the client about signs/symptoms to watch for, the nurse will base the teaching on which of the following physiological principles?

As the aneurysm grows, more tension is placed on the vessel wall, which increases the risk for rupture.

A child has experienced a "bee-sting" while at the park. The health care provider is walking by and notices the child has swelling around the eyes, lips, and face in general. What priority assessment should the nurse make at this time?

Assess and establish an open airway.

A toddler seems to have a little "cold" and runny nose. At bedtime, he appears to be OK. A few hours later, parents awaken hearing a "tight" coughing sound. They recognize the child is not breathing well, so they rush to the emergency department. On arrival, the nurses suspect bronchial asthma based on which of the following assessment data? Select all that apply ( 3 answers).

Audible wheezing , Respiratory rate—44 with prolonged exhalation, Sitting upright, leaning forward, and using accessory muscles to breathe

Although growth rate is variable among types of bacteria, the growth of bacteria is dependent on:

Availability of nutrients

A client with a history of emphysema from long-term cigarette smoking has loss of many alveoli. When comparing the type I alveolar cell physiologic function with the primary role of type II alveoli, the nurse would be aware that the type II alveoli are responsible for:

Production of surfactant

A client is receiving home care for the treatment of a wound on the inside of her lower leg that is 3 cm in diameter with a yellow wound bed and clear exudate. Assessment of the client's legs reveals edema and a darkened pigmentation over the ankles and shins of both legs. What is this client's most likely diagnosis?

Chronic venous insufficiency

Following several weeks of increasing fatigue and a subsequent diagnostic workup, a client has been diagnosed with mitral valve regurgitation. Failure of this heart valve would have which of the following consequences?

Backflow from the left ventricle to the left atrium

A 25-year-old cystic fibrosis client presents to the clinic in obvious respiratory distress. Following physical exam, the health care provider suspects bronchiectasis based on which of the following findings? Select all that apply (3 answers).

Blood-tinged sputum , Wheezing throughout the lung fields, Copious amounts of foul-smelling purulent sputum

Bronchial circulation differs from the pulmonary circulation by providing blood for the:

Conducting airways

Above the glottis that opens and closes for speech, the epiglottis performs which physiologic functions during swallowing?

Cover the larynx

As a result of hypoxemia and polycythemia, persons with chronic obstructive bronchitis are prone to:

Pulmonary hypertension

A respiratory therapist has asked a client to breathe in as deeply as possible during a pulmonary function test. Inspiration is normally the result of which of the following phenomena?

Decreased intrathoracic pressure

The client is immobilized following a hip injury and has begun demonstrating lower leg discoloration with edema, pain, tenderness, and increased warmth in the midcalf area. He has many of the manifestations of:

Deep vein thrombosis

A client has just been admitted to the postsurgical unit following a below-the-knee amputation. Which of the following measures should her care team prioritize to prevent atelectasis during the client's immediate recovery?

Deep-breathing exercises and early mobilization

Implantation of a pacemaker is most likely to benefit a client with which of the following cardiomyopathies?

Dilated cardiomyopathy (DCM)

For which of the following types of shock might intravenous antibiotic therapy be indicated?

Distributive shock

A mother rushes her toddler into the emergency department stating, "My baby can't breathe." Initial assessment reveals the child is struggling to breathe in an upright position. He has both inspiratory and expiratory stridor and is using his chest muscles to breath. The nurse suspects the child has which of the following acute respiratory infections?

Epiglottitis

The client with emphysema should be educated about changes in lung tissue that may include which of the following changes? Select all that apply ( 3 answers).

Loss of elastic recoil , Difficulty exhaling due to inability to recoil , Increased lung compliance

Most respiratory disorders in infants produce a decrease in:

Lung compliance

The "cold viruses" are rapidly spread from person to person. The greatest source of spread is:

Fingers

Chronic stable angina, associated with inadequate blood flow to meet the metabolic demands of the myocardium, is caused by:

Fixed coronary obstruction

A client has recently received a pneumococcal vaccine and the client's B cells are consequently producing antibodies. Which of the following cells may enhance this production of antibodies?

Helper T cells

Football fans at a college have been shocked to learn of the sudden death of a star player, an event that was attributed in the media to "an enlarged heart." Which of the following disorders was the player's most likely cause of death?

Hypertrophic cardiomyopathy (HCM)

A client has just returned from his surgical procedure. During initial vital sign measurements, the nurse notes that the client's heart rate is 111 beats/minute and the BP is 100/78 (borderline low). In this early postoperative period, the nurse should be diligently monitoring the client for the development of:

Hypovolemic shock due to acute intravascular volume loss

A 1-day-old infant was exposed to an infectious microorganism prior to discharge home from the hospital, but was able to affect a sufficient immune response in the hours and days following exposure. The nurse knows that which of the following immunoglobulins assisted with this process?

IgG

A client with a history of emphysema is experiencing hypoxemia after a taxing physical therapy appointment. Which of the following physiologic phenomena will occur as a consequence of hypoxemia?

Increased heart rate

The sensation of chest tightness due to an impending asthmatic attack appears to be related to which of the following physiological causes?

Input from lung receptors that monitor bronchial constriction.

An elderly female client who reports increasing fatigue has been diagnosed with aortic stenosis, a disease that her primary care provider believes may have been long-standing. Which of the following compensatory mechanisms has most likely maintained the woman's ejection fraction until recently?

Left ventricular hypertrophy

A teenage male develops a severe case of "athlete's foot." He asks, "How did I get this?" The health care worker explains that certain fungi become infectious (called dermatophytes) and exhibit which of the following characteristics?

Limited to cooler cutaneous surfaces

A motor vehicle accident has resulted in critical injury for the driver of the car. The driver has hit the steering wheel with his chest and fractured his sternum and some ribs. Which of the following manifestations would lead the staff to suspect the driver has developed a tension pneumothorax? Select all that apply ( 2 answers).

Mediastinal shift of the trachea toward one side, Subcutaneous emphysema palpated in the upper chest/neck region

One of the principal mechanisms by which the heart compensates for increased workload is:

Myocardial hypertrophy

Increased upper airway resistance and decreased airflow into the lungs in neonates (0 to 4 weeks of age) can result from:

Nasal congestion

While caring for a pediatric client admitted with a viral infection, the nurse knows that which type of cell will be the child's primary defense against the virus?

Natural killer (NK) cells

When skin is broken, germs can enter. Transmission of infectious agents is directly related to the:

Number of pathogens absorbed

Which of the following is an example of how international travel has contributed to increased prevalence and incidence of nonindigenous diseases?

Outbreak of hemolytic-uremic syndrome related to contaminated salad being shipped to various regions

A teenaged cystic fibrosis client presents to the clinic. The health care provider (HCP) knows that cystic fibrosis (CF) causes severe chronic respiratory disease in children. In addition, the HCP should also focus his or her assessment on which of the other body systems affected by CF?

Pancreatic

When a client with a history of asthma takes a walk outside on a windy day with high pollen counts, she may experience an asthma attack, resulting in an increase in respiration rate and wheezing. The body's response is likely related to which pathophysiological principle?

Parasympathetic nervous system stimulation resulting in airway constriction

A 33-year-old client who is a long-term intravenous user of heroin has been recently diagnosed with hepatitis C. Which of the following portals of entry most likely led to the client's infection?

Penetration

Following surgery, a client had a chest x-ray that reported some opacities in the lung bases likely due to atelectasis. Which of the following pathophysiologic processes will result from this condition?

Perfusion without ventilation

A client was in car accident client while not wearing a seatbelt and has sustained multiple rib fractures. During assessment, the nurse is having a hard time hearing heart sounds, and the client reports chest pain/pressure repeatedly. This client may be experiencing:

Pericardial effusion

While lecturing on blood pressure, the nurse will emphasize that the body maintains its blood pressure by adjusting the cardiac output to compensate for changes in which of the following physiologic processes?

Peripheral vascular resistance

Which of the following is most likely to precipitate an asthmatic attack in a child with a diagnosis of extrinsic, or atopic, asthma?

Pet dander

A child who has never been vaccinated is brought to the emergency department with a respiratory infection. The child is struggling to breath and is very anxious. The health care providers suspect epiglottitis. Which of the following interventions would be a priority?

Place the child upright in bed and begin preparing for a tracheostomy placement.

A client with a diagnosis of aplastic anemia has undergone allogenic bone marrow transplantation. Which of the following signs and symptoms would most clearly suggest the existence of graft versus host disease (GVHD)?

Presence of a pruritic rash that has begun to slough off

A client asks why his blood pressure pills seem to make him go to the bathroom to urinate frequently when they are not water pills (diuretics). Which of the following physiologic processes explains the long-term regulation of blood pressure most accurately?

Renal monitoring and adjustment of extracellular fluid volume

The mechanism by which humans recognize self-cells from non-self (antigens)-cells is called:

Self-tolerance

Following a kitchen accident with a knife, the client's cut has experienced a decrease in the amount of bleeding and has developed a clot. The nurse knows this is primarily a result of humoral control of blood flow with the release of:

Serotonin

Clients who have been bed-ridden for a long time likely will experience:

Shallow, quiet breathing, which impairs the spreading of surfactant

A client has experienced a bout of coughing after aspirating some of his secretions. The client's coughing was triggered by which of the following?

Signals from receptors in the tracheobronchial wall

If the parasympathetic neurotransmitter releases acetylcholine, the nurse should anticipate observing what changes in the ECG pattern?

Slowing of heart rate to below 60 beats/minute

A client with an 80-pack-year history of tobacco smoking has presented to the clinic complaining of "bronchitis" cough for the past 5 months, weight loss, and shortness of breath. Today, this client "got scared" when he coughed up blood in his sputum. The health care provider is concerned this client may have which of the following possible diagnoses?

Small cell lung cancer due to smoking history,

Which of the following characteristics of the lungs of infants and small children creates an increased risk of respiratory disorders?

Smaller airways create a susceptibility to changes in airway resistance and airflow.

A client who lives with angina pectoris has taken a sublingual dose of nitroglycerin to treat the chest pain he experiences while mowing his lawn. This drug facilitates release of nitric oxide, which will have what physiologic effect?

Smooth muscle relaxation of vessels

A client with a long history of "hay fever" has recently begun a series of immunotherapy (allergy shots). This treatment potentially will achieve a therapeutic effect by:

Stimulating production of IgG to combine with antigens

A 6-hour-old newborn develops a critical respiratory problem and is rushed to the ICU. The ICU nurses suspect the infant has respiratory distress syndrome (RDS) based on which findings? Select all that apply.

Substernal retractions with each breathe, Bluish discoloration of the skin and mucous membranes (central cyanosis), Expiratory grunting

A 6-month-old infant has been hospitalized with acute bronchiolitis. Which of the following treatments should be prioritized in the infant's care?

Supplementary oxygen therapy

A client with a long-standing diagnosis of Crohn disease has developed a perianal abscess. Which of the following treatments will this client most likely require?

Surgical draining

Which of the following medications helps treat the inflammatory reaction of asthma clients diagnosed with late-phase asthma response?

Systemic corticosteroids

When lecturing to a group of students about the pathophysiological principles behind heart failure, the instructor explains that cardiac output represents:

The amount of blood the heart pumps each minute

When thinking in terms of airway radius with regard to resistance, the lung structure responsible for the most airway resistance to airflow would be:

The bronchioles near the trachea

The pathogenic capacity of the tubercle bacillus is related to:

The initiation of a cell-mediated immune response

A nurse who provides weekly care in a homeless shelter has unknowingly inhaled airborne Mycobacterium tuberculosis and has subsequently developed latent tuberculosis infection. Which of the following is true of this nurse?

The nurse is likely asymptomatic.

With acute respiratory distress syndrome (ARDS), a client progressively increases his work of breathing. The physiological principle behind this respiratory distress is related to:

The stiffening of the lung, making it more difficult to inflate

The most important complication of atherosclerosis that may cause occlusion of small heart vessels is:

Thrombosis

A man sustained a puncture injury to his chest that caused a tension pneumothorax to form. This is a life-threatening condition because:

Trapped, inspired air collapses the lung.

The nurse caring for a population of HIV clients needs to be assessing for which of the following diseases that amounts to the leading cause of death for people with HIV?

Tuberculosis

In an ICU setting, one assessment that would lead the nurse to suspect shock has resulted in decrease blood flow to vital organs is:

Urine output less than 20 mL/hour

Generalized acute hypoxia in lung tissue, when alveolar oxygen levels drop below 60 mm Hg, causes pulmonary:

Vasoconstriction

Preload represents the volume work of the heart and is largely determined by:

Venous blood return

A male client with a history of angina has presented to the emergency department with uncharacteristic chest pain, and his subsequent ECG reveals T-wave elevation. This finding suggests an abnormality with which of the following aspects of the cardiac cycle?

Ventricular repolarization

The clinic nurse suspects the client is having a genetically determined hypersensitivity to common environmental allergens since the client is experiencing which of the following clinical manifestations? Select all that apply ( 3 answers)

hives, runny nose, wheezing

A child with asthma is walking outside and develops a bronchospasm. The school nurse knows this bronchospasm has what effects on bronchioles with airflow? Select all that apply (2).

impairs airflow, narrowing of bronchioles

A client with newly diagnosed squamous cell carcinoma of the lung asks, "So how do we treat this cancer?" Which response from the health care provider is most accurate? Select all that apply ( 3 answers).

radiation therapy, surgery to remove tumor, chemotherapy

A college student is lamenting the fact that she has developed a cold on the weekend prior to exam week. Which of the following statements shows that the student has an accurate understanding of her upper respiratory infection?

suppose I should have been washing my hands more in the past few days."