Patho Final Study

When advising a morbidly obese client about the benefits of weight reduction, which statement would be most accurate to share?

"A 10-pound loss of weight can produce a decrease in blood pressure."

A frantic parent reports a large mass in the child's abdomen; after diagnostic testing, the health care provider diagnoses a Wilms tumor, stage IV. After the provider leaves the room, the parents ask the nurse, "What does this mean?" Which response by the nurse is most accurate?

"A cancer of the kidney has most likely spread to the lungs."

An adult male who is 6'11" tall has a diagnosis of acromegaly. The man is explaining to a curious but sympathetic coworker exactly what accounts for his extraordinary height. Which explanation demonstrates a sound understanding of his health problem?

"A tumor in my brain threw off my hormone levels after I finished adolescence."

A health educator is performing a health promotion workshop with the staff of a large, urban homeless shelter, and a component of the teaching centers around tuberculosis. One of the staff members comments, "Anyone who's had contact with tuberculosis in the past can give it to any of the other residents of the shelter, even if they didn't get sick themselves." How could the educator best respond to this comment?

"Actually, people who have the latent form of the disease won't be sick and can't spread it either."

An autopsy is being performed on a 44-year-old female who died unexpectedly of heart failure. Which components of the pathologist's report is most suggestive of a possible history of poorly controlled blood pressure?

"Arterial sclerosis of subcortical brain regions noted."

A female neonate has been in respiratory distress since delivery and is unresponsive to oxygen therapy. Endoscopy has confirmed a diagnosis of esophageal atresia and tracheoesophageal fistula (EA/TEF). Which explanation should the care team provide to the infant's parents?

"We will have to perform surgery to correct the hole in her throat to make sure that she is able to swallow and breathe normally."

A client has recently been diagnosed with renal calculi and asks the nurse, "What should I be eating to prevent stone formation?" What is the most appropriate response to the client's statement?

"What you eat can influence your risk of stone formation, but many other factors like hormones and your metabolism are involved."

A client is in cardiogenic shock following a massive myocardial infarction. The client's family asks the nurse, "Why are the health care providers recommending dialysis since its the heart that is sick?" Which response by the nurse is most appropriate at this time?

"When a person has a large heart attack and goes into shock due to heart failure, there is a decrease in renal perfusion which allows toxins to increase in the blood."

A client is reading a brochure on atherosclerosis while in the waiting room of medical clinic. Which excerpt from the educational brochure warrants correction?

"Because smoking causes a permanent increase in your risk of heart disease, it's best not to start."

A client arrives with a shoulder dislocation related to sword fighting practice. Which educational topic is most accurate regarding this injury?

"Dislocations become recurrent. They recur with the same motion but require less and less force each time."

An adolescent male with type 1 diabetes is exasperated by his regimen of blood sugar monitoring and insulin administration, and has told his mother that he wants to scale both back. Which response by his mother is most accurate?

"Even though it's hard to do, you need to continue so you don't go blind or need a kidney transplant down the road."

A young adult client has just been diagnosed with acute glomerulonephritis. Which question should the nurse ask this client in attempting to establish a cause?

"Have you had any type of infection within the past 2 weeks?"

A family physician is performing client teaching about the influenza virus with each client who has come to the clinic to receive that year's vaccine. Which statement by the client best reflects an accurate understanding of the flu virus?

"I could come down with viral or bacterial pneumonia as a result of a bad flu bug."

An adult diagnosed with renal failure secondary to diabetes mellitus is scheduled to begin dialysis soon. Which statement by the client reflects an accurate understanding of the process of hemodialysis?

"I will not be able to go about my normal routine during treatment."

A 17-year-old male has been diagnosed with osteosarcoma of the upper tibia following several months of leg pain. Which statement by the client demonstrates that he has an accurate understanding of his diagnosis?

"I'm really nervous about having to get surgery and chemo."

A 64-year-old man was diagnosed 19 months ago with bilateral osteoarthritis (OA) in his knees, and has come to his family physician for a checkup. The client and his physician are discussing the effects of his health problem and the measures that the man has taken to accommodate and treat his OA in his daily routines. Which statement by the client would necessitate further teaching?

"I've been avoiding painkillers because I know they can mask damage that I might be inflicting on my knees."

A young woman has been diagnosed by her family physician with primary Raynaud disease. The woman is distraught, stating, "I've always been healthy and I can't believe I have a disease now." What would be her physician's most appropriate response?

"If you make sure to keep yourself warm, it will have a fairly minimal effect; I'll also give you pills to enhance your circulation."

While being tackled, a 20 year-old football player put out his hand to break his fall to the ground. Because the intense pain in his wrist did not subside by the end of the game, he was brought to an emergency department, where diagnostic imaging indicated an incomplete tear of the ligament surrounding his wrist joint. At the time of admission, his wrist was swollen with a severely restricted range of motion. What will his care team most likely tell the player about his diagnosis and treatment?

"It looks like a mild to moderate sprain and you'll need to keep it immobilized for a few weeks."

A public health nurse is conducting a health promotion teaching session at a senior citizens drop-in center. Which teaching point about hip fractures in older adults is most justified?

"Most hip fractures are actually a break at the very top of the thigh bone."

A nurse is performing client education with an adult recently diagnosed with chronic kidney disease. Which statement by the client would the nurse most likely want to correct or clarify?

"My kidney problems increase my chance of developing high blood pressure or diabetes."

A client will be on long term steroid therapy after a kidney transplant. Which teaching points should the health care provider emphasize?

"One of the risks that these steroids bring is the possibility that part of a bone might die."

On a routine physical exam visit, the physician mentions that he hears a new murmur. The client gets worried and asks, "What does this mean?" The physician responds:

"One of your heart valves is not opening properly. We need to do an echocardiogram to see which valve is having problems."

The mother of a 7-year-old boy who has recently been diagnosed with childhood asthma has come to the education center to learn more about her son's condition. Which teaching point is most justifiable?

"Research has shown that viruses may actually be a factor in childhood asthma."

Following a progressive onset of fatigue, aching, and joint stiffness over the last two years, a 69-year-old male has recently been diagnosed with rheumatoid arthritis (RA). Which teaching point should his primary care physician include during the office visit in which this diagnosis is communicated to the client?

"Steroids and anti-inflammatory drugs that I'll prescribe will likely bring some relief to your symptoms."

Which teaching point would be most appropriate for a group of older adults who are concerned about their cardiac health?

"The plaque that builds up in your heart vessels obstructs the normal flow of blood and can even break loose and lodge itself in a vessel."

A 3-year-old girl has just been diagnosed with type 1A diabetes. Her parents are currently receiving education from the diabetes education nurse. How can the nurse best explain to the parents the etiology (cause) of their daughter's diabetes?

"The problem that underlies her diabetes is that her own body has destroyed the cells in her pancreas that produce insulin."

A male client has just been diagnosed with esophageal cancer. He knew he was losing weight and fatigued most days, but he just attributed it to aging and working. The physician recommends chemotherapy and irradiation. However, the cancer has already metastasized. The client asks the nurse what he can expect if he agrees to the treatments. The nurse responds:

"The therapies may shrink the cancer in an effort to increase survival of the cancer."

A female client presented to her primary care physician with classic signs/symptoms of Cushing syndrome. Upon testing, it was discovered that the client had vaginal small cell carcinoma. How can the health care providers explain the Cushing syndrome signs/symptoms to this client?

"The tumor in your vagina is secreting a hormone called adrenocorticotropic hormone (ACTH), which is responsible for these signs/symptoms."

A 36-year-old female who has experienced diverse symptoms for several years has finally had her health problems attributed to scleroderma (systemic sclerosis), and has committed herself to learning as much about the disease as she can. Which statement would the clinican want to correct or clarify?

"The worst part of this so far has been learning that there aren't any treatments for scleroderma."

Following several days of intermittent upper right quadrant pain, a 29-year-old obese, Native American/First Nation woman has been diagnosed with cholelithiasis. The nurse at the clinic has taught the client about the pathophysiology and contributing factors to her health problem, as well as some of the likely treatment options. Which statement by the client demonstrates a sound understanding of her diagnosis?

"This explains why my skin was yellow-tinged lately and why I had those pains that spread to my upper back and right shoulder."

A 62-year-old female smoker is distraught at her recent diagnosis of small cell lung cancer (SCLC). How can her physician most appropriately respond to her?

"This is very difficult to hear, I'm sure, and we have to observe to see if it spreads because that often happens."

When a 55-year-old client's routine blood work returns, the nurse notes that the client's C-reactive protein (CRP) is elevated. The client asks what that means. The nurse responds:

"This means you have elevated serum markers for systemic inflammation that has been associated with vascular disease."

When educating a college student who lives in a crowded apartment and was recently diagnosed with tuberculosis, the school nurse will emphasize which treatment plan?

"To destroy this bacterium, you must strictly adhere to a long-term drug regimen of several medications."

A number of older adults have come to attend a wellness clinic that includes both blood pressure monitoring and education about how to best control blood pressure. Which teaching point is most accurate?

"Too much alcohol, too little exercise, and too much body fat all contribute to high blood pressure."

Which teaching points about acute tubular necrosis (ATN) should the renal nurse educator include in the orientation session of new nurses?

"Trauma, burns, and major surgery are common precursors to ATN."

A nurse is collecting a urine specimen prior to measuring the albumin level in a client's urine. A colleague states, "I thought albumin was related to liver function, not the kidney." How can the nurse best respond to this statement?

"Urine albumin levels are useful for diagnosing diabetic kidney disease."

As part of a public health initiative, a nurse is teaching a group of older adults about ways to promote and maintain their health. Which teaching points about the common cold is most accurate for the nurse to share with this group of senior citizens?

"Use caution when choosing over-the-counter drugs for your cold; most people do best with rest and anti-fever medications."

A 51-year-old male professional is in the habit of consuming 6 to 8 rum and Cokes each evening after work. He assures the nurse practitioner who is performing his regular physical exam that his drinking is under control and does not have negative implications for his work or family life. How could the nurse best respond to the client's statement?

"When your body has to regularly break down that much alcohol, your blood and the functional cells in your liver accumulate a lot of potentially damaging toxic by-products."

An endocrinologist is providing care for a 30-year-old male who has lived with the effects of increased levels of growth hormone (GH). Which teaching point about the client's future health risks is most accurate?

"When your pituitary gland is enlarged, there's a real risk that you'll develop some sight deficiencies."

A 71-year-old male has been recently diagnosed with a stage III tumor of colorectal cancer, and is attempting to increase his knowledge base of his diagnosis. Which statement about colorectal cancer demonstrates a sound understanding of the disease?

"While diet is thought to play a role in the development of colorectal cancer, the ultimate causes are largely unknown."

A 51-year-old female client who is 2 days postoperative in a surgical unit of a hospital is at risk of developing atelectasis as a result of being largely immobile. Which teaching point by her nurse is most appropriate?

"You should breathe deeply and cough to help your lungs expand as much as possible while you're in bed."

A 70-year-old male with a 40 pack-year history of smoking and longstanding non-insulin dependent diabetes has been diagnosed with pancreatic cancer. Which teaching points should the physician provide?

"You will likely be facing surgery in the near future, but know that this is very unlikely to eliminate your cancer."

A pediatrician is teaching a group of medical students about some of the particularities of heart failure in children as compared with older adults. Which statement by the physician best captures an aspect of these differences?

"You'll find that, in pediatric clients, pulmonary edema is more often interstitial rather than alveolar, so you often won't hear crackles."

A health care provider for an obese male who has a history of diabetes and hypertension reports that the client's glomerular filtration rate (GFR) is 51 mL/min with elevated serum creatinine levels. Which statement by the health care provider will likely answer the client's question about the result?

"Your chronic kidney disease has likely been caused by your diabetes and high blood pressure."

Following a history of gastric pain and an endoscopy, a client has been diagnosed with a duodenal peptic ulcer. Which teaching point should his caregiver provide?

"Your family history, your smoking history, and NSAID use may all have contributed to this problem."

A client has been taking up to 2400 mg of ibuprofen per day for chronic pain following a motor vehicle accident. The client is diagnosed with chronic analgesic nephritis. The client states, "I thought that taking too many drugs hurt your liver if anything, not your kidneys." What is the most appropriate response to the client's statement?

"Your kidneys are vulnerable to damage because of how much blood flows through them and the fact that they break down many drugs."

A client has been diagnosed with mitral valve stenosis following his recovery from rheumatic fever. Which teaching point would be most accurate to convey to the client?

"Your mitral valve isn't opening up enough for blood to flow into the part of your heart that sends blood into circulation."

The mother of 6-year-old male and female fraternal twins has brought her son to see a pediatrician because he is nearly 4 inches shorter than his sister. Which phenomenon would the physician most likely suspect as contributing factor to the boy's short stature?

A shortage of hypothalamic GHRH production

Which phenomenon is most likely occurring during a child's alveolar stage of lung development?

A single-capillary network exists and the lungs are capable of respiration.

Four weeks after returning from a tropical vacation, a 40-year-old man has presented to the emergency department with malaise, nausea, and yellow sclera. Serology has confirmed a diagnosis of hepatitis A (HAV). What teaching is most appropriate for this client?

A vaccine before your trip would have prevented this, but your body will rid itself of the virus in time.

A nursing instructor is explaining the role of vascular smooth muscle cells in relation to increases in systemic circulation. During discussion, which neurotransmitter is primarily responsible for contraction of the entire muscle cell layer, thus resulting in decreased vessel lumen radius?

Norepinephrine

A client with pancreatic cancer is admitted for portal hypertension and is symptomatic with ascites. Following paracentesis and removal of 7.5 L of ascitic fluid, the nurse should anticipate that the physician will order which medication to assist in maintaining an effective circulating fluid volume?

Albumin (Human) 5%.

During a routine physical exam for a client diagnosed with hypertension, the nurse practitioner will be most concerned if which assessment is found?

Noted hemorrhages and microaneurysms during evaluation of internal eye.

A 30-year-old woman presents at a hospital after fainting at a memorial service and she is diagnosed as being in neurogenic shock. Which signs/symptoms is she most likely to display?

Dry and warm skin

The clinician is caring for a client suspected of having contracted C. difficile. Assessment reveals abdominal distension and new onset fever. What is the clinician's best action?

Notify the health care provider immediately of the findings.

A client with pancreatitis is admitted with weight loss, nausea, and vomiting. To maintain nutrition, the physician orders parenteral nutrition to be started. Knowing that a major side effect of parenteral nutrition is a hyperosmolar hyperglycemic state, the clinician should assess the client for which clinical manifestations?

Dry lips, excess urine output, and seizures.

After several months of persistent heartburn, a 57-year-old female client has been diagnosed with gastroesophageal reflux disease (GERD). Which treatment regimen is likely to best address the woman's health problem?

Proton pump inhibitors; avoiding large meals; remaining upright after meals

A 43-year-old male client has presented to the emergency department with vomiting that he claims is of a sudden onset. The client also states that the emesis has often contained frank blood in the hours prior to admission. His vital signs are stable with temperature 98.3°F (36.8°C), pulse 88, BP 140/87, and respiratory rate 18. Which potential contributing factor would the health care team suspect first?

Alcohol consumption

The nurse is caring for a client with achalasia. Which interventions should the nurse prioritize in the plan of care? Select all that apply.

a. Arrange for small, frequent meals. b. Have oropharyngeal suctioning equipment at bedside. c. Position client with head of bed elevated.

The clinician is caring for a client with late stage cirrhosis who is prescribed the beta-blocker propranolol. Which complications of cirrhosis will the clinician expect to be reduced by administration of propranolol? Select all that apply.

a. Esophageal varices b. Ascites c. Thrombocytopenia

The clinician is caring for a client with severe acute pancreatitis. Which interventions should the clinician prioritize? Select all that apply.

a. Infuse intravenous fluids. b. Keep client NPO. c. Maintain nasogastric tube.

The clinician is caring for the client with extrahepatic cholestasis. Which symptom does the clinician anticipate uncovering during the history and assessment?

Pruritus with consequences of deficient levels of fat-soluble vitamins.

An adult diagnosed with type 1 diabetes is aware of the multiple effects that insulin has on his metabolism. Which physiologic processes are actions of insulin? Select all that apply.

a. Inhibiting protein breakdown b. Promoting glucose uptake by target cells. c. Facilitating triglyceride synthesis by the liver

The neonatal ICU nurse is aware that type II alveolar cells produce surfactant and they usually develop at how many weeks' gestation?

24-28 weeks

A nurse is providing care for a client who has been admitted with a newly diagnosed bilateral pleural effusion. Which finding from the nurse's initial assessment of the client is incongruent with the client's diagnosis and would require further investigation?

The client reports sharp pain exacerbated by deep inspiration.

The nurse is creating a care plan for a premature infant with respiratory distress syndrome. Which aspects of care should the nurse include in the plan? Select all that apply.

a. Administration of synthetic surfactant b. Monitoring blood glucose c. Delivery of oxygen under positive pressure d. Keeping infant in incubator

While rock climbing, a 22-year-old male has endured a severe head injury. Which statement best captures expected clinical manifestations and treatments for his immediate condition?

Hypoventilation may exist, resulting in increased PCO2 and hypoxemia that may require mechanical ventilation.

A physician is providing care for several clients on a medical unit of a hospital. In which situation would the physician be most likely to rule out hypertension as a contributing factor?

A 61-year-old man who has a heart valve infection and recurrent fever

The clinician is caring for several patients. Given the typical treatments for each of the listed client conditions, which client should the clinician prioritize as most at risk for acute gastrointestinal bleeding?

A 65-year-old client being treated for atrial fibrillation and coronary artery disease

Which client should the emergency department staff suspect to be high risk for the development of a thoracic aortic aneurysm?

A 66-year-old client with facial edema, a cough, and neck vein distention

A number of clients have presented to the emergency department in the last 32 hours with reports that are preliminarily indicative of myocardial infarction. Which client is least likely to have an ST-segment myocardial infarction (STEMI)?

A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest

In which client situations would a physician be most justified in preliminarily ruling out pericarditis as a contributing pathology to the client's health problems?

A 77-year-old with diminished S3 and S4 heart tones, irregular heart rate, and a history of atrial fibrillation

While working triage in the emergency department, which client report should alert the nurse to imminent danger and, thus, that client should be seen first?

A client holding the abdomen and reporting a tearing and ripping feeling inside.

Which diagnostic bloodwork is most suggestive of chronic kidney disease (CKD)?

A client with low vitamin D levels, low calcitrol levels, and elevated parathyroid hormone (PTH) levels

Which client who presented to a walk-in medical clinic is most likely to be diagnosed with rhinosinusitis rather than a common cold?

A man complaining of general fatigue, a headache, and facial pain with a temperature of 100.9°F (38.2°C)

Which situation would be most deserving of a pediatrician's attention?

A midwife notes that a newborn infant's chest is retracting on inspiration and that the child is grunting.

Which clinical finding among older adults is most likely to be viewed as a normal part of age-related changes?

78-year-old client whose glomerular filtration rate (GFR) has been steadily declining over several years

The clinician knows that which patient listed below is at high risk for developing a hip fracture?

82-year-old female with macular degeneration who uses a walker to go to the bathroom.

Which individual is most likely to develop a form of reactive arthritis?

A 24-year-old male who completed treatment for a chlamydia infection 1 year ago.

Which individual is at the highest risk of developing a urinary tract infection (UTI)?

A 30-year-old woman with poorly controlled diabetes mellitus

Which client is most clearly displaying the signs and symptoms of irritable bowel disease (IBD)?

A 51-year-old male who states that his stomach pain is in his lower abdomen, "comes and goes" and "feels more like a cramp than a dull ache."

In which of the following hospital clients would the care team most realistically anticipate finding normal cholesterol levels?

A 51-year-old male with a diagnosis of hemorrhagic stroke and consequent unilateral weakness

A 41-year-old male client has presented to the emergency department with an acute onset of increased respiratory rate and difficulty breathing. STAT chest X-ray indicates diffuse bilateral infiltrates of his lung tissue and ECG displays no cardiac dysfunction. What is this client's most likely diagnosis?

Acute lung injury

While on tour, a 32-year-old male musician has presented to the emergency department of a hospital after a concert complaining of severe and sudden abdominal pain. He admits to a history of copious alcohol use in recent years, and his vital signs include temperature 38.8°C (101.8°F), blood pressure 89/48 mm Hg and heart rate 116 beats per minute. Blood work indicates that his serum levels of C-reactive protein, amylase, and lipase are all elevated. Which diagnosis would the care team suspect first?

Acute pancreatitis

A 77-year-old lifetime smoker has been diagnosed with a tumor in his lung at the site of an old tubercule scarring site, located in a peripheral area of his bronchiolar tissue. What is this client's most likely diagnosis?

Adenocarcinoma

To maintain hematocrit levels in clients with kidney failure, the nurse should be prepared to perform which intervention?

Administer a subcutaneous injection of recombinant human erythropoietin (rhEPO).

A 60 year-old man has long managed his type 1 diabetes effectively with a combination of vigilant blood sugar monitoring, subcutaneous insulin administration, and conscientious eating habits. This morning, however, his wife has noted that he appears pale and clammy and appears to be in a stupor, though he is responsive. She suspects that he has made an error in his insulin administration and that he is experiencing a hypoglycemic episode. Which action should be the wife's first choice?

Administration of 15 to 20 g of glucose in a concentrated carbohydrate source.

A young boy who is deaf and has bilateral cataracts is brought to the clinic. The parent found blood in the toilet after the boy voided. Urinalysis confirms heavy microscopic hematuria as well as proteinuria. What will the health care team's initial differential diagnosis most likely be?

Alport syndrome

Which recent admission to an emergency department is most likely to be diagnosed with a greenstick fracture?

An 8-year-old boy who fell out of a tree and onto his arm.

Four clients were admitted to the emergency department with severe chest pain. All were given preliminary treatment with aspirin, morphine, oxygen, and nitrates and were monitored by ECG. Which client most likely experienced myocardial infarction?

An 80-year-old woman whose pain started at 6 AM shortly after awakening and was not relieved by nitrates or rest; the ECG showed ST-segment elevation with inverted T waves and abnormal Q waves; levels of cardiac markers subsequently rose

Which long-term care resident is most likely to be exhibiting the signs and symptoms of chronic obstructive pulmonary disease (COPD)?

An 81-year-old male who has a productive cough and recurrent respiratory infections.

The mother of a 19-week-old infant has brought her baby in for assessment to a pediatrician because of the baby's persistent weight loss and diarrhea. An intestinal biopsy has confirmed a diagnosis of celiac disease, and the child's mother is anxious to know what caused the disease. What aspect of the etiology of celiac disease would underlie the explanation that the physician provides?

An inappropriate T-cell mediated response results in increased levels of antibodies and an inflammatory response.

A new client arrives at the clinic. The physician is suspecting the client may have systemic lupus erythematosus (SLE) given the clinical manifestations related to joint pain, skin changes, and history of pleural effusions. The nurse should anticipate which diagnostic test will be a priority to facilitate with the diagnosis?

Anti-DNA antibody test.

A clinician is providing care for a client who has had a cast applied to her fractured arm 6 hours prior. The client is now reporting severe pain that she describes as "even worse than when I broke my arm." What would be the clinician's best course of action?

Assessment of motor and sensory function with the goal of identifying compartment syndrome.

In the early morning, a parent brings the 5-year-old child to the emergency room. The child is wheezing, short of breath, and has a dry cough. The parent states that the child has always been very healthy. The child went to bed with only a slight cold and a runny nose but woke up coughing shortly after 4 a.m. The symptoms worsened so dramatically that parent brought the child to the hospital. The care team would most likely suspect that the child has:

Asthma.

A 70-year-old male client presents to the emergency department reporting pain in his calf that is exacerbated when he walks. His pedal and popliteal pulses are faintly palpable and his leg distal to the pain is noticeably reddened. The nurse knows that the client is likely experiencing which medical diagnosis/possible treatment plan listed below?

Atherosclerotic occlusive disease necessitating thrombolytic therapy

A female older adult client has presented with a new onset of shortness of breath, and the client's physician has ordered measurement of her brain natriuretic peptide (BNP) levels along with other diagnostic tests. What is the most accurate rationale for the physician's choice of bloodwork?

BNP is released as a compensatory mechanism during heart failure and measuring it can help differentiate the client's dyspnea from a respiratory pathology.

A client is admitted to the hospital with acute kidney injury (AKI). Which diagnostic test will the nurse assess to best determine the cause of the AKI?

BUN:creatinine or urea:creatinine ratio

The clinician caring for a client with protal hypertension and subsequent development of esophageal varices will likely receive a prescription for which drug class to assist with decreasing portal pressure?

Beta-adrenergic blocking agent

A clinician on a medical unit is providing care for a 37-year-old female client who has a diagnosis of Graves disease. Which treatment would the clinician most likely anticipate providing for the client?

Beta-adrenergic blocking medications (beta-blockers) to reduce sympathetic nervous stimulation

A nurse who works on a pediatric cardiology unit of a hospital is providing care for an infant with a diagnosis of tetralogy of Fallot. Which pathophysiologic result should the nurse anticipate?

Blood outflow into the pulmonary circulation is restricted by pulmonic valve stenosis.

The nurse is caring for an older adult client with acute glomerulonephritis who develops sudden-onset dyspnea. The client's vital signs are: blood pressure 175/96 mm Hg; heart rate 98 bpm; respiratory rate 22 breaths/min; oxygen saturation 88% on room air. What is the nurse's priority assessment?

Breath sounds

Which medication would the nurse anticipate being prescribed for the client with renal failure who has hyperphosphatemia?

Calcium carbonate

Mr. V. has been admitted for exacerbation of his chronic heart failure (HF). When the nurse walks into his room, he is sitting on the edge of the bed, gasping for air, and his lips are dusty blue. Vital signs reveal heart rate 112, respiratory rate 36, and pulse oximeter reading of 81%. He starts coughing up frothy, pink sputum. The priority intervention is:

Call for emergency assistance utilizing hospital protocol.

A client with kidney cancer who underwent exploratory surgery has returned to the postoperative unit with a report of severe burning and indigestion in the epigastric region. Which intervention by the clinican would be priority for this client?

Call the surgeon for a prescription for a proton pump inhibitor (PPI) to prevent stress ulcer development.

A client is admitted to the hospital in Addisonian crisis 1 month after a diagnosis of Addison disease. The clinician knows which clinical manifestation would support this diagnosis?

Change in level of consciousness and profound hypotension

The nurse is caring for a client in intensive care receiving mechanical ventilation and intravenous insulin infusion. The nurse notes sudden onset hypotension, tachycardia, and jugular vein distension. What should the nurse do first?

Check the tidal volume setting on the ventilator.

A physical assessment of a 28-year-old female client indicates that the blood pressure in her legs is lower than that in her arms and that her brachial pulse is weaker in her left arm than in her right. In addition, her femoral pulses are weak bilaterally. Which possibility would her care provider be most likely to suspect?

Coarctation of the aorta

A 24-year-old woman undergoing a premarital screening test is found to have elevated levels of AST, ALT, and IgG, but no antibody-specific markers for viral hepatitis. A liver biopsy reveals inflammation and cellular damage. Which treatment is most likely to be effective for her?

Corticosteroids and immunosuppressant drugs

A 28-year-old man presents with reports of diarrhea, fecal urgency, and weight loss. His stool is light-colored and malodorous, and it tends to float and be difficult to flush. He has also noted tender, red bumps on his shins and reports pain and stiffness in his elbows and knees. Sigmoidoscopy reveals discontinuous, granulomatous lesions; no blood is detected in his stool. Which diagnosis would his care team first suspect?

Crohn disease

Which clinical finding would be most closely associated with a client who has interstitial lung disease in comparison to chronic obstructive pulmonary disease (COPD)?

Decreased tidal volume

A nurse is administering morning medications to a number of clients on a medical unit. Which medication regimen is most suggestive that the client has a diagnosis of heart failure?

Diuretic, ACE inhibitor, beta-blocker

The nurse practitioner is working in an overnight sleep lab assessing and diagnosing clients with sleep apnea. During this diagnostic procedure, the nurse notes that a client's blood pressure is 162/97 mm Hg. The nurse explains this connection to the client based on which pathophysiologic principle?

During apneic periods the client experiences hypoxemia, which stimulates chemoreceptors to induce vasoconstriction.

The nurse working in the ICU knows that chronic elevation of left ventricular end-diastolic pressure will result in the client displaying which clinical manifestation?

Dyspnea and crackles in bilateral lung bases.

A 34-year-old man who is an intravenous drug user has presented to the emergency department with malaise, abdominal pain, and lethargy. The health care team wants to rule out endocarditis as a diagnosis. Staff of the department would most realistically anticipate which set of diagnostics?

Echocardiogram, blood cultures, temperature

A client reports having diarrhea that has lasted days. Which intervention would the nurse recommend to decrease the diarrhea?

Electrolyte drink containing sodium and glucose

A 53-year-old woman with a history of chronic alcohol abuse but without visible jaundice comes to the clinic complaining of nausea and weakness. She admits to taking acetaminophen for persistent headaches but denies exceeding the recommended daily dose; she has not taken any other medications. She is suspected of having acetaminophen toxicity. Which diagnostic test finding would implicate a different cause of her symptoms?

Elevated serum HBsAG level

A 3-year-old child with right-sided heart failure has been admitted for worsening of their condition. Which assessment would be considered one of the earliest signs of systemic venous congestion in this toddler?

Enlargement of liver

All of the following interventions are ordered STAT for a client stung by a bee who is experiencing severe respiratory distress and faintness. Which priority intervention will the nurse administer first?

Epinephrine

Parents of a 20-month-old infant report that he refuses food or eats poorly and that he grimaces when he swallows. He also is irritable and cries a lot. The mother is worried that he ate something inappropriate this morning, because he vomited something that looked like coffee grounds. Which health problem would the care team first suspect?

Esophagitis from gastrointestinal reflux

Which pain descriptions would lead the nurse to suspect the client is experiencing ureteral colic?

Excruciating pain in the flank and upper outer quadrant of abdomen that radiates to bladder area

The clinician notes a client's bilirubin level is 2.5 mg/dL (42.8 μmol/L). Which assessment is most relevant for the clinician to perform based on these results? The clinican should assess the client's:

Eyes

A 66-year-old male presents to the emergency room accompanied by his wife, who claims that he has been acting confused. The man is reporting a sudden onset of severe weakness and malaise and has a dry cough and diarrhea. His temperature is 102.8°F (39.3°C) and his blood work indicates his sodium level at 126 mEq/L (126 mmol/L) [normal 135-145 mEq/L // 135-145 mmol/L]. Based on this assessment, the nurse suspects the client has:

Legionella pneumonia

An ultramarathon runner is admitted following a day-long, 50-mile (80-kilometer) race because urinary volume is drastically decreased and the urine is dark red. What is the likely cause of the red urine?

Myoglobinuria

A middle-aged woman is admitted with acute pyelonephritis. Which assessment finding correlates with this diagnosis?

Flank pain, dysuria, and nausea/vomiting

A 40-year-old man who is morbidly obese and leads a sedentary lifestyle has recently been diagnosed with type 2 diabetes. Which aspects of the man's obesity likely contributed to his new health problem?

Free fatty acids contribute to problems such as beta cell dysfunction and insulin resistance.

Which statement best describes an aspect of the normal process of glucose metabolism?

Glucose that exceeds metabolic needs is converted and stored by the liver.

A client in the intensive care unit is receiving a blood transfusion. The client immediately developed a reddish-color urine flowing into the Foley bag. What is likely the cause of this red urine and what priority intervention should the nurse implement?

Hemoglobinuria indicating an acute hemolytic reaction; the transfusion must be stopped immediately.

A baby is born to a mother with active hepatitis B. Which medication does the clinician anticipate administering today?

Hepatitis B immune globulin (HBIG).

A 29 year-old female has been admitted to the emergency department following a suicide attempt by overdose of acetaminophen. What physiologic changes in the client's liver and accompanying altered diagnostic results does the nurse anticipate?

Hepatocellular necrosis evidenced by increased ALT and AST levels.

A premature infant on mechanical ventilation has developed bronchopulmonary dysplasia (BPD) and is showing manifestations of hypoxemia, low lung compliance, and respiratory distress. Which factors are the most likely contributors to the infant's present health problem?

High inspired oxygen concentration and injury from positive-pressure ventilation

A pneumonia that occurs 48 hours or more after admission to the hospital is considered:

Hospital-acquired pneumonia

A clincian is providing care for a male client with a longstanding hiatal hernia. Which statement most accurately captures an aspect of the pathophysiology of hiatal hernias?

If esophageal acid clearance is impaired, esophagitis can result.

A 16-year-old boy has been diagnosed with ankylosing spondylitis. Which etiology is responsible for his health problem?

Immune response

A client has been diagnosed with possible IgA nephropathy. The nurse will educate the client about which essential diagnostic test to confirm this diagnosis?

Immunofluorescence microscopy

Following the identification of low blood levels of cortisol and low 24-hour urinary free cortisol, a 51-year-old female client has been diagnosed with a primary adrenal cortical insufficiency. Which health consequence would be attributable to her low levels of cortisol?

Impaired immunologic and inflammatory response

Following the diagnosis of acute renal failure, the nurse knows that one of the earliest manifestations of tubular damage is which laboratory/diagnostic result?

Inability to concentrate urine

Which assessment findings would the health care provider consider as most indicative of acute renal failure?

Increased nitrogenous waste levels; decreased glomerular filtration rate (GFR)

Following the identification of low levels of T3 and T4 coupled with the presence of a goiter, a 28-year-old female has been diagnosed with Hashimoto thyroiditis. In light of this diagnosis, which assessment result would constitute an unexpected finding?

Increased white cell count and audible crackles on chest auscultation.

A 22 year-old student has developed a fever and diarrhea while on a backpacking trip in Southeast Asia. His oral temperature is 101.4°F (38.6°C). The diarrhea is bloody, frequent, and small in volume. These clinical manifestations are distressing enough that he is visiting a local medical clinic in the area. Which diagnosis best characterizes this health problem?

Inflammatory diarrhea

A 22-year-old male is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. What immediate treatments are most likely to benefit the man?

Infusion of normal saline or Ringer's lactate to maintain the vascular space.

A 40-year-old man who uses heroin intravenously was diagnosed with hepatitis C (HCV) 1 year ago and now has chronic viral hepatitis. Which statement by the client to his care provider would warrant correction by the nurse?

It is at least a bit reassuring that my liver isn't undergoing damage when I'm not experiencing symptoms.

A client has been following a low-fat diet due to a diagnosis of high triglycerides and to lose weight. The client asks the clinician how it is possible that the extra weight and high triglycerides persist despite taking in such low levels of fat. What is the clinician's best response?

It is important to reduce your total caloric intake, including carbohydrates.

Due to her progressing osteoarthritis (OA), an 80-year-old woman is no longer able to perform her activities of daily living without assistance. Which phenomeon most likely underlies the woman's situation?

Loss of articular cartilage and synovitis has resulted from inflammation caused when joint cartilage attempted to repair itself.

Which pathophysiologic phenomeon would be most indicative of ankylosing spondylitis?

Loss of motion in the spinal column and eventual kyphosis.

The nurse assesses a client with renal failure for encephalopathy caused by uremia. Which clinical manifestation will the nurse likely find?

Loss of recent memory and inattention.

Which hospitalized client is most clearly demonstrating the signs and symptoms of liver failure?

Low hemoglobin levels, low platelet levels, and spider angiomas present

The nurse is caring for a client who develops sudden onset dyspnea. Which assessment should the nurse prioritize to best identify if the cause may be a pulmonary embolism?

Lower limb appearance

Around three weeks after razing an old chicken house, a 71-year-old retired farmer has developed a fever, nausea and vomiting. After ruling out more common health problems, his care provider eventually made a diagnosis of histoplasmosis. Which physiologic process is most likely taking place?

Macrophages are able to remove the offending fungi from the bloodstream but can't destroy them.

Which laboratory value result correlates to the development of diabetic glomerulosclerosis?

Microalbuminuria

A 20-year-old woman has visited her family physician due to occasional bouts of bloody diarrhea over the past several weeks, a phenomenon that she experienced 2 years prior as well. Her physician has diagnosed her with ulcerative colitis based on her history and visualization of the affected region by colonoscopy and sigmoidoscopy. Which pathophysiologic phenomenon is most likely to underlie the client's health problem?

Mucosal hemorrhages that have developed into crypt abscesses, which have in turn necrotized and ulcerated.

Which of these activities or conditions will inhibit growth hormone (GH)?

Obesity

While speaking to a senior citizen club about osteoarthritis (OA), which facts are accurate to share?

Obesity in women has been correlated to having OA in the knees.

A 35-year-old woman who has been in recovery from alcoholism for 2 years presents at her primary care physician's office with chronic hip pain. She reports that as part of her commitment to recovery, she began exercising regularly about a year earlier. After a month or two, her hip began to hurt when she ran on the treadmill. She stretches, has had a physical trainer check her form to ensure that it is correct, and rests adequately between each workout. Six months ago the pain began waking her at night, and now it is constant. She is not aware of any injury to her hip and has no other outward symptoms. What is most likely to be the cause of her pain?

Osteonecrosis

A 13-year-old girl and her father come in to the local health clinic hoping to see an orthopedic doctor about the girl's stiff and warm knee. The father reports that she hurt it sliding into base during a softball game, and the daughter concurs, but with further discussion it becomes clear that the slide made an existing pain worse. Her knee had been stiff, warm, and shiny, and had been keeping her awake at night for a week or so before the game. What might be the cause of the girl's symptoms?

Osteosarcoma

A 3-year-old boy has developed croup following a winter cold. His care provider would recognize that which microorganisms and treatments are most likely to be related and effective, respectively?

Parainfluenza virus, treated with a mist tent and oxygen therapy.

A client has a ureteral calculi in the proximal region. The nurse is planning to educate the client about the treatment of choice for removal of the stone in this location. For which intervention will the nuse eucate the client?

Percutaneous nephrolithotomy

The nurse is caring for a client admitted for treatment of active sarcoidosis. What is the nurse's best approach to assessing this client?

Perform a complete head-to-toe assessment.

During assessment of a client with systemic lupus erythematosus (SLE), the respiratory therapist hears a friction rub when the stethoscope is placed over the heart. Which complication of SLE will the respiratory therapist document in the medical records and report to the health care provider?

Pericarditis

A child with rhinosinusitis should be monitored for complications. Which assessment finding would alert the nurse that a complication is developing?

Periorbital edema

A formerly normotensive woman, pregnant for the first time, develops hypertension and headaches at 26 weeks' gestation. Her blood pressure is 154/110 mm Hg and she has proteinuria. What other labs should be ordered for her?

Platelet count; serum creatinine; liver enzymes

A short, nonsmoking 44-year-old male presents to the emergency room with left-sided chest pain and a cough. He states the pain started abruptly and worsens with deep breathing and coughing. He denies recent injury. Assessment includes shallow respirations with a rate of 36, normal breath sounds, no cyanosis. Which condition is most likely causing his symptoms?

Pleuritis related to infection

The nurse is caring for a group of clients and is reviewing the arterial blood gas results for each. Which client should the nurse assess first? The client with:

Pneumonia and a PaO2 of 60 mm Hg (7.98 kPa) and a PaCO2 of 40 mm Hg (5.32 kPa)

A hemodynamically stable and conscious client is brought into the emergency department after a crush injury to the pelvis from all-terrain vehicle (ATV) rollover. What action should the nurse prioritize?

Preventing movement of the pelvic area

A 56-year-old female with a diagnosis of breast cancer has developed bone metastases that her oncologist would like to treat with radiation therapy. What is her physician's most likely primary goal in the treatment plan of the metastases?

Prevention of pathologic fractures.

The initial medical management for a symptomatic client with obstructive hypertrophic cardiomyopathy (HCM) would be administering a medication to block the effects of catecholamines. The nurse will anticipate administering which medication?

Propranolol, a beta-adrenergic blocker

Which phenomenon contributes to the difficulties with absorption, distribution, and elimination of drugs that are associated with kidney disease?

Reductions in plasma proteins increase the amount of free drug and decrease the amount of protein-bound drug.

When working with a client with diffuse scleroderma who is exhibiting a 'stone face' expression, the clinician should consider which of these two to be a priority diagnosis for this client?

Risk for aspiration related to swallowing impairments.

Following a motorcycle accident which resulted in bilateral femoral fractures, a client has been placed in skeletal traction. The health care providers would recognize which risk is priority to assess for regularly?

Risk of thromboemboli

A child has just been diagnosed with systemic lupus erythematosus (SLE). Which assessment finding would be considered the most accurate prognostic indicator of the extent/seriousness of the disease?

Rust/blood-colored urine.

Following destruction of the pituitary gland, ACTH stimulation stops. Without ACTH to stimulate the adrenal glands, the adrenal glands' production of cortisol drops. This is an example of which type of endocrine disorder?

Secondary

A client in the intensive care unit has a blood pressure of 87/39 mm Hg and has warm, flushed skin accompanying his sudden decline in level of consciousness. The client also has arterial and venous dilatation and a decrease in systemic vascular resistance. What is this client's most likely diagnosis?

Septic shock

Which medication will likely be prescribed for a client with elevated LDL and triglyceride levels?

Simvastatin, an HMG-CoA reductase inhibitor or 'statin'

A client asks the physician why her hip fracture (head of the femur) bone has died (osteonecrosis). The physician responds based on which pathophysiologic principle?

Since the head of the femur has only limited collateral circulation, interruption in the blood flow from the fracture causes necrosis and irreversible damage.

A 68-year-old black man who has smoked for at least 50 years reports that lately he feels as though food is getting stuck in his throat. At first this was a problem just with dry food, but now his morning oatmeal is getting "stuck." On questioning, he reports drinking at least 3 alcoholic beverages nearly every day. Which is most likely his problem?

Squamous cell carcinoma of the esophagus

A male client has just been diagnosed with hyperuricemia following multiple flare-ups of his metatarsophalangeal joint associated with severe pain and swelling that is affecting his sleep. The clinician should anticipate that which medications may be prescribed for this client? Select all that apply.

a. Allopurinol to decrease uric acid levels. b. Sulfinpyrazone to increase excretion of urate.

A nurse is working on a health care cost analysis related to total knee arthroplasty in the treatment of osteoarthritis. What should the nurse cite as a priority reason to reduce surgery wait times for clients requiring joint replacement?

Stress placed on joints while awaiting surgery can increase the need for additional surgeries.

The nurse is caring for a client with small cell lung cancer (SCLC) and known mediastinal lymph node involvement. What new assessment finding should the nurse prioritize as evidence the client requires emergent intervention?

Swelling of the neck and face

While reviewing the following diagnostic findings on a group of clients with joint complaints, which finding would be a priority for further investigation and possible medical intervention?

Synovial fluid aspiration indicates the presence of monosodium urate crystals.

An IV drug abuser walks into the ED telling the nurse, "I am sick." The client looks feverish with flushed, moist skin; dehydrated with dry lips/mucous membranes; and fatigued. The assessment reveals a loud murmur. An echocardiogram was ordered that shows a large vegetation growing on the client's mitral valve. The client is admitted to ICU. The nurse will be assessing this client for which possible life-threatening complication?

Systemic emboli, especially to brain.

The physician is considering prescribing an anti-tumor necrosis factor (TNF) like infliximab for a client with rheumatoid arthritis (RA). Which statement is accurate about the advantages of using a TNF inhibitor?

TNF inhibitors help slow the disease progression and improve your ability to perform routine ADL functions.

Which statement best captures the role of the adrenal cortex in maintaining homeostasis?

The adrenal cortical hormones are primarily steroids and sex hormones.

A 74-year-old man is being assessed by a nurse as part of a weekly basic health assessment at the long term care facility where he resides. His blood pressure at the time is 148/97 mm Hg, with a consequent pulse pressure of 51 mm Hg. The nurse would recognize that which of the following is the most significant determinant of the resident's pulse pressure?

The amount of blood that his heart ejects from the left ventricle during each beat

A woman with a diagnosis of type 2 diabetes has been ordered a hemoglobin A1C test for the first time by her primary care provider. The woman states, "I don't see why you want to test my blood cells when it's sugar that's the problem." What aspect of physiology will underlie the care provider's response to the client?

The amount of glucose attached to A1C cells reflects the average blood glucose levels over the life of the cell.

When explaining the role of liver Kupffer cells to a group of students, which statement about the function of these cells is most accurate?

The cells are capable of removing and phagocytizing old and defective blood cells.

A young adult with a history of intermittent flank pain, repeated urinary tract infections (UTIs), and hematuria is diagnosed with autosomal dominant polycystic kidney disease (ADPKD). Which pathophysiologic abnormality most likely has contributed to the development of ADPKD?

The client has inherited a tendency for epithelial cells in the tubules to proliferate inappropriately.

A physiotherapist is measuring the lying, sitting, and standing blood pressure of a client who has been admitted to the hospital following a syncopal episode and recent falls. Which fact about the client best relates to these health problems?

The client is 89 years old and takes a diuretic medication for his congestive heart failure.

A nurse is providing care for an older, previously healthy adult male who has been diagnosed today with pneumococcal pneumonia. Which sign/symptom is the nurse most likely to encounter?

The client will have a cough producing clear sputum, and he will have faint breath sounds and fine crackles.

The nurse is caring for a group of four male clients with chronic kidney disease (CKD) and coronary artery disease. The nurse will prioritize which client as being at greatest risk for angina?

The client with a hemoglobin level of 8.0 g/dL (80 g/L)

A client with severe dermatitis from poison ivy has been prescribed prednisone, a corticosteroid, for the treatment of his skin condition. The client has been informed to gradually taper off rather than abruptly stop the prednisone. What is the most accurate rationale for this dosing protocol?

The client's hypothalamic-pituitary-adrenal (HPA) system will require recovery time before normal adrenal function is restored.

A 31-year-old female at 30 weeks' gestation has been diagnosed with peripartum cardiomyopathy. Which statement best captures an aspect of peripartum cardiomyopathy?

The diagnosis might be attributable to a disordered immune response, nutritional factors, or infectious processes.

A 51-year-old male has been diagnosed with alcohol-induced liver disease. He admits to the physician he does not understand what the liver does in the body. Which of these statements best explains the liver's function?

The liver metabolizes most components of food and also cleans the blood of bacteria and drugs.

A physician is explaining to a group of medical students the concept of Virchow's triad as it applies to venous thrombosis. Which clinical observation of a 50-year-old male client is most likely unrelated to a component of Virchow's triad?

The man has decreased cardiac output and an ejection fraction of 30%.

Emergency medical technicians respond to a call to find an 80-year-old man who is showing signs and symptoms of severe shock. Which phenomenon is most likely taking place?

The man's alpha- and beta-adrenergic receptors have been activated, resulting in vasoconstriction and increased heart rate.

Which statement best captures an aspect of the function of the hypothalamic-pituitary-adrenal (HPA) system?

The pituitary gland communicates with the adrenal cortex through the release of ACTH.

An 8-year-old child has just been diagnosed with juvenile idiopathic arthritis (JIA). The parents ask the nurse about the prognosis for this condition. What is the nurse's best response?

The prognosis is dependent on the type of JIA with which your child has been diagnosed.

A number of clients on a geriatric subacute medical floor of a hospital have developed foul-smelling diarrhea over the last several days, and subsequent culture of stool samples has confirmed the presence of Clostridium difficile in each case. The care team on the unit would recognize that which factor likely contributed to the health problem and would anticipate which treatment?

The use of broad spectrum antibiotics likely played a role in the developments of the infections, and most clients would likely receive metronidazole as a treatment.

Though the client's primary care provider has downplayed the symptoms, a geriatrician suspects that an 82-year-old female has polymyalgia rheumatica. Which characteristic symptomatology would most likely have led the specialist to suspect this health problem?

The woman complains of aching and morning stiffness in her neck, shoulder and pelvis.

A 41-year-old woman has been diagnosed as having a loose body of cartilage in her left knee. What data would be most likely to lead clinicians to this diagnosis?

The woman experiences intermittent, painful locking of her joint.

A client with a newborn infant is also the caregiver for her 75-year-old mother, who lives with them and who has diabetes. The client requests pneumonia vaccinations for her entire household. Which vaccine is most likely to be effective for the baby?

There is no effective vaccine for newborn infants.

A client being investigated for systemic lupus erythematosus (SLE) has an elevated antinuclear antibody result and asks the nurse what this means. What is the nurse's best response?

This is a nonspecific marker for autoimmune activity, so you will require additional tests.

The nurse is caring for a client with small cell lung cancer who has developed a syndrome associated with hyperglycemia, hypokalemia, and sodium and water retention. The client asks the nurse why this occurring. How should the nurse respond?

This is the result of tumor cells releasing the adrenal hormones, such as cortisol, in excessive amounts.

An older adult man reports recent urinary hesitation and is eventually diagnosed with benign prostatic hyperplasia (BPH). Which clinical manifestations would the health care provider expect prior to the resolution of this health problem?

Urinary frequency and urgency and pain

A 56-year-old male is obese and has poorly-controlled type 2 diabetes mellitus. The home care nurse who changes the dressing on his chronic foot ulcer three times weekly has noted that the client's bone is now visible in the wound bed. The client has a fever and has not complained of any notable increase in pain to his foot. Which statement best captures what is likely occurring?

Vascular insufficiency has contributed to infection in both soft tissue and now his bone.

An 8-year-old female is diagnosed with a third urinary tract infection (UTI) this calendar year. For what condition is it most important for the nurse to advocate assessment?

Vesicoureteral reflux

Because nephropathy is an important cause of end-stage renal failure in children, a toddler who has had an uncomplicated bout of urinary tract infection (UTI) should still be evaluated for the presence of which renal disorder?

Vesicoureteral reflux

The clinician walks into a room and finds the client forcefully expelling stomach contents into a wash basin. When documenting this occurrence, the clinician will use the term:

Vomiting

A client with small cell lung cancer (SCLC) has developed a paraneoplastic syndrome called Cushing syndrome. Based on this new complication, the nurse will likely assess which clinical manifestation of Cushing syndrome?

Weight gain, moon face, buffalo hump, purple striae on abdomen.

A 28-year-old client who participates in triathlon competitions has been diagnosed with a meniscus tear in the left knee, and arthroscopic repair is recommended. The client wishes to continue competing and wants to avoid any invasive procedures. What is the nurse's best response?

Without corrective procedures now, joint degeneration could result in requiring joint replacement later in life.

A client is admitted for a relapse for sarcoidosis. Knowing this is usually caused by an inflammatory process, the nurse can anticipate administering:

a corticosteroid.

Which scenario would put a client at risk for experiencing a thyroid problem due to a decrease in thyroxine-binding globulin (TBG)? Select all that apply.

a. 18-year-old female client with anorexia nervosa weighing 78 pounds who has consumed no protein for the past 3 years. b. 75-year-old man receiving chronic glucocorticoid therapy to treat his severe chronic obstructive pulmonary disease (COPD) c. 55-year-old male with cirrhosis due to alcohol abuse

The nurse is monitoring a group of clients being treated for various chronic illnesses. Which clients should the nurse prioritize as most at risk for hyperkalemia? Select all that apply.

a. 76-year-old with type 2 diabetes controlled with insulin and taking an ACE inhibitor b. 25-year-old with acute kidney injury taking penicillin

A 2-month-old infant is breastfed and diagnosed with cystic fibrosis. The infant is being evaluated for possible pancreatic abnormalities based on which clinical assessment finding(s)? Select all that apply.

a. 8 to 10 liquid stools/day b. Too much fat in the stools c. Weight has remained the same as birth

The nurse is caring for a group of clients and deciding who should receive prophylaxis for venous thromboembolism (VTE). Which clients should the nurse identify at high risk for VTE? Select all that apply.

a. A 45-year-old with a fractured patella b. A 65-year-old who had a stroke and is now immobile c. A 25-year-old on oral contraceptives who smokes

Which individuals are at risk for developing urinary obstructions? Select all that apply.

a. A 70-year-old male with benign prostatic hyperplasia (BPH) b. A 58-year-old male with renal calculi c. A 28-year-old male with a neurogenic bladder secondary to spinal cord injury d. A 29-year-old female, pregnant for the first time

The nurse suspects the client may have developed partial bilateral ureter obstruction. What evidence assessment findings support this suspicion? Select all that apply.

a. A urine specific gravity of 1.001 b. An increase in urine output

Which clinical interventions would be considered priority when managing a client with life-threatening myxedema coma? Select all that apply.

a. Administer 50% dextrose to raise glucose levels. b. Place on oxygen therapy to encourage deep breathing. c. Administer 3% sodium IV solution to increase sodium levels.

The clinician is planning care for a client with ankylosing spondylitis (AS). Which interventions should the nurse include in the plan of care? Select all that apply.

a. Administration of analgesics b. Physiotherapy consult c. Application of heat to involved joints

For several years, a single mother of 2 has been averaging 2 to 3 bottles of wine each night and recently has added several ounces of brandy as well. She now has been diagnosed with cirrhosis. Which physical manifestations of cirrhosis would the clinician expect to find during assessment? Select all that apply.

a. Ascites b. Epigastric pain c. Bleeding tendencies d. Anorexia

A health care provider is attempting a differential diagnosis of a 30-year-old female who is suspected of having systemic lupus erythematosus (SLE). Which assessment and history findings correlate with SLE? Select all that apply.

a. Blood work indicates low red cells, white cells, and platelets. b. She complains of intermittent joint pain. c. The client has been hospitalized twice in the past for pleural effusions. d. The client has a "butterfly rash" on her nose and cheeks.

A client has recently been diagnosed with large cell carcinoma, and the nurse is preparing the client for diagnostic testing to identify distal metastases. Which sites should the nurse explain to the client as the primary focus for the investigation? Select all that apply.

a. Bone b. Liver c. Brain

The clinician is assessing a client with suspected dysphagia. Which cranial nerves (CN) should the clinician assess? Select all that apply.

a. CN V b. CN IX c. CN X d. CN XII

A community health nurse is preparing an awareness campaign about the risks factors for developing hypersensitivity pneumonitis. Which risk factors should the nurse include? Select all that apply.

a. Caring for pigeons b. Stacking hay bales inside a barn c. Repairing air conditioners

A client is admitted with the diagnosis of obstructive jaundice. Which assessment findings would the nurse expect to see in this client? Select all that apply.

a. Dark urine b. Elevated conjugated bilirubin levels c. Severe itching d. Clay-colored stools

A 22-year-old woman has sustained a lateral blow to her right knee during a game, and subsequent imaging has confirmed a severe meniscus injury. Which consequences should the woman expect over the course of recovery? Select all that apply.

a. Decreased lubrication in the knee joint b. Reduced shock absorption capacity c. Decreased stability of the knee

A nurse is teaching parents of a child who is being discharged after treatment for a streptococcal infection. For what symptoms should the nurse teach the parents to observe, because they are related to the risk for poststreptococcal glomerulonephritis? Select all that apply.

a. Edema b. Decreased urine output

The nurse is assessing a female neonate on the neonate's first clinic appointment after leaving the hospital. Which manifestations leads the nurse to suspect the neonate has developed a urinary tract infection? Select all that apply.

a. Fever higher than 101°F (38.3°C) b. Poor skin perfusion with ashen color c. Abdominal distention d. Irritability

The physician is caring for a client with end-stage liver disease who is at risk for hepatic encephalopathy. For which complications that increase the risk for hepatic encephalopathy should the physician assess? Select all that apply.

a. High colonic pH b. Gastrointestinal bleeding c. Constipation

The clinician knows that a client with diabetes admitted for a lower limb infection likely is experiencing which pathophysiologic principle listed below? Select all that apply.

a. Hyperglycemia may provide an environment that enhances the growth of microorganisms. b. Many clients with diabetes have sensory deficits and ignore minor trauma just because they can't feel it in their feet. c. Clients with chronic diabetes may have vascular problems that impair circulation and therefore cells needed for adequate inflammatory response can't reach the site.

An infant born with congenital hypothyroidism who does not receive care from any health care provider is likely to develop which complications? Select all that apply.

a. Impaired physical growth b. Intellectual disability

The nurse is caring for a client with nephrosis and notes generalized edema. The nurse attributes this finding to which processes? Select all that apply.

a. Increased permeability of glomerular capillaries b. Increased aldosterone levels c. Decreased serum albumin

The health care provider is planning care for a client with breast cancer and metastasis to bone who has been admitted for palliative care. What should the health care provider include in the plan of care? Select all that apply.

a. Initiating falls prevention protocols b. Preparing the client for radiotherapy c. Administration of bisphosphonates

Upon admission to the ICU, a client with a history of cor pulmonale will likely be exhibiting which clinical manifestations of right-sided heart failure? Select all that apply.

a. Jugular vein distension b. +4 pitting edema in lower extremities c. Altered level of consciousness

When counseling an adolescent client with a meniscus injury from sports, which treatment conservative measure(s) will the clinician provide education? Select all that apply.

a. Knee immobilization b. Isometric quadriceps exercises

Which clinical manifestations would lead the nurse to suspect that a client with renal failure is developing uremia? Select all that apply.

a. Lethargy and confusion. b. Extreme itching. c. Weakness and fatigue.

A client with systemic lupus erythematosus (SLE) glomerulonephritis is experiencing a worsening of the disease and has progressed to the higher classes resulting in renal involvement. Which medication(s) will likely be prescribed by the health care provider to treat the deterioration of the renal function? Select all that apply.

a. Lisinipril, an angiotensin-converting enzyme (ACE) inhibitor b. Oral corticosteroid

A nurse is teaching a student about nephrotic syndrome. Which statement(s) about the pathogenesis of nephrotic syndrome is accurate and should be included in the education? Select all that apply.

a. Loss of colloidal osmotic pressure causes generalized edema. b. Massive proteinuria is a result of the increased permeability. c. Increased glomerular membrane permeability allow proteins to escape from the plasma into glomerular filtrate.Increased glomerular membrane permeability allow proteins to escape from the plasma into glomerular filtrate.

Which clinical manifestations should the nurse expect to find during physical assessment of a client diagnosed with bronchiectasis? Select all that apply:

a. Low hemoglobin levels b. Recurrent chest infections c. Production of purulent sputum

The nurse is creating a plan of care for a client with autosomal dominant polycystic kidney disease (ADPKD). What should the nurse include in the plan of care? Select all that apply.

a. Low sodium diet b. Administration of antihypertensives c. Inspection of urine output

Which clients scheduled for an interventional radiology procedure requiring administration of radiocontrast dye would be considered high risk for nephrotoxicity? Select all that apply.

a. Middle-aged adult with diabetes undergoing diagnostic testing for new-onset proteinuria b. Young adult with a history of glomerular nephritis who is reporting severe flank pain?

The nurse is planning the care for a client with acute kidney injury (AKI). What should the nurse prioritize in the client's plan of care? Select all that apply.

a. Monitoring electrolyte levels b. Assessing fluid balance c. Promoting infection control

A client returns to the clinic for review of previous laboratory values. A diagnose of ankylosing spondylitis (AS) is made, based on laboratory results and manifestations of low back pain which worsens when resting, thigh pain like that of sciatica, and morning stiffness. Which educational teaching would be appropriate to provide? Select all that apply.

a. Muscle-strengthening exercises for extensor muscle group b. Proper posture c. Use of firm mattress with one small pillow

The nurse caring for a child with respiratory problems is concerned he may be developing respiratory failure. Upon assessment, which findings correlate to impending respiratory failure? Select all that apply.

a. Nasal flaring b. Grunting on expiration c. Severe accessory muscle retractions

The nurse is caring for a client who is being treated for pneumonia. The nurse suspects the client has developed pleuritis. Which assessment findings support the nurse's suspicion of pleuritis? Select all that apply.

a. Pain when deep breathing and coughing b. Shoulder pain c. Unequal chest expansion on inspiration

A 78-year-old male client has undergone a total knee replacement. He just doesn't feel like getting out of bed and moving around. After 3 days of staying in bed, the physical therapist encourages him to get out of bed to the chair for meals. He starts to complain of dizziness and lightheadedness. These symptoms are primarily caused by which pathophysiologic principle? Select all that apply.

a. Peripheral vasoconstriction mechanism has failed. b. Client is experiencing a reduction in plasma volume.

As a consequence of long-standing lung disease, a client is in a chronic state of hypoxia. Which phenomena would the client's care team be most justified in anticipating? Select all that apply.

a. Personality changes b. Hyperventilation c. Increased erythropoietin production

A client with rheumatoid arthritis has been taking a combination of disease-modifying antirheumatic drugs (DMARDs), which are a variety of immunosuppressants and immunomodulators, for years. Which laboratory result(s) indicate the client may be experiencing toxic adverse effects and will need the medications adjusted? Select all that apply.

a. Platelet count 10,000/μL (100 ×109/L) b. Absolute neutrophil count of 500/μL (0.50 ×109/L) c. Red blood cell count of 8.0 ×106/μL (8.0 ×1012/L)

A client has developed hypersplenism caused by portal hypertension. Which laboratory value(s) will the physician recognize as correlating with this diagnosis? Select all that apply.

a. Platelet count of 90,000/μL (90 ×109/L) b. Hemoglobin level of 9.5 g/dL (95 g/L) c. White blood cell count of 3,000/μL (3.0 × 109/L)

The clinician is caring for a client with end-stage biliary cirrhosis. What should the clinician include in this client's plan of care? Select all that apply.

a. Promote intake of foods rich in vitamin D. b. Inspect skin for evidence of breakdown. c. Monitor client for signs of acute blood loss.

A client with hypertension, arthritis, and early chronic kidney disease (CKD) has developed viral gastroenteritis and is unable to consume adequate fluids. Which prescribed medications should the nurse caution the client about taking due to the increased risk for prerenal acute kidney injury? Select all that apply.

a. Ramipril b. Hydrochlorothiazide c. Ibuprofen

A client has been admitted with a fractured pelvis that occurred in an auto accident just a few hours ago. The family has noticed a slight change in behavior. Which other clinical manifestations would lead the physician to suspect the client has developed a fat emboli? Select all that apply.

a. Reports of substernal chest pain b. Profuse diaphoresis with pallor noted c. Pulse rate 120 with temperature of 99.7°F (37.6°C)

Following physical assessment, which abnormality(ies) leads the health care provider to suspect the client has metabolic syndrome? Select all that apply.

a. Sitting blood pressure reading of 145/96 mm Hg b. Five foot (1.5 meter) tall female with abdominal waist measurement of 45 inches (114 cm) c. Fasting triglyceride level of 230 mg/dL 92.6 mmol/L)

A client with type 2 diabetes has just screened positive for microalbuminuria. What should the nurse discuss with the client as most likely to be included in the treatment plan? Select all that apply.

a. Smoking cessation b. Referral to dietitian c. Measuring HgbA1C level

The nurse knows that which clinical manifestations may be present with the diagnosis of acute nephritic syndrome? Select all that apply.

a. Sudden onset of hematuria b. Edema c. Proteinuria

The physician is providing education to the child and parents about treatment for the ankle strain the child experienced while playing sports this afternoon. Which topic(s) should the physician address in this education? Select all that apply.

a. Take over-the-counter ibuprofen pain relievers b. Place an ice pack on the injured area for the next few days c. Pick up a removable splint at the store to provide support to the ankle

Parents have brought their child to the emergency department with abdominal pain. Which clinical manifestations would lead the health care team to suspect the child has appendicitis? Select all that apply.

a. Tenderness in right lower quadrant with palpation. b. Rebound tenderness in inguinal areas upon palpation.

The clinician is teaching a client about the risk for venous thrombosis and venous thromboemboli as part of discharge instructions. What should the clinician include when teaching the client? Select all that apply.

a. The risk for a thromboembolic event lasts for months after you have been discharged. b. Notify your health care provider of any evidence of calf swelling and redness. c. If you become suddenly short of breath, call an ambulance immediately.

A client with COPD asks the nurse which medications are prescribed to help with breathing. The nurse will educate the client about which medications to help COPD in the long-term? Select all that apply.

a. Tiotropium, an anticholinergic. b. Salmeterol, a bronchodilator.

When educating the client with ankylosing spondylitis, the nurse should emphasize which treatment interventions? Select all that apply.

a. Try using the heating pad prior to exercise to help stretching and improve movement. b. Encourage sleeping supine on an extra firm mattress if possible.

A nurse is caring for a group of clients and reviewing the recent laboratory values and medical charts. What adult client(s) is exhibiting early manifestations of prerenal acute kidney injury (AKI), which should be reported to the health care provider? Select all that apply.

a. Urine output has dropped from 1200 mL/24 hours to current 300 mL/24 hours. b. Blood urea nitrogen (BUN) to creatinine ratio has gone from 10:1 to 21:1.

The nurse is creating a teaching plan on self-management for a client with moderate rheumatoid arthritis. What should the nurse include in the teaching plan? Select all that apply.

a. Use of heat or cold on joints b. Techniques to reduce joint use c. Use of assistive devices

A 5-year-old child who had been receiving dialysis treatments has undergone renal transplant and will now be taking prednisone. The parents are hopeful the child's development and overall health will normalize. The nurse should inform the parents that taking prednisone can result in some similar adverse effects as living with chronic kidney disease (CKD). Which effects should the nurse include? Select all that apply.

a. Weakened bone structure b. Increased risk for infection c. Delayed growth d. Fluid retention

A client has undergone insertion of a drug-eluting stent. Based on clinical trials, which medications, when taken in combination, have been found effective to prevent restenosis if taken for up to 1 year after the procedure? Select all that apply.

a. clopidogrel b. Aspirin

A client who has been on a high-protein diet comes to the emergency department with respiratory symptoms. Upon analysis of arterial blood gases (ABGs), the client is diagnosed with hypercapnia. Which ABG results confirm this diagnosis? Select all that apply.

a. pH 7.31 (Normal 7.35-7.45) b. PCO2 58 mm Hg (7.71 kPa) [Normal 35-45 mm Hg, 4.7 - 5.9 kPa] c. Serum HCO3 33 mEq/L (33 mmol/L) [Normal 22-28 mEq/L, 22-28 mmol/L]

A client arrives at the ED complaining of numbness in left lower leg. Upon assessment, the nurse finds the lower left leg to be cold to touch, pedal and posterior tibial pulses non-palpable, and a sharp line of paralysis/paresthesia. The nurse's next action is based on the fact that:

acute arterial occlusion is a medical emergency requiring immediate intervention to restore blood flow.

The nurse is caring for clients with chronic respiratory disorders. For which client with cyanosis should the nurse intervene first? The client with cyanosis and:

anemia of chronic disease and a hemoglobin of 8.7 g/dL (87 g/L).

Following prosthetic joint replacement of the knee, the client continues to complain of pain and discomfort above what would be expected. There is poor incisional healing. The clinician is concerned when she sees that the incision is still draining after 3 weeks post-op. The clinician suspects a prosthetic joint infection. The clinician should anticipate the physician will prescribe:

antimicrobial treatment depending on the microbe.

A 77-year-old client with a history of coronary artery disease and heart failure has arrived in the emergency room with a rapid heart rate and feeling of "impending doom." Based on pathophysiologic principles, the nurse knows the rapid heart rate could:

be a result of catecholamines released from SNS, which could increase the myocardial oxygen demand.

An older adult client arrives to the health care provider's office complaining of a "sore" that won't heal on the lower leg. Upon assessment, the nurse finds thin, shiny, bluish brown pigmented desquamative skin. It is located medially over the lower leg. The nurse will educate the client that the usual treatment is:

compression therapy to help facilitate blood flow back to the vena cava.

If a virus has caused inflammation resulting in endothelial dysfunction, an excessive amount of endothelins in the blood can result in:

contraction of the underlying smooth muscles within the vessels.

The nurse is caring for a group of infants with bronchiolitis. Which infant should the nurse prioritize as requiring immediate intervention? The infant who:

has diminishing wheezing and cyanosis.

A nurse will be providing care for a female client who has a diagnosis of heart failure that has been characterized as being primarily right-sided. Which statement best describes the presentation that the nurse should anticipate? The client:

has pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain.

A middle-aged man walks into the emergency department reporting chest pain radiating to the neck, shortness of breath, and nausea. His heart rate is 120 and BP is 94/60. The ED physician recognizes the client is having an acute MI with decreased cardiac output. The nurse identifies the nausea to be in response to:

hypoxia exerting a direct effect on the chemoreceptor trigger zone.

A client has recently been diagnosed with H. pylori gastritis. The nurse knows that this form of gastritis is usually treated with a combination of an antibiotic and:

inhibitors

A client who suffered a stroke is having difficulty swallowing food and beverages. The client complains that it feels like "the food is sticking to the back of my throat." Given this information, the priority clinical interventions would be to:

make the client "nothing per os" (NPO) and call the physician.

When providing education to a client diagnosed with a benign bone tumor, the clinician should emphasize the fact that benign tumors primarily:

tend to grow very slowly without destroying the supporting tissue.