Patho Midterm

Of the following situations, which one would be an example of a maladaptive cellular change?

- A 44-year-old male with a 60-pack-per year smoking history who was diagnosed with a histological grade 3 lung cancer

A patient diagnosed with H pylori asks the nurse, "How an infection can occur in the stomach since it is an acid environment?" The nurse responds,

- "H. pylori produces an enzyme called urease that converts gastric juices into ammonia, which neutralizes the acidic stomach environment."

Following a serious bout of bacterial meningitis, the parents of a 14-month old have noted the child is not responding to verbal commands. The nurse will explain the pathophysiologic principle behind this by making which statement?

- "This may be due to a loss of hair cells and damage to the auditory nerve."

While working at the triage desk in the local emergency department, which of the following patients is likely having a medical emergency and needs to be seen first?

- 55 year old truck-driver complaining of sudden onset of ocular pain and blurred vision.

A physician is providing care for a number of patients on a medical unit of a large, university hospital. The physician is discussing with a colleague the differentiation between diseases that are caused by abnormal molecules and diseases that cause disease. Which of the following patients most clearly demonstrates the consequences of molecules that cause disease?

- A 30-year-old homeless man who has Pneumocystis carinii pneumonia (PCP) and is HIV positive.

A nurse is assessing clients on a medical-surgical unit. Which clients are at increased risk for hypophosphatemia? (Select all that apply.)

- A 36-year-old who is malnourished - A 42-year-old with uncontrolled diabetes - A 76-year-old who is prescribed antacids

In which of the following individuals would a clinician most suspect multiple myeloma as a diagnosis?

- A 40 year-old man who has had 3 broken bones over the past 6 months and whose serum calcium and creatinine levels are elevated.

A nurse is providing care for several clients on a neurological unit of a hospital. In which of the following clients would the nurse be justified in predicting a problem with thermoregulation?

- A 66-year-old male with damage to his thalamus secondary to a cerebral vascular accident

Which of the following patients would be most likely to be experiencing an increase in renal erythropoietin production?

- A 71-year-old smoker admitted to hospital with exacerbation of his chronic obstructive pulmonary disease (COPD)

A member of the health care team is researching the etiology and pathogenesis of a number of clients who are under his care in a hospital context. Which of the following aspects of clients' situations best characterizes pathogenesis rather than etiology?

- A client who has increasing serum ammonia levels due to liver cirrhosis

Of the following list of patients, which would likely benefit the most from hyperbaric oxygen therapy?

- A trauma patient who developed Clostridium spp., an anaerobic bacterial infection in their femur.

A 41-year-old female with a family history of breast cancer has had a baseline mammogram. She states that she performs monthly self-breast exams but really has a hard time evaluating her lumps since she has numerous cysts. At her annual mammogram, the technician views a suspicious area and refers her to the radiologist. She asks the nurse in the office, "How can a lump appear so quickly?" The nurse's response is based on which of the following principles?

- A tumor is undetectable until it has doubled 30 times and contains at least 1 billion cells.

A 72-year-old woman with a recent onset of syncopal episodes has been referred to a cardiologist by her family physician. As part of the patient's diagnostic workup, the cardiologist has ordered her to wear a Holter monitor for 24 hours. Which of the following statements best captures an aspect of Holter monitoring?

- Accurate interpretation of the results requires correlating the findings with the activity that the woman was doing at the time of recording.

Which is a malignant tumor of glandular epithelial cells

- Adenocarcinoma

Which are considered stages of the general adaptation syndrome?

- Alarm - Resistance - Exhaustion

The primary care provider knows which of the following statements below will also benefit an adult client with a diagnosis of diabetes mellitus performing isometric exercise to help control his blood glucose levels?

- An increase in his basal metabolic level

Staphylococcus aureus commonly found in the skin, nares, and other body sites of patients without any signs and symptoms of infection is known as which of the following conditions listed below?

- Bacterial colonization

A 37-year-old male has survived a logging accident in which the severing of his femoral artery and consequent blood loss resulted in cardiogenic shock. On recovery, one of the deficits that he finds most frustrating is a significant loss of visual acuity. Which is the most likely rationale for his vision damage?

- Circulatory collapse causes rapid death of retinal neurons.

Which of the following are the requirements for blood clotting

- Clotting factor - Presence of platelets

A physical assessment of a 28-year-old female patient indicates that her 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 of the following possibilities would her care provider be most likely to suspect?

- Coarctation of the aorta

A nurse is caring for an older adult client who is admitted with moderate dehydration. Which intervention should the nurse implement to prevent injury while in the hospital?

- Dangle the client on the bedside before ambulating.

Your ESRD patient is receiving two units of packed red blood cells for anemia (Hgb of 8.2). Twenty minutes into the first transfusion, the nurse observes the patient has a flushed face, hives over upper body trunk, and is complaining of pain in lower back. His vital signs include pulse rate of 110 and BP drop to 95/56. What is the nurse's priority action?

- Discontinue the transfusion and begin an infusion of normal saline.

The nurse practitioner working in an overnight sleep lab assessing and diagnosing patients with sleep apnea. During this diagnostic procedure, the nurse notes that a patient's blood pressure is 162/97. The nurse explains this connection to the patient based on which of the following pathophysiological principles?

- During apneic periods the patient 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 patient displaying which of the following clinical manifestations?

- Dyspnea and crackles in bilateral lung bases.

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 of the following sets of diagnostics?

- Echocardiogram, blood cultures, temperature

A nurse is assessing a client who has an electrolyte imbalance related to renal failure. For which potential complications of this electrolyte imbalance should the nurse assess? (Select all that apply.)

- Electrocardiogram changes - Paralytic ileus - Skeletal muscle weakness

Which of the following statements provides blood work results and rationale that would be most closely associated with acute coronary syndrome?

- Elevated creatine kinase and troponin, both of which normally exist intracellularly rather than in circulation.

Tumor necrosis factor-α and IL-1 are major cytokines that mediate inflammation. If the patient is developing a systemic response to an infection, the nurse will likely assess which of the following clinical manifestations? Select all that apply.

- Elevated temperature. Tachycardia. Anorexia

The physician suspects that a patient under a lot of stress (stimulation of the sympathetic nervous system) is experiencing stress-induced release of vasopressin. Knowing the effects of an activated renin-angiotensin-aldosterone system (RAAS), the nurse should be assessing the patient for which primary nursing diagnosis?

- Fluid volume excess related to retention of water in the body

A 30-year-old woman has sought care because of her recurrent photophobia, tearing,and eye irritation. During assessment, her care provider asks about any history of coldsores or genital herpes. What is the rationale for the care provider's line of questioning?

- HSV infection of the cornea is a common cause of corneal ulceration and blindness.

A particular disease has a debilitating effect on the ability of sufferers to perform their activities of daily living and is a significant cause of decreased quality of life. However, few people die as a result of the disease's direct effects. There are hundreds of thousands of Americans living with the disease but relatively few new cases in recent years. Which of the following statements best conveys an accurate epidemiological characterization of the disease?

- High morbidity; low mortality; high prevalence, low incidence

When explaining what is occurring when their child has an acute bronchial asthma attack, the nurse will emphasize that which mediator is primarily responsible for the bronchial constriction?

- Histamine.

The nurse is teaching new nursing assistants on the unit about the phenomenon of muscle hypertrophy. Which of the following clients on the unit is most likely to experience muscle hypertrophy? A client with:

- Hypertension, obesity and decreased activity tolerance.

Muscular fibers increase their size as a consequence of practicing physical exercise. This is an example of:

- Hypertrophy

A nurse is caring for clients with electrolyte imbalances on a medical-surgical unit. Which clinical manifestations are correctly paired with the contributing electrolyte imbalance? (Select all that apply.)

- Hypokalemia - Flaccid paralysis with respiratory depression - Hyponatremia - Decreased level of consciousness

A 60-year-old man has presented to his family physician following an earache that hasbecome progressively more painful in recent days. Following a history and examination with an otoscope, the man has been diagnosed with otitis externa. Which of thephysician's following statements to the man is most accurate?

- I'll prescribe some ear drops for you, and in the meantime, it's important not to use ear swabs."

Which is characteristic of benign neoplasms?

- Inability to metastasize to distant sites

Which of the following aspects of a patient's site of inflammation would help the care provider rule out chronic inflammation?

- Increased neutrophils

A nurse assesses a client who is admitted for treatment of fluid overload. Which manifestations should the nurse expect to find? (Select all that apply.)

- Increased pulse rate - Distended neck veins - Skeletal muscle weakness

An 81-year-old male patient who has a diagnosis of orthostatic hypotension is experiencing an episode of particularly low blood pressure.The man's body has responded by increasing levels of angiotensin II in the bloodstream, a hormone that decreases the glomerular filtration rate in the kidneys and contributes to an increase in blood pressure. Which of the following phenomena best describes what has occurred?

- Negative feedback

A 29-year-old woman has been diagnosed with otosclerosis after several years of progressive hearing loss. What pathophysiologic process has characterized her diagnosis?

- New spongy bone has been formed around her stapes and oval window.

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 the contraction of the entire muscle cell layer does resulting in decreased vessel lumen radius?

- Norepinephrine

During a routine physical exam for a patient diagnosed with hypertension, the nurse practitioner will be most concerned if which of the following assessments are found?

- Noted hemorrhages and microaneurysms during evaluation of the internal eye

A 44-year-old female who is on her feet for the duration of her entire work week has developed varicose veins in her legs. What teaching point would her care provider be most justified in emphasizing to the woman?

- Once you have varicose veins, there's little that can be done to reverse them."

A 71-year-old male patient with a history of myocardial infarction (MI) and peripheralvascular disease (PVD) has been advised by his family physician to begin taking 81 mgaspirin once daily. Which of the following statements best captures an aspect of theunderlying rationale for the physician's suggestion?

- Platelet aggregation can be precluded through inhibition of prostaglandin production by aspirin.

Which of the following patients is most likely to have impairments to the wound healing process? A patient with

- Poorly controlled blood sugars with small blood vessel disease.

The family of a 68-year-old man who is in the end stages of small cell lung cancer is distraught at his visible body wasting that has worsened in recent weeks. Which of the following phenomena best accounts for the patient's anorexia and cachexia?

- Products of the tumor itself as well as a hypermetabolic state cause cachexia

The family of a 68-year-old man who is in the end stages of small cell lung cancer are distraught at his visible body wasting that has worsened in recent weeks. Which of the following phenomena best accounts for the client's anorexia and cachexia?

- Products of the tumor itself as well as a hypermetabolic state cause cachexia.

Following a car accident of a male teenager who did not have his seatbelt on, he arrived in the emergency department with a traumatic brain injury. He has severe cerebral edema following emergent craniotomy. Throughout the night, the nurse has been monitoring and reporting changes in his assessment. Which of the following assessments correspond to a supratentorial herniation that has progressed to include midbrain involvement?

- Pupils fixed at approximately 5 mm in diameter - Respiration rate of 40 breaths/minute - Decerebrate posturing following painful stimulation of the sternum

This component of the homeostatic mechanism is in charge of receiving information form the environment:

- Sensor

A nurse assesses a client who is prescribed a medication that inhibits aldosterone secretion and release. For which potential complications should the nurse assess? (Select all that apply.)

- Serum potassium level of 5.4 mEq/L - Blood osmolality of 250 mOsm/L

A 30-year-old woman who has given birth 12 hours prior is displaying signs and symptoms of disseminated intravascular coagulation (DIC). The client's husband is confused as to why a disease of coagulation can result in bleeding. Which of the nurse's following statements best characterizes DIC?

- So much clotting takes place that there are no available clotting components left, and bleeding ensues."

Which of the following statements is an accurate descriptor of the role of viruses in human infections?

- Some viruses are capable of transforming normal host cells into malignant cells.

A nurse at a long term care facility provides care for an 85 year-old man who has had recent transient ischemic attacks (TIAs). Which statement best identifies future complications associated with TIAs?

- TIAs resolve rapidly but may place the client at an increased risk for stroke.

A client asks the health care provider why his lower legs look purple. The health care provider will base the response on which pathophysiologic principle?

- The bruising around the ankles is due to the fact that it is a dependent area where the capillary pressure is higher.

Which of the following characteristics could apply to healthy somatic cells rather than cancerous cells?

- The cells are unable to proliferate except by mitotic division.

A clinician is conducting an assessment of a male client suspected of having a disorder of motor function. Which of the following assessment findings would suggest a possible upper motor neuron (UMN) lesion?

- The client displays increased muscle tone.

The nurse knows a client who is a long-distance runner is able to respond effectively to the increased oxygen demands while running is due to which of the following statements listed below?

- The insular and anterior cingulated cortex interacts with the hypothalamic centers, resulting in stimulation of the medullary cardiovascular centers.

A 77-year-old man is a hospital inpatient admitted for exacerbation of his chronic obstructive pulmonary disease (COPD), and a respiratory therapist (RT) is assessing the client for the first time. Which of the following aspects of the patient's current state of health would be best characterized as a symptom rather than a sign?

- The patient notes that he has increased work of breathing when lying supine.

Which of the following physiological processes would be considered a positive feedback mechanism?

- The platelet aggregation mechanism for closing minute ruptures in very small blood vessels during accidental injury

The medical team is assessing a newly admitted patient who is hypothermic following a night spent lost on a ski slope. The health care professionals would recognize that which of the following phenomena most likely contributed to minimizing the client's heat loss in a cold environment?

- The tissue thickness of the outer shell increased and preserved heat.

A geriatrician and social worker are facilitating a family meeting for the children andwife of a 79-year-old man who has been diagnosed with Alzheimer disease. What goal of treatment will the clinicians most likely prioritize in their interactions with the family?

- The use of medications such as donepezil and rivastigmine to slow the progression of the disease

A patient is brought into the emergency room because he has been suffering from high blood pressure for the last 15 years. Last week, his blood pressure was really high. After that, the patient experienced dizziness, imbalance, ear ringing, and decreased hearing in his right ear. What part of the ear could be affected?

- Vestibular portion

A client with a diagnosis of atrophic gastritis and consequent pernicious anemia is receiving high oral doses of vitamin B12. Which of the following changes would be most likely expected by his care provider at the completion of his treatment?

- a decrease in mean corpuscular volume

Laboratory testing is ordered for a male patient during a clinic visit for a routine follow-up assessment of hypertension. When interpreting lab values, the nurse knows that

- a normal value represents the test results that fall within the bell curve.

The nurse knows that which of the following treatment plans listed below is most likely to be prescribed after a computed tomography (CT) scan of the head reveals a new-onset aneurysmal subarachnoid hemorrhage?

- craniotomy and clipping of the affected vessel

20-year-old has been admitted to a rehabilitation center after hospital treatment for an ischemic stroke. Which of the following aspects of the client's history would be considered to have contributed to his stroke? Select all that apply. The client

- is an African American male. - blood pressure has historically been in the range of 150s/90s. - was diagnosed with type 2 diabetes 8 years ago.

The nurse knows which component is needed for long-lasting immunity in a client with a diagnosis of sepsis without the causative agent identified?

- lymphocytes

If the anterior-posterior dimension of the eyeball is too long, the focus point for an infinitely distant target is anterior to the retina. This client would be diagnosed as having:

- myopia.

A male international business traveler has returned from a trip to Indonesia. While there, he hired a prostitute for companionship and engaged in unprotected sex on more than one occasion. Unbeknownst to him, this prostitute harbored the hepatitis C virus. Upon return to the United States, he exhibited no symptoms and returned to his usual activities. During this period of no outward symptoms, the man would be classified as being in

- the preclinical stage of disease.

Which of the following would be considered an abnormal finding when the nursepractitioner uses an otoscope to look at a toddler's ear? The tympanic membrane is described as

- yellow, amber discoloration noted."

Which situation can best be characterized as an example of passive immunity?

A 6-week-old infant receives antibodies from his mother's breast milk

A 22 year-old female college student is shocked to receive a diagnosis of myasthenia gravis. What are the etiology and most likely treatment for her health problem?

A decline in functioning acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins

During a flu shot clinic, one of the questions the student nurse asks relates to whether the patient has had Guillain-Barré syndrome in his medical history. The patient asks, "What is that?" How should the nursing student reply?

A type of paralysis that affects movement on both sides of the body that may even involve the respiratory muscles"

Programmed cell death is also known as:

Apoptosis

A community health care nurse is teaching a group of female high school students about the importance of regular Papanicolaou (Pap) smears. The nurse recognizes that what fact underlies the rationale for this teaching?

Cancer of the uterine cervix develops incrementally at a cellular level.

A nurse on a neurology unit is assessing a female brain-injured client. The client is unresponsive to speech, and her pupils are dilated and do not react to light. She is breathing regularly, but her respiratory rate is 45 breaths/minute. In response to a noxious stimulus, her arms and legs extend rigidly. What is her level of impairment?

Coma

Which of the following assessment and laboratory findings would be most closely associated with acute leukemia?

High blast cell counts and fever

A 60-year-old male office worker presents to a clinic complaining of new onset of lower back pain that has been worsening over the last 6 weeks. The nurse knows which of the following components of his physical assessment and history is most indicative of a serious pathological process (like aortic aneurysm or cancer)?

His onset of pain has been gradual, and he has no prior history of lower back problems

While undergoing a kidney transplant from a non-family member, the client's transplanted kidney has just had the arterial clamps removed. The OR staff notices that the organ is turning purple with no urine output. When explaining to the family why they had to remove the donor kidney, the nurse will anticipate that the surgeon would likely include which statement?

Hyperacute rejection occurs because antibodies against HLA antigens are deposited in vessels, causing necrosis

Which is characteristic of benign neoplasms

Inability to metastasize to distant sites

This is a malignant tumor of the connective tissue

Osteosarcoma

A client with a diagnosis of hemolytic anemia has gone to a community-based laboratory for follow-up blood work. The lab technician confirms with the client that hematocrit is one of the components of the blood work. The client replies, "I thought the point of the blood work was to see how many red blood cells I have today." How could the technician best respond to the client's statement?

The hematocrit measures the mass that your red blood cells account for in a quantity of your blood."

The father of a third grade girl has brought his daughter to a walk-in clinic because he believes the girl has pink eye, which has been going around the students in her class. The nurse at the clinic concurs with the father's suspicion of conjunctivitis. Which of the follow-up explanation by the nurse is most accurate?

The surfaces of her eyes have bacteria or a virus established, and it's important to maintain good hand hygiene until it goes away."

The mother of an 18 month old child is concerned that her child is lethargic and not eating foods that he normally enjoys. She takes him to the pediatrician for a check-up. Which of the following clinically manifestations would lead the healthcare provider to suspect the child may have a neuroblastoma? Select all that apply.

• Large protruding abdomen. • Weight loss. • Crying when joints/position is changed.