Pathophysiology

A woman has a long-running compulsion to repeatedly check if the doors of her home are locked, and has received a diagnosis of obsessive-compulsive disorder (OCD). Her husband is at a loss to understand her irrational behavior and has sought help from a therapist himself to deal with the effect that the wife's OCD is having on their daily lives. Which of the husband's statements would require correction?

"I'm glad that this is something that's a result of life stressors and is not associated with any dysfunction in her brain." Rationale: OCD is thought to have a neurophysiologic component and is not a consequence of stress. Medications combined with behavioral therapy provide a good prognosis and SSRI antidepressants are often used. OCD has a prevalence of 2%.

Which of the following statements by the husband of a client with Alzheimer disease demonstrates an accurate understanding of his wife's medication regimen?

"I'm really hoping these medications will slow down her mental losses."

A 44-year-old woman has sought care for the treatment of headaches that have been increasing in severity and frequency and has been subsequently diagnosed with migraines. Which of the following teaching points should her care provider emphasize?

"It would be helpful for you to take control of your diet, sleep schedule, and stress levels."

A nurse is changing the wound dressing on a coccyx-region pressure injury of an immobilized client. The existing dressing is saturated with both watery, clear discharge and foul, grayish-colored liquid. Which entry in the client's chart most accurately documents these findings?

"Large amounts of suppurative and serous exudates noted."

A client who was exposed to hepatitis A at a local restaurant has recovered from the disease. At her annual physical, the client asks the health care provider if she should go to her health department and get the hepatitis A "shot." The best response, based on the concepts of adaptive immunity, by the health care provider would be:

"No, since having an active case, you have already developed antigens against hepatitis A."

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

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

A client with cancer has been receiving amphotericin B intravenously. The client asks, "How will this help with my fungal disease?" The health care provider responds:

"This drug binds to ergosterol and forms holes in the cell membrane, killing the fungus."

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

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

The family of a multiple sclerosis client asks, "What psychological manifestations may we expect to see in our mother?" The health care provider informs them to expect which of the following? Select all that apply.

3 answers: 1. Inattentiveness 2. Depression 3.Forgetfulness

When lecturing about heart attacks (myocardial infarctions), the instructor will emphasize the client may present with: Select all that apply.

3 answers: 1. Pain that radiates to the left arm 2. Substernal chest pain 3. Neck pain

A psychiatrist is providing care for a 68-year-old female whose anxiety disorder is significantly decreasing her quality of life. The nurse knows that the client will likely benefit from which pharmacologic therapies listed below?

A drug that influences gamma-aminobutyric acid (GABA) levels

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

A man who acquired malaria while on a tropical vacation

A client who experienced a traumatic head injury from a severe blow to the back of his head now lives with numerous function deficits, including an inability to maintain steady posture while he is in a standing position, although he is steadier when walking. Which of the following disorders most likely resulted from his injury?

A vestibulocerebellar disorder

An otherwise healthy client has been referred to a pain clinic because she claims to experience exquisite pain from the friction of her clothes on her torso. This client is likely to be diagnosed with which of the following health problems?

Allodynia

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

Antibodies

A client with a surgical wound has developed excessive granulation tissue extending above the wound edges. Which action should the nurse take?

Ask the health care provider about surgical options to remove the excess tissue and promote wound healing. ~Rationale: During the proliferative phase of healing, excessive granulation tissue, sometimes referred to as "proud flesh," may form and extend above the edges of the wound, preventing reepithelialization. The nurse should inquire about surgical removal or chemical cauterization to allow healing to proceed. This is not necrotic tissue and would not be responsive to debridement via wet-to-dry dressings. This tissue differs from keloids, which is an overgrowth of scar tissue (rather than granulation tissue) and is not caused by a dry wound bed.

A family brings their elderly mom to the emergency department. The client had a short period of time where she was confused, had slurred speech and appeared to have a weak arm. Now she is back to her normal self. Suspecting a transient ischemic attacks (TIAs), the health care provider will order diagnostic testing looking for:

Atherosclerotic lesions in cerebral vessels

Major histocompatibility complex (MHC) molecules, with human leukocyte antigens (HLAs), are markers on all nucleated cells and have an important role in:

Avoiding transplant rejections

An elderly client has been brought to his primary care provider by his wife, who is concerned about his recent decrease in coordination. Upon assessment, his primary care provider notes that the client's gait is wide-based, unsteady, and lacking in fluidity, although his muscle tone appears normal. This client requires further assessment for which of the following health problems?

Cerebellar disorders

The intracranial volume that is most capable of compensating for increasing intracranial pressure is the:

Cerebrospinal fluid

Which most accurately describes the characteristics of saprophytes? They:

Derive energy from decaying organic matter

A 50-year-old woman has experienced devastating consequences in her family and work life as a result of her longstanding alcohol addiction. Her levels and pathways of which neurotransmitter are likely to differ from an individual's without addiction?

Dopamine

The effector cells of the immune system have the primary function of:

Eliminating the antigens

A 9-month-old infant has been diagnosed with botulism after he was fed honey. The child's mother was prompted to seek care because of this child's sudden onset of neuromuscular deficits, which were later attributed to the release of substances by Clostridium botulinum. Which virulence factor contributed to this child's illness?

Exotoxins

A 63-year-old woman has begun a diet that purports to minimize the quantity and effects of free radicals in her body. Which physiologic process could best underlie her care provider's teaching about her new diet?

Free radicals increase cytokine expression and adhesion molecule levels, resulting in increased inflammation.

Following surgery for a large malignant brain tumor, the nurse should anticipate discussing which further treatment option with the family that may ensure that any remaining cancer cells will be killed?

Gamma knife radiation

A high school senior sustained a concussion during a football game. Which of the following signs and symptoms would indicate the presence of postconcussion syndrome in the days and weeks following his injury?

Headaches and memory lapses

A family brings a client to the emergency department with increasing lethargy and disorientation. They think the client had a seizure on the drive over to the hospital. The client has been sick with a "cold virus" for the last few days. On admission, the clients' temperature is 102°F. Which other clinical manifestations may lead to the diagnosis of encephalitis?

Impaired neck flexion resulting from muscle spasm

A client's primary care provider has ordered direct antigen detection in the care of a client with a serious symptomatology of unknown origin. Which of the following processes will be conducted?

Introduction of monoclonal antibodies to a blood sample from the client

Following a head injury, a client is diagnosed with a possible intracranial epidural hematoma. During the initial assessment, the client suddenly becomes unconscious. Other clinical manifestations that correlate with this diagnosis may include:

Ipsilateral pupil dilation

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

Limited to cooler cutaneous surfaces

Innate immunity, also called natural or native immunity, consists of mechanisms that respond specifically to:

Microbes

A client has developed pericarditis following an episode of acute glomerulonephritis, developments that may be attributable to the presence of similar epitopes on group A beta-hemolytic streptococci and the antigens in the client's heart tissue. Which of the following has most likely accounted for this client's autoimmune response?

Molecular mimicry

Since catecholamines can be degraded by enzymes, the medication category usually prescribed to treat a Parkinson disease client, thereby controlling this interaction, is:

Monoamine oxidase (MAO) inhibitor

A client presented to the emergency department of the hospital with a swollen, reddened, painful leg wound and has been diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) cellulitis. The client's physician has ordered a complete blood count and white cell differential. Which blood component would the physician most likely anticipate to be elevated?

Neutrophils

While explaining the role of skeletal muscle relaxants, such as succinylcholine, used during anesthesia, the faculty mentions that these effects are caused by blocking:

Nicotinic acetylcholine receptors, muscle-type receptor (NM)

Although both eukaryotes and prokaryotes are capable of causing infectious diseases in humans, eukaryotes are unique because they have a/an:

Organized nucleus

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

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

More complex patterns of movements, such as throwing a ball or picking up a fork, are controlled by which portion of the frontal lobe?

Premotor cortex

In the usual course (stages) after a pathogen has entered the host body, the stage when the host initially develops the appearance of signs/symptoms like a mild fever and body aches is:

Prodromal

A client with laryngeal dystonia has gotten to the point that people on the telephone cannot understand her. She has heard about getting Botox injections into her vocal cords. The nurse will teach about the actions of Botox. Which is the most accurate description? This drug:

Produces paralysis of the larynx muscles by blocking acetylcholine release

A recently injured (3 months ago) client with a spinal cord injury at T4 to T5 is experiencing a complication. He looks extremely ill. The nurse recognizes this as autonomic dysreflexia (autonomic hyperreflexia). His BP is 210/108; skin very pale; gooseflesh noted on arms. The priority nursing intervention would be to:

Scan his bladder to make sure it is empty

When a person is stung on the index finger by a bee, the thalamus interprets the pain as:

Somewhere on the hand

A client's cell-mediated immune response has resulted in the release of regulator T cells. These cells will perform which of the following roles?

Suppressing the immune response to limit proliferation of potentially harmful lymphocytes

The family member of a client with bipolar disorder reports the client is in a manic phase. What instructions should the health care provider give the family member to watch for, because it can lead to harm?

The client may self-medicate with alcohol or recreational drugs.

A geriatrician and social worker are facilitating a family meeting for the children and wife 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

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

Tuberculosis

A client with a long history of cigarette smoking and poorly controlled hypertension has experienced recent psychomotor deficits as a result of hemorrhagic brain damage. The client's psychomotor deficits are likely the result of:

Vascular dementia

Which of the following characteristics differentiates a migraine with aura from a migraine without aura?

Visual symptoms that precede the headache

A client has been diagnosed with a cerebral aneurysm and placed under close observation before treatment commences. Which of the following pathophysiologic conditions has contributed to this client's diagnosis?

Weakness in the muscular wall of an artery