Unit 7
A 29-year-old woman has been diagnosed with otosclerosis after several years of progressive hearing loss. What pathophysiological process has characterized her diagnosis? A) New spongy bone has been formed around her stapes and oval window. B) Her incus, malleus, and stapes have become disconnected from her normal neural pathways. C) Her temporal bone is experiencing unusually rapid resorption. D) Her tympanic cavity is becoming filled with bone due to inappropriate osteogenesis.
A
A 31-year-old female has been recently diagnosed with type 2 diabetes mellitus and is attending a diabetes education class. Which of the following statements by the woman demonstrates an accurate understanding of her health problem? A) "I'll have to control my blood sugars, my blood pressure, and my cholesterol in order to make sure I don't develop sight problems." B) "I'm grieving the fact that I won't be able to get pregnant without causing permanent damage to my vision." C) "It's surprising that sugar in my blood can accumulate on the lens of my eye and cause a loss of sight." D) "I want to avoid going through the treatments for sight restoration that I would need if my diabetes causes damage to my vision."
A
A 38-year-old male has presented to a clinic for the treatment of severe dermatitis after contact with poison ivy on a camping trip. The client has been prescribed prednisone, a corticosteroid, for the treatment of his skin condition. The client's care provider has emphasized that dosages of the drug will be gradually tapered off rather than stopped upon resolution of the symptoms. What is the most accurate rationale for this dosing protocol? A) The client's hypothalamic-pituitary-adrenal (HPA) system will require recovery time before normal function is restored. B) Steroids can induce a dependency that it best addressed with a gradual withdrawal. C) HPA function is heightened during steroid administration and must return to normal levels before the drug is completely stopped. D) Abrupt cessation of the drug can contribute to symptoms similar to Cushing syndrome.
A
A 48-year-old woman has been found to have nodules on her thyroid that must be biopsied to determine whether or not they are malignant. Which of the following imaging techniques will be most helpful to the surgeon in visualization of the nodes for fine needle aspiration? A) Ultrasound B) Magnetic resonance imaging C) Radioactive scanning using radioiodine D) Radioactive scanning using sestamibi
A
A client in an acute medicine unit of a hospital with a diagnosis of small bowel obstruction is complaining of intense, diffuse pain in her abdomen. Which of the following physiological phenomena is most likely contributing to her complaint? A) Nociceptive afferents are conducting the sensation of pain along the cranial and spinal nerve pathways of the ANS. B) First-order neurons are inappropriately signaling pain to the dorsal root ganglion. C) The client is experiencing neuropathic pain. D) The client's C fibers are conducting pain in the absence of damaged Aδ fibers.
A
A female patient presented to her primary care physician with classic signs and symptoms of Cushing syndrome. Upon testing, it was discovered that the patient had vaginal small cell carcinoma. How can the health care providers explain her Cushing syndrome signs and symptoms to this patient? A) "Your tumor in your vagina is secreting a hormone called adrenocorticotropic hormone (ACTH), which is responsible for these signs and symptoms." B) "We are going to have to run some more tests. We think you might have a problem with your pituitary gland." C) "There is no connection between the Cushing syndrome and the vaginal carcinoma. You have two very distinct problems occurring at the same time." D) "We need to check your thyroid. Your Cushing syndrome may be caused by hypofunction of this gland."
A
A nurse on a medical unit is providing care for a 37-year-old female patient who has a diagnosis of Graves disease. Which of the following treatments would the nurse most likely anticipate providing for the client? A) -Adrenergic-blocking medications to reduce sympathetic nervous stimulation B) Administration of levothyroxine to supplement thyroid function C) Calcium channel blocking medications to reduce heart rate and cardiac risks D) Administration of somatostatin analogs to inhibit GH production
A
A public health nurse is teaching a health promotion class to a group of older adults at a seniors' center. A woman attending states that, "My husband has got dry macular degeneration, and I don't know what we're going to do when he goes blind from it." How can the nurse best respond to the woman's statement? A) "Vitamins C and E as well as zinc and beta carotene may have some value in slowing the progression of his disease." B) "You should talk to your doctor about the surgical options that might help preserve his sight." C) "If your husband can lower his blood pressure and bad cholesterol, it can possibly slow the progression of his disease." D) "Cataract surgery is showing promise as a way of replacing the part of the eye associated with macular degeneration."
A
A student is feeling inside her backpack to find her mobile phone. There are a number of other items in the bag other than the phone. The nurse knows that which of the following terms best describes one's ability to sense of shape and size of an object in the absence of visualization? A) Stereognosis B) Astereognosis C) Modalities D) Somesthesia
A
During a physical exam, the nurse practitioner notes that the patient's optic disk is very pale with a larger size/depth of the optic cup. At this point, they are thinking the patient may have A) glaucoma. B) diabetes retinopathy. C) macular degeneration. D) retinal tear.
A
Following focal seizures that have damaged the dominant hemisphere of a patient's auditory association cortex, the nurse may observe the patient displaying A) receptive aphasia. B) facial drooping. C) auditory hallucinations. D) delusions of grandeur.
A
Neurotransmitters like catecholamines (e.g., dopamine and epinephrine) have a reaction time of A) milliseconds. B) less than 10 minutes. C) 24 to 36 hours. D) 4 to 7 days.
A
Otitis media (OM), which can occur in any age group, is the most common diagnosis made by health care providers who care for children. Which bacterial pathogen causes the largest proportion of cases that result in sensorineural hearing loss? A) Streptococcus pneumoniae B) Acoustic neuromas C) Haemophilus influenzae D) Parainfluenza
A
Which of the following best describes the half-life of a highly protein-bound drug such as thyroxine (99% protein bound)? The half-life would be A) much longer to reduce the concentration of the hormone by one half. B) shorter because only a little of the hormone has to be used up to reduce the concentration. C) dependent on which drugs were in the blood system holding on to the hormone. D) dependent on the liver to carry the hormone to its designated target organ
A
Which of the following hospital patients is most likely to be diagnosed with complex regional pain syndrome II (CRPS II)? A) A man who has been admitted for treatment of continuing hyperalgesia after sustaining a nerve injury in a motor vehicle accident B) A woman who requires analgesia more than 3 months after an episode of shingles C) A male client with diabetes mellitus who requires analgesia prior to each dressing change on his chronic foot wound D) A female who has seemingly unprovoked attacks of pain that are accompanied by facial tics and spasms
A
Which of the following questions is most likely to be clinically useful in the differential diagnosis of sensorineural versus conductive hearing loss? A) "What medications do you currently take?" B) "What effect is this hearing loss having on your quality of life?" C) "Has your hearing loss developed quickly or more slowly?" D) "Do you ever hear a persistent ringing in your ears?"
A
Which of the following statements best captures an aspect of the role of hormones in the body? A) Some chemical substances can function as hormones or be integrated with the central and peripheral nervous systems. B) Hormones directly initiate many of the processes that contribute to homeostasis. C) Control of body processes is ensured by the fact that a single hormone can only exert one effect on one specific system or tissue. D) Each hormone that exists in the body is produced by only one specific endocrine gland.
A
Which of the following statements best captures the essence of a second messenger in the mechanisms of the endocrine system? A) Second messengers act as the intracellular signal that responds to the presence of a hormone. B) Endocrine-producing cells must release both a hormone and a second messenger in order to exert a distant effect. C) Second messengers act to supplement hormone effects on cell receptors when the desired hormonal effect must be either increased. D) Second messengers provide an alternative pathway for endocrine effects on a cell that bypass the normal receptor pathways.
A
Match the pain theory to the correct physiologic basis for the pain. A. Specificity theory B. Pattern theory C. Gate control theory D. Neuromatrix theory 1. Light touch applied to the skin would produce the sensation of touch through low-frequency firing of the receptor. 2. Repeated sweeping of a soft-bristled brush on the skin over or near a painful area may result in pain reduction for several minutes. 3. Proposes that the brain contains a widely distributed neural network that contains somatosensory, limbic, and thalamocortical components. 4. Describes how an acute injury is predicted to be but does not take into account the person's feelings of how the pain feels to him or her.
A - 4 B- 1 C - 2 D - 3
Testing for short stature growth hormone (GH) problems can be done by pharmacologic means. Which of the following medications can be utilized to test for a rise in GH? Select all that apply. A) Insulin B) Levodopa C) Persantine D) Dobutamine E) Sestamibi
A B
Of the following list of nursing interventions, which would be considered priority when managing a patient with life-threatening myxedematous coma? Select all that apply. A) Administer 3% sodium IV solution to increase sodium levels. B) Administer 50% dextrose to raise glucose levels. C) Place on oxygen therapy to encourage deep breathing. D) Place on a warming bed to raise body temperature. E) Administer sedatives frequently to prevent seizures.
A B C
A nurse who works in the office of an endocrinologist is orienting a new staff member. Which of the following teaching points is the nurse justified in including in the orientation? Select all that apply. A) "A bodily process can be the result of the combined effect of several different hormones from different sources." B) "A single hormone can act not only on one process or organ but often on several different locations or processes." C) "It's common for production of hormones to be far removed from the tissue where they ultimately exert their effect." D) "Sometimes hormones act locally on the area where they were produced, like in the case of paracrine and autocrine actions." E) "The regulation in homeostasis requires that hormones be absent from the body when their effect is not needed."
A B C D
While a travel during a vacation via car, the mother notes that her 14-year-old child is getting sick. The mother suspects motion sickness. Which of the following clinical manifestations would confirm this diagnosis? Select all that apply. A) Rapid breathing B) Feeling faint C) Red, flushed face D) Rapid pulse rate E) Severe balance problems
A B D
Which of the following individuals would be considered at high risk for developing cataracts? Select all that apply. A) An 88-year-old female with osteoporosis and congestive heart failure B) A 51-year-old female whose rheumatoid arthritis is controlled with oral corticosteroids C) A 50-year-old male who takes nebulized bronchodilators four times daily for the management of his emphysema D) A 39-year-old woman with a history of open-angle glaucoma and poorly controlled diabetes E) A 29-year-old artist who spends long hours in sunlight painting landscapes
A B D E
When assessing a patient diagnosed with brain stem ischemia complaining of vertigo, the nurse will likely observe which of the following clinical manifestations? Select all that apply. A) Inability to coordinate voluntary muscular movements B) Difficulty in articulating words C) Feelings of ear fullness D) Deafness E) Facial weakness
A B E
Of the following patient conditions, which patients would be at risk for experiencing a thyroid problem due to a decrease in thyroxine-binding globulin (TBG)? Select all that apply. A) A 55-year-old male with cirrhosis due to alcohol abuse B) A 47-year-old female experiencing hot flashes and excess diaphoresis related to menopause C) A 75-year-old man receiving chronic glucocorticoid therapy to treat his severe chronic obstructive pulmonary disease (COPD) D) A 18-year-old female anorexia nervosa patient weighing 78 lb and has consumed no protein for the past 3 years
A C D
Which of the following patients would be considered high risk for developing papilledema? Select all that apply. A) A 2-year-old patient who has a shunt placed following delivery where he was diagnosed with hydrocephalus B) A 55-year-old male with substernal chest pain radiating down both arms and experiencing nausea C) A 43-year-old male with diabetes, renal insufficiency, and BP 200/107 D) A 25-year-old motorcyclist who was in an accident and has a potential subdural hematoma E) An 18-year-old female complaining of severe cramps with her menstrual bleeding
A C D
A 4-year-old boy has had otitis media with effusion (OME) for several weeks, and his condition has recently progressed to acute otitis media (AOM). Which of the following factors could have contributed to his AOM? Select all that apply. A) Reflux of fluid from the boy's nose into his middle ear B) A deficiency in immunoglobulin M C) Accumulation of cerumen in the external acoustic meatus D) Sensorineural deficits in the auditory control apparatus E) Exposure to respiratory virus
A E
A 28-year-old male who is 611 tall has a diagnosis of acromegaly. The man is explaining to a curious but sympathetic coworker exactly what accounts for his extraordinary height. Which of the following explanations demonstrates a sound understanding of his health problem? A) "My pituitary gland produced a much higher than normal amount of growth hormone when I was a child." B) "A tumor in my brain threw off my hormone levels after I was finished adolescence." C) "My liver is malfunctioning and produces too many of the hormones that ultimately cause growth." D) "The high sugar levels that go along with my diabetes made my pituitary gland overproduce the hormones that cause you to grow."
B
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 cold sores or genital herpes. What is the rationale for the care provider's line of questioning? A) Herpes simplex virus (HSV) conjunctivitis indicated a need for antiviral rather than antibacterial treatment. B) HSV infection of the cornea is a common cause of corneal ulceration and blindness. C) Chronic viral infection of the eyes can result in HSV autoinoculation of the mouth and labia. D) A history of HSV with eye irritation is suggestive of glaucoma
B
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? A) Decreased cerebral perfusion results in progressive damage to the optic nerve. B) Circulatory collapse causes rapid death of retinal neurons. C) Lack of oxygen results in a distortion of the fovea. D) The visual cortex is susceptible to hypoxic necrosis.
B
A 7-year-old child had an emergency appendectomy during the night. When trying to assess his pain, the nurse should A) ask him to rate his pain on a scale of 0 to 10, with 0 = no pain and 10 = worse pain ever. B) show him a scale with faces of actual children and have him point to the picture that best describes how he is feeling. C) consider his pulse and BP readings to be the most specific indicators of the amount of pain he is experiencing. D) try to distract him by blowing bubbles to minimize the use of opioids so that he does not become addicted to the narcotic.
B
A 70-year-old woman with a diagnosis of benign paroxysmal positional vertigo (BPPV) is receiving teaching from her physician about her diagnosis. The client is eager to avoid future episodes of vertigo and has asked the physician what she can do to prevent future episodes. How can the physician best respond? A) "Unfortunately there aren't any proven treatments for your condition." B) "There are some exercises that I'll teach you to help reorient your inner ear and prevent vertigo." C) "Although they involve some risks, there are some options for ear surgery that can prevent future vertigo." D) "We usually don't actively treat BPPV unless it starts to affect your hearing."
B
A care aide at a long-term care facility has informed a resident physician that an 80-year-old woman's eyes appear to be inflamed and that her eyelids are caked with sticky secretions. The woman has been subsequently diagnosed with posterior blepharitis. Which of the following treatments is the physician likely to initiate? A) Surgical repair of the woman's blocked meibomian glands B) Warm compresses to be applied regularly to her eyes in addition to oral antibiotics C) Regularly scheduled cleansing of the woman's eyes with normal saline D) Intravenous steroids coupled with topical antibiotic ointment
B
A client with a new diagnosis of an endocrine disorder is unclear how the body can control the levels of different hormones over time. Which of the following statements most accurately underlies the dominant regulation process of hormone levels in the body? A) A positive feedback cycle ensures that stable levels of hormones exist in the body over time. B) With input from various sensors, hormone production and release are adjusted based on existing hormone levels. C) The hypothalamus ensures that hormone levels correspond accurately to the diurnal cycle. D) The pituitary gland is genetically programmed to stimulate and inhibit hormone production and/or release based on the needs at different points in the life cycle.
B
A middle-aged woman has acromegaly as a result of a pituitary adenoma that was found and removed when she was a teenager. The physician is suspecting that the tumor has returned and has ordered a diagnostic work-up. A glucose load is ordered. If the tumor has returned, the nurse would expect which of the following results? A) The glucoses load will suppress GH level. B) The growth hormone level will not be suppressed following glucose load. C) The glucose load will raise her serum glucose level to the point of requiring insulin. D) There will be no change in the serum growth hormone level following the glucose load.
B
A mother is placing her child into the bathtub. The child immediately jumps out of the tub and begins to cry, stating his feet are "burning." The nurse in the emergency department knows that the child's response is based on which of the following pathophysiological principles listed below? A) Children react much quicker to contact with hot water than adults. B) The tactile sensation occurs well in advance of the burning sensation. The local withdrawal reflex reacts first. C) It takes a long time for thermal signals to be processed before the brain can send a signal through the spinal cord and tell the foot to withdraw. D) The thermal processing center is located on the rapid conducting anterolateral system on the same side of the brain as the injury.
B
A patient exhibiting problems with his or her thyroid has been scheduled for a radioactive scan. From the following list of patients, what would the nurse question as to whether this would be a safe procedure for this patient? A) An adult patient having an episode of wheezing from allergies B) A young female patient who has been trying to get pregnant C) A middle-aged male patient with uncontrolled type 2 diabetes mellitus D) An elderly patient who has a history of aortic stenosis
B
A patient with diabetes mellitus has just undergone a right, below-the-knee amputation following gangrene infection. A few days post-op, the patient confides in the nurse that he still feels his right foot. Knowing the pathophysiologic principles behind this, the nurse can A) administer a psychotropic medication to help the patient cope with the loss of his leg. B) explain that many amputees have this sensation and that one theory surmises that the end of a regenerating nerve becomes trapped in the scar tissue of the amputation site. C) call the physician and ask him for an order for a psychological consult. D) educate the patient that this area has an usually abnormal increase in sensitivity to sensation but that it will go away with time.
B
As the eyes rotate upward, the upper eyelid reflexively retracts. Which cranial nerve is primarily responsible for this response? A) Cranial nerve I B) Cranial nerve III C) Cranial nerve VI D) Cranial nerve IV
B
During the follicular stage of menstruation, increased estradiol production causes an increase in FSH production. This increase in FSH production by the anterior pituitary gland will have what effect on the follicle? A) The follicle will continue to grow until it can no longer stay in its membrane. B) The follicle will die, which results in a fall of FSH. C) The follicle will continue to grow and produce estradiol. D) The follicle will secrete additional hormones to attract swimming sperm.
B
Following a knee injury, a football player is taking ibuprofen, a nonsteroidal anti-inflammatory drug, for the control of pain. Which of the following drug actions is most likely to result in diminished sensation of pain for the player? A) The drug inhibits communication by third-order neurons between the thalamus and cerebral cortex. B) The drug inhibits the enzyme needed for prostaglandin synthesis. C) The drug changes the postexcitatory potential in C fibers, leading to pain sensitization. D) The drug slows the conduction velocity of myelinated Aδ fibers in the pain pathway.
B
Following a long history of fatigue, weakness, and poor appetite, a 39-year-old male has been diagnosed with hypopituitarism. Which of the following clinical findings would most likely cause his care team to suspect that the man has an additional endocrine disorder from a different source? A) The man has a low sperm count and has been unable to have children. B) The man has a chronic platelet deficiency and is occasionally anemic. C) The client is 5'2'' tall and was consistently short for his age as a child. D) The man displays the signs and symptoms of hypothyroidism.
B
Following a meal, a woman's blood glucose level has increased. In addition, her pancreas has increased the amount of insulin produced and released. Which of the following phenomena has occurred? A) Increased hormone level according to a negative feedback mechanism B) Adjustment according to the level of the substance a hormone regulates C) Hormone production and release via the positive feedback cycle D) Hypothalamic-pituitary control of hormone levels
B
Following a serious bout of bacterial meningitis, the parents of a 14-month-old has noted the child is not responding to verbal commands. The nurse will explain the pathophysiologic principle behind this by educating the patients by which of the following statements? A) "This could be caused by the same organism that caused the meningitis, infecting the child's tympanic membrane." B) "This may be due to a loss of hair cells and damage to the auditory nerve." C) "The ear and the lining of the brain that was infected are all connected together." D) "It is common for meningitis to use up all the natural killer cells and therefore increase the risk of having brain tumors develop."
B
Following destruction of the pituitary gland, ACTH stimulation stops. Without ACTH to stimulate the adrenal glands, the adrenals' production of cortisol drops. This is an example of which type of endocrine disorder? A) Primary B) Secondary C) Tertiary D) Somatic
B
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 of the following health consequences would be attributable to her low levels of cortisol? A) Visible exophthalmos B) Impaired immunological and inflammatory response C) Diminished secondary sex characteristics D) Insufficient regulation of serum potassium and sodium levels
B
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 patient would be diagnosed as having A) hyperopia. B) myopia. C) cycloplegia. D) presbyopia
B
If the patient's dorsal columns are not functioning, the nurse will observe which of the following responses during neurotesting, where the nurse asks the patient to close his eyes and then proceeds to touch corresponding parts of the body on each side simultaneously with two sharp points? A) Grimacing when body touched with sharp points B) No response to two-point discrimination C) Heightened proprioceptive response D) Inability to identify which way his finger was moved during the test
B
Staff at the care facility note that a woman has started complaining of back pain in recent weeks and occasionally groans in pain. She has many comorbids that require several prescription medications. The nurse knows that which of the following factors is likely to complicate the clinician's assessment and treatment of the client's pain? A) Neural pain pathways in the elderly differ from those in younger adults and are less responsive to treatment. B) Assessment and treatment are possibly complicated by the large number of drugs that the client receives. C) Accurate pain assessment is not possible in clients with significant cognitive deficits. D) Frequent complaints of pain in older adults with dementia normally indicate hyperalgesia rather than an underlying physical problem.
B
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 follow-up explanation by the nurse is most accurate? A) "The insides of her eyelids have become infected. This often produces severe discomfort." B) "The surfaces of her eyes have bacteria or a virus established, and it's important to maintain good hand hygiene until it goes away." C) "An antibiotic ointment will likely resolve her infection, but pain control will be necessary in the mean time." D) "It's important to aggressively treat this in children, since damage to her sight can result if it's not treated."
B
Which of the following individuals is most likely to be diagnosed with a central vestibular disorder? A) A man who got up quickly from his bed and sustained an injury after he "blacked out" B) A woman who has ongoing difficulty in balancing herself when walking C) A woman who suffered a loss of consciousness after being struck on the head during a soccer game D) A man who states that he feels car sick whenever he rides in the back seat of a vehicle
B
Which of the following statements best captures an aspect of the function of the hypothalamic-pituitary-adrenal (HPA) system? A) Adrenocorticotropic hormone (ACTH) released by the hypothalamus controls to release of cortisol. B) The pituitary gland communicates with the adrenal cortex through the release of ACTH. C) The adrenal cortex receives corticotrophin-releasing hormone (CRH) and in turn releases cortisol. D) The pituitary gland causes a release of CRH from the hypothalamus, which promotes hormone release from the adrenal cortex.
B
Which of the following statements best captures the role of the adrenal cortex in maintaining homeostasis? A) The adrenal cortex is responsible for the production of epinephrine and norepinephrine that are part of the sympathetic nervous system. B) The adrenal cortical hormones are primarily steroids and sex hormones. C) Redundant, secondary production of adrenal cortical hormones can compensate for the loss of the adrenal glands. D) Normal sexual function is dependent on adequate adrenal cortical function.
B
Which of the following would be an example of a child born with congenital insensitivity to pain? A child who A) develops pins-and-needles sensation after jumping out of a tree. B) fell off a skate board and fractured ankle but did not feel any pain and just noted swelling in foot. C) skinned knee from a bike accident but only told parents when it started burning. D) cries every time the wind blows because it hurts his face and ears.
B
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? A) A 17-year-old high school student who has a red, itchy eye B) A 55-year-old truck driver complaining of sudden onset of ocular pain and blurred vision C) A 45-year-old school teacher complaining of a red eye that is draining yellow secretions D) An infant with red eyes who is irritable and refusing to eat
B
An infant born with congenital hypothyroidism and has not sought care from any health care provider is likely to develop which of the following complications? Select all that apply. A) Deformed joints and bone spurs B) Impaired physical growth C) Mental retardation D) Loss of fine motor control and arthritis E) Down syndrome
B C
Stepping out of a mall and into the sunshine has caused a man's pupils to constrict. Place the following anatomical components of the man's pupillary reflex in the ascending chronological order that they responded to the light. Use all the options. A) Oculomotor nuclei B) Retinal ganglionic cells C) Preganglionic neurons D) Pretectal nuclei
B D C A
A 21-year-old female is suspected of having inadequate function of her hypothalamic-pituitary-thyroid system. Her care provider is planning to inject thyrotropin-releasing hormone (TRH) and then measure her levels of TSH. Which of the following diagnostic tests is being performed? A) Suppression test B) Radioimmunoassay (RIA) test C) Stimulation test D) Metabolite excretion test
C
A 25-year-old woman who works as an air-traffic controller presents with facial pain and severe headache. She reports that she sometimes feels the pain in her neck or ear and that it is particularly bad during very busy times at the airport. What is the most likely diagnosis? A) Migraine headache B) Cluster headache C) Temporomandibular joint syndrome D) Sinus headache
C
A 3-year-old girl has been diagnosed with amblyopia. Which of the following pathophysiological processes is most likely to underlie her health problem? A) The child may have a congenital deficit of rods and/or cones. B) The girl may have chronic bacterial conjunctivitis. C) She may have been born with infantile cataracts. D) The child may have a neural pathway disorder.
C
A 30-year-old female has suffered a third-degree burn to her hand after spilling hot oil on it in a kitchen accident. Which of the following teaching points by a member of her care team is most appropriate? A) "Tell us as soon as you sense the beginnings of a round of pain, and we will start with analgesics." B) "Opioids like morphine often cause constipation, but if this happens to you, we will discontinue opioids and change to another family of medications." C) "Opioids aren't without side effects, but we will take action to manage these side effects, so you can continue getting these drugs." D) "It's imperative that we prevent you from developing a tolerance for opioids while you're getting treatment for your burn."
C
A 38-year-old woman takes clomiphene, an infertility drug that works by competing with, and thereby blocking, cellular receptors for estrogen. Which of the following statements is most likely to be true of this client? A) Receptors for all other steroid hormones will also be blocked. B) Up-regulation will increase the number of estrogen receptors on each target cell. C) Estrogen will continue to pass freely through the cellular membranes. D) Laboratory tests will reveal an increase in cyclic adenosine monophosphate (cAMP) levels.
C
A 51-year-old woman has been diagnosed with Cushing syndrome after a diagnostic workup that reveals cortisol hypersecretion. The nurse knows which of the following assessment findings would be inconsistent with her diagnosis? A) Increased blood pressure and decreased potassium levels B) A protruding abdomen and a "buffalo hump" on the back C) Poor stress management and hyperpigmentation D) A "moon face" and muscle weakness
C
A 51-year-old woman has been experiencing signs and symptoms of perimenopause and has sought help from her family physician. A deficiency in estrogen levels has been determined to be a contributing factor. Which of the following phenomena could potentially underlie the woman's health problem? A) Sufficient synthesis of estrogen but inadequate vesicle-mediated release B) Inadequate synthesis in the rough endoplasmic reticulum of her ovarian cells C) Insufficient estrogen production within the smooth endoplasmic reticulum of the relevant cells D) A lack of prohormone precursors needed for estrogen synthesis and release
C
A 60-year-old man has presented to his family physician following an earache that has become progressively more painful in recent days. Following a history and examination with an otoscope, the man has been diagnosed with otitis externa. Which of the physician's following statements to the man is most accurate? A) "You'll need to avoid getting any water in your ear until you finish your course of antibiotic pills." B) "I'm going to instill some warm water into your ear to flush out debris and bacteria." C) "I'll prescribe some ear drops for you, and in the mean time, it's important not to use ear swabs." D) "This likely happened because your ears aren't draining like they should, but antibiotics that you'll put in your ears will resolve this."
C
A college junior calls his mother, a nurse, complaining of "not being able to see." When questioned further, he describes, "A gray curtain just went down my right visual field. I don't know what to do." The nurse should recognize this symptom as which of the following conditions and have her teenager go to the emergency department immediately. A) Glaucoma B) Strabismus C) Retinal detachment D) Macular degeneration
C
A nurse on a postsurgical unit is providing care for a 76-year-old female client who is 2 days posthemiarthroplasty (hip replacement) and who states that her pain has been out of control for the last several hours, though she is not exhibiting signs of pain. Which of the following guidelines should the nurse use for short-term and long-term treatment of the client's pain? A) Reconciling the client's need for opioid analgesics with the risk of addiction to these drugs B) Recognizing the client's pain is not likely self-limiting C) Knowing that the client's self-report of pain is the most reliable indicator of pain D) Realizing that chronic pain is likely to require innovative and complex treatment
C
A nurse practitioner is assessing a 7-year-old boy who has been brought to the clinic by his mother, who is concerned about her son's increasingly frequent, severe headaches. Which of the nurse's following questions is least likely to yield data that will allow for a confirmation or ruling out of migraines as the cause of his problem? A) "Does your son have a family history of migraines?" B) "When your son has a headache, does he ever have nausea and vomiting as well?" C) "Does your son have any food allergies that have been identified?" D) "Is your son generally pain free during the intervals between headaches?"
C
A patient has sought medical attention because of a loss of different half-fields in the two eyes. Knowing the potential causes of this complaint, the nurse anticipates that the physician will order tests looking for A) metal fragments in the eyes. B) hemorrhages in the capillaries of both eyes. C) an enlarging pituitary tumor. D) subarachnoid hemorrhage.
C
A woman with severe visual and auditory deficits is able to identify individuals by running her fingers lightly over their face. Which of the following sources is most likely to provide the input that allows for the woman's unique ability? A) Pacinian corpuscles B) Ruffini end organs C) Meissner corpuscles D) Free nerve endings
C
An example of a single hormone that can exert effects in different tissues, erythropoietin, made in the kidney stimulates the bone marrow to produce A) platelets. B) natural killer cells. C) red blood cells. D) mast cells.
C
As part of a health promotion initiative, a public health nurse is meeting with a group of older adult residents of an assisted living facility. Which of the following teaching points about hearing loss in the elderly should the nurse include in the teaching session? A) "It is actually a myth that seniors have worse and worse hearing as they age." B) "Most hearing loss in older adults is the result of easily fixed problems, such as impacted ear wax." C) "Experts don't quite know what causes seniors to lose their hearing with age, but drugs like aspirin can contribute to the problem." D) "With older adults, the goal is to adjust lifestyle to accommodate diminished hearing rather than trying to treat the hearing loss itself."
C
As part of the diagnostic workup for a client's long-standing vertigo, a clinician wants to gauge the eye movements that occur in the client. Which of the following tests is the clinician most likely to utilize? A) Romberg test B) Rotational tests C) Electronystagmography (ENG) D) Caloric stimulation
C
During a procedure to remove impacted cerumen, the nurse should be assessing the patient for which of the following most critical complications? A) Excessive bleeding from the ear B) Pain related to instillation of warm fluids to soften the cerumen C) Symptomatic bradycardia from vagal nerve innervation D) Respiratory distress related to fluid entering bronchiole tubes
C
Since steroid hormones are bound to protein carriers for transport, this means A) they are water soluble and circulate freely in the blood. B) they are degraded by enzymes in the blood. C) they are inactive in the bound state. D) they will be converted into a useable form by enzymes in the blood.
C
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 of the following phenomena would the physician most likely suspect as contributing factor to the boy's short stature? A) Genetic short stature B) Lack of IGF receptors in epiphyseal long bones C) A shortage of hypothalamic GHRH production D) Excess insulin production resulting in chronically low blood glucose levels
C
When educating the parents of a child who has just had tympanostomy tube insertion, the nurse should provide further teaching if the parents say which of the following statements? A) "I will call the physician if I see that the tube has come out." B) "I will be looking for any drainage coming from the ears." C) "I'm so glad that we can take the child swimming next week when we go on vacation." D) "I'm so glad we had the child tested for allergies prior to having these tubes placed."
C
Which of the following hormones are derivatives of cholesterol? A) Epinephrine and norepinephrine B) Insulin and glucagon C) Aldosterone and testosterone D) Eicosanoids and retinoids
C
Which of the following preoperative teaching points related to corneal transplantation is most justified? A) "You should know that there is a significant risk that your body will reject the transplant." B) "The cornea is highly vascular, and therefore you will be at risk for hemorrhage." C) "Your new cornea would come from someone who has recently died." D) "You run a risk of developing a major inflammatory response post-op and will need frequent follow-up appointments."
C
While batting, a baseball player is struck in the ribs by a pitch. Place the following components of the player's pain pathway in the chronological order as they contribute to the player's sensation of pain. Use all the options. A) Thalamus B) Dorsal root ganglion body C) Dorsal root ganglion periphery D) Axon E) Cerebral cortex
C B D A E
A 30-year-old woman has presented to her family doctor complaining of three distressing episodes over the last several months during which she got extremely dizzy, had loud ringing in her ears, and felt like her ears were full of fluid. She states that her hearing diminishes, and she feels nauseous during these episodes. What diagnosis is the physician most likely to first suspect? A) Acute otitis media B) Acute vestibular neuronitis C) Benign paroxysmal positional vertigo (BPPV) D) Ménière disease
D
A 32-year-old man is complaining of burning, itching, photophobia, and severe pain in his right eye after swimming in the ocean. To determine that the eye condition was a corneal rather than a conjunctival disease, which of the following would be the distinguishing symptom? A) Burning B) Itching C) Photophobia D) Severe pain
D
A 4-month-old infant and his mother are at an appointment with a pediatrician to follow up his nonaccommodative strabismus and to determine a treatment plan. Which of the following treatments is most likely to prevent future loss of vision? A) Prescribing glasses once the infant is 6 months of age B) Use of beta-adrenergic blockers and latanoprost eye drops C) Regularly scheduled eye exams and monitoring of self-correction of his eyes D) Surgical correction of the musculature
D
A 46-year-old male has presented to the emergency department because of the eye pain, severe headache, and blurred vision that have followed an eye exam at an optometrist's office earlier in the day. The client tells the triage nurse that he received eye drops during the exam "to keep my pupils wide open." What differential diagnosis will the care team first suspect? A) Infectious conjunctivitis B) Keratitis C) Corneal trauma D) Angle-closure glaucoma
D
A 58-year-old woman comes to the clinic for evaluation of a sharp, intermittent, severe, stabbing facial pain that she describes as, "like an electric shock." The pain occurs only on one side of her face; it seems to be triggered when she chews, brushes her teeth, or sometimes when she merely touches her face. There is no numbness associated with the pain. What is most likely causing her pain? A) Postherpetic neuralgia B) Migraine headache C) Complex regional pain syndrome D) Trigeminal neuralgia
D
A 60-year-old male client with a long history of back pain has had little success with a variety of analgesic regimens that his family physician has prescribed. He has recently been diagnosed with a chronic pain disorder. Which of the following teaching points about chronic pain would his physician most likely emphasize to the client? A) "If your pain comes and goes, then we won't characterize it as chronic, and it will require different treatment." B) "You need to remind yourself that this is a purely physical phenomenon that requires physical treatment." C) "Our challenge is to bring you relief but still treat the underlying back problem that your body is telling you about." D) "These pain signals your body is sending likely serve no real, useful, or protective function."
D
A client with a history of an endocrine disorder exhibits signs and symptoms of hormone deficiency. Which of the following processes would the client's care team most likely rule out first as a contributing factor? A) The client's target cells lack sufficient receptors for the hormone in question. B) Hormone production is sufficient, but affinity on the part of the target cells is lacking. C) The process of down-regulation has resulted in decreased hormone sensitivity. D) Up-regulation has increased the sensitivity of the body to particular hormone levels.
D
A female client with bone metastases secondary to lung cancer is admitted for palliative radiation treatment and pain control. The client is presently experiencing pain that she rates at 9 out of 10. Which of the following nonpharmacological treatments is most likely to be a useful and appropriate supplement to pharmacological analgesia at this point? A) Teaching the client guided imagery and meditation B) Initiating neurostimulation C) Heat therapy D) Relaxation and distraction
D
A patient is admitted to the hospital in adrenal crisis 1 month after a diagnosis of Addison disease. The nurse knows which of the following clinical manifestations would support this diagnosis? A) Hyperactive deep tendon reflexes and slow, shallow breathing B) Cerebral spinal fluid leakage and impaired swallowing C) Irregular heart rate and decreased temperature D) Change in the level of consciousness and profound hypotension
D
A stroke affecting which of the following areas of the brain would be most likely to leave an individual's vestibular system intact and posture and balance maintained? A) The brain stem B) The thalamus C) The temporal and parietal cortex D) The limbic system of the cerebrum
D
After receiving change-of-shift report about the following four patients, which patient should the nurse assess first? A) A 22-year-old admitted with SIADH who has a serum sodium level of 130 mEq/L B) A 31-year-old who has iatrogenic Cushing syndrome with a capillary blood glucose level of 204 mg/dL C) A 53-year-old who has Addison disease and is due for a scheduled dose of hydrocortisone (Solu-Cortef) D) A 70-year-old returning from PACU following partial thyroidectomy who is extremely agitated, has an irregular pulse rate of 134, and has an elevated temperature of 103.2°F
D
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 of the following teaching points about the client's future health risks is most accurate? A) "It's not unusual for high GH levels to cause damage to your hypothalamus." B) "GH excess inhibits your pancreas from producing enough insulin." C) "The high levels of GH that circulate in your body can result in damage to your liver." D) "When your pituitary gland is enlarged, there's a real risk that you'll develop some sight deficiencies."
D
Distraught at the persistent ringing in his ears and his inability to alleviate it, a 50-year-old man has visited his health care provider. After diagnostic testing, no objective cause (like impacted cerumen or vascular abnormality) was found. Given these testing results, which of the following teaching points by the care provider is most appropriate? A) "This is most often the result of a psychological disturbance, and therapy is often useful in relieving tinnitus." B) "There are many drugs such as blood pressure pills, relaxants, heart medications, and antihistamines that can cause tinnitus." C) "A specialist can listen with a sensitive microphone to determine whether you are actually hearing these sounds." D) "There are some treatments like tinnitus retraining therapy, which includes the extended use of low-noise generators, which has shown good success."
D
During descent, an airplane passenger is complaining that his "ears are plugged." What aspect of the structure and function of the ear best accounts for the passenger's complaint? A) The inner ear adjusts its volume in response to atmospheric pressure, increasing during low pressure and decreasing in high pressure. B) The eustachian tubes must remain patent to equalize pressure between the middle ear and inner ear. C) The tympanic membrane is selectively permeable in order to accommodate pressure changes, and this capacity is often impaired during upper respiratory infections. D) Air must be able to flow between the middle ear and nasopharynx in order to accommodate pressure changes
D
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 of the following assessment results would constitute an unexpected finding? A) The presence of myxedema in the woman's face and extremities B) Recent weight gain despite a loss of appetite and chronic fatigue C) Coarse, dry skin and hair with decreased sweat production D) Increased white cell count and audible crackles on chest auscultation
D
Growth hormone (GH) secretion is inhibited by A) hypoglycemia. B) starvation. C) heavy exercise. D) obesity.
D
When explaining about structural classifications to a group of students, the instructor discusses the peptides and proteins. They talk about small hormones and hormones as large and complex as growth hormone (GH), which has approximately how many amino acids involved? A) 50 amino acids B) 100 amino acids C) 150 amino acids D) 200 amino acids
D
Which of the following statements best captures the relationship between the hypothalamus and the pituitary gland as it relates to endocrine function? A) The hypothalamus directly measures the levels of most hormones throughout the body and inhibits or stimulates the pituitary accordingly. B) The pituitary gland coordinates and dictates the release of hormones from the hypothalamus that act on their intended target cells. C) The pituitary gland and hypothalamus have two-way communication that mediates the signals from neuronal inputs. D) The hypothalamus receives input from numerous sources throughout the body and directs the pituitary to then control many target glands and cells.
D
Which of the following would be considered an abnormal finding when the nurse practitioner uses an otoscope to look at a toddler's ear? The tympanic membrane is described as A) "transparent." B) "a shallow, oval cone pointing inward toward apex." C) "small, whitish cord seen traversing the middle ear from back to front." D) "yellow, amber discoloration noted."
D
