..........

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

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

Which of the following clients is at a high risk for developing dilated cardiomyopathy?

A 44-year-old noncompliant female who forgets to take her hypertensive medications

A health care professional has recommended biofeedback to a client as a method of dealing with the high levels of stress in her life. Which of the following explanations best characterizes an aspect of biofeedback treatment?

"You'll hopefully be able to gain control over skeletal muscle contractions."

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

A client is experiencing muscle atrophy following 2 weeks in traction after a motor vehicle accident. Which of the following factors has most likely contributed to the atrophy of the client's muscle cells?

A reduction of skeletal muscle use secondary to the traction treatment

. 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 45-year-old woman with a diagnosis of shingles is experiencing an acute onset of severe neuropathic pain. Which stage of Selye's characterization of stress response is the woman most likely experiencing at the moment?

Alarm

A 61-year-old male client is scheduled to begin chemotherapy for the treatment of his bone cancer shortly. Staff at the cancer center have educated the man and his wife about the goals, course, and expectations of his treatment. Which of the following medications and treatments might the man anticipate needing during and after his course of treatment?

Antiemetics and packed red blood cell (PRBC) transfusions

The nurse is providing care for a client with a diagnosis of amyotrophic lateral sclerosis (ALS). The nurse recognizes which of the following mechanisms is suspected to play a role in the cellular death associated with ALS?

Apoptosis

Which of the following patients, when faced with acute stressful situations, would be considered at highest risk for becoming noncompliant with their medication regimen?

End-stage renal failure patient experiencing electrolyte imbalances related to having trouble sticking to his prescribed diet

A patient with malignant melanoma has been prescribed alpha interferon, a biologic response modifier. Since this drug prolongs the cell cycle, increasing the percentage of cells in the G0 phase, and stimulates NK cells and T-lymphocyte killer cells, the nurse can anticipate that he may experience which of the following common side effects?

Fever, chills, and fatigue

. 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

. During a period of stress, the nurse asks the patient to close his eyes and think of a calm, relaxing place where he can feel the wind blowing on his cheek and smell the salty air from the ocean. This is an example of utilizing which type of treatment for stress reduction?

Guided imagery

The laboratory technologists are discussing a new blood test that helps establish a differential diagnosis between shortness of breath with a cardiac etiology and shortness of breath with a respiratory/pulmonary etiology. A positive result is purported to indicate a cardiac etiology. The marketers of the test report that 99.8% of patients who have confirmed cardiac etiologies test positive in the test. However, 1.3% of patients who do not have cardiac etiologies for their shortness of breath also test positive. Which of the following statements best characterizes this blood test?

High sensitivity; low specificity

Which of the following statements by a student demonstrates a sound understanding of the cellular processes of hypertrophy and hyperplasia?

I know that cells like neurons have little capacity for hyperplastic growth."

A patient who has been awaiting the results of a bone marrow biopsy for several days is experiencing stress as a result of uncertainty and the possibility that abnormal cell growth may be detected. A physical examination and blood work would most likely yield which of the following results?

Increased blood pressure and heart rate; increased antidiuretic hormone (ADH)

Which of the following statements most accurately conveys an aspect of cell injury due to impaired calcium homeostasis?

Injured cells tend to accumulate calcium.

A medical student is scheduled to undergo a clinical exam of his assessment skills under the supervision of the attending physician. As a result of this stressor, the student has high serum levels of glucocorticoid hormones such as cortisol. Which of the following statements best captures an aspect of the role of glucocorticoid hormones such as cortisol in the physiological response to stress?

Osteoblast activity and protein synthesis are suppressed in order to refocus energy.

An 80-year-old woman is slated for total hip replacement the following day and is experiencing a large amount of stress around her potential surgical outcomes. Which of the following is most likely to be uninvolved in the physiological response to her stress?

Parathyroid

Following a biopsy, a 54-year-old man has been diagnosed as having a benign neoplastic tumor. Which of the following characteristics most likely applies to his tumor?

The well-differentiated, neoplastic cells are clustered together in a single mass

An occupational health officer who works in the context of a large police force is attempting to understand the role that stress may play in the health of his clients. According to Selye, which of the following statements best captures an aspect of the phenomenon of stress?

Periods of stress can be developmentally positive or negative.

As part of a community class, student nurses are developing a class to teach expectant parents the importance of having their child properly secured in a child safety seat. During the class, the students are going to have a safety officer examine the car seats that the parents have installed in their vehicles. This is an example of which type of prevention?

Primary prevention

The nurse is providing care for a 21-year-old female client with gas gangrene secondary to her compound fracture in her arm. Which of the following assessment findings would the nurse most reasonably expect to find when caring for a client with a diagnosis of gas gangrene?

Spreading edema

A multidisciplinary health care team operates a program aimed at the prevention, identification, and treatment of diabetes on a large Indian reservation. Which of the following aspects of the program would be most likely to be classified as secondary prevention?

Staffing a booth where community residents who are attending a baseball tournament can have their blood glucose levels checked

Which of the following enzymes listed below is responsible for cancer cells' ability to prevent aging of the cells and contributes to cellular immortality that is so characteristic of this disease process?

Telomerase

An occupational therapist conducts a group therapy program called MindWorks with older adults who have diagnoses of dementia and Alzheimer disease. The goal of the group is to slow the cognitive decline of clients by engaging them in regular, organized mental activity such as reading maps and solving puzzles. How would the program most likely be characterized?

Tertiary prevention

A counseling psychologist is working with a 30-year-old female client who is experiencing the symptoms of posttraumatic stress disorder (PTSD) following a house fire several months prior. Which of the client's following diagnostic results could most likely be interpreted as a manifestation of PTSD?

The client has decreased levels of cortisol.

A 68-year-old male client with aortic stenosis secondary to calcification of the aortic valve is receiving care. Which of the following statements best captures an aspect of this client's condition?

The client has possibly undergone damage as a result of calcification following cellular injury

The clinical educator of a hospital medical unit has the mandate of establishing evidence-based practice guidelines for the nursing care on the unit. Which of the following statements most accurately captures a guiding principle of the nurse's task?

The guidelines will combine individual expertise with external systematic evidence.

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

A 77-year-old male client with a diagnosis of stomach cancer has been found to have metastases in his liver. The client and his family are surprised at this turn of events, stating that they do not see how he could have developed cancer in his liver. Which of the following facts would underlie the reply that the care team provides?

The portal circulatory system brings venous blood from the GI tract into the liver.

. Upon entering the room of a 74-year-old client receiving brachytherapy for cervical cancer, you find the radiation implant and the position-holding device in the client's bed. What is the nurse's first best action?

Use tongs to place the implant in the radiation container

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.

Which target of both chemotherapy and radiation treatment accounts for adverse as well as therapeutic effects?

Rapidly proliferating cells

A client who has had a diagnosis of lung cancer is scheduled to begin radiation treatment. The nurse knows that which of the following statements listed below about potential risks of radiation is most accurate?

"Some clients experience longer-term irritation of skin adjacent to the treatment site."

A new myocardial infarction patient requiring angioplasty and stent placement has arrived to his first cardiac rehabilitation appointment. In this first session, a review of the pathogenesis of coronary artery disease is addressed. Which statement by the patient verifies to the nurse that he has understood the nurse's teachings about coronary artery disease?

"Sounds like this began because of inflammation inside my artery that made it easy to form fatty streaks, which lead to my clogged artery."

As part of a first aid class, a health care instructor is teaching a group of industrial workers about how electrical injuries can cause cell damage. Which of the statements made by one of the workers indicates that further teaching is necessary?

"The greater the skin resistance, the greater the amount of deep and systemic damage a victim is likely to incur."

A woman is surprised to read on the Internet that certain infections can cause cancer and has sought clarification from her family physician during an office visit. How can the physician best respond to the woman's query?

"There are many viruses, but only a very few of them have been shown to cause cancer in humans."

A 60-year-old man has presented to a clinic and is requesting screening for tumor markers after reading about them in a magazine. What can the clinician most accurately tell the man about the clinical use of tumor markers?

"Tumor markers alone aren't enough to confirm whether you have cancer or not, so they're not a very useful screening tool."

A young patient has just been diagnosed with xeroderma pigmentosum. When teaching the family about this disease, the nurse should emphasize which of the following points? Select all that apply

"Wear long sleeves, long pants, gloves, a hat, sunglasses with side shields, and sunscreen while outdoors." "The best time to allow the child to play outside is in the evening hours after the sun goes down."

The neuroscience nursing unit has developed a set of step-by-step directions of what should occur if a nursing assessment reveals that the patient may be exhibiting clinical manifestations of a cerebrovascular accident (CVA). Which of the following statements about clinical practice guidelines are accurate? Select all that apply.

) When developing a CVA set of step-by-step directions, the nursing unit should ask for assistance from experts in the neuroscience field. The potential users of the guidelines should pilot test it for further feedback The development of evidence-based practice guidelines requires a research review from different studies to develop the most accurate diagnostic method to implement. A meta-analysis could be utilized to combine evidence from different studies to produce a more accurate diagnostic method.

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.

Which of the following patients of a primary care physician would not require extra screening for cancer?

A 38-year-old female with Down syndrome and congenital scoliosis

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

Based on the assessment results, which of the following hospital patients is most likely to be experiencing the effects of chronic stress?

A 45-year-old paraplegic who is experiencing delayed wound healing of an ischial ulcer

At an international nursing conference, many discussions and breakout sessions focused on the World Health Organization (WHO) views on health. Of the following comments made by nurses during a discussion session, which statements would be considered a good representation of the WHO definition? Select all that apply.

A) Interests in keeping the elderly population engaged in such activities as book reviews and word games during social time B) Increase in the number of chair aerobics classes provided in the skilled care facilities C) Interventions geared toward keeping the elderly population diagnosed with diabetes mellitus under tight blood glucose control by providing in-home cooking classes D) Providing transportation for renal dialysis patients to and from their hemodialysis sessions E) Providing handwashing teaching sessions to a group of young children

. Blood-borne cancerous cells have recently spread from a woman's primary tumor in her pancreas to her bones. Which of the following components of the woman's immune system are likely to be directly involved in the attempt to eradicate the potential metastasis? Select all that apply.

A)T lymphocytes B) Macrophages C) Natural killer (NK) cells D) B cells

As part of a screening program for prostate cancer, men at a senior citizens' center are having their blood levels of prostate-specific antigen (PSA) measured. Which of the following statements would best characterize a high positive predictive value but a low negative predictive value for this screening test?

All of the men who had high PSA levels developed prostate cancer; several men who had low PSA levels also developed prostate cancer

A widow, who lost her husband a few weeks ago, is having trouble with insomnia and maintaining her normal sleep pattern. When visiting with her health care provider, he suggests a prescription to help regain her normal circadian pattern. This is based on the fact that interruption of sleep-wake cycles can cause which of the following problems? Select all that apply

Alterations in the immune function that can result in an infection An increased risk in accidents when sleep deprived similar to those under the influence of alcohol

An epidemiologist is conducting a program of research aimed at identifying factors associated with incidence and prevalence of congenital cardiac defects in infants. The researcher has recruited a large number of mothers whose infants were born with cardiac defects as well as mothers whose infants were born with healthy hearts. The researcher is comparing the nutritional habits of all the mothers while their babies were in utero. Which of the following types of study is the epidemiologist most likely conducting?

Case-control study

A nurse is teaching a group of older adults about the value of including foods containing antioxidants in their diet. Which of the following statements best captures the rationale underlying the nurse's advice?

Antioxidants inhibit the actions of reactive oxygen species

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 in the emergency department admits a male client who has experienced severe frostbite to his hands and toes after becoming lost on a ski hill. The nurse recognizes that which of the following phenomena has contributed to his tissue damage?

Decreased blood flow has induced hypoxia

A 7-year-old boy is admitted to the hospital with a suspected diagnosis of lead toxicity. Which of the following assessment findings is most congruent with the client's diagnosis?

Hemoglobin 9.9 g/dL

Unbeknownst to her or her care team, a 51-year-old woman's breast cancer has an etiology rooted in the fact that tumor-suppressing genes are present but have been silenced. Consequently, she has not synthesized normal cancer-suppressing proteins, and neoplasia has resulted. What process has accounted for the woman's cancer?

Epigenetic mechanisms

A 26-year-old man who survived childhood acute lymphocytic leukemia (ALL), one of the most common childhood cancers, now complains of weakness, fatigue, and shortness of breath. His treatment for ALL likely included anthracyclines. What is the most likely cause of his symptoms?

Heart failure resulting from childhood chemotherapy

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

A 51-year-old female has been found to have a metastatic lesion in her lung, and her oncologist is unsure of the site of the primary tumor. Which of the following procedures is most likely to aid in this determination?

Immunohistochemistry

A 61-year-old woman with a 40-pack-a year history of cigarette smoking and a diagnosis of chronic obstructive pulmonary disease (COPD) is experiencing an increase in arterial levels of CO2. This change has been detected in the client's medulla, aortic bodies, and carotid bodies, stimulating the inspiratory center in the medulla oblongata, which has in turn caused the diaphragm to contract more forcefully and increase the respiratory rate. Which of the following terms best describes the role of the inspiratory

Integrator/comparator

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

Large protruding abdomen Weight loss Crying when position is changed

A student is attempting to trace the feedback cycle involved in the stress response. Which of the following neural structures is thought to be the central integrating site for the stress response?

Locus ceruleus

Which of the following situations would be classified as a complication of a disease or outcome from the treatment regimen? Select all that apply.

Massive pulmonary emboli following diagnosis of new-onset atrial fibrillation Development of pulmonary fibrosis following treatment with bleomycin, an antibiotic chemotherapy agent used in treatment of lymphoma

. 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

The nurse caring for a lung cancer patient with metastasis to the brain suspects the patient has developed a paraneoplastic syndrome known as syndrome of inappropriate antidiuretic hormone (SIADH) secretion. Which laboratory result in this patient who has gained 3 lb in a day would alert the nurse to the possibility of SIADH?

Serum sodium of 115 mmol/L

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 community health nurse is teaching a group of recent graduates about the large variety of factors that influence an individual's health or lack thereof. The nurse is referring to the Healthy People 2020 report from the U.S. Department of Health and Human Services as a teaching example. Of the following aspects discussed, which

The client has a family history of cardiovascular disease related to hypercholesterolemia and remains noncompliant with the treatment regime.

. When explaining to a patient admitted for stress-induced supraventricular tachycardia, the nurse will incorporate which of the following statements about what happens in the body as a result of excess stress?

The corticotropin-releasing factor stimulates the release of norepinephrine, which is responsible for "fight-or-flight" reaction to stress

. An electrician who has been working 14 to 16 hour/day for several weeks in order to ensure the financial survival of his business presents to his family physician with complaints of persistent headaches and insomnia. His family physician attributes the physical complaints to the ongoing stress that the man has been undergoing. Which of the following factors has most likely contributed the most to the man's response to this stressful period of his life?

The fact that he has previously had difficulty coping with stress

The nurse is teaching a group of new mothers about postpartum nutrition, when one of the clients states that she was told to avoid eating fish too often due to the risk of mercury poisoning. Which of the nurse's following responses most accurately addresses the clients concerns?

There are some modest risks, but they are only associated with some long-living fish."

An oncology nurse who has worked for many years providing care for children with cancer has taken a job on an adult oncology unit of a hospital. What differences might the nurse anticipate in this new job?

There will be a greater number of cancers that are epithelial in origin

A home health nurse is making a visit to a family with an 8-month-old infant with severe motor deterioration. The physician has diagnosed the infant with Tay-Sachs disease. The parents are asking the nurse why this happened. The nurse will base her answer knowing the root cause of Tay-Sachs is

an enzyme defect causing abnormal lipid accumulation in the brain

A nurse practitioner is working in a crowded neighborhood where the population is primarily immigrants from China. The nurse has designed a research study to follow children from kindergarten to the age of 25. She is going to be looking at their diet, successful progression in school, health practices, and development of disease, to name a few items. This type of research is known as

cohort study.

A patient with Parkinson disease has challenged himself to maintain mobility for longer than the physician predicts. He strives every day to walk 5 to 10 steps further than the day before. This phenomenon, being researched by social psychologists, is known as

hardiness.

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.

As of November 1, 2012, there were a total of 10 confirmed cases of Hantavirus infection in people who were recent visitors (mid-June to end of August, 2012) to Yosemite National Park. Three visitors with confirmed cases died. Health officials believe that 9 out of the 10 people with Hantavirus were exposed while staying in Curry Village in the Signature Tent Cabins. This is an example of

the incidence of people who are at risk for developing Hantavirus while staying in Yosemite National Park.

A female patient with a recent diagnosis of systemic lupus erythematosus (SLE) has been told that this is an autoimmune disease whereby the immune system is attacking the body's cells and tissues. She knows that she has inflammation and tissue damage. She asks her nurse to explain "What cells in the body are triggering this inflammation?" The nurse responds that

the lymphocytes that migrate to the brain, where they secrete cytokines, which trigger inflammation.

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

A cancer patient has been prescribed 5-fluorouracil, an antimetabolite chemotherapy agent. This medication stops normal development and division by interrupting the S-phase of the cell cycle. When teaching this patient, the nurse explains that during the S-phase of the cell cycle,

the synthesis of DNA occurs, causing two separate sets of chromosomes to develop.

During a myocardial infarction (MI), a patient with a 97% occlusion of his left descending artery develops ventricular arrhythmias due to the amount of ischemia occurring in the myocardium. While educating the patient about MIs, the nurse will base her teaching on the fact that

treatment needs to be sought immediately so that the buildup of lactic acid is limited and cellular changes can be reversed