Patho exam 3- clinical questions
An adult client with a history of worsening respiratory symptoms has presented for care. Which assessment question will best allow the clinician to address the possibility of chronic bronchitis?
"Do you tend to have a cough even when you don't feel sick?"
With the increased risk of drug toxicity among chronically ill older adults, which statement by the nurse explains why the older adult's kidney is vulnerable to toxic injury?
"The kidney is rich in blood supply and can concentrate toxins in high levels in the medullary portion of the kidney."
The respiratory therapist explains respiratory acidosis to the orientee. The therapist knows the orientee understands the topic when she verbalizes which concept?
"The manifestations of respiratory acidosis often are intermixed with those of oxygen deficit."
The nurse is caring for a client who is a carrier of hepatitis B. Which of these does the nurse teach the family?
"Your loved one may not look ill, but the virus is present in his blood."
Oxygen has been prescribed for a client with chronic obstructive pulmonary disease (COPD). Which amount of oxygen is considered most appropriate for the COPD client?
1 to 2 L/min
The initiating event in the development of nephrotic syndrome is a derangement in the glomerular membrane that causes increased permeability to which substance?
Plasma proteins
The nurse is caring for the following group of clients. Select the client most likely to be diagnosed with respiratory alkalosis.
A 26-year-old female with anxiety who has been hyperventilating
Which client is likely at the greatest risk of developing a urinary tract infection?
A 79-year-old client with an indwelling catheter
The nurse who is providing care for several clients recognizes which client is at the highest risk for developing an acid-base imbalance?
A client who is being treated for acute kidney injury and who requires dialysis
Which client most likely faces the highest risk of developing secondary pulmonary hypertension?
A client with COPD and a 35 pack-year smoking history.
Of the following clients, who would be at highest risk for developing hyperkalemia?
A male admitted for acute renal failure following a drug overdose
The nurse is caring for a client with an acid-base imbalance. Which of these does the nurse recognize is correct regarding compensation?
A pH moves toward the normal range.
Which individual likely faces the highest risk of developing chronic pancreatitis?
A woman who has 6 to 8 alcoholic beverages each evening
Which statement about the use of angiotensin-converting enzyme (ACE) inhibitors and autosomal recessive polycystic kidney disease (ARPKD) is accurate?
ACE inhibitors may interrupt the renin-angiotensin-aldosterone system to reduce renal vasoconstriction.
Which client is displaying manifestations of having a kidney stone?
Acute onset of colicky flank pain radiating to lower abdomen
A child is recovering from a bout with group A beta-hemolytic Streptococcus infection. The child returns to the clinic a week later complaining of decrease in urine output with puffiness and edema noted in the face and hands. The health care provider suspects the child has developed:
Acute postinfectious glomerulonephritis
Given the fact that acute pancreatitis can result in severe, life-threatening complications, the nurse should be assessing the client for which complication?
Acute tubular necrosis
A client is brought to the emergency department reporting shortness of breath. Assessment reveals a full, bounding pulse; severe edema; and audible crackles in lower lung fields bilaterally. Which action by the nurse is most appropriate?
Administer diuretics as ordered.
There are both metabolic and respiratory effects on the acid-base balance in the body. How do metabolic disorders change the pH of the body?
Alter the plasma HCO3-
Chronic kidney disease impacts many systems in the body. What is the most common hematologic disorder caused by CKD?
Anemia
A client has been diagnosed with chronic kidney disease (CKD). Which drug category is usually administered to treat coexisting conditions that manifest early in CKD?
Antihypertensive medications
An older adult client presents with loose mucus-filled stools. The nurse suspects the client has Clostridium difficile. What is a priority assessment for the nurse?
Ask the client about his or her antibiotic use.
Prolonged immobility is implicated in the development of which disorder?
Atelectasis and pulmonary embolism
One of the accepted methods of screening for colorectal cancer is testing for occult blood in the stool. To reduce the likelihood of a false-positive result on these tests, what instructions will the nurse provide?
Avoid nonsteroidal anti-inflammatory drugs (NSAIDs) for 1 week prior to testing.
Symptoms of gastric cancer include vague epigastric pain, which makes early detection difficult. The nurse would expect a client to undergo which diagnostic examination to determine the location of the gastric cancer?
Barium x-ray
The nurse recognizes the role of the lungs in acid-base balance is regulation of which of the following?
CO2
Which assessment should be prioritized in the care of a client who is being treated for a serum potassium level of 2.7 mEq/L (2.7 mmol/L)?
Cardiac monitoring looking for prolonged PR interval and flattening of the T wave
Hospitalized neonates are at greatest risk of developing septicemia related to which procedure?
Catheter-associated bacteriuria
During a lecture discussing nausea and vomiting, the nurse reviews the role of the chemoreceptor trigger zone which may be stimulated (causing vomiting) by which factors? Select all that apply.
Chemotherapeutic agents Salmonella food poisoning Increased intracranial pressure
A client is diagnosed with pulmonary embolism. Which symptom would most likely be present?
Chest pain and dyspnea
"The kidney is rich in blood supply and can concentrate toxins in high levels in the medullary portion of the kidney."
Client with prostatic hyperplasia
The nurse caring for four male clients recognizes which client is at highest risk for developing postrenal kidney failure?
Client with prostatic hyperplasia
The incidence of stomach cancer has significantly decreased in the United States, yet it remains the leading cause of death worldwide. The nurse understands the reason for the high mortality rate in stomach cancer is because of which reason?
Clients have few early symptoms of the disease.
Crohn disease is recognized by sharply demarcated, granulomatous lesions that are surrounded by normal-appearing mucosal tissue. The nurse recognizes these lesions to be defined by which description?
Cobblestone
An older adult client expresses concern about straining to pass stools that are small and hard. What term will the health care provider use to document this in this client's chart?
Constipation
A client has developed chronic hypoxia and has developed pulmonary hypertension (HTN). The nurse recognizes that the most likely cause of pulmonary hypertension would be:
Constriction of the pulmonary vessels in response to hypoxemia
The family asks the nurse what the usual treatment of focal segmental glomerulosclerosis entails. What is the nurse's best response?
Corticosteroids
What intervention is appropriate for a client with sarcoidosis?
Corticosteroids
A client asks, "Why did my provider order a glomerular filtration rate (GFR) to my usual blood work?" The nurse's best response is based on the fact that GFR can estimate serum levels of which substance?
Creatinine
The nurse is caring for a client with liver disease who has edema throughout the body. When reviewing the medical record, the nurse recognizes that which altered diagnostic test is consistent with development of edema?
Decreased albumin
A client with ascites suddenly develops a change in mental status, elevated neutrophil count, and abdominal pain. Which additional complications should the nurse monitor the client for? Select all that apply.
Diarrhea Shock Hepatic encephalopathy
The nurse is instructing a client with advanced kidney disease (AKD) about a dietary regimen. Which restriction should the nurse be sure to include in the treatment plan to decrease the progress of renal impairment in people with AKD?
Dietary protein
Several urine tests can be useful in establishing a diagnosis of acute renal failure (ARF). The nurse must consider that fractional excretion of sodium can be particularly affected by administration of which type of drug?
Diuretics
The nurse is caring for a client with recurring urinary tract infections (UTIs). The client asks, "Other than taking antibiotics, what else can I do?" Which response by the nurse is most accurate?
Drink lots of fluids to help relieve the signs/symptoms of UTIs.
Which dermatologic problem most often accompanies chronic kidney disease (CKD)?
Dry skin and pruritus
Pharmacologic treatment for peptic ulcers has changed over the past several decades. The nurse knows that the goal for pharmacologic treatment is focused on:
Eradicating Helicobacter pylori (H. pylori)
Which procedure is a nonsurgical method of treatment for renal calculi (kidney stones)?
Extracorporeal shock wave lithotripsy (ESWL)
The nurse is teaching her client with hepatobiliary disease about her diet. She tells her that she may have steatorrhea, which is the malabsorption of which dietary component?
Fat
Good hand-washing techniques are important in health care. The nurse knows that bacterial infections can be prevented by good hand washing techniques. Which route of transmission is most common for Clostridium difficile?
Fecal-oral transmission
The emergency room provider diagnoses a client with a hemothorax. Which could be possible causes of this condition?
Fractured ribs following car accident
The health care provider is reviewing laboratory results of a client. Select the diagnostic test that is considered the best measurement of overall kidney function.
Glomerular filtration rate (GFR)
The nurse is aware that the major role of the kidneys in regulating acid-base balance is to increase the production of which chemical component?
HCO3-
The nurse is aware that the major role of the kidneys in regulating acid-base balance is to increase the production of:
HCO3−
Which clients would be considered at a higher risk for developing Goodpasture syndrome, an aggressive form of glomerulonephritis? Select all that apply.
Hair stylist expert who specializes in coloring (dying) hair Older adult with a recent influenza infection Painter working with a busy construction crew who finishes all the house painting, indoor and outdoor
The most common forms of peptic ulcer are duodenal and gastric ulcers. What are the most common risk factors for peptic ulcer disease?
Helicobacter pylori (H. pylori)
The physician suspects that a client with kidney stones has developed magnesium ammonium phosphate (struvite) stones based on which urinalysis results? Select all that apply.
High bacterial count High urine phosphate level Alkaline urine pH
A health care provider suspects a client may have developed pancreatitis. Which laboratory value will confirm this diagnosis?
High serum amylase and lipase
A nurse is assessing a client for early manifestations of chronic kidney disease (CKD). Which would the nurse expect the client to display?
Hypertension
The nurse is caring for the client with hepatocellular carcinoma. What does the nurse recognize is a cause of this disease?
Illness with hepatitis B or C
Which factor is most likely to precipitate an asthmatic attack in a child with a diagnosis of extrinsic, or atopic, asthma?
Pet dander
Corticosteroids
Increase washout of urine
The nurse is planning care for a client with a urinary tract obstruction. The nurse includes assessment for which possible complication?
Increased blood pressure
The nurse is reviewing laboratory results of a client who has liver failure. Which finding would place the client at increased risk for bleeding?
Increased prothrombin time
When caring for the client with hepatic failure, the nurse recognizes that which problem places the client at increased risk for bleeding?
Increased prothrombin time
A client is to receive a radiocontrast media as part of a diagnostic scan. Which intervention is intended to reduce the nephrotoxic effects of the radiocontrast media?
Increasing the normal saline intravenous infusion rate prior to the exam
What is the usual cause of acute pyelonephritis?
Infection
A client presents with sudden onset of hematuria, variable proteinuria, decreased GFR, oliguria, and signs of impaired renal function. Upon taking a history the nurse learns that the client had strep throat 3 weeks ago. Upon renal biopsy the diagnosis of acute glomerulonephritis is confirmed. What mechanism of damage is the most plausible?
Injury resulting from circulating antigen-antibody complexes that become trapped in the glomerular membrane.
In hemodialysis, access to the vascular system is most commonly through:
Internal arteriovenous fistula
Lymph fluid arises directly from which space?
Interstitial
The nurse is evaluating a client's blood gases. The client has a pH of 7.35. How does the nurse interpret this value?
It is within a normal range.
According to the Kidney Disease Outcome Quality Initiative (KDOQI) guidelines, in the first stage of kidney disease, the nurse will assess which finding?
Kidney damage with normal glomerular filtration rate (GFR)
Vitamin D metabolism is deranged in clients with chronic kidney disease (CKD). The nurse recognizes that which statement regarding vitamin D is correct?
Kidneys convert inactive vitamin D to its active form, calcitriol.
A client has these arterial blood gas values: anion gap 20 mEq/L (20 mmol/L), pH 7.29, PCO2 37 mm Hg (4.92 mmol/L), HCO3- 11 mEq/L (11 mmol/L), base excess -6 mEq/L (-6 mmol/L). With what condition do these values correspond?
Lactic acidosis
The nurse teaches a client with a new diagnosis of asthma about measures to prevent asthma attacks. What should the nurse include in the teaching plan? Select all that apply.
Limit exposure to dust. Use an inhaled cromolyn. Schedule the influenza vaccine.
When caring for the client with portal hypertension and ascites, which dietary intervention does the nurse suggest to prevent the progression of fluid accumulation?
Limit intake of sodium.
When caring for a client with diabetes insipidus (DI), the nurse plans to evaluate which laboratory study?
Measurement of antidiuretic hormone (ADH) and plasma/urine osmolality
The nurse is reviewing the following lab results of a client diagnosed with renal failure:pH: 7.24PCO2: 38 mm Hg (5.05 kPa)HCO3:18 mEq/L (18 mmol/L)The nurse would interpret this as:
Metabolic acidosis
A client tells the nurse that the client has been taking Alka-Seltzer (bicarbonate—antacid) four times a day for the past 2 weeks for an upset stomach. Upon assessment of the client, the nurse notes hyperactive reflexes, tetany, and mental confusion. Arterial blood gases reveal pH 7.55; serum HCO3− 37 mEq/L (37 mmol/L). The nurse suspects the client may be experiencing:
Metabolic alkalosis
The client with substance use disorder was found unconscious after overdosing on heroin 2 days prior. Because of prolonged pressure on the muscles the client has developed myoglobinuria, causing which complication?
Obstruction of the renal tubules with myoglobin and damaged tubular cells
Pressure generated as water moves across a membrane is also known as which of the following?
Osmotic pressure
A nurse caring for a client with asthma monitors respiratory function. Which data indicate the client has mild intermittent asthma?
PEF 400 mL in AM, 390 mL at noon, symptoms occur twice a week
When assessing a client with acute cholecystitis, the nurse anticipates the client's report of pain will be consistent with which description?
Pain in the right upper quadrant referred to the same shoulder
While assessing a peritoneal dialysis client in the home, the nurse notes that the fluid draining from the abdomen is cloudy, is white in color, and contains a strong odor. The nurse suspects this client has developed a serious complication known as:
Peritonitis
Which assessment does the nurse recognize is consistent with signs and symptoms of acute pancreatitis?
Periumbilical pain
Pain is an expected assessment finding in clients who have which lung disease?
Pleuritis
A client in renal failure has marked decrease in renal blood flow caused by hypovolemia, the result of gastrointestinal bleeding. The nurse is aware that this form of renal failure can be reversed if the bleeding is under control. Which form of acute renal injury does this client have?
Prerenal failure
A client in liver failure asks, "How does the liver process ammonia in healthy individuals?" Which explanation from the health care provider explains the mechanism how ammonia is removed from the blood by the liver?
Processes ammonia into urea, releasing it into the circulation
Which assessment finding would lead the nurse to suspect the client has developed nephrotic syndrome?
Proteinuria and generalized edema
An adult client has been diagnosed with gastroesophageal reflux disease (GERD) after reporting ongoing "heartburn" unrelieved with antacids. Which medication should the nurse anticipate being prescribed for this client?
Proton pump inhibitor (PPI)
Three days following surgical repair of a hip fracture a client becomes anxious and complains of sudden shortness of breath. What disorder is the client most likely experiencing?
Pulmonary embolism
Pulmonary hypertension is usually caused by long-term exposure to hypoxemia. When pulmonary vessels are exposed to hypoxemia, what is their response?
Pulmonary vessels constrict
The nurse needs to assess the oxygen status of a client who is suddenly experiencing shortness of breath. The most appropriate noninvasive measurement technique would be:
Pulse oximetry
The nurse recognizes that acute renal injury is characterized by which of the following?
Rapid decline in renal function
A client is suspected of having the onset of alcoholic liver disease. The nurse should be assessing for which manifestation related to the necrosis of liver cells?
Rapid onset of jaundice
The renal control mechanism of restoring the acid-base balance is accomplished through which process?
Reabsorption of HCO3 and excretion of H+ restores acid-base balance through the renal control mechanisms.
An older adult client has been hospitalized for the treatment of acute pyelonephritis. Which characteristic of the client is most likely implicated in the etiology of this current health problem?
Recently had a urinary tract infection
Which protective measure of the peritoneum helps keep abdominal inflammation and infection localized?
Secretes fibrinous substance
When educating residents of a senior citizen living facility, the nurse should review which information about colorectal cancer? Select all that apply.
Seek out medication attention for any blood in the stool. Most cases are quite advanced before symptoms become apparent.
The GFR is considered to be the best measure of renal function. What is used to estimate the GFR?
Serum creatinine
A child struggling to breathe is brought to the emergency department with a prolonged bronchospasm and severe hypoxemia. Assessment revealed the use of accessory muscles, a weak cough, audible wheezing sound, moist skin, and tachycardia. What is the most likely diagnosis?
Severe asthma attack
A client is diagnosed with early chronic kidney disease (CKD). The nurse will recommend which actions to slow progression of renal damage? Select all that apply.
Smoking cessation Blood pressure control Angiotensin converting enzyme (ACE) inhibitor administration Blood glucose control
Which meal choice is most likely to exacerbate an individual's celiac disease?
Spaghetti with meatballs and garlic bread
Which clinical manifestation would lead the nurse to suspect the client has malabsorption syndrome with a deficiency in fat absorption?
Steatorrhea
A nurse administering a client's medication tells the client that a proton pump inhibitor has been added. When the client asks the purpose of the medication, the nurse responds that it is to prevent:
Stress ulcer
A nurse is caring for a client with a low sodium level and increased water retention. Hematocrit and blood urea nitrogen levels are decreased, urine osmolality is high, and serum osmolality is low. A chest x-ray shows a possible lung mass. Based on these findings, which problem could the client be diagnosed with?
Syndrome of inappropriate antidiuretic hormone (SIADH)
Which medication helps treat the inflammatory reaction of clients with asthma who are diagnosed with an acute flare of their asthma response?
Systemic corticosteroids
What is the nurse's expectation about a client's ability to compensate for a metabolic blood gas disorder?
The client will compensate with the respiratory system.
The parents of a child with cystic fibrosis ask the nurse to explain the sweat test performed on their newborn. How should the nurse respond?
The sweat test measures the concentration of salt in the infant's sweat.
An older adult client who has been restricted to bed by numerous comorbidities for several weeks has been diagnosed with a large pleural effusion. Which treatment modality is most likely to resolve the client's most recent health problem?
Thoracentesis
A client with chronic kidney disease (CKD) will be managed with peritoneal dialysis. Which description of this type of dialysis is most accurate?
Treatment involves the introduction into the peritoneum of a sterile dialyzing solution, which is drained after a specified time.
An obese client with a history of gout and a sedentary lifestyle has been advised by the primary health care provider to avoid organ meats, certain fish, and other foods that are high in purines. This treatment would be advised for which type of kidney stones?
Uric acid stones
The nurse caring for an older adult notes a marked decrease in mental acuity over a 24-hour period. What assessment indicates the most likely cause of this change?
Urine cloudy with strong odor
Which clinical manifestation would lead the nurse to suspect a client has developed fluid volume excess?
Weight gain
A rare condition caused by gastrin-secreting tumors most commonly found in the small intestine or pancreas is called:
Zollinger-Ellison syndrome
The primary care provider for a newly admitted hospital client has added the glomerular filtration rate (GFR) to the blood work scheduled for this morning. The client's GFR results return as 50 mL/minute/1.73 m2. The nurse explains to the client that this result represents:
a loss of over half the client's normal kidney function.
The nurse assesses a client in an ambulatory care facility. Which manifestation(s) leads the nurse to advocate for investigation of possible acute pyelonephritis? Select all that apply.
abrupt onset of fever and chills flank pain in the back urinary urgency and frequency
When explaining acute pancreatitis to a newly diagnosed client, the nurse will emphasize that the pathogenesis begins with an inflammatory process whereby:
activated pancreatic enzymes escape into surrounding tissues, causing autodigestion of pancreatic tissue.
The nurse is reviewing the lab results of a client with suspected nephrotic syndrome. The nurse anticipates the results to include:
protein in the urine.
A client with a 25-year history of smoking is diagnosed with emphysema. Physical assessment reveals an increased anterior-posterior chest diameter. Which term should the nurse use to document this finding?
barrel chest
As other mechanisms prepare to respond to a pH imbalance, immediate buffering is a result of increased:
bicarbonate/carbonic acid regulation.
The term chronic obstructive pulmonary disease (COPD) can be a combination of two types of obstructive airway diseases. Which disease processes have been identified as being part of COPD?
chronic bronchitis and emphysema
The nurse is reviewing the medical history of four clients. Which client is at highest risk for developing peptic ulcer disease?
client with a prior diagnosis of Helicobacter pylori who refused treatment
The nurse is reviewing the laboratory results for a client. Which laboratory findings would the nurse correlate with nephrotic syndrome?
elevated urine protein level (>3.5 g/day) and hypoalbuminemia
The nurse is evaluating the urinalysis results of a client presenting with polyuria and lower abdominal pain due to a suspected urinary tract infection (UTI). Which finding should the nurse report as evidence of a UTI?
increased nitrites
The nurse assesses a client in the emergency department with reports of abdominal pain. Which assessment finding will the nurse interpret as supporting appendicitis?
increased pain when pressure to the lower right quandrant is released
A client with a blood glucose reading of 673 mg/dl (37.4 mmol/l) is diagnosed with diabetic ketoacidosis (DKA). Blood gas results are as follows: serum pH 7.29; HCO3− level 19 mEq/dl (19 mmol/l); PCO2 level 32 mm Hg. The nurse should prepare for which initial treatment orders?
initiation of an insulin IV infusion along with fluid replacement
A client is brought to the emergency department and immediately diagnosed with a tension pneumothorax. The priority intervention would be:
insertion of a large-bore needle or chest tube.
How will the nurse describe unilateral chest pain associated with respiratory movements?
pleuritic
